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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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[['There is no doubt that the doctor-patient relationship today transcends the physical environment of the consultation room\n', '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\n', 'Support'], ['But we must not forget that we must maintain the same ethical and professional codes as in the real environment\n', '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\n', 'Support'], ['The clinical practice of medicine by means of consultations exclusively by letter, telephone, radio, press or internet, is contrary to the deontological norms\n', '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\n', 'Support'], ['The correct action implies inescapably the personal and direct contact between the doctor and the patient\n', '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\n', 'Support']]
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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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[['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\n', 'Severe diffuse axonal injury\n', 'Support'], ['After a traffic accident a 38-year-old patient is admitted to the ICU in coma\n', '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\n', 'Support'], ['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\n', 'Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brainstem are evidenced in this imaging test\n', 'Support'], ['Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brainstem are evidenced in this imaging test\n', 'Severe diffuse axonal injury\n', 'Support']]
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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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[['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\n', 'Intravenous cyclosporine 2mg/kg\n', 'Support'], ['Etanercept is not approved in Europe for inflammatory bowel disease (for the time being)\n', 'Treatment with etanercept (an anti-TNFa antibody) should be considered\n', 'Attack']]
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224_63
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[['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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[['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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', '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', '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', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Something aortic\n', 'this is going to be aortic stenosis...\n', 'Support'], ['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\n', 'this is going to be aortic stenosis...\n', 'Support'], ["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\n", 'Surgical indication\n', 'Support'], ['we allow the ventricle to claudicate\n', 'If we do 1 we take away life expectancy\n', 'Support'], ['If we do 1 we take away life expectancy\n', 'Diuretics and more frequent check-ups by a specialist\n', 'Attack'], ['2 is outdated: balloon valvuloplasty?\n', 'In case of increasing dyspnea on exertion, percutaneous dilatation of the aortic valve with a balloon catheter should be performed\n', 'Attack'], ['Only if the surgical risk is unaffordable, and in that case we would do 5, TAVI implantation\n', 'Implantation of a percutaneous valve\n', 'Support'], ['But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n', 'Only if the surgical risk is unaffordable, and in that case we would do 5, TAVI implantation\n', 'Attack'], ['But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n', 'so to the operating room\n', 'Support'], ['so to the operating room\n', 'Implantation of a percutaneous valve\n', 'Attack'], ['The correct thing to do is 3, without a doubt: replace with a prosthesis, preferably mechanical unless the patient has a contraindication for anticoagulation\n', 'Replacement of the aortic valve with a prosthesis/bioprosthesis\n', 'Support'], ["But it's rare, complex and only done in pediatrics\n", "A homograft? That's the Ross technique, I take the pulmonary and put it where the aortic\n", 'Attack'], ["But it's rare, complex and only done in pediatrics\n", 'Replacement of the aortic valve with a homograft\n', 'Attack'], ['But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n', 'Implantation of a percutaneous valve\n', 'Attack']]
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430_115
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[['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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[['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'], ['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'], ['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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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']]
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[['Patient on her 30th post-transplant day of hematopoietic precursor transplantation, in severe neutropenia who presents with cough with hemoptotic expectoration\n', 'This picture is usually seen in infection by Aspergillus spp\n', 'Support'], ['This picture is usually seen in infection by Aspergillus spp\n', 'Invasive pulmonary aspergillosis\n', 'Support'], ['We can rule out infection by Staphylococcus aureus because of previous treatment\n', 'Pneumonia due to Staphylococcus aureus\n', 'Attack'], ['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)\n', 'We can rule out infection by Staphylococcus aureus because of previous treatment\n', 'Support']]
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588_63
| null | null |
[]
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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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[['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-Premise', 'I-Premise', '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', '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'], ['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'], ['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'], ['O', 'O', 'O'], ['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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['But if there are data of poor prognosis and the possibility of metastases - as in this case\n', 'it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n', 'Support'], ['it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n', 'I think the correct answer is 3\n', 'Support'], ['I think the correct answer is 3\n', 'This is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support'], ['But if there are data of poor prognosis and the possibility of metastases - as in this case\n', 'This is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support'], ['it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n', 'This is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support'], ['answers 2,4 and 5 are clearly false\n', 'Follicular pattern is an indication for prophylactic cervical lymph node emptying\n', 'Attack'], ['answers 2,4 and 5 are clearly false\n', 'The report allows us to rule out with total certainty a papillary carcinoma in the remaining thyroid\n', 'Attack'], ['answers 2,4 and 5 are clearly false\n', 'Measurement of plasma calcitonin will allow us to distinguish between papillary and follicular carcinoma\n', 'Attack'], ['The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed\n', 'As there is no capsular invasion, no further surgery is necessary\n', 'Support'], ['But if there are data of poor prognosis and the possibility of metastases - as in this case\n', 'The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed\n', 'Attack']]
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535_121
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[['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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[['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'], ['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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Clinical case of SLE with renal involvement, in which positive double-stranded anti-DNA increases the risk of nephritis\n', 'Anti-two-stranded or native anti-DNA correlates with the risk of nephritis\n', 'Support'], ['As for the rest, anti-Sm are specific to SLE\n', 'The anti-Sm antibodies are not specific for this pathology\n', 'Attack'], ['ANA are detected in more than 90% of cases\n', 'ANA (antinuclear antibodies) are detected in 50% of cases\n', 'Attack'], ['anti-centromere are typical of scleroderma\n', 'Anti-centromere antibodies are detected in 90% of cases\n', 'Attack']]
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452_149
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[['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.']]
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[['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']]
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[['Clearly the answer is 4, with a very characteristic clinic of temporary seizures\n', 'Complex partial temporal lobe seizure\n', 'Support']]
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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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[['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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Answer 4: simply by the way of expressing it, it should already have been ruled out\n', 'The report allows to rule out papillary carcinoma with total certainty in the remaining thyroid\n', 'Attack'], ['Answer 5: you already know that calcitonin is used in medullary carcinoma and not in differentiated carcinoma\n', 'Measurement of plasma calcitonin will allow us to differentiate between papillary and follicular carcinoma\n', 'Attack'], ['Answer 2: prophylactic emptying is indicated in the medullary\n', 'The follicular pattern is an indication for prophylactic cervical lymph node emptying\n', 'Attack'], ['The only ones in which complete thyroidectomy is not recommended are microcarcinomas measuring less than 1 cm\n', 'As there is no capsular invasion it is not convenient to perform further surgery\n', 'Attack'], ['The only ones in which complete thyroidectomy is not recommended are microcarcinomas measuring less than 1 cm\n', 'It is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support']]
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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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[['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'], ['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'], ['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', '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', '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', 'B-Marker', 'B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n', 'Study of hormone receptors and HER2\n', 'Support'], ['positive HER2 receptors imply greater aggressiveness of the tumor\n', 'The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n', 'Support'], ['Answer 1 can be ruled out visu visu\n', 'Complete phenotypic study by flow cytometry\n', 'Attack'], ['while answers 3 and 4 should be ruled out\n', 'Study of hormone receptors, e-cadherin and study of first degree relatives\n', 'Attack'], ['while answers 3 and 4 should be ruled out\n', 'Study of BRCA 1-2 and study of first-degree relatives\n', 'Attack'], ['treatment with trastuzumab and positive hormone receptors would imply the use of hormone therapy\n', 'The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n', 'Support'], ['being the first woman in the family with breast carcinoma\n', "the study of the patient's relatives would not be obligatory\n", 'Support'], ["the study of the patient's relatives would not be obligatory\n", 'while answers 3 and 4 should be ruled out\n', 'Support']]
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310_216
