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
values | options dict | correct_option int64 1 5 | explanations dict |
|---|---|---|---|---|---|---|---|---|
582 | 2,022 | 208 | A 53-year-old man with no history of interest who after a bad movement in the gym notices low back pain that after a few hours radiates to the back of the right leg and reaches the lateral edge of the foot. On examination he presents positive Lasègue maneuver at 40o, abolished hamstring reflex and he cannot stand on ti... | He describes S1 root involvement by the inability to tiptoe and the absence of the Achilles reflex, in addition to the distribution of pain down the leg. Of our options, the cause that can produce damage to S1 is L5-S1 disc herniation. | NEUROLOGY | {
"1": "Right L2-L3 disc herniation.",
"2": "Right L3-L4 disc herniation.",
"3": "Right L4-L5 disc herniation.",
"4": "Right L5-S1 disc herniation.",
"5": null
} | 4 | {
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"... |
160 | 2,013 | 117 | A 35-year-old man presenting hematuria after respiratory infections for several years, a blood test shows creatinine 1 mg/dl with no other alterations and urine hematocytes 50/field being 80% dysmorphic, with proteinuria of 0.8 grams in 24 hours. What is the most likely diagnosis? | The correct answer is: 3. IgA nephropathy. Given that the clinical presentation of this nephropathy appears in a very unspecific way, to identify the responsible disease we must rely on its epidemiology. Since he is a young male, with a history of previous respiratory infections, a relationship between these infections... | NEPHROLOGY | {
"1": "Minimal change nephropathy.",
"2": "Membranous glomerulonephritis.",
"3": "IgA nephropathy.",
"4": "Proliferative and diffuse glomerulonephritis.",
"5": "Focal and primary segmental glomerulosclerosis."
} | 3 | {
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... |
312 | 2,016 | 217 | An 84-year-old woman presents with loss of vision in the left eye of 4 days of evolution accompanied by metamorphopsia. The macula shows abundant hard exudates, two small deep hemorrhages and a localized neurosensory retinal detachment. In the contralateral eye there are abundant soft drusen. Given this picture, which ... | In principle, this is an easy question, as it deals with a disease that is frequently repeated in the MIR exams. The description is typical of option 2. It is an exudative AMD (although as we said in question 215, with the new classification, we would speak of an advanced AMD in its neovascular variant). In any case, w... | OPHTHALMOLOGY | {
"1": "Acute posterior vitreous detachment.",
"2": "Exudative age-related macular degeneration (AMD).",
"3": "Central retinal artery obstruction.",
"4": "Non-arteritic anterior ischemic optic neuropathy.",
"5": null
} | 2 | {
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"text": "In the examination there are lesions in the macula. With that we can rule out acute posterior vitreous detachment, which does not produce vi... |
24 | 2,011 | 115 | A 68-year-old man is evaluated for fever, weight loss and dyspnea on exertion. The EP reveals a new aortic diastolic murmur and stigmata of peripheral embolisms. Echocardiography showed a 1 cm vegetation on the aortic valve and two blood cultures isolated penicillin-sensitive Streptococcus bovis. After starting treatme... | Another gift of a question, the association of S.bovis endocarditis and colon cancer. By the way, it is funny that they give Chest Rx as a test to be performed..... are you telling me that a patient with fever and dyspnea will have an echocardiogram before a simple chest x-ray? And on the other hand... why don't those ... | INFECTIOUS | {
"1": "Glucose tolerance test.",
"2": "Chest X-ray.",
"3": "Upper gastrointestinal endoscopy.",
"4": "Colonoscopy.",
"5": "Abdominal ultrasound."
} | 4 | {
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"... |
260 | 2,014 | 99 | A 45-year-old woman comes to the clinic referred from surgery with the diagnosis of a neuroendocrine tumor diagnosed after partial pancreatectomy for a 2-cm tumor in the tail of the pancreas. The tumor had been detected by chance in an abdominal CT scan requested to complete the study of a simple hepatic cyst. On quest... | Very nice clinical question from MEN. Pancreatic neuroendocrine tumor + pituitary adenoma (prolactinoma) + hyperparathyroidism (renoureteral colic in young people): MEN 1. Medium difficulty because you have to know the MEN triad and recognize the different tumors. | ENDOCRINOLOGY | {
"1": "Multiple endocrine neoplasia type 1 or Wermer's syndrome.",
"2": "Multiple endocrine neoplasia type 2 A or Sipple's syndrome.",
"3": "Multiple endocrine neoplasia type 2B.",
"4": "Somatostatinoma.",
"5": "A PTH-producing neuroendocrine tumor."
} | 1 | {
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"text": "Pancreatic neuroendocrine tumor + pituitary adenoma (prolactinoma) + hyperparathyroidism (renoureteral colic in young people): MEN 1."
},
"... |
211 | 2,014 | 87 | A 78-year-old woman comes to the emergency department for left iliac fossa pain of 24 hours of evolution associated with fever and occasional vomiting. On examination, there is selective pain on palpation in the left iliac fossa with a feeling of occupation, defense and positive decompression. When acute diverticulitis... | Answer 1 is incorrect because the imaging tests of choice would be ultrasound or CT; answer 3 is incorrect because the laparoscopic approach is indicated from the start; answer 4 is incorrect because the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second epi... | GENERAL SURGERY | {
"1": "The safest and best performing complementary examination is the barium contrast enema.",
"2": "In case of contained pelvic abscess, percutaneous drainage guided by CT or ultrasound is indicated.",
"3": "If surgical intervention is required after resolution of the acute episode, the laparoscopic approach i... | 2 | {
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"text": "Answer 1 is incorrect because the imaging tests of choice would be ultrasound or CT;"
},
"2": {
"exist": false,
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... |
162 | 2,013 | 121 | A 52-year-old patient with stage V chronic kidney disease, secondary to autosomal dominant polycystic kidney disease, receives a cadaver donor kidney graft. A 34-year-old brother of his comes to visit him and says he does not know if he has the disease because he has never seen a doctor since he was a teenager. What at... | The correct answer is: 2. Abdomino-pelvic ultrasound. Abdomino-pelvic ultrasound is undoubtedly the most specific and sensitive test for the diagnosis of polycystic kidney disease and, above all, the cheapest to demonstrate whether or not the patient's sibling has inherited polycystic kidney disease. | NEPHROLOGY | {
"1": "Genetic mutational and linkage study.",
"2": "Abdomino-pelvic ultrasound.",
"3": "Helical computed axial tomography with iodinated contrast.",
"4": "Abdominal and cerebral MRI.",
"5": "Periodic clinical controls."
} | 2 | {
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"text": "Abdomino-pelvic ultrasound is undoubtedly the mo... |
207 | 2,014 | 181 | A 43-year-old woman referred to the Hospital's Lower Genital Tract Pathology Clinic for presenting with a cervico-vaginal cytology reported as "L-SIL" (Low Grade Intraepithelial Lesion). She refers repeated vaginal infections (Trichomoniasis,...) and having had more than 5 sexual partners in her life. The best care str... | The best answer to this question is number 5. Most of the lesions identified as L-SIL are associated with HPV infection: for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection. On the other hand, according to the latest studies, 70% of the cytologies reported as L... | GYNECOLOGY AND OBSTETRICS | {
"1": "Conization with diathermy loop.",
"2": "Endocervical curettage with Kevorkian curettage.",
"3": "Endometrial biopsy with Cornier cannula.",
"4": "Hysterectomy without adnexectomy.",
"5": "Advise her to stop smoking and contraceptives and to have a control in 6 months."
} | 5 | {
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584 | 2,022 | 73 | A 51-year-old woman, menopausal for a year and a half, who consults for vaginal spotting of 2 weeks' evolution. She reports that the spotting is less than a menstrual period. The ultrasound shows a 7 mm endometrium. Mark the correct option: | The endometrium is thickened for a menopausal woman (some guidelines put the limit at 5 and others at 3mm). And the first complementary test to perform would be an endometrial biopsy. If this is not decisive, hysteroscopy will be considered as a second option. | OBSTETRICS AND GYNECOLOGY | {
"1": "The endometrium is thickened and in view of the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula.",
"2": "The endometrium is not thickened so she is prescribed tranexamic acid and ambulatory follow-up.",
"3": "Indications for diagnostic hysteroscopy without the need for endometria... | 1 | {
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"text": "The endometrium is thickened for a menopausal woman (some guidelines put the limit at 5 and others at 3mm). And the first complementary test to ... |
138 | 2,012 | 165 | A child who comes to the outpatient clinic because he brings his hand to his ear, without fever or acute inflammatory signs and who on examination shows a pinkish/amber eardrum. As history he refers that one month ago he presented an episode of otalgia, fever accompanied by irritability and that he was treated with amo... | Reading the case, we are discarding options: child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis). On otoscopy, a pinkish and amber eardrum is observed: there are no scales, so it is not 4 (cholesteatomatous chronic otitis media); nor perf... | OTORHINOLARYNGOLOGY AND MAXILLOFACIAL SURGERY | {
"1": "Recurrent acute otitis media.",
"2": "Serous otitis media.",
"3": "Simple chronic otitis media.",
"4": "Chronic cholesteatomatous otitis media.",
"5": "Mastoiditis."
} | 2 | {
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"text": "child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)."
},
... |
136 | 2,012 | 132 | A 60-year-old man comes to the emergency department for a coma crisis. Ex-smoker for 3 years, with no other history of interest. A CT scan shows multiple metastases. What is the most probable origin? | Pretty easy, isn't it? Lung cancer is the most frequent cause of brain metastases and in 20-30% of cases it is as a result of them that the primary tumor is diagnosed (as here). | ONCOLOGY | {
"1": "Head and neck cancer.",
"2": "Lung cancer.",
"3": "Urinary bladder cancer.",
"4": "Colon cancer.",
"5": "Pancreatic cancer."
