mradermacher/Llama-3-Instruct-Neurona-8b-v2-i1-GGUF
8B • Updated • 1.14k
id int64 0 620 | year int64 2.01k 2.02k | question_id_specific int64 1 235 | full_question stringlengths 123 1.09k | full_answer stringlengths 26 2.98k | type stringclasses 64
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402 | 2,016 | 183 | 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 ... | 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 consu... | PRIMARY CARE AND SOCIAL NETWORKS | {
"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... | 3 | {
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237 | 2,014 | 144 | 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? | 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 brai... | NEUROLOGY | {
"1": "Acute subdural hematoma.",
"2": "Trobocytopenic purpura.",
"3": "Cerebral hemorrhagic contusion.",
"4": "Severe diffuse axonal injury.",
"5": "Hypoxic-ischemic encephalopathy."
} | 4 | {
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620 | 2,022 | 121 | 79-year-old woman admitted for an osteoporotic hip fracture. Regarding secondary prevention of fragility fractures, point out the WRONG answer: | In osteoporosis, one of the main risks associated with the increased risk of fracture is low adherence to treatment, so answer 1 is correct. Answer 2 is found in the SER guidelines, which confirm that some studies conclude that bone remodeling markers can be useful for early monitoring of adherence and response to trea... | TRAUMATOLOGY | {
"1": "Low adherence to treatment is associated with an increased risk of fracture.",
"2": "Bone remodeling markers may be useful for early monitoring of treatment response.",
"3": "Vitamin D monotherapy is effective in reducing these fractures in non-institutionalized elderly people.",
"4": "Increasing dietar... | 3 | {
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"text": "In osteoporosis, one of the main risks associated with the increased risk of fracture is low adherence to treatment, so answer 1 is correct."
... |
396 | 2,016 | 136 | A 41-year-old man comes to the Emergency Department for three days of swelling and pain in the right knee, with functional impotence and fever Two weeks earlier he had had a self-limited diarrhea. On examination there is joint effusion, so we proceed to perform an arthrocentesis and obtain 50 cc of cloudy fluid, with d... | Gram negative does NOT rule out infection. We mark four. | TRAUMATOLOGY AND ORTHOPEDICS | {
"1": "Treatment with cloxacillin and ceftriaxone should be initiated pending the result of the fluid culture.",
"2": "It is advisable to perform daily arthrocentesis to relieve symptoms and avoid joint destruction.",
"3": "If the culture is negative, it is probably reactive arthritis.",
"4": "The negativity o... | 4 | {
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253 | 2,014 | 86 | 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? | 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). | DIGESTIVE TRACT | {
"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.",
... | 4 | {
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224 | 2,014 | 63 | 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 ... | 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 ha... | CARDIOLOGY | {
"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 va... | 3 | {
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"text": "If we do 1 we take away life expectancy, because we allow the ventricle to claudicate."
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430 | 2,018 | 115 | 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)... | 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 ... | INFECTIOUS DISEASES AND MICROBIOLOGY | {
"1": "Septic embolisms.",
"2": "Invasive pulmonary aspergillosis.",
"3": "Pneumonia due to Staphylococcus aureus.",
"4": "Systemic candidiasis.",
"5": null
} | 2 | {
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"text": "Patient on her 30th post-transplant day of hemato... |
588 | 2,022 | 63 | A 36-year-old male consults for conjunctival hyperemia and foreign body sensation. Which of the following pathologies does NOT correspond to the above mentioned examination? | The involvement of the preauricular node is the typical lymphadenopathy of conjunctival infectious conditions. It is true that typical bacterial conjunctivitis does not usually present with lymphadenopathy. They have a more rapid and self-resolving course and do not awaken the lymphoid response as adenoviruses typicall... | OPHTHALMOLOGY | {
"1": "Adenoviral conjunctivitis.",
"2": "Allergic conjunctivitis.",
"3": "Parinaud's oculoglandular syndrome.",
"4": "Chlamydia conjunctivitis.",
"5": null
} | 2 | {
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"text": "Adenopathy being very typical of adenoviral conjunctivitis, this option is the easiest to rule out."
},
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11 | 2,011 | 74 | 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: | 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 ... | SURGERY | {
"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 p... | 3 | {
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"text": "The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed. But if there... |
535 | 2,021 | 121 | 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 patho... | 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. | RHEUMATOLOGY | {
"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": null
} | 4 | {
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"text": "anti-Sm are specific to SLE,"
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452 | 2,018 | 149 | 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? | Clearly the answer is 4, with a very characteristic clinic of temporary seizures. | NEUROLOGY | {
"1": "Generalized non-convulsive seizure or typical absence.",
"2": "Continuous partial epilepsy.",
"3": "Amyotonic crisis.",
"4": "Complex partial temporal lobe seizure.",
"5": null
} | 4 | {
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"... |
55 | 2,011 | 74 | 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: | 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 alre... | ENDOCRINOLOGY | {
"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 ... | 3 | {
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"text": "Answers 1 and 3 are contrary, one recommends completing thyroidectomy and the other does not. The only ones in which complete thyroidectomy ... |
281 | 2,016 | 33 | 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? | 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 sin... | PATHOLOGICAL ANATOMY | {
"1": "Complete phenotypic study by flow cytometry.",
"2": "Study of hormone receptors and HER2.",
"3": "Study of hormone receptors, e-cadherin and study of first degree relatives.",
"4": "Study of BRCA 1-2 and study of first-degree relatives.",
"5": null
} | 2 | {
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"text": "Answer 1 can be ruled out visu visu,"
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310 | 2,016 | 216 | 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 ... | 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 ... | OPHTHALMOLOGY | {
"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": null
} | 1 | {
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"text": "The cause of shaken baby syndrome is almost always abuse, so the answer is 1."
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293 | 2,016 | 214 | 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? | 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. | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | {
"1": "Cutaneous lymphoma.",
"2": "Atopic dermatitis.",
"3": "Psoriasis.",
"4": "Ichthyosis.",
"5": null
} | 3 | {
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132 | 2,012 | 229 | 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. Subseq... | 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 indi... | NEUROLOGY AND NEUROSURGERY | {
"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 a... | 2 | {
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"text": "Answer 1: it cannot be because a hemorrhagic transformation does not give such a brutal elevation of LDH and Cr, in addition to not explaini... |
49 | 2,011 | 159 | An 8 year old boy with lameness of the right lower extremity, of insidious presentation and one month of evolution. There is no history of trauma or constitutional signs. On examination there is evidence of restriction to passive mobilization of the limb, especially in abduction and internal rotation. Of the following ... | The correct answer is 3. Perthes disease is more common and has a better prognosis in younger children. | PEDIATRICS | {
"1": "It is advisable to perform a hip X-ray.",
"2": "In transient synovitis the onset is usually acute.",
"3": "In Legg-Calvé-Perthes disease the prognosis is worse the younger the age of onset.",
"4": "The cause may be a hypercoagulable state.",
"5": "The therapeutic option will vary depending on the degr... | 3 | {
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120 | 2,012 | 192 | 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: | As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate. | PREVENTIVE MEDICINE AND EPIDEMIOLOGY | {
"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)."
} | 3 | {
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304 | 2,016 | 174 | 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 180... | 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 w... | NEPHROLOGY | {
"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... | 3 | {
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214 | 2,014 | 228 | 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 ... | 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.) i... | RHEUMATOLOGY | {
"1": "Arthritis due to microcrystals.",
"2": "Reactive arthritis.",
"3": "Bacterial infectious arthritis.",
"4": "Mycobacterial infectious arthritis.",
"5": "Rheumatoid arthritis."
} | 3 | {
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"text": "And above all, because of its implications, the first one to always rule out."
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249 | 2,014 | 120 | 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... | 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 amast... | INFECTIOUS DISEASES | {
"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 a... | 1 | {
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"text": "All these data are suggestive of visceral Leishmaniasis, so an OM biopsy should be performed to look for amastigotes and confirm the diagnosi... |
53 | 2,011 | 146 | 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....: | 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... | PSYCHIATRY | {
"1": "Post-traumatic stress reaction.",
"2": "Acute\" dependent personality disorder.",
"3": "Depressive disorder.",
"4": "Agoraphobia.",
"5": "Anguish crisis."