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[['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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[['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'], ['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', 'I-Premise'], ['O', 'O', 'O', 'O', 'B-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', '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']]
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[['we have a blow to the right eye area, with a hematoma on the eyelid\n', 'Therefore, something other than the blow has caused hemorrhages in both retinas\n', 'Support'], ['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\n', 'Therefore, something other than the blow has caused hemorrhages in both retinas\n', 'Support'], ['we have a blow to the right eye area, with a hematoma on the eyelid\n', 'Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n', 'Support'], ['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\n', 'Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n', 'Support'], ['Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n', '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)\n', 'Support'], ['The cause of shaken baby syndrome is almost always abuse\n', 'the answer is 1\n', 'Support'], ['the answer is 1\n', 'It is a highly suggestive history of child abuse\n', 'Support'], ['The cause of shaken baby syndrome is almost always abuse\n', 'It is a highly suggestive history of child abuse\n', 'Support'], ['Options 2 and 3 are easy to rule out\n', 'It is the normal evolution of a non-perforating intraocular trauma\n', 'Attack'], ['Options 2 and 3 are easy to rule out\n', 'The most likely diagnosis is Berlin edema\n', 'Attack'], ['nothing indicates perforating trauma, and it does not explain the hemorrhages in the other eye\n', 'Options 2 and 3 are easy to rule out\n', 'Support'], ['And the berlin edema is an edema of the macula and appears as a whitish lesion, which is not described in the statement\n', 'The most likely diagnosis is Berlin edema\n', 'Attack'], ['However, if we read answer 4 carefully, it does not tell us that if there is child maltreatment Purstcher can occur\n', "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\n", 'Attack'], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "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\n", 'Attack'], ["In Purstcher's there are hemorrhages, but also cottony exudates and edema\n", "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\n", 'Attack'], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "If there are only hemorrhages, it's not Purstcher's\n", 'Support'], ["In Purstcher's there are hemorrhages, but also cottony exudates and edema\n", "If there are only hemorrhages, it's not Purstcher's\n", 'Support'], ["If there are only hemorrhages, it's not Purstcher's\n", "It is the characteristic picture of Purstcher's traumatic retinal angiopathy\n", 'Attack'], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "It is the characteristic picture of Purstcher's traumatic retinal angiopathy\n", 'Attack']]
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293_214
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[['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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[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-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', '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']]
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[['On examination, the nails show the presence of nail pitting and distal yellowish areas in an oil stain\n', 'although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n', 'Support'], ['although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n', 'Psoriasis\n', 'Support'], ['although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n', 'Any of the 4 options can be the cause of erythroderma\n', 'Attack']]
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132_229
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[['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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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', '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'], ['B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Schistocytes in smear\n', 'a patient with certain history who has: - Schistocytes in smear\n', 'Support'], ['Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation\n', 'Bicytopenia: here the causes can be very, very varied\n', 'Support'], ['Elevation of LDH and Bilirubin\n', 'which indicates a massive rupture of red blood cells\n', 'Support'], ['Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n', 'Elevation of LDH and Bilirubin\n', 'Support'], ['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\n', 'New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke\n', 'Attack'], ['Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n', 'New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke\n', 'Attack'], ['Answer 2: urgent plasmapheresis... in case of thrombotic thrombocytopenic purpura, yes\n', 'Initiate urgent plasmapheresis\n', 'Support'], ['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\n', 'Initiate urgent plasmapheresis\n', 'Support'], ['Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation\n', 'Initiate urgent plasmapheresis\n', 'Support'], ['It also explains the negative direct Coombs, elevated LDH and Cr\n', 'Initiate urgent plasmapheresis\n', 'Support'], ["Direct Coombs' test was negative\n", 'Initiate urgent plasmapheresis\n', 'Support'], ['Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n', 'Initiate urgent plasmapheresis\n', 'Support'], ["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\n", 'Beginning of treatment with glucocorticoids at a dose of 1 mg/kg/day\n', 'Attack'], ['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\n', 'Search for triggering cause of DIC\n', 'Attack'], ['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\n', 'Suspected multiple myeloma: bone marrow aspirate\n', 'Attack']]
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49_159
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[]
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120_192
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[['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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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Do not revaccinate\n', 'Support'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Do not revaccinate\n', 'Support'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Restart vaccination schedule (0-1-6 months)\n', 'Attack'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Restart vaccination schedule (0-1-2-12 months)\n', 'Attack'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)\n', 'Attack'], ['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Restart vaccination schedule (0-1-6 months)\n', 'Attack'], ['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Restart vaccination schedule (0-1-2-12 months)\n', 'Attack'], ['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)\n', 'Attack']]
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304_174
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[['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.']]
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[['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']]
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[['In this case we are dealing with an elderly patient with chronic treatment with NSAIDs that produces arterial hypertension secondary to renal hypoperfusion\n', '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\n', 'Support']]
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214_228
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[['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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[['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'], ['B-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'], ['O', 'O', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['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\n', 'Arthritis due to microcrystals\n', 'Support'], ['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\n', 'Reactive arthritis\n', 'Support'], ['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\n', 'Rheumatoid arthritis\n', 'Support'], ['With the data provided and taking into account that this is a young male\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Bacterial infectious arthritis\n', 'Support'], ['Acute monoarthritis associated with fever, leukocytosis with neutrophilia and increased acute phase reactants does not always have a septic origin\n', 'Mycobacterial infectious arthritis\n', 'Attack'], ['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\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['Physical examination reveals inflammatory signs and joint effusion in the right knee\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['Laboratory tests showed leukocytosis with neutrophilia and elevated C-reactive protein\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['And above all, because of its implications, the first one to always rule out\n', 'Arthritis due to microcrystals\n', 'Attack']]
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249_120
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[['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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[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-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']]
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[['All these data are suggestive of visceral Leishmaniasis\n', 'an OM biopsy should be performed to look for amastigotes and confirm the diagnosis\n', 'Support'], ['We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia\n', 'All these data are suggestive of visceral Leishmaniasis\n', 'Support'], ['All these data are suggestive of visceral Leishmaniasis\n', 'I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n', 'Support'], ['an OM biopsy should be performed to look for amastigotes and confirm the diagnosis\n', 'I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n', 'Support'], ['We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia\n', 'I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n', 'Support']]
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53_146
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[['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.']]
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[['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']]
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[['We first eliminate the most striking "acute" personality disorder.\n', 'Acute" dependent personality disorder.\n', 'Attack'], ['There are no "acute" characteristics in our personality.\n', 'We first eliminate the most striking "acute" personality disorder.\n', 'Support'], ['Depressive disorder? There is a time criterion that is not met\n', 'it may be sad, but sad is not depression\n', 'Support'], ['agoraphobia? if it was something like that we would have been told the context post-traumatic stress reaction?\n', 'Agoraphobia\n', 'Attack'], ['it may be sad, but sad is not depression\n', 'Depressive disorder\n', 'Attack'], ['So by elimination 5. Crisis of distress\n', 'Anguish crisis\n', 'Support'], ['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"\n', 'Breaking up with a partner I understand is hard, but not exceptional\n', 'Support'], ['Breaking up with a partner I understand is hard, but not exceptional\n', 'Post-traumatic stress reaction\n', 'Attack'], ['The correct term would be post-traumatic stress disorder or acute stress reaction\n', 'Breaking up with a partner I understand is hard, but not exceptional\n', 'Support'], ['Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins\n', 'Post-traumatic stress reaction\n', 'Attack'], ['Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins\n', 'Agoraphobia\n', 'Attack']]
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48_158
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[['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.']]