} | 2 | {
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"text": "Lung cancer is the most frequent cause of brain ... |
518 | 2,021 | 105 | A 24-year-old woman with a history of migraine, on propranolol and oral contraceptives, presents with severe dyspnea, hoarseness, rash, nausea and vomiting 30 minutes after taking metamizole. His blood pressure is 90/40 mmHg and SatO2 is 90%. The most correct initial treatment would be to administer: | We are faced with an anaphylactic reaction to metamizole, in which it is necessary to act quickly or the patient could progress to cardiac arrest. It is important to assess the severity of the allergic reactions, since, in this case, early treatment is essential to prevent high mortality if not applied. The treatment o... | CRITICAL AND EMERGENCY CARE | {
"1": "Adrenaline.",
"2": "Adrenaline and dexchlorpheniramine.",
"3": "Adrenaline, dexchlorpheniramine and methylprednisolone.",
"4": "Adrenaline, dexchlorpheniramine and glucagon.",
"5": null
} | 4 | {
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"... |
581 | 2,022 | 205 | 61-year-old male, smoker and hypertensive, who comes to the emergency department for sudden loss of strength and tingling sensation in the right hand lasting about 15 minutes, with almost complete recovery afterwards. ECG: sinus rhythm at 93 bpm. In relation to the most probable diagnosis, indicate the FALSE answer: | The case is a TIA (transient ischemic attack). The basic etiological study includes echodoppler of supra-aortic trunks +/- cerebral arteries, echocardiogram and directed blood analysis. | NEUROLOGY | {
"1": "A probable cause is an arterioarterial embolism due to detachment of a carotid plaque.",
"2": "Doppler ultrasound of supra-aortic trunks is not very useful for diagnosis.",
"3": "A cranial CT scan is necessary to assess the impact on the brain parenchyma.",
"4": "Surgical treatment is indicated if imagi... | 2 | {
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543 | 2,022 | 39 | A 35-year-old patient consults to confirm a suspected allergy to Anisakis simplex. She has previously suffered a clinical picture of gastrointestinal anisakiasis after eating fish. The tests performed show specific IgE levels of 10 KU/l against Anisakis simplex. Which of the following would be the dietary recommendatio... | Anisakis simplex is a parasite frequently found in fish. To avoid reactions with this parasite, a diet free of fresh and raw fish (anchovies in vinegar, smoked, salted fish, sushi, etc.) should be followed. Deep-frozen fish or fresh fish previously frozen at -20ºC for at least 5 days before cooking can be consumed, as ... | ALLERGOLOGY | {
"1": "He cannot eat any fish, crustaceans, mollusks or cephalopods.",
"2": "He can eat fresh fish cooked on the grill.",
"3": "May eat commercially flash-frozen fish.",
"4": "You can eat fresh marinated or cold smoked fish.",
"5": null
} | 3 | {
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... |
2 | 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 4 days of hospitalization and treatment with absolute diet, piperacillin-tazobactam serum therapy, the patient continues with fever, persistent abdominal pain and leukocytosis. The ... | In this question, they insist on the age and comorbidity of the patient, as well as the time of evolution, so the answer will probably not be 1. In any case, the ideal would be to drain the gallbladder that has not gone up again, so the answer I would give would be 2. | DIGESTIVE | {
"1": "Urgent surgical treatment.",
"2": "Biliary drainage by percutaneous cholecystostomy.",
"3": "Replace piperacillin-tazobactam with metronidazole-cefotaxime.",
"4": "Replace piperacillin-tazobactam with amikacin-clindamycin.",
"5": "Add an aminoglycoside such as gentamicin to the treatment."
} | 2 | {
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"text": "In this question, they insist on the age and comorbidity of the patient, as well as the time of evolution, so the answer will probably not be 1.... |
122 | 2,012 | 119 | A 17-year-old woman came to the emergency department with acute symptoms of high fever, pharyngeal pain and cervical lymphadenopathy. She had previously been diagnosed with acute pharyngitis and was treated with amoxicillin, and later presented with a generalized macular skin rash. Laboratory tests showed slight leukoc... | The correct answer is the first one. It is a typical picture of infectious mononucleosis. Although a similar picture may occur in acute toxoplasmosis, less than 1% of acute toxoplasma infections present as mononucleosis. Characteristic of Epstein-Barr infectious mononucleosis is the appearance of macular rash after tre... | MICROBIOLOGY | {
"1": "It is a typical picture of infectious mononucleosis.",
"2": "Varicella zoster infection.",
"3": "Acute toxoplasmosis.",
"4": "Lyme disease.",
"5": "Infection by herpes virus 8."
} | 1 | {
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"text": "Characteristic of Epstein-Barr infectious mononucleosis is the appearance of macular rash after treatment with amoxicillin."
},
"2": {
... |
36 | 2,011 | 130 | An 85-year-old woman consults for fatigue and weakness especially in the mornings. She is sometimes unsteady when walking and has to sit down to regain her balance. On two occasions she has had to sit down to keep from falling but denies symptoms of dizziness. She has arterial hypertension, urinary incontinence and ost... | The correct answer is to initiate treatment with L-dopa, since the clinical picture described is of a parkinsonism whose diagnosis is exclusively clinical. The rest of the answers can be made for differential diagnosis, but the performance of complementary tests does not justify delaying the initiation of treatment. | NEUROLOGY AND NEUROSURGERY | {
"1": "Assess visual acuity.",
"2": "Perform an MRI.",
"3": "Tilt table study.",
"4": "Measure blood pressure lying down and standing up.",
"5": "Therapeutic attempt with L-dopa."
} | 5 | {
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"text": "The rest of the answers can be made for differential diagnosis, but the performance of complementary tests does not justify delaying the init... |
338 | 2,016 | 31 | 20-year-old woman with ovarian tumor of 15 cm, solid-cystic, detected by ultrasound after presenting with unspecific abdominal symptoms. In the histopathological study of the corresponding specimen, teeth, hairs, areas of intestinal epithelium, areas of squamous epithelium (15%) and bronchial epithelium, as well as neu... | Mature cystic teratoma (common in the ovary of the adult female). Mass with a large cyst occupying most of it; in its cavity there is sebaceous material and hairs. The wall, generally a few millimeters thick, has the structure of skin, with its epidermal surface towards the cavity. Because of this preponderant developm... | GYNECOLOGY AND OBSTETRICS | {
"1": "Teratocarcinoma.",
"2": "Immature teratoma.",
"3": "Mature cystic teratoma.",
"4": "Dysgerminoma.",
"5": null
} | 3 | {
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... |
432 | 2,018 | 117 | An 85-year-old man with a peripheral venous catheter who, one week after being hospitalized for a stroke, begins with shivering and fever. Blood cultures are performed and microbiology reports that gram-positive cocci are growing in clusters. Pending the antibiogram, what is the most appropriate antibiotic treatment? | The most frequent cause of catheter infection is a bacterium that colonizes the skin. The Gram stain tells us that it is a staphylococcus, most of the species of this genus acquired in-hospital are methicillin resistant, so they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the... | INFECTIOUS DISEASES AND MICROBIOLOGY | {
"1": "Cefazolin.",
"2": "Cloxacillin.",
"3": "Vancomycin.",
"4": "Linezolid.",
"5": null
} | 3 | {
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"text": "The Gram stain tells us that it is a staphylococcus, most of the species of this genus acquired in-hospital are methicillin resistant, so they... |
513 | 2,021 | 38 | A 72-year-old patient presents to the emergency department with severe lingual angioedema. She has no associated urticaria and no history of drug or food allergy. His personal history includes type 2 diabetes mellitus, dyslipidemia, hypertension, hypothyroidism and Parkinson's disease. In regular treatment with metform... | Of the proposed drugs, the least likely options would be 3, since metformin very rarely causes lingual angioedema (in March 2020 there was only one case described worldwide) and 4, since, among the adverse reactions of levodopa, angioedema is classified among the very rare ones (frequency less than 0.1%). Of the two re... | CRITICAL AND EMERGENCY CARE | {
"1": "Enalapril.",
"2": "Simvastatin.",
"3": "Metformin or levodopa equally.",
"4": "Levodopa.",
"5": null
} | 1 | {
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"text": "the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%),"
},
"2": {
"... |
580 | 2,022 | 198 | A 35-year-old woman referred to the emergency department for head trauma due to a fall on a scooter, with no loss of consciousness or amnesia. The examination shows a closed head injury with concussion and mild headache without nausea and vomiting. The neurological examination is normal and the Glasgow index is 15. In ... | After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test. | NEUROLOGY | {
"1": "Cranial CT scan without contrast.",
"2": "Cranial CT with contrast.",
"3": "No imaging test.",
"4": "Simple skull radiography.",
"5": null
} | 3 | {
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"text": "After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming... |
248 | 2,014 | 118 | A 34-year-old man consults for fever and malaise. The medical history includes a history of homosexual relations for the last 4 months with a new partner. 2 months before the current consultation he had a painless ulcerative lesion on the glans penis with bilateral inguinal lymphadenopathy, all self-limited. Serologica... | Direct response question. This is syphilis (both by antecendent and serology) in the secondary stage, so treatment is with Benzathine Penicillin 2.4 MU in a single dose. | INFECTIOUS DISEASES | {
"1": "None.",
"2": "Intravenous penicillin G, 24 MU every day for 14 days.",
"3": "Benzathine penicillin 2.4 MU intramuscular, 3 doses in three consecutive weeks.",
"4": "Ceftriaxone 2 grams intramuscular in a single dose.",
"5": "Benzathine penicillin 2.4 MU intramuscularly in a single dose."
