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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['An', '8-year-old', 'boy', 'consults', 'for', 'the', 'appearance', 'of', 'pubic', 'hair', 'at', 'the', 'base', 'of', 'the', 'penis', 'for', 'the', 'last', '12', 'months.'], ['The', 'testicle', 'has', 'not', 'increased', 'in', 'volume', 'and', 'the', 'penis', 'has', 'not', 'increased', 'in', 'size.'], ['There', 'is', 'no', 'increase', 'in', 'growth', 'rate', 'in', 'the', 'last', 'year.'], ['The', 'bone', 'age', 'is', 'one', 'year', 'older', 'than', 'the', 'chronological', 'age.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Central', 'precocious', 'puberty.'], ['2-', 'Peripheral', 'precocious', 'puberty.'], ['3-', 'Early', 'adrenarche.'], ['4-', 'Adrenal', 'tumor.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['In', 'the', 'male,', 'the', 'onset', 'of', 'puberty', 'is', 'considered', 'normal', 'from', 'the', 'age', 'of', '9', 'years,', 'therefore', 'in', 'this', 'case', 'it', 'is', 'a', 'premature', 'puberty.'], ['The', 'onset', 'of', 'puberty', 'is', 'defined', 'as', 'an', 'increase', 'in', 'testicular', 'volume', '(greater', 'than', 'or', 'equal', 'to', '4cc);', 'by', 'specifying', 'that', 'the', 'testicular', 'size', 'has', 'not', 'increased,', 'we', 'can', 'rule', 'out', 'options', '1', 'and', '2.'], ['The', 'excessive', 'secretion', 'of', 'androgens', 'produced', 'by', 'an', 'adrenal', 'tumor', 'would', 'cause', 'a', 'greater', 'amount', 'of', 'hair', 'and', 'an', 'increase', 'in', 'penile', 'size,', 'which', 'our', 'patient', 'does', 'not', 'present.'], ['Therefore,', 'the', 'correct', 'option', 'is', 'early', 'adrenarche.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In the male, the onset of puberty is considered normal from the age of 9 years\n', 'therefore in this case it is a premature puberty\n', 'Support'], ['the testicular size has not increased\n', 'we can rule out options 1 and 2\n', 'Support'], ['we can rule out options 1 and 2\n', 'Central precocious puberty\n', 'Attack'], ['we can rule out options 1 and 2\n', 'Peripheral precocious puberty\n', 'Attack'], ['The onset of puberty is defined as an increase in testicular volume (greater than or equal to 4cc)\n', 'we can rule out options 1 and 2\n', 'Support'], ['The onset of puberty is defined as an increase in testicular volume (greater than or equal to 4cc)\n', 'the testicular size has not increased\n', 'Attack'], ['The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n', 'Therefore, the correct option is early adrenarche\n', 'Support'], ['The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n', 'Adrenal tumor\n', 'Attack'], ['An 8-year-old boy consults for the appearance of pubic hair at the base of the penis for the last 12 months\n', 'The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n', 'Attack'], ['The testicle has not increased in volume and the penis has not increased in size\n', 'The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n', 'Attack'], ['Therefore, the correct option is early adrenarche\n', 'Early adrenarche\n', 'Support']]
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300_106
|
[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'man', 'from', 'Cameroon', 'consults', 'for', 'fever', 'cough', 'and', 'left', 'hemithorax', 'pain', 'of', '1', "month's", 'evolution.'], ['He', 'took', 'amoxicillin-clavulanic', 'acid', 'for', '1', 'week', 'without', 'improvement', 'of', 'symptoms.'], ['A', 'blood', 'test', 'showed', 'a', 'white', 'blood', 'cell', 'count', 'of', '8000/microL', 'and', 'a', 'hemoglobin', 'of', '12.8', 'g/dL.'], ['Chest', 'X-ray', 'showed', 'a', 'loculated', 'left', 'pleural', 'effusion', 'occupying', 'one', 'third', 'of', 'the', 'hemithorax.'], ['A', 'thoracentesis', 'shows', 'a', 'yellowish', 'fluid', 'with', 'the', 'following', 'features:', 'red', 'blood', 'cells', '2000/uL,', 'leukocytes', '2500/uL,', 'with', '90%', 'lymphocytes,', 'protein', '4.9', 'g/dL,', 'lactate', 'dehydrogenase', '550', 'U/L,', 'glucose', '67', 'mg/dL,', 'and', 'absence', 'of', 'malignant', 'cells', 'on', 'cytology.'], ['Which', 'of', 'the', 'following', 'tests', 'would', 'be', 'most', 'useful', 'in', 'diagnosing', 'the', 'cause', 'of', 'the', 'pleural', 'effusion?'], ['1-', 'A', 'thoracic', 'computed', 'tomography', '(CT)', 'scan.'], ['2-', 'Pleural', 'fluid', 'pH', 'measurement.'], ['3-', 'Measurement', 'of', 'adenosine', 'deaminase', 'in', 'pleural', 'fluid.'], ['4-', 'Tuberculin', 'test.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'determination', 'of', 'ADA,', 'in', 'the', 'presence', 'of', 'a', 'pneumonia', 'of', 'long', 'evolution', 'that', 'does', 'not', 'improve', 'with', 'antibiotic', 'treatment,', 'with', 'an', 'effusion', 'with', 'abundant', 'leukocytes', 'and', 'lymphocytic', 'predominance,', 'in', 'which', 'the', 'presence', 'of', 'neoplasia', 'is', 'ruled', 'out,', 'with', 'values', 'higher', 'than', '70', 'UI/L,', 'should', 'lead', 'us', 'to', 'have', 'a', 'high', 'degree', 'of', 'suspicion', 'about', 'tuberculous', 'etiology', 'and', 'send', 'the', 'pleural', 'fluid', 'to', 'microbiology', 'for', 'tuberculosis', 'study.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L\n', 'The determination of ADA, in the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L, should lead us to have a high degree of suspicion about tuberculous etiology and send the pleural fluid to microbiology for tuberculosis study\n', 'Support'], ['The determination of ADA, in the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L, should lead us to have a high degree of suspicion about tuberculous etiology and send the pleural fluid to microbiology for tuberculosis study\n', 'Measurement of adenosine deaminase in pleural fluid\n', 'Support']]
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434_119
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '38-year-old', 'woman', 'of', 'veterinary', 'profession,', 'in', 'charge', 'of', 'monitoring', 'wild', 'animals', 'and', 'assisting', 'in', 'the', 'delivery', 'of', 'domestic', 'livestock.'], ['She', 'starts', 'with', 'a', 'high', 'fever', 'with', 'chills,', 'headache,', 'myalgia', 'and', 'non-productive', 'cough', 'that', 'she', 'interprets', 'as', 'a', 'flu-like', 'process.'], ['She', 'presented', 'with', 'chest', 'pain.'], ['Chest', 'X-ray', 'showed', 'bilateral', 'pulmonary', 'infiltrates', 'in', 'lower', 'fields.'], ['A', 'serologic', 'test', 'was', 'performed', 'with', 'elevated', 'antibody', 'titers', 'against', 'phase', 'I', 'antigens.'], ['Which', 'of', 'the', 'following', 'statements', 'is', 'TRUE?'], ['1-', 'The', 'way', 'of', 'transmission', 'of', 'this', 'entity', 'is', 'by', 'ticks.'], ['2-', 'Both', 'doxycycline', 'and', 'hydroxychloroquine', 'are', 'effective', 'in', 'treating', 'acute', 'forms', 'of', 'this', 'disease.'], ['3-', 'In', 'its', 'acute', 'form', 'it', 'also', 'presents,', 'generally,', 'elevation', 'of', 'antibodies', 'against', 'phase', 'I', 'antigens.'], ['4-', 'Mortality', 'in', 'acute', 'forms', 'is', 'almost', 'nonexistent.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Acute', 'infection', 'by', 'Coxiella', 'burnetii', 'manifested', 'in', 'this', 'case', 'by', 'Pneumonia.'], ['Coxiella', 'infection', 'is', 'not', 'transmitted', 'by', 'ticks.'], ['The', 'contact', 'can', 'be', 'with', 'high', 'probability', 'at', 'the', 'time', 'of', 'delivery', 'of', 'an', 'infected', 'farm', 'animal,', 'in', 'which', 'the', 'bacterium', 'is', 'disseminated', 'in', 'aerosols.'], ['The', 'treatment', 'of', 'choice', 'is', 'with', 'doxycycline', 'in', 'the', 'acute', 'phase', '(if', 'meningitis', 'is', 'present,', 'quinolones', 'are', 'preferred', 'due', 'to', 'penetration', 'of', 'the', 'blood-brain', 'barrier).'], ['The', 'combination', 'of', 'doxycycline', 'plus', 'hicroxychloroquine', 'can', 'be', 'used,', 'but', 'for', 'chronic', 'Q', 'fever', '(which', 'is', 'where', 'elevation', 'of', 'antibodies', 'against', 'phase', 'I', 'antigens', 'is', 'observed', 'and', 'carries', 'a', 'higher', 'risk', 'of', 'mortality).']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Coxiella infection is not transmitted by ticks\n', 'The way of transmission of this entity is by ticks\n', 'Attack'], ['The contact can be with high probability at the time of delivery of an infected farm animal, in which the bacterium is disseminated in aerosols\n', 'Coxiella infection is not transmitted by ticks\n', 'Attack'], ['A serologic test was performed with elevated antibody titers against phase I antigens\n', 'elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality\n', 'Support'], ['The combination of doxycycline plus hicroxychloroquine can be used, but for chronic Q fever\n', 'Both doxycycline and hydroxychloroquine are effective in treating acute forms of this disease\n', 'Attack'], ['elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality\n', 'In its acute form it also presents, generally, elevation of antibodies against phase I antigens\n', 'Attack'], ['The treatment of choice is with doxycycline in the acute phase\n', 'Both doxycycline and hydroxychloroquine are effective in treating acute forms of this disease\n', 'Attack'], ['elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality\n', 'Mortality in acute forms is almost nonexistent\n', 'Attack']]
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563_175
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[['QUESTION', 'TYPE:', 'PREVENTIVE', 'MEDICINE'], ['CLINICAL', 'CASE:'], ['A', '62-year-old', 'patient', 'who', 'consults', 'because', 'of', 'close', 'contact', 'in', 'recent', 'weeks', 'with', 'a', 'person', 'with', 'active', 'tuberculosis.'], ['Mantoux', 'test', 'is', 'positive', '(12', 'mm).'], ['His', 'history', 'includes', 'treatment', 'with', 'oral', 'anticoagulants', '(acenocoumarol)', 'for', 'a', 'deep', 'vein', 'thrombosis', 'a', 'few', 'months', 'ago.'], ['He', 'does', 'not', 'report', 'fever', 'or', 'cough', 'and', 'is', 'asymptomatic.'], ['Chest', 'X-ray', 'is', 'normal.'], ['Which', 'of', 'the', 'following', 'treatments', 'is', 'the', 'most', 'advisable?'], ['1-', 'Isoniazid,', 'for', 'nine', 'months.'], ['2-', 'Rifampicin,', 'for', 'four', 'months.'], ['3-', 'Isoniazid', 'and', 'rifampicin,', 'for', 'three', 'months.'], ['4-', 'Isoniazid', 'and', 'rifapentine,', 'for', 'three', 'months.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['As', 'of', '2018,', 'there', 'are', 'four', 'dosing', 'schedules', 'for', 'treatment', 'of', 'latent', 'TB', 'infection', 'recommended', 'by', 'the', 'CDC', 'using', 'isoniazid', '(INH),', 'rifapentine', '(RPT)', 'or', 'rifampin', '(RIF).'], ['All', 'treatments', 'are', 'effective.'], ['Health', 'care', 'providers', 'should', 'prescribe', 'the', 'shorter', 'treatments,', 'which', 'are', 'more', 'convenient,', 'whenever', 'possible.'], ['The', 'shortest', 'combination', 'would', 'be', 'Isoniazid', '+', 'Rifapentine', 'for', 'three', 'months', 'or', 'Rifampicin', 'for', 'four', 'months.'], ['However,', 'the', 'fact', 'that', 'he', 'is', 'taking', 'acenocoumarol', 'means', 'that', 'the', 'indication', 'for', 'this', 'patient', 'is', 'Isoniazid', 'for', '9', 'months,', 'since', 'there', 'is', 'interaction', 'between', 'the', 'rifamycin', 'derivatives', '(rifapentine', 'and', 'rifampicin).']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Health care providers should prescribe the shorter treatments, which are more convenient, whenever possible\n', 'The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months\n', 'Support'], ['The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months\n', 'Rifampicin, for four months\n', 'Support'], ['The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months\n', 'Isoniazid and rifapentine, for three months\n', 'Support'], ['As of 2018, there are four dosing schedules for treatment of latent TB infection recommended by the CDC using isoniazid (INH), rifapentine (RPT) or rifampin (RIF)\n', 'All treatments are effective\n', 'Support'], ['All treatments are effective\n', 'Health care providers should prescribe the shorter treatments, which are more convenient, whenever possible\n', 'Support'], ['However, the fact that he is taking acenocoumarol means that the indication for this patient is Isoniazid for 9 months, since there is interaction between the rifamycin derivatives (rifapentine and rifampicin)\n', 'Isoniazid, for nine months\n', 'Support']]
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89_57
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[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'man', 'consults', 'for', 'right', 'calf', 'pain', 'when', 'climbing', 'hills', 'and', 'stairs', 'and', 'when', 'walking', 'on', 'level', 'ground', 'for', 'a', 'prolonged', 'period', 'of', 'time.'], ['He', 'reports', 'that', 'the', 'pain', 'becomes', 'so', 'intense', 'with', 'exertion', 'that', 'he', 'is', 'forced', 'to', 'stand', 'up,', 'which', 'causes', 'the', 'pain', 'to', 'improve', 'in', 'a', 'matter', 'of', 'minutes.'], ['As', 'personal', 'history,', 'the', 'patient', 'is', 'a', 'smoker', 'of', '20', 'cigarettes', 'a', 'day,', 'diabetic', 'on', 'metformin', 'and', 'hypertensive.'], ['On', 'examination,', 'there', 'is', 'good', 'peripheral', 'perfusion', 'of', 'the', 'right', 'foot,', 'but', 'the', 'patient', 'has', 'a', 'decreased', 'pedal', 'pulse.'], ['Which', 'of', 'the', 'following', 'complementary', 'tests', 'should', 'be', 'ordered', 'initially', 'for', 'the', 'diagnosis', 'and', 'assessment', 'of', 'the', 'severity', 'of', 'the', "patient's", 'disease?'], ['1-', 'Arteriography', 'of', 'lower', 'extremities.'], ['2-', 'Ankle-brachial', 'index.'], ['3-', 'Computerized', 'axial', 'tomography', 'with', 'vascular', 'reconstruction', 'of', 'lower', 'extremities.'], ['4-', 'Tape', 'stress', 'test.'], ['5-', 'Magnetic', 'resonance', 'imaging.'], ['CORRECT', 'ANSWER:', '2'], ['Although', 'the', 'diagnosis', 'of', 'peripheral', 'arteriopathy', 'is', 'fundamentally', 'clinical', '(in', 'this', 'patient', 'the', 'picture', 'is', 'very', 'typical),', 'we', 'can', 'objectively', 'assess', 'the', 'severity', 'of', 'the', 'disease', 'with', 'the', 'use', 'of', 'bloodless', 'techniques.'], ['The', 'most', 'important', 'is', 'the', 'ankle-brachial', 'index.'], ['Therefore,', 'answer', '2', 'is', 'correct.'], ['Imaging', 'techniques', '(arteriography,', 'angioCT', 'or', 'angioMRI)', 'are', 'used', 'when', 'surgical', 'repair', 'of', 'arterial', 'occlusion', 'is', 'considered.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['we can objectively assess the severity of the disease with the use of bloodless techniques\n', 'The most important is the ankle-brachial index\n', 'Support'], ['The most important is the ankle-brachial index\n', 'answer 2 is correct\n', 'Support'], ['answer 2 is correct\n', 'Ankle-brachial index\n', 'Support'], ['Although the diagnosis of peripheral arteriopathy is fundamentally clinical (in this patient the picture is very typical)\n', 'we can objectively assess the severity of the disease with the use of bloodless techniques\n', 'Attack'], ['The most important is the ankle-brachial index\n', 'Ankle-brachial index\n', 'Support'], ['Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered\n', 'Arteriography of lower extremities\n', 'Attack'], ['Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered\n', 'Computerized axial tomography with vascular reconstruction of lower extremities\n', 'Attack'], ['Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered\n', 'Magnetic resonance imaging\n', 'Attack']]
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586_75
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[['QUESTION', 'TYPE:', 'OBSTETRICS', 'AND', 'GYNECOLOGY'], ['CLINICAL', 'CASE:'], ['A', '30-year-old', 'woman', 'requesting', 'a', 'contraceptive', 'method.'], ['She', 'has', 'a', 'history', 'of', 'an', 'emergency', 'cesarean', 'section', '7', 'months', 'ago,', 'giving', 'birth', 'to', 'a', '3,550', 'g', 'baby', 'girl.'], ['She', 'is', 'exclusively', 'breastfeeding.'], ['Point', 'out', 'the', 'correct', 'statement:'], ['1-', 'Explain', 'to', 'her', 'that,', 'if', 'she', 'is', 'amenorrheic,', 'she', 'does', 'not', 'require', 'another', 'contraceptive', 'method', 'since', 'breastfeeding', 'is', 'sufficient', 'as', 'a', 'contraceptive', 'method.'], ['2-', 'He', 'informed', 'her', 'that', 'the', 'levonogestrel', 'IUD', 'is', 'contraindicated', 'because', 'she', 'had', 'a', 'cesarean', 'section', 'less', 'than', 'a', 'year', 'ago.'], ['3-', 'He', 'explains', 'that', 'she', 'could', 'use', 'a', 'gestagen-only', 'hormonal', 'method.'], ['4-', 'She', 'is', 'offered', 'combined', 'hormonal', 'contraception.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Given', 'her', 'circumstances', 'and', 'taking', 'into', 'account', 'that', 'she', 'is', 'exclusively', 'breastfeeding,', 'the', 'best', 'thing', 'to', 'do', 'would', 'be', 'to', 'prescribe', 'only', 'gestagens.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['She is exclusively breastfeeding\n', 'Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens\n', 'Support'], ['She has a history of an emergency cesarean section 7 months ago, giving birth to a 3,550 g baby girl\n', 'Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens\n', 'Support'], ['Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens\n', 'He explains that she could use a gestagen-only hormonal method\n', 'Support']]
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461_148
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY', '(ECTOPIC)'], ['CLINICAL', 'CASE:'], ['A', '59-year-old', 'woman', 'with', 'recent', 'onset', 'of', 'epileptic', 'seizures', 'comes', 'to', 'the', 'emergency', 'department.'], ['On', 'examination', 'she', 'presents', 'left', 'pyramidal', 'signs', 'and', 'papillary', 'edema.'], ['A', 'brain', 'MRI', 'shows', 'a', 'right', 'hemispheric', 'mass', 'with', 'edema,', 'midline', 'deviation', 'and', 'signs', 'of', 'tentorial', 'herniation.'], ['She', 'reports', 'that', 'for', 'the', 'past', 'week', 'she', 'has', 'been', 'suffering', 'from', 'headache', 'that', 'has', 'been', 'progressing', 'in', 'intensity.'], ['Which', 'of', 'the', 'following', 'features', 'associated', 'with', 'headache', 'seems', 'most', 'likely', 'for', 'this', 'patient?'], ['1-', 'Morning', 'predominance.'], ['2-', 'It', 'does', 'not', 'change', 'with', 'effort.'], ['3-', 'Photophobia.'], ['4-', 'Sonophobia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['It', 'is', 'a', 'headache', 'in', 'the', 'context', 'of', 'papilledema.'], ['In', 'this', 'case', 'the', 'papilledema', 'is', 'due', 'to', 'increased', 'intracranial', 'pressure', 'due', 'to', 'a', 'tumor.'], ['The', 'headache', 'due', 'to', 'increased', 'intracranial', 'pressure', 'is', 'of', 'positional', 'type', '(it', 'increases', 'with', 'Valsalva', 'maneuvers', 'and', 'when', 'bending', 'down),', 'so', 'option', '2', 'is', 'not', 'correct.'], ['In', 'addition,', 'it', 'is', 'predominantly', 'morning', '(option', '1', 'is', 'correct)', 'because', 'in', 'the', 'morning', 'intracranial', 'pressure', 'naturally', 'rises.'], ['Migraine-type', 'headaches', 'may', 'be', 'associated', 'with', 'photophobia', 'or', 'sonophobia', '(answers', '3', 'and', '4).'], ['But', 'this', 'headache', 'is', 'not', 'a', 'migraine', 'headache.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['It is a headache in the context of papilledema\n', 'In this case the papilledema is due to increased intracranial pressure due to a tumor\n', 'Support'], ['A brain MRI shows a right hemispheric mass with edema, midline deviation and signs of tentorial herniation\n', 'In this case the papilledema is due to increased intracranial pressure due to a tumor\n', 'Support'], ['On examination she presents left pyramidal signs and papillary edema\n', 'It is a headache in the context of papilledema\n', 'Support'], ['it increases with Valsalva maneuvers and when bending down\n', 'The headache due to increased intracranial pressure is of positional type\n', 'Support'], ['The headache due to increased intracranial pressure is of positional type\n', 'so option 2 is not correct\n', 'Support'], ['The headache due to increased intracranial pressure is of positional type\n', 'It does not change with effort\n', 'Attack'], ['so option 2 is not correct\n', 'It does not change with effort\n', 'Attack'], ['In addition, it is predominantly morning\n', 'option 1 is correct\n', 'Support'], ['In addition, it is predominantly morning\n', 'Morning predominance\n', 'Support'], ['option 1 is correct\n', 'Morning predominance\n', 'Support'], ['in the morning intracranial pressure naturally rises\n', 'In addition, it is predominantly morning\n', 'Support'], ['In this case the papilledema is due to increased intracranial pressure due to a tumor\n', 'in the morning intracranial pressure naturally rises\n', 'Support'], ['But this headache is not a migraine headache\n', 'Migraine-type headaches may be associated with photophobia or sonophobia (answers 3 and 4)\n', 'Attack'], ['But this headache is not a migraine headache\n', 'Photophobia\n', 'Attack'], ['But this headache is not a migraine headache\n', 'Sonophobia\n', 'Attack']]
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547_125
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[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '23-year-old', 'male', 'diagnosed', 'with', 'Wolff-Parkinson-White', 'syndrome', 'who', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'palpitations.'], ['The', 'ECG', 'shows', 'an', 'irregular', 'wide', 'QRS', 'tachycardia,', 'with', 'a', 'heart', 'rate', 'of', '205', 'bpm,', 'compatible', 'with', 'pre-excited', 'atrial', 'fibrillation.'], ['Which', 'of', 'the', 'following', 'drugs', 'do', 'you', 'consider', 'appropriate', 'to', 'stop', 'the', 'tachycardia:'], ['1-', 'Verapamil.'], ['2-', 'Digoxin.'], ['3-', 'Adenosine.'], ['4-', 'Procainamide.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Procainamide.'], ['The', 'treatment', 'of', 'choice', 'for', 'Wolff-Parkinson-White', 'syndrome', 'is', 'cardioversion', 'with', 'direct', 'current.'], ['Heart', 'rate', 'slowing', 'drugs,', 'commonly', 'used', 'in', 'atrial', 'fibrillation,', 'are', 'ineffective,', 'and', 'digoxin', 'and', 'non-dihydropyridine', 'calcium', 'channel', 'blockers', '(e.g.,', 'verapamil,', 'diltiazem)', 'are', 'contraindicated', 'because', 'they', 'may', 'increase', 'the', 'ventricular', 'rate', 'and', 'cause', 'ventricular', 'fibrillation.'], ['If', 'cardioversion', 'is', 'not', 'possible,', 'drugs', 'that', 'prolong', 'the', 'refractory', 'period', 'of', 'accessory', 'connection', 'should', 'be', 'used.'], ['IV', 'procainamide', 'or', 'amiodarone', 'is', 'preferred,', 'but', 'any', 'class', 'Ia,', 'Ic', 'or', 'III', 'antiarrhythmic', 'drug', 'can', 'be', 'used.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['digoxin and non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) are contraindicated\n', 'Digoxin\n', 'Attack'], ['digoxin and non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) are contraindicated\n', 'Verapamil\n', 'Attack'], ['Procainamide\n', 'Procainamide\n', 'Support'], ['Heart rate slowing drugs, commonly used in atrial fibrillation, are ineffective\n', 'Adenosine\n', 'Attack'], ['IV procainamide or amiodarone is preferred, but any class Ia, Ic or III antiarrhythmic drug can be used\n', 'Procainamide\n', 'Support']]
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193_161
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['In', 'a', '3-month-old', 'infant', 'all', 'the', 'clinical', 'manifestations', 'outlined', 'below', 'would', 'make', 'it', 'necessary', 'to', 'rule', 'out', 'cystic', 'fibrosis,', 'EXCEPT:'], ['1-', 'Delayed', 'meconium', 'evacuation.'], ['2-', 'Salty', 'taste', 'of', 'the', 'skin.'], ['3-', 'Isolation', 'of', 'secretions', 'of', 'Pseudomonas', 'aeruginosa.'], ['4-', 'Deterioration/detention', 'of', 'the', 'weight', 'curve.'], ['5-', 'Hypernatremic', 'dehydration.'], ['CORRECT', 'ANSWER:', '5'], ['Dehydration', 'may', 'be', 'due', 'to', 'diarrhea', 'of', 'other', 'etiologies.'], ['I', 'have', 'doubts', 'about', 'answer', '3', 'since', 'it', 'does', 'not', 'specify', 'which', 'secretions', 'are', 'involved.'], ['We', 'have', 'to', 'understand', 'that', 'the', 'growth', 'of', 'Pseudomona', 'aeruginosa', 'is', 'in', 'the', 'culture', 'of', 'bronchial', 'secretions.'], ['Because', 'clearly', 'the', 'indication', 'to', 'perform', 'a', 'sweat', 'chlorine', '(to', 'rule', 'out', 'FQP)', 'are', 'the', 'HIPOnatremic', 'dehydrations', 'and', 'not', 'the', 'hypernatremic', 'ones', 'as', 'the', 'answer', 'says.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Dehydration may be due to diarrhea of other etiologies\n', 'Hypernatremic dehydration\n', 'Support'], ['We have to understand that the growth of Pseudomona aeruginosa is in the culture of bronchial secretions\n', 'Because clearly the indication to perform a sweat chlorine (to rule out FQP) are the HIPOnatremic dehydrations and not the hypernatremic ones as the answer says\n', 'Support'], ['Because clearly the indication to perform a sweat chlorine (to rule out FQP) are the HIPOnatremic dehydrations and not the hypernatremic ones as the answer says\n', 'Hypernatremic dehydration\n', 'Attack']]
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431_116
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '38-year-old', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'fever', 'above', '39ºC', 'and', 'deterioration', 'of', 'consciousness', 'after', 'a', 'trip', 'to', 'Equatorial', 'Guinea', 'without', 'antimalarial', 'prophylaxis.'], ['Laboratory', 'tests', 'showed', 'creatinine', '3.4', 'mg/dL,', 'AST', '764', 'UlL,', 'ALT', '678', 'UlL.'], ['The', 'laboratory', 'reports', 'the', 'visualization', 'of', 'Plasmodium', 'falciparum', 'in', 'the', 'blood', 'with', 'a', 'parasitemia', 'level', 'of', '6%.'], ['What', 'treatment', 'would', 'you', 'initiate', 'at', 'this', 'time?'], ['1-', 'Mefloquine', 'orally.'], ['2-', 'Intravenous', 'artesunate.'], ['3-', 'Doxycycline', 'orally.'], ['4-', 'Oral', 'quinine', 'sulfate.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['In', 'severe', 'cases', 'of', 'Plasmodium', 'infection,', 'the', 'greatest', 'risk', 'of', 'mortality', 'occurs', 'in', 'the', 'first', '24', 'hours', 'of', 'clinical', 'presentation,', 'so', 'treatment', 'should', 'be', 'started', 'immediately.'], ['Treatment', 'with', 'parenteral', 'or', 'intramuscular', 'artesunate', 'is', 'more', 'indicated', 'in', 'severe', 'Plasmodium', 'infection,', 'both', 'in', 'adults', 'and', 'children', 'and', 'in', 'pregnant', 'women.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The laboratory reports the visualization of Plasmodium falciparum in the blood with a parasitemia level of 6%\n', 'In severe cases of Plasmodium infection, the greatest risk of mortality occurs in the first 24 hours of clinical presentation\n', 'Support'], ['In severe cases of Plasmodium infection, the greatest risk of mortality occurs in the first 24 hours of clinical presentation\n', 'treatment should be started immediately\n', 'Support'], ['treatment should be started immediately\n', 'Treatment with parenteral or intramuscular artesunate is more indicated in severe Plasmodium infection, both in adults and children and in pregnant women\n', 'Support'], ['Treatment with parenteral or intramuscular artesunate is more indicated in severe Plasmodium infection, both in adults and children and in pregnant women\n', 'Intravenous artesunate\n', 'Support']]
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569_152
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[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['24-year-old', 'male', 'presenting', 'with', 'dysmorphic', 'microhematuria,', 'proteinuria', 'of', '3', 'g/24', 'h,', 'eGFR', '(CKD-EPI)', '85', 'ml/min', 'and', 'sensorineural', 'hearing', 'loss.'], ['He', 'reports', 'that', 'his', 'maternal', 'grandmother', 'required', 'dialysis', 'at', '70', 'years', 'of', 'age', 'and', 'both', 'his', 'mother', 'and', 'younger', 'sister', 'have', 'isolated', 'microhematuria.'], ['Which', 'of', 'the', 'following', 'diseases', 'is', 'more', 'likely?'], ['1-', 'Alport', 'syndrome.'], ['2-', 'IgA', 'nephropathy.'], ['3-', 'Fabry', 'disease.'], ['4-', 'Autosomal', 'dominant', 'polycystic', 'kidney', 'disease.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Textbook', 'case,', 'little', 'to', 'add.'], ['Microhematuria,', 'proteinuria', 'and', 'sensorineural', 'hearing', 'loss', 'in', 'a', 'young', 'male', 'with', 'a', 'family', 'history', 'of', 'women', 'with', 'hematuria', '=', 'Alport', 'syndrome.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Claim', 'I-Claim']]
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[['Microhematuria, proteinuria and sensorineural hearing loss in a young male with a family history of women with hematuria\n', 'Alport syndrome\n', 'Support'], ['Alport syndrome\n', 'Alport syndrome\n', 'Support']]
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501_76
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '5-year-old', 'boy', 'diagnosed', 'with', 'chronic', 'renal', 'failure.'], ['He', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'vomiting,', 'malaise,', 'and', 'palpitations.'], ['An', 'electrocardiogram', 'was', 'performed', 'with', 'T-wave', 'elevation', 'and', 'blood', 'tests', 'showed', 'potassium', 'levels', 'of', '5.9', 'mEq/L.'], ['Immediate', 'administration', 'of', 'calcium', 'gluconate', 'is', 'decided.'], ['What', 'is', 'the', 'purpose', 'of', 'this', 'treatment?'], ['1-', 'Encourage', 'the', 'displacement', 'of', 'potassium', 'from', 'the', 'plasma', 'space', 'to', 'the', 'intracellular', 'space.'], ['2-', 'Chelate', 'circulating', 'potassium', 'to', 'favor', 'its', 'hepatic', 'elimination.'], ['3-', 'Chelate', 'circulating', 'potassium', 'to', 'favor', 'its', 'renal', 'elimination.'], ['4-', 'Antagonize', 'the', 'action', 'of', 'potassium', 'on', 'the', 'myocardial', 'cell', 'membrane.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Calcium', 'gluconate', 'has', 'no', 'effect', 'on', 'blood', 'potassium', 'levels', '(therefore', 'options', '1,', '2', 'and', '3', 'are', 'ruled', 'out).'], ['Its', 'function', 'is', 'to', 'decrease', 'the', 'excitability', 'of', 'cardiac', 'myocytes', 'to', 'decrease', 'the', 'likelihood', 'of', 'developing', 'heart', 'rhythm', 'disorders.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Calcium gluconate has no effect on blood potassium levels\n', 'therefore options 1, 2 and 3 are ruled out\n', 'Support'], ['therefore options 1, 2 and 3 are ruled out\n', 'Encourage the displacement of potassium from the plasma space to the intracellular space\n', 'Attack'], ['therefore options 1, 2 and 3 are ruled out\n', 'Chelate circulating potassium to favor its hepatic elimination\n', 'Attack'], ['therefore options 1, 2 and 3 are ruled out\n', 'Chelate circulating potassium to favor its renal elimination\n', 'Attack'], ['Its function is to decrease the excitability of cardiac myocytes to decrease the likelihood of developing heart rhythm disorders\n', 'Antagonize the action of potassium on the myocardial cell membrane\n', 'Support']]
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242_111
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '50-year-old', 'man', 'with', 'chronic', 'bronchitis', 'is', 'admitted', 'for', 'pneumonia', 'with', 'positive', 'blood', 'culture', 'for', 'Streptococcus', 'pneumoniae,', 'with', 'an', 'MIC', 'to', 'penicillin', 'of', '0.0125', 'mg/l.'], ['Treatment', 'was', 'started', 'with', 'penicillin', '2', 'million', 'every', '4h.'], ['On', 'the', 'fifth', 'day,', 'she', 'still', 'has', 'a', 'fever', 'of', '38ºC.'], ['Which', 'of', 'the', 'following', 'decisions', 'do', 'you', 'think', 'is', 'correct?'], ['1-', 'I', 'would', 'change', 'the', 'treatment', 'to', 'ceftriaxone', 'because', 'of', 'its', 'greater', 'efficacy.'], ['2-', 'I', 'would', 'add', 'a', 'quinolone', 'to', 'the', 'treatment.'], ['3-', 'I', 'would', 'switch', 'to', 'amoxicillin/clavulanic', 'acid.'], ['4-', 'It', 'would', 'rule', 'out', 'the', 'presence', 'of', 'pleural', 'empyema.'], ['5-', 'I', 'would', 'continue', 'with', 'the', 'same', 'treatment,', 'assuming', 'it', 'is', 'simply', 'a', 'timing', 'issue.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'patient', 'is', 'a', 'man', 'with', 'pneumonia', 'with', 'isolated', 'germ', 'in', 'blood', 'culture', 'and', 'antibiogram.'], ['According', 'to', 'the', 'data', 'provided,', 'it', 'is', 'a', 'pneumococcus', 'sensitive', 'to', 'penicillin', '(MIC', '<', '0.125),', 'so', 'treatment', 'is', 'started', 'with', 'penicillin', 'at', 'high', 'doses', 'every', '4', 'h,', 'despite', 'which', 'the', 'fever', 'persists.'], ['If', 'we', 'analyze', 'the', 'case', 'carefully,', 'the', 'treatment', 'should', 'be', 'effective', 'since', 'the', 'germ', 'is', 'totally', 'sensitive', 'to', 'the', 'drug', 'and', 'the', 'dosage', 'is', 'adequate', '(so', 'that', 'high', 'concentrations', 'of', 'the', 'drug', 'should', 'be', 'maintained', 'at', 'all', 'times,', 'remember', 'that', 'the', 'efficacy', 'of', 'beta-lactams', 'is', 'time-dependent', 'and', 'the', 'antibiotic', 'concentrations', 'in', 'blood', 'should', 'be', 'above', 'the', 'MIC', 'permanently', 'to', 'achieve', 'effectiveness', 'and', 'avoid', 'the', 'production', 'of', 'resistance).'], ['In', 'such', 'a', 'case,', 'what', 'could', 'be', 'happening,', 'probably,', 'although', 'the', 'antibiotic', 'is', 'the', 'right', 'one,', 'it', 'is', 'not', 'reaching', 'the', 'infectious', 'focus', 'adequately', 'because', 'an', 'empyema', 'has', 'probably', 'occurred.'], ['We', 'should', 'rule', 'out', 'the', 'existence', 'of', 'an', 'empyema', 'and', 'drain', 'it', 'while', 'continuing', 'with', 'the', 'antibiotic', 'treatment.'], ['If', 'the', 'dosage', 'had', 'not', 'been', 'adequate', 'and', 'the', 'presence', 'of', 'drug', 'resistance', 'was', 'possible,', 'one', 'option', 'could', 'have', 'been', 'to', 'treat', 'with', 'ceftriaxone', 'at', 'high', 'doses,', 'since', 'we', 'should', 'remember', 'that', 'streptococcus', 'does', 'not', 'produce', 'beta-lactamase', 'and', 'beta-lactam', 'resistance', 'is', 'produced', 'by', 'another', 'mechanism', '(using', 'amoxicillin-clavulanate', 'would', 'not', 'provide', 'us', 'with', 'anything).'], ['With', 'quinolone', 'we', 'do', 'not', 'increase', 'the', 'spectrum', 'and', 'it', 'is', 'evident', 'that', 'the', 'poor', 'evolution', 'of', 'the', 'patient', 'is', 'not', 'only', 'a', 'problem', 'of', 'time.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The patient is a man with pneumonia with isolated germ in blood culture and antibiogram\n', 'According to the data provided, it is a pneumococcus sensitive to penicillin (MIC < 0.125)\n', 'Support'], ['According to the data provided, it is a pneumococcus sensitive to penicillin (MIC < 0.125)\n', 'treatment is started with penicillin at high doses every 4 h, despite which the fever persists\n', 'Support'], ['the germ is totally sensitive to the drug and the dosage is adequate\n', 'If we analyze the case carefully, the treatment should be effective\n', 'Support'], ['so that high concentrations of the drug should be maintained at all times, remember that the efficacy of beta-lactams is time-dependent and the antibiotic concentrations in blood should be above the MIC permanently to achieve effectiveness and avoid the production of resistance\n', 'the germ is totally sensitive to the drug and the dosage is adequate\n', 'Support'], ['an empyema has probably occurred\n', 'it is not reaching the infectious focus adequately\n', 'Support'], ['it is not reaching the infectious focus adequately\n', 'although the antibiotic is the right one\n', 'Attack'], ['an empyema has probably occurred\n', 'We should rule out the existence of an empyema and drain it while continuing with the antibiotic treatment\n', 'Support'], ['We should rule out the existence of an empyema and drain it while continuing with the antibiotic treatment\n', 'It would rule out the presence of pleural empyema\n', 'Support'], ['If the dosage had not been adequate and the presence of drug resistance was possible, one option could have been to treat with ceftriaxone at high doses\n', 'I would change the treatment to ceftriaxone because of its greater efficacy\n', 'Support'], ['we should remember that streptococcus does not produce beta-lactamase and beta-lactam resistance is produced by another mechanism\n', 'If the dosage had not been adequate and the presence of drug resistance was possible, one option could have been to treat with ceftriaxone at high doses\n', 'Support'], ['using amoxicillin-clavulanate would not provide us with anything\n', 'I would switch to amoxicillin/clavulanic acid\n', 'Attack'], ['With quinolone we do not increase the spectrum\n', 'I would add a quinolone to the treatment\n', 'Attack'], ['it is evident that the poor evolution of the patient is not only a problem of time\n', 'I would continue with the same treatment, assuming it is simply a timing issue\n', 'Attack'], ['treatment is started with penicillin at high doses every 4 h, despite which the fever persists\n', 'If we analyze the case carefully, the treatment should be effective\n', 'Support'], ['According to the data provided, it is a pneumococcus sensitive to penicillin (MIC < 0.125)\n', 'the germ is totally sensitive to the drug and the dosage is adequate\n', 'Support']]
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487_68
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[['QUESTION', 'TYPE:', 'GENETICS'], ['CLINICAL', 'CASE:'], ['What', 'genetic', 'and', 'reproductive', 'counseling', 'would', 'you', 'indicate', 'to', 'a', '30-year-old', 'woman', 'who', 'consults', 'because', 'she', 'is', 'a', 'carrier', 'of', 'a', 'premutation', 'in', 'the', 'FMR1', 'gene,', 'responsible', 'for', 'Fragile', 'X', 'syndrome,', 'and', 'who', 'wishes', 'to', 'have', 'offspring.'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'All', 'her', 'male', 'children', 'will', 'be', 'carriers', 'and,', 'therefore,', 'will', 'manifest', 'the', 'disease.'], ['2-', 'There', 'is', 'a', 'phenomenon', 'of', 'genetic', 'anticipation,', 'so', 'their', 'offspring', 'will', 'present', 'more', 'severe', 'and', 'earlier', 'symptoms.'], ['3-', 'Preimplantation', 'genetic', 'diagnosis', 'for', 'sex', 'selection', 'of', 'embryos', 'by', 'fluorescence', 'in', 'situ', 'hybridization', '(FISH)', 'is', 'the', 'best', 'option', 'for', 'healthy', 'offspring.'], ['4-', '50%', 'of', 'her', 'daughters', 'will', 'be', 'carriers,', 'but', 'will', 'not', 'present', 'clinical', 'manifestations', 'of', 'the', 'disease.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Another', 'classic', 'MIR,', 'asked', 'in', '2019', 'and', 'in', '2017,', 'fragile', 'X', 'syndrome.'], ['Also,', 'on', 'the', 'same', 'concept', 'as', 'question', '44,', 'the', 'phenomenon', 'of', 'genetic', 'anticipation.'], ['Triplet', 'expansion', 'diseases,', 'such', 'as', 'this', 'one,', 'can', 'have', 'the', 'anticipation', 'phenomenon', 'whereby', 'females', 'with', 'premutations', '(between', '55-200', 'repeats)', 'can', 'have', 'children', 'with', 'full', 'mutations', '(more', 'than', '200', 'repeats', 'of', 'the', 'triplet)', 'and', 'more', 'obvious,', 'more', 'severe', 'and/or', 'earlier', 'clinical,', 'in', 'both', 'males', 'and', 'females', '(Fragile', 'X', 'syndrome,', 'early', 'ovarian', 'failure,', 'tremor/ataxia', 'associated', 'with', 'Fragile', 'X).']]
