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HiTZ zentroa 49

{ "1": "Central precocious puberty.", "2": "Peripheral precocious puberty.", "3": "Early adrenarche.", "4": "Adrenal tumor.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 321, 542 ] ], "word_ranges": [ [ 60, 96 ] ], "text": "The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present. Therefore, the correct option is early adrenarche." }, "2": { "exist": true, "char_ranges": [ [ 321, 542 ] ], "word_ranges": [ [ 60, 96 ] ], "text": "The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present. Therefore, the correct option is early adrenarche." }, "3": { "exist": true, "char_ranges": [ [ 321, 542 ] ], "word_ranges": [ [ 60, 96 ] ], "text": "The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present. Therefore, the correct option is early adrenarche." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "A thoracic computed tomography (CT) scan.", "2": "Pleural fluid pH measurement.", "3": "Measurement of adenosine deaminase in pleural fluid.", "4": "Tuberculin test.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 421 ] ], "word_ranges": [ [ 0, 67 ] ], "text": "The determination of ADA, in the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L, should lead us to have a high degree of suspicion about tuberculous etiology and send the pleural fluid to microbiology for tuberculosis study." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The way of transmission of this entity is by ticks.", "2": "Both doxycycline and hydroxychloroquine are effective in treating acute forms of this disease.", "3": "In its acute form it also presents, generally, elevation of antibodies against phase I antigens.", "4": "Mortality in acute forms is almost nonexistent.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 75, 122 ] ], "word_ranges": [ [ 11, 18 ] ], "text": "Coxiella infection is not transmitted by ticks." }, "2": { "exist": true, "char_ranges": [ [ 431, 640 ] ], "word_ranges": [ [ 68, 101 ] ], "text": "The combination of doxycycline plus hicroxychloroquine can be used, but for chronic Q fever (which is where elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality)." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Isoniazid, for nine months.", "2": "Rifampicin, for four months.", "3": "Isoniazid and rifampicin, for three months.", "4": "Isoniazid and rifapentine, for three months.", "5": null }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Arteriography of lower extremities.", "2": "Ankle-brachial index.", "3": "Computerized axial tomography with vascular reconstruction of lower extremities.", "4": "Tape stress test.", "5": "Magnetic resonance imaging." }

{ "1": { "exist": true, "char_ranges": [ [ 295, 417 ] ], "word_ranges": [ [ 44, 60 ] ], "text": "Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered." }, "2": { "exist": true, "char_ranges": [ [ 123, 262 ] ], "word_ranges": [ [ 17, 39 ] ], "text": "we can objectively assess the severity of the disease with the use of bloodless techniques. The most important is the ankle-brachial index." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Explain to her that, if she is amenorrheic, she does not require another contraceptive method since breastfeeding is sufficient as a contraceptive method.", "2": "He informed her that the levonogestrel IUD is contraindicated because she had a cesarean section less than a year ago.", "3": "He explains that she could use a gestagen-only hormonal method.", "4": "She is offered combined hormonal contraception.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 145 ] ], "word_ranges": [ [ 0, 23 ] ], "text": "Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Morning predominance.", "2": "It does not change with effort.", "3": "Photophobia.", "4": "Sonophobia.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 299, 423 ] ], "word_ranges": [ [ 50, 68 ] ], "text": "In addition, it is predominantly morning (option 1 is correct) because in the morning intracranial pressure naturally rises." }, "2": { "exist": true, "char_ranges": [ [ 135, 298 ] ], "word_ranges": [ [ 24, 50 ] ], "text": "The headache due to increased intracranial pressure is of positional type (it increases with Valsalva maneuvers and when bending down), so option 2 is not correct." }, "3": { "exist": true, "char_ranges": [ [ 424, 561 ] ], "word_ranges": [ [ 68, 89 ] ], "text": "Migraine-type headaches may be associated with photophobia or sonophobia (answers 3 and 4). But this headache is not a migraine headache." }, "4": { "exist": true, "char_ranges": [ [ 424, 561 ] ], "word_ranges": [ [ 68, 89 ] ], "text": "Migraine-type headaches may be associated with photophobia or sonophobia (answers 3 and 4). But this headache is not a migraine headache." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Verapamil.", "2": "Digoxin.", "3": "Adenosine.", "4": "Procainamide.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 196, 384 ] ], "word_ranges": [ [ 25, 47 ] ], "text": "digoxin and non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) are contraindicated because they may increase the ventricular rate and cause ventricular fibrillation." }, "2": { "exist": true, "char_ranges": [ [ 196, 384 ] ], "word_ranges": [ [ 25, 47 ] ], "text": "digoxin and non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) are contraindicated because they may increase the ventricular rate and cause ventricular fibrillation." }, "3": { "exist": true, "char_ranges": [ [ 111, 191 ] ], "word_ranges": [ [ 13, 24 ] ], "text": "Heart rate slowing drugs, commonly used in atrial fibrillation, are ineffective," }, "4": { "exist": true, "char_ranges": [ [ 385, 543 ] ], "word_ranges": [ [ 47, 70 ] ], "text": "If cardioversion is not possible, drugs that prolong the refractory period of accessory connection should be used. IV procainamide or amiodarone is preferred," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Delayed meconium evacuation.", "2": "Salty taste of the skin.", "3": "Isolation of secretions of Pseudomonas aeruginosa.", "4": "Deterioration/detention of the weight curve.", "5": "Hypernatremic dehydration." }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 256, 409 ] ], "word_ranges": [ [ 42, 67 ] ], "text": "clearly the indication to perform a sweat chlorine (to rule out FQP) are the HIPOnatremic dehydrations and not the hypernatremic ones as the answer says." } }

{ "1": "Mefloquine orally.", "2": "Intravenous artesunate.", "3": "Doxycycline orally.", "4": "Oral quinine sulfate.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 325 ] ], "word_ranges": [ [ 0, 48 ] ], "text": "In severe cases of Plasmodium infection, the greatest risk of mortality occurs in the first 24 hours of clinical presentation, so treatment should be started immediately. Treatment with parenteral or intramuscular artesunate is more indicated in severe Plasmodium infection, both in adults and children and in pregnant women." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Alport syndrome.", "2": "IgA nephropathy.", "3": "Fabry disease.", "4": "Autosomal dominant polycystic kidney disease.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 30, 169 ] ], "word_ranges": [ [ 5, 26 ] ], "text": "Microhematuria, proteinuria and sensorineural hearing loss in a young male with a family history of women with hematuria = Alport syndrome." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Encourage the displacement of potassium from the plasma space to the intracellular space.", "2": "Chelate circulating potassium to favor its hepatic elimination.", "3": "Chelate circulating potassium to favor its renal elimination.", "4": "Antagonize the action of potassium on the myocardial cell membrane.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 103 ] ], "word_ranges": [ [ 0, 18 ] ], "text": "Calcium gluconate has no effect on blood potassium levels (therefore options 1, 2 and 3 are ruled out)." }, "2": { "exist": true, "char_ranges": [ [ 0, 103 ] ], "word_ranges": [ [ 0, 18 ] ], "text": "Calcium gluconate has no effect on blood potassium levels (therefore options 1, 2 and 3 are ruled out)." }, "3": { "exist": true, "char_ranges": [ [ 0, 103 ] ], "word_ranges": [ [ 0, 18 ] ], "text": "Calcium gluconate has no effect on blood potassium levels (therefore options 1, 2 and 3 are ruled out)." }, "4": { "exist": true, "char_ranges": [ [ 104, 233 ] ], "word_ranges": [ [ 18, 37 ] ], "text": "Its function is to decrease the excitability of cardiac myocytes to decrease the likelihood of developing heart rhythm disorders." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "I would change the treatment to ceftriaxone because of its greater efficacy.", "2": "I would add a quinolone to the treatment.", "3": "I would switch to amoxicillin/clavulanic acid.", "4": "It would rule out the presence of pleural empyema.", "5": "I would continue with the same treatment, assuming it is simply a timing issue." }

{ "1": { "exist": true, "char_ranges": [ [ 999, 1228 ] ], "word_ranges": [ [ 162, 199 ] ], "text": "If the dosage had not been adequate and the presence of drug resistance was possible, one option could have been to treat with ceftriaxone at high doses, since we should remember that streptococcus does not produce beta-lactamase" }, "2": { "exist": true, "char_ranges": [ [ 1357, 1491 ] ], "word_ranges": [ [ 215, 241 ] ], "text": "With quinolone we do not increase the spectrum and it is evident that the poor evolution of the patient is not only a problem of time." }, "3": { "exist": true, "char_ranges": [ [ 1233, 1356 ] ], "word_ranges": [ [ 200, 215 ] ], "text": "beta-lactam resistance is produced by another mechanism (using amoxicillin-clavulanate would not provide us with anything)." }, "4": { "exist": true, "char_ranges": [ [ 756, 998 ] ], "word_ranges": [ [ 123, 162 ] ], "text": "although the antibiotic is the right one, it is not reaching the infectious focus adequately because an empyema has probably occurred. We should rule out the existence of an empyema and drain it while continuing with the antibiotic treatment." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "All her male children will be carriers and, therefore, will manifest the disease.", "2": "There is a phenomenon of genetic anticipation, so their offspring will present more severe and earlier symptoms.", "3": "Preimplantation genetic diagnosis for sex selection of embryos by fluorescence in situ hybridization (FISH) is the best option for healthy offspring.", "4": "50% of her daughters will be carriers, but will not present clinical manifestations of the disease.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 150, 535 ] ], "word_ranges": [ [ 25, 81 ] ], "text": "Triplet expansion diseases, such as this one, can have the anticipation phenomenon whereby females with premutations (between 55-200 repeats) can have children with full mutations (more than 200 repeats of the triplet) and more obvious, more severe and/or earlier clinical, in both males and females (Fragile X syndrome, early ovarian failure, tremor/ataxia associated with Fragile X)." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Rituximab-CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisone).", "2": "Rituximab-CVP (Cyclophosphamide, Vincristine, Prednisone).", "3": "Do not treat and monitor (wait and see).", "4": "Rituxirnab-Bendamustine.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 225 ] ], "word_ranges": [ [ 0, 35 ] ], "text": "There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing," }, "2": { "exist": true, "char_ranges": [ [ 0, 225 ] ], "word_ranges": [ [ 0, 35 ] ], "text": "There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing," }, "3": { "exist": true, "char_ranges": [ [ 0, 225 ] ], "word_ranges": [ [ 0, 35 ] ], "text": "There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing," }, "4": { "exist": true, "char_ranges": [ [ 0, 225 ] ], "word_ranges": [ [ 0, 35 ] ], "text": "There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy, but given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Right hemicolectomy.", "2": "Extended right hemicolectomy.", "3": "Subtotal colectomy.", "4": "Total colectomy with ileorectal anatomosis.", "5": "Total colectomy with ileoanal anatomy." }

