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HiTZ zentroa 49

{ "1": "Right L2-L3 disc herniation.", "2": "Right L3-L4 disc herniation.", "3": "Right L4-L5 disc herniation.", "4": "Right L5-S1 disc herniation.", "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, 235 ] ], "word_ranges": [ [ 0, 42 ] ], "text": "He describes S1 root involvement by the inability to tiptoe and the absence of the Achilles reflex, in addition to the distribution of pain down the leg. Of our options, the cause that can produce damage to S1 is L5-S1 disc herniation." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Minimal change nephropathy.", "2": "Membranous glomerulonephritis.", "3": "IgA nephropathy.", "4": "Proliferative and diffuse glomerulonephritis.", "5": "Focal and primary segmental glomerulosclerosis." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 204, 511 ] ], "word_ranges": [ [ 32, 80 ] ], "text": "Since he is a young male, with a history of previous respiratory infections, a relationship between these infections and renal pathology is established. Based on this we think about IgA nephropathy, which besides being the most frequent glomerulonephritis, it is presented in most of the cases as described." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Acute posterior vitreous detachment.", "2": "Exudative age-related macular degeneration (AMD).", "3": "Central retinal artery obstruction.", "4": "Non-arteritic anterior ischemic optic neuropathy.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 394, 591 ] ], "word_ranges": [ [ 71, 103 ] ], "text": "In the examination there are lesions in the macula. With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula." }, "2": { "exist": true, "char_ranges": [ [ 1270, 1459 ] ], "word_ranges": [ [ 211, 237 ] ], "text": "They describe hard exudates, deep hemorrhages and localized neurosensory retinal detachment. All this in the macula. These are the characteristic findings of neovascular (or exudative) AMD." }, "3": { "exist": true, "char_ranges": [ [ 990, 1269 ] ], "word_ranges": [ [ 164, 211 ] ], "text": "In the case of arterial occlusion, there is intracellular edema that is seen as absence of hemorrhages and a whitish, pale fundus. In addition, the entire retina is globally affected, and a cherry-red spot may appear in the macula. In this case the lesions are totally different." }, "4": { "exist": true, "char_ranges": [ [ 592, 759 ] ], "word_ranges": [ [ 103, 127 ] ], "text": "And also non-arteritic anterior ischemic optic neuropathy, because although it produces visual loss and is typical of older people, it does not produce metamorphopsia." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Glucose tolerance test.", "2": "Chest X-ray.", "3": "Upper gastrointestinal endoscopy.", "4": "Colonoscopy.", "5": "Abdominal ultrasound." }

{ "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": [ [ 28, 84 ] ], "word_ranges": [ [ 5, 13 ] ], "text": "the association of S.bovis endocarditis and colon cancer." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Multiple endocrine neoplasia type 1 or Wermer's syndrome.", "2": "Multiple endocrine neoplasia type 2 A or Sipple's syndrome.", "3": "Multiple endocrine neoplasia type 2B.", "4": "Somatostatinoma.", "5": "A PTH-producing neuroendocrine tumor." }

{ "1": { "exist": true, "char_ranges": [ [ 38, 171 ] ], "word_ranges": [ [ 6, 22 ] ], "text": "Pancreatic neuroendocrine tumor + pituitary adenoma (prolactinoma) + hyperparathyroidism (renoureteral colic in young people): MEN 1." }, "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": "The safest and best performing complementary examination is the barium contrast enema.", "2": "In case of contained pelvic abscess, percutaneous drainage guided by CT or ultrasound is indicated.", "3": "If surgical intervention is required after resolution of the acute episode, the laparoscopic approach is contraindicated.", "4": "In case of acute uncomplicated diverticulitis, elective sigmoidectomy is indicated after cure of the first acute episode.", "5": "If generalized peritonitis occurs, the most appropriate surgical technique is the practice of a derivative colostomy without resection of the affected sigmoid segment." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 84 ] ], "word_ranges": [ [ 0, 15 ] ], "text": "Answer 1 is incorrect because the imaging tests of choice would be ultrasound or CT;" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 85, 169 ] ], "word_ranges": [ [ 15, 28 ] ], "text": "answer 3 is incorrect because the laparoscopic approach is indicated from the start;" }, "4": { "exist": true, "char_ranges": [ [ 170, 383 ] ], "word_ranges": [ [ 28, 66 ] ], "text": "answer 4 is incorrect because the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia;" }, "5": { "exist": true, "char_ranges": [ [ 384, 556 ] ], "word_ranges": [ [ 66, 94 ] ], "text": "and answer 5 is incorrect because surgery in cases of perforation with peritonitis should always resect the affected segment of colon to control the focus of the infection." } }

{ "1": "Genetic mutational and linkage study.", "2": "Abdomino-pelvic ultrasound.", "3": "Helical computed axial tomography with iodinated contrast.", "4": "Abdominal and cerebral MRI.", "5": "Periodic clinical controls." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 54, 301 ] ], "word_ranges": [ [ 7, 42 ] ], "text": "Abdomino-pelvic ultrasound is undoubtedly the most specific and sensitive test for the diagnosis of polycystic kidney disease and, above all, the cheapest to demonstrate whether or not the patient's sibling has inherited polycystic kidney disease." }, "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": "Conization with diathermy loop.", "2": "Endocervical curettage with Kevorkian curettage.", "3": "Endometrial biopsy with Cornier cannula.", "4": "Hysterectomy without adnexectomy.", "5": "Advise her to stop smoking and contraceptives and to have a control in 6 months." }

{ "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": [ [ 46, 588 ] ], "word_ranges": [ [ 9, 105 ] ], "text": "Most of the lesions identified as L-SIL are associated with HPV infection: for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection. On the other hand, according to the latest studies, 70% of the cytologies reported as LSIL will remit, 15% will persist and another 15% will show a more severe cytology, without being able to differentiate whether it is a biological progression or a lesion hidden in the initial cytology. Because of this, it is best to return for a follow-up at 6 months." } }

{ "1": "The endometrium is thickened and in view of the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula.", "2": "The endometrium is not thickened so she is prescribed tranexamic acid and ambulatory follow-up.", "3": "Indications for diagnostic hysteroscopy without the need for endometrial biopsy.", "4": "The endometrium is not thickened, but since she has clinical signs of metrorrhagia, an endometrial biopsy is indicated.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 183 ] ], "word_ranges": [ [ 0, 31 ] ], "text": "The endometrium is thickened for a menopausal woman (some guidelines put the limit at 5 and others at 3mm). And the first complementary test to perform would be an endometrial biopsy." }, "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": "Recurrent acute otitis media.", "2": "Serous otitis media.", "3": "Simple chronic otitis media.", "4": "Chronic cholesteatomatous otitis media.", "5": "Mastoiditis." }

{ "1": { "exist": true, "char_ranges": [ [ 45, 179 ] ], "word_ranges": [ [ 7, 28 ] ], "text": "child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)." }, "2": { "exist": true, "char_ranges": [ [ 389, 458 ] ], "word_ranges": [ [ 63, 73 ] ], "text": "Otoscopy is characteristic of serous otitis media (answer 2 correct)." }, "3": { "exist": true, "char_ranges": [ [ 312, 388 ] ], "word_ranges": [ [ 50, 63 ] ], "text": "nor perforations or adhesions, so it is not 3 (simple chronic otitis media)." }, "4": { "exist": true, "char_ranges": [ [ 180, 311 ] ], "word_ranges": [ [ 28, 50 ] ], "text": "On otoscopy, a pinkish and amber eardrum is observed: there are no scales, so it is not 4 (cholesteatomatous chronic otitis media);" }, "5": { "exist": true, "char_ranges": [ [ 45, 179 ] ], "word_ranges": [ [ 7, 28 ] ], "text": "child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)." } }

{ "1": "Head and neck cancer.", "2": "Lung cancer.", "3": "Urinary bladder cancer.", "4": "Colon cancer.", "5": "Pancreatic cancer." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 23, 177 ] ], "word_ranges": [ [ 4, 34 ] ], "text": "Lung cancer is the most frequent cause of brain metastases and in 20-30% of cases it is as a result of them that the primary tumor is diagnosed (as here)." }, "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": "Adrenaline.", "2": "Adrenaline and dexchlorpheniramine.", "3": "Adrenaline, dexchlorpheniramine and methylprednisolone.", "4": "Adrenaline, dexchlorpheniramine and glucagon.", "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": [ [ 587, 930 ] ], "word_ranges": [ [ 93, 140 ] ], "text": "In this particular case, since the patient was previously treated with propranolol, this indicates that the correct answer is 4, which includes the administration of glucagon, which is administered because patients taking beta-blockers can be resistant to treatment with adrenaline and develop refractory hypotension and prolonged bradycardia." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "A probable cause is an arterioarterial embolism due to detachment of a carotid plaque.", "2": "Doppler ultrasound of supra-aortic trunks is not very useful for diagnosis.", "3": "A cranial CT scan is necessary to assess the impact on the brain parenchyma.", "4": "Surgical treatment is indicated if imaging tests reveal carotid stenosis >70%.", "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": "He cannot eat any fish, crustaceans, mollusks or cephalopods.", "2": "He can eat fresh fish cooked on the grill.", "3": "May eat commercially flash-frozen fish.", "4": "You can eat fresh marinated or cold smoked fish.", "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": "Urgent surgical treatment.", "2": "Biliary drainage by percutaneous cholecystostomy.", "3": "Replace piperacillin-tazobactam with metronidazole-cefotaxime.", "4": "Replace piperacillin-tazobactam with amikacin-clindamycin.", "5": "Add an aminoglycoside such as gentamicin to the treatment." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 143 ] ], "word_ranges": [ [ 0, 28 ] ], "text": "In this question, they insist on the age and comorbidity of the patient, as well as the time of evolution, so the answer will probably not be 1." }, "2": { "exist": true, "char_ranges": [ [ 146, 269 ] ], "word_ranges": [ [ 28, 54 ] ], "text": "In any case, the ideal would be to drain the gallbladder that has not gone up again, so the answer I would give would be 2." }, "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": "It is a typical picture of infectious mononucleosis.", "2": "Varicella zoster infection.", "3": "Acute toxoplasmosis.", "4": "Lyme disease.", "5": "Infection by herpes virus 8." }