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[['O', 'O', 'O'], ['O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Triplet expansion diseases, such as this one, can have the anticipation phenomenon whereby females with premutations (between 55-200 repeats) can have children with full mutations (more than 200 repeats of the triplet) and more obvious, more severe and/or earlier clinical, in both males and females (Fragile X syndrome, early ovarian failure, tremor/ataxia associated with Fragile X)\n', 'There is a phenomenon of genetic anticipation, so their offspring will present more severe and earlier symptoms\n', 'Support'], ['Also, on the same concept as question 44, the phenomenon of genetic anticipation\n', 'There is a phenomenon of genetic anticipation, so their offspring will present more severe and earlier symptoms\n', 'Support']]
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364_176
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[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'with', 'a', 'history', 'of', 'type', '2', 'diabetes', 'treated', 'with', 'oral', 'antidiabetics,', 'hypertension', 'treated', 'with', 'beta-blockers', 'and', 'ACE', 'inhibitors,', 'and', 'NYHA', 'grade', '1', 'congestive', 'heart', 'failure', 'with', 'LVEF', 'of', '48%,', 'and', 'currently', 'asymptomatic.'], ['Functional', 'status:', 'ECOG', '0.'], ['History', 'of', '2', 'years', 'of', 'evolution', 'of', 'small', 'lumps', 'in', 'the', 'neck.'], ['Biopsy', 'of', 'cervical', 'adenopathy:', 'follicular', 'lymphoma', 'grade', '2.'], ['Extension', 'study:', 'Hb', '12', 'g/dL,', 'Leukocytes', '6,900/microL', '(Neutrophils', '60%,', 'Lymphocytes', '27%,', 'Monocytes', '6%,', 'Eosinophils', '4%,', 'Basophils', '4%),', 'Platelets', '220,000/microL.'], ['MO:', 'infiltrate', 'by', 'follicular', 'lymphoma.'], ['Creatinine', '1.5', 'mg/dL,', 'LDH', '235', 'U/L,', 'Beta2', 'microglobulin', '2.1', 'microg/mL.'], ['CT:', 'lymphadenopathies', 'less', 'than', '3', 'cm', 'in', 'cervical,', 'axillary,', 'retroperitoneal,', 'iliac', 'and', 'inguinal', 'territories;', 'liver', 'and', 'spleen', 'are', 'normal.'], ['Which', 'of', 'the', 'following', 'treatments', 'is', 'the', 'most', 'appropriate?'], ['1-', 'Rituximab-CHOP', '(Cyclophosphamide,', 'Adriamycin,', 'Vincristine,', 'Prednisone).'], ['2-', 'Rituximab-CVP', '(Cyclophosphamide,', 'Vincristine,', 'Prednisone).'], ['3-', 'Do', 'not', 'treat', 'and', 'monitor', '(wait', 'and', 'see).'], ['4-', 'Rituxirnab-Bendamustine.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['There', 'may', 'be', 'debate', 'about', 'whether', 'to', 'start', 'Rituximab', 'with', 'another', 'cytostatic', 'drug', 'or', 'in', 'monotherapy,', 'but', 'given', 'the', 'lack', 'of', 'survival', 'benefit', 'with', 'early', 'initiation', 'of', 'treatment,', 'the', 'NCCN', 'guidelines', 'recommend', 'waiting', 'and', 'seeing,', 'unless', 'GELF', 'criteria', 'are', 'met', 'to', 'initiate', 'treatment:', 'GELF', 'criteria', '(Follicular', 'Lymphoma', 'Study', 'Group):', '-', 'Involvement', 'of', '≥3', 'nodal', 'areas,', 'each', 'with', 'a', 'diameter', '≥', '3', 'cm.'], ['-', 'Any', 'nodal', 'or', 'extranodal', 'mass', 'with', 'a', 'diameter', '≥', '7', 'cm.'], ['-', 'B', 'symptoms.'], ['-', 'Splenomegaly.'], ['-', 'Pleural', 'effusion', 'or', 'ascites.'], ['-', 'Cytopenias', '(leukocytes', '<', '1.0', 'x', '109', '/', 'L', 'and/or', 'platelets', '<', '100', 'x', '109', '/', 'L).'], ['-', 'Leukemia', '(>', '5.0', 'x', '109', '/L', 'of', 'malignant', 'cells).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O'], ['O', 'O'], ['O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing, unless GELF criteria are met to initiate treatment: GELF criteria (Follicular Lymphoma Study Group)\n', 'There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy\n', 'Attack'], ['given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing, unless GELF criteria are met to initiate treatment: GELF criteria (Follicular Lymphoma Study Group)\n', 'Do not treat and monitor (wait and see)\n', 'Support']]
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90_32
|
[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman', 'is', 'diagnosed', 'with', 'colon', 'cancer', 'located', 'in', 'the', 'hepatic', 'angle.'], ['She', 'has', 'a', 'family', 'history', 'of', 'colon', 'cancer', 'in', 'her', 'mother,', 'an', 'aunt', 'at', 'the', 'age', 'of', '45', 'and', 'a', 'grandfather.'], ['The', 'most', 'accepted', 'surgical', 'intervention', 'is:'], ['1-', 'Right', 'hemicolectomy.'], ['2-', 'Extended', 'right', 'hemicolectomy.'], ['3-', 'Subtotal', 'colectomy.'], ['4-', 'Total', 'colectomy', 'with', 'ileorectal', 'anatomosis.'], ['5-', 'Total', 'colectomy', 'with', 'ileoanal', 'anatomy.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'statement', 'with', 'the', 'family', 'history', 'indicates', 'that', 'this', 'is', 'a', 'case', 'of', 'hereditary', 'nonpolyposis', 'colorectal', 'cancer', '(Lynch', 'syndrome).'], ['The', 'age', 'and', 'right', 'location', 'data', 'lead', 'us', 'to', 'answer', '4:', 'total', 'colectomy', 'with', 'ileorectal', 'anastomosis.'], ['If', 'a', 'conventional', 'right', 'hemicolectomy', 'type', 'surgery', 'is', 'performed,', 'the', 'chances', 'of', 'recurrence', 'are', 'higher', 'than', '30%.'], ['Excision', 'of', 'the', 'rectum', 'is', 'not', 'necessary', 'prophylactically.']]
|
[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['If a conventional right hemicolectomy type surgery is performed, the chances of recurrence are higher than 30%\n', 'Right hemicolectomy\n', 'Attack'], ['The age and right location data lead us to answer 4: total colectomy with ileorectal anastomosis\n', 'Total colectomy with ileorectal anatomosis\n', 'Support']]
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528_134
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['53-year-old', 'woman', 'with', 'a', 'personal', 'history', 'of', 'obesity', 'and', 'migraine.'], ['Her', 'blood', 'pressure', 'has', 'been', 'taken', 'repeatedly', 'at', 'the', "doctor's", 'and', "nurse's", 'office,', 'presenting', 'figures', 'below', '140/90', 'mmHg.'], ['However,', 'an', 'approved', 'blood', 'pressure', 'measuring', 'device', 'has', 'been', 'purchased', 'and', 'she', 'has', 'been', 'taught', 'how', 'to', 'use', 'it', 'correctly.'], ['He', 'comes', 'in', 'showing', 'blood', 'pressure', 'recordings', 'taken', 'at', 'home', 'over', 'several', 'weeks', 'with', 'values', 'above', '140/90', 'mmHg.'], ['Mark', 'the', 'correct', 'answer:'], ['1-', 'She', 'has', 'secondary', 'hypertension.'], ['2-', 'Presents', 'masked', 'arterial', 'hypertension.'], ['3-', 'Presents', 'isolated', 'clinical', 'hypertension.'], ['4-', 'Presents', 'refractory', 'arterial', 'hypertension.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'patient', 'described', 'is', 'the', 'definition', 'of', 'masked', 'HT,', 'normal', 'figures', 'in', 'consultation', 'and', 'elevated', 'on', 'AMPA', 'or', 'ABPM', '(option', '2', 'correct).'], ['It', 'is', 'not', 'secondary', 'HT', 'because', 'no', 'study', 'has', 'been', 'done', 'to', 'confirm', 'it', '(option', '1', 'incorrect).'], ['It', 'is', 'not', 'isolated', 'HT', 'because', 'the', 'elevated', 'figures', 'are', 'maintained', 'for', 'several', 'weeks', '(option', '3', 'incorrect).'], ['It', 'is', 'not', 'refractory', 'HT', 'because', 'it', 'has', 'not', 'yet', 'been', 'treated', '(option', '4', 'incorrect).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['normal figures in consultation and elevated on AMPA or ABPM\n', 'The patient described is the definition of masked HT\n', 'Support'], ['He comes in showing blood pressure recordings taken at home over several weeks with values above 140/90 mmHg\n', 'normal figures in consultation and elevated on AMPA or ABPM\n', 'Support'], ["Her blood pressure has been taken repeatedly at the doctor's and nurse's office, presenting figures below 140/90 mmHg\n", 'normal figures in consultation and elevated on AMPA or ABPM\n', 'Support'], ['The patient described is the definition of masked HT\n', 'option 2 correct\n', 'Support'], ['option 2 correct\n', 'Presents masked arterial hypertension\n', 'Support'], ['It is not secondary HT because no study has been done to confirm it\n', 'option 1 incorrect\n', 'Support'], ['option 1 incorrect\n', 'She has secondary hypertension\n', 'Attack'], ['the elevated figures are maintained for several weeks\n', 'It is not isolated HT\n', 'Support'], ['It is not isolated HT\n', 'option 3 incorrect\n', 'Support'], ['option 3 incorrect\n', 'Presents isolated clinical hypertension\n', 'Attack'], ['It is not refractory HT because it has not yet been treated\n', 'option 4 incorrect\n', 'Support'], ['option 4 incorrect\n', 'Presents refractory arterial hypertension\n', 'Attack']]
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583_70
|
[['QUESTION', 'TYPE:', 'OBSTETRICS', 'AND', 'GYNECOLOGY'], ['CLINICAL', 'CASE:'], ['A', '43-year-old', 'woman', 'with', 'a', 'levonorgestrel', 'intrauterine', 'device', 'who', 'consults', 'for', 'lack', 'of', 'rest', 'at', 'night', 'with', 'the', 'appearance', 'of', 'heat', 'and', 'palpitations.'], ['In', 'the', 'analytical', 'analysis', 'highlights', 'free', 'T4', '10.5', 'pmol/L', '(9-19),', 'thyrotropin', '2.1', 'mIU/L', '(0.30-5.00),', 'FSH', '95.6', 'IU/L', '(1.38-16.7),', 'LH', '21', 'IU/L', '(2.4-9.3),', 'estradiol', '<', '0.07', 'nmol/L', '(0.07', '-', '1.14).'], ['What', 'is', 'the', 'most', 'appropriate', 'treatment?'], ['1-', 'Benzodiazepines.'], ['2-', 'Vaginal', 'estrogens.'], ['3-', 'Oral', 'estrogens', 'and', 'progestogens', 'in', 'continuous', 'regimen.'], ['4-', 'Transdermal', 'estrogens', 'in', 'a', 'continuous', 'regimen.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'hormonal', 'profile', 'we', 'are', 'told', 'is', 'in', 'menopausal', 'range', '(FSH', '>20;', 'estradiol', '<5)', 'and', 'the', 'patient', 'has', 'systemic', 'vasomotor', 'symptoms.'], ['Therefore,', 'it', 'would', 'be', 'more', 'appropriate', 'to', 'administer', 'systemic', 'estrogens.'], ['To', 'compensate,', 'she', 'already', 'has', 'a', 'local', 'uterine', 'progestin', '(levonorgestrel', 'IUD).']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
|
[['FSH >20; estradiol <5\n', 'The hormonal profile we are told is in menopausal range\n', 'Support'], ['the patient has systemic vasomotor symptoms\n', 'The hormonal profile we are told is in menopausal range\n', 'Support'], ['The hormonal profile we are told is in menopausal range\n', 'Therefore, it would be more appropriate to administer systemic estrogens\n', 'Support'], ['Therefore, it would be more appropriate to administer systemic estrogens\n', 'Transdermal estrogens in a continuous regimen\n', 'Support']]
|
195_163
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '15-month-old', 'boy,', 'who', 'during', 'dinner,', 'after', 'eating', 'a', 'bite', 'of', 'tortilla,', 'suddenly', 'presented', 'with', 'facial', 'reddening', 'predominantly', 'perioral,', 'habonous', 'lesions', 'on', 'the', 'trunk', 'and', 'extremities', 'and', 'cough.'], ['On', 'arrival', 'at', 'the', 'center,', 'the', 'patient', 'was', 'conscious', 'and,', 'in', 'addition', 'to', 'what', 'was', 'described', 'above,', 'the', 'following', 'were', 'observed:', 'suprasternal', 'twitching,', 'abundant', 'watery', 'rhinorrhea,', 'bilateral', 'hypoventilation', 'without', 'wheezing', 'and', 'capillary', 'refill', 'of', 'less', 'than', '2', 'seconds.'], ['Of', 'the', 'following', 'statements,', 'indicate', 'the', 'CORRECT', 'answer:'], ['1-', 'The', 'priority', 'is', 'to', 'cannulate', 'a', 'venous', 'line.'], ['2-', 'Intramuscular', 'methylprednisolone', 'is', 'the', 'treatment', 'of', 'choice.'], ['3-', 'It', 'is', 'a', 'picture', 'of', 'urticaria', 'associated', 'with', 'asthma,', 'and', 'should', 'be', 'treated', 'with', 'antihistamines', 'and', 'inhaled', 'bronchodilators.'], ['4-', 'Parents', 'should', 'be', 'advised', 'to', 'transfer', 'to', 'a', 'hospital', 'emergency', 'department.'], ['5-', 'Intramuscular', 'adrenaline', 'should', 'be', 'administered', 'without', 'further', 'delay.'], ['CORRECT', 'ANSWER:', '5'], ['She', 'is', 'describing', 'egg', 'anaphylaxis,', 'a', 'potentially', 'fatal', 'condition.'], ['The', 'treatment', 'of', 'choice', 'is', 'intramuscular', 'adrenaline,', 'and', 'effectively,', 'without', 'wasting', 'too', 'much', 'time.'], ['The', 'first', 'thing', 'is', 'INTRAMUSCULAR', 'adrenaline', 'NOW!'], ['The', 'venous', 'route,', 'corticosteroids,', 'antihistamines,', 'etc.', 'will', 'come', 'later.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['The treatment of choice is intramuscular adrenaline, and effectively, without wasting too much time\n', 'The first thing is INTRAMUSCULAR adrenaline NOW\n', 'Support'], ['A 15-month-old boy, who during dinner, after eating a bite of tortilla, suddenly presented with facial reddening predominantly perioral, habonous lesions on the trunk and extremities and cough.\n', 'She is describing egg anaphylaxis, a potentially fatal condition\n', 'Support'], ['On arrival at the center, the patient was conscious and, in addition to what was described above, the following were observed: suprasternal twitching, abundant watery rhinorrhea, bilateral hypoventilation without wheezing and capillary refill of less than 2 seconds\n', 'She is describing egg anaphylaxis, a potentially fatal condition\n', 'Support'], ['The first thing is INTRAMUSCULAR adrenaline NOW\n', 'Intramuscular adrenaline should be administered without further delay\n', 'Support'], ['The treatment of choice is intramuscular adrenaline, and effectively, without wasting too much time\n', 'Intramuscular adrenaline should be administered without further delay\n', 'Support'], ['The venous route, corticosteroids, antihistamines, etc. will come later\n', 'The priority is to cannulate a venous line\n', 'Attack'], ['The venous route, corticosteroids, antihistamines, etc. will come later\n', 'Intramuscular methylprednisolone is the treatment of choice\n', 'Attack'], ['The venous route, corticosteroids, antihistamines, etc. will come later\n', 'It is a picture of urticaria associated with asthma, and should be treated with antihistamines and inhaled bronchodilators\n', 'Attack']]
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84_49
|
[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '75-year-old', 'man,', 'hypertensive', 'and', 'dyslipidemic', 'with', 'a', 'history', 'of', 'heart', 'failure', 'due', 'to', 'left', 'ventricular', 'systolic', 'dysfunction', '(EF', '<', '30%).'], ['He', 'comes', 'to', 'our', 'office', 'for', 'worsening', 'of', 'his', 'usual', 'dyspnea', 'in', 'recent', 'weeks.'], ['His', 'systolic', 'blood', 'pressure', 'is', '160/95', 'mmHg', 'with', 'a', 'heart', 'rate', 'of', '65', 'bpm.'], ['In', 'the', 'physical', 'examination', 'no', 'crackles', 'were', 'heard', 'and', 'his', 'jugular', 'venous', 'pressure', 'was', 'normal.'], ['He', 'provides', 'a', 'creatinine', 'determination', 'that', 'is', '3.7', 'mg/dL', 'with', 'ions', 'within', 'normal.'], ['Which', 'of', 'the', 'following', 'drugs', 'is', 'the', 'most', 'appropriate', 'to', 'improve', 'the', 'prognosis', 'of', 'his', 'heart', 'failure?'], ['1-', 'Enalapril.'], ['2-', 'Losartan.'], ['3-', 'Spironolactone.'], ['4-', 'Bisoprolol.'], ['5-', 'Eplerenone.'], ['CORRECT', 'ANSWER:', '4'], ['In', 'a', 'patient', 'with', 'multiple', 'CVRF', 'with', 'concomitant', 'heart', 'and', 'renal', 'failure', '(presumably', 'of', 'multiple', 'etiology:', 'renal', 'hypoperfusion,', 'arteriosclerosis...),', 'we', 'must', 'be', 'very', 'careful', 'when', 'using', 'diuretics', 'and', 'ACEI/ARA-II,', 'since', 'we', 'can', 'worsen', 'renal', 'function', 'and/or', 'increase', 'potassium', 'levels', '(among', 'diuretics,', 'spironolactone', 'and', 'eplerenone', 'are', '"potassium-sparing").'], ['Therefore,', 'in', 'this', 'case', 'we', 'will', 'use', 'bisoprolol.']]
