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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '53-year-old', 'man', 'with', 'no', 'history', 'of', 'interest', 'who', 'after', 'a', 'bad', 'movement', 'in', 'the', 'gym', 'notices', 'low', 'back', 'pain', 'that', 'after', 'a', 'few', 'hours', 'radiates', 'to', 'the', 'back', 'of', 'the', 'right', 'leg', 'and', 'reaches', 'the', 'lateral', 'edge', 'of', 'the', 'foot.'], ['On', 'examination', 'he', 'presents', 'positive', 'Lasègue', 'maneuver', 'at', '40o,', 'abolished', 'hamstring', 'reflex', 'and', 'he', 'cannot', 'stand', 'on', 'tiptoe.'], ['The', 'most', 'probable', 'etiological', 'diagnosis', 'is:'], ['1-', 'Right', 'L2-L3', 'disc', 'herniation.'], ['2-', 'Right', 'L3-L4', 'disc', 'herniation.'], ['3-', 'Right', 'L4-L5', 'disc', 'herniation.'], ['4-', 'Right', 'L5-S1', 'disc', 'herniation.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['He', 'describes', 'S1', 'root', 'involvement', 'by', 'the', 'inability', 'to', 'tiptoe', 'and', 'the', 'absence', 'of', 'the', 'Achilles', 'reflex,', 'in', 'addition', 'to', 'the', 'distribution', 'of', 'pain', 'down', 'the', 'leg.'], ['Of', 'our', 'options,', 'the', 'cause', 'that', 'can', 'produce', 'damage', 'to', 'S1', 'is', 'L5-S1', 'disc', 'herniation.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', '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 inability to tiptoe and the absence of the Achilles reflex, in addition to the distribution of pain down the leg\n', 'He describes S1 root involvement\n', 'Support'], ['He describes S1 root involvement\n', 'Of our options, the cause that can produce damage to S1 is L5-S1 disc herniation\n', 'Support'], ['Of our options, the cause that can produce damage to S1 is L5-S1 disc herniation\n', 'Right L5-S1 disc herniation\n', 'Support']]
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160_117
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[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'man', 'presenting', 'hematuria', 'after', 'respiratory', 'infections', 'for', 'several', 'years,', 'a', 'blood', 'test', 'shows', 'creatinine', '1', 'mg/dl', 'with', 'no', 'other', 'alterations', 'and', 'urine', 'hematocytes', '50/field', 'being', '80%', 'dysmorphic,', 'with', 'proteinuria', 'of', '0.8', 'grams', 'in', '24', 'hours.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Minimal', 'change', 'nephropathy.'], ['2-', 'Membranous', 'glomerulonephritis.'], ['3-', 'IgA', 'nephropathy.'], ['4-', 'Proliferative', 'and', 'diffuse', 'glomerulonephritis.'], ['5-', 'Focal', 'and', 'primary', 'segmental', 'glomerulosclerosis.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is:', '3.'], ['IgA', 'nephropathy.'], ['Given', 'that', 'the', 'clinical', 'presentation', 'of', 'this', 'nephropathy', 'appears', 'in', 'a', 'very', 'unspecific', 'way,', 'to', 'identify', 'the', 'responsible', 'disease', 'we', 'must', 'rely', 'on', 'its', 'epidemiology.'], ['Since', 'he', 'is', 'a', 'young', 'male,', 'with', 'a', 'history', 'of', 'previous', 'respiratory', 'infections,', 'a', 'relationship', 'between', 'these', 'infections', 'and', 'renal', 'pathology', 'is', 'established.'], ['Based', 'on', 'this', 'we', 'think', 'about', 'IgA', 'nephropathy,', 'which', 'besides', 'being', 'the', 'most', 'frequent', 'glomerulonephritis,', 'it', 'is', 'presented', 'in', 'most', 'of', 'the', 'cases', 'as', 'described.']]
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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'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['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'], ['O', 'O', 'O'], ['B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The correct answer is: 3\n', 'IgA nephropathy\n', 'Support'], ['The correct answer is: 3\n', 'IgA nephropathy\n', 'Support'], ['Since he is a young male, with a history of previous respiratory infections, a relationship between these infections and renal pathology is established\n', 'Based on this we think about IgA nephropathy, which besides being the most frequent glomerulonephritis, it is presented in most of the cases as described\n', 'Support'], ['A 35-year-old man presenting hematuria after respiratory infections for several years, a blood test shows creatinine 1 mg/dl with no other alterations and urine hematocytes 50/field being 80% dysmorphic, with proteinuria of 0.8 grams in 24 hours\n', 'IgA nephropathy\n', 'Support'], ['Based on this we think about IgA nephropathy, which besides being the most frequent glomerulonephritis, it is presented in most of the cases as described\n', 'IgA nephropathy\n', 'Support']]
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312_217
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['An', '84-year-old', 'woman', 'presents', 'with', 'loss', 'of', 'vision', 'in', 'the', 'left', 'eye', 'of', '4', 'days', 'of', 'evolution', 'accompanied', 'by', 'metamorphopsia.'], ['The', 'macula', 'shows', 'abundant', 'hard', 'exudates,', 'two', 'small', 'deep', 'hemorrhages', 'and', 'a', 'localized', 'neurosensory', 'retinal', 'detachment.'], ['In', 'the', 'contralateral', 'eye', 'there', 'are', 'abundant', 'soft', 'drusen.'], ['Given', 'this', 'picture,', 'which', 'of', 'the', 'following', 'diagnoses', 'do', 'you', 'think', 'is', 'the', 'most', 'likely?'], ['1-', 'Acute', 'posterior', 'vitreous', 'detachment.'], ['2-', 'Exudative', 'age-related', 'macular', 'degeneration', '(AMD).'], ['3-', 'Central', 'retinal', 'artery', 'obstruction.'], ['4-', 'Non-arteritic', 'anterior', 'ischemic', 'optic', 'neuropathy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['In', 'principle,', 'this', 'is', 'an', 'easy', 'question,', 'as', 'it', 'deals', 'with', 'a', 'disease', 'that', 'is', 'frequently', 'repeated', 'in', 'the', 'MIR', 'exams.'], ['The', 'description', 'is', 'typical', 'of', 'option', '2.'], ['It', 'is', 'an', 'exudative', 'AMD', '(although', 'as', 'we', 'said', 'in', 'question', '215,', 'with', 'the', 'new', 'classification,', 'we', 'would', 'speak', 'of', 'an', 'advanced', 'AMD', 'in', 'its', 'neovascular', 'variant).'], ['In', 'any', 'case,', 'we', 'have', 'an', 'elderly', 'patient', 'with', 'vision', 'loss', 'and', 'metamorphopsia', 'in', 'one', 'eye.'], ['In', 'the', 'examination', 'there', 'are', 'lesions', 'in', 'the', 'macula.'], ['With', 'that', 'we', 'can', 'rule', 'out', 'acute', 'posterior', 'vitreous', 'detachment,', 'which', 'does', 'not', 'produce', 'visual', 'loss,', 'nor', 'metamorphopsia,', 'nor', 'lesions', 'in', 'the', 'macula.'], ['And', 'also', 'non-arteritic', 'anterior', 'ischemic', 'optic', 'neuropathy,', 'because', 'although', 'it', 'produces', 'visual', 'loss', 'and', 'is', 'typical', 'of', 'older', 'people,', 'it', 'does', 'not', 'produce', 'metamorphopsia.'], ['And', 'there', 'are', 'no', 'lesions', 'in', 'the', 'macula', 'but', 'papilla', 'edema.'], ['In', 'central', 'retinal', 'artery', 'obstruction,', 'metamorphopsia', 'is', 'not', 'particularly', 'characteristic', '(visual', 'loss', 'and', 'advanced', 'age', 'are),', 'but', 'the', 'lesions', 'in', 'the', 'fundus', 'of', 'the', 'eye', 'vary.'], ['In', 'the', 'case', 'of', 'arterial', 'occlusion,', 'there', 'is', 'intracellular', 'edema', 'that', 'is', 'seen', 'as', 'absence', 'of', 'hemorrhages', 'and', 'a', 'whitish,', 'pale', 'fundus.'], ['In', 'addition,', 'the', 'entire', 'retina', 'is', 'globally', 'affected,', 'and', 'a', 'cherry-red', 'spot', 'may', 'appear', 'in', 'the', 'macula.'], ['In', 'this', 'case', 'the', 'lesions', 'are', 'totally', 'different.'], ['They', 'describe', 'hard', 'exudates,', 'deep', 'hemorrhages', 'and', 'localized', 'neurosensory', 'retinal', 'detachment.'], ['All', 'this', 'in', 'the', 'macula.'], ['These', 'are', 'the', 'characteristic', 'findings', 'of', 'neovascular', '(or', 'exudative)', 'AMD.'], ['As', 'a', 'clue,', 'in', 'the', 'other', 'eye', 'there', 'are', 'abundant', 'soft', 'drusen.'], ['Drusen', 'are', 'the', 'typical', 'findings', 'of', 'AMD.'], ['So', 'he', 'has', 'AMD', 'in', 'both', 'eyes', 'and', 'in', 'the', 'right', 'eye', 'it', 'has', 'recently', 'become', 'complicated', 'by', 'the', 'appearance', 'of', 'neovascularization.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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'], ['O', 'B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-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-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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 description is typical of option 2\n', 'Exudative age-related macular degeneration (AMD)\n', 'Support'], ['although as we said in question 215, with the new classification, we would speak of an advanced AMD in its neovascular variant\n', 'It is an exudative AMD\n', 'Attack'], ['It is an exudative AMD\n', 'Exudative age-related macular degeneration (AMD)\n', 'Support'], ['In any case, we have an elderly patient with vision loss and metamorphopsia in one eye\n', 'With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula\n', 'Attack'], ['In the examination there are lesions in the macula\n', 'With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula\n', 'Attack'], ['With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula\n', 'Acute posterior vitreous detachment\n', 'Attack'], ['although it produces visual loss and is typical of older people, it does not produce metamorphopsia\n', 'And also non-arteritic anterior ischemic optic neuropathy\n', 'Support'], ['And also non-arteritic anterior ischemic optic neuropathy\n', 'Non-arteritic anterior ischemic optic neuropathy\n', 'Attack'], ['And there are no lesions in the macula but papilla edema\n', 'And also non-arteritic anterior ischemic optic neuropathy\n', 'Support'], ['In any case, we have an elderly patient with vision loss and metamorphopsia in one eye\n', 'In central retinal artery obstruction, metamorphopsia is not particularly characteristic (visual loss and advanced age are), but the lesions in the fundus of the eye vary\n', 'Attack'], ['In central retinal artery obstruction, metamorphopsia is not particularly characteristic (visual loss and advanced age are), but the lesions in the fundus of the eye vary\n', 'Central retinal artery obstruction\n', 'Attack'], ['In this case the lesions are totally different\n', 'Central retinal artery obstruction\n', 'Attack'], ['In addition, the entire retina is globally affected, and a cherry-red spot may appear in the macula\n', 'Central retinal artery obstruction\n', 'Attack'], ['In the case of arterial occlusion, there is intracellular edema that is seen as absence of hemorrhages and a whitish, pale fundus\n', 'Central retinal artery obstruction\n', 'Attack'], ['They describe hard exudates, deep hemorrhages and localized neurosensory retinal detachment\n', 'These are the characteristic findings of neovascular (or exudative) AMD\n', 'Support'], ['All this in the macula\n', 'These are the characteristic findings of neovascular (or exudative) AMD\n', 'Support'], ['As a clue, in the other eye there are abundant soft drusen\n', 'These are the characteristic findings of neovascular (or exudative) AMD\n', 'Support'], ['As a clue, in the other eye there are abundant soft drusen\n', 'Drusen are the typical findings of AMD\n', 'Support'], ['These are the characteristic findings of neovascular (or exudative) AMD\n', 'Acute posterior vitreous detachment\n', 'Support'], ['Drusen are the typical findings of AMD\n', 'Acute posterior vitreous detachment\n', 'Support'], ['So he has AMD in both eyes and in the right eye it has recently become complicated by the appearance of neovascularization\n', 'Acute posterior vitreous detachment\n', 'Support']]
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24_115
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[['QUESTION', 'TYPE:', 'INFECTIOUS'], ['CLINICAL', 'CASE:'], ['A', '68-year-old', 'man', 'is', 'evaluated', 'for', 'fever,', 'weight', 'loss', 'and', 'dyspnea', 'on', 'exertion.'], ['The', 'EP', 'reveals', 'a', 'new', 'aortic', 'diastolic', 'murmur', 'and', 'stigmata', 'of', 'peripheral', 'embolisms.'], ['Echocardiography', 'showed', 'a', '1', 'cm', 'vegetation', 'on', 'the', 'aortic', 'valve', 'and', 'two', 'blood', 'cultures', 'isolated', 'penicillin-sensitive', 'Streptococcus', 'bovis.'], ['After', 'starting', 'treatment', 'for', 'endocarditis,', 'which', 'of', 'the', 'following', 'examinations', 'could', 'help', 'us', 'in', 'the', 'diagnosis?'], ['1-', 'Glucose', 'tolerance', 'test.'], ['2-', 'Chest', 'X-ray.'], ['3-', 'Upper', 'gastrointestinal', 'endoscopy.'], ['4-', 'Colonoscopy.'], ['5-', 'Abdominal', 'ultrasound.'], ['CORRECT', 'ANSWER:', '4'], ['Another', 'gift', 'of', 'a', 'question,', 'the', 'association', 'of', 'S.bovis', 'endocarditis', 'and', 'colon', 'cancer.'], ['By', 'the', 'way,', 'it', 'is', 'funny', 'that', 'they', 'give', 'Chest', 'Rx', 'as', 'a', 'test', 'to', 'be', 'performed.....', 'are', 'you', 'telling', 'me', 'that', 'a', 'patient', 'with', 'fever', 'and', 'dyspnea', 'will', 'have', 'an', 'echocardiogram', 'before', 'a', 'simple', 'chest', 'x-ray?'], ['And', 'on', 'the', 'other', 'hand...', 'why', "don't", 'those', 'who', 'write', 'the', 'MIR', 'ask', 'shorter', 'questions', 'without', 'so', 'much', 'back', 'and', 'forth?'], ['If', 'what', 'they', 'want', 'is', 'to', 'ask', 'the', 'test', 'to', 'be', 'performed', 'on', 'a', 'patient', 'with', 'S.', 'bovis', 'endocarditis,', 'they', 'could', 'ask', 'the', 'question', 'directly', 'without', 'telling', 'us', 'about', 'the', "patient's", 'moles...']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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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[['By the way, it is funny that they give Chest Rx as a test to be performed..... are you telling me that a patient with fever and dyspnea will have an echocardiogram before a simple chest x-ray?\n', 'Chest X-ray\n', 'Attack'], ['Another gift of a question, the association of S.bovis endocarditis and colon cancer\n', 'Colonoscopy\n', 'Support']]
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260_99
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[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'comes', 'to', 'the', 'clinic', 'referred', 'from', 'surgery', 'with', 'the', 'diagnosis', 'of', 'a', 'neuroendocrine', 'tumor', 'diagnosed', 'after', 'partial', 'pancreatectomy', 'for', 'a', '2-cm', 'tumor', 'in', 'the', 'tail', 'of', 'the', 'pancreas.'], ['The', 'tumor', 'had', 'been', 'detected', 'by', 'chance', 'in', 'an', 'abdominal', 'CT', 'scan', 'requested', 'to', 'complete', 'the', 'study', 'of', 'a', 'simple', 'hepatic', 'cyst.'], ['On', 'questioning', 'the', 'patient,', 'the', 'history', 'of', 'irregular', 'menstruation,', 'amenorrhea', 'for', 'the', 'last', '6', 'months,', 'and', 'repeated', 'renal', 'colic', 'since', 'she', 'was', '20', 'years', 'old,', 'for', 'which', 'she', 'has', 'required', 'lithotripsy', 'on', 'several', 'occasions,', 'stand', 'out.'], ['She', 'also', 'has', 'a', 'family', 'history', 'of', 'renoureteral', 'colic.'], ['What', 'is', 'her', 'suspected', 'diagnosis?'], ['1-', 'Multiple', 'endocrine', 'neoplasia', 'type', '1', 'or', "Wermer's", 'syndrome.'], ['2-', 'Multiple', 'endocrine', 'neoplasia', 'type', '2', 'A', 'or', "Sipple's", 'syndrome.'], ['3-', 'Multiple', 'endocrine', 'neoplasia', 'type', '2B.'], ['4-', 'Somatostatinoma.'], ['5-', 'A', 'PTH-producing', 'neuroendocrine', 'tumor.'], ['CORRECT', 'ANSWER:', '1'], ['Very', 'nice', 'clinical', 'question', 'from', 'MEN.'], ['Pancreatic', 'neuroendocrine', 'tumor', '+', 'pituitary', 'adenoma', '(prolactinoma)', '+', 'hyperparathyroidism', '(renoureteral', 'colic', 'in', 'young', 'people):', 'MEN', '1.'], ['Medium', 'difficulty', 'because', 'you', 'have', 'to', 'know', 'the', 'MEN', 'triad', 'and', 'recognize', 'the', 'different', 'tumors.']]
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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', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['Pancreatic neuroendocrine tumor + pituitary adenoma (prolactinoma) + hyperparathyroidism (renoureteral colic in young people)\n', 'MEN 1\n', 'Support'], ['MEN 1\n', "Multiple endocrine neoplasia type 1 or Wermer's syndrome\n", 'Support']]
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211_87
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[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'left', 'iliac', 'fossa', 'pain', 'of', '24', 'hours', 'of', 'evolution', 'associated', 'with', 'fever', 'and', 'occasional', 'vomiting.'], ['On', 'examination,', 'there', 'is', 'selective', 'pain', 'on', 'palpation', 'in', 'the', 'left', 'iliac', 'fossa', 'with', 'a', 'feeling', 'of', 'occupation,', 'defense', 'and', 'positive', 'decompression.'], ['When', 'acute', 'diverticulitis', 'is', 'suspected,', 'which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'The', 'safest', 'and', 'best', 'performing', 'complementary', 'examination', 'is', 'the', 'barium', 'contrast', 'enema.'], ['2-', 'In', 'case', 'of', 'contained', 'pelvic', 'abscess,', 'percutaneous', 'drainage', 'guided', 'by', 'CT', 'or', 'ultrasound', 'is', 'indicated.'], ['3-', 'If', 'surgical', 'intervention', 'is', 'required', 'after', 'resolution', 'of', 'the', 'acute', 'episode,', 'the', 'laparoscopic', 'approach', 'is', 'contraindicated.'], ['4-', 'In', 'case', 'of', 'acute', 'uncomplicated', 'diverticulitis,', 'elective', 'sigmoidectomy', 'is', 'indicated', 'after', 'cure', 'of', 'the', 'first', 'acute', 'episode.'], ['5-', 'If', 'generalized', 'peritonitis', 'occurs,', 'the', 'most', 'appropriate', 'surgical', 'technique', 'is', 'the', 'practice', 'of', 'a', 'derivative', 'colostomy', 'without', 'resection', 'of', 'the', 'affected', 'sigmoid', 'segment.'], ['CORRECT', 'ANSWER:', '2'], ['Answer', '1', 'is', 'incorrect', 'because', 'the', 'imaging', 'tests', 'of', 'choice', 'would', 'be', 'ultrasound', 'or', 'CT;', 'answer', '3', 'is', 'incorrect', 'because', 'the', 'laparoscopic', 'approach', 'is', 'indicated', 'from', 'the', 'start;', 'answer', '4', 'is', 'incorrect', 'because', 'the', 'indication', 'in', 'the', 'first', 'episode', 'is', 'for', 'those', 'under', '50', 'years', 'of', 'age,', 'in', 'the', 'rest', 'it', 'is', 'indicated', 'after', 'the', 'second', 'episode', 'or', 'in', 'cases', 'of', 'persistent', 'symptoms', 'or', 'suspected', 'neoplasia;', 'and', 'answer', '5', 'is', 'incorrect', 'because', 'surgery', 'in', 'cases', 'of', 'perforation', 'with', 'peritonitis', 'should', 'always', 'resect', 'the', 'affected', 'segment', 'of', 'colon', 'to', 'control', 'the', 'focus', 'of', 'the', 'infection.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['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', '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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['the imaging tests of choice would be ultrasound or CT\n', 'Answer 1 is incorrect\n', 'Support'], ['the laparoscopic approach is indicated from the start\n', 'answer 3 is incorrect\n', 'Support'], ['the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia\n', 'answer 4 is incorrect\n', 'Support'], ['surgery in cases of perforation with peritonitis should always resect the affected segment of colon to control the focus of the infection\n', 'answer 5 is incorrect\n', 'Support'], ['Answer 1 is incorrect\n', 'The safest and best performing complementary examination is the barium contrast enema\n', 'Attack'], ['answer 3 is incorrect\n', 'If surgical intervention is required after resolution of the acute episode, the laparoscopic approach is contraindicated\n', 'Attack'], ['answer 4 is incorrect\n', 'In case of acute uncomplicated diverticulitis, elective sigmoidectomy is indicated after cure of the first acute episode\n', 'Attack'], ['A 78-year-old woman comes to the emergency department for left iliac fossa pain of 24 hours of evolution associated with fever and occasional vomiting\n', 'the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia\n', 'Attack'], ['answer 5 is incorrect\n', 'If generalized peritonitis occurs, the most appropriate surgical technique is the practice of a derivative colostomy without resection of the affected sigmoid segment\n', 'Attack']]
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162_121
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'patient', 'with', 'stage', 'V', 'chronic', 'kidney', 'disease,', 'secondary', 'to', 'autosomal', 'dominant', 'polycystic', 'kidney', 'disease,', 'receives', 'a', 'cadaver', 'donor', 'kidney', 'graft.'], ['A', '34-year-old', 'brother', 'of', 'his', 'comes', 'to', 'visit', 'him', 'and', 'says', 'he', 'does', 'not', 'know', 'if', 'he', 'has', 'the', 'disease', 'because', 'he', 'has', 'never', 'seen', 'a', 'doctor', 'since', 'he', 'was', 'a', 'teenager.'], ['What', 'attitude', 'or', 'test', 'do', 'you', 'think', 'is', 'the', 'most', 'appropriate', 'to', 'recommend', 'at', 'that', 'moment?'], ['1-', 'Genetic', 'mutational', 'and', 'linkage', 'study.'], ['2-', 'Abdomino-pelvic', 'ultrasound.'], ['3-', 'Helical', 'computed', 'axial', 'tomography', 'with', 'iodinated', 'contrast.'], ['4-', 'Abdominal', 'and', 'cerebral', 'MRI.'], ['5-', 'Periodic', 'clinical', 'controls.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is:', '2.'], ['Abdomino-pelvic', 'ultrasound.'], ['Abdomino-pelvic', 'ultrasound', 'is', 'undoubtedly', 'the', 'most', 'specific', 'and', 'sensitive', 'test', 'for', 'the', 'diagnosis', 'of', 'polycystic', 'kidney', 'disease', 'and,', 'above', 'all,', 'the', 'cheapest', 'to', 'demonstrate', 'whether', 'or', 'not', 'the', "patient's", 'sibling', 'has', 'inherited', 'polycystic', 'kidney', 'disease.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The correct answer is: 2\n', 'Abdomino-pelvic ultrasound\n', 'Support'], ['The correct answer is: 2\n', 'Abdomino-pelvic ultrasound\n', 'Support'], ["Abdomino-pelvic ultrasound is undoubtedly the most specific and sensitive test for the diagnosis of polycystic kidney disease and, above all, the cheapest to demonstrate whether or not the patient's sibling has inherited polycystic kidney disease\n", 'Abdomino-pelvic ultrasound\n', 'Support']]
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207_181
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '43-year-old', 'woman', 'referred', 'to', 'the', "Hospital's", 'Lower', 'Genital', 'Tract', 'Pathology', 'Clinic', 'for', 'presenting', 'with', 'a', 'cervico-vaginal', 'cytology', 'reported', 'as', '"L-SIL"', '(Low', 'Grade', 'Intraepithelial', 'Lesion).'], ['She', 'refers', 'repeated', 'vaginal', 'infections', '(Trichomoniasis,...)', 'and', 'having', 'had', 'more', 'than', '5', 'sexual', 'partners', 'in', 'her', 'life.'], ['The', 'best', 'care', 'strategy', 'for', 'this', 'woman', 'is:'], ['1-', 'Conization', 'with', 'diathermy', 'loop.'], ['2-', 'Endocervical', 'curettage', 'with', 'Kevorkian', 'curettage.'], ['3-', 'Endometrial', 'biopsy', 'with', 'Cornier', 'cannula.'], ['4-', 'Hysterectomy', 'without', 'adnexectomy.'], ['5-', 'Advise', 'her', 'to', 'stop', 'smoking', 'and', 'contraceptives', 'and', 'to', 'have', 'a', 'control', 'in', '6', 'months.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'best', 'answer', 'to', 'this', 'question', 'is', 'number', '5.'], ['Most', 'of', 'the', 'lesions', 'identified', 'as', 'L-SIL', 'are', 'associated', 'with', 'HPV', 'infection:', 'for', 'this', 'reason,', 'it', 'is', 'advisable', 'to', 'stop', 'smoking,', 'as', 'this', 'is', 'a', 'factor', 'in', 'the', 'progression', 'of', 'the', 'said', 'infection.'], ['On', 'the', 'other', 'hand,', 'according', 'to', 'the', 'latest', 'studies,', '70%', 'of', 'the', 'cytologies', 'reported', 'as', 'LSIL', 'will', 'remit,', '15%', 'will', 'persist', 'and', 'another', '15%', 'will', 'show', 'a', 'more', 'severe', 'cytology,', 'without', 'being', 'able', 'to', 'differentiate', 'whether', 'it', 'is', 'a', 'biological', 'progression', 'or', 'a', 'lesion', 'hidden', 'in', 'the', 'initial', 'cytology.'], ['Because', 'of', 'this,', 'it', 'is', 'best', 'to', 'return', 'for', 'a', 'follow-up', 'at', '6', 'months.'], ['Given', 'the', "woman's", 'personal', 'history', '(more', 'than', '5', 'sexual', 'partners', 'and', 'repeat', 'infections)', 'and', 'her', 'age,', 'a', 'referral', 'for', 'colposcopy', 'would', 'be', 'ideal.'], ['However,', 'answer', '5', 'says', 'control', 'in', '6', 'months,', 'but', 'does', 'not', 'specify', 'which', 'control', '(it', 'could', 'be', 'a', 'colposcopy', 'or', 'cytology).']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Most of the lesions identified as L-SIL are associated with HPV infection\n', 'for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection\n', 'Support'], ['for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection\n', 'The best answer to this question is number 5\n', 'Support'], ['On the other hand, according to the latest studies, 70% of the cytologies reported as LSIL will remit, 15% will persist and another 15% will show a more severe cytology, without being able to differentiate whether it is a biological progression or a lesion hidden in the initial cytology\n', 'Because of this, it is best to return for a follow-up at 6 months\n', 'Support'], ["Given the woman's personal history (more than 5 sexual partners and repeat infections) and her age\n", 'a referral for colposcopy would be ideal\n', 'Support'], ['The best answer to this question is number 5\n', 'Advise her to stop smoking and contraceptives and to have a control in 6 months\n', 'Support'], ['Because of this, it is best to return for a follow-up at 6 months\n', 'Advise her to stop smoking and contraceptives and to have a control in 6 months\n', 'Support'], ['a referral for colposcopy would be ideal\n', 'Advise her to stop smoking and contraceptives and to have a control in 6 months\n', 'Support'], ['However, answer 5 says control in 6 months, but does not specify which control (it could be a colposcopy or cytology)\n', 'Advise her to stop smoking and contraceptives and to have a control in 6 months\n', 'Support']]
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584_73
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[['QUESTION', 'TYPE:', 'OBSTETRICS', 'AND', 'GYNECOLOGY'], ['CLINICAL', 'CASE:'], ['A', '51-year-old', 'woman,', 'menopausal', 'for', 'a', 'year', 'and', 'a', 'half,', 'who', 'consults', 'for', 'vaginal', 'spotting', 'of', '2', "weeks'", 'evolution.'], ['She', 'reports', 'that', 'the', 'spotting', 'is', 'less', 'than', 'a', 'menstrual', 'period.'], ['The', 'ultrasound', 'shows', 'a', '7', 'mm', 'endometrium.'], ['Mark', 'the', 'correct', 'option:'], ['1-', 'The', 'endometrium', 'is', 'thickened', 'and', 'in', 'view', 'of', 'the', "patient's", 'symptoms,', 'an', 'endometrial', 'biopsy', 'is', 'taken', 'with', 'a', 'Cornier', 'cannula.'], ['2-', 'The', 'endometrium', 'is', 'not', 'thickened', 'so', 'she', 'is', 'prescribed', 'tranexamic', 'acid', 'and', 'ambulatory', 'follow-up.'], ['3-', 'Indications', 'for', 'diagnostic', 'hysteroscopy', 'without', 'the', 'need', 'for', 'endometrial', 'biopsy.'], ['4-', 'The', 'endometrium', 'is', 'not', 'thickened,', 'but', 'since', 'she', 'has', 'clinical', 'signs', 'of', 'metrorrhagia,', 'an', 'endometrial', 'biopsy', 'is', 'indicated.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'endometrium', 'is', 'thickened', 'for', 'a', 'menopausal', 'woman', '(some', 'guidelines', 'put', 'the', 'limit', 'at', '5', 'and', 'others', 'at', '3mm).'], ['And', 'the', 'first', 'complementary', 'test', 'to', 'perform', 'would', 'be', 'an', 'endometrial', 'biopsy.'], ['If', 'this', 'is', 'not', 'decisive,', 'hysteroscopy', 'will', 'be', 'considered', 'as', 'a', 'second', 'option.']]
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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'], ['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'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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'], ['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']]
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[["A 51-year-old woman, menopausal for a year and a half, who consults for vaginal spotting of 2 weeks' evolution\n", 'The endometrium is thickened for a menopausal woman\n', 'Support'], ['The endometrium is thickened for a menopausal woman\n', "The endometrium is thickened and in view of the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula\n", 'Support'], ['some guidelines put the limit at 5 and others at 3mm\n', 'The endometrium is thickened for a menopausal woman\n', 'Support'], ['And the first complementary test to perform would be an endometrial biopsy\n', "The endometrium is thickened and in view of the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula\n", 'Support']]
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138_165
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[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'child', 'who', 'comes', 'to', 'the', 'outpatient', 'clinic', 'because', 'he', 'brings', 'his', 'hand', 'to', 'his', 'ear,', 'without', 'fever', 'or', 'acute', 'inflammatory', 'signs', 'and', 'who', 'on', 'examination', 'shows', 'a', 'pinkish/amber', 'eardrum.'], ['As', 'history', 'he', 'refers', 'that', 'one', 'month', 'ago', 'he', 'presented', 'an', 'episode', 'of', 'otalgia,', 'fever', 'accompanied', 'by', 'irritability', 'and', 'that', 'he', 'was', 'treated', 'with', 'amoxicillin', '40', 'mg/kg/day.'], ['What', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Recurrent', 'acute', 'otitis', 'media.'], ['2-', 'Serous', 'otitis', 'media.'], ['3-', 'Simple', 'chronic', 'otitis', 'media.'], ['4-', 'Chronic', 'cholesteatomatous', 'otitis', 'media.'], ['5-', 'Mastoiditis.'], ['CORRECT', 'ANSWER:', '2'], ['Reading', 'the', 'case,', 'we', 'are', 'discarding', 'options:', 'child', 'with', 'otalgia,', 'but', 'without', 'fever', 'or', 'acute', 'inflammatory', 'signs:', 'it', 'is', 'neither', '1', '(recurrent', 'acute', 'otitis', 'media)', 'nor', '5', '(mastoiditis).'], ['On', 'otoscopy,', 'a', 'pinkish', 'and', 'amber', 'eardrum', 'is', 'observed:', 'there', 'are', 'no', 'scales,', 'so', 'it', 'is', 'not', '4', '(cholesteatomatous', 'chronic', 'otitis', 'media);', 'nor', 'perforations', 'or', 'adhesions,', 'so', 'it', 'is', 'not', '3', '(simple', 'chronic', 'otitis', 'media).'], ['Otoscopy', 'is', 'characteristic', 'of', 'serous', 'otitis', 'media', '(answer', '2', 'correct).'], ['It', 'is', 'known', 'by', 'ENT,', 'pediatricians', 'and', 'family', 'physicians', 'that', 'in', 'the', 'month', 'following', 'an', 'acute', 'otitis', 'media,', 'the', 'middle', 'ear', 'is', 'occupied', 'by', 'a', 'mucous', 'content', 'whose', 'evolution', 'should', 'be', 'monitored.'], ['I', 'do', 'not', 'think', 'that', 'this', 'is', 'a', 'contestable', 'issue', 'either.']]