{ "1": { "exist": true, "char_ranges": [ [ 221, 344 ] ], "word_ranges": [ [ 34, 49 ] ], "text": "Characteristic of Epstein-Barr infectious mononucleosis is the appearance of macular rash after treatment with amoxicillin." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 90, 220 ] ], "word_ranges": [ [ 15, 34 ] ], "text": "Although a similar picture may occur in acute toxoplasmosis, less than 1% of acute toxoplasma infections present as mononucleosis." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Assess visual acuity.", "2": "Perform an MRI.", "3": "Tilt table study.", "4": "Measure blood pressure lying down and standing up.", "5": "Therapeutic attempt with L-dopa." }

{ "1": { "exist": true, "char_ranges": [ [ 156, 317 ] ], "word_ranges": [ [ 23, 48 ] ], "text": "The rest of the answers can be made for differential diagnosis, but the performance of complementary tests does not justify delaying the initiation of treatment." }, "2": { "exist": true, "char_ranges": [ [ 156, 317 ] ], "word_ranges": [ [ 23, 48 ] ], "text": "The rest of the answers can be made for differential diagnosis, but the performance of complementary tests does not justify delaying the initiation of treatment." }, "3": { "exist": true, "char_ranges": [ [ 156, 317 ] ], "word_ranges": [ [ 23, 48 ] ], "text": "The rest of the answers can be made for differential diagnosis, but the performance of complementary tests does not justify delaying the initiation of treatment." }, "4": { "exist": true, "char_ranges": [ [ 156, 317 ] ], "word_ranges": [ [ 23, 48 ] ], "text": "The rest of the answers can be made for differential diagnosis, but the performance of complementary tests does not justify delaying the initiation of treatment." }, "5": { "exist": true, "char_ranges": [ [ 0, 155 ] ], "word_ranges": [ [ 0, 23 ] ], "text": "The correct answer is to initiate treatment with L-dopa, since the clinical picture described is of a parkinsonism whose diagnosis is exclusively clinical." } }

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

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 383, 649 ] ], "word_ranges": [ [ 62, 105 ] ], "text": "The tissues that compose the tumor are well differentiated (mature or adult type); apart from skin structures many other tissues can be observed, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Cefazolin.", "2": "Cloxacillin.", "3": "Vancomycin.", "4": "Linezolid.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 86, 279 ] ], "word_ranges": [ [ 14, 44 ] ], "text": "The Gram stain tells us that it is a staphylococcus, most of the species of this genus acquired in-hospital are methicillin resistant, so they are considered resistant to Cloxacillin, Cefazolin" }, "2": { "exist": true, "char_ranges": [ [ 86, 279 ] ], "word_ranges": [ [ 14, 44 ] ], "text": "The Gram stain tells us that it is a staphylococcus, most of the species of this genus acquired in-hospital are methicillin resistant, so they are considered resistant to Cloxacillin, Cefazolin" }, "3": { "exist": true, "char_ranges": [ [ 415, 516 ] ], "word_ranges": [ [ 66, 81 ] ], "text": "the experience with vancomycin use in this setting is considered the empirical choice for vancomycin." }, "4": { "exist": true, "char_ranges": [ [ 284, 403 ] ], "word_ranges": [ [ 45, 64 ] ], "text": "there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Enalapril.", "2": "Simvastatin.", "3": "Metformin or levodopa equally.", "4": "Levodopa.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 337, 457 ] ], "word_ranges": [ [ 54, 70 ] ], "text": "the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%)," }, "2": { "exist": true, "char_ranges": [ [ 462, 520 ] ], "word_ranges": [ [ 71, 80 ] ], "text": "their association with simvastatin is also less than 0.1%." }, "3": { "exist": true, "char_ranges": [ [ 66, 173 ] ], "word_ranges": [ [ 12, 28 ] ], "text": "metformin very rarely causes lingual angioedema (in March 2020 there was only one case described worldwide)" }, "4": { "exist": true, "char_ranges": [ [ 188, 306 ] ], "word_ranges": [ [ 31, 49 ] ], "text": "among the adverse reactions of levodopa, angioedema is classified among the very rare ones (frequency less than 0.1%)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Cranial CT scan without contrast.", "2": "Cranial CT with contrast.", "3": "No imaging test.", "4": "Simple skull radiography.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 246 ] ], "word_ranges": [ [ 0, 42 ] ], "text": "After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test." }, "2": { "exist": true, "char_ranges": [ [ 0, 246 ] ], "word_ranges": [ [ 0, 42 ] ], "text": "After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test." }, "3": { "exist": true, "char_ranges": [ [ 0, 246 ] ], "word_ranges": [ [ 0, 42 ] ], "text": "After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test." }, "4": { "exist": true, "char_ranges": [ [ 0, 246 ] ], "word_ranges": [ [ 0, 42 ] ], "text": "After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "None.", "2": "Intravenous penicillin G, 24 MU every day for 14 days.", "3": "Benzathine penicillin 2.4 MU intramuscular, 3 doses in three consecutive weeks.", "4": "Ceftriaxone 2 grams intramuscular in a single dose.", "5": "Benzathine penicillin 2.4 MU intramuscularly in a single dose." }

{ "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": [ [ 26, 169 ] ], "word_ranges": [ [ 3, 27 ] ], "text": "This is syphilis (both by antecendent and serology) in the secondary stage, so treatment is with Benzathine Penicillin 2.4 MU in a single dose." } }

{ "1": "Seasonal influenza, pneumococcal, tetravalent meningitis and hepatitis A.", "2": "Seasonal influenza, Td, pneumococcal and tetravalent meningitis.", "3": "Tetravalent meningitis, pneumococcal and seasonal flu.", "4": "Td, tetravalent meningitis, pneumococcal.", "5": "Triple viral, seasonal flu, pneumococcal." }

{ "1": { "exist": true, "char_ranges": [ [ 462, 1948 ] ], "word_ranges": [ [ 74, 300 ] ], "text": "All four vaccines in option 1 are administrable. In a little more detail: Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases. Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus. It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them. Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious. Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended. Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications, so annual vaccination against this disease is indicated. If the patient's immune status is very deteriorated, the response to vaccination is diminished. In this case, it is essential to vaccinate all the people living with the HIV-infected person to prevent them from transmitting the disease. Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults, so vaccination is recommended, although in patients with counts below 200/mm3 the protective response is usually not sufficient." }, "2": { "exist": true, "char_ranges": [ [ 221, 461 ] ], "word_ranges": [ [ 32, 74 ] ], "text": "Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to \"health personnel\") answers 2, 4 and 5 are wrong." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": true, "char_ranges": [ [ 221, 461 ] ], "word_ranges": [ [ 32, 74 ] ], "text": "Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to \"health personnel\") answers 2, 4 and 5 are wrong." }, "5": { "exist": true, "char_ranges": [ [ 221, 461 ] ], "word_ranges": [ [ 32, 74 ] ], "text": "Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to \"health personnel\") answers 2, 4 and 5 are wrong." } }

{ "1": "She has a bacterial sepsis of undetermined origin and should be given ceftriaxone and supportive care.", "2": "She has bacterial sepsis of undetermined origin and should be given vancomycin, ceftacidime and supportive care.", "3": "This is infectious mononucleosis with a severe course and glucocorticoids should be administered.", "4": "This is an infectious mononucleosis of severe course and treatment with Acyclovir should be initiated.", "5": "I would perform a bone marrow biopsy/aspirate and, if hemophagocytosis is confirmed, initiate treatment with immunosuppressants." }

