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[['QUESTION', 'TYPE:', 'PRIMARY', 'CARE', 'AND', 'SOCIAL', 'NETWORKS'], ['CLINICAL', 'CASE:'], ['Juan,', 'a', 'second', 'year', 'resident,', 'attends', 'Sofia,', 'a', '15', 'year', 'old', 'girl', 'in', 'the', 'emergency', 'room,', 'who', 'apparently', 'fainted', 'at', 'school', 'without', 'losing', 'consciousness.'], ['The', 'patient', 'says', 'that', 'she', 'was', 'due', 'to', 'take', 'an', 'exam,', 'which', 'caused', 'her', 'a', 'lot', 'of', 'anxiety.'], ['From', 'the', 'interrogation,', 'it', 'appears', 'that', 'she', 'was', 'being', 'bullied', 'by', 'her', 'classmates', 'and', 'that', 'she', 'may', 'have', 'an', 'eating', 'disorder.'], ['Vital', 'signs', 'and', 'neurological', 'examination', 'are', 'normal.'], ['Juan', 'keeps', 'Sofia', 'under', 'observation', 'while', 'waiting', 'for', 'her', 'parents', 'to', 'come', 'to', 'the', 'service,', 'periodically', 'taking', 'a', 'look', 'at', 'how', 'the', 'patient', 'is', 'doing.'], ['After', 'the', 'initial', 'scare,', 'the', 'patient', 'seems', 'to', 'be', 'increasingly', 'animated', 'and', 'is', 'very', 'friendly.'], ['On', 'one', 'occasion,', 'Juan', 'finds', 'her', 'actively', 'chatting', 'on', 'her', 'cell', 'phone.'], ['Juan', 'tells', 'her', 'that', 'it', 'would', 'be', 'better', 'for', 'her', 'to', 'put', 'the', 'cell', 'phone', 'down', 'and', 'rest', 'and', 'to', 'reassure', 'her,', 'he', 'tells', 'her', 'that', 'he', 'also', 'uses', 'social', 'networks', 'a', 'lot', 'since', 'college.'], ['Sofia', 'apologizes', 'for', 'not', 'knowing', 'that', 'she', 'should', 'have', 'her', 'cell', 'phone', 'turned', 'off,', 'and', 'after', 'turning', 'it', 'off,', 'asks', 'if', 'she', 'can', 'make', 'a', 'friend', 'request', 'on', 'Facebook.'], ['What', 'do', 'you', 'think', 'is', "Juan's", 'best', 'response?'], ['1-', 'Tell', 'him', 'to', 'make', 'the', 'friend', 'request', 'and', 'that', 'he', 'will', 'accept', 'it,', 'as', 'he', 'is', 'sure', 'that', 'there', 'are', 'no', 'inappropriate', 'items', 'on', 'his', 'page', 'for', 'a', 'girl', 'of', "Sofia's", 'age.'], ['2-', 'Because', 'you', 'consider', 'Sofia', 'a', 'vulnerable', 'patient', 'and', 'are', 'concerned', 'that', 'she', 'may', 'misinterpret', 'a', 'rejection,', 'agree', 'to', 'let', 'her', 'make', 'the', 'request', 'but', 'only', 'allow', 'her', 'access', 'to', 'certain', 'content', 'on', 'your', 'page.'], ['3-', 'Answer', 'that', 'it', 'is', 'important', 'to', 'maintain', 'certain', 'professional', 'boundaries', 'between', 'patients', 'and', 'physicians', 'and', 'that,', 'unfortunately,', 'if', 'you', 'make', 'the', 'request', 'you', 'will', 'not', 'be', 'able', 'to', 'accept', 'it,', 'so', 'it', 'is', 'better', 'not', 'to', 'do', 'so.'], ['4-', 'Tell', 'him', 'to', 'make', 'the', 'request', 'but', 'without', 'any', 'intention', 'of', 'accepting', 'it.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['There', 'is', 'no', 'doubt', 'that', 'the', 'doctor-patient', 'relationship', 'today', 'transcends', 'the', 'physical', 'environment', 'of', 'the', 'consultation', 'room.'], ['But', 'we', 'must', 'not', 'forget', 'that', 'we', 'must', 'maintain', 'the', 'same', 'ethical', 'and', 'professional', 'codes', 'as', 'in', 'the', 'real', 'environment.'], ['The', 'code', 'of', 'ethics', 'Article', '26-3.'], ['The', 'clinical', 'practice', 'of', 'medicine', 'by', 'means', 'of', 'consultations', 'exclusively', 'by', 'letter,', 'telephone,', 'radio,', 'press', 'or', 'internet,', 'is', 'contrary', 'to', 'the', 'deontological', 'norms.'], ['The', 'correct', 'action', 'implies', 'inescapably', 'the', 'personal', 'and', 'direct', 'contact', 'between', 'the', 'doctor', 'and', 'the', 'patient.']]
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[['There is no doubt that the doctor-patient relationship today transcends the physical environment of the consultation room\n', 'Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n', 'Support'], ['But we must not forget that we must maintain the same ethical and professional codes as in the real environment\n', 'Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n', 'Support'], ['The clinical practice of medicine by means of consultations exclusively by letter, telephone, radio, press or internet, is contrary to the deontological norms\n', 'Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n', 'Support'], ['The correct action implies inescapably the personal and direct contact between the doctor and the patient\n', 'Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n', 'Support']]
237_144
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['After', 'a', 'traffic', 'accident', 'a', '38-year-old', 'patient', 'is', 'admitted', 'to', 'the', 'ICU', 'in', 'coma.'], ['After', 'several', 'days', 'the', 'patient', 'does', 'not', 'improve', 'neurologically', 'and', 'a', 'CT', 'scan', 'shows', 'hemorrhagic', 'punctate', 'lesions', 'in', 'the', 'corpus', 'callosum', 'and', 'cortico-subcortical', 'junction.'], ['What', 'is', 'the', 'diagnosis?'], ['1-', 'Acute', 'subdural', 'hematoma.'], ['2-', 'Trobocytopenic', 'purpura.'], ['3-', 'Cerebral', 'hemorrhagic', 'contusion.'], ['4-', 'Severe', 'diffuse', 'axonal', 'injury.'], ['5-', 'Hypoxic-ischemic', 'encephalopathy.'], ['CORRECT', 'ANSWER:', '4'], ['Diffuse', 'axonal', 'injury', 'produces', 'an', 'early', 'and', 'sustained', 'deterioration', 'of', 'the', 'level', 'of', 'consciousness', '(as', 'mentioned', 'in', 'the', 'case', 'statement)', 'without', 'a', 'lesion', 'on', 'CT', 'scan', 'to', 'justify', 'the', 'picture.'], ['Sometimes,', 'punctate', 'hemorrhages', 'at', 'the', 'level', 'of', 'the', 'corpus', 'callosum,', 'corticosubcortical', 'junction', 'and', 'dorsolateral', 'portion', 'of', 'the', 'brainstem', 'are', 'evidenced', 'in', 'this', 'imaging', 'test.']]
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[['Diffuse axonal injury produces an early and sustained deterioration of the level of consciousness (as mentioned in the case statement) without a lesion on CT scan to justify the picture\n', 'Severe diffuse axonal injury\n', 'Support'], ['After a traffic accident a 38-year-old patient is admitted to the ICU in coma\n', 'Diffuse axonal injury produces an early and sustained deterioration of the level of consciousness (as mentioned in the case statement) without a lesion on CT scan to justify the picture\n', 'Support'], ['After several days the patient does not improve neurologically and a CT scan shows hemorrhagic punctate lesions in the corpus callosum and cortico-subcortical junction\n', 'Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brainstem are evidenced in this imaging test\n', 'Support'], ['Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brainstem are evidenced in this imaging test\n', 'Severe diffuse axonal injury\n', 'Support']]
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253_86
[['QUESTION', 'TYPE:', 'DIGESTIVE', 'TRACT'], ['CLINICAL', 'CASE:'], ['A', '37-year-old', 'woman', 'with', 'extensive', 'ulcerative', 'colitis', 'presents', 'a', 'severe', 'flare-up', 'for', 'which', 'treatment', 'with', 'prednisone', 'at', 'a', 'dose', 'of', '1', 'mg/kg', 'is', 'started.'], ['After', 'one', 'week', 'of', 'treatment,', 'the', 'patient', 'shows', 'no', 'improvement.'], ['What', 'is', 'the', 'next', 'therapeutic', 'measure', 'to', 'be', 'taken?'], ['1-', 'Emergency', 'subtotal', 'colectomy', 'and', 'in', 'a', 'second', 'time', 'prostectomy', 'and', 'ileoanal', 'reservoir.'], ['2-', 'Associate', 'an', 'immunosuppressant', 'such', 'as', 'azathioprine.'], ['3-', 'Associate', 'mesalazine', 'in', 'doses', 'of', '4g', 'per', 'day', 'orally', 'and', 'rectal', 'triamcinolone', '1', 'application', 'every', '12', 'hours.'], ['4-', 'Intravenous', 'cyclosporine', '2mg/kg.'], ['5-', 'Treatment', 'with', 'etanercept', '(an', 'anti-TNFa', 'antibody)', 'should', 'be', 'considered.'], ['CORRECT', 'ANSWER:', '4'], ['When', 'a', 'severe', 'flare', 'does', 'not', 'respond', 'to', 'iv', 'corticosteroid', 'therapy', 'at', 'full', 'doses', '(1mg/kg', 'body', 'weight),', 'it', 'is', 'necessary', 'to', 'switch', 'to', 'cyclosporine', 'or', 'infliximab.'], ['Etanercept', 'is', 'not', 'approved', 'in', 'Europe', 'for', 'inflammatory', 'bowel', 'disease', '(for', 'the', 'time', 'being).']]
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[['When a severe flare does not respond to iv corticosteroid therapy at full doses (1mg/kg body weight), it is necessary to switch to cyclosporine or infliximab\n', 'Intravenous cyclosporine 2mg/kg\n', 'Support'], ['Etanercept is not approved in Europe for inflammatory bowel disease (for the time being)\n', 'Treatment with etanercept (an anti-TNFa antibody) should be considered\n', 'Attack']]
224_63
[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'patient', 'who', 'has', 'been', 'complaining', 'of', 'dyspnea', 'on', 'medium', 'exertion', 'for', '6', 'months.'], ['He', 'has', 'not', 'presented', 'angina', 'or', 'syncope.'], ['Physical', 'examination', 'and', 'diagnostic', 'tests', 'show', 'a', 'mean', 'aortic', 'transvalvular', 'gradient', 'of', '55', 'mmHg', 'and', 'a', 'calculated', 'area', 'of', '0.7', 'cm².'], ['Ejection', 'fraction', 'of', '65%.'], ['The', 'treatment', 'to', 'be', 'indicated', 'for', 'this', 'patient', 'is:'], ['1-', 'Diuretics', 'and', 'more', 'frequent', 'check-ups', 'by', 'a', 'specialist.'], ['2-', 'In', 'case', 'of', 'increasing', 'dyspnea', 'on', 'exertion,', 'percutaneous', 'dilatation', 'of', 'the', 'aortic', 'valve', 'with', 'a', 'balloon', 'catheter', 'should', 'be', 'performed.'], ['3-', 'Replacement', 'of', 'the', 'aortic', 'valve', 'with', 'a', 'prosthesis/bioprosthesis.'], ['4-', 'Replacement', 'of', 'the', 'aortic', 'valve', 'with', 'a', 'homograft.'], ['5-', 'Implantation', 'of', 'a', 'percutaneous', 'valve.'], ['CORRECT', 'ANSWER:', '3'], ['Something', 'aortic.'], ['They', 'give', 'me', 'a', 'gradient,', 'which', 'without', 'knowing', 'the', 'values', 'seems', 'somewhat', 'high', '(55', 'mmHg!)', 'and', 'the', 'area,', 'which', 'looks', 'tiny', 'to', 'the', 'naked', 'eye:', 'this', 'is', 'going', 'to', 'be', 'aortic', 'stenosis...'], ['And', 'he', 'has', 'dyspnea.'], ['Symptomatic', 'aortic', 'stenosis,', 'will', 'the', 'examiner', 'want', 'me', 'to', 'send', 'him', 'for', 'surgery?'], ['With', 'the', 'guidelines', 'in', 'hand,', "that's", 'right:', 'this', 'is', 'a', 'severe', 'stenosis', 'both', 'in', 'terms', 'of', 'area', '(<1', 'cm²)', 'and', 'mean', 'gradient', '(>40', 'mmHg),', 'with', 'a', 'preserved', 'ejection', 'fraction,', 'and', 'symptomatic.'], ['Surgical', 'indication.'], ['If', 'we', 'do', '1', 'we', 'take', 'away', 'life', 'expectancy,', 'because', 'we', 'allow', 'the', 'ventricle', 'to', 'claudicate.'], ['2', 'is', 'outdated:', 'balloon', 'valvuloplasty?'], ['Only', 'if', 'the', 'surgical', 'risk', 'is', 'unaffordable,', 'and', 'in', 'that', 'case', 'we', 'would', 'do', '5,', 'TAVI', 'implantation', '(see', '[1]).'], ['But', 'this', 'is', 'a', '52-year-old', 'man,', 'who', 'we', 'assume', 'has', 'good', 'bodywork', 'because', 'he', 'walks', 'to', 'have', 'dyspnea,', 'so', 'to', 'the', 'operating', 'room.'], ['So', 'to', 'the', 'operating', 'room.'], ['A', 'homograft?', "That's", 'the', 'Ross', 'technique,', 'I', 'take', 'the', 'pulmonary', 'and', 'put', 'it', 'where', 'the', 'aortic.'], ['But', "it's", 'rare,', 'complex', 'and', 'only', 'done', 'in', 'pediatrics.'], ['The', 'correct', 'thing', 'to', 'do', 'is', '3,', 'without', 'a', 'doubt:', 'replace', 'with', 'a', 'prosthesis,', 'preferably', 'mechanical', 'unless', 'the', 'patient', 'has', 'a', 'contraindication', 'for', 'anticoagulation.']]