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[['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']]
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[['The correct answer is 1\n', 'Inject an intravenous anticholinergic\n', 'Support'], ['The anticholinergic can be administered intravenously and also intramuscularly if I am not mistaken\n', 'The correct answer is 1\n', 'Support'], ['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\n', 'The correct answer is 1\n', 'Support']]
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490_106
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[['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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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['It is a definitive promyelocytic leukemia with t(15;17)\n', 'as it is well known by all of you the treatment is with arsenic trioxide + ATRA\n', 'Support'], ['as it is well known by all of you the treatment is with arsenic trioxide + ATRA\n', 'Start treatment with arsenic trioxide, ATRA and supportive therapy\n', 'Support'], ['Option 1 leaves the treatment incomplete\n', 'If asymptomatic, transretinoic acid (ATRA) will be started and day hospital controls will be recommended\n', 'Attack'], ["there is only ATRA and it must be treated as long as the patient's condition allows it, whether or not there are symptoms\n", 'Option 1 leaves the treatment incomplete\n', 'Support'], ['Option 3 3 years ago would have been the correct option but nowadays neither chemotherapy nor heparin is used\n', 'It is a myeloblastic leukemia type M3, so chemotherapy and heparin will be started to control disseminated intravascular coagulation\n', 'Attack'], ['that fever is due to the leukemia itself and the priority is to start specific treatment for leukemia\n', 'option 4 is false\n', 'Support'], ['option 4 is false\n', 'Antibiotic treatment should be started. When the fever disappears, leukemia treatment should be started\n', 'Attack']]
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416_76
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[['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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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', '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-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', 'B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'B-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'B-Claim', 'B-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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Atrial Fibrillation\n', 'at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until proven otherwise\n', 'Support'], ['at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until proven otherwise\n', 'Mesenteric ischemia\n', 'Support'], ['Acute abdominal pain\n', 'ischemia\n', 'Support'], ['SIRS\n', 'ischemia\n', 'Support'], ['renal failure\n', 'ischemia\n', 'Support'], ['metabolic acidosis\n', 'ischemia\n', 'Support'], ['probably an elevated lactic...\n', 'ischemia\n', 'Support'], ['we could also have been told of intestinal pneumatosis\n', 'CT: The finding of portal gas is also highly indicative of mesenteric ischemia\n', 'Support'], ['ischemia\n', 'Mesenteric ischemia\n', 'Support'], ['CT: The finding of portal gas is also highly indicative of mesenteric ischemia\n', 'Mesenteric ischemia\n', 'Support'], ['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\n', 'Perforation of gastric or duodenal ulcus\n', 'Attack'], ['Biliary ileus: There would be a history of biliary colic or pain in the right hypochondrium\n', 'Biliary leak\n', 'Attack'], ['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\n', 'Biliary leak\n', 'Attack'], ['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\n', 'Obstructive neoplasm of the sigma with perforation\n', 'Attack']]
|
45_154
| null | null |
[]
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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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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['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\n', '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\n', 'Support'], ['A 20-year-old woman with a 15-cm solid-cystic ovarian tumor detected by ultrasound after presenting with nonspecific abdominal symptoms\n', 'The tissues that make up the tumor are well differentiated (mature or adult-type)\n', 'Support'], ['The tissues that make up the tumor are well differentiated (mature or adult-type)\n', 'Mature cystic teratoma is a common benign tumor of the ovary in adult women\n', 'Support'], ['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\n', 'Mature cystic teratoma is a common benign tumor of the ovary in adult women\n', 'Support'], ['Mature cystic teratoma is a common benign tumor of the ovary in adult women\n', 'Mature cystic teratoma\n', 'Support']]
|
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.']]
|
[['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', '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'], ['O', 'O', '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', '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'], ['O', 'B-Diagnostics', 'I-Diagnostics', 'I-Diagnostics'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Several months have passed, she has not improved and refers intense pain after physical activity that subsides with rest in the hours following exercise\n', 'Exercise-induced compartment syndrome is an exercise-induced condition of the leg\n', 'Support'], ['Diagnosis is made by measuring compartment pressures at rest, during exercise and after exercise\n', 'answer 2 correct\n', 'Support'], ['answer 2 correct\n', 'Determination of posterior compartment pressure immediately after activity\n', 'Support']]
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389_235
| null | null |
[]
|
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.']]
|
[['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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['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'], ['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']]
|
[['Transcortical have preserved repetition\n', 'Sensitive transcortical aphasia\n', 'Attack'], ["Broca's aphasia has preserved comprehension and absence of fluent speech\n", "Broca's aphasia\n", 'Attack'], ["Wernicke's aphasia is characterized by fluent speech (even in excess) with paraphasias and problems with comprehension, nomination and repetition\n", "Wernicke's aphasia\n", 'Support']]
|
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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[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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-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', '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-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In a case like this we must rule out endometrial neoplasia\n', 'an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy\n', 'Support'], ['We are being presented with a case of postmenopausal metrorrhagia\n', 'In a case like this we must rule out endometrial neoplasia\n', 'Support'], ['an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy\n', 'Endometrial biopsy.\n', 'Support'], ['A cervical biopsy is not of interest in this case\n', 'Random cervical biopsies\n', 'Attack'], ['the cytology is normal\n', 'A cervical biopsy is not of interest in this case\n', 'Support'], ['hormonal assessment is not going to be useful in the diagnosis of endometrial neoplasia\n', 'A cervical biopsy is not of interest in this case\n', 'Support'], ["A 69-year-old woman comes to your office reporting genital bleeding of several months' evolution\n", 'Finally, prescribing cyclic progesterone is not indicated in a postmenopausal woman\n', 'Support'], ['Finally, prescribing cyclic progesterone is not indicated in a postmenopausal woman\n', 'Prescribe cyclic progesterone\n', 'Attack']]
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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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[['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'], ['B-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'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['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']]
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[['An abdominal ultrasound shows stenosis of both renal arteries\n', 'If the renal arteries are stenosed, blood has difficulty reaching the kidneys\n', 'Support'], ['If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate\n', 'Enalapril\n', 'Support'], ['If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate\n', 'And if neither kidney filters, because both have arterial stenosis, we have a problem\n', 'Support']]
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481_171
| null | null |
[]
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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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[['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'], ['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', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['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\n', 'Correct Answer 1\n', 'Support'], ['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\n', 'The options would be total or partial arthroplasty\n', 'Support'], ['Correct Answer 1\n', 'Hip hemiarthroplasty\n', 'Support'], ['in elderly patients, partial arthroplasty is preferred because it is a shorter and less aggressive surgery than total hip arthroplasty\n', 'Hip hemiarthroplasty\n', 'Support'], ['We would consider this technique in basicervical fractures and trochanteric mass lesions, not in subcapital fractures\n', 'Answer 2 incorrect\n', 'Support'], ['Answer 2 incorrect\n', 'Trochanteric nail fixation\n', 'Attack'], ['We would consider this technique in nondisplaced subcapital fractures in young patients\n', 'Incorrect Answer 3\n', 'Support'], ['We would only consider non-surgical treatment in a patient with a very poor baseline general condition: bedridden patients with low life expectancy\n', 'Incorrect answer 4\n', 'Support'], ['Incorrect answer 4\n', 'Conservative: bed-chair life\n', 'Attack']]
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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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[['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'], ['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', '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', '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', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['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)\n', 'They are describing HELLP syndrome\n', 'Support'], ['34-week primigravida with blood pressure of 165/95 and headache of two days of evolution\n', 'They are describing HELLP syndrome\n', 'Support'], ['The laboratory is called because of the presence of schistocytes in the peripheral blood smear\n', 'They are describing HELLP syndrome\n', 'Support'], ['They are describing HELLP syndrome\n', '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\n', 'Support'], ['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\n', 'Immediate termination of pregnancy\n', 'Support'], ['She received the second dose of corticosteroids for fetal maturation 24 hours ago\n', '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\n', 'Support'], ['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\n', '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\n', 'Support']]
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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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[['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'], ['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'], ['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'], ['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', 'B-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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['B-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']]
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[['It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5\n', 'Neoadjuvant chemo/radiotherapy, conditioning the option of radical surgery on initial response\n', 'Attack'], ['It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5\n', 'Cephalic duodenopancreatectomy, with percutaneous ablation by radiofrequency or alcoholization of the hepatic lesion\n', 'Attack'], ['the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct\n', 'Metallic biliary prosthesis by endoscopic retrograde cholangiopancreatography with the option of palliative chemotherapy\n', 'Support'], ['In principle she is a patient in moderately good general condition\n', 'the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct\n', 'Support']]
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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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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-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'], ['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'], ['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'], ['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', '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', 'B-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', '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'], ['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', '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'], ['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']]
|
[['Since the most frequent cause of vaginal bleeding in postmenopausal women is urogenital atrophy, the existence of an endometrial pathology cannot be ruled out\n', 'Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n', 'Support'], ['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 (...)\n', '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\n', 'Support'], ['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\n', 'Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n', 'Support'], ['It is recommended to use a cut-off point of 3mm for endometrial biopsy in the symptomatic patient\n', 'Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n', 'Support']]
|