{ "1": { "exist": true, "char_ranges": [ [ 610, 873 ] ], "word_ranges": [ [ 94, 136 ] ], "text": "The clinical data could be consistent with a septic process, however, the main infectious foci have been reasonably ruled out and one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range, which should draw our attention." }, "2": { "exist": true, "char_ranges": [ [ 610, 873 ] ], "word_ranges": [ [ 94, 136 ] ], "text": "The clinical data could be consistent with a septic process, however, the main infectious foci have been reasonably ruled out and one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range, which should draw our attention." }, "3": { "exist": true, "char_ranges": [ [ 874, 1184 ] ], "word_ranges": [ [ 136, 180 ] ], "text": "On the other hand, a complication of the EBV mononucleosis suffered by our patient should be evaluated, among the possible complications are hemolytic anemia, meningoecephalitis (normal CSF) or Guillain-Barré sd. Guillain-Barré syndrome, which are not very consistent with the clinical picture presented to us." }, "4": { "exist": true, "char_ranges": [ [ 874, 1184 ] ], "word_ranges": [ [ 136, 180 ] ], "text": "On the other hand, a complication of the EBV mononucleosis suffered by our patient should be evaluated, among the possible complications are hemolytic anemia, meningoecephalitis (normal CSF) or Guillain-Barré sd. Guillain-Barré syndrome, which are not very consistent with the clinical picture presented to us." }, "5": { "exist": true, "char_ranges": [ [ 1657, 1938 ] ], "word_ranges": [ [ 237, 276 ] ], "text": "Hyperferritinemia >3000 in a suggestive clinical context necessitates treatment of the patient (mainly with immunosuppressants and corticosteroids) since mortality is very high and early treatment is essential. The definitive diagnosis is made by microscopic study of an OM biopsy." } }

{ "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": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": true, "char_ranges": [ [ 145, 421 ] ], "word_ranges": [ [ 22, 70 ] ], "text": "Option 4 is describing to us a T4 stage, either by invasion of adjacent organs or perforation. The T4s carry a much higher chance of recurrence, in fact there are ongoing studies that propose prophylactic HIPEC in T4 and second look surgery + HIPEC in perforated colon tumors." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Start treatment with corticosteroids.", "2": "Initiate treatment with cyclophosphamide.", "3": "Initiate treatment with mycophenolate mofetil.", "4": "Watchful waiting.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 186 ] ], "word_ranges": [ [ 0, 33 ] ], "text": "In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in treatment obligatory due to their levels." }, "2": { "exist": true, "char_ranges": [ [ 0, 186 ] ], "word_ranges": [ [ 0, 33 ] ], "text": "In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in treatment obligatory due to their levels." }, "3": { "exist": true, "char_ranges": [ [ 0, 186 ] ], "word_ranges": [ [ 0, 33 ] ], "text": "In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in treatment obligatory due to their levels." }, "4": { "exist": true, "char_ranges": [ [ 201, 364 ] ], "word_ranges": [ [ 36, 59 ] ], "text": "with the patient being asymptomatic and with objective evidence of lack of activity, close follow-up should be performed without restarting or modifying treatment." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Administer naloxone, flumazenil and thiamine.", "2": "Administer naloxone, flumazenil and hypertonic glucose.", "3": "Administer naloxone and flumazenil.", "4": "Administer thiamine and hypertonic glucose.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 130, 306 ] ], "word_ranges": [ [ 21, 48 ] ], "text": "although there is no history of intoxication, we have to go to the most frequent and that we can antagonize with antidotes: benzodiazepines (flumazenil) and opiates (naloxone)." }, "4": { "exist": true, "char_ranges": [ [ 307, 422 ] ], "word_ranges": [ [ 48, 67 ] ], "text": "If we suspect ethylene glycol intoxication, we would administer thiamine, but there are no data to make us suspect." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Simple abdominal X-ray.", "2": "pHmetry.", "3": "Abdominal ultrasound.", "4": "Determination of electrolytes in sweat.", "5": "Esophagogastroscopy." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 103, 170 ] ], "word_ranges": [ [ 18, 26 ] ], "text": "the clinical description is textbook hypertrophic pyloric stenosis." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Debut of type 2 diabetes mellitus, with dyspnea probably due to pneumonia or thromboembolism, since she is taking anovulatory drugs.", "2": "It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause.", "3": "Debut of type 1 diabetes with ketoacidosis. Treat with bicarbonate and after correction of acidosis, add intravenous insulin.", "4": "It looks like diabetic ketoacidosis, but it could be alcoholic. BAC should be determined before starting insulin therapy.", "5": "Treat with rapid subcutaneous insulin, serum therapy and ask him to drink plenty of fluids." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 31, 158 ] ], "word_ranges": [ [ 5, 24 ] ], "text": "Priority is iv insulin administration and serum therapy. Bicarbonate if pH < 7. Insulin administration should never be delayed." }, "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": "Oral isotretinoin.", "2": "Intralesional meglumine antimoniate.", "3": "Systemic corticosteroids.", "4": "Oral amoxicillin.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 433, 588 ] ], "word_ranges": [ [ 75, 99 ] ], "text": "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis, so it is clear." }, "2": { "exist": true, "char_ranges": [ [ 433, 588 ] ], "word_ranges": [ [ 75, 99 ] ], "text": "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis, so it is clear." }, "3": { "exist": true, "char_ranges": [ [ 433, 588 ] ], "word_ranges": [ [ 75, 99 ] ], "text": "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis, so it is clear." }, "4": { "exist": true, "char_ranges": [ [ 433, 588 ] ], "word_ranges": [ [ 75, 99 ] ], "text": "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis, so it is clear." }, "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": "Spectrometry by magnetic resonance.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 184 ] ], "word_ranges": [ [ 0, 30 ] ], "text": "We present a case of chronic compartment syndrome. For its diagnosis it is necessary to measure the pressure of the affected compartments at rest and after activity (answer 2 correct)." }, "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": "22q11 deletion study (Di George or Velo-cardio-facial syndrome).", "2": "Study of FMR1 gene expansion, responsible for Fragile X syndrome.", "3": "Sequencing of genes related to HRAS (Noonan syndrome).", "4": "Genetic study of Williams Beuren syndrome.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 309, 431 ] ], "word_ranges": [ [ 40, 58 ] ], "text": "just with the words \"thymic dysfunction\", hypocalcemia and cardiopathy, we would have to go straight to DiGeorge syndrome." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 637, 763 ] ], "word_ranges": [ [ 96, 115 ] ], "text": "can also be associated with cardiopathy, but above all it is characterized by short stature, cardiopathy and bone alterations;" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Behçet's disease.", "2": "Reactive arthritis syndrome.", "3": "Sweet's syndrome.", "4": "Vitamin A deficiency.", "5": "Gonococcal infection." }

{ "1": { "exist": true, "char_ranges": [ [ 339, 434 ] ], "word_ranges": [ [ 50, 66 ] ], "text": "In Behçet's disease oral and genital aphthous ulcers may occur but urethritis is not a feature." }, "2": { "exist": true, "char_ranges": [ [ 208, 338 ] ], "word_ranges": [ [ 31, 50 ] ], "text": "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present." }, "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": "Percutaneous revascularization.", "2": "Medical treatment.", "3": "Myocardial revascularization surgery.", "4": "Implantation of balloon counterpulsation.", "5": "Cardiac transplantation." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 245 ] ], "word_ranges": [ [ 0, 33 ] ], "text": "We are talking about a patient with 3-vessel coronary artery disease and, very importantly, with severe ventricular dysfunction. Under these conditions, the treatment of choice would be surgical (myocardial revascularization surgery or by-pass)." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Acute urticaria of pharmacological cause.", "2": "Erythema minor exudative secondary to drugs.", "3": "Pharmacological Stevens-Johnson syndrome.", "4": "Epidermal toxic necrolysis.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 236, 326 ] ], "word_ranges": [ [ 39, 54 ] ], "text": "If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson" }, "4": { "exist": true, "char_ranges": [ [ 0, 235 ] ], "word_ranges": [ [ 0, 39 ] ], "text": "We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area. Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Disordered echocardiogram.", "2": "Pulmonary scintigraphy.", "3": "Pulmonary angio-CT.", "4": "Electrocardiogram.", "5": "Chest X-ray." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 111, 272 ] ], "word_ranges": [ [ 23, 48 ] ], "text": "a patient with advanced renal failure (stage 5) is contraindicated for any imaging study that requires the administration of IV contrast, such as CT angiography." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "She is in the moment of evolution in which vasospasm is more frequent.", "2": "This progressive deterioration is probably secondary to aneurysm rebleeding.", "3": "Subacute deterioration is most likely due to hydrocephalus.", "4": "The diagnostic technique of choice is cerebral angiography.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 277 ] ], "word_ranges": [ [ 0, 40 ] ], "text": "Vasospasm as a complication of subarachnoid hemorrhage usually occurs early, in the week after the hemorrhage. The progressive deterioration with alteration of the level of consciousness makes us suspect one of the complications that can occur in this condition: hydrocephalus." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Huntington's disease.", "2": "Wilson's disease.", "3": "Tourette's syndrome.", "4": "Sydenham's chorea.", "5": "Juvenile-onset Parkinson's disease." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 176 ] ], "word_ranges": [ [ 0, 27 ] ], "text": "The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course." }, "2": { "exist": true, "char_ranges": [ [ 326, 454 ] ], "word_ranges": [ [ 49, 68 ] ], "text": "in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders." }, "3": { "exist": true, "char_ranges": [ [ 0, 176 ] ], "word_ranges": [ [ 0, 27 ] ], "text": "The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course." }, "4": { "exist": true, "char_ranges": [ [ 177, 306 ] ], "word_ranges": [ [ 27, 45 ] ], "text": "Sydenham's chorea is typical of younger children with a history of streptococcal infection and resolution is usually spontaneous." }, "5": { "exist": true, "char_ranges": [ [ 0, 176 ] ], "word_ranges": [ [ 0, 27 ] ], "text": "The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course." } }