[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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'], ['O', 'O', 'O'], ['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', '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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['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', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-Claim', 'I-Claim'], ['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'], ['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', '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-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'], ['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']]
[['Something aortic\n', 'this is going to be aortic stenosis...\n', 'Support'], ['They give me a gradient, which without knowing the values seems somewhat high (55 mmHg!) and the area, which looks tiny to the naked eye\n', 'this is going to be aortic stenosis...\n', 'Support'], ["With the guidelines in hand, that's right: this is a severe stenosis both in terms of area (<1 cm²) and mean gradient (>40 mmHg), with a preserved ejection fraction, and symptomatic\n", 'Surgical indication\n', 'Support'], ['we allow the ventricle to claudicate\n', 'If we do 1 we take away life expectancy\n', 'Support'], ['If we do 1 we take away life expectancy\n', 'Diuretics and more frequent check-ups by a specialist\n', 'Attack'], ['2 is outdated: balloon valvuloplasty?\n', 'In case of increasing dyspnea on exertion, percutaneous dilatation of the aortic valve with a balloon catheter should be performed\n', 'Attack'], ['Only if the surgical risk is unaffordable, and in that case we would do 5, TAVI implantation\n', 'Implantation of a percutaneous valve\n', 'Support'], ['But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n', 'Only if the surgical risk is unaffordable, and in that case we would do 5, TAVI implantation\n', 'Attack'], ['But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n', 'so to the operating room\n', 'Support'], ['so to the operating room\n', 'Implantation of a percutaneous valve\n', 'Attack'], ['The correct thing to do is 3, without a doubt: replace with a prosthesis, preferably mechanical unless the patient has a contraindication for anticoagulation\n', 'Replacement of the aortic valve with a prosthesis/bioprosthesis\n', 'Support'], ["But it's rare, complex and only done in pediatrics\n", "A homograft? That's the Ross technique, I take the pulmonary and put it where the aortic\n", 'Attack'], ["But it's rare, complex and only done in pediatrics\n", 'Replacement of the aortic valve with a homograft\n', 'Attack'], ['But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n', 'Implantation of a percutaneous valve\n', 'Attack']]
430_115
[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'woman', 'who', 'underwent', 'hematopoietic', 'precursor', 'transplantation', '30', 'days', 'ago', 'and', 'has', 'severe', 'neutropenia.'], ['She', 'starts', 'with', 'cough', 'and', 'hemoptotic', 'expectoration', 'in', 'addition', 'to', 'fever', 'and', 'moderate', 'exertional', 'dyspnea', 'that', 'does', 'not', 'improve', 'despite', 'five', 'days', 'of', 'treatment', 'with', 'amoxicillin-clavulanic', 'acid', '(875/125', 'mg/8', 'h)', 'and', 'levofloxacin', '(500', 'mg/12', 'h).'], ['Chest', 'X-ray', 'shows', 'multiple', 'ill-defined', 'pulmonary', 'nodules,', 'some', 'of', 'them', 'cavitated.'], ['Among', 'the', 'following,', 'which', 'is', 'the', 'most', 'probable', 'diagnosis', 'of', 'suspicion?'], ['1-', 'Septic', 'embolisms.'], ['2-', 'Invasive', 'pulmonary', 'aspergillosis.'], ['3-', 'Pneumonia', 'due', 'to', 'Staphylococcus', 'aureus.'], ['4-', 'Systemic', 'candidiasis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Patient', 'on', 'her', '30th', 'post-transplant', 'day', 'of', 'hematopoietic', 'precursor', 'transplantation,', 'in', 'severe', 'neutropenia', 'who', 'presents', 'with', 'cough', 'with', 'hemoptotic', 'expectoration.'], ['This', 'picture', 'is', 'usually', 'seen', 'in', 'infection', 'by', 'Aspergillus', 'spp.'], ['We', 'can', 'rule', 'out', 'infection', 'by', 'Staphylococcus', 'aureus', 'because', 'of', 'previous', 'treatment,', 'although', 'we', 'do', 'not', 'know', 'if', 'it', 'raises', 'the', 'response', 'also', 'a', 'possible', 'MRSA.']]
[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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', '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', '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']]
[['Patient on her 30th post-transplant day of hematopoietic precursor transplantation, in severe neutropenia who presents with cough with hemoptotic expectoration\n', 'This picture is usually seen in infection by Aspergillus spp\n', 'Support'], ['This picture is usually seen in infection by Aspergillus spp\n', 'Invasive pulmonary aspergillosis\n', 'Support'], ['We can rule out infection by Staphylococcus aureus because of previous treatment\n', 'Pneumonia due to Staphylococcus aureus\n', 'Attack'], ['She starts with cough and hemoptotic expectoration in addition to fever and moderate exertional dyspnea that does not improve despite five days of treatment with amoxicillin-clavulanic acid (875/125 mg/8 h) and levofloxacin (500 mg/12 h)\n', 'We can rule out infection by Staphylococcus aureus because of previous treatment\n', 'Support']]
588_63
null
null
[]
11_74
[['QUESTION', 'TYPE:', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Ten', 'days', 'after', 'performing', 'a', 'hemithyroidectomy', 'on', 'a', 'patient', 'with', 'a', '1.5', 'cm', 'thyroid', 'nodule', 'you', 'receive', 'the', 'following', 'anatomopathologic', 'report:', '"very', 'cellular', 'follicular', 'pattern', 'without', 'capsular', 'invasion', 'and', 'infiltrating', 'adjacent', 'blood', 'vessels', 'and', 'nerves".'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'As', 'there', 'is', 'no', 'capsular', 'invasion,', 'no', 'further', 'surgery', 'is', 'necessary.'], ['2-', 'Follicular', 'pattern', 'is', 'an', 'indication', 'for', 'prophylactic', 'cervical', 'lymph', 'node', 'emptying.'], ['3-', 'This', 'is', 'a', 'follicular', 'carcinoma', 'and', 'requires', 'completion', 'of', 'thyroidectomy.'], ['4-', 'The', 'report', 'allows', 'us', 'to', 'rule', 'out', 'with', 'total', 'certainty', 'a', 'papillary', 'carcinoma', 'in', 'the', 'remaining', 'thyroid.'], ['5-', 'Measurement', 'of', 'plasma', 'calcitonin', 'will', 'allow', 'us', 'to', 'distinguish', 'between', 'papillary', 'and', 'follicular', 'carcinoma.'], ['CORRECT', 'ANSWER:', '3'], ['I', 'think', 'the', 'correct', 'answer', 'is', '3', 'answers', '2,4', 'and', '5', 'are', 'clearly', 'false.'], ['The', 'doubt', 'is', 'between', '1', 'and', '2.'], ['The', 'statement', 'of', '1', 'is', 'correct', 'in', 'cases', 'of', 'follicular', 'carcinoma', 'without', 'capsular', 'invasion', 'a', 'total', 'thyroidectomy', 'can', 'be', 'performed.'], ['But', 'if', 'there', 'are', 'data', 'of', 'poor', 'prognosis', 'and', 'the', 'possibility', 'of', 'metastases', '-', 'as', 'in', 'this', 'case', '-', 'it', 'is', 'best', 'to', 'complete', 'the', 'thyroidectomy', 'and', 'perform', 'a', 'radioactive', 'iodine', 'scan', 'to', 'rule', 'out', 'metastases', 'or', 'treat', 'them', 'if', 'they', 'are', 'present.']]
[['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', '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', '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'], ['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'], ['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', '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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['But if there are data of poor prognosis and the possibility of metastases - as in this case\n', 'it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n', 'Support'], ['it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n', 'I think the correct answer is 3\n', 'Support'], ['I think the correct answer is 3\n', 'This is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support'], ['But if there are data of poor prognosis and the possibility of metastases - as in this case\n', 'This is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support'], ['it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n', 'This is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support'], ['answers 2,4 and 5 are clearly false\n', 'Follicular pattern is an indication for prophylactic cervical lymph node emptying\n', 'Attack'], ['answers 2,4 and 5 are clearly false\n', 'The report allows us to rule out with total certainty a papillary carcinoma in the remaining thyroid\n', 'Attack'], ['answers 2,4 and 5 are clearly false\n', 'Measurement of plasma calcitonin will allow us to distinguish between papillary and follicular carcinoma\n', 'Attack'], ['The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed\n', 'As there is no capsular invasion, no further surgery is necessary\n', 'Support'], ['But if there are data of poor prognosis and the possibility of metastases - as in this case\n', 'The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed\n', 'Attack']]
535_121
[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'black', 'woman', 'consults', 'for', 'the', 'appearance', 'of', 'edema', 'in', 'the', 'lower', 'limbs,', 'decreased', 'diuresis,', 'fever', 'and', 'a', 'malar', 'rash', 'in', 'butterfly', 'wings', 'of', '20', 'days', 'of', 'evolution.'], ['Laboratory', 'tests', 'showed', 'creatinine', '3', 'mg/dl,', 'leukopenia,', 'hemoglobin', '10.5', 'g/dl', '(normochromic', 'normocytic),', 'CRP', '9', 'mg/dl', 'and', 'ESR', '60', 'mm.'], ['Regarding', 'the', 'pathology', 'presented', 'by', 'this', 'patient,', 'point', 'out', 'the', 'correct', 'answer:'], ['1-', 'The', 'anti-Sm', 'antibodies', 'are', 'not', 'specific', 'for', 'this', 'pathology.'], ['2-', 'Anti-centromere', 'antibodies', 'are', 'detected', 'in', '90%', 'of', 'cases.'], ['3-', 'ANA', '(antinuclear', 'antibodies)', 'are', 'detected', 'in', '50%', 'of', 'cases.'], ['4-', 'Anti-two-stranded', 'or', 'native', 'anti-DNA', 'correlates', 'with', 'the', 'risk', 'of', 'nephritis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Another', 'question', 'about', 'SLE', 'antibodies.'], ['Clinical', 'case', 'of', 'SLE', 'with', 'renal', 'involvement,', 'in', 'which', 'positive', 'double-stranded', 'anti-DNA', 'increases', 'the', 'risk', 'of', 'nephritis.'], ['As', 'for', 'the', 'rest,', 'anti-Sm', 'are', 'specific', 'to', 'SLE,', 'ANA', 'are', 'detected', 'in', 'more', 'than', '90%', 'of', 'cases,', 'and', 'anti-centromere', 'are', 'typical', 'of', 'scleroderma.']]
[['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'], ['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', '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'], ['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'], ['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'], ['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', 'O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['Clinical case of SLE with renal involvement, in which positive double-stranded anti-DNA increases the risk of nephritis\n', 'Anti-two-stranded or native anti-DNA correlates with the risk of nephritis\n', 'Support'], ['As for the rest, anti-Sm are specific to SLE\n', 'The anti-Sm antibodies are not specific for this pathology\n', 'Attack'], ['ANA are detected in more than 90% of cases\n', 'ANA (antinuclear antibodies) are detected in 50% of cases\n', 'Attack'], ['anti-centromere are typical of scleroderma\n', 'Anti-centromere antibodies are detected in 90% of cases\n', 'Attack']]
452_149
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'woman', 'with', 'an', 'epileptic', 'seizure', 'presenting', 'with', 'the', 'following', 'clinical', 'features:', 'epigastric', 'aura,', 'unpleasant', 'odor,', 'disconnection', 'from', 'the', 'environment,', 'motor', 'automatisms', '(sucking,', 'swallowing,', 'opening', 'and', 'closing', 'of', 'one', 'hand)', 'and', 'postcritical', 'amnesia,', 'what', 'is', 'your', 'diagnostic', 'suspicion?'], ['1-', 'Generalized', 'non-convulsive', 'seizure', 'or', 'typical', 'absence.'], ['2-', 'Continuous', 'partial', 'epilepsy.'], ['3-', 'Amyotonic', 'crisis.'], ['4-', 'Complex', 'partial', 'temporal', 'lobe', 'seizure.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Clearly', 'the', 'answer', 'is', '4,', 'with', 'a', 'very', 'characteristic', 'clinic', 'of', 'temporary', 'seizures.']]
[['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', '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'], ['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']]
[['Clearly the answer is 4, with a very characteristic clinic of temporary seizures\n', 'Complex partial temporal lobe seizure\n', 'Support']]
55_74
[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['Ten', 'days', 'after', 'performing', 'a', 'hemithyroidectomy', 'on', 'a', 'patient', 'with', 'a', '1.5', 'cm', 'thyroid', 'nodule', 'you', 'receive', 'the', 'following', 'definitive', 'report', 'from', 'the', 'pathologist:', '"very', 'cellular', 'follicular', 'pattern', 'without', 'capsular', 'invasion', 'invading', 'adjacent', 'blood', 'vessels', 'and', 'nerves".'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'As', 'there', 'is', 'no', 'capsular', 'invasion', 'it', 'is', 'not', 'convenient', 'to', 'perform', 'further', 'surgery.'], ['2-', 'The', 'follicular', 'pattern', 'is', 'an', 'indication', 'for', 'prophylactic', 'cervical', 'lymph', 'node', 'emptying.'], ['3-', 'It', 'is', 'a', 'follicular', 'carcinoma', 'and', 'requires', 'completion', 'of', 'thyroidectomy.'], ['4-', 'The', 'report', 'allows', 'to', 'rule', 'out', 'papillary', 'carcinoma', 'with', 'total', 'certainty', 'in', 'the', 'remaining', 'thyroid.'], ['5-', 'Measurement', 'of', 'plasma', 'calcitonin', 'will', 'allow', 'us', 'to', 'differentiate', 'between', 'papillary', 'and', 'follicular', 'carcinoma.'], ['CORRECT', 'ANSWER:', '3'], ['I', 'find', 'this', 'question', 'a', 'bit', 'more', 'difficult', 'since', 'you', 'have', 'to', 'have', 'clear', 'concepts', 'of', 'pathologic', 'anatomy.'], ['In', 'any', 'case,', 'it', 'is', 'possible', 'to', 'exclude', 'by', 'exclusion', 'and', 'by', 'the', 'way', 'the', 'answers', 'are', 'expressed:', 'Answer', '2:', 'prophylactic', 'emptying', 'is', 'indicated', 'in', 'the', 'medullary.'], ['Answer', '4:', 'simply', 'by', 'the', 'way', 'of', 'expressing', 'it,', 'it', 'should', 'already', 'have', 'been', 'ruled', 'out.'], ['Answer', '5:', 'you', 'already', 'know', 'that', 'calcitonin', 'is', 'used', 'in', 'medullary', 'carcinoma', 'and', 'not', 'in', 'differentiated', 'carcinoma.'], ['Answers', '1', 'and', '3', 'are', 'contrary,', 'one', 'recommends', 'completing', 'thyroidectomy', 'and', 'the', 'other', 'does', 'not.'], ['The', 'only', 'ones', 'in', 'which', 'complete', 'thyroidectomy', 'is', 'not', 'recommended', 'are', 'microcarcinomas', 'measuring', 'less', 'than', '1', 'cm.']]
[['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', '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'], ['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'], ['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'], ['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', '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']]
[['Answer 4: simply by the way of expressing it, it should already have been ruled out\n', 'The report allows to rule out papillary carcinoma with total certainty in the remaining thyroid\n', 'Attack'], ['Answer 5: you already know that calcitonin is used in medullary carcinoma and not in differentiated carcinoma\n', 'Measurement of plasma calcitonin will allow us to differentiate between papillary and follicular carcinoma\n', 'Attack'], ['Answer 2: prophylactic emptying is indicated in the medullary\n', 'The follicular pattern is an indication for prophylactic cervical lymph node emptying\n', 'Attack'], ['The only ones in which complete thyroidectomy is not recommended are microcarcinomas measuring less than 1 cm\n', 'As there is no capsular invasion it is not convenient to perform further surgery\n', 'Attack'], ['The only ones in which complete thyroidectomy is not recommended are microcarcinomas measuring less than 1 cm\n', 'It is a follicular carcinoma and requires completion of thyroidectomy\n', 'Support']]
281_33
[['QUESTION', 'TYPE:', 'PATHOLOGICAL', 'ANATOMY'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'woman', 'diagnosed', 'with', 'an', 'infiltrating', 'ductal', 'carcinoma', 'of', 'the', 'breast', 'and', 'no', 'family', 'history', 'of', 'neoplasia.'], ['What', 'additional', 'studies', 'should', 'be', 'performed', 'on', 'the', 'tumor', 'for', 'its', 'clinical-therapeutic', 'implications?'], ['1-', 'Complete', 'phenotypic', 'study', 'by', 'flow', 'cytometry.'], ['2-', 'Study', 'of', 'hormone', 'receptors', 'and', 'HER2.'], ['3-', 'Study', 'of', 'hormone', 'receptors,', 'e-cadherin', 'and', 'study', 'of', 'first', 'degree', 'relatives.'], ['4-', 'Study', 'of', 'BRCA', '1-2', 'and', 'study', 'of', 'first-degree', 'relatives.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'would', 'be', '2,', 'HORMONE', 'AND', 'HER2', 'RECEPTOR', 'STUDY,', 'since', 'positive', 'HER2', 'receptors', 'imply', 'greater', 'aggressiveness', 'of', 'the', 'tumor', 'but', 'treatment', 'with', 'trastuzumab', 'and', 'positive', 'hormone', 'receptors', 'would', 'imply', 'the', 'use', 'of', 'hormone', 'therapy.'], ['Answer', '1', 'can', 'be', 'ruled', 'out', 'visu', 'visu,', 'while', 'answers', '3', 'and', '4', 'should', 'be', 'ruled', 'out', 'since,', 'being', 'the', 'first', 'woman', 'in', 'the', 'family', 'with', 'breast', 'carcinoma,', 'the', 'study', 'of', 'the', "patient's", 'relatives', 'would', 'not', 'be', 'obligatory.'], ['Likewise,', 'e-cadherin', 'is', 'important', 'for', 'the', 'differential', 'diagnosis', 'of', 'a', 'lobular', 'breast', 'carcinoma,', 'not', 'a', 'ductal', 'one.']]
