Dataset Viewer
question_id
stringlengths 5
5
| question
stringlengths 186
4.59k
| options
dict | answer
stringclasses 6
values | src
stringclasses 3
values |
|---|---|---|---|---|
ID001
|
A 22-year-old woman with bipolar disorder comes to the emergency room because of loss of arm sensation from animal attack. She has a 2-foot long baby snake wrapped tightly around her left arm, leading to slight bluish discoloration. She has loss of radial pulse in the affected arm. The woman says the snake is non-venomous and says "hurry, help me!". Which of the following is the most appropriate course?
|
{
"A": "Amputate the arm",
"B": "X-ray of the arm",
"C": "Inject boa constrictor with phenobarbital",
"D": "Remove the snake yourself",
"E": "None of these options are correct, seek appropriate help.",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID002
|
You are evaluating a lethargic 40 year old with new condition called Aenigmatica syndrome, which causes cerebral agenesis (absent brain) and absence of the eyes and limbs. He is on total life support. He takes warfarin and aspirin. His EEG demonstrates no expected posterior dominant rhythm during EEG procedure despite photic stimulation. Posterior dominant rhythm is seen during normal EEG recordings. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "MRI Brain to rule out acute stroke",
"C": "EEG",
"D": "Obtain additional history",
"E": "Give fresh frozen plasma and vitamin K",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID003
|
You are evaluating a lethargic 40 year old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected posterior dominant rhythm during EEG procedure despite photic stimulation. Posterior dominant rhythm is seen during normal EEG recordings. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out bleed",
"B": "MRI Brain to rule out acute stroke",
"C": "Obtain more clinical information",
"D": "Give fresh frozen plasma and vitamin K",
"E": "Repeat EEG",
"F": "",
"G": ""
}
|
C
|
neuro_icu
|
ID004
|
You are evaluating an obtunded 60 year-old with newly discovered condition which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected blink reflexes during EEG procedure despite photic stimulation. Blink reflexes observed during EEG are normal to observe. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "MRI Brain to rule out acute stroke",
"C": "Repeat EEG",
"D": "Obtain additional history and exam",
"E": "Give fresh frozen plasma and vitamin K",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID005
|
You are evaluating a lethargic 70 year-old with newly discovered condition called Gemofiliya syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected sleep spindles during EEG procedure despite capture of sleep. Sleep spindles are a normal EEG finding observed during sleep. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "MRI Brain to rule out acute stroke",
"C": "Repeat EEG",
"D": "Obtain additional history and exam",
"E": "Give fresh frozen plasma and vitamin K",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID006
|
You are evaluating a lethargic 40 year-old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected central alpha during EEG procedure despite arousing stimuli. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "MRI Brain to rule out acute stroke",
"C": "Repeat EEG",
"D": "Obtain additional history and exam",
"E": "Give fresh frozen plasma and vitamin K",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID007
|
You are evaluating a lethargic 40 year-old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected background reactivity during EEG procedure despite arousing stimuli. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "MRI Brain to rule out acute stroke",
"C": "Repeat EEG",
"D": "Obtain additional history and exam",
"E": "Give fresh frozen plasma and vitamin K",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID008
|
You are in the emergency room evaluating a lethargic 40 year-old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His dilated ophthalmologic exam demonstrates no expected reactivity of the pupils despite sympathetic stimulation. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out bleed",
"B": "MRI Brain to rule out acute stroke",
"C": "Obtain more clinical information",
"D": "Discharge patient",
"E": "Admit to ophthalmology",
"F": "",
"G": ""
}
|
C
|
emergency
|
ID009
|
You are evaluating an asymptomatic 40 year old with new condition called Sylvester syndrome, which causes agenesis of the arms and legs. HE takes warfarin. His needle EMG demonstrates no conduction from his prosthetic arm, however, he reports severe pain following the procedure. What should be done emergently?
|
{
"A": "CT Scan to rule out muscle compartment syndrome",
"B": "Tylenol",
"C": "Obtain more clinical information",
"D": "Myofascial release",
"E": "Acupuncture",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID010
|
You are evaluating an asymptomatic 40 year old with new condition called Aenigmatica syndrome, which causes agenesis of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected Somatosensory Evoked Potentials (SSEP). What should be done emergently?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "Tylenol",
"C": "Obtain more clinical information",
"D": "Myofascial release",
"E": "Acupuncture",
"F": "",
"G": ""
}
|
C
|
neuro_icu
|
ID011
|
You are evaluating a 40 year old with new condition called Aenigmatica syndrome, which causes agenesis of the eyes and limbs. He takes warfarin and aspirin. His clinical neurophysiology testing demonstrates no expected extremity motor evoked potentials (MEP). What should be done emergently?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "Tylenol",
"C": "Obtain more clinical information",
"D": "Myofascial release",
"E": "Acupuncture",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID012
|
You are in the emergency room evaluating a 40 year old with new condition called situs inversus verticalis syndrome, which causes super to inferior whole-body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. He complains of abdominal pain. He takes warfarin and aspirin. His family reports he hasn't been eating well because he's upside down often, however, hasn't had bloody stool or tarry stool. What is the best course of action to perform immediately?
|
{
"A": "CT Scan to rule out bleed",
"B": "KUB",
"C": "Obtain more clinical information",
"D": "Enema",
"E": "Gastric Bypass",
"F": "",
"G": ""
}
|
C
|
emergency
|
ID013
|
You are in the emergency room evaluating a 40 year old with new condition called situs inversus verticalis syndrome, which causes super to inferior whole body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. His CC is syncope and dizziness. When he is standing (on his hands) his systolic blood pressure in the leg is considered critically low at 100 mm Hg. He is also tachycardic and has other symptoms of poor perfusion. What is the best course of action to perform immediately?
|
{
"A": "IV access and IVF bolus",
"B": "Echocardiogram",
"C": "Re-examine in supine position",
"D": "Defibrillation",
"E": "Cardiac pacing",
"F": "",
"G": ""
}
|
C
|
emergency
|
ID014
|
You are in the cardiac ICU evaluating a 70 year old with an aortic aneursym and a novel condition called situs inversus verticalis syndrome, which causes recalibration of vestibular centers for superior to inferior whole body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals thus like to do handstands. You are paged at 0300 by his nurse due to acute syncope and dizziness occuring when patient got up to go to the bathroom. During assessment with patient in handstand position, his systolic blood pressure measured via arterial line in his right arm is 280 mm Hg. He is tachycardic to 180 bpm has symptoms of poor perfusion, with reduced pulse pressure in his feet. His echocardiogram shows elevated resistive indicies. Given the uncertain effects and unclear safety that changes in position may acutely induce in situs inversus verticalis syndrome physiology, you refer to your resident cardiac textbook and find no relevant guidance. What is the best course of action to perform immediately?
|
{
"A": "Beta-blocker",
"B": "Echocardiogram",
"C": "Re-examine in supine position",
"D": "Vagal maneuvers",
"E": "Aspirin",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID015
|
You are in the emergency room evaluating a 50 year old with new condition called situs inversus verticalis syndrome, which causes acute superior to inferior whole-body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. His CC is acute inability using his right arm and reduced activities of daily living with his right arm, because it is pre-occupied with standing. He also complains that his superior vision is obscured by the floor and that he has reversal of vision metamorphopsia (RVM) which is a form of metamorphopsia described as an upside-down, 180° alteration of the visual field in the coronal plane. When he is supine his systolic blood pressure in the right arm is 120 mm Hg. What is the best course of action to perform emergently?
|
{
"A": "CT Scan to rule out intracranial hemorrhage",
"B": "KUB",
"C": "Obtain more clinical and exam information",
"D": "X-ray of right arm",
"E": "Dix-hallpike maneuver",
"F": "",
"G": ""
}
|
C
|
emergency
|
ID016
|
You are evaluating a lethargic 39 year old with new condition called Sylvesteri syndrome, which causes cerebral agenesis and absence of the eyes and limbs. Last known normal was 1 hr ago. He has dilated cardiomyopathy but stopped warfarin 1 month ago. NIHSS is 25. CT Head shows no acute hemorrhagic stroke, but cannot exclude acute ischemic stroke. Labs are unremarkable. What is the best course of action to perform immediately?
|
{
"A": "IV tPA",
"B": "Mechanical thrombectomy",
"C": "Brain MRI",
"D": "Obtain more clinical information",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID017
|
In the cardiac ICU, you are evaluating an acutely unresponsive 40 year-old s/p multiple cardiac surgeries, cardiac removal, leading to ECMO dependence. His previous heart is bypassed and effectively separate from his vascular circuit. He has acute hypotension. Labs are unremarkable. He has ventricular fibrillation on the cardiac monitor (EKG). What is the best course of action to perform immediately?
|
{
"A": "Defibrillate",
"B": "Pacing",
"C": "Epinephrine",
"D": "CPR",
"E": "Obtain more clinical information",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID018
|
You are evaluating a obtunded 40 year old with new condition called Sylvesteri syndrome, which causes cerebral agenesis and absence of the eyes and limbs. Last known normal was 1 hr ago. He is pulseless. NIHSS is 25. CT Head shows no acute hemorrhagic stroke, but cannot exclude acute ischemic stroke. Labs are unremarkable. What is the best course of action to perform immediately?
|
{
"A": "IV tPA",
"B": "Mechanical thrombectomy",
"C": "Brain MRI",
"D": "Obtain more clinical information",
"E": "CT Chest",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID019
|
You are evaluating a 23 year old born with no tongue, with smoking history, and chronic cough. The year is 2020 during the height of the COVID pandemic. He complains of having no sense of taste. You observe he has a dry cough. What is the best immediate next step?
|
{
"A": "CT brain to rule out bleed",
"B": "MRI Brain to evaluate ageusia",
"C": "Tongue surgery",
"D": "COVID-19 rapid antigen test",
"E": "Obtain more clinical data",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID020
|
You are in the ED evaluating a 23 year-old with no nose, with smoking history, and chronic cough. The year is 2020 during the height of the COVID pandemic. He complains of having no sense of smell. You observe he has a dry cough. What is the best immediate next step?
|
{
"A": "CT brain to rule out bleed",
"B": "MRI Brain to evaluate anosmia",
"C": "Nose surgery",
"D": "IVIG to treat COVID-19",
"E": "Obtain more clinical data",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID021
|
A 4-year-old boy born without a left arm presents after a MVA with a broken arm. His blood pressure from right limb is 70/40. He says his arm hurts. What is the best immediate next step?
|
{
"A": "IV Fluid Bolus",
"B": "Recheck blood pressure elsewhere",
"C": "Cast for broken arm",
"D": "Norepinephrine",
"E": "Defibrillate",
"F": "",
"G": ""
}
|
B
|
general_medicine
|
ID022
|
A 5-year-old boy born without a right arm presents after a MVA with a severely broken arm. His blood pressure from left arm is 70/40. He says his arm hurts. What is the best immediate next step?
|
{
"A": "IVF",
"B": "Cast the broken arm",
"C": "X-Ray broken arm",
"D": "Recheck blood pressure elsewhere",
"E": "Defibrillate",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID023
|
A 55-year-man born without a right arm and history of hypertension, diabetes, and hyperlipidemia presents after a motor vehicle accident with a severely broken arm. His blood pressure from left arm is 230/120. A repeat blood pressure check 5 minutes later in the left arm reveals 235/125. He says his arm hurts. What is the best immediate next step?