|
[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['in this case we will use bisoprolol\n', 'Bisoprolol\n', 'Support'], ['In a patient with multiple CVRF with concomitant heart and renal failure (presumably of multiple etiology: renal hypoperfusion, arteriosclerosis...)\n', 'we must be very careful when using diuretics and ACEI/ARA-II\n', 'Support'], ['we can worsen renal function and/or increase potassium levels (among diuretics, spironolactone and eplerenone are "potassium-sparing")\n', 'we must be very careful when using diuretics and ACEI/ARA-II\n', 'Support'], ['we must be very careful when using diuretics and ACEI/ARA-II\n', 'Enalapril\n', 'Attack'], ['we must be very careful when using diuretics and ACEI/ARA-II\n', 'Losartan\n', 'Attack'], ['we must be very careful when using diuretics and ACEI/ARA-II\n', 'Spironolactone\n', 'Attack'], ['we must be very careful when using diuretics and ACEI/ARA-II\n', 'Eplerenone\n', 'Attack']]
|
427_95
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'confusional', 'symptoms', 'accompanied', 'by', 'dysphonia.'], ['On', 'examination', 'she', 'has', 'a', 'palpable', 'neck', 'mass', 'and', 'a', 'blood', 'test', 'shows', 'plasma', 'calcium', 'levels', 'of', '15', 'mg/dL', '(normal', 'up', 'to', '10.2', 'mg/dL).'], ['Given', 'these', 'findings,', 'which', 'of', 'the', 'following', 'diagnoses', 'should', 'be', 'suspected?'], ['1-', 'Parathyroid', 'carcinoma.'], ['2-', 'Medullary', 'thyroid', 'carcinoma.'], ['3-', 'MEN', 'type', 'I.'], ['4-', 'Parathyroid', 'adenoma.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Palpable', 'mass', 'in', 'the', 'neck:', 'suspect', 'thyroid/parathyroid', 'pathology.'], ['It', 'is', 'associated', 'with', 'hypercalcemia,', 'therefore,', 'the', 'option', 'of', 'medullary', 'thyroid', 'cancer', 'is', 'ruled', 'out', '(it', 'does', 'not', 'affect', 'the', 'level', 'of', 'calcemia).'], ['To', 'think', 'of', 'MEN', 'type', 'I', 'we', 'should', 'associate', 'other', 'pathologies', '(pituitary,', 'pancreatic', 'or', 'duodenal', 'tumors).'], ['The', 'presence', 'of', 'a', 'calcemia', 'higher', 'than', '13mgr/dl,', 'together', 'with', 'dysphonia,', 'indicates', 'a', 'malignant', 'tumor', '(higher', 'calcemia', 'level', 'and', 'infiltration),', 'therefore', 'we', 'opt', 'for', 'option', '1.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL\n', 'normal up to 10.2 mg/dL\n', 'Support'], ['therefore, the option of medullary thyroid cancer is ruled out\n', 'Medullary thyroid carcinoma\n', 'Attack'], ['it does not affect the level of calcemia\n', 'therefore, the option of medullary thyroid cancer is ruled out\n', 'Support'], ['It is associated with hypercalcemia\n', 'therefore, the option of medullary thyroid cancer is ruled out\n', 'Support'], ['Palpable mass in the neck\n', 'suspect thyroid/parathyroid pathology\n', 'Support'], ['To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)\n', 'MEN type I\n', 'Attack'], ['The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration)\n', 'therefore we opt for option 1\n', 'Support'], ['therefore we opt for option 1\n', 'Parathyroid carcinoma\n', 'Support'], ['A 45-year-old woman comes to the emergency department with confusional symptoms accompanied by dysphonia\n', 'To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)\n', 'Attack'], ['On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL\n', 'To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)\n', 'Attack'], ['On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL\n', 'The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration)\n', 'Support']]
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462_151
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY', '(ECTOPIC)'], ['CLINICAL', 'CASE:'], ['A', '13-year-old', 'boy', 'presents', 'with', 'subacute', 'headache', 'and', 'diplopia.'], ['Neurologic', 'examination', 'shows', 'vertical', 'gaze', 'palsy', 'and', 'MRI', 'shows', 'a', 'contrast-enhancing', 'lesion', 'in', 'the', 'pineal', 'region', 'obstructing', 'the', 'aqueduct', 'of', 'Sylvian.'], ['The', 'most', 'likely', 'diagnosis', 'is:'], ['1-', 'Glioblastoma.'], ['2-', 'Medulloblastoma.'], ['3-', 'Germ', 'cell', 'tumor.'], ['4-', 'Meningioma.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Diplopia', 'is', 'usually', 'caused', 'by', 'acute', 'or', 'secondary', 'strabismus.'], ['Vertical', 'gaze', 'palsy', 'is', 'due', 'to', 'a', 'midbrain', 'lesion.'], ['In', 'this', 'case', 'the', 'MRI', 'already', 'places', 'the', 'origin', 'of', 'the', 'symptoms', 'in', 'the', 'pineal', 'gland.'], ['The', 'most', 'frequent', 'tumor', 'in', 'this', 'region', 'is', 'the', 'germ', 'cell', 'tumor', '(answer', '3).']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In this case the MRI already places the origin of the symptoms in the pineal gland\n', 'The most frequent tumor in this region is the germ cell tumor (answer 3)\n', 'Support'], ['The most frequent tumor in this region is the germ cell tumor (answer 3)\n', 'Germ cell tumor\n', 'Support']]
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557_168
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[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['58-year-old', 'male,', 'obese,', 'asymptomatic,', 'moderate', 'drinker,', 'who', 'presents', 'a', 'first', 'baseline', 'blood', 'glucose', 'of', '153', 'mg/d', 'with', 'negative', 'glycosuria.'], ['In', 'the', 'following', 'weeks', 'he', 'has', 'had', 'two', 'other', 'baseline', 'blood', 'glucose', 'readings', 'of', '118', 'and', '136', 'mg/dl.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'appropriate', 'approach', 'to', 'confirm', 'the', 'diagnosis', 'of', 'diabetes', 'mellitus:'], ['1-', 'Practice', 'a', 'blood', 'glucose', 'curve', 'with', '75', 'g', 'of', 'glucose.'], ['2-', 'Already', 'meets', 'diagnostic', 'criteria', 'for', 'diabetes', 'mellitus.'], ['3-', 'Request', 'a', 'determination', 'of', 'basal', 'insulinemia', 'or', 'C-peptide.'], ['4-', 'Request', 'a', 'determination', 'of', 'glycosylated', 'hemoglobin.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Diagnostic', 'Criteria', 'for', 'DM', 'according', 'to', 'ISPAD', '2018', '*Classic', 'symptoms', 'of', 'diabetes', 'with', 'blood', 'glucose', '>', '200mgr/dl', 'or:', '*', 'Fasting', 'glycemia', '≥', '126mgr/dl', '(fasting', 'at', 'least', '8h)', 'or', '*', 'Glycemia', 'at', '2h', 'SOG', '≥', '200mgr/dl', '(on', '2', 'occasions)', 'or', '*', 'HbA1C', '≥', '6.5%.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Diagnostic Criteria for DM according to ISPAD 2018 *Classic symptoms of diabetes with blood glucose > 200mgr/dl or: * Fasting glycemia ≥ 126mgr/dl (fasting at least 8h) or * Glycemia at 2h SOG ≥ 200mgr/dl (on 2 occasions) or * HbA1C ≥ 6.5%\n', 'Already meets diagnostic criteria for diabetes mellitus\n', 'Support']]
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35_68
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[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '56-year-old', 'patient', 'with', 'no', 'personal', 'or', 'family', 'history', 'of', 'interest', 'is', 'studied', 'because', 'he', 'has', 'been', 'having', 'difficulty', 'walking', 'with', 'his', 'right', 'leg', 'for', 'six', 'months.'], ['He', 'reports', 'no', 'other', 'symptoms.'], ['The', 'examination', 'shows', 'a', '4/5', 'weakness', 'for', 'dorsal', 'flexion', 'and', 'eversion', 'of', 'the', 'foot', 'and', '4/5', 'for', 'flexion', 'and', 'inversion', 'of', 'the', 'foot,', 'with', 'increased', 'muscle', 'reflexes', 'and', 'Babinski', 'present,', 'the', 'rest', 'being', 'normal.'], ['The', 'syndromic', 'diagnosis', 'would', 'be:'], ['1-', 'Mononeuropathy', 'of', 'the', 'right', 'common', 'peroneal', 'nerve.'], ['2-', 'Focal', 'involvement', 'of', 'the', 'first', 'motor', 'neuron', 'and', 'probably', 'of', 'the', 'second.'], ['3-', 'Right', 'hemimedullary', 'involvement', '(Brown-Sequard).'], ['4-', 'Multiple', 'mononeuropathy', 'with', 'involvement', 'of', 'the', 'common', 'peroneal', 'and', 'right', 'posterior', 'tibial', 'nerve.'], ['5-', 'Right', 'lumbar', 'plexopathy.'], ['CORRECT', 'ANSWER:', '2'], ['Answer', '1', 'incorrect:', 'It', 'does', 'not', 'explain', 'pyramidalism.'], ['Answer', '2', 'correct:', 'A', 'nonspecific', 'answer,', 'but', 'probably', 'the', 'correct', 'answer.'], ['Answer', '3', 'incorrect:', 'We', 'would', 'lack', 'data', 'to', 'think', 'of', 'a', 'Brown', 'Sequard', 'hemimedullary', 'syndrome.'], ['It', 'would', 'explain', 'the', 'pyramidalism,', 'but', 'we', 'would', 'be', 'missing', 'data', 'suggestive', 'of', 'this', 'picture', 'such', 'as', 'a', 'contralateral', 'hypoesthesia.'], ['Incorrect', 'answer', '4:', 'It', 'could', 'explain', 'the', 'difficulty', 'in', 'dorsiflexion', 'and', 'plantar', 'flexion', 'of', 'the', 'foot,', 'but', 'not', 'the', 'pyramidalism.'], ['Incorrect', 'answer', '5:', 'In', 'a', 'similar', 'way', 'to', 'the', 'previous', 'one,', 'it', 'could', 'explain', 'part', 'of', 'the', 'clinical', 'picture,', 'but', 'not', 'the', 'pyramidalism.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['It does not explain pyramidalism\n', 'Answer 1 incorrect\n', 'Support'], ['We would lack data to think of a Brown Sequard hemimedullary syndrome\n', 'Answer 3 incorrect\n', 'Support'], ['It could explain the difficulty in dorsiflexion and plantar flexion of the foot, but not the pyramidalism\n', 'Incorrect answer 4\n', 'Support'], ['it could explain part of the clinical picture, but not the pyramidalism\n', 'Incorrect answer 5\n', 'Support'], ['It would explain the pyramidalism, but we would be missing data suggestive of this picture such as a contralateral hypoesthesia\n', 'Answer 3 incorrect\n', 'Support'], ['It does not explain pyramidalism\n', 'Mononeuropathy of the right common peroneal nerve\n', 'Attack'], ['We would lack data to think of a Brown Sequard hemimedullary syndrome\n', 'Right hemimedullary involvement (Brown-Sequard)\n', 'Attack'], ['It would explain the pyramidalism, but we would be missing data suggestive of this picture such as a contralateral hypoesthesia\n', 'Right hemimedullary involvement (Brown-Sequard)\n', 'Attack'], ['It could explain the difficulty in dorsiflexion and plantar flexion of the foot, but not the pyramidalism\n', 'Multiple mononeuropathy with involvement of the common peroneal and right posterior tibial nerve.\n', 'Attack'], ['it could explain part of the clinical picture, but not the pyramidalism\n', 'Right lumbar plexopathy\n', 'Attack']]
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271_170
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[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY', 'AND', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'man', 'comes', 'to', 'your', 'office', 'for', 'evaluation', 'of', 'a', 'scheduled', 'cholecystectomy', 'by', 'laparoscopy.'], ['He', 'has', 'a', 'history', 'of', 'arterial', 'hypertension', 'under', 'treatment', 'for', '10', 'years.'], ['He', 'denies', 'heart', 'or', 'pulmonary', 'disease.'], ['She', 'has', 'no', 'chest', 'pain.'], ['She', 'has', 'an', 'active', 'life', 'and', 'goes', 'daily', 'to', 'the', 'gym', 'where', 'she', 'alternates', 'swimming', 'and', 'walking', 'on', 'the', 'treadmill', 'for', 'at', 'least', 'one', 'hour.'], ['Usual', 'treatment:', 'nebivolol', '5', 'mg', 'every', '24', 'hours', 'and', 'hydrochlorothiazide', '12.5', 'mg', 'daily.'], ['Physical', 'examination:', 'weight', '73', 'kgs;', 'height', '179', 'cm;', 'blood', 'pressure', '138/80', 'mmHg;', 'heart', 'rate', '60', 'beats/minute.'], ['No', 'murmurs', 'are', 'auscultated', 'Which', 'of', 'the', 'following', 'is', 'the', 'most', 'appropriate', 'preoperative', 'approach?'], ['1-', 'Perform', 'a', 'stress', 'test.'], ['2-', 'Perform', 'echocardiography'], ['3-', 'Perform', 'a', 'thallium', 'and', 'dipyridamole', 'scan.'], ['4-', 'Perform', 'electrocardiogram.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'a', 'completely', 'gratuitous', 'question,', 'from', 'a', 'healthier', 'gentleman', 'than', 'me', 'who', 'is', 'going', 'to', 'undergo', 'low-risk', 'surgery', 'on', 'a', 'scheduled', 'basis.'], ['The', 'answer', 'is', 'obviously', '4.'], ['Had', 'there', 'been', 'a', 'fifth', 'option', 'it', 'would', 'have', 'been', 'that', 'nothing', 'needs', 'to', 'be', 'done,', 'which', 'might', 'have', 'generated', 'some', 'doubt', 'in', 'the', 'student,', 'but', 'since', 'the', 'question', 'does', 'not', 'exist', 'it', 'is', 'a', 'piece', 'of', 'candy.'], ['Although', 'there', 'are', 'many', 'protocols', 'on', 'preoperative', 'procedures,', 'almost', 'as', 'many', 'as', 'there', 'are', 'hospitals,', 'the', 'question', 'makes', 'it', 'easy', 'by', 'putting', 'a', 'very', 'old', 'patient,', '80', 'years', 'old.'], ['The', 'age', 'range', 'from', 'which', 'it', 'is', 'considered', 'mandatory', 'to', 'request', 'an', 'ECG', 'varies', 'between', '45,', '50,', '60', 'or', 'even', 'some', 'say', '70', 'years.'], ['For', 'example:', '>', '50', 'years:', 'always,', 'except', 'if', 'a', 'previous', 'ECG', 'is', 'available', '<', '50', 'years:', 'only', 'if', 'there', 'is', 'known', 'or', 'suspected', 'heart', 'disease', '(CVRF),', 'severe', 'DM,', 'hyperthyroidism', 'or', 'severe', 'COPD.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['The answer is obviously 4\n', 'Perform electrocardiogram\n', 'Support'], ['Had there been a fifth option it would have been that nothing needs to be done, which might have generated some doubt in the student, but since the question does not exist it is a piece of candy\n', 'The answer is obviously 4\n', 'Support'], ['Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old\n', 'The answer is obviously 4\n', 'Support'], ['The age range from which it is considered mandatory to request an ECG varies between 45, 50, 60 or even some say 70 years\n', 'The answer is obviously 4\n', 'Support'], ['An 80-year-old man comes to your office for evaluation of a scheduled cholecystectomy by laparoscopy\n', 'Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old\n', 'Support']]
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306_207
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[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '34-year-old', 'patient', 'playing', 'tennis', 'is', 'hit', 'by', 'a', 'tennis', 'ball', 'in', 'the', 'left', 'orbit.'], ['On', 'examination', 'he', 'presents', 'significant', 'palpebral', 'hematoma,', 'hyposphagmia,', 'diplopia', 'to', 'the', 'upper', 'vision', 'with', 'limitation', 'of', 'the', 'upper', 'version', 'of', 'the', 'eyeball.'], ['What', 'would', 'you', 'suspect?'], ['1-', 'Fracture', 'of', 'the', 'inferior', 'wall', 'of', 'the', 'floor', 'of', 'the', 'orbit', 'with', 'entrapment', 'of', 'the', 'inferior', 'rectus', 'muscle.'], ['2-', 'Zygomatic', 'arch', 'fracture.'], ['3-', 'Fracture', 'of', 'the', 'superior', 'wall', 'of', 'the', 'orbit', 'with', 'entrapment', 'of', 'the', 'superior', 'rectus', 'muscle.'], ['4-', 'Dentoalveolar', 'fracture.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'statement', 'describes', 'diplopia', 'to', 'superior', 'vision', 'with', 'limitation', 'of', 'upper', 'eyeball', 'extension.'], ['As', 'the', 'mechanical', 'function', 'of', 'the', 'left', 'inferior', 'rectus', 'is', 'compromised,', 'it', 'would', 'not', 'allow', 'to', 'complete', 'the', 'supraduccion', 'movement', 'generating', 'vertical', 'diplopia,', 'this', 'plus', 'the', 'traumatic', 'antecedent', 'allows', 'to', 'suspect', 'a', 'fracture', 'of', 'the', 'orbital', 'floor', 'with', 'muscular', 'entrapment', 'of', 'the', 'inferior', 'rectus.'], ['Fracture', 'of', 'the', 'roof', 'is', 'much', 'less', 'frequent', 'and', 'the', 'entrapment', 'of', 'the', 'superior', 'rectus', 'would', 'cause', 'limitation', 'for', 'infraduction.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Fracture of the roof is much less frequent\n', 'Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n', 'Attack'], ['entrapment of the superior rectus would cause limitation for infraduction\n', 'Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n', 'Attack'], ['As the mechanical function of the left inferior rectus is compromised, it would not allow to complete the supraduccion movement generating vertical diplopia, this plus the traumatic antecedent allows to suspect a fracture of the orbital floor with muscular entrapment of the inferior rectus\n', 'Fracture of the inferior wall of the floor of the orbit with entrapment of the inferior rectus muscle\n', 'Support']]
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328_83
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[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '49-year-old', 'man', 'who', 'consults', 'for', 'severe', 'polyuria', 'and', 'polydipsia', 'and', 'unintentional', 'weight', 'loss', 'of', '10', 'kg', 'and', 'is', 'diagnosed', 'with', 'diabetes', 'mellitus', 'due', 'to', 'a', 'plasma', 'blood', 'glucose', 'of', '322', 'mg/dL', 'and', 'a', 'glycosylated', 'hemoglobin', 'of', '9.8%.'], ['His', 'physician', 'gave', 'him', 'dietary', 'recommendations,', 'the', 'convenience', 'of', 'physical', 'exercise,', 'and', 'he', 'started', 'treatment', 'with', 'metformin', '850', 'mg/12', 'hours', 'and', 'glimepiride', '6', 'mg/day.'], ['In', 'the', 'following', 'weeks', 'the', 'glycemic', 'controls', 'are', 'progressively', 'reduced.'], ['At', '4', 'months', 'glycemia', 'is', '94', 'mg/dL', 'and', 'HbA1c', 'is', '5.9%.'], ['The', 'patient', 'complains', 'of', 'frequent', 'episodes', 'of', 'dizziness,', 'epigastric', 'pain,', 'blurred', 'vision,', 'sweating', 'and', 'tremor,', 'which', 'improve', 'with', 'food', 'and', 'occur', 'mainly', 'in', 'the', 'late', 'morning', 'and', 'late', 'afternoon.'], ['What', 'modification', 'would', 'you', 'propose', 'in', 'his', 'treatment?'], ['1-', 'Review', 'dietary', 'carbohydrate', 'distribution.'], ['2-', 'Discontinue', 'metformin.'], ['3-', 'Discontinue', 'sulfonylurea.'], ['4-', 'Substitute', 'metformin', 'with', 'a', 'DPP4', 'inhibitor.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Discontinue', 'sulfonylurea', 'because', 'of', 'Risk', 'of', 'hypoglycemia.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Discontinue sulfonylurea because of Risk of hypoglycemia\n', 'Discontinue sulfonylurea\n', 'Support']]
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223_62
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[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', '60-year-old', 'diabetic', 'patient', 'with', 'stable', 'angina', 'secondary', 'to', 'ischemic', 'heart', 'disease', 'due', 'to', 'subtotal', 'obstruction', 'in', 'the', 'middle', 'third', 'of', 'the', 'anterior', 'descending', 'coronary', 'artery,', 'what', 'treatment', 'would', 'you', 'propose?'], ['1-', 'Medical', 'with', 'vasodilators', 'and', 'beta-blockers', 'to', 'avoid', 'angina.'], ['2-', 'Expectorant', 'with', 'rigorous', 'rest,', 'since', 'decreasing', 'myocardial', 'oxygen', 'demand', 'should', 'decrease', 'angina.'], ['3-', 'Surgical', 'revascularization', 'of', 'the', 'ischemic', 'myocardium', 'by', 'means', 'of', 'a', 'left', 'mammary', 'artery', 'bypass', 'distal', 'to', 'the', 'lesion', 'in', 'the', 'diseased', 'coronary', 'artery.'], ['4-', 'Dilatation', 'of', 'the', 'coronary', 'artery', 'lesion', 'by', 'therapeutic', 'catheterization.'], ['5-', 'Therapeutic', 'catheterization', 'to', 'dilate', 'the', 'lesion', 'of', 'the', 'diseased', 'artery', 'and', 'implantation', 'of', 'a', 'stent', 'in', 'the', 'dilated', 'area.'], ['CORRECT', 'ANSWER:', '5'], ['Stable', 'angina', 'in', 'diabetics:', 'this', 'question', 'is', 'a', 'nod', 'to', 'the', 'BARI-2D', 'study', '(NEJM', '2009),', 'which', 'showed', 'that', 'medical', 'management', 'was', 'not', 'inferior', 'to', 'revascularization', '(in', 'fact,', 'the', 'new', 'guidelines', 'reflect', 'the', 'trend', 'that', 'not', 'all', 'coronary', 'stenosis', 'should', 'be', 'systematically', 'opened).'], ['Answer', '1', 'is', 'along', 'these', 'lines,', 'although', 'I', 'miss', 'statins,', 'ACE', 'inhibitors', 'and', 'antiplatelet', 'agents,', 'and', 'I', 'have', 'too', 'many', 'vasodilators', '(nitrates', 'are', 'class', 'IIb,', 'if', 'my', 'memory', 'serves', 'me', 'correctly).'], ['2', 'is', 'absurd:', 'sitting', 'down', 'to', 'avoid', 'angina?'], ["That's", 'like', 'cutting', 'down', 'the', 'forest', 'to', 'prevent', 'fires.'], ['3', 'to', '5', 'are', 'about', 'revascularization:', 'since', 'it', 'is', 'a', 'single', 'vessel', 'and', 'not', 'a', 'proximal', 'LAD,', 'revascularization', 'would', 'have', 'to', 'be', 'percutaneous,', 'so', 'we', 'discard', '3.'], ['Between', '4', 'and', '5,', 'the', 'fifth', 'is', 'more', 'complete:', 'not', 'only', 'would', 'it', 'be', 'necessary', 'to', 'dilate,', 'but', 'also', 'to', 'implant', 'a', 'stent.'], ['So', 'the', 'doubt', 'would', 'be', 'between', '1', 'and', '5.'], ['Applying', 'the', 'general', 'rules', 'of', 'response', 'in', 'the', 'MIR,', 'if', 'two', 'options', 'are', 'similar', 'except', 'in', 'one', 'detail,', 'the', 'correct', 'one', 'is', 'one', 'of', 'these,', 'so', 'we', 'would', 'mark', '5', '(and', 'this', 'is', 'what', 'would', 'be', 'done', 'in', 'any', 'hospital', 'nowadays:', 'a', 'suboccluded', 'artery', 'is', 'dilated', 'directly).'], ['On', 'the', 'other', 'hand,', 'and', 'although', '1', 'is', 'incomplete,', 'I', 'suppose', 'the', 'author', 'wanted', 'to', 'be', 'clever', 'and', 'show', 'that', 'he', 'has', 'read', 'the', 'latest', 'articles.'], ['Conclusion:', 'I', 'would', 'mark', '5...', 'but', 'I', 'would', 'not', 'be', 'surprised', 'if', 'it', 'was', '1.']]
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[['O', 'O', 'O'], ['O', 'O'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['2 is absurd: sitting down to avoid angina?\n', 'Expectorant with rigorous rest, since decreasing myocardial oxygen demand should decrease angina\n', 'Attack'], ['although I miss statins, ACE inhibitors and antiplatelet agents, and I have too many vasodilators (nitrates are class IIb, if my memory serves me correctly)\n', 'Answer 1 is along these lines\n', 'Attack'], ['Answer 1 is along these lines\n', 'Medical with vasodilators and beta-blockers to avoid angina\n', 'Support'], ['although I miss statins, ACE inhibitors and antiplatelet agents, and I have too many vasodilators (nitrates are class IIb, if my memory serves me correctly)\n', 'Medical with vasodilators and beta-blockers to avoid angina\n', 'Attack'], ["That's like cutting down the forest to prevent fires\n", '2 is absurd: sitting down to avoid angina?\n', 'Support'], ['3 to 5 are about revascularization: since it is a single vessel and not a proximal LAD, revascularization would have to be percutaneous\n', 'we discard 3\n', 'Support'], ['we discard 3\n', 'Surgical revascularization of the ischemic myocardium by means of a left mammary artery bypass distal to the lesion in the diseased coronary artery\n', 'Attack'], ['Between 4 and 5, the fifth is more complete\n', 'Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area\n', 'Support'], ['not only would it be necessary to dilate, but also to implant a stent\n', 'Between 4 and 5, the fifth is more complete\n', 'Support'], ['and this is what would be done in any hospital nowadays: a suboccluded artery is dilated directly\n', 'we would mark 5\n', 'Support'], ['Applying the general rules of response in the MIR, if two options are similar except in one detail, the correct one is one of these\n', 'we would mark 5\n', 'Support'], ['we would mark 5\n', 'Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area\n', 'Support'], ['Between 4 and 5, the fifth is more complete\n', 'Dilatation of the coronary artery lesion by therapeutic catheterization\n', 'Attack'], ['I would mark 5... but I would not be surprised if it was 1\n', 'Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area\n', 'Support']]
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468_122
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[['QUESTION', 'TYPE:', 'ORTHOPEDIC', 'SURGERY', 'AND', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'man', 'consults', 'for', 'non-radiating', 'lumbar', 'pain', 'of', '1', "week's", 'duration,', 'of', 'progressive', 'intensity,', 'accompanied', 'by', 'marked', 'limitation', 'of', 'spinal', 'mobility', 'and', 'febrile', 'fever.'], ['The', 'lumbar', 'spine', 'X-ray', 'shows', 'no', 'alterations.'], ['What', 'diagnosis', 'should', 'we', 'rule', 'out', 'first', 'and', 'with', 'what', 'technique?'], ['1-', 'Vertebral', 'crush', 'with', 'computed', 'tomography', '(CT).'], ['2-', 'Bone', 'metastases', 'with', 'technetium', 'bone', 'scan.'], ['3-', 'Vertebral', 'ankylosing', 'hyperostosis', 'with', 'dorsolumbar', 'spine', 'x-ray.'], ['4-', 'Pyogenic', 'spondylodiscitis', 'with', 'magnetic', 'resonance', 'imaging', '(MRI).'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'suspect', 'spondylodiscitis', '-', 'the', 'febrile', 'fever', 'and', 'the', 'limitation', 'of', 'mobility', 'of', 'the', 'spine', 'with', 'the', 'acute', 'course', 'give', 'the', 'key', '-,', 'and', 'the', 'indicated', 'test', 'is', 'the', 'MRI.'], ['"The', 'most', 'demonstrative', 'test', 'is', 'magnetic', 'resonance', 'imaging', '(MRI),', 'which', 'is', 'positive', 'even', 'in', 'the', 'first', '2', 'weeks', 'of', 'the', 'picture,', 'which', 'facilitates', 'early', 'diagnosis,', 'with', 'a', 'sensitivity', 'of', '90%".'], ['Vertebral', 'crushing', 'would', 'be', 'seen', 'in', 'the', 'simple', 'X-ray,', 'as', 'well', 'as', 'vertebral', 'ankylosing', 'hyperostosis', 'and', 'many', 'metastases.'], ['In', 'addition,', 'there', 'is', 'no', 'data', 'in', 'the', 'history', 'pointing', 'to', 'bone', 'metastases', '(oncologic', 'history,', 'weight', 'loss', 'etc).']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['the febrile fever and the limitation of mobility of the spine with the acute course give the key\n', 'We suspect spondylodiscitis\n', 'Support'], ['We suspect spondylodiscitis\n', 'the indicated test is the MRI\n', 'Support'], ['the indicated test is the MRI\n', 'Pyogenic spondylodiscitis with magnetic resonance imaging (MRI)\n', 'Support'], ['"The most demonstrative test is magnetic resonance imaging (MRI), which is positive even in the first 2 weeks of the picture, which facilitates early diagnosis, with a sensitivity of 90%"\n', 'the indicated test is the MRI\n', 'Support'], ['In addition, there is no data in the history pointing to bone metastases (oncologic history, weight loss etc)\n', 'Bone metastases with technetium bone scan\n', 'Attack'], ['Vertebral crushing would be seen in the simple X-ray, as well as vertebral ankylosing hyperostosis and many metastases\n', 'Vertebral crush with computed tomography (CT)\n', 'Attack'], ['We suspect spondylodiscitis\n', 'Pyogenic spondylodiscitis with magnetic resonance imaging (MRI)\n', 'Support']]
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96_170
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[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['60-year-old', 'male', 'patient', 'who', 'refers', '10', 'days', 'ago', 'the', 'appearance', 'of', 'blistering', 'lesions', 'on', 'dorsum', 'of', 'hands', 'after', 'sun', 'exposure.'], ['The', 'picture', 'is', 'accompanied', 'by', 'skin', 'fragility.'], ['Histopathologically', 'there', 'is', 'a', 'subepidermal', 'blister', 'with', 'PAS+', 'deposits', 'in', 'and', 'around', 'the', 'superficial', 'dermal', 'vessels.'], ['The', 'most', 'plausible', 'diagnosis', 'is:'], ['1-', 'Familial', 'benign', 'pemphigus.'], ['2-', 'Pemphigoid.'], ['3-', 'Porphyria', 'cutanea', 'tarda.'], ['4-', 'Pemphigus', 'vulgaris.'], ['5-', 'Scalded', 'skin', 'syndrome.'], ['CORRECT', 'ANSWER:', '3'], ['Porphyria', 'cutanea', 'tarda', '(PCT)', 'is', 'the', 'most', 'common', 'porphyria', 'and', 'can', 'present', 'with', 'three', 'major', 'clinical', 'forms:', 'familial,', 'sporadic', 'and', 'toxic.'], ['Clinically,', 'it', 'is', 'characterized', 'by', 'marked', 'skin', 'fragility', 'with', 'the', 'appearance', 'of', 'erosions,', 'vesicles', 'and', 'blisters', 'after', 'minimal', 'trauma.'], ['The', 'most', 'frequent', 'sites', 'are', 'the', 'back', 'of', 'the', 'hands', 'and', 'the', 'face,', 'i.e.', 'the', 'areas', 'of', 'greatest', 'photoexposure.'], ['Clinically,', 'the', 'most', 'important', 'differential', 'diagnosis', 'should', 'be', 'established', 'with', 'pseudoporphyria', 'or', 'phototoxic', 'bullous', 'dermatitis,', 'in', 'which', 'the', 'blisters', 'and', 'cutaneous', 'erosions', 'are', 'produced', 'by', 'photosensitivity,', 'induced', 'by', 'drugs', 'such', 'as', 'tetracyclines,', 'sulfonamides,', 'etc.'], ['However,', 'unlike', 'porphyria,', 'porphyrin', 'levels', 'in', 'serum,', 'feces', 'and', 'urine', 'are', 'normal.'], ['The', 'histopathological', 'differential', 'diagnosis', 'should', 'be', 'established', 'with', 'those', 'diseases', 'showing', 'dermal', 'hyaline', 'deposits,', 'such', 'as:', 'hyalinosis', 'cutis,', 'in', 'which', 'unlike', 'porphyria,', 'PAS-positive', 'hyaline', 'deposits', 'are', 'extensive', 'and', 'massively', 'occupy', 'the', 'deep', 'dermis', 'and', 'subcutaneous', 'cellular', 'tissue;', 'Milium', 'colloid', 'in', 'which', 'hyaline', 'material,', 'usually', 'PAS', 'negative', 'expands', 'the', 'papillary', 'dermis,', 'forming', 'characteristic', 'clefts', 'and', 'fissures;', 'and', 'lipoid', 'proteinosis,', 'in', 'which', 'the', 'material', 'is', 'deposited', 'throughout', 'the', 'dermis,', 'has', 'a', 'distribution', 'not', 'only', 'perivascular', 'but', 'more', 'extensive', 'than', 'in', 'porphyria,', 'and', 'usually', 'affects', 'sweat', 'glands.']]
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[['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['Clinically, it is characterized by marked skin fragility with the appearance of erosions, vesicles and blisters after minimal trauma\n', 'Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n', 'Support'], ['The picture is accompanied by skin fragility\n', 'Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n', 'Support'], ['Histopathologically there is a subepidermal blister with PAS+ deposits in and around the superficial dermal vessels\n', 'Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n', 'Support'], ['Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n', 'Porphyria cutanea tarda\n', 'Support'], ['60-year-old male patient who refers 10 days ago the appearance of blistering lesions on dorsum of hands after sun exposure\n', 'Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n', 'Support'], ['The most frequent sites are the back of the hands and the face, i.e. the areas of greatest photoexposure\n', 'Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n', 'Support']]
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603_112
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '61-year-old', 'woman,', 'administrative,', 'with', 'a', 'history', 'of', 'overweight,', 'hypertension,', 'dyslipidemia', 'and', 'metabolic', 'syndrome,', 'who', 'consults', 'for', 'pain', 'in', 'both', 'buttocks,', 'left', 'trochanteric', 'region,', 'lateral', 'aspect', 'of', 'the', 'left', 'thigh', 'up', 'to', 'the', 'knee', 'and', 'left', 'leg', 'up', 'to', 'the', 'middle', 'third.'], ['The', 'pain', 'appears', 'when', 'the', 'lower', 'limb', 'is', 'lifted', 'with', 'the', 'knee', 'extended,', 'but', 'is', 'relieved', 'when', 'the', 'knee', 'is', 'flexed.'], ['What', 'is', 'the', 'first', 'clinical', 'suspicion?'], ['1-', 'Gouty', 'arthritis', 'of', 'the', 'left', 'hip.'], ['2-', 'Left', 'coxofemoral', 'arthrosis.'], ['3-', 'Radiated', 'low', 'back', 'pain', '/', 'lumbosciatica.'], ['4-', 'Claudication', 'due', 'to', 'canal', 'stenosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'most', 'common', 'symptomatology', 'of', 'a', 'patient', 'with', 'coxarthrosis', 'includes:', 'hip', 'pain', 'that', 'limits', 'ambulation,', 'nocturnal', 'discomfort', 'and', 'even', 'at', 'rest,', 'hip', 'stiffness', 'and', 'locking.'], ['Coxo-femoral', 'osteoarthrosis', 'presents', 'with', 'a', 'negative', 'Lasegue', 'test.'], ['Wrong', 'answer', '2.'], ['Low', 'back', 'pain', 'of', 'a', 'neuropathic', 'nature', 'usually', 'presents', 'with', 'unilateral', 'and', 'distributed', 'radiculopathy', 'according', 'to', 'dermatomes.'], ['The', 'recognized', 'risk', 'factors', 'are', 'most', 'frequently:', 'women,', 'obesity,', 'smoking', 'and', 'sedentary', 'lifestyle', 'or', 'situations', 'of', 'prolonged', 'sitting.'], ['The', 'lumbosciatica', 'is', 'usually', 'referred', 'to', 'the', 'buttock,', 'posterior', 'aspect', 'of', 'the', 'thighs', 'and', 'even', 'inguinal.'], ['The', 'clinical', 'case', 'describes', 'the', 'Lasegue', 'maneuver', 'or', 'test;', 'a', 'provocation', 'test', 'that', 'evidences', 'radicular', 'irritation', 'in', 'the', 'lumbosacral', 'region', '(Answer', '3', 'correct).'], ['Claudication', 'due', 'to', 'canal', 'stenosis', 'typically', 'presents', 'with', 'pain', 'that', 'worsens', 'with', 'trunk', 'extension', '(walking,', 'standing)', 'and', 'is', 'relieved', 'with', 'flexion', '(sitting,', 'sleeping', 'in', 'the', 'fetal', 'position...)', 'Wrong', 'answer', '4.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n', 'The most common symptomatology of a patient with coxarthrosis includes: hip pain that limits ambulation, nocturnal discomfort and even at rest, hip stiffness and locking\n', 'Attack'], ['The pain appears when the lower limb is lifted with the knee extended, but is relieved when the knee is flexed\n', 'Coxo-femoral osteoarthrosis presents with a negative Lasegue test\n', 'Attack'], ['The most common symptomatology of a patient with coxarthrosis includes: hip pain that limits ambulation, nocturnal discomfort and even at rest, hip stiffness and locking\n', 'Wrong answer 2\n', 'Support'], ['Coxo-femoral osteoarthrosis presents with a negative Lasegue test\n', 'Wrong answer 2\n', 'Support'], ['Wrong answer 2\n', 'Left coxofemoral arthrosis\n', 'Attack'], ['A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n', 'Low back pain of a neuropathic nature usually presents with unilateral and distributed radiculopathy according to dermatomes\n', 'Support'], ['A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n', 'The recognized risk factors are most frequently: women, obesity, smoking and sedentary lifestyle or situations of prolonged sitting\n', 'Support'], ['A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n', 'The lumbosciatica is usually referred to the buttock, posterior aspect of the thighs and even inguinal\n', 'Support'], ['The clinical case describes the Lasegue maneuver or test\n', 'a provocation test that evidences radicular irritation in the lumbosacral region\n', 'Support'], ['The pain appears when the lower limb is lifted with the knee extended, but is relieved when the knee is flexed\n', 'a provocation test that evidences radicular irritation in the lumbosacral region\n', 'Support'], ['a provocation test that evidences radicular irritation in the lumbosacral region\n', 'Answer 3 correct\n', 'Attack'], ['Low back pain of a neuropathic nature usually presents with unilateral and distributed radiculopathy according to dermatomes\n', 'Answer 3 correct\n', 'Support'], ['The recognized risk factors are most frequently: women, obesity, smoking and sedentary lifestyle or situations of prolonged sitting\n', 'Answer 3 correct\n', 'Support'], ['The lumbosciatica is usually referred to the buttock, posterior aspect of the thighs and even inguinal\n', 'Answer 3 correct\n', 'Support'], ['Claudication due to canal stenosis typically presents with pain that worsens with trunk extension (walking, standing) and is relieved with flexion (sitting, sleeping in the fetal position...)\n', 'Wrong answer 4\n', 'Support'], ['Wrong answer 4\n', 'Claudication due to canal stenosis\n', 'Attack']]
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574_100
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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'woman', 'with', 'a', 'history', 'of', 'arterial', 'hypertension', 'and', 'diabetes', 'mellitus', 'who', 'suddenly', 'presents', 'with', 'language', 'impairment.'], ['On', 'arrival', 'at', 'the', 'hospital,', 'an', 'unknown', 'atrial', 'fibrillation', 'is', 'observed,', 'and', 'on', 'examination', 'she', 'presents', 'fluent', 'speech', 'with', 'a', 'tendency', 'to', 'slurred', 'speech,', 'poor', 'language', 'comprehension,', 'inability', 'to', 'repeat', 'and', 'dysnomia.'], ['Semiologically', 'she', 'presents', 'a', 'picture', 'compatible', 'with:'], ['1-', "Broca's", 'aphasia.'], ['2-', 'Conduction', 'aphasia.'], ['3-', 'Sensitive', 'transcortical', 'aphasia.'], ['4-', "Wernicke's", 'aphasia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['It', 'is', 'a', 'semiology', 'question', 'that', 'helps', 'us', 'to', 'remember', 'the', 'types', 'of', 'aphasia.'], ['The', 'following', 'aspects', 'should', 'be', 'taken', 'into', 'account:', 'language', 'emission', '(fluent,', 'non-fluent,', 'non-emission),', 'comprehension', '(yes', 'or', 'no),', 'repetition', '(yes', 'or', 'no)', 'and', 'nomination.'], ["Wernicke's", 'aphasia', 'or', 'sensitive', 'aphasia', 'has', 'a', 'fluent', 'language,', 'does', 'not', 'understand,', 'does', 'not', 'repeat', 'and', 'does', 'not', 'nominate,', 'just', 'like', 'the', 'patient', 'in', 'the', 'question.'], ['Sensory', 'transcortical', 'aphasia', 'differs', 'from', 'sensory', 'aphasia', 'in', 'that', 'patients', 'are', 'able', 'to', 'repeat.'], ['Conduction', 'aphasia', 'differs', 'from', 'sensory', 'aphasia', 'in', 'that', 'comprehension', 'is', 'preserved,', 'all', 'else', 'being', 'equal.'], ['Finally,', 'in', "broca's", 'aphasia', 'the', 'language', 'is', 'non-fluent,', 'comprehension', 'is', 'preserved,', 'it', 'does', 'not', 'repeat', 'and', 'does', 'not', 'nominate.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['It is a semiology question that helps us to remember the types of aphasia\n', 'The following aspects should be taken into account: language emission (fluent, non-fluent, non-emission), comprehension (yes or no), repetition (yes or no) and nomination\n', 'Support'], ['On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n', "Wernicke's aphasia or sensitive aphasia has a fluent language, does not understand, does not repeat and does not nominate, just like the patient in the question\n", 'Support'], ["Wernicke's aphasia or sensitive aphasia has a fluent language, does not understand, does not repeat and does not nominate, just like the patient in the question\n", "Wernicke's aphasia\n", 'Support'], ['On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n', 'Sensory transcortical aphasia differs from sensory aphasia in that patients are able to repeat\n', 'Attack'], ['Sensory transcortical aphasia differs from sensory aphasia in that patients are able to repeat\n', 'Sensitive transcortical aphasia\n', 'Attack'], ['On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n', 'Conduction aphasia differs from sensory aphasia in that comprehension is preserved, all else being equal\n', 'Attack'], ['Conduction aphasia differs from sensory aphasia in that comprehension is preserved, all else being equal\n', 'Conduction aphasia\n', 'Attack'], ['On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n', "Finally, in broca's aphasia the language is non-fluent, comprehension is preserved, it does not repeat and does not nominate\n", 'Attack'], ["Finally, in broca's aphasia the language is non-fluent, comprehension is preserved, it does not repeat and does not nominate\n", "Broca's aphasia\n", 'Attack']]
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67_111
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[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY', 'MEDICINE'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'male', 'patient', 'with', 'a', 'history', 'of', 'uric', 'lithiasis', 'and', 'repeated', 'expulsive', 'nephritic', 'colic', 'for', 'the', 'past', '25', 'years', 'comes', 'to', 'the', 'emergency', 'room', 'reporting', 'palpitations', 'and', 'severe', 'right', 'lumbar', 'pain', 'for', 'the', 'past', '2', 'hours.'], ['Urinalysis', 'shows', 'a', 'pH', 'of', '5.5', 'and', 'leukocyturia', 'without', 'proteinuria.'], ['The', 'electrocardiogram', 'confirms', 'a', 'previously', 'unknown', 'AF.'], ['Blood', 'biochemistry', 'shows', 'a', 'Creat', 'of', '0.9,', 'Ca', 'of', '11', 'and', 'LDH', 'of', '950.'], ['What', 'is', 'the', 'most', 'useful', 'diagnostic', 'maneuver', 'to', 'perform?'], ['1-', 'Plain', 'abdominal', 'x-ray.'], ['2-', 'Intravenous', 'urography.'], ['3-', 'Spiral', 'CT', 'with', 'contrast.'], ['4-', 'Abdominal', 'ultrasound.'], ['5-', 'Doppler', 'ultrasound.'], ['CORRECT', 'ANSWER:', '3'], ['In', 'principle,', 'what', 'you', 'tell', 'us', 'does', 'not', 'fit', 'with', 'a', 'nephritic', 'colic.'], ['The', 'urine', 'is', 'normal', '(without', 'hematuria,', 'caused', 'by', 'the', 'lithiasis', 'as', 'it', 'progresses),', 'the', 'Creat', 'is', 'normal', '(it', 'can', 'rise', 'up', 'to', '1.9', 'in', 'nephritic', 'colic).'], ['The', 'increase', 'in', 'LDH', 'is', 'non-specific', 'and', 'can', 'be', 'found', 'in', 'hepatic', 'parenchymal', 'lesions,', 'AMI', 'or', 'pulmonary', 'embolism,', 'as', 'well', 'as', 'in', 'many', 'other', 'less', 'frequent', 'cases', '(tumors,', 'myopathies,', 'etc.).'], ['In', 'this', 'case,', 'we', 'have', 'an', 'important', 'risk', 'factor', 'for', 'embolism,', 'which', 'is', 'atrial', 'fibrillation,', 'which,', 'in', 'addition,', 'being', 'a', '45-year-old', 'male,', 'with', 'no', 'previous', 'history,', 'does', 'not', 'seem', 'to', 'respond', 'to', 'an', 'underlying', 'structural', 'heart', 'disease', 'together', 'with', 'right', 'lumbar', 'pain,', 'which', 'could', 'correspond', 'to', 'irritation', 'of', 'the', 'pleura', 'at', 'the', 'level', 'of', 'the', 'right', 'lumbar', 'spine.'], ['Spiral', 'CT', 'with', 'contrast', 'has', 'acquired', 'great', 'value', 'in', 'the', 'diagnosis', 'of', 'PTE,', 'due', 'to', 'its', 'rapidity', 'and', 'good', 'sensitivity,', 'higher', 'than', '83-92%', 'in', 'most', 'studies,', 'and', 'according', 'to', 'some', 'it', 'can', 'reach', '100%', 'for', 'central', 'thrombi,', 'located', 'in', 'main,', 'lobar', 'or', 'segmental', 'pulmonary', 'arteries.'], ['Its', 'specificity', 'is', 'greater', 'than', '90%.'], ['Nodes', 'can', 'produce', 'false', 'positives.'], ['It', 'can', 'also', 'provide', 'an', 'alternative', 'diagnosis', 'in', 'case', 'PTE', 'is', 'not', 'confirmed,', 'so', 'it', 'would', 'be', 'a', 'very', 'useful', 'test.'], ['Doppler', 'ultrasound', 'would', 'be', 'the', 'most', 'useful', 'test', 'to', 'diagnose', 'the', 'source', 'of', 'the', 'emboli,', 'so', 'it', 'could', 'also', 'be', 'a', 'valid', 'answer', 'depending', 'on', 'what', 'they', 'mean', 'by', '"useful".'], ['It', 'is', 'a', 'noninvasive', 'technique', 'that', 'has', 'demonstrated', 'its', 'good', 'sensitivity', 'and', 'specificity', 'in', 'the', 'diagnosis', 'of', 'DVT', 'compared', 'to', 'phlebography.'], ['It', 'also', 'allows', 'the', 'diagnosis', 'of', 'other', 'pathologies', 'that', 'could', 'justify', 'the', "patient's", 'symptoms.'], ['Its', 'limitations', 'are', 'the', 'assessment', 'of', 'infrapopliteal', 'thrombi', 'and,', 'in', 'many', 'cases,', 'in', 'patients', 'who', 'are', 'not', 'thin,', 'of', 'the', 'iliac', 'and', 'cava', 'veins.']]
