correct_option int64 1 5 | explanations dict | full_answer stringlengths 26 2.98k | full_answer_no_ref stringlengths 26 2.89k | full_question stringlengths 123 1.09k | id int64 0 620 | lang stringclasses 1
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values | year int64 2.01k 2.02k | rag dict |
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... | There is no doubt that the doctor-patient relationship today transcends the physical environment of the consultation room. But we must not forget that we must maintain the same ethical and professional codes as in the real environment. The code of ethics Article 26-3. The clinical practice of medicine by means of consu... | There is no doubt that the doctor-patient relationship today transcends the physical environment of the consultation room. But we must not forget that we must maintain the same ethical and professional codes as in the real environment. The code of ethics Article 26-3. The clinical practice of medicine by means of consu... | Juan, a second year resident, attends Sofia, a 15 year old girl in the emergency room, who apparently fainted at school without losing consciousness. The patient says that she was due to take an exam, which caused her a lot of anxiety. From the interrogation, it appears that she was being bullied by her classmates and ... | 402 | en | {
"1": "Tell him to make the friend request and that he will accept it, as he is sure that there are no inappropriate items on his page for a girl of Sofia's age.",
"2": "Because you consider Sofia a vulnerable patient and are concerned that she may misinterpret a rejection, agree to let her make the request but only... | 183 | PRIMARY CARE AND SOCIAL NETWORKS | 2,016 | {
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{
"id": "pubmed23n0091_3667",
"title": "[Telling the patient the diagnosis of cancer].",
"score": 0.009988023952095809,
"content": "Four cases are presented for discussion. In the first case, the patient bel... |
4 | {
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"... | Diffuse axonal injury produces an early and sustained deterioration of the level of consciousness (as mentioned in the case statement) without a lesion on CT scan to justify the picture. Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brai... | Diffuse axonal injury produces an early and sustained deterioration of the level of consciousness (as mentioned in the case statement) without a lesion on CT scan to justify the picture. Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brai... | After a traffic accident a 38-year-old patient is admitted to the ICU in coma. After several days the patient does not improve neurologically and a CT scan shows hemorrhagic punctate lesions in the corpus callosum and cortico-subcortical junction. What is the diagnosis? | 237 | en | {
"1": "Acute subdural hematoma.",
"2": "Trobocytopenic purpura.",
"3": "Cerebral hemorrhagic contusion.",
"4": "Severe diffuse axonal injury.",
"5": "Hypoxic-ischemic encephalopathy."
} | 144 | NEUROLOGY | 2,014 | {
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"id": "pubmed23n0113_8474",
"title": "[Clinicopathological studies of diffuse axonal injury--five autopsy cases].",
"score": 0.01890999910801891,
"content": "In severe head injuries, delayed intracerebral ... |
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"text": "In osteoporosis, one of the main risks associated with the increased risk of fracture is low adherence to treatment, so answer 1 is correct."
... | In osteoporosis, one of the main risks associated with the increased risk of fracture 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 trea... | In osteoporosis, one of the main risks associated with the increased risk of fracture is low adherence to treatment, so [HIDDEN]. 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. [HID... | 79-year-old woman admitted for an osteoporotic hip fracture. Regarding secondary prevention of fragility fractures, point out the WRONG answer: | 620 | en | {
"1": "Low adherence to treatment is associated with an increased risk of fracture.",
"2": "Bone remodeling markers may be useful for early monitoring of treatment response.",
"3": "Vitamin D monotherapy is effective in reducing these fractures in non-institutionalized elderly people.",
"4": "Increasing dietar... | 121 | TRAUMATOLOGY | 2,022 | {
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"id": "pubmed23n0298_13589",
"title": "Prevention of hip fractures by correcting calcium and vitamin D insufficiencies in elderly people.",
"score": 0.018311036789297658,
"content": "For a 50-year old cauc... |
4 | {
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"... | Gram negative does NOT rule out infection. We mark four. | Gram negative does NOT rule out infection. We mark [HIDDEN]. | A 41-year-old man comes to the Emergency Department for three days of swelling and pain in the right knee, with functional impotence and fever Two weeks earlier he had had a self-limited diarrhea. On examination there is joint effusion, so we proceed to perform an arthrocentesis and obtain 50 cc of cloudy fluid, with d... | 396 | en | {
"1": "Treatment with cloxacillin and ceftriaxone should be initiated pending the result of the fluid culture.",
"2": "It is advisable to perform daily arthrocentesis to relieve symptoms and avoid joint destruction.",
"3": "If the culture is negative, it is probably reactive arthritis.",
"4": "The negativity o... | 136 | TRAUMATOLOGY AND ORTHOPEDICS | 2,016 | {
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"id": "pubmed23n0705_7704",
"title": "Approach to septic arthritis.",
"score": 0.019324122479462285,
"content": "Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidit... |
4 | {
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"... | When a severe flare does not respond to iv corticosteroid therapy at full doses (1mg/kg body weight), it is necessary to switch to cyclosporine or infliximab. Etanercept is not approved in Europe for inflammatory bowel disease (for the time being). | When a severe flare does not respond to iv corticosteroid therapy at full doses (1mg/kg body weight), it is necessary to switch to cyclosporine or infliximab. Etanercept is not approved in Europe for inflammatory bowel disease (for the time being). | A 37-year-old woman with extensive ulcerative colitis presents a severe flare-up for which treatment with prednisone at a dose of 1 mg/kg is started. After one week of treatment, the patient shows no improvement. What is the next therapeutic measure to be taken? | 253 | en | {
"1": "Emergency subtotal colectomy and in a second time prostectomy and ileoanal reservoir.",
"2": "Associate an immunosuppressant such as azathioprine.",
"3": "Associate mesalazine in doses of 4g per day orally and rectal triamcinolone 1 application every 12 hours.",
"4": "Intravenous cyclosporine 2mg/kg.",
... | 86 | DIGESTIVE TRACT | 2,014 | {
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"id": "pubmed23n0257_19331",
"title": "Cyclosporine for the treatment of fulminant ulcerative colitis in children. Immediate response, long-term results, and impact on surgery.",
"score": 0.018532818532818532,
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"text": "If we do 1 we take away life expectancy, because we allow the ventricle to claudicate."
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"char_ranges": ... | Something aortic. They give me a gradient, which without knowing the values seems somewhat high (55 mmHg!) and the area, which looks tiny to the naked eye: this is going to be aortic stenosis... And he has dyspnea. Symptomatic aortic stenosis, will the examiner want me to send him for surgery? With the guidelines in ha... | Something aortic. They give me a gradient, which without knowing the values seems somewhat high (55 mmHg!) and the area, which looks tiny to the naked eye: this is going to be aortic stenosis... And he has dyspnea. Symptomatic aortic stenosis, will the examiner want me to send him for surgery? With the guidelines in ha... | A 52-year-old patient who has been complaining of dyspnea on medium exertion for 6 months. He has not presented angina or syncope. Physical examination and diagnostic tests show a mean aortic transvalvular gradient of 55 mmHg and a calculated area of 0.7 cm². Ejection fraction of 65%. The treatment to be indicated for ... | 224 | en | {
"1": "Diuretics and more frequent check-ups by a specialist.",
"2": "In case of increasing dyspnea on exertion, percutaneous dilatation of the aortic valve with a balloon catheter should be performed.",
"3": "Replacement of the aortic valve with a prosthesis/bioprosthesis.",
"4": "Replacement of the aortic va... | 63 | CARDIOLOGY | 2,014 | {
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"id": "pubmed23n0944_14334",
"title": "[Aortic stenosis is a common disease which requires individualized treatment].",
"score": 0.01738934056007227,
"content": "Aortic stenosis is the most common valvular... |
2 | {
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"text": "Patient on her 30th post-transplant day of hemato... | Patient on her 30th post-transplant day of hematopoietic precursor transplantation, in severe neutropenia who presents with cough with hemoptotic expectoration. This picture is usually seen in infection by Aspergillus spp. We can rule out infection by Staphylococcus aureus because of previous treatment, although we do ... | Patient on her 30th post-transplant day of hematopoietic precursor transplantation, in severe neutropenia who presents with cough with hemoptotic expectoration. This picture is usually seen in infection by Aspergillus spp. We can rule out infection by Staphylococcus aureus because of previous treatment, although we do ... | A 65-year-old woman who underwent hematopoietic precursor transplantation 30 days ago and has severe neutropenia. She starts with cough and hemoptotic expectoration in addition to fever and moderate exertional dyspnea that does not improve despite five days of treatment with amoxicillin-clavulanic acid (875/125 mg/8 h)... | 430 | en | {
"1": "Septic embolisms.",
"2": "Invasive pulmonary aspergillosis.",
"3": "Pneumonia due to Staphylococcus aureus.",
"4": "Systemic candidiasis.",
"5": null
} | 115 | INFECTIOUS DISEASES AND MICROBIOLOGY | 2,018 | {
"clinical_case_options": {
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{
"id": "pubmed23n0610_2963",
"title": "Septic pulmonary embolism: three case reports.",
"score": 0.014958560743885182,
"content": "We present three cases of septic pulmonary embolism which occurred as a res... |
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"text": "Adenopathy being very typical of adenoviral conjunctivitis, this option is the easiest to rule out."
},
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"ch... | The involvement of the preauricular node is the typical lymphadenopathy of conjunctival infectious conditions. It is true that typical bacterial conjunctivitis does not usually present with lymphadenopathy. They have a more rapid and self-resolving course and do not awaken the lymphoid response as adenoviruses typicall... | The involvement of the preauricular node is the typical lymphadenopathy of conjunctival infectious conditions. It is true that typical bacterial conjunctivitis does not usually present with lymphadenopathy. They have a more rapid and self-resolving course and do not awaken the lymphoid response as adenoviruses typicall... | A 36-year-old male consults for conjunctival hyperemia and foreign body sensation. Which of the following pathologies does NOT correspond to the above mentioned examination? | 588 | en | {
"1": "Adenoviral conjunctivitis.",
"2": "Allergic conjunctivitis.",
"3": "Parinaud's oculoglandular syndrome.",
"4": "Chlamydia conjunctivitis.",
"5": null
} | 63 | OPHTHALMOLOGY | 2,022 | {
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{
"id": "pubmed23n0668_21993",
"title": "[Trachoma in patients with allergic conjunctivitis].",
"score": 0.01869812145041503,
"content": "The aim of this paper was to identify a possible association between ... |
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"text": "The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed. But if there... | I think the correct answer is 3 answers 2,4 and 5 are clearly false. The doubt is between 1 and 2. The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed. But if there are data of poor prognosis and the possibility of metastases - as in this case ... | I think [HIDDEN] answers [HIDDEN]. The doubt is [HIDDEN]. The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed. But if there are data of poor prognosis and the possibility of metastases - as in this case - it is best to complete the thyroidectom... | Ten days after performing a hemithyroidectomy on a patient with a 1.5 cm thyroid nodule you receive the following anatomopathologic report: "very cellular follicular pattern without capsular invasion and infiltrating adjacent blood vessels and nerves". Point out the correct answer: | 11 | en | {
"1": "As there is no capsular invasion, no further surgery is necessary.",
"2": "Follicular pattern is an indication for prophylactic cervical lymph node emptying.",
"3": "This is a follicular carcinoma and requires completion of thyroidectomy.",
"4": "The report allows us to rule out with total certainty a p... | 74 | SURGERY | 2,011 | {
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{
"id": "pubmed23n0306_4298",
"title": "Selective treatment of differentiated thyroid carcinoma.",
"score": 0.01702405099971023,
"content": "Over a period of 20 years 84 papillary and 82 follicular carcinoma... |
4 | {
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"text": "anti-Sm are specific to SLE,"
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"word... | Another question about SLE antibodies. Clinical case of SLE with renal involvement, in which positive double-stranded anti-DNA increases the risk of nephritis. As for the rest, anti-Sm are specific to SLE, ANA are detected in more than 90% of cases, and anti-centromere are typical of scleroderma. | Another question about SLE antibodies. Clinical case of SLE with renal involvement, in which positive double-stranded anti-DNA increases the risk of nephritis. As for the rest, anti-Sm are specific to SLE, ANA are detected in more than 90% of cases, and anti-centromere are typical of scleroderma. | A 27-year-old black woman consults for the appearance of edema in the lower limbs, decreased diuresis, fever and a malar rash in butterfly wings of 20 days of evolution. Laboratory tests showed creatinine 3 mg/dl, leukopenia, hemoglobin 10.5 g/dl (normochromic normocytic), CRP 9 mg/dl and ESR 60 mm. Regarding the patho... | 535 | en | {
"1": "The anti-Sm antibodies are not specific for this pathology.",
"2": "Anti-centromere antibodies are detected in 90% of cases.",
"3": "ANA (antinuclear antibodies) are detected in 50% of cases.",
"4": "Anti-two-stranded or native anti-DNA correlates with the risk of nephritis.",
"5": null
} | 121 | RHEUMATOLOGY | 2,021 | {
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{
"id": "pubmed23n0395_10395",
"title": "Clinical and laboratory features of systemic lupus erythematosus (SLE) in Pakistani patients.",
"score": 0.016190476190476193,
"content": "To study the clinico-pathol... |
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"... | Clearly the answer is 4, with a very characteristic clinic of temporary seizures. | Clearly the answer is [HIDDEN], with a very characteristic clinic of temporary seizures. | In a woman with an epileptic seizure presenting with the following clinical features: epigastric aura, unpleasant odor, disconnection from the environment, motor automatisms (sucking, swallowing, opening and closing of one hand) and postcritical amnesia, what is your diagnostic suspicion? | 452 | en | {
"1": "Generalized non-convulsive seizure or typical absence.",
"2": "Continuous partial epilepsy.",
"3": "Amyotonic crisis.",
"4": "Complex partial temporal lobe seizure.",
"5": null
} | 149 | NEUROLOGY | 2,018 | {
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"id": "pubmed23n0334_12575",
"title": "[Ictal semiology of temporal partial complex seizures: usefulness for localizing and lateralizing the origin of the attacks].",
"score": 0.018812930577636458,
"conten... |
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"text": "Answers 1 and 3 are contrary, one recommends completing thyroidectomy and the other does not. The only ones in which complete thyroidectomy ... | I find this question a bit more difficult since you have to have clear concepts of pathologic anatomy. In any case, it is possible to exclude by exclusion and by the way the answers are expressed: Answer 2: prophylactic emptying is indicated in the medullary. Answer 4: simply by the way of expressing it, it should alre... | I find this question a bit more difficult since you have to have clear concepts of pathologic anatomy. In any case, it is possible to exclude by exclusion and by the way the answers are expressed: Answer 2: prophylactic emptying is indicated in the medullary. Answer 4: simply by the way of expressing it, [HIDDEN]. Answ... | Ten days after performing a hemithyroidectomy on a patient with a 1.5 cm thyroid nodule you receive the following definitive report from the pathologist: "very cellular follicular pattern without capsular invasion invading adjacent blood vessels and nerves". Point out the correct answer: | 55 | en | {
"1": "As there is no capsular invasion it is not convenient to perform further surgery.",
"2": "The follicular pattern is an indication for prophylactic cervical lymph node emptying.",
"3": "It is a follicular carcinoma and requires completion of thyroidectomy.",
"4": "The report allows to rule out papillary ... | 74 | ENDOCRINOLOGY | 2,011 | {
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{
"id": "wiki20220301en195_1167",
"title": "Medullary thyroid cancer",
"score": 0.01678690344062153,
"content": "Prognosis Depending on source, the overall 5-year survival rate for medullary thyroid cancer i... |
2 | {
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"text": "Answer 1 can be ruled out visu visu,"
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... | The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY, since positive HER2 receptors imply greater aggressiveness of the tumor but treatment with trastuzumab and positive hormone receptors would imply the use of hormone therapy. Answer 1 can be ruled out visu visu, while answers 3 and 4 should be ruled out sin... | [HIDDEN] since positive HER2 receptors imply greater aggressiveness of the tumor but treatment with trastuzumab and positive hormone receptors would imply the use of hormone therapy. [HIDDEN], while [HIDDEN], being the first woman in the family with breast carcinoma, the study of the patient's relatives would not be ob... | A 67-year-old woman diagnosed with an infiltrating ductal carcinoma of the breast and no family history of neoplasia. What additional studies should be performed on the tumor for its clinical-therapeutic implications? | 281 | en | {
"1": "Complete phenotypic study by flow cytometry.",
"2": "Study of hormone receptors and HER2.",
"3": "Study of hormone receptors, e-cadherin and study of first degree relatives.",
"4": "Study of BRCA 1-2 and study of first-degree relatives.",
"5": null
} | 33 | PATHOLOGICAL ANATOMY | 2,016 | {
"clinical_case_options": {
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{
"id": "pubmed23n0267_6734",
"title": "The significance of family history for patients with carcinoma of the breast.",
"score": 0.01532967032967033,
"content": "Since the risk of carcinoma of the breast is ... |
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"text": "The cause of shaken baby syndrome is almost always abuse, so the answer is 1."