} | 5 | {
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222 | 2,014 | 197 | 30-year-old HIV (+) homosexual male who participates as a volunteer in an AIDS patient support center. According to his medical history he received diphtheria toxoid (Td) 6 years ago, MMR vaccine in childhood and adolescence, and hepatitis B 3 years ago. He is currently asymptomatic with a CD4 count above 200 cls/micro... | Vaccination recommendations for HIV+ adults include hepatitis B, influenza, MMR, pneumococcal, Td and Tdap, and for some adults, hepatitis A, or combined A and B, bacterial meningitis, HPV and meningococcal (Source [1]). Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there wo... | EPIDEMIOLOGY | {
"1": "Seasonal influenza, pneumococcal, tetravalent meningitis and hepatitis A.",
"2": "Seasonal influenza, Td, pneumococcal and tetravalent meningitis.",
"3": "Tetravalent meningitis, pneumococcal and seasonal flu.",
"4": "Td, tetravalent meningitis, pneumococcal.",
"5": "Triple viral, seasonal flu, pneumo... | 1 | {
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"text": "All four vaccines in option 1 are administrable. In a little more detail: Vaccine against tetanus and diphtheria: all persons should be vac... |
244 | 2,014 | 114 | A 16-year-old boy consults for presenting with pustular tonsillitis, fever up to 38.5°C, painful cervical lymphadenopathy, non-pruritic macular rash on the chest and mild hepatosplenomegaly, of 4-5 days of evolution. Paul-Bunnell test and Ig M for Epstein-Barr virus are positive. During his admission he developed conti... | Difficult question in which the correct answer could give rise to discussion. The patient is a 16-year-old male who is admitted for a fairly clear case of mononucleosis due to EBV infection that becomes complicated during admission. The data available to us are: - Pancytopenia. - Hepatopathy. - Coagulopathy. - Absence ... | INFECTIOUS DISEASES | {
"1": "She has a bacterial sepsis of undetermined origin and should be given ceftriaxone and supportive care.",
"2": "She has bacterial sepsis of undetermined origin and should be given vancomycin, ceftacidime and supportive care.",
"3": "This is infectious mononucleosis with a severe course and glucocorticoids ... | 5 | {
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"text": "The clinical data could be consistent with a septic process, however, the main infectious foci have been reasonably ruled out and one of the... |
420 | 2,018 | 78 | A 52-year-old man was referred to the gastroenterology department for hematochezia, tenesmus and reduction of stool diameter. A series of tests were performed and a diagnosis of adenocarcinoma of the sigma without distant metastasis was made. The patient underwent surgery and was referred to the medical oncology depart... | They are not asking about factors that affect oncologic prognosis and therefore imply a change in QT strategy. This question is straightforward. Option 4 is describing to us a T4 stage, either by invasion of adjacent organs or perforation. The T4s carry a much higher chance of recurrence, in fact there are ongoing stud... | GENERAL SURGERY | {
"1": "The presence of anemia at diagnosis.",
"2": "The existence of a family history of colorectal cancer.",
"3": "The size of the primary lesion and histological differentiation.",
"4": "Perforation or adhesion of the tumor to adjacent organs.",
"5": null
} | 4 | {
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321 | 2,016 | 144 | A 50-year-old man diagnosed with polyangiitis with granulomatosis 10 years earlier and untreated for the past 5 years is asymptomatic at a scheduled check-up. Chest X-ray, blood tests and urine sediment are normal except for positive anti-neutrophil cytoplasmic antibodies (ANCA) at titer 1/320, with anti-proteinase 3 s... | In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in treatment obligatory due to their levels. In this case, with the patient being asymptomatic and with objective evidence of lack of activity, close follow-up should be performe... | RHEUMATOLOGY | {
"1": "Start treatment with corticosteroids.",
"2": "Initiate treatment with cyclophosphamide.",
"3": "Initiate treatment with mycophenolate mofetil.",
"4": "Watchful waiting.",
"5": null
} | 4 | {
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"text": "In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in... |
516 | 2,021 | 103 | A 56-year-old patient is found comatose at home. He has a history of arterial hypertension and diabetes mellitus. He has no toxic habits or any other chronic disease. He is on treatment with irbesartan and empaglifozin. He shows no signs of malnutrition. His blood pressure is 110/60 mmHg, heart rate 110 bpm, 90% SatO2,... | We find a patient with hypoventilation. Glycemia is correct (we rule out hyperosmolar coma and hypoglycemia, option 2 and 4), so, although there is no history of intoxication, we have to go to the most frequent and that we can antagonize with antidotes: benzodiazepines (flumazenil) and opiates (naloxone). If we suspect... | CRITICAL AND EMERGENCY CARE | {
"1": "Administer naloxone, flumazenil and thiamine.",
"2": "Administer naloxone, flumazenil and hypertonic glucose.",
"3": "Administer naloxone and flumazenil.",
"4": "Administer thiamine and hypertonic glucose.",
"5": null
} | 3 | {
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44 | 2,011 | 153 | Child 28 days old, born at term. History of normal pregnancy and delivery. He has been breastfed since birth. He consults because 8 days ago he started vomiting, initially sporadically and since 5 days ago, after all feedings. He is permanently hungry. The vomiting is of "squirting" food content. On palpation, the abdo... | The correct answer is 3. Easy question if pathology is suspected, which I also think is simple because the clinical description is textbook hypertrophic pyloric stenosis. | PEDIATRICS | {
"1": "Simple abdominal X-ray.",
"2": "pHmetry.",
"3": "Abdominal ultrasound.",
"4": "Determination of electrolytes in sweat.",
"5": "Esophagogastroscopy."
} | 3 | {
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54 | 2,011 | 72 | A 22-year-old female student with no history of pathology or use of medications except anovulatory drugs comes to the emergency department for deterioration of general condition and need to take deep breaths. She reports weight loss in the last 2-3 days, polydipsia, polyuria and nausea. No cough or febrile sensation. E... | Debut of DM with ketoacidosis. Priority is iv insulin administration and serum therapy. Bicarbonate if pH < 7. Insulin administration should never be delayed. | ENDOCRINOLOGY | {
"1": "Debut of type 2 diabetes mellitus, with dyspnea probably due to pneumonia or thromboembolism, since she is taking anovulatory drugs.",
"2": "It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause.",
"3": "Debut of type... | 2 | {
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"text": "Priority is iv insulin administration and serum ... |
553 | 2,022 | 177 | 33-year-old patient, resident of Valencia, who consults for presenting on the right cheek an erythematous-orange plaque after an insect bite that has been growing slowly until reaching 1.5 cm and that in the last weeks has ulcerated and covered with a scammocostra. The lesion only causes discrete discomfort if scratche... | The fact that the place of residence is mentioned already gives us many clues. A "bite" that transforms into a lesion in an uncovered area with a crusty surface and that bothers little or nothing... in the Mediterranean basin this is cutaneous leishmaniasis or oriental button. And while it is true that the lesion is < ... | DERMATOLOGY | {
"1": "Oral isotretinoin.",
"2": "Intralesional meglumine antimoniate.",
"3": "Systemic corticosteroids.",
"4": "Oral amoxicillin.",
"5": null
} | 2 | {
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"text": "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis, s... |
608 | 2,022 | 115 | A 27-year-old male, a regular athlete, refers pain in the right leg after continuous running. He has visited a physiotherapist on several occasions and has been diagnosed with calf overload. Several months have passed, he has not improved and refers intense pain after physical activity that subsides with rest in the fo... | We present a case of chronic compartment syndrome. For its diagnosis it is necessary to measure the pressure of the affected compartments at rest and after activity (answer 2 correct). | TRAUMATOLOGY | {
"1": "Positron emission tomography with 18 FDG.",
"2": "Determination of posterior compartment pressure immediately after activity.",
"3": "Doppler ultrasound to rule out a circulatory disorder of the lower extremity.",
"4": "Spectrometry by magnetic resonance.",
"5": null
} | 2 | {
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"text": "We present a case of chronic compartment syndrome... |
294 | 2,016 | 44 | Amalia is a 3-year-old girl who has undergone surgery for tetralogy of Fallot. She also presented thymic dysfunction in the neonatal period and hypocalcemia as well as a nasal voice and psychomotor retardation. Which genetic test do you consider most appropriate to reach an etiological diagnosis? | Question in which the clinical picture must be recognized: cardiovascular anomalies - Tetralogy of Fallot -; thymic aplasia/hypoplasia - leading to primary T-cell immunodeficiency; parathyroid aplasia/hypoplasia - hence hypocalcemia -; palatal anomalies - nasal voice; psychomotor retardation. In my opinion, just with t... | GENETICS AND IMMUNOLOGY | {
"1": "22q11 deletion study (Di George or Velo-cardio-facial syndrome).",
"2": "Study of FMR1 gene expansion, responsible for Fragile X syndrome.",
"3": "Sequencing of genes related to HRAS (Noonan syndrome).",
"4": "Genetic study of Williams Beuren syndrome.",
"5": null
} | 1 | {
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"text": "just with the words \"thymic dysfunction\", hypocalcemia and cardiopathy, we would have to go straight to DiGeorge syndrome."
},
"2": {
... |
156 | 2,012 | 230 | A 40-year-old patient who comes to the emergency room with aphthous stomatitis, conjunctivitis, urethritis, balanitis and joint pain. Which of the following diagnoses is the most likely? | Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis. The only problem is that the statement speaks of joint pain and not arthritis... Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arth... | RHEUMATOLOGY | {
"1": "Behçet's disease.",
"2": "Reactive arthritis syndrome.",
"3": "Sweet's syndrome.",
"4": "Vitamin A deficiency.",
"5": "Gonococcal infection."
} | 2 | {
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"text": "In Behçet's disease oral and genital aphthous ulcers may occur but urethritis is not a feature."
},
"2": {
"exist": true,
"char_r... |
82 | 2,012 | 45 | A 60-year-old man reports precordial pain after medium exertion. Coronary angiography shows significant stenosis in the proximal segments of the three main vessels with good distal bed. Ventricular function is depressed (<30%). What is the best therapeutic option? | We are talking about a patient with 3-vessel coronary artery disease and, very importantly, with severe ventricular dysfunction. Under these conditions, the treatment of choice would be surgical (myocardial revascularization surgery or by-pass). In the case of a patient with preserved LV function, the choice of surgica... | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Percutaneous revascularization.",
"2": "Medical treatment.",
"3": "Myocardial revascularization surgery.",
"4": "Implantation of balloon counterpulsation.",
"5": "Cardiac transplantation."
} | 3 | {
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485 | 2,020 | 49 | A 60-year-old man on carbamazepine treatment for epilepsy presenting with fever (38.8°C), odynophagia, conjunctivitis, brownish skin lesions spread over a large body surface, target-like in appearance and accompanied by epidermal detachment (greater than 30%) at the slightest friction. It is very likely that she is pre... | We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area. Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4). If the epidermal detachment is less than 10% then we would be dealing with Stevens-J... | DERMATOLOGY | {
"1": "Acute urticaria of pharmacological cause.",
"2": "Erythema minor exudative secondary to drugs.",
"3": "Pharmacological Stevens-Johnson syndrome.",
"4": "Epidermal toxic necrolysis.",
"5": null
} | 4 | {
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219 | 2,014 | 124 | A 72-year-old woman with type 2 diabetes and stage 5 chronic renal insufficiency. Given the suspicion of pulmonary thromboembolism, indicate which diagnostic test is contraindicated: | This is a very simple question and very useful for the management of PTE in the ED. There is no need to worry: a patient with advanced renal failure (stage 5) is contraindicated for any imaging study that requires the administration of IV contrast, such as CT angiography. All other examinations do not require it and th... | NEPHROLOGY | {
"1": "Disordered echocardiogram.",
"2": "Pulmonary scintigraphy.",
"3": "Pulmonary angio-CT.",
"4": "Electrocardiogram.",
"5": "Chest X-ray."
} | 3 | {
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"3": {
"exist": true,
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578 | 2,022 | 107 | A 55-year-old male who suffers a subarachnoid hemorrhage due to a ruptured middle cerebral artery aneurysm. He is treated surgically. After a good evolution in which he recovers the ability to walk, one month after suffering the hemorrhage, he presents a progressive deterioration, becoming cloudy and with difficulty to... | Vasospasm as a complication of subarachnoid hemorrhage usually occurs early, in the week after the hemorrhage. The progressive deterioration with alteration of the level of consciousness makes us suspect one of the complications that can occur in this condition: hydrocephalus. The diagnostic technique of choice in this... | NEUROLOGY | {
"1": "She is in the moment of evolution in which vasospasm is more frequent.",
"2": "This progressive deterioration is probably secondary to aneurysm rebleeding.",
"3": "Subacute deterioration is most likely due to hydrocephalus.",
"4": "The diagnostic technique of choice is cerebral angiography.",
"5": nul... | 3 | {
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199 | 2,013 | 74 | In a patient presenting in the second decade of life with a progressive picture of parkinsonism, tremor, dystonia and behavioral alteration, you should always perform a study to rule out the presence of a disease whose appropriate treatment can improve neurological symptoms and stop the clinical course. What disease is... | The key in the question is "stopping the clinical course", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course. Sydenham's chorea is typical of younger children with a history of streptococcal infection and resolution is usually spontaneous. On the other ... | NEUROLOGY | {
"1": "Huntington's disease.",
"2": "Wilson's disease.",
"3": "Tourette's syndrome.",
"4": "Sydenham's chorea.",
"5": "Juvenile-onset Parkinson's disease."