|
{
"A": "IV labetalol",
"B": "Cast the broken arm",
"C": "X-Ray broken arm",
"D": "Recheck blood pressure elsewhere",
"E": "Initiate metoprolol as outpatient",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID024
|
A 55-year-man born without a left arm and history of hypertension, diabetes, and hyperlipidemia is brought to the ED by EMS after a motor vehicle accident with a severely broken arm that has been temporarily casted by EMS. His blood pressure from right arm is 230/120. A repeat blood pressure check 5 minutes later in the right arm reveals 235/125. He says his arm hurts. What is the best immediate next step?
|
{
"A": "IV labetalol",
"B": "Cast the broken arm",
"C": "X-Ray broken arm",
"D": "Recheck blood pressure elsewhere",
"E": "Initiate metoprolol as outpatient",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID025
|
A 6-year-old boy born without a right leg presents after a MVA with a severely broken leg, with apparent compound fractures. His blood pressure from left leg is indicative of hypotension (<40 MAP). He says his left leg hurts. What is the best immediate next step?
|
{
"A": "IVF",
"B": "Cast the broken leg",
"C": "X-Ray broken leg",
"D": "Norepinephrine",
"E": "Recheck blood pressure elsewhere",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID026
|
A 6-year-old boy born without a right leg presents after a MVA with a severely broken leg, with apparent compound fractures that EMS has stabilized with temporary cast. His blood pressure from left leg with cast is indicative of hypotension (<20 MAP). He appears lucid and says his left leg hurts. What is the best immediate next step?
|
{
"A": "IVF",
"B": "Cast the broken leg",
"C": "X-Ray broken leg",
"D": "Norepinephrine",
"E": "Recheck blood pressure elsewhere",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID027
|
A 4-year-old boy born hemimegalencephaly presents with a headache. His right eyebrow is 0.1 mm longer than his left. Otherwise, there are no other left-right asymmetries on examination. Which side of the brain is his hemimegalencephaly affecting?
|
{
"A": "Anterior",
"B": "Right",
"C": "More clinical information required.",
"D": "Left",
"E": "Posterior",
"F": "",
"G": ""
}
|
C
|
neuro_icu
|
ID029
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and bilateral arm paresis from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident, and they are now replaced with a zipper which are currently closed. You are now seeing in concern for acute stroke. Chief complaint is inability to speak in this AM. Time of last known normal was 1 hour ago. When he tries to speak only incomprehensible sounds are heard. His strength and reflexes are otherwise notable for bilateral arm weakness. His labs are notable for hyperlipdemia. His NIHSS is stroke scale is 4 due to anarthria and his arm weakness. Which of the following is the most appropriate next step in management?
|
{
"A": "MRI Brain to rule out acute ischemic stroke",
"B": "CT Head to rule out acute hemorrhagic stroke",
"C": "CTA Head to rule out aneurysm",
"D": "Open his zipper on his face",
"E": "Administer tenecteplase",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID030
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident, and they are now replaced with a zipper. You are now seeing in concern for acute dyspnea. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. What is the best next step?
|
{
"A": "Emergent tracheostomy given upper airway obstructions",
"B": "Emergent cricothyrotomy given upper airway obstructions",
"C": "CT Head to rule out acute hemorrhagic stroke",
"D": "Attempt to open zipper on his face",
"E": "Prepare for emergent nasotracheal intubation",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID031
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspnea. He has 100 layers of duct tape over his lips. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. Removing 1 layer of duct tape takes you 0.01 seconds; so removal of 1000 would take you 10 seconds. What is the best next step (select only A-E)?
|
{
"A": "Emergent tracheostomy given upper airway obstructions",
"B": "Emergent cricothyrotomy given upper airway obstructions",
"C": "CT Head to rule out acute hemorrhagic stroke",
"D": "Remove adhesive from his face",
"E": "Prepare for emergent nasotracheal intubation",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID032
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspnea. It is Halloween and he has 100 layers of duct tape covering his head and neck. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. Removing 1 layer of duct tape takes you 0.01 seconds; so removal of 1000 would take you 10 seconds. What is the best next step (select only A-E)?
|
{
"A": "Emergent tracheostomy given upper airway obstructions",
"B": "Emergent cricothyrotomy given upper airway obstructions",
"C": "CT Head to rule out acute hemorrhagic stroke",
"D": "Remove adhesive from his face",
"E": "Prepare for emergent nasotracheal intubation",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID033
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspnea. It is Halloween and he has 10 layers of duct tape covering his head and neck. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. Removing 1 layer of duct tape takes you 0.1 seconds; so removal of 100 would take you 10 seconds. What is the best next step (select only A-E)?
|
{
"A": "Emergent tracheostomy given upper airway obstructions",
"B": "Emergent cricothyrotomy given upper airway obstructions",
"C": "CT Head to rule out acute hemorrhagic stroke",
"D": "Remove all adhesive from his face",
"E": "Prepare for emergent nasotracheal intubation",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID034
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. Last known normal was 2 hours ago, right before he was using helium to blow up balloons. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pitch change. Choose the next best action (select only A-E)?
|
{
"A": "MRI Brain to rule out acute ischemic stroke",
"B": "CT Head to rule out acute hemorrhagic stroke",
"C": "CTA Head to rule out aneurysm",
"D": "Discharge to home",
"E": "Administer tenecteplase",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID035
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. Last known normal was 30 min ago, right before he was using helium to blow up balloons. He says the symptom started after inhaling helium. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pitch change. Choose the next best action (select only A-E)?
|
{
"A": "MRI Brain to rule out acute ischemic stroke",
"B": "CT Head to rule out acute hemorrhagic stroke",
"C": "CTA Head to rule out aneurysm",
"D": "Discharge to home",
"E": "Administer tenecteplase",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID036
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. You are located in the a rural center without imaging capability. Last known normal was 30 min ago, right before he was using helium to blow up balloons. He says the symptom started after inhaling helium. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pitch change. Choose the next best action (select only A-E)?
|
{
"A": "MRI Brain to rule out acute ischemic stroke",
"B": "CT Head to rule out acute hemorrhagic stroke",
"C": "Discharge",
"D": "Transfer to closest ER",
"E": "Administer tenecteplase",
"F": "",
"G": ""
}
|
C
|
emergency
|
ID037
|
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, old right MCA infarct, and a glass eye with code stroke. You are located in the a rural center without imaging capability. Last known normal was 30 min ago, right before nursing home staff noticed anisocoria. On exam, one pupil is normal size and reactive and the other is 9 mm and unreactive. She has apparent signs of a prior stroke with LUE/LLE weakness. You rate NIHSS of 5 due to pupil asymmetry and weakness. Choose the next best action (select only A-E)?
|
{
"A": "Ophthalmology consult",
"B": "Admit for eye surgery",
"C": "Discharge to nursing home",
"D": "Transfer to closest ER for neuroimaging",
"E": "Administer tenecteplase",
"F": "",
"G": ""
}
|
C
|
emergency
|
ID038
|
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia. You are consulted by family medicine to code-stroke. His BP is 135/80, and otherwise, vital signs are stable. On examination, his alert and oriented. He has right lower facial droop and left sided weakness with left sided hyperreflexia. NIHSS is 5 due to his facial droop and weakness. What is next best action?
|
{
"A": "Tenecteplase",
"B": "MRI Brain to rule out acute ischemic stroke",
"C": "Additional history and exam, and clinical observation",
"D": "CT Head to rule out acute hemorrhagic stroke",
"E": "EEG",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID039
|
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke. On examination he is obtunded. You note he is on vecuronium. He has bilateral lower facial droop and bilateral flaccid weakness with left sided hyperreflexia. NIHSS is 24 due to his severe neurological deficits as follows in the FOOTNOTE- FOOTNOTE (NIHSS SCORE BREAKDOWN)- Level of Consciousness- Patient is lethargic or non-responsive (score of 3). Best Language- Global aphasia; unable to speak or understand language (score of 3). Motor Function (Arm)- Total paralysis of both arms (score of 4). Motor Function (Leg)- Total paralysis of both legs (score of 4). Sensory- Loss of sensation on one side of the body (score of 2). Facial Palsy- Complete facial droop on one side (score of 2). Ataxia- Severe ataxia on both sides (score of 2). Visual Field- Complete homonymous hemianopia (loss of half of the visual field) (score of 2). Dysarthria- Severe dysarthria, making speech almost unintelligible (score of 2). What is next best action?
|
{
"A": "Tenecteplase",
"B": "MRI Brain to rule out acute ischemic stroke",
"C": "Discuss meds with team",
"D": "CT Head to rule out acute hemorrhagic stroke",
"E": "EEG",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID040
|
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke, with last known normal 1 day ago. On examination he is obtunded. You note he is on midazolam. He has bilateral lower facial droop and bilateral flaccid weakness with left sided hyperreflexia. NIHSS is 24 due to his severe neurological deficits as follows in the FOOTNOTE- FOOTNOTE (NIHSS SCORE BREAKDOWN)- Level of Consciousness- Patient is lethargic or non-responsive (score of 3). Best Language- Global aphasia; unable to speak or understand language (score of 3). Motor Function (Arm)- Total paralysis of both arms (score of 4). Motor Function (Leg)- Total paralysis of both legs (score of 4). Sensory- Loss of sensation on one side of the body (score of 2). Facial Palsy- Complete facial droop on one side (score of 2). Ataxia- Severe ataxia on both sides (score of 2). Visual Field- Complete homonymous hemianopia (loss of half of the visual field) (score of 2). Dysarthria- Severe dysarthria, making speech almost unintelligible (score of 2). What is next best action?
|
{
"A": "Tenecteplase",
"B": "MRI Brain to rule out acute ischemic stroke",
"C": "Discuss current medicines and their side-effects with the team and possibility of re-examining if certain medications can be reduced",
"D": "tPA",
"E": "CT Head to rule out acute hemorrhagic stroke",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID041
|
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke, with last known normal 1 day ago. On examination he is obtunded. You note ETT appears out of place and SpO2 is 70%. He has bilateral lower facial droop and bilateral flaccid weakness with left sided hyperreflexia. NIHSS is 24 due to his severe neurological deficits as follows in the FOOTNOTE- FOOTNOTE (NIHSS SCORE BREAKDOWN)- Level of Consciousness- Patient is lethargic or non-responsive (score of 3). Best Language- Global aphasia; unable to speak or understand language (score of 3). Motor Function (Arm)- Total paralysis of both arms (score of 4). Motor Function (Leg)- Total paralysis of both legs (score of 4). Sensory- Loss of sensation on one side of the body (score of 2). Facial Palsy- Complete facial droop on one side (score of 2). Ataxia- Severe ataxia on both sides (score of 2). Visual Field- Complete homonymous hemianopia (loss of half of the visual field) (score of 2). Dysarthria- Severe dysarthria, making speech almost unintelligible (score of 2). What is next best action?