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... | Easy question in principle, but with a bit of a catch. If you have the right intuition when you read it and go straight to what you think, you will probably get it right. The problem is option 4, which can confuse us. Let's see: we have a blow to the right eye area, with a hematoma on the eyelid. So far so normal. The ... | Easy question in principle, but with a bit of a catch. If you have the right intuition when you read it and go straight to what you think, you will probably get it right. The problem is option 4, which can confuse us. Let's see: we have a blow to the right eye area, with a hematoma on the eyelid. So far so normal. The ... | A parent comes to the emergency department with his 2-year-old son because he reports that he has hit his right eye while playing. Indeed, a hematoma is observed on the right eyelid, apparently of no importance. The fundus examination showed intraretinal hemorrhages not only in the eye referred by the parents but also ... | 310 | en | {
"1": "It is a highly suggestive history of child abuse.",
"2": "It is the normal evolution of a non-perforating intraocular trauma.",
"3": "The most likely diagnosis is Berlin edema.",
"4": "It is the characteristic picture of Purstcher's traumatic retinal angiopathy.",
"5": null
} | 216 | OPHTHALMOLOGY | 2,016 | {
"clinical_case_options": {
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{
"id": "pubmed23n0763_14041",
"title": "History of head trauma in a 6-year-old boy: maybe more than meets the eye (and head).",
"score": 0.015039606080068508,
"content": "It is spring and you are meeting fo... |
3 | {
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... | Any of the 4 options can be the cause of erythroderma, although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely. | Any of the 4 options can be the cause of erythroderma, although the description of nail lesions highly suggestive of psoriasis makes this diagnosis [HIDDEN]. | A patient comes to the emergency department with erythroderma with fever and general malaise. On examination, the nails show the presence of nail pitting and distal yellowish areas in an oil stain. What is the primary disease that caused the condition? | 293 | en | {
"1": "Cutaneous lymphoma.",
"2": "Atopic dermatitis.",
"3": "Psoriasis.",
"4": "Ichthyosis.",
"5": null
} | 214 | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | 2,016 | {
"clinical_case_options": {
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{
"id": "pubmed23n0511_17192",
"title": "Exfoliative dermatitis. Erythroderma can be a sign of a significant underlying disorder.",
"score": 0.0196078431372549,
"content": "64-year-old man presented with a 3... |
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"text": "Answer 1: it cannot be because a hemorrhagic transformation does not give such a brutal elevation of LDH and Cr, in addition to not explaini... | Let's see: a patient with certain history who has: - Schistocytes in smear: indicates microangiopathic anemia, red cell rupture of mechanical cause, which can be seen mainly in PTT, autoimmune hemolytic anemia and DIC. - Bicytopenia: here the causes can be very, very varied. - Elevation of LDH and Bilirubin, which indi... | Let's see: a patient with certain history who has: - Schistocytes in smear: indicates microangiopathic anemia, red cell rupture of mechanical cause, which can be seen mainly in PTT, autoimmune hemolytic anemia and DIC. - Bicytopenia: here the causes can be very, very varied. - Elevation of LDH and Bilirubin, which indi... | A 54-year-old man, with a personal history of DM, hypertension and mild chronic renal insufficiency, presented with somnolence and right hemiparesis. Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation. Cranial CT: ischemic lesions with microhemorrhagic necrosis. Subseq... | 132 | en | {
"1": "New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke.",
"2": "Initiate urgent plasmapheresis.",
"3": "Beginning of treatment with glucocorticoids at a dose of 1 mg/kg/day.",
"4": "Search for triggering cause of DIC.",
"5": "Suspected multiple myeloma: bone marrow a... | 229 | NEUROLOGY AND NEUROSURGERY | 2,012 | {
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"RRF-2": [
{
"id": "pubmed23n0928_18867",
"title": "Incidental Thrombotic Thrombocytopenic Purpura during Acute Ischemic Stroke and Thrombolytic Treatment.",
"score": 0.019327731092436976,
"content": "Intravenous tissu... |
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... | The correct answer is 3. Perthes disease is more common and has a better prognosis in younger children. | The [HIDDEN] Perthes disease is more common and has a better prognosis in younger children. | An 8 year old boy with lameness of the right lower extremity, of insidious presentation and one month of evolution. There is no history of trauma or constitutional signs. On examination there is evidence of restriction to passive mobilization of the limb, especially in abduction and internal rotation. Of the following ... | 49 | en | {
"1": "It is advisable to perform a hip X-ray.",
"2": "In transient synovitis the onset is usually acute.",
"3": "In Legg-Calvé-Perthes disease the prognosis is worse the younger the age of onset.",
"4": "The cause may be a hypercoagulable state.",
"5": "The therapeutic option will vary depending on the degr... | 159 | PEDIATRICS | 2,011 | {
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"id": "pubmed23n0585_17655",
"title": "Legg-calve-perthes disease: a review of cases with onset before six years of age.",
"score": 0.016483145308383435,
"content": "The prognosis for children in whom Legg... |
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... | As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate. | As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate. | A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l. He refers complete vaccination according to the standard hepatitis B vaccination schedule 4 years ago. It would be advisable: | 120 | en | {
"1": "Restart vaccination schedule (0-1-6 months).",
"2": "Restart vaccination schedule (0-1-2-12 months).",
"3": "Do not revaccinate.",
"4": "Give a booster dose.",
"5": "Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)."
} | 192 | PREVENTIVE MEDICINE AND EPIDEMIOLOGY | 2,012 | {
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"id": "pubmed23n0084_11900",
"title": "Vaccination against hepatitis B: comparison of three different vaccination schedules.",
"score": 0.019149715961150816,
"content": "Three different hepatitis B vaccina... |
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... | Before intensifying antihypertensive treatment, the potential causes should be resolved. In this case we are dealing with an elderly patient with chronic treatment with NSAIDs that produces arterial hypertension secondary to renal hypoperfusion. The most reasonable option would be to withdraw ibuprofen and replace it w... | Before intensifying antihypertensive treatment, the potential causes should be resolved. In this case we are dealing with an elderly patient with chronic treatment with NSAIDs that produces arterial hypertension secondary to renal hypoperfusion. The most reasonable option would be to withdraw ibuprofen and replace it w... | 87-year-old man with a history of hypertension and gonarthrosis. Baseline situation with full functional and cognitive autonomy that allows him to continue living alone in the community. He is receiving regular treatment with perindopril and thiazide diuretic for blood pressure control and routinely takes ibuprofen 180... | 304 | en | {
"1": "I would add a calcium channel blocker.",
"2": "I would increase the dose of hydrochlorothiazide to 25 mg/day.",
"3": "I would change ibuprofen for paracetamol to avoid the possible influence of paracetamol on the effect of hypotensives.",
"4": "I would add an alpha blocker because of the high prevalence... | 174 | NEPHROLOGY | 2,016 | {
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"title": "Study population and treatment titration in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT).",
"score": 0.019142700128228614,... |
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"text": "And above all, because of its implications, the first one to always rule out."
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... | Acute monoarthritis associated with fever, leukocytosis with neutrophilia and increased acute phase reactants does not always have a septic origin. In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) i... | Acute monoarthritis associated with fever, leukocytosis with neutrophilia and increased acute phase reactants does not always have a septic origin. In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) i... | A 19-year-old man consults for a 24-hour history of pain, swelling and functional impotence of the right knee accompanied by a fever of 38°C. Physical examination reveals inflammatory signs and joint effusion in the right knee. Laboratory tests showed leukocytosis with neutrophilia and elevated C-reactive protein. The ... | 214 | en | {
"1": "Arthritis due to microcrystals.",
"2": "Reactive arthritis.",
"3": "Bacterial infectious arthritis.",
"4": "Mycobacterial infectious arthritis.",
"5": "Rheumatoid arthritis."
} | 228 | RHEUMATOLOGY | 2,014 | {
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"id": "pubmed23n1134_16871",
"title": "Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report.",
"score": 0.018608274190756446,
"content": "B... |
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"text": "All these data are suggestive of visceral Leishmaniasis, so an OM biopsy should be performed to look for amastigotes and confirm the diagnosi... | Easy and quite typical question. We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia. All these data are suggestive of visceral Leishmaniasis, so an OM biopsy should be performed to look for amast... | Easy and quite typical question. We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia. All these data are suggestive of visceral Leishmaniasis, so an OM biopsy should be performed to look for amast... | A 53-year-old woman consults for a fever of 15 days of evolution, without symptoms of infectious focality. On examination, a painful hepatomegaly is detected at 5 cm from the costal margin and the spleen is palpated at 14 cm from the left costal margin. The blood count showed Hb 8.5 g/dL, leukocytes 630/ml (lymphocytes... | 249 | en | {
"1": "I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis.",
"2": "Pancytopenia is justified by C virus-associated cirrhosis and I would not perform further testing.",
"3": "Probably a medullary toxicity due to prednisone that would be treated with drug withdrawal a... | 120 | INFECTIOUS DISEASES | 2,014 | {
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{
"id": "Pharmacology_Katzung_5336",
"title": "Pharmacology_Katzung",
"score": 0.015720418404982162,
"content": "Sharon Safrin, MD A 35-year-old white woman who recently tested seropositive for both HIV and ... |
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"text": "Breaking up with a partner I understand is hard, but not exceptional."
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... | Here it is good that they tell you their antecedents (we all have antecedents because we all have a life) and that they rule out organic pathology. That is fundamental. Let us not forget that also the hypochondriacs have body. We first eliminate the most striking "acute" personality disorder. Personality accompanies us... | Here it is good that they tell you their antecedents (we all have antecedents because we all have a life) and that they rule out organic pathology. That is fundamental. Let us not forget that also the hypochondriacs have body. We first eliminate the most striking "acute" personality disorder. Personality accompanies us... | A 31-year-old man with no psychiatric history comes to the emergency room complaining...¨ symptoms of anxiety. Two days ago he experienced another episode of the same symptoms... .... 1 week ago he broke up with his partner... ruled out any organic pathology....: | 53 | en | {
"1": "Post-traumatic stress reaction.",
"2": "Acute\" dependent personality disorder.",
"3": "Depressive disorder.",
"4": "Agoraphobia.",
"5": "Anguish crisis."
} | 146 | PSYCHIATRY | 2,011 | {
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"id": "pubmed23n0691_18392",
"title": "[Depressive symptoms in pathomimia: comorbidity or psychiatric factitious disorder?].",
"score": 0.013958849141978997,
"content": "The factitious disorders, more comm... |
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... | The correct answer is 1. The anticholinergic can be administered intravenously and also intramuscularly if I am not mistaken. The occurrence of dystonia as a side effect is common in children and is one of the main reasons why pediatricians do not usually prescribe some antiemetics in children. | [HIDDEN] The anticholinergic can be administered intravenously and also intramuscularly if I am not mistaken. The occurrence of dystonia as a side effect is common in children and is one of the main reasons why pediatricians do not usually prescribe some antiemetics in children. | A 10-year-old boy is brought to the Emergency Department because for the last 2 hours he has been involuntarily turning his neck to the right associated with marked cervical pain at each turn. The grandmother subsequently tells us that he has been vomiting since yesterday, so she gave him a syrup; what would be the mos... | 48 | en | {
"1": "Inject an intravenous anticholinergic.",
"2": "Do not treat until an electroencephalogram is performed in the following days.",
"3": "Do not treat until the result of the cerebrospinal fluid culture is known in the next few days.",
"4": "Call the on-call psychiatrist.",
"5": "Start an intravenous anti... | 158 | PEDIATRICS | 2,011 | {
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{
"id": "wiki20220301en201_27434",
"title": "Kay's Tutor v Ayrshire & Arran Health Board",
"score": 0.013917054356038013,
"content": "\"Meningitis is a disease which causes inflammation of one or more of the... |
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"text": "Option 1 leaves the treatment incomplete, there is only ATRA and it must be treated as long as the patient's condition allows it, whether or ... | It is a definitive promyelocytic leukemia with t(15;17), and as it is well known by all of you the treatment is with arsenic trioxide + ATRA. Option 1 leaves the treatment incomplete, there is only ATRA and it must be treated as long as the patient's condition allows it, whether or not there are symptoms. Option 3 3 ye... | It is a definitive promyelocytic leukemia with t(15;17), and as it is well known by all of you the treatment is with arsenic trioxide + ATRA. Option 1 leaves the treatment incomplete, there is only ATRA and it must be treated as long as the patient's condition allows it, whether or not there are symptoms. Option 3 3 ye... | A 65-year-old woman referred to the emergency department for fever and alterations in the laboratory tests: hemoglobin 11.4 g/dL, leukocytes 0.86 x103/μL,(neutrophils 41.9%, lymphocytes 55.8%),platelets 48.0 x103/μL, fibrinogen 118 mg/dL,D-dimer 20.2 μg/mL. Bone marrow examination was performed and she was diagnosed wi... | 490 | en | {
"1": "If asymptomatic, transretinoic acid (ATRA) will be started and day hospital controls will be recommended.",
"2": "Start treatment with arsenic trioxide, ATRA and supportive therapy.",
"3": "It is a myeloblastic leukemia type M3, so chemotherapy and heparin will be started to control disseminated intravasc... | 106 | HEMATOLOGY | 2,020 | {
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{
"id": "pubmed23n0807_4899",
"title": "Postremission therapy in acute promyelocytic leukemia: room for improvement?",
"score": 0.018812930577636458,
"content": "A 29-year-old white man presented to the hosp... |
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"text": "We would have been told of a history of NSAID use, or a history of pain that improves with ingestion, of pneumoperitoneum on chest X-ray."