[['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', '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', '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'], ['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', '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', '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'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O']]
[['The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n', 'Study of hormone receptors and HER2\n', 'Support'], ['positive HER2 receptors imply greater aggressiveness of the tumor\n', 'The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n', 'Support'], ['Answer 1 can be ruled out visu visu\n', 'Complete phenotypic study by flow cytometry\n', 'Attack'], ['while answers 3 and 4 should be ruled out\n', 'Study of hormone receptors, e-cadherin and study of first degree relatives\n', 'Attack'], ['while answers 3 and 4 should be ruled out\n', 'Study of BRCA 1-2 and study of first-degree relatives\n', 'Attack'], ['treatment with trastuzumab and positive hormone receptors would imply the use of hormone therapy\n', 'The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n', 'Support'], ['being the first woman in the family with breast carcinoma\n', "the study of the patient's relatives would not be obligatory\n", 'Support'], ["the study of the patient's relatives would not be obligatory\n", 'while answers 3 and 4 should be ruled out\n', 'Support']]
310_216
[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'parent', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'his', '2-year-old', 'son', 'because', 'he', 'reports', 'that', 'he', 'has', 'hit', 'his', 'right', 'eye', 'while', 'playing.'], ['Indeed,', 'a', 'hematoma', 'is', 'observed', 'on', 'the', 'right', 'eyelid,', 'apparently', 'of', 'no', 'importance.'], ['The', 'fundus', 'examination', 'showed', 'intraretinal', 'hemorrhages', 'not', 'only', 'in', 'the', 'eye', 'referred', 'by', 'the', 'parents', 'but', 'also', 'in', 'the', 'other', 'eye.'], ['It', 'is', 'noteworthy', 'that', 'the', 'child', 'appears', 'drowsy', 'and', 'with', 'little', 'tone.'], ['Which', 'of', 'the', 'following', 'statements', 'should', 'you', 'consider', 'regarding', 'this', 'clinical', 'picture?'], ['1-', 'It', 'is', 'a', 'highly', 'suggestive', 'history', 'of', 'child', 'abuse.'], ['2-', 'It', 'is', 'the', 'normal', 'evolution', 'of', 'a', 'non-perforating', 'intraocular', 'trauma.'], ['3-', 'The', 'most', 'likely', 'diagnosis', 'is', 'Berlin', 'edema.'], ['4-', 'It', 'is', 'the', 'characteristic', 'picture', 'of', "Purstcher's", 'traumatic', 'retinal', 'angiopathy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Easy', 'question', 'in', 'principle,', 'but', 'with', 'a', 'bit', 'of', 'a', 'catch.'], ['If', 'you', 'have', 'the', 'right', 'intuition', 'when', 'you', 'read', 'it', 'and', 'go', 'straight', 'to', 'what', 'you', 'think,', 'you', 'will', 'probably', 'get', 'it', 'right.'], ['The', 'problem', 'is', 'option', '4,', 'which', 'can', 'confuse', 'us.'], ["Let's", 'see:', 'we', 'have', 'a', 'blow', 'to', 'the', 'right', 'eye', 'area,', 'with', 'a', 'hematoma', 'on', 'the', 'eyelid.'], ['So', 'far', 'so', 'normal.'], ['The', 'problem', 'is', 'that', 'retinal', 'hemorrhages', 'appear', 'not', 'only', 'in', 'that', 'eye', '(which', 'in', 'itself', 'is', 'rare,', 'because', 'an', 'external', 'blow', 'to', 'the', 'eye', 'in', 'a', 'child', 'rarely', 'causes', 'bleeding', 'in', 'the', 'retina),', 'but', 'also', 'in', 'the', 'other', 'eye.'], ['Therefore,', 'something', 'other', 'than', 'the', 'blow', 'has', 'caused', 'hemorrhages', 'in', 'both', 'retinas.'], ['Then', 'we', 'are', 'told', 'that', 'the', 'child', 'seems', 'drowsy', 'and', 'with', 'little', 'tone.'], ['Here', 'we', 'already', 'have', 'the', 'two', 'keys;', 'we', 'have', 'to', 'suspect', 'what', 'is', 'not', 'mentioned', 'in', 'the', 'answers,', 'but', 'which', 'is', 'what', 'the', 'child', 'has:', 'the', 'shaken', 'baby', 'syndrome', '(shaken', 'baby', 'syndrome).'], ['Characteristic', 'of', 'this', 'syndrome', 'are', 'bilateral', 'retinal', 'hemorrhages,', 'cerebral', 'edema', 'and', 'subdural', 'hematoma.'], ['There', 'may', 'also', 'be', 'fracture', 'of', 'long', 'bones', 'and', 'other', 'problems.'], ['Numbness', 'and', 'hypotonia', 'allow', 'us', 'to', 'suspect', 'intracranial', 'complications.'], ['The', 'cause', 'of', 'shaken', 'baby', 'syndrome', 'is', 'almost', 'always', 'abuse,', 'so', 'the', 'answer', 'is', '1.'], ['Options', '2', 'and', '3', 'are', 'easy', 'to', 'rule', 'out:', 'nothing', 'indicates', 'perforating', 'trauma,', 'and', 'it', 'does', 'not', 'explain', 'the', 'hemorrhages', 'in', 'the', 'other', 'eye.'], ['And', 'the', 'berlin', 'edema', 'is', 'an', 'edema', 'of', 'the', 'macula', 'and', 'appears', 'as', 'a', 'whitish', 'lesion,', 'which', 'is', 'not', 'described', 'in', 'the', 'statement.'], ['The', 'catch', 'is', 'option', '4.'], ["Purstcher's", 'retinopathy', 'can', 'also', 'appear', 'in', 'the', 'context', 'of', 'the', 'child', 'of', 'the', 'shaken', 'child,', 'and', 'therefore', 'occur', 'in', 'the', 'case', 'of', 'child', 'abuse.'], ['Seeing', 'these', 'two', 'partly', 'related', 'questions,', 'we', 'may', 'hesitate.'], ['However,', 'if', 'we', 'read', 'answer', '4', 'carefully,', 'it', 'does', 'not', 'tell', 'us', 'that', 'if', 'there', 'is', 'child', 'maltreatment', 'Purstcher', 'can', 'occur.'], ['It', 'states', 'that', 'the', 'picture', 'described', 'above', '(intraretinal', 'hemorrhages,', 'without', 'other', 'findings)', 'is', 'characteristic', 'of', "Purstcher's", 'angiopathy.', 'It', 'is', 'not.'], ['In', "Purstcher's", 'there', 'are', 'hemorrhages,', 'but', 'also', 'cottony', 'exudates', 'and', 'edema.'], ['If', 'there', 'are', 'only', 'hemorrhages,', "it's", 'not', "Purstcher's."], ["Here's", 'the', 'messy', 'bit,', 'but', "it's", 'really', 'well', 'worded.'], ['If', 'he', 'had', 'a', 'Purstcher', 'it', 'could', 'also', 'be', 'for', 'child', 'abuse,', 'but', 'he', "doesn't."]]
[['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'], ['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', 'B-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', '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', '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'], ['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'], ['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'], ['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'], ['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'], ['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'], ['B-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', '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', '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-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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'], ['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'], ['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'], ['B-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']]
[['we have a blow to the right eye area, with a hematoma on the eyelid\n', 'Therefore, something other than the blow has caused hemorrhages in both retinas\n', 'Support'], ['The problem is that retinal hemorrhages appear not only in that eye (which in itself is rare, because an external blow to the eye in a child rarely causes bleeding in the retina), but also in the other eye\n', 'Therefore, something other than the blow has caused hemorrhages in both retinas\n', 'Support'], ['we have a blow to the right eye area, with a hematoma on the eyelid\n', 'Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n', 'Support'], ['The problem is that retinal hemorrhages appear not only in that eye (which in itself is rare, because an external blow to the eye in a child rarely causes bleeding in the retina), but also in the other eye\n', 'Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n', 'Support'], ['Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n', 'Here we already have the two keys; we have to suspect what is not mentioned in the answers, but which is what the child has: the shaken baby syndrome (shaken baby syndrome)\n', 'Support'], ['The cause of shaken baby syndrome is almost always abuse\n', 'the answer is 1\n', 'Support'], ['the answer is 1\n', 'It is a highly suggestive history of child abuse\n', 'Support'], ['The cause of shaken baby syndrome is almost always abuse\n', 'It is a highly suggestive history of child abuse\n', 'Support'], ['Options 2 and 3 are easy to rule out\n', 'It is the normal evolution of a non-perforating intraocular trauma\n', 'Attack'], ['Options 2 and 3 are easy to rule out\n', 'The most likely diagnosis is Berlin edema\n', 'Attack'], ['nothing indicates perforating trauma, and it does not explain the hemorrhages in the other eye\n', 'Options 2 and 3 are easy to rule out\n', 'Support'], ['And the berlin edema is an edema of the macula and appears as a whitish lesion, which is not described in the statement\n', 'The most likely diagnosis is Berlin edema\n', 'Attack'], ['However, if we read answer 4 carefully, it does not tell us that if there is child maltreatment Purstcher can occur\n', "Purstcher's retinopathy can also appear in the context of the child of the shaken child, and therefore occur in the case of child abuse\n", 'Attack'], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "Purstcher's retinopathy can also appear in the context of the child of the shaken child, and therefore occur in the case of child abuse\n", 'Attack'], ["In Purstcher's there are hemorrhages, but also cottony exudates and edema\n", "Purstcher's retinopathy can also appear in the context of the child of the shaken child, and therefore occur in the case of child abuse\n", 'Attack'], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "If there are only hemorrhages, it's not Purstcher's\n", 'Support'], ["In Purstcher's there are hemorrhages, but also cottony exudates and edema\n", "If there are only hemorrhages, it's not Purstcher's\n", 'Support'], ["If there are only hemorrhages, it's not Purstcher's\n", "It is the characteristic picture of Purstcher's traumatic retinal angiopathy\n", 'Attack'], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "It is the characteristic picture of Purstcher's traumatic retinal angiopathy\n", 'Attack']]
293_214
[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'erythroderma', 'with', 'fever', 'and', 'general', 'malaise.'], ['On', 'examination,', 'the', 'nails', 'show', 'the', 'presence', 'of', 'nail', 'pitting', 'and', 'distal', 'yellowish', 'areas', 'in', 'an', 'oil', 'stain.'], ['What', 'is', 'the', 'primary', 'disease', 'that', 'caused', 'the', 'condition?'], ['1-', 'Cutaneous', 'lymphoma.'], ['2-', 'Atopic', 'dermatitis.'], ['3-', 'Psoriasis.'], ['4-', 'Ichthyosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Any', 'of', 'the', '4', 'options', 'can', 'be', 'the', 'cause', 'of', 'erythroderma,', 'although', 'the', 'description', 'of', 'nail', 'lesions', 'highly', 'suggestive', 'of', 'psoriasis', 'makes', 'this', 'diagnosis', 'the', 'most', 'likely.']]
