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@@ -6,77 +6,304 @@ tags:
 - dense
 - generated_from_trainer
 - dataset_size:492
-- loss:TripletLoss
+- loss:MultipleNegativesRankingLoss
 base_model: llm-semantic-router/mmbert-embed-32k-2d-matryoshka
 widget:
-- source_sentence: A 7-year-old boy with a history of fetal alcohol syndrome is brought
-    by his mother to the emergency room for malaise and lethargy. His mother reports
-    that the family was on vacation in a cabin in the mountains for the past 10 days.
-    Five days ago, the child developed a fever with a max temperature of 102.6°F (39.2°F).
-    She also reports that he was given multiple medications to try to bring down his
-    fever. Although his fever resolved two days ago, the child has become increasingly
-    lethargic. He started having non-bilious, non-bloody emesis one day prior to presentation.
-    His current temperature is 100°F (37.8°C), blood pressure is 95/55 mmHg, pulse
-    is 110/min, and respirations are 22/min. On exam, the child is lethargic and minimally
-    reactive. Mild hepatomegaly is noted. A biopsy of this patient’s liver would likely
-    reveal which of the following?
+- source_sentence: 'A 60-year-old man is rushed to the emergency room after he was
+    found unconscious in bed that afternoon. The patient’s wife says he has been confused
+    and irritable for the past several days. She says he has a history of chronic
+    daily alcohol abuse and has been hospitalized multiple times with similar symptoms
+    His temperature is 37°C (98.6°F), the blood pressure is 110/80 mm Hg, the pulse
+    is 90/min, and the respiratory rate is 14/min. On physical examination, the patient
+    is minimally responsive to painful stimuli. His abdomen is distended with positive
+    shifting dullness. Laboratory results are as follows:
+
+    Complete blood count
+
+    Hematocrit 35%
+
+    Platelets 100,000/mm3
+
+    White blood cells 5000/mm3
+
+    Liver function studies
+
+    Serum Albumin 2 g/dL
+
+    Alkaline phosphatase (ALP) 200 IU/L
+
+    Aspartate aminotransferase (AST) 106 IU/L
+
+    Alanine aminotransferase (ALT) 56 IU/L
+
+    The patient is admitted to the hospital and started on the appropriate treatment
+    to improve his mental status. Which of the following best describes the mechanism
+    of action of the drug that is most likely used to treat this patient’s symptoms?'
+  sentences:
+  - 'A 60-year-old man is rushed to the emergency room after he was found unconscious
+    in bed that afternoon. The patient’s wife says he has been confused and irritable
+    for the past several days. She says he has a history of chronic daily alcohol
+    abuse and has been hospitalized multiple times with similar symptoms His temperature
+    is 37°C (98.6°F), the blood pressure is 110/80 mm Hg, the pulse is 90/min, and
+    the respiratory rate is 14/min. On physical examination, the patient is minimally
+    responsive to painful stimuli. His abdomen is distended with positive shifting
+    dullness. Laboratory results are as follows:
+
+    Complete blood count
+
+    Hematocrit 35%
+
+    Platelets 100,000/mm3
+
+    White blood cells 5000/mm3
+
+    Liver function studies
+
+    Serum Albumin 2 g/dL
+
+    Alkaline phosphatase (ALP) 200 IU/L
+
+    Aspartate aminotransferase (AST) 106 IU/L
+
+    Alanine aminotransferase (ALT) 56 IU/L
+
+    The patient is admitted to the hospital and started on the appropriate treatment
+    to improve his mental status. Which of the following best describes the mechanism
+    of action of the drug that is most likely used to treat this patient’s symptoms?
+
+
+    Answer: Decreases pH in the gastrointestinal lumen'
+  - 'A 65-year-old man is brought to the emergency department after loss of consciousness.
+    He is accompanied by his wife. He is started on intravenous fluids, and his vital
+    signs are assessed. His blood pressure is 85/50 mm Hg, pulse 50/min, and respiratory
+    rate 10/min. He has been admitted in the past for a heart condition. His wife
+    is unable to recall the name of the condition, but she does know that the doctor
+    recommended some medications at that time in case his condition worsened. She
+    has brought with her the test reports from previous medical visits over the last
+    few months. She says that she has noticed that he often has difficulty breathing
+    and requires three pillows to sleep at night to avoid being short of breath. He
+    can only walk for a few kilometers before he has to stop and rest. His wife also
+    reports that he has had occasional severe coughing spells with pinkish sputum
+    production. She also mentions that he has been drinking alcohol for the past 30
+    years. Which of the following medications will improve the prognosis of this patient?
+
+
+    Answer: Enalapril'
+  - 'A 71-year-old African American man is brought to the emergency department with
+    a worsening productive cough and dyspnea for 2 days. He has had generalized bone
+    pain for 2 months. He was admitted for pyelonephritis last month. He also received
+    outpatient treatment for pneumonia almost 2 months ago. Over the past 2 months,
+    he has been taking over-the-counter ibuprofen for pain as needed. He appears anxious.
+    The vital signs include: temperature 38.8°C (101.8°F), pulse 95/min, respiratory
+    rate 20/min, and blood pressure 155/90 mm Hg. The conjunctivae are pale. Crackles
+    are heard in the right lower lobe. The cardiac examination shows no abnormalities.
+    The laboratory studies show the following:
+
+    Hemoglobin 9 g/dL
+
+    Mean corpuscular volume 95 μm3
+
+    Leukocyte count 13,500/mm3
+
+    Segmented neutrophils 75%
+
+    Lymphocytes 25%
+
+    Platelet count 240,000/mm3
+
+    ESR 85 mm/hr
+
+    Serum
+
+    Na+ 135 mEq/L
+
+    K+ 4.2 mEq/L
+
+    Cl− 113 mEq/L
+
+    HCO3− 20 mEq/L
+
+    Ca+ 12.4 mg/dL
+
+    Albumin 4 g/dL
+
+    Urea nitrogen 38 mg/dL
+
+    Creatinine 2.2 mg/dL
+
+    A chest X-ray shows a right lower lobe opacity and blurring of the ipsilateral
+    diaphragmatic dome. Skull and pelvic X-rays are performed (see image). Which of
+    the following is the most likely underlying cause of this patient’s recent infections?
+
+
+    Answer: Hypogammaglobulinemia'
+- source_sentence: 'A 35-year-old man presents to the physician with concerns that
+    a “bad flu” he has had for the past 10 days is getting worse and causing sleeplessness.
+    On presentation today, his sore throat has improved; however, fever and chest
+    and body aches persist despite the use of ibuprofen. He reports sharp, intermittent
+    chest pain that worsens with exertion. He has not traveled outside the United
+    States recently and does not have a history of substance abuse or alcohol use.