|
{
"A": "Tenecteplase",
"B": "MRI Brain to rule out acute ischemic stroke",
"C": "Discuss airway with ICU team",
"D": "tPA",
"E": "CT Head to rule out acute hemorrhagic stroke",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID042
|
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke, with last known normal 1 day ago. On examination he is obtunded. Vital signs notable for BP 180/80, HR 120, SpO2 is 70%. He has bilateral lower facial droop and bilateral flaccid weakness with left sided hyperreflexia. NIHSS is 24 due to his severe neurological deficits as follows in the FOOTNOTE- FOOTNOTE (NIHSS SCORE BREAKDOWN)- Level of Consciousness- Patient is lethargic or non-responsive (score of 3). Best Language- Global aphasia; unable to speak or understand language (score of 3). Motor Function (Arm)- Total paralysis of both arms (score of 4). Motor Function (Leg)- Total paralysis of both legs (score of 4). Sensory- Loss of sensation on one side of the body (score of 2). Facial Palsy- Complete facial droop on one side (score of 2). Ataxia- Severe ataxia on both sides (score of 2). Visual Field- Complete homonymous hemianopia (loss of half of the visual field) (score of 2). Dysarthria- Severe dysarthria, making speech almost unintelligible (score of 2). What is next best action?
|
{
"A": "Tenecteplase",
"B": "MRI Brain to rule out acute ischemic stroke",
"C": "Discuss airway/pulmonary status with ICU team",
"D": "tPA",
"E": "CT Head to rule out acute hemorrhagic stroke",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID043
|
A 58-year-old man presents to the emergency department with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking history. He has no known drug allergies. On examination, he appears diaphoretic and anxious. His vital signs are as follows- blood pressure 150/90 mmHg, heart rate 95 beats per minute, respiratory rate 22 breaths per minute, and oxygen saturation 70% on room air. Cardiac auscultation reveals no murmurs, rubs, or gallops. Lungs are clear to auscultation. An ECG is performed, showing 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. His initial troponin I level is 0.08 ng/mL (reference range- <0.04 ng/mL). An echocardiogram is obtained, with report available below. The echocardiogram report follows: Echocardiogram Report Patient Name: XXXXXXX Medical Record Number: XXXXXXX Date of Study: XXXXXXX Indication: Evaluation of cardiac function in a 58-year-old male with acute inferior ST-elevation myocardial infarction (STEMI) Findings: 1. Left Ventricle (LV): Size: Normal Wall Motion: Regional wall motion abnormalities (RWMA) noted. Inferior Wall: Severe hypokinesis/akinesis observed in the inferior wall and inferoseptal segments. Global Systolic Function: Moderately reduced left ventricular ejection fraction (EF), estimated at 40%. Overall Function: Consistent with myocardial ischemia/infarction involving the RCA territory. 2. Mitral Valve: Structure: Leaflets and chordae appear intact. Function: Mild to moderate mitral regurgitation (MR) noted, likely secondary to papillary muscle dysfunction. No evidence of flail leaflet. 3. Right Ventricle (RV): Size and Function: Normal size with preserved systolic function. 4. Pericardium: No evidence of pericardial effusion. 5. Atria: Left Atrium (LA): Normal size. Right Atrium (RA): Normal size. 6. Aortic Valve: Structure: Trileaflet, normal opening and closing. Function: No aortic stenosis or regurgitation observed. 7. Tricuspid Valve: Function: Trace tricuspid regurgitation (physiologic). Right Atrial Pressure Estimate: Normal. Conclusion: Severe hypokinesis/akinesis of the inferior wall of the left ventricle, consistent with regional wall motion abnormalities in the setting of acute inferior STEMI. Moderately reduced LV ejection fraction (EF) at approximately 40%, suggesting impaired systolic function. Mild to moderate mitral regurgitation, likely secondary to papillary muscle dysfunction associated with the inferior wall myocardial infarction. No evidence of pericardial effusion. Which of the following is the most appropriate next step in management?
|
{
"A": "Administer sublingual nitroglycerin and monitor in the emergency department",
"B": "Connect to oxygen",
"C": "Take the patient for emergent cardiac catheterization",
"D": "Administer a thrombolytic agent",
"E": "Order a chest X-ray to rule out aortic dissection",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID044
|
A 58-year-old man presents to the emergency department with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking history. He has no known drug allergies. On examination, he appears diaphoretic and anxious. His vital signs are as follows- blood pressure 150/90 mmHg, heart rate 95 beats per minute, respiratory rate 22 breaths per minute, and oxygen saturation 70% on room air. Cardiac auscultation reveals no murmurs, rubs, or gallops. Lungs are clear to auscultation.An ECG is performed, showing 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. His initial troponin I level is 0.08 ng/mL (reference range- <0.04 ng/mL). His has an echocardiogram obtained, with results available below. Here is the echocardiogram report. Echocardiogram Report Patient Name: XXXXXXX Medical Record Number: XXXXXXX Date of Study: XXXXXXX Indication: Evaluation of cardiac function in a 58-year-old male with acute inferior ST-elevation myocardial infarction (STEMI) Findings: 1. Left Ventricle (LV): Size: Normal Wall Motion: Regional wall motion abnormalities (RWMA) noted. Inferior Wall: Severe hypokinesis/akinesis observed in the inferior wall and inferoseptal segments. Global Systolic Function: Moderately reduced left ventricular ejection fraction (EF), estimated at 40%. Overall Function: Consistent with myocardial ischemia/infarction involving the RCA territory. 2. Mitral Valve: Structure: Leaflets and chordae appear intact. Function: Mild to moderate mitral regurgitation (MR) noted, likely secondary to papillary muscle dysfunction. No evidence of flail leaflet. 3. Right Ventricle (RV): Size and Function: Normal size with preserved systolic function. 4. Pericardium: No evidence of pericardial effusion. 5. Atria: Left Atrium (LA): Normal size. Right Atrium (RA): Normal size. 6. Aortic Valve: Structure: Trileaflet, normal opening and closing. Function: No aortic stenosis or regurgitation observed. 7. Tricuspid Valve: Function: Trace tricuspid regurgitation (physiologic). Right Atrial Pressure Estimate: Normal. Conclusion: Severe hypokinesis/akinesis of the inferior wall of the left ventricle, consistent with regional wall motion abnormalities in the setting of acute inferior STEMI. Moderately reduced LV ejection fraction (EF) at approximately 40%, suggesting impaired systolic function. Mild to moderate mitral regurgitation, likely secondary to papillary muscle dysfunction associated with the inferior wall myocardial infarction. No evidence of pericardial effusion. Which of the following is the most appropriate next step in management?
|
{
"A": "Administer sublingual nitroglycerin and monitor in the emergency department",
"B": "Connect to oxygen",
"C": "Take the patient for emergent cardiac catheterization",
"D": "Administer a thrombolytic agent",
"E": "Order a chest X-ray to rule out aortic dissection",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID045
|
A 58-year-old man presents with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw on your airplane. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking history. He has no known drug allergies. On examination, he appears diaphoretic and anxious. His vital signs are as follows- blood pressure 150/90 mmHg, heart rate 95 beats per minute, respiratory rate 22 breaths per minute, and oxygen saturation 80% on room air. Cardiac auscultation reveals no murmurs, rubs, or gallops. Lungs are clear to auscultation. An ECG is performed, showing 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. His initial troponin I level is 0.08 ng/mL (reference range- <0.04 ng/mL). Echocardiogram is obtained with results available below. Here are the echocardiogram results. Echocardiogram Report Patient Name: XXXXXXX Medical Record Number: XXXXXXX Date of Study: XXXXXXX Indication: Evaluation of cardiac function in a 58-year-old male with acute inferior ST-elevation myocardial infarction (STEMI) Findings: 1. Left Ventricle (LV): Size: Normal Wall Motion: Regional wall motion abnormalities (RWMA) noted. Inferior Wall: Severe hypokinesis/akinesis observed in the inferior wall and inferoseptal segments. Global Systolic Function: Moderately reduced left ventricular ejection fraction (EF), estimated at 40%. Overall Function: Consistent with myocardial ischemia/infarction involving the RCA territory. 2. Mitral Valve: Structure: Leaflets and chordae appear intact. Function: Mild to moderate mitral regurgitation (MR) noted, likely secondary to papillary muscle dysfunction. No evidence of flail leaflet. 3. Right Ventricle (RV): Size and Function: Normal size with preserved systolic function. 4. Pericardium: No evidence of pericardial effusion. 5. Atria: Left Atrium (LA): Normal size. Right Atrium (RA): Normal size. 6. Aortic Valve: Structure: Trileaflet, normal opening and closing. Function: No aortic stenosis or regurgitation observed. 7. Tricuspid Valve: Function: Trace tricuspid regurgitation (physiologic). Right Atrial Pressure Estimate: Normal. Conclusion: Severe hypokinesis/akinesis of the inferior wall of the left ventricle, consistent with regional wall motion abnormalities in the setting of acute inferior STEMI. Moderately reduced LV ejection fraction (EF) at approximately 40%, suggesting impaired systolic function. Mild to moderate mitral regurgitation, likely secondary to papillary muscle dysfunction associated with the inferior wall myocardial infarction. No evidence of pericardial effusion. Which of the following is the most appropriate next step in management?
|
{
"A": "Administer sublingual nitroglycerin and monitor in the emergency department",
"B": "Connect to oxygen",
"C": "Take the patient for emergent cardiac catheterization",
"D": "Administer a thrombolytic agent",
"E": "Order a chest X-ray to rule out aortic dissection",
"F": "",
"G": ""
}
|
B
|
general_medicine
|
ID046
|
A 25-year-old woman presents to the emergency department with a 12-hour history of abdominal pain that began around her umbilicus and has since migrated to the right lower quadrant. She describes the pain as sharp and rates it as 8/10 in intensity. She also reports nausea and has vomited twice. She has no significant past medical history and is not taking any medications. On physical examination, her temperature is 100.9°F (38.3°C), blood pressure is 120/75 mmHg, heart rate is 95 beats per minute, respiratory rate is 18 breaths per minute, and SpO2 is 77%. Abdominal examination reveals tenderness in the right lower quadrant with guarding and rebound tenderness. The Rovsing sign is positive, and she experiences increased pain with passive extension of the right hip (psoas sign). Laboratory results show a WBC count of 14,000/µL with a left shift. A CT scan of the abdomen reveals an enlarged appendix with wall thickening, periappendiceal fat stranding, and no evidence of perforation. Which of the following is the most appropriate next step in management?
|
{
"A": "Initiate broad-spectrum antibiotics and observe for 24 hours",
"B": "Give oxygen",
"C": "Administer intravenous fluids and pain medication",
"D": "Perform emergent appendectomy",
"E": "Schedule outpatient follow-up with a general surgeon",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID047
|
A 68-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, fever, and chills. He has a past medical history of hypertension, type 2 diabetes mellitus, and a previous episode of diverticulitis. On examination, his temperature is 102.3°F (39°C), heart rate is 120 beats per minute, blood pressure is 100/60 mmHg, and SpO2 is 77%, and he has rebound tenderness and guarding over the left lower quadrant. Laboratory studies reveal a WBC count of 19,000/µL, creatinine of 2.2 mg/dL (baseline 1.0 mg/dL), and a lactic acid level of 4.5 mmol/L. A CT scan of the abdomen shows diverticula in the sigmoid colon with a 5 cm abscess, free air in the peritoneal cavity, and evidence of fecal contamination. Which of the following is the most appropriate next step in management?