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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', 'I-Premise', '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', 'I-Premise', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)\n', 'Mastoiditis\n', 'Attack'], ['child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)\n', 'Recurrent acute otitis media\n', 'Attack'], ['without fever or acute inflammatory signs\n', 'Recurrent acute otitis media\n', 'Attack'], ['without fever or acute inflammatory signs\n', 'Mastoiditis\n', 'Attack'], ['On otoscopy, a pinkish and amber eardrum is observed: there are no scales, so it is not 4 (cholesteatomatous chronic otitis media); nor perforations or adhesions, so it is not 3 (simple chronic otitis media)\n', 'Chronic cholesteatomatous otitis media\n', 'Attack'], ['On otoscopy, a pinkish and amber eardrum is observed: there are no scales, so it is not 4 (cholesteatomatous chronic otitis media); nor perforations or adhesions, so it is not 3 (simple chronic otitis media)\n', 'Simple chronic otitis media\n', 'Attack'], ['Otoscopy is characteristic of serous otitis media (answer 2 correct)\n', 'Serous otitis media\n', 'Support'], ['on examination shows a pinkish/amber eardrum\n', 'Serous otitis media\n', 'Support'], ['It is known by ENT, pediatricians and family physicians that in the month following an acute otitis media, the middle ear is occupied by a mucous content whose evolution should be monitored\n', 'Serous otitis media\n', 'Support'], ['As history he refers that one month ago he presented an episode of otalgia, fever accompanied by irritability and that he was treated with amoxicillin 40 mg/kg/day\n', 'Serous otitis media\n', 'Support']]
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136_132
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[['QUESTION', 'TYPE:', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'a', 'coma', 'crisis.'], ['Ex-smoker', 'for', '3', 'years,', 'with', 'no', 'other', 'history', 'of', 'interest.'], ['A', 'CT', 'scan', 'shows', 'multiple', 'metastases.'], ['What', 'is', 'the', 'most', 'probable', 'origin?'], ['1-', 'Head', 'and', 'neck', 'cancer.'], ['2-', 'Lung', 'cancer.'], ['3-', 'Urinary', 'bladder', 'cancer.'], ['4-', 'Colon', 'cancer.'], ['5-', 'Pancreatic', 'cancer.'], ['CORRECT', 'ANSWER:', '2'], ['Pretty', 'easy,', "isn't", 'it?'], ['Lung', 'cancer', 'is', 'the', 'most', 'frequent', 'cause', 'of', 'brain', 'metastases', 'and', 'in', '20-30%', 'of', 'cases', 'it', 'is', 'as', 'a', 'result', 'of', 'them', 'that', 'the', 'primary', 'tumor', 'is', 'diagnosed', '(as', 'here).']]
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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'], ['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'], ['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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Lung cancer is the most frequent cause of brain metastases and in 20-30% of cases it is as a result of them that the primary tumor is diagnosed (as here)\n', 'Lung cancer\n', 'Support'], ['A CT scan shows multiple metastases\n', 'Lung cancer\n', 'Support']]
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518_105
|
[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman', 'with', 'a', 'history', 'of', 'migraine,', 'on', 'propranolol', 'and', 'oral', 'contraceptives,', 'presents', 'with', 'severe', 'dyspnea,', 'hoarseness,', 'rash,', 'nausea', 'and', 'vomiting', '30', 'minutes', 'after', 'taking', 'metamizole.'], ['His', 'blood', 'pressure', 'is', '90/40', 'mmHg', 'and', 'SatO2', 'is', '90%.'], ['The', 'most', 'correct', 'initial', 'treatment', 'would', 'be', 'to', 'administer:'], ['1-', 'Adrenaline.'], ['2-', 'Adrenaline', 'and', 'dexchlorpheniramine.'], ['3-', 'Adrenaline,', 'dexchlorpheniramine', 'and', 'methylprednisolone.'], ['4-', 'Adrenaline,', 'dexchlorpheniramine', 'and', 'glucagon.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'are', 'faced', 'with', 'an', 'anaphylactic', 'reaction', 'to', 'metamizole,', 'in', 'which', 'it', 'is', 'necessary', 'to', 'act', 'quickly', 'or', 'the', 'patient', 'could', 'progress', 'to', 'cardiac', 'arrest.'], ['It', 'is', 'important', 'to', 'assess', 'the', 'severity', 'of', 'the', 'allergic', 'reactions,', 'since,', 'in', 'this', 'case,', 'early', 'treatment', 'is', 'essential', 'to', 'prevent', 'high', 'mortality', 'if', 'not', 'applied.'], ['The', 'treatment', 'of', 'choice', 'is', 'IM', 'adrenaline', '(only', 'switch', 'to', 'IV', 'if', 'anaphylaxis', 'is', 'refractory),', 'which', 'has', 'been', 'shown', 'to', 'increase', 'survival,', 'and', 'administration', 'can', 'be', 'repeated', 'every', '5-15', 'minutes', 'if', 'symptoms', 'do', 'not', 'subside.'], ['As', 'adjuvant', 'treatment,', 'dexchlorpheniramine', 'could', 'be', 'administered.'], ['In', 'this', 'particular', 'case,', 'since', 'the', 'patient', 'was', 'previously', 'treated', 'with', 'propranolol,', 'this', 'indicates', 'that', 'the', 'correct', 'answer', 'is', '4,', 'which', 'includes', 'the', 'administration', 'of', 'glucagon,', 'which', 'is', 'administered', 'because', 'patients', 'taking', 'beta-blockers', 'can', 'be', 'resistant', 'to', 'treatment', 'with', 'adrenaline', 'and', 'develop', 'refractory', 'hypotension', 'and', 'prolonged', 'bradycardia.'], ['The', 'dose', 'in', 'adults', 'is', '1', 'to', '2mg,', 'IV', 'or', 'IM,', 'which', 'can', 'be', 'repeated', 'in', '5', 'minutes', 'or', 'followed', 'by', 'an', 'infusion', 'at', '5-15mcg/min.']]
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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'], ['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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Claim', 'I-Claim', '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-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A 24-year-old woman with a history of migraine, on propranolol and oral contraceptives, presents with severe dyspnea, hoarseness, rash, nausea and vomiting 30 minutes after taking metamizole\n', 'We are faced with an anaphylactic reaction to metamizole, in which it is necessary to act quickly or the patient could progress to cardiac arrest\n', 'Support'], ['In this particular case, since the patient was previously treated with propranolol\n', 'this indicates that the correct answer is 4, which includes the administration of glucagon\n', 'Support'], ['patients taking beta-blockers can be resistant to treatment with adrenaline and develop refractory hypotension and prolonged bradycardia\n', 'this indicates that the correct answer is 4, which includes the administration of glucagon\n', 'Support'], ['this indicates that the correct answer is 4, which includes the administration of glucagon\n', 'Adrenaline, dexchlorpheniramine and glucagon\n', 'Support'], ['The treatment of choice is IM adrenaline (only switch to IV if anaphylaxis is refractory), which has been shown to increase survival, and administration can be repeated every 5-15 minutes if symptoms do not subside\n', 'Adrenaline, dexchlorpheniramine and glucagon\n', 'Support'], ['As adjuvant treatment, dexchlorpheniramine could be administered\n', 'Adrenaline, dexchlorpheniramine and glucagon\n', 'Support']]
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581_205
| null | null |
[]
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543_39
|
[['QUESTION', 'TYPE:', 'ALLERGOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'patient', 'consults', 'to', 'confirm', 'a', 'suspected', 'allergy', 'to', 'Anisakis', 'simplex.'], ['She', 'has', 'previously', 'suffered', 'a', 'clinical', 'picture', 'of', 'gastrointestinal', 'anisakiasis', 'after', 'eating', 'fish.'], ['The', 'tests', 'performed', 'show', 'specific', 'IgE', 'levels', 'of', '10', 'KU/l', 'against', 'Anisakis', 'simplex.'], ['Which', 'of', 'the', 'following', 'would', 'be', 'the', 'dietary', 'recommendation', 'for', 'this', 'patient?'], ['1-', 'He', 'cannot', 'eat', 'any', 'fish,', 'crustaceans,', 'mollusks', 'or', 'cephalopods.'], ['2-', 'He', 'can', 'eat', 'fresh', 'fish', 'cooked', 'on', 'the', 'grill.'], ['3-', 'May', 'eat', 'commercially', 'flash-frozen', 'fish.'], ['4-', 'You', 'can', 'eat', 'fresh', 'marinated', 'or', 'cold', 'smoked', 'fish.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Anisakis', 'simplex', 'is', 'a', 'parasite', 'frequently', 'found', 'in', 'fish.'], ['To', 'avoid', 'reactions', 'with', 'this', 'parasite,', 'a', 'diet', 'free', 'of', 'fresh', 'and', 'raw', 'fish', '(anchovies', 'in', 'vinegar,', 'smoked,', 'salted', 'fish,', 'sushi,', 'etc.)', 'should', 'be', 'followed.'], ['Deep-frozen', 'fish', 'or', 'fresh', 'fish', 'previously', 'frozen', 'at', '-20ºC', 'for', 'at', 'least', '5', 'days', 'before', 'cooking', 'can', 'be', 'consumed,', 'as', 'long', 'as', 'it', 'is', 'cooked', 'at', 'high', 'temperatures', '>60ºC', '(roasted,', 'fried,', 'etc.),', 'avoiding', 'raw,', 'grilled', 'or', 'microwaved', 'preparations.'], ['It', 'is', 'recommended', 'to', 'consume', 'preferably', 'the', 'tails', 'because', 'the', 'larvae', 'of', 'the', 'parasite', 'are', 'usually', 'close', 'to', 'the', 'viscera', 'of', 'the', 'head.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Anisakis simplex is a parasite frequently found in fish\n', 'To avoid reactions with this parasite, a diet free of fresh and raw fish (anchovies in vinegar, smoked, salted fish, sushi, etc.) should be followed\n', 'Support'], ['To avoid reactions with this parasite, a diet free of fresh and raw fish (anchovies in vinegar, smoked, salted fish, sushi, etc.) should be followed\n', 'Deep-frozen fish or fresh fish previously frozen at -20ºC for at least 5 days before cooking can be consumed, as long as it is cooked at high temperatures >60ºC (roasted, fried, etc.), avoiding raw, grilled or microwaved preparations\n', 'Support'], ['Deep-frozen fish or fresh fish previously frozen at -20ºC for at least 5 days before cooking can be consumed, as long as it is cooked at high temperatures >60ºC (roasted, fried, etc.), avoiding raw, grilled or microwaved preparations\n', 'May eat commercially flash-frozen fish\n', 'Support']]
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2_36
|
[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['An', '87-year-old', 'patient', 'with', 'a', 'history', 'of', 'chronic', 'bronchitis', 'and', 'heart', 'failure', 'has', 'been', 'diagnosed', 'with', 'acute', 'calculous', 'cholecystitis.'], ['After', '4', 'days', 'of', 'hospitalization', 'and', 'treatment', 'with', 'absolute', 'diet,', 'piperacillin-tazobactam', 'serum', 'therapy,', 'the', 'patient', 'continues', 'with', 'fever,', 'persistent', 'abdominal', 'pain', 'and', 'leukocytosis.'], ['The', 'most', 'appropriate', 'attitude', 'at', 'this', 'time', 'would', 'be:'], ['1-', 'Urgent', 'surgical', 'treatment.'], ['2-', 'Biliary', 'drainage', 'by', 'percutaneous', 'cholecystostomy.'], ['3-', 'Replace', 'piperacillin-tazobactam', 'with', 'metronidazole-cefotaxime.'], ['4-', 'Replace', 'piperacillin-tazobactam', 'with', 'amikacin-clindamycin.'], ['5-', 'Add', 'an', 'aminoglycoside', 'such', 'as', 'gentamicin', 'to', 'the', 'treatment.'], ['CORRECT', 'ANSWER:', '2'], ['In', 'this', 'question,', 'they', 'insist', 'on', 'the', 'age', 'and', 'comorbidity', 'of', 'the', 'patient,', 'as', 'well', 'as', 'the', 'time', 'of', 'evolution,', 'so', 'the', 'answer', 'will', 'probably', 'not', 'be', '1.'], ['In', 'any', 'case,', 'the', 'ideal', 'would', 'be', 'to', 'drain', 'the', 'gallbladder', 'that', 'has', 'not', 'gone', 'up', 'again,', 'so', 'the', 'answer', 'I', 'would', 'give', 'would', 'be', '2.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['In this question, they insist on the age and comorbidity of the patient, as well as the time of evolution\n', 'the answer will probably not be 1\n', 'Support'], ['In any case, the ideal would be to drain the gallbladder that has not gone up again, so the answer I would give would be 2\n', 'Biliary drainage by percutaneous cholecystostomy\n', 'Support']]
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122_119
|
[['QUESTION', 'TYPE:', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '17-year-old', 'woman', 'came', 'to', 'the', 'emergency', 'department', 'with', 'acute', 'symptoms', 'of', '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', 'and', 'presence', 'of', 'activated', 'leukocytes,', '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', 'infection.'], ['3-', 'Acute', 'toxoplasmosis.'], ['4-', 'Lyme', 'disease.'], ['5-', 'Infection', 'by', 'herpes', 'virus', '8.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', 'the', 'first', 'one.'], ['It', 'is', 'a', 'typical', 'picture', 'of', 'infectious', 'mononucleosis.'], ['Although', 'a', 'similar', 'picture', 'may', 'occur', 'in', 'acute', 'toxoplasmosis,', 'less', 'than', '1%', 'of', 'acute', 'toxoplasma', 'infections', 'present', 'as', 'mononucleosis.'], ['Characteristic', 'of', 'Epstein-Barr', 'infectious', 'mononucleosis', 'is', 'the', 'appearance', 'of', 'macular', 'rash', 'after', 'treatment', 'with', 'amoxicillin.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', '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 the first one\n', 'It is a typical picture of infectious mononucleosis\n', 'Support'], ['It is a typical picture of infectious mononucleosis\n', 'It is a typical picture of infectious mononucleosis\n', 'Attack'], ['Although a similar picture may occur in acute toxoplasmosis, less than 1% of acute toxoplasma infections present as mononucleosis\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', 'It is a typical picture of infectious mononucleosis\n', 'Support'], ['Characteristic of Epstein-Barr infectious mononucleosis is the appearance of macular rash after treatment with amoxicillin\n', 'It is a typical picture of infectious mononucleosis\n', 'Support']]
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36_130
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[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['An', '85-year-old', 'woman', 'consults', 'for', 'fatigue', 'and', 'weakness', 'especially', 'in', 'the', 'mornings.'], ['She', 'is', 'sometimes', 'unsteady', 'when', 'walking', 'and', 'has', 'to', 'sit', 'down', 'to', 'regain', 'her', 'balance.'], ['On', 'two', 'occasions', 'she', 'has', 'had', 'to', 'sit', 'down', 'to', 'keep', 'from', 'falling', 'but', 'denies', 'symptoms', 'of', 'dizziness.'], ['She', 'has', 'arterial', 'hypertension,', 'urinary', 'incontinence', 'and', 'osteoarthritis.'], ['Her', 'treatment', 'is', 'hydrochlorothiazide', '(25', 'mg/d),', 'oxybutynin', '(10', 'mg/d),', 'lisinopril', '(10', 'mg/d),', 'calcium', '(1500', 'mg/d)', 'and', 'paracetamol', '(3', 'g/d).'], ['On', 'examination', 'he', 'has', 'a', 'blood', 'pressure', 'of', '115/70', 'mm', 'Hg,', 'pulse', '80', 'bpm.'], ['His', 'movements', 'are', 'slow.'], ['He', 'has', 'a', 'moderate', 'hand', 'tremor.'], ['She', 'can', 'get', 'up', 'from', 'the', 'chair', 'slowly', 'but', 'without', 'needing', 'to', 'lean', 'on', 'her', 'arms.'], ['She', 'walks', 'slightly', 'leaning', 'forward', 'with', 'little', 'swinging', 'of', 'the', 'arms.'], ['Turns', 'slowly', 'but', 'without', 'losing', 'balance.'], ['She', 'is', 'unable', 'to', 'stand', 'on', 'one', 'foot.'], ['Which', 'of', 'the', 'following', 'possible', 'actions', 'would', 'you', 'perform', 'first?'], ['1-', 'Assess', 'visual', 'acuity.'], ['2-', 'Perform', 'an', 'MRI.'], ['3-', 'Tilt', 'table', 'study.'], ['4-', 'Measure', 'blood', 'pressure', 'lying', 'down', 'and', 'standing', 'up.'], ['5-', 'Therapeutic', 'attempt', 'with', 'L-dopa.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'correct', 'answer', 'is', 'to', 'initiate', 'treatment', 'with', 'L-dopa,', 'since', 'the', 'clinical', 'picture', 'described', 'is', 'of', 'a', 'parkinsonism', 'whose', 'diagnosis', 'is', 'exclusively', 'clinical.'], ['The', 'rest', 'of', 'the', 'answers', 'can', 'be', 'made', 'for', 'differential', 'diagnosis,', 'but', 'the', 'performance', 'of', 'complementary', 'tests', 'does', 'not', 'justify', 'delaying', 'the', 'initiation', 'of', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['The correct answer is to initiate treatment with L-dopa, since the clinical picture described is of a parkinsonism whose diagnosis is exclusively clinical\n', 'Therapeutic attempt with L-dopa\n', 'Support'], ['the performance of complementary tests does not justify delaying the initiation of treatment\n', 'Therapeutic attempt with L-dopa\n', 'Support']]
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338_31
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['20-year-old', 'woman', 'with', 'ovarian', 'tumor', 'of', '15', 'cm,', 'solid-cystic,', 'detected', 'by', 'ultrasound', 'after', 'presenting', 'with', 'unspecific', '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:', '3'], ['Mature', 'cystic', 'teratoma', '(common', 'in', 'the', 'ovary', 'of', 'the', 'adult', 'female).'], ['Mass', 'with', 'a', 'large', 'cyst', 'occupying', 'most', 'of', 'it;', 'in', 'its', 'cavity', 'there', 'is', 'sebaceous', 'material', 'and', 'hairs.'], ['The', 'wall,', 'generally', 'a', 'few', 'millimeters', 'thick,', 'has', 'the', 'structure', 'of', 'skin,', 'with', 'its', 'epidermal', 'surface', 'towards', 'the', 'cavity.'], ['Because', 'of', 'this', 'preponderant', 'development', 'of', 'cutaneous', 'structures', 'it', 'is', 'usually', 'called', 'dermoid', 'cyst.'], ['The', 'tissues', 'that', 'compose', 'the', 'tumor', 'are', 'well', 'differentiated', '(mature', 'or', 'adult', 'type);', 'apart', 'from', 'skin', 'structures', 'many', 'other', 'tissues', 'can', 'be', 'observed,', 'particularly', 'in', 'a', 'thickening', 'or', 'spur', 'that', 'eminences', 'into', 'the', 'cavity,', 'in', 'which', 'there', 'are', 'often', 'teeth,', 'cartilage', 'and', 'bone.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['20-year-old woman with ovarian tumor of 15 cm, solid-cystic, detected by ultrasound after presenting with unspecific abdominal symptoms\n', 'Mature cystic teratoma (common in the ovary of the adult female)\n', 'Support'], ['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\n', 'Mass with a large cyst occupying most of it; in its cavity there is sebaceous material and hairs\n', 'Support'], ['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\n', 'apart from skin structures many other tissues can be observed, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n', 'Support'], ['20-year-old woman with ovarian tumor of 15 cm, solid-cystic, detected by ultrasound after presenting with unspecific abdominal symptoms\n', 'The tissues that compose the tumor are well differentiated (mature or adult type)\n', 'Support'], ['Mature cystic teratoma (common in the ovary of the adult female)\n', 'Mature cystic teratoma\n', 'Support'], ['apart from skin structures many other tissues can be observed, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n', 'Mature cystic teratoma (common in the ovary of the adult female)\n', 'Support'], ['Mass with a large cyst occupying most of it; in its cavity there is sebaceous material and hairs\n', 'Mature cystic teratoma (common in the ovary of the adult female)\n', 'Support'], ['The wall, generally a few millimeters thick, has the structure of skin, with its epidermal surface towards the cavity\n', 'Mature cystic teratoma (common in the ovary of the adult female)\n', 'Support'], ['Because of this preponderant development of cutaneous structures it is usually called dermoid cyst\n', 'Mature cystic teratoma (common in the ovary of the adult female)\n', 'Support'], ['The tissues that compose the tumor are well differentiated (mature or adult type)\n', 'Mature cystic teratoma (common in the ovary of the adult female)\n', 'Support']]
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432_117
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['An', '85-year-old', 'man', 'with', 'a', 'peripheral', 'venous', 'catheter', 'who,', 'one', 'week', 'after', 'being', 'hospitalized', 'for', 'a', 'stroke,', 'begins', 'with', 'shivering', 'and', 'fever.'], ['Blood', 'cultures', 'are', 'performed', 'and', 'microbiology', 'reports', 'that', 'gram-positive', 'cocci', 'are', 'growing', 'in', 'clusters.'], ['Pending', 'the', 'antibiogram,', 'what', 'is', 'the', 'most', 'appropriate', 'antibiotic', 'treatment?'], ['1-', 'Cefazolin.'], ['2-', 'Cloxacillin.'], ['3-', 'Vancomycin.'], ['4-', 'Linezolid.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'most', 'frequent', 'cause', 'of', 'catheter', 'infection', 'is', 'a', 'bacterium', 'that', 'colonizes', 'the', 'skin.'], ['The', 'Gram', 'stain', 'tells', 'us', 'that', 'it', 'is', 'a', 'staphylococcus,', 'most', 'of', 'the', 'species', 'of', 'this', 'genus', 'acquired', 'in-hospital', 'are', 'methicillin', 'resistant,', 'so', 'they', 'are', 'considered', 'resistant', 'to', 'Cloxacillin,', 'Cefazolin', 'and', 'there', 'are', 'no', 'clinical', 'data', 'about', 'the', 'efficacy', 'of', 'linezolid', 'for', 'the', 'treatment', 'of', 'systemic', 'infection', 'related', 'to', 'catheter.'], ['This,', 'plus', 'the', 'experience', 'with', 'vancomycin', 'use', 'in', 'this', 'setting', 'is', 'considered', 'the', 'empirical', 'choice', 'for', 'vancomycin.']]
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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'], ['B-Premise', 'I-Premise', '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'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n', 'Cloxacillin\n', 'Attack'], ['they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n', 'Cefazolin\n', 'Attack'], ['they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n', 'Linezolid\n', 'Attack'], ['The Gram stain tells us that it is a staphylococcus, most of the species of this genus acquired in-hospital are methicillin resistant\n', 'they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n', 'Support'], ['they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n', 'This, plus the experience with vancomycin use in this setting is considered the empirical choice for vancomycin\n', 'Support'], ['This, plus the experience with vancomycin use in this setting is considered the empirical choice for vancomycin\n', 'Vancomycin\n', 'Support']]
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513_38
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[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'patient', 'presents', 'to', 'the', 'emergency', 'department', 'with', 'severe', 'lingual', 'angioedema.'], ['She', 'has', 'no', 'associated', 'urticaria', 'and', 'no', 'history', 'of', 'drug', 'or', 'food', 'allergy.'], ['His', 'personal', 'history', 'includes', 'type', '2', 'diabetes', 'mellitus,', 'dyslipidemia,', 'hypertension,', 'hypothyroidism', 'and', "Parkinson's", 'disease.'], ['In', 'regular', 'treatment', 'with', 'metformin,', 'simvastatin,', 'enalapril,', 'thyroxine', 'and', 'levodopa.'], ['Which', 'of', 'the', 'following', 'drugs', 'is', 'most', 'likely', 'the', 'causal', 'drug', 'of', 'the', 'clinical', 'picture', 'described?'], ['1-', 'Enalapril.'], ['2-', 'Simvastatin.'], ['3-', 'Metformin', 'or', 'levodopa', 'equally.'], ['4-', 'Levodopa.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Of', 'the', 'proposed', 'drugs,', 'the', 'least', 'likely', 'options', 'would', 'be', '3,', 'since', 'metformin', 'very', 'rarely', 'causes', 'lingual', 'angioedema', '(in', 'March', '2020', 'there', 'was', 'only', 'one', 'case', 'described', 'worldwide)', 'and', '4,', 'since,', 'among', 'the', 'adverse', 'reactions', 'of', 'levodopa,', 'angioedema', 'is', 'classified', 'among', 'the', 'very', 'rare', 'ones', '(frequency', 'less', 'than', '0.1%).'], ['Of', 'the', 'two', 'remaining', 'options,', 'the', 'drugs', 'most', 'frequently', 'and', 'classically', 'associated', 'with', 'lingual', 'angioedema', 'are', 'ACE', 'inhibitors', '(frequency', 'around', '0.2%),', 'and', 'their', 'association', 'with', 'simvastatin', 'is', 'also', 'less', 'than', '0.1%.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Of the proposed drugs, the least likely options would be 3\n', 'and 4\n', 'Support'], ['Of the proposed drugs, the least likely options would be 3\n', 'Metformin or levodopa equally\n', 'Attack'], ['and 4\n', 'Levodopa\n', 'Attack'], ['A 72-year-old patient presents to the emergency department with severe lingual angioedema\n', 'metformin very rarely causes lingual angioedema (in March 2020 there was only one case described worldwide)\n', 'Attack'], ['A 72-year-old patient presents to the emergency department with severe lingual angioedema\n', 'among the adverse reactions of levodopa, angioedema is classified among the very rare ones (frequency less than 0.1%)\n', 'Attack'], ['metformin very rarely causes lingual angioedema (in March 2020 there was only one case described worldwide)\n', 'Of the proposed drugs, the least likely options would be 3\n', 'Support'], ['among the adverse reactions of levodopa, angioedema is classified among the very rare ones (frequency less than 0.1%)\n', 'and 4\n', 'Support'], ['Of the two remaining options, the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%), and their association with simvastatin is also less than 0.1%\n', 'Enalapril\n', 'Support'], ['A 72-year-old patient presents to the emergency department with severe lingual angioedema\n', 'Of the two remaining options, the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%), and their association with simvastatin is also less than 0.1%\n', 'Support'], ['Of the two remaining options, the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%), and their association with simvastatin is also less than 0.1%\n', 'Simvastatin\n', 'Attack']]
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580_198
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman', 'referred', 'to', 'the', 'emergency', 'department', 'for', 'head', 'trauma', 'due', 'to', 'a', 'fall', 'on', 'a', 'scooter,', 'with', 'no', 'loss', 'of', 'consciousness', 'or', 'amnesia.'], ['The', 'examination', 'shows', 'a', 'closed', 'head', 'injury', 'with', 'concussion', 'and', 'mild', 'headache', 'without', 'nausea', 'and', 'vomiting.'], ['The', 'neurological', 'examination', 'is', 'normal', 'and', 'the', 'Glasgow', 'index', 'is', '15.'], ['In', 'this', 'situation,', 'which', 'imaging', 'test', 'is', 'indicated', 'first?'], ['1-', 'Cranial', 'CT', 'scan', 'without', 'contrast.'], ['2-', 'Cranial', 'CT', 'with', 'contrast.'], ['3-', 'No', 'imaging', 'test.'], ['4-', 'Simple', 'skull', 'radiography.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['After', 'a', 'TBI', 'in', 'a', 'patient', 'who', 'is', 'not', 'anticoagulated', 'or', 'antiplatelet,', 'with', 'no', 'known', 'risk', 'factors', 'for', 'hemorrhage,', 'and', 'who', 'does', 'not', 'present', 'alarming', 'data', 'in', 'the', 'anamnesis', 'or', 'physical', 'examination,', 'it', 'is', 'not', 'necessary', 'to', 'perform', 'a', 'cranial', 'imaging', 'test.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test\n', 'No imaging test\n', 'Support']]
|
248_118
|
[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '34-year-old', 'man', 'consults', 'for', 'fever', 'and', 'malaise.'], ['The', 'medical', 'history', 'includes', 'a', 'history', 'of', 'homosexual', 'relations', 'for', 'the', 'last', '4', 'months', 'with', 'a', 'new', 'partner.'], ['2', 'months', 'before', 'the', 'current', 'consultation', 'he', 'had', 'a', 'painless', 'ulcerative', 'lesion', 'on', 'the', 'glans', 'penis', 'with', 'bilateral', 'inguinal', 'lymphadenopathy,', 'all', 'self-limited.'], ['Serological', 'studies', 'were', 'requested', 'with', 'the', 'following', 'results:', 'HIV', 'negative,', 'RPR', '1/320,', 'HAART', '1/128.'], ['What', 'treatment', 'would', 'you', 'indicate', 'for', 'this', 'patient?'], ['1-', 'None.'], ['2-', 'Intravenous', 'penicillin', 'G,', '24', 'MU', 'every', 'day', 'for', '14', 'days.'], ['3-', 'Benzathine', 'penicillin', '2.4', 'MU', 'intramuscular,', '3', 'doses', 'in', 'three', 'consecutive', 'weeks.'], ['4-', 'Ceftriaxone', '2', 'grams', 'intramuscular', 'in', 'a', 'single', 'dose.'], ['5-', 'Benzathine', 'penicillin', '2.4', 'MU', 'intramuscularly', 'in', 'a', 'single', 'dose.'], ['CORRECT', 'ANSWER:', '5'], ['Direct', 'response', 'question.'], ['This', 'is', 'syphilis', '(both', 'by', 'antecendent', 'and', 'serology)', 'in', 'the', 'secondary', 'stage,', 'so', 'treatment', 'is', 'with', 'Benzathine', 'Penicillin', '2.4', 'MU', 'in', 'a', 'single', 'dose.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-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'], ['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'], ['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-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['This is syphilis (both by antecendent and serology) in the secondary stage\n', 'treatment is with Benzathine Penicillin 2.4 MU in a single dose\n', 'Support'], ['treatment is with Benzathine Penicillin 2.4 MU in a single dose\n', 'Benzathine penicillin 2.4 MU intramuscularly in a single dose\n', 'Support']]
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222_197
|
[['QUESTION', 'TYPE:', 'EPIDEMIOLOGY'], ['CLINICAL', 'CASE:'], ['30-year-old', 'HIV', '(+)', 'homosexual', 'male', 'who', 'participates', 'as', 'a', 'volunteer', 'in', 'an', 'AIDS', 'patient', 'support', 'center.'], ['According', 'to', 'his', 'medical', 'history', 'he', 'received', 'diphtheria', 'toxoid', '(Td)', '6', 'years', 'ago,', 'MMR', 'vaccine', 'in', 'childhood', 'and', 'adolescence,', 'and', 'hepatitis', 'B', '3', 'years', 'ago.'], ['He', 'is', 'currently', 'asymptomatic', 'with', 'a', 'CD4', 'count', 'above', '200', 'cls/microliter.'], ['Which', 'vaccines', 'should', 'we', 'recommend?'], ['1-', 'Seasonal', 'influenza,', 'pneumococcal,', 'tetravalent', 'meningitis', 'and', 'hepatitis', 'A.'], ['2-', 'Seasonal', 'influenza,', 'Td,', 'pneumococcal', 'and', 'tetravalent', 'meningitis.'], ['3-', 'Tetravalent', 'meningitis,', 'pneumococcal', 'and', 'seasonal', 'flu.'], ['4-', 'Td,', 'tetravalent', 'meningitis,', 'pneumococcal.'], ['5-', 'Triple', 'viral,', 'seasonal', 'flu,', 'pneumococcal.'], ['CORRECT', 'ANSWER:', '1'], ['Vaccination', 'recommendations', 'for', 'HIV+', 'adults', 'include', 'hepatitis', 'B,', 'influenza,', 'MMR,', 'pneumococcal,', 'Td', 'and', 'Tdap,', 'and', 'for', 'some', 'adults,', 'hepatitis', 'A,', 'or', 'combined', 'A', 'and', 'B,', 'bacterial', 'meningitis,', 'HPV', 'and', 'meningococcal', '(Source', '[1]).'], ['Considering', 'that', 'the', 'individual', 'has', 'received', 'some', 'vaccines,', 'has', 'a', 'CD4', 'count', '>100', '(if', 'lower', 'there', 'would', 'be', 'a', 'contraindication)', 'and', 'works', 'in', 'a', 'center', 'that', 'helps', 'AIDS', 'patients', '(he', 'is', 'equated', 'to', '"health', 'personnel")', 'answers', '2,', '4', 'and', '5', 'are', 'wrong.'], ['All', 'four', 'vaccines', 'in', 'option', '1', 'are', 'administrable.'], ['In', 'a', 'little', 'more', 'detail:', 'Vaccine', 'against', 'tetanus', 'and', 'diphtheria:', 'all', 'persons', 'should', 'be', 'vaccinated', 'against', 'these', 'two', 'diseases.'], ['Hepatitis', 'B', 'vaccine:', 'hepatitis', 'B', 'and', 'HIV', 'viruses', 'share', 'the', 'same', 'routes', 'of', 'transmission,', 'so', 'it', 'is', 'common', 'for', 'HIV-infected', 'patients', 'to', 'also', 'be', 'infected', 'with', 'hepatitis', 'B', 'virus.'], ['It', 'is', 'therefore', 'important', 'to', 'know', 'whether', 'the', 'HIV-infected', 'person', 'has', 'markers', 'of', 'hepatitis', 'B', 'infection', 'and', 'to', 'proceed', 'with', 'vaccination', 'if', 'he/she', 'does', 'not', 'have', 'them.'], ['Vaccination', 'against', 'hepatitis', 'A:', 'Hepatitis', 'A', 'in', 'a', 'person', 'with', 'hepatitis', 'B,', 'hepatitis', 'C', 'or', 'other', 'liver', 'disease', 'can', 'be', 'very', 'serious.'], ['Since', 'these', 'infections', 'are', 'more', 'frequent', 'in', 'HIV-infected', 'patients,', 'vaccination', 'against', 'hepatitis', 'A', 'is', 'recommended.'], ['Vaccination', 'against', 'influenza:', 'influenza', 'in', 'a', 'patient', 'with', 'a', 'lack', 'of', 'immune', 'response', 'is', 'more', 'serious', 'and', 'presents', 'a', 'greater', 'risk', 'of', 'complications,', 'so', 'annual', 'vaccination', 'against', 'this', 'disease', 'is', 'indicated.'], ['If', 'the', "patient's", 'immune', 'status', 'is', 'very', 'deteriorated,', 'the', 'response', 'to', 'vaccination', 'is', 'diminished.'], ['In', 'this', 'case,', 'it', 'is', 'essential', 'to', 'vaccinate', 'all', 'the', 'people', 'living', 'with', 'the', 'HIV-infected', 'person', 'to', 'prevent', 'them', 'from', 'transmitting', 'the', 'disease.'], ['Pneumococcal', 'vaccine:', 'pneumococcal', 'infections', '(especially', 'pneumonia)', 'are', 'up', 'to', '10', 'times', 'more', 'frequent', 'in', 'HIV-infected', 'persons', 'than', 'in', 'HIV-uninfected', 'adults,', 'so', 'vaccination', 'is', 'recommended,', 'although', 'in', 'patients', 'with', 'counts', 'below', '200/mm3', 'the', 'protective', 'response', 'is', 'usually', 'not', 'sufficient.'], ['They', 'should', 'receive', 'a', 'second', 'dose', 'at', '3-5', 'years', 'of', 'age.'], ['HIV-infected', 'children', 'should', 'be', 'vaccinated', 'with', 'pneumococcal', 'conjugate', 'vaccine', 'with', 'the', 'corresponding', 'number', 'of', 'doses', 'according', 'to', 'age.'], ['Vaccination', 'against', 'Haemophilus', 'Influenzae', 'type', 'b:', 'this', 'bacterium', 'causes', 'pneumonia', 'and', 'meningitis,', 'especially', 'in', 'children.'], ['Although', 'in', 'HIV-infected', 'adults', 'it', 'represents', 'a', 'small', 'number', 'of', 'the', 'causes', 'of', 'infection,', 'vaccination', 'is', 'recommended.'], ['Vaccination', 'against', 'measles,', 'rubella', 'and', 'mumps', '(MMR):', 'all', 'three', 'diseases', 'can', 'become', 'more', 'serious', 'in', 'HIV-infected', 'patients,', 'especially', 'measles,', 'so', 'all', 'of', 'them', 'should', 'be', 'vaccinated,', 'provided', 'that', 'immunosuppression', 'is', 'not', 'severe', '(count', 'less', 'than', '200/mm3).']]