{ "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, "char_ranges": [ [ 131, 228 ] ], "word_ranges": [ [ 19, 35 ] ], "text": "The age and right location data lead us to answer 4: total colectomy with ileorectal anastomosis." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "She has secondary hypertension.", "2": "Presents masked arterial hypertension.", "3": "Presents isolated clinical hypertension.", "4": "Presents refractory arterial hypertension.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 134, 223 ] ], "word_ranges": [ [ 22, 39 ] ], "text": "It is not secondary HT because no study has been done to confirm it (option 1 incorrect)." }, "2": { "exist": true, "char_ranges": [ [ 0, 133 ] ], "word_ranges": [ [ 0, 22 ] ], "text": "The patient described is the definition of masked HT, normal figures in consultation and elevated on AMPA or ABPM (option 2 correct)." }, "3": { "exist": true, "char_ranges": [ [ 224, 329 ] ], "word_ranges": [ [ 39, 56 ] ], "text": "It is not isolated HT because the elevated figures are maintained for several weeks (option 3 incorrect)." }, "4": { "exist": true, "char_ranges": [ [ 330, 411 ] ], "word_ranges": [ [ 56, 71 ] ], "text": "It is not refractory HT because it has not yet been treated (option 4 incorrect)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Benzodiazepines.", "2": "Vaginal estrogens.", "3": "Oral estrogens and progestogens in continuous regimen.", "4": "Transdermal estrogens in a continuous regimen.", "5": null }

{ "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, "char_ranges": [ [ 0, 202 ] ], "word_ranges": [ [ 0, 31 ] ], "text": "The hormonal profile we are told is in menopausal range (FSH >20; estradiol <5) and the patient has systemic vasomotor symptoms. Therefore, it would be more appropriate to administer systemic estrogens." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The priority is to cannulate a venous line.", "2": "Intramuscular methylprednisolone is the treatment of choice.", "3": "It is a picture of urticaria associated with asthma, and should be treated with antihistamines and inhaled bronchodilators.", "4": "Parents should be advised to transfer to a hospital emergency department.", "5": "Intramuscular adrenaline should be administered without further delay." }

{ "1": { "exist": true, "char_ranges": [ [ 167, 288 ] ], "word_ranges": [ [ 23, 39 ] ], "text": "The first thing is INTRAMUSCULAR adrenaline NOW! The venous route, corticosteroids, antihistamines, etc. will come later." }, "2": { "exist": true, "char_ranges": [ [ 167, 288 ] ], "word_ranges": [ [ 23, 39 ] ], "text": "The first thing is INTRAMUSCULAR adrenaline NOW! The venous route, corticosteroids, antihistamines, etc. will come later." }, "3": { "exist": true, "char_ranges": [ [ 167, 288 ] ], "word_ranges": [ [ 23, 39 ] ], "text": "The first thing is INTRAMUSCULAR adrenaline NOW! The venous route, corticosteroids, antihistamines, etc. will come later." }, "4": { "exist": true, "char_ranges": [ [ 167, 288 ] ], "word_ranges": [ [ 23, 39 ] ], "text": "The first thing is INTRAMUSCULAR adrenaline NOW! The venous route, corticosteroids, antihistamines, etc. will come later." }, "5": { "exist": true, "char_ranges": [ [ 0, 166 ] ], "word_ranges": [ [ 0, 23 ] ], "text": "She is describing egg anaphylaxis, a potentially fatal condition. The treatment of choice is intramuscular adrenaline, and effectively, without wasting too much time." } }

{ "1": "Enalapril.", "2": "Losartan.", "3": "Spironolactone.", "4": "Bisoprolol.", "5": "Eplerenone." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 353 ] ], "word_ranges": [ [ 0, 46 ] ], "text": "In a patient with multiple CVRF with concomitant heart and renal failure (presumably of multiple etiology: renal hypoperfusion, arteriosclerosis...), we must be very careful when using diuretics and ACEI/ARA-II, since we can worsen renal function and/or increase potassium levels (among diuretics, spironolactone and eplerenone are \"potassium-sparing\")." }, "2": { "exist": true, "char_ranges": [ [ 0, 353 ] ], "word_ranges": [ [ 0, 46 ] ], "text": "In a patient with multiple CVRF with concomitant heart and renal failure (presumably of multiple etiology: renal hypoperfusion, arteriosclerosis...), we must be very careful when using diuretics and ACEI/ARA-II, since we can worsen renal function and/or increase potassium levels (among diuretics, spironolactone and eplerenone are \"potassium-sparing\")." }, "3": { "exist": true, "char_ranges": [ [ 0, 353 ] ], "word_ranges": [ [ 0, 46 ] ], "text": "In a patient with multiple CVRF with concomitant heart and renal failure (presumably of multiple etiology: renal hypoperfusion, arteriosclerosis...), we must be very careful when using diuretics and ACEI/ARA-II, since we can worsen renal function and/or increase potassium levels (among diuretics, spironolactone and eplerenone are \"potassium-sparing\")." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 0, 353 ] ], "word_ranges": [ [ 0, 46 ] ], "text": "In a patient with multiple CVRF with concomitant heart and renal failure (presumably of multiple etiology: renal hypoperfusion, arteriosclerosis...), we must be very careful when using diuretics and ACEI/ARA-II, since we can worsen renal function and/or increase potassium levels (among diuretics, spironolactone and eplerenone are \"potassium-sparing\")." } }

{ "1": "Parathyroid carcinoma.", "2": "Medullary thyroid carcinoma.", "3": "MEN type I.", "4": "Parathyroid adenoma.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 315, 489 ] ], "word_ranges": [ [ 47, 73 ] ], "text": "The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration), therefore we opt for option 1." }, "2": { "exist": true, "char_ranges": [ [ 66, 209 ] ], "word_ranges": [ [ 8, 31 ] ], "text": "It is associated with hypercalcemia, therefore, the option of medullary thyroid cancer is ruled out (it does not affect the level of calcemia)." }, "3": { "exist": true, "char_ranges": [ [ 210, 314 ] ], "word_ranges": [ [ 31, 47 ] ], "text": "To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Glioblastoma.", "2": "Medulloblastoma.", "3": "Germ cell tumor.", "4": "Meningioma.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 110, 267 ] ], "word_ranges": [ [ 18, 48 ] ], "text": "In this case the MRI already places the origin of the symptoms in the pineal gland. The most frequent tumor in this region is the germ cell tumor (answer 3)." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Practice a blood glucose curve with 75 g of glucose.", "2": "Already meets diagnostic criteria for diabetes mellitus.", "3": "Request a determination of basal insulinemia or C-peptide.", "4": "Request a determination of glycosylated hemoglobin.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 240 ] ], "word_ranges": [ [ 0, 43 ] ], "text": "Diagnostic Criteria for DM according to ISPAD 2018 *Classic symptoms of diabetes with blood glucose > 200mgr/dl or: * Fasting glycemia ≥ 126mgr/dl (fasting at least 8h) or * Glycemia at 2h SOG ≥ 200mgr/dl (on 2 occasions) or * HbA1C ≥ 6.5%." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Mononeuropathy of the right common peroneal nerve.", "2": "Focal involvement of the first motor neuron and probably of the second.", "3": "Right hemimedullary involvement (Brown-Sequard).", "4": "Multiple mononeuropathy with involvement of the common peroneal and right posterior tibial nerve.", "5": "Right lumbar plexopathy." }

{ "1": { "exist": true, "char_ranges": [ [ 20, 53 ] ], "word_ranges": [ [ 3, 8 ] ], "text": "It does not explain pyramidalism." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 147, 346 ] ], "word_ranges": [ [ 22, 54 ] ], "text": "We would lack data to think of a Brown Sequard hemimedullary syndrome. It would explain the pyramidalism, but we would be missing data suggestive of this picture such as a contralateral hypoesthesia." }, "4": { "exist": true, "char_ranges": [ [ 367, 473 ] ], "word_ranges": [ [ 57, 74 ] ], "text": "It could explain the difficulty in dorsiflexion and plantar flexion of the foot, but not the pyramidalism." }, "5": { "exist": true, "char_ranges": [ [ 494, 604 ] ], "word_ranges": [ [ 77, 97 ] ], "text": "In a similar way to the previous one, it could explain part of the clinical picture, but not the pyramidalism." } }

{ "1": "Perform a stress test.", "2": "Perform echocardiography", "3": "Perform a thallium and dipyridamole scan.", "4": "Perform electrocardiogram.", "5": null }