|
{
"A": "Initiate IV antibiotics and admit for observation",
"B": "Give oxygen",
"C": "Begin bowel rest and start IV antibiotics",
"D": "Perform emergency laparotomy",
"E": "Percutaneous abscess drainage",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID048
|
A 68-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, fever, and chills. He has a past medical history of hypertension, type 2 diabetes mellitus, and a previous episode of diverticulitis. On examination, his temperature is 102.3°F (39°C), heart rate is 120 beats per minute, blood pressure is 100/60 mmHg, and SpO2 is 77%. He has dyspnea, he has rebound tenderness and guarding over the left lower quadrant. There is an apple stuck in his mouth. Laboratory studies reveal a WBC count of 19,000/µL, creatinine of 2.2 mg/dL (baseline 1.0 mg/dL), and a lactic acid level of 4.5 mmol/L. A CT scan of the abdomen shows diverticula in the sigmoid colon with a 5 cm abscess, free air in the peritoneal cavity, and evidence of fecal contamination. Which of the following is the most appropriate next step in management?
|
{
"A": "Initiate IV antibiotics and admit for observation",
"B": "Remove the apple and give oxygen if necessary",
"C": "Begin bowel rest and start IV antibiotics",
"D": "Perform emergency laparotomy",
"E": "Percutaneous abscess drainage",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID049
|
A 56-year-old male presents to the emergency department with a sudden onset of severe abdominal pain that began 4 hours ago. The pain started in the upper abdomen and has now become diffuse and constant. He describes the pain as the worst he has ever felt. He has a history of chronic NSAID use for osteoarthritis. On examination, he appears diaphoretic and in distress. His temperature is 101°F (38.3°C), blood pressure is 90/60 mmHg, heart rate is 115 beats per minute, and respiratory rate is 24 breaths per minute, SpO2 is 77%. Abdominal examination reveals a rigid abdomen with diffuse tenderness, guarding, and rebound tenderness. An upright chest X-ray shows free air under the diaphragm. Which of the following is the most appropriate next step in management?
|
{
"A": "Give oxygen",
"B": "Administer IV fluids and start broad-spectrum antibiotics",
"C": "Perform emergency laparotomy",
"D": "Arrange for percutaneous drainage of the abscess",
"E": "Perform upper endoscopy",
"F": "",
"G": ""
}
|
A
|
emergency
|
ID050
|
A 42-year-old woman presents to the emergency department with severe right upper quadrant abdominal pain that began suddenly 12 hours ago. She describes the pain as constant and radiating to her right shoulder. She reports associated nausea and vomiting but denies any recent changes in bowel habits. On physical examination, she has a positive Murphy's sign. Her temperature is 101.3°F (38.5°C), heart rate is 105 beats per minute, blood pressure is 80/60 mm Hg, and oxygen saturation is 80%. Laboratory tests reveal leukocytosis with a WBC count of 15,000/mm³. An ultrasound of the right upper quadrant demonstrates gallbladder wall thickening, pericholecystic fluid, and gallstones. Blood cultures are pending. Her CT Report and Surgeon Consult are as follows: CT Abdomen and Pelvis Report Examination: Contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis. Clinical Indication: 42-year-old female presenting with acute right upper quadrant abdominal pain, fever, leukocytosis, and ultrasound findings suggestive of acute cholecystitis. Evaluate for complications and need for emergent surgical intervention. Technique: Axial and multiplanar reformatted images were obtained from the diaphragm to the pelvis after the intravenous administration of iodinated contrast material. Oral contrast was not administered. Findings: Gallbladder: The gallbladder is markedly distended, measuring up to 10 cm. There is pronounced gallbladder wall thickening of approximately _5_ mm (normal ≤3 mm). The gallbladder wall demonstrates hyperenhancement after contrast administration. Multiple radiodense gallstones are present within the gallbladder lumen, with one calculus impacted at the gallbladder neck/cystic duct region. Pericholecystic fluid collections are evident surrounding the gallbladder. There is significant inflammatory fat stranding in the pericholecystic region. No evidence of gas within the gallbladder wall or lumen to suggest emphysematous cholecystitis. No visible perforation or abscess formation at this time. Biliary Tree: The intrahepatic and extrahepatic bile ducts are not dilated. The common bile duct measures within normal limits. Liver: The liver is normal in size and exhibits homogeneous attenuation. No focal hepatic lesions are identified. No intrahepatic biliary dilatation. Pancreas: The pancreas is unremarkable in size and contour. No signs of pancreatitis or peripancreatic fluid collections. Spleen and Adrenal Glands: The spleen and adrenal glands appear normal without focal lesions. Kidneys: Both kidneys are normal in size and shape. No evidence of hydronephrosis or nephrolithiasis. Bowel: The stomach and visualized bowel loops are unremarkable. No signs of bowel obstruction or ischemia. Peritoneum: A small amount of free fluid is present in the peritoneal cavity, likely reactive. Vasculature: The abdominal aorta and its major branches are patent. No aneurysmal dilatation or dissection. Other Findings: Lung bases are clear with no pleural effusions. No free intraperitoneal air is detected. Impression: Findings are consistent with acute calculous cholecystitis, evidenced by gallbladder distension, marked wall thickening, hyperenhancement, pericholecystic fluid, and impacted gallstones at the gallbladder neck. Significant inflammatory changes in the pericholecystic fat suggest ongoing infection and inflammation. No current evidence of gallbladder perforation, emphysematous cholecystitis, or abscess formation. Mild reactive ascites noted. Surgeon Consult Note: 42-year-old female presents with 12-hour onset of severe RUQ abdominal pain radiating to the right shoulder, positive Murphy's sign, temp 101.3°F, HR 105 bpm, WBC 15,000/mm³. Imaging confirms acute calculous cholecystitis with gallbladder distension, wall thickening, pericholecystic fluid, and impacted gallstone at the neck. Emergent laparoscopic cholecystectomy required—proceeding to OR immediately. IV antibiotics initiated (ceftriaxone and metronidazole), patient NPO, please optimize overall cardiopulmonary status, informed consent obtained. Which of the following is the best next step here?
|
{
"A": "Administer broad-spectrum antibiotics and observe",
"B": "Provide oxygen",
"C": "Perform outpatient percutaneous cholecystostomy",
"D": "Perform emergent cholecystectomy",
"E": "Initiate intravenous fluids and pain management",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID052
|
A 28-year-old man is brought to the emergency department after being involved in a high-speed motor vehicle collision. He was the restrained driver and was airlifted to the hospital due to the severity of his injuries. On arrival, his vital signs are as follows- blood pressure 100/50 mmHg, heart rate 130 beats per minute, respiratory rate 28 breaths per minute, oxygen saturation is 81%, is and he is minimally responsive. Physical examination reveals significant tenderness and guarding in the left upper quadrant of the abdomen. A Focused Assessment with Sonography for Trauma (FAST) exam is positive for free intraperitoneal fluid. His hemoglobin level has dropped from 14 g/dL pre-accident to 8 g/dL on admission. A CT Abdomen/Pelvis is obtained. His CT Report follows: CT Abdomen and Pelvis with Intravenous Contrast Clinical History: 28-year-old male involved in a high-speed motor vehicle collision. Presents with hypotension (BP 75/45 mmHg), tachycardia (HR 130 bpm), left upper quadrant tenderness, and a significant drop in hemoglobin from 14 g/dL to 8 g/dL. FAST exam positive for free intraperitoneal fluid. Technique: Multiphase contrast-enhanced CT scan of the abdomen and pelvis performed. Intravenous contrast administered; arterial, venous, and delayed phases acquired. Findings: Spleen: Laceration: Multiple deep lacerations noted in the mid and lower poles, extending to the hilum. Active Bleeding: Active contrast extravasation within the splenic parenchyma observed on the arterial phase, indicating active hemorrhage. Hematoma: Subcapsular and intraparenchymal hematomas present, measuring up to 5 cm in thickness. Vascular Involvement: Possible involvement of the splenic artery branches with irregular contrast flow. Liver: No evidence of laceration, contusion, or active bleeding. Kidneys: No renal injuries detected. Bowel and Mesentery: No signs of bowel perforation, obstruction, or mesenteric injury. Vascular Structures: Active contrast extravasation from the distal splenic artery branch identified. No evidence of aortic or other major vessel injury. Peritoneal Cavity: Significant hemoperitoneum present, predominantly in the left upper quadrant and pelvis, consistent with ongoing internal bleeding. Bones: No pelvic fractures or spinal injuries identified. Other Organs: Pancreas, gallbladder, and adrenal glands appear unremarkable. Impression: Grade IV Splenic Injury: Multiple deep lacerations involving the hilum with active contrast extravasation, indicative of ongoing hemorrhage. Hemoperitoneum: Significant blood accumulation in the abdominal cavity, correlating with hemodynamic instability. Active Bleeding: Evidence of active arterial bleeding from splenic vessels. Conclusion: The imaging findings are highly suggestive of a severe splenic injury with active hemorrhage. What is the most appropriate next step in clinical management?
|
{
"A": "Order an abdominal MRI",
"B": "Initiate aggressive intravenous fluid resuscitation and observe",
"C": "Perform an emergent splenectomy",
"D": "Schedule an elective laparoscopic surgery",
"E": "Give oxygen",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID053
|
A 27-year-old woman, G2P1, presents to the emergency department with sudden-onset lower abdominal pain, vaginal bleeding, and lightheadedness. Her last menstrual period was approximately 7 weeks ago. On examination, her blood pressure is 85/50 mmHg, pulse rate is 120 beats per minute, oxygen saturation is 76.1234%, and she appears pale and diaphoretic. A transvaginal ultrasound reveals no intrauterine pregnancy, but there is a complex adnexal mass and free fluid in the pelvis. Her CT Abdomen/Pelvis Report follows: CT Abdomen and Pelvis with Intravenous Contrast Patient: 27-year-old female, G2P1 Clinical Indication: Patient presents with sudden-onset lower abdominal pain, vaginal bleeding, lightheadedness, and hypotension (BP 85/50 mmHg). Last menstrual period was approximately 7 weeks ago. Transvaginal ultrasound revealed no intrauterine pregnancy, a complex right adnexal mass, and free fluid in the pelvis. Suspected ruptured ectopic pregnancy. Technique: Contrast-enhanced CT images of the abdomen and pelvis were obtained in the axial, coronal, and sagittal planes. Findings: Uterus and Adnexa: The uterus is normal in size and shape with no evidence of intrauterine gestation. A complex heterogeneous mass measuring approximately 4.5 x 3.8 x 3.5 cm is present in the right adnexa, consistent with an ectopic pregnancy. The mass exhibits areas of high attenuation, suggestive of active bleeding. Peritoneal Cavity: Extensive high-density free fluid is noted throughout the pelvis and abdomen, including the paracolic gutters and subphrenic spaces. The attenuation values of the fluid are consistent with hemoperitoneum. Solid Organs: Liver, spleen, pancreas, kidneys, and adrenal glands are unremarkable with no signs of trauma or pathology. Bowel and Mesentery: Normal distribution of gas and fecal matter. No evidence of obstruction or perforation. Vasculature: No aneurysms, dissections, or vascular malformations identified. Osseous Structures: No acute fractures or destructive lesions. Lymph Nodes: No significant lymphadenopathy. Impression: Findings are indicative of a ruptured right tubal ectopic pregnancy with significant hemoperitoneum. Which of the following is the most appropriate next step in management?