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[['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The urine is normal (without hematuria, caused by the lithiasis as it progresses)\n', 'In principle, what you tell us does not fit with a nephritic colic\n', 'Support'], ['the Creat is normal (it can rise up to 1.9 in nephritic colic)\n', 'In principle, what you tell us does not fit with a nephritic colic\n', 'Support'], ['which, in addition, being a 45-year-old male, with no previous history, does not seem to respond to an underlying structural heart disease together with right lumbar pain, which could correspond to irritation of the pleura at the level of the right lumbar spine\n', 'In this case, we have an important risk factor for embolism, which is atrial fibrillation\n', 'Support'], ['The increase in LDH is non-specific and can be found in hepatic parenchymal lesions, AMI or pulmonary embolism, as well as in many other less frequent cases (tumors, myopathies, etc.)\n', 'In this case, we have an important risk factor for embolism, which is atrial fibrillation\n', 'Support'], ['It can also provide an alternative diagnosis in case PTE is not confirmed\n', 'it would be a very useful test\n', 'Support'], ['it would be a very useful test\n', 'Spiral CT with contrast\n', 'Support'], ['Spiral CT with contrast has acquired great value in the diagnosis of PTE\n', 'Spiral CT with contrast\n', 'Support'], ['It can also provide an alternative diagnosis in case PTE is not confirmed\n', 'Spiral CT with contrast\n', 'Support'], ['Doppler ultrasound would be the most useful test to diagnose the source of the emboli\n', 'Doppler ultrasound\n', 'Support'], ['it could also be a valid answer depending on what they mean by "useful"\n', 'Doppler ultrasound\n', 'Support'], ['Its limitations are the assessment of infrapopliteal thrombi and, in many cases, in patients who are not thin, of the iliac and cava veins\n', 'it could also be a valid answer depending on what they mean by "useful"\n', 'Attack'], ['Its limitations are the assessment of infrapopliteal thrombi and, in many cases, in patients who are not thin, of the iliac and cava veins\n', 'Doppler ultrasound\n', 'Attack']]
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77_31
|
[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '17-year-old', 'boy', 'with', "Crohn's", 'disease', 'with', 'colonic', 'involvement', 'of', '2', 'years', 'of', 'evolution,', 'in', 'maintenance', 'treatment', 'with', 'azathioprine,', 'consults', 'for', 'the', 'appearance', 'since', '5', 'days', 'ago', 'of', 'purplish-red,', 'hot,', 'painful,', 'bilateral', 'subcutaneous', 'nodules', 'of', 'pretibial', 'location,', 'associated', 'with', 'an', 'increase', 'in', 'the', 'number', 'of', 'stools', 'and', 'abdominal', 'pain.'], ['The', 'most', 'appropriate', 'approach', 'in', 'this', 'case', 'is:'], ['1-', 'Recommend', 'relative', 'rest', 'and', 'warm', 'cloths', 'on', 'both', 'legs', 'and', 'add', 'antidepressant', 'treatment.'], ['2-', 'Biopsy', 'skin', 'areas', 'away', 'from', 'the', 'injured', 'areas', 'and', 'prescribe', 'opioid', 'analgesics', 'at', 'the', 'beginning.'], ['3-', 'Biopsy', 'skin', 'areas', 'away', 'from', 'the', 'injured', 'areas', 'and', 'prescribe', 'opioid', 'analgesics', 'at', 'the', 'beginning.'], ['4-', 'Suspect', 'bilateral', 'lower', 'extremity', 'ischemia', 'of', 'drug', 'origin.'], ['5-', 'Adjustment', 'of', 'the', 'treatment', 'of', 'the', 'disease.'], ['CORRECT', 'ANSWER:', '5'], ['It', 'appears', 'that', 'the', 'patient', 'has', 'erythema', 'nodosum', 'lesions', 'associated', 'with', 'a', 'flare', 'of', 'his', 'disease,', 'which', 'is', 'common.'], ['Treatment', 'of', 'the', 'disease', 'and', 'its', 'control', 'usually', 'improves', 'the', 'cutaneous', 'lesions.'], ['The', 'lesions', 'should', 'not', 'be', 'biopsied.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Treatment of the disease and its control usually improves the cutaneous lesions\n', 'Adjustment of the treatment of the disease\n', 'Support'], ['The lesions should not be biopsied\n', 'Biopsy skin areas away from the injured areas and prescribe opioid analgesics at the beginning\n', 'Attack'], ['The lesions should not be biopsied\n', 'Biopsy skin areas away from the injured areas and prescribe opioid analgesics at the beginning\n', 'Attack'], ['It appears that the patient has erythema nodosum lesions associated with a flare of his disease, which is common\n', 'Treatment of the disease and its control usually improves the cutaneous lesions\n', 'Support']]
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440_97
| null | null |
[]
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203_47
|
[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['55-year-old', 'woman,', 'operated', 'on', 'for', 'appendicitis', '24', 'years', 'ago,', 'who', 'comes', 'in', 'because', 'while', 'previously', 'well,', 'she', 'has', 'started', 'with', 'repeated', 'vomiting', 'after', 'breakfast,', 'about', '12', 'hours', 'ago,', 'associated', 'with', 'abdominal', 'distention.'], ['She', 'presented', 'a', 'diarrhea', 'stool', 'a', 'few', 'hours', 'after', 'the', 'onset', 'of', 'the', 'symptoms.'], ['Examination', 'revealed', 'abdominal', 'distension,', 'tympanism', 'and', 'increased', 'bowel', 'sounds,', 'but', 'no', 'peritoneal', 'irritation.'], ['Laboratory', 'tests', 'showed', 'no', 'abnormalities.'], ['The', 'abdominal', 'X-ray', 'showed', 'dilatation', 'of', 'the', 'small', 'bowel', 'loops,', 'without', 'gas', 'in', 'the', 'rectal', 'ampulla.'], ['Regarding', 'this', 'case', 'it', 'is', 'true', 'that:'], ['1-', 'This', 'is', 'a', 'picture', 'of', 'intestinal', 'flange', 'obstruction', 'requiring', 'emergency', 'laparotomy.'], ['2-', 'Most', 'likely', 'we', 'are', 'facing', 'a', 'case', 'of', 'obstruction', 'at', 'the', 'level', 'of', 'the', 'large', 'intestine.'], ['3-', 'The', 'fact', 'that', 'the', 'patient', 'presented', 'a', 'diarrheal', 'stool', 'allows', 'us', 'to', 'exclude', 'the', 'diagnosis', 'of', 'intestinal', 'obstruction.', 'Further', 'imaging', 'studies', 'are', 'necessary', 'to', 'ensure', 'a', 'diagnosis.'], ['4-', 'We', 'should', 'indicate', 'the', 'practice', 'of', 'a', 'decompressive', 'colonoscopy.'], ['5-', 'Initial', 'management', 'should', 'be', 'conservative,', 'with', 'serum', 'therapy,', 'nasogastric', 'aspiration', 'and', 'periodic', 'clinical,', 'analytical', 'and', 'radiographic', 'monitoring.'], ['CORRECT', 'ANSWER:', '5'], ['This', 'is', 'a', 'typical', 'description', 'of', 'a', 'picture', 'of', 'intestinal', 'obstruction', 'due', 'to', 'bridging', 'or', 'adhesions', 'due', 'to', 'previous', 'surgery.'], ['The', 'correct', 'answer', 'is', '5', 'and', 'not', '1', 'because', 'most', 'of', 'these', 'situations', 'resolve', 'spontaneously', 'with', 'conservative', 'treatment.']]
|
[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['most of these situations resolve spontaneously with conservative treatment\n', 'The correct answer is 5 and not 1\n', 'Support'], ['The correct answer is 5 and not 1\n', 'Initial management should be conservative, with serum therapy, nasogastric aspiration and periodic clinical, analytical and radiographic monitoring\n', 'Support']]
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158_133
|
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY', 'AND', 'ORTHOPEDICS'], ['CLINICAL', 'CASE:'], ['Obese', '12-year-old', 'boy', '(87', 'kg).'], ['He', 'has', 'been', 'complaining', 'of', 'mechanical', 'pain', 'in', 'the', 'right', 'thigh', 'and', 'knee', 'for', '4', 'months.'], ['Clinical', 'examination', 'reveals', 'a', '1', 'cm', 'discrepancy', 'in', 'the', 'length', 'of', 'the', 'lower', 'extremities', 'and', 'an', 'attitude', 'of', 'the', 'right', 'lower', 'extremity', 'in', 'external', 'rotation', 'with', 'loss', 'of', 'internal', 'rotation.'], ['We', 'should', 'suspect', 'that', 'he', 'presents:'], ['1-', 'Juvenile', 'chronic', 'arthritis.'], ['2-', 'Epiphysiolysis', 'capitis', 'femoris.'], ['3-', 'Fracture', 'of', 'the', 'femoral', 'neck', 'due', 'to', 'overload.'], ['4-', 'Perthes', 'disease.'], ['5-', 'Sequelae', 'of', 'developmental', 'dysplasia', 'of', 'the', 'hip.'], ['CORRECT', 'ANSWER:', '2'], ['We', 'are', 'presented', 'with', 'an', 'adolescent', 'patient', 'who', 'is', 'overweight', 'with', 'pain', 'in', 'the', 'thigh', 'and', 'knee,', 'a', 'length', 'discrepancy', 'of', '1', 'cm', 'and', 'the', 'limb', 'in', 'external', 'rotation.'], ['This', 'picture', 'should', 'automatically', 'lead', 'us', 'to', 'mark', 'epiphysiolysis', 'capitis', 'femoris', '(proximal', 'femoral', 'epiphysiolysis,', 'the', 'fact', 'of', 'reading', 'it', 'in', 'Latin', 'nomina', 'is', 'a', 'bit', 'of', 'a', 'misunderstanding', 'but', 'it', 'should', 'not', 'mislead', 'us).'], ['We', 'should', 'think', 'of', 'this', 'one', 'because', 'it', 'is', 'the', 'most', 'frequent', 'and', 'possible', '(correct', 'answer', '2).'], ['The', 'other', 'options', 'are', 'not', 'impossible', 'but', 'they', 'are', 'less', 'frequent', 'and', 'they', 'would', 'not', 'ask', 'us', 'this', 'if', 'they', 'wanted', 'us', 'to', 'choose', 'another', 'option.'], ['If', 'they', 'were', 'sequelae', 'of', 'hip', 'dysplasia,', 'it', 'would', 'not', 'have', 'this', '4-month', 'onset', 'and', 'the', 'age', 'of', 'onset', 'would', 'be', 'earlier.'], ['Complications', 'of', 'dysplasia', 'are', 'dislocations', 'and', 'subluxations', 'that', 'may', 'require', 'surgery', 'and', 'avascular', 'necrosis', 'of', 'the', 'head', '(false', 'answer', '5).'], ['Perthes', 'disease', 'occurs', 'in', 'younger', 'children', '(4-9', 'years)', 'with', 'episodes', 'of', 'limping', 'and', 'pain', 'in', 'the', 'hip', 'and', 'knee', '(false', 'answer', '4).'], ['In', 'a', 'child', 'the', 'most', 'typical', 'would', 'be', 'a', 'fracture', 'at', 'the', 'level', 'of', 'the', 'physis,', 'not', 'at', 'the', 'level', 'of', 'the', 'femoral', 'neck,', 'so', 'we', 'discard', '3.'], ['For', 'us', 'to', 'consider', 'this', 'option', 'we', 'would', 'have', 'to', 'have', 'been', 'presented', 'with', 'a', 'bone', 'cyst,', 'something', 'that', 'would', 'justify', 'a', 'weakness', 'in', 'the', 'femoral', 'neck', 'area.'], ['As', 'for', 'juvenile', 'chronic', 'arthritis,', 'it', 'is', 'a', 'rheumatoid', 'option', 'surrounded', 'by', 'trauma', 'options.'], ['They', 'do', 'not', 'speak', 'to', 'us', 'of', 'rheumatologic', 'factors', 'in', 'an', 'analytical', 'analysis,', 'nor', 'of', 'a', 'polyarticular', 'picture.'], ['Perhaps', 'we', 'could', 'think', 'about', 'this', 'one', 'because', 'they', 'talk', 'about', 'pain', 'in', 'the', 'right', 'knee,', 'but', 'this', 'picture', 'that', 'they', 'present', 'us', 'is', 'limited', 'to', 'the', 'right', 'lower', 'limb,', 'they', 'do', 'not', 'talk', 'about', 'other', 'joints', 'or', 'fever', 'or', 'other', 'accompanying', 'systemic', 'symptoms,', 'so', 'it', 'is', 'not', 'an', 'option', 'to', 'evaluate,', 'especially', 'with', 'the', 'other', 'options', 'presented', 'to', 'us', 'that', 'would', 'be', 'more', 'likely', 'in', 'view', 'of', 'the', 'picture', 'presented', 'to', 'us', '(option', '1', 'false).'], ['In', 'addition,', 'the', 'knee', 'pain', 'in', 'this', 'case', 'refers', 'to', 'a', 'referred', 'pain', 'of', 'the', 'hip,', 'without', 'involvement', 'of', 'the', 'knee.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Obese 12-year-old boy (87 kg)\n', 'We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n', 'Support'], ['He has been complaining of mechanical pain in the right thigh and knee for 4 months\n', 'We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n', 'Support'], ['Clinical examination reveals a 1 cm discrepancy in the length of the lower extremities and an attitude of the right lower extremity in external rotation with loss of internal rotation\n', 'We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n', 'Support'], ['We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n', 'This picture should automatically lead us to mark epiphysiolysis capitis femoris (proximal femoral epiphysiolysis, the fact of reading it in Latin nomina is a bit of a misunderstanding but it should not mislead us\n', 'Support'], ['This picture should automatically lead us to mark epiphysiolysis capitis femoris (proximal femoral epiphysiolysis, the fact of reading it in Latin nomina is a bit of a misunderstanding but it should not mislead us\n', 'Epiphysiolysis capitis femoris\n', 'Support'], ['We should think of this one because it is the most frequent and possible (correct answer 2)\n', 'Epiphysiolysis capitis femoris\n', 'Support'], ['If they were sequelae of hip dysplasia, it would not have this 4-month onset and the age of onset would be earlier\n', 'Sequelae of developmental dysplasia of the hip\n', 'Attack'], ['Obese 12-year-old boy (87 kg)\n', 'Sequelae of developmental dysplasia of the hip\n', 'Attack'], ['He has been complaining of mechanical pain in the right thigh and knee for 4 months\n', 'Sequelae of developmental dysplasia of the hip\n', 'Attack'], ['Complications of dysplasia are dislocations and subluxations that may require surgery and avascular necrosis of the head (false answer 5)\n', 'Sequelae of developmental dysplasia of the hip\n', 'Attack'], ['Perthes disease occurs in younger children (4-9 years) with episodes of limping and pain in the hip and knee (false answer 4)\n', 'Perthes disease\n', 'Attack'], ['In a child the most typical would be a fracture at the level of the physis, not at the level of the femoral neck, so we discard 3.\n', 'Fracture of the femoral neck due to overload\n', 'Attack'], ['As for juvenile chronic arthritis, it is a rheumatoid option surrounded by trauma options\n', 'Juvenile chronic arthritis\n', 'Attack'], ['They do not speak to us of rheumatologic factors in an analytical analysis, nor of a polyarticular picture\n', 'Juvenile chronic arthritis\n', 'Attack'], ['He has been complaining of mechanical pain in the right thigh and knee for 4 months\n', 'Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)\n', 'Support'], ['Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)\n', 'Juvenile chronic arthritis\n', 'Attack'], ['In addition, the knee pain in this case refers to a referred pain of the hip, without involvement of the knee\n', 'Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)\n', 'Support']]
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46_155
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '1-year-old', 'boy', 'whose', 'mother', 'has', 'just', 'been', 'diagnosed', 'with', 'bacilliferous', 'pulmonary', 'tuberculosis,', 'having', 'started', 'correct', 'treatment.'], ['The', 'child', 'is', 'asymptomatic', 'with', 'a', 'normal', 'examination,', 'negative', 'tuberculin', 'test', '(PT)', 'and', 'normal', 'chest', 'Rx.'], ['What', 'would', 'be', 'the', 'attitude', 'to', 'adopt', 'in', 'the', 'child?'], ['1-', 'Only', 'separate', 'him', 'from', 'the', 'mother', 'until', 'her', 'treatment', 'is', 'completed', '(at', 'least', '6', 'months).'], ['2-', 'Perform', 'a', 'high-resolution', 'CT', 'scan', 'of', 'the', 'lung,', 'and', 'if', 'normal,', 'repeat', 'PT', 'at', '8-12', 'weeks.'], ['3-', 'Chemoprophylaxis', 'with', 'isoniazid', '(INH)', 'until', 'the', "mother's", 'smear', 'test', 'is', 'negative.'], ['4-', 'Chemoprophylaxis', 'with', 'INH', '6-9', 'months.', 'New', 'PT', 'and', 'chest', 'X-ray', 'at', 'the', 'end', 'of', 'treatment,', 'to', 'decide', 'whether', 'or', 'not', 'to', 'conclude', 'treatment.'], ['5-', 'Chemoprophylaxis', 'with', 'INH,', '8-12', 'weeks.', 'Repeat', 'PT.', 'If', 'negative,', 'stop', 'treatment.', 'If', 'positive,', 'perform', 'chest', 'X-ray', 'to', 'decide', 'whether', 'or', 'not', 'there', 'is', 'disease.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'correct', 'answer', 'is', '5.'], ['The', 'mother', 'should', 'be', 'isolated', 'for', 'the', 'first', '2-4', 'weeks', 'of', 'treatment,', 'after', 'which', 'she', 'would', 'no', 'longer', 'be', 'contagious.'], ['If', 'the', 'result', 'of', 'the', 'repeat', 'PT', 'is', 'still', 'negative,', 'the', 'child', 'should', 'not', 'be', 'tested', 'again.'], ['If', 'it', 'is', 'positive,', 'the', 'X-ray', '(or', 'pulmonary', 'CT', 'in', 'younger', 'children)', 'should', 'be', 'repeated.']]
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[['The correct answer is 5\n', 'Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease\n', 'Support'], ['If the result of the repeat PT is still negative, the child should not be tested again\n', 'Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease\n', 'Support'], ['If it is positive, the X-ray (or pulmonary CT in younger children) should be repeated\n', 'Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease\n', 'Support']]
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593_146
| null | null |
[]
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395_136
| null | null |
[]
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424_91
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'woman', 'consults', 'for', 'secondary', 'amenorrhea', 'of', 'one', 'year', 'of', 'evolution.'], ['She', 'has', 'no', 'iatrogenic', 'history.'], ['Analytically,', 'the', 'estradiol', 'concentration', 'is', 'below', 'normal', 'and', 'the', 'prolactin', 'value', 'is', '12', 'ng/mL.'], ['Indicate', 'which', 'of', 'the', 'following', 'examinations', 'would', 'you', 'request', 'as', 'a', 'first', 'step', 'to', 'try', 'to', 'identify', 'the', 'origin', 'of', 'the', 'disorder:'], ['1-', 'Hypothalamohypophyseal', 'MRI.'], ['2-', 'Karyotype.'], ['3-', 'Basal', 'FSH.'], ['4-', 'Chorionic', 'gonadotropin', 'stimulation.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Young', 'woman', 'with', 'secondary', 'amenorrhea,', 'with', 'no', 'history', 'of', 'interest.'], ['Prolactin', 'values', 'are', 'normal', '(values', 'above', '20ngr/ml', 'are', 'considered', 'hyperprolectinemia),', 'thus', 'ruling', 'out', 'hyperprolactinemia', 'as', 'the', 'cause', 'of', 'amenorrhea.'], ['They', 'tell', 'us', 'that', 'the', 'estrogen', 'level', 'is', 'low.'], ['In', 'this', 'case', 'we', 'should', 'suspect', 'early', 'ovarian', 'failure.'], ['For', 'its', 'diagnosis', 'we', 'will', 'ask', 'for', 'a', 'basal', 'FSH', '(in', 'cases', 'of', 'premature', 'ovarian', 'failure', 'it', 'would', 'be', 'elevated).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['values above 20ngr/ml are considered hyperprolectinemia\n', 'Prolactin values are normal\n', 'Support'], ['Analytically, the estradiol concentration is below normal and the prolactin value is 12 ng/mL\n', 'Prolactin values are normal\n', 'Support'], ['For its diagnosis we will ask for a basal FSH\n', 'Basal FSH\n', 'Support'], ['They tell us that the estrogen level is low\n', 'In this case we should suspect early ovarian failure\n', 'Support'], ['In this case we should suspect early ovarian failure\n', 'For its diagnosis we will ask for a basal FSH\n', 'Support'], ['in cases of premature ovarian failure it would be elevated\n', 'In this case we should suspect early ovarian failure\n', 'Support']]
|
169_87
|
[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'CARDIOVASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'woman,', 'hypertensive', 'and', 'diabetic,', 'who', 'has', 'worked', 'as', 'a', 'sales', 'clerk', 'all', 'her', 'life.'], ['She', 'consults', 'for', 'an', 'internal', 'malleolar', 'lesion', 'in', 'the', 'right', 'leg', 'with', 'intense', 'pain', 'throughout', 'the', 'day', 'that', 'worsens', 'at', 'night.'], ['On', 'examination,', 'there', 'are', 'uncomplicated', 'varicose', 'cords', 'in', 'both', 'extremities', 'and', 'normal', 'femoral', 'and', 'popliteal', 'pulses', 'with', 'absence', 'of', 'distal', 'pulses.'], ['What', 'examination', 'should', 'we', 'perform', 'first?'], ['1-', 'Venous', 'echo-Doppler', 'of', 'lower', 'limbs.'], ['2-', 'Angioresonance', 'of', 'lower', 'limbs.'], ['3-', 'Arteriography.'], ['4-', 'Ankle-brachial', 'index.'], ['5-', 'AngioCT.'], ['CORRECT', 'ANSWER:', '4'], ['At', 'least', 'for', 'me,', 'as', 'a', 'family', 'physician,', 'I', 'usually', 'start', 'with', 'the', 'least', 'invasive', 'and', 'most', 'cost-effective', 'tests,', 'and', 'in', 'the', 'case', 'described,', 'an', 'ischemic', 'problem', 'in', 'the', 'lower', 'limbs', 'is', 'the', 'ankle-brachial', 'index.']]
|
[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['At least for me, as a family physician, I usually start with the least invasive and most cost-effective tests, and in the case described, an ischemic problem in the lower limbs is the ankle-brachial index\n', 'Ankle-brachial index\n', 'Support']]
|
95_170
|
[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'male', 'patient', 'who', 'reported', '10', 'days', 'ago', 'the', 'appearance', 'of', 'blistering', 'lesions', 'on', 'the', 'dorsum', 'of', 'the', 'hands', 'after', 'sun', 'exposure.'], ['The', 'picture', 'is', 'accompanied', 'by', 'skin', 'fragility.'], ['Histopathologically', 'there', 'is', 'a', 'subepidermal', 'blister', 'with', 'PAS+', 'deposits', 'in', 'and', 'around', 'the', 'superficial', 'dermal', 'vessels.'], ['The', 'most', 'plausible', 'diagnosis', 'is:'], ['1-', 'Familial', 'benign', 'pemphigus.'], ['2-', 'Pemphigoid.'], ['3-', 'Porphyria', 'cutanea', 'tarda.'], ['4-', 'Pemphigus', 'vulgaris.'], ['5-', 'Scalded', 'skin', 'syndrome.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'fact', 'of', 'being', 'a', 'photoinduced', 'picture,', 'the', 'histology', 'and', 'the', 'age', 'make', 'the', 'diagnosis', 'of', 'PCT', 'more', 'probable', '(3).'], ['The', 'rest', 'of', 'the', 'answers', 'do', 'not', 'fit', 'with', 'the', 'clinical', 'picture', 'or', 'the', 'histology.']]
|
[['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n', 'Porphyria cutanea tarda\n', 'Support'], ['The rest of the answers do not fit with the clinical picture or the histology\n', 'Scalded skin syndrome\n', 'Attack'], ['The rest of the answers do not fit with the clinical picture or the histology\n', 'Pemphigus vulgaris\n', 'Attack'], ['The rest of the answers do not fit with the clinical picture or the histology\n', 'Pemphigoid\n', 'Attack'], ['The rest of the answers do not fit with the clinical picture or the histology\n', 'Familial benign pemphigus\n', 'Attack'], ['A 60-year-old male patient who reported 10 days ago the appearance of blistering lesions on the dorsum of the hands after sun exposure\n', 'The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n', 'Support'], ['Histopathologically there is a subepidermal blister with PAS+ deposits in and around the superficial dermal vessels\n', 'The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n', 'Support'], ['The picture is accompanied by skin fragility\n', 'The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n', 'Support']]
|
537_1
| null | null |
[]
|
363_97
|
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'patient', 'who,', 'due', 'to', 'hematemesis', 'due', 'to', 'ulcus,', 'receives', 'a', 'transfusion', 'of', '2', 'packed', 'red', 'blood', 'cells.'], ['5-10', 'minutes', 'after', 'starting', 'the', 'transfusion,', 'she', 'begins', 'with', 'fever,', 'chills,', 'hypotension', 'and', 'pain', 'in', 'the', 'lumbar', 'region.'], ['What', 'would', 'be', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Bacterial', 'contamination', 'of', 'the', 'blood.'], ['2-', 'Febrile', 'reaction', 'secondary', 'to', 'transfusion.'], ['3-', 'Febrile', 'reaction', 'due', 'to', 'plasma', 'contaminating', 'red', 'blood', 'cells.'], ['4-', 'Hemolytic', 'transfusion', 'reaction.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Acute', 'hemolytic', 'transfusion', 'reactions', 'can', 'occur', 'within', 'minutes.'], ['Clinically', 'they', 'are', 'characterized', 'by', 'chills,', 'fever,', 'urticaria,', 'tachycardia,', 'nausea', 'and', 'vomiting,', 'lumbar', 'pain,', 'hemorrhage', 'due', 'to', 'disseminated', 'intravascular', 'coagulation', '(DIC).....'], ['We', 'are', 'told', 'of', 'a', 'patient', 'who,', 'within', 'minutes', 'of', 'starting', 'a', 'transfusion,', 'presented', 'with', 'an', 'acute', 'and', 'very', 'serious', 'condition', '(with', 'shock).'], ['Such', 'an', 'acute', 'and', 'severe', 'situation', 'only', 'fits', 'option', '4.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['Acute hemolytic transfusion reactions can occur within minutes\n', 'Hemolytic transfusion reaction\n', 'Support'], ['5-10 minutes after starting the transfusion, she begins with fever, chills, hypotension and pain in the lumbar region\n', 'Clinically they are characterized by chills, fever, urticaria, tachycardia, nausea and vomiting, lumbar pain, hemorrhage due to disseminated intravascular coagulation (DIC).....\n', 'Support'], ['Clinically they are characterized by chills, fever, urticaria, tachycardia, nausea and vomiting, lumbar pain, hemorrhage due to disseminated intravascular coagulation (DIC).....\n', 'Acute hemolytic transfusion reactions can occur within minutes\n', 'Support'], ['We are told of a patient who, within minutes of starting a transfusion, presented with an acute and very serious condition (with shock)\n', 'Such an acute and severe situation only fits option 4\n', 'Support'], ['Such an acute and severe situation only fits option 4\n', 'Hemolytic transfusion reaction\n', 'Support']]
|
339_33
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['67-year-old', 'woman', 'diagnosed', 'with', 'an', 'infiltrating', 'ductal', 'carcinoma', 'of', 'the', 'breast', 'and', 'no', 'family', 'history', 'of', 'neoplasia.'], ['What', 'additional', 'studies', 'should', 'be', 'performed', 'on', 'the', 'tumor', 'for', 'its', 'clinical-therapeutic', 'implications?'], ['1-', 'Complete', 'phenotypic', 'study', 'by', 'flow', 'cytometry.'], ['2-', 'Study', 'of', 'hormone', 'receptors', 'and', 'HER2.'], ['3-', 'Study', 'of', 'hormone', 'receptors,', 'e-cadherin', 'and', 'study', 'of', 'first-degree', 'relatives.'], ['4-', 'BRCA', '1-2', 'study', 'and', 'study', 'of', 'first-degree', 'relatives.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['All', 'breast', 'carcinomas', 'should', 'be', 'accompanied', 'by', 'the', 'study', 'of', 'hormone', 'receptors', 'and', 'HER-2', 'for', 'the', 'prognostic', 'implications', 'of', 'the', 'tumor,', 'as', 'well', 'as', 'the', 'adequacy', 'of', 'the', 'treatment', 'of', 'the', 'same,', 'since', 'depending', 'on', 'the', 'result', 'will', 'apply', 'some', 'drugs', 'or', 'others.'], ['The', 'study', 'of', 'relatives', 'and', 'the', 'BCRA', 'gene', 'is', 'not', 'indicated', 'since', 'she', 'does', 'not', 'have', 'a', 'family', 'history', 'of', 'neoplasia.']]