+    Physical examination shows the temperature is 38.3°C (100.9°F), the heart rate
+    is 110/min, the blood pressure is 120/60 mm Hg, and the oxygen saturation is 98%
+    on room air. There is bilateral pedal edema at the level of the ankle. Auscultation
+    reveals normal S1 and S2 and a third early diastolic heart sound. Jugular vein
+    distention is observed. An ECG shows sinus tachycardia and diffuse ST-segment
+    elevation throughout the precordial leads with 1.0-mm PR-segment depression in
+    leads I and II.
+
+    Laboratory results
+
+    WBC 14,000/mm3
+
+    Lymphocyte count 70%
+
+    Hematocrit 45%
+
+    CRP 56 mg/dL
+
+    Troponin T 1.15 ng/mL
+
+    Troponin I 0.2 ng/mL
+
+    Ck-MB 22 ng/mL
+
+    Coxsackie type b viral antibody  positive
+
+    A chest x-ray shows clear lung fields bilaterally and a mildly enlarged cardiac
+    silhouette. Transthoracic ultrasound reveals a left ventricular ejection fraction
+    of 30%. Which of the following is the cause of difficulty sleeping for this patient?'
   sentences:
-  - 'A 7-year-old boy with a history of fetal alcohol syndrome is brought by his mother
-    to the emergency room for malaise and lethargy. His mother reports that the family
-    was on vacation in a cabin in the mountains for the past 10 days. Five days ago,
-    the child developed a fever with a max temperature of 102.6°F (39.2°F). She also
-    reports that he was given multiple medications to try to bring down his fever.
-    Although his fever resolved two days ago, the child has become increasingly lethargic.
-    He started having non-bilious, non-bloody emesis one day prior to presentation.
-    His current temperature is 100°F (37.8°C), blood pressure is 95/55 mmHg, pulse
-    is 110/min, and respirations are 22/min. On exam, the child is lethargic and minimally
-    reactive. Mild hepatomegaly is noted. A biopsy of this patient’s liver would likely
-    reveal which of the following?
-
-
-    Answer: Microvesicular steatosis'
-  - 'A 2-day-old newborn boy is brought to the emergency department because of apnea,
-    cyanosis, and seizures. He is severely hypoglycemic and does not improve with
-    glucagon administration. His blood pressure is 100/62 mm Hg and heart rate is
-    75/min. Blood tests show high lactate levels. Physical examination is notable
-    for hepatomegaly. Which of the following enzymes is most likely to be deficient
-    in this baby?
-
-
-    Answer: Glucose-6-phosphatase'
-  - 'A 49-year-old woman comes to the office complaining of 2 weeks of urinary incontinence.
-    She says she first noticed some light, urinary dribbling that would increase with
-    sneezing or coughing. This dribble soon worsened, soaking through a pad every
-    3 hours. She denies any fevers, chills, abdominal pain, hematuria, dysuria, abnormal
-    vaginal discharge, or increased urinary frequency. The patient had a bilateral
-    tubal ligation 3 weeks ago. Her last menstrual period was 2 weeks ago. Her menses
-    are regular and last 5 days. She has had 3 pregnancies that each resulted in uncomplicated,
-    term vaginal deliveries. Her last pregnancy was 2 years ago. The patient has hypothyroidism
-    and takes daily levothyroxine. She denies tobacco, alcohol, or illicit drug use.
-    She has no history of sexually transmitted diseases. She is sexually active with
-    her husband of 25 years. Her BMI is 26 kg/m^2. On physical examination, the abdomen
-    is soft, nondistended, and nontender without palpable masses or hepatosplenomegaly.
-    Rectal tone is normal. The uterus is anteverted, mobile, and nontender. There
-    are no adnexal masses. Urine is seen pooling in the vaginal vault. Urinalysis
-    is unremarkable. Which of the following is next best step in diagnosis?
-
-
-    Answer: Methylene blue instillation into the bladder'
+  - 'A 20-year-old female with type I diabetes mellitus presents to the emergency
+    department with altered mental status. Her friend said that she has been out late
+    either studying for upcoming tests or attending prayer group meetings. As far
+    as the friend can recollect, the patient appeared to be in her usual state of
+    health until only two days ago, when she was prescribed trimethoprim-sulfamethoxazole
+    for a urinary tract infection. The patient complained that the medication was
+    making her feel nauseous and bloated. The patient also relies on glargine and
+    lispro for glycemic control. Her temperature is 100.5°F (38.1°C), blood pressure
+    is 95/55 mmHg, pulse is 130/min, and respirations are 30/min. Her pupils are equal
+    and reactive to light bilaterally. The remainder of the physical exam is unremarkable.
+    Her basic metabolic panel is displayed below:
+
+
+    Serum:
+
+    Na+: 116 mEq/L
+
+    Cl-: 90 mEq/L
+
+    K+: 5.0 mEq/L
+
+    HCO3-: 2 mEq/L
+
+    BUN: 50 mg/dL
+
+    Glucose: 1,200 mg/dL
+
+    Creatinine: 1.5 mg/dL
+
+
+    Which of the following is true regarding this patient''s presentation?
+
+
+    Answer: Hyperkalemia is independent of the patient''s total body potassium stores'
+  - 'A 24-year-old woman, otherwise healthy, presents with a non-productive cough,
+    sore throat, and myalgia. The patient reports that her symptoms started gradually
+    2 weeks ago and have not improved. She has no significant past medical history
+    and no current medications. She is a college student and denies any recent overseas
+    travel. The patient received the flu vaccine this year, and her 2-part PPD required
+    for school was negative. She does not smoke, drink, or use recreational drugs.
+    The patient denies being sexually active. The vital signs include: temperature
+    37.0°C (98.6°F), blood pressure 110/75 mm Hg, pulse 98/min, respirations 20/min,
+    and oxygen saturation 99% on room air. On physical exam, the patient is alert
+    and cooperative. The cardiac exam is normal. There are rales present bilaterally
+    over both lung fields. The skin and conjunctiva are pale. The laboratory tests
+    are pending. The chest X-ray is shown in the image. Which of the following laboratory
+    findings would also commonly be found in this patient?
+
+
+    Answer: Low serum levels of complement'
+  - 'A 35-year-old man presents to the physician with concerns that a “bad flu” he
+    has had for the past 10 days is getting worse and causing sleeplessness. On presentation
+    today, his sore throat has improved; however, fever and chest and body aches persist
+    despite the use of ibuprofen. He reports sharp, intermittent chest pain that worsens
+    with exertion. He has not traveled outside the United States recently and does
+    not have a history of substance abuse or alcohol use. Physical examination shows
+    the temperature is 38.3°C (100.9°F), the heart rate is 110/min, the blood pressure
+    is 120/60 mm Hg, and the oxygen saturation is 98% on room air. There is bilateral
+    pedal edema at the level of the ankle. Auscultation reveals normal S1 and S2 and
+    a third early diastolic heart sound. Jugular vein distention is observed. An ECG
+    shows sinus tachycardia and diffuse ST-segment elevation throughout the precordial
+    leads with 1.0-mm PR-segment depression in leads I and II.