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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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O'], ['O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel")\n', 'answers 2, 4 and 5 are wrong\n', 'Support'], ['answers 2, 4 and 5 are wrong\n', 'Seasonal influenza, Td, pneumococcal and tetravalent meningitis\n', 'Attack'], ['answers 2, 4 and 5 are wrong\n', 'Td, tetravalent meningitis, pneumococcal\n', 'Attack'], ['answers 2, 4 and 5 are wrong\n', 'Triple viral, seasonal flu, pneumococcal\n', 'Attack'], ['All four vaccines in option 1 are administrable\n', 'Seasonal influenza, pneumococcal, tetravalent meningitis and hepatitis A\n', 'Support'], ['Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications\n', 'annual vaccination against this disease is indicated\n', 'Support'], ['annual vaccination against this disease is indicated\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults\n', 'vaccination is recommended\n', 'Support'], ['although in patients with counts below 200/mm3 the protective response is usually not sufficient\n', 'vaccination is recommended\n', 'Attack'], ['vaccination is recommended\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['They should receive a second dose at 3-5 years of age\n', 'although in patients with counts below 200/mm3 the protective response is usually not sufficient\n', 'Support'], ['Although in HIV-infected adults it represents a small number of the causes of infection, vaccination is recommended\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['Vaccination against measles, rubella and mumps (MMR): all three diseases can become more serious in HIV-infected patients, especially measles\n', 'all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3)\n', 'Support'], ['all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3)\n', 'All four vaccines in option 1 are administrable\n', 'Support'], ['He is currently asymptomatic with a CD4 count above 200 cls/microliter\n', 'all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3)\n', 'Support']]
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244_114
|
[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '16-year-old', 'boy', 'consults', 'for', 'presenting', 'with', 'pustular', 'tonsillitis,', 'fever', 'up', 'to', '38.5°C,', 'painful', 'cervical', 'lymphadenopathy,', 'non-pruritic', 'macular', 'rash', 'on', 'the', 'chest', 'and', 'mild', 'hepatosplenomegaly,', 'of', '4-5', 'days', 'of', 'evolution.'], ['Paul-Bunnell', 'test', 'and', 'Ig', 'M', 'for', 'Epstein-Barr', 'virus', 'are', 'positive.'], ['During', 'his', 'admission', 'he', 'developed', 'continuous', 'fever', 'up', 'to', '40ºC,', 'pancytopenia,', 'icteric', 'hepatitis', 'and', 'coagulopathy', 'of', 'progressive', 'intensity.'], ['One', 'week', 'after', 'admission,', 'he', 'was', 'transferred', 'to', 'the', 'ICU', 'due', 'to', 'confusion', 'and', 'respiratory', 'failure.'], ['Blood', 'cultures', 'and', 'a', 'urine', 'culture', 'were', 'negative,', 'CSF', 'was', 'normal', 'and', 'the', 'chest', 'x-ray', 'showed', 'no', 'infiltrates.'], ['Procalcitonin', 'is', 'normal,', 'but', 'CRP', 'and', 'ferritin', 'are', 'very', 'elevated.'], ['Of', 'the', 'following', 'statements,', 'which', 'would', 'be', 'the', 'most', 'correct', 'diagnostic', 'and', 'therapeutic', 'approach?'], ['1-', 'She', 'has', 'a', 'bacterial', 'sepsis', 'of', 'undetermined', 'origin', 'and', 'should', 'be', 'given', 'ceftriaxone', 'and', 'supportive', 'care.'], ['2-', 'She', 'has', 'bacterial', 'sepsis', 'of', 'undetermined', 'origin', 'and', 'should', 'be', 'given', 'vancomycin,', 'ceftacidime', 'and', 'supportive', 'care.'], ['3-', 'This', 'is', 'infectious', 'mononucleosis', 'with', 'a', 'severe', 'course', 'and', 'glucocorticoids', 'should', 'be', 'administered.'], ['4-', 'This', 'is', 'an', 'infectious', 'mononucleosis', 'of', 'severe', 'course', 'and', 'treatment', 'with', 'Acyclovir', 'should', 'be', 'initiated.'], ['5-', 'I', 'would', 'perform', 'a', 'bone', 'marrow', 'biopsy/aspirate', 'and,', 'if', 'hemophagocytosis', 'is', 'confirmed,', 'initiate', 'treatment', 'with', 'immunosuppressants.'], ['CORRECT', 'ANSWER:', '5'], ['Difficult', 'question', 'in', 'which', 'the', 'correct', 'answer', 'could', 'give', 'rise', 'to', 'discussion.'], ['The', 'patient', 'is', 'a', '16-year-old', 'male', 'who', 'is', 'admitted', 'for', 'a', 'fairly', 'clear', 'case', 'of', 'mononucleosis', 'due', 'to', 'EBV', 'infection', 'that', 'becomes', 'complicated', 'during', 'admission.'], ['The', 'data', 'available', 'to', 'us', 'are:', '-', 'Pancytopenia.', '-', 'Hepatopathy.', '-', 'Coagulopathy.'], ['-', 'Absence', 'of', 'infectious', 'focus:', 'negative', 'blood', 'cultures,', 'negative', 'urine', 'cultures,', 'normal', 'X-ray,', 'normal', 'CSF.'], ['-', 'CRP', 'and', 'Ferritin', 'elevated', '/', 'normal', 'Procalcitonin.'], ['The', 'possible', 'complications', 'that', 'could', 'have', 'occurred', '(and', 'that', 'are', 'considered', 'in', 'the', 'answers)', 'are', 'sepsis', 'or', 'a', 'bad', 'evolution', 'of', 'mononucleosis.'], ['The', 'clinical', 'data', 'could', 'be', 'consistent', 'with', 'a', 'septic', 'process,', 'however,', 'the', 'main', 'infectious', 'foci', 'have', 'been', 'reasonably', 'ruled', 'out', 'and', 'one', 'of', 'the', 'most', 'sensitive', 'and', 'specific', 'markers', 'of', 'bacteremia', '(procalcitonin)', 'is', 'in', 'the', 'normal', 'range,', 'which', 'should', 'draw', 'our', 'attention.'], ['On', 'the', 'other', 'hand,', 'a', 'complication', 'of', 'the', 'EBV', 'mononucleosis', 'suffered', 'by', 'our', 'patient', 'should', 'be', 'evaluated,', 'among', 'the', 'possible', 'complications', 'are', 'hemolytic', 'anemia,', 'meningoecephalitis', '(normal', 'CSF)', 'or', 'Guillain-Barré', 'sd.', 'Guillain-Barré', 'syndrome,', 'which', 'are', 'not', 'very', 'consistent', 'with', 'the', 'clinical', 'picture', 'presented', 'to', 'us.'], ['Another', 'possible', 'complication', 'of', 'exceptional', 'severity', 'would', 'be', 'hemophagocytic', 'syndrome;', 'this', 'is', 'a', 'rare', 'entity', 'that', 'occurs', 'in', 'certain', 'predisposed', 'subjects', 'and', 'is', 'characterized', 'by', 'an', 'uncontrolled', 'activation', 'and', 'proliferation', 'of', 'histiocytes', 'and', 'T', 'lymphocytes,', 'which', 'produces', 'a', 'state', 'of', 'hypercytokinemia.'], ['The', 'diagnostic', 'criteria,', 'revised', 'in', '2004,', 'include', 'persistent', 'high', 'fever,', 'hepatosplenomegaly,', 'cytopenias,', 'hypertriglyceridemia,', 'hyperferritinemia,', 'and', 'hypofibrinogenemia.'], ['Hyperferritinemia', '>3000', 'in', 'a', 'suggestive', 'clinical', 'context', 'necessitates', 'treatment', 'of', 'the', 'patient', '(mainly', 'with', 'immunosuppressants', 'and', 'corticosteroids)', 'since', 'mortality', 'is', 'very', 'high', 'and', 'early', 'treatment', 'is', 'essential.'], ['The', 'definitive', 'diagnosis', 'is', 'made', 'by', 'microscopic', 'study', 'of', 'an', 'OM', 'biopsy.'], ['Although', 'in', 'this', 'question', 'they', 'do', 'not', 'quantify', 'the', 'value', 'of', 'ferritinemia,', 'it', 'is', 'a', 'remarkable', 'data', 'and', 'given', 'that', 'the', 'clinical', 'picture', 'is', 'suggestive,', 'meeting', 'the', 'diagnostic', 'criteria,', 'it', 'seems', 'to', 'me', 'that', 'answer', '5', 'would', 'be', 'the', 'most', 'accurate.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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 main infectious foci have been reasonably ruled out\n', 'The clinical data could be consistent with a septic process\n', 'Attack'], ['one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n', 'The clinical data could be consistent with a septic process\n', 'Attack'], ['the main infectious foci have been reasonably ruled out\n', 'She has a bacterial sepsis of undetermined origin and should be given ceftriaxone and supportive care\n', 'Attack'], ['one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n', 'She has a bacterial sepsis of undetermined origin and should be given ceftriaxone and supportive care\n', 'Attack'], ['the main infectious foci have been reasonably ruled out\n', 'She has bacterial sepsis of undetermined origin and should be given vancomycin, ceftacidime and supportive care\n', 'Attack'], ['one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n', 'She has bacterial sepsis of undetermined origin and should be given vancomycin, ceftacidime and supportive care\n', 'Attack'], ['the main infectious foci have been reasonably ruled out\n', 'which should draw our attention\n', 'Support'], ['one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n', 'which should draw our attention\n', 'Support'], ['which are not very consistent with the clinical picture presented to us\n', 'among the possible complications are hemolytic anemia, meningoecephalitis (normal CSF) or Guillain-Barré sd. Guillain-Barré syndrome\n', 'Attack'], ['this is a rare entity that occurs in certain predisposed subjects and is characterized by an uncontrolled activation and proliferation of histiocytes and T lymphocytes, which produces a state of hypercytokinemia\n', 'Another possible complication of exceptional severity would be hemophagocytic syndrome\n', 'Support'], ['The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n', 'Another possible complication of exceptional severity would be hemophagocytic syndrome\n', 'Support'], ['CRP and ferritin are very elevated\n', 'The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n', 'Support'], ['CRP and ferritin are very elevated\n', 'Hyperferritinemia >3000 in a suggestive clinical context necessitates treatment of the patient (mainly with immunosuppressants and corticosteroids) since mortality is very high and early treatment is essential\n', 'Support'], ['A 16-year-old boy consults for presenting with pustular tonsillitis, fever up to 38.5°C, painful cervical lymphadenopathy, non-pruritic macular rash on the chest and mild hepatosplenomegaly, of 4-5 days of evolution\n', 'The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n', 'Support'], ['Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n', 'I would perform a bone marrow biopsy/aspirate and, if hemophagocytosis is confirmed, initiate treatment with immunosuppressants\n', 'Support'], ['CRP and ferritin are very elevated\n', 'Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n', 'Support'], ['Another possible complication of exceptional severity would be hemophagocytic syndrome\n', 'Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n', 'Support'], ['The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n', 'Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n', 'Support'], ['Hyperferritinemia >3000 in a suggestive clinical context necessitates treatment of the patient (mainly with immunosuppressants and corticosteroids) since mortality is very high and early treatment is essential\n', 'Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n', 'Support']]
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420_78
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[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'man', 'was', 'referred', 'to', 'the', 'gastroenterology', 'department', 'for', 'hematochezia,', 'tenesmus', 'and', 'reduction', 'of', 'stool', 'diameter.'], ['A', 'series', 'of', 'tests', 'were', 'performed', 'and', 'a', 'diagnosis', 'of', 'adenocarcinoma', 'of', 'the', 'sigma', 'without', 'distant', 'metastasis', 'was', 'made.'], ['The', 'patient', 'underwent', 'surgery', 'and', 'was', 'referred', 'to', 'the', 'medical', 'oncology', 'department', 'for', 'evaluation', 'of', 'complementary', 'chemotherapy', 'treatment.'], ['Which', 'of', 'the', 'following', 'is', 'a', 'poor', 'prognostic', 'factor', 'after', 'surgical', 'resection', 'and', 'should', 'be', 'taken', 'into', 'account', 'when', 'planning', 'chemotherapy', 'treatment?'], ['1-', 'The', 'presence', 'of', 'anemia', 'at', 'diagnosis.'], ['2-', 'The', 'existence', 'of', 'a', 'family', 'history', 'of', 'colorectal', 'cancer.'], ['3-', 'The', 'size', 'of', 'the', 'primary', 'lesion', 'and', 'histological', 'differentiation.'], ['4-', 'Perforation', 'or', 'adhesion', 'of', 'the', 'tumor', 'to', 'adjacent', 'organs.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['They', 'are', 'not', 'asking', 'about', 'factors', 'that', 'affect', 'oncologic', 'prognosis', 'and', 'therefore', 'imply', 'a', 'change', 'in', 'QT', 'strategy.'], ['This', 'question', 'is', 'straightforward.'], ['Option', '4', 'is', 'describing', 'to', 'us', 'a', 'T4', 'stage,', 'either', 'by', 'invasion', 'of', 'adjacent', 'organs', 'or', 'perforation.'], ['The', 'T4s', 'carry', 'a', 'much', 'higher', 'chance', 'of', 'recurrence,', 'in', 'fact', 'there', 'are', 'ongoing', 'studies', 'that', 'propose', 'prophylactic', 'HIPEC', 'in', 'T4', 'and', 'second', 'look', 'surgery', '+', 'HIPEC', 'in', 'perforated', 'colon', 'tumors.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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']]
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[['Option 4 is describing to us a T4 stage, either by invasion of adjacent organs or perforation\n', 'Perforation or adhesion of the tumor to adjacent organs\n', 'Support'], ['The T4s carry a much higher chance of recurrence\n', 'Perforation or adhesion of the tumor to adjacent organs\n', 'Support'], ['in fact there are ongoing studies that propose prophylactic HIPEC in T4 and second look surgery + HIPEC in perforated colon tumors\n', 'Perforation or adhesion of the tumor to adjacent organs\n', 'Support']]
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321_144
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '50-year-old', 'man', 'diagnosed', 'with', 'polyangiitis', 'with', 'granulomatosis', '10', 'years', 'earlier', 'and', 'untreated', 'for', 'the', 'past', '5', 'years', 'is', 'asymptomatic', 'at', 'a', 'scheduled', 'check-up.'], ['Chest', 'X-ray,', 'blood', 'tests', 'and', 'urine', 'sediment', 'are', 'normal', 'except', 'for', 'positive', 'anti-neutrophil', 'cytoplasmic', 'antibodies', '(ANCA)', 'at', 'titer', '1/320,', 'with', 'anti-proteinase', '3', 'specificity,', 'which', 'had', 'previously', 'been', 'negative.'], ['What', 'is', 'the', 'most', 'advisable', 'therapeutic', 'approach?'], ['1-', 'Start', 'treatment', 'with', 'corticosteroids.'], ['2-', 'Initiate', 'treatment', 'with', 'cyclophosphamide.'], ['3-', 'Initiate', 'treatment', 'with', 'mycophenolate', 'mofetil.'], ['4-', 'Watchful', 'waiting.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['In', 'ANCA', 'vasculitis,', 'whatever', 'it', 'is,', 'these', 'antibodies', 'have', 'been', 'shown', 'to', 'be', 'related', 'to', 'the', 'activity', 'of', 'the', 'disease,', 'but', 'at', 'no', 'time', 'are', 'changes', 'in', 'treatment', 'obligatory', 'due', 'to', 'their', 'levels.'], ['In', 'this', 'case,', 'with', 'the', 'patient', 'being', 'asymptomatic', 'and', 'with', 'objective', 'evidence', 'of', 'lack', 'of', 'activity,', 'close', 'follow-up', 'should', 'be', 'performed', 'without', 'restarting', 'or', 'modifying', 'treatment.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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, with the patient being asymptomatic and with objective evidence of lack of activity, close follow-up should be performed without restarting or modifying treatment\n', 'Watchful waiting\n', 'Support'], ['A 50-year-old man diagnosed with polyangiitis with granulomatosis 10 years earlier and untreated for the past 5 years is asymptomatic at a scheduled check-up\n', 'In this case, with the patient being asymptomatic and with objective evidence of lack of activity, close follow-up should be performed without restarting or modifying treatment\n', 'Support'], ['In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in treatment obligatory due to their levels\n', 'Watchful waiting\n', 'Support']]
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516_103
|
[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '56-year-old', 'patient', 'is', 'found', 'comatose', 'at', 'home.'], ['He', 'has', 'a', 'history', 'of', 'arterial', 'hypertension', 'and', 'diabetes', 'mellitus.'], ['He', 'has', 'no', 'toxic', 'habits', 'or', 'any', 'other', 'chronic', 'disease.'], ['He', 'is', 'on', 'treatment', 'with', 'irbesartan', 'and', 'empaglifozin.'], ['He', 'shows', 'no', 'signs', 'of', 'malnutrition.'], ['His', 'blood', 'pressure', 'is', '110/60', 'mmHg,', 'heart', 'rate', '110', 'bpm,', '90%', 'SatO2,', 'capillary', 'glucose', '120', 'mg/dl', 'and', 'respiratory', 'rate', '7', 'rpm.'], ['Which', 'initial', 'therapeutic', 'approach', 'do', 'you', 'think', 'is', 'the', 'most', 'correct?'], ['1-', 'Administer', 'naloxone,', 'flumazenil', 'and', 'thiamine.'], ['2-', 'Administer', 'naloxone,', 'flumazenil', 'and', 'hypertonic', 'glucose.'], ['3-', 'Administer', 'naloxone', 'and', 'flumazenil.'], ['4-', 'Administer', 'thiamine', 'and', 'hypertonic', 'glucose.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'find', 'a', 'patient', 'with', 'hypoventilation.'], ['Glycemia', 'is', 'correct', '(we', 'rule', 'out', 'hyperosmolar', 'coma', 'and', 'hypoglycemia,', 'option', '2', 'and', '4),', 'so,', 'although', 'there', 'is', 'no', 'history', 'of', 'intoxication,', 'we', 'have', 'to', 'go', 'to', 'the', 'most', 'frequent', 'and', 'that', 'we', 'can', 'antagonize', 'with', 'antidotes:', 'benzodiazepines', '(flumazenil)', 'and', 'opiates', '(naloxone).'], ['If', 'we', 'suspect', 'ethylene', 'glycol', 'intoxication,', 'we', 'would', 'administer', 'thiamine,', 'but', 'there', 'are', 'no', 'data', 'to', 'make', 'us', 'suspect.']]
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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'], ['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'], ['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', 'I-Premise', 'I-Premise', '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'], ['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'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['His blood pressure is 110/60 mmHg, heart rate 110 bpm, 90% SatO2, capillary glucose 120 mg/dl and respiratory rate 7 rpm\n', 'We find a patient with hypoventilation\n', 'Support'], ['A 56-year-old patient is found comatose at home\n', 'We find a patient with hypoventilation\n', 'Support'], ['we rule out hyperosmolar coma and hypoglycemia, option 2 and 4\n', 'Administer naloxone, flumazenil and hypertonic glucose\n', 'Attack'], ['we rule out hyperosmolar coma and hypoglycemia, option 2 and 4\n', 'Administer thiamine and hypertonic glucose\n', 'Attack'], ['so, although there is no history of intoxication, we have to go to the most frequent and that we can antagonize with antidotes: benzodiazepines (flumazenil) and opiates (naloxone)\n', 'Administer naloxone and flumazenil\n', 'Support'], ['but there are no data to make us suspect\n', 'If we suspect ethylene glycol intoxication, we would administer thiamine\n', 'Attack'], ['If we suspect ethylene glycol intoxication, we would administer thiamine\n', 'Administer naloxone, flumazenil and thiamine\n', 'Attack']]
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44_153
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['Child', '28', 'days', 'old,', 'born', 'at', 'term.'], ['History', 'of', 'normal', 'pregnancy', 'and', 'delivery.'], ['He', 'has', 'been', 'breastfed', 'since', 'birth.'], ['He', 'consults', 'because', '8', 'days', 'ago', 'he', 'started', 'vomiting,', 'initially', 'sporadically', 'and', 'since', '5', 'days', 'ago,', 'after', 'all', 'feedings.'], ['He', 'is', 'permanently', 'hungry.'], ['The', 'vomiting', 'is', 'of', '"squirting"', 'food', 'content.'], ['On', 'palpation,', 'the', 'abdomen', 'is', 'soft', 'and', 'depressible,', 'without', 'visceromegaly.'], ['The', 'blood', 'gas', 'analysis', 'showed', 'pH', '7.49,', 'bicarbonate', '30', 'mEq/l,', 'pCO2', '53', 'mmHg,', 'base', 'excess', '+8', 'mEq/l.'], ['Ions:', 'Na', '137', 'mEq/l,', 'K', '3.1', 'mEq/l,', 'Cl', '94', 'mEq/l.'], ['Taking', 'into', 'account', 'the', 'most', 'probable', 'diagnosis', 'in', 'the', 'clinical', 'picture', 'described,', 'what', 'is', 'the', 'complementary', 'test', 'of', 'choice', 'to', 'confirm', 'this', 'clinical', 'diagnosis?'], ['1-', 'Simple', 'abdominal', 'X-ray.'], ['2-', 'pHmetry.'], ['3-', 'Abdominal', 'ultrasound.'], ['4-', 'Determination', 'of', 'electrolytes', 'in', 'sweat.'], ['5-', 'Esophagogastroscopy.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['Easy', 'question', 'if', 'pathology', 'is', 'suspected,', 'which', 'I', 'also', 'think', 'is', 'simple', 'because', 'the', 'clinical', 'description', 'is', 'textbook', 'hypertrophic', 'pyloric', 'stenosis.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O', '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']]
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[['The correct answer is 3\n', 'Abdominal ultrasound\n', 'Support'], ['the clinical description is textbook hypertrophic pyloric stenosis\n', 'The correct answer is 3\n', 'Support']]
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54_72
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '22-year-old', 'female', 'student', 'with', 'no', 'history', 'of', 'pathology', 'or', 'use', 'of', 'medications', 'except', 'anovulatory', 'drugs', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'deterioration', 'of', 'general', 'condition', 'and', 'need', 'to', 'take', 'deep', 'breaths.'], ['She', 'reports', 'weight', 'loss', 'in', 'the', 'last', '2-3', 'days,', 'polydipsia,', 'polyuria', 'and', 'nausea.'], ['No', 'cough', 'or', 'febrile', 'sensation.'], ['Examination:', 'appearance', 'of', 'gravity,', 'blood', 'pressure', '100/60', 'mmHg,', 'deep', 'and', 'rapid', 'breathing', '(28rpm),', 'level', 'of', 'consciousness', 'preserved,', 'dry', 'mucous', 'membranes.'], ['No', 'fever.'], ['CBC:', 'blood', 'glucose', '420', 'mg/dL,', 'Na+', '131', 'mEq/L,', 'K+', 'normal,', 'pH', '7.08,', 'bicarbonate', '8', 'mEq/L', 'and', 'ketonuria', '(+++)', 'Which', 'answer', 'do', 'you', 'think', 'is', 'more', 'correct?'], ['1-', 'Debut', 'of', 'type', '2', 'diabetes', 'mellitus,', 'with', 'dyspnea', 'probably', 'due', 'to', 'pneumonia', 'or', 'thromboembolism,', 'since', 'she', 'is', 'taking', 'anovulatory', 'drugs.'], ['2-', 'It', 'is', 'a', 'diabetic', 'ketoacidosis.', 'It', 'must', 'be', 'treated', 'with', 'intravenous', 'insulin,', 'serum', 'therapy,', 'general', 'measures', 'and', 'search', 'for', 'precipitating', 'cause.'], ['3-', 'Debut', 'of', 'type', '1', 'diabetes', 'with', 'ketoacidosis.', 'Treat', 'with', 'bicarbonate', 'and', 'after', 'correction', 'of', 'acidosis,', 'add', 'intravenous', 'insulin.'], ['4-', 'It', 'looks', 'like', 'diabetic', 'ketoacidosis,', 'but', 'it', 'could', 'be', 'alcoholic.', 'BAC', 'should', 'be', 'determined', 'before', 'starting', 'insulin', 'therapy.'], ['5-', 'Treat', 'with', 'rapid', 'subcutaneous', 'insulin,', 'serum', 'therapy', 'and', 'ask', 'him', 'to', 'drink', 'plenty', 'of', 'fluids.'], ['CORRECT', 'ANSWER:', '2'], ['Debut', 'of', 'DM', 'with', 'ketoacidosis.'], ['Priority', 'is', 'iv', 'insulin', 'administration', 'and', 'serum', 'therapy.'], ['Bicarbonate', 'if', 'pH', '<', '7.'], ['Insulin', 'administration', 'should', 'never', 'be', 'delayed.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', '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'], ['B-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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[['Debut of DM with ketoacidosis\n', 'It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n', 'Support'], ['Priority is iv insulin administration and serum therapy\n', 'It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n', 'Support'], ['Bicarbonate if pH < 7\n', 'It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n', 'Support'], ['Insulin administration should never be delayed\n', 'It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n', 'Support']]
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553_177
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[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['33-year-old', 'patient,', 'resident', 'of', 'Valencia,', 'who', 'consults', 'for', 'presenting', 'on', 'the', 'right', 'cheek', 'an', 'erythematous-orange', 'plaque', 'after', 'an', 'insect', 'bite', 'that', 'has', 'been', 'growing', 'slowly', 'until', 'reaching', '1.5', 'cm', 'and', 'that', 'in', 'the', 'last', 'weeks', 'has', 'ulcerated', 'and', 'covered', 'with', 'a', 'scammocostra.'], ['The', 'lesion', 'only', 'causes', 'discrete', 'discomfort', 'if', 'scratched.'], ['The', 'patient', 'has', 'a', 'history', 'of', 'plaque', 'psoriasis', 'treated', 'with', 'subcutaneous', 'adalimumab.'], ['She', 'is', 'in', 'good', 'general', 'condition', 'and', 'does', 'not', 'take', 'any', 'other', 'drugs', 'and', 'does', 'not', 'report', 'any', 'drug', 'allergies.'], ['Indicate', 'the', 'treatment', 'you', 'would', 'use:'], ['1-', 'Oral', 'isotretinoin.'], ['2-', 'Intralesional', 'meglumine', 'antimoniate.'], ['3-', 'Systemic', 'corticosteroids.'], ['4-', 'Oral', 'amoxicillin.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'fact', 'that', 'the', 'place', 'of', 'residence', 'is', 'mentioned', 'already', 'gives', 'us', 'many', 'clues.'], ['A', '"bite"', 'that', 'transforms', 'into', 'a', 'lesion', 'in', 'an', 'uncovered', 'area', 'with', 'a', 'crusty', 'surface', 'and', 'that', 'bothers', 'little', 'or', 'nothing...', 'in', 'the', 'Mediterranean', 'basin', 'this', 'is', 'cutaneous', 'leishmaniasis', 'or', 'oriental', 'button.'], ['And', 'while', 'it', 'is', 'true', 'that', 'the', 'lesion', 'is', '<', '4', 'cm', 'and', 'unique,', 'we', 'are', 'told', 'that', 'the', 'patient', 'is', 'being', 'treated', 'with', 'adalimumab,', 'an', 'anti-TNF', 'monoclonal', 'antibody.'], ['With', 'the', 'exception', 'of', 'meglumine', 'antimoniate,', 'none', 'of', 'the', 'other', 'treatments', 'proposed', 'in', 'the', 'different', 'options', 'are', 'indicated', 'in', 'leishmaniasis,', 'so', 'it', 'is', 'clear.'], ['The', 'only', 'thing', 'that', 'is', 'more', 'debatable', 'is', 'that,', 'as', 'this', 'is', 'an', 'immunosuppressed', 'patient,', 'systemic', 'treatment', 'would', 'probably', 'be', 'more', 'appropriate.'], ['I', "don't", 'know', 'if', 'for', 'that', 'reason', 'contestable,', 'but', 'at', 'least,', 'debatable.']]
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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'], ['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'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['33-year-old patient, resident of Valencia, who consults for presenting on the right cheek an erythematous-orange plaque after an insect bite that has been growing slowly until reaching 1.5 cm and that in the last weeks has ulcerated and covered with a scammocostra\n', 'The fact that the place of residence is mentioned already gives us many clues\n', 'Support'], ['A "bite" that transforms into a lesion in an uncovered area with a crusty surface and that bothers little or nothing..\n', 'in the Mediterranean basin this is cutaneous leishmaniasis or oriental button\n', 'Support'], ['The fact that the place of residence is mentioned already gives us many clues\n', 'in the Mediterranean basin this is cutaneous leishmaniasis or oriental button\n', 'Support'], ['And while it is true that the lesion is < 4 cm and unique, we are told that the patient is being treated with adalimumab, an anti-TNF monoclonal antibody\n', 'With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n', 'Attack'], ['in the Mediterranean basin this is cutaneous leishmaniasis or oriental button\n', 'With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n', 'Support'], ['With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n', 'Intralesional meglumine antimoniate\n', 'Support'], ['With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n', 'it is clear\n', 'Support'], ['it is clear\n', 'Intralesional meglumine antimoniate\n', 'Support']]
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608_115
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'male,', 'a', 'regular', 'athlete,', 'refers', 'pain', 'in', 'the', 'right', 'leg', 'after', 'continuous', 'running.'], ['He', 'has', 'visited', 'a', 'physiotherapist', 'on', 'several', 'occasions', 'and', 'has', 'been', 'diagnosed', 'with', 'calf', 'overload.'], ['Several', 'months', 'have', 'passed,', 'he', 'has', 'not', 'improved', 'and', 'refers', 'intense', 'pain', 'after', 'physical', 'activity', 'that', 'subsides', 'with', 'rest', 'in', 'the', 'following', 'hours', 'of', 'exercise.'], ['What', 'test', 'can', 'help', 'in', 'the', 'diagnosis?'], ['1-', 'Positron', 'emission', 'tomography', 'with', '18', 'FDG.'], ['2-', 'Determination', 'of', 'posterior', 'compartment', 'pressure', 'immediately', 'after', 'activity.'], ['3-', 'Doppler', 'ultrasound', 'to', 'rule', 'out', 'a', 'circulatory', 'disorder', 'of', 'the', 'lower', 'extremity.'], ['4-', 'Spectrometry', 'by', 'magnetic', 'resonance.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'present', 'a', 'case', 'of', 'chronic', 'compartment', 'syndrome.'], ['For', 'its', 'diagnosis', 'it', 'is', 'necessary', 'to', 'measure', 'the', 'pressure', 'of', 'the', 'affected', 'compartments', 'at', 'rest', 'and', 'after', 'activity', '(answer', '2', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['For its diagnosis it is necessary to measure the pressure of the affected compartments at rest and after activity\n', 'answer 2 correct\n', 'Support'], ['We present a case of chronic compartment syndrome\n', 'For its diagnosis it is necessary to measure the pressure of the affected compartments at rest and after activity\n', 'Support'], ['answer 2 correct\n', 'Determination of posterior compartment pressure immediately after activity\n', 'Support']]
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294_44
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[['QUESTION', 'TYPE:', 'GENETICS', 'AND', 'IMMUNOLOGY'], ['CLINICAL', 'CASE:'], ['Amalia', 'is', 'a', '3-year-old', 'girl', 'who', 'has', 'undergone', 'surgery', 'for', 'tetralogy', 'of', 'Fallot.'], ['She', 'also', 'presented', 'thymic', 'dysfunction', 'in', 'the', 'neonatal', 'period', 'and', 'hypocalcemia', 'as', 'well', 'as', 'a', 'nasal', 'voice', 'and', 'psychomotor', 'retardation.'], ['Which', 'genetic', 'test', 'do', 'you', 'consider', 'most', 'appropriate', 'to', 'reach', 'an', 'etiological', 'diagnosis?'], ['1-', '22q11', 'deletion', 'study', '(Di', 'George', 'or', 'Velo-cardio-facial', 'syndrome).'], ['2-', 'Study', 'of', 'FMR1', 'gene', 'expansion,', 'responsible', 'for', 'Fragile', 'X', 'syndrome.'], ['3-', 'Sequencing', 'of', 'genes', 'related', 'to', 'HRAS', '(Noonan', 'syndrome).'], ['4-', 'Genetic', 'study', 'of', 'Williams', 'Beuren', 'syndrome.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Question', 'in', 'which', 'the', 'clinical', 'picture', 'must', 'be', 'recognized:', 'cardiovascular', 'anomalies', '-', 'Tetralogy', 'of', 'Fallot', '-;', 'thymic', 'aplasia/hypoplasia', '-', 'leading', 'to', 'primary', 'T-cell', 'immunodeficiency;', 'parathyroid', 'aplasia/hypoplasia', '-', 'hence', 'hypocalcemia', '-;', 'palatal', 'anomalies', '-', 'nasal', 'voice;', 'psychomotor', 'retardation.'], ['In', 'my', 'opinion,', 'just', 'with', 'the', 'words', '"thymic', 'dysfunction",', 'hypocalcemia', 'and', 'cardiopathy,', 'we', 'would', 'have', 'to', 'go', 'straight', 'to', 'DiGeorge', 'syndrome.'], ['Indeed,', 'the', 'genetic', 'defect', 'is', 'a', '22q11.2', 'deletion', '(which', 'if', 'we', 'know', 'it,', 'the', 'better,', 'but', 'with', 'the', 'clinic', 'it', 'would', 'be', 'enough', 'for', 'us).'], ['The', 'only', 'option', 'with', 'which', 'there', 'could', 'be', 'doubt', 'is', 'Noonan', 'syndrome,', 'which', 'can', 'also', 'be', 'associated', 'with', 'cardiopathy,', 'but', 'above', 'all', 'it', 'is', 'characterized', 'by', 'short', 'stature,', 'cardiopathy', 'and', 'bone', 'alterations;', 'moreover,', 'in', 'most', 'cases', 'it', 'is', 'caused', 'by', 'an', 'alteration', 'in', 'the', 'PTPN11', 'gene,', 'not', 'in', 'those', 'mentioned', 'in', 'the', 'question.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Question in which the clinical picture must be recognized: cardiovascular anomalies - Tetralogy of Fallot -; thymic aplasia/hypoplasia - leading to primary T-cell immunodeficiency; parathyroid aplasia/hypoplasia - hence hypocalcemia -; palatal anomalies - nasal voice; psychomotor retardation\n', 'In my opinion, just with the words "thymic dysfunction", hypocalcemia and cardiopathy, we would have to go straight to DiGeorge syndrome\n', 'Support'], ['In my opinion, just with the words "thymic dysfunction", hypocalcemia and cardiopathy, we would have to go straight to DiGeorge syndrome\n', '22q11 deletion study (Di George or Velo-cardio-facial syndrome)\n', 'Support'], ['Indeed, the genetic defect is a 22q11.2 deletion (which if we know it, the better, but with the clinic it would be enough for us)\n', '22q11 deletion study (Di George or Velo-cardio-facial syndrome)\n', 'Support'], ['moreover, in most cases it is caused by an alteration in the PTPN11 gene, not in those mentioned in the question\n', 'Sequencing of genes related to HRAS (Noonan syndrome)\n', 'Attack'], ['moreover, in most cases it is caused by an alteration in the PTPN11 gene, not in those mentioned in the question\n', 'The only option with which there could be doubt is Noonan syndrome, which can also be associated with cardiopathy\n', 'Attack'], ['but above all it is characterized by short stature, cardiopathy and bone alterations\n', 'The only option with which there could be doubt is Noonan syndrome, which can also be associated with cardiopathy\n', 'Attack']]
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156_230
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '40-year-old', 'patient', 'who', 'comes', 'to', 'the', 'emergency', 'room', 'with', 'aphthous', 'stomatitis,', 'conjunctivitis,', 'urethritis,', 'balanitis', 'and', 'joint', 'pain.'], ['Which', 'of', 'the', 'following', 'diagnoses', 'is', 'the', 'most', 'likely?'], ['1-', "Behçet's", 'disease.'], ['2-', 'Reactive', 'arthritis', 'syndrome.'], ['3-', "Sweet's", 'syndrome.'], ['4-', 'Vitamin', 'A', 'deficiency.'], ['5-', 'Gonococcal', 'infection.'], ['CORRECT', 'ANSWER:', '2'], ['Given', 'this', 'clinical', 'picture', 'and', 'without', 'having', 'complementary', 'tests', 'available,', 'the', 'most', 'likely', 'diagnosis', 'is', 'reactive', 'arthritis.'], ['The', 'only', 'problem', 'is', 'that', 'the', 'statement', 'speaks', 'of', 'joint', 'pain', 'and', 'not', 'arthritis...'], ["Reiter's", 'syndrome', '(triad', 'of', 'conjunctivitis,', 'urethritis', 'and', 'arthritis)', 'is', 'one', 'of', 'the', 'forms', 'in', 'which', 'reactive', 'arthritis', 'can', 'present.'], ['In', "Behçet's", 'disease', 'oral', 'and', 'genital', 'aphthous', 'ulcers', 'may', 'occur', 'but', 'urethritis', 'is', 'not', 'a', 'feature.'], ['And', 'the', 'characteristic', 'ocular', 'condition', 'is', 'uveitis.']]