} | 2 | {
"1": {
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"text": "The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments ... |
331 | 2,016 | 87 | In a hospitalized patient who is unable to feed orally for more than 6 days, in which of the following clinical situations are we necessarily to use parenteral nutrition? | Paralytic ileus is a failure of intestinal propulsion that appears acutely in the absence of mechanical obstruction; it is secondary to various causes and affects intestinal contractility. Therefore, parenteral administration is necessary. | ENDOCRINOLOGY | {
"1": "Cardioembolic stroke with complete neurologic dysphagia.",
"2": "Cachexia due to chronic empyema in immunocompromised patient.",
"3": "Prolonged paralytic syndrome.",
"4": "Advanced Alzheimer's disease with severe risk of bronchial aspiration.",
"5": null
} | 3 | {
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205 | 2,014 | 214 | A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin. Which of the following is the most likely diagnostic approach? | Chancroid is a solitary lesion. Secondary syphilis usually occurs as a generalized rash or as characteristic lesions on palms and soles (syphilitic nails) with a longer latency period. Trichomonas balanitis is always associated with urethritis, which is not referred to in the question. Therefore, the answer is 1. Howev... | DERMATOLOGY | {
"1": "Genital candidiasis.",
"2": "Chancroid.",
"3": "Secondary syphilis.",
"4": "Trichomonas balanitis.",
"5": "Dermatophyte fungal infection."
} | 1 | {
"1": {
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"text": "Chancroid is a solitary lesion."
},
"3": {
... |
441 | 2,018 | 98 | A 21-year-old woman comes for consultation with a hormonal study showing FSH 0.29 mUl/mL (normal in follicular phase = 3.50-12.50 mUl/mL) and LH < 0.1 mUl/mL (normal in follicular phase 2.40-12.60 mUl/mL). We should make a differential diagnosis between the following clinical situations EXCEPT: | This is because in early ovarian failure FSH and LH are elevated. This is confirmed by the SEGO protocol called Early Menoguia. The rest of the diagnoses are consistent with these analytical parameters. | GYNECOLOGY AND OBSTETRICS | {
"1": "Administration of combined oral contraceptives.",
"2": "Premature ovarian failure.",
"3": "Eating behavior disorder.",
"4": "Craniopharyngioma.",
"5": null
} | 2 | {
"1": {
"exist": true,
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"text": "The rest of the diagnoses are consistent with these analytical parameters."
},
"2": {
"exist": true,
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... |
302 | 2,016 | 111 | In a patient with rheumatoid arthritis treated with methotrexate, prednisone and indomethacin who acutely presents edema and increased plasma creatinine with a poorly expressive urine sediment and proteinuria less than 100 mg/24 h the most likely cause is: | Prerenal acute renal failure due to NSAIDs seems the most plausible option in this case. Tubulointerstitial nephritis due to methotrexate is less likely due to the absence of rash, fever or eosinophilia, which although rare in the MIR usually appear. Although GMN and renal amyloidosis are relatively frequent in RA, the... | NEPHROLOGY | {
"1": "Renal amyloidosis.",
"2": "Glomerulonephritis secondary to rheumatoid arthritis.",
"3": "Renal failure due to non-steroidal anti-inflammatory drugs.",
"4": "Interstitial nephritis due to methotrexate.",
"5": null
} | 3 | {
"1": {
"exist": true,
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"word_ranges": [
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40,
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"text": "Although GMN and renal amyloidosis are relatively frequent in RA, the anodyne urine sediment and the absence of proteinuria make these option... |
517 | 2,021 | 104 | A 34-year-old male is involved in a traffic accident and is attended at the scene of the accident. The medical personnel observe that he is pale, sweaty, has a thready pulse with a blood pressure of 90/50 mmHg, a heart rate of 127 bpm, a respiratory rate of 28 rpm and an oxygen saturation of 92%. He was infused with 20... | In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock). The guidelines to follow should always contemplate the replenishment of blood volume (if possible, with blood products as early as possible) and control of the focus. In this case, given the vital compromise, the need for transfus... | CRITICAL AND EMERGENCY CARE | {
"1": "Type-specific blood transfusion required.",
"2": "Requires emergency blood transfusion (O Rh negative).",
"3": "A possible blood transfusion with crossmatching tests should be prepared.",
"4": "Try again infusion of another 20 ml/kg of crystalloids.",
"5": null
} | 2 | {
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"text": "In this case, given the vital compromise, the ... |
520 | 2,021 | 38 | A 72-year-old patient comes to the emergency department for presenting with severe and significant lingual angioedema. She does not present associated urticaria and has no history of drug or food allergy. His personal history includes type 2 diabetes mellitus, dyslipidemia, hypertension, hypothyroidism and Parkinson's ... | Angioedema is a type of profound urticaria that can be of drug etiology (not IgE-mediated) and in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause, so in this case it would be the correct answer (if we speak in probabilistic terms). | DERMATOLOGY | {
"1": "Enalapril.",
"2": "Simvastatin.",
"3": "Metformin or levodopa equally.",
"4": "Levodopa.",
"5": null
} | 1 | {
"1": {
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"text": "Angioedema is a type of profound urticaria that can be of drug etiology (not IgE-mediated) and in this case, ACEIs (such as enalapril) are consi... |
379 | 2,016 | 133 | A 20-year-old girl comes to the emergency department because she has noticed after getting up, when looking in the mirror, weakness in the right half of the face (including the forehead, closing the eyelid and smiling). She is accompanied by dysgeusia, with a sensation of metallic taste of food as well as hyperacusis a... | We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain. In this case the treatment is corticoid. The first one would not be correct because although within the age range of multiple sclerosis debut, the presentation is usually gradual over days and the nuclear involve... | NEUROLOGY | {
"1": "The most probable diagnosis is a demyelinating plaque in the contralateral hemiprotuberance, the most necessary complementary exploration would be a cranial MRI.",
"2": "Oral corticosteroids are the treatment of choice for the patient.",
"3": "Intravenous fibrinolysis should be considered if the evolution... | 2 | {
"1": {
"exist": true,
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"text": "The first one would not be correct because although within the age range of multiple sclerosis debut, the presentation is usually gradual ove... |
600 | 2,022 | 184 | A 70-year-old woman who has been complaining for 1 month of pain and stiffness in the shoulder girdle and pelvic girdle, which predominates when she gets up and improves with mobilization, without fever, headache or general condition. Physical examination showed stiffness and pain on mobilization of the shoulders and h... | In this case, he is describing the cardinal symptoms of polymyalgia rheumatica. Older patient, over 50 years of age, presenting with pain and stiffness in both girdles, associated with an elevation of acute phase reactants. He presents all the indispensable criteria: age equal to or greater than 50 years, bilateral oma... | RHEUMATOLOGY | {
"1": "Rheumatoid arthritis, would initiate treatment with methotrexate.",
"2": "Fibromyalgia, would initiate treatment with duloxetine.",
"3": "Polymyalgia rheumatica, would initiate treatment with corticosteroids.",
"4": "Ankylosing spondylitis, I would initiate treatment with non-steroidal anti-inflammatory... | 3 | {
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415 | 2,018 | 72 | A 45-year-old man with a history of febrile illness and chest pain comes to the hospital with dyspnea and tachypnea. On physical examination his blood pressure is low, jugular venous pressure is elevated with a prominent descending sinus x and he has a paradoxical pulse. What diagnosis would you suspect? | It is the classic exploration: he had a fever and pain, he had pericarditis with effusion, and now this is causing tamponade. Hence the hypotension (his heart cannot fill well with blood and pump), jugular engorgement and dependence on respiration to achieve preload and cardiac output (i.e. paradoxical pulse). | CARDIOLOGY AND CARDIOVASCULAR SURGERY | {
"1": "Dilated cardiomyopathy.",
"2": "Pericardial effusion with cardiac tamponade.",
"3": "Constrictive pericarditis.",
"4": "Ischemic heart disease.",
"5": null
} | 2 | {
"1": {
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"text": "he had a fever and pain, he had pericarditis wit... |
560 | 2,022 | 180 | A 26-year-old woman diagnosed with systemic lupus erythematosus, on treatment with hydroxychloroquine, who consults for a feeling of generalized weakness that has progressively set in over the last 15 days. The physical examination reveals cutaneous pallor and the CBC shows Hb 7.4 g/dL, Hct 31%, MCV 108. Which of the f... | They give to know of a patient with SLE in treatment with Hydroxychloroquine. She has a hb of 7.4 and a MCV over 100, adding pallor and weakness, we would be dealing with a macrocytic anemia. In my opinion, the most suitable would be alternative 2, since hydroxyloroquine has been reported to decrease the absorption of ... | HEMATOLOGY | {
"1": "Haptoglobin.",
"2": "Coombs' test.",
"3": "Vitamin B12.",
"4": "Antinuclear antibodies.",
"5": null
} | 2 | {
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"text": "In my opinion, the most suitable would be alte... |
358 | 2,016 | 232 | A 24-year-old woman consults after noticing inguinal lymphadenopathies. The interrogation does not show any local discomfort or data suggestive of sexually transmitted infection. The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful. No skin lesions are seen on t... | The correct answer is 3. In the inguinal region, the lymph nodes can acquire a size of up to 1.5 cm being normal. In addition, the rest of the data of the inguinal exploration (no pain, mobile, soft, etc.) corroborates this. On the other hand, there are no signs or symptoms that make us think of a sexually transmitted ... | GYNECOLOGY AND OBSTETRICS | {
"1": "A lupus serology since it is most likely a Treponema pallidum infection.",
"2": "A gynecological examination to rule out ovarian cancer.",
"3": "From the clinical features it seems to be normal lymph nodes and complementary explorations should not be performed.",
"4": "A Paul-Bunell test should be perfo... | 3 | {
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"text": "On the other hand, there are no signs or symptoms that make us think of a sexually transmitted infection."