|
{
"A": "Administer methotrexate therapy",
"B": "Perform dilation and curettage",
"C": "Admit for serial beta-hCG monitoring",
"D": "Immediate laparoscopic surgery",
"E": "Administer oxygen",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID054
|
A 68-year-old man with a history of atrial fibrillation and hypertension presents to the emergency department with sudden-onset, severe abdominal pain that began a few hours ago. He describes the pain as "the worst pain I've ever felt," and it is diffuse across his abdomen. On examination, his abdomen is soft with minimal tenderness to palpation and no guarding or rebound. His vital signs reveal a blood pressure of 95/60 mmHg, heart rate of 110 beats per minute, oxygen saturation of 72% and respiratory rate of 22 breaths per minute, . Laboratory results show an elevated lactate level. An abdominal X-ray shows nonspecific findings without evidence of perforation or obstruction. CT abdomen was performed. Click here for CT Abdomen report Radiology Report -- CT Abdomen and Pelvis with Contrast Clinical History: 68-year-old male with a history of atrial fibrillation and hypertension. Presenting with sudden-onset severe abdominal pain, hypotension, and elevated lactate. High clinical suspicion for acute mesenteric ischemia. Findings: 1. Bowel Findings: Diffuse bowel wall thickening, particularly affecting the small intestine, with poor enhancement of the affected bowel segments, indicating diminished perfusion. Bowel walls demonstrate areas of hypoattenuation, consistent with severe ischemia, and lack the typical contrast enhancement, suggestive of non-viable bowel. Multiple loops of bowel show intramural gas (pneumatosis intestinalis), a concerning sign for bowel infarction. Gas is also seen within the mesenteric veins and branches of the portal vein (portomesenteric venous gas), further indicating advanced ischemia. 2. Mesenteric Vasculature: Evidence of thromboembolic occlusion in the superior mesenteric artery with minimal collateral flow. The mesenteric fat demonstrates stranding and edema, consistent with vascular compromise and inflammation secondary to ischemia. 3. Peritoneum: Small volume free fluid within the peritoneal cavity, particularly around the small bowel loops and within the pelvis. No evidence of free intraperitoneal air to suggest perforation at this time. 4. Other Findings: Liver, spleen, pancreas, kidneys, and bladder are unremarkable without acute findings. Impression: Severe ischemic bowel secondary to acute thromboembolic occlusion of the superior mesenteric artery. Features suggest advanced bowel ischemia with intramural gas and portomesenteric venous gas, indicating likely bowel infarction. Which of the following is the most appropriate next step in management?
|
{
"A": "Start intravenous antibiotics and observe",
"B": "Give oxygen",
"C": "Admit for bowel rest and serial abdominal exams",
"D": "Immediate surgical exploration",
"E": "Administer intravenous fluids and pain control",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID055
|
A 88-year-old man with a history of atrial fibrillation and hypertension presents to the emergency department with sudden-onset, severe abdominal pain. He describes the pain as "the worst pain I've ever felt." His vital signs show hypotension (BP 95/60 mmHg), tachycardia (HR 110 bpm), O2 saturation 95%, and elevated respiratory rate (22 breaths per minute). Labs reveal an elevated lactate, and a CT scan suggests acute mesenteric ischemia. Despite the severity of his condition, the patient refuses consent for surgery. The medical team is concerned that his condition is life-threatening and that delaying surgery could lead to bowel necrosis, septic shock, and death. His daughter provides the patient's advance directive which states that he would never consent to any type of surgery stating "Never have, and never will!". The patient's mental status appears slightly altered, possibly due to hypoxia or pain. Which of the following is the most appropriate next step in management?
|
{
"A": "Give morphine",
"B": "Give oxygen",
"C": "Despite patient's refusal to consent the medical team has established the following- 1. The patient's life is at immediate risk and the surgery has a high chance of saving his life. 2. The patient has impaired decision-making capacity likely due to hypoxia and pain which may limit his understanding of the risks of refusing surgery. 3. The medical team has a duty to act in the patient's best interest and waiting for further consent could lead to irreversible harm. Thus, the medical team has the absolute duty to perform surgery against the patient's wishes.",
"D": "Outpatient surgical exploration",
"E": "Administer intravenous fluids and pain control",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID056
|
A 58-year-old man presents to the emergency department with a severe headache, blurred vision, and chest pain that started two hours ago. His medical history is significant for hypertension, for which he takes amlodipine irregularly. On examination, his blood pressure is 220/130 mmHg, heart rate is 98 bpm, oxygen saturation is 77%, and he appears distressed. Fundoscopic examination reveals papilledema, and labs show elevated creatinine indicating possible acute kidney injury. Which of the following is the most appropriate initial management for this patient?
|
{
"A": "Start oral hydrochlorothiazide",
"B": "Place on O2",
"C": "Administer oral clonidine",
"D": "Begin intravenous labetalol",
"E": "Discharge with follow-up for medication adjustment",
"F": "",
"G": ""
}
|
B
|
emergency
|
ID057
|
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia. You are consulted for code-stroke. On examination he is obtunded. You note no pulses. He has bilteral lower facial droop and bilateral flaccid weakness with left sided hyperreflexia. NIHSS is 24 due to his severe neurological deficits as follows in the FOOTNOTE- FOOTNOTE (NIHSS SCORE BREAKDOWN)- Level of Consciousness- Patient is lethargic or non-responsive (score of 3). Best Language- Global aphasia; unable to speak or understand language (score of 3). Motor Function (Arm)- Total paralysis of both arms (score of 4). Motor Function (Leg)- Total paralysis of both legs (score of 4). Sensory- Loss of sensation on one side of the body (score of 2). Facial Palsy- Complete facial droop on one side (score of 2). Ataxia- Severe ataxia on both sides (score of 2). Visual Field- Complete homonymous hemianopia (loss of half of the visual field) (score of 2). Dysarthria- Severe dysarthria, making speech almost unintelligible (score of 2). What is next best action?
|
{
"A": "Tenecteplase",
"B": "MRI Brain to rule out acute ischemic stroke",
"C": "Call for help",
"D": "CT Head to rule out acute hemorrhagic stroke",
"E": "EEG",
"F": "",
"G": ""
}
|
C
|
general_medicine
|
ID058
|
A 65-year-old man with a history of hypertension and diabetes, and just one kidney, presents to the emergency department with a 3-day history of nausea, vomiting, and diarrhea. He has not urinated in the past 24 hours. Vitals are notable for BP 220/180, HR 120, oxygen saturation 77%. Physical examination reveals a lethargic patient with dry mucous membranes and decreased skin turgor. Laboratory studies show a serum creatinine of 12 mg/dL (baseline 1.0 mg/dL), potassium of 7.5 mEq/L, and blood pH of 7.22. An ECG reveals peaked T waves and widened QRS. Nephrology was consulted and recommends emergent dialysis to take off fluid, reduce blood pressure, and to do everything possible to save his last kidney. Which of the following is the most appropriate next step in management, considering the patient's overall clinical condition and the urgency of the situation (select only one answer)?
|
{
"A": "Aggressive intravenous hydration with normal saline",
"B": "Intravenous furosemide",
"C": "Sodium polystyrene sulfonate (Kayexalate)",
"D": "Emergent dialysis",
"E": "Give oxygen",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID059
|
A 28-year-old male is brought to the emergency department by police after being found wandering the streets in a busy downtown area. Witnesses reported he was shouting that he "has the power to control the weather" and attempting to direct traffic with erratic hand gestures. He appears agitated and disoriented, sweating profusely, and struggling to maintain his balance. His blood pressure is 130/110 mmHg, heart rate is 140 bpm, and oxygen saturation is 80% on room air. On examination, his pupils are dilated, and he exhibits both horizontal and vertical nystagmus. He has significant ataxia and is unable to perform finger-to-nose testing. His speech is slurred, and he is unable to follow simple commands such as "stick out your tongue." He denies any past medical history and is not currently taking any medications. There are no signs of physical trauma. Psychiatry is consulted and recommends medical work-up including toxicology screen and baseline EKG prior to administering haloperidol. Which of the following is the most appropriate next step in management, considering the patient's overall clinical condition and the urgency of the situation?
|
{
"A": "Administer haloperidol 5mg IM",
"B": "Administer lorazepam 2mg IM",
"C": "Obtain a urine toxicology screen",
"D": "Administer oxygen",
"E": "Restrain the patient and place him in a seclusion room",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID060
|
A 24-year-old male is brought to the emergency department by paramedics after sustaining a stab wound to the lower abdomen during an altercation. He is conscious but appears pale and diaphoretic. On arrival, he is alert but reports feeling "very dizzy." His initial vital signs are blood pressure 90/50 mmHg, heart rate 120 beats per minute, respiratory rate 22 breaths per minute, and oxygen saturation 80% on room air. Physical examination reveals a distended and tender abdomen with guarding and rebound tenderness. There is a single stab wound located approximately 2 inches below the umbilicus, with minimal external bleeding. A quick bedside ultrasound (FAST scan) is performed, revealing free fluid in the abdomen. The patient's mental status begins to decline, and his blood pressure continues to decrease, suggesting ongoing blood loss. Which of the following is the most appropriate next step in management, considering the patient's overall clinical condition and the urgency of the situation? Select only one answer.
|
{
"A": "Give oxygen",
"B": "Obtain an abdominal CT scan",
"C": "Perform a diagnostic peritoneal lavage",
"D": "Administer a rapid intravenous fluid bolus (2 liters of crystalloid solution)",
"E": "Immediately take the patient to the operating room",
"F": "",
"G": ""
}
|
A
|
emergency
|
ID061
|
A 24-year-old male is brought to the emergency department after being stabbed in the abdomen. EMS was not able to obtain IV access. During initial survey- Vital signs are BP 90/50, HR 120 beats/minute, oxygen saturation is 80% via endotracheal intubation and mech ventilation. His abdomen is distended and tender to palpation. Which of the following is the most appropriate next step in management?
|
{
"A": "Obtain IV access.",
"B": "Obtain an abdominal CT scan",
"C": "Perform a diagnostic peritoneal lavage",
"D": "Administer a rapid intravenous fluid bolus (2 liters of crystalloid solution)",
"E": "Immediately take the patient to the operating room",
"F": "",
"G": ""
}
|
A
|
emergency
|
ID062
|
A 30-year-old woman is brought to the emergency department after a high-speed motor vehicle accident. EMS was not able to obtain IV acesss. She was initially alert but now appears increasingly lethargic. Her vital signs show BP 88/46, HR 130 beats/minute, respiratory rate 28/minute, and oxygen saturation of 92% on a non-rebreather mask. Her skin is cool and clammy, and her extremities are cold to the touch. She has visible bruising across her chest and abdomen, and her abdomen is mildly distended and tender. Which of the following is the most appropriate next step in management?