[['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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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', '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']]
[['On examination, the nails show the presence of nail pitting and distal yellowish areas in an oil stain\n', 'although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n', 'Support'], ['although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n', 'Psoriasis\n', 'Support'], ['although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n', 'Any of the 4 options can be the cause of erythroderma\n', 'Attack']]
132_229
[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'man,', 'with', 'a', 'personal', 'history', 'of', 'DM,', 'hypertension', 'and', 'mild', 'chronic', 'renal', 'insufficiency,', 'presented', 'with', 'somnolence', 'and', 'right', 'hemiparesis.'], ['Laboratory', 'tests:', 'creatinine', '2.3', 'mg/dl,', 'Hb', '10.3', 'g/dl', 'and', 'platelets', '20000', 'mm3,', 'with', 'normal', 'coagulation.'], ['Cranial', 'CT:', 'ischemic', 'lesions', 'with', 'microhemorrhagic', 'necrosis.'], ['Subsequently,', 'he', 'began', 'with', 'progressive', 'deterioration', 'of', 'the', 'level', 'of', 'consciousness', 'and', 'increase', 'of', 'Cr,', 'LDH', 'and', 'unconjugated', 'bilirubin.'], ['Direct', "Coombs'", 'test', 'was', 'negative.'], ['Schistocytes', 'in', 'smear.'], ['In', 'view', 'of', 'the', 'diagnostic', 'suspicion,', 'the', 'following', 'conduct', 'is', 'to', 'be', 'followed:'], ['1-', 'New', 'cranial', 'CT', 'in', 'the', 'presence', 'of', 'suspected', 'hemorrhagic', 'transformation', 'of', 'ischemic', 'stroke.'], ['2-', 'Initiate', 'urgent', 'plasmapheresis.'], ['3-', 'Beginning', 'of', 'treatment', 'with', 'glucocorticoids', 'at', 'a', 'dose', 'of', '1', 'mg/kg/day.'], ['4-', 'Search', 'for', 'triggering', 'cause', 'of', 'DIC.'], ['5-', 'Suspected', 'multiple', 'myeloma:', 'bone', 'marrow', 'aspirate.'], ['CORRECT', 'ANSWER:', '2'], ["Let's", 'see:', 'a', 'patient', 'with', 'certain', 'history', 'who', 'has:', '-', 'Schistocytes', 'in', 'smear:', 'indicates', 'microangiopathic', 'anemia,', 'red', 'cell', 'rupture', 'of', 'mechanical', 'cause,', 'which', 'can', 'be', 'seen', 'mainly', 'in', 'PTT,', 'autoimmune', 'hemolytic', 'anemia', 'and', 'DIC.'], ['-', 'Bicytopenia:', 'here', 'the', 'causes', 'can', 'be', 'very,', 'very', 'varied.'], ['-', 'Elevation', 'of', 'LDH', 'and', 'Bilirubin,', 'which', 'indicates', 'a', 'massive', 'rupture', 'of', 'red', 'blood', 'cells.'], ['-', 'Negative', 'direct', "Coombs'", 'test:', 'essential', 'data,', 'indicating', 'that', 'there', 'is', 'no', 'antibody', 'that', 'sticks', 'to', 'the', 'red', 'blood', 'cells.'], ['With', 'these', 'wickers', 'we', 'are', 'going', 'to', 'weave', 'the', 'basket:', 'Answer', '1:', 'it', 'cannot', 'be', 'because', 'a', 'hemorrhagic', 'transformation', 'does', 'not', 'give', 'such', 'a', 'brutal', 'elevation', 'of', 'LDH', 'and', 'Cr,', 'in', 'addition', 'to', 'not', 'explaining', 'schistocytosis.'], ['Answer', '2:', 'urgent', 'plasmapheresis...', 'in', 'case', 'of', 'thrombotic', 'thrombocytopenic', 'purpura,', 'yes;', 'I', 'like', 'this', 'answer', 'because', 'it', 'justifies', 'bicytopenia,', 'since', 'microangiopathic', 'hemolytic', 'anemia', 'is', 'produced', 'by', 'rupture', 'of', 'red', 'blood', 'cells', 'when', 'they', 'are', 'fragmented', 'by', 'ultralong', 'von', 'Willebrand', 'factor', 'multimers', 'in', 'case', 'of', 'deficiency', 'of', 'the', 'ADAMST13', 'enzyme,', 'resulting', 'in', 'brutal', 'platelet', 'aggregates', 'and', 'the', 'flow', 'cytometer', 'does', 'not', 'count', '400', 'platelets,', 'but', 'a', 'molondron', 'of', 'platelets', 'that', 'form', 'a', 'mass,', 'hence', 'the', 'thrombocytopenia.'], ['It', 'also', 'explains', 'the', 'negative', 'direct', 'Coombs,', 'elevated', 'LDH', 'and', 'Cr.'], ['Answer', '3:', 'a', 'situation', 'as', 'critical', 'as', 'that', "patient's", 'indicates', 'that', 'something', 'big', 'is', 'going', 'on', 'and', 'I', 'would', 'not', 'sit', 'and', 'wait', 'for', 'glucocorticoids', 'to', 'take', 'effect...and', 'I', 'do', 'not', 'know', 'right', 'now', 'what', 'pathology', 'gives', 'that', 'symptomatology', 'and', 'has', 'that', 'treatment', 'as', 'standard.'], ['Answer', '4:', 'looking', 'for', 'a', 'trigger', 'for', 'DIC...it', 'would', 'make', 'sense', 'if', 'it', 'were', 'not', 'for', 'the', 'fact', 'that', 'in', 'DIC', 'it', 'is', 'VERY', 'characteristic', 'the', 'consumption', 'of', 'coagulation', 'factors,', 'which', 'is', 'not', 'present', 'in', 'this', 'case.'], ['Answer', '5:', 'a', 'myeloma', 'does', 'not', 'give', 'schistocytosis', 'nor', 'does', 'it', 'have', 'this', 'symptomatology,', 'they', 'would', 'have', 'to', 'give', 'other', 'data', 'that', 'would', 'support', 'this', 'pathology,', 'such', 'as', 'bone', 'pain', 'and', 'hypercalcemia...']]
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[['Schistocytes in smear\n', 'a patient with certain history who has: - Schistocytes in smear\n', 'Support'], ['Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation\n', 'Bicytopenia: here the causes can be very, very varied\n', 'Support'], ['Elevation of LDH and Bilirubin\n', 'which indicates a massive rupture of red blood cells\n', 'Support'], ['Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n', 'Elevation of LDH and Bilirubin\n', 'Support'], ['Answer 1: it cannot be because a hemorrhagic transformation does not give such a brutal elevation of LDH and Cr, in addition to not explaining schistocytosis\n', 'New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke\n', 'Attack'], ['Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n', 'New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke\n', 'Attack'], ['Answer 2: urgent plasmapheresis... in case of thrombotic thrombocytopenic purpura, yes\n', 'Initiate urgent plasmapheresis\n', 'Support'], ['I like this answer because it justifies bicytopenia, since microangiopathic hemolytic anemia is produced by rupture of red blood cells when they are fragmented by ultralong von Willebrand factor multimers in case of deficiency of the ADAMST13 enzyme, resulting in brutal platelet aggregates and the flow cytometer does not count 400 platelets, but a molondron of platelets that form a mass, hence the thrombocytopenia\n', 'Initiate urgent plasmapheresis\n', 'Support'], ['Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation\n', 'Initiate urgent plasmapheresis\n', 'Support'], ['It also explains the negative direct Coombs, elevated LDH and Cr\n', 'Initiate urgent plasmapheresis\n', 'Support'], ["Direct Coombs' test was negative\n", 'Initiate urgent plasmapheresis\n', 'Support'], ['Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n', 'Initiate urgent plasmapheresis\n', 'Support'], ["Answer 3: a situation as critical as that patient's indicates that something big is going on and I would not sit and wait for glucocorticoids to take effect...and I do not know right now what pathology gives that symptomatology and has that treatment as standard\n", 'Beginning of treatment with glucocorticoids at a dose of 1 mg/kg/day\n', 'Attack'], ['Answer 4: looking for a trigger for DIC...it would make sense if it were not for the fact that in DIC it is VERY characteristic the consumption of coagulation factors, which is not present in this case\n', 'Search for triggering cause of DIC\n', 'Attack'], ['Answer 5: a myeloma does not give schistocytosis nor does it have this symptomatology, they would have to give other data that would support this pathology, such as bone pain and hypercalcemia\n', 'Suspected multiple myeloma: bone marrow aspirate\n', 'Attack']]
49_159
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120_192
[['QUESTION', 'TYPE:', 'PREVENTIVE', 'MEDICINE', 'AND', 'EPIDEMIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '40-year-old', 'orthopedic', 'surgeon', 'who', 'in', 'a', 'routine', 'serology', 'was', 'found', 'to', 'have', 'anti-HBs', 'levels', 'of', '30', 'IU/l.'], ['He', 'refers', 'complete', 'vaccination', 'according', 'to', 'the', 'standard', 'hepatitis', 'B', 'vaccination', 'schedule', '4', 'years', 'ago.'], ['It', 'would', 'be', 'advisable:'], ['1-', 'Restart', 'vaccination', 'schedule', '(0-1-6', 'months).'], ['2-', 'Restart', 'vaccination', 'schedule', '(0-1-2-12', 'months).'], ['3-', 'Do', 'not', 'revaccinate.'], ['4-', 'Give', 'a', 'booster', 'dose.'], ['5-', 'Give', 'anti-hepatitis', 'B', 'immunoglobulin', 'and', 'restart', 'vaccination', 'schedule', '(0-1-2-12', 'months).'], ['CORRECT', 'ANSWER:', '3'], ['As', 'long', 'as', 'the', 'serological', 'levels', 'of', 'anti-HBs', 'are', 'above', '10', 'IU/l', 'it', 'is', 'not', 'necessary', 'to', 'revaccinate.']]
[['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'], ['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', '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'], ['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'], ['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']]
[['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Do not revaccinate\n', 'Support'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Do not revaccinate\n', 'Support'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Restart vaccination schedule (0-1-6 months)\n', 'Attack'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Restart vaccination schedule (0-1-2-12 months)\n', 'Attack'], ['A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n', 'Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)\n', 'Attack'], ['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Restart vaccination schedule (0-1-6 months)\n', 'Attack'], ['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Restart vaccination schedule (0-1-2-12 months)\n', 'Attack'], ['As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n', 'Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)\n', 'Attack']]
304_174
[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['87-year-old', 'man', 'with', 'a', 'history', 'of', 'hypertension', 'and', 'gonarthrosis.'], ['Baseline', 'situation', 'with', 'full', 'functional', 'and', 'cognitive', 'autonomy', 'that', 'allows', 'him', 'to', 'continue', 'living', 'alone', 'in', 'the', 'community.'], ['He', 'is', 'receiving', 'regular', 'treatment', 'with', 'perindopril', 'and', 'thiazide', 'diuretic', 'for', 'blood', 'pressure', 'control', 'and', 'routinely', 'takes', 'ibuprofen', '1800', 'mg/day', 'to', 'control', 'the', 'symptoms', 'derived', 'from', 'his', 'gonarthrosis.'], ['After', 'routine', 'control,', 'a', 'persistent', 'blood', 'pressure', 'of', '190', 'and', 'TAD', '80', 'mmHg', 'was', 'observed.'], ['What', 'would', 'be', 'the', 'most', 'reasonable', 'therapeutic', 'modification', 'to', 'achieve', 'blood', 'pressure', 'control?'], ['1-', 'I', 'would', 'add', 'a', 'calcium', 'channel', 'blocker.'], ['2-', 'I', 'would', 'increase', 'the', 'dose', 'of', 'hydrochlorothiazide', 'to', '25', 'mg/day.'], ['3-', 'I', 'would', 'change', 'ibuprofen', 'for', 'paracetamol', 'to', 'avoid', 'the', 'possible', 'influence', 'of', 'paracetamol', 'on', 'the', 'effect', 'of', 'hypotensives.'], ['4-', 'I', 'would', 'add', 'an', 'alpha', 'blocker', 'because', 'of', 'the', 'high', 'prevalence', 'of', 'prostatic', 'syndrome', 'in', 'males', 'of', 'this', 'age.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Before', 'intensifying', 'antihypertensive', 'treatment,', 'the', 'potential', 'causes', 'should', 'be', 'resolved.'], ['In', 'this', 'case', 'we', 'are', 'dealing', 'with', 'an', 'elderly', 'patient', 'with', 'chronic', 'treatment', 'with', 'NSAIDs', 'that', 'produces', 'arterial', 'hypertension', 'secondary', 'to', 'renal', 'hypoperfusion.'], ['The', 'most', 'reasonable', 'option', 'would', 'be', 'to', 'withdraw', 'ibuprofen', 'and', 'replace', 'it', 'with', 'an', 'analgesic', 'from', 'a', 'group', 'other', 'than', 'NSAIDs', '(paracetamol,', 'opiates),', 'subsequently', 'monitoring', 'the', 'evolution', 'of', 'blood', 'pressure.']]
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[['In this case we are dealing with an elderly patient with chronic treatment with NSAIDs that produces arterial hypertension secondary to renal hypoperfusion\n', 'The most reasonable option would be to withdraw ibuprofen and replace it with an analgesic from a group other than NSAIDs (paracetamol, opiates), subsequently monitoring the evolution of blood pressure\n', 'Support']]
214_228
[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '19-year-old', 'man', 'consults', 'for', 'a', '24-hour', 'history', 'of', 'pain,', 'swelling', 'and', 'functional', 'impotence', 'of', 'the', 'right', 'knee', 'accompanied', 'by', 'a', 'fever', 'of', '38°C.'], ['Physical', 'examination', 'reveals', 'inflammatory', 'signs', 'and', 'joint', 'effusion', 'in', 'the', 'right', 'knee.'], ['Laboratory', 'tests', 'showed', 'leukocytosis', 'with', 'neutrophilia', 'and', 'elevated', 'C-reactive', 'protein.'], ['The', 'syndromic', 'diagnosis', 'of', 'acute', 'monoarthritis', 'is', 'made.'], ['What', 'is', 'the', 'most', 'likely', 'etiologic', 'diagnosis?'], ['1-', 'Arthritis', 'due', 'to', 'microcrystals.'], ['2-', 'Reactive', 'arthritis.'], ['3-', 'Bacterial', 'infectious', 'arthritis.'], ['4-', 'Mycobacterial', 'infectious', 'arthritis.'], ['5-', 'Rheumatoid', 'arthritis.'], ['CORRECT', 'ANSWER:', '3'], ['Acute', 'monoarthritis', 'associated', 'with', 'fever,', 'leukocytosis', 'with', 'neutrophilia', 'and', 'increased', 'acute', 'phase', 'reactants', 'does', 'not', 'always', 'have', 'a', 'septic', 'origin.'], ['In', 'the', 'absence', 'of', 'further', 'information', '(more', 'complete', 'anamnesis', 'on', 'the', 'current', 'disease,', 'risk', 'factors,', 'personal', 'and', 'family', 'history,', 'extra-articular', 'symptoms', 'or', 'signs,', 'etc.)', 'it', 'can', 'be', 'said', 'that', 'also', '1', 'and', '2', '(and', 'very', 'exceptionally', '5)', 'could', 'debut', 'with', 'a', 'similar', 'clinical', 'and', 'biological', 'picture.'], ['With', 'the', 'data', 'provided', 'and', 'taking', 'into', 'account', 'that', 'this', 'is', 'a', 'young', 'male,', 'the', 'most', 'likely', 'option', 'would', 'be', 'bacterial', 'infectious', 'arthritis', '(that', 'caused', 'by', 'mycobacteria', 'usually', 'have', 'a', 'chronic', 'course).'], ['And', 'above', 'all,', 'because', 'of', 'its', 'implications,', 'the', 'first', 'one', 'to', 'always', 'rule', 'out.']]
[['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'], ['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'], ['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'], ['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', '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'], ['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', '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']]
[['In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) it can be said that also 1 and 2 (and very exceptionally 5) could debut with a similar clinical and biological picture\n', 'Arthritis due to microcrystals\n', 'Support'], ['In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) it can be said that also 1 and 2 (and very exceptionally 5) could debut with a similar clinical and biological picture\n', 'Reactive arthritis\n', 'Support'], ['In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) it can be said that also 1 and 2 (and very exceptionally 5) could debut with a similar clinical and biological picture\n', 'Rheumatoid arthritis\n', 'Support'], ['With the data provided and taking into account that this is a young male\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Bacterial infectious arthritis\n', 'Support'], ['Acute monoarthritis associated with fever, leukocytosis with neutrophilia and increased acute phase reactants does not always have a septic origin\n', 'Mycobacterial infectious arthritis\n', 'Attack'], ['A 19-year-old man consults for a 24-hour history of pain, swelling and functional impotence of the right knee accompanied by a fever of 38°C\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['Physical examination reveals inflammatory signs and joint effusion in the right knee\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['Laboratory tests showed leukocytosis with neutrophilia and elevated C-reactive protein\n', 'the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n', 'Support'], ['And above all, because of its implications, the first one to always rule out\n', 'Arthritis due to microcrystals\n', 'Attack']]
249_120
[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '53-year-old', 'woman', 'consults', 'for', 'a', 'fever', 'of', '15', 'days', 'of', 'evolution,', 'without', 'symptoms', 'of', 'infectious', 'focality.'], ['On', 'examination,', 'a', 'painful', 'hepatomegaly', 'is', 'detected', 'at', '5', 'cm', 'from', 'the', 'costal', 'margin', 'and', 'the', 'spleen', 'is', 'palpated', 'at', '14', 'cm', 'from', 'the', 'left', 'costal', 'margin.'], ['The', 'blood', 'count', 'showed', 'Hb', '8.5', 'g/dL,', 'leukocytes', '630/ml', '(lymphocytes', '63%,', 'monocytes', '20%,', 'neutrophils', '17%)', 'and', 'platelets', '35,000/ml.'], ['Biochemistry', 'shows', 'moderate', 'elevation', 'of', 'liver', 'biochemistry,', 'LDH', 'is', 'normal', 'and', 'polyclonal', 'hypergammaglobulinemia', '(3.5', 'g/dL)', 'is', 'observed', 'in', 'the', 'proteinogram.'], ['He', 'has', 'a', 'history', 'of', 'known', 'HIV', 'infection', 'for', '10', 'years', 'and', 'irregular', 'adherence', 'to', 'antiretroviral', 'treatment,', 'with', 'recent', 'determinations', 'of', 'CD4', 'lymphocytes', '350', 'cells/mL', 'and', 'HIV', 'viral', 'load', 'of', '154', 'copies/mL.'], ['For', 'the', 'past', '3', 'months', 'she', 'has', 'been', 'treated', 'for', 'seronegative', 'symmetrical', 'polyarthritis', 'with', '10-20', 'mg/day', 'of', 'prednisone.'], ['Which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'I', 'would', 'perform', 'a', 'bone', 'marrow', 'biopsy,', 'since', 'the', 'most', 'probable', 'diagnosis', 'is', 'visceral', 'leishmaniasis.'], ['2-', 'Pancytopenia', 'is', 'justified', 'by', 'C', 'virus-associated', 'cirrhosis', 'and', 'I', 'would', 'not', 'perform', 'further', 'testing.'], ['3-', 'Probably', 'a', 'medullary', 'toxicity', 'due', 'to', 'prednisone', 'that', 'would', 'be', 'treated', 'with', 'drug', 'withdrawal', 'and', 'filgastrim.'], ['4-', 'I', 'would', 'request', 'an', 'ANAs', 'determination', 'to', 'rule', 'out', 'disseminated', 'systemic', 'lupus.'], ['5-', 'I', 'would', 'intensify', 'antiretroviral', 'therapy,', 'as', 'it', 'is', 'likely', 'that', 'all', 'manifestations', 'are', 'due', 'to', 'HIV.'], ['CORRECT', 'ANSWER:', '1'], ['Easy', 'and', 'quite', 'typical', 'question.'], ['We', 'are', 'told', 'about', 'an', 'HIV', 'patient', 'with', 'irregular', 'follow-up', 'of', 'antiretroviral', 'treatment,', 'presenting', 'fever,', 'hepatosplenomegaly,', 'pancytopenia', 'and', 'polyclonal', 'hypergammaglobulinemia.'], ['All', 'these', 'data', 'are', 'suggestive', 'of', 'visceral', 'Leishmaniasis,', 'so', 'an', 'OM', 'biopsy', 'should', 'be', 'performed', 'to', 'look', 'for', 'amastigotes', 'and', 'confirm', 'the', 'diagnosis.']]