},
"2": {
"exist": false,
... |
414 | 2,018 | 71 | An 84-year-old man with chronic heart failure in functional grade II secondary to ischemic heart disease with severe non-revascularizable systolic dysfunction, stage 3 chronic kidney disease (glomerular filtration rate 45-50 mL/min) and permanent atrial fibrillation with heart rate >80 beats per minute. Which of the fo... | Ivabradine, in fact, is contraindicated in patients with atrial fibrillation. Initially (although evidence has recently emerged that qualifies this information) ivabradine was said to be selective over the sodium If current in the sinus node. If the patient is in AF, it makes no sense to act on the sinus node. | CARDIOLOGY AND CARDIOVASCULAR SURGERY | {
"1": "Ivabradine.",
"2": "Angiotensin converting enzyme inhibitors.",
"3": "Antialdosterone.",
"4": "Beta-blockers.",
"5": null
} | 1 | {
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"char_ranges": [
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"text": "Ivabradine, in fact, is contraindicated in patients with atrial fibrillation."
},
"2": {
"exist": false,
"char_ranges": [],
"word... |
131 | 2,012 | 221 | An individual presents with "muscle weakness" (spastic hemiparesis) of both right extremities, with hyperreflexia and Babinski's sign, along with a "facial flaccid paralysis" of the left hemiface, with inability to close the left eye or retract the left side of the mouth, in addition to other alterations. From the data... | Question always involves the brainstem. We have a right hemiparesis and involvement of the left facial nucleus, since it has affected the upper and lower facial; therefore we have a crossed clinical picture, having to think about brainstem involvement. If we have in a quick diagram where the nuclei of the cranial pairs... | NEUROLOGY AND NEUROSURGERY | {
"1": "At the level of the area 4 of Brodmann of the cerebral cortex of the right side.",
"2": "In the internal capsule, posterior arm on the right side.",
"3": "In the left cerebral peduncle.",
"4": "In the medial portion of the caudal protuberance of the left side.",
"5": "In the medulla oblongata before d... | 4 | {
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70 | 2,012 | 127 | A 30-year-old woman with a drug addiction PD in a current detoxification period is brought to the ED with profound somnolence, with no other symptoms. We find out that her treatment includes olanzapine and benzodiazepines. What should we do first? | Overuse of the drugs he is taking should be suspected. Olanzapine has no antidote, so, in principle, we should antagonize the effect of benzodiazepines. If the patient continues to be drowsy and does not respond to stimuli, we should proceed to intubate to secure the airway. | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCY MEDICINE | {
"1": "Proceed to IOT.",
"2": "Perform a skull X-ray.",
"3": "Administer flumazenil.",
"4": "Administer naloxone.",
"5": "Wait until he wakes up."
} | 3 | {
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463 | 2,019 | 71 | Woman with hypotension and tissue hypoperfusion in whom the following parameters are objectified after insertion of a Swan-Ganz catheter: cardiac index 1.4 L/min/m2, pulmonary capillary wedge pressure 25 mmHg and systemic vascular resistances 2000 dynes/m2. The type of shock presented by the patient is: | We are not given any further data on the patient except that she is in shock (tissue hypoperfusion) and on introducing a Swan-Ganz catheter we find a low cardiac index (<2), elevated PCP (25mmHg) and elevated systemic resistances (normal: 600-1200 dyne/m2). These data are compatible with cardiogenic origin of shock. | CRITICAL CARE AND EMERGENCY | {
"1": "Cardiogenic.",
"2": "Septic.",
"3": "Hypovolemic.",
"4": "Anaphylactic.",
"5": null
} | 1 | {
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"text": "We are not given any further data on the patient except that she is in shock (tissue hypoperfusion) and on introducing a Swan-Ganz catheter we f... |
476 | 2,020 | 93 | A 58-year-old hypertensive man comes to the emergency department for a 30-second syncope while jogging, with spontaneous recovery and no sequelae. Blood pressure is 135/65 mmHg. Cardiac auscultation shows a loud, intense systolic murmur, which is reduced with Valsalva maneuvers and an attenuated second tone. The ECG sh... | The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis. | CRITICAL CARE | {
"1": "The clinical picture suggests pulmonary thromboembolism.",
"2": "The data provided indicate hypertrophic cardiomyopathy with severe obstruction of the left ventricular outflow tract.",
"3": "These data correspond to severe aortic stenosis.",
"4": "Aortic dissection should be excluded by contrast-enhance... | 3 | {
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546 | 2,022 | 124 | 82-year-old woman with chronic atrial fibrillation of 10 years of evolution and preserved biventricular systolic function who presents with episodes of symptomatic complete atrioventricular block, so it is decided to implant a definitive cardiac pacing system. Which of the following is indicated: | VVI pacemaker (ventricular unicameral). | CARDIOLOGY | {
"1": "DDD pacemaker (bicameral).",
"2": "VVI pacemaker (ventricular unicameral).",
"3": "AAI pacemaker (single-chamber atrial pacemaker).",
"4": "Ventricular resynchronization therapy (CRT).",
"5": null
} | 2 | {
"1": {
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"text": "VVI pacemaker (ventricular unicameral)."
},
"3"... |
313 | 2,016 | 177 | A 57-year-old patient diagnosed with stage T3N1M0 adenocarcinoma of the colon. He was treated with resection followed by postoperative FOLFOX chemotherapy (fluorouracil, leucovorin and oxaliplatin) for 6 months. In a routine control, two years later, carcinoembryonic antigen (CEA) elevation to 30 ng/mL (previously less... | We are faced with a situation of probable liver metastasis from a localized colon adenocarcinoma treated 2 years ago. Probable because we do not have histological confirmation, although as it usually happens, what else could it be? As this is a situation of oligometastasis and the treatments for advanced colon adenocar... | ONCOLOGY | {
"1": "Chemotherapy with FOLFIRI (fluorouracil, leucovorin and irinotecan) plus bevacizumab.",
"2": "Monochemotherapy with capecitabine.",
"3": "Assessment for surgical resection of the hepatic lesion.",
"4": "Hepatic radiotherapy.",
"5": null
} | 3 | {
"1": {
"exist": true,
"char_ranges": [
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"text": "In case of an unresectable situation, chemotherapy treatment would be considered with the intention of converting the single metastatic lesi... |
482 | 2,020 | 173 | A patient is brought to the ED from a fire occurring inside an enclosed building where polyurethane foams were present. He is conscious, but presents with increasing mental dullness, headache, and severe dyspnea. Oxygen saturation by pulse oximetry is 92% and capillary lactic acid is 8 mEq/l. What specific treatment do... | The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes). Knowing this, and that we are dealing with cyanide poisoning, it is easier to answer the question. Among the basic initial treatment measures would be the administration of oxy... | CRITICAL CARE | {
"1": "Administration of oxygen by means of a 50% Venturi type mask.",
"2": "Administration of intravenous hydroxycobalamin.",
"3": "Ventilation with hyperbaric chamber.",
"4": "Fluid therapy with infusion of physiological saline solution at 21 ml/h.",
"5": null
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
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41,
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]
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"text": "Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1),"
},
... |
105 | 2,012 | 233 | In a 35-year-old patient with a depressive syndrome on treatment with serotonin reuptake inhibitors, the use of the following antimicrobials is contraindicated: | Spontaneous reports of serotonergic syndrome associated with concomitant administration of linezolid and serotonergic agents, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs), have been reported. | PHARMACOLOGY | {
"1": "Doxycycline.",
"2": "Amoxicillin-Clavulanic acid.",
"3": "Daptomycin.",
"4": "Linezolid.",
"5": "Vancomycin."
} | 4 | {
"1": {
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"... |
73 | 2,012 | 62 | A 37-year-old man with no past history of interest comes to the emergency department for syncope while walking. He had started two days earlier with dyspnea on exertion. Examination: weight 75 kg, BP 75/50 mm Hg. SatO2 89%. Pulmonary auscultation was normal. Cardiac auscultation: rhythmic tachycardic tones at 130 bpm. ... | The clinical case is a typical pulmonary thromboembolism. In this case it is associated with persistent arterial hypotension. Option 2 would be correct if the patient were not hypotensive. Option 3 is not correct since diagnostic confirmation is not necessary to initiate anticoagulant therapy in case of PTE without hyp... | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCIES | {
"1": "Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed.",
"2": "Enoxaparin: 80 mg sc every 12 hours, starting upon diagnostic suspicion.",
"3": "Enoxaparin; 80 mg sc every 12 hours, starting upon diagnostic confirmation.",
"4": "Fondapar... | 1 | {
"1": {
"exist": true,
"char_ranges": [
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],
"text": "Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis, so the correct option is 1."
},
"2": {
"exist"... |
538 | 2,021 | 2 | A fall with anterior shoulder fracture-dislocation that was reduced in the emergency department. A sling was placed and its removal was recommended after 3 weeks. On removal of the immobilization, an area of dysesthesia circumscribed to the lateral region of the shoulder was observed. The patient can perform abduction,... | Dysesthesia of the lateral aspect of the deltoid region of the shoulder (area innervated by the axillary nerve) and paralysis of the deltoid (primary muscle for abduction beyond 15°). The rotator cuff is undamaged in the MRI, ruling out option 1 (it would show us tendinopathy of the teres major). Adhesive capsulitis pr... | TRAUMATOLOGY | {
"1": "Tendinopathy of the teres major.",
"2": "Adhesive capsulitis.",
"3": "Suprascapular nerve neuropathy.",
"4": "Axillary nerve injury.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
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184,
297
]
],
"word_ranges": [
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],
"text": "The rotator cuff is undamaged in the MRI, ruling out option 1 (it would show us tendinopathy of the teres major)."
},
"2": {
"exist":... |
139 | 2,012 | 166 | A 64-year-old smoker and heavy drinker with no other history of interest. The picture he explains is odynodysphagia of 3 months of evolution and left otalgia. He provides a dentist's report that rules out a dental cause. He also refers to having been visited by different specialists and provides a head and neck CAT sca... | We are presented with a patient with risk factors for oropharyngeal cancer, but in whom the examination and tests are normal. What is going on here? This question is reverse psychology: what did the questioner want me to know? This question was asked by an otolaryngologist. He already tells you that the dentist "didn't... | OTORHINOLARYNGOLOGY AND MAXILLOFACIAL SURGERY | {
"1": "Dental cause / reevaluation by the dentist.",
"2": "Abscess of the base of the tongue / debridement.",
"3": "Ankyloglossia / surgical release of the same.",
"4": "Malignant process of oropharynx / repeat CT scan and biopsy.",
"5": "Nonspecific inflammation / corticosteroid treatment."
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
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301,
354
]
],
"word_ranges": [
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"text": "the dentist \"didn't see anything\", so he rules out 1."