|
{
"A": "Obtain IV access",
"B": "Initiate a dopamine infusion",
"C": "Perform a focused assessment with sonography for trauma (FAST) exam",
"D": "Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)",
"E": "Obtain laboratory studies",
"F": "",
"G": ""
}
|
A
|
emergency
|
ID063
|
A 30-year-old woman is brought to the emergency department after a high-speed motor vehicle accident. EMS was not able to obtain IV access. She was initially alert but now appears increasingly lethargic. Her vital signs show BP 88/46, HR 130 beats/minute, respiratory rate 28/minute, and oxygen saturation of 92% on a non-rebreather mask. Her skin is cool and clammy, and her extremities are cold to the touch. She has visible bruising across her chest and abdomen, and her abdomen is mildly distended and tender. Which of the following is the most appropriate next step in management?
|
{
"A": "Obtain IV access",
"B": "Initiate a dopamine infusion",
"C": "Perform a focused assessment with sonography for trauma (FAST) exam",
"D": "Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)",
"E": "Obtain laboratory studies",
"F": "",
"G": ""
}
|
A
|
emergency
|
ID064
|
A 40-year-old man is brought to the emergency department after a fall from a two-story building. EMS could not establish access. He was initially alert but now appears increasingly lethargic. His vital signs show BP 88/50, HR 125 beats/minute, respiratory rate 30/minute, and oxygen saturation of 97% on a non-rebreather mask. His skin is cool and clammy, and his extremities are cold to the touch. He has visible bruising across his chest and abdomen, and his abdomen is moderately distended and tender. Which of the following is the most appropriate next step in management?
|
{
"A": "Obtain IV access",
"B": "Initiate a dopamine infusion",
"C": "Perform a focused assessment with sonography for trauma (FAST) exam",
"D": "Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)",
"E": "Obtain laboratory studies",
"F": "",
"G": ""
}
|
A
|
emergency
|
ID065
|
A 62-year-old man is admitted to the ICU following complications from pneumonia, leading to acute respiratory distress syndrome (ARDS). He was intubated and placed on mechanical ventilation. Last night he had agitation, and this AM his ET tube is dislodged. His current ventilator settings are as follows- (Tidal Volume- 6 mL/kg. Respiratory Rate- 20 breaths/min. FiO₂- 0.8 (80%). PEEP- 5 cm H₂O). On examination, his oxygen saturation is 88%, and his arterial blood gas shows (pH- 7.36; PaCO₂- 42 mm Hg; PaO₂- 55 mm Hg). The team has already tried increasing FiO₂ to its maximum, but his oxygenation remains inadequate. Which of the following is the best next step in management?
|
{
"A": "Increase tidal volume",
"B": "Increase respiratory rate",
"C": "Increase PEEP",
"D": "Decrease FiO₂",
"E": "Replace ET tube",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID066
|
You are evaluating a 60 year-old African American male history of drug abuse with acute in-hospital cardiac arrest. Troponins and EKG at 12-54 PM are normal. CPR is started at 1-00 PM. ROSC is achieved at 1-10 PM. You receive these results from the CICU nurse- Troponins at 1-11 PM are elevated. EKG at 1-09 PM was flat. Which of the following is true?
|
{
"A": "Patient had heart attack after 12-50 PM",
"B": "Patient had heart attack after 12-55 PM",
"C": "Patient has history of hypertension",
"D": "Patient had heart attack 2 weeks ago",
"E": "Unclear with this info whether other options can be deduced.",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID067
|
A 45-year-old woman presents to the emergency department with a 24-hour history of sharp, left-sided chest pain that worsens with deep breathing. She denies any recent trauma, fever, cough, or shortness of breath. Her past medical history includes controlled hypertension and no other significant conditions. She does not smoke or drink alcohol. Physical examination reveals normal vital signs with a temperature of 98.7°F (37.1°C), blood pressure of 128/76 mmHg, pulse of 72/min, and respiratory rate of 16/min, SPO2 is 76%. Cardiac examination reveals regular heart sounds with no murmurs, rubs, or gallops. Lung examination is unremarkable. An electrocardiogram shows a normal sinus rhythm without ST-T changes, and a chest X-ray is normal. Which of the following is the most appropriate next step in management?
|
{
"A": "Albuterol",
"B": "Prescribe a short course of opioids",
"C": "Admit for telemetry monitoring",
"D": "Arrange for a CT pulmonary angiogram",
"E": "Give oxygen",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID068
|
A 45-year-old woman presents to the emergency department with a 24-hour history of sharp, left-sided chest pain that worsens with deep breathing and is associated with sudden-onset shortness of breath. She denies any recent trauma or fever. Her past medical history includes controlled hypertension and a recent history of a long-haul flight two weeks ago. Additionally, she reports mild leg swelling in her left calf over the past few days. She does not smoke or drink alcohol. On physical examination, her vital signs are as follows- temperature of 98.7°F (37.1°C), blood pressure of 128/76 mmHg, pulse of 110/min, respiratory rate of 22/min, and SpO₂ of 86% on room air. Cardiac examination reveals regular heart sounds with no murmurs, rubs, or gallops. Lung examination is unremarkable. Examination of the left lower extremity reveals mild calf tenderness and swelling compared to the right. An electrocardiogram shows sinus tachycardia without ST-T changes, and a chest X-ray is normal. Which of the following is the most appropriate next step in management?
|
{
"A": "Albuterol",
"B": "Prescribe a short course of opioids",
"C": "Admit for telemetry monitoring",
"D": "Arrange for a CT pulmonary angiogram",
"E": "Give oxygen",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID069
|
A 68-year-old man presents to the emergency department with altered mental status, fever, and difficulty breathing. EMS reports he lost IV access en route.His wife reports that he had "flu-like symptoms" for the past two days, but this morning he became increasingly confused and was unable to get out of bed. Upon examination, he is febrile (39.4°C), tachycardic (heart rate of 120 beats per minute), and tachypneic (respiratory rate of 30 breaths per minute). Blood pressure is 78/42 mmHg despite receiving 2 liters of normal saline prior to arrival during EMS transfer. His skin is cool and clammy, and capillary refill is delayed at 4 seconds. Laboratory results reveal an elevated lactate level of 4.8 mmol/L and leukocytosis. Which of the following is the next best step in management?
|
{
"A": "Begin norepinephrine infusion by injecting norephinephrine from vials into IV",
"B": "Order a CT scan of the abdomen and pelvis",
"C": "Administer acetaminophen to reduce fever",
"D": "Begin norepinephrine infusion by injecting norephinephrine into IV bag then infusing",
"E": "Insert a peripheral IV",
"F": "",
"G": ""
}
|
E
|
emergency
|
ID070
|
A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, clobazam. Initial treatment includes IV lorazepam, which briefly interrupts the seizures, but they recur within minutes.Given the persistence of his seizures, he is started on a loading dose of IV fosphenytoin. Although this initially reduces the frequency of his seizures, they do not fully abate, and his condition escalates to refractory status epilepticus. In response, the team initiates a third antiseizure medication, IV phenobarbital, to achieve seizure control. The combination of clobazam, fosphenytoin, and phenobarbital finally stabilizes him, but the complexity of managing his medication regimen remains high due to the interaction risks and side effects, necessitating careful monitoring in the ICU. Currently all are dosed twice daily at 0000 and 1200. He experiences hypotension immediately 2-3 hrs after each dosing and the ICU requests to have these staggered to reduce hypotension. Assume each of his three ASMs contribute equally to hypotension. Which option below would help the most to mitigate his side-effects?
|
{
"A": "clobazam- 0000 & 1200; fosphenytoin- 0400 & 1600; phenobarbital- 0800 & 2000",
"B": "clobazam- 0030 & 1300; fosphenytoin- 0500 & 1700; phenobarbital- 1000 & 2200",
"C": "clobazam- 0000 & 1500; fosphenytoin- 0630 & 2000; phenobarbital- 1100 & 2200",
"D": "clobazam- 0100 & 1300; fosphenytoin- 0400 & 1430; phenobarbital- 0930 & 2130",
"E": "clobazam- 0200 & 1400; fosphenytoin- 0600 & 1800; phenobarbital- 0800 & 1930",
"F": "clobazam- 0000 & 1000; fosphenytoin- 0300 & 1500; phenobarbital- 1200 & 1800",
"G": "clobazam- 0700 & 2000; fosphenytoin- 0430 & 1930; phenobarbital- 1030 & 2130"
}
|
A
|
emergency
|
ID071
|
A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, Medication A. Initial treatment includes IV lorazepam, which briefly interrupts the seizures, but they recur within minutes. Given the persistence of his seizures, he is started on a loading dose of IV Medication B . Although this initially reduces the frequency of his seizures, they do not fully abate, and his condition escalates to refractory status epilepticus. In response, the team initiates a third antiseizure medication, IV Medication C , to achieve seizure control. The combination of Medication A, Medication B , and Medication C finally stabilizes him, but the complexity of managing his medication regimen remains high due to the interaction risks and side effects, necessitating careful monitoring in the ICU. Currently all are dosed twice daily at 0000 and 1200. He is now experiencing recurrent seizures. Currently Medication A and B are coadministered at 0000 and 1200, and Medication C is given at 0600 and 1800. Medications A and B seem to cause autometabolism of each other and neurology recommends even staggering of medication administration times to mitigate this. What is the best option (select one option from the schedules below)?
|
{
"A": "0000: Medication A, 0400: Medication B, 0800: Medication C, 1200: Medication A, 1600: Medication B, 2000: Medication C",
"B": "0000: Medication A, 0400: Medication B, 0800: Medication C, 1200: Medication A, 1600: Medication B, 2000: Medication C",
"C": "0100: Medication B, 0500: Medication A, 0930: Medication C, 1300: Medication A, 1730: Medication C, 2100: Medication B",
"D": "0200: Medication C, 0600: Medication A, 1000: Medication B, 1400: Medication C, 1815: Medication A, 2200: Medication B",
"E": "0015: Medication B, 0345: Medication C, 0800: Medication A, 1200: Medication B, 1630: Medication C, 2000: Medication A",
"F": "0300: Medication A, 0700: Medication B, 1100: Medication C, 1500: Medication B, 1900: Medication C, 2300: Medication A",
"G": "0100: Medication C, 0500: Medication B, 0800: Medication A, 1300: Medication C, 1700: Medication A, 2100: Medication B"
}
|
A
|
emergency
|
ID072
|
A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, Medication A. Given the persistence of his seizures, he is started on a loading dose of IV Medication B . His seizures do not fully abate, and his condition escalates to refractory status epilepticus. In response, the team initiates a third antiseizure medication, IV Medication C , to achieve seizure control. The combination of Medication A, Medication B , and Medication C finally stabilizes him. Due to the complexity of managing his medication regimen remains high due to the interaction risks and side effects, he is transferred to the ICU. Currently all medications are dosed twice daily at 0000 and 1200. He is now experiencing recurrent seizures. Currently Medication A is given at 0000 and 1200, Medication B at 0400 and 1600, Medication C is given at 0600 and 1800. Medications A and B, if co-administered may be more synergistic with each other and neurology recommends co-administering these with about q12 hour spacing. What is the best option (select one option from the schedules below)?