[['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', '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', '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', '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', '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', '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'], ['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', '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-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']]
[['All these data are suggestive of visceral Leishmaniasis\n', 'an OM biopsy should be performed to look for amastigotes and confirm the diagnosis\n', 'Support'], ['We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia\n', 'All these data are suggestive of visceral Leishmaniasis\n', 'Support'], ['All these data are suggestive of visceral Leishmaniasis\n', 'I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n', 'Support'], ['an OM biopsy should be performed to look for amastigotes and confirm the diagnosis\n', 'I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n', 'Support'], ['We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia\n', 'I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n', 'Support']]
53_146
[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['A', '31-year-old', 'man', 'with', 'no', 'psychiatric', 'history', 'comes', 'to', 'the', 'emergency', 'room', 'complaining...¨', 'symptoms', 'of', 'anxiety.'], ['Two', 'days', 'ago', 'he', 'experienced', 'another', 'episode', 'of', 'the', 'same', 'symptoms...', '....'], ['1', 'week', 'ago', 'he', 'broke', 'up', 'with', 'his', 'partner...', 'ruled', 'out', 'any', 'organic', 'pathology....:'], ['1-', 'Post-traumatic', 'stress', 'reaction.'], ['2-', 'Acute"', 'dependent', 'personality', 'disorder.'], ['3-', 'Depressive', 'disorder.'], ['4-', 'Agoraphobia.'], ['5-', 'Anguish', 'crisis.'], ['CORRECT', 'ANSWER:', '5'], ['Here', 'it', 'is', 'good', 'that', 'they', 'tell', 'you', 'their', 'antecedents', '(we', 'all', 'have', 'antecedents', 'because', 'we', 'all', 'have', 'a', 'life)', 'and', 'that', 'they', 'rule', 'out', 'organic', 'pathology.'], ['That', 'is', 'fundamental.'], ['Let', 'us', 'not', 'forget', 'that', 'also', 'the', 'hypochondriacs', 'have', 'body.'], ['We', 'first', 'eliminate', 'the', 'most', 'striking', '"acute"', 'personality', 'disorder.'], ['Personality', 'accompanies', 'us', 'all', 'our', 'lives.'], ['There', 'are', 'no', '"acute"', 'characteristics', 'in', 'our', 'personality.'], ['Depressive', 'disorder?', 'There', 'is', 'a', 'time', 'criterion', 'that', 'is', 'not', 'met,', 'it', 'may', 'be', 'sad,', 'but', 'sad', 'is', 'not', 'depression', '(1).'], ['agoraphobia?', 'if', 'it', 'was', 'something', 'like', 'that', 'we', 'would', 'have', 'been', 'told', 'the', 'context', 'post-traumatic', 'stress', 'reaction?'], ["That's", 'a', 'good', 'one.'], ['The', 'correct', 'term', 'would', 'be', 'post-traumatic', 'stress', 'disorder', 'or', 'acute', 'stress', 'reaction,', 'and', 'according', 'to', 'ICD', '10:', '"The', 'stressor', 'may', 'be', 'a', 'devastating', 'traumatic', 'experience', 'involving', 'a', 'serious', 'threat', 'to', 'the', 'safety', 'or', 'physical', 'integrity', 'of', 'the', 'patient', 'or', 'loved', 'one(s)', '(e.g.,', 'natural', 'catastrophes,', 'accidents,', 'battles,', 'muggings,', 'rapes)', 'or', 'an', 'abrupt', 'and', 'threatening', 'change', 'in', 'the', "individual's", 'rank', 'or', 'social', 'environment', '(e.g.,', 'loss', 'of', 'several', 'loved', 'ones,', 'house', 'fire,', 'etc.).', ')"', 'or', 'more', 'briefly:', '"exceptionally', 'threatening', 'or', 'catastrophic', 'nature"', 'Breaking', 'up', 'with', 'a', 'partner', 'I', 'understand', 'is', 'hard,', 'but', 'not', 'exceptional.'], ['So', 'by', 'elimination', '5.', 'Crisis', 'of', 'distress.'], ['This', 'is', 'a', 'useful', 'question,', 'common', 'in', 'daily', 'practice,', 'and', 'so', 'we', 'see', 'that', 'we', 'must', 'avoid', 'giving', 'a', 'diagnosis', 'of', 'long', 'evolution', 'for', 'a', 'natural', 'reaction.'], ['Diagnoses', '1', 'to', '4', 'would', 'be', 'like', 'calling', 'diabetic', 'the', 'one', 'who', 'has', 'hyperglycemia', 'after', 'eating', 'three', 'muffins.'], ['Useful', 'and', 'realistic', 'question.']]
[['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', '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'], ['O', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-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', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', '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-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', 'I-Premise', 'I-Premise'], ['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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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', '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'], ['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']]
[['We first eliminate the most striking "acute" personality disorder.\n', 'Acute" dependent personality disorder.\n', 'Attack'], ['There are no "acute" characteristics in our personality.\n', 'We first eliminate the most striking "acute" personality disorder.\n', 'Support'], ['Depressive disorder? There is a time criterion that is not met\n', 'it may be sad, but sad is not depression\n', 'Support'], ['agoraphobia? if it was something like that we would have been told the context post-traumatic stress reaction?\n', 'Agoraphobia\n', 'Attack'], ['it may be sad, but sad is not depression\n', 'Depressive disorder\n', 'Attack'], ['So by elimination 5. Crisis of distress\n', 'Anguish crisis\n', 'Support'], ['according to ICD 10: "The stressor may be a devastating traumatic experience involving a serious threat to the safety or physical integrity of the patient or loved one(s) (e.g., natural catastrophes, accidents, battles, muggings, rapes) or an abrupt and threatening change in the individual\'s rank or social environment (e.g., loss of several loved ones, house fire, etc.). )" or more briefly: "exceptionally threatening or catastrophic nature"\n', 'Breaking up with a partner I understand is hard, but not exceptional\n', 'Support'], ['Breaking up with a partner I understand is hard, but not exceptional\n', 'Post-traumatic stress reaction\n', 'Attack'], ['The correct term would be post-traumatic stress disorder or acute stress reaction\n', 'Breaking up with a partner I understand is hard, but not exceptional\n', 'Support'], ['Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins\n', 'Post-traumatic stress reaction\n', 'Attack'], ['Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins\n', 'Agoraphobia\n', 'Attack']]
48_158
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '10-year-old', 'boy', 'is', 'brought', 'to', 'the', 'Emergency', 'Department', 'because', 'for', 'the', 'last', '2', 'hours', 'he', 'has', 'been', 'involuntarily', 'turning', 'his', 'neck', 'to', 'the', 'right', 'associated', 'with', 'marked', 'cervical', 'pain', 'at', 'each', 'turn.'], ['The', 'grandmother', 'subsequently', 'tells', 'us', 'that', 'he', 'has', 'been', 'vomiting', 'since', 'yesterday,', 'so', 'she', 'gave', 'him', 'a', 'syrup;', 'what', 'would', 'be', 'the', 'most', 'appropriate', 'therapeutic', 'approach?'], ['1-', 'Inject', 'an', 'intravenous', 'anticholinergic.'], ['2-', 'Do', 'not', 'treat', 'until', 'an', 'electroencephalogram', 'is', 'performed', 'in', 'the', 'following', 'days.'], ['3-', 'Do', 'not', 'treat', 'until', 'the', 'result', 'of', 'the', 'cerebrospinal', 'fluid', 'culture', 'is', 'known', 'in', 'the', 'next', 'few', 'days.'], ['4-', 'Call', 'the', 'on-call', 'psychiatrist.'], ['5-', 'Start', 'an', 'intravenous', 'antibiotic', 'after', 'obtaining', 'a', 'pharyngeal', 'swab.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', '1.'], ['The', 'anticholinergic', 'can', 'be', 'administered', 'intravenously', 'and', 'also', 'intramuscularly', 'if', 'I', 'am', 'not', 'mistaken.'], ['The', 'occurrence', 'of', 'dystonia', 'as', 'a', 'side', 'effect', 'is', 'common', 'in', 'children', 'and', 'is', 'one', 'of', 'the', 'main', 'reasons', 'why', 'pediatricians', 'do', 'not', 'usually', 'prescribe', 'some', 'antiemetics', 'in', 'children.']]
[['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'], ['O', 'O', 'O', 'O', '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', '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', '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'], ['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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['The correct answer is 1\n', 'Inject an intravenous anticholinergic\n', 'Support'], ['The anticholinergic can be administered intravenously and also intramuscularly if I am not mistaken\n', 'The correct answer is 1\n', 'Support'], ['The occurrence of dystonia as a side effect is common in children and is one of the main reasons why pediatricians do not usually prescribe some antiemetics in children\n', 'The correct answer is 1\n', 'Support']]
490_106
[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'woman', 'referred', 'to', 'the', 'emergency', 'department', 'for', 'fever', 'and', 'alterations', 'in', 'the', 'laboratory', 'tests:', 'hemoglobin', '11.4', 'g/dL,', 'leukocytes', '0.86', 'x103/μL,(neutrophils', '41.9%,', 'lymphocytes', '55.8%),platelets', '48.0', 'x103/μL,', 'fibrinogen', '118', 'mg/dL,D-dimer', '20.2', 'μg/mL.'], ['Bone', 'marrow', 'examination', 'was', 'performed', 'and', 'she', 'was', 'diagnosed', 'with', 'acute', 'leukemia', 'with', 't(15;17)', 'in', '60%', 'of', 'the', 'cells.'], ['Which', 'of', 'the', 'following', 'answers', 'is', 'correct?'], ['1-', 'If', 'asymptomatic,', 'transretinoic', 'acid', '(ATRA)', 'will', 'be', 'started', 'and', 'day', 'hospital', 'controls', 'will', 'be', 'recommended.'], ['2-', 'Start', 'treatment', 'with', 'arsenic', 'trioxide,', 'ATRA', 'and', 'supportive', 'therapy.'], ['3-', 'It', 'is', 'a', 'myeloblastic', 'leukemia', 'type', 'M3,', 'so', 'chemotherapy', 'and', 'heparin', 'will', 'be', 'started', 'to', 'control', 'disseminated', 'intravascular', 'coagulation.'], ['4-', 'Antibiotic', 'treatment', 'should', 'be', 'started.', 'When', 'the', 'fever', 'disappears,', 'leukemia', 'treatment', 'should', 'be', 'started.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'a', 'definitive', 'promyelocytic', 'leukemia', 'with', 't(15;17),', 'and', 'as', 'it', 'is', 'well', 'known', 'by', 'all', 'of', 'you', 'the', 'treatment', 'is', 'with', 'arsenic', 'trioxide', '+', 'ATRA.'], ['Option', '1', 'leaves', 'the', 'treatment', 'incomplete,', 'there', 'is', 'only', 'ATRA', 'and', 'it', 'must', 'be', 'treated', 'as', 'long', 'as', 'the', "patient's", 'condition', 'allows', 'it,', 'whether', 'or', 'not', 'there', 'are', 'symptoms.'], ['Option', '3', '3', 'years', 'ago', 'would', 'have', 'been', 'the', 'correct', 'option', 'but', 'nowadays', 'neither', 'chemotherapy', 'nor', 'heparin', 'is', 'used.'], ['And', 'option', '4', 'is', 'false', 'because', 'that', 'fever', 'is', 'due', 'to', 'the', 'leukemia', 'itself', 'and', 'the', 'priority', 'is', 'to', 'start', 'specific', 'treatment', 'for', 'leukemia.']]
