id int64 0 620 | year int64 2.01k 2.02k | question_id_specific int64 1 235 | full_question stringlengths 123 1.09k | full_answer stringlengths 26 2.98k | type stringclasses 64
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|---|---|---|---|---|---|---|---|---|
410 | 2,018 | 195 | A 75 a man is admitted to the hospital because he refuses to eat and has lost 30% of his weight. He has a history of multiple sclerosis which has worsened in recent months. His only family member who was his sister died 3 months ago and since then he has deteriorated. He has become incontinent, has stopped eating and p... | The correct answer is 1 since the patient is in a situation of psychotic depression and is not able to decide for his life and it does not seem that the patient has filled in the last will and testament, the most convenient thing to do is to present the case to the ethics committee of the center to make a decision on t... | PRIMARY CARE | {
"1": "Ask the hospital ethics committee to help determine the decision that is in the best interest of the patient.",
"2": "Assess whether the residence will take the patient if PEG is not performed.",
"3": "Seek a court order to perform PEG.",
"4": "Enrolling the patient in terminal palliative care.",
"5":... | 1 | {
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"text": "the patient is in a situation of psychotic depression and is not able to decide for his life and it does not seem that the patient has filled i... |
361 | 2,016 | 94 | A 51-year-old man is admitted from the emergency department for macrocytic anemia (Hb 6.3 g/dL, MCV 120 fL). Studies ruled out a deficiency origin. Reticulocytes were 24000/microL. The bone marrow study is compatible with myelodysplastic syndrome (MDS). Cytogenetics shows a 5q deletion. Which is the correct statement r... | This is a young patient with no comorbidities and is therefore a candidate for treatment with curative intent, so option 4 is ruled out. Option 3 is also incorrect since we cannot know the patient's IPSS since we do not know the number of blasts and the number of leukocytes and platelets to calculate the risk. Option 2... | HEMATOLOGY | {
"1": "This deletion (5q-) is an alteration of good prognosis and has a specific treatment (lenalidomide).",
"2": "It would be advisable in this patient to perform HLA typing in order to organize an allogeneic transplant.",
"3": "This is a patient with a high International Prognostic Index (IPSS).",
"4": "Trea... | 1 | {
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"text": "Therefore the correct one is 1 since it is true that it has a favorable cytogenetics (5q-) and has a specific treatment lenalidomide, also ... |
172 | 2,013 | 50 | A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter. Which of the following statements is FALSE? | Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality). The patient is not hyperventilating but hypoventilating because PCO2 is elevated. The alveolar art... | PNEUMOLOGY | {
"1": "The patient is hyperventilating.",
"2": "The alveolar arterial oxygen gradient is elevated.",
"3": "The patient is in respiratory acidosis.",
"4": "Bicarbonate level is normal.",
"5": "Initiation of mechanical ventilation should be considered."
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"text": "The patient is not hyperventilating but hypoventilating because PCO2 is elevated."
},
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83 | 2,012 | 48 | What therapeutic intervention would you consider in a 67-year-old patient with idiopathic dilated cardiomyopathy, left bundle branch block, left ventricular ejection fraction of 26%, mitral insufficiency grade II-III/IV, undergoing treatment with furosemide, spironolactone, enalapril and bisoprolol and who remains in N... | We are talking about a patient with heart failure with severe LV dysfunction (EF < 35%), LBBB (wide QRS), who is following optimal medical treatment and who remains in advanced functional class despite this. Coronary revascularization does not appear to be of much benefit in this patient at this time. Nor does mitral v... | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Surgical coronary revascularization.",
"2": "Mitral valve replacement.",
"3": "Implantation of an aortic balloon pump.",
"4": "Implantation of a ventricular assist device.",
"5": "Implantation of a cardiac resynchronization system."
} | 5 | {
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"text": "Coronary revascularization does not appear to be of much benefit in this patient at this time."
},
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141 | 2,012 | 135 | A 2-year-old boy, his personal history includes: 3 episodes of acute otitis media, 1 meningococcal meningitis and 2 pneumonias (one middle lobe and one left upper lobe). She has been admitted on 3 occasions for thrombopenic purpura (on three occasions antiplatelet antibodies were negative and bone marrow showed normal ... | The correct answer is 1. Wiskott-Aldrich syndrome associates immunodeficiency, thrombopenia and atopic dermatitis with the immunological study described in the statement. | PEDIATRICS | {
"1": "Wiskott-Aldrich syndrome.",
"2": "Hyper IgE syndrome.",
"3": "Transient hypogammaglobulinemia of infancy.",
"4": "Severe X-associated combined immunodeficiency.",
"5": "Common variable immunodeficiency."
} | 1 | {
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"text": "Wiskott-Aldrich syndrome associates immunodeficiency, thrombopenia and atopic dermatitis with the immunological study described in the statemen... |
317 | 2,016 | 139 | A 70-year-old woman with a history of anorexia, weight loss, muscle and proximal joint discomfort and pain in the temporomandibular region comes to the emergency department for unilateral vision loss (hand movement), sudden and painless onset (afferent pupillary defect). What test would you order first for diagnostic p... | It is possibly a temporal arteritis, the clinical picture and a CBC with increased reactants are enough to confirm the suspicion. Then an ocular evaluation should be done to rule out AIN, urgent treatment should be instituted (if there is AIN, 3 boluses of methylprednisolone 1 g, if there is not, prednisone mg/kg) and ... | RHEUMATOLOGY | {
"1": "Lumbar puncture.",
"2": "C Reactive Protein.",
"3": "Magnetic resonance angiography.",
"4": "Carotid ultrasound.",
"5": null
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"text": "It is possibly a temporal arteritis, the clinical... |
550 | 2,022 | 129 | 65-year-old male presenting to the emergency department for appearance of cyanotic mottled lesions on the toes of both feet. Personal history: smoking, hypertension and dyslipidemia. Chest X-ray: mediastinal widening. Thoracic-abdominal-pelvic CT angiography: descending thoracic aortic aneurysm 7 cm in diameter, distal... | Thoracic stent implantation is indicated. | CARDIOLOGY | {
"1": "Statin therapy is indicated to stabilize the thrombus.",
"2": "Urgent diagnostic aortography is necessary.",
"3": "At surgery, the aneurysmal segment is replaced by a tubular prosthesis with reimplantation of the supra-aortic trunks.",
"4": "Thoracic stent implantation is indicated.",
"5": null
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110 | 2,012 | 152 | Patient 76 years old, parity 3-0-3-1, with menopause at age 52. She reports that for at least 4-5 years she has had vulvar pruritus of variable intensity which has been treated sometimes with self-medication and other times on the advice of her general practitioner with topical preparations (creams and washes). The pru... | The correct answer is 5. Vulvar carcinoma is characterized by chronic vulvar itching resistant to multiple treatments, appearance of lumpiness or ulceration, dysuria and urinary urgency, and late pain and bleeding. | GYNECOLOGY AND OBSTETRICS | {
"1": "Genital herpes.",
"2": "Paget's disease of the vulva.",
"3": "Urethral caruncle.",
"4": "Chronic granuloma of the vulva.",
"5": "Vulvar squamous cell carcinoma."
} | 5 | {
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419 | 2,018 | 77 | An 80-year-old woman comes to the emergency department with abdominal pain starting in the epigastrium and radiating later to the left iliac fossa. An abdominal CT scan is performed, showing inflammation of the sigmoid walls and a 2 cm mesenteric abscess. The treatment of choice is: | In this question we are presented with a clinical picture whose manifestations are compatible with acute diverticulitis, already asked on numerous occasions previously. A case of acute diverticulitis complicated with small mesenteric abscess (< 2-3 cm) is presented. Abscesses should be drained by CT-guided percutaneous... | GENERAL SURGERY | {
"1": "Admission to the ward with absolute diet and broad-spectrum antibiotic treatment.",
"2": "Discharge colostomy.",
"3": "Drainage by laparoscopic surgery.",
"4": "Urgent surgery with sigmoidectomy and colorectal anastomosis.",
"5": null
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"text": "in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed ... |
37 | 2,011 | 227 | A 78-year-old woman consults for acute vision loss of the left eye. In the last 3 weeks she has presented with fever, pain in the shoulders, neck and hips, and moderate headache. Funduscopy shows a pale and edematous optic disc. Mobilization of the shoulders and hips produces pain. There are no alterations on palpation... | The clinical presentation is strongly suggestive of giant cell arteritis (GCA), with febrile fever, shoulder girdle and pelvic pain, and headache. Age and sex also point to this possibility. Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA. T... | OPHTHALMOLOGY | {
"1": "Request a Doppler ultrasound of temporal arteries.",
"2": "Start treatment with prednisone 60mg per day and aspirin 100 mg per day.",
"3": "Start treatment with prednisone 10 mg per day.",
"4": "Request a temporal artery biopsy.",
"5": "Request a brain magnetic resonance imaging."