} | 5 | {
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"text": "Breaking up with a partner I understand is hard, but not exceptional."
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48 | 2,011 | 158 | 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 mos... | 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. | PEDIATRICS | {
"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 anti... | 1 | {
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490 | 2,020 | 106 | 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 wi... | 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 ye... | HEMATOLOGY | {
"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 intravasc... | 2 | {
"1": {
"exist": true,
"char_ranges": [
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],
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],
"text": "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 ... |
416 | 2,018 | 76 | 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 ... | 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 pro... | GENERAL SURGERY | {
"1": "Perforation of gastric or duodenal ulcus.",
"2": "Biliary leak.",
"3": "Obstructive neoplasm of the sigma with perforation.",
"4": "Mesenteric ischemia.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
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]
],
"word_ranges": [
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106,
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]
],
"text": "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."
... |
45 | 2,011 | 154 | A 9-year-old boy, asymptomatic with an innocent murmur, undergoes an ECG that documents Wolf-Parkinson-White Syndrome. Which of the following statements is FALSE? | The correct answer is 1. It is also answered with the statement that begins by saying that the child is asymptomatic. The error seems to me to be a misconception because for the study of a murmur an ECG is not usually requested but an echocardiography. Heart failure is a complication of Wolf-Parkinson-White syndrome an... | PEDIATRICS | {
"1": "He needs treatment for heart failure.",
"2": "She may present with paroxysmal supraventricular tachycardia.",
"3": "The 2D-Doppler ultrasound will rule out its association with Ebstein's disease.",
"4": "It is convenient to perform a 24-hour ECG (Holter) and ergometry.",
"5": "In certain patients, abl... | 1 | {
"1": {
"exist": true,
"char_ranges": [
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]
],
"word_ranges": [
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21
]
],
"text": "It is also answered with the statement that begins by saying that the child is asymptomatic."
},
"2": {
"exist": false,
"char_range... |
336 | 2,016 | 31 | A 20-year-old woman with a 15-cm solid-cystic ovarian tumor detected by ultrasound after presenting with nonspecific abdominal symptoms. In the histopathological study of the corresponding specimen, teeth, hairs, areas of intestinal epithelium, areas of squamous epithelium (15%) and bronchial epithelium, as well as neu... | 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 te... | GYNECOLOGY AND OBSTETRICS | {
"1": "Teratocarcinoma.",
"2": "Immature teratoma.",
"3": "Mature cystic teratoma.",
"4": "Dysgerminoma.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": true,
"char_ranges": [
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... |
609 | 2,022 | 115 | A 27-year-old male, a regular athlete, refers pain in the right leg after continuous running. He has visited a physiotherapist on several occasions and has been diagnosed with calf overload. Several months have passed, she has not improved and refers intense pain after physical activity that subsides with rest in the h... | 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 fasciot... | TRAUMATOLOGY | {
"1": "Positron emission tomography with 18 FDG.",
"2": "Determination of posterior compartment pressure immediately after activity.",
"3": "Doppler ultrasound to rule out a circulatory disorder of the lower extremity.",
"4": "Magnetic resonance spectroscopy.",
"5": null
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
0,
282
]
],
"word_ranges": [
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0,
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],
"text": "Exercise-induced compartment syndrome is an exerc... |
389 | 2,016 | 235 | A 3-month-old infant correctly vaccinated for his age, who after two weeks of rhinorrhea, sneezing and coughing, is admitted for intensification of coughing spells, with cyanosis at the end of them, ending with deep inspiration or inspiratory rooster, requiring stimulation, aspiration of secretions and oxygen to recove... | We are being asked about the pertussis vaccine. Option 1 is correct, it is the diphtheria-tetanus-pertussis vaccine. Option 4 is also correct, since they are inactivated microorganisms. Now we are left with the doubt between 2 and 3... Option 3 is the one that "is not true among all those proposed to us": immunity last... | PEDIATRICS | {
"1": "The vaccine in Spain is administered in combination with diphtheria and tetanus.",
"2": "Adults who will be in contact with infants under 6 months of age should be vaccinated.",
"3": "Both natural and vaccinal immunity remains for life.",
"4": "Vaccination is prepared from killed microorganisms.",
"5"... | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
116
]
],
"word_ranges": [
[
0,
17
]
],
"text": "We are being asked about the pertussis vaccine. Option 1 is correct, it is the diphtheria-tetanus-pertussis vaccine."
},
"2": {
"exist":... |
201 | 2,013 | 76 | 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: | 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. | NEUROLOGY | {
"1": "Global aphasia.",
"2": "Wernicke's aphasia.",
"3": "Broca's aphasia.",
"4": "Sensitive transcortical aphasia.",
"5": "Transcortical motor aphasia."
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
115,
261
]
],
"word_ranges": [
[
14,
33
]
],
"text": "Wernicke's aphasia is characterized by fluent ... |
345 | 2,016 | 159 | 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 atti... | 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 hormon... | GYNECOLOGY AND OBSTETRICS | {
"1": "Prescribe cyclic progesterone.",
"2": "Endometrial biopsy.",
"3": "Random cervical biopsies.",
"4": "Hormonal evaluation with FSH, LH and estradiol.",
"5": null
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
[
412,
487
]
],
"word_ranges": [
[
68,
78
]
],
"text": "prescribing cyclic progesterone is not indicated in a postmenopausal woman."
},
"2": {
"exist": true,
"char_ranges": [
[
... |
166 | 2,013 | 82 | 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: | 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 glo... | CARDIOLOGY AND CARDIOVASCULAR SURGERY | {
"1": "Enalapril.",
"2": "Propanolol.",
"3": "Amiloride.",
"4": "Prazosin.",
"5": "Amlodipine."
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
222,
344
]
],
"word_ranges": [
[
34,
55
]
],
"text": "If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate."
},
"2": {
... |
481 | 2,020 | 171 | A 67-year-old woman with a history of dyslipidemia, who comes to the ED with dysuria and pollakiuria followed by fever, chills, and deterioration of general condition. On arrival she appears severe and is tachycardic, tachypneic, with blood pressure 60/40 mmHg and temperature of 39°C. Which of the following measures wo... | Patient presenting with fever+tachypnea+FC>100 = 3 criteria of SIRS (Systemic Inflammatory Response Syndrome). Reminder: sepsis is a SIRS due to infection, which leads to a decrease in SVR, resulting in a decrease in preload and stroke volume leading to hypotension. The first therapeutic measures are the administration... | CRITICAL CARE | {
"1": "Intravenous perfusion of dobutamine.",
"2": "Serum lactate measurement.",
"3": "Extraction of blood cultures.",
"4": "Fluid administration.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
613,
718
]
],
"word_ranges": [
[
93,
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]
],
"text": "the vasoactive drug of choice in the context of septic shock is noradrenaline ([3], [4]) (answer 1 FALSE)"
},
"2": {
"exist": true,
... |
612 | 2,022 | 116 | 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 subc... | 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 arth... | TRAUMATOLOGY | {
"1": "Hip hemiarthroplasty.",
"2": "Trochanteric nail fixation.",
"3": "Fixation with cannulated screws.",
"4": "Conservative: bed-chair life.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
422
]
],
"word_ranges": [
[
0,
65
]
],
"text": "Correct Answer 1: Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, gi... |
585 | 2,022 | 74 | 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 re... | 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. | OBSTETRICS AND GYNECOLOGY | {
"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 termin... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
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},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
3 | 2,011 | 37 | 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 ... | 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 bei... | DIGESTIVE | {
"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 ... | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
39,
157
]
],
"word_ranges": [
[
9,
29
]
],
"text": "It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5."
},
"2": {
"exi... |
439 | 2,018 | 96 | 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 ... | 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, particularl... | GYNECOLOGY AND OBSTETRICS | {
"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 ... | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
97,
620
]
],
"word_ranges": [
[
14,
92
]
],
"text": "the existence of an endometrial pathology cannot be ruled out. According to the SEGO: \"Abnormal genital bleeding is the main sign of suspicio... |
192 | 2,013 | 160 | 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 ex... | 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 int... | PEDIATRICS | {
"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.",
"... | 5 | {
"1": {
"exist": true,
"char_ranges": [
[
186,
279
]
],
"word_ranges": [
[
31,
46
]
],
"text": "The rest of the answers touch on many of the \"myths\" and customs surrounding gastroenteritis."
},
"2": {
"exist": true,
"char_r... |
261 | 2,014 | 100 | A 63-year-old woman comes to the emergency department reporting severe headache with signs of meningeal irritation, bilateral visual disturbances and ophthalmoplegia. A CT scan showed a 2 cm space-occupying lesion in the sella turcica compatible with pituitary adenoma with signs of intratumoral hemorrhage, with deviati... | Very difficult question of pituitary apoplexy. It is a marginal topic in the MIR and also the answer is complex. Eliminating answers we are left with intervene (answer 4) or not to intervene (answer 2). In patients with hemodynamic instability, decreased level of consciousness, decreased visual acuity and extensive vis... | ENDOCRINOLOGY | {
"1": "Diagnostic suspicion is pituitary apoplexy.",
"2": "Treatment with high-dose corticosteroids should be initiated and the evolution observed, since this treatment could reduce the volume of the lesion and avoid intervention.",
"3": "Treatment with glucocorticoids should be considered to avoid secondary adr... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
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},
"4": {
"exist": true,
"... |
289 | 2,016 | 65 | 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... | 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 postprandia... | GENERAL SURGERY | {
"1": "Biliary reflux gastropathy.",
"2": "Gastric adenocarcinoma.",
"3": "Rapid gastric emptying syndrome (dumping).",
"4": "Afferent loop syndrome with bacterial overgrowth.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
981,
1097
]
],
"word_ranges": [
[
151,
167
]
],
"text": "Biliary reflux gastropathy is an endoscopic diagnosis, moreover it is not associated with diarrhea or malabsorption."
},
"2": {
"e... |
366 | 2,016 | 106 | 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... | 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 po... | PNEUMOLOGY AND THORACIC SURGERY | {
"1": "A thoracic computed tomography (CT) scan.",
"2": "Pleural fluid pH measurement.",
"3": "Measurement of pleural fluid adenosine deaminase.",
"4": "Tuberculin test.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
281,
505
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],
"word_ranges": [
[
... |
544 | 2,022 | 40 | 16-year-old woman diagnosed with allergic rhinoconjunctivitis due to sensitization to grass pollens since she was 10 years old, who does not fully control the symptomatology during the pollination season with oral antihistamines and nasal topical corticosteroids. Which etiologic therapeutic option would be indicated: | Currently the only effective treatment capable of modifying the natural course of respiratory allergy is specific allergen immunotherapy for a minimum of 3 consecutive years. In this patient the conventional treatment has not worked, so it is possible to escalate to specific allergen immunotherapy. It is true that it i... | ALLERGOLOGY | {
"1": "Specific immunotherapy by sublingual or subcutaneous route for a minimum period of 3 years.",
"2": "Specific immunotherapy by sublingual or subcutaneous route for a maximum period of 1 year.",
"3": "Omalizumab subcutaneously every 4 weeks for up to 1 year.",
"4": "Omalizumab subcutaneously every 4 weeks... | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
174
]
],
"word_ranges": [
[
0,
25
]
],
"text": "Currently the only effective treatment capable of modifying the natural course of respiratory allergy is specific allergen immunotherapy for a m... |
533 | 2,021 | 179 | A 32-year-old woman with multiple endocrine neoplasia syndrome type 2A (MEN-2A) and carrier of a mutation in RET. In a neck ultrasound a 6 mm hypoechogenic nodule with calcifications inside is identified. It was decided to perform a total thyroidectomy and cervical lymph node removal. In the macroscopic study a total o... | Typical medullary thyroid RET (C cells, elevated calcitonin, inherited MEN-2nd, typical MIR question). | ONCOLOGY | {
"1": "Multifocal medullary carcinoma.",
"2": "Multifocal papillary carcinoma.",
"3": "Follicular carcinoma.",
"4": "Hyperplasia of parafollicular cells.",
"5": null
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
102
]
],
"word_ranges": [
[
0,
13
]
],
"text": "Typical medullary thyroid RET (C cells, elevated calcitonin, inherited MEN-2nd, typical MIR question)."
},
"2": {
"exist": false,
"c... |
80 | 2,012 | 37 | A 52-year-old man who consults for a second opinion on the need to perform a liver biopsy for the study of hypertransaminasemia detected two years ago in routine company analyses. His family history includes the death of his father of an unidentified etiology of epatic cirrhosis. Asymptomatic and performing social and ... | This is a patient who already has a diagnosis of hemochromatosis, due to a positive genetic study and data of iron overload (IST >45% and elevated ferritin). Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis. The treatment of ch... | DIGESTIVE SYSTEM | {
"1": "Perform liver biopsy.",
"2": "Perform hepatic MRI.",
"3": "Initiate treatment with phlebotomies.",
"4": "Start treatment with desferroxamine.",
"5": "Start treatment with Vitamin E."
} | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
158,
300
]
],
"word_ranges": [
[
27,
52
]
],
"text": "Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis... |
394 | 2,016 | 225 | Mariano is a 53-year-old man who comes to your office reporting that he has been feeling very unwell for several years. He relates his discomfort to a behavior that he finds absurd but that he is unable to avoid. This behavior, which she always does when she comes home from work, consists of turning the doorknob of the... | In this question they ask for the name of the symptom, not the disease, so therefore the correct answer is compulsion. According to the DSM-5, a compulsion is a repetitive behavior (e.g., washing hands, tidying up, checking things) or mental act (e.g., praying, counting, repeating words silently) that the subject perfo... | PSYCHIATRY | {
"1": "Obsessive-compulsive disorder.",
"2": "Obsession.",
"3": "Impulsion.",
"4": "Compulsion.",
"5": null
} | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
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"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
229 | 2,014 | 178 | Previously healthy 10-month-old infant with acute gastroenteritis of one day's evolution and signs of mild dehydration, without blood or mucus in the stool and without oral tolerance. What is the initial treatment of choice in our environment? | The infant presents with acute GEA without signs of alarm or severe dehydration. The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated. Answer 1 may give rise to doubts, due to the fact that the statement says that the patient "does not tolerate th... | PEDIATRICS | {
"1": "Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet.",
"2": "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and continue with his usual diet.",
"3": "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) maintain us... | 2 | {
"1": {
"exist": true,
"char_ranges": [
[
81,
532
]
],
"word_ranges": [
[
13,
93
]
],
"text": "The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated. Answer 1 may gi... |
198 | 2,013 | 73 | A 77-year-old man with a history of type 2 Diabetes Mellitus was diagnosed 2 years ago with mild cognitive impairment. At that time a Minimental (Folstein) 28/30, abbreviated Yesavage Test 14/15, a CBC with normal TSH and maturation factors along with negative LUES and HIV serologies and a magnetic resonance imaging (M... | This case describes an Alzheimer's disease with insidious onset of short-term memory problems. Clinically it can be distinguished from other options by the absence of behavioral problems (typical of frontotemporal dementia) and hallucinations (early in Lewy body disease). Vascular dementia is diagnosed by criteria that... | NEUROLOGY | {
"1": "Frontotemporal dementia.",
"2": "Alzheimer's disease.",
"3": "Vascular dementia.",
"4": "Lewy body disease.",
"5": "Creutzfeldt-Jakob disease."
} | 2 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
272
]
],
"word_ranges": [
[
0,
38
]
],
"text": "This case describes an Alzheimer's disease with insidious onset of short-term memory problems. Clinically it can be distinguished from other opt... |
351 | 2,016 | 161 | A 27-year-old woman referred to a gynecology office for evaluation, reporting dyspareunia for about 8 months, along with dyschezia and occasional rectorrhagia coinciding with menstruation for 3-4 months. She also reports dysmenorrhea for years, which she controls well with ibuprofen. She has been trying to get pregnant... | The clinical case presented is a woman of childbearing age (27 years) presenting dyspareunia + dysmenorrhea + infertility, which should lead us to think of endometriosis. The clinical history and ultrasound give a diagnosis of suspicion, but the diagnosis of certainty is given by direct observation (with or without ass... | GYNECOLOGY AND OBSTETRICS | {
"1": "Transvaginal ultrasound.",
"2": "Diagnostic laparoscopy.",
"3": "Magnetic resonance imaging.",
"4": "Colonoscopy.",
"5": null
} | 2 | {
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"text": "The clinical history and ultrasound give a dia... |
69 | 2,012 | 124 | The daughter of an 82-year-old woman consults us because she has found her mother more confused than usual. The patient is diagnosed with moderate Alzheimer's disease. She also has AF, depression and osteoarthritis. She has been receiving stable treatment for 3 years, including digoxin, acenocoumarol, fluoxetine for th... | The most likely cause is a digitalis intoxication, which would produce this slowing of conduction, which is seen in the heart rate. Probably secondary to renal failure due to ibuprofen toxicity (but this is a bit of a stretch). | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCY MEDICINE | {
"1": "Progression of Alzheimer's disease.",
"2": "Worsening depression.",
"3": "Digitalis intoxication.",
"4": "Dementia due to Lewy bodies.",
"5": "Ibuprofen toxicity."
} | 3 | {
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140 | 2,012 | 134 | A newborn of 37 weeks gestational age, with no pathological findings in the prenatal ultrasound, presents in the examination performed in the delivery room a "stop" to the passage of the nasogastric tube. Chest and abdominal X-ray showed an atresic esophageal pouch, with normal gastrointestinal pneumatization. After a ... | The correct answer is 3. The fact that there is intestinal aeration points to the existence of a fistula of the lower esophageal segment with the trachea or with a bronchus. In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway. | PEDIATRICS | {
"1": "Due to the impossibility of swallowing saliva.",
"2": "Because of frequently associated cardiac malformations.",
"3": "Because of the risk of aspiration pneumonitis.",
"4": "Due to the impossibility of enteral feeding.",
"5": "Associated tracheomalacia."
} | 3 | {
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475 | 2,020 | 89 | A 46-year-old man with bipolar disorder is brought to the emergency department after an over-ingestion of lithium carbonate. Examination reveals severe tremor, ataxia, dysarthria, myoclonus and fasciculations. Lithemia is 4.1 mEq/L (toxicity > 1.6 mEq/L). Which of the following therapeutic options would be most indicat... | We are dealing with a case of severe lithium intoxication (lithemia > 3.5 mEq/L is life threatening), therefore, the therapeutic option of choice is to start hemodialysis urgently. Remember that activated charcoal is NOT indicated in lithium intoxication. | CRITICAL CARE | {
"1": "Aminophylline associated with a cathartic.",
"2": "Activated charcoal.",
"3": "Hemodialysis.",
"4": "Forced diuresis.",
"5": null
} | 3 | {
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"text": "Remember that activated charcoal is NOT indica... |
85 | 2,012 | 50 | A patient with a history of febrile illness and chest pain comes to the hospital with dyspnea and tachypnea. On physical examination his blood pressure is low, jugular venous pressure is elevated with a deep descending sinus "X" and he has a paradoxical pulse. What pathology should you suspect? | Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration; it represents an exaggeration of the physiological phenomenon consisting of inspiratory lowering of BP (normal up to 10 mmHg). In cardiac tamponade, inspiration, which causes an increase in blood flow to the right chambers, increasing their vol... | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Ischemic heart disease.",
"2": "Dilated cardiomyopathy.",
"3": "Severe aortic stenosis.",
"4": "Constrictive pericarditis.",
"5": "Pericardial effusion with cardiac tamponade."
} | 5 | {
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527 | 2,021 | 31 | A patient's arterial blood gas result is: pH: 7.40, PaCO2 60 mmHg; bicarbonate 36 mM/L. What is the presenting disturbance: | Blood gases can be misleading since a normal pH may suggest that there is no disturbance of acid-base balance, instead it is masking a double disturbance in opposite directions as in this case. The patient presents with respiratory acidosis (PaCO2 60 mmHg; normal to 50) and compensatory metabolic alkalosis (bicarbonate... | NEPHROLOGY | {
"1": "None, pH is normal.",
"2": "Respiratory acidosis.",
"3": "Respiratory acidosis and metabolic alkalosis.",
"4": "Metabolic alkalosis.",
"5": null
} | 3 | {
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407 | 2,016 | 81 | A 30-year-old woman comes to the clinic reporting anxiety, weight loss of about 6 kgs and a feeling of "nervousness" in the last three months. Physical examination showed tachycardia, hyperreflexia and absence of goiter. TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are decreased. A scan reve... | Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter. In contrast to all other causes of hyperthyroidism, serum thyroglobulin is not elevated and is almost always low or at the lower limit of normal. The fundamental do... | ONCOLOGY (ECTOPIC) | {
"1": "Factitious thyrotoxicosis.",
"2": "Hyperthyroidism due to Graves' disease.",
"3": "Ovarian teratoma (ovarian stromal).",
"4": "Subacute thyroiditis.",
"5": null
} | 1 | {
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15 | 2,011 | 126 | For the third time in the last 6 months an 84-year-old man with advanced dementia is admitted to a hospital for aspiration pneumonia. He has lost 9.5 kg in the last 10 months. He has a pressure ulcer in the sacrum. He does not communicate verbally, does not ambulate and is dependent for all activities of daily living. ... | This is perhaps the least scientific of this year's MIR questions, since its answer is based on the interpretation of a law, which is also of an autonomous nature. Probably the spirit of the examiner wants to reflect this law, in an extreme case. Let's see, starting from article 11 of Law 41 /2002, of November 14 (1), ... | PALLIATIVE CARE | {
"1": "Place an indwelling SNG and discharge to a skilled nursing home.",
"2": "Place a mid-term NGUS and discharge to a nursing home with specialized care until bedsores heal.",
"3": "Discharge to a nursing home with specialized care until pressure ulcers heal.",
"4": "Place a gastrostomy tube and discharge h... | 5 | {
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322 | 2,016 | 85 | A 22-year-old boy with hyposmia presents lack of development of secondary sexual characteristics and infertility. Bilateral testicular volume of 4 mL. Analytically, EST-I 1.2 U/L (vn 5-15); LH 0.6 U/L (vn 3-15); testosterone 100 ng/dL (vn 300-1200), prolactin normal. State your proposed treatment to achieve fertility: | This is a Kallman syndrome (hypogonadotropic hypogonadism + olfactory disturbance). Triptorelin is a GnRH agonist, which by continuous action reduces FSH and LH, and is used in sex hormone-dependent cancers, as well as precocious puberty. Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pit... | UROLOGY | {
"1": "GnRH infusion pump.",
"2": "Monthly intramuscular administration of triptorelin.",
"3": "Intramuscular administration of FSH and LH once a week.",
"4": "Treatment with bromocriptine.",
"5": null
} | 1 | {
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"text": "To induce testicular maturation, pulsatile GnRH with pump, hCG or FSH+hCG can be used."
},
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610 | 2,022 | 116 | 95-year-old woman living in a nursing home, independent for 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 subcapit... | Displaced hip fracture, Garden III-IV. Surgical treatment. Hip hemiarthroplasty. Option 2 treatment for pertrochanteric fractures. Option 3. Non-displaced fractures. Option 4. Non ambulatory patients with minimal pain and high surgical risk. | TRAUMATOLOGY | {
"1": "Hip hemiarthroplasty.",
"2": "Trochanteric nail fixation.",
"3": "Fixation with cannulated screws.",
"4": "Conservative: bed-chair life.",
"5": null
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"text": "Displaced hip fracture, Garden III-IV. Surgical treatment. Hip hemiarthroplasty."
},
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391 | 2,016 | 222 | A 26-year-old single man is brought in by his family because he has been refusing to leave his home for 3 months. The reason given by the patient is the belief that he has an asymmetrical jaw and a crooked face. According to the patient, this situation is progressive and he looks more and more deformed when he looks in... | Another simple question with an immediate answer, which offers no doubt. It describes a patient worried about a non-existent physical defect, whose concern distresses him and prevents him from leaving the house. As a psychiatry resident, I wish the MIR questions in my specialty were a bit more thought-provoking and in-... | PSYCHIATRY | {
"1": "Major depressive disorder with delusional ideas incongruent with mood.",
"2": "Obsessive-compulsive disorder.",
"3": "Paranoid schizophrenia.",
"4": "Body dysmorphic disorder.",
"5": null
} | 4 | {
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324 | 2,016 | 55 | A 70-year-old female patient is admitted to the ICU after suffering anterior AMI treated by coronary angioplasty and stent placement in the anterior descending artery. Four days later, she suddenly presents hypotension that requires vigorous volume support, initiation of vasoactive drugs, orotracheal intubation and con... | Mortality is not so low, the oximetric jump occurs in the case of septum rupture, as well as fremitus (hence the correct answer is 3) and complications can occur up to the first week. | CRITICAL, PALLIATIVE AND EMERGENCY CARE | {
"1": "Mortality with medical treatment is 20%.",
"2": "In case of free wall rupture, there is an oxymetric jump in the right ventricle in the Swan-Ganz catheterization.",
"3": "In case of free wall rupture, there is no palpable frémito.",
"4": "Mechanical complications usually appear on the first post-infarct... | 3 | {
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240 | 2,014 | 150 | A 76-year-old man consults for cognitive impairment, slowness and clumsiness of movements, of eight months of evolution. The family reports that the patient had visual hallucinations, so his primary care physician prescribed low doses of risperidone, with a significant worsening of motor status. In view of these data, ... | The correct answer is 2 because it presents the case with the typical symptoms of dementia due to Lewy bodies, being the guiding symptom visual hallucinations. Progressive cognitive impairment, parkinsonian motor signs (inferred from clumsiness of movements) and hypersensitivity to neuroleptics even in small doses are ... | NEUROLOGY | {
"1": "Alzheimer's disease.",
"2": "Dementia due to Lewy bodies.",
"3": "Frontotemporal dementia.",
"4": "Vascular dementia.",
"5": "Sporadic Creutzfeldt-Jakob disease."
} | 2 | {
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"text": "The correct answer is 2 because it presents the c... |
68 | 2,012 | 123 | A 64-year-old man with a history of hypertension and ischemic heart disease comes to the emergency department for oppressive chest pain while watching television. In the ED triage consultation, T. art values of 155/95 mmHg and a capillary O2 saturation of 95% are detected. Which of the following is the most correct cou... | If the ECG shows ischemic changes, we will obviously treat the patient in the emergency room and notify the cardiologist. If not, you will be treated as if it were angina and observed, with serial enzymes and treatment in the observation area. | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCY MEDICINE | {
"1": "Instruct her to go to the waiting room. You will be notified for tests.",
"2": "This patient should be treated in the vital emergency room (shock room).",
"3": "We will notify the cardiologist on duty to evaluate the patient.",
"4": "From the Triage consultation, the patient will be referred to the Coro... | 5 | {
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206 | 2,014 | 125 | Faced with a 49-year-old man, asymptomatic, with a family history of a father who died of prostate cancer, who in a routine company control is identified a PSA (Prostate Specific Antigen) of 5.9 ng / ml, with a ratio of free PSA / total PSA of 11% and that a rectal examination shows increased consistency in the right p... | The patient has a PSA >4 and a palpation with increased consistency, which implies the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer. | UROLOGY | {
"1": "Suggest to the patient the performance of a transrectal ultrasound and prostate biopsy.",
"2": "Perform an abdominopelvic CT scan.",
"3": "Initiate treatment with 5 alpha Reductase Inhibitors to reduce PSA levels by half.",
"4": "Initiate combined treatment of LHRH analogues and antiandrogens.",
"5": ... | 1 | {
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"text": "The patient has a PSA >4 and a palpation with increased consistency, which implies the need for a transrectal ultrasound-guided biopsy to diagno... |
570 | 2,022 | 153 | A 19-year-old male with no past history of interest comes to the emergency department because after a respiratory infection he presents with asthenia, malaise, oliguria and headache. Physical examination: BP 210/120 mmHg, fundus with hypertensive retinopathy grade III. Laboratory tests: Hb 7.4 g/dl, platelets 85,000/mm... | Difficult question. The patient presents with thrombotic microangiopathy (TMA) with acute renal failure. This points to HUS, TTP, drug-induced TMA, or TMA mediated by complement, coagulation, or metabolism. Normal ADAMTS-13 levels rule out TTP (incorrect choice 1). The absence of gastrointestinal symptoms rules out typ... | NEPHROLOGY | {
"1": "Thrombotic thrombocytopenic purpura.",
"2": "Atypical hemolytic uremic syndrome.",
"3": "Disseminated intravascular coagulation.",
"4": "Typical hemolytic uremic syndrome.",
"5": null
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506 | 2,020 | 87 | Faced with sudden-onset obsessive-compulsive disorder (OCD) in a 9-year-old boy who also presents with tics and chorea as neurological manifestations, infection by: | There is a large literature on this subject. It never ceases to amaze us the strange ways of biology and that the axiom "the longest is the right one" is fulfilled in this case. | PSYCHIATRY | {
"1": "Streptococcus viridans.",
"2": "Alpha-hemolytic streptococcus.",
"3": "Beta-hemolytic streptococcus, group A.",
"4": "Enterococcus.",
"5": null
} | 3 | {
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619 | 2,022 | 121 | 79-year-old woman admitted for an osteoporotic hip fracture. Regarding secondary prevention of fragility fractures, point out the WRONG answer: | There are doubts regarding the efficacy of calcium or vitamin D administered in monotherapy for the treatment of osteoporosis; they point out that "administered together they seem to have a certain degree of efficacy in the prevention of non-vertebral fractures, which is clearer in people who are deficient in them, as ... | TRAUMATOLOGY | {
"1": "Low adherence to treatment is associated with an increased risk of fracture.",
"2": "Bone remodeling markers may be useful for early monitoring of response to treatment.",
"3": "Vitamin D monotherapy is effective in reducing these fractures in non-institutionalized elderly people.",
"4": "Increasing die... | 3 | {
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161 | 2,013 | 118 | A 60-year-old woman diagnosed with chronic bronchopathy, diabetes mellitus, hypertension and treated for 4 months with Omeprazole, Metformin, Salbutamol, Ipratropium Bromide and Enalapril 20 mg + Hydrochlorothiazide 25 mg comes to your office for fatigue, decreased appetite, with slight dyspnea and occasional cough, va... | The correct answer is: 4. Antihypertensive. In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia. | NEPHROLOGY | {
"1": "Renal insufficiency.",
"2": "Hyponatremia.",
"3": "Potassium deficiency.",
"4": "Antihypertensive.",
"5": "Metformin."
} | 4 | {
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269 | 2,014 | 141 | A 55-year-old asthmatic patient comes to the ED with an exacerbation. One hour after administration of supplemental oxygen and two nebulizations of salbutamol the patient does not improve. On examination, he breathes at 42 rpm with supraclavicular pull v with scattered inspiratory and expiratory wheezing. Peak flow has... | In a severe asthma crisis all options are indicated or may be indicated before more aggressive options. In the case of a bad evolution with acidosis etc., the patient would be tributary to invasive medication. | PNEUMOLOGY | {
"1": "Increase oxygen flow.",
"2": "Administer 80 mg of methylprednisolone iv.",
"3": "Nebulize ipratropium bromide together with salbutamol every 20 minutes.",
"4": "Administer intravenous magnesium.",
"5": " Start noninvasive mechanical ventilation."
} | 5 | {
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18 | 2,011 | 138 | If a patient reports having for months now enlargement of the tongue, with no other alterations of the tongue causing constant biting, which disease would you think of the following: | Question shared with ENT. Amyloidosis is a localized or systemic deposition of fibrillar proteins. It can be primary or secondary. The most frequently affected organs are the kidneys and the heart. Sometimes amyloid deposits appear on the tongue which can produce macroglossia. | DERMATOLOGY | {
"1": "Hypoglossal paralysis.",
"2": "Hyperthyroidism.",
"3": "Mastocytosis.",
"4": "Amyloidosis.",
"5": "Facial granuloma."
} | 4 | {
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250 | 2,014 | 78 | A 55-year-old man, father of a celiac child, with iron-deficiency anemia and a recent increase in the stool rhythm, has been tested negative for HLA-DQ2 and HLA-DQ8 alleles. Which diagnostic test is the most appropriate in this case? | Middle-aged male with iron deficiency anemia and increased number of stools, a colonoscopy should be done to rule out colorectal cancer!!! If the HLA is negative it is very unlikely to be celiac disease (high negative predictive value). | DIGESTIVE SYSTEM | {
"1": "Determination of anti-transglutaminase IgA antibodies.",
"2": "Upper endoscopy with duodenal biopsies.",
"3": "D-xylose test.",
"4": "Evaluate response to gluten-free diet.",
"5": "Colonoscopy."
} | 5 | {
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5 | 2,011 | 44 | A 66-year-old man reports daily heartburn since youth, which he treats with alkalis. An upper endoscopy shows mild erosive esophagitis and displaced squamous columnar junction approximately 7 cm. The esophageal biopsies showed mild erosive esophagitis and a columnar squamous junction displaced approximately 7 cm from t... | This patient presents Barrett's esophagus with low grade dysplasia. I do not like the question, since not being with acid production inhibition the dysplasia may be conditioned by inflammation and not be real. In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflu... | DIGESTIVE | {
"1": "Given that the esophagitis is mild and the dysplasia is low grade, it is advisable to continue treatment with alkalines.",
"2": "Indefinite treatment with high doses of PPI since it has been demonstrated that this prevents the progression of Barrett's esophagus to adenocarcinoma, making endoscopic surveilla... | 4 | {
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"exist": true,
"... |
359 | 2,016 | 91 | The determination in a 70-year-old woman of hematocrit 32%, Hb 9.6 g/dL, MCV 85 fL (70-99), Fe 25 ug/dL (37-145) and ferritin 350 ng/mL (15-150), is more suggestive of: | Polymyalgia rheumatica. Classic example I suppose, and it is seen in the clinic in droves. Older woman with normocitic anemia and clear ferrokinetic pattern of chronic disorder (hyposideremia but hyperferritinemia). The only one that fits, and it fits perfectly, is number 3; they only needed to give us a high ESR. 1: i... | HEMATOLOGY | {
"1": "Recent blood loss through the digestive tract.",
"2": "Intestinal malabsorption.",
"3": "Polymyalgia rheumatica.",
"4": "Thalassemia minor.",
"5": null
} | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
316,
436
]
],
"word_ranges": [
[
51,
73
]
],
"text": "1: if it is a recent loss, the MCV could remain normal, but the ferritin should be affected, and certainly not elevated."
},
"2": {
"... |
108 | 2,012 | 219 | A man has a partial deletion in the dystrophin gene (chromosome Xp21) which causes the semiology of Becker muscular dystrophy. He goes to the genetic consultation with his wife, to assess the risks of transmission of the disease. What correct information will be provided in the course of the genetic counseling? | It is the male who presents the disease, which we are told is X-linked, so there are only two options left: 2 and 3. 2 is not because the males will receive the Y chromosome from the father and the X from the mother, who is healthy, so the daughters will be able to carry the disease (correct option 3). | GENETICS AND IMMUNOLOGY | {
"1": "According to autosomal dominant inheritance, half of her children will inherit the disease and without distinction of sexes.",
"2": "Their daughters will not inherit the disease, but all their future sons will be carriers and can transmit the mutation to 50%.",
"3": "Their sons will not inherit the diseas... | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
0,
303
]
],
"word_ranges": [
[
0,
60
]
],
"text": "It is the male who presents the disease, which we... |
255 | 2,014 | 94 | A 65-year-old woman with a history of joint pain and under treatment with anti-inflammatory drugs is referred for anemia. In the complementary studies she presented red blood cells 3,164,000, Hto. 32%, Hb 11g/dl, MCV 69 fl, Leukocytes 7800, Platelets 370,000, CRP 0.29 mg/dl, Fe 20ng/ml, Ferritin 18 ng/ml, Glucose 105 m... | It is a study of iron deficiency anemia with normal gastroscopy and colonoscopy, having ruled out possible celiac disease. We have yet to see jejunum and ileum, so we will have to perform a capsule endoscopy. In iron deficiency anemia, a digestive cause must always be ruled out. | DIGESTIVE SYSTEM | {
"1": "Jejunum biopsy.",
"2": "Arteriography.",
"3": "Endoscopic capsule.",
"4": "Radioisotopes.",
"5": "Pelvic MRI."
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
0,
208
]
],
"word_ranges": [
[
... |
303 | 2,016 | 111 | In a patient with rheumatoid arthritis on methotrexate, prednisone and indomethacin who acutely presents with edema and increased plasma creatinine with poorly expressive urine sediment and proteinuria less than 100 mg/24 h the most likely cause is: | Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course. GMN associated with rheumatoid arthritis characteristically alters the sediment, and renal failure due to NSAIDs has a more chronic course, with papillary necrosis. Thus, given the course and the alterations described, ... | NEPHROLOGY | {
"1": "Renal amyloidosis.",
"2": "Glomerulonephritis secondary to rheumatoid arthritis.",
"3": "Renal failure due to nonsteroidal anti-inflammatory drugs.",
"4": "Interstitial nephritis due to methotrexate.",
"5": null
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
100
]
],
"word_ranges": [
[
0,
15
]
],
"text": "Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course."
},
"2": {
"exist": true,
"char... |
539 | 2,021 | 3 | A 45-year-old patient who presents with a first episode of low back pain of 3 weeks' evolution that prevents him from carrying out his normal life. She does not refer trauma or other underlying pathology. In the physical examination there is no neurological deficit. Which imaging test would be indicated? | A first episode of acute low back pain (less than 6 weeks duration), does not require imaging tests in the absence of "red flags" that may indicate an underlying process, such as a fracture, infection or malignant tumor. | TRAUMATOLOGY | {
"1": "As this is the first episode of low back pain, only a simple X-ray of the lumbar spine.",
"2": "MRI, which provides more information on soft tissue and possible herniations.",
"3": "CT scan, to better assess the bone structure and possible fractures.",
"4": "No indication for imaging test.",
"5": null... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
408 | 2,018 | 190 | A 45-year-old woman diagnosed with stage IV breast cancer with multiple bone metastases on hormonal treatment and iv bisphosphonates. She comes to your office referring intense bone pain (VAS=7), in several locations without associated neurological symptoms and exarcerbations of pain (VAS=9) several times a day that fo... | The correct answer is 4 because if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen and it will also help us to use the antalgic synergy. We should change the treatment to a major opioid and treat the disrruptive pain vigorously since she is at almost the maximum ... | PRIMARY CARE | {
"1": "Suspend ibuprofen and tramadol and start a major opioid such as morphine or oxycodone.",
"2": "Suspend tramadol, maintain ibuprofen and initiate a major opioid such as morphine and oxycodone.",
"3": "Discontinue ibuprofen and tramadol and start a major opioid such as morphine or oxycodone and at the same ... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
29 | 2,011 | 60 | A 71-year-old patient, smoker of 2 packs of cigarettes/day for 50 years, with good quality of life and no other pathologic history of interest, consults for cough and hemoptotic expectoration. Physical examination revealed no significant pathological findings. Chest X-ray showed a mass of 4x3.4 cm lower right, a findin... | 1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis. 2: Age should not be a limiting factor, especially considering that it is only 71 years old, but especially because the patient's "quality of life" is good (and I put "quality of life" because it is a term used erroneou... | NEUROLOGY AND THORACIC SURGERY | {
"1": "Perform mediastinoscopy.",
"2": "Surgical intervention with curative intent should be contraindicated due to the advanced age of the patient.",
"3": "An oxygen consumption test should be performed, given the respiratory limitation he presents.",
"4": "Surgical resection (lobectomy of the lower lobe of t... | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
9,
99
]
],
"word_ranges": [
[
3,
17
]
],
"text": "These are diagnostic tests, they are meaningless since you have already made the diagnosis."
},
"2": {
"exist": true,
"char_ranges": ... |
10 | 2,011 | 37 | A 76-year-old woman with no history other than hypertension consults for painless jaundice and pruritus with anorexia. Laboratory tests show a bilirubin level of 12 mg/dl (with 9.5 direct bilirubin). Abdominal ultrasound shows dilatation of the intrahepatic and extrahepatic biliary tract, together with a single 2 cm no... | I think the correct answer is 4, although both lesions are resectable, pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication because it does not prolong survival and has a high morbidity. Surgical bypass has more complications than placing a self-expanding metallic prosthesis that has... | SURGERY | {
"1": "Adjuvant chemo/radiotherapy, conditioning radical surgery to the initial response.",
"2": "Percutaneous external drainage is palliative, with eventual conversion to internal drainage in case of intolerance or complications.",
"3": "Surgical biliary bypass, with or without prophylactic gastrojejunostomy de... | 4 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"4": {
"exist": true,
"... |
284 | 2,016 | 57 | A 72-year-old woman presents to the hospital with oppressive chest pain of 2 hours' duration. Blood pressure is 68/32 mm Hg, heart rate is 124 beats/min, respiratory rate is 32 breaths/min, oxygen saturation is 91% with oxygen at 50%, bilateral crackles on pulmonary auscultation. An ECG shows a subepicardial lesion in ... | Perform urgent coronary angiography. | CARDIOLOGY AND VASCULAR SURGERY | {
"1": "Start i.v. nitrate infusion.",
"2": "Perform fibrinolysis with tenecteplase (TNK).",
"3": "Perform urgent coronary angioplasty.",
"4": "Administer furosemide 40 mg i.v.",
"5": null
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
0,
36
]
],
"word_ranges": [
[
... |
188 | 2,013 | 230 | A 57-year-old patient had an acute myocardial infarction and has a blood test with cholesterol 312 mg/dl, LDL 241 mg/dl, HDL 29 and normal TG. He smoked 30 cig/day, was not obese, his blood pressure was 145/90 mm Hg and he did not have diabetes. When asked about family history, he mentioned that an uncle on his mother'... | Question on a fashionable topic in recent years: dyslipidemia; I would answer it by rule out. The treatment for hypercholesterolemia is statins so we rule out answers 2 and 4. The statin in a patient with cardiovascular disease (such as an AMI) is a lifelong treatment (we discard 1) since it is not taken until LDL leve... | ENDOCRINOLOGY | {
"1": "Treat with statins until cholesterol is normalized and recommend healthy lifestyle (diet, exercise and no smoking).",
"2": "Rule out hypothyroidism or other systemic disease, recommend a healthy lifestyle and treat with fibrates to normalize cholesterol.",
"3": "It is not necessary to rule out secondary d... | 5 | {
"1": {
"exist": true,
"char_ranges": [
[
176,
338
]
],
"word_ranges": [
[
30,
59
]
],
"text": "The statin in a patient with cardiovascular disease (such as an AMI) is a lifelong treatment (we discard 1) since it is not taken until LDL l... |
349 | 2,016 | 160 | A 45-year-old woman, mother of 3 children, attends an early diagnosis consultation. Cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion. Which of the following options would you choose? | The correct answer is 2. According to the 2014 SEGO Oncoguide on cervical cancer prevention, when a cytology shows a high-grade squamous intraepithelial lesion, the action to be taken is a colposcopy, with or without biopsy depending on the findings (regardless of the patient's age and parity). | GYNECOLOGY AND OBSTETRICS | {
"1": "Repeat cytology in 1 month.",
"2": "Colposcopy with possible biopsy.",
"3": "Hysterectomy with bilateral salpinguectomy and ovarian conservation.",
"4": "Fractionated uterine curettage.",
"5": null
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
25,
295
]
],
"word_ranges": [
[
5,
47
]
],
"text": "According to the 2014 SEGO Oncoguide on cervical... |
290 | 2,016 | 50 | A 58-year-old man referred a 3-week history of progressive, mildly painful skin lesions on his left arm. It had started as an erythematous lesion on his left thumb. He had visible reddish striae as connecting lines between the lesions. The patient had no fever or other general symptoms. He had been working in his garde... | The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma, so the first two would be ruled out. The history of having been working in the garden points more to a sporotrichosis, although the fact that the question asks for the "causative agent" and not th... | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | {
"1": "Dermatophytosis due to Microsporum gypseum.",
"2": "Cutaneous infection by Staphylococcus aureus.",
"3": "Sporotrichosis.",
"4": "Cutaneous infection by Mycobacterium marinum.",
"5": null
} | 3 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
160
]
],
"word_ranges": [
[
0,
23
]
],
"text": "The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma, so the first two wou... |
305 | 2,016 | 174 | An 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 ... | One of the mechanisms that produce the hypotensive effect of ACE inhibitors such as perindopril is the increased action of vasodilator prostaglan-dins on the kidney, which decreases hydrosaline retention and therefore increases diuresis and lowers blood pressure. NSAIDs inhibit prostaglandin synthesis and decrease rena... | NEPHROLOGY | {
"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 to 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 ... | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
264,
621
]
],
"word_ranges": [
[
... |
104 | 2,012 | 91 | A 34-year-old man referred to the clinic for persistent LDL cholesterol levels above 250 mg/dL. The patient is asymptomatic but on examination there are whitish indurated spots on elbows, knees and eyelids. His BP is 135/85 mmHg. Her father died of myocardial infarction at the age of 48 years. The fasting blood test sh... | This is a heterozygous familial hypercholesterolemia. We must know how to recognize the disease and know the criteria. It seems to me to be of high difficulty. | ENDOCRINOLOGY | {
"1": "It is an autosomal codominant hereditary disease, with a high penetrance, so it is frequent that some of the parents and siblings of the individual also suffer from it.",
"2": "The genetic disorder affects the gene encoding the LDL cholesterol receptor and more than 900 mutations have been described.",
"3... | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
0,
118
]
],
"word_ranges": [
[
... |
38 | 2,011 | 232 | A 52-year-old woman consults for having noticed during the previous week a yellowish discoloration of the conjunctivae. She does not refer to risky sexual behavior or epidemiological history of risk of viral hepatitis. She does not consume alcohol or hepatotoxic drugs. She reports a one-year history of generalized prur... | A middle-aged woman with Sjögren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes us think of primary biliary cirrhosis. To diagnose it we will use antimitochondrial antibodies (AMA IgG). Therefore, it would be answer 1. | OPHTHALMOLOGY | {
"1": "Anti-mitochondrial antibodies.",
"2": "Study of iron metabolism.",
"3": "Study of copper metabolism.",
"4": "Hepatic MRI.",
"5": "Serology of virus B and virus C."
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
249
]
],
"word_ranges": [
[
0,
33
]
],
"text": "A middle-aged woman with Sjögren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes ... |
376 | 2,016 | 130 | A 39-year-old man who in the last 3 months has had two episodes of wide and involuntary jumping movements of the left limbs, which in about two minutes lead to loss of consciousness. In the neuroradiological study a right frontal expansive lesion suggestive of cerebral glioma was found.How would you classify this patie... | They refer to a partial seizure that is followed by loss of level of consciousness, so strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities). For this reason the most correct opt... | NEUROLOGY | {
"1": "Generalized symptomatic.",
"2": "Partially symptomatic.",
"3": "Partial cryptogenic.",
"4": "Partial secondarily generalized symptomatic.",
"5": null
} | 2 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": true,
"char_ranges": [
[
300,
505
]
],
"word_ranges": [
[
47,
82
]
],
"text": "the most correct option would be two because i... |
163 | 2,013 | 122 | A 66-year-old man with a history of ankylosing spondylitis of long evolution. He presents proteinuria of 6 grams per day with hypoalbuminemia and edema. In the urinary sediment no hematuria is detected. His plasma creatinine is 1.6 mg/dL and his glomerular filtration rate is 45 mL/min. Glycemia 110 mg/dL. His severe sp... | The correct answer is: 3. Subcutaneous fat biopsy. Lupus erythematosus, some vasculitides, Goodpasture's disease and other systemic diseases (ankylosing spondylitis is one of them) affect the kidney and condition its prognosis. The appearance of urinary abnormalities or renal impairment of parenchymal cause are indicat... | NEPHROLOGY | {
"1": "To initiate corticoids for suspicion of minimal change glomerular disease.",
"2": "Treat with cyclophosphamide for suspected membranous glomerulopathy.",
"3": "Subcutaneous fat biopsy.",
"4": "Initiate dialysis.",
"5": "Glucose overload test to rule out diabetic nephropathy."
} | 3 | {
"1": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
"text": ""
},
"3": {
"exist": true,
"char_ranges": [
[
1000,
1123
]
],
"word_ranges": [
[
... |
148 | 2,012 | 158 | A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner. Her medical history shows several similar complaints in the previous year, two of them after a self-injurious gesture. Frequent conflicts in the couple's relationship, job changes and family arguments a... | The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misunderstood... maybe she is right... The issue is that she cannot stand rejection and has self-injurious gestures. The diagnosis is 1. 3, 4 and 5 are not even close, there is no clinica... | PSYCHIATRY | {
"1": "Borderline personality disorder.",
"2": "Histrionic personality disorder.",
"3": "Dysthymia.",
"4": "Dissociative disorder.",
"5": "Depersonalization disorder."
} | 1 | {
"1": {
"exist": true,
"char_ranges": [
[
0,
269
]
],
"word_ranges": [
[
0,
46
]
],
"text": "The woman is 23 years old and is pissed off. She needs support and a lot of emotional education to curb her impulsivity... she feels misundersto... |
178 | 2,013 | 94 | 18-month-old boy, with complete vaccination schedule to date, who consults the Emergency Department for swelling of the right knee after playing in the park, without obvious trauma. In the directed anamnesis, the mother refers that an uncle of hers had similar problems. The ultrasound examination is compatible with hem... | In this question they also do not stop dropping clues to throw us headlong into the correct diagnosis. Let's review: a small child who suffers a hemarthrosis without clear trauma. An uncle of his had similar problems, so we suspect hereditary disease. The APTT, which evaluates the intrinsic coagulation pathway (involvi... | HEMATOLOGY | {
"1": "Marfan syndrome.",
"2": "Von Willebrand's disease.",
"3": "Ehlers-Danlos disease.",
"4": "Hemophilia A.",
"5": "Bemard-Soulier disease."
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
252,
440
]
],
"word_ranges": [
[
42,
72
]
],
"text": "The APTT, which evaluates the intrinsic coagulation pathway (involving factors V, VIII, IX, X, XI and XII) is elongated. Hereditary coagulati... |
100 | 2,012 | 85 | A 24-year-old man reports progressive asthenia for at least 6 months, hoarse voice, slow speech, drowsiness and swelling of the hands, feet and face. Examination: pulse at 52 beats per minute, abotarada face and dry and pale skin. CBC: mild anemia, cholesterol 385 mg/dL (normal <220), creatinine 1.3 mg/dL (normal: 0.5-... | This is severe primary hypothyroidism. Treatment is with thyroxine. If there is no nodule, neither echo nor FNA is indicated. | ENDOCRINOLOGY | {
"1": "Perform a thyroid ultrasound before starting treatment.",
"2": "Determine free T3 and perform a pituitary MRI.",
"3": "Treat with L-triiodothyronine and a statin.",
"4": "Treat with L-Tyroxine and determine antithyroid antibodies.",
"5": "Perform thyroid cytology prior to treatment."
} | 4 | {
"1": {
"exist": true,
"char_ranges": [
[
68,
125
]
],
"word_ranges": [
[
9,
20
]
],
"text": "If there is no nodule, neither echo nor FNA is indicated."
},
"2": {
"exist": false,
"char_ranges": [],
"word_ranges": [],
... |
End of preview. Expand in Data Studio
Antidote CasiMedicos Dataset - Possible Answers Explanations in Resident Medical Exams
We present a new multilingual parallel medical dataset of commented medical exams which includes not only explanatory arguments for the correct answer but also arguments to explain why the remaining possible answers are incorrect.
This dataset can be used for various NLP tasks including: Medical Question Answering, Explanatory Argument Extraction or Explanation Generation.
The data source consists of Resident Medical Intern or Médico Interno Residente (MIR) exams, originally created by CasiMedicos, a Spanish community of medical professionals who collaboratively, voluntarily, and free of charge, publishes written explanations about the possible answers included in the MIR exams. The aim is to generate a resource that helps future medical doctors to study towards the MIR examinations. The commented MIR exams, including the explanations, are published in the CasiMedicos Project MIR 2.0 website.
We have extracted, clean, structure and annotated the available data so that each document in casimedicos-raw dataset includes the clinical case, the correct answer, the multiple-choice questions and the annotated explanations written by native Spanish medical doctors.
Furthermore, the original Spanish data has been translated to create a parallel multilingual dataset in 4 languages: English, French, Italian and Spanish.
| Antidote CasiMedicos splits | |
|---|---|
| train | 434 |
| validation | 63 |
| test | 125 |
- 📖 Paper:HiTZ@Antidote: Argumentation-driven Explainable Artificial Intelligence for Digital Medicine
- 💻 Github Repo (Data and Code): https://github.com/ixa-ehu/antidote-casimedicos
- 🌐 Project Website: https://univ-cotedazur.eu/antidote
- Funding: CHIST-ERA XAI 2019 call. Antidote (PCI2020-120717-2) funded by MCIN/AEI /10.13039/501100011033 and by European Union NextGenerationEU/PRTR
Example
In this repository you can find the following data:
- casimedicos-raw: The textual content including Clinical Case (C), Question (Q), Possible Answers (P), and Explanation (E) as shown in the example above.
- casimedicos-exp: The manual annotations linking the explanations of the correct and incorrect possible answers.
Data Explanation
The following attributes composed casimedicos-raw:
- id: unique doc identifier.
- year: year in which the exam was published by the Spanish Ministry of Health.
- question_id_specific: id given to the original exam published by the Spanish Ministry of Health.
- full_question: Clinical Case (C) and Question (Q) as illustrated in the example document above.
- full answer: Full commented explanation (E) as illustrated in the example document above.
- type: medical speciality.
- options: Possible Answers (P) as illustrated in the example document above.
- correct option: solution to the exam question.
Additionally, the following jsonl attribute was added to create casimedicos-exp:
- explanations: for each possible answer above, manual annotation states whether:
- the explanation for each possible answer exists in the full comment (E) and
- if present, then we provide character and token offsets plus the text corresponding to the explanation for each possible answer.
The process of manually annotating the corpus consisted of specifying where the explanations of the correct and incorrect answers begin and end. In order to obtain grammatically complete correct answer explanations, annotating full sentences or subordinate clauses was preferred over shorter spans.
Citation
If you use the textual content casimedicos-raw of the Antidote CasiMedicos dataset then please cite the following paper:
@inproceedings{Agerri2023HiTZAntidoteAE,
title={HiTZ@Antidote: Argumentation-driven Explainable Artificial Intelligence for Digital Medicine},
author={Rodrigo Agerri and I{\~n}igo Alonso and Aitziber Atutxa and Ander Berrondo and Ainara Estarrona and Iker Garc{\'i}a-Ferrero and Iakes Goenaga and Koldo Gojenola and Maite Oronoz and Igor Perez-Tejedor and German Rigau and Anar Yeginbergenova},
booktitle={SEPLN 2023: 39th International Conference of the Spanish Society for Natural Language Processing.},
year={2023}
}
Additionally, cite the previous and the following paper if you also use casimedicos-exp, namely, the manual annotations linking the explanations with the correct and incorrect possible answers ("explanations" attribute in the jsonl data):
@misc{goenaga2023explanatory,
title={Explanatory Argument Extraction of Correct Answers in Resident Medical Exams},
author={Iakes Goenaga and Aitziber Atutxa and Koldo Gojenola and Maite Oronoz and Rodrigo Agerri},
year={2023},
eprint={2312.00567},
archivePrefix={arXiv}
}
Contact: Rodrigo Agerri HiTZ Center - Ixa, University of the Basque Country UPV/EHU
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