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[['QUESTION', 'TYPE:', 'PRIMARY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '75', 'a', 'man', 'is', 'admitted', 'to', 'the', 'hospital', 'because', 'he', 'refuses', 'to', 'eat', 'and', 'has', 'lost', '30%', 'of', 'his', 'weight.'], ['He', 'has', 'a', 'history', 'of', 'multiple', 'sclerosis', 'which', 'has', 'worsened', 'in', 'recent', 'months.'], ['His', 'only', 'family', 'member', 'who', 'was', 'his', 'sister', 'died', '3', 'months', 'ago', 'and', 'since', 'then', 'he', 'has', 'deteriorated.'], ['He', 'has', 'become', 'incontinent,', 'has', 'stopped', 'eating', 'and', 'participating', 'in', 'social', 'events.'], ['He', 'is', 'suffering', 'from', 'psychotic', 'depression.'], ['He', 'is', 'physically', 'able', 'to', 'eat.'], ['Psychotropic', 'medication', 'is', 'started', 'and', 'discontinued', 'due', 'to', 'adverse', 'events.'], ['If', 'his', 'nutritional', 'status', 'improves', 'it', 'is', 'possible', 'to', 'resume', 'his', 'medications.'], ['He', 'refuses', 'intravenous', 'fluids', 'and', 'then', 'accepts', 'them', 'but', 'the', 'IV', 'is', 'started', 'a', 'few', 'hours', 'later.'], ['An', 'alternative', 'is', 'to', 'perform', 'a', 'percutaneous', 'endoscopic', 'gastrostomy', '(PEG)', 'and', 'discharge', 'him', 'to', 'his', 'residence.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'appropriate', 'course', 'of', 'action', 'for', 'this', 'patient?'], ['1-', 'Ask', 'the', 'hospital', 'ethics', 'committee', 'to', 'help', 'determine', 'the', 'decision', 'that', 'is', 'in', 'the', 'best', 'interest', 'of', 'the', 'patient.'], ['2-', 'Assess', 'whether', 'the', 'residence', 'will', 'take', 'the', 'patient', 'if', 'PEG', 'is', 'not', 'performed.'], ['3-', 'Seek', 'a', 'court', 'order', 'to', 'perform', 'PEG.'], ['4-', 'Enrolling', 'the', 'patient', 'in', 'terminal', 'palliative', 'care.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', '1', 'since', 'the', 'patient', 'is', 'in', 'a', 'situation', 'of', 'psychotic', 'depression', 'and', 'is', 'not', 'able', 'to', 'decide', 'for', 'his', 'life', 'and', 'it', 'does', 'not', 'seem', 'that', 'the', 'patient', 'has', 'filled', 'in', 'the', 'last', 'will', 'and', 'testament,', 'the', 'most', 'convenient', 'thing', 'to', 'do', 'is', 'to', 'present', 'the', 'case', 'to', 'the', 'ethics', 'committee', 'of', 'the', 'center', 'to', 'make', 'a', 'decision', 'on', 'the', 'matter', 'in', 'accordance', 'with', 'the', 'law.']]
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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'], ['B-Premise', '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'], ['B-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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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', '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', 'I-Premise', 'I-Premise', '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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[['the patient is in a situation of psychotic depression and is not able to decide for his life and it does not seem that the patient has filled in the last will and testament\n', 'The correct answer is 1\n', 'Support'], ['the patient is in a situation of psychotic depression and is not able to decide for his life and it does not seem that the patient has filled in the last will and testament\n', 'the most convenient thing to do is to present the case to the ethics committee of the center to make a decision on the matter in accordance with the law\n', 'Support'], ['The correct answer is 1\n', 'Ask the hospital ethics committee to help determine the decision that is in the best interest of the patient\n', 'Support'], ['the most convenient thing to do is to present the case to the ethics committee of the center to make a decision on the matter in accordance with the law\n', 'Ask the hospital ethics committee to help determine the decision that is in the best interest of the patient\n', 'Support']]
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361_94
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '51-year-old', 'man', 'is', 'admitted', 'from', 'the', 'emergency', 'department', 'for', 'macrocytic', 'anemia', '(Hb', '6.3', 'g/dL,', 'MCV', '120', 'fL).'], ['Studies', 'ruled', 'out', 'a', 'deficiency', 'origin.'], ['Reticulocytes', 'were', '24000/microL.'], ['The', 'bone', 'marrow', 'study', 'is', 'compatible', 'with', 'myelodysplastic', 'syndrome', '(MDS).'], ['Cytogenetics', 'shows', 'a', '5q', 'deletion.'], ['Which', 'is', 'the', 'correct', 'statement', 'regarding', 'this', 'patient?'], ['1-', 'This', 'deletion', '(5q-)', 'is', 'an', 'alteration', 'of', 'good', 'prognosis', 'and', 'has', 'a', 'specific', 'treatment', '(lenalidomide).'], ['2-', 'It', 'would', 'be', 'advisable', 'in', 'this', 'patient', 'to', 'perform', 'HLA', 'typing', 'in', 'order', 'to', 'organize', 'an', 'allogeneic', 'transplant.'], ['3-', 'This', 'is', 'a', 'patient', 'with', 'a', 'high', 'International', 'Prognostic', 'Index', '(IPSS).'], ['4-', 'Treatment', 'in', 'this', 'case', 'would', 'be', 'transfusion', 'only.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['This', 'is', 'a', 'young', 'patient', 'with', 'no', 'comorbidities', 'and', 'is', 'therefore', 'a', 'candidate', 'for', 'treatment', 'with', 'curative', 'intent,', 'so', 'option', '4', 'is', 'ruled', 'out.'], ['Option', '3', 'is', 'also', 'incorrect', 'since', 'we', 'cannot', 'know', 'the', "patient's", 'IPSS', 'since', 'we', 'do', 'not', 'know', 'the', 'number', 'of', 'blasts', 'and', 'the', 'number', 'of', 'leukocytes', 'and', 'platelets', 'to', 'calculate', 'the', 'risk.'], ['Option', '2', 'is', 'also', 'incorrect', 'since', 'the', 'indication', 'for', 'a', 'bone', 'marrow', 'transplant', 'in', 'MDS', 'is', 'those', 'patients', 'with', 'high', 'or', 'intermediate-2', 'IPSS,', 'and', 'in', 'this', 'case', 'we', 'do', 'not', 'know', 'the', 'risk,', 'the', 'only', 'thing', 'we', 'know', 'about', 'the', 'risk', 'is', 'the', 'cytogenetics', 'which', 'is', 'of', 'good', 'prognosis', 'that', 'would', 'give', 'us', '0', 'points.'], ['Therefore', 'the', 'correct', 'one', 'is', '1', 'since', 'it', 'is', 'true', 'that', 'it', 'has', 'a', 'favorable', 'cytogenetics', '(5q-)', 'and', 'has', 'a', 'specific', 'treatment', 'lenalidomide,', 'also', 'used', 'in', 'other', 'pathologies', 'such', 'as', 'multiple', 'myeloma.']]
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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'], ['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'], ['B-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'], ['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'], ['O', 'B-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', 'O', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-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', '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', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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']]
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[['This is a young patient with no comorbidities\n', 'is therefore a candidate for treatment with curative intent\n', 'Support'], ['is therefore a candidate for treatment with curative intent\n', 'option 4 is ruled out\n', 'Support'], ['option 4 is ruled out\n', 'Treatment in this case would be transfusion only\n', 'Attack'], ["we cannot know the patient's IPSS\n", 'Option 3 is also incorrect\n', 'Support'], ['we do not know the number of blasts and the number of leukocytes and platelets to calculate the risk\n', "we cannot know the patient's IPSS\n", 'Support'], ['Option 3 is also incorrect\n', 'This is a patient with a high International Prognostic Index (IPSS)\n', 'Attack'], ['the indication for a bone marrow transplant in MDS is those patients with high or intermediate-2 IPSS\n', 'Option 2 is also incorrect\n', 'Support'], ['Option 2 is also incorrect\n', 'It would be advisable in this patient to perform HLA typing in order to organize an allogeneic transplant\n', 'Attack'], ['in this case we do not know the risk, the only thing we know about the risk is the cytogenetics which is of good prognosis that would give us 0 points\n', 'Option 2 is also incorrect\n', 'Support'], ['Therefore the correct one is 1\n', 'This deletion (5q-) is an alteration of good prognosis and has a specific treatment (lenalidomide)\n', 'Support'], ['it is true that it has a favorable cytogenetics (5q-) and has a specific treatment lenalidomide, also used in other pathologies such as multiple myeloma\n', 'Therefore the correct one is 1\n', 'Support']]
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172_50
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[['QUESTION', 'TYPE:', 'PNEUMOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'with', 'severe', 'COPD', 'comes', 'to', 'the', 'ED', 'with', 'an', 'acute', 'onset', 'and', 'presents', 'an', 'arterial', 'blood', 'gas', 'drawn', 'with', 'Fi02', 'of', '31%', 'at', 'sea', 'level', 'with', 'a', 'Pa02', 'of', '86', 'mm', 'Hg,', 'PaC02', '65', 'mm', 'Hg,', 'pH', '7.13', 'and', 'Bicarbonate', '27', 'mmol/liter.'], ['Which', 'of', 'the', 'following', 'statements', 'is', 'FALSE?'], ['1-', 'The', 'patient', 'is', 'hyperventilating.'], ['2-', 'The', 'alveolar', 'arterial', 'oxygen', 'gradient', 'is', 'elevated.'], ['3-', 'The', 'patient', 'is', 'in', 'respiratory', 'acidosis.'], ['4-', 'Bicarbonate', 'level', 'is', 'normal.'], ['5-', 'Initiation', 'of', 'mechanical', 'ventilation', 'should', 'be', 'considered.'], ['CORRECT', 'ANSWER:', '1'], ['Blood', 'gas', 'analysis', 'shows', 'an', 'acute', 'respiratory', 'acidosis,', 'due', 'to', 'an', 'increase', 'in', 'PCO2', 'of', 'short', 'evolution', 'time', 'because', 'the', 'kidney', 'has', 'not', 'yet', 'had', 'time', 'to', 'retain', 'bicarbonates', '(bicarbonate', 'level', 'at', 'the', 'high', 'limit', 'of', 'normality).'], ['The', 'patient', 'is', 'not', 'hyperventilating', 'but', 'hypoventilating', 'because', 'PCO2', 'is', 'elevated.'], ['The', 'alveolar', 'arterial', 'oxygen', 'gradient', 'is', 'altered', 'since', 'the', 'patient', 'has', 'a', 'normal', 'PaO2,', 'but', 'because', 'he', 'has', 'a', 'high', 'FiO2.'], ['If', 'he', 'were', 'without', 'oxygen,', 'he', 'would', 'be', 'hypoxemic.'], ['Respiratory', 'acidosis', 'below', '7.20', 'is', 'a', 'reason', 'to', 'consider', 'noninvasive', 'mechanical', 'ventilation', 'acutely', 'and', 'in', 'principle', 'temporarily', 'in', 'a', 'patient', 'with', 'severe', 'COPD.']]
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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'], ['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'], ['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', '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', 'I-Claim', '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'], ['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']]
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[['A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n', 'Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality)\n', 'Support'], ['Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality)\n', 'The patient is in respiratory acidosis\n', 'Support'], ['The patient is not hyperventilating but hypoventilating because PCO2 is elevated\n', 'The patient is hyperventilating\n', 'Attack'], ['A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n', 'The patient is not hyperventilating but hypoventilating because PCO2 is elevated\n', 'Support'], ['A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n', 'The alveolar arterial oxygen gradient is altered since the patient has a normal PaO2, but because he has a high FiO2\n', 'Support'], ['The alveolar arterial oxygen gradient is altered since the patient has a normal PaO2, but because he has a high FiO2\n', 'The alveolar arterial oxygen gradient is elevated\n', 'Support'], ['Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality)\n', 'Bicarbonate level is normal\n', 'Support'], ['Respiratory acidosis below 7.20 is a reason to consider noninvasive mechanical ventilation acutely and in principle temporarily in a patient with severe COPD\n', 'Initiation of mechanical ventilation should be considered\n', 'Support'], ['A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n', 'Respiratory acidosis below 7.20 is a reason to consider noninvasive mechanical ventilation acutely and in principle temporarily in a patient with severe COPD\n', 'Support']]
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83_48
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[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['What', 'therapeutic', 'intervention', 'would', 'you', 'consider', 'in', 'a', '67-year-old', 'patient', 'with', 'idiopathic', 'dilated', 'cardiomyopathy,', 'left', 'bundle', 'branch', 'block,', 'left', 'ventricular', 'ejection', 'fraction', 'of', '26%,', 'mitral', 'insufficiency', 'grade', 'II-III/IV,', 'undergoing', 'treatment', 'with', 'furosemide,', 'spironolactone,', 'enalapril', 'and', 'bisoprolol', 'and', 'who', 'remains', 'in', 'NYHA', 'functional', 'class', 'III?'], ['1-', 'Surgical', 'coronary', 'revascularization.'], ['2-', 'Mitral', 'valve', 'replacement.'], ['3-', 'Implantation', 'of', 'an', 'aortic', 'balloon', 'pump.'], ['4-', 'Implantation', 'of', 'a', 'ventricular', 'assist', 'device.'], ['5-', 'Implantation', 'of', 'a', 'cardiac', 'resynchronization', 'system.'], ['CORRECT', 'ANSWER:', '5'], ['We', 'are', 'talking', 'about', 'a', 'patient', 'with', 'heart', 'failure', 'with', 'severe', 'LV', 'dysfunction', '(EF', '<', '35%),', 'LBBB', '(wide', 'QRS),', 'who', 'is', 'following', 'optimal', 'medical', 'treatment', 'and', 'who', 'remains', 'in', 'advanced', 'functional', 'class', 'despite', 'this.'], ['Coronary', 'revascularization', 'does', 'not', 'appear', 'to', 'be', 'of', 'much', 'benefit', 'in', 'this', 'patient', 'at', 'this', 'time.'], ['Nor', 'does', 'mitral', 'valve', 'replacement,', 'firstly', 'because', 'mitral', 'regurgitation', 'is', 'most', 'likely', 'the', 'result', 'of', 'mitral', 'annular', 'dilatation,', 'and', 'secondly', 'because', 'we', 'would', 'need', 'an', 'echocardiographic', 'assessment', 'of', 'the', 'mitral', 'valve', 'to', 'determine', 'whether', 'there', 'is', 'any', 'alteration.'], ['Intra-aortic', 'balloon', 'counterpulsation', 'implantation', 'would', 'not', 'be', 'indicated', 'in', 'this', 'patient', '(it', 'is', 'used', 'in', 'situations', 'of', 'cardiogenic', 'shock,', 'in', 'post-AMI', 'mechanical', 'complications,', 'as', 'a', 'bridge', 'to', 'cardiac', 'Tx...).'], ['The', 'ventricular', 'assist', 'device', 'would', 'also', 'not', 'be', 'indicated', 'in', 'this', 'patient.'], ['What', 'would', 'really', 'benefit', 'him', 'of', 'all', 'the', 'answers', 'is', 'number', '5,', 'the', 'resynchronization', 'device.'], ['By', 'achieving', 'simultaneous', 'stimulation', 'of', 'both', 'ventricles,', 'a', 'mechanical', 'synergy', 'is', 'achieved', 'that', 'improves', 'cardiac', 'function.'], ['The', 'indications', 'for', 'the', 'application', 'of', 'CRT', '(cardiac', 'resynchronization', 'therapy)', 'are', 'precisely', 'those', 'mentioned', 'at', 'the', 'beginning:', 'severe', 'ventricular', 'dysfunction,', 'asynchrony', 'demonstrated', 'by', 'the', 'presence', 'of', 'wide', 'QRS', 'in', 'the', 'ECG', '(usually', 'due', 'to', 'LBBB)', 'and', 'advanced', 'functional', 'class', '(III-IV)', 'despite', 'optimal', 'medical', 'treatment.']]
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[['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', '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', 'B-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', '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'], ['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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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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[['Coronary revascularization does not appear to be of much benefit in this patient at this time\n', 'Surgical coronary revascularization\n', 'Attack'], ['We are talking about a patient with heart failure with severe LV dysfunction (EF < 35%), LBBB (wide QRS), who is following optimal medical treatment and who remains in advanced functional class despite this\n', 'Coronary revascularization does not appear to be of much benefit in this patient at this time\n', 'Support'], ['firstly because mitral regurgitation is most likely the result of mitral annular dilatation\n', 'Nor does mitral valve replacement\n', 'Support'], ['secondly because we would need an echocardiographic assessment of the mitral valve to determine whether there is any alteration\n', 'Nor does mitral valve replacement\n', 'Support'], ['Nor does mitral valve replacement\n', 'Mitral valve replacement\n', 'Attack'], ['it is used in situations of cardiogenic shock, in post-AMI mechanical complications, as a bridge to cardiac Tx\n', 'Intra-aortic balloon counterpulsation implantation would not be indicated in this patient\n', 'Support'], ['Intra-aortic balloon counterpulsation implantation would not be indicated in this patient\n', 'Implantation of an aortic balloon pump\n', 'Attack'], ['The ventricular assist device would also not be indicated in this patient\n', 'Implantation of a ventricular assist device\n', 'Attack'], ['What would really benefit him of all the answers is number 5, the resynchronization device\n', 'Implantation of a cardiac resynchronization system\n', 'Support'], ['By achieving simultaneous stimulation of both ventricles, a mechanical synergy is achieved that improves cardiac function\n', 'What would really benefit him of all the answers is number 5, the resynchronization device\n', 'Support'], ['The indications for the application of CRT (cardiac resynchronization therapy) are precisely those mentioned at the beginning: severe ventricular dysfunction, asynchrony demonstrated by the presence of wide QRS in the ECG (usually due to LBBB) and advanced functional class (III-IV) despite optimal medical treatment\n', 'What would really benefit him of all the answers is number 5, the resynchronization device\n', 'Support']]
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141_135
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '2-year-old', 'boy,', 'his', 'personal', 'history', 'includes:', '3', 'episodes', 'of', 'acute', 'otitis', 'media,', '1', 'meningococcal', 'meningitis', 'and', '2', 'pneumonias', '(one', 'middle', 'lobe', 'and', 'one', 'left', 'upper', 'lobe).'], ['She', 'has', 'been', 'admitted', 'on', '3', 'occasions', 'for', 'thrombopenic', 'purpura', '(on', 'three', 'occasions', 'antiplatelet', 'antibodies', 'were', 'negative', 'and', 'bone', 'marrow', 'showed', 'normal', 'megakaryocytes).'], ['Several', 'males', 'of', 'the', 'maternal', 'family', 'had', 'died', 'in', 'childhood', 'due', 'to', 'infectious', 'processes.'], ['The', 'examination', 'showed', 'typical', 'lesions', 'of', 'atopic', 'dermatitis.'], ['The', 'immunological', 'study', 'showed', 'a', 'slight', 'decrease', 'in', 'T', 'lymphocyte', 'subpopulations;', 'elevated', 'IgA', 'and', 'IgE;', 'decreased', 'IgM', 'and', 'IgG', 'at', 'the', 'lower', 'limit', 'of', 'normal.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Wiskott-Aldrich', 'syndrome.'], ['2-', 'Hyper', 'IgE', 'syndrome.'], ['3-', 'Transient', 'hypogammaglobulinemia', 'of', 'infancy.'], ['4-', 'Severe', 'X-associated', 'combined', 'immunodeficiency.'], ['5-', 'Common', 'variable', 'immunodeficiency.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', '1.'], ['Wiskott-Aldrich', 'syndrome', 'associates', 'immunodeficiency,', 'thrombopenia', 'and', 'atopic', 'dermatitis', 'with', 'the', 'immunological', 'study', 'described', '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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Disease', 'I-Disease', 'I-Disease'], ['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']]
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[['The correct answer is 1\n', 'Wiskott-Aldrich syndrome\n', 'Support'], ['Wiskott-Aldrich syndrome associates immunodeficiency, thrombopenia and atopic dermatitis with the immunological study described in the statement\n', 'Wiskott-Aldrich syndrome\n', 'Support'], ['She has been admitted on 3 occasions for thrombopenic purpura (on three occasions antiplatelet antibodies were negative and bone marrow showed normal megakaryocytes)\n', 'Wiskott-Aldrich syndrome\n', 'Support'], ['The examination showed typical lesions of atopic dermatitis\n', 'Wiskott-Aldrich syndrome\n', 'Support'], ['The immunological study showed a slight decrease in T lymphocyte subpopulations; elevated IgA and IgE; decreased IgM and IgG at the lower limit of normal.\n', 'Wiskott-Aldrich syndrome\n', 'Support']]
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317_139
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'woman', 'with', 'a', 'history', 'of', 'anorexia,', 'weight', 'loss,', 'muscle', 'and', 'proximal', 'joint', 'discomfort', 'and', 'pain', 'in', 'the', 'temporomandibular', 'region', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'unilateral', 'vision', 'loss', '(hand', 'movement),', 'sudden', 'and', 'painless', 'onset', '(afferent', 'pupillary', 'defect).'], ['What', 'test', 'would', 'you', 'order', 'first', 'for', 'diagnostic', 'purposes?'], ['1-', 'Lumbar', 'puncture.'], ['2-', 'C', 'Reactive', 'Protein.'], ['3-', 'Magnetic', 'resonance', 'angiography.'], ['4-', 'Carotid', 'ultrasound.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'possibly', 'a', 'temporal', 'arteritis,', 'the', 'clinical', 'picture', 'and', 'a', 'CBC', 'with', 'increased', 'reactants', 'are', 'enough', 'to', 'confirm', 'the', 'suspicion.'], ['Then', 'an', 'ocular', 'evaluation', 'should', 'be', 'done', 'to', 'rule', 'out', 'AIN,', 'urgent', 'treatment', 'should', 'be', 'instituted', '(if', 'there', 'is', 'AIN,', '3', 'boluses', 'of', 'methylprednisolone', '1', 'g,', 'if', 'there', 'is', 'not,', 'prednisone', 'mg/kg)', 'and', 'biopsy', 'should', 'be', 'evaluated.']]
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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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 70-year-old woman with a history of anorexia, weight loss, muscle and proximal joint discomfort and pain in the temporomandibular region comes to the emergency department for unilateral vision loss (hand movement), sudden and painless onset (afferent pupillary defect)\n', 'It is possibly a temporal arteritis, the clinical picture and a CBC with increased reactants are enough to confirm the suspicion\n', 'Support'], ['It is possibly a temporal arteritis, the clinical picture and a CBC with increased reactants are enough to confirm the suspicion\n', 'C Reactive Protein\n', 'Support']]
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550_129
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[]
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110_152
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['Patient', '76', 'years', 'old,', 'parity', '3-0-3-1,', 'with', 'menopause', 'at', 'age', '52.'], ['She', 'reports', 'that', 'for', 'at', 'least', '4-5', 'years', 'she', 'has', 'had', 'vulvar', 'pruritus', 'of', 'variable', 'intensity', 'which', 'has', 'been', 'treated', 'sometimes', 'with', 'self-medication', 'and', 'other', 'times', 'on', 'the', 'advice', 'of', 'her', 'general', 'practitioner', 'with', 'topical', 'preparations', '(creams', 'and', 'washes).'], ['The', 'pruritus', 'has', 'evolved', 'intermittently,', 'but', 'for', 'the', 'last', '3-4', 'months', 'she', 'has', 'also', 'noticed', 'a', 'small', 'lump', 'on', 'the', 'left', 'labium', 'majus', 'of', 'the', 'vulva,', 'which', 'has', 'been', 'leaking', 'serohaematically', 'on', 'rubbing', 'for', 'a', 'few', 'days;', 'she', 'therefore', 'consulted', 'a', 'gynecologist.'], ['On', 'questioning,', 'she', 'reports', 'occasional', 'dysuria', 'and', 'her', 'general', 'condition', 'is', 'good.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'in', 'this', 'patient?'], ['1-', 'Genital', 'herpes.'], ['2-', "Paget's", 'disease', 'of', 'the', 'vulva.'], ['3-', 'Urethral', 'caruncle.'], ['4-', 'Chronic', 'granuloma', 'of', 'the', 'vulva.'], ['5-', 'Vulvar', 'squamous', 'cell', 'carcinoma.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'correct', 'answer', 'is', '5.'], ['Vulvar', 'carcinoma', 'is', 'characterized', 'by', 'chronic', 'vulvar', 'itching', 'resistant', 'to', 'multiple', 'treatments,', 'appearance', 'of', 'lumpiness', 'or', 'ulceration,', 'dysuria', 'and', 'urinary', 'urgency,', 'and', 'late', 'pain', 'and', 'bleeding.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', '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', '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', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', '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 5\n', 'Vulvar squamous cell carcinoma\n', 'Support'], ['Vulvar carcinoma is characterized by chronic vulvar itching resistant to multiple treatments, appearance of lumpiness or ulceration, dysuria and urinary urgency, and late pain and bleeding\n', 'Vulvar squamous cell carcinoma\n', 'Support'], ['she reports occasional dysuria and her general condition is good\n', 'Vulvar squamous cell carcinoma\n', 'Support'], ['She reports that for at least 4-5 years she has had vulvar pruritus of variable intensity which has been treated sometimes with self-medication and other times on the advice of her general practitioner with topical preparations (creams and washes)\n', 'Vulvar squamous cell carcinoma\n', 'Support'], ['The pruritus has evolved intermittently, but for the last 3-4 months she has also noticed a small lump on the left labium majus of the vulva, which has been leaking serohaematically on rubbing for a few days; she therefore consulted a gynecologist.\n', 'Vulvar squamous cell carcinoma\n', 'Support']]
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419_77
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[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'abdominal', 'pain', 'starting', 'in', 'the', 'epigastrium', 'and', 'radiating', 'later', 'to', 'the', 'left', 'iliac', 'fossa.'], ['An', 'abdominal', 'CT', 'scan', 'is', 'performed,', 'showing', 'inflammation', 'of', 'the', 'sigmoid', 'walls', 'and', 'a', '2', 'cm', 'mesenteric', 'abscess.'], ['The', 'treatment', 'of', 'choice', 'is:'], ['1-', 'Admission', 'to', 'the', 'ward', 'with', 'absolute', 'diet', 'and', 'broad-spectrum', 'antibiotic', 'treatment.'], ['2-', 'Discharge', 'colostomy.'], ['3-', 'Drainage', 'by', 'laparoscopic', 'surgery.'], ['4-', 'Urgent', 'surgery', 'with', 'sigmoidectomy', 'and', 'colorectal', 'anastomosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['In', 'this', 'question', 'we', 'are', 'presented', 'with', 'a', 'clinical', 'picture', 'whose', 'manifestations', 'are', 'compatible', 'with', 'acute', 'diverticulitis,', 'already', 'asked', 'on', 'numerous', 'occasions', 'previously.'], ['A', 'case', 'of', 'acute', 'diverticulitis', 'complicated', 'with', 'small', 'mesenteric', 'abscess', '(<', '2-3', 'cm)', 'is', 'presented.'], ['Abscesses', 'should', 'be', 'drained', 'by', 'CT-guided', 'percutaneous', 'puncture,', 'since', 'the', 'intra-abdominal', 'approach', 'can', 'spread', 'the', 'contents', 'into', 'the', 'abdominal', 'cavity.'], ['However,', 'in', 'small', 'abscesses', 'with', 'Hinchey', 'grade', 'I', 'divertciulitis,', 'in', 'patients', 'without', 'great', 'deterioration', 'of', 'the', 'general', 'condition', 'as', 'in', 'the', 'proposed', 'case,', 'they', 'can', 'be', 'managed', 'by', 'conservative', 'treatment', 'with', 'intravenous', 'antiobiotic', 'therapy', 'and', 'absolute', 'diet,', 'therefore', 'the', 'correct', 'option', 'is', '1.'], ['The', 'urgent', 'surgical', 'approach', 'should', 'be', 'reserved', 'for', 'cases', 'that', 'present', 'peritonitis', '(grade', 'III,', 'IV)', 'by', 'resection', 'of', 'the', 'affected', 'segment', 'and', 'primary', 'anastomosis', 'in', 'stable', 'patients', 'or', 'carry', 'out', 'the', 'Hartamn', 'intervention', 'that', 'includes', 'resection', 'with', 'terminal', 'colostomy', 'and', 'closure', 'of', 'the', 'distal', 'rectal', 'stump', 'performing', 'anastomosis', 'in', 'a', 'second', 'surgical', 'time.']]
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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', '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'], ['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', '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', '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', 'B-Marker', '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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A case of acute diverticulitis complicated with small mesenteric abscess (< 2-3 cm) is presented\n', 'In this question we are presented with a clinical picture whose manifestations are compatible with acute diverticulitis\n', 'Support'], ['the intra-abdominal approach can spread the contents into the abdominal cavity\n', 'Abscesses should be drained by CT-guided percutaneous puncture\n', 'Support'], ['However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n', 'Abscesses should be drained by CT-guided percutaneous puncture\n', 'Attack'], ['However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n', 'Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n', 'Support'], ['A case of acute diverticulitis complicated with small mesenteric abscess (< 2-3 cm) is presented\n', 'However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n', 'Support'], ['The urgent surgical approach should be reserved for cases that present peritonitis (grade III, IV) by resection of the affected segment and primary anastomosis in stable patients or carry out the Hartamn intervention that includes resection with terminal colostomy and closure of the distal rectal stump performing anastomosis in a second surgical time\n', 'Urgent surgery with sigmoidectomy and colorectal anastomosis\n', 'Attack'], ['The urgent surgical approach should be reserved for cases that present peritonitis (grade III, IV) by resection of the affected segment and primary anastomosis in stable patients or carry out the Hartamn intervention that includes resection with terminal colostomy and closure of the distal rectal stump performing anastomosis in a second surgical time\n', 'Drainage by laparoscopic surgery\n', 'Attack'], ['The urgent surgical approach should be reserved for cases that present peritonitis (grade III, IV) by resection of the affected segment and primary anastomosis in stable patients or carry out the Hartamn intervention that includes resection with terminal colostomy and closure of the distal rectal stump performing anastomosis in a second surgical time\n', 'Discharge colostomy\n', 'Attack'], ['therefore the correct option is 1\n', 'Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n', 'Support'], ['However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n', 'therefore the correct option is 1\n', 'Support']]
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37_227
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'consults', 'for', 'acute', 'vision', 'loss', 'of', 'the', 'left', 'eye.'], ['In', 'the', 'last', '3', 'weeks', 'she', 'has', 'presented', 'with', 'fever,', 'pain', 'in', 'the', 'shoulders,', 'neck', 'and', 'hips,', 'and', 'moderate', 'headache.'], ['Funduscopy', 'shows', 'a', 'pale', 'and', 'edematous', 'optic', 'disc.'], ['Mobilization', 'of', 'the', 'shoulders', 'and', 'hips', 'produces', 'pain.'], ['There', 'are', 'no', 'alterations', 'on', 'palpation', 'of', 'the', 'temporal', 'arteries.'], ['Laboratory', 'data:', 'hemoglobin', '9.7', 'g/dL', 'ferritin', '450', 'ng/mL', 'erythrocyte', 'sedimentation', 'rate', '115', 'mm/h.'], ['What', 'is', 'the', 'most', 'appropriate', 'immediate', 'action', 'in', 'this', 'patient?'], ['1-', 'Request', 'a', 'Doppler', 'ultrasound', 'of', 'temporal', 'arteries.'], ['2-', 'Start', 'treatment', 'with', 'prednisone', '60mg', 'per', 'day', 'and', 'aspirin', '100', 'mg', 'per', 'day.'], ['3-', 'Start', 'treatment', 'with', 'prednisone', '10', 'mg', 'per', 'day.'], ['4-', 'Request', 'a', 'temporal', 'artery', 'biopsy.'], ['5-', 'Request', 'a', 'brain', 'magnetic', 'resonance', 'imaging.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'clinical', 'presentation', 'is', 'strongly', 'suggestive', 'of', 'giant', 'cell', 'arteritis', '(GCA),', 'with', 'febrile', 'fever,', 'shoulder', 'girdle', 'and', 'pelvic', 'pain,', 'and', 'headache.'], ['Age', 'and', 'sex', 'also', 'point', 'to', 'this', 'possibility.'], ['Abrupt', 'unilateral', 'visual', 'loss', 'with', 'pale', 'papillary', 'edema', 'is', 'highly', 'indicative', 'of', 'arteritic', 'ischemic', 'optic', 'neuropathy', 'due', 'to', 'GCA.'], ['The', 'ESR', 'is', 'elevated,', 'which', 'further', 'clarifies', 'the', 'diagnosis.'], ['We', 'have', 'to', 'quickly', 'start', 'corticosteroid', 'treatment.'], ['We', 'can', 'already', 'rule', 'out', '1', 'and', '5', 'because', 'they', 'do', 'not', 'contribute', 'anything.'], ['4', 'could', 'make', 'us', 'doubt,', 'and', 'it', 'is', 'true', 'that', 'we', 'will', 'have', 'to', 'ask', 'for', 'a', 'temporal', 'artery', 'biopsy,', 'but', 'that', 'is', 'not', 'immediate:', 'the', 'statement', 'makes', 'it', 'very', 'clear', 'that', 'we', 'have', 'to', 'act', 'immediately.'], ['The', 'current', 'trend', 'is', 'to', 'use', 'megadoses', 'of', 'intravenous', 'corticosteroids,', 'and', 'although', 'aspirin', 'has', 'traditionally', 'been', 'proposed', 'to', 'reduce', 'ischemic', 'events,', 'the', 'evidence', 'currently', 'indicates', 'that', 'antiplatelet', 'agents', 'do', 'not', 'contribute', 'much.'], ['An', 'oral', 'corticosteroid', 'dose', 'of', 'around', '1mg/kg', 'would', 'also', 'be', 'acceptable.'], ['Therefore,', 'if', 'we', 'rule', 'out', '3', 'because', 'the', 'dose', 'is', 'too', 'low,', 'we', 'would', 'have', 'to', 'stay', 'with', '2.'], ['With', 'reservations,', 'since', 'aspirin', 'has', 'a', 'rather', 'dubious', 'role,', 'and', 'the', 'corticosteroid', 'dose', 'remains', 'ambiguous', '(we', 'do', 'not', 'know', 'how', 'much', 'the', 'patient', 'weighs).'], ['Of', 'all', 'the', 'ophthalmology', 'questions,', 'this', 'is', 'perhaps', 'the', 'one', 'most', 'likely', 'to', 'be', 'contested.']]
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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', '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', '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'], ['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', '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', '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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', 'B-Marker', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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'], ['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'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['Age and sex also point to this possibility\n', 'The clinical presentation is strongly suggestive of giant cell arteritis (GCA)\n', 'Support'], ['febrile fever, shoulder girdle and pelvic pain, and headache\n', 'The clinical presentation is strongly suggestive of giant cell arteritis (GCA)\n', 'Support'], ['The ESR is elevated\n', 'Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA\n', 'Support'], ['Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA\n', 'We have to quickly start corticosteroid treatment.\n', 'Support'], ['The clinical presentation is strongly suggestive of giant cell arteritis (GCA)\n', 'We have to quickly start corticosteroid treatment.\n', 'Support'], ['they do not contribute anything\n', 'We can already rule out 1 and 5\n', 'Support'], ['We can already rule out 1 and 5\n', 'Request a Doppler ultrasound of temporal arteries\n', 'Attack'], ['We can already rule out 1 and 5\n', 'Request a brain magnetic resonance imaging\n', 'Attack'], ['if we rule out 3 because the dose is too low, we would have to stay with 2.\n', 'Start treatment with prednisone 10 mg per day\n', 'Attack'], ['if we rule out 3 because the dose is too low, we would have to stay with 2.\n', 'Start treatment with prednisone 60mg per day and aspirin 100 mg per day\n', 'Support'], ['4 could make us doubt, and it is true that we will have to ask for a temporal artery biopsy, but that is not immediate: the statement makes it very clear that we have to act immediately\n', 'Request a temporal artery biopsy\n', 'Attack'], ['With reservations, since aspirin has a rather dubious role\n', 'if we rule out 3 because the dose is too low, we would have to stay with 2.\n', 'Attack'], ['The current trend is to use megadoses of intravenous corticosteroids\n', 'if we rule out 3 because the dose is too low, we would have to stay with 2.\n', 'Support'], ['The ESR is elevated\n', 'which further clarifies the diagnosis\n', 'Support'], ['which further clarifies the diagnosis\n', 'Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA\n', 'Support'], ['although aspirin has traditionally been proposed to reduce ischemic events, the evidence currently indicates that antiplatelet agents do not contribute much\n', 'if we rule out 3 because the dose is too low, we would have to stay with 2.\n', 'Support'], ['corticosteroid dose remains ambiguous (we do not know how much the patient weighs)\n', 'if we rule out 3 because the dose is too low, we would have to stay with 2.\n', 'Attack']]
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532_67
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[]
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272_69
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[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'with', 'extensive', 'ulcerative', 'colitis', 'of', '15', 'years', 'of', 'evolution', 'and', 'in', 'clinical', 'remission', 'for', 'the', 'last', '3', 'years,', 'comes', 'to', 'our', 'office', 'to', 'be', 'informed', 'about', 'the', 'risk', 'of', 'colorectal', 'cancer', 'and', 'about', 'the', 'possibility', 'of', 'participating', 'in', 'prevention', 'programs.'], ['It', 'is', 'correct', 'to', 'inform', 'him', 'that:'], ['1-', 'Ulcerative', 'colitis', 'is', 'only', 'associated', 'with', 'an', 'increased', 'risk', 'of', 'colorectal', 'cancer', 'in', 'smokers.'], ['2-', 'In', 'her', 'case,', 'given', 'that', 'she', 'is', 'in', 'long-term', 'remission,', 'the', 'screening', 'advised', 'to', 'the', 'general', 'population', 'is', 'considered', 'appropriate.'], ['3-', 'In', 'cases', 'such', 'as', 'yours,', 'it', 'is', 'considered', 'appropriate', 'to', 'undergo', 'periodic', 'colonoscopies', 'with', 'multiple', 'biopsies', 'staggered', 'along', 'the', 'entire', 'colon.'], ['4-', 'In', 'cases', 'such', 'as', 'yours,', 'screening', 'with', 'periodic', 'fecal', 'occult', 'blood', 'tests', 'is', 'considered', 'appropriate,', 'but', 'with', 'a', 'higher', 'frequency', 'than', 'that', 'used', 'in', 'screening', 'the', 'general', 'population.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Patients', 'with', 'inflammatory', 'bowel', 'disease', '(IBD)', 'have', 'an', 'increased', 'risk', 'of', 'colorectal', 'cancer,', 'whether', 'or', 'not', 'they', 'are', 'smokers.'], ['It', 'is', 'recommended', 'to', 'start', 'screening', '8-10', 'years', 'after', 'diagnosis', 'of', 'IBD', '(or', 'earlier', 'if', 'primary', 'sclerosing', 'cholangitis', 'or', 'other', 'events', 'occur', 'during', 'this', 'interval).'], ['The', 'recommended', 'techniques', 'are', 'colonoscopy', 'with', 'random', 'biopsies', '(answer', '3)', 'and', 'pancolonic', 'chromoendoscopy', 'with', 'staining,', 'which', 'is', 'currently', 'the', 'gold', 'standard', 'because', 'it', 'detects', 'dysplasia', 'better,', 'although', 'it', 'requires', 'more', 'technical', 'experience.']]