... | This is a classic picture and the author of the question has taken care to give us enough clues so that we do not miss it. When reading this statement, multiple alarms go off: - Atrial Fibrillation: at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until pro... | This is a classic picture and the author of the question has taken care to give us enough clues so that we do not miss it. When reading this statement, multiple alarms go off: - Atrial Fibrillation: at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until pro... | A 78-year-old woman with dementia and institutionalized is brought in by her caregivers for significant abdominal pain with deterioration of general condition and abdominal distension. CBC shows leukocytosis, elevated hematocrit, renal failure and metabolic acidosis. ECG shows atrial fibrillation. Abdominal tomography ... | 416 | en | {
"1": "Perforation of gastric or duodenal ulcus.",
"2": "Biliary leak.",
"3": "Obstructive neoplasm of the sigma with perforation.",
"4": "Mesenteric ischemia.",
"5": null
} | 76 | GENERAL SURGERY | 2,018 | {
"clinical_case_options": {
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"id": "pubmed23n0710_17980",
"title": "Synchronous celiac axis and superior mesenteric artery embolism.",
"score": 0.015858324077502158,
"content": "We present a case of combined celiac axis and superior m... |
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"text": "It is also answered with the statement that begins by saying that the child is asymptomatic."
},
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"char_range... | The correct answer is 1. It is also answered with the statement that begins by saying that the child is asymptomatic. The error seems to me to be a misconception because for the study of a murmur an ECG is not usually requested but an echocardiography. Heart failure is a complication of Wolf-Parkinson-White syndrome an... | [HIDDEN] It is also answered with the statement that begins by saying that the child is asymptomatic. The error seems to me to be a misconception because for the study of a murmur an ECG is not usually requested but an echocardiography. Heart failure is a complication of Wolf-Parkinson-White syndrome and rarely a debut... | A 9-year-old boy, asymptomatic with an innocent murmur, undergoes an ECG that documents Wolf-Parkinson-White Syndrome. Which of the following statements is FALSE? | 45 | en | {
"1": "He needs treatment for heart failure.",
"2": "She may present with paroxysmal supraventricular tachycardia.",
"3": "The 2D-Doppler ultrasound will rule out its association with Ebstein's disease.",
"4": "It is convenient to perform a 24-hour ECG (Holter) and ergometry.",
"5": "In certain patients, abl... | 154 | PEDIATRICS | 2,011 | {
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"id": "pubmed23n0310_4422",
"title": "[Tachycardia-induced syncopes].",
"score": 0.015123088293820003,
"content": "In 50% of the patients presenting with a syncope, the cause is cardiac. The incidence of s... |
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... | Mature cystic teratoma is a common benign tumor of the ovary in adult women. The tissues that make up the tumor are well differentiated (mature or adult-type); apart from cutaneous structures many other tissues can be seen, particularly in a thickening or spur that eminences into the cavity, in which there are often te... | Mature cystic teratoma is a common benign tumor of the ovary in adult women. The tissues that make up the tumor are well differentiated (mature or adult-type); apart from cutaneous structures many other tissues can be seen, particularly in a thickening or spur that eminences into the cavity, in which there are often te... | A 20-year-old woman with a 15-cm solid-cystic ovarian tumor detected by ultrasound after presenting with nonspecific abdominal symptoms. In the histopathological study of the corresponding specimen, teeth, hairs, areas of intestinal epithelium, areas of squamous epithelium (15%) and bronchial epithelium, as well as neu... | 336 | en | {
"1": "Teratocarcinoma.",
"2": "Immature teratoma.",
"3": "Mature cystic teratoma.",
"4": "Dysgerminoma.",
"5": null
} | 31 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
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"id": "pubmed23n0721_21912",
"title": "Malignant transformation of ovarian mature cystic teratoma with a predominant pulmonary type small cell carcinoma component.",
"score": 0.016298946531504672,
"content... |
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"text": "Exercise-induced compartment syndrome is an exerc... | Exercise-induced compartment syndrome is an exercise-induced condition of the leg. It is characterized by reversible ischemia of the muscles of a muscle compartment. Diagnosis is made by measuring compartment pressures at rest, during exercise and after exercise (answer 2 correct). Treatment usually consists of fasciot... | Exercise-induced compartment syndrome is an exercise-induced condition of the leg. It is characterized by reversible ischemia of the muscles of a muscle compartment. Diagnosis is made by measuring compartment pressures at rest, during exercise and after exercise ([HIDDEN]). Treatment usually consists of fasciotomies of... | A 27-year-old male, a regular athlete, refers pain in the right leg after continuous running. He has visited a physiotherapist on several occasions and has been diagnosed with calf overload. Several months have passed, she has not improved and refers intense pain after physical activity that subsides with rest in the h... | 609 | en | {
"1": "Positron emission tomography with 18 FDG.",
"2": "Determination of posterior compartment pressure immediately after activity.",
"3": "Doppler ultrasound to rule out a circulatory disorder of the lower extremity.",
"4": "Magnetic resonance spectroscopy.",
"5": null
} | 115 | TRAUMATOLOGY | 2,022 | {
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{
"id": "pubmed23n0489_6509",
"title": "[MR-Imaging of lower leg muscle perfusion].",
"score": 0.017677937316658947,
"content": "This article describes the potential of dynamic contrast- enhanced magnetic re... |
3 | {
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"text": "We are being asked about the pertussis vaccine. Option 1 is correct, it is the diphtheria-tetanus-pertussis vaccine."
},
"2": {
"exist":... | We are being asked about the pertussis vaccine. Option 1 is correct, it is the diphtheria-tetanus-pertussis vaccine. Option 4 is also correct, since they are inactivated microorganisms. Now we are left with the doubt between 2 and 3... Option 3 is the one that "is not true among all those proposed to us": immunity last... | We are being asked about the pertussis vaccine. Option 1 is [HIDDEN], it is the diphtheria-tetanus-pertussis vaccine. Option 4 is also [HIDDEN], since they are inactivated microorganisms. Now we are left with the doubt between 2 and 3... Option 3 is the one that "is not true among all those proposed to us": immunity la... | A 3-month-old infant correctly vaccinated for his age, who after two weeks of rhinorrhea, sneezing and coughing, is admitted for intensification of coughing spells, with cyanosis at the end of them, ending with deep inspiration or inspiratory rooster, requiring stimulation, aspiration of secretions and oxygen to recove... | 389 | en | {
"1": "The vaccine in Spain is administered in combination with diphtheria and tetanus.",
"2": "Adults who will be in contact with infants under 6 months of age should be vaccinated.",
"3": "Both natural and vaccinal immunity remains for life.",
"4": "Vaccination is prepared from killed microorganisms.",
"5"... | 235 | PEDIATRICS | 2,016 | {
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"id": "pubmed23n0415_19247",
"title": "[Culture-confirmed whooping cough in a tertiary center over a twelve-year period].",
"score": 0.01575757575757576,
"content": "To study the characteristics of patient... |
2 | {
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"text": "Wernicke's aphasia is characterized by fluent ... | Transcortical have preserved repetition. Broca's aphasia has preserved comprehension and absence of fluent speech. Wernicke's aphasia is characterized by fluent speech (even in excess) with paraphasias and problems with comprehension, nomination and repetition. | Transcortical have preserved repetition. Broca's aphasia has preserved comprehension and absence of fluent speech. Wernicke's aphasia is characterized by fluent speech (even in excess) with paraphasias and problems with comprehension, nomination and repetition. | A patient who presents with problems in understanding spoken and written language, inability to name objects and repeat words that are said to him, incomprehensible fluent speech with semantic and phonemic paraphasias. This is a: | 201 | en | {
"1": "Global aphasia.",
"2": "Wernicke's aphasia.",
"3": "Broca's aphasia.",
"4": "Sensitive transcortical aphasia.",
"5": "Transcortical motor aphasia."
} | 76 | NEUROLOGY | 2,013 | {
"clinical_case_options": {
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{
"id": "pubmed23n0350_5294",
"title": "Frontal-opercular aphasia.",
"score": 0.015045248868778281,
"content": "The standard nomenclature divides nonfluent aphasic syndromes with relatively spared comprehens... |
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"text": "prescribing cyclic progesterone is not indicated in a postmenopausal woman."
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... | We are being presented with a case of postmenopausal metrorrhagia. In a case like this we must rule out endometrial neoplasia, so an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy. A cervical biopsy is not of interest in this case since the cytology is normal and hormon... | We are being presented with a case of postmenopausal metrorrhagia. In a case like this we must rule out endometrial neoplasia, so an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy. A cervical biopsy is not of interest in this case since the cytology is normal and [HIDDE... | A 69-year-old woman comes to your office reporting genital bleeding of several months' evolution. She denies hormone replacement therapy and anticoagulation. She provides normal cervicovaginal cytology. General and genital physical examination without findings of interest. BMI of 38kg/m2. Indicate the most correct atti... | 345 | en | {
"1": "Prescribe cyclic progesterone.",
"2": "Endometrial biopsy.",
"3": "Random cervical biopsies.",
"4": "Hormonal evaluation with FSH, LH and estradiol.",
"5": null
} | 159 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
"clinical_case_options": {
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"id": "pubmed23n0356_10102",
"title": "Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy?",
"score": 0.01702405099971023,
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"text": "If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate."
},
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... | If the renal arteries are stenosed, blood has difficulty reaching the kidneys. That is, both are poorly perfused and can only create the pressure gradient necessary for filtration by contraction of the efferent arteriole. If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glo... | If the renal arteries are stenosed, blood has difficulty reaching the kidneys. That is, both are poorly perfused and can only create the pressure gradient necessary for filtration by contraction of the efferent arteriole. If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glo... | A 45-year-old woman presents arterial hypertension (190/120 mmHg) accompanied by K 2.5 mEq/l. An abdominal ultrasound shows stenosis of both renal arteries. Indicate which treatment is contraindicated: | 166 | en | {
"1": "Enalapril.",
"2": "Propanolol.",
"3": "Amiloride.",
"4": "Prazosin.",
"5": "Amlodipine."
} | 82 | CARDIOLOGY AND CARDIOVASCULAR SURGERY | 2,013 | {
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{
"id": "pubmed23n1056_17286",
"title": "[Hypertensive crisis in a 3-year-old boy - neurovascular conflict?]",
"score": 0.017261904761904763,
"content": "Hypertensive crisis is a sudden rise in blood pressur... |
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"text": "the vasoactive drug of choice in the context of septic shock is noradrenaline ([3], [4]) (answer 1 FALSE)"
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... | Patient presenting with fever+tachypnea+FC>100 = 3 criteria of SIRS (Systemic Inflammatory Response Syndrome). Reminder: sepsis is a SIRS due to infection, which leads to a decrease in SVR, resulting in a decrease in preload and stroke volume leading to hypotension. The first therapeutic measures are the administration... | Patient presenting with fever+tachypnea+FC>100 = 3 criteria of SIRS (Systemic Inflammatory Response Syndrome). Reminder: sepsis is a SIRS due to infection, which leads to a decrease in SVR, resulting in a decrease in preload and stroke volume leading to hypotension. The first therapeutic measures are the administration... | A 67-year-old woman with a history of dyslipidemia, who comes to the ED with dysuria and pollakiuria followed by fever, chills, and deterioration of general condition. On arrival she appears severe and is tachycardic, tachypneic, with blood pressure 60/40 mmHg and temperature of 39°C. Which of the following measures wo... | 481 | en | {
"1": "Intravenous perfusion of dobutamine.",
"2": "Serum lactate measurement.",
"3": "Extraction of blood cultures.",
"4": "Fluid administration.",
"5": null
} | 171 | CRITICAL CARE | 2,020 | {
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{
"id": "pubmed23n0712_25044",
"title": "Sepsis, severe sepsis, and septic shock: current evidence for emergency department management.",
"score": 0.017427884615384616,
"content": "In the middle of a busy sh... |
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"text": "Correct Answer 1: Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, gi... | Correct Answer 1: Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, given that the injury described presents a high probability of necrosis of the femoral head. The options would be total or partial arthroplasty: in elderly patients, partial arth... | [HIDDEN]: Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, given that the injury described presents a high probability of necrosis of the femoral head. The options would be total or partial arthroplasty: in elderly patients, partial arthroplasty... | 95-year-old woman living in a nursing home, independent for her basic activities of daily living, goes out to the garden for walks. She has a history of hypertension, dyslipidemia, osteoporosis and mild cognitive impairment. She suffers a fall when getting up at night to go to the bathroom. X-ray shows a displaced subc... | 612 | en | {
"1": "Hip hemiarthroplasty.",
"2": "Trochanteric nail fixation.",
"3": "Fixation with cannulated screws.",
"4": "Conservative: bed-chair life.",
"5": null
} | 116 | TRAUMATOLOGY | 2,022 | {
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"id": "pubmed23n0359_688",
"title": "Ethics in practice.",
"score": 0.018706293706293706,
"content": "H. K. is a ninety-two-year-old woman with Alzheimer's disease and mild hypertension. She resides at a n... |
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"... | They are describing HELLP syndrome. With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination. | They are describing HELLP syndrome. With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination. | 34-week primigravida with blood pressure of 165/95 and headache of two days of evolution. Laboratory tests: hemoglobin 10.5 g/dL, platelets 98,000/mm3, AST 356 IU/L (0-31), ALT 234 IU/L (0-31), LDH 878 IU/L (125-243). The laboratory is called because of the presence of schistocytes in the peripheral blood smear. She re... | 585 | en | {
"1": "Expectant management with antihypertensive drugs and magnesium sulfate until the maternal platelets improve.",
"2": "Expectant attitude with antihypertensive treatment at home and controls every 48 hours.",
"3": "Termination of gestation when she completes fetal lung maturation.",
"4": "Immediate termin... | 74 | OBSTETRICS AND GYNECOLOGY | 2,022 | {
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"id": "pubmed23n1161_25666",
"title": "HELLP syndrome manifesting as abnormal fetal umbilical artery blood flow and rapidly worsening laboratory indexes: A case report.",
"score": 0.019424799622819428,
"co... |
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"text": "It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5."