{ "1": "Cardioembolic stroke with complete neurologic dysphagia.", "2": "Cachexia due to chronic empyema in immunocompromised patient.", "3": "Prolonged paralytic syndrome.", "4": "Advanced Alzheimer's disease with severe risk of bronchial aspiration.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 239 ] ], "word_ranges": [ [ 0, 32 ] ], "text": "Paralytic ileus is a failure of intestinal propulsion that appears acutely in the absence of mechanical obstruction; it is secondary to various causes and affects intestinal contractility. Therefore, parenteral administration is necessary." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Genital candidiasis.", "2": "Chancroid.", "3": "Secondary syphilis.", "4": "Trichomonas balanitis.", "5": "Dermatophyte fungal infection." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 31 ] ], "word_ranges": [ [ 0, 5 ] ], "text": "Chancroid is a solitary lesion." }, "3": { "exist": true, "char_ranges": [ [ 32, 184 ] ], "word_ranges": [ [ 5, 28 ] ], "text": "Secondary syphilis usually occurs as a generalized rash or as characteristic lesions on palms and soles (syphilitic nails) with a longer latency period." }, "4": { "exist": true, "char_ranges": [ [ 185, 286 ] ], "word_ranges": [ [ 28, 43 ] ], "text": "Trichomonas balanitis is always associated with urethritis, which is not referred to in the question." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Administration of combined oral contraceptives.", "2": "Premature ovarian failure.", "3": "Eating behavior disorder.", "4": "Craniopharyngioma.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 128, 202 ] ], "word_ranges": [ [ 22, 33 ] ], "text": "The rest of the diagnoses are consistent with these analytical parameters." }, "2": { "exist": true, "char_ranges": [ [ 0, 127 ] ], "word_ranges": [ [ 0, 22 ] ], "text": "This is because in early ovarian failure FSH and LH are elevated. This is confirmed by the SEGO protocol called Early Menoguia." }, "3": { "exist": true, "char_ranges": [ [ 128, 202 ] ], "word_ranges": [ [ 22, 33 ] ], "text": "The rest of the diagnoses are consistent with these analytical parameters." }, "4": { "exist": true, "char_ranges": [ [ 128, 202 ] ], "word_ranges": [ [ 22, 33 ] ], "text": "The rest of the diagnoses are consistent with these analytical parameters." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Renal amyloidosis.", "2": "Glomerulonephritis secondary to rheumatoid arthritis.", "3": "Renal failure due to non-steroidal anti-inflammatory drugs.", "4": "Interstitial nephritis due to methotrexate.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 251, 403 ] ], "word_ranges": [ [ 40, 63 ] ], "text": "Although GMN and renal amyloidosis are relatively frequent in RA, the anodyne urine sediment and the absence of proteinuria make these options unlikely." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 88 ] ], "word_ranges": [ [ 0, 15 ] ], "text": "Prerenal acute renal failure due to NSAIDs seems the most plausible option in this case." }, "4": { "exist": true, "char_ranges": [ [ 89, 250 ] ], "word_ranges": [ [ 15, 40 ] ], "text": "Tubulointerstitial nephritis due to methotrexate is less likely due to the absence of rash, fever or eosinophilia, which although rare in the MIR usually appear." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Type-specific blood transfusion required.", "2": "Requires emergency blood transfusion (O Rh negative).", "3": "A possible blood transfusion with crossmatching tests should be prepared.", "4": "Try again infusion of another 20 ml/kg of crystalloids.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 257, 405 ] ], "word_ranges": [ [ 40, 64 ] ], "text": "In this case, given the vital compromise, the need for transfusion is very urgent, so the indication is emergency blood transfusion (O Rh negative)." }, "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": "Enalapril.", "2": "Simvastatin.", "3": "Metformin or levodopa equally.", "4": "Levodopa.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 275 ] ], "word_ranges": [ [ 0, 46 ] ], "text": "Angioedema is a type of profound urticaria that can be of drug etiology (not IgE-mediated) and in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause, so in this case it would be the correct answer (if we speak in probabilistic terms)." }, "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": "The most probable diagnosis is a demyelinating plaque in the contralateral hemiprotuberance, the most necessary complementary exploration would be a cranial MRI.", "2": "Oral corticosteroids are the treatment of choice for the patient.", "3": "Intravenous fibrinolysis should be considered if the evolution time is less than 3h.", "4": "Most likely the picture is irreversible.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 149, 448 ] ], "word_ranges": [ [ 22, 69 ] ], "text": "The first one would not be correct because although within the age range of multiple sclerosis debut, the presentation is usually gradual over days and the nuclear involvement of the VII cranial nerve (which could simulate a peripheral facial) would not cause dysgeusia, hyperacusis or mastoid pain." }, "2": { "exist": true, "char_ranges": [ [ 0, 148 ] ], "word_ranges": [ [ 0, 22 ] ], "text": "We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain. In this case the treatment is corticoid." }, "3": { "exist": true, "char_ranges": [ [ 449, 585 ] ], "word_ranges": [ [ 69, 94 ] ], "text": "In the third answer they propose us that it is a vascular picture and therefore that the facial paralysis is central, so it is discarded" }, "4": { "exist": true, "char_ranges": [ [ 590, 714 ] ], "word_ranges": [ [ 95, 114 ] ], "text": "the last one is not correct because most of the idiopathic peripheral facial paralysis (Bell's palsy) heal without sequelae." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Rheumatoid arthritis, would initiate treatment with methotrexate.", "2": "Fibromyalgia, would initiate treatment with duloxetine.", "3": "Polymyalgia rheumatica, would initiate treatment with corticosteroids.", "4": "Ankylosing spondylitis, I would initiate treatment with non-steroidal anti-inflammatory drugs.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 361 ] ], "word_ranges": [ [ 0, 56 ] ], "text": "In this case, he is describing the cardinal symptoms of polymyalgia rheumatica. Older patient, over 50 years of age, presenting with pain and stiffness in both girdles, associated with an elevation of acute phase reactants. He presents all the indispensable criteria: age equal to or greater than 50 years, bilateral omalgia and increased acute phase reactants." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Dilated cardiomyopathy.", "2": "Pericardial effusion with cardiac tamponade.", "3": "Constrictive pericarditis.", "4": "Ischemic heart disease.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 31, 311 ] ], "word_ranges": [ [ 5, 49 ] ], "text": "he had a fever and pain, he had pericarditis with effusion, and now this is causing tamponade. Hence the hypotension (his heart cannot fill well with blood and pump), jugular engorgement and dependence on respiration to achieve preload and cardiac output (i.e. paradoxical pulse)." }, "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": "Haptoglobin.", "2": "Coombs' test.", "3": "Vitamin B12.", "4": "Antinuclear antibodies.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 192, 539 ] ], "word_ranges": [ [ 36, 95 ] ], "text": "In my opinion, the most suitable would be alternative 2, since hydroxyloroquine has been reported to decrease the absorption of folic acid, and since she has a complication of SLE, in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption. And for this it would be first to determine with the direct coombs." }, "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 lupus serology since it is most likely a Treponema pallidum infection.", "2": "A gynecological examination to rule out ovarian cancer.", "3": "From the clinical features it seems to be normal lymph nodes and complementary explorations should not be performed.", "4": "A Paul-Bunell test should be performed to rule out infectious mononucleosis.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 225, 330 ] ], "word_ranges": [ [ 41, 60 ] ], "text": "On the other hand, there are no signs or symptoms that make us think of a sexually transmitted infection." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 25, 224 ] ], "word_ranges": [ [ 5, 41 ] ], "text": "In the inguinal region, the lymph nodes can acquire a size of up to 1.5 cm being normal. In addition, the rest of the data of the inguinal exploration (no pain, mobile, soft, etc.) corroborates this." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Ivabradine.", "2": "Angiotensin converting enzyme inhibitors.", "3": "Antialdosterone.", "4": "Beta-blockers.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 77 ] ], "word_ranges": [ [ 0, 10 ] ], "text": "Ivabradine, in fact, is contraindicated in patients with atrial fibrillation." }, "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": "At the level of the area 4 of Brodmann of the cerebral cortex of the right side.", "2": "In the internal capsule, posterior arm on the right side.", "3": "In the left cerebral peduncle.", "4": "In the medial portion of the caudal protuberance of the left side.", "5": "In the medulla oblongata before decussation of the right cortico-spinal fascicle." }