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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', 'B-Premise', 'B-Premise', 'O', 'B-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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n', 'Reactive arthritis syndrome\n', 'Support'], ['The only problem is that the statement speaks of joint pain and not arthritis\n', 'Reactive arthritis syndrome\n', 'Attack'], ['A 40-year-old patient who comes to the emergency room with aphthous stomatitis\n', 'Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n', 'Support'], ['conjunctivitis\n', 'Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n', 'Support'], ['urethritis\n', 'Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n', 'Support'], ['balanitis\n', 'Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n', 'Support'], ['joint pain\n', 'The only problem is that the statement speaks of joint pain and not arthritis\n', 'Support'], ['conjunctivitis\n', "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", 'Support'], ['urethritis\n', "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", 'Support'], ['The only problem is that the statement speaks of joint pain and not arthritis\n', "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", 'Attack'], ["Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", 'Reactive arthritis syndrome\n', 'Support'], ['A 40-year-old patient who comes to the emergency room with aphthous stomatitis\n', "In Behçet's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", 'Support'], ['urethritis\n', "In Behçet's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", 'Attack'], ["In Behçet's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", "Behçet's disease\n", 'Attack'], ['A 40-year-old patient who comes to the emergency room with aphthous stomatitis\n', "Behçet's disease\n", 'Support'], ['urethritis\n', "Behçet's disease\n", 'Attack'], ['conjunctivitis\n', "Behçet's disease\n", 'Attack'], ['And the characteristic ocular condition is uveitis\n', "In Behçet's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", 'Support'], ['conjunctivitis\n', 'And the characteristic ocular condition is uveitis\n', 'Attack']]
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82_45
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[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'reports', 'precordial', 'pain', 'after', 'medium', 'exertion.'], ['Coronary', 'angiography', 'shows', 'significant', 'stenosis', 'in', 'the', 'proximal', 'segments', 'of', 'the', 'three', 'main', 'vessels', 'with', 'good', 'distal', 'bed.'], ['Ventricular', 'function', 'is', 'depressed', '(<30%).'], ['What', 'is', 'the', 'best', 'therapeutic', 'option?'], ['1-', 'Percutaneous', 'revascularization.'], ['2-', 'Medical', 'treatment.'], ['3-', 'Myocardial', 'revascularization', 'surgery.'], ['4-', 'Implantation', 'of', 'balloon', 'counterpulsation.'], ['5-', 'Cardiac', 'transplantation.'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'talking', 'about', 'a', 'patient', 'with', '3-vessel', 'coronary', 'artery', 'disease', 'and,', 'very', 'importantly,', 'with', 'severe', 'ventricular', 'dysfunction.'], ['Under', 'these', 'conditions,', 'the', 'treatment', 'of', 'choice', 'would', 'be', 'surgical', '(myocardial', 'revascularization', 'surgery', 'or', 'by-pass).'], ['In', 'the', 'case', 'of', 'a', 'patient', 'with', 'preserved', 'LV', 'function,', 'the', 'choice', 'of', 'surgical', 'vs.', 'percutaneous', 'treatment', 'would', 'be', 'more', 'questionable,', 'since', 'today,', 'thanks', 'to', 'drug-eluting', 'stents,', 'the', 'differences', 'in', 'terms', 'of', 'morbidity', 'and', 'mortality', 'between', 'by-pass', 'surgery', 'and', 'angioplasty', 'are', 'minimal.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Under these conditions, the treatment of choice would be surgical (myocardial revascularization surgery or by-pass)\n', 'Myocardial revascularization surgery\n', 'Support'], ['We are talking about a patient with 3-vessel coronary artery disease and, very importantly, with severe ventricular dysfunction\n', 'Under these conditions, the treatment of choice would be surgical (myocardial revascularization surgery or by-pass)\n', 'Support'], ['since today, thanks to drug-eluting stents, the differences in terms of morbidity and mortality between by-pass surgery and angioplasty are minimal\n', 'In the case of a patient with preserved LV function, the choice of surgical vs. percutaneous treatment would be more questionable\n', 'Support']]
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485_49
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[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'on', 'carbamazepine', 'treatment', 'for', 'epilepsy', 'presenting', 'with', 'fever', '(38.8°C),', 'odynophagia,', 'conjunctivitis,', 'brownish', 'skin', 'lesions', 'spread', 'over', 'a', 'large', 'body', 'surface,', 'target-like', 'in', 'appearance', 'and', 'accompanied', 'by', 'epidermal', 'detachment', '(greater', 'than', '30%)', 'at', 'the', 'slightest', 'friction.'], ['It', 'is', 'very', 'likely', 'that', 'she', 'is', 'presenting', 'a', 'clinical', 'picture', 'of:'], ['1-', 'Acute', 'urticaria', 'of', 'pharmacological', 'cause.'], ['2-', 'Erythema', 'minor', 'exudative', 'secondary', 'to', 'drugs.'], ['3-', 'Pharmacological', 'Stevens-Johnson', 'syndrome.'], ['4-', 'Epidermal', 'toxic', 'necrolysis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'are', 'dealing', 'with', 'a', 'severe', 'patient,', 'with', 'target', 'lesions', 'and', "Nikolsky's", 'sign', 'in', '>', '30%', 'of', 'the', 'body', 'surface', 'area.'], ['Together', 'with', 'the', 'history', 'of', 'treatment', 'with', 'carbamazepine,', 'the', 'suspicion', 'will', 'be', 'of', 'toxic', 'epidermal', 'necrolysis', '(answer', '4).'], ['If', 'the', 'epidermal', 'detachment', 'is', 'less', 'than', '10%', 'then', 'we', 'would', 'be', 'dealing', 'with', 'Stevens-Johnson', '(and', 'intermediate', 'cases', 'are', 'referred', 'to', 'as', 'overlap,', 'since', 'it', 'is', 'a', 'whole', 'spectrum).'], ['Incidentally,', 'we', 'would', 'recommend', 'immediate', 'admission', 'to', 'a', 'major', 'burn', 'unit.']]
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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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A 60-year-old man on carbamazepine treatment for epilepsy presenting with fever (38.8°C), odynophagia, conjunctivitis, brownish skin lesions spread over a large body surface, target-like in appearance and accompanied by epidermal detachment (greater than 30%) at the slightest friction\n', "We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area\n", 'Support'], ['Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)\n', 'Epidermal toxic necrolysis\n', 'Support'], ["We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area\n", 'Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)\n', 'Support'], ['A 60-year-old man on carbamazepine treatment for epilepsy presenting with fever (38.8°C), odynophagia, conjunctivitis, brownish skin lesions spread over a large body surface, target-like in appearance and accompanied by epidermal detachment (greater than 30%) at the slightest friction\n', 'If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson (and intermediate cases are referred to as overlap, since it is a whole spectrum)\n', 'Attack'], ['If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson (and intermediate cases are referred to as overlap, since it is a whole spectrum)\n', 'Pharmacological Stevens-Johnson syndrome\n', 'Attack'], ['Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)\n', 'Incidentally, we would recommend immediate admission to a major burn unit\n', 'Support']]
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219_124
| null | null |
[]
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578_107
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '55-year-old', 'male', 'who', 'suffers', 'a', 'subarachnoid', 'hemorrhage', 'due', 'to', 'a', 'ruptured', 'middle', 'cerebral', 'artery', 'aneurysm.'], ['He', 'is', 'treated', 'surgically.'], ['After', 'a', 'good', 'evolution', 'in', 'which', 'he', 'recovers', 'the', 'ability', 'to', 'walk,', 'one', 'month', 'after', 'suffering', 'the', 'hemorrhage,', 'he', 'presents', 'a', 'progressive', 'deterioration,', 'becoming', 'cloudy', 'and', 'with', 'difficulty', 'to', 'obey', 'orders.'], ['Mark', 'the', 'correct', 'statement:'], ['1-', 'She', 'is', 'in', 'the', 'moment', 'of', 'evolution', 'in', 'which', 'vasospasm', 'is', 'more', 'frequent.'], ['2-', 'This', 'progressive', 'deterioration', 'is', 'probably', 'secondary', 'to', 'aneurysm', 'rebleeding.'], ['3-', 'Subacute', 'deterioration', 'is', 'most', 'likely', 'due', 'to', 'hydrocephalus.'], ['4-', 'The', 'diagnostic', 'technique', 'of', 'choice', 'is', 'cerebral', 'angiography.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Vasospasm', 'as', 'a', 'complication', 'of', 'subarachnoid', 'hemorrhage', 'usually', 'occurs', 'early,', 'in', 'the', 'week', 'after', 'the', 'hemorrhage.'], ['The', 'progressive', 'deterioration', 'with', 'alteration', 'of', 'the', 'level', 'of', 'consciousness', 'makes', 'us', 'suspect', 'one', 'of', 'the', 'complications', 'that', 'can', 'occur', 'in', 'this', 'condition:', 'hydrocephalus.'], ['The', 'diagnostic', 'technique', 'of', 'choice', 'in', 'this', 'case', 'is', 'neuroimaging', 'with', 'cranial', 'CT.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['B-Claim', '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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[['After a good evolution in which he recovers the ability to walk, one month after suffering the hemorrhage, he presents a progressive deterioration, becoming cloudy and with difficulty to obey orders\n', 'Vasospasm as a complication of subarachnoid hemorrhage usually occurs early, in the week after the hemorrhage\n', 'Attack'], ['Vasospasm as a complication of subarachnoid hemorrhage usually occurs early, in the week after the hemorrhage\n', 'She is in the moment of evolution in which vasospasm is more frequent\n', 'Attack'], ['The progressive deterioration with alteration of the level of consciousness makes us suspect one of the complications that can occur in this condition: hydrocephalus\n', 'Subacute deterioration is most likely due to hydrocephalus\n', 'Support'], ['The diagnostic technique of choice in this case is neuroimaging with cranial CT\n', 'The diagnostic technique of choice is cerebral angiography\n', 'Attack'], ['The progressive deterioration with alteration of the level of consciousness makes us suspect one of the complications that can occur in this condition: hydrocephalus\n', 'This progressive deterioration is probably secondary to aneurysm rebleeding\n', 'Attack']]
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199_74
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'presenting', 'in', 'the', 'second', 'decade', 'of', 'life', 'with', 'a', 'progressive', 'picture', 'of', 'parkinsonism,', 'tremor,', 'dystonia', 'and', 'behavioral', 'alteration,', 'you', 'should', 'always', 'perform', 'a', 'study', 'to', 'rule', 'out', 'the', 'presence', 'of', 'a', 'disease', 'whose', 'appropriate', 'treatment', 'can', 'improve', 'neurological', 'symptoms', 'and', 'stop', 'the', 'clinical', 'course.'], ['What', 'disease', 'is', 'it?'], ['1-', "Huntington's", 'disease.'], ['2-', "Wilson's", 'disease.'], ['3-', "Tourette's", 'syndrome.'], ['4-', "Sydenham's", 'chorea.'], ['5-', 'Juvenile-onset', "Parkinson's", 'disease.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'key', 'in', 'the', 'question', 'is', '"stopping', 'the', 'clinical', 'course",', 'as', "Hungtinton's", 'disease,', "Tourette's", 'and', "Parkinson's", 'disease', 'do', 'not', 'have', 'treatments', 'that', 'can', 'stop', 'the', 'clinical', 'course.'], ["Sydenham's", 'chorea', 'is', 'typical', 'of', 'younger', 'children', 'with', 'a', 'history', 'of', 'streptococcal', 'infection', 'and', 'resolution', 'is', 'usually', 'spontaneous.'], ['On', 'the', 'other', 'hand,', 'in', 'clinical', 'cases', 'it', 'is', 'recommended', 'to', 'rule', 'out', "Wilson's", 'disease', 'in', 'young', 'patients', 'with', 'movement', 'and', 'neuropsychiatric', 'disorders.']]
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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', 'O', 'O', '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', 'I-Claim', '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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Disease', 'I-Disease', 'I-Disease'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 key in the question is "stopping the clinical course", as Hungtinton\'s disease, Tourette\'s and Parkinson\'s disease do not have treatments that can stop the clinical course\n', "Huntington's disease\n", 'Attack'], ['The key in the question is "stopping the clinical course", as Hungtinton\'s disease, Tourette\'s and Parkinson\'s disease do not have treatments that can stop the clinical course\n', "Tourette's syndrome\n", 'Attack'], ['The key in the question is "stopping the clinical course", as Hungtinton\'s disease, Tourette\'s and Parkinson\'s disease do not have treatments that can stop the clinical course\n', "uvenile-onset Parkinson's disease\n", 'Attack'], ['a patient presenting in the second decade of life\n', 'you should always perform a study to rule out the presence of a disease whose appropriate treatment can improve neurological symptoms and stop the clinical course\n', 'Support'], ['progressive picture of parkinsonism, tremor, dystonia and behavioral alteration\n', 'you should always perform a study to rule out the presence of a disease whose appropriate treatment can improve neurological symptoms and stop the clinical course\n', 'Support'], ['a patient presenting in the second decade of life\n', "Sydenham's chorea is typical of younger children with a history of streptococcal infection and resolution is usually spontaneous\n", 'Attack'], ["On the other hand, in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders\n", "Wilson's disease\n", 'Support'], ['progressive picture of parkinsonism, tremor, dystonia and behavioral alteration\n', "On the other hand, in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders\n", 'Support'], ['a patient presenting in the second decade of life\n', "On the other hand, in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders\n", 'Support']]
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331_87
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'hospitalized', 'patient', 'who', 'is', 'unable', 'to', 'feed', 'orally', 'for', 'more', 'than', '6', 'days,', 'in', 'which', 'of', 'the', 'following', 'clinical', 'situations', 'are', 'we', 'necessarily', 'to', 'use', 'parenteral', 'nutrition?'], ['1-', 'Cardioembolic', 'stroke', 'with', 'complete', 'neurologic', 'dysphagia.'], ['2-', 'Cachexia', 'due', 'to', 'chronic', 'empyema', 'in', 'immunocompromised', 'patient.'], ['3-', 'Prolonged', 'paralytic', 'syndrome.'], ['4-', 'Advanced', "Alzheimer's", 'disease', 'with', 'severe', 'risk', 'of', 'bronchial', 'aspiration.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Paralytic', 'ileus', 'is', 'a', 'failure', 'of', 'intestinal', 'propulsion', 'that', 'appears', 'acutely', 'in', 'the', 'absence', 'of', 'mechanical', 'obstruction;', 'it', 'is', 'secondary', 'to', 'various', 'causes', 'and', 'affects', 'intestinal', 'contractility.'], ['Therefore,', 'parenteral', 'administration', 'is', 'necessary.']]
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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', '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', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Paralytic ileus is a failure of intestinal propulsion that appears acutely in the absence of mechanical obstruction\n', 'Prolonged paralytic syndrome\n', 'Support'], ['Paralytic ileus is a failure of intestinal propulsion that appears acutely in the absence of mechanical obstruction\n', 'Therefore, parenteral administration is necessary\n', 'Support'], ['it is secondary to various causes and affects intestinal contractility\n', 'Therefore, parenteral administration is necessary\n', 'Support']]
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205_214
|
[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'young', 'man', 'who', '3', 'days', 'after', 'a', 'risky', 'sexual', 'contact', 'presents', 'numerous', 'pustular', 'lesions,', 'small,', 'very', 'pruritic', 'and', 'evolving', 'to', 'tiny', 'erosions', 'affecting', 'the', 'entire', 'glans', 'and', 'the', 'inner', 'face', 'of', 'the', 'foreskin.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnostic', 'approach?'], ['1-', 'Genital', 'candidiasis.'], ['2-', 'Chancroid.'], ['3-', 'Secondary', 'syphilis.'], ['4-', 'Trichomonas', 'balanitis.'], ['5-', 'Dermatophyte', 'fungal', 'infection.'], ['CORRECT', 'ANSWER:', '1'], ['Chancroid', 'is', 'a', 'solitary', 'lesion.'], ['Secondary', 'syphilis', 'usually', 'occurs', 'as', 'a', 'generalized', 'rash', 'or', 'as', 'characteristic', 'lesions', 'on', 'palms', 'and', 'soles', '(syphilitic', 'nails)', 'with', 'a', 'longer', 'latency', 'period.'], ['Trichomonas', 'balanitis', 'is', 'always', 'associated', 'with', 'urethritis,', 'which', 'is', 'not', 'referred', 'to', 'in', 'the', 'question.'], ['Therefore,', 'the', 'answer', 'is', '1.'], ['However,', 'the', 'clinical', 'picture', 'suggests', 'herpes', 'simplex', 'rather', 'than', 'candidiasis', 'and', '5', 'also', 'refers', 'to', 'fungi', '(although', 'dermatophytes', 'do', 'not', 'cause', 'balanitis)....', 'from', 'our', 'point', 'of', 'view,', 'even', 'if', 'we', 'consider', '1', 'to', 'be', 'correct,', 'the', 'question', 'is', 'misleading', 'and', 'could', 'be', 'open', 'to', 'challenge.'], ['Moreover,', 'genital', 'candidiasis', 'is', 'not', 'necessarily', 'sexually', 'transmitted.']]
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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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin\n', 'Chancroid is a solitary lesion\n', 'Attack'], ['Chancroid is a solitary lesion\n', 'Chancroid\n', 'Attack'], ['Secondary syphilis usually occurs as a generalized rash or as characteristic lesions on palms and soles (syphilitic nails) with a longer latency period\n', 'Secondary syphilis\n', 'Attack'], ['A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin\n', 'Secondary syphilis usually occurs as a generalized rash or as characteristic lesions on palms and soles (syphilitic nails) with a longer latency period\n', 'Attack'], ['Therefore, the answer is 1\n', 'Genital candidiasis\n', 'Support'], ['which is not referred to in the question\n', 'Trichomonas balanitis is always associated with urethritis\n', 'Attack'], ['Trichomonas balanitis is always associated with urethritis\n', 'Trichomonas balanitis\n', 'Attack'], ['A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin\n', 'Moreover, genital candidiasis is not necessarily sexually transmitted\n', 'Attack'], ['However, the clinical picture suggests herpes simplex rather than candidiasis and 5 also refers to fungi\n', 'Genital candidiasis\n', 'Attack'], ['Moreover, genital candidiasis is not necessarily sexually transmitted\n', 'Genital candidiasis\n', 'Attack'], ['although dermatophytes do not cause balanitis\n', 'However, the clinical picture suggests herpes simplex rather than candidiasis and 5 also refers to fungi\n', 'Attack'], ['from our point of view, even if we consider 1 to be correct, the question is misleading and could be open to challenge\n', 'Genital candidiasis\n', 'Support']]
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441_98
| null | null |
[]
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302_111
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'with', 'rheumatoid', 'arthritis', 'treated', 'with', 'methotrexate,', 'prednisone', 'and', 'indomethacin', 'who', 'acutely', 'presents', 'edema', 'and', 'increased', 'plasma', 'creatinine', 'with', 'a', 'poorly', 'expressive', 'urine', 'sediment', 'and', 'proteinuria', 'less', 'than', '100', 'mg/24', 'h', 'the', 'most', 'likely', 'cause', 'is:'], ['1-', 'Renal', 'amyloidosis.'], ['2-', 'Glomerulonephritis', 'secondary', 'to', 'rheumatoid', 'arthritis.'], ['3-', 'Renal', 'failure', 'due', 'to', 'non-steroidal', 'anti-inflammatory', 'drugs.'], ['4-', 'Interstitial', 'nephritis', 'due', 'to', 'methotrexate.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Prerenal', 'acute', 'renal', 'failure', 'due', 'to', 'NSAIDs', 'seems', 'the', 'most', 'plausible', 'option', 'in', 'this', 'case.'], ['Tubulointerstitial', 'nephritis', 'due', 'to', 'methotrexate', 'is', 'less', 'likely', 'due', 'to', 'the', 'absence', 'of', 'rash,', 'fever', 'or', 'eosinophilia,', 'which', 'although', 'rare', 'in', 'the', 'MIR', 'usually', 'appear.'], ['Although', 'GMN', 'and', 'renal', 'amyloidosis', 'are', 'relatively', 'frequent', 'in', 'RA,', 'the', 'anodyne', 'urine', 'sediment', 'and', 'the', 'absence', 'of', 'proteinuria', 'make', 'these', 'options', 'unlikely.']]
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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', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Claim', '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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[['Prerenal acute renal failure due to NSAIDs seems the most plausible option in this case\n', 'Renal failure due to non-steroidal anti-inflammatory drugs\n', 'Support'], ['Tubulointerstitial nephritis due to methotrexate is less likely due to the absence of rash, fever or eosinophilia\n', 'Interstitial nephritis due to methotrexate\n', 'Attack'], ['the anodyne urine sediment and the absence of proteinuria make these options unlikely\n', 'Although GMN and renal amyloidosis are relatively frequent in RA\n', 'Attack'], ['the anodyne urine sediment and the absence of proteinuria make these options unlikely\n', 'Renal amyloidosis\n', 'Attack'], ['the anodyne urine sediment and the absence of proteinuria make these options unlikely\n', 'Glomerulonephritis secondary to rheumatoid arthritis\n', 'Attack']]
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517_104
|
[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '34-year-old', 'male', 'is', 'involved', 'in', 'a', 'traffic', 'accident', 'and', 'is', 'attended', 'at', 'the', 'scene', 'of', 'the', 'accident.'], ['The', 'medical', 'personnel', 'observe', 'that', 'he', 'is', 'pale,', 'sweaty,', 'has', 'a', 'thready', 'pulse', 'with', 'a', 'blood', 'pressure', 'of', '90/50', 'mmHg,', 'a', 'heart', 'rate', 'of', '127', 'bpm,', 'a', 'respiratory', 'rate', 'of', '28', 'rpm', 'and', 'an', 'oxygen', 'saturation', 'of', '92%.'], ['He', 'was', 'infused', 'with', '20', 'ml/kg', 'of', 'crystalloids.'], ['During', 'his', 'transfer', 'to', 'the', 'hospital', 'his', 'vital', 'signs', 'improve', 'transiently', 'and', 'then', 'deteriorate', 'on', 'arrival', 'at', 'the', 'hospital.'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'Type-specific', 'blood', 'transfusion', 'required.'], ['2-', 'Requires', 'emergency', 'blood', 'transfusion', '(O', 'Rh', 'negative).'], ['3-', 'A', 'possible', 'blood', 'transfusion', 'with', 'crossmatching', 'tests', 'should', 'be', 'prepared.'], ['4-', 'Try', 'again', 'infusion', 'of', 'another', '20', 'ml/kg', 'of', 'crystalloids.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['In', 'a', 'polytraumatized', 'patient,', 'the', 'first', 'cause', 'of', 'shock', 'is', 'blood', 'loss', '(hemorrhagic', 'shock).'], ['The', 'guidelines', 'to', 'follow', 'should', 'always', 'contemplate', 'the', 'replenishment', 'of', 'blood', 'volume', '(if', 'possible,', 'with', 'blood', 'products', 'as', 'early', 'as', 'possible)', 'and', 'control', 'of', 'the', 'focus.'], ['In', 'this', 'case,', 'given', 'the', 'vital', 'compromise,', 'the', 'need', 'for', 'transfusion', 'is', 'very', 'urgent,', 'so', 'the', 'indication', 'is', 'emergency', 'blood', 'transfusion', '(O', 'Rh', 'negative).']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock)\n', 'The guidelines to follow should always contemplate the replenishment of blood volume (if possible, with blood products as early as possible) and control of the focus\n', 'Support'], ['In this case, given the vital compromise, the need for transfusion is very urgent\n', 'so the indication is emergency blood transfusion (O Rh negative)\n', 'Support'], ['During his transfer to the hospital his vital signs improve transiently and then deteriorate on arrival at the hospital\n', 'In this case, given the vital compromise, the need for transfusion is very urgent\n', 'Support'], ['A 34-year-old male is involved in a traffic accident and is attended at the scene of the accident\n', 'In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock)\n', 'Support'], ['The medical personnel observe that he is pale, sweaty, has a thready pulse with a blood pressure of 90/50 mmHg, a heart rate of 127 bpm, a respiratory rate of 28 rpm and an oxygen saturation of 92%\n', 'In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock)\n', 'Support'], ['so the indication is emergency blood transfusion (O Rh negative)\n', 'Requires emergency blood transfusion (O Rh negative)\n', 'Support']]
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520_38
|
[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'patient', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'presenting', 'with', 'severe', 'and', 'significant', 'lingual', 'angioedema.'], ['She', 'does', 'not', 'present', 'associated', 'urticaria', 'and', 'has', 'no', 'history', 'of', 'drug', 'or', 'food', 'allergy.'], ['His', 'personal', 'history', 'includes', 'type', '2', 'diabetes', 'mellitus,', 'dyslipidemia,', 'hypertension,', 'hypothyroidism', 'and', "Parkinson's", 'disease.'], ['She', 'is', 'on', 'regular', 'treatment', 'with', 'metformin,', 'simvastatin,', 'enalapril,', 'thyroxine', 'and', 'levodopa.'], ['Which', 'of', 'the', 'following', 'drugs', 'is', 'most', 'likely', 'the', 'causal', 'drug', 'of', 'the', 'clinical', 'picture', 'described?'], ['1-', 'Enalapril.'], ['2-', 'Simvastatin.'], ['3-', 'Metformin', 'or', 'levodopa', 'equally.'], ['4-', 'Levodopa.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Angioedema', 'is', 'a', 'type', 'of', 'profound', 'urticaria', 'that', 'can', 'be', 'of', 'drug', 'etiology', '(not', 'IgE-mediated)', 'and', 'in', 'this', 'case,', 'ACEIs', '(such', 'as', 'enalapril)', 'are', 'considered', 'the', 'most', 'frequent', 'pharmacological', 'cause,', 'so', 'in', 'this', 'case', 'it', 'would', 'be', 'the', 'correct', 'answer', '(if', 'we', 'speak', 'in', 'probabilistic', 'terms).']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['Angioedema is a type of profound urticaria that can be of drug etiology (not IgE-mediated)\n', 'in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause\n', 'Support'], ['in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause\n', 'so in this case it would be the correct answer (if we speak in probabilistic terms)\n', 'Support'], ['so in this case it would be the correct answer (if we speak in probabilistic terms)\n', 'Enalapril\n', 'Support'], ['in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause\n', 'Enalapril\n', 'Support']]
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379_133
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'girl', 'comes', 'to', 'the', 'emergency', 'department', 'because', 'she', 'has', 'noticed', 'after', 'getting', 'up,', 'when', 'looking', 'in', 'the', 'mirror,', 'weakness', 'in', 'the', 'right', 'half', 'of', 'the', 'face', '(including', 'the', 'forehead,', 'closing', 'the', 'eyelid', 'and', 'smiling).'], ['She', 'is', 'accompanied', 'by', 'dysgeusia,', 'with', 'a', 'sensation', 'of', 'metallic', 'taste', 'of', 'food', 'as', 'well', 'as', 'hyperacusis', 'and', 'ipsilateral', 'mastoid', 'pain.'], ['On', 'examination', 'there', 'is', 'no', 'evidence', 'of', 'strength', 'deficits', 'or', 'sensory', 'deficits', 'in', 'the', 'extremities', 'or', 'speech', 'or', 'language', 'disorders.'], ['In', 'this', 'case,', 'which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'The', 'most', 'probable', 'diagnosis', 'is', 'a', 'demyelinating', 'plaque', 'in', 'the', 'contralateral', 'hemiprotuberance,', 'the', 'most', 'necessary', 'complementary', 'exploration', 'would', 'be', 'a', 'cranial', 'MRI.'], ['2-', 'Oral', 'corticosteroids', 'are', 'the', 'treatment', 'of', 'choice', 'for', 'the', 'patient.'], ['3-', 'Intravenous', 'fibrinolysis', 'should', 'be', 'considered', 'if', 'the', 'evolution', 'time', 'is', 'less', 'than', '3h.'], ['4-', 'Most', 'likely', 'the', 'picture', 'is', 'irreversible.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'describe', 'a', 'picture', 'of', 'typical', 'peripheral', 'facial', 'paralysis,', 'with', 'dysgeusia,', 'hyperacusis', 'and', 'mastoid', 'pain.'], ['In', 'this', 'case', 'the', 'treatment', 'is', 'corticoid.'], ['The', 'first', 'one', 'would', 'not', 'be', 'correct', 'because', 'although', 'within', 'the', 'age', 'range', 'of', 'multiple', 'sclerosis', 'debut,', 'the', 'presentation', 'is', 'usually', 'gradual', 'over', 'days', 'and', 'the', 'nuclear', 'involvement', 'of', 'the', 'VII', 'cranial', 'nerve', '(which', 'could', 'simulate', 'a', 'peripheral', 'facial)', 'would', 'not', 'cause', 'dysgeusia,', 'hyperacusis', 'or', 'mastoid', 'pain.'], ['In', 'the', 'third', 'answer', 'they', 'propose', 'us', 'that', 'it', 'is', 'a', 'vascular', 'picture', 'and', 'therefore', 'that', 'the', 'facial', 'paralysis', 'is', 'central,', 'so', 'it', 'is', 'discarded', 'and', 'the', 'last', 'one', 'is', 'not', 'correct', 'because', 'most', 'of', 'the', 'idiopathic', 'peripheral', 'facial', 'paralysis', "(Bell's", 'palsy)', 'heal', 'without', 'sequelae.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', '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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'O', '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']]
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[['We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain\n', 'In this case the treatment is corticoid\n', 'Support'], ['In this case the treatment is corticoid\n', 'Oral corticosteroids are the treatment of choice for the patient\n', 'Support'], ['We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain\n', 'although within the age range of multiple sclerosis debut, the presentation is usually gradual over days and the nuclear involvement of the VII cranial nerve (which could simulate a peripheral facial) would not cause dysgeusia, hyperacusis or mastoid pain\n', 'Attack'], ['although within the age range of multiple sclerosis debut, the presentation is usually gradual over days and the nuclear involvement of the VII cranial nerve (which could simulate a peripheral facial) would not cause dysgeusia, hyperacusis or mastoid pain\n', 'The first one would not be correct\n', 'Support'], ['The first one would not be correct\n', 'The most probable diagnosis is a demyelinating plaque in the contralateral hemiprotuberance, the most necessary complementary exploration would be a cranial MRI\n', 'Attack'], ['In the third answer they propose us that it is a vascular picture\n', 'it is discarded\n', 'Support'], ['therefore that the facial paralysis is central\n', 'it is discarded\n', 'Support'], ['We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain\n', 'therefore that the facial paralysis is central\n', 'Attack'], ['it is discarded\n', 'Intravenous fibrinolysis should be considered if the evolution time is less than 3h\n', 'Attack'], ["most of the idiopathic peripheral facial paralysis (Bell's palsy) heal without sequelae\n", 'the last one is not correct\n', 'Support'], ['the last one is not correct\n', 'Most likely the picture is irreversible\n', 'Attack']]
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600_184
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'woman', 'who', 'has', 'been', 'complaining', 'for', '1', 'month', 'of', 'pain', 'and', 'stiffness', 'in', 'the', 'shoulder', 'girdle', 'and', 'pelvic', 'girdle,', 'which', 'predominates', 'when', 'she', 'gets', 'up', 'and', 'improves', 'with', 'mobilization,', 'without', 'fever,', 'headache', 'or', 'general', 'condition.'], ['Physical', 'examination', 'showed', 'stiffness', 'and', 'pain', 'on', 'mobilization', 'of', 'the', 'shoulders', 'and', 'hips.'], ['Laboratory', 'tests', 'show', 'elevated', 'ESR', 'and', 'C-reactive', 'protein.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'and', 'what', 'treatment', 'would', 'you', 'prescribe?'], ['1-', 'Rheumatoid', 'arthritis,', 'would', 'initiate', 'treatment', 'with', 'methotrexate.'], ['2-', 'Fibromyalgia,', 'would', 'initiate', 'treatment', 'with', 'duloxetine.'], ['3-', 'Polymyalgia', 'rheumatica,', 'would', 'initiate', 'treatment', 'with', 'corticosteroids.'], ['4-', 'Ankylosing', 'spondylitis,', 'I', 'would', 'initiate', 'treatment', 'with', 'non-steroidal', 'anti-inflammatory', 'drugs.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['In', 'this', 'case,', 'he', 'is', 'describing', 'the', 'cardinal', 'symptoms', 'of', 'polymyalgia', 'rheumatica.'], ['Older', 'patient,', 'over', '50', 'years', 'of', 'age,', 'presenting', 'with', 'pain', 'and', 'stiffness', 'in', 'both', 'girdles,', 'associated', 'with', 'an', 'elevation', 'of', 'acute', 'phase', 'reactants.'], ['He', 'presents', 'all', 'the', 'indispensable', 'criteria:', 'age', 'equal', 'to', 'or', 'greater', 'than', '50', 'years,', 'bilateral', 'omalgia', 'and', 'increased', 'acute', 'phase', 'reactants.'], ['Of', 'the', 'optional', 'criteria,', 'he', 'presents', 'stiffness,', 'pain', 'or', 'limitation', 'in', 'the', 'hip.'], ['Initial', 'treatment', 'is', 'corticosteroids', 'at', 'medium', 'doses.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Older patient, over 50 years of age, presenting with pain and stiffness in both girdles, associated with an elevation of acute phase reactants\n', 'In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n', 'Support'], ['He presents all the indispensable criteria: age equal to or greater than 50 years, bilateral omalgia and increased acute phase reactants\n', 'In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n', 'Support'], ['Of the optional criteria, he presents stiffness, pain or limitation in the hip\n', 'In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n', 'Support'], ['In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n', 'Initial treatment is corticosteroids at medium doses\n', 'Support'], ['Initial treatment is corticosteroids at medium doses\n', 'Polymyalgia rheumatica, would initiate treatment with corticosteroids\n', 'Support'], ['In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n', 'Polymyalgia rheumatica, would initiate treatment with corticosteroids\n', 'Support']]
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415_72
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[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'CARDIOVASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'man', 'with', 'a', 'history', 'of', 'febrile', 'illness', 'and', 'chest', 'pain', 'comes', 'to', 'the', 'hospital', 'with', 'dyspnea', 'and', 'tachypnea.'], ['On', 'physical', 'examination', 'his', 'blood', 'pressure', 'is', 'low,', 'jugular', 'venous', 'pressure', 'is', 'elevated', 'with', 'a', 'prominent', 'descending', 'sinus', 'x', 'and', 'he', 'has', 'a', 'paradoxical', 'pulse.'], ['What', 'diagnosis', 'would', 'you', 'suspect?'], ['1-', 'Dilated', 'cardiomyopathy.'], ['2-', 'Pericardial', 'effusion', 'with', 'cardiac', 'tamponade.'], ['3-', 'Constrictive', 'pericarditis.'], ['4-', 'Ischemic', 'heart', 'disease.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'the', 'classic', 'exploration:', 'he', 'had', 'a', 'fever', 'and', 'pain,', 'he', 'had', 'pericarditis', 'with', 'effusion,', 'and', 'now', 'this', 'is', 'causing', 'tamponade.'], ['Hence', 'the', 'hypotension', '(his', 'heart', 'cannot', 'fill', 'well', 'with', 'blood', 'and', 'pump),', 'jugular', 'engorgement', 'and', 'dependence', 'on', 'respiration', 'to', 'achieve', 'preload', 'and', 'cardiac', 'output', '(i.e.', 'paradoxical', 'pulse).']]