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"exi... | This case does not seem so easy to me. It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5. In principle she is a patient in moderately good general condition, so the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 bei... | This case does not seem so easy to me. It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5. In principle she is a patient in moderately good general condition, so the ideal would be to perform a permanent biliary diversion and chemotherapy, option [HIDD... | A 76-year-old woman with no history other than hypertension consults for painless jaundice and pruritus with anorexia. Laboratory tests show bilirubin of 12 mg/dl (9.5 direct). Ultrasound shows intrahepatic and extrahepatic biliary dilatation together with a single hepatic nodule smaller than 2 cm located peripherally ... | 3 | en | {
"1": "Neoadjuvant chemo/radiotherapy, conditioning the option of radical surgery on initial response.",
"2": "Percutaneous external biliary drainage with palliative character with eventual reconversion to internal drainage in case of intolerance or complications.",
"3": "Palliative surgical biliary bypass with ... | 37 | DIGESTIVE | 2,011 | {
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{
"id": "pubmed23n0965_4332",
"title": "Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access.",
"score": 0.01504603637996856,
"content": "Endoscopic retrograde cholangi... |
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"text": "the existence of an endometrial pathology cannot be ruled out. According to the SEGO: \"Abnormal genital bleeding is the main sign of suspicio... | Since the most frequent cause of vaginal bleeding in postmenopausal women is urogenital atrophy, the existence of an endometrial pathology cannot be ruled out. According to the SEGO: "Abnormal genital bleeding is the main sign of suspicion that should lead us to rule out an endometrial neoplastic pathology, particularl... | Since the most frequent cause of vaginal bleeding in postmenopausal women is urogenital atrophy, the existence of an endometrial pathology cannot be ruled out. According to the SEGO: "Abnormal genital bleeding is the main sign of suspicion that should lead us to rule out an endometrial neoplastic pathology, particularl... | A 64-year-old woman. Menopause at 54 years of age. Two pregnancies and eutocic deliveries. She does not take any medication. She comes to the emergency department reporting two days of vaginal bleeding with discomfort in the hypogastrium. The clinical examination performed by the gynecologist does not show any lesions ... | 439 | en | {
"1": "Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not.",
"2": "Endometrial biopsy by aspiration in consultation. With it I can get the diagnosis very reliably and it is inexpensive.",
"3": "Hysteroscopy with sedation and directed ... | 96 | GYNECOLOGY AND OBSTETRICS | 2,018 | {
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{
"id": "wiki20220301en024_103785",
"title": "Heavy menstrual bleeding",
"score": 0.017523809523809525,
"content": "Diagnosis The NICE guidelines states that: \"Many women presenting to primary care with sym... |
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"text": "The rest of the answers touch on many of the \"myths\" and customs surrounding gastroenteritis."
},
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"exist": true,
"char_r... | The baby is not dehydrated and is in good general condition. Try to avoid dehydration by replenishing what is being lost, avoiding drastic changes in feeding habits as much as possible. The rest of the answers touch on many of the "myths" and customs surrounding gastroenteritis. There is also no evidence of lactose int... | The baby is not dehydrated and is in good general condition. Try to avoid dehydration by replenishing what is being lost, avoiding drastic changes in feeding habits as much as possible. The rest of the answers touch on many of the "myths" and customs surrounding gastroenteritis. There is also no evidence of lactose int... | The parents of a 5-month-old infant come because their child, who attends day care, has been presenting for 3 days, coinciding with an upper respiratory tract infection, liquid stools numbering 4 per day, occasional alimentary vomiting, and axillary temperature of 38.3°C. He is being fed with mixed breastfeeding. On ex... | 192 | en | {
"1": "An estimation of losses should be made, recommend a 4-hour fast and rehydrate during this time with oral rehydration solution.",
"2": "It is advisable to introduce rice cereals for their astringent effect.",
"3": "A stool culture should be performed as soon as possible to exclude a bacterial origin.",
"... | 160 | PEDIATRICS | 2,013 | {
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"id": "wiki20220301en044_38924",
"title": "Oral rehydration therapy",
"score": 0.017806267806267807,
"content": "An exception is if the severely malnourished child also has severe diarrhea (in which case R... |
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"... | Very difficult question of pituitary apoplexy. It is a marginal topic in the MIR and also the answer is complex. Eliminating answers we are left with intervene (answer 4) or not to intervene (answer 2). In patients with hemodynamic instability, decreased level of consciousness, decreased visual acuity and extensive vis... | Very difficult question of pituitary apoplexy. It is a marginal topic in the MIR and also the answer is complex. Eliminating answers we are left with intervene (answer 4) or not to intervene (answer 2). In patients with hemodynamic instability, decreased level of consciousness, decreased visual acuity and extensive vis... | A 63-year-old woman comes to the emergency department reporting severe headache with signs of meningeal irritation, bilateral visual disturbances and ophthalmoplegia. A CT scan showed a 2 cm space-occupying lesion in the sella turcica compatible with pituitary adenoma with signs of intratumoral hemorrhage, with deviati... | 261 | en | {
"1": "Diagnostic suspicion is pituitary apoplexy.",
"2": "Treatment with high-dose corticosteroids should be initiated and the evolution observed, since this treatment could reduce the volume of the lesion and avoid intervention.",
"3": "Treatment with glucocorticoids should be considered to avoid secondary adr... | 100 | ENDOCRINOLOGY | 2,014 | {
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"RRF-2": [
{
"id": "pubmed23n0904_4285",
"title": "Presenting Symptoms of Pituitary Apoplexy.",
"score": 0.019327731092436976,
"content": "The classical term \"pituitary apoplexy\" (PA) describes a clinical syndrome us... |
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"text": "Biliary reflux gastropathy is an endoscopic diagnosis, moreover it is not associated with diarrhea or malabsorption."
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"e... | The statement has described the clinical features of this syndrome. It is usually a late complication (the patient was operated 20 years ago for a Bilroth II, remember that it is a partial gastrectomy, closure of the gastric stump and anastomosis of the first jejunal loop to the stump), it is accompanied by postprandia... | The statement has described the clinical features of this syndrome. It is usually a late complication (the patient was operated 20 years ago for a Bilroth II, remember that it is a partial gastrectomy, closure of the gastric stump and anastomosis of the first jejunal loop to the stump), it is accompanied by postprandia... | Point out from among the following the most likely complication presented by a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and... | 289 | en | {
"1": "Biliary reflux gastropathy.",
"2": "Gastric adenocarcinoma.",
"3": "Rapid gastric emptying syndrome (dumping).",
"4": "Afferent loop syndrome with bacterial overgrowth.",
"5": null
} | 65 | GENERAL SURGERY | 2,016 | {
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"id": "InternalMed_Harrison_22609",
"title": "InternalMed_Harrison",
"score": 0.018672919923571306,
"content": "afferent loop synDromes Although rarely seen today as a result of the decrease in the perform... |
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... | Suspicion is very high for tuberculous pleural effusion, in a young patient from an area with a high rate of TB, a lymphocytic exudate pointing to TB, lymphoma or tumor. Tumor unlikely due to age, negative cytology. Lymphoma could be but no evidence of associated nodal pathology. High adenosine deaminase in LP would po... | Suspicion is very high for tuberculous pleural effusion, in a young patient from an area with a high rate of TB, a lymphocytic exudate pointing to TB, lymphoma or tumor. Tumor unlikely due to age, negative cytology. Lymphoma could be but no evidence of associated nodal pathology. High adenosine deaminase in LP would po... | A 32-year-old man from Cameroon consults for fever cough and left hemithorax pain of 1 month of evolution. He took amoxicillin-clavulanic acid for 1 week without improvement of symptoms. A blood test showed a white blood cell count of 8000/microL and a hemoglobin of 12.8 g/dL. Chest X-ray shows a loculated left pleural... | 366 | en | {
"1": "A thoracic computed tomography (CT) scan.",
"2": "Pleural fluid pH measurement.",
"3": "Measurement of pleural fluid adenosine deaminase.",
"4": "Tuberculin test.",
"5": null
} | 106 | PNEUMOLOGY AND THORACIC SURGERY | 2,016 | {
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"RRF-2": [
{
"id": "pubmed23n0492_372",
"title": "[Cuttoff values of biochemical tests on pleural fluid: their usefulness in differential diagnosis of 1,040 patients with pleural effusion].",
"score": 0.01951265943270512,
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"text": "Currently the only effective treatment capable of modifying the natural course of respiratory allergy is specific allergen immunotherapy for a m... | Currently the only effective treatment capable of modifying the natural course of respiratory allergy is specific allergen immunotherapy for a minimum of 3 consecutive years. In this patient the conventional treatment has not worked, so it is possible to escalate to specific allergen immunotherapy. It is true that it i... | Currently the only effective treatment capable of modifying the natural course of respiratory allergy is specific allergen immunotherapy for a minimum of 3 consecutive years. In this patient the conventional treatment has not worked, so it is possible to escalate to specific allergen immunotherapy. [HIDDEN] It is true ... | 16-year-old woman diagnosed with allergic rhinoconjunctivitis due to sensitization to grass pollens since she was 10 years old, who does not fully control the symptomatology during the pollination season with oral antihistamines and nasal topical corticosteroids. Which etiologic therapeutic option would be indicated: | 544 | en | {
"1": "Specific immunotherapy by sublingual or subcutaneous route for a minimum period of 3 years.",
"2": "Specific immunotherapy by sublingual or subcutaneous route for a maximum period of 1 year.",
"3": "Omalizumab subcutaneously every 4 weeks for up to 1 year.",
"4": "Omalizumab subcutaneously every 4 weeks... | 40 | ALLERGOLOGY | 2,022 | {
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"RRF-2": [
{
"id": "pubmed23n0596_8782",
"title": "Comparison of the long-term efficacy of subcutaneous and sublingual immunotherapies in perennial rhinitis.",
"score": 0.019424799622819428,
"content": "Both sublingual... |
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"text": "Typical medullary thyroid RET (C cells, elevated calcitonin, inherited MEN-2nd, typical MIR question)."
},
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"c... | Typical medullary thyroid RET (C cells, elevated calcitonin, inherited MEN-2nd, typical MIR question). | Typical medullary thyroid RET (C cells, elevated calcitonin, inherited MEN-2nd, typical MIR question). | A 32-year-old woman with multiple endocrine neoplasia syndrome type 2A (MEN-2A) and carrier of a mutation in RET. In a neck ultrasound a 6 mm hypoechogenic nodule with calcifications inside is identified. It was decided to perform a total thyroidectomy and cervical lymph node removal. In the macroscopic study a total o... | 533 | en | {
"1": "Multifocal medullary carcinoma.",
"2": "Multifocal papillary carcinoma.",
"3": "Follicular carcinoma.",
"4": "Hyperplasia of parafollicular cells.",
"5": null
} | 179 | ONCOLOGY | 2,021 | {
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"id": "pubmed23n0614_16360",
"title": "Histopathologic and clinical features of medullary microcarcinoma and C-cell hyperplasia in prophylactic thyroidectomies for medullary carcinoma: a study of 42 cases.",
"score"... |
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"text": "Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis... | This is a patient who already has a diagnosis of hemochromatosis, due to a positive genetic study and data of iron overload (IST >45% and elevated ferritin). Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis. The treatment of ch... | This is a patient who already has a diagnosis of hemochromatosis, due to a positive genetic study and data of iron overload (IST >45% and elevated ferritin). Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis. The treatment of ch... | A 52-year-old man who consults for a second opinion on the need to perform a liver biopsy for the study of hypertransaminasemia detected two years ago in routine company analyses. His family history includes the death of his father of an unidentified etiology of epatic cirrhosis. Asymptomatic and performing social and ... | 80 | en | {
"1": "Perform liver biopsy.",
"2": "Perform hepatic MRI.",
"3": "Initiate treatment with phlebotomies.",
"4": "Start treatment with desferroxamine.",
"5": "Start treatment with Vitamin E."
} | 37 | DIGESTIVE SYSTEM | 2,012 | {
"clinical_case_options": {
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{
"id": "pubmed23n1071_23095",
"title": "Hemochromatosis, alcoholism and unhealthy dietary fat: a case report.",
"score": 0.019801980198019802,
"content": "Hereditary hemochromatosis is an autosomal recessiv... |
4 | {
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"... | In this question they ask for the name of the symptom, not the disease, so therefore the correct answer is compulsion. According to the DSM-5, a compulsion is a repetitive behavior (e.g., washing hands, tidying up, checking things) or mental act (e.g., praying, counting, repeating words silently) that the subject perfo... | In this question they ask for the name of the symptom, not the disease, so therefore [HIDDEN]. According to the DSM-5, a compulsion is a repetitive behavior (e.g., washing hands, tidying up, checking things) or mental act (e.g., praying, counting, repeating words silently) that the subject performs in response to an ob... | Mariano is a 53-year-old man who comes to your office reporting that he has been feeling very unwell for several years. He relates his discomfort to a behavior that he finds absurd but that he is unable to avoid. This behavior, which she always does when she comes home from work, consists of turning the doorknob of the... | 394 | en | {
"1": "Obsessive-compulsive disorder.",
"2": "Obsession.",
"3": "Impulsion.",
"4": "Compulsion.",
"5": null
} | 225 | PSYCHIATRY | 2,016 | {
"clinical_case_options": {
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{
"id": "pubmed23n1009_24025",
"title": "Toddler Sleep Challenges: All in a Day's Work.",
"score": 0.009900990099009901,
"content": "Leo is a 26-month-old boy who you are seeing for an urgent care visit due ... |
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"text": "The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated. Answer 1 may gi... | The infant presents with acute GEA without signs of alarm or severe dehydration. The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated. Answer 1 may give rise to doubts, due to the fact that the statement says that the patient "does not tolerate th... | The infant presents with acute GEA without signs of alarm or severe dehydration. The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated. Answer 1 may give rise to doubts, due to the fact that the statement says that the patient "does not tolerate th... | Previously healthy 10-month-old infant with acute gastroenteritis of one day's evolution and signs of mild dehydration, without blood or mucus in the stool and without oral tolerance. What is the initial treatment of choice in our environment? | 229 | en | {
"1": "Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet.",
"2": "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and continue with his usual diet.",
"3": "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) maintain us... | 178 | PEDIATRICS | 2,014 | {
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"id": "pubmed23n0075_19694",
"title": "[Comparative study of 2 oral rehydration solutions containing 60 or 90 mmol/L of sodium and with different osmolalities].",
"score": 0.017588325652841783,
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"text": "This case describes an Alzheimer's disease with insidious onset of short-term memory problems. Clinically it can be distinguished from other opt... | This case describes an Alzheimer's disease with insidious onset of short-term memory problems. Clinically it can be distinguished from other options by the absence of behavioral problems (typical of frontotemporal dementia) and hallucinations (early in Lewy body disease). Vascular dementia is diagnosed by criteria that... | This case describes an Alzheimer's disease with insidious onset of short-term memory problems. Clinically it can be distinguished from other options by the absence of behavioral problems (typical of frontotemporal dementia) and hallucinations (early in Lewy body disease). Vascular dementia is diagnosed by criteria that... | A 77-year-old man with a history of type 2 Diabetes Mellitus was diagnosed 2 years ago with mild cognitive impairment. At that time a Minimental (Folstein) 28/30, abbreviated Yesavage Test 14/15, a CBC with normal TSH and maturation factors along with negative LUES and HIV serologies and a magnetic resonance imaging (M... | 198 | en | {
"1": "Frontotemporal dementia.",
"2": "Alzheimer's disease.",
"3": "Vascular dementia.",
"4": "Lewy body disease.",
"5": "Creutzfeldt-Jakob disease."