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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', '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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A 60-year-old man with extensive ulcerative colitis of 15 years of evolution and in clinical remission for the last 3 years, comes to our office to be informed about the risk of colorectal cancer and about the possibility of participating in prevention programs\n', 'Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers\n', 'Support'], ['Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers\n', 'It is recommended to start screening 8-10 years after diagnosis of IBD (or earlier if primary sclerosing cholangitis or other events occur during this interval)\n', 'Support'], ['It is recommended to start screening 8-10 years after diagnosis of IBD (or earlier if primary sclerosing cholangitis or other events occur during this interval)\n', 'The recommended techniques are colonoscopy with random biopsies (answer 3) and pancolonic chromoendoscopy with staining, which is currently the gold standard\n', 'Support'], ['it detects dysplasia better, although it requires more technical experience\n', 'The recommended techniques are colonoscopy with random biopsies (answer 3) and pancolonic chromoendoscopy with staining, which is currently the gold standard\n', 'Support'], ['The recommended techniques are colonoscopy with random biopsies (answer 3) and pancolonic chromoendoscopy with staining, which is currently the gold standard\n', 'In cases such as yours, it is considered appropriate to undergo periodic colonoscopies with multiple biopsies staggered along the entire colon\n', 'Support'], ['Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers\n', 'Ulcerative colitis is only associated with an increased risk of colorectal cancer in smokers\n', 'Attack']]
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428_61
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '62-year-old', 'man', 'comes', 'to', 'the', 'hospital', 'emergency', 'department', 'with', 'a', 'fever', 'of', '38.3″C', 'and', 'chills.'], ['He', 'is', 'tachycardic', 'and', 'tachypneic.'], ['Blood', 'tests:', 'leukocytosis', 'with', 'left', 'shift.'], ['Blood', 'pressure', 'is', '90/60', 'mmHg.'], ['No', 'murmurs', 'are', 'heard', 'on', 'cardiac', 'auscultation', 'and', 'chest', 'X-ray', 'rules', 'out', 'pneumonia.'], ['As', 'history', 'of', 'interest', 'she', 'refers', 'repeated', 'urinary', 'tract', 'infections.'], ['A', 'week', 'ago', 'the', 'primary', 'care', 'physician', 'prescribed', 'cefuroxime,', 'a', 'drug', 'he', 'is', 'currently', 'taking.'], ['Two', 'blood', 'cultures', 'were', 'taken', 'and', 'urine', 'was', 'sent', 'for', 'sediment', 'examination', 'and', 'microbiological', 'culture.'], ['The', 'sediment', 'was', 'pathological,', 'with', 'intense', 'pyuria,', 'but', 'negative', 'nitrites.'], ['After', '24', 'hours,', 'the', 'microbiology', 'laboratory', 'reported', 'that', 'both', 'the', 'urine', 'and', 'the', 'blood', 'cultures', 'were', 'positive,', 'and', 'the', 'results', 'showed', 'gram-positive', 'cocci', 'grouped', 'in', 'chains,', 'pending', 'identification', 'and', 'antibiogram.'], ['Pending', 'the', 'definitive', 'result,', 'what', 'would', 'you', 'recommend?'], ['1-', 'Continue', 'with', 'cefuroxime', 'while', 'awaiting', 'the', 'definitive', 'result,', 'since', 'the', 'patient', 'has', 'undergone', 'multiple', 'treatments', 'and', 'we', 'should', 'not', 'make', 'a', 'mistake', 'in', 'his', 'current', 'treatment.'], ['2-', 'Change', 'to', 'ertapenem,', 'considering', 'the', 'possibility', 'of', 'multiresistant', 'microorganisms.'], ['3-', 'Switch', 'to', 'a', 'broad-spectrum', 'antimicrobial', 'treatment', 'that', 'covers', 'Enterococcus', 'spp.'], ['4-', 'Switch', 'to', 'broad-spectrum', 'antimicrobial', 'therapy', 'containing', 'imipenem,', 'considering', 'the', 'possibility', 'of', 'Staphylococcus', 'aureus,', 'since', 'our', 'hospital', 'has', 'a', 'high', 'incidence', 'of', 'methicillin-resistant', 'S.', 'aureus', '(MRSA).'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['With', 'the', 'urine', 'nitrite', 'test', 'we', 'detect', 'the', 'presence', 'of', 'nitrites', 'in', 'the', 'urine.'], ['These', 'appear', 'due', 'to', 'the', 'presence', 'in', 'the', 'urine', 'of', 'a', 'high', 'concentration', 'of', 'bacteria', 'possessing', 'the', 'enzyme', 'nitrate', 'reductase,', 'which', 'is', 'capable', 'of', 'reducing', 'the', 'nitrates', 'present', 'in', 'the', 'urine', 'to', 'nitrites.'], ['This', 'enzyme', 'is', 'active', 'in', 'most', 'of', 'the', 'bacteria', 'that', 'most', 'frequently', 'cause', 'urinary', 'tract', 'infection,', 'such', 'as', 'many', 'Gram-negative', 'bacilli.'], ['Other', 'microorganisms,', 'relatively', 'frequent', 'causes', 'of', 'urinary', 'tract', 'infection,', 'do', 'not', 'possess', 'this', 'enzyme', 'and', 'do', 'not', 'reduce', 'nitrates,', 'such', 'as', 'enterococci,', 'staphylococci', 'and', 'yeasts.'], ['As', 'the', 'Gram', 'stain', 'indicates', 'that', 'the', 'bacteria', 'are', 'grouped', 'in', 'chains,', 'as', 'this', 'is', 'typical', 'of', 'enterococcus,', 'we', 'suggest', 'the', 'need', 'to', 'cover', 'this', 'group', 'of', 'bacteria', 'with', 'antibiotic', 'treatment.'], ['Staphylococci', 'are', 'typically', 'seen', 'on', 'Gram', 'stain', 'as', 'Gram-positive', 'cocci', 'forming', 'clusters', 'and', 'yeasts,', 'although', 'with', 'the', 'same', 'staining,', 'have', 'a', 'different', 'typical', 'morphology', 'than', 'Gram-positive', 'cocci.']]
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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'], ['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'], ['B-Premise', '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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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'], ['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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', 'B-Claim', '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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[['These appear due to the presence in the urine of a high concentration of bacteria possessing the enzyme nitrate reductase, which is capable of reducing the nitrates present in the urine to nitrites\n', 'This enzyme is active in most of the bacteria that most frequently cause urinary tract infection, such as many Gram-negative bacilli\n', 'Support'], ['This enzyme is active in most of the bacteria that most frequently cause urinary tract infection, such as many Gram-negative bacilli\n', 'Other microorganisms, relatively frequent causes of urinary tract infection, do not possess this enzyme and do not reduce nitrates, such as enterococci, staphylococci and yeasts\n', 'Support'], ['Other microorganisms, relatively frequent causes of urinary tract infection, do not possess this enzyme and do not reduce nitrates, such as enterococci, staphylococci and yeasts\n', 'As the Gram stain indicates that the bacteria are grouped in chains, as this is typical of enterococcus, we suggest the need to cover this group of bacteria with antibiotic treatment\n', 'Support'], ['As the Gram stain indicates that the bacteria are grouped in chains, as this is typical of enterococcus, we suggest the need to cover this group of bacteria with antibiotic treatment\n', 'Switch to a broad-spectrum antimicrobial treatment that covers Enterococcus spp\n', 'Support']]
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393_224
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[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'presents', 'with', 'a', 'long', 'history', 'of', 'multiple', 'physical', 'symptoms:', 'memory', 'loss,', 'headache,', 'dizziness,', 'vomiting,', 'genital', 'pain,', 'limb', 'pain,', 'abdominal', 'distention,', 'and', 'menstrual', 'irregularities.'], ['The', 'various', 'medical', 'examinations', 'have', 'ruled', 'out', 'any', 'medical', 'illness.'], ['Which', 'of', 'the', 'following', 'is', 'most', 'likely', 'to', 'be', 'the', 'case?'], ['1-', 'Conversive', 'disorder.'], ['2-', 'Hypochondriac', 'disorder.'], ['3-', 'Somatization', 'disorder.'], ['4-', 'Dissociative', 'disorder.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['According', 'to', 'ICD-10', 'the', 'criteria', 'for', 'diagnosing', 'Somatization', 'Disorder', '(F45.0)', 'are:', 'A.'], ['History', 'of', 'multiple', 'physical', 'symptoms,', 'which', 'begins', 'before', 'age', '30,', 'persists', 'for', 'several', 'years,', 'and', 'compels', 'seeking', 'medical', 'attention', 'or', 'causes', 'significant', 'impairment', 'socially,', 'occupationally,', 'or', 'in', 'other', 'important', 'areas', 'of', 'the', "individual's", 'activity.'], ['B.'], ['All', 'of', 'the', 'following', 'criteria', 'must', 'be', 'met,', 'and', 'each', 'symptom', 'can', 'occur', 'at', 'any', 'time', 'during', 'the', 'disturbance:', '1.'], ['Four', 'painful', 'symptoms:', 'history', 'of', 'pain', 'related', 'to', 'at', 'least', 'four', 'areas', 'of', 'the', 'body', 'or', 'four', 'functions', '(e.g.,', 'head,', 'abdomen,', 'back,', 'joints,', 'extremities,', 'chest,', 'rectum;', 'during', 'menstruation,', 'sexual', 'intercourse,', 'or', 'urination).'], ['Two', 'gastrointestinal', 'symptoms:', 'history', 'of', 'at', 'least', 'two', 'gastrointestinal', 'symptoms', 'other', 'than', 'pain', '(e.g.,', 'nausea,', 'bloating,', 'vomiting', '[not', 'during', 'pregnancy],', 'diarrhea,', 'or', 'intolerance', 'to', 'different', 'foods).'], ['3.'], ['A', 'sexual', 'symptom:', 'history', 'of', 'at', 'least', 'one', 'sexual', 'or', 'reproductive', 'symptom', 'other', 'than', 'pain', '(e.g.,', 'sexual', 'indifference,', 'erectile', 'or', 'ejaculatory', 'dysfunction,', 'irregular', 'menses,', 'excessive', 'menstrual', 'leakage,', 'vomiting', 'during', 'pregnancy).'], ['4.'], ['A', 'pseudoneurological', 'symptom:', 'History', 'of', 'at', 'least', 'one', 'symptom', 'or', 'deficit', 'suggestive', 'of', 'a', 'neurological', 'disorder', 'not', 'limited', 'to', 'pain', '(conversion', 'symptoms', 'of', 'the', 'type', 'of', 'impaired', 'psychomotor', 'coordination', 'or', 'balance,', 'localized', 'muscle', 'paralysis', 'or', 'weakness,', 'difficulty', 'swallowing,', 'lump-in-throat', 'sensation,', 'aphonia,', 'urinary', 'retention,', 'hallucinations,', 'loss', 'of', 'tactile', 'and', 'painful', 'sensation,', 'diplopia,', 'blindness,', 'deafness,', 'seizures;', 'dissociative', 'symptoms', 'such', 'as', 'amnesia;', 'or', 'loss', 'of', 'consciousness', 'other', 'than', 'fainting).'], ['C.'], ['Either', 'of', 'the', 'following', 'two', 'characteristics:', '1.'], ['Upon', 'adequate', 'examination,', 'none', 'of', 'the', 'symptoms', 'in', 'Criterion', 'B', 'can', 'be', 'explained', 'by', 'the', 'presence', 'of', 'a', 'known', 'medical', 'illness', 'or', 'by', 'the', 'direct', 'effects', 'of', 'a', 'substance', '(e.g.,', 'drugs', 'or', 'medication).'], ['2.'], ['If', 'a', 'medical', 'illness', 'is', 'present,', 'the', 'physical', 'symptoms', 'or', 'social', 'or', 'occupational', 'impairment', 'are', 'excessive', 'compared', 'to', 'what', 'would', 'be', 'expected', 'from', 'the', 'history,', 'physical', 'examination,', 'or', 'laboratory', 'findings.'], ['D.'], ['The', 'symptoms', 'are', 'not', 'intentionally', 'produced', 'and', 'are', 'not', 'simulated', '(unlike', 'in', 'factitious', 'disorder', 'and', 'simulation).'], ['Everything', 'fits', 'with', 'what', 'is', 'described', 'in', 'the', 'statement.'], ['Conversive', 'or', 'dissociative', 'disorder', 'is', 'ruled', 'out', 'because', 'these', 'are', 'usually', 'related', 'to', 'psychological', 'factors,', 'associated', 'with', 'the', 'symptom', 'or', 'deficit', '(not', 'deliberate).'], ['The', 'onset', 'or', 'exacerbation', 'of', 'the', 'condition', 'is', 'preceded', 'by', 'conflicts', 'or', 'other', 'triggers,', 'which', 'is', 'not', 'mentioned', 'in', 'the', 'statement.'], ['Neither', 'would', 'it', 'be', 'a', 'hypochondriacal', 'disorder', 'because', 'this', 'implies', 'a', 'preoccupation', 'and', 'fear', 'of', 'having,', 'or', 'the', 'conviction', 'of', 'having,', 'a', 'serious', 'illness', 'based', 'on', 'the', 'personal', 'interpretation', 'of', 'somatic', 'symptoms.'], ['But', 'it', 'does', 'not', 'involve', 'physical', 'signs', 'or', 'symptoms.']]
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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'], ['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'], ['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', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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', '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'], ['B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', "History of multiple physical symptoms, which begins before age 30, persists for several years, and compels seeking medical attention or causes significant impairment socially, occupationally, or in other important areas of the individual's activity\n", 'Support'], ['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', 'Four painful symptoms: history of pain related to at least four areas of the body or four functions (e.g., head, abdomen, back, joints, extremities, chest, rectum; during menstruation, sexual intercourse, or urination)\n', 'Support'], ['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', 'Two gastrointestinal symptoms: history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting [not during pregnancy], diarrhea, or intolerance to different foods)\n', 'Support'], ['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', 'A sexual symptom: history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual leakage, vomiting during pregnancy)\n', 'Support'], ['Everything fits with what is described in the statement\n', 'Somatization disorder\n', 'Support'], ['According to ICD-10 the criteria for diagnosing Somatization Disorder (F45.0)\n', 'Somatization disorder\n', 'Support'], ['Conversive or dissociative disorder is ruled out\n', 'Conversive disorder\n', 'Attack'], ['Conversive or dissociative disorder is ruled out\n', 'Dissociative disorder\n', 'Attack'], ['these are usually related to psychological factors, associated with the symptom or deficit (not deliberate)\n', 'Conversive or dissociative disorder is ruled out\n', 'Support'], ['The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement\n', 'Conversive or dissociative disorder is ruled out\n', 'Support'], ['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', 'The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement\n', 'Support'], ['Neither would it be a hypochondriacal disorder\n', 'Hypochondriac disorder\n', 'Attack'], ['this implies a preoccupation and fear of having, or the conviction of having, a serious illness based on the personal interpretation of somatic symptoms\n', 'Neither would it be a hypochondriacal disorder\n', 'Support'], ['But it does not involve physical signs or symptoms\n', 'Neither would it be a hypochondriacal disorder\n', 'Support'], ['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', 'this implies a preoccupation and fear of having, or the conviction of having, a serious illness based on the personal interpretation of somatic symptoms\n', 'Attack'], ['A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n', 'But it does not involve physical signs or symptoms\n', 'Attack']]
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124_46
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[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '58-year-old', 'woman', 'comes', 'for', 'a', 'follow-up', 'visit', 'for', 'diabetes', 'mellitus', 'and', 'hypertension.'], ['She', 'feels', 'well', 'but', 'states', 'that', 'she', 'has', 'stopped', 'taking', 'verapamil', 'because', 'of', 'constipation.'], ['She', 'presents', 'with', 'intolerance', 'to', 'ACE', 'inhibitors', 'due', 'to', 'coughing.'], ['On', 'examination,', 'blood', 'pressure', 'is', '156/92', 'mm', 'Hg.'], ['CBC', 'includes', 'a', 'creatinine', 'of', '1.6', 'mg/dL,', '24-hour', 'urine', 'protein', 'excretion', 'of', '1.5', 'g/day,', 'and', 'a', 'creatinine', 'clearance', 'of', '45', 'ml/min.'], ['On', 'this', 'basis,', 'what', 'is', 'the', 'most', 'effective', 'treatment', 'to', 'slow', 'the', 'progression', 'of', 'the', "patient's", 'type', '2', 'diabetic', 'nephropathy?'], ['1-', 'Angiotensin', 'converting', 'enzyme', 'inhibitor.'], ['2-', 'Angiotensin', 'receptor', 'blocker.'], ['3-', 'Calcium', 'antagonist.'], ['4-', 'Alpha-blocker.'], ['5-', 'Beta-blocker.'], ['CORRECT', 'ANSWER:', '2'], ['This', 'question', 'is', 'typical', 'and', 'quite', 'easy.'], ['The', 'antihypertensive', 'drugs', 'that', 'have', 'been', 'shown', 'to', 'slow', 'the', 'progression', 'of', 'diabetic', 'nephropathy', 'are', 'the', 'ACE', 'inhibitors', 'and', 'ARAIIs.'], ['Specifically,', 'angiotensin', 'II', 'receptor', 'blockers', 'have', 'demonstrated', 'their', 'efficacy', 'in', 'this', 'field', 'for', 'type', '2', 'DM,', 'which', 'together', 'with', 'the', 'side', 'effects', 'that', 'IECAS', 'produce', 'in', 'the', 'patient', 'makes', 'an', 'ARAII', 'the', 'drug', 'of', 'choice.'], ['This', 'does', 'not', 'seem', 'to', 'me', 'to', 'be', 'an', 'open', 'question', '(without', 'going', 'into', 'pharmacoeconomic', 'issues,', 'of', 'course...).']]
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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'], ['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', '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-Disease', 'I-Disease', 'I-Disease', 'I-Disease'], ['O', 'B-Treatment', 'I-Treatment', 'I-Treatment', 'I-Treatment'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['Specifically, angiotensin II receptor blockers have demonstrated their efficacy in this field for type 2 DM, which together with the side effects that IECAS produce in the patient makes an ARAII the drug of choice\n', 'Angiotensin receptor blocker\n', 'Support'], ['She presents with intolerance to ACE inhibitors due to coughing\n', 'Specifically, angiotensin II receptor blockers have demonstrated their efficacy in this field for type 2 DM, which together with the side effects that IECAS produce in the patient makes an ARAII the drug of choice\n', 'Support']]
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405_31
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[['QUESTION', 'TYPE:', 'ONCOLOGY', '(ECTOPIC)'], ['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', 'embryonic', '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:', '2'], ['Teratoma', 'is', 'the', 'most', 'frequent', 'germinal', 'tumor.'], ['It', 'presents', 'differentiation', 'in', 'elements', 'of', 'the', 'three', 'embryonic', 'layers:', 'endoderm,', 'mesoderm', 'and', 'ectoderm.'], ['Macroscopically', 'they', 'can', 'be', 'cystic', 'or', 'solid,', 'and', 'histologically', 'the', 'tissues', 'composing', 'the', 'tumor', 'can', 'be', 'mature', '(well', 'differentiated,', 'like', 'adult', 'tissues)', 'or', 'immature', '(like', 'embryonic', 'tissues).Mature', 'cystic', 'teratoma', 'is', 'the', 'most', 'frequent:', 'they', 'represent', 'on', 'average', '10%', 'of', 'ovarian', 'tumors', '(5-25%', 'depending', 'on', 'the', 'casuistry).'], ['They', 'occur', 'at', 'any', 'age.'], ['They', 'predominate', 'in', 'ectodermal', 'tissues,', 'such', 'as', 'skin,', 'lining', 'a', 'cavity', 'of', 'keratinous', 'content.'], ['In', 'the', 'cavity', 'a', 'spur', 'is', 'recognized', 'from', 'which', 'hair', 'or', 'tooth', 'structures', 'often', 'arise.'], ['Frequent', 'tissues', 'include:', 'nervous', 'tissue,', 'usually', 'glial', 'and', 'ependymal', 'epithelium,', 'respiratory', 'and', 'digestive', 'epithelia', 'and', 'various', 'mesodermal', 'structures.'], ['They', 'are', 'bilateral', 'in', 'about', '10%', 'of', 'cases.'], ['The', 'mature', 'cystic', 'teratoma', 'is', 'benign,', 'but', 'in', '2%', 'of', 'them', 'a', 'malignant', 'tumor', 'may', 'develop', 'from', 'one', 'of', 'the', 'tissue', 'components', '(spinocellular', 'carcinoma,', 'carcinoid,', 'adenocarcinoma,', 'thyroid', 'tissue', 'carcinoma,', 'sarcoma).'], ['In', 'this', 'case', 'at', 'first', 'we', 'thought', 'that', 'the', 'option', 'was', 'mature', 'cystic', 'teratoma', 'but', 'thanks', 'to', 'Ramón,', 'when', 'we', 'read', 'it', 'more', 'carefully,', 'we', 'found', 'that', 'it', 'had', 'neuroectodermal', 'and', 'embryonal', 'elements', 'in', 'several', 'of', 'the', 'histological', 'preparations,', 'so', 'we', 'consider', 'that', 'the', 'correct', 'answer', 'is', '2.']]
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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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', '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-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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']]
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[['but thanks to Ramón, when we read it more carefully, we found that it had neuroectodermal and embryonal elements in several of the histological preparations\n', 'so we consider that the correct answer is 2\n', 'Support'], ['so we consider that the correct answer is 2\n', 'Immature teratoma\n', 'Support']]
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497_127
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[['QUESTION', 'TYPE:', 'MEDICAL', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man,', 'smoker', 'of', '40', 'packs/year,', 'who', 'consults', 'for', 'pain', 'in', 'the', 'ulnar', 'border', 'of', 'the', 'left', 'arm', 'and', 'left', 'palpebral', 'ptosis', 'since', 'one', 'month', 'ago.'], ['Chest', 'X-ray', 'shows', 'a', 'mass', 'in', 'the', 'left', 'upper', 'lobe', 'and', 'CT', 'scan', 'confirms', 'the', 'lesion', 'with', 'invasion', 'of', 'the', 'second', 'rib.'], ['In', 'relation', 'to', 'the', 'suspected', 'diagnosis,', 'the', 'most', 'appropriate', 'treatment', 'is:'], ['1-', 'Neoadjuvant', 'chemotherapy', 'with', 'combined', 'chemoradiotherapy,', 'followed', 'by', 'surgery.'], ['2-', 'Neoadjuvant', 'chemotherapy', 'without', 'surgery,', 'followed', 'by', 'radiotherapy.'], ['3-', 'Surgery', 'followed', 'by', 'combined', 'chemoradiotherapy.'], ['4-', 'Radiotherapy', 'without', 'chemotherapy,', 'followed', 'by', 'surgery.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Typical', "smoker's", 'pancoast,', 'probably', 'an', 'epidermoid,', 'with', "Horner's", 'sdr.'], ['Best', 'would', 'be', 'chemoradio', 'followed', 'by', 'surgical', 'salvage.'], ['In', 'the', 'old', 'days', 'it', 'was', 'just', 'RT', 'and', 'surgery.'], ['Maybe', 'not', 'far', 'off', 'enter', 'immunotherapy', 'in', 'first', 'line.'], ['There', 'are', 'more', 'and', 'more', 'new', 'things.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[["Typical smoker's pancoast, probably an epidermoid, with Horner's sdr\n", 'Best would be chemoradio followed by surgical salvage\n', 'Support'], ['Best would be chemoradio followed by surgical salvage\n', 'Neoadjuvant chemotherapy with combined chemoradiotherapy, followed by surgery\n', 'Support']]
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307_207
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '34-year-old', 'patient', 'playing', 'tennis', 'is', 'hit', 'by', 'a', 'ball', 'at', 'the', 'level', 'of', 'the', 'left', 'orbit.'], ['On', 'examination', 'he', 'presents', 'significant', 'palpebral', 'hematoma,', 'hyposphagmia,', 'diplopia', 'to', 'superior', 'vision', 'with', 'limitation', 'of', 'the', 'upper', 'version', 'of', 'the', 'eyeball.'], ['What', 'would', 'you', 'suspect?'], ['1-', 'Fracture', 'of', 'the', 'inferior', 'wall', 'of', 'the', 'floor', 'of', 'the', 'orbit', 'with', 'trapping', 'of', 'the', 'inferior', 'rectus', 'muscle.'], ['2-', 'Zygomatic', 'arch', 'fracture.'], ['3-', 'Fracture', 'of', 'the', 'superior', 'wall', 'of', 'the', 'orbit', 'with', 'entrapment', 'of', 'the', 'superior', 'rectus', 'muscle.'], ['4-', 'Dentoalveolar', 'fracture.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['This', 'question', 'has', 'a', 'small', 'typo', '(one', 'would', 'say', '"tennis"),', 'but', 'personally', 'I', 'am', 'a', 'little', 'more', 'bothered', 'by', 'the', 'error', 'in', 'the', 'description', 'of', 'the', 'scan.'], ['Specifically', 'when', 'they', 'say', '"diplopia', 'to', 'superior', 'vision', 'with', 'limitation', 'of', 'the', 'superior', 'version', 'of', 'the', 'eyeball".'], ['Versions', 'are', 'bilateral', 'conjugated', 'movements', 'of', 'both', 'eyes.'], ['That', 'is,', 'a', 'version', 'is', 'composed', 'of', 'the', 'sum', 'of', 'two', 'ductions,', 'since', 'duction', 'is', 'the', 'movement', 'of', 'only', 'one', 'eye.'], ['When', 'you', 'explore', 'the', 'versions,', 'specifically', 'the', 'superior', 'version', 'or', 'supraversion,', 'both', 'eyes', 'rotate', 'upward.'], ['At', 'that', 'time,', 'you', 'may', 'encounter', 'a', 'limitation', 'of', 'the', 'movement', 'of', 'one', 'eye.'], ['In', 'this', 'case,', 'when', 'you', 'scan', 'the', 'supraversion,', 'you', 'suspect', 'or', 'you', 'detect', 'a', 'limitation', 'in', 'the', 'movement', 'of', 'the', 'left', 'eye.'], ['And', 'we', 'would', 'call', 'this', 'a', 'limitation', 'to', 'the', 'supraversion', 'of', 'that', 'eye.'], ['It', "doesn't", 'make', 'sense', 'to', 'talk', 'about', 'limitation', 'to', 'the', 'version', 'of', 'the', 'eyeball,', 'because', 'the', 'version', 'is', 'always', 'of', 'both', 'eyeballs.'], ['Okay,', 'it', 'is', 'understood,', 'but', 'it', 'is', 'an', 'important', 'misconception', 'that', 'should', 'not', 'be', 'made', 'by', 'the', 'person', 'writing', 'the', 'question', '(who', 'is', 'supposed', 'to', 'be', 'an', 'expert', 'on', 'the', 'subject),', 'but', 'well,', 'as', 'I', 'do', 'not', 'think', 'it', 'is', 'a', 'reason', 'to', 'challenge', 'the', 'question,', "let's", 'go', 'on.'], ['It', 'is', 'about', 'a', 'patient', 'who', 'has', 'received', 'a', 'blow.'], ['All', 'four', 'answers', 'are', 'fractures,', 'so', 'we', 'have', 'a', 'pretty', 'definite', 'picture.'], ['The', 'palpebral', 'hematoma', 'and', 'hyposphagma', '(subconjunctival', 'hemorrhage)', 'does', 'not', 'give', 'us', 'the', 'key', 'data.'], ['What', 'is', 'important', 'is', 'that', 'the', 'eye', 'that', 'has', 'received', 'the', 'blow', 'does', 'not', 'go', 'up,', 'and', 'therefore', 'there', 'is', 'double', 'vision', 'in', 'the', 'superior', 'gaze.'], ['It', 'might', 'be', 'tempting', 'to', 'answer', '3,', 'thinking', 'that', 'because', 'the', 'superior', 'rectus', 'is', 'trapped,', 'it', 'does', 'not', 'work', 'and', 'therefore', 'the', 'eye', 'cannot', 'go', 'up.'], ['However,', 'muscles', 'trapped', 'in', 'a', 'fracture', 'do', 'not', 'automatically', 'lose', 'their', 'muscular', 'action.'], ['What', 'happens', 'is', 'that', 'they', 'become', 'trapped,', 'they', 'are', '"hooked",', 'and', 'cannot', 'stretch.'], ['The', 'problem', 'is', 'that', 'the', 'inferior', 'wall', 'has', 'been', 'broken,', 'the', 'inferior', 'rectus', 'has', 'been', 'trapped,', 'and', 'when', 'the', 'eye', 'must', 'look', 'up,', 'this', 'inferior', 'rectus', 'cannot', 'stretch', 'as', 'it', 'should.'], ['It', 'is', 'not', 'paralysis,', 'but', 'a', 'restrictive', 'problem.'], ['This', 'question', 'could', 'also', 'be', 'answered', 'by', 'discarding.'], ['Options', '2', 'and', '4', 'can', 'be', 'ignored', 'because', 'they', 'are', 'too', 'far', 'away', 'from', 'the', 'extraocular', 'muscles', 'to', 'produce', 'diplopia.'], ['And', 'as', 'for', 'the', 'walls', 'of', 'the', 'orbit,', 'the', 'ones', 'that', 'break', 'most', 'frequently', 'are', 'the', 'inferior', 'and', 'medial', 'wall.'], ['The', 'superior', 'wall', 'ruptures', 'very', 'rarely.']]
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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'], ['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'], ['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'], ['O', 'O'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-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', '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', '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'], ['B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Versions are bilateral conjugated movements of both eyes\n', 'That is, a version is composed of the sum of two ductions, since duction is the movement of only one eye\n', 'Support'], ['That is, a version is composed of the sum of two ductions, since duction is the movement of only one eye\n', 'When you explore the versions, specifically the superior version or supraversion, both eyes rotate upward\n', 'Support'], ['When you explore the versions, specifically the superior version or supraversion, both eyes rotate upward\n', 'At that time, you may encounter a limitation of the movement of one eye\n', 'Support'], ['In this case, when you scan the supraversion, you suspect or you detect a limitation in the movement of the left eye\n', 'And we would call this a limitation to the supraversion of that eye\n', 'Support'], ['What is important is that the eye that has received the blow does not go up\n', 'therefore there is double vision in the superior gaze\n', 'Support'], ['thinking that because the superior rectus is trapped, it does not work and therefore the eye cannot go up\n', 'It might be tempting to answer 3\n', 'Support'], ['However, muscles trapped in a fracture do not automatically lose their muscular action\n', 'It might be tempting to answer 3\n', 'Attack'], ['It might be tempting to answer 3\n', 'Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n', 'Support'], ['However, muscles trapped in a fracture do not automatically lose their muscular action\n', 'Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n', 'Attack'], ['What is important is that the eye that has received the blow does not go up\n', 'It might be tempting to answer 3\n', 'Support'], ['However, muscles trapped in a fracture do not automatically lose their muscular action\n', 'What happens is that they become trapped, they are "hooked", and cannot stretch\n', 'Support'], ['What happens is that they become trapped, they are "hooked", and cannot stretch\n', 'The problem is that the inferior wall has been broken, the inferior rectus has been trapped, and when the eye must look up, this inferior rectus cannot stretch as it should\n', 'Support'], ['The problem is that the inferior wall has been broken, the inferior rectus has been trapped, and when the eye must look up, this inferior rectus cannot stretch as it should\n', 'It is not paralysis, but a restrictive problem\n', 'Support'], ['The problem is that the inferior wall has been broken, the inferior rectus has been trapped, and when the eye must look up, this inferior rectus cannot stretch as it should\n', 'Fracture of the inferior wall of the floor of the orbit with trapping of the inferior rectus muscle\n', 'Support'], ['they are too far away from the extraocular muscles to produce diplopia\n', 'Options 2 and 4 can be ignored\n', 'Support'], ['Options 2 and 4 can be ignored\n', 'Zygomatic arch fracture\n', 'Attack'], ['Options 2 and 4 can be ignored\n', 'Dentoalveolar fracture\n', 'Attack'], ['And as for the walls of the orbit, the ones that break most frequently are the inferior and medial wall\n', 'Fracture of the inferior wall of the floor of the orbit with trapping of the inferior rectus muscle\n', 'Support'], ['The superior wall ruptures very rarely\n', 'Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n', 'Attack']]
|
589_63
| null | null |
[]
|
350_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'], ['Colposcopy', 'with', 'possible', 'biopsy.'], ['H-SIL', '(High-grade', 'squamous', 'intraepithelial', 'lesion)*:', 'includes', 'changes', 'suggestive', 'of', 'CIN2', 'and', 'CIN3/CIS.'], ['The', 'cytologic', 'diagnosis', 'must', 'be', 'confirmed', 'by', 'biopsy,', 'for', 'which', 'it', 'is', 'necessary', 'to', 'perform', 'a', 'directed', 'biopsy', 'by', 'colposcopy.']]
|
[['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'], ['B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Colposcopy with possible biopsy\n', 'Colposcopy with possible biopsy\n', 'Support'], ['The cytologic diagnosis must be confirmed by biopsy, for which it is necessary to perform a directed biopsy by colposcopy\n', 'Colposcopy with possible biopsy\n', 'Support'], ['The cytologic diagnosis must be confirmed by biopsy, for which it is necessary to perform a directed biopsy by colposcopy\n', 'Colposcopy with possible biopsy\n', 'Support'], ['H-SIL (High-grade squamous intraepithelial lesion)\n', 'Colposcopy with possible biopsy\n', 'Support'], ['H-SIL (High-grade squamous intraepithelial lesion)\n', 'includes changes suggestive of CIN2 and CIN3/CIS\n', 'Support']]
|
25_116
|
[['QUESTION', 'TYPE:', 'INFECTIOUS'], ['CLINICAL', 'CASE:'], ['A', '40-year-old', 'woman', 'is', 'admitted', 'to', 'the', 'Emergency', 'Department', 'with', 'a', 'fever', 'of', '38ºC', 'and', 'right', 'lumbar', 'pain.'], ['The', 'CBC', 'shows', '25000', 'leukocytes/mm3', 'with', 'left', 'deviation', 'and', 'an', 'abdominal', 'ultrasound', 'shows', 'a', 'coralliform', 'lithiasis.'], ['What', 'microorganism', 'do', 'we', 'expect', 'to', 'find?'], ['1-', 'Escherichia', 'coli.'], ['2-', 'Enterococcus', 'faecalis.'], ['3-', 'Salmonella', 'typhi.'], ['4-', 'Candida', 'albicans.'], ['5-', 'Proteus', 'mirabilis.'], ['CORRECT', 'ANSWER:', '5'], ['Epidemiology', 'question', 'shared', 'with', 'URO.'], ['Coraliform', 'lithiasis', 'are', 'associated', 'with', 'urea-folding', 'germs:', 'Proteus', 'in', 'the', 'first', 'place,', 'Pseudomonas,', 'Klebsiella', 'and', 'some', 'staphylococci.']]
|
[['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', 'O', 'B-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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['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']]
|
[['Coraliform lithiasis are associated with urea-folding germs: Proteus in the first place, Pseudomonas, Klebsiella and some staphylococci\n', 'Proteus mirabilis\n', 'Support'], ['an abdominal ultrasound shows a coralliform lithiasis\n', 'Proteus mirabilis\n', 'Support']]
|
103_89
| null | null |
[]
|
22_112
|
[['QUESTION', 'TYPE:', 'INFECTIOUS'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'comes', 'to', 'the', 'Emergency', 'Department', 'with', 'fever', 'without', 'focus', 'of', '24', 'h', 'of', 'evolution,', 'hypothyroidism', 'and', 'impression', 'of', 'severity.'], ['She', 'underwent', 'a', 'splenectomy', '2', 'years', 'ago', 'for', 'staging', 'of', "Hosgkin's", 'disease.'], ['Which', 'microorganism', 'is', 'most', 'frequently', 'implicated?'], ['1-', 'Streptococcus', 'pneumoniae.'], ['2-', 'Pseudomonas', 'aeruginosa.'], ['3-', 'Salmonella', 'no', 'typhi.'], ['4-', 'Pneumocystis', 'jirovecii.'], ['5-', 'Streptococcus', 'viridans.'], ['CORRECT', 'ANSWER:', '1'], ['Another', 'one', 'on', 'epidemiology.'], ['In', 'splenectomized', 'patients,', 'the', 'risk', 'of', 'acquiring', 'serious', 'infections', 'by', 'encapsulated', 'germs', 'is', 'increased,', 'again', 'Pneumococcus', 'being', 'the', 'most', 'frequent.']]
|
[['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'], ['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', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['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', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['In splenectomized patients, the risk of acquiring serious infections by encapsulated germs is increased\n', 'Pneumococcus being the most frequent.\n', 'Support'], ["She underwent a splenectomy 2 years ago for staging of Hosgkin's disease\n", 'Pneumococcus being the most frequent.\n', 'Support'], ["She underwent a splenectomy 2 years ago for staging of Hosgkin's disease\n", 'Streptococcus pneumoniae\n', 'Support'], ['Pneumococcus being the most frequent.\n', 'Streptococcus pneumoniae\n', 'Support']]
|
488_105
|
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'patient', 'who', 'in', 'the', 'last', '6', 'months,', 'in', 'two', 'routine', 'analyses,', 'presents', 'progressive', 'lymphocytosis.'], ['In', 'the', 'last', 'one,', 'hemoglobin', '15.4', 'g/dL;', 'leukocytes', '18.5', 'x103/μL', 'with', '82%', 'of', 'mature', 'lymphocytes', 'that', 'by', 'flow', 'cytometry', 'express', 'CD5/CD19/CD23', 'antigens', 'and', 'platelets', '240', 'x103/μL.'], ['What', 'attitude', 'do', 'you', 'think', 'is', 'correct?'], ['1-', 'Study', 'of', 'TP53', 'mutations', 'to', 'establish', 'prognosis.'], ['2-', 'Bone', 'aspirate/biopsy', 'to', 'confirm', 'the', 'diagnosis.'], ['3-', 'PET/CT', 'to', 'establish', 'the', 'therapeutic', 'attitude.'], ['4-', 'New', 'clinical', 'and', 'analytical', 'control', 'in', '6', 'months.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['A', 'question', 'that', 'I', 'think', 'can', 'be', 'complicated', 'for', 'a', 'MIR', 'examiner.'], ['We', 'are', 'told', 'of', 'a', 'leukocytosis', 'at', 'the', 'expense', 'of', 'lymphocytes', 'with', 'a', 'B-CLL', 'phenotype.'], ['It', 'seems', 'that', 'there', 'are', 'no', 'other', 'alarming', 'data.'], ['No', 'clinical', 'data', 'are', 'given', '(so', 'we', 'assume', 'that', 'the', 'patient', 'is', 'asymptomatic).'], ['No', 'cytopenias...'], ['Conclusion:', 'FOLLOW', 'UP.'], ['The', 'main', 'hesitation', 'with', 'the', 'answer', 'should', 'be', 'with', 'option', '1.'], ['Why', 'do', 'I', 'consider', 'it', 'incorrect?'], ['Because', 'the', 'TP53', 'mutation,', 'although', 'it', 'establishes', 'prognosis,', 'is', 'not', 'indicated', 'at', 'diagnosis,', 'but', 'when', 'treatment', 'is', 'going', 'to', 'be', 'initiated', '(first', 'line', 'and', 'prior', 'to', 'successive', 'lines', 'in', 'case', 'they', 'are', 'needed).'], ['It', 'would', 'be', 'possible', 'to', 'go', 'too', 'far', 'in', 'this', 'question', 'in', 'which', 'the', 'percentage', 'given', 'does', 'not', 'refer', 'directly', 'to', 'clonal', 'lymphocytes,', 'so', 'that', 'it', 'could', 'even', 'be', 'a', 'monoclonal', 'B', 'lymphocytosis.'], ['But', 'this', 'is', 'going', 'too', 'far.']]
|
[['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', 'I-Premise', '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'], ['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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['No clinical data are given\n', 'so we assume that the patient is asymptomatic\n', 'Support'], ['We are told of a leukocytosis at the expense of lymphocytes with a B-CLL phenotype\n', 'It seems that there are no other alarming data\n', 'Support'], ['It seems that there are no other alarming data\n', 'Conclusion: FOLLOW UP\n', 'Support'], ['so we assume that the patient is asymptomatic\n', 'Conclusion: FOLLOW UP\n', 'Support'], ['No cytopenias...\n', 'Conclusion: FOLLOW UP\n', 'Support'], ['Conclusion: FOLLOW UP\n', 'New clinical and analytical control in 6 months\n', 'Support'], ['But this is going too far\n', 'Why do I consider it incorrect?\n', 'Support'], ['Because the TP53 mutation, although it establishes prognosis, is not indicated at diagnosis, but when treatment is going to be initiated (first line and prior to successive lines in case they are needed)\n', 'It would be possible to go too far in this question in which the percentage given does not refer directly to clonal lymphocytes\n', 'Support'], ['It would be possible to go too far in this question in which the percentage given does not refer directly to clonal lymphocytes\n', 'so that it could even be a monoclonal B lymphocytosis\n', 'Support'], ['so that it could even be a monoclonal B lymphocytosis\n', 'But this is going too far\n', 'Support'], ['Why do I consider it incorrect?\n', 'Study of TP53 mutations to establish prognosis\n', 'Attack']]
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111_153
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '59-year-old', 'woman', 'consults', 'a', 'gynecologist', 'for', 'a', 'spontaneous,', 'spontaneous,', 'uniorificial', 'discharge', 'from', 'the', 'right', 'nipple', '(unilateral)', 'without', 'palpable', 'nodularity.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Given', 'the', 'hematic', 'nature', 'of', 'the', 'discharge,', 'the', 'most', 'likely', 'diagnosis', 'is', 'infiltrating', 'ductal', 'carcinoma.'], ['2-', 'Intraductal', 'papilloma.'], ['3-', "Paget's", 'disease', 'of', 'the', 'nipple.'], ['4-', 'Tumor', 'hyperprolactinemia.'], ['5-', 'Mammography', 'will', 'indicate', 'the', 'diagnosis.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is', '2.'], ['In', 'the', 'presence', 'of', 'unilateral', 'and', 'uniorificial', 'hematic', 'telorrhea,', 'the', 'most', 'frequent', 'cause', 'is', 'intraductal', 'papilloma', '(50%),', 'followed', 'by', 'ductal', 'ectasia', 'and', 'carcinoma.'], ['When', 'associated', 'with', 'palpable', 'mass,', '60%', 'correspond', 'to', 'carcinoma.'], ["Paget's", 'disease', 'is', 'of', 'the', 'eczematous', 'type.'], ['In', 'hyperprolactinemia,', 'telorrhea', 'is', 'bilateral', 'and', 'pluriorificial.'], ['Mammography', 'often', 'does', 'not', 'show', 'papillomas,', 'being', 'more', 'useful', 'ultrasound', 'and', 'galactography.']]