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[['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'], ['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'], ['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['It is the classic exploration: he had a fever and pain, he had pericarditis with effusion, and now this is causing tamponade\n', 'Pericardial effusion with cardiac tamponade\n', 'Support'], ['Hence the hypotension (his heart cannot fill well with blood and pump), jugular engorgement and dependence on respiration to achieve preload and cardiac output (i.e. paradoxical pulse)\n', 'It is the classic exploration: he had a fever and pain, he had pericarditis with effusion, and now this is causing tamponade\n', 'Support']]
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560_180
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '26-year-old', 'woman', 'diagnosed', 'with', 'systemic', 'lupus', 'erythematosus,', 'on', 'treatment', 'with', 'hydroxychloroquine,', 'who', 'consults', 'for', 'a', 'feeling', 'of', 'generalized', 'weakness', 'that', 'has', 'progressively', 'set', 'in', 'over', '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'], ['They', 'give', 'to', 'know', 'of', 'a', 'patient', 'with', 'SLE', 'in', 'treatment', 'with', 'Hydroxychloroquine.'], ['She', 'has', 'a', 'hb', 'of', '7.4', 'and', 'a', 'MCV', 'over', '100,', 'adding', 'pallor', 'and', 'weakness,', 'we', 'would', 'be', 'dealing', 'with', 'a', 'macrocytic', 'anemia.'], ['In', 'my', 'opinion,', 'the', 'most', 'suitable', 'would', 'be', 'alternative', '2,', 'since', 'hydroxyloroquine', 'has', 'been', 'reported', 'to', 'decrease', 'the', 'absorption', 'of', 'folic', 'acid,', 'and', 'since', 'she', 'has', 'a', 'complication', 'of', 'SLE,', 'in', 'this', 'case,', 'we', 'could', 'be', 'dealing', 'with', 'an', 'autoimmune', 'hemolytic', 'anemia', 'with', 'folic', 'acid', 'consumption.'], ['And', 'for', 'this', 'it', 'would', 'be', 'first', 'to', 'determine', 'with', 'the', 'direct', 'coombs.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['She has a hb of 7.4 and a MCV over 100, adding pallor and weakness\n', 'we would be dealing with a macrocytic anemia\n', 'Support'], ['They give to know of a patient with SLE in treatment with Hydroxychloroquine\n', 'we would be dealing with a macrocytic anemia\n', 'Support'], ['In my opinion, the most suitable would be alternative 2\n', "Coombs' test\n", 'Support'], ['since hydroxyloroquine has been reported to decrease the absorption of folic acid\n', 'in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n', 'Support'], ['since she has a complication of SLE\n', 'in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n', 'Support'], ['in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n', 'In my opinion, the most suitable would be alternative 2\n', 'Support'], ['in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n', 'And for this it would be first to determine with the direct coombs\n', 'Support'], ['And for this it would be first to determine with the direct coombs\n', "Coombs' test\n", 'Support']]
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358_232
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman', 'consults', 'after', 'noticing', 'inguinal', 'lymphadenopathies.'], ['The', 'interrogation', 'does', 'not', 'show', 'any', 'local', 'discomfort', 'or', 'data', 'suggestive', 'of', 'sexually', 'transmitted', 'infection.'], ['The', 'examination', 'revealed', 'two', 'lymphadenopathies,', 'one', 'in', 'each', 'groin,', '1', 'cm', 'in', 'diameter,', 'soft,', 'mobile,', 'non-painful.'], ['No', 'skin', 'lesions', 'are', 'seen', 'on', 'the', 'lower', 'limbs,', 'anus', 'or', 'perineum.'], ['Which', 'test', 'do', 'you', 'consider', 'essential?'], ['1-', 'A', 'lupus', 'serology', 'since', 'it', 'is', 'most', 'likely', 'a', 'Treponema', 'pallidum', 'infection.'], ['2-', 'A', 'gynecological', 'examination', 'to', 'rule', 'out', 'ovarian', 'cancer.'], ['3-', 'From', 'the', 'clinical', 'features', 'it', 'seems', 'to', 'be', 'normal', 'lymph', 'nodes', 'and', 'complementary', 'explorations', 'should', 'not', 'be', 'performed.'], ['4-', 'A', 'Paul-Bunell', 'test', 'should', 'be', 'performed', 'to', 'rule', 'out', 'infectious', 'mononucleosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['In', 'the', 'inguinal', 'region,', 'the', 'lymph', 'nodes', 'can', 'acquire', 'a', 'size', 'of', 'up', 'to', '1.5', 'cm', 'being', 'normal.'], ['In', 'addition,', 'the', 'rest', 'of', 'the', 'data', 'of', 'the', 'inguinal', 'exploration', '(no', 'pain,', 'mobile,', 'soft,', 'etc.)', 'corroborates', 'this.'], ['On', 'the', 'other', 'hand,', 'there', 'are', 'no', 'signs', 'or', 'symptoms', 'that', 'make', 'us', 'think', 'of', 'a', 'sexually', 'transmitted', 'infection.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful\n', 'In the inguinal region, the lymph nodes can acquire a size of up to 1.5 cm being normal\n', 'Support'], ['On the other hand, there are no signs or symptoms that make us think of a sexually transmitted infection\n', 'A lupus serology since it is most likely a Treponema pallidum infection\n', 'Attack'], ['The correct answer is 3\n', 'From the clinical features it seems to be normal lymph nodes and complementary explorations should not be performed\n', 'Support'], ['In the inguinal region, the lymph nodes can acquire a size of up to 1.5 cm being normal\n', 'The correct answer is 3\n', 'Support'], ['In addition, the rest of the data of the inguinal exploration (no pain, mobile, soft, etc.) corroborates this\n', 'The correct answer is 3\n', 'Support']]
|
414_71
| null | null |
[]
|
131_221
|
[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['An', 'individual', 'presents', 'with', '"muscle', 'weakness"', '(spastic', 'hemiparesis)', 'of', 'both', 'right', 'extremities,', 'with', 'hyperreflexia', 'and', "Babinski's", 'sign,', 'along', 'with', 'a', '"facial', 'flaccid', 'paralysis"', 'of', 'the', 'left', 'hemiface,', 'with', 'inability', 'to', 'close', 'the', 'left', 'eye', 'or', 'retract', 'the', 'left', 'side', 'of', 'the', 'mouth,', 'in', 'addition', 'to', 'other', 'alterations.'], ['From', 'the', 'data', 'described,', 'it', 'is', 'an', 'alteration', 'that', 'affects,', 'among', 'other', 'elements,', 'the', 'motor', 'fascicles:', 'cortico-spinal', 'and', 'cortico-nuclear,', 'but', 'at', 'what', 'level', 'of', 'the', 'neuroaxis', 'would', 'the', 'lesion', 'be', 'located?'], ['1-', 'At', 'the', 'level', 'of', 'the', 'area', '4', 'of', 'Brodmann', 'of', 'the', 'cerebral', 'cortex', 'of', 'the', 'right', 'side.'], ['2-', 'In', 'the', 'internal', 'capsule,', 'posterior', 'arm', 'on', 'the', 'right', 'side.'], ['3-', 'In', 'the', 'left', 'cerebral', 'peduncle.'], ['4-', 'In', 'the', 'medial', 'portion', 'of', 'the', 'caudal', 'protuberance', 'of', 'the', 'left', 'side.'], ['5-', 'In', 'the', 'medulla', 'oblongata', 'before', 'decussation', 'of', 'the', 'right', 'cortico-spinal', 'fascicle.'], ['CORRECT', 'ANSWER:', '4'], ['Question', 'always', 'involves', 'the', 'brainstem.'], ['We', 'have', 'a', 'right', 'hemiparesis', 'and', 'involvement', 'of', 'the', 'left', 'facial', 'nucleus,', 'since', 'it', 'has', 'affected', 'the', 'upper', 'and', 'lower', 'facial;', 'therefore', 'we', 'have', 'a', 'crossed', 'clinical', 'picture,', 'having', 'to', 'think', 'about', 'brainstem', 'involvement.'], ['If', 'we', 'have', 'in', 'a', 'quick', 'diagram', 'where', 'the', 'nuclei', 'of', 'the', 'cranial', 'pairs', 'start', 'from:', 'the', 'first', '4', 'above', 'the', 'pons,', 'the', 'next', '4', 'in', 'the', 'pons,', 'and', 'the', 'last', '4', 'below', 'the', 'pons,', 'we', 'have', 'that', 'the', 'facial', 'nucleus', 'is', 'in', 'the', 'middle', '4.'], ['That', 'is,', 'left', 'facial', 'nucleus,', 'left', 'pons,', 'so', 'answer', '4.']]
|
[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['An individual presents with "muscle weakness" (spastic hemiparesis) of both right extremities, with hyperreflexia and Babinski\'s sign, along with a "facial flaccid paralysis" of the left hemiface, with inability to close the left eye or retract the left side of the mouth, in addition to other alterations\n', 'We have a right hemiparesis and involvement of the left facial nucleus, since it has affected the upper and lower facial\n', 'Support'], ['We have a right hemiparesis and involvement of the left facial nucleus, since it has affected the upper and lower facial\n', 'therefore we have a crossed clinical picture, having to think about brainstem involvement\n', 'Support'], ['If we have in a quick diagram where the nuclei of the cranial pairs start from: the first 4 above the pons, the next 4 in the pons, and the last 4 below the pons, we have that the facial nucleus is in the middle 4\n', 'That is, left facial nucleus, left pons, so answer 4\n', 'Support'], ['That is, left facial nucleus, left pons, so answer 4\n', 'In the medial portion of the caudal protuberance of the left side\n', 'Support']]
|
70_127
|
[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY', 'MEDICINE'], ['CLINICAL', 'CASE:'], ['A', '30-year-old', 'woman', 'with', 'a', 'drug', 'addiction', 'PD', 'in', 'a', 'current', 'detoxification', 'period', 'is', 'brought', 'to', 'the', 'ED', 'with', 'profound', 'somnolence,', 'with', 'no', 'other', 'symptoms.'], ['We', 'find', 'out', 'that', 'her', 'treatment', 'includes', 'olanzapine', 'and', 'benzodiazepines.'], ['What', 'should', 'we', 'do', 'first?'], ['1-', 'Proceed', 'to', 'IOT.'], ['2-', 'Perform', 'a', 'skull', 'X-ray.'], ['3-', 'Administer', 'flumazenil.'], ['4-', 'Administer', 'naloxone.'], ['5-', 'Wait', 'until', 'he', 'wakes', 'up.'], ['CORRECT', 'ANSWER:', '3'], ['Overuse', 'of', 'the', 'drugs', 'he', 'is', 'taking', 'should', 'be', 'suspected.'], ['Olanzapine', 'has', 'no', 'antidote,', 'so,', 'in', 'principle,', 'we', 'should', 'antagonize', 'the', 'effect', 'of', 'benzodiazepines.'], ['If', 'the', 'patient', 'continues', 'to', 'be', 'drowsy', 'and', 'does', 'not', 'respond', 'to', 'stimuli,', 'we', 'should', 'proceed', 'to', 'intubate', 'to', 'secure', 'the', 'airway.']]
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[['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 principle, we should antagonize the effect of benzodiazepines\n', 'Administer flumazenil\n', 'Support']]
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463_71
|
[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY'], ['CLINICAL', 'CASE:'], ['Woman', 'with', 'hypotension', 'and', 'tissue', 'hypoperfusion', 'in', 'whom', 'the', 'following', 'parameters', 'are', 'objectified', 'after', 'insertion', 'of', 'a', 'Swan-Ganz', 'catheter:', 'cardiac', 'index', '1.4', 'L/min/m2,', 'pulmonary', 'capillary', 'wedge', 'pressure', '25', 'mmHg', 'and', 'systemic', 'vascular', 'resistances', '2000', 'dynes/m2.'], ['The', 'type', 'of', 'shock', 'presented', 'by', 'the', 'patient', 'is:'], ['1-', 'Cardiogenic.'], ['2-', 'Septic.'], ['3-', 'Hypovolemic.'], ['4-', 'Anaphylactic.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['We', 'are', 'not', 'given', 'any', 'further', 'data', 'on', 'the', 'patient', 'except', 'that', 'she', 'is', 'in', 'shock', '(tissue', 'hypoperfusion)', 'and', 'on', 'introducing', 'a', 'Swan-Ganz', 'catheter', 'we', 'find', 'a', 'low', 'cardiac', 'index', '(<2),', 'elevated', 'PCP', '(25mmHg)', 'and', 'elevated', 'systemic', 'resistances', '(normal:', '600-1200', 'dyne/m2).'], ['These', 'data', 'are', 'compatible', 'with', 'cardiogenic', 'origin', 'of', 'shock.']]
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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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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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[['We are not given any further data on the patient except that she is in shock (tissue hypoperfusion) and on introducing a Swan-Ganz catheter we find a low cardiac index (<2), elevated PCP (25mmHg) and elevated systemic resistances (normal: 600-1200 dyne/m2)\n', 'These data are compatible with cardiogenic origin of shock\n', 'Support'], ['These data are compatible with cardiogenic origin of shock\n', 'Cardiogenic\n', 'Support']]
|
476_93
|
[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '58-year-old', 'hypertensive', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'a', '30-second', 'syncope', 'while', 'jogging,', 'with', 'spontaneous', 'recovery', 'and', 'no', 'sequelae.'], ['Blood', 'pressure', 'is', '135/65', 'mmHg.'], ['Cardiac', 'auscultation', 'shows', 'a', 'loud,', 'intense', 'systolic', 'murmur,', 'which', 'is', 'reduced', 'with', 'Valsalva', 'maneuvers', 'and', 'an', 'attenuated', 'second', 'tone.'], ['The', 'ECG', 'shows', 'sinus', 'rhythm', 'at', '72', 'bpm,', 'with', 'criteria', 'of', 'left', 'ventricular', 'hypertrophy', 'and', 'inverted', 'T', 'waves', 'in', 'anterior', 'face.'], ['Point', 'out', 'the', 'correct', 'statement:'], ['1-', 'The', 'clinical', 'picture', 'suggests', 'pulmonary', 'thromboembolism.'], ['2-', 'The', 'data', 'provided', 'indicate', 'hypertrophic', 'cardiomyopathy', 'with', 'severe', 'obstruction', 'of', 'the', 'left', 'ventricular', 'outflow', 'tract.'], ['3-', 'These', 'data', 'correspond', 'to', 'severe', 'aortic', 'stenosis.'], ['4-', 'Aortic', 'dissection', 'should', 'be', 'excluded', 'by', 'contrast-enhanced', 'computed', 'tomography.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'data', 'provided', 'on', 'the', 'characteristics', 'of', 'the', 'murmur', '(it', 'DECREASES', 'with', 'Valsalva)', 'and', 'the', 'data', 'on', 'left', 'ventricular', 'hypertrophy,', 'lead', 'us', 'to', 'the', 'diagnosis', 'of', 'severe', 'aortic', 'stenosis.']]
|
[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Cardiac auscultation shows a loud, intense systolic murmur, which is reduced with Valsalva maneuvers and an attenuated second tone\n', 'The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis\n', 'Support'], ['The ECG shows sinus rhythm at 72 bpm, with criteria of left ventricular hypertrophy and inverted T waves in anterior face\n', 'The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis\n', 'Support'], ['The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis\n', 'These data correspond to severe aortic stenosis\n', 'Support']]
|
546_124
| null | null |
[]
|
313_177
|
[['QUESTION', 'TYPE:', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '57-year-old', 'patient', 'diagnosed', 'with', 'stage', 'T3N1M0', 'adenocarcinoma', 'of', 'the', 'colon.'], ['He', 'was', 'treated', 'with', 'resection', 'followed', 'by', 'postoperative', 'FOLFOX', 'chemotherapy', '(fluorouracil,', 'leucovorin', 'and', 'oxaliplatin)', 'for', '6', 'months.'], ['In', 'a', 'routine', 'control,', 'two', 'years', 'later,', 'carcinoembryonic', 'antigen', '(CEA)', 'elevation', 'to', '30', 'ng/mL', '(previously', 'less', 'than', '2', 'ng/mL)', 'was', 'detected.'], ['She', 'has', 'no', 'symptoms,', 'physical', 'examination', 'is', 'unremarkable,', 'chest', 'X-ray', 'is', 'normal.'], ['CT', 'scan', 'shows', 'a', '3', 'cm', 'mass', 'in', 'the', 'right', 'hepatic', 'lobe', 'that', 'is', 'captured', 'on', 'PET.'], ['No', 'other', 'alterations', 'are', 'observed', 'in', 'CT', 'or', 'PET.'], ['What', 'is', 'the', 'most', 'correct', 'approach?'], ['1-', 'Chemotherapy', 'with', 'FOLFIRI', '(fluorouracil,', 'leucovorin', 'and', 'irinotecan)', 'plus', 'bevacizumab.'], ['2-', 'Monochemotherapy', 'with', 'capecitabine.'], ['3-', 'Assessment', 'for', 'surgical', 'resection', 'of', 'the', 'hepatic', 'lesion.'], ['4-', 'Hepatic', 'radiotherapy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'faced', 'with', 'a', 'situation', 'of', 'probable', 'liver', 'metastasis', 'from', 'a', 'localized', 'colon', 'adenocarcinoma', 'treated', '2', 'years', 'ago.'], ['Probable', 'because', 'we', 'do', 'not', 'have', 'histological', 'confirmation,', 'although', 'as', 'it', 'usually', 'happens,', 'what', 'else', 'could', 'it', 'be?'], ['As', 'this', 'is', 'a', 'situation', 'of', 'oligometastasis', 'and', 'the', 'treatments', 'for', 'advanced', 'colon', 'adenocarcinoma', 'allow', 'prolonged', 'survival', 'with', 'good', 'quality', 'of', 'life', 'in', 'these', 'patients,', 'if', 'there', 'is', 'nothing', 'to', 'contraindicate', 'surgery,', 'this', 'should', 'be', 'the', 'first', 'option', '(correct', 'answer', '3).'], ['I', 'attach', 'the', 'algorithm', 'proposed', 'by', 'the', 'NCCN', 'in', 'situations', 'of', 'recurrence', '(http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf).'], ['In', 'case', 'of', 'an', 'unresectable', 'situation,', 'chemotherapy', 'treatment', 'would', 'be', 'considered', 'with', 'the', 'intention', 'of', 'converting', 'the', 'single', 'metastatic', 'lesion', 'into', 'a', 'resectable', 'one.'], ['Since', 'more', 'than', '12', 'months', 'have', 'passed', 'since', 'FOLFOX', 'treatment,', 'the', 'same', 'scheme', 'could', 'be', 'used,', 'although', 'FOLFIRI+bevacizumab', 'would', 'also', 'be', 'useful.'], ['Capecitabine', 'monotherapy,', 'in', 'the', "patient's", 'current', 'situation,', 'would', 'also', 'not', 'be', 'a', 'good', 'starting', 'option,', 'since', 'the', 'responses', 'are', 'lower', 'compared', 'to', 'FOLFOX', 'or', 'FOLFIRI', 'plus', 'antiangiogenic', 'combinations.'], ['Hepatic', 'radiotherapy', 'could', 'be', 'considered,', 'since', 'there', 'are', 'SBRT', 'techniques', 'that', 'achieve', 'very', 'good', 'results,', 'but', 'in', 'this', 'case', 'it', 'is', 'best', 'to', 'start', 'by', 'asking', 'for', 'an', 'assessment', 'by', 'the', 'surgeons', 'and', 'if', 'they', 'rule', 'out', 'surgery', 'we', 'would', 'consider', 'RT.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', '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']]
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[['As this is a situation of oligometastasis and the treatments for advanced colon adenocarcinoma allow prolonged survival with good quality of life in these patients, if there is nothing to contraindicate surgery, this should be the first option\n', 'Assessment for surgical resection of the hepatic lesion\n', 'Support'], ['correct answer 3\n', 'Assessment for surgical resection of the hepatic lesion\n', 'Support'], ['the responses are lower compared to FOLFOX or FOLFIRI plus antiangiogenic combinations\n', "Capecitabine monotherapy, in the patient's current situation, would also not be a good starting option\n", 'Support'], ['there are SBRT techniques that achieve very good results\n', 'Hepatic radiotherapy could be considered\n', 'Support'], ['but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT\n', 'Assessment for surgical resection of the hepatic lesion\n', 'Support'], ['but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT\n', 'Hepatic radiotherapy could be considered\n', 'Attack'], ['although FOLFIRI+bevacizumab would also be useful\n', 'Chemotherapy with FOLFIRI (fluorouracil, leucovorin and irinotecan) plus bevacizumab\n', 'Support'], ["Capecitabine monotherapy, in the patient's current situation, would also not be a good starting option\n", 'Monochemotherapy with capecitabine\n', 'Attack'], ['Hepatic radiotherapy could be considered\n', 'Hepatic radiotherapy\n', 'Support'], ['but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT\n', 'Hepatic radiotherapy\n', 'Attack']]
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482_173
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[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'is', 'brought', 'to', 'the', 'ED', 'from', 'a', 'fire', 'occurring', 'inside', 'an', 'enclosed', 'building', 'where', 'polyurethane', 'foams', 'were', 'present.'], ['He', 'is', 'conscious,', 'but', 'presents', 'with', 'increasing', 'mental', 'dullness,', 'headache,', 'and', 'severe', 'dyspnea.'], ['Oxygen', 'saturation', 'by', 'pulse', 'oximetry', 'is', '92%', 'and', 'capillary', 'lactic', 'acid', 'is', '8', 'mEq/l.'], ['What', 'specific', 'treatment', 'do', 'you', 'consider', 'most', 'appropriate?'], ['1-', 'Administration', 'of', 'oxygen', 'by', 'means', 'of', 'a', '50%', 'Venturi', 'type', 'mask.'], ['2-', 'Administration', 'of', 'intravenous', 'hydroxycobalamin.'], ['3-', 'Ventilation', 'with', 'hyperbaric', 'chamber.'], ['4-', 'Fluid', 'therapy', 'with', 'infusion', 'of', 'physiological', 'saline', 'solution', 'at', '21', 'ml/h.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'first', 'thing', 'we', 'need', 'to', 'know', 'is', 'that', 'combustion', 'of', 'polyurethane', 'at', 'high', 'temperature', 'results', 'in', 'the', 'release', 'of', 'cyanide', '(very', 'intuitive,', 'yes).'], ['Knowing', 'this,', 'and', 'that', 'we', 'are', 'dealing', 'with', 'cyanide', 'poisoning,', 'it', 'is', 'easier', 'to', 'answer', 'the', 'question.'], ['Among', 'the', 'basic', 'initial', 'treatment', 'measures', 'would', 'be', 'the', 'administration', 'of', 'oxygen', 'therapy', 'with', 'FiO2', '1', '(not', '0.5', 'as', 'stated', 'in', 'option', '1),', 'and', 'an', 'antidote,', 'in', 'this', 'case', 'hydroxycobalamin', '(this', 'was', 'asked', 'similarly', 'last', 'year).'], ['Ventilation', 'with', 'hyperbaric', 'chamber', 'would', 'only', 'be', 'indicated', 'in', 'case', 'of', 'coexistence', 'of', 'carbon', 'monoxide', '(CO)', 'poisoning.'], ['What', 'is', 'stated', 'in', 'option', '4', 'about', 'fluid', 'therapy', 'is', 'not', 'indicated;', 'in', 'case', 'of', 'associated', 'shock,', 'volume', 'would', 'be', 'administered,', 'but', 'in', 'any', 'case', 'not', 'at', 'that', 'rate,', 'but', 'in', 'rapid', 'boluses.']]