{ "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, "char_ranges": [ [ 363, 658 ] ], "word_ranges": [ [ 66, 119 ] ], "text": "Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old. The age range from which it is considered mandatory to request an ECG varies between 45, 50, 60 or even some say 70 years." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Fracture of the inferior wall of the floor of the orbit with entrapment of the inferior rectus muscle.", "2": "Zygomatic arch fracture.", "3": "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle.", "4": "Dentoalveolar fracture.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 96, 387 ] ], "word_ranges": [ [ 13, 57 ] ], "text": "As the mechanical function of the left inferior rectus is compromised, it would not allow to complete the supraduccion movement generating vertical diplopia, this plus the traumatic antecedent allows to suspect a fracture of the orbital floor with muscular entrapment of the inferior rectus." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 388, 513 ] ], "word_ranges": [ [ 57, 77 ] ], "text": "Fracture of the roof is much less frequent and the entrapment of the superior rectus would cause limitation for infraduction." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Review dietary carbohydrate distribution.", "2": "Discontinue metformin.", "3": "Discontinue sulfonylurea.", "4": "Substitute metformin with a DPP4 inhibitor.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 57 ] ], "word_ranges": [ [ 0, 7 ] ], "text": "Discontinue sulfonylurea because of Risk of hypoglycemia." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Medical with vasodilators and beta-blockers to avoid angina.", "2": "Expectorant with rigorous rest, since decreasing myocardial oxygen demand should decrease angina.", "3": "Surgical revascularization of the ischemic myocardium by means of a left mammary artery bypass distal to the lesion in the diseased coronary artery.", "4": "Dilatation of the coronary artery lesion by therapeutic catheterization.", "5": "Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area." }

{ "1": { "exist": true, "char_ranges": [ [ 867, 1119 ] ], "word_ranges": [ [ 149, 196 ] ], "text": "Applying the general rules of response in the MIR, if two options are similar except in one detail, the correct one is one of these, so we would mark 5 (and this is what would be done in any hospital nowadays: a suboccluded artery is dilated directly)." }, "2": { "exist": true, "char_ranges": [ [ 461, 503 ] ], "word_ranges": [ [ 73, 81 ] ], "text": "2 is absurd: sitting down to avoid angina?" }, "3": { "exist": true, "char_ranges": [ [ 594, 711 ] ], "word_ranges": [ [ 96, 117 ] ], "text": "since it is a single vessel and not a proximal LAD, revascularization would have to be percutaneous, so we discard 3." }, "4": { "exist": true, "char_ranges": [ [ 712, 827 ] ], "word_ranges": [ [ 117, 140 ] ], "text": "Between 4 and 5, the fifth is more complete: not only would it be necessary to dilate, but also to implant a stent." }, "5": { "exist": true, "char_ranges": [ [ 867, 1119 ] ], "word_ranges": [ [ 149, 196 ] ], "text": "Applying the general rules of response in the MIR, if two options are similar except in one detail, the correct one is one of these, so we would mark 5 (and this is what would be done in any hospital nowadays: a suboccluded artery is dilated directly)." } }

{ "1": "Vertebral crush with computed tomography (CT).", "2": "Bone metastases with technetium bone scan.", "3": "Vertebral ankylosing hyperostosis with dorsolumbar spine x-ray.", "4": "Pyogenic spondylodiscitis with magnetic resonance imaging (MRI).", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 354, 473 ] ], "word_ranges": [ [ 60, 78 ] ], "text": "Vertebral crushing would be seen in the simple X-ray, as well as vertebral ankylosing hyperostosis and many metastases." }, "2": { "exist": true, "char_ranges": [ [ 487, 584 ] ], "word_ranges": [ [ 80, 96 ] ], "text": "there is no data in the history pointing to bone metastases (oncologic history, weight loss etc)." }, "3": { "exist": true, "char_ranges": [ [ 354, 473 ] ], "word_ranges": [ [ 60, 78 ] ], "text": "Vertebral crushing would be seen in the simple X-ray, as well as vertebral ankylosing hyperostosis and many metastases." }, "4": { "exist": true, "char_ranges": [ [ 0, 164 ] ], "word_ranges": [ [ 0, 30 ] ], "text": "We suspect spondylodiscitis - the febrile fever and the limitation of mobility of the spine with the acute course give the key -, and the indicated test is the MRI." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Familial benign pemphigus.", "2": "Pemphigoid.", "3": "Porphyria cutanea tarda.", "4": "Pemphigus vulgaris.", "5": "Scalded skin syndrome." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 377 ] ], "word_ranges": [ [ 0, 59 ] ], "text": "Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic. Clinically, it is characterized by marked skin fragility with the appearance of erosions, vesicles and blisters after minimal trauma. The most frequent sites are the back of the hands and the face, i.e. the areas of greatest photoexposure." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Gouty arthritis of the left hip.", "2": "Left coxofemoral arthrosis.", "3": "Radiated low back pain / lumbosciatica.", "4": "Claudication due to canal stenosis.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 171, 253 ] ], "word_ranges": [ [ 25, 36 ] ], "text": "Coxo-femoral osteoarthrosis presents with a negative Lasegue test. Wrong answer 2." }, "3": { "exist": true, "char_ranges": [ [ 617, 775 ] ], "word_ranges": [ [ 87, 110 ] ], "text": "The clinical case describes the Lasegue maneuver or test; a provocation test that evidences radicular irritation in the lumbosacral region (Answer 3 correct)." }, "4": { "exist": true, "char_ranges": [ [ 776, 983 ] ], "word_ranges": [ [ 110, 140 ] ], "text": "Claudication due to canal stenosis typically presents with pain that worsens with trunk extension (walking, standing) and is relieved with flexion (sitting, sleeping in the fetal position...) Wrong answer 4." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Broca's aphasia.", "2": "Conduction aphasia.", "3": "Sensitive transcortical aphasia.", "4": "Wernicke's aphasia.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 611, 736 ] ], "word_ranges": [ [ 92, 111 ] ], "text": "Finally, in broca's aphasia the language is non-fluent, comprehension is preserved, it does not repeat and does not nominate." }, "2": { "exist": true, "char_ranges": [ [ 505, 610 ] ], "word_ranges": [ [ 77, 92 ] ], "text": "Conduction aphasia differs from sensory aphasia in that comprehension is preserved, all else being equal." }, "3": { "exist": true, "char_ranges": [ [ 409, 504 ] ], "word_ranges": [ [ 63, 77 ] ], "text": "Sensory transcortical aphasia differs from sensory aphasia in that patients are able to repeat." }, "4": { "exist": true, "char_ranges": [ [ 247, 408 ] ], "word_ranges": [ [ 37, 63 ] ], "text": "Wernicke's aphasia or sensitive aphasia has a fluent language, does not understand, does not repeat and does not nominate, just like the patient in the question." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Plain abdominal x-ray.", "2": "Intravenous urography.", "3": "Spiral CT with contrast.", "4": "Abdominal ultrasound.", "5": "Doppler ultrasound." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 754, 1059 ] ], "word_ranges": [ [ 127, 178 ] ], "text": "Spiral CT with contrast has acquired great value in the diagnosis of PTE, due to its rapidity and good sensitivity, higher than 83-92% in most studies, and according to some it can reach 100% for central thrombi, located in main, lobar or segmental pulmonary arteries. Its specificity is greater than 90%." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Recommend relative rest and warm cloths on both legs and add antidepressant treatment.", "2": "Biopsy skin areas away from the injured areas and prescribe opioid analgesics at the beginning.", "3": "Biopsy skin areas away from the injured areas and prescribe opioid analgesics at the beginning.", "4": "Suspect bilateral lower extremity ischemia of drug origin.", "5": "Adjustment of the treatment of the disease." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 230 ] ], "word_ranges": [ [ 0, 37 ] ], "text": "It appears that the patient has erythema nodosum lesions associated with a flare of his disease, which is common. Treatment of the disease and its control usually improves the cutaneous lesions. The lesions should not be biopsied." }, "3": { "exist": true, "char_ranges": [ [ 0, 230 ] ], "word_ranges": [ [ 0, 37 ] ], "text": "It appears that the patient has erythema nodosum lesions associated with a flare of his disease, which is common. Treatment of the disease and its control usually improves the cutaneous lesions. The lesions should not be biopsied." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 0, 230 ] ], "word_ranges": [ [ 0, 37 ] ], "text": "It appears that the patient has erythema nodosum lesions associated with a flare of his disease, which is common. Treatment of the disease and its control usually improves the cutaneous lesions. The lesions should not be biopsied." } }

{ "1": "We would start antibiotic treatment as soon as we suspect the diagnosis.", "2": "We would indicate as a preferential complementary test a hysterosalpingography for tubal assessment.", "3": "Delay in diagnosis and treatment increases the occurrence of sequelae.", "4": "The presence of abscess would be a criterion for hospitalization.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 141, 315 ] ], "word_ranges": [ [ 19, 47 ] ], "text": "answer 2 is the false answer and, therefore, the one that should be marked. This is because hysterosalpingography can spread the infection to the pelvic and abdominal cavity." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "This is a picture of intestinal flange obstruction requiring emergency laparotomy.", "2": "Most likely we are facing a case of obstruction at the level of the large intestine.", "3": "The fact that the patient presented a diarrheal stool allows us to exclude the diagnosis of intestinal obstruction. Further imaging studies are necessary to ensure a diagnosis.", "4": "We should indicate the practice of a decompressive colonoscopy.", "5": "Initial management should be conservative, with serum therapy, nasogastric aspiration and periodic clinical, analytical and radiographic monitoring." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 240 ] ], "word_ranges": [ [ 0, 38 ] ], "text": "This is a typical description of a picture of intestinal obstruction due to bridging or adhesions due to previous surgery. The correct answer is 5 and not 1 because most of these situations resolve spontaneously with conservative treatment." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 0, 240 ] ], "word_ranges": [ [ 0, 38 ] ], "text": "This is a typical description of a picture of intestinal obstruction due to bridging or adhesions due to previous surgery. The correct answer is 5 and not 1 because most of these situations resolve spontaneously with conservative treatment." } }