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.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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']]
|
[['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\n', 'The baby is not dehydrated and is in good general condition\n', 'Support'], ['The abdomen is soft and depressible, without masses or megaliths, and the fontanel is normotensive\n', 'The baby is not dehydrated and is in good general condition\n', 'Support'], ['Except for the presence of watery rhinorrhea, the rest of the examination by organs and devices is normal\n', 'The baby is not dehydrated and is in good general condition\n', 'Support'], ['Try to avoid dehydration by replenishing what is being lost, avoiding drastic changes in feeding habits as much as possible\n', "It is advisable to replace losses after each bowel movement with oral rehydration solution and continue with the patient's usual diet\n", 'Support'], ['There is also no evidence of lactose intolerance (perianal irritation, frothy and acid stools, etc.) that would advise lactose-free milk\n', 'The use of lactose-free formula should be recommended\n', 'Attack']]
|
261_100
| null | null |
[]
|
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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[['O', 'O', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['the patient was operated 20 years ago for a Bilroth II\n', 'It is usually a late complication\n', 'Support'], ['If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node)\n', 'Gastric adenocarcinoma\n', 'Attack'], ['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\n', 'If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node)\n', 'Attack'], ['It is not dumping\n', 'Rapid gastric emptying syndrome (dumping)\n', 'Attack'], ['it does not speak of vegetative symptoms (palpitations, facial flushing, etc...)\n', 'It is not dumping\n', 'Support'], ['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\n', 'it does not speak of vegetative symptoms (palpitations, facial flushing, etc...)\n', 'Support'], ['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\n', 'moreover it is not associated with diarrhea or malabsorption\n', 'Attack'], ['Biliary reflux gastropathy is an endoscopic diagnosis\n', 'Biliary reflux gastropathy\n', 'Attack'], ['moreover it is not associated with diarrhea or malabsorption\n', 'Biliary reflux gastropathy\n', 'Attack'], ['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\n', 'there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12\n', 'Support'], ['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\n', '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)\n', 'Support'], ['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)\n', 'Afferent loop syndrome with bacterial overgrowth\n', 'Support'], ['there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12\n', 'Afferent loop syndrome with bacterial overgrowth\n', 'Support']]
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366_106
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[['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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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['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', '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'], ['O', 'B-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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-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'], ['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'], ['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']]
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[['a young patient from an area with a high rate of TB, a lymphocytic exudate pointing to TB, lymphoma or tumor\n', 'Suspicion is very high for tuberculous pleural effusion\n', 'Support'], ['Suspicion is very high for tuberculous pleural effusion\n', 'Measurement of pleural fluid adenosine deaminase\n', 'Support'], ['A 32-year-old man from Cameroon consults for fever cough and left hemithorax pain of 1 month of evolution\n', 'Tumor unlikely due to age, negative cytology\n', 'Support'], ['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\n', 'Tumor unlikely due to age, negative cytology\n', 'Support'], ['High adenosine deaminase in LP would point with great certainty to a pleural TB\n', 'Measurement of pleural fluid adenosine deaminase\n', 'Support']]
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544_40
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[['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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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['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'], ['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'], ['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'], ['B-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'], ['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'], ['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']]
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[['In this patient the conventional treatment has not worked\n', 'it is possible to escalate to specific allergen immunotherapy\n', 'Support'], ['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\n', 'Specific immunotherapy by sublingual or subcutaneous route for a minimum period of 3 years\n', 'Support'], ['it is possible to escalate to specific allergen immunotherapy\n', 'Specific immunotherapy by sublingual or subcutaneous route for a minimum period of 3 years\n', 'Support'], ['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\n', 'Omalizumab is a biological treatment that would only be indicated in cases of severe moderate bronchial asthma secondary to respiratory allergy\n', 'Attack'], ['Omalizumab is a biological treatment that would only be indicated in cases of severe moderate bronchial asthma secondary to respiratory allergy\n', 'Omalizumab subcutaneously every 4 weeks for up to 1 year\n', 'Attack'], ['Omalizumab is a biological treatment that would only be indicated in cases of severe moderate bronchial asthma secondary to respiratory allergy\n', 'Omalizumab subcutaneously every 4 weeks for a minimum period of 6 months\n', 'Attack']]
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533_179
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[['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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[['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'], ['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'], ['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'], ['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'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-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'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O']]
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[['C cells, elevated calcitonin, inherited MEN-2nd\n', 'Typical medullary thyroid RET\n', 'Support'], ['Typical medullary thyroid RET\n', 'Multifocal medullary carcinoma\n', 'Support']]
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80_37
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[['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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[['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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'], ['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'], ['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']]
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[['The treatment of choice is phlebotomy\n', 'Initiate treatment with phlebotomies\n', 'Support'], ['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)\n', 'The treatment of choice is phlebotomy\n', 'Support'], ['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\n', 'The treatment of choice is phlebotomy\n', 'Support'], ['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\n', 'Perform liver biopsy\n', 'Attack']]
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394_225
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[['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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[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-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', 'B-Marker', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['therefore the correct answer is compulsion\n', 'Compulsion\n', 'Support'], ['In this question they ask for the name of the symptom, not the disease\n', 'therefore the correct answer is compulsion\n', 'Support'], ['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\n', '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\n', 'Support'], ['Sometimes he has tried to resist doing this but has only succeeded in distressing himself and delaying the behavior for a few minutes\n', 'The goal of the behaviors or mental acts is to prevent or decrease anxiety or discomfort, or to avoid some feared event or situation\n', 'Support']]
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229_178
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[['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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[['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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The infant presents with acute GEA without signs of alarm or severe dehydration\n', 'The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated\n', 'Support'], ['The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated\n', 'Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and continue with his usual diet\n', 'Support'], ['In this case, intravenous rehydration could be started...\n', 'Answer 1 may give rise to doubts, due to the fact that the statement says that the patient "does not tolerate the oral route"\n', 'Support'], ['but it would not be advisable to leave the patient on an absolute diet for 8 hours, nor a subsequent astringent diet\n', 'Answer 1 may give rise to doubts, due to the fact that the statement says that the patient "does not tolerate the oral route"\n', 'Attack'], ['Answer 1 may give rise to doubts, due to the fact that the statement says that the patient "does not tolerate the oral route"\n', 'Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet\n', 'Attack'], ['but it would not be advisable to leave the patient on an absolute diet for 8 hours, nor a subsequent astringent diet\n', 'Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet\n', 'Attack'], ['so I prefer answer 2\n', 'Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and continue with his usual diet\n', 'Support'], ['The rest of the treatments do not provide any benefit\n', 'Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) maintain usual feeding and oral amoxicillin 10 days\n', 'Attack'], ['The rest of the treatments do not provide any benefit\n', 'Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and start feeding with lactose-free formulas\n', 'Attack'], ['The rest of the treatments do not provide any benefit\n', 'Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) maintain usual feeding and loperamide 7 days\n', 'Attack']]
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198_73
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[['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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[['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'], ['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'], ['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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[["This case describes an Alzheimer's disease with insidious onset of short-term memory problems\n", "Alzheimer's disease\n", 'Support'], ['The patient was accompanied by his wife, who reported a slow progressive evolution of memory impairment (e.g., sometimes confused with insulin doses)\n', "This case describes an Alzheimer's disease with insidious onset of short-term memory problems\n", 'Support'], ['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)\n', 'Frontotemporal dementia\n', 'Attack'], ['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)\n', 'Lewy body disease\n', 'Attack'], ['There are no hallucinations or behavioral disorder.\n', '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)\n', 'Support'], ['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\n', 'Vascular dementia\n', 'Attack'], ['Creutzfeldt-Jacob disease is mostly rapidly progressive and usually presents with other clinical, abnormal neurological examination and MRI alterations.\n', 'Creutzfeldt-Jakob disease\n', 'Attack']]
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351_161
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[['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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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['The clinical case presented is a woman of childbearing age (27 years) presenting dyspareunia + dysmenorrhea + infertility\n', 'which should lead us to think of endometriosis\n', 'Support'], ['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\n', 'The clinical history and ultrasound give a diagnosis of suspicion\n', 'Attack'], ['The clinical history and ultrasound give a diagnosis of suspicion\n', 'Transvaginal ultrasound\n', 'Attack'], ['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\n', 'Diagnostic laparoscopy\n', 'Support']]
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69_124
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[['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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[['O', 'O', 'O', 'O', 'O', 'O', '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'], ['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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-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']]
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[['which is seen in the heart rate\n', 'The most likely cause is a digitalis intoxication, which would produce this slowing of conduction\n', 'Support'], ['The most likely cause is a digitalis intoxication, which would produce this slowing of conduction\n', 'Digitalis intoxication\n', 'Support'], ['Probably secondary to renal failure due to ibuprofen toxicity (but this is a bit of a stretch)\n', 'Ibuprofen toxicity\n', 'Support']]
|
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.']]