} | 2 | {
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"text": "The clinical presentation is strongly suggestive ... |
532 | 2,021 | 67 | A 26-year-old woman, with a history of a pregnancy at the age of 24 years ending in spontaneous abortion in the 12th week that did not require curettage, comes to the consultation presenting daily vaginal bleeding of one month of evolution, without fever or pain. Ultrasound showed an increase in the endometrial lining,... | It elevates chorionic gonadotropin. It has curative treatment. | ONCOLOGY | {
"1": "Placental bed tumor.",
"2": "Atypical endometrial hyperplasia.",
"3": "Endometrial polyp.",
"4": "Choriocarcinoma.",
"5": null
} | 4 | {
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272 | 2,016 | 69 | A 60-year-old man with extensive ulcerative colitis of 15 years of evolution and in clinical remission for the last 3 years, comes to our office to be informed about the risk of colorectal cancer and about the possibility of participating in prevention programs. It is correct to inform him that: | Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers. It is recommended to start screening 8-10 years after diagnosis of IBD (or earlier if primary sclerosing cholangitis or other events occur during this interval). The recommended techniques are co... | DIGESTIVE SYSTEM | {
"1": "Ulcerative colitis is only associated with an increased risk of colorectal cancer in smokers.",
"2": "In her case, given that she is in long-term remission, the screening advised to the general population is considered appropriate.",
"3": "In cases such as yours, it is considered appropriate to undergo pe... | 3 | {
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428 | 2,018 | 61 | A 62-year-old man comes to the hospital emergency department with a fever of 38.3″C and chills. He is tachycardic and tachypneic. Blood tests: leukocytosis with left shift. Blood pressure is 90/60 mmHg. No murmurs are heard on cardiac auscultation and chest X-ray rules out pneumonia. As history of interest she refers r... | With the urine nitrite test we detect the presence of nitrites in the urine. These appear due to the presence in the urine of a high concentration of bacteria possessing the enzyme nitrate reductase, which is capable of reducing the nitrates present in the urine to nitrites. This enzyme is active in most of the bacteri... | INFECTIOUS DISEASES AND MICROBIOLOGY | {
"1": "Continue with cefuroxime while awaiting the definitive result, since the patient has undergone multiple treatments and we should not make a mistake in his current treatment.",
"2": "Change to ertapenem, considering the possibility of multiresistant microorganisms.",
"3": "Switch to a broad-spectrum antimi... | 3 | {
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393 | 2,016 | 224 | A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities. The various medical examinations have ruled out any medical illness. Which of the following is most likely to be the case? | According to ICD-10 the criteria for diagnosing Somatization Disorder (F45.0) are: A. History of multiple physical symptoms, which begins before age 30, persists for several years, and compels seeking medical attention or causes significant impairment socially, occupationally, or in other important areas of the individ... | PSYCHIATRY | {
"1": "Conversive disorder.",
"2": "Hypochondriac disorder.",
"3": "Somatization disorder.",
"4": "Dissociative disorder.",
"5": null
} | 3 | {
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"text": "Conversive or dissociative disorder is ruled out because these are usually related to psychological factors, associated with the symptom ... |
124 | 2,012 | 46 | A 58-year-old woman comes for a follow-up visit for diabetes mellitus and hypertension. She feels well but states that she has stopped taking verapamil because of constipation. She presents with intolerance to ACE inhibitors due to coughing. On examination, blood pressure is 156/92 mm Hg. CBC includes a creatinine of 1... | This question is typical and quite easy. The antihypertensive drugs that have been shown to slow the progression of diabetic nephropathy are the ACE inhibitors and ARAIIs. Specifically, angiotensin II receptor blockers have demonstrated their efficacy in this field for type 2 DM, which together with the side effects th... | NEPHROLOGY | {
"1": "Angiotensin converting enzyme inhibitor.",
"2": "Angiotensin receptor blocker.",
"3": "Calcium antagonist.",
"4": "Alpha-blocker.",
"5": "Beta-blocker."
} | 2 | {
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"text": "angiotensin II receptor blockers have demonstrated their efficacy in this field for type 2 DM, which together with the side effects that IECA... |
405 | 2,016 | 31 | 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... | Teratoma is the most frequent germinal tumor. It presents differentiation in elements of the three embryonic layers: endoderm, mesoderm and ectoderm. Macroscopically they can be cystic or solid, and histologically the tissues composing the tumor can be mature (well differentiated, like adult tissues) or immature (like ... | ONCOLOGY (ECTOPIC) | {
"1": "Teratocarcinoma.",
"2": "Immature teratoma.",
"3": "Mature cystic teratoma.",
"4": "Dysgerminoma.",
"5": null
} | 2 | {
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"text": "we found that it had neuroectodermal and e... |
497 | 2,020 | 127 | A 60-year-old man, smoker of 40 packs/year, who consults for pain in the ulnar border of the left arm and left palpebral ptosis since one month ago. Chest X-ray shows a mass in the left upper lobe and CT scan confirms the lesion with invasion of the second rib. In relation to the suspected diagnosis, the most appropria... | Typical smoker's pancoast, probably an epidermoid, with Horner's sdr. Best would be chemoradio followed by surgical salvage. In the old days it was just RT and surgery. Maybe not far off enter immunotherapy in first line. There are more and more new things. | MEDICAL ONCOLOGY | {
"1": "Neoadjuvant chemotherapy with combined chemoradiotherapy, followed by surgery.",
"2": "Neoadjuvant chemotherapy without surgery, followed by radiotherapy.",
"3": "Surgery followed by combined chemoradiotherapy.",
"4": "Radiotherapy without chemotherapy, followed by surgery.",
"5": null
} | 1 | {
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"text": "Typical smoker's pancoast, probably an epidermoid, with Horner's sdr. Best would be chemoradio followed by surgical salvage."
},
"2": {
... |
307 | 2,016 | 207 | A 34-year-old patient playing tennis is hit by a ball at the level of the left orbit. On examination he presents significant palpebral hematoma, hyposphagmia, diplopia to superior vision with limitation of the upper version of the eyeball. What would you suspect? | This question has a small typo (one would say "tennis"), but personally I am a little more bothered by the error in the description of the scan. Specifically when they say "diplopia to superior vision with limitation of the superior version of the eyeball". Versions are bilateral conjugated movements of both eyes. That... | OPHTHALMOLOGY | {
"1": "Fracture of the inferior wall of the floor of the orbit with trapping of the inferior rectus muscle.",
"2": "Zygomatic arch fracture.",
"3": "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle.",
"4": "Dentoalveolar fracture.",
"5": null
} | 1 | {
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"text": "And as for the walls of the orbit, the ones that break most frequently are the inferior and medial wall."
},
"2": {
"exist": true... |
589 | 2,022 | 63 | A 36-year-old male who consults for conjunctival hyperemia and foreign body sensation. Which of the following pathologies does NOT correspond to the above mentioned examination? | We are being presented with a picture of conjunctival inflammation or conjunctivitis and asked which of them is not associated with pre-auricular lymphadenopathy. Adenovirus conjunctivitis can be associated with inflammation of the pre-auricular or ipsilateral sub-mandibular lymph node (option 1 discarded). Allergic co... | OPHTHALMOLOGY | {
"1": "Adenoviral conjunctivitis.",
"2": "Allergic conjunctivitis.",
"3": "Parinaud's oculoglandular syndrome.",
"4": "Chlamydia conjunctivitis.",
"5": null
} | 2 | {
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"text": "Adenovirus conjunctivitis can be associated with inflammation of the pre-auricular or ipsilateral sub-mandibular lymph node (option 1 discard... |
350 | 2,016 | 160 | 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? | Colposcopy with possible biopsy. H-SIL (High-grade squamous intraepithelial lesion)*: includes changes suggestive of CIN2 and CIN3/CIS. The cytologic diagnosis must be confirmed by biopsy, for which it is necessary to perform a directed biopsy by colposcopy. | GYNECOLOGY AND OBSTETRICS | {
"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
} | 2 | {
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"text": "The cytologic diagnosis must be confirmed by b... |
25 | 2,011 | 116 | A 40-year-old woman is admitted to the Emergency Department with a fever of 38ºC and right lumbar pain. The CBC shows 25000 leukocytes/mm3 with left deviation and an abdominal ultrasound shows a coralliform lithiasis. What microorganism do we expect to find? | Epidemiology question shared with URO. Coraliform lithiasis are associated with urea-folding germs: Proteus in the first place, Pseudomonas, Klebsiella and some staphylococci. | INFECTIOUS | {
"1": "Escherichia coli.",
"2": "Enterococcus faecalis.",
"3": "Salmonella typhi.",
"4": "Candida albicans.",
"5": "Proteus mirabilis."
} | 5 | {
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103 | 2,012 | 89 | A 55-year-old patient diagnosed with hypertension 2 months ago at a company check-up. Laboratory tests: glucose 129 mg/dL, cholesterol 202 mg/dL, LDLc 160 mg/dL, HDLc 38 mg/dL, triglycerides 171 mg/dL, creatinine 1.1 mg/dL. He consults for poor blood pressure control, malleolar edema and dyspnea that is occasionally no... | HbA1c would be useful in this patient for the diagnosis of diabetes but not for the target organ involvement of hypertension. | ENDOCRINOLOGY | {
"1": "Transthoracic echocardiogram.",
"2": "Performance of fundus examination.",
"3": "Determination of microalbuminuria.",
"4": "Ankle-brachial index.",
"5": "Determination of glycosylated hemoglobin."
} | 5 | {
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22 | 2,011 | 112 | A patient comes to the Emergency Department with fever without focus of 24 h of evolution, hypothyroidism and impression of severity. She underwent a splenectomy 2 years ago for staging of Hosgkin's disease. Which microorganism is most frequently implicated? | Another one on epidemiology. In splenectomized patients, the risk of acquiring serious infections by encapsulated germs is increased, again Pneumococcus being the most frequent. | INFECTIOUS | {
"1": "Streptococcus pneumoniae.",
"2": "Pseudomonas aeruginosa.",
"3": "Salmonella no typhi.",
"4": "Pneumocystis jirovecii.",
"5": "Streptococcus viridans."
} | 1 | {
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"text": "In splenectomized patients, the risk of acquiring serious infections by encapsulated germs is increased, again Pneumococcus being the most freq... |
488 | 2,020 | 105 | A 67-year-old patient who in the last 6 months, in two routine analyses, presents progressive lymphocytosis. In the last one, hemoglobin 15.4 g/dL; leukocytes 18.5 x103/μL with 82% of mature lymphocytes that by flow cytometry express CD5/CD19/CD23 antigens and platelets 240 x103/μL. What attitude do you think is correc... | A question that I think can be complicated for a MIR examiner. We are told of a leukocytosis at the expense of lymphocytes with a B-CLL phenotype. It seems that there are no other alarming data. No clinical data are given (so we assume that the patient is asymptomatic). No cytopenias... Conclusion: FOLLOW UP. The main ... | HEMATOLOGY | {
"1": "Study of TP53 mutations to establish prognosis.",
"2": "Bone aspirate/biopsy to confirm the diagnosis.",
"3": "PET/CT to establish the therapeutic attitude.",
"4": "New clinical and analytical control in 6 months.",
"5": null
} | 4 | {
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"text": "the TP53 mutation, although it establishes prognosis, is not indicated at diagnosis, but when treatment is going to be initiated (first line... |
111 | 2,012 | 153 | A 59-year-old woman consults a gynecologist for a spontaneous, spontaneous, uniorificial discharge from the right nipple (unilateral) without palpable nodularity. What is the most likely diagnosis? | The correct answer is 2. In the presence of unilateral and uniorificial hematic telorrhea, the most frequent cause is intraductal papilloma (50%), followed by ductal ectasia and carcinoma. When associated with palpable mass, 60% correspond to carcinoma. Paget's disease is of the eczematous type. In hyperprolactinemia, ... | GYNECOLOGY AND OBSTETRICS | {
"1": "Given the hematic nature of the discharge, the most likely diagnosis is infiltrating ductal carcinoma.",
"2": "Intraductal papilloma.",
"3": "Paget's disease of the nipple.",
"4": "Tumor hyperprolactinemia.",
"5": "Mammography will indicate the diagnosis."
} | 2 | {
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"text": "When associated with palpable mass, 60% correspond to carcinoma."