|
[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
|
[['she does not have a family history of neoplasia\n', 'The study of relatives and the BCRA gene is not indicated\n', 'Support'], ['The study of relatives and the BCRA gene is not indicated\n', 'BRCA 1-2 study and study of first-degree relatives\n', 'Attack'], ['All breast carcinomas should be accompanied by the study of hormone receptors and HER-2 for the prognostic implications of the tumor, as well as the adequacy of the treatment of the same, since depending on the result will apply some drugs or others\n', 'Complete phenotypic study by flow cytometry\n', 'Support'], ['The study of relatives and the BCRA gene is not indicated\n', 'Study of hormone receptors, e-cadherin and study of first-degree relatives\n', 'Attack']]
|
144_142
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '13-year-old', 'girl', 'consults', 'us', 'for', 'weight', 'loss,', 'asthenia,', 'secondary', 'amenorrhea', 'and', 'constipation.'], ['Examination', 'revealed', 'a', 'temperature', 'of', '35ºC,', 'weight', 'below', 'the', '3rd', 'percentile,', 'bradycardia', 'and', 'orthostatic', 'hypotension.'], ['Laboratory', 'tests', 'showed', 'anemia', 'with', 'mild', 'leukopenia,', 'cholesterol', 'of', '230', 'mg/dL', 'and', 'on', 'the', 'electrocardiogram', 'a', 'flattened', 'T', 'wave', 'with', 'ST-segment', 'elevation', 'and', 'prolonged', 'QTc.'], ['What', 'process', 'would', 'you', 'suspect', 'and', 'what', 'would', 'you', 'do', 'next?'], ['1-', 'Suspect', 'anorexia', 'nervosa', 'and', 'inquire', 'about', 'intake,', 'body', 'image,', 'etc.'], ['2-', 'Suspect', 'hypothyroidism', 'and', 'request', 'TSH', 'and', 'thyroid', 'hormones.'], ['3-', 'Suspect', 'cardiomyopathy', 'and', 'request', 'echocardiography.'], ['4-', 'I', 'would', 'suspect', 'celiac', 'disease', 'and', 'request', 'anti-transglutaminase', 'IgA', 'antibodies.'], ['5-', 'Suspect', 'panhypopituitarism', 'and', 'request', 'a', 'cranial', 'CT', 'scan.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', '1.'], ['The', 'symptoms', 'and', 'signs', 'described', 'are', 'the', 'biological', 'findings', 'associated', 'with', 'anorexia', 'nervosa.'], ['The', 'ECG', 'disturbances', 'are', 'derived', 'from', 'electrolyte', 'disturbances.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['The correct answer is 1\n', 'Suspect anorexia nervosa and inquire about intake, body image, etc\n', 'Support'], ['The symptoms and signs described are the biological findings associated with anorexia nervosa\n', 'Suspect anorexia nervosa and inquire about intake, body image, etc\n', 'Support'], ['A 13-year-old girl consults us for weight loss, asthenia, secondary amenorrhea and constipation\n', 'Suspect anorexia nervosa and inquire about intake, body image, etc\n', 'Support'], ['Examination revealed a temperature of 35ºC, weight below the 3rd percentile, bradycardia and orthostatic hypotension.\n', 'Suspect anorexia nervosa and inquire about intake, body image, etc\n', 'Support'], ['on the electrocardiogram a flattened T wave with ST-segment elevation and prolonged QTc\n', 'The ECG disturbances are derived from electrolyte disturbances.\n', 'Support'], ['The ECG disturbances are derived from electrolyte disturbances.\n', 'Suspect anorexia nervosa and inquire about intake, body image, etc\n', 'Support']]
|
356_166
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', 'pregnant', 'woman,', '10', 'weeks', 'pregnant,', 'comes', 'to', 'the', 'emergency', 'room', 'with', 'a', 'blood', 'pressure', 'of', '160/105', 'mmHg.'], ['She', 'is', 'in', 'good', 'general', 'condition,', 'with', 'only', 'mild', 'headache,', 'which', 'is', 'the', 'reason', 'for', 'taking', 'her', 'blood', 'pressure.'], ['After', '4', 'hours', 'of', 'rest', 'she', 'presented', 'with', 'a', 'blood', 'pressure', 'of', '150/95mmHg.'], ['A', 'complete', 'blood', 'count', 'is', 'normal', 'and', 'proteinuria', 'is', 'negative.'], ['What', 'type', 'of', 'hypertension', 'does', 'she', 'have?'], ['1-', 'Moderate', 'pre-eclampsia.'], ['2-', 'Pregnancy-induced', 'hypertension.'], ['3-', 'Chronic', 'hypertension.'], ['4-', 'Eclampsia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Chronic', 'hypertension.'], ['This', 'is', 'hypertension', 'that', 'is', 'detected', 'before', 'pregnancy', 'or', 'before', 'the', '20th', 'week', 'of', 'pregnancy', 'and/or', 'persists', 'at', '12', 'weeks', 'postpartum.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['This is hypertension that is detected before pregnancy or before the 20th week of pregnancy and/or persists at 12 weeks postpartum\n', 'Chronic hypertension\n', 'Support'], ['A pregnant woman, 10 weeks pregnant, comes to the emergency room with a blood pressure of 160/105 mmHg\n', 'This is hypertension that is detected before pregnancy or before the 20th week of pregnancy and/or persists at 12 weeks postpartum\n', 'Support'], ['Chronic hypertension\n', 'Chronic hypertension\n', 'Support']]
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495_64
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[['QUESTION', 'TYPE:', 'MEDICAL', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['65-year-old', 'woman', 'with', 'no', 'comorbidities,', 'undergoing', 'left', 'breast-conserving', 'surgery', 'with', 'selective', 'sentinel', 'lymph', 'node', 'biopsy.'], ['The', 'pathological', 'anatomy', 'of', 'the', 'specimen', 'shows', 'an', 'infiltrating', 'ductal', 'carcinoma', 'grade', 'III', 'of', '11', 'mm,', 'two', 'negative', 'sentinel', 'nodes,', 'estrogen', 'receptors:', '0%,', 'progesterone', 'receptors:', '0%,', 'Ki', '67:', '70%,', 'HER2:', 'negative.'], ['The', 'extension', 'study', 'is', 'negative.'], ['Adjuvant', 'treatment', 'would', 'be:'], ['1-', 'Chemotherapy', 'based', 'on', 'anthracyclines', 'and', 'taxanes,', 'radiotherapy', 'and', 'trastuzumab.'], ['2-', 'Chemotherapy', 'based', 'on', 'anthracyclines', 'and', 'taxanes,', 'radiotherapy', 'and', 'tamoxifen.'], ['3-', 'Chemotherapy', 'based', 'on', 'anthracyclines', 'and', 'taxanes,', 'and', 'radiotherapy.'], ['4-', 'Chemotherapy', 'based', 'on', 'anthracyclines', 'and', 'taxanes,', 'radiotherapy', 'and', 'aromatase', 'inhibitors,', 'since', 'it', 'is', 'postmenopausal.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Typical', 'question,', 'conservative', 'surgery', 'implies', 'radiate,', 'for', 'sure.'], ['High', 'grade,', 'and', 'no', 'hormone', 'receptors', 'or', 'her2', '(the', 'dreaded', 'triple', 'negative).'], ['I', 'was', 'there', 'when', 'there', 'were', 'no', 'taxanes', 'or', 'herceptin', 'and', 'I', 'was', 'in', 'the', 'trials', 'that', 'showed', 'that', 'more', 'and', 'more', 'are', 'being', 'cured,', 'unfortunately', 'still', 'not', 'all.'], ['That', 'is', 'why', 'today,', 'anthracyclines', '(does', 'not', 'suffer', 'from', 'heart)', 'and', 'taxanes', 'before', 'RT.'], ['My', 'specialty', 'is', 'beautiful,', 'and', 'will', 'be', 'more', 'so', 'in', 'the', 'coming', 'years.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['That is why today, anthracyclines (does not suffer from heart) and taxanes before RT\n', 'Chemotherapy based on anthracyclines and taxanes, and radiotherapy\n', 'Support'], ['High grade, and no hormone receptors or her2 (the dreaded triple negative)\n', 'That is why today, anthracyclines (does not suffer from heart) and taxanes before RT\n', 'Support'], ['I was there when there were no taxanes or herceptin and I was in the trials that showed that more and more are being cured, unfortunately still not all\n', 'That is why today, anthracyclines (does not suffer from heart) and taxanes before RT\n', 'Support']]
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355_166
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', 'pregnant', 'woman,', '10', 'weeks', 'pregnant,', 'comes', 'to', 'the', 'emergency', 'room', 'with', 'a', 'blood', 'pressure', 'of', '160/105', 'mmHg.'], ['She', 'is', 'in', 'good', 'general', 'condition,', 'with', 'only', 'mild', 'headache,', 'which', 'is', 'the', 'reason', 'for', 'taking', 'her', 'blood', 'pressure.'], ['After', '4', 'hours', 'of', 'rest', 'she', 'presented', 'with', 'a', 'blood', 'pressure', 'of', '150/95mmHg.'], ['A', 'complete', 'blood', 'count', 'is', 'normal', 'and', 'proteinuria', 'is', 'negative.'], ['What', 'type', 'of', 'hypertension', 'is', 'present?'], ['1-', 'Moderate', 'preeclampsia.'], ['2-', 'Pregnancy-induced', 'hypertension.'], ['3-', 'Chronic', 'hypertension.'], ['4-', 'Eclampsia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['The', 'SEGO', 'in', 'its', '2006', 'protocol', '"Hypertensive', 'disorders', 'of', 'pregnancy"', 'refers', 'that', 'this', 'is', 'chronic', 'hypertension,', 'although', 'diagnosed', 'in', 'pregnancy.'], ['This', 'is', 'because', 'it', 'has', 'been', 'diagnosed', 'at', '10', 'weeks', 'of', 'gestation.'], ['Above', '20', "weeks'", 'gestation,', 'we', 'would', 'be', 'talking', 'about', 'preeclampsia', '(if', 'HT', '+', 'proteinuria', 'or', 'uterine', 'artery', 'pulsatility', 'index', 'above', 'the', '95th', 'percentile),', 'pregnancy-induced', 'hypertension', '(only', 'HT)', 'or', 'eclampsia', '(a', 'form', 'of', 'severe', 'preeclampsia).']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The SEGO in its 2006 protocol "Hypertensive disorders of pregnancy" refers that this is chronic hypertension, although diagnosed in pregnancy\n', 'Chronic hypertension\n', 'Support'], ['This is because it has been diagnosed at 10 weeks of gestation\n', 'The SEGO in its 2006 protocol "Hypertensive disorders of pregnancy" refers that this is chronic hypertension, although diagnosed in pregnancy\n', 'Support'], ["Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", 'Moderate preeclampsia\n', 'Attack'], ['This is because it has been diagnosed at 10 weeks of gestation\n', "Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", 'Attack'], ["Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", 'Pregnancy-induced hypertension\n', 'Attack'], ["Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", 'Eclampsia\n', 'Attack'], ['The SEGO in its 2006 protocol "Hypertensive disorders of pregnancy" refers that this is chronic hypertension, although diagnosed in pregnancy\n', 'The correct answer is 3\n', 'Support'], ['The correct answer is 3\n', 'Chronic hypertension\n', 'Support']]
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94_31
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[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '17-year-old', 'boy', 'with', "Crohn's", 'disease', 'with', 'colonic', 'involvement', 'of', '2', 'years', 'of', 'evolution,', 'in', 'maintenance', 'treatment', 'with', 'azathioprine,', 'consults', 'for', 'the', 'appearance', 'for', '5', 'days', 'of', 'subcutaneous', 'red', 'purplish,', 'hot,', 'painful,', 'bilateral,', 'pretibial', 'localization', 'nodules,', 'associated', 'with', 'an', 'increase', 'in', 'the', 'number', 'of', 'stools', 'and', 'abdominal', 'pain.'], ['The', 'most', 'appropriate', 'approach', 'in', 'this', 'case', 'is:'], ['1-', 'Recommend', 'relative', 'rest', 'and', 'warm', 'cloths', 'on', 'both', 'legs', 'and', 'add', 'antidepressant', 'treatment.'], ['2-', 'Biopsy', 'areas', 'of', 'skin', 'away', 'from', 'the', 'injured', 'areas', 'and', 'prescribe', 'opioid', 'analgesics', 'for', 'entry.'], ['3-', 'Suspect', 'the', 'existence', 'of', 'a', 'malignant', 'intestinal', 'tumor', 'lesion', 'as', 'a', 'trigger', 'of', 'the', 'cutaneous', 'process.'], ['4-', 'Suspect', 'bilateral', 'lower', 'extremity', 'ischemia', 'of', 'drug-induced', 'origin.'], ['5-', 'Adjustment', 'of', 'bowel', 'disease', 'treatment.'], ['CORRECT', 'ANSWER:', '5'], ['The', "patient's", 'presenting', 'picture', 'is', 'presumably', 'erythema', 'nodosum.'], ['About', '10%', 'of', 'cases', 'of', 'erythema', 'nodosum', 'are', 'associated', 'with', 'inflammatory', 'bowel', 'disease,', 'both', 'ulcerative', 'colitis', 'and', "Crohn's", 'disease.'], ['As', 'mentioned,', 'in', 'most', 'cases,', 'erythema', 'nodosum', 'has', 'a', 'self-limited', 'course.'], ['When', 'associated', 'with', 'inflammatory', 'bowel', 'disease,', 'erythema', 'nodosum', 'usually', 'resolves', 'with', 'treatment', 'of', 'the', 'intestinal', 'flare,', 'and', 'recurs', 'with', 'disease', 'recurrences.'], ['Local', 'measures', 'include', 'elevation', 'of', 'the', 'legs', 'and', 'bed', 'rest.'], ['In', 'particularly', 'severe', 'cases,', 'oral', 'administration', 'of', 'potassium', 'iodide', 'has', 'been', 'shown', 'to', 'be', 'helpful.'], ['Although', 'the', 'use', 'of', 'aspirin', 'and', 'other', 'NSAIDs', 'is', 'effective', 'for', 'erythema', 'nodosum,', 'their', 'use', 'in', 'patients', 'with', 'inflammatory', 'bowel', 'disease', 'should', 'be', 'limited,', 'as', 'they', 'may', 'worsen', 'the', 'intestinal', 'picture,', 'the', 'usefulness', 'of', 'antidepressants', 'in', 'this', 'picture', 'has', 'not', 'been', 'described,', 'so', 'answer', 'nº1', 'would', 'not', 'be', 'correct.']]
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[['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['the usefulness of antidepressants in this picture has not been described\n', 'answer nº1 would not be correct\n', 'Support'], ['answer nº1 would not be correct\n', 'Recommend relative rest and warm cloths on both legs and add antidepressant treatment\n', 'Attack'], ["About 10% of cases of erythema nodosum are associated with inflammatory bowel disease, both ulcerative colitis and Crohn's disease\n", 'Adjustment of bowel disease treatment.\n', 'Support'], ['When associated with inflammatory bowel disease, erythema nodosum usually resolves with treatment of the intestinal flare, and recurs with disease recurrences\n', 'Adjustment of bowel disease treatment.\n', 'Support']]
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39_134
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[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['60-year-old', 'woman,', 'diagnosed', 'with', 'breast', 'cancer', 'treated', 'with', 'surgery', 'and', 'radiotherapy', '10', 'years', 'ago.'], ['Currently', 'with', 'metastases', 'in', 'the', 'dorsal', 'spine', 'and', 'sacroiliac', 'joint,', 'for', 'which', 'she', 'has', 'received', 'monthly', 'treatment', 'with', 'i.v.', 'zoledronic', 'acid', 'for', 'the', 'last', 'two', 'years.'], ['The', 'patient', 'presented', 'spontaneous', 'bone', 'exposure', 'at', 'the', 'level', 'of', 'the', 'mandibular', 'bone', 'of', 'approximately', '2', 'cm.'], ['There', 'are', 'no', 'signs', 'of', 'acute', 'infection', 'and', 'the', 'gum', 'around', 'the', 'bone', 'exposure', 'is', 'strictly', 'normal.'], ['The', 'mandibular', 'CT', 'scan', 'shows', 'an', 'area', 'of', 'bone', 'sclerosis.'], ['What', 'would', 'be', 'the', 'diagnosis?'], ['1-', 'Odontogenic', 'abscess.'], ['2-', 'Osteonecrosis', 'due', 'to', 'bisphosphonates.'], ['3-', 'Osteoradionecrosis.'], ['4-', 'Dental', 'root', 'included.'], ['5-', 'Metastasis', 'of', 'breast', 'carcinoma.'], ['CORRECT', 'ANSWER:', '2'], ['This', 'one', 'has', 'been', 'difficult', 'for', 'me,', 'we', 'are', 'going', 'to', 'rule', 'it', 'out.'], ['1', 'cannot', 'be,', 'because', 'there', 'would', 'be', 'infectious', 'signs.'], ['Answer', '2', 'is', 'possible', 'because', 'bisphosphonates', 'create', 'mandibular', 'necrosis.'], ['3', 'seems', 'unlikely', 'to', 'me', 'because', 'the', 'radiotherapy', 'that', 'the', 'patient', 'received', 'would', 'be', 'oriented', 'on', 'the', 'breast', 'and', 'not', 'on', 'the', 'mandible.'], ['I', 'rule', 'out', 'number', '4,', 'as', 'it', 'is', 'not', 'a', 'case', 'of', 'dental', 'root', 'involvement.'], ['5', 'is', 'possible;', 'after', 'all,', 'the', 'patient', 'already', 'has', 'bone', 'metastases.'], ['So,', 'I', 'hesitate', 'between', '2', 'and', '5,', 'which', 'one', 'to', 'choose?'], ['I', 'am', 'certainly', 'not', 'sure', 'what', 'a', 'bone', 'sclerosis', 'means', 'on', 'a', 'CT', 'scan,', 'but', 'a', 'bone', 'metastasis', 'would', 'be', 'more', 'destructive', 'than', 'sclerotizing.'], ['On', 'the', 'other', 'hand,', 'using', 'reverse', 'psychology,', 'what', 'did', 'the', 'questioner', 'want', 'me', 'to', 'know?'], ['That', 'bisphosphonates', 'can', 'create', 'mandibular', 'necrosis?'], ['Or', 'that', 'a', 'woman', 'with', 'several', 'bone', 'metastases', 'can', 'have', 'a', 'metastasis', 'also', 'in', 'the', 'mandible?'], ['The', 'latter', 'seems', 'too', 'simple,', 'and', 'would', 'make', 'me', 'lean', 'more', 'towards', '2,', 'but', "it's", 'not', 'clear', 'to', 'me.'], ['Be', 'that', 'as', 'it', 'may,', 'between', 'two', 'possible', 'answers', 'you', 'have', 'to', 'always', 'answer,', 'and', 'between', '2', 'and', '5,', 'you', 'have', 'to', 'check', '2,', 'which', 'is', 'more', 'likely.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['there would be infectious signs\n', '1 cannot be\n', 'Support'], ['the radiotherapy that the patient received would be oriented on the breast and not on the mandible\n', '3 seems unlikely to me\n', 'Support'], ['bisphosphonates create mandibular necrosis\n', 'Answer 2 is possible\n', 'Support'], ['it is not a case of dental root involvement\n', 'I rule out number 4\n', 'Support'], ['the patient already has bone metastases\n', '5 is possible\n', 'Support'], ['1 cannot be\n', 'Odontogenic abscess\n', 'Attack'], ['Answer 2 is possible\n', 'Osteonecrosis due to bisphosphonates\n', 'Support'], ['3 seems unlikely to me\n', 'Osteoradionecrosis\n', 'Attack'], ['I rule out number 4\n', 'Dental root included\n', 'Attack'], ['5 is possible\n', 'Metastasis of breast carcinoma\n', 'Support'], ['between two possible answers you have to always answer, and between 2 and 5, you have to check 2, which is more likely\n', 'Metastasis of breast carcinoma\n', 'Attack'], ['between two possible answers you have to always answer, and between 2 and 5, you have to check 2, which is more likely\n', 'Osteonecrosis due to bisphosphonates\n', 'Support']]
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252_83
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[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['What', 'disease', 'would', 'we', 'suspect', 'in', 'a', 'young', 'patient', 'with', 'a', 'frequent', 'history', 'of', 'dysphagia', 'to', 'solids', 'and', 'liquids', 'with', 'repeated', 'food', 'impactions,', 'without', 'symptoms', 'of', 'heartburn', 'and', 'in', 'whom', 'oral', 'endoscopy', 'shows', 'multiple', 'concentric', 'esophageal', 'rings', 'with', 'normal', 'mucosa', '(trachealized', 'appearance)?'], ['1-', 'Herpetic', 'esophagitis.'], ['2-', 'Eosinophilic', 'esophagitis.'], ['3-', 'Candidiasis', 'esophagitis.'], ['4-', 'Cytomegalovirus', 'esophagitis.'], ['5-', 'Adenocarcinoma', 'of', 'the', 'esophagus.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'endoscopic', 'appearance', 'of', 'trachealized', 'esophagus', 'is', 'very', 'typical', 'of', 'eosinophilic', 'esophagitis,', 'which', 'presents', 'with', 'dysphagia', 'and', 'repeated', 'food', 'impactions.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['a young patient with a frequent history of dysphagia to solids and liquids with repeated food impactions, without symptoms of heartburn and in whom oral endoscopy shows multiple concentric esophageal rings with normal mucosa (trachealized appearance)\n', 'The endoscopic appearance of trachealized esophagus is very typical of eosinophilic esophagitis, which presents with dysphagia and repeated food impactions\n', 'Support'], ['The endoscopic appearance of trachealized esophagus is very typical of eosinophilic esophagitis, which presents with dysphagia and repeated food impactions\n', 'Eosinophilic esophagitis\n', 'Support']]
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57_77
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', '42-year-old', 'obese', 'woman,', 'cortisol', 'levels', 'in', 'blood,', 'urine', 'and', 'saliva', 'are', 'determined', 'and', 'in', 'all', 'the', 'determinations', 'they', 'are', 'elevated.'], ['After', 'performing', 'the', 'nocturnal', 'suppression', 'test', 'with', 'dexamethasone,', 'cortisol', 'levels', 'in', 'blood', 'remain', 'elevated,', 'so', 'ACTH', 'independent', "Cushing's", 'syndrome', 'is', 'suspected,', 'what', 'additional', 'test', 'would', 'you', 'request', 'to', 'confirm', 'the', 'diagnosis', 'at', 'this', 'time?'], ['1-', 'A', 'petrosal', 'sinus', 'catheterization.'], ['2-', 'A', 'gammagraphy', 'with', 'labeled', 'somatostatin', '(Octreoscan).'], ['3-', 'A', 'scan', 'with', 'Sesta-MIBI.'], ['4-', 'An', 'abdominal', 'ultrasound.'], ['5-', 'An', 'adrenal', 'CT', 'scan.'], ['CORRECT', 'ANSWER:', '5'], ['Anyway,', 'I', 'think', 'that', 'the', 'clinical', 'case', 'is', 'poorly', 'stated,', 'since', 'before', 'doing', 'the', 'CT', 'scan,', 'ACTH', 'should', 'be', 'measured', 'and,', 'once', 'ACTH', 'is', 'suppressed,', 'the', 'CT', 'scan', 'should', 'be', 'done.'], ['But', 'since', 'the', 'question', 'is', '"what', 'would', 'you', 'do', 'to', 'confirm', 'the', 'diagnosis', 'of', 'suspected', 'ACTH', 'independent', "Cushing's", 'syndrome",', 'the', 'answer', 'is', 'CT.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['the answer is CT\n', 'An adrenal CT scan\n', 'Support'], ['before doing the CT scan, ACTH should be measured and, once ACTH is suppressed, the CT scan should be done\n', 'Anyway, I think that the clinical case is poorly stated\n', 'Support']]
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595_88
| null | null |
[]
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98_171
|
[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['The', 'patient', 'presents', 'since', '2', 'weeks', 'ago', 'a', 'pruritic', 'eruption', 'consisting', 'of', 'multiple', 'polygonal', 'erythematous-violaceous', 'papules,', 'with', 'flattened', 'surface,', 'preferentially', 'located', 'on', 'the', 'anterior', 'aspect', 'of', 'the', 'wrists,', 'pretibial', 'area', 'and', 'lumbar', 'area.'], ['She', 'also', 'presents', 'whitish', 'reticulated', 'lesions', 'in', 'the', 'jugal', 'mucosa.'], ['What', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Pityriasis', 'versicolor.'], ['2-', 'Mycosis', 'fungoides.'], ['3-', 'Psoriasis', 'in', 'drops.'], ['4-', 'Pityriasis', 'rosea', 'of', 'Gibert.'], ['5-', 'Lichen', 'planus.'], ['CORRECT', 'ANSWER:', '5'], ['Lichen', 'planus', 'is', 'a', 'very', 'common', 'dermatosis', 'of', 'unknown', 'etiology', 'characterized', 'by', 'the', 'appearance', 'of', 'pruritic', 'polygonal', 'papules,', 'with', 'a', 'purplish', 'color', 'and', 'shiny', 'surface,', 'preferentially', 'located', 'in', 'the', 'distal', 'areas', 'of', 'the', 'extremities.'], ['Characteristically', 'these', 'papules', 'show', 'a', 'symmetrical', 'distribution', 'and', 'are', 'preferentially', 'located', 'on', 'the', 'anterior', 'aspect', 'of', 'the', 'wrists', '(Figure', '1)', 'and', 'ankles.'], ['Oral', 'mucosal', 'involvement', 'is', 'very', 'frequent,', 'and', 'approximately', '75%', 'of', 'patients', 'with', 'lichen', 'planus', 'show', 'an', 'asymptomatic', 'whitish', 'reticulation', 'affecting', 'the', 'jugal', 'or', 'lingual', 'mucosa.']]