+
+    Laboratory results
+
+    WBC 14,000/mm3
+
+    Lymphocyte count 70%
+
+    Hematocrit 45%
+
+    CRP 56 mg/dL
+
+    Troponin T 1.15 ng/mL
+
+    Troponin I 0.2 ng/mL
+
+    Ck-MB 22 ng/mL
+
+    Coxsackie type b viral antibody  positive
+
+    A chest x-ray shows clear lung fields bilaterally and a mildly enlarged cardiac
+    silhouette. Transthoracic ultrasound reveals a left ventricular ejection fraction
+    of 30%. Which of the following is the cause of difficulty sleeping for this patient?
+
+
+    Answer: Decreased cardiac contractility due to cardiac myocyte injury'
 - source_sentence: A 45-year-old Caucasian man is given nitroglycerin for the management
     of his stable angina. Nitroglycerin given for the rapid relief of acute angina
     would most likely be given through what route of administration?
   sentences:
-  - 'A 45-year-old man comes to the clinic concerned about his recent exposure to
-    radon. He heard from his co-worker that radon exposure can cause lung cancer.
-    He brings in a study concerning the risks of radon exposure. In the study, there
-    were 300 patients exposed to radon, and 18 developed lung cancer over a 10-year
-    period. To compare, there were 500 patients without radon exposure and 11 developed
-    lung cancer over the same 10-year period. If we know that 0.05% of the population
-    has been exposed to radon, what is the attributable risk percent for developing
-    lung cancer over a 10 year period after radon exposure?
+  - 'A 43-year-old man is brought to the emergency department because of severe retrosternal
+    pain radiating to the back and left shoulder for 4 hours. The pain began after
+    attending a farewell party for his coworker at a local bar. He had 3–4 episodes
+    of nonbilious vomiting before the onset of the pain. He has hypertension. His
+    father died of cardiac arrest at the age of 55 years. He has smoked one pack of
+    cigarettes daily for the last 23 years and drinks 2–3 beers daily. His current
+    medications include amlodipine and valsartan. He appears pale. His temperature
+    is 37° C (98.6° F), pulse is 115/min, and blood pressure is 90/60 mm Hg. There
+    are decreased breath sounds over the left base and crepitus is palpable over the
+    thorax. Abdominal examination shows tenderness to palpation in the epigastric
+    region; bowel sounds are normal. Laboratory studies show:
+
+    Hemoglobin 16.5 g/dL
+
+    Leukocyte count 11,100/mm3
+
+    Serum
+
+    Na+ 133 mEq/L
 
+    K+ 3.2 mEq/L
 
-    Answer: 63.3%'
+    Cl- 98 mEq/L
+
+    HCO3- 30 mEq/L
+
+    Creatinine 1.4 mg/dL
+
+    An ECG shows sinus tachycardia with left ventricular hypertrophy. Intravenous
+    fluid resuscitation and antibiotics are begun. Which of the following is the most
+    appropriate test to confirm the diagnosis in this patient?"
+
+
+    Answer: CT scan of the chest'
+  - 'A 45-year-old Caucasian man is given nitroglycerin for the management of his
+    stable angina. Nitroglycerin given for the rapid relief of acute angina would
+    most likely be given through what route of administration?
+
+
+    Answer: Sublingual'
   - 'A 67-year-old man with stable coronary artery disease comes to the physician
     for a follow-up examination. Aside from occasional exertional chest pain on mowing
     the lawn or prolonged jogging, he feels well. He goes jogging for 20 minutes once
@@ -87,157 +314,160 @@ widget:
 
 
     Answer: Reflex sympathetic activity'
-  - 'A 45-year-old Caucasian man is given nitroglycerin for the management of his
-    stable angina. Nitroglycerin given for the rapid relief of acute angina would
-    most likely be given through what route of administration?
+- source_sentence: 'A 42-year-old woman comes to the physician for a routine health
+    maintenance examination. She has generalized fatigue and has had difficulties
+    doing her household duties for the past 3 months. She has eczema and gastroesophageal
+    reflux disease. She has a history of using intravenous methamphetamine in her
+    youth but has not used illicit drugs in 23 years. Her medications include topical
+    clobetasol and pantoprazole. She is 160 cm (5 ft 3 in) tall and weighs 105 kg
+    (231 lb); BMI is 42 kg/m2. Her temperature is 37°C (98.6°F), pulse is 95/min,
+    and blood pressure is 145/90 mm Hg. The lungs are clear to auscultation. Cardiac
+    examination shows no abnormalities. Pelvic examination shows a normal vagina and
+    cervix. Laboratory studies show:
 
+    Hemoglobin 13.1 g/dL
 
-    Answer: Sublingual'
-- source_sentence: "A 12-year-old boy is brought in by his mother for a routine checkup.\
-    \ The patient’s mother says he is frequently fatigued and looks pale. She also\
-    \ claims that he has recently become “much quieter” than normal and is no longer\
-    \ interested in playing baseball with his friends. The patient’s mother believes\
-    \ it may just be “growing pains.” The patient has no significant medical history.\
-    \ He is the 90th percentile for height and weight and has been meeting all developmental\
-    \ milestones. The patient is afebrile, and his vital signs are within normal limits.\
-    \ Physical examination reveals several small bruises on the patient’s right arm\
-    \ and on both thighs. Laboratory findings are significant for the following:\n\
-    Sodium 140 mEq/L\nPotassium 4.2 mEq/L\nChloride 101 mEq/L\nBicarbonate 27 mEq/L\n\
-    BUN 16 mg/dL\nCreatinine 1.2 mg/dL\nGlucose (fasting) 111 mg/dL\n  WBC 3,400/mm3\n\
-    RBC 4.20 x 106/mm3\nHematocrit 22%\nHemoglobin 7.1 g/dL\nPlatelet count 109,000/mm3\n\
-    A peripheral blood smear reveals myeloblasts. Which of the following is the next\
-    \ best step in the management of this patient?"
-  sentences:
-  - 'A 62-year-old man is brought to the emergency department with a 2-day history
-    of cough productive of yellowish sputum. He has had fever, chills, and worsening
-    shortness of breath over this time. He has a 10-year history of hypertension and
-    hyperlipidemia. He does not drink alcohol or smoke cigarettes. His current medications
-    include atorvastatin, amlodipine, and metoprolol. His temperature is 38.9°C (102.0°F),
-    pulse is 105/min, respirations are 27/min, and blood pressure is 110/70 mm Hg.
-    He appears in mild distress. He has rales over the left lower lung field. The
-    remainder of the examination shows no abnormalities. Leukocyte count is 15,000/mm3
-    (87% segmented neutrophils). Arterial blood gas analysis on room air shows:
-
-    pH 7.44
-
-    pO2 68 mm Hg
-
-    pCO2 28 mm Hg
-
-    HCO3- 24 mEq/L
-
-    O2 saturation 91%
-
-    An x-ray of the chest shows a consolidation in the left lower lobe. Asking the
-    patient to lie down in the left lateral decubitus position would most likely result
-    in which of the following?"