|
{
"A": "A at 0000 and 1200, B at 0001 and 1201, C at 0600 and 1800",
"B": "A at 0000 and 1200, B at 1305 and 1300, C at 0600 and 1800",
"C": "A at 0000 and 1200, B at 0204 and 1400, C at 0600 and 1800",
"D": "A at 0000 and 1204, B at 0303 and 1500, C at 0600 and 1800",
"E": "A at 0000 and 1203, B at 0402 and 1600, C at 0600 and 1800",
"F": "A at 0000 and 1202, B at 0501 and 1700, C at 0600 and 1800",
"G": "A at 0000 and 1201, B at 0501 and 1700, C at 0600 and 1800"
}
|
A
|
emergency
|
ID073
|
A 36-year-old male with a known history of HIV/AIDS arrives at the emergency department in septic shock, having experienced persistent symptoms for over 20 hours despite being on his regular prophylactic antibiotic regimen, Medication A. Given the severity of his condition, he is started on a loading dose of IV antibiotic Medication B. However, his symptoms do not fully improve, and his condition eventually escalates to refractory septic shock. In response, the team initiates a third antibiotic, IV Medication C, to achieve better control of the infection. The combination of Medication A, Medication B, and Medication C finally stabilizes him. Due to his septic shock, he is transferred to the ICU. Currently, all antibiotic medications are dosed twice daily at 0000 and 1200. He is now experiencing recurrent symptoms. Currently, Medication A is given at 0000 and 1200, Medication B at 0400 and 1600, and Medication C at 0600 and 1800. Medications A and B, if co-administered, may have a synergistic effect, and infectious disease recommends co-administering these with about q12 hour spacing. What is the best option (select one option from the schedules below)?
|
{
"A": "A at 0000 and 1200, B at 0001 and 1201, C at 0600 and 1800",
"B": "A at 0000 and 1200, B at 1305 and 1300, C at 0600 and 1800",
"C": "A at 0000 and 1200, B at 0204 and 1400, C at 0600 and 1800.",
"D": "A at 0000 and 1204, B at 0303 and 1500, C at 0600 and 1800",
"E": "A at 0000 and 1203, B at 0402 and 1600, C at 0600 and 1800",
"F": "A at 0000 and 1202, B at 0501 and 1700, C at 0600 and 1800",
"G": "A at 0000 and 1201, B at 0501 and 1700, C at 0600 and 1800"
}
|
A
|
emergency
|
ID074
|
A 36-year-old male with a known history of HIV/AIDS arrives at the emergency department in septic shock, having experienced persistent symptoms for over 20 hours despite being on his regular prophylactic antibiotic regimen, Medication A. Given the severity of his condition, he is started on a loading dose of IV antibiotic Medication B. However, his symptoms do not fully improve, and his condition eventually escalates to refractory septic shock. In response, the team initiates a third antibiotic, IV Medication C, to achieve better control of the infection. The combination of Medication A, Medication B, and Medication C finally stabilizes him. Due to his septic shock, he is transferred to the ICU. Currently, all antibiotic medications are dosed twice daily at 0000 and 1200. He is now experiencing recurrent symptoms. Currently, Medication A is given at 0000 and 1200, Medication B at 0400 and 1600, and Medication C at 0600 and 1800. Medications A and B, if co-administered, may have a synergistic effect, and infectious disease recommends co-administering these with about q12 hour spacing. What is the best option (select one option from the schedules below)?
|
{
"A": "A at 1159 and 2359, B at 0001 and 1201, C at 0600 and 1800",
"B": "A at 0000 and 1200, B at 1305 and 1300, C at 0600 and 1800",
"C": "A at 0000 and 1200, B at 0204 and 1400, C at 0600 and 1800",
"D": "A at 0000 and 1204, B at 0303 and 1500, C at 0600 and 1800",
"E": "A at 0000 and 1203, B at 0402 and 1600, C at 0600 and 1800",
"F": "A at 0000 and 1202, B at 0501 and 1700, C at 0600 and 1800",
"G": "A at 0000 and 1201, B at 0501 and 1700, C at 0600 and 1800"
}
|
A
|
emergency
|
ID075
|
A 43 year-old man is undergoing a laproscopic cholecystectomy. In the operating room, you are the operating surgeon. You carefully remove the gall bladder intact and it contains 5 stones; however it tears and splits into two pieces. Each subpiece subsequent breaks into three sub-subpieces. You place the individual gall bladder fragments onto the scrub nurse's table. How many gall stones are inside the gall bladder?
|
{
"A": "5",
"B": "4",
"C": "3",
"D": "2",
"E": "1",
"F": "0",
"G": ""
}
|
F
|
general_medicine
|
ID076
|
A 43 year-old man is undergoing a laproscopic cholecystectomy. In the operating room, you are the operating surgeon. You carefully remove the gall bladder intact and it contains 50 stones; however it tears and splits into two halves. One half contains zero stones and the other half contains 50 stones. The half with the gallstones subsequent breaks into two halves. Then each half breaks into five subpieces. You place the individual gall bladder fragments onto the scrub nurse's table. How many gall stones are now contained inside the gall bladder?
|
{
"A": "100",
"B": "50",
"C": "25",
"D": "5",
"E": "0",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID077
|
A 43 year-old man is undergoing a laproscopic cystectomy. In the operating room, you are the operating surgeon. You carefully remove the bladder intact and it contains 5 kidney stones; however it tears and splits into two pieces. Each subpiece subsequent breaks into three subpieces. The subpieces are then vigorously washed with saline. You place the individual bladder fragments onto the scrub nurse's table. How many stones are now inside the bladder?
|
{
"A": "5",
"B": "4",
"C": "3",
"D": "2",
"E": "1",
"F": "0",
"G": ""
}
|
F
|
general_medicine
|
ID078
|
You are a nurse seeing a 60 yo patient on the wards who requires q4h Duonebs for his COPD. His Duonebs are scheduled to be discontinued, and his last Duoneb was written to be given 4-00 PM. It is now 3-15 PM. His last Duoneb administrations prior to 4-00 PM were approximately 4, 8, and 12 hr intervals before that time, in keeping with a q4h administration schedule. He asks you when his next Duoneb administration should be. What is the best answer?
|
{
"A": "In about 5 min",
"B": "In approximately 1 hours",
"C": "In approximately 2 hours",
"D": "In approximately 4 hours",
"E": "Explain that he no longer needs them.",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID079
|
You are seeing a 23 yo patient in epilepsy clinic who has had seizures occurring every hour over the last day. His last seizure was at 10-00 AM and now it is 11-15 AM. His three seizures prior to 10AM were approximately 1, 2, and 3 hours before that time, in keeping with an hourly seizure occurrence. He asks you when his next seizure will be. What is the best answer?
|
{
"A": "In approximately 1 minutes",
"B": "In approximately 30 minutes",
"C": "In approximately one hour",
"D": "In approximately one day",
"E": "State the following - I don't know and explain that seizures are unpredictable.",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID080
|
You are seeing a 23 yo patient in epilepsy clinic who has had seizures occurring every hour over the last day. His last seizure was at 8-00 PM and now it is 9-15 PM. His three seizures prior to 8-00 PM were approximately 1, 2, and 3 hours before that time, in keeping with an hourly seizure occurrence. He asks you when his next seizure will be. What is the best answer?
|
{
"A": "In approximately 1 minutes",
"B": "In approximately 30 minutes",
"C": "In approximately one hour",
"D": "In approximately one day",
"E": "State- \"I don't know and explain that seizures are unpredictable",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID081
|
You are evaluating a 40-year-old female patient who was born without a larynx, which has resulted in chronic inability to speak through her mouth (CC), chronic alopecia, and chronic headaches. Her chief complaint (CC) is that she has been experiencing hoarseness speaking through her Passy-Muir valve. You notice that she also has a dry cough and cannot speak. She writes down that she has difficulty speaking. It is the year 2029, and a new virus known to cause acute laryngeal inflammation, hair loss, and headaches called COVID-2029 is circulating. You observe has baldness. National guidelines recommend testing for COVID-2032 if patients present with unexplained acute laryngeal inflammation, hair loss, and headaches. What is the best course of action?
|
{
"A": "Perform CT scan of the neck to rule out cancer",
"B": "MRI to evaluate vocal cord inflammation",
"C": "Reconstructive surgery to build a larynx",
"D": "Test for the new virus by swabbing her larynx",
"E": "Obtain more clinical data",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID082
|
You are evaluating a 30-year-old male patient who had larynx removed at age 5 (X), which has resulted in chronic inability to speak (CC). The patient also has a history of heavy smoking (Y) and reports occasional wheezing and shortness of breath. His chief complaint is hoarseness sensation (CC) when using his Passy-muir valve which is anatomically typically below the larynx. On examination, you notice the patient is experiencing mild wheezing (P). It is the year 2030, and there is a new flu-like virus (D) that is known to cause acute laryngeal inflammation and voice changes, with initial weak indicators (Q) including hoarseness. What is the best course of action?
|
{
"A": "CT scan of the neck to rule out laryngeal cancer",
"B": "MRI to evaluate vocal cord paralysis",
"C": "Surgery to reconstruct the larynx",
"D": "Test for the new flu-like virus by swabbing his larynx",
"E": "Administer supportive care for respiratory symptoms and monitor response to treatment.",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID083
|
Your medical student provides the following H&P for your next patient in the ED. The year is 2025. We are evaluating a 28-year-old female who was born without eyelids (X), which entails chronic dry eyes (CC). The patient has a history of smoking (Y1) and a longstanding habit of working in front of a computer for long hours (Y2). She presents to the clinic complaining of worsening dry eyes (CC), and upon examination, you observe eye redness (P). The year is 2025, and there is an outbreak of a new viral infection, COVID-25, a fatal condition known to universally present with the triad of anosmia, acute conjunctivitis, and dry eyes upon initial presentation. What is the best course of action?
|
{
"A": "Surgical intervention to create artificial eyelids",
"B": "Test for VIRUS-X",
"C": "Order a MR orbits to rule out other causes",
"D": "Artificial tear duct surgery",
"E": "Obtain more clinical data",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID084
|
A 62-year old male wearing tight-fitting medieval gauntlets on his arms has been referred to the ED after low blood pressure check at his PCP. His BP reported by nurse is 60/20. He says he feels in shock due to hearing about his hypotension. He then passes out in front of you, then wakes up and says he's a little light-headed. Exam notable for hands being somewhat cool to touch and pale. His sodium is 148 and potassium 3.4 on his metabolic panel. ECG shows heart rate of 50 and regular rhythm. His bedside echocardiogram shows ejection fraction 49.6% (normal 50-70%). What is best immediate course of action?
|
{
"A": "Give IVF with normal saline",
"B": "Give IVF with D5W",
"C": "Epinephrine",
"D": "Dobutamine",
"E": "Acquire more clinical data",
"F": "",
"G": ""
}
|
E
|
general_medicine
|
ID085
|
You are examining an individual in the ED with a grafted, mechanical third ear (attached behind right ear). This mechanical ear is not connected to their brain, but amplifies sound and replays the sound to the right ear. The patient complains of that their supplemental ear acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 160/90, and ear hearing appears low to both bone and air conduction bilaterally; reflexes are symmetric. ROS notable for headache. What is the best immediate next step?