{ "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": [ [ 172, 521 ] ], "word_ranges": [ [ 27, 95 ] ], "text": "we have a crossed clinical picture, having to think about brainstem involvement. If we have in a quick diagram where the nuclei of the cranial pairs start from: the first 4 above the pons, the next 4 in the pons, and the last 4 below the pons, we have that the facial nucleus is in the middle 4. That is, left facial nucleus, left pons, so answer 4." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Proceed to IOT.", "2": "Perform a skull X-ray.", "3": "Administer flumazenil.", "4": "Administer naloxone.", "5": "Wait until he wakes up." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 152 ] ], "word_ranges": [ [ 0, 24 ] ], "text": "Overuse of the drugs he is taking should be suspected. Olanzapine has no antidote, so, in principle, we should antagonize the effect of benzodiazepines." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Cardiogenic.", "2": "Septic.", "3": "Hypovolemic.", "4": "Anaphylactic.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 317 ] ], "word_ranges": [ [ 0, 50 ] ], "text": "We are not given any further data on the patient except that she is in shock (tissue hypoperfusion) and on introducing a Swan-Ganz catheter we find a low cardiac index (<2), elevated PCP (25mmHg) and elevated systemic resistances (normal: 600-1200 dyne/m2). These data are compatible with cardiogenic origin of shock." }, "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": "The clinical picture suggests pulmonary thromboembolism.", "2": "The data provided indicate hypertrophic cardiomyopathy with severe obstruction of the left ventricular outflow tract.", "3": "These data correspond to severe aortic stenosis.", "4": "Aortic dissection should be excluded by contrast-enhanced computed tomography.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 181 ] ], "word_ranges": [ [ 0, 29 ] ], "text": "The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "DDD pacemaker (bicameral).", "2": "VVI pacemaker (ventricular unicameral).", "3": "AAI pacemaker (single-chamber atrial pacemaker).", "4": "Ventricular resynchronization therapy (CRT).", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 39 ] ], "word_ranges": [ [ 0, 4 ] ], "text": "VVI pacemaker (ventricular unicameral)." }, "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": "Chemotherapy with FOLFIRI (fluorouracil, leucovorin and irinotecan) plus bevacizumab.", "2": "Monochemotherapy with capecitabine.", "3": "Assessment for surgical resection of the hepatic lesion.", "4": "Hepatic radiotherapy.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 633, 942 ] ], "word_ranges": [ [ 91, 137 ] ], "text": "In case of an unresectable situation, chemotherapy treatment would be considered with the intention of converting the single metastatic lesion into a resectable one. Since more than 12 months have passed since FOLFOX treatment, the same scheme could be used, although FOLFIRI+bevacizumab would also be useful." }, "2": { "exist": true, "char_ranges": [ [ 943, 1140 ] ], "word_ranges": [ [ 137, 165 ] ], "text": "Capecitabine monotherapy, in the patient's current situation, would also not be a good starting option, since the responses are lower compared to FOLFOX or FOLFIRI plus antiangiogenic combinations." }, "3": { "exist": true, "char_ranges": [ [ 232, 495 ] ], "word_ranges": [ [ 37, 78 ] ], "text": "As this is a situation of oligometastasis and the treatments for advanced colon adenocarcinoma allow prolonged survival with good quality of life in these patients, if there is nothing to contraindicate surgery, this should be the first option (correct answer 3)." }, "4": { "exist": true, "char_ranges": [ [ 1141, 1378 ] ], "word_ranges": [ [ 165, 207 ] ], "text": "Hepatic radiotherapy could be considered, since there are SBRT techniques that achieve very good results, but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Administration of oxygen by means of a 50% Venturi type mask.", "2": "Administration of intravenous hydroxycobalamin.", "3": "Ventilation with hyperbaric chamber.", "4": "Fluid therapy with infusion of physiological saline solution at 21 ml/h.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 243, 376 ] ], "word_ranges": [ [ 41, 64 ] ], "text": "Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1)," }, "2": { "exist": true, "char_ranges": [ [ 243, 423 ] ], "word_ranges": [ [ 41, 71 ] ], "text": "Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin" }, "3": { "exist": true, "char_ranges": [ [ 462, 579 ] ], "word_ranges": [ [ 77, 94 ] ], "text": "Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning." }, "4": { "exist": true, "char_ranges": [ [ 580, 759 ] ], "word_ranges": [ [ 94, 127 ] ], "text": "What is stated in option 4 about fluid therapy is not indicated; in case of associated shock, volume would be administered, but in any case not at that rate, but in rapid boluses." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Doxycycline.", "2": "Amoxicillin-Clavulanic acid.", "3": "Daptomycin.", "4": "Linezolid.", "5": "Vancomycin." }

{ "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, 228 ] ], "word_ranges": [ [ 0, 26 ] ], "text": "Spontaneous reports of serotonergic syndrome associated with concomitant administration of linezolid and serotonergic agents, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs), have been reported." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed.", "2": "Enoxaparin: 80 mg sc every 12 hours, starting upon diagnostic suspicion.", "3": "Enoxaparin; 80 mg sc every 12 hours, starting upon diagnostic confirmation.", "4": "Fondaparinux: 7.5 mg sc daily.", "5": "Emergency pulmonary thromboendarterectomy." }

{ "1": { "exist": true, "char_ranges": [ [ 443, 557 ] ], "word_ranges": [ [ 69, 87 ] ], "text": "Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis, so the correct option is 1." }, "2": { "exist": true, "char_ranges": [ [ 126, 188 ] ], "word_ranges": [ [ 18, 29 ] ], "text": "Option 2 would be correct if the patient were not hypotensive." }, "3": { "exist": true, "char_ranges": [ [ 189, 329 ] ], "word_ranges": [ [ 29, 50 ] ], "text": "Option 3 is not correct since diagnostic confirmation is not necessary to initiate anticoagulant therapy in case of PTE without hypotension." }, "4": { "exist": true, "char_ranges": [ [ 330, 356 ] ], "word_ranges": [ [ 50, 55 ] ], "text": "Option 4 is not indicated." }, "5": { "exist": true, "char_ranges": [ [ 357, 442 ] ], "word_ranges": [ [ 55, 69 ] ], "text": "Option 5 would be correct only if the patient had a contraindication to fibrinolysis." } }

{ "1": "Tendinopathy of the teres major.", "2": "Adhesive capsulitis.", "3": "Suprascapular nerve neuropathy.", "4": "Axillary nerve injury.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 184, 297 ] ], "word_ranges": [ [ 29, 50 ] ], "text": "The rotator cuff is undamaged in the MRI, ruling out option 1 (it would show us tendinopathy of the teres major)." }, "2": { "exist": true, "char_ranges": [ [ 298, 419 ] ], "word_ranges": [ [ 50, 67 ] ], "text": "Adhesive capsulitis presents with pain and stiffness of the shoulder, especially on active and passive external rotation." }, "3": { "exist": true, "char_ranges": [ [ 420, 621 ] ], "word_ranges": [ [ 67, 97 ] ], "text": "The suprascapular nerve innervates the supraspinatus muscle, which contributes to the first 15º of shoulder abduction (preserved in the statement) and does not innervate the skin of the reflected area." }, "4": { "exist": true, "char_ranges": [ [ 0, 183 ] ], "word_ranges": [ [ 0, 29 ] ], "text": "Dysesthesia of the lateral aspect of the deltoid region of the shoulder (area innervated by the axillary nerve) and paralysis of the deltoid (primary muscle for abduction beyond 15°)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Dental cause / reevaluation by the dentist.", "2": "Abscess of the base of the tongue / debridement.", "3": "Ankyloglossia / surgical release of the same.", "4": "Malignant process of oropharynx / repeat CT scan and biopsy.", "5": "Nonspecific inflammation / corticosteroid treatment." }