-
-
-    Answer: Increase in A-a gradient'
-  - "A 12-year-old boy is brought in by his mother for a routine checkup. The patient’s\
-    \ mother says he is frequently fatigued and looks pale. She also claims that he\
-    \ has recently become “much quieter” than normal and is no longer interested in\
-    \ playing baseball with his friends. The patient’s mother believes it may just\
-    \ be “growing pains.” The patient has no significant medical history. He is the\
-    \ 90th percentile for height and weight and has been meeting all developmental\
-    \ milestones. The patient is afebrile, and his vital signs are within normal limits.\
-    \ Physical examination reveals several small bruises on the patient’s right arm\
-    \ and on both thighs. Laboratory findings are significant for the following:\n\
-    Sodium 140 mEq/L\nPotassium 4.2 mEq/L\nChloride 101 mEq/L\nBicarbonate 27 mEq/L\n\
-    BUN 16 mg/dL\nCreatinine 1.2 mg/dL\nGlucose (fasting) 111 mg/dL\n  WBC 3,400/mm3\n\
-    RBC 4.20 x 106/mm3\nHematocrit 22%\nHemoglobin 7.1 g/dL\nPlatelet count 109,000/mm3\n\
-    A peripheral blood smear reveals myeloblasts. Which of the following is the next\
-    \ best step in the management of this patient?\n\nAnswer: Bone marrow biopsy"
-  - 'A 3-month-old boy is brought to the physician by his mother because of poor weight
-    gain. She also reports a dusky blue discoloration to his skin during feedings
-    and when crying. On examination, there is a harsh, systolic murmur heard over
-    the left upper sternal border. An x-ray of the chest is shown below. Which of
-    the following is the most likely cause of his symptoms?
-
-
-    Answer: Right ventricular outflow obstruction'
-- source_sentence: 'A 33-year-old pregnant woman in the 28th week of gestation presents
-    to the emergency department for evaluation of bilateral edema of her legs. It
-    seems to worsen at the end of the day and has lasted for the past 3 weeks. History
-    reveals that this is her 3rd pregnancy. Vital signs include: blood pressure 120/80
-    mm Hg, heart rate 74/min, respiratory rate 18/min, and temperature 36.6°C (98.0°F).
-    Body mass index is 36 kg/m2. Physical examination reveals bilateral leg edema
-    with engorged surface veins. A photograph of the patient’s legs is shown. Which
-    of the following is the best initial management of the patient?'
+    Leukocyte count 7,800/mm3
+
+    Platelet count 312,000/mm3
+
+    Serum
+
+    Na+ 141 mEq/L
+
+    K+ 4.6 mEq/L
+
+    Cl- 98 mEq/L
+
+    Urea nitrogen 12 mg/dL
+
+    Fasting glucose 110 mg/dL
+
+    Creatinine 0.8 mg/dL
+
+    Total cholesterol 269 mg/dL
+
+    HDL-cholesterol 55 mg/dL
+
+    LDL-cholesterol 160 mg/dL
+
+    Triglycerides 320 mg/dL
+
+    Urinalysis is within normal limits. An x-ray of the chest shows no abnormalities.
+    She has not lost any weight over the past year despite following supervised weight
+    loss programs, including various diets and exercise regimens. Which of the following
+    is the most appropriate next step in management of this patient?"'
   sentences:
-  - 'A 32-year-old G2P0A1 woman presents at 36 weeks of gestation for the first time
-    during her pregnancy. The patient has no complaints, currently. However, her past
-    medical history reveals seizure disorder, which is under control with valproic
-    acid and lithium. She has not seen her neurologist during the past 2 years, in
-    the absence of any complaints. She also reports a previous history of elective
-    abortion. The physical examination is insignificant. Her blood pressure is 130/75
-    mm Hg and pulse is 80/min. The patient is scheduled to undergo regular laboratory
-    tests and abdominal ultrasound. Given her past medical history, which of the following
-    conditions is her fetus most likely going to develop?
-
-
-    Answer: Neural tube defects (NTDs)'
-  - 'A 33-year-old pregnant woman in the 28th week of gestation presents to the emergency
-    department for evaluation of bilateral edema of her legs. It seems to worsen at
-    the end of the day and has lasted for the past 3 weeks. History reveals that this
-    is her 3rd pregnancy. Vital signs include: blood pressure 120/80 mm Hg, heart
-    rate 74/min, respiratory rate 18/min, and temperature 36.6°C (98.0°F). Body mass
-    index is 36 kg/m2. Physical examination reveals bilateral leg edema with engorged
-    surface veins. A photograph of the patient’s legs is shown. Which of the following
-    is the best initial management of the patient?
-
-
-    Answer: Compression stockings'
-  - 'A 22-year-old primigravida is admitted to the obstetrics ward with leg swelling
-    at 35 weeks gestation. She denies any other symptoms. Her pregnancy has been uneventful
-    and she was compliant with the recommended prenatal care. Her vital signs were
-    as follows: blood pressure, 168/95 mm Hg; heart rate, 86/min; respiratory rate,
-    16/min; and temperature, 36.7℃ (98℉). The fetal heart rate was 141/min. The physical
-    examination was significant for 2+ pitting edema of the lower extremity. A dipstick
-    test shows 1+ proteinuria. On reassessment 15 minutes later without administration
-    of an antihypertensive, her blood pressure was 141/88 mm Hg, and the fetal heart
-    rate was 147/min. A decision was made to observe the patient and continue the
-    work-up without initiating antihypertensive therapy. Which of the following clinical
-    features would make the suspected diagnosis into a more severe form?
-
-
-    Answer: Blood pressure of 165/90 mm Hg reassessed 4 hours later'
-- source_sentence: A previously healthy 23-year-old woman comes to the physician because
-    of a 1-week history of vaginal discharge. She has no pain or pruritus. She is
-    sexually active with one male partner and uses condoms inconsistently. Pelvic
-    examination shows a malodorous gray vaginal discharge. Microscopic examination
-    of the vaginal discharge is shown. Which of the following is the most likely diagnosis?
+  - 'A 17-year-old male with a history of bipolar disorder presents to clinic with
+    a rash (Image A) that he noticed one week after starting a medication to stabilize
+    his mood. The medication blocks voltage-gated sodium channels and can be used
+    to treat partial simple, partial complex, and generalized tonic-clonic seizures.
+    Regarding the patient''s rash, what is the next step in management?
+
+
+    Answer: Immediately discontinue the drug'
+  - 'A 42-year-old woman comes to the physician for a routine health maintenance examination.
+    She has generalized fatigue and has had difficulties doing her household duties
+    for the past 3 months. She has eczema and gastroesophageal reflux disease. She
+    has a history of using intravenous methamphetamine in her youth but has not used
+    illicit drugs in 23 years. Her medications include topical clobetasol and pantoprazole.
+    She is 160 cm (5 ft 3 in) tall and weighs 105 kg (231 lb); BMI is 42 kg/m2. Her
+    temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 145/90 mm
+    Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities.