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[['The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes)\n', 'Knowing this, and that we are dealing with cyanide poisoning, it is easier to answer the question\n', 'Support'], ['Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin\n', 'Administration of oxygen by means of a 50% Venturi type mask\n', 'Attack'], ['Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin\n', 'Administration of intravenous hydroxycobalamin\n', 'Support'], ['The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes)\n', 'Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning\n', 'Attack'], ['Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning\n', 'Ventilation with hyperbaric chamber\n', 'Attack'], ['What is stated in option 4 about fluid therapy is not indicated\n', 'Fluid therapy with infusion of physiological saline solution at 21 ml/h\n', 'Attack'], ['in case of associated shock, volume would be administered, but in any case not at that rate, but in rapid boluses\n', 'What is stated in option 4 about fluid therapy is not indicated\n', 'Support']]
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105_233
| null | null |
[]
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73_62
|
[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCIES'], ['CLINICAL', 'CASE:'], ['A', '37-year-old', 'man', 'with', 'no', 'past', 'history', 'of', 'interest', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'syncope', 'while', 'walking.'], ['He', 'had', 'started', 'two', 'days', 'earlier', 'with', 'dyspnea', 'on', 'exertion.'], ['Examination:', 'weight', '75', 'kg,', 'BP', '75/50', 'mm', 'Hg.'], ['SatO2', '89%.'], ['Pulmonary', 'auscultation', 'was', 'normal.'], ['Cardiac', 'auscultation:', 'rhythmic', 'tachycardic', 'tones', 'at', '130', 'bpm.'], ['Abdomen', 'normal.'], ['Extremities:', 'no', 'alterations.'], ['Normal', 'hemogram.'], ['Troponin', '1.2', 'ng', '/', 'ml.'], ['ECG:', 'Sensual', 'tachycardia', 'at', '130', 'bpm.'], ['Inverted', 'T', 'in', 'V1-V4.'], ['Thoracic', 'CT', 'angiography:', 'repletion', 'defect', 'in', 'both', 'main', 'pulmonary', 'arteries.'], ['One', 'hour', 'after', 'arrival', 'at', 'the', 'emergency', 'room,', 'BP', '70/55', 'mm', 'Hg', 'persists.'], ['What', 'would', 'be', 'the', 'most', 'appropriate', 'initial', 'treatment?'], ['1-', 'Unfractionated', 'heparin,', '10,000U', 'iv', 'on', 'clinical', 'suspicion.', 'Fibrinolysis', 'with', 'tPA', '100', 'mg', 'iv', 'once', 'the', 'diagnosis', 'is', 'confirmed.'], ['2-', 'Enoxaparin:', '80', 'mg', 'sc', 'every', '12', 'hours,', 'starting', 'upon', 'diagnostic', 'suspicion.'], ['3-', 'Enoxaparin;', '80', 'mg', 'sc', 'every', '12', 'hours,', 'starting', 'upon', 'diagnostic', 'confirmation.'], ['4-', 'Fondaparinux:', '7.5', 'mg', 'sc', 'daily.'], ['5-', 'Emergency', 'pulmonary', 'thromboendarterectomy.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'clinical', 'case', 'is', 'a', 'typical', 'pulmonary', 'thromboembolism.'], ['In', 'this', 'case', 'it', 'is', 'associated', 'with', 'persistent', 'arterial', 'hypotension.'], ['Option', '2', 'would', 'be', 'correct', 'if', 'the', 'patient', 'were', 'not', 'hypotensive.'], ['Option', '3', 'is', 'not', 'correct', 'since', 'diagnostic', 'confirmation', 'is', 'not', 'necessary', 'to', 'initiate', 'anticoagulant', 'therapy', 'in', 'case', 'of', 'PTE', 'without', 'hypotension.'], ['Option', '4', 'is', 'not', 'indicated.'], ['Option', '5', 'would', 'be', 'correct', 'only', 'if', 'the', 'patient', 'had', 'a', 'contraindication', 'to', 'fibrinolysis.'], ['Persistent', 'hypotension', 'in', 'PTE', 'is', 'the', 'most', 'widely', 'accepted', 'indication', 'for', 'fibrinolysis,', 'so', 'the', 'correct', 'option', 'is', '1.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-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'], ['B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['In this case it is associated with persistent arterial hypotension\n', 'Option 2 would be correct if the patient were not hypotensive\n', 'Support'], ['Option 2 would be correct if the patient were not hypotensive\n', 'Enoxaparin: 80 mg sc every 12 hours, starting upon diagnostic suspicion\n', 'Attack'], ['diagnostic confirmation is not necessary to initiate anticoagulant therapy in case of PTE without hypotension\n', 'Option 3 is not correct\n', 'Support'], ['Option 3 is not correct\n', 'Enoxaparin; 80 mg sc every 12 hours, starting upon diagnostic confirmation\n', 'Attack'], ['Option 4 is not indicated\n', 'Fondaparinux: 7.5 mg sc daily\n', 'Attack'], ['Option 5 would be correct only if the patient had a contraindication to fibrinolysis\n', 'Emergency pulmonary thromboendarterectomy\n', 'Attack'], ['Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis\n', 'the correct option is 1\n', 'Support'], ['the correct option is 1\n', 'Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed\n', 'Support'], ['Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis\n', 'Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed\n', 'Support']]
|
538_2
| null | null |
[]
|
139_166
|
[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'smoker', 'and', 'heavy', 'drinker', 'with', 'no', 'other', 'history', 'of', 'interest.'], ['The', 'picture', 'he', 'explains', 'is', 'odynodysphagia', 'of', '3', 'months', 'of', 'evolution', 'and', 'left', 'otalgia.'], ['He', 'provides', 'a', "dentist's", 'report', 'that', 'rules', 'out', 'a', 'dental', 'cause.'], ['He', 'also', 'refers', 'to', 'having', 'been', 'visited', 'by', 'different', 'specialists', 'and', 'provides', 'a', 'head', 'and', 'neck', 'CAT', 'scan', '(without', 'iodine', 'contrast)', 'which', 'is', 'reported', 'as', 'normal.'], ['On', 'examination', 'there', 'was', 'a', 'decrease', 'in', 'the', 'propulsive', 'capacity', 'of', 'the', 'tongue;', 'palpation', 'of', 'the', 'base', 'of', 'the', 'left', 'tongue', 'showed', 'an', 'induration', 'of', 'stony', 'consistency', 'of', 'approximately', '3cm', 'and', 'with', 'indirect', 'laryngoscopy', 'no', 'ulceration', 'of', 'the', 'mucosa', 'was', 'observed.'], ['Cervical', 'palpation', 'is', 'negative', 'for', 'lymphadenopathy.'], ['What', 'is', 'your', 'presumptive', 'diagnosis', 'and', 'course', 'of', 'action?'], ['1-', 'Dental', 'cause', '/', 'reevaluation', 'by', 'the', 'dentist.'], ['2-', 'Abscess', 'of', 'the', 'base', 'of', 'the', 'tongue', '/', 'debridement.'], ['3-', 'Ankyloglossia', '/', 'surgical', 'release', 'of', 'the', 'same.'], ['4-', 'Malignant', 'process', 'of', 'oropharynx', '/', 'repeat', 'CT', 'scan', 'and', 'biopsy.'], ['5-', 'Nonspecific', 'inflammation', '/', 'corticosteroid', 'treatment.'], ['CORRECT', 'ANSWER:', '4'], ['We', 'are', 'presented', 'with', 'a', 'patient', 'with', 'risk', 'factors', 'for', 'oropharyngeal', 'cancer,', 'but', 'in', 'whom', 'the', 'examination', 'and', 'tests', 'are', 'normal.'], ['What', 'is', 'going', 'on', 'here?'], ['This', 'question', 'is', 'reverse', 'psychology:', 'what', 'did', 'the', 'questioner', 'want', 'me', 'to', 'know?'], ['This', 'question', 'was', 'asked', 'by', 'an', 'otolaryngologist.'], ['He', 'already', 'tells', 'you', 'that', 'the', 'dentist', '"didn\'t', 'see', 'anything",', 'so', 'he', 'rules', 'out', '1.'], ['It', 'is', 'not', 'an', 'abscess', 'of', 'the', 'base', 'of', 'the', 'tongue', 'either,', 'because', 'in', 'three', 'months', 'it', 'would', 'have', 'killed', 'him:', 'neither', 'is', '2.'], ['So', 'we', 'are', 'left', 'with', 'ankyloglossia,', 'tongue', 'base', 'cancer', 'and', 'non-specific', 'inflammation.'], ['When', 'there', 'is', 'doubt', 'that', 'it', 'could', 'be', 'cancer,', 'we', 'should', 'not', 'fool', 'around', 'and', 'order', 'a', 'new', 'CT', 'scan', 'and', 'biopsy.'], ['Tongue', 'base', 'cancers', 'are', 'very', 'treacherous', 'and', 'it', 'is', 'one', 'of', 'the', 'fears', 'of', 'any', 'otolaryngologist', 'when', 'he', 'suspects', 'a', 'neoplasm.'], ['It', 'is', 'not', 'uncommon', 'for', 'them', 'to', 'arise', 'without', 'exophytic', 'masses', 'or', 'ulcerations', 'of', 'the', 'tongue', 'mucosa', 'and', 'they', 'are', 'difficult', 'to', 'detect', 'on', 'CT', 'when', 'contrast', 'is', 'not', 'used.'], ['The', 'correct', 'answer', 'is', '4', 'and', 'I', 'do', 'not', 'think', 'it', 'can', 'be', 'challenged.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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'], ['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'], ['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'], ['O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', '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 already tells you that the dentist "didn\'t see anything", so he rules out 1\n', 'Dental cause / reevaluation by the dentist\n', 'Attack'], ["He provides a dentist's report that rules out a dental cause\n", 'Dental cause / reevaluation by the dentist\n', 'Attack'], ['It is not an abscess of the base of the tongue either, because in three months it would have killed him: neither is 2\n', 'Abscess of the base of the tongue / debridement\n', 'Attack'], ['The picture he explains is odynodysphagia of 3 months of evolution and left otalgia\n', 'Abscess of the base of the tongue / debridement\n', 'Attack'], ['When there is doubt that it could be cancer, we should not fool around and order a new CT scan and biopsy\n', 'Malignant process of oropharynx / repeat CT scan and biopsy\n', 'Support'], ['Tongue base cancers are very treacherous and it is one of the fears of any otolaryngologist when he suspects a neoplasm\n', 'Malignant process of oropharynx / repeat CT scan and biopsy\n', 'Support'], ['palpation of the base of the left tongue showed an induration of stony consistency of approximately 3cm and with indirect laryngoscopy no ulceration of the mucosa was observed\n', 'Malignant process of oropharynx / repeat CT scan and biopsy\n', 'Support'], ['He also refers to having been visited by different specialists and provides a head and neck CAT scan (without iodine contrast) which is reported as normal\n', 'Malignant process of oropharynx / repeat CT scan and biopsy\n', 'Support'], ['It is not uncommon for them to arise without exophytic masses or ulcerations of the tongue mucosa and they are difficult to detect on CT when contrast is not used\n', 'Malignant process of oropharynx / repeat CT scan and biopsy\n', 'Support'], ['The correct answer is 4 and I do not think it can be challenged\n', 'Malignant process of oropharynx / repeat CT scan and biopsy\n', 'Support']]
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446_130
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '28-year-old', 'man', 'comes', 'to', 'the', 'hospital', 'emergency', 'room', 'with', 'gross', 'hematuria.'], ['Which', 'of', 'the', 'following', 'urinalysis', 'abnormalities', 'would', 'support', 'a', 'diagnosis', 'of', 'glomerulonephritis?'], ['1-', 'Dysmorphic', 'red', 'blood', 'cells', 'and/or', 'hematic', 'casts.'], ['2-', 'Proteinuria', 'of', '1', 'g/day,', 'with', 'negative', 'test', 'strip', 'result', 'and', 'with', 'microalbuminuria', 'greater', 'than', '300', 'mg/24', 'hours.'], ['3-', 'Coexistence', 'of', 'hematuria', 'with', 'pyuria', 'without', 'bacteriuria.'], ['4-', 'Clots', 'in', 'the', 'urine', 'with', 'the', 'naked', 'eye.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Glomerulonephritis', 'is', 'typically', 'associated', 'with', 'dysmorphic', 'red', 'blood', 'cells', 'and', 'hematic', 'casts', 'in', 'the', 'sediment', '(option', '1', 'correct).'], ['Proteinuria', 'can', 'also', 'appear', 'in', 'variable', 'range,', 'although', 'it', 'is', 'not', 'usual', 'in', 'the', 'form', 'of', 'isolated', 'microalbuminuria', '(incorrect', 'option', '2),', 'and', 'hematuria', 'with', 'pyuria', 'although', 'it', 'is', 'not', 'characteristic', '(incorrect', 'option', '3).'], ['Clots', 'usually', 'appear', 'in', 'the', 'context', 'of', 'alterations', 'of', 'the', 'lower', 'urinary', 'tract', '(option', '4', 'incorrect).']]
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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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Disease'], ['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'], ['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', '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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim', 'O', 'B-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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[['Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment\n', 'Dysmorphic red blood cells and/or hematic casts\n', 'Support'], ['Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment\n', 'option 1 correct\n', 'Support'], ['option 1 correct\n', 'Dysmorphic red blood cells and/or hematic casts\n', 'Support'], ['although it is not usual in the form of isolated microalbuminuria\n', 'Proteinuria can also appear in variable range\n', 'Attack'], ['although it is not usual in the form of isolated microalbuminuria\n', 'incorrect option 2\n', 'Support'], ['incorrect option 2\n', 'Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours\n', 'Attack'], ['although it is not usual in the form of isolated microalbuminuria\n', 'Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours\n', 'Attack'], ['hematuria with pyuria although it is not characteristic\n', 'incorrect option 3\n', 'Support'], ['incorrect option 3\n', 'Coexistence of hematuria with pyuria without bacteriuria\n', 'Attack'], ['hematuria with pyuria although it is not characteristic\n', 'Coexistence of hematuria with pyuria without bacteriuria\n', 'Attack'], ['Clots usually appear in the context of alterations of the lower urinary tract\n', 'option 4 incorrect\n', 'Support'], ['option 4 incorrect\n', 'Clots in the urine with the naked eye\n', 'Attack'], ['Clots usually appear in the context of alterations of the lower urinary tract\n', 'Clots in the urine with the naked eye\n', 'Attack']]
|
551_130
| null | null |
[]
|
383_150
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '12-month-old', 'boy,', 'who', 'in', 'the', 'health', 'examinations', 'performed', 'since', 'birth', 'presents', 'right', 'testicle', 'in', 'the', 'inguinal', 'canal', 'that', 'is', 'not', 'possible', 'to', 'descend', 'to', 'the', 'scrotum.'], ['Mark', 'the', 'correct', 'answer:'], ['1-', 'The', 'most', 'probable', 'diagnosis', 'is', 'retractile', 'testicle.'], ['2-', 'Wait', 'until', 'two', 'years', 'of', 'age', 'for', 'its', 'spontaneous', 'decrease.'], ['3-', 'Human', 'chorionic', 'gonadotropin', 'is', 'the', 'treatment', 'of', 'first', 'choice.'], ['4-', 'The', 'indication', 'for', 'orchidopexy', 'should', 'not', 'be', 'deferred.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'retractile', 'testicle', 'is', 'characterized', 'by', 'the', 'testicle', 'being', 'permanently', 'outside', 'the', 'scrotal', 'sac,', 'being', 'possible', 'to', 'descend', 'it', 'manually', '(although', 'when', 'it', 'is', 'released', 'it', 'automatically', 'returns', 'to', 'its', 'initial', 'location).'], ['It', 'is', 'usually', 'due', 'to', 'a', 'short', 'pedicle.'], ['In', 'this', 'case', 'we', 'are', 'being', 'told', 'that', 'the', 'teste', 'is', 'always', 'in', 'the', 'inguinal', 'canal', '(cryptorchidism)', 'so', 'we', 'can', 'discard', 'option', '1.'], ['Hormonal', 'treatment', 'with', 'HCG', 'has', 'already', 'fallen', 'into', 'disuse,', 'due', 'to', 'its', 'low', 'efficacy,', 'possibility', 'of', 'reascension', 'and', 'because', 'apoptotic', 'and', 'inflammatory', 'phenomena', 'have', 'been', 'described', 'in', 'the', 'teste', 'associated', 'with', 'its', 'use', '(we', 'discard', 'option', '3).'], ['Orchidopexy', 'is', 'the', 'treatment', 'of', 'choice', 'when', 'we', 'are', 'faced', 'with', 'cryptorchidism,', 'being', 'desirable', 'to', 'perform', 'it', 'between', '6', 'months', 'and', 'one', 'year', 'of', 'age,', 'and', 'should', 'not', 'be', 'deferred', 'beyond', 'two', 'years', 'of', 'age.']]
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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', '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'], ['O', 'B-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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In this case we are being told that the teste is always in the inguinal canal (cryptorchidism)\n', 'we can discard option 1\n', 'Support'], ['we can discard option 1\n', 'The most probable diagnosis is retractile testicle\n', 'Attack'], ['In this case we are being told that the teste is always in the inguinal canal (cryptorchidism)\n', 'The retractile testicle is characterized by the testicle being permanently outside the scrotal sac, being possible to descend it manually (although when it is released it automatically returns to its initial location)\n', 'Attack'], ['The retractile testicle is characterized by the testicle being permanently outside the scrotal sac, being possible to descend it manually (although when it is released it automatically returns to its initial location)\n', 'The most probable diagnosis is retractile testicle\n', 'Attack'], ['Orchidopexy is the treatment of choice when we are faced with cryptorchidism, being desirable to perform it between 6 months and one year of age, and should not be deferred beyond two years of age\n', 'The indication for orchidopexy should not be deferred\n', 'Support'], ['Hormonal treatment with HCG has already fallen into disuse, due to its low efficacy, possibility of reascension and because apoptotic and inflammatory phenomena have been described in the teste associated with its use\n', 'we discard option 3\n', 'Support'], ['Hormonal treatment with HCG has already fallen into disuse, due to its low efficacy, possibility of reascension and because apoptotic and inflammatory phenomena have been described in the teste associated with its use\n', 'Human chorionic gonadotropin is the treatment of first choice\n', 'Attack'], ['we discard option 3\n', 'Human chorionic gonadotropin is the treatment of first choice\n', 'Attack']]
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614_118
|
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '41-year-old', 'male', 'consults', 'for', 'gonalgia', 'of', 'several', "days'", 'evolution.'], ['During', 'the', 'examination,', 'the', 'Thessaly', 'test', '(pain', 'with', 'internal', 'and', 'external', 'rotation', 'movements', 'with', 'the', 'knee', 'flexed)', 'is', 'positive.'], ['Which', 'of', 'the', 'following', 'lesions', 'is', 'most', 'likely', 'to', 'occur?'], ['1-', 'Meniscal', 'injury.'], ['2-', 'Injury', 'by', 'rupture', 'of', 'the', 'anterior', 'cruciate', 'ligament.'], ['3-', 'Injury', 'by', 'rupture', 'of', 'the', 'posterior', 'cruciate', 'ligament.'], ['4-', 'Degenerative', 'arthropathy', 'injury.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'Thessaly', 'maneuver', 'consists', 'of', 'the', 'patient,', 'using', 'monopodal', 'support', 'and', 'knee', 'flexion', 'of', '5º', 'and', 'then', '20º,', 'performing', 'internal', 'and', 'external', 'rotations', 'of', 'the', 'leg.'], ['In', 'case', 'this', 'reproduces', 'the', 'pain', 'that', 'the', 'patient', 'refers,', 'the', 'test', 'will', 'be', 'considered', 'as', 'positive.'], ['It', 'is', 'a', 'test', 'used', 'for', 'the', 'diagnosis', 'of', 'meniscal', 'pathology', '(sensitivity', 'greater', 'than', '90%', 'and', 'specificity', 'greater', 'than', '95%)', '(Answer', '1', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['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'], ['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5º and then 20º, performing internal and external rotations of the leg\n', 'In case this reproduces the pain that the patient refers, the test will be considered as positive\n', 'Support'], ['During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive\n', 'The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5º and then 20º, performing internal and external rotations of the leg\n', 'Support'], ['It is a test used for the diagnosis of meniscal pathology\n', 'Answer 1 correct\n', 'Support'], ['sensitivity greater than 90% and specificity greater than 95%\n', 'Answer 1 correct\n', 'Support'], ['In case this reproduces the pain that the patient refers, the test will be considered as positive\n', 'It is a test used for the diagnosis of meniscal pathology\n', 'Support'], ['During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive\n', 'In case this reproduces the pain that the patient refers, the test will be considered as positive\n', 'Support'], ['Answer 1 correct\n', 'Meniscal injury\n', 'Support']]
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499_182
| null | null |
[]
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613_118
|
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '41-year-old', 'male', 'consults', 'for', 'gonalgia', 'of', 'several', "days'", 'evolution.'], ['On', 'examination,', 'the', 'Thessaly', 'test', '(pain', 'with', 'internal', 'and', 'external', 'rotation', 'movements', 'with', 'the', 'knee', 'flexed)', 'is', 'positive.'], ['Which', 'of', 'the', 'following', 'injuries', 'is', 'more', 'likely?'], ['1-', 'Meniscal', 'injury.'], ['2-', 'Injury', 'due', 'to', 'rupture', 'of', 'the', 'anterior', 'cruciate', 'ligament.'], ['3-', 'Injury', 'by', 'rupture', 'of', 'the', 'posterior', 'cruciate', 'ligament.'], ['4-', 'Degenerative', 'arthropathy', 'injury.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Thessaly', 'test.', 'Provocation', 'test', 'performed', 'in', 'suspected', 'meniscal', 'injury.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', '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'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Thessaly test. Provocation test performed in suspected meniscal injury\n', 'Meniscal injury\n', 'Support']]
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247_117
|
[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'man', 'diagnosed', 'with', 'type', '2', 'diabetes', 'mellitus', 'comes', 'to', 'our', 'office.'], ['He', 'reported', 'a', 'fever', 'of', '40ºC', 'with', 'chills', 'and', 'shivering,', 'arthromyalgia', 'and', 'headache,', 'for', 'which', 'he', 'started', 'treatment', 'with', 'paracetamol.'], ['The', 'symptoms', 'started', '24', 'hours', 'before', 'his', 'return', 'to', 'Spain.'], ['Three', 'days', 'later', 'she', 'presented', 'a', 'generalized', 'maculopapular', 'rash', 'that', 'evolved', 'into', 'more', 'intense', 'petechiae', 'on', 'the', 'lower', 'limbs.'], ['She', 'presented', 'blood', 'tests', 'with', 'leukopenia', 'with', '3,200/mm3', 'and', 'platelets', '91,000/mm3', 'and', 'severe', 'elevation', 'of', 'aminotransferases.'], ['The', 'thick', 'blood', 'drop,', 'peripheral', 'blood', 'smear,', 'PCR', 'and', 'malaria', 'antigen', 'are', 'negative.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Coronavirus', 'infection.'], ['2-', 'Lymphocytic', 'choriomeningitis.'], ['3-', 'Dengue.'], ['4-', 'Chikungunya', 'virus', 'infection.'], ['5-', 'Saint', 'Louis', 'encephalitis.'], ['CORRECT', 'ANSWER:', '3'], ['It', 'is', 'striking', 'in', 'this', 'question', 'that', 'we', 'are', 'told', 'that', 'our', 'patient', 'has', 'returned', 'to', 'Spain,', 'but', 'not', 'from', 'where', '(which', 'could', 'help', 'us', 'to', 'make', 'digressions', 'about', 'the', 'possible', 'cause).'], ['However,', 'the', 'description', 'of', 'the', 'picture', 'is', 'very', 'exhaustive', 'as', 'well', 'as', 'typical,', 'so', 'the', 'question', 'is', 'easy.'], ['It', 'is', 'a', 'disease', 'that', 'produces', 'fever,', 'arthralgias', 'and', 'a', 'generalized', 'exanthema', 'with', 'petechiae', 'on', 'the', 'lower', 'limbs.'], ['The', 'CBC', 'shows', 'leukopenia', 'accompanied', 'by', 'plateletopenia', 'and', 'elevated', 'transaminases.'], ['Malaria', 'has', 'been', 'ruled', 'out', 'as', 'a', 'possible', 'cause.'], ['All', 'the', 'data', 'are', 'highly', 'suggestive', 'of', 'Dengue,', 'especially', 'the', 'plateletopenia', 'and', 'petechiae', '(suggestive', 'of', 'capillary', 'fragility),', 'answer', '3', 'correct.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['the description of the picture is very exhaustive as well as typical\n', 'All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n', 'Support'], ['It is a disease that produces fever, arthralgias and a generalized exanthema with petechiae on the lower limbs\n', 'All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n', 'Support'], ['The CBC shows leukopenia accompanied by plateletopenia and elevated transaminases\n', 'All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n', 'Support'], ['Malaria has been ruled out as a possible cause\n', 'All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n', 'Support'], ['All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n', 'answer 3 correct\n', 'Support'], ['All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n', 'Dengue\n', 'Support'], ['answer 3 correct\n', 'Dengue\n', 'Support']]
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88_56
|
[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'with', 'a', 'history', 'of', 'hypertension', 'treated', 'with', 'amlodipine', 'was', 'admitted', '3', 'months', 'ago', 'for', 'heart', 'failure', 'and', 'atrial', 'fibrillation.'], ['She', 'came', 'to', 'your', 'office', 'for', 'a', 'cardiological', 'check-up.'], ['The', 'discharge', 'report', 'shows', 'the', 'result', 'of', 'the', 'echocardiogram', 'showing', 'moderate', 'left', 'ventricular', 'dysfunction', 'and', 'the', 'discharge', 'treatment:', 'amlodipine', 'was', 'discontinued', 'and', 'furosemide', 'and', 'enalapril', 'were', 'started.'], ['The', 'patient', 'reports', 'feeling', 'better,', 'without', 'fatigue', 'and', 'with', 'less', 'leg', 'edema,', 'but', 'she', 'is', 'still', 'not', 'completely', 'well.'], ['Physical', 'examination', 'showed', 'no', 'signs', 'of', 'heart', 'failure,', 'but', 'her', 'blood', 'pressure', 'and', 'heart', 'rate', 'were', '150/90', 'mmHg', 'and', '120', 'bpm,', 'respectively.'], ['The', 'ECG', 'shows', 'atrial', 'fibrillation', 'at', '110-120', 'bpm.'], ['Which', 'treatment', 'is', 'most', 'likely', 'to', 'improve', 'symptoms', 'and', 'reduce', 'mortality', 'from', 'cardiovascular', 'events?'], ['1-', 'Digoxin', 'and', 'acetylsalicylic', 'acid.'], ['2-', 'Atenolol', 'and', 'acetylsalicylic', 'acid.'], ['3-', 'Verapamil', 'and', 'acenocoumarol.'], ['4-', 'Carvedilol', 'and', 'acenocoumarol.'], ['5-', 'Carvedilol', 'and', 'clopidogrel.'], ['CORRECT', 'ANSWER:', '4'], ['Typical', 'very', 'long', 'and', 'rambling', 'question', 'but', 'not', 'really', 'too', 'complicated...'], ['The', 'patient', 'is', 'in', 'heart', 'failure', 'with', 'moderate', 'ventricular', 'dysfunction', 'and', 'also', 'presents', 'atrial', 'fibrillation;', 'she', 'has', 'criteria', 'for', 'anticoagulation,', 'and', 'between', 'the', 'two', 'options', 'that', 'include', 'acenocoumarol', 'we', 'are', 'inclined', 'to', 'choose', 'option', '4,', 'since', 'it', 'includes', 'carvedilol,', 'a', 'drug', 'that', 'has', 'been', 'shown', 'to', 'increase', 'survival', 'in', 'heart', 'failure.'], ['Verapamil', '(and', 'calcium', 'antagonists', 'in', 'general)', 'are', 'contraindicated', 'in', 'systolic', 'heart', 'failure:', 'they', 'do', 'not', 'increase', 'survival', '(they', 'even', 'increase', 'morbidity', 'and', 'mortality)', 'and', 'specifically', 'the', 'non-dihydropyridines', '(verapamil', 'and', 'diltiazem)', 'should', 'not', 'be', 'associated', 'with', 'beta-blockers', 'due', 'to', 'the', 'increased', 'risk', 'of', 'conduction', 'system', 'blockade.']]
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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'], ['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'], ['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-Premise', 'I-Premise', '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-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'], ['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', 'B-Claim', 'I-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', 'I-Claim', 'I-Claim'], ['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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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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[['she has criteria for anticoagulation\n', 'between the two options that include acenocoumarol we are inclined to choose option 4\n', 'Support'], ['it includes carvedilol, a drug that has been shown to increase survival in heart failure\n', 'between the two options that include acenocoumarol we are inclined to choose option 4\n', 'Support'], ['between the two options that include acenocoumarol we are inclined to choose option 4\n', 'Carvedilol and acenocoumarol\n', 'Support'], ['Verapamil (and calcium antagonists in general) are contraindicated in systolic heart failure: they do not increase survival (they even increase morbidity and mortality) and specifically the non-dihydropyridines (verapamil and diltiazem) should not be associated with beta-blockers due to the increased risk of conduction system blockade\n', 'Verapamil and acenocoumaro\n', 'Attack']]
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536_122
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['75-year-old', 'male,', 'hypertensive', 'on', 'treatment', 'with', 'enalapril', '(20', 'mg/day),', 'who', 'consults', 'for', 'deterioration', 'of', 'general', 'condition,', 'bitemporal', 'headache', 'and', 'mandibular', 'claudication', 'of', '3', 'weeks', 'of', 'evolution.'], ['In', 'addition,', 'in', 'the', 'last', 'hours,', 'he', 'refers', 'two', 'episodes', 'of', 'amaurosis', 'fugax', 'of', 'the', 'left', 'eye.'], ['Physical', 'examination', 'revealed', 'thickening', 'and', 'absence', 'of', 'pulse', 'in', 'the', 'left', 'temporal', 'artery.'], ['Analysis:', 'CRP', '6', 'mg/dl', '(VN', '<1);', 'hemoglobin', '10.5', 'g/dl;', 'ESR', '92', 'mm.'], ['Chest', 'X-ray', 'normal.'], ['Considering', 'the', 'most', 'likely', 'diagnosis,', 'check', 'the', 'correct', 'option', 'regarding', 'treatment:'], ['1-', 'Rituximab', 'should', 'be', 'administered,', 'since', 'glucocorticoids', 'have', 'been', 'relegated', 'to', 'second-line', 'treatment', 'due', 'to', 'their', 'side', 'effects.'], ['2-', 'Tocilizumab', 'has', 'been', 'shown', 'to', 'be', 'effective', 'in', 'reducing', 'recurrences', 'and', 'cumulative', 'prednisone', 'dose', 'in', 'more', 'than', '50%', 'of', 'patients.'], ['3-', 'In', 'the', 'presence', 'of', 'ischemic', 'symptoms,', 'and', 'in', 'order', 'not', 'to', 'worsen', 'the', 'vascular', 'risk', 'of', 'the', 'patient,', 'the', 'use', 'of', 'glucocorticoids', 'at', 'doses', 'higher', 'than', '30', 'mg/day', 'should', 'be', 'avoided.'], ['4-', 'In', 'conjunction', 'with', 'glucocorticoid', 'boluses', 'of', '1', 'g/day,', 'infliximab', 'should', 'be', 'used', 'as', 'a', 'first-line', 'drug', 'for', 'remission', 'induction.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Clinical', 'case', 'of', 'giant', 'cell', 'arteritis.'], ['Corticosteroid', 'therapy', 'remains', 'the', 'first', 'choice', '(answer', '1', 'incorrect),', 'to', 'be', 'administered', 'as', 'pulses', '(doses', 'differ', 'according', 'to', 'the', 'literature,', 'but', 'at', 'least', '125', 'mg/d)', 'in', 'case', 'of', 'ocular', 'involvement', '(answer', '3', 'incorrect).'], ['The', 'current', 'treatment', 'of', 'choice', 'for', 'corticosteroid', 'sparing', 'is', 'Tocilizumab', '(answer', '4', 'incorrect),', 'which', 'has', 'also', 'been', 'shown', 'to', 'reduce', 'recurrences', '(answer', '2', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['The current treatment of choice for corticosteroid sparing is Tocilizumab (answer 4 incorrect), which has also been shown to reduce recurrences\n', 'answer 4 incorrect\n', 'Support'], ['answer 4 incorrect\n', 'In conjunction with glucocorticoid boluses of 1 g/day, infliximab should be used as a first-line drug for remission induction\n', 'Attack'], ['answer 1 incorrect\n', 'Rituximab should be administered, since glucocorticoids have been relegated to second-line treatment due to their side effects\n', 'Attack'], ['answer 3 incorrect\n', 'In the presence of ischemic symptoms, and in order not to worsen the vascular risk of the patient, the use of glucocorticoids at doses higher than 30 mg/day should be avoided\n', 'Attack'], ['Corticosteroid therapy remains the first choice (answer 1 incorrect), to be administered as pulses (doses differ according to the literature, but at least 125 mg/d) in case of ocular involvement\n', 'answer 1 incorrect\n', 'Support'], ['answer 1 incorrect\n', 'answer 3 incorrect\n', 'Support'], ['The current treatment of choice for corticosteroid sparing is Tocilizumab (answer 4 incorrect), which has also been shown to reduce recurrences\n', 'answer 2 correct\n', 'Support'], ['answer 2 correct\n', 'Tocilizumab has been shown to be effective in reducing recurrences and cumulative prednisone dose in more than 50% of patients\n', 'Support']]
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492_107
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['An', '18-year-old', 'patient', 'who', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'epistaxis', 'of', 'several', "days'", 'evolution,', 'with', 'no', 'personal', 'or', 'family', 'history', 'of', 'interest.'], ['On', 'examination', 'he', 'is', 'afebrile,', 'multiple', 'ecchymoses', 'are', 'observed,', 'no', 'splenomegaly', 'is', 'palpable.'], ['Laboratory', 'tests:', 'leukocytes', '7.2', 'x103/μL,', 'Hb', '12.3', 'g/dL,', 'platelets', '6.0', 'x103/μL.'], ['Thrombocytopenia', 'is', 'confirmed', 'in', 'the', 'smear,', 'where', 'platelets', 'of', 'increased', 'size', 'are', 'observed.'], ['Coagulation', 'and', 'biochemistry', 'studies', 'are', 'normal.'], ['What', 'do', 'you', 'consider', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['2-', 'Disseminated', 'intravascular', 'coagulation.'], ['3-', 'Thrombocytopenia', 'induced', 'by', 'infection.'], ['4-', 'Primary', 'immune', 'thrombocytopenia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'an', 'easy', 'clinical', 'case', 'only', 'presenting', 'thrombopenia', 'with', 'clinic,', 'petechiae', 'and', 'epistaxis.'], ['1', 'is', 'false,', 'there', 'would', 'be', 'fever,', 'hemolysis', 'data,', 'neurological', 'symptoms,', 'in', 'the', 'smear', 'there', 'would', 'be', 'schistocytes.'], ['In', '2', 'the', 'coagulation', 'must', 'be', 'altered', 'and', 'in', 'this', 'case', 'it', 'is', 'not', 'mentioned.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'I-Claim'], ['O', 'B-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'], ['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', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['there would be fever, hemolysis data, neurological symptoms, in the smear there would be schistocytes\n', '1 is false\n', 'Support'], ['1 is false\n', 'Thrombotic thrombocytopenic purpura\n', 'Attack'], ['in this case it is not mentioned\n', 'In 2 the coagulation must be altered\n', 'Attack'], ['In 2 the coagulation must be altered\n', 'Disseminated intravascular coagulation\n', 'Attack']]
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599_183
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[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['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', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Antiphospholipid', 'syndrome.'], ['2-', 'Factor', 'V', 'of', 'Leiden.'], ['3-', 'Hemophilia.'], ['4-', 'Acute', 'pericarditis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['In', 'this', 'clinical', 'case,', 'we', 'are', 'presented', 'with', 'a', 'woman', 'who', 'rapidly', 'presents', 'dyspnea', 'with', 'hypoxemia,', 'a', 'picture', 'compatible', 'with', 'pulmonary', 'thromboembolism.'], ['The', 'prothrombin', 'time', 'of', '90%', 'and', 'the', 'aPTT', 'with', 'a', 'ratio', 'of', '2,', 'is', 'translating', 'a', 'coagulation', 'problem;', 'and', 'antiphospholipid', 'antibodies', 'can', 'be', 'detected', 'through', 'the', 'prolongation', 'of', 'phospholipid-dependent', 'coagulation', 'tests,', 'correct', 'answer', '1.'], ['On', 'the', 'other', 'hand,', 'although', 'factor', 'V', 'Leiden', 'has', 'been', 'identified', 'as', 'a', 'common', 'cause', 'of', 'familial', 'thrombosis,', 'it', 'would', 'not', 'alter', 'the', 'clotting', 'time.'], ['In', 'the', 'case', 'of', 'hemophilia', 'there', 'would', 'be', 'a', 'problem', 'in', 'blood', 'coagulation', 'but', 'it', 'is', 'not', 'a', 'frequent', 'cause', 'of', 'thromboembolism.'], ['Finally,', 'although', 'acute', 'pericarditis', 'could', 'manifest', 'itself', 'in', '4', 'days', 'and', 'with', 'tachycardia,', 'the', 'rest', 'of', 'the', 'symptoms', 'or', 'analytical', 'parameters', 'are', 'not', 'characteristic.']]