[['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'], ['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', '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'], ['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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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', 'B-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']]
[['It is a definitive promyelocytic leukemia with t(15;17)\n', 'as it is well known by all of you the treatment is with arsenic trioxide + ATRA\n', 'Support'], ['as it is well known by all of you the treatment is with arsenic trioxide + ATRA\n', 'Start treatment with arsenic trioxide, ATRA and supportive therapy\n', 'Support'], ['Option 1 leaves the treatment incomplete\n', 'If asymptomatic, transretinoic acid (ATRA) will be started and day hospital controls will be recommended\n', 'Attack'], ["there is only ATRA and it must be treated as long as the patient's condition allows it, whether or not there are symptoms\n", 'Option 1 leaves the treatment incomplete\n', 'Support'], ['Option 3 3 years ago would have been the correct option but nowadays neither chemotherapy nor heparin is used\n', 'It is a myeloblastic leukemia type M3, so chemotherapy and heparin will be started to control disseminated intravascular coagulation\n', 'Attack'], ['that fever is due to the leukemia itself and the priority is to start specific treatment for leukemia\n', 'option 4 is false\n', 'Support'], ['option 4 is false\n', 'Antibiotic treatment should be started. When the fever disappears, leukemia treatment should be started\n', 'Attack']]
416_76
[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'with', 'dementia', 'and', 'institutionalized', 'is', 'brought', 'in', 'by', 'her', 'caregivers', 'for', 'significant', 'abdominal', 'pain', 'with', 'deterioration', 'of', 'general', 'condition', 'and', 'abdominal', 'distension.'], ['CBC', 'shows', 'leukocytosis,', 'elevated', 'hematocrit,', 'renal', 'failure', 'and', 'metabolic', 'acidosis.'], ['ECG', 'shows', 'atrial', 'fibrillation.'], ['Abdominal', 'tomography', 'shows', 'edematous', 'small', 'bowel', 'loops,', 'with', 'intestinal', 'and', 'portal', 'accumulation.'], ['The', 'most', 'probable', 'diagnosis', 'is:'], ['1-', 'Perforation', 'of', 'gastric', 'or', 'duodenal', 'ulcus.'], ['2-', 'Biliary', 'leak.'], ['3-', 'Obstructive', 'neoplasm', 'of', 'the', 'sigma', 'with', 'perforation.'], ['4-', 'Mesenteric', 'ischemia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'a', 'classic', 'picture', 'and', 'the', 'author', 'of', 'the', 'question', 'has', 'taken', 'care', 'to', 'give', 'us', 'enough', 'clues', 'so', 'that', 'we', 'do', 'not', 'miss', 'it.'], ['When', 'reading', 'this', 'statement,', 'multiple', 'alarms', 'go', 'off:', '-', 'Atrial', 'Fibrillation:', 'at', 'the', 'mir', 'and', 'at', 'the', 'ED', 'door,', 'any', 'elderly', 'person', 'with', 'AF', 'and', 'abdominal', 'pain', 'is', 'emboligenic', 'mesenteric', 'ischemia', 'until', 'proven', 'otherwise.'], ['-', 'Acute', 'abdominal', 'pain,', 'SIRS,', 'renal', 'failure,', 'metabolic', 'acidosis', '(ischemia!),', 'probably', 'an', 'elevated', 'lactic...'], ['-', 'CT:', 'The', 'finding', 'of', 'portal', 'gas', 'is', 'also', 'highly', 'indicative', 'of', 'mesenteric', 'ischemia,', 'we', 'could', 'also', 'have', 'been', 'told', 'of', 'intestinal', 'pneumatosis.'], ['Why', 'are', 'not', 'the', 'other', 'pictures?'], ['-', 'Perforated', 'ulcus:', 'We', 'would', 'have', 'been', 'told', 'of', 'a', 'history', 'of', 'NSAID', 'use,', 'or', 'a', 'history', 'of', 'pain', 'that', 'improves', 'with', 'ingestion,', 'of', 'pneumoperitoneum', 'on', 'chest', 'X-ray.'], ['-', 'Biliary', 'ileus:', 'There', 'would', 'be', 'a', 'history', 'of', 'biliary', 'colic', 'or', 'pain', 'in', 'the', 'right', 'hypochondrium,', 'they', 'would', 'also', 'speak', 'of', 'aerobilia', 'in', 'the', 'imaging', 'test', 'and', 'dilatation', 'of', 'the', 'small', 'loops', 'with', 'image', '(or', 'not)', 'of', 'biliary', 'lithiasis', 'in', 'the', 'terminal', 'ileum.'], ['-', 'Neo', 'sigmoidoscopy:', 'In', 'the', 'myocardial', 'imaging', 'they', 'would', 'speak', 'of', 'weight', 'loss,', 'change', 'of', 'stool', 'habit,', 'pneumoperitoneum', 'in', 'Rx', 'or', 'CT', 'and', 'peritonitic', 'abdominal', 'exploration', 'and', 'may', 'even', 'be', 'able', 'to', 'palpate', 'the', 'mass.']]
[['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'], ['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'], ['O', 'O', 'O', 'O', 'O'], ['O', 'B-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', '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', 'O', 'O', 'O'], ['O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-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'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'B-Premise', 'B-Premise', 'I-Premise', 'B-Premise', 'I-Premise', 'B-Claim', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', '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', '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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['Atrial Fibrillation\n', 'at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until proven otherwise\n', 'Support'], ['at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until proven otherwise\n', 'Mesenteric ischemia\n', 'Support'], ['Acute abdominal pain\n', 'ischemia\n', 'Support'], ['SIRS\n', 'ischemia\n', 'Support'], ['renal failure\n', 'ischemia\n', 'Support'], ['metabolic acidosis\n', 'ischemia\n', 'Support'], ['probably an elevated lactic...\n', 'ischemia\n', 'Support'], ['we could also have been told of intestinal pneumatosis\n', 'CT: The finding of portal gas is also highly indicative of mesenteric ischemia\n', 'Support'], ['ischemia\n', 'Mesenteric ischemia\n', 'Support'], ['CT: The finding of portal gas is also highly indicative of mesenteric ischemia\n', 'Mesenteric ischemia\n', 'Support'], ['Perforated ulcus: We would have been told of a history of NSAID use, or a history of pain that improves with ingestion, of pneumoperitoneum on chest X-ray\n', 'Perforation of gastric or duodenal ulcus\n', 'Attack'], ['Biliary ileus: There would be a history of biliary colic or pain in the right hypochondrium\n', 'Biliary leak\n', 'Attack'], ['they would also speak of aerobilia in the imaging test and dilatation of the small loops with image (or not) of biliary lithiasis in the terminal ileum\n', 'Biliary leak\n', 'Attack'], ['Neo sigmoidoscopy: In the myocardial imaging they would speak of weight loss, change of stool habit, pneumoperitoneum in Rx or CT and peritonitic abdominal exploration and may even be able to palpate the mass\n', 'Obstructive neoplasm of the sigma with perforation\n', 'Attack']]
45_154
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336_31
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'woman', 'with', 'a', '15-cm', 'solid-cystic', 'ovarian', 'tumor', 'detected', 'by', 'ultrasound', 'after', 'presenting', 'with', 'nonspecific', 'abdominal', 'symptoms.'], ['In', 'the', 'histopathological', 'study', 'of', 'the', 'corresponding', 'specimen,', 'teeth,', 'hairs,', 'areas', 'of', 'intestinal', 'epithelium,', 'areas', 'of', 'squamous', 'epithelium', '(15%)', 'and', 'bronchial', 'epithelium,', 'as', 'well', 'as', 'neuroectodermal', 'and', 'embryonal', '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:', '3'], ['Mature', 'cystic', 'teratoma', 'is', 'a', 'common', 'benign', 'tumor', 'of', 'the', 'ovary', 'in', 'adult', 'women.'], ['The', 'tissues', 'that', 'make', 'up', 'the', 'tumor', 'are', 'well', 'differentiated', '(mature', 'or', 'adult-type);', 'apart', 'from', 'cutaneous', 'structures', 'many', 'other', 'tissues', 'can', 'be', 'seen,', 'particularly', 'in', 'a', 'thickening', 'or', 'spur', 'that', 'eminences', 'into', 'the', 'cavity,', 'in', 'which', 'there', 'are', 'often', 'teeth,', 'cartilage', 'and', 'bone.']]
[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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', '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']]
[['In the histopathological study of the corresponding specimen, teeth, hairs, areas of intestinal epithelium, areas of squamous epithelium (15%) and bronchial epithelium, as well as neuroectodermal and embryonal elements are found in several of the histological preparations\n', 'apart from cutaneous structures many other tissues can be seen, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n', 'Support'], ['A 20-year-old woman with a 15-cm solid-cystic ovarian tumor detected by ultrasound after presenting with nonspecific abdominal symptoms\n', 'The tissues that make up the tumor are well differentiated (mature or adult-type)\n', 'Support'], ['The tissues that make up the tumor are well differentiated (mature or adult-type)\n', 'Mature cystic teratoma is a common benign tumor of the ovary in adult women\n', 'Support'], ['apart from cutaneous structures many other tissues can be seen, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n', 'Mature cystic teratoma is a common benign tumor of the ovary in adult women\n', 'Support'], ['Mature cystic teratoma is a common benign tumor of the ovary in adult women\n', 'Mature cystic teratoma\n', 'Support']]
609_115
[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'male,', 'a', 'regular', 'athlete,', 'refers', 'pain', 'in', 'the', 'right', 'leg', 'after', 'continuous', 'running.'], ['He', 'has', 'visited', 'a', 'physiotherapist', 'on', 'several', 'occasions', 'and', 'has', 'been', 'diagnosed', 'with', 'calf', 'overload.'], ['Several', 'months', 'have', 'passed,', 'she', 'has', 'not', 'improved', 'and', 'refers', 'intense', 'pain', 'after', 'physical', 'activity', 'that', 'subsides', 'with', 'rest', 'in', 'the', 'hours', 'following', 'exercise.'], ['What', 'test', 'can', 'help', 'in', 'the', 'diagnosis?'], ['1-', 'Positron', 'emission', 'tomography', 'with', '18', 'FDG.'], ['2-', 'Determination', 'of', 'posterior', 'compartment', 'pressure', 'immediately', 'after', 'activity.'], ['3-', 'Doppler', 'ultrasound', 'to', 'rule', 'out', 'a', 'circulatory', 'disorder', 'of', 'the', 'lower', 'extremity.'], ['4-', 'Magnetic', 'resonance', 'spectroscopy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Exercise-induced', 'compartment', 'syndrome', 'is', 'an', 'exercise-induced', 'condition', 'of', 'the', 'leg.'], ['It', 'is', 'characterized', 'by', 'reversible', 'ischemia', 'of', 'the', 'muscles', 'of', 'a', 'muscle', 'compartment.'], ['Diagnosis', 'is', 'made', 'by', 'measuring', 'compartment', 'pressures', 'at', 'rest,', 'during', 'exercise', 'and', 'after', 'exercise', '(answer', '2', 'correct).'], ['Treatment', 'usually', 'consists', 'of', 'fasciotomies', 'of', 'the', 'affected', 'compartments.'], ['Although', 'MRI', 'is', 'not', 'very', 'useful', 'in', 'establishing', 'the', 'diagnosis,', 'it', 'can', 'help', 'in', 'the', 'differential', 'diagnosis.']]
[['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'], ['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'], ['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'], ['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-Diagnostics', 'I-Diagnostics', 'I-Diagnostics'], ['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-Claim', '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'], ['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']]
[['Several months have passed, she has not improved and refers intense pain after physical activity that subsides with rest in the hours following exercise\n', 'Exercise-induced compartment syndrome is an exercise-induced condition of the leg\n', 'Support'], ['Diagnosis is made by measuring compartment pressures at rest, during exercise and after exercise\n', 'answer 2 correct\n', 'Support'], ['answer 2 correct\n', 'Determination of posterior compartment pressure immediately after activity\n', 'Support']]
389_235
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201_76
[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'who', 'presents', 'with', 'problems', 'in', 'understanding', 'spoken', 'and', 'written', 'language,', 'inability', 'to', 'name', 'objects', 'and', 'repeat', 'words', 'that', 'are', 'said', 'to', 'him,', 'incomprehensible', 'fluent', 'speech', 'with', 'semantic', 'and', 'phonemic', 'paraphasias.'], ['This', 'is', 'a:'], ['1-', 'Global', 'aphasia.'], ['2-', "Wernicke's", 'aphasia.'], ['3-', "Broca's", 'aphasia.'], ['4-', 'Sensitive', 'transcortical', 'aphasia.'], ['5-', 'Transcortical', 'motor', 'aphasia.'], ['CORRECT', 'ANSWER:', '2'], ['Transcortical', 'have', 'preserved', 'repetition.'], ["Broca's", 'aphasia', 'has', 'preserved', 'comprehension', 'and', 'absence', 'of', 'fluent', 'speech.'], ["Wernicke's", 'aphasia', 'is', 'characterized', 'by', 'fluent', 'speech', '(even', 'in', 'excess)', 'with', 'paraphasias', 'and', 'problems', 'with', 'comprehension,', 'nomination', 'and', 'repetition.']]
[['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'], ['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', 'B-Claim', 'I-Claim', 'I-Claim'], ['O', 'O', 'O'], ['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'], ['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']]
[['Transcortical have preserved repetition\n', 'Sensitive transcortical aphasia\n', 'Attack'], ["Broca's aphasia has preserved comprehension and absence of fluent speech\n", "Broca's aphasia\n", 'Attack'], ["Wernicke's aphasia is characterized by fluent speech (even in excess) with paraphasias and problems with comprehension, nomination and repetition\n", "Wernicke's aphasia\n", 'Support']]
345_159
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '69-year-old', 'woman', 'comes', 'to', 'your', 'office', 'reporting', 'genital', 'bleeding', 'of', 'several', "months'", 'evolution.'], ['She', 'denies', 'hormone', 'replacement', 'therapy', 'and', 'anticoagulation.'], ['She', 'provides', 'normal', 'cervicovaginal', 'cytology.'], ['General', 'and', 'genital', 'physical', 'examination', 'without', 'findings', 'of', 'interest.'], ['BMI', 'of', '38kg/m2.'], ['Indicate', 'the', 'most', 'correct', 'attitude:'], ['1-', 'Prescribe', 'cyclic', 'progesterone.'], ['2-', 'Endometrial', 'biopsy.'], ['3-', 'Random', 'cervical', 'biopsies.'], ['4-', 'Hormonal', 'evaluation', 'with', 'FSH,', 'LH', 'and', 'estradiol.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'are', 'being', 'presented', 'with', 'a', 'case', 'of', 'postmenopausal', 'metrorrhagia.'], ['In', 'a', 'case', 'like', 'this', 'we', 'must', 'rule', 'out', 'endometrial', 'neoplasia,', 'so', 'an', 'endometrial', 'biopsy', 'would', 'be', 'indicated,', 'either', 'by', 'Cornier', 'cannula', 'if', 'possible,', 'or', 'by', 'hysteroscopy.'], ['A', 'cervical', 'biopsy', 'is', 'not', 'of', 'interest', 'in', 'this', 'case', 'since', 'the', 'cytology', 'is', 'normal', 'and', 'hormonal', 'assessment', 'is', 'not', 'going', 'to', 'be', 'useful', 'in', 'the', 'diagnosis', 'of', 'endometrial', 'neoplasia.'], ['Finally,', 'prescribing', 'cyclic', 'progesterone', 'is', 'not', 'indicated', 'in', 'a', 'postmenopausal', 'woman.']]