+    Pelvic examination shows a normal vagina and cervix. Laboratory studies show:
+
+    Hemoglobin 13.1 g/dL
+
+    Leukocyte count 7,800/mm3
+
+    Platelet count 312,000/mm3
+
+    Serum
+
+    Na+ 141 mEq/L
+
+    K+ 4.6 mEq/L
+
+    Cl- 98 mEq/L
+
+    Urea nitrogen 12 mg/dL
+
+    Fasting glucose 110 mg/dL
+
+    Creatinine 0.8 mg/dL
+
+    Total cholesterol 269 mg/dL
+
+    HDL-cholesterol 55 mg/dL
+
+    LDL-cholesterol 160 mg/dL
+
+    Triglycerides 320 mg/dL
+
+    Urinalysis is within normal limits. An x-ray of the chest shows no abnormalities.
+    She has not lost any weight over the past year despite following supervised weight
+    loss programs, including various diets and exercise regimens. Which of the following
+    is the most appropriate next step in management of this patient?"
+
+
+    Answer: Bariatric surgery'
+  - 'A 43-year-old woman visits her primary care provider complaining of fatigue.
+    Although she has had it for several months, her fatigue has been worsening over
+    the past few weeks. She has no other symptoms. Past medical history is significant
+    for hypertension. She takes chlorthalidone, an oral contraceptive pill, and a
+    multivitamin every day. Family history is noncontributory. She drinks about 1
+    bottle of wine every day and started taking a shot or two of whisky or vodka every
+    morning before work to “clear out the cobwebs”. She was recently fired from her
+    job. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure
+    is 110/65 mm Hg, and temperature is 36.7°C (98.1°F). On physical exam, she appears
+    malnourished and anxious. Her conjunctiva are pale, and glossitis is noted on
+    oral exam. Her heart has a regular rate and rhythm and her lungs are clear to
+    auscultation bilaterally. She has no gait or balance abnormalities. Lab results
+    show a hemoglobin of 10 g/dL, with a mean corpuscular volume (MCV) of 108 fl.
+    Elevated level of which of the following will most likely to be found in this
+    patient?
+
+
+    Answer: Homocysteine'
+- source_sentence: A 45-year-old woman, gravida 3, para 2, at 18 weeks' gestation
+    comes to the physician for a prenatal visit. Ultrasonography at a previous visit
+    when she was at 12 weeks' gestation showed a hypoplastic nasal bone. Pelvic examination
+    shows a uterus consistent in size with an 18-week gestation. Maternal serum studies
+    show low α-fetoprotein and free estriol concentrations, and increased inhibin
+    A and β-hCG concentrations. Physical examination of the infant after delivery
+    is most likely to show which of the following findings?
   sentences:
-  - 'A previously healthy 23-year-old woman comes to the physician because of a 1-week
-    history of vaginal discharge. She has no pain or pruritus. She is sexually active
-    with one male partner and uses condoms inconsistently. Pelvic examination shows
-    a malodorous gray vaginal discharge. Microscopic examination of the vaginal discharge
-    is shown. Which of the following is the most likely diagnosis?
-
-
-    Answer: Bacterial vaginosis'
-  - 'A 22-year-old female presents to her physician for evaluation of a vaginal discharge,
-    itching, and irritation. She recently started a new relationship with her boyfriend,
-    who is her only sexual partner. He does not report any genitourinary symptoms.
-    She takes oral contraceptives and does not use  barrier contraception. The medical
-    history is unremarkable. The vital signs are within normal limits. A gynecologic
-    examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant
-    odor and numerous punctate red maculae on the ectocervix. The remainder of the
-    exam is normal. Which of the following organisms will most likely be revealed
-    on wet mount microscopy?
-
-
-    Answer: Motile round or oval-shaped microorganisms'
-  - 'A 38-year-old woman, gravida 4, para 3, at 20 weeks'' gestation comes to the
-    physician for a prenatal care visit. She used fertility enhancing treatment for
-    her current pregnancy. Her other children were born before 37 weeks'' gestation.
-    She is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28.4 kg/m2. Her
-    vital signs are within normal limits. The abdomen is nontender, and no contractions
-    are felt. Ultrasonography shows a cervical length of 22 mm and a fetal heart rate
-    of 140/min. Which of the following is the most likely diagnosis?
-
-
-    Answer: Cervical insufficiency'
+  - 'A 45-year-old woman, gravida 3, para 2, at 18 weeks'' gestation comes to the
+    physician for a prenatal visit. Ultrasonography at a previous visit when she was
+    at 12 weeks'' gestation showed a hypoplastic nasal bone. Pelvic examination shows
+    a uterus consistent in size with an 18-week gestation. Maternal serum studies
+    show low α-fetoprotein and free estriol concentrations, and increased inhibin
+    A and β-hCG concentrations. Physical examination of the infant after delivery
+    is most likely to show which of the following findings?
+
+
+    Answer: Single transverse palmar crease'
+  - 'A 35-year-old woman gravida 2, para 1, comes to the physician for her first prenatal
+    visit. Pregnancy and delivery of her first child were uncomplicated. She is not
+    sure about the date of her last menstrual period. Pelvic examination shows a uterus
+    consistent in size with a 10-week gestation. An ultrasound examination confirms
+    the gestational age and shows one fetus with no indication of multiple gestations.
+    During counseling on pregnancy risks and possible screening and diagnostic tests,
+    the patient states she would like to undergo screening for Down syndrome. She
+    would prefer immediate and secure screening with a low risk to herself and the
+    fetus. Which of the following is the most appropriate next step in management
+    at this time?
+
+
+    Answer: Cell-free fetal DNA testing'
+  - 'A 6-month-old male presents with a painless, enlarged left scrotum. After examining
+    the patient, you suspect this enlargement is secondary to serous fluid entering
+    and accumulating in the scrotum through a patent processus vaginalis. Which of
+    the following would be the most useful next step in confirming the diagnosis of
+    this patient’s condition?