},
"2": {
"exist": true,
"char_ranges": [
[
355,
4... |
446 | 2,018 | 130 | A 28-year-old man comes to the hospital emergency room with gross hematuria. Which of the following urinalysis abnormalities would support a diagnosis of glomerulonephritis? | Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment (option 1 correct). Proteinuria can also appear in variable range, although it is not usual in the form of isolated microalbuminuria (incorrect option 2), and hematuria with pyuria although it is not characteris... | NEPHROLOGY | {
"1": "Dysmorphic red blood cells and/or hematic casts.",
"2": "Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours.",
"3": "Coexistence of hematuria with pyuria without bacteriuria.",
"4": "Clots in the urine with the naked eye.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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0,
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"word_ranges": [
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"text": "Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment (option 1 correct)."
},
"2": {
... |
551 | 2,022 | 130 | An 85-year-old man in permanent atrial fibrillation consults for abrupt pain and coldness in the right foot for 6 hours. On examination he presents plantar cyanosis with partial sensory and mobility deficit. The femoral pulse is palpable, while the popliteal and distal pulses of this extremity are absent. Which of the ... | Urgent surgical treatment by thromboembolectomy. | CARDIOLOGY | {
"1": "Discourage revascularization surgery because of prolonged ischemia time.",
"2": "Apply heat and notify the on-call vascular surgeon.",
"3": "Urgent surgical treatment by thromboembolectomy.",
"4": "Urgent medical treatment with intravenous prostaglandins.",
"5": null
} | 3 | {
"1": {
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... |
383 | 2,016 | 150 | A 12-month-old boy, who in the health examinations performed since birth presents right testicle in the inguinal canal that is not possible to descend to the scrotum. Mark the correct answer: | The retractile testicle is characterized by the testicle being permanently outside the scrotal sac, being possible to descend it manually (although when it is released it automatically returns to its initial location). It is usually due to a short pedicle. In this case we are being told that the teste is always in the ... | PEDIATRICS | {
"1": "The most probable diagnosis is retractile testicle.",
"2": "Wait until two years of age for its spontaneous decrease.",
"3": "Human chorionic gonadotropin is the treatment of first choice.",
"4": "The indication for orchidopexy should not be deferred.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
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379
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"word_ranges": [
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40,
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"text": "In this case we are being told that the teste is always in the inguinal canal (cryptorchidism) so we can discard option 1."
},
"2": {
... |
614 | 2,022 | 118 | A 41-year-old male consults for gonalgia of several days' evolution. During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive. Which of the following lesions is most likely to occur? | The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5º and then 20º, performing internal and external rotations of the leg. In case this reproduces the pain that the patient refers, the test will be considered as positive. It is a test used for the diagnosis of meniscal pathology ... | TRAUMATOLOGY | {
"1": "Meniscal injury.",
"2": "Injury by rupture of the anterior cruciate ligament.",
"3": "Injury by rupture of the posterior cruciate ligament.",
"4": "Degenerative arthropathy injury.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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0,
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"word_ranges": [
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0,
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],
"text": "The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5º and then 20º, performing internal and external rot... |
499 | 2,020 | 182 | A 60-year-old man with abdominal pain and upper gastrointestinal bleeding was found to have an abdominal tumor related to the gastric wall. Histology shows a spindle cell tumor with few mitoses, positive for CD117. The most likely diagnosis is: | The GI stromal tumor is better known as GIST, positive CD117, ckit, PDGF, manual. | MEDICAL ONCOLOGY | {
"1": "Neurofibroma of the gastric wall.",
"2": "Gastrointestinal stromal tumor.",
"3": "Leiomyoma.",
"4": "Granulocytic sarcoma.",
"5": null
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
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"word_ranges": [
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0,
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"text": "The GI stromal tumor is better known as GIST, posi... |
613 | 2,022 | 118 | A 41-year-old male consults for gonalgia of several days' evolution. On examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive. Which of the following injuries is more likely? | Thessaly test. Provocation test performed in suspected meniscal injury. | TRAUMATOLOGY | {
"1": "Meniscal injury.",
"2": "Injury due to rupture of the anterior cruciate ligament.",
"3": "Injury by rupture of the posterior cruciate ligament.",
"4": "Degenerative arthropathy injury.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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0,
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"word_ranges": [
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0,
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"text": "Thessaly test. Provocation test performed in suspected meniscal injury."
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges... |
247 | 2,014 | 117 | A 54-year-old man diagnosed with type 2 diabetes mellitus comes to our office. He reported a fever of 40ºC with chills and shivering, arthromyalgia and headache, for which he started treatment with paracetamol. The symptoms started 24 hours before his return to Spain. Three days later she presented a generalized maculo... | It is striking in this question that we are told that our patient has returned to Spain, but not from where (which could help us to make digressions about the possible cause). However, the description of the picture is very exhaustive as well as typical, so the question is easy. It is a disease that produces fever, art... | INFECTIOUS DISEASES | {
"1": "Coronavirus infection.",
"2": "Lymphocytic choriomeningitis.",
"3": "Dengue.",
"4": "Chikungunya virus infection.",
"5": "Saint Louis encephalitis."
} | 3 | {
"1": {
"exist": false,
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"2": {
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88 | 2,012 | 56 | A 78-year-old woman with a history of hypertension treated with amlodipine was admitted 3 months ago for heart failure and atrial fibrillation. She came to your office for a cardiological check-up. The discharge report shows the result of the echocardiogram showing moderate left ventricular dysfunction and the discharg... | Typical very long and rambling question but not really too complicated... The patient is in heart failure with moderate ventricular dysfunction and also presents atrial fibrillation; she has criteria for anticoagulation, and between the two options that include acenocoumarol we are inclined to choose option 4, since it... | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Digoxin and acetylsalicylic acid.",
"2": "Atenolol and acetylsalicylic acid.",
"3": "Verapamil and acenocoumarol.",
"4": "Carvedilol and acenocoumarol.",
"5": "Carvedilol and clopidogrel."
} | 4 | {
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536 | 2,021 | 122 | 75-year-old male, hypertensive on treatment with enalapril (20 mg/day), who consults for deterioration of general condition, bitemporal headache and mandibular claudication of 3 weeks of evolution. In addition, in the last hours, he refers two episodes of amaurosis fugax of the left eye. Physical examination revealed t... | Clinical case of giant cell arteritis. Corticosteroid therapy remains the first choice (answer 1 incorrect), to be administered as pulses (doses differ according to the literature, but at least 125 mg/d) in case of ocular involvement (answer 3 incorrect). The current treatment of choice for corticosteroid sparing is To... | RHEUMATOLOGY | {
"1": "Rituximab should be administered, since glucocorticoids have been relegated to second-line treatment due to their side effects.",
"2": "Tocilizumab has been shown to be effective in reducing recurrences and cumulative prednisone dose in more than 50% of patients.",
"3": "In the presence of ischemic sympto... | 2 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
108
]
],
"word_ranges": [
[
0,
15
]
],
"text": "Clinical case of giant cell arteritis. Corticosteroid therapy remains the first choice (answer 1 incorrect),"
},
"2": {
"exist": true,
... |
492 | 2,020 | 107 | An 18-year-old patient who comes to the emergency department with epistaxis of several days' evolution, with no personal or family history of interest. On examination he is afebrile, multiple ecchymoses are observed, no splenomegaly is palpable. Laboratory tests: leukocytes 7.2 x103/μL, Hb 12.3 g/dL, platelets 6.0 x103... | This is an easy clinical case only presenting thrombopenia with clinic, petechiae and epistaxis. 1 is false, there would be fever, hemolysis data, neurological symptoms, in the smear there would be schistocytes. In 2 the coagulation must be altered and in this case it is not mentioned. | HEMATOLOGY | {
"1": "Thrombotic thrombocytopenic purpura.",
"2": "Disseminated intravascular coagulation.",
"3": "Thrombocytopenia induced by infection.",
"4": "Primary immune thrombocytopenia.",
"5": null
} | 4 | {
"1": {
"exist": true,
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"text": "1 is false, there would be fever, hemolysis data, neurological symptoms, in the smear there would be schistocytes."
},
"2": {
"exist":... |
599 | 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 clinical case, we are presented with a woman who rapidly presents dyspnea with hypoxemia, a picture compatible with pulmonary thromboembolism. The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem; and antiphospholipid antibodies can be detected through the prolongatio... | RHEUMATOLOGY | {
"1": "Antiphospholipid syndrome.",
"2": "Factor V of Leiden.",
"3": "Hemophilia.",
"4": "Acute pericarditis.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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"text": "In this clinical case, we are presented with a woman who rapidly presents dyspnea with hypoxemia, a picture compatible with pulmonary thromboemb... |
134 | 2,012 | 169 | A 35-year-old man comes to the emergency department with pain in his right eye of 3 days' evolution. Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite. What is the diagnosis? | Dendritic corneal ulcer is typical of herpes simplex keratitis. It presents with pain, not too striking, and scarce or absent red eye. There are ulcers resembling dendrites that may confuse us in the diagnosis. These pseudodendrites are found in herpes Zoster and in corneal abrasions in resolution. Although in practice... | OPHTHALMOLOGY | {
"1": "Herpetic keratitis.",
"2": "Corneal abrasion.",
"3": "Fungal keratitis.",
"4": "Bacterial keratitis.",
"5": "Glaucomatocyclic crisis."
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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"word_ranges": [
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"text": "Dendritic corneal ulcer is typical of herpes simplex keratitis. It presents with pain, not too striking, and scarce or absent red eye."
},
"... |
245 | 2,014 | 115 | A patient undergoing chemotherapy for leukemia is admitted for pneumonia for which treatment with cefepime has been prescribed. A chest X-ray/CT scan shows an infiltrate with halo sign and crescentic meniscus. The lesion is peripheral and a transthoracic puncture is indicated for sampling. Pending definitive histologic... | Direct response question. This is a patient undergoing chemotherapy with respiratory symptoms and the "halo sign" on X-ray, very suggestive of invasive pulmonary aspergillosis. Treatment is with voriconazole. Aspergillus is resistant to fluconazole, so it would not be a valid option. | INFECTIOUS DISEASES | {
"1": "Ganciclovir.",
"2": "Caspofungin.",
"3": "Fluconazole.",
"4": "Piperacillin-tazobactam.",
"5": "Voriconazole."