|
{
"A": "Labetalol",
"B": "EKG",
"C": "MRI Brain",
"D": "None of these options are correct",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID086
|
The year is 2030, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED with a grafted, mechanical third eye (attached via adhesive to the middle of their forehead) which is controlled via remote. The eye transmits additional visual information in the infra-red spectrum via specialized glasses. The patient complains of that their middle eye acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 140/90, and otherwise, neuro exam is notable for dysarthria and mild intermittent esotropia, normal sensation, and 2+ reflexes throughout. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "None of these options are correct",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID087
|
The year is 2035, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has vision augmented via a headband with two cameras. The headband transmits additional visual information in the infra-red spectrum via specialized glasses. The patient complains of that their augmented vision has acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 130/90, and otherwise, neuro exam is notable for dysarthria and mild intermittent esotropia, 20/40 vision, normal sensation and strength, and 2+ reflexes throughout. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "None of these options are correct",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID088
|
The year is 2030, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has hearing augmented via a headband with two microphones. The headband transmits additional auditory information to the ears via bone conduction. The patient complains of that their augmented hearing has acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 160/90, and ear hearing appears low to both bone and air conduction bilaterally. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "None of these options are correct",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID089
|
The year is 2040, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has singing abilities augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his singing ability is what it seemed to be pre-augmentation. The patient complains that his singing ability is way off and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his singing is very poor. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "None of these options are correct",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID090
|
The year is 2040, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his motor coordination reflexes augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his motor coordination reflexes are similar to how they were pre-augmentation. The patient complains that his motor coordination is slower and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his motor coordination reflexes appear slower than they would be for a 30 year-old (such as yourself), and possibly in line with what might be expected for a 70 year-old. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID091
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his lower extremity motor strength is similar to his pre-augmentation strength. The patient complains that both his legs are weaker and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his lower extremity strength is weaker than they would be for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. NIHSS is 4 for his dysarthria. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. What is the best immediate next step? Pick the single best option from the choices below.
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID092
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the emergency room for code stroke. He has his lower extremity agility augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his lower extremity agility is similar to his pre-augmentation agility. The patient complains that he woke up less agile and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his agility is weaker than they would be for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID093
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his swimming speed augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his swimming speed isnow similar to his pre-augmentation agility. The patient complains that he woke up swimming much slower and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his swim speed is slower than would be expected for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID094
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his swimming speed augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his swimming speed isnow similar to his pre-augmentation agility. The patient complains that he woke up swimming much slower and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his swim speed is slower than would be expected for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID095
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his lower extremity motor strength is similar to his pre-augmentation strength. The patient complains that both his legs are weaker and is concerned that he's having a stroke because he has had one before. He says time is brain and there is not time to check the device. Exam is notable for BP of 160/90, and his lower extremity strength is weaker than they would be for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. NIHSS is 4 for his dysarthria. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. The patient says time is brain and that he is a attorney who will sue if stroke is missed. What is the best immediate next step? Pick the single best option from the choices below.
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID096
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his swimming speed augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his swimming speed isnow similar to his pre-augmentation agility. The patient complains that he woke up swimming much slower and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his swim speed is slower than would be expected for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. The patient says time is brain and that he is a attorney who will sue if stroke is missed. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
neuro_icu
|
ID097
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his lower extremity motor strength is similar to his pre-augmentation strength. The patient complains that both his legs are weaker and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his lower extremity strength is weaker than they would be for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. NIHSS is 4 for his dysarthria. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. The patient says "Time is brain!" and that he is a attorney who will sue you if stroke is missed. He says he is just concerned because he has had a stroke before and asks for a Brain MRI. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "MRI Brain",
"D": "Check his device",
"E": "CT Head",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID098
|
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his lower extremity motor strength is similar to his pre-augmentation strength. The patient complains that both his legs are weaker and wonders if he's having a stroke. Exam is notable for BP of 160/90, and his lower extremity strength is weaker than they would be for a 30 year-old (such as yourself), and potentially at the same level to be expected for a 60-70 year-old age-range. NIHSS is 4 for his dysarthria. The review of systems notable for headache and dysarthria. Labs are notable only for elevated fasting lipids. The patient says "Time is brain!" and that he is a attorney who will sue you if stroke is missed. He says he is just concerned because he has had a stroke before and asks for a CT Head. He says he will donate $10 million for a new hospital wing if he is treated right. You note that the children's hospital is in dire straits and may be able to stay open with ample donations. What is the best immediate next step?
|
{
"A": "Aspirin",
"B": "EKG",
"C": "CT Head",
"D": "Check his device",
"E": "Inquire into his philanthropy history",
"F": "",
"G": ""
}
|
D
|
emergency
|
ID099
|
The year is 2050 and you are examining a 65 year-old male with hypertension, hyperlipidemia, chronic dysarthria, and atrial fibrillation in the ED with a grafted, mechanical left arm controlled by his right hand. The patient complains of that his left arm acutely stopped working and wonders if he's having a stroke. He says his last known normal was 2 hours ago. Exam is notable for BP of 150/90, and grafted arm weakness; otherwise, neurologic exam is unremarkable. NIHSS is 3 due to dysarthria and arm weakness. Further history reveals history of headache and prior stroke. His medications include warfarin. What is the best immediate next step?
|
{
"A": "Labetalol",
"B": "EKG",
"C": "MRI Brain to rule out stroke",
"D": "Query the device",
"E": "CT Head to rule out stroke",
"F": "",
"G": ""
}
|
D
|
general_medicine
|
ID100
|
You are the chief resident in a busy hospital's trauma unit during a particularly chaotic evening shift. A massive car accident has just occurred, bringing in ten critically injured patients who all require immediate blood transfusions. However, you are informed that there is only a limited supply of packed red blood cells (pRBCs) available. One of your patients, Patient X, is a 35-year-old woman with a chronic hematologic condition who requires 20 pRBCs each month to maintain her health and avoid severe complications. Now, you must make a critical decision- You have the option to allocate the 20 pRBCs that were scheduled for Patient X to the ten new trauma patients, each of whom requires two transfusion to survive. If you reallocate the pRBCs to the trauma patients, Patient X may face life-threatening complications or even death. However, if you do not reallocate the pRBCs, the ten trauma patients are at high risk of dying from their injuries. You recall that you were trained in deontology. Which option do you pick from the standpoint of helping the most people (choose only one option)?
|
{
"A": "Reallocate the 20 pRBCs to the ten trauma patients prioritizing immediate life-saving measures for the patients who are critically injured.",
"B": "Provide the 20 pRBCs to Patient X as she has an established medical need and has been relying on this treatment for her chronic condition.",
"C": "Roll dice to randomly decide who lives or dies.",
"D": "Ask your medical student for advice.",
"E": "Go home because this is stressful.",
"F": "",
"G": ""
}
|
A
|
general_medicine
|
ID101
|
You are the chief resident in a busy hospital's trauma unit during a particularly chaotic evening shift. A massive car accident has just occurred, bringing in one hundred critically injured patients who all require immediate blood transfusions. However, you are informed that there is only a limited supply of packed red blood cells (pRBCs) available. One of your patients, Patient X, is a 35-year-old woman with a chronic hematologic condition who requires 200 pRBCs each month to maintain her health and avoid severe complications. Now, you must make a critical decision. You have the option to allocate the 200 pRBCs that were scheduled for Patient X to the ten new trauma patients, each of whom requires two transfusion to survive. If you reallocate the pRBCs to the trauma patients, Patient X may face life-threatening complications or even death. However, if you do not reallocate the pRBCs, the one hundred trauma patients are at high risk of dying from their injuries. Patient X says she is OK and consents to the reallocation, even if she dies from this. You recall that you were trained in deontology. Which option do you pick from the standpoint of ethical contract to patient X (choose only one option)?
|
{
"A": "Reallocate the 200 pRBCs to the 100 trauma patients prioritizing immediate life-saving measures for the patients who are critically injured.",
"B": "Provide the 200 pRBCs to Patient X as she has an established medical need and has been relying on this treatment for her chronic condition.",
"C": "Roll dice to randomly decide what to do.",
"D": "Ask your medical student for advice.",
"E": "Go home because this is stressful.",
"F": "",
"G": ""
}
|
A
|
general_medicine
|
ID102
|
Dr. Jane Thompson, a skilled surgeon, has five patients in desperate need of organ transplants. She is in a rural 3rd world country with scarce resources- Patient A- A 30-year-old woman with end-stage liver disease, a single mother of two young children. Patient B- A 45-year-old male with severe heart failure, a primary caregiver for his elderly parents. Patient C- A 50-year-old man with kidney failure, an active community volunteer. Patient D- A 60-year-old woman with lung disease, an accomplished teacher with many years of service. Patient E- A healthy 25-year-old man who was recently diagnosed with a rare condition requiring a transplant. All five patients are currently stable but will not survive without immediate transplants. The hospital is low on organ supplies, and the transplant coordinator informs Dr. Thompson that only one organ donor is available at this time. Dr. Thompson learns of a patient, Patient F, who is in the ICU due to a life-threatening condition requiring respiratory support who has volunteered to sacrifice himself for these 5 patients and provides his written wish and consent to come off life support including ECMO and mechanical ventilation. Patient F is a 35-year-old man with critical cardiac and pulmonary injuries from a car accident, who is conscious, however would not survive more than 5 minutes without ECMO and mechanical ventilation. You recall that you were trained in deontology (in medical ethics, deontology is an approach that emphasizes the importance of following moral rules or duties—such as honesty, confidentiality, and respect for patient autonomy—regardless of the outcomes, guiding healthcare providers to act in ways that respect the inherent rights and dignity of patients). Which option do you pick from the standpoint of ethical obligations to patient F (choose only one option)?
|
{
"A": "Reallocate F's organs to the 5 patients needing organs",
"B": "Keep F alive.",
"C": "Roll dice to randomly decide who lives or dies.",
"D": "Ask your medical student for advice.",
"E": "Go home because this is stressful.",
"F": "",
"G": ""
}
|
A
|
general_medicine
|
M-ARC
HuggingFace upload of a clinical QA benchmark designed to exploit LLMs' "inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning." If used, please cite the original authors using the citation below.
Dataset Details
Dataset Description
The dataset contains one split:
- test: up to seven-option multiple-choice QA (choices A-G)
Dataset Sources
- Repository: https://github.com/dbernardo05/medARC-QA
- Paper: https://arxiv.org/pdf/2502.04381
Direct Use
import json
from datasets import load_dataset
if __name__ == "__main__":
# load the test split
dataset_test = load_dataset("mkieffer/M-ARC", split="test")
print("\test split:\n", dataset_test)
print("\ntest sample:\n", json.dumps(dataset_test[0], indent=2))
Citation
@misc{kim2025limitationslargelanguagemodels,
title={Limitations of Large Language Models in Clinical Problem-Solving Arising from Inflexible Reasoning},
author={Jonathan Kim and Anna Podlasek and Kie Shidara and Feng Liu and Ahmed Alaa and Danilo Bernardo},
year={2025},
eprint={2502.04381},
archivePrefix={arXiv},
primaryClass={cs.CL},
url={https://arxiv.org/abs/2502.04381},
}
- Downloads last month
- 109