|
[['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'], ['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'], ['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', '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'], ['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'], ['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 correct answer is 2\n', 'Intraductal papilloma\n', 'Support'], ['In the presence of unilateral and uniorificial hematic telorrhea, the most frequent cause is intraductal papilloma (50%), followed by ductal ectasia and carcinoma\n', 'Intraductal papilloma\n', 'Support'], ['A 59-year-old woman consults a gynecologist for a spontaneous, spontaneous, uniorificial discharge from the right nipple (unilateral\n', 'Intraductal papilloma\n', 'Support'], ['In hyperprolactinemia, telorrhea is bilateral and pluriorificial\n', 'Tumor hyperprolactinemia\n', 'Attack'], ['A 59-year-old woman consults a gynecologist for a spontaneous, spontaneous, uniorificial discharge from the right nipple (unilateral\n', 'Tumor hyperprolactinemia\n', 'Attack'], ["Paget's disease is of the eczematous type\n", "Paget's disease of the nipple\n", 'Attack'], ['Mammography often does not show papillomas, being more useful ultrasound and galactography.\n', 'Mammography will indicate the diagnosis\n', 'Attack'], ['Mammography often does not show papillomas, being more useful ultrasound and galactography.\n', 'Intraductal papilloma\n', 'Support'], ['without palpable nodularity\n', 'When associated with palpable mass, 60% correspond to carcinoma\n', 'Attack']]
|
119_119
|
[['QUESTION', 'TYPE:', 'INFECTOLOGY'], ['CLINICAL', 'CASE:'], ['A', '17-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'a', 'high', 'fever,', 'pharyngeal', 'pain', 'and', 'cervical', 'lymphadenopathy.'], ['She', 'had', 'previously', 'been', 'diagnosed', 'with', 'acute', 'pharyngitis', 'and', 'was', 'treated', 'with', 'amoxicillin,', 'and', 'later', 'presented', 'with', 'a', 'generalized', 'macular', 'skin', 'rash.'], ['Laboratory', 'tests', 'showed', 'slight', 'leukocytosis', 'with', 'lymphocytosis', 'and', 'presence', 'of', 'activated', 'lymphocytes,', 'slight', 'thrombopenia', 'and', 'slightly', 'increased', 'transaminases.'], ['What', 'would', 'be', 'the', 'most', 'likely', 'diagnosis', 'of', 'this', 'clinical', 'picture?'], ['1-', 'It', 'is', 'a', 'typical', 'picture', 'of', 'infectious', 'mononucleosis.'], ['2-', 'Varicella', 'zoster', 'virus', 'infection.'], ['3-', 'Acute', 'toxoplasmosis.'], ['4-', 'Lyme', 'disease.'], ['5-', 'Infection', 'by', 'herpes', 'virus', '8.'], ['CORRECT', 'ANSWER:', '1'], ['Of', 'course', 'it', 'is', 'a', 'typical', 'picture', '(EBV,', 'CMV,', 'VH6,', 'Toxoplasma),', 'of', 'which', 'you', 'will', 'not', 'see', 'so', 'clearly', 'at', 'the', 'emergency', 'room', 'door', 'when', 'you', 'are', 'on', 'call.'], ['Be', 'careful', 'with', 'the', 'bad', 'blood', 'in', 'answer', '3,', 'because', 'an', 'acute', 'toxoplasmosis', 'can', 'behave', 'like', 'this', 'and', 'also', 'give', 'a', 'macular', 'exanthema,', 'although', 'the', 'one', 'of', 'this', 'girl', 'is', 'related', 'to', 'the', 'intake', 'of', 'amoxicillin.'], ['By', 'the', 'way,', 'I', 'add', 'a', 'note,', 'if', 'instead', 'of', 'a', 'girl', 'of', '17', 'years', 'so', 'clear', 'it', 'were', 'a', 'young', 'man/girl', 'with', 'risky', 'sexual', 'relations,', 'do', 'not', 'forget', 'the', 'HIV', 'primoinfection', 'as', 'a', 'cause', 'of', 'mononucleosis', 'syndrome.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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', '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'], ['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', '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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[['Laboratory tests showed slight leukocytosis with lymphocytosis and presence of activated lymphocytes, slight thrombopenia and slightly increased transaminases\n', 'Of course it is a typical picture (EBV, CMV, VH6, Toxoplasma)\n', 'Support'], ['Be careful with the bad blood in answer 3, because an acute toxoplasmosis can behave like this and also give a macular exanthema, although the one of this girl is related to the intake of amoxicillin\n', 'Acute toxoplasmosis\n', 'Attack'], ['She had previously been diagnosed with acute pharyngitis and was treated with amoxicillin, and later presented with a generalized macular skin rash\n', 'Be careful with the bad blood in answer 3, because an acute toxoplasmosis can behave like this and also give a macular exanthema, although the one of this girl is related to the intake of amoxicillin\n', 'Support'], ['if instead of a girl of 17 years so clear it were a young man/girl with risky sexual relations\n', 'do not forget the HIV primoinfection as a cause of mononucleosis syndrome\n', 'Support']]
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562_183
|
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'with', 'no', 'history', 'of', 'interest', 'consults', 'for', 'dyspneic', 'sensation', 'of', 'about', '4', 'days', 'of', 'evolution.'], ['Examination', 'shows', 'rhythmic', 'tachycardia,', 'without', 'murmurs,', 'and', 'pulmonary', 'auscultation', 'is', 'normal.'], ['Arterial', 'blood', 'gases', 'showed', 'a', 'pO2', 'of', '70', 'mmHg', 'and', 'a', 'pCO2', 'of', '32', 'mmHg.'], ['Hemogram,', 'renal', 'and', 'hepatic', 'function', 'are', 'normal.'], ['Prothrombin', 'time', '90%,', 'activated', 'partial', 'thromboplastin', 'time', '(APTT)', 'ratio', 'of', '2', 'to', 'control', '(N', '<1.2).'], ['Which', 'of', 'the', 'following', 'diagnoses', 'is', 'the', 'most', 'likely:'], ['1-', 'Antiphospholipid', 'syndrome.'], ['2-', 'Factor', 'V', 'of', 'Leiden.'], ['3-', 'Hemophilia.'], ['4-', 'Acute', 'pericarditis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['In', 'this', 'question', 'what', 'they', 'assume', 'is', 'that', 'this', 'is', 'a', '45-year-old', 'woman', 'who', 'is', 'diagnosed', 'with', 'pulmonary', 'thromboembolism', '(PTE).'], ['With', 'this', 'diagnosis,', 'options', '3', 'and', '4', 'are', 'directly', 'excluded', '(also,', 'she', 'is', 'female,', 'so', 'we', 'would', 'not', 'have', 'to', 'think', 'about', 'hemophilia)', 'As', 'an', 'analytical', 'data,', 'it', 'says', 'that', 'there', 'is', 'a', 'lengthening', 'of', 'the', 'aPTT.'], ['So,', 'they', 'want', 'you', 'to', 'know,', 'she', 'has', 'positive', 'lupus', 'ac', 'and', 'link', 'it', 'directly', 'to', 'antiphospholipid', 'syndrome', '(APS).'], ['A', "Leiden's", 'does', 'not', 'alter', 'coagulation,', 'so', 'it', 'is', 'ruled', 'out', 'as', 'well.'], ['Anyway,', 'although', 'it', 'is', 'not', 'within', 'the', 'possible', 'answers,', 'lupus', 'positivity', 'can', 'be', 'related', 'to', 'a', 'myriad', 'of', 'clinical', 'situations,', 'syndromes', 'and', 'pathologies.'], ['Assuming', 'that', 'a', 'PTE', '+', 'lupus', 'is', 'a', 'PFS', 'seems', 'to', 'me', 'to', 'be', 'a', 'bit', 'of', 'a', 'stretch,', 'but', 'it', 'is', 'the', 'most', 'likely', 'with', 'the', 'data', 'provided.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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'], ['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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 question what they assume is that this is a 45-year-old woman who is diagnosed with pulmonary thromboembolism (PTE)\n', 'With this diagnosis, options 3 and 4 are directly excluded\n', 'Support'], ['With this diagnosis, options 3 and 4 are directly excluded\n', 'Hemophilia\n', 'Attack'], ['With this diagnosis, options 3 and 4 are directly excluded\n', 'Acute pericarditis\n', 'Attack'], ['also, she is female\n', 'so we would not have to think about hemophilia\n', 'Support'], ['so we would not have to think about hemophilia\n', 'Hemophilia\n', 'Attack'], ['As an analytical data, it says that there is a lengthening of the aPTT\n', 'So, they want you to know, she has positive lupus ac and link it directly to antiphospholipid syndrome (APS)\n', 'Support'], ['So, they want you to know, she has positive lupus ac and link it directly to antiphospholipid syndrome (APS)\n', 'Antiphospholipid syndrome\n', 'Support'], ["A Leiden's does not alter coagulation, so it is ruled out as well\n", 'Factor V of Leiden\n', 'Attack'], ['Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)\n', "A Leiden's does not alter coagulation, so it is ruled out as well\n", 'Support'], ['Assuming that a PTE + lupus is a PFS seems to me to be a bit of a stretch, but it is the most likely with the data provided\n', 'Antiphospholipid syndrome\n', 'Support']]
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514_97
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[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['After', 'a', 'traffic', 'accident', 'you', 'attend', 'to', 'an', 'injured', 'person.'], ['The', 'patient', 'opens', 'his', 'eyes', 'at', 'your', 'call,', 'but', 'only', 'utters', 'words', 'that', 'are', 'inappropriate.'], ['On', 'motor', 'examination,', 'the', 'pain', 'is', 'localized', 'in', 'the', 'right', 'extremities,', 'but', 'spreads', 'on', 'stimulation', 'of', 'the', 'left', 'extremities.'], ['How', 'would', 'you', 'describe', 'his', 'condition', 'according', 'to', 'the', 'Glasgow', 'Coma', 'Scale?'], ['1-', 'E3V2M4.'], ['2-', 'E3V3M5.'], ['3-', 'E2V3M4.'], ['4-', 'E2V4M5.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'first', 'thing', 'we', 'should', 'know', 'when', 'applying', 'the', 'Glasgow', 'Coma', 'Scale', 'to', 'a', 'patient', 'is', 'that', 'we', 'should', 'always', 'keep', 'the', 'best', 'value', 'in', 'each', 'sphere', '(ocular', 'response,', 'motor', 'response', 'and', 'verbal', 'response).'], ['In', 'this', 'case,', 'we', 'have', 'a', 'patient', 'who', 'has', 'an', 'ocular', 'opening', 'to', 'the', 'call', '(ocular', 'response', '3', 'out', 'of', '4),', 'emits', 'inappropriate', 'words', '(verbal', 'response', '3', 'out', 'of', '5)', 'and', 'localizes', 'pain', 'with', 'right', 'extremities', '(motor', 'response', '5', 'out', 'of', '6).'], ['The', 'Glasgow', 'Coma', 'Scale', 'score', 'would', 'be', '11', '(out', 'of', '15).'], ['The', 'best', 'value', 'of', 'the', 'examination', 'is', 'taken', 'because', 'in', 'many', 'cases', '(assessment', 'of', 'a', 'polytraumatized', 'patient,', 'ischemic', 'stroke', 'or', 'spontaneous', 'acute', 'cerebral', 'bleeding),', 'the', 'motor', 'examination', 'may', 'be', 'artifacted', 'by', 'other', 'elements.'], ['For', 'example:', 'in', 'a', 'polytraumatized', 'patient', '(such', 'as', 'the', 'one', 'in', 'question),', 'the', 'response', 'presented', 'with', 'left', 'extremities', 'may', 'be', 'due', 'to', 'localized', 'trauma', 'in', 'that', 'area,', 'and', 'not', 'strictly', 'speaking', 'to', 'an', 'underlying', 'traumatic', 'brain', 'injury.'], ['Likewise,', 'sometimes', 'the', 'verbal', 'response', 'may', 'be', 'underestimated', 'in', 'the', 'polytraumatized', 'patient', 'due', 'to', 'airway', 'obstruction', '(e.g.,', 'due', 'to', 'the', 'tongue', 'retreating', 'into', 'the', 'oropharynx).'], ['By', 'always', 'assessing', 'the', 'best', 'response,', 'we', 'will', 'have', 'a', 'truer', 'picture', 'of', 'the', "patient's", 'condition.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n', 'ocular response 3 out of 4\n', 'Support'], ['In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n', 'verbal response 3 out of 5\n', 'Support'], ['In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n', 'motor response 5 out of 6\n', 'Support'], ['In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n', 'The Glasgow Coma Scale score would be 11 (out of 15)\n', 'Support'], ['ocular response 3 out of 4\n', 'The Glasgow Coma Scale score would be 11 (out of 15)\n', 'Support'], ['verbal response 3 out of 5\n', 'The Glasgow Coma Scale score would be 11 (out of 15)\n', 'Support'], ['motor response 5 out of 6\n', 'The Glasgow Coma Scale score would be 11 (out of 15)\n', 'Support'], ['The Glasgow Coma Scale score would be 11 (out of 15)\n', 'E3V3M5\n', 'Support'], ['ocular response 3 out of 4\n', 'E3V3M5\n', 'Support'], ['verbal response 3 out of 5\n', 'E3V3M5\n', 'Support'], ['motor response 5 out of 6\n', 'E3V3M5\n', 'Support'], ['For example: in a polytraumatized patient (such as the one in question), the response presented with left extremities may be due to localized trauma in that area, and not strictly speaking to an underlying traumatic brain injury\n', 'The best value of the examination is taken because in many cases (assessment of a polytraumatized patient, ischemic stroke or spontaneous acute cerebral bleeding), the motor examination may be artifacted by other elements\n', 'Support'], ['Likewise, sometimes the verbal response may be underestimated in the polytraumatized patient due to airway obstruction (e.g., due to the tongue retreating into the oropharynx)\n', 'The best value of the examination is taken because in many cases (assessment of a polytraumatized patient, ischemic stroke or spontaneous acute cerebral bleeding), the motor examination may be artifacted by other elements\n', 'Support'], ['The best value of the examination is taken because in many cases (assessment of a polytraumatized patient, ischemic stroke or spontaneous acute cerebral bleeding), the motor examination may be artifacted by other elements\n', "By always assessing the best response, we will have a truer picture of the patient's condition\n", 'Support']]
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101_86
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[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '55-year-old', 'woman', 'consults', 'for', 'fatigue', 'and', 'polyuria', 'of', 'two', "years'", 'evolution.'], ['Laboratory', 'tests', 'reveal', 'hypercalcemia,', 'increased', 'PTH', 'and', 'increased', 'bone', 'turnover', 'markers.'], ['The', 'radiographic', 'study', 'shows', 'subperiosteal', 'resorption', 'and', 'osteoporosis.'], ['Sestamibi', 'scintigraphy', 'revealed', 'a', 'parathyroid', 'adenoma.'], ['Parathyroidectomy', 'was', 'performed', 'with', 'minimally', 'invasive', 'surgery.'], ['Postoperatively,', 'the', 'patient', 'developed', 'severe', 'hypocalcemia', 'and', 'tetany,', 'with', 'PTH', 'below', '5', 'ng/l.'], ['The', 'patient', 'responds', 'well', 'to', 'initial', 'treatment', 'with', 'intravenous', 'calcium', 'and', 'later', 'with', 'oral', 'calcium', 'and', 'vitamin', 'D.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Permanent', 'surgical', 'hypoparathyroidism.'], ['2-', 'Transfusion', 'of', 'citrated', 'blood.'], ['3-', 'Vitamin', 'D', 'insufficiency.'], ['4-', 'Hungry', 'bone', 'syndrome.'], ['5-', 'Osteomalacia.'], ['CORRECT', 'ANSWER:', '4'], ['Question', 'of', 'very', 'high', 'difficulty,', 'I', 'would', 'not', 'worry', 'about', 'having', 'failed', 'it.'], ['It', 'is', 'easy', 'to', 'get', 'confused', 'with', 'the', 'hypoparathyroidism', 'answer.'], ['Permanent', 'post-surgical', 'hypoparathyroidism', 'after', 'parathyroidectomy', 'of', 'an', 'adenoma', 'with', 'minimally', 'invasive', 'surgery', 'is', 'rare.'], ['I', 'write', 'a', 'brief', 'summary', 'of', 'the', 'hungry', 'bone', 'syndrome', 'that', 'I', 'have', 'found', 'in', 'a', 'clinical', 'case', 'in', 'the', 'Annals', 'of', 'Internal', 'Medicine', '[1]:', '"The', 'pathophysiology', 'of', 'the', 'hungry', 'bone', 'syndrome', '(HBS)', 'is', 'related', 'to', 'an', 'imbalance', 'between', 'bone', 'formation', 'and', 'bone', 'resorption,', 'which', 'is', 'associated', 'with', 'hypocalcemia,', 'hypophosphatemia', 'and', 'hypomagnesemia', '(1).'], ['This', 'syndrome', 'can', 'be', 'observed', 'after', 'surgery', 'in', 'patients', 'with', 'primary', 'hyperparathyroidism', '(HPT),', 'as', 'well', 'as', 'in', 'tertiary', 'HPT', 'of', 'chronic', 'renal', 'failure,', 'and', 'to', 'a', 'lesser', 'extent', 'after', 'treatment', 'of', 'processes', 'with', 'excess', 'of', 'circulating', 'thyroid', 'hormones', '(2).'], ['In', 'PTH,', 'there', 'is', 'an', 'excess', 'of', 'parathyroid', 'hormone', '(PTH)', 'which', 'stimulates', 'osteoclastic', 'activity', 'causing', 'demineralization', 'of', 'the', 'bone', 'matrix', 'and', 'releasing', 'calcium', 'into', 'the', 'bloodstream.'], ['After', 'parathyroidectomy,', 'serum', 'PTH', 'levels', 'drop', 'dramatically,', 'thus,', 'PTH-induced', 'bone', 'resorption', 'ceases,', 'while', 'osteoblastic', 'activity', 'continues', 'resulting', 'in', 'increased', 'bone', 'uptake', 'of', 'calcium,', 'phosphate', 'and', 'magnesium,', 'thus', 'SHH', 'appears', '(3)."']]
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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'], ['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'], ['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'], ['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'], ['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'], ['B-Claim', 'I-Claim', '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', 'B-Disease', 'I-Disease', 'I-Disease', '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', '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', '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', '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']]
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[['Permanent post-surgical hypoparathyroidism after parathyroidectomy of an adenoma with minimally invasive surgery is rare\n', 'Permanent surgical hypoparathyroidism\n', 'Attack'], ['This syndrome can be observed after surgery in patients with primary hyperparathyroidism (HPT), as well as in tertiary HPT of chronic renal failure, and to a lesser extent after treatment of processes with excess of circulating thyroid hormones (2)\n', 'Hungry bone syndrome\n', 'Support'], ['In PTH, there is an excess of parathyroid hormone (PTH) which stimulates osteoclastic activity causing demineralization of the bone matrix and releasing calcium into the bloodstream\n', 'Hungry bone syndrome\n', 'Support'], ['After parathyroidectomy, serum PTH levels drop dramatically, thus, PTH-induced bone resorption ceases, while osteoblastic activity continues resulting in increased bone uptake of calcium, phosphate and magnesium, thus SHH appears\n', 'Hungry bone syndrome\n', 'Support'], ['Laboratory tests reveal hypercalcemia, increased PTH and increased bone turnover markers\n', 'Hungry bone syndrome\n', 'Support'], ['The radiographic study shows subperiosteal resorption and osteoporosis\n', 'Hungry bone syndrome\n', 'Support'], ['Postoperatively, the patient developed severe hypocalcemia and tetany, with PTH below 5 ng/l\n', 'Hungry bone syndrome\n', 'Support']]
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230_179
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '4-year-old', 'boy', 'comes', 'to', 'the', 'health', 'center', 'who,', '5', 'minutes', 'before,', 'starts', 'with', 'angioedema', 'in', 'the', 'face,', 'conjunctivitis,', 'nasal', 'congestion', 'and', 'hoarseness,', 'coinciding', 'with', 'the', 'ingestion', 'of', 'a', 'spoonful', 'of', 'yogurt', 'given', 'to', 'him', 'by', 'mistake', 'at', 'school.'], ['Among', 'the', 'antecedents,', 'he', 'was', 'diagnosed', 'with', "cow's", 'milk', 'protein', 'allergy.'], ['Examination', 'revealed', 'mild', 'hypotension,', 'heart', 'rate', '110', 'bpm,', 'O2', 'Sat', '93%,', 'pale', 'and', 'slightly', 'sweaty,', 'with', 'scattered', 'wheezing.'], ['What', 'is', 'the', 'first', 'treatment', 'of', 'choice?'], ['1-', 'Provoke', 'vomiting.'], ['2-', 'Adrenaline', '1/1000', 'subcutaneous.'], ['3-', 'Intramuscular', 'adrenaline', '1/1000.'], ['4-', 'Intramuscular', 'methylprednisolone.'], ['5-', 'Nebulized', 'salbutamol.'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'facing', 'a', 'case', 'of', 'Anaphylaxis', 'so', 'the', 'first', 'measure', 'is', 'to', 'administer', 'Adrenaline', '1/1000', 'intramuscular', '(0.01mg/kg).'], ['Subsequently,', 'systemic', 'corticosteroids', 'such', 'as', 'methylprednisolone', 'will', 'be', 'given,', 'which', 'will', 'take', 'a', 'few', 'hours', 'to', 'take', 'effect.'], ['So', 'adrenaline', 'first,', 'as', 'it', 'is', 'faster', 'acting,', 'then', 'the', 'rest', '(Question', 'very', 'similar', 'to', 'one', 'last', 'year,', 'instead', 'of', 'yogurt,', 'it', 'was', 'omelet).']]
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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'], ['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'], ['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'], ['O', 'B-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', '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'], ['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', 'O', 'O', 'O', 'O']]
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[['We are facing a case of Anaphylaxis\n', 'the first measure is to administer Adrenaline 1/1000 intramuscular (0.01mg/kg)\n', 'Support'], ['the first measure is to administer Adrenaline 1/1000 intramuscular (0.01mg/kg)\n', 'Intramuscular adrenaline 1/1000\n', 'Support'], ['So adrenaline first, as it is faster acting, then the rest\n', 'Intramuscular adrenaline 1/1000\n', 'Support']]
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479_164
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[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'man', 'presenting', 'since', '48', 'hours', 'with', 'fever', 'of', '38.7°C,', 'cough,', 'purulent', 'expectoration', 'and', 'dyspnea.'], ['Constants:', 'BP', '85/60', 'mmHg,', 'heart', 'rate', '100', 'bpm,', 'respiratory', 'rate', '35', 'rpm,', 'SatO2', '80%.'], ['Of', 'note', 'was', 'the', 'presence', 'of', 'confusion', 'and', 'crackles', 'in', 'the', 'left', 'lower', 'lung', 'field.'], ['Chest', 'X-ray', 'confirms', 'the', 'existence', 'of', 'pneumonia', 'of', 'the', 'lingula', 'and', 'left', 'lower', 'lobe.'], ['What', 'would', 'be', 'the', 'appropriate', 'place', 'of', 'care?'], ['1-', 'Outpatient', 'treatment', 'at', 'home.'], ['2-', 'Admission', 'to', 'an', 'emergency', 'observation', 'unit.'], ['3-', 'Hospital', 'admission', 'to', 'the', 'ward.'], ['4-', 'Admission', 'to', 'the', 'Intensive', 'Care', 'Unit.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Applying', 'the', 'CURB-65', 'severity', 'scale', '(one', 'of', 'the', 'most', 'commonly', 'used', 'in', 'the', 'ED', 'for', 'stratifying', 'the', 'severity', 'of', 'pneumonia,', 'although', 'in', 'this', 'case', 'simply', 'applying', 'common', 'sense,', 'the', 'patient', 'should', 'be', 'admitted', 'to', 'the', 'ICU),', 'we', 'would', 'have', 'a', 'score', 'of', 'at', 'least', '4', 'points', '(we', 'would', 'be', 'missing', 'the', 'serum', 'urea', 'data),', 'which', 'gives', 'us', 'severity', 'criteria.'], ['Since', 'there', 'are', 'no', 'criteria', 'that', 'contraindicate', 'admission', 'to', 'the', 'ICU,', 'admission', 'to', 'the', 'unit', 'would', 'be', 'indicated.']]
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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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Since there are no criteria that contraindicate admission to the ICU, admission to the unit would be indicated\n', 'Admission to the Intensive Care Unit\n', 'Support'], ['Applying the CURB-65 severity scale (one of the most commonly used in the ED for stratifying the severity of pneumonia, although in this case simply applying common sense, the patient should be admitted to the ICU), we would have a score of at least 4 points (we would be missing the serum urea data), which gives us severity criteria\n', 'Admission to the Intensive Care Unit\n', 'Support'], ['although in this case simply applying common sense, the patient should be admitted to the ICU\n', 'Admission to the Intensive Care Unit\n', 'Support']]
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515_101
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[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['15-year-old', 'male,', 'admitted', 'after', 'being', 'run', 'over', 'on', 'the', 'public', 'road,', 'resulting', 'in', 'being', 'ejected.'], ['He', 'was', 'admitted', 'conscious', 'and', 'oriented,', 'with', 'intense', 'pain', 'in', 'the', 'left', 'hemithorax', 'and', 'dyspnea.'], ['Physical', 'examination', 'showed', 'blood', 'pressure', '90/60', 'mmHg,', 'heart', 'rate', '130', 'bpm,', 'basal', 'oxygen', 'saturation', '90%,', 'respiratory', 'rate', '35', 'rpm.'], ['There', 'is', 'complete', 'hypophonesis', 'in', 'the', 'left', 'hemithorax', 'and', 'dullness', 'to', 'percussion.'], ['Chest', 'X-ray', 'shows', 'multiple', 'left', 'costal', 'fractures', 'and', 'massive', 'ipsilateral', 'pleural', 'effusion.'], ['Placement', 'of', 'a', 'pleural', 'drain', 'is', 'indicated,', 'with', '1700', 'cc', 'of', 'hematic', 'fluid', 'coming', 'out.'], ['What', 'is', 'the', 'decision', 'to', 'be', 'made:'], ['1-', 'Institute', 'noninvasive', 'mechanical', 'ventilation', 'and', 'request', 'blood', 'transfusion.'], ['2-', 'Analgesia,', 'oxygen', 'therapy,', 'request', 'blood', 'transfusion', 'and', 'indicate', 'urgent', 'surgery.'], ['3-', 'Orotracheal', 'intubation,', 'request', 'blood', 'transfusion', 'and', 'observation', 'for,', 'in', 'case', 'of', 'worsening,', 'indicate', 'surgical', 'intervention.'], ['4-', 'Orotracheal', 'intubation', 'and', 'urgent', 'CT', 'scan', 'for', 'accurate', 'assessment', 'of', 'lesions.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['There', 'are', 'two', 'answers', 'that', 'we', 'can', 'immediately', 'rule', 'out', 'if', 'we', 'stick', 'to', 'the', 'initial', 'management', 'of', 'severe', 'chest', 'trauma:', '1', '(noninvasive', 'ventilation', 'is', 'not', 'indicated', 'because', 'it', 'does', 'not', 'secure', 'the', 'airway)', 'and', '3', '(observation', 'in', 'these', 'cases,', 'waiting', 'for', 'worsening,', 'only', 'leads', 'to', 'increased', 'morbidity', 'and', 'mortality).'], ['Between', 'options', '2', 'and', '4', 'there', 'could', 'be', 'controversy', 'between', 'the', 'literature', 'and', 'the', 'usual', 'clinical', 'practice,', 'in', 'which', 'we', 'usually', 'have', 'to', 'face', 'in', 'a', 'delicate', 'balance', 'the', 'clinical', 'stability', 'of', 'the', 'patient', '(and', 'what', 'we', 'can', '"make', 'up"', 'this', 'stability', 'with', 'our', 'life', 'support', 'therapies)', 'and', 'the', 'actions', 'that', 'result', 'in', 'better', 'patient', 'care', 'for', 'the', 'definitive', 'treatment', 'of', 'the', 'lesions.'], ['We', 'are', 'dealing', 'with', 'a', 'severe', 'polytraumatized', 'patient.'], ['With', 'the', 'data', 'provided', 'by', 'the', 'question,', 'a', 'patient', 'who', 'seems', 'to', 'be', 'in', 'shock', '(tachycardia,', 'hypoxemia,', 'tachypnea...', 'although', 'we', 'do', 'not', 'receive', 'data,', 'for', 'example,', 'on', 'lactacidemia),', 'and', 'in', 'whom', 'we', 'have', 'to', 'our', 'knowledge', 'a', 'left', 'thoracic', 'trauma,', 'which', 'not', 'only', 'implies', 'bone', 'injury,', 'but', 'may', 'mask', 'other', 'injuries', 'of', 'high', 'severity', 'and', 'which', 'are', 'not', 'diagnosed', 'with', 'a', 'chest', 'X-ray:', 'myocardial', 'contusion,', 'pericardial', 'effusion,', 'splenic', 'injury,', 'diaphragmatic', 'injury...'], ['We', 'place', 'a', 'left', 'pleural', 'drain', 'on', 'the', 'patient', 'and', 'obtain', 'a', 'debit', 'of', '1700cc', 'of', 'hematic', 'fluid.'], ['If', 'we', 'follow', 'the', 'ATLS', '(ATLS-Advanced', 'Trauma', 'Life', 'Support', '10th', 'edition)', 'guidelines', 'for', 'the', 'care', 'of', 'severely', 'polytraumatized', 'patients,', 'they', 'tell', 'us', 'that', 'an', 'immediate', 'bleeding', 'of', 'more', 'than', '1500cc', 'of', 'blood', 'is', 'an', 'indication', 'for', 'urgent', 'thoracotomy,', 'and', 'that', 'even', 'in', 'patients', 'with', 'a', 'bleeding', 'of', 'less', 'than', '1500cc,', 'if', 'the', 'debit', 'persists', 'at', 'a', 'rate', 'of', '200mL/h', 'for', '2', 'to', '4h,', 'this', 'indication', 'would', 'also', 'exist.'], ['Therefore,', 'the', 'person', 'who', 'asked', 'the', 'MIR', 'question', 'wants', 'us', 'to', 'answer', 'option', '2.'], ['However,', 'in', 'real', 'life,', 'the', 'course', 'of', 'action', 'will', 'depend', 'on', 'the', 'stability', 'of', 'the', 'patient', 'when', 'we', 'have', 'applied', 'the', 'treatments', 'indicated', 'in', 'option', '2:', 'adequate', 'analgesia,', 'oxygen', 'therapy', 'and', 'initiation', 'of', 'blood', 'transfusion.'], ['If', 'by', 'optimizing', 'the', 'patient', 'we', 'manage', 'to', 'stabilize', 'him', 'and', 'assess', 'that', 'it', 'is', 'safe', 'to', 'transfer', 'him,', 'the', 'performance', 'of', 'a', 'body', 'CT', 'scan', 'will', 'define', 'in', 'much', 'greater', 'detail', 'the', 'lesions', 'he', 'has,', 'and', 'will', 'help', 'to', 'ensure', 'that', 'the', 'surgery', 'he', 'will', 'probably', 'end', 'up', 'undergoing', 'will', 'be', 'a', 'definitive', 'surgery', 'and', 'not', 'just', 'damage', 'control', 'surgery.'], ['In', 'this', 'case,', 'the', 'doubt', 'would', 'arise', 'with', 'option', '4,', 'although,', 'as', 'I', 'say,', 'everything', 'will', 'depend', 'on', 'the', 'clinical', 'stability', 'of', 'the', 'patient', 'and', 'the', 'time', 'we', 'have', 'before', 'achieving', 'definitive', 'control', 'of', 'the', 'hemorrhagic', 'focus', '(which', 'is,', 'after', 'all,', 'what', 'we', 'are', 'after', 'in', 'this', 'situation).']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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'], ['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', 'I-Claim', '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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Claim', 'I-Claim', 'I-Claim', '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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['There are two answers that we can immediately rule out if we stick to the initial management of severe chest trauma: 1 (noninvasive ventilation is not indicated because it does not secure the airway) and 3 (observation in these cases, waiting for worsening, only leads to increased morbidity and mortality)\n', 'Institute noninvasive mechanical ventilation and request blood transfusion\n', 'Attack'], ['There are two answers that we can immediately rule out if we stick to the initial management of severe chest trauma: 1 (noninvasive ventilation is not indicated because it does not secure the airway) and 3 (observation in these cases, waiting for worsening, only leads to increased morbidity and mortality)\n', 'Orotracheal intubation, request blood transfusion and observation for, in case of worsening, indicate surgical intervention\n', 'Attack'], ['tachycardia, hypoxemia, tachypnea... although we do not receive data, for example, on lactacidemia\n', 'With the data provided by the question, a patient who seems to be in shock (tachycardia, hypoxemia, tachypnea... although we do not receive data, for example, on lactacidemia), and in whom we have to our knowledge a left thoracic trauma, which not only implies bone injury, but may mask other injuries of high severity and which are not diagnosed with a chest X-ray: myocardial contusion, pericardial effusion, splenic injury, diaphragmatic injury...\n', 'Support'], ['We place a left pleural drain on the patient and obtain a debit of 1700cc of hematic fluid\n', 'If we follow the ATLS (ATLS-Advanced Trauma Life Support 10th edition) guidelines for the care of severely polytraumatized patients, they tell us that an immediate bleeding of more than 1500cc of blood is an indication for urgent thoracotomy\n', 'Support'], ['If we follow the ATLS (ATLS-Advanced Trauma Life Support 10th edition) guidelines for the care of severely polytraumatized patients, they tell us that an immediate bleeding of more than 1500cc of blood is an indication for urgent thoracotomy\n', 'Therefore, the person who asked the MIR question wants us to answer option 2\n', 'Support'], ['even in patients with a bleeding of less than 1500cc, if the debit persists at a rate of 200mL/h for 2 to 4h, this indication would also exist\n', 'Therefore, the person who asked the MIR question wants us to answer option 2\n', 'Support'], ['Therefore, the person who asked the MIR question wants us to answer option 2\n', 'Analgesia, oxygen therapy, request blood transfusion and indicate urgent surgery\n', 'Support'], ['However, in real life, the course of action will depend on the stability of the patient when we have applied the treatments indicated in option 2: adequate analgesia, oxygen therapy and initiation of blood transfusion\n', 'Analgesia, oxygen therapy, request blood transfusion and indicate urgent surgery\n', 'Support'], ['However, in real life, the course of action will depend on the stability of the patient when we have applied the treatments indicated in option 2: adequate analgesia, oxygen therapy and initiation of blood transfusion\n', 'If by optimizing the patient we manage to stabilize him and assess that it is safe to transfer him, the performance of a body CT scan will define in much greater detail the lesions he has, and will help to ensure that the surgery he will probably end up undergoing will be a definitive surgery and not just damage control surgery\n', 'Support'], ['If by optimizing the patient we manage to stabilize him and assess that it is safe to transfer him, the performance of a body CT scan will define in much greater detail the lesions he has, and will help to ensure that the surgery he will probably end up undergoing will be a definitive surgery and not just damage control surgery\n', 'In this case, the doubt would arise with option 4\n', 'Support'], ['although, as I say, everything will depend on the clinical stability of the patient and the time we have before achieving definitive control of the hemorrhagic focus (which is, after all, what we are after in this situation)\n', 'In this case, the doubt would arise with option 4\n', 'Attack'], ['If by optimizing the patient we manage to stabilize him and assess that it is safe to transfer him, the performance of a body CT scan will define in much greater detail the lesions he has, and will help to ensure that the surgery he will probably end up undergoing will be a definitive surgery and not just damage control surgery\n', 'Orotracheal intubation and urgent CT scan for accurate assessment of lesions\n', 'Support'], ['In this case, the doubt would arise with option 4\n', 'Orotracheal intubation and urgent CT scan for accurate assessment of lesions\n', 'Support'], ['although, as I say, everything will depend on the clinical stability of the patient and the time we have before achieving definitive control of the hemorrhagic focus (which is, after all, what we are after in this situation)\n', 'Orotracheal intubation and urgent CT scan for accurate assessment of lesions\n', 'Attack']]
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234_105
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'man', 'comes', 'to', 'the', 'Emergency', 'Department', 'with', 'a', 'pathological', 'fracture', 'of', 'the', 'left', 'femur.'], ['After', 'surgery,', 'a', 'diagnostic', 'study', 'is', 'performed', 'to', 'determine', 'the', 'underlying', 'pathology', 'with', 'the', 'following', 'findings:', 'hemoglobin', '9.5', 'g/dl,', 'total', 'proteins', '11', 'g/dl,', '(VN:', '6-8', 'g/dl),', 'serum', 'albumin', '2', 'g/dl,', '(VN', '3.5-5.0', 'g/dl),', 'beta', '2', 'microglobulin', '6', 'mg/l', '(VN', '1.1-2.4', 'mg/l),', 'serum', 'creatinine', '1.8', 'mg/dl', '(VN:', '0.1-1.4', 'mg/dl).'], ['Indicate', 'which', 'diagnostic', 'tests', 'would', 'be', 'necessary', 'to', 'confirm', 'the', 'most', 'likely', 'diagnosis:'], ['1-', 'Radiological', 'bone', 'series', 'and', 'bone', 'marrow', 'aspirate.'], ['2-', 'Serum', 'and', 'urine', 'electrophoresis', 'and', 'renal', 'function', 'tests.'], ['3-', 'Bone', 'marrow', 'aspirate', 'and', 'serum', 'calcium', 'concentration.'], ['4-', 'Bone', 'marrow', 'aspirate', 'and', 'serum', 'and', 'urine', 'electrophoresis.'], ['5-', 'Biopsy', 'of', 'the', 'pathological', 'fracture', 'and', 'radiological', 'bone', 'series.'], ['CORRECT', 'ANSWER:', '4'], ['She', 'is', 'going', 'to', 'have', 'myeloma.'], ['For', 'diagnosis,', 'a', 'sample', '(bone', 'marrow)', 'and', 'electrophoresis', 'to', 'determine', 'the', 'type', 'of', 'monoclonal', 'peak.'], ['Then,', 'for', 'extension,', 'prognostic', 'value', 'and', 'to', 'decide', 'treatments,', 'the', 'rest,', 'but', 'once', 'diagnosed.']]