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[['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']]
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[['The correct answer is 3\n', 'Because of the risk of aspiration pneumonitis\n', 'Support'], ['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\n', 'Because of the risk of aspiration pneumonitis\n', 'Support'], ['Chest and abdominal X-ray showed an atresic esophageal pouch, with normal gastrointestinal pneumatization\n', 'Because of the risk of aspiration pneumonitis\n', 'Support'], ['In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway\n', 'Because of the risk of aspiration pneumonitis\n', 'Support'], ['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\n', 'In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway\n', 'Support']]
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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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[['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'], ['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'], ['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'], ['O', 'B-Claim'], ['O', 'B-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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Lithemia is 4.1 mEq/L (toxicity > 1.6 mEq/L)\n', 'We are dealing with a case of severe lithium intoxication (lithemia > 3.5 mEq/L is life threatening)\n', 'Support'], ['therefore, the therapeutic option of choice is to start hemodialysis urgently\n', 'Hemodialysis\n', 'Support'], ['Remember that activated charcoal is NOT indicated in lithium intoxication\n', 'Activated charcoal\n', 'Attack']]
|
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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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'B-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'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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']]
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[['For all these reasons, the correct answer is 5\n', 'Pericardial effusion with cardiac tamponade\n', 'Support'], ['In cardiac tamponade, the deep sinus X is characteristic\n', 'For all these reasons, the correct answer is 5\n', 'Support'], ['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\n', 'In a normal heart this exaggerated displacement, caused by the pressure exerted by the tamponade on the RV free wall, does not occur\n', 'Support'], ['In a normal heart this exaggerated displacement, caused by the pressure exerted by the tamponade on the RV free wall, does not occur\n', 'For all these reasons, the correct answer is 5\n', 'Support'], ['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)\n', 'For all these reasons, the correct answer is 5\n', 'Support'], ['Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration\n', '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\n', 'Support'], ['it represents an exaggeration of the physiological phenomenon consisting of inspiratory lowering of BP (normal up to 10 mmHg)\n', '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\n', 'Support']]
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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.']]
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[['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']]
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[["A patient's arterial blood gas result is: pH: 7.40, PaCO2 60 mmHg; bicarbonate 36 mM/L\n", 'Blood gases can be misleading\n', 'Support'], ['since a normal pH may suggest that there is no disturbance of acid-base balance\n', 'Blood gases can be misleading\n', 'Support'], ['instead it is masking a double disturbance in opposite directions as in this case\n', 'Blood gases can be misleading\n', 'Support'], ['PaCO2 60 mmHg\n', 'The patient presents with respiratory acidosis\n', 'Support'], ['normal to 50\n', 'The patient presents with respiratory acidosis\n', 'Support'], ['The patient presents with respiratory acidosis\n', 'Respiratory acidosis and metabolic alkalosis\n', 'Support'], ['bicarbonate 36 mmol/l\n', 'compensatory metabolic alkalosis\n', 'Support'], ['normal to 28\n', 'compensatory metabolic alkalosis\n', 'Support'], ['compensatory metabolic alkalosis\n', 'Respiratory acidosis and metabolic alkalosis\n', 'Attack'], ['This is the typical blood gas of the patient with COPD and compensated chronic respiratory failure\n', 'Respiratory acidosis and metabolic alkalosis\n', 'Support']]
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407_81
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[['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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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter\n', 'Factitious thyrotoxicosis\n', 'Support'], ['Physical examination showed tachycardia, hyperreflexia and absence of goiter\n', 'Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter\n', 'Support'], ['TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are decreased\n', 'Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter\n', 'Support'], ['TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are decreased\n', '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\n', 'Support'], ['hyperthyroidism\n', 'Factitious thyrotoxicosis\n', 'Support']]
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15_126
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[['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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[['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'], ['B-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'], ['O', 'O', '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'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['O', 'B-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', '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', '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', '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', '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'], ['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'], ['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']]
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[['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\n', 'Discharge home with palliative care from the health area\n', 'Support'], ['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\n', 'Discharge home with palliative care from the health area\n', 'Support'], ['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\n', 'It thus seems clear that the intended response is 5\n', 'Support'], ['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\n', 'Discharge home with palliative care from the health area\n', 'Support'], ['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\n', 'It thus seems clear that the intended response is 5\n', 'Support'], ['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\n', 'It thus seems clear that the intended response is 5\n', 'Support']]
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322_85
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[['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.']]
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[['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']]
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[['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\n', 'Monthly intramuscular administration of triptorelin\n', 'Attack'], ['A 22-year-old boy with hyposmia presents lack of development of secondary sexual characteristics and infertility\n', '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\n', 'Attack'], ['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\n', 'Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pituitary tumors...\n', 'Attack'], ['he has normal PRL\n', 'Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pituitary tumors...\n', 'Attack'], ['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\n', '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\n', 'Attack'], ['Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pituitary tumors...\n', 'Treatment with bromocriptine\n', 'Attack'], ['To induce testicular maturation, pulsatile GnRH with pump, hCG or FSH+hCG can be used\n', 'GnRH infusion pump\n', 'Support'], ['LH is not used as a treatment, it would be stimulated by intermittent GnRH\n', 'Intramuscular administration of FSH and LH once a week\n', 'Attack']]
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610_116
| null | null |
[]
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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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[['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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['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\n', 'Body dysmorphic disorder\n', 'Support'], ['It describes a patient worried about a non-existent physical defect, whose concern distresses him and prevents him from leaving the house\n', 'Body dysmorphic disorder\n', 'Support']]
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324_55
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[['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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[['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O'], ['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', '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'], ['O', 'B-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', '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', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Mortality is not so low\n', 'Mortality with medical treatment is 20%\n', 'Attack'], ['hence the correct answer is 3\n', 'In case of free wall rupture, there is no palpable frémito\n', 'Support'], ['the oximetric jump occurs in the case of septum rupture, as well as fremitus\n', 'In case of free wall rupture, there is no palpable frémito\n', 'Support'], ['the oximetric jump occurs in the case of septum rupture, as well as fremitus\n', 'In case of free wall rupture, there is an oxymetric jump in the right ventricle in the Swan-Ganz catheterization\n', 'Attack'], ['complications can occur up to the first week\n', 'Mechanical complications usually appear on the first post-infarction day\n', 'Attack']]
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240_150
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[['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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[['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', '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', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', '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'], ['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']]
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[['it presents the case with the typical symptoms of dementia due to Lewy bodies, being the guiding symptom visual hallucinations\n', 'The correct answer is 2\n', 'Support'], ['The correct answer is 2\n', 'Dementia due to Lewy bodies\n', 'Support'], ['Progressive cognitive impairment, parkinsonian motor signs (inferred from clumsiness of movements) and hypersensitivity to neuroleptics even in small doses are also mentioned\n', 'The correct answer is 2\n', 'Support']]
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68_123
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[['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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[['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', '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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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']]
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[['If the ECG shows ischemic changes, we will obviously treat the patient in the emergency room and notify the cardiologist\n', 'We will do an ECG in less than 10 minutes\n', 'Support'], ['If not, you will be treated as if it were angina and observed, with serial enzymes and treatment in the observation area\n', 'We will do an ECG in less than 10 minutes\n', 'Support']]
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206_125
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[['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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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'O', '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']]
|
[['The patient has a PSA >4 and a palpation with increased consistency\n', 'the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer\n', 'Support'], ['the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer\n', 'Suggest to the patient the performance of a transrectal ultrasound and prostate biopsy\n', 'Support'], ['the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer\n', 'Suggest to the patient the performance of a transrectal ultrasound and prostate biopsy\n', 'Support']]
|
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).']]