+
+
+    Answer: Transillumination test followed by scrotal ultrasound'
 pipeline_tag: sentence-similarity
 library_name: sentence-transformers
 ---
@@ -291,9 +521,9 @@ from sentence_transformers import SentenceTransformer
 model = SentenceTransformer("sentence_transformers_model_id")
 # Run inference
 sentences = [
-    'A previously healthy 23-year-old woman comes to the physician because of a 1-week history of vaginal discharge. She has no pain or pruritus. She is sexually active with one male partner and uses condoms inconsistently. Pelvic examination shows a malodorous gray vaginal discharge. Microscopic examination of the vaginal discharge is shown. Which of the following is the most likely diagnosis?',
-    'A previously healthy 23-year-old woman comes to the physician because of a 1-week history of vaginal discharge. She has no pain or pruritus. She is sexually active with one male partner and uses condoms inconsistently. Pelvic examination shows a malodorous gray vaginal discharge. Microscopic examination of the vaginal discharge is shown. Which of the following is the most likely diagnosis?\n\nAnswer: Bacterial vaginosis',
-    'A 22-year-old female presents to her physician for evaluation of a vaginal discharge, itching, and irritation. She recently started a new relationship with her boyfriend, who is her only sexual partner. He does not report any genitourinary symptoms. She takes oral contraceptives and does not use  barrier contraception. The medical history is unremarkable. The vital signs are within normal limits. A gynecologic examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant odor and numerous punctate red maculae on the ectocervix. The remainder of the exam is normal. Which of the following organisms will most likely be revealed on wet mount microscopy?\n\nAnswer: Motile round or oval-shaped microorganisms',
+    "A 45-year-old woman, gravida 3, para 2, at 18 weeks' gestation comes to the physician for a prenatal visit. Ultrasonography at a previous visit when she was at 12 weeks' gestation showed a hypoplastic nasal bone. Pelvic examination shows a uterus consistent in size with an 18-week gestation. Maternal serum studies show low α-fetoprotein and free estriol concentrations, and increased inhibin A and β-hCG concentrations. Physical examination of the infant after delivery is most likely to show which of the following findings?",
+    "A 45-year-old woman, gravida 3, para 2, at 18 weeks' gestation comes to the physician for a prenatal visit. Ultrasonography at a previous visit when she was at 12 weeks' gestation showed a hypoplastic nasal bone. Pelvic examination shows a uterus consistent in size with an 18-week gestation. Maternal serum studies show low α-fetoprotein and free estriol concentrations, and increased inhibin A and β-hCG concentrations. Physical examination of the infant after delivery is most likely to show which of the following findings?\n\nAnswer: Single transverse palmar crease",
+    'A 35-year-old woman gravida 2, para 1, comes to the physician for her first prenatal visit. Pregnancy and delivery of her first child were uncomplicated. She is not sure about the date of her last menstrual period. Pelvic examination shows a uterus consistent in size with a 10-week gestation. An ultrasound examination confirms the gestational age and shows one fetus with no indication of multiple gestations. During counseling on pregnancy risks and possible screening and diagnostic tests, the patient states she would like to undergo screening for Down syndrome. She would prefer immediate and secure screening with a low risk to herself and the fetus. Which of the following is the most appropriate next step in management at this time?\n\nAnswer: Cell-free fetal DNA testing',
 ]
 embeddings = model.encode(sentences)
 print(embeddings.shape)
@@ -302,9 +532,9 @@ print(embeddings.shape)
 # Get the similarity scores for the embeddings
 similarities = model.similarity(embeddings, embeddings)
 print(similarities)
-# tensor([[1.0000, 0.9727, 0.8125],
-#         [0.9727, 0.9922, 0.8555],
-#         [0.8125, 0.8555, 1.0000]], dtype=torch.bfloat16)
+# tensor([[1.0000, 0.9805, 0.5273],
+#         [0.9805, 1.0000, 0.5430],
+#         [0.5273, 0.5430, 1.0000]], dtype=torch.bfloat16)
 ```
 
 <!--
@@ -357,16 +587,17 @@ You can finetune this model on your own dataset.
   | type    | string                                                                              | string                                                                               | string                                                                               |
   | details | <ul><li>min: 36 tokens</li><li>mean: 219.2 tokens</li><li>max: 791 tokens</li></ul> | <ul><li>min: 49 tokens</li><li>mean: 227.77 tokens</li><li>max: 819 tokens</li></ul> | <ul><li>min: 51 tokens</li><li>mean: 159.34 tokens</li><li>max: 430 tokens</li></ul> |
 * Samples:
-  | sentence_0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                | sentence_1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                | sentence_2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
-  |:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|:----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
-  | <code>A 54-year-old man with a long-standing history of chronic obstructive pulmonary disease (COPD) presents to the clinic for progressive shortness of breath. The patient reports generalized fatigue, distress, and difficulty breathing that is exacerbated with exertion. Physical examination demonstrates clubbing of the fingers, and an echocardiogram shows right ventricular hypertrophy. The patient is placed on a medication for symptom control. One month later, the patient returns for follow up with some improvement in symptoms. Laboratory tests are drawn and shown below:<br><br>Serum:<br>Na+: 137 mEq/L<br>Cl-: 101 mEq/L<br>K+: 4.8 mEq/L<br>HCO3-: 25 mEq/L<br>BUN: 8.5 mg/dL<br>Glucose: 117 mg/dL<br>Creatinine: 1.4 mg/dL<br>Thyroid-stimulating hormone: 1.8 µU/mL<br>Ca2+: 9.6 mg/dL<br>AST: 159 U/L<br>ALT: 201 U/L<br><br>What is the mechanism of action of the likely medication given?</code>                                                                                                                                                      | <code>A 54-year-old man with a long-standing history of chronic obstructive pulmonary disease (COPD) presents to the clinic for progressive shortness of breath. The patient reports generalized fatigue, distress, and difficulty breathing that is exacerbated with exertion. Physical examination demonstrates clubbing of the fingers, and an echocardiogram shows right ventricular hypertrophy. The patient is placed on a medication for symptom control. One month later, the patient returns for follow up with some improvement in symptoms. Laboratory tests are drawn and shown below:<br><br>Serum:<br>Na+: 137 mEq/L<br>Cl-: 101 mEq/L<br>K+: 4.8 mEq/L<br>HCO3-: 25 mEq/L<br>BUN: 8.5 mg/dL<br>Glucose: 117 mg/dL<br>Creatinine: 1.4 mg/dL<br>Thyroid-stimulating hormone: 1.8 µU/mL<br>Ca2+: 9.6 mg/dL<br>AST: 159 U/L<br>ALT: 201 U/L<br><br>What is the mechanism of action of the likely medication given?<br><br>Answer: Competitive inhibition of endothelin-1 receptors</code>                                                                                      | <code>A 60-year-old man with known history of chronic obstructive pulmonary disease is brought by ambulance to the emergency department due to shortness of breath. He is out of breath and cannot string a sentence together. The emergency technician suggests that the man tried his tiotropium inhaler multiple times without success. The patient's vitals are as follows: afebrile, BP 90/60, HR 120, RR 24. Oxygen saturation is 90%. An EKG is obtained that shows narrow-complex tachycardia with irregular P waves preceding each QRS complex and irregular PR intervals. What is the best next step in management?<br><br>Answer: Give oxygen immediately</code> |