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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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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', 'I-Claim', 'I-Claim', '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', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 clinical case, we are presented with a woman who rapidly presents dyspnea with hypoxemia\n', 'a picture compatible with pulmonary thromboembolism\n', 'Support'], ['Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)\n', 'The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem\n', 'Support'], ['The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem\n', 'correct answer 1\n', 'Support'], ['antiphospholipid antibodies can be detected through the prolongation of phospholipid-dependent coagulation tests\n', 'correct answer 1\n', 'Support'], ['correct answer 1\n', 'Antiphospholipid syndrome\n', 'Support'], ['Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)\n', 'On the other hand, although factor V Leiden has been identified as a common cause of familial thrombosis, it would not alter the clotting time\n', 'Attack'], ['On the other hand, although factor V Leiden has been identified as a common cause of familial thrombosis, it would not alter the clotting time\n', 'Factor V of Leiden\n', 'Attack'], ['In the case of hemophilia there would be a problem in blood coagulation but it is not a frequent cause of thromboembolism\n', 'Hemophilia\n', 'Attack'], ['Finally, although acute pericarditis could manifest itself in 4 days and with tachycardia, the rest of the symptoms or analytical parameters are not characteristic\n', 'Acute pericarditis\n', 'Attack']]
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134_169
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'pain', 'in', 'his', 'right', 'eye', 'of', '3', "days'", 'evolution.'], ['Biomicroscopic', 'examination', 'of', 'the', 'anterior', 'segment', 'shows,', 'after', 'fluorescein', 'staining,', 'a', 'central', 'corneal', 'ulcer', 'in', 'the', 'form', 'of', 'a', 'dendrite.'], ['What', 'is', 'the', 'diagnosis?'], ['1-', 'Herpetic', 'keratitis.'], ['2-', 'Corneal', 'abrasion.'], ['3-', 'Fungal', 'keratitis.'], ['4-', 'Bacterial', 'keratitis.'], ['5-', 'Glaucomatocyclic', 'crisis.'], ['CORRECT', 'ANSWER:', '1'], ['Dendritic', 'corneal', 'ulcer', 'is', 'typical', 'of', 'herpes', 'simplex', 'keratitis.'], ['It', 'presents', 'with', 'pain,', 'not', 'too', 'striking,', 'and', 'scarce', 'or', 'absent', 'red', 'eye.'], ['There', 'are', 'ulcers', 'resembling', 'dendrites', 'that', 'may', 'confuse', 'us', 'in', 'the', 'diagnosis.'], ['These', 'pseudodendrites', 'are', 'found', 'in', 'herpes', 'Zoster', 'and', 'in', 'corneal', 'abrasions', 'in', 'resolution.'], ['Although', 'in', 'practice', 'we', 'should', 'pay', 'attention', 'to', 'the', 'shape', 'of', 'the', 'dendrite', '(the', 'true', 'dendrite', 'is', 'deeper', 'and', 'has', 'terminal', 'bulbs', 'at', 'the', 'end', 'of', 'each', 'branch),', 'and', 'pay', 'attention', 'to', 'the', 'evolution', 'of', 'the', 'pain', '(in', 'the', 'pseudodendrite', 'after', 'abrasion', 'the', 'pain', 'should', 'improve),', 'when', 'answering', 'a', 'MIR', 'question', 'it', 'is', 'simpler:', 'if', 'it', 'is', 'a', 'dendrite,', 'the', 'first', 'thing', 'we', 'have', 'to', 'think', 'is', 'herpes.'], ['Fungal', 'and', 'bacterial', 'keratitis', 'have', 'corneal', 'infiltrates.'], ['And', 'glaucomatocyclitic', 'crisis', '(Posner', 'Schlossman', 'syndrome)', 'is', 'a', 'type', 'of', 'idiopathic', 'hypertensive', 'anterior', 'uveitis,', 'which', 'does', 'not', 'present', 'with', 'ulceration.']]
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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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['Dendritic corneal ulcer is typical of herpes simplex keratitis\n', 'Herpetic keratitis\n', 'Support'], ['Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite\n', 'Herpetic keratitis\n', 'Support'], ["A 35-year-old man comes to the emergency department with pain in his right eye of 3 days' evolution\n", 'Herpetic keratitis\n', 'Support'], ['It presents with pain, not too striking, and scarce or absent red eye\n', 'Herpetic keratitis\n', 'Support'], ['Although in practice we should pay attention to the shape of the dendrite (the true dendrite is deeper and has terminal bulbs at the end of each branch), and pay attention to the evolution of the pain (in the pseudodendrite after abrasion the pain should improve), when answering a MIR question it is simpler: if it is a dendrite, the first thing we have to think is herpes\n', 'Herpetic keratitis\n', 'Support'], ['Fungal and bacterial keratitis have corneal infiltrates\n', 'Fungal keratitis\n', 'Attack'], ['Fungal and bacterial keratitis have corneal infiltrates\n', 'Bacterial keratitis\n', 'Attack'], ['Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite\n', 'Glaucomatocyclic crisis\n', 'Attack'], ['And glaucomatocyclitic crisis (Posner Schlossman syndrome) is a type of idiopathic hypertensive anterior uveitis, which does not present with ulceration\n', 'Glaucomatocyclic crisis\n', 'Attack']]
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245_115
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'undergoing', 'chemotherapy', 'for', 'leukemia', 'is', 'admitted', 'for', 'pneumonia', 'for', 'which', 'treatment', 'with', 'cefepime', 'has', 'been', 'prescribed.'], ['A', 'chest', 'X-ray/CT', 'scan', 'shows', 'an', 'infiltrate', 'with', 'halo', 'sign', 'and', 'crescentic', 'meniscus.'], ['The', 'lesion', 'is', 'peripheral', 'and', 'a', 'transthoracic', 'puncture', 'is', 'indicated', 'for', 'sampling.'], ['Pending', 'definitive', 'histologic', 'and', 'microbiologic', 'results,', 'what', 'antimicrobial', 'would', 'you', 'add', 'to', 'the', 'treatment?'], ['1-', 'Ganciclovir.'], ['2-', 'Caspofungin.'], ['3-', 'Fluconazole.'], ['4-', 'Piperacillin-tazobactam.'], ['5-', 'Voriconazole.'], ['CORRECT', 'ANSWER:', '5'], ['Direct', 'response', 'question.'], ['This', 'is', 'a', 'patient', 'undergoing', 'chemotherapy', 'with', 'respiratory', 'symptoms', 'and', 'the', '"halo', 'sign"', 'on', 'X-ray,', 'very', 'suggestive', 'of', 'invasive', 'pulmonary', 'aspergillosis.'], ['Treatment', 'is', 'with', 'voriconazole.'], ['Aspergillus', 'is', 'resistant', 'to', 'fluconazole,', 'so', 'it', 'would', 'not', 'be', 'a', 'valid', 'option.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-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'], ['B-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', 'I-Claim']]
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[['This is a patient undergoing chemotherapy with respiratory symptoms and the "halo sign" on X-ray\n', 'very suggestive of invasive pulmonary aspergillosis\n', 'Support'], ['very suggestive of invasive pulmonary aspergillosis\n', 'Treatment is with voriconazole\n', 'Support'], ['Treatment is with voriconazole\n', 'Voriconazole\n', 'Support'], ['Aspergillus is resistant to fluconazole\n', 'it would not be a valid option\n', 'Support'], ['it would not be a valid option\n', 'Fluconazole\n', 'Attack'], ['Aspergillus is resistant to fluconazole\n', 'Fluconazole\n', 'Attack']]
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387_156
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '5-month-old', 'infant', 'exclusively', 'breastfed', 'until', 'the', 'present,', 'who', 'due', 'to', 'maternal', 'work', 'was', 'introduced', 'a', 'bottle', 'with', 'formula', 'and', 'a', 'few', 'days', 'ago', 'was', 'added', 'cereals', 'with', 'and', 'without', 'gluten.'], ['Family', 'history:', '28-year-old', 'mother', 'with', 'asthma,', '32-year-old', 'healthy', 'father', 'and', '5-year-old', 'brother', 'with', 'celiac', 'disease', 'and', 'atopic', 'dermatitis.'], ['As', 'personal', 'history,', 'pregnancy', 'without', 'incidents', 'and', 'delivery', 'by', 'cesarean', 'section,', 'having', 'been', 'offered', 'a', 'bottle', 'with', 'starter', 'formula', 'on', 'the', 'first', 'day', 'of', 'life', 'in', 'the', 'maternity', 'ward.'], ['Since', 'a', 'few', 'days', 'ago', 'she', 'starts', 'with', 'abdominal', 'distension,', 'diarrhea', 'stools,', 'refusal', 'to', 'feed,', 'peribuccal', 'erythema', 'with', 'longer', 'duration', 'after', 'bottle', 'feeding', 'and', 'lately', 'vomiting', 'after', 'feeding,', 'tolerating', 'well', 'the', 'breast.'], ['What', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Celiac', 'disease.'], ['2-', 'Acute', 'gastroenteritis.'], ['3-', "Cow's", 'milk', 'protein', 'allergy.'], ['4-', 'Bottle', 'allergy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Child', 'with', 'multiple', 'family', 'history', 'of', 'allergy', '(asthma,', 'atopy),', 'who', 'has', 'received', 'artificial', 'milk', 'in', 'the', 'first', 'hours', 'of', 'life', '(sensitization', 'to', "cow's", 'milk', 'protein)', 'and', 'who,', 'coinciding', 'with', 'the', 'intake', 'of', 'artificial', 'milk,', 'starts', 'digestive', 'symptoms', 'and', 'exanthema', '=', 'APLV.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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', 'B-Claim']]
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[['APLV\n', "Cow's milk protein allergy\n", 'Support']]
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41_139
|
[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Given', 'a', 'patient', 'with', 'poor', 'general', 'condition,', 'fever', '(axillary', 'temperature', '39.5º),', 'bilateral', 'submandibular', 'swelling', 'of', 'six', "days'", 'evolution,', 'mouth', 'pain', 'and', 'trismus,', 'which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'The', 'first', 'diagnostic', 'probability', 'is', 'carcinoma', 'of', 'the', 'floor', 'of', 'the', 'mouth', 'with', 'bilateral', 'cervical', 'metastases.'], ['2-', 'The', 'therapeutic', 'priority', 'is', 'to', 'ensure', 'the', "patient's", 'nutrition.'], ['3-', 'We', 'are', 'almost', 'certainly', 'facing', 'a', 'mediastinitis.'], ['4-', 'We', 'must', 'consider', 'as', 'a', 'priority', 'the', 'risk', 'of', 'airway', 'obstruction.'], ['5-', 'We', 'must', 'perform', 'as', 'a', 'first', 'diagnostic', 'measure', 'a', 'cytology', 'by', 'fine', 'needle', 'aspiration', 'puncture.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'patient', 'is', 'in', 'serious', 'condition.'], ['The', 'trismus', 'and', 'fever', 'suggest', 'a', 'deep', 'cervical', 'space', 'infection', 'and', 'that', 'is', 'not', 'a', 'game', 'because', 'the', 'airway', 'can', 'become', 'obstructed.'], ['Knowing', 'this,', 'options', '1,', '2', 'and', '5', 'are', 'out', 'of', 'place', 'and', 'I', 'am', 'left', 'with', '3', 'and', '4.'], ['There', 'may', 'already', 'be', 'mediastinitis;', 'after', 'all,', 'that', 'is', 'the', 'natural', 'history', 'of', 'cervical', 'deep', 'space', 'infections,', 'but', 'answer', '4', 'is', 'more', 'correct', 'and', 'besides,', 'we', 'are', 'in', 'the', 'ENT', 'block,', 'the', 'airway', 'specialty.'], ['I', 'like', 'this', 'question', 'because', 'it', 'requires', 'knowledge', 'that', 'is', 'important', 'in', 'clinical', 'practice.']]
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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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed\n', 'Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n', 'Support'], ['we are in the ENT block, the airway specialty.\n', 'answer 4 is more correct\n', 'Support'], ['Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n', 'The first diagnostic probability is carcinoma of the floor of the mouth with bilateral cervical metastases\n', 'Attack'], ['Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n', "The therapeutic priority is to ensure the patient's nutrition\n", 'Attack'], ['Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n', 'We must perform as a first diagnostic measure a cytology by fine needle aspiration puncture\n', 'Attack'], ['answer 4 is more correct\n', 'We must consider as a priority the risk of airway obstruction\n', 'Support'], ['There may already be mediastinitis\n', 'We are almost certainly facing a mediastinitis\n', 'Support']]
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385_153
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'of', 'a', 'newborn', 'with', 'microcephaly,', 'intrauterine', 'growth', 'retardation,', 'congenital', 'heart', 'disease,', 'vertical', 'talus', 'foot', 'and', 'a', 'peculiar', 'facies', '(microphthalmia,', 'small', 'palpebral', 'fissures,', 'micrognathia', 'and', 'dysplastic', 'ears),', 'hands', 'with', 'the', 'index', 'and', 'little', 'finger', 'above', 'the', 'middle', 'and', 'ring', 'fingers?'], ['1-', 'Trisomy', '18', "(Edwards'", 'syndrome).'], ['2-', 'Trisomy', '13', "(Patau's", 'syndrome).'], ['3-', 'Trisomy', '21', '(Down', 'syndrome).'], ['4-', 'Trisomy', '9.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['You', 'are', 'faithfully', 'describing', 'an', "Edwards'", 'syndrome.'], ['Although', 'the', 'cardiopathies', 'and', 'the', 'alteration', 'of', 'the', 'foot', 'that', 'he', 'describes', 'are', 'common', 'to', 'several', 'chromosomopathies,', 'the', 'alteration', 'of', 'the', 'fingers', 'and', 'toes', 'is', 'very', 'characteristic', 'of', "Edwards'", 'syndrome.']]
|
[['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'], ['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'], ['O', 'B-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']]
|
[["You are faithfully describing an Edwards' syndrome\n", "Trisomy 18 (Edwards' syndrome)\n", 'Support'], ["Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome\n", "Trisomy 18 (Edwards' syndrome)\n", 'Support']]
|
194_162
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '3-year-old', 'girl', 'from', 'Bangladesh', 'consults', 'for', 'intermittent', 'febrile', 'episodes', 'of', '3', "weeks'", 'duration,', 'associated', 'with', 'weakness', 'and', 'loss', 'of', 'appetite.'], ['Physical', 'examination', 'showed', 'marked', 'splenomegaly', 'and', 'mucocutaneous', 'pallor.'], ['Complementary', 'tests', 'include:', 'hemoglobin', '8.5', 'mg/dL,', 'hematocrit', '26%,', 'MCV', '86', 'fL,', 'MCH', '29', 'pg,', 'leukocytes', '2800/mL', 'with', '300', 'neutrophils', '/ml,', 'platelets', '54000/ml,', 'GOT', '85', 'U/l,', 'GPT92', 'U/l', 'and', 'polyclonal', 'hypergammaglobulinemia', 'in', 'serum', 'proteinogram.'], ['Indicate', 'the', 'most', 'probable', 'diagnosis', 'with', 'the', 'data', 'available', 'at', 'this', 'time:'], ['1-', 'Acute', 'lymphoblastic', 'leukemia.'], ['2-', "Burkitt's", 'lymphoma.'], ['3-', 'Visceral', 'leishmaniasis.'], ['4-', 'Miliary', 'tuberculosis.'], ['5-', 'Chronic', 'malaria.'], ['CORRECT', 'ANSWER:', '3'], ['Data', 'such', 'as', 'pancytopenia', 'and', 'hypergammaglobulinemia', 'are', 'very', 'characteristic', 'of', 'kala-azar.'], ['The', 'origin', 'of', 'the', 'girl', 'is', 'also', 'indicative', 'of', 'this', 'diagnosis,', 'although', 'it', 'is', 'a', 'disease', 'that', 'also', 'occurs', 'in', 'the', 'Mediterranean', 'area.'], ['In', 'the', 'differential', 'diagnosis,', 'it', 'is', 'important', 'to', 'keep', 'in', 'mind', 'the', 'possibility', 'of', 'leukosis.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-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'], ['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', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Complementary tests include: hemoglobin 8.5 mg/dL, hematocrit 26%, MCV 86 fL, MCH 29 pg, leukocytes 2800/mL with 300 neutrophils /ml, platelets 54000/ml, GOT 85 U/l, GPT92 U/l and polyclonal hypergammaglobulinemia in serum proteinogram\n', 'Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar\n', 'Support'], ['Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar\n', 'Visceral leishmaniasis\n', 'Support'], ['A 3-year-old girl from Bangladesh\n', 'The origin of the girl is also indicative of this diagnosis, although it is a disease that also occurs in the Mediterranean area\n', 'Support']]
|
371_126
| null | null |
[]
|
283_56
| null | null |
[]
|
109_149
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'asymptomatic', 'woman', 'goes', 'for', 'a', 'gynecological', 'health', 'check-up', 'because', 'she', 'wishes', 'to', 'become', 'pregnant.'], ['During', 'this', 'check-up,', 'a', '4cm', 'uterine', 'myoma', 'is', 'detected,', 'partly', 'intramural', 'and', 'partly', 'subserosal,', 'located', 'on', 'the', 'anterior', 'aspect', 'of', 'the', 'uterus', 'and', 'which', 'does', 'not', 'deform', 'the', 'endometrial', 'cavity.'], ['What', 'approach', 'would', 'you', 'recommend?'], ['1-', 'Laparoscopic', 'myomectomy.'], ['2-', 'Laparotomic', 'myomectomy.'], ['3-', 'Myoma', 'embolization', 'by', 'arterial', 'catheterization.'], ['4-', 'Treatment', 'with', 'Gn-Rh', 'analogues', 'for', 'three', 'months', 'before', 'attempting', 'pregnancy.'], ['5-', 'Attempting', 'pregnancy', 'without', 'any', 'previous', 'treatment.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'correct', 'answer', 'is', '5.'], ['An', 'asymptomatic', 'myoma', 'of', 'this', 'size', 'that', 'does', 'not', 'deform', 'the', 'endometrial', 'cavity', 'is', 'not', 'a', 'problem', 'for', 'pregnancy.']]
|
[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Treatment', 'I-Treatment'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['The correct answer is 5\n', 'Attempting pregnancy without any previous treatment\n', 'Support'], ['An asymptomatic myoma of this size that does not deform the endometrial cavity is not a problem for pregnancy\n', 'Attempting pregnancy without any previous treatment\n', 'Support'], ['During this check-up, a 4cm uterine myoma is detected, partly intramural and partly subserosal, located on the anterior aspect of the uterus and which does not deform the endometrial cavity\n', 'Attempting pregnancy without any previous treatment\n', 'Support']]
|
92_235
|
[['QUESTION', 'TYPE:', 'PALLIATIVE', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'patient', 'diagnosed', 'with', 'breast', 'neoplasia', '10', 'years', 'ago.'], ['She', 'underwent', 'treatment', 'with', 'radiochemotherapy', 'and', 'then', 'hormonal', 'therapy', 'for', '5', 'years.'], ['A', 'bone', 'scan', 'study', 'performed', 'for', 'polytopic', 'bone', 'pain', 'showed', 'the', 'presence', 'of', 'bone', 'metastases.'], ['She', 'is', 'currently', 'under', 'treatment', 'with', 'minor', 'opioids', 'and', 'NSAIDs', 'with', 'good', 'pain', 'control.'], ['She', 'consulted', 'for', 'headache', 'that', 'did', 'not', 'subside', 'with', 'the', 'current', 'analgesia', 'and', 'a', 'CT', 'scan', 'of', 'the', 'brain', 'showed', 'images', 'compatible', 'with', 'brain', 'metastases.'], ['In', 'relation', 'to', 'the', 'treatment', 'of', 'pain,', 'indicate', 'the', 'CORRECT', 'one:'], ['1-', 'Switch', 'to', 'major', 'opioids.'], ['2-', 'Extra', 'doses', 'of', 'opioids', 'should', 'be', 'administered', 'as', 'necessary.'], ['3-', 'Corticoids', 'should', 'be', 'added.'], ['4-', 'Switch', 'to', 'a', 'major', 'opioid', 'and', 'maintain', 'NSAIDs.'], ['5-', 'The', 'patient', 'should', 'be', 'admitted', 'for', 'intravenous', 'treatment', 'with', 'major', 'opioid.'], ['CORRECT', 'ANSWER:', '3'], ['Brain', 'metastases', 'produce', 'pain', 'due', 'to', 'cranial', 'hypertension.'], ['The', 'treatment', 'of', 'choice', 'is', 'corticosteroids.'], ['Dexamethasone', 'in', 'oral', 'doses', 'of', '4', 'to', '16', 'mg/day', 'is', 'the', 'treatment', 'of', 'choice.']]
|
[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['The treatment of choice is corticosteroids\n', 'Corticoids should be added\n', 'Support'], ['Brain metastases produce pain due to cranial hypertension\n', 'The treatment of choice is corticosteroids\n', 'Support']]
|
342_158
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman,', 'primigestation,', 'suffers', 'a', 'spontaneous', 'abortion', 'at', '7', 'weeks', 'of', 'gestation.'], ['The', 'anatomopathological', 'study', 'of', 'the', 'abortive', 'remains', 'indicates', 'molar', 'disease.'], ['We', 'should', 'inform', 'you', 'that:'], ['1-', 'The', 'risk', 'of', 'a', 'new', 'molar', 'gestation', 'in', 'a', 'future', 'pregnancy', 'is', '50%.'], ['2-', 'She', 'should', 'not', 'become', 'pregnant', 'until', 'she', 'has', 'undergone', 'periodic', 'controls', 'and', 'has', 'spent', 'one', 'year', 'with', 'negative', 'BHCG', 'levels.'], ['3-', 'Subsequent', 'controls', 'are', 'not', 'necessary', 'if', 'the', 'evacuation', 'of', 'the', 'trophoblastic', 'tissue', 'was', 'complete.'], ['4-', 'It', 'is', 'necessary', 'to', 'carry', 'out', 'periodic', 'controls', 'since', '40%', 'of', 'the', 'cases', 'will', 'develop', 'a', 'gestational', 'trophoblastic', 'neoplasia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Gestational', 'trophoblastic', 'disease', 'should', 'be', 'followed', 'up', '(regardless', 'of', 'whether', 'the', 'evacuation', 'has', 'been', 'complete', 'or', 'not)', 'and', 'the', 'patient', 'should', 'be', 'advised', 'not', 'to', 'become', 'pregnant', 'again', 'until', 'at', 'least', '6', 'months', 'with', 'negative', 'BHCG', 'titers.'], ['The', 'risk', 'of', 'recurrence', 'in', 'another', 'pregnancy', 'is', 'low', '(1/55)', 'and', '90%', 'of', 'cases', 'progress', 'satisfactorily', 'without', 'developing', 'neoplasia.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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']]
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[['the patient should be advised not to become pregnant again until at least 6 months with negative BHCG titers\n', 'She should not become pregnant until she has undergone periodic controls and has spent one year with negative BHCG levels\n', 'Support'], ['The risk of recurrence in another pregnancy is low (1/55)\n', 'The risk of a new molar gestation in a future pregnancy is 50%\n', 'Attack'], ['regardless of whether the evacuation has been complete or not\n', 'Gestational trophoblastic disease should be followed up\n', 'Support'], ['90% of cases progress satisfactorily without developing neoplasia\n', 'It is necessary to carry out periodic controls since 40% of the cases will develop a gestational trophoblastic neoplasia\n', 'Attack'], ['Gestational trophoblastic disease should be followed up\n', 'Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete\n', 'Attack'], ['regardless of whether the evacuation has been complete or not\n', 'Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete\n', 'Attack']]
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357_232
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman', 'consults', 'after', 'noticing', 'inguinal', 'lymphadenopathy.'], ['The', 'interrogation', 'does', 'not', 'reveal', 'any', 'local', 'discomfort', 'or', 'data', 'suggestive', 'of', 'sexually', 'transmitted', 'infection.'], ['The', 'examination', 'revealed', 'two', 'lymphadenopathies,', 'one', 'in', 'each', 'groin,', '1', 'cm', 'in', 'diameter,', 'soft,', 'mobile,', 'non-painful.'], ['No', 'skin', 'lesions', 'are', 'seen', 'on', 'the', 'lower', 'limbs,', 'anus', 'or', 'perineum.'], ['Which', 'test', 'do', 'you', 'consider', 'essential?'], ['1-', 'A', 'lues', 'serology', 'since', 'it', 'is', 'most', 'likely', 'a', 'Treponema', 'pallidum', 'infection.'], ['2-', 'A', 'gynecological', 'examination', 'to', 'rule', 'out', 'ovarian', 'cancer.'], ['3-', 'By', 'the', 'clinical', 'characteristics', 'it', 'seems', 'to', 'be', 'normal', 'lymph', 'nodes', 'and', 'complementary', 'explorations', 'should', 'not', 'be', 'done.'], ['4-', 'A', 'Paul-Bunell', 'test', 'should', 'be', 'performed', 'to', 'rule', 'out', 'infectious', 'mononucleosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'presence', 'of', 'inguinal', 'nodes', 'up', 'to', '1-1.5cm', 'may', 'be', 'normal', 'in', 'the', 'absence', 'of', 'symptoms.'], ['In', 'this', 'case,', 'they', 'are', 'very', 'nonspecific', 'nodes,', 'without', 'signs', 'of', 'malignancy', '(mobile,', 'soft,', 'not', 'painful)', 'that', 'do', 'not', 'lead', 'us', 'to', 'suspect', 'neoplastic', 'infiltration', 'and', 'the', 'lack', 'of', 'other', 'clinical', 'signs', 'also', 'leads', 'us', 'to', 'rule', 'out', 'the', 'presence', 'of', 'STD.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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', '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']]
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[['The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms\n', 'By the clinical characteristics it seems to be normal lymph nodes and complementary explorations should not be done\n', 'Support'], ['In this case, they are very nonspecific nodes, without signs of malignancy (mobile, soft, not painful)\n', 'that do not lead us to suspect neoplastic infiltration\n', 'Attack'], ['the lack of other clinical signs also leads us to rule out the presence of STD\n', 'A lues serology since it is most likely a Treponema pallidum infection\n', 'Attack'], ['that do not lead us to suspect neoplastic infiltration\n', 'A gynecological examination to rule out ovarian cancer\n', 'Attack'], ['The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful\n', 'The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms\n', 'Support']]
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596_121
|
[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['79-year-old', 'woman', 'admitted', 'for', 'an', 'osteoporotic', 'hip', 'fracture.'], ['Regarding', 'secondary', 'prevention', 'of', 'fragility', 'fractures,', 'point', 'out', 'the', 'WRONG', 'answer:'], ['1-', 'Low', 'adherence', 'to', 'treatment', 'is', 'associated', 'with', 'an', 'increased', 'risk', 'of', 'fracture.'], ['2-', 'Bone', 'remodeling', 'markers', 'may', 'be', 'useful', 'for', 'early', 'monitoring', 'of', 'response', 'to', 'treatment.'], ['3-', 'Vitamin', 'D', 'monotherapy', 'is', 'effective', 'in', 'reducing', 'such', 'fractures', 'in', 'non-institutionalized', 'elderly.'], ['4-', 'Increasing', 'dietary', 'calcium', 'or', 'taking', 'calcium', 'supplements', 'alone', 'does', 'not', 'protect', 'against', 'the', 'occurrence', 'of', 'fractures.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['This', 'question', 'corresponds', 'to', 'the', 'section', 'on', 'traumatology;', 'however,', 'it', 'could', 'be', 'answered', 'with', 'knowledge', 'of', 'rheumatology', 'and', 'with', 'the', 'osteoporosis', 'recommendations', 'of', 'the', 'Spanish', 'Society', 'of', 'Rheumatology.'], ['In', 'osteoporosis,', 'one', 'of', 'the', 'main', 'risks', 'associated', 'with', 'increased', 'fracture', 'risk', 'is', 'low', 'adherence', 'to', 'treatment,', 'so', 'answer', '1', 'is', 'correct.'], ['Answer', '2', 'is', 'found', 'in', 'the', 'SER', 'guidelines,', 'which', 'confirm', 'that', 'some', 'studies', 'conclude', 'that', 'bone', 'remodeling', 'markers', 'can', 'be', 'useful', 'for', 'early', 'monitoring', 'of', 'adherence', 'and', 'response', 'to', 'treatment.'], ['Answer', '4', 'is', 'correct', 'because', 'again', 'in', 'the', 'SER', '2019', 'guidelines', 'they', 'quote:', '"The', 'current', 'scientific', 'evidence', 'allows', 'us', 'to', 'affirm', 'that', 'neither', 'increasing', 'dietary', 'calcium', 'nor', 'taking', 'calcium', 'supplements', 'alone', 'protects', 'against', 'the', 'appearance', 'of', 'fractures".'], ['Therefore,', 'the', 'correct', 'answer', 'to', 'this', 'question', 'is', 'option', '3.'], ['Patients', 'on', 'pharmacological', 'treatment', 'for', 'OP', 'should', 'use', 'calcium', 'and', 'vitamin', 'D', 'supplements', 'because', 'practically', 'all', 'clinical', 'trials', 'that', 'have', 'demonstrated', 'efficacy', 'of', 'antiosteoporotic', 'drugs', 'routinely', 'include', 'calcium', 'supplements', 'and', 'cholecalciferol', '(vitamin', 'D3),', 'but', 'not', 'in', 'monotherapy.']]
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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'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'B-Marker', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['In osteoporosis, one of the main risks associated with increased fracture risk is low adherence to treatment\n', 'answer 1 is correct.\n', 'Support'], ['answer 1 is correct.\n', 'Low adherence to treatment is associated with an increased risk of fracture\n', 'Support'], ['answer 1 is correct.\n', 'Low adherence to treatment is associated with an increased risk of fracture\n', 'Support'], ['Answer 2 is found in the SER guidelines, which confirm that some studies conclude that bone remodeling markers can be useful for early monitoring of adherence and response to treatment\n', 'Bone remodeling markers may be useful for early monitoring of response to treatment\n', 'Support'], ['again in the SER 2019 guidelines they quote: "The current scientific evidence allows us to affirm that neither increasing dietary calcium nor taking calcium supplements alone protects against the appearance of fractures"\n', 'Answer 4 is correct\n', 'Support'], ['Answer 4 is correct\n', 'Increasing dietary calcium or taking calcium supplements alone does not protect against the occurrence of fractures\n', 'Support'], ['Therefore, the correct answer to this question is option 3\n', 'Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly\n', 'Attack'], ['Patients on pharmacological treatment for OP should use calcium and vitamin D supplements because practically all clinical trials that have demonstrated efficacy of antiosteoporotic drugs routinely include calcium supplements and cholecalciferol (vitamin D3), but not in monotherapy\n', 'Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly\n', 'Attack']]
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334_82
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[['QUESTION', 'TYPE:', 'PHARMACOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'woman', 'diagnosed', 'with', 'type', '1', 'diabetes', 'mellitus', 'for', '24', 'years.'], ['She', 'comes', 'to', 'the', 'office', 'with', '3', 'months', 'of', 'clinical', 'evolution', 'of', 'tingling', 'in', 'both', 'feet,', 'with', 'distribution', 'in', 'sock,', 'with', 'paresthetic', 'pain', 'and', 'sensation', 'of', 'hot', 'feet', 'predominantly', 'at', 'night,', 'which', 'significantly', 'interferes', 'with', 'sleep.'], ['Which', 'of', 'the', 'following', 'drugs', 'would', 'you', 'use', 'in', 'the', 'first', 'line', 'for', 'the', 'treatment', 'of', 'her', 'pathology?'], ['1-', 'Ibuprofen.'], ['2-', 'Oxycodone.'], ['3-', 'Duloxetine.'], ['4-', 'Paracetamol.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Duloxetine;', 'the', 'clinical', 'picture', 'described', 'is', 'of', 'diabetic', 'neuropathy.'], ['Of', 'the', 'drugs', 'proposed,', 'the', 'first', 'choice', 'would', 'be', 'a', 'dual', 'antidepressant', 'such', 'as', 'duloxetine.']]
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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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-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']]
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[['the clinical picture described is of diabetic neuropathy\n', 'Of the drugs proposed, the first choice would be a dual antidepressant such as duloxetine\n', 'Support'], ['the clinical picture described is of diabetic neuropathy\n', 'Duloxetine\n', 'Support'], ['She comes to the office with 3 months of clinical evolution of tingling in both feet, with distribution in sock, with paresthetic pain and sensation of hot feet predominantly at night, which significantly interferes with sleep\n', 'the clinical picture described is of diabetic neuropathy\n', 'Support'], ['A woman diagnosed with type 1 diabetes mellitus for 24 years\n', 'the clinical picture described is of diabetic neuropathy\n', 'Support']]
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81_44
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[]
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386_154
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['The', 'appearance', 'of', 'a', 'high', 'fever', 'of', '39°C', 'in', 'a', '10-month-old', 'infant', 'that', 'abruptly', 'subsides', 'after', '3-5', 'days,', 'followed', 'by', 'a', 'cephalocaudal', 'morbilliform', 'exanthema', 'with', 'enanthema', 'consisting', 'of', 'reddish', 'papules', 'on', 'the', 'palate,', 'and', 'resolving', 'within', 'a', 'week,', 'associated', 'with', 'good', 'general', 'condition,', 'is', 'usually', 'caused', 'by:'], ['1-', 'Parvovirus', 'B19.'], ['2-', 'Herpes', 'virus', 'type', '6.'], ['3-', 'Coxackie', 'A16', 'virus.'], ['4-', 'Primoinfection', 'by', 'Epstein-Barr', 'virus.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'question', 'of', 'exanthematous', 'diseases', 'that', 'pediatricians', 'and', 'MIR', 'exam', 'takers', 'like', 'so', 'much.'], ['By', 'the', 'picture', 'of', 'high', 'fever', 'of', 'several', 'days', 'that', 'suddenly', 'subsides', 'with', 'the', 'appearance', 'of', 'a', 'rash,', 'we', 'have', 'a', 'sudden', 'exanthem,', 'caused', 'by', 'Herpes', 'virus', 'type', '6', '(remember', 'the', 'mnemonic', 'rule', 'of', '"sudden', 'Hexanthem").'], ['Parvovirus', 'B19', 'is', 'the', 'cause', 'of', 'erythema', 'infectiosum', 'or', '"fifth', 'disease",', 'whose', 'characteristic', 'rash', 'is', 'on', 'the', 'cheeks,', 'giving', 'the', 'appearance', 'of', 'a', 'slapped', 'face.'], ['Coxackie', 'A16', 'causes', 'herpangina', 'and', 'also', 'boca-mano-pie', 'disease,', 'which', 'presents', 'an', 'initially', 'macular', 'rash,', 'which', 'does', 'not', 'respect', 'palms', 'or', 'soles', 'and', 'evolves', 'into', 'bursting', 'vesicles.'], ['Finally,', 'EBV', 'infection', 'produces', 'a', 'mononucleosis', 'syndrome', 'with', 'high', 'fever', 'lasting', 'several', 'days,', 'with', 'pharyngeal', 'erythema', 'and', 'grayish', 'exudates', 'on', 'the', 'tonsils.'], ['It', 'can', 'present', 'if', 'penicillins', 'are', 'given', 'to', 'treat', 'it', '(when', 'confused', 'with', 'a', 'streptococcal', 'pharyngotonsillitis)', 'a', 'generalized', 'exanthema.'], ['In', 'addition,', 'it', 'also', 'presents', 'with', 'fatigue,', 'hepatic', 'inflammation', 'with', 'increased', 'transaminases', 'and', 'splenomegaly.']]