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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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['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'], ['B-Claim', 'I-Claim', '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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[['Then, for extension, prognostic value and to decide treatments, the rest, but once diagnosed\n', 'For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak\n', 'Support'], ['She is going to have myeloma\n', 'For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak\n', 'Support'], ['For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak\n', 'Bone marrow aspirate and serum and urine electrophoresis\n', 'Support']]
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174_52
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[['QUESTION', 'TYPE:', 'PNEUMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'man', 'consults', 'for', 'moderate', 'exertional', 'dyspnea', 'of', 'progressive', 'onset', 'in', 'recent', 'years.'], ['He', 'has', 'daily', 'whitish', 'expectoration', 'and', 'sometimes', 'breath', 'sounds,', 'especially', 'in', 'winter', 'with', 'respiratory', 'infections.'], ['He', 'has', 'been', 'a', 'smoker', 'of', 'about', '20', 'cigarettes', 'a', 'day', 'for', 'the', 'last', '45', 'years.'], ['On', 'examination', 'he', 'is', 'eupneic,', 'normocolored,', 'with', 'an', 'oxygen', 'saturation', 'of', '94%,', 'and', 'has', 'generalized', 'decreased', 'vesicular', 'murmur', 'on', 'chest', 'auscultation', 'as', 'the', 'only', 'findings', 'of', 'interest.'], ['Chest', 'X-ray', 'shows', 'an', 'elongated', 'cardiac', 'silhouette,', 'with', 'signs', 'of', 'hyperinflation', 'or', 'pulmonary', 'air', 'trapping,', 'without', 'other', 'alterations.'], ['Spirometry', 'was', 'performed', 'with', 'the', 'following', 'result:', 'FVC', '84%,', 'FEV1', '58%,', 'FEV1/FVC', '61%,', 'unchanged', 'after', 'bronchodilator.'], ['Among', 'those', 'indicated,', 'indicate', 'the', 'most', 'appropriate', 'treatment', 'for', 'this', 'patient:'], ['1-', 'Daily', 'inhaled', 'corticosteroid.'], ['2-', 'Home', 'oxygen', 'therapy', 'with', 'portable', 'oxygen', 'source', 'for', 'ambulation.'], ['3-', 'Oral', 'leukotriene', 'antagonist.'], ['4-', 'Oral', 'corticosteroid', 'for', 'three', 'months.'], ['5-', 'Inhaled', 'tiotropium.'], ['CORRECT', 'ANSWER:', '5'], ['In', 'a', 'patient', 'with', 'a', 'low', 'symptomatic', 'COPD', 'that', 'could', 'probably', 'be', 'classified', 'as', 'GOLD', '2,', 'the', 'starting', 'treatment', 'can', 'be', 'either', 'with', 'inhaled', 'tiotropium', 'or', 'with', 'a', 'long-acting', 'beta', 'two.'], ['Therefore', 'there', 'is', 'no', 'doubt', 'in', 'the', 'correct', 'answer.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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', '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'], ['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', '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']]
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[['In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n', 'Inhaled tiotropium\n', 'Support'], ['On examination he is eupneic, normocolored, with an oxygen saturation of 94%, and has generalized decreased vesicular murmur on chest auscultation as the only findings of interest\n', 'In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n', 'Support'], ['A 67-year-old man consults for moderate exertional dyspnea of progressive onset in recent years\n', 'In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n', 'Support'], ['He has daily whitish expectoration and sometimes breath sounds, especially in winter with respiratory infections\n', 'In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n', 'Support'], ['Chest X-ray shows an elongated cardiac silhouette, with signs of hyperinflation or pulmonary air trapping, without other alterations\n', 'In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n', 'Support']]
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143_141
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['Given', 'a', '7-month-old', 'child', 'with', 'fever', 'and', 'irritability,', 'bulging', 'fontanel', 'and', 'a', 'cerebrospinal', 'fluid', 'study', 'with', '110', 'cells/mm3', '(75%', 'lymphocytes),', 'protein', '120', 'mg/dl', 'and', 'glucose', '28', 'mg/dl', '(serum', 'glycemia', '89', 'mg/dl),', 'what', 'is', 'the', 'most', 'reasonable', 'diagnostic', 'suspicion?'], ['1-', 'Viral', 'meningitis.'], ['2-', 'Bacterial', 'meningitis.'], ['3-', 'Tuberculous', 'meningitis.'], ['4-', 'Mononucleosis', 'syndrome.'], ['5-', 'Guillain-Barre', 'syndrome.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['It', 'defines', 'a', 'typical', 'cerebrospinal', 'fluid', 'of', 'tuberculosis.'], ['In', 'clinical', 'practice', 'things', 'might', 'not', 'be', 'so', 'simple......']]
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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', '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-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']]
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[['The correct answer is 3\n', 'Tuberculous meningitis\n', 'Support'], ['It defines a typical cerebrospinal fluid of tuberculosis\n', 'Tuberculous meningitis\n', 'Support'], ['Given a 7-month-old child with fever and irritability, bulging fontanel and a cerebrospinal fluid study with 110 cells/mm3 (75% lymphocytes), protein 120 mg/dl and glucose 28 mg/dl (serum glycemia 89 mg/dl)\n', 'Tuberculous meningitis\n', 'Support']]
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9_36
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[['QUESTION', 'TYPE:', 'SURGERY'], ['CLINICAL', 'CASE:'], ['An', '87-year-old', 'patient', 'with', 'a', 'history', 'of', 'chronic', 'bronchitis', 'and', 'heart', 'failure,', 'has', 'been', 'diagnosed', 'with', 'acute', 'calculous', 'cholecystitis', '.'], ['After', 'four', 'days', 'of', 'treatment', 'with', 'absolute', 'diet,', 'serum', 'therapy', 'and', 'piperacillin/tazobactam,', 'the', 'patient', 'continues', 'with', 'fever,', 'persistent', 'abdominal', 'pain', 'and', 'leukocytosis.'], ['The', 'most', 'appropriate', 'attitude', 'at', 'this', 'time', 'would', 'be:'], ['1-', 'Surgical', 'treatment', '(urgent', 'cholecystectomy).'], ['2-', 'Biliary', 'drainage', 'by', 'percutaneous', 'cholecystostomy.'], ['3-', 'Substitute', 'metronidazole', '+', 'cefotaxime', 'for', 'piperacillin/tazobactam.'], ['4-', 'Replace', 'piperacillin/tazobactam', 'with', 'amikacin+clindamycin.'], ['5-', 'Add', 'gentamicin.'], ['CORRECT', 'ANSWER:', '2'], ['I', 'think', 'the', 'correct', 'answer', 'is', '2', 'although', 'the', 'treatment', 'for', 'acute', 'cholecystitis', 'is', 'cholecystectomy,', 'for', 'this', 'it', 'is', 'necessary', 'that', 'the', 'patient', 'is', 'a', 'surgical', 'candidate,', 'in', 'this', 'case', 'it', 'is', 'an', 'elderly', 'patient,', 'with', 'previous', 'diseases', 'that', 'increase', 'the', 'surgical', 'risk', 'and', 'would', 'be', 'an', 'ASA', 'IV', 'for', 'an', 'urgent', 'intervention.'], ['In', 'these', 'cases', 'cholecystostomy', 'can', 'cure', 'cholecystitis;', 'and', 'after', 'recovery,', 'assess', 'scheduled', 'surgery', 'according', 'to', 'the', "patient's", 'situation.']]
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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', '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'], ['O', 'B-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'], ['O', 'B-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', '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'], ['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']]
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[['I think the correct answer is 2\n', 'Biliary drainage by percutaneous cholecystostomy.\n', 'Support'], ['although the treatment for acute cholecystitis is cholecystectomy\n', 'I think the correct answer is 2\n', 'Support'], ['for this it is necessary that the patient is a surgical candidate, in this case it is an elderly patient, with previous diseases that increase the surgical risk and would be an ASA IV for an urgent intervention\n', 'I think the correct answer is 2\n', 'Support'], ['In these cases cholecystostomy can cure cholecystitis\n', 'I think the correct answer is 2\n', 'Support']]
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601_112
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '61-year-old', 'woman,', 'administrative,', 'with', 'a', 'history', 'of', 'overweight,', 'hypertension,', 'dyslipidemia', 'and', 'metabolic', 'syndrome,', 'who', 'consults', 'for', 'pain', 'in', 'both', 'buttocks,', 'left', 'trochanteric', 'region,', 'lateral', 'aspect', 'of', 'the', 'left', 'thigh', 'up', 'to', 'the', 'knee', 'and', 'left', 'leg', 'up', 'to', 'the', 'middle', 'third.'], ['The', 'pain', 'appears', 'when', 'the', 'lower', 'limb', 'is', 'lifted', 'with', 'the', 'knee', 'extended,', 'but', 'is', 'relieved', 'when', 'the', 'knee', 'is', 'flexed.'], ['What', 'is', 'the', 'first', 'clinical', 'suspicion?'], ['1-', 'Gouty', 'arthritis', 'of', 'the', 'left', 'hip.'], ['2-', 'Left', 'coxofemoral', 'arthrosis.'], ['3-', 'Radiated', 'low', 'back', 'pain', '/', 'lumbosciatica.'], ['4-', 'Claudication', 'due', 'to', 'canal', 'stenosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Positive', "Lasegue's", 'sign,', 'reappearance', 'of', 'the', 'symptoms', 'when', 'performing', 'the', 'extension', 'maneuver', 'of', 'the', 'affected', 'limb,', 'compatible', 'with', 'involvement', 'of', 'nerve', 'roots', 'at', 'the', 'lumbosacral', 'spine', 'level.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-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', '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 pain appears when the lower limb is lifted with the knee extended, but is relieved when the knee is flexed\n', "Positive Lasegue's sign, reappearance of the symptoms when performing the extension maneuver of the affected limb, compatible with involvement of nerve roots at the lumbosacral spine level\n", 'Support'], ["Positive Lasegue's sign, reappearance of the symptoms when performing the extension maneuver of the affected limb, compatible with involvement of nerve roots at the lumbosacral spine level\n", 'Radiated low back pain / lumbosciatica\n', 'Support']]
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202_44
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[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Patient', 'with', 'acute', 'pancreatitis.'], ['Computerized', 'Axial', 'Tomography', '(CAT)', 'performed', '72', 'hours', 'after', 'admission', 'showed', 'necrosis', 'of', '50%', 'of', 'the', 'pancreas.'], ['At', 'the', '3rd', 'week', 'of', 'admission', 'the', 'patient', 'began', 'with', 'high', 'fever', 'and', 'leukocytosis.'], ['Urgent', 'chest', 'X-ray', 'and', 'urinary', 'sediment', 'are', 'requested,', 'both', 'being', 'normal.'], ['Indicate', 'the', 'next', 'step', 'to', 'follow:'], ['1-', 'Fine', 'needle', 'aspiration', 'of', 'pancreatic', 'necrosis', 'guided', 'by', 'ultrasound', 'or', 'CT.'], ['2-', 'Bronchoalveolar', 'aspirate,', 'urine', 'culture', 'and', 'blood', 'cultures.'], ['3-', 'Abdominal', 'MRI.'], ['4-', 'Urgent', 'cholecystectomy.'], ['5-', 'Echoendoscopy', 'with', 'puncture', 'of', 'the', 'necrosis.'], ['CORRECT', 'ANSWER:', '1'], ['Although', 'the', 'latest', 'recommendations', 'on', 'the', 'management', 'of', 'severe', 'acute', 'pancreatitis', 'advise', 'against', 'FNA', 'because', 'of', 'the', 'risk', 'of', 'infection', 'of', 'sterile', 'necrosis.'], ['Current', 'management', 'is', 'governed', 'by', 'stepwise', 'treatment.'], ['In', 'the', 'situation', 'described', 'in', 'the', 'question', 'the', 'current', 'treatment', 'is', 'to', 'start', 'antibiotics', 'and', 'assess', 'response.']]
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[['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'], ['B-Premise', 'I-Premise', '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', '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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', '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']]
|
[['Although the latest recommendations on the management of severe acute pancreatitis advise against FNA because of the risk of infection of sterile necrosis\n', 'Fine needle aspiration of pancreatic necrosis guided by ultrasound or CT\n', 'Attack']]
|
259_97
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'man', 'who', 'goes', 'for', 'a', 'check-up', 'at', 'his', 'company.'], ['A', 'body', 'mass', 'index', 'of', '32.8', 'kg/m2', 'and', 'fasting', 'blood', 'glucose', 'of', '138', 'mg/l', 'were', 'detected.'], ['One', 'month', 'later,', 'glycemia', '13', 'mg/dl.'], ['Which', 'therapeutic', 'recommendation', 'would', 'you', 'make', 'first?'], ['1-', 'Administer', 'metformin.'], ['2-', 'Prescribe', 'a', 'sulfonylurea.'], ['3-', 'Behavioral', 'changes.', 'Diet', 'and', 'physical', 'exercise.'], ['4-', 'Insulin', 'before', 'each', 'meal.'], ['5-', 'Take', 'acarbose', 'at', 'night,', 'before', 'going', 'to', 'bed.'], ['CORRECT', 'ANSWER:', '3'], ['Behavioral', 'changes:', 'diet', 'and', 'physical', 'exercise.'], ['This', 'is', 'the', 'first', 'thing', 'we', 'do', 'when', 'diagnosed', 'with', 'type', '2', 'diabetes.'], ['This', 'is', 'a', 'good', 'question', 'to', 'remember', 'that', 'before', 'any', 'drug,', 'we', 'must', 'insist', 'on', 'changing', 'habits.'], ['Then', 'we', 'would', 'prescribe', 'Metformin.']]
|
[['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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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'], ['O', 'O', 'O'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
|
[['This is the first thing we do when diagnosed with type 2 diabetes\n', 'Behavioral changes: diet and physical exercise\n', 'Support'], ['This is a good question to remember that before any drug, we must insist on changing habits\n', 'Behavioral changes: diet and physical exercise\n', 'Support'], ['Behavioral changes: diet and physical exercise\n', 'Behavioral changes. Diet and physical exercise\n', 'Support']]
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204_220
|
[['QUESTION', 'TYPE:', 'GENETICS', 'AND', 'IMMUNOLOGY'], ['CLINICAL', 'CASE:'], ['A', '43-year-old', 'man', 'consults', 'for', 'diarrheal', 'syndrome,', 'and', 'refers', 'among', 'his', 'history', '3', 'pneumonias', 'in', 'adulthood.'], ['Which', 'of', 'the', 'following', 'immunological', 'studies', 'should', 'we', 'request:'], ['1-', 'Serum', 'immunoglobulin', 'count', 'and', 'antibody', 'production', 'capacity', 'test.'], ['2-', 'Phagocytosis', 'test', 'and', 'oxidative', 'metabolism', 'of', 'neutrophils.'], ['3-', 'Apoptosis', 'test', '(programmed', 'cell', 'death)', 'in', 'the', "patient's", 'circulating', 'lymphocytes.'], ['4-', 'Study', 'of', 'the', 'repertoire', 'and', 'clonality', 'of', 'T', 'lymphocytes', '(alpha/beta).'], ['5-', 'In', 'this', 'patient', 'it', 'would', 'not', 'be', 'appropriate', 'to', 'request', 'any', 'immunological', 'study.'], ['CORRECT', 'ANSWER:', '1'], ['More', 'than', '2', 'lobar', 'pneumonias', 'make', 'it', 'necessary', 'to', 'rule', 'out', 'an', 'immunologic', 'deficit.']]
|
[['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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['More than 2 lobar pneumonias make it necessary to rule out an immunologic deficit\n', 'Serum immunoglobulin count and antibody production capacity test\n', 'Support']]
|
4_40
|
[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', 'man', 'presents', 'abruptly', 'with', 'asthenia', 'and', 'jaundice', 'with', 'transaminases', 'above', '2000', 'IU/L.'], ['Serological', 'markers', 'show', 'the', 'following', 'pattern:', 'anti-HAV', 'IgM', 'negative,', 'HBsAg', 'negative', 'anti-HBc', 'IgM', 'positive,', 'anti-HCV', 'negative.'], ['What', 'is', 'the', 'diagnosis?'], ['1-', 'Chronic', 'hepatitis', 'B.'], ['2-', 'Non-viral', 'acute', 'hepatitis.'], ['3-', 'Acute', 'hepatitis', 'B.'], ['4-', 'D', '(delta)', 'virus', 'superinfection.'], ['5-', 'Acute', 'hepatitis', 'A', 'and', 'B.'], ['CORRECT', 'ANSWER:', '3'], ['An', 'interesting', 'one', 'that', 'in', 'general', 'needs', 'to', 'be', 'studied.'], ['By', 'the', 'form', 'of', 'presentation,', 'it', 'is', 'clearly', 'an', 'acute', 'hepatitis,', 'so', 'option', '1', 'is', 'ruled', 'out.'], ['The', 'negative', 'IgM', 'of', 'HAV', 'rules', 'out', '5', 'and', 'the', 'negative', 'HBs', 'Ag', 'rules', 'out', '4', '(to', 'have', 'delta', 'virus', 'you', 'need', 'surface', 'antigen', 'B).'], ['When', 'having', 'IgM', 'anti', 'HBc', 'we', 'speak', 'of', 'an', 'acute', 'hepatitis', 'B', '(3),', 'since', 'there', 'is', 'a', 'window', 'period', 'of', 'negativization', 'of', 'the', 'antigen.']]
|
[['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', 'I-Premise'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-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', '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', 'I-Claim', 'O', 'B-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-Claim', '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', 'I-Premise', 'I-Premise', 'I-Premise']]
|
[['By the form of presentation, it is clearly an acute hepatitis\n', 'option 1 is ruled out\n', 'Support'], ['option 1 is ruled out\n', 'Chronic hepatitis B\n', 'Attack'], ['By the form of presentation, it is clearly an acute hepatitis\n', 'Chronic hepatitis B\n', 'Attack'], ['to have delta virus you need surface antigen B\n', 'the negative HBs Ag rules out 4\n', 'Support'], ['the negative HBs Ag rules out 4\n', 'D (delta) virus superinfection\n', 'Attack'], ['The negative IgM of HAV rules out 5\n', 'Acute hepatitis A and B\n', 'Attack'], ['When having IgM anti HBc we speak of an acute hepatitis B (3)\n', 'Acute hepatitis B\n', 'Support'], ['there is a window period of negativization of the antigen\n', 'When having IgM anti HBc we speak of an acute hepatitis B (3)\n', 'Support']]
|
372_127
|
[['QUESTION', 'TYPE:', 'PNEUMOLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['55-year-old', 'man', 'who', 'consults', 'for', 'dysphonia.'], ['In', 'the', 'anamnesis', 'he', 'refers', 'to', 'a', 'month', 'of', 'asthenia', 'and', 'unquantified', 'weight', 'loss.'], ['Chest', 'X-ray', 'shows', 'increased', 'density', 'in', 'the', 'left', 'upper', 'lobe', 'and', 'occupation', 'of', 'the', 'aortopulmonary', 'window.'], ['Bronchoscopy', 'shows', 'paralysis', 'of', 'the', 'left', 'vocal', 'cord,', 'without', 'endoscopic', 'image', 'suggestive', 'of', 'neoplasia.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Pulmonary', 'neoplasia.'], ['2-', 'Sarcoidosis.'], ['3-', 'Silicosis.'], ['4-', 'Tuberculosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'most', 'frequent', 'cause', 'of', 'recurrent', 'nerve', 'palsy', 'is', 'bronchopulmonary', 'carcinoma.'], ['The', 'fact', 'that', 'it', 'is', 'not', 'accessible', 'to', 'endoscopic', 'vision', 'does', 'not', 'mean', 'that', 'it', 'is', 'not', 'there.']]
|
[['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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 fact that it is not accessible to endoscopic vision does not mean that it is not there\n', 'The most frequent cause of recurrent nerve palsy is bronchopulmonary carcinoma\n', 'Support'], ['The most frequent cause of recurrent nerve palsy is bronchopulmonary carcinoma\n', 'Pulmonary neoplasia\n', 'Support']]
|
377_131
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'female', 'patient', 'debuted', 'two', 'years', 'earlier', 'with', 'an', 'apraxia', 'of', 'speech', 'and', 'has', 'developed', 'rigid-akinetic', 'parkinsonism', 'predominantly', 'in', 'the', 'right', 'hemibody', 'with', 'superimposed', 'myoclonias', 'and', 'alien', 'hand', 'or', 'foreign', 'limb', 'phenomenon.What', 'diagnosis', 'do', 'you', 'consider', 'most', 'likely?'], ['1-', "Parkinson's", 'disease.'], ['2-', 'Corticobasal', 'degeneration.'], ['3-', "Alzheimer's", 'disease.'], ['4-', "Huntington's", 'disease.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['As', 'it', 'is', 'described', 'as', 'an', 'apraxic', 'phenomenon', 'followed', 'by', 'an', 'asymmetric', 'rigid-akinetic', 'parkinsonism', 'and', 'with', 'superimposed', 'myoclonias,', 'it', 'is', 'typical', 'of', 'corticobasal', 'degeneration.'], ["Parkinson's", 'disease', 'cannot', 'be', 'because', 'they', 'do', 'not', 'present', 'apraxia', 'as', 'initial', 'feature,', "Alzheimer's", 'disease', 'does', 'not', 'present', 'an', 'asymmetric', 'parkinsonism', 'and', 'the', 'typical', "Huntinton's", 'disease', 'is', 'not', 'of', 'so', 'old', 'people', 'and', 'when', 'it', 'debuts', 'with', 'advanced', 'age', 'it', 'behaves', 'like', 'a', 'chorea.']]
|
[['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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', '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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
|
[['it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias\n', 'it is typical of corticobasal degeneration\n', 'Support'], ['it is typical of corticobasal degeneration\n', 'Corticobasal degeneration\n', 'Support'], ['it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias\n', 'they do not present apraxia as initial feature\n', 'Attack'], ['they do not present apraxia as initial feature\n', "Parkinson's disease cannot be\n", 'Support'], ["Parkinson's disease cannot be\n", "Parkinson's disease\n", 'Attack'], ['it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias\n', "Alzheimer's disease does not present an asymmetric parkinsonism\n", 'Attack'], ["Alzheimer's disease does not present an asymmetric parkinsonism\n", "Alzheimer's disease\n", 'Attack'], ['A 65-year-old female patient debuted two years earlier with an apraxia of speech and has developed rigid-akinetic parkinsonism predominantly in the right hemibody with superimposed myoclonias and alien hand or foreign limb phenomenon\n', "typical Huntinton's disease is not of so old people and when it debuts with advanced age it behaves like a chorea\n", 'Attack'], ["typical Huntinton's disease is not of so old people and when it debuts with advanced age it behaves like a chorea\n", "Huntington's disease\n", 'Attack']]
|
145_143
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '1', 'month', 'old', 'infant,', 'exclusively', 'breastfed,', 'consults', 'because', 'he', 'has', 'a', 'bowel', 'movement', 'every', '5', 'or', '6', 'days', 'with', 'straining', 'but', 'with', 'a', 'soft', 'consistency,', 'what', 'would', 'our', 'attitude', 'be?'], ['1-', 'Start', 'laxative', 'treatment.'], ['2-', 'Supplement', 'breastfeeding', 'with', 'anti-constipation', 'formula.'], ['3-', 'Start', 'daily', 'rectal', 'stimulation.'], ['4-', 'It', 'is', 'considered', 'normal', 'intestinal', 'rhythm.'], ['5-', 'Refer', 'to', 'Pediatric', 'Digestive', 'to', 'rule', 'out', 'aganglionic', 'megacolon.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'correct', 'answer', 'is', '4.'], ['The', 'normal', 'range', 'of', 'stool', 'output', 'in', 'young', 'infants', 'is', 'very', 'wide.'], ['To', 'suspect', 'aganglionic', 'megacolon', 'there', 'is', 'usually', 'a', 'delay', 'in', 'the', 'evacuation', 'of', 'meconium', 'and', 'often', 'other', 'associated', 'symptoms', 'such', 'as', 'abdominal', 'distension,', 'difficulty', 'in', 'gaining', 'weight,', 'etc.']]
|
[['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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 4\n', 'It is considered normal intestinal rhythm\n', 'Support'], ['The normal range of stool output in young infants is very wide\n', 'The correct answer is 4\n', 'Support'], ['To suspect aganglionic megacolon there is usually a delay in the evacuation of meconium and often other associated symptoms such as abdominal distension, difficulty in gaining weight, et\n', 'Refer to Pediatric Digestive to rule out aganglionic megacolon\n', 'Attack'], ['A 1 month old infant, exclusively breastfed, consults because he has a bowel movement every 5 or 6 days with straining but with a soft consistency\n', 'It is considered normal intestinal rhythm\n', 'Support']]
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567_150
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '47-year-old', 'woman', 'consults', 'for', 'voiding', 'syndrome.'], ['She', 'is', 'diagnosed', 'with', 'uncomplicated', 'urinary', 'tract', 'infection', 'and', 'treated', 'with', 'ciprofloxacin', 'for', '5', 'days.'], ['A', 'week', 'later,', 'she', 'consulted', 'again', 'for', 'general', 'malaise,', 'arthralgias', 'and', 'the', 'appearance', 'of', 'a', 'skin', 'rash.'], ['In', 'the', 'analytical', 'analysis,', 'the', 'glomerular', 'filtration', 'rate', 'was', '45', 'ml/min', '(CKD-EPI),', 'whereas', '6', 'months', 'ago', 'it', 'was', '100', 'ml/min.'], ['In', 'the', 'sediment', 'leukocytes', 'are', 'identified,', 'being', 'negative', 'for', 'nitrites.'], ['Of', 'the', 'following,', 'which', 'is', 'the', 'most', 'probable', 'cause', 'of', 'his', 'renal', 'failure?'], ['1-', 'Postinfectious', 'glomerulonephritis.'], ['2-', 'Ciprofloxacin', 'nephrotoxicity.'], ['3-', 'Acute', 'pyelonephritis.'], ['4-', 'Acute', 'interstitial', 'nephritis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['General', 'malaise,', 'arthralgias,', 'skin', 'rash,', 'acute', 'renal', 'failure', 'and', 'active', 'sediment', 'with', 'sterile', 'leukocyturia', 'following', 'the', 'intake', 'of', 'a', 'drug', 'is', 'highly', 'suggestive', 'of', 'AIN', '(option', '4', 'correct).'], ['Among', 'drugs,', 'antibiotics', 'are', 'the', 'most', 'frequent', 'cause,', 'and', 'ciprofloxacin', 'is', 'one', 'of', 'the', 'most', 'common.'], ['Direct', 'nephrotoxicity', 'is', 'very', 'rare', 'and', 'is', 'characterized', 'by', 'crystallization', 'in', 'the', 'renal', 'tubules', '(incorrect', 'option', '2).'], ['Postinfectious', 'glomerulonephritis', 'is', 'more', 'typical', 'of', 'children', 'and', 'adults', 'older', 'than', '60', 'years,', 'and', 'usually', 'manifests', 'with', 'hematuria', 'after', 'streptococcal', 'infections', '(option', '1', 'incorrect).'], ['Acute', 'pyelonephritis', 'would', 'have', 'been', 'presented', 'with', 'high', 'fever', 'and', 'renal', 'fossa', 'pain', '(option', '3', 'incorrect).']]
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[['O', 'O', 'O'], ['O', 'O'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', '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', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['A week later, she consulted again for general malaise, arthralgias and the appearance of a skin rash\n', 'General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n', 'Support'], ['In the sediment leukocytes are identified, being negative for nitrites\n', 'General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n', 'Support'], ['General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n', 'option 4 correct\n', 'Support'], ['General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n', 'Acute interstitial nephritis\n', 'Support'], ['option 4 correct\n', 'Acute interstitial nephritis\n', 'Support'], ['Among drugs, antibiotics are the most frequent cause, and ciprofloxacin is one of the most common\n', 'General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n', 'Support'], ['She is diagnosed with uncomplicated urinary tract infection and treated with ciprofloxacin for 5 days\n', 'Among drugs, antibiotics are the most frequent cause, and ciprofloxacin is one of the most common\n', 'Support'], ['Direct nephrotoxicity is very rare and is characterized by crystallization in the renal tubules\n', 'Ciprofloxacin nephrotoxicity\n', 'Attack'], ['incorrect option 2\n', 'Ciprofloxacin nephrotoxicity\n', 'Attack'], ['Direct nephrotoxicity is very rare and is characterized by crystallization in the renal tubules\n', 'incorrect option 2\n', 'Support'], ['A 47-year-old woman consults for voiding syndrome\n', 'Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after streptococcal infections\n', 'Attack'], ['Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after streptococcal infections\n', 'option 1 incorrect\n', 'Support'], ['option 1 incorrect\n', 'Postinfectious glomerulonephritis\n', 'Attack'], ['Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after streptococcal infections\n', 'Postinfectious glomerulonephritis\n', 'Attack'], ['Acute pyelonephritis would have been presented with high fever and renal fossa pain\n', 'option 3 incorrect\n', 'Support'], ['Acute pyelonephritis would have been presented with high fever and renal fossa pain\n', 'Acute pyelonephritis\n', 'Attack'], ['option 3 incorrect\n', 'Acute pyelonephritis\n', 'Attack']]
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177_93
|
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '30-year-old', 'woman,', 'asymptomatic,', 'is', 'found', 'to', 'be', 'anemic', 'on', 'routine', 'examination.'], ['Physical', 'examination', 'reveals', 'conjunctival', 'jaundice', 'and', 'splenomegaly.'], ['The', 'patient', 'refers', 'to', 'a', 'family', 'history', 'of', 'biliary', 'lithiasis', 'at', 'an', 'early', 'age.'], ['All', 'this', 'suggests', 'the', 'most', 'probable', 'diagnosis', 'of:'], ['1-', 'Glucose', '6-phosphate', 'dehydrogenase', 'deficiency.'], ['2-', 'Thalassemia', 'minor.'], ['3-', 'Vitamin', 'Bl2', 'and/or', 'folic', 'acid', 'deficiency.'], ['4-', 'Familial', 'pyruvate', 'kinase', 'deficiency.'], ['5-', 'Hereditary', 'spherocytosis.'], ['CORRECT', 'ANSWER:', '5'], ['You', 'have', 'probably', 'looked', 'at', 'answer', '5,', 'hereditary', 'spherocytosis,', 'associated', 'with', 'biliary', 'lithiasis', 'at', 'an', 'early', 'age.'], ['Exactly,', 'that', 'is', 'the', 'correct', 'one.'], ['In', 'the', 'statement', 'they', 'have', 'not', 'stopped', 'giving', 'clues:', 'conjunctival', 'jaundice,', 'splenomegaly', 'and', 'family', 'history', 'of', 'biliary', 'lithiasis', 'at', 'an', 'early', 'age.'], ['He', 'has', 'reached', '30', 'years', 'of', 'age', 'without', 'suffering', 'a', 'hemolytic', 'crisis,', 'without', 'suffering', 'any', 'symptoms.'], ['There', 'was', 'no', 'mention', 'of', 'microcytosis', 'or', 'macrocytosis', 'to', 'suggest', 'thalassemia', 'minor', 'or', 'B12', 'and/or', 'folic', 'acid', 'deficiency.'], ['Nor', 'of', 'hemolytic', 'crisis', 'associated', 'with', 'the', 'consumption', 'of', 'drugs,', 'infections', 'or', 'ingestion', 'of', 'beans', 'or', 'peas.'], ['They', 'have', 'not', 'given', 'any', 'clues', 'to', 'stop', 'to', 'think', 'about', 'other', 'possibilities.']]
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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'], ['B-Premise', 'I-Premise', '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'], ['O', 'B-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'], ['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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']]
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[['You have probably looked at answer 5, hereditary spherocytosis, associated with biliary lithiasis at an early age\n', 'Hereditary spherocytosis\n', 'Support'], ['The patient refers to a family history of biliary lithiasis at an early age\n', 'You have probably looked at answer 5, hereditary spherocytosis, associated with biliary lithiasis at an early age\n', 'Support'], ['Physical examination reveals conjunctival jaundice and splenomegaly\n', 'In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age\n', 'Support'], ['The patient refers to a family history of biliary lithiasis at an early age\n', 'In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age\n', 'Support'], ['In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age\n', 'Hereditary spherocytosis\n', 'Support'], ['There was no mention of microcytosis or macrocytosis to suggest thalassemia minor or B12 and/or folic acid deficiency\n', 'Thalassemia minor\n', 'Attack'], ['There was no mention of microcytosis or macrocytosis to suggest thalassemia minor or B12 and/or folic acid deficiency\n', 'Vitamin Bl2 and/or folic acid deficiency\n', 'Attack']]
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125_105
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['19-year-old', 'woman,', 'weight', '60', 'kg,', 'with', 'acute', 'dehydration', 'due', 'to', 'long', 'exposure', 'to', 'the', 'sun.'], ['Blood', 'pressure', 'lying', 'down', '100/60', 'mmHg.'], ['Standing', '70/50', 'mmHg', 'with', 'dizziness.'], ['Serum', 'sodium', 'levels', '155', 'mmol/L.'], ['What', 'is', 'the', 'most', 'correct', 'treatment,', 'in', 'the', 'first', '24', 'hours,', 'taking', 'into', 'account', 'the', 'data', 'available', 'to', 'us?'], ['1-', 'Hypertonic', 'saline', '(3%),', '500', 'ml', '+', '500', 'ml', 'of', '5%', 'glucose.'], ['2-', 'Hyposaline', 'saline', '(0.45%),', '3000', 'ml.'], ['3-', 'Serum', 'glucose', '5%', '1000', 'ml.'], ['4-', 'Oral', 'hydration', 'with', '1', 'liter', 'of', 'water.'], ['5-', 'Isotonic', 'saline', '(0.9%),', '2000', 'ml.'], ['CORRECT', 'ANSWER:', '2'], ['This', 'question', 'is', 'not', 'an', 'easy', 'one.'], ['The', 'available', 'literature', 'is', 'somewhat', 'controversial', '(some', 'guidelines', 'advise', 'using', 'glucose', 'saline,', 'others', 'absolutely', 'forbid', 'it...)', 'so', 'I', 'have', 'decided', 'to', 'rely', 'on', 'the', 'treatment', 'recommended', 'by', 'Harrison,', 'which', 'is', 'the', 'manual', 'that', 'MIR', 'examiners', 'usually', 'rely', 'on.'], ['This', 'girl', 'presents', 'with', 'hypernatremia', 'due', 'to', 'extrarenal', 'free', 'water', 'losses.'], ['The', 'goal', 'is', 'to', 'replace', 'the', 'lost', 'water', 'and', 'reduce', 'the', 'natremia', 'at', 'a', 'rate', 'of', 'no', 'more', 'than', '12', 'mmol/day.'], ['To', 'calculate', 'fluid', 'therapy,', 'the', 'water', 'deficit', 'must', 'first', 'be', 'calculated.'], ['Water', 'def.', 'Water', '=', '(Natremia-140/140)xTotal', 'body', 'water.', 'TBW', '=', 'Weight', 'in', 'kg', 'x', '0.4', 'in', 'females/0.5', 'in', 'males.'], ['In', 'this', 'case,', 'the', 'water', 'deficit', 'is:', '([[tel:155-140/140|155-140/140]])x60x0.4', '=', '2.57', 'liters.'], ['There', 'are', 'only', 'two', 'answers', 'that', 'come', 'close', 'to', 'this', 'figure,', 'but', '2', 'seems', 'more', 'correct,', 'as', 'it', 'is', 'the', 'only', 'one', 'that', 'completely', 'covers', 'the', 'water', 'deficit', 'and', 'uses', 'a', 'hyposodium', 'solution.']]
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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'], ['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', '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'], ['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', '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', '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', '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'], ['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'], ['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']]
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[['The available literature is somewhat controversial (some guidelines advise using glucose saline\n', 'Hypertonic saline (3%), 500 ml + 500 ml of 5% glucose\n', 'Support'], ['others absolutely forbid it\n', 'Hypertonic saline (3%), 500 ml + 500 ml of 5% glucose\n', 'Attack'], ['Serum sodium levels 155 mmol/L\n', 'This girl presents with hypernatremia due to extrarenal free water losses\n', 'Support'], ['There are only two answers that come close to this figure, but 2 seems more correct, as it is the only one that completely covers the water deficit and uses a hyposodium solution\n', 'Hyposaline saline (0.45%), 3000 ml\n', 'Support']]
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510_151
|
[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', '43-year-old', 'male', 'with', 'no', 'past', 'history', 'of', 'interest', 'consults', 'for', 'a', 'ten-day', 'history', 'of', 'jaundice', 'of', 'the', 'skin', 'and', 'mucous', 'membranes,', 'choluria', 'and', 'acholia.'], ['He', 'does', 'not', 'report', 'abdominal', 'pain,', 'weight', 'loss', 'or', 'other', 'symptoms,', 'except', 'generalized', 'pruritus.'], ['She', 'denies', 'alcohol', 'consumption.'], ['She', 'does', 'not', 'take', 'any', 'medication', 'except', 'occasional', 'ibuprofen', 'for', 'muscle', 'pain', 'after', 'sports', 'activities.'], ['The', 'CBC', 'shows', 'increased', 'bilirubin', 'at', 'the', 'expense', 'of', 'direct', 'bilirubin.'], ['An', 'urgent', 'ultrasound', 'shows', 'a', 'normal', 'liver,', 'vesicular', 'cholesterosis', 'and', 'absence', 'of', 'bile', 'duct', 'dilatation,', 'with', 'no', 'other', 'alterations', 'of', 'interest.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Acute', 'cholangitis', 'due', 'to', 'biliary', 'mud.'], ['2-', 'Toxic', 'hepatitis', 'due', 'to', 'ibuprofen.'], ['3-', 'Cholangiocarcinoma.'], ['4-', "Gilbert's", 'syndrome.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'believe', 'that', 'this', 'question', 'is', 'open', 'to', 'challenge.'], ['Ibuprofen', 'hepatitis', 'is', 'a', 'rare', 'adverse', 'effect', 'with', 'a', 'prevalence', 'of', 'about', '3.7/100,000', 'users', 'and', '1.1/100,000', 'prescriptions.'], ['It', 'appears', 'that', 'it', 'may', 'be', 'related', 'to', 'dose', 'and', 'duration', 'of', 'treatment,', 'but', 'there', 'is', 'little', 'evidence', 'on', 'this.'], ['Among', 'the', 'NSAIDs', 'with', 'the', 'highest', 'risk', 'are', 'diclofenac', 'and', 'sulindac.'], ['In', 'terms', 'of', 'frequency,', 'the', 'prevalence', 'of', 'cholangiocarcinoma', 'is', '2/100,000', 'patients,', 'a', 'very', 'comparable', 'frequency.'], ['The', 'absence', 'of', 'bile', 'duct', 'dilatation', 'in', 'cholangiocarcinomas', 'can', 'be', 'seen', 'in', 'cases', 'of', 'intrahepatic', 'cholangiocarcinomas', 'or', 'in', 'those', 'with', 'mixed', 'histology', 'with', 'hepatocarcinoma.'], ['It', 'is', 'true', 'that', 'the', 'acute', 'course', 'and', 'the', 'absence', 'of', 'constitutional', 'syndrome', 'may', 'make', 'us', 'think', 'against', 'this', 'option', 'and', 'tip', 'the', 'balance', 'towards', 'ibuprofen', 'hepatitis.'], ['Regarding', 'the', 'other', 'options:', 'acute', 'cholangitis', 'is', 'characterized', 'by', 'the', 'triad', 'of', 'jaundice,', 'abdominal', 'pain', 'and', 'fever;', "Gilbert's", 'syndrome', 'is', 'an', 'increase', 'in', 'bilirubin', 'at', 'the', 'expense', 'of', 'indirectness.']]
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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'], ['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'], ['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'], ['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'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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']]
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[['An urgent ultrasound shows a normal liver, vesicular cholesterosis and absence of bile duct dilatation, with no other alterations of interest\n', 'The absence of bile duct dilatation in cholangiocarcinomas can be seen in cases of intrahepatic cholangiocarcinomas or in those with mixed histology with hepatocarcinoma\n', 'Support'], ['He does not report abdominal pain, weight loss or other symptoms, except generalized pruritus\n', 'It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n', 'Attack'], ['It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n', 'The absence of bile duct dilatation in cholangiocarcinomas can be seen in cases of intrahepatic cholangiocarcinomas or in those with mixed histology with hepatocarcinoma\n', 'Attack'], ['It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n', 'Toxic hepatitis due to ibuprofen\n', 'Support'], ['The absence of bile duct dilatation in cholangiocarcinomas can be seen in cases of intrahepatic cholangiocarcinomas or in those with mixed histology with hepatocarcinoma\n', 'Cholangiocarcinoma\n', 'Support'], ['He does not report abdominal pain, weight loss or other symptoms, except generalized pruritus\n', 'acute cholangitis is characterized by the triad of jaundice, abdominal pain and fever\n', 'Attack'], ['acute cholangitis is characterized by the triad of jaundice, abdominal pain and fever\n', 'Acute cholangitis due to biliary mud\n', 'Attack'], ['It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n', 'Cholangiocarcinoma\n', 'Attack'], ['The CBC shows increased bilirubin at the expense of direct bilirubin\n', "Gilbert's syndrome is an increase in bilirubin at the expense of indirectness\n", 'Attack'], ["Gilbert's syndrome is an increase in bilirubin at the expense of indirectness\n", "Gilbert's syndrome\n", 'Attack']]
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268_140
|
[['QUESTION', 'TYPE:', 'PULMONOLOGY'], ['CLINICAL', 'CASE:'], ['A', '50-year-old', 'patient', 'presenting', 'with', 'a', 'pleural', 'effusion', 'with', 'the', 'following', 'features:', 'straw-like', 'appearance,', 'pH', '7.3,', 'pleural', 'protein/serum', 'ratio', '0.8,', 'pleural', 'LDH/serum', 'ratio', '0.9,', 'Gram', 'and', "Ziehl's", 'negative,', 'total', 'lipids,', 'cholesterol', 'and', 'triglycerides', 'normal,', 'mesothelial', 'cells', '<5%,', 'intense', 'lymphocytosis', 'without', 'atypia,', 'ADA', '64', 'U/L.'], ['What', 'diagnosis', 'would', 'you', 'suggest?'], ['1-', 'Pleural', 'empyema.'], ['2-', 'Pleural', 'effusion', 'due', 'to', 'heart', 'failure', '(transudate).'], ['3-', 'Pleural', 'mesothelioma.'], ['4-', 'Tuberculous', 'pleural', 'effusion.'], ['5-', 'Effusion', 'secondary', 'to', 'pulmonary', 'infarction.'], ['CORRECT', 'ANSWER:', '4'], ['It', 'is', 'a', 'lymphocytic', 'exudate', 'whose', 'main', 'diagnoses', 'are', 'tumor', 'and', 'tuberculous', 'pleuritis.'], ['They', 'do', 'not', 'give', 'the', 'value', 'of', 'glucose', 'which', 'should', 'be', 'lowered,', 'but', 'if', 'the', 'cytology', 'shows', 'absence', 'of', 'malignant', 'cells', 'so', 'we', 'are', 'left', 'with', 'tuberculous', 'pleuritis.'], ['Other', 'possible', 'diagnoses', 'such', 'as', 'lymphoma', 'are', 'not', 'mentioned', 'in', 'the', 'answers.']]