{ "1": { "exist": true, "char_ranges": [ [ 301, 354 ] ], "word_ranges": [ [ 51, 61 ] ], "text": "the dentist \"didn't see anything\", so he rules out 1." }, "2": { "exist": true, "char_ranges": [ [ 355, 473 ] ], "word_ranges": [ [ 61, 85 ] ], "text": "It is not an abscess of the base of the tongue either, because in three months it would have killed him: neither is 2." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": true, "char_ranges": [ [ 559, 665 ] ], "word_ranges": [ [ 97, 119 ] ], "text": "When there is doubt that it could be cancer, we should not fool around and order a new CT scan and biopsy." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Dysmorphic red blood cells and/or hematic casts.", "2": "Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours.", "3": "Coexistence of hematuria with pyuria without bacteriuria.", "4": "Clots in the urine with the naked eye.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 128 ] ], "word_ranges": [ [ 0, 18 ] ], "text": "Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment (option 1 correct)." }, "2": { "exist": true, "char_ranges": [ [ 129, 263 ] ], "word_ranges": [ [ 18, 39 ] ], "text": "Proteinuria can also appear in variable range, although it is not usual in the form of isolated microalbuminuria (incorrect option 2)," }, "3": { "exist": true, "char_ranges": [ [ 268, 345 ] ], "word_ranges": [ [ 40, 51 ] ], "text": "hematuria with pyuria although it is not characteristic (incorrect option 3)." }, "4": { "exist": true, "char_ranges": [ [ 346, 445 ] ], "word_ranges": [ [ 51, 67 ] ], "text": "Clots usually appear in the context of alterations of the lower urinary tract (option 4 incorrect)." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Discourage revascularization surgery because of prolonged ischemia time.", "2": "Apply heat and notify the on-call vascular surgeon.", "3": "Urgent surgical treatment by thromboembolectomy.", "4": "Urgent medical treatment with intravenous prostaglandins.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 48 ] ], "word_ranges": [ [ 0, 5 ] ], "text": "Urgent surgical treatment by thromboembolectomy." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The most probable diagnosis is retractile testicle.", "2": "Wait until two years of age for its spontaneous decrease.", "3": "Human chorionic gonadotropin is the treatment of first choice.", "4": "The indication for orchidopexy should not be deferred.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 257, 379 ] ], "word_ranges": [ [ 40, 63 ] ], "text": "In this case we are being told that the teste is always in the inguinal canal (cryptorchidism) so we can discard option 1." }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 380, 620 ] ], "word_ranges": [ [ 63, 100 ] ], "text": "Hormonal treatment with HCG has already fallen into disuse, due to its low efficacy, possibility of reascension and because apoptotic and inflammatory phenomena have been described in the teste associated with its use (we discard option 3)." }, "4": { "exist": true, "char_ranges": [ [ 621, 766 ] ], "word_ranges": [ [ 100, 125 ] ], "text": "Orchidopexy is the treatment of choice when we are faced with cryptorchidism, being desirable to perform it between 6 months and one year of age," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Meniscal injury.", "2": "Injury by rupture of the anterior cruciate ligament.", "3": "Injury by rupture of the posterior cruciate ligament.", "4": "Degenerative arthropathy injury.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 403 ] ], "word_ranges": [ [ 0, 66 ] ], "text": "The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5º and then 20º, performing internal and external rotations of the leg. In case this reproduces the pain that the patient refers, the test will be considered as positive. It is a test used for the diagnosis of meniscal pathology (sensitivity greater than 90% and specificity greater than 95%) (Answer 1 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": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Neurofibroma of the gastric wall.", "2": "Gastrointestinal stromal tumor.", "3": "Leiomyoma.", "4": "Granulocytic sarcoma.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 81 ] ], "word_ranges": [ [ 0, 14 ] ], "text": "The GI stromal tumor is better known as GIST, positive CD117, ckit, PDGF, manual." }, "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": "Meniscal injury.", "2": "Injury due to rupture of the anterior cruciate ligament.", "3": "Injury by rupture of the posterior cruciate ligament.", "4": "Degenerative arthropathy injury.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 71 ] ], "word_ranges": [ [ 0, 9 ] ], "text": "Thessaly test. Provocation test performed in suspected meniscal injury." }, "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": "Coronavirus infection.", "2": "Lymphocytic choriomeningitis.", "3": "Dengue.", "4": "Chikungunya virus infection.", "5": "Saint Louis encephalitis." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 523, 649 ] ], "word_ranges": [ [ 87, 104 ] ], "text": "All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)," }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Digoxin and acetylsalicylic acid.", "2": "Atenolol and acetylsalicylic acid.", "3": "Verapamil and acenocoumarol.", "4": "Carvedilol and acenocoumarol.", "5": "Carvedilol and clopidogrel." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 408, 501 ] ], "word_ranges": [ [ 62, 74 ] ], "text": "Verapamil (and calcium antagonists in general) are contraindicated in systolic heart failure:" }, "4": { "exist": true, "char_ranges": [ [ 182, 407 ] ], "word_ranges": [ [ 25, 62 ] ], "text": "fibrillation; she has criteria for anticoagulation, and between the two options that include acenocoumarol we are inclined to choose option 4, since it includes carvedilol, a drug that has been shown to increase survival in heart failure." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Rituximab should be administered, since glucocorticoids have been relegated to second-line treatment due to their side effects.", "2": "Tocilizumab has been shown to be effective in reducing recurrences and cumulative prednisone dose in more than 50% of patients.", "3": "In the presence of ischemic symptoms, and in order not to worsen the vascular risk of the patient, the use of glucocorticoids at doses higher than 30 mg/day should be avoided.", "4": "In conjunction with glucocorticoid boluses of 1 g/day, infliximab should be used as a first-line drug for remission induction.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 108 ] ], "word_ranges": [ [ 0, 15 ] ], "text": "Clinical case of giant cell arteritis. Corticosteroid therapy remains the first choice (answer 1 incorrect)," }, "2": { "exist": true, "char_ranges": [ [ 352, 419 ] ], "word_ranges": [ [ 52, 63 ] ], "text": "which has also been shown to reduce recurrences (answer 2 correct)." }, "3": { "exist": true, "char_ranges": [ [ 109, 255 ] ], "word_ranges": [ [ 15, 39 ] ], "text": "to be administered as pulses (doses differ according to the literature, but at least 125 mg/d) in case of ocular involvement (answer 3 incorrect)." }, "4": { "exist": true, "char_ranges": [ [ 256, 351 ] ], "word_ranges": [ [ 39, 52 ] ], "text": "The current treatment of choice for corticosteroid sparing is Tocilizumab (answer 4 incorrect)," }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Thrombotic thrombocytopenic purpura.", "2": "Disseminated intravascular coagulation.", "3": "Thrombocytopenia induced by infection.", "4": "Primary immune thrombocytopenia.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 97, 211 ] ], "word_ranges": [ [ 14, 32 ] ], "text": "1 is false, there would be fever, hemolysis data, neurological symptoms, in the smear there would be schistocytes." }, "2": { "exist": true, "char_ranges": [ [ 212, 286 ] ], "word_ranges": [ [ 32, 47 ] ], "text": "In 2 the coagulation must be altered and in this case it is not mentioned." }, "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": "Antiphospholipid syndrome.", "2": "Factor V of Leiden.", "3": "Hemophilia.", "4": "Acute pericarditis.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 384 ] ], "word_ranges": [ [ 0, 56 ] ], "text": "In this clinical case, we are presented with a woman who rapidly presents dyspnea with hypoxemia, a picture compatible with pulmonary thromboembolism. The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem; and antiphospholipid antibodies can be detected through the prolongation of phospholipid-dependent coagulation tests, correct answer 1." }, "2": { "exist": true, "char_ranges": [ [ 385, 528 ] ], "word_ranges": [ [ 56, 81 ] ], "text": "On the other hand, although factor V Leiden has been identified as a common cause of familial thrombosis, it would not alter the clotting time." }, "3": { "exist": true, "char_ranges": [ [ 529, 651 ] ], "word_ranges": [ [ 81, 103 ] ], "text": "In the case of hemophilia there would be a problem in blood coagulation but it is not a frequent cause of thromboembolism." }, "4": { "exist": true, "char_ranges": [ [ 652, 816 ] ], "word_ranges": [ [ 103, 127 ] ], "text": "Finally, although acute pericarditis could manifest itself in 4 days and with tachycardia, the rest of the symptoms or analytical parameters are not characteristic." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Herpetic keratitis.", "2": "Corneal abrasion.", "3": "Fungal keratitis.", "4": "Bacterial keratitis.", "5": "Glaucomatocyclic crisis." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 134 ] ], "word_ranges": [ [ 0, 22 ] ], "text": "Dendritic corneal ulcer is typical of herpes simplex keratitis. It presents with pain, not too striking, and scarce or absent red eye." }, "2": { "exist": true, "char_ranges": [ [ 610, 674 ] ], "word_ranges": [ [ 101, 115 ] ], "text": "if it is a dendrite, the first thing we have to think is herpes." }, "3": { "exist": true, "char_ranges": [ [ 675, 731 ] ], "word_ranges": [ [ 115, 122 ] ], "text": "Fungal and bacterial keratitis have corneal infiltrates." }, "4": { "exist": true, "char_ranges": [ [ 675, 731 ] ], "word_ranges": [ [ 115, 122 ] ], "text": "Fungal and bacterial keratitis have corneal infiltrates." }, "5": { "exist": true, "char_ranges": [ [ 736, 885 ] ], "word_ranges": [ [ 123, 142 ] ], "text": "glaucomatocyclitic crisis (Posner Schlossman syndrome) is a type of idiopathic hypertensive anterior uveitis, which does not present with ulceration." } }

{ "1": "Ganciclovir.", "2": "Caspofungin.", "3": "Fluconazole.", "4": "Piperacillin-tazobactam.", "5": "Voriconazole." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 209, 284 ] ], "word_ranges": [ [ 28, 41 ] ], "text": "Aspergillus is resistant to fluconazole, so it would not be a valid option." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 26, 208 ] ], "word_ranges": [ [ 3, 28 ] ], "text": "This is a patient undergoing chemotherapy with respiratory symptoms and the \"halo sign\" on X-ray, very suggestive of invasive pulmonary aspergillosis. Treatment is with voriconazole." } }