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[['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n', 'Lichen planus\n', 'Support'], ['The patient presents since 2 weeks ago a pruritic eruption consisting of multiple polygonal erythematous-violaceous papules, with flattened surface, preferentially located on the anterior aspect of the wrists, pretibial area and lumbar area\n', 'Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n', 'Support'], ['Characteristically these papules show a symmetrical distribution and are preferentially located on the anterior aspect of the wrists (Figure 1) and ankles\n', 'Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n', 'Support'], ['She also presents whitish reticulated lesions in the jugal mucosa\n', 'Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n', 'Support'], ['Oral mucosal involvement is very frequent, and approximately 75% of patients with lichen planus show an asymptomatic whitish reticulation affecting the jugal or lingual mucosa\n', 'Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n', 'Support']]
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118_117
|
[['QUESTION', 'TYPE:', 'INFECTOLOGY'], ['CLINICAL', 'CASE:'], ['A', '14-year-old', 'asymptomatic', 'boy', 'whose', 'father', 'has', 'just', 'been', 'diagnosed', 'with', 'pulmonary', 'TB', 'undergoes', 'a', 'Mantoux', 'test,', 'with', 'a', 'negative', 'result.'], ['What', 'is', 'the', 'appropriate', 'course', 'of', 'action?'], ['1-', 'Reassure', 'her', 'that', 'she', 'is', 'not', 'at', 'risk.'], ['2-', 'Chest', 'X-ray.'], ['3-', 'Start', 'chemoprophylaxis', 'and', 'repeat', 'skin', 'test', 'after', '3', 'months.'], ['4-', 'Repeat', 'skin', 'test', 'at', 'one', 'month.'], ['5-', 'A', 'sputum', 'study', 'should', 'be', 'performed', 'before', 'starting', 'chemoprophylaxis', 'with', 'Isoniazid', 'for', '1', 'year.'], ['CORRECT', 'ANSWER:', '3'], ['In', 'young', 'contacts,', 'chemoprophylaxis', 'should', 'be', 'started', 'even', 'if', 'the', 'mantoux', 'test', 'is', 'negative', 'and', 'repeated', 'after', '2-3', 'months', 'to', 'decide', 'whether', 'to', 'continue', 'treatment', 'for', '6', 'months', '(if', 'it', 'turns', 'positive)', 'or', 'to', 'stop', 'it.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In young contacts, chemoprophylaxis should be started even if the mantoux test is negative and repeated after 2-3 months to decide whether to continue treatment for 6 months (if it turns positive) or to stop it\n', 'Start chemoprophylaxis and repeat skin test after 3 months\n', 'Support'], ['A 14-year-old asymptomatic boy whose father has just been diagnosed with pulmonary TB undergoes a Mantoux test, with a negative result\n', 'Start chemoprophylaxis and repeat skin test after 3 months\n', 'Support']]
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388_233
| null | null |
[]
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421_78
|
[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'man', 'was', 'referred', 'to', 'the', 'gastroenterology', 'department', 'for', 'hematochezia,', 'tenesmus', 'and', 'reduction', 'of', 'stool', 'diameter.'], ['A', 'series', 'of', 'tests', 'were', 'performed', 'and', 'a', 'diagnosis', 'of', 'adenocarcinoma', 'of', 'the', 'sigma', 'without', 'distant', 'metastasis', 'was', 'made.'], ['The', 'patient', 'underwent', 'surgery', 'and', 'was', 'referred', 'to', 'the', 'medical', 'oncology', 'department', 'for', 'evaluation', 'of', 'complementary', 'chemotherapy', 'treatment.'], ['Which', 'of', 'the', 'following', 'is', 'a', 'poor', 'prognostic', 'factor', 'after', 'surgical', 'resection', 'and', 'should', 'be', 'taken', 'into', 'account', 'when', 'planning', 'chemotherapy', 'treatment?'], ['1-', 'The', 'presence', 'of', 'anemia', 'at', 'diagnosis.'], ['2-', 'The', 'existence', 'of', 'a', 'family', 'history', 'of', 'colorectal', 'cancer.'], ['3-', 'The', 'size', 'of', 'the', 'primary', 'lesion', 'and', 'histological', 'differentiation.'], ['4-', 'Perforation', 'or', 'adhesion', 'of', 'the', 'tumor', 'to', 'adjacent', 'organs.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['On', 'this', 'occasion,', 'we', 'are', 'asked', 'about', 'which', 'factors', 'have', 'the', 'greatest', 'influence', 'in', 'order', 'to', 'carry', 'out', 'adjuvant', 'chemotherapy', 'in', 'colorectal', 'cancer.'], ['In', 'order', 'to', 'do', 'so,', 'we', 'must', 'know', 'which', 'are', 'the', 'poor', 'prognostic', 'factors', 'in', 'this', 'pathology', 'where', 'obstruction', 'or', 'intestinal', 'perforation', 'due', 'to', 'the', 'lesion,', 'invasion', 'of', 'adjacent', 'organs,', 'elevation', 'of', 'tumor', 'markers', 'such', 'as', 'CEA', 'and', 'the', 'histology', 'of', 'the', 'neoplasm', 'stand', 'out.'], ['Among', 'these,', 'less', 'importance', 'is', 'given', 'to', 'the', 'size', 'of', 'the', 'lesion', 'than', 'to', 'its', 'degree', 'of', 'invasion', 'of', 'the', 'intestinal', 'wall', 'or', 'other', 'adjacent', 'structures,', 'a', 'criterion', 'that', 'must', 'be', 'taken', 'into', 'account', 'for', 'staging', 'by', 'TNM', 'or', 'Astler-Coller', 'classification,', 'which', 'guide', 'the', 'indication', 'of', 'adjuvant', 'treatment', 'after', 'the', 'surgical', 'approach.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Among these, less importance is given to the size of the lesion than to its degree of invasion of the intestinal wall or other adjacent structures, a criterion that must be taken into account for staging by TNM or Astler-Coller classification, which guide the indication of adjuvant treatment after the surgical approach\n', 'The size of the primary lesion and histological differentiation\n', 'Attack'], ['Among these, less importance is given to the size of the lesion than to its degree of invasion of the intestinal wall or other adjacent structures, a criterion that must be taken into account for staging by TNM or Astler-Coller classification, which guide the indication of adjuvant treatment after the surgical approach\n', 'Perforation or adhesion of the tumor to adjacent organs\n', 'Support'], ['we must know which are the poor prognostic factors in this pathology\n', 'obstruction or intestinal perforation due to the lesion, invasion of adjacent organs, elevation of tumor markers such as CEA and the histology of the neoplasm stand out\n', 'Support'], ['obstruction or intestinal perforation due to the lesion, invasion of adjacent organs, elevation of tumor markers such as CEA and the histology of the neoplasm stand out\n', 'Among these, less importance is given to the size of the lesion than to its degree of invasion of the intestinal wall or other adjacent structures, a criterion that must be taken into account for staging by TNM or Astler-Coller classification, which guide the indication of adjuvant treatment after the surgical approach\n', 'Support']]
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500_45
|
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['15-year-old', 'female', 'presenting', 'with', 'delayed', 'menarche', 'and', 'short', 'stature.'], ['She', 'does', 'not', 'have', 'intellectual', 'disability.'], ['Which', 'of', 'the', 'following', 'genetic', 'tests', 'would', 'be', 'routinely', 'used', 'for', 'the', 'diagnosis', 'of', 'this', 'patient:'], ['1-', 'Massive', 'sequencing', '(NGS).'], ['2-', 'FISH.'], ['3-', 'DNA', 'and/or', 'RNA', 'microarrays.'], ['4-', 'Karyotype.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['In', 'a', 'woman', 'with', 'delayed', 'puberty', 'and', 'short', 'stature', 'we', 'should', 'always', 'think', 'about', 'and', 'rule', 'out', 'Turner', 'syndrome,', 'whose', 'diagnosis', 'is', 'made', 'by', 'karyotyping', '(45X0).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['15-year-old female presenting with delayed menarche and short stature\n', 'In a woman with delayed puberty and short stature we should always think about and rule out Turner syndrome, whose diagnosis is made by karyotyping (45X0)\n', 'Support'], ['In a woman with delayed puberty and short stature we should always think about and rule out Turner syndrome, whose diagnosis is made by karyotyping (45X0)\n', 'Karyotype\n', 'Support']]
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611_116
|
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['95-year-old', 'woman', 'living', 'in', 'a', 'nursing', 'home,', 'independent', 'for', 'her', 'basic', 'activities', 'of', 'daily', 'living,', 'goes', 'out', 'to', 'the', 'garden', 'for', 'walks.'], ['She', 'has', 'a', 'history', 'of', 'hypertension,', 'dyslipidemia,', 'osteoporosis', 'and', 'mild', 'cognitive', 'impairment.'], ['She', 'suffers', 'a', 'fall', 'when', 'getting', 'up', 'at', 'night', 'to', 'go', 'to', 'the', 'bathroom.'], ['X-ray', 'shows', 'a', 'displaced', 'subcapital', 'fracture', 'of', 'the', 'right', 'hip.'], ['What', 'is', 'the', 'recommended', 'treatment?'], ['1-', 'Hip', 'hemiarthroplasty.'], ['2-', 'Trochanteric', 'nail', 'fixation.'], ['3-', 'Fixation', 'with', 'cannulated', 'screws.'], ['4-', 'Conservative:', 'bed-chair', 'life.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['We', 'are', 'told', 'of', 'a', 'case', 'of', 'a', '95-year-old', 'patient', 'with', 'a', 'displaced', 'intracapsular', '(subcapital)', 'hip', 'fracture.'], ['In', 'this', 'case,', 'the', 'surgical', 'options', 'may', 'be', 'the', 'use', 'of', 'cannulated', 'screws', 'or', 'hip', 'arthroplasty.'], ['Cannulated', 'screws', 'are', 'reserved', 'for', 'cases', 'of', 'non-displaced', 'fractures', '(Wrong', 'answer', '2)', 'so', 'the', 'most', 'indicated', 'option', 'would', 'be', 'arthroplasty,', 'in', 'this', 'case', 'hemiarthroplasty', '(Correct', 'answer', '1).'], ['Trochanteric', 'pins', 'are', 'reserved', 'for', 'extracapsular', 'fractures', '(Wrong', 'answer', '2)', 'and', 'conservative', 'treatment', 'is', 'only', 'considered', 'in', 'patients', 'with', 'very', 'low', 'functional', 'demand', 'or', 'surgical', 'contraindication', '(Wrong', 'answer', '4).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['We are told of a case of a 95-year-old patient with a displaced intracapsular (subcapital) hip fracture\n', 'In this case, the surgical options may be the use of cannulated screws or hip arthroplasty\n', 'Support'], ['Cannulated screws are reserved for cases of non-displaced fractures\n', 'In this case, the surgical options may be the use of cannulated screws or hip arthroplasty\n', 'Attack'], ['Cannulated screws are reserved for cases of non-displaced fractures\n', 'Wrong answer 2\n', 'Support'], ['Wrong answer 2\n', 'Fixation with cannulated screws\n', 'Attack'], ['Cannulated screws are reserved for cases of non-displaced fractures\n', 'so the most indicated option would be arthroplasty, in this case hemiarthroplasty\n', 'Support'], ['In this case, the surgical options may be the use of cannulated screws or hip arthroplasty\n', 'so the most indicated option would be arthroplasty, in this case hemiarthroplasty\n', 'Support'], ['so the most indicated option would be arthroplasty, in this case hemiarthroplasty\n', 'Correct answer 1\n', 'Support'], ['Correct answer 1\n', 'Hip hemiarthroplasty\n', 'Support'], ['Trochanteric pins are reserved for extracapsular fractures\n', 'Wrong answer 2\n', 'Support'], ['Wrong answer 2\n', 'Trochanteric nail fixation\n', 'Attack'], ['conservative treatment is only considered in patients with very low functional demand or surgical contraindication\n', 'Wrong answer 4\n', 'Support'], ['Wrong answer 4\n', 'Conservative: bed-chair life\n', 'Attack']]
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542_38
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[['QUESTION', 'TYPE:', 'ALLERGOLOGY'], ['CLINICAL', 'CASE:'], ['A', '25-year-old', 'woman', 'with', 'a', 'history', 'of', 'allergic', 'bronchial', 'asthma', 'due', 'to', 'sensitization', 'to', 'grass', 'pollens', 'and', 'atopic', 'dermatitis.'], ['She', 'suddenly', 'presents', 'hypotension,', 'tachycardia,', 'urticaria', 'and', 'bronchospasm', 'after', 'ingesting', 'peanuts', 'and', 'is', 'transferred', 'to', 'the', 'emergency', 'department.'], ['What', 'would', 'be', 'the', 'order', 'of', 'drugs', 'to', 'be', 'administered', 'and', 'what', 'laboratory', 'test', 'could', 'be', 'requested', 'for', 'further', 'evaluation?'], ['1-', 'Intramuscular', 'adrenaline,', 'followed', 'by', 'an', 'inhaled', 'bronchodilator', 'of', 'the', 'SABA', 'type', 'and', 'intramuscular', 'dexchlorpheniramine.', 'Then', 'request', 'serum', 'tryptase.'], ['2-', 'An', 'inhaled', 'SABA-type', 'bronchodilator,', 'followed', 'by', 'intramuscular', 'dexchlorpheniramine', 'and', 'intramuscular', 'adrenaline.', 'Then', 'order', 'serum', 'tryptase.'], ['3-', 'Intramuscular', 'dexchlorpheniramine,', 'followed', 'by', 'an', 'inhaled', 'bronchodilator', 'of', 'the', 'SABA', 'type', 'and', 'intramuscular', 'adrenaline.', 'Then', 'request', 'eosinophil', 'cationic', 'protein.'], ['4-', 'Intramuscular', 'adrenaline,', 'followed', 'by', 'an', 'inhaled', 'bronchodilator', 'of', 'the', 'SABA', 'type', 'and', 'intramuscular', 'dexchlorpheniramine.', 'Then', 'request', 'eosinophil', 'cationic', 'protein.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'patient', 'is', 'suffering', 'from', 'anaphylactic', 'shock', 'secondary', 'to', 'peanut', 'ingestion.'], ['The', 'treatment', 'of', 'anaphylaxis', 'and', 'anaphylactic', 'shock', 'of', 'first', 'choice', 'is', 'intramuscular', 'adrenaline', '1mg/ml', '(dose', '0.01', 'mg/kg,', 'in', 'adults', '0.5', 'mg', 'maximum).'], ['Followed', 'by', 'symptomatic', 'treatment', 'to', 'stabilize', 'the', 'airway', 'with', '100%', 'high', 'flow', 'O2,', 'ensure', 'large', 'caliber', 'venous', 'access,', 'fluid', 'replacement', 'and', 'continuous', 'monitoring', '(HR,', 'BP,', 'SatO2', ',', 'diuresis).'], ['As', 'adjuvant', 'treatment,', 'an', 'inhaled', 'bronchodilator', 'such', 'as', 'SABA,', 'intramuscular', 'dexchlorpheniramine', 'or', 'corticosteroids', 'such', 'as', 'hydrocortisone', 'IV', 'or', 'methylprednisolone', 'IV', 'can', 'be', 'administered.'], ['Adrenaline', 'can', 'be', 'repeated', 'at', 'the', 'same', 'doses', 'every', '5', 'minutes', 'a', 'maximum', 'of', '3', 'times', 'and', 'if', 'after', '15', 'minutes', 'there', 'is', 'no', 'response,', 'IV', 'adrenaline', 'infusion', 'should', 'be', 'started,', 'Glucagon', '(if', 'treatment', 'with', 'beta-blockers),', 'Atropine', '(if', 'prolonged', 'bradycardia)', 'or', 'Vasopressors', '(if', 'refractory', 'hypotension).'], ['The', 'laboratory', 'marker', 'that', 'should', 'be', 'requested', 'if', 'anaphylaxis', 'is', 'suspected', 'is', 'serum', 'tryptase', 'in', 'the', 'first', 'hour', 'for', 'a', 'basal', 'determination', 'and', 'another', 'at', '4-6', 'hours', 'to', 'observe', 'its', 'elevation', 'curve.'], ['It', 'is', 'not', 'an', 'emergency', 'marker', 'but', 'it', 'is', 'very', 'useful', 'for', 'future', 'allergological', 'study.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['She suddenly presents hypotension, tachycardia, urticaria and bronchospasm after ingesting peanuts and is transferred to the emergency department\n', 'The patient is suffering from anaphylactic shock secondary to peanut ingestion\n', 'Support'], ['The patient is suffering from anaphylactic shock secondary to peanut ingestion\n', 'The treatment of anaphylaxis and anaphylactic shock of first choice is intramuscular adrenaline 1mg/ml (dose 0.01 mg/kg, in adults 0.5 mg maximum)\n', 'Support'], ['The treatment of anaphylaxis and anaphylactic shock of first choice is intramuscular adrenaline 1mg/ml (dose 0.01 mg/kg, in adults 0.5 mg maximum)\n', 'Followed by symptomatic treatment to stabilize the airway with 100% high flow O2, ensure large caliber venous access, fluid replacement and continuous monitoring (HR, BP, SatO2 , diuresis)\n', 'Support'], ['The treatment of anaphylaxis and anaphylactic shock of first choice is intramuscular adrenaline 1mg/ml (dose 0.01 mg/kg, in adults 0.5 mg maximum)\n', 'Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase\n', 'Support'], ['Followed by symptomatic treatment to stabilize the airway with 100% high flow O2, ensure large caliber venous access, fluid replacement and continuous monitoring (HR, BP, SatO2 , diuresis)\n', 'As adjuvant treatment, an inhaled bronchodilator such as SABA, intramuscular dexchlorpheniramine or corticosteroids such as hydrocortisone IV or methylprednisolone IV can be administered\n', 'Support'], ['As adjuvant treatment, an inhaled bronchodilator such as SABA, intramuscular dexchlorpheniramine or corticosteroids such as hydrocortisone IV or methylprednisolone IV can be administered\n', 'Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase\n', 'Support'], ['As adjuvant treatment, an inhaled bronchodilator such as SABA, intramuscular dexchlorpheniramine or corticosteroids such as hydrocortisone IV or methylprednisolone IV can be administered\n', 'Adrenaline can be repeated at the same doses every 5 minutes a maximum of 3 times and if after 15 minutes there is no response, IV adrenaline infusion should be started, Glucagon (if treatment with beta-blockers), Atropine (if prolonged bradycardia) or Vasopressors (if refractory hypotension)\n', 'Support'], ['The laboratory marker that should be requested if anaphylaxis is suspected is serum tryptase in the first hour for a basal determination and another at 4-6 hours to observe its elevation curve\n', 'Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase\n', 'Support']]
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79_36
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[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['Which', 'of', 'the', 'following', 'clinical', 'data,', 'recorded', 'during', 'the', 'clinical', 'history', 'taking', 'of', 'a', 'patient', 'with', 'diarrhea', 'of', 'more', 'than', '4', 'weeks', 'of', 'evolution,', 'can', 'be', 'found', 'in', 'people', 'without', 'organic', 'pathology:'], ['1-', 'Weight', 'loss', 'with', 'or', 'without', 'rectorrhagia.'], ['2-', 'Persistence', 'of', 'diarrhea', 'during', 'the', 'night.'], ['3-', 'Onset', 'of', 'symptoms', 'after', 'age', '50.'], ['4-', 'Presence', 'of', 'dermatitis', 'and/or', 'arthritis', 'during', 'the', 'examination.'], ['5-', 'Expulsion', 'of', 'mucus', 'in', 'more', 'than', '25%', 'of', 'defecations.'], ['CORRECT', 'ANSWER:', '5'], ['Although', 'mucus', 'is', 'usually', 'more', 'frightening', 'in', 'the', 'consultation,', 'it', 'falls', 'within', 'the', 'Rome', 'II', 'criteria', 'for', 'the', 'diagnosis', 'of', 'Irritable', 'Bowel', 'Syndrome.'], ['All', 'the', 'rest', 'are', 'typical', 'signs', 'of', 'organicity,', 'although', 'I', 'think', 'the', 'question', 'is', 'poorly', 'phrased,', 'since', 'any', 'of', 'these', 'data', '(especially', 'age)', 'can', 'be', 'found', 'in', 'patients', 'who', 'in', 'the', 'end', 'have', 'nothing,', 'what', 'happens', 'is', 'that', 'in', 'these', 'cases', 'we', 'must', 'always', 'look', 'for', 'organicity.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['Although mucus is usually more frightening in the consultation, it falls within the Rome II criteria for the diagnosis of Irritable Bowel Syndrome\n', 'Expulsion of mucus in more than 25% of defecations\n', 'Support'], ['All the rest are typical signs of organicity\n', 'Weight loss with or without rectorrhagia\n', 'Attack'], ['All the rest are typical signs of organicity\n', 'Persistence of diarrhea during the night\n', 'Attack'], ['All the rest are typical signs of organicity\n', 'Onset of symptoms after age 50\n', 'Attack'], ['All the rest are typical signs of organicity\n', 'Presence of dermatitis and/or arthritis during the examination\n', 'Attack'], ['since any of these data (especially age) can be found in patients who in the end have nothing, what happens is that in these cases we must always look for organicity\n', 'although I think the question is poorly phrased\n', 'Support']]
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524_54
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[['QUESTION', 'TYPE:', 'STATISTICS'], ['CLINICAL', 'CASE:'], ['An', '86-year-old', 'woman', 'in', 'whom', 'nonvalvular', 'atrial', 'fibrillation', 'has', 'been', 'detected.'], ['She', 'has', 'a', 'CHADS2', 'score', 'of', '3', 'points.'], ['In', 'the', 'literature,', 'similar', 'patients', 'on', 'warfarin', 'therapy', 'have', 'a', 'stroke', 'risk', 'of', '2.2%', 'vs.', '5.2%', 'in', 'patients', 'without', 'warfarin.'], ['What', 'would', 'be', 'the', 'number', 'needed', 'to', 'treat', '(NNT)', 'to', 'prevent', 'an', 'emboligenic', 'stroke', 'with', 'anticoagulation', 'therapy:'], ['1-', '3'], ['2-', '19,2.'], ['3-', '33,3.'], ['4-', '49,5.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['On', 'average,', 'if', '100', 'patients', 'like', 'this', 'woman', 'are', 'treated', 'with', 'warfarin,', 'the', 'number', 'of', 'strokes', 'is', 'reduced', 'by', '3', '(from', '5.2', 'untreated', 'to', '3.2', 'treated).'], ['Therefore,', 'if', 'you', 'treat', '33.3', 'patients', 'like', 'this', 'woman', 'with', 'warfarin,', 'you', 'reduce', 'the', 'number', 'of', 'strokes', 'by', '1:', 'the', 'NNT', 'is', '33.3.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['On average, if 100 patients like this woman are treated with warfarin, the number of strokes is reduced by 3 (from 5.2 untreated to 3.2 treated)\n', 'Therefore, if you treat 33.3 patients like this woman with warfarin, you reduce the number of strokes by 1\n', 'Support'], ['Therefore, if you treat 33.3 patients like this woman with warfarin, you reduce the number of strokes by 1\n', 'the NNT is 33.3\n', 'Support'], ['the NNT is 33.3\n', '33,3\n', 'Support']]
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319_141
|
[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'boy', 'consults', 'for', 'lumbosacral', 'pain', 'of', 'inflammatory', 'rhythm', 'of', '4', 'months', 'of', 'evolution.'], ['Also', 'bilateral', 'thalalgia', 'and', 'morning', 'stiffness', 'for', '1', 'hour.'], ['In', 'the', 'last', '2', 'months,', 'onset', 'of', 'diarrhea', 'with', 'loss', 'of', '4', 'kg', 'of', 'weight.'], ['What', 'is', 'the', 'most', 'correct', 'diagnostic', 'approach?'], ['1-', 'Given', 'the', "patient's", 'age,', 'he', 'most', 'likely', 'suffers', 'from', 'non-specific', 'low', 'back', 'pain', 'and', 'tendonitis', 'in', 'the', 'feet.', 'If', 'the', 'diarrhea', 'persists,', 'a', 'digestive', 'study', 'would', 'be', 'performed.'], ['2-', 'I', 'would', 'perform', 'a', 'digestive', 'study', 'to', 'rule', 'out', 'tumor', 'pathology.', 'The', 'lumbar', 'pain', 'may', 'be', 'due', 'to', 'visceral', 'pathology.'], ['3-', 'The', 'clinical', 'picture', 'is', 'very', 'suggestive', 'of', 'spondyloarthritis.', 'Inflammatory', 'bowel', 'disease', 'should', 'be', 'ruled', 'out.'], ['4-', 'I', 'would', 'request', 'a', 'lumbar', 'MRI', 'to', 'rule', 'out', 'disc', 'herniation', 'and', 'if', 'diarrhea', 'persists,', 'a', 'digestive', 'study.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'clinical', 'picture', 'is', 'typical', 'of', 'spondyloarthritis,', 'and', 'together', 'with', 'the', 'digestive', 'symptoms', 'it', 'is', 'probably', 'associated', 'with', 'inflammatory', 'bowel', 'disease.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['In the last 2 months, onset of diarrhea with loss of 4 kg of weight\n', 'The clinical picture is typical of spondyloarthritis, and together with the digestive symptoms it is probably associated with inflammatory bowel disease\n', 'Support']]
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400_147
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY', 'AND', 'ORTHOPEDICS'], ['CLINICAL', 'CASE:'], ['A', '13-year-old', 'boy', 'presents', 'dorsal', 'pain', 'of', 'several', 'months', 'of', 'evolution,', 'only', 'on', 'standing', 'and', 'walking,', 'what', 'diagnosis', 'should', 'we', 'consider?'], ['1-', "Scheuermann's", 'disease.'], ['2-', 'Thoracic', 'scoliosis.'], ['3-', 'Malignant', 'tumor', 'of', 'the', 'vertebral', 'body.'], ['4-', 'It', 'is', 'a', 'mechanical', 'overload.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'pain', 'is', 'of', 'mechanical', 'characteristics,', 'and', 'the', 'most', 'frequent', 'cause', 'of', 'mechanical', 'back', 'pain', 'in', 'adolescents', 'is', 'mechanical', 'overload.'], ['There', 'is', 'no', 'data', 'in', 'the', 'statement', 'to', 'suggest', 'any', 'of', 'the', 'other', 'etiologies.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
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[['There is no data in the statement to suggest any of the other etiologies\n', "Scheuermann's disease\n", 'Attack'], ['There is no data in the statement to suggest any of the other etiologies\n', 'Thoracic scoliosis\n', 'Attack'], ['There is no data in the statement to suggest any of the other etiologies\n', 'Malignant tumor of the vertebral body\n', 'Attack'], ['There is no data in the statement to suggest any of the other etiologies\n', 'It is a mechanical overload\n', 'Support'], ['There is no data in the statement to suggest any of the other etiologies\n', 'the most frequent cause of mechanical back pain in adolescents is mechanical overload\n', 'Support'], ['the most frequent cause of mechanical back pain in adolescents is mechanical overload\n', 'The pain is of mechanical characteristics\n', 'Support'], ['the most frequent cause of mechanical back pain in adolescents is mechanical overload\n', 'It is a mechanical overload\n', 'Support'], ['The pain is of mechanical characteristics\n', 'It is a mechanical overload\n', 'Support']]
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196_164
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[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '4-year-old', 'boy', 'consulted', 'for', 'the', 'appearance', 'over', 'the', 'last', 'three', 'days', 'of', 'skin', 'lesions', 'on', 'the', 'legs', 'and', 'buttocks.'], ['His', 'parents', 'reported', 'that', 'his', 'pediatrician', 'had', 'diagnosed', 'an', 'upper', 'respiratory', 'tract', 'infection', '10', 'days', 'earlier.'], ['In', 'the', 'last', '12', 'hours', 'she', 'presented', 'intense', 'colicky', 'abdominal', 'pain', 'and', 'had', 'two', 'diarrheal', 'stools.'], ['Afebrile.'], ['No', 'weight', 'loss.'], ['On', 'examination', 'she', 'has', 'numerous', 'petechiae', 'and', 'palpable', 'purpuric', 'lesions', 'predominantly', 'on', 'the', 'buttocks', 'and', 'lower', 'extremities.'], ['Good', 'general', 'condition', 'although', 'she', 'has', 'intense', 'abdominal', 'pain.'], ['Abdominal', 'palpation', 'is', 'difficult', 'to', 'assess', 'due', 'to', 'diffuse', 'pain.'], ['No', 'visceromegaly.'], ['No', 'other', 'findings', 'of', 'interest', 'on', 'examination.'], ['Which', 'of', 'the', 'following', 'data', 'does', 'NOT', 'support', 'your', 'diagnostic', 'suspicion?'], ['1-', 'Knee', 'and', 'ankle', 'arthritis.'], ['2-', 'Hematuria.'], ['3-', 'Plateletopenia.'], ['4-', 'Fecal', 'occult', 'blood.'], ['5-', 'Scrotal', 'edema.'], ['CORRECT', 'ANSWER:', '3'], ['You', 'are', 'describing', 'a', 'Schönlein-Henoch', 'purpura', 'which', 'is', 'a', 'vasculitic', 'phenomenon,', 'so', 'the', 'lesions', 'are', 'not', 'due', 'to', 'plateletopenia.'], ['Scrotal', 'edema', '(sometimes', 'even', 'torsion', 'of', "Morgani's", 'capsid', 'of', 'the', 'testis)', 'is', 'not', 'exceptional', 'in', 'males', 'with', 'S.', 'Schönlein-Henoch.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise'], ['B-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['You are describing a Schönlein-Henoch purpura which is a vasculitic phenomenon, so the lesions are not due to plateletopenia\n', 'Plateletopenia\n', 'Attack'], ["Scrotal edema (sometimes even torsion of Morgani's capsid of the testis) is not exceptional in males with S. Schönlein-Henoch\n", 'Scrotal edema\n', 'Support']]
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509_150
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[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['83-year-old', 'male', 'who', 'consults', 'for', 'a', 'recurrent', 'picture', 'of', 'abdominal', 'pain', 'in', 'the', 'left', 'iliac', 'fossa,', 'accompanied', 'by', 'diarrhea', 'of', 'up', 'to', '6', 'stools', 'per', 'day', 'without', 'pathological', 'products,', 'of', '10-15', 'days', 'of', 'evolution.'], ['No', 'fever', 'or', 'general', 'condition', 'was', 'reported.'], ['A', 'recent', 'blood', 'test', 'showed', 'no', 'leukocytosis', 'and', 'a', 'negative', 'fecal', 'occult', 'blood', 'test.'], ['On', 'examination', 'there', 'is', 'mild', 'pain', 'on', 'palpation', 'of', 'the', 'left', 'iliac', 'fossa', 'without', 'peritoneal', 'irritation.'], ['He', 'had', 'a', 'colonoscopy', 'three', 'years', 'ago', 'in', 'which', 'diverticula', 'were', 'reported', 'along', 'the', 'entire', 'colon,', 'more', 'numerous', 'in', 'the', 'left', 'colon,', 'with', 'no', 'other', 'associated', 'lesions.'], ['Which', 'of', 'the', 'following', 'would', 'be', 'the', 'best', 'approach', 'to', 'follow?'], ['1-', 'Empirical', 'treatment', 'with', 'antibiotics.'], ['2-', 'Request', 'a', 'preferential', 'colonoscopy.'], ['3-', 'Request', 'urgent', 'abdominal', 'ultrasound.'], ['4-', 'Refer', 'to', 'surgery', 'to', 'evaluate', 'sigmoidectomy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['They', 'refer', 'to', 'a', 'concept', 'that', 'has', 'emerged', 'relatively', 'recently', 'and', 'is', 'not', 'present', 'in', 'all', 'clinical', 'guidelines', 'as', 'uncomplicated', 'symptomatic', 'diverticular', 'disease.'], ['In', 'these', 'cases,', 'the', 'therapeutic', 'trial', 'with', 'rifaximin', 'is', 'recommended,', 'being', 'the', 'true', 'number', '1.'], ['The', 'absence', 'of', 'acute', 'phase', 'reactants', 'in', 'the', 'CBC', 'suggests', 'that', 'she', 'does', 'not', 'have', 'acute', 'diverticulitis', 'at', 'the', 'time', 'of', 'consultation', 'that', 'would', 'lead', 'us', 'to', 'request', 'an', 'imaging', 'test', 'to', 'rule', 'it', 'out.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['83-year-old male who consults for a recurrent picture of abdominal pain in the left iliac fossa, accompanied by diarrhea of up to 6 stools per day without pathological products, of 10-15 days of evolution\n', 'They refer to a concept that has emerged relatively recently and is not present in all clinical guidelines as uncomplicated symptomatic diverticular disease\n', 'Support'], ['In these cases, the therapeutic trial with rifaximin is recommended, being the true number 1\n', 'Empirical treatment with antibiotics\n', 'Support'], ['They refer to a concept that has emerged relatively recently and is not present in all clinical guidelines as uncomplicated symptomatic diverticular disease\n', 'In these cases, the therapeutic trial with rifaximin is recommended, being the true number 1\n', 'Support'], ['On examination there is mild pain on palpation of the left iliac fossa without peritoneal irritation\n', 'The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out\n', 'Support'], ['No fever or general condition was reported\n', 'The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out\n', 'Support'], ['The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out\n', 'Request urgent abdominal ultrasound\n', 'Support']]
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549_128
| null | null |
[]
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221_48
|
[['QUESTION', 'TYPE:', 'ANATOMIC', 'PATHOLOGY'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'man', 'with', 'ataxia,', 'headaches', 'and', 'solid-cystic', 'mass', 'in', 'the', 'right', 'cerebellar', 'hemisphere', 'underwent', 'surgery', 'and', 'a', 'lesion', 'was', 'resected,', 'histologically', 'showing', 'cells', 'with', 'long', 'thin', 'cytoplasmic', 'processes,', 'fascicular', 'and', 'microcystic', 'pattern,', 'numerous', 'vessels', 'and', "Rosenthal's", 'fibers.'], ['The', 'most', 'probable', 'anatomopathologic', 'diagnosis', 'is:'], ['1-', 'Pilocytic', 'astrocytoma.'], ['2-', 'Pleomorphic', 'xanthoastrocytoma.'], ['3-', 'Central', 'neurocytoma.'], ['4-', 'Liponeurocytoma.'], ['5-', 'Prion', 'disease.'], ['CORRECT', 'ANSWER:', '1'], ['A', 'question', 'that', 'does', 'not', 'seem', 'to', 'have', 'a', 'second', 'intention,', 'as', 'there', 'are', 'no', 'confusing', 'elements.'], ['The', 'statement', 'concisely', 'summarizes', 'the', 'description', 'of', 'pilocytic', 'astrocytoma.'], ['The', 'Rosenthal', 'fibers', 'may', 'confuse', 'us', 'as', 'they', 'are', 'not', 'very', 'specific,', 'and', 'make', 'us', 'think,', 'for', 'example,', 'of', 'pleomorphic', 'xanthoastrocytoma', 'in', 'which', 'they', 'can', 'also', 'be', 'found,', 'but', 'the', 'cell', 'morphology', 'described', '(long', 'and', 'thin', 'cytoplasmic', 'processes,', 'which', 'are', 'the', 'ones', 'that', 'give', 'the', 'name', '"pilocytic")', 'keeps', 'us', 'the', 'first', 'option', 'as', 'the', 'correct', 'one.'], ['We', 'can', 'find', 'a', 'good', 'description', 'of', 'the', 'entity,', 'explaining', 'what', 'distinguishes', 'it', 'from', 'other', 'glial', 'tumors', 'in', 'Practical', 'Surgical', 'Neuropathology.'], ['A', 'Diagnostic', 'Approach.'], ['A.'], ['Perry,', 'D.J.'], ['Brat.'], ['p82-88.'], ['Churchill', 'Livingstone', 'Elsevier.'], ['2010.'], ['(Philadephia).']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['O'], ['O', 'O'], ['O'], ['O'], ['O', 'O', 'O'], ['O'], ['O']]
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[['The statement concisely summarizes the description of pilocytic astrocytoma\n', 'Pilocytic astrocytoma\n', 'Support'], ['The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found\n', 'The statement concisely summarizes the description of pilocytic astrocytoma\n', 'Attack'], ['the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name "pilocytic") keeps us the first option as the correct one\n', 'The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found\n', 'Attack'], ['long and thin cytoplasmic processes, which are the ones that give the name "pilocytic"\n', 'the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name "pilocytic") keeps us the first option as the correct one\n', 'Support'], ['long and thin cytoplasmic processes, which are the ones that give the name "pilocytic"\n', 'The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found\n', 'Attack'], ['the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name "pilocytic") keeps us the first option as the correct one\n', 'The statement concisely summarizes the description of pilocytic astrocytoma\n', 'Support']]
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606_113
|
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['35-year-old', 'male,', 'letter', 'carrier,', 'with', 'no', 'history', 'of', 'interest,', 'who', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'acute', 'cervical', 'pain', 'of', '24', 'hours', 'of', 'evolution,', 'without', 'previous', 'trauma,', 'which', 'radiates', 'to', 'the', 'left', 'arm', 'up', 'to', 'the', 'hand', 'and', 'is', 'accompanied', 'by', 'paresthesia', 'in', 'the', 'radial', 'border', 'of', 'the', 'forearm.'], ['She', 'presents', 'no', 'objectifiable', 'loss', 'of', 'strength,', 'preserves', 'neck', 'mobility', 'although', 'it', 'is', 'painful', 'and', 'contracture', 'of', 'the', 'paravertebral', 'musculature', 'is', 'appreciated.'], ['The', 'first', 'attitude', 'will', 'be:'], ['1-', 'Conservative', 'treatment', 'with', 'non-steroidal', 'anti-inflammatory', 'drugs,', 'local', 'heat', 'and', 'relative', 'rest.'], ['2-', 'Urgent', 'call', 'to', 'the', 'neurosurgeon', 'for', 'surgical', 'evaluation.'], ['3-', 'Preferential', 'request', 'for', 'MRI', 'and', 'electromyogram.'], ['4-', 'Preferential', 'referral', 'to', 'traumatology', 'outpatients.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Correct', 'answer', '1.'], ['75%', 'of', 'patients', 'with', 'radiculopathy', 'improve', 'with', 'non-surgical', 'treatment,', 'this', 'being', 'the', 'treatment', 'of', 'choice', 'in', 'the', 'initial', 'stages.'], ['Magnetic', 'resonance', 'imaging', 'is', 'of', 'choice', 'in', 'certain', '"red', 'flags":', 'fever,', 'weight', 'loss,', 'nocturnal', 'pain,', 'persistence', 'of', 'symptoms', 'despite', 'conservative', 'treatment', 'and', 'loss', 'of', 'strength', '(incorrect', 'answer', '3).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim']]
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[['Correct answer 1\n', 'Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest\n', 'Support'], ['75% of patients with radiculopathy improve with non-surgical treatment, this being the treatment of choice in the initial stages\n', 'Urgent call to the neurosurgeon for surgical evaluation\n', 'Attack'], ['Magnetic resonance imaging is of choice in certain "red flags": fever, weight loss, nocturnal pain, persistence of symptoms despite conservative treatment and loss of strength\n', 'incorrect answer 3\n', 'Support'], ['incorrect answer 3\n', 'Preferential request for MRI and electromyogram\n', 'Attack']]
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436_223
| null | null |
[]
|
220_126
| null | null |
[]
|
483_174
|
[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '22-year-old', 'woman', 'presents', 'with', 'sudden', 'cardiac', 'arrest', 'with', 'a', 'rhythm', 'that', 'is', 'considered', 'amenable', 'to', 'defibrillation.'], ['Chest', 'compressions', 'and', 'ventilations', 'are', 'being', 'performed,', 'a', 'defibrillator', 'shock', 'has', 'been', 'delivered,', 'and', 'a', 'peripheral', 'venous', 'line', 'has', 'been', 'cannulated.'], ['Which', 'of', 'the', 'following', 'would', 'be', 'correct', 'next:'], ['1-', 'Administration', 'of', '150', 'mg', 'of', 'intravenous', 'amiodarone.'], ['2-', 'Administration', 'of', '300', 'mg', 'of', 'intravenous', 'amiodarone.'], ['3-', 'Administration', 'of', '1', 'mg', 'of', 'intravenous', 'atropine.'], ['4-', 'Administer', '2', 'mg', 'of', 'intravenous', 'atropine.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Controversial', 'question,', 'since', 'amiodarone', '(the', 'dose', 'is', 'correct,', '300mg),', 'is', 'administered', 'after', 'the', 'third', 'shock,', 'and', 'not', 'after', 'the', 'first', 'defibrillation,', 'which', 'is', 'what', 'we', 'are', 'told', 'in', 'the', 'statement.'], ['Although,', 'be', 'careful,', 'that', 'is', 'what', 'the', 'guidelines', 'say.'], ['I', 'am', 'sure', 'that', 'more', 'than', 'one', 'of', 'us', 'has', 'administered', 'amiodarone', 'as', 'soon', 'as', 'we', 'have', 'had', 'venous', 'access', 'available', 'in', 'the', 'event', 'of', 'a', 'shockable', 'rhythm.'], ['The', 'other', 'options', 'are', 'incorrect.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Although, be careful, that is what the guidelines say\n', 'Controversial question, since amiodarone (the dose is correct, 300mg), is administered after the third shock, and not after the first defibrillation\n', 'Attack'], ['I am sure that more than one of us has administered amiodarone as soon as we have had venous access available in the event of a shockable rhythm\n', 'Administration of 300 mg of intravenous amiodarone\n', 'Support'], ['The other options are incorrect\n', 'Administration of 150 mg of intravenous amiodarone\n', 'Attack'], ['The other options are incorrect\n', 'Administration of 1 mg of intravenous atropine\n', 'Attack'], ['The other options are incorrect\n', 'Administer 2 mg of intravenous atropine\n', 'Attack'], ['I am sure that more than one of us has administered amiodarone as soon as we have had venous access available in the event of a shockable rhythm\n', 'Controversial question, since amiodarone (the dose is correct, 300mg), is administered after the third shock, and not after the first defibrillation\n', 'Attack']]
|
113_93
|
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'healthy', 'woman', 'consults', 'for', 'asthenia.'], ['The', 'CBC', 'shows', 'microcytic', 'and', 'hypochromic', 'anemia', '(hemoglobin', '7', 'g/dL,', 'mean', 'corpuscular', 'volume', '68', 'fl,', 'mean', 'corpuscular', 'hemoglobin', '24', 'pg)', 'with', 'an', 'elevated', 'red', 'cell', 'distribution', 'amplitude', '(ADE', '20%),', 'decreased', 'reticulocytes', '(0.3%,', '30000/l', 'absolute),', 'decreased', 'hemoglobin', 'content', 'in', 'reticulocytes', '(17', 'pg)', 'and', 'discrete', 'thrombocytosis', '(500000', 'platelets).'], ['With', 'the', 'CBC', 'data,', 'what', 'would', 'be', 'your', 'diagnostic', 'suspicion', 'even', 'without', 'having', 'the', "patient's", 'biochemistry?'], ['1-', 'Thalassemic', 'trait.'], ['2-', 'Central', 'anemia,', 'arregenerative,', 'due', 'to', 'folic', 'acid', 'deficiency.'], ['3-', 'Peripheral,', 'regenerative,', 'hemolytic', 'anemia.'], ['4-', 'Peripheral', 'anemia,', 'regenerative,', 'due', 'to', 'acute', 'active', 'hemorrhage.'], ['5-', 'Central', 'anemia,', 'arregenerative,', 'due', 'to', 'iron', 'deficiency.'], ['CORRECT', 'ANSWER:', '5'], ['With', 'the', 'data', 'we', 'are', 'given,', 'the', 'first', 'thing', 'that', 'comes', 'to', 'mind', 'is', 'that', 'it', 'is', 'an', 'arregenerative', 'anemia,', 'since', 'the', 'bone', 'marrow', 'has', 'not', 'responded', 'with', 'an', 'exaltation', 'of', 'erythropoiesis;', 'in', 'this', 'way', 'we', 'have', 'already', 'eliminated', 'the', 'options', 'that', 'speak', 'of', 'regenerative', 'anemia.'], ['The', 'next', 'thing', 'that', 'orients', 'us', 'towards', 'the', 'cause', 'is', 'that', 'it', 'is', 'microcytic', 'and', 'hypochromic,', 'which', 'is', 'characteristic', 'of', 'iron', 'deficiency', 'anemia,', 'since', 'folic', 'deficiency', 'gives', 'rise', 'to', 'megaloblastic', 'anemia', 'and', 'active', 'hemorrhage', 'does', 'not', 'give', 'microcytosis', 'or', 'hypochromia,', 'but', 'normocytosis', 'and', 'normochromia.'], ['We', 'are', 'almost', 'inclined', 'to', 'answer', '5,', 'central', 'arregenerative', 'anemia', 'due', 'to', 'iron', 'deficiency...but', 'there', 'remains', 'answer', '1,', '"thalassemic', 'trait",', 'which', 'makes', 'us', 'uncomfortable', 'and', 'makes', 'us', 'doubt', 'if', 'we', 'are', 'not', 'going', 'for', 'the', 'apparently', 'easy', 'thing...until', 'we', 'remember', 'that', 'in', 'thalassemia', 'the', 'ADE', 'is', 'normal.'], ['Definitely,', 'this', 'girl', 'of', 'childbearing', 'age', 'has', 'iron', 'deficiency', 'anemia,', 'something', 'quite', 'common.'], ['Those', 'who', 'have', 'doubts', 'can', 'consult', '"Hematology.'], ['Manual', 'básico', 'razonado"', 'by', 'Jesús', 'San', 'Miguel.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O']]
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[['A 35-year-old healthy woman consults for asthenia\n', 'With the data we are given\n', 'Support'], ['With the data we are given\n', 'the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n', 'Support'], ['the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n', 'Central anemia, arregenerative, due to iron deficiency\n', 'Support'], ['the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n', 'Central anemia, arregenerative, due to folic acid deficiency\n', 'Support'], ['the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n', 'Peripheral, regenerative, hemolytic anemia\n', 'Attack'], ['the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n', 'Peripheral anemia, regenerative, due to acute active hemorrhage\n', 'Attack'], ['The next thing that orients us towards the cause is that it is microcytic and hypochromic, which is characteristic of iron deficiency anemia, since folic deficiency gives rise to megaloblastic anemia and active hemorrhage does not give microcytosis or hypochromia, but normocytosis and normochromia\n', 'Central anemia, arregenerative, due to iron deficiency\n', 'Support'], ['The CBC shows microcytic and hypochromic anemia (hemoglobin 7 g/dL, mean corpuscular volume 68 fl, mean corpuscular hemoglobin 24 pg\n', 'With the data we are given\n', 'Support'], ['with an elevated red cell distribution amplitude (ADE 20%)\n', 'With the data we are given\n', 'Attack'], ['decreased reticulocytes (0.3%, 30000/l absolute)\n', 'With the data we are given\n', 'Support'], ['decreased hemoglobin content in reticulocytes (17 pg)\n', 'With the data we are given\n', 'Support'], ['discrete thrombocytosis (500000 platelets)\n', 'With the data we are given\n', 'Support'], ['The CBC shows microcytic and hypochromic anemia (hemoglobin 7 g/dL, mean corpuscular volume 68 fl, mean corpuscular hemoglobin 24 pg\n', 'Central anemia, arregenerative, due to iron deficiency\n', 'Support'], ['the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n', 'Central anemia, arregenerative, due to folic acid deficiency\n', 'Attack'], ['with an elevated red cell distribution amplitude (ADE 20%)\n', 'Thalassemic trait\n', 'Attack'], ['We are almost inclined to answer 5, central arregenerative anemia due to iron deficiency...but there remains answer 1, "thalassemic trait", which makes us uncomfortable and makes us doubt if we are not going for the apparently easy thing...until we remember that in thalassemia the ADE is normal\n', 'Thalassemic trait\n', 'Attack'], ['Definitely, this girl of childbearing age has iron deficiency anemia, something quite common\n', 'Central anemia, arregenerative, due to iron deficiency\n', 'Support']]
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59_51
|
[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY', 'AND', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '47-year-old', 'male', 'patient', 'who', 'consults', 'the', 'emergency', 'department', 'for', 'sudden', 'loss', 'of', 'consciousness', 'Which', 'of', 'the', 'following', 'has', 'a', 'higher', 'diagnostic', 'yield?'], ['1-', 'Clinical', 'history.'], ['2-', 'Electrocardiogram.'], ['3-', 'Holter', 'recording.'], ['4-', 'EEG.'], ['5-', 'Cranial', 'CT', 'scan.'], ['CORRECT', 'ANSWER:', '1'], ['Obviously,', 'it', 'is', 'the', 'only', 'answer', 'that', 'encompasses', 'all', 'the', 'causes', 'of', 'sudden', 'loss', 'of', 'consciousness', 'and', 'that', 'allows', 'us', 'to', 'somehow', 'filter', 'the', 'diagnosis.']]