{ "1": "Juvenile chronic arthritis.", "2": "Epiphysiolysis capitis femoris.", "3": "Fracture of the femoral neck due to overload.", "4": "Perthes disease.", "5": "Sequelae of developmental dysplasia of the hip." }

{ "1": { "exist": true, "char_ranges": [ [ 1471, 1885 ] ], "word_ranges": [ [ 258, 334 ] ], "text": "Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)." }, "2": { "exist": true, "char_ranges": [ [ 375, 467 ] ], "word_ranges": [ [ 63, 80 ] ], "text": "We should think of this one because it is the most frequent and possible (correct answer 2)." }, "3": { "exist": true, "char_ranges": [ [ 989, 1119 ] ], "word_ranges": [ [ 170, 198 ] ], "text": "In a child the most typical would be a fracture at the level of the physis, not at the level of the femoral neck, so we discard 3." }, "4": { "exist": true, "char_ranges": [ [ 862, 988 ] ], "word_ranges": [ [ 148, 170 ] ], "text": "Perthes disease occurs in younger children (4-9 years) with episodes of limping and pain in the hip and knee (false answer 4)." }, "5": { "exist": true, "char_ranges": [ [ 723, 861 ] ], "word_ranges": [ [ 128, 148 ] ], "text": "Complications of dysplasia are dislocations and subluxations that may require surgery and avascular necrosis of the head (false answer 5)." } }

{ "1": "Only separate him from the mother until her treatment is completed (at least 6 months).", "2": "Perform a high-resolution CT scan of the lung, and if normal, repeat PT at 8-12 weeks.", "3": "Chemoprophylaxis with isoniazid (INH) until the mother's smear test is negative.", "4": "Chemoprophylaxis with INH 6-9 months. New PT and chest X-ray at the end of treatment, to decide whether or not to conclude treatment.", "5": "Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease." }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 25, 314 ] ], "word_ranges": [ [ 5, 57 ] ], "text": "The mother should be isolated for the first 2-4 weeks of treatment, after which she would no longer be contagious. If the result of the repeat PT is still negative, the child should not be tested again. If it is positive, the X-ray (or pulmonary CT in younger children) should be repeated." } }

{ "1": "Insulinoma.", "2": "PPoma.", "3": "VIPoma.", "4": "Glucagonoma.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 60 ] ], "word_ranges": [ [ 0, 7 ] ], "text": "Vasoactive intestinal peptide (VIP). VIPoma-diarrhea. The 3." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "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 prevent joint destruction.", "3": "If the culture is negative, it is likely to be reactive arthritis.", "4": "Negative Gram stain rules out septic arthritis.", "5": null }

{ "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, "char_ranges": [ [ 0, 64 ] ], "word_ranges": [ [ 0, 11 ] ], "text": "A gram negative stain never rules out the presence of infection." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Hypothalamohypophyseal MRI.", "2": "Karyotype.", "3": "Basal FSH.", "4": "Chorionic gonadotropin stimulation.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 218, 424 ] ], "word_ranges": [ [ 29, 67 ] ], "text": "They tell us that the estrogen level is low. In this case we should suspect early ovarian failure. For its diagnosis we will ask for a basal FSH (in cases of premature ovarian failure it would be elevated)." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Venous echo-Doppler of lower limbs.", "2": "Angioresonance of lower limbs.", "3": "Arteriography.", "4": "Ankle-brachial index.", "5": "AngioCT." }

{ "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, "char_ranges": [ [ 40, 205 ] ], "word_ranges": [ [ 8, 35 ] ], "text": "I usually start with the least invasive and most cost-effective tests, and in the case described, an ischemic problem in the lower limbs is the ankle-brachial index." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Familial benign pemphigus.", "2": "Pemphigoid.", "3": "Porphyria cutanea tarda.", "4": "Pemphigus vulgaris.", "5": "Scalded skin syndrome." }

{ "1": { "exist": true, "char_ranges": [ [ 113, 191 ] ], "word_ranges": [ [ 20, 35 ] ], "text": "The rest of the answers do not fit with the clinical picture or the histology." }, "2": { "exist": true, "char_ranges": [ [ 113, 191 ] ], "word_ranges": [ [ 20, 35 ] ], "text": "The rest of the answers do not fit with the clinical picture or the histology." }, "3": { "exist": true, "char_ranges": [ [ 0, 112 ] ], "word_ranges": [ [ 0, 20 ] ], "text": "The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)." }, "4": { "exist": true, "char_ranges": [ [ 113, 191 ] ], "word_ranges": [ [ 20, 35 ] ], "text": "The rest of the answers do not fit with the clinical picture or the histology." }, "5": { "exist": true, "char_ranges": [ [ 113, 191 ] ], "word_ranges": [ [ 20, 35 ] ], "text": "The rest of the answers do not fit with the clinical picture or the histology." } }

{ "1": "Hip disarticulation.", "2": "Treatment with ifosfamide and tamoxifen for 6 cycles prior to resection surgery to reduce the size of the lesion.", "3": "Marginal surgery removing the pseudocapsule that these tumors usually form in response to their rapid growth.", "4": "Modified right hemipelvectomy.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 206, 412 ] ], "word_ranges": [ [ 32, 61 ] ], "text": "Radical amputation surgery has not been shown to improve survival being reserved for selected cases (invasion of neurovascular structures, pathologic fracture...). Therefore, we discard both option 1 and 4;" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 413, 494 ] ], "word_ranges": [ [ 61, 76 ] ], "text": "option 3 is also discarded, because it is a smaller margin than the extended one;" }, "4": { "exist": true, "char_ranges": [ [ 206, 412 ] ], "word_ranges": [ [ 32, 61 ] ], "text": "Radical amputation surgery has not been shown to improve survival being reserved for selected cases (invasion of neurovascular structures, pathologic fracture...). Therefore, we discard both option 1 and 4;" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Bacterial contamination of the blood.", "2": "Febrile reaction secondary to transfusion.", "3": "Febrile reaction due to plasma contaminating red blood cells.", "4": "Hemolytic transfusion reaction.", "5": null }

{ "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, "char_ranges": [ [ 242, 433 ] ], "word_ranges": [ [ 29, 62 ] ], "text": "We are told of a patient who, within minutes of starting a transfusion, presented with an acute and very serious condition (with shock). Such an acute and severe situation only fits option 4." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Complete phenotypic study by flow cytometry.", "2": "Study of hormone receptors and HER2.", "3": "Study of hormone receptors, e-cadherin and study of first-degree relatives.", "4": "BRCA 1-2 study and study of first-degree relatives.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 187 ] ], "word_ranges": [ [ 0, 32 ] ], "text": "All breast carcinomas should be accompanied by the study of hormone receptors and HER-2 for the prognostic implications of the tumor, as well as the adequacy of the treatment of the same," }, "3": { "exist": true, "char_ranges": [ [ 251, 363 ] ], "word_ranges": [ [ 43, 64 ] ], "text": "The study of relatives and the BCRA gene is not indicated since she does not have a family history of neoplasia." }, "4": { "exist": true, "char_ranges": [ [ 251, 363 ] ], "word_ranges": [ [ 43, 64 ] ], "text": "The study of relatives and the BCRA gene is not indicated since she does not have a family history of neoplasia." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Suspect anorexia nervosa and inquire about intake, body image, etc.", "2": "Suspect hypothyroidism and request TSH and thyroid hormones.", "3": "Suspect cardiomyopathy and request echocardiography.", "4": "I would suspect celiac disease and request anti-transglutaminase IgA antibodies.", "5": "Suspect panhypopituitarism and request a cranial CT scan." }

{ "1": { "exist": true, "char_ranges": [ [ 25, 119 ] ], "word_ranges": [ [ 5, 18 ] ], "text": "The symptoms and signs described are the biological findings associated with anorexia nervosa." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Moderate pre-eclampsia.", "2": "Pregnancy-induced hypertension.", "3": "Chronic hypertension.", "4": "Eclampsia.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 22, 153 ] ], "word_ranges": [ [ 2, 23 ] ], "text": "This is hypertension that is detected before pregnancy or before the 20th week of pregnancy and/or persists at 12 weeks postpartum." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Chemotherapy based on anthracyclines and taxanes, radiotherapy and trastuzumab.", "2": "Chemotherapy based on anthracyclines and taxanes, radiotherapy and tamoxifen.", "3": "Chemotherapy based on anthracyclines and taxanes, and radiotherapy.", "4": "Chemotherapy based on anthracyclines and taxanes, radiotherapy and aromatase inhibitors, since it is postmenopausal.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 307, 380 ] ], "word_ranges": [ [ 52, 63 ] ], "text": "today, anthracyclines (does not suffer from heart) and taxanes before RT." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Moderate preeclampsia.", "2": "Pregnancy-induced hypertension.", "3": "Chronic hypertension.", "4": "Eclampsia.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 232, 469 ] ], "word_ranges": [ [ 37, 71 ] ], "text": "Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)." }, "2": { "exist": true, "char_ranges": [ [ 232, 469 ] ], "word_ranges": [ [ 37, 71 ] ], "text": "Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)." }, "3": { "exist": true, "char_ranges": [ [ 25, 231 ] ], "word_ranges": [ [ 5, 37 ] ], "text": "The SEGO in its 2006 protocol \"Hypertensive disorders of pregnancy\" refers that this is chronic hypertension, although diagnosed in pregnancy. This is because it has been diagnosed at 10 weeks of gestation." }, "4": { "exist": true, "char_ranges": [ [ 232, 469 ] ], "word_ranges": [ [ 37, 71 ] ], "text": "Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Recommend relative rest and warm cloths on both legs and add antidepressant treatment.", "2": "Biopsy areas of skin away from the injured areas and prescribe opioid analgesics for entry.", "3": "Suspect the existence of a malignant intestinal tumor lesion as a trigger of the cutaneous process.", "4": "Suspect bilateral lower extremity ischemia of drug-induced origin.", "5": "Adjustment of bowel disease treatment." }