} | 73 | NEUROLOGY | 2,013 | {
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"id": "wiki20220301en001_276351",
"title": "Dementia",
"score": 0.014585883312933496,
"content": "Imaging A CT scan or MRI scan is commonly performed to possibly find either normal pressure hydrocephalus, ... |
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"text": "The clinical history and ultrasound give a dia... | The clinical case presented is a woman of childbearing age (27 years) presenting dyspareunia + dysmenorrhea + infertility, which should lead us to think of endometriosis. The clinical history and ultrasound give a diagnosis of suspicion, but the diagnosis of certainty is given by direct observation (with or without ass... | The clinical case presented is a woman of childbearing age (27 years) presenting dyspareunia + dysmenorrhea + infertility, which should lead us to think of endometriosis. The clinical history and ultrasound give a diagnosis of suspicion, but the diagnosis of certainty is given by direct observation (with or without ass... | A 27-year-old woman referred to a gynecology office for evaluation, reporting dyspareunia for about 8 months, along with dyschezia and occasional rectorrhagia coinciding with menstruation for 3-4 months. She also reports dysmenorrhea for years, which she controls well with ibuprofen. She has been trying to get pregnant... | 351 | en | {
"1": "Transvaginal ultrasound.",
"2": "Diagnostic laparoscopy.",
"3": "Magnetic resonance imaging.",
"4": "Colonoscopy.",
"5": null
} | 161 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0525_18087",
"title": "[Endometriosis with massive hemorrhagic ascites: a case report and review of the literature].",
"score": 0.013496616651956457,
"content": "Endometriosis is defined as... |
3 | {
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... | The most likely cause is a digitalis intoxication, which would produce this slowing of conduction, which is seen in the heart rate. Probably secondary to renal failure due to ibuprofen toxicity (but this is a bit of a stretch). | The most likely cause is a digitalis intoxication, which would produce this slowing of conduction, which is seen in the heart rate. Probably secondary to renal failure due to ibuprofen toxicity (but this is a bit of a stretch). | The daughter of an 82-year-old woman consults us because she has found her mother more confused than usual. The patient is diagnosed with moderate Alzheimer's disease. She also has AF, depression and osteoarthritis. She has been receiving stable treatment for 3 years, including digoxin, acenocoumarol, fluoxetine for th... | 69 | en | {
"1": "Progression of Alzheimer's disease.",
"2": "Worsening depression.",
"3": "Digitalis intoxication.",
"4": "Dementia due to Lewy bodies.",
"5": "Ibuprofen toxicity."
} | 124 | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCY MEDICINE | 2,012 | {
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"title": "Paraneoplastic Encephalopathy in a Patient With Metastatic Lung Cancer: A Case Study.",
"score": 0.01595873786407767,
"content": "<bCASE STUDY</b RS, a 36-year-old fe... |
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... | The correct answer is 3. The fact that there is intestinal aeration points to the existence of a fistula of the lower esophageal segment with the trachea or with a bronchus. In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway. | The [HIDDEN] The fact that there is intestinal aeration points to the existence of a fistula of the lower esophageal segment with the trachea or with a bronchus. In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway. | A newborn of 37 weeks gestational age, with no pathological findings in the prenatal ultrasound, presents in the examination performed in the delivery room a "stop" to the passage of the nasogastric tube. Chest and abdominal X-ray showed an atresic esophageal pouch, with normal gastrointestinal pneumatization. After a ... | 140 | en | {
"1": "Due to the impossibility of swallowing saliva.",
"2": "Because of frequently associated cardiac malformations.",
"3": "Because of the risk of aspiration pneumonitis.",
"4": "Due to the impossibility of enteral feeding.",
"5": "Associated tracheomalacia."
} | 134 | PEDIATRICS | 2,012 | {
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"title": "The prevalence and effects of aspiration among neonates at the time of discharge.",
"score": 0.01720573032048442,
"content": "Neonates undergoing heart surgery for CH... |
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"text": "Remember that activated charcoal is NOT indica... | We are dealing with a case of severe lithium intoxication (lithemia > 3.5 mEq/L is life threatening), therefore, the therapeutic option of choice is to start hemodialysis urgently. Remember that activated charcoal is NOT indicated in lithium intoxication. | We are dealing with a case of severe lithium intoxication (lithemia > 3.5 mEq/L is life threatening), therefore, the therapeutic option of choice is [HIDDEN]. Remember that activated charcoal is [HIDDEN]. | A 46-year-old man with bipolar disorder is brought to the emergency department after an over-ingestion of lithium carbonate. Examination reveals severe tremor, ataxia, dysarthria, myoclonus and fasciculations. Lithemia is 4.1 mEq/L (toxicity > 1.6 mEq/L). Which of the following therapeutic options would be most indicat... | 475 | en | {
"1": "Aminophylline associated with a cathartic.",
"2": "Activated charcoal.",
"3": "Hemodialysis.",
"4": "Forced diuresis.",
"5": null
} | 89 | CRITICAL CARE | 2,020 | {
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"id": "pubmed23n0522_8152",
"title": "[Acute intoxication with sustained-release lithium carbonate tablets. A propos of a case].",
"score": 0.019232547387887194,
"content": "To describe the case of a patie... |
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... | Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration; it represents an exaggeration of the physiological phenomenon consisting of inspiratory lowering of BP (normal up to 10 mmHg). In cardiac tamponade, inspiration, which causes an increase in blood flow to the right chambers, increasing their vol... | Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration; it represents an exaggeration of the physiological phenomenon consisting of inspiratory lowering of BP (normal up to 10 mmHg). In cardiac tamponade, inspiration, which causes an increase in blood flow to the right chambers, increasing their vol... | A patient with a history of febrile illness and chest pain comes to the hospital with dyspnea and tachypnea. On physical examination his blood pressure is low, jugular venous pressure is elevated with a deep descending sinus "X" and he has a paradoxical pulse. What pathology should you suspect? | 85 | en | {
"1": "Ischemic heart disease.",
"2": "Dilated cardiomyopathy.",
"3": "Severe aortic stenosis.",
"4": "Constrictive pericarditis.",
"5": "Pericardial effusion with cardiac tamponade."
} | 50 | CARDIOLOGY AND VASCULAR SURGERY | 2,012 | {
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"title": "Cases from the Osler Medical Service at Johns Hopkins University.",
"score": 0.017324133793310333,
"content": "PRESENTING FEATURES: A 70-year-old African American man ... |
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... | Blood gases can be misleading since a normal pH may suggest that there is no disturbance of acid-base balance, instead it is masking a double disturbance in opposite directions as in this case. The patient presents with respiratory acidosis (PaCO2 60 mmHg; normal to 50) and compensatory metabolic alkalosis (bicarbonate... | Blood gases can be misleading since a normal pH may suggest that there is no disturbance of acid-base balance, instead it is masking a double disturbance in opposite directions as in this case. The patient presents with respiratory acidosis (PaCO2 60 mmHg; normal to 50) and compensatory metabolic alkalosis (bicarbonate... | A patient's arterial blood gas result is: pH: 7.40, PaCO2 60 mmHg; bicarbonate 36 mM/L. What is the presenting disturbance: | 527 | en | {
"1": "None, pH is normal.",
"2": "Respiratory acidosis.",
"3": "Respiratory acidosis and metabolic alkalosis.",
"4": "Metabolic alkalosis.",
"5": null
} | 31 | NEPHROLOGY | 2,021 | {
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"title": "Respiratory acidosis",
"score": 0.018596642272922945,
"content": "Diagnosis Diagnoses can be done by doing an ABG (Arterial Blood Gas) laboratory study, with a pH ... |
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... | Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter. In contrast to all other causes of hyperthyroidism, serum thyroglobulin is not elevated and is almost always low or at the lower limit of normal. The fundamental do... | Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter. In contrast to all other causes of hyperthyroidism, serum thyroglobulin is not elevated and is almost always low or at the lower limit of normal. The fundamental do... | A 30-year-old woman comes to the clinic reporting anxiety, weight loss of about 6 kgs and a feeling of "nervousness" in the last three months. Physical examination showed tachycardia, hyperreflexia and absence of goiter. TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are decreased. A scan reve... | 407 | en | {
"1": "Factitious thyrotoxicosis.",
"2": "Hyperthyroidism due to Graves' disease.",
"3": "Ovarian teratoma (ovarian stromal).",
"4": "Subacute thyroiditis.",
"5": null
} | 81 | ONCOLOGY (ECTOPIC) | 2,016 | {
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"id": "pubmed23n0534_2003",
"title": "RET/PTC3 rearrangement and thyroid differentiation gene analysis in a struma ovarii fortuitously revealed by elevated serum thyroglobulin concentration.",
"score": 0.01923254738... |
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... | This is perhaps the least scientific of this year's MIR questions, since its answer is based on the interpretation of a law, which is also of an autonomous nature. Probably the spirit of the examiner wants to reflect this law, in an extreme case. Let's see, starting from article 11 of Law 41 /2002, of November 14 (1), ... | This is perhaps the least scientific of this year's MIR questions, since its answer is based on the interpretation of a law, which is also of an autonomous nature. Probably the spirit of the examiner wants to reflect this law, in an extreme case. Let's see, starting from article 11 of Law 41 /2002, of November 14 (1), ... | For the third time in the last 6 months an 84-year-old man with advanced dementia is admitted to a hospital for aspiration pneumonia. He has lost 9.5 kg in the last 10 months. He has a pressure ulcer in the sacrum. He does not communicate verbally, does not ambulate and is dependent for all activities of daily living. ... | 15 | en | {
"1": "Place an indwelling SNG and discharge to a skilled nursing home.",
"2": "Place a mid-term NGUS and discharge to a nursing home with specialized care until bedsores heal.",
"3": "Discharge to a nursing home with specialized care until pressure ulcers heal.",
"4": "Place a gastrostomy tube and discharge h... | 126 | PALLIATIVE CARE | 2,011 | {
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"id": "pubmed23n0313_6771",
"title": "[For terminal cancer patient inserted with four tubes to live at home--from discussion with family].",
"score": 0.01814449917898194,
"content": "The patient was an 86-... |
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"text": "To induce testicular maturation, pulsatile GnRH with pump, hCG or FSH+hCG can be used."
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"char_ranges": [... | This is a Kallman syndrome (hypogonadotropic hypogonadism + olfactory disturbance). Triptorelin is a GnRH agonist, which by continuous action reduces FSH and LH, and is used in sex hormone-dependent cancers, as well as precocious puberty. Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pit... | This is a Kallman syndrome (hypogonadotropic hypogonadism + olfactory disturbance). Triptorelin is a GnRH agonist, which by continuous action reduces FSH and LH, and is used in sex hormone-dependent cancers, as well as precocious puberty. Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pit... | A 22-year-old boy with hyposmia presents lack of development of secondary sexual characteristics and infertility. Bilateral testicular volume of 4 mL. Analytically, EST-I 1.2 U/L (vn 5-15); LH 0.6 U/L (vn 3-15); testosterone 100 ng/dL (vn 300-1200), prolactin normal. State your proposed treatment to achieve fertility: | 322 | en | {
"1": "GnRH infusion pump.",
"2": "Monthly intramuscular administration of triptorelin.",
"3": "Intramuscular administration of FSH and LH once a week.",
"4": "Treatment with bromocriptine.",
"5": null
} | 85 | UROLOGY | 2,016 | {
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"title": "[Effect of pulsatile GnRH therapy on pituitary-testicular axis function in male patients with pituitary stalk interruption syndrome].",
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"text": "Displaced hip fracture, Garden III-IV. Surgical treatment. Hip hemiarthroplasty."
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... | Displaced hip fracture, Garden III-IV. Surgical treatment. Hip hemiarthroplasty. Option 2 treatment for pertrochanteric fractures. Option 3. Non-displaced fractures. Option 4. Non ambulatory patients with minimal pain and high surgical risk. | Displaced hip fracture, Garden III-IV. Surgical treatment. Hip hemiarthroplasty. Option 2 treatment for pertrochanteric fractures. Option 3. Non-displaced fractures. Option 4. Non ambulatory patients with minimal pain and high surgical risk. | 95-year-old woman living in a nursing home, independent for basic activities of daily living, goes out to the garden for walks. She has a history of hypertension, dyslipidemia, osteoporosis and mild cognitive impairment. She suffers a fall when getting up at night to go to the bathroom. X-ray shows a displaced subcapit... | 610 | en | {
"1": "Hip hemiarthroplasty.",
"2": "Trochanteric nail fixation.",
"3": "Fixation with cannulated screws.",
"4": "Conservative: bed-chair life.",
"5": null
} | 116 | TRAUMATOLOGY | 2,022 | {
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"id": "pubmed23n0359_688",
"title": "Ethics in practice.",
"score": 0.018089960886571055,
"content": "H. K. is a ninety-two-year-old woman with Alzheimer's disease and mild hypertension. She resides at a n... |
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"... | Another simple question with an immediate answer, which offers no doubt. It describes a patient worried about a non-existent physical defect, whose concern distresses him and prevents him from leaving the house. As a psychiatry resident, I wish the MIR questions in my specialty were a bit more thought-provoking and in-... | Another simple question with an immediate answer, which offers no doubt. It describes a patient worried about a non-existent physical defect, whose concern distresses him and prevents him from leaving the house. As a psychiatry resident, I wish the MIR questions in my specialty were a bit more thought-provoking and in-... | A 26-year-old single man is brought in by his family because he has been refusing to leave his home for 3 months. The reason given by the patient is the belief that he has an asymmetrical jaw and a crooked face. According to the patient, this situation is progressive and he looks more and more deformed when he looks in... | 391 | en | {
"1": "Major depressive disorder with delusional ideas incongruent with mood.",
"2": "Obsessive-compulsive disorder.",
"3": "Paranoid schizophrenia.",
"4": "Body dysmorphic disorder.",
"5": null
} | 222 | PSYCHIATRY | 2,016 | {
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"RRF-2": [
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"id": "pubmed23n0648_15276",
"title": "Who rules the roost?",
"score": 0.009900990099009901,
"content": "Adam's mother was concerned about her 3-year-old son's hyperactivity, violence, and activity level. ... |
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... | Mortality is not so low, the oximetric jump occurs in the case of septum rupture, as well as fremitus (hence the correct answer is 3) and complications can occur up to the first week. | Mortality is not so low, the oximetric jump occurs in the case of septum rupture, as well as fremitus (hence [HIDDEN]) and complications can occur up to the first week. | A 70-year-old female patient is admitted to the ICU after suffering anterior AMI treated by coronary angioplasty and stent placement in the anterior descending artery. Four days later, she suddenly presents hypotension that requires vigorous volume support, initiation of vasoactive drugs, orotracheal intubation and con... | 324 | en | {
"1": "Mortality with medical treatment is 20%.",
"2": "In case of free wall rupture, there is an oxymetric jump in the right ventricle in the Swan-Ganz catheterization.",
"3": "In case of free wall rupture, there is no palpable frémito.",
"4": "Mechanical complications usually appear on the first post-infarct... | 55 | CRITICAL, PALLIATIVE AND EMERGENCY CARE | 2,016 | {
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"id": "pubmed23n0114_7402",
"title": "Myocardial rupture following acute myocardial infarction.",
"score": 0.019704911667637354,
"content": "Ten patients, eight males and two females, suffered myocardial r... |
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"text": "The correct answer is 2 because it presents the c... | The correct answer is 2 because it presents the case with the typical symptoms of dementia due to Lewy bodies, being the guiding symptom visual hallucinations. Progressive cognitive impairment, parkinsonian motor signs (inferred from clumsiness of movements) and hypersensitivity to neuroleptics even in small doses are ... | The [HIDDEN] because it presents the case with the typical symptoms of dementia due to Lewy bodies, being the guiding symptom visual hallucinations. Progressive cognitive impairment, parkinsonian motor signs (inferred from clumsiness of movements) and hypersensitivity to neuroleptics even in small doses are also mentio... | A 76-year-old man consults for cognitive impairment, slowness and clumsiness of movements, of eight months of evolution. The family reports that the patient had visual hallucinations, so his primary care physician prescribed low doses of risperidone, with a significant worsening of motor status. In view of these data, ... | 240 | en | {
"1": "Alzheimer's disease.",
"2": "Dementia due to Lewy bodies.",
"3": "Frontotemporal dementia.",
"4": "Vascular dementia.",
"5": "Sporadic Creutzfeldt-Jakob disease."