|
[['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'], ['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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim']]
|
[['Urine system: proteinuria 300 mg/dl, sediment 15 red blood cells per field\n', 'The patient presents with thrombotic microangiopathy (TMA) with acute renal failure\n', 'Support'], ['The patient presents with thrombotic microangiopathy (TMA) with acute renal failure\n', 'This points to HUS, TTP, drug-induced TMA, or TMA mediated by complement, coagulation, or metabolism\n', 'Support'], ['Normal ADAMTS-13 levels rule out TTP\n', 'incorrect choice 1\n', 'Support'], ['Normal ADAMTS-13 levels rule out TTP\n', 'Thrombotic thrombocytopenic purpura\n', 'Attack'], ['incorrect choice 1\n', 'Thrombotic thrombocytopenic purpura\n', 'Attack'], ['ADAMTS-13 levels are normal\n', 'Normal ADAMTS-13 levels rule out TTP\n', 'Support'], ['The absence of gastrointestinal symptoms rules out typical Shiga toxin HUS\n', 'incorrect choice 4\n', 'Support'], ['The absence of gastrointestinal symptoms rules out typical Shiga toxin HUS\n', 'Typical hemolytic uremic syndrome\n', 'Attack'], ['incorrect choice 4\n', 'Typical hemolytic uremic syndrome\n', 'Attack'], ['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\n', 'Atypical hemolytic uremic syndrome\n', 'Support'], ['option 2 correct\n', 'Atypical hemolytic uremic syndrome\n', 'Support'], ['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\n', 'option 2 correct\n', 'Support'], ['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\n', 'Pneumococcal infections can also cause HUS, although it is rare and more so in adults\n', 'Support'], ['Pneumococcal infections can also cause HUS, although it is rare and more so in adults\n', 'The absence of gastrointestinal symptoms rules out typical Shiga toxin HUS\n', 'Support'], ['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\n', '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\n', 'Support']]
|
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.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O'], ['O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['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\n', 'Beta-hemolytic streptococcus, group A\n', 'Support']]
|
619_121
| null | null |
[]
|
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.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Disease'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-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']]
|
[['The correct answer is: 4\n', 'Antihypertensive\n', 'Support'], ['The correct answer is: 4\n', 'Antihypertensive\n', 'Support'], ["In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia\n", 'Antihypertensive\n', 'Support'], ['treated for 4 months with Omeprazole, Metformin, Salbutamol, Ipratropium Bromide and Enalapril 20 mg + Hydrochlorothiazide 25 mg\n', "In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia\n", 'Support']]
|
269_141
| null | null |
[]
|
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.']]
|
[['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', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Sometimes amyloid deposits appear on the tongue which can produce macroglossia\n', 'Amyloidosis\n', 'Support'], ['If a patient reports having for months now enlargement of the tongue, with no other alterations of the tongue causing constant biting\n', 'Sometimes amyloid deposits appear on the tongue which can produce macroglossia\n', 'Support'], ['Amyloidosis is a localized or systemic deposition of fibrillar proteins\n', 'Amyloidosis\n', 'Support']]
|
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).']]
|
[['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'], ['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', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', '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']]
|
[['Middle-aged male with iron deficiency anemia and increased number of stools\n', 'a colonoscopy should be done to rule out colorectal cancer!!!\n', 'Support'], ['a colonoscopy should be done to rule out colorectal cancer!!!\n', 'Colonoscopy\n', 'Support'], ['If the HLA is negative it is very unlikely to be celiac disease (high negative predictive value)\n', 'Determination of anti-transglutaminase IgA antibodies\n', 'Attack']]
|
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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[['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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[["In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", 'The correct answer is 4\n', 'Support'], ["This patient presents Barrett's esophagus with low grade dysplasia\n", "In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", 'Support'], ['not being with acid production inhibition the dysplasia may be conditioned by inflammation and not be real\n', "In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", 'Attack'], ['The correct answer is 4\n', 'Periodic surveillance endoscopies and indefinite treatment with PPI.\n', 'Support'], ["In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", 'Periodic surveillance endoscopies and indefinite treatment with PPI.\n', 'Support']]
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359_91
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[['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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[['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', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim'], ['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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Older woman with normocitic anemia and clear ferrokinetic pattern of chronic disorder (hyposideremia but hyperferritinemia)\n', 'The only one that fits, and it fits perfectly, is number 3; they only needed to give us a high ESR\n', 'Support'], ['The only one that fits, and it fits perfectly, is number 3; they only needed to give us a high ESR\n', 'Polymyalgia rheumatica\n', 'Support'], ['Polymyalgia rheumatica\n', 'Polymyalgia rheumatica\n', 'Support'], ['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)\n', '1: if it is a recent loss, the MCV could remain normal, but the ferritin should be affected, and certainly not elevated\n', 'Attack'], ['1: if it is a recent loss, the MCV could remain normal, but the ferritin should be affected, and certainly not elevated\n', 'Recent blood loss through the digestive tract\n', 'Attack'], ['2: the same. If it is due to Fe malabsorption, ferritin should be low\n', 'Intestinal malabsorption\n', 'Attack'], ['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)\n', '2: the same. If it is due to Fe malabsorption, ferritin should be low\n', 'Attack'], ['And if it were due to B12 malabsorption, the MCV would be clearly higher\n', 'Intestinal malabsorption\n', 'Attack'], ['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)\n', 'And if it were due to B12 malabsorption, the MCV would be clearly higher\n', 'Attack'], ['4: 70 tachycardia and normal MCV. This one is too much\n', 'Thalassemia minor\n', 'Attack'], ['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)\n', '4: 70 tachycardia and normal MCV. This one is too much\n', 'Attack']]
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108_219
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[['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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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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', '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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['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']]
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[['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\n', 'Their daughters will not inherit the disease, but all their future sons will be carriers and can transmit the mutation to 50%\n', 'Support'], ['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\n', 'Their sons will not inherit the disease, but all their future daughters will be carriers and can transmit the mutation to 50%\n', 'Support'], ['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)\n', 'Their daughters will not inherit the disease, but all their future sons will be carriers and can transmit the mutation to 50%\n', 'Attack'], ['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)\n', 'Their sons will not inherit the disease, but all their future daughters will be carriers and can transmit the mutation to 50%\n', 'Support']]
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255_94
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[['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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[['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'], ['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', 'I-Premise', 'I-Premise'], ['B-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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-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'], ['B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['We have yet to see jejunum and ileum\n', 'we will have to perform a capsule endoscopy\n', 'Support'], ['we will have to perform a capsule endoscopy\n', 'Endoscopic capsule\n', 'Support'], ['It is a study of iron deficiency anemia with normal gastroscopy and colonoscopy, having ruled out possible celiac disease\n', 'We have yet to see jejunum and ileum\n', 'Support']]
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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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[['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', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-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'], ['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-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'], ['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']]
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[['Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course\n', 'Renal amyloidosis\n', 'Attack'], ['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\n', 'Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course\n', 'Support'], ['GMN associated with rheumatoid arthritis characteristically alters the sediment\n', 'Glomerulonephritis secondary to rheumatoid arthritis\n', 'Attack'], ['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\n', 'GMN associated with rheumatoid arthritis characteristically alters the sediment\n', 'Support'], ['renal failure due to NSAIDs has a more chronic course, with papillary necrosis\n', 'Renal failure due to nonsteroidal anti-inflammatory drugs\n', 'Attack'], ['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\n', 'renal failure due to NSAIDs has a more chronic course, with papillary necrosis\n', 'Support'], ['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\n', 'Interstitial nephritis due to methotrexate\n', 'Support'], ['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\n', '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\n', 'Support']]
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539_3
| null | null |
[]
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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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[['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'], ['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', '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', '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'], ['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'], ['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'], ['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'], ['O', 'O'], ['O', 'O', 'O'], ['B-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', '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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['A 45-year-old woman diagnosed with stage IV breast cancer with multiple bone metastases on hormonal treatment and iv bisphosphonates\n', 'if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen\n', 'Support'], ['if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen\n', 'The correct answer is 4\n', 'Support'], ['it will also help us to use the antalgic synergy\n', 'The correct answer is 4\n', 'Support'], ['since she is at almost the maximum pain she can bear\n', 'We should change the treatment to a major opioid and treat the disrruptive pain vigorously\n', 'Support'], ['We should change the treatment to a major opioid and treat the disrruptive pain vigorously\n', '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\n', 'Support'], ['The correct answer is 4\n', '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\n', 'Support']]
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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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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', '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'], ['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']]
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[['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)\n', '2: Age should not be a limiting factor\n', 'Support'], ['1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis\n', 'Perform mediastinoscopy\n', 'Attack'], ['1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis\n', 'A trantoracic puncture should be performed\n', 'Attack'], ['2: Age should not be a limiting factor\n', 'Surgical intervention with curative intent should be contraindicated due to the advanced age of the patient.\n', 'Attack'], ['3: Presents a very mild respiratory limitation, does not require such a test\n', 'An oxygen consumption test should be performed, given the respiratory limitation he presents\n', 'Attack'], ['4: Is the correct one\n', 'Surgical resection (lobectomy of the lower lobe of the right lung) should be indicated directly\n', 'Support']]
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10_37
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[['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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[['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'], ['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', '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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Marker', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['although both lesions are resectable\n', 'I think the correct answer is 4\n', 'Attack'], ['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\n', 'I think the correct answer is 4\n', 'Support'], ['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\n', 'Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n', 'Support'], ['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\n', 'Surgical biliary bypass, with or without prophylactic gastrojejunostomy depending on intraoperative findings\n', 'Attack'], ['although both lesions are resectable\n', 'Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n', 'Attack'], ['I think the correct answer is 4\n', 'Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n', 'Support'], ['pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication\n', 'I think the correct answer is 4\n', 'Support'], ['it does not prolong survival and has a high morbidity\n', 'pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication\n', 'Support'], ['pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication\n', 'Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n', 'Support']]
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284_57
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[]
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188_230
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[['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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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The treatment for hypercholesterolemia is statins so we rule out answers 2 and 4\n', 'Rule out hypothyroidism or other systemic disease, recommend a healthy lifestyle and treat with fibrates to normalize cholestero\n', 'Attack'], ['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.\n', 'Treat with statins until cholesterol is normalized and recommend healthy lifestyle (diet, exercise and no smoking)\n', 'Attack'], ['The treatment for hypercholesterolemia is statins so we rule out answers 2 and 4\n', 'Rule out secondary dyslipidemia, treat with resins (resincholestyramine) and fibrates and re-commend a healthy lifestyle. Prohibit alcohol\n', 'Attack'], ['Between 3 and 5, 5 is more complete as it includes treatment and control of other risk factors\n', 'Rule out secondary dyslipidemia, request a family study and treat with statins to maintain a good lipid profile. Control of other risk factors\n', 'Support'], ['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\n', "Ruling out secondary dyslipidemia is easy with the patient's clinical history and a blood test with thyroid function\n", 'Support'], ['He smoked 30 cig/day, was not obese, his blood pressure was 145/90 mm Hg and he did not have diabetes\n', "Ruling out secondary dyslipidemia is easy with the patient's clinical history and a blood test with thyroid function\n", 'Support'], ["Ruling out secondary dyslipidemia is easy with the patient's clinical history and a blood test with thyroid function\n", 'Rule out secondary dyslipidemia, request a family study and treat with statins to maintain a good lipid profile. Control of other risk factors\n', 'Support']]
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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).']]