[['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'], ['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'], ['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'], ['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', '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-Marker', 'B-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', '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']]
[['In a case like this we must rule out endometrial neoplasia\n', 'an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy\n', 'Support'], ['We are being presented with a case of postmenopausal metrorrhagia\n', 'In a case like this we must rule out endometrial neoplasia\n', 'Support'], ['an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy\n', 'Endometrial biopsy.\n', 'Support'], ['A cervical biopsy is not of interest in this case\n', 'Random cervical biopsies\n', 'Attack'], ['the cytology is normal\n', 'A cervical biopsy is not of interest in this case\n', 'Support'], ['hormonal assessment is not going to be useful in the diagnosis of endometrial neoplasia\n', 'A cervical biopsy is not of interest in this case\n', 'Support'], ["A 69-year-old woman comes to your office reporting genital bleeding of several months' evolution\n", 'Finally, prescribing cyclic progesterone is not indicated in a postmenopausal woman\n', 'Support'], ['Finally, prescribing cyclic progesterone is not indicated in a postmenopausal woman\n', 'Prescribe cyclic progesterone\n', 'Attack']]
166_82
[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'CARDIOVASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'presents', 'arterial', 'hypertension', '(190/120', 'mmHg)', 'accompanied', 'by', 'K', '2.5', 'mEq/l.'], ['An', 'abdominal', 'ultrasound', 'shows', 'stenosis', 'of', 'both', 'renal', 'arteries.'], ['Indicate', 'which', 'treatment', 'is', 'contraindicated:'], ['1-', 'Enalapril.'], ['2-', 'Propanolol.'], ['3-', 'Amiloride.'], ['4-', 'Prazosin.'], ['5-', 'Amlodipine.'], ['CORRECT', 'ANSWER:', '1'], ['If', 'the', 'renal', 'arteries', 'are', 'stenosed,', 'blood', 'has', 'difficulty', 'reaching', 'the', 'kidneys.'], ['That', 'is,', 'both', 'are', 'poorly', 'perfused', 'and', 'can', 'only', 'create', 'the', 'pressure', 'gradient', 'necessary', 'for', 'filtration', 'by', 'contraction', 'of', 'the', 'efferent', 'arteriole.'], ['If', 'we', 'administer', 'an', 'ACEI,', 'we', 'will', 'provoke', 'the', 'relaxation', 'of', 'this', 'arteriole', 'and', 'the', 'fall', 'of', 'the', 'glomerular', 'filtration', 'rate.'], ['And', 'if', 'neither', 'kidney', 'filters,', 'because', 'both', 'have', 'arterial', 'stenosis,', 'we', 'have', 'a', 'problem....']]
[['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', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-Claim'], ['O', 'B-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'], ['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'], ['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']]
[['An abdominal ultrasound shows stenosis of both renal arteries\n', 'If the renal arteries are stenosed, blood has difficulty reaching the kidneys\n', 'Support'], ['If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate\n', 'Enalapril\n', 'Support'], ['If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate\n', 'And if neither kidney filters, because both have arterial stenosis, we have a problem\n', 'Support']]
481_171
null
null
[]
612_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'], ['Correct', 'Answer', '1:', 'Given', 'that', 'this', 'is', 'a', 'displaced', 'subcapital', 'hip', 'fracture,', 'the', 'surgical', 'treatment', 'we', 'should', 'consider', 'is', 'hip', 'joint', 'replacement,', 'given', 'that', 'the', 'injury', 'described', 'presents', 'a', 'high', 'probability', 'of', 'necrosis', 'of', 'the', 'femoral', 'head.'], ['The', 'options', 'would', 'be', 'total', 'or', 'partial', 'arthroplasty:', 'in', 'elderly', 'patients,', 'partial', 'arthroplasty', 'is', 'preferred', 'because', 'it', 'is', 'a', 'shorter', 'and', 'less', 'aggressive', 'surgery', 'than', 'total', 'hip', 'arthroplasty.'], ['Answer', '2', 'incorrect:', 'We', 'would', 'consider', 'this', 'technique', 'in', 'basicervical', 'fractures', 'and', 'trochanteric', 'mass', 'lesions,', 'not', 'in', 'subcapital', 'fractures.'], ['Incorrect', 'Answer', '3:', 'We', 'would', 'consider', 'this', 'technique', 'in', 'nondisplaced', 'subcapital', 'fractures', 'in', 'young', 'patients.'], ['Incorrect', 'answer', '4:', 'We', 'would', 'only', 'consider', 'non-surgical', 'treatment', 'in', 'a', 'patient', 'with', 'a', 'very', 'poor', 'baseline', 'general', 'condition:', 'bedridden', 'patients', 'with', 'low', 'life', 'expectancy.']]
[['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-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'], ['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'], ['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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, given that the injury described presents a high probability of necrosis of the femoral head\n', 'Correct Answer 1\n', 'Support'], ['Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, given that the injury described presents a high probability of necrosis of the femoral head\n', 'The options would be total or partial arthroplasty\n', 'Support'], ['Correct Answer 1\n', 'Hip hemiarthroplasty\n', 'Support'], ['in elderly patients, partial arthroplasty is preferred because it is a shorter and less aggressive surgery than total hip arthroplasty\n', 'Hip hemiarthroplasty\n', 'Support'], ['We would consider this technique in basicervical fractures and trochanteric mass lesions, not in subcapital fractures\n', 'Answer 2 incorrect\n', 'Support'], ['Answer 2 incorrect\n', 'Trochanteric nail fixation\n', 'Attack'], ['We would consider this technique in nondisplaced subcapital fractures in young patients\n', 'Incorrect Answer 3\n', 'Support'], ['We would only consider non-surgical treatment in a patient with a very poor baseline general condition: bedridden patients with low life expectancy\n', 'Incorrect answer 4\n', 'Support'], ['Incorrect answer 4\n', 'Conservative: bed-chair life\n', 'Attack']]
585_74
[['QUESTION', 'TYPE:', 'OBSTETRICS', 'AND', 'GYNECOLOGY'], ['CLINICAL', 'CASE:'], ['34-week', 'primigravida', 'with', 'blood', 'pressure', 'of', '165/95', 'and', 'headache', 'of', 'two', 'days', 'of', 'evolution.'], ['Laboratory', 'tests:', 'hemoglobin', '10.5', 'g/dL,', 'platelets', '98,000/mm3,', 'AST', '356', 'IU/L', '(0-31),', 'ALT', '234', 'IU/L', '(0-31),', 'LDH', '878', 'IU/L', '(125-243).'], ['The', 'laboratory', 'is', 'called', 'because', 'of', 'the', 'presence', 'of', 'schistocytes', 'in', 'the', 'peripheral', 'blood', 'smear.'], ['She', 'received', 'the', 'second', 'dose', 'of', 'corticosteroids', 'for', 'fetal', 'maturation', '24', 'hours', 'ago.'], ['On', 'obstetric', 'ultrasound', 'the', 'estimated', 'fetal', 'weight', 'is', 'in', 'the', '1st', 'percentile', 'for', 'gestational', 'age', 'and', 'the', 'umbilical', 'artery', 'Doppler', 'shows', 'absence', 'of', 'end-diastolic', 'flow.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'indicated', 'clinical', 'approach?'], ['1-', 'Expectant', 'management', 'with', 'antihypertensive', 'drugs', 'and', 'magnesium', 'sulfate', 'until', 'the', 'maternal', 'platelets', 'improve.'], ['2-', 'Expectant', 'attitude', 'with', 'antihypertensive', 'treatment', 'at', 'home', 'and', 'controls', 'every', '48', 'hours.'], ['3-', 'Termination', 'of', 'gestation', 'when', 'she', 'completes', 'fetal', 'lung', 'maturation.'], ['4-', 'Immediate', 'termination', 'of', 'pregnancy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['They', 'are', 'describing', 'HELLP', 'syndrome.'], ['With', 'these', 'weeks', 'of', 'gestation', 'and', 'with', 'the', 'fetus', 'recently', 'matured', '(she', 'has', 'already', 'been', 'given', 'two', 'doses', 'of', 'corticosteroids),', 'the', 'attitude', 'is', 'immediate', 'termination.']]
[['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'], ['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'], ['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', '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'], ['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', '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']]
[['Laboratory tests: hemoglobin 10.5 g/dL, platelets 98,000/mm3, AST 356 IU/L (0-31), ALT 234 IU/L (0-31), LDH 878 IU/L (125-243)\n', 'They are describing HELLP syndrome\n', 'Support'], ['34-week primigravida with blood pressure of 165/95 and headache of two days of evolution\n', 'They are describing HELLP syndrome\n', 'Support'], ['The laboratory is called because of the presence of schistocytes in the peripheral blood smear\n', 'They are describing HELLP syndrome\n', 'Support'], ['They are describing HELLP syndrome\n', 'With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n', 'Support'], ['With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n', 'Immediate termination of pregnancy\n', 'Support'], ['She received the second dose of corticosteroids for fetal maturation 24 hours ago\n', 'With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n', 'Support'], ['On obstetric ultrasound the estimated fetal weight is in the 1st percentile for gestational age and the umbilical artery Doppler shows absence of end-diastolic flow\n', 'With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n', 'Support']]
3_37
[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', '76-year-old', 'woman', 'with', 'no', 'history', 'other', 'than', 'hypertension', 'consults', 'for', 'painless', 'jaundice', 'and', 'pruritus', 'with', 'anorexia.'], ['Laboratory', 'tests', 'show', 'bilirubin', 'of', '12', 'mg/dl', '(9.5', 'direct).'], ['Ultrasound', 'shows', 'intrahepatic', 'and', 'extrahepatic', 'biliary', 'dilatation', 'together', 'with', 'a', 'single', 'hepatic', 'nodule', 'smaller', 'than', '2', 'cm', 'located', 'peripherally', 'on', 'the', 'anterior', 'aspect', 'of', 'the', 'left', 'lobe.'], ['The', 'CT', 'scan', 'confirms', 'these', 'findings', 'also', 'demonstrating', 'the', 'presence', 'of', 'a', 'pancreatic', 'mass', 'of', '3.5', 'cm.', 'In', 'the', 'pancreatic', 'head.'], ['The', 'aspiration', 'puncture', 'of', 'the', 'hepatic', 'nodule', 'is', 'conclusive', 'for', 'adenocarcinoma.'], ['Indicate', 'the', 'best', 'therapeutic', 'option:'], ['1-', 'Neoadjuvant', 'chemo/radiotherapy,', 'conditioning', 'the', 'option', 'of', 'radical', 'surgery', 'on', 'initial', 'response.'], ['2-', 'Percutaneous', 'external', 'biliary', 'drainage', 'with', 'palliative', 'character', 'with', 'eventual', 'reconversion', 'to', 'internal', 'drainage', 'in', 'case', 'of', 'intolerance', 'or', 'complications.'], ['3-', 'Palliative', 'surgical', 'biliary', 'bypass', 'with', 'or', 'without', 'prophylactic', 'gastrojejunostomy', 'depending', 'on', 'intraoperative', 'findings.'], ['4-', 'Metallic', 'biliary', 'prosthesis', 'by', 'endoscopic', 'retrograde', 'cholangiopancreatography', 'with', 'the', 'option', 'of', 'palliative', 'chemotherapy.'], ['5-', 'Cephalic', 'duodenopancreatectomy,', 'with', 'percutaneous', 'ablation', 'by', 'radiofrequency', 'or', 'alcoholization', 'of', 'the', 'hepatic', 'lesion.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'case', 'does', 'not', 'seem', 'so', 'easy', 'to', 'me.'], ['It', 'is', 'a', 'pancreatic', 'adenocarcinoma', 'with', 'metastasis,', 'so', 'the', 'treatment', 'should', 'be', 'palliative,', 'so', 'we', 'remove', 'options', '1', 'and', '5.'], ['In', 'principle', 'she', 'is', 'a', 'patient', 'in', 'moderately', 'good', 'general', 'condition,', 'so', 'the', 'ideal', 'would', 'be', 'to', 'perform', 'a', 'permanent', 'biliary', 'diversion', 'and', 'chemotherapy,', 'option', '4', 'being', 'the', 'one', 'I', 'consider', 'most', 'correct.']]
[['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'], ['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', 'I-Premise', 'I-Premise', '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', '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', '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'], ['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', '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'], ['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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5\n', 'Neoadjuvant chemo/radiotherapy, conditioning the option of radical surgery on initial response\n', 'Attack'], ['It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5\n', 'Cephalic duodenopancreatectomy, with percutaneous ablation by radiofrequency or alcoholization of the hepatic lesion\n', 'Attack'], ['the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct\n', 'Metallic biliary prosthesis by endoscopic retrograde cholangiopancreatography with the option of palliative chemotherapy\n', 'Support'], ['In principle she is a patient in moderately good general condition\n', 'the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct\n', 'Support']]
439_96
[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'woman.'], ['Menopause', 'at', '54', 'years', 'of', 'age.'], ['Two', 'pregnancies', 'and', 'eutocic', 'deliveries.'], ['She', 'does', 'not', 'take', 'any', 'medication.'], ['She', 'comes', 'to', 'the', 'emergency', 'department', 'reporting', 'two', 'days', 'of', 'vaginal', 'bleeding', 'with', 'discomfort', 'in', 'the', 'hypogastrium.'], ['The', 'clinical', 'examination', 'performed', 'by', 'the', 'gynecologist', 'does', 'not', 'show', 'any', 'lesions', 'in', 'the', 'external', 'genitalia,', 'vagina', 'or', 'cervix.'], ['Vaginal', 'examination', 'is', 'inconclusive.'], ['Which', 'of', 'the', 'following', 'seems', 'to', 'you', 'to', 'be', 'the', 'most', 'appropriate', 'first', 'diagnostic', 'approach?'], ['1-', 'Transvaginal', 'ultrasound', 'and', 'measurement', 'of', 'endometrial', 'thickness.', 'Depending', 'on', 'this,', 'an', 'endometrial', 'biopsy', 'should', 'be', 'taken', 'or', 'not.'], ['2-', 'Endometrial', 'biopsy', 'by', 'aspiration', 'in', 'consultation.', 'With', 'it', 'I', 'can', 'get', 'the', 'diagnosis', 'very', 'reliably', 'and', 'it', 'is', 'inexpensive.'], ['3-', 'Hysteroscopy', 'with', 'sedation', 'and', 'directed', 'biopsy', 'if', 'a', 'lesion', 'is', 'seen.'], ['4-', 'I', 'would', 'perform', 'a', 'microbleed,', 'since', 'it', 'is', 'the', 'test', 'that', 'would', 'provide', 'me', 'with', 'the', 'definitive', 'diagnosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Since', 'the', 'most', 'frequent', 'cause', 'of', 'vaginal', 'bleeding', 'in', 'postmenopausal', 'women', 'is', 'urogenital', 'atrophy,', 'the', 'existence', 'of', 'an', 'endometrial', 'pathology', 'cannot', 'be', 'ruled', 'out.'], ['According', 'to', 'the', 'SEGO:', '"Abnormal', 'genital', 'bleeding', 'is', 'the', 'main', 'sign', 'of', 'suspicion', 'that', 'should', 'lead', 'us', 'to', 'rule', 'out', 'an', 'endometrial', 'neoplastic', 'pathology,', 'particularly', 'in', 'postmenopausal', 'patients,', 'or', 'those', 'with', 'associated', 'risk', 'factors', '(...)', 'Given', 'the', 'sign', 'of', 'suspicion,', 'the', 'performance', 'of', 'a', 'transvaginal', 'ultrasound,', 'or', 'in', 'its', 'absence', 'transrectal,', 'allows', 'us', 'to:', 'rule', 'out', 'organic', 'pathology', '(fibroids,', 'polyps);', 'measurement', 'of', 'endometrial', 'thickness', 'in', 'a', 'longitudinal', 'cut.'], ['It', 'is', 'recommended', 'to', 'use', 'a', 'cut-off', 'point', 'of', '3mm', 'for', 'endometrial', 'biopsy', 'in', 'the', 'symptomatic', 'patient".']]