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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', 'I-Premise', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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', 'I-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', '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 picture of high fever of several days that suddenly subsides with the appearance of a rash, we have a sudden exanthem\n', 'Herpes virus type 6\n', 'Support'], ['Parvovirus B19 is the cause of erythema infectiosum or "fifth disease", whose characteristic rash is on the cheeks, giving the appearance of a slapped face\n', 'Parvovirus B19\n', 'Attack'], ['a high fever of 39°C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition\n', 'Parvovirus B19 is the cause of erythema infectiosum or "fifth disease", whose characteristic rash is on the cheeks, giving the appearance of a slapped face\n', 'Attack'], ['a high fever of 39°C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition\n', 'Coxackie A16 causes herpangina and also boca-mano-pie disease, which presents an initially macular rash, which does not respect palms or soles and evolves into bursting vesicles\n', 'Attack'], ['Coxackie A16 causes herpangina and also boca-mano-pie disease, which presents an initially macular rash, which does not respect palms or soles and evolves into bursting vesicles\n', 'Coxackie A16 virus\n', 'Attack'], ['a high fever of 39°C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition\n', 'EBV infection produces a mononucleosis syndrome with high fever lasting several days, with pharyngeal erythema and grayish exudates on the tonsils\n', 'Attack'], ['EBV infection produces a mononucleosis syndrome with high fever lasting several days, with pharyngeal erythema and grayish exudates on the tonsils\n', 'Primoinfection by Epstein-Barr virus\n', 'Attack'], ['Herpes virus type 6\n', 'Herpes virus type 6\n', 'Support']]
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239_146
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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'man', 'is', 'admitted', 'for', 'a', 'sudden', 'onset', 'of', 'aphasia', 'and', 'right', 'hemiparesis.'], ['His', 'history', 'includes', 'hypertension,', 'well', 'controlled', 'with', 'diet', 'and', 'cognitive', 'deterioration', 'in', 'the', 'last', 'year', 'under', 'study', 'by', 'his', 'neurologist.'], ['The', 'emergency', 'cranial', 'CT', 'scan', 'shows', 'a', 'left', 'frontal', 'lobar', 'hematoma', 'without', 'contrast', 'uptake.'], ['What', 'is', 'the', 'most', 'probable', 'cause', 'of', 'the', 'hematoma?'], ['1-', 'Arteriovenous', 'malformation', 'masked', 'by', 'acute', 'hematoma.'], ['2-', 'Chronic', 'arterial', 'hypertension.'], ['3-', 'Isolated', 'vasculitis', 'of', 'the', 'nervous', 'system.'], ['4-', 'Brain', 'tumor.'], ['5-', 'Cerebral', 'amyloid', 'angiopathy', '(congophilic', 'angiopathy).'], ['CORRECT', 'ANSWER:', '5'], ['Amyloid', 'angiopathy', 'is', 'the', 'most', 'common', 'cause', 'of', 'spontaneous', 'non-hypertensive', 'hemorrhage', 'in', 'elderly', 'patients,', 'and', 'is', 'usually', 'lobar', 'in', 'location', '(as', 'in', 'the', 'case).'], ['They', 'often', 'appear', 'in', 'association', 'with', "Alzheimer's", 'disease', '(CTO', 'Manual).'], ['The', 'response', 'that', 'may', 'cause', 'the', 'most', 'doubts', 'is', '2,', 'hypertension,', 'but', 'the', 'most', 'frequent', 'localizations', 'are:', 'putamen,', 'thalamus,', 'pons', 'and', 'cerebellum.'], ['Therefore,', 'most', 'of', 'the', 'time', 'these', 'are', 'deep', 'hemorrhages', '(CTO', 'Manual).'], ['In', 'addition,', 'as', 'a', 'clue', 'it', 'tells', 'us', 'that', 'the', 'patient', 'has', 'well-controlled', 'hypertension', 'without', 'drugs,', 'although', 'this', 'data', 'would', 'not', 'serve', 'to', 'rule', 'out', 'the', 'response.'], ['Answer', '1,', 'a', 'malformation', 'is', 'typical', 'of', 'young', 'patients,', 'rare', 'in', 'older', 'people.'], ['It', 'also', 'decreases', 'the', 'chance', 'of', 'not', 'finding', 'a', 'malformation', 'with', 'contrast-enhanced', 'CT.'], ['Answer', '4,', 'a', 'brain', 'tumor,', 'does', 'not', 'seem', 'likely', 'since', 'the', 'mass', 'is', 'not', 'seen', 'on', 'CT,', 'and', 'as', 'in', 'the', 'previous', 'case,', 'it', 'is', 'more', 'difficult', 'not', 'to', 'find', 'such', 'a', 'lesion', 'after', 'contrast', 'administration.'], ['Answer', '3', 'does', 'not', 'seem', 'correct', 'since', 'vasculitis', 'is', 'a', 'rare', 'entity', 'and', 'more', 'so', 'in', 'older', 'people.']]
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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'], ['B-Premise', 'I-Premise', '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'], ['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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-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'], ['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-Marker', 'B-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', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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 emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake\n', 'Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case)\n', 'Support'], ['Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case)\n', 'Cerebral amyloid angiopathy (congophilic angiopathy)\n', 'Support'], ['the most frequent localizations are: putamen, thalamus, pons and cerebellum\n', 'The response that may cause the most doubts is 2, hypertension\n', 'Attack'], ['The emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake\n', 'the most frequent localizations are: putamen, thalamus, pons and cerebellum\n', 'Attack'], ['In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs\n', 'The response that may cause the most doubts is 2, hypertension\n', 'Attack'], ['In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs\n', 'although this data would not serve to rule out the response\n', 'Attack'], ['An 80-year-old man is admitted for a sudden onset of aphasia and right hemiparesis\n', 'Answer 1, a malformation is typical of young patients, rare in older people\n', 'Support'], ['Answer 1, a malformation is typical of young patients, rare in older people\n', 'Arteriovenous malformation masked by acute hematoma\n', 'Attack'], ['the mass is not seen on CT\n', 'Answer 4, a brain tumor, does not seem likely\n', 'Support'], ['Answer 4, a brain tumor, does not seem likely\n', 'Brain tumor\n', 'Attack'], ['In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs\n', 'Chronic arterial hypertension\n', 'Attack'], ['it is more difficult not to find such a lesion after contrast administration\n', 'Answer 4, a brain tumor, does not seem likely\n', 'Support'], ['Answer 3 does not seem correct since vasculitis is a rare entity and more so in older people\n', 'Isolated vasculitis of the nervous system\n', 'Attack']]
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525_53
| null | null |
[]
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287_64
| null | null |
[]
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472_140
|
[['QUESTION', 'TYPE:', 'ORTHOPEDIC', 'SURGERY', 'AND', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['65-year-old', 'obese', 'woman', 'who', 'suffers', 'a', 'fall', 'on', 'her', 'hand', 'with', 'her', 'elbow', 'in', 'extension.'], ['She', 'presents', 'with', 'arm', 'pain', 'with', 'swelling', 'and', 'functional', 'impotence', 'of', 'the', 'arm', 'and', 'inability', 'to', 'extend', 'the', 'wrist', 'and', 'fingers.'], ['It', 'is', 'most', 'likely', 'to', 'present:'], ['1-', 'Dislocation', 'fracture', 'of', 'proximal', 'humerus.'], ['2-', 'Elbow', 'dislocation.'], ['3-', 'Diaphyseal', 'fracture', 'of', 'the', 'humerus', 'associated', 'with', 'double', 'forearm', 'fracture.'], ['4-', 'Diaphyseal', 'fracture', 'of', 'humerus', 'with', 'radial', 'nerve', 'injury.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'must', 'take', 'into', 'account', 'all', 'the', 'clinical', 'data', 'provided:', 'after', 'trauma', 'we', 'have', 'pain', 'in', 'the', 'arm', 'with', 'soft', 'tissue', 'involvement', 'and', 'the', 'impossibility', 'of', 'extending', 'the', 'wrist', 'and', 'fingers.'], ['The', 'only', 'option', 'that', 'includes', 'all', 'the', 'data', 'is', '4.'], ['Option', '1', 'does', 'not', 'explain', 'the', 'involvement', 'of', 'the', 'wrist', 'and', 'fingers.'], ['The', 'elbow', 'dislocation', 'does', 'not', 'explain', 'the', 'lack', 'of', 'finger', 'mobility', 'as', 'well', 'as', 'the', 'diaphyseal', 'fracture', 'of', 'the', 'humerus', 'and', 'double', 'forearm.'], ['"Direct', 'mechanism', 'is', 'possible,', 'as', 'is', 'indirect', 'transmission', 'of', 'forces', 'from', 'the', 'elbow', 'and', 'hand...radial', 'nerve', 'involvement', 'is', 'extremely', 'frequent,', 'reaching', 'an', 'incidence', 'of', '10-18%', 'of', 'cases."', 'Proximal', 'humerus', 'fracture-dislocation', 'would', 'have', 'greater', 'involvement', 'at', 'the', 'shoulder,', 'elbow', 'dislocation', 'at', 'the', 'elbow,', 'and', 'there', 'is', 'no', 'data', 'to', 'suggest', 'double', 'forearm', 'fracture.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', '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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-Claim', 'I-Claim', 'I-Claim', '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']]
|
[['We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n', 'The only option that includes all the data is 4\n', 'Support'], ['The only option that includes all the data is 4\n', 'Diaphyseal fracture of humerus with radial nerve injury\n', 'Support'], ['We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n', 'Option 1 does not explain the involvement of the wrist and fingers\n', 'Attack'], ['Option 1 does not explain the involvement of the wrist and fingers\n', 'Dislocation fracture of proximal humerus\n', 'Attack'], ['We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n', 'The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm\n', 'Attack'], ['The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm\n', 'Elbow dislocation\n', 'Attack'], ['We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n', 'Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow\n', 'Attack'], ['We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n', 'there is no data to suggest double forearm fracture\n', 'Attack'], ['Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow\n', 'Diaphyseal fracture of the humerus associated with double forearm fracture\n', 'Attack'], ['there is no data to suggest double forearm fracture\n', 'Diaphyseal fracture of the humerus associated with double forearm fracture\n', 'Attack']]
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173_51
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[['QUESTION', 'TYPE:', 'PNEUMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '53-year-old', 'woman', 'with', 'bronchial', 'asthma', 'comes', 'to', 'the', 'allergy', 'clinic', 'for', 'a', 'checkup.'], ['She', 'reports', 'repeated', 'exacerbations', 'with', 'nocturnal', 'symptoms,', 'frequent', 'use', 'of', 'rescue', 'medication', 'and', 'dyspnea', 'on', 'exertion', 'when', 'walking', 'on', 'level', 'ground.'], ['Spirometry', 'shows', 'a', 'pre-bronchodilator', 'FEV1/FVC', 'ratio', 'of', '60%', 'and', 'FEV1', 'of', '55%.'], ['Skin', 'tests', 'are', 'positive', 'for', 'mites', 'and', 'total', 'IgE', 'of', '150', 'IU/ml.'], ['The', 'patient', 'is', 'being', 'treated', 'with', 'a', 'combination', 'of', 'high-dose', 'salmeterol/budesonide', '(50/500', 'mg:', '2', 'puffs', 'twice', 'daily),', 'maintenance', 'oral', 'prednisone', '(10', 'mg/day)', 'and', 'theophylline.'], ['Of', 'the', 'following', 'options,', 'which', 'is', 'the', 'most', 'advisable', 'therapeutic', 'approach?'], ['1-', 'Add', 'magnesium', 'sulfate.'], ['2-', 'Increase', 'the', 'dose', 'of', 'prednisone', 'to', '30', 'mg/day.'], ['3-', 'Add', 'omalizumab.'], ['4-', 'Nebulized', 'treatment', 'at', 'home.'], ['5-', 'Switch', 'to', 'a', 'combination', 'with', 'high', 'doses', 'of', 'budesonide', 'and', 'formoterol.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'indication', 'of', 'omalizumab', 'in', 'a', 'patient', 'such', 'as', 'the', 'one', 'referred', 'to', 'is', 'a', 'correct', 'indication,', 'although', 'in', 'severe', 'asthma', 'that', 'is', 'difficult', 'to', 'control,', 'there', 'are', 'other', 'prior', 'measures', 'that', 'are', 'not', 'contemplated', 'and', 'that', 'must', 'always', 'be', 'taken', 'into', 'account', 'before', 'resorting', 'to', 'this', 'treatment.'], ['It', 'is', 'mandatory', 'to', 'ensure', 'firstly', 'that', 'it', 'is', 'truly', 'asthma', 'and', 'not', 'another', 'disease', 'that', 'simulates', 'asthma,', 'secondly', 'that', 'there', 'are', 'no', 'complications', 'that', 'worsen', 'the', 'evolution', 'as', 'could', 'be', 'the', 'presence', 'of', 'gastroesophageal', 'reflux,', 'bronchiectasis,', 'presence', 'of', 'opportunistic', 'germs', 'given', 'the', 'chronic', 'treatment', 'with', 'steroids,', 'etc;', 'and', 'thirdly,', 'it', 'is', 'necessary', 'to', 'confirm', 'that', 'the', 'patient', 'complies', 'with', 'the', 'treatments', 'correctly,', 'especially', 'the', 'inhaled', 'treatment,', 'etc.'], ['Once', 'all', 'of', 'the', 'above', 'has', 'been', 'checked,', 'it', 'would', 'be', 'time', 'to', 'start', 'a', 'trial', 'treatment', 'with', 'omalizumab.']]
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[['The indication of omalizumab in a patient such as the one referred to is a correct indication, although in severe asthma that is difficult to control, there are other prior measures that are not contemplated and that must always be taken into account before resorting to this treatment\n', 'Add omalizumab\n', 'Support'], ['Once all of the above has been checked, it would be time to start a trial treatment with omalizumab\n', 'Add omalizumab\n', 'Support']]
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480_171
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[]
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58_199
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[['QUESTION', 'TYPE:', 'GENETICS'], ['CLINICAL', 'CASE:'], ['An', 'asymptomatic', '31-year-old', 'woman', '(Consultant)', 'is', 'asymptomatic', 'and', 'has', 'a', '10-week', 'gestation', 'according', 'to', 'ultrasound', 'study', '(primiparous).'], ['Her', 'younger', 'brother', '(index', 'case)', 'aged', '26', 'years', 'is', 'affected', 'by', 'ataxia', 'and', 'genetically', 'diagnosed', 'as', 'a', 'heterozygous', 'carrier', 'of', 'an', 'expansive', 'mutation', 'of', '70', 'CAG', 'repeats', 'in', 'the', 'SCA3', 'gene', '(chromosome', '14).'], ['The', 'patient', 'is', 'referred', 'to', 'the', 'genetic', 'counseling', 'office', 'where', 'a', 'possible', 'chorionic', 'villus', 'biopsy', 'to', 'study', 'the', 'fetal', 'genotype', 'is', 'evaluated.'], ['Is', 'this', 'invasive', 'procedure', 'indicated', 'as', 'a', 'pre-natal', 'diagnosis', '(PND)', 'in', 'this', 'case?'], ['1-', 'It', 'is', 'indicated', 'after', 'studying', 'the', "Consultant's", 'genotype', 'and', 'only', 'if', 'it', 'is', 'heterozygous.'], ['2-', 'This', 'is', 'not', 'indicated,', 'since', 'SCA3', 'ataxia', 'is', 'full', 'penetrance', 'and', 'the', 'Consultant', 'is', 'asymptomatic', 'and', 'therefore', 'has', 'not', 'inherited', 'the', 'mutation.'], ['3-', 'It', 'may', 'be', 'indicated', 'in', 'the', 'next', 'pregnancy,', 'after', 'studying', 'the', 'genotype', 'of', 'the', 'first', 'child', 'and', 'detecting', 'the', 'mutation', 'in', 'it.'], ['4-', 'SCA3', 'ataxia', 'is', 'recessively', 'inherited,', 'so', 'there', 'is', 'no', 'appreciable', 'risk', 'of', 'disease', 'transmission', 'and', 'PND', 'is', 'not', 'indicated.'], ['5-', 'This', 'is', 'indicated', 'regardless', 'of', 'the', "Consultant's", 'genotype,', 'since', 'SCA3', 'ataxia', 'is', 'maternally', 'inherited', '(transmitted', 'by', 'women).'], ['CORRECT', 'ANSWER:', '1'], ['SCA3', 'is', 'Spinocerebellar', 'Ataxia', 'type', '3', 'also', 'called', 'Machado-Joseph', 'disease.'], ['It', 'is', 'caused', 'by', 'mutations', 'in', 'the', 'ATXN3', 'gene', 'by', 'the', 'CAG', 'triplet', 'repeat', 'expansion', 'mechanism.'], ['Affected', 'individuals', 'have', 'between', '52', 'and', '86', 'CAG', 'triplet', 'repeats', 'in', 'heterozygosis', 'with', 'complete', 'penetrance.'], ['The', 'heterozygous', 'mutation', 'carrier', 'has', 'the', 'disease', 'as', 'its', 'inheritance', 'pattern', 'is', 'autosomal', 'dominant.'], ['In', 'this', 'clinical', 'case,', 'the', 'one', 'who', 'has', 'the', 'disease', 'and', 'has', 'the', 'mutated', 'gene', 'in', 'heterozygosis', 'is', 'the', 'brother', '(26', 'years', 'old)', 'of', 'the', 'pregnant', 'woman.'], ['I', 'think', 'that', 'before', 'doing', 'the', 'chorion', 'biopsy,', 'the', 'pregnant', 'woman', 'should', 'be', 'tested', 'to', 'know', 'her', 'ATXN3', 'gene', 'status.'], ['She', 'has', 'a', '50%', 'chance', 'of', 'carrying', 'the', 'mutation', 'and', 'having', 'the', 'disease,', 'but', 'since', 'she', 'is', '31', 'years', 'old,', 'I', 'think', 'she', 'should', 'have', 'already', 'had', 'symptoms.'], ['Nevertheless,', 'I', 'would', 'do', 'the', 'genetic', 'test', 'on', 'the', 'pregnant', 'woman', 'to', 'be', 'on', 'the', 'safe', 'side.'], ['If', 'she', 'came', 'out', 'without', 'the', 'mutation,', 'there', 'would', 'be', 'nothing', 'more', 'to', 'do', 'because', 'the', 'disease', 'would', 'no', 'longer', 'be', 'transmitted.'], ['If', 'she', 'came', 'out', 'with', 'the', 'mutation,', 'then', 'I', 'would', 'do', 'a', 'chorionic', 'villus', 'biopsy.'], ['Answers', '1', 'and', '2', 'are', 'both', 'true,', 'but', 'I', 'think', 'answer', '1', 'is', 'more', 'true', 'than', 'answer', '2.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['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', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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']]
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[['I think answer 1 is more true than answer 2\n', "It is indicated after studying the Consultant's genotype and only if it is heterozygous\n", 'Support'], ['She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n', 'Nevertheless, I would do the genetic test on the pregnant woman to be on the safe side\n', 'Attack'], ['I think answer 1 is more true than answer 2\n', 'This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation\n', 'Attack'], ['She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n', 'This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation\n', 'Support'], ['Answers 1 and 2 are both true\n', "It is indicated after studying the Consultant's genotype and only if it is heterozygous\n", 'Support'], ['Answers 1 and 2 are both true\n', 'This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation\n', 'Support'], ['Her younger brother (index case) aged 26 years is affected by ataxia and genetically diagnosed as a heterozygous carrier of an expansive mutation of 70 CAG repeats in the SCA3 gene (chromosome 14)\n', 'She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n', 'Support'], ['In this clinical case, the one who has the disease and has the mutated gene in heterozygosis is the brother (26 years old) of the pregnant woman\n', 'She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n', 'Support']]
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51_230
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['37-week', 'pregnant', 'woman', 'with', 'positive', 'hepatitis', 'B', 'virus', 'surface', 'antigen.'], ['She', 'consults', 'about', 'the', 'guidelines', 'to', 'be', 'followed', 'with', 'the', 'newborn', 'and', 'whether', 'she', 'can', 'breastfeed.'], ['What', 'advice', 'do', 'you', 'think', 'is', 'most', 'appropriate?'], ['1-', 'Administer', 'hepatitis', 'B', 'vaccine', 'at', 'birth.', 'Artificial', 'feeding.'], ['2-', 'Vaccination', 'and', 'immunoglobulins', 'should', 'be', 'administered', 'at', 'birth.', 'Breastfeeding', 'from', 'one', 'month', 'onwards.'], ['3-', 'Immunoglobulins', 'at', 'birth', 'and', 'artificial', 'breastfeeding.'], ['4-', 'Vaccination', 'and', 'immunoglobulins', 'at', 'birth.', 'Maternal', 'feeding.'], ['5-', 'Artificial', 'feeding', 'and', 'isolation', 'for', '4', 'weeks.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'correct', 'answer', 'is', '4.'], ['Children', 'born', 'to', 'HBV', 'carrier', 'mothers', 'should', 'be', 'administered', 'hepatitis', 'B', 'vaccine', 'and', 'immunoglobulin', 'at', 'different', 'puncture', 'sites', 'within', 'the', 'first', '24', 'hours', 'of', 'life.'], ['Although', 'the', 'virus', 'is', 'excreted', 'in', 'breast', 'milk,', 'the', 'risk', 'of', 'infection', 'by', 'this', 'route', 'is', 'very', 'low', 'and', 'therefore', 'it', 'is', 'not', 'currently', 'a', 'contraindication', 'for', 'breastfeeding.']]
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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'], ['O', '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'], ['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'], ['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life\n', 'The correct answer is 4\n', 'Support'], ['Although the virus is excreted in breast milk, the risk of infection by this route is very low\n', 'Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life\n', 'Support'], ['it is not currently a contraindication for breastfeeding\n', 'The correct answer is 4\n', 'Support']]
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184_65
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[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'with', 'obesity', '(body', 'mass', 'index', '38)', 'is', 'referred', 'to', 'your', 'office.'], ['In', 'the', 'clinical', 'history', 'the', 'patient', 'refers', 'that', 'he/she', 'has', 'been', 'obese', 'since', 'the', 'age', 'of', '17', '(currently', '36', 'years', 'old),', 'having', 'been', 'on', 'multiple', 'diets', 'with', 'weight', 'loss', 'ranging', 'from', '5', 'to', '10', 'kg', 'but', 'has', 'subsequently', 'regained', 'weight.'], ['The', 'patient', 'is', 'currently', 'on', 'a', '1500', 'Kcal', 'diet', '(self-administered', 'and', 'not', 'restricted', 'in', 'fat)', 'with', 'a', 'good', 'follow-up', 'of', 'this', 'diet,', 'performing', 'one', 'hour', 'of', 'aerobic', 'exercise', '4', 'days', 'a', 'week.'], ['She', 'has', 'lost', '3', 'kg', 'but', 'needs', 'an', 'additional', 'loss', 'of', '7', 'kg', 'more.'], ['Given', 'the', 'possibility', 'of', 'adding', 'a', 'drug', 'against', 'obesity,', 'which', 'one', 'would', 'you', 'use', 'to', 'reduce', 'fat', 'absorption?'], ['1-', 'Orlistat.'], ['2-', 'Topiramate.'], ['3-', 'Sibutramine.'], ['4-', 'Liraglutide.'], ['5-', 'Metformin.'], ['CORRECT', 'ANSWER:', '1'], ['Orlistat', 'acts', 'by', 'decreasing', 'fat', 'absorption;', 'it', 'is', 'currently', 'the', 'only', 'drug', 'approved', 'for', 'use', 'in', 'obesity.']]
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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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n', 'Orlistat\n', 'Support'], ['Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n', 'Topiramate\n', 'Attack'], ['Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n', 'Sibutramine\n', 'Attack'], ['Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n', 'Liraglutide\n', 'Attack'], ['Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n', 'Metformin\n', 'Attack']]
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295_75
|
[['QUESTION', 'TYPE:', 'GENETICS', 'AND', 'IMMUNOLOGY'], ['CLINICAL', 'CASE:'], ['Indicate', 'the', 'clinical', 'situation', 'that,', 'in', 'relation', 'to', 'hepatitis', 'B', 'virus', 'infection,', 'presents', 'a', '5-year-old', 'patient', 'from', 'Nigeria,', 'with', 'normal', 'physical', 'examination', 'and', 'with', 'the', 'following', 'serology', 'against', 'hepatitis', 'B:', 'HBsAg', '+', '/', 'ANTI-', 'HBs', '-', '/', 'HBeAg', '-', '/', 'ANTI-', 'Hbe', '+', '/', 'ANTI-', 'Hbc', 'IgM', '-', '/', 'ANTI-', 'Hbc', 'IgG', '+/', 'DNA', 'HBV', '+:'], ['1-', 'Acute', 'infection.'], ['2-', 'Chronic', 'infection.'], ['3-', 'Vaccinated', 'patient.'], ['4-', 'Asymptomatic', 'carrier.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Question', 'in', 'which', 'having', 'a', 'table', 'in', 'the', 'head', 'comes', 'out', 'alone', 'discarding', 'options:', 'Option', '1:', 'The', 'acute', 'infection', 'would', 'be', 'HBeAg', '+', 'and', 'ANTI-HBe', '-', '.', 'In', 'addition', 'the', 'ANTI-HBec', 'would', 'be', 'IgM', 'type', '(only', 'for', 'this', 'last', 'data,', 'we', 'would', 'have', 'to', 'discard', 'it', 'in', 'a', 'direct', 'way).'], ['Option', '2:', 'the', 'correct', 'one.'], ['It', 'complies', 'with', 'all', 'the', 'characteristics.'], ['Option', '3:', 'The', 'vaccinated', 'patient', 'cannot', 'have', 'DNA', 'of', 'the', 'virus', '(the', 'only', 'thing', 'that', 'positivizes', 'in', 'a', 'vaccinated', 'patient', 'is', 'the', 'AntiBs.', 'IgG', 'type).'], ['Option', '4:', 'The', 'option', 'that', 'could', 'offer', 'more', 'doubts.'], ['In', 'the', 'asymptomatic', 'carrier', '(chronic', 'carrier', '/', 'seroconverted)', 'the', 'difference', 'is', 'that', 'there', 'is', 'no', 'viral', 'DNA.']]
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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', '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', '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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type\n', 'only for this last data, we would have to discard it in a direct way\n', 'Support'], ['a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +\n', 'Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type\n', 'Attack'], ['only for this last data, we would have to discard it in a direct way\n', 'Acute infection\n', 'Attack'], ['Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type\n', 'Acute infection\n', 'Attack'], ['Option 2: the correct one\n', 'Chronic infection\n', 'Support'], ['It complies with all the characteristics\n', 'Option 2: the correct one\n', 'Support'], ['a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +\n', 'It complies with all the characteristics\n', 'Support'], ['the only thing that positivizes in a vaccinated patient is the AntiBs. IgG type\n', 'Option 3: The vaccinated patient cannot have DNA of the virus\n', 'Support'], ['Option 3: The vaccinated patient cannot have DNA of the virus\n', 'Vaccinated patient\n', 'Attack'], ['a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +\n', 'In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA\n', 'Attack'], ['In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA\n', 'Option 4: The option that could offer more doubts\n', 'Attack'], ['In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA\n', 'Asymptomatic carrier\n', 'Attack']]
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559_160
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman,', 'taking', 'contraceptives,', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'febrile', 'syndrome', 'and', 'paresthesias', 'in', 'the', 'left', 'hemibody.'], ['Blood', 'tests', 'show', 'Hb', '7.5', 'g/dL,', 'platelets', '7,000/microl,', 'normal', 'leukocytes', 'with', 'normal', 'differential', 'count,', 'LDH', '1,200', 'IU/l,', 'reticulocytes', '10%', '(normal', '0.5-2%),', 'undetectable', 'serum', 'haptoglobin,', 'negative', 'direct', "Coombs'", 'test', 'and', 'peripheral', 'blood', 'smear', 'with', 'schistocytes.'], ['Coagulation', '(prothrombin', 'time', 'and', 'APTT)', 'normal.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnosis:'], ['1-', 'Autoimmune', 'hemolytic', 'anemia.'], ['2-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['3-', 'Evans', 'syndrome', '(hemolytic', 'anemia', 'and', 'immune', 'thrombopenia).'], ['4-', 'Idiopathic', 'immune', 'thrombocytopenia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'fear', 'of', 'all', 'on-call', 'hematologists...', 'that', 'you', 'will', 'get', 'a', 'TTP.'], ['Because,', 'although', 'infrequent,', 'it', 'is', 'the', 'greatest', 'hematologic', 'emergency.'], ['The', 'clinical', 'case', 'is', 'fairly', 'typical.'], ['A', 'young', 'person', 'with', 'fever', 'and', 'neurological', 'symptoms', 'that', 'make', 'him', 'go', 'to', 'the', 'emergency', 'department', '(he', 'is', 'on', 'the', 'run).'], ['Laboratory', 'tests', 'show', 'anemia', 'with', 'evidence', 'of', 'hemolysis', '(increased', 'LDH', 'and', 'retis,', 'presence', 'of', 'schistocytes', 'in', 'peripheral', 'blood)', 'and', 'severe', 'thrombopenia.'], ['In', 'addition,', 'coagulation', 'is', 'normal.'], ['To', 'distinguish', 'it', 'from', 'the', 'rest', 'of', 'things', '(although', 'you', 'should', 'not', 'hesitate...)', 'it', 'tells', 'you', 'that', 'the', 'coombs', 'is', 'negative.'], ['As', 'a', 'reminder:', 'URGENT', 'TREATMENT:', 'PLASMATIC', 'REPLACEMENTS.'], ['The', 'diagnostic', 'confirmation', 'is', 'the', 'ADAMTS', '13', 'deficit,', 'but', 'treatment', 'is', 'started', 'before', 'having', 'that', 'value,', 'which', 'is', 'not', 'usually', 'done', 'urgently.'], ['And,', 'as', 'we', 'all', 'know,', 'these', 'things', 'usually', 'come', 'at', 'night', 'and/or', 'weekends,', 'to', 'make', 'things', 'more', 'difficult....']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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'], ['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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', '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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[['The fear of all on-call hematologists... that you will get a TTP\n', 'Thrombotic thrombocytopenic purpura\n', 'Support'], ['Because, although infrequent, it is the greatest hematologic emergency\n', 'The clinical case is fairly typical\n', 'Support'], ['The clinical case is fairly typical\n', 'Thrombotic thrombocytopenic purpura\n', 'Support'], ['it tells you that the coombs is negative\n', 'To distinguish it from the rest of things (although you should not hesitate...)\n', 'Support'], ['In addition, coagulation is normal\n', 'To distinguish it from the rest of things (although you should not hesitate...)\n', 'Support'], ['Laboratory tests show anemia with evidence of hemolysis (increased LDH and retis, presence of schistocytes in peripheral blood) and severe thrombopenia\n', 'To distinguish it from the rest of things (although you should not hesitate...)\n', 'Support'], ['A young person with fever and neurological symptoms that make him go to the emergency department\n', 'To distinguish it from the rest of things (although you should not hesitate...)\n', 'Support'], ['To distinguish it from the rest of things (although you should not hesitate...)\n', 'The clinical case is fairly typical\n', 'Support']]
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558_160
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman,', 'taking', 'contraceptives,', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'febrile', 'syndrome', 'and', 'paresthesias', 'in', 'the', 'left', 'hemibody.'], ['Blood', 'tests', 'showed', 'Hb', '7.5', 'g/dL,', 'platelets', '7,000/microl,', 'normal', 'leukocytes', 'with', 'normal', 'differential', 'count,', 'LDH', '1,200', 'IU/l,', 'reticulocytes', '10%', '(normal', '0.5-2%),', 'undetectable', 'serum', 'haptoglobin,', 'negative', 'direct', "Coombs'", 'test', 'and', 'peripheral', 'blood', 'smear', 'with', 'schistocytes.'], ['Coagulation', '(prothrombin', 'time', 'and', 'APTT)', 'normal.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnosis:'], ['1-', 'Autoimmune', 'hemolytic', 'anemia.'], ['2-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['3-', 'Evans', 'syndrome', '(hemolytic', 'anemia', 'and', 'immune', 'thrombopenia).'], ['4-', 'Idiopathic', 'immune', 'thrombocytopenia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'patient', 'presents', 'criteria', 'for', 'Thrombotic', 'Thrombocytopenic', 'Purpura', '(TTP):', '1.'], ['Neurological', 'alteration.'], ['2.'], ['Febrile', 'syndrome', '(fever).'], ['3.'], ['Coombs', 'negative', 'migroangiopathic', 'hemolytic', 'anemia', '(presence', 'of', 'schistocytes).'], ['4.'], ['Thrombopenia.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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', 'O'], ['B-Premise', 'I-Premise'], ['O'], ['B-Premise', 'I-Premise', 'I-Premise'], ['O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O'], ['B-Premise']]
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[['The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n', 'Thrombotic thrombocytopenic purpura\n', 'Support'], ['Neurological alteration\n', 'The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n', 'Support'], ['Febrile syndrome (fever)\n', 'The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n', 'Support'], ['Coombs negative migroangiopathic hemolytic anemia (presence of schistocytes)\n', 'The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n', 'Support'], ['Thrombopenia\n', 'The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n', 'Support']]
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