{ "1": { "exist": true, "char_ranges": [ [ 589, 894 ] ], "word_ranges": [ [ 84, 133 ] ], "text": "Although the use of aspirin and other NSAIDs is effective for erythema nodosum, their use in patients with inflammatory bowel disease should be limited, as they may worsen the intestinal picture, the usefulness of antidepressants in this picture has not been described, so answer nº1 would not be correct." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 270, 429 ] ], "word_ranges": [ [ 38, 59 ] ], "text": "When associated with inflammatory bowel disease, erythema nodosum usually resolves with treatment of the intestinal flare, and recurs with disease recurrences." } }

{ "1": "Odontogenic abscess.", "2": "Osteonecrosis due to bisphosphonates.", "3": "Osteoradionecrosis.", "4": "Dental root included.", "5": "Metastasis of breast carcinoma." }

{ "1": { "exist": true, "char_ranges": [ [ 64, 118 ] ], "word_ranges": [ [ 13, 23 ] ], "text": "out. 1 cannot be, because there would be infectious signs." }, "2": { "exist": true, "char_ranges": [ [ 577, 644 ] ], "word_ranges": [ [ 105, 116 ] ], "text": "scan, but a bone metastasis would be more destructive than sclerotizing." }, "3": { "exist": true, "char_ranges": [ [ 192, 322 ] ], "word_ranges": [ [ 32, 55 ] ], "text": "3 seems unlikely to me because the radiotherapy that the patient received would be oriented on the breast and not on the mandible." }, "4": { "exist": true, "char_ranges": [ [ 323, 458 ] ], "word_ranges": [ [ 55, 81 ] ], "text": "I rule out number 4, as it is not a case of dental root involvement. 5 is possible; after all, the patient already has bone metastases." }, "5": { "exist": true, "char_ranges": [ [ 577, 644 ] ], "word_ranges": [ [ 105, 116 ] ], "text": "scan, but a bone metastasis would be more destructive than sclerotizing." } }

{ "1": "Herpetic esophagitis.", "2": "Eosinophilic esophagitis.", "3": "Candidiasis esophagitis.", "4": "Cytomegalovirus esophagitis.", "5": "Adenocarcinoma of the esophagus." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 156 ] ], "word_ranges": [ [ 0, 20 ] ], "text": "The endoscopic appearance of trachealized esophagus is very typical of eosinophilic esophagitis, which presents with dysphagia and repeated food impactions." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "A petrosal sinus catheterization.", "2": "A gammagraphy with labeled somatostatin (Octreoscan).", "3": "A scan with Sesta-MIBI.", "4": "An abdominal ultrasound.", "5": "An adrenal CT scan." }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Intravenous cefotaxime administration.", "2": "Lumbar puncture.", "3": "Collection of blood culture.", "4": "Intravenous fluids.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 186, 251 ] ], "word_ranges": [ [ 25, 33 ] ], "text": "Early initiation of antibiotic therapy (cefotaxime) is essential." }, "2": { "exist": true, "char_ranges": [ [ 252, 333 ] ], "word_ranges": [ [ 33, 47 ] ], "text": "However, in an unstable patient such as ours, a lumbar puncture is not indicated." }, "3": { "exist": true, "char_ranges": [ [ 118, 185 ] ], "word_ranges": [ [ 14, 25 ] ], "text": "Blood culture can be obtained together with the initial blood test." }, "4": { "exist": true, "char_ranges": [ [ 0, 117 ] ], "word_ranges": [ [ 0, 14 ] ], "text": "Patient with suspected meningococcal sepsis. Stabilization with fluids (hypotension) according to ABCDE is essential." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Pityriasis versicolor.", "2": "Mycosis fungoides.", "3": "Psoriasis in drops.", "4": "Pityriasis rosea of Gibert.", "5": "Lichen planus." }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 0, 384 ] ], "word_ranges": [ [ 0, 56 ] ], "text": "Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities. Characteristically these papules show a symmetrical distribution and are preferentially located on the anterior aspect of the wrists (Figure 1) and ankles." } }

{ "1": "Reassure her that she is not at risk.", "2": "Chest X-ray.", "3": "Start chemoprophylaxis and repeat skin test after 3 months.", "4": "Repeat skin test at one month.", "5": "A sputum study should be performed before starting chemoprophylaxis with Isoniazid for 1 year." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 211 ] ], "word_ranges": [ [ 0, 36 ] ], "text": "In young contacts, chemoprophylaxis should be started even if the mantoux test is negative and repeated after 2-3 months to decide whether to continue treatment for 6 months (if it turns positive) or to stop it." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Upper gastrointestinal endoscopy.", "2": "Esophageal pHmetry of 24 hours.", "3": "Carbon 13 breath test for Helicobacter pylori.", "4": "Esophago-gastro-duodenal barium study.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 232 ] ], "word_ranges": [ [ 0, 39 ] ], "text": "We are being presented with a case of eosinophilic esophagitis (adolescent male, with heartburn and dysphagia, and a history of atopic dermatitis). Of all the tests proposed to us, the least indicated in this case would be option 3." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The presence of anemia at diagnosis.", "2": "The existence of a family history of colorectal cancer.", "3": "The size of the primary lesion and histological differentiation.", "4": "Perforation or adhesion of the tumor to adjacent organs.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 422, 472 ] ], "word_ranges": [ [ 70, 80 ] ], "text": "less importance is given to the size of the lesion" }, "4": { "exist": true, "char_ranges": [ [ 18, 295 ] ], "word_ranges": [ [ 3, 49 ] ], "text": "we are asked about which factors have the greatest influence in order to carry out adjuvant chemotherapy in colorectal cancer. In order to do so, we must know which are the poor prognostic factors in this pathology where obstruction or intestinal perforation due to the lesion," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Massive sequencing (NGS).", "2": "FISH.", "3": "DNA and/or RNA microarrays.", "4": "Karyotype.", "5": null }

{ "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, "char_ranges": [ [ 0, 155 ] ], "word_ranges": [ [ 0, 26 ] ], "text": "In a woman with delayed puberty and short stature we should always think about and rule out Turner syndrome, whose diagnosis is made by karyotyping (45X0)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Hip hemiarthroplasty.", "2": "Trochanteric nail fixation.", "3": "Fixation with cannulated screws.", "4": "Conservative: bed-chair life.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 197, 383 ] ], "word_ranges": [ [ 33, 60 ] ], "text": "Cannulated screws are reserved for cases of non-displaced fractures (Wrong answer 2) so the most indicated option would be arthroplasty, in this case hemiarthroplasty (Correct answer 1)." }, "2": { "exist": true, "char_ranges": [ [ 197, 459 ] ], "word_ranges": [ [ 33, 70 ] ], "text": "Cannulated screws are reserved for cases of non-displaced fractures (Wrong answer 2) so the most indicated option would be arthroplasty, in this case hemiarthroplasty (Correct answer 1). Trochanteric pins are reserved for extracapsular fractures (Wrong answer 2)" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": true, "char_ranges": [ [ 464, 596 ] ], "word_ranges": [ [ 71, 89 ] ], "text": "conservative treatment is only considered in patients with very low functional demand or surgical contraindication (Wrong answer 4)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase.", "2": "An inhaled SABA-type bronchodilator, followed by intramuscular dexchlorpheniramine and intramuscular adrenaline. Then order serum tryptase.", "3": "Intramuscular dexchlorpheniramine, followed by an inhaled bronchodilator of the SABA type and intramuscular adrenaline. Then request eosinophil cationic protein.", "4": "Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request eosinophil cationic protein.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 901, 1094 ] ], "word_ranges": [ [ 129, 161 ] ], "text": "The laboratory marker that should be requested if anaphylaxis is suspected is serum tryptase in the first hour for a basal determination and another at 4-6 hours to observe its elevation curve." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": true, "char_ranges": [ [ 901, 1094 ] ], "word_ranges": [ [ 129, 161 ] ], "text": "The laboratory marker that should be requested if anaphylaxis is suspected is serum tryptase in the first hour for a basal determination and another at 4-6 hours to observe its elevation curve." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Weight loss with or without rectorrhagia.", "2": "Persistence of diarrhea during the night.", "3": "Onset of symptoms after age 50.", "4": "Presence of dermatitis and/or arthritis during the examination.", "5": "Expulsion of mucus in more than 25% of defecations." }

{ "1": { "exist": true, "char_ranges": [ [ 148, 193 ] ], "word_ranges": [ [ 23, 31 ] ], "text": "All the rest are typical signs of organicity," }, "2": { "exist": true, "char_ranges": [ [ 148, 193 ] ], "word_ranges": [ [ 23, 31 ] ], "text": "All the rest are typical signs of organicity," }, "3": { "exist": true, "char_ranges": [ [ 148, 193 ] ], "word_ranges": [ [ 23, 31 ] ], "text": "All the rest are typical signs of organicity," }, "4": { "exist": true, "char_ranges": [ [ 148, 193 ] ], "word_ranges": [ [ 23, 31 ] ], "text": "All the rest are typical signs of organicity," }, "5": { "exist": true, "char_ranges": [ [ 0, 147 ] ], "word_ranges": [ [ 0, 23 ] ], "text": "Although mucus is usually more frightening in the consultation, it falls within the Rome II criteria for the diagnosis of Irritable Bowel Syndrome." } }