-  | <code>A 20-year-old female with type I diabetes mellitus presents to the emergency department with altered mental status. Her friend said that she has been out late either studying for upcoming tests or attending prayer group meetings. As far as the friend can recollect, the patient appeared to be in her usual state of health until only two days ago, when she was prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. The patient complained that the medication was making her feel nauseous and bloated. The patient also relies on glargine and lispro for glycemic control. Her temperature is 100.5°F (38.1°C), blood pressure is 95/55 mmHg, pulse is 130/min, and respirations are 30/min. Her pupils are equal and reactive to light bilaterally. The remainder of the physical exam is unremarkable. Her basic metabolic panel is displayed below:<br><br>Serum:<br>Na+: 116 mEq/L<br>Cl-: 90 mEq/L<br>K+: 5.0 mEq/L<br>HCO3-: 2 mEq/L<br>BUN: 50 mg/dL<br>Glucose: 1,200 mg/dL<br>Creatinine: 1.5 mg/dL<br><br>Which of the following...</code> | <code>A 20-year-old female with type I diabetes mellitus presents to the emergency department with altered mental status. Her friend said that she has been out late either studying for upcoming tests or attending prayer group meetings. As far as the friend can recollect, the patient appeared to be in her usual state of health until only two days ago, when she was prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. The patient complained that the medication was making her feel nauseous and bloated. The patient also relies on glargine and lispro for glycemic control. Her temperature is 100.5°F (38.1°C), blood pressure is 95/55 mmHg, pulse is 130/min, and respirations are 30/min. Her pupils are equal and reactive to light bilaterally. The remainder of the physical exam is unremarkable. Her basic metabolic panel is displayed below:<br><br>Serum:<br>Na+: 116 mEq/L<br>Cl-: 90 mEq/L<br>K+: 5.0 mEq/L<br>HCO3-: 2 mEq/L<br>BUN: 50 mg/dL<br>Glucose: 1,200 mg/dL<br>Creatinine: 1.5 mg/dL<br><br>Which of the following...</code> | <code>A 53-year-old woman with type 2 diabetes mellitus is admitted for evaluation of recurrent episodes of nausea, tremors, and excessive sweating. She works as a nurse and reports self-measured blood glucose levels below 50 mg/dL on several occasions. Her family history is positive for borderline personality disorder. The only medication listed in her history is metformin. Which of the following is the most appropriate next step in management?<br><br>Answer: Ask the patient if she is taking any medications other than metformin</code>                                                                                                               |
-  | <code>A 50-year-old man undergoes parathyroidectomy for treatment-resistant hyperparathyroidism. The procedure is complicated by brisk bleeding from an artery that travels along the external branch of the superior laryngeal nerve. To stop the bleeding, the artery is ligated at its origin. Which of the following is most likely the origin of the artery that was injured in this patient?</code>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | <code>A 50-year-old man undergoes parathyroidectomy for treatment-resistant hyperparathyroidism. The procedure is complicated by brisk bleeding from an artery that travels along the external branch of the superior laryngeal nerve. To stop the bleeding, the artery is ligated at its origin. Which of the following is most likely the origin of the artery that was injured in this patient?<br><br>Answer: External carotid artery</code>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          | <code>A 57-year-old man comes to the physician with a 3-month history of right flank pain. Urinalysis shows 60 RBC/hpf. Renal ultrasound shows a 3 cm, well-defined mass in the upper pole of the right kidney. A photomicrograph of a section of the resected mass is shown. Which of the following is the most likely diagnosis?<br><br>Answer: Oncocytoma</code>                                                                                                                                                                                                                                                                                                         |
-* Loss: [<code>TripletLoss</code>](https://sbert.net/docs/package_reference/sentence_transformer/losses.html#tripletloss) with these parameters:
+  | sentence_0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | sentence_1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | sentence_2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
+  |:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|:---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
+  | <code>A 48-year-old woman presents to the emergency department because of increasingly severe right upper abdominal pain, fever, and non-bloody vomiting for the last 5 hours. The pain is dull, intermittent, and radiates to her right shoulder. During the past 3 months, she has had recurring abdominal discomfort after meals. The patient underwent an appendectomy more than 30 years ago. She has hypertension, diabetes mellitus type 2, and chronic back pain. She takes bisoprolol, metformin, and ibuprofen daily. She is 171 cm (5 ft 6 in) tall and weighs 99 kg (218 lb). Her BMI is 35.2 kg/m2. She appears uncomfortable and is clutching her abdomen. Her temperature is 38.5°C (101.3°F), pulse is 108/min, and blood pressure is 150/82 mm Hg. Abdominal examination shows right upper quadrant abdominal tenderness and guarding. Upon deep palpation of the right upper quadrant, the patient pauses during inspiration. Laboratory studies show the following:<br>Blood<br>Hemoglobin 13.1 g/dL<br>Leukocyte count 10,900/mm3<br>P...</code>                                        | <code>A 48-year-old woman presents to the emergency department because of increasingly severe right upper abdominal pain, fever, and non-bloody vomiting for the last 5 hours. The pain is dull, intermittent, and radiates to her right shoulder. During the past 3 months, she has had recurring abdominal discomfort after meals. The patient underwent an appendectomy more than 30 years ago. She has hypertension, diabetes mellitus type 2, and chronic back pain. She takes bisoprolol, metformin, and ibuprofen daily. She is 171 cm (5 ft 6 in) tall and weighs 99 kg (218 lb). Her BMI is 35.2 kg/m2. She appears uncomfortable and is clutching her abdomen. Her temperature is 38.5°C (101.3°F), pulse is 108/min, and blood pressure is 150/82 mm Hg. Abdominal examination shows right upper quadrant abdominal tenderness and guarding. Upon deep palpation of the right upper quadrant, the patient pauses during inspiration. Laboratory studies show the following:<br>Blood<br>Hemoglobin 13.1 g/dL<br>Leukocyte count 10,900/mm3<br>P...</code>                                        | <code>A 27-year-old woman presents with acute abdominal pain in her right upper quadrant. The pain came on suddenly while she was eating dinner. After this pain she began feeling dizzy and came to the emergency department. In the ED, her blood pressure is 75/40 mmHg, pulse is 100/minute, and she is afebrile. On physical exam, she feels too light-headed to ambulate. She demonstrates normal bowel sounds with tenderness upon palpation in the right upper quadrant. The patient is deemed too unstable for imaging. An abdominal radiograph and CT are reviewed from a recent previous visit to the ED for mild abdominal pain, and are shown in Figures A and B, respectively. Which of the following specific additional findings in her history supports the most likely diagnosis?<br><br>Answer: Use of oral contraceptives (OCPs) for birth control</code>                                                                                                                                                                            |