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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'], ['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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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'], ['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-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']]
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[['It is a lymphocytic exudate whose main diagnoses are tumor and tuberculous pleuritis\n', 'Tuberculous pleural effusion\n', 'Support'], ['They do not give the value of glucose which should be lowered\n', 'if the cytology shows absence of malignant cells so we are left with tuberculous pleuritis\n', 'Attack'], ['if the cytology shows absence of malignant cells so we are left with tuberculous pleuritis\n', 'Tuberculous pleural effusion\n', 'Support']]
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465_116
|
[['QUESTION', 'TYPE:', 'BIOSTATISTICS'], ['CLINICAL', 'CASE:'], ['In', 'a', 'subject', 'over', '65', 'years', 'of', 'age', 'a', 'tuberculin', 'test', 'has', 'shown', 'an', 'induration', 'of', '3', 'mm.'], ['The', 'induration', 'on', 'a', 'second', 'test,', 'performed', '10', 'days', 'later,', 'is', '13', 'mm.'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'The', 'first', 'reaction', 'is', 'a', 'false', 'positive.'], ['2-', 'The', 'second', 'reaction', 'is', 'a', 'true', 'positive.'], ['3-', 'The', 'first', 'reaction', 'is', 'a', 'true', 'negative.'], ['4-', 'The', 'second', 'reaction', 'is', 'a', 'false', 'positive.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ["Let's", 'see,', 'if', 'that', 'subject', 'was', 'not', 'in', 'any', 'risk', 'group,', 'the', 'positive', 'is', 'in', 'the', '15mm,', 'therefore', 'both', 'tests', 'are', 'negative,', 'and', 'as', 'only', 'one', 'answer', 'refers', 'to', 'negative,', "that's", 'it.'], ['But', 'both', 'could', 'be', 'false', 'negatives.']]
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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'], ['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'], ['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', '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-Claim', 'I-Claim', 'I-Claim', '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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[["therefore both tests are negative, and as only one answer refers to negative, that's it.\n", 'The first reaction is a true negative\n', 'Support'], ['But both could be false negatives\n', "therefore both tests are negative, and as only one answer refers to negative, that's it.\n", 'Support'], ['that subject was not in any risk group, the positive is in the 15mm\n', "therefore both tests are negative, and as only one answer refers to negative, that's it.\n", 'Support']]
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340_33
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'woman', 'diagnosed', 'with', 'infiltrating', 'ductal', 'carcinoma', 'of', 'the', 'breast', 'with', 'no', 'family', 'history', 'of', 'neoplasia.'], ['What', 'additional', 'studies', 'should', 'be', 'performed', 'on', 'the', 'tumor', 'because', 'of', 'its', 'clinical', 'and', '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', 'answer', 'is', '2,', 'study', 'of', 'hormone', 'receptors', 'and', 'HER2.'], ['This', 'is', 'because', 'no', 'study', 'of', 'first-degree', 'relatives', 'is', 'appropriate,', 'as', 'it', 'does', 'not', 'appear', 'to', 'be', 'hereditary', 'breast', 'cancer', 'since', 'there', 'is', 'no', 'family', 'history', 'of', 'neoplasia.'], ['On', 'the', 'other', 'hand,', 'there', 'is', 'no', 'indication', 'for', 'BRCA', '1-2', 'study.']]
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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'], ['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', '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'], ['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', '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']]
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[['The answer is 2, study of hormone receptors and HER2\n', 'Study of hormone receptors and HER2\n', 'Support'], ['there is no family history of neoplasia\n', 'it does not appear to be hereditary breast cancer\n', 'Support'], ['This is because no study of first-degree relatives is appropriate\n', 'Study of hormone receptors, e-cadherin and study of first degree relatives\n', 'Attack'], ['This is because no study of first-degree relatives is appropriate\n', 'Study of BRCA 1-2 and study of first-degree relatives\n', 'Attack'], ['it does not appear to be hereditary breast cancer\n', 'This is because no study of first-degree relatives is appropriate\n', 'Support'], ['On the other hand, there is no indication for BRCA 1-2 study\n', 'Study of BRCA 1-2 and study of first-degree relatives\n', 'Support']]
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561_180
|
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '26-year-old', 'woman', 'diagnosed', 'with', 'systemic', 'lupus', 'erythematosus,', 'on', 'treatment', 'with', 'hydroxychloroquine,', 'consults', 'for', 'a', 'feeling', 'of', 'generalized', 'weakness', 'that', 'has', 'progressively', 'developed', 'in', 'the', 'last', '15', 'days.'], ['The', 'physical', 'examination', 'reveals', 'cutaneous', 'pallor', 'and', 'the', 'CBC', 'shows', 'Hb', '7.4', 'g/dL,', 'Hct', '31%,', 'MCV', '108.'], ['Which', 'of', 'the', 'following', 'tests', 'will', 'be', 'most', 'useful', 'in', 'deciding', 'the', 'course', 'of', 'action?'], ['1-', 'Haptoglobin.'], ['2-', 'Coombs', 'test.'], ['3-', 'Vitamin', 'B12.'], ['4-', 'Antinuclear', 'antibodies.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'tells', 'us', 'about', 'a', 'patient', 'with', 'a', 'diagnosis', 'of', 'lupus', 'and', 'macrocytic', 'anemia.'], ['In', 'the', 'end,', 'all', 'the', 'data', 'are', 'usually', 'given', 'for', 'a', 'reason.'], ['The', 'onset', 'of', 'the', 'picture', 'seems', 'relatively', 'rapid', 'and', 'it', 'is', 'also', 'associated', 'with', 'an', 'autoimmune', 'disease,', 'so', 'it', 'seems', 'that', 'they', 'want', 'you', 'to', 'associate', 'it', 'with', 'an', 'autoimmune', 'hemolytic', 'anemia.'], ['The', 'low', 'haptoglobin', 'would', 'tell', 'us', 'it', 'is', '"hemolytic",', 'the', 'coombs', 'test', 'would', 'tell', 'us', 'it', 'is', '"autoimmune".'], ['Vitamin', 'B12,', 'probably', 'the', 'MCV', 'would', 'be', 'higher', 'than', '108', 'and', 'the', 'onset', 'of', 'the', 'clinical', 'picture', 'would', 'be', 'slower.'], ['The', 'ANA', 'would', 'not', 'give', 'us', 'anything', 'in', 'relation', 'to', 'the', 'anemia,', 'since', 'it', 'already', 'has', 'a', 'diagnosis.'], ['Therefore,', 'correct', 'answer', '2.'], ['As', 'a', 'note,', 'autoimmune', 'hemolytic', 'anemias', 'are', 'usually', 'slightly', 'macrocytic', 'due', 'to', 'reticulocytosis.'], ['Remember', 'to', 'ask', 'for', 'reticulocytes.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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'], ['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', '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', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Claim', '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']]
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[['A 26-year-old woman diagnosed with systemic lupus erythematosus, on treatment with hydroxychloroquine, consults for a feeling of generalized weakness that has progressively developed in the last 15 days\n', 'It tells us about a patient with a diagnosis of lupus and macrocytic anemia\n', 'Support'], ['The onset of the picture seems relatively rapid and it is also associated with an autoimmune disease\n', 'it seems that they want you to associate it with an autoimmune hemolytic anemia\n', 'Support'], ['The ANA would not give us anything in relation to the anemia, since it already has a diagnosis\n', 'Antinuclear antibodies\n', 'Attack'], ['The physical examination reveals cutaneous pallor and the CBC shows Hb 7.4 g/dL, Hct 31%, MCV 108\n', 'probably the MCV would be higher than 108\n', 'Attack'], ['A 26-year-old woman diagnosed with systemic lupus erythematosus, on treatment with hydroxychloroquine, consults for a feeling of generalized weakness that has progressively developed in the last 15 days\n', 'the onset of the clinical picture would be slower\n', 'Attack'], ['probably the MCV would be higher than 108\n', 'Vitamin B12\n', 'Attack'], ['the onset of the clinical picture would be slower\n', 'Vitamin B12\n', 'Attack'], ['Vitamin B12\n', 'Vitamin B12\n', 'Attack'], ['The ANA would not give us anything in relation to the anemia, since it already has a diagnosis\n', 'Therefore, correct answer 2\n', 'Support'], ['Vitamin B12\n', 'Therefore, correct answer 2\n', 'Support'], ['the coombs test would tell us it is "autoimmune"\n', 'Therefore, correct answer 2\n', 'Support'], ['The low haptoglobin would tell us it is "hemolytic"\n', 'Therefore, correct answer 2\n', 'Support'], ['Therefore, correct answer 2\n', 'Coombs test\n', 'Support']]
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451_175
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[['QUESTION', 'TYPE:', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '36-year-old', 'man', 'with', 'no', 'PA', 'of', 'interest', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'sudden', 'onset', 'of', 'severe', 'pain', 'in', 'the', 'posterior', 'aspect', 'of', 'the', 'right', 'lower', 'limb', 'extending', 'to', 'the', 'foot.'], ['On', 'examination', 'he', 'presented:', 'Positive', 'right', 'Lasège', 'at', '10º,', 'decreased', 'strength', 'in', 'plantar', 'flexion', 'of', 'the', 'right', 'foot,', 'hypoesthesia', 'in', 'the', 'external', 'border', 'of', 'the', 'right', 'foot', 'and', 'absence', 'of', 'right', 'Achilles', 'reflex.'], ['The', 'simple', 'X-ray', 'of', 'the', 'lumbar', 'spine', 'does', 'not', 'show', 'significant', 'alterations.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Herniated', 'disc', 'L1/L2.'], ['2-', 'Horsetail', 'syndrome.'], ['3-', 'L4/L5', 'disc', 'herniation.'], ['4-', 'Herniated', 'disc', 'L5/S1.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Acute', 'sciatica', 'probably', 'due', 'to', 'disc', 'extrusion.'], ['Both', 'the', 'sensory', 'distribution,', 'the', 'paresis', 'for', 'plantar', 'flexion', '(tiptoe)', 'and', 'the', 'absence', 'of', 'the', 'Achilles', 'reflex', 'are', 'typical', 'of', 'S1', 'root', 'involvement,', 'which', 'is', 'typically', 'affected', 'with', 'L5/S1', 'disc', 'herniation', '(posterolateral).'], ['An', 'L1/L2', '(posterolateral)', 'herniation', 'would', 'affect', 'the', 'L2', 'root,', 'an', 'L4/L5', 'herniation', 'would', 'affect', 'the', 'L5', 'and', 'cauda', 'equina', 'would', 'involve', 'more', 'symptomatology', 'than', 'simple', 'S1', 'involvement.']]
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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', 'I-Premise', 'I-Premise', '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', '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'], ['O', 'O'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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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[['On examination he presented: Positive right Lasège at 10º, decreased strength in plantar flexion of the right foot, hypoesthesia in the external border of the right foot and absence of right Achilles reflex\n', 'Both the sensory distribution, the paresis for plantar flexion (tiptoe) and the absence of the Achilles reflex are typical of S1 root involvement, which is typically affected with L5/S1 disc herniation (posterolateral)\n', 'Support'], ['An L1/L2 (posterolateral) herniation would affect the L2 root\n', 'Herniated disc L1/L2\n', 'Attack'], ['A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot\n', 'Both the sensory distribution, the paresis for plantar flexion (tiptoe) and the absence of the Achilles reflex are typical of S1 root involvement, which is typically affected with L5/S1 disc herniation (posterolateral)\n', 'Support'], ['an L4/L5 herniation would affect the L5\n', 'L4/L5 disc herniation\n', 'Attack'], ['A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot\n', 'An L1/L2 (posterolateral) herniation would affect the L2 root\n', 'Attack'], ['A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot\n', 'an L4/L5 herniation would affect the L5\n', 'Attack'], ['cauda equina would involve more symptomatology than simple S1 involvement\n', 'Horsetail syndrome\n', 'Attack'], ['On examination he presented: Positive right Lasège at 10º, decreased strength in plantar flexion of the right foot, hypoesthesia in the external border of the right foot and absence of right Achilles reflex\n', 'cauda equina would involve more symptomatology than simple S1 involvement\n', 'Attack']]
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399_141
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY', 'AND', 'ORTHOPEDICS'], ['CLINICAL', 'CASE:'], ['20-year-old', 'male,', 'who', 'consults', 'for', 'lumbosacral', 'pain', 'of', 'inflammatory', 'rhythm', 'of', '4', 'months', 'of', 'evolution.'], ['Also', 'bilateral', 'thalalgia', 'and', 'morning', 'stiffness', 'for', '1', 'hour.'], ['In', 'the', 'last', '2', 'months,', 'onset', 'of', 'diarrhea', 'with', 'loss', 'of', '4', 'kg', 'of', 'weight.'], ['What', 'is', 'the', 'most', 'correct', 'diagnostic', 'approach?'], ['1-', 'Given', 'the', "patient's", 'age,', 'he', 'most', 'likely', 'suffers', 'from', 'non-specific', 'low', 'back', 'pain', 'and', 'tendonitis', 'of', 'the', 'feet.', 'If', 'the', 'diarrhea', 'persists,', 'a', 'digestive', 'study', 'would', 'be', 'performed.'], ['2-', 'Perform', 'a', 'digestive', 'study', 'to', 'rule', 'out', 'tumor', 'pathology.', 'Low', 'back', 'pain', 'may', 'be', 'due', 'to', 'visceral', 'pathology.'], ['3-', 'The', 'clinical', 'picture', 'is', 'very', 'suggestive', 'of', 'spondyloarthritis.', 'Inflammatory', 'bowel', 'disease', 'should', 'be', 'ruled', 'out.'], ['4-', 'I', 'would', 'request', 'a', 'lumbar', 'MRI', 'to', 'rule', 'out', 'disc', 'herniation', 'and', 'if', 'diarrhea', 'persists,', 'a', 'digestive', 'study.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'patient', 'presents', 'the', 'clinical', 'features', 'of', 'spondylarthropathy,', 'which', 'is', 'often', 'associated', 'with', 'inflammatory', 'bowel', 'disease,', 'as', 'this', 'case', 'suggests.']]
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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'], ['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'], ['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'], ['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'], ['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']]
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[['The patient presents the clinical features of spondylarthropathy, which is often associated with inflammatory bowel disease, as this case suggests\n', 'The clinical picture is very suggestive of spondyloarthritis. Inflammatory bowel disease should be ruled out\n', 'Support']]
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12_92
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[['QUESTION', 'TYPE:', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '30-year-old', 'man', 'suffers', 'a', 'fall', 'from', 'a', 'standing', 'height', 'of', '2', 'meters.'], ['On', 'arrival', 'at', 'the', 'emergency', 'room', 'on', 'a', 'stretcher,', 'he', 'is', 'conscious', 'and', 'oriented,', 'with', 'bladder', 'catheterization', 'and', 'clear', 'urine.'], ['He', 'shows', 'swelling', 'of', 'the', 'left', 'heel', 'and', 'mild', 'tingling', 'in', 'the', 'anterior', 'aspect', 'of', 'the', 'left', 'thigh', 'and', 'scrotum', 'as', 'well', 'as', 'dysesthesia', 'in', 'both', 'feet.'], ['The', 'patient', 'says', 'goodbye', 'to', 'the', 'stretcher-bearer', 'with', 'a', 'handshake', 'and', 'a', 'simultaneous', 'pat', 'on', 'the', 'shoulder.'], ['Rotation', 'of', 'the', 'lower', 'limbs', 'on', 'the', 'stretcher', 'grasped', 'by', 'the', 'ankles', 'is', 'painless', 'and', 'compression', 'of', 'the', 'pelvis', 'is', 'asymptomatic.'], ['Next:'], ['1-', 'The', 'patient', 'will', 'be', 'seated', 'on', 'the', 'stretcher', 'so', 'that', 'the', 'cervical', 'spine', 'can', 'be', 'explored.'], ['2-', 'Refer', 'to', 'radiology', 'for', 'study', 'of', 'the', 'lower', 'extremities', '(feet,', 'femurs,', 'pelvis).'], ['3-', 'We', 'will', 'palpate', 'the', 'abdomen', 'and', 'roll', 'en', 'bloc', 'to', 'palpate', 'the', 'thoracolumbar', 'spine.'], ['4-', 'We', 'will', 'place', 'a', 'cervical', 'collar', 'and', 'refer', 'to', 'radiology', 'for', 'imaging', 'of', 'the', 'lower', 'extremities', 'and', 'cervical', 'spine.'], ['5-', 'We', 'will', 'request', 'an', 'abdominal', 'ultrasound.'], ['CORRECT', 'ANSWER:', '3'], ['I', 'believe', 'that', 'the', 'correct', 'answer', 'is', '3.'], ['The', 'patient,', 'due', 'to', 'the', 'mechanism', 'of', 'injury', '(foot', 'fall),', 'the', 'calcaneal', 'fracture', 'and', 'the', 'neurological', 'symptoms,', 'suggests', 'a', 'low', 'spinal', 'cord', 'injury', 'due', 'to', 'a', 'fracture', 'of', 'the', 'lumbar', 'spine.'], ['The', 'injury', 'is', 'not', 'high', 'because', 'he', 'moves', 'his', 'arms.'], ['It', 'also', 'does', 'not', 'appear', 'to', 'be', 'a', 'pelvic', 'injury', 'because', 'of', 'the', 'absence', 'of', 'pain', 'on', 'mobilization', 'or', 'palpation.'], ['If', 'there', 'is', 'a', 'suspicion', 'of', 'pelvic', 'injury', 'in', 'the', 'primary', 'evaluation', 'of', 'all', 'polytraumatized', '(ATLS)', 'a', 'spinal', 'exploration', 'should', 'be', 'performed', 'by', 'rotating', 'the', 'spine', 'en', 'bloc', 'to', 'avoid', 'producing', 'more', 'injury.'], ['Abdominal', 'palpation', 'is', 'also', 'part', 'of', 'the', 'initial', 'evaluation.'], ['Abdominal', 'ultrasound', 'may', 'be', 'indicated', 'in', 'hemodynamically', 'unstable', 'patients', 'if', 'abdominal', 'injuries', 'are', 'suspected', 'but', 'in', 'any', 'case', 'it', 'is', 'done', 'after', 'the', 'initial', 'evaluation.']]
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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'], ['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'], ['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', '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', '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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Marker', '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', 'B-Marker', 'O', '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'], ['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']]
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[['The injury is not high\n', 'The patient will be seated on the stretcher so that the cervical spine can be explored\n', 'Attack'], ['It also does not appear to be a pelvic injury\n', 'Refer to radiology for study of the lower extremities (feet, femurs, pelvis)\n', 'Attack'], ['The patient, due to the mechanism of injury (foot fall), the calcaneal fracture and the neurological symptoms, suggests a low spinal cord injury due to a fracture of the lumbar spine\n', 'I believe that the correct answer is 3\n', 'Support'], ['The patient, due to the mechanism of injury (foot fall), the calcaneal fracture and the neurological symptoms, suggests a low spinal cord injury due to a fracture of the lumbar spine\n', 'We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n', 'Support'], ['I believe that the correct answer is 3\n', 'We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n', 'Support'], ['If there is a suspicion of pelvic injury in the primary evaluation of all polytraumatized (ATLS) a spinal exploration should be performed by rotating the spine en bloc to avoid producing more injury\n', 'I believe that the correct answer is 3\n', 'Support'], ['If there is a suspicion of pelvic injury in the primary evaluation of all polytraumatized (ATLS) a spinal exploration should be performed by rotating the spine en bloc to avoid producing more injury\n', 'We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n', 'Support'], ['Abdominal palpation is also part of the initial evaluation\n', 'We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n', 'Support'], ['Abdominal palpation is also part of the initial evaluation\n', 'I believe that the correct answer is 3\n', 'Support'], ['Abdominal ultrasound may be indicated in hemodynamically unstable patients if abdominal injuries are suspected but in any case it is done after the initial evaluation\n', 'Abdominal palpation is also part of the initial evaluation\n', 'Support'], ['Rotation of the lower limbs on the stretcher grasped by the ankles is painless\n', 'Refer to radiology for study of the lower extremities (feet, femurs, pelvis)\n', 'Attack'], ['compression of the pelvis is asymptomatic\n', 'Refer to radiology for study of the lower extremities (feet, femurs, pelvis)\n', 'Attack'], ['he moves his arms\n', 'The injury is not high\n', 'Support'], ['the absence of pain on mobilization or palpation\n', 'It also does not appear to be a pelvic injury\n', 'Support']]
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605_113
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['35-year-old', 'male,', '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', 'non-steroidal', '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', 'traumatology', 'outpatients.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['In', 'this', 'case', 'we', 'describe', 'a', 'case', 'of', 'cervicobrachialgia', 'without', 'alarm', 'signs', 'at', 'the', 'present', 'time,', 'so', 'the', 'most', 'indicated', 'treatment', 'at', 'this', 'time', 'would', 'be', 'conservative,', 'based', 'on', 'NSAIDs,', 'local', 'heat', 'and', 'rest.'], ['This', 'is', 'not', 'an', 'urgent', 'case,', 'so', 'answer', '2', 'would', 'not', 'be', 'valid.'], ['The', 'performance', 'of', 'an', 'MRI', 'and', 'an', 'electromyogram', 'are', 'valid', 'options', 'for', 'the', 'etiological', 'study', 'of', 'the', 'picture,', 'however,', 'it', 'is', 'necessary', 'to', 'emphasize', 'that', 'we', 'should', 'first', 'perform', 'a', 'correct', 'pain', 'management,', 'so', 'since', 'we', 'are', 'asked', 'about', 'the', 'first', 'attitude,', 'option', '1', 'would', 'be', 'more', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['In this case we describe a case of cervicobrachialgia without alarm signs at the present time\n', 'so the most indicated treatment at this time would be conservative, based on NSAIDs, local heat and rest\n', 'Support'], ['This is not an urgent case\n', 'so answer 2 would not be valid\n', 'Support'], ['so answer 2 would not be valid\n', 'Urgent call to the neurosurgeon for surgical evaluation\n', 'Attack'], ['so the most indicated treatment at this time would be conservative, based on NSAIDs, local heat and rest\n', 'Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest\n', 'Support'], ['however, it is necessary to emphasize that we should first perform a correct pain management\n', 'The performance of an MRI and an electromyogram are valid options for the etiological study of the picture\n', 'Attack'], ['so since we are asked about the first attitude, option 1 would be more valid\n', 'The performance of an MRI and an electromyogram are valid options for the etiological study of the picture\n', 'Attack'], ['so since we are asked about the first attitude, option 1 would be more valid\n', 'Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest\n', 'Support'], ['so since we are asked about the first attitude, option 1 would be more valid\n', 'Preferential request for MRI and electromyogram\n', 'Attack']]
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443_102
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'woman,', 'without', 'relevant', 'comorbidities,', 'operated', 'on', 'for', 'a', 'right', 'breast', 'cancer', 'by', 'means', 'of', 'an', 'extended', 'lumpectomy', 'and', 'selective', 'sentinel', 'lymph', 'node', 'biopsy,', 'with', 'the', 'following', 'anatomopathological', 'result:', 'Infiltrating', 'ductal', 'carcinoma', 'poorly', 'dlferentiated', '(grade', '3),', 'size', '2.2', 'cm', '(pT2),', 'estrogen', 'and', 'progesterone', 'receptor', 'positive,', 'Ki67', '25%,', 'HER2', 'negative.'], ['There', 'is', 'macroscopic', 'involvement', 'of', 'the', 'sentinel', 'lymph', 'node,', 'although', 'there', 'is', 'no', 'involvement', 'of', 'the', 'rest', 'of', 'the', 'isolated', 'axillary', 'nodes', '(pN1).'], ['What', 'adjuvant', 'systemic', 'treatment', 'do', 'you', 'consider', 'most', 'appropriate', 'for', 'this', 'patient?'], ['1-', 'Adjuvant', 'hormone', 'therapy', 'including', 'aromatase', 'inhibitors.'], ['2-', 'Adjuvant', 'chemotherapy,', 'preferably', 'with', 'anthracyclines', 'and', 'taxanes,', 'followed', 'by', 'hormone', 'therapy.'], ['3-', 'Adjuvant', 'chemotherapy', 'in', 'association', 'with', 'the', 'monoclonal', 'antibody', 'trastuzumab,', 'followed', 'by', 'hormone', 'therapy.'], ['4-', 'Adjuvant', 'chemotherapy,', 'preferably', 'with', 'anthracyclines', 'and', 'taxanes.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'a', 'Luminal', 'B.', 'According', 'to', 'the', 'SEGO,', 'this', 'patient', 'is', 'a', 'candidate', 'for', 'chemotherapy', 'treatment', 'because', 'of', 'the', 'high', 'histologic', 'grade', 'and', 'high', 'tumor', 'proliferation.']]
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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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', 'I-Claim', 'I-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', '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']]
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[['because of the high histologic grade and high tumor proliferation\n', 'According to the SEGO, this patient is a candidate for chemotherapy treatment\n', 'Support'], ['A 64-year-old woman, without relevant comorbidities, operated on for a right breast cancer by means of an extended lumpectomy and selective sentinel lymph node biopsy, with the following anatomopathological result: Infiltrating ductal carcinoma poorly dlferentiated (grade 3), size 2.2 cm (pT2), estrogen and progesterone receptor positive, Ki67 25%, HER2 negative\n', 'because of the high histologic grade and high tumor proliferation\n', 'Support'], ['According to the SEGO, this patient is a candidate for chemotherapy treatment\n', 'Adjuvant chemotherapy, preferably with anthracyclines and taxanes, followed by hormone therapy\n', 'Support']]
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197_71
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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '10-year-old', 'boy', 'with', 'brief', 'episodes', 'of', 'distractibility', '(<', '1', 'minute)', 'in', 'which', 'he', 'does', 'not', 'respond', 'to', 'calls', 'and', 'blinks.'], ['An', 'EEG', 'shows', 'spike-wave', 'discharges', 'at', '3', 'cycles', 'per', 'second.'], ['First-line', 'elective', 'treatment', 'would', 'be', 'with:'], ['1-', 'Valproate.'], ['2-', 'Carbamazepine.'], ['3-', 'Phenytoin.'], ['4-', 'Gabapentin.'], ['5-', 'Clonazepam.'], ['CORRECT', 'ANSWER:', '1'], ['Absences', 'behave', 'as', 'brief', 'episodes', 'of', 'abrupt', 'loss', 'of', 'consciousness', 'without', 'alteration', 'of', 'postural', 'control;', 'they', 'typically', 'last', 'seconds', 'and', 'can', 'be', 'repeated', 'many', 'times', 'a', 'day,', 'are', 'usually', 'accompanied', 'by', 'small', 'bilateral', 'motor', 'signs', '(blinking,', 'chewing)', 'and', 'consciousness', 'is', 'recovered', 'equally', 'abruptly,', 'without', 'subsequent', 'confusion', 'or', 'memory', 'of', 'the', 'episode', '(MIR', '03-04,', '248;', 'MIR', '97-98,', '51).'], ['The', 'age', 'of', 'onset', 'is', 'usually', 'between', '4', 'years', 'and', 'early', 'adolescence,', 'being', 'the', 'most', 'frequent', 'cause', 'of', 'seizures', 'in', 'this', 'age', 'range.'], ['EEG', 'findings', 'are', 'typically', 'generalized', 'and', 'symmetrical', 'spike-wave', 'discharges', 'at', '3', 'Hz', '(MIR', '99-00F,', '67)', 'coinciding', 'with', 'seizures,', 'although', 'in', 'the', 'interictal', 'EEG', 'there', 'are', 'more', 'periods', 'of', 'abnormal', 'activity', 'than', 'clinically', 'visible.'], ['The', 'most', 'appropriate', 'drugs', 'for', 'the', 'treatment', 'of', 'absences', 'are', 'Valproate', 'and', 'Ethosuximide', '(CTO', 'Manual).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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']]
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[['The most appropriate drugs for the treatment of absences are Valproate and Ethosuximide (CTO Manual)\n', 'Valproate\n', 'Support'], ['brief episodes of distractibility (< 1 minute) in which he does not respond to calls and blinks\n', 'Absences behave as brief episodes of abrupt loss of consciousness without alteration of postural control; they typically last seconds and can be repeated many times a day, are usually accompanied by small bilateral motor signs (blinking, chewing) and consciousness is recovered equally abruptly, without subsequent confusion or memory of the episode (MIR 03-04, 248; MIR 97-98, 51).\n', 'Support'], ['A 10-year-old boy\n', 'The age of onset is usually between 4 years and early adolescence, being the most frequent cause of seizures in this age range\n', 'Support'], ['An EEG shows spike-wave discharges at 3 cycles per second\n', 'EEG findings are typically generalized and symmetrical spike-wave discharges at 3 Hz (MIR 99-00F, 67) coinciding with seizures, although in the interictal EEG there are more periods of abnormal activity than clinically visible\n', 'Support']]
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478_134
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[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['35-year-old', 'male,', 'transferred', 'to', 'the', 'emergency', 'department', 'after', 'a', 'traffic', 'accident.'], ['On', 'admission,', 'a', 'Glasgow', 'scale', 'score', 'of', '15,', 'blood', 'pressure', 'of', '140/90', 'mmHg,', 'respiratory', 'rate', 'of', '35', 'rpm', 'and', 'heart', 'rate', 'of', '110', 'bpm,', 'with', 'a', 'baseline', 'oxygen', 'saturation', 'of', '91%.'], ['On', 'examination', 'there', 'is', 'right', 'thoracic', 'hypophonesis', 'and', 'tympanism', 'on', 'percussion.What', 'is', 'the', 'presumptive', 'diagnosis?'], [':'], ['1-', 'Traumatic', 'cardiac', 'tamponade.'], ['2-', 'Right', 'tension', 'pneumothorax.'], ['3-', 'Massive', 'right', 'hemothorax.'], ['4-', 'Pulmonary', 'contusion.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['This', 'is', 'an', 'easy', 'and', 'classic', 'question', 'that', 'you', 'can', 'also', 'apply', 'to', 'daily', 'clinical', 'practice.'], ['Hypophonesis', 'in', 'a', 'hemithorax', '+', 'tympanism', '=', 'pneumothorax.'], ['If', 'there', 'is', 'dullness', 'on', 'percussion:', 'hemothorax.'], ['In', 'either', 'case,', 'in', 'case', 'of', 'hypophonesis', 'of', 'a', 'hemithorax', 'in', 'a', 'severe', 'and', 'unstable', 'polytraumatized', 'patient:', 'thoracic', 'drainage', '(if', 'possible,', 'large', 'caliber', 'if', 'placed', 'in', 'a', 'hospital', 'environment,', 'since', 'although', 'the', 'predominant', 'lesion', 'is', 'pneumothorax,', 'a', 'hemothorax', 'component', 'can', 'be', 'found', 'which,', 'in', 'case', 'of', 'placing', 'a', 'fine', 'drainage,', 'could', 'obstruct', 'it).']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['On examination there is right thoracic hypophonesis and tympanism on percussion\n', 'Hypophonesis in a hemithorax + tympanism = pneumothorax\n', 'Support'], ['Hypophonesis in a hemithorax + tympanism = pneumothorax\n', 'Right tension pneumothorax\n', 'Support'], ['On examination there is right thoracic hypophonesis and tympanism on percussion\n', 'If there is dullness on percussion: hemothorax\n', 'Attack'], ['If there is dullness on percussion: hemothorax\n', 'Massive right hemothorax\n', 'Attack']]
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97_171
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[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Patient', 'presenting', 'since', '2', 'weeks', 'ago', 'with', 'a', 'pruritic', 'eruption', 'consisting', 'of', 'multiple', 'polygonal', 'erythematous-violaceous', 'papules,', 'flattened', 'surface,', 'preferentially', 'located', 'on', 'the', 'anterior', 'aspect', 'of', 'wrists,', 'pretibial', 'area', 'and', 'lumbar', 'area.'], ['She', 'also', 'presents', 'whitish', 'reticulated', 'lesions', 'in', 'the', 'jugal', 'mucosa.'], ['What', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Pityriasis', 'versicolor.'], ['2-', 'Mycosis', 'fungoides.'], ['3-', 'Psoriasis', 'in', 'drops.'], ['4-', 'Pityriasis', 'rosea', 'of', 'Gibert.'], ['5-', 'Lichen', 'planus.'], ['CORRECT', 'ANSWER:', '5'], ['They', 'are', 'undoubtedly', 'describing', 'the', 'typical', 'lesions', '(both', 'on', 'skin', 'and', 'oral', 'mucosa)', 'of', 'a', 'lichen', 'planus', '(5).']]
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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', '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', 'B-Claim', 'I-Claim'], ['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'], ['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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[['They are undoubtedly describing the typical lesions (both on skin and oral mucosa) of a lichen planus (5)\n', 'Lichen planus\n', 'Support']]
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426_94
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '73-year-old', 'patient...swallowing', 'a', 'complete', 'neurological', 'dysphagia', 'secondary', 'to', 'a', 'cardioembolic', 'stroke', 'in', 'the', 'left', 'middle', 'cerebral', 'artery', 'territory.', 'will', 'require', 'long-term', 'nutritional', 'support.'], ['Of', 'the', 'following', 'treatment', 'modalities,', 'which', 'do', 'you', 'consider', 'most', 'appropriate', 'for', 'this', 'case?'], ['1-', 'Enteral', 'nutrition', 'by', 'nasogastric', 'tube.'], ['2-', 'Enteral', 'nutrition', 'by', 'nasoduodenal', 'tube.'], ['3-', 'Enteral', 'nutrition', 'by', 'gastrostomy.'], ['4-', 'Enteral', 'nutrition', 'by', 'jejunostomy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Enteral', 'nutrition', 'is', 'a', 'nutritional', 'support', 'technique', 'that', 'involves', 'administering', 'nutrients', 'directly', 'into', 'the', 'gastrointestinal', 'tract', 'by', 'gavage.'], ['The', 'choice', 'of', 'the', 'route', 'of', 'formula', 'administration', 'depends', 'on', 'the', 'nutritional', 'status,', 'age', 'of', 'the', 'patient', 'and', 'the', 'underlying', 'disease.'], ['If', 'enteral', 'nutrition', 'is', 'considered', 'to', 'be', 'of', 'short', 'duration,', 'the', 'route', 'of', 'choice', 'is', 'the', 'nasogastric', 'or', 'nasoduodenal-', 'nasojejunal', 'tube...'], ['If', 'prolonged', 'nutrition', 'is', 'anticipated', 'the', 'route', 'of', 'choice', 'is', 'gastrostomy', '(option', '3),', 'with', 'jejunostomy', 'being', 'reserved', 'for', 'cases', 'in', 'which', 'it', 'is', 'not', 'possible', 'to', 'use', 'the', 'gastric', 'route.']]
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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'], ['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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 73-year-old patient...swallowing a complete neurological dysphagia secondary to a cardioembolic stroke in the left middle cerebral artery territory. will require long-term nutritional support\n', 'f enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube...\n', 'Attack'], ['f enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube...\n', 'Enteral nutrition by nasoduodenal tube\n', 'Attack'], ['If prolonged nutrition is anticipated the route of choice is gastrostomy (option 3), with jejunostomy being reserved for cases in which it is not possible to use the gastric route\n', 'Enteral nutrition by gastrostomy\n', 'Support'], ['If prolonged nutrition is anticipated the route of choice is gastrostomy (option 3), with jejunostomy being reserved for cases in which it is not possible to use the gastric route\n', 'Enteral nutrition by jejunostomy\n', 'Attack'], ['f enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube...\n', 'Enteral nutrition by nasogastric tube\n', 'Attack']]
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262_58
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[['QUESTION', 'TYPE:', 'PHARMACOLOGY'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'woman', 'with', 'a', 'history', 'of', 'hypertension', 'and', 'moderate', 'heart', 'failure', 'presents', 'with', 'a', 'persistent,', 'dry', 'cough', 'that', 'begins', 'as', 'an', 'itchy', 'sensation', 'in', 'the', 'throat.'], ['What', 'is', 'the', 'drug', 'suspected', 'of', 'causing', 'the', "patient's", 'clinical', 'and', 'laboratory', 'alteration?'], ['1-', 'Hydrochlorothiazide.'], ['2-', 'Bisoprolol.'], ['3-', 'Furosemide.'], ['4-', 'Enalapril.'], ['5-', 'Hydralazine.'], ['CORRECT', 'ANSWER:', '4'], ['These', 'are', 'typical', 'adverse', 'effects', 'of', 'ACEIs,', 'in', 'the', 'case', 'of', 'cough', 'it', 'is', 'usually', 'dry', 'and', 'irritative', 'and', 'appears', 'in', 'up', 'to', '3%', 'of', 'patients.'], ['Hyperkalemia', 'may', 'also', 'appear', 'in', '1%.']]
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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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['in the case of cough it is usually dry and irritative and appears in up to 3% of patients\n', 'These are typical adverse effects of ACEIs\n', 'Support'], ['Hyperkalemia may also appear in 1%\n', 'These are typical adverse effects of ACEIs\n', 'Support'], ['A 70-year-old woman with a history of hypertension and moderate heart failure presents with a persistent, dry cough that begins as an itchy sensation in the throat\n', 'in the case of cough it is usually dry and irritative and appears in up to 3% of patients\n', 'Support']]
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346_159
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['69-year-old', 'woman', 'who', 'comes', 'to', 'your', 'office', 'referring', 'genital', 'bleeding', 'of', 'several', 'months', 'of', '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'], ['The', 'correct', 'answer', 'is', '2.'], ['We', 'are', 'dealing', 'with', 'a', 'case', 'of', 'postmenopausal', 'metrorrhagia,', 'whose', 'most', 'frequent', 'cause', 'is', 'genital', 'atrophy', 'in', 'the', 'first', 'place', 'and', 'endometrial', 'cancer', 'in', 'the', 'second', 'place.'], ['The', 'data', 'given', 'on', 'obesity', 'should', 'lead', 'us', 'to', 'suspect', 'endometrial', 'cancer,', 'since', 'peripheral', 'fat', 'is', 'converted', 'to', 'estrone,', 'and', 'these', 'estrogens', 'cause', 'the', 'endometrium', 'to', 'proliferate.'], ['On', 'the', 'other', 'hand,', 'she', 'provides', 'a', 'normal', 'cytology,', 'which', 'rules', 'out', 'option', '3.'], ['The', 'hormonal', 'evaluation', 'is', 'not', 'opportune,', 'since', 'we', 'understand', 'that', 'the', 'patient', 'is', 'in', 'menopause.'], ['We', 'should', 'not', 'prescribe', 'treatment', 'without', 'first', 'ruling', 'out', 'organic', 'causes.']]