} | 5 | {
"1": {
"exist": false,
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"text": ""
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"2": {
"exist": false,
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"3": {
"exist": true,
"char_ranges": [
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... |
387 | 2,016 | 156 | A 5-month-old infant exclusively breastfed until the present, who due to maternal work was introduced a bottle with formula and a few days ago was added cereals with and without gluten. Family history: 28-year-old mother with asthma, 32-year-old healthy father and 5-year-old brother with celiac disease and atopic derma... | Child with multiple family history of allergy (asthma, atopy), who has received artificial milk in the first hours of life (sensitization to cow's milk protein) and who, coinciding with the intake of artificial milk, starts digestive symptoms and exanthema = APLV. | PEDIATRICS | {
"1": "Celiac disease.",
"2": "Acute gastroenteritis.",
"3": "Cow's milk protein allergy.",
"4": "Bottle allergy.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
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"text": ""
},
"3": {
"exist": true,
"char_ranges": [
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... |
41 | 2,011 | 139 | Given a patient with poor general condition, fever (axillary temperature 39.5º), bilateral submandibular swelling of six days' evolution, mouth pain and trismus, which of the following statements is correct? | This patient is in serious condition. The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed. Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4. There may already be mediastinitis; after all, that is the natural history of... | OTORHINOLARYNGOLOGY AND MAXILLOFACIAL SURGERY | {
"1": "The first diagnostic probability is carcinoma of the floor of the mouth with bilateral cervical metastases.",
"2": "The therapeutic priority is to ensure the patient's nutrition.",
"3": "We are almost certainly facing a mediastinitis.",
"4": "We must consider as a priority the risk of airway obstruction... | 4 | {
"1": {
"exist": true,
"char_ranges": [
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]
],
"word_ranges": [
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0,
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]
],
"text": "This patient is in serious condition. The trismus and fever suggest a deep cervical space infection and that is not a game because the airway ca... |
385 | 2,016 | 153 | What is the most likely diagnosis of a newborn with microcephaly, intrauterine growth retardation, congenital heart disease, vertical talus foot and a peculiar facies (microphthalmia, small palpebral fissures, micrognathia and dysplastic ears), hands with the index and little finger above the middle and ring fingers? | You are faithfully describing an Edwards' syndrome. Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome. | PEDIATRICS | {
"1": "Trisomy 18 (Edwards' syndrome).",
"2": "Trisomy 13 (Patau's syndrome).",
"3": "Trisomy 21 (Down syndrome).",
"4": "Trisomy 9.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
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252
]
],
"word_ranges": [
[
7,
37
]
],
"text": "Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fing... |
194 | 2,013 | 162 | A 3-year-old girl from Bangladesh consults for intermittent febrile episodes of 3 weeks' duration, associated with weakness and loss of appetite. Physical examination showed marked splenomegaly and mucocutaneous pallor. Complementary tests include: hemoglobin 8.5 mg/dL, hematocrit 26%, MCV 86 fL, MCH 29 pg, leukocytes ... | Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar. The origin of the girl is also indicative of this diagnosis, although it is a disease that also occurs in the Mediterranean area. In the differential diagnosis, it is important to keep in mind the possibility of leukosis. | PEDIATRICS | {
"1": "Acute lymphoblastic leukemia.",
"2": "Burkitt's lymphoma.",
"3": "Visceral leishmaniasis.",
"4": "Miliary tuberculosis.",
"5": "Chronic malaria."
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
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"exist": true,
"char_ranges": [
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371 | 2,016 | 126 | A 59-year-old woman with a personal history of breast cancer operated on 8 months ago and osteoporosis, suffers a fall and has a fracture of the neck of the right femur. She undergoes surgery and remains in the hospital resting in a cast for 10 days. A week after her discharge, she suddenly feels short of breath, which... | The other antecedents and findings are very directly related to the increased risk of thrombotic phenomena. Osteoporosis is not a risk factor for thrombosis. | PULMONOLOGY AND THORACIC SURGERY | {
"1": "History of breast cancer.",
"2": "History of osteoporosis.",
"3": "History of having been at rest for more than 3 days.",
"4": "Presence of unilateral edema of the right calf.",
"5": null
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
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0,
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]
],
"word_ranges": [
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0,
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]
],
"text": "The other antecedents and findings are very directly related to the increased risk of thrombotic phenomena."
},
"2": {
"exist": true,
... |
283 | 2,016 | 56 | A 54-year-old patient is admitted for thermometric fever of 38°C in the previous five days and dyspnea at rest (LV) that appeared 6 hours before coming to the hospital. Examination in the emergency room was compatible with heart failure and the ECG showed complete atrioventricular block with an escape ventricular rate ... | Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram. | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram.",
"2": "Antibiotic therapy according to antibiogram and implantation of intra-aortic balloon counterpulsation and transient pacemaker for up to 3 weeks, after which a permanent pacemaker w... | 1 | {
"1": {
"exist": true,
"char_ranges": [
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119
]
],
"word_ranges": [
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0,
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]
],
"text": "Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram."
},
"2": {
"exis... |
109 | 2,012 | 149 | A 32-year-old asymptomatic woman goes for a gynecological health check-up because she wishes to become pregnant. During this check-up, a 4cm uterine myoma is detected, partly intramural and partly subserosal, located on the anterior aspect of the uterus and which does not deform the endometrial cavity. What approach wo... | The correct answer is 5. An asymptomatic myoma of this size that does not deform the endometrial cavity is not a problem for pregnancy. | GYNECOLOGY AND OBSTETRICS | {
"1": "Laparoscopic myomectomy.",
"2": "Laparotomic myomectomy.",
"3": "Myoma embolization by arterial catheterization.",
"4": "Treatment with Gn-Rh analogues for three months before attempting pregnancy.",
"5": "Attempting pregnancy without any previous treatment."
} | 5 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": false,
... |
92 | 2,012 | 235 | A 60-year-old patient diagnosed with breast neoplasia 10 years ago. She underwent treatment with radiochemotherapy and then hormonal therapy for 5 years. A bone scan study performed for polytopic bone pain showed the presence of bone metastases. She is currently under treatment with minor opioids and NSAIDs with good p... | Brain metastases produce pain due to cranial hypertension. The treatment of choice is corticosteroids. Dexamethasone in oral doses of 4 to 16 mg/day is the treatment of choice. | PALLIATIVE CARE | {
"1": "Switch to major opioids.",
"2": "Extra doses of opioids should be administered as necessary.",
"3": "Corticoids should be added.",
"4": "Switch to a major opioid and maintain NSAIDs.",
"5": "The patient should be admitted for intravenous treatment with major opioid."
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
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},
"3": {
"exist": true,
"char_ranges": [
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... |
342 | 2,016 | 158 | A 24-year-old woman, primigestation, suffers a spontaneous abortion at 7 weeks of gestation. The anatomopathological study of the abortive remains indicates molar disease. We should inform you that: | Gestational trophoblastic disease should be followed up (regardless of whether the evacuation has been complete or not) and the patient should be advised not to become pregnant again until at least 6 months with negative BHCG titers. The risk of recurrence in another pregnancy is low (1/55) and 90% of cases progress sa... | GYNECOLOGY AND OBSTETRICS | {
"1": "The risk of a new molar gestation in a future pregnancy is 50%.",
"2": "She should not become pregnant until she has undergone periodic controls and has spent one year with negative BHCG levels.",
"3": "Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete.",
"... | 2 | {
"1": {
"exist": false,
"char_ranges": [],
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},
"2": {
"exist": true,
"char_ranges": [
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],
"word_ranges": [
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0,
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"text": "Gestational trophoblastic disease should be follo... |
357 | 2,016 | 232 | A 24-year-old woman consults after noticing inguinal lymphadenopathy. The interrogation does not reveal any local discomfort or data suggestive of sexually transmitted infection. The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful. No skin lesions are seen on t... | The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms. In this case, they are very nonspecific nodes, without signs of malignancy (mobile, soft, not painful) that do not lead us to suspect neoplastic infiltration and the lack of other clinical signs also leads us to rule out the presence... | GYNECOLOGY AND OBSTETRICS | {
"1": "A lues serology since it is most likely a Treponema pallidum infection.",
"2": "A gynecological examination to rule out ovarian cancer.",
"3": "By the clinical characteristics it seems to be normal lymph nodes and complementary explorations should not be done.",
"4": "A Paul-Bunell test should be perfor... | 3 | {
"1": {
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"2": {
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"exist": true,
"char_ranges": [
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... |
596 | 2,022 | 121 | 79-year-old woman admitted for an osteoporotic hip fracture. Regarding secondary prevention of fragility fractures, point out the WRONG answer: | This question corresponds to the section on traumatology; however, it could be answered with knowledge of rheumatology and with the osteoporosis recommendations of the Spanish Society of Rheumatology. In osteoporosis, one of the main risks associated with increased fracture risk is low adherence to treatment, so answer... | RHEUMATOLOGY | {
"1": "Low adherence to treatment is associated with an increased risk of fracture.",
"2": "Bone remodeling markers may be useful for early monitoring of response to treatment.",
"3": "Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly.",
"4": "Increasing dietary cal... | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
201,
334
]
],
"word_ranges": [
[
28,
50
]
],
"text": "In osteoporosis, one of the main risks associated with increased fracture risk is low adherence to treatment, so answer 1 is correct."
},
... |
334 | 2,016 | 82 | A woman diagnosed with type 1 diabetes mellitus for 24 years. She comes to the office with 3 months of clinical evolution of tingling in both feet, with distribution in sock, with paresthetic pain and sensation of hot feet predominantly at night, which significantly interferes with sleep. Which of the following drugs w... | Duloxetine; the clinical picture described is of diabetic neuropathy. Of the drugs proposed, the first choice would be a dual antidepressant such as duloxetine. | PHARMACOLOGY | {
"1": "Ibuprofen.",
"2": "Oxycodone.",
"3": "Duloxetine.",
"4": "Paracetamol.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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},
"3": {
"exist": true,
"char_ranges": [
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... |
81 | 2,012 | 44 | A 78-year-old patient diagnosed with idiopathic dilated cardiomyopathy with mild left ventricular dysfunction (ejection fraction 48%) and chronic atrial fibrillation. Which of the following drugs should be avoided in his treatment? | Digoxin is useful as a symptomatic treatment (it is a positive inotropic) in heart failure, although it does not improve survival. Carvedilol is a very well tolerated aß-blocker (due to its anti-a1 effect) that is associated with symptomatic and survival improvement. Acenocoumarol (Sintrom) would be indicated in this p... | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Digoxin.",
"2": "Carvedilol.",
"3": "Acenocoumarol.",
"4": "Enalapril.",
"5": "Ibuprofen."
} | 5 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
130
]
],
"word_ranges": [
[
0,
21
]
],
"text": "Digoxin is useful as a symptomatic treatment (it is a positive inotropic) in heart failure, although it does not improve survival."