|
[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
|
[['that encompasses all the causes of sudden loss of consciousness and that allows us to somehow filter the diagnosis\n', 'Clinical history\n', 'Support'], ['that encompasses all the causes of sudden loss of consciousness and that allows us to somehow filter the diagnosis\n', 'Obviously, it is the only answer\n', 'Support'], ['Obviously, it is the only answer\n', 'Clinical history\n', 'Support']]
|
412_54
|
[['QUESTION', 'TYPE:', 'BIOSTATISTICS'], ['CLINICAL', 'CASE:'], ['Elizabeth', 'has', 'three', 'sons', 'and', 'one', 'daughter', '(Mary),', 'all', 'of', 'whom', 'are', 'healthy.'], ['A', 'brother', 'and', 'a', 'maternal', 'uncle', 'of', 'Isabel', 'died', 'of', 'Duchenne', 'disease:', 'an', 'X-linked', 'recessive', 'disease.'], ['At', 'present,', 'Maria', 'wants', 'to', 'become', 'pregnant', 'and', 'wants', 'to', 'know', 'the', 'risk', 'of', 'transmitting', 'the', 'disease', 'to', 'her', 'offspring.'], ['With', 'the', 'data', 'collected,', 'what', 'is', 'the', 'probability', 'that', 'Maria', 'is', 'a', 'carrier', 'of', 'Duchenne', 'disease?'], ['1-', '2/3.'], ['2-', '1/2.'], ['3-', '1/4.'], ['4-', 'Less', 'than', '1/4.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'maternal', 'grandmother', 'carried', 'the', 'mutation', 'in', 'one', 'copy', 'of', 'the', 'gene', 'on', 'an', 'X', 'chromosome', '(we', 'are', 'not', 'told', 'that', 'she', 'had', 'the', 'disease,', 'but', 'a', 'son', 'of', 'hers,', "Isabel's", 'maternal', 'uncle,', 'did', 'have', 'the', 'disease).'], ["Isabel's", 'mother', 'continues', 'to', 'carry', 'it,', 'since', 'one', 'of', "Isabel's", 'brothers', 'has', 'suffered', 'from', 'the', 'disease', 'but', 'not', 'her', 'father.'], ['Thus,', 'Isabel', 'has', 'a', '50%', 'chance', 'of', 'having', 'inherited', 'the', 'mutated', 'gene', 'from', 'her', 'mother', '(as', 'her', 'children', 'are', 'all', 'healthy,', 'we', 'are', 'not', 'sure', 'if', 'she', 'is', 'a', 'carrier),', 'and', 'therefore', 'her', 'daughter', 'has', 'a', '25%', 'chance', 'of', 'having', 'inherited', 'the', 'mutated', 'gene', 'from', 'her', 'grandmother.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[["one of Isabel's brothers has suffered from the disease but not her father\n", "Isabel's mother continues to carry it\n", 'Support'], ['The maternal grandmother carried the mutation in one copy of the gene on an X chromosome\n', "Isabel's mother continues to carry it\n", 'Support'], ['her children are all healthy\n', 'we are not sure if she is a carrier\n', 'Support'], ['Thus, Isabel has a 50% chance of having inherited the mutated gene from her mother\n', 'therefore her daughter has a 25% chance of having inherited the mutated gene from her grandmother\n', 'Support'], ['therefore her daughter has a 25% chance of having inherited the mutated gene from her grandmother\n', '1/4\n', 'Support']]
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347_159
|
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['69-year-old', 'woman', 'who', 'comes', 'to', 'your', 'office', 'referring', 'genital', 'bleeding', 'of', 'several', 'months', 'of', 'evolution.'], ['She', 'denies', 'hormone', 'replacement', 'therapy', 'and', 'anticoagulation.'], ['She', 'provides', 'normal', 'cervicovaginal', 'cytology.'], ['General', 'and', 'genital', 'physical', 'examination', 'without', 'findings', 'of', 'interest.'], ['BMI', 'of', '38kg/m2.'], ['Indicate', 'the', 'most', 'correct', 'attitude:'], ['1-', 'Prescribe', 'cyclic', 'progesterone.'], ['2-', 'Endometrial', 'biopsy.'], ['3-', 'Random', 'biopsies', 'of', 'the', 'cervix.'], ['4-', 'Hormonal', 'assessment', 'with', 'FSH,', 'LH', 'and', 'estradiol.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Endometrial', 'biopsy.'], ['Peri-', 'or', 'menopause:', '-', 'Due', 'to', 'the', 'high', 'prevalence', 'of', 'organic', 'pathology', 'during', 'this', 'period', 'it', 'is', 'necessary', 'to', 'systematically', 'perform', 'endometrial', 'biopsy', '(Cornier', 'or', 'Hysteroscopy).']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Endometrial biopsy\n', 'Endometrial biopsy\n', 'Support'], ['Peri- or menopause\n', 'Endometrial biopsy\n', 'Support'], ['Due to the high prevalence of organic pathology during this period it is necessary to systematically perform endometrial biopsy (Cornier or Hysteroscopy)\n', 'Endometrial biopsy\n', 'Support'], ['Peri- or menopause\n', 'Due to the high prevalence of organic pathology during this period it is necessary to systematically perform endometrial biopsy (Cornier or Hysteroscopy)\n', 'Support']]
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325_56
|
[['QUESTION', 'TYPE:', 'CRITICAL,', 'PALLIATIVE', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'patient', 'is', 'admitted', 'for', 'thermometric', 'fever', 'of', '38°C', 'in', 'the', 'previous', 'five', 'days', 'and', 'dyspnea', 'at', 'rest', '(NYHA', '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', 'of', '45', 'bpm.'], ['Signs', 'of', 'heart', 'failure', 'are', 'refractory', 'to', 'medical', 'treatment', 'and', 'transesophageal', 'echocardiography', 'shows', 'an', 'aortic', 'valve', 'with', 'an', 'effective', 'regurgitant', 'orifice', 'of', '0.5', 'cm2.'], ['Serial', 'cultures', 'are', 'positive', 'for', 'Streptococcus', 'gallolyticus.'], ['Indicate', 'the', 'best', 'course', 'of', 'action:'], ['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', 'will', 'be', 'implanted.'], ['3-', 'Implantation', 'of', 'transient', 'pacemaker,', 'antibiotic', 'therapy', 'according', 'to', 'antibiogram', 'and', 'percutaneous', 'implantation', 'of', 'aortic', 'valve', 'prosthesis.'], ['4-', 'Urgent', 'implantation', 'of', 'definitive', 'pacemaker', 'with', 'antibiotic', 'therapy', 'according', 'to', 'antibiogram', 'for', '6', 'weeks.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', '1,', 'since', 'the', 'indications', 'for', 'cardiac', 'surgery', 'include', 'the', 'appearance', 'of', 'heart', 'failure', 'or', 'new', 'conduction', 'disorders,', 'and', 'in', 'this', 'case', 'it', 'presents', 'both.']]
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[['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Examination in the emergency room was compatible with heart failure and the ECG showed complete atrioventricular block with an escape ventricular rate of 45 bpm\n', 'the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both\n', 'Support'], ['the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both\n', 'The correct answer is 1\n', 'Support'], ['The correct answer is 1\n', 'Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram\n', 'Support']]
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335_175
|
[['QUESTION', 'TYPE:', 'PHARMACOLOGY'], ['CLINICAL', 'CASE:'], ['An', '88-year-old', 'man', 'comes', 'for', 'consultation', 'because', 'he', 'has', 'fallen', '3', 'times', 'in', 'the', 'last', '6', 'months.'], ['None', 'of', 'the', 'falls', 'was', 'accompanied', 'by', 'dizziness', 'or', 'syncope.'], ['One', 'fall', 'occurred', 'while', 'he', 'was', 'walking', 'in', 'the', 'garden.'], ['His', 'medical', 'history', 'includes', 'hypertension', 'without', 'postural', 'changes', 'in', 'blood', 'pressure,', 'gout,', 'osteoarthritis,', 'and', 'depression.'], ['She', 'takes', '5', 'medications', 'regularly.'], ['Which', 'of', 'the', 'following', 'is', 'most', 'likely', 'to', 'contribute', 'to', 'falls', 'in', 'this', 'patient?'], ['1-', 'Allopurinol.'], ['2-', 'Hydrochlorothiazide.'], ['3-', 'Lisinopril.'], ['4-', 'Paroxetine.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Paroxetine;', 'complicated', 'question', 'since', 'both', 'hydrochlorothiazide', 'and', 'lisinopril', 'can', 'also', 'produce', 'falls', 'in', 'the', 'elderly,', 'but', 'they', 'would', 'generally', 'be', 'accompanied', 'by', 'dizziness.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'O', 'O', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness\n', 'Hydrochlorothiazide\n', 'Attack'], ['both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness\n', 'Lisinopril\n', 'Attack'], ['Paroxetine\n', 'Paroxetine\n', 'Support']]
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19_109
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[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'woman', 'has', 'traveled', 'to', 'Cuba', 'from', 'where', 'she', 'arrived', 'three', 'days', 'ago.'], ['The', 'day', 'after', 'her', 'return,', 'she', 'goes', 'to', 'her', 'family', 'doctor', 'for', 'high', 'fever,', 'intense', 'arthromyalgia', 'and', 'headache', 'that', 'had', 'started', 'before', 'the', 'return', 'trip', 'and', 'he', 'prescribes', 'her', 'paracetamol.'], ['Three', 'days', 'later', 'and', 'with', 'no', 'improvement,', 'he', 'presented', 'in', 'the', 'morning', 'with', 'a', 'generalized', 'pruritic', 'maculo-papular', 'rash,', 'which', 'was', 'more', 'intense', 'on', 'the', 'lower', 'limbs', 'where', 'it', 'developed', 'into', 'petechiae,', 'for', 'which', 'he', 'went', 'to', 'the', 'emergency', 'department.'], ['There', 'is', 'no', 'relevant', 'data', 'in', 'the', 'EC', 'except', 'platelets', '75000/mm3', '(htco', '36%,', 'leukocytes', '4100', '79%', 'neutrophils).'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Infectious', 'mononucleosis.'], ['2-', 'Allergic', 'exanthema.'], ['3-', 'P.', 'falciparum', 'malaria.'], ['4-', 'Typhoid', 'fever.'], ['5-', 'Dengue', 'fever.'], ['CORRECT', 'ANSWER:', '5'], ['In', 'this', 'case', 'I', 'believe', 'that', 'the', 'correct', 'answer', 'is', '5.'], ['The', '1', 'should', 'not', 'be', 'because', 'although', 'the', 'clinical', 'picture', 'is', 'suggestive,', 'it', 'does', 'not', 'present', 'lymphocytosis.'], ['It', 'does', 'not', 'seem', 'to', 'be', 'an', 'allergic', 'exanthema', 'from', 'the', 'clinical', 'picture.'], ['And', 'certainly', 'she', 'does', 'not', 'have', 'symptoms', 'or', 'clinical', 'signs', 'compatible', 'with', 'malaria', 'or', 'typhoid', 'fever.'], ['What', 'points', 'to', 'dengue,', 'in', 'addition', 'to', 'the', 'clinical', 'signs,', 'is', 'the', 'plateletopenia.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise']]
|
[['although the clinical picture is suggestive, it does not present lymphocytosis\n', 'The 1 should not be\n', 'Support'], ['although the clinical picture is suggestive, it does not present lymphocytosis\n', 'Infectious mononucleosis\n', 'Attack'], ['What points to dengue, in addition to the clinical signs, is the plateletopenia\n', 'In this case I believe that the correct answer is 5\n', 'Support'], ['It does not seem to be an allergic exanthema from the clinical picture\n', 'Allergic exanthema\n', 'Attack'], ['certainly she does not have symptoms or clinical signs compatible with malaria or typhoid fever\n', 'P. falciparum malaria\n', 'Attack'], ['certainly she does not have symptoms or clinical signs compatible with malaria or typhoid fever\n', 'Typhoid fever\n', 'Attack'], ['What points to dengue, in addition to the clinical signs, is the plateletopenia\n', 'Dengue fever\n', 'Support'], ['platelets 75000/mm3 (htco 36%, leukocytes 4100 79% neutrophils)\n', 'Dengue fever\n', 'Support']]
|
401_147
|
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY', 'AND', 'ORTHOPEDICS'], ['CLINICAL', 'CASE:'], ['A', '13-year-old', 'boy', 'presents', 'dorsal', 'pain', 'of', 'several', 'months', 'of', 'evolution,', 'only', 'when', 'standing', 'and', 'walking,', 'what', 'diagnosis', 'should', 'we', 'consider?'], ['1-', "Scheuermann's", 'disease.'], ['2-', 'Thoracic', 'scoliosis.'], ['3-', 'Malignant', 'tumor', 'of', 'the', 'vertebral', 'body.'], ['4-', 'It', 'is', 'a', 'mechanical', 'overload.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['A', 'malignant', 'tumor', 'would', 'also', 'hurt', 'at', 'rest.'], ['As', 'for', 'Scheuermann', 'and', 'scoliosis,', 'we', 'should', 'be', 'given', 'some', 'physical', 'data', 'because', 'the', 'patient', 'presents', 'with', 'a', 'specific', 'examination', 'that', 'would', 'give', 'us', 'the', 'diagnosis.']]
|
[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['the patient presents with a specific examination that would give us the diagnosis\n', 'As for Scheuermann and scoliosis, we should be given some physical data\n', 'Support'], ['A malignant tumor would also hurt at rest\n', 'Malignant tumor of the vertebral body\n', 'Support'], ['As for Scheuermann and scoliosis, we should be given some physical data\n', "Scheuermann's disease\n", 'Attack']]
|
607_115
| null | null |
[]
|
453_150
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '25-year-old', 'man', 'consults', 'for', 'tremor.'], ['Examination', 'reveals', 'dysarthria', 'and', 'dystonia.'], ['He', 'has', 'a', 'family', 'history', 'of', 'psychiatric', 'illness', 'and', 'movement', 'disorders.'], ['Which', 'diagnostic', 'test', 'do', 'you', 'consider', 'most', 'accurate?'], ['1-', 'DATS', 'CAN.'], ['2-', 'Nerve', 'conduction', 'study.'], ['3-', 'Electroencephalogram.'], ['4-', 'Copper', 'in', 'urine', 'of', '24.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['If', 'they', 'are', 'talking', 'about', 'a', 'young', 'man', '20-30', 'years', 'old,', 'with', 'tremor', 'and', 'dystonia,', 'whether', 'or', 'not', 'he', 'has', 'a', 'family', 'history,', 'and', 'especially', 'if', 'one', 'of', 'the', 'options', 'tells', 'me', 'about', 'copper', 'in', 'urine,', 'they', 'are', 'telling', 'me', 'to', 'think', 'of', "Wilson's", 'disease.'], ['I', 'do', 'not', 'think', 'of', 'juvenile', "Parkinson's,", 'nor', 'an', 'epileptic', 'clinic.'], ['So', 'the', 'correct', 'answer', 'is', '4.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['If they are talking about a young man 20-30 years old, with tremor and dystonia, whether or not he has a family history, and especially if one of the options tells me about copper in urine\n', "they are telling me to think of Wilson's disease\n", 'Support'], ['So the correct answer is 4\n', 'Copper in urine of 24\n', 'Support'], ["they are telling me to think of Wilson's disease\n", 'Copper in urine of 24\n', 'Support'], ["they are telling me to think of Wilson's disease\n", "I do not think of juvenile Parkinson's, nor an epileptic clinic\n", 'Attack'], ["they are telling me to think of Wilson's disease\n", 'So the correct answer is 4\n', 'Support']]
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529_166
|
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['An', '18-year-old', 'patient', 'consulted', 'for', 'edema.'], ['A', 'complete', 'blood', 'test', 'showed', 'proteinuria', 'of', '8', 'g/day', 'without', 'microhematuria,', 'hypoalbuminemia', 'and', 'hypercholesterolemia', 'with', 'normal', 'renal', 'function.'], ['He', 'was', 'empirically', 'administered', 'corticosteroids.'], ['After', 'one', 'month,', 'the', 'clinical', 'picture', 'has', 'completely', 'disappeared.'], ['What', 'is', 'your', 'diagnostic', 'hypothesis?'], ['1-', 'Amyloidosis.'], ['2-', 'IgA', 'nephropathy', 'or', "Berger's", 'disease.'], ['3-', 'Alport', 'syndrome.'], ['4-', 'Nephropathy', 'with', 'minimal', 'changes.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'describe', 'a', 'young', 'patient', 'with', 'criteria', 'of', 'nephrotic', 'syndrome', 'with', 'excellent', 'response', 'to', 'corticosteroids.'], ['Without', 'biopsy,', 'the', 'clinical', 'presentation', 'and', 'evolution', 'suggest', 'a', 'nephropathy', 'with', 'minimal', 'changes,', 'which', 'usually', 'presents', 'with', 'normal', 'or', 'slightly', 'altered', 'renal', 'function', 'together', 'with', 'nephrotic', 'syndrome,', 'and', 'which', 'in', '85-90%', 'of', 'cases', 'resolves', 'with', 'steroid', 'treatment.'], ['The', 'age', 'is', 'the', 'only', 'data', 'that', 'is', 'a', 'bit', 'shaky,', 'since', 'although', 'it', 'is', 'the', 'most', 'frequent', 'cause', 'of', 'idiopathic', 'nephrotic', 'syndrome', 'in', 'children', 'and', 'adolescents,', 'it', 'is', 'usually', 'recommended', 'to', 'perform', 'a', 'biopsy', 'prior', 'to', 'treatment', 'in', 'those', 'older', 'than', '16', 'years,', 'in', 'any', 'case', 'it', 'does', 'not', 'admit', 'much', 'discussion.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['After one month, the clinical picture has completely disappeared\n', 'We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids\n', 'Support'], ['A complete blood test showed proteinuria of 8 g/day without microhematuria, hypoalbuminemia and hypercholesterolemia with normal renal function\n', 'We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids\n', 'Support'], ['He was empirically administered corticosteroids\n', 'We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids\n', 'Support'], ['Without biopsy, the clinical presentation and evolution suggest a nephropathy with minimal changes, which usually presents with normal or slightly altered renal function together with nephrotic syndrome, and which in 85-90% of cases resolves with steroid treatment\n', 'Nephropathy with minimal changes\n', 'Support'], ['since although it is the most frequent cause of idiopathic nephrotic syndrome in children and adolescents, it is usually recommended to perform a biopsy prior to treatment in those older than 16 years\n', 'The age is the only data that is a bit shaky\n', 'Support'], ['in any case it does not admit much discussion\n', 'since although it is the most frequent cause of idiopathic nephrotic syndrome in children and adolescents, it is usually recommended to perform a biopsy prior to treatment in those older than 16 years\n', 'Attack'], ['The age is the only data that is a bit shaky\n', 'Without biopsy, the clinical presentation and evolution suggest a nephropathy with minimal changes, which usually presents with normal or slightly altered renal function together with nephrotic syndrome, and which in 85-90% of cases resolves with steroid treatment\n', 'Attack']]
|
258_96
|
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '62-year-old', 'man', 'with', 'type', '2', 'diabetes', 'mellitus', 'of', '10', 'years', 'of', 'evolution', 'is', 'treated', 'with', 'metformin', 'and', 'sitagliptin.'], ['He', 'does', 'little', 'physical', 'exercise', 'and', 'follows', 'an', 'adequate', 'diet.'], ['In', 'the', 'last', '6', 'months', 'he', 'has', 'lost', 'weight', 'and', 'has', 'more', 'asthenia.'], ['Her', 'glycemic', 'controls', 'have', 'deteriorated', 'from', 'baseline', 'blood', 'glucose', 'levels', 'of', '110-140', 'mg/dL', 'to', '170-200', 'mg/dL,', 'as', 'well', 'as', 'her', 'glycosylated', 'hemoglobin', 'which', 'has', 'gone', 'from', '7.1', 'to', '8.5%.'], ['The', 'most', 'appropriate', 'therapeutic', 'measure', 'to', 'be', 'taken', 'is:'], ['1-', 'Increase', 'dietary', 'protein', 'and', 'long-chain', 'carbohydrate', 'intake', 'to', 'improve', 'asthenia', 'and', 'weight', 'loss.'], ['2-', 'To', 'associate', 'a', 'basal', 'insulin', 'dose', 'to', 'the', 'treatment.'], ['3-', 'Associate', 'with', 'ascarbose', 'treatment.'], ['4-', 'Substitute', 'sitagliptin', 'for', 'pioglitazone.'], ['5-', 'Substitute', 'metformin', 'for', 'glimepiride.'], ['CORRECT', 'ANSWER:', '2'], ['To', 'associate', 'a', 'basal', 'insulin', 'dose', 'to', 'the', 'treatment.'], ['Expected', 'question', 'on', 'a', 'very', 'important', 'subject:', 'diabetes', 'and', 'its', 'treatment.'], ['Patient', 'poorly', 'controlled', 'with', 'metformin', 'and', 'sitagliptin', 'with', 'discrete', 'cardinal', 'symptoms', '(weight', 'loss,', 'asthenia).'], ['The', 'best', 'option', 'is', 'insulin', 'to', 'control', 'cardinal', 'symptoms', 'and', 'decrease', 'HbA1c', 'to', '<', '7%.']]