},
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119 | 2,012 | 119 | A 17-year-old woman comes to the emergency department with a high fever, pharyngeal pain and cervical lymphadenopathy. She had previously been diagnosed with acute pharyngitis and was treated with amoxicillin, and later presented with a generalized macular skin rash. Laboratory tests showed slight leukocytosis with lym... | Of course it is a typical picture (EBV, CMV, VH6, Toxoplasma), of which you will not see so clearly at the emergency room door when you are on call. Be careful with the bad blood in answer 3, because an acute toxoplasmosis can behave like this and also give a macular exanthema, although the one of this girl is related ... | INFECTOLOGY | {
"1": "It is a typical picture of infectious mononucleosis.",
"2": "Varicella zoster virus infection.",
"3": "Acute toxoplasmosis.",
"4": "Lyme disease.",
"5": "Infection by herpes virus 8."
} | 1 | {
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562 | 2,022 | 183 | A 45-year-old woman with no history of interest consults for dyspneic sensation of about 4 days of evolution. Examination shows rhythmic tachycardia, without murmurs, and pulmonary auscultation is normal. Arterial blood gases showed a pO2 of 70 mmHg and a pCO2 of 32 mmHg. Hemogram, renal and hepatic function are normal... | In this question what they assume is that this is a 45-year-old woman who is diagnosed with pulmonary thromboembolism (PTE). With this diagnosis, options 3 and 4 are directly excluded (also, she is female, so we would not have to think about hemophilia) As an analytical data, it says that there is a lengthening of the ... | HEMATOLOGY | {
"1": "Antiphospholipid syndrome.",
"2": "Factor V of Leiden.",
"3": "Hemophilia.",
"4": "Acute pericarditis.",
"5": null
} | 1 | {
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"text": "As an analytical data, it says that there is a lengthening of the aPTT. So, they want you to know, she has positive lupus ac and link it dire... |
514 | 2,021 | 97 | After a traffic accident you attend to an injured person. The patient opens his eyes at your call, but only utters words that are inappropriate. On motor examination, the pain is localized in the right extremities, but spreads on stimulation of the left extremities. How would you describe his condition according to the... | The first thing we should know when applying the Glasgow Coma Scale to a patient is that we should always keep the best value in each sphere (ocular response, motor response and verbal response). In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate word... | CRITICAL AND EMERGENCY CARE | {
"1": "E3V2M4.",
"2": "E3V3M5.",
"3": "E2V3M4.",
"4": "E2V4M5.",
"5": null
} | 2 | {
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101 | 2,012 | 86 | A 55-year-old woman consults for fatigue and polyuria of two years' evolution. Laboratory tests reveal hypercalcemia, increased PTH and increased bone turnover markers. The radiographic study shows subperiosteal resorption and osteoporosis. Sestamibi scintigraphy revealed a parathyroid adenoma. Parathyroidectomy was pe... | Question of very high difficulty, I would not worry about having failed it. It is easy to get confused with the hypoparathyroidism answer. Permanent post-surgical hypoparathyroidism after parathyroidectomy of an adenoma with minimally invasive surgery is rare. I write a brief summary of the hungry bone syndrome that I ... | ENDOCRINOLOGY | {
"1": "Permanent surgical hypoparathyroidism.",
"2": "Transfusion of citrated blood.",
"3": "Vitamin D insufficiency.",
"4": "Hungry bone syndrome.",
"5": "Osteomalacia."
} | 4 | {
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"text": "Permanent post-surgical hypoparathyroidism after parathyroidectomy of an adenoma with minimally invasive surgery is rare."
},
"2": {
... |
230 | 2,014 | 179 | A 4-year-old boy comes to the health center who, 5 minutes before, starts with angioedema in the face, conjunctivitis, nasal congestion and hoarseness, coinciding with the ingestion of a spoonful of yogurt given to him by mistake at school. Among the antecedents, he was diagnosed with cow's milk protein allergy. Examin... | We are facing a case of Anaphylaxis so the first measure is to administer Adrenaline 1/1000 intramuscular (0.01mg/kg). Subsequently, systemic corticosteroids such as methylprednisolone will be given, which will take a few hours to take effect. So adrenaline first, as it is faster acting, then the rest (Question very si... | PEDIATRICS | {
"1": "Provoke vomiting.",
"2": "Adrenaline 1/1000 subcutaneous.",
"3": "Intramuscular adrenaline 1/1000.",
"4": "Intramuscular methylprednisolone.",
"5": "Nebulized salbutamol."
} | 3 | {
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479 | 2,020 | 164 | A 72-year-old man presenting since 48 hours with fever of 38.7°C, cough, purulent expectoration and dyspnea. Constants: BP 85/60 mmHg, heart rate 100 bpm, respiratory rate 35 rpm, SatO2 80%. Of note was the presence of confusion and crackles in the left lower lung field. Chest X-ray confirms the existence of pneumonia ... | Applying the CURB-65 severity scale (one of the most commonly used in the ED for stratifying the severity of pneumonia, although in this case simply applying common sense, the patient should be admitted to the ICU), we would have a score of at least 4 points (we would be missing the serum urea data), which gives us sev... | CRITICAL CARE | {
"1": "Outpatient treatment at home.",
"2": "Admission to an emergency observation unit.",
"3": "Hospital admission to the ward.",
"4": "Admission to the Intensive Care Unit.",
"5": null
} | 4 | {
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515 | 2,021 | 101 | 15-year-old male, admitted after being run over on the public road, resulting in being ejected. He was admitted conscious and oriented, with intense pain in the left hemithorax and dyspnea. Physical examination showed blood pressure 90/60 mmHg, heart rate 130 bpm, basal oxygen saturation 90%, respiratory rate 35 rpm. T... | There are two answers that we can immediately rule out if we stick to the initial management of severe chest trauma: 1 (noninvasive ventilation is not indicated because it does not secure the airway) and 3 (observation in these cases, waiting for worsening, only leads to increased morbidity and mortality). Between opti... | CRITICAL AND EMERGENCY CARE | {
"1": "Institute noninvasive mechanical ventilation and request blood transfusion.",
"2": "Analgesia, oxygen therapy, request blood transfusion and indicate urgent surgery.",
"3": "Orotracheal intubation, request blood transfusion and observation for, in case of worsening, indicate surgical intervention.",
"4"... | 2 | {
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"text": "(noninvasive ventilation is not indicated because it does not secure the airway)"
},
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"exist": true,
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... |
234 | 2,014 | 105 | A 72-year-old man comes to the Emergency Department with a pathological fracture of the left femur. After surgery, a diagnostic study is performed to determine the underlying pathology with the following findings: hemoglobin 9.5 g/dl, total proteins 11 g/dl, (VN: 6-8 g/dl), serum albumin 2 g/dl, (VN 3.5-5.0 g/dl), beta... | She is going to have myeloma. For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak. Then, for extension, prognostic value and to decide treatments, the rest, but once diagnosed. | HEMATOLOGY | {
"1": "Radiological bone series and bone marrow aspirate.",
"2": "Serum and urine electrophoresis and renal function tests.",
"3": "Bone marrow aspirate and serum calcium concentration.",
"4": "Bone marrow aspirate and serum and urine electrophoresis.",
"5": "Biopsy of the pathological fracture and radiologi... | 4 | {
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174 | 2,013 | 52 | A 67-year-old man consults for moderate exertional dyspnea of progressive onset in recent years. He has daily whitish expectoration and sometimes breath sounds, especially in winter with respiratory infections. He has been a smoker of about 20 cigarettes a day for the last 45 years. On examination he is eupneic, normoc... | In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two. Therefore there is no doubt in the correct answer. | PNEUMOLOGY | {
"1": "Daily inhaled corticosteroid.",
"2": "Home oxygen therapy with portable oxygen source for ambulation.",
"3": "Oral leukotriene antagonist.",
"4": "Oral corticosteroid for three months.",
"5": "Inhaled tiotropium."
} | 5 | {
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143 | 2,012 | 141 | Given a 7-month-old child with fever and irritability, bulging fontanel and a cerebrospinal fluid study with 110 cells/mm3 (75% lymphocytes), protein 120 mg/dl and glucose 28 mg/dl (serum glycemia 89 mg/dl), what is the most reasonable diagnostic suspicion? | The correct answer is 3. It defines a typical cerebrospinal fluid of tuberculosis. In clinical practice things might not be so simple...... | PEDIATRICS | {
"1": "Viral meningitis.",
"2": "Bacterial meningitis.",
"3": "Tuberculous meningitis.",
"4": "Mononucleosis syndrome.",
"5": "Guillain-Barre syndrome."
} | 3 | {
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9 | 2,011 | 36 | An 87-year-old patient with a history of chronic bronchitis and heart failure, has been diagnosed with acute calculous cholecystitis . After four days of treatment with absolute diet, serum therapy and piperacillin/tazobactam, the patient continues with fever, persistent abdominal pain and leukocytosis. The most approp... | I think the correct answer is 2 although the treatment for acute cholecystitis is cholecystectomy, for this it is necessary that the patient is a surgical candidate, in this case it is an elderly patient, with previous diseases that increase the surgical risk and would be an ASA IV for an urgent intervention. In these ... | SURGERY | {
"1": "Surgical treatment (urgent cholecystectomy).",
"2": "Biliary drainage by percutaneous cholecystostomy.",
"3": "Substitute metronidazole + cefotaxime for piperacillin/tazobactam.",
"4": "Replace piperacillin/tazobactam with amikacin+clindamycin.",
"5": "Add gentamicin."
} | 2 | {
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"text": "I think the correct answer is 2 although the trea... |
601 | 2,022 | 112 | A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third. The pain appears when the lower limb is lifted with... | Positive Lasegue's sign, reappearance of the symptoms when performing the extension maneuver of the affected limb, compatible with involvement of nerve roots at the lumbosacral spine level. | TRAUMATOLOGY | {
"1": "Gouty arthritis of the left hip.",
"2": "Left coxofemoral arthrosis.",
"3": "Radiated low back pain / lumbosciatica.",
"4": "Claudication due to canal stenosis.",
"5": null
} | 3 | {
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202 | 2,013 | 44 | Patient with acute pancreatitis. Computerized Axial Tomography (CAT) performed 72 hours after admission showed necrosis of 50% of the pancreas. At the 3rd week of admission the patient began with high fever and leukocytosis. Urgent chest X-ray and urinary sediment are requested, both being normal. Indicate the next ste... | Although the latest recommendations on the management of severe acute pancreatitis advise against FNA because of the risk of infection of sterile necrosis. Current management is governed by stepwise treatment. In the situation described in the question the current treatment is to start antibiotics and assess response. | GENERAL SURGERY | {
"1": "Fine needle aspiration of pancreatic necrosis guided by ultrasound or CT.",
"2": "Bronchoalveolar aspirate, urine culture and blood cultures.",
"3": "Abdominal MRI.",
"4": "Urgent cholecystectomy.",
"5": "Echoendoscopy with puncture of the necrosis."