},
"2": ... |
386 | 2,016 | 154 | The appearance of a high fever of 39°C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition, is usually caused by: | The question of exanthematous diseases that pediatricians and MIR exam takers like so much. By the picture of high fever of several days that suddenly subsides with the appearance of a rash, we have a sudden exanthem, caused by Herpes virus type 6 (remember the mnemonic rule of "sudden Hexanthem"). Parvovirus B19 is th... | PEDIATRICS | {
"1": "Parvovirus B19.",
"2": "Herpes virus type 6.",
"3": "Coxackie A16 virus.",
"4": "Primoinfection by Epstein-Barr virus.",
"5": null
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
[
300,
456
]
],
"word_ranges": [
[
50,
75
]
],
"text": "Parvovirus B19 is the cause of erythema infectiosum or \"fifth disease\", whose characteristic rash is on the cheeks, giving the appearance o... |
239 | 2,014 | 146 | An 80-year-old man is admitted for a sudden onset of aphasia and right hemiparesis. His history includes hypertension, well controlled with diet and cognitive deterioration in the last year under study by his neurologist. The emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake. What is... | Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case). They often appear in association with Alzheimer's disease (CTO Manual). The response that may cause the most doubts is 2, hypertension, but the most frequent loc... | NEUROLOGY | {
"1": "Arteriovenous malformation masked by acute hematoma.",
"2": "Chronic arterial hypertension.",
"3": "Isolated vasculitis of the nervous system.",
"4": "Brain tumor.",
"5": "Cerebral amyloid angiopathy (congophilic angiopathy)."
} | 5 | {
"1": {
"exist": true,
"char_ranges": [
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606,
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]
],
"word_ranges": [
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],
"text": "Answer 1, a malformation is typical of young patients, rare in older people."
},
"2": {
"exist": true,
"char_ranges": [
[
... |
525 | 2,021 | 53 | A 42-year-old woman visits her family physician for gonalgia. Opportunistic use is made of the consultation to assess lifestyles, especially smoking. If you want to follow the health education strategy based on the five "a's" model, which of the following is NOT included in this strategy: | The 5A summarizes the activities that should be performed by healthcare personnel during the brief intervention with the patient to stop smoking and are: find out, advise, analyze, help, accompany or agree. Therefore, the one that is not included in the strategy would be option 2: increase. | PREVENTIVE MEDICINE | {
"1": "Inquire: ask about risk factors and risk behaviors (ask the patient if she smokes).",
"2": "Increase: increase risk perception to facilitate change (explain the consequences of smoking).",
"3": "Advise: give clear, specific and personalized advice (advise smoking cessation).",
"4": "Agree: collaborative... | 2 | {
"1": {
"exist": false,
"char_ranges": [],
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},
"2": {
"exist": true,
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"word_ranges": [
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"text": "The 5A summarizes the activities that should be p... |
287 | 2,016 | 64 | 65-year-old patient presenting progressive dyspnea of 5 days of evolution until becoming resting, three-pillow orthopnea and episodes of paroxysmal nocturnal dyspnea. Auscultation highlights bilateral crackles, holosystolic murmur radiating to the axilla and gallop rhythm for the third and fourth sounds. Mark the CORRE... | The fourth noise usually appears when there is a certain degree of valvular stenosis. | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "The third noise coincides with the rapid filling phase of the ventricular diastole of the cardiac cycle.",
"2": "The most likely diagnosis is heart failure.",
"3": "The holosystolic murmur may correspond to mitral insufficiency.",
"4": "The fourth noise usually appears when there is a certain degree of ... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
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},
"3": {
"exist": false,
"char_ranges": [],
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"4": {
"exist": true,
"... |
472 | 2,020 | 140 | 65-year-old obese woman who suffers a fall on her hand with her elbow in extension. She presents with arm pain with swelling and functional impotence of the arm and inability to extend the wrist and fingers. It is most likely to present: | We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers. The only option that includes all the data is 4. Option 1 does not explain the involvement of the wrist and fingers. The elbow dislocation... | ORTHOPEDIC SURGERY AND TRAUMATOLOGY | {
"1": "Dislocation fracture of proximal humerus.",
"2": "Elbow dislocation.",
"3": "Diaphyseal fracture of the humerus associated with double forearm fracture.",
"4": "Diaphyseal fracture of humerus with radial nerve injury.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
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"word_ranges": [
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"text": "Option 1 does not explain the involvement of the wrist and fingers."
},
"2": {
"exist": true,
"char_ranges": [
[
29... |
173 | 2,013 | 51 | A 53-year-old woman with bronchial asthma comes to the allergy clinic for a checkup. She reports repeated exacerbations with nocturnal symptoms, frequent use of rescue medication and dyspnea on exertion when walking on level ground. Spirometry shows a pre-bronchodilator FEV1/FVC ratio of 60% and FEV1 of 55%. Skin tests... | The indication of omalizumab in a patient such as the one referred to is a correct indication, although in severe asthma that is difficult to control, there are other prior measures that are not contemplated and that must always be taken into account before resorting to this treatment. It is mandatory to ensure firstly... | PNEUMOLOGY | {
"1": "Add magnesium sulfate.",
"2": "Increase the dose of prednisone to 30 mg/day.",
"3": "Add omalizumab.",
"4": "Nebulized treatment at home.",
"5": "Switch to a combination with high doses of budesonide and formoterol."
} | 3 | {
"1": {
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480 | 2,020 | 171 | A 67-year-old woman with a history of dyslipidemia, who comes to the ED with dysuria and pollakiuria followed by fever, chills, and deterioration of general condition. On arrival she appears severe and is tachycardic, tachypneic, with blood pressure 60/40 mmHg and temperature of 39°C. Which of the following measures wo... | Among the options presented, the only measure not included in the Surviving Sepsis Campaign guidelines on the management of sepsis and septic shock (like the patient we are dealing with) is the administration of IV dobutamine. The appropriate procedure would consist of fluid administration, blood culture extraction, se... | CRITICAL CARE | {
"1": "Intravenous perfusion of dobutamine.",
"2": "Serum lactate measurement.",
"3": "Extraction of blood cultures.",
"4": "Fluid administration.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
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0,
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"word_ranges": [
[
0,
36
]
],
"text": "Among the options presented, the only measure not included in the Surviving Sepsis Campaign guidelines on the management of sepsis and septic sh... |
58 | 2,011 | 199 | An asymptomatic 31-year-old woman (Consultant) is asymptomatic and has a 10-week gestation according to ultrasound study (primiparous). Her younger brother (index case) aged 26 years is affected by ataxia and genetically diagnosed as a heterozygous carrier of an expansive mutation of 70 CAG repeats in the SCA3 gene (ch... | SCA3 is Spinocerebellar Ataxia type 3 also called Machado-Joseph disease. It is caused by mutations in the ATXN3 gene by the CAG triplet repeat expansion mechanism. Affected individuals have between 52 and 86 CAG triplet repeats in heterozygosis with complete penetrance. The heterozygous mutation carrier has the diseas... | GENETICS | {
"1": "It is indicated after studying the Consultant's genotype and only if it is heterozygous.",
"2": "This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation.",
"3": "It may be indicated in the next pregnancy, after studying th... | 1 | {
"1": {
"exist": true,
"char_ranges": [
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372,
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"word_ranges": [
[
55,
130
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],
"text": "In this clinical case, the one who has the disease and has the mutated gene in heterozygosis is the brother (26 years old) of the pregnant w... |
51 | 2,011 | 230 | 37-week pregnant woman with positive hepatitis B virus surface antigen. She consults about the guidelines to be followed with the newborn and whether she can breastfeed. What advice do you think is most appropriate? | The correct answer is 4. Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life. Although the virus is excreted in breast milk, the risk of infection by this route is very low and therefore it is not currently a co... | PEDIATRICS | {
"1": "Administer hepatitis B vaccine at birth. Artificial feeding.",
"2": "Vaccination and immunoglobulins should be administered at birth. Breastfeeding from one month onwards.",
"3": "Immunoglobulins at birth and artificial breastfeeding.",
"4": "Vaccination and immunoglobulins at birth. Maternal feeding.",... | 4 | {
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184 | 2,013 | 65 | A patient with obesity (body mass index 38) is referred to your office. In the clinical history the patient refers that he/she has been obese since the age of 17 (currently 36 years old), having been on multiple diets with weight loss ranging from 5 to 10 kg but has subsequently regained weight. The patient is currentl... | Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity. | ENDOCRINOLOGY | {
"1": "Orlistat.",
"2": "Topiramate.",
"3": "Sibutramine.",
"4": "Liraglutide.",
"5": "Metformin."
} | 1 | {
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"text": "Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity."
},
"2": {
"exist": false,
"c... |
295 | 2,016 | 75 | Indicate the clinical situation that, in relation to hepatitis B virus infection, presents a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +: | Question in which having a table in the head comes out alone discarding options: Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type (only for this last data, we would have to discard it in a direct way). Option 2: the correct one. It complies with all the charact... | GENETICS AND IMMUNOLOGY | {
"1": "Acute infection.",
"2": "Chronic infection.",
"3": "Vaccinated patient.",
"4": "Asymptomatic carrier.",
"5": null
} | 2 | {
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"exist": true,
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"text": "Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type (only for this last data, we would... |
559 | 2,022 | 160 | A 35-year-old woman, taking contraceptives, comes to the emergency department with febrile syndrome and paresthesias in the left hemibody. Blood tests show Hb 7.5 g/dL, platelets 7,000/microl, normal leukocytes with normal differential count, LDH 1,200 IU/l, reticulocytes 10% (normal 0.5-2%), undetectable serum haptogl... | The fear of all on-call hematologists... that you will get a TTP. Because, although infrequent, it is the greatest hematologic emergency. The clinical case is fairly typical. A young person with fever and neurological symptoms that make him go to the emergency department (he is on the run). Laboratory tests show anemi... | HEMATOLOGY | {
"1": "Autoimmune hemolytic anemia.",
"2": "Thrombotic thrombocytopenic purpura.",
"3": "Evans syndrome (hemolytic anemia and immune thrombopenia).",
"4": "Idiopathic immune thrombocytopenia.",
"5": null
} | 2 | {
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"char_ranges": [
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"word_ranges": [
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"text": "The clinical case is fairly typical. A young p... |
558 | 2,022 | 160 | A 35-year-old woman, taking contraceptives, comes to the emergency department with febrile syndrome and paresthesias in the left hemibody. Blood tests showed Hb 7.5 g/dL, platelets 7,000/microl, normal leukocytes with normal differential count, LDH 1,200 IU/l, reticulocytes 10% (normal 0.5-2%), undetectable serum hapto... | The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP): 1. Neurological alteration. 2. Febrile syndrome (fever). 3. Coombs negative migroangiopathic hemolytic anemia (presence of schistocytes). 4. Thrombopenia. | HEMATOLOGY | {
"1": "Autoimmune hemolytic anemia.",
"2": "Thrombotic thrombocytopenic purpura.",
"3": "Evans syndrome (hemolytic anemia and immune thrombopenia).",
"4": "Idiopathic immune thrombocytopenia.",
"5": null
} | 2 | {
"1": {
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"word_ranges": [
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"text": "The patient presents criteria for Thrombotic Thro... |
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