|
[['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'], ['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', 'B-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'], ['O', 'B-Claim', 'I-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The correct answer is 2\n', 'Colposcopy with possible biopsy\n', 'Support'], ['Cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion\n', "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)\n", 'Support'], ['A 45-year-old woman, mother of 3 children, attends an early diagnosis consultation\n', "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)\n", 'Support']]
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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']]
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[['A 58-year-old man referred a 3-week history of progressive, mildly painful skin lesions on his left arm\n', 'The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n', 'Support'], ['It had started as an erythematous lesion on his left thumb\n', 'The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n', 'Support'], ['The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n', 'the first two would be ruled out\n', 'Support'], ['the first two would be ruled out\n', 'Dermatophytosis due to Microsporum gypseum\n', 'Attack'], ['the first two would be ruled out\n', 'Cutaneous infection by Staphylococcus aureus\n', 'Attack'], ['He had been working in his garden but did not remember any injuries\n', 'The history of having been working in the garden points more to a sporotrichosis\n', 'Support'], ['although the fact that the question asks for the "causative agent" and not the name of the disease misleads a little\n', 'The history of having been working in the garden points more to a sporotrichosis\n', 'Attack'], ['The history of having been working in the garden points more to a sporotrichosis\n', 'Sporotrichosis\n', 'Support'], ['The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n', 'Sporotrichosis\n', 'Support'], ['The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n', 'Cutaneous infection by Mycobacterium marinum\n', 'Attack']]
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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.']]
|
[['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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['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\n', 'I would change ibuprofen to paracetamol to avoid the possible influence of paracetamol on the effect of hypotensives\n', 'Support']]
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104_91
| null | null |
[]
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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']]
|
[["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\n", 'To diagnose it we will use antimitochondrial antibodies (AMA IgG)\n', 'Support'], ["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\n", 'Therefore, it would be answer 1\n', 'Support'], ['To diagnose it we will use antimitochondrial antibodies (AMA IgG)\n', 'Anti-mitochondrial antibodies\n', 'Support'], ['Therefore, it would be answer 1\n', 'Anti-mitochondrial antibodies\n', 'Support']]
|
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.']]
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[['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']]
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[['They refer to a partial seizure that is followed by loss of level of consciousness\n', '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)\n', 'Support'], ['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)\n', 'Partially symptomatic\n', 'Support'], ['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)\n', 'Partial secondarily generalized symptomatic\n', 'Attack'], ['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)\n', 'For this reason the most correct option would be two\n', 'Support'], ['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\n', 'For this reason the most correct option would be two\n', 'Support'], ['For this reason the most correct option would be two\n', 'Partially symptomatic\n', 'Support']]
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163_122
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[['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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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', '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'], ['B-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', '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'], ['O', 'B-Claim', 'I-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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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', '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']]
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[['The correct answer is: 3\n', 'Subcutaneous fat biopsy\n', 'Support'], ['The correct answer is: 3\n', 'Subcutaneous fat biopsy\n', 'Support'], ['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\n', 'Subcutaneous fat biopsy\n', 'Support'], ['He presents proteinuria of 6 grams per day with hypoalbuminemia and edema\n', '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\n', 'Support'], ['In the urinary sediment no hematuria is detected\n', '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\n', 'Support'], ["A non-negligible number of patients with evolved AD is amyloidosis, which also matches the patient's symptomatology\n", 'Therefore, and given that amyloidosis can be diagnosed with a subcutaneous fat biopsy, it is answer 3 that should be considered valid\n', 'Support'], ['Therefore, and given that amyloidosis can be diagnosed with a subcutaneous fat biopsy, it is answer 3 that should be considered valid\n', 'Subcutaneous fat biopsy\n', 'Support']]
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148_158
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[['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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[['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Disease', 'I-Disease', 'I-Disease'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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'], ['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', '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', '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'], ['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']]
|
[['A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner\n', 'The woman is 23 years old and is pissed off\n', 'Support'], ['The diagnosis is 1\n', 'Borderline personality disorder\n', 'Support'], ['The issue is that she cannot stand rejection and has self-injurious gestures\n', 'The diagnosis is 1\n', 'Support'], ['3, 4 and 5 are not even close, there is no clinical picture described in the question\n', 'Dysthymia\n', 'Attack'], ['3, 4 and 5 are not even close, there is no clinical picture described in the question\n', 'Dissociative disorder\n', 'Attack'], ['3, 4 and 5 are not even close, there is no clinical picture described in the question\n', 'Depersonalization disorder\n', 'Attack'], ['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\n', 'Dissociative disorder\n', 'Attack'], ['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\n', 'Depersonalization disorder\n', 'Attack'], ['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\n', 'Dysthymia\n', 'Attack'], ['A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner\n', '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\n', 'Support'], ['Her medical history shows several similar complaints in the previous year, two of them after a self-injurious gesture\n', '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\n', 'Support'], ['She says she feels misunderstood by everyone, including the psychiatrists attending her\n', '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\n', 'Support'], ['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\n', 'Borderline personality disorder\n', 'Support'], ['Frantic efforts to avoid real or imagined abandonment\n', '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\n', 'Support'], ['A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation\n', '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\n', 'Support'], ['Identity disturbance: marked and persistently unstable self-image or sense of self\n', '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\n', 'Support'], ['Impulsivity in at least two areas, which is potentially self-harming (e.g., spending, sex, substance abuse, reckless driving, binge eating)\n', '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\n', 'Support'], ['Recurrent suicidal behaviors, attempts or threats, or self-mutilating behavior\n', '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\n', 'Support'], ['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)\n', '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\n', 'Support'], ['Chronic feelings of emptiness\n', '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\n', 'Support'], ['Inappropriate and intense anger or difficulties in controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).\n', '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\n', 'Support'], ['Transient stress-related paranoid ideation or severe dissociative symptoms.\n', '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\n', 'Support'], ['Not comfortable in situations where he/she is not the center of attention\n', '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\n', 'Support'], ['Interaction with others is often characterized by sexually seductive or provocative behavior\n', '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\n', 'Support'], ['Displays a superficial and rapidly changing emotional expression\n', '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\n', 'Attack'], ['Constantly uses physical appearance to draw attention to him/herself\n', '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\n', 'Support'], ['Has a way of speaking that is excessively subjective and lacking in nuance\n', '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\n', 'Support'], ['Shows self-dramatization, theatricality and exaggerated emotional expression\n', '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\n', 'Support'], ['Is suggestible, e.g., easily influenced by others or by circumstances\n', '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\n', 'Support'], ['considers his relationships more intimate than they really are\n', '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\n', 'Support']]
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178_94
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[['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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[['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'], ['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', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['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', 'B-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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['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\n', 'a small child who suffers a hemarthrosis without clear trauma\n', 'Support'], ['The ultrasound examination is compatible with hemarthrosis\n', 'a small child who suffers a hemarthrosis without clear trauma\n', 'Support'], ['In the directed anamnesis, the mother refers that an uncle of hers had similar problems\n', 'An uncle of his had similar problems, so we suspect hereditary disease\n', 'Support'], ['in the analysis performed only an APTT lengthening of 52″ (normal 25-35″) stands out\n', 'The APTT, which evaluates the intrinsic coagulation pathway (involving factors V, VIII, IX, X, XI and XII) is elongated\n', 'Support'], ['Hereditary coagulation problem\n', 'We thus discard answers 1, 2 and 5\n', 'Support'], ['Hereditary coagulation problem\n', 'Marfan syndrome\n', 'Attack'], ['Hereditary coagulation problem\n', 'Bemard-Soulier disease\n', 'Attack'], ['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)\n', 'Hemophilia A\n', 'Support'], ['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)\n', "Von Willebrand's disease\n", 'Attack'], ['We thus discard answers 1, 2 and 5\n', 'Ehlers-Danlos disease\n', 'Attack']]
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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.']]