} | 150 | NEUROLOGY | 2,014 | {
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"title": "Unusual features of Creutzfeldt-Jakob disease followed-up in a memory clinic.",
"score": 0.018436703483432453,
"content": "Sporadic Creutzfeldt-Jakob disease (sCJD) ge... |
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... | If the ECG shows ischemic changes, we will obviously treat the patient in the emergency room and notify the cardiologist. If not, you will be treated as if it were angina and observed, with serial enzymes and treatment in the observation area. | If the ECG shows ischemic changes, we will obviously treat the patient in the emergency room and notify the cardiologist. If not, you will be treated as if it were angina and observed, with serial enzymes and treatment in the observation area. | A 64-year-old man with a history of hypertension and ischemic heart disease comes to the emergency department for oppressive chest pain while watching television. In the ED triage consultation, T. art values of 155/95 mmHg and a capillary O2 saturation of 95% are detected. Which of the following is the most correct cou... | 68 | en | {
"1": "Instruct her to go to the waiting room. You will be notified for tests.",
"2": "This patient should be treated in the vital emergency room (shock room).",
"3": "We will notify the cardiologist on duty to evaluate the patient.",
"4": "From the Triage consultation, the patient will be referred to the Coro... | 123 | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCY MEDICINE | 2,012 | {
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"id": "pubmed23n0824_24077",
"title": "Breaking bad (news) death-telling in the emergency department.",
"score": 0.016946778711484593,
"content": "Many physicians struggle with death-telling in sudden deat... |
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"text": "The patient has a PSA >4 and a palpation with increased consistency, which implies the need for a transrectal ultrasound-guided biopsy to diagno... | The patient has a PSA >4 and a palpation with increased consistency, which implies the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer. | The patient has a PSA >4 and a palpation with increased consistency, which implies the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer. | Faced with a 49-year-old man, asymptomatic, with a family history of a father who died of prostate cancer, who in a routine company control is identified a PSA (Prostate Specific Antigen) of 5.9 ng / ml, with a ratio of free PSA / total PSA of 11% and that a rectal examination shows increased consistency in the right p... | 206 | en | {
"1": "Suggest to the patient the performance of a transrectal ultrasound and prostate biopsy.",
"2": "Perform an abdominopelvic CT scan.",
"3": "Initiate treatment with 5 alpha Reductase Inhibitors to reduce PSA levels by half.",
"4": "Initiate combined treatment of LHRH analogues and antiandrogens.",
"5": ... | 125 | UROLOGY | 2,014 | {
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"id": "pubmed23n1038_3448",
"title": "Histopathology, pharmacotherapy, and predictors of prostatic malignancy in elderly male patients with raised prostate-specific antigen levels - A prospective study.",
"score": 0... |
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"text": "Normal ADAMTS-13 levels rule out TTP (incorrect choice 1)."
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... | Difficult question. The patient presents with thrombotic microangiopathy (TMA) with acute renal failure. This points to HUS, TTP, drug-induced TMA, or TMA mediated by complement, coagulation, or metabolism. Normal ADAMTS-13 levels rule out TTP (incorrect choice 1). The absence of gastrointestinal symptoms rules out typ... | Difficult question. The patient presents with thrombotic microangiopathy (TMA) with acute renal failure. This points to HUS, TTP, drug-induced TMA, or TMA mediated by complement, coagulation, or metabolism. Normal ADAMTS-13 levels rule out TTP ([HIDDEN]). The absence of gastrointestinal symptoms rules out typical Shiga... | A 19-year-old male with no past history of interest comes to the emergency department because after a respiratory infection he presents with asthenia, malaise, oliguria and headache. Physical examination: BP 210/120 mmHg, fundus with hypertensive retinopathy grade III. Laboratory tests: Hb 7.4 g/dl, platelets 85,000/mm... | 570 | en | {
"1": "Thrombotic thrombocytopenic purpura.",
"2": "Atypical hemolytic uremic syndrome.",
"3": "Disseminated intravascular coagulation.",
"4": "Typical hemolytic uremic syndrome.",
"5": null
} | 153 | NEPHROLOGY | 2,022 | {
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"id": "pubmed23n1108_5666",
"title": "Thrombotic Microangiopathy in a Severe Pediatric Case of COVID-19.",
"score": 0.017966484047695776,
"content": "In this case report, we report a pediatric patient with... |
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... | There is a large literature on this subject. It never ceases to amaze us the strange ways of biology and that the axiom "the longest is the right one" is fulfilled in this case. | There is a large literature on this subject. It never ceases to amaze us the strange ways of biology and that the axiom "the longest is [HIDDEN]" is fulfilled in this case. | Faced with sudden-onset obsessive-compulsive disorder (OCD) in a 9-year-old boy who also presents with tics and chorea as neurological manifestations, infection by: | 506 | en | {
"1": "Streptococcus viridans.",
"2": "Alpha-hemolytic streptococcus.",
"3": "Beta-hemolytic streptococcus, group A.",
"4": "Enterococcus.",
"5": null
} | 87 | PSYCHIATRY | 2,020 | {
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... | There are doubts regarding the efficacy of calcium or vitamin D administered in monotherapy for the treatment of osteoporosis; they point out that "administered together they seem to have a certain degree of efficacy in the prevention of non-vertebral fractures, which is clearer in people who are deficient in them, as ... | There are doubts regarding the efficacy of calcium or vitamin D administered in monotherapy for the treatment of osteoporosis; they point out that "administered together they seem to have a certain degree of efficacy in the prevention of non-vertebral fractures, which is clearer in people who are deficient in them, as ... | 79-year-old woman admitted for an osteoporotic hip fracture. Regarding secondary prevention of fragility fractures, point out the WRONG answer: | 619 | en | {
"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 these fractures in non-institutionalized elderly people.",
"4": "Increasing die... | 121 | TRAUMATOLOGY | 2,022 | {
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"... | The correct answer is: 4. Antihypertensive. In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia. | The [HIDDEN] Antihypertensive. In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia. | A 60-year-old woman diagnosed with chronic bronchopathy, diabetes mellitus, hypertension and treated for 4 months with Omeprazole, Metformin, Salbutamol, Ipratropium Bromide and Enalapril 20 mg + Hydrochlorothiazide 25 mg comes to your office for fatigue, decreased appetite, with slight dyspnea and occasional cough, va... | 161 | en | {
"1": "Renal insufficiency.",
"2": "Hyponatremia.",
"3": "Potassium deficiency.",
"4": "Antihypertensive.",
"5": "Metformin."
} | 118 | NEPHROLOGY | 2,013 | {
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... | In a severe asthma crisis all options are indicated or may be indicated before more aggressive options. In the case of a bad evolution with acidosis etc., the patient would be tributary to invasive medication. | In a severe asthma crisis all options are indicated or may be indicated before more aggressive options. In the case of a bad evolution with acidosis etc., the patient would be tributary to invasive medication. | A 55-year-old asthmatic patient comes to the ED with an exacerbation. One hour after administration of supplemental oxygen and two nebulizations of salbutamol the patient does not improve. On examination, he breathes at 42 rpm with supraclavicular pull v with scattered inspiratory and expiratory wheezing. Peak flow has... | 269 | en | {
"1": "Increase oxygen flow.",
"2": "Administer 80 mg of methylprednisolone iv.",
"3": "Nebulize ipratropium bromide together with salbutamol every 20 minutes.",
"4": "Administer intravenous magnesium.",
"5": " Start noninvasive mechanical ventilation."
} | 141 | PNEUMOLOGY | 2,014 | {
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"... | Question shared with ENT. Amyloidosis is a localized or systemic deposition of fibrillar proteins. It can be primary or secondary. The most frequently affected organs are the kidneys and the heart. Sometimes amyloid deposits appear on the tongue which can produce macroglossia. | Question shared with ENT. Amyloidosis is a localized or systemic deposition of fibrillar proteins. It can be primary or secondary. The most frequently affected organs are the kidneys and the heart. Sometimes amyloid deposits appear on the tongue which can produce macroglossia. | If a patient reports having for months now enlargement of the tongue, with no other alterations of the tongue causing constant biting, which disease would you think of the following: | 18 | en | {
"1": "Hypoglossal paralysis.",
"2": "Hyperthyroidism.",
"3": "Mastocytosis.",
"4": "Amyloidosis.",
"5": "Facial granuloma."
} | 138 | DERMATOLOGY | 2,011 | {
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"content": "The enlargement of the tissues of the mouth, lips and face seen in OFG is painless. Melkersso... |
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"... | Middle-aged male with iron deficiency anemia and increased number of stools, a colonoscopy should be done to rule out colorectal cancer!!! If the HLA is negative it is very unlikely to be celiac disease (high negative predictive value). | Middle-aged male with iron deficiency anemia and increased number of stools, a colonoscopy should be done to rule out colorectal cancer!!! If the HLA is negative it is [HIDDEN] (high negative predictive value). | A 55-year-old man, father of a celiac child, with iron-deficiency anemia and a recent increase in the stool rhythm, has been tested negative for HLA-DQ2 and HLA-DQ8 alleles. Which diagnostic test is the most appropriate in this case? | 250 | en | {
"1": "Determination of anti-transglutaminase IgA antibodies.",
"2": "Upper endoscopy with duodenal biopsies.",
"3": "D-xylose test.",
"4": "Evaluate response to gluten-free diet.",
"5": "Colonoscopy."
} | 78 | DIGESTIVE SYSTEM | 2,014 | {
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"... | This patient presents Barrett's esophagus with low grade dysplasia. I do not like the question, since not being with acid production inhibition the dysplasia may be conditioned by inflammation and not be real. In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflu... | This patient presents Barrett's esophagus with low grade dysplasia. I do not like the question, since not being with acid production inhibition the dysplasia may be conditioned by inflammation and not be real. In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflu... | A 66-year-old man reports daily heartburn since youth, which he treats with alkalis. An upper endoscopy shows mild erosive esophagitis and displaced squamous columnar junction approximately 7 cm. The esophageal biopsies showed mild erosive esophagitis and a columnar squamous junction displaced approximately 7 cm from t... | 5 | en | {
"1": "Given that the esophagitis is mild and the dysplasia is low grade, it is advisable to continue treatment with alkalines.",
"2": "Indefinite treatment with high doses of PPI since it has been demonstrated that this prevents the progression of Barrett's esophagus to adenocarcinoma, making endoscopic surveilla... | 44 | DIGESTIVE | 2,011 | {
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"text": "1: if it is a recent loss, the MCV could remain normal, but the ferritin should be affected, and certainly not elevated."
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"... | Polymyalgia rheumatica. Classic example I suppose, and it is seen in the clinic in droves. Older woman with normocitic anemia and clear ferrokinetic pattern of chronic disorder (hyposideremia but hyperferritinemia). The only one that fits, and it fits perfectly, is number 3; they only needed to give us a high ESR. 1: i... | Polymyalgia rheumatica. Classic example I suppose, and it is seen in the clinic in droves. Older woman with normocitic anemia and clear ferrokinetic pattern of chronic disorder (hyposideremia but hyperferritinemia). [HIDDEN] they only needed to give us a high ESR. [HIDDEN] 2: the same. [HIDDEN] And if it were due to B1... | The determination in a 70-year-old woman of hematocrit 32%, Hb 9.6 g/dL, MCV 85 fL (70-99), Fe 25 ug/dL (37-145) and ferritin 350 ng/mL (15-150), is more suggestive of: | 359 | en | {
"1": "Recent blood loss through the digestive tract.",
"2": "Intestinal malabsorption.",
"3": "Polymyalgia rheumatica.",
"4": "Thalassemia minor.",
"5": null
} | 91 | HEMATOLOGY | 2,016 | {
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"title": "[Iron deficiency anemia is not always simple].",
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"content": "Malabsorption of oraliron is rare, and more frequently suspected than prove... |
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"text": "It is the male who presents the disease, which we... | It is the male who presents the disease, which we are told is X-linked, so there are only two options left: 2 and 3. 2 is not because the males will receive the Y chromosome from the father and the X from the mother, who is healthy, so the daughters will be able to carry the disease (correct option 3). | It is the male who presents the disease, which we are told is X-linked, so there are only two options left: 2 and 3. 2 is not because the males will receive the Y chromosome from the father and the X from the mother, who is healthy, so the daughters will be able to carry the disease ([HIDDEN]). | A man has a partial deletion in the dystrophin gene (chromosome Xp21) which causes the semiology of Becker muscular dystrophy. He goes to the genetic consultation with his wife, to assess the risks of transmission of the disease. What correct information will be provided in the course of the genetic counseling? | 108 | en | {
"1": "According to autosomal dominant inheritance, half of her children will inherit the disease and without distinction of sexes.",
"2": "Their daughters will not inherit the disease, but all their future sons will be carriers and can transmit the mutation to 50%.",
"3": "Their sons will not inherit the diseas... | 219 | GENETICS AND IMMUNOLOGY | 2,012 | {
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... | It is a study of iron deficiency anemia with normal gastroscopy and colonoscopy, having ruled out possible celiac disease. We have yet to see jejunum and ileum, so we will have to perform a capsule endoscopy. In iron deficiency anemia, a digestive cause must always be ruled out. | It is a study of iron deficiency anemia with normal gastroscopy and colonoscopy, having ruled out possible celiac disease. We have yet to see jejunum and ileum, so we will have to perform a capsule endoscopy. In iron deficiency anemia, a digestive cause must always be ruled out. | A 65-year-old woman with a history of joint pain and under treatment with anti-inflammatory drugs is referred for anemia. In the complementary studies she presented red blood cells 3,164,000, Hto. 32%, Hb 11g/dl, MCV 69 fl, Leukocytes 7800, Platelets 370,000, CRP 0.29 mg/dl, Fe 20ng/ml, Ferritin 18 ng/ml, Glucose 105 m... | 255 | en | {
"1": "Jejunum biopsy.",
"2": "Arteriography.",
"3": "Endoscopic capsule.",
"4": "Radioisotopes.",
"5": "Pelvic MRI."
} | 94 | DIGESTIVE SYSTEM | 2,014 | {
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"text": "Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course."