|
[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
|
[['To associate a basal insulin dose to the treatment\n', 'To associate a basal insulin dose to the treatment\n', 'Support'], ['Patient poorly controlled with metformin and sitagliptin with discrete cardinal symptoms (weight loss, asthenia)\n', 'To associate a basal insulin dose to the treatment\n', 'Support'], ['Patient poorly controlled with metformin and sitagliptin with discrete cardinal symptoms (weight loss, asthenia)\n', 'The best option is insulin to control cardinal symptoms and decrease HbA1c to < 7%\n', 'Support']]
|
375_128
|
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'patient', 'under', 'study', 'for', 'possible', 'meningitis,', 'with', 'fever,', 'headache', 'and', 'vomiting', 'of', '2', 'days', 'of', 'evolution.'], ['A', 'brain', 'MRI', 'and', 'lumbar', 'puncture', 'were', 'performed.'], ['Twenty', 'hours', 'later,', 'on', 'getting', 'up', 'to', 'go', 'to', 'the', 'bathroom,', 'he', 'complains', 'of', 'severe', 'headache,', 'very', 'marked', 'when', 'he', 'sits', 'up', 'but', 'disappears', 'when', 'he', 'lies', 'down.'], ['She', 'no', 'longer', 'has', 'fever', 'or', 'vomiting.'], ['What', 'is', 'most', 'likely', 'the', 'origin', 'of', 'this', 'headache?'], ['1-', 'Meningitis', 'remains', 'the', 'fundamental', 'cause', 'of', 'her', 'headache,', 'as', 'it', 'is', 'the', 'same', 'type', 'of', 'headache', 'as', 'at', 'the', 'onset', 'of', 'symptoms.'], ['2-', 'It', 'is', 'a', 'post', 'lumbar', 'puncture', 'headache.'], ['3-', 'It', 'is', 'necessary', 'to', 'look', 'for', 'a', 'different', 'cause', 'to', 'this', 'headache,', 'because', 'it', 'is', 'not', 'typical', 'of', 'post-lumbar', 'puncture', 'syndrome', 'or', 'meningitis.'], ['4-', 'Most', 'likely', 'it', 'was', 'not', 'a', 'viral', 'meningitis,', 'but', 'a', 'subarachnoid', 'hemorrhage.', 'For', 'this', 'reason,', 'the', 'initial', 'headache', 'disappears', 'almost', 'completely', 'when', 'lying', 'down.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'picture', 'they', 'describe', 'of', 'intense', 'headache', 'with', 'orthostatism', 'that', 'disappears', 'when', 'lying', 'down,', 'although', 'it', 'is', 'true', 'that', 'the', 'most', 'typical', 'presentation', 'is', 'between', 'the', 'first', '24-48', 'hours', 'and', 'in', 'this', 'case', 'it', 'is', 'somewhat', 'earlier.'], ['Even', 'so,', 'the', 'rest', 'of', 'the', 'answers', 'are', 'improbable:', 'the', 'first', 'cannot', 'be', 'because', 'we', 'have', 'not', 'been', 'told', 'what', 'the', 'initial', 'headache', 'was', 'like;', 'the', 'third,', 'although', 'it', 'could', 'be', 'due', 'to', 'the', 'time', 'of', 'onset', '(as', 'I', 'said', 'a', 'little', 'earlier', 'than', 'expected),', 'the', 'reality', 'is', 'that', 'the', 'headache', 'with', 'orthostasis', 'is', 'so', 'typical', 'that', 'it', 'would', 'be', 'the', 'most', 'probable', 'cause;', 'the', 'last', 'one', 'could', 'not', 'be', 'either', 'because', 'SAH', 'does', 'not', 'follow', 'this', 'pattern', 'in', 'relation', 'to', 'orthostasis.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A 45-year-old patient under study for possible meningitis, with fever, headache and vomiting of 2 days of evolution\n', 'we have not been told what the initial headache was like\n', 'Support'], ['we have not been told what the initial headache was like\n', 'he first cannot be\n', 'Support'], ['The picture they describe of intense headache with orthostatism that disappears when lying down, although it is true that the most typical presentation is between the first 24-48 hours and in this case it is somewhat earlier\n', 'It is a post lumbar puncture headache\n', 'Support'], ['SAH does not follow this pattern in relation to orthostasis\n', 'the last one could not be either\n', 'Support'], ['the last one could not be either\n', 'Most likely it was not a viral meningitis, but a subarachnoid hemorrhage. For this reason, the initial headache disappears almost completely when lying down\n', 'Support'], ['the third, although it could be due to the time of onset (as I said a little earlier than expected), the reality is that the headache with orthostasis is so typical that it would be the most probable cause\n', 'It is necessary to look for a different cause to this headache, because it is not typical of post-lumbar puncture syndrome or meningitis\n', 'Attack'], ['he first cannot be\n', 'Meningitis remains the fundamental cause of her headache, as it is the same type of headache as at the onset of symptoms\n', 'Attack'], ['Even so, the rest of the answers are improbable\n', 'Most likely it was not a viral meningitis, but a subarachnoid hemorrhage. For this reason, the initial headache disappears almost completely when lying down\n', 'Attack'], ['SAH does not follow this pattern in relation to orthostasis\n', 'It is necessary to look for a different cause to this headache, because it is not typical of post-lumbar puncture syndrome or meningitis\n', 'Attack'], ['Even so, the rest of the answers are improbable\n', 'Meningitis remains the fundamental cause of her headache, as it is the same type of headache as at the onset of symptoms\n', 'Attack']]
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352_161
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[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'woman', 'referred', 'to', 'the', 'gynecology', 'office', 'for', 'evaluation', 'referring', 'dyspareunia', 'for', 'about', '8', 'months,', 'along', 'with', 'dyschezia', 'and', 'occasional', 'rectorrhagia', 'coinciding', 'with', 'menstruation', 'for', '3-4', 'months.'], ['She', 'also', 'reports', 'dysmenorrhea', 'for', 'years,', 'which', 'she', 'controls', 'well', 'with', 'ibuprofen.'], ['She', 'has', 'been', 'trying', 'to', 'get', 'pregnant', 'for', '16', 'months', 'without', 'success.'], ['In', 'the', 'gynecological', 'examination', 'she', 'only', 'shows', 'pain', 'when', 'pressing', 'on', 'the', 'posterior', 'vaginal', 'fornix.'], ['Which', 'test', 'do', 'you', 'consider', 'would', 'allow', 'you', 'to', 'reach', 'a', 'diagnosis', 'of', 'certainty', 'of', 'her', 'pathology?'], ['1-', 'Transvaginal', 'ultrasound.'], ['2-', 'Diagnostic', 'laparoscopy.'], ['3-', 'Magnetic', 'resonance', 'imaging.'], ['4-', 'Colonoscopy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is', '2.'], ['We', 'are', 'facing', 'a', 'suspicion', 'of', 'endometriosis,', 'due', 'to', 'the', 'symptoms', 'and', 'signs', 'given', 'in', 'the', 'statement.'], ['We', 'are', 'asked', 'for', 'a', 'diagnosis', 'of', 'certainty,', 'and', 'the', 'Gold', 'Standard', 'for', 'the', 'diagnosis', 'of', 'this', 'disease', 'is', 'diagnostic', 'laparoscopy.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The correct answer is 2\n', 'Diagnostic laparoscopy\n', 'Support'], ['A 27-year-old woman referred to the gynecology office for evaluation referring dyspareunia for about 8 months, along with dyschezia and occasional rectorrhagia coinciding with menstruation for 3-4 months\n', 'We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n', 'Support'], ['She also reports dysmenorrhea for years, which she controls well with ibuprofen\n', 'We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n', 'Support'], ['She has been trying to get pregnant for 16 months without success\n', 'We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n', 'Support'], ['In the gynecological examination she only shows pain when pressing on the posterior vaginal fornix\n', 'We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n', 'Support']]
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575_102
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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '29-year-old', 'woman', 'with', 'a', 'history', 'of', 'febrile', 'seizures', 'and', 'a', 'heavy', 'smoker.'], ['She', 'consults', 'for', 'frequent,', 'stereotyped', 'episodes', 'that', 'begin', 'with', 'an', 'ascending', 'epigastric', 'sensation', 'and', 'an', 'unpleasant', 'odor,', 'followed', 'by', 'disconnection', 'from', 'the', 'environment.'], ['Family', 'members', 'who', 'are', 'with', 'her', 'observe', 'that', 'she', 'makes', 'sucking', 'movements', 'and', 'repeated', 'opening', 'and', 'closing', 'movements', 'of', 'the', 'left', 'hand.'], ['After', 'two', 'minutes', 'the', 'movements', 'subside,', 'but', 'she', 'has', 'difficulty', 'responding', 'appropriately', 'and', 'only', 'partially', 'remembers', 'what', 'happened.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Complex', 'focal', 'temporal', 'lobe', 'seizures.'], ['2-', 'Transient', 'ischemic', 'attacks', 'in', 'right', 'carotid', 'territory.'], ['3-', 'Simple', 'focal', 'motor', 'seizures.'], ['4-', 'Episodes', 'of', 'transient', 'global', 'amnesia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'clinical', 'case', 'makes', 'a', 'textbook', 'description', 'of', 'a', 'medial', 'temporal', 'seizure.'], ['The', 'aura', 'of', 'ascending', 'epigastric', 'sensation', 'and', 'olfactory', 'alteration', 'and', 'the', 'subsequent', 'description', 'of', 'the', 'seizure', 'with', 'alteration', 'of', 'the', 'level', 'of', 'consciousness', '(disconnection', 'from', 'the', 'environment)', 'with', 'oral', 'and', 'manual', 'automatisms.'], ['The', 'current', 'classification', 'is', 'the', '2017', 'ILAE', 'classification', 'that', 'would', 'describe', 'this', 'seizure', 'as', 'focal', 'seizure', 'with', 'altered', 'level', 'of', 'consciousness,', 'but', 'in', 'the', 'MIR', 'they', 'still', 'use', 'the', 'old', 'terminology', '(complex', 'is', 'what', 'altered', 'level', 'of', 'consciousness', 'was', 'called).']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The clinical case makes a textbook description of a medial temporal seizure\n', 'Complex focal temporal lobe seizures\n', 'Support'], ['The aura of ascending epigastric sensation and olfactory alteration and the subsequent description of the seizure with alteration of the level of consciousness (disconnection from the environment) with oral and manual automatisms\n', 'The clinical case makes a textbook description of a medial temporal seizure\n', 'Support']]
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278_31
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[['QUESTION', 'TYPE:', 'PATHOLOGICAL', 'ANATOMY'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'woman', 'with', 'a', '15', 'cm', 'solid-cystic', 'ovarian', 'tumor', 'detected', 'by', 'ultrasound', 'after', 'presenting', 'with', 'non-specific', 'abdominal', 'symptoms.'], ['In', 'the', 'anatomopathological', 'study', 'of', 'the', 'corresponding', 'specimen,', 'teeth,', 'hairs,', 'areas', 'of', 'intestinal', 'epithelium,', 'areas', 'of', 'squamous', 'epithelium', '(15%)', 'and', 'bronchial', 'epithelium,', 'as', 'well', 'as', 'neuroectodermal', 'and', 'embryonic', 'elements', 'are', 'found', 'in', 'several', 'of', 'the', 'histological', 'preparations.'], ['In', 'reference', 'to', 'this', 'case,', 'point', 'out', 'the', 'correct', 'diagnosis:'], ['1-', 'Teratocarcinoma.'], ['2-', 'Immature', 'teratoma.'], ['3-', 'Mature', 'cystic', 'teratoma.'], ['4-', 'Dysgerminoma.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['After', 'reading', 'the', 'question', 'and', 'the', 'possible', 'answers,', 'we', 'have', 'two', 'tumor', 'and', 'two', 'non-tumor', 'options.'], ['At', 'no', 'time', 'are', 'atypical', 'cellular', 'features', 'mentioned,', 'so', 'we', 'can', 'safely', 'rule', 'out', 'tumor', 'lesions,', 'leaving', 'doubts', 'between', 'answers', '2', 'and', '3.'], ['In', 'this', 'case,', 'we', 'would', 'have', 'to', 'opt', 'for', 'IMMATURE', 'TERATOMA,', 'mentioning', 'the', 'presence', 'of', 'embryonic', 'remains.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['we can safely rule out tumor lesions, leaving doubts between answers 2 and 3\n', 'Teratocarcinoma\n', 'Attack'], ['we can safely rule out tumor lesions, leaving doubts between answers 2 and 3\n', 'Dysgerminoma\n', 'Attack'], ['In this case, we would have to opt for IMMATURE TERATOMA, mentioning the presence of embryonic remains\n', 'Immature teratoma\n', 'Support'], ['At no time are atypical cellular features mentioned\n', 'we can safely rule out tumor lesions, leaving doubts between answers 2 and 3\n', 'Support']]
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225_64
|
[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['An', '82-year-old', 'patient', 'presents', 'with', 'sudden', 'and', 'frequent', 'dizziness,', 'without', 'prodromes,', 'of', 'short', 'duration', 'and', 'which', 'subsides', 'spontaneously,', 'without', 'ever', 'presenting', 'syncope.'], ['Physical', 'examination', 'and', 'baseline', 'electrocardiogram', 'are', 'normal.'], ['In', 'an', 'ambulatory', 'electrocardiogram', 'recording', 'during', '24', 'hours,', 'short', 'phases', 'of', 'absence', 'of', 'P', 'waves', 'prior', 'to', 'QRS', 'with', 'an', 'escape', 'rhythm', 'of', 'the', 'atrioventricular', 'junction', 'with', 'narrow', 'QRS', 'at', '40', 'bpm', 'and', 'a', 'wave', 'at', 'the', 'beginning', 'of', 'the', 'ST', 'segment', 'corresponding', 'to', 'a', 'retrograde', 'P', 'were', 'detected', 'in', 'the', 'vigil', 'period.'], ['No', 'asystole', 'periods', 'longer', 'than', '3', 'seconds', 'are', 'detected.'], ['Given', 'this', 'you', 'would', 'say:'], ['1-', 'The', 'patient', 'has', 'a', 'third-degree', 'AVB', 'and', 'requires', 'pacemaker', 'implantation.'], ['2-', 'The', 'absence', 'of', 'periods', 'of', 'asystole', '>3', 'seconds', 'excludes', 'a', 'cardiac', 'cause', 'of', 'dizziness.'], ['3-', 'Drug', 'treatment', 'to', 'increase', 'conduction', 'in', 'the', 'AV', 'node', 'would', 'be', 'indicated.'], ['4-', 'The', 'patient', 'presents', 'sinus', 'dysfunction', 'with', 'sinoatrial', 'block', 'and', 'requires', 'pacemaker', 'implantation', 'due', 'to', 'symptoms.'], ['5-', 'The', 'alterations', 'detected', 'in', 'the', 'ambulatory', 'electrocardiogram', 'are', 'typical', 'of', 'patients', 'of', 'this', 'age', 'and', 'there', 'is', 'no', 'indication', 'for', 'therapeutic', 'intervention.'], ['CORRECT', 'ANSWER:', '5'], ['What', 'are', 'these', 'findings', 'in', 'the', 'Holter?'], ['If', 'the', 'sinus', 'node', 'fails,', 'the', 'AV', 'node', 'takes', 'over', 'and', 'stimulates', 'the', 'ventricle.'], ['In', '10%', 'of', 'people', 'there', 'is', 'retrograde', 'conduction,', 'so', 'that', 'beat', 'generated', 'in', 'the', 'AVN', 'stimulates', 'both', 'ventricles', 'and', 'atria,', 'giving', 'a', 'retrograde', 'P', 'as', 'reported', 'in', 'the', 'study.'], ['In', 'this', 'sense,', 'no', 'problem.'], ['Likewise,', 'there', 'are', 'also', 'no', 'pauses', 'longer', 'than', '3', 'seconds', 'that', 'could', 'cause', 'cardiogenic', 'syncope', '(which,', 'in', 'fact,', 'he', 'has', 'never', 'suffered).'], ['Option', '1', 'is', 'ruled', 'out:', 'it', 'is', 'not', 'a', 'complete', 'AVB.'], ['Option', '2', 'cannot', 'be', 'answered', 'either:', 'to', 'exclude,', 'what', 'is', 'said', 'to', 'exclude...'], ['It', 'is', 'like', 'never/always.'], ['Option', '3', 'does', 'not', 'make', 'much', 'sense:', 'we', 'could', 'suspend', 'those', 'that', 'impair', 'conduction', '(beta-blockers,', 'calcium', 'antagonists),', 'but', 'drugs', 'that', 'facilitate,', 'as', 'long', 'as', 'we', 'do', 'not', 'give', 'him', 'a', 'perfusion', 'of', 'atropine', 'to', 'take', 'home...'], ['In', 'option', '4,', 'stating', 'that', 'he', 'has', 'sinoatrial', 'block', 'is', 'a', 'bit', 'of', 'a', 'rap:', 'without', 'an', 'electrophysiological', 'study', 'it', 'cannot', 'be', 'said,', 'he', 'does', 'not', 'necessarily', 'have', 'SA', 'block,', 'and', 'this', 'alone', 'would', 'not', 'indicate', 'the', 'implantation', 'of', 'a', 'pacemaker.'], ['So,', 'finally,', 'I', 'would', 'check', 'option', '5.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['it is not a complete AVB\n', 'Option 1 is ruled out\n', 'Support'], ['Option 1 is ruled out\n', 'The patient has a third-degree AVB and requires pacemaker implantation\n', 'Attack'], ['Option 2 cannot be answered either: to exclude, what is said to exclude...\n', 'The absence of periods of asystole >3 seconds excludes a cardiac cause of dizziness\n', 'Attack'], ['It is like never/always\n', 'Option 2 cannot be answered either: to exclude, what is said to exclude...\n', 'Support'], ['which, in fact, he has never suffered\n', 'Likewise, there are also no pauses longer than 3 seconds that could cause cardiogenic syncope\n', 'Support'], ['we could suspend those that impair conduction (beta-blockers, calcium antagonists)\n', 'Option 3 does not make much sense\n', 'Attack'], ['but drugs that facilitate, as long as we do not give him a perfusion of atropine to take home...\n', 'Option 3 does not make much sense\n', 'Support'], ['he has sinoatrial block\n', 'In option 4, stating that he has sinoatrial block is a bit of a rap: without an electrophysiological study it cannot be said\n', 'Support'], ['he does not necessarily have SA block\n', 'this alone would not indicate the implantation of a pacemaker.\n', 'Support'], ['In option 4, stating that he has sinoatrial block is a bit of a rap: without an electrophysiological study it cannot be said\n', 'The patient presents sinus dysfunction with sinoatrial block and requires pacemaker implantation due to symptoms\n', 'Attack'], ['Option 3 does not make much sense\n', 'Drug treatment to increase conduction in the AV node would be indicated\n', 'Attack'], ['this alone would not indicate the implantation of a pacemaker.\n', 'The patient presents sinus dysfunction with sinoatrial block and requires pacemaker implantation due to symptoms\n', 'Attack'], ['So, finally, I would check option 5\n', 'The alterations detected in the ambulatory electrocardiogram are typical of patients of this age and there is no indication for therapeutic intervention\n', 'Support'], ['If the sinus node fails, the AV node takes over and stimulates the ventricle\n', 'it is not a complete AVB\n', 'Support']]
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370_125
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[['QUESTION', 'TYPE:', 'PULMONOLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'former', 'smoker', 'patient,', 'previously', 'diagnosed', 'with', 'COPD', 'comes', 'in', 'for', 'a', 'checkup.'], ['The', 'physical', 'examination', 'reveals', 'digital', 'hypokratism', 'of', 'recent', 'onset.'], ['What', 'is', 'the', 'most', 'acceptable', 'explanation', 'for', 'this', 'finding', 'in', 'the', 'clinical', 'context', 'described?'], ['1-', 'Pulmonary', 'carcinoma.'], ['2-', 'Bronchiectasis.'], ['3-', 'Pulmonary', 'fibrosis.'], ['4-', 'Cyanotic', 'heart', 'disease.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['In', 'a', 'digital', 'hypokratitis', 'of', 'recent', 'onset', 'in', 'a', 'smoking', 'patient,', 'the', 'first', 'option', 'to', 'rule', 'out', 'is', 'bronchopulmonary', 'carcinoma.'], ['Other', 'pathologies', 'can', 'also', 'occur', 'but', 'not', 'so', 'suddenly.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['A former smoker patient, previously diagnosed with COPD comes in for a checkup\n', 'In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma\n', 'Support'], ['The physical examination reveals digital hypokratism of recent onset\n', 'In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma\n', 'Support'], ['In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma\n', 'Pulmonary carcinoma\n', 'Support']]
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332_88
| null | null |
[]
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78_33
|
[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '55-year-old', 'postmenopausal', 'woman', 'consults', 'for', 'asthenia', 'and', 'dyspnea', 'on', 'exertion.'], ['In', 'the', 'anamnesis', 'she', 'reported', 'slight', 'epigastralgia', 'and', 'occasional', 'heartburn.'], ['No', 'metrorrhagia.'], ['Laboratory', 'tests:', 'Hb6', 'gr/dL,', 'MCV', '69', 'fl,', 'sideremia', '13', 'micrograms/dL,', 'ferritin', '4', 'ngr/mL.'], ['Gastrointestinal', 'endoscopy:', 'small', 'sliding', 'hiatal', 'hernia', 'with', 'no', 'signs', 'of', 'esophagitis.'], ['What', 'is', 'the', 'most', 'correct', 'approach?'], ['1-', 'Administer', 'oral', 'iron', 'and', 'monitor', 'the', 'evolution', 'of', 'anemia.'], ['2-', 'Treat', 'with', 'proton', 'pump', 'inhibitors', 'and', 'evaluate', 'at', 'three', 'months.'], ['3-', 'Recommend', 'a', 'complete', 'colonoscopy.'], ['4-', 'Perform', 'an', 'endoscopic', 'capsule', 'study.'], ['5-', 'Request', 'a', 'gynecological', 'evaluation.'], ['CORRECT', 'ANSWER:', '3'], ['We', 'have', 'a', 'case', 'of', 'chronic', 'iron', 'deficiency', 'anemia,', 'without', 'obvious', 'bleeding.'], ['The', 'first', 'cause', 'of', 'iron', 'deficiency', 'anemia', 'is', 'occult', 'bleeding', 'of', 'digestive', 'origin.'], ['The', 'existence', 'of', 'clinical', 'symptoms', 'suggestive', 'of', 'pathology', 'of', 'the', 'upper', 'digestive', 'tract', 'has', 'led', 'us', 'to', 'begin', 'the', 'study', 'with', 'upper', 'endoscopy,', 'but', 'there', 'is', 'no', 'pathology', 'to', 'justify', 'the', 'anemia,', 'so', 'further', 'investigation', 'is', 'necessary,', 'which', 'rules', 'out', 'answers', '1', 'and', '2.'], ['Between', '3', 'and', '4,', 'large', 'bowel', 'lesions', 'are', 'much', 'more', 'common', 'and', 'should', 'be', 'ruled', 'out', 'before', 'small', 'bowel', 'lesions.'], ['In', 'fact', 'the', 'recommendations', 'of', 'capsule', 'endoscopy', 'in', 'anemia', 'studies', 'are', 'restricted.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['We have a case of chronic iron deficiency anemia, without obvious bleeding\n', 'The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy,\n', 'Support'], ['The first cause of iron deficiency anemia is occult bleeding of digestive origin\n', 'The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy,\n', 'Support'], ['there is no pathology to justify the anemia\n', 'further investigation is necessary, which rules out answers 1 and 2\n', 'Support'], ['further investigation is necessary, which rules out answers 1 and 2\n', 'Administer oral iron and monitor the evolution of anemia\n', 'Attack'], ['further investigation is necessary, which rules out answers 1 and 2\n', 'Treat with proton pump inhibitors and evaluate at three months\n', 'Attack'], ['In fact the recommendations of capsule endoscopy in anemia studies are restricted\n', 'Perform an endoscopic capsule study\n', 'Attack'], ['Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions\n', 'Recommend a complete colonoscopy\n', 'Support'], ['Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions\n', 'Request a gynecological evaluation\n', 'Attack'], ['Laboratory tests: Hb6 gr/dL, MCV 69 fl, sideremia 13 micrograms/dL, ferritin 4 ngr/mL\n', 'We have a case of chronic iron deficiency anemia, without obvious bleeding\n', 'Support'], ['No metrorrhagia\n', 'We have a case of chronic iron deficiency anemia, without obvious bleeding\n', 'Support'], ['A 55-year-old postmenopausal woman consults for asthenia and dyspnea on exertion\n', 'We have a case of chronic iron deficiency anemia, without obvious bleeding\n', 'Support'], ['Gastrointestinal endoscopy: small sliding hiatal hernia with no signs of esophagitis\n', 'The first cause of iron deficiency anemia is occult bleeding of digestive origin\n', 'Support']]
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397_140
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[['QUESTION', 'TYPE:', 'TRAUMATOLOGY', 'AND', 'ORTHOPEDICS'], ['CLINICAL', 'CASE:'], ['You', 'assess', 'a', '66-year-old', 'patient', 'with', 'accentuated', 'groin', 'pain', 'with', 'prolonged', 'standing', 'a', 'few', 'days', 'a', 'month.'], ['A', 'plain', 'radiograph', 'of', 'the', 'hips', 'shows', 'narrowing', 'of', 'the', 'femoroacetabular', 'joint', 'space,', 'sclerosis', 'and', 'osteophytes.'], ['What', 'is', 'your', 'attitude?'], ['1-', 'I', 'make', 'the', 'diagnosis', 'of', 'coxarthrosis', 'and', 'send', 'to', 'the', 'traumatologist', 'to', 'place', 'a', 'hip', 'prosthesis.'], ['2-', 'Start', 'treatment', 'with', 'weak', 'opioids', 'that', 'have', 'shown', 'evidence', 'of', 'halting', 'disease', 'progression.'], ['3-', 'I', 'instigate', 'treatment', 'with', 'paracetamol,', 'explain', 'that', 'the', 'evolution', 'is', 'very', 'variable', 'and', 'the', 'surgical', 'indication', 'depends', 'on', 'functionality', 'and', 'pain', 'control.'], ['4-', 'Because', 'of', 'the', 'radiological', 'features', 'described,', 'I', 'need', 'a', 'hip', 'MRI', 'before', 'making', 'a', 'therapeutic', 'decision.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['You', 'present', 'with', 'coxarthrosis', '(no', 'further', 'imaging', 'tests', 'are', 'needed),', 'and', 'conservative', 'options', 'are', 'exhausted', 'before', 'opting', 'for', 'surgical', 'treatment.'], ['Weak', 'opioids', 'are', 'not', 'the', 'initial', 'treatment', 'of', 'choice.']]
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[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['Weak opioids are not the initial treatment of choice\n', 'Start treatment with weak opioids that have shown evidence of halting disease progression\n', 'Attack'], ['conservative options are exhausted before opting for surgical treatment\n', 'I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n', 'Attack'], ['no further imaging tests are needed\n', 'Because of the radiological features described, I need a hip MRI before making a therapeutic decision\n', 'Attack'], ['You present with coxarthrosis\n', 'I instigate treatment with paracetamol, explain that the evolution is very variable and the surgical indication depends on functionality and pain control\n', 'Support'], ['conservative options are exhausted before opting for surgical treatment\n', 'I instigate treatment with paracetamol, explain that the evolution is very variable and the surgical indication depends on functionality and pain control\n', 'Support']]
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275_74
|
[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'man,', 'diagnosed', 'with', 'cirrhosis', 'of', 'the', 'liver', 'and', 'an', 'active', 'drinker,', 'is', 'admitted', 'for', 'progressive', 'abdominal', 'distension', 'with', 'diffuse', 'malaise,', 'of', 'two', 'weeks', 'of', 'evolution.'], ['He', 'reported', 'no', 'fever', 'or', 'other', 'symptoms.'], ['On', 'examination,', 'there', 'was', 'a', 'changeable', 'dullness', 'on', 'abdominal', 'percussion,', 'with', 'absence', 'of', 'edema.'], ['A', 'diagnostic', 'paracentesis', 'is', 'performed,', 'finding', 'a', 'slightly', 'cloudy', 'fluid,', 'with', '2,300', 'cells/mL,', 'of', 'which', '30%', 'are', 'lymphocytes,', '60%', 'polymorphonuclear', 'and', '10%', 'red', 'blood', 'cells.'], ['What', 'is', 'the', 'first', 'therapeutic', 'measure', 'you', 'would', 'prescribe', 'for', 'this', 'patient', 'immediately?'], ['1-', 'Salt', 'and', 'fluid', 'restriction.'], ['2-', 'Diuretic', 'treatment', 'with', 'oral', 'spironolactone.'], ['3-', 'Treatment', 'with', 'a', 'third', 'generation', 'cephalosporin.'], ['4-', 'Evacuative', 'paracentesis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['This', 'is', 'spontaneous', 'bacterial', 'peritonitis', '(SBP),', 'defined', 'by', 'the', 'presence', 'of', '>', '250', 'polymorphonuclears/mL', 'in', 'the', 'ascitic', 'fluid', '(in', 'this', 'case', 'there', 'are', '1,380,', 'which', 'is', '60%', 'of', '2,300).'], ['It', 'is', 'an', 'indication', 'to', 'start', '3rd', 'generation', 'cephalosporins', '(ceftriaxone', 'or', 'cefotaxime)', 'and', 'albumin.'], ['The', 'rest', 'are', 'treatments', 'that', 'can', 'wait', 'for', 'improvement', '(they', 'do', 'not', 'speak', 'of', 'tension', 'ascites).']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['in this case there are 1,380, which is 60% of 2,300\n', 'This is spontaneous bacterial peritonitis (SBP), defined by the presence of > 250 polymorphonuclears/mL in the ascitic fluid\n', 'Support'], ['This is spontaneous bacterial peritonitis (SBP), defined by the presence of > 250 polymorphonuclears/mL in the ascitic fluid\n', 'It is an indication to start 3rd generation cephalosporins (ceftriaxone or cefotaxime) and albumin\n', 'Support'], ['It is an indication to start 3rd generation cephalosporins (ceftriaxone or cefotaxime) and albumin\n', 'Treatment with a third generation cephalosporin\n', 'Support']]
|
418_77
|
[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'room', 'with', 'abdominal', 'pain', 'starting', 'in', 'the', 'epigastrium', 'and', 'radiating', 'later', 'to', 'the', 'left', 'iliac', 'fossa.'], ['An', 'abdominal', 'CT', 'scan', 'is', 'performed,', 'showing', 'inflammation', 'in', 'the', 'walls', 'of', 'the', 'sigma', 'and', 'mesenteric', 'abscess', 'of', '2', 'cm.'], ['The', 'treatment', 'of', 'choice', 'is:'], ['1-', 'Admission', 'to', 'the', 'ward', 'with', 'absolute', 'diet', 'and', 'broad-spectrum', 'antibiotic', 'treatment.'], ['2-', 'Discharge', 'colostomy.'], ['3-', 'Drainage', 'by', 'laparoscopic', 'surgery.'], ['4-', 'Urgent', 'surgery', 'with', 'sigmoidectomy', 'and', 'colorectal', 'anastomosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['We', 'are', 'asked', 'about', 'the', 'management', 'of', 'a', 'very', 'common', 'pathology,', 'diverticulitis.'], ['And', 'we', 'are', 'asked', 'about', 'the', 'different', 'therapeutic', 'options', 'depending', 'on', 'how', 'advanced', 'it', 'is.'], ['The', 'correct', 'answer', 'is', '1,', 'it', 'does', 'not', 'meet', 'the', 'criteria', 'to', 'require', 'drainage', 'by', 'guided', 'puncture', '(the', 'abscess', 'is', 'not', 'larger', 'than', '5-6', 'cm).'], ['Discharge', 'colostomy', 'in', 'this', 'case', 'makes', 'no', 'sense', 'whatsoever,', 'since', 'it', 'is', 'not', 'a', 'question', 'of', 'solving', 'an', 'obstructive', 'condition.'], ['Drainage', 'by', 'laparoscopic', 'surgery', 'is', 'not', 'indicated', 'in', 'this', 'case.'], ['It', 'could', 'be', 'indicated', 'in', 'the', 'absence', 'of', 'the', 'possibility', 'of', 'percutaneous', 'drainage', 'after', 'failure', 'of', 'conservative', 'treatment,', 'although', 'it', 'is', 'a', 'very', 'controversial', 'option', 'at', 'this', 'time.'], ['Sigmoidectomy', 'and', 'anastomosis', 'is', 'also', 'not', 'required.'], ['In', 'a', 'high', 'number', 'of', 'cases,', 'after', 'the', 'resolution', 'of', 'the', 'symptoms,', 'the', 'outbreaks', 'are', 'reduced', 'and', 'they', 'can', 'be', 'prevented', 'with', 'diet', 'and', 'hygienic', 'dietary', 'habits.']]
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[['O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The correct answer is 1\n', 'Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n', 'Support'], ['the abscess is not larger than 5-6 cm\n', 'it does not meet the criteria to require drainage by guided puncture\n', 'Support'], ['it is not a question of solving an obstructive condition\n', 'Discharge colostomy in this case makes no sense whatsoever,\n', 'Support'], ['Discharge colostomy in this case makes no sense whatsoever,\n', 'Discharge colostomy\n', 'Attack'], ['Drainage by laparoscopic surgery is not indicated in this case\n', 'Drainage by laparoscopic surgery\n', 'Attack'], ['it does not meet the criteria to require drainage by guided puncture\n', 'The correct answer is 1\n', 'Support'], ['although it is a very controversial option at this time\n', 'Drainage by laparoscopic surgery is not indicated in this case\n', 'Support'], ['It could be indicated in the absence of the possibility of percutaneous drainage after failure of conservative treatment\n', 'Drainage by laparoscopic surgery is not indicated in this case\n', 'Attack'], ['Sigmoidectomy and anastomosis is also not required\n', 'Urgent surgery with sigmoidectomy and colorectal anastomosis\n', 'Attack'], ['In a high number of cases, after the resolution of the symptoms, the outbreaks are reduced and they can be prevented with diet and hygienic dietary habits\n', 'Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n', 'Support']]
|
200_75
| null | null |
[]
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469_137
|
[['QUESTION', 'TYPE:', 'ORTHOPEDIC', 'SURGERY', 'AND', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['93-year-old', 'woman', 'with', 'a', 'history', 'of', 'COPD,', 'AHT,', 'dyslipidemia,', 'atrial', 'fibrillation', 'and', 'ischemic', 'heart', 'disease.'], ['She', 'lives', 'alone.'], ['She', 'has', 'ventricular', 'ejection', 'fraction', '53%,', 'creatinine', '1.5', 'mg/dL,', 'normal', 'coagulation.'], ['She', 'receives', 'treatment', 'with', 'inhaled', 'bronchodilators', 'and', 'ASA', '100', 'mg', 'per', 'day.'], ['She', 'suffers', 'a', 'fall', 'in', 'the', 'street,', 'after', 'which', 'it', 'is', 'impossible', 'for', 'her', 'to', 'stand', 'or', 'sit', 'up,', 'with', 'intense', 'pain', 'in', 'the', 'right', 'hip', 'on', 'mobilization,', 'great', 'shortening', 'and', 'external', 'rotation', 'of', 'the', 'leg.'], ['When', 'and', 'how', 'should', 'she', 'be', 'treated?'], ['1-', 'Admission', 'for', 'transthoracic', 'ultrasound,', 'assessment', 'by', 'Cardiology', 'and', 'then', 'closed', 'reduction', 'and', 'fixation', 'with', 'plate', 'screw.'], ['2-', 'Admission', 'for', 'evaluation', 'by', 'Nephrology', 'and', 'Cardiology,', 'and', 'then', 'Traumatology', 'will', 'decide', 'whether', 'to', 'use', 'an', 'arthroplasty', 'or', 'a', 'trochanteric', 'nail.'], ['3-', 'Admission', 'to', 'Internal', 'Medicine', '/', 'Geriatrics,', 'progressive', 'stabilization', 'of', 'comorbidities,', 'conservative', 'orthopedic', 'treatment.'], ['4-', 'Closed', 'reduction', 'and', 'fixation', 'of', 'the', 'fracture', 'within', '48', 'hours,', 'very', 'early', 'sedation,', 'orthogeriatric', 'management.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['A', 'new', 'approach', 'is', 'currently', 'being', 'developed', 'for', 'the', 'treatment', 'of', 'these', 'patients,', 'which', 'tries', 'to', 'coordinate', 'from', 'the', 'beginning', 'the', 'activity', 'of', 'the', 'different', 'sectors', 'involved,', 'avoiding', 'that', 'the', 'transfer', 'of', 'the', 'patient', 'from', 'one', 'to', 'another', 'takes', 'place', 'at', 'the', 'end', 'of', 'the', 'treatment', 'of', 'each', 'part.'], ['This', 'idea', 'gave', 'rise', 'to', 'the', 'so-called', 'orthogeriatric', 'units",', 'which', 'combine', 'the', "surgeon's", 'surgical', 'activity', 'with', 'that', 'of', 'the', "patient's", 'immediate', 'rehabilitation', 'and', 'the', 'controls', 'and', 'follow-up', 'of', 'internal', 'medicine.'], ['From', 'the', 'very', 'beginning', 'of', 'the', 'process,', 'the', 'social', 'workers', 'and', 'the', 'various', 'vital', 'and', 'support', 'aids', 'are', 'put', 'in', 'place', 'to', 'ensure', 'that', 'recovery', 'is', 'as', 'rapid', 'and', 'complete', 'as', 'possible.', '...'], ['In', 'most', 'cases,', 'surgery', 'should', 'be', 'performed', 'as', 'soon', 'as', 'possible,', 'as', 'soon', 'as', 'the', 'patient', 'is', 'medically', 'stabilized.'], ['There', 'is', 'a', 'contraindication', 'to', 'surgery', 'in', 'patients', 'with', 'unstable', 'medical', 'comorbidity,', 'but', 'several', 'studies', 'have', 'shown', 'that', 'delaying', 'surgery', 'beyond', '48', 'h', 'after', 'admission', 'increases', 'mortality.'], ['This', 'is', 'why', 'the', 'ideal', 'time', 'to', 'intervene', 'in', 'these', 'patients', 'is', 'after', 'achieving', 'stabilization', 'of', 'their', 'medical', 'pathologies,', 'taking', 'care', 'that', 'this', 'takes', 'place', 'before', '48', 'h', 'have', 'elapsed."', 'There', 'is', 'no', 'data', 'to', 'suggest', 'that', 'he', 'has', 'any', 'unstable', 'comorbidity', 'at', 'the', 'present', 'time,', 'so', 'surgery', 'in', 'less', 'than', '48', 'hours', 'and', 'orthogeriatric', 'management', 'is', 'of', 'interest.']]
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[['O', 'O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['There is no data to suggest that he has any unstable comorbidity at the present time\n', 'surgery in less than 48 hours and orthogeriatric management is of interest\n', 'Support'], ['surgery in less than 48 hours and orthogeriatric management is of interest\n', 'Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n', 'Support'], ['In most cases, surgery should be performed as soon as possible, as soon as the patient is medically stabilized\n', 'Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n', 'Support'], ['There is a contraindication to surgery in patients with unstable medical comorbidity, but several studies have shown that delaying surgery beyond 48 h after admission increases mortality\n', 'Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n', 'Support'], ['This is why the ideal time to intervene in these patients is after achieving stabilization of their medical pathologies, taking care that this takes place before 48 h have elapsed\n', 'Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n', 'Support'], ['There is no data to suggest that he has any unstable comorbidity at the present time\n', 'Admission to Internal Medicine / Geriatrics, progressive stabilization of comorbidities, conservative orthopedic treatment\n', 'Attack']]
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378_132
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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'patient', 'presents', 'with', 'progressive', 'memory', 'loss', 'and', 'word', 'finding', 'difficulty', 'of', 'one', "year's", 'duration.'], ['What', 'is', 'the', 'most', 'useful', 'examination', 'to', 'characterize', 'the', 'type', 'of', 'cognitive', 'deficit', 'he', 'presents', 'with?'], ['1-', 'Neuropsychological', 'evaluation.'], ['2-', 'Brain', 'magnetic', 'resonance', 'imaging.'], ['3-', 'Positron', 'Emission', 'Tomography.'], ['4-', 'Electroencephalogram.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'characterization', 'of', 'cognitive', 'deterioration', 'processes', 'is', 'still', 'clinical,', 'with', 'imaging', 'tests', '(MRI', 'or', 'PET)', 'being', 'a', 'support', 'tool', 'in', 'some', 'occasions.'], ['The', 'first', 'option', 'would', 'be', 'the', 'correct', 'one', 'because', 'it', 'allows', 'us', 'to', 'measure', 'in', 'a', 'standardized', 'way', 'each', 'of', 'the', 'cognitive', 'domains,', 'which', 'will', 'allow', 'us', 'to', 'frame', 'the', "patient's", 'deficits', 'in', 'a', 'specific', 'syndrome', 'and', 'to', 'monitor', 'the', 'deterioration', 'with', 'repeated', 'scans', 'over', 'time.']]
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[['O', 'O', 'O'], ['O', 'O'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim'], ['O', 'O'], ['O', 'O', 'O'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
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[['The first option would be the correct one\n', 'Neuropsychological evaluation\n', 'Support'], ["it allows us to measure in a standardized way each of the cognitive domains, which will allow us to frame the patient's deficits in a specific syndrome and to monitor the deterioration with repeated scans over time\n", 'The first option would be the correct one\n', 'Support'], ['The characterization of cognitive deterioration processes is still clinical, with imaging tests (MRI or PET) being a support tool in some occasions\n', 'Brain magnetic resonance imaging\n', 'Support'], ['The characterization of cognitive deterioration processes is still clinical, with imaging tests (MRI or PET) being a support tool in some occasions\n', 'Positron Emission Tomography\n', 'Support']]
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