{ "1": "3", "2": "19,2.", "3": "33,3.", "4": "49,5.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 270 ] ], "word_ranges": [ [ 0, 49 ] ], "text": "On average, if 100 patients like this woman are treated with warfarin, the number of strokes is reduced by 3 (from 5.2 untreated to 3.2 treated). Therefore, if you treat 33.3 patients like this woman with warfarin, you reduce the number of strokes by 1: the NNT is 33.3." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Given the patient's age, he most likely suffers from non-specific low back pain and tendonitis in the feet. If the diarrhea persists, a digestive study would be performed.", "2": "I would perform a digestive study to rule out tumor pathology. The lumbar pain may be due to visceral pathology.", "3": "The clinical picture is very suggestive of spondyloarthritis. Inflammatory bowel disease should be ruled out.", "4": "I would request a lumbar MRI to rule out disc herniation and if diarrhea persists, a digestive study.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 153 ] ], "word_ranges": [ [ 0, 21 ] ], "text": "The clinical picture is typical of spondyloarthritis, and together with the digestive symptoms it is probably associated with inflammatory bowel disease." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Scheuermann's disease.", "2": "Thoracic scoliosis.", "3": "Malignant tumor of the vertebral body.", "4": "It is a mechanical overload.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 134, 207 ] ], "word_ranges": [ [ 20, 34 ] ], "text": "There is no data in the statement to suggest any of the other etiologies." }, "2": { "exist": true, "char_ranges": [ [ 134, 207 ] ], "word_ranges": [ [ 20, 34 ] ], "text": "There is no data in the statement to suggest any of the other etiologies." }, "3": { "exist": true, "char_ranges": [ [ 134, 207 ] ], "word_ranges": [ [ 20, 34 ] ], "text": "There is no data in the statement to suggest any of the other etiologies." }, "4": { "exist": true, "char_ranges": [ [ 0, 133 ] ], "word_ranges": [ [ 0, 20 ] ], "text": "The pain is of mechanical characteristics, and the most frequent cause of mechanical back pain in adolescents is mechanical overload." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Knee and ankle arthritis.", "2": "Hematuria.", "3": "Plateletopenia.", "4": "Fecal occult blood.", "5": "Scrotal edema." }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 0, 252 ] ], "word_ranges": [ [ 0, 38 ] ], "text": "You are describing a Schönlein-Henoch purpura which is a vasculitic phenomenon, so the lesions are not due to plateletopenia. Scrotal edema (sometimes even torsion of Morgani's capsid of the testis) is not exceptional in males with S. Schönlein-Henoch." } }

{ "1": "Empirical treatment with antibiotics.", "2": "Request a preferential colonoscopy.", "3": "Request urgent abdominal ultrasound.", "4": "Refer to surgery to evaluate sigmoidectomy.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 251 ] ], "word_ranges": [ [ 0, 38 ] ], "text": "They refer to a concept that has emerged relatively recently and is not present in all clinical guidelines as uncomplicated symptomatic diverticular disease. In these cases, the therapeutic trial with rifaximin is recommended, being the true number 1." }, "2": { "exist": true, "char_ranges": [ [ 252, 442 ] ], "word_ranges": [ [ 38, 73 ] ], "text": "The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out." }, "3": { "exist": true, "char_ranges": [ [ 252, 442 ] ], "word_ranges": [ [ 38, 73 ] ], "text": "The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Add sacubitril/valsartan.", "2": "Add ivabradine.", "3": "Discontinue lisinopril and start sacubitril/valsartan.", "4": "Discontinue carvedilol and start ivabradine.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 57 ] ], "word_ranges": [ [ 0, 5 ] ], "text": "Discontinue lisinopril and initiate sacubitril/valsartan." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Pilocytic astrocytoma.", "2": "Pleomorphic xanthoastrocytoma.", "3": "Central neurocytoma.", "4": "Liponeurocytoma.", "5": "Prion disease." }

{ "1": { "exist": true, "char_ranges": [ [ 171, 504 ] ], "word_ranges": [ [ 26, 82 ] ], "text": "The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found, but the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\") keeps us the first option as the correct one." }, "2": { "exist": true, "char_ranges": [ [ 171, 504 ] ], "word_ranges": [ [ 26, 82 ] ], "text": "The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found, but the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\") keeps us the first option as the correct one." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest.", "2": "Urgent call to the neurosurgeon for surgical evaluation.", "3": "Preferential request for MRI and electromyogram.", "4": "Preferential referral to traumatology outpatients.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 147 ] ], "word_ranges": [ [ 0, 22 ] ], "text": "Correct answer 1. 75% of patients with radiculopathy improve with non-surgical treatment, this being the treatment of choice in the initial stages." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 148, 345 ] ], "word_ranges": [ [ 22, 50 ] ], "text": "Magnetic resonance imaging is of choice in certain \"red flags\": fever, weight loss, nocturnal pain, persistence of symptoms despite conservative treatment and loss of strength (incorrect answer 3)." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Recommend that their children have a T. cruzi serology because of the risk of transplacental transmission.", "2": "Inform the patient of the risk of T. cruzi transmission and the attitude to be taken during pregnancy, delivery and postpartum.", "3": "Recommend that her husband have T. cruzi serology because of the risk of having sexually transmitted the disease to her.", "4": "Recommend that her siblings have T. cruzi serology because of the risk of vectorial transmission.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 483, 638 ] ], "word_ranges": [ [ 82, 108 ] ], "text": "having had two pregnancies in these years of stay in Spain, it should be suggested that her children also be tested for the probable vertical transmission." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 69 ] ], "word_ranges": [ [ 0, 12 ] ], "text": "The sexual route is not a means of transmission of Trypanosoma cruzi." }, "4": { "exist": true, "char_ranges": [ [ 219, 472 ] ], "word_ranges": [ [ 36, 81 ] ], "text": "The woman was already infected by the parasite when she arrived in Spain, it may be correct to suggest that her siblings have a T. cruzi serology test because of the risk that her mother may have transmitted the infection vertically to all her siblings." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Low-protein diet.", "2": "Administration of loop diuretics.", "3": "Restriction of salt in the diet.", "4": "Administration of NSAIDs.", "5": "Administration of angiotensin-converting enzyme inhibitors." }

{ "1": { "exist": true, "char_ranges": [ [ 88, 211 ] ], "word_ranges": [ [ 17, 40 ] ], "text": "to reduce edema in these patients, it is recommended that it be low-protein and low-salt, so options 1 and 3 would be true." }, "2": { "exist": true, "char_ranges": [ [ 212, 415 ] ], "word_ranges": [ [ 40, 73 ] ], "text": "ACE inhibitors are also administered as primary treatment for nephrotic syndrome, since they decrease urinary protein excretion, as do ARA II and loop diuretics, so options 2 and 5 would also be correct." }, "3": { "exist": true, "char_ranges": [ [ 88, 211 ] ], "word_ranges": [ [ 17, 40 ] ], "text": "to reduce edema in these patients, it is recommended that it be low-protein and low-salt, so options 1 and 3 would be true." }, "4": { "exist": true, "char_ranges": [ [ 597, 677 ] ], "word_ranges": [ [ 104, 118 ] ], "text": "since precisely one of the causes of nephrotic syndrome is the intake of NSAIDs," }, "5": { "exist": true, "char_ranges": [ [ 212, 415 ] ], "word_ranges": [ [ 40, 73 ] ], "text": "ACE inhibitors are also administered as primary treatment for nephrotic syndrome, since they decrease urinary protein excretion, as do ARA II and loop diuretics, so options 2 and 5 would also be correct." } }

{ "1": "Administration of 150 mg of intravenous amiodarone.", "2": "Administration of 300 mg of intravenous amiodarone.", "3": "Administration of 1 mg of intravenous atropine.", "4": "Administer 2 mg of intravenous atropine.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 30, 70 ] ], "word_ranges": [ [ 3, 9 ] ], "text": "amiodarone (the dose is correct, 300mg)," }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Thalassemic trait.", "2": "Central anemia, arregenerative, due to folic acid deficiency.", "3": "Peripheral, regenerative, hemolytic anemia.", "4": "Peripheral anemia, regenerative, due to acute active hemorrhage.", "5": "Central anemia, arregenerative, due to iron deficiency." }

{ "1": { "exist": true, "char_ranges": [ [ 830, 863 ] ], "word_ranges": [ [ 131, 137 ] ], "text": "in thalassemia the ADE is normal." }, "2": { "exist": true, "char_ranges": [ [ 109, 266 ] ], "word_ranges": [ [ 21, 46 ] ], "text": "the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia." }, "3": { "exist": true, "char_ranges": [ [ 109, 266 ] ], "word_ranges": [ [ 21, 46 ] ], "text": "the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 287, 566 ] ], "word_ranges": [ [ 50, 90 ] ], "text": "orients us towards the cause is that it is microcytic and hypochromic, which is characteristic of iron deficiency anemia, since folic deficiency gives rise to megaloblastic anemia and active hemorrhage does not give microcytosis or hypochromia, but normocytosis and normochromia." } }