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"1": "Renal amyloidosis.",
"2": "Glomerulonephritis secondary to rheumatoid arthritis.",
"3": "Renal failure due to nonsteroidal anti-inflammatory drugs.",
"4": "Interstitial nephritis due to methotrexate.",
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"... | A first episode of acute low back pain (less than 6 weeks duration), does not require imaging tests in the absence of "red flags" that may indicate an underlying process, such as a fracture, infection or malignant tumor. | A first episode of acute low back pain (less than 6 weeks duration), does not require imaging tests in the absence of "red flags" that may indicate an underlying process, such as a fracture, infection or malignant tumor. | A 45-year-old patient who presents with a first episode of low back pain of 3 weeks' evolution that prevents him from carrying out his normal life. She does not refer trauma or other underlying pathology. In the physical examination there is no neurological deficit. Which imaging test would be indicated? | 539 | en | {
"1": "As this is the first episode of low back pain, only a simple X-ray of the lumbar spine.",
"2": "MRI, which provides more information on soft tissue and possible herniations.",
"3": "CT scan, to better assess the bone structure and possible fractures.",
"4": "No indication for imaging test.",
"5": null... | 3 | TRAUMATOLOGY | 2,021 | {
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"... | The correct answer is 4 because if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen and it will also help us to use the antalgic synergy. We should change the treatment to a major opioid and treat the disrruptive pain vigorously since she is at almost the maximum ... | [HIDDEN] if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen and it will also help us to use the antalgic synergy. We should change the treatment to a major opioid and treat the disrruptive pain vigorously since she is at almost the maximum pain she can bear. | A 45-year-old woman diagnosed with stage IV breast cancer with multiple bone metastases on hormonal treatment and iv bisphosphonates. She comes to your office referring intense bone pain (VAS=7), in several locations without associated neurological symptoms and exarcerbations of pain (VAS=9) several times a day that fo... | 408 | en | {
"1": "Suspend ibuprofen and tramadol and start a major opioid such as morphine or oxycodone.",
"2": "Suspend tramadol, maintain ibuprofen and initiate a major opioid such as morphine and oxycodone.",
"3": "Discontinue ibuprofen and tramadol and start a major opioid such as morphine or oxycodone and at the same ... | 190 | PRIMARY CARE | 2,018 | {
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"char_ranges": ... | 1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis. 2: Age should not be a limiting factor, especially considering that it is only 71 years old, but especially because the patient's "quality of life" is good (and I put "quality of life" because it is a term used erroneou... | 1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis. 2: Age should not be a limiting factor, especially considering that it is only 71 years old, but especially because the patient's "quality of life" is good (and I put "quality of life" because it is a term used erroneou... | A 71-year-old patient, smoker of 2 packs of cigarettes/day for 50 years, with good quality of life and no other pathologic history of interest, consults for cough and hemoptotic expectoration. Physical examination revealed no significant pathological findings. Chest X-ray showed a mass of 4x3.4 cm lower right, a findin... | 29 | en | {
"1": "Perform mediastinoscopy.",
"2": "Surgical intervention with curative intent should be contraindicated due to the advanced age of the patient.",
"3": "An oxygen consumption test should be performed, given the respiratory limitation he presents.",
"4": "Surgical resection (lobectomy of the lower lobe of t... | 60 | NEUROLOGY AND THORACIC SURGERY | 2,011 | {
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"... | I think the correct answer is 4, although both lesions are resectable, pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication because it does not prolong survival and has a high morbidity. Surgical bypass has more complications than placing a self-expanding metallic prosthesis that has... | I think [HIDDEN], although both lesions are resectable, pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication because it does not prolong survival and has a high morbidity. Surgical bypass has more complications than placing a self-expanding metallic prosthesis that has a median paten... | A 76-year-old woman with no history other than hypertension consults for painless jaundice and pruritus with anorexia. Laboratory tests show a bilirubin level of 12 mg/dl (with 9.5 direct bilirubin). Abdominal ultrasound shows dilatation of the intrahepatic and extrahepatic biliary tract, together with a single 2 cm no... | 10 | en | {
"1": "Adjuvant chemo/radiotherapy, conditioning radical surgery to the initial response.",
"2": "Percutaneous external drainage is palliative, with eventual conversion to internal drainage in case of intolerance or complications.",
"3": "Surgical biliary bypass, with or without prophylactic gastrojejunostomy de... | 37 | SURGERY | 2,011 | {
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"1": "Start i.v. nitrate infusion.",
"2": "Perform fibrinolysis with tenecteplase (TNK).",
"3": "Perform urgent coronary angioplasty.",
"4": "Administer furosemide 40 mg i.v.",
"5": null
} | 57 | CARDIOLOGY AND VASCULAR SURGERY | 2,016 | {
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"text": "The statin in a patient with cardiovascular disease (such as an AMI) is a lifelong treatment (we discard 1) since it is not taken until LDL l... | Question on a fashionable topic in recent years: dyslipidemia; I would answer it by rule out. The treatment for hypercholesterolemia is statins so we rule out answers 2 and 4. The statin in a patient with cardiovascular disease (such as an AMI) is a lifelong treatment (we discard 1) since it is not taken until LDL leve... | Question on a fashionable topic in recent years: dyslipidemia; I would answer it by rule out. The treatment for hypercholesterolemia is statins so we [HIDDEN]. The statin in a patient with cardiovascular disease (such as an AMI) is a lifelong treatment [HIDDEN] since it is not taken until LDL levels are normalized. Bet... | A 57-year-old patient had an acute myocardial infarction and has a blood test with cholesterol 312 mg/dl, LDL 241 mg/dl, HDL 29 and normal TG. He smoked 30 cig/day, was not obese, his blood pressure was 145/90 mm Hg and he did not have diabetes. When asked about family history, he mentioned that an uncle on his mother'... | 188 | en | {
"1": "Treat with statins until cholesterol is normalized and recommend healthy lifestyle (diet, exercise and no smoking).",
"2": "Rule out hypothyroidism or other systemic disease, recommend a healthy lifestyle and treat with fibrates to normalize cholesterol.",
"3": "It is not necessary to rule out secondary d... | 230 | ENDOCRINOLOGY | 2,013 | {
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"title": "Hypercholesterolemia",
"score": 0.014267802326084137,
"content": "Treatment Treatment recommendations have been based on four risk levels for heart disease. For e... |
2 | {
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"text": "According to the 2014 SEGO Oncoguide on cervical... | The correct answer is 2. According to the 2014 SEGO Oncoguide on cervical cancer prevention, when a cytology shows a high-grade squamous intraepithelial lesion, the action to be taken is a colposcopy, with or without biopsy depending on the findings (regardless of the patient's age and parity). | The [HIDDEN]. According to the 2014 SEGO Oncoguide on cervical cancer prevention, when a cytology shows a high-grade squamous intraepithelial lesion, the action to be taken is a colposcopy, with or without biopsy depending on the findings (regardless of the patient's age and parity). | A 45-year-old woman, mother of 3 children, attends an early diagnosis consultation. Cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion. Which of the following options would you choose? | 349 | en | {
"1": "Repeat cytology in 1 month.",
"2": "Colposcopy with possible biopsy.",
"3": "Hysterectomy with bilateral salpinguectomy and ovarian conservation.",
"4": "Fractionated uterine curettage.",
"5": null
} | 160 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
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"id": "Gynecology_Novak_3040",
"title": "Gynecology_Novak",
"score": 0.01308227465214761,
"content": "2. Treatment is recommended for a histologic diagnosis of CIN 3 or if colposcopy is unsatisfactory. Alt... |
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"text": "The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma, so the first two wou... | The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma, so the first two would be ruled out. The history of having been working in the garden points more to a sporotrichosis, although the fact that the question asks for the "causative agent" and not th... | The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma, so the first two would be [HIDDEN]. The history of having been working in the garden points more to a sporotrichosis, although the fact that the question asks for the "causative agent" and not the... | A 58-year-old man referred a 3-week history of progressive, mildly painful skin lesions on his left arm. It had started as an erythematous lesion on his left thumb. He had visible reddish striae as connecting lines between the lesions. The patient had no fever or other general symptoms. He had been working in his garde... | 290 | en | {
"1": "Dermatophytosis due to Microsporum gypseum.",
"2": "Cutaneous infection by Staphylococcus aureus.",
"3": "Sporotrichosis.",
"4": "Cutaneous infection by Mycobacterium marinum.",
"5": null
} | 50 | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | 2,016 | {
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"id": "article-29407_8",
"title": "Sporotrichosis -- History and Physical",
"score": 0.010371376811594203,
"content": "Sporotrichosis has an incubation period of several days to 3 months after exposure. In... |
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... | One of the mechanisms that produce the hypotensive effect of ACE inhibitors such as perindopril is the increased action of vasodilator prostaglan-dins on the kidney, which decreases hydrosaline retention and therefore increases diuresis and lowers blood pressure. NSAIDs inhibit prostaglandin synthesis and decrease rena... | One of the mechanisms that produce the hypotensive effect of ACE inhibitors such as perindopril is the increased action of vasodilator prostaglan-dins on the kidney, which decreases hydrosaline retention and therefore increases diuresis and lowers blood pressure. NSAIDs inhibit prostaglandin synthesis and decrease rena... | An 87-year-old man with a history of hypertension and gonarthrosis. Baseline situation with full functional and cognitive autonomy that allows him to continue living alone in the community. He is receiving regular treatment with perindopril and thiazide diuretic for blood pressure control and routinely takes ibuprofen ... | 305 | en | {
"1": "I would add a calcium channel blocker.",
"2": "I would increase the dose of hydrochlorothiazide to 25 mg/day.",
"3": "I would change ibuprofen to paracetamol to avoid the possible influence of paracetamol on the effect of hypotensives.",
"4": "I would add an alpha-blocker because of the high prevalence ... | 174 | NEPHROLOGY | 2,016 | {
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"title": "Study population and treatment titration in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT).",
"score": 0.019049346879535557,... |
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... | This is a heterozygous familial hypercholesterolemia. We must know how to recognize the disease and know the criteria. It seems to me to be of high difficulty. | This is a heterozygous familial hypercholesterolemia. We must know how to recognize the disease and know the criteria. It seems to me to be of high difficulty. | A 34-year-old man referred to the clinic for persistent LDL cholesterol levels above 250 mg/dL. The patient is asymptomatic but on examination there are whitish indurated spots on elbows, knees and eyelids. His BP is 135/85 mmHg. Her father died of myocardial infarction at the age of 48 years. The fasting blood test sh... | 104 | en | {
"1": "It is an autosomal codominant hereditary disease, with a high penetrance, so it is frequent that some of the parents and siblings of the individual also suffer from it.",
"2": "The genetic disorder affects the gene encoding the LDL cholesterol receptor and more than 900 mutations have been described.",
"3... | 91 | ENDOCRINOLOGY | 2,012 | {
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"title": "Diagnosis of families with familial hypercholesterolaemia and/or Apo B-100 defect by means of DNA analysis of LDL-receptor gene mutations.",
"score": 0.014588610563842763,
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"text": "A middle-aged woman with Sjögren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes ... | A middle-aged woman with Sjögren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes us think of primary biliary cirrhosis. To diagnose it we will use antimitochondrial antibodies (AMA IgG). Therefore, it would be answer 1. | A middle-aged woman with Sjögren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes us think of primary biliary cirrhosis. To diagnose it we will use antimitochondrial antibodies (AMA IgG). Therefore, it would be [HIDDEN]. | A 52-year-old woman consults for having noticed during the previous week a yellowish discoloration of the conjunctivae. She does not refer to risky sexual behavior or epidemiological history of risk of viral hepatitis. She does not consume alcohol or hepatotoxic drugs. She reports a one-year history of generalized prur... | 38 | en | {
"1": "Anti-mitochondrial antibodies.",
"2": "Study of iron metabolism.",
"3": "Study of copper metabolism.",
"4": "Hepatic MRI.",
"5": "Serology of virus B and virus C."
} | 232 | OPHTHALMOLOGY | 2,011 | {
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"title": "[Acute hepatitis secondary to hepatitis E. Report of two cases from a population of high socioeconomic level Lima].",
"score": 0.016979638822936904,
"content": "We de... |
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"text": "the most correct option would be two because i... | They refer to a partial seizure that is followed by loss of level of consciousness, so strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities). For this reason the most correct opt... | They refer to a partial seizure that is followed by loss of level of consciousness, so strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities). For this reason [HIDDEN] because it ... | A 39-year-old man who in the last 3 months has had two episodes of wide and involuntary jumping movements of the left limbs, which in about two minutes lead to loss of consciousness. In the neuroradiological study a right frontal expansive lesion suggestive of cerebral glioma was found.How would you classify this patie... | 376 | en | {
"1": "Generalized symptomatic.",
"2": "Partially symptomatic.",
"3": "Partial cryptogenic.",
"4": "Partial secondarily generalized symptomatic.",
"5": null
} | 130 | NEUROLOGY | 2,016 | {
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"id": "pubmed23n0812_5508",
"title": "[Rare cases of reflex epilepsy in patients with gliomas of the left hemisphere].",
"score": 0.01838731443994602,
"content": "We present the cases of symptomatic reflex... |
3 | {
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... | The correct answer is: 3. Subcutaneous fat biopsy. Lupus erythematosus, some vasculitides, Goodpasture's disease and other systemic diseases (ankylosing spondylitis is one of them) affect the kidney and condition its prognosis. The appearance of urinary abnormalities or renal impairment of parenchymal cause are indicat... | [HIDDEN] Lupus erythematosus, some vasculitides, Goodpasture's disease and other systemic diseases (ankylosing spondylitis is one of them) affect the kidney and condition its prognosis. The appearance of urinary abnormalities or renal impairment of parenchymal cause are indications for renal biopsy, even with proteinur... | A 66-year-old man with a history of ankylosing spondylitis of long evolution. He presents proteinuria of 6 grams per day with hypoalbuminemia and edema. In the urinary sediment no hematuria is detected. His plasma creatinine is 1.6 mg/dL and his glomerular filtration rate is 45 mL/min. Glycemia 110 mg/dL. His severe sp... | 163 | en | {
"1": "To initiate corticoids for suspicion of minimal change glomerular disease.",
"2": "Treat with cyclophosphamide for suspected membranous glomerulopathy.",
"3": "Subcutaneous fat biopsy.",
"4": "Initiate dialysis.",
"5": "Glucose overload test to rule out diabetic nephropathy."
} | 122 | NEPHROLOGY | 2,013 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en019_111574",
"title": "Glomerular filtration rate",
"score": 0.0180999180999181,
"content": "A urinalysis is helpful even when not showing any pathology, as this finding suggests an ex... |
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"text": "The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misundersto... | The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misunderstood... maybe she is right... The issue is that she cannot stand rejection and has self-injurious gestures. The diagnosis is 1. 3, 4 and 5 are not even close, there is no clinica... | [HIDDEN] The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misunderstood... maybe she is right... The issue is that she cannot stand rejection and has self-injurious gestures. The diagnosis is 1. [HIDDEN] there is no clinical picture des... | A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner. Her medical history shows several similar complaints in the previous year, two of them after a self-injurious gesture. Frequent conflicts in the couple's relationship, job changes and family arguments a... | 148 | en | {
"1": "Borderline personality disorder.",
"2": "Histrionic personality disorder.",
"3": "Dysthymia.",
"4": "Dissociative disorder.",
"5": "Depersonalization disorder."