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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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-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-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'O', 'O', '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', 'I-Claim', 'I-Claim']]
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[['The correct answer is 2\n', 'Endometrial biopsy\n', 'Support'], ['BMI of 38kg/m2\n', 'The data given on obesity should lead us to suspect endometrial cancer\n', 'Support'], ['peripheral fat is converted to estrone, and these estrogens cause the endometrium to proliferate\n', 'The data given on obesity should lead us to suspect endometrial cancer\n', 'Support'], ['which rules out option 3\n', 'Random cervical biopsies\n', 'Attack'], ['On the other hand, she provides a normal cytology\n', 'which rules out option 3\n', 'Support'], ['She provides normal cervicovaginal cytology\n', 'On the other hand, she provides a normal cytology\n', 'Support'], ['The hormonal evaluation is not opportune\n', 'Hormonal evaluation with FSH, LH and estradiol\n', 'Attack'], ['the patient is in menopause\n', 'The hormonal evaluation is not opportune\n', 'Support'], ['69-year-old woman who comes to your office referring genital bleeding of several months of evolution\n', 'the patient is in menopause\n', 'Support'], ['We should not prescribe treatment without first ruling out organic causes\n', 'Prescribe cyclic progesterone\n', 'Attack']]
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170_89
|
[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'CARDIOVASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '62-year-old', 'patient', 'who', 'has', 'had', 'a', 'pericardial', 'bioprosthesis', 'in', 'mitral', 'position', 'for', 'two', 'years.'], ['He', 'is', 'admitted', 'urgently', 'for', 'acute', 'coronary', 'syndrome.'], ['Two', 'days', 'later', 'and', 'after', 'a', 'favorable', 'evolution,', 'he', 'suddenly', 'presented', 'heart', 'failure', 'with', 'acute', 'pulmonary', 'edema.'], ['Select', 'the', 'diagnostic', 'option', 'in', 'this', 'case', 'from', 'the', 'following', 'possibilities:'], ['1-', 'Acute', 'post-infarction', 'mitral', 'insufficiency.'], ['2-', 'Left', 'ventricular', 'aneurysm.'], ['3-', 'Acute', 'ventricular', 'septal', 'defect.'], ['4-', 'Postinfarction', 'atrial', 'septal', 'defect.'], ['5-', 'Dysfunction', 'of', 'the', 'bioprosthesis', 'due', 'to', 'probable', 'acute', 'endocarditis.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'valve', 'is', 'biological', 'and,', 'in', 'general,', 'the', 'veils', 'are', 'not', 'sewn', 'to', 'the', 'papillary', 'muscles,', 'so', 'we', "don't", 'care', 'what', 'happens', 'to', 'them.'], ['A', 'ventricular', 'aneurysm', 'depresses', 'LVEF,', 'but', 'does', 'not', 'suddenly', 'put', 'you', 'into', 'PAD.'], ['In', 'contrast,', 'a', 'VSD', 'sharply', 'increases', 'flow', 'to', 'the', 'pulmonary', 'bed,', 'causing', 'pulmonary', 'edema,', 'and', 'is', 'also', 'one', 'of', 'the', 'most', 'frequent', 'complications', 'of', 'AMI.'], ['Ischemic', 'ASD...', 'I', 'do', 'not', 'deny', 'that', 'it', 'exists,', 'but', 'it', 'does', 'not', 'even', 'appear', 'in', 'the', 'guidelines.'], ['And', 'endocarditis', 'would', 'not', 'require', 'so', 'many', 'saddlebags.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['A ventricular aneurysm depresses LVEF, but does not suddenly put you into PAD\n', 'Left ventricular aneurysm\n', 'Attack'], ['In contrast, a VSD sharply increases flow to the pulmonary bed, causing pulmonary edema, and is also one of the most frequent complications of AMI\n', 'Acute ventricular septal defect\n', 'Support'], ['Two days later and after a favorable evolution, he suddenly presented heart failure with acute pulmonary edema\n', 'In contrast, a VSD sharply increases flow to the pulmonary bed, causing pulmonary edema, and is also one of the most frequent complications of AMI\n', 'Support'], ['And endocarditis would not require so many saddlebags\n', 'Dysfunction of the bioprosthesis due to probable acute endocarditis\n', 'Attack'], ['Ischemic ASD... I do not deny that it exists, but it does not even appear in the guidelines\n', 'Postinfarction atrial septal defect\n', 'Attack']]
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40_136
|
[['QUESTION', 'TYPE:', 'OTOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'smoker', 'and', 'heavy', 'drinker', 'reports', 'painless', 'right', 'jugulodigastric', 'lymphadenopathy', 'of', 'progressive', 'growth', 'in', 'the', 'last', 'two', 'months', 'whose', 'fine', 'needle', 'aspiration', 'was', 'reported', 'as', 'squamous', 'cell', 'carcinoma.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'location', 'of', 'the', 'primary', 'tumor:'], ['1-', 'Scalp.'], ['2-', 'Parotid.'], ['3-', 'Lung.'], ['4-', 'Esophagus.'], ['5-', 'Larynx.'], ['CORRECT', 'ANSWER:', '5'], ['You', 'are', 'in', 'the', 'middle', 'of', 'the', 'ENT', 'block.'], ['You', 'have', 'already', 'passed', 'the', 'Pneumology', 'and', 'Digestive', 'blocks.'], ['Dermatology', 'is', 'still', 'to', 'come', 'out,', 'but', 'a', 'dermatologist', '(answer', '1)', 'would', 'not', 'ask', 'this.'], ['So', 'we', 'are', 'left', 'with', 'parotid', 'and', 'larynx;', 'but', 'parotid', 'squamous', 'cell', 'carcinoma', 'is', 'rare;', 'I', 'would', 'mark', '5', 'and', 'rest', 'easy.'], ['Perhaps', 'because', 'all', 'the', 'adenopathies', 'at', 'this', 'level', 'that', 'I', 'have', 'seen', 'have', 'ended', 'up', 'corresponding', 'to', 'carcinomas', 'of', 'the', 'upper', 'aerodigestive', 'tract.']]
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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'], ['O', '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', 'B-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'], ['B-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', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['all the adenopathies at this level that I have seen have ended up corresponding to carcinomas of the upper aerodigestive tract.\n', 'I would mark 5 and rest easy\n', 'Support'], ['parotid squamous cell carcinoma is rare\n', 'So we are left with parotid and larynx\n', 'Attack'], ['parotid squamous cell carcinoma is rare\n', 'I would mark 5 and rest easy\n', 'Support'], ['a dermatologist (answer 1) would not ask this\n', 'Scalp\n', 'Attack'], ['I would mark 5 and rest easy\n', 'Larynx\n', 'Support'], ['You have already passed the Pneumology and Digestive blocks\n', 'Esophagus\n', 'Attack'], ['You have already passed the Pneumology and Digestive blocks\n', 'Lung\n', 'Attack'], ['parotid squamous cell carcinoma is rare\n', 'Parotid\n', 'Attack']]
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126_59
|
[['QUESTION', 'TYPE:', 'PNEUMOLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'man,', 'a', 'retired', 'office', 'worker', 'and', 'smoker', 'of', '1', 'pack', 'of', 'cigarettes', 'a', 'day,', 'comes', 'to', 'the', 'clinic', 'with', 'a', 'persistent,', 'generally', 'dry', 'cough', 'and', 'progressive', 'dyspnea', 'of', '2', 'years', 'of', 'evolution', 'which', 'is', 'currently', 'grade', '2.'], ['The', 'patient', 'denies', 'other', 'symptoms.'], ['Physical', 'examination', 'shows', 'no', 'relevant', 'data.'], ['The', 'attitude', 'to', 'follow', 'would', 'be:'], ['1-', 'Start', 'treatment', 'with', 'inhaled', 'bronchodilators.'], ['2-', 'Chest', 'X-ray', 'and', 'spirometry', 'with', 'bronchodilator', 'test.'], ['3-', 'Prescribe', 'oral', 'corticosteroids.'], ['4-', 'Thoracic', 'CT', 'scan.'], ['5-', 'Perform', 'basal', 'arterial', 'blood', 'gases.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is', '2', '(Perform', 'chest', 'X-ray', 'and', 'spirometry', 'with', 'bronchodilator', 'test).'], ['It', 'is', 'probably', 'COPD', 'but', 'we', 'must', 'confirm', 'it', 'and', 'assess', 'the', 'severity', 'of', 'the', 'obstruction', 'with', 'spirometry', 'before', 'starting', 'treatment.'], ['He', 'is', 'a', 'patient', 'at', 'risk', 'for', 'lung', 'cancer', 'so', 'it', 'is', 'mandatory', 'to', 'perform', 'a', 'chest', 'X-ray', 'to', 'rule', 'out', 'this', 'or', 'other', 'pathologies', 'that', 'would', 'justify', 'the', 'symptoms,', 'although', 'most', 'likely', 'they', 'are', 'due', 'to', 'the', 'debut', 'of', 'his', 'COPD.']]
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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', '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'], ['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', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['The correct answer is 2 (Perform chest X-ray and spirometry with bronchodilator test)\n', 'Chest X-ray and spirometry with bronchodilator test\n', 'Support'], ['It is probably COPD but we must confirm it and assess the severity of the obstruction with spirometry before starting treatment\n', 'Chest X-ray and spirometry with bronchodilator test\n', 'Support'], ['He is a patient at risk for lung cancer so it is mandatory to perform a chest X-ray to rule out this or other pathologies that would justify the symptoms, although most likely they are due to the debut of his COPD\n', 'Chest X-ray and spirometry with bronchodilator test\n', 'Support'], ['A 65-year-old man, a retired office worker and smoker of 1 pack of cigarettes a day, comes to the clinic with a persistent, generally dry cough and progressive dyspnea of 2 years of evolution which is currently grade 2\n', 'Chest X-ray and spirometry with bronchodilator test\n', 'Support']]
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568_151
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '22-year-old', 'male', 'presents', 'to', 'the', 'emergency', 'department', 'with', '"almost', 'black"', 'urine', 'for', 'the', 'past', '12', 'hours.'], ['He', 'has', 'no', 'past', 'history', 'of', 'interest', 'and', 'is', 'not', 'taking', 'any', 'medications.'], ['He', 'refers', 'an', 'upper', 'respiratory', 'catarrhal', 'symptoms', 'since', '4-5', 'days', 'ago', 'for', 'which', 'he', 'has', 'taken', 'paracetamol.'], ['Examination:', 'temperature', '37.3', 'ºC,', 'BP', '150/95,', 'HR', '85', 'bpm,', 'slight', 'pharyngeal', 'erythema,', 'the', 'rest', 'normal.'], ['Laboratory', 'tests', 'showed:', 'Hb', '12.8', 'g/dl,', 'Hcto', '39%,', 'leukocytes', '10,500/mm3', 'with', 'normal', 'formula,', 'platelets', '250,000/mm3,', 'normal', 'coagulation,', 'urea', '25', 'mg/dl,', 'creatinine', '0.8', 'mg/dl,', 'ions,', 'hepatic,', 'lipid,', 'albumin', 'and', 'total', 'proteins', 'normal.'], ['Normal', 'autoimmunity', 'study', 'and', 'negative', 'viral', 'serology.'], ['Urine', '24', 'h', 'with', 'proteinuria', 'of', '0.75', 'g/24', 'h,', 'sediment', 'with', '10', 'erythrocytes', 'per', 'field', '(90%', 'dysmorphic),', 'no', 'leukocyturia.'], ['Renal', 'ultrasound', 'was', 'normal.'], ['Which', 'diagnosis', 'do', 'you', 'think', 'is', 'more', 'likely?'], ['1-', 'Nephropathy', 'with', 'minimal', 'changes.'], ['2-', 'Postinfectious', 'glomerulonephritis.'], ['3-', 'IgA', 'nephropathy.'], ['4-', 'Acute', 'interstitial', 'nephritis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['A', 'picture', 'of', 'macroscopic', 'hematuria', 'and', 'mild', 'proteinuria', 'with', 'normal', 'creatinine', 'levels,', 'accompanied', 'by', 'an', 'upper', 'tract', 'catarrhal', 'picture,', 'is', 'very', 'suggestive', 'of', 'IgA', 'nephropathy', '(option', '3', '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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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-Claim', 'I-Claim', 'I-Claim']]
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[['A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n', 'option 3 correct\n', 'Support'], ['Urine 24 h with proteinuria of 0.75 g/24 h, sediment with 10 erythrocytes per field (90% dysmorphic), no leukocyturia\n', 'A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n', 'Support'], ['Laboratory tests showed: Hb 12.8 g/dl, Hcto 39%, leukocytes 10,500/mm3 with normal formula, platelets 250,000/mm3, normal coagulation, urea 25 mg/dl, creatinine 0.8 mg/dl, ions, hepatic, lipid, albumin and total proteins normal\n', 'A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n', 'Support'], ['A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n', 'IgA nephropathy\n', 'Support'], ['option 3 correct\n', 'IgA nephropathy\n', 'Support'], ['He refers an upper respiratory catarrhal symptoms since 4-5 days ago for which he has taken paracetamol\n', 'A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n', 'Support'], ['A 22-year-old male presents to the emergency department with "almost black" urine for the past 12 hours\n', 'A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n', 'Support']]
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286_60
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[]
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228_75
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[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'with', 'clinical', 'signs', 'of', 'heart', 'failure', 'who', 'presents', 'with', 'ascites', 'disproportionately', 'elevated', 'in', 'relation', 'to', 'peripheral', 'edema,', 'the', 'most', 'likely', 'etiology', 'would', 'be:'], ['1-', 'Severe', 'aortic', 'stenosis.'], ['2-', 'Dilated', 'cardiomyopathy', 'with', 'significant', 'left', 'ventricular', 'dysfunction.'], ['3-', 'Primary', 'pulmonary', 'hypertension.'], ['4-', 'Obstructive', 'hypertrophic', 'cardiomyopathy.'], ['5-', 'Constrictive', 'pericarditis.'], ['CORRECT', 'ANSWER:', '5'], ['They', 'tell', 'us', 'about', 'clinical', 'symptoms', 'of', 'right', 'failure,', 'with', 'edema', 'and', 'ascites.'], ['Therefore,', 'we', 'rule', 'out', 'left', 'heart', 'failure:', 'EAo,', 'dilated', 'with', 'DSVI', 'and', 'a', 'MHO.'], ['Of', 'the', 'two', 'we', 'are', 'left', 'with,', 'in', 'constrictive', 'pericarditis', 'we', 'have', 'increased', 'filling', 'pressures', 'in', 'right', 'chambers,', 'which', 'cause', 'retrograde', 'pressure', 'increase', 'with', 'hepatic', 'congestion,', 'ascites,', 'edema,', 'etc.'], ['On', 'the', 'contrary,', 'in', 'pulmonary', 'hypertension,', 'the', 'tricuspid', 'valve', 'is', 'responsible', '(a', 'priori)', 'for', '"containing"', 'this', 'overpressure.']]
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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', 'O', 'O'], ['O', 'B-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', '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'], ['B-Claim', 'I-Claim', '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']]
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[['Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO\n', 'Severe aortic stenosis\n', 'Attack'], ['Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO\n', 'Dilated cardiomyopathy with significant left ventricular dysfunction\n', 'Attack'], ['Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO\n', 'Obstructive hypertrophic cardiomyopathy\n', 'Attack'], ['a patient with clinical signs of heart failure who presents with ascites disproportionately elevated in relation to peripheral edema\n', 'Of the two we are left with, in constrictive pericarditis we have increased filling pressures in right chambers, which cause retrograde pressure increase with hepatic congestion, ascites, edema, etc\n', 'Support'], ['Of the two we are left with, in constrictive pericarditis we have increased filling pressures in right chambers, which cause retrograde pressure increase with hepatic congestion, ascites, edema, etc\n', 'Constrictive pericarditis\n', 'Support']]
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217_122
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'man', 'is', 'diagnosed', 'with', 'a', 'left', 'renal', 'tumor', 'suggestive', 'of', 'renal', 'cell', 'carcinoma.'], ['His', 'preoperative', 'workup', 'shows', 'elevated', 'levels', 'of', 'GPT,', 'alkaline', 'phosphatase', 'and', 'alpha-2-globulin', 'and', 'prolonged', 'prothrombin', 'time.'], ['The', 'liver', 'is', 'diffusely', 'enlarged,', 'but', 'without', 'defects', 'of', 'hepatic', 'infiltration.'], ['The', 'most', 'likely', 'rationale', 'for', 'these', 'findings', 'is', 'due', 'to:'], ['1-', 'Hepatic', 'metastases.'], ['2-', 'Intrahepatic', 'tumor', 'thrombosis.'], ['3-', 'Acute', 'hepatitis.'], ['4-', 'Presence', 'of', 'hepatotoxic', 'substances', 'produced', 'by', 'the', 'tumor.'], ['5-', 'Hemochromatosis.'], ['CORRECT', 'ANSWER:', '4'], ['Very', 'easy', 'question', 'in', 'which', 'we', 'are', 'being', 'presented', 'with', 'a', 'patient', 'with', "Stauffer's", 'syndrome,', 'a', 'paraneoplastic', 'syndrome', 'consisting', 'of', 'liver', 'dysfunction', 'secondary', 'to', 'toxic', 'products', 'secreted', 'by', 'a', 'number', 'of', 'tumors', '(most', 'frequently,', 'renal', 'cell', 'carcinoma,', 'like', 'the', 'one', 'in', 'this', 'case).'], ['As', 'in', 'this', 'case,', 'cholestasis', '(elevation', 'of', 'alkaline', 'phosphatase),', 'mobilization', 'of', 'hepatic', 'enzymes', 'and', 'lengthening', 'of', 'the', 'prothrombin', 'time', 'indicate', 'liver', 'dysfunction.'], ['Metastases', 'are', 'ruled', 'out', '(there', 'are', 'no', 'defects', 'of', 'hepatic', 'infiltration),', 'intrahepatic', 'tumor', 'thrombosis', '(it', 'would', 'give', 'another', 'symptomatology', 'and', 'this', 'would', 'be', 'more', 'acute),', 'and', 'acute', 'hepatitis', 'and', 'hemochromatosis', '(they', 'are', 'not', 'in', 'context', 'nor', 'is', 'it', 'what', 'the', 'author', 'of', 'the', 'question', 'wants', 'us', 'to', 'think).']]
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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', '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'], ['O', 'B-Disease', 'I-Disease', 'I-Disease'], ['O', 'B-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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'O', 'B-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']]
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[['there are no defects of hepatic infiltration\n', 'Metastases are ruled out\n', 'Support'], ['it would give another symptomatology and this would be more acute\n', 'intrahepatic tumor thrombosis\n', 'Support'], ['they are not in context nor is it what the author of the question wants us to think\n', 'acute hepatitis and hemochromatosis\n', 'Support'], ['Metastases are ruled out\n', 'Hepatic metastases\n', 'Attack'], ['intrahepatic tumor thrombosis\n', 'Intrahepatic tumor thrombosi\n', 'Attack'], ['acute hepatitis and hemochromatosis\n', 'Acute hepatitis\n', 'Attack'], ['acute hepatitis and hemochromatosis\n', 'Hemochromatosis\n', 'Attack'], ["we are being presented with a patient with Stauffer's syndrome, a paraneoplastic syndrome consisting of liver dysfunction secondary to toxic products secreted by a number of tumors (most frequently, renal cell carcinoma, like the one in this case)\n", 'Presence of hepatotoxic substances produced by the tumor\n', 'Support'], ['As in this case, cholestasis (elevation of alkaline phosphatase), mobilization of hepatic enzymes and lengthening of the prothrombin time indicate liver dysfunction\n', 'Presence of hepatotoxic substances produced by the tumor\n', 'Support']]
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142_138
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['12-year-old', 'girl,', 'only', 'child', 'of', 'healthy,', 'non-consanguineous', 'parents.'], ['There', 'is', 'no', 'personal', 'or', 'family', 'history', 'of', 'interest.'], ['In', 'the', 'clinical', 'examination', 'to', 'start', 'a', 'sports', 'activity,', 'you', 'find', 'a', 'discrete', 'hepatomegaly', 'of', 'normal', 'consistency,', 'so', 'you', 'request', 'a', 'blood', 'test,', 'which', 'highlights', 'an', 'ASAT', 'of', '80U', '/', 'l,', 'ALAT', '105', 'U', '/', 'l,', 'electrophoretic', 'proteinogram', 'with', 'all', 'protein', 'fractions', 'in', 'normal', 'range', 'and', 'negativity', 'of', 'serology', 'for', 'hepatotropic', 'viruses.'], ['What', 'should', 'you', 'rule', 'out', 'and', 'what', 'test', 'would', 'you', 'indicate', 'for', 'it?'], ['1-', 'Deficiency', 'of', 'alpha', '1', 'antitrypsin.', 'Thoracic', 'TAC', 'to', 'confirm', 'emphysema.'], ['2-', 'Mucoviscidosis.', 'Determination', 'of', 'chlorine', 'in', 'sweat.'], ['3-', 'Autoimmune', 'hepatitis.', 'Liver', 'biopsy.'], ['4-', 'Glycogenosis', 'type', 'VI', '(phosphorylase', 'deficiency).', 'Muscle', 'biopsy.'], ['5-', "Wilson's", 'disease.', 'Determine', 'ceruloplasmin', 'and', 'copper', 'in', 'blood', 'and', 'urine.'], ['CORRECT', 'ANSWER:', '5'], ['In', 'fact,', 'I', 'would', 'not', 'test', 'this', 'patient', 'at', 'this', 'time,', 'and', 'I', 'would', 'check', 'if', 'the', 'transaminase', 'level', 'has', 'normalized', 'at', 'a', 'later', 'time,', 'since', 'the', 'most', 'frequent', 'cause,', 'at', 'least', 'in', 'children,', 'is', 'a', 'transient', 'elevation', 'in', 'the', 'context', 'of', 'viral', 'diseases', '(most', 'frequently', 'cytomegalovirus', 'and', 'Epstein-Barr', 'virus).'], ['The', 'minimal', 'elevation', 'of', 'liver', 'enzymes', 'and', 'the', 'fact', 'that', 'it', 'has', 'a', 'normal', 'protein', 'profile', 'goes', 'against', 'chronicity...'], ['If', 'I', 'had', 'to', 'choose', 'I', 'would', 'choose', 'answer', '5,', 'which', 'seems', 'to', 'me', 'the', 'least', 'aggressive,', 'and', 'if', 'I', 'had', 'to', 'do', 'analytical', 'tests', 'I', 'would', 'add', 'the', 'determination', 'of', 'alpha-1-antitrypsin', '(without', 'CT)', 'and', 'markers', 'of', 'celiac', 'disease,', 'because', 'celiac', 'disease', 'can', 'also', 'be', 'associated', 'with', 'some', 'hypertransaminemia.']]
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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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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']]
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[['If I had to choose I would choose answer 5, which seems to me the least aggressive\n', "Wilson's disease. Determine ceruloplasmin and copper in blood and urine\n", 'Support'], ['In the clinical examination to start a sports activity, you find a discrete hepatomegaly of normal consistency, so you request a blood test, which highlights an ASAT of 80U / l, ALAT 105 U / l, electrophoretic proteinogram with all protein fractions in normal range and negativity of serology for hepatotropic viruses\n', 'if I had to do analytical tests I would add the determination of alpha-1-antitrypsin (without CT) and markers of celiac disease, because celiac disease can also be associated with some hypertransaminemia\n', 'Support'], ['The minimal elevation of liver enzymes and the fact that it has a normal protein profile goes against chronicity\n', 'Autoimmune hepatitis. Liver biopsy\n', 'Attack'], ['In the clinical examination to start a sports activity, you find a discrete hepatomegaly of normal consistency, so you request a blood test, which highlights an ASAT of 80U / l, ALAT 105 U / l, electrophoretic proteinogram with all protein fractions in normal range and negativity of serology for hepatotropic viruses\n', 'Autoimmune hepatitis. Liver biopsy\n', 'Attack']]
|
267_139
|
[['QUESTION', 'TYPE:', 'PNEUMOLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'with', 'liver', 'cirrhosis', 'and', 'ascites,', 'who', 'develops', 'a', 'pleural', 'effusion', 'with', 'the', 'following', 'data', 'in', 'the', 'pleural', 'fluid:', 'LDH', '45', 'U/L', '(serum', '220', 'U/L),', 'pleural/serum', 'protein', 'ratio', '0.3', 'and', 'pleural/serum', 'LDH', 'ratio', '0.2.'], ['What', 'would', 'be', 'the', 'appropriate', 'attitude?'], ['1-', 'The', 'study', 'of', 'the', 'fluid', 'with', 'cell', 'count,', 'glucose,', 'pH,', 'ADA,', 'cholesterol', 'and', 'culture', 'should', 'be', 'extended.', 'ADA,', 'cholesterol', 'and', 'culture.'], ['2-', 'Blind', 'pleural', 'biopsy.'], ['3-', 'Diagnostic', 'videothoracoscopy.'], ['4-', 'Empirical', 'antibiotherapy', 'for', 'suspected', 'parapneumonic', 'effusion.'], ['5-', 'Continue', 'treatment', 'of', 'his', 'liver', 'disease.'], ['CORRECT', 'ANSWER:', '5'], ['They', 'describe', 'pleural', 'fluid', 'parameters', 'of', 'transudate,', 'so', 'if', 'the', 'patient', 'is', 'not', 'in', 'heart', 'failure', 'it', 'is', 'a', 'hydropic', 'decompensation.'], ['No', 'other', 'studies', 'are', 'needed.']]
|
[['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['B-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'], ['O', 'O', 'O', 'O', 'O']]
|
[['They describe pleural fluid parameters of transudate\n', 'if the patient is not in heart failure it is a hydropic decompensation\n', 'Support']]
|
99_84
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'diabetic', 'patient', 'is', 'consulting', 'for', 'the', 'first', 'time', 'regarding', 'the', 'treatment', 'of', 'his', 'disease.'], ['Which', 'of', 'the', 'following', 'goals', 'would', 'you', 'recommend', 'to', 'him', 'first?'], ['1-', 'Maintain', 'blood', 'pressure', 'below', '110/70', 'mmHg.'], ['2-', 'Smoking', 'cessation.'], ['3-', 'Maintain', 'a', 'body', 'mass', 'index', '(BMI)', 'less', 'than', '21.'], ['4-', 'Perform', 'daily', 'basal', 'capillary', 'glycemia.'], ['5-', 'Avoidance', 'of', 'animal', 'fats', 'in', 'the', 'diet.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'rest', 'are', 'not', 'indications.'], ['The', 'target', 'BP', 'is', '<', '130/85', 'mmHg.']]
|
[['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', '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', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Treatment', 'I-Treatment', 'I-Treatment', 'I-Treatment', 'I-Treatment', 'I-Treatment', 'I-Treatment'], ['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']]
|
[]
|
380_135
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '25-year-old', 'patient,', 'during', 'a', 'tennis', 'match,', 'has', 'intense', 'pain', 'in', 'the', 'neck', 'and', 'in', 'the', 'left', 'eye.'], ['The', 'next', 'morning', 'he', 'wakes', 'up', 'with', 'a', 'feeling', 'of', 'gait', 'instability', 'and', 'has', 'palpebral', 'ptosis', 'of', 'the', 'left', 'eye', 'and', 'anisocoria,', 'with', 'the', 'left', 'pupil', 'being', 'smaller', 'than', 'the', 'right.'], ['The', 'patient', 'maintains', 'good', 'visual', 'acuity.'], ['Where', 'would', 'you', 'most', 'likely', 'locate', 'the', 'lesion?'], ['1-', 'III', 'cranial', 'pair.'], ['2-', 'Optic', 'chiasm.'], ['3-', 'Superior', 'cervical', 'ganglion.'], ['4-', 'Spinal', 'bulb.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'picture', 'presented', 'to', 'us', 'is', 'that', 'of', 'a', 'Horner', 'syndrome', '(miosis', 'with', 'ptosis)', 'so', 'the', 'possibilities', 'are', 'reduced', 'to', 'options', '3', 'or', '4,', 'but', 'they', 'specify', 'that', 'the', 'patient', 'presents', 'gait', 'instability,', 'which', 'is', 'not', 'justified', 'by', 'a', 'Horner', 'due', 'to', 'carotid', 'dissection', 'affecting', 'the', 'superior', 'cervical', 'ganglion,', 'which', 'is', 'what', 'they', 'want', 'us', 'to', 'believe', 'when', 'they', 'talk', 'about', 'pain', 'in', 'the', 'neck', 'and', 'in', 'the', 'eye.'], ['If', 'the', 'patient', 'really', 'has', 'ataxia,', 'the', 'only', 'possible', 'location', 'would', 'be', 'the', 'spinal', 'cord.']]
|
[['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'], ['B-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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', 'B-Marker', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
|
[['The picture presented to us is that of a Horner syndrome (miosis with ptosis)\n', 'the possibilities are reduced to options 3 or 4\n', 'Support'], ['the possibilities are reduced to options 3 or 4\n', 'III cranial pair\n', 'Attack'], ['the possibilities are reduced to options 3 or 4\n', 'Optic chiasm\n', 'Attack'], ['If the patient really has ataxia, the only possible location would be the spinal cord\n', 'Spinal bulb\n', 'Support'], ['they specify that the patient presents gait instability\n', 'which is not justified by a Horner due to carotid dissection affecting the superior cervical ganglion, which is what they want us to believe when they talk about pain in the neck and in the eye\n', 'Support'], ['which is not justified by a Horner due to carotid dissection affecting the superior cervical ganglion, which is what they want us to believe when they talk about pain in the neck and in the eye\n', 'Superior cervical ganglion\n', 'Attack']]
|
341_33
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'woman', 'diagnosed', 'with', 'infiltrating', 'ductal', 'carcinoma', 'of', 'the', 'breast', 'with', 'no', 'family', 'history', 'of', 'neoplasia.'], ['What', 'additional', 'studies', 'should', 'be', 'performed', 'on', 'the', 'tumor', 'because', 'of', 'its', 'clinical', 'and', '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'], ['Study', 'of', 'hormone', 'receptors', 'and', 'HER2.'], ['Both', 'for', 'the', 'type', 'of', 'treatment', 'and', 'to', 'study', 'the', 'prognostic', 'factor', 'and', 'adjuvant', 'treatment,', 'it', 'is', 'necessary', 'to', 'know', 'the', 'different', 'hormonal', 'receptors', '(estrogen', 'and', 'progesterone)', 'as', 'well', 'as', 'HER2-neu.']]
|
[['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'], ['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', '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'], ['O', 'O'], ['O', 'O', 'O'], ['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']]
|
[['Both for the type of treatment and to study the prognostic factor and adjuvant treatment, it is necessary to know the different hormonal receptors (estrogen and progesterone) as well as HER2-neu\n', 'Study of hormone receptors and HER2\n', 'Support'], ['Study of hormone receptors and HER2\n', 'Study of hormone receptors and HER2\n', 'Support']]
|
308_215
|
[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '47-year-old', 'man', 'with', 'myopia', 'magna,', 'who', 'underwent', 'cataract', 'surgery', '2', 'years', 'ago,', 'comes', 'to', 'the', 'emergency', 'room', 'reporting', 'a', 'profound', 'and', 'painless', 'loss', 'of', 'vision', 'in', 'his', 'right', 'eye.'], ['Which', 'of', 'the', 'following', 'diagnoses', 'can', 'cause', 'this', 'symptomatology?'], ['1-', 'Post-surgical', 'endophthalmitis.'], ['2-', 'Retinal', 'detachment.'], ['3-', 'Age-related', 'macular', 'degeneration,', 'wet', 'form.'], ['4-', 'Posterior', 'vitreous', 'detachment.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['He', 'refers', 'to', 'a', 'patient', 'post', 'cataract', 'surgery', '2', 'years', 'ago', 'with', 'deep', 'and', 'painless', 'loss', 'of', 'OD.'], ['Post-surgical', 'endophthalmitis', 'is', 'more', 'associated', 'with', 'patients', 'in', 'the', 'immediate', 'postoperative', 'period,', 'besides', 'being', 'very', 'painful', 'with', 'rapidly', 'progressive', 'decrease', 'in', 'visual', 'acuity,', 'so', 'it', 'is', 'not', 'correct.'], ['Retinal', 'detachment', 'is', 'consistent', 'with', 'the', 'clinical', 'case', 'because', 'it', 'is', 'also', 'a', 'myopic', 'patient', 'who', 'tend', 'to', 'have', 'a', 'special', 'predisposition', 'to', 'detachment.'], ['ARMD', 'usually', 'occurs', 'in', 'older', 'patients', 'and', 'the', 'decrease', 'in', 'vision', 'is', 'progressive.'], ['In', 'PVD', 'there', 'may', 'or', 'may', 'not', 'be', 'a', 'slight', 'decrease', 'in', 'visual', 'acuity', 'and', 'the', 'patient', 'usually', 'reports', 'some', 'discomfort', 'or', 'pain', 'at', 'the', 'onset', 'of', 'the', 'clinical', 'picture.']]
|
[['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'], ['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', 'I-Claim', 'I-Claim'], ['O', 'B-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', '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', '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', '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'], ['B-Claim', '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']]
|
[['A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye\n', 'Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period\n', 'Attack'], ['Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period\n', 'it is not correct\n', 'Support'], ['besides being very painful with rapidly progressive decrease in visual acuity\n', 'it is not correct\n', 'Support'], ['Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period\n', 'Post-surgical endophthalmitis\n', 'Attack'], ['it is not correct\n', 'Post-surgical endophthalmitis\n', 'Attack'], ['ARMD usually occurs in older patients and the decrease in vision is progressive\n', 'Age-related macular degeneration, wet form\n', 'Attack'], ['A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye\n', 'ARMD usually occurs in older patients and the decrease in vision is progressive\n', 'Attack'], ['A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye\n', 'In PVD there may or may not be a slight decrease in visual acuity and the patient usually reports some discomfort or pain at the onset of the clinical picture\n', 'Attack'], ['In PVD there may or may not be a slight decrease in visual acuity and the patient usually reports some discomfort or pain at the onset of the clinical picture\n', 'Posterior vitreous detachment\n', 'Attack'], ['Retinal detachment is consistent with the clinical case\n', 'Retinal detachment\n', 'Support'], ['it is also a myopic patient who tend to have a special predisposition to detachment\n', 'Retinal detachment is consistent with the clinical case\n', 'Support']]
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519_176
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[]
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63_200
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[['QUESTION', 'TYPE:', 'ANATOMY'], ['CLINICAL', 'CASE:'], ['A', '31-year-old', 'bricklayer', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'tenosynovitis', 'caused', 'by', 'a', 'penetrating', 'wound.'], ['On', 'examination,', 'the', 'ulnar', 'bursa', 'is', 'found', 'to', 'be', 'infected', 'with', 'consequent', 'tendon', 'necrosis.'], ['Which', 'tendon', 'will', 'be', 'affected?'], ['1-', 'Tendon', 'of', 'the', 'flexor', 'carpi', 'ulnaris.'], ['2-', 'Tendon', 'of', 'the', 'abductor', 'pollicis', 'longus.'], ['3-', 'Tendon', 'of', 'the', 'deep', 'flexor', 'of', 'the', 'fingers.'], ['4-', 'Radial', 'carpal', 'flexor', 'tendon.'], ['5-', 'Palmaris', 'longus', 'tendon.'], ['CORRECT', 'ANSWER:', '1'], ['Both', 'the', 'flexor', 'carpi', 'radialis', 'and', 'the', 'abductor', 'pollicis', 'longus', 'are', 'anatomically', 'far', 'from', 'the', 'ulnar.'], ['The', 'palmaris', 'longus', 'is', 'medial,', 'as', 'is', 'the', 'flexor', 'digitorum', 'profundus.'], ['The', 'tendon', 'that', 'runs', 'alongside', 'the', 'ulnar', 'nerve,', 'inserting', 'into', 'the', 'pisiform,', 'is', 'the', 'flexor', 'carpi', 'ulnaris,', 'thus', 'answer', '1.']]