+  | <code>A 42-year-old man presents to his primary care provider for abdominal pain. He reports that for several months he has been experiencing a stabbing pain above the umbilicus during meals. He denies associated symptoms of nausea, vomiting, or diarrhea. The patient’s past medical history is significant for hypertension and hyperlipidemia for which he takes amlodipine and atorvastatin. His family history is significant for lung cancer in his father. The patient is a current smoker with a 20 pack-year smoking history and drinks 3-5 beers per week. Initial laboratory testing is as follows:<br><br>Serum:<br>Na+: 141 mEq/L<br>K+: 4.6 mEq/L<br>Cl-: 102 mEq/L<br>HCO3-: 25 mEq/L<br>Urea nitrogen: 14 mg/dL<br>Creatinine: 1.1 mg/dL<br>Glucose: 120 mg/dL<br>Calcium: 8.4 mg/dL<br>Alkaline phosphatase: 66 U/L<br>Aspartate aminotransferase (AST): 40 U/L<br>Alanine aminotransferase (ALT): 52 U/L<br>Gastrin: 96 pg/mL (<100 pg/mL)<br>Lipase: 90 U/L (<160 U/L)<br><br>The patient is started on a proton pump inhibitor without symptomatic improvement after 6 w...</code> | <code>A 42-year-old man presents to his primary care provider for abdominal pain. He reports that for several months he has been experiencing a stabbing pain above the umbilicus during meals. He denies associated symptoms of nausea, vomiting, or diarrhea. The patient’s past medical history is significant for hypertension and hyperlipidemia for which he takes amlodipine and atorvastatin. His family history is significant for lung cancer in his father. The patient is a current smoker with a 20 pack-year smoking history and drinks 3-5 beers per week. Initial laboratory testing is as follows:<br><br>Serum:<br>Na+: 141 mEq/L<br>K+: 4.6 mEq/L<br>Cl-: 102 mEq/L<br>HCO3-: 25 mEq/L<br>Urea nitrogen: 14 mg/dL<br>Creatinine: 1.1 mg/dL<br>Glucose: 120 mg/dL<br>Calcium: 8.4 mg/dL<br>Alkaline phosphatase: 66 U/L<br>Aspartate aminotransferase (AST): 40 U/L<br>Alanine aminotransferase (ALT): 52 U/L<br>Gastrin: 96 pg/mL (<100 pg/mL)<br>Lipase: 90 U/L (<160 U/L)<br><br>The patient is started on a proton pump inhibitor without symptomatic improvement after 6 w...</code> | <code>A 42-year-old man comes to his primary care physician complaining of abdominal pain. He describes intermittent, burning, epigastric pain over the past 4 months. He reports that the pain worsens following meals. He had an upper gastrointestinal endoscopy done 2 months ago that showed a gastric ulcer without evidence of malignancy. The patient was prescribed pantoprazole with minimal improvement in symptoms. He denies nausea, vomiting, diarrhea, or melena. The patient has no other medical problems. He had a total knee replacement 3 years ago following a motor vehicle accident for which he took naproxen for 2 months for pain management. He has smoked 1 pack per day since the age 22 and drinks 1-2 beers several nights a week with dinner. He works as a truck driver, and his diet consists of mostly of fast food. His family history is notable for hypertension in his paternal grandfather and coronary artery disease in his mother. On physical examination, the abdomen is soft, nondistended, and ...</code> |
+  | <code>A 62-year-old woman comes to the physician in June for a routine check-up. She has chronic back pain and underwent an appendectomy at the age of 27. She is married and has two kids. The patient recently got back from a cruise to Mexico where she celebrated her 40th wedding anniversary. Her last mammogram was 6 months ago and showed no abnormalities. Her last Pap smear was 2 years ago and unremarkable. A colonoscopy 5 years ago was normal. Her mother died of breast cancer last year and her father has arterial hypertension. Her immunization records show that she has never received a pneumococcal or a shingles vaccine, her last tetanus booster was 6 years ago, and her last influenza vaccine was 2 years ago. She drinks 1– 2 alcoholic beverages every weekend. She takes a multivitamin daily and uses topical steroids. She regularly attends water aerobic classes and physical therapy for her back pain. She is 168 cm (5 ft 6 in) tall and weighs 72 kg (160 lb); BMI is 26 kg/m2. Her temperature is...</code>                                                    | <code>A 62-year-old woman comes to the physician in June for a routine check-up. She has chronic back pain and underwent an appendectomy at the age of 27. She is married and has two kids. The patient recently got back from a cruise to Mexico where she celebrated her 40th wedding anniversary. Her last mammogram was 6 months ago and showed no abnormalities. Her last Pap smear was 2 years ago and unremarkable. A colonoscopy 5 years ago was normal. Her mother died of breast cancer last year and her father has arterial hypertension. Her immunization records show that she has never received a pneumococcal or a shingles vaccine, her last tetanus booster was 6 years ago, and her last influenza vaccine was 2 years ago. She drinks 1– 2 alcoholic beverages every weekend. She takes a multivitamin daily and uses topical steroids. She regularly attends water aerobic classes and physical therapy for her back pain. She is 168 cm (5 ft 6 in) tall and weighs 72 kg (160 lb); BMI is 26 kg/m2. Her temperature is...</code>                                                    | <code>A 66-year-old G3P3 presents with an 8-year-history of back pain, perineal discomfort, difficulty urinating, recurrent malaise, and low-grade fevers. These symptoms have recurred regularly for the past 5–6 years. She also says that there are times when she experiences a feeling of having a foreign body in her vagina. With the onset of symptoms, she was evaluated by a physician who prescribed her medications after a thorough examination and recommended a vaginal pessary, but she was non-compliant. She had 3 vaginal deliveries She has been menopausal since 51 years of age. She does not have a history of malignancies or cardiovascular disease. She has type 2 diabetes mellitus that is controlled with diet and metformin. Her vital signs include: blood pressure 110/60 mm Hg, heart rate 91/min, respiratory rate 13/min, and temperature 37.4℃ (99.3℉). On physical examination, there is bilateral costovertebral angle tenderness. The urinary bladder is non-palpable. The gynecologic examination reve...</code> |
+* Loss: [<code>MultipleNegativesRankingLoss</code>](https://sbert.net/docs/package_reference/sentence_transformer/losses.html#multiplenegativesrankingloss) with these parameters:
   ```json
   {
-      "distance_metric": "TripletDistanceMetric.COSINE",
-      "triplet_margin": 0.1
+      "scale": 20.0,
+      "similarity_fct": "cos_sim",
+      "gather_across_devices": false
   }
   ```
 
@@ -505,15 +736,15 @@ You can finetune this model on your own dataset.
 }
 ```
 
-#### TripletLoss
+#### MultipleNegativesRankingLoss
 ```bibtex
-@misc{hermans2017defense,
-    title={In Defense of the Triplet Loss for Person Re-Identification},
-    author={Alexander Hermans and Lucas Beyer and Bastian Leibe},
+@misc{henderson2017efficient,
+    title={Efficient Natural Language Response Suggestion for Smart Reply},
+    author={Matthew Henderson and Rami Al-Rfou and Brian Strope and Yun-hsuan Sung and Laszlo Lukacs and Ruiqi Guo and Sanjiv Kumar and Balint Miklos and Ray Kurzweil},
     year={2017},
-    eprint={1703.07737},
+    eprint={1705.00652},
     archivePrefix={arXiv},
-    primaryClass={cs.CV}
+    primaryClass={cs.CL}
 }
 ```
 

model.safetensors

@@ -1,3 +1,3 @@
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-oid sha256:d03e1552ecb8c1f4e677263184b2b95d7618da59040085a27d806449b5717b39
+oid sha256:f3b07bc5fa03580dcc3c4ff90771f8d30a50c8822989015e54bd568a518d5cf8
 size 613892480