} | 158 | PSYCHIATRY | 2,012 | {
"clinical_case_options": {
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{
"id": "pubmed23n0647_23136",
"title": "[A case of depression whose symptoms cured by setting her psychological base on the transcendent level].",
"score": 0.015141242937853107,
"content": "We report the ca... |
4 | {
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"text": "The APTT, which evaluates the intrinsic coagulation pathway (involving factors V, VIII, IX, X, XI and XII) is elongated. Hereditary coagulati... | In this question they also do not stop dropping clues to throw us headlong into the correct diagnosis. Let's review: a small child who suffers a hemarthrosis without clear trauma. An uncle of his had similar problems, so we suspect hereditary disease. The APTT, which evaluates the intrinsic coagulation pathway (involvi... | In this question they also do not stop dropping clues to throw us headlong into [HIDDEN]. Let's review: a small child who suffers a hemarthrosis without clear trauma. An uncle of his had similar problems, so we suspect hereditary disease. The APTT, which evaluates the intrinsic coagulation pathway (involving factors V,... | 18-month-old boy, with complete vaccination schedule to date, who consults the Emergency Department for swelling of the right knee after playing in the park, without obvious trauma. In the directed anamnesis, the mother refers that an uncle of hers had similar problems. The ultrasound examination is compatible with hem... | 178 | en | {
"1": "Marfan syndrome.",
"2": "Von Willebrand's disease.",
"3": "Ehlers-Danlos disease.",
"4": "Hemophilia A.",
"5": "Bemard-Soulier disease."
} | 94 | HEMATOLOGY | 2,013 | {
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"RRF-2": [
{
"id": "pubmed23n0052_9437",
"title": "Further evidence for recessive inheritance of von Willebrand disease with abnormal binding of von Willebrand factor to factor VIII.",
"score": 0.0168928470455188,
"con... |
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"text": "If there is no nodule, neither echo nor FNA is indicated."
},
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... | This is severe primary hypothyroidism. Treatment is with thyroxine. If there is no nodule, neither echo nor FNA is indicated. | This is severe primary hypothyroidism. Treatment is with thyroxine. If there is no nodule, neither echo nor FNA is indicated. | A 24-year-old man reports progressive asthenia for at least 6 months, hoarse voice, slow speech, drowsiness and swelling of the hands, feet and face. Examination: pulse at 52 beats per minute, abotarada face and dry and pale skin. CBC: mild anemia, cholesterol 385 mg/dL (normal <220), creatinine 1.3 mg/dL (normal: 0.5-... | 100 | en | {
"1": "Perform a thyroid ultrasound before starting treatment.",
"2": "Determine free T3 and perform a pituitary MRI.",
"3": "Treat with L-triiodothyronine and a statin.",
"4": "Treat with L-Tyroxine and determine antithyroid antibodies.",
"5": "Perform thyroid cytology prior to treatment."
} | 85 | ENDOCRINOLOGY | 2,012 | {
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"id": "pubmed23n0417_23288",
"title": "[Hypothyreoidism with thyroglobulin antibodies during corticoid replacement in a 54-year-old man with isolated ACTH deficiency]",
"score": 0.016403361344537813,
"cont... |
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"text": "The first step is to try conservative treatment (we ruled out the first option)."
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... | We are talking about a 66-year-old patient with pain on some days, pain of an occasional nature. Although the diagnosis is clearly osteoarthritis, it does not lead directly to a surgical indication. The first step is to try conservative treatment (we ruled out the first option). Osteoarthritis is a degenerative process... | We are talking about a 66-year-old patient with pain on some days, pain of an occasional nature. Although the diagnosis is clearly osteoarthritis, it does not lead directly to a surgical indication. The first step is to try conservative treatment [HIDDEN]. Osteoarthritis is a degenerative process that opioids certainly... | You evaluate a 66-year-old patient with groin pain accentuated by prolonged standing a few days a month. A plain radiograph of the hips shows narrowing of the femoroacetabular joint space, sclerosis and osteophytes. What is your approach? | 398 | en | {
"1": "I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis.",
"2": "Start treatment with weak opioids that have shown evidence in stopping the progression of the disease.",
"3": "I insist treatment with paracetamol, explain that the evolution is very variable and the sur... | 140 | TRAUMATOLOGY AND ORTHOPEDICS | 2,016 | {
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"id": "pubmed23n0298_22238",
"title": "[Coxarthroses].",
"score": 0.01951265943270512,
"content": "Osteoarthritis of the hip is a frequent disease affecting 2 to 4% adults. The main symptoms are inguinal p... |
3 | {
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... | You are describing sarcoidosis. | You are describing sarcoidosis. | A 30-year-old donkey man undergoes a chest X-ray to formalize an employment contract in a company. The X-ray shows a bilateral interstitial pattern of reticular type, bilateral hilar and mediastinal adenopathies. Bronchofibroscopy with bronchoalveolar lavage is indicated and the cell count shows the following results: ... | 28 | en | {
"1": "Extrinsic allergic alveolitis.",
"2": "Pneumoconiosis.",
"3": "Sarcoidosis.",
"4": "Carcinomatous lymphangitis.",
"5": "Idiopathic pulmonary hemosiderosis."
} | 58 | NEUROLOGY AND THORACIC SURGERY | 2,011 | {
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"id": "pubmed23n0583_3415",
"title": "Bronchoalveolar lavage in sarcoidosis.",
"score": 0.01846494213750851,
"content": "There is no single cell type present in bronchoalveolar lavage (BAL) fluid that appe... |
3 | {
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... | The rest of the answers are incorrect. With a BIRADS 3 this is the correct attitude to follow. | The rest of the answers are [HIDDEN]. With a BIRADS 3 this is [HIDDEN] attitude to follow. | A 40-year-old woman consults because she has noticed a lump in the superoexternal quadrant of the right breast for the past month. She provides a report of a mammography that describes a BIRADS 3 lesion: | 587 | en | {
"1": "Reassure her, since an imaging test has already been done and malignancy has been ruled out.",
"2": "This classification probably implies surgery, given that the probability of cancer is greater than 10%. He explains it to her and refers her preferentially to the Breast Unit.",
"3": "This is a probably be... | 76 | OBSTETRICS AND GYNECOLOGY | 2,022 | {
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{
"id": "pubmed23n0424_10969",
"title": "Evaluation of abnormal mammography results and palpable breast abnormalities.",
"score": 0.017900990099009903,
"content": "Because approximately 1 in 10 women with a ... |
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"text": "Patient with obesity, hypertension and increased HbA1C. In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly ... | Patient with obesity, hypertension and increased HbA1C. In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly reduces AT, HbA1C and BMI. Glipizide is of the sulfonylurea group. Its use should be avoided in patients with heart disease. Acarbose can interact with beta-blockers, such as t... | Patient with obesity, hypertension and increased HbA1C. In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly reduces AT, HbA1C and BMI. Glipizide is of the sulfonylurea group. Its use should be avoided in patients with heart disease. Acarbose can interact with beta-blockers, such as t... | A 58-year-old man comes for a scheduled check-up for type 2 diabetes mellitus diagnosed 6 years ago. He has a personal history of hypertension, dyslipidemia, ischemic heart disease and pancreatitis of biliary origin. His medication includes lisinopril, metoprolol, metformin, ASA and atorvastatin. Physical examination s... | 554 | en | {
"1": "Empaglifozin.",
"2": "Glipizide.",
"3": "Acarbose.",
"4": "Sitagliptin.",
"5": null
} | 50 | ENDOCRINOLOGY | 2,022 | {
"clinical_case_options": {
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{
"id": "pubmed23n0600_10828",
"title": "Reducing global cardiovascular risk in patients with type 2 diabetes mellitus.",
"score": 0.019419306184012067,
"content": "Type 2 diabetes mellitus (T2DM) and its co... |
4 | {
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"... | Patient with harmful alcohol consumption (60g and female), high fever, hepatic encephalopathy (disorientation, asterixis), very high direct bilirubin, jaundice, painful hepatomegaly, coagulopathy (elevated prothrombin time) and mild elevation of transaminases (less than 5 times the upper limit of normal) suggest acute ... | Patient with harmful alcohol consumption (60g and female), high fever, hepatic encephalopathy (disorientation, asterixis), very high direct bilirubin, jaundice, painful hepatomegaly, coagulopathy (elevated prothrombin time) and mild elevation of transaminases (less than 5 times the upper limit of normal) suggest acute ... | A 50-year-old woman comes to the emergency department with asthenia, anorexia, weight loss, jaundice, fever and abdominal pain. She has no recent history of blood transfusion, risky sexual contacts or addiction to parenteral drugs. Habitual consumption of 60 grams of alcohol per day during the last five years, consumpt... | 251 | en | {
"1": "Hepatic abscess.",
"2": "Acute cholecystitis.",
"3": "Acute cholangitis.",
"4": "Alcoholic hepatitis.",
"5": "Acute pancreatitis."
} | 81 | DIGESTIVE SYSTEM | 2,014 | {
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{
"id": "pubmed23n0702_20431",
"title": "[Acute pancreatitis and acalculous cholecystitis associated with viral hepatitis A].",
"score": 0.01793758043758044,
"content": "We report the case of a 14 year-old m... |
4 | {
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"text": "Migraine and vascular disorders, accompanied by other neurological symptoms or nausea, photophobia, etc., are quickly ruled out, as well as ... | Just as last year they wanted to paint a nurse as bad for waking us up for a patient with myasthenia, this year they entertain us by presenting a patient asking for a CT scan. I interpret that they show a patient stressed by her children with recurrent headaches of occipital location that she previously relieved with a... | Just as last year they wanted to paint a nurse as bad for waking us up for a patient with myasthenia, this year they entertain us by presenting a patient asking for a CT scan. I interpret that they show a patient stressed by her children with recurrent headaches of occipital location that she previously relieved with a... | A 42-year-old married woman with 2 school-age children consults her family physician for a severe headache of about 7 days' evolution. Although she has been having similar episodes for more than a year, in the last 2 months they have worsened considerably. The pain is like a weight that starts in the occipital area, sp... | 128 | en | {
"1": "Migraine.",
"2": "Vascular disorders.",
"3": "Temporal artery arteritis.",
"4": "Tension.",
"5": "Oncologic."
} | 79 | NEUROLOGY AND NEUROSURGERY | 2,012 | {
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{
"id": "pubmed23n0093_16112",
"title": "[Swimming induced vascular headache].",
"score": 0.01720573032048442,
"content": "We experienced 3 cases of characteristic headache induced by swimming. The first cas... |
4 | {
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"... | In this question, they give an important piece of information when it comes to suspecting a diagnosis, which is the antitransglutaminase antibodies that must lead you to suspect celiac disease. The rest of the symptoms fall perfectly within the picture and although probably several of the tests that it says will be don... | In this question, they give an important piece of information when it comes to suspecting a diagnosis, which is the antitransglutaminase antibodies that must lead you to suspect celiac disease. The rest of the symptoms fall perfectly within the picture and although probably several of the tests that it says will be don... | A 27-year-old woman under study in the dermatology department for recurrent episodes of oral aphthous ulcers. She was referred to the gastrointestinal department for a blood test showing Hb 11.5 gr/dl Fe 38 AST 52 ALT 64 Ac antitrasglutaminase IgA 177. The patient reported only occasional diffuse abdominal discomfort. ... | 0 | en | {
"1": "Capsule endoscopy.",
"2": "Colonoscopy.",
"3": "Serology for hepatitis b and c virus.",
"4": "Intestinal biopsy.",
"5": "Abdominal ultrasound."
} | 34 | DIGESTIVE | 2,011 | {
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{
"id": "pubmed23n1164_2588",
"title": "Epstein-Barr Virus Hepatitis Masquerading as Painless Jaundice.",
"score": 0.018521679754182313,
"content": "Epstein-Barr virus (EBV) infection typically presents with... |
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"text": "The rest of the entities offered do not present with chylous ascitic fluid."
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... | The characteristics of the fluid described are milky, i.e., chylous ascitic fluid. Taking into account the age of the patient and the constitutional syndrome described, it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid, since there is no mention of inf... | The characteristics of the fluid described are milky, i.e., chylous ascitic fluid. Taking into account the age of the patient and the constitutional syndrome described, it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid, since there is no mention of inf... | An 80-year-old woman consults for presenting, since 1 month ago, a progressive increase in abdominal perimeter. During the previous 4-5 months she noted asthenia, anorexia and unspecified weight loss. Physical examination revealed tension ascites and malleolar edema, with no other relevant signs. An ultrasound and CT s... | 256 | en | {
"1": "Hydropic decompensation secondary to liver cirrhosis.",
"2": "Chylous ascites due to non-Hodgkin's lymphoma.",
"3": "Peritoneal tuberculosis.",
"4": "Peritoneal metastasis of adenocarcinoma.",
"5": "Ascites secondary to constrictive pericarditis."
} | 162 | DIGESTIVE SYSTEM | 2,014 | {
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"title": "Ascites",
"score": 0.01899189918991899,
"content": "Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the ... |
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"text": "Cervicalgia without alarm signs. Conservative treatment with a success rate of 75%-90%."
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"char_ranges": [],... | Cervicalgia without alarm signs. Conservative treatment with a success rate of 75%-90%. | Cervicalgia without alarm signs. Conservative treatment with a success rate of 75%-90%. | A 35-year-old man, a letter carrier, with no history of interest, who comes to the emergency department for acute cervical pain of 24 hours of evolution, without previous trauma, which radiates to the left arm up to the hand and is accompanied by paresthesia in the radial border of the forearm. She presents no objectif... | 604 | en | {
"1": "Conservative treatment with nonsteroidal anti-inflammatory drugs, local heat and relative rest.",
"2": "Urgent call to the neurosurgeon for surgical evaluation.",
"3": "Preferential request for MRI and electromyogram.",
"4": "Preferential referral to outpatient traumatology consultations.",
"5": null
... | 113 | TRAUMATOLOGY | 2,022 | {
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"id": "pubmed23n0938_6536",
"title": "Sudden Onset of Severe Cervical Pain in an Adolescent Girl: Case Report and Review of Literature.",
"score": 0.018672919923571306,
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"text": "what is not indicated is the determination of the JAK-2 mutation, which is used in the diagnosis of chronic myeloproliferative syndromes, ... | The first thing is to know the diagnosis of the clinical case that we are presented with, it is a primary immune thrombocytopenia (ITP), only the platelet series is altered with normal coagulation. The first test to be performed is a peripheral blood smear to check if these platelets are real and there is no pseudothro... | The first thing is to know the diagnosis of the clinical case that we are presented with, it is a primary immune thrombocytopenia (ITP), only the platelet series is altered with normal coagulation. The first test to be performed is a peripheral blood smear to check if these platelets are real and there is no pseudothro... | A 25-year-old woman presents to the emergency department with ecchymosis and petechiae in the lower extremities and gingivorrhage in the last few days. Her blood count showed the following data: Hb 13 g/dL, leukocytes 8,500/microL with normal leukocyte formula and platelets 9,000/mm3. The determination of coagulation t... | 362 | en | {
"1": "JAK-2 mutation.",
"2": "Bone marrow aspirate.",
"3": "Antinuclear antibodies.",
"4": "Peripheral blood smear.",
"5": null
} | 96 | HEMATOLOGY | 2,016 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "wiki20220301en099_51325",
"title": "List of MeSH codes (E01)",
"score": 0.01899189918991899,
"content": "– cytodiagnosis – amniocentesis – biopsy – biopsy, needle – biopsy, fine-needle – chorionic v... |
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