{ "1": "Celiac disease.", "2": "Acute gastroenteritis.", "3": "Cow's milk protein allergy.", "4": "Bottle allergy.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 264 ] ], "word_ranges": [ [ 0, 41 ] ], "text": "Child with multiple family history of allergy (asthma, atopy), who has received artificial milk in the first hours of life (sensitization to cow's milk protein) and who, coinciding with the intake of artificial milk, starts digestive symptoms and exanthema = APLV." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The first diagnostic probability is carcinoma of the floor of the mouth with bilateral cervical metastases.", "2": "The therapeutic priority is to ensure the patient's nutrition.", "3": "We are almost certainly facing a mediastinitis.", "4": "We must consider as a priority the risk of airway obstruction.", "5": "We must perform as a first diagnostic measure a cytology by fine needle aspiration puncture." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 214 ] ], "word_ranges": [ [ 0, 39 ] ], "text": "This patient is in serious condition. The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed. Knowing this, options 1, 2 and 5 are out of place" }, "2": { "exist": true, "char_ranges": [ [ 0, 214 ] ], "word_ranges": [ [ 0, 39 ] ], "text": "This patient is in serious condition. The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed. Knowing this, options 1, 2 and 5 are out of place" }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": true, "char_ranges": [ [ 0, 214 ] ], "word_ranges": [ [ 0, 39 ] ], "text": "This patient is in serious condition. The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed. Knowing this, options 1, 2 and 5 are out of place" } }

{ "1": "Trisomy 18 (Edwards' syndrome).", "2": "Trisomy 13 (Patau's syndrome).", "3": "Trisomy 21 (Down syndrome).", "4": "Trisomy 9.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 52, 252 ] ], "word_ranges": [ [ 7, 37 ] ], "text": "Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome." }, "2": { "exist": true, "char_ranges": [ [ 52, 252 ] ], "word_ranges": [ [ 7, 37 ] ], "text": "Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": true, "char_ranges": [ [ 52, 252 ] ], "word_ranges": [ [ 7, 37 ] ], "text": "Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Acute lymphoblastic leukemia.", "2": "Burkitt's lymphoma.", "3": "Visceral leishmaniasis.", "4": "Miliary tuberculosis.", "5": "Chronic malaria." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 151 ] ], "word_ranges": [ [ 0, 22 ] ], "text": "Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar. The origin of the girl is also indicative of this diagnosis," }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "History of breast cancer.", "2": "History of osteoporosis.", "3": "History of having been at rest for more than 3 days.", "4": "Presence of unilateral edema of the right calf.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 107 ] ], "word_ranges": [ [ 0, 16 ] ], "text": "The other antecedents and findings are very directly related to the increased risk of thrombotic phenomena." }, "2": { "exist": true, "char_ranges": [ [ 108, 157 ] ], "word_ranges": [ [ 16, 24 ] ], "text": "Osteoporosis is not a risk factor for thrombosis." }, "3": { "exist": true, "char_ranges": [ [ 0, 107 ] ], "word_ranges": [ [ 0, 16 ] ], "text": "The other antecedents and findings are very directly related to the increased risk of thrombotic phenomena." }, "4": { "exist": true, "char_ranges": [ [ 0, 107 ] ], "word_ranges": [ [ 0, 16 ] ], "text": "The other antecedents and findings are very directly related to the increased risk of thrombotic phenomena." }, "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": [ [ 0, 119 ] ], "word_ranges": [ [ 0, 15 ] ], "text": "Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram." }, "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": "Laparoscopic myomectomy.", "2": "Laparotomic myomectomy.", "3": "Myoma embolization by arterial catheterization.", "4": "Treatment with Gn-Rh analogues for three months before attempting pregnancy.", "5": "Attempting pregnancy without any previous treatment." }

{ "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, 135 ] ], "word_ranges": [ [ 5, 24 ] ], "text": "An asymptomatic myoma of this size that does not deform the endometrial cavity is not a problem for pregnancy." } }

{ "1": "Switch to major opioids.", "2": "Extra doses of opioids should be administered as necessary.", "3": "Corticoids should be added.", "4": "Switch to a major opioid and maintain NSAIDs.", "5": "The patient should be admitted for intravenous treatment with major opioid." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 102 ] ], "word_ranges": [ [ 0, 14 ] ], "text": "Brain metastases produce pain due to cranial hypertension. The treatment of choice is corticosteroids." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "The risk of a new molar gestation in a future pregnancy is 50%.", "2": "She should not become pregnant until she has undergone periodic controls and has spent one year with negative BHCG levels.", "3": "Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete.", "4": "It is necessary to carry out periodic controls since 40% of the cases will develop a gestational trophoblastic neoplasia.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 233 ] ], "word_ranges": [ [ 0, 37 ] ], "text": "Gestational trophoblastic disease should be followed up (regardless of whether the evacuation has been complete or not) and the patient should be advised not to become pregnant again until at least 6 months with negative BHCG titers." }, "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 lues serology since it is most likely a Treponema pallidum infection.", "2": "A gynecological examination to rule out ovarian cancer.", "3": "By the clinical characteristics it seems to be normal lymph nodes and complementary explorations should not be done.", "4": "A Paul-Bunell test should be performed to rule out infectious mononucleosis.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 328 ] ], "word_ranges": [ [ 0, 58 ] ], "text": "The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms. In this case, they are very nonspecific nodes, without signs of malignancy (mobile, soft, not painful) that do not lead us to suspect neoplastic infiltration and the lack of other clinical signs also leads us to rule out the presence of STD." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Low adherence to treatment is associated with an increased risk of fracture.", "2": "Bone remodeling markers may be useful for early monitoring of response to treatment.", "3": "Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly.", "4": "Increasing dietary calcium or taking calcium supplements alone does not protect against the occurrence of fractures.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 201, 334 ] ], "word_ranges": [ [ 28, 50 ] ], "text": "In osteoporosis, one of the main risks associated with increased fracture risk is low adherence to treatment, so answer 1 is correct." }, "2": { "exist": true, "char_ranges": [ [ 335, 520 ] ], "word_ranges": [ [ 50, 80 ] ], "text": "Answer 2 is found in the SER guidelines, which confirm that some studies conclude that bone remodeling markers can be useful for early monitoring of adherence and response to treatment." }, "3": { "exist": true, "char_ranges": [ [ 831, 1114 ] ], "word_ranges": [ [ 127, 164 ] ], "text": "Patients on pharmacological treatment for OP should use calcium and vitamin D supplements because practically all clinical trials that have demonstrated efficacy of antiosteoporotic drugs routinely include calcium supplements and cholecalciferol (vitamin D3), but not in monotherapy." }, "4": { "exist": true, "char_ranges": [ [ 521, 770 ] ], "word_ranges": [ [ 80, 117 ] ], "text": "Answer 4 is correct because again in the SER 2019 guidelines they quote: \"The current scientific evidence allows us to affirm that neither increasing dietary calcium nor taking calcium supplements alone protects against the appearance of fractures\"." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Ibuprofen.", "2": "Oxycodone.", "3": "Duloxetine.", "4": "Paracetamol.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 12, 160 ] ], "word_ranges": [ [ 1, 24 ] ], "text": "the clinical picture described is of diabetic neuropathy. Of the drugs proposed, the first choice would be a dual antidepressant such as duloxetine." }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Digoxin.", "2": "Carvedilol.", "3": "Acenocoumarol.", "4": "Enalapril.", "5": "Ibuprofen." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 130 ] ], "word_ranges": [ [ 0, 21 ] ], "text": "Digoxin is useful as a symptomatic treatment (it is a positive inotropic) in heart failure, although it does not improve survival." }, "2": { "exist": true, "char_ranges": [ [ 131, 267 ] ], "word_ranges": [ [ 21, 41 ] ], "text": "Carvedilol is a very well tolerated aß-blocker (due to its anti-a1 effect) that is associated with symptomatic and survival improvement." }, "3": { "exist": true, "char_ranges": [ [ 268, 374 ] ], "word_ranges": [ [ 41, 56 ] ], "text": "Acenocoumarol (Sintrom) would be indicated in this patient with chronic AF to avoid thromboembolic events." }, "4": { "exist": true, "char_ranges": [ [ 375, 602 ] ], "word_ranges": [ [ 56, 86 ] ], "text": "Enalapril and ACE inhibitors in general, by inhibiting the renin-angiotensin-aldosterone axis, suppress part of the neurohormonal effects that occur in heart failure; they improve survival in patients with systolic dysfunction." }, "5": { "exist": true, "char_ranges": [ [ 603, 750 ] ], "word_ranges": [ [ 86, 107 ] ], "text": "Ibuprofen and NSAIDs in general are contraindicated in patients with heart failure because they inhibit prostaglandin synthesis at the renal level," } }