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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', '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', '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', 'B-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'], ['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', 'B-Marker', 'B-Claim', 'I-Claim']]
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[['Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar.\n', 'Tendon of the abductor pollicis longus\n', 'Attack'], ['Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar.\n', 'Radial carpal flexor tendon\n', 'Attack'], ['The palmaris longus is medial, as is the flexor digitorum profundus\n', 'Palmaris longus tendon\n', 'Attack'], ['answer 1\n', 'Tendon of the flexor carpi ulnaris\n', 'Support'], ['The tendon that runs alongside the ulnar nerve, inserting into the pisiform, is the flexor carpi ulnaris\n', 'answer 1\n', 'Support'], ['The palmaris longus is medial, as is the flexor digitorum profundus\n', 'Tendon of the deep flexor of the fingers\n', 'Attack']]
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30_61
|
[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'previously', 'diagnosed', 'with', 'COPD', 'comes', 'to', 'the', 'emergency', 'room', 'for', '3', 'days', 'with', 'increased', 'dyspnea', 'until', 'he', 'is', 'at', 'rest,', 'cough', 'with', 'whitish', 'expectoration', 'and', 'marked', 'drowsiness.'], ['After', 'receiving', 'treatment', 'with', 'oxygen', 'at', 'low', 'concentrations,', 'bronchodilators', 'and', 'coticoids,', 'a', 'second', 'arterial', 'blood', 'gas', 'with', '28%', 'inspiratory', 'oxygen', 'fraction', 'shows', 'a', 'pH', 'of', '7.32,', 'pO2', '61', 'mmHg,', 'pCO2', '58', 'mmHg,', 'HCO3-', '29', 'mmol/l.'], ['What', 'would', 'be', 'the', 'interpretation', 'you', 'would', 'make', 'of', 'the', 'arterial', 'blood', 'gas', 'and', 'what', 'treatment', 'would', 'you', 'use?'], ['1-', 'Increase', 'oxygen', 'flow', 'because', 'he', 'has', 'acute', 'respiratory', 'acidosis', 'and', 'hypoxemia.'], ['2-', 'I', 'would', 'initiate', 'noninvasive', 'mechanical', 'ventilation', 'because', 'he', 'has', 'acute', 'hypercapnic', 'respiratory', 'failure', 'with', 'moderate', 'respiratory', 'acidosis.'], ['3-', 'I', 'would', 'add', 'sodium', 'bicarbonate', 'to', 'correct', 'the', 'acute', 'metabolic', 'acidosis.'], ['4-', 'The', 'patient', 'does', 'not', 'have', 'respiratory', 'insufficiency', 'so', 'he', 'would', 'continue', 'with', 'the', 'same', 'pharmacological', 'regimen.'], ['5-', 'I', 'would', 'add', 'intravenous', 'aminophylline', 'as', 'a', 'respiratory', 'stimulant,', 'since', 'I', 'appreciate', 'hypoxemia', 'and', 'hypercapnia.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'a', 'very', 'bad', 'question,', 'I', 'will', 'bet', 'on', 'one', 'answer,', 'but', 'depending', 'on', 'data', 'that', 'we', 'are', 'not', 'given,', 'three', 'answers', 'could', 'be', 'valid.'], ['The', 'trap', 'is', 'that', 'they', 'give', 'us', 'the', 'initial', 'clinical', 'picture', 'WITHOUT', 'GASOMETRY', 'and', 'then', 'they', 'give', 'us', 'the', 'blood', 'gases', 'afterwards', 'WITHOUT', 'CLINIC,', 'so', 'there', 'is', 'no', 'way', 'of', 'knowing', 'what', 'the', 'evolution', 'of', 'the', 'patient', 'has', 'been', 'with', 'our', 'treatment,', 'so', 'it', 'is', 'impossible', 'to', 'know', 'what', 'to', 'do.'], ['If', 'the', 'patient', 'initially', 'came', 'with', 'a', 'blood', 'gas', 'with', 'a', 'pH', 'of', '7.05', 'and', 'now', 'has', 'the', 'one', 'we', 'are', 'given,', 'we', 'are', 'doing', 'well', '(although', 'we', 'are', 'not', 'told', 'the', 'time', 'interval', 'between', 'one', 'thing', 'and', 'the', 'other)', 'and,', 'in', 'this', 'case,', 'it', 'could', 'be', 'worthwhile', 'to', 'continue', 'with', 'the', 'same', 'treatment.'], ['If', 'nothing', 'has', 'evolved,', 'the', 'clinical', 'picture', 'is', 'the', 'same', 'and', 'the', 'blood', 'gas', 'at', 'the', 'beginning', 'was', 'similar,', 'something', 'should', 'be', 'done', '(also', 'depending', 'on', 'the', "patient's", 'baseline', 'status,', 'which', 'they', 'do', 'not', 'tell', 'us', 'either).'], ['If', 'we', 'decide', 'to', 'do', 'something,', 'at', 'present', 'we', 'might', 'decide', 'to', 'use', 'ventilation', 'rather', 'than', 'theophylline,', 'although', 'with', '"so', 'little"', 'alteration', 'of', 'pH', '(and', 'even', 'more', 'so', 'if', 'we', 'think', 'that', 'this', 'is', 'a', 'chronic', 'patient', 'who', 'may', 'have', 'a', 'baseline', 'blood', 'gas', 'similar', 'to', 'the', 'one', 'presented', 'to', 'us)', 'it', 'may', 'seem', '"exaggerated".'], ['We', 'have', 'nothing', '"against"', 'theophylline', '(we', 'are', 'not', 'told', 'of', 'any', 'contraindication),', 'but', 'nowadays', 'it', 'is', 'rare', 'to', 'resort', 'to', 'it.'], ['1:', 'Wrong,', 'he', 'is', 'a', '"retentive"', 'patient', 'and', 'increasing', 'O2', 'flow', 'is', 'highly', 'likely', 'to', 'increase', 'hypercapnia', 'and,', 'therefore,', 'acidosis.'], ['2:', 'We', 'will', 'keep', 'this', 'one', 'as', 'correct.'], ['3:', 'It', 'is', 'not', 'a', 'metabolic', 'acidosis,', 'the', 'bicarbonate', 'is', 'not', 'decreased,', 'on', 'the', 'contrary,', 'it', 'is', 'slightly', 'increased', 'trying', 'to', 'compensate', 'the', 'respiratory', 'acidosis.'], ['4:', 'He', 'does', 'not', 'reach', 'respiratory', 'failure', 'by', 'definition', '(pO2', '60),', 'but', 'he', 'has', 'hypercapnia', 'and', 'slight', 'acidosis.'], ['If', 'we', 'knew', 'the', 'first', 'blood', 'gas', 'and', 'she', 'was', 'much', 'worse', '(i.e.', 'she', 'was', 'doing', 'very', 'well),', 'continuing', 'with', 'the', 'same', 'medication', 'would', 'be', 'an', 'option,', 'but', 'this', 'data', 'is', 'missing!!!,', 'in', 'any', 'case', 'it', 'seems', 'to', 'be', 'a', 'trick', 'answer.'], ['5:', 'At', 'present', 'and', '-as', 'already', 'mentioned-', 'taking', 'into', 'account', 'that', 'there', 'is', 'no', 'formal', 'contraindication,', 'it', 'is', 'not', 'usually', 'used.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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', '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', 'B-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', '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-Marker', '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', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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']]
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[['he is a "retentive" patient and increasing O2 flow is highly likely to increase hypercapnia and, therefore, acidosis\n', '1: Wrong\n', 'Support'], ['the bicarbonate is not decreased, on the contrary, it is slightly increased trying to compensate the respiratory acidosis\n', '3: It is not a metabolic acidosis\n', 'Support'], ['If we knew the first blood gas and she was much worse (i.e. she was doing very well), continuing with the same medication would be an option\n', '4: He does not reach respiratory failure by definition (pO2 60), but he has hypercapnia and slight acidosis\n', 'Support'], ['but this data is missing!!!\n', 'If we knew the first blood gas and she was much worse (i.e. she was doing very well), continuing with the same medication would be an option\n', 'Attack'], ['but this data is missing!!!\n', '4: He does not reach respiratory failure by definition (pO2 60), but he has hypercapnia and slight acidosis\n', 'Attack'], ['The trap is that they give us the initial clinical picture WITHOUT GASOMETRY and then they give us the blood gases afterwards WITHOUT CLINIC\n', 'there is no way of knowing what the evolution of the patient has been with our treatment\n', 'Support'], ['The trap is that they give us the initial clinical picture WITHOUT GASOMETRY and then they give us the blood gases afterwards WITHOUT CLINIC\n', 'it is impossible to know what to do\n', 'Support'], ['If the patient initially came with a blood gas with a pH of 7.05 and now has the one we are given, we are doing well (although we are not told the time interval between one thing and the other)\n', 'in this case, it could be worthwhile to continue with the same treatment\n', 'Support'], ['If nothing has evolved, the clinical picture is the same and the blood gas at the beginning was similar\n', 'something should be done\n', 'Support'], ['something should be done\n', 'If we decide to do something, at present we might decide to use ventilation rather than theophylline\n', 'Support'], ['although with "so little" alteration of pH (and even more so if we think that this is a chronic patient who may have a baseline blood gas similar to the one presented to us) it may seem "exaggerated"\n', 'If we decide to do something, at present we might decide to use ventilation rather than theophylline\n', 'Attack'], ['We have nothing "against" theophylline (we are not told of any contraindication), but nowadays it is rare to resort to it\n', '5: At present and -as already mentioned- taking into account that there is no formal contraindication, it is not usually used\n', 'Support'], ['in this case, it could be worthwhile to continue with the same treatment\n', 'The patient does not have respiratory insufficiency so he would continue with the same pharmacological regimen\n', 'Support'], ['If we decide to do something, at present we might decide to use ventilation rather than theophylline\n', 'I would add intravenous aminophylline as a respiratory stimulant, since I appreciate hypoxemia and hypercapnia\n', 'Attack'], ['We have nothing "against" theophylline (we are not told of any contraindication), but nowadays it is rare to resort to it\n', 'I would add intravenous aminophylline as a respiratory stimulant, since I appreciate hypoxemia and hypercapnia\n', 'Attack'], ['If we decide to do something, at present we might decide to use ventilation rather than theophylline\n', 'I would initiate noninvasive mechanical ventilation because he has acute hypercapnic respiratory failure with moderate respiratory acidosis\n', 'Support'], ['1: Wrong\n', 'Increase oxygen flow because he has acute respiratory acidosis and hypoxemia\n', 'Attack'], ['2: We will keep this one as correct.\n', 'I would initiate noninvasive mechanical ventilation because he has acute hypercapnic respiratory failure with moderate respiratory acidosis\n', 'Support'], ['3: It is not a metabolic acidosis\n', 'I would add sodium bicarbonate to correct the acute metabolic acidosis\n', 'Attack'], ['4: He does not reach respiratory failure by definition (pO2 60), but he has hypercapnia and slight acidosis\n', 'The patient does not have respiratory insufficiency so he would continue with the same pharmacological regimen\n', 'Support'], ['5: At present and -as already mentioned- taking into account that there is no formal contraindication, it is not usually used\n', 'I would add intravenous aminophylline as a respiratory stimulant, since I appreciate hypoxemia and hypercapnia\n', 'Attack']]
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226_71
|
[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['An', '82-year-old', 'hypertensive', 'woman', 'on', 'atenolol,', 'hydrochlorothiazide', 'and', 'digoxin.'], ['She', 'comes', 'to', 'the', 'emergency', 'room', 'for', 'atrial', 'fibrillation', 'and', 'is', 'administered', 'IV', 'verapamil.'], ['The', 'ECG', 'showed', 'complete', 'atrioventricular', 'block.'], ['What', 'is', 'the', 'most', 'probable', 'cause', 'of', 'this', 'clinical', 'situation?'], ['1-', 'Digitalis', 'intoxication', 'due', 'to', 'pharmacokinetic', 'interaction', 'with', 'verapamil.'], ['2-', 'Hypokalemia', 'due', 'to', 'administration', 'of', 'thiazide', 'and', 'digoxin.'], ['3-', 'Pharmacodynamic', 'interaction', 'of', 'beta-blocker,', 'digoxin', 'and', 'verapamil.'], ['4-', 'Hypotensive', 'effect', 'of', 'thiazide', 'diuretic.'], ['5-', 'Cardiac', 'arrhythmia', 'due', 'to', 'verapamil.'], ['CORRECT', 'ANSWER:', '3'], ['He', 'already', 'takes', 'two', 'AV', 'node', 'brakers', 'and', 'you', 'add', 'a', 'third,', 'and', 'are', 'you', 'surprised', 'that', 'he', 'gets', 'complete', 'AV', 'block', 'after', 'messing', 'with', 'drugs', 'from', 'different', 'families', 'but', 'same', 'effect', '(pharmacodynamics)?'], ['Three.'], ['And', 'remember', 'that', 'drugs', 'are', 'like', 'drinks', 'when', 'you', 'go', 'to', 'a', 'bar:', "don't", 'mix!']]
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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'], ['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', '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'], ['O', 'B-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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['He already takes two AV node brakers and you add a third, and are you surprised that he gets complete AV block after messing with drugs from different families but same effect (pharmacodynamics)?\n', 'Three\n', 'Support'], ['Three\n', 'Pharmacodynamic interaction of beta-blocker, digoxin and verapamil\n', 'Support']]
|
565_148
| null | null |
[]
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135_38
|
[['QUESTION', 'TYPE:', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'man', 'with', 'Child', 'A', 'liver', 'cirrhosis', 'with', 'no', 'history', 'of', 'decompensation.'], ['After', 'detection', 'of', 'a', 'focal', 'hepatic', 'lesion', 'on', 'screening', 'ultrasound,', 'the', 'study', 'is', 'completed', 'with', 'a', 'thoracoabdominal', 'CT', 'scan.'], ['This', 'scan', 'showed', 'the', 'presence', 'of', '4', 'liver', 'lesions', '(one', 'of', 'them', 'up', 'to', '6', 'cm)', 'with', 'uptake', 'pattern', 'typical', 'of', 'hepatocarcinoma,', 'tumor', 'vascular', 'invasion', 'and', 'a', 'metastasis', 'in', 'the', 'right', 'adrenal', 'gland.'], ['No', 'ascites', 'is', 'observed.'], ['The', 'patient', 'reports', 'only', 'asthenia,', 'but', 'no', 'general', 'syndrome.'], ['The', 'treatment', 'of', 'this', 'patient', 'would', 'be:'], ['1-', 'Symptomatic', 'and', 'supportive', 'treatment,', 'since', 'he', 'presented', 'an', 'advanced', 'hepatocarcinoma', 'with', 'vascular', 'invasion', 'and', 'metastasis.'], ['2-', 'Transarterial', 'chemoembolization', '(TACE),', 'since', 'the', 'treatment', 'increases', 'survival', 'in', 'patients', 'with', 'advanced', 'hepatocarcinoma.'], ['3-', 'Systemic', 'chemotherapy', 'with', 'doxorubicin', 'iv', 'since', 'he', 'presents', 'disseminated', 'disease', 'but', 'he', 'is', 'in', 'good', 'general', 'condition.'], ['4-', 'Treatment', 'with', 'oral', 'sorafenib,', 'since', 'this', 'is', 'a', 'patient', 'with', 'good', 'general', 'condition,', 'Child', 'A', 'and', 'advanced', 'stage', 'hepatocarcinoma', 'BCLC-C.'], ['5-', 'The', 'appropriate', 'treatment', 'is', 'liver', 'transplantation', 'as', 'it', 'is', 'the', 'only', 'procedure', 'that', 'completely', 'eliminates', 'the', 'primary', 'tumor', 'and', 'avoids', 'future', 'complications', 'of', 'cirrhosis.'], ['CORRECT', 'ANSWER:', '4'], ['Comment:', 'The', 'patient', 'presents', 'a', 'good', 'general', 'condition', 'with', 'a', 'recently', 'diagnosed', 'hepatocarcinoma,', 'not', 'giving', 'him', 'any', 'type', 'of', 'treatment', 'other', 'than', 'symptomatic', 'and', 'supportive', 'at', 'this', 'stage', 'would', 'not', 'be', 'the', 'right', 'thing', 'to', 'do.'], ['TACE', 'would', 'not', 'be', 'indicated', 'because', 'of', 'extrahepatic', 'involvement.'], ['Transplantation', 'would', 'also', 'not', 'be', 'done', 'if', 'he', 'has', 'extrahepatic', 'disease.'], ['We', 'are', 'left', 'with', 'answers', '3', 'and', '4,', 'both', 'with', 'systemic', 'treatment', '(indicated', 'because', 'it', 'is', 'metastatic)', 'and', 'the', 'correct', 'answer', 'is', '4,', 'for', 'all', 'the', 'reasons', 'given', 'therein.']]
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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', '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'], ['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'], ['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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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']]
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[['The patient presents a good general condition with a recently diagnosed hepatocarcinoma, not giving him any type of treatment other than symptomatic and supportive at this stage would not be the right thing to do\n', 'Symptomatic and supportive treatment, since he presented an advanced hepatocarcinoma with vascular invasion and metastasis\n', 'Attack'], ['TACE would not be indicated because of extrahepatic involvement\n', 'Transarterial chemoembolization (TACE), since the treatment increases survival in patients with advanced hepatocarcinoma\n', 'Attack'], ['Transplantation would also not be done if he has extrahepatic disease\n', 'The appropriate treatment is liver transplantation as it is the only procedure that completely eliminates the primary tumor and avoids future complications of cirrhosis\n', 'Attack'], ['the correct answer is 4, for all the reasons given therein\n', 'Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C\n', 'Support'], ['answers 3 and 4, both with systemic treatment (indicated because it is metastatic)\n', 'Systemic chemotherapy with doxorubicin iv since he presents disseminated disease but he is in good general condition\n', 'Support'], ['answers 3 and 4, both with systemic treatment (indicated because it is metastatic)\n', 'Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C\n', 'Support'], ['This scan showed the presence of 4 liver lesions (one of them up to 6 cm) with uptake pattern typical of hepatocarcinoma, tumor vascular invasion and a metastasis in the right adrenal gland\n', 'Systemic chemotherapy with doxorubicin iv since he presents disseminated disease but he is in good general condition\n', 'Support'], ['This scan showed the presence of 4 liver lesions (one of them up to 6 cm) with uptake pattern typical of hepatocarcinoma, tumor vascular invasion and a metastasis in the right adrenal gland\n', 'Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C\n', 'Support']]
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556_55
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['63-year-old', 'diabetic', 'patient', 'whose', 'family', 'physician', 'has', 'requested', 'a', 'blood', 'test', 'to', 'determine', 'vitamin', 'B12', 'levels.What', 'is', 'the', 'antidiabetic', 'drug', 'he', 'is', 'taking', 'that', 'warrants', 'such', 'a', 'request:'], ['1-', 'Gliclazide.'], ['2-', 'Metformin.'], ['3-', 'Repaglinide.'], ['4-', 'Pioglitazone.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Metformin', 'is', 'an', 'oral', 'antidiabetic', 'widely', 'used', 'in', 'the', 'treatment', 'of', 'type', '2', 'diabetes', 'mellitus.'], ['The', 'best', 'known', 'side', 'effects', 'are', 'gastrointestinal', 'side', 'effects', 'and', 'lactic', 'acidosis;', 'however,', 'vitamin', 'B', '12', 'malabsorption,', 'is', 'less', 'well', 'known.'], ['A', 'decrease', 'in', 'vitamin', 'B', '12', 'levels', 'is', 'observed', 'in', 'patients', 'treated', 'with', 'metformin.'], ['The', 'mechanism', 'by', 'which', 'this', 'deficit', 'occurs', 'is', 'not', 'clear', 'and', 'it', 'is', 'known', 'to', 'be', 'reversible', 'when', 'treatment', 'is', 'interrupted.']]
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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', 'O', 'O', 'O', 'O'], ['O', 'B-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', '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'], ['B-Claim', 'I-Claim', '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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[['A decrease in vitamin B 12 levels is observed in patients treated with metformin\n', 'Metformin\n', 'Support'], ['63-year-old diabetic patient whose family physician has requested a blood test to determine vitamin B12 levels\n', 'A decrease in vitamin B 12 levels is observed in patients treated with metformin\n', 'Support'], ['63-year-old diabetic patient whose family physician has requested a blood test to determine vitamin B12 levels\n', 'however, vitamin B 12 malabsorption, is less well known\n', 'Support']]
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448_148
|
[['QUESTION', 'TYPE:', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '59-year-old', 'woman', 'with', 'recent', 'onset', 'of', 'epileptic', 'seizures', 'comes', 'to', 'the', 'emergency', 'department.'], ['The', 'examination', 'showed', 'left', 'pyramidal', 'signs', 'and', 'papillary', 'edema.'], ['Brain', 'MRI', 'showed', 'a', 'right', 'hemispheric', 'mass', 'with', 'edema,', 'midline', 'deviation', 'and', 'signs', 'of', 'tentorial', 'herniation.'], ['She', 'reports', 'a', 'headache', 'that', 'has', 'been', 'progressing', 'in', 'intensity', 'for', 'the', 'past', 'week.'], ['Which', 'of', 'the', 'following', 'features', 'associated', 'with', 'headache', 'seems', 'most', 'likely', 'in', 'this', 'patient?'], ['1-', 'Predominance', 'in', 'the', 'morning.'], ['2-', 'It', 'does', 'not', 'change', 'with', 'effort.'], ['3-', 'Photophobia.'], ['4-', 'Sonophobia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['They', 'describe', 'a', 'recent', 'diagnosis', 'of', 'cerebral', 'LOE', 'with', 'signs', 'of', 'intracranial', 'hypertension', '(edema,', 'midline', 'deviation,', 'papilledema).'], ['The', 'associated', 'headache', 'is', 'typically', 'morning', 'headache,', 'with', 'increasing', 'ICP', 'values', 'at', 'night.']]
|
[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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', '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']]
|
[['edema, midline deviation, papilledema\n', 'They describe a recent diagnosis of cerebral LOE with signs of intracranial hypertension\n', 'Support'], ['They describe a recent diagnosis of cerebral LOE with signs of intracranial hypertension\n', 'The associated headache is typically morning headache, with increasing ICP values at night\n', 'Support'], ['She reports a headache that has been progressing in intensity for the past week\n', 'The associated headache is typically morning headache, with increasing ICP values at night\n', 'Support']]
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591_64
|
[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '68-year-old', 'woman', 'who', 'wears', '+4.00', 'diopter', 'glasses', 'for', 'distance', 'vision', 'in', 'both', 'eyes.'], ['She', 'consults', 'because', 'since', 'a', 'few', 'weeks', 'ago', 'she', 'has', 'been', 'having', 'eye', 'pain', 'with', 'headache', 'and', 'blurred', 'vision', 'at', 'night', 'when', 'she', 'is', 'watching', 'television', 'in', 'twilight.'], ['Which', 'of', 'the', 'following', 'pathologies', 'is', 'she', 'most', 'likely', 'to', 'present?'], ['1-', 'Glaucoma', 'due', 'to', 'primary', 'angular', 'closure.'], ['2-', 'Migraine.'], ['3-', 'Actinic', 'keratitis.'], ['4-', 'Dry', 'eye', 'syndrome.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['We', 'are', 'presented', 'with', 'a', '68-year-old', 'woman', 'with', 'moderate', 'hyperopia', 'and', 'no', 'history', 'of', 'cataract', 'surgery.'], ['This', 'is', 'not', 'a', 'mere', 'coincidence:', 'the', 'fact', 'that', 'the', 'patient', 'is', 'hyperopic', 'is', 'important,', 'because', 'the', 'eyeballs', 'of', 'hyperopic', 'patients', 'are', 'shorter,', 'with', 'a', 'certain', 'conflict', 'of', 'space', 'in', 'the', 'anterior', 'segment', 'when', 'the', 'crystalline', 'lens', 'undergoes', 'a', 'process', 'of', 'intumescence', 'secondary', 'to', 'age', '(what', 'patients', 'call', 'incipient', 'cataract).'], ['In', 'the', 'clinical', 'case,', 'moreover,', 'the', 'ocular', 'and', 'headache', 'pain', 'occurs', 'in', 'scotopic', 'situations,', 'or', 'in', 'situations', 'of', 'dim', 'ambient', 'lighting,', 'which', 'produces', 'an', 'average', 'mydriasis', 'to', 'optimize', 'the', 'light', 'influx', 'to', 'the', 'eyeball.'], ['It', 'is', 'evident,', 'therefore,', 'that', 'the', 'patient', 'suffers', 'from', 'primary', 'angular', 'closure', 'processes', 'that', 'possibly', 'self-resolve', 'when', 'the', 'triggering', 'situation', 'ceases,', 'and', 'not', 'a', 'true', 'acute', 'glaucoma', 'attack.'], ['But', 'these', 'intermittent', 'angular', 'closures', 'are', 'contemplated', 'within', 'the', 'spectrum', 'of', 'glaucoma', 'due', 'to', 'primary', 'angular', 'closure', '(option', '1', 'correct).'], ['Migraine,', 'not', 'being', 'a', 'Neurology', 'question,', 'can', 'sometimes', 'be', 'a', 'confounder', 'in', 'the', 'usual', 'clinic;', 'however,', 'patients', 'are', 'usually', 'younger,', 'or', 'at', 'least', 'have', 'a', 'clear', 'history', 'of', 'migraine,', 'and,', 'above', 'all,', 'they', 'present', 'symptomatologic', 'worsening', 'with', 'intense', 'sensory', 'stimuli', '(photophobia', 'and', 'phonophobia),', 'but', 'symptoms', 'are', 'not', 'worsened', 'precisely', 'in', 'cases', 'of', 'dim', 'lighting', '(option', '2', 'incorrect).'], ['Actinic', 'keratitis', 'occurs', 'precisely', 'in', 'patients', 'exposed', 'to', 'ultraviolet', 'radiation', 'that', 'is', 'not', 'properly', 'filtered', 'before', 'reaching', 'the', 'cornea;', 'it', 'is', 'typical', 'of', 'welders', '(it', 'is', 'called', "welder's", 'keratitis),', 'skiers', 'and', 'other', 'people', 'with', 'very', 'intense', 'light', 'exposures', 'and', 'without', 'adequate', 'eye', 'protection', '(wrong', 'option', '3).'], ['Dry', 'eye', 'syndrome', 'does', 'not', 'usually', 'produce', 'headache,', 'and', 'ocular', 'discomfort', 'does', 'not', 'go', 'beyond', 'the', 'persistent', 'discomfort', 'that', 'patients', 'might', 'define', 'as', 'pain', 'because', 'of', 'its', 'recently', 'more', 'studied', 'neuropathic', 'component.'], ['Some', 'forms', 'of', 'dry', 'eye', 'may', 'be', 'worse', 'in', 'the', 'evening', 'but', 'others', 'are', 'worse', 'in', 'the', 'morning,', 'and', 'it', 'depends', 'mainly', 'on', 'the', 'frequency', 'of', 'blinking.'], ['In', 'addition,', 'dry', 'eye', 'syndrome', 'is', 'an', 'outdated', 'term;', 'nowadays', 'it', 'is', 'preferred', 'to', 'speak', 'of', 'dry', 'eye', 'disease', '(incorrect', 'option', '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', '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'], ['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'], ['O', 'B-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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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'], ['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', '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', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['A 68-year-old woman who wears +4.00 diopter glasses for distance vision in both eyes\n', 'We are presented with a 68-year-old woman with moderate hyperopia and no history of cataract surgery\n', 'Support'], ['We are presented with a 68-year-old woman with moderate hyperopia and no history of cataract surgery\n', 'This is not a mere coincidence: the fact that the patient is hyperopic is important, because the eyeballs of hyperopic patients are shorter, with a certain conflict of space in the anterior segment when the crystalline lens undergoes a process of intumescence secondary to age (what patients call incipient cataract)\n', 'Support'], ['She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight\n', 'In the clinical case, moreover, the ocular and headache pain occurs in scotopic situations, or in situations of dim ambient lighting, which produces an average mydriasis to optimize the light influx to the eyeball\n', 'Support'], ['In the clinical case, moreover, the ocular and headache pain occurs in scotopic situations, or in situations of dim ambient lighting, which produces an average mydriasis to optimize the light influx to the eyeball\n', 'It is evident, therefore, that the patient suffers from primary angular closure processes that possibly self-resolve when the triggering situation ceases, and not a true acute glaucoma attack\n', 'Support'], ['It is evident, therefore, that the patient suffers from primary angular closure processes that possibly self-resolve when the triggering situation ceases, and not a true acute glaucoma attack\n', 'But these intermittent angular closures are contemplated within the spectrum of glaucoma due to primary angular closure\n', 'Support'], ['But these intermittent angular closures are contemplated within the spectrum of glaucoma due to primary angular closure\n', 'option 1 correct\n', 'Support'], ['option 1 correct\n', 'Glaucoma due to primary angular closure\n', 'Support'], ['A 68-year-old woman who wears +4.00 diopter glasses for distance vision in both eyes\n', 'however, patients are usually younger, or at least have a clear history of migraine, and, above all, they present symptomatologic worsening with intense sensory stimuli (photophobia and phonophobia), but symptoms are not worsened precisely in cases of dim lighting\n', 'Attack'], ['however, patients are usually younger, or at least have a clear history of migraine, and, above all, they present symptomatologic worsening with intense sensory stimuli (photophobia and phonophobia), but symptoms are not worsened precisely in cases of dim lighting\n', 'option 2 incorrect\n', 'Support'], ['however, patients are usually younger, or at least have a clear history of migraine, and, above all, they present symptomatologic worsening with intense sensory stimuli (photophobia and phonophobia), but symptoms are not worsened precisely in cases of dim lighting\n', 'Migraine, not being a Neurology question, can sometimes be a confounder in the usual clinic\n', 'Attack'], ['option 2 incorrect\n', 'Migraine\n', 'Attack'], ['Actinic keratitis occurs precisely in patients exposed to ultraviolet radiation that is not properly filtered before reaching the cornea\n', 'wrong option 3\n', 'Support'], ["it is typical of welders (it is called welder's keratitis), skiers and other people with very intense light exposures and without adequate eye protection\n", 'wrong option 3\n', 'Support'], ['wrong option 3\n', 'Actinic keratitis\n', 'Attack'], ['She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight\n', 'Dry eye syndrome does not usually produce headache\n', 'Attack'], ['She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight\n', 'ocular discomfort does not go beyond the persistent discomfort that patients might define as pain because of its recently more studied neuropathic component\n', 'Attack'], ['Dry eye syndrome does not usually produce headache\n', 'incorrect option 4\n', 'Support'], ['ocular discomfort does not go beyond the persistent discomfort that patients might define as pain because of its recently more studied neuropathic component\n', 'incorrect option 4\n', 'Support'], ['incorrect option 4\n', 'Dry eye syndrome\n', 'Attack']]
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291_157
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[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['An', '8-year-old', 'patient', 'presenting', 'with', 'superficial', 'pustular', 'lesions,', 'erosions', 'and', 'yellowish', 'crusts', 'around', 'the', 'mouth', 'for', 'the', 'last', '3', 'days:'], ['1-', 'Exudative', 'erythema', 'multiforme.'], ['2-', 'Contagious', 'impetigo.'], ['3-', 'Infantile', 'acne.'], ['4-', 'Pustular', 'psoriasis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'a', 'typical', 'and', 'frequent', 'clinical', 'picture', 'in', 'children.'], ['You', 'are', 'describing', 'a', 'contagious', 'impetigo.'], ['There', 'is', 'not', 'much', 'dispute.'], ['The', 'most', 'frequent', 'causative', 'agent', 'in', 'the', 'bullous', 'form', 'is', 'S.', 'aureus', 'phage', 'II.']]
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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'], ['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'], ['B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['There is not much dispute\n', 'You are describing a contagious impetigo\n', 'Support'], ['You are describing a contagious impetigo\n', 'Contagious impetigo\n', 'Support']]
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213_160
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '75-year-old', 'woman,', 'with', 'menopause', 'at', 'age', '52,', 'with', 'no', 'family', 'or', 'personal', 'history', 'of', 'fracture,', 'diagnosed', 'with', 'temporal', 'arteritis,', 'who', 'is', 'going', 'to', 'start', 'treatment', 'with', 'high-dose', 'prednisone', 'and', 'expects', 'to', 'be', 'treated', 'for', 'at', 'least', 'one', 'year.'], ['The', 'delay', 'of', 'densitometry', '(DXA)', 'in', 'her', 'center', 'is', '4-5', 'months.'], ['Preventive', 'treatment', 'for', 'osteoporosis', 'is', 'considered.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'appropriate', 'approach?'], ['1-', 'Request', 'DXA', 'and', 'wait', 'for', 'the', 'result.'], ['2-', 'Assess', 'absolute', 'risk', 'of', 'fracture', 'using', 'the', 'FRAX', 'questionnaire', 'without', 'BMD', 'and', 'treat', 'only', 'if', 'it', 'is', 'high.'], ['3-', 'Start', 'treatment', 'with', 'bisphosphonates', 'and', 'vitamin', 'D', '(800', 'IU/day).'], ['4-', 'Administer', 'calcium', 'supplementation', '(1g)', 'and', 'vitamin', 'D', '(800', 'IU/day).'], ['5-', 'Assess', 'for', 'osteopenia', 'on', 'radiographs', 'and', 'treat', 'if', 'present.'], ['CORRECT', 'ANSWER:', '4'], ['In', 'the', 'data', 'you', 'provide', 'there', 'are', 'no', 'clinical', 'risk', 'factors', 'for', 'osteoporosis', 'prior', 'to', 'the', 'current', 'disease.'], ['Since', 'a', 'prolonged', 'and', 'high-dose', 'prednisone', 'regimen', 'will', 'be', 'established,', 'it', 'is', 'advisable,', 'in', 'addition', 'to', 'the', 'non-pharmacological', 'preventive', 'measures,', 'to', 'initiate', 'treatment', 'in', 'any', 'case', 'to', 'minimize', 'the', 'secondary', 'loss', 'of', 'bone', 'mass', 'that', 'occurs', 'with', 'the', 'administration', 'of', 'glucocorticoids', '(and,', 'above', 'all,', 'in', 'the', 'first', 'months).'], ['Therefore,', 'and', 'for', 'this', 'reason', 'alone,', 'options', '1,', '2', 'and', '5', 'would', 'be', 'discarded', '(the', 'three', 'of', 'them', 'have', 'another', 'conditioning', 'factor).'], ['In', 'this', 'context,', 'and', 'in', 'the', 'case', 'of', 'a', 'person', 'over', '65', 'years', 'of', 'age,', 'an', 'appropriate', 'attitude', 'would', 'be', 'to', 'administer', 'calcium', 'supplements', '(corticosteroids', 'are', 'osteopenizantes', 'because', 'they', 'produce,', 'among', 'other', 'mechanisms,', 'a', 'negative', 'balance', 'of', 'this', 'element)', 'and', 'vitamin', 'D.'], ['The', 'option', 'of', 'associating', 'a', 'bisphosphonate', 'could', 'also', 'be', 'considered,', 'but', 'calcium', 'supplementation', 'is', 'missing', 'in', 'proposal', '3.']]
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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'], ['O', 'O', 'O', 'O', 'O', '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', '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', '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'], ['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', 'B-Claim', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['the three of them have another conditioning factor\n', 'Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n', 'Support'], ['a prolonged and high-dose prednisone regimen will be established\n', 'it is advisable, in addition to the non-pharmacological preventive measures, to initiate treatment in any case to minimize the secondary loss of bone mass that occurs with the administration of glucocorticoids (and, above all, in the first months)\n', 'Support'], ['there are no clinical risk factors for osteoporosis prior to the current disease\n', 'Request DXA and wait for the result\n', 'Attack'], ['it is advisable, in addition to the non-pharmacological preventive measures, to initiate treatment in any case to minimize the secondary loss of bone mass that occurs with the administration of glucocorticoids (and, above all, in the first months)\n', 'Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n', 'Support'], ['Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n', 'Request DXA and wait for the result\n', 'Attack'], ['Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n', 'Assess absolute risk of fracture using the FRAX questionnaire without BMD and treat only if it is high\n', 'Attack'], ['Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n', 'Assess for osteopenia on radiographs and treat if present\n', 'Attack'], ['a person over 65 years of age\n', 'an appropriate attitude would be to administer calcium supplements (corticosteroids are osteopenizantes because they produce, among other mechanisms, a negative balance of this element) and vitamin D\n', 'Support'], ['an appropriate attitude would be to administer calcium supplements (corticosteroids are osteopenizantes because they produce, among other mechanisms, a negative balance of this element) and vitamin D\n', 'Administer calcium supplementation (1g) and vitamin D (800 IU/day)\n', 'Support'], ['calcium supplementation is missing in proposal 3\n', 'The option of associating a bisphosphonate could also be considered\n', 'Attack'], ['The option of associating a bisphosphonate could also be considered\n', 'Start treatment with bisphosphonates and vitamin D (800 IU/day)\n', 'Support'], ['calcium supplementation is missing in proposal 3\n', 'Start treatment with bisphosphonates and vitamin D (800 IU/day)\n', 'Attack']]
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442_100
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['34-year-old', 'woman', 'who', 'consults', 'for', 'repeated', 'coitorragia.'], ['She', 'brings', 'a', 'cytology', 'with', 'a', 'high', 'grade', 'intraepithelial', 'lesion', '(U-SIL).'], ['Subsequently,', 'colposcopy', 'and', 'biopsy', 'were', 'performed', 'on', 'a', 'mosaic', 'area', 'and', 'histology', 'showed', 'a', 'focus', 'of', 'invasive', 'squamous', 'cell', 'carcinoma', 'of', '2', 'mm', 'in', 'length.'], ['Which', 'therapeutic', 'option', 'is', 'the', 'most', 'appropriate', 'for', 'this', 'patient?'], ['1-', 'Conization.'], ['2-', 'Total', 'hysterectomy', 'without', 'adnexectomy.'], ['3-', 'Pelvic', 'radiotherapy', 'with', 'curative', 'intent.'], ['4-', 'Repeat', 'a', 'more', 'extensive', 'biopsy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['According', 'to', 'the', 'SEGO:', '"Excise', 'the', 'entire', 'lesion', 'so', 'that', 'it', 'can', 'be', 'evaluated', 'histologically.'], ['It', 'involves', 'excision', 'of', 'the', 'entire', 'transformation', 'zone.'], ['In', 'general,', 'the', 'excision', 'should', 'be', 'adapted', 'to', 'the', 'size', 'and', 'characteristics', 'of', 'the', 'lesion.'], ['Three', 'types', 'of', 'excision', 'are', 'distinguished', 'according', 'to', 'the', 'presence', 'of', 'the', 'endocervical', 'component', 'of', 'the', 'lesion.'], ['Excision', 'type', '1', '(applicable', 'in', 'cases', 'with', 'transformation', 'zone', 'type', '1,', 'in', 'which', 'the', 'diathermic', 'loop', 'should', 'not', 'include', 'endocervical', 'canal', 'or', 'exceed', '8', 'mm', 'in', 'depth),', 'excision', 'type', '2', '(indicated', 'in', 'transformation', 'zones', 'type', '2,', 'involves', 'resecting', 'a', 'small', 'part', 'of', 'endocervical', 'canal', 'visible', 'by', 'colposcopy)', 'and', 'excision', 'type', '3', '(indicated', 'in', 'transformation', 'zones', 'type', '3,', 'includes', 'part', 'of', 'endocervical', 'epithelium)".'], ['When', 'they', 'speak', 'of', 'excision,', 'it', 'is', 'synonymous', 'with', 'conization;', 'as', 'the', 'lesion', 'is', 'less', 'than', '8mm', 'deep,', 'this', 'is', 'the', 'indicated', 'treatment.']]
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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'], ['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', '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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Claim', '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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[['According to the SEGO: "Excise the entire lesion so that it can be evaluated histologically\n', 'When they speak of excision, it is synonymous with conization\n', 'Support'], ['as the lesion is less than 8mm deep, this is the indicated treatment\n', 'When they speak of excision, it is synonymous with conization\n', 'Support'], ['When they speak of excision, it is synonymous with conization\n', 'Conization\n', 'Support'], ['as the lesion is less than 8mm deep, this is the indicated treatment\n', 'Conization\n', 'Support'], ['It involves excision of the entire transformation zone\n', 'When they speak of excision, it is synonymous with conization\n', 'Support']]
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491_106
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['65-year-old', 'woman', 'referred', 'to', 'the', 'ED', 'for', 'fever', 'and', 'alterations', 'in', 'the', 'CBC:', '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.'], ['A', 'bone', 'marrow', 'examination', 'was', 'performed', 'and', 'the', 'patient', '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', 'initiated', 'and', 'controls', 'in', 'day', 'hospital', 'will', 'be', 'recommended.'], ['2-', 'Treatment', 'with', 'arsenic', 'trioxide,', 'ATRA', 'and', 'supportive', 'therapy', 'will', 'be', 'initiated.'], ['3-', 'It', 'is', 'a', 'myeloblastic', 'leukemia', 'type', 'M3,', 'so', 'chemotherapy', 'and', 'heparin', 'treatment', 'will', 'be', 'initiated', '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'], ['I', 'think', 'this', 'is', 'a', 'very', 'nice', 'question.'], ['There', 'is', 'no', 'doubt', 'about', 'the', 'diagnosis.'], ['Because', 'if', 'you', "don't", 'know', 'the', 'translocation,', 'nothing', 'happens...', 'the', 'answers', 'give', 'you', 'the', 'diagnosis.'], ['Now', "it's", 'time', 'to', 'find', 'out', 'how', 'acute', 'promyelocytic', 'leukemia', 'is', 'currently', 'treated', '(ATRA', 'aside...', 'which', "I'm", 'sure', 'you', 'know).'], ['As', 'of', '2017,', 'the', 'PETHEMA', 'protocol', 'for', 'APL', 'in', 'low', 'to', 'intermediate', 'risk', 'patients', '(and/or', 'over', '70', 'years', 'of', 'age)', 'is', 'ATO+ATRA.'], ['In', 'high', 'risk', 'patients,', 'it', 'is', 'treated', 'with', 'ATRA+chemotherapy.'], ['I', "don't", 'think', 'they', 'want', 'you', 'to', 'know', 'how', 'risk', 'is', 'established', 'in', 'promielos,', 'but', 'it', 'is', 'based', 'on', 'leukocyte', 'and', 'platelet', 'counts.'], ['In', 'this', 'case,', 'it', "doesn't", 'score', 'anything', 'for', 'the', 'score', 'since', 'you', 'have', '<10,000', 'leukocytes', 'and', '>40,000', 'platelets.'], ['That', 'is,', 'it', 'is', 'a', 'low', 'risk.'], ['Correct', 'answer', '2.'], ['Perhaps', 'some', 'people', 'have', 'been', 'confused', 'by', 'option', '3.'], ['One', 'of', 'the', 'main', 'causes', 'of', 'mortality', 'in', 'the', 'induction', 'of', 'a', 'promyelocyte', 'is', 'coagulopathy,', 'but', 'option', '3', 'is', 'totally', 'incorrect.'], ['We', 'could', 'only', 'mess', 'things', 'up', 'even', 'more', 'by', 'putting', 'heparin!!!!'], ['I', "don't", 'know', 'what', 'they', 'are', 'explaining', 'right', 'now', 'in', 'the', 'academies,', 'but', 'it', 'is', 'clear', 'that', 'they', 'wanted', 'you', 'to', 'know', 'that', 'many', 'promyelocytes,', 'since', '3', 'little', 'years', 'ago,', 'are', 'not', 'treated', 'with', 'chemotherapy.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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'], ['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'], ['B-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[["ATRA aside... which I'm sure you know\n", "Now it's time to find out how acute promyelocytic leukemia is currently treated\n", 'Support'], ["In this case, it doesn't score anything for the score since you have <10,000 leukocytes and >40,000 platelets\n", 'That is, it is a low risk\n', 'Support'], ["In this case, it doesn't score anything for the score since you have <10,000 leukocytes and >40,000 platelets\n", 'In high risk patients, it is treated with ATRA+chemotherapy\n', 'Attack'], ['Correct answer 2\n', 'Treatment with arsenic trioxide, ATRA and supportive therapy will be initiated\n', 'Support'], ['As of 2017, the PETHEMA protocol for APL in low to intermediate risk patients (and/or over 70 years of age) is ATO+ATRA\n', 'Treatment with arsenic trioxide, ATRA and supportive therapy will be initiated\n', 'Support'], ['That is, it is a low risk\n', 'In high risk patients, it is treated with ATRA+chemotherapy\n', 'Attack'], ['That is, it is a low risk\n', 'As of 2017, the PETHEMA protocol for APL in low to intermediate risk patients (and/or over 70 years of age) is ATO+ATRA\n', 'Support'], ['One of the main causes of mortality in the induction of a promyelocyte is coagulopathy, but option 3 is totally incorrect\n', 'It is a myeloblastic leukemia type M3, so chemotherapy and heparin treatment will be initiated to control disseminated intravascular coagulation\n', 'Attack'], ['We could only mess things up even more by putting heparin!!!!\n', 'One of the main causes of mortality in the induction of a promyelocyte is coagulopathy, but option 3 is totally incorrect\n', 'Support'], ["I don't know what they are explaining right now in the academies, but it is clear that they wanted you to know that many promyelocytes, since 3 little years ago, are not treated with chemotherapy\n", 'It is a myeloblastic leukemia type M3, so chemotherapy and heparin treatment will be initiated to control disseminated intravascular coagulation\n', 'Attack']]
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277_226
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[['QUESTION', 'TYPE:', 'DIGESTIVE', 'TRACT'], ['CLINICAL', 'CASE:'], ['In', 'a', 'colon', 'cancer', 'screening', 'program,', 'a', '52-year-old', 'patient', 'undergoes', 'a', 'colonoscopy.'], ['The', 'entire', 'colon', 'is', 'normal', 'except', 'for', 'the', 'finding', 'of', 'a', '2', 'cm', 'pedunculated', 'polyp', 'in', 'the', 'sigma', 'which', 'is', 'removed', 'with', 'a', 'diathermy', 'loop.'], ['The', 'anatomopathological', 'result', 'indicates', 'that', 'there', 'is', 'a', 'carcinoma', 'in', 'situ', 'limited', 'to', 'the', 'head', 'of', 'the', 'polyp.'], ['She', 'has', 'a', 'thoracoabdominal', 'CT', 'scan', 'reported', 'as', 'normal.'], ['Indicate', 'the', 'correct', 'course', 'of', 'action.'], ['1-', 'Segmental', 'resection', 'of', 'the', 'affected', 'colon.'], ['2-', 'Periodic', 'endoscopic', 'surveillance.'], ['3-', 'Local', 'resection', 'of', 'the', 'base', 'of', 'the', 'polyp.'], ['4-', 'Sigmoidectomy', 'plus', 'lymphadenectomy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Carcinoma', 'in', 'situ', 'is', 'delimited', 'by', 'the', 'basement', 'membrane,', 'i.e.', 'it', 'is', 'not', 'invasive', 'yet,', 'and', 'therefore', 'the', 'treatment', 'is', 'polypectomy,', 'which', 'is', 'already', 'done.'], ['Subsequently,', 'an', 'endoscopic', 'follow-up', '(with', 'biopsies)', 'should', 'be', 'performed', 'at', 'an', 'interval', 'of', '3', 'to', '6', 'months', 'depending', 'on', 'the', "patient's", 'history,', 'age', 'and', 'concomitant', 'pathologies.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['O', 'B-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-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Carcinoma in situ is delimited by the basement membrane, i.e. it is not invasive yet\n', 'therefore the treatment is polypectomy, which is already done\n', 'Support'], ['therefore the treatment is polypectomy, which is already done\n', "Subsequently, an endoscopic follow-up (with biopsies) should be performed at an interval of 3 to 6 months depending on the patient's history, age and concomitant pathologies\n", 'Support'], ["Subsequently, an endoscopic follow-up (with biopsies) should be performed at an interval of 3 to 6 months depending on the patient's history, age and concomitant pathologies\n", 'Periodic endoscopic surveillance\n', 'Support']]
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155_83
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '62-year-old', 'man', 'with', 'a', 'history', 'of', 'arterial', 'hypertension', 'under', 'treatment', 'with', 'captopril,', 'duodenal', 'ulcer', 'and', 'uric', 'acid', 'urolithiasis.'], ['He', 'consults', 'for', 'typical', 'podagra', 'crisis', 'similar', 'to', 'others', 'presented', 'in', 'the', 'last', 'two', 'years.'], ['Examination', 'showed', 'tophi', 'in', 'both', 'pinnae.'], ['Analyses', 'show', 'uric', 'acid', '10.1', 'mg/dl,', 'creatine', '1.5', 'mg/dl.'], ['Indicate', 'which', 'of', 'the', 'following', 'answers', 'is', 'FALSE', 'in', 'relation', 'to', 'his', 'possible', 'treatment', 'with', 'allopurinol.'], ['1-', 'Its', 'use', 'is', 'second', 'choice', 'when', 'uricosurics', 'have', 'failed.'], ['2-', 'Its', 'prolonged', 'use', 'is', 'practically', 'obligatory', 'because', 'there', 'are', 'tophi.'], ['3-', 'Its', 'introduction', 'should', 'be', 'delayed', 'until', 'the', 'current', 'attack', 'has', 'resolved', 'with', 'anti-inflammatory', 'drugs', 'or', 'colchicine.'], ['4-', 'Its', 'introduction', 'should', 'be', 'gradual', 'up', 'to', 'a', 'dose', 'that', 'achieves', 'a', 'uricemia', 'below', '6', 'mg/dL.'], ['5-', 'In', 'the', 'first', 'months', 'of', 'treatment', 'it', 'is', 'advisable', 'to', 'associate', 'low', 'doses', 'of', 'colchicine', 'to', 'prevent', 'new', 'attacks.'], ['CORRECT', 'ANSWER:', '1'], ['Allopurinol', 'is', 'always', 'the', 'treatment', 'of', 'choice,', 'especially', 'in', 'the', 'case', 'of', 'tophaceous', 'gout.'], ['Moreover,', 'in', 'this', 'case,', 'uricosuric', 'acid', 'could', 'worsen', 'urolithiasis', 'by', 'increasing', 'uricosuria', '(sorry', 'for', 'the', 'redundancy...).']]