} | 1 | {
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259 | 2,014 | 97 | A 54-year-old man who goes for a check-up at his company. A body mass index of 32.8 kg/m2 and fasting blood glucose of 138 mg/l were detected. One month later, glycemia 13 mg/dl. Which therapeutic recommendation would you make first? | Behavioral changes: diet and physical exercise. This is the first thing we do when diagnosed with type 2 diabetes. This is a good question to remember that before any drug, we must insist on changing habits. Then we would prescribe Metformin. | ENDOCRINOLOGY | {
"1": "Administer metformin.",
"2": "Prescribe a sulfonylurea.",
"3": "Behavioral changes. Diet and physical exercise.",
"4": "Insulin before each meal.",
"5": "Take acarbose at night, before going to bed."
} | 3 | {
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204 | 2,014 | 220 | A 43-year-old man consults for diarrheal syndrome, and refers among his history 3 pneumonias in adulthood. Which of the following immunological studies should we request: | More than 2 lobar pneumonias make it necessary to rule out an immunologic deficit. | GENETICS AND IMMUNOLOGY | {
"1": "Serum immunoglobulin count and antibody production capacity test.",
"2": "Phagocytosis test and oxidative metabolism of neutrophils.",
"3": "Apoptosis test (programmed cell death) in the patient's circulating lymphocytes.",
"4": "Study of the repertoire and clonality of T lymphocytes (alpha/beta).",
"... | 1 | {
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"text": "More than 2 lobar pneumonias make it necessary to rule out an immunologic deficit."
},
"2": {
"exist": false,
"char_ranges": [],
... |
4 | 2,011 | 40 | A man presents abruptly with asthenia and jaundice with transaminases above 2000 IU/L. Serological markers show the following pattern: anti-HAV IgM negative, HBsAg negative anti-HBc IgM positive, anti-HCV negative. What is the diagnosis? | An interesting one that in general needs to be studied. By the form of presentation, it is clearly an acute hepatitis, so option 1 is ruled out. The negative IgM of HAV rules out 5 and the negative HBs Ag rules out 4 (to have delta virus you need surface antigen B). When having IgM anti HBc we speak of an acute hepatit... | DIGESTIVE | {
"1": "Chronic hepatitis B.",
"2": "Non-viral acute hepatitis.",
"3": "Acute hepatitis B.",
"4": "D (delta) virus superinfection.",
"5": "Acute hepatitis A and B."
} | 3 | {
"1": {
"exist": true,
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"text": "By the form of presentation, it is clearly an acute hepatitis, so option 1 is ruled out."
},
"2": {
"exist": false,
"char_ranges":... |
372 | 2,016 | 127 | 55-year-old man who consults for dysphonia. In the anamnesis he refers to a month of asthenia and unquantified weight loss. Chest X-ray shows increased density in the left upper lobe and occupation of the aortopulmonary window. Bronchoscopy shows paralysis of the left vocal cord, without endoscopic image suggestive of ... | The most frequent cause of recurrent nerve palsy is bronchopulmonary carcinoma. The fact that it is not accessible to endoscopic vision does not mean that it is not there. | PNEUMOLOGY AND THORACIC SURGERY | {
"1": "Pulmonary neoplasia.",
"2": "Sarcoidosis.",
"3": "Silicosis.",
"4": "Tuberculosis.",
"5": null
} | 1 | {
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"text": "The most frequent cause of recurrent nerve palsy is bronchopulmonary carcinoma."
},
"2": {
"exist": false,
"char_ranges": [],
"wo... |
377 | 2,016 | 131 | A 65-year-old female patient debuted two years earlier with an apraxia of speech and has developed rigid-akinetic parkinsonism predominantly in the right hemibody with superimposed myoclonias and alien hand or foreign limb phenomenon.What diagnosis do you consider most likely? | As it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias, it is typical of corticobasal degeneration. Parkinson's disease cannot be because they do not present apraxia as initial feature, Alzheimer's disease does not present an asymmetric parkins... | NEUROLOGY | {
"1": "Parkinson's disease.",
"2": "Corticobasal degeneration.",
"3": "Alzheimer's disease.",
"4": "Huntington's disease.",
"5": null
} | 2 | {
"1": {
"exist": true,
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"text": "Parkinson's disease cannot be because they do not present apraxia as initial feature,"
},
"2": {
"exist": true,
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145 | 2,012 | 143 | A 1 month old infant, exclusively breastfed, consults because he has a bowel movement every 5 or 6 days with straining but with a soft consistency, what would our attitude be? | The correct answer is 4. The normal range of stool output in young infants is very wide. To suspect aganglionic megacolon there is usually a delay in the evacuation of meconium and often other associated symptoms such as abdominal distension, difficulty in gaining weight, etc. | PEDIATRICS | {
"1": "Start laxative treatment.",
"2": "Supplement breastfeeding with anti-constipation formula.",
"3": "Start daily rectal stimulation.",
"4": "It is considered normal intestinal rhythm.",
"5": "Refer to Pediatric Digestive to rule out aganglionic megacolon."
} | 4 | {
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567 | 2,022 | 150 | A 47-year-old woman consults for voiding syndrome. She is diagnosed with uncomplicated urinary tract infection and treated with ciprofloxacin for 5 days. A week later, she consulted again for general malaise, arthralgias and the appearance of a skin rash. In the analytical analysis, the glomerular filtration rate was 4... | General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN (option 4 correct). Among drugs, antibiotics are the most frequent cause, and ciprofloxacin is one of the most common. Direct nephrotoxicity is very rare ... | NEPHROLOGY | {
"1": "Postinfectious glomerulonephritis.",
"2": "Ciprofloxacin nephrotoxicity.",
"3": "Acute pyelonephritis.",
"4": "Acute interstitial nephritis.",
"5": null
} | 4 | {
"1": {
"exist": true,
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"text": "Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after stre... |
177 | 2,013 | 93 | A 30-year-old woman, asymptomatic, is found to be anemic on routine examination. Physical examination reveals conjunctival jaundice and splenomegaly. The patient refers to a family history of biliary lithiasis at an early age. All this suggests the most probable diagnosis of: | You have probably looked at answer 5, hereditary spherocytosis, associated with biliary lithiasis at an early age. Exactly, that is the correct one. In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age. He has reached 30 years o... | HEMATOLOGY | {
"1": "Glucose 6-phosphate dehydrogenase deficiency.",
"2": "Thalassemia minor.",
"3": "Vitamin Bl2 and/or folic acid deficiency.",
"4": "Familial pyruvate kinase deficiency.",
"5": "Hereditary spherocytosis."
} | 5 | {
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125 | 2,012 | 105 | 19-year-old woman, weight 60 kg, with acute dehydration due to long exposure to the sun. Blood pressure lying down 100/60 mmHg. Standing 70/50 mmHg with dizziness. Serum sodium levels 155 mmol/L. What is the most correct treatment, in the first 24 hours, taking into account the data available to us? | This question is not an easy one. The available literature is somewhat controversial (some guidelines advise using glucose saline, others absolutely forbid it...) so I have decided to rely on the treatment recommended by Harrison, which is the manual that MIR examiners usually rely on. This girl presents with hypernatr... | NEPHROLOGY | {
"1": "Hypertonic saline (3%), 500 ml + 500 ml of 5% glucose.",
"2": "Hyposaline saline (0.45%), 3000 ml.",
"3": "Serum glucose 5% 1000 ml.",
"4": "Oral hydration with 1 liter of water.",
"5": "Isotonic saline (0.9%), 2000 ml."
} | 2 | {
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"text": "In this case, the water deficit is: ([[tel:1... |
510 | 2,021 | 151 | A 43-year-old male with no past history of interest consults for a ten-day history of jaundice of the skin and mucous membranes, choluria and acholia. He does not report abdominal pain, weight loss or other symptoms, except generalized pruritus. She denies alcohol consumption. She does not take any medication except oc... | We believe that this question is open to challenge. Ibuprofen hepatitis is a rare adverse effect with a prevalence of about 3.7/100,000 users and 1.1/100,000 prescriptions. It appears that it may be related to dose and duration of treatment, but there is little evidence on this. Among the NSAIDs with the highest risk a... | DIGESTIVE | {
"1": "Acute cholangitis due to biliary mud.",
"2": "Toxic hepatitis due to ibuprofen.",
"3": "Cholangiocarcinoma.",
"4": "Gilbert's syndrome.",
"5": null
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
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],
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],
"text": "acute cholangitis is characterized by the triad of jaundice, abdominal pain and fever;"
},
"2": {
"exist": true,
"char_ranges":... |
268 | 2,014 | 140 | A 50-year-old patient presenting with a pleural effusion with the following features: straw-like appearance, pH 7.3, pleural protein/serum ratio 0.8, pleural LDH/serum ratio 0.9, Gram and Ziehl's negative, total lipids, cholesterol and triglycerides normal, mesothelial cells <5%, intense lymphocytosis without atypia, A... | It is a lymphocytic exudate whose main diagnoses are tumor and tuberculous pleuritis. They do not give the value of glucose which should be lowered, but if the cytology shows absence of malignant cells so we are left with tuberculous pleuritis. Other possible diagnoses such as lymphoma are not mentioned in the answers. | PULMONOLOGY | {
"1": "Pleural empyema.",
"2": "Pleural effusion due to heart failure (transudate).",
"3": "Pleural mesothelioma.",
"4": "Tuberculous pleural effusion.",
"5": "Effusion secondary to pulmonary infarction."
} | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
465 | 2,020 | 116 | In a subject over 65 years of age a tuberculin test has shown an induration of 3 mm. The induration on a second test, performed 10 days later, is 13 mm. Point out the correct answer: | Let's see, if that subject was not in any risk group, the positive is in the 15mm, therefore both tests are negative, and as only one answer refers to negative, that's it. But both could be false negatives. | BIOSTATISTICS | {
"1": "The first reaction is a false positive.",
"2": "The second reaction is a true positive.",
"3": "The first reaction is a true negative.",
"4": "The second reaction is a false positive.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": true,
"char_ranges": [
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],
"word_ranges": [
[
... |
340 | 2,016 | 33 | A 67-year-old woman diagnosed with infiltrating ductal carcinoma of the breast with no family history of neoplasia. What additional studies should be performed on the tumor because of its clinical and therapeutic implications? | The answer is 2, study of hormone receptors and HER2. This is because no study of first-degree relatives is appropriate, as it does not appear to be hereditary breast cancer since there is no family history of neoplasia. On the other hand, there is no indication for BRCA 1-2 study. | GYNECOLOGY AND OBSTETRICS | {
"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
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
70,
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... |
561 | 2,022 | 180 | A 26-year-old woman diagnosed with systemic lupus erythematosus, on treatment with hydroxychloroquine, consults for a feeling of generalized weakness that has progressively developed in the last 15 days. The physical examination reveals cutaneous pallor and the CBC shows Hb 7.4 g/dL, Hct 31%, MCV 108. Which of the foll... | It tells us about a patient with a diagnosis of lupus and macrocytic anemia. In the end, all the data are usually given for a reason. The onset of the picture seems relatively rapid and it is also associated with an autoimmune disease, so it seems that they want you to associate it with an autoimmune hemolytic anemia. ... | HEMATOLOGY | {
"1": "Haptoglobin.",
"2": "Coombs test.",
"3": "Vitamin B12.",
"4": "Antinuclear antibodies.",
"5": null
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
134,
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]
],
"word_ranges": [
[
26,
76
]
],
"text": "The onset of the picture seems relatively rapi... |
451 | 2,018 | 175 | A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot. On examination he presented: Positive right Lasège at 10º, decreased strength in plantar flexion of the right foot, hypoesthesia in the exter... | Acute sciatica probably due to disc extrusion. Both the sensory distribution, the paresis for plantar flexion (tiptoe) and the absence of the Achilles reflex are typical of S1 root involvement, which is typically affected with L5/S1 disc herniation (posterolateral). An L1/L2 (posterolateral) herniation would affect the... | NEUROSURGERY | {
"1": "Herniated disc L1/L2.",
"2": "Horsetail syndrome.",
"3": "L4/L5 disc herniation.",
"4": "Herniated disc L5/S1.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
267,
329
]
],
"word_ranges": [
[
39,
48
]
],
"text": "An L1/L2 (posterolateral) herniation would affect the L2 root,"
},
"2": {
"exist": true,
"char_ranges": [
[
374,
... |
399 | 2,016 | 141 | 20-year-old male, who consults for lumbosacral pain of inflammatory rhythm of 4 months of evolution. Also bilateral thalalgia and morning stiffness for 1 hour. In the last 2 months, onset of diarrhea with loss of 4 kg of weight. What is the most correct diagnostic approach? | The patient presents the clinical features of spondylarthropathy, which is often associated with inflammatory bowel disease, as this case suggests. | TRAUMATOLOGY AND ORTHOPEDICS | {
"1": "Given the patient's age, he most likely suffers from non-specific low back pain and tendonitis of the feet. If the diarrhea persists, a digestive study would be performed.",
"2": "Perform a digestive study to rule out tumor pathology. Low back pain may be due to visceral pathology.",
"3": "The clinical pi... | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": true,
"char_ranges": [
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... |
12 | 2,011 | 92 | A 30-year-old man suffers a fall from a standing height of 2 meters. On arrival at the emergency room on a stretcher, he is conscious and oriented, with bladder catheterization and clear urine. He shows swelling of the left heel and mild tingling in the anterior aspect of the left thigh and scrotum as well as dysesthes... | I believe that the correct answer is 3. The patient, due to the mechanism of injury (foot fall), the calcaneal fracture and the neurological symptoms, suggests a low spinal cord injury due to a fracture of the lumbar spine. The injury is not high because he moves his arms. It also does not appear to be a pelvic injury ... | SURGERY | {
"1": "The patient will be seated on the stretcher so that the cervical spine can be explored.",
"2": "Refer to radiology for study of the lower extremities (feet, femurs, pelvis).",
"3": "We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine.",
"4": "We will place a cervical collar a... | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
0,
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]
],
"word_ranges": [
[
... |
605 | 2,022 | 113 | 35-year-old male, letter carrier, with no history of interest, who comes to the emergency department for acute cervical pain of 24 hours of evolution, without previous trauma, which radiates to the left arm up to the hand and is accompanied by paresthesia in the radial border of the forearm. She presents no objectifiab... | In this case we describe a case of cervicobrachialgia without alarm signs at the present time, so the most indicated treatment at this time would be conservative, based on NSAIDs, local heat and rest. This is not an urgent case, so answer 2 would not be valid. The performance of an MRI and an electromyogram are valid o... | TRAUMATOLOGY | {
"1": "Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest.",
"2": "Urgent call to the neurosurgeon for surgical evaluation.",
"3": "Preferential request for MRI and electromyogram.",
"4": "Preferential referral to traumatology outpatients.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
200
]
],
"word_ranges": [
[
0,
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]
],
"text": "In this case we describe a case of cervicobrachialgia without alarm signs at the present time, so the most indicated treatment at this time woul... |
443 | 2,018 | 102 | A 64-year-old woman, without relevant comorbidities, operated on for a right breast cancer by means of an extended lumpectomy and selective sentinel lymph node biopsy, with the following anatomopathological result: Infiltrating ductal carcinoma poorly dlferentiated (grade 3), size 2.2 cm (pT2), estrogen and progesteron... | It is a Luminal B. According to the SEGO, this patient is a candidate for chemotherapy treatment because of the high histologic grade and high tumor proliferation. | GYNECOLOGY AND OBSTETRICS | {
"1": "Adjuvant hormone therapy including aromatase inhibitors.",
"2": "Adjuvant chemotherapy, preferably with anthracyclines and taxanes, followed by hormone therapy.",
"3": "Adjuvant chemotherapy in association with the monoclonal antibody trastuzumab, followed by hormone therapy.",
"4": "Adjuvant chemothera... | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
0,
163
]
],
"word_ranges": [
[
0,
27
]
],
"text": "It is a Luminal B. According to the SEGO, this pa... |
197 | 2,013 | 71 | A 10-year-old boy with brief episodes of distractibility (< 1 minute) in which he does not respond to calls and blinks. An EEG shows spike-wave discharges at 3 cycles per second. First-line elective treatment would be with: | Absences behave as brief episodes of abrupt loss of consciousness without alteration of postural control; they typically last seconds and can be repeated many times a day, are usually accompanied by small bilateral motor signs (blinking, chewing) and consciousness is recovered equally abruptly, without subsequent confu... | NEUROLOGY | {
"1": "Valproate.",
"2": "Carbamazepine.",
"3": "Phenytoin.",
"4": "Gabapentin.",
"5": "Clonazepam."
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
739,
840
]
],
"word_ranges": [
[
113,
128
]
],
"text": "The most appropriate drugs for the treatment of absences are Valproate and Ethosuximide (CTO Manual)."
},
"2": {
"exist": false,
... |
478 | 2,020 | 134 | 35-year-old male, transferred to the emergency department after a traffic accident. On admission, a Glasgow scale score of 15, blood pressure of 140/90 mmHg, respiratory rate of 35 rpm and heart rate of 110 bpm, with a baseline oxygen saturation of 91%. On examination there is right thoracic hypophonesis and tympanism ... | This is an easy and classic question that you can also apply to daily clinical practice. Hypophonesis in a hemithorax + tympanism = pneumothorax. If there is dullness on percussion: hemothorax. In either case, in case of hypophonesis of a hemithorax in a severe and unstable polytraumatized patient: thoracic drainage (i... | CRITICAL CARE | {
"1": "Traumatic cardiac tamponade.",
"2": "Right tension pneumothorax.",
"3": "Massive right hemothorax.",
"4": "Pulmonary contusion.",
"5": null
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
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]
],
"word_ranges": [
[
16,
24
]
],
"text": "Hypophonesis in a hemithorax + tympanism = pneu... |
97 | 2,012 | 171 | Patient presenting since 2 weeks ago with a pruritic eruption consisting of multiple polygonal erythematous-violaceous papules, flattened surface, preferentially located on the anterior aspect of wrists, pretibial area and lumbar area. She also presents whitish reticulated lesions in the jugal mucosa. What is the most ... | They are undoubtedly describing the typical lesions (both on skin and oral mucosa) of a lichen planus (5). | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | {
"1": "Pityriasis versicolor.",
"2": "Mycosis fungoides.",
"3": "Psoriasis in drops.",
"4": "Pityriasis rosea of Gibert.",
"5": "Lichen planus."
} | 5 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": false,
... |
426 | 2,018 | 94 | A 73-year-old patient...swallowing a complete neurological dysphagia secondary to a cardioembolic stroke in the left middle cerebral artery territory. will require long-term nutritional support. Of the following treatment modalities, which do you consider most appropriate for this case? | Enteral nutrition is a nutritional support technique that involves administering nutrients directly into the gastrointestinal tract by gavage. The choice of the route of formula administration depends on the nutritional status, age of the patient and the underlying disease. If enteral nutrition is considered to be of s... | ENDOCRINOLOGY | {
"1": "Enteral nutrition by nasogastric tube.",
"2": "Enteral nutrition by nasoduodenal tube.",
"3": "Enteral nutrition by gastrostomy.",
"4": "Enteral nutrition by jejunostomy.",
"5": null
} | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
275,
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]
],
"word_ranges": [
[
39,
60
]
],
"text": "If enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube..."
},... |
262 | 2,014 | 58 | A 70-year-old woman with a history of hypertension and moderate heart failure presents with a persistent, dry cough that begins as an itchy sensation in the throat. What is the drug suspected of causing the patient's clinical and laboratory alteration? | These are typical adverse effects of ACEIs, in the case of cough it is usually dry and irritative and appears in up to 3% of patients. Hyperkalemia may also appear in 1%. | PHARMACOLOGY | {
"1": "Hydrochlorothiazide.",
"2": "Bisoprolol.",
"3": "Furosemide.",
"4": "Enalapril.",
"5": "Hydralazine."
} | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
346 | 2,016 | 159 | 69-year-old woman who comes to your office referring genital bleeding of several months of evolution. She denies hormone replacement therapy and anticoagulation. She provides normal cervicovaginal cytology. General and genital physical examination without findings of interest. BMI of 38kg/m2. Indicate the most correct ... | The correct answer is 2. We are dealing with a case of postmenopausal metrorrhagia, whose most frequent cause is genital atrophy in the first place and endometrial cancer in the second place. The data given on obesity should lead us to suspect endometrial cancer, since peripheral fat is converted to estrone, and these ... | GYNECOLOGY AND OBSTETRICS | {
"1": "Prescribe cyclic progesterone.",
"2": "Endometrial biopsy.",
"3": "Random cervical biopsies.",
"4": "Hormonal evaluation with FSH, LH and estradiol.",
"5": null
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
[
541,
615
]
],
"word_ranges": [
[
88,
99
]
],
"text": "We should not prescribe treatment without first ruling out organic causes."
},
"2": {
"exist": true,
"char_ranges": [
[
... |
170 | 2,013 | 89 | A 62-year-old patient who has had a pericardial bioprosthesis in mitral position for two years. He is admitted urgently for acute coronary syndrome. Two days later and after a favorable evolution, he suddenly presented heart failure with acute pulmonary edema. Select the diagnostic option in this case from the followin... | The valve is biological and, in general, the veils are not sewn to the papillary muscles, so we don't care what happens to them. A ventricular aneurysm depresses LVEF, but does not suddenly put you into PAD. In contrast, a VSD sharply increases flow to the pulmonary bed, causing pulmonary edema, and is also one of the ... | CARDIOLOGY AND CARDIOVASCULAR SURGERY | {
"1": "Acute post-infarction mitral insufficiency.",
"2": "Left ventricular aneurysm.",
"3": "Acute ventricular septal defect.",
"4": "Postinfarction atrial septal defect.",
"5": "Dysfunction of the bioprosthesis due to probable acute endocarditis."
} | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
356,
448
]
],
"word_ranges": [
[
62,
80
]
],
"text": "Ischemic ASD... I do not deny that it exists, but it does not even appear in the guidelines."
},
"2": {
"exist": true,
"char_rang... |
40 | 2,011 | 136 | A 64-year-old smoker and heavy drinker reports painless right jugulodigastric lymphadenopathy of progressive growth in the last two months whose fine needle aspiration was reported as squamous cell carcinoma. Which of the following is the most likely location of the primary tumor: | You are in the middle of the ENT block. You have already passed the Pneumology and Digestive blocks. Dermatology is still to come out, but a dermatologist (answer 1) would not ask this. So we are left with parotid and larynx; but parotid squamous cell carcinoma is rare; I would mark 5 and rest easy. Perhaps because all... | OTOLARYNGOLOGY AND MAXILLOFACIAL SURGERY | {
"1": "Scalp.",
"2": "Parotid.",
"3": "Lung.",
"4": "Esophagus.",
"5": "Larynx."
} | 5 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": false,
... |
126 | 2,012 | 59 | A 65-year-old man, a retired office worker and smoker of 1 pack of cigarettes a day, comes to the clinic with a persistent, generally dry cough and progressive dyspnea of 2 years of evolution which is currently grade 2. The patient denies other symptoms. Physical examination shows no relevant data. The attitude to foll... | The correct answer is 2 (Perform chest X-ray and spirometry with bronchodilator test). It is probably COPD but we must confirm it and assess the severity of the obstruction with spirometry before starting treatment. He is a patient at risk for lung cancer so it is mandatory to perform a chest X-ray to rule out this or ... | PNEUMOLOGY AND THORACIC SURGERY | {
"1": "Start treatment with inhaled bronchodilators.",
"2": "Chest X-ray and spirometry with bronchodilator test.",
"3": "Prescribe oral corticosteroids.",
"4": "Thoracic CT scan.",
"5": "Perform basal arterial blood gases."
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
216,
430
]
],
"word_ranges": [
[
34,
76
]
],
"text": "He is a patient at risk for lung cancer so it ... |
568 | 2,022 | 151 | A 22-year-old male presents to the emergency department with "almost black" urine for the past 12 hours. He has no past history of interest and is not taking any medications. He refers an upper respiratory catarrhal symptoms since 4-5 days ago for which he has taken paracetamol. Examination: temperature 37.3 ºC, BP 150... | A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy (option 3 correct). | NEPHROLOGY | {
"1": "Nephropathy with minimal changes.",
"2": "Postinfectious glomerulonephritis.",
"3": "IgA nephropathy.",
"4": "Acute interstitial nephritis.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
0,
193
]
],
"word_ranges": [
[
... |
286 | 2,016 | 60 | A 60-year-old man with a history of hypertension and dyslipidemia has recently been diagnosed with heart failure. After performing the relevant tests, it was found that the left ventricular ejection fraction was preserved (>50%). With regard to treatment, indicate the CORRECT answer: | Treatment with diuretics should be started at high doses. | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Initial treatment should be directed to the underlying pathological process.",
"2": "Treatment with diuretics should be started at high doses.",
"3": "If nitrate treatment is required, it should be started at low doses.",
"4": "Dyspnea can be treated by reducing neurohormonal activation with angiotensin... | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
0,
57
]
],
"word_ranges": [
[
0,
9
]
],
"text": "Treatment with diuretics should be started at high ... |
228 | 2,014 | 75 | In a patient with clinical signs of heart failure who presents with ascites disproportionately elevated in relation to peripheral edema, the most likely etiology would be: | They tell us about clinical symptoms of right failure, with edema and ascites. Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO. Of the two we are left with, in constrictive pericarditis we have increased filling pressures in right chambers, which cause retrograde pressure increase with hepat... | CARDIOLOGY | {
"1": "Severe aortic stenosis.",
"2": "Dilated cardiomyopathy with significant left ventricular dysfunction.",
"3": "Primary pulmonary hypertension.",
"4": "Obstructive hypertrophic cardiomyopathy.",
"5": "Constrictive pericarditis."
} | 5 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
155
]
],
"word_ranges": [
[
0,
27
]
],
"text": "They tell us about clinical symptoms of right failure, with edema and ascites. Therefore, we rule out left heart failure: EAo, dilated with DSVI... |
217 | 2,014 | 122 | A 54-year-old man is diagnosed with a left renal tumor suggestive of renal cell carcinoma. His preoperative workup shows elevated levels of GPT, alkaline phosphatase and alpha-2-globulin and prolonged prothrombin time. The liver is diffusely enlarged, but without defects of hepatic infiltration. The most likely rationa... | Very easy question in which we are being presented with a patient with Stauffer's syndrome, a paraneoplastic syndrome consisting of liver dysfunction secondary to toxic products secreted by a number of tumors (most frequently, renal cell carcinoma, like the one in this case). As in this case, cholestasis (elevation of ... | NEPHROLOGY | {
"1": "Hepatic metastases.",
"2": "Intrahepatic tumor thrombosis.",
"3": "Acute hepatitis.",
"4": "Presence of hepatotoxic substances produced by the tumor.",
"5": "Hemochromatosis."
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
443,
515
]
],
"word_ranges": [
[
65,
76
]
],
"text": "Metastases are ruled out (there are no defects of hepatic infiltration),"
},
"2": {
"exist": true,
"char_ranges": [
[
... |
142 | 2,012 | 138 | 12-year-old girl, only child of healthy, non-consanguineous parents. There is no personal or family history of interest. In the clinical examination to start a sports activity, you find a discrete hepatomegaly of normal consistency, so you request a blood test, which highlights an ASAT of 80U / l, ALAT 105 U / l, elect... | In fact, I would not test this patient at this time, and I would check if the transaminase level has normalized at a later time, since the most frequent cause, at least in children, is a transient elevation in the context of viral diseases (most frequently cytomegalovirus and Epstein-Barr virus). The minimal elevation ... | PEDIATRICS | {
"1": "Deficiency of alpha 1 antitrypsin. Thoracic TAC to confirm emphysema.",
"2": "Mucoviscidosis. Determination of chlorine in sweat.",
"3": "Autoimmune hepatitis. Liver biopsy.",
"4": "Glycogenosis type VI (phosphorylase deficiency). Muscle biopsy.",
"5": "Wilson's disease. Determine ceruloplasmin and co... | 5 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
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267 | 2,014 | 139 | In a patient with liver cirrhosis and ascites, who develops a pleural effusion with the following data in the pleural fluid: LDH 45 U/L (serum 220 U/L), pleural/serum protein ratio 0.3 and pleural/serum LDH ratio 0.2. What would be the appropriate attitude? | They describe pleural fluid parameters of transudate, so if the patient is not in heart failure it is a hydropic decompensation. No other studies are needed. | PNEUMOLOGY | {
"1": "The study of the fluid with cell count, glucose, pH, ADA, cholesterol and culture should be extended. ADA, cholesterol and culture.",
"2": "Blind pleural biopsy.",
"3": "Diagnostic videothoracoscopy.",
"4": "Empirical antibiotherapy for suspected parapneumonic effusion.",
"5": "Continue treatment of h... | 5 | {
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99 | 2,012 | 84 | A 60-year-old diabetic patient is consulting for the first time regarding the treatment of his disease. Which of the following goals would you recommend to him first? | The rest are not indications. The target BP is < 130/85 mmHg. | ENDOCRINOLOGY | {
"1": "Maintain blood pressure below 110/70 mmHg.",
"2": "Smoking cessation.",
"3": "Maintain a body mass index (BMI) less than 21.",
"4": "Perform daily basal capillary glycemia.",
"5": "Avoidance of animal fats in the diet."
} | 2 | {
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"text": "The rest are not indications. The target BP is < 130/85 mmHg."
},
"2": {
"exist": true,
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2... |
380 | 2,016 | 135 | A 25-year-old patient, during a tennis match, has intense pain in the neck and in the left eye. The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right. The patient maintains good visual acuity. Where would... | The picture presented to us is that of a Horner syndrome (miosis with ptosis) so the possibilities are reduced to options 3 or 4, but they specify that the patient presents gait instability, which is not justified by a Horner due to carotid dissection affecting the superior cervical ganglion, which is what they want us... | NEUROLOGY | {
"1": "III cranial pair.",
"2": "Optic chiasm.",
"3": "Superior cervical ganglion.",
"4": "Spinal bulb.",
"5": null
} | 4 | {
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341 | 2,016 | 33 | A 67-year-old woman diagnosed with infiltrating ductal carcinoma of the breast with no family history of neoplasia. What additional studies should be performed on the tumor because of its clinical and therapeutic implications? | Study of hormone receptors and HER2. Both for the type of treatment and to study the prognostic factor and adjuvant treatment, it is necessary to know the different hormonal receptors (estrogen and progesterone) as well as HER2-neu. | GYNECOLOGY AND OBSTETRICS | {
"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
} | 2 | {
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"text": "Both for the type of treatment and to study the ... |
308 | 2,016 | 215 | A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye. Which of the following diagnoses can cause this symptomatology? | He refers to a patient post cataract surgery 2 years ago with deep and painless loss of OD. Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period, besides being very painful with rapidly progressive decrease in visual acuity, so it is not correct. Retinal detachment is con... | OPHTHALMOLOGY | {
"1": "Post-surgical endophthalmitis.",
"2": "Retinal detachment.",
"3": "Age-related macular degeneration, wet form.",
"4": "Posterior vitreous detachment.",
"5": null
} | 2 | {
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"text": "Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period, besides being very painful with rapidly ... |
519 | 2,021 | 176 | A 25-year-old woman comes to the ED accompanied by a friend reporting that she was the victim of a sexual assault 4 hours ago. The patient is very affected, answering her questions inconsistently, slowly and not being able to remember how the assault occurred. Her vital signs (blood pressure, heart rate and temperature... | All the actions detailed are correct except the one detailed in option 2. The collection of samples of legal interest will only be carried out in the presence of the coroner, and, without the presence of the coroner, the woman must give her written consent. In addition, the taking of gynecological samples must be adapt... | CRITICAL AND EMERGENCY CARE | {
"1": "Contact the duty court.",
"2": "Immediate gynecological examination with cervical cytology.",
"3": "Administer 500 mg of intramuscular ceftriaxone, 1 g of azithromycin orally and 2 g of tinidazole orally in single doses.",
"4": "Administer 1500 mg of levonorgestrel orally in a single dose.",
"5": null... | 2 | {
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"text": "The collection of samples of legal interest wil... |
63 | 2,011 | 200 | A 31-year-old bricklayer comes to the emergency department with tenosynovitis caused by a penetrating wound. On examination, the ulnar bursa is found to be infected with consequent tendon necrosis. Which tendon will be affected? | Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar. The palmaris longus is medial, as is the flexor digitorum profundus. The tendon that runs alongside the ulnar nerve, inserting into the pisiform, is the flexor carpi ulnaris, thus answer 1. | ANATOMY | {
"1": "Tendon of the flexor carpi ulnaris.",
"2": "Tendon of the abductor pollicis longus.",
"3": "Tendon of the deep flexor of the fingers.",
"4": "Radial carpal flexor tendon.",
"5": "Palmaris longus tendon."
} | 1 | {
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"text": "The tendon that runs alongside the ulnar nerve, inserting into the pisiform, is the flexor carpi ulnaris, thus answer 1."
},
"2": {
"... |
30 | 2,011 | 61 | A patient previously diagnosed with COPD comes to the emergency room for 3 days with increased dyspnea until he is at rest, cough with whitish expectoration and marked drowsiness. After receiving treatment with oxygen at low concentrations, bronchodilators and coticoids, a second arterial blood gas with 28% inspiratory... | This is a very bad question, I will bet on one answer, but depending on data that we are not given, three answers could be valid. The trap is that they give us the initial clinical picture WITHOUT GASOMETRY and then they give us the blood gases afterwards WITHOUT CLINIC, so there is no way of knowing what the evolution... | NEUROLOGY AND THORACIC SURGERY | {
"1": "Increase oxygen flow because he has acute respiratory acidosis and hypoxemia.",
"2": "I would initiate noninvasive mechanical ventilation because he has acute hypercapnic respiratory failure with moderate respiratory acidosis.",
"3": "I would add sodium bicarbonate to correct the acute metabolic acidosis.... | 4 | {
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"text": "Wrong, he is a \"retentive\" patient and increasing O2 flow is highly likely to increase hypercapnia and, therefore, acidosis."
},
"2... |
226 | 2,014 | 71 | An 82-year-old hypertensive woman on atenolol, hydrochlorothiazide and digoxin. She comes to the emergency room for atrial fibrillation and is administered IV verapamil. The ECG showed complete atrioventricular block. What is the most probable cause of this clinical situation? | He already takes two AV node brakers and you add a third, and are you surprised that he gets complete AV block after messing with drugs from different families but same effect (pharmacodynamics)? Three. And remember that drugs are like drinks when you go to a bar: don't mix! | CARDIOLOGY | {
"1": "Digitalis intoxication due to pharmacokinetic interaction with verapamil.",
"2": "Hypokalemia due to administration of thiazide and digoxin.",
"3": "Pharmacodynamic interaction of beta-blocker, digoxin and verapamil.",
"4": "Hypotensive effect of thiazide diuretic.",
"5": "Cardiac arrhythmia due to ve... | 3 | {
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565 | 2,022 | 148 | A 48-year-old patient referred to the nephrology department for an estimated glomerular filtration rate (eGFR) of 32 ml/min/1.72 mL/min/1.72 mL. Which of the following data would NOT suggest chronic kidney disease? | Adequate corticomedullary differentiation is suggestive of no chronic parenchymal impairment, and is a frequent finding in acute renal failure (option 4 correct). A family history of nephropathy could indicate the existence of a hereditary disorder (incorrect option 2). Small kidneys and hyperphosphatemia are features ... | NEPHROLOGY | {
"1": "Small sized kidneys.",
"2": "Family history of nephropathy.",
"3": "Elevated levels of phosphorus in blood.",
"4": "Good ultrasound differentiation of renal cortex and medulla.",
"5": null
} | 4 | {
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"exist": true,
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],
"text": "Small kidneys and hyperphosphatemia are features of chronic kidney disease (option 1 and 3 incorrect)."
},
"2": {
"exist": true,
... |
135 | 2,012 | 38 | A 64-year-old man with Child A liver cirrhosis with no history of decompensation. After detection of a focal hepatic lesion on screening ultrasound, the study is completed with a thoracoabdominal CT scan. This scan showed the presence of 4 liver lesions (one of them up to 6 cm) with uptake pattern typical of hepatocarc... | Comment: The patient presents a good general condition with a recently diagnosed hepatocarcinoma, not giving him any type of treatment other than symptomatic and supportive at this stage would not be the right thing to do. TACE would not be indicated because of extrahepatic involvement. Transplantation would also not b... | ONCOLOGY | {
"1": "Symptomatic and supportive treatment, since he presented an advanced hepatocarcinoma with vascular invasion and metastasis.",
"2": "Transarterial chemoembolization (TACE), since the treatment increases survival in patients with advanced hepatocarcinoma.",
"3": "Systemic chemotherapy with doxorubicin iv si... | 4 | {
"1": {
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"char_ranges": [
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1,
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"text": "The patient presents a good general condition with a recently diagnosed hepatocarcinoma, not giving him any type of treatment other than symptom... |
556 | 2,022 | 55 | 63-year-old diabetic patient whose family physician has requested a blood test to determine vitamin B12 levels.What is the antidiabetic drug he is taking that warrants such a request: | Metformin is an oral antidiabetic widely used in the treatment of type 2 diabetes mellitus. The best known side effects are gastrointestinal side effects and lactic acidosis; however, vitamin B 12 malabsorption, is less well known. A decrease in vitamin B 12 levels is observed in patients treated with metformin. The me... | ENDOCRINOLOGY | {
"1": "Gliclazide.",
"2": "Metformin.",
"3": "Repaglinide.",
"4": "Pioglitazone.",
"5": null
} | 2 | {
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"text": "Metformin is an oral antidiabetic widely used in ... |
448 | 2,018 | 148 | A 59-year-old woman with recent onset of epileptic seizures comes to the emergency department. The examination showed left pyramidal signs and papillary edema. Brain MRI showed a right hemispheric mass with edema, midline deviation and signs of tentorial herniation. She reports a headache that has been progressing in i... | They describe a recent diagnosis of cerebral LOE with signs of intracranial hypertension (edema, midline deviation, papilledema). The associated headache is typically morning headache, with increasing ICP values at night. | NEUROSURGERY | {
"1": "Predominance in the morning.",
"2": "It does not change with effort.",
"3": "Photophobia.",
"4": "Sonophobia.",
"5": null
} | 1 | {
"1": {
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"text": "They describe a recent diagnosis of cerebral LOE with signs of intracranial hypertension (edema, midline deviation, papilledema). The associated... |
591 | 2,022 | 64 | A 68-year-old woman who wears +4.00 diopter glasses for distance vision in both eyes. She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight. Which of the following pathologies is she most likely to present? | We are presented with a 68-year-old woman with moderate hyperopia and no history of cataract surgery. This is not a mere coincidence: the fact that the patient is hyperopic is important, because the eyeballs of hyperopic patients are shorter, with a certain conflict of space in the anterior segment when the crystalline... | OPHTHALMOLOGY | {
"1": "Glaucoma due to primary angular closure.",
"2": "Migraine.",
"3": "Actinic keratitis.",
"4": "Dry eye syndrome.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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"text": "It is evident, therefore, that the patient suffers from primary angular closure processes that possibly self-resolve when the triggering si... |
291 | 2,016 | 157 | An 8-year-old patient presenting with superficial pustular lesions, erosions and yellowish crusts around the mouth for the last 3 days: | It is a typical and frequent clinical picture in children. You are describing a contagious impetigo. There is not much dispute. The most frequent causative agent in the bullous form is S. aureus phage II. | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | {
"1": "Exudative erythema multiforme.",
"2": "Contagious impetigo.",
"3": "Infantile acne.",
"4": "Pustular psoriasis.",
"5": null
} | 2 | {
"1": {
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"text": "It is a typical and frequent clinical picture in ... |
213 | 2,014 | 160 | A 75-year-old woman, with menopause at age 52, with no family or personal history of fracture, diagnosed with temporal arteritis, who is going to start treatment with high-dose prednisone and expects to be treated for at least one year. The delay of densitometry (DXA) in her center is 4-5 months. Preventive treatment f... | In the data you provide there are no clinical risk factors for osteoporosis prior to the current disease. Since a prolonged and high-dose prednisone regimen will be established, it is advisable, in addition to the non-pharmacological preventive measures, to initiate treatment in any case to minimize the secondary loss ... | RHEUMATOLOGY | {
"1": "Request DXA and wait for the result.",
"2": "Assess absolute risk of fracture using the FRAX questionnaire without BMD and treat only if it is high.",
"3": "Start treatment with bisphosphonates and vitamin D (800 IU/day).",
"4": "Administer calcium supplementation (1g) and vitamin D (800 IU/day).",
"5... | 4 | {
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"text": "Since a prolonged and high-dose prednisone regimen will be established, it is advisable, in addition to the non-pharmacological preventive me... |
442 | 2,018 | 100 | 34-year-old woman who consults for repeated coitorragia. She brings a cytology with a high grade intraepithelial lesion (U-SIL). Subsequently, colposcopy and biopsy were performed on a mosaic area and histology showed a focus of invasive squamous cell carcinoma of 2 mm in length. Which therapeutic option is the most ap... | According to the SEGO: "Excise the entire lesion so that it can be evaluated histologically. It involves excision of the entire transformation zone. In general, the excision should be adapted to the size and characteristics of the lesion. Three types of excision are distinguished according to the presence of the endoce... | GYNECOLOGY AND OBSTETRICS | {
"1": "Conization.",
"2": "Total hysterectomy without adnexectomy.",
"3": "Pelvic radiotherapy with curative intent.",
"4": "Repeat a more extensive biopsy.",
"5": null
} | 1 | {
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"char_ranges": [
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"text": "as the lesion is less than 8mm deep, this is the indicated treatment."
},
"2": {
"exist": false,
"char_ranges": [],
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491 | 2,020 | 106 | 65-year-old woman referred to the ED for fever and alterations in the CBC: hemoglobin 11.4 g/dL, leukocytes 0.86 x103/μL,(neutrophils 41.9 %, lymphocytes 55.8 %),platelets 48.0 x103/μL, fibrinogen 118 mg/dL,D-dimer 20.2 μg/mL. A bone marrow examination was performed and the patient was diagnosed with acute leukemia wit... | I think this is a very nice question. There is no doubt about the diagnosis. Because if you don't know the translocation, nothing happens... the answers give you the diagnosis. Now it's time to find out how acute promyelocytic leukemia is currently treated (ATRA aside... which I'm sure you know). As of 2017, the PETHEM... | HEMATOLOGY | {
"1": "If asymptomatic, transretinoic acid (ATRA) will be initiated and controls in day hospital will be recommended.",
"2": "Treatment with arsenic trioxide, ATRA and supportive therapy will be initiated.",
"3": "It is a myeloblastic leukemia type M3, so chemotherapy and heparin treatment will be initiated to c... | 2 | {
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"text": "As of 2017, the PETHEMA protocol for APL in lo... |
277 | 2,016 | 226 | In a colon cancer screening program, a 52-year-old patient undergoes a colonoscopy. The entire colon is normal except for the finding of a 2 cm pedunculated polyp in the sigma which is removed with a diathermy loop. The anatomopathological result indicates that there is a carcinoma in situ limited to the head of the po... | Carcinoma in situ is delimited by the basement membrane, i.e. it is not invasive yet, and therefore the treatment is polypectomy, which is already done. Subsequently, an endoscopic follow-up (with biopsies) should be performed at an interval of 3 to 6 months depending on the patient's history, age and concomitant patho... | DIGESTIVE TRACT | {
"1": "Segmental resection of the affected colon.",
"2": "Periodic endoscopic surveillance.",
"3": "Local resection of the base of the polyp.",
"4": "Sigmoidectomy plus lymphadenectomy.",
"5": null
} | 2 | {
"1": {
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"char_ranges": [
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"word_ranges": [
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"text": "an endoscopic follow-up (with biopsies) should... |
155 | 2,012 | 83 | A 62-year-old man with a history of arterial hypertension under treatment with captopril, duodenal ulcer and uric acid urolithiasis. He consults for typical podagra crisis similar to others presented in the last two years. Examination showed tophi in both pinnae. Analyses show uric acid 10.1 mg/dl, creatine 1.5 mg/dl. ... | Allopurinol is always the treatment of choice, especially in the case of tophaceous gout. Moreover, in this case, uricosuric acid could worsen urolithiasis by increasing uricosuria (sorry for the redundancy...). | RHEUMATOLOGY | {
"1": "Its use is second choice when uricosurics have failed.",
"2": "Its prolonged use is practically obligatory because there are tophi.",
"3": "Its introduction should be delayed until the current attack has resolved with anti-inflammatory drugs or colchicine.",
"4": "Its introduction should be gradual up t... | 1 | {
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"text": "Allopurinol is always the treatment of choice, especially in the case of tophaceous gout."
},
"2": {
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"char_ranges": [... |
373 | 2,016 | 86 | We are referred from ophthalmology to a 31-year-old man who consulted for loss of vision and progressive headache. Physical examination showed temporal hemianopsia and pituitary MRI showed a 35 x 30 x 20 mm turnoration compressing chiasm and cavernous sinus. The results of the functional study are cortisol 14 microg/dL... | From what is described it is a macroprolactinoma as it is a pituitary tumor of more than one centimeter, which secretes prolactin and with an insufficiency of the rest of pituitary hormones. The first line treatment of choice is dopaminergic agonists, although when the visual field is affected, surgery may be chosen. I... | NEUROLOGY | {
"1": "Dopaminergic agonists.",
"2": "Transsphenoidal surgery.",
"3": "External radiotherapy or radiosurgery.",
"4": "Treatment of hypogonadotropic hypogonadism with testosterone.",
"5": null
} | 1 | {
"1": {
"exist": true,
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0,
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"text": "From what is described it is a macroprolactinoma as it is a pituitary tumor of more than one centimeter, which secretes prolactin and with an in... |
523 | 2,021 | 124 | A 45-year-old patient was diagnosed with HIV infection three months ago, presenting at that time with CD4 45 lymphocytes/µl and an HIV-1 viral load of 500,000 copies/ml. At that time he had a negative Mantoux test. He started treatment with an integrase inhibitor and two reverse transcriptase inhibitors, and at one mon... | We are dealing with a patient with HIV infection in a situation of severe immunosuppression (<50 CD4+) and a very high viral load, who has followed the expected evolution from the immunovirological point of view after the start of treatment (after 12 weeks, the viral load has ostensibly decreased - answer 2 would not b... | INFECTIOUS DISEASES | {
"1": "It is a lymph node tuberculosis related to an incomplete immunologic recovery.",
"2": "Treatment failure and it is an opportunistic infection.",
"3": "This is an opportunistic infection unmasked within a picture of immune reconstitution.",
"4": "A negative Mantoux test rules out tuberculosis.",
"5": n... | 3 | {
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"exist": true,
"char_ranges": [
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"text": "The diagnosis of lymph node tuberculosis is immediate when detecting \"isolated acid-fast bacilli and epithelioid granulomas\" in the punc... |
417 | 2,018 | 76 | 78-year-old woman with dementia and institutionalized is brought by her caregivers for significant abdominal pain with deterioration of general condition and abdominal distension. CBC shows leukocytosis, elevated hematocrit, renal failure and metabolic acidosis. ECG shows atrial fibrillation. Abdominal tomography shows... | Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease. In this case we are given characteristic biochemical data (leukocytosis, me... | GENERAL SURGERY | {
"1": "Perforation of gastric or duodenal ulcus.",
"2": "Biliary leak.",
"3": "Obstructive neoplasia of the sigma with perforation.",
"4": "Mesenteric ischemia.",
"5": null
} | 4 | {
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403 | 2,016 | 135 | A 25-year-old patient, during a tennis match, has severe pain in his neck and left eye. The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right. The patient maintains good visual acuity, where would you mos... | Claude-Bernard-Horner syndrome is an old acquaintance of the MIR exam. We do not see it daily in clinical practice, but it appears in many exams. Characteristic is upper eyelid ptosis and miosis of that eye. This occurs due to a deficit of sympathetic innervation of the orbital territory. The sympathetic nervous system... | OPHTHALMOLOGY (ECTOPIC) | {
"1": "III cranial nerve.",
"2": "Optic chiasm.",
"3": "Upper cervical ganglion.",
"4": "Spinal cord.",
"5": null
} | 3 | {
"1": {
"exist": true,
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"text": "An alteration of the III cranial nerve can produce ptosis, but the pupil, if affected, should be in mydriasis."
},
"2": {
"exist"... |
42 | 2,011 | 150 | A one-and-a-half year old boy comes to the emergency room with abdominal pain and jaundice. On examination, an abdominal mass is palpated. An ultrasound shows the presence of a common bile duct cyst. What therapeutic approach should we adopt? | The correct answer is 4. A common bile duct cyst is a congenital pathology that usually presents clinically beyond the neonatal period. It is appropriate to have a quality image that delimits the lesion in order to decide the surgical approach. | PEDIATRICS | {
"1": "A percutaneous puncture for peritoneal lavage will be performed to verify that the cyst contains bile in order to leave a drainage to improve the abdominal pain.",
"2": "An exploratory laparotomy will be indicated and a radical resection of the entire biliary tract will be performed to replace it with a loo... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
445 | 2,018 | 233 | 45-year-old woman. Two previous pregnancies with normal deliveries (G2PN2). Heavy menstrual bleeding for approximately 1 year. Ultrasound shows a 2 cm subserosal myoma that has been stable for several years. Endometrial biopsy was performed and it was normal. The patient has hemoglobin 10 g/dL despite oral ferrotherapy... | According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option. | GYNECOLOGY AND OBSTETRICS | {
"1": "Total hysterectomy preserving appendages.",
"2": "Combined oral contraceptives.",
"3": "Endometrial ablation.",
"4": "Levonorgestrel IUD.",
"5": null
} | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
511 | 2,021 | 152 | A 79-year-old hypertensive woman on treatment with olmesartan comes for consultation for watery diarrhea of 4 to 6 stools per day for the past two months. Three months ago she was treated with nonsteroidal anti-inflammatory drugs for 3 weeks for lumbosciatica. Gastroscopy and colonoscopy were performed, both without ma... | The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings. In our case, the patient presents findings compatible with collagenous colitis (band of co... | DIGESTIVE | {
"1": "Microscopic colitis.",
"2": "Enteropathy due to NSAIDs.",
"3": "Olmesartan-associated enteropathy.",
"4": "Irritable bowel syndrome.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
243,
377
]
],
"word_ranges": [
[
29,
47
]
],
"text": "the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns)"
},
... |
33 | 2,011 | 65 | A 64-year-old man, diagnosed with myasthenia gravis 1 year ago, treated with low-dose steroids (3 mg/day of deflazacort) and anticholinesterase drugs, asymptomatic for 6 months, consults for mild difficulty in swallowing and evening diplopia for a few days. He was admitted to the hospital for suspected myasthenic crisi... | This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement. The respiratory symptoms correspond to an exhaustion of the muscles, first inspiratory and then accessory (the patient does not appear fatigued or tachypneic because the muscles are exh... | NEUROLOGY AND NEUROSURGERY | {
"1": "Reassure the nurse and family that the patient is a habitual snorer and is peacefully asleep. The patient should be placed in lateral decubitus.",
"2": "Notify intensive care for suspected acute respiratory failure, to assess possible orotracheal intubation and assisted ventilation.",
"3": "Perform polyso... | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
0,
134
]
],
"word_ranges": [
[
0,
18
]
],
"text": "This is a patient with decompensated myasthenia w... |
129 | 2,012 | 81 | A 78-year-old male consults for a year-long history of progressive cognitive impairment with memory and orientation lapses. His family reports recurrent visual hallucinations, occasional falls and striking motor slowing. What is the most likely diagnosis? | Dementia with visual hallucinations at the beginning of the course (in the first 2 years) is very suggestive of Lewy bodies, and is the guiding symptom in these questions. If we add to this the falls and motor slowing suggestive of parkinsonism, it makes the question easier. Therefore, number 3 is correct. | NEUROLOGY AND NEUROSURGERY | {
"1": "Multi-infarct vascular dementia.",
"2": "Alzheimer's type dementia.",
"3": "Dementia with diffuse Lewy bodies.",
"4": "Frontotemporal dementia.",
"5": "Normal pressure hydrocephalus."
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
0,
307
]
],
"word_ranges": [
[
... |
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