{ "1": "Parvovirus B19.", "2": "Herpes virus type 6.", "3": "Coxackie A16 virus.", "4": "Primoinfection by Epstein-Barr virus.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 300, 456 ] ], "word_ranges": [ [ 50, 75 ] ], "text": "Parvovirus B19 is the cause of erythema infectiosum or \"fifth disease\", whose characteristic rash is on the cheeks, giving the appearance of a slapped face." }, "2": { "exist": true, "char_ranges": [ [ 92, 299 ] ], "word_ranges": [ [ 14, 50 ] ], "text": "By the picture of high fever of several days that suddenly subsides with the appearance of a rash, we have a sudden exanthem, caused by Herpes virus type 6 (remember the mnemonic rule of \"sudden Hexanthem\")." }, "3": { "exist": true, "char_ranges": [ [ 457, 635 ] ], "word_ranges": [ [ 75, 101 ] ], "text": "Coxackie A16 causes herpangina and also boca-mano-pie disease, which presents an initially macular rash, which does not respect palms or soles and evolves into bursting vesicles." }, "4": { "exist": true, "char_ranges": [ [ 636, 792 ] ], "word_ranges": [ [ 101, 123 ] ], "text": "Finally, EBV infection produces a mononucleosis syndrome with high fever lasting several days, with pharyngeal erythema and grayish exudates on the tonsils." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Arteriovenous malformation masked by acute hematoma.", "2": "Chronic arterial hypertension.", "3": "Isolated vasculitis of the nervous system.", "4": "Brain tumor.", "5": "Cerebral amyloid angiopathy (congophilic angiopathy)." }

{ "1": { "exist": true, "char_ranges": [ [ 606, 682 ] ], "word_ranges": [ [ 94, 107 ] ], "text": "Answer 1, a malformation is typical of young patients, rare in older people." }, "2": { "exist": true, "char_ranges": [ [ 299, 444 ] ], "word_ranges": [ [ 46, 67 ] ], "text": "the most frequent localizations are: putamen, thalamus, pons and cerebellum. Therefore, most of the time these are deep hemorrhages (CTO Manual)." }, "3": { "exist": true, "char_ranges": [ [ 956, 1049 ] ], "word_ranges": [ [ 156, 174 ] ], "text": "Answer 3 does not seem correct since vasculitis is a rare entity and more so in older people." }, "4": { "exist": true, "char_ranges": [ [ 769, 955 ] ], "word_ranges": [ [ 120, 156 ] ], "text": "Answer 4, a brain tumor, does not seem likely since the mass is not seen on CT, and as in the previous case, it is more difficult not to find such a lesion after contrast administration." }, "5": { "exist": true, "char_ranges": [ [ 0, 230 ] ], "word_ranges": [ [ 0, 34 ] ], "text": "Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case). They often appear in association with Alzheimer's disease (CTO Manual)." } }

{ "1": "Inquire: ask about risk factors and risk behaviors (ask the patient if she smokes).", "2": "Increase: increase risk perception to facilitate change (explain the consequences of smoking).", "3": "Advise: give clear, specific and personalized advice (advise smoking cessation).", "4": "Agree: collaboratively agree on goals for change (assess readiness to make a quit attempt).", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 291 ] ], "word_ranges": [ [ 0, 47 ] ], "text": "The 5A summarizes the activities that should be performed by healthcare personnel during the brief intervention with the patient to stop smoking and are: find out, advise, analyze, help, accompany or agree. Therefore, the one that is not included in the strategy would be option 2: increase." }, "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": "The third noise coincides with the rapid filling phase of the ventricular diastole of the cardiac cycle.", "2": "The most likely diagnosis is heart failure.", "3": "The holosystolic murmur may correspond to mitral insufficiency.", "4": "The fourth noise usually appears when there is a certain degree of valvular stenosis.", "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, 85 ] ], "word_ranges": [ [ 0, 14 ] ], "text": "The fourth noise usually appears when there is a certain degree of valvular stenosis." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Dislocation fracture of proximal humerus.", "2": "Elbow dislocation.", "3": "Diaphyseal fracture of the humerus associated with double forearm fracture.", "4": "Diaphyseal fracture of humerus with radial nerve injury.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 231, 298 ] ], "word_ranges": [ [ 41, 53 ] ], "text": "Option 1 does not explain the involvement of the wrist and fingers." }, "2": { "exist": true, "char_ranges": [ [ 299, 435 ] ], "word_ranges": [ [ 53, 76 ] ], "text": "The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm." }, "3": { "exist": true, "char_ranges": [ [ 622, 796 ] ], "word_ranges": [ [ 103, 128 ] ], "text": "Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow, and there is no data to suggest double forearm fracture." }, "4": { "exist": true, "char_ranges": [ [ 58, 230 ] ], "word_ranges": [ [ 10, 41 ] ], "text": "after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers. The only option that includes all the data is 4." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Add magnesium sulfate.", "2": "Increase the dose of prednisone to 30 mg/day.", "3": "Add omalizumab.", "4": "Nebulized treatment at home.", "5": "Switch to a combination with high doses of budesonide and formoterol." }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "3": { "exist": true, "char_ranges": [ [ 0, 94 ] ], "word_ranges": [ [ 0, 17 ] ], "text": "The indication of omalizumab in a patient such as the one referred to is a correct indication," }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Intravenous perfusion of dobutamine.", "2": "Serum lactate measurement.", "3": "Extraction of blood cultures.", "4": "Fluid administration.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 0, 226 ] ], "word_ranges": [ [ 0, 36 ] ], "text": "Among the options presented, the only measure not included in the Surviving Sepsis Campaign guidelines on the management of sepsis and septic shock (like the patient we are dealing with) is the administration of IV dobutamine." }, "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": "It is indicated after studying the Consultant's genotype and only if it is heterozygous.", "2": "This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation.", "3": "It may be indicated in the next pregnancy, after studying the genotype of the first child and detecting the mutation in it.", "4": "SCA3 ataxia is recessively inherited, so there is no appreciable risk of disease transmission and PND is not indicated.", "5": "This is indicated regardless of the Consultant's genotype, since SCA3 ataxia is maternally inherited (transmitted by women)." }

{ "1": { "exist": true, "char_ranges": [ [ 372, 777 ] ], "word_ranges": [ [ 55, 130 ] ], "text": "In this clinical case, the one who has the disease and has the mutated gene in heterozygosis is the brother (26 years old) of the pregnant woman. I think that before doing the chorion biopsy, the pregnant woman should be tested to know her ATXN3 gene status. She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms." }, "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": "Administer hepatitis B vaccine at birth. Artificial feeding.", "2": "Vaccination and immunoglobulins should be administered at birth. Breastfeeding from one month onwards.", "3": "Immunoglobulins at birth and artificial breastfeeding.", "4": "Vaccination and immunoglobulins at birth. Maternal feeding.", "5": "Artificial feeding and isolation for 4 weeks." }

{ "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": [ [ 25, 186 ] ], "word_ranges": [ [ 5, 30 ] ], "text": "Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Orlistat.", "2": "Topiramate.", "3": "Sibutramine.", "4": "Liraglutide.", "5": "Metformin." }

{ "1": { "exist": true, "char_ranges": [ [ 0, 102 ] ], "word_ranges": [ [ 0, 17 ] ], "text": "Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity." }, "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": "Acute infection.", "2": "Chronic infection.", "3": "Vaccinated patient.", "4": "Asymptomatic carrier.", "5": null }

{ "1": { "exist": true, "char_ranges": [ [ 81, 260 ] ], "word_ranges": [ [ 14, 50 ] ], "text": "Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type (only for this last data, we would have to discard it in a direct way)." }, "2": { "exist": true, "char_ranges": [ [ 261, 329 ] ], "word_ranges": [ [ 50, 61 ] ], "text": "Option 2: the correct one. It complies with all the characteristics." }, "3": { "exist": true, "char_ranges": [ [ 330, 391 ] ], "word_ranges": [ [ 61, 72 ] ], "text": "Option 3: The vaccinated patient cannot have DNA of the virus" }, "4": { "exist": true, "char_ranges": [ [ 475, 633 ] ], "word_ranges": [ [ 86, 112 ] ], "text": "Option 4: The option that could offer more doubts. In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA." }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }

{ "1": "Autoimmune hemolytic anemia.", "2": "Thrombotic thrombocytopenic purpura.", "3": "Evans syndrome (hemolytic anemia and immune thrombopenia).", "4": "Idiopathic immune thrombocytopenia.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 139, 603 ] ], "word_ranges": [ [ 21, 95 ] ], "text": "The clinical case is fairly typical. A young person with fever and neurological symptoms that make him go to the emergency department (he is on the run). Laboratory tests show anemia with evidence of hemolysis (increased LDH and retis, presence of schistocytes in peripheral blood) and severe thrombopenia. In addition, coagulation is normal. To distinguish it from the rest of things (although you should not hesitate...) it tells you that the coombs is negative." }, "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": "Autoimmune hemolytic anemia.", "2": "Thrombotic thrombocytopenic purpura.", "3": "Evans syndrome (hemolytic anemia and immune thrombopenia).", "4": "Idiopathic immune thrombocytopenia.", "5": null }

{ "1": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "2": { "exist": true, "char_ranges": [ [ 0, 231 ] ], "word_ranges": [ [ 0, 27 ] ], "text": "The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP): 1. Neurological alteration. 2. Febrile syndrome (fever). 3. Coombs negative migroangiopathic hemolytic anemia (presence of schistocytes). 4. Thrombopenia." }, "3": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "4": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" }, "5": { "exist": false, "char_ranges": [], "word_ranges": [], "text": "" } }