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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'], ['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', 'B-Treatment', 'I-Treatment', 'I-Treatment'], ['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', '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'], ['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', 'O', 'O', 'O', 'O']]
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[['Allopurinol is always the treatment of choice, especially in the case of tophaceous gout\n', 'Its use is second choice when uricosurics have failed\n', 'Support'], ['Moreover, in this case, uricosuric acid could worsen urolithiasis by increasing uricosuria\n', 'Allopurinol is always the treatment of choice, especially in the case of tophaceous gout\n', 'Support']]
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373_86
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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['We', 'are', 'referred', 'from', 'ophthalmology', 'to', 'a', '31-year-old', 'man', 'who', 'consulted', 'for', 'loss', 'of', 'vision', 'and', 'progressive', 'headache.'], ['Physical', 'examination', 'showed', 'temporal', 'hemianopsia', 'and', 'pituitary', 'MRI', 'showed', 'a', '35', 'x', '30', 'x', '20', 'mm', 'turnoration', 'compressing', 'chiasm', 'and', 'cavernous', 'sinus.'], ['The', 'results', 'of', 'the', 'functional', 'study', 'are', 'cortisol', '14', 'microg/dL,', 'TSH', '1.4', 'microU/ml,', 'T4L', '1.2', 'ng/dL,', 'prolactin', '480', 'microg/L', '(vn', '<', '15),', 'testosterone', '160', 'ng/dL', '(vn', '300-1200),', 'FSH', '1.2', 'U/I.,', '(vn', '5-15)', 'and', 'LH', '2', 'U/L', '(vn', '3-15).'], ['What', 'is', 'the', 'initial', 'therapeutic', 'approach?'], ['1-', 'Dopaminergic', 'agonists.'], ['2-', 'Transsphenoidal', 'surgery.'], ['3-', 'External', 'radiotherapy', 'or', 'radiosurgery.'], ['4-', 'Treatment', 'of', 'hypogonadotropic', 'hypogonadism', 'with', 'testosterone.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['From', 'what', 'is', 'described', 'it', 'is', 'a', 'macroprolactinoma', 'as', 'it', 'is', 'a', 'pituitary', 'tumor', 'of', 'more', 'than', 'one', 'centimeter,', 'which', 'secretes', 'prolactin', 'and', 'with', 'an', 'insufficiency', 'of', 'the', 'rest', 'of', 'pituitary', 'hormones.'], ['The', 'first', 'line', 'treatment', 'of', 'choice', 'is', 'dopaminergic', 'agonists,', 'although', 'when', 'the', 'visual', 'field', 'is', 'affected,', 'surgery', 'may', 'be', 'chosen.'], ['In', 'this', 'case,', 'the', 'cavernous', 'sinus', 'is', 'pressured', 'by', 'the', 'mass,', 'so', 'the', 'surgical', 'risk', 'increases.'], ['Therefore,', 'in', 'this', 'particular', 'case,', 'the', 'surgical', 'option', 'seems', 'more', 'risky.'], ['Taking', 'this', 'into', 'account', 'and', 'the', 'fact', 'that', 'it', 'is', 'a', 'tumor', 'that', 'produces', 'high', 'levels', 'of', 'prolactin,', 'which', 'indicates', 'that', 'it', 'probably', 'responds', 'to', 'pharmacological', 'blockade,', 'the', 'most', 'appropriate', 'option', 'would', 'be', 'option', '1,', 'treatment', 'with', 'dopaminergic', 'agonists.']]
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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', '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'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-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', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-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', 'I-Premise', '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', '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'], ['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']]
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[['it is a pituitary tumor of more than one centimeter, which secretes prolactin and with an insufficiency of the rest of pituitary hormones\n', 'From what is described it is a macroprolactinoma\n', 'Support'], ['The first line treatment of choice is dopaminergic agonists\n', 'Dopaminergic agonists\n', 'Support'], ['the surgical risk increases\n', 'Transsphenoidal surgery\n', 'Attack'], ['In this case, the cavernous sinus is pressured by the mass\n', 'the surgical risk increases\n', 'Support'], ['although when the visual field is affected, surgery may be chosen\n', 'Transsphenoidal surgery\n', 'Support'], ['Therefore, in this particular case, the surgical option seems more risky\n', 'Transsphenoidal surgery\n', 'Attack'], ['Taking this into account and the fact that it is a tumor that produces high levels of prolactin, which indicates that it probably responds to pharmacological blockade, the most appropriate option would be option 1, treatment with dopaminergic agonists\n', 'Dopaminergic agonists\n', 'Support'], ['In this case, the cavernous sinus is pressured by the mass\n', 'Therefore, in this particular case, the surgical option seems more risky\n', 'Support']]
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523_124
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'patient', 'was', 'diagnosed', 'with', 'HIV', 'infection', 'three', 'months', 'ago,', 'presenting', 'at', 'that', 'time', 'with', 'CD4', '45', 'lymphocytes/µl', 'and', 'an', 'HIV-1', 'viral', 'load', 'of', '500,000', 'copies/ml.'], ['At', 'that', 'time', 'he', 'had', 'a', 'negative', 'Mantoux', 'test.'], ['He', 'started', 'treatment', 'with', 'an', 'integrase', 'inhibitor', 'and', 'two', 'reverse', 'transcriptase', 'inhibitors,', 'and', 'at', 'one', 'month', 'he', 'had', '25,000', 'copies', 'and', 'CD4', 'had', 'risen', 'to', '80/µL.'], ['She', 'consulted', 'for', 'presenting', 'a', 'picture', 'of', 'cervical', 'lymphadenopathy', 'and', 'fever', 'of', 'two', 'weeks', 'of', 'evolution.'], ['The', 'puncture', 'of', 'one', 'of', 'the', 'lymph', 'nodes', 'showed', 'isolated', 'acid-fast', 'bacilli', 'and', 'epithelioid', 'granulomas:'], ['1-', 'It', 'is', 'a', 'lymph', 'node', 'tuberculosis', 'related', 'to', 'an', 'incomplete', 'immunologic', 'recovery.'], ['2-', 'Treatment', 'failure', 'and', 'it', 'is', 'an', 'opportunistic', 'infection.'], ['3-', 'This', 'is', 'an', 'opportunistic', 'infection', 'unmasked', 'within', 'a', 'picture', 'of', 'immune', 'reconstitution.'], ['4-', 'A', 'negative', 'Mantoux', 'test', 'rules', 'out', 'tuberculosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'dealing', 'with', 'a', 'patient', 'with', 'HIV', 'infection', 'in', 'a', 'situation', 'of', 'severe', 'immunosuppression', '(<50', 'CD4+)', 'and', 'a', 'very', 'high', 'viral', 'load,', 'who', 'has', 'followed', 'the', 'expected', 'evolution', 'from', 'the', 'immunovirological', 'point', 'of', 'view', 'after', 'the', 'start', 'of', 'treatment', '(after', '12', 'weeks,', 'the', 'viral', 'load', 'has', 'ostensibly', 'decreased', '-', 'answer', '2', 'would', 'not', 'be', 'correct,', 'remember', 'that', 'it', 'is', 'desirable', 'that', 'it', 'becomes', 'negative', '24', 'weeks', 'after', 'the', 'start', 'of', 'treatment,', 'although', 'in', 'patients', 'with', 'higher', 'CV', 'like', 'ours,', 'it', 'could', 'take', 'longer', '-', 'and', 'the', 'CD4+', 'count', 'has', 'begun', 'to', 'rise).'], ['A', 'negative', 'Mantoux', 'test', 'does', 'not', 'rule', 'out', 'tuberculosis', '(incorrect', 'answer', '4),', 'since', 'in', 'patients', 'with', 'severe', 'immunosuppression', 'it', 'can', 'give', 'false', 'negatives.'], ['The', 'diagnosis', 'of', 'lymph', 'node', 'tuberculosis', 'is', 'immediate', 'when', 'detecting', '"isolated', 'acid-fast', 'bacilli', 'and', 'epithelioid', 'granulomas"', 'in', 'the', 'puncture', 'of', 'one', 'of', 'the', 'lymph', 'nodes,', 'however:', 'considering', 'the', 'patient', 'profile,', 'this', 'process', 'will', 'have', 'been', 'clinically', 'unmasked', 'during', 'the', 'immunological', 'reconstitution', 'and', 'the', 'infection', 'is', 'not', 'the', 'consequence', 'of', 'an', 'incomplete', 'immunological', 'recovery', '(correct', 'answer', 'number', '3).']]
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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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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', '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', 'O', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['A 45-year-old patient was diagnosed with HIV infection three months ago, presenting at that time with CD4 45 lymphocytes/µl and an HIV-1 viral load of 500,000 copies/ml\n', 'We are dealing with a patient with HIV infection in a situation of severe immunosuppression (<50 CD4+) and a very high viral load, who has followed the expected evolution from the immunovirological point of view after the start of treatment (after 12 weeks, the viral load has ostensibly decreased\n', 'Support'], ['answer 2 would not be correct\n', 'Treatment failure and it is an opportunistic infection\n', 'Attack'], ['although in patients with higher CV like ours, it could take longer - and the CD4+ count has begun to rise\n', 'answer 2 would not be correct\n', 'Support'], ['although in patients with higher CV like ours, it could take longer - and the CD4+ count has begun to rise\n', 'remember that it is desirable that it becomes negative 24 weeks after the start of treatment\n', 'Attack'], ['A negative Mantoux test does not rule out tuberculosis\n', 'incorrect answer 4\n', 'Support'], ['incorrect answer 4\n', 'A negative Mantoux test rules out tuberculosis\n', 'Attack'], ['A negative Mantoux test does not rule out tuberculosis\n', 'A negative Mantoux test rules out tuberculosis\n', 'Attack'], ['since in patients with severe immunosuppression it can give false negatives\n', 'A negative Mantoux test does not rule out tuberculosis\n', 'Support'], ['however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n', 'The diagnosis of lymph node tuberculosis is immediate when detecting "isolated acid-fast bacilli and epithelioid granulomas" in the puncture of one of the lymph nodes\n', 'Attack'], ['however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n', 'This is an opportunistic infection unmasked within a picture of immune reconstitution\n', 'Support'], ['however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n', 'It is a lymph node tuberculosis related to an incomplete immunologic recovery\n', 'Attack'], ['however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n', 'correct answer number 3\n', 'Support'], ['correct answer number 3\n', 'This is an opportunistic infection unmasked within a picture of immune reconstitution\n', 'Support']]
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417_76
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[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['78-year-old', 'woman', 'with', 'dementia', 'and', 'institutionalized', 'is', 'brought', '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', 'neoplasia', 'of', 'the', 'sigma', 'with', 'perforation.'], ['4-', 'Mesenteric', 'ischemia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Typical', 'case', 'of', 'acute', 'mesenteric', 'ischemia,', 'which', 'should', 'be', 'suspected', 'in', 'elderly', 'patients', 'with', 'abdominal', 'pain', 'and', 'distension', 'of', 'sudden', 'onset,', 'diarrhea', 'or', 'vomiting', 'and', 'who', 'present', 'cardiovascular', 'risk', 'factors,', 'especially', 'emboligenic', 'heart', 'disease.'], ['In', 'this', 'case', 'we', 'are', 'given', 'characteristic', 'biochemical', 'data', '(leukocytosis,', 'metabolic', 'acidosis', 'due', 'to', 'lactic', 'acid,', 'hemoconcentration', 'due', 'to', 'loss', 'of', 'fluid', 'to', 'the', 'third', 'space...)', 'and', 'imaging', 'tests', '(dilated', 'loops,', 'pneumatosis,', 'gas', 'at', 'portal', 'level...)', 'suggestive', 'of', 'mesenteric', 'ischemia.']]
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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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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']]
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[['78-year-old woman with dementia and institutionalized is brought by her caregivers for significant abdominal pain with deterioration of general condition and abdominal distension\n', 'Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n', 'Support'], ['ECG shows atrial fibrillation\n', 'Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n', 'Support'], ['CBC shows leukocytosis, elevated hematocrit, renal failure and metabolic acidosis\n', 'Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n', 'Support'], ['Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n', 'Mesenteric ischemia\n', 'Support'], ['suggestive of mesenteric ischemia\n', 'Mesenteric ischemia\n', 'Support']]
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403_135
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY', '(ECTOPIC)'], ['CLINICAL', 'CASE:'], ['A', '25-year-old', 'patient,', 'during', 'a', 'tennis', 'match,', 'has', 'severe', 'pain', 'in', 'his', 'neck', 'and', 'left', 'eye.'], ['The', 'next', 'morning', 'he', 'wakes', 'up', 'with', 'a', 'feeling', 'of', 'gait', 'instability', 'and', 'has', 'palpebral', 'ptosis', 'of', 'the', 'left', 'eye', 'and', 'anisocoria,', 'with', 'the', 'left', 'pupil', 'being', 'smaller', 'than', 'the', 'right.'], ['The', 'patient', 'maintains', 'good', 'visual', 'acuity,', 'where', 'would', 'you', 'most', 'likely', 'locate', 'the', 'lesion?'], ['1-', 'III', 'cranial', 'nerve.'], ['2-', 'Optic', 'chiasm.'], ['3-', 'Upper', 'cervical', 'ganglion.'], ['4-', 'Spinal', 'cord.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Claude-Bernard-Horner', 'syndrome', 'is', 'an', 'old', 'acquaintance', 'of', 'the', 'MIR', 'exam.'], ['We', 'do', 'not', 'see', 'it', 'daily', 'in', 'clinical', 'practice,', 'but', 'it', 'appears', 'in', 'many', 'exams.'], ['Characteristic', 'is', 'upper', 'eyelid', 'ptosis', 'and', 'miosis', 'of', 'that', 'eye.'], ['This', 'occurs', 'due', 'to', 'a', 'deficit', 'of', 'sympathetic', 'innervation', 'of', 'the', 'orbital', 'territory.'], ['The', 'sympathetic', 'nervous', 'system', 'innervates', 'the', 'Müller', 'muscle,', 'which', 'is', 'an', 'accessory', 'muscle', 'to', 'the', 'levator', 'of', 'the', 'upper', 'eyelid.'], ['If', 'the', 'Müller', 'ceases', 'to', 'function,', 'the', 'eyelid', 'descends', 'slightly.'], ['It', 'also', 'innervates', 'the', 'iris', 'dilator', 'muscle.'], ['Therefore,', 'the', 'sphincter', 'muscle,', 'its', 'antagonist,', 'is', 'unopposed', 'and', 'the', 'balance', 'of', 'the', 'pupil', 'shifts', 'toward', 'miosis.'], ['It', 'explains', 'ptosis', 'and', 'miosis', 'of', 'the', 'left', 'eye,', 'so', 'we', 'suspect', "Horner's", 'in', 'that', 'eye.'], ['She', 'also', 'describes', 'what', 'may', 'have', 'happened:', 'after', 'a', 'possible', 'sudden', 'movement', 'while', 'playing', 'tennis,', 'she', 'has', 'neck', 'pain', 'and', 'a', "Horner's."], ['We', 'should', 'suspect', 'an', 'aneurysm.'], ['We', 'should', 'suspect', 'a', 'dissecting', 'carotid', 'aneurysm,', 'which', 'is', 'one', 'of', 'the', 'best', 'known', '(and', 'most', 'serious)', 'causes', 'of', 'an', 'acquired', "Horner's", 'syndrome.'], ['The', 'superior', 'cervical', 'ganglion', 'is', 'a', 'ganglion', 'of', 'the', 'sympathetic', 'nervous', 'system', 'located', 'in', 'the', 'sheath', 'of', 'the', 'carotid', 'artery,', 'and', 'at', 'this', 'level', 'it', 'has', 'been', 'affected.'], ['We', 'can', 'also', 'try', 'to', 'get', 'this', 'answer', 'right', 'by', 'ruling', 'out.'], ['An', 'alteration', 'of', 'the', 'III', 'cranial', 'nerve', 'can', 'produce', 'ptosis,', 'but', 'the', 'pupil,', 'if', 'affected,', 'should', 'be', 'in', 'mydriasis.'], ['And', 'damage', 'to', 'the', 'third', 'cranial', 'nerve', 'should', 'also', 'produce', 'some', 'type', 'of', 'ophthalmoplegia,', 'with', 'diplopia.'], ['An', 'involvement', 'of', 'the', 'optic', 'chiasm', 'would', 'produce', 'a', 'bilateral', 'loss', 'of', 'vision', '(probably', 'a', 'bitemporal', 'hemianopsia).'], ['We', 'are', 'told', 'in', 'the', 'statement', 'that', 'he', 'maintains', 'good', 'visual', 'acuity.'], ['On', 'the', 'other', 'hand,', 'there', 'would', 'also', 'be', 'no', 'ptosis', 'or', 'anisocoria.'], ['And', 'finally,', 'an', 'alteration', 'of', 'the', 'medulla', 'oblongata', 'would', 'produce', 'different', 'neurological', 'symptoms', 'not', 'described,', 'and', 'there', 'should', 'be', 'no', 'ptosis', 'or', 'pupillary', 'alterations,', 'because', 'the', 'third', 'pair', 'is', 'located', 'in', 'the', 'midbrain', 'and', 'the', 'sympathetic', 'nuclei', 'in', 'the', 'spinal', 'cord.']]
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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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'O', 'O', 'O', 'O', 'O', 'B-Marker', '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', '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', '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', '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'], ['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'], ['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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n', 'Characteristic is upper eyelid ptosis and miosis of that eye\n', 'Support'], ['It explains ptosis and miosis of the left eye\n', "so we suspect Horner's in that eye\n", 'Support'], ['The sympathetic nervous system innervates the Müller muscle, which is an accessory muscle to the levator of the upper eyelid\n', 'Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n', 'Support'], ['If the Müller ceases to function, the eyelid descends slightly\n', 'Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n', 'Support'], ['It also innervates the iris dilator muscle\n', 'Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n', 'Support'], ['Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n', 'It explains ptosis and miosis of the left eye\n', 'Support'], ['The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n', 'It explains ptosis and miosis of the left eye\n', 'Support'], ["She also describes what may have happened: after a possible sudden movement while playing tennis, she has neck pain and a Horner's\n", 'We should suspect an aneurysm\n', 'Support'], ["so we suspect Horner's in that eye\n", "We should suspect a dissecting carotid aneurysm, which is one of the best known (and most serious) causes of an acquired Horner's syndrome\n", 'Support'], ["We should suspect a dissecting carotid aneurysm, which is one of the best known (and most serious) causes of an acquired Horner's syndrome\n", 'The superior cervical ganglion is a ganglion of the sympathetic nervous system located in the sheath of the carotid artery, and at this level it has been affected\n', 'Support'], ['This occurs due to a deficit of sympathetic innervation of the orbital territory\n', 'Characteristic is upper eyelid ptosis and miosis of that eye\n', 'Support'], ['This occurs due to a deficit of sympathetic innervation of the orbital territory\n', 'The superior cervical ganglion is a ganglion of the sympathetic nervous system located in the sheath of the carotid artery, and at this level it has been affected\n', 'Support'], ['The superior cervical ganglion is a ganglion of the sympathetic nervous system located in the sheath of the carotid artery, and at this level it has been affected\n', 'Upper cervical ganglion\n', 'Support'], ['but the pupil, if affected, should be in mydriasis\n', 'An alteration of the III cranial nerve can produce ptosis\n', 'Attack'], ['The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n', 'but the pupil, if affected, should be in mydriasis\n', 'Attack'], ['but the pupil, if affected, should be in mydriasis\n', 'III cranial nerve\n', 'Attack'], ['And damage to the third cranial nerve should also produce some type of ophthalmoplegia, with diplopia\n', 'III cranial nerve\n', 'Attack'], ['The patient maintains good visual acuity\n', 'And damage to the third cranial nerve should also produce some type of ophthalmoplegia, with diplopia\n', 'Attack'], ['The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n', 'And damage to the third cranial nerve should also produce some type of ophthalmoplegia, with diplopia\n', 'Attack'], ['We are told in the statement that he maintains good visual acuity\n', 'An involvement of the optic chiasm would produce a bilateral loss of vision (probably a bitemporal hemianopsia)\n', 'Attack'], ['An involvement of the optic chiasm would produce a bilateral loss of vision (probably a bitemporal hemianopsia)\n', 'Optic chiasm\n', 'Attack'], ['On the other hand, there would also be no ptosis or anisocoria\n', 'Optic chiasm\n', 'Attack'], ['The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n', 'On the other hand, there would also be no ptosis or anisocoria\n', 'Attack'], ['And finally, an alteration of the medulla oblongata would produce different neurological symptoms not described, and there should be no ptosis or pupillary alterations, because the third pair is located in the midbrain and the sympathetic nuclei in the spinal cord\n', 'Spinal cord\n', 'Attack'], ['The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n', 'And finally, an alteration of the medulla oblongata would produce different neurological symptoms not described, and there should be no ptosis or pupillary alterations, because the third pair is located in the midbrain and the sympathetic nuclei in the spinal cord\n', 'Attack']]
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42_150
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', 'one-and-a-half', 'year', 'old', 'boy', 'comes', 'to', 'the', 'emergency', 'room', 'with', 'abdominal', 'pain', 'and', 'jaundice.'], ['On', 'examination,', 'an', 'abdominal', 'mass', 'is', 'palpated.'], ['An', 'ultrasound', 'shows', 'the', 'presence', 'of', 'a', 'common', 'bile', 'duct', 'cyst.'], ['What', 'therapeutic', 'approach', 'should', 'we', 'adopt?'], ['1-', 'A', 'percutaneous', 'puncture', 'for', 'peritoneal', 'lavage', 'will', 'be', 'performed', 'to', 'verify', 'that', 'the', 'cyst', 'contains', 'bile', 'in', 'order', 'to', 'leave', 'a', 'drainage', 'to', 'improve', 'the', 'abdominal', 'pain.'], ['2-', 'An', 'exploratory', 'laparotomy', 'will', 'be', 'indicated', 'and', 'a', 'radical', 'resection', 'of', 'the', 'entire', 'biliary', 'tract', 'will', 'be', 'performed', 'to', 'replace', 'it', 'with', 'a', 'loop', 'of', 'intestine.'], ['3-', 'A', 'laparotomy', 'will', 'be', 'indicated', 'to', 'drain', 'the', 'cyst', 'and', 'when', 'the', 'dilatation', 'remits', 'the', 'drainage', 'will', 'be', 'removed.'], ['4-', 'A', 'cholangio-resonance', 'will', 'be', 'performed', 'to', 'delimit', 'the', 'cyst', 'and', 'a', 'laparotomy', 'will', 'be', 'indicated', 'for', 'cyst', 'resection', 'and', 'anastomosis', 'of', 'the', 'biliary', 'tract.'], ['5-', 'A', 'HIDA', 'gammagraphic', 'study', 'is', 'necessary', 'to', 'delimit', 'the', 'cyst', 'and', 'to', 'be', 'able', 'to', 'perform', 'percutaneous', 'drainage', 'safely.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'correct', 'answer', 'is', '4.'], ['A', 'common', 'bile', 'duct', 'cyst', 'is', 'a', 'congenital', 'pathology', 'that', 'usually', 'presents', 'clinically', 'beyond', 'the', 'neonatal', 'period.'], ['It', 'is', 'appropriate', 'to', 'have', 'a', 'quality', 'image', 'that', 'delimits', 'the', 'lesion', 'in', 'order', 'to', 'decide', 'the', 'surgical', 'approach.']]
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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', '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', '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', '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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 common bile duct cyst is a congenital pathology that usually presents clinically beyond the neonatal period\n', 'The correct answer is 4\n', 'Support'], ['It is appropriate to have a quality image that delimits the lesion in order to decide the surgical approach\n', 'The correct answer is 4\n', 'Support'], ['The correct answer is 4\n', 'A cholangio-resonance will be performed to delimit the cyst and a laparotomy will be indicated for cyst resection and anastomosis of the biliary tract\n', 'Support'], ['An ultrasound shows the presence of a common bile duct cyst\n', 'The correct answer is 4\n', 'Support'], ['A one-and-a-half year old boy comes to the emergency room with abdominal pain and jaundice\n', 'The correct answer is 4\n', 'Support']]
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445_233
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['45-year-old', 'woman.'], ['Two', 'previous', 'pregnancies', 'with', 'normal', 'deliveries', '(G2PN2).'], ['Heavy', 'menstrual', 'bleeding', 'for', 'approximately', '1', 'year.'], ['Ultrasound', 'shows', 'a', '2', 'cm', 'subserosal', 'myoma', 'that', 'has', 'been', 'stable', 'for', 'several', 'years.'], ['Endometrial', 'biopsy', 'was', 'performed', 'and', 'it', 'was', 'normal.'], ['The', 'patient', 'has', 'hemoglobin', '10', 'g/dL', 'despite', 'oral', 'ferrotherapy', 'and', 'the', 'amount', 'of', 'menstrual', 'flow', 'has', 'not', 'decreased', 'despite', 'treatment', 'with', 'tranexamic', 'acid', 'and', 'mefenamic', 'acid.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'treatment', 'of', 'first', 'choice', 'in', 'this', 'patient?'], ['1-', 'Total', 'hysterectomy', 'preserving', 'appendages.'], ['2-', 'Combined', 'oral', 'contraceptives.'], ['3-', 'Endometrial', 'ablation.'], ['4-', 'Levonorgestrel', 'IUD.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['According', 'to', 'the', 'SEGO,', 'in', 'perimenopausal', 'women', 'with', 'heavy', 'and/or', 'prolonged', 'menstrual', 'bleeding', 'who', 'require', 'contraception,', 'the', 'levonorgestrel', 'IUD', '(also', 'called', 'MIRENA', 'IUD)', 'is', 'the', 'first', 'option.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-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'], ['B-Premise', 'I-Premise', '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', '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', 'I-Claim'], ['O', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Heavy menstrual bleeding for approximately 1 year\n', 'According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option\n', 'Support'], ['According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option\n', 'Levonorgestrel IUD\n', 'Support']]
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511_152
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[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', '79-year-old', 'hypertensive', 'woman', 'on', 'treatment', 'with', 'olmesartan', 'comes', 'for', 'consultation', 'for', 'watery', 'diarrhea', 'of', '4', 'to', '6', 'stools', 'per', 'day', 'for', 'the', 'past', 'two', 'months.'], ['Three', 'months', 'ago', 'she', 'was', 'treated', 'with', 'nonsteroidal', 'anti-inflammatory', 'drugs', 'for', '3', 'weeks', 'for', 'lumbosciatica.'], ['Gastroscopy', 'and', 'colonoscopy', 'were', 'performed,', 'both', 'without', 'macroscopic', 'alterations.'], ['Duodenal', 'biopsies', 'were', 'normal,', 'while', 'colon', 'biopsies', 'showed', 'a', 'chronic', 'inflammatory', 'infiltrate', 'of', 'the', 'lamina', 'propria', 'with', 'an', 'irregular', 'band', 'of', 'collagen', 'immediately', 'below', 'the', 'mucosal', 'surface', 'epithelium', 'with', 'a', 'thickness', 'greater', 'than', '10', 'mm', 'and', 'a', 'number', 'of', 'intraepithelial', 'lymphocytes', '>20', 'per', '100', 'epithelial', 'cells.'], ['Which', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Microscopic', 'colitis.'], ['2-', 'Enteropathy', 'due', 'to', 'NSAIDs.'], ['3-', 'Olmesartan-associated', 'enteropathy.'], ['4-', 'Irritable', 'bowel', 'syndrome.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'diagnostic', 'criteria', 'for', 'microscopic', 'colitis', 'are:', 'a)Chronic', 'or', 'intermittent', 'non-bloody', 'watery', 'diarrhea', 'b)Colonic', 'mucosa', 'assessed', 'by', 'colonoscopy', 'macroscopically', 'normal', 'or', 'near', 'normal', 'c)Characteristic', 'histopathological', 'findings.'], ['In', 'our', 'case,', 'the', 'patient', 'presents', 'findings', 'compatible', 'with', 'collagenous', 'colitis', '(band', 'of', 'collagen', 'underlying', 'the', 'epithelium', 'greater', 'than', '10', 'microns)', 'and', 'lymphocytic', '(more', 'than', '20', 'intraepithelial', 'lymphocytes).'], ['The', 'treatment', 'of', 'this', 'pathology', 'is', 'topical', 'corticosteroids', 'with', 'low', 'oral', 'bioavailability', '(mainly', 'budesonide).'], ['Olmesartan', 'enteropathy', 'produces', 'a', 'picture', 'similar', 'to', 'celiac', 'disease', 'and', 'is', 'characterized', 'by', 'duodenal', 'biopsy', 'with', 'villous', 'atrophy,', 'mucosal', 'inflammation', 'with', 'increased', 'intraepithelial', 'lymphocytes', 'and', 'cryptitis.'], ['In', 'this', 'case', 'a', 'normal', 'duodenal', 'biopsy', 'is', 'described,', 'but', 'it', 'would', 'be', 'interesting', 'to', 'keep', 'the', 'concept', 'for', 'future', 'examinations.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', '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'], ['B-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']]
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[['A 79-year-old hypertensive woman on treatment with olmesartan comes for consultation for watery diarrhea of 4 to 6 stools per day for the past two months\n', 'The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n', 'Support'], ['band of collagen underlying the epithelium greater than 10 microns\n', 'In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n', 'Support'], ['more than 20 intraepithelial lymphocytes\n', 'In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n', 'Support'], ['Gastroscopy and colonoscopy were performed, both without macroscopic alterations\n', 'The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n', 'Support'], ['In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n', 'The treatment of this pathology is topical corticosteroids with low oral bioavailability (mainly budesonide)\n', 'Support'], ['In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n', 'The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n', 'Support'], ['The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n', 'Microscopic colitis\n', 'Support'], ['Olmesartan enteropathy produces a picture similar to celiac disease and is characterized by duodenal biopsy with villous atrophy, mucosal inflammation with increased intraepithelial lymphocytes and cryptitis\n', 'Olmesartan-associated enteropathy\n', 'Attack'], ['Duodenal biopsies were normal, while colon biopsies showed a chronic inflammatory infiltrate of the lamina propria with an irregular band of collagen immediately below the mucosal surface epithelium with a thickness greater than 10 mm and a number of intraepithelial lymphocytes >20 per 100 epithelial cells\n', 'Olmesartan enteropathy produces a picture similar to celiac disease and is characterized by duodenal biopsy with villous atrophy, mucosal inflammation with increased intraepithelial lymphocytes and cryptitis\n', 'Attack'], ['In this case a normal duodenal biopsy is described\n', 'Olmesartan enteropathy produces a picture similar to celiac disease and is characterized by duodenal biopsy with villous atrophy, mucosal inflammation with increased intraepithelial lymphocytes and cryptitis\n', 'Attack'], ['In this case a normal duodenal biopsy is described\n', 'but it would be interesting to keep the concept for future examinations\n', 'Attack']]
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33_65
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[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'man,', 'diagnosed', 'with', 'myasthenia', 'gravis', '1', 'year', 'ago,', 'treated', 'with', 'low-dose', 'steroids', '(3', 'mg/day', 'of', 'deflazacort)', 'and', 'anticholinesterase', 'drugs,', 'asymptomatic', 'for', '6', 'months,', 'consults', 'for', 'mild', 'difficulty', 'in', 'swallowing', 'and', 'evening', 'diplopia', 'for', 'a', 'few', 'days.'], ['He', 'was', 'admitted', 'to', 'the', 'hospital', 'for', 'suspected', 'myasthenic', 'crisis', 'and', 'treatment', 'was', 'started.'], ['The', 'next', 'day', 'the', 'patient', 'alerts', 'at', '03', 'hours', 'in', 'the', 'morning', 'because', 'the', 'patient', 'makes', 'a', 'strange', 'noise', 'when', 'breathing', 'in,', 'like', 'a', 'soft', 'snoring,', 'the', 'patient', 'is', 'sound', 'asleep', 'and', 'very', 'sweaty,', 'but', 'does', 'not', 'seem', 'to', 'be', 'fatigued.'], ['What', 'is', 'the', 'most', 'correct', 'attitude?'], ['1-', 'Reassure', 'the', 'nurse', 'and', 'family', 'that', 'the', 'patient', 'is', 'a', 'habitual', 'snorer', 'and', 'is', 'peacefully', 'asleep.', 'The', 'patient', 'should', 'be', 'placed', 'in', 'lateral', 'decubitus.'], ['2-', 'Notify', 'intensive', 'care', 'for', 'suspected', 'acute', 'respiratory', 'failure,', 'to', 'assess', 'possible', 'orotracheal', 'intubation', 'and', 'assisted', 'ventilation.'], ['3-', 'Perform', 'polysomnographic', 'study', 'to', 'rule', 'out', 'sleep', 'apnea.'], ['4-', 'Decrease', 'steroid', 'dose;', 'if', 'he', 'has', 'a', 'steroid', 'myopathy', 'he', 'will', 'improve.'], ['5-', 'Order', 'a', 'thoracic', 'CT', 'scan', 'to', 'rule', 'out', 'compressive', 'thymoma', 'over', 'the', 'trachea', 'associated', 'with', 'myasthenia.'], ['CORRECT', 'ANSWER:', '2'], ['This', 'is', 'a', 'patient', 'with', 'decompensated', 'myasthenia', 'with', 'bulbar', 'symptoms', '(dysphagia)', 'and', 'therefore', 'risk', 'of', 'respiratory', 'muscle', 'involvement.'], ['The', 'respiratory', 'symptoms', 'correspond', 'to', 'an', 'exhaustion', 'of', 'the', 'muscles,', 'first', 'inspiratory', 'and', 'then', 'accessory', '(the', 'patient', 'does', 'not', 'appear', 'fatigued', 'or', 'tachypneic', 'because', 'the', 'muscles', 'are', 'exhausted),', 'progressing', 'to', 'a', 'carbonic', 'coma.']]
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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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Premise', 'I-Premise', 'I-Premise', '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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[['He was admitted to the hospital for suspected myasthenic crisis\n', 'This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n', 'Support'], ['A 64-year-old man, diagnosed with myasthenia gravis 1 year ago, treated with low-dose steroids (3 mg/day of deflazacort) and anticholinesterase drugs, asymptomatic for 6 months, consults for mild difficulty in swallowing and evening diplopia for a few days\n', 'This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n', 'Support'], ['The respiratory symptoms correspond to an exhaustion of the muscles, first inspiratory and then accessory (the patient does not appear fatigued or tachypneic because the muscles are exhausted), progressing to a carbonic coma\n', 'This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n', 'Support'], ['This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n', 'Notify intensive care for suspected acute respiratory failure, to assess possible orotracheal intubation and assisted ventilation\n', 'Support']]
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129_81
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[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'male', 'consults', 'for', 'a', 'year-long', 'history', 'of', 'progressive', 'cognitive', 'impairment', 'with', 'memory', 'and', 'orientation', 'lapses.'], ['His', 'family', 'reports', 'recurrent', 'visual', 'hallucinations,', 'occasional', 'falls', 'and', 'striking', 'motor', 'slowing.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Multi-infarct', 'vascular', 'dementia.'], ['2-', "Alzheimer's", 'type', 'dementia.'], ['3-', 'Dementia', 'with', 'diffuse', 'Lewy', 'bodies.'], ['4-', 'Frontotemporal', 'dementia.'], ['5-', 'Normal', 'pressure', 'hydrocephalus.'], ['CORRECT', 'ANSWER:', '3'], ['Dementia', 'with', 'visual', 'hallucinations', 'at', 'the', 'beginning', 'of', 'the', 'course', '(in', 'the', 'first', '2', 'years)', 'is', 'very', 'suggestive', 'of', 'Lewy', 'bodies,', 'and', 'is', 'the', 'guiding', 'symptom', 'in', 'these', 'questions.'], ['If', 'we', 'add', 'to', 'this', 'the', 'falls', 'and', 'motor', 'slowing', 'suggestive', 'of', 'parkinsonism,', 'it', 'makes', 'the', 'question', 'easier.'], ['Therefore,', 'number', '3', 'is', 'correct.']]
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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'], ['B-Premise', 'I-Premise', 'I-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', 'B-Claim', 'I-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', 'B-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', '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']]
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[['Dementia with visual hallucinations at the beginning of the course (in the first 2 years) is very suggestive of Lewy bodies, and is the guiding symptom in these questions\n', 'Dementia with diffuse Lewy bodies\n', 'Support'], ['His family reports recurrent visual hallucinations\n', 'Dementia with diffuse Lewy bodies\n', 'Support'], ['If we add to this the falls and motor slowing suggestive of parkinsonism, it makes the question easier.\n', 'Dementia with diffuse Lewy bodies\n', 'Support'], ['occasional falls and striking motor slowing\n', 'Dementia with diffuse Lewy bodies\n', 'Support'], ['Therefore, number 3 is correct\n', 'Dementia with diffuse Lewy bodies\n', 'Support'], ['Dementia with visual hallucinations at the beginning of the course (in the first 2 years) is very suggestive of Lewy bodies, and is the guiding symptom in these questions\n', 'Therefore, number 3 is correct\n', 'Support'], ['If we add to this the falls and motor slowing suggestive of parkinsonism, it makes the question easier.\n', 'Therefore, number 3 is correct\n', 'Support']]
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