[['O', 'O', 'O', 'O', 'O'], ['O', 'O'], ['B-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'], ['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'], ['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', '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', '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'], ['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', '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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['Since the most frequent cause of vaginal bleeding in postmenopausal women is urogenital atrophy, the existence of an endometrial pathology cannot be ruled out\n', 'Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n', 'Support'], ['According to the SEGO: "Abnormal genital bleeding is the main sign of suspicion that should lead us to rule out an endometrial neoplastic pathology, particularly in postmenopausal patients, or those with associated risk factors (...)\n', 'Given the sign of suspicion, the performance of a transvaginal ultrasound, or in its absence transrectal, allows us to: rule out organic pathology (fibroids, polyps); measurement of endometrial thickness in a longitudinal cut\n', 'Support'], ['Given the sign of suspicion, the performance of a transvaginal ultrasound, or in its absence transrectal, allows us to: rule out organic pathology (fibroids, polyps); measurement of endometrial thickness in a longitudinal cut\n', 'Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n', 'Support'], ['It is recommended to use a cut-off point of 3mm for endometrial biopsy in the symptomatic patient\n', 'Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n', 'Support']]
192_160
[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['The', 'parents', 'of', 'a', '5-month-old', 'infant', 'come', 'because', 'their', 'child,', 'who', 'attends', 'day', 'care,', 'has', 'been', 'presenting', 'for', '3', 'days,', 'coinciding', 'with', 'an', 'upper', 'respiratory', 'tract', 'infection,', 'liquid', 'stools', 'numbering', '4', 'per', 'day,', 'occasional', 'alimentary', 'vomiting,', 'and', 'axillary', 'temperature', 'of', '38.3°C.'], ['He', 'is', 'being', 'fed', 'with', 'mixed', 'breastfeeding.'], ['On', 'examination', 'the', 'infant', 'is', 'in', 'good', 'general', 'condition,', 'is', 'well', 'nourished', 'and', 'hydrated', 'and', 'his', 'breathing', 'is', 'eupneic;', 'his', 'weight', 'is', '4,730g', 'and', 'has', 'decreased', 'by', '70g', 'with', 'respect', 'to', 'the', 'previous', 'week.'], ['The', 'abdomen', 'is', 'soft', 'and', 'depressible,', 'without', 'masses', 'or', 'megaliths,', 'and', 'the', 'fontanel', 'is', 'normotensive.'], ['Except', 'for', 'the', 'presence', 'of', 'watery', 'rhinorrhea,', 'the', 'rest', 'of', 'the', 'examination', 'by', 'organs', 'and', 'devices', 'is', 'normal.'], ['Of', 'the', 'following', 'statements,', 'indicate', 'the', 'answer', 'that', 'you', 'consider', 'CORRECT:'], ['1-', 'An', 'estimation', 'of', 'losses', 'should', 'be', 'made,', 'recommend', 'a', '4-hour', 'fast', 'and', 'rehydrate', 'during', 'this', 'time', 'with', 'oral', 'rehydration', 'solution.'], ['2-', 'It', 'is', 'advisable', 'to', 'introduce', 'rice', 'cereals', 'for', 'their', 'astringent', 'effect.'], ['3-', 'A', 'stool', 'culture', 'should', 'be', 'performed', 'as', 'soon', 'as', 'possible', 'to', 'exclude', 'a', 'bacterial', 'origin.'], ['4-', 'The', 'use', 'of', 'lactose-free', 'formula', 'should', 'be', 'recommended.'], ['5-', 'It', 'is', 'advisable', 'to', 'replace', 'losses', 'after', 'each', 'bowel', 'movement', 'with', 'oral', 'rehydration', 'solution', 'and', 'continue', 'with', 'the', "patient's", 'usual', 'diet.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'baby', 'is', 'not', 'dehydrated', 'and', 'is', 'in', 'good', 'general', 'condition.'], ['Try', 'to', 'avoid', 'dehydration', 'by', 'replenishing', 'what', 'is', 'being', 'lost,', 'avoiding', 'drastic', 'changes', 'in', 'feeding', 'habits', 'as', 'much', 'as', 'possible.'], ['The', 'rest', 'of', 'the', 'answers', 'touch', 'on', 'many', 'of', 'the', '"myths"', 'and', 'customs', 'surrounding', 'gastroenteritis.'], ['There', 'is', 'also', 'no', 'evidence', 'of', 'lactose', 'intolerance', '(perianal', 'irritation,', 'frothy', 'and', 'acid', 'stools,', 'etc.)', 'that', 'would', 'advise', 'lactose-free', 'milk.']]
[['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'], ['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', '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', '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', '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', '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', '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'], ['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'], ['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']]
[['On examination the infant is in good general condition, is well nourished and hydrated and his breathing is eupneic; his weight is 4,730g and has decreased by 70g with respect to the previous week\n', 'The baby is not dehydrated and is in good general condition\n', 'Support'], ['The abdomen is soft and depressible, without masses or megaliths, and the fontanel is normotensive\n', 'The baby is not dehydrated and is in good general condition\n', 'Support'], ['Except for the presence of watery rhinorrhea, the rest of the examination by organs and devices is normal\n', 'The baby is not dehydrated and is in good general condition\n', 'Support'], ['Try to avoid dehydration by replenishing what is being lost, avoiding drastic changes in feeding habits as much as possible\n', "It is advisable to replace losses after each bowel movement with oral rehydration solution and continue with the patient's usual diet\n", 'Support'], ['There is also no evidence of lactose intolerance (perianal irritation, frothy and acid stools, etc.) that would advise lactose-free milk\n', 'The use of lactose-free formula should be recommended\n', 'Attack']]
261_100
null
null
[]
289_65
[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Point', 'out', 'from', 'among', 'the', 'following', 'the', 'most', 'likely', 'complication', 'presented', 'by', 'a', 'patient', 'operated,', '20', 'years', 'ago,', 'of', 'gastric', 'ulcer', 'by', 'antrectomy', 'and', 'gastrojejunostomy', '(Billroth', 'II)', 'who', 'comes', 'to', 'your', 'office', 'referring', 'postpradial', 'abdominal', 'pain,', 'abdominal', 'distension,', 'diarrhea', 'and', 'analytical', 'data', 'of', 'malabsorption', 'of', 'fats', 'and', 'vitamin', 'B12:'], ['1-', 'Biliary', 'reflux', 'gastropathy.'], ['2-', 'Gastric', 'adenocarcinoma.'], ['3-', 'Rapid', 'gastric', 'emptying', 'syndrome', '(dumping).'], ['4-', 'Afferent', 'loop', 'syndrome', 'with', 'bacterial', 'overgrowth.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'statement', 'has', 'described', 'the', 'clinical', 'features', 'of', 'this', 'syndrome.'], ['It', 'is', 'usually', 'a', 'late', 'complication', '(the', 'patient', 'was', 'operated', '20', 'years', 'ago', 'for', 'a', 'Bilroth', 'II,', 'remember', 'that', 'it', 'is', 'a', 'partial', 'gastrectomy,', 'closure', 'of', 'the', 'gastric', 'stump', 'and', 'anastomosis', 'of', 'the', 'first', 'jejunal', 'loop', 'to', 'the', 'stump),', 'it', 'is', 'accompanied', 'by', 'postprandial', 'pain,', 'abdominal', 'distension.'], ['What', 'has', 'occurred', 'is', 'a', 'stenosis', 'of', 'the', 'afferent', 'loop,', 'so', 'that', 'biliary', 'and', 'pancreatic', 'secretions', 'do', 'not', 'mix', 'with', 'the', 'bolus,', 'they', 'accumulate,', 'produce', 'pain', 'that', 'is', 'relieved', 'by', 'vomiting,', 'fat', 'absorption', 'is', 'not', 'possible', '(lack', 'of', 'pancreatic', 'lipase),', 'so', 'there', 'is', 'diarrhea,', 'and', 'if', 'associated', 'with', 'bacterial', 'overgrowth,', 'there', 'is', 'malabsorption', 'of', 'vitamin', 'B12.'], ['If', 'it', 'were', 'gastric', 'adenocarcinoma,', 'they', 'would', 'have', 'spoken', 'of', 'constitutional', 'syndrome,', 'extradigestive', 'manifestations', '(sister', 'Maria', 'Jose', 'node,', 'Krukenberg', 'tumor,', 'Virchow', 'node).'], ['It', 'is', 'not', 'dumping', 'because', 'it', 'does', 'not', 'speak', 'of', 'vegetative', 'symptoms', '(palpitations,', 'facial', 'flushing,', 'etc...).'], ['Biliary', 'reflux', 'gastropathy', 'is', 'an', 'endoscopic', 'diagnosis,', 'moreover', 'it', 'is', 'not', 'associated', 'with', 'diarrhea', 'or', 'malabsorption.']]
[['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', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['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'], ['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', '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-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', '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'], ['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', '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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]
[['the patient was operated 20 years ago for a Bilroth II\n', 'It is usually a late complication\n', 'Support'], ['If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node)\n', 'Gastric adenocarcinoma\n', 'Attack'], ['a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n', 'If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node)\n', 'Attack'], ['It is not dumping\n', 'Rapid gastric emptying syndrome (dumping)\n', 'Attack'], ['it does not speak of vegetative symptoms (palpitations, facial flushing, etc...)\n', 'It is not dumping\n', 'Support'], ['a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n', 'it does not speak of vegetative symptoms (palpitations, facial flushing, etc...)\n', 'Support'], ['a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n', 'moreover it is not associated with diarrhea or malabsorption\n', 'Attack'], ['Biliary reflux gastropathy is an endoscopic diagnosis\n', 'Biliary reflux gastropathy\n', 'Attack'], ['moreover it is not associated with diarrhea or malabsorption\n', 'Biliary reflux gastropathy\n', 'Attack'], ['a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n', 'there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12\n', 'Support'], ['a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n', 'What has occurred is a stenosis of the afferent loop, so that biliary and pancreatic secretions do not mix with the bolus, they accumulate, produce pain that is relieved by vomiting, fat absorption is not possible (lack of pancreatic lipase)\n', 'Support'], ['What has occurred is a stenosis of the afferent loop, so that biliary and pancreatic secretions do not mix with the bolus, they accumulate, produce pain that is relieved by vomiting, fat absorption is not possible (lack of pancreatic lipase)\n', 'Afferent loop syndrome with bacterial overgrowth\n', 'Support'], ['there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12\n', 'Afferent loop syndrome with bacterial overgrowth\n', 'Support']]
366_106
[['QUESTION', 'TYPE:', 'PNEUMOLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'man', 'from', 'Cameroon', 'consults', 'for', 'fever', 'cough', 'and', 'left', 'hemithorax', 'pain', 'of', '1', 'month', 'of', 'evolution.'], ['He', 'took', 'amoxicillin-clavulanic', 'acid', 'for', '1', 'week', 'without', 'improvement', 'of', 'symptoms.'], ['A', 'blood', 'test', 'showed', 'a', 'white', 'blood', 'cell', 'count', 'of', '8000/microL', 'and', 'a', 'hemoglobin', 'of', '12.8', 'g/dL.'], ['Chest', 'X-ray', 'shows', 'a', 'loculated', 'left', 'pleural', 'effusion', 'occupying', 'one', 'third', 'of', 'the', 'hemithorax.'], ['A', 'thoracentesis', 'shows', 'a', 'yellowish', 'fluid', 'with', 'the', 'following', 'features:', 'red', 'blood', 'cells', '2000/µL,', 'leukocytes', '2500/µL', 'with', '90%', 'lymphocytes,', 'protein', '4.9', 'g/dL,', 'lactate', 'dehydrogenase', '550', 'VIL,', 'glucose', '67', 'mg/dL,', 'and', 'absence', 'of', 'malignant', 'cells', 'on', 'cytologic', 'study.'], ['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', 'pleural', 'fluid', 'adenosine', 'deaminase.'], ['4-', 'Tuberculin', 'test.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Suspicion', 'is', 'very', 'high', 'for', 'tuberculous', 'pleural', 'effusion,', 'in', 'a', 'young', 'patient', 'from', 'an', 'area', 'with', 'a', 'high', 'rate', 'of', 'TB,', 'a', 'lymphocytic', 'exudate', 'pointing', 'to', 'TB,', 'lymphoma', 'or', 'tumor.'], ['Tumor', 'unlikely', 'due', 'to', 'age,', 'negative', 'cytology.'], ['Lymphoma', 'could', 'be', 'but', 'no', 'evidence', 'of', 'associated', 'nodal', 'pathology.'], ['High', 'adenosine', 'deaminase', 'in', 'LP', 'would', 'point', 'with', 'great', 'certainty', 'to', 'a', 'pleural', 'TB', 'although', 'it', 'would', 'be', 'advisable', 'to', 'confirm', 'the', 'diagnosis', 'with', 'a', 'pleural', 'biopsy', 'since', 'it', 'can', 'also', 'occur', 'in', 'lymphomas', 'and', 'empyemas', 'of', 'other', 'origin.']]
[['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'], ['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', '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'], ['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', '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-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', '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']]
[['a young patient from an area with a high rate of TB, a lymphocytic exudate pointing to TB, lymphoma or tumor\n', 'Suspicion is very high for tuberculous pleural effusion\n', 'Support'], ['Suspicion is very high for tuberculous pleural effusion\n', 'Measurement of pleural fluid adenosine deaminase\n', 'Support'], ['A 32-year-old man from Cameroon consults for fever cough and left hemithorax pain of 1 month of evolution\n', 'Tumor unlikely due to age, negative cytology\n', 'Support'], ['A thoracentesis shows a yellowish fluid with the following features: red blood cells 2000/µL, leukocytes 2500/µL with 90% lymphocytes, protein 4.9 g/dL, lactate dehydrogenase 550 VIL, glucose 67 mg/dL, and absence of malignant cells on cytologic study\n', 'Tumor unlikely due to age, negative cytology\n', 'Support'], ['High adenosine deaminase in LP would point with great certainty to a pleural TB\n', 'Measurement of pleural fluid adenosine deaminase\n', 'Support']]
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CasiMedicos-Arg: A Medical Question Answering Dataset Annotated with Explanatory Argumentative Structures

CasiMedicos-Arg is, to the best of our knowledge, the first multilingual dataset for Medical Question Answering where correct and incorrect diagnoses for a clinical case are enriched with a natural language explanation written by doctors. The casimedicos-exp have been manually annotated with argument components (i.e., premise, claim) and argument relations (i.e., attack, support). Thus, Multilingual CasiMedicos-arg dataset consists of 558 clinical cases (English, Spanish, French, Italian) with explanations, where we annotated 5021 claims, 2313 premises, 2431 support relations, and 1106 attack relations.

Antidote CasiMedicos-Arg splits
train 434
validation 63
test 125

Example of Document in Antidote CasiMedicos Dataset

Structure of CasiMedicos Dataset 

id: question id,
text: tokenized text for the argument component detection (list of lists)
labels: labels for the argument component detection (list of lists)
relations: relations between arguments (list of <argument1, argument2, relation> triplets)

Results of Argument Component Detection using LLMs

Citation

If you use CasiMedicos-Arg then please cite the following paper:

@inproceedings{sviridova-etal-2024-casimedicos,
    title = {{CasiMedicos-Arg: A Medical Question Answering Dataset Annotated with Explanatory Argumentative Structures}},
    author = "Sviridova, Ekaterina  and
      Yeginbergen, Anar  and
      Estarrona, Ainara  and
      Cabrio, Elena  and
      Villata, Serena  and
      Agerri, Rodrigo",
    booktitle = "Proceedings of the 2024 Conference on Empirical Methods in Natural Language Processing",
    year = "2024",
    url = "https://aclanthology.org/2024.emnlp-main.1026",
    pages = "18463--18475"
}

Contact: Rodrigo Agerri HiTZ Center - Ixa, University of the Basque Country UPV/EHU

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