{ "1": "Clinical history.", "2": "Electrocardiogram.", "3": "Holter recording.", "4": "EEG.", "5": "Cranial CT scan." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 148 ] ], "word_ranges": [ [ 0, 25 ] ], "text": "Obviously, it is the only answer that encompasses all the causes of sudden loss of consciousness and that allows us to somehow filter the diagnosis." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "2/3.", "2": "1/2.", "3": "1/4.", "4": "Less than 1/4.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 576 ] ], "word_ranges": [ [ 0, 104 ] ], "text": "The maternal grandmother carried the mutation in one copy of the gene on an X chromosome (we are not told that she had the disease, but a son of hers, Isabel's maternal uncle, did have the disease). Isabel's mother continues to carry it, since one of Isabel's brothers has suffered from the disease but not her father. Thus, Isabel has a 50% chance of having inherited the mutated gene from her mother (as her children are all healthy, we are not sure if she is a carrier), and therefore her daughter has a 25% chance of having inherited the mutated gene from her grandmother." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Prescribe cyclic progesterone.", "2": "Endometrial biopsy.", "3": "Random biopsies of the cervix.", "4": "Hormonal assessment with FSH, LH and estradiol.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 20, 196 ] ], "word_ranges": [ [ 2, 28 ] ], "text": "Peri- or menopause: - Due to the high prevalence of organic pathology during this period it is necessary to systematically perform endometrial biopsy (Cornier or Hysteroscopy)." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram.", "2": "Antibiotic therapy according to antibiogram and implantation of intra-aortic balloon counterpulsation and transient pacemaker for up to 3 weeks, after which a permanent pacemaker will be implanted.", "3": "Implantation of transient pacemaker, antibiotic therapy according to antibiogram and percutaneous implantation of aortic valve prosthesis.", "4": "Urgent implantation of definitive pacemaker with antibiotic therapy according to antibiogram for 6 weeks.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 31, 170 ] ], "word_ranges": [ [ 6, 28 ] ], "text": "the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Allopurinol.", "2": "Hydrochlorothiazide.", "3": "Lisinopril.", "4": "Paroxetine.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 39, 171 ] ], "word_ranges": [ [ 4, 23 ] ], "text": "both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness." }, "3": { "exist": true, "char_ranges": [ [ 39, 171 ] ], "word_ranges": [ [ 4, 23 ] ], "text": "both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness." }, "4": { "exist": true, "char_ranges": [ [ 39, 171 ] ], "word_ranges": [ [ 4, 23 ] ], "text": "both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Infectious mononucleosis.", "2": "Allergic exanthema.", "3": "P. falciparum malaria.", "4": "Typhoid fever.", "5": "Dengue fever." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 233, 291 ] ], "word_ranges": [ [ 41, 51 ] ], "text": "And certainly she does not have symptoms or clinical signs" }, "3": { "exist": true, "char_ranges": [ [ 237, 332 ] ], "word_ranges": [ [ 42, 57 ] ], "text": "certainly she does not have symptoms or clinical signs compatible with malaria or typhoid fever." }, "4": { "exist": true, "char_ranges": [ [ 237, 332 ] ], "word_ranges": [ [ 42, 57 ] ], "text": "certainly she does not have symptoms or clinical signs compatible with malaria or typhoid fever." }, "5": { "exist": true, "char_ranges": [ [ 53, 159 ], [ 334, 414 ] ], "word_ranges": [ [ 11, 28 ], [ 57, 70 ] ], "text": "The 1 should not be because although the clinical picture is suggestive, it does not present lymphocytosis. What points to dengue, in addition to the clinical signs, is the plateletopenia." } }

{ "1": "Scheuermann's disease.", "2": "Thoracic scoliosis.", "3": "Malignant tumor of the vertebral body.", "4": "It is a mechanical overload.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 43, 205 ] ], "word_ranges": [ [ 8, 34 ] ], "text": "As for Scheuermann and scoliosis, we should be given some physical data because the patient presents with a specific examination that would give us the diagnosis." }, "2": { "exist": true, "char_ranges": [ [ 43, 205 ] ], "word_ranges": [ [ 8, 34 ] ], "text": "As for Scheuermann and scoliosis, we should be given some physical data because the patient presents with a specific examination that would give us the diagnosis." }, "3": { "exist": true, "char_ranges": [ [ 0, 42 ] ], "word_ranges": [ [ 0, 8 ] ], "text": "A malignant tumor would also hurt at rest." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "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 }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 158 ] ], "word_ranges": [ [ 0, 21 ] ], "text": "Clinical suspicion of chronic compartment syndrome (CCS). The diagnosis is made by obtaining compartment pressures at rest, during exercise and post-exercise." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "DATS CAN.", "2": "Nerve conduction study.", "3": "Electroencephalogram.", "4": "Copper in urine of 24.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 332 ] ], "word_ranges": [ [ 0, 62 ] ], "text": "If they are talking about a young man 20-30 years old, with tremor and dystonia, whether or not he has a family history, and especially if one of the options tells me about copper in urine, they are telling me to think of Wilson's disease. I do not think of juvenile Parkinson's, nor an epileptic clinic. So the correct answer is 4." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 332 ] ], "word_ranges": [ [ 0, 62 ] ], "text": "If they are talking about a young man 20-30 years old, with tremor and dystonia, whether or not he has a family history, and especially if one of the options tells me about copper in urine, they are telling me to think of Wilson's disease. I do not think of juvenile Parkinson's, nor an epileptic clinic. So the correct answer is 4." }, "4": { "exist": true, "char_ranges": [ [ 0, 332 ] ], "word_ranges": [ [ 0, 62 ] ], "text": "If they are talking about a young man 20-30 years old, with tremor and dystonia, whether or not he has a family history, and especially if one of the options tells me about copper in urine, they are telling me to think of Wilson's disease. I do not think of juvenile Parkinson's, nor an epileptic clinic. So the correct answer is 4." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Amyloidosis.", "2": "IgA nephropathy or Berger's disease.", "3": "Alport syndrome.", "4": "Nephropathy with minimal changes.", "5": null }

{ "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, "char_ranges": [ [ 0, 311 ] ], "word_ranges": [ [ 0, 42 ] ], "text": "We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids. Without biopsy, the clinical presentation and evolution suggest a nephropathy with minimal changes, which usually presents with normal or slightly altered renal function together with nephrotic syndrome," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Increase dietary protein and long-chain carbohydrate intake to improve asthenia and weight loss.", "2": "To associate a basal insulin dose to the treatment.", "3": "Associate with ascarbose treatment.", "4": "Substitute sitagliptin for pioglitazone.", "5": "Substitute metformin for glimepiride." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 127, 324 ] ], "word_ranges": [ [ 20, 49 ] ], "text": "Patient poorly controlled with metformin and sitagliptin with discrete cardinal symptoms (weight loss, asthenia). The best option is insulin to control cardinal symptoms and decrease HbA1c to < 7%." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Meningitis remains the fundamental cause of her headache, as it is the same type of headache as at the onset of symptoms.", "2": "It is a post lumbar puncture headache.", "3": "It is necessary to look for a different cause to this headache, because it is not typical of post-lumbar puncture syndrome or meningitis.", "4": "Most likely it was not a viral meningitis, but a subarachnoid hemorrhage. For this reason, the initial headache disappears almost completely when lying down.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 275, 360 ] ], "word_ranges": [ [ 46, 62 ] ], "text": "the first cannot be because we have not been told what the initial headache was like;" }, "2": { "exist": true, "char_ranges": [ [ 0, 96 ] ], "word_ranges": [ [ 0, 14 ] ], "text": "The picture they describe of intense headache with orthostatism that disappears when lying down," }, "3": { "exist": true, "char_ranges": [ [ 361, 567 ] ], "word_ranges": [ [ 62, 101 ] ], "text": "the third, although it could be due to the time of onset (as I said a little earlier than expected), the reality is that the headache with orthostasis is so typical that it would be the most probable cause;" }, "4": { "exist": true, "char_ranges": [ [ 568, 669 ] ], "word_ranges": [ [ 101, 119 ] ], "text": "the last one could not be either because SAH does not follow this pattern in relation to orthostasis." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Transvaginal ultrasound.", "2": "Diagnostic laparoscopy.", "3": "Magnetic resonance imaging.", "4": "Colonoscopy.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 25, 248 ] ], "word_ranges": [ [ 5, 43 ] ], "text": "We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement. We are asked for a diagnosis of certainty, and the Gold Standard for the diagnosis of this disease is diagnostic laparoscopy." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Complex focal temporal lobe seizures.", "2": "Transient ischemic attacks in right carotid territory.", "3": "Simple focal motor seizures.", "4": "Episodes of transient global amnesia.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 308, 564 ] ], "word_ranges": [ [ 44, 84 ] ], "text": "The current classification is the 2017 ILAE classification that would describe this seizure as focal seizure with altered level of consciousness, but in the MIR they still use the old terminology (complex is what altered level of consciousness was called)." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Teratocarcinoma.", "2": "Immature teratoma.", "3": "Mature cystic teratoma.", "4": "Dysgerminoma.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 98, 191 ] ], "word_ranges": [ [ 16, 32 ] ], "text": "At no time are atypical cellular features mentioned, so we can safely rule out tumor lesions," }, "2": { "exist": true, "char_ranges": [ [ 246, 335 ] ], "word_ranges": [ [ 42, 56 ] ], "text": "we would have to opt for IMMATURE TERATOMA, mentioning the presence of embryonic remains." }, "3": { "exist": true, "char_ranges": [ [ 246, 335 ] ], "word_ranges": [ [ 42, 56 ] ], "text": "we would have to opt for IMMATURE TERATOMA, mentioning the presence of embryonic remains." }, "4": { "exist": true, "char_ranges": [ [ 98, 191 ] ], "word_ranges": [ [ 16, 32 ] ], "text": "At no time are atypical cellular features mentioned, so we can safely rule out tumor lesions," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The patient has a third-degree AVB and requires pacemaker implantation.", "2": "The absence of periods of asystole >3 seconds excludes a cardiac cause of dizziness.", "3": "Drug treatment to increase conduction in the AV node would be indicated.", "4": "The patient presents sinus dysfunction with sinoatrial block and requires pacemaker implantation due to symptoms.", "5": "The alterations detected in the ambulatory electrocardiogram are typical of patients of this age and there is no indication for therapeutic intervention." }