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[['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']]
|
[['Treatment is with thyroxine\n', 'Treat with L-Tyroxine and determine antithyroid antibodies\n', 'Support'], ['If there is no nodule, neither echo nor FNA is indicated\n', 'Perform a thyroid ultrasound before starting treatment\n', 'Attack'], ['If there is no nodule, neither echo nor FNA is indicated\n', 'Perform thyroid cytology prior to treatment\n', 'Attack'], ['If there is no nodule, neither echo nor FNA is indicated\n', 'Determine free T3 and perform a pituitary MRI\n', 'Attack']]
|
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.']]
|
[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['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-Claim', 'I-Claim', 'I-Claim', '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', '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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Although the diagnosis is clearly osteoarthritis, it does not lead directly to a surgical indication\n', 'I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n', 'Attack'], ['The first step is to try conservative treatment\n', 'I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n', 'Attack'], ['we ruled out the first option\n', 'I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n', 'Attack'], ['The first step is to try conservative treatment\n', 'we ruled out the first option\n', 'Support'], ['Osteoarthritis is a degenerative process that opioids certainly do not stop\n', 'we rule out option two\n', 'Support'], ['Osteoarthritis is a degenerative process that opioids certainly do not stop\n', 'Start treatment with weak opioids that have shown evidence in stopping the progression of the disease\n', 'Attack'], ['we rule out option two\n', 'Start treatment with weak opioids that have shown evidence in stopping the progression of the disease\n', 'Attack'], ['Option four can also be quickly discarded\n', 'Because of the radiological features described, I need a hip MRI before making a therapeutic decision\n', 'Attack'], ['We are talking about a 66-year-old patient with pain on some days, pain of an occasional nature\n', 'the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest\n', 'Support'], ['the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest\n', 'Option four can also be quickly discarded\n', 'Support'], ['the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest\n', 'Because of the radiological features described, I need a hip MRI before making a therapeutic decision\n', 'Attack']]
|
28_58
| null | null |
[]
|
587_76
| null | null |
[]
|
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.']]
|
[['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', 'I-Premise'], ['B-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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Patient with obesity, hypertension and increased HbA1C\n', 'In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly reduces AT, HbA1C and BMI\n', 'Support'], ['In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly reduces AT, HbA1C and BMI\n', 'Empaglifozin\n', 'Support'], ['Glipizide is of the sulfonylurea group\n', 'Its use should be avoided in patients with heart disease\n', 'Support'], ['Its use should be avoided in patients with heart disease\n', 'Glipizide\n', 'Attack'], ['Sitagliptin has been shown to decrease HbA1C but not HT or BMI\n', 'Sitagliptin\n', 'Attack'], ['His medication includes lisinopril, metoprolol, metformin, ASA and atorvastatin\n', 'Acarbose can interact with beta-blockers, such as those taken by our patient\n', 'Support'], ['Acarbose can interact with beta-blockers, such as those taken by our patient\n', 'Acarbose\n', 'Attack']]
|
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.']]
|
[['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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'B-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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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']]
|
[['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)\n', 'suggest acute alcohol hepatitis\n', 'Support'], ['suggest acute alcohol hepatitis\n', 'Alcoholic hepatitis\n', 'Support']]
|
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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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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']]
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[['Both the initially occipital location, the 2-year evolution time, and the sensation of weight lead to answer 4, a tension headache\n', 'Tension\n', 'Support'], ['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")\n', 'Tension\n', 'Support'], ['Although she has been having similar episodes for more than a year, in the last 2 months they have worsened considerably\n', 'Tension\n', 'Support'], ['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\n', 'Temporal artery arteritis\n', 'Attack'], ['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\n', 'Migraine\n', 'Attack'], ['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\n', 'Vascular disorders\n', 'Attack'], ['Tumor headache is usually "in crescendo", not recurrent as the case suggests, and is accompanied by other neurological symptoms or intracranial hypertension\n', 'Oncologi\n', 'Attack'], ['Although she has been having similar episodes for more than a year, in the last 2 months they have worsened considerably\n', 'Oncologi\n', 'Attack'], ['A 42-year-old married woman\n', 'Temporal artery arteritis\n', 'Attack']]
|
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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[['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', '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'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', 'B-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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The rest of the symptoms fall perfectly within the picture\n', 'In this question, they give an important piece of information when it comes to suspecting a diagnosis, which is the antitransglutaminase antibodies\n', 'Support'], ['A 27-year-old woman under study in the dermatology department for recurrent episodes of oral aphthous ulcers\n', 'The rest of the symptoms fall perfectly within the picture\n', 'Support'], ['a blood test showing Hb 11.5 gr/dl Fe 38 AST 52 ALT 64 Ac antitrasglutaminase IgA 177\n', 'The rest of the symptoms fall perfectly within the picture\n', 'Support'], ['The patient reported only occasional diffuse abdominal discomfort\n', 'The rest of the symptoms fall perfectly within the picture\n', 'Support'], ['She reports no signs of hemorrhage or jaundice\n', 'The rest of the symptoms fall perfectly within the picture\n', 'Support'], ['The physical examination is normal\n', 'The rest of the symptoms fall perfectly within the picture\n', 'Support'], ['In this question, they give an important piece of information when it comes to suspecting a diagnosis, which is the antitransglutaminase antibodies\n', 'that must lead you to suspect celiac disease\n', 'Support'], ['that must lead you to suspect celiac disease\n', 'the answer that will give us the diagnosis is 4 (intestinal biopsy)\n', 'Support'], ['the answer that will give us the diagnosis is 4 (intestinal biopsy)\n', 'Intestinal biopsy\n', 'Support'], ['although probably several of the tests that it says will be done\n', 'the answer that will give us the diagnosis is 4 (intestinal biopsy)\n', 'Attack']]
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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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[['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'], ['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'], ['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'], ['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', 'O', 'O'], ['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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'O', 'B-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', 'B-Marker', 'B-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']]
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[['The characteristics of the fluid described are milky\n', 'chylous ascitic fluid\n', 'Support'], ['chylous ascitic fluid\n', "Chylous ascites due to non-Hodgkin's lymphoma\n", 'Support'], ['Taking into account the age of the patient and the constitutional syndrome described\n', "it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", 'Support'], ["it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", "Chylous ascites due to non-Hodgkin's lymphoma\n", 'Support'], ['there is no mention of infectious symptoms\n', "it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", 'Support'], ['The rest of the entities offered do not present with chylous ascitic fluid\n', 'Hydropic decompensation secondary to liver cirrhosis\n', 'Attack'], ['The rest of the entities offered do not present with chylous ascitic fluid\n', 'Peritoneal metastasis of adenocarcinoma\n', 'Attack'], ["it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", 'Peritoneal tuberculosis\n', 'Attack'], ['The rest of the entities offered do not present with chylous ascitic fluid\n', 'Ascites secondary to constrictive pericarditis\n', 'Attack']]
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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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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Conservative treatment with a success rate of 75%-90%\n', 'Conservative treatment with nonsteroidal anti-inflammatory drugs, local heat and relative rest\n', 'Support']]
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362_96
| null | null |
[]
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