{ "1": { "exist": true, "char_ranges": [ [ 448, 496 ] ], "word_ranges": [ [ 77, 88 ] ], "text": "Option 1 is ruled out: it is not a complete AVB." }, "2": { "exist": true, "char_ranges": [ [ 497, 596 ] ], "word_ranges": [ [ 88, 105 ] ], "text": "Option 2 cannot be answered either: to exclude, what is said to exclude... It is like never/always." }, "3": { "exist": true, "char_ranges": [ [ 597, 812 ] ], "word_ranges": [ [ 105, 141 ] ], "text": "Option 3 does not make much sense: we could suspend those that impair conduction (beta-blockers, calcium antagonists), but drugs that facilitate, as long as we do not give him a perfusion of atropine to take home..." }, "4": { "exist": true, "char_ranges": [ [ 813, 1044 ] ], "word_ranges": [ [ 141, 182 ] ], "text": "In option 4, stating that he has sinoatrial block is a bit of a rap: without an electrophysiological study it cannot be said, he does not necessarily have SA block, and this alone would not indicate the implantation of a pacemaker." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Pulmonary carcinoma.", "2": "Bronchiectasis.", "3": "Pulmonary fibrosis.", "4": "Cyanotic heart disease.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 123 ] ], "word_ranges": [ [ 0, 20 ] ], "text": "In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma." }, "2": { "exist": true, "char_ranges": [ [ 124, 177 ] ], "word_ranges": [ [ 20, 29 ] ], "text": "Other pathologies can also occur but not so suddenly." }, "3": { "exist": true, "char_ranges": [ [ 124, 177 ] ], "word_ranges": [ [ 20, 29 ] ], "text": "Other pathologies can also occur but not so suddenly." }, "4": { "exist": true, "char_ranges": [ [ 124, 177 ] ], "word_ranges": [ [ 20, 29 ] ], "text": "Other pathologies can also occur but not so suddenly." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Determine serum PTH levels.", "2": "Determine serum vitamin D levels.", "3": "Determination of hydroxyprolinuria.", "4": "Plain chest X-ray.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 253 ] ], "word_ranges": [ [ 0, 37 ] ], "text": "Urinary hydroxyproline: Urinary hydroxyproline excretion reflects the degradation of bone collagen, but is also influenced by the metabolism of other tissues (cartilage, skin) and by the absorption of products rich in collagen, such as meat or gelatins." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Administer oral iron and monitor the evolution of anemia.", "2": "Treat with proton pump inhibitors and evaluate at three months.", "3": "Recommend a complete colonoscopy.", "4": "Perform an endoscopic capsule study.", "5": "Request a gynecological evaluation." }

{ "1": { "exist": true, "char_ranges": [ [ 158, 418 ] ], "word_ranges": [ [ 25, 69 ] ], "text": "The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy, but there is no pathology to justify the anemia, so further investigation is necessary, which rules out answers 1 and 2." }, "2": { "exist": true, "char_ranges": [ [ 158, 418 ] ], "word_ranges": [ [ 25, 69 ] ], "text": "The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy, but there is no pathology to justify the anemia, so further investigation is necessary, which rules out answers 1 and 2." }, "3": { "exist": true, "char_ranges": [ [ 419, 528 ] ], "word_ranges": [ [ 69, 89 ] ], "text": "Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions." }, "4": { "exist": true, "char_ranges": [ [ 419, 528 ] ], "word_ranges": [ [ 69, 89 ] ], "text": "Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis.", "2": "Start treatment with weak opioids that have shown evidence of halting disease progression.", "3": "I instigate treatment with paracetamol, explain that the evolution is very variable and the surgical indication depends on functionality and pain control.", "4": "Because of the radiological features described, I need a hip MRI before making a therapeutic decision.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 199 ] ], "word_ranges": [ [ 0, 29 ] ], "text": "You present with coxarthrosis (no further imaging tests are needed), and conservative options are exhausted before opting for surgical treatment. Weak opioids are not the initial treatment of choice." }, "3": { "exist": true, "char_ranges": [ [ 0, 199 ] ], "word_ranges": [ [ 0, 29 ] ], "text": "You present with coxarthrosis (no further imaging tests are needed), and conservative options are exhausted before opting for surgical treatment. Weak opioids are not the initial treatment of choice." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Salt and fluid restriction.", "2": "Diuretic treatment with oral spironolactone.", "3": "Treatment with a third generation cephalosporin.", "4": "Evacuative paracentesis.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 280, 373 ] ], "word_ranges": [ [ 43, 59 ] ], "text": "The rest are treatments that can wait for improvement (they do not speak of tension ascites)." }, "2": { "exist": true, "char_ranges": [ [ 280, 373 ] ], "word_ranges": [ [ 43, 59 ] ], "text": "The rest are treatments that can wait for improvement (they do not speak of tension ascites)." }, "3": { "exist": true, "char_ranges": [ [ 0, 279 ] ], "word_ranges": [ [ 0, 43 ] ], "text": "This is spontaneous bacterial peritonitis (SBP), defined by the presence of > 250 polymorphonuclears/mL in the ascitic fluid (in this case there are 1,380, which is 60% of 2,300). It is an indication to start 3rd generation cephalosporins (ceftriaxone or cefotaxime) and albumin." }, "4": { "exist": true, "char_ranges": [ [ 280, 373 ] ], "word_ranges": [ [ 43, 59 ] ], "text": "The rest are treatments that can wait for improvement (they do not speak of tension ascites)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Admission to the ward with absolute diet and broad-spectrum antibiotic treatment.", "2": "Discharge colostomy.", "3": "Drainage by laparoscopic surgery.", "4": "Urgent surgery with sigmoidectomy and colorectal anastomosis.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 722, 877 ] ], "word_ranges": [ [ 117, 144 ] ], "text": "In a high number of cases, after the resolution of the symptoms, the outbreaks are reduced and they can be prevented with diet and hygienic dietary habits." }, "2": { "exist": true, "char_ranges": [ [ 303, 426 ] ], "word_ranges": [ [ 52, 72 ] ], "text": "Discharge colostomy in this case makes no sense whatsoever, since it is not a question of solving an obstructive condition." }, "3": { "exist": true, "char_ranges": [ [ 193, 302 ] ], "word_ranges": [ [ 32, 52 ] ], "text": "it does not meet the criteria to require drainage by guided puncture (the abscess is not larger than 5-6 cm)." }, "4": { "exist": true, "char_ranges": [ [ 670, 721 ] ], "word_ranges": [ [ 110, 117 ] ], "text": "Sigmoidectomy and anastomosis is also not required." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The diagnosis of this affectation is based on clinical criteria.", "2": "A basic blood test including iron profile, thyroid hormones and B 12 and folic acid should be performed.", "3": "The treatment would be indicated in patients who present alteration of sleep or quality of life but does not alter the course of the disease.", "4": "The diagnosis is confirmed by muscle biopsy.", "5": "Pramipexole and ropirinol are used in the treatment." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 133, 268 ] ], "word_ranges": [ [ 23, 42 ] ], "text": "An iron profile, thyroid hormone and vitamin determinations should be performed to rule out other diseases with similar symptomatology." }, "3": { "exist": true, "char_ranges": [ [ 269, 448 ] ], "word_ranges": [ [ 42, 70 ] ], "text": "Treatment is symptomatic and is instituted when it interferes with sleep or quality of life, and the first choice treatment is dopamine agonists such as pramipexole and ropirinol." }, "4": { "exist": true, "char_ranges": [ [ 0, 132 ] ], "word_ranges": [ [ 0, 23 ] ], "text": "The diagnosis is based on clinical criteria, so muscle biopsy is only performed to rule out other diseases, not to confirm this one." }, "5": { "exist": true, "char_ranges": [ [ 269, 448 ] ], "word_ranges": [ [ 42, 70 ] ], "text": "Treatment is symptomatic and is instituted when it interferes with sleep or quality of life, and the first choice treatment is dopamine agonists such as pramipexole and ropirinol." } }

{ "1": "Admission for transthoracic ultrasound, assessment by Cardiology and then closed reduction and fixation with plate screw.", "2": "Admission for evaluation by Nephrology and Cardiology, and then Traumatology will decide whether to use an arthroplasty or a trochanteric nail.", "3": "Admission to Internal Medicine / Geriatrics, progressive stabilization of comorbidities, conservative orthopedic treatment.", "4": "Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management.", "5": null }

{ "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, "char_ranges": [ [ 982, 1328 ] ], "word_ranges": [ [ 158, 217 ] ], "text": "This is why the ideal time to intervene in these patients is after achieving stabilization of their medical pathologies, taking care that this takes place before 48 h have elapsed.\" There is no data to suggest that he has any unstable comorbidity at the present time, so surgery in less than 48 hours and orthogeriatric management is of interest." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Neuropsychological evaluation.", "2": "Brain magnetic resonance imaging.", "3": "Positron Emission Tomography.", "4": "Electroencephalogram.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 275 ] ], "word_ranges": [ [ 0, 45 ] ], "text": "The characterization of cognitive deterioration processes is still clinical, with imaging tests (MRI or PET) being a support tool in some occasions. The first option would be the correct one because it allows us to measure in a standardized way each of the cognitive domains," }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 275 ] ], "word_ranges": [ [ 0, 45 ] ], "text": "The characterization of cognitive deterioration processes is still clinical, with imaging tests (MRI or PET) being a support tool in some occasions. The first option would be the correct one because it allows us to measure in a standardized way each of the cognitive domains," }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }