question
stringlengths 66
3.58k
| answer
stringlengths 1
230
| options
dict | meta_info
stringclasses 2
values | answer_idx
stringclasses 4
values | metamap_phrases
sequencelengths 1
184
| multiple_choice
stringlengths 405
4.28k
| embedding
sequencelengths 768
768
| result
dict |
|---|---|---|---|---|---|---|---|---|
A 23-year-old pregnant woman at 22 weeks gestation presents with burning upon urination. She states it started 1 day ago and has been worsening despite drinking more water and taking cranberry extract. She otherwise feels well and is followed by a doctor for her pregnancy. Her temperature is 97.7°F (36.5°C), blood pressure is 122/77 mmHg, pulse is 80/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam is notable for an absence of costovertebral angle tenderness and a gravid uterus. Which of the following is the best treatment for this patient? | Nitrofurantoin | {
"A": "Ampicillin",
"B": "Ceftriaxone",
"C": "Doxycycline",
"D": "Nitrofurantoin"
} | step2&3 | D | [
"23 year old pregnant woman",
"weeks presents",
"burning",
"urination",
"states",
"started 1 day",
"worsening",
"drinking",
"water",
"taking cranberry extract",
"feels well",
"followed by",
"doctor",
"pregnancy",
"temperature",
"97",
"36",
"blood pressure",
"mmHg",
"pulse",
"80 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Physical exam",
"notable",
"absence",
"costovertebral angle tenderness",
"gravid uterus",
"following",
"best treatment",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 23-year-old pregnant woman at 22 weeks gestation presents with burning upon urination. She states it started 1 day ago and has been worsening despite drinking more water and taking cranberry extract. She otherwise feels well and is followed by a doctor for her pregnancy. Her temperature is 97.7°F (36.5°C), blood pressure is 122/77 mmHg, pulse is 80/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam is notable for an absence of costovertebral angle tenderness and a gravid uterus. Which of the following is the best treatment for this patient?
Choose one of the following::
A. Ampicillin
B. Ceftriaxone
C. Doxycycline
D. Nitrofurantoin | [
0.012075288221240044,
0.023733213543891907,
0.0069312104023993015,
-0.06190581992268562,
0.018889514729380608,
0.023695584386587143,
0.02218231000006199,
0.022488681599497795,
-0.02052321285009384,
-0.031163224950432777,
0.02406448870897293,
0.009421787224709988,
0.005800200626254082,
-0.05111544579267502,
-0.011783071793615818,
0.019224107265472412,
-0.023464329540729523,
0.028266428038477898,
0.005339768715202808,
0.009242228232324123,
0.00004067631743964739,
0.002149648265913129,
-0.008346940390765667,
0.009317442774772644,
-0.007740353234112263,
-0.0308529045432806,
0.006855540443211794,
0.012745053507387638,
-0.001689587370492518,
-0.060499582439661026,
0.03021681122481823,
0.045169077813625336,
-0.01666346564888954,
-0.033116865903139114,
0.0000018622220068209572,
-0.05182122811675072,
0.0026418515481054783,
-0.015292102470993996,
0.06129468232393265,
-0.04413788393139839,
0.009305497631430626,
-0.055839695036411285,
0.040661849081516266,
0.0762379989027977,
-0.0066180042922496796,
-0.03245379030704498,
0.05501626804471016,
0.08768735080957413,
-0.03561779111623764,
-0.021679798141121864,
0.0023658054415136576,
-0.050754815340042114,
-0.0033893738873302937,
0.06318362802267075,
0.040031418204307556,
-0.05419943481683731,
-0.033526260405778885,
0.00852374080568552,
0.026986107230186462,
0.022396693006157875,
-0.006674685515463352,
-0.02221773937344551,
-0.017898045480251312,
0.0016627900768071413,
-0.057585593312978745,
-0.007401446346193552,
-0.05411094054579735,
-0.05677126348018646,
0.002737271599471569,
0.0022046079393476248,
0.02069108746945858,
0.003722989931702614,
0.0187058188021183,
0.05334683880209923,
-0.06833088397979736,
-0.04495946317911148,
-0.01998053677380085,
-0.019425515085458755,
-0.023867744952440262,
-0.0032400505151599646,
-0.031180525198578835,
0.042383793741464615,
-0.03406934812664986,
0.08214110136032104,
0.04061540216207504,
0.003039998235180974,
0.032762136310338974,
-0.012876235879957676,
-0.0019803117029368877,
-0.008276401087641716,
0.019596166908740997,
-0.043369874358177185,
0.012668843381106853,
0.02998305857181549,
-0.048051945865154266,
-0.0030416601803153753,
0.006631720811128616,
0.007712833117693663,
0.05938912183046341,
-0.045658621937036514,
0.0485043041408062,
0.026333842426538467,
0.09295576810836792,
-0.006791110150516033,
-0.023208437487483025,
0.06561283022165298,
0.02944079227745533,
0.005731347016990185,
-0.011224975809454918,
0.045831210911273956,
-0.04687456786632538,
0.0364956296980381,
-0.03253651410341263,
-0.012242533266544342,
0.08110163360834122,
0.02354406751692295,
-0.05890173092484474,
-0.013284001499414444,
0.014541389420628548,
0.039971865713596344,
-0.004161495715379715,
0.026968002319335938,
0.020091572776436806,
0.0025517772883176804,
0.03577248007059097,
0.02527773752808571,
-0.003898611990734935,
0.014927750453352928,
-0.016831032931804657,
0.031781576573848724,
0.006126535590738058,
0.014970269054174423,
-0.052232127636671066,
0.06387060135602951,
-0.03631224483251572,
-0.05414309725165367,
0.005639276932924986,
-0.02780032716691494,
0.007571793626993895,
0.04402463883161545,
-0.056244369596242905,
-0.040710847824811935,
0.03935505077242851,
-0.005732845049351454,
0.006897754967212677,
0.008806057274341583,
-0.01352076604962349,
-0.0033454501535743475,
0.05292985215783119,
0.0479818619787693,
-0.01661810092628002,
-0.06716344505548477,
-0.04061195254325867,
0.02050689607858658,
-0.02105576917529106,
0.008865085430443287,
-0.016151187941432,
-0.006694301962852478,
0.06260939687490463,
0.03990865871310234,
-0.022156642749905586,
-0.046154893934726715,
-0.004466005600988865,
-0.03283986821770668,
-0.00592653127387166,
0.0440354123711586,
0.053287290036678314,
0.10831504315137863,
-0.013130804523825645,
0.015185204334557056,
-0.02892269194126129,
-0.014485426247119904,
0.04959787800908089,
-0.005397277418524027,
0.0001175626675831154,
-0.0022572195157408714,
0.008171376772224903,
0.01804312877357006,
-0.011393084190785885,
-0.009951101616024971,
0.019583700224757195,
0.03477320447564125,
0.012616337276995182,
-0.0342663899064064,
0.017368264496326447,
0.016930824145674706,
0.05513756349682808,
-0.00032363770878873765,
-0.0481831319630146,
-0.04811810702085495,
-0.07720106095075607,
0.016136350110173225,
-0.024637673050165176,
-0.008650306612253189,
0.019850514829158783,
0.01040075346827507,
0.01850912533700466,
0.019542010501027107,
0.049402866512537,
-0.010770810768008232,
-0.03813983500003815,
-0.055296387523412704,
-0.056368179619312286,
0.09231485426425934,
-0.02940959669649601,
-0.008888032287359238,
-0.040375787764787674,
0.029327718541026115,
0.009098086506128311,
-0.010775580070912838,
-0.11270088702440262,
0.02263035625219345,
0.029441064223647118,
-0.040858495980501175,
0.03248053789138794,
0.051851365715265274,
0.00917014293372631,
0.03463861718773842,
-0.02247742749750614,
-0.040763355791568756,
0.009348871186375618,
-0.013766959309577942,
-0.03591703996062279,
-0.023955950513482094,
-0.0504629909992218,
-0.040325429290533066,
-0.022375991567969322,
-0.04264051467180252,
-0.012033910490572453,
-0.058754220604896545,
0.06263048201799393,
0.03607852756977081,
-0.04455200582742691,
0.023726170882582664,
0.01231644582003355,
0.05765681341290474,
0.03800014778971672,
-0.031555160880088806,
0.026036221534013748,
0.0422525517642498,
-0.04620153456926346,
0.03515186160802841,
-0.07086149603128433,
-0.02766423113644123,
0.0007017017342150211,
-0.028722340241074562,
-0.014920531772077084,
0.007303450256586075,
-0.06196656450629234,
0.04384422302246094,
-0.04875298589468002,
0.05285108834505081,
-0.011899261735379696,
-0.009554239921271801,
0.02215617336332798,
0.0003158918407279998,
-0.07213271409273148,
-0.027077265083789825,
0.005599036347121,
-0.03790851682424545,
-0.04958928003907204,
-0.0011926075676456094,
0.036137018352746964,
-0.04548982158303261,
-0.029026024043560028,
-0.027365557849407196,
-0.012322407215833664,
0.03972029313445091,
-0.02678033523261547,
0.023408478125929832,
0.004473675508052111,
0.007602824829518795,
0.011706334538757801,
0.026542821899056435,
-0.0043992819264531136,
-0.01782274805009365,
-0.05731212720274925,
0.05120210722088814,
0.023558245971798897,
-0.006546678487211466,
-0.0015501095913350582,
0.07454334944486618,
-0.00607437826693058,
0.009750361554324627,
0.0013742599403485656,
-0.003653814783319831,
0.01664462313055992,
0.07615631818771362,
0.012150133028626442,
0.053795985877513885,
0.012127840891480446,
-0.018913697451353073,
0.012657539919018745,
-0.023470096290111542,
-0.004475126508623362,
0.01670333556830883,
-0.10149084776639938,
-0.08413946628570557,
-0.0047498405911028385,
-0.011920345947146416,
-0.02800172008574009,
-0.014125056564807892,
-0.02194111980497837,
-0.010224783793091774,
0.032244905829429626,
-0.0007862400379963219,
-0.001959502464160323,
0.041184697300195694,
0.013383595272898674,
-0.025474408641457558,
-0.06666582077741623,
-0.045702818781137466,
-0.03340072184801102,
0.012912670150399208,
0.02532719448208809,
-0.07776635140180588,
0.015309566631913185,
-0.046466171741485596,
0.07684320211410522,
-0.05755133554339409,
0.037462372332811356,
-0.011099601164460182,
-0.03170953691005707,
-0.058742109686136246,
-0.033225882798433304,
-0.040561314672231674,
0.022402610629796982,
-0.015263937413692474,
-0.05899295583367348,
-0.045289039611816406,
-0.004230325575917959,
-0.06335780024528503,
-0.005377350375056267,
0.0008325314847752452,
0.007323007099330425,
-0.04541675001382828,
-0.04138711467385292,
0.010783643461763859,
-0.012899207882583141,
0.057390157133340836,
0.05644511431455612,
-0.047265347093343735,
-0.0157649964094162,
-0.02561856620013714,
0.05385766923427582,
0.005441977642476559,
-0.023122558370232582,
0.03738553076982498,
0.023583881556987762,
0.0670238509774208,
-0.10602518171072006,
-0.04295246675610542,
0.04975317046046257,
-0.014527775347232819,
-0.04161418601870537,
-0.039786793291568756,
-0.050887610763311386,
0.03967542201280594,
-0.002610933966934681,
0.042639054358005524,
-0.013230942189693451,
0.011034397408366203,
0.028223104774951935,
-0.045726221054792404,
-0.0073827398009598255,
-0.0034595984034240246,
0.013700330629944801,
-0.05015343055129051,
0.06583870947360992,
-0.07535803318023682,
-0.0009424613672308624,
0.0034487356897443533,
-0.03944797068834305,
0.03898465633392334,
0.041105736047029495,
-0.01741458661854267,
-0.025703107938170433,
-0.06306284666061401,
-0.017011944204568863,
-0.040122050791978836,
0.05251418799161911,
-0.03562838211655617,
0.043406326323747635,
-0.02333657257258892,
-0.020351968705654144,
0.06199197471141815,
-0.024665407836437225,
-0.02991759032011032,
0.01719682291150093,
-0.010604126378893852,
-0.012815558351576328,
0.02482345513999462,
0.017536964267492294,
0.008794676512479782,
0.032352346926927567,
0.08338621258735657,
0.02583252638578415,
-0.038854651153087616,
-0.004708676598966122,
0.0472349151968956,
-0.00028822963940910995,
0.014729930087924004,
-0.029711054638028145,
0.06450248509645462,
0.016870828345417976,
-0.03830622136592865,
-0.0515507347881794,
-0.00013493065489456058,
0.06696528941392899,
0.047167785465717316,
0.01200967375189066,
-0.018512669950723648,
0.02598588354885578,
0.009175272658467293,
-0.035942185670137405,
0.017059262841939926,
0.030643681064248085,
-0.010640600696206093,
-0.0031996541656553745,
-0.05983234569430351,
0.02206018567085266,
-0.01708516851067543,
-0.06915640830993652,
-0.039156749844551086,
0.01952166110277176,
-0.0002642830368131399,
0.06742236763238907,
0.06646520644426346,
-0.013334330171346664,
-0.011726557277143002,
0.003513882402330637,
-0.03155950829386711,
0.006416154094040394,
0.08412326127290726,
0.031491223722696304,
0.025366177782416344,
0.00884014368057251,
0.02952198125422001,
-0.0233122818171978,
-0.023142090067267418,
-0.007522940635681152,
-0.02153213694691658,
0.008144393563270569,
-0.016095079481601715,
-0.03966733068227768,
0.011639897711575031,
0.04223659262061119,
0.03579683229327202,
-0.005275891162455082,
0.08486489951610565,
-0.03235248476266861,
-0.059863388538360596,
0.016954362392425537,
0.015662888064980507,
0.021444404497742653,
-0.013290771283209324,
0.056889697909355164,
0.030754614621400833,
0.02659718133509159,
-0.06770318746566772,
-0.005843627732247114,
0.00695601524785161,
-0.022977015003561974,
-0.04810002073645592,
0.04257474094629288,
-0.08871132135391235,
0.0033984517212957144,
0.03761860355734825,
0.02884245663881302,
0.04624383896589279,
0.0034105509985238314,
0.047507960349321365,
-0.005039584822952747,
-0.028173621743917465,
0.039735905826091766,
0.0035006508696824312,
0.014032378792762756,
-0.01633893884718418,
0.03581457585096359,
0.013793548569083214,
-0.029629062861204147,
0.016900034621357918,
-0.03227164223790169,
-0.0075315446592867374,
0.02617601677775383,
0.02812572941184044,
-0.007821187376976013,
0.0009152133134193718,
-0.0150365699082613,
0.05793291702866554,
0.010175601579248905,
-0.030560115352272987,
0.029872288927435875,
-0.02160547487437725,
-0.05612644925713539,
-0.09500343352556229,
-0.0020184172317385674,
-0.0009942809119820595,
0.09723697602748871,
-0.05864134803414345,
-0.03508578613400459,
0.03584545850753784,
0.0509776696562767,
-0.002337017096579075,
0.054074984043836594,
-0.031164053827524185,
-0.04019114747643471,
0.0028396914713084698,
-0.010275175794959068,
-0.003047752194106579,
0.02061031013727188,
0.0071829454973340034,
0.008356054313480854,
0.027227818965911865,
0.01711190491914749,
-0.03308616578578949,
-0.04098355025053024,
-0.01263971347361803,
-0.046973370015621185,
0.03725804015994072,
0.0004886309616267681,
-0.0065701971761882305,
-0.06991935521364212,
-0.022954201325774193,
-0.02512654848396778,
-0.002623047214001417,
0.0017241754103451967,
0.008536466397345066,
-0.020085828378796577,
0.06728764623403549,
-0.0038108523003757,
-0.010890125297009945,
0.01488225907087326,
-0.03128470852971077,
-0.006837213411927223,
-0.03101535700261593,
-0.030010001733899117,
-0.04175344854593277,
-0.012249181047081947,
-0.044830527156591415,
-0.009295208379626274,
0.032568078488111496,
0.020386353135108948,
-0.03558832034468651,
0.01448206789791584,
0.028555219992995262,
-0.005501891020685434,
0.027887985110282898,
-0.0011726579396054149,
-0.015365216881036758,
-0.012371059507131577,
0.04986228793859482,
-0.007109974045306444,
-0.00259229214861989,
0.051191240549087524,
-4.499891924625552e-33,
0.016648441553115845,
-0.05280230566859245,
0.0459008626639843,
-0.020965341478586197,
0.07706563174724579,
0.08436885476112366,
0.017241938039660454,
0.018570372834801674,
-0.04268134385347366,
0.039762645959854126,
-0.016185685992240906,
-0.0013714111410081387,
0.032602958381175995,
0.07955782860517502,
-0.02677614986896515,
-0.019977891817688942,
0.007732345722615719,
0.008331667631864548,
-0.025464888662099838,
0.04459172487258911,
0.022458629682660103,
-0.01504131592810154,
-0.02132387086749077,
-0.03645165264606476,
0.020345771685242653,
-0.045454058796167374,
0.03283556550741196,
-0.0049337656237185,
0.039964813739061356,
0.006321767810732126,
0.027660364285111427,
-0.04661991074681282,
0.03465164452791214,
0.00319896312430501,
-0.04326217621564865,
0.04808962717652321,
0.017411107197403908,
0.004639608319848776,
0.01084822230041027,
-0.015920238569378853,
-0.004650156479328871,
-0.033863041549921036,
-0.021436184644699097,
0.006101123057305813,
0.01663690246641636,
-0.10395941883325577,
-0.018383875489234924,
-0.03010832518339157,
-0.003325589234009385,
-0.07321079820394516,
-0.05741872265934944,
0.023192793130874634,
0.002472300548106432,
-0.03383263945579529,
-0.06306031346321106,
0.04881211742758751,
-0.03788581117987633,
0.055965401232242584,
-0.03390096500515938,
0.009718685410916805,
-0.04345880076289177,
0.006756775546818972,
-0.004893215838819742,
-0.05673998221755028,
-0.037995193153619766,
-0.048092860728502274,
-0.07373562455177307,
0.027674822136759758,
-0.006681064143776894,
0.010059475898742676,
-0.054918479174375534,
0.017856255173683167,
0.018344709649682045,
-0.07088274508714676,
0.02317073382437229,
-0.03369959816336632,
-0.013543115928769112,
-0.00904533825814724,
-0.03560730069875717,
0.05082284286618233,
-0.012073167599737644,
0.008853593841195107,
-0.08530392497777939,
0.0262079369276762,
-0.023061668500304222,
-0.018150698393583298,
0.017134910449385643,
-0.02029314637184143,
0.031159020960330963,
0.009348917752504349,
0.10933541506528854,
-0.01894337683916092,
0.0023511298932135105,
-0.019505932927131653,
-0.023822560906410217,
-0.030642366036772728,
0.01964833401143551,
0.08427396416664124,
0.02271716296672821,
0.053572963923215866,
0.054275091737508774,
-0.04300648346543312,
-0.009104897268116474,
-0.012612815015017986,
0.0070615797303617,
-0.008095478639006615,
0.005812329240143299,
0.021611398085951805,
0.008121291175484657,
-0.019321896135807037,
-0.010477352887392044,
0.020827770233154297,
0.0044937641359865665,
-0.017728198319673538,
-0.027438435703516006,
0.03104652836918831,
0.01360930223017931,
0.06414512544870377,
0.0509527213871479,
0.0699089989066124,
0.076992928981781,
-0.004031419288367033,
0.023163706064224243,
-0.008861498907208443,
-0.02062651328742504,
-0.045998040586709976,
0.045277465134859085,
0.06998652964830399,
-0.0049782199785113335,
-0.0006224805256351829,
-0.008754472248256207,
0.023761941120028496,
2.566168291195936e-7,
0.06493202596902847,
0.035647086799144745,
-0.025709306821227074,
-0.04199076443910599,
0.007469698786735535,
-0.03933923318982124,
0.01629655621945858,
0.0006242296658456326,
0.040090229362249374,
-0.013028720393776894,
-0.005010632332414389,
0.007329395040869713,
0.0032017966732382774,
0.0026791179552674294,
-0.015962759032845497,
-0.04387038201093674,
-0.013986139558255672,
0.0318886861205101,
0.01975364238023758,
-0.029447635635733604,
0.017182862386107445,
-0.032880984246730804,
-0.06288862973451614,
-0.006840639282017946,
-0.06103592738509178,
-0.020642705261707306,
0.0745365247130394,
0.01871228776872158,
-0.0019125400576740503,
-0.006931614596396685,
-0.018477123230695724,
0.019816268235445023,
-0.00900570023804903,
-0.03137001395225525,
-0.024832068011164665,
0.0142946382984519,
0.056559380143880844,
0.014379668049514294,
0.013494757935404778,
-0.016268400475382805,
0.0060781631618738174,
0.023971032351255417,
-0.012253113090991974,
-0.010368583723902702,
-0.006423625163733959,
0.00859061349183321,
-0.04234575480222702,
0.03073892928659916,
0.04940561577677727,
-0.030200988054275513,
-0.013094199821352959,
0.019129516556859016,
-0.040841229259967804,
0.07934562116861343,
-0.015338124707341194,
0.028005307540297508,
-0.023651117458939552,
-0.0019314420642331243,
0.020192325115203857,
0.01335520762950182,
-0.02336634323000908,
0.0018863796722143888,
0.01641121134161949,
0.017998382449150085,
0.07110687345266342,
-0.030437566339969635,
-0.012299399822950363,
1.5469940727484352e-34,
0.0052038561552762985,
-0.05556139722466469,
0.002309550065547228,
-0.027611956000328064,
0.0020032632164657116,
-0.009512996301054955,
-0.03666013106703758,
0.022050509229302406,
0.02669496461749077,
-0.047786857932806015,
0.04784388467669487
] | {
"ds_index": 0,
"similar_dg_indices": [
189298,
368928,
218519,
675341,
34572,
1177938,
345809,
175708,
434014,
657071,
291614,
560059,
288366,
691074,
608844,
1069336,
725087,
760248,
153514,
91764
]
} |
A 3-month-old baby died suddenly at night while asleep. His mother noticed that he had died only after she awoke in the morning. No cause of death was determined based on the autopsy. Which of the following precautions could have prevented the death of the baby? | Placing the infant in a supine position on a firm mattress while sleeping | {
"A": "Placing the infant in a supine position on a firm mattress while sleeping",
"B": "Keeping the infant covered and maintaining a high room temperature",
"C": "Application of a device to maintain the sleeping position",
"D": "Avoiding pacifier use during sleep"
} | step2&3 | A | [
"3 month old baby died",
"night",
"asleep",
"mother",
"died only",
"awoke in",
"morning",
"cause of death",
"based",
"autopsy",
"following precautions",
"prevented",
"death",
"baby"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 3-month-old baby died suddenly at night while asleep. His mother noticed that he had died only after she awoke in the morning. No cause of death was determined based on the autopsy. Which of the following precautions could have prevented the death of the baby?
Choose one of the following::
A. Placing the infant in a supine position on a firm mattress while sleeping
B. Keeping the infant covered and maintaining a high room temperature
C. Application of a device to maintain the sleeping position
D. Avoiding pacifier use during sleep | [
0.04293583333492279,
-0.02980363368988037,
0.018573299050331116,
-0.04176231101155281,
0.0027881592977792025,
-0.005306230392307043,
-0.013410243205726147,
0.004804094322025776,
-0.04939677193760872,
-0.03028998337686062,
0.07743054628372192,
-0.0014506119769066572,
-0.00214918190613389,
-0.07971066981554031,
-0.00406328309327364,
0.018445346504449844,
0.022397823631763458,
-0.013206840492784977,
-0.01783139258623123,
0.021399717777967453,
0.003413522383198142,
0.07141940295696259,
-0.0020826212130486965,
-0.04542846605181694,
0.012443100102245808,
0.041201140731573105,
-0.031033990904688835,
-0.06419702619314194,
-0.038098886609077454,
-0.053941138088703156,
0.020981883630156517,
-0.021655861288309097,
-0.0016502626240253448,
-0.06677103042602539,
0.0000016805249742901651,
0.030279777944087982,
-0.001416164101101458,
-0.00244629243388772,
-0.013864795677363873,
-0.06763474643230438,
-0.03699397295713425,
-0.037329744547605515,
0.0072891912423074245,
0.006824561394751072,
-0.013442245312035084,
-0.023687392473220825,
0.0037787335459142923,
0.04903862252831459,
-0.07822294533252716,
0.03762361407279968,
0.005644176620990038,
-0.016048911958932877,
-0.010323460213840008,
0.02545071393251419,
0.015932627022266388,
-0.008575217798352242,
0.0005853766924701631,
0.030170409008860588,
0.027677437290549278,
-0.019832825288176537,
0.0013880908954888582,
0.037046194076538086,
-0.011598041281104088,
-0.004201560281217098,
-0.01082461979240179,
-0.04198627918958664,
0.018887249752879143,
-0.11059397459030151,
-0.03739723190665245,
-0.015146385878324509,
-0.059599753469228745,
0.014884792268276215,
0.023255474865436554,
0.02178400382399559,
-0.05265292152762413,
-0.019216513261198997,
0.030908256769180298,
0.003668043529614806,
0.04083378240466118,
-0.02092735841870308,
0.01969701610505581,
0.06270495802164078,
-0.012551327235996723,
0.023897239938378334,
0.032077569514513016,
0.010263108648359776,
-0.004740111064165831,
-0.015686964616179466,
-0.0183741245418787,
0.027824766933918,
0.007438872009515762,
0.00997998658567667,
-0.05293883755803108,
-0.028951698914170265,
0.004955403972417116,
0.0215174350887537,
-0.008758812211453915,
0.0026450594887137413,
0.04709499701857567,
-0.060223087668418884,
-0.005260193254798651,
-0.05192755162715912,
0.025413719937205315,
0.007397014182060957,
0.007891019806265831,
-0.0755862146615982,
0.004319225903600454,
-0.017614323645830154,
-0.037875112146139145,
0.051880352199077606,
-0.0012776744551956654,
0.011366038583219051,
0.013328249566257,
0.06869278848171234,
0.10822703689336777,
0.04988470673561096,
0.018999826163053513,
-0.046368058770895004,
0.05677787587046623,
0.028025971725583076,
-0.04250451177358627,
-0.019162850454449654,
-0.03138076514005661,
0.02250630222260952,
-0.016819749027490616,
-0.03669854253530502,
0.06462069600820541,
0.053058285266160965,
-0.03134370222687721,
0.00166249496396631,
0.015812193974852562,
0.020847609266638756,
-0.005989914759993553,
0.013567162677645683,
0.013363128527998924,
-0.008995866402983665,
0.011174961924552917,
0.04539909213781357,
-0.052326567471027374,
0.02078201249241829,
-0.0022367772180587053,
-0.0522567555308342,
-0.0033368198201060295,
0.03305661678314209,
-0.06650605797767639,
0.027969300746917725,
-0.022017452865839005,
0.005015495698899031,
0.03826947882771492,
-0.0005449179443530738,
0.02854345552623272,
-0.022912735119462013,
-0.002962471917271614,
-0.012363139539957047,
0.026062369346618652,
0.025603504851460457,
0.006949321366846561,
0.0380416177213192,
0.030445512384176254,
-0.03927973657846451,
0.040631890296936035,
-0.0055488585494458675,
0.004753937479108572,
-0.015648407861590385,
0.008496595546603203,
-0.006294430699199438,
0.027190862223505974,
0.034614771604537964,
-0.0581299252808094,
-0.0386551134288311,
-0.05061205476522446,
-0.04067549109458923,
0.028850020840764046,
0.008616219274699688,
-0.022122886031866074,
0.024336351081728935,
-0.10783568769693375,
0.010905691422522068,
0.052579592913389206,
-0.06204649806022644,
-0.00954605732113123,
0.06676248461008072,
0.007664609234780073,
-0.021358991041779518,
-0.0067164478823542595,
-0.029262548312544823,
-0.029595430940389633,
-0.05188971385359764,
0.003896454581990838,
0.0033565089106559753,
-0.012433445081114769,
0.0251991618424654,
-0.0032144696451723576,
0.0019831093959510326,
-0.013371231965720654,
0.04057144746184349,
-0.007052605040371418,
0.014252394437789917,
-0.04130532965064049,
0.007272889371961355,
0.014948206953704357,
-0.013943210244178772,
0.01327822171151638,
0.013664856553077698,
-0.0394706204533577,
0.02133212611079216,
-0.02769416570663452,
0.00813431665301323,
0.0029999001417309046,
-0.01779692806303501,
-0.0360250249505043,
0.03957683965563774,
0.05314605310559273,
-0.004042268730700016,
-0.0058993985876441,
-0.004373454954475164,
0.017410768195986748,
0.0034080378245562315,
-0.06782033294439316,
0.053276073187589645,
-0.019371936097741127,
0.05718274414539337,
-0.013478731736540794,
0.014218061231076717,
-0.016380351036787033,
-0.04827100783586502,
-0.004676540847867727,
-0.021591655910015106,
0.004896838217973709,
-0.041021928191185,
0.07429329305887222,
0.012544711120426655,
-0.044081393629312515,
-0.017568061128258705,
-0.03521207347512245,
0.010132506489753723,
-0.020052693784236908,
-0.05590299144387245,
-0.015919869765639305,
-0.054372746497392654,
-0.0505509115755558,
0.011746975593268871,
-0.039009835571050644,
-0.04554279148578644,
-0.011323679238557816,
-0.0659886822104454,
0.010611772537231445,
0.008095012046396732,
-0.01847907528281212,
-0.012950262054800987,
-0.03496049717068672,
-0.0013259921688586473,
-0.0006045229965820909,
0.026149271056056023,
0.03021528199315071,
-0.005780823063105345,
-0.0007762592285871506,
0.06189217418432236,
-0.020788442343473434,
-0.03614804148674011,
-0.01389767974615097,
0.007533889263868332,
0.029388276860117912,
-0.012835592031478882,
-0.00028695157379843295,
-0.0586405023932457,
0.046930741518735886,
0.025583595037460327,
0.02730538323521614,
0.028514791280031204,
0.023200200870633125,
0.002876871032640338,
0.03794192150235176,
0.024046016857028008,
0.011633653193712234,
-0.026992935687303543,
0.019519200548529625,
-0.036215055733919144,
0.022851912304759026,
-0.025029251351952553,
-0.016881506890058517,
0.013089146465063095,
0.009315883740782738,
0.014456937089562416,
-0.015180546790361404,
0.019544649869203568,
0.0012947572395205498,
-0.04698538780212402,
0.03213784843683243,
-0.0024449662305414677,
-0.0060697440057992935,
0.03215114772319794,
0.01519226934760809,
0.0018980581080541015,
-0.026301175355911255,
-0.026661492884159088,
-0.040110230445861816,
0.003851881017908454,
-0.024697288870811462,
-0.02226749062538147,
0.030749140307307243,
0.07096963375806808,
0.04485262185335159,
0.0024419052060693502,
-0.021037759259343147,
0.05449076369404793,
0.015759648755192757,
0.03707055747509003,
-0.07841993868350983,
0.04531782865524292,
0.04737892374396324,
-0.059803303331136703,
0.016331583261489868,
0.02721434459090233,
-0.06570964306592941,
0.002705350983887911,
-0.007985791191458702,
-0.09955676645040512,
0.03647422045469284,
0.09976641088724136,
0.07421579211950302,
-0.005873928777873516,
-0.016939906403422356,
0.0261713694781065,
-0.024239223450422287,
-0.04618247225880623,
-0.03587770834565163,
-0.0117303766310215,
-0.00453402241691947,
-0.023510858416557312,
-0.010591280646622181,
-0.05164836347103119,
-0.0153850968927145,
-0.04805024340748787,
-0.02766384743154049,
0.09051049500703812,
-0.008460604585707188,
-0.08827588707208633,
-0.019787456840276718,
0.02868303284049034,
-0.008854446932673454,
-0.03991863876581192,
0.02899128384888172,
-0.0766187459230423,
-0.02400299906730652,
-0.0022288637701421976,
-0.06055677309632301,
0.003620361676439643,
-0.020582906901836395,
0.015294214710593224,
-0.05433841422200203,
-0.036826781928539276,
-0.002211739541962743,
-0.005575657356530428,
-0.021304642781615257,
-0.0019419185118749738,
0.031870171427726746,
-0.002200609538704157,
0.022746078670024872,
-0.0039579616859555244,
0.0639931932091713,
-0.015227757394313812,
0.0018187032546848059,
0.08127287030220032,
-0.0002796494518406689,
0.028683651238679886,
0.019326426088809967,
0.03391154110431671,
-0.014607380144298077,
-0.009235088713467121,
-0.00044639260158874094,
0.014977263286709785,
0.0058478694409132,
-0.01892201229929924,
-0.02756335213780403,
0.0259542353451252,
-0.011661281809210777,
-0.08852465450763702,
-0.10330698639154434,
-0.041601214557886124,
0.03859556093811989,
-0.06212599575519562,
0.03775594383478165,
-0.0040551722049713135,
-0.03352506086230278,
-0.011843602173030376,
0.015234649181365967,
-0.005356490146368742,
0.040661077946424484,
0.04625411704182625,
-0.01694595441222191,
0.038906510919332504,
0.0068109966814517975,
-0.02639055624604225,
0.03352547064423561,
-0.009997929446399212,
0.07375489920377731,
0.03213917836546898,
0.019334662705659866,
0.03675663471221924,
-0.012908263131976128,
0.0029698829166591167,
-0.0008032806217670441,
0.03612932562828064,
0.009018306620419025,
-0.005945132579654455,
-0.03153399005532265,
-0.06342588365077972,
0.015073503367602825,
-0.008293728344142437,
0.03919030353426933,
-0.0026964806020259857,
-0.05735576152801514,
0.003085874719545245,
-0.03950389102101326,
0.03537765145301819,
-0.003786595771089196,
-0.0006901715532876551,
-0.00613867724314332,
-0.007659482769668102,
0.0034997547045350075,
-0.0023629365023225546,
0.027676112949848175,
-0.10989410430192947,
-0.08407346904277802,
-0.05443549528717995,
0.09353739023208618,
-0.0019477534806355834,
0.012194396927952766,
-0.006927831098437309,
-0.03481265902519226,
-0.017188725993037224,
0.06852404028177261,
0.0032929526641964912,
-0.014652459882199764,
-0.00626635504886508,
-0.05945926532149315,
-0.013605508022010326,
-0.021436212584376335,
-0.03423822671175003,
0.04600134491920471,
-0.036314815282821655,
0.03345412760972977,
0.02405177801847458,
0.05055706948041916,
0.07728533446788788,
0.06662333756685257,
0.0019983879756182432,
-0.02733105979859829,
0.04306231811642647,
-0.04496164247393608,
0.005016598850488663,
0.03641611710190773,
0.02913472428917885,
-0.024197211489081383,
0.016851771622896194,
-0.032602373510599136,
-0.019936630502343178,
0.018229609355330467,
-0.05851040408015251,
-0.018680794164538383,
-0.007451467216014862,
0.04122141748666763,
-0.09842599928379059,
0.005058975424617529,
-0.0070323278196156025,
-0.007150769233703613,
0.030513737350702286,
-0.0439138263463974,
-0.002354579046368599,
-0.08311302214860916,
0.027272026985883713,
-0.01458805613219738,
0.014745280146598816,
-0.0352177768945694,
0.010599304921925068,
-0.03467698395252228,
-0.03042702004313469,
0.0350966639816761,
0.020624475553631783,
-0.007959358394145966,
0.012347095645964146,
-0.011699982918798923,
0.03714768961071968,
-0.0018074387917295098,
0.012878327630460262,
0.0076165939681231976,
-0.0467400848865509,
-0.017015833407640457,
0.03633568808436394,
0.04359959065914154,
0.03469349071383476,
-0.005522398743778467,
0.0007830287213437259,
-0.024820171296596527,
-0.07938910275697708,
0.009920231997966766,
0.0972224548459053,
0.016029544174671173,
0.022622806951403618,
0.015231241472065449,
0.039936237037181854,
0.010913762263953686,
0.023521889001131058,
0.010381092317402363,
0.010093257762491703,
-0.03848611190915108,
-0.014943473041057587,
-0.022265242412686348,
-0.07742895931005478,
-0.012355958111584187,
-0.027191096916794777,
0.02253665030002594,
0.039155784994363785,
-0.02904069796204567,
-0.012980139814317226,
-0.028794627636671066,
-0.0568951852619648,
-0.07953193038702011,
0.027908917516469955,
-0.008680541068315506,
0.025615496560931206,
0.008097408339381218,
0.03195733204483986,
0.03431849554181099,
0.012656536884605885,
-0.0038440527860075235,
-0.01656411960721016,
-0.011162498965859413,
0.04882589727640152,
0.008436924777925014,
-0.027315566316246986,
-0.003504261141642928,
0.00278567336499691,
0.018703946843743324,
0.01602867804467678,
-0.01399873849004507,
-0.019190212711691856,
0.007545763161033392,
-0.03977705165743828,
0.032548144459724426,
0.0028871812392026186,
-0.0131539236754179,
0.0045204199850559235,
-0.008045337162911892,
0.06920745968818665,
-0.024116773158311844,
-0.009783202782273293,
0.0704113095998764,
-0.04037083685398102,
0.010721058584749699,
-0.005660000257194042,
0.04932159557938576,
0.020168691873550415,
0.017463302239775658,
-5.465797102064164e-33,
0.035061199218034744,
-0.01662186160683632,
0.07487925887107849,
-0.03356224671006203,
0.06270851194858551,
0.05883030965924263,
-0.016321325674653053,
0.055290400981903076,
0.01585397683084011,
0.015224023722112179,
-0.017571108415722847,
0.020296407863497734,
0.013698079623281956,
0.03465576097369194,
0.0524195171892643,
-0.0004171544569544494,
-0.047813910990953445,
-0.017026342451572418,
-0.008098321966826916,
0.030427072197198868,
-0.05391737446188927,
-0.029613103717565536,
-0.021961834281682968,
-0.0032982174307107925,
-0.00045969628263264894,
-0.03216737136244774,
-0.01061927154660225,
-0.02822287008166313,
-0.0337626151740551,
0.008432074449956417,
-0.025770794600248337,
-0.05740732327103615,
0.011832018382847309,
-0.04914817586541176,
-0.03950843960046768,
-0.026980943977832794,
0.020780203863978386,
-0.034822020679712296,
0.10372328758239746,
-0.040205907076597214,
-0.10436972230672836,
-0.0026420019567012787,
0.05650154873728752,
0.0208544060587883,
0.06817633658647537,
-0.03146521747112274,
-0.03721507638692856,
-0.013928956352174282,
0.03901692107319832,
-0.04105321317911148,
0.005781473591923714,
0.022007865831255913,
0.026176512241363525,
-0.017454134300351143,
0.05617494881153107,
-0.07708762586116791,
-0.026604261249303818,
-0.043566614389419556,
0.02435864880681038,
-0.019796112552285194,
-0.013478798791766167,
0.029908228665590286,
-0.03984835371375084,
-0.04081803560256958,
-0.010181179270148277,
-0.00605727918446064,
0.008892134763300419,
0.09211347252130508,
-0.04134198650717735,
0.04546419531106949,
0.012333119288086891,
0.07377290725708008,
0.042349591851234436,
-0.007043746300041676,
-0.018346961587667465,
-0.01042863167822361,
-0.00866085384041071,
0.012235583737492561,
0.01175893284380436,
-0.00989063736051321,
-0.03659737482666969,
0.01563461683690548,
0.018966006115078926,
0.02112620696425438,
-0.004596178885549307,
0.02218346856534481,
-0.01534821093082428,
0.07797275483608246,
-0.027728691697120667,
0.013190091587603092,
0.026591990143060684,
0.021569058299064636,
0.0016830877866595984,
-0.004131551831960678,
0.03703960031270981,
-0.02644943818449974,
0.0455186702311039,
-0.01620457135140896,
0.0059775603003799915,
-0.012324362061917782,
0.0695943757891655,
0.006052702199667692,
0.029086440801620483,
-0.004839958157390356,
-0.013533315621316433,
-0.023201055824756622,
0.045928068459033966,
0.058857060968875885,
0.030727941542863846,
-0.03236992657184601,
0.019696468487381935,
-0.032683975994586945,
0.07528557628393173,
-0.04451663792133331,
-0.04028071463108063,
0.07384880632162094,
0.0220035333186388,
-0.011599848978221416,
0.03902559354901314,
0.014602317474782467,
0.009058328345417976,
0.07103828340768814,
-0.02294517681002617,
0.01696660928428173,
-0.01956063136458397,
-0.08468052744865417,
0.028793279081583023,
0.040089260786771774,
-0.03561152517795563,
0.022693779319524765,
0.02326297014951706,
0.04860348999500275,
2.4226039840868907e-7,
0.030759504064917564,
-0.025910988450050354,
-0.012789858505129814,
-0.08038774132728577,
0.024365298449993134,
-0.050024744123220444,
-0.017946463078260422,
-0.007533949799835682,
0.02565634436905384,
0.02404220961034298,
0.08175947517156601,
-0.0556342788040638,
0.0018554311245679855,
0.04165913909673691,
-0.01656419038772583,
0.04802168533205986,
0.03927159309387207,
0.033766064792871475,
-0.005787485279142857,
-0.04531118646264076,
0.011462187394499779,
-0.017697196453809738,
-0.04611200466752052,
-0.028257843106985092,
-0.020757585763931274,
0.006285644602030516,
-0.005215590354055166,
-0.04794758930802345,
0.011798509396612644,
-0.01649794727563858,
0.026674356311559677,
0.10657114535570145,
0.033078715205192566,
0.011155538260936737,
-0.047508351504802704,
-0.041402120143175125,
0.015056006610393524,
0.08395446836948395,
0.02293814904987812,
0.01663491129875183,
0.039482127875089645,
0.021964162588119507,
-0.01829543709754944,
0.017363881692290306,
0.03821776807308197,
0.05413447320461273,
-0.009730876423418522,
0.027385957539081573,
-0.03073558397591114,
-0.0013323267921805382,
-0.012882435694336891,
0.038305748254060745,
-0.018338359892368317,
0.06534527987241745,
-0.01919654570519924,
-0.03504374995827675,
-0.051281679421663284,
0.06288758665323257,
0.024570398032665253,
0.06675881892442703,
0.05828537046909332,
-0.09802055358886719,
0.04678291082382202,
-0.03599732741713524,
-0.009080879390239716,
-0.0015827862080186605,
0.004435512237250805,
1.1609773399727428e-34,
-0.030283182859420776,
-0.06061447784304619,
0.0023242654278874397,
-0.004934663884341717,
0.028388194739818573,
-0.002390666166320443,
0.041726525872945786,
-0.002803546143695712,
0.014739387668669224,
-0.022519294172525406,
0.01714177615940571
] | {
"ds_index": 1,
"similar_dg_indices": [
415219,
1158853,
772480,
117515,
134916,
989137,
484455,
889741,
1024245,
37420,
165385,
634062,
879300,
1093361,
1067247,
508740,
747999,
364659,
838908,
540018
]
} |
A mother brings her 3-week-old infant to the pediatrician's office because she is concerned about his feeding habits. He was born without complications and has not had any medical problems up until this time. However, for the past 4 days, he has been fussy, is regurgitating all of his feeds, and his vomit is yellow in color. On physical exam, the child's abdomen is minimally distended but no other abnormalities are appreciated. Which of the following embryologic errors could account for this presentation? | Abnormal migration of ventral pancreatic bud | {
"A": "Abnormal migration of ventral pancreatic bud",
"B": "Complete failure of proximal duodenum to recanalize",
"C": "Abnormal hypertrophy of the pylorus",
"D": "Failure of lateral body folds to move ventrally and fuse in the midline"
} | step1 | A | [
"mother",
"week old infant",
"pediatrician's office",
"concerned",
"feeding habits",
"born",
"complications",
"not",
"medical problems",
"time",
"past",
"days",
"fussy",
"regurgitating",
"feeds",
"vomit",
"yellow",
"color",
"physical exam",
"child's abdomen",
"distended",
"abnormalities",
"following embryologic errors",
"account",
"presentation"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A mother brings her 3-week-old infant to the pediatrician's office because she is concerned about his feeding habits. He was born without complications and has not had any medical problems up until this time. However, for the past 4 days, he has been fussy, is regurgitating all of his feeds, and his vomit is yellow in color. On physical exam, the child's abdomen is minimally distended but no other abnormalities are appreciated. Which of the following embryologic errors could account for this presentation?
Choose one of the following::
A. Abnormal migration of ventral pancreatic bud
B. Complete failure of proximal duodenum to recanalize
C. Abnormal hypertrophy of the pylorus
D. Failure of lateral body folds to move ventrally and fuse in the midline | [
0.026952698826789856,
-0.031756412237882614,
0.004452844150364399,
-0.019596818834543228,
0.030684635043144226,
-0.005236943252384663,
-0.008118001744151115,
0.022362463176250458,
-0.04767468571662903,
-0.012683065608143806,
0.03719678893685341,
-0.03232448548078537,
0.031261686235666275,
0.005271419882774353,
0.015393228270113468,
0.00898622814565897,
0.022290142253041267,
-0.0027600491885095835,
-0.00994165986776352,
0.030857812613248825,
-0.037789877504110336,
0.025670597329735756,
0.02610698901116848,
-0.0561327300965786,
-0.0038227504119277,
0.016384826973080635,
-0.015112549997866154,
0.012022111564874649,
-0.06635738164186478,
-0.03472020477056503,
0.02393965795636177,
0.013090977445244789,
-0.01508482825011015,
0.014415238983929157,
0.0000018898722373705823,
0.05855253338813782,
-0.003589387983083725,
-0.025254912674427032,
-0.038805216550827026,
0.014590086415410042,
-0.03669958934187889,
-0.03294258937239647,
-0.02924002893269062,
-0.020121410489082336,
0.028343530371785164,
-0.051730092614889145,
-0.00035652299993671477,
0.09318748116493225,
-0.026317261159420013,
-0.008443816564977169,
0.02551981806755066,
0.019231831654906273,
0.005307458341121674,
0.018039416521787643,
0.02541828155517578,
0.02367441914975643,
-0.023822857066988945,
0.026006806641817093,
-0.00888445321470499,
0.0075028459541499615,
0.020783130079507828,
0.007443223614245653,
0.01972283609211445,
0.0028787930496037006,
-0.02598022110760212,
-0.026782965287566185,
0.032264091074466705,
-0.08392497152090073,
0.00013900600606575608,
0.0327397882938385,
0.019567131996154785,
-0.0018733468605205417,
0.01083910372108221,
0.04219033569097519,
-0.02414124831557274,
-0.06589662283658981,
0.06150009110569954,
0.03010343201458454,
-0.032714419066905975,
0.010643864050507545,
0.03100241906940937,
-0.011298170313239098,
-0.006971719209104776,
0.04749329760670662,
0.01999843679368496,
-0.03402184695005417,
0.008660400286316872,
-0.06535053998231888,
-0.07647771388292313,
0.005840211641043425,
-0.004165299236774445,
0.0002223239716840908,
-0.011364016681909561,
0.009844421409070492,
0.005339523311704397,
0.03677595406770706,
-0.0528547465801239,
-0.037621062248945236,
0.006776881404221058,
-0.011928344145417213,
0.02387118525803089,
-0.0807986930012703,
-0.04177509993314743,
0.02219606190919876,
0.00044666900066658854,
0.02999463863670826,
0.01803133636713028,
0.027643751353025436,
-0.021197358146309853,
0.05881674960255623,
0.03144397959113121,
0.003201347077265382,
-0.037123903632164,
0.02267618663609028,
0.022851986810564995,
0.003479828592389822,
0.04125465452671051,
-0.0521220862865448,
-0.027330676093697548,
0.03260849043726921,
0.00039749982533976436,
0.035389602184295654,
-0.037408530712127686,
-0.001003389828838408,
-0.06497592478990555,
0.004158772993832827,
0.05165817588567734,
0.02599259652197361,
-0.010108076967298985,
-0.010182539001107216,
-0.027388479560613632,
-0.03020116686820984,
-0.06540805846452713,
0.07060004025697708,
-0.019800325855612755,
0.01131505984812975,
0.038372062146663666,
-0.00004665000597015023,
-0.049428585916757584,
0.0039878725074231625,
-0.03893737494945526,
-0.04939771816134453,
-0.04930444061756134,
0.03779718279838562,
-0.05518495664000511,
0.017375469207763672,
-0.014424743130803108,
-0.0037758576218038797,
0.04772114381194115,
0.03946284204721451,
-0.00446949852630496,
-0.06990209221839905,
-0.03923432528972626,
-0.009168279357254505,
0.0008572391816414893,
0.040768515318632126,
0.0177187267690897,
-0.02430420182645321,
-0.033721912652254105,
-0.06824993342161179,
0.0007428508251905441,
-0.03898189589381218,
-0.010878478176891804,
-0.05111143738031387,
-0.003926291596144438,
0.00392648670822382,
0.016680791974067688,
-0.0035379778128117323,
-0.06474022567272186,
0.01764560118317604,
0.003032520180568099,
0.00419241888448596,
0.026292281225323677,
0.011156474240124226,
0.006061260588467121,
0.01707415282726288,
-0.09590902924537659,
-0.04795417562127113,
0.039390355348587036,
-0.019489269703626633,
0.024266349151730537,
0.05678018182516098,
0.0006339882384054363,
0.005087005440145731,
-0.03910766541957855,
-0.036671437323093414,
-0.002636662218719721,
0.04813063144683838,
-0.03916425257921219,
-0.00027716776821762323,
-0.02325129508972168,
0.04173783212900162,
-0.03455708920955658,
-0.03883872926235199,
-0.016913970932364464,
0.08740615099668503,
-0.034641362726688385,
0.004969192203134298,
0.011719556525349617,
0.005241623148322105,
-0.0010189329041168094,
-0.005806443747133017,
0.018298296257853508,
0.023443305864930153,
-0.03172505274415016,
0.04383910447359085,
-0.03645087406039238,
0.027521109208464622,
-0.05747077241539955,
-0.014004136435687542,
0.019862504675984383,
-0.031005779281258583,
-0.003687335178256035,
0.019394127652049065,
-0.012581968680024147,
0.03406878933310509,
0.030915575101971626,
-0.012231852859258652,
-0.052327126264572144,
0.04819866642355919,
-0.011606556363403797,
-0.003698555286973715,
0.010729188099503517,
-0.008940929546952248,
-0.0059802234172821045,
-0.00977652333676815,
0.012063367292284966,
0.010846628807485104,
-0.0020551378838717937,
-0.03242585435509682,
0.045188747346401215,
0.02750219590961933,
-0.05180298537015915,
0.06780781596899033,
-0.007558261044323444,
0.006289119832217693,
-0.03354567289352417,
-0.07946359366178513,
0.0021360579412430525,
0.029174264520406723,
-0.06259243935346603,
-0.023858943954110146,
-0.057517845183610916,
-0.034437648952007294,
0.04889455810189247,
-0.04607512801885605,
0.029044736176729202,
0.02235022373497486,
0.021417587995529175,
0.027256254106760025,
-0.012801025062799454,
-0.0008885557763278484,
-0.01071672048419714,
-0.018035098910331726,
0.029289403930306435,
-0.01469527930021286,
-0.00664043752476573,
-0.004332546144723892,
-0.042309291660785675,
-0.001163047505542636,
-0.032090529799461365,
0.03927038237452507,
-0.008931735530495644,
-0.06105681136250496,
0.003983589354902506,
-0.045271698385477066,
0.015185277909040451,
0.0458545908331871,
-0.00026981745031662285,
0.03805878385901451,
0.013023585081100464,
0.0321534164249897,
-0.004127229563891888,
0.031360384076833725,
-0.021197989583015442,
-0.00908779539167881,
0.0403074212372303,
0.0015829154290258884,
0.014094994403421879,
0.0010057579493150115,
-0.017785130068659782,
0.01999342255294323,
-0.005750549491494894,
0.009082571603357792,
0.0007912034634500742,
-0.021306686103343964,
-0.026033367961645126,
0.013289516791701317,
0.010816157795488834,
-0.038886658847332,
-0.015470657497644424,
-0.0038373752031475306,
0.030906302854418755,
-0.034293174743652344,
-0.019047053530812263,
0.0005824223044328392,
-0.022796407341957092,
0.05750856176018715,
-0.018135569989681244,
0.07958102971315384,
-0.04980826377868652,
0.0007297837291844189,
-0.016798127442598343,
-0.003884080331772566,
0.021452173590660095,
0.07755430787801743,
0.019278816878795624,
0.01794976182281971,
-0.00794163253158331,
0.0462522953748703,
0.04306434467434883,
0.004519779235124588,
-0.004366716835647821,
0.06131935492157936,
-0.0016993844183161855,
0.00597862945869565,
-0.002250098157674074,
-0.0827520415186882,
0.04403633624315262,
0.03318629786372185,
0.03702609986066818,
0.006013911217451096,
-0.013729983009397984,
-0.033290281891822815,
0.0034217541106045246,
0.0342683345079422,
-0.02289932779967785,
-0.007470022886991501,
-0.03877894580364227,
-0.00006315756763797253,
-0.013698553666472435,
0.012069986201822758,
-0.04367605224251747,
-0.03695018216967583,
0.05342189222574234,
0.022863324731588364,
-0.02782389149069786,
0.028883695602416992,
-0.0669754147529602,
-0.016390882432460785,
-0.0037305301520973444,
-0.036565035581588745,
0.022396044805645943,
0.004387847147881985,
0.051087718456983566,
-0.058118242770433426,
-0.03456050157546997,
-0.020413625985383987,
-0.07453306019306183,
0.038123082369565964,
-0.09196487814188004,
-0.04653671011328697,
0.02017802745103836,
-0.006429808679968119,
-0.022118620574474335,
-0.04002529755234718,
-0.003328246297314763,
0.06093776971101761,
0.02309304103255272,
-0.026187045499682426,
0.038446053862571716,
0.02648448385298252,
-0.08205142617225647,
0.07503026723861694,
0.016508635133504868,
0.03885039687156677,
0.041592150926589966,
0.005532903131097555,
-0.036096274852752686,
-0.028286021202802658,
0.01252103690057993,
-0.010896765626966953,
-0.0260198675096035,
-0.04558248445391655,
-0.018490038812160492,
0.040104225277900696,
-0.01068007480353117,
0.007336673326790333,
-0.0820322036743164,
-0.021052243188023567,
0.058922696858644485,
-0.02157559245824814,
0.025193804875016212,
0.028447961434721947,
0.009282020851969719,
-0.05064099282026291,
-0.0651073232293129,
-0.01718796230852604,
-0.004373507108539343,
0.04703975096344948,
0.025424201041460037,
0.04983924701809883,
-0.08035049587488174,
-0.007123506162315607,
0.037688884884119034,
0.03521806001663208,
0.046658750623464584,
-0.028691720217466354,
0.012582377530634403,
0.05362023040652275,
0.014610839076340199,
0.013610991649329662,
-0.09195924550294876,
0.044073350727558136,
0.06720944494009018,
0.005329350009560585,
-0.0866895243525505,
-0.05152306705713272,
0.021694665774703026,
-0.01817634142935276,
0.014846385456621647,
0.00046513162669725716,
0.008138871751725674,
0.0053045484237372875,
-0.019467564299702644,
-0.012186619453132153,
-0.000814251892734319,
-0.0866197720170021,
-0.012153816409409046,
-0.04573534056544304,
0.012514629401266575,
-0.034792326390743256,
0.049354467540979385,
-0.038428209722042084,
-0.0025617743376642466,
-0.004642785992473364,
0.020561937242746353,
0.050183698534965515,
0.008830404840409756,
0.010520966723561287,
-0.007885112427175045,
-0.048084184527397156,
0.049170758575201035,
0.026978885754942894,
0.016921499744057655,
0.05766022950410843,
0.06859327852725983,
0.006299785804003477,
-0.03675451502203941,
-0.0016060082707554102,
0.014909220859408379,
-0.06324759125709534,
0.0346849262714386,
0.047212760895490646,
-0.022747617214918137,
-0.02567949704825878,
-0.045287229120731354,
0.0361577644944191,
0.014562507160007954,
0.10098765790462494,
-0.04039105772972107,
-0.05497331544756889,
0.0035345430951565504,
0.010592464357614517,
-0.006915947422385216,
0.03497667610645294,
-0.018758919090032578,
-0.023622848093509674,
0.049954358488321304,
-0.06832417100667953,
-0.03179190680384636,
0.00047026577522046864,
-0.03991089388728142,
-0.09154731780290604,
0.04708980768918991,
-0.02078556828200817,
0.0014587042387574911,
0.06090446189045906,
0.030395042151212692,
-0.018291383981704712,
-0.09623932838439941,
0.03651638701558113,
-0.01152062602341175,
0.010150320827960968,
-0.015866031870245934,
0.012561840936541557,
-0.01368582434952259,
-0.02689400129020214,
0.002189379185438156,
0.01348560955375433,
-0.02567412331700325,
0.07791875302791595,
-0.015979604795575142,
-0.06390894949436188,
0.03411261737346649,
0.0027290794532746077,
0.047313135117292404,
-0.02319273352622986,
0.004390318877995014,
0.046008069068193436,
0.06338412314653397,
0.010382710956037045,
0.016536276787519455,
0.00795595534145832,
-0.057025182992219925,
0.015154779888689518,
0.045797284692525864,
0.059013497084379196,
0.046714749187231064,
-0.03037511743605137,
-0.021285416558384895,
0.042459845542907715,
0.034232817590236664,
0.014178774319589138,
-0.00350080244243145,
0.007230846211314201,
-0.05522223562002182,
0.024188058450818062,
-0.0441121980547905,
-0.020847003906965256,
0.03331936150789261,
-0.019590092822909355,
0.04664170369505882,
0.04606759920716286,
-0.03139583021402359,
-0.05019798502326012,
-0.05517628416419029,
-0.008999517187476158,
-0.06760913878679276,
0.031201737001538277,
-0.001968831056728959,
0.011219685897231102,
-0.028972169384360313,
-0.014287905767560005,
-0.015158954076468945,
0.049767687916755676,
0.00991941336542368,
-0.009889212436974049,
-0.030200084671378136,
0.057696372270584106,
-0.056048739701509476,
0.023541955277323723,
-0.025818368420004845,
0.0038456120528280735,
0.019737929105758667,
-0.03102235123515129,
0.05351845175027847,
-0.04434211179614067,
0.006361383479088545,
-0.020518993958830833,
-0.0211475919932127,
0.00960691086947918,
-0.06645217537879944,
0.020879479125142097,
-0.008264324627816677,
0.0637609139084816,
-0.015607411041855812,
0.029544174671173096,
0.09795504063367844,
0.019940687343478203,
-0.0077943988144397736,
0.00514349527657032,
0.039404161274433136,
0.0450722873210907,
0.05548560619354248,
-5.172552771178267e-33,
-0.012428982183337212,
-0.0037460278254002333,
0.04646172747015953,
-0.02248610556125641,
0.02704981155693531,
0.08480268716812134,
0.023663442581892014,
0.025254465639591217,
-0.020883578807115555,
0.006654900033026934,
-0.03411125764250755,
-0.034191254526376724,
0.00930817611515522,
0.037469036877155304,
0.0210709385573864,
-0.01167905144393444,
-0.0002763024822343141,
-0.04063327983021736,
0.014957227744162083,
0.0032474228646606207,
-0.012864591553807259,
-0.015306024812161922,
-0.03480803593993187,
0.00979115441441536,
-0.01563086174428463,
-0.03413667902350426,
0.05768880620598793,
0.017164478078484535,
0.003162981476634741,
-0.036721713840961456,
0.0174457635730505,
-0.07341709733009338,
-0.02324517071247101,
-0.037630293518304825,
-0.08020368963479996,
-0.08007479459047318,
0.03493621200323105,
-0.013657716102898121,
0.012953529134392738,
-0.008480374701321125,
-0.08892089128494263,
0.03850319981575012,
0.04604000970721245,
0.01284612063318491,
0.03155039623379707,
-0.025904053822159767,
-0.01895645633339882,
-0.015652108937501907,
-0.02401980198919773,
0.00010435315925860777,
-0.011005128733813763,
0.0008321956847794354,
0.0008397248457185924,
-0.008115029893815517,
0.026608726009726524,
-0.03528495505452156,
0.009508426301181316,
-0.08068229258060455,
0.04183443635702133,
-0.016653498634696007,
0.012363063171505928,
-0.012455340474843979,
-0.009661138989031315,
-0.034869417548179626,
0.0033023080322891474,
0.024461081251502037,
0.02815462090075016,
0.07583294808864594,
-0.0634203553199768,
0.019456351175904274,
-0.01472481433302164,
0.019447151571512222,
-0.019416451454162598,
-0.10822994261980057,
-0.0004099212819710374,
-0.034263819456100464,
0.04811219125986099,
0.02523854188621044,
-0.04093695431947708,
0.028154157102108,
-0.039719197899103165,
-0.031952910125255585,
-0.04031100496649742,
0.008810737170279026,
-0.01579219661653042,
-0.058638542890548706,
-0.003719417378306389,
-0.0012465264881029725,
-0.02438032068312168,
-0.005458810366690159,
0.09648627042770386,
0.0038505771663039923,
-0.012976457364857197,
0.0420897901058197,
-0.04871559143066406,
-0.03461821377277374,
0.09050735831260681,
-0.01552029512822628,
-0.031962793320417404,
0.04493025317788124,
0.038158465176820755,
-0.01695971190929413,
0.00795210525393486,
-0.01013211626559496,
-0.020043622702360153,
0.029579434543848038,
-0.0025102130603045225,
0.01595199666917324,
-0.01263690460473299,
-0.03542221337556839,
0.026136033236980438,
-0.014241091907024384,
0.04311199486255646,
-0.014913655817508698,
-0.0176352821290493,
0.050460170954465866,
0.013624146580696106,
-0.00920784194022417,
0.009289992973208427,
0.08265295624732971,
0.009475518949329853,
0.02225225791335106,
-0.04313415288925171,
0.011803052388131618,
-0.034406375139951706,
-0.09264922887086868,
0.006155233830213547,
0.03218089044094086,
-0.006433847825974226,
0.031730376183986664,
0.05092770233750343,
0.022759465500712395,
2.725266767811263e-7,
0.00740983709692955,
0.01678442396223545,
-0.02615078166127205,
-0.07590862363576889,
0.04245689883828163,
-0.031000008806586266,
-0.038185618817806244,
0.07208503782749176,
-0.052043940871953964,
-0.01830410212278366,
0.05965078994631767,
0.023710446432232857,
-0.034253738820552826,
0.04079112410545349,
0.01803063228726387,
0.04167097061872482,
-0.03070451319217682,
0.027972770854830742,
0.015788741409778595,
-0.019115673378109932,
0.044129807502031326,
0.01990540139377117,
-0.03546038642525673,
-0.03834933415055275,
0.052727360278367996,
0.05412329360842705,
0.0005846877465955913,
0.024093080312013626,
0.012323293834924698,
0.02650509960949421,
-0.01083489041775465,
0.04725504294037819,
0.04529071971774101,
0.020670490339398384,
-0.055924300104379654,
-0.028504349291324615,
0.04721369221806526,
0.00397908641025424,
0.016494659706950188,
0.013045857660472393,
0.0064932010136544704,
0.04867745190858841,
0.032002877444028854,
0.08735274523496628,
-0.057416290044784546,
0.032788146287202835,
0.009921631775796413,
0.057433027774095535,
0.032130155712366104,
-0.019769728183746338,
-0.047212984412908554,
0.048724137246608734,
0.0629400983452797,
0.07073064893484116,
-0.020529503002762794,
-0.019848890602588654,
0.012964491732418537,
-0.03744826465845108,
0.035096175968647,
0.05268372222781181,
0.009289676323533058,
-0.05472032353281975,
-0.0026127337478101254,
0.004774294327944517,
0.03774361312389374,
0.05659620091319084,
-0.04747779667377472,
2.193354220433085e-34,
-0.03291916102170944,
-0.07544630765914917,
0.02378874644637108,
-0.0764639601111412,
-0.009361655451357365,
-0.0130689088255167,
0.028893552720546722,
0.01442724373191595,
0.005536016542464495,
-0.0064298491925001144,
0.04027293995022774
] | {
"ds_index": 2,
"similar_dg_indices": [
246876,
91867,
1096347,
8698,
678547,
437704,
1032414,
594095,
183816,
743876,
713522,
110073,
463100,
435808,
889633,
1008001,
890411,
470887,
431283,
582572
]
} |
A pulmonary autopsy specimen from a 58-year-old woman who died of acute hypoxic respiratory failure was examined. She had recently undergone surgery for a fractured femur 3 months ago. Initial hospital course was uncomplicated, and she was discharged to a rehab facility in good health. Shortly after discharge home from rehab, she developed sudden shortness of breath and had cardiac arrest. Resuscitation was unsuccessful. On histological examination of lung tissue, fibrous connective tissue around the lumen of the pulmonary artery is observed. Which of the following is the most likely pathogenesis for the present findings? | Thromboembolism | {
"A": "Thromboembolism",
"B": "Pulmonary ischemia",
"C": "Pulmonary hypertension",
"D": "Pulmonary passive congestion"
} | step1 | A | [
"pulmonary autopsy specimen",
"58 year old woman",
"died",
"acute hypoxic respiratory failure",
"examined",
"recently",
"surgery",
"fractured femur 3 months",
"Initial hospital course",
"uncomplicated",
"discharged",
"rehab facility",
"good health",
"discharge home",
"rehab",
"sudden shortness of breath",
"cardiac",
"Resuscitation",
"unsuccessful",
"histological examination",
"lung tissue",
"fibrous connective tissue",
"lumen of",
"pulmonary artery",
"observed",
"following",
"most likely pathogenesis",
"present findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A pulmonary autopsy specimen from a 58-year-old woman who died of acute hypoxic respiratory failure was examined. She had recently undergone surgery for a fractured femur 3 months ago. Initial hospital course was uncomplicated, and she was discharged to a rehab facility in good health. Shortly after discharge home from rehab, she developed sudden shortness of breath and had cardiac arrest. Resuscitation was unsuccessful. On histological examination of lung tissue, fibrous connective tissue around the lumen of the pulmonary artery is observed. Which of the following is the most likely pathogenesis for the present findings?
Choose one of the following::
A. Thromboembolism
B. Pulmonary ischemia
C. Pulmonary hypertension
D. Pulmonary passive congestion | [
0.0027352094184607267,
-0.011233444325625896,
0.01278590876609087,
0.02723526768386364,
0.036408644169569016,
0.0025037864688783884,
-0.04584849253296852,
0.031591612845659256,
-0.06133299693465233,
-0.039759423583745956,
0.016883959993720055,
-0.027969039976596832,
0.04924095422029495,
0.020244352519512177,
0.00776082556694746,
-0.022205865010619164,
-0.022709861397743225,
-0.008317872881889343,
-0.02115626074373722,
-0.00043972209095954895,
-0.01990652084350586,
0.08500541746616364,
0.06601089239120483,
0.014316155575215816,
0.0510491244494915,
0.010570541024208069,
0.004443466663360596,
-0.02524297870695591,
-0.04006949067115784,
0.025290705263614655,
0.038049742579460144,
-0.02082895301282406,
-0.0230069849640131,
-0.09182316809892654,
0.0000020476320514717372,
0.03204188868403435,
-0.030976343899965286,
-0.001690181903541088,
-0.027363382279872894,
-0.028357520699501038,
0.053762078285217285,
0.023503253236413002,
0.028927411884069443,
0.006911504082381725,
-0.05463649705052376,
-0.04025191441178322,
-0.022680368274450302,
0.06995450705289841,
-0.04634612798690796,
-0.012540305033326149,
0.030401790514588356,
0.0237899012863636,
-0.009831051342189312,
-0.005921374540776014,
0.041714031249284744,
0.022919699549674988,
-0.022139672189950943,
0.05200045183300972,
0.023014482110738754,
-0.05317794159054756,
-0.009896990843117237,
-0.040453653782606125,
0.0549081489443779,
0.016707725822925568,
-0.06190704181790352,
-0.015092207118868828,
0.06660997122526169,
-0.029602330178022385,
-0.017956970259547234,
0.06163874268531799,
-0.07936657220125198,
-0.02935566008090973,
0.04063859209418297,
0.036763716489076614,
-0.0456860214471817,
0.0046907709911465645,
0.059040091931819916,
0.014256644062697887,
0.018766159191727638,
-0.01096329279243946,
0.09044347703456879,
-0.002948023146018386,
-0.006087168585509062,
0.05265986919403076,
0.031472474336624146,
-0.12690572440624237,
-0.014865849167108536,
0.026158412918448448,
-0.010249602608382702,
0.0068784235045313835,
-0.06763379275798798,
-0.03763580694794655,
0.00008928133320296183,
-0.018225379288196564,
-0.0684291422367096,
0.016323063522577286,
-0.034404490143060684,
0.013112792745232582,
0.05689840763807297,
-0.09139356762170792,
-0.05084456503391266,
-0.05669296160340309,
0.038512881845235825,
0.017260104417800903,
-0.05428094416856766,
-0.08637569099664688,
-0.040747303515672684,
-0.018924647942185402,
-0.011751687154173851,
-0.010682792402803898,
0.051627714186906815,
0.006037745624780655,
0.008528321981430054,
0.08143795281648636,
-0.017403611913323402,
0.007706725038588047,
-0.033116575330495834,
-0.06536085903644562,
-0.022434573620557785,
0.04153551906347275,
-0.05418207496404648,
0.00335636711679399,
-0.0376758836209774,
0.043053485453128815,
-0.020053667947649956,
-0.04353141412138939,
0.008581835776567459,
0.05258256942033768,
0.008809195831418037,
0.04852301627397537,
0.011135251261293888,
0.034002844244241714,
-0.019279267638921738,
0.010438919998705387,
-0.002120526973158121,
-0.05640796944499016,
0.0068212468177080154,
0.031040189787745476,
-0.018998518586158752,
0.0010648977477103472,
0.031827207654714584,
0.004072686191648245,
0.016728365793824196,
0.0064549073576927185,
-0.01812959648668766,
-0.02224334515631199,
0.00873035378754139,
0.0567249171435833,
0.007077121175825596,
0.047763384878635406,
-0.02989834174513817,
-0.013250736519694328,
-0.1257838010787964,
-0.03242390602827072,
-0.01927141845226288,
0.0009948147926479578,
0.03005460649728775,
-0.05262688919901848,
-0.006572832353413105,
-0.03532040864229202,
0.006279613822698593,
0.015815991908311844,
0.033696215599775314,
-0.06691686809062958,
-0.0009301957907155156,
0.012493512593209743,
-0.042768269777297974,
0.04350249096751213,
-0.04004413262009621,
0.02334265224635601,
0.003490183036774397,
0.03600267320871353,
0.0014786523533985019,
-0.02584819123148918,
-0.056009989231824875,
0.0653347447514534,
0.018167948350310326,
-0.037552978843450546,
-0.006406360771507025,
0.028496570885181427,
0.002950672758743167,
0.025759462267160416,
0.02307046949863434,
-0.008924863301217556,
0.043993737548589706,
0.02031782828271389,
-0.03417814522981644,
-0.027757136151194572,
0.042845021933317184,
-0.07432811707258224,
0.02121063694357872,
0.02441037818789482,
-0.029296139255166054,
0.025265902280807495,
-0.01010267436504364,
0.03406920284032822,
-0.03418827801942825,
0.01300408598035574,
-0.009662113152444363,
0.04127351939678192,
-0.04837888479232788,
-0.021728377789258957,
-0.008704934269189835,
0.05011584609746933,
0.0025158370845019817,
0.06772048771381378,
-0.0069556040689349174,
-0.04957805573940277,
-0.010649019852280617,
-0.002492309780791402,
-0.0586254857480526,
-0.0011169920908287168,
0.0623299665749073,
-0.033268220722675323,
-0.01912369392812252,
-0.008048386313021183,
-0.025125592947006226,
0.027863508090376854,
-0.05597200617194176,
-0.0037294342182576656,
-0.00044493729365058243,
-0.052245333790779114,
0.0013465739320963621,
0.025656672194600105,
-0.048413898795843124,
0.013389344327151775,
-0.03061126172542572,
0.012405207380652428,
-0.024549957364797592,
-0.03598560765385628,
0.02302974835038185,
-0.02028055302798748,
0.0282143484801054,
0.0411686897277832,
-0.10011456161737442,
0.015164025127887726,
-0.014955034479498863,
0.015752194449305534,
0.011143346317112446,
0.019995832815766335,
-0.010473805479705334,
-0.019670875743031502,
-0.047734055668115616,
-0.03988292068243027,
-0.026480071246623993,
-0.028355423361063004,
0.01652734912931919,
0.010454812087118626,
-0.022998224943876266,
0.02094244584441185,
-0.010824929922819138,
-0.0009325840510427952,
0.053047552704811096,
0.03239722549915314,
0.012708988972008228,
0.018000135198235512,
-0.005305476952344179,
0.037395138293504715,
-0.03423642739653587,
-0.10094062238931656,
0.005011965986341238,
-0.04032478481531143,
0.03392990306019783,
0.04493023827672005,
-0.03289666026830673,
-0.0011012484319508076,
-0.00015957365394569933,
0.007522470783442259,
0.01565016433596611,
-0.006068110000342131,
0.004326889757066965,
0.026979193091392517,
0.028261996805667877,
-0.0013482721988111734,
-0.04039252549409866,
0.004726307932287455,
-0.06843817979097366,
0.016470162197947502,
0.01892753131687641,
0.05027635395526886,
0.012788088992238045,
0.007921910844743252,
-0.004902326501905918,
0.00971396453678608,
-0.00011034224735340104,
0.02320115640759468,
-0.005330646876245737,
-0.0070326486602425575,
0.02671874687075615,
0.024188267067074776,
-0.014727924019098282,
0.018475323915481567,
0.025407394394278526,
-0.03511642664670944,
0.002972241258248687,
-0.061706844717264175,
-0.05418987572193146,
0.02119472064077854,
0.019796276465058327,
0.0651823952794075,
0.029308974742889404,
0.022995438426733017,
0.013335548341274261,
0.014308381825685501,
-0.006721118930727243,
0.060154110193252563,
0.004529162310063839,
0.012597926892340183,
-0.05764539912343025,
-0.03747491538524628,
-0.002694058697670698,
0.0016583878314122558,
-0.006620773114264011,
-0.016661448404192924,
0.01432911865413189,
0.03451289236545563,
0.024414367973804474,
-0.10320478677749634,
0.02589653991162777,
-0.011727781966328621,
-0.01870918832719326,
0.06336190551519394,
-0.04751249775290489,
-0.022500675171613693,
-0.02578846737742424,
0.021894441917538643,
-0.0037849696818739176,
0.005318408366292715,
0.04516102373600006,
-0.004878315608948469,
0.013413585722446442,
-0.018295127898454666,
-0.024678941816091537,
-0.013521160930395126,
-0.007725078612565994,
0.01783931627869606,
-0.022524887695908546,
-0.03769578039646149,
0.021041374653577805,
0.06531180441379547,
0.02201804891228676,
-0.007871769368648529,
0.010327390395104885,
0.02370622754096985,
-0.0007640983094461262,
0.014785812236368656,
-0.10250558704137802,
0.035215601325035095,
0.03934080898761749,
-0.015016431920230389,
-0.08168771862983704,
0.003018536837771535,
-0.008178550750017166,
0.007964946329593658,
-0.036251235753297806,
0.03660302236676216,
0.05361216142773628,
0.03873082250356674,
0.005874503403902054,
0.002981544006615877,
0.03999590128660202,
-0.014588446356356144,
-0.022475380450487137,
0.0039099412970244884,
0.03400225564837456,
-0.048319458961486816,
-0.013665472157299519,
-0.008751694113016129,
0.04420686513185501,
-0.0007352277752943337,
0.04009278118610382,
-0.017204251140356064,
0.0017019585939124227,
0.027579711750149727,
-0.026944557204842567,
0.06784337013959885,
0.0005979560664854944,
0.03095463290810585,
-0.06853736937046051,
-0.02727157436311245,
0.02771626226603985,
-0.0598723478615284,
-0.003941533621400595,
-0.007768303621560335,
-0.029385417699813843,
0.06064584478735924,
0.03072320856153965,
0.018364062532782555,
0.04069456458091736,
-0.005160996224731207,
-0.03362484648823738,
0.0575188584625721,
-0.017469080165028572,
-0.03391940891742706,
-0.004811133723706007,
0.008909566327929497,
0.002349032089114189,
-0.07834455370903015,
0.03803253918886185,
0.09883689880371094,
-0.02557544969022274,
0.07706126570701599,
-0.008391027338802814,
0.010708341374993324,
0.002517047803848982,
0.039231181144714355,
-0.014429904520511627,
-0.014706272631883621,
-0.022808227688074112,
0.024905366823077202,
0.019147224724292755,
-0.011648816056549549,
0.008315409533679485,
0.05301076918840408,
-0.013909971341490746,
-0.03402010723948479,
0.0026336463633924723,
-0.012068056501448154,
0.024296173825860023,
-0.04479220137000084,
0.03585729002952576,
-0.04693973436951637,
-0.026062149554491043,
-0.06002865731716156,
-0.005137242376804352,
-0.01650661788880825,
0.06261682510375977,
-0.01067650318145752,
0.017314517870545387,
0.03845467045903206,
0.020686758682131767,
-0.09237825125455856,
-0.0069806743413209915,
0.03428298607468605,
-0.020527254790067673,
0.06836537271738052,
-0.037788644433021545,
0.015438334085047245,
0.04465454816818237,
-0.0002496358356438577,
-0.03749997541308403,
-0.014763887971639633,
0.029901819303631783,
0.05254259705543518,
0.10274329036474228,
-0.043491430580616,
0.018286876380443573,
-0.0424245148897171,
0.04110937565565109,
0.11466646194458008,
0.03287240117788315,
-0.0021882832515984774,
-0.0001342239265795797,
0.0033933199010789394,
0.02613799087703228,
0.018917089328169823,
0.025977402925491333,
-0.014457697048783302,
0.041441660374403,
-0.007087940350174904,
-0.04313908517360687,
-0.0002863635600078851,
-0.007349387742578983,
-0.05881267040967941,
-0.02108282968401909,
0.0008029442396946251,
-0.01657090336084366,
-0.025458401069045067,
-0.016986636444926262,
0.01592421904206276,
-0.028247540816664696,
0.014388618990778923,
-0.012018226087093353,
-0.03631822392344475,
-0.023262454196810722,
0.012023425661027431,
-0.018922623246908188,
-0.04138045758008957,
0.02367977239191532,
-0.0045351008884608746,
0.02568865194916725,
-0.047653332352638245,
-0.07098033279180527,
-0.007276402786374092,
0.014199548400938511,
-0.005359422881156206,
0.05237232521176338,
0.015597495250403881,
-0.019852403551340103,
0.03127065673470497,
0.023174317553639412,
-0.008054055273532867,
0.017513412982225418,
-0.019625013694167137,
0.009540549479424953,
0.053897321224212646,
0.00811702385544777,
0.04835734888911247,
-0.004136656876653433,
-0.015603876672685146,
0.03364254906773567,
0.007309913635253906,
0.05246495455503464,
-0.03315582126379013,
0.021016445010900497,
0.024170761927962303,
0.000287465110886842,
-0.03276382386684418,
-0.0044645522721111774,
-0.029494009912014008,
0.006921823602169752,
0.0006130351102910936,
0.010861502960324287,
0.08294092863798141,
0.00039622848271392286,
-0.00899022538214922,
-0.011992421001195908,
-0.042911283671855927,
-0.07354991883039474,
0.015826642513275146,
0.011910762637853622,
0.004928925074636936,
0.017014512792229652,
-0.08256346732378006,
0.0007028791005723178,
0.034746404737234116,
0.011519517749547958,
0.03816637024283409,
0.0025408787187188864,
0.06578753143548965,
-0.005233850330114365,
0.01775195077061653,
-0.04821502044796944,
-0.0015259445644915104,
0.005095485132187605,
-0.014029769226908684,
0.0015422685537487268,
0.016146546229720116,
-0.022109394893050194,
-0.023085594177246094,
0.04694833233952522,
0.0048619480803608894,
0.07259682565927505,
-0.007897473871707916,
-0.033890943974256516,
-0.03321799635887146,
-0.013074157759547234,
0.023221218958497047,
0.0063536823727190495,
-0.024381175637245178,
-0.019706230610609055,
0.019216204062104225,
0.05330808088183403,
0.024219876155257225,
-0.001425015041604638,
-5.3154194158413305e-33,
0.023764919489622116,
-0.07174624502658844,
0.056812554597854614,
-0.033111657947301865,
0.03149230033159256,
0.07435870170593262,
0.0066370656713843346,
-0.03583165630698204,
-0.050268396735191345,
0.021224141120910645,
0.006384748034179211,
-0.004600143060088158,
0.028901804238557816,
0.019130079075694084,
-0.037451744079589844,
-0.009781386703252792,
0.04310475289821625,
-0.03781335428357124,
0.002360470127314329,
-0.03509325906634331,
-0.04495204985141754,
0.018281210213899612,
-0.030203387141227722,
0.007886677049100399,
0.03080395609140396,
0.008790560998022556,
0.039713356643915176,
-0.00935669057071209,
0.00785664189606905,
-0.02091861329972744,
0.02860703505575657,
-0.046283889561891556,
0.022602109238505363,
-0.0012610608246177435,
-0.02661072462797165,
-0.018910419195890427,
0.0066278353333473206,
-0.044290196150541306,
0.07067357003688812,
0.010960541665554047,
-0.01641928404569626,
-0.02624020352959633,
0.018378684297204018,
0.04764163866639137,
0.06916450709104538,
0.010077114216983318,
-0.0421721450984478,
0.010500885546207428,
0.009397146292030811,
-0.029886068776249886,
0.031657591462135315,
0.03130234777927399,
0.011631643399596214,
-0.0034731305204331875,
-0.0028464961796998978,
-0.02807820402085781,
-0.018096020445227623,
0.013015695847570896,
0.03907906636595726,
-0.029387827962636948,
0.0314365029335022,
0.03805170953273773,
0.026332790032029152,
0.04432301968336105,
-0.050322044640779495,
0.05218806490302086,
0.05496674403548241,
0.054621949791908264,
-0.036032482981681824,
0.09233664721250534,
-0.0562993660569191,
-0.0008925081929191947,
0.018711626529693604,
-0.01335639227181673,
-0.10060806572437286,
0.01488878671079874,
0.0023730590473860502,
0.0004000296466983855,
0.03459678590297699,
-0.008119710721075535,
-0.023522842675447464,
0.010608959943056107,
0.0061049372889101505,
-0.02350171096622944,
-0.01891787350177765,
-0.007089706603437662,
0.028787950053811073,
0.016846084967255592,
-0.046294376254081726,
-0.013187776319682598,
0.07549725472927094,
0.0209172572940588,
0.004344342276453972,
-0.03425690531730652,
-0.0023082573898136616,
-0.09311582893133163,
0.03878139331936836,
-0.010315610095858574,
0.03649961203336716,
0.048131003975868225,
0.050058308988809586,
0.024283964186906815,
-0.006699015386402607,
-0.011573607102036476,
-0.03965586796402931,
-0.018886912614107132,
0.015779685229063034,
0.029242143034934998,
0.0012922427849844098,
0.030243242159485817,
0.005558445118367672,
-0.04567635431885719,
0.025808798149228096,
0.016377750784158707,
-0.018424442037940025,
0.08565152436494827,
-0.010270693339407444,
0.04236236959695816,
0.028273683041334152,
0.032162342220544815,
0.028699714690446854,
-0.04001500457525253,
-0.06608640402555466,
0.004548708442598581,
-0.08086350560188293,
-0.061618346720933914,
0.01313578151166439,
0.022808382287621498,
0.004766048397868872,
-0.042221274226903915,
-0.011388695798814297,
0.03772663325071335,
2.842015192072722e-7,
0.027453944087028503,
-0.06864632666110992,
0.0017322310013696551,
-0.08882461488246918,
-0.004876953549683094,
-0.016932759433984756,
0.00524491211399436,
0.00902149360626936,
-0.032520193606615067,
0.04287364333868027,
-0.028929635882377625,
0.03924879804253578,
0.002641347236931324,
-0.04107601195573807,
-0.06236240267753601,
0.034065864980220795,
0.010691840201616287,
0.022077973932027817,
0.03158758953213692,
0.03460121154785156,
-0.052478134632110596,
-0.022470736876130104,
-0.07316256314516068,
0.02042519487440586,
-0.0015614244621247053,
0.024667877703905106,
-0.022552920505404472,
-0.08108805119991302,
-0.08021291345357895,
-0.0638507604598999,
-0.035800397396087646,
-0.0007563048275187612,
0.014622875489294529,
0.01769368350505829,
-0.00972672738134861,
0.01828618347644806,
0.06423062086105347,
0.03855719044804573,
-0.004904832225292921,
-0.0482185073196888,
-0.004807694349437952,
-0.036045581102371216,
0.03737376257777214,
0.05522133409976959,
0.022727392613887787,
0.03725263848900795,
-0.05943915247917175,
-0.0021714705508202314,
0.004006519448012114,
0.06144651025533676,
-0.05007181316614151,
0.019948018714785576,
-0.003385514486581087,
-0.0023916231002658606,
0.015501806512475014,
0.010587888769805431,
-0.04657280072569847,
-0.007448974065482616,
0.0038480288349092007,
-0.018367184326052666,
0.029059095308184624,
-0.04217715561389923,
-0.023929813876748085,
-0.06597520411014557,
0.021557288244366646,
0.019679367542266846,
-0.07305599749088287,
1.931500455995439e-34,
-0.05152592062950134,
-0.031638700515031815,
-0.0566449910402298,
-0.009643275290727615,
-0.009175476618111134,
-0.05688788741827011,
0.004802171606570482,
0.02564687468111515,
-0.021339159458875656,
0.00256484211422503,
-0.03003810904920101
] | {
"ds_index": 3,
"similar_dg_indices": [
331461,
587300,
870113,
875590,
481350,
100248,
695499,
52829,
105519,
496935,
1076275,
187847,
587005,
709027,
854015,
839392,
1072164,
500732,
110138,
557155
]
} |
A 20-year-old woman presents with menorrhagia for the past several years. She says that her menses “have always been heavy”, and she has experienced easy bruising for as long as she can remember. Family history is significant for her mother, who had similar problems with bruising easily. The patient's vital signs include: heart rate 98/min, respiratory rate 14/min, temperature 36.1°C (96.9°F), and blood pressure 110/87 mm Hg. Physical examination is unremarkable. Laboratory tests show the following: platelet count 200,000/mm3, PT 12 seconds, and PTT 43 seconds. Which of the following is the most likely cause of this patient’s symptoms? | Von Willebrand disease | {
"A": "Hemophilia A",
"B": "Lupus anticoagulant",
"C": "Protein C deficiency",
"D": "Von Willebrand disease"
} | step1 | D | [
"20 year old woman presents",
"menorrhagia",
"past",
"years",
"menses",
"always",
"heavy",
"easy bruising",
"long",
"remember",
"Family history",
"significant",
"mother",
"similar problems",
"bruising easily",
"patient's vital signs include",
"heart rate 98 min",
"respiratory rate",
"min",
"temperature 36",
"96 9F",
"blood pressure",
"87 mm Hg",
"Physical examination",
"unremarkable",
"Laboratory tests show",
"following",
"platelet count 200",
"mm3",
"PT",
"seconds",
"PTT",
"seconds",
"following",
"most likely cause",
"patients symptoms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 20-year-old woman presents with menorrhagia for the past several years. She says that her menses “have always been heavy”, and she has experienced easy bruising for as long as she can remember. Family history is significant for her mother, who had similar problems with bruising easily. The patient's vital signs include: heart rate 98/min, respiratory rate 14/min, temperature 36.1°C (96.9°F), and blood pressure 110/87 mm Hg. Physical examination is unremarkable. Laboratory tests show the following: platelet count 200,000/mm3, PT 12 seconds, and PTT 43 seconds. Which of the following is the most likely cause of this patient’s symptoms?
Choose one of the following::
A. Hemophilia A
B. Lupus anticoagulant
C. Protein C deficiency
D. Von Willebrand disease | [
0.0012076407438144088,
-0.08292624354362488,
0.012538234703242779,
-0.005348374135792255,
0.008875359781086445,
0.013853175565600395,
0.03804603964090347,
0.01969395950436592,
-0.03627815470099449,
-0.008101793937385082,
0.0645957812666893,
0.004385555628687143,
-0.04127689078450203,
0.017865488305687904,
0.026871563866734505,
-0.020522937178611755,
-0.02879452519118786,
-0.0023960331454873085,
-0.03741878643631935,
0.016559859737753868,
0.04064910113811493,
0.000520230969414115,
0.028463304042816162,
-0.008957309648394585,
-0.001536186202429235,
-0.04544490575790405,
-0.020783891901373863,
-0.01908814162015915,
0.002518946770578623,
-0.013622994534671307,
-0.01079624891281128,
-0.025340287014842033,
-0.03920745477080345,
-0.044614534825086594,
0.0000017746189087120001,
-0.044126298278570175,
-0.03064841590821743,
-0.02086857706308365,
0.03742729127407074,
0.006272607017308474,
-0.02780863642692566,
-0.03969793766736984,
0.04408610612154007,
-0.0034292920026928186,
0.0013067240361124277,
-0.054570574313402176,
-0.05135370418429375,
0.10780706256628036,
-0.03232996165752411,
0.030928490683436394,
0.03193780779838562,
0.08248557895421982,
-0.060200877487659454,
-0.0503237210214138,
0.09306301176548004,
-0.04075026512145996,
-0.040326766669750214,
-0.06784681975841522,
0.01903252676129341,
0.010625436902046204,
0.05260166525840759,
-0.024670613929629326,
0.03177536278963089,
0.031044604256749153,
-0.06038280948996544,
-0.021821213886141777,
0.016177412122488022,
-0.06308300048112869,
-0.012634101323783398,
0.025884805247187614,
-0.032755047082901,
0.044017184525728226,
0.07278399169445038,
0.050357937812805176,
-0.06515055894851685,
-0.0070573254488408566,
0.03062955103814602,
-0.0058666616678237915,
-0.03505544736981392,
-0.023563111200928688,
0.012653450481593609,
0.028184721246361732,
-0.002114935778081417,
0.07393653690814972,
-0.002141539938747883,
-0.04720081016421318,
0.014149985276162624,
-0.00951068289577961,
0.027636507526040077,
-0.02988439053297043,
-0.021955227479338646,
-0.04160413518548012,
0.003164633410051465,
-0.018838144838809967,
-0.007537142839282751,
-0.038076404482126236,
-0.013227557763457298,
0.00321035529486835,
0.04347367584705353,
0.014992211945354939,
-0.05473417416214943,
-0.019805287942290306,
-0.032829076051712036,
0.00860556960105896,
-0.07075349986553192,
-0.05307522043585777,
-0.019281424582004547,
-0.00743792625144124,
-0.04333566874265671,
0.00802999921143055,
0.047566745430231094,
0.0435691699385643,
-0.04414571449160576,
-0.03116823174059391,
0.07078888267278671,
0.024440869688987732,
-0.04616409167647362,
-0.02330746315419674,
-0.02241584286093712,
0.02985997125506401,
-0.0011461214162409306,
0.00420011393725872,
0.041110578924417496,
-0.050376590341329575,
0.022062549367547035,
0.0020108167082071304,
-0.025197582319378853,
-0.003737841034308076,
-0.013775515370070934,
-0.02914639562368393,
0.0003352343919686973,
-0.010219517163932323,
-0.01916591264307499,
0.04999212920665741,
0.006003837566822767,
-0.0052397181279957294,
-0.0010510124266147614,
0.032642338424921036,
-0.024025220423936844,
-0.014616914093494415,
-0.046235132962465286,
-0.04520811140537262,
0.034145236015319824,
0.0100451884791255,
-0.03241153061389923,
0.08508400619029999,
-0.036055080592632294,
0.03105907142162323,
0.0014918218366801739,
0.032470159232616425,
0.024577295407652855,
-0.014582420699298382,
-0.021678771823644638,
0.0022348768543452024,
0.025969037786126137,
0.06300754845142365,
-0.010015145875513554,
0.013498381711542606,
0.03426802530884743,
-0.049009621143341064,
-0.014246379025280476,
-0.05049668624997139,
-0.0011749239638447762,
0.03193394094705582,
-0.01777907833456993,
0.05444392189383507,
-0.02030169405043125,
0.05080708861351013,
-0.0302964486181736,
0.03238729014992714,
0.021931389346718788,
-0.04207652434706688,
0.028531445190310478,
-0.020925352349877357,
-0.06482163816690445,
-0.03245551511645317,
-0.09552224725484848,
0.05874686688184738,
0.021361220628023148,
-0.038562703877687454,
0.010506987571716309,
0.0056570726446807384,
0.12402386218309402,
-0.08911429345607758,
-0.038578663021326065,
0.01925835758447647,
0.02757526934146881,
-0.06709390133619308,
-0.009200824424624443,
-0.030252262949943542,
-0.037511274218559265,
0.01502627320587635,
0.000835205486509949,
0.009383327327668667,
-0.020346783101558685,
0.03187376633286476,
-0.03463374823331833,
0.04606208950281143,
-0.007411078084260225,
-0.01659836620092392,
-0.004164621699601412,
-0.028197849169373512,
0.014577056281268597,
0.022431662306189537,
-0.05871603637933731,
0.01930338889360428,
0.022183319553732872,
0.021482929587364197,
0.04203442856669426,
0.00034069627872668207,
-0.0029188236221671104,
0.0242171473801136,
0.0682796835899353,
-0.07434190809726715,
0.03466486558318138,
0.03934800624847412,
0.01848537288606167,
0.038861922919750214,
-0.06896206736564636,
0.020205259323120117,
0.02267591655254364,
0.006709565408527851,
-0.0284567978233099,
-0.016832321882247925,
0.01313247624784708,
-0.004383861552923918,
0.022063935175538063,
0.013622862286865711,
0.020062895491719246,
-0.07796870917081833,
-0.003784767584875226,
0.05406372621655464,
-0.033410750329494476,
-0.04760099947452545,
-0.02165674977004528,
0.017770132049918175,
0.02963912859559059,
-0.007555915974080563,
0.003548882668837905,
0.024386314675211906,
-0.06232516095042229,
-0.017881210893392563,
-0.09002002328634262,
0.008625535294413567,
0.008828477934002876,
-0.07010021060705185,
-0.08716077357530594,
0.05880695581436157,
-0.049957722425460815,
0.04285241663455963,
-0.02804284170269966,
0.035155829042196274,
-0.009044501930475235,
0.0257794838398695,
0.020843861624598503,
0.03572896122932434,
-0.03470291942358017,
0.00039588712388649583,
-0.03357531502842903,
-0.06162513047456741,
-0.016151608899235725,
0.01851191557943821,
0.019774332642555237,
-0.012001113966107368,
-0.017504839226603508,
-0.022882413119077682,
-0.04240486025810242,
0.04137728735804558,
-0.015212350524961948,
0.042351093143224716,
-0.01031905971467495,
0.025007463991642,
0.023856839165091515,
0.009775552898645401,
-0.028432797640562057,
0.012831765227019787,
-0.0187961608171463,
0.027122747153043747,
0.07770425826311111,
0.04222775995731354,
0.007183766923844814,
0.07337787002325058,
0.026381444185972214,
0.03814099356532097,
0.0033653953578323126,
-0.0004911068244837224,
-0.0060253506526350975,
0.005071512423455715,
0.012274847365915775,
0.00019819670706056058,
-0.01916331984102726,
-0.04120679572224617,
0.019778070971369743,
-0.03451906889677048,
-0.02459702081978321,
-0.01882999576628208,
0.01752704754471779,
0.07761397212743759,
0.00626878347247839,
0.050465021282434464,
0.0003907691570930183,
0.005431270692497492,
0.0007681541028432548,
-0.005927202291786671,
-0.0035811476409435272,
0.011225746013224125,
0.06092934310436249,
-0.009928688406944275,
0.011956204660236835,
0.026318274438381195,
0.019654259085655212,
0.00010838508023880422,
0.0368809774518013,
-0.0658789798617363,
0.030474644154310226,
-0.04484874755144119,
0.007081863470375538,
-0.05823146924376488,
0.039475176483392715,
0.019224202260375023,
0.023391252383589745,
0.04784266650676727,
-0.05931844189763069,
-0.02992880344390869,
-0.01136952918022871,
-0.020189017057418823,
-0.025123383849859238,
-0.015472540631890297,
-0.04354659840464592,
-0.008349817246198654,
-0.007577373646199703,
0.013884310610592365,
-0.007793463300913572,
0.05557846277952194,
0.029217660427093506,
0.007125750184059143,
-0.010522397235035896,
0.007165372837334871,
-0.041394371539354324,
0.0008732276037335396,
0.03496309742331505,
-0.028385542333126068,
0.04654240608215332,
-0.007946527563035488,
0.02002846449613571,
-0.008447823114693165,
-0.08492621779441833,
0.06381969898939133,
-0.05168304219841957,
0.07727538049221039,
-0.04472547397017479,
0.057267382740974426,
-0.012670851312577724,
-0.011265138164162636,
-0.01699654944241047,
-0.03667682409286499,
0.07899188250303268,
-0.02048470266163349,
-0.05419120937585831,
0.00043211039155721664,
-0.012792355380952358,
0.0052429200150072575,
-0.01857571117579937,
0.017346778884530067,
-0.0365028902888298,
0.012164684012532234,
-0.014668857678771019,
-0.051547933369874954,
-0.03012288361787796,
-0.03590812906622887,
-0.02381361648440361,
-0.056604351848363876,
-0.024762798100709915,
0.03381098806858063,
-0.01243321318179369,
-0.023151284083724022,
-0.006484047044068575,
-0.03864714875817299,
-0.0225164033472538,
-0.02870428003370762,
0.015281564556062222,
-0.002355017699301243,
0.012430648319423199,
-0.003672944149002433,
-0.060581088066101074,
0.004431633278727531,
-0.02552015520632267,
-0.015507803298532963,
0.05453440546989441,
-0.023968223482370377,
-0.012015688233077526,
0.048675354570150375,
-0.017689354717731476,
-0.031309738755226135,
-0.0029409194830805063,
0.015683572739362717,
-0.017776774242520332,
-0.08522484451532364,
0.026634331792593002,
0.071137435734272,
0.013203534297645092,
0.01361366268247366,
-0.04379470646381378,
0.06643813848495483,
0.010175003670156002,
-0.07251715660095215,
-0.05541400611400604,
-0.02081112749874592,
0.015718858689069748,
0.04842131957411766,
0.01563144102692604,
-0.01595255546271801,
0.013781843706965446,
0.016191216185688972,
0.010835887864232063,
0.0016854394925758243,
-0.01449177972972393,
-0.044220540672540665,
0.05274511128664017,
0.04074684903025627,
0.05896452069282532,
0.031423889100551605,
-0.05038497969508171,
-0.022298017516732216,
-0.0032692619133740664,
0.004379895981401205,
0.02722189389169216,
0.017252499237656593,
0.05488245189189911,
0.04996747523546219,
0.011263793334364891,
-0.025156810879707336,
0.012989860028028488,
0.057739049196243286,
0.06098603457212448,
0.03480397164821625,
-0.04004157707095146,
0.005193602293729782,
-0.04381200298666954,
0.0060720969922840595,
-0.003931150771677494,
0.03569941967725754,
0.047467246651649475,
0.023172810673713684,
-0.03388165682554245,
0.019671142101287842,
0.039548151195049286,
0.014601795002818108,
0.0575309656560421,
0.1052141934633255,
-0.0066491723991930485,
-0.043978527188301086,
0.035982709378004074,
0.002621695399284363,
0.02473636344075203,
0.025856101885437965,
0.00814021471887827,
-0.02405455894768238,
0.034749146550893784,
-0.015764549374580383,
-0.09852079302072525,
0.026928238570690155,
-0.02803177200257778,
-0.06062840297818184,
-0.04873574152588844,
-0.06447847932577133,
-0.0072721801698207855,
-0.0028671009931713343,
-0.008960389532148838,
0.01065881084650755,
-0.03379017487168312,
0.05641305819153786,
-0.01077838335186243,
-0.027002830058336258,
0.03302185609936714,
-0.007623038720339537,
-0.052301935851573944,
-0.04443976655602455,
-0.0053289164789021015,
0.01972275599837303,
0.03491457551717758,
0.03785359859466553,
-0.08631838113069534,
-0.06348460912704468,
0.027373628690838814,
0.026042582467198372,
0.0324137918651104,
0.008446700870990753,
-0.01728021167218685,
0.03496125340461731,
-0.028348302468657494,
-0.02111927419900894,
0.016429487615823746,
-0.030058542266488075,
-0.01127762533724308,
0.049876630306243896,
0.001518817967735231,
0.04506991058588028,
0.014885308220982552,
-0.02540079690515995,
0.016643255949020386,
0.0289302971214056,
0.025638526305556297,
-0.04392449930310249,
-0.006372855044901371,
-0.010363648645579815,
0.004832443781197071,
0.09276347607374191,
-0.019305506721138954,
-0.0019169828156009316,
0.01715930923819542,
0.038883138447999954,
-0.014632230624556541,
0.056742772459983826,
0.04575447738170624,
0.031145310029387474,
-0.046500273048877716,
-0.04698387533426285,
0.02790738455951214,
0.021522408351302147,
-0.012554552406072617,
0.013126476667821407,
-0.0017454763874411583,
-0.03426433727145195,
0.0007603414123877883,
0.012647807598114014,
0.030544338747859,
-0.006275263149291277,
0.00873765628784895,
0.059134963899850845,
0.040173448622226715,
0.010045772418379784,
-0.014885243959724903,
-0.06659035384654999,
-0.012607916258275509,
0.02882322669029236,
-0.0077665564604103565,
-0.05480227991938591,
-0.018766509369015694,
-0.02012021467089653,
-0.014856275171041489,
0.030946260318160057,
0.026885703206062317,
-0.045449718832969666,
0.0197452362626791,
0.029270416125655174,
-0.04813557118177414,
0.027138497680425644,
-0.02854292094707489,
0.033962417393922806,
-0.04623141139745712,
0.10384522378444672,
0.043198492377996445,
0.030494827777147293,
0.019832508638501167,
-4.817545395706274e-33,
0.028528619557619095,
-0.03551994264125824,
0.011364414356648922,
-0.08320213854312897,
0.035070985555648804,
0.08880405873060226,
-0.017974063754081726,
-0.011615123599767685,
-0.011933290399610996,
0.045128513127565384,
-0.017931155860424042,
-0.04483366012573242,
0.007877019234001637,
0.06559386104345322,
-0.023462234064936638,
-0.045352060347795486,
-0.012721292674541473,
0.01304667629301548,
-0.0029013794846832752,
-0.0009183831280097365,
-0.019874898716807365,
-0.019892381504178047,
-0.030145835131406784,
0.02110869623720646,
0.00846121460199356,
-0.04643641784787178,
0.022132134065032005,
0.03238041698932648,
-0.02276005782186985,
0.021678410470485687,
0.014823950827121735,
-0.04713913053274155,
0.02508593164384365,
0.01299092173576355,
0.009068822488188744,
-0.007355180568993092,
0.007479443680495024,
-0.04832429066300392,
0.023663369938731194,
0.03192512318491936,
0.022798113524913788,
-0.015110475942492485,
0.02418586239218712,
0.024167075753211975,
0.0745549276471138,
-0.06600770354270935,
-0.02149660885334015,
-0.0017210794612765312,
-0.001992433099076152,
-0.05558616667985916,
0.03800789266824722,
0.00902638304978609,
0.00995645858347416,
-0.04071984440088272,
0.02060278132557869,
0.03165776655077934,
-0.007447428070008755,
0.004093378782272339,
-0.06158915162086487,
-0.05062839388847351,
-0.013817714527249336,
-0.022091083228588104,
-0.021431775763630867,
-0.06365890055894852,
-0.013810050673782825,
0.015702348202466965,
0.02997698076069355,
0.03937922790646553,
-0.007681995630264282,
0.022342942655086517,
-0.07438113540410995,
0.01921335607767105,
0.024439971894025803,
-0.03836755454540253,
0.0027856396045535803,
0.04213780164718628,
-0.0007031183922663331,
-0.04428592324256897,
0.05098668113350868,
-0.010157442651689053,
-0.03613119572401047,
-0.04226084426045418,
-0.08213140070438385,
0.04251672327518463,
-0.003929669037461281,
-0.03950677439570427,
0.004339159931987524,
-0.02802727371454239,
-0.02279360219836235,
-0.04901037737727165,
0.09553509205579758,
0.013664361089468002,
-0.0033283375669270754,
0.021940208971500397,
-0.023024732246994972,
-0.0771988108754158,
0.005887809209525585,
0.014817850664258003,
0.054951753467321396,
0.02603001706302166,
0.06728219240903854,
0.03494720906019211,
0.005620105657726526,
-0.043827589601278305,
0.009898461401462555,
0.006151743698865175,
0.016942476853728294,
0.02228843979537487,
-0.012605246156454086,
-0.013168754056096077,
0.003577707102522254,
0.0003256202326156199,
0.004653074312955141,
0.05290377140045166,
-0.029460156336426735,
0.005193787626922131,
-0.03362995386123657,
0.008992033079266548,
0.06024273857474327,
0.04379802197217941,
0.05786812677979469,
-0.01520899310708046,
0.002108542015776038,
-0.0035602538846433163,
-0.029725026339292526,
-0.07325334846973419,
0.04854922741651535,
0.030195605009794235,
0.03461085259914398,
-0.007456032559275627,
0.02373296022415161,
0.019489049911499023,
2.4540065624023555e-7,
-0.0037126035895198584,
0.020967815071344376,
-0.003951547667384148,
-0.06137309595942497,
0.009487844072282314,
-0.012462734244763851,
-0.004958614706993103,
0.03461256995797157,
0.052853669971227646,
0.007824651896953583,
0.028301559388637543,
0.014031815342605114,
0.012405858375132084,
-0.001247744308784604,
0.0056939213536679745,
-0.012300079688429832,
-0.06732437759637833,
0.03984978049993515,
0.054701998829841614,
0.0005834372132085264,
-0.028712162747979164,
-0.03044196590781212,
-0.043842509388923645,
-0.018480334430933,
-0.005273512564599514,
0.023782862350344658,
0.030005769804120064,
-0.057004332542419434,
-0.02275882475078106,
0.0063454583287239075,
0.046221598982810974,
-0.017430666834115982,
-0.008258662186563015,
0.03391614556312561,
0.023193234577775,
-0.037067316472530365,
0.06915082037448883,
0.034105703234672546,
0.0496765673160553,
0.05361383408308029,
0.010385861620306969,
0.007393297739326954,
0.018316444009542465,
-0.02698863483965397,
0.043008215725421906,
0.03869304060935974,
-0.05083756893873215,
-0.0011388288112357259,
0.03271804004907608,
-0.03581798076629639,
-0.03009062632918358,
0.05852895230054855,
-0.0002525353629607707,
0.07083122432231903,
-0.027615100145339966,
-0.016753416508436203,
0.00474721472710371,
0.03378624841570854,
-0.026921818032860756,
-0.023739082738757133,
-0.009175524115562439,
-0.008920208550989628,
-0.04784192889928818,
-0.02234203927218914,
0.08336353302001953,
-0.06298485398292542,
-0.042380012571811676,
1.9025004134299283e-34,
-0.05749879777431488,
-0.01601707935333252,
0.006312018260359764,
-0.03191974386572838,
-0.039088889956474304,
-0.02010110393166542,
0.010695693083107471,
0.011259958148002625,
-0.02331635355949402,
-0.006906745955348015,
0.011942537501454353
] | {
"ds_index": 4,
"similar_dg_indices": [
924990,
1035976,
117476,
827638,
760462,
640973,
1090974,
612518,
817148,
629038,
872765,
292323,
88443,
453170,
189256,
766742,
6725,
215334,
603908,
839132
]
} |
A 40-year-old zookeeper presents to the emergency department complaining of severe abdominal pain that radiates to her back, and nausea. The pain started 2 days ago and slowly increased until she could not tolerate it any longer. Past medical history is significant for hypertension and hypothyroidism. Additionally, she reports that she was recently stung by one of the zoo’s smaller scorpions, but did not seek medical treatment. She takes aspirin, levothyroxine, oral contraceptive pills, and a multivitamin daily. Family history is noncontributory. Today, her blood pressure is 108/58 mm Hg, heart rate is 99/min, respiratory rate is 21/min, and temperature is 37.0°C (98.6°F). On physical exam, she is a well-developed, obese female that looks unwell. Her heart has a regular rate and rhythm. Radial pulses are weak but symmetric. Her lungs are clear to auscultation bilaterally. Her lateral left ankle is swollen, erythematous, and painful to palpate. An abdominal CT is consistent with acute pancreatitis. Which of the following is the most likely etiology for this patient’s disease? | Scorpion sting | {
"A": "Aspirin",
"B": "Oral contraceptive pills",
"C": "Scorpion sting",
"D": "Hypothyroidism"
} | step1 | C | [
"40 year old",
"presents",
"emergency department",
"severe abdominal",
"radiates",
"back",
"nausea",
"pain started 2 days",
"slowly increased",
"not",
"longer",
"Past medical history",
"significant",
"hypertension",
"hypothyroidism",
"reports",
"recently stung",
"one",
"smaller scorpions",
"not",
"medical treatment",
"takes aspirin",
"levothyroxine",
"oral contraceptive pills",
"multivitamin daily",
"Family history",
"Today",
"blood pressure",
"58 mm Hg",
"heart rate",
"99 min",
"respiratory rate",
"min",
"temperature",
"98",
"physical exam",
"well",
"obese female",
"looks unwell",
"heart",
"regular rate",
"rhythm",
"Radial pulses",
"weak",
"symmetric",
"lungs",
"clear",
"auscultation",
"lateral",
"swollen",
"erythematous",
"painful to palpate",
"abdominal CT",
"consistent with acute pancreatitis",
"following",
"most likely etiology",
"patients disease"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 40-year-old zookeeper presents to the emergency department complaining of severe abdominal pain that radiates to her back, and nausea. The pain started 2 days ago and slowly increased until she could not tolerate it any longer. Past medical history is significant for hypertension and hypothyroidism. Additionally, she reports that she was recently stung by one of the zoo’s smaller scorpions, but did not seek medical treatment. She takes aspirin, levothyroxine, oral contraceptive pills, and a multivitamin daily. Family history is noncontributory. Today, her blood pressure is 108/58 mm Hg, heart rate is 99/min, respiratory rate is 21/min, and temperature is 37.0°C (98.6°F). On physical exam, she is a well-developed, obese female that looks unwell. Her heart has a regular rate and rhythm. Radial pulses are weak but symmetric. Her lungs are clear to auscultation bilaterally. Her lateral left ankle is swollen, erythematous, and painful to palpate. An abdominal CT is consistent with acute pancreatitis. Which of the following is the most likely etiology for this patient’s disease?
Choose one of the following::
A. Aspirin
B. Oral contraceptive pills
C. Scorpion sting
D. Hypothyroidism | [
0.041528016328811646,
0.0041341823525726795,
0.05436461418867111,
-0.005820955615490675,
0.03556220605969429,
-0.0021513206884264946,
-0.040080439299345016,
0.08345287293195724,
0.025585278868675232,
-0.010524336248636246,
-0.004060998093336821,
0.0861320048570633,
0.012300276197493076,
-0.009805182926356792,
0.016247792169451714,
0.01693592220544815,
-0.025933077558875084,
-0.00494529539719224,
0.015303433872759342,
0.01831088960170746,
-0.03576819971203804,
0.0299533661454916,
0.044875506311655045,
0.06170928478240967,
0.054133132100105286,
-0.025691956281661987,
0.009563624858856201,
-0.0020450593437999487,
0.03545762598514557,
-0.029670197516679764,
-0.007346039637923241,
-0.052412085235118866,
-0.0158615093678236,
-0.04464464634656906,
0.0000020291138298489386,
0.021120721474289894,
-0.00873072724789381,
-0.0014558740658685565,
0.029861653223633766,
-0.01735525205731392,
-0.009515643119812012,
-0.09704186022281647,
0.03732357919216156,
-0.008304242976009846,
0.0009118574671447277,
-0.08066447824239731,
0.033861029893159866,
0.03262524679303169,
-0.008126898668706417,
-0.0370117649435997,
0.01938546448945999,
0.022553248330950737,
-0.031120190396904945,
0.006595114711672068,
-0.05640018358826637,
-0.033920515328645706,
-0.038813307881355286,
-0.04717334732413292,
-0.012058529071509838,
0.04225632920861244,
0.013971948996186256,
0.024706847965717316,
0.029101764783263206,
0.02723897062242031,
-0.0293879397213459,
0.03981490060687065,
-0.02326054312288761,
-0.07698482275009155,
0.05722513794898987,
0.0035646602045744658,
-0.039358772337436676,
0.012568088248372078,
0.016097763553261757,
0.03302668035030365,
-0.03903359919786453,
-0.04149705544114113,
0.07049914449453354,
-0.007849917747080326,
0.004037107806652784,
-0.01769162341952324,
0.06124356389045715,
0.04566507786512375,
-0.015087385661900043,
0.05323237553238869,
-0.02367129921913147,
-0.0776982381939888,
-0.006834310945123434,
-0.03386823460459709,
-0.025285184383392334,
-0.05615171045064926,
-0.0071119144558906555,
-0.06007462739944458,
0.022849559783935547,
0.06560216099023819,
-0.07426091283559799,
-0.016032541170716286,
0.0039881630800664425,
-0.04688964784145355,
0.055062435567379,
-0.07740718126296997,
-0.04624493792653084,
0.005206854082643986,
-0.0514867939054966,
-0.004766112193465233,
0.0672566294670105,
0.04031052812933922,
-0.040908802300691605,
0.03734416514635086,
-0.03515065088868141,
0.07034396380186081,
0.00784275308251381,
0.018046312034130096,
-0.01738791912794113,
-0.02987349033355713,
0.10375329107046127,
-0.009848139248788357,
0.006371098104864359,
-0.0989627093076706,
0.0318240225315094,
0.05384128913283348,
0.0043397811241447926,
0.05107911303639412,
0.01857215166091919,
0.05122283846139908,
0.024737505242228508,
0.02398541010916233,
-0.01977214589715004,
-0.0026755977887660265,
0.04136226698756218,
0.033514320850372314,
-0.01815226674079895,
0.008714914321899414,
-0.03011677786707878,
0.022483300417661667,
0.019424816593527794,
-0.007573002949357033,
-0.031500499695539474,
0.02558146044611931,
0.015843186527490616,
0.007464857771992683,
-0.05714578554034233,
-0.03747604414820671,
-0.004643150605261326,
-0.012872311286628246,
0.029581554234027863,
0.02810310386121273,
0.008748128078877926,
0.06956952810287476,
-0.007140795700252056,
0.02205963246524334,
-0.07675784081220627,
-0.023363294079899788,
-0.04562928155064583,
-0.010965144261717796,
-0.029347216710448265,
0.016523147001862526,
0.026384688913822174,
-0.013100635260343552,
-0.004744722507894039,
-0.011351441964507103,
0.008808041922748089,
-0.007855003699660301,
0.014757194556295872,
0.00953101646155119,
-0.061589185148477554,
0.019890015944838524,
0.0388597771525383,
0.07211550325155258,
-0.03263655677437782,
0.09990318864583969,
-0.0020236449781805277,
0.04696211591362953,
0.0430675707757473,
0.022333292290568352,
0.005755505990236998,
0.02894982323050499,
-0.06032174453139305,
-0.033401090651750565,
0.048114798963069916,
0.0006092489347793162,
0.022089319303631783,
0.0012038775021210313,
0.014073250815272331,
-0.044689375907182693,
0.00733314361423254,
-0.00011004286352545023,
0.03894517570734024,
-0.0023798993788659573,
-0.03400295600295067,
-0.019141366705298424,
-0.031633131206035614,
-0.00285273976624012,
-0.045783162117004395,
0.018362000584602356,
0.03320184722542763,
0.027136318385601044,
-0.03074503131210804,
-0.02394755370914936,
-0.010877941735088825,
-0.038983289152383804,
-0.03825775533914566,
0.027150824666023254,
-0.024910617619752884,
0.04960525035858154,
-0.02143305167555809,
0.02885890007019043,
0.011648913845419884,
0.02280486933887005,
-0.011835548095405102,
0.0010875443695113063,
0.011858023703098297,
-0.0011806446127593517,
0.02732318826019764,
-0.013131440617144108,
0.012979666702449322,
0.036765340715646744,
0.025790320709347725,
0.0028604515828192234,
-0.03436949476599693,
0.03489115834236145,
0.005214449018239975,
0.015933793038129807,
0.015621299855411053,
-0.01510158833116293,
-0.07185636460781097,
-0.02389635518193245,
-0.002718229778110981,
-0.011130806989967823,
0.02511456049978733,
-0.036521587520837784,
0.03469041734933853,
0.04122335836291313,
-0.048099689185619354,
0.012255227193236351,
-0.05775131285190582,
0.034234028309583664,
0.021877622231841087,
-0.055180519819259644,
0.025250330567359924,
0.02429254911839962,
-0.05081130564212799,
0.007075896020978689,
-0.0400770902633667,
-0.04004901275038719,
-0.02267291210591793,
-0.023977460339665413,
-0.018597275018692017,
0.03910139575600624,
-0.049069393426179886,
0.08192655444145203,
-0.048048943281173706,
0.022722050547599792,
0.01959838904440403,
-0.00013752139057032764,
-0.02521221712231636,
-0.030905406922101974,
-0.05722888559103012,
0.01864716410636902,
-0.01706712320446968,
-0.05915524438023567,
-0.0453074611723423,
0.005491640418767929,
-0.018121208995580673,
-0.044147178530693054,
-0.010692417621612549,
-0.02151697501540184,
-0.006785574369132519,
-0.0005936241941526532,
0.007606382016092539,
0.0035936401691287756,
-0.014428043738007545,
-0.0004437701136339456,
0.008291797712445259,
0.06084069237112999,
-0.0033198073506355286,
0.004443936049938202,
-0.07874526083469391,
0.039359498769044876,
0.059559669345617294,
-0.005355090368539095,
0.0010388654191046953,
0.032002609223127365,
-0.005002619698643684,
0.03239225968718529,
-0.02064109407365322,
-0.006862354464828968,
0.00018752542382571846,
0.0025256937369704247,
0.06335412710905075,
-0.046192120760679245,
0.005949345882982016,
-0.02639794535934925,
-0.018169883638620377,
-0.06923716515302658,
-0.04385976865887642,
-0.03335458040237427,
-0.12206636369228363,
0.028937777504324913,
0.01513759233057499,
0.03385809436440468,
0.012860851362347603,
0.01014741137623787,
0.013167713768780231,
0.025103434920310974,
-0.0065927570685744286,
0.01857183128595352,
-0.0007371943211182952,
0.04700082913041115,
0.008716130629181862,
-0.018677523359656334,
0.010357080027461052,
-0.006136634387075901,
-0.03716253861784935,
-0.010464377701282501,
0.028976934030652046,
-0.04130520671606064,
-0.05986877158284187,
-0.04543264955282211,
0.036117929965257645,
-0.024606110528111458,
0.04808148369193077,
0.036122847348451614,
-0.03204428404569626,
-0.06874259561300278,
-0.000820179411675781,
0.03007560595870018,
0.013472862541675568,
-0.008685118518769741,
-0.029431449249386787,
-0.013301897794008255,
-0.009750550612807274,
0.05745876207947731,
0.01251385360956192,
0.039621077477931976,
0.026000166311860085,
-0.03769658878445625,
-0.06851595640182495,
-0.006131925154477358,
0.004655363969504833,
0.055609919130802155,
0.03634117916226387,
-0.04425976797938347,
0.010438677854835987,
0.06272630393505096,
-0.030948933213949203,
0.00192535319365561,
-0.06647000461816788,
-0.002479715272784233,
-0.025356585159897804,
0.01801476627588272,
-0.08228116482496262,
-0.04924224689602852,
0.007868170738220215,
-0.007773431949317455,
-0.03900771588087082,
-0.06334484368562698,
0.01631186716258526,
0.06691409647464752,
-0.009700327180325985,
-0.029236678034067154,
-0.0191483274102211,
0.02818400226533413,
0.0060197035782039165,
-0.00904466025531292,
0.029351886361837387,
0.05658499523997307,
0.014977429993450642,
0.009791498072445393,
0.023700209334492683,
-0.05376588925719261,
-0.07383394241333008,
0.011387353762984276,
-0.05675509199500084,
0.05648689717054367,
0.007295225281268358,
-0.023051690310239792,
0.02686520293354988,
-0.036509741097688675,
-0.048390429466962814,
-0.031145352870225906,
0.0410919226706028,
0.025346925482153893,
0.00509186927229166,
0.018091369420289993,
-0.016284476965665817,
-0.006549472454935312,
-0.012254172936081886,
-0.052635304629802704,
0.024628937244415283,
0.010170609690248966,
-0.013148343190550804,
-0.024248497560620308,
-0.005380596034228802,
-0.015361903235316277,
0.012330416589975357,
0.008336028084158897,
0.0319269560277462,
-0.024813124909996986,
0.01956385374069214,
0.06000630930066109,
-0.02836279571056366,
-0.054352156817913055,
0.017347536981105804,
0.06403149664402008,
0.058628376573324203,
-0.03354059159755707,
-0.039229538291692734,
0.00945393554866314,
0.0313274972140789,
0.03272388502955437,
0.00567628676071763,
-0.040196895599365234,
0.04530387371778488,
-0.0015812345081940293,
0.05483166500926018,
-0.047555360943078995,
0.011658817529678345,
-0.021178537979722023,
-0.019340213388204575,
-0.061737723648548126,
0.06850530207157135,
-0.0040063089691102505,
0.014540855772793293,
-0.05005830153822899,
0.04936664551496506,
0.022811105474829674,
0.01999693550169468,
0.044156741350889206,
0.03304392844438553,
0.06376823037862778,
0.04525290057063103,
-0.04721471667289734,
0.0463070310652256,
0.0249607115983963,
-0.034560609608888626,
-0.006458761170506477,
0.010064199566841125,
-0.033035460859537125,
-0.0792270302772522,
-0.011769914999604225,
0.0440494529902935,
0.009278697893023491,
0.012227841652929783,
0.025913871824741364,
-0.025621002539992332,
0.03366972878575325,
0.030156726017594337,
0.05509263649582863,
0.021094301715493202,
0.04904457926750183,
-0.004544810391962528,
-0.0336027592420578,
0.04000874236226082,
0.04618380591273308,
0.05787793546915054,
0.008916839957237244,
0.05258536711335182,
-0.01527877151966095,
0.050319403409957886,
-0.02934100478887558,
-0.04894541949033737,
0.005815613083541393,
0.0021656614262610674,
-0.04326023906469345,
0.0385756678879261,
-0.08182655274868011,
-0.02847323566675186,
0.019758811220526695,
-0.014630156569182873,
0.02217765897512436,
-0.02765171229839325,
0.0439905971288681,
0.001635098597034812,
-0.025235198438167572,
0.011313388124108315,
0.01608225889503956,
0.012100043706595898,
-0.0343485102057457,
-0.010975671000778675,
0.0031226957216858864,
0.010225723497569561,
0.0031101717613637447,
-0.08911588788032532,
-0.13055667281150818,
0.03282536566257477,
-0.01667151413857937,
0.013229571282863617,
0.002554840175434947,
-0.06253913789987564,
-0.002654507290571928,
-0.00534328306093812,
0.00017498731904197484,
0.015970634296536446,
0.0043743024580180645,
-0.008106599561870098,
-0.010486897081136703,
0.015261715278029442,
0.04605802148580551,
0.0154781648889184,
-0.028139732778072357,
-0.00014029078010935336,
-0.013714165426790714,
0.032619453966617584,
-0.04021883383393288,
-0.01149474736303091,
-0.024202637374401093,
0.02611732669174671,
0.009179859422147274,
-0.012066635303199291,
0.0026581529527902603,
0.054907310754060745,
-0.013077493757009506,
-0.014874028973281384,
0.0191990677267313,
0.06926871091127396,
-0.0435275137424469,
-0.04046894982457161,
-0.0455734021961689,
-0.0067013842053711414,
0.018628401681780815,
-0.01966792345046997,
-0.03482454642653465,
0.007708823308348656,
-0.016853822395205498,
-0.023566795513033867,
0.015813395380973816,
-0.0018293517641723156,
-0.011597717180848122,
0.046125952154397964,
0.07093248516321182,
-0.02846183441579342,
0.034588105976581573,
-0.03783790022134781,
0.022123949602246284,
0.023128876462578773,
0.010810508392751217,
-0.044689927250146866,
-0.03315876051783562,
0.026460081338882446,
-0.07129161059856415,
0.000019227351003792137,
-0.003431687830016017,
-0.029980972409248352,
-0.005247053690254688,
-0.08448950201272964,
0.011703457683324814,
-0.003316570073366165,
-0.0019071517745032907,
0.039609186351299286,
-0.011535665020346642,
0.00748872384428978,
0.05831999331712723,
-0.015269034542143345,
0.003663661191239953,
-0.010243789292871952,
-5.076548310836687e-33,
0.04161520674824715,
-0.030818423256278038,
0.020537810400128365,
-0.024363502860069275,
0.034366436302661896,
0.07014196366071701,
-0.028097350150346756,
-0.05888619273900986,
-0.06679010391235352,
0.015361063182353973,
-0.029734211042523384,
0.0010457737371325493,
0.02014879509806633,
0.06654053926467896,
-0.035577088594436646,
-0.04844030737876892,
-0.005541438236832619,
0.0164555124938488,
-0.024526050314307213,
-0.036995481699705124,
0.02292829193174839,
-0.014124381355941296,
-0.046535421162843704,
-0.08438309282064438,
-0.032343894243240356,
0.03773612529039383,
0.05395068973302841,
0.028800826519727707,
0.008825208060443401,
-0.012036110274493694,
0.011327734217047691,
-0.04613948240876198,
0.019540397450327873,
-0.02592317759990692,
-0.02220863290131092,
-0.0065719960257411,
0.038021914660930634,
-0.06547509878873825,
0.03407502919435501,
-0.014664827845990658,
0.047346409410238266,
-0.06785381585359573,
0.006652893032878637,
-0.00008313281432492658,
0.028498513624072075,
-0.037750113755464554,
-0.03799435496330261,
-0.02761741727590561,
0.01782321371138096,
-0.070679672062397,
-0.007820104248821735,
0.011126745492219925,
0.024439215660095215,
-0.02255708910524845,
-0.015661131590604782,
0.015416905283927917,
0.018674056977033615,
0.05097294971346855,
0.055256351828575134,
-0.0036245365627110004,
0.045284125953912735,
-0.024340510368347168,
0.004755691159516573,
0.009025556966662407,
-0.03785599395632744,
-0.004517762456089258,
0.03462466597557068,
0.008511190302670002,
-0.04899653047323227,
0.01779816672205925,
-0.09645510464906693,
0.04327484592795372,
0.01209255587309599,
-0.10811302810907364,
-0.041245102882385254,
0.02277415432035923,
0.05171646550297737,
0.04154206067323685,
-0.012228144332766533,
-0.05195831134915352,
-0.014227326959371567,
-0.0332656130194664,
-0.021980665624141693,
-0.014030822552740574,
0.013880572281777859,
0.05849751457571983,
0.005064842291176319,
0.016505703330039978,
0.0003774845681618899,
0.01274145022034645,
0.10756132006645203,
-0.0288644190877676,
-0.00376535183750093,
-0.008758948184549809,
0.0527903214097023,
-0.033634115010499954,
0.07243356108665466,
0.014946294017136097,
0.023149611428380013,
0.034287482500076294,
0.0541214756667614,
-0.022510826587677002,
-0.008162634447216988,
0.03165494278073311,
-0.017245590686798096,
0.008658722043037415,
0.00875807274132967,
-0.024667857214808464,
0.03935043886303902,
-0.0027130369562655687,
0.01821034774184227,
-0.009812399744987488,
0.006187723949551582,
0.013058033771812916,
0.010562468320131302,
0.009029875509440899,
0.01531110517680645,
0.015558437444269657,
0.050214316695928574,
0.08218740671873093,
-0.004928090143948793,
0.02074458636343479,
-0.04802168533205986,
-0.04479612782597542,
-0.020705893635749817,
-0.049441903829574585,
0.018629781901836395,
0.012828703038394451,
-0.04492299258708954,
-0.03523746877908707,
0.025526229292154312,
-0.0002408012078376487,
2.697616992008989e-7,
0.05430042743682861,
0.02077353186905384,
-0.009858901612460613,
-0.08427701145410538,
-0.014693822711706161,
0.019978627562522888,
-0.0005585677572526038,
-0.00537746911868453,
-0.021617302671074867,
0.006907211150974035,
0.018431471660733223,
0.04026094079017639,
-0.036130212247371674,
0.018108636140823364,
0.06208101660013199,
0.013390634208917618,
-0.07303190231323242,
0.015487750992178917,
0.017281243577599525,
-0.013695413246750832,
0.005847403779625893,
-0.031214838847517967,
-0.045195698738098145,
-0.05633252486586571,
0.02727695181965828,
0.011829182505607605,
-0.014391088858246803,
-0.025001421570777893,
-0.047292836010456085,
-0.0355745404958725,
-0.024554841220378876,
0.08018288016319275,
0.010354685597121716,
-0.0067338477820158005,
0.01486241351813078,
-0.04086195304989815,
0.02955603040754795,
0.04275193437933922,
0.021936863660812378,
0.017152704298496246,
0.03694296255707741,
0.015987977385520935,
0.02015621028840542,
0.0037374813109636307,
0.0732128918170929,
0.004878440871834755,
-0.018188145011663437,
0.020191647112369537,
0.021100280806422234,
0.029025103896856308,
-0.05251951143145561,
0.01179429143667221,
0.01675315946340561,
0.06239711120724678,
-0.008810324594378471,
0.05619277060031891,
-0.02953336387872696,
-0.045633938163518906,
-0.007914196699857712,
-0.017059853300452232,
-0.02710641734302044,
-0.04248375445604324,
-0.040534935891628265,
0.010862435214221478,
0.058585744351148605,
-0.061834849417209625,
-0.0329476073384285,
2.374170965528477e-34,
0.001569234998896718,
-0.024353766813874245,
0.006127153057605028,
-0.057746272534132004,
-0.04317894205451012,
-0.0053602769039571285,
0.02749091200530529,
-0.002615995006635785,
0.01448732428252697,
-0.05788591876626015,
0.008374209515750408
] | {
"ds_index": 5,
"similar_dg_indices": [
81540,
923614,
743742,
73561,
64284,
196195,
1087444,
293169,
656884,
233652,
652817,
812110,
344240,
1093398,
415343,
97879,
917076,
1154338,
1114911,
893932
]
} |
A 25-year-old primigravida presents to her physician for a routine prenatal visit. She is at 34 weeks gestation, as confirmed by an ultrasound examination. She has no complaints, but notes that the new shoes she bought 2 weeks ago do not fit anymore. The course of her pregnancy has been uneventful and she has been compliant with the recommended prenatal care. Her medical history is unremarkable. She has a 15-pound weight gain since the last visit 3 weeks ago. Her vital signs are as follows: blood pressure, 148/90 mm Hg; heart rate, 88/min; respiratory rate, 16/min; and temperature, 36.6℃ (97.9℉). The blood pressure on repeat assessment 4 hours later is 151/90 mm Hg. The fetal heart rate is 151/min. The physical examination is significant for 2+ pitting edema of the lower extremity. Which of the following tests o should confirm the probable condition of this patient? | 24-hour urine protein | {
"A": "Bilirubin assessment",
"B": "Coagulation studies",
"C": "Leukocyte count with differential",
"D": "24-hour urine protein"
} | step2&3 | D | [
"year old primigravida presents",
"physician",
"routine prenatal visit",
"weeks gestation",
"confirmed by",
"ultrasound examination",
"complaints",
"notes",
"new shoes",
"bought 2 weeks",
"not fit",
"course",
"pregnancy",
"compliant",
"recommended prenatal care",
"medical history",
"unremarkable",
"pound weight gain",
"last visit",
"weeks",
"vital signs",
"follows",
"blood pressure",
"90 mm Hg",
"heart rate",
"88 min",
"respiratory rate",
"min",
"temperature",
"36",
"97",
"blood",
"repeat assessment",
"hours later",
"90 mm Hg",
"fetal heart rate",
"min",
"physical examination",
"significant",
"pitting edema",
"lower extremity",
"following tests",
"confirm",
"probable condition",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 25-year-old primigravida presents to her physician for a routine prenatal visit. She is at 34 weeks gestation, as confirmed by an ultrasound examination. She has no complaints, but notes that the new shoes she bought 2 weeks ago do not fit anymore. The course of her pregnancy has been uneventful and she has been compliant with the recommended prenatal care. Her medical history is unremarkable. She has a 15-pound weight gain since the last visit 3 weeks ago. Her vital signs are as follows: blood pressure, 148/90 mm Hg; heart rate, 88/min; respiratory rate, 16/min; and temperature, 36.6℃ (97.9℉). The blood pressure on repeat assessment 4 hours later is 151/90 mm Hg. The fetal heart rate is 151/min. The physical examination is significant for 2+ pitting edema of the lower extremity. Which of the following tests o should confirm the probable condition of this patient?
Choose one of the following::
A. Bilirubin assessment
B. Coagulation studies
C. Leukocyte count with differential
D. 24-hour urine protein | [
-0.013434482738375664,
-0.03743705898523331,
-0.022961042821407318,
-0.012889974750578403,
0.010452140122652054,
-0.008017762564122677,
-0.025461284443736076,
0.04915029555559158,
-0.01887853629887104,
0.028556637465953827,
0.04961457848548889,
-0.03735170140862465,
0.020590605214238167,
-0.030836503952741623,
-0.007985183969140053,
-0.003125217044726014,
-0.030573593452572823,
0.005387980956584215,
-0.019613489508628845,
-0.004527254030108452,
-0.030745666474103928,
-0.01562096830457449,
0.0082022026181221,
-0.01883539929986,
0.02893490344285965,
0.011863382533192635,
0.028081685304641724,
-0.027120085433125496,
-0.00802994892001152,
-0.08309555053710938,
0.02554318681359291,
0.018154766410589218,
0.017307398840785027,
-0.06230656057596207,
0.0000018041140492641716,
-0.05102306604385376,
0.005113755818456411,
-0.022048765793442726,
0.041588153690099716,
-0.01452228706330061,
-0.015414812602102757,
-0.07007443904876709,
0.011272937059402466,
0.01495394203811884,
-0.052044279873371124,
-0.10452158004045486,
-0.013389520347118378,
0.06586337834596634,
-0.02701639011502266,
0.023913953453302383,
0.020851870998740196,
0.035043492913246155,
-0.04525675252079964,
-0.003239603713154793,
0.08244948834180832,
-0.05984675511717796,
-0.016203172504901886,
-0.00244208425283432,
0.01605362445116043,
0.007465943228453398,
0.02543017826974392,
-0.005364205222576857,
0.030320312827825546,
0.03523900732398033,
-0.06957195699214935,
-0.0011872737668454647,
0.08941388875246048,
-0.049026474356651306,
0.009353827685117722,
0.004458686336874962,
0.027807923033833504,
0.02143705263733864,
0.03977544605731964,
0.0939403772354126,
-0.06374780833721161,
-0.037857066839933395,
0.02093544602394104,
-0.02497575618326664,
-0.016717474907636642,
-0.02463548071682453,
0.03477178141474724,
0.034988436847925186,
-0.015478705056011677,
0.0326770581305027,
-0.02613769844174385,
-0.026471156626939774,
0.02419957146048546,
-0.020131351426243782,
0.015003287233412266,
-0.0011765321251004934,
0.008860958740115166,
-0.044691551476716995,
0.017891282215714455,
0.029608845710754395,
-0.025401929393410683,
-0.01566416583955288,
0.00355963665060699,
0.0037190490402281284,
0.05555709823966026,
-0.05120261013507843,
-0.039549320936203,
-0.002488389378413558,
0.014061695896089077,
0.001800456433556974,
-0.038278285413980484,
-0.027473868802189827,
-0.013708442449569702,
0.012246956117451191,
-0.07770725339651108,
0.07499803602695465,
0.0002536121755838394,
0.026804650202393532,
-0.03347242251038551,
0.005309764761477709,
0.09197898954153061,
0.017033938318490982,
-0.06058786064386368,
-0.07587512582540512,
-0.004626290872693062,
0.027101442217826843,
-0.020349420607089996,
0.04523180425167084,
0.04347251355648041,
-0.002886273665353656,
-0.04188665747642517,
-0.008062162436544895,
0.000194379550521262,
0.01860487461090088,
-0.01809932291507721,
0.01278963964432478,
0.026747897267341614,
-0.00807472225278616,
-0.019616320729255676,
0.06400132924318314,
0.02355290949344635,
-0.023083241656422615,
0.015495633706450462,
0.0464228019118309,
-0.005119418725371361,
-0.014404501765966415,
-0.017196984961628914,
-0.06552136689424515,
-0.025173712521791458,
0.03289708122611046,
-0.023515451699495316,
0.05712968111038208,
0.004644915461540222,
-0.015267881564795971,
0.03994348272681236,
0.04238197207450867,
0.015017060562968254,
-0.03979597985744476,
0.002906839130446315,
0.020989518612623215,
0.01670984737575054,
0.05070601776242256,
0.02457463927567005,
0.008914212696254253,
0.010506261140108109,
-0.06820636242628098,
0.005398607347160578,
-0.055239200592041016,
-0.028165876865386963,
0.01647467352449894,
0.01568949595093727,
0.0033923888113349676,
0.052849870175123215,
0.05115474388003349,
-0.033213552087545395,
0.02740493044257164,
-0.022741232067346573,
0.014745458029210567,
0.025902176275849342,
0.052136555314064026,
-0.012597721070051193,
0.04294329136610031,
-0.031651247292757034,
-0.0457594059407711,
0.029985681176185608,
-0.08611518889665604,
0.02066347375512123,
0.04618369787931442,
0.0451180562376976,
-0.07413601875305176,
0.009551397524774075,
-0.00994805060327053,
-0.04388066753745079,
-0.03986639901995659,
-0.019357483834028244,
-0.06453177332878113,
-0.031699370592832565,
-0.0018393521895632148,
-0.01722247153520584,
-0.015338421799242496,
-0.016029834747314453,
0.06391843408346176,
-0.016443835571408272,
-0.00141016929410398,
-0.006768320221453905,
0.021418511867523193,
-0.02391841635107994,
-0.0353793166577816,
0.050364550203084946,
0.0017870092997327447,
-0.03848965838551521,
0.041926637291908264,
0.04561711102724075,
0.055395737290382385,
-0.01963542215526104,
-0.034364983439445496,
0.03060629777610302,
0.017686760053038597,
0.016785919666290283,
-0.04581334441900253,
0.03524940833449364,
0.018962420523166656,
0.0085888197645545,
0.027680600062012672,
-0.06735826283693314,
0.0385698601603508,
0.021684041246771812,
0.021178564056754112,
-0.0034131743013858795,
0.003516571130603552,
-0.02383175864815712,
-0.021217256784439087,
0.0142550989985466,
-0.007780501153320074,
-0.016477888450026512,
-0.08881457895040512,
0.061126552522182465,
0.004466881975531578,
-0.023909056559205055,
0.029051410034298897,
0.015157756395637989,
0.036418572068214417,
0.03261623904109001,
-0.051604073494672775,
0.015224006026983261,
0.006428247317671776,
-0.040249843150377274,
-0.05905777961015701,
-0.05658940598368645,
-0.05547652766108513,
-0.013834127224981785,
-0.05310056358575821,
-0.0013410516548901796,
0.032725293189287186,
-0.051382604986429214,
0.029966289177536964,
-0.018690133467316628,
0.0015492747770622373,
-0.025430500507354736,
0.019429173320531845,
-0.0005952864303253591,
0.022580765187740326,
-0.047551821917295456,
-0.01032933034002781,
-0.016551099717617035,
-0.04327789694070816,
-0.05329300835728645,
-0.000491814746055752,
-0.024963542819023132,
-0.026746544986963272,
0.006098129786550999,
-0.052888646721839905,
0.012283717282116413,
0.00977078266441822,
-0.02139979414641857,
0.03010910004377365,
0.019759049639105797,
0.017626803368330002,
0.0225802194327116,
0.022831739857792854,
0.0030868134927004576,
0.004908187780529261,
-0.0048333206214010715,
0.02735534869134426,
0.04145530238747597,
0.012909999117255211,
-0.005201294552534819,
0.09147988259792328,
0.0044675469398498535,
0.04022447392344475,
0.00911098811775446,
0.0002586425980553031,
0.009268474765121937,
0.046180326491594315,
0.05408075824379921,
0.011643635109066963,
-0.020990930497646332,
-0.011712796054780483,
0.04537149518728256,
-0.02899959683418274,
-0.01242587249726057,
0.009426431730389595,
-0.02493695542216301,
0.012942491099238396,
0.012188689783215523,
0.05256820470094681,
-0.020787879824638367,
0.05040547251701355,
0.005594881717115641,
-0.017940610647201538,
-0.00529053807258606,
0.06072518602013588,
0.043747350573539734,
0.012367329560220242,
0.02499360591173172,
0.033381808549165726,
0.017722951248288155,
-0.050356581807136536,
0.018763242289423943,
0.011257448233664036,
-0.00004931884541292675,
-0.005105930846184492,
-0.01495051383972168,
-0.039011187851428986,
0.0107631990686059,
0.08221202343702316,
0.044888731092214584,
-0.003325830213725567,
-0.020054413005709648,
-0.0029423877131193876,
-0.011536592617630959,
-0.02170073240995407,
-0.03213841840624809,
0.0015916925622150302,
-0.06431462615728378,
-0.016947472468018532,
-0.0011017684591934085,
-0.0461849682033062,
-0.004933338612318039,
0.005271031055599451,
-0.009333635680377483,
-0.0006405526073649526,
-0.038702141493558884,
0.010354714468121529,
-0.03467662259936333,
0.044225648045539856,
0.02345702052116394,
-0.054976269602775574,
0.005161541048437357,
0.007546346168965101,
0.03522142767906189,
-0.00395080354064703,
-0.07937347888946533,
0.02265402488410473,
-0.01211611833423376,
0.023709779605269432,
-0.11581519991159439,
0.00933907926082611,
0.007371758576482534,
-0.00023735113791190088,
-0.03609386086463928,
-0.048175036907196045,
-0.0015669886488467455,
0.05810689181089401,
-0.018798310309648514,
-0.04372752457857132,
0.029187386855483055,
0.002151650143787265,
-0.032655082643032074,
0.06494622677564621,
-0.008661961182951927,
0.002365421736612916,
-0.00722429808229208,
-0.020779093727469444,
-0.011855405755341053,
-0.03361271694302559,
-0.02937067672610283,
-0.005007294472306967,
-0.028975944966077805,
0.03682996332645416,
-0.014781107194721699,
-0.011632032692432404,
-0.00316034397110343,
-0.03693295270204544,
-0.10332946479320526,
-0.006837233901023865,
0.05763432756066322,
-0.010257329791784286,
0.05474668741226196,
-0.0032102500554174185,
-0.0042238859459757805,
0.02047407068312168,
-0.0025670905597507954,
-0.05955275148153305,
0.0331445187330246,
0.01951121725142002,
-0.006575072184205055,
0.03408842906355858,
0.02252390794456005,
-0.03809935227036476,
0.021394377574324608,
0.06502983719110489,
-0.01934780552983284,
-0.04742080345749855,
0.036899369210004807,
0.05880003049969673,
-0.024157321080565453,
0.00003435091639403254,
-0.05902281776070595,
0.08931024372577667,
0.03411750867962837,
-0.06728436797857285,
-0.033209700137376785,
-0.004107546526938677,
0.0025297151878476143,
-0.005722993053495884,
0.031138591468334198,
-0.05688319727778435,
0.006629481911659241,
-0.04116855561733246,
0.023347122594714165,
0.02271273545920849,
0.010374068282544613,
-0.024175314232707024,
0.03231948986649513,
-0.03492166846990585,
0.07582341134548187,
0.03778660669922829,
-0.01600104570388794,
-0.035127319395542145,
-0.053975120186805725,
-0.025769701227545738,
0.09786327928304672,
0.06557253748178482,
0.004094431642442942,
-0.006230643019080162,
0.017122361809015274,
0.0016320106806233525,
0.05349187180399895,
0.07325395941734314,
0.012842485681176186,
0.021823568269610405,
-0.02363518998026848,
-0.04533683881163597,
0.009278676472604275,
-0.04179248958826065,
0.029133768752217293,
-0.000599730177782476,
0.11277082562446594,
0.050205640494823456,
-0.021640213206410408,
0.04476574435830116,
0.028274428099393845,
0.021656133234500885,
0.042743563652038574,
0.11708135157823563,
0.0102864820510149,
-0.011962683871388435,
0.0010584347182884812,
0.06025955453515053,
0.051350515335798264,
-0.006645757704973221,
-0.0177543293684721,
-0.03295602649450302,
0.06157462298870087,
-0.05567963421344757,
-0.009911506436765194,
0.026322847232222557,
-0.04217394441366196,
-0.08855114877223969,
0.033570557832717896,
-0.06734961271286011,
-0.06632637232542038,
-0.0035191038623452187,
0.024509787559509277,
-0.02331029623746872,
-0.06373264640569687,
0.03480636328458786,
-0.023834263905882835,
0.029253331944346428,
0.032206449657678604,
-0.0036612246185541153,
-0.04868737608194351,
0.022068819031119347,
-0.04143601655960083,
0.020667631179094315,
0.028938498347997665,
0.06613323837518692,
-0.034916892647743225,
-0.0569806732237339,
0.0014299530303105712,
0.027010571211576462,
0.030772680416703224,
-0.03066827543079853,
0.002597289625555277,
0.015584181062877178,
-0.028044002130627632,
0.024128030985593796,
-0.02760554850101471,
-0.03360392153263092,
-0.07896590232849121,
-0.03990110009908676,
-0.003626506309956312,
0.06375453621149063,
0.02923407033085823,
-0.02139582671225071,
0.000966210849583149,
-0.0034367076586931944,
0.009362784214317799,
-0.028486551716923714,
0.01675613410770893,
0.0503007136285305,
-0.013831383548676968,
0.038138508796691895,
-0.0480930358171463,
-0.04565657302737236,
-0.022608816623687744,
0.018331428989768028,
0.03608842194080353,
0.02444370649755001,
0.013018546625971794,
-0.002547243842855096,
-0.07640088349580765,
-0.027282550930976868,
-0.032166413962841034,
0.008079666644334793,
0.0014928504824638367,
-0.0029673438984900713,
-0.03299253433942795,
-0.01692901737987995,
0.013238540850579739,
0.06163857877254486,
-0.003644391195848584,
-0.006091695744544268,
0.022901270538568497,
0.039377324283123016,
-0.06768500059843063,
-0.02675008773803711,
-0.04768321290612221,
-0.018050791695713997,
-0.02461567521095276,
0.01933196373283863,
0.01629643328487873,
-0.026126492768526077,
-0.011927844025194645,
-0.03798214718699455,
0.0007828425732441247,
-0.007982319220900536,
-0.007761689834296703,
0.024542059749364853,
-0.035993196070194244,
0.04513112083077431,
-0.050358548760414124,
0.028346223756670952,
0.02186957560479641,
-0.01083166990429163,
-0.009923621080815792,
0.05281376093626022,
-0.015629375353455544,
0.049008358269929886,
0.04731246829032898,
-5.0672725583827456e-33,
0.03044288419187069,
-0.037654172629117966,
0.05384392291307449,
-0.03687688708305359,
0.026632824912667274,
0.10710135847330093,
-0.01650269515812397,
0.01316861156374216,
-0.03728756681084633,
0.01965729147195816,
-0.0320785716176033,
-0.02462238073348999,
0.03094426728785038,
0.06883443146944046,
-0.009860813617706299,
-0.025609245523810387,
0.015039232559502125,
-0.005159320309758186,
-0.0010779957519844174,
-0.01569371670484543,
-0.03692138195037842,
-0.004001137800514698,
0.02147783525288105,
-0.005690603516995907,
-0.005078721791505814,
-0.02688201516866684,
-0.004111470188945532,
0.004595598671585321,
-0.02436833642423153,
0.020105676725506783,
0.019113212823867798,
-0.02918980084359646,
0.013158489018678665,
-0.004370913840830326,
0.005351480562239885,
-0.02295362390577793,
-0.01700650528073311,
-0.06955598294734955,
0.04131145775318146,
-0.013283893465995789,
-0.036274004727602005,
-0.0035995072685182095,
0.03492961451411247,
0.007178394123911858,
0.032461583614349365,
-0.03499904274940491,
-0.02209707722067833,
-0.04038098081946373,
0.04032627120614052,
-0.04164927825331688,
-0.007027547340840101,
0.014673328958451748,
0.016006624326109886,
-0.01905064843595028,
-0.022362899035215378,
0.009109203703701496,
-0.03401552513241768,
-0.042807403951883316,
-0.0027093191165477037,
-0.023207558318972588,
-0.016240889206528664,
-0.004951501730829477,
-0.03257341310381889,
-0.05517667159438133,
-0.0026188914198428392,
-0.016269544139504433,
0.027190417051315308,
0.039693571627140045,
-0.02809302881360054,
0.015922171995043755,
-0.07661732286214828,
0.020696241408586502,
0.00047601768164895475,
-0.050711702555418015,
0.03037513978779316,
-0.032457735389471054,
-0.01866346225142479,
0.03556738793849945,
0.033321626484394073,
0.038223765790462494,
-0.020382121205329895,
-0.012017807923257351,
-0.05298883840441704,
0.0019579539075493813,
-0.03312746435403824,
-0.020547721534967422,
0.009929550811648369,
-0.0479772724211216,
0.003765396075323224,
-0.02576782926917076,
0.09052218496799469,
0.007039167918264866,
0.03211309760808945,
-0.014600545167922974,
0.001067354460246861,
-0.0839168056845665,
0.06268519163131714,
-0.011148154735565186,
0.02813979610800743,
0.026794692501425743,
0.09596690535545349,
-0.026193415746092796,
0.058501455932855606,
0.007831308990716934,
0.00501903286203742,
-0.007732974365353584,
-0.02890188805758953,
-0.02056080289185047,
-0.026872729882597923,
0.0030581483151763678,
0.017874116078019142,
-0.022691573947668076,
0.014811437577009201,
-0.00645529804751277,
-0.02636885643005371,
0.025652315467596054,
0.0156689565628767,
0.050762902945280075,
0.03399860858917236,
0.04322478547692299,
-0.0041884672828018665,
0.040261298418045044,
0.025606362149119377,
0.0305120050907135,
-0.055581483989953995,
-0.08560815453529358,
0.05726546794176102,
0.036190979182720184,
-0.05110481381416321,
0.010674141347408295,
0.04083261266350746,
0.05169893801212311,
2.6081937676281086e-7,
0.040176115930080414,
0.003993325401097536,
-0.03047301061451435,
-0.05020030215382576,
0.04530709236860275,
-0.043333254754543304,
-0.03582070395350456,
-0.015972120687365532,
0.015532218851149082,
-0.021507643163204193,
0.060310788452625275,
-0.009565138258039951,
-0.004770513623952866,
0.032903239130973816,
0.04938429594039917,
-0.03585701435804367,
0.002963606035336852,
-0.016032934188842773,
0.017824340611696243,
-0.03090941160917282,
-0.01238030381500721,
0.005538807716220617,
-0.0938926711678505,
-0.051635995507240295,
-0.00769529165700078,
0.023058926686644554,
0.01962319388985634,
-0.04725976288318634,
-0.016370782628655434,
-0.006059295032173395,
0.055839817970991135,
0.030078889802098274,
0.030849602073431015,
0.03698435053229332,
-0.014185179024934769,
0.0027847872115671635,
0.016578562557697296,
0.056033890694379807,
0.010430666618049145,
0.05224248394370079,
0.012798318639397621,
0.026634715497493744,
0.01690993458032608,
-0.02702888660132885,
0.05604172497987747,
0.04309884458780289,
-0.04850872978568077,
-0.04191964119672775,
0.032901208847761154,
-0.04308893159031868,
0.03518201783299446,
0.01248983945697546,
-0.018838435411453247,
0.08919232338666916,
-0.011698487214744091,
0.022308696061372757,
-0.058579135686159134,
0.0030088007915765047,
0.025809943675994873,
0.04655411094427109,
-0.004789223428815603,
-0.08644934743642807,
0.03480065241456032,
-0.008829115889966488,
0.07618304342031479,
-0.04324498772621155,
-0.020311657339334488,
1.6966176288356934e-34,
-0.05362316220998764,
-0.03890833258628845,
-0.006679941900074482,
-0.051699988543987274,
-0.000011659355550364126,
-0.02356865257024765,
0.0290983933955431,
0.01854773610830307,
0.0343751460313797,
-0.06255875527858734,
-0.0027182751800864935
] | {
"ds_index": 6,
"similar_dg_indices": [
984306,
546339,
1110574,
171778,
572380,
1140088,
854837,
956892,
457084,
873907,
560739,
104845,
16541,
141914,
813832,
16846,
941290,
482905,
956358,
273937
]
} |
A 3900-g (8.6-lb) male infant is delivered at 39 weeks' gestation via spontaneous vaginal delivery. Pregnancy and delivery were uncomplicated but a prenatal ultrasound at 20 weeks showed a defect in the pleuroperitoneal membrane. Further evaluation of this patient is most likely to show which of the following findings? | Gastric fundus in the thorax | {
"A": "Gastric fundus in the thorax",
"B": "Pancreatic ring around the duodenum",
"C": "Hypertrophy of the gastric pylorus",
"D": "Large bowel in the inguinal canal"
} | step1 | A | [
"male infant",
"delivered",
"weeks",
"gestation",
"spontaneous vaginal delivery",
"Pregnancy",
"delivery",
"uncomplicated",
"prenatal ultrasound",
"20 weeks showed",
"defect",
"pleuroperitoneal membrane",
"Further evaluation",
"patient",
"most likely to show",
"following findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 3900-g (8.6-lb) male infant is delivered at 39 weeks' gestation via spontaneous vaginal delivery. Pregnancy and delivery were uncomplicated but a prenatal ultrasound at 20 weeks showed a defect in the pleuroperitoneal membrane. Further evaluation of this patient is most likely to show which of the following findings?
Choose one of the following::
A. Gastric fundus in the thorax
B. Pancreatic ring around the duodenum
C. Hypertrophy of the gastric pylorus
D. Large bowel in the inguinal canal | [
0.001574395690113306,
0.02596426010131836,
-0.020101221278309822,
-0.004428078420460224,
0.018953928723931313,
-0.0003089744132012129,
0.01643252559006214,
-0.002247048309072852,
-0.07180038094520569,
-0.011559476144611835,
0.05350065231323242,
-0.05311122536659241,
0.016719087958335876,
0.027261754497885704,
0.03182423487305641,
-0.032579533755779266,
-0.009157347492873669,
0.01791040413081646,
-0.03196829557418823,
-0.004152161069214344,
-0.03749721124768257,
0.008143482729792595,
-0.01496849674731493,
-0.04802357777953148,
0.040127791464328766,
0.007890341803431511,
0.020403338596224785,
0.02289477549493313,
-0.0201769657433033,
-0.023076597601175308,
0.058261919766664505,
0.026635829359292984,
0.016038969159126282,
-0.006898848339915276,
0.0000020098918867006432,
-0.006256920285522938,
-0.008681431412696838,
-0.017151692882180214,
-0.0024352511391043663,
-0.00986641738563776,
-0.01963888294994831,
-0.060320816934108734,
-0.034316834062337875,
-0.042923230677843094,
0.010207059793174267,
-0.05726109817624092,
0.01837674155831337,
0.04914550110697746,
-0.029268182814121246,
-0.004890747833997011,
-0.006291148252785206,
0.08709120005369186,
-0.03287952393293381,
0.035701118409633636,
0.06838374584913254,
-0.07397003471851349,
-0.04967811703681946,
-0.02382272109389305,
0.010470821522176266,
-0.05940950661897659,
0.019848693162202835,
0.02243443951010704,
0.031238915398716927,
-0.01824427954852581,
-0.03315287455916405,
-0.026216596364974976,
0.02145458571612835,
-0.12206998467445374,
-0.024526840075850487,
0.03324994072318077,
-0.0006728688022121787,
0.00017672234389465302,
0.004334940575063229,
0.05286136269569397,
-0.07097593694925308,
-0.07623125612735748,
0.01697273552417755,
0.06058024242520332,
-0.014004969038069248,
-0.017132535576820374,
0.06292293965816498,
-0.018325865268707275,
-0.022519493475556374,
0.047480810433626175,
0.029762087389826775,
-0.023736990988254547,
0.023018771782517433,
-0.008978708647191525,
0.02114393375813961,
0.032555703073740005,
0.031047804281115532,
-0.007549964357167482,
0.01370688434690237,
0.011973228305578232,
0.0205756276845932,
0.021572453901171684,
-0.07637744396924973,
-0.04797770828008652,
0.017211485654115677,
-0.01988404057919979,
0.02937271073460579,
-0.035154618322849274,
-0.02333224192261696,
-0.00041105563286691904,
-0.019574740901589394,
0.0016164935659617186,
-0.01650184951722622,
0.024163365364074707,
-0.02861538901925087,
0.03212587907910347,
0.04658288508653641,
0.020027242600917816,
0.01395365223288536,
-0.004797628149390221,
-0.004980909172445536,
-0.009515736252069473,
-0.008902336470782757,
-0.051877789199352264,
-0.03363949432969093,
0.04604782909154892,
-0.013033830560743809,
0.020855555310845375,
0.005205517169088125,
0.019755512475967407,
-0.03264876455068588,
0.022215159609913826,
0.017769942060112953,
0.015767564997076988,
-0.05616587772965431,
0.014156575314700603,
0.035120639950037,
0.037756580859422684,
0.008594316430389881,
0.07541526854038239,
-0.01869858428835869,
-0.021362250670790672,
-0.0071801538579165936,
-0.013882256112992764,
0.0073437802493572235,
0.012995608150959015,
0.023824019357562065,
-0.02777256816625595,
-0.05301008000969887,
0.05858871340751648,
-0.0036830974277108908,
-0.0014180481666699052,
-0.026311878114938736,
-0.05495116487145424,
0.023791702464222908,
0.054886847734451294,
-0.004691015928983688,
-0.016913464292883873,
-0.07035123556852341,
0.018409734591841698,
0.014797267504036427,
0.030036794021725655,
-0.005702001508325338,
-0.01886482536792755,
-0.007074170745909214,
-0.08145686239004135,
0.009104795753955841,
-0.020586112514138222,
0.0065028793178498745,
0.0046319239772856236,
0.007512898650020361,
-0.04714621230959892,
0.021346425637602806,
0.04512766748666763,
0.0018267061095684767,
-0.00732787698507309,
0.00034805486211553216,
-0.03352194279432297,
0.013490616343915462,
-0.018601207062602043,
-0.022038374096155167,
0.012988116592168808,
-0.0997893214225769,
-0.041068896651268005,
-0.010685698129236698,
-0.06984009593725204,
0.028572775423526764,
-0.033604446798563004,
0.035461824387311935,
-0.004188879393041134,
0.05371275916695595,
-0.027616774663329124,
0.01849011518061161,
-0.008620059117674828,
-0.005859254859387875,
-0.01177028939127922,
-0.01565585657954216,
0.01125691644847393,
-0.013402375392615795,
0.006152622867375612,
-0.007093314081430435,
0.067875936627388,
-0.01582854986190796,
0.08420083671808243,
-0.014973631128668785,
0.06328869611024857,
-0.03063959628343582,
-0.0221094973385334,
0.00185047194827348,
0.0229390487074852,
-0.030862463638186455,
-0.009967650286853313,
-0.023684149608016014,
0.011432484723627567,
-0.019026057794690132,
0.02074125036597252,
-0.011132992804050446,
-0.009619779884815216,
-0.017544543370604515,
-0.020155228674411774,
-0.010210143402218819,
0.0279254000633955,
-0.004178622271865606,
0.0038680557627230883,
0.04470996931195259,
0.014889725483953953,
-0.020019611343741417,
-0.03283552825450897,
0.014449539594352245,
0.018725477159023285,
-0.0052699437364935875,
0.030135909095406532,
0.01440952904522419,
0.041277479380369186,
-0.025711966678500175,
-0.024708423763513565,
0.028935369104146957,
-0.007809571456164122,
0.010586095973849297,
0.04753465577960014,
0.00882861390709877,
0.011247293092310429,
-0.007787649519741535,
-0.02576194331049919,
0.018097717314958572,
-0.015118819661438465,
-0.06394168734550476,
-0.004109714645892382,
-0.032656725496053696,
-0.02991870790719986,
0.011069702915847301,
-0.03965336084365845,
0.005321348085999489,
0.022472146898508072,
0.04586487635970116,
0.02853427268564701,
0.016007917001843452,
0.013347464613616467,
-0.040175821632146835,
0.029339134693145752,
0.0008476166985929012,
0.029650768265128136,
0.015625832602381706,
-0.011928078718483448,
0.0293823704123497,
-0.07200287282466888,
-0.011567382141947746,
-0.039455559104681015,
0.0365777425467968,
-0.02865539863705635,
0.01706460490822792,
-0.008125634863972664,
-0.043577641248703,
0.04124261811375618,
0.03230101615190506,
0.010683312080800533,
0.025833696126937866,
0.03278052806854248,
-0.02279321476817131,
0.026466192677617073,
-0.038979485630989075,
0.04109976440668106,
0.010721821337938309,
0.008741607889533043,
-0.017723331227898598,
0.012247184291481972,
-0.009854115545749664,
0.0631173625588417,
-0.04233599454164505,
0.007699281442910433,
0.01509625930339098,
-0.010314053855836391,
-0.00404611648991704,
0.07186804711818695,
0.03449692577123642,
0.002519194269552827,
-0.05092744529247284,
0.037822261452674866,
0.05789840221405029,
-0.009571502916514874,
0.020595431327819824,
-0.020791826769709587,
-0.04289329797029495,
0.030593309551477432,
-0.017007198184728622,
0.06107310205698013,
-0.05377231165766716,
0.00923653319478035,
-0.0011930374894291162,
0.009281931445002556,
0.018830742686986923,
0.01918843761086464,
0.02246156334877014,
0.08760300278663635,
-0.05433541536331177,
-0.0051351324655115604,
-0.009599879384040833,
-0.0371578074991703,
-0.0017260980093851686,
-0.009381514973938465,
0.01710234023630619,
-0.018529800698161125,
0.020493514835834503,
-0.08614597469568253,
-0.014610213227570057,
0.061709947884082794,
0.035710014402866364,
-0.038691066205501556,
-0.07495462149381638,
0.03984609991312027,
-0.015823163092136383,
-0.043038930743932724,
-0.03912131115794182,
0.0038754455745220184,
0.021053938195109367,
0.004384559113532305,
-0.00834454596042633,
-0.017825713381171227,
-0.04956037178635597,
-0.07971087098121643,
0.05654512718319893,
-0.05664536729454994,
-0.03331433981657028,
0.038631509989500046,
-0.07825936377048492,
0.01614321395754814,
0.01833784021437168,
-0.0602387897670269,
-0.03478667512536049,
-0.010810666717588902,
0.022152720019221306,
-0.03214816004037857,
-0.03981773555278778,
0.01586165465414524,
-0.08225154131650925,
-0.02491515502333641,
-0.08847478777170181,
0.006688491906970739,
0.026786739006638527,
0.0010121965315192938,
-0.05555901676416397,
-0.02793266624212265,
0.016470035538077354,
0.04813195765018463,
0.0015089145163074136,
-0.000889983435627073,
-0.04834814369678497,
-0.04476882144808769,
-0.07383203506469727,
0.050204358994960785,
0.04132411628961563,
0.01239831279963255,
-0.01010369136929512,
-0.03359968960285187,
0.021834811195731163,
0.018875956535339355,
-0.06390558183193207,
0.021232377737760544,
0.015766426920890808,
-0.023451071232557297,
0.01685057207942009,
0.044604331254959106,
-0.04343138262629509,
0.005216790363192558,
-0.04472987353801727,
0.009659643284976482,
0.06251748651266098,
0.047468025237321854,
0.05578121170401573,
0.033269934356212616,
-0.027468370273709297,
0.02249213308095932,
0.02294074557721615,
-0.0290510356426239,
0.04915452376008034,
0.019190141931176186,
-0.039373304694890976,
0.04141993448138237,
-0.02388755790889263,
-0.02535081095993519,
-0.015073845162987709,
0.013772471807897091,
-0.04430360719561577,
-0.0418902188539505,
0.027008499950170517,
0.036380115896463394,
-0.01582525297999382,
0.030859218910336494,
-0.07956886291503906,
0.04279860854148865,
0.018601927906274796,
0.032718874514102936,
-0.031182941049337387,
-0.06206279993057251,
-0.040179293602705,
0.02055021934211254,
0.03474462404847145,
0.07336142659187317,
-0.04105410352349281,
0.04207390919327736,
-0.0011229050578549504,
-0.05811110511422157,
0.016534507274627686,
-0.05414213985204697,
-0.0046394579112529755,
-0.030340513214468956,
0.008481414057314396,
-0.0051977988332509995,
-0.022874949499964714,
0.005689583253115416,
0.015985187143087387,
-0.024896249175071716,
0.0850638598203659,
0.014255180954933167,
0.019556595012545586,
-0.0030808818992227316,
0.025879554450511932,
-0.0018822663696482778,
0.020215120166540146,
0.05355684459209442,
0.07901104539632797,
0.04262957721948624,
0.0514214001595974,
0.036132704466581345,
-0.019058967009186745,
0.08037448674440384,
-0.015016265213489532,
-0.03875918313860893,
0.061113033443689346,
0.053023695945739746,
0.04325665161013603,
-0.013513664714992046,
0.029668424278497696,
-0.03371969237923622,
-0.0023891329765319824,
0.08264168351888657,
-0.022919360548257828,
-0.046062856912612915,
-0.04013606533408165,
0.05985574051737785,
-0.03214628994464874,
0.01576583832502365,
0.0057868193835020065,
0.02965906821191311,
0.0662866160273552,
-0.08966992795467377,
-0.025103112682700157,
0.011273723095655441,
-0.02090667374432087,
-0.07771249115467072,
0.03039979748427868,
0.003878711722791195,
0.007603066507726908,
-0.007303272839635611,
0.03282672539353371,
-0.0015584197826683521,
-0.03673936799168587,
0.034064408391714096,
-0.026308367028832436,
0.00956029910594225,
-0.0446106418967247,
-0.0391111820936203,
0.023505665361881256,
0.022271396592259407,
-0.01395094022154808,
-0.023936357349157333,
0.007197658997029066,
-0.01057991199195385,
-0.06185309961438179,
-0.024690791964530945,
0.01243958342820406,
0.03955560177564621,
0.037965741008520126,
0.019070522859692574,
-0.012013491243124008,
0.03681197017431259,
-0.008685086853802204,
0.00966400746256113,
-0.007897630333900452,
-0.00347121711820364,
-0.0296756774187088,
0.01885722018778324,
0.07064006477594376,
0.051811035722494125,
0.03415659815073013,
-0.05331539735198021,
-0.027548421174287796,
0.017512185499072075,
0.07277210801839828,
-0.07823793590068817,
0.05002694949507713,
0.028643257915973663,
-0.005678718443959951,
-0.0182191114872694,
-0.04990372434258461,
-0.05102958157658577,
0.0205303356051445,
-0.006303675472736359,
0.03279927372932434,
0.021593302488327026,
0.012430553324520588,
-0.0062548937276005745,
-0.05220022052526474,
0.007773612625896931,
-0.04079379513859749,
0.012232120148837566,
-0.0113747026771307,
0.05852237343788147,
-0.03142991662025452,
-0.03100445121526718,
-0.013398217037320137,
0.02785480208694935,
0.012774446979165077,
0.03622174263000488,
-0.05103285238146782,
0.054567672312259674,
-0.05860821157693863,
0.033482085913419724,
-0.036703843623399734,
-0.035608455538749695,
-0.030863160267472267,
0.000662958831526339,
0.02627832442522049,
-0.0023051283787935972,
-0.006415649317204952,
0.021793946623802185,
0.0073711867444217205,
0.012464304454624653,
-0.002273361198604107,
0.03774433210492134,
-0.0031406881753355265,
0.020933473482728004,
-0.0133834732696414,
0.053665779531002045,
0.05485255643725395,
0.013622462749481201,
-0.0190549585968256,
-0.04562603309750557,
0.043209467083215714,
0.03688783943653107,
0.04451435059309006,
-5.370136841162185e-33,
-0.03315659984946251,
-0.04057272523641586,
0.0629236102104187,
-0.031257569789886475,
0.027882050722837448,
0.13093268871307373,
0.007333208806812763,
0.017871392890810966,
0.005112797487527132,
0.003997947555035353,
0.0010181936668232083,
-0.07652547210454941,
0.021391764283180237,
0.04000638797879219,
-0.009156896732747555,
-0.037089571356773376,
0.013842790387570858,
-0.04860199615359306,
0.05606982111930847,
-0.021989913657307625,
-0.04352535307407379,
0.004728845786303282,
-0.024110442027449608,
0.022142793983221054,
-0.022847434505820274,
-0.06947169452905655,
-0.005004060920327902,
0.03482352942228317,
0.044394705444574356,
-0.004908295348286629,
0.010669277980923653,
-0.06775661557912827,
-0.011835702694952488,
-0.05885101109743118,
-0.05999121069908142,
-0.023240765556693077,
0.016748730093240738,
-0.01156424917280674,
0.017353685572743416,
0.027994826436042786,
-0.06330782175064087,
0.025321323424577713,
0.026922382414340973,
0.015982700511813164,
0.04797343909740448,
-0.04358505457639694,
0.015293227508664131,
-0.011521297506988049,
0.0018210139824077487,
-0.0392313115298748,
-0.007917547598481178,
0.020888831466436386,
-0.019693244248628616,
-0.06018500030040741,
0.04575316980481148,
-0.050663504749536514,
-0.012227692641317844,
-0.017641620710492134,
0.010961206629872322,
-0.005894011352211237,
0.04036203771829605,
-0.013544135726988316,
-0.0011471183970570564,
-0.06808985769748688,
-0.005952910985797644,
0.014285481534898281,
0.11646565049886703,
0.05459218844771385,
-0.055169716477394104,
-0.015783673152327538,
0.002949609188362956,
-0.013242545537650585,
-0.024074260145425797,
-0.062279947102069855,
-0.025824518874287605,
0.002162499586120248,
-0.006384232547134161,
-0.03211953863501549,
-0.03511287271976471,
0.019125765189528465,
0.026194671168923378,
-0.015031659975647926,
-0.07482996582984924,
0.026019345968961716,
-0.0398125946521759,
-0.06522170454263687,
-0.009082701988518238,
0.010444685816764832,
0.005414416082203388,
0.0177898071706295,
0.07717356085777283,
-0.04605679214000702,
-0.011549319140613079,
-0.02490498311817646,
0.012214114889502525,
-0.10488815605640411,
0.06447887420654297,
-0.02170943096280098,
0.0009332574554719031,
-0.0038503254763782024,
0.06222568079829216,
-0.02665967121720314,
-0.023698430508375168,
-0.006215216591954231,
0.0030837205704301596,
-0.0004948072601109743,
0.001610930310562253,
0.07602255791425705,
-0.029900865629315376,
0.02566598169505596,
0.020365718752145767,
-0.03693804889917374,
0.05212707817554474,
0.028723953291773796,
-0.050902824848890305,
0.05443688854575157,
0.019454628229141235,
0.0014523043064400554,
0.0007266036700457335,
0.07981254905462265,
0.009140844456851482,
0.021692028269171715,
-0.06407757848501205,
0.041811104863882065,
-0.08757469058036804,
-0.05000607669353485,
0.022724507376551628,
0.029119137674570084,
-0.018459802493453026,
0.02854415401816368,
0.055357031524181366,
0.05086035653948784,
2.7953737458119576e-7,
0.0038689598441123962,
0.03533606976270676,
-0.026808468624949455,
-0.05806618183851242,
0.05488177388906479,
-0.06323255598545074,
-0.00612094160169363,
0.03509189561009407,
-0.017265234142541885,
0.0168741624802351,
0.05082040652632713,
0.04036353528499603,
-0.01814894750714302,
0.032345641404390335,
-0.018305471166968346,
0.020520230755209923,
0.004755659494549036,
-0.011345514096319675,
0.005058427806943655,
-0.012410784140229225,
0.03831465542316437,
0.030913546681404114,
-0.006245321128517389,
-0.024788955226540565,
-0.03890567272901535,
0.08122723549604416,
-0.005997440777719021,
-0.0466066338121891,
0.03054736740887165,
-0.01039617694914341,
-0.023136300966143608,
0.040954966098070145,
0.016993649303913116,
0.047439269721508026,
-0.0012428689515218139,
-0.01796828582882881,
0.08259506523609161,
0.02303365059196949,
0.005187547765672207,
-0.019300108775496483,
-0.0212382972240448,
-0.008652055636048317,
0.05401133745908737,
-0.013301507569849491,
-0.03397858887910843,
0.07549963146448135,
-0.05078393220901489,
0.030056722462177277,
0.02983829937875271,
-0.03209030628204346,
0.002985109807923436,
0.02035381831228733,
0.0080148596316576,
0.05013019219040871,
-0.025738278403878212,
-0.014814725145697594,
-0.024503933265805244,
-0.02626001089811325,
-0.01874535344541073,
-0.029948601499199867,
0.018352556973695755,
-0.05420924350619316,
0.009313576854765415,
-0.0027512041851878166,
-0.001012642402201891,
0.03768071159720421,
-0.02427562139928341,
1.9204657323658354e-34,
-0.034901294857263565,
-0.05445774644613266,
-0.04500164836645126,
-0.06662263721227646,
0.009785915724933147,
0.004613331984728575,
0.04490262269973755,
-0.0033248604740947485,
0.004963740706443787,
0.01676904410123825,
0.031566321849823
] | {
"ds_index": 7,
"similar_dg_indices": [
167093,
75197,
734922,
346745,
577573,
140048,
776305,
1016247,
791019,
159550,
516973,
1078434,
948556,
456855,
212191,
1190087,
856772,
782961,
650471,
902405
]
} |
A 62-year-old woman presents for a regular check-up. She complains of lightheadedness and palpitations which occur episodically. Past medical history is significant for a myocardial infarction 6 months ago and NYHA class II chronic heart failure. She also was diagnosed with grade I arterial hypertension 4 years ago. Current medications are aspirin 81 mg, atorvastatin 10 mg, enalapril 10 mg, and metoprolol 200 mg daily. Her vital signs are a blood pressure of 135/90 mm Hg, a heart rate of 125/min, a respiratory rate of 14/min, and a temperature of 36.5°C (97.7°F). Cardiopulmonary examination is significant for irregular heart rhythm and decreased S1 intensity. ECG is obtained and is shown in the picture (see image). Echocardiography shows a left ventricular ejection fraction of 39%. Which of the following drugs is the best choice for rate control in this patient? | Digoxin | {
"A": "Atenolol",
"B": "Diltiazem",
"C": "Propafenone",
"D": "Digoxin"
} | step1 | D | [
"62 year old woman presents",
"regular check-up",
"lightheadedness",
"palpitations",
"occur",
"Past medical history",
"significant",
"myocardial infarction",
"months",
"NYHA class II chronic heart failure",
"diagnosed",
"grade I arterial hypertension 4",
"Current medications",
"aspirin 81 mg",
"atorvastatin 10 mg",
"enalapril 10 mg",
"metoprolol 200 mg daily",
"vital signs",
"blood pressure",
"90 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"97",
"Cardiopulmonary examination",
"significant",
"irregular heart rhythm",
"decreased S1 intensity",
"ECG",
"obtained",
"shown",
"picture",
"see image",
"Echocardiography shows",
"left ventricular ejection fraction",
"following drugs",
"best choice",
"rate control",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 62-year-old woman presents for a regular check-up. She complains of lightheadedness and palpitations which occur episodically. Past medical history is significant for a myocardial infarction 6 months ago and NYHA class II chronic heart failure. She also was diagnosed with grade I arterial hypertension 4 years ago. Current medications are aspirin 81 mg, atorvastatin 10 mg, enalapril 10 mg, and metoprolol 200 mg daily. Her vital signs are a blood pressure of 135/90 mm Hg, a heart rate of 125/min, a respiratory rate of 14/min, and a temperature of 36.5°C (97.7°F). Cardiopulmonary examination is significant for irregular heart rhythm and decreased S1 intensity. ECG is obtained and is shown in the picture (see image). Echocardiography shows a left ventricular ejection fraction of 39%. Which of the following drugs is the best choice for rate control in this patient?
Choose one of the following::
A. Atenolol
B. Diltiazem
C. Propafenone
D. Digoxin | [
-0.018180375918745995,
-0.04564428701996803,
-0.001263229176402092,
0.030986415222287178,
-0.007997761480510235,
0.013384196907281876,
-0.0379159115254879,
0.034335363656282425,
0.0005257619195617735,
0.031636592000722885,
0.026114439591765404,
0.004350370727479458,
0.004012141842395067,
0.02725858986377716,
-0.05297234654426575,
-0.01802939549088478,
0.009765309281647205,
0.03097323141992092,
0.0366525761783123,
-0.021033277735114098,
0.008895114064216614,
-0.01911425217986107,
0.004664320964366198,
0.022402839735150337,
0.06049329414963722,
0.008931264281272888,
0.030075740069150925,
-0.049257244914770126,
-0.011346862651407719,
-0.03880118578672409,
0.014388278126716614,
0.014378963969647884,
0.0008412591996602714,
-0.04002302885055542,
0.0000018959528915729607,
-0.05181928351521492,
0.015628067776560783,
0.021976305171847343,
0.026277294382452965,
-0.09863962233066559,
0.03378964215517044,
-0.11194734275341034,
0.032405998557806015,
0.0035507057327777147,
-0.01787712797522545,
-0.03916946426033974,
0.0028700935654342175,
-0.010020003654062748,
-0.023526959121227264,
-0.013689029030501842,
0.02664964832365513,
0.06404463201761246,
-0.04962028190493584,
-0.02548922598361969,
0.029368959367275238,
-0.07698129862546921,
0.0004738819261547178,
-0.01748972199857235,
0.03914101794362068,
0.04374947398900986,
-0.017734281718730927,
-0.025696013122797012,
-0.00047063082456588745,
0.038342658430337906,
0.08759583532810211,
-0.0031377854757010937,
-0.013215073384344578,
-0.0789366066455841,
-0.038198072463274,
0.03167114406824112,
0.005117064341902733,
0.07640915364027023,
0.04885784909129143,
0.04690202698111534,
-0.03828318044543266,
0.004328547045588493,
0.010953526012599468,
-0.07023394852876663,
-0.03500087559223175,
-0.013454154133796692,
0.043788328766822815,
0.018927838653326035,
-0.03940698876976967,
0.01859004981815815,
0.011180193163454533,
-0.05809250846505165,
0.027405664324760437,
0.0028187257703393698,
0.036670900881290436,
0.020961357280611992,
0.007168713957071304,
-0.07198747247457504,
0.030081920325756073,
-0.008449079468846321,
-0.03311317786574364,
0.00393177242949605,
0.0013538002967834473,
-0.0038603097200393677,
0.0225866436958313,
-0.020898889750242233,
-0.02288147248327732,
0.022030269727110863,
0.09595167636871338,
-0.011316522024571896,
0.012586253695189953,
-0.0011146169854328036,
-0.00788133591413498,
0.017475653439760208,
-0.011042908765375614,
0.08389986306428909,
0.007729317061603069,
0.04972117394208908,
-0.010142183862626553,
0.02342013083398342,
0.08338046073913574,
-0.039903704077005386,
-0.09605779498815536,
-0.04369412362575531,
-0.02473549358546734,
0.08257628977298737,
0.0026288507506251335,
-0.007353759836405516,
0.062222547829151154,
0.020379187539219856,
0.002925661625340581,
0.019460346549749374,
-0.016671882942318916,
-0.011218903586268425,
0.014473584480583668,
-0.046201735734939575,
0.009444593451917171,
-0.003706121351569891,
-0.01836041361093521,
-0.01633954979479313,
0.021568069234490395,
0.013720253482460976,
0.006907407660037279,
0.07545100152492523,
-0.018800295889377594,
-0.033797599375247955,
0.03498278930783272,
-0.03620506823062897,
-0.010020172223448753,
0.0010714002419263124,
-0.02179030328989029,
0.045471373945474625,
0.015444290824234486,
0.04054161161184311,
-0.001769796945154667,
0.032003529369831085,
0.01235740352421999,
0.017955707386136055,
-0.0026224071625620127,
0.0041933306492865086,
-0.021662339568138123,
0.009658812545239925,
-0.01659936085343361,
0.010925672017037868,
-0.0207465048879385,
-0.052113424986600876,
0.02433202974498272,
0.024023298174142838,
0.017843449488282204,
0.00548478914424777,
0.04287444055080414,
0.030259568244218826,
0.016254102811217308,
0.05169130489230156,
-0.03560347110033035,
0.018289893865585327,
0.014198237098753452,
0.0013052120339125395,
0.0003261531819589436,
0.014397300779819489,
-0.00016723346197977662,
-0.04925992712378502,
-0.010229009203612804,
-0.03059219755232334,
-0.0004601032705977559,
-0.0534549243748188,
-0.021300358697772026,
0.019234677776694298,
-0.00786012876778841,
-0.004208384081721306,
0.043139565736055374,
-0.0018587062368169427,
-0.07063060253858566,
-0.0764734297990799,
-0.008821507915854454,
-0.02036932483315468,
-0.01102490071207285,
0.010878044180572033,
-0.06139642372727394,
0.06577084213495255,
0.01846308447420597,
0.00991891324520111,
-0.07226083427667618,
-0.034445345401763916,
-0.03092888556420803,
0.042500317096710205,
-0.014841986820101738,
0.016880912706255913,
-0.036478251218795776,
0.035302743315696716,
-0.04752608761191368,
0.02464614436030388,
0.018857071176171303,
0.025136902928352356,
-0.020319513976573944,
0.03342758119106293,
0.02742464654147625,
0.03577602654695511,
0.04402704909443855,
-0.06495466828346252,
0.04702311381697655,
0.03722088783979416,
-0.006324589252471924,
0.056765876710414886,
-0.07434313744306564,
0.0040748328901827335,
-0.021008936688303947,
0.03695705905556679,
-0.000568929361179471,
0.0004128628352191299,
0.010180091485381126,
-0.0009588582324795425,
-0.04408929497003555,
0.011345451697707176,
0.026006439700722694,
-0.07404941320419312,
0.01282183825969696,
0.02490515075623989,
-0.028351018205285072,
-0.002744449768215418,
-0.013902846723794937,
-0.002840268425643444,
0.031884968280792236,
-0.08400733023881912,
0.01590948924422264,
0.020214850082993507,
-0.013379956595599651,
-0.056930061429739,
-0.04927385225892067,
-0.03081848844885826,
-0.008011125028133392,
0.013099296018481255,
-0.0020844456739723682,
0.015959812328219414,
-0.0055045923218131065,
-0.007727000862360001,
0.004667513072490692,
0.02105759270489216,
-0.021185947582125664,
0.04411749541759491,
0.013326875865459442,
0.085158571600914,
-0.03800976276397705,
0.017843419685959816,
-0.0013984953984618187,
-0.04216250032186508,
0.013319832272827625,
-0.012682677246630192,
-0.003556747455149889,
-0.015757832676172256,
-0.004311417695134878,
-0.042568549513816833,
-0.00999127235263586,
0.053702667355537415,
-0.020608196035027504,
0.010957874357700348,
0.0035629207268357277,
-0.07275786995887756,
0.019513104110956192,
0.02231542207300663,
-0.026071688160300255,
-0.014934583567082882,
-0.026140285655856133,
0.05030544847249985,
0.022870231419801712,
-0.032718364149332047,
0.05794012174010277,
0.004215378779917955,
0.04956527799367905,
0.03798794001340866,
0.04089822992682457,
0.010923895984888077,
-0.04405881464481354,
0.02619626373052597,
0.052290674299001694,
-0.019168775528669357,
-0.010097549296915531,
0.016967998817563057,
0.004407213069498539,
-0.018737562000751495,
0.014465942047536373,
0.017851129174232483,
-0.05876731500029564,
0.026028869673609734,
-0.05225661024451256,
0.029992669820785522,
-0.005655428394675255,
0.019641155377030373,
-0.013232404366135597,
-0.00012643967056646943,
-0.025507023558020592,
-0.010353539139032364,
0.09625758230686188,
0.047476038336753845,
-0.0005673462874256074,
0.046300601214170456,
0.05208253860473633,
-0.015594006516039371,
-0.026361670345067978,
-0.011599590070545673,
-0.0026483936235308647,
-0.02874726802110672,
-0.07849951088428497,
-0.042817965149879456,
0.03892965242266655,
-0.023091495037078857,
0.03831411525607109,
-0.02547680400311947,
-0.01667112484574318,
0.016342736780643463,
0.0006658844649791718,
-0.015662651509046555,
-0.02701592445373535,
-0.028076911345124245,
-0.10566156357526779,
-0.02630956470966339,
-0.03625226020812988,
-0.024439461529254913,
0.012099115177989006,
0.0346091128885746,
0.006289285607635975,
0.012089850381016731,
-0.0022972060833126307,
-0.0018201578641310334,
-0.028284607455134392,
0.05014273524284363,
0.00377755262888968,
-0.0734482929110527,
-0.005965567193925381,
0.04148417338728905,
0.0238808561116457,
-0.021402232348918915,
0.009577789343893528,
0.035457778722047806,
0.05342293903231621,
-0.003314642934128642,
-0.05818748101592064,
0.019409537315368652,
-0.010097987949848175,
-0.005976500920951366,
-0.019316909834742546,
-0.04578554257750511,
0.06907323002815247,
-0.0175919272005558,
-0.008827581070363522,
-0.02784287929534912,
0.026554804295301437,
0.02197882905602455,
0.029509229585528374,
0.005429363343864679,
-0.016374683007597923,
0.07342354208230972,
0.05643751099705696,
-0.02746840938925743,
-0.051301077008247375,
0.020229369401931763,
-0.001406688941642642,
0.013247608207166195,
0.000494425359647721,
0.07733909040689468,
-0.009693270549178123,
-0.04873616248369217,
-0.04497397691011429,
-0.1002560555934906,
-0.009397496469318867,
-0.030154738575220108,
-0.013053260743618011,
-0.014339987188577652,
0.03185642138123512,
-0.02903948538005352,
0.015891840681433678,
0.022297661751508713,
-0.019956324249505997,
-0.06718777865171432,
0.04994582384824753,
-0.025053054094314575,
0.022298414260149002,
0.009897365234792233,
0.02288648672401905,
-0.054214563220739365,
-0.0017772212158888578,
0.02783595770597458,
0.023426581174135208,
-0.03589960187673569,
-0.0025039794854819775,
0.0572136752307415,
0.03938610851764679,
-0.027071239426732063,
0.018640531226992607,
0.03713513910770416,
0.006470391992479563,
-0.007423970382660627,
-0.021435918286442757,
-0.019995909184217453,
0.04594011977314949,
0.055198658257722855,
-0.01825406588613987,
-0.021379129961133003,
-0.015153858810663223,
-0.02420572191476822,
0.010213576257228851,
-0.005280313082039356,
0.005330808460712433,
-0.04652918875217438,
0.05460705980658531,
-0.030960548669099808,
0.06158870458602905,
-0.00185540528036654,
-0.05296177789568901,
-0.0471387654542923,
0.006833973806351423,
-0.0743015930056572,
0.10165615379810333,
0.023823389783501625,
0.008308950811624527,
0.03483922407031059,
0.037431713193655014,
-0.030946098268032074,
0.034188028424978256,
0.04812266677618027,
-0.05210547149181366,
0.03524619713425636,
-0.021658530458807945,
-0.009555956348776817,
-0.005383605603128672,
-0.010477508418262005,
-0.02893085964024067,
-0.004284878261387348,
0.05963461846113205,
0.03629595413804054,
-0.012225260026752949,
0.10090930759906769,
0.019821809604763985,
0.08940336108207703,
-0.030853139236569405,
0.037613894790410995,
-0.0007228461909107864,
-0.004815306980162859,
0.00956723652780056,
-0.06451929360628128,
0.027647189795970917,
-0.04062237963080406,
0.0073533146642148495,
-0.031331926584243774,
0.03187330812215805,
-0.025651782751083374,
0.024261608719825745,
0.02086230367422104,
-0.012737130746245384,
-0.03836095333099365,
0.020967788994312286,
-0.02239372394979,
-0.080263152718544,
0.07984288036823273,
-0.017351578921079636,
-0.023300020024180412,
-0.005051456857472658,
-0.025534767657518387,
0.02105697989463806,
0.023388303816318512,
0.03880471736192703,
-0.01327067706733942,
-0.05323415622115135,
0.04122067242860794,
-0.004299057647585869,
-0.006699579302221537,
0.014049732126295567,
-0.04916338622570038,
-0.06735248863697052,
-0.0582248754799366,
0.0054238336160779,
0.00038792984560132027,
-0.006456328555941582,
0.03441440314054489,
-0.02401777356863022,
0.0011954974615946412,
-0.05149374529719353,
-0.04437549412250519,
0.011353541165590286,
-0.018887726590037346,
-0.04456743970513344,
-0.0678999274969101,
-0.026298923417925835,
0.061027128249406815,
-0.07521036267280579,
-0.024283431470394135,
0.041662998497486115,
0.029966147616505623,
0.027846239507198334,
-0.006066215690225363,
0.013878852128982544,
0.009908474050462246,
0.0034128879196941853,
0.05833446606993675,
-0.02377403900027275,
-0.02358880080282688,
0.017690466716885567,
0.0025319086853414774,
-0.0014430154114961624,
-0.00971943698823452,
0.05855872482061386,
-0.010412522591650486,
0.02669372782111168,
-0.05005813017487526,
-0.0009956832509487867,
-0.01184502337127924,
-0.003285942366346717,
-0.03795841336250305,
0.00946019683033228,
0.040172189474105835,
0.01966775581240654,
0.030660314485430717,
0.006462139543145895,
0.017184501513838768,
-0.0021861104760318995,
0.06964513659477234,
0.009148560464382172,
-0.04956730455160141,
-0.010062068700790405,
-0.08771385252475739,
-0.0021325042471289635,
0.01421411894261837,
0.02661675028502941,
-0.0011266627116128802,
0.017606372013688087,
-0.04610457643866539,
-0.022894801571965218,
0.023444628342986107,
0.03585164248943329,
0.005930548999458551,
-0.07451455295085907,
0.03133882209658623,
-0.000017057949662557803,
-0.019494200125336647,
-0.051270075142383575,
-0.04847581312060356,
0.000548648415133357,
0.02142365276813507,
-0.026485774666070938,
0.029877716675400734,
-0.014073171652853489,
-5.142190854122481e-33,
0.017420703545212746,
-0.005796703509986401,
0.023463724181056023,
-0.05848507583141327,
-0.01521363202482462,
0.04439856857061386,
-0.036449845880270004,
-0.00851294957101345,
-0.07772421091794968,
0.04711994156241417,
-0.02651934139430523,
-0.015649881213903427,
0.026330195367336273,
0.030081460252404213,
-0.008663570508360863,
-0.07565643638372421,
-0.021040719002485275,
0.032602421939373016,
-0.009525113739073277,
-0.015996268019080162,
-0.007178191095590591,
0.010250713676214218,
0.007375609595328569,
-0.03849055990576744,
-0.011193091981112957,
0.05836097151041031,
0.05311475321650505,
-0.01732821576297283,
-0.012751515954732895,
0.018940908834338188,
0.006411261856555939,
0.06418350338935852,
0.005447168834507465,
-0.031626809388399124,
0.02692938596010208,
0.012158586643636227,
-0.015804734081029892,
-0.042368460446596146,
0.04642121493816376,
-0.011017979122698307,
0.055503811687231064,
-0.05159242823719978,
0.07284094393253326,
0.05105026066303253,
-0.004809440579265356,
-0.025659386068582535,
-0.022200142964720726,
-0.016015123575925827,
-0.007642723154276609,
-0.03380517661571503,
-0.02168118767440319,
0.047208864241838455,
0.0060267760418355465,
-0.00787374284118414,
-0.05302846059203148,
-0.002236034255474806,
-0.014560246840119362,
0.018846726045012474,
-0.0035998958628624678,
-0.017038051038980484,
-0.04442466422915459,
0.02466842159628868,
0.0012599751353263855,
-0.013252920471131802,
-0.04565746709704399,
0.013455302454531193,
0.0080580348148942,
0.02647547423839569,
-0.013046737760305405,
0.04968232288956642,
-0.07171911746263504,
0.050920069217681885,
-0.0014378274790942669,
-0.04731663689017296,
-0.009358661249279976,
-0.014307982288300991,
0.044496819376945496,
0.0011877493234351277,
0.0027537508867681026,
0.021370762959122658,
-0.03294662758708,
-0.011840115301311016,
-0.06404687464237213,
-0.01590045727789402,
0.002957420889288187,
0.0441930890083313,
-0.036161888390779495,
-0.014753974042832851,
0.03780432045459747,
0.0034558516927063465,
0.10429731756448746,
0.01629597321152687,
0.05390756577253342,
-0.0037918754387646914,
0.04241691902279854,
-0.042820557951927185,
0.022338323295116425,
-0.005385655909776688,
0.013866077177226543,
-0.03505711257457733,
0.08253549039363861,
0.02399296499788761,
0.06588639318943024,
-0.006447201129049063,
-0.01891709491610527,
0.016688235104084015,
-0.017542755231261253,
-0.02225298248231411,
0.016109241172671318,
0.03690212219953537,
-0.020263537764549255,
0.004140486940741539,
0.0037858770228922367,
0.008260717615485191,
-0.023185748606920242,
-0.007739377673715353,
0.0350751169025898,
0.04268447309732437,
0.013392778113484383,
-0.03452104702591896,
-0.014124150387942791,
-0.02113489806652069,
0.061258237808942795,
0.016897069290280342,
-0.0331231951713562,
-0.014259424060583115,
0.004484779201447964,
0.06042291224002838,
-0.0707637295126915,
-0.008716652169823647,
0.016541818156838417,
-0.013661355711519718,
2.7707255867426284e-7,
-0.02604793757200241,
-0.016466518864035606,
0.027068613097071648,
-0.03206285461783409,
-0.009301167912781239,
-0.018410490825772285,
-0.03573894500732422,
0.030937256291508675,
-0.05284146964550018,
-0.03162837773561478,
0.037048112601041794,
-0.019146433100104332,
-0.0021520459558814764,
-0.056054119020700455,
0.08287892490625381,
-0.07214873284101486,
-0.023888511583209038,
-0.0012242039665579796,
0.013780836015939713,
-0.062223099172115326,
0.01560339704155922,
-0.038691554218530655,
-0.05181622877717018,
-0.038119126111269,
-0.006133746355772018,
0.045323774218559265,
-0.011022847145795822,
-0.029983799904584885,
-0.07484842836856842,
0.006597939413040876,
-0.024542752653360367,
0.07785936444997787,
0.0186273492872715,
0.012140466831624508,
-0.04806756600737572,
-0.026963407173752785,
0.01857638731598854,
0.05046037957072258,
-0.07778744399547577,
-0.02462518960237503,
0.023479288443922997,
0.02695908211171627,
0.008401510305702686,
0.02927548997104168,
0.0159935150295496,
0.0932181179523468,
-0.05000762268900871,
0.00807378999888897,
-0.01620940864086151,
-0.034338004887104034,
0.03285374119877815,
-0.013037517666816711,
-0.05938924849033356,
0.10308545082807541,
0.018840236589312553,
0.07655566185712814,
-0.06068628281354904,
0.03518996387720108,
0.05915560573339462,
-0.0001460195198887959,
-0.020565873011946678,
-0.05514106526970863,
-0.03817898780107498,
0.03223544731736183,
0.06980482488870621,
-0.044264279305934906,
-0.051023390144109726,
2.173463799908966e-34,
-0.008364668115973473,
-0.0420059971511364,
-0.001829142333008349,
-0.0342746302485466,
0.03135065361857414,
-0.03397557884454727,
0.026349157094955444,
0.019218670204281807,
0.009723042137920856,
-0.041329629719257355,
-0.01086181215941906
] | {
"ds_index": 8,
"similar_dg_indices": [
763933,
916931,
680629,
1158516,
444575,
1001648,
1135460,
1044942,
871091,
515466,
1093307,
241871,
172152,
109764,
941654,
216249,
384768,
50457,
33443,
657798
]
} |
A 35-year-old male presents to his primary care physician with complaints of seasonal allergies. He has been using intranasal vasoconstrictors several times per day for several weeks. What is a likely sequela of the chronic use of topical nasal decongestants? | Persistent congestion | {
"A": "Epistaxis",
"B": "Permanent loss of smell",
"C": "Persistent nasal crusting",
"D": "Persistent congestion"
} | step1 | D | [
"35 year old male presents",
"primary care physician",
"complaints",
"seasonal allergies",
"using intranasal vasoconstrictors",
"times per day",
"several weeks",
"likely sequela of",
"chronic use",
"topical nasal decongestants"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 35-year-old male presents to his primary care physician with complaints of seasonal allergies. He has been using intranasal vasoconstrictors several times per day for several weeks. What is a likely sequela of the chronic use of topical nasal decongestants?
Choose one of the following::
A. Epistaxis
B. Permanent loss of smell
C. Persistent nasal crusting
D. Persistent congestion | [
0.008484790101647377,
-0.03329770267009735,
0.009521854110062122,
0.013618012890219688,
0.011048389598727226,
0.0002512510400265455,
0.05127178505063057,
-0.007006174419075251,
0.01121040154248476,
0.02837785705924034,
0.053357332944869995,
-0.0016463232459500432,
0.00259594083763659,
-0.027829330414533615,
0.0013676584931090474,
0.034589603543281555,
-0.03598615899682045,
0.0058773597702383995,
0.004372375085949898,
-0.02594115026295185,
-0.0040776608511805534,
0.022253215312957764,
0.006637221202254295,
0.021453503519296646,
0.05473995581269264,
-0.04560190439224243,
0.013971692882478237,
-0.05741376429796219,
0.0034773540683090687,
-0.0391412153840065,
0.07621340453624725,
-0.036166079342365265,
0.03203387185931206,
-0.02435685694217682,
0.000001570962012920063,
-0.0006512312684208155,
0.0026311916299164295,
0.056811001151800156,
0.04073164612054825,
-0.04113700985908508,
0.042707525193691254,
-0.012439895421266556,
0.05818352848291397,
0.02156132459640503,
-0.05729275941848755,
-0.0778961181640625,
-0.005577415227890015,
-0.03460335731506348,
-0.001963652204722166,
-0.006976015400141478,
-0.012336354702711105,
0.0330263189971447,
-0.04071245342493057,
0.01763140968978405,
0.05714140459895134,
-0.019234756007790565,
0.009966320358216763,
-0.019464174285531044,
-0.014248337596654892,
-0.03693274036049843,
-0.029993729665875435,
-0.002792700659483671,
0.00949732307344675,
0.0274259801954031,
0.049012601375579834,
0.004288137424737215,
0.022075481712818146,
-0.02703632228076458,
0.026639467105269432,
-0.05805335193872452,
0.06909734755754471,
0.026184745132923126,
-0.005130232311785221,
0.07868057489395142,
-0.07061158120632172,
-0.014958304353058338,
-0.008836790919303894,
-0.06247163563966751,
0.003476327983662486,
-0.04247474670410156,
0.10843099653720856,
0.0429517962038517,
-0.02299373596906662,
0.02433180995285511,
0.01117178425192833,
-0.04512585699558258,
0.017076188698410988,
0.022675959393382072,
0.04346131160855293,
-0.03048696741461754,
0.062900111079216,
-0.07755490392446518,
0.011026918888092041,
0.019608095288276672,
-0.039840105921030045,
0.010683184489607811,
0.04797663167119026,
0.002325189532712102,
0.018773464486002922,
0.006778348237276077,
-0.013966136611998081,
-0.05130418762564659,
0.02389572188258171,
0.0012340281391516328,
-0.03778081014752388,
-0.02221495285630226,
-0.005542881321161985,
-0.03841575235128403,
0.01230422593653202,
0.022868257015943527,
0.008990827016532421,
-0.01816258206963539,
0.015047244727611542,
-0.016992492601275444,
0.0364387109875679,
-0.012007719837129116,
-0.05356324836611748,
-0.008477558381855488,
-0.018640557304024696,
-0.030301177874207497,
-0.027632104232907295,
0.014941861853003502,
-0.029728200286626816,
0.030254341661930084,
-0.02608109638094902,
0.062242552638053894,
0.015669209882616997,
0.02298426814377308,
-0.009511049836874008,
-0.024319401010870934,
0.022218521684408188,
-0.05776958167552948,
-0.012584451586008072,
-0.000716936425305903,
-0.018188541755080223,
-0.007447350304573774,
0.006111384369432926,
0.07440390437841415,
-0.00476083206012845,
0.010426555760204792,
0.019414864480495453,
-0.027164053171873093,
-0.05020841211080551,
-0.017016205936670303,
-0.00016224305727519095,
0.03553682193160057,
0.009706047363579273,
-0.009466650895774364,
-0.027452386915683746,
0.01105293445289135,
0.01025954820215702,
0.01868017390370369,
-0.035869818180799484,
0.023041237145662308,
0.012157436460256577,
0.002243379130959511,
0.10165168344974518,
-0.03570162132382393,
-0.04711077734827995,
0.0028451576363295317,
0.007707254495471716,
-0.06329643726348877,
0.0106614725664258,
-0.0347738079726696,
-0.022972360253334045,
0.05106687173247337,
-0.013242855668067932,
0.037607766687870026,
-0.007265594322234392,
0.030350053682923317,
-0.0606398843228817,
0.07543295621871948,
-0.05837284401059151,
0.01899927295744419,
-0.024355696514248848,
-0.018817881122231483,
-0.005725186318159103,
-0.04017460346221924,
-0.03062703087925911,
-0.03631245344877243,
0.0077125816605985165,
0.019993869587779045,
0.009867002256214619,
-0.01428862102329731,
0.021020974963903427,
0.03830114006996155,
0.022912774235010147,
-0.04600711166858673,
0.05118792876601219,
-0.04431656375527382,
0.0007186889415606856,
-0.026093384250998497,
-0.03143824264407158,
0.018977101892232895,
-0.007765408139675856,
0.011398750357329845,
0.012646040879189968,
-0.03484728932380676,
-0.024818599224090576,
0.005195912439376116,
0.006857439875602722,
-0.004663176368921995,
0.026947136968374252,
0.06224319338798523,
0.0008104685111902654,
0.05929873138666153,
-0.022049158811569214,
-0.06449819356203079,
-0.03669283911585808,
-0.02663671039044857,
0.017802288755774498,
-0.018124844878911972,
0.04941302537918091,
-0.029695739969611168,
0.007806828711181879,
-0.015286607667803764,
-0.004751783795654774,
0.05716639384627342,
-0.041615866124629974,
0.03158238157629967,
-0.02482774667441845,
0.0459347739815712,
0.06389348953962326,
0.019893484190106392,
-0.06404437124729156,
-0.011006358079612255,
0.00707494281232357,
-0.032217759639024734,
-0.03438398614525795,
-0.05773281678557396,
0.03037315607070923,
-0.006216192152351141,
-0.009941088035702705,
-0.08333709836006165,
-0.019879590719938278,
0.021514762192964554,
0.055904168635606766,
-0.022287432104349136,
-0.016019755974411964,
0.035129938274621964,
0.007653654087334871,
0.004538877867162228,
-0.05780244246125221,
-0.07391095161437988,
0.030001983046531677,
-0.000029104525310685858,
0.04875240847468376,
0.003074034582823515,
-0.0738125890493393,
0.02625310979783535,
0.0018445616587996483,
-0.05544709414243698,
-0.05795982852578163,
0.08893316984176636,
-0.021872933954000473,
0.07789117842912674,
-0.07262223213911057,
-0.029209338128566742,
-0.03206762298941612,
-0.05309368669986725,
-0.006469672080129385,
0.020829375833272934,
-0.044424593448638916,
-0.023635094985365868,
-0.0608510784804821,
0.0004722479498013854,
-0.0022191107273101807,
-0.00920617114752531,
-0.02200957201421261,
0.039406564086675644,
-0.011707336641848087,
0.0036343734245747328,
0.016993459314107895,
0.002386763459071517,
-0.0022808907087892294,
0.0501348115503788,
-0.021845418959856033,
0.019244158640503883,
0.024139204993844032,
0.04292028024792671,
0.0076959277503192425,
0.011662033386528492,
-0.0633966401219368,
-0.05032753199338913,
-0.006211217492818832,
0.028798727318644524,
0.00620580418035388,
-0.020028740167617798,
0.015995357185602188,
-0.04290890321135521,
-0.01096613984555006,
0.03952450305223465,
0.03727787733078003,
0.04939780384302139,
0.023337388411164284,
-0.0345328189432621,
0.03221268579363823,
0.032557014375925064,
0.009446672163903713,
0.013963027857244015,
-0.006066000554710627,
0.02933671697974205,
-0.039806414395570755,
-0.011921986006200314,
-0.012057428248226643,
-0.027623284608125687,
0.021312683820724487,
0.010448679327964783,
-0.09672190248966217,
0.034683309495449066,
0.061796143651008606,
-0.018387265503406525,
0.035955216735601425,
0.0627991259098053,
-0.03459502011537552,
-0.0048218718729913235,
-0.03844280168414116,
-0.057998958975076675,
0.034486059099435806,
0.029241610318422318,
0.012384336441755295,
-0.05047660320997238,
-0.009344996884465218,
0.03832579776644707,
-0.013297934085130692,
-0.023510385304689407,
-0.013265127316117287,
-0.015001250430941582,
-0.0038772313855588436,
0.013405994512140751,
-0.022897033020853996,
0.02692561410367489,
-0.011123627424240112,
-0.012509480118751526,
-0.000465088029159233,
0.03726980462670326,
-0.015288599766790867,
0.013281892985105515,
-0.03211547061800957,
0.02303004451096058,
0.002031149808317423,
-0.04426471143960953,
-0.0049961949698626995,
-0.012607607059180737,
0.0006139528704807162,
-0.020011765882372856,
-0.01915009878575802,
-0.0058330451138317585,
0.017342662438750267,
-0.002186296973377466,
-0.03848111629486084,
0.0310568418353796,
0.00009340610995423049,
-0.03122573532164097,
-0.002116952557116747,
-0.06702138483524323,
0.0986771360039711,
0.048307474702596664,
-0.05326530337333679,
0.031903643161058426,
-0.030100978910923004,
-0.02025199867784977,
0.048299409449100494,
0.05390457063913345,
-0.006347874645143747,
-0.0003508137888275087,
-0.014956632629036903,
0.0068479860201478004,
-0.008556423708796501,
-0.03441236540675163,
-0.05238441005349159,
-0.04670850187540054,
0.027942612767219543,
0.0013508533593267202,
-0.017107516527175903,
0.07509743422269821,
0.003498668083921075,
-0.023357488214969635,
-0.04252217710018158,
-0.007006245665252209,
-0.0018302855314686894,
-0.026653952896595,
0.04255494102835655,
-0.060968875885009766,
0.013872833922505379,
0.019511081278324127,
0.014727819710969925,
-0.008059559389948845,
0.02590280771255493,
-0.0022647695150226355,
-0.00005028460145695135,
-0.031161775812506676,
0.021585287526249886,
-0.016942540183663368,
-0.02941260300576687,
-0.020086361095309258,
-0.0240289568901062,
-0.0028321382123976946,
0.03385941684246063,
0.07717621326446533,
0.02625994198024273,
-0.01199735514819622,
-0.010495386086404324,
0.031044907867908478,
0.06727506965398788,
-0.01667388342320919,
-0.07484724372625351,
-0.0382717065513134,
0.009240713901817799,
0.018496375530958176,
0.01438769232481718,
-0.09225139766931534,
-0.03229052945971489,
0.01596113294363022,
0.01285608671605587,
0.014475111849606037,
0.004266112111508846,
-0.011657770723104477,
0.0285127442330122,
-0.11409030109643936,
0.05949252471327782,
0.010801843367516994,
-0.07445566356182098,
-0.017095796763896942,
0.013960229232907295,
-0.026365753263235092,
0.06473816931247711,
-0.023330911993980408,
-0.006398653611540794,
0.020695406943559647,
0.04977775365114212,
-0.043908968567848206,
0.022107712924480438,
0.09020616859197617,
-0.05236247181892395,
0.024000495672225952,
-0.06339888274669647,
0.021480560302734375,
-0.0879877358675003,
-0.03995230793952942,
0.022513892501592636,
-0.00731567433103919,
0.08056465536355972,
0.0069427574053406715,
0.04860129579901695,
-0.0596250556409359,
-0.003953006584197283,
0.033029284328222275,
-0.013870149850845337,
0.09166064858436584,
0.053368207067251205,
0.10544561594724655,
0.02721916325390339,
0.033462196588516235,
0.03727400675415993,
-0.007761204149574041,
0.018673758953809738,
-0.04479902610182762,
-0.041273169219493866,
0.036159150302410126,
0.03346985578536987,
0.02701151743531227,
0.037589747458696365,
-0.029764188453555107,
-0.0023081281688064337,
-0.053893767297267914,
-0.03443799912929535,
0.0362420529127121,
-0.0003533510898705572,
-0.016828548163175583,
-0.009634577669203281,
0.04390803351998329,
-0.04396401345729828,
-0.011321313679218292,
-0.017099924385547638,
-0.004200400784611702,
-0.04096470773220062,
0.010929794050753117,
0.05048626288771629,
0.07544447481632233,
0.02475585602223873,
-0.00851294957101345,
-0.04846201464533806,
0.034974779933691025,
-0.029785774648189545,
0.04282302409410477,
0.06968706101179123,
-0.008056771010160446,
-0.01703987456858158,
0.004039278719574213,
0.012483554892241955,
0.01908712275326252,
-0.05138241872191429,
0.007693102583289146,
-0.018662214279174805,
0.034437548369169235,
0.05715305730700493,
0.04075220599770546,
0.01532557513564825,
0.022202491760253906,
0.041912857443094254,
0.02342924475669861,
-0.01252814196050167,
0.022224068641662598,
-0.03382233902812004,
0.04282615706324577,
-0.018756844103336334,
0.0037437027785927057,
-0.01943613775074482,
-0.011732971295714378,
0.0479385107755661,
0.014429462142288685,
0.005462955217808485,
0.004805344622582197,
0.01926044374704361,
-0.05296667665243149,
-0.030277367681264877,
0.004862223751842976,
0.02070874162018299,
0.02323104627430439,
0.0031602189410477877,
-0.02941354736685753,
-0.04648379608988762,
-0.030172700062394142,
0.0744001567363739,
0.012475063093006611,
0.03551672399044037,
-0.0036932271905243397,
-0.05354258790612221,
0.06746912747621536,
-0.033827077597379684,
-0.020447013899683952,
-0.043369147926568985,
0.005673523526638746,
0.0035986730363219976,
-0.044911280274391174,
-0.07079099118709564,
0.020734107121825218,
0.02822304330766201,
-0.03023962303996086,
0.022173289209604263,
-0.05967339500784874,
-0.013007868081331253,
0.03523538261651993,
0.061172451823949814,
-0.010529667139053345,
-0.03840475529432297,
-0.015011807903647423,
0.016622578725218773,
0.0037020414602011442,
-0.008007739670574665,
0.09148170053958893,
0.06333576142787933,
0.031062092632055283,
-0.04708186537027359,
-4.9591755672490665e-33,
0.002686881460249424,
0.004345024935901165,
0.03650438413023949,
-0.02711133100092411,
-0.004939688835293055,
0.0372970849275589,
-0.034361761063337326,
-0.01745624840259552,
-0.041511014103889465,
-0.023491252213716507,
-0.011228101328015327,
0.030038056895136833,
0.016977153718471527,
0.04075925424695015,
0.05574188008904457,
-0.03517243266105652,
-0.009986530989408493,
0.012225789949297905,
0.019100243225693703,
0.0005404996918514371,
0.0076347338035702705,
-0.01693466491997242,
-0.0012383981375023723,
-0.048351921141147614,
-0.003194982884451747,
-0.03800935298204422,
0.08301015198230743,
-0.07644231617450714,
-0.0189738180488348,
0.043880950659513474,
0.01728856936097145,
-0.013496726751327515,
0.044999878853559494,
0.0016805963823571801,
-0.004990702029317617,
-0.05854392424225807,
-0.03808724880218506,
-0.0023036133497953415,
-0.00023229318321682513,
-0.06601143628358841,
-0.05710996314883232,
0.004113451112061739,
0.02662844955921173,
0.015461199916899204,
0.10347264260053635,
-0.005148757249116898,
-0.009875752031803131,
-0.011041412129998207,
-0.00755656324326992,
-0.02149667963385582,
-0.024665821343660355,
0.04578957334160805,
0.012508290819823742,
0.03856184333562851,
-0.05020039528608322,
0.05840016156435013,
0.025513026863336563,
0.04774454981088638,
0.042481616139411926,
0.021434413269162178,
-0.017749952152371407,
0.010446645319461823,
-0.030181201174855232,
0.00761514762416482,
-0.020028702914714813,
-0.06608621776103973,
0.03510422632098198,
0.0435154028236866,
-0.03715042397379875,
-0.0028833847027271986,
-0.07305771112442017,
-0.019347846508026123,
-0.02135283127427101,
0.005861207377165556,
0.03681700676679611,
0.004987358581274748,
0.04927055910229683,
0.0021424111910164356,
-0.0478130541741848,
0.05342214182019234,
-0.04960055649280548,
0.011451403610408306,
0.021253123879432678,
-0.058747079223394394,
-0.0021718586795032024,
0.06918521225452423,
0.005307395942509174,
0.02569480799138546,
0.05116376653313637,
-0.019175678491592407,
0.06342948228120804,
0.016731031239032745,
0.010779423639178276,
0.007849732413887978,
0.04609212651848793,
-0.07705603539943695,
0.057052042335271835,
0.0018137205624952912,
0.020739883184432983,
-0.013050024397671223,
-0.00933031551539898,
0.031007561832666397,
-0.010328587144613266,
0.011224457062780857,
-0.029920583590865135,
-0.00048269829130731523,
0.004498135764151812,
0.00637136772274971,
-0.03984159603714943,
-0.025407565757632256,
0.026515807956457138,
0.021085228770971298,
-0.022702347487211227,
0.017913663759827614,
0.0183864776045084,
0.025645175948739052,
0.02279953844845295,
0.028083689510822296,
0.028453892096877098,
0.010603408329188824,
-0.01064895000308752,
-0.028208667412400246,
0.06616062670946121,
0.0040360852144658566,
-0.0024567670188844204,
-0.006698912940919399,
0.03503302484750748,
0.01708785444498062,
0.02512938715517521,
-0.009646478109061718,
0.028305165469646454,
-0.057949669659137726,
2.473821894000139e-7,
-0.0019081890350207686,
-0.032971642911434174,
-0.03658869490027428,
-0.017680082470178604,
0.04993268474936485,
-0.059613555669784546,
0.008915412239730358,
-0.0004634565848391503,
-0.027265025302767754,
-0.00369283021427691,
0.04208149388432503,
-0.01506736222654581,
-0.013531490229070187,
-0.0057319896295666695,
0.026533277705311775,
0.022277921438217163,
-0.02741027995944023,
-0.06272537261247635,
-0.03822069987654686,
-0.008482051081955433,
0.03655268996953964,
0.011044797487556934,
-0.05065413936972618,
-0.011347312480211258,
0.04541938006877899,
0.012429310940206051,
-0.04908054694533348,
-0.02152176760137081,
-0.020882127806544304,
0.005847913678735495,
0.038271501660346985,
-0.0238628052175045,
0.026672234758734703,
0.06528440117835999,
-0.014597907662391663,
0.014899901114404202,
0.0025965149980038404,
0.019034164026379585,
-0.046645209193229675,
0.022241735830903053,
0.015335672535002232,
-0.04902876913547516,
-0.047401584684848785,
0.06378316134214401,
-0.03202829509973526,
-0.0028568103443831205,
-0.026176361367106438,
0.046483103185892105,
-0.030213922262191772,
0.002197437919676304,
0.0515332967042923,
-0.01575026474893093,
-0.09014774113893509,
0.013143632560968399,
0.01787363365292549,
-0.004698160570114851,
-0.026707006618380547,
0.004642771556973457,
0.07393759489059448,
-0.005523003172129393,
-0.05768439173698425,
-0.07608377933502197,
0.03468376398086548,
-0.08567915111780167,
0.025052271783351898,
-0.0034431747626513243,
-0.04813866689801216,
1.3529380929381667e-34,
0.02108238823711872,
-0.014810961671173573,
-0.02612616866827011,
-0.04340783879160881,
0.07461343705654144,
-0.03639154136180878,
-0.026153959333896637,
0.04741178825497627,
0.03110249899327755,
-0.04376351833343506,
-0.083145871758461
] | {
"ds_index": 9,
"similar_dg_indices": [
1067592,
589413,
628463,
19788,
246212,
265325,
78871,
909840,
802337,
254070,
134669,
889408,
1077726,
446470,
543345,
1145948,
981845,
1157670,
1176422,
297165
]
} |
A 46-year-old woman comes to the physician because of a 2-week history of diplopia and ocular pain when reading the newspaper. She also has a 3-month history of amenorrhea, hot flashes, and increased sweating. She reports that she has been overweight all her adult life and is happy to have lost 6.8-kg (15-lb) of weight in the past 2 months. Her pulse is 110/min, and blood pressure is 148/98 mm Hg. Physical examination shows moist palms and a nontender thyroid gland that is enlarged to two times its normal size. Ophthalmologic examination shows prominence of the globes of the eyes, bilateral lid retraction, conjunctival injection, and an inability to converge the eyes. There is no pain on movement of the extraocular muscles. Visual acuity is 20/20 bilaterally. Neurologic examination shows a fine resting tremor of the hands. Deep tendon reflexes are 3+ with a shortened relaxation phase. Which of the following is the most likely cause of this patient's ocular complaints? | Glycosaminoglycan accumulation in the orbit | {
"A": "Granulomatous inflammation of the cavernous sinus",
"B": "Abnormal communication between the cavernous sinus and the internal carotid artery",
"C": "Glycosaminoglycan accumulation in the orbit",
"D": "Sympathetic hyperactivity of levator palpebrae superioris\n\""
} | step2&3 | C | [
"year old woman",
"physician",
"2-week history",
"diplopia",
"ocular pain",
"reading",
"newspaper",
"3 month history of amenorrhea",
"hot flashes",
"increased sweating",
"reports",
"overweight",
"adult life",
"happy to",
"lost",
"kg",
"weight",
"past",
"months",
"pulse",
"min",
"blood pressure",
"98 mm Hg",
"Physical examination shows moist palms",
"nontender thyroid gland",
"enlarged",
"two times",
"normal size",
"Ophthalmologic examination shows prominence",
"globes",
"eyes",
"bilateral lid retraction",
"conjunctival injection",
"to converge",
"eyes",
"pain",
"movement",
"extraocular muscles",
"Visual acuity",
"20/20",
"Neurologic examination shows",
"fine resting tremor of",
"hands",
"Deep tendon reflexes",
"3",
"shortened relaxation phase",
"following",
"most likely cause",
"patient's ocular complaints"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 46-year-old woman comes to the physician because of a 2-week history of diplopia and ocular pain when reading the newspaper. She also has a 3-month history of amenorrhea, hot flashes, and increased sweating. She reports that she has been overweight all her adult life and is happy to have lost 6.8-kg (15-lb) of weight in the past 2 months. Her pulse is 110/min, and blood pressure is 148/98 mm Hg. Physical examination shows moist palms and a nontender thyroid gland that is enlarged to two times its normal size. Ophthalmologic examination shows prominence of the globes of the eyes, bilateral lid retraction, conjunctival injection, and an inability to converge the eyes. There is no pain on movement of the extraocular muscles. Visual acuity is 20/20 bilaterally. Neurologic examination shows a fine resting tremor of the hands. Deep tendon reflexes are 3+ with a shortened relaxation phase. Which of the following is the most likely cause of this patient's ocular complaints?
Choose one of the following::
A. Granulomatous inflammation of the cavernous sinus
B. Abnormal communication between the cavernous sinus and the internal carotid artery
C. Glycosaminoglycan accumulation in the orbit
D. Sympathetic hyperactivity of levator palpebrae superioris
" | [
0.01239357702434063,
-0.03028293512761593,
0.038095567375421524,
-0.003231855807825923,
0.05714306980371475,
0.024383753538131714,
-0.032405003905296326,
0.08974099904298782,
0.05266934260725975,
-0.013779832981526852,
0.025570305064320564,
0.055986884981393814,
-0.005101935006678104,
-0.055295251309871674,
-0.02757137641310692,
0.01241578720510006,
-0.048831261694431305,
0.01648017019033432,
-0.06559589505195618,
0.012212476693093777,
-0.017451774328947067,
0.0012860101414844394,
0.04283451661467552,
-0.020999671891331673,
0.06238027662038803,
-0.02120720036327839,
0.04709777235984802,
0.0027419808320701122,
-0.003438939107581973,
0.004343096632510424,
-0.02359781228005886,
-0.023339683189988136,
-0.036767687648534775,
-0.026482414454221725,
0.0000019361639260750962,
0.023855486884713173,
0.04755229502916336,
0.004761045332998037,
0.042507659643888474,
0.0004215676453895867,
0.007827571593225002,
-0.05010206624865532,
0.06911665946245193,
0.0009394505177624524,
-0.008033924736082554,
-0.09874947369098663,
0.01792873814702034,
-0.008291763253509998,
-0.03344833105802536,
0.022083450108766556,
0.022443091496825218,
0.09083864092826843,
-0.01923493668437004,
0.01869361475110054,
0.05654239282011986,
-0.013538101688027382,
-0.022488785907626152,
-0.007502635009586811,
-0.0744667798280716,
0.018770020455121994,
0.014951358549296856,
-0.032861460000276566,
-0.016109395772218704,
0.027887020260095596,
-0.07334701716899872,
0.023075824603438377,
0.028262222185730934,
-0.046804279088974,
0.02043425664305687,
0.022250249981880188,
0.04860987514257431,
0.014707707799971104,
0.032254189252853394,
0.08798060566186905,
-0.056546829640865326,
0.028695428743958473,
0.025528447702527046,
-0.020654644817113876,
0.006155188661068678,
-0.028960973024368286,
0.07212180644273758,
0.020150071009993553,
-0.013818652369081974,
0.052522752434015274,
-0.04501593858003616,
-0.0626627653837204,
0.029842400923371315,
0.02689770795404911,
0.02302553877234459,
-0.03048253245651722,
0.029721049591898918,
-0.07018812000751495,
0.0178257804363966,
0.019600896164774895,
-0.0207795612514019,
-0.03470964729785919,
-0.012131444178521633,
-0.0761285349726677,
0.00244624144397676,
-0.021919313818216324,
-0.005364974029362202,
0.010889825411140919,
-0.02468399703502655,
0.0021956847049295902,
-0.019074350595474243,
0.0209810771048069,
-0.018069224432110786,
-0.012013274244964123,
-0.007628618739545345,
0.0372917503118515,
-0.003897967515513301,
0.0389082096517086,
-0.024583833292126656,
-0.060547374188899994,
0.05553799867630005,
-0.043973226100206375,
-0.012487565167248249,
-0.005318638402968645,
0.0217595137655735,
0.007527587469667196,
-0.017724933102726936,
0.05556495860219002,
0.05259281024336815,
-0.018071699887514114,
-0.04624854773283005,
0.06863948702812195,
0.046331290155649185,
-0.02564064785838127,
-0.010342661291360855,
-0.000980096054263413,
0.022386424243450165,
0.029286321252584457,
-0.04621906206011772,
0.034607209265232086,
0.040966279804706573,
0.020065296441316605,
-0.0012574506690725684,
0.07019335776567459,
0.024790611118078232,
0.001223048777319491,
-0.007940729148685932,
-0.04925559088587761,
-0.057790473103523254,
-0.006135906558483839,
-0.031540125608444214,
0.00346547388471663,
0.013733670115470886,
0.02095840312540531,
0.022946616634726524,
0.05027518421411514,
-0.0008586575859226286,
-0.018339117988944054,
-0.04978741332888603,
-0.00430239038541913,
0.017988985404372215,
0.0009149311226792634,
0.032341379672288895,
-0.0011466285213828087,
0.010875068604946136,
-0.02829805575311184,
-0.0031914589926600456,
-0.03622009605169296,
0.029416542500257492,
0.009367214515805244,
0.019556984305381775,
0.03958047926425934,
0.05024831369519234,
0.03461403027176857,
-0.07367105036973953,
0.05725782364606857,
-0.01866600289940834,
0.044534992426633835,
0.01858312264084816,
0.02823759987950325,
-0.04137815907597542,
0.02234662137925625,
-0.05320732668042183,
-0.03518922999501228,
-0.010994527488946915,
-0.06119251623749733,
0.0032121967524290085,
0.013581446371972561,
0.06217828020453453,
-0.029284626245498657,
-0.04783302918076515,
0.00994076393544674,
-0.0718240812420845,
-0.05202106758952141,
0.02686918154358864,
-0.040626898407936096,
-0.028155962005257607,
-0.004744936712086201,
-0.04544813930988312,
0.01655842922627926,
0.014843611977994442,
0.025212902575731277,
-0.029939312487840652,
-0.02212320640683174,
-0.03785163164138794,
-0.0023542488925158978,
-0.02080315165221691,
0.012550955638289452,
-0.014167399145662785,
0.028786903247237206,
-0.048042330890893936,
0.03764210268855095,
0.01301394309848547,
0.017824983224272728,
-0.004619780462235212,
0.02789626270532608,
-0.010962419211864471,
0.007887636311352253,
0.06051236763596535,
-0.05701814219355583,
0.032159898430109024,
0.04376846179366112,
0.033679500222206116,
0.006874354090541601,
-0.0940030962228775,
0.062051933258771896,
0.021360104903578758,
0.021121785044670105,
-0.006147889886051416,
-0.003070053644478321,
-0.05234716087579727,
-0.025496257469058037,
0.004143436439335346,
-0.010007750242948532,
-0.03556628152728081,
-0.07556507736444473,
0.028427274897694588,
0.028356002643704414,
-0.06497808545827866,
-0.027687259018421173,
-0.04521908611059189,
0.0011803143424913287,
0.05336252227425575,
-0.00043573506991378963,
0.02199668437242508,
-0.005516935605555773,
0.00044900388456881046,
-0.060568492859601974,
-0.03511924669146538,
-0.04137130826711655,
0.005910289008170366,
-0.0022975141182541847,
-0.002073561539873481,
-0.011332973837852478,
-0.05536201223731041,
0.03126395493745804,
-0.008451825007796288,
-0.00662791496142745,
0.02955659292638302,
-0.00854434259235859,
-0.0453774593770504,
0.08789433538913727,
-0.08791343122720718,
0.032227523624897,
-0.06320762634277344,
-0.02541055902838707,
0.0038421344943344593,
0.04485713317990303,
-0.004077768884599209,
-0.02804376743733883,
-0.039253637194633484,
0.010229413397610188,
-0.04212568327784538,
-0.046502936631441116,
0.0025437225122004747,
0.030035782605409622,
-0.01778183877468109,
0.044236764311790466,
0.01525481604039669,
0.034690145403146744,
-0.021613096818327904,
0.0065168351866304874,
0.033550675958395004,
0.05998175963759422,
0.030106419697403908,
0.041303087025880814,
0.012319114990532398,
0.06758397817611694,
0.03803122416138649,
-0.01891760528087616,
-0.026982255280017853,
0.009166046045720577,
-0.010696149431169033,
-0.002497813431546092,
0.02816091664135456,
0.05633550509810448,
0.008077068254351616,
0.0317285992205143,
0.042121849954128265,
0.0036252548452466726,
-0.012366045266389847,
-0.012674265541136265,
-0.02446521446108818,
0.06118525564670563,
0.007486719638109207,
0.06965451687574387,
0.004895180929452181,
0.0047196135856211185,
0.007951539009809494,
-0.022884150967001915,
0.009863854385912418,
-0.028492631390690804,
-0.015866978093981743,
0.0009732635808177292,
-0.015161191113293171,
0.01684984564781189,
0.01586058735847473,
0.00696765398606658,
-0.0029067303985357285,
-0.030026167631149292,
-0.0241060983389616,
-0.009588995017111301,
-0.03936970606446266,
-0.05336015671491623,
0.03745054081082344,
0.05155906081199646,
-0.003241113852709532,
0.024120435118675232,
0.023063382133841515,
0.010253953747451305,
0.01573963463306427,
-0.01701849140226841,
0.02850346639752388,
-0.009987868368625641,
-0.011053607799112797,
-0.04480024427175522,
0.003447816241532564,
0.009439709596335888,
-0.004217179957777262,
0.013120459392666817,
0.0004580566892400384,
0.019155509769916534,
-0.0031784221064299345,
0.04076693207025528,
0.009973254054784775,
0.019741492345929146,
0.028208568692207336,
0.01905200071632862,
0.019283868372440338,
0.025001468136906624,
0.030237430706620216,
-0.04475485160946846,
-0.05023417994379997,
0.011680934578180313,
-0.051370564848184586,
-0.004847361706197262,
-0.03918174281716347,
0.033869095146656036,
0.014279513619840145,
0.005566994193941355,
-0.018472082912921906,
-0.04395558685064316,
0.0851438120007515,
0.050310950726270676,
-0.04926383122801781,
-0.016757911071181297,
-0.055989351123571396,
0.009359961375594139,
0.01090159174054861,
-0.01844971440732479,
0.007690983824431896,
0.008738557808101177,
-0.009164366871118546,
-0.03336922451853752,
-0.00656157685443759,
-0.045414648950099945,
-0.07650981843471527,
-0.04124901443719864,
0.010864791460335255,
0.06390915811061859,
-0.0016554218018427491,
-0.006817835383117199,
-0.002554746111854911,
-0.033174026757478714,
-0.05121227353811264,
0.005320731550455093,
0.0630718320608139,
-0.04034983366727829,
0.008366260677576065,
-0.03828194737434387,
-0.009127911180257797,
0.025780651718378067,
-0.01100472453981638,
0.0023951197508722544,
0.02521626092493534,
-0.035141471773386,
-0.0012670918367803097,
0.07539648562669754,
0.008633818477392197,
0.010860083624720573,
-0.01830790750682354,
0.02259589172899723,
-0.022819673642516136,
-0.024548783898353577,
-0.002965295221656561,
0.06795446574687958,
-0.0031665030401200056,
0.005192856770008802,
0.05630916357040405,
0.02520299330353737,
0.0803859680891037,
-0.0940241813659668,
-0.09783802926540375,
-0.016673685982823372,
0.024990811944007874,
0.04017495736479759,
-0.015456393361091614,
-0.10522468388080597,
0.025254888460040092,
0.016622794792056084,
0.052705179899930954,
-0.04504577815532684,
0.00203257636167109,
-0.038238681852817535,
0.0674624964594841,
-0.07073263078927994,
0.0828867256641388,
0.007164673414081335,
-0.07660309225320816,
-0.019633708521723747,
0.009600727818906307,
0.039504293352365494,
0.036388471722602844,
0.002300846856087446,
-0.02746538259088993,
0.0017303685890510678,
0.0353500060737133,
-0.0346473827958107,
0.07863827049732208,
0.04548065736889839,
-0.006993993651121855,
0.10182948410511017,
0.004334853962063789,
0.0763179138302803,
-0.1026659905910492,
-0.04307982698082924,
0.01123062428086996,
-0.05854212865233421,
0.06986414641141891,
0.08246519416570663,
0.0011348500847816467,
0.031925152987241745,
-0.000443204800831154,
0.05416395887732506,
0.039730142802000046,
0.08390383422374725,
0.007629652041941881,
-0.01701613888144493,
0.04434378072619438,
0.03979292884469032,
0.019732410088181496,
0.02435152418911457,
0.045652762055397034,
-0.06538549810647964,
0.004995061084628105,
-0.026000747457146645,
-0.025439780205488205,
0.021837428212165833,
-0.009144487790763378,
-0.05483706295490265,
0.030078213661909103,
-0.03955825790762901,
-0.03618195652961731,
0.035523902624845505,
0.04111720249056816,
0.01633588969707489,
-0.023228920996189117,
0.0691935122013092,
-0.018650637939572334,
0.01688416302204132,
-0.049684055149555206,
-0.02398824319243431,
-0.08507135510444641,
-0.06566892564296722,
-0.03270271420478821,
0.05048854276537895,
0.04679480195045471,
0.052007779479026794,
-0.014261811040341854,
0.059266895055770874,
-0.04547461122274399,
-0.020047150552272797,
0.004322530701756477,
-0.016879593953490257,
-0.026116210967302322,
0.004887097980827093,
-0.018182646483182907,
-0.016042763367295265,
0.014524647034704685,
-0.02475905977189541,
-0.01543490681797266,
-0.029538333415985107,
0.06273926794528961,
0.059750571846961975,
0.008452280424535275,
-0.07504391670227051,
0.03823221102356911,
-0.00982736237347126,
-0.0038891835138201714,
0.007755101192742586,
-0.008832715451717377,
-0.0026740224566310644,
0.015001198276877403,
0.04131055250763893,
0.0355459563434124,
-0.027417033910751343,
0.03205285593867302,
-0.03820972889661789,
0.03604430332779884,
0.010572011582553387,
0.0578940212726593,
-0.06408331543207169,
-0.060411736369132996,
-0.020146412774920464,
0.00821808073669672,
-0.0057933274656534195,
-0.00202769017778337,
0.0035619803238660097,
-0.013966565951704979,
-0.025943759828805923,
-0.015332045033574104,
0.010917648673057556,
0.017744123935699463,
-0.018093252554535866,
0.019371652975678444,
0.034302741289138794,
-0.002024613320827484,
-0.028267456218600273,
0.030220407992601395,
-0.08834512531757355,
-0.023394295945763588,
-0.017319926992058754,
0.013074713759124279,
-0.012621110305190086,
0.02345430850982666,
-0.04204270616173744,
-0.019268371164798737,
-0.013534468598663807,
-0.013300439342856407,
0.013693882152438164,
-0.012800877913832664,
-0.0023147747851908207,
-0.012893211096525192,
0.02148839458823204,
0.03191233053803444,
0.033019840717315674,
-0.02986791357398033,
0.032899968326091766,
-0.037519246339797974,
0.02461053617298603,
0.02782611735165119,
-4.875163720679767e-33,
0.016295989975333214,
-0.01774601824581623,
0.03203456103801727,
-0.038113199174404144,
0.009080042131245136,
0.06826066970825195,
-0.05438564345240593,
-0.0035335191059857607,
-0.047908514738082886,
0.020952370017766953,
0.001177474856376648,
0.018996626138687134,
0.0037028479855507612,
0.06725169718265533,
-0.041292812675237656,
-0.055844973772764206,
-0.02427252195775509,
0.021427154541015625,
-0.02407909370958805,
-0.05484984442591667,
-0.025983016937971115,
-0.046369947493076324,
-0.02724522352218628,
-0.0023566957097500563,
-0.007726308889687061,
-0.007517746649682522,
0.034066904336214066,
-0.009524268098175526,
0.02220694161951542,
0.018606537953019142,
-0.002452295273542404,
0.016000235453248024,
0.0005269366083666682,
0.05646994337439537,
0.010013880208134651,
-0.04000569134950638,
-0.02912556752562523,
-0.08197981864213943,
0.013607482425868511,
-0.012346615083515644,
-0.037909504026174545,
0.019268207252025604,
0.024237848818302155,
-0.02326442487537861,
0.07006349414587021,
-0.019069025292992592,
0.002079689409583807,
-0.03388074040412903,
-0.06916201114654541,
0.016938665881752968,
-0.005738850217312574,
0.01525952760130167,
0.039364010095596313,
-0.016302790492773056,
-0.016829371452331543,
-0.01972101628780365,
0.008930359035730362,
0.03828131780028343,
0.027550939470529556,
0.027735644951462746,
-0.041777100414037704,
0.02004479616880417,
-0.022113922983407974,
-0.0075109112076461315,
0.018399279564619064,
-0.005699547939002514,
0.031186960637569427,
0.007575983181595802,
-0.06960706412792206,
-0.034390147775411606,
-0.08386398106813431,
-0.02700531668961048,
-0.01722390577197075,
-0.05065301060676575,
0.012548951432108879,
-0.046684667468070984,
0.03138541057705879,
-0.030185168609023094,
0.01388840563595295,
0.0644778311252594,
-0.02931375801563263,
-0.016300667077302933,
-0.02060827612876892,
-0.023504480719566345,
0.010785778984427452,
0.0062279049307107925,
-0.0068514239974319935,
-0.010157090611755848,
0.009637911804020405,
0.029488714411854744,
0.07669568806886673,
0.020229412242770195,
0.025171194225549698,
-0.03899860754609108,
0.040659163147211075,
-0.028314445167779922,
0.010769638232886791,
-0.012894202955067158,
-0.0005840384983457625,
-0.015137946233153343,
0.06983457505702972,
-0.015202108770608902,
0.015654366463422775,
0.028851166367530823,
-0.0051530273631215096,
0.04901067912578583,
-0.03685663640499115,
-0.009545641951262951,
-0.009631463326513767,
0.0005931598134338856,
-0.010202711448073387,
-0.004900995176285505,
-0.023318924009799957,
0.07330258935689926,
-0.03658811375498772,
-0.0059985993430018425,
0.0042329272255301476,
0.053694888949394226,
0.03901047259569168,
0.01626453548669815,
-0.012614909559488297,
-0.03010154329240322,
0.02737973816692829,
-0.02671315334737301,
-0.033999036997556686,
-0.022083714604377747,
0.02844558283686638,
0.052029844373464584,
0.015727762132883072,
0.0005893316119909286,
-0.008048982359468937,
0.024920115247368813,
2.7302019134367583e-7,
-0.0020823918748646975,
0.04884615167975426,
0.010944348759949207,
-0.04694525897502899,
0.019638344645500183,
0.0027327006682753563,
0.04195016622543335,
0.018222561106085777,
-0.027063285931944847,
-0.033887650817632675,
0.03950886055827141,
0.03436093404889107,
-0.016282647848129272,
-0.046015940606594086,
0.04654639959335327,
-0.01778779923915863,
-0.002211723243817687,
-0.008829573169350624,
0.0009970932733267546,
-0.02481602318584919,
-0.009377348236739635,
-0.054555345326662064,
-0.03899813070893288,
-0.04993610456585884,
0.045638829469680786,
-0.02432258054614067,
-0.020976128056645393,
-0.035226039588451385,
-0.01967286504805088,
0.011086764745414257,
0.0005443227710202336,
0.02377403900027275,
0.009451093152165413,
0.02520391345024109,
-0.04219070449471474,
-0.07431147247552872,
0.011871173046529293,
0.006752059329301119,
-0.08107370138168335,
0.036492470651865005,
0.024457212537527084,
-0.020421123132109642,
-0.012493081390857697,
0.00022439028543885797,
-0.003276601666584611,
0.0022715243976563215,
-0.0694253072142601,
0.04066002741456032,
-0.04297173023223877,
-0.03543296828866005,
-0.02448686957359314,
-0.0040880185551941395,
-0.02940436266362667,
0.03784316033124924,
0.012044370174407959,
0.0705447569489479,
-0.04277940094470978,
-0.016018226742744446,
0.022287890315055847,
-0.07249214500188828,
0.0034351779613643885,
-0.03941802307963371,
-0.0013130310690030456,
-0.0520033985376358,
0.0659019723534584,
-0.04201572760939598,
-0.048878014087677,
2.41783185628939e-34,
0.016652727499604225,
-0.008952820673584938,
-0.0014260623138397932,
-0.08139465749263763,
-0.03030763380229473,
-0.05099112167954445,
0.01431544590741396,
0.014524071477353573,
0.05706433206796646,
-0.04148464649915695,
-0.020004427060484886
] | {
"ds_index": 10,
"similar_dg_indices": [
327043,
507847,
1202338,
1197213,
1114068,
1200208,
1202361,
911627,
552034,
802217,
697051,
263564,
456358,
157120,
718205,
1095701,
1118812,
773443,
342807,
268946
]
} |
A 1-year-old boy presents to the emergency department with weakness and a change in his behavior. His parents state that they first noticed the change in his behavior this morning and it has been getting worse. They noticed the patient was initially weak in his upper body and arms, but now he won’t move his legs with as much strength or vigor as he used to. Physical exam is notable for bilateral ptosis with a sluggish pupillary response, a very weak sucking and gag reflex, and shallow respirations. The patient is currently drooling and his diaper is dry. The parents state he has not had a bowel movement in over 1 day. Which of the following is the pathophysiology of this patient’s condition? | Blockade of presynaptic acetylcholine release at the neuromuscular junction | {
"A": "Autoantibodies against the presynaptic voltage-gated calcium channels",
"B": "Autoimmune demyelination of peripheral nerves",
"C": "Blockade of presynaptic acetylcholine release at the neuromuscular junction",
"D": "Lower motor neuron destruction in the anterior horn"
} | step2&3 | C | [
"year old boy presents",
"emergency department",
"weakness",
"change in",
"behavior",
"parents state",
"first",
"change in",
"behavior",
"morning",
"getting worse",
"patient",
"initially weak",
"upper body",
"arms",
"now",
"move",
"legs",
"strength",
"vigor",
"used to",
"Physical exam",
"notable",
"bilateral ptosis",
"sluggish pupillary response",
"very weak sucking",
"gag reflex",
"shallow respirations",
"patient",
"currently drooling",
"diaper",
"dry",
"parents state",
"not",
"bowel movement",
"1 day",
"following",
"pathophysiology",
"patients condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 1-year-old boy presents to the emergency department with weakness and a change in his behavior. His parents state that they first noticed the change in his behavior this morning and it has been getting worse. They noticed the patient was initially weak in his upper body and arms, but now he won’t move his legs with as much strength or vigor as he used to. Physical exam is notable for bilateral ptosis with a sluggish pupillary response, a very weak sucking and gag reflex, and shallow respirations. The patient is currently drooling and his diaper is dry. The parents state he has not had a bowel movement in over 1 day. Which of the following is the pathophysiology of this patient’s condition?
Choose one of the following::
A. Autoantibodies against the presynaptic voltage-gated calcium channels
B. Autoimmune demyelination of peripheral nerves
C. Blockade of presynaptic acetylcholine release at the neuromuscular junction
D. Lower motor neuron destruction in the anterior horn | [
0.025642454624176025,
-0.02153688855469227,
0.019719893112778664,
0.001396216219291091,
0.013112710788846016,
0.010838544927537441,
-0.027259500697255135,
0.058954037725925446,
-0.03749445825815201,
-0.02251758612692356,
0.055991142988204956,
-0.05574769899249077,
-0.007998429238796234,
-0.03340651094913483,
0.02004721760749817,
-0.006182103417813778,
0.042730651795864105,
-0.01447291299700737,
-0.04750913009047508,
0.011423507705330849,
-0.003101795446127653,
0.027583645656704903,
0.006316930986940861,
-0.0033644784707576036,
0.07011467218399048,
0.005348256789147854,
0.007910892367362976,
-0.02707677148282528,
-0.026379402726888657,
-0.07383379340171814,
-0.03195289522409439,
0.028721347451210022,
0.0009775873040780425,
-0.01607792265713215,
0.000001810889330045029,
0.008745701052248478,
0.010481923818588257,
-0.01234911847859621,
0.024332698434591293,
-0.01848605088889599,
-0.04216565564274788,
-0.05155330151319504,
0.04187572002410889,
-0.011682532727718353,
-0.049608390778303146,
-0.12208212167024612,
0.028767341747879982,
0.07467583566904068,
-0.011895895935595036,
0.025196721777319908,
0.02237248606979847,
0.07336869835853577,
-0.009423465467989445,
-0.008414492942392826,
0.04959198459982872,
0.004544995259493589,
-0.014303271658718586,
-0.026627017185091972,
0.01269455160945654,
-0.004784177988767624,
0.011372431181371212,
-0.020351001992821693,
0.03254995495080948,
0.002979448065161705,
-0.04155890643596649,
-0.005128579214215279,
0.08342500776052475,
-0.04547823220491409,
0.0030478662811219692,
-0.00478318752720952,
-0.012207155115902424,
0.00916220247745514,
0.08660585433244705,
0.050646424293518066,
-0.0482696034014225,
0.012875892221927643,
0.04097861051559448,
0.0051516760140657425,
-0.0136491097509861,
-0.005862712860107422,
0.03059559315443039,
0.02858051471412182,
0.0036974349059164524,
0.03479325771331787,
-0.002465968020260334,
-0.06040109694004059,
-0.0011460529640316963,
-0.02038302645087242,
-0.03171965479850769,
-0.04366256296634674,
0.007407821714878082,
-0.06609074026346207,
0.005458355415612459,
-0.006149164866656065,
-0.019214237108826637,
0.012437391094863415,
-0.004372416064143181,
-0.006268679164350033,
0.020889604464173317,
-0.061178646981716156,
-0.0016913173021748662,
-0.04452433064579964,
0.004708567168563604,
-0.011704061180353165,
-0.012736252509057522,
-0.008789613842964172,
-0.04640689864754677,
0.04532739520072937,
-0.051575083285570145,
0.06629952043294907,
-0.027448566630482674,
0.011819902807474136,
-0.04626372084021568,
0.039113689213991165,
0.07290341705083847,
-0.005699720233678818,
-0.010437705554068089,
-0.03026481904089451,
0.03452013060450554,
-0.004438553471118212,
-0.010847603902220726,
0.02892691269516945,
0.008596163243055344,
0.03059707023203373,
-0.04628157988190651,
0.06625021249055862,
0.014908869750797749,
-0.00302116759121418,
0.01925528794527054,
0.03672308847308159,
-0.011286917142570019,
-0.061400048434734344,
-0.03576688840985298,
0.016856173053383827,
0.018150553107261658,
0.024059029296040535,
0.03421739116311073,
0.035905349999666214,
-0.0581364743411541,
0.002650430891662836,
-0.030405603349208832,
-0.05436341091990471,
0.0067306519486010075,
0.012297206558287144,
-0.02032092586159706,
0.03370567038655281,
-0.0037440580781549215,
0.006300949025899172,
0.03147042915225029,
0.022277826443314552,
0.011147805489599705,
-0.011735889129340649,
0.0018739559454843402,
-0.017088694497942924,
-0.015774928033351898,
0.01631469465792179,
0.029967742040753365,
0.00626198248937726,
-0.024323981255292892,
-0.06726110726594925,
0.016538813710212708,
-0.008575516752898693,
-0.00831939373165369,
-0.01952413097023964,
-0.028211427852511406,
0.04316159337759018,
0.059440381824970245,
0.010056789964437485,
-0.033642906695604324,
0.039172932505607605,
-0.04937613010406494,
0.017901698127388954,
0.03200685605406761,
0.05844426155090332,
0.009414452128112316,
0.05295552313327789,
-0.02880067564547062,
-0.0570494718849659,
-0.01709999144077301,
-0.01690291427075863,
0.009260646067559719,
0.038080845028162,
0.04990403726696968,
-0.01914878934621811,
0.017748601734638214,
-0.04125797748565674,
-0.04565679281949997,
0.0025877533480525017,
-0.036545369774103165,
-0.022049646824598312,
-0.02711324766278267,
0.02801954746246338,
-0.020391589030623436,
0.005195518955588341,
0.028524283319711685,
0.06452877074480057,
-0.020924339070916176,
0.025798508897423744,
0.039613209664821625,
0.0036597310099750757,
0.0378260612487793,
-0.013295694254338741,
-0.018768560141324997,
0.005156151484698057,
-0.05923022702336311,
0.0642918199300766,
-0.000544705253560096,
0.00048693252028897405,
0.024416262283921242,
-0.024145789444446564,
-0.048802562057971954,
0.012180500663816929,
0.006291392259299755,
-0.03473808616399765,
-0.006552853621542454,
0.013569382019340992,
0.014060964807868004,
-0.018618855625391006,
-0.11012554168701172,
0.04011436924338341,
-0.018976176157593727,
0.021180538460612297,
0.05002913624048233,
0.01723783276975155,
-0.05169219896197319,
0.014373675920069218,
0.05347145348787308,
0.006865029223263264,
-0.022404538467526436,
-0.07807149738073349,
0.038551583886146545,
0.0057985722087323666,
-0.04798927158117294,
0.02773359790444374,
-0.03820158168673515,
0.026782387867569923,
-0.005511362571269274,
-0.03558550402522087,
0.003486237721517682,
0.046559061855077744,
-0.022669201716780663,
-0.006215787958353758,
-0.056587375700473785,
-0.04360513016581535,
-0.015132686123251915,
-0.07835949212312698,
0.02055339142680168,
0.04884503409266472,
-0.017102329060435295,
0.04224920645356178,
-0.01695391908288002,
-0.02269127033650875,
-0.03128884732723236,
-0.007762501481920481,
0.028622755780816078,
0.016941461712121964,
0.024495383724570274,
0.007981805130839348,
-0.04532688111066818,
-0.05575446039438248,
-0.05755980685353279,
-0.02174355834722519,
-0.017401792109012604,
-0.02222346141934395,
-0.051146768033504486,
-0.011241677217185497,
0.008865321055054665,
0.0363907553255558,
0.030854102224111557,
0.06981607526540756,
0.0000511817452206742,
0.01975736953318119,
0.029418034479022026,
0.014062023721635342,
-0.019091323018074036,
0.018823720514774323,
-0.0028034227434545755,
0.03077787347137928,
0.060161665081977844,
0.016723252832889557,
0.02236430160701275,
0.023551087826490402,
-0.015808915719389915,
0.025485824793577194,
-0.0012137178564444184,
-0.02864532358944416,
-0.0072830538265407085,
-0.006821598391979933,
0.06315908581018448,
0.007966708391904831,
0.017441563308238983,
0.012515424750745296,
0.007946353405714035,
-0.07555446773767471,
-0.009368018247187138,
-0.04559583216905594,
-0.047821689397096634,
0.05807633697986603,
-0.02640448696911335,
0.07653556019067764,
0.04023822396993637,
0.009544174186885357,
0.006225910037755966,
-0.007649359293282032,
-0.007634361740201712,
0.04322971776127815,
0.014767189510166645,
-0.039542779326438904,
0.01222726609557867,
0.05356796830892563,
0.09128306061029434,
0.01755528338253498,
-0.009329873137176037,
-0.05049062892794609,
-0.012355953454971313,
0.01595219038426876,
0.003885311773046851,
-0.07723584026098251,
0.015376721508800983,
0.008853623643517494,
-0.0001743747852742672,
0.029139995574951172,
-0.004573802929371595,
-0.027669450268149376,
-0.012381459586322308,
0.005474372301250696,
-0.010582421906292439,
0.011476924642920494,
0.007991816848516464,
-0.030893446877598763,
-0.013411047868430614,
0.03204130008816719,
-0.007718293461948633,
-0.013940464705228806,
0.03394124656915665,
0.009591163136065006,
-0.0037601194344460964,
0.02242589369416237,
-0.08047093451023102,
0.06127655878663063,
0.01831374689936638,
-0.04639751464128494,
0.0034931693226099014,
0.03754580393433571,
0.05302080139517784,
-0.030113238841295242,
-0.08105580508708954,
-0.055713094770908356,
0.00458473339676857,
0.014751001261174679,
-0.06390977650880814,
0.023775523528456688,
-0.00010196914081461728,
-0.018835216760635376,
-0.027891328558325768,
-0.03936615213751793,
0.030749747529625893,
0.05340087413787842,
-0.030223600566387177,
0.008035438135266304,
-0.009735519997775555,
0.050205279141664505,
-0.0013952748849987984,
0.030841803178191185,
0.005483402404934168,
0.011520283296704292,
-0.029286380857229233,
-0.018561124801635742,
-0.03074546344578266,
-0.024056779220700264,
-0.03146422654390335,
-0.016578661277890205,
-0.08515230566263199,
0.02404642291367054,
-0.024431072175502777,
0.010536039248108864,
0.00008033244375837967,
0.008004330098628998,
-0.13530108332633972,
-0.04963529109954834,
0.023385532200336456,
-0.03168890252709389,
0.016567964106798172,
-0.01342837419360876,
0.0029496653005480766,
-0.029147446155548096,
-0.022632990032434464,
-0.0050565507262945175,
0.0493653267621994,
0.04320782050490379,
-0.0470716767013073,
0.05426197871565819,
-0.03615402430295944,
-0.03488694503903389,
0.010081996209919453,
0.04768069088459015,
0.029126804322004318,
-0.04187769815325737,
0.008349893614649773,
0.10011809319257736,
-0.02417469397187233,
0.009438428096473217,
-0.02166547253727913,
0.06007607281208038,
0.05886191874742508,
-0.020491793751716614,
-0.051000017672777176,
-0.04195095971226692,
0.012454346753656864,
0.010358015075325966,
0.0189938023686409,
-0.05605895072221756,
0.018817715346813202,
0.003841912839561701,
-0.014542737044394016,
-0.006859146058559418,
-0.0003039879084099084,
-0.0746292695403099,
0.021901912987232208,
-0.08342476934194565,
0.07790946215391159,
-0.043403126299381256,
-0.007819781079888344,
-0.06754288077354431,
-0.006525438278913498,
-0.0006275713094510138,
0.02185271680355072,
0.05020100995898247,
0.0056165787391364574,
-0.015927543863654137,
0.019642788916826248,
-0.054130371659994125,
0.033796023577451706,
0.022164857015013695,
-0.009204665198922157,
-0.026955634355545044,
-0.01621382310986519,
-0.0006097994046285748,
0.037615954875946045,
-0.051827218383550644,
0.048123933374881744,
-0.03717251494526863,
0.08122275024652481,
0.014099756255745888,
0.0596156045794487,
-0.002060077851638198,
0.01841188222169876,
0.02581332065165043,
0.0741819441318512,
0.158505380153656,
-0.0418308824300766,
-0.0356832854449749,
-0.015730436891317368,
0.009982134215533733,
0.05078159272670746,
0.007016913499683142,
-0.02488476037979126,
-0.022005030885338783,
0.04741908982396126,
0.008190733380615711,
-0.041998520493507385,
0.010036403313279152,
-0.07641123980283737,
-0.03131278604269028,
0.023427385836839676,
-0.01027936302125454,
-0.08093643933534622,
0.007966629229485989,
0.0022078489419072866,
-0.0038852987345308065,
-0.04279138892889023,
0.02093791961669922,
0.00035275620757602155,
-0.011840731836855412,
0.005521565210074186,
-0.0021701836958527565,
-0.027746764943003654,
-0.03893058001995087,
0.035820189863443375,
0.016339071094989777,
-0.022892165929079056,
0.10124162584543228,
-0.03686041757464409,
-0.1142723485827446,
0.0007620383403263986,
0.008934391662478447,
-0.014517555944621563,
0.015745358541607857,
-0.007627737242728472,
0.007066574413329363,
0.03937685117125511,
-0.006130953785032034,
0.00021744165860582143,
-0.027850478887557983,
-0.08049912005662918,
0.003864212427288294,
-0.0036475376691669226,
0.07942403107881546,
0.048976290971040726,
-0.03509379178285599,
0.03708284720778465,
0.01967782713472843,
0.037418268620967865,
-0.02112220786511898,
-0.007989514619112015,
0.0007863373029977083,
-0.029405707493424416,
0.007591464091092348,
-0.01981133222579956,
-0.040016841143369675,
0.01966693438589573,
-0.01766328699886799,
0.005022790748625994,
0.05003437027335167,
0.032002657651901245,
-0.08412624150514603,
-0.06495055556297302,
-0.0494220145046711,
0.0027184158097952604,
0.012827283702790737,
0.015047702006995678,
0.0098166698589921,
-0.040324822068214417,
-0.03521062806248665,
0.01051346119493246,
0.05737235024571419,
-0.027653465047478676,
0.016047893092036247,
0.0012963133631274104,
0.05328723415732384,
-0.04010544344782829,
0.02742665633559227,
-0.033969756215810776,
0.03134093061089516,
-0.009086726233363152,
-0.02322012558579445,
0.02216106653213501,
-0.020057907328009605,
-0.021204739809036255,
-0.03374863043427467,
0.01933703012764454,
0.0177370086312294,
-0.037911392748355865,
-0.01264091208577156,
-0.0332164540886879,
0.018103115260601044,
0.027087055146694183,
-0.013463604263961315,
0.006697290111333132,
0.014739957638084888,
-0.03402499109506607,
0.06018561124801636,
0.06600737571716309,
0.026746513321995735,
0.018163146451115608,
-5.0160573715433724e-33,
0.037663646042346954,
-0.01201179064810276,
0.01808086596429348,
-0.027970274910330772,
0.02631862834095955,
0.083319291472435,
-0.01801983453333378,
0.02249104343354702,
-0.06734345108270645,
0.011217586696147919,
-0.019595781341195107,
-0.011597550474107265,
0.02056915871798992,
0.05709853395819664,
0.04043739661574364,
-0.03788476064801216,
-0.008895945735275745,
-0.027911299839615822,
-0.006376543082296848,
-0.021610016003251076,
-0.010919122956693172,
-0.021842246875166893,
0.01506137941032648,
-0.010936819948256016,
-0.012951355427503586,
-0.055154573172330856,
0.034649550914764404,
0.018377533182501793,
-0.02450302056968212,
-0.0019371150992810726,
0.012054986320436,
-0.05804182216525078,
0.014270318672060966,
-0.008591629564762115,
-0.03782040253281593,
-0.04470566287636757,
0.01458826195448637,
-0.006684170104563236,
0.04173741862177849,
-0.0800878033041954,
-0.07242961972951889,
0.030227819457650185,
0.0776473879814148,
0.028405893594026566,
0.06155085191130638,
-0.031645484268665314,
-0.0082415621727705,
-0.027218418195843697,
0.03529355302453041,
-0.007053873967379332,
0.007762865629047155,
0.029127459973096848,
-0.007398485671728849,
-0.026264242827892303,
0.002911000046879053,
-0.028492268174886703,
0.0046981219202280045,
-0.043867893517017365,
0.03176300227642059,
-0.04191027954220772,
-0.03102155029773712,
0.05760987848043442,
-0.010212402790784836,
-0.038009949028491974,
-0.0158619936555624,
0.03193433955311775,
0.02809702418744564,
0.041219353675842285,
-0.02762787416577339,
0.044488660991191864,
-0.03047831542789936,
0.013784889131784439,
0.030383210629224777,
-0.061131011694669724,
-0.027391893789172173,
0.0067491610534489155,
-0.016336817294359207,
0.025121625512838364,
0.06391264498233795,
0.061709389090538025,
-0.050000205636024475,
-0.03153263032436371,
-0.002518065506592393,
-0.013231114484369755,
-0.015402715653181076,
0.005484472960233688,
0.0023964527063071728,
-0.039210036396980286,
-0.02488461323082447,
-0.03617337346076965,
0.09172109514474869,
0.0014827981358394027,
0.03182180970907211,
0.04894781857728958,
-0.04268326610326767,
-0.04929111897945404,
0.08420050889253616,
0.05492498353123665,
0.017757460474967957,
0.005998707842081785,
0.035603102296590805,
-0.018593192100524902,
0.03551170602440834,
0.008046545088291168,
-0.00047213173820637167,
0.016460955142974854,
-0.024630790576338768,
0.009450763463973999,
-0.014852742664515972,
-0.0003688823780976236,
0.03898193687200546,
-0.007967035286128521,
-0.02323116548359394,
0.0652792900800705,
-0.03585029020905495,
0.046355053782463074,
-0.007617128547281027,
0.041105717420578,
0.025647897273302078,
0.018447043374180794,
-0.02038510888814926,
0.08027378469705582,
-0.005972783546894789,
-0.020291047170758247,
-0.0056675937958061695,
-0.08076787739992142,
-0.010129074566066265,
0.102413110435009,
-0.013005103915929794,
-0.01030606310814619,
0.04800023138523102,
-0.0019343856256455183,
2.638224714246462e-7,
0.0489763543009758,
0.014340776018798351,
-0.012457660399377346,
-0.0644550770521164,
-0.012278851121664047,
-0.03201482817530632,
-0.03404485434293747,
0.050131093710660934,
-0.001387885888107121,
-0.04313232749700546,
0.04166482388973236,
0.012050187215209007,
-0.02270806021988392,
0.017742536962032318,
0.0233102235943079,
0.027953365817666054,
-0.029861606657505035,
0.04979785904288292,
0.011898121796548367,
-0.019954893738031387,
-0.005932772997766733,
-0.014496784657239914,
-0.060546230524778366,
-0.010373829863965511,
0.016820581629872322,
0.002769074635580182,
-0.019588319584727287,
0.025055792182683945,
0.01865972764790058,
0.0063269552774727345,
0.002623756416141987,
-0.020785633474588394,
0.027141373604536057,
-0.0108503932133317,
-0.06647613644599915,
0.002158655086532235,
0.003997858613729477,
-0.0009759881650097668,
-0.01958409883081913,
-0.013668995350599289,
0.004804684780538082,
0.03211113065481186,
0.03064143657684326,
0.026676885783672333,
0.026022927835583687,
-0.013800744898617268,
0.016202649101614952,
0.038283612579107285,
0.028569795191287994,
0.04901671037077904,
-0.01359808910638094,
0.012718168087303638,
0.0018689421704038978,
0.08320785313844681,
-0.028560062870383263,
0.026783853769302368,
-0.0027451084461063147,
-0.0519351065158844,
0.047316137701272964,
-0.018203463405370712,
-0.010663356631994247,
-0.031210435554385185,
-0.010242033749818802,
-0.03486156836152077,
0.03560720384120941,
-0.0066922795958817005,
-0.04895591363310814,
2.2920838072876567e-34,
-0.035745661705732346,
-0.03930496796965599,
0.02991444803774357,
-0.09904719144105911,
0.009204942733049393,
-0.01912522315979004,
0.03867851942777634,
0.05633809044957161,
-0.022366434335708618,
-0.04778171330690384,
-0.01960833929479122
] | {
"ds_index": 11,
"similar_dg_indices": [
123567,
427538,
469349,
138771,
107773,
866068,
829474,
282031,
279768,
71481,
129734,
1096277,
975956,
1044745,
16079,
665596,
792950,
992508,
202,
683926
]
} |
A 9-month-old female is brought to the emergency department after experiencing a seizure. She was born at home and was normal at birth according to her parents. Since then, they have noticed that she does not appear to be achieving developmental milestones as quickly as her siblings, and often appears lethargic. Physical exam reveals microcephaly, very light pigmentation (as compared to her family), and a "musty" body odor. The varied manifestations of this disease can most likely be attributed to which of the following genetic principles? | Pleiotropy | {
"A": "Anticipation",
"B": "Multiple gene mutations",
"C": "Pleiotropy",
"D": "Variable expressivity"
} | step1 | C | [
"month old female",
"brought",
"emergency department",
"experiencing",
"seizure",
"born at home",
"normal at birth",
"parents",
"Since then",
"not appear to",
"developmental milestones",
"siblings",
"often appears lethargic",
"Physical exam reveals microcephaly",
"very light pigmentation",
"compared",
"family",
"musty",
"body odor",
"varied manifestations of",
"disease",
"most likely",
"attributed",
"following genetic"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 9-month-old female is brought to the emergency department after experiencing a seizure. She was born at home and was normal at birth according to her parents. Since then, they have noticed that she does not appear to be achieving developmental milestones as quickly as her siblings, and often appears lethargic. Physical exam reveals microcephaly, very light pigmentation (as compared to her family), and a "musty" body odor. The varied manifestations of this disease can most likely be attributed to which of the following genetic principles?
Choose one of the following::
A. Anticipation
B. Multiple gene mutations
C. Pleiotropy
D. Variable expressivity | [
0.006099233403801918,
0.02513524889945984,
0.025850504636764526,
-0.026449475437402725,
0.05268523097038269,
0.026507560163736343,
-0.025909656658768654,
0.05973220616579056,
-0.025985462591052055,
-0.0503532811999321,
0.07050182670354843,
-0.0026897587813436985,
-0.030283605679869652,
-0.006610540673136711,
0.00022187302238307893,
-0.017929157242178917,
0.0036564089823514223,
0.023739030584692955,
-0.02944844216108322,
0.003937315661460161,
-0.011796767823398113,
0.01743556372821331,
0.0517597533762455,
-0.03168046101927757,
0.00525759207084775,
-0.024455714970827103,
0.011565206572413445,
-0.01743837259709835,
-0.029268408194184303,
0.025427838787436485,
0.001020124414935708,
0.03350606560707092,
-0.03058566153049469,
-0.0001226943131769076,
0.0000018288717456016457,
-0.009847649373114109,
-0.006946901325136423,
-0.013766186311841011,
0.03054092638194561,
-0.04850425571203232,
-0.020103279501199722,
0.0007527919369749725,
-0.0024577670264989138,
0.00812395941466093,
0.0016314992681145668,
-0.0921906903386116,
0.01867404393851757,
0.11566925048828125,
-0.05924749746918678,
-0.03391376882791519,
0.032122377306222916,
0.03034333884716034,
-0.008560148067772388,
0.008936654776334763,
0.12337948381900787,
0.009063583798706532,
-0.006898368708789349,
0.03400196507573128,
-0.02304839715361595,
-0.11045663058757782,
0.04864201322197914,
0.014709098264575005,
-0.0036445807199925184,
0.018160445615649223,
-0.027245664969086647,
-0.008915217593312263,
0.01628514565527439,
-0.06596379727125168,
-0.012177149765193462,
0.026184197515249252,
0.02775607630610466,
-0.009343698620796204,
0.07618413120508194,
0.05909615382552147,
-0.0036284627858549356,
0.020074967294931412,
0.012927494943141937,
-0.0170246884226799,
-0.03590276464819908,
-0.01108870841562748,
0.03517850860953331,
0.040096133947372437,
0.017334021627902985,
0.020285991951823235,
0.0424102284014225,
-0.005990953184664249,
0.007129564881324768,
-0.03211717680096626,
-0.06045987457036972,
-0.03701531141996384,
-0.019199803471565247,
-0.03334486857056618,
-0.02364383637905121,
-0.022630752995610237,
-0.012902467511594296,
-0.013830993324518204,
-0.018983952701091766,
-0.020460018888115883,
0.030201511457562447,
0.002180113922804594,
0.018985003232955933,
-0.05801292136311531,
-0.012034333311021328,
0.010460006073117256,
-0.056677501648664474,
-0.012316027656197548,
-0.04737040027976036,
0.034362807869911194,
-0.031105060130357742,
0.011428630910813808,
-0.023140039294958115,
0.02932274341583252,
-0.05282354727387428,
-0.012219933792948723,
0.05586883798241615,
0.004656562115997076,
-0.02819531410932541,
-0.030123813077807426,
0.028247078880667686,
-0.0023477505892515182,
0.002411974361166358,
0.04306064918637276,
0.009828954935073853,
0.006119116675108671,
-0.03683599457144737,
0.03573375195264816,
-0.009901586920022964,
-0.013851854018867016,
0.009752403013408184,
-0.018263889476656914,
-0.011854186654090881,
-0.025686342269182205,
-0.0387670062482357,
0.03517262265086174,
0.029507219791412354,
0.039833005517721176,
0.07979883253574371,
0.026601413264870644,
-0.0670386552810669,
0.044975731521844864,
-0.005649581551551819,
-0.05845820531249046,
-0.016471458598971367,
-0.005192199256271124,
-0.10124748945236206,
0.07936810702085495,
-0.006571766454726458,
-0.01903555542230606,
0.011294444091618061,
0.002781590213999152,
0.001964520663022995,
-0.06279172748327255,
-0.03563918545842171,
-0.009112144820392132,
0.03973666951060295,
0.020219359546899796,
-0.01457906048744917,
-0.0030249031260609627,
0.005578738171607256,
-0.06846288591623306,
0.04254379868507385,
-0.05863285809755325,
0.00918001402169466,
-0.04060940071940422,
0.015269114635884762,
0.043889496475458145,
0.06548575311899185,
0.010108135640621185,
0.0009651831933297217,
0.016621634364128113,
-0.0016568246064707637,
0.0004051297146361321,
0.04899100959300995,
0.016484074294567108,
-0.013339334167540073,
0.05285331979393959,
-0.02822236716747284,
-0.02457183040678501,
0.0039406889118254185,
-0.024887075647711754,
-0.013660556636750698,
0.02282037027180195,
0.06958324462175369,
0.00529254088178277,
-0.006777174770832062,
-0.03250022977590561,
-0.03293144702911377,
0.07185772061347961,
0.005853952374309301,
0.006087497342377901,
-0.015384974889457226,
0.05711743235588074,
0.01505928486585617,
0.006454170681536198,
-0.05943610891699791,
0.03225339204072952,
0.0011608725180849433,
0.026230493560433388,
-0.008816363289952278,
0.01555472332984209,
-0.003374553984031081,
-0.03352157399058342,
0.0012388755567371845,
0.05984053760766983,
-0.06693725287914276,
0.09632429480552673,
0.0018546147039160132,
0.0012939739972352982,
-0.04242297261953354,
-0.02087537758052349,
-0.06732716411352158,
-0.0033511719666421413,
0.049465958029031754,
-0.011561994440853596,
0.024099595844745636,
-0.01903299055993557,
0.020854460075497627,
-0.0039052809588611126,
-0.09394802153110504,
0.014117556624114513,
0.004415938165038824,
0.010598599910736084,
0.04080567881464958,
-0.034711964428424835,
-0.05465205758810043,
0.022287772968411446,
0.03387216106057167,
-0.009623337537050247,
0.015568561851978302,
-0.06717316061258316,
0.03225279599428177,
0.030923428013920784,
-0.06880200654268265,
0.01677645742893219,
-0.03501923382282257,
0.020460033789277077,
-0.0016820848686620593,
0.000031634190236218274,
-0.03765084221959114,
0.03619671240448952,
-0.034041400998830795,
-0.01640835590660572,
-0.020374948158860207,
-0.02235577628016472,
0.00807511992752552,
-0.04454052820801735,
0.034321561455726624,
0.02829178050160408,
-0.014188840053975582,
0.012919245287775993,
-0.012467472814023495,
-0.006900888402014971,
0.025529470294713974,
0.011300303041934967,
-0.0379299633204937,
0.04032524302601814,
-0.05213319882750511,
0.024928638711571693,
-0.05705680698156357,
-0.039282120764255524,
-0.05079690366983414,
0.03560280799865723,
0.013537182472646236,
-0.04560313746333122,
-0.07075571268796921,
-0.01212332770228386,
0.0333024300634861,
-0.004180937074124813,
-0.013816697522997856,
0.06126817315816879,
0.01820748671889305,
0.006840647663921118,
0.02668973058462143,
-0.00024183167261071503,
-0.03500450402498245,
0.02155228890478611,
0.038734134286642075,
0.042352862656116486,
0.05023094639182091,
0.014417601749300957,
-0.0023319970350712538,
-0.02355288341641426,
0.007495270110666752,
0.03021826595067978,
-0.01835111901164055,
-0.008900182321667671,
-0.013899669982492924,
0.060234084725379944,
0.03645753115415573,
0.004602664615958929,
-0.040975555777549744,
0.03504694998264313,
0.026260273531079292,
-0.008297329768538475,
-0.02666938304901123,
0.016499347984790802,
-0.013186056166887283,
0.04678836837410927,
-0.010790243744850159,
0.054259542375802994,
-0.0157903041690588,
0.0071660978719592094,
-0.013596600852906704,
-0.01027111615985632,
-0.008174301125109196,
0.12337969988584518,
-0.0115129966288805,
0.03308522328734398,
-0.009574702009558678,
0.061806559562683105,
0.0460958257317543,
-0.014207960106432438,
-0.015254798345267773,
0.0462290458381176,
0.022160543128848076,
0.029473591595888138,
0.01798512041568756,
-0.11446873098611832,
0.0015600400511175394,
0.05182867869734764,
0.005677354987710714,
-0.03180385008454323,
-0.024564484134316444,
-0.028150498867034912,
0.004618419334292412,
0.0033489575143903494,
-0.048930469900369644,
0.013220901601016521,
-0.018140120431780815,
-0.05414033308625221,
-0.024373367428779602,
0.0033211929257959127,
-0.015141098760068417,
-0.035698309540748596,
0.015199634246528149,
0.022394604980945587,
0.010618523694574833,
0.0032277037389576435,
-0.036742351949214935,
0.012388358823955059,
0.03397459536790848,
-0.027378834784030914,
0.0040013291873037815,
0.047612179070711136,
0.055469781160354614,
-0.034707631915807724,
-0.01735883764922619,
-0.016913510859012604,
-0.04818863049149513,
0.04030230641365051,
-0.040940769016742706,
0.04462968930602074,
-0.004626481793820858,
-0.009497485123574734,
0.023533998057246208,
-0.008143337443470955,
0.04547221586108208,
-0.0240130927413702,
0.012011311948299408,
-0.03648107126355171,
-0.007510532159358263,
0.0444733127951622,
-0.06846299022436142,
0.023255448788404465,
-0.019961612299084663,
0.009062495082616806,
0.012927735224366188,
-0.010122797451913357,
-0.02619304694235325,
-0.02346900664269924,
-0.0014613504754379392,
-0.014889903366565704,
-0.05536450073122978,
0.027085114270448685,
-0.01903410069644451,
0.021431591361761093,
-0.02428775280714035,
-0.060533106327056885,
-0.06973634660243988,
-0.023576268926262856,
0.06210332363843918,
-0.03048337809741497,
0.02962072193622589,
-0.004945032298564911,
0.000990338739939034,
-0.004345945082604885,
-0.039524663239717484,
0.04567335918545723,
0.04665791243314743,
-0.007551847957074642,
-0.019910363480448723,
-0.007828859612345695,
-0.0414353609085083,
0.0398387610912323,
0.0021969357039779425,
0.041276589035987854,
0.049607593566179276,
-0.053134530782699585,
0.022305842489004135,
0.03940935805439949,
-0.023202933371067047,
0.04803993180394173,
-0.0513533353805542,
0.10129956156015396,
0.039546649903059006,
0.017635203897953033,
-0.009507820010185242,
-0.04682324454188347,
0.055649153888225555,
-0.036190129816532135,
0.031004682183265686,
-0.055114295333623886,
0.03277861326932907,
-0.00887920893728733,
-0.02492978796362877,
-0.041089389473199844,
-0.002949237823486328,
-0.07411526888608932,
0.04168248549103737,
-0.028146598488092422,
0.06952053308486938,
-0.01484611164778471,
-0.015486663207411766,
-0.05949326977133751,
-0.040369465947151184,
-0.016503306105732918,
0.010794934816658497,
0.024013744667172432,
0.043712910264730453,
0.011534380726516247,
0.011511426419019699,
-0.03870321810245514,
0.049158528447151184,
0.06561193615198135,
0.0002682575723156333,
0.005722343921661377,
0.04525606334209442,
-0.013407221995294094,
-0.06790041923522949,
-0.03199398145079613,
0.049369119107723236,
-0.03038317896425724,
0.03564886748790741,
0.044522725045681,
-0.025475872680544853,
0.019288688898086548,
0.0007472574943676591,
0.00860134232789278,
0.0793495923280716,
0.1516750603914261,
-0.0487208254635334,
-0.03948935121297836,
-0.01876629889011383,
0.017344504594802856,
0.023475661873817444,
0.0019311201758682728,
-0.04311003163456917,
-0.05935204401612282,
0.025910204276442528,
0.0006528648664243519,
-0.05252988263964653,
0.006475478410720825,
-0.027834678068757057,
-0.048577189445495605,
0.004224289208650589,
-0.044075045734643936,
-0.014853434637188911,
0.04615674167871475,
-0.01566927134990692,
-0.029270267114043236,
-0.08522997051477432,
0.04133794456720352,
0.01543964073061943,
0.007572932168841362,
0.043573636561632156,
-0.025962654501199722,
-0.03488800674676895,
-0.041596319526433945,
0.014571149833500385,
0.01417083851993084,
-0.011701913550496101,
0.06403756886720657,
-0.041691720485687256,
-0.030920790508389473,
0.003935943357646465,
0.004619795363396406,
0.024978691712021828,
0.019510162994265556,
-0.008697565644979477,
-0.01201627030968666,
-0.006013215985149145,
0.013295415788888931,
0.02174302749335766,
-0.03747885674238205,
-0.05571684241294861,
-0.0200874675065279,
-0.010827546939253807,
0.10769341140985489,
-0.03050641156733036,
-0.008696657605469227,
0.0467621274292469,
-0.005110472906380892,
0.0498151034116745,
0.03625565022230148,
0.013870764523744583,
0.03136039525270462,
-0.0291048102080822,
0.06558021903038025,
0.00348796253092587,
-0.038671135902404785,
0.03299590200185776,
-0.01860612817108631,
0.04135771840810776,
0.08352160453796387,
-0.012757875956594944,
-0.045456577092409134,
-0.07280438393354416,
0.010152814909815788,
-0.05023441091179848,
0.02651515044271946,
0.008079112507402897,
0.02774069271981716,
-0.05438549444079399,
-0.032824236899614334,
0.009476808831095695,
0.014643292874097824,
0.016915664076805115,
-0.0018445339519530535,
0.004977323114871979,
0.011592014692723751,
-0.028781836852431297,
0.04592493548989296,
-0.02769578993320465,
-0.03357691690325737,
-0.002158230869099498,
-0.030169297009706497,
0.03759947046637535,
-0.04393898323178291,
-0.03649238869547844,
-0.053719013929367065,
0.0013738962588831782,
0.0009504444315098226,
0.0196787528693676,
0.002797071123495698,
-0.021305106580257416,
0.09003991633653641,
-0.05904596671462059,
-0.004864155314862728,
0.03189955651760101,
-0.04017039015889168,
0.026664970442652702,
-0.006687241140753031,
0.00015263003297150135,
0.03704597428441048,
0.0503711923956871,
-5.453124170936346e-33,
0.030201833695173264,
-0.04621035233139992,
0.06008974462747574,
0.017560312524437904,
0.03554213047027588,
0.02399640902876854,
-0.016131939366459846,
0.016532188281416893,
-0.04062445089221001,
0.0006083663320168853,
-0.009536703117191792,
-0.005652102641761303,
0.00016406447684857994,
0.06280377507209778,
0.016040701419115067,
-0.012641910463571548,
-0.03808323293924332,
-0.04179517179727554,
-0.02393171936273575,
-0.04330960661172867,
-0.013681593351066113,
-0.01148221455514431,
-0.027386130765080452,
0.001204566447995603,
-0.014264182187616825,
-0.04314818233251572,
0.038113582879304886,
0.013918482698500156,
-0.024929607287049294,
-0.004428134765475988,
0.020118825137615204,
-0.0738256499171257,
-0.01866152510046959,
-0.005106738768517971,
-0.017139030620455742,
-0.06395521014928818,
-0.011392696760594845,
-0.029794173315167427,
0.030654920265078545,
-0.07647065818309784,
-0.0650881826877594,
-0.007889569737017155,
0.055354028940200806,
0.020721185952425003,
0.06792384386062622,
0.00700104096904397,
-0.004197875037789345,
-0.058176130056381226,
0.02613651193678379,
-0.07010375708341599,
-0.010515492409467697,
0.013722286559641361,
0.010550116188824177,
0.05003147944808006,
0.008957868441939354,
-0.07023759931325912,
-0.01948832906782627,
-0.04323304817080498,
0.06607664376497269,
-0.015620384365320206,
-0.009827341884374619,
-0.0020178109407424927,
-0.019557073712348938,
-0.021189695224165916,
0.05962331220507622,
0.009765587747097015,
0.056856464594602585,
0.024622946977615356,
-0.061461806297302246,
0.014272548258304596,
-0.013385354541242123,
-0.008052072487771511,
-0.019935136660933495,
-0.07900605350732803,
-0.02895558439195156,
0.03688013553619385,
0.03915264829993248,
0.011350813321769238,
0.0006560229230672121,
0.07033293694257736,
-0.056439902633428574,
-0.03032592684030533,
-0.012737064622342587,
0.03463341295719147,
0.00038351776311174035,
0.009205366484820843,
-0.010372526943683624,
-0.02664998359978199,
0.010461617261171341,
-0.030277173966169357,
0.02757211960852146,
0.03460409864783287,
0.03380322828888893,
0.014389553107321262,
-0.042824000120162964,
-0.04890379682183266,
0.0757652223110199,
-0.0011529606999829412,
0.00596045795828104,
0.023554835468530655,
0.06883291900157928,
0.02391410432755947,
0.050017643719911575,
-0.02557654306292534,
0.020717833191156387,
0.0030843147542327642,
-0.02211696468293667,
-0.02839871123433113,
-0.02413778193295002,
-0.008029666729271412,
0.04115268588066101,
-0.010738639160990715,
0.0054460614919662476,
0.020113704726099968,
-0.07185424119234085,
0.025875048711895943,
0.02415328286588192,
-0.018854957073926926,
0.04161231592297554,
0.07636137306690216,
0.01341301016509533,
0.03535215184092522,
0.022653479129076004,
-0.026467425748705864,
-0.029971837997436523,
-0.06945260614156723,
-0.030361399054527283,
0.06155844032764435,
-0.036908116191625595,
0.024770645424723625,
0.04376552626490593,
0.028993049636483192,
2.6496934424358187e-7,
0.02930455468595028,
0.05172594636678696,
-0.008743793703615665,
-0.035060666501522064,
0.03326134756207466,
-0.041723206639289856,
-0.02923556976020336,
-0.0010933097219094634,
-0.011088370345532894,
-0.007438519969582558,
0.038848426192998886,
0.040341392159461975,
0.0033492993097752333,
0.00958284642547369,
-0.004264950752258301,
0.06623385846614838,
-0.003415048820897937,
0.02846905030310154,
0.04760916158556938,
0.006727891508489847,
-0.04206498712301254,
0.010039746761322021,
-0.03977316990494728,
-0.024107661098241806,
0.0388215146958828,
0.005068185273557901,
-0.014509153552353382,
0.019356871023774147,
0.03407016023993492,
0.02963068336248398,
-0.014203968457877636,
0.02078728750348091,
0.020120445638895035,
0.03846220299601555,
-0.03946932405233383,
-0.050684768706560135,
-0.02441398613154888,
-0.00973590649664402,
-0.02893235720694065,
0.00877901166677475,
0.018892887979745865,
0.022482600063085556,
0.0059609790332615376,
0.07486423850059509,
-0.028104353696107864,
0.020143281668424606,
-0.021825036033988,
0.03260824456810951,
-0.0009600485791452229,
-0.023283420130610466,
-0.0007613174384459853,
0.009027545340359211,
0.031583137810230255,
0.0346076563000679,
-0.02194838598370552,
-0.03656051307916641,
-0.00829912070184946,
-0.016581755131483078,
0.03982141241431236,
-0.006664558779448271,
-0.000293560151476413,
-0.07585346698760986,
-0.014921513386070728,
-0.03297337144613266,
0.03918654844164848,
0.01306956447660923,
-0.024349931627511978,
2.3385339716556282e-34,
-0.0387747548520565,
-0.029119018465280533,
-0.019575748592615128,
-0.0911668911576271,
0.014390453696250916,
-0.049776140600442886,
-0.0035973854828625917,
0.013219127431511879,
-0.0042135994881391525,
-0.04510334134101868,
-0.023428229615092278
] | {
"ds_index": 12,
"similar_dg_indices": [
866530,
911185,
611821,
862353,
1093847,
62819,
212345,
484127,
806015,
188252,
905744,
281868,
800488,
912532,
923838,
429982,
1074807,
381061,
255193,
99804
]
} |
A 23-year-old man comes to the physician for evaluation of decreased hearing, dizziness, and ringing in his right ear for the past 6 months. Physical examination shows multiple soft, yellow plaques and papules on his arms, chest, and back. There is sensorineural hearing loss and weakness of facial muscles bilaterally. His gait is unsteady. An MRI of the brain shows a 3-cm mass near the right internal auditory meatus and a 2-cm mass at the left cerebellopontine angle. The abnormal cells in these masses are most likely derived from which of the following embryological structures? | Neural crest | {
"A": "Neural tube",
"B": "Surface ectoderm",
"C": "Neural crest",
"D": "Notochord"
} | step1 | C | [
"23 year old man",
"physician",
"evaluation",
"decreased hearing",
"dizziness",
"ringing in",
"right ear",
"past 6 months",
"Physical examination shows multiple soft",
"yellow plaques",
"papules",
"arms",
"chest",
"back",
"sensorineural hearing loss",
"weakness",
"facial muscles",
"gait",
"unsteady",
"MRI of",
"brain shows",
"3",
"mass",
"right internal auditory meatus",
"2 cm mass",
"left cerebellopontine angle",
"abnormal cells",
"masses",
"most likely derived",
"following embryological structures"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 23-year-old man comes to the physician for evaluation of decreased hearing, dizziness, and ringing in his right ear for the past 6 months. Physical examination shows multiple soft, yellow plaques and papules on his arms, chest, and back. There is sensorineural hearing loss and weakness of facial muscles bilaterally. His gait is unsteady. An MRI of the brain shows a 3-cm mass near the right internal auditory meatus and a 2-cm mass at the left cerebellopontine angle. The abnormal cells in these masses are most likely derived from which of the following embryological structures?
Choose one of the following::
A. Neural tube
B. Surface ectoderm
C. Neural crest
D. Notochord | [
0.002837224630638957,
-0.03254668042063713,
0.013499091379344463,
-0.011420013383030891,
0.024547848850488663,
0.03313831984996796,
0.028437849134206772,
0.0038428588304668665,
-0.04507791996002197,
0.03970307111740112,
-0.017578747123479843,
0.011318803764879704,
-0.02476414293050766,
-0.048065755516290665,
0.03938093036413193,
0.02846730500459671,
-0.022707242518663406,
0.003611575346440077,
-0.004984396044164896,
0.0001595830253791064,
-0.03318459913134575,
-0.008205248042941093,
0.03822147101163864,
-0.009280969388782978,
-0.011662567965686321,
-0.013407444581389427,
0.0513492226600647,
0.006894541438668966,
-0.018563726916909218,
-0.03355446457862854,
-0.005944044329226017,
0.0035453448072075844,
-0.025809986516833305,
0.022063182666897774,
0.000001914403355840477,
0.06917016953229904,
0.023845095187425613,
-0.0057327584363520145,
0.032472725957632065,
-0.0019213968189433217,
-0.024155789986252785,
0.026729855686426163,
-0.05069098621606827,
0.009502077475190163,
0.010998004116117954,
-0.07252174615859985,
-0.038603294640779495,
0.05657161399722099,
-0.025598512962460518,
0.019119564443826675,
0.009219719097018242,
0.022245345637202263,
0.05800477787852287,
0.014904063194990158,
0.10696087777614594,
-0.003893497632816434,
0.0005913983914069831,
0.012055628933012486,
-0.03931328281760216,
0.010120576247572899,
0.05680250748991966,
-0.02194874733686447,
0.0016108958516269922,
-0.0019373057875782251,
-0.003062319476157427,
-0.027534540742635727,
0.09084183722734451,
-0.09308736771345139,
-0.012881528586149216,
-0.004315533675253391,
0.061733756214380264,
-0.0005211599636822939,
0.04344998672604561,
0.07302539795637131,
0.014543700963258743,
-0.04603365808725357,
0.013906791806221008,
0.05864426866173744,
-0.04577914997935295,
-0.013564317487180233,
-0.013252148404717445,
-0.0319807305932045,
-0.016964653506875038,
-0.00012705383414868265,
0.02096763625741005,
-0.06625358760356903,
0.00991129968315363,
-0.037016794085502625,
-0.006765672937035561,
-0.039939433336257935,
0.006524156779050827,
-0.03568939492106438,
0.056022562086582184,
0.04513411223888397,
0.012875250540673733,
0.015662547200918198,
-0.02852676995098591,
-0.058216214179992676,
0.037850819528102875,
-0.03988540545105934,
-0.019446544349193573,
-0.022839218378067017,
-0.08865663409233093,
0.06915848702192307,
-0.07527993619441986,
-0.029894132167100906,
-0.06415708363056183,
0.03436475992202759,
-0.006098504643887281,
0.024300716817378998,
-0.00015498031280003488,
0.05151120200753212,
-0.021030940115451813,
0.0006584433140233159,
0.04067568853497505,
-0.029965078458189964,
-0.002400757512077689,
-0.01730296015739441,
-0.00040679980884306133,
0.03793980926275253,
-0.0014389118878170848,
0.009842656552791595,
0.01689034327864647,
0.04665418714284897,
0.014696270227432251,
0.0029251810628920794,
-0.018981797620654106,
-0.005022119265049696,
-0.006067151669412851,
-0.0253361277282238,
-0.001173084951005876,
0.06588105857372284,
-0.066362664103508,
0.0394744873046875,
-0.003941400907933712,
0.014659604988992214,
0.029089530929923058,
0.04108795151114464,
0.03238869458436966,
0.018540307879447937,
-0.025530554354190826,
0.018605319783091545,
-0.07457088679075241,
0.00522646913304925,
-0.045133065432310104,
-0.016713419929146767,
-0.06688028573989868,
0.035502269864082336,
-0.0003986968658864498,
0.021184513345360756,
-0.03314196690917015,
-0.041281621903181076,
-0.05761253088712692,
0.006292919162660837,
0.05296884477138519,
0.04920443892478943,
-0.035033032298088074,
-0.03305601328611374,
0.0014959272230044007,
-0.06266459077596664,
0.04039205610752106,
-0.012155461125075817,
-0.031596578657627106,
0.0034525240771472454,
-0.007974336855113506,
-0.006828646175563335,
0.03365866467356682,
-0.01936742663383484,
-0.05132574215531349,
0.010673927143216133,
-0.011322874575853348,
-0.02594621852040291,
0.010031037032604218,
0.010456728748977184,
-0.019308801740407944,
0.0757327452301979,
-0.10590335726737976,
-0.024209558963775635,
-0.00821820367127657,
-0.08040300011634827,
0.007101297844201326,
-0.02340417541563511,
0.0694865882396698,
-0.049717314541339874,
-0.039783671498298645,
0.00709613086655736,
-0.012734653428196907,
-0.0016964266542345285,
0.01885339803993702,
0.02562139555811882,
0.008027036674320698,
0.04998600110411644,
-0.043153807520866394,
0.041687894612550735,
-0.012701459228992462,
0.013207724317908287,
-0.03281790018081665,
-0.014188521541655064,
-0.04001537710428238,
0.04480600729584694,
-0.004128770437091589,
0.019943688064813614,
0.06260217726230621,
-0.04224185273051262,
-0.10274408012628555,
-0.016061242669820786,
-0.039257097989320755,
-0.017598960548639297,
-0.07828571647405624,
0.0652008056640625,
-0.035142604261636734,
-0.005072537809610367,
-0.016301341354846954,
-0.01560533419251442,
0.005341068375855684,
0.0722150132060051,
0.0041487072594463825,
0.011433686129748821,
-0.08217975497245789,
0.030419260263442993,
-0.00594716053456068,
-0.04725123569369316,
0.06256522983312607,
0.02441500686109066,
-0.006850956007838249,
0.04734664410352707,
0.029730910435318947,
0.016387244686484337,
0.026071658357977867,
-0.054186996072530746,
-0.001106037525460124,
0.030240202322602272,
-0.005182688590139151,
0.05575206130743027,
-0.014600883238017559,
0.000698316958732903,
-0.03891819342970848,
-0.03447197377681732,
0.0037217061035335064,
0.05468899756669998,
-0.010022788308560848,
-0.08816355466842651,
0.003238346893340349,
-0.014568247832357883,
0.01977614313364029,
-0.011686927638947964,
-0.019127406179904938,
0.01919023133814335,
0.03687145933508873,
0.014456333592534065,
-0.04445720463991165,
-0.05262262374162674,
0.026282627135515213,
0.02789616771042347,
-0.05215540528297424,
0.029368121176958084,
-0.036899082362651825,
0.057517159730196,
-0.06932935118675232,
-0.03802258148789406,
-0.017745718359947205,
0.02852523885667324,
0.003783006686717272,
-0.03931625187397003,
-0.028558792546391487,
-0.020951226353645325,
-0.0010419368045404553,
-0.00844753161072731,
0.00476022157818079,
0.04311974346637726,
0.005701801739633083,
0.06214868649840355,
-0.03382038325071335,
0.02071237936615944,
-0.036854568868875504,
-0.004627854097634554,
0.041225045919418335,
0.05666244775056839,
0.017342211678624153,
-0.030587226152420044,
0.0013309373753145337,
0.03317483142018318,
0.0029502951074391603,
-0.008675060234963894,
-0.021685566753149033,
0.0026259853038936853,
-0.032174862921237946,
-0.01775784231722355,
0.0081232450902462,
0.015987521037459373,
-0.0783044844865799,
0.05800127238035202,
0.025559211149811745,
0.0022409555967897177,
0.008242562413215637,
0.019970985129475594,
-0.017324531450867653,
0.08189310878515244,
-0.0032617340330034494,
0.08101583272218704,
-0.02850126288831234,
0.040928591042757034,
0.053088221698999405,
-0.014082231558859348,
-0.008166789077222347,
0.09844490885734558,
-0.027326522395014763,
0.03590395674109459,
-0.018627621233463287,
0.05542470142245293,
0.0861130803823471,
0.03300414979457855,
-0.00411913963034749,
0.017465153709053993,
-0.015975471585989,
-0.002613119315356016,
-0.03439311310648918,
-0.1202724426984787,
-0.01317258644849062,
0.05883755534887314,
-0.028671570122241974,
0.0382898785173893,
0.02492509037256241,
0.016068236902356148,
0.012448308058083057,
0.002310862299054861,
0.006251547485589981,
-0.000047841884224908426,
0.016251180320978165,
0.024573463946580887,
-0.009284498170018196,
-0.006441647652536631,
-0.028356827795505524,
-0.018642429262399673,
0.009744741953909397,
0.044857338070869446,
-0.00776928523555398,
-0.003429226577281952,
-0.029051296412944794,
-0.007677653804421425,
0.038850829005241394,
-0.015337875112891197,
-0.007228265982121229,
0.09918703138828278,
0.056957900524139404,
-0.0022865058854222298,
-0.031235771253705025,
-0.00442669540643692,
-0.09427880495786667,
0.006207493133842945,
-0.028622709214687347,
0.0320429764688015,
0.01419734489172697,
0.03835318610072136,
-0.01104099303483963,
0.04350574314594269,
0.026520775631070137,
0.0531083345413208,
-0.02398804761469364,
-0.022961221635341644,
0.01692695915699005,
0.026322782039642334,
-0.048909250646829605,
0.044468481093645096,
0.0026174448430538177,
-0.040846459567546844,
0.02128620818257332,
0.026751991361379623,
0.0060833897441625595,
0.008761647157371044,
0.044795554131269455,
0.03261847794055939,
-0.08144566416740417,
0.020104089751839638,
-0.011865892447531223,
-0.00374496984295547,
-0.02457375079393387,
0.007664797827601433,
-0.07494226098060608,
-0.029886413365602493,
0.03722357004880905,
-0.01690341718494892,
0.03449885547161102,
-0.01785435527563095,
-0.06452948600053787,
0.02378115803003311,
-0.02213587798178196,
0.016362227499485016,
0.034005243331193924,
0.012685257010161877,
0.022410187870264053,
-0.06699159741401672,
0.009150952100753784,
0.0034350212663412094,
-0.028242724016308784,
0.014334311708807945,
-0.0212857685983181,
-0.028902938589453697,
0.07254139333963394,
0.018098145723342896,
-0.009371921420097351,
-0.01925446279346943,
-0.023620357736945152,
0.014775479212403297,
0.04157210513949394,
0.016486018896102905,
0.0055694119073450565,
-0.03506522998213768,
0.04048246145248413,
-0.01418988686054945,
0.0273885615170002,
-0.060560744255781174,
-0.009975713677704334,
0.012354223988950253,
-0.02115345001220703,
-0.002036804100498557,
-0.03471243008971214,
-0.07399314641952515,
0.044708479195833206,
-0.018502695485949516,
0.05048226937651634,
-0.007419289089739323,
-0.0003927507495973259,
0.0009050861117430031,
0.025369348004460335,
-0.01446513831615448,
0.07040627300739288,
-0.00586111843585968,
0.03262840583920479,
0.03622682765126228,
0.020548539236187935,
0.007036205381155014,
0.041515424847602844,
0.07299346476793289,
0.007092009764164686,
0.07246499508619308,
0.06576833128929138,
0.004021855071187019,
-0.033868804574012756,
-0.01714255101978779,
-0.01965470425784588,
0.007496993523091078,
0.014079767279326916,
0.09049776941537857,
0.03127717971801758,
-0.000799856788944453,
-0.026224279776215553,
0.0029608584009110928,
0.04237424582242966,
0.11643797159194946,
-0.0035630404017865658,
-0.02377878502011299,
-0.016527237370610237,
0.0016062279464676976,
0.015652338042855263,
-0.0035564496647566557,
-0.02387753129005432,
-0.04931872710585594,
0.0011248666560277343,
-0.04871716722846031,
-0.051821257919073105,
0.005273893475532532,
-0.03138824552297592,
-0.08280862867832184,
0.023334834724664688,
0.03814714401960373,
-0.013819568790495396,
0.00077387026976794,
0.050242066383361816,
0.005772540345788002,
-0.017706360667943954,
0.008434614166617393,
0.010913608595728874,
-0.04854954034090042,
0.06532896310091019,
-0.0311976820230484,
0.0006497003487311304,
-0.06572442501783371,
-0.014471844770014286,
0.05180615559220314,
-0.008967631496489048,
0.10167264938354492,
-0.03194731846451759,
0.008008070290088654,
0.016529489308595657,
0.011773752979934216,
0.03172888979315758,
-0.007536226883530617,
0.00003993079735664651,
-0.01948140375316143,
0.058330237865448,
0.02856452576816082,
0.006787712685763836,
0.0015270026633515954,
-0.004073360003530979,
0.00765686109662056,
0.04549471288919449,
0.062169019132852554,
0.013235380873084068,
-0.028612323105335236,
-0.007798476610332727,
-0.019792472943663597,
0.02312624454498291,
0.053167615085840225,
-0.02708979696035385,
0.0016078929184004664,
0.01569257862865925,
0.026833830401301384,
-0.006375803612172604,
0.004834397695958614,
0.00007397360604954883,
-0.0020579269621521235,
0.023239202797412872,
0.05377345159649849,
0.011141120456159115,
-0.03566017746925354,
-0.04645242542028427,
-0.006421883124858141,
-0.022753583267331123,
0.011144434101879597,
-0.045198705047369,
0.03567156568169594,
-0.0535380095243454,
-0.04903525859117508,
-0.004864489659667015,
0.062490224838256836,
0.0283607579767704,
0.04449418932199478,
-0.03326229751110077,
0.003735384438186884,
-0.034844815731048584,
-0.03280537948012352,
-0.016610661521553993,
-0.06588071584701538,
-0.029523542150855064,
0.01233106479048729,
0.03176327422261238,
-0.0535334087908268,
0.004835924599319696,
-0.0044424692168831825,
0.02211585082113743,
0.01408904604613781,
-0.030007436871528625,
0.021837927401065826,
0.0031962033826857805,
0.03962383419275284,
-0.01951128989458084,
-0.015089084394276142,
0.07852949947118759,
-0.027063986286520958,
0.024786313995718956,
0.008436622098088264,
0.0032575943041592836,
-0.02028675004839897,
-0.01407247968018055,
-5.938489461810715e-33,
0.01711537502706051,
-0.031018318608403206,
0.02850526012480259,
-0.027176864445209503,
-0.02871011756360531,
0.043169181793928146,
-0.034451138228178024,
-0.04911822825670242,
-0.018336698412895203,
-0.0019524514209479094,
0.03089972957968712,
-0.013273729011416435,
0.003230458591133356,
0.020715003833174706,
0.004371583461761475,
0.0019891916308552027,
-0.01005373802036047,
-0.05274023115634918,
-0.010157013311982155,
-0.05055214837193489,
0.025886530056595802,
-0.007369885221123695,
-0.018330831080675125,
-0.055310897529125214,
-0.03923207148909569,
0.004043099470436573,
0.047415632754564285,
0.00975331012159586,
-0.024622168391942978,
0.019963638857007027,
-0.01642431505024433,
-0.055020738393068314,
-0.05150560662150383,
-0.014639761298894882,
0.016492648050189018,
-0.09444583207368851,
-0.032489318400621414,
0.025356940925121307,
0.028083045035600662,
-0.0015815846854820848,
-0.0034570726566016674,
0.0008738776668906212,
0.07257702201604843,
-0.024133777245879173,
0.06916538625955582,
0.02734559401869774,
0.009336537681519985,
-0.04376624524593353,
-0.04349688068032265,
-0.032764993607997894,
-0.02265380322933197,
-0.0077486285008490086,
0.016477931290864944,
0.002951157744973898,
-0.010809261351823807,
-0.09349734336137772,
0.0011437383946031332,
0.026528744027018547,
-0.016292618587613106,
0.01342063769698143,
0.008237587288022041,
0.0342458114027977,
0.004765343386679888,
-0.005009668413549662,
0.019518332555890083,
0.06536077708005905,
0.09479590505361557,
-0.0051168580539524555,
-0.08679991960525513,
-0.028771523386240005,
-0.05453616380691528,
0.05831613764166832,
0.0008872230537235737,
-0.08877464383840561,
0.053115762770175934,
0.003476967802271247,
-0.01350540854036808,
0.021670108661055565,
0.03736656531691551,
0.02876259572803974,
-0.018297020345926285,
-0.03071349672973156,
0.008729449473321438,
0.005929984617978334,
0.014028871431946754,
-0.04185185208916664,
-0.026152916252613068,
-0.018537865951657295,
-0.020281143486499786,
-0.023086972534656525,
0.04115363582968712,
0.004352980758994818,
-0.02392130345106125,
0.014256718568503857,
0.041105736047029495,
-0.05398781970143318,
0.05248934030532837,
-0.025380214676260948,
0.000906134198885411,
-0.011156085878610611,
0.07772677391767502,
0.004280573688447475,
0.03250269591808319,
-0.03697631508111954,
0.017115315422415733,
-0.027705786749720573,
-0.0226593054831028,
-0.028716083616018295,
-0.035044021904468536,
0.01783042773604393,
-0.021326476708054543,
-0.026597240939736366,
0.06228587403893471,
0.011993002146482468,
-0.011380651034414768,
0.004286592360585928,
-0.012148566544055939,
-0.03779085353016853,
0.018731702119112015,
0.035045325756073,
0.014367065392434597,
-0.01233572419732809,
-0.0502128005027771,
0.03186818212270737,
-0.044117674231529236,
-0.05498502030968666,
0.02981179766356945,
0.044848401099443436,
0.004919857252389193,
0.007383094169199467,
0.013570419512689114,
0.043970171362161636,
2.744486096162291e-7,
-0.028046326711773872,
0.0038941213861107826,
-0.006261309143155813,
-0.06263294816017151,
0.03469013050198555,
-0.015568647533655167,
-0.04230767488479614,
-0.008495298214256763,
-0.009491507895290852,
-0.015087271109223366,
0.024618659168481827,
0.05097203329205513,
-0.006128806155174971,
-0.012516473419964314,
-0.000300677987979725,
0.02097269520163536,
-0.07886054366827011,
0.007080964744091034,
0.0313510037958622,
0.018536614254117012,
0.02795594558119774,
0.007198559120297432,
-0.03555363416671753,
-0.05992048233747482,
0.04183170571923256,
0.02663128450512886,
-0.03147893399000168,
-0.0035444190725684166,
0.02270401641726494,
-0.04333903267979622,
-0.0049681877717375755,
0.012339962646365166,
0.0071633318439126015,
0.07228530198335648,
0.009932838380336761,
-0.06289593875408173,
-0.0008741415804252028,
-0.03708648309111595,
0.00947978813201189,
0.025405429303646088,
0.018147870898246765,
0.06570055335760117,
0.04198161140084267,
0.07983165234327316,
-0.06728538125753403,
0.008212842978537083,
-0.05427420511841774,
-0.010320272296667099,
0.01130056194961071,
0.007615536451339722,
-0.04044294357299805,
-0.0016813225811347365,
0.02785985916852951,
-0.023026442155241966,
-0.005275082308799028,
-0.023148292675614357,
0.005999390501528978,
-0.0035733075346797705,
0.03785049170255661,
0.04178310185670853,
-0.01660074293613434,
-0.035142190754413605,
0.007105369120836258,
0.015491149388253689,
-0.04505806788802147,
-0.023024747148156166,
-0.028729628771543503,
2.377556251505601e-34,
-0.022038046270608902,
-0.04301975667476654,
-0.038906410336494446,
-0.055501725524663925,
-0.051168445497751236,
-0.01508072018623352,
0.06564802676439285,
-0.015576950274407864,
-0.015120603144168854,
-0.021657481789588928,
-0.036405049264431
] | {
"ds_index": 13,
"similar_dg_indices": [
3911,
594964,
795992,
971134,
215853,
569704,
864149,
1040646,
668593,
148968,
673,
642397,
1201271,
28800,
877658,
907747,
784613,
1141747,
1167439,
336491
]
} |
A 62-year-old woman comes to the physician because of coughing and fatigue during the past 2 years. In the morning, the cough is productive of white phlegm. She becomes short of breath walking up a flight of stairs. She has hypertension and hyperlipidemia. She has recently retired from working as a nurse at a homeless shelter. She has smoked 1 pack of cigarettes daily for 40 years. Current medications include ramipril and fenofibrate. Her temperature is 36.5°C (97.7°F), respirations are 24/min, pulse is 85/min, and blood pressure is 140/90 mm Hg. Scattered wheezing and rhonchi are heard throughout both lung fields. There are no murmurs, rubs, or gallops but heart sounds are distant. Which of the following is the most likely underlying cause of this patient's symptoms? | Progressive obstruction of expiratory airflow | {
"A": "Chronic decrease in pulmonary compliance",
"B": "Local accumulation of kinins",
"C": "Progressive obstruction of expiratory airflow",
"D": "Incremental loss of functional residual capacity\n\""
} | step2&3 | C | [
"62 year old woman",
"physician",
"coughing",
"fatigue",
"past",
"years",
"morning",
"cough",
"productive",
"white phlegm",
"short of breath walking",
"flight",
"stairs",
"hypertension",
"hyperlipidemia",
"recently retired",
"working",
"nurse",
"homeless shelter",
"smoked 1 pack",
"cigarettes daily",
"40 years",
"Current medications include ramipril",
"fenofibrate",
"temperature",
"36",
"97",
"respirations",
"min",
"pulse",
"85 min",
"blood pressure",
"90 mm Hg",
"Scattered wheezing",
"rhonchi",
"heard",
"lung fields",
"murmurs",
"rubs",
"heart sounds",
"distant",
"following",
"most likely underlying cause",
"patient's symptoms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 62-year-old woman comes to the physician because of coughing and fatigue during the past 2 years. In the morning, the cough is productive of white phlegm. She becomes short of breath walking up a flight of stairs. She has hypertension and hyperlipidemia. She has recently retired from working as a nurse at a homeless shelter. She has smoked 1 pack of cigarettes daily for 40 years. Current medications include ramipril and fenofibrate. Her temperature is 36.5°C (97.7°F), respirations are 24/min, pulse is 85/min, and blood pressure is 140/90 mm Hg. Scattered wheezing and rhonchi are heard throughout both lung fields. There are no murmurs, rubs, or gallops but heart sounds are distant. Which of the following is the most likely underlying cause of this patient's symptoms?
Choose one of the following::
A. Chronic decrease in pulmonary compliance
B. Local accumulation of kinins
C. Progressive obstruction of expiratory airflow
D. Incremental loss of functional residual capacity
" | [
0.0023056473582983017,
0.025971848517656326,
0.040753960609436035,
0.0300306286662817,
0.04653748869895935,
-0.0033662377391010523,
-0.041949789971113205,
0.05771411955356598,
-0.010077951475977898,
-0.02840249054133892,
0.03969055414199829,
0.0318286307156086,
0.020460136234760284,
-0.06553374975919724,
0.005158108659088612,
-0.02858666330575943,
-0.0084501001983881,
0.001410697354003787,
0.019625909626483917,
-0.013425445184111595,
-0.05222873389720917,
0.010405617766082287,
0.024129051715135574,
0.02300592139363289,
0.045268137007951736,
-0.010121922008693218,
0.002901175059378147,
-0.03191114217042923,
0.014932677149772644,
0.0031360380817204714,
0.014334049075841904,
-0.032126180827617645,
-0.01643465831875801,
-0.026501549407839775,
0.000002036242449321435,
-0.024896198883652687,
-0.014458827674388885,
0.03393663465976715,
0.03530610352754593,
-0.08338464051485062,
0.02296706847846508,
-0.0003993553400505334,
0.028191620483994484,
-0.008630769327282906,
-0.06105908378958702,
-0.10746392607688904,
0.010640140622854233,
0.06648153066635132,
-0.008236808702349663,
-0.011336744762957096,
0.004204098600894213,
0.027075236663222313,
-0.07851647585630417,
-0.019416343420743942,
0.07153196632862091,
-0.041176389902830124,
0.0012396062957122922,
-0.040108274668455124,
0.007731238845735788,
-0.0015539011219516397,
0.006818318739533424,
-0.006077050697058439,
0.0006841986905783415,
0.044739980250597,
-0.02404564991593361,
0.011281867511570454,
0.03179406374692917,
-0.017183300107717514,
0.034370314329862595,
0.020779887214303017,
-0.045628517866134644,
0.026114849373698235,
0.047333013266325,
0.053623832762241364,
-0.05444534122943878,
-0.03430069610476494,
0.07040996849536896,
-0.04284379631280899,
-0.029832087457180023,
-0.009084056131541729,
0.09948858618736267,
0.03857927396893501,
0.00407800916582346,
0.0040955692529678345,
-0.029978720471262932,
-0.0713425949215889,
0.010824576951563358,
0.008072134107351303,
0.0008653515251353383,
-0.02756579965353012,
0.017845192924141884,
-0.12361729890108109,
-0.002157076494768262,
0.02596440538764,
-0.06415514647960663,
0.014610344544053078,
0.03603719547390938,
0.030400674790143967,
0.051161907613277435,
-0.03577258065342903,
-0.047468435019254684,
-0.044482532888650894,
0.034774452447891235,
0.028046607971191406,
-0.0410793200135231,
-0.03728846088051796,
-0.06582675874233246,
-0.024561086669564247,
-0.0633857324719429,
0.04225612059235573,
0.02041539177298546,
0.0012780679389834404,
-0.032538846135139465,
0.04270289093255997,
0.06992273777723312,
-0.036087002605199814,
-0.07659775018692017,
-0.09443440288305283,
0.0008996202959679067,
0.04021337255835533,
0.012656370177865028,
0.00693963747471571,
0.008580666035413742,
0.06621681898832321,
0.0024223600048571825,
0.032698776572942734,
-0.000919527024962008,
-0.006964372470974922,
-0.015064949169754982,
0.03106902353465557,
-0.005945697892457247,
0.021565329283475876,
-0.015387543477118015,
0.008626800030469894,
0.04047950729727745,
-0.022764218971133232,
-0.013051285408437252,
0.08200773596763611,
-0.011285875923931599,
-0.004645491484552622,
-0.01507151685655117,
-0.021398434415459633,
-0.01905517466366291,
-0.034820206463336945,
-0.025148015469312668,
0.015181678347289562,
0.03827358037233353,
0.041624702513217926,
0.014428135938942432,
0.04826764017343521,
-0.02271532267332077,
0.006382007151842117,
-0.03604929894208908,
0.007282877340912819,
0.0220217015594244,
0.041299689561128616,
-0.002554641803726554,
0.006472362671047449,
-0.012099682353436947,
-0.07740849256515503,
-0.004871342331171036,
-0.026025736704468727,
0.04071033000946045,
-0.027538878843188286,
0.020421359688043594,
0.00639227544888854,
0.07971756905317307,
0.04487014561891556,
-0.056381888687610626,
0.04466639831662178,
-0.017879297956824303,
0.05264052376151085,
0.0007021845085546374,
0.006532984785735607,
-0.022538738325238228,
0.07410974055528641,
0.01602317951619625,
-0.05790053680539131,
0.0056313336826860905,
-0.02436605654656887,
-0.0014858072390779853,
0.05070028826594353,
0.024292662739753723,
-0.053878992795944214,
0.025770338252186775,
-0.019047679379582405,
-0.00537077384069562,
-0.01562089379876852,
-0.004065170884132385,
-0.07717419415712357,
0.009107177145779133,
0.01573128253221512,
-0.05040064826607704,
0.012812892906367779,
-0.011036324314773083,
0.030030539259314537,
-0.043160438537597656,
-0.02215355634689331,
-0.009144285693764687,
-0.005831033922731876,
-0.06265665590763092,
-0.035840194672346115,
0.0018611637642607093,
0.03752058371901512,
-0.027174288406968117,
0.051227595657110214,
0.029656164348125458,
-0.02342788688838482,
0.00836124550551176,
-0.014241166412830353,
0.0047779688611626625,
-0.005639553535729647,
0.0577268972992897,
-0.03941289335489273,
-0.01156883966177702,
0.019852356985211372,
0.00216122274287045,
0.041492804884910583,
-0.05596515163779259,
-0.027490561828017235,
-0.012210411950945854,
-0.012615370564162731,
0.030504796653985977,
0.0017342395149171352,
-0.06180403009057045,
0.005970995407551527,
-0.03987567871809006,
0.0019349887734279037,
0.0073899817653000355,
-0.07991218566894531,
0.023507727310061455,
0.025951700285077095,
-0.041058558970689774,
0.005655947607010603,
-0.06823177635669708,
0.055261481553316116,
0.009293446317315102,
0.004832004196941853,
0.0068884133361279964,
0.033695947378873825,
0.003733920631930232,
-0.02759750746190548,
-0.028269736096262932,
-0.050276413559913635,
-0.045306477695703506,
-0.04426192492246628,
0.04227939993143082,
0.021860608831048012,
-0.06874851882457733,
0.05361557379364967,
-0.00006362386193359271,
-0.00821510050445795,
0.042647600173950195,
0.04747899994254112,
0.028208237141370773,
0.047282345592975616,
-0.040476445108652115,
0.013381004333496094,
-0.055063117295503616,
-0.07155292481184006,
-0.029142240062355995,
-0.01594473235309124,
-0.0036432365886867046,
-0.001885079313069582,
-0.048169247806072235,
-0.0024864254519343376,
-0.003330173436552286,
0.0005804204265587032,
-0.03671526908874512,
0.01831963285803795,
-0.022078966721892357,
-0.0073224022053182125,
0.037305429577827454,
0.0036398081574589014,
-0.03703968971967697,
-0.0008676487486809492,
-0.05797586590051651,
0.056766316294670105,
0.04059402272105217,
0.03748159483075142,
-0.015360064804553986,
0.034018248319625854,
0.010843213647603989,
0.030520901083946228,
-0.014266422018408775,
0.004763090051710606,
0.002892685355618596,
-0.0025508133694529533,
0.04135199636220932,
0.016458142548799515,
0.0008360320935025811,
0.006018768064677715,
0.037173714488744736,
-0.008290222845971584,
-0.015757616609334946,
-0.048691291362047195,
-0.011285139247775078,
0.04172811284661293,
-0.03018278256058693,
0.08490694314241409,
-0.020511722192168236,
0.02248699590563774,
-0.04135438799858093,
0.036496225744485855,
0.005458339117467403,
0.03456369414925575,
0.03294339030981064,
0.008926570415496826,
-0.04900966212153435,
0.03803686797618866,
0.0493941605091095,
0.007149809971451759,
-0.02208966389298439,
0.004068002570420504,
-0.03076416440308094,
-0.01587054319679737,
-0.02460549958050251,
-0.07436197996139526,
0.06728837639093399,
0.011345596052706242,
0.021039128303527832,
0.00009484137990511954,
-0.02263348177075386,
-0.048912931233644485,
-0.004851690959185362,
-0.010564346797764301,
0.0014786326792091131,
0.010403419844806194,
-0.028300844132900238,
-0.023937394842505455,
0.003658234840258956,
-0.0027672438882291317,
0.0009162770002149045,
0.027771558612585068,
-0.02683652751147747,
-0.00012134233838878572,
-0.037954509258270264,
0.03765251860022545,
-0.026168830692768097,
0.06697539240121841,
-0.001180359860882163,
-0.05848267674446106,
-0.015724655240774155,
-0.0013828544178977609,
0.011717934161424637,
-0.023327989503741264,
-0.06775166839361191,
-0.002460209419950843,
0.04975571483373642,
0.015878401696681976,
-0.06185494735836983,
0.024575969204306602,
0.03451298177242279,
-0.019309181720018387,
-0.050451748073101044,
-0.009563838131725788,
0.06056433171033859,
0.0179777592420578,
-0.007187086623162031,
-0.007190636359155178,
0.038805801421403885,
-0.00008095031080301851,
-0.00881894025951624,
0.04023793339729309,
0.01090636383742094,
-0.00039976357948035,
0.013051485642790794,
-0.010780935175716877,
-0.003489444963634014,
-0.027315622195601463,
0.048876479268074036,
-0.011190888471901417,
-0.04086325317621231,
0.04872947931289673,
-0.007735913619399071,
0.014307881705462933,
0.0036559852305799723,
-0.032829903066158295,
-0.03484867885708809,
-0.018288008868694305,
0.05767132714390755,
-0.03813474252820015,
0.02715066447854042,
0.004707138519734144,
0.012145554646849632,
0.0011846089037135243,
-0.0022504860535264015,
-0.027312295511364937,
-0.008776946924626827,
0.04299880564212799,
-0.008832278661429882,
0.05605819448828697,
0.07902248948812485,
-0.06480427086353302,
-0.022503405809402466,
0.009209221228957176,
-0.007331465370953083,
-0.07228847593069077,
0.036007340997457504,
0.06339333206415176,
0.025278758257627487,
-0.022081920877099037,
0.02358931675553322,
0.05021361634135246,
0.05089842900633812,
-0.0154619961977005,
-0.048283740878105164,
-0.008647160604596138,
0.025037549436092377,
0.0013535756152123213,
-0.027143577113747597,
-0.028111418709158897,
0.016600267961621284,
0.026174716651439667,
0.03113185428082943,
0.00014767331595066935,
-0.0035897959023714066,
-0.06716800481081009,
0.0382542759180069,
-0.07166658341884613,
0.06727834790945053,
-0.029896147549152374,
0.007753966376185417,
-0.040125951170921326,
-0.0351540669798851,
0.017549358308315277,
0.08389745652675629,
0.06833048164844513,
0.026389790698885918,
0.028412092477083206,
0.04222220554947853,
-0.06785903126001358,
0.05065973848104477,
0.06713124364614487,
-0.006524058990180492,
0.04572952538728714,
-0.0470302514731884,
0.02690727263689041,
0.027878984808921814,
-0.051581479609012604,
-0.0010007802629843354,
-0.018379971385002136,
0.06852179765701294,
0.01630525477230549,
0.028117956593632698,
-0.026555195450782776,
0.03253326565027237,
0.01765388995409012,
-0.01457449235022068,
0.09979970753192902,
0.04829137772321701,
-0.009433728642761707,
0.023645026609301567,
0.0339631512761116,
0.038562413305044174,
0.022534552961587906,
0.044368453323841095,
-0.10024790465831757,
0.050739891827106476,
-0.022448550909757614,
-0.00445695873349905,
0.023667575791478157,
0.02313079498708248,
-0.05980217084288597,
0.05660918354988098,
-0.03414583206176758,
-0.10125767439603806,
0.029884694144129753,
-0.000016489791960339062,
0.02418045699596405,
-0.014637639746069908,
0.013489068485796452,
0.00817363616079092,
-0.030559396371245384,
0.03317601606249809,
0.006231813691556454,
-0.026186395436525345,
-0.024731239303946495,
0.030660562217235565,
0.039221785962581635,
0.0030540614388883114,
-0.04300491511821747,
-0.03215950354933739,
-0.04654762148857117,
0.005080769769847393,
0.009354043751955032,
0.04478275403380394,
0.008379419334232807,
-0.013596081174910069,
0.028378130868077278,
-0.04535399377346039,
-0.020826686173677444,
-0.00111482385545969,
-0.011316911317408085,
-0.0379854254424572,
0.002046015812084079,
-0.00905577465891838,
0.07951629906892776,
-0.016723942011594772,
-0.009347766637802124,
0.04403914138674736,
-0.03660375997424126,
0.02528245933353901,
-0.013518395833671093,
-0.01496087945997715,
0.018356285989284515,
0.036611925810575485,
-0.0029800659976899624,
-0.030467478558421135,
-0.034818727523088455,
0.013758683577179909,
-0.013691756874322891,
0.004457828123122454,
-0.024751322343945503,
0.016556646674871445,
0.00003050672785320785,
0.008251520805060863,
-0.04171048104763031,
0.0020216822158545256,
0.01333016250282526,
-0.006578980013728142,
-0.016297530382871628,
-0.019284412264823914,
-0.01622830145061016,
0.023224592208862305,
0.04101124033331871,
0.014577720314264297,
-0.013738194480538368,
0.03763197362422943,
0.05586555600166321,
-0.06075451150536537,
0.0025624879635870457,
-0.03686913102865219,
-0.020742759108543396,
-0.01347342599183321,
-0.03367966040968895,
0.0011340451892465353,
0.023561010137200356,
-0.016457607969641685,
-0.05600586161017418,
0.01673159748315811,
-0.0029201547149568796,
0.03632953390479088,
-0.002473927568644285,
-0.03998659923672676,
-0.0004558247746899724,
-0.045482419431209564,
0.011303555220365524,
-0.00016349136421922594,
-0.0025209966115653515,
-0.021399464458227158,
0.052836015820503235,
-0.0058379885740578175,
0.07527201622724533,
0.03120502270758152,
-5.473577772640654e-33,
0.03209059312939644,
-0.05609838664531708,
0.038929034024477005,
-0.02944258227944374,
0.026566071435809135,
0.06781142950057983,
-0.012515823356807232,
-0.0480523556470871,
-0.09426048398017883,
0.011970536783337593,
-0.04202854633331299,
-0.001866005128249526,
0.029687194153666496,
0.030825218185782433,
-0.044385094195604324,
-0.05866200476884842,
0.0018448889022693038,
0.010956947691738605,
-0.013372634537518024,
-0.03873069956898689,
0.02580375410616398,
-0.017862988635897636,
-0.0293120164424181,
-0.03034154698252678,
-0.004992256406694651,
0.008867793716490269,
0.04933568462729454,
-0.0034903003834187984,
-0.02213677577674389,
0.025599846616387367,
0.0051187570206820965,
-0.0058924006298184395,
0.02281719632446766,
-0.024049391970038414,
-0.009239733219146729,
-0.008603052236139774,
-0.02963731251657009,
-0.042771171778440475,
0.048547256737947464,
-0.0005853488692082465,
-0.020735131576657295,
-0.02868146263062954,
0.03186209872364998,
0.046640556305646896,
0.09150976687669754,
-0.028681671246886253,
-0.010315051302313805,
-0.03510363772511482,
0.0525108277797699,
-0.0038400166667997837,
-0.024214832112193108,
0.04795016720890999,
0.018522661179304123,
0.005077879410237074,
-0.08096705377101898,
-0.0020237520802766085,
-0.01753988303244114,
0.028219982981681824,
0.007065221667289734,
-0.02220712974667549,
0.011067002080380917,
0.016545508056879044,
0.0044985366985201836,
0.01156622264534235,
-0.034909091889858246,
-0.001973651582375169,
0.04780188947916031,
0.010197285562753677,
-0.03153406083583832,
0.05490737780928612,
-0.1220676451921463,
0.023048149421811104,
-0.014917916618287563,
-0.07211878895759583,
-0.04257992282509804,
0.02193540334701538,
0.01736196130514145,
0.002615255070850253,
0.015416794456541538,
0.005578079726547003,
-0.013600205071270466,
0.0018024626187980175,
-0.006656972225755453,
-0.0346943624317646,
-0.019866440445184708,
0.04478539898991585,
0.0022867084480822086,
0.007536086719483137,
0.018565785139799118,
0.002172451000660658,
0.10699575394392014,
0.004858859349042177,
0.04038385674357414,
-0.01492083165794611,
0.004983884282410145,
-0.038926053792238235,
0.07707472890615463,
-0.011919679120182991,
0.01596405915915966,
0.03482567146420479,
0.1105131208896637,
0.014313316904008389,
0.045322973281145096,
0.035125307738780975,
-0.009639006108045578,
0.009093309752643108,
0.0005369652644731104,
-0.02340875379741192,
0.0035968925803899765,
0.01095915213227272,
0.014528455212712288,
-0.01101820357143879,
-0.02641279064118862,
0.04634786397218704,
0.011332670226693153,
0.030990272760391235,
-0.008764061145484447,
0.05573294311761856,
0.0211890060454607,
-0.004429308697581291,
0.029697557911276817,
0.03376137465238571,
-0.011288763955235481,
-0.01666375808417797,
-0.061449985951185226,
-0.02360243909060955,
0.025569824501872063,
0.049448154866695404,
0.007576633244752884,
-0.05098041519522667,
0.003219889011234045,
-0.0050176773220300674,
2.920125439231924e-7,
0.03854890912771225,
-0.06814257800579071,
0.047945261001586914,
-0.06363503634929657,
-0.008063387125730515,
-0.05335864797234535,
-0.020914366468787193,
0.024749236181378365,
-0.03651663288474083,
0.013178265653550625,
0.011623130179941654,
-0.01927560567855835,
0.01568642631173134,
0.0016796075506135821,
0.003579627489671111,
-0.029448753222823143,
-0.02549606002867222,
0.02410326898097992,
-0.012038052082061768,
-0.012851886451244354,
0.022502250969409943,
-0.00284397485665977,
-0.10549104958772659,
-0.041082073003053665,
0.02101372554898262,
0.0360603965818882,
-0.017442351207137108,
-0.06138254329562187,
-0.028102073818445206,
-0.0279818344861269,
0.011069471947848797,
-0.04730263352394104,
0.037098199129104614,
0.03106684982776642,
-0.014223640784621239,
0.014187582768499851,
0.046693529933691025,
0.05831277742981911,
-0.02750234864652157,
-0.011214719153940678,
-0.005023736972361803,
-0.01795671135187149,
0.008318671956658363,
0.020528273656964302,
0.02007495053112507,
0.03939663991332054,
-0.06947796791791916,
0.002304541878402233,
-0.021046379581093788,
0.006559282075613737,
0.0076558636501431465,
-0.0035395226441323757,
0.011272541247308254,
0.06597861647605896,
-0.017857031896710396,
0.06097111850976944,
-0.05731293931603432,
-0.004361928440630436,
-0.005521291401237249,
-0.06935667991638184,
0.00568869523704052,
-0.04263463616371155,
-0.009018299169838428,
-0.04523201286792755,
0.05880504846572876,
-0.04999347776174545,
-0.05820346251130104,
2.2583409205230664e-34,
-0.0531945526599884,
-0.021142421290278435,
-0.02949778363108635,
-0.07421695441007614,
0.014451571740210056,
-0.0870964527130127,
0.001081430003978312,
0.03806859999895096,
0.03731934353709221,
-0.05871613696217537,
-0.04360077902674675
] | {
"ds_index": 14,
"similar_dg_indices": [
350095,
607136,
1037803,
428227,
1030162,
873338,
1020281,
759584,
931589,
882567,
1044116,
1079248,
915290,
1052216,
883548,
885688,
373773,
888608,
508793,
356702
]
} |
A 68-year-old man presents to the emergency department with leg pain. He states that the pain started suddenly while he was walking outside. The patient has a past medical history of diabetes, hypertension, obesity, and atrial fibrillation. His temperature is 99.3°F (37.4°C), blood pressure is 152/98 mmHg, pulse is 97/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for a cold and pale left leg. The patient’s sensation is markedly diminished in the left leg when compared to the right, and his muscle strength is 1/5 in his left leg. Which of the following is the best next step in management? | Heparin drip | {
"A": "Graded exercise and aspirin",
"B": "Heparin drip",
"C": "Surgical thrombectomy",
"D": "Tissue plasminogen activator"
} | step2&3 | B | [
"68 year old man presents",
"emergency department",
"leg pain",
"states",
"pain started",
"walking outside",
"patient",
"past medical diabetes",
"hypertension",
"obesity",
"atrial fibrillation",
"temperature",
"99",
"4C",
"blood pressure",
"98 mmHg",
"pulse",
"97 min",
"respirations",
"min",
"oxygen saturation",
"99",
"room air",
"Physical exam",
"notable",
"cold",
"pale left leg",
"patients sensation",
"markedly diminished",
"left leg",
"compared",
"right",
"muscle strength",
"1/5",
"left leg",
"following",
"best next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 68-year-old man presents to the emergency department with leg pain. He states that the pain started suddenly while he was walking outside. The patient has a past medical history of diabetes, hypertension, obesity, and atrial fibrillation. His temperature is 99.3°F (37.4°C), blood pressure is 152/98 mmHg, pulse is 97/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for a cold and pale left leg. The patient’s sensation is markedly diminished in the left leg when compared to the right, and his muscle strength is 1/5 in his left leg. Which of the following is the best next step in management?
Choose one of the following::
A. Graded exercise and aspirin
B. Heparin drip
C. Surgical thrombectomy
D. Tissue plasminogen activator | [
0.019798997789621353,
-0.03995079547166824,
0.022476855665445328,
0.06668438017368317,
-0.017076414078474045,
0.003068147459998727,
-0.004548588301986456,
0.050346776843070984,
-0.008314541541039944,
-0.02931327372789383,
0.03416983783245087,
0.009942288510501385,
0.01862223446369171,
-0.05937374755740166,
0.03187977150082588,
-0.0026773882564157248,
0.005247853696346283,
-0.01782245561480522,
0.01547309197485447,
-0.013419490307569504,
-0.0413508303463459,
0.040632158517837524,
0.03098246455192566,
0.0180880818516016,
0.04671930521726608,
-0.013496470637619495,
0.04034749045968056,
-0.035008419305086136,
0.027874398976564407,
-0.0501127652823925,
-0.0631234347820282,
-0.024800900369882584,
0.010986095294356346,
-0.1100158765912056,
0.00000209851691579388,
-0.017867974936962128,
0.007967127487063408,
-0.005044678226113319,
0.05429966375231743,
-0.0673210471868515,
0.03679371625185013,
-0.09296678751707077,
0.05862948298454285,
0.00983648281544447,
-0.0380704440176487,
-0.09178813546895981,
0.03719591349363327,
0.08494514971971512,
-0.06936904788017273,
0.028272703289985657,
0.020563511177897453,
-0.010036568157374859,
-0.06105020269751549,
0.03940485045313835,
-0.007888889871537685,
-0.03899945318698883,
-0.0351375974714756,
-0.06317808479070663,
0.041355349123477936,
0.047101475298404694,
-0.013024745509028435,
-0.01664625108242035,
0.02727675251662731,
0.02637304738163948,
-0.035760484635829926,
0.05985105037689209,
0.034046340733766556,
-0.006246286444365978,
0.011226753704249859,
-0.0021569272503256798,
-0.041908297687768936,
0.037818193435668945,
0.06862381845712662,
0.0326053611934185,
-0.007751896046102047,
-0.011805824935436249,
0.08479198068380356,
-0.035760920494794846,
0.012947823852300644,
-0.018071891739964485,
0.03175859898328781,
0.02860112115740776,
-0.014923058450222015,
0.062065813690423965,
-0.04335605725646019,
-0.030407758429646492,
-0.011406046338379383,
0.027507003396749496,
0.027390997856855392,
-0.03541425243020058,
-0.012219320051372051,
-0.03693075478076935,
0.017845969647169113,
0.016393180936574936,
-0.05082841217517853,
-0.021131593734025955,
0.0015085163759067655,
0.020727217197418213,
0.02241653949022293,
-0.06069314107298851,
-0.026726722717285156,
0.0076136160641908646,
0.07036943733692169,
-0.009608818218111992,
-0.0024412614293396473,
-0.03634663298726082,
-0.046111371368169785,
0.03333081305027008,
-0.0845356211066246,
0.04972698166966438,
-0.01721728965640068,
0.0632275864481926,
-0.04016456753015518,
0.026346588507294655,
0.08073630183935165,
-0.025887252762913704,
-0.0384785495698452,
-0.08579804003238678,
0.03678353503346443,
0.013855451717972755,
-0.045691587030887604,
0.0018831189954653382,
0.05512496456503868,
0.011260689236223698,
0.00213412893936038,
0.01615280844271183,
-0.040078870952129364,
0.045648008584976196,
0.025720423087477684,
0.0358433797955513,
0.015516554936766624,
0.0060524591244757175,
-0.008243356831371784,
-0.004551622085273266,
0.020713264122605324,
-0.03837331756949425,
-0.0012786979787051678,
0.039148639887571335,
-0.01567555032670498,
0.004254341125488281,
-0.009457011707127094,
0.005110227502882481,
0.014620020985603333,
-0.01506537664681673,
0.01161705981940031,
0.008506527170538902,
0.0033762429375201464,
0.04149952158331871,
-0.03469371795654297,
0.02324090339243412,
-0.04800635576248169,
0.01161330658942461,
-0.02547050267457962,
0.024624831974506378,
-0.024717099964618683,
0.0020264743361622095,
0.04610800743103027,
0.0065580434165894985,
0.00502417329698801,
-0.03386634960770607,
0.007706290576606989,
-0.028799589723348618,
-0.008110771887004375,
-0.036535654217004776,
0.011174877174198627,
-0.005907597951591015,
-0.0011196851264685392,
0.09844190627336502,
-0.03757243603467941,
0.04648648202419281,
-0.043999843299388885,
0.03934419900178909,
0.003251628717407584,
0.011612028814852238,
-0.04832114279270172,
0.013628948479890823,
0.03515363112092018,
-0.02949100360274315,
0.010593576356768608,
-0.04389909654855728,
-0.026291638612747192,
0.015322629362344742,
0.0015852028736844659,
-0.054484572261571884,
0.008530314080417156,
0.012119478546082973,
-0.03473109006881714,
-0.0027116616256535053,
-0.05634033679962158,
-0.0031578647904098034,
-0.044237952679395676,
-0.017072126269340515,
-0.03172612562775612,
0.008608616888523102,
0.03724009171128273,
0.03196358308196068,
-0.009259224869310856,
0.013762742280960083,
-0.03737414628267288,
0.03971868380904198,
-0.037558961659669876,
0.0034917357843369246,
-0.09194022417068481,
0.03771200776100159,
-0.052300114184617996,
0.03713531047105789,
0.029366718605160713,
0.02413569577038288,
0.0558793842792511,
-0.022823920473456383,
-0.017043134197592735,
0.035764019936323166,
0.034668516367673874,
-0.056335438042879105,
0.03085809201002121,
0.0005238588782958686,
-0.0027746115811169147,
-0.0030387884471565485,
-0.0798933133482933,
0.035164546221494675,
-0.019016699865460396,
-0.05083596706390381,
0.027149178087711334,
-0.0003331673506181687,
-0.06948290020227432,
0.016245614737272263,
0.020174335688352585,
-0.00398113252595067,
-0.02248331718146801,
-0.07498127222061157,
0.028913192451000214,
0.026402590796351433,
-0.03487925976514816,
-0.04124731570482254,
-0.07599873095750809,
0.0634210854768753,
0.012676051817834377,
-0.03538735583424568,
0.011986041441559792,
0.017870403826236725,
-0.013113291934132576,
-0.05323996767401695,
-0.04575633630156517,
-0.05271104723215103,
-0.022894015535712242,
-0.0475110188126564,
0.010068271309137344,
0.026188209652900696,
-0.07443124055862427,
0.060971397906541824,
-0.05937047302722931,
0.031114578247070312,
0.024709289893507957,
0.028822455555200577,
-0.0037432494573295116,
0.03530307486653328,
0.05729613080620766,
0.023253416642546654,
-0.02386157028377056,
-0.020252957940101624,
0.02315685525536537,
-0.023570619523525238,
-0.028698517009615898,
-0.023487575352191925,
-0.009222823195159435,
-0.0005217186990194023,
-0.011169984936714172,
0.02365874871611595,
0.005202015861868858,
0.022084517404437065,
0.015293868258595467,
-0.019167998805642128,
0.04372703284025192,
0.003791292430832982,
-0.038109347224235535,
-0.0224986020475626,
-0.017281370237469673,
0.053618423640728,
0.009386046789586544,
-0.0019422067562118173,
0.040905967354774475,
0.07266827672719955,
0.025216802954673767,
0.04124893620610237,
0.008307578042149544,
-0.003368607722222805,
-0.002353088464587927,
0.01047809049487114,
0.03467312455177307,
0.0063105057924985886,
-0.032817400991916656,
0.022915316745638847,
0.025577446445822716,
-0.03816479817032814,
-0.040944889187812805,
-0.04333055764436722,
-0.06790010631084442,
-0.04757044464349747,
0.0025014106649905443,
0.025406286120414734,
0.06734351068735123,
0.027044184505939484,
0.020341645926237106,
0.01854429952800274,
-0.009596421383321285,
0.04133324697613716,
0.05434047803282738,
-0.0005892703775316477,
0.019210027530789375,
0.010446209460496902,
0.03355874866247177,
-0.019100766628980637,
-0.012697344645857811,
-0.03901016712188721,
-0.017458545044064522,
-0.018973201513290405,
0.01844235509634018,
-0.03500612825155258,
0.027939943596720695,
0.006719217635691166,
0.022559283301234245,
0.037322837859392166,
0.015405061654746532,
0.00850110873579979,
0.00016886458615772426,
-0.021441778168082237,
0.03686616197228432,
-0.03315509110689163,
-0.01789379119873047,
-0.007877257652580738,
0.028796324506402016,
-0.06661548465490341,
-0.004365758970379829,
0.0697450116276741,
0.009449763223528862,
0.022817179560661316,
-0.00022084971715230495,
-0.004593820311129093,
0.017159676179289818,
0.08825477957725525,
0.011581574566662312,
-0.05551036074757576,
-0.005936048924922943,
-0.008008579723536968,
0.018441399559378624,
0.025166738778352737,
-0.07575387507677078,
0.03882145136594772,
0.019019555300474167,
-0.03140544146299362,
-0.06492607295513153,
0.06664176285266876,
0.017959704622626305,
0.0311578419059515,
-0.022602416574954987,
-0.041873250156641006,
-0.007060565520077944,
0.08354360610246658,
0.020121216773986816,
0.06150427088141441,
0.06315361708402634,
0.03563500940799713,
0.034784190356731415,
-0.03950740396976471,
-0.007584013510495424,
-0.011378353461623192,
-0.013839374296367168,
-0.03262293338775635,
-0.015995513647794724,
0.013404859229922295,
-0.0015923113096505404,
0.024892708286643028,
-0.06970110535621643,
0.09232315421104431,
0.016787000000476837,
-0.029614081606268883,
0.025897419080138206,
-0.04676881805062294,
-0.057945333421230316,
-0.015496118925511837,
0.013016559183597565,
-0.051813382655382156,
0.013144046999514103,
-0.009963891468942165,
0.010362060740590096,
0.02974623814225197,
0.028151340782642365,
-0.01388776395469904,
0.05602638050913811,
0.012345547787845135,
-0.021735774353146553,
0.002738211303949356,
-0.011644684709608555,
-0.02643817476928234,
0.013713685795664787,
0.08433684706687927,
-0.0005991554935462773,
-0.04701642319560051,
-0.040330663323402405,
0.05839059501886368,
-0.01624802127480507,
-0.023563306778669357,
-0.019031668081879616,
-0.0036385399289429188,
0.06229417026042938,
-0.015862293541431427,
0.012643063440918922,
-0.011118688620626926,
0.015029140748083591,
0.017139693722128868,
0.040391989052295685,
-0.06498286873102188,
0.027845464646816254,
-0.05797898396849632,
0.0481916107237339,
-0.011305584572255611,
0.046288590878248215,
-0.034186940640211105,
-0.01407117024064064,
-0.06523509323596954,
0.046133916825056076,
-0.0070462399162352085,
-0.006491972133517265,
-0.059900663793087006,
0.01991843804717064,
0.00378350168466568,
0.07290089130401611,
0.08544760942459106,
-0.02533745765686035,
0.012200587429106236,
0.06399611383676529,
-0.04659337177872658,
0.034249305725097656,
0.04650549590587616,
0.008479222655296326,
0.009904377162456512,
-0.03684417903423309,
-0.04500381648540497,
0.04036030173301697,
-0.015878507867455482,
-0.05037253722548485,
0.01956753432750702,
0.03331966698169708,
0.008479202166199684,
0.02666935883462429,
-0.02057543583214283,
0.035662755370140076,
0.03835104778409004,
-0.0009199558407999575,
0.08480823040008545,
0.034337714314460754,
0.015659619122743607,
0.04184676706790924,
0.01450068037956953,
0.050407350063323975,
-0.02179473452270031,
-0.01858428679406643,
0.019788477569818497,
0.03163271024823189,
-0.02757062017917633,
-0.07257068157196045,
0.003318152390420437,
-0.017276782542467117,
-0.07237423956394196,
0.012988581322133541,
-0.09356676787137985,
-0.016597742214798927,
0.002335422672331333,
0.008681896142661572,
0.025998670607805252,
-0.013254034332931042,
0.031572502106428146,
0.02133270539343357,
-0.0029015603940933943,
0.07546829432249069,
0.00937704462558031,
-0.03761967271566391,
0.013367443345487118,
-0.038010742515325546,
0.028455613180994987,
0.02331889234483242,
0.0031276377849280834,
-0.04537331312894821,
-0.0486566387116909,
-0.0022046605590730906,
-0.027039961889386177,
0.03792443498969078,
-0.004390633199363947,
-0.0323321707546711,
0.03829020634293556,
-0.0216273982077837,
-0.016409030184149742,
0.021243790164589882,
0.00013699254486709833,
-0.05663524568080902,
-0.03206370770931244,
-0.05191629007458687,
0.0773552805185318,
0.010348120704293251,
-0.025193242356181145,
0.008348743431270123,
0.033464521169662476,
0.017698973417282104,
0.015544750727713108,
0.012784441001713276,
-0.006310229655355215,
-0.00835370272397995,
0.01523325964808464,
-0.016245560720562935,
-0.03204389289021492,
-0.045437201857566833,
-0.007145908195525408,
-0.013471642509102821,
-0.004259041510522366,
0.06106431037187576,
0.02670842409133911,
-0.018170956522226334,
-0.04524720087647438,
-0.007868554443120956,
0.004968034103512764,
-0.01410217396914959,
-0.02469003200531006,
0.013149553909897804,
0.003559307660907507,
-0.001201965962536633,
0.021235700696706772,
-0.017367713153362274,
0.0012492231326177716,
0.029405130073428154,
0.026571571826934814,
-0.07124274224042892,
-0.024470342323184013,
-0.029598917812108994,
-0.027647914364933968,
0.007368955295532942,
0.008614900521934032,
-0.025732651352882385,
-0.03083880804479122,
0.006454633083194494,
-0.04959456995129585,
-0.004656905308365822,
0.026162458583712578,
-0.03966757282614708,
-0.03301675617694855,
-0.07530361413955688,
0.025381384417414665,
0.03183615952730179,
-0.027155352756381035,
0.04101027920842171,
-0.026506967842578888,
-0.0029426345136016607,
0.11196094006299973,
0.032636187970638275,
-0.013707398436963558,
0.01912139356136322,
-5.303687982220124e-33,
0.05018579959869385,
0.005707050208002329,
-0.02318953536450863,
-0.10396923869848251,
0.012326737865805626,
0.10118524730205536,
-0.013149386271834373,
-0.008255606517195702,
-0.09107359498739243,
0.033002179116010666,
-0.00332878646440804,
-0.002253127284348011,
0.03097730316221714,
0.029273344203829765,
-0.00421472592279315,
-0.0698888897895813,
0.006511715240776539,
0.017641296610236168,
-0.0029353455174714327,
-0.002168642822653055,
-0.035264670848846436,
-0.009040568955242634,
0.002395941410213709,
-0.03658003360033035,
0.026479879394173622,
-0.003581640310585499,
0.0195026658475399,
0.020730702206492424,
-0.018633287400007248,
0.0019592363387346268,
0.02361011505126953,
-0.04256550967693329,
0.04344236105680466,
-0.03716600686311722,
-0.03223671391606331,
-0.02649044804275036,
0.021012263372540474,
-0.02868175134062767,
0.025739794597029686,
-0.013273876160383224,
-0.014278427697718143,
-0.061546675860881805,
0.0197763592004776,
-0.010651414282619953,
0.014763189479708672,
-0.03718520700931549,
-0.05608990043401718,
-0.007213389966636896,
0.06636226922273636,
-0.040919337421655655,
0.01671273447573185,
0.014271505177021027,
-0.008192918263375759,
-0.01786649413406849,
-0.022988639771938324,
0.009000626392662525,
0.0018418007530272007,
0.051965873688459396,
-0.005298389587551355,
-0.050086937844753265,
-0.015485727228224277,
-0.013319076038897038,
-0.020138664171099663,
-0.015414610505104065,
-0.04840569943189621,
0.014625833369791508,
-0.03735853359103203,
0.009209327399730682,
-0.05999515950679779,
-0.006197074428200722,
-0.08093392103910446,
0.057839300483465195,
-0.0031387608032673597,
-0.031517572700977325,
-0.02877228893339634,
-0.016011830419301987,
-0.002736355410888791,
0.04120250418782234,
0.04526839777827263,
0.00005504119326360524,
-0.039803288877010345,
0.015752343460917473,
-0.036447688937187195,
-0.021748270839452744,
0.030359795317053795,
0.011434457264840603,
0.0004520562360994518,
-0.034483883529901505,
0.008842465467751026,
-0.02928789146244526,
0.05518679693341255,
-0.01676558144390583,
0.06689352542161942,
0.014798874966800213,
0.020302752032876015,
-0.025266213342547417,
0.005339952651411295,
0.0805947408080101,
0.010622437112033367,
0.048947956413030624,
0.012500394135713577,
-0.01260776724666357,
0.001466075424104929,
0.0014646019553765655,
-0.04311465099453926,
0.014412228018045425,
0.008613917045295238,
-0.007340256590396166,
0.008484636433422565,
0.04466661065816879,
0.012598948553204536,
-0.060643188655376434,
-0.005203210283070803,
0.035434290766716,
0.02118147350847721,
0.02507304772734642,
0.027600331231951714,
0.08015449345111847,
0.01736261323094368,
-0.01235920749604702,
-0.03965459391474724,
0.018132979050278664,
-0.014659580774605274,
-0.0034881362225860357,
-0.04377841204404831,
-0.03540349379181862,
0.03155212104320526,
0.011297259479761124,
-0.05974475294351578,
-0.01745721884071827,
0.00261511723510921,
-0.021061213687062263,
2.674068753094616e-7,
0.05334603413939476,
-0.04996923729777336,
-0.01870419643819332,
-0.09623748809099197,
0.005759928375482559,
-0.019947046414017677,
0.009906318970024586,
0.009294250048696995,
0.005185649264603853,
-0.027033532038331032,
0.04819130897521973,
-0.0056292107328772545,
-0.03594386950135231,
0.00044222918222658336,
0.03123319521546364,
0.00842235516756773,
-0.014212505891919136,
0.003950318321585655,
0.024776345118880272,
-0.035627394914627075,
-0.03766977787017822,
-0.0415860153734684,
-0.07618558406829834,
0.006941886153072119,
-0.03369225189089775,
-0.0007080913055688143,
0.022760003805160522,
-0.07206132262945175,
-0.03682137280702591,
-0.05748884379863739,
0.036465249955654144,
-0.005626157857477665,
0.03414561226963997,
-0.004077107645571232,
0.005788418464362621,
0.00427656015381217,
-0.01796240173280239,
0.06697189807891846,
-0.05847594514489174,
0.0017236312851309776,
-0.0077583338133990765,
0.007209240458905697,
0.013364575803279877,
-0.014655760489404202,
0.06116166338324547,
0.022876577451825142,
-0.07082058489322662,
-0.011446117423474789,
0.06359543651342392,
0.023930884897708893,
0.016759494319558144,
0.03795570135116577,
0.016795918345451355,
0.05650849640369415,
0.019921457394957542,
0.028318991884589195,
-0.07537467777729034,
0.004332088399678469,
0.033523060381412506,
0.0033269731793552637,
0.0094158248975873,
-0.005548867397010326,
0.030799560248851776,
0.035784460604190826,
0.06210855394601822,
-0.047172121703624725,
-0.05203525349497795,
1.9858569678163926e-34,
-0.014100881293416023,
0.003607764607295394,
0.00206566764973104,
-0.008558460511267185,
-0.05104151740670204,
-0.03246108815073967,
-0.022339576855301857,
0.0053641535341739655,
0.03253059461712837,
-0.0721474215388298,
-0.02757711336016655
] | {
"ds_index": 15,
"similar_dg_indices": [
49244,
530873,
1071666,
471098,
760998,
187953,
401056,
999637,
559153,
205473,
432952,
422377,
783675,
750932,
923981,
799341,
362936,
589107,
123928,
625649
]
} |
A 76-year-old African American man presents to his primary care provider complaining of urinary frequency. He wakes up 3-4 times per night to urinate while he previously only had to wake up once per night. He also complains of post-void dribbling and difficulty initiating a stream of urine. He denies any difficulty maintaining an erection. His past medical history is notable for non-alcoholic fatty liver disease, hypertension, hyperlipidemia, and gout. He takes aspirin, atorvastatin, enalapril, and allopurinol. His family history is notable for prostate cancer in his father and lung cancer in his mother. He has a 15-pack-year smoking history and drinks alcohol socially. On digital rectal exam, his prostate is enlarged, smooth, and non-tender. Which of the following medications is indicated in this patient? | Tamsulosin | {
"A": "Hydrochlorothiazide",
"B": "Midodrine",
"C": "Oxybutynin",
"D": "Tamsulosin"
} | step1 | D | [
"76 year old African American man presents",
"primary care provider",
"urinary frequency",
"wakes up",
"times",
"night to",
"only",
"to wake up",
"night",
"post-void dribbling",
"difficulty initiating",
"stream of urine",
"denies",
"difficulty maintaining",
"erection",
"past medical history",
"notable",
"non-alcoholic fatty liver disease",
"hypertension",
"hyperlipidemia",
"gout",
"takes aspirin",
"atorvastatin",
"enalapril",
"allopurinol",
"family history",
"notable",
"prostate cancer",
"father",
"lung cancer",
"mother",
"pack-year smoking history",
"drinks alcohol",
"digital rectal exam",
"prostate",
"enlarged",
"smooth",
"non-tender",
"following medications",
"indicated",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 76-year-old African American man presents to his primary care provider complaining of urinary frequency. He wakes up 3-4 times per night to urinate while he previously only had to wake up once per night. He also complains of post-void dribbling and difficulty initiating a stream of urine. He denies any difficulty maintaining an erection. His past medical history is notable for non-alcoholic fatty liver disease, hypertension, hyperlipidemia, and gout. He takes aspirin, atorvastatin, enalapril, and allopurinol. His family history is notable for prostate cancer in his father and lung cancer in his mother. He has a 15-pack-year smoking history and drinks alcohol socially. On digital rectal exam, his prostate is enlarged, smooth, and non-tender. Which of the following medications is indicated in this patient?
Choose one of the following::
A. Hydrochlorothiazide
B. Midodrine
C. Oxybutynin
D. Tamsulosin | [
0.04270806536078453,
0.05798357352614403,
-0.0016108567360788584,
0.0034905318170785904,
0.006524860393255949,
0.0424463227391243,
0.026008980348706245,
0.011480608023703098,
-0.0012674988247454166,
-0.025556014850735664,
0.08851081132888794,
-0.0635509043931961,
-0.023604044690728188,
0.001742297550663352,
0.011626417748630047,
0.07277332246303558,
-0.029781555756926537,
0.04935905709862709,
0.005342502146959305,
-0.03150211647152901,
-0.04246402904391289,
-0.0402754582464695,
-0.0211822260171175,
-0.014571364037692547,
0.027150485664606094,
0.0089922109618783,
0.0269865021109581,
-0.0010040111374109983,
-0.0416930690407753,
-0.030837755650281906,
0.021293535828590393,
0.05312538146972656,
-0.03293526545166969,
-0.054005011916160583,
0.0000018000110912907985,
-0.07581249624490738,
0.017967382445931435,
0.006565239280462265,
0.07417511940002441,
-0.06416696310043335,
-0.006771002430468798,
-0.03726157918572426,
0.07555155456066132,
0.008399803191423416,
0.0030889753252267838,
-0.044470928609371185,
0.027838874608278275,
0.059827566146850586,
-0.022777672857046127,
0.0195463877171278,
0.017475683242082596,
0.04222840815782547,
-0.028117842972278595,
-0.0009509277297183871,
0.027258891612291336,
-0.014860549010336399,
0.0029016342014074326,
-0.035523753613233566,
-0.005500477273017168,
0.03286808356642723,
0.02075015939772129,
-0.06348086148500443,
-0.03781004995107651,
0.04770953208208084,
0.020060734823346138,
-0.028427816927433014,
0.034127186983823776,
-0.05373024567961693,
0.007072885986417532,
-0.0019827261567115784,
0.022881949320435524,
0.06366770714521408,
0.06131024658679962,
0.05986901372671127,
-0.03641621023416519,
-0.00526807364076376,
0.01750032790005207,
-0.022418474778532982,
-0.023295825347304344,
-0.025073282420635223,
0.023969510570168495,
0.03701488673686981,
-0.017784349620342255,
0.023628266528248787,
-0.0007202691049315035,
-0.020185226574540138,
0.029998235404491425,
0.028447430580854416,
0.014230312779545784,
-0.021471591666340828,
0.0517570897936821,
-0.08412918448448181,
0.0656907707452774,
-0.008261050097644329,
-0.030271638184785843,
-0.005021996796131134,
0.021051425486803055,
0.0228437352925539,
0.07146191596984863,
-0.017002668231725693,
-0.0014370291028171778,
0.003673719009384513,
0.019495002925395966,
0.012128425762057304,
-0.06972865015268326,
0.08396369218826294,
0.00397392688319087,
-0.025902915745973587,
-0.035843051970005035,
0.06036566197872162,
0.016123801469802856,
0.04415342956781387,
-0.005224577151238918,
0.012603368610143661,
0.08135177195072174,
-0.05102381482720375,
-0.07036367803812027,
0.003608561120927334,
0.029978850856423378,
0.030632512643933296,
0.01031882967799902,
0.011589480563998222,
-0.0009980538161471486,
0.00006542825576616451,
0.055904049426317215,
0.05960774049162865,
-0.03633054345846176,
0.016350237652659416,
0.020284997299313545,
-0.024466848000884056,
0.024975258857011795,
-0.04016672447323799,
-0.028944697231054306,
0.004356886725872755,
-0.03368838503956795,
-0.016256816685199738,
0.026904642581939697,
0.027450881898403168,
-0.027500398457050323,
-0.0037369912024587393,
-0.02007809840142727,
-0.017952319234609604,
-0.010325141251087189,
-0.006950873415917158,
0.023111918941140175,
-0.02709588222205639,
-0.014951324090361595,
0.002595605095848441,
0.020609375089406967,
0.013460712507367134,
0.006743213161826134,
0.028293773531913757,
0.022813767194747925,
0.0108305923640728,
0.003947922494262457,
-0.01754998043179512,
0.012459896504878998,
-0.019494831562042236,
-0.032711587846279144,
-0.00434885872527957,
-0.02476257085800171,
-0.018254704773426056,
-0.018667588010430336,
-0.0441124252974987,
0.00002164267425541766,
0.014582629315555096,
0.09646294265985489,
0.08858897536993027,
0.00009571231930749491,
0.04864807426929474,
-0.040874797850847244,
0.009617135860025883,
0.0014443157706409693,
-0.04897301271557808,
-0.03939560055732727,
-0.0020487464498728514,
0.022785194218158722,
0.017501283437013626,
-0.021172959357500076,
-0.03108212724328041,
-0.02513585425913334,
0.002440331969410181,
0.022807223722338676,
-0.05662604048848152,
-0.022758956998586655,
0.025729192420840263,
0.026660816743969917,
-0.02833029069006443,
-0.011799308471381664,
-0.0578077994287014,
0.023160742595791817,
-0.003011608263477683,
-0.07265246659517288,
-0.010317145846784115,
0.015186256729066372,
0.045596711337566376,
-0.024982837960124016,
-0.007830019108951092,
0.022178074344992638,
0.025537585839629173,
-0.05682504177093506,
-0.042424872517585754,
0.006578759290277958,
0.04948015883564949,
-0.056658726185560226,
0.021964842453598976,
-0.01146085374057293,
0.025140883401036263,
0.03638201579451561,
0.003201242769137025,
-0.09708849340677261,
0.030234796926379204,
0.022957971319556236,
-0.05724197253584862,
0.017577961087226868,
0.04785392805933952,
0.012313363142311573,
0.04786922037601471,
-0.014989519491791725,
0.01658792793750763,
-0.012083983048796654,
-0.03787143900990486,
-0.013202589005231857,
-0.005579987540841103,
-0.026745237410068512,
-0.018852313980460167,
0.0009387504542246461,
-0.012984342873096466,
0.01021606381982565,
-0.06725096702575684,
0.03644728660583496,
0.022712798789143562,
-0.08239533752202988,
0.014890526421368122,
0.002236167201772332,
-0.006767474580556154,
0.03510487824678421,
0.02069108746945858,
0.020199652761220932,
0.04787791892886162,
0.02032296173274517,
0.024474626407027245,
-0.05710679665207863,
-0.03053838387131691,
0.0016338879941031337,
-0.012313693761825562,
-0.002272666897624731,
0.020024558529257774,
-0.02191430702805519,
0.061140190809965134,
0.013289750553667545,
0.0009891546797007322,
-0.0036938576959073544,
0.0052059548906981945,
0.016169659793376923,
0.09499263018369675,
-0.049062009900808334,
0.03035850264132023,
0.009050005115568638,
-0.057681724429130554,
0.013097020797431469,
-0.03810763731598854,
-0.015266895294189453,
0.006060925778001547,
-0.01745796576142311,
-0.032522112131118774,
0.008732670918107033,
0.04430839419364929,
-0.017834005877375603,
0.032599061727523804,
-0.023795105516910553,
-0.0033580034505575895,
0.03150952607393265,
0.0024050353094935417,
-0.04038456454873085,
-0.01486350130289793,
-0.07033946365118027,
0.03669232502579689,
0.0610286109149456,
-0.021234866231679916,
0.04191490262746811,
0.029413430020213127,
0.026758059859275818,
0.012812924571335316,
0.0327579602599144,
-0.026543570682406425,
-0.02056371234357357,
0.0012019001878798008,
0.04566468670964241,
0.05542287975549698,
0.009374642744660378,
-0.037448544055223465,
0.01605902425944805,
-0.03514740616083145,
0.020128782838582993,
-0.006906484719365835,
-0.04162547364830971,
0.012294789776206017,
-0.027564529329538345,
0.026149015873670578,
0.005540451966226101,
0.013204669579863548,
0.008572163991630077,
-0.03589119017124176,
-0.007355344481766224,
-0.011545771732926369,
0.05278487130999565,
-0.04308133199810982,
0.00902444589883089,
0.003169582923874259,
0.010564749129116535,
-0.007782491855323315,
0.0022946768440306187,
-0.03382718190550804,
-0.01366222370415926,
-0.08120130747556686,
-0.021661872044205666,
-0.03096829354763031,
0.05986519902944565,
-0.022573145106434822,
0.002816066611558199,
0.005806757137179375,
0.01028058398514986,
-0.005477881524711847,
-0.012176334857940674,
-0.011272883042693138,
0.028375670313835144,
0.029569093137979507,
-0.04458713158965111,
0.01033999677747488,
-0.012481472454965115,
-0.01891830936074257,
-0.034420594573020935,
0.031058339402079582,
0.006567039526998997,
-0.014734978787600994,
-0.04544663429260254,
0.036782413721084595,
-0.05236508697271347,
0.06196901947259903,
0.032385267317295074,
-0.046745941042900085,
-0.011474254541099072,
-0.020876146852970123,
0.04759988933801651,
-0.03795879706740379,
-0.06064186990261078,
-0.01822749711573124,
0.006181637290865183,
-0.012764755636453629,
-0.06946317106485367,
0.03061257116496563,
0.003615917405113578,
-0.026808319613337517,
-0.008800821378827095,
-0.02442636340856552,
0.04699915274977684,
0.05570217967033386,
-0.019962314516305923,
0.05143635720014572,
-0.022592054679989815,
0.010929497890174389,
0.0060194856487214565,
-0.006851171609014273,
-0.008123436942696571,
0.03252994269132614,
0.01687183976173401,
-0.025060618296265602,
-0.015135814435780048,
-0.02034652978181839,
0.010980198159813881,
0.00534514244645834,
-0.012312788516283035,
0.078242726624012,
0.0056341844610869884,
0.004862480331212282,
0.024830950424075127,
-0.046713460236787796,
-0.07339499145746231,
-0.05770207941532135,
0.03297426179051399,
-0.08474147319793701,
0.022459251806139946,
-0.04857023060321808,
-0.05268697440624237,
0.03319958969950676,
-0.019657162949442863,
-0.07955198734998703,
0.042788513004779816,
-0.008410926908254623,
-0.018440840765833855,
0.025097988545894623,
-0.02623211406171322,
-0.04155929759144783,
-0.029093561694025993,
0.025339672341942787,
-0.05411548167467117,
-0.03522298112511635,
0.03672656789422035,
0.07654982805252075,
0.016722826287150383,
-0.029236478731036186,
-0.053489938378334045,
0.06240334361791611,
0.04947301372885704,
-0.04285481199622154,
-0.06086840480566025,
-0.0034081535413861275,
0.044316258281469345,
0.036005426198244095,
-0.006571907550096512,
-0.056025050580501556,
-0.00008093832002487034,
0.02158268913626671,
-0.002390861976891756,
-0.008725518360733986,
-0.0072929346933960915,
-0.10763063281774521,
0.0427946038544178,
-0.08682529628276825,
0.08413586765527725,
-0.03196178004145622,
-0.07432079315185547,
-0.02958988957107067,
0.026727592572569847,
-0.026204882189631462,
0.0661819577217102,
0.015383468009531498,
-0.015183612704277039,
0.005512091796845198,
0.020736733451485634,
0.00013512892473954707,
0.030070923268795013,
0.07403124123811722,
-0.029136890545487404,
0.05840597674250603,
-0.020379021763801575,
0.047425154596567154,
-0.004151050932705402,
-0.0381230004131794,
-0.04083099588751793,
0.03545743599534035,
0.0014347834512591362,
0.0032876641489565372,
0.029602406546473503,
-0.05624886602163315,
0.028493870049715042,
0.07355047762393951,
0.0009695787448436022,
0.06080561876296997,
-0.02304394170641899,
0.040027569979429245,
-0.04094719514250755,
0.013752615079283714,
-0.007006358355283737,
0.014591931365430355,
0.026682214811444283,
-0.004427298903465271,
0.04290120676159859,
-0.0010594476480036974,
-0.015879295766353607,
0.016899850219488144,
-0.028224032372236252,
-0.011929561384022236,
0.030153417959809303,
-0.022641073912382126,
-0.03238232061266899,
0.08156399428844452,
-0.03334633633494377,
0.01793176680803299,
0.04405127465724945,
0.027286209166049957,
0.015107577666640282,
-0.0311242938041687,
0.016976261511445045,
-0.03551950305700302,
-0.04380922019481659,
-0.04828629642724991,
0.0032930055167526007,
0.049050137400627136,
-0.027307862415909767,
-0.05249204486608505,
-0.05052737146615982,
-0.05907365679740906,
-0.018839465454220772,
0.02566191554069519,
-0.03058496117591858,
0.04608898609876633,
-0.01988908089697361,
0.04386131837964058,
-0.034443389624357224,
-0.01382326241582632,
-0.019462749361991882,
-0.05308641493320465,
-0.04624156653881073,
-0.04146769642829895,
-0.03980814665555954,
-0.020541124045848846,
0.0398663692176342,
-0.055134594440460205,
0.05833704024553299,
0.025811169296503067,
0.013679307885468006,
0.020464807748794556,
0.00813591480255127,
0.015022742561995983,
-0.021225683391094208,
0.03825561702251434,
-0.011175992898643017,
-0.03645993396639824,
-0.022956503555178642,
-0.00797272939234972,
-0.02492578513920307,
0.0035478530917316675,
0.06883151084184647,
-0.03545408323407173,
0.008101138286292553,
-0.05125664174556732,
-0.012951902113854885,
-0.030259987339377403,
0.00994441844522953,
-0.021853694692254066,
0.001189709291793406,
0.05585211142897606,
0.006050323601812124,
0.0273861363530159,
-0.0023553550709038973,
0.011324096471071243,
-0.02564062550663948,
0.07762493938207626,
-0.030880508944392204,
-0.04629833623766899,
-0.0421082004904747,
-0.0047049797140061855,
-0.028488047420978546,
-0.019800880923867226,
-0.040454793721437454,
0.0022586348932236433,
-0.018935691565275192,
0.012022500857710838,
0.014091623947024345,
0.04088800027966499,
-0.02718368172645569,
-0.013762990944087505,
0.01662581041455269,
0.04316406697034836,
-0.018986806273460388,
0.024160245433449745,
-0.025750864297151566,
-0.04998991638422012,
-0.03840199485421181,
0.05790302902460098,
-0.006790642626583576,
0.05399113893508911,
0.0464811697602272,
-4.527246412853156e-33,
0.01845613121986389,
-0.02461354434490204,
0.011119814589619637,
-0.08419252187013626,
0.0523141473531723,
0.05774768814444542,
-0.012700713239610195,
-0.01897795870900154,
-0.050423040986061096,
0.046152252703905106,
-0.010356315411627293,
-0.014275465160608292,
0.02808835357427597,
0.08334676176309586,
-0.0017299113096669316,
-0.02117830142378807,
-0.00817902386188507,
-0.007840519770979881,
-0.007788956630975008,
0.04894813522696495,
-0.008315237239003181,
0.0025989925488829613,
-0.060790758579969406,
-0.0016593689797446132,
0.0047112926840782166,
-0.025006765499711037,
0.07989992946386337,
-0.04220013692975044,
-0.019609395414590836,
-0.003700694302096963,
-0.011409605853259563,
-0.005470868665724993,
0.03493320196866989,
-0.004261325113475323,
-0.005130483768880367,
0.037685759365558624,
-0.03206093981862068,
-0.019429299980401993,
0.04568836838006973,
-0.0029691036324948072,
-0.026586994528770447,
-0.009733923710882664,
0.05743445083498955,
0.036095377057790756,
0.045937202870845795,
-0.09021594375371933,
-0.00045348392450250685,
-0.044107768684625626,
-0.002865750575438142,
-0.04098071902990341,
0.020431961864233017,
0.04622622951865196,
0.031552545726299286,
0.014034207910299301,
-0.1062689945101738,
0.044899892061948776,
-0.02196270227432251,
0.02044273167848587,
0.01727929897606373,
0.020844951272010803,
-0.02011018618941307,
0.027117768302559853,
0.015001090243458748,
-0.046048641204833984,
-0.0410848893225193,
-0.007420496549457312,
0.002641961444169283,
0.0001762201136443764,
0.002781119430437684,
-0.013975751586258411,
-0.08109360933303833,
0.0008321889908984303,
-0.03528093919157982,
-0.09593807905912399,
0.003995212260633707,
0.004456749185919762,
0.018746061250567436,
-0.02975178137421608,
0.062165893614292145,
0.033296965062618256,
0.01688285544514656,
-0.036975469440221786,
-0.04711499810218811,
-0.002069386187940836,
-0.02047148533165455,
0.057753730565309525,
0.004836599808186293,
-0.0493733212351799,
0.01447755005210638,
-0.019229058176279068,
0.09131592512130737,
0.029660319909453392,
0.04058469831943512,
0.01836174912750721,
-0.03736769035458565,
-0.00722837820649147,
0.025528332218527794,
0.04184851795434952,
0.007340752519667149,
-0.025302482768893242,
0.04953022301197052,
0.027954207733273506,
0.042349379509687424,
-0.033391449600458145,
-0.004082927946001291,
0.01619260013103485,
-0.00982517097145319,
-0.014990690164268017,
-0.01541263796389103,
0.031703874468803406,
-0.0286374781280756,
0.035895269364118576,
0.010415373370051384,
0.016841253265738487,
0.0009782082634046674,
0.032996781170368195,
-0.008628720417618752,
0.11302471160888672,
0.0003226177650503814,
0.0270027294754982,
0.016178304329514503,
0.002745109610259533,
0.024493474513292313,
0.03690222278237343,
-0.07764160633087158,
-0.018117954954504967,
-0.005846700165420771,
0.06982868909835815,
-0.001998817315325141,
0.025556599721312523,
-0.003221547231078148,
-0.05907650291919708,
2.7051194706473325e-7,
-0.058333031833171844,
-0.03522004187107086,
-0.002505576703697443,
-0.07803837954998016,
0.03072233311831951,
-0.06820809096097946,
-0.019918568432331085,
0.025286979973316193,
-0.013544512912631035,
-0.009524918161332607,
0.06184876337647438,
0.004073265939950943,
-0.01300193089991808,
-0.05345264822244644,
0.022251848131418228,
-0.03604857251048088,
-0.02399769425392151,
-0.04994197562336922,
0.00025073380675166845,
-0.0024659677874296904,
0.03135205805301666,
-0.03609427809715271,
-0.05421687290072441,
-0.006200323812663555,
-0.037415556609630585,
-0.0447661317884922,
-0.022730909287929535,
0.009978623129427433,
-0.0230483990162611,
0.00766174029558897,
-0.03461470082402229,
0.010741889476776123,
0.008482709527015686,
0.0422062911093235,
-0.05639077350497246,
-0.0035454807803034782,
0.03961404412984848,
0.016563590615987778,
-0.041329268366098404,
-0.017739582806825638,
0.008538217283785343,
0.0011148075573146343,
-0.020620806142687798,
0.06553547829389572,
0.006798357702791691,
0.06296897679567337,
-0.07349672168493271,
-0.0032064816914498806,
-0.009833852760493755,
-0.0128385741263628,
0.03420111536979675,
0.014363529160618782,
-0.020651742815971375,
0.08591008931398392,
-0.013730745762586594,
0.08819135278463364,
0.001357880188152194,
-0.005360411945730448,
0.07665878534317017,
0.009150356985628605,
-0.03193363919854164,
0.01582466810941696,
0.010886413045227528,
-0.04212208464741707,
0.05929599702358246,
-0.06255131214857101,
-0.03014378622174263,
1.81901356743329e-34,
0.03516344726085663,
-0.0008444166160188615,
0.025781899690628052,
-0.03867257013916969,
0.009890412911772728,
-0.010583565570414066,
0.008693106472492218,
0.018781451508402824,
0.0014817077899351716,
-0.022071516141295433,
-0.03439357876777649
] | {
"ds_index": 16,
"similar_dg_indices": [
6494,
56736,
246783,
359828,
605643,
491279,
506147,
677453,
554278,
823109,
694484,
632777,
559072,
399528,
1054098,
404983,
1119376,
200428,
346022,
196121
]
} |
A 68-year-old man comes to the physician because of recurrent episodes of nausea and abdominal discomfort for the past 4 months. The discomfort is located in the upper abdomen and sometimes occurs after eating, especially after a big meal. He has tried to go for a walk after dinner to help with digestion, but his complaints have only increased. For the past 3 weeks he has also had symptoms while climbing the stairs to his apartment. He has type 2 diabetes mellitus, hypertension, and stage 2 peripheral arterial disease. He has smoked one pack of cigarettes daily for the past 45 years. He drinks one to two beers daily and occasionally more on weekends. His current medications include metformin, enalapril, and aspirin. He is 168 cm (5 ft 6 in) tall and weighs 126 kg (278 lb); BMI is 45 kg/m2. His temperature is 36.4°C (97.5°F), pulse is 78/min, and blood pressure is 148/86 mm Hg. On physical examination, the abdomen is soft and nontender with no organomegaly. Foot pulses are absent bilaterally. An ECG shows no abnormalities. Which of the following is the most appropriate next step in diagnosis? | Cardiac stress test | {
"A": "Esophagogastroduodenoscopy",
"B": "Hydrogen breath test",
"C": "Cardiac stress test",
"D": "Abdominal ultrasonography of the right upper quadrant"
} | step2&3 | C | [
"68 year old man",
"physician",
"of recurrent episodes",
"nausea",
"abdominal discomfort",
"past",
"months",
"discomfort",
"upper abdomen",
"sometimes occurs",
"eating",
"big meal",
"to go",
"walk",
"dinner to help",
"digestion",
"complaints",
"only increased",
"past",
"weeks",
"symptoms",
"climbing",
"stairs",
"apartment",
"type 2 diabetes mellitus",
"hypertension",
"stage 2 peripheral arterial disease",
"smoked one pack",
"cigarettes daily",
"past",
"years",
"drinks one",
"two beers daily",
"occasionally",
"weekends",
"current medications include metformin",
"enalapril",
"aspirin",
"5 ft 6",
"tall",
"kg",
"BMI",
"kg/m2",
"temperature",
"36 4C",
"97",
"pulse",
"min",
"blood pressure",
"mm Hg",
"physical examination",
"abdomen",
"soft",
"nontender",
"organomegaly",
"Foot pulses",
"absent",
"ECG shows",
"abnormalities",
"following",
"most appropriate next step",
"diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 68-year-old man comes to the physician because of recurrent episodes of nausea and abdominal discomfort for the past 4 months. The discomfort is located in the upper abdomen and sometimes occurs after eating, especially after a big meal. He has tried to go for a walk after dinner to help with digestion, but his complaints have only increased. For the past 3 weeks he has also had symptoms while climbing the stairs to his apartment. He has type 2 diabetes mellitus, hypertension, and stage 2 peripheral arterial disease. He has smoked one pack of cigarettes daily for the past 45 years. He drinks one to two beers daily and occasionally more on weekends. His current medications include metformin, enalapril, and aspirin. He is 168 cm (5 ft 6 in) tall and weighs 126 kg (278 lb); BMI is 45 kg/m2. His temperature is 36.4°C (97.5°F), pulse is 78/min, and blood pressure is 148/86 mm Hg. On physical examination, the abdomen is soft and nontender with no organomegaly. Foot pulses are absent bilaterally. An ECG shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
Choose one of the following::
A. Esophagogastroduodenoscopy
B. Hydrogen breath test
C. Cardiac stress test
D. Abdominal ultrasonography of the right upper quadrant | [
0.038424041122198105,
0.027001911774277687,
0.034958433359861374,
0.020841073244810104,
0.030027149245142937,
0.004697359167039394,
-0.01771942712366581,
0.05174605920910835,
0.018255548551678658,
-0.0010006050579249859,
0.03517475351691246,
0.035960603505373,
-0.030206279829144478,
-0.030531160533428192,
0.0013485875679180026,
0.02867514081299305,
-0.014259598217904568,
-0.01537560299038887,
0.0010682649444788694,
0.008624629117548466,
-0.0615287721157074,
-0.009890774264931679,
0.015779251232743263,
0.01797524280846119,
0.060728609561920166,
-0.0006529363454319537,
0.03043852001428604,
-0.06499268114566803,
-0.007695200853049755,
-0.018825992941856384,
0.01853954792022705,
-0.021778937429189682,
-0.05897156149148941,
0.026760997250676155,
0.0000019236852040194208,
-0.00045694506843574345,
0.02717076987028122,
0.00401523569598794,
0.05406787618994713,
-0.0614609457552433,
0.010513662360608578,
-0.054694946855306625,
0.04359009116888046,
-0.007360239513218403,
-0.021685805171728134,
-0.07373952120542526,
0.02031428925693035,
0.06262839585542679,
0.027114704251289368,
-0.0070443530566990376,
0.021113762632012367,
-0.03205282613635063,
-0.05669866129755974,
-0.017539845779538155,
0.007668137550354004,
0.0012818140676245093,
-0.013735123910009861,
-0.06160612031817436,
0.005223022773861885,
0.04363112896680832,
0.04733005911111832,
-0.02805277146399021,
0.019350433722138405,
0.0502343587577343,
-0.036818161606788635,
0.027927326038479805,
0.03782659396529198,
-0.03313010558485985,
0.03488164767622948,
0.008007415570318699,
-0.03414224460721016,
0.03819527477025986,
0.040053840726614,
0.03794921189546585,
-0.04538953676819801,
-0.036262381821870804,
0.07080017775297165,
-0.059332359582185745,
-0.013329989276826382,
-0.0011478845262899995,
0.08318575471639633,
0.024318626150488853,
-0.020763643085956573,
0.018467063084244728,
-0.007486342918127775,
-0.0069091301411390305,
0.01243069488555193,
-0.014991573058068752,
0.014730043709278107,
-0.05745076760649681,
0.015267427079379559,
-0.05070611461997032,
0.035086654126644135,
0.01456046849489212,
-0.05244076997041702,
-0.0051638288423419,
0.02017277106642723,
0.01804240420460701,
0.048200685530900955,
-0.0681217759847641,
-0.04983365908265114,
-0.0003202552907168865,
0.026831699535250664,
0.021278206259012222,
-0.0394466333091259,
0.01591324619948864,
-0.028848091140389442,
0.022989997640252113,
-0.07967959344387054,
0.05111246556043625,
0.0013137467904016376,
0.01748821884393692,
-0.08198358863592148,
0.026207121089100838,
0.07374463230371475,
-0.035858772695064545,
-0.051591310650110245,
-0.07488593459129333,
-0.008898882195353508,
0.04074506834149361,
0.00676690973341465,
0.0346611924469471,
0.06162518635392189,
0.034732263535261154,
0.013018622063100338,
0.02970120497047901,
-0.005803793668746948,
0.005288205109536648,
0.0229721087962389,
0.07213414460420609,
0.017665885388851166,
-0.004065406508743763,
-0.038244105875492096,
0.011159551329910755,
0.0341634638607502,
-0.06858225911855698,
-0.020432669669389725,
0.0544653981924057,
-0.052820269018411636,
-0.010775526985526085,
-0.01933341659605503,
0.0026001413352787495,
0.015086580999195576,
0.01661640964448452,
0.02740284986793995,
-0.01093874778598547,
0.018774550408124924,
0.032223183661699295,
0.001363300601951778,
0.030589953064918518,
-0.04735390841960907,
-0.008078683167696,
0.005909087602049112,
0.006348129827529192,
-0.019616413861513138,
0.011139274574816227,
0.03129378706216812,
-0.007478104904294014,
-0.00544742913916707,
-0.02959568239748478,
-0.0247473306953907,
-0.011720225214958191,
0.01569790206849575,
0.0095964465290308,
-0.02840300463140011,
0.021277060732245445,
0.05921066552400589,
0.053410161286592484,
-0.07121755182743073,
0.06976325809955597,
-0.026708440855145454,
0.04258255288004875,
0.036097507923841476,
0.03398537635803223,
-0.005570806562900543,
-0.032916706055402756,
0.023622263222932816,
0.005977127235382795,
-0.018038293346762657,
-0.050936322659254074,
0.006592127028852701,
0.05365423858165741,
0.016383087262511253,
-0.04889387637376785,
-0.03323514014482498,
-0.008291254751384258,
0.044811226427555084,
-0.02555679716169834,
-0.036328013986349106,
-0.03252136707305908,
0.0040329317562282085,
0.022225990891456604,
0.009141634218394756,
-0.00363787985406816,
0.0034847126808017492,
0.018673444166779518,
-0.05480724573135376,
-0.029808374121785164,
-0.007184735499322414,
0.007964126765727997,
-0.058696068823337555,
-0.008965029381215572,
-0.0016066901152953506,
0.0042305756360292435,
-0.01422856654971838,
0.04281771555542946,
0.03143616020679474,
0.03419271856546402,
0.020672766491770744,
-0.0347980372607708,
-0.01418574433773756,
-0.025451619178056717,
0.031739164143800735,
-0.019232435151934624,
-0.021053440868854523,
0.03994303196668625,
0.030016466975212097,
0.004243815783411264,
-0.042690709233284,
0.018676796928048134,
-0.029738185927271843,
-0.005592106841504574,
0.02709323540329933,
0.00039731667493470013,
-0.009161535650491714,
-0.03426958620548248,
-0.020579267293214798,
0.003111004363745451,
0.02611153945326805,
-0.07508587092161179,
0.05169273167848587,
0.03133596107363701,
-0.09245811402797699,
0.007937724702060223,
-0.07316063344478607,
0.015399808995425701,
0.012916693463921547,
-0.050677452236413956,
0.030916491523385048,
0.06377765536308289,
-0.030149085447192192,
-0.05911104753613472,
-0.07562953978776932,
-0.03690013289451599,
-0.01976005919277668,
-0.056282658129930496,
-0.025139102712273598,
0.049244802445173264,
-0.06048491224646568,
0.07118693739175797,
-0.028622891753911972,
0.017354583367705345,
-0.004539438057690859,
-0.014545667916536331,
0.0347328707575798,
0.014965579845011234,
-0.021175285801291466,
0.03704330325126648,
-0.01711406745016575,
-0.06784209609031677,
-0.03406483680009842,
-0.027753064408898354,
-0.0000254343067354057,
-0.020696604624390602,
-0.0019400882301852107,
-0.005202039610594511,
-0.014018557034432888,
-0.03475689888000488,
0.007665732409805059,
-0.0035899283830076456,
-0.021230170503258705,
0.014076794497668743,
0.011034837923943996,
0.040843769907951355,
-0.042674534022808075,
-0.021330147981643677,
-0.0337592288851738,
0.06842990964651108,
0.05320378392934799,
0.014946314506232738,
0.04703235626220703,
0.04709576815366745,
0.03495292365550995,
0.03013102151453495,
0.011610237881541252,
-0.0010883404174819589,
-0.019547341391444206,
-0.03517985716462135,
0.04803294315934181,
-0.06103185564279556,
-0.0018439762061461806,
0.014329642057418823,
0.04094618186354637,
-0.07849308848381042,
-0.053074512630701065,
-0.020839350298047066,
-0.0645475685596466,
0.08827599883079529,
-0.013018317520618439,
0.04186280816793442,
0.006310217082500458,
0.003274740884080529,
-0.014870124869048595,
0.01834563910961151,
0.011974303051829338,
0.019972825422883034,
0.055424515157938004,
0.010563629679381847,
0.016151420772075653,
0.05903947725892067,
0.007214599289000034,
0.0061066062189638615,
-0.029251793399453163,
-0.02736254781484604,
-0.0007326736813411117,
-0.060289252549409866,
-0.02127266302704811,
-0.008037653751671314,
0.049789074808359146,
-0.02825636975467205,
0.03210999071598053,
0.03889766335487366,
-0.008024932816624641,
-0.04433005675673485,
-0.007917848415672779,
0.012032749131321907,
0.0019974918104708195,
-0.00828142836689949,
-0.04214421287178993,
0.019854163751006126,
0.012933844700455666,
-0.0024250175338238478,
0.009676530957221985,
0.040793560445308685,
0.05096950754523277,
-0.024996934458613396,
-0.023856794461607933,
0.031212495639920235,
-0.05907585099339485,
0.05877647548913956,
0.028395315632224083,
-0.037307899445295334,
0.020071005448698997,
0.04200127348303795,
0.0014308112440630794,
0.0026020307559520006,
-0.05917397886514664,
0.02392854541540146,
-0.022942310199141502,
0.03134596720337868,
-0.08730266988277435,
-0.0011358370538800955,
0.02833346463739872,
-0.013798457570374012,
-0.05295967310667038,
-0.04617377370595932,
0.059862952679395676,
0.025490030646324158,
-0.03557037562131882,
0.043142497539520264,
0.004324797075241804,
0.012683015316724777,
-0.01964125782251358,
0.04279400035738945,
-0.0027245930396020412,
0.03653465956449509,
0.015761882066726685,
-0.026207081973552704,
0.01963210105895996,
-0.0268356055021286,
-0.043534066528081894,
0.015487751923501492,
-0.04224802926182747,
0.07183846086263657,
-0.007235415279865265,
0.024235161021351814,
0.03369582071900368,
-0.029575787484645844,
-0.08345780521631241,
-0.05342702195048332,
0.047161903232336044,
-0.01782097853720188,
0.009820590727031231,
-0.0067331683821976185,
-0.027065277099609375,
-0.012161851860582829,
0.013906022533774376,
-0.04695313051342964,
0.043392568826675415,
0.011819357983767986,
-0.003969148267060518,
0.03472169488668442,
-0.029763422906398773,
-0.048949770629405975,
0.019716432318091393,
0.0030674838926643133,
-0.020921727642416954,
-0.0741749256849289,
0.03172312304377556,
0.05634428188204765,
0.008920210413634777,
-0.04200736805796623,
-0.030507629737257957,
0.04168215021491051,
0.08255668729543686,
-0.04533608630299568,
-0.08844755589962006,
0.026676781475543976,
0.05629289150238037,
0.03358232602477074,
0.040690142661333084,
-0.03654777258634567,
0.03971973434090614,
-0.005480879917740822,
0.062224049121141434,
-0.03607494756579399,
0.02544882707297802,
-0.0857643410563469,
0.030689062550663948,
-0.06407217681407928,
0.0729890987277031,
-0.01831517554819584,
-0.007134904619306326,
-0.056058019399642944,
-0.008089049719274044,
0.0121768768876791,
0.052059341222047806,
0.07490412145853043,
0.007741783745586872,
0.02259572595357895,
0.03575935587286949,
-0.027705302461981773,
0.043694715946912766,
0.031447600573301315,
0.020690495148301125,
0.03440063074231148,
0.030068257823586464,
0.000520935864187777,
0.014129196293652058,
0.012309814803302288,
0.0054421331733465195,
-0.018798839300870895,
0.021111737936735153,
0.03481091931462288,
0.015568628907203674,
-0.034644581377506256,
0.032629430294036865,
0.06453323364257812,
0.016978519037365913,
0.04543687403202057,
-0.0009584897197782993,
-0.04119352623820305,
0.024815086275339127,
0.03605978563427925,
0.04157906770706177,
0.022651584818959236,
0.03863915055990219,
-0.02383830025792122,
0.061281803995370865,
-0.017981557175517082,
-0.03486371412873268,
0.01606183871626854,
0.020858051255345345,
-0.07574493438005447,
0.008183264173567295,
-0.019108157604932785,
-0.0921921655535698,
0.006023556459695101,
-0.020106546580791473,
0.02784324623644352,
-0.006436761934310198,
0.03872532770037651,
-0.010826791636645794,
-0.014220278710126877,
-0.0005492923664860427,
-0.028104042634367943,
-0.03081403113901615,
-0.059658490121364594,
-0.032474908977746964,
0.032750871032476425,
0.013008850626647472,
0.0029518178198486567,
-0.05950184166431427,
-0.07714701443910599,
0.013553100638091564,
0.005258152727037668,
0.052493415772914886,
-0.013643437065184116,
-0.022933311760425568,
0.015069662593305111,
-0.01927265152335167,
-0.042438145726919174,
-0.007578505203127861,
-0.018321523442864418,
-0.06712189316749573,
-0.02075752429664135,
-0.011958871968090534,
0.04111277684569359,
-0.009684077464044094,
-0.02660803124308586,
0.03269527852535248,
-0.010584693402051926,
0.02149503491818905,
-0.01528695598244667,
0.01842496357858181,
-0.019974827766418457,
0.016009867191314697,
0.04658287763595581,
-0.030614448711276054,
-0.004452275577932596,
0.019149798899888992,
0.0027931591030210257,
-0.015700563788414,
0.0265195369720459,
0.022197211161255836,
-0.000884521403349936,
-0.007888025604188442,
-0.0432121567428112,
-0.0005062871496193111,
0.00033327483106404543,
0.0029891319572925568,
-0.0022150177974253893,
-0.010650798678398132,
-0.0023320934269577265,
-0.016002533957362175,
0.017733924090862274,
-0.02098711021244526,
-0.01443044189363718,
0.02974458783864975,
0.06897486001253128,
-0.08221948146820068,
-0.031133759766817093,
-0.01647757925093174,
-0.014445129781961441,
-0.009038403630256653,
-0.016497502103447914,
-0.01754704862833023,
0.016254469752311707,
-0.012244677171111107,
-0.037898093461990356,
0.013844629749655724,
0.027084162458777428,
-0.0555972158908844,
0.019052237272262573,
-0.04339443892240524,
0.00913732685148716,
0.024593068286776543,
0.03323936462402344,
0.00213517970405519,
0.010509064421057701,
-0.04288969561457634,
0.0729667991399765,
-0.03631390258669853,
0.02662814036011696,
0.022083347663283348,
-4.591696564056834e-33,
0.029465332627296448,
-0.015376179479062557,
0.020240705460309982,
-0.07282231003046036,
0.03558112308382988,
0.05637887865304947,
-0.03835665062069893,
-0.023024898022413254,
-0.047047391533851624,
0.04499547556042671,
-0.04901207238435745,
-0.03329768776893616,
0.02667255327105522,
0.03760982304811478,
-0.02157163992524147,
-0.04882986471056938,
0.041434526443481445,
0.043324876576662064,
-0.02449142187833786,
0.023833442479372025,
-0.0059209102764725685,
-0.022862408310174942,
-0.0704125463962555,
-0.0757133886218071,
0.011032789014279842,
0.03899960219860077,
0.059171952307224274,
0.018350962549448013,
-0.014346028678119183,
0.01124549936503172,
0.0024087908677756786,
-0.0018559354357421398,
0.0376102589070797,
-0.01773918978869915,
-0.029627472162246704,
0.007195657584816217,
0.004739875439554453,
-0.04681583121418953,
0.02985178306698799,
0.019189517945051193,
0.043170325458049774,
-0.09281785041093826,
0.023276977241039276,
0.011768943630158901,
0.038474105298519135,
-0.04180794209241867,
-0.023831162601709366,
-0.029579967260360718,
0.01804325170814991,
-0.05572732537984848,
0.019443705677986145,
0.01623206026852131,
0.025178346782922745,
-0.019366037100553513,
-0.04314610734581947,
0.016976479440927505,
-0.004905284848064184,
0.00383023195900023,
0.03272512927651405,
-0.020732035860419273,
-0.043931640684604645,
-0.0011752091813832521,
0.00894875917583704,
-0.021378817036747932,
-0.05080407112836838,
0.003656188026070595,
-0.0022710429038852453,
0.0066206855699419975,
-0.049727946519851685,
0.011087779887020588,
-0.1013755351305008,
0.024504339322447777,
-0.03747609257698059,
-0.12619437277317047,
-0.0044988966546952724,
0.012867143377661705,
0.06999770551919937,
0.008220963180065155,
0.012445618398487568,
-0.005320913624018431,
-0.0013195229694247246,
-0.004596731159836054,
-0.029595687985420227,
-0.021949904039502144,
-0.011611329391598701,
-0.03129727393388748,
0.007710095029324293,
-0.04919426143169403,
-0.00404680659994483,
0.0043574911542236805,
0.1537240594625473,
-0.04720909520983696,
0.04657177999615669,
0.004537671338766813,
-0.002228323370218277,
-0.036105457693338394,
0.049666013568639755,
0.01867620088160038,
0.009458879940211773,
0.0244344100356102,
0.056156840175390244,
-0.02121315523982048,
0.014158806763589382,
-0.009446446783840656,
-0.009639781899750233,
0.04331335797905922,
0.025616949424147606,
-0.002224668860435486,
0.02569771185517311,
0.00039176910649985075,
-0.0054592713713645935,
-0.022362492978572845,
-0.003794233314692974,
0.032205283641815186,
0.00337931327521801,
0.05047326907515526,
-0.014222024008631706,
0.06490015983581543,
-0.008503327146172523,
0.0550331175327301,
0.012847389094531536,
-0.03361239656805992,
-0.004176547285169363,
0.001964111812412739,
-0.07590747624635696,
-0.04307377338409424,
-0.00638117641210556,
0.007709905505180359,
-0.017470205202698708,
-0.03032163716852665,
0.020257020369172096,
-0.048797447234392166,
2.7219618914386956e-7,
0.015846343711018562,
-0.03246431425213814,
-0.004312584642320871,
-0.07631415873765945,
-0.014472165144979954,
-0.038062065839767456,
0.02684212662279606,
0.03905327618122101,
-0.0282587967813015,
0.0061231194995343685,
0.06338904798030853,
0.004213912412524223,
-0.043293435126543045,
-0.002586710499599576,
0.06128919869661331,
-0.04547613859176636,
-0.06076286360621452,
0.04121740534901619,
0.023369628936052322,
-0.03405940532684326,
0.02874179370701313,
-0.005327614024281502,
-0.04748376086354256,
-0.04697175696492195,
-0.0024538845755159855,
-0.005249574780464172,
0.007612102199345827,
-0.0016260320553556085,
-0.05147548392415047,
-0.004019555170089006,
0.021814487874507904,
0.033784981817007065,
0.027470190078020096,
-0.008965657092630863,
-0.03240848705172539,
-0.010436853393912315,
0.0377207025885582,
0.06291843205690384,
-0.017786825075745583,
-0.0025657082442194223,
0.03085818700492382,
-0.011203122325241566,
0.020395396277308464,
0.015406107529997826,
0.05908321589231491,
-0.0345643050968647,
-0.05483211204409599,
0.052761711180210114,
0.033284079283475876,
-0.006569322664290667,
-0.03619248420000076,
0.008542588911950588,
0.014250497333705425,
0.07678090035915375,
0.00369686889462173,
0.0943024531006813,
-0.04430079087615013,
0.009163910523056984,
-0.00290481373667717,
-0.003152497112751007,
-0.00917076412588358,
-0.014064698480069637,
-0.01822267659008503,
-0.002786305034533143,
0.06574437767267227,
-0.05290825664997101,
-0.06364819407463074,
1.9338787657571908e-34,
-0.03866075351834297,
0.009531756862998009,
0.021398460492491722,
-0.07853902131319046,
-0.015241364017128944,
-0.04120219498872757,
-0.00589880021288991,
0.03683196380734444,
0.03465218096971512,
-0.04357811436057091,
-0.0260014571249485
] | {
"ds_index": 17,
"similar_dg_indices": [
1033910,
1024537,
103887,
672623,
596391,
114663,
11726,
487502,
209978,
338608,
130202,
965691,
999616,
846644,
233513,
923175,
21612,
582992,
913723,
1001097
]
} |
A 27-year-old female presents to general medical clinic for a routine checkup. She has a genetic disease marked by a mutation in a chloride transporter. She has a history of chronic bronchitis. She has a brother with a similar history of infections as well as infertility. Which of the following is most likely true regarding a potential vitamin deficiency complication secondary to this patient's chronic illness? | It may manifest itself as a prolonged PT | {
"A": "It may result in corneal vascularization",
"B": "It may result in the triad of confusion, ophthalmoplegia, and ataxia",
"C": "It may be exacerbated by excessive ingestion of raw eggs",
"D": "It may manifest itself as a prolonged PT"
} | step1 | D | [
"27 year old female presents",
"general medical clinic",
"routine checkup",
"genetic disease marked",
"mutation",
"chloride transporter",
"history of chronic bronchitis",
"brother",
"similar history",
"infections",
"infertility",
"following",
"most likely true",
"potential vitamin deficiency complication secondary to",
"patient's chronic illness"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old female presents to general medical clinic for a routine checkup. She has a genetic disease marked by a mutation in a chloride transporter. She has a history of chronic bronchitis. She has a brother with a similar history of infections as well as infertility. Which of the following is most likely true regarding a potential vitamin deficiency complication secondary to this patient's chronic illness?
Choose one of the following::
A. It may result in corneal vascularization
B. It may result in the triad of confusion, ophthalmoplegia, and ataxia
C. It may be exacerbated by excessive ingestion of raw eggs
D. It may manifest itself as a prolonged PT | [
0.030110780149698257,
-0.03206493705511093,
-0.008356507867574692,
0.026396574452519417,
0.025865964591503143,
-0.007791304495185614,
-0.01889953203499317,
0.024253929033875465,
0.04744861647486687,
-0.006724158301949501,
0.058332692831754684,
0.0127257714048028,
0.007804531138390303,
-0.07758786529302597,
-0.03744318336248398,
0.03577658534049988,
-0.020160265266895294,
-0.014839750714600086,
-0.011008297093212605,
0.012840783223509789,
-0.03586309030652046,
0.024928312748670578,
0.01692919246852398,
-0.029595162719488144,
0.027203064411878586,
-0.014433157630264759,
0.04040801152586937,
0.016545454040169716,
0.02009005658328533,
-0.008536982350051403,
0.018861396238207817,
0.005843422841280699,
0.004724977537989616,
-0.06756677478551865,
0.0000014853018228677684,
0.00014897668734192848,
-0.006156580988317728,
-0.022761426866054535,
0.006004975643008947,
-0.0030758276116102934,
-0.0382162369787693,
-0.009903921745717525,
0.01782490871846676,
0.016700977459549904,
0.02422742359340191,
-0.014951443299651146,
0.012449901551008224,
0.04423220828175545,
-0.0520198829472065,
-0.02266695722937584,
0.018685519695281982,
0.10234186798334122,
0.009634505957365036,
0.03974265977740288,
0.04006844386458397,
-0.060334861278533936,
0.026350680738687515,
0.06345421075820923,
-0.03256426379084587,
-0.003914667293429375,
0.016475971788167953,
0.052879154682159424,
-0.018589327111840248,
0.03690193220973015,
-0.015345752239227295,
0.008553799241781235,
-0.02211863547563553,
-0.017080508172512054,
0.008983432315289974,
0.026346269994974136,
0.05173949897289276,
0.03192644193768501,
0.019096268340945244,
0.07265789061784744,
-0.0378866083920002,
-0.02792973816394806,
0.0689006894826889,
-0.026721380650997162,
-0.04834791272878647,
0.0002605697372928262,
0.05111241713166237,
-0.001362887560389936,
0.0006680217920802534,
0.026447013020515442,
-0.02957586944103241,
-0.03304633870720863,
-0.01237032376229763,
-0.015053755603730679,
-0.0448843389749527,
-0.016135869547724724,
-0.04169405624270439,
-0.07259117811918259,
-0.00412382185459137,
0.016778871417045593,
-0.02096594125032425,
-0.013123124837875366,
-0.004548360127955675,
0.03726537153124809,
0.04318505525588989,
-0.0725717842578888,
0.006175684742629528,
-0.03019881062209606,
-0.04627741873264313,
0.0222375076264143,
-0.029144706204533577,
-0.01713981293141842,
-0.002641116501763463,
0.06199297681450844,
-0.027525633573532104,
0.024557476863265038,
0.01711905747652054,
0.012621721252799034,
-0.05192048102617264,
0.03538420423865318,
0.05473702400922775,
0.021191509440541267,
-0.024294354021549225,
-0.019430264830589294,
0.007465198170393705,
0.039463382214307785,
-0.047907400876283646,
0.017379483208060265,
-0.01595485955476761,
0.016692567616701126,
-0.06864073872566223,
0.06372992694377899,
-0.010990522801876068,
0.011287333443760872,
0.01865297183394432,
-0.05875116214156151,
0.010117067955434322,
-0.042176928371191025,
0.0013978536007925868,
0.03344028443098068,
0.0025533363223075867,
0.011389097198843956,
0.02135016955435276,
0.019065948203206062,
-0.049030907452106476,
-0.013867032714188099,
-0.020375661551952362,
-0.04966139793395996,
-0.07726689428091049,
0.02413390576839447,
0.03898323327302933,
0.05342189222574234,
0.015271557494997978,
-0.037740014493465424,
0.04017672687768936,
0.06093981862068176,
0.012440619990229607,
-0.019332999363541603,
0.03768956661224365,
0.009141088463366032,
0.07030536234378815,
0.02790537104010582,
-0.00671140942722559,
-0.03787742555141449,
0.03166278451681137,
-0.048596691340208054,
-0.004630372393876314,
-0.04283411055803299,
0.04667290300130844,
-0.06501240283250809,
0.00996605958789587,
0.012974712066352367,
0.0699128583073616,
0.04165562614798546,
-0.08345228433609009,
0.03109082020819187,
-0.006283123511821032,
0.0354713499546051,
0.0063999793492257595,
0.017355913296341896,
-0.0044950214214622974,
0.024417230859398842,
0.038664449006319046,
-0.04235660284757614,
0.004102009814232588,
0.0072490377351641655,
0.008424843661487103,
0.03877086192369461,
0.03039894625544548,
-0.005403666291385889,
-0.018141701817512512,
-0.024760834872722626,
-0.003271467052400112,
-0.022057563066482544,
0.010767822153866291,
-0.03731124848127365,
0.00046435819240286946,
0.03960239142179489,
0.015748953446745872,
-0.03069462440907955,
-0.048872314393520355,
0.02506827563047409,
-0.007375185377895832,
-0.005218521226197481,
0.009325307793915272,
-0.022495495155453682,
-0.021016797050833702,
-0.01660216599702835,
0.00959251169115305,
0.04216763377189636,
-0.07410411536693573,
0.1092909500002861,
-0.02733973041176796,
0.022566255182027817,
0.018006635829806328,
-0.07146376371383667,
0.02853897586464882,
-0.0006024837493896484,
0.04927738010883331,
-0.009065232239663601,
0.034956201910972595,
0.003559621050953865,
-0.01808902993798256,
-0.0066910311579704285,
-0.09310052543878555,
0.018589748069643974,
0.005177588667720556,
-0.015016935765743256,
-0.009229825809597969,
-0.010811378248035908,
-0.002175604458898306,
-0.008109749294817448,
-0.022597892209887505,
0.01586788147687912,
-0.03334379196166992,
-0.07432953268289566,
0.03583897650241852,
0.029290372505784035,
-0.05318622291088104,
0.033950939774513245,
-0.047003135085105896,
0.034438710659742355,
0.015208852477371693,
-0.049230411648750305,
-0.027697626501321793,
0.020665690302848816,
-0.02753554657101631,
-0.06044962257146835,
-0.045218322426080704,
-0.006216338369995356,
-0.0013917143223807216,
-0.030350733548402786,
-0.0007337082060985267,
-0.0077462163753807545,
-0.05820058286190033,
0.030178692191839218,
0.000002478386250004405,
0.01663391664624214,
0.005681312642991543,
0.022233663126826286,
-0.002709013409912586,
0.05055722966790199,
-0.027190737426280975,
0.03276757150888443,
-0.12552696466445923,
0.01430748961865902,
-0.017305588349699974,
0.029627205803990364,
-0.0012685752008110285,
-0.01242933701723814,
-0.04867871478199959,
-0.015469633974134922,
0.04122891277074814,
0.003441088367253542,
-0.01955079659819603,
0.03009096533060074,
-0.008491788059473038,
-0.01730780489742756,
0.024722043424844742,
0.02938651293516159,
-0.011546687223017216,
0.025749843567609787,
-0.055268868803977966,
0.03432551771402359,
0.022875970229506493,
0.03754013404250145,
0.012620357796549797,
0.054686423391103745,
0.008837915025651455,
0.0061149075627326965,
-0.009960588067770004,
-0.005487700458616018,
0.010074812918901443,
0.011120068840682507,
0.025694390758872032,
-0.018482739105820656,
-0.01253040786832571,
0.00023448829597327858,
0.04308000206947327,
0.025800785049796104,
-0.03571638837456703,
0.004764040932059288,
-0.009127601981163025,
0.023597819730639458,
-0.030724231153726578,
0.029178671538829803,
0.026788020506501198,
0.049288373440504074,
-0.03509165719151497,
0.014800908043980598,
0.030990177765488625,
0.00771472929045558,
0.031892143189907074,
-0.010712120682001114,
-0.006825335789471865,
0.012939251028001308,
0.025204362347722054,
-0.00015405466547235847,
-0.01178334467113018,
-0.0036594578996300697,
-0.0353265106678009,
0.025573810562491417,
0.016846084967255592,
-0.044415973126888275,
0.03804111108183861,
0.06316634267568588,
-0.0010168015724048018,
0.002132587367668748,
0.03197077661752701,
-0.03888590261340141,
-0.020918291062116623,
-0.025485623627901077,
-0.026092305779457092,
0.022793373093008995,
-0.09214870631694794,
-0.01567244715988636,
-0.002058051060885191,
-0.0393931120634079,
-0.022361377254128456,
-0.021128900349140167,
0.0168900303542614,
0.039769139140844345,
-0.0008812382002361119,
0.011646158061921597,
-0.05147659778594971,
0.012325575575232506,
-0.005091147031635046,
-0.02708488143980503,
0.015333393588662148,
0.03066169284284115,
0.03500119224190712,
-0.003955727908760309,
-0.0497715137898922,
-0.021677441895008087,
-0.0015562267508357763,
0.0005763734225183725,
-0.06357591599225998,
0.012932241894304752,
0.019272975623607635,
-0.006520410068333149,
0.005703425500541925,
0.011623512022197247,
0.027654703706502914,
0.02252386137843132,
-0.034464720636606216,
-0.00617104209959507,
-0.0012718072393909097,
0.06351529061794281,
-0.04838535934686661,
0.06591086834669113,
0.03145377337932587,
-0.013150088489055634,
0.031017465516924858,
0.03388015553355217,
-0.023517966270446777,
-0.020326539874076843,
-0.005319821182638407,
-0.027754049748182297,
-0.04021885246038437,
0.019939415156841278,
-0.02701394632458687,
0.019878948107361794,
0.035541847348213196,
0.025504622608423233,
-0.12414316833019257,
-0.038878511637449265,
0.0557829849421978,
-0.08581526577472687,
0.05632591247558594,
-0.00351092335768044,
-0.019474955275654793,
0.0061083403415977955,
-0.02663934789597988,
-0.05654314532876015,
0.05405168980360031,
0.032814715057611465,
0.007267847191542387,
0.07712548971176147,
-0.04518846049904823,
-0.01223604567348957,
-0.02214037999510765,
0.04213908314704895,
0.01304740272462368,
0.0034109207335859537,
0.06227462366223335,
0.050248950719833374,
0.0413135290145874,
-0.02005089446902275,
-0.0324847511947155,
0.0716092512011528,
0.0805778056383133,
-0.01379541214555502,
-0.014767331071197987,
-0.014255636371672153,
0.054163627326488495,
-0.016358019784092903,
0.009062280878424644,
-0.07014373689889908,
0.034269366413354874,
-0.006968474015593529,
0.035697177052497864,
0.01555152889341116,
-0.0032637440599501133,
-0.0699755921959877,
0.04417499154806137,
-0.06162417680025101,
0.03406509384512901,
0.007666626945137978,
0.013168449513614178,
-0.03961779177188873,
-0.0219087116420269,
0.009680122137069702,
0.06374076753854752,
0.027562320232391357,
0.007568307686597109,
0.00580838555470109,
0.0345403216779232,
-0.05381619557738304,
0.07758665084838867,
0.027232667431235313,
-0.057989586144685745,
0.06348289549350739,
0.010213164612650871,
-0.010524648241698742,
-0.00797790102660656,
-0.050418589264154434,
-0.005442172288894653,
0.033152952790260315,
0.03908606246113777,
-0.017019707709550858,
-0.014439735561609268,
-0.04726007208228111,
-0.001161683350801468,
0.04920709878206253,
0.05141216143965721,
0.05614807456731796,
0.02873058244585991,
0.01586991734802723,
0.008852770552039146,
0.01776047796010971,
-0.008936670608818531,
0.010672317817807198,
0.017979349941015244,
-0.10148642212152481,
-0.0007270144415087998,
-0.06329850852489471,
-0.0472269244492054,
0.003111623227596283,
-0.007948365993797779,
-0.04391208663582802,
0.005916660185903311,
-0.04433329403400421,
-0.049502186477184296,
-0.004740979056805372,
-0.021026568487286568,
-0.0577261783182621,
-0.027039088308811188,
0.04103880375623703,
-0.018224921077489853,
0.0005261487094685435,
-0.027793969959020615,
0.003397430758923292,
-0.068653404712677,
-0.03449314832687378,
0.06804320961236954,
0.06476561725139618,
-0.019059691578149796,
0.03897484019398689,
-0.004786481149494648,
-0.05268259719014168,
-0.02030208706855774,
0.027147933840751648,
-0.0028640113305300474,
-0.025648444890975952,
-0.0010924477828666568,
-0.01354993786662817,
-0.0031442679464817047,
0.016415730118751526,
-0.04765107110142708,
-0.040356822311878204,
-0.04814356565475464,
0.04128720983862877,
0.009247865527868271,
0.10557739436626434,
0.05210083723068237,
-0.039756521582603455,
0.08161608129739761,
0.02417057938873768,
0.0085395323112607,
0.017635880038142204,
0.01611732877790928,
0.08433922380208969,
-0.04326663538813591,
0.011605719104409218,
-0.02758736163377762,
-0.022975077852606773,
-0.0031243935227394104,
-0.04882301762700081,
-0.012391122989356518,
0.014189477078616619,
0.01110572274774313,
0.023863814771175385,
-0.052514057606458664,
0.007237831596285105,
-0.03792479634284973,
-0.008969497866928577,
0.015106587670743465,
-0.0379052497446537,
-0.015101850032806396,
0.010022413916885853,
-0.009193814359605312,
0.045511625707149506,
0.03366871178150177,
-0.034171175211668015,
-0.03392285108566284,
0.030020805075764656,
-0.04347126558423042,
-0.0198924969881773,
-0.0715370923280716,
-0.045921772718429565,
-0.018894603475928307,
0.0005918432725593448,
-0.07321981340646744,
0.04145878925919533,
0.0057737999595701694,
-0.02502194233238697,
-0.03271816298365593,
-0.010200925171375275,
0.05481736734509468,
-0.01100163720548153,
0.018508566543459892,
0.014995254576206207,
-0.09540920704603195,
-0.013480291701853275,
0.05201173201203346,
-0.05666331201791763,
-0.00874155480414629,
0.04304801672697067,
-0.0047596474178135395,
0.031425539404153824,
0.01416904479265213,
-4.975927831116223e-33,
0.015458382666110992,
-0.05023612454533577,
0.043343350291252136,
0.03277745097875595,
0.041551023721694946,
0.04538743197917938,
-0.019181281328201294,
-0.036679841578006744,
-0.08267658948898315,
-0.015464422293007374,
-0.007720676716417074,
0.04332484304904938,
0.019092122092843056,
0.05134224146604538,
-0.01098721195012331,
-0.024640973657369614,
0.01787918247282505,
-0.01030574832111597,
0.00892996322363615,
-0.022900989279150963,
-0.02753639407455921,
-0.01241039577871561,
-0.016569029539823532,
-0.023919727653265,
0.010826975107192993,
-0.06486062705516815,
0.07634251564741135,
-0.013335914351046085,
-0.028075410053133965,
0.02945595420897007,
0.0460321381688118,
0.0004837632004637271,
-0.007182237226516008,
0.009492283686995506,
-0.014370696619153023,
-0.09292852878570557,
-0.0116545669734478,
-0.017192484810948372,
-0.016186319291591644,
0.008771614171564579,
-0.03828812390565872,
0.003393899416550994,
0.0040195658802986145,
0.025196053087711334,
0.023574260994791985,
-0.028982270509004593,
-0.016401994973421097,
-0.034010473638772964,
-0.0034733926877379417,
-0.0389561764895916,
-0.026783734560012817,
0.020616989582777023,
0.00793288741260767,
0.03969760239124298,
-0.0251814816147089,
0.03839726001024246,
-0.01000186987221241,
0.004768586251884699,
0.05969875678420067,
0.015281652100384235,
0.014835557900369167,
-0.009603312239050865,
0.027675891295075417,
-0.044873423874378204,
-0.024203956127166748,
-0.02469230629503727,
0.027757680043578148,
-0.01855054311454296,
-0.06373485177755356,
0.014526138082146645,
-0.07577867060899734,
-0.02161088027060032,
-0.07671162486076355,
0.00787507463246584,
-0.03006392903625965,
-0.01799061894416809,
0.0018614778527989984,
0.009656506590545177,
0.007464350666850805,
0.014843610115349293,
-0.06086823344230652,
-0.006441479083150625,
-0.05359664559364319,
-0.03993765264749527,
-0.03459455817937851,
0.010217593982815742,
-0.016368335112929344,
-0.026499038562178612,
0.028432555496692657,
-0.04568645730614662,
0.06741008907556534,
0.02002785913646221,
0.03265253081917763,
0.007427676115185022,
-0.03751102089881897,
-0.02188488095998764,
0.010741788893938065,
-0.013784523122012615,
-0.0066632782109081745,
0.058213476091623306,
0.04422838240861893,
0.04262269288301468,
0.050434526056051254,
-0.08893875777721405,
-0.038286954164505005,
0.032742615789175034,
0.05747673287987709,
-0.015378808602690697,
-0.03215523436665535,
-0.017672820016741753,
-0.014088161289691925,
-0.017713529989123344,
0.010039514862000942,
0.057630304247140884,
-0.016533473506569862,
0.0451420433819294,
0.008075188845396042,
0.06582126021385193,
0.039715725928545,
0.05494898930191994,
0.018245821818709373,
0.013715648092329502,
-0.0005680501344613731,
-0.0028946928214281797,
-0.02165418490767479,
-0.03183843195438385,
0.03189275413751602,
0.06996265798807144,
-0.010203924030065536,
0.0029482992831617594,
0.027587050572037697,
-0.0041664838790893555,
2.4078320848275325e-7,
0.03099733218550682,
-0.008774112910032272,
-0.009446692653000355,
-0.08187941461801529,
0.00699752988293767,
-0.07621745765209198,
-0.022971516475081444,
0.007318836636841297,
0.04146764427423477,
0.035823460668325424,
0.057222794741392136,
-0.00554458424448967,
-0.022386090829968452,
-0.023301687091588974,
0.026873812079429626,
0.07757750153541565,
-0.008789419196546078,
-0.019058967009186745,
0.0566793754696846,
-0.022472035139799118,
0.01956046372652054,
-0.00799521990120411,
-0.08896058052778244,
-0.02941802702844143,
0.06496395915746689,
-0.027427302673459053,
0.014958901330828667,
-0.002727921586483717,
-0.023472558706998825,
0.020711494609713554,
0.037155091762542725,
0.002289655152708292,
0.04081989824771881,
0.0836896002292633,
-0.04332808405160904,
-0.06565646827220917,
0.0011993411462754011,
0.055600591003894806,
-0.034796420484781265,
-0.010077647864818573,
-0.027260692790150642,
0.04834824427962303,
0.010428684763610363,
0.08547335118055344,
-0.028736356645822525,
0.06648265570402145,
-0.029562467709183693,
-0.02727941796183586,
0.01710490509867668,
-0.004526832140982151,
0.037313155829906464,
0.054473258554935455,
0.0005373376188799739,
0.02985864318907261,
-0.015155435539782047,
0.04396573454141617,
-0.03731359541416168,
-0.017162976786494255,
0.01759091205894947,
-0.021186720579862595,
0.010946212336421013,
-0.08388863503932953,
0.01602046936750412,
-0.03564463555812836,
0.06540916860103607,
0.0037254085764288902,
-0.057857412844896317,
1.4905039927629913e-34,
-0.054107122123241425,
-0.014716219156980515,
0.00863831676542759,
-0.0646388828754425,
0.017822150141000748,
-0.020286770537495613,
0.01173427328467369,
0.026393864303827286,
0.007046840153634548,
-0.05662505701184273,
-0.03536626696586609
] | {
"ds_index": 18,
"similar_dg_indices": [
171773,
898772,
777986,
217116,
536006,
484927,
685449,
1048693,
400137,
227046,
671193,
481402,
825472,
718614,
74389,
201672,
476620,
835550,
1050144,
799826
]
} |
A previously healthy 36-year-old man comes to the physician for a yellow discoloration of his skin and dark-colored urine for 2 weeks. He does not drink any alcohol. Physical examination shows jaundice. Abdominal and neurologic examinations show no abnormalities. Serum studies show increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). A liver biopsy is performed and a photomicrograph after periodic acid-Schiff-staining is shown. Which of the following is the most likely additional finding in this patient? | Bullous changes of the lung bases on chest CT | {
"A": "Bullous changes of the lung bases on chest CT",
"B": "Beading of intra- and extrahepatic bile ducts on ERCP",
"C": "Myocardial iron deposition on cardiovascular MRI",
"D": "Dark corneal ring on slit-lamp examination"
} | step1 | A | [
"healthy 36 year old man",
"physician",
"yellow discoloration",
"skin",
"dark-colored urine",
"2 weeks",
"not drink",
"alcohol",
"Physical examination shows jaundice",
"Abdominal",
"neurologic examinations show",
"abnormalities",
"Serum studies show increased levels",
"alanine aminotransferase",
"ALT",
"aspartate aminotransferase",
"AST",
"liver biopsy",
"performed",
"photomicrograph",
"periodic acid-Schiff-staining",
"shown",
"following",
"most likely additional finding",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A previously healthy 36-year-old man comes to the physician for a yellow discoloration of his skin and dark-colored urine for 2 weeks. He does not drink any alcohol. Physical examination shows jaundice. Abdominal and neurologic examinations show no abnormalities. Serum studies show increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). A liver biopsy is performed and a photomicrograph after periodic acid-Schiff-staining is shown. Which of the following is the most likely additional finding in this patient?
Choose one of the following::
A. Bullous changes of the lung bases on chest CT
B. Beading of intra- and extrahepatic bile ducts on ERCP
C. Myocardial iron deposition on cardiovascular MRI
D. Dark corneal ring on slit-lamp examination | [
0.03476365655660629,
-0.016444269567728043,
0.036412425339221954,
-0.006654792930930853,
0.03079814463853836,
-0.019832074642181396,
-0.02170621231198311,
0.04524672031402588,
0.0069376882165670395,
-0.015239639207720757,
0.024236636236310005,
0.022875864058732986,
-0.01853610947728157,
-0.02239072695374489,
0.015290128998458385,
0.0813128873705864,
0.006773080211132765,
-0.030544444918632507,
-0.009660691022872925,
-0.005587857216596603,
-0.010213096626102924,
-0.028289763256907463,
0.08836217224597931,
0.02351287007331848,
0.028012031689286232,
0.02072240598499775,
-0.00047287726192735136,
-0.03398243337869644,
-0.012209384702146053,
0.001518608070909977,
-0.033876582980155945,
-0.011021407321095467,
-0.008901569992303848,
0.0041671753861010075,
0.000001459840632378473,
-0.015433967113494873,
-0.016672438010573387,
-0.04512207582592964,
0.000404324266128242,
-0.005760263651609421,
-0.02392958290874958,
0.005375532899051905,
0.0213216133415699,
-0.008829721249639988,
-0.02036672830581665,
-0.04010414704680443,
0.03508775308728218,
0.06888055801391602,
-0.041019849479198456,
-0.010470490902662277,
0.021921643987298012,
0.042855601757764816,
0.0033878139220178127,
-0.007504167500883341,
0.08149591833353043,
-0.052766334265470505,
0.008419542573392391,
0.030835192650556564,
-0.049953073263168335,
0.06585035473108292,
0.03649292141199112,
0.012772410176694393,
0.016461260616779327,
0.007882296107709408,
0.007630242500454187,
0.029156869277358055,
0.006696007680147886,
-0.032017193734645844,
0.033556174486875534,
-0.021917464211583138,
-0.022999128326773643,
-0.01912221498787403,
0.013154612854123116,
0.07292931526899338,
-0.01515212096273899,
-0.014874857850372791,
0.05893274024128914,
0.027086405083537102,
-0.03736717253923416,
0.007275095675140619,
0.10823242366313934,
0.020223485305905342,
-0.0070984335616230965,
0.04171108454465866,
0.017593631520867348,
-0.000978346448391676,
-0.010138249956071377,
-0.030261414125561714,
-0.02764984220266342,
-0.018943490460515022,
-0.042127422988414764,
-0.048769760876894,
0.03785501420497894,
0.0494198352098465,
-0.025347385555505753,
-0.014158436097204685,
0.022809326648712158,
-0.06792120635509491,
0.03481472283601761,
-0.05507748946547508,
0.049497880041599274,
-0.0057955156080424786,
-0.13548409938812256,
0.0441712848842144,
-0.03243126720190048,
0.04822355508804321,
0.023235520347952843,
0.00841654371470213,
-0.04463209956884384,
0.04837241768836975,
0.04270758479833603,
0.005014436785131693,
-0.050623711198568344,
0.030264288187026978,
0.06833153963088989,
-0.030111948028206825,
-0.014166707172989845,
-0.026311511173844337,
-0.0005894826026633382,
0.05388534814119339,
0.0358196422457695,
0.026225531473755836,
-0.04265579953789711,
0.058632709085941315,
0.004043285269290209,
-0.003515188582241535,
-0.010201860219240189,
-0.010311468504369259,
-0.02057095803320408,
0.008781463839113712,
0.011077490635216236,
-0.0364413820207119,
-0.057403963059186935,
-0.009441856294870377,
0.010315196588635445,
-0.0017896367935463786,
0.020020775496959686,
0.046183083206415176,
-0.05235213041305542,
-0.020043442025780678,
-0.0009441145230084658,
-0.014381613582372665,
0.012105555273592472,
0.028840316459536552,
0.012591696344316006,
0.027901098132133484,
0.014909692108631134,
0.005318485666066408,
0.018805650994181633,
0.03203311935067177,
0.043303944170475006,
0.005753509700298309,
-0.026887517422437668,
0.010639178566634655,
0.013615100644528866,
0.018145909532904625,
-0.037793662399053574,
-0.022656822577118874,
-0.014470080845057964,
-0.016555815935134888,
0.04368679225444794,
-0.03271174803376198,
0.055645331740379333,
-0.04412435367703438,
-0.039460279047489166,
0.013437955640256405,
0.05543670803308487,
0.012957325205206871,
-0.03251409903168678,
0.02751840651035309,
0.003808744018897414,
0.02901616506278515,
0.02094757743179798,
0.0009990409016609192,
-0.07038785517215729,
0.0267392136156559,
-0.007128620520234108,
-0.021577278152108192,
-0.00250340742059052,
-0.01487035397440195,
0.008470078930258751,
0.032591525465250015,
0.036646731197834015,
-0.0035130747128278017,
-0.02231193333864212,
0.025830460712313652,
0.035774778574705124,
-0.016136927530169487,
0.018662096932530403,
-0.02485613524913788,
0.030156126245856285,
0.007749686948955059,
0.01051686704158783,
-0.02820047363638878,
-0.023700280115008354,
0.016286008059978485,
-0.029406961053609848,
-0.0263648834079504,
0.010594774968922138,
-0.0010287908371537924,
-0.02514590695500374,
-0.062398236244916916,
-0.012611424550414085,
0.0459999218583107,
-0.06014437973499298,
0.050102077424526215,
0.026883196085691452,
0.006264520343393087,
-0.019767070189118385,
-0.014875071123242378,
-0.013057490810751915,
-0.029069378972053528,
0.07214540243148804,
-0.01872994937002659,
0.03686795383691788,
0.017006734386086464,
0.002788603538647294,
0.02235947921872139,
-0.06308037787675858,
0.043771978467702866,
0.009726779535412788,
-0.009719190187752247,
-0.0032399590127170086,
-0.04394477605819702,
-0.046180855482816696,
0.000285800953861326,
0.01869453862309456,
0.01411806046962738,
0.013292252086102962,
-0.0722528025507927,
0.00876773800700903,
0.01032384391874075,
-0.055076200515031815,
0.03546925261616707,
-0.03588710352778435,
0.019008047878742218,
0.018122145906090736,
-0.027799978852272034,
-0.007459703832864761,
0.0744185820221901,
-0.017327342182397842,
-0.026185911148786545,
-0.0371849499642849,
-0.03959975764155388,
0.012280703522264957,
-0.019173894077539444,
-0.05379233881831169,
0.024428853765130043,
-0.03540434688329697,
0.08211148530244827,
-0.019598152488470078,
-0.002859672764316201,
0.03769038990139961,
0.039923202246427536,
-0.005316954106092453,
-0.003530047368258238,
-0.10616153478622437,
0.03249453008174896,
-0.029271284118294716,
-0.012353031896054745,
-0.05639951303601265,
0.014216603711247444,
0.019601067528128624,
0.018965335562825203,
-0.06164701655507088,
-0.01758868806064129,
0.027762068435549736,
0.0010692881187424064,
-0.02804575301706791,
0.03753937408328056,
-0.0020296971779316664,
-0.0042389072477817535,
0.011493355967104435,
0.03629676252603531,
-0.03244004026055336,
-0.000536058796569705,
-0.07130716741085052,
0.03738678991794586,
0.06137821450829506,
0.00006367090827552602,
0.016841204836964607,
0.045362550765275955,
-0.016647135838866234,
0.046750206500291824,
0.006405999418348074,
-0.0021825984586030245,
-0.0056612067855894566,
-0.0442565381526947,
0.007934004068374634,
0.004199502523988485,
-0.03930122032761574,
-0.013758584856987,
0.0288761667907238,
-0.05298151820898056,
-0.015482808463275433,
-0.03233486786484718,
-0.08003473281860352,
0.07588627189397812,
-0.021421663463115692,
0.0335875041782856,
0.018396545201539993,
0.01585104502737522,
0.002705614548176527,
0.002071201801300049,
0.019645821303129196,
0.08501778542995453,
0.04171602427959442,
-0.01079821027815342,
0.014709255658090115,
0.003314104164019227,
0.008399344980716705,
-0.010395688004791737,
-0.021061353385448456,
0.027185717597603798,
0.008102960884571075,
-0.0373811349272728,
-0.005817197263240814,
-0.08092022687196732,
0.03034244105219841,
-0.013168458826839924,
-0.006378429941833019,
0.019883187487721443,
-0.0003991870325990021,
-0.019766915589571,
0.02006656676530838,
0.010055853053927422,
0.0015638764016330242,
0.0384884774684906,
-0.01103183813393116,
0.016020603477954865,
0.01560433954000473,
-0.04981943592429161,
-0.0414559580385685,
0.07926315814256668,
0.026874281466007233,
-0.00580452848225832,
-0.0258259866386652,
0.07784441113471985,
-0.05385156720876694,
-0.01546803954988718,
0.016133766621351242,
0.001530370325781405,
0.045713990926742554,
0.011243358254432678,
-0.00787198357284069,
-0.004789602942764759,
-0.06284357607364655,
0.015422997064888477,
0.030207131057977676,
0.025202160701155663,
-0.06751532107591629,
0.01604238711297512,
0.0007629654137417674,
-0.021624090149998665,
-0.026184456422924995,
-0.055601879954338074,
0.013912631198763847,
-0.02212737686932087,
-0.05259418860077858,
0.0010397030273452401,
0.011986478231847286,
0.003823384176939726,
-0.04406117647886276,
0.038410648703575134,
0.010221102274954319,
0.008146464824676514,
0.017053337767720222,
-0.00914942380040884,
-0.04627382382750511,
-0.047610439360141754,
-0.028368642553687096,
0.017535531893372536,
-0.018892399966716766,
0.030016053467988968,
-0.003864219645038247,
0.02428760938346386,
0.03899243474006653,
-0.05590265244245529,
-0.11360765248537064,
-0.06520488113164902,
0.07062177360057831,
-0.07075574994087219,
0.02339334785938263,
0.0025397310964763165,
-0.037653598934412,
-0.004824361298233271,
-0.03058738447725773,
-0.0698285922408104,
0.0739981159567833,
0.010546408593654633,
0.03211239352822304,
-0.06246451288461685,
-0.024238605052232742,
-0.00949556939303875,
-0.008207341656088829,
0.015498417429625988,
0.01140571665018797,
-0.04645713046193123,
0.02538122422993183,
0.0972236767411232,
0.0032472661696374416,
-0.02774980291724205,
-0.05716452747583389,
0.06496065109968185,
0.05493641644716263,
-0.022088732570409775,
-0.07861576229333878,
-0.011138327419757843,
0.041146837174892426,
0.04667678102850914,
0.051944799721241,
-0.02652721107006073,
0.08428013324737549,
-0.009434150531888008,
0.027620242908596992,
-0.02162165194749832,
-0.025654379278421402,
-0.058795832097530365,
0.009898803196847439,
-0.0561758354306221,
0.06110009551048279,
-0.008646016009151936,
0.011440771631896496,
-0.051784269511699677,
0.02125963754951954,
0.03514884039759636,
-0.008873283863067627,
0.028156980872154236,
0.013496466912329197,
0.030719056725502014,
-0.0006267660646699369,
-0.033460307866334915,
0.016185017302632332,
0.08482696861028671,
-0.052619315683841705,
0.034619830548763275,
-0.009748676791787148,
-0.002643955871462822,
-0.01844998076558113,
-0.03736947476863861,
-0.008229157887399197,
-0.01575091853737831,
-0.007584824226796627,
0.014374307356774807,
0.05409974977374077,
-0.06712551414966583,
-0.0056580957025289536,
0.07804423570632935,
0.07243108749389648,
0.07271700352430344,
0.00539766950532794,
0.01833837479352951,
0.008779686875641346,
0.0035842321813106537,
-0.014138076454401016,
-0.018032986670732498,
0.007594088092446327,
-0.046627942472696304,
0.008327716030180454,
0.06374335289001465,
-0.06280560791492462,
0.020169904455542564,
-0.016201404854655266,
-0.041802357882261276,
-0.011345690116286278,
-0.12721963226795197,
-0.03243723511695862,
0.048913195729255676,
-0.033947598189115524,
-0.028378954157233238,
-0.020022189244627953,
0.05356821045279503,
-0.013204889371991158,
-0.010181466117501259,
-0.015553907491266727,
-0.0370381735265255,
-0.0440606065094471,
-0.07087744027376175,
0.012319122441112995,
0.02806979976594448,
0.02086060680449009,
0.04617699235677719,
-0.035728514194488525,
-0.08037793636322021,
0.004114777781069279,
0.002474464476108551,
0.022423597052693367,
0.013113795779645443,
-0.005743667483329773,
-0.022739121690392494,
0.017474647611379623,
0.00021590437972918153,
-0.02187812142074108,
0.027382247149944305,
-0.061309173703193665,
0.006620625965297222,
0.020004836842417717,
0.017369210720062256,
0.01874593086540699,
-0.011727673001587391,
0.06722919642925262,
0.0028121096547693014,
0.04832085967063904,
0.002837295876815915,
0.04162592440843582,
0.0244294460862875,
-0.02834867686033249,
0.0026913979090750217,
-0.06303767114877701,
-0.05020628124475479,
0.035451680421829224,
0.0028627454303205013,
-0.042138777673244476,
0.06695286929607391,
0.060367800295352936,
-0.007663663476705551,
-0.04931628331542015,
-0.0203873161226511,
-0.0078346012160182,
-0.01593247801065445,
0.006977647077292204,
-0.0024624024517834187,
-0.00661426642909646,
-0.006113717332482338,
-0.01756218820810318,
0.03768770769238472,
0.008283471688628197,
-0.022069890052080154,
0.01714344322681427,
0.07179508358240128,
-0.04234716668725014,
-0.02778160199522972,
-0.07927586138248444,
0.0018473936943337321,
-0.021592432633042336,
-0.0006980281323194504,
-0.016633329913020134,
-0.03380934149026871,
-0.008286549709737301,
-0.04857245832681656,
0.05687536671757698,
0.02416618913412094,
-0.03705666959285736,
-0.0037642482202500105,
-0.013162784278392792,
0.02383953146636486,
-0.03843490406870842,
0.00944907683879137,
0.032772041857242584,
-0.062323905527591705,
0.0059983255341649055,
0.0681835412979126,
0.0126102976500988,
0.024301420897245407,
0.042148396372795105,
-5.0102162666457395e-33,
0.07705721259117126,
-0.017824284732341766,
0.024477994069457054,
-0.0060289581306278706,
0.015377816744148731,
0.08571543544530869,
-0.035637982189655304,
-0.010100961662828922,
-0.036391619592905045,
0.01247565820813179,
0.0027131880633533,
-0.009127731435000896,
0.02933332696557045,
0.03203830122947693,
-0.0012110155075788498,
-0.04007676616311073,
0.022450417280197144,
-0.0011472342303022742,
0.006372733972966671,
-0.006056138779968023,
-0.01883338950574398,
-0.04485434293746948,
0.002811316167935729,
0.013176913373172283,
-0.03555845096707344,
0.002237253123894334,
0.05379334092140198,
0.011145184747874737,
-0.019791800528764725,
0.01924700103700161,
0.03194707632064819,
-0.05098477378487587,
-0.010668078437447548,
0.02009599283337593,
-0.0014128722250461578,
-0.0731961727142334,
-0.007885780185461044,
-0.03428034856915474,
0.04764573276042938,
0.009053406305611134,
-0.08133574575185776,
-0.02631869912147522,
-0.003146111499518156,
-0.016643695533275604,
-0.007094037719070911,
0.008530565537512302,
-0.029403092339634895,
-0.023600857704877853,
-0.005716485902667046,
-0.0028004697524011135,
0.03776687756180763,
0.019702699035406113,
0.07425102591514587,
0.01303185150027275,
-0.01586511731147766,
0.019003916531801224,
0.033780522644519806,
-0.05975804477930069,
0.02114548347890377,
0.027327364310622215,
0.001676597516052425,
0.0020227308850735426,
-0.006948508322238922,
0.0028049007523804903,
-0.04744287580251694,
-0.016118591651320457,
0.04973720386624336,
0.04232040047645569,
-0.03867132216691971,
0.014591890387237072,
-0.09183871746063232,
0.0005003357073292136,
-0.02839258499443531,
-0.1430988609790802,
0.011674855835735798,
-0.02340182475745678,
0.07359028607606888,
-0.01198968943208456,
0.033002473413944244,
0.03370346501469612,
-0.014381100423634052,
-0.0059912241995334625,
-0.0345243439078331,
-0.01065843366086483,
-0.016195999458432198,
0.018372680991888046,
-0.0051831272430717945,
-0.05220239609479904,
-0.01905149780213833,
-0.024065209552645683,
0.09381531178951263,
0.03490322455763817,
0.0243259035050869,
0.014987658709287643,
-0.031468164175748825,
0.01467710081487894,
0.009769744239747524,
0.022569185122847557,
-0.006344551220536232,
0.015006475150585175,
0.007179686333984137,
0.010610121302306652,
0.05418679490685463,
-0.009595858864486217,
-0.046430401504039764,
0.0024760833475738764,
0.04747321084141731,
-0.0031847311183810234,
-0.02675742097198963,
0.018240561708807945,
0.015251838602125645,
-0.015332655981183052,
0.0029527528677135706,
-0.013571019284427166,
0.01099465973675251,
0.06856624037027359,
0.01137241069227457,
0.05775325000286102,
0.015637213364243507,
0.04855884611606598,
0.042322561144828796,
-0.03856077045202255,
0.017660874873399734,
-0.0016717188991606236,
-0.031815800815820694,
-0.023261159658432007,
0.04565407708287239,
-0.004073422867804766,
-0.03435768559575081,
-0.008177826181054115,
0.017490895465016365,
-0.03944918140769005,
2.5652499857642397e-7,
0.010516811162233353,
-0.036656737327575684,
-0.026645513251423836,
-0.06361937522888184,
0.02792675420641899,
-0.06312121450901031,
0.010042794048786163,
-0.008936676196753979,
-0.023231089115142822,
0.013757736422121525,
0.001669843913987279,
0.03740081191062927,
-0.04294448345899582,
-0.025630895048379898,
0.0898386612534523,
-0.009180985391139984,
-0.04764213413000107,
0.003337632864713669,
0.06153173744678497,
0.03278354927897453,
0.01279910746961832,
-0.026713931933045387,
-0.07849380373954773,
-0.036053694784641266,
0.04843181371688843,
-0.054918158799409866,
-0.010448702611029148,
0.005419427063316107,
-0.03163943439722061,
0.04725656658411026,
-0.005121167283505201,
0.0573655366897583,
0.06370685994625092,
0.07891522347927094,
-0.034555770456790924,
-0.05588209629058838,
0.0325058251619339,
-0.0034929958637803793,
-0.03272060304880142,
0.018756229430437088,
0.0025045578368008137,
0.034322742372751236,
0.020881563425064087,
0.07068926095962524,
-0.006236565299332142,
0.06700245290994644,
-0.014168918132781982,
-0.04335577040910721,
-0.0013263466535136104,
0.006824949290603399,
-0.04010556638240814,
0.0013219916727393866,
0.003755841637030244,
0.06066795438528061,
-0.02230742946267128,
0.03156816586852074,
-0.043564338237047195,
-0.006389036774635315,
-0.02759835682809353,
0.014706980437040329,
0.017916003242135048,
-0.0018685607938095927,
-0.02317642793059349,
-0.015936048701405525,
0.020714249461889267,
-0.05173284187912941,
-0.0765329971909523,
1.713574823612526e-34,
-0.002602171851322055,
-0.030904553830623627,
0.027147002518177032,
-0.04857413098216057,
-0.010869842953979969,
-0.01954800821840763,
-0.039811357855796814,
-0.0034882717300206423,
-0.0014685417991131544,
-0.02023697830736637,
-0.04350960627198219
] | {
"ds_index": 19,
"similar_dg_indices": [
278803,
588198,
74321,
851286,
925681,
552848,
533254,
281538,
637805,
580694,
216475,
111984,
594522,
978102,
76393,
308814,
513902,
1144011,
823265,
967041
]
} |
A 69-year-old male presents to the emergency room with back pain. He has a history of personality disorder and metastatic prostate cancer and was not a candidate for surgical resection. He began chemotherapy but discontinued due to unremitting nausea. He denies any bowel or bladder incontinence. He has never had pain like this before and is demanding morphine. The nurse administers IV morphine and he feels more comfortable. Vital signs are stable. On physical examination you note tenderness to palpation along the lower spine, weakness in the bilateral lower extremities, left greater than right. Neurological examination is also notable for hyporeflexia in the knee and ankle jerks bilaterally. You conduct a rectal examination, which reveals saddle anesthesia. Regarding this patient, what is the most likely diagnosis and the appropriate next step in management? | The most likely diagnosis is cauda equina syndrome and steroids should be started prior to MRI | {
"A": "The most likely diagnosis is cauda equina syndrome and steroids should be started prior to MRI",
"B": "The most likely diagnosis is cauda equina syndrome and steroids should be started after to MRI",
"C": "The most likely diagnosis is cauda equina syndrome and the patient should be rushed to radiation",
"D": "The most likely diagnosis is conus medullaris syndrome and steroids should be started prior to MRI"
} | step2&3 | A | [
"69 year old male presents",
"emergency room",
"back pain",
"history of personality disorder",
"metastatic prostate cancer",
"not",
"candidate",
"surgical resection",
"began chemotherapy",
"discontinued due to",
"nausea",
"denies",
"bowel",
"bladder incontinence",
"never",
"pain",
"before",
"demanding morphine",
"nurse administers IV morphine",
"feels more",
"Vital signs",
"stable",
"physical examination",
"note tenderness",
"palpation",
"lower spine",
"weakness in",
"bilateral lower extremities",
"left greater than right",
"Neurological examination",
"notable",
"hyporeflexia",
"knee",
"ankle jerks",
"conduct",
"rectal examination",
"reveals saddle anesthesia",
"patient",
"most likely diagnosis",
"appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 69-year-old male presents to the emergency room with back pain. He has a history of personality disorder and metastatic prostate cancer and was not a candidate for surgical resection. He began chemotherapy but discontinued due to unremitting nausea. He denies any bowel or bladder incontinence. He has never had pain like this before and is demanding morphine. The nurse administers IV morphine and he feels more comfortable. Vital signs are stable. On physical examination you note tenderness to palpation along the lower spine, weakness in the bilateral lower extremities, left greater than right. Neurological examination is also notable for hyporeflexia in the knee and ankle jerks bilaterally. You conduct a rectal examination, which reveals saddle anesthesia. Regarding this patient, what is the most likely diagnosis and the appropriate next step in management?
Choose one of the following::
A. The most likely diagnosis is cauda equina syndrome and steroids should be started prior to MRI
B. The most likely diagnosis is cauda equina syndrome and steroids should be started after to MRI
C. The most likely diagnosis is cauda equina syndrome and the patient should be rushed to radiation
D. The most likely diagnosis is conus medullaris syndrome and steroids should be started prior to MRI | [
0.06486030668020248,
0.033449336886405945,
0.03171972930431366,
-0.004814840387552977,
0.014442660845816135,
0.018865227699279785,
-0.005546045023947954,
0.0461040623486042,
-0.05843031778931618,
-0.014865252189338207,
0.024239514023065567,
-0.016646096482872963,
-0.0012222406221553683,
-0.005439459346234798,
0.06258406490087509,
0.002544477116316557,
0.008372661657631397,
0.01743008755147457,
-0.024760514497756958,
-0.011124175041913986,
-0.05106901377439499,
0.027068505063652992,
-0.004081233870238066,
-0.01781945303082466,
0.02302565798163414,
0.04399236664175987,
0.029591703787446022,
0.012476281262934208,
-0.023905914276838303,
-0.039121780544519424,
-0.019716277718544006,
0.011812612414360046,
-0.039072275161743164,
-0.014156182296574116,
0.0000019469839571684133,
-0.0180926863104105,
-0.004664285574108362,
-0.03407570347189903,
-0.004719557706266642,
-0.07469151169061661,
-0.02851402945816517,
-0.05496993660926819,
0.06382328271865845,
-0.025697022676467896,
-0.014820926822721958,
-0.07985453307628632,
0.005683935713022947,
0.043098434805870056,
-0.004564544651657343,
-0.009173881262540817,
0.016154341399669647,
0.026525860652327538,
-0.042547643184661865,
-0.016240514814853668,
0.01391408871859312,
0.008949685841798782,
-0.03397553786635399,
-0.05982876569032669,
0.021227609366178513,
0.010161254554986954,
0.007413025479763746,
-0.006603226065635681,
0.02618960663676262,
0.020008644089102745,
-0.032270245254039764,
0.017102351412177086,
0.04311704263091087,
0.004364249296486378,
-0.015248488634824753,
-0.0028924394864588976,
-0.01120403315871954,
0.048575807362794876,
0.05913785845041275,
0.032528553158044815,
-0.07730045914649963,
-0.027162054553627968,
0.04590978845953941,
-0.0008722796919755638,
-0.007517145946621895,
-0.023606812581419945,
0.034929852932691574,
0.04370066523551941,
-0.0037757335230708122,
0.012851576320827007,
0.01092959102243185,
-0.0674566775560379,
0.013799086213111877,
0.0016373104881495237,
0.04658402502536774,
-0.03550751507282257,
-0.023119697347283363,
-0.013222645968198776,
0.06268630176782608,
-0.010824272409081459,
-0.05898967385292053,
0.0448053814470768,
0.003400346962735057,
0.02049151249229908,
0.026101242750883102,
-0.1002948209643364,
-0.016290245577692986,
0.006670039147138596,
0.041655994951725006,
-0.01567290537059307,
-0.017915543168783188,
0.04035721346735954,
-0.02179928869009018,
0.018776481971144676,
-0.024132471531629562,
0.035858459770679474,
0.007845167070627213,
0.06211577355861664,
-0.05926600471138954,
-0.027027737349271774,
0.0668749138712883,
-0.017730064690113068,
-0.020581383258104324,
-0.03336813300848007,
0.025336647406220436,
0.07214289903640747,
0.025876695290207863,
0.034598495811223984,
0.004926218185573816,
0.0021458587143570185,
0.024531854316592216,
0.016932999715209007,
0.012555687688291073,
0.0006975897704251111,
0.02878379262983799,
0.047306135296821594,
0.04325197637081146,
-0.07257393002510071,
-0.047823697328567505,
-0.017758825793862343,
0.01267955917865038,
0.04359486326575279,
0.0174709539860487,
0.024879319593310356,
-0.03197817504405975,
-0.01708313263952732,
-0.033348821103572845,
0.01173486653715372,
0.06109790503978729,
0.02577286958694458,
0.0028947044629603624,
0.018387306481599808,
-0.00568643631413579,
0.0036992086097598076,
0.005293325055390596,
0.011013198643922806,
-0.06616140902042389,
-0.005960597191005945,
-0.043862808495759964,
-0.006590606179088354,
0.006131887435913086,
0.02596372365951538,
0.005453001242130995,
-0.037348054349422455,
-0.03218141198158264,
0.014766438864171505,
0.017039647325873375,
-0.026874002069234848,
-0.009202675893902779,
-0.01062832586467266,
-0.021570393815636635,
0.025823138654232025,
0.008966546505689621,
0.04969564452767372,
-0.03160401061177254,
0.06180234253406525,
-0.0522456169128418,
0.0459933839738369,
0.01012206356972456,
0.016951551660895348,
-0.03991987556219101,
-0.008773510344326496,
0.030487582087516785,
0.006034197751432657,
0.012498460710048676,
-0.047307685017585754,
-0.005834846757352352,
0.013544964604079723,
-0.001549768727272749,
-0.028380949050188065,
0.0030498497653752565,
-0.017184071242809296,
0.04748772457242012,
-0.032094527035951614,
-0.01897445321083069,
-0.04035376384854317,
-0.010492042638361454,
0.017963875085115433,
-0.04780573397874832,
0.04647654667496681,
0.03718206286430359,
0.04831263795495033,
-0.06344787776470184,
-0.04158199578523636,
-0.001232873066328466,
0.0031607889104634523,
-0.010428731329739094,
0.0478174164891243,
-0.0710514709353447,
0.07588175684213638,
-0.022914152592420578,
0.09163907170295715,
-0.031033046543598175,
-0.0004935169708915055,
0.053071096539497375,
0.0001985165581572801,
-0.05043048411607742,
-0.004364357329905033,
-0.01916489191353321,
-0.017596177756786346,
0.015295733697712421,
0.08686485141515732,
-0.009064733050763607,
-0.030878370627760887,
-0.08861172199249268,
0.028682732954621315,
-0.03911487013101578,
0.01098205428570509,
0.022203747183084488,
0.025995172560214996,
-0.08999468386173248,
-0.054236531257629395,
0.003419129876419902,
0.018871132284402847,
-0.007251703180372715,
-0.05927933752536774,
0.012113395147025585,
0.014271780848503113,
-0.02050076238811016,
-0.02757885493338108,
-0.02584170736372471,
0.027052395045757294,
-0.05527873709797859,
-0.0012947029899805784,
-0.004978553391993046,
0.03474334254860878,
-0.005805778782814741,
-0.06584039330482483,
-0.04790946841239929,
-0.05801323428750038,
0.003421677276492119,
-0.06562428921461105,
-0.004023617133498192,
0.02447068877518177,
-0.03859291970729828,
0.06940176337957382,
0.010338705033063889,
0.009995851665735245,
-0.005758443381637335,
-0.023450445383787155,
0.07275225222110748,
-0.031453315168619156,
0.004964833613485098,
0.04875817522406578,
0.002138776471838355,
-0.09621797502040863,
-0.011628934182226658,
-0.04049753397703171,
0.021132679656147957,
-0.045335207134485245,
-0.025400612503290176,
0.015310779213905334,
0.021410975605249405,
-0.026302402839064598,
0.000987722654826939,
0.0045357318595051765,
-0.0009662986267358065,
0.028058286756277084,
0.04668000340461731,
-0.01669616810977459,
-0.05432058870792389,
0.010629060678184032,
-0.004898372571915388,
0.036390576511621475,
0.04805312678217888,
-0.02474445104598999,
0.08134710043668747,
0.053040627390146255,
0.007634444627910852,
-0.010529319755733013,
-0.003711642464622855,
0.01784983091056347,
-0.055898845195770264,
0.0003700714441947639,
0.03063707984983921,
-0.005949709098786116,
0.02568002976477146,
0.02437243051826954,
0.006072362884879112,
-0.07173486053943634,
-0.010892597027122974,
-0.038996655493974686,
-0.08701347559690475,
0.033109284937381744,
0.014242555946111679,
0.024528810754418373,
0.0473347082734108,
0.009356335736811161,
0.014012708328664303,
0.0013948302948847413,
0.009601018391549587,
0.01620972715318203,
0.07767947018146515,
-0.024330496788024902,
0.045749783515930176,
0.062379851937294006,
0.017882084473967552,
0.011446223594248295,
-0.011687807738780975,
-0.08961031585931778,
0.040009256452322006,
-0.03262120112776756,
-0.03660779818892479,
-0.036226898431777954,
0.004042850807309151,
-0.027174359187483788,
0.016713136807084084,
0.06562771648168564,
0.024200132116675377,
-0.010366860777139664,
-0.011668514460325241,
-0.008007598109543324,
0.01214628852903843,
0.004724232945591211,
-0.019220344722270966,
-0.01706579700112343,
-0.01678222045302391,
0.0009316290961578488,
-0.004596326500177383,
0.01618082821369171,
0.0073988176882267,
-0.049796659499406815,
0.033880408853292465,
-0.03799420967698097,
-0.02210870012640953,
0.07545851171016693,
0.023969199508428574,
-0.009981343522667885,
-0.016327518969774246,
-0.0031894813291728497,
0.011308343149721622,
0.014013302512466908,
-0.018995339050889015,
-0.0064032431691884995,
0.03434465825557709,
-0.03368444740772247,
-0.08998658508062363,
0.04516708850860596,
-0.004972477909177542,
0.005650654435157776,
-0.020885044708848,
-0.0809009000658989,
0.01344176847487688,
0.05259926989674568,
0.002205250086262822,
0.009375454857945442,
-0.05999423936009407,
0.03164730221033096,
-0.009981795214116573,
-0.0055894129909574986,
-0.008121722377836704,
-0.009233771823346615,
0.03409045562148094,
-0.07110824435949326,
-0.008969055488705635,
0.008069667965173721,
-0.08443526178598404,
0.02112421579658985,
-0.060295794159173965,
0.06787709146738052,
-0.016358468681573868,
-0.030652916058897972,
0.0017671693349257112,
-0.06768880784511566,
-0.07119052112102509,
-0.04317905753850937,
0.06415855884552002,
-0.005863205064088106,
-0.003617756301537156,
-0.035018473863601685,
-0.024417618289589882,
-0.001116279629059136,
0.03327913209795952,
-0.037601932883262634,
0.05643075704574585,
0.007044662721455097,
-0.06446121633052826,
0.02953123301267624,
-0.0034586372785270214,
-0.0020310659892857075,
0.012634401209652424,
0.048803891986608505,
-0.03483157604932785,
-0.002537934109568596,
0.025831270962953568,
0.05108294263482094,
-0.023586129769682884,
0.023947210982441902,
0.007270248141139746,
0.030979415401816368,
0.0336616076529026,
-0.03050532191991806,
-0.03517933562397957,
-0.028164366260170937,
0.02223595231771469,
-0.005366690456867218,
0.043495383113622665,
-0.03795184940099716,
-0.002286020666360855,
0.03790564835071564,
0.03540217876434326,
-0.08454500883817673,
0.01515873335301876,
-0.07405927777290344,
-0.029504738748073578,
-0.03408467397093773,
0.09391258656978607,
-0.05144563317298889,
-0.057449717074632645,
-0.09040845185518265,
0.034170977771282196,
-0.005221830680966377,
0.052323609590530396,
0.08156493306159973,
0.003189976792782545,
0.05058664083480835,
0.029831038787961006,
-0.07925774902105331,
0.0015309605514630675,
0.025650687515735626,
-0.010756508447229862,
0.06420300155878067,
-0.010237501002848148,
0.017333511263132095,
0.022558122873306274,
-0.03612108901143074,
0.02469409815967083,
-0.0014250446110963821,
0.027379067614674568,
0.008119183592498302,
0.023434879258275032,
-0.031713321805000305,
0.017294256016612053,
-0.006392769515514374,
0.00442635640501976,
0.08980732411146164,
-0.011741643771529198,
-0.03177390992641449,
-0.012339059263467789,
0.01748742163181305,
0.03767133131623268,
0.01976821757853031,
-0.05279335752129555,
0.04953625053167343,
0.059188321232795715,
0.028014469891786575,
-0.06276843696832657,
0.010440487414598465,
-0.06359228491783142,
-0.023974768817424774,
-0.013808120042085648,
0.01945492997765541,
-0.013704679906368256,
0.01232691016048193,
-0.038769833743572235,
0.02751414105296135,
0.06115426868200302,
0.0022246618755161762,
-0.025057194754481316,
0.015264407731592655,
-0.0030747870914638042,
-0.021896230056881905,
-0.02337810769677162,
-0.011446909047663212,
0.004362595267593861,
-0.011257587000727654,
-0.034295618534088135,
0.02672579512000084,
-0.02984813041985035,
-0.09446308761835098,
0.04558560624718666,
-0.033482979983091354,
-0.028986338526010513,
-0.011826637201011181,
0.01677151583135128,
0.01640256866812706,
-0.011317269876599312,
-0.028058771044015884,
0.02430647797882557,
0.0019020297331735492,
-0.08041363954544067,
-0.034053172916173935,
-0.025054575875401497,
0.010460115037858486,
0.07253250479698181,
-0.07801371812820435,
0.04707908257842064,
0.005211693700402975,
0.023885807022452354,
-0.054012056440114975,
0.03635910153388977,
0.011723916046321392,
-0.005181898362934589,
-0.012290192767977715,
-0.01469157263636589,
-0.042996954172849655,
0.0010722168954089284,
0.04250967875123024,
-0.04522990807890892,
0.021976908668875694,
0.08109401166439056,
0.005127871874719858,
-0.01396422740072012,
-0.03098243661224842,
-0.04832646995782852,
0.013187330216169357,
0.0018126334762200713,
0.028018692508339882,
-0.04543596878647804,
-0.03366007283329964,
0.003315469715744257,
0.0025419630110263824,
-0.02417588233947754,
0.03669406473636627,
0.010836979374289513,
0.08767204731702805,
0.0032573530916124582,
-0.004098278470337391,
-0.005237198434770107,
0.01049047987908125,
-0.004453651607036591,
-0.021673347800970078,
-0.005806311499327421,
-0.012356000021100044,
-0.015075557865202427,
-0.027403634041547775,
0.030099157243967056,
0.06938108801841736,
-0.03543098270893097,
-0.01372385025024414,
-0.0627865418791771,
0.03207509219646454,
0.04907617345452309,
0.0067222630605101585,
-0.0022109495475888252,
-0.0076353782787919044,
-0.047832928597927094,
0.09379788488149643,
0.031634338200092316,
-0.006140727084130049,
0.03355776146054268,
-4.5423930249054855e-33,
0.017012624070048332,
-0.01901935040950775,
0.006219344679266214,
-0.08381977677345276,
0.024619856849312782,
0.016223520040512085,
-0.038238879293203354,
-0.020443687215447426,
-0.01677512377500534,
-0.0017932726768776774,
-0.05233222246170044,
-0.033386215567588806,
0.024325212463736534,
0.047000426799058914,
-0.019460322335362434,
-0.03144994005560875,
-0.00005239815800450742,
0.026434464380145073,
-0.015144911594688892,
0.04728781059384346,
0.025228960439562798,
0.04173603653907776,
-0.0012446604669094086,
-0.033451829105615616,
0.05474505200982094,
-0.01711399294435978,
0.024687357246875763,
0.004951325245201588,
-0.027966191992163658,
-0.02258649840950966,
-0.021399138495326042,
-0.038994722068309784,
0.026599500328302383,
-0.023286009207367897,
-0.041431453078985214,
-0.01320667378604412,
0.05920076370239258,
-0.011487907730042934,
0.016020875424146652,
-0.00548581825569272,
-0.019421730190515518,
-0.0373663604259491,
0.11050024628639221,
0.009150461293756962,
0.027654992416501045,
-0.045072201639413834,
-0.019788118079304695,
-0.005954135674983263,
0.020700421184301376,
-0.02817286178469658,
0.07545140385627747,
0.024299796670675278,
0.016523366793990135,
-0.02589775063097477,
-0.006226716097444296,
0.0016511216526851058,
-0.008014487102627754,
-0.007877474650740623,
0.049161605536937714,
-0.014622941613197327,
-0.04078619182109833,
0.022498149424791336,
0.024529948830604553,
-0.057378221303224564,
-0.02564312145113945,
0.0211910642683506,
0.013517051935195923,
0.028432128950953484,
-0.036171164363622665,
0.07019035518169403,
-0.05779402330517769,
0.023678971454501152,
-0.01604684442281723,
-0.050399135798215866,
0.018118049949407578,
0.006130726542323828,
0.04491418972611427,
0.010743082500994205,
-0.04147263988852501,
0.07565195113420486,
0.04480105638504028,
-0.01849672943353653,
-0.05462542176246643,
-0.03796437382698059,
0.008563018403947353,
-0.0029600777197629213,
0.022758783772587776,
-0.001091326936148107,
-0.013270464725792408,
-0.050063662230968475,
0.07936635613441467,
0.0256568044424057,
0.04560808837413788,
0.0007836964796297252,
-0.007858210243284702,
-0.009746501222252846,
0.04062386229634285,
0.07053901255130768,
0.0299565177410841,
-0.008603560738265514,
0.05206651985645294,
-0.016937358304858208,
-0.00378162763081491,
-0.01947164535522461,
-0.024673013016581535,
-0.007236022036522627,
0.008910460397601128,
-0.01119787897914648,
0.031535129994153976,
0.02083726041018963,
0.03897938132286072,
-0.03712575137615204,
0.017500201240181923,
0.09160218387842178,
-0.008673782460391521,
0.031150739639997482,
0.0007759765139780939,
0.023842433467507362,
0.005588780157268047,
0.03533780202269554,
-0.006322033237665892,
-0.04593547806143761,
-0.010227970778942108,
0.01623421162366867,
-0.05108437314629555,
-0.023560205474495888,
0.0002624608459882438,
0.03464314714074135,
-0.0012410469353199005,
0.007327524945139885,
0.044145550578832626,
-0.01478344202041626,
2.6859851232075016e-7,
0.014710563234984875,
0.020955843850970268,
0.011611735448241234,
-0.12541627883911133,
0.029727671295404434,
-0.019751254469156265,
0.021296747028827667,
0.031145719811320305,
-0.00849901046603918,
-0.06101168692111969,
0.03687046468257904,
0.018227294087409973,
0.016361625865101814,
-0.0005278933676891029,
0.009278117679059505,
-0.07047571986913681,
-0.007989632897078991,
0.0020231157541275024,
0.014685236848890781,
-0.046427540481090546,
0.012302504852414131,
-0.0826961025595665,
-0.08083170652389526,
-0.01799810864031315,
-0.041128698736429214,
0.006872932426631451,
0.01049246359616518,
-0.02002566307783127,
-0.03303425386548042,
-0.0012689046561717987,
0.030468594282865524,
0.02162729762494564,
-0.03237618878483772,
0.01876027137041092,
-0.04191044345498085,
-0.027355434373021126,
0.004624210763722658,
0.026254134252667427,
-0.013042133301496506,
-0.06799197942018509,
0.005239695776253939,
-0.009927622973918915,
0.028606710955500603,
0.06020365282893181,
0.03277129307389259,
0.03597959131002426,
0.0014792750589549541,
0.0013611846370622516,
0.004992475267499685,
0.050935156643390656,
0.012293602339923382,
0.003683844581246376,
0.014954580925405025,
0.0593184232711792,
0.013327142223715782,
0.04136171564459801,
-0.010995079763233662,
-0.03259630501270294,
0.03227126598358154,
0.03563123568892479,
-0.015123646706342697,
0.014877645298838615,
0.012199563905596733,
0.004385761916637421,
0.0396832674741745,
-0.07717529684305191,
-0.036911651492118835,
2.1145005900119875e-34,
-0.0010862065246328712,
0.006575793493539095,
0.037061549723148346,
-0.04874179884791374,
-0.024599507451057434,
-0.02008691057562828,
0.009097565896809101,
-0.018209198489785194,
0.0243698600679636,
-0.07149654626846313,
-0.04262160509824753
] | {
"ds_index": 20,
"similar_dg_indices": [
887349,
354868,
994827,
1096034,
44006,
973115,
254055,
3680,
446388,
88647,
946226,
1009060,
1160403,
205576,
1114993,
712938,
1001679,
386225,
531764,
670385
]
} |
An investigator is studying the function of the lateral nucleus of the hypothalamus in an experimental animal. Using a viral vector, the genes encoding chloride-conducting channelrhodopsins are injected into this nucleus. Photostimulation of the channels causes complete inhibition of action potential generation. Persistent photostimulation is most likely to result in which of the following abnormalities in these animals? | Anorexia | {
"A": "Hypothermia",
"B": "Hyperthermia",
"C": "Polydipsia",
"D": "Anorexia"
} | step1 | D | [
"investigator",
"studying",
"function",
"lateral nucleus",
"hypothalamus",
"experimental animal",
"Using",
"viral vector",
"genes encoding chloride conducting channelrhodopsins",
"injected",
"nucleus",
"channels causes complete inhibition",
"Persistent",
"most likely to result",
"following abnormalities",
"animals"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An investigator is studying the function of the lateral nucleus of the hypothalamus in an experimental animal. Using a viral vector, the genes encoding chloride-conducting channelrhodopsins are injected into this nucleus. Photostimulation of the channels causes complete inhibition of action potential generation. Persistent photostimulation is most likely to result in which of the following abnormalities in these animals?
Choose one of the following::
A. Hypothermia
B. Hyperthermia
C. Polydipsia
D. Anorexia | [
-0.009990324266254902,
-0.050716057419776917,
0.0011256278958171606,
-0.016755731776356697,
-0.015785640105605125,
0.05286391079425812,
0.01776074804365635,
0.01162815373390913,
-0.009077147580683231,
-0.030720850452780724,
0.0034930913243442774,
0.0417502336204052,
-0.021464340388774872,
-0.07781529426574707,
0.03596127778291702,
0.021824553608894348,
0.02948368526995182,
0.004274012055248022,
-0.0619005411863327,
-0.04856620356440544,
-0.012451980262994766,
-0.01881932094693184,
0.012286204844713211,
-0.018567686900496483,
0.04926693066954613,
-0.03916538134217262,
0.0026888023130595684,
-0.0319545678794384,
-0.02606135979294777,
0.022291650995612144,
0.014030754566192627,
0.050516922026872635,
0.009830063208937645,
-0.03982648625969887,
0.000001225430082740786,
-0.008735441602766514,
0.013444307260215282,
0.00710579939186573,
0.054329633712768555,
0.013402791693806648,
0.01124491635710001,
-0.0060700965113937855,
0.0068905167281627655,
0.029617680236697197,
0.015884147956967354,
-0.07413136214017868,
0.04348580539226532,
0.01646002009510994,
-0.019394250586628914,
0.017354194074869156,
-0.012529639527201653,
0.031343020498752594,
0.041898563504219055,
0.0348806232213974,
0.14758825302124023,
0.042553454637527466,
0.04647919163107872,
0.08444808423519135,
-0.02203742414712906,
0.0006194501766003668,
0.027987726032733917,
0.030736083164811134,
-0.009462379850447178,
-0.010933274403214455,
0.01890806294977665,
-0.019264109432697296,
0.034184329211711884,
-0.021113870665431023,
-0.021580537781119347,
-0.07577028125524521,
-0.015479043126106262,
0.011937734670937061,
0.019219936802983284,
0.1189737319946289,
-0.06715481728315353,
-0.07027082145214081,
0.007233167067170143,
-0.0014649328077211976,
0.018217751756310463,
-0.0076102884486317635,
0.02373565547168255,
-0.006660929881036282,
-0.013091782107949257,
0.04985927790403366,
0.028903746977448463,
-0.0362093485891819,
0.058792583644390106,
-0.026886872947216034,
-0.031355615705251694,
0.032019853591918945,
0.040282588452100754,
-0.032830458134412766,
-0.001293786452151835,
-0.0008335495367646217,
-0.015918554738163948,
0.04493599757552147,
-0.0358351469039917,
0.00590342003852129,
0.015831369906663895,
-0.06363245099782944,
-0.03810762241482735,
-0.03740034997463226,
0.011615980416536331,
0.001966735813766718,
-0.022298134863376617,
-0.055658116936683655,
-0.02826433628797531,
0.12158815562725067,
0.012436483055353165,
0.02642817050218582,
-0.0507378876209259,
0.013344953767955303,
-0.03849068284034729,
0.008859139867126942,
0.0986933633685112,
-0.011177650652825832,
-0.012622406706213951,
0.03677210584282875,
0.01134190522134304,
0.022169580683112144,
-0.1417175978422165,
-0.010170521214604378,
-0.007950995117425919,
0.03978939354419708,
0.005309731233865023,
0.04395660012960434,
0.018431443721055984,
0.0010365024209022522,
0.001075101550668478,
0.025295520201325417,
0.025649990886449814,
-0.006998858880251646,
-0.031953081488609314,
0.018399465829133987,
-0.034512728452682495,
0.016638578847050667,
0.024136150255799294,
0.03104463405907154,
-0.03346293047070503,
0.01764926314353943,
0.03967447206377983,
-0.01563556119799614,
-0.03014276549220085,
0.00792809296399355,
-0.034997325390577316,
0.05822816491127014,
-0.033675145357847214,
0.008452056907117367,
0.018173707649111748,
0.018181439489126205,
-0.009939349256455898,
0.008284980431199074,
-0.012610655277967453,
0.003920974675565958,
0.05936293676495552,
0.04105985909700394,
-0.0019988028798252344,
-0.011060758493840694,
-0.0034750753547996283,
0.00372275966219604,
0.06072349473834038,
-0.041665803641080856,
0.04760610684752464,
-0.050316549837589264,
0.006963525898754597,
0.03051692806184292,
-0.02727343887090683,
0.018845463171601295,
-0.025883419439196587,
-0.02032422088086605,
0.014210972003638744,
0.02489117719233036,
-0.05058436840772629,
0.040402285754680634,
-0.041485123336315155,
0.029891422018408775,
0.0008382967207580805,
0.0028691168408840895,
-0.003082518931478262,
-0.059124574065208435,
-0.0034415675327181816,
0.04133902117609978,
0.016214026138186455,
0.015006844885647297,
-0.024095186963677406,
-0.00005124186282046139,
0.00824027881026268,
-0.050954513251781464,
0.018034735694527626,
-0.020047489553689957,
-0.002114976989105344,
0.03702893480658531,
0.0031362478621304035,
0.00903470441699028,
0.01310813706368208,
0.038553569465875626,
-0.003227673703804612,
-0.028135208413004875,
-0.03411410376429558,
-0.014415664598345757,
0.043232452124357224,
0.01779615692794323,
0.05630584433674812,
0.07164021581411362,
-0.03084922395646572,
0.04392234981060028,
0.02211454138159752,
-0.021501924842596054,
0.016188008710741997,
0.005084168165922165,
0.056005045771598816,
-0.000038085596315795556,
0.06370047479867935,
-0.026588549837470055,
0.043692704290151596,
-0.00874133687466383,
-0.022533977404236794,
-0.027633603662252426,
-0.11161060631275177,
0.004004392307251692,
-0.00644794013351202,
0.07514045387506485,
-0.05537198856472969,
0.008022024296224117,
0.021817490458488464,
-0.01456589438021183,
-0.04901034012436867,
0.023922612890601158,
-0.020485252141952515,
-0.10777998715639114,
-0.029735350981354713,
0.03130299970507622,
-0.03151381388306618,
0.020626738667488098,
-0.007615097798407078,
0.00015386230370495468,
0.07295969873666763,
-0.02175298146903515,
-0.051856011152267456,
-0.007851534523069859,
-0.013615294359624386,
-0.0770871713757515,
-0.00918509066104889,
0.002589629730209708,
0.05305851250886917,
0.013764450326561928,
0.039796117693185806,
-0.037781551480293274,
-0.06482884287834167,
0.01471438817679882,
-0.025880632922053337,
-0.046260181814432144,
0.010922368615865707,
0.07311482727527618,
0.006697633769363165,
0.08085551857948303,
-0.021670378744602203,
0.019171936437487602,
-0.08470886945724487,
-0.020847653970122337,
0.002882259665057063,
0.01887490600347519,
-0.022922609001398087,
-0.005981072783470154,
-0.03372928500175476,
-0.028439322486519814,
0.009690500795841217,
0.0452682226896286,
-0.03820723667740822,
0.02721378020942211,
0.008865158073604107,
0.018885692581534386,
0.013013222254812717,
0.0175478532910347,
0.039726074784994125,
0.020016824826598167,
0.03479335457086563,
0.05042361095547676,
0.05114370211958885,
0.011912016198039055,
0.05854251608252525,
0.08493512123823166,
-0.015335427597165108,
-0.034291498363018036,
0.005192555487155914,
-0.00010768036008812487,
-0.01993582211434841,
-0.019946100190281868,
-0.003705686889588833,
0.03922860324382782,
-0.02648012898862362,
0.05551119148731232,
0.0405438058078289,
-0.05026760324835777,
0.035593513399362564,
0.026005180552601814,
0.014805753715336323,
0.053583595901727676,
0.030900513753294945,
0.015637578442692757,
0.046997539699077606,
0.045694611966609955,
0.008609936572611332,
-0.03845899552106857,
-0.02584136091172695,
0.0035203443840146065,
-0.02315150573849678,
0.001008687075227499,
0.0019304945599287748,
-0.003086821874603629,
0.054852843284606934,
-0.01827622577548027,
-0.005699556786566973,
0.00018094599363394082,
-0.01667868159711361,
-0.032401639968156815,
-0.023325104266405106,
-0.08465832471847534,
-0.023902766406536102,
0.06969017535448074,
-0.017491061240434647,
-0.0657978504896164,
0.012593550607562065,
0.05489172786474228,
0.016408288851380348,
-0.021615030243992805,
0.005520370323210955,
0.03727368265390396,
-0.002068587578833103,
-0.009990129619836807,
0.006949357222765684,
0.02128140814602375,
-0.023030614480376244,
-0.0020608685445040464,
0.009706233628094196,
0.00875717680901289,
-0.010573067702353,
0.012211247347295284,
0.008119748905301094,
-0.039396241307258606,
0.024438073858618736,
-0.0022249692119657993,
-0.01080412045121193,
-0.0012184672523289919,
0.10984492301940918,
-0.035035640001297,
0.008344725705683231,
0.013653949834406376,
-0.004248908720910549,
-0.017139043658971786,
-0.024364959448575974,
0.014206495136022568,
-0.00886541698127985,
-0.034458380192518234,
-0.02468078024685383,
-0.030568400397896767,
0.006875490769743919,
0.02624853514134884,
-0.045562513172626495,
0.022147024050354958,
0.03547358885407448,
-0.037847891449928284,
-0.02594568207859993,
0.05254049971699715,
0.017182879149913788,
0.0434788353741169,
0.01992102898657322,
0.039444077759981155,
-0.003707689233124256,
-0.014855430461466312,
0.019998306408524513,
0.0497967004776001,
-0.03921656683087349,
0.02591148018836975,
-0.01677371747791767,
-0.07226143032312393,
-0.005765082314610481,
-0.06806068122386932,
-0.08845102041959763,
-0.030151354148983955,
0.0892224833369255,
-0.000728730927221477,
0.10242491215467453,
-0.040328118950128555,
-0.0588214248418808,
0.0025479979813098907,
0.02120102383196354,
-0.007008472923189402,
0.008587729185819626,
0.021737901493906975,
0.01040616910904646,
0.014262212440371513,
0.003737316932529211,
0.0033633573912084103,
-0.016585346311330795,
-0.001119439140893519,
0.009126588702201843,
0.0074746571481227875,
0.00496716471388936,
0.04266030341386795,
0.030416542664170265,
0.06726237386465073,
-0.01905765011906624,
0.07030908763408661,
-0.023329220712184906,
0.005185951013118029,
0.04014376178383827,
-0.015165099874138832,
0.011036030948162079,
-0.009916736744344234,
0.00649658776819706,
-0.03689616918563843,
-0.012318078428506851,
0.012940746732056141,
-0.010260417126119137,
0.015809250995516777,
0.005372951738536358,
-0.03312620148062706,
0.0645909383893013,
-0.020374178886413574,
0.04563208296895027,
-0.037331048399209976,
-0.012799284420907497,
-0.03462380915880203,
-0.007558710873126984,
-0.02311018668115139,
0.08105651289224625,
-0.005763369612395763,
0.013274776749312878,
0.008535799570381641,
-0.020726609975099564,
-0.012791401706635952,
0.02391747012734413,
0.07068581134080887,
-0.049398090690374374,
-0.007191536948084831,
-0.025650665163993835,
-0.008857564069330692,
-0.02499067597091198,
-0.0638967975974083,
0.008431361988186836,
-0.007584445644170046,
0.10452467948198318,
-0.007072971668094397,
-0.02039261907339096,
-0.046835653483867645,
-0.032507821917533875,
0.06698348373174667,
0.015216046944260597,
0.07672225683927536,
-0.013802317902445793,
0.025387264788150787,
-0.015031397342681885,
-0.029374422505497932,
0.01597505249083042,
0.00774553744122386,
0.029639439657330513,
-0.0331350676715374,
-0.05695939064025879,
-0.04845631122589111,
0.020762721076607704,
0.025055216625332832,
0.00854494608938694,
-0.048738423734903336,
-0.024303510785102844,
-0.10666214674711227,
-0.025938812643289566,
0.041845422238111496,
0.03193617984652519,
-0.014241746626794338,
-0.004554384853690863,
-0.011708226054906845,
-0.0113626504316926,
0.007603041362017393,
-0.04342136159539223,
-0.0017527886666357517,
-0.07044732570648193,
0.005674483720213175,
0.0367029532790184,
0.045276448130607605,
-0.020657341927289963,
0.08746373653411865,
0.008295207284390926,
-0.011343353427946568,
-0.002759395632892847,
-0.00573706766590476,
-0.008413075469434261,
0.008438900113105774,
-0.00044405664084479213,
-0.03677913174033165,
0.028743373230099678,
0.0588921457529068,
0.0076645915396511555,
-0.04488549754023552,
-0.002905454020947218,
-0.019342269748449326,
0.0201890729367733,
0.0916132777929306,
0.03960343450307846,
-0.05087927728891373,
-0.009574344381690025,
0.03373058885335922,
-0.05151123180985451,
0.06747690588235855,
0.013407732360064983,
0.010896580293774605,
-0.023786121979355812,
-0.03515784442424774,
0.005158090498298407,
0.024457722902297974,
-0.01700904406607151,
-0.04109501838684082,
-0.04148656129837036,
0.005864482372999191,
0.055546194314956665,
-0.054281894117593765,
-0.008263461291790009,
0.004196404945105314,
-0.02067399024963379,
-0.03887390345335007,
-0.009121411480009556,
-0.010685411281883717,
-0.04840166121721268,
-0.0005413785111159086,
0.011425592005252838,
0.020244810730218887,
0.042627207934856415,
0.0034226097632199526,
-0.08638478070497513,
-0.01739698089659214,
0.024617038667201996,
-0.016822166740894318,
-0.009466691873967648,
-0.042808033525943756,
0.0004072932933922857,
0.035681016743183136,
0.042531538754701614,
-0.03034391440451145,
-0.006921215448528528,
-0.044889356940984726,
0.01625453494489193,
-0.010393817909061909,
0.022752849385142326,
0.016698675230145454,
-0.019064128398895264,
0.010752961970865726,
-0.06696616858243942,
-0.009880632162094116,
0.03765665739774704,
-0.03704017773270607,
0.012341419234871864,
0.0221623033285141,
-0.026830030605196953,
0.008830355480313301,
-0.038248058408498764,
-4.7264728688503633e-33,
0.021328605711460114,
-0.04722622036933899,
0.053037386387586594,
-0.022049032151699066,
-0.03240805119276047,
0.04176177829504013,
-0.03689946234226227,
0.021726537495851517,
-0.015426908619701862,
-0.014776237308979034,
-0.0038446339312940836,
-0.008688261732459068,
0.02596977725625038,
0.001602320116944611,
0.007427210919559002,
-0.004822099581360817,
-0.028058363124728203,
-0.08529598265886307,
0.00938498880714178,
-0.022521289065480232,
-0.0012201224453747272,
0.021890753880143166,
-0.03484846651554108,
0.03841309994459152,
-0.019562695175409317,
-0.017482386901974678,
-0.05787431076169014,
-0.04877854883670807,
-0.05467638000845909,
-0.025820542126893997,
0.010742289014160633,
-0.019762465730309486,
-0.06049207225441933,
-0.024046165868639946,
-0.00042755817412398756,
-0.037477996200323105,
0.004870310425758362,
-0.02952316775918007,
0.027363190427422523,
-0.06790085136890411,
-0.0790950283408165,
0.02842766046524048,
0.04058009013533592,
-0.016333580017089844,
0.02379503846168518,
0.05400384962558746,
-0.04544563591480255,
-0.05082060024142265,
0.004630631301552057,
-0.004088640213012695,
-0.05652179196476936,
-0.0007551581365987659,
0.030456174165010452,
0.014829541556537151,
-0.024800632148981094,
-0.002471313811838627,
-0.0028176833875477314,
-0.012021191418170929,
-0.031213684007525444,
0.025486383587121964,
0.009342236444354057,
0.05107171833515167,
-0.010628892108798027,
-0.0018946952186524868,
0.06328456103801727,
-0.026609856635332108,
0.04492596536874771,
0.04185012727975845,
-0.02015058510005474,
0.04043218120932579,
-0.007360580377280712,
0.04031221568584442,
0.009661169722676277,
-0.08424156904220581,
0.010455714538693428,
-0.05371200293302536,
0.03956040367484093,
-0.010462830774486065,
0.09774500131607056,
0.010492168366909027,
-0.033425793051719666,
0.02336467243731022,
0.00845039077103138,
-0.028858494013547897,
0.018218092620372772,
-0.0061128512024879456,
0.0018441715510562062,
-0.09625192731618881,
-0.004542190581560135,
-0.027662213891744614,
0.06221337616443634,
0.07397247105836868,
0.03593011572957039,
0.031659483909606934,
0.00044512347085401416,
0.024940207600593567,
0.015485203824937344,
-0.019866660237312317,
-0.020733142271637917,
-0.029312442988157272,
0.025637729093432426,
0.0026748627424240112,
0.019296720623970032,
-0.022191684693098068,
-0.029058121144771576,
-0.014725983142852783,
-0.0032457909546792507,
0.011081220582127571,
0.007637307979166508,
-0.003478974336758256,
-0.0006926326313987374,
-0.004522285424172878,
0.0688793733716011,
0.031450774520635605,
-0.03657304123044014,
-0.012571094557642937,
0.04893435910344124,
-0.014957583509385586,
-0.013638434000313282,
0.011485567316412926,
0.02463299036026001,
0.03980225324630737,
0.02929784171283245,
0.03070247359573841,
-0.024706806987524033,
-0.045947253704071045,
-0.002944458043202758,
0.08027383685112,
-0.03222858905792236,
0.012507704086601734,
0.0032344195060431957,
-0.013399041257798672,
2.2143517242056987e-7,
0.016219599172472954,
0.0030644803773611784,
-0.007223638240247965,
-0.004926391877233982,
0.030314017087221146,
-0.10077869892120361,
0.0010408037342131138,
0.00007782501052133739,
-0.018705982714891434,
-0.06411778926849365,
0.05131003260612488,
-0.010557635687291622,
0.00990330707281828,
-0.013454491272568703,
0.01458016224205494,
-0.03625463321805,
-0.013711112551391125,
-0.008070528507232666,
0.0640576183795929,
-0.05336468294262886,
0.043343883007764816,
0.014039137400686741,
-0.0445319227874279,
0.002909116679802537,
0.013407672755420208,
-0.011441824026405811,
0.02096475660800934,
0.0030763118993490934,
0.007348358631134033,
0.0058367131277918816,
-0.006254870444536209,
0.05311435088515282,
0.010910608805716038,
0.03409460559487343,
-0.05368591472506523,
-0.08668936789035797,
-0.026784876361489296,
0.00910305418074131,
-0.0184570774435997,
-0.015625523403286934,
-0.004869046155363321,
0.024357007816433907,
-0.012293389067053795,
0.05153745040297508,
-0.038239073008298874,
-0.01571294292807579,
-0.016529954969882965,
-0.0044064694084227085,
0.06491126865148544,
0.022841328755021095,
0.008252445608377457,
-0.041553013026714325,
-0.018603650853037834,
0.007120172493159771,
-0.013308675959706306,
-0.020859263837337494,
-0.028597693890333176,
0.02597205340862274,
0.04102762043476105,
-0.013085583224892616,
-0.009761328808963299,
-0.035171885043382645,
-0.013252041302621365,
0.06722429394721985,
0.07753971964120865,
-0.0077688139863312244,
-0.05265073478221893,
1.2685142952919764e-34,
0.020629173144698143,
-0.044610388576984406,
-0.033660903573036194,
-0.03705257549881935,
-0.0013551277806982398,
-0.03375294432044029,
-0.03753645345568657,
-0.02569800801575184,
-0.003590333042666316,
-0.06810277700424194,
-0.028811020776629448
] | {
"ds_index": 21,
"similar_dg_indices": [
355781,
92432,
717196,
280068,
436135,
605656,
412782,
138159,
64573,
401769,
850979,
152391,
560582,
358885,
466042,
220446,
190585,
780143,
1138618,
1191108
]
} |
A 52-year-old woman comes to the physician because of a 6-month history of generalized fatigue, low-grade fever, and a 10-kg (22-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Her hemoglobin concentration is 7.5 g/dL and leukocyte count is 41,800/mm3. Leukocyte alkaline phosphatase activity is low. Peripheral blood smear shows basophilia with myelocytes and metamyelocytes. Bone marrow biopsy shows cellular hyperplasia with proliferation of immature granulocytic cells. Which of the following mechanisms is most likely responsible for this patient's condition? | Unregulated expression of the ABL1 gene | {
"A": "Cytokine-independent activation of the JAK-STAT pathway",
"B": "Loss of function of the APC gene",
"C": "Altered expression of the retinoic acid receptor gene",
"D": "Unregulated expression of the ABL1 gene"
} | step1 | D | [
"year old woman",
"physician",
"month history",
"generalized fatigue",
"low-grade fever",
"a 10 kg",
"weight loss",
"Physical examination shows generalized pallor",
"splenomegaly",
"hemoglobin concentration",
"7.5 g/dL",
"leukocyte count",
"800 mm3",
"Leukocyte alkaline phosphatase activity",
"low",
"Peripheral blood smear shows basophilia",
"myelocytes",
"metamyelocytes",
"Bone marrow biopsy shows cellular hyperplasia",
"proliferation",
"immature granulocytic",
"following mechanisms",
"most likely responsible",
"patient's condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 52-year-old woman comes to the physician because of a 6-month history of generalized fatigue, low-grade fever, and a 10-kg (22-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Her hemoglobin concentration is 7.5 g/dL and leukocyte count is 41,800/mm3. Leukocyte alkaline phosphatase activity is low. Peripheral blood smear shows basophilia with myelocytes and metamyelocytes. Bone marrow biopsy shows cellular hyperplasia with proliferation of immature granulocytic cells. Which of the following mechanisms is most likely responsible for this patient's condition?
Choose one of the following::
A. Cytokine-independent activation of the JAK-STAT pathway
B. Loss of function of the APC gene
C. Altered expression of the retinoic acid receptor gene
D. Unregulated expression of the ABL1 gene | [
0.04190851375460625,
-0.06390683352947235,
0.04624263942241669,
-0.008161740377545357,
0.04303555563092232,
0.020528951659798622,
-0.02018863894045353,
0.04381025210022926,
-0.012857066467404366,
0.03835902363061905,
0.035212330520153046,
0.016753584146499634,
-0.010116816498339176,
-0.011786958202719688,
0.01199441310018301,
0.03116256184875965,
-0.035390209406614304,
-0.011448435485363007,
-0.034885723143815994,
-0.002048441907390952,
-0.014691363088786602,
0.05751281976699829,
0.05421852692961693,
-0.01800290308892727,
0.029376672580838203,
-0.020039428025484085,
0.008874945342540741,
-0.016516350209712982,
-0.012938493862748146,
0.0121390912681818,
-0.003952417057007551,
-0.035130977630615234,
-0.044049568474292755,
-0.08655380457639694,
0.000001614244752090599,
-0.03215336427092552,
0.008728303015232086,
-0.026786671951413155,
0.03873675316572189,
0.03169552981853485,
0.0008956079254858196,
-0.009288094006478786,
0.06232335790991783,
0.0032560748513787985,
-0.04078202694654465,
-0.10381589084863663,
-0.02245611697435379,
0.08075304329395294,
-0.04752199351787567,
-0.0019828053191304207,
0.01490126084536314,
0.03167704865336418,
-0.03443509712815285,
-0.017304930835962296,
0.08472244441509247,
-0.025140726938843727,
0.004810280166566372,
0.013397768139839172,
0.03990224003791809,
-0.06492752581834793,
0.03667573630809784,
0.012323079630732536,
0.0062175835482776165,
-0.0010831891559064388,
-0.03331179544329643,
0.0077744098380208015,
0.06333477050065994,
-0.027019022032618523,
0.027513321489095688,
-0.003420972265303135,
-0.050670892000198364,
-0.03652571141719818,
0.07977132499217987,
0.05425126478075981,
0.024309061467647552,
0.02557261474430561,
0.06713136285543442,
-0.03753381967544556,
-0.016063978895545006,
-0.028795164078474045,
0.009808792732656002,
0.013494168408215046,
0.021530423313379288,
0.051460523158311844,
0.028093241155147552,
-0.06934159249067307,
-0.014023516327142715,
-0.015959303826093674,
-0.029289420694112778,
-0.0008396826451644301,
0.03860555589199066,
-0.03557240962982178,
0.030396735295653343,
0.05045728012919426,
-0.08586461842060089,
-0.005500826518982649,
0.01318132784217596,
0.052959881722927094,
0.04549745097756386,
-0.048012930899858475,
-0.013656155206263065,
-0.04005855694413185,
-0.007786113303154707,
0.019649719819426537,
-0.03415614366531372,
-0.07447321712970734,
-0.012240172363817692,
-0.05033152177929878,
-0.041587911546230316,
0.0041099353693425655,
0.0090606939047575,
-0.020976409316062927,
-0.058435723185539246,
0.0007955610053613782,
0.0753750130534172,
0.0024052595254033804,
-0.06959160417318344,
-0.005596621427685022,
-0.00396001385524869,
0.022476322948932648,
0.01164483092725277,
0.017737312242388725,
0.02950001321732998,
0.007670918479561806,
0.014459329657256603,
-0.003508754074573517,
-0.02371419221162796,
0.010541263036429882,
-0.009029857814311981,
-0.06007133424282074,
0.00536161195486784,
-0.04486038163304329,
-0.007327954284846783,
0.03166333958506584,
0.03231586515903473,
-0.015548822470009327,
0.011837533675134182,
0.04356669262051582,
-0.014001702889800072,
0.012574844993650913,
-0.02806052751839161,
-0.04597548767924309,
-0.046806104481220245,
-0.037007734179496765,
-0.016039039939641953,
0.05153542384505272,
-0.029355041682720184,
0.0707702785730362,
-0.013007102534174919,
0.05038292333483696,
-0.02580174058675766,
-0.029831377789378166,
-0.02452431432902813,
0.0012729217996820807,
0.010074605233967304,
-0.009201503358781338,
0.004741605371236801,
-0.001761547988280654,
-0.02175961434841156,
-0.050676871091127396,
0.03422131389379501,
-0.06910698860883713,
0.07022035121917725,
-0.011719070374965668,
-0.0017197461565956473,
0.03193950653076172,
0.04671745374798775,
0.03310951963067055,
-0.10348982363939285,
0.019889965653419495,
-0.012841803953051567,
0.010673382319509983,
0.03580218553543091,
0.018407301977276802,
-0.036598626524209976,
0.01349333394318819,
-0.0570579394698143,
-0.012419763021171093,
0.015483519993722439,
-0.012958540581166744,
0.028522063046693802,
0.038460951298475266,
0.07738485932350159,
-0.0535145066678524,
-0.006409666500985622,
0.009465407580137253,
0.004380188882350922,
0.009786569513380527,
0.009698159992694855,
-0.03392348065972328,
0.01526730041950941,
0.04156682267785072,
-0.006664716638624668,
0.02355216071009636,
-0.04731978848576546,
0.02429136447608471,
-0.020291410386562347,
0.023999197408556938,
-0.0027322089299559593,
-0.015096167102456093,
0.0427737757563591,
0.008809100836515427,
-0.0310222078114748,
0.01781926117837429,
-0.06540968269109726,
0.06326906383037567,
0.016361186280846596,
-0.017218295484781265,
-0.053413938730955124,
-0.02473442815244198,
-0.01926327869296074,
0.0013674991205334663,
0.06946004182100296,
-0.044754769653081894,
0.03667888417840004,
0.014163289219141006,
0.007682993076741695,
-0.03527280315756798,
-0.049262888729572296,
0.003941609989851713,
-0.011217495426535606,
-0.03729445859789848,
0.0018887100741267204,
-0.004770835395902395,
0.0026050794404000044,
-0.0020473829936236143,
0.005431464873254299,
-0.012250297702848911,
-0.021899376064538956,
-0.05904540792107582,
0.03164614737033844,
0.043153781443834305,
-0.026409246027469635,
0.020089907571673393,
-0.043299492448568344,
0.06117339804768562,
-0.009128998965024948,
-0.04190073907375336,
-0.02221103198826313,
0.04348274692893028,
-0.037272531539201736,
-0.04516671225428581,
-0.07744502276182175,
-0.005746957380324602,
0.0013822627952322364,
-0.008466585539281368,
-0.03961234167218208,
0.010268261656165123,
-0.035029347985982895,
0.06531579047441483,
-0.03294451907277107,
-0.00994245894253254,
0.023449931293725967,
-0.0073761967942118645,
0.01043285708874464,
0.023968074470758438,
-0.018012864515185356,
0.03381158038973808,
-0.05925735831260681,
-0.03011186607182026,
-0.00036428088787943125,
-0.014691195450723171,
-0.01540519017726183,
0.018301552161574364,
-0.09038011729717255,
-0.011011715047061443,
0.01611263118684292,
0.0064513906836509705,
-0.03675546869635582,
0.03582111373543739,
-0.03498190641403198,
0.04325488582253456,
0.03765176236629486,
0.01358243077993393,
-0.050696440041065216,
-0.015001864172518253,
0.026654204353690147,
0.03247303143143654,
0.0512583963572979,
0.03137582540512085,
-0.009143556468188763,
0.07695399224758148,
0.0070519037544727325,
0.030251288786530495,
0.02211105078458786,
-0.028019944205880165,
-0.00846625491976738,
0.03290295600891113,
0.033660490065813065,
0.05029893293976784,
-0.029433712363243103,
-0.0038547776639461517,
0.03229377791285515,
-0.020380202680826187,
-0.049763023853302,
-0.045768480747938156,
-0.024148333817720413,
0.0648932009935379,
-0.0021032255608588457,
0.07041936367750168,
0.022752735763788223,
0.038309987634420395,
-0.015760082751512527,
0.007276395335793495,
0.004540035035461187,
0.030360566452145576,
0.04440046846866608,
0.013518589548766613,
0.012955852784216404,
0.0012202811194583774,
0.06824599206447601,
0.028498858213424683,
-0.01396417897194624,
-0.04686923325061798,
0.014252856373786926,
-0.017432034015655518,
-0.007858063094317913,
-0.02286660671234131,
0.03741288185119629,
-0.032431356608867645,
-0.017748726531863213,
0.029866032302379608,
0.009027714841067791,
-0.013547335751354694,
-0.0013878002064302564,
0.002159222960472107,
0.0013141081435605884,
0.049320004880428314,
-0.06682448834180832,
-0.000964470615144819,
-0.007394148502498865,
-0.03556240722537041,
0.009540548548102379,
0.009546871297061443,
0.030890129506587982,
0.017776764929294586,
-0.0015532635152339935,
0.05415421724319458,
-0.02427944727241993,
0.04264209792017937,
0.039693307131528854,
0.003577586729079485,
0.05123356357216835,
0.0014315081061795354,
0.014887952245771885,
-0.04619954898953438,
-0.09475745260715485,
-0.006157453637570143,
-0.04953725263476372,
0.016605421900749207,
-0.08125931024551392,
0.041644398123025894,
0.01979784481227398,
-0.02511749602854252,
-0.023696880787611008,
-0.032048191875219345,
0.04623375087976456,
0.019972676411271095,
-0.052175283432006836,
-0.018769973888993263,
-0.011779486201703548,
-0.0012225299142301083,
-0.10234417766332626,
0.025420354679226875,
0.0009849871275946498,
0.0035722050815820694,
0.004591025877743959,
-0.023643672466278076,
-0.0361003577709198,
-0.03582267463207245,
0.03125159069895744,
-0.054413799196481705,
-0.02487357333302498,
0.027270516380667686,
-0.04315296560525894,
0.04099521040916443,
0.013412469066679478,
-0.03858264908194542,
-0.062129564583301544,
-0.03834107145667076,
0.06501058489084244,
-0.008978760801255703,
0.032460447400808334,
-0.023663267493247986,
-0.0425831563770771,
-0.00902619119733572,
-0.016139943152666092,
0.01079824659973383,
0.04953501373529434,
-0.026252180337905884,
0.00920818094164133,
0.04149752855300903,
-0.01345613319426775,
-0.003692297264933586,
-0.009792771190404892,
0.018237335607409477,
-0.05571151524782181,
-0.06476320326328278,
0.0560615211725235,
0.11272013932466507,
0.011409107595682144,
-0.0028605274856090546,
-0.023573601618409157,
0.06332540512084961,
0.06716083735227585,
-0.0521622933447361,
-0.01594173163175583,
0.0021845560986548662,
0.020696189254522324,
0.03422984480857849,
0.012508314102888107,
-0.008479452691972256,
0.028717681765556335,
-0.02861081436276436,
0.01603059284389019,
0.0010000307811424136,
-0.0021865719463676214,
-0.05546686425805092,
0.028448842465877533,
-0.039946042001247406,
0.06349482387304306,
-0.03173518180847168,
-0.018863921985030174,
-0.02538851462304592,
-0.025736156851053238,
0.03367265313863754,
0.0319761261343956,
0.03126192465424538,
0.028012629598379135,
0.028852833434939384,
0.028895510360598564,
-0.043959151953458786,
0.020614271983504295,
0.04732990264892578,
-0.04036688059568405,
0.056567855179309845,
-0.002543945098295808,
-0.0002723669749684632,
0.01638452522456646,
-0.02105475403368473,
0.010792430490255356,
0.0025566674303263426,
0.039418693631887436,
0.05096505209803581,
0.06638112664222717,
-0.04987633600831032,
0.024185964837670326,
0.02707059495151043,
0.060703251510858536,
0.11542239040136337,
0.032408203929662704,
0.018666597083210945,
-0.0021139720920473337,
0.008375793695449829,
0.01713201217353344,
0.041069529950618744,
-0.014440644532442093,
0.010873686522245407,
0.0029296374414116144,
-0.01297189574688673,
-0.059741679579019547,
0.00929524376988411,
-0.01585894450545311,
-0.053602129220962524,
-0.04933668673038483,
-0.006251339800655842,
-0.013752240687608719,
0.006771329790353775,
-0.010846412740647793,
-0.027163485065102577,
-0.012572149746119976,
0.0627673789858818,
0.0058238995261490345,
-0.0261017344892025,
0.014813810586929321,
0.009411404840648174,
-0.04591601341962814,
-0.06775863468647003,
0.028227057307958603,
0.045405805110931396,
-0.011839277110993862,
0.00889470987021923,
-0.09035049378871918,
-0.09377765655517578,
0.038790009915828705,
-0.010672040283679962,
0.040041062980890274,
-0.015224142000079155,
-0.03341851383447647,
-0.006624636240303516,
0.022613350301980972,
0.04962595924735069,
-0.0022801680024713278,
0.004079434555023909,
-0.029643075540661812,
0.05928894877433777,
-0.005450656171888113,
0.043094802647829056,
-0.0022275052033364773,
0.016581477597355843,
0.08337190002202988,
-0.00908158253878355,
0.009024341590702534,
-0.0005700263427570462,
-0.006032387726008892,
-0.0044976891949772835,
0.005865984130650759,
0.054496899247169495,
0.005662315525114536,
-0.0033987541683018208,
0.00829571858048439,
-0.005108611658215523,
-0.003098868764936924,
0.08405458182096481,
0.05141134187579155,
-0.020910682156682014,
-0.02629667893052101,
-0.05780597776174545,
-0.011942064389586449,
0.008526219055056572,
0.00856242049485445,
-0.032358892261981964,
0.009055444039404392,
-0.03495180606842041,
0.01180526427924633,
0.033335115760564804,
0.031614381819963455,
-0.01849532686173916,
-0.011130441911518574,
-0.010512122884392738,
-0.022990470752120018,
0.011220456101000309,
-0.04367667809128761,
-0.002322391141206026,
-0.03272682800889015,
0.001253392081707716,
0.024502506479620934,
0.03748840466141701,
-0.036934543401002884,
-0.015370958484709263,
-0.014700382016599178,
0.012343278154730797,
-0.015080506913363934,
-0.03258609026670456,
-0.001110870041884482,
0.018008820712566376,
-0.025559380650520325,
0.01125465240329504,
0.043935734778642654,
0.04522794857621193,
-0.053640998899936676,
0.09617932140827179,
0.05566165968775749,
0.03660827875137329,
-0.006001403089612722,
-5.5193526246876274e-33,
0.0433587022125721,
-0.054681818932294846,
0.040599510073661804,
0.020384088158607483,
0.001008122111670673,
0.05741514638066292,
-0.04494618996977806,
-0.034658126533031464,
-0.07400832325220108,
0.03215394541621208,
-0.026665305718779564,
-0.028983695432543755,
-0.0004604765272233635,
0.046472471207380295,
-0.055580805987119675,
-0.0007061873329803348,
0.002556187566369772,
-0.003341380972415209,
-0.017576158046722412,
-0.025166016072034836,
-0.02220575138926506,
-0.011109389364719391,
-0.04540148377418518,
-0.036676641553640366,
0.003090744372457266,
-0.015481050126254559,
0.054954104125499725,
0.02763548493385315,
-0.0036960523575544357,
0.01095196045935154,
0.036296695470809937,
-0.013955574482679367,
0.025143899023532867,
0.025779563933610916,
0.014421087689697742,
-0.019039994105696678,
-0.011330584064126015,
-0.021974733099341393,
0.05104927718639374,
0.04511113837361336,
-0.06472127884626389,
-0.0028705389704555273,
0.048150453716516495,
0.0034487037919461727,
0.015541894361376762,
0.012059916742146015,
-0.06626645475625992,
-0.0314599834382534,
-0.039977263659238815,
-0.02091594785451889,
-0.008100224658846855,
0.014605640433728695,
0.032011453062295914,
-0.001640267320908606,
-0.03753618523478508,
-0.027506086975336075,
-0.012485550716519356,
0.024335196241736412,
0.04497591406106949,
-0.017226258292794228,
-0.008544014766812325,
0.016124458983540535,
0.002562189009040594,
0.027877379208803177,
-0.013158685527741909,
-0.010699603706598282,
0.04162922501564026,
-0.011118866503238678,
-0.07275840640068054,
0.002239145338535309,
-0.08180727809667587,
-0.011886275373399258,
-0.020924387499690056,
-0.022318629547953606,
-0.007499471306800842,
0.005081567447632551,
0.04790226370096207,
-0.004893289878964424,
0.06689479947090149,
0.021785806864500046,
-0.0059897867031395435,
-0.007080435752868652,
0.038076844066381454,
0.01129419356584549,
-0.02790122851729393,
0.008453823626041412,
0.018048202618956566,
-0.03235942870378494,
-0.047838933765888214,
-0.03592913970351219,
0.09204424172639847,
0.045061346143484116,
0.025342078879475594,
0.02180515043437481,
-0.04757178574800491,
-0.0354338176548481,
0.0619199238717556,
-0.010808225721120834,
0.03566591069102287,
0.04421485215425491,
0.059732452034950256,
0.06934717297554016,
-0.015098478645086288,
-0.04467889666557312,
-0.052539438009262085,
0.02630653791129589,
-0.01763243041932583,
-0.0348958894610405,
-0.00464450241997838,
-0.006325333379209042,
0.006462860386818647,
-0.019944552332162857,
-0.006278255023062229,
0.023432902991771698,
-0.018518123775720596,
0.034397024661302567,
-0.022130118682980537,
0.022730983793735504,
0.04378997161984444,
-0.00469550583511591,
0.06150411069393158,
-0.007064106408506632,
0.0074523938819766045,
-0.026667604222893715,
-0.05946657806634903,
-0.0461447574198246,
-0.009389711543917656,
-0.005882012192159891,
-0.008244597353041172,
-0.007044390309602022,
0.05496785789728165,
0.03542516753077507,
2.621862904561567e-7,
0.039348673075437546,
0.006325172260403633,
-0.06616175919771194,
-0.12011152505874634,
0.030811795964837074,
-0.03650008514523506,
-0.02986525557935238,
0.00037730796611867845,
-0.06084064021706581,
0.0019569278229027987,
0.02474510669708252,
-0.0003694458573590964,
0.013242073357105255,
-0.05323613062500954,
0.0026691798120737076,
0.007475685328245163,
-0.014098799787461758,
0.004042802378535271,
0.036188650876283646,
0.026885993778705597,
-0.028917204588651657,
-0.018141314387321472,
-0.07434345036745071,
-0.01212996058166027,
0.05317392572760582,
-0.024328768253326416,
-0.023848075419664383,
-0.018486376851797104,
-0.018644146621227264,
-0.017640626057982445,
0.04174433648586273,
-0.06271880120038986,
0.06152336671948433,
0.08165667951107025,
-0.03764285519719124,
-0.02291598916053772,
0.004826026037335396,
0.023560743778944016,
0.017497364431619644,
0.01863778755068779,
0.010577577166259289,
-0.03337428718805313,
0.05255648493766785,
-0.019258372485637665,
-0.0163972657173872,
0.04070931673049927,
-0.05873282998800278,
-0.021959980949759483,
0.025969156995415688,
0.03354509174823761,
-0.03697742149233818,
0.05145025625824928,
-0.0322577990591526,
0.0610111840069294,
0.01138045359402895,
-0.0037909559905529022,
-0.07168503105640411,
0.028097137808799744,
-0.041723739355802536,
-0.07429889589548111,
-0.02592458203434944,
-0.021000606939196587,
-0.0011928874300792813,
-0.022418053820729256,
0.021601630374789238,
0.006520883645862341,
-0.028920158743858337,
1.9196027082906907e-34,
-0.03125149384140968,
-0.017645789310336113,
0.04485870525240898,
-0.038408730179071426,
-0.028093038126826286,
-0.061822209507226944,
-0.04167203605175018,
0.09283965826034546,
0.01886596716940403,
-0.051521990448236465,
-0.0019360464066267014
] | {
"ds_index": 22,
"similar_dg_indices": [
754745,
598892,
1034734,
744221,
240078,
125014,
1066514,
899882,
400358,
1030831,
193002,
106659,
85792,
644811,
1037803,
855491,
116801,
379904,
1178778,
616908
]
} |
A 42-year-old woman is in the hospital recovering from a cholecystectomy performed 3 days ago that was complicated by cholangitis. She is being treated with IV piperacillin-tazobactam. She calls the nurse to her room because she says that her heart is racing. She also demands that someone come in to clean the pile of garbage off of the floor because it is attracting flies. Her pulse is 112/min, respiratory rate is 20/min, temperature is 38.0°C (100.4°F), and blood pressure is 150/90 mm Hg. On physical examination, the patient appears sweaty, distressed, and unable to remain still. She is oriented to person, but not place or time. Palpation of the abdomen shows no tenderness, rebound, or guarding. Which of the following is the most likely diagnosis in this patient? | Delirium tremens | {
"A": "Acute cholangitis",
"B": "Alcoholic hallucinosis",
"C": "Delirium tremens",
"D": "Hepatic encephalopathy"
} | step1 | C | [
"year old woman",
"hospital recovering",
"cholecystectomy performed 3 days",
"complicated",
"cholangitis",
"treated with IV piperacillin-tazobactam",
"calls",
"nurse",
"room",
"heart",
"racing",
"demands",
"clean",
"pile",
"garbage",
"floor",
"flies",
"pulse",
"min",
"respiratory rate",
"20 min",
"temperature",
"100 4F",
"blood pressure",
"90 mm Hg",
"physical examination",
"patient appears sweaty",
"distressed",
"unable to",
"oriented to person",
"not place",
"time",
"Palpation of",
"abdomen shows",
"tenderness",
"guarding",
"following",
"most likely diagnosis",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 42-year-old woman is in the hospital recovering from a cholecystectomy performed 3 days ago that was complicated by cholangitis. She is being treated with IV piperacillin-tazobactam. She calls the nurse to her room because she says that her heart is racing. She also demands that someone come in to clean the pile of garbage off of the floor because it is attracting flies. Her pulse is 112/min, respiratory rate is 20/min, temperature is 38.0°C (100.4°F), and blood pressure is 150/90 mm Hg. On physical examination, the patient appears sweaty, distressed, and unable to remain still. She is oriented to person, but not place or time. Palpation of the abdomen shows no tenderness, rebound, or guarding. Which of the following is the most likely diagnosis in this patient?
Choose one of the following::
A. Acute cholangitis
B. Alcoholic hallucinosis
C. Delirium tremens
D. Hepatic encephalopathy | [
0.028323384001851082,
-0.011095906607806683,
0.03149113804101944,
-0.01254625990986824,
0.01600380428135395,
-0.010064451023936272,
-0.03688729554414749,
0.06289567798376083,
0.0026051511522382498,
-0.01513582095503807,
0.00717872055247426,
0.021426210179924965,
0.005126239266246557,
-0.026916861534118652,
0.0020104905124753714,
0.011825361289083958,
-0.014116124249994755,
0.005980629939585924,
-0.03526166453957558,
0.045450955629348755,
-0.03264809399843216,
-0.006524795200675726,
0.024636611342430115,
0.01102394051849842,
0.08541998267173767,
0.0013892317656427622,
0.026719573885202408,
-0.03152792528271675,
0.024578897282481194,
-0.035497330129146576,
-0.010919108055531979,
-0.03424176946282387,
-0.03996272385120392,
-0.03413283824920654,
0.0000016381387695219018,
-0.009639881551265717,
-0.0015674785245209932,
-0.02139248326420784,
0.0031790912616997957,
-0.09405563026666641,
0.025618601590394974,
-0.08435682952404022,
0.0798460841178894,
-0.023505061864852905,
-0.06627921015024185,
-0.10312174260616302,
-0.020986128598451614,
0.08191536366939545,
-0.01793702319264412,
0.0031404232140630484,
0.013229257427155972,
0.03993256390094757,
-0.06162087991833687,
0.006366975139826536,
0.03486661985516548,
-0.025731494650244713,
-0.028229059651494026,
-0.03672812506556511,
0.033788856118917465,
0.034021008759737015,
0.010781371966004372,
0.027606766670942307,
0.03532066196203232,
0.04654953256249428,
-0.036345262080430984,
0.007145139388740063,
-0.009130056947469711,
-0.011752056889235973,
0.02085927315056324,
-0.006217390764504671,
-0.040095940232276917,
0.01834680140018463,
0.05543484166264534,
0.06809365004301071,
-0.05708431452512741,
-0.00448704045265913,
0.03587732091546059,
-0.03289857134222984,
0.019359087571501732,
-0.018520556390285492,
0.10130825638771057,
0.07422914355993271,
-0.006750705651938915,
0.039520733058452606,
-0.032535988837480545,
-0.028340376913547516,
0.007568505592644215,
-0.009156174026429653,
-0.0059882341884076595,
-0.042805757373571396,
0.009962436743080616,
-0.05252870172262192,
0.0183545108884573,
0.02794785052537918,
-0.07182275503873825,
-0.0016917187022045255,
0.014954835176467896,
-0.003443381516262889,
0.00011566764442250133,
-0.06882867217063904,
-0.0675719752907753,
-0.02620098553597927,
-0.019260384142398834,
0.019070390611886978,
-0.012608504854142666,
-0.033528514206409454,
-0.062060754746198654,
0.008671367540955544,
-0.0478803925216198,
0.04967176541686058,
-0.0007773035322315991,
0.03752792254090309,
-0.012061981484293938,
0.0007487016846425831,
0.08720783144235611,
-0.028769079595804214,
-0.03950054198503494,
-0.06692958623170853,
-0.01724371872842312,
0.06230883672833443,
-0.010582620278000832,
0.048162758350372314,
0.05659342557191849,
0.014088981784880161,
0.022352034226059914,
0.039777208119630814,
0.021736470982432365,
-0.01118452101945877,
0.00004046704270876944,
0.021242894232273102,
0.006452971138060093,
-0.019546426832675934,
-0.021097948774695396,
-0.015151402913033962,
0.010603880509734154,
0.01913248747587204,
0.004478911403566599,
0.06339995563030243,
-0.03823819383978844,
0.001090747071430087,
0.00761228846386075,
-0.058193761855363846,
0.058360081166028976,
0.03183085471391678,
-0.024682996794581413,
0.04988543316721916,
0.03412189707159996,
-0.021642930805683136,
0.014992746524512768,
0.03293534740805626,
-0.021930551156401634,
0.002675829455256462,
-0.03835443779826164,
-0.01715327426791191,
-0.034218087792396545,
0.043166786432266235,
-0.008501973003149033,
-0.015246354974806309,
-0.0326358824968338,
-0.06201758235692978,
0.017650295048952103,
-0.024050088599324226,
0.0694897323846817,
-0.019869143143296242,
-0.023272091522812843,
0.01837117224931717,
0.02715766802430153,
0.05985322967171669,
-0.018426667898893356,
0.05280459299683571,
-0.01713724061846733,
0.04601944610476494,
0.056714288890361786,
0.0193057581782341,
-0.004773652646690607,
0.028779659420251846,
-0.0041117314249277115,
-0.059618525207042694,
-0.01272183284163475,
-0.03323718532919884,
0.0036393385380506516,
0.07300969958305359,
0.011400348506867886,
-0.03300664201378822,
-0.012913050130009651,
-0.019877051934599876,
-0.0009502348257228732,
-0.02437920682132244,
0.0009190067648887634,
-0.03945227712392807,
-0.029727226123213768,
0.009504971094429493,
0.0009119698661379516,
0.01567929796874523,
0.001958326669409871,
0.013104426674544811,
-0.03482441231608391,
-0.07283789664506912,
0.02831943705677986,
0.004350044298917055,
-0.04185078293085098,
-0.008070415817201138,
0.006208276376128197,
0.05684228613972664,
-0.02948138490319252,
0.07185066491365433,
0.014553509652614594,
0.002175403293222189,
0.05429960414767265,
-0.017256876453757286,
0.005148693453520536,
-0.0072245849296450615,
0.025897199288010597,
-0.01331847719848156,
0.01643713191151619,
0.06901741027832031,
0.013068417087197304,
-0.01471311878412962,
-0.06462180614471436,
0.03464849665760994,
-0.014614338055253029,
0.02269541472196579,
0.009515553712844849,
0.013167878612875938,
-0.04176513850688934,
-0.01405929122120142,
-0.005377068649977446,
-0.007009820081293583,
0.01734546571969986,
-0.08023951947689056,
0.018594874069094658,
0.010050718672573566,
-0.05265560373663902,
-0.012339922599494457,
-0.028525933623313904,
0.05058615282177925,
-0.004486824385821819,
-0.03588009998202324,
-0.019157079979777336,
0.08009393513202667,
-0.031979139894247055,
-0.027640188112854958,
-0.022013721987605095,
-0.030616194009780884,
0.01757611148059368,
-0.035836536437273026,
-0.022291529923677444,
0.030580876395106316,
-0.03755143657326698,
0.061889827251434326,
-0.009625512175261974,
0.004041158594191074,
-0.01905994489789009,
-0.004803485237061977,
0.012353972531855106,
0.00829493161290884,
0.0024538557045161724,
0.023100046440958977,
-0.025806184858083725,
-0.07632552832365036,
-0.030389631167054176,
0.00754149816930294,
0.03157523646950722,
-0.04191362485289574,
-0.02050214447081089,
-0.02371363341808319,
0.012333842925727367,
-0.029673144221305847,
-0.018221503123641014,
0.0423433780670166,
-0.02709626965224743,
-0.017152361571788788,
0.030858945101499557,
0.013862596824765205,
-0.011599637567996979,
-0.028919309377670288,
-0.011731239035725594,
0.05562662333250046,
0.04150455445051193,
-0.010561799630522728,
0.024453571066260338,
0.03991485387086868,
0.004666367080062628,
0.05072852969169617,
0.005208889022469521,
0.00892065092921257,
-0.014242980629205704,
0.005110868718475103,
0.0550776906311512,
-0.03414161875844002,
0.009332060813903809,
0.030550602823495865,
0.00794256292283535,
-0.047418273985385895,
-0.06474822014570236,
-0.049309127032756805,
-0.067669577896595,
0.06642051786184311,
-0.009302743710577488,
0.07276607304811478,
-0.024117546156048775,
0.024828659370541573,
-0.025665482506155968,
-0.0061034238897264,
-0.009222753345966339,
0.046193987131118774,
0.0405229851603508,
-0.006451461464166641,
-0.005567512474954128,
0.059939175844192505,
0.03194292634725571,
-0.030945688486099243,
-0.02181629091501236,
-0.036515478044748306,
-0.012245007790625095,
-0.016697583720088005,
-0.03783430904150009,
-0.018685709685087204,
0.035633645951747894,
0.034434154629707336,
0.046932097524404526,
0.020555851981043816,
-0.006125725340098143,
-0.015206909738481045,
0.031325217336416245,
-0.005511110182851553,
-0.01098216138780117,
-0.0039135487750172615,
-0.01225375384092331,
-0.026139209046959877,
-0.00006140305777080357,
0.0016292242798954248,
0.025446970015764236,
0.025632711127400398,
0.0330176018178463,
-0.04695487022399902,
-0.049358151853084564,
0.020921075716614723,
-0.04484327882528305,
0.020809611305594444,
0.032407019287347794,
-0.041964709758758545,
0.019210128113627434,
0.05756146460771561,
-0.0061613889411091805,
-0.013227509334683418,
-0.05439990758895874,
-0.0023523052223026752,
0.003573313122615218,
0.025472400709986687,
-0.10188978165388107,
0.0018270565196871758,
0.002734275534749031,
-0.028450891375541687,
-0.03781808912754059,
-0.034185219556093216,
0.05260797590017319,
0.06493724882602692,
-0.0186017993837595,
-0.01472614798694849,
-0.01427612267434597,
0.024858884513378143,
0.016786333173513412,
0.0449809767305851,
-0.0026920686941593885,
0.02617071568965912,
0.013722041621804237,
-0.0156431682407856,
-0.029479626566171646,
-0.015531904995441437,
-0.03565671667456627,
-0.001878857729025185,
-0.0449320413172245,
0.07216805964708328,
-0.009417062625288963,
-0.00013684695295523852,
0.0014975627418607473,
-0.07698546350002289,
-0.12152248620986938,
-0.03764542564749718,
0.048716723918914795,
-0.010708744637668133,
0.006369345355778933,
-0.015580704435706139,
-0.02250930294394493,
0.023987889289855957,
0.014788865111768246,
-0.020813027396798134,
0.037360209971666336,
0.046319544315338135,
-0.01417123805731535,
0.013585535809397697,
-0.015642333775758743,
-0.03773980587720871,
0.032108549028635025,
0.02521621435880661,
0.03464322164654732,
-0.048661913722753525,
0.009362563490867615,
0.0728219524025917,
-0.014683558605611324,
-0.0016014693537726998,
-0.008259989321231842,
0.09355895966291428,
0.041921794414520264,
-0.011868775822222233,
-0.05746180936694145,
-0.015953347086906433,
0.021339917555451393,
0.02276693284511566,
0.01615476980805397,
-0.02651471272110939,
0.047332026064395905,
0.0158078670501709,
0.024257682263851166,
-0.03921923413872719,
0.014364032074809074,
-0.037252865731716156,
-0.0006609722040593624,
-0.05960232391953468,
0.0863136500120163,
0.014758411794900894,
-0.00979037769138813,
-0.0702173188328743,
-0.00875631533563137,
-0.01197283435612917,
0.04898829385638237,
0.0507022887468338,
0.024200044572353363,
0.03151646628975868,
0.0071068271063268185,
-0.06602250039577484,
0.05081366002559662,
0.048989251255989075,
-0.0019521458307281137,
0.022390227764844894,
-0.016692351549863815,
-0.0037083616480231285,
-0.028291942551732063,
-0.04552997276186943,
0.005667082034051418,
-0.003526445245370269,
0.06655357778072357,
0.04977329820394516,
0.026460742577910423,
0.022623373195528984,
0.018950054422020912,
-0.02548488788306713,
0.012842189520597458,
0.08077138662338257,
0.029670145362615585,
-0.02603091485798359,
0.0191261637955904,
0.03720643371343613,
0.03969726338982582,
0.019487006589770317,
0.03092445246875286,
-0.005860461853444576,
0.05909847468137741,
0.012312275357544422,
-0.008068902418017387,
0.023960093036293983,
-0.019705869257450104,
-0.06347576528787613,
0.028780803084373474,
-0.09827372431755066,
-0.11146435886621475,
-0.003985644783824682,
0.01110977865755558,
-0.010954950004816055,
-0.018210072070360184,
0.01832396909594536,
-0.001875653280876577,
-0.0007284378516487777,
0.011114964261651039,
-0.0042948112823069096,
-0.049627672880887985,
-0.07081789523363113,
0.019114764407277107,
0.0036463404539972544,
-0.0016516397008672357,
-0.009568436071276665,
-0.04630270227789879,
-0.09728392958641052,
0.01897616498172283,
-0.0349411778151989,
0.04304590821266174,
-0.010728118941187859,
-0.004578200168907642,
-0.03581944480538368,
-0.002015157602727413,
0.003573063062503934,
0.03016558103263378,
-0.008806318044662476,
-0.03850535675883293,
-0.011898677796125412,
-0.0013468486722558737,
0.03434770926833153,
0.0035932217724621296,
-0.026174383237957954,
0.04337017610669136,
0.016880210489034653,
0.044004011899232864,
-0.01922338828444481,
0.004284340888261795,
-0.007799786981195211,
0.047252628952264786,
0.02638794295489788,
-0.018453404307365417,
-0.014677101746201515,
0.024778392165899277,
0.027362095192074776,
-0.02906046435236931,
0.03898873180150986,
0.04756733402609825,
-0.03371404856443405,
-0.04603609815239906,
-0.058884963393211365,
0.0378996804356575,
0.00909925065934658,
0.005240883678197861,
-0.009940789081156254,
-0.016542717814445496,
-0.02451896294951439,
0.019854426383972168,
0.034034837037324905,
-0.01864289864897728,
0.01331025455147028,
0.009173033758997917,
0.10562955588102341,
-0.04659648239612579,
-0.009220210835337639,
-0.04386776685714722,
-0.013816176913678646,
-0.04566137492656708,
0.016050629317760468,
0.015017777681350708,
0.007831997238099575,
0.034560613334178925,
-0.01758936233818531,
-0.007850945927202702,
0.01785733364522457,
0.0014920724788680673,
-0.0024955205153673887,
-0.05714672431349754,
-0.035305485129356384,
0.03269173949956894,
0.020266298204660416,
0.012395225465297699,
0.012486597523093224,
-0.03939719498157501,
0.055243682116270065,
0.003957055974751711,
0.029045404866337776,
0.0167642030864954,
-4.810254391995299e-33,
0.03483879566192627,
-0.032544974237680435,
0.025635402649641037,
-0.05434809625148773,
0.001892460510134697,
0.07515779882669449,
-0.048225268721580505,
-0.024396447464823723,
-0.07131969928741455,
0.0062038591131567955,
-0.04126347601413727,
-0.0037491722032427788,
0.025170885026454926,
0.07840666174888611,
0.014646383002400398,
-0.09066971391439438,
-0.01670396514236927,
0.027930594980716705,
-0.01675344631075859,
-0.015283913351595402,
-0.00019928444817196578,
-0.0025791809894144535,
-0.019879650324583054,
-0.0613364614546299,
-0.0025501928757876158,
-0.008912377059459686,
0.03742970898747444,
0.006336303427815437,
-0.01826527528464794,
-0.021822255104780197,
-0.013960625045001507,
-0.022824209183454514,
0.042313072830438614,
-0.02526708133518696,
-0.01867504045367241,
-0.011002142913639545,
0.036389417946338654,
-0.08403132855892181,
0.03661089017987251,
0.015126161277294159,
-0.019869593903422356,
-0.05128432437777519,
0.023946961387991905,
0.020838957279920578,
0.05605702102184296,
-0.025151250883936882,
0.003273970214650035,
-0.028487669304013252,
0.031056758016347885,
-0.044773608446121216,
0.010444517247378826,
0.032580457627773285,
0.019340218976140022,
-0.057491231709718704,
0.00818855781108141,
-0.017005259171128273,
-0.009316177107393742,
0.015285629779100418,
-0.004505579825490713,
-0.02919136732816696,
-0.030954208225011826,
0.017507145181298256,
-0.014167181216180325,
-0.016514236107468605,
-0.04806022718548775,
0.04425560683012009,
0.04294374957680702,
0.024294430390000343,
-0.05645604431629181,
0.061634428799152374,
-0.10235429555177689,
0.02866588719189167,
-0.002606714377179742,
-0.09358052909374237,
-0.032408442348241806,
-0.027249379083514214,
0.07182696461677551,
0.016816716641187668,
-0.02475390024483204,
-0.014212872833013535,
-0.025142526254057884,
-0.02247334085404873,
-0.022888055071234703,
-0.04019150137901306,
-0.0032924837432801723,
0.02803886868059635,
0.010851625353097916,
-0.03322960436344147,
0.009003733284771442,
-0.013126385398209095,
0.13896219432353973,
0.02883242815732956,
0.03471413999795914,
0.007449859753251076,
0.011205961927771568,
-0.05533710867166519,
0.05755232647061348,
0.03941668942570686,
0.034133076667785645,
0.002023609820753336,
0.08042103052139282,
0.004241244401782751,
0.0039935484528541565,
0.02796919457614422,
-0.011666502803564072,
0.043682441115379333,
-0.02302941121160984,
-0.009189052507281303,
0.018314117565751076,
0.0017728775274008512,
0.022112514823675156,
-0.0254324022680521,
-0.01249085832387209,
0.06175202503800392,
0.00048607183271087706,
0.02408549003303051,
0.01942942477762699,
0.01859024167060852,
0.02758035622537136,
0.04273725673556328,
0.0008205660269595683,
0.05148862674832344,
-0.010053225792944431,
-0.000563731009606272,
-0.033119622617959976,
-0.049846284091472626,
-0.011182512156665325,
0.05017741024494171,
-0.04484373331069946,
-0.049910079687833786,
0.02863866090774536,
0.0062655056826770306,
2.6062772917612165e-7,
0.052963562309741974,
-0.009872146882116795,
0.0059901135973632336,
-0.07557480037212372,
-0.013843625783920288,
-0.011675073765218258,
-0.005729751195758581,
-0.004022310487926006,
-0.006562383379787207,
-0.04183270409703255,
-0.003916142974048853,
0.019202731549739838,
-0.01017739623785019,
0.007071421016007662,
0.06809952855110168,
-0.03255029767751694,
-0.016959410160779953,
0.02480080910027027,
0.017021089792251587,
-0.048462484031915665,
-0.005295283626765013,
-0.03537749871611595,
-0.08275853842496872,
-0.03869031369686127,
0.015854021534323692,
0.03078833967447281,
0.0007120974478311837,
-0.057766351848840714,
-0.03845634311437607,
0.013781296089291573,
-0.031377241015434265,
0.015402654185891151,
0.008715047501027584,
0.007705189287662506,
-0.02646111510694027,
-0.039023514837026596,
0.05968722701072693,
0.05906345322728157,
-0.024844154715538025,
0.03507194295525551,
0.015750151127576828,
-0.0017501680413261056,
0.006339692510664463,
0.0026844474487006664,
0.05542236566543579,
0.014592667110264301,
-0.050726957619190216,
0.04899662733078003,
0.025494985282421112,
0.002986096777021885,
-0.01991007663309574,
-0.002632839372381568,
0.012035720981657505,
0.08246513456106186,
0.008227700367569923,
0.07275165617465973,
-0.05442918464541435,
-0.0446586050093174,
0.010847281664609909,
-0.01645727828145027,
0.0010173782939091325,
-0.03567096218466759,
-0.005946289282292128,
-0.03612755984067917,
0.07731941342353821,
-0.07567304372787476,
-0.06376969814300537,
1.966833933553486e-34,
-0.010900845751166344,
-0.02092617377638817,
-0.0013815455604344606,
-0.042509473860263824,
-0.014253530651330948,
-0.04672306030988693,
0.013174623250961304,
0.03204956278204918,
0.024882033467292786,
-0.038469795137643814,
-0.014100473374128342
] | {
"ds_index": 23,
"similar_dg_indices": [
129873,
525738,
771091,
1105879,
535120,
13611,
933722,
258762,
690368,
997865,
693938,
1020925,
473521,
675058,
81659,
114800,
1025652,
1151251,
751655,
155626
]
} |
A 48-year-old woman comes to the emergency department because of a photosensitive blistering rash on her hands, forearms, and face for 3 weeks. The lesions are not itchy. She has also noticed that her urine has been dark brown in color recently. Twenty years ago, she was successfully treated for Coats disease of the retina via retinal sclerotherapy. She is currently on hormonal replacement therapy for perimenopausal symptoms. Her aunt and sister have a history of a similar skin lesions. Examination shows multiple fluid-filled blisters and oozing erosions on the forearms, dorsal side of both hands, and forehead. There is hyperpigmented scarring and patches of bald skin along the sides of the blisters. Laboratory studies show a normal serum ferritin concentration. Which of the following is the most appropriate next step in management to induce remission in this patient? | Begin phlebotomy therapy | {
"A": "Pursue liver transplantation",
"B": "Begin oral thalidomide therapy",
"C": "Begin phlebotomy therapy",
"D": "Begin oral hydroxychloroquine therapy"
} | step2&3 | C | [
"48 year old woman",
"emergency department",
"of",
"photosensitive blistering",
"hands",
"forearms",
"face",
"weeks",
"lesions",
"not itchy",
"urine",
"dark brown",
"color recently",
"Twenty years",
"treated",
"Coats",
"retina",
"retinal sclerotherapy",
"currently",
"hormonal replacement",
"perimenopausal symptoms",
"aunt",
"sister",
"history of",
"similar skin lesions",
"Examination shows multiple fluid filled blisters",
"erosions",
"forearms",
"dorsal side",
"hands",
"forehead",
"hyperpigmented scarring",
"patches",
"bald skin",
"sides",
"blisters",
"Laboratory studies show",
"normal serum ferritin concentration",
"following",
"most appropriate next step",
"management to induce remission in",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 48-year-old woman comes to the emergency department because of a photosensitive blistering rash on her hands, forearms, and face for 3 weeks. The lesions are not itchy. She has also noticed that her urine has been dark brown in color recently. Twenty years ago, she was successfully treated for Coats disease of the retina via retinal sclerotherapy. She is currently on hormonal replacement therapy for perimenopausal symptoms. Her aunt and sister have a history of a similar skin lesions. Examination shows multiple fluid-filled blisters and oozing erosions on the forearms, dorsal side of both hands, and forehead. There is hyperpigmented scarring and patches of bald skin along the sides of the blisters. Laboratory studies show a normal serum ferritin concentration. Which of the following is the most appropriate next step in management to induce remission in this patient?
Choose one of the following::
A. Pursue liver transplantation
B. Begin oral thalidomide therapy
C. Begin phlebotomy therapy
D. Begin oral hydroxychloroquine therapy | [
0.017028572037816048,
-0.05868125706911087,
0.03010142222046852,
-0.0348997637629509,
0.013175738975405693,
0.009672320447862148,
-0.022045934572815895,
0.020916102454066277,
0.08091119676828384,
0.022595753893256187,
0.025330781936645508,
0.03623022884130478,
0.016971077769994736,
-0.025312969461083412,
-0.02816617861390114,
0.04381530359387398,
-0.00792731437832117,
0.022834505885839462,
-0.0071144746616482735,
0.006152843590825796,
0.030899766832590103,
0.006530471611768007,
0.05055242031812668,
-0.002867758274078369,
0.008405650965869427,
-0.02208040840923786,
0.005895896814763546,
-0.03572066128253937,
-0.013871397823095322,
0.011543065309524536,
0.016027001664042473,
-0.015564657747745514,
0.003311026841402054,
-0.02684006094932556,
0.000001958298753379495,
0.01656622812151909,
0.01730562187731266,
-0.02871166542172432,
0.12908317148685455,
-0.029874933883547783,
-0.010352146811783314,
-0.06479910016059875,
0.05765615776181221,
-0.01263600867241621,
-0.00043943943455815315,
-0.06904866546392441,
-0.008448571898043156,
0.09459899365901947,
-0.0660705417394638,
-0.012631273828446865,
0.0035315079148858786,
0.03141321241855621,
0.07205259799957275,
0.06086744740605354,
0.07257083058357239,
0.00982468668371439,
-0.03029894083738327,
-0.009545530192553997,
0.02886199951171875,
-0.011462812311947346,
0.003705692710354924,
0.014177867211401463,
0.030891550704836845,
-0.05310314521193504,
-0.02585677057504654,
-0.05144070088863373,
0.060960669070482254,
-0.029732512310147285,
-0.00858799833804369,
-0.006064853630959988,
0.022656621411442757,
-0.01045304350554943,
-0.008544436655938625,
0.07265310734510422,
-0.013113602995872498,
0.0378849171102047,
0.03398871049284935,
0.005140249617397785,
-0.016902271658182144,
-0.0063103255815804005,
-0.006058990024030209,
0.023427283391356468,
-0.01255324948579073,
0.09157899022102356,
0.026151305064558983,
0.03051307424902916,
-0.01767825521528721,
-0.0012191756395623088,
0.010117908008396626,
-0.011640484444797039,
0.07501769065856934,
-0.0695338249206543,
-0.03029147908091545,
0.06954807043075562,
-0.08903775364160538,
-0.005658087320625782,
-0.029926979914307594,
0.014815677888691425,
0.035737909376621246,
-0.02610068954527378,
0.030672751367092133,
-0.01885317824780941,
-0.03691954165697098,
0.04565468057990074,
-0.06821687519550323,
-0.041396621614694595,
0.0038450041320174932,
-0.013604997657239437,
0.01627562753856182,
0.057624801993370056,
0.012494942173361778,
0.019695350900292397,
-0.009957972913980484,
-0.01475220825523138,
0.05214548110961914,
-0.015480346977710724,
-0.030863212421536446,
-0.006836943794041872,
0.02133326791226864,
0.021488210186362267,
0.010580557398498058,
-0.011588211171329021,
0.007686502765864134,
0.010837766341865063,
-0.0372878797352314,
0.03086937963962555,
0.038802459836006165,
0.005642689764499664,
-0.013345140032470226,
0.009685754776000977,
0.008525984361767769,
-0.015899788588285446,
-0.059120167046785355,
-0.023211149498820305,
-0.03366291522979736,
0.01461754459887743,
-0.010966992005705833,
0.059577204287052155,
0.015093623660504818,
0.029108189046382904,
-0.026760021224617958,
-0.04503793269395828,
-0.0302966870367527,
-0.017236100509762764,
-0.02229890786111355,
0.020696420222520828,
0.028687115758657455,
0.006801865994930267,
0.007965059019625187,
0.007323208265006542,
-0.0426269993185997,
-0.020743606612086296,
-0.05666447430849075,
0.011220959015190601,
0.012372245080769062,
0.01761414296925068,
-0.010176965035498142,
-0.014424762688577175,
0.009329946711659431,
0.010728046298027039,
0.013913917355239391,
-0.026238836348056793,
0.0679689273238182,
-0.02841654233634472,
-0.00954077672213316,
0.061202555894851685,
0.032330844551324844,
0.04125908762216568,
-0.028150271624326706,
0.0027916780672967434,
-0.006599524989724159,
-0.007770882453769445,
0.01699242927134037,
-0.017204970121383667,
-0.07682403177022934,
0.0014011301100254059,
-0.0038199028931558132,
-0.0172959603369236,
-0.014093337580561638,
0.021242324262857437,
0.044491611421108246,
0.009440146386623383,
0.09096057713031769,
-0.056467510759830475,
-0.042040951550006866,
0.06843625754117966,
-0.006279426161199808,
-0.03854868561029434,
-0.016169993206858635,
0.0374673567712307,
-0.01916879415512085,
-0.01551100891083479,
0.013443086296319962,
0.0263972207903862,
-0.04105142503976822,
0.043896257877349854,
-0.03031574934720993,
-0.07016567140817642,
0.020735684782266617,
0.012269292958080769,
0.023698195815086365,
-0.0667642131447792,
-0.042546048760414124,
0.11210965365171432,
-0.04167540743947029,
0.048514120280742645,
0.005132809281349182,
0.03383485972881317,
0.006479837000370026,
-0.03910760581493378,
-0.04222850129008293,
-0.013051069341599941,
0.06887674331665039,
-0.05612483620643616,
0.015299485065042973,
0.0317247211933136,
-0.03011963702738285,
0.03223521634936333,
-0.04847119003534317,
0.009067995473742485,
-0.021354347467422485,
0.0020786519162356853,
-0.028566300868988037,
0.007737613748759031,
-0.03429655358195305,
-0.03420520946383476,
-0.010797454044222832,
-0.013492930680513382,
-0.04159418120980263,
-0.09530047327280045,
0.0031026017386466265,
-0.009503023698925972,
-0.031165022403001785,
0.01806362345814705,
-0.05396699160337448,
0.013694199733436108,
0.05039053037762642,
-0.00964320544153452,
-0.016661211848258972,
0.01769767515361309,
-0.014865349046885967,
-0.013905391097068787,
-0.04347364231944084,
0.001500464859418571,
0.015659058466553688,
-0.042527083307504654,
-0.07621961832046509,
0.010491066612303257,
-0.02652036026120186,
0.05168749392032623,
-0.02641208842396736,
-0.01308872364461422,
0.0059138135984539986,
0.04117785394191742,
-0.0751420259475708,
0.05712168291211128,
-0.13125276565551758,
-0.04320391267538071,
-0.08557730913162231,
0.017445582896471024,
-0.013058542273938656,
0.012514608912169933,
0.01157870888710022,
-0.051791753619909286,
-0.006243052892386913,
-0.022433239966630936,
-0.005361048970371485,
0.0035928336437791586,
-0.0033608090598136187,
0.04083354398608208,
-0.03668832406401634,
-0.008247715421020985,
0.01971219852566719,
0.03094981610774994,
-0.03287201002240181,
-0.042860228568315506,
-0.025472773239016533,
0.07668008655309677,
0.04207611083984375,
0.009533151984214783,
0.0017514537321403623,
-0.04232906922698021,
-0.018774695694446564,
0.028556838631629944,
-0.009463077411055565,
-0.031108807772397995,
-0.014774095267057419,
0.01725112274289131,
0.013449478894472122,
0.006858104839920998,
-0.036623645573854446,
0.04230711609125137,
-0.00315396161749959,
0.0041009290143847466,
-0.011499547399580479,
-0.008245470933616161,
-0.03576115891337395,
-0.02475188858807087,
-0.0214809812605381,
0.09144071489572525,
-0.020317209884524345,
0.03669770434498787,
-0.03302817791700363,
-0.047078073024749756,
-0.02101399376988411,
-0.030183635652065277,
0.020503563806414604,
-0.008851457387208939,
0.013315653428435326,
0.003615122986957431,
0.017058372497558594,
0.01934630610048771,
-0.023316433653235435,
0.0003129063989035785,
0.012652178294956684,
-0.01139324065297842,
-0.010592693462967873,
-0.055700402706861496,
0.06380289793014526,
-0.00938678253442049,
-0.013051973655819893,
0.0133005790412426,
0.02327967993915081,
0.039092302322387695,
0.027737678959965706,
-0.03284137323498726,
-0.018528766930103302,
0.008289335295557976,
-0.05134740099310875,
-0.02167809195816517,
-0.01932854764163494,
-0.05102349817752838,
0.011119615286588669,
0.028392953798174858,
-0.0011258410522714257,
0.01939575746655464,
0.024376554414629936,
-0.02840757556259632,
0.011225798167288303,
0.051957473158836365,
0.027856554836034775,
0.017370829358696938,
0.020215440541505814,
-0.013247823342680931,
0.07382350414991379,
-0.034774474799633026,
-0.060834672302007675,
0.05368410050868988,
0.018103720620274544,
0.049795325845479965,
-0.03453318774700165,
0.05690816044807434,
-0.010213070549070835,
-0.010512443259358406,
0.012639529071748257,
0.014664234593510628,
-0.004010253120213747,
0.008969414047896862,
-0.042680829763412476,
0.02495606057345867,
0.01618494652211666,
0.03100631758570671,
0.002511839149519801,
-0.04657350853085518,
-0.006170455366373062,
0.0117772426456213,
0.003474450670182705,
-0.04243104159832001,
0.025844773277640343,
-0.04118325933814049,
0.044819194823503494,
-0.048811111599206924,
-0.02149743214249611,
0.011879842728376389,
-0.003186232876032591,
0.0019461935153231025,
-0.009243235923349857,
-0.03249422088265419,
-0.08748450875282288,
-0.06828693300485611,
0.034927017986774445,
-0.027908941730856895,
0.06296956539154053,
-0.02875569649040699,
-0.06827369332313538,
0.028300058096647263,
-0.01824410818517208,
0.011655369773507118,
0.0922388955950737,
-0.014559468254446983,
-0.004175684880465269,
-0.004511265084147453,
-0.04234753176569939,
0.05202827230095863,
-0.017529170960187912,
0.08426230400800705,
-0.047766055911779404,
-0.03220349922776222,
0.018067996948957443,
0.039097271859645844,
-0.010588860139250755,
0.03465583920478821,
-0.031582094728946686,
0.05662132799625397,
0.0806725025177002,
-0.11530176550149918,
-0.0439157672226429,
-0.025456948205828667,
0.026674438267946243,
0.0033565969206392765,
0.023134438320994377,
-0.047601379454135895,
0.02909541130065918,
-0.01438954658806324,
0.051118869334459305,
-0.013740278780460358,
0.019527778029441833,
0.002453774679452181,
-0.005769934039562941,
-0.023044945672154427,
0.020012397319078445,
0.025787396356463432,
-0.10832479596138,
-0.04459239915013313,
0.04942839965224266,
0.018450593575835228,
0.03855355083942413,
0.00628417544066906,
0.021783068776130676,
0.059585828334093094,
0.002621715422719717,
-0.017983902245759964,
-0.020737405866384506,
0.07503069937229156,
-0.06045844778418541,
0.027142124250531197,
-0.019255423918366432,
0.003222845960408449,
-0.0198789332062006,
-0.038393307477235794,
-0.04747715964913368,
-0.011657771654427052,
0.025024350732564926,
0.0613553524017334,
-0.05651095509529114,
-0.02838914841413498,
0.0231741014868021,
0.01010133046656847,
0.02966751530766487,
0.06451871991157532,
0.011766191571950912,
0.0015866018366068602,
-0.014600500464439392,
0.016574479639530182,
0.029496265575289726,
0.019537849351763725,
-0.039163365960121155,
0.014463542029261589,
-0.031957246363162994,
0.013868664391338825,
-0.03420025855302811,
0.02374778687953949,
-0.03669627755880356,
-0.053663451224565506,
0.010350462980568409,
-0.03879234194755554,
0.02960103563964367,
-0.004016109276562929,
0.012007372453808784,
-0.014903049916028976,
-0.08488339185714722,
0.06451641023159027,
0.026027381420135498,
-0.014216890558600426,
0.05156553164124489,
0.024108415469527245,
-0.028028734028339386,
-0.01673366129398346,
-0.01104064378887415,
0.03139173239469528,
-0.0052538164891302586,
0.05306975916028023,
-0.035697489976882935,
-0.023944096639752388,
0.005971383769065142,
-0.023091120645403862,
-0.013740923255681992,
0.0008300697663798928,
-0.06359471380710602,
-0.004487231839448214,
-0.008561359718441963,
0.02251371368765831,
0.004452615976333618,
0.0045967805199325085,
0.006355638615787029,
-0.002778746886178851,
0.016010161489248276,
0.003301887772977352,
0.06219201534986496,
0.005874226801097393,
0.09180538356304169,
0.017511753365397453,
0.001937525114044547,
0.05303927883505821,
0.017196612432599068,
0.0003407530311960727,
0.0004041996144223958,
0.04656827449798584,
0.03197214752435684,
0.007464373949915171,
0.025500299409031868,
0.010684954933822155,
-0.00018602127966005355,
-0.05609646439552307,
0.02464953251183033,
0.0066191693767905235,
-0.03070075809955597,
-0.00998849980533123,
-0.015784775838255882,
0.04794679582118988,
0.0027309402357786894,
-0.027148103341460228,
-0.0014196891570463777,
-0.025989169254899025,
-0.013564207591116428,
0.0014274648856371641,
0.06310351192951202,
-0.0419694222509861,
-0.002355586737394333,
0.01805487833917141,
0.025874515995383263,
-0.06699833273887634,
-0.004158189054578543,
-0.027208497747778893,
-0.034938063472509384,
-0.043372828513383865,
0.01654631644487381,
-0.05375748127698898,
-0.014957216568291187,
-0.07586146891117096,
0.018674660474061966,
-0.02733522839844227,
0.0007185715949162841,
-0.012941241264343262,
0.009517544880509377,
0.06078287586569786,
-0.0527348555624485,
-0.04226824268698692,
0.008479081094264984,
0.016680335626006126,
0.0036223011557012796,
0.097971610724926,
0.022349031642079353,
-0.04024886712431908,
0.00033297299523837864,
-5.3878857038336474e-33,
0.041576504707336426,
-0.010512235574424267,
0.05514770373702049,
-0.00973375141620636,
-0.013758069835603237,
0.06360729038715363,
-0.015872934833168983,
-0.0015563342021778226,
-0.03010970540344715,
0.006654439028352499,
0.007617315277457237,
0.020185986533761024,
0.030275916680693626,
0.08821960538625717,
-0.044285278767347336,
-0.0033631387632340193,
-0.010322623886168003,
0.0019503579242154956,
-0.054622262716293335,
0.017002705484628677,
-0.02706851065158844,
-0.03223857283592224,
-0.012101998552680016,
-0.00869059469550848,
-0.010486462153494358,
0.039310306310653687,
0.035252053290605545,
-0.04647890478372574,
0.011311352252960205,
0.027372688055038452,
0.0083914240822196,
-0.05013536289334297,
-0.001339759910479188,
0.014981021173298359,
0.0017626816406846046,
-0.032096926122903824,
-0.01928725466132164,
0.006463994272053242,
-0.02249758131802082,
0.07495728135108948,
-0.07148051261901855,
0.0045847343280911446,
-0.03753785789012909,
-0.06187782064080238,
0.006951234769076109,
-0.04472264274954796,
-0.02382669225335121,
0.022607935592532158,
-0.0382174588739872,
0.04256412386894226,
0.00865576509386301,
0.021616822108626366,
0.059742044657468796,
-0.06305232644081116,
-0.00289461319334805,
0.016402240842580795,
0.033914633095264435,
0.042972393333911896,
-0.030976803973317146,
0.0021826813463121653,
-0.019666330888867378,
-0.05746253579854965,
-0.008559135720133781,
-0.023241661489009857,
-0.0668921172618866,
-0.0028460498433560133,
0.007258191239088774,
0.04063025116920471,
0.02157054841518402,
0.02085745707154274,
-0.09336908906698227,
-0.0030023055151104927,
-0.06394726783037186,
-0.05098879709839821,
-0.010472151450812817,
0.018652454018592834,
0.05367018282413483,
-0.00421632407233119,
-0.03607676178216934,
0.03549595922231674,
-0.03845680505037308,
0.014366097748279572,
0.003535499796271324,
0.008069571107625961,
-0.00910736620426178,
0.05484292656183243,
0.03384525328874588,
-0.022419868037104607,
0.020093411207199097,
-0.012953564524650574,
0.06978745013475418,
0.05029035732150078,
0.018693627789616585,
-0.028398171067237854,
-0.03444880619645119,
-0.021426118910312653,
-0.005794532131403685,
0.07578413933515549,
0.008581225760281086,
-0.022735439240932465,
0.045252684503793716,
0.06758658587932587,
0.011668680235743523,
0.01255233958363533,
-0.0266690943390131,
0.013688579201698303,
0.026345863938331604,
-0.013037790544331074,
-0.04470297694206238,
0.02595423348248005,
0.004736844915896654,
0.023577222600579262,
-0.015044409781694412,
0.11955105513334274,
0.03730911761522293,
-0.00356940645724535,
0.015716450288891792,
0.04318414255976677,
0.0029927408322691917,
-0.026066910475492477,
0.048551976680755615,
-0.0411875918507576,
0.04298964887857437,
-0.001004003919661045,
-0.018373969942331314,
-0.04260125756263733,
-0.007153267040848732,
-0.01626311056315899,
-0.04276898130774498,
0.019179971888661385,
0.03299526870250702,
0.03250711038708687,
2.827309799613431e-7,
-0.005542974453419447,
-0.01089730765670538,
-0.037054505199193954,
-0.03440630063414574,
0.023936793208122253,
-0.02229897864162922,
0.007337166927754879,
-0.008334921672940254,
-0.017653821036219597,
0.017131386324763298,
0.00892562884837389,
0.0063114408403635025,
-0.0056968266144394875,
-0.05964292585849762,
0.019173013046383858,
-0.03159136697649956,
-0.030620340257883072,
0.022301819175481796,
0.04661282151937485,
0.011525079607963562,
-0.033402588218450546,
-0.05491647496819496,
-0.02496509626507759,
0.004603771027177572,
0.047997165471315384,
-0.03656371682882309,
0.018544256687164307,
-0.026749180629849434,
-0.03641164302825928,
-0.0012473671231418848,
-0.03573988005518913,
0.05848192423582077,
0.021536298096179962,
0.07121432572603226,
-0.02538716048002243,
-0.052027542144060135,
-0.0316690132021904,
0.02547706663608551,
0.028382617980241776,
0.05401485040783882,
-0.0087906364351511,
0.0557679682970047,
0.027302291244268417,
0.033313024789094925,
-0.056939613074064255,
0.0029885992407798767,
-0.0525243878364563,
-0.03841202333569527,
0.07300100475549698,
0.0011699822498485446,
0.0052864886820316315,
0.003740133950486779,
-0.0401775985956192,
0.014865136705338955,
0.029485108330845833,
0.04723259061574936,
-0.025805316865444183,
-0.0015453423839062452,
0.03781778737902641,
0.006542843300849199,
-0.00019657955272123218,
-0.02384883165359497,
-0.023720569908618927,
-0.048932455480098724,
0.0001774776028469205,
-0.0716577097773552,
-0.04003429040312767,
2.269494571120195e-34,
0.029256345704197884,
-0.08821749687194824,
0.015125652775168419,
-0.03325478732585907,
-0.039321739226579666,
-0.021120315417647362,
-0.03983080014586449,
0.005568144377321005,
-0.007000606972724199,
-0.01866689696907997,
0.015814082697033882
] | {
"ds_index": 24,
"similar_dg_indices": [
1123346,
894116,
88340,
176805,
155597,
417644,
260688,
1127255,
327703,
377969,
886877,
480052,
764377,
661668,
74220,
870250,
819669,
545962,
486461,
513606
]
} |
A 53-year-old man comes to the emergency department because of severe right-sided flank pain for 3 hours. The pain is colicky, radiates towards his right groin, and he describes it as 8/10 in intensity. He has vomited once. He has no history of similar episodes in the past. Last year, he was treated with naproxen for swelling and pain of his right toe. He has a history of hypertension. He drinks one to two beers on the weekends. Current medications include amlodipine. He appears uncomfortable. His temperature is 37.1°C (99.3°F), pulse is 101/min, and blood pressure is 130/90 mm Hg. Examination shows a soft, nontender abdomen and right costovertebral angle tenderness. An upright x-ray of the abdomen shows no abnormalities. A CT scan of the abdomen and pelvis shows a 7-mm stone in the proximal ureter and grade I hydronephrosis on the right. Which of the following is most likely to be seen on urinalysis? | Urinary pH: 4.7 | {
"A": "Urinary pH: 7.3",
"B": "Urinary pH: 4.7",
"C": "Positive nitrites test",
"D": "Largely positive urinary protein"
} | step2&3 | B | [
"year old man",
"emergency department",
"of severe right-sided flank pain",
"hours",
"pain",
"colicky",
"radiates",
"right groin",
"8/10",
"intensity",
"vomited",
"history of similar episodes",
"past",
"year",
"treated with naproxen",
"swelling",
"pain",
"right toe",
"history of hypertension",
"drinks one",
"two beers",
"weekends",
"Current medications include amlodipine",
"appears",
"temperature",
"99",
"pulse",
"min",
"blood pressure",
"90 mm Hg",
"Examination shows",
"soft",
"nontender abdomen",
"right costovertebral angle tenderness",
"upright x-ray of",
"abdomen shows",
"abnormalities",
"CT scan",
"abdomen",
"pelvis shows",
"7-mm stone",
"proximal ureter",
"grade I hydronephrosis",
"right",
"following",
"most likely to",
"seen",
"urinalysis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 53-year-old man comes to the emergency department because of severe right-sided flank pain for 3 hours. The pain is colicky, radiates towards his right groin, and he describes it as 8/10 in intensity. He has vomited once. He has no history of similar episodes in the past. Last year, he was treated with naproxen for swelling and pain of his right toe. He has a history of hypertension. He drinks one to two beers on the weekends. Current medications include amlodipine. He appears uncomfortable. His temperature is 37.1°C (99.3°F), pulse is 101/min, and blood pressure is 130/90 mm Hg. Examination shows a soft, nontender abdomen and right costovertebral angle tenderness. An upright x-ray of the abdomen shows no abnormalities. A CT scan of the abdomen and pelvis shows a 7-mm stone in the proximal ureter and grade I hydronephrosis on the right. Which of the following is most likely to be seen on urinalysis?
Choose one of the following::
A. Urinary pH: 7.3
B. Urinary pH: 4.7
C. Positive nitrites test
D. Largely positive urinary protein | [
0.02972961962223053,
0.03564140200614929,
-0.0005750684067606926,
0.012185460887849331,
-0.013319708406925201,
0.013749565929174423,
0.024680640548467636,
0.040410976856946945,
0.006918976083397865,
-0.01470499113202095,
0.028741998597979546,
0.011775562539696693,
-0.035397741943597794,
-0.015247037634253502,
0.01808452606201172,
0.0324849970638752,
-0.021403459832072258,
-0.007391481660306454,
-0.03399445861577988,
-0.0037693504709750414,
-0.0663323849439621,
-0.002978374483063817,
-0.005943355616182089,
0.012998298741877079,
0.031069662421941757,
0.029159288853406906,
0.027718355879187584,
0.03763348236680031,
-0.011334683746099472,
-0.05134540796279907,
-0.028470369055867195,
0.05563115328550339,
-0.029788929969072342,
-0.04593000188469887,
0.000001763312070579559,
-0.05795615166425705,
0.021075958386063576,
-0.02710876613855362,
0.006564207840710878,
-0.02484309859573841,
-0.016939260065555573,
-0.07230187952518463,
0.030669698491692543,
-0.01708446629345417,
-0.0021884252782911062,
-0.04383213445544243,
0.031924374401569366,
0.09161561727523804,
-0.06713328510522842,
-0.021404769271612167,
0.016078608110547066,
0.005111165810376406,
-0.03277353569865227,
0.020359637215733528,
0.06207514554262161,
-0.08541158586740494,
-0.03963838890194893,
-0.02430705912411213,
-0.0320560596883297,
0.062285590916872025,
0.03141620382666588,
-0.006528656929731369,
0.011395339854061604,
0.011851991526782513,
-0.056553132832050323,
0.01644941046833992,
0.009760857559740543,
-0.05089957267045975,
0.018992919474840164,
0.015247436240315437,
-0.018515288829803467,
0.03234777972102165,
0.04548600688576698,
0.034053657203912735,
-0.05860127508640289,
-0.05201592668890953,
0.06010746583342552,
0.014649825170636177,
0.031009966507554054,
-0.02524443529546261,
0.030808493494987488,
0.03380364924669266,
-0.03148708492517471,
0.04996927082538605,
-0.009601926431059837,
-0.05470557510852814,
0.03817674517631531,
-0.0042648823000490665,
0.008190048858523369,
-0.00738663412630558,
-0.019782420247793198,
-0.026762835681438446,
0.031118405982851982,
0.0224249679595232,
-0.022087881341576576,
-0.011225114576518536,
0.0035186042077839375,
0.01964627206325531,
0.06448926031589508,
-0.04126621037721634,
0.001738948398269713,
0.02889154478907585,
-0.006341195199638605,
0.05302580073475838,
-0.02144223265349865,
0.03738975524902344,
-0.014285487122833729,
-0.00854304526001215,
-0.041183359920978546,
0.035716693848371506,
0.0014810946304351091,
0.049992240965366364,
-0.002640252700075507,
-0.01659071072936058,
0.08431091904640198,
-0.03530935198068619,
-0.037445422261953354,
-0.020630700513720512,
0.030816731974482536,
0.08510541170835495,
0.03365977108478546,
0.03755421191453934,
0.016156399622559547,
0.027182437479496002,
0.04006587713956833,
0.056404635310173035,
-0.004055441822856665,
0.009244556538760662,
-0.014703968539834023,
0.03941697999835014,
0.0304340198636055,
-0.008209685795009136,
-0.016782468184828758,
0.03992597013711929,
-0.011022783815860748,
-0.034998901188373566,
0.010129370726644993,
0.03243846446275711,
-0.024043897166848183,
0.001965648727491498,
-0.036411553621292114,
-0.006914484314620495,
0.006707225926220417,
0.002156684873625636,
0.0454486608505249,
-0.021611854434013367,
0.00029724850901402533,
-0.04108959063887596,
0.021101290360093117,
0.0011439953232184052,
-0.05346017703413963,
-0.027541114017367363,
-0.04544197395443916,
0.034458234906196594,
-0.03124256618320942,
0.0007781554595567286,
0.0097384974360466,
-0.02199265919625759,
0.013601104728877544,
-0.019173163920640945,
0.00043316822848282754,
-0.014399036765098572,
-0.036485206335783005,
-0.014364555478096008,
-0.03897407278418541,
0.008592264726758003,
0.02442815713584423,
0.06865480542182922,
0.011668160557746887,
0.05397731065750122,
-0.01720896176993847,
0.04381909221410751,
0.051080234348773956,
-0.04554491490125656,
0.007982995361089706,
-0.0028163648676127195,
-0.01005171425640583,
-0.010727188549935818,
-0.010392235592007637,
-0.01495649479329586,
-0.002312164753675461,
-0.02122865617275238,
-0.000512102444190532,
-0.044966112822294235,
0.031373441219329834,
0.02826268970966339,
0.05179153010249138,
-0.0165493693202734,
-0.04164312407374382,
-0.0405365414917469,
-0.0653914362192154,
-0.007441763300448656,
-0.04255165159702301,
0.022190386429429054,
0.019845180213451385,
0.00453453091904521,
-0.017301956191658974,
0.013882203958928585,
0.026692403480410576,
0.00802701711654663,
-0.05328656733036041,
-0.023608844727277756,
0.029866887256503105,
0.05736776068806648,
-0.06542981415987015,
0.0030456515960395336,
0.031942278146743774,
0.029809072613716125,
0.018747273832559586,
0.006334271747618914,
-0.014593619853258133,
-0.0017920075915753841,
0.03621649369597435,
-0.043948497623205185,
0.020829448476433754,
0.061819691210985184,
0.0134317297488451,
-0.019504670053720474,
-0.037096284329891205,
0.029763832688331604,
-0.02063385769724846,
-0.014531529508531094,
-0.05293598026037216,
-0.007792441174387932,
-0.037902966141700745,
-0.0013388923835009336,
-0.0063596502877771854,
0.01667526736855507,
-0.03760702162981033,
-0.07202917337417603,
0.018453150987625122,
0.01984626054763794,
-0.04304324835538864,
0.023557722568511963,
-0.034660063683986664,
0.042419660836458206,
0.020238008350133896,
-0.037574224174022675,
0.04565306007862091,
0.05787428468465805,
-0.0022704165894538164,
-0.043234653770923615,
-0.06033812463283539,
-0.019582392647862434,
0.04447758197784424,
-0.011555961333215237,
-0.018333641812205315,
0.043906982988119125,
-0.05521956831216812,
0.07043172419071198,
-0.020491648465394974,
0.04041576385498047,
-0.006382366642355919,
-0.013720361515879631,
0.012640060856938362,
0.027699969708919525,
-0.08288980275392532,
0.0026413763407617807,
-0.009170218370854855,
-0.05810093134641647,
-0.034401435405015945,
-0.014500577002763748,
0.012268392369151115,
-0.04548521339893341,
-0.018744878470897675,
-0.005774232558906078,
-0.028995251283049583,
0.05022842064499855,
-0.0051584928296506405,
0.0006327925948426127,
0.020798590034246445,
0.043917372822761536,
0.022019630298018456,
0.01837730035185814,
-0.04428350552916527,
-0.0018513756804168224,
-0.06298957765102386,
0.057971589267253876,
0.03842110186815262,
0.018540801480412483,
0.01792747527360916,
0.09756068885326385,
0.02506425231695175,
0.04157048836350441,
-0.0031761808786541224,
0.00035208274493925273,
-0.018040016293525696,
0.033286385238170624,
0.06343798339366913,
0.016650870442390442,
0.008269671350717545,
-0.037664927542209625,
0.007353230379521847,
-0.06019612029194832,
-0.00544562004506588,
-0.03809894993901253,
-0.12554527819156647,
0.007408710662275553,
0.008068978786468506,
0.0373430997133255,
0.015386384911835194,
0.01616499200463295,
0.018773891031742096,
-0.01717054285109043,
0.0005427766009233892,
0.009728381410241127,
0.03379439190030098,
-0.025042006745934486,
-0.01874666102230549,
0.030678391456604004,
-0.03178666904568672,
-0.021462492644786835,
-0.024295572191476822,
0.0015885611064732075,
0.021095259115099907,
-0.06888313591480255,
-0.013612098060548306,
-0.053387414664030075,
0.05106460303068161,
-0.014677734114229679,
0.009142700582742691,
0.05697599798440933,
0.009792092256247997,
-0.02367779240012169,
-0.019281204789876938,
-0.0086401691660285,
0.02909015864133835,
-0.028734702616930008,
-0.06215158477425575,
-0.023658085614442825,
0.02944754995405674,
-0.005326320417225361,
-0.02511250041425228,
0.046851448714733124,
0.037198785692453384,
-0.026652304455637932,
-0.05052501708269119,
0.014845401979982853,
-0.042032305151224136,
0.02685590088367462,
0.027130410075187683,
-0.01723850704729557,
0.018518995493650436,
0.02226756140589714,
0.04056434705853462,
0.027345487847924232,
-0.049747973680496216,
0.024146482348442078,
0.012295400723814964,
0.02284824661910534,
-0.10542269051074982,
-0.014269743114709854,
0.004143997561186552,
0.0002732200373429805,
-0.026043660938739777,
-0.00939300749450922,
-0.005507660564035177,
0.09577704221010208,
-0.015374556183815002,
0.06890875846147537,
0.01836276985704899,
0.002676344010978937,
0.07474852353334427,
0.011552197858691216,
0.022889580577611923,
0.02667783573269844,
0.007630238775163889,
-0.023879364132881165,
0.029105762019753456,
-0.030227994546294212,
-0.04123787581920624,
0.044231582432985306,
-0.059062302112579346,
0.0482821986079216,
0.03359270468354225,
-0.021339520812034607,
-0.00431092781946063,
-0.05350041761994362,
-0.07817982137203217,
-0.023212812840938568,
0.01915968395769596,
0.0057109929621219635,
-0.0022493735887110233,
-0.013388426043093204,
-0.01830323413014412,
0.06206589937210083,
-0.004255546256899834,
-0.05115843564271927,
0.06308764964342117,
0.008672436699271202,
-0.022306492552161217,
0.008196982555091381,
-0.02875916287302971,
-0.05640995502471924,
0.001782873529009521,
0.024301540106534958,
-0.013507853262126446,
-0.04022008180618286,
0.019630374386906624,
0.06041669845581055,
-0.03488585725426674,
-0.03965640440583229,
-0.06738962233066559,
0.09187038242816925,
0.036446426063776016,
-0.05831509456038475,
-0.0947054922580719,
-0.011886811815202236,
0.016414787620306015,
0.028750821948051453,
0.040545590221881866,
-0.06955116242170334,
0.026284784078598022,
0.010209580883383751,
0.029298849403858185,
-0.03435274213552475,
-0.0011362220393493772,
-0.05812477692961693,
0.009763195179402828,
-0.06903350353240967,
0.05368892103433609,
-0.008315220475196838,
-0.028155066072940826,
-0.02551989071071148,
0.012750495225191116,
0.014576354064047337,
0.061002667993307114,
0.10703471302986145,
0.0022421337198466063,
0.006478259339928627,
0.020084979012608528,
-0.027340667322278023,
0.04838116839528084,
0.07243785262107849,
0.03750762715935707,
-0.012563350610435009,
0.012161772698163986,
0.043945033103227615,
0.014981294050812721,
-0.015064570121467113,
-0.012196218594908714,
0.03514847159385681,
0.006861056201159954,
0.027060450986027718,
0.00848218984901905,
-0.028408490121364594,
0.0016149061266332865,
0.043874502182006836,
0.018940014764666557,
0.05433626100420952,
-0.002942232182249427,
0.013597085140645504,
-0.0011832836316898465,
0.09154397249221802,
-0.0017462939722463489,
-0.006538598332554102,
0.0625935047864914,
0.034984178841114044,
0.030194418504834175,
-0.030443625524640083,
-0.07103331387042999,
0.013753054663538933,
-0.016160834580659866,
-0.051689859479665756,
0.03822769224643707,
-0.07309150695800781,
-0.05801142379641533,
0.030069703236222267,
-0.008078958839178085,
0.03218767046928406,
0.0409693606197834,
0.030006475746631622,
-0.02853720635175705,
-0.056630395352840424,
0.006354953162372112,
-0.03096090443432331,
-0.014081579633057117,
-0.08730348199605942,
-0.0714353621006012,
0.015868879854679108,
0.0055282264947891235,
-0.026075609028339386,
-0.041926994919776917,
-0.05524619296193123,
0.0017702712211757898,
0.02364344336092472,
0.019669001922011375,
0.008792496286332607,
-0.0001863117067841813,
0.03154834359884262,
0.03242708742618561,
-0.043795205652713776,
0.01648528315126896,
0.008013840764760971,
-0.061335839331150055,
-0.028510555624961853,
-0.03720098361372948,
0.026764927431941032,
0.08257226645946503,
-0.08394530415534973,
0.0017497449880465865,
0.023287486284971237,
0.02487810328602791,
-0.029441237449645996,
0.015672972425818443,
0.032551076263189316,
-0.014899548143148422,
0.014011567458510399,
-0.07160861790180206,
-0.048366062343120575,
0.0213044211268425,
0.002011962467804551,
-0.022580869495868683,
0.021745072677731514,
0.06639324128627777,
-0.05062442272901535,
-0.01309856679290533,
-0.044137462973594666,
-0.022900277748703957,
-0.014928030781447887,
0.006339368410408497,
-0.009571352042257786,
0.0006346513400785625,
-0.03348911926150322,
-0.05457277223467827,
0.0451008565723896,
-0.027086393907666206,
0.004942541476339102,
0.01110213901847601,
0.060990121215581894,
0.006746732164174318,
-0.02898593805730343,
-0.03744282200932503,
-0.006366434972733259,
0.016590578481554985,
-0.02634362131357193,
-0.031141219660639763,
0.040108468383550644,
-0.0203073862940073,
-0.06058767810463905,
-0.00007322678720811382,
0.037241145968437195,
-0.042974766343832016,
0.018463676795363426,
-0.03485216572880745,
-0.012493882328271866,
-0.014275448396801949,
0.02759431302547455,
0.0014184763422235847,
-0.04388383775949478,
-0.02610466629266739,
0.07528030127286911,
-0.0490388423204422,
0.04973125457763672,
0.029091304168105125,
-4.762643932051119e-33,
0.02393699437379837,
-0.011166224256157875,
-0.003197592915967107,
-0.08627306669950485,
0.061410851776599884,
0.08531595766544342,
-0.015994034707546234,
-0.022107809782028198,
-0.0861305221915245,
0.0005581231089308858,
0.004579002968966961,
-0.033543188124895096,
0.046782802790403366,
0.0624372772872448,
-0.012607409618794918,
-0.04378478229045868,
0.015590088441967964,
-0.0003103292256128043,
-0.009708077646791935,
0.04162638261914253,
-0.005292360670864582,
-0.029310736805200577,
-0.00743623124435544,
-0.042223088443279266,
-0.01981349103152752,
-0.032543592154979706,
0.07447128742933273,
0.0037648070137947798,
0.012343148700892925,
0.0005258357850834727,
-0.010909262113273144,
-0.04404690861701965,
0.043889328837394714,
-0.01944461651146412,
-0.023767616599798203,
-0.019349480047822,
0.0010039760963991284,
-0.020533224567770958,
-0.0016532334266230464,
-0.0027874524239450693,
0.032120637595653534,
-0.04807143285870552,
0.02396480180323124,
-0.02541142702102661,
0.03965682163834572,
-0.07581371814012527,
-0.037436604499816895,
-0.0006927106296643615,
0.01795629970729351,
-0.07750918716192245,
0.011762168258428574,
0.021910084411501884,
0.0028436044231057167,
-0.025898750871419907,
-0.05307348445057869,
0.002197298454120755,
-0.00015947880456224084,
0.03498862311244011,
-0.04331175237894058,
0.021802032366394997,
-0.08170729875564575,
-0.001315108616836369,
0.04969821870326996,
-0.08717029541730881,
-0.0326349101960659,
-0.009820075705647469,
0.009313292801380157,
0.03817339614033699,
-0.0015055129770189524,
0.003689910750836134,
-0.058660559356212616,
0.019683560356497765,
0.009543252177536488,
-0.10408537834882736,
0.03547458350658417,
-0.06064135208725929,
0.018116187304258347,
0.0030573063995689154,
0.053176794201135635,
0.022703710943460464,
0.0061861746944487095,
-0.03319144621491432,
-0.057172760367393494,
-0.01763133518397808,
0.0026431437581777573,
-0.049605850130319595,
0.0036175926215946674,
-0.023716434836387634,
0.01867872290313244,
0.0030001534614712,
0.10885605961084366,
0.01286054216325283,
0.034657932817935944,
0.01465157512575388,
-0.01934858411550522,
0.030050531029701233,
0.03192133083939552,
0.08749231696128845,
0.004918803460896015,
0.023664958775043488,
0.016747072339057922,
-0.02464299276471138,
0.024083200842142105,
-0.021604252979159355,
-0.02928503230214119,
0.043212149292230606,
-0.001368446392007172,
-0.010932834818959236,
0.010618165135383606,
0.03858068585395813,
-0.00048424332635477185,
-0.0001971354940906167,
0.008986057713627815,
-0.006760056596249342,
0.03643203154206276,
0.032849960029125214,
-0.0037660980597138405,
-0.02416941337287426,
0.032157089561223984,
0.06982504576444626,
0.026188556104898453,
-0.006369920447468758,
-0.024953924119472504,
0.04854925349354744,
-0.028167251497507095,
-0.05679704621434212,
0.012154377065598965,
0.06751268357038498,
-0.008202031254768372,
0.02580725960433483,
0.016320189461112022,
0.007057271432131529,
2.5465323005846585e-7,
0.01978897675871849,
-0.024370266124606133,
0.006851376965641975,
-0.05696076899766922,
0.020320547744631767,
-0.03468461334705353,
-0.01294881384819746,
0.013316009193658829,
0.05398767814040184,
-0.02617872878909111,
0.028612950816750526,
0.058613523840904236,
-0.026083219796419144,
0.010471525602042675,
0.05743652209639549,
-0.020878376439213753,
0.0014623376773670316,
-0.0037567170802503824,
0.0037755845114588737,
0.0018480586586520076,
0.0033856744412332773,
-0.0400700718164444,
-0.10611625760793686,
-0.013830424286425114,
-0.05125272646546364,
0.003162040375173092,
-0.0005445179995149374,
-0.010092467069625854,
-0.00002971893991343677,
-0.030645398423075676,
-0.035556599497795105,
-0.017822083085775375,
-0.02902495488524437,
0.04137732461094856,
-0.012329790741205215,
0.023276710882782936,
0.056892648339271545,
0.03538387641310692,
-0.028050323948264122,
-0.03613060712814331,
-0.02191738598048687,
-0.02023174799978733,
0.008491940796375275,
0.013829648494720459,
0.05915515869855881,
0.07531892508268356,
-0.030783258378505707,
-0.026109574362635612,
-0.0034626976121217012,
-0.0002225417410954833,
-0.00350527954287827,
-0.011786852963268757,
0.003707533935084939,
0.0440676175057888,
-0.006282948888838291,
0.048508211970329285,
-0.019518829882144928,
-0.004140209872275591,
0.015174591913819313,
0.010685937479138374,
0.003170506563037634,
-0.008949559181928635,
0.0333617739379406,
0.02073301188647747,
0.056498218327760696,
-0.06213830038905144,
-0.042659979313611984,
1.8342362192764385e-34,
-0.017650092020630836,
-0.003302218159660697,
0.004181114491075277,
-0.03930801898241043,
-0.028365880250930786,
-0.0008173102396540344,
-0.005379021167755127,
0.015340601094067097,
0.013093455694615841,
-0.061862777918577194,
0.020906997844576836
] | {
"ds_index": 25,
"similar_dg_indices": [
1070774,
72993,
338200,
931466,
118264,
84677,
607063,
397084,
522670,
417593,
114109,
465197,
690830,
722948,
871849,
1090105,
1153701,
825811,
850399,
824153
]
} |
A 5-year-old girl is brought to the clinic by her mother for excessive hair growth. Her mother reports that for the past 2 months she has noticed hair at the axillary and pubic areas. She denies any family history of precocious puberty and reports that her daughter has been relatively healthy with an uncomplicated birth history. She denies any recent illnesses, weight change, fever, vaginal bleeding, pain, or medication use. Physical examination demonstrates Tanner stage 4 development. A pelvic ultrasound shows an ovarian mass. Laboratory studies demonstrates an elevated level of estrogen. What is the most likely diagnosis? | Granulosa cell tumor | {
"A": "Granulosa cell tumor",
"B": "Idiopathic precocious puberty",
"C": "McCune-Albright syndrome",
"D": "Sertoli-Leydig tumor"
} | step2&3 | A | [
"5 year old girl",
"brought",
"clinic",
"mother",
"excessive hair growth",
"mother reports",
"past",
"months",
"hair",
"axillary",
"pubic areas",
"denies",
"family history",
"precocious puberty",
"reports",
"daughter",
"relatively healthy",
"uncomplicated birth history",
"denies",
"recent illnesses",
"weight change",
"fever",
"vaginal bleeding",
"pain",
"medication use",
"Physical examination demonstrates Tanner stage 4 development",
"pelvic ultrasound shows",
"ovarian mass",
"Laboratory studies demonstrates",
"elevated level",
"estrogen",
"most likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 5-year-old girl is brought to the clinic by her mother for excessive hair growth. Her mother reports that for the past 2 months she has noticed hair at the axillary and pubic areas. She denies any family history of precocious puberty and reports that her daughter has been relatively healthy with an uncomplicated birth history. She denies any recent illnesses, weight change, fever, vaginal bleeding, pain, or medication use. Physical examination demonstrates Tanner stage 4 development. A pelvic ultrasound shows an ovarian mass. Laboratory studies demonstrates an elevated level of estrogen. What is the most likely diagnosis?
Choose one of the following::
A. Granulosa cell tumor
B. Idiopathic precocious puberty
C. McCune-Albright syndrome
D. Sertoli-Leydig tumor | [
0.03592313081026077,
0.009515577927231789,
-0.01688443124294281,
-0.02060615085065365,
0.037563879042863846,
0.004792397376149893,
0.0007018300821073353,
0.013886586762964725,
-0.0018251808360219002,
-0.008564256131649017,
0.0558939091861248,
-0.03192412108182907,
-0.04282217100262642,
-0.011411059647798538,
-0.05020107328891754,
0.04698759689927101,
-0.027271654456853867,
0.012619647197425365,
-0.004084717016667128,
-0.003162186127156019,
0.011079832911491394,
0.01683587208390236,
0.042300332337617874,
-0.04530109092593193,
0.004790377803146839,
-0.012648996897041798,
0.013323488645255566,
0.015835780650377274,
-0.06103615090250969,
0.02809956483542919,
0.04298359900712967,
-0.013456244952976704,
-0.03589658811688423,
0.009487349539995193,
0.000001767178218869958,
-0.05129920691251755,
0.015409242361783981,
-0.017284533008933067,
0.03536117821931839,
0.031179549172520638,
0.018962716683745384,
0.011886040680110455,
0.020365295931696892,
-0.006424127612262964,
0.04561958089470863,
-0.05262255296111107,
0.003383099567145109,
0.03485976904630661,
0.006460814271122217,
-0.014655988663434982,
-0.002945940475910902,
-0.0075902375392615795,
0.00023437179333996028,
0.050391100347042084,
0.08756548911333084,
-0.018064206466078758,
-0.009422975592315197,
-0.04178260639309883,
0.03063766472041607,
-0.0052850376814603806,
0.05252458155155182,
-0.03515060991048813,
-0.0042943754233419895,
0.00470827566459775,
-0.04389360547065735,
-0.016599996015429497,
0.035567618906497955,
-0.046980325132608414,
-0.00034265697468072176,
0.001425362192094326,
0.058245912194252014,
0.023632284253835678,
0.06467243283987045,
0.07405031472444534,
-0.029395071789622307,
0.022300293669104576,
0.01843663863837719,
-0.006799759808927774,
-0.06766956299543381,
-0.004706056788563728,
0.017291102558374405,
-0.040511030703783035,
-0.006652303505688906,
0.07952578365802765,
0.029248477891087532,
0.03833266720175743,
-0.0022740934509783983,
0.02588142454624176,
-0.03511705622076988,
-0.045550599694252014,
0.026131194084882736,
-0.03932810574769974,
-0.0036950064823031425,
0.00438876124098897,
-0.046293992549180984,
-0.007978660985827446,
-0.05575175955891609,
-0.004599045496433973,
0.029384078457951546,
-0.02420181781053543,
0.006905074696987867,
-0.03514702990651131,
-0.043261852115392685,
0.003560905810445547,
-0.06834995001554489,
0.01780739612877369,
-0.02744721621274948,
-0.009366463869810104,
-0.011583574116230011,
0.029189828783273697,
0.038605768233537674,
0.0021441762801259756,
-0.01760205440223217,
-0.025291291996836662,
0.040007635951042175,
-0.007827159017324448,
-0.03250843286514282,
-0.0519682876765728,
-0.0025788149796426296,
0.01563984900712967,
-0.00859752856194973,
0.04837331548333168,
0.010677470825612545,
-0.005839552264660597,
0.002595182741060853,
0.019761890172958374,
-0.008939639665186405,
0.02647213637828827,
0.02281205914914608,
-0.03722262382507324,
0.0065343645401299,
-0.003497790778055787,
-0.011037482880055904,
0.025595946237444878,
-0.017392896115779877,
0.011802028864622116,
0.01501600630581379,
0.06299211084842682,
0.034694891422986984,
0.018929241225123405,
-0.032236311584711075,
-0.06423895806074142,
-0.01375603023916483,
-0.01847800426185131,
-0.10908866673707962,
0.071225605905056,
-0.0046692704781889915,
-0.014509451575577259,
0.018758483231067657,
0.014260106720030308,
-0.0012372848577797413,
-0.045370541512966156,
0.018735522404313087,
-0.010526883415877819,
-0.01791585609316826,
0.03879394754767418,
0.00622941367328167,
0.006527360528707504,
0.04123460873961449,
-0.014556129463016987,
0.01020499411970377,
-0.06970570981502533,
-0.052398357540369034,
0.02365376055240631,
0.020717546343803406,
0.03906762972474098,
0.06328972429037094,
0.0010476328898221254,
-0.11899276077747345,
0.05519281327724457,
-0.03503991290926933,
-0.00902521051466465,
0.03754405677318573,
-0.01485420297831297,
-0.0684468224644661,
0.03524656593799591,
-0.028258102014660835,
0.02411680854856968,
-0.0044005261734128,
0.0029370959382504225,
-0.02424226887524128,
0.03213260695338249,
0.07129870355129242,
-0.044241707772016525,
-0.04756536707282066,
0.028360221534967422,
-0.028876325115561485,
-0.001692407764494419,
0.0103205731138587,
0.008999967016279697,
-0.03571367263793945,
0.026322336867451668,
-0.09673959016799927,
0.008887181058526039,
0.0007161624962463975,
0.020399266853928566,
-0.003336470341309905,
-0.0006544701755046844,
-0.03938879817724228,
0.03378867357969284,
0.03811688721179962,
-0.05330765247344971,
0.008158435113728046,
-0.016883427277207375,
-0.0691651850938797,
0.004759386647492647,
-0.035302042961120605,
0.026012562215328217,
0.015261923894286156,
-0.01573418639600277,
-0.008074653334915638,
0.03333263099193573,
0.032463084906339645,
-0.010228266008198261,
0.03241616114974022,
0.012457352131605148,
0.004373347386717796,
0.03885803371667862,
-0.055724505335092545,
0.023646071553230286,
-0.010327286086976528,
-0.018290486186742783,
-0.018971096724271774,
-0.015153235755860806,
-0.04623616114258766,
-0.05350446701049805,
0.007946192286908627,
-0.0036911347415298223,
-0.003132936079055071,
-0.05711071565747261,
-0.026347501203417778,
0.04097908362746239,
-0.0027153119444847107,
0.02474159561097622,
-0.020547140389680862,
0.019807644188404083,
0.024164650589227676,
0.043652404099702835,
0.013820948079228401,
-0.011752053163945675,
-0.04854096472263336,
0.013834018260240555,
-0.03948720544576645,
-0.057315900921821594,
0.05250979959964752,
-0.08470650017261505,
-0.01226839330047369,
0.026364510878920555,
-0.051968466490507126,
0.015910327434539795,
-0.017733575776219368,
-0.012484662234783173,
0.034176312386989594,
0.04083467647433281,
-0.01853273995220661,
0.08700146526098251,
-0.061804257333278656,
-0.04349372908473015,
-0.007934861816465855,
-0.024118635803461075,
0.001459141611121595,
0.0798276886343956,
-0.015279260464012623,
-0.026832787320017815,
-0.02928825467824936,
-0.02439366653561592,
-0.024375274777412415,
0.008992738090455532,
0.004408085718750954,
0.02550816908478737,
0.037604182958602905,
-0.0013403079938143492,
0.01736721396446228,
0.023834917694330215,
-0.05325968191027641,
0.019090501591563225,
-0.011077496223151684,
0.07605045288801193,
0.07639451324939728,
-0.018507441505789757,
0.015051811002194881,
-0.0006769259343855083,
0.005705584306269884,
-0.01608181744813919,
0.0011813505552709103,
-0.031924448907375336,
0.037547435611486435,
0.026637963950634003,
0.01894177682697773,
0.04617868736386299,
-0.05864616110920906,
-0.011605887673795223,
0.020972641184926033,
0.03482311964035034,
-0.024511970579624176,
-0.013258079998195171,
0.0008119240519590676,
0.046893272548913956,
-0.002701997524127364,
0.015822771936655045,
-0.010184413753449917,
-0.0008913046331144869,
-0.008166506886482239,
-0.02470751665532589,
0.06161271408200264,
-0.010656962171196938,
0.0020100721158087254,
0.02948336862027645,
-0.0036206573713570833,
-0.01562568172812462,
0.006071390584111214,
0.00032596554956398904,
0.02187327854335308,
0.026173315942287445,
0.011438434012234211,
0.008984492160379887,
-0.02390095964074135,
-0.09199920296669006,
0.03815559670329094,
0.07612547278404236,
0.020155342295765877,
0.02353685349225998,
0.011734605766832829,
-0.006967413239181042,
-0.04849366843700409,
-0.010758038610219955,
-0.009254504926502705,
0.047064922749996185,
-0.010058089159429073,
-0.005720468237996101,
0.004304175265133381,
-0.014401811175048351,
-0.05823429673910141,
0.01939498446881771,
-0.022316906601190567,
0.03799165412783623,
-0.025384534150362015,
-0.03928002342581749,
-0.024136211723089218,
0.04594459757208824,
0.0202490221709013,
0.0017223081085830927,
-0.01963302120566368,
-0.037868302315473557,
0.05941533297300339,
-0.025123201310634613,
-0.06312105804681778,
0.00459270691499114,
-0.018684981390833855,
0.036359164863824844,
-0.05706597492098808,
0.10033613443374634,
0.00043246240238659084,
-0.0031775408424437046,
-0.0015637201722711325,
0.03551359474658966,
0.04574231058359146,
0.00547241372987628,
-0.008641323074698448,
-0.03447999432682991,
-0.02718851901590824,
0.014092262834310532,
-0.04649306461215019,
0.022368382662534714,
-0.005626587197184563,
0.006008228287100792,
0.0078221894800663,
-0.03317822888493538,
0.004155566915869713,
-0.0464041493833065,
-0.04092276096343994,
-0.036091309040784836,
-0.05592555180191994,
0.009988983161747456,
-0.04240673780441284,
0.05003862828016281,
-0.012105736881494522,
-0.039353206753730774,
-0.03232443705201149,
-0.043610330671072006,
0.0636439397931099,
-0.02356310561299324,
0.04801448434591293,
0.0005303965881466866,
-0.0688273161649704,
0.0011579726124182343,
-0.06725788116455078,
0.0209197998046875,
0.03230570629239082,
0.0034732718486338854,
0.005682768300175667,
0.005448666401207447,
-0.05201736465096474,
0.042632151395082474,
0.010454813949763775,
0.09065507352352142,
-0.033426377922296524,
-0.052937354892492294,
0.023582547903060913,
0.02021305449306965,
-0.03259456902742386,
-0.006446482613682747,
-0.05901051685214043,
0.07067322731018066,
0.06263583153486252,
-0.05545203015208244,
-0.049778301268815994,
-0.02458111383020878,
0.011662871576845646,
0.018751051276922226,
-0.002539054723456502,
0.017552660778164864,
0.008180001750588417,
0.02673199586570263,
-0.07159856706857681,
-0.008025784976780415,
-0.02251163311302662,
-0.06808961927890778,
0.0440090037882328,
0.009598924778401852,
0.0890100747346878,
0.04307984933257103,
-0.026236288249492645,
-0.009226983413100243,
0.00861040223389864,
0.03630731254816055,
0.08594828099012375,
-0.016212046146392822,
0.0038538863882422447,
0.035317543894052505,
-0.0028540759813040495,
-0.02571996860206127,
0.05152994021773338,
0.0694127082824707,
0.012745078653097153,
0.07772333920001984,
-0.0009330643806606531,
0.06619568169116974,
0.007625700905919075,
-0.03311722353100777,
0.014951672405004501,
-0.03357106074690819,
-0.018512219190597534,
0.0627443864941597,
-0.00872862059623003,
-0.05521521717309952,
0.0013772206148132682,
0.0148597601801157,
0.0688825473189354,
0.13332830369472504,
-0.03359518200159073,
0.024929538369178772,
0.039866916835308075,
0.04252287372946739,
0.002961746184155345,
0.00007571238529635593,
0.055417630821466446,
-0.0293870959430933,
0.00960840005427599,
-0.05187004432082176,
-0.07263767719268799,
0.019480111077427864,
-0.050187066197395325,
-0.05994519591331482,
-0.028167540207505226,
-0.02923034504055977,
0.00552588002756238,
0.037635546177625656,
-0.011171886697411537,
-0.01172846183180809,
-0.06420353800058365,
0.053634777665138245,
0.020493093878030777,
0.03490650653839111,
-0.008531798608601093,
-0.051503438502550125,
-0.08932691067457199,
-0.05904702469706535,
0.01466338150203228,
0.03132251650094986,
-0.005851690657436848,
0.006294480990618467,
-0.027965368703007698,
-0.04507286101579666,
0.02392563596367836,
-0.035957012325525284,
0.008661330677568913,
0.004608900286257267,
-0.013898816891014576,
-0.028390761464834213,
-0.05369621142745018,
0.020099040120840073,
0.03246725723147392,
0.07538524270057678,
-0.016815386712551117,
0.0016639137174934149,
0.019186051562428474,
0.03443252295255661,
-0.024950368329882622,
-0.06087001785635948,
0.020469119772315025,
-0.0016158968210220337,
-0.015717756003141403,
-0.057591382414102554,
-0.010693060234189034,
0.0387505441904068,
-0.08335567265748978,
0.029420113191008568,
0.01038898341357708,
-0.02819087542593479,
0.04642701894044876,
-0.016857773065567017,
-0.0017015849007293582,
0.015319808386266232,
0.0002673899580258876,
-0.033343106508255005,
-0.02130763977766037,
-0.04053317382931709,
0.012850499711930752,
0.01205657608807087,
-0.02063111588358879,
-0.004989143460988998,
-0.011958273127675056,
-0.040026672184467316,
-0.017663348466157913,
0.030339695513248444,
0.07144700735807419,
0.02609282173216343,
0.03898266330361366,
-0.0018779061501845717,
0.037997178733348846,
0.02322610281407833,
-0.046068210154771805,
-0.009491409175097942,
-0.05061598867177963,
0.0029972109477967024,
0.029270630329847336,
0.017837921157479286,
-0.022022180259227753,
-0.04858754575252533,
0.01575118489563465,
-0.0019672976341098547,
-0.023785371333360672,
-0.018653996288776398,
-0.02068990096449852,
0.008010691963136196,
-0.07124289125204086,
0.017340827733278275,
0.050406161695718765,
-0.08673565089702606,
-0.011907647363841534,
0.00894555076956749,
0.053409334272146225,
0.008068561553955078,
0.003136672079563141,
-4.491315223968365e-33,
0.006116938311606646,
-0.023011019453406334,
0.028652165085077286,
0.007382143288850784,
0.00046842260053381324,
0.04906250908970833,
-0.03741912171244621,
0.003093739040195942,
-0.013145583681762218,
0.02570810355246067,
0.0029651173390448093,
0.0007630346808582544,
-0.005360971204936504,
0.05383216589689255,
-0.03211434185504913,
0.00357273081317544,
-0.004151490051299334,
-0.050514623522758484,
-0.0012869660276919603,
-0.021592210978269577,
0.03167541325092316,
-0.011313676834106445,
0.0015090315137058496,
0.038559846580028534,
0.021519888192415237,
-0.03060140274465084,
0.025614431127905846,
-0.01976027712225914,
-0.03947959095239639,
0.005363928619772196,
0.04432249069213867,
-0.01013552863150835,
0.004672093782573938,
0.005774893332272768,
0.010348592884838581,
-0.06329605728387833,
-0.010554357431828976,
-0.016109861433506012,
0.015538621693849564,
0.004134912043809891,
-0.051462821662425995,
0.04436998814344406,
0.07592732459306717,
-0.009462705813348293,
0.07055708020925522,
-0.05105296149849892,
0.0170245710760355,
-0.01517567876726389,
-0.014733957126736641,
-0.021725604310631752,
-0.013918496668338776,
-0.020820753648877144,
0.001315352157689631,
-0.03604340925812721,
0.01862494647502899,
0.06960488855838776,
-0.03904253616929054,
-0.04026084020733833,
0.002909226343035698,
0.014108559116721153,
-0.013898584060370922,
-0.0304957777261734,
-0.01697511412203312,
-0.004826446995139122,
-0.001125212525948882,
0.009492692537605762,
0.04178881272673607,
-0.008275826461613178,
-0.03746642917394638,
0.0062453788705170155,
-0.028408203274011612,
-0.008898446336388588,
-0.02656755968928337,
-0.1079564243555069,
0.01975167728960514,
0.07342860847711563,
-0.0016541575314477086,
-0.03722554072737694,
0.02543957345187664,
0.11154453456401825,
-0.06552470475435257,
-0.056747984141111374,
-0.045367732644081116,
0.03792718052864075,
-0.019812554121017456,
-0.01181845460087061,
0.03306296095252037,
-0.019388094544410706,
-0.010501686483621597,
-0.031381621956825256,
-0.0024106784258037806,
0.038952410221099854,
-0.03127024695277214,
0.03626754879951477,
-0.008327188901603222,
-0.044636938720941544,
0.12617842853069305,
-0.00519579416140914,
-0.0035690690856426954,
0.023960396647453308,
0.09093613922595978,
0.0536903478205204,
0.0003987335367128253,
-0.03983597084879875,
-0.03595279902219772,
-0.0017612488009035587,
-0.039231590926647186,
-0.0033129798248410225,
-0.03965092822909355,
0.010475867427885532,
-0.012981031090021133,
0.04222981259226799,
0.0010453847935423255,
0.011280324310064316,
0.00022495267330668867,
0.02984735183417797,
0.012168081477284431,
0.08012795448303223,
0.03865567222237587,
0.10731161385774612,
0.022338341921567917,
-0.004727575927972794,
0.01178562082350254,
-0.020136618986725807,
-0.03749759495258331,
-0.03529385104775429,
-0.013532782904803753,
0.019194064661860466,
-0.014597507193684578,
0.06681204587221146,
0.034142494201660156,
0.029693884775042534,
2.4611662752249686e-7,
-0.006514395121484995,
0.03425145149230957,
0.04093707725405693,
-0.061100129038095474,
0.06751934438943863,
-0.06719452142715454,
-0.0015360148390755057,
0.0037107430398464203,
0.019773516803979874,
-0.007997062057256699,
-0.003951869904994965,
0.01908062770962715,
-0.001505793072283268,
0.002006241586059332,
0.011393657885491848,
0.0017628498608246446,
-0.012365955859422684,
-0.005391374696046114,
0.06532570719718933,
0.0013064397498965263,
0.01135674212127924,
-0.035520076751708984,
-0.02670680731534958,
-0.05779389292001724,
0.03168494254350662,
-0.005449180491268635,
-0.008814143016934395,
0.027036868035793304,
0.013498513959348202,
-0.0061681680381298065,
-0.018486103042960167,
-0.012168003246188164,
0.013323621824383736,
0.03339945524930954,
0.015798160806298256,
-0.05368693172931671,
-0.044032882899045944,
0.010311161167919636,
0.014463666826486588,
0.0638439729809761,
-0.006720139179378748,
0.06767501682043076,
-0.022073455154895782,
0.04748179763555527,
0.0011653387919068336,
-0.011567431502044201,
-0.046202901750802994,
-0.04595015570521355,
0.011295631527900696,
-0.02881675958633423,
-0.040288206189870834,
0.006783015560358763,
-0.061734121292829514,
0.08579571545124054,
-0.03765527531504631,
0.010547787882387638,
0.0235646553337574,
-0.011503868736326694,
0.05254680663347244,
0.009657616727054119,
-0.039008330553770065,
-0.00516628660261631,
-0.01599438115954399,
-0.004223026800900698,
0.03984356299042702,
-0.014327331446111202,
0.015316345728933811,
1.463367292414526e-34,
-0.04401961714029312,
-0.024134105071425438,
-0.008759723044931889,
-0.10367590188980103,
-0.004495752975344658,
0.008157666772603989,
0.005578089039772749,
-0.004823146853595972,
0.03524068742990494,
-0.0640491396188736,
0.025428032502532005
] | {
"ds_index": 26,
"similar_dg_indices": [
594291,
148841,
873211,
274811,
556745,
925067,
507037,
1025911,
315812,
650822,
1029082,
115480,
553340,
291882,
519083,
1120034,
1148374,
91561,
90826,
873839
]
} |
A 16-year-old boy is brought to the physician by his mother because she is worried about his behavior. Yesterday, he was expelled from school for repeatedly skipping classes. Over the past 2 months, he was suspended 3 times for bullying and aggressive behavior towards his peers and teachers. Once, his neighbor found him smoking cigarettes in his backyard. In the past, he consistently maintained an A grade average and had been a regular attendee of youth group events at their local church. The mother first noticed this change in behavior 3 months ago, around the time at which his father moved out after discovering his wife was having an affair. Which of the following defense mechanisms best describes the change in this patient's behavior? | Acting out | {
"A": "Acting out",
"B": "Projection",
"C": "Passive aggression",
"D": "Regression"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"mother",
"worried",
"behavior",
"expelled from school",
"repeatedly skipping classes",
"past",
"months",
"suspended 3 times",
"bullying",
"aggressive behavior",
"peers",
"teachers",
"neighbor found",
"smoking cigarettes",
"backyard",
"past",
"maintained",
"grade average",
"a regular",
"youth group events",
"local church",
"mother first",
"change in behavior",
"months",
"time",
"father moved out",
"discovering",
"wife",
"following defense mechanisms best",
"change in",
"patient's behavior"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 16-year-old boy is brought to the physician by his mother because she is worried about his behavior. Yesterday, he was expelled from school for repeatedly skipping classes. Over the past 2 months, he was suspended 3 times for bullying and aggressive behavior towards his peers and teachers. Once, his neighbor found him smoking cigarettes in his backyard. In the past, he consistently maintained an A grade average and had been a regular attendee of youth group events at their local church. The mother first noticed this change in behavior 3 months ago, around the time at which his father moved out after discovering his wife was having an affair. Which of the following defense mechanisms best describes the change in this patient's behavior?
Choose one of the following::
A. Acting out
B. Projection
C. Passive aggression
D. Regression | [
0.02913767099380493,
0.012611047364771366,
-0.0007173503399826586,
-0.01822786033153534,
-0.04217955470085144,
0.030096547678112984,
-0.016018178313970566,
0.029415536671876907,
0.011005891487002373,
-0.02305850200355053,
0.059828177094459534,
-0.005257232114672661,
-0.044323597103357315,
-0.04850262776017189,
-0.012549789622426033,
0.04926313832402229,
-0.013845428824424744,
0.0060281879268586636,
0.041458625346422195,
-0.004170355852693319,
0.013570340350270271,
-0.0014998589176684618,
0.003995327744632959,
-0.0419161319732666,
0.03787641227245331,
-0.028719406574964523,
0.00605996185913682,
-0.017403222620487213,
0.020846275612711906,
-0.08582580834627151,
0.012988913804292679,
0.010360482148826122,
0.020562944933772087,
0.01812145486474037,
0.0000018656600104804966,
-0.025600211694836617,
0.0008177068084478378,
-0.026956450194120407,
0.051752958446741104,
-0.06435942649841309,
0.006307416129857302,
-0.056481245905160904,
0.0389932356774807,
0.05177920311689377,
-0.028673987835645676,
-0.07354159653186798,
-0.0007738249260000885,
0.043060850352048874,
0.03161078318953514,
0.04638509824872017,
-0.02002803608775139,
-0.037064291536808014,
-0.038807135075330734,
0.01942521147429943,
-0.03795002028346062,
0.016111264005303383,
0.02335844747722149,
-0.029311876744031906,
0.0011647545034065843,
-0.064419686794281,
0.010886359959840775,
-0.0724295973777771,
-0.04867046698927879,
-0.002808202290907502,
-0.038331273943185806,
0.013683215714991093,
0.07129354774951935,
0.02626405842602253,
0.004483454395085573,
-0.01633826456964016,
-0.010575533844530582,
0.030474746599793434,
0.0671626552939415,
0.020770806819200516,
-0.020246997475624084,
0.053255755454301834,
0.02951575256884098,
-0.04167192056775093,
0.029581017792224884,
-0.021975908428430557,
0.033023614436388016,
0.03881634771823883,
-0.015019280835986137,
0.019149137660861015,
0.016286347061395645,
-0.08827973157167435,
0.006030067801475525,
-0.014713013544678688,
-0.04164087027311325,
-0.048219580203294754,
0.06767046451568604,
-0.08768846839666367,
-0.018836086615920067,
0.036725353449583054,
-0.006587062031030655,
0.0018237076001241803,
-0.00857317354530096,
-0.03721394017338753,
0.023965666070580482,
-0.026816871017217636,
-0.029354728758335114,
0.01789790950715542,
0.037027664482593536,
-0.03180382028222084,
-0.0214740838855505,
0.023382075130939484,
-0.05484040081501007,
-0.004092189017683268,
-0.010477575473487377,
0.11104603856801987,
-0.08612024784088135,
0.008302954025566578,
0.006444952916353941,
0.02013794705271721,
0.11644384264945984,
0.0007705855532549322,
-0.007352255750447512,
0.008188112638890743,
0.0067536369897425175,
0.03451653942465782,
-0.047980427742004395,
0.00023421731020789593,
-0.03623015061020851,
0.033372268080711365,
0.009308424778282642,
-0.01834597997367382,
-0.027695152908563614,
-0.009542562998831272,
0.030169617384672165,
0.05178488418459892,
-0.01684320531785488,
-0.036216508597135544,
0.028928622603416443,
0.031727880239486694,
-0.01722949929535389,
0.06453081965446472,
0.014096387661993504,
0.04017703980207443,
-0.0967000275850296,
0.03088548220694065,
-0.040457967668771744,
-0.003017572918906808,
0.03528786823153496,
0.000680779165122658,
-0.04372501000761986,
0.03597059100866318,
-0.02178921364247799,
-0.04228329658508301,
0.03702463582158089,
-0.010814525187015533,
-0.02367113158106804,
-0.002349922666326165,
0.04606299102306366,
-0.029413579031825066,
0.008085095323622227,
0.014749376103281975,
0.03827793896198273,
0.023065920919179916,
-0.03037407621741295,
-0.08837909996509552,
-0.014974968507885933,
-0.03611332178115845,
0.035249292850494385,
-0.02808552421629429,
0.06395397335290909,
0.0415189154446125,
0.05024169757962227,
-0.020846083760261536,
-0.059506043791770935,
-0.020766595378518105,
-0.0687924474477768,
-0.026603681966662407,
-0.014202415011823177,
0.03874611854553223,
-0.0033992244862020016,
0.049043163657188416,
-0.05547070875763893,
-0.02064196765422821,
-0.04821126535534859,
-0.024232778698205948,
-0.03441740572452545,
0.04773907735943794,
-0.0213344506919384,
-0.029153987765312195,
0.014594322070479393,
-0.008948530070483685,
-0.05134567990899086,
-0.03689369559288025,
-0.012615954503417015,
0.003383190603926778,
-0.03831803426146507,
0.013594214804470539,
0.003859094576910138,
-0.02948727272450924,
-0.018128015100955963,
0.06557784229516983,
0.009621579200029373,
-0.009348347783088684,
0.010544102638959885,
0.018574008718132973,
0.001728999661281705,
-0.0626680925488472,
0.041559234261512756,
0.06889044493436813,
-0.007900883443653584,
0.021924609318375587,
-0.013314538635313511,
-0.052085790783166885,
-0.010292124934494495,
-0.018329929560422897,
-0.042531177401542664,
0.03003196232020855,
0.00917986873537302,
0.001224019331857562,
0.013681365177035332,
-0.001430993783287704,
0.01878877356648445,
-0.00728449085727334,
-0.09360122680664062,
-0.000966676336247474,
-0.019347960129380226,
0.040339890867471695,
-0.030972778797149658,
0.04741195961833,
-0.014705969952046871,
-0.07418091595172882,
-0.005059408955276012,
-0.01780589297413826,
0.05394108220934868,
-0.062145646661520004,
0.007278961595147848,
0.013398452661931515,
-0.022557668387889862,
0.007531150244176388,
0.03071286901831627,
0.023324254900217056,
0.043557409197092056,
-0.015004378743469715,
0.001778298057615757,
0.05857298523187637,
0.033479560166597366,
-0.014554266817867756,
-0.010416623204946518,
-0.050787050276994705,
0.025560269132256508,
-0.027674267068505287,
0.03846999630331993,
0.06255528330802917,
-0.02285054884850979,
0.019558845087885857,
0.007320437114685774,
-0.026287361979484558,
-0.014180222526192665,
0.006689098197966814,
-0.02504671737551689,
-0.03167804703116417,
-0.008863185532391071,
0.021774478256702423,
-0.03411120921373367,
-0.008246270939707756,
-0.04515550658106804,
-0.03383054956793785,
-0.03434237092733383,
-0.028585463762283325,
-0.025808390229940414,
-0.026936331763863564,
-0.015956418588757515,
0.0690765455365181,
0.0002913462230935693,
0.0006541344337165356,
-0.0025138058699667454,
0.011964695528149605,
-0.02291291579604149,
0.007165572606027126,
0.0050485762767493725,
0.04637999087572098,
0.010069204494357109,
0.08354214578866959,
0.05397361144423485,
-0.0177248977124691,
0.00844596792012453,
-0.004842529539018869,
-0.0017249195370823145,
0.017007388174533844,
-0.02674461528658867,
0.021658532321453094,
-0.043830059468746185,
0.014073362573981285,
0.02967314049601555,
-0.021654479205608368,
-0.0012996660079807043,
0.04308244213461876,
-0.013767038471996784,
-0.07655929774045944,
-0.0018437471007928252,
0.01645132526755333,
0.024240855127573013,
0.05287955328822136,
-0.01811685785651207,
0.052484482526779175,
0.03785266354680061,
0.022794673219323158,
-0.02405449189245701,
0.002820687834173441,
0.007562379818409681,
-0.014347010292112827,
-0.015653852373361588,
-0.031895533204078674,
-0.0705639123916626,
0.07152821868658066,
0.06365563720464706,
-0.03473084419965744,
-0.005345761310309172,
0.012512676417827606,
0.007527606561779976,
-0.008318072184920311,
-0.000410323787946254,
-0.12106487900018692,
0.0027943041641265154,
-0.00229173363186419,
0.018019704148173332,
-0.014012950472533703,
0.013905986212193966,
0.020324459299445152,
0.04152882099151611,
-0.024267608299851418,
0.00353690842166543,
0.07590415328741074,
0.02179400622844696,
0.042197879403829575,
-0.04106903076171875,
0.02749241702258587,
0.01939772628247738,
0.02196066454052925,
-0.03279731422662735,
0.06576471775770187,
-0.0034426564816385508,
-0.010269570164382458,
-0.05583653971552849,
0.015241135843098164,
0.028244061395525932,
-0.01307590864598751,
-0.03193066641688347,
-0.007381096947938204,
0.015952089801430702,
-0.02493337169289589,
-0.09367672353982925,
-0.0152361411601305,
-0.0373360775411129,
-0.03455470874905586,
-0.038969606161117554,
0.013619584031403065,
-0.045110173523426056,
-0.02000710554420948,
-0.02606925740838051,
-0.03539513796567917,
0.044998664408922195,
-0.011556833982467651,
-0.04433556646108627,
-0.02840057574212551,
0.017813418060541153,
0.025706151500344276,
-0.006984771694988012,
0.049451086670160294,
-0.02567596361041069,
-0.010920838452875614,
-0.006177143193781376,
0.023955805227160454,
-0.031703222543001175,
0.010830216109752655,
-0.006866042502224445,
0.020133867859840393,
-0.06408273428678513,
0.014164913445711136,
-0.02790183387696743,
0.020406045019626617,
0.021422522142529488,
-0.06087236851453781,
-0.09908074885606766,
-0.020936142653226852,
0.004705402068793774,
-0.011319928802549839,
0.058063920587301254,
0.010070152580738068,
-0.001913905725814402,
-0.025916505604982376,
0.009333707392215729,
0.028370916843414307,
0.043527837842702866,
0.05301062762737274,
-0.010959823615849018,
-0.04678284004330635,
-0.037577129900455475,
0.007781929336488247,
0.017055463045835495,
0.010980061255395412,
-0.038218289613723755,
-0.016373269259929657,
0.03787001594901085,
0.00750071881338954,
-0.00936095044016838,
-0.01887880451977253,
0.0392862893640995,
0.061534713953733444,
0.05480315163731575,
-0.045236632227897644,
-0.035116761922836304,
0.013096432201564312,
-0.00686940923333168,
-0.01669328846037388,
-0.014815712347626686,
-0.04718887805938721,
-0.018376443535089493,
0.0014040772803127766,
0.030048171058297157,
0.001075376057997346,
0.029074255377054214,
0.004698498640209436,
0.06788599491119385,
-0.03437715768814087,
0.019189076498150826,
0.04886795952916145,
0.03515614941716194,
-0.01908932439982891,
0.013150817714631557,
0.004961858969181776,
0.04254863038659096,
0.030017662793397903,
-0.0113894147798419,
-0.0179910846054554,
0.024882012978196144,
-0.030400486662983894,
0.05757937952876091,
0.011658989824354649,
-0.03910617530345917,
0.052832067012786865,
-0.04738488793373108,
0.03398429974913597,
0.00253492989577353,
-0.0001512493909103796,
0.025522472336888313,
-0.04941709339618683,
0.0526898056268692,
0.04632144048810005,
-0.06255229562520981,
-0.05971888452768326,
0.013573729433119297,
-0.009322045370936394,
0.025127466768026352,
0.11383010447025299,
-0.02503904327750206,
0.03267119824886322,
0.04981372505426407,
-0.018807068467140198,
0.0104973204433918,
-0.028429348021745682,
-0.04072963446378708,
0.044586990028619766,
0.011896771378815174,
0.0638897642493248,
-0.0017550967168062925,
0.017826806753873825,
0.02787981741130352,
-0.027718808501958847,
-0.02554534748196602,
0.0035088234581053257,
-0.1015557199716568,
0.03606545180082321,
-0.0406893789768219,
0.0014725602231919765,
-0.03503831475973129,
-0.0029426785185933113,
-0.01618320494890213,
0.019699478521943092,
0.03763756528496742,
0.06311409175395966,
-0.06958075612783432,
-0.04914524033665657,
-0.005986060481518507,
0.01317044161260128,
-0.0198419988155365,
0.08239757269620895,
-0.03621130809187889,
-0.027622375637292862,
-0.005807419307529926,
-0.02234676480293274,
-0.012266987934708595,
-0.028398964554071426,
0.027407331392169,
-0.044982943683862686,
0.04305003210902214,
0.03506851941347122,
-0.0385759174823761,
-0.08155399560928345,
-0.08149706572294235,
0.03112136386334896,
-0.023525042459368706,
0.051375407725572586,
0.05462046340107918,
-0.011249185539782047,
-0.001681113732047379,
0.04310676082968712,
0.00031659286469221115,
-0.01929934322834015,
0.010903064161539078,
0.03556760028004646,
-0.04021666571497917,
0.06813257932662964,
0.0016794032417237759,
0.014347963966429234,
-0.020183132961392403,
-0.022148655727505684,
-0.035156287252902985,
0.012320797890424728,
-0.037256136536598206,
-0.0704900473356247,
-0.08227048814296722,
-0.027950182557106018,
0.00811562966555357,
-0.01731208711862564,
-0.003569429973140359,
-0.014030792750418186,
0.014075673185288906,
-0.02185663767158985,
0.03442991524934769,
0.07740471512079239,
0.026495151221752167,
0.008344965055584908,
-0.01900595985352993,
-0.006325803231447935,
-0.03920421749353409,
0.02100052498281002,
-0.06272367388010025,
0.0305114034563303,
-0.010400894097983837,
0.032107289880514145,
0.018146298825740814,
0.052966877818107605,
0.020034372806549072,
-0.018469490110874176,
-0.0283962395042181,
-0.002202485455200076,
-0.007801408879458904,
-0.028496086597442627,
-0.003456579986959696,
0.017224503681063652,
-0.03057197481393814,
0.012414177879691124,
0.038209784775972366,
-0.010221626609563828,
0.004585361573845148,
0.07219473272562027,
0.021119292825460434,
0.017234697937965393,
-0.0054120286367833614,
-4.9036694586872074e-33,
0.019795142114162445,
-0.021297389641404152,
0.012391251511871815,
-0.01313825137913227,
0.0002487247693352401,
0.016590099781751633,
-0.02026222087442875,
-0.007623552810400724,
-0.035777170211076736,
0.007084377575665712,
0.021020838990807533,
0.051445648074150085,
0.0011041925754398108,
0.016241401433944702,
0.004188732709735632,
-0.036744408309459686,
-0.027291379868984222,
-0.033584222197532654,
-0.035393327474594116,
-0.05437483638525009,
0.011096658185124397,
0.038697972893714905,
0.030991023406386375,
-0.06615175306797028,
0.02092527039349079,
0.002338441787287593,
0.00012633412552531809,
-0.006116899196058512,
-0.06102766469120979,
-0.003996135666966438,
-0.0006083138869144022,
-0.00896672997623682,
0.012859178707003593,
-0.030103201046586037,
0.06555544584989548,
-0.03484935685992241,
-0.02565508522093296,
-0.012639086693525314,
0.058014165610075,
-0.09858531504869461,
-0.04601467028260231,
-0.003959976602345705,
0.049252916127443314,
0.016756750643253326,
0.05239058658480644,
-0.04429047554731369,
-0.0098055275157094,
-0.025579050183296204,
0.025576990097761154,
0.029004767537117004,
-0.04690459743142128,
0.010670475661754608,
-0.03482690453529358,
-0.0067370058968663216,
-0.06728432327508926,
0.01605055294930935,
-0.03960508108139038,
0.07879216223955154,
-0.05760149285197258,
0.002838501473888755,
-0.03402315825223923,
0.015032797120511532,
-0.0293915756046772,
0.03522402048110962,
0.030171196907758713,
0.005257703829556704,
0.023828070610761642,
0.03811786696314812,
-0.008525079116225243,
-0.010478469543159008,
-0.050801683217287064,
0.00004483430166146718,
0.029336532577872276,
-0.04686820134520531,
-0.018955131992697716,
-0.042732976377010345,
-0.030360329896211624,
-0.048759158700704575,
0.05139606073498726,
0.012055310420691967,
-0.05961533635854721,
0.029066231101751328,
-0.01841149479150772,
-0.010063274763524532,
-0.026103323325514793,
-0.008304680697619915,
0.004130231682211161,
-0.023517297580838203,
-0.01850075274705887,
-0.020407557487487793,
0.020430512726306915,
-0.02519516460597515,
0.00949286948889494,
0.059318166226148605,
0.036139726638793945,
-0.01348868478089571,
0.058674778789281845,
-0.004791076295077801,
0.011181525886058807,
-0.01330357976257801,
0.0412103496491909,
-0.013208243995904922,
0.005575858522206545,
-0.007469484116882086,
0.032782647758722305,
-0.025874393060803413,
-0.022836588323116302,
-0.004848693963140249,
-0.03183912858366966,
-0.028509877622127533,
0.026967745274305344,
0.00829904805868864,
0.010313542559742928,
0.0391564816236496,
-0.06056727468967438,
0.03128756210207939,
0.025676431134343147,
-0.004796789027750492,
0.08245798945426941,
-0.021450527012348175,
-0.001368373166769743,
0.08848116546869278,
0.012636501342058182,
-0.03428781405091286,
0.004970775917172432,
0.0046623144298791885,
0.0566013865172863,
0.09302020072937012,
-0.0395549014210701,
-0.04198072850704193,
0.07535712420940399,
-0.01953377202153206,
2.6060669711114315e-7,
0.001954481238499284,
-0.0033523051533848047,
-0.028027553111314774,
-0.05603677034378052,
0.07237869501113892,
-0.01885504461824894,
-0.0028125615790486336,
0.06057358533143997,
0.11673326790332794,
0.018566759303212166,
0.05256842449307442,
-0.01958192139863968,
-0.010478767566382885,
0.011920557357370853,
0.05328938737511635,
0.000016260142729151994,
-0.016957534477114677,
-0.05900094658136368,
0.050971969962120056,
0.0065118190832436085,
0.02655503898859024,
0.0125410296022892,
-0.01928046904504299,
0.020438894629478455,
-0.011965670622885227,
-0.023364830762147903,
-0.034150563180446625,
0.063552625477314,
0.00574565539136529,
0.00019665098807308823,
0.020692383870482445,
-0.007974390871822834,
0.003674467094242573,
0.054585665464401245,
-0.0511145256459713,
0.03378406539559364,
-0.06159060448408127,
0.04920872673392296,
-0.03446564823389053,
0.030936963856220245,
-0.004055931698530912,
0.01506735198199749,
0.0016409090021625161,
0.01776103489100933,
0.031486742198467255,
-0.008205931633710861,
-0.01877458766102791,
0.05950475111603737,
-0.038472648710012436,
0.0015239084605127573,
0.0002937300887424499,
0.001013098401017487,
-0.022611496970057487,
0.09049918502569199,
-0.024457689374685287,
0.04514569789171219,
0.03625966235995293,
-0.0017062885453924537,
-0.001702839508652687,
0.021728424355387688,
-0.009128330275416374,
-0.04266204312443733,
0.013345818035304546,
-0.013293503783643246,
0.05786740407347679,
0.0032098861411213875,
0.013035187497735023,
1.7552510345070946e-34,
-0.021724622696638107,
-0.012180553749203682,
-0.0024128456134349108,
-0.08674708008766174,
0.012213669717311859,
-0.030944794416427612,
-0.007077827583998442,
0.049484677612781525,
0.04313473030924797,
-0.031911954283714294,
0.002227173885330558
] | {
"ds_index": 27,
"similar_dg_indices": [
1163886,
632284,
703733,
699487,
763027,
252440,
747343,
188751,
139160,
991804,
131791,
1182047,
165418,
68958,
518482,
611116,
753628,
234535,
370109,
769839
]
} |
A 63-year-old woman presents to her primary-care doctor for a 2-month history of vision changes, specifically citing the gradual onset of double vision. Her double vision is present all the time and does not get better or worse throughout the day. She has also noticed that she has a hard time keeping her right eye open, and her right eyelid looks 'droopy' in the mirror. Physical exam findings during primary gaze are shown in the photo. Her right pupil is 6 mm and poorly reactive to light. The rest of her neurologic exam is unremarkable. Laboratory studies show an Hb A1c of 5.0%. Which of the following is the next best test for this patient? | MR angiography of the head | {
"A": "Direct fundoscopy",
"B": "Intraocular pressures",
"C": "MR angiography of the head",
"D": "Temporal artery biopsy"
} | step2&3 | C | [
"63 year old woman presents",
"primary-care doctor",
"2 month history",
"vision changes",
"gradual onset",
"double vision",
"double vision",
"present",
"time",
"not",
"better",
"worse",
"day",
"hard time keeping",
"right eye open",
"right eyelid looks",
"mirror",
"Physical exam findings",
"primary gaze",
"shown",
"right pupil",
"6 mm",
"poorly reactive to light",
"rest",
"neurologic exam",
"unremarkable",
"Laboratory studies show",
"Hb A1c",
"5.0",
"following",
"next best test",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 63-year-old woman presents to her primary-care doctor for a 2-month history of vision changes, specifically citing the gradual onset of double vision. Her double vision is present all the time and does not get better or worse throughout the day. She has also noticed that she has a hard time keeping her right eye open, and her right eyelid looks 'droopy' in the mirror. Physical exam findings during primary gaze are shown in the photo. Her right pupil is 6 mm and poorly reactive to light. The rest of her neurologic exam is unremarkable. Laboratory studies show an Hb A1c of 5.0%. Which of the following is the next best test for this patient?
Choose one of the following::
A. Direct fundoscopy
B. Intraocular pressures
C. MR angiography of the head
D. Temporal artery biopsy | [
0.00805443525314331,
-0.0254612248390913,
0.0055074989795684814,
0.013886886648833752,
-0.0015002147993072867,
0.011629278771579266,
-0.016406076028943062,
0.060836829245090485,
0.07306553423404694,
-0.011769627220928669,
0.0352327935397625,
-0.06672971695661545,
0.00025370853836648166,
0.006133377552032471,
-0.026398368179798126,
0.014382213354110718,
-0.005198507569730282,
-0.011010419577360153,
-0.013536945916712284,
0.019959110766649246,
-0.02622654289007187,
-0.004263655282557011,
0.020181747153401375,
-0.02582744136452675,
0.010976715944707394,
-0.009833245538175106,
0.05401065945625305,
-0.047761786729097366,
-0.0008403916144743562,
0.02164064347743988,
-0.02556109055876732,
-0.0017101664561778307,
-0.040624525398015976,
-0.024549786001443863,
0.0000017794754967326298,
-0.020216450095176697,
0.025331424549221992,
-0.026382574811577797,
0.023340998217463493,
-0.004430334083735943,
-0.013873172923922539,
-0.044858917593955994,
0.04774142801761627,
0.00961827952414751,
-0.05065789818763733,
-0.06977664679288864,
-0.03058786131441593,
0.017446935176849365,
-0.028914213180541992,
-0.015978440642356873,
0.04592795670032501,
0.049660228192806244,
0.010110652074217796,
-0.001100787310861051,
0.0030462935101240873,
-0.007671404164284468,
-0.004958115518093109,
0.022842122241854668,
-0.02405475080013275,
-0.006342196371406317,
0.042639732360839844,
-0.005707135424017906,
0.02825506404042244,
0.03920082747936249,
-0.04826490953564644,
0.012237653136253357,
0.024648800492286682,
-0.00637923926115036,
-0.008829576894640923,
0.0304957814514637,
0.01073702797293663,
0.023833321407437325,
0.04477846249938011,
0.042316507548093796,
-0.023804033175110817,
0.0044655282981693745,
0.043243419378995895,
-0.016438964754343033,
-0.0023477107752114534,
-0.033226754516363144,
0.04079011455178261,
-0.04791048541665077,
-0.012664423324167728,
0.058007869869470596,
-0.06901301443576813,
-0.06978928297758102,
0.0031628396827727556,
0.04491362348198891,
0.030101394280791283,
0.0339977964758873,
0.04331320524215698,
-0.029813973233103752,
-0.029262984171509743,
0.0343368761241436,
-0.027693040668964386,
-0.0445464625954628,
0.005563307087868452,
0.024393780156970024,
0.007142412010580301,
-0.010745611041784286,
0.03747103363275528,
0.003058268455788493,
-0.07717437297105789,
0.007051478605717421,
-0.0766025111079216,
0.045451730489730835,
-0.026562510058283806,
0.08148609101772308,
-0.0015282410895451903,
0.06173006445169449,
0.05981748551130295,
0.04265206679701805,
-0.0032898501958698034,
-0.03845391795039177,
0.07996278256177902,
-0.052179474383592606,
-0.0025451891124248505,
-0.022933928295969963,
-0.015622754581272602,
0.0069802324287593365,
0.002427544677630067,
0.007687031757086515,
0.036738090217113495,
0.008201953023672104,
-0.0017558684339746833,
0.026517441496253014,
0.022090815007686615,
-0.06174460053443909,
0.007613311987370253,
-0.03749996796250343,
0.006535686086863279,
0.013765854761004448,
-0.026676340028643608,
0.05438297986984253,
0.03154265880584717,
0.050120849162340164,
-0.008572216145694256,
0.04652811214327812,
-0.04336482658982277,
-0.007121887058019638,
0.008008415810763836,
-0.0016499162884429097,
-0.012753303162753582,
0.027347354218363762,
-0.01157331932336092,
0.011709121987223625,
-0.005454475991427898,
0.00012290934682823718,
0.034634098410606384,
0.02344449795782566,
0.031396325677633286,
-0.028037749230861664,
-0.03788890689611435,
-0.03781126067042351,
0.0019088537665084004,
0.04019450396299362,
0.008420922793447971,
0.04173625633120537,
-0.018674543127417564,
-0.07002568244934082,
0.0433199480175972,
-0.000894125085324049,
0.06887678802013397,
0.009656094014644623,
0.02047542855143547,
0.045467693358659744,
0.03720642626285553,
0.03648091107606888,
-0.05374293029308319,
0.07856795936822891,
0.0018736164784058928,
0.03498934954404831,
0.02038789913058281,
-0.04329930245876312,
-0.015847692266106606,
-0.03411903232336044,
-0.01477131899446249,
-0.04170897230505943,
0.024957701563835144,
-0.04837806150317192,
-0.02457231841981411,
0.018389735370874405,
0.046939682215452194,
-0.0125120859593153,
-0.03178408369421959,
-0.013623478822410107,
-0.09008554369211197,
-0.04048675298690796,
0.022017737850546837,
-0.034977905452251434,
-0.019334187731146812,
0.004782806150615215,
-0.023505674675107002,
-0.010531140491366386,
-0.0037870733067393303,
0.004358472768217325,
-0.01935616321861744,
0.0035007568076252937,
-0.04068153351545334,
-0.02086392417550087,
0.0010166787542402744,
-0.026233011856675148,
0.007226529996842146,
0.014494507573544979,
-0.05097713693976402,
0.05784262716770172,
0.03859255090355873,
0.017131121829152107,
-0.02186913602054119,
-0.026011770591139793,
-0.02306051179766655,
-0.004842881578952074,
0.04626825824379921,
-0.04641229659318924,
0.04114937037229538,
-0.013225356116890907,
0.024725614115595818,
-0.00300766434520483,
-0.10439068078994751,
0.019513750448822975,
0.007700023707002401,
0.04811275005340576,
0.026366954669356346,
0.0068260435946285725,
-0.007564158644527197,
0.047927845269441605,
0.026452891528606415,
0.01112418994307518,
-0.03042180836200714,
-0.053628236055374146,
0.040669526904821396,
0.006996823940426111,
-0.07364025712013245,
0.04132777452468872,
0.024295801296830177,
-0.015084084123373032,
0.018571866676211357,
-0.02545865997672081,
0.0354568287730217,
0.027854731306433678,
0.006841953378170729,
-0.0059682526625692844,
-0.038176219910383224,
0.0405241921544075,
-0.0491134412586689,
0.004109087400138378,
-0.03839878365397453,
0.024984249845147133,
-0.033255837857723236,
0.0250827856361866,
-0.020174434408545494,
0.020551161840558052,
0.017536533996462822,
-0.06360592693090439,
-0.037533339112997055,
0.018250929191708565,
-0.06673623621463776,
0.04900483414530754,
-0.05703632906079292,
-0.0007615576032549143,
0.007258396130055189,
0.004878263454884291,
0.017056994140148163,
-0.06942316889762878,
-0.04321911931037903,
-0.050516463816165924,
0.01595430262386799,
0.05705657973885536,
-0.048191964626312256,
0.019620206207036972,
-0.03655007481575012,
0.03679004684090614,
-0.022038031369447708,
0.013740894384682178,
-0.005704179406166077,
0.004912100732326508,
0.026476211845874786,
0.03375547379255295,
0.04176951199769974,
0.008713806048035622,
0.030901990830898285,
0.035797011107206345,
0.05633804574608803,
0.01060723140835762,
-0.003017877461388707,
0.03784378990530968,
0.0237262062728405,
0.012479596771299839,
-0.009856174699962139,
0.007398498710244894,
0.012890310026705265,
0.022429898381233215,
0.020857904106378555,
-0.004924644250422716,
-0.002156950766220689,
-0.046166639775037766,
-0.015125293284654617,
0.10269340872764587,
0.01139589212834835,
0.028338594362139702,
0.005582819692790508,
0.056495632976293564,
0.00381159083917737,
-0.04641685634851456,
0.027245748788118362,
0.008499610237777233,
0.02712083049118519,
0.009368231520056725,
-0.01592818647623062,
-0.007410652469843626,
0.016552401706576347,
-0.02584921009838581,
-0.005739530548453331,
0.00347858015447855,
-0.05142940953373909,
-0.05959130823612213,
-0.005314193665981293,
-0.0436968170106411,
-0.0010341898305341601,
0.03716575354337692,
0.013668257743120193,
0.031031059101223946,
0.0003694191691465676,
0.00018269404245074838,
0.009593493305146694,
0.00041942077223211527,
0.012995701283216476,
0.00531045300886035,
-0.0359494574368,
-0.018428320065140724,
-0.007596979383379221,
-0.05876772850751877,
-0.008941469714045525,
-0.0249456949532032,
0.008546972647309303,
-0.012820919044315815,
-0.0058925519697368145,
0.11567237973213196,
-0.05632201209664345,
0.023606527596712112,
0.009813097305595875,
-0.02302844077348709,
0.011902394704520702,
0.050572123378515244,
0.025210082530975342,
-0.010583090595901012,
-0.08665906637907028,
0.04437016323208809,
-0.06560063362121582,
0.008063194341957569,
-0.03858211264014244,
0.08061759918928146,
0.01381105650216341,
0.0025557654444128275,
0.026380077004432678,
-0.043884918093681335,
0.02508625015616417,
0.03250531107187271,
0.009744834154844284,
-0.023469867184758186,
-0.04372295364737511,
0.023499980568885803,
0.025192275643348694,
0.01932195946574211,
-0.02198721654713154,
-0.017530793324112892,
0.0033404617570340633,
-0.02071707509458065,
-0.005416912026703358,
-0.022382741793990135,
-0.05522715672850609,
-0.04437366873025894,
-0.003765207016840577,
0.03342653810977936,
0.011082027107477188,
-0.0638740137219429,
-0.0021582841873168945,
-0.0650334358215332,
-0.11333999782800674,
-0.03041934221982956,
0.019144020974636078,
-0.0662434920668602,
0.03664444759488106,
-0.02080702595412731,
0.021633220836520195,
-0.006165995262563229,
-0.03150932490825653,
-0.0076811970211565495,
0.05253560096025467,
0.011671945452690125,
-0.009600067511200905,
0.05972522124648094,
-0.012488107196986675,
0.056125517934560776,
0.007791638839989901,
-0.03621216118335724,
-0.0009180681081488729,
-0.07699181884527206,
0.000042682819184847176,
0.04729354754090309,
-0.01940182037651539,
0.0015535267302766442,
0.06456421315670013,
0.0653262659907341,
0.04250025376677513,
-0.08459632843732834,
-0.04634323716163635,
-0.04235118255019188,
0.0445532351732254,
0.04100267216563225,
-0.030586518347263336,
-0.12076032161712646,
0.04922114685177803,
-0.01143715437501669,
0.0559774748980999,
-0.019443873316049576,
-0.004095777869224548,
-0.012010733596980572,
0.03805512562394142,
-0.035971660166978836,
0.049132611602544785,
-0.010524583049118519,
-0.07068091630935669,
-0.012489717453718185,
-0.00841181818395853,
0.032708436250686646,
0.07262034714221954,
0.010587562806904316,
0.0010590655729174614,
0.01185341365635395,
-0.008251633495092392,
0.03659740462899208,
0.06374287605285645,
0.061828844249248505,
-0.07343564927577972,
0.028190473094582558,
-0.012359488755464554,
0.05309869721531868,
0.011474312283098698,
-0.04050201177597046,
-0.01410443615168333,
-0.019730303436517715,
0.08051974326372147,
0.011799600906670094,
-0.024105148389935493,
0.012636917643249035,
-0.0012805762235075235,
0.06192890927195549,
0.04638317972421646,
0.06895778328180313,
0.04285096749663353,
-0.07680284231901169,
-0.0017959908582270145,
0.02079777978360653,
-0.017590176314115524,
-0.05204159393906593,
0.032673146575689316,
-0.012020902708172798,
0.013311791233718395,
0.05464933067560196,
-0.012243440374732018,
0.006423098500818014,
-0.009519373066723347,
-0.014816757291555405,
0.020377982407808304,
-0.06670591980218887,
-0.04047226533293724,
0.014682830311357975,
0.034971266984939575,
-0.01960836723446846,
0.0061449091881513596,
0.005089905112981796,
-0.006225235294550657,
0.02263740636408329,
-0.06229909136891365,
0.003412272548303008,
-0.05874623358249664,
-0.0016692850040271878,
-0.004802479408681393,
0.036133404821157455,
0.007924177683889866,
0.0421275794506073,
-0.009775949642062187,
0.04162062704563141,
-0.03311720862984657,
-0.011617792770266533,
-0.015617113560438156,
-0.015623277984559536,
-0.012963692657649517,
-0.017250342294573784,
-0.0016914146253839135,
-0.016548529267311096,
-0.03631843999028206,
-0.0171231459826231,
-0.027462225407361984,
-0.05414176359772682,
-0.0374586246907711,
0.03124232217669487,
0.041269849985837936,
-0.016907544806599617,
0.0363774374127388,
-0.027787139639258385,
0.025163918733596802,
-0.01771330088376999,
0.023728881031274796,
0.049860887229442596,
-0.002034091157838702,
0.10956680774688721,
0.010110914707183838,
-0.049198735505342484,
-0.014709873124957085,
0.012483157217502594,
0.02949051931500435,
-0.0068598478101193905,
0.06950046122074127,
0.015025043860077858,
-0.040811408311128616,
0.022195523604750633,
0.015605847351253033,
0.01069978903979063,
-0.012418719939887524,
0.005238954909145832,
-0.008654419332742691,
0.0039186011999845505,
-0.029758436605334282,
0.0019365939078852534,
0.0049194758757948875,
-0.023704804480075836,
-0.007717288564890623,
0.015058619901537895,
-0.052952609956264496,
-0.05588313937187195,
-0.032914914190769196,
-0.005627546459436417,
-0.015088989399373531,
-0.008566770702600479,
0.030872579663991928,
-0.04632753133773804,
0.030128611251711845,
-0.026716284453868866,
-0.027950365096330643,
0.022879669442772865,
0.009670520201325417,
0.036608003079891205,
-0.017115596681833267,
0.04980039969086647,
-0.019696736708283424,
0.06277526915073395,
0.020734697580337524,
0.005024819169193506,
-0.039302852004766464,
0.03967130184173584,
0.019422490149736404,
0.0093118567019701,
0.048426173627376556,
-5.77562655621421e-33,
0.03209027275443077,
0.023875271901488304,
0.03646848350763321,
-0.08171192556619644,
0.022631147876381874,
0.06377550214529037,
-0.0028901046607643366,
-0.01295616663992405,
-0.06487848609685898,
0.022259103134274483,
0.006180324126034975,
0.011929161846637726,
0.0062249223701655865,
0.06048378348350525,
-0.033244818449020386,
-0.03580889478325844,
-0.03038233518600464,
0.0317826084792614,
-0.028663042932748795,
-0.04837800934910774,
-0.05371691286563873,
-0.018682992085814476,
-0.01827671006321907,
-0.007534178905189037,
-0.05454235523939133,
0.012338079512119293,
0.04509362205862999,
0.018536947667598724,
-0.016248248517513275,
0.07228868454694748,
0.03827931731939316,
-0.002584836445748806,
0.02549811638891697,
0.06619054079055786,
0.03530021756887436,
-0.04940527677536011,
-0.05303825065493584,
-0.06185881420969963,
0.020236432552337646,
-0.007265131454914808,
-0.10286365449428558,
0.02472100965678692,
0.025795284658670425,
-0.006934138014912605,
0.0340765155851841,
-0.0457247719168663,
-0.036323193460702896,
-0.025991221889853477,
0.0011051495093852282,
0.009139188565313816,
0.015580498613417149,
0.016843151301145554,
0.03555459529161453,
0.042928311973810196,
-0.03800906240940094,
0.0034662806428968906,
-0.004781585652381182,
-0.00010094905883306637,
-0.03882335498929024,
0.056614287197589874,
0.0211816243827343,
-0.0281684510409832,
-0.0036972647067159414,
0.04084176942706108,
-0.027841009199619293,
0.015355524607002735,
0.06772267818450928,
-0.018149487674236298,
-0.03328147530555725,
-0.0484420470893383,
-0.07204214483499527,
-0.07820841670036316,
-0.010199247859418392,
0.0048883031122386456,
-0.037359192967414856,
0.005358339287340641,
0.010560080409049988,
-0.003953338600695133,
0.023209000006318092,
0.022016430273652077,
-0.02834019996225834,
-0.016660869121551514,
-0.06271689385175705,
0.009142622351646423,
0.0014781176578253508,
0.03852586820721626,
-0.03854621201753616,
-0.039258573204278946,
0.060716405510902405,
-0.013426429592072964,
0.051654696464538574,
0.05994220823049545,
0.04257633909583092,
-0.015147306025028229,
0.011507193557918072,
-0.024063346907496452,
0.018018189817667007,
0.0012016291730105877,
0.004303282126784325,
0.01644614338874817,
0.09262505173683167,
0.004913405515253544,
0.09288087487220764,
-0.017687879502773285,
-0.04287615045905113,
0.018459031358361244,
-0.021011443808674812,
-0.07524972409009933,
-0.01812467724084854,
0.03363759070634842,
0.01904991641640663,
-0.030396107584238052,
-0.0087899100035429,
0.04442617669701576,
-0.0449298694729805,
0.02140164002776146,
0.01476365327835083,
0.07311084121465683,
0.04966260492801666,
-0.05505124107003212,
-0.00016097935440484434,
0.02412961982190609,
0.01116989366710186,
0.011842063628137112,
-0.01135614886879921,
-0.0207125935703516,
0.003787417896091938,
-0.014787951484322548,
-0.03165894374251366,
-0.03366180136799812,
-0.009974602609872818,
0.02272212691605091,
2.67361997430271e-7,
0.02435394376516342,
0.022961776703596115,
-0.056482527405023575,
-0.04664062708616257,
0.00783089641481638,
-0.044082045555114746,
0.026484163478016853,
0.004423459060490131,
-0.01277078501880169,
0.002922291401773691,
0.0384599007666111,
0.004781918600201607,
-0.03761076182126999,
-0.08603084832429886,
0.0594455860555172,
0.005012398585677147,
0.01731681264936924,
0.018437575548887253,
-0.014219904318451881,
-0.03271828591823578,
-0.03070068173110485,
-0.04079359397292137,
-0.07309505343437195,
-0.032477352768182755,
0.0005703578935936093,
-0.06719978153705597,
-0.02512506954371929,
-0.011229844763875008,
-0.004821872338652611,
0.025251513347029686,
-0.01724369265139103,
0.0670674741268158,
0.03319701924920082,
0.05347271263599396,
-0.05239470675587654,
-0.06259128451347351,
0.009780309163033962,
-0.01325484924018383,
-0.05992531403899193,
0.036942802369594574,
0.04714910686016083,
0.06080474704504013,
0.023511240258812904,
-0.03132179006934166,
0.05340295284986496,
0.03482887148857117,
-0.019316215068101883,
0.04954350367188454,
-0.02820514515042305,
-0.04942508041858673,
0.004167987033724785,
-0.026158101856708527,
-0.05118918418884277,
0.032203663140535355,
-0.0006385676097124815,
0.07756195217370987,
-0.043463487178087234,
-0.0011269351234659553,
0.056547485291957855,
-0.06258204579353333,
0.02064095251262188,
-0.02614656277000904,
0.009266600012779236,
-0.05218598619103432,
0.037037383764982224,
-0.05833841860294342,
-0.057753901928663254,
1.966027847485959e-34,
-0.021198956295847893,
-0.02102949284017086,
0.02498430386185646,
-0.031639520078897476,
0.01046465802937746,
-0.034854378551244736,
-0.015446560457348824,
-0.005911674350500107,
-0.015073931775987148,
-0.018238380551338196,
-0.030380064621567726
] | {
"ds_index": 28,
"similar_dg_indices": [
398377,
456409,
382319,
249287,
280022,
43561,
1012139,
352565,
350239,
654694,
590309,
662151,
396823,
1174404,
380200,
884679,
865487,
752803,
18682,
560206
]
} |
An investigator is studying the modification of newly formed polypeptides in plated eukaryotic cells. After the polypeptides are released from the ribosome, a chemically-tagged protein attaches covalently to lysine residues on the polypeptide chain, forming a modified polypeptide. When a barrel-shaped complex is added to the cytoplasm, the modified polypeptide lyses, resulting in individual amino acids and the chemically-tagged proteins. Which of the following post-translational modifications has most likely occurred? | Ubiquitination | {
"A": "Glycosylation",
"B": "Phosphorylation",
"C": "Carboxylation",
"D": "Ubiquitination"
} | step1 | D | [
"investigator",
"studying",
"modification",
"newly formed polypeptides",
"plated eukaryotic cells",
"polypeptides",
"released",
"ribosome",
"a chemically tagged protein",
"lysine residues",
"polypeptide chain",
"forming",
"modified polypeptide",
"barrel-shaped complex",
"added",
"cytoplasm",
"modified polypeptide lyses",
"resulting in individual amino acids",
"chemically tagged proteins",
"following post-translational modifications",
"most likely occurred"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An investigator is studying the modification of newly formed polypeptides in plated eukaryotic cells. After the polypeptides are released from the ribosome, a chemically-tagged protein attaches covalently to lysine residues on the polypeptide chain, forming a modified polypeptide. When a barrel-shaped complex is added to the cytoplasm, the modified polypeptide lyses, resulting in individual amino acids and the chemically-tagged proteins. Which of the following post-translational modifications has most likely occurred?
Choose one of the following::
A. Glycosylation
B. Phosphorylation
C. Carboxylation
D. Ubiquitination | [
0.022956373170018196,
-0.08038327842950821,
0.04526754096150398,
-0.0006107299122959375,
0.0061724805273115635,
0.012388928793370724,
-0.019179897382855415,
-0.013734373264014721,
0.029192892834544182,
-0.009615970775485039,
0.039310868829488754,
-0.015288097783923149,
0.03489295020699501,
-0.01748983934521675,
0.03667951747775078,
0.0581691637635231,
-0.014241672120988369,
0.0017253777477890253,
-0.05002947896718979,
0.009389377199113369,
-0.031050605699419975,
-0.0010021048365160823,
0.020552387461066246,
-0.056423597037792206,
0.0008468606974929571,
0.007155554369091988,
-0.046266891062259674,
-0.011108160950243473,
0.012648718431591988,
-0.004516327753663063,
-0.011146501637995243,
0.04384240880608559,
-0.00013776325795333833,
-0.10617853701114655,
0.0000016685371519997716,
-0.048607926815748215,
-0.05816249921917915,
-0.004770898260176182,
-0.006978739984333515,
0.027888186275959015,
-0.007940210402011871,
-0.03164329379796982,
-0.019558046013116837,
-0.006438172422349453,
0.03530789166688919,
-0.0364648774266243,
0.03896727040410042,
0.02057616412639618,
-0.014235331676900387,
-0.005191348493099213,
-0.0013468667166307569,
-0.06397043913602829,
0.04581192135810852,
0.03658131882548332,
0.08710968494415283,
-0.02210746705532074,
-0.016432426869869232,
-0.003520604455843568,
-0.06664083898067474,
0.036873746663331985,
0.02842930518090725,
-0.024062516167759895,
0.008219387382268906,
-0.011274631135165691,
0.029672779142856598,
-0.014545734040439129,
0.022418374195694923,
-0.05865340307354927,
0.015796242281794548,
-0.03404001146554947,
0.012524137273430824,
-0.02894548512995243,
-0.03107573837041855,
0.02524533122777939,
0.018061848357319832,
-0.059095095843076706,
0.02337253838777542,
-0.020255085080862045,
0.05830492451786995,
0.012153279967606068,
0.02102046273648739,
-0.03082161583006382,
-0.013882075436413288,
-0.0018584361532703042,
-0.009835678152740002,
-0.03820069134235382,
0.005303012672811747,
-0.06865821033716202,
-0.09320691972970963,
0.04318927973508835,
-0.00655072508379817,
-0.015512374229729176,
0.015901433303952217,
0.03991914168000221,
0.05954187735915184,
0.02296823263168335,
0.023151710629463196,
-0.008550327271223068,
-0.027517227455973625,
-0.00798607338219881,
0.007026598788797855,
0.030761074274778366,
0.03022068925201893,
0.03157667815685272,
-0.027090411633253098,
-0.01832413300871849,
0.0115539925172925,
-0.015568118542432785,
-0.05048732832074165,
0.018709301948547363,
-0.02937338501214981,
0.04982119798660278,
-0.03349689021706581,
0.019218746572732925,
0.0840703547000885,
0.04356938600540161,
0.0173812098801136,
0.06173237785696983,
0.0548446886241436,
0.0545596145093441,
-0.023727240040898323,
-0.010538127273321152,
-0.03423555567860603,
0.0495942123234272,
-0.0333784744143486,
0.025378825142979622,
0.010167247615754604,
-0.059287432581186295,
-0.030753839761018753,
-0.014410444535315037,
-0.015615656971931458,
-0.02192019857466221,
-0.0413670614361763,
0.026491330936551094,
-0.05886203423142433,
-0.0007474012672901154,
-0.017774978652596474,
0.012634452432394028,
-0.008803620003163815,
-0.03533952310681343,
-0.015719415619969368,
-0.0022937003523111343,
0.008017235435545444,
0.0019548481795936823,
0.021248869597911835,
0.021641317754983902,
-0.03384263813495636,
0.07594374567270279,
0.06841893494129181,
0.014105896465480328,
-0.041415005922317505,
0.05032505840063095,
-0.008260910399258137,
0.021120162680745125,
-0.006389239337295294,
0.018492350354790688,
-0.026707211509346962,
-0.0231748316437006,
0.01703605055809021,
-0.010356570594012737,
0.013918733224272728,
-0.07118318229913712,
0.010100550018250942,
-0.05150244012475014,
-0.019579021260142326,
0.04078901559114456,
0.014995597302913666,
0.019368179142475128,
0.06555606424808502,
0.0009174820152111351,
-0.022947629913687706,
-0.08964905142784119,
-0.0027312759775668383,
0.03802302107214928,
-0.011859188787639141,
0.02961319498717785,
-0.02829173393547535,
0.020743748173117638,
-0.009822762571275234,
-0.01918114349246025,
0.015088928863406181,
0.048737917095422745,
0.02541026473045349,
-0.045988261699676514,
-0.058939263224601746,
0.018795980140566826,
0.00256625865586102,
-0.045280344784259796,
0.049614179879426956,
-0.010937117040157318,
0.04002290219068527,
0.06410802900791168,
0.06797997653484344,
-0.050331100821495056,
-0.023761874064803123,
0.04929665848612785,
-0.03489644080400467,
0.02572997286915779,
0.011397009715437889,
-0.05773318186402321,
0.06012740358710289,
0.011606762185692787,
0.036707207560539246,
0.056111518293619156,
-0.009397956542670727,
-0.023967865854501724,
-0.04371657595038414,
-0.014988092705607414,
-0.04555073007941246,
0.08145622164011002,
0.03892285376787186,
0.03923661261796951,
0.01649327203631401,
0.020019832998514175,
0.020278800278902054,
0.03748926520347595,
-0.02675977163016796,
-0.02882111258804798,
-0.06266938894987106,
-0.017577698454260826,
0.014854312874376774,
0.004704765509814024,
-0.016041219234466553,
-0.017746474593877792,
0.016632359474897385,
-0.054661888629198074,
-0.013835364021360874,
0.0020519751124083996,
-0.034487608820199966,
-0.03343774005770683,
0.01104423776268959,
0.027346424758434296,
0.022455411031842232,
0.035628922283649445,
0.014412950724363327,
-0.01052389107644558,
0.029031265527009964,
-0.024300307035446167,
-0.009229903109371662,
0.06188367307186127,
-0.020575739443302155,
-0.06743421405553818,
-0.022076208144426346,
-0.00684336805716157,
0.084679514169693,
-0.01970568299293518,
0.03825883939862251,
0.010133926756680012,
0.03524407744407654,
0.006469911430031061,
-0.03665613383054733,
-0.012307004071772099,
0.017284534871578217,
-0.009321623481810093,
0.021020960062742233,
0.027230286970734596,
-0.05944371595978737,
-0.007661781739443541,
-0.005356406327337027,
0.03605895861983299,
0.06423074752092361,
0.05208565667271614,
0.057415131479501724,
0.0760025680065155,
-0.024892887100577354,
-0.039724476635456085,
-0.03507696092128754,
0.040246352553367615,
-0.03708500787615776,
0.011696971021592617,
0.05651327967643738,
0.027504855766892433,
-0.004173469264060259,
-0.014141974039375782,
0.026122229173779488,
-0.059935588389635086,
-0.001699163462035358,
0.00038448561099357903,
0.03253009915351868,
-0.005516839679330587,
0.029068859294056892,
0.0546368844807148,
0.0004896334721706808,
0.009777873754501343,
0.014634576626121998,
0.06247098371386528,
-0.013096644543111324,
-0.05632589012384415,
-0.062432579696178436,
-0.09831997007131577,
-0.054325126111507416,
0.015999574214220047,
0.03682340309023857,
-0.05167249217629433,
0.011824890971183777,
0.017483418807387352,
0.05367977172136307,
0.03602040931582451,
-0.02679145336151123,
0.033037591725587845,
0.060742612928152084,
0.05464545264840126,
-0.017813250422477722,
-0.01546892523765564,
-0.03309322148561478,
0.024860255420207977,
-0.018489252775907516,
-0.015959328040480614,
0.023873697966337204,
0.05402367562055588,
0.0294321458786726,
0.0034185603726655245,
-0.06530450284481049,
0.028118645772337914,
0.0009736868087202311,
-0.08725185692310333,
0.019584326073527336,
-0.05016806721687317,
0.00788789801299572,
0.05792803689837456,
-0.00706533482298255,
-0.0055940039455890656,
-0.04119336977601051,
0.014985412359237671,
0.02798726037144661,
-0.06588241457939148,
0.01631290465593338,
0.09148908406496048,
-0.003964326810091734,
0.04937545582652092,
0.008524242788553238,
-0.02310376614332199,
-0.00196070340462029,
0.008237357251346111,
0.011362115852534771,
0.0309985913336277,
-0.019611604511737823,
0.00008187619096133858,
-0.05583145469427109,
-0.06967239826917648,
-0.02458225190639496,
-0.005759183317422867,
0.021378759294748306,
0.07104761153459549,
0.041380416601896286,
-0.011475851759314537,
0.020640257745981216,
-0.019518079236149788,
0.03164564073085785,
-0.020854011178016663,
-0.007190835662186146,
-0.009969213977456093,
-0.00006988913082750514,
-0.014434754848480225,
-0.020968375727534294,
-0.03611277416348457,
-0.025230538100004196,
0.06357300281524658,
-0.04595952481031418,
-0.035240478813648224,
0.01163994986563921,
-0.00834090169519186,
-0.10188121348619461,
-0.030253944918513298,
-0.013712665066123009,
0.010068384930491447,
0.03721325844526291,
-0.03852878138422966,
-0.06466387957334518,
0.007498883176594973,
-0.02313200756907463,
0.008484289050102234,
0.004033659119158983,
-0.01418186817318201,
0.03438673913478851,
0.003944726660847664,
0.02205357328057289,
-0.011850163340568542,
-0.0617743618786335,
-0.026614420115947723,
0.045242369174957275,
-0.03918478265404701,
0.050208840519189835,
-0.033123984932899475,
-0.06555362045764923,
0.004055737517774105,
-0.003200763603672385,
-0.04383597895503044,
-0.0156375952064991,
0.057970140129327774,
0.012171346694231033,
-0.054439641535282135,
-0.0027182986959815025,
-0.0004775785200763494,
-0.006096080876886845,
0.02075597457587719,
-0.016591407358646393,
0.01762598194181919,
0.004488085862249136,
0.047029878944158554,
0.03406411036849022,
-0.007022344972938299,
0.021597228944301605,
-0.0659780502319336,
0.003123650560155511,
-0.01027024257928133,
0.029611216858029366,
0.020839648321270943,
-0.0027563523035496473,
-0.008230493403971195,
0.049649108201265335,
-0.013603395782411098,
0.007327936124056578,
0.02037426084280014,
-0.038717761635780334,
0.05867520719766617,
-0.05915825814008713,
-0.014841489493846893,
-0.04304490238428116,
-0.03296200558543205,
-0.003140324028208852,
-0.01799471490085125,
0.004083011765033007,
-0.015325863845646381,
0.03411000967025757,
-0.028606092557311058,
0.03497016802430153,
-0.07307898998260498,
-0.008866002783179283,
-0.00041245014290325344,
-0.07752073556184769,
-0.005759102758020163,
0.0068749720230698586,
-0.0050372350960969925,
-0.015180855058133602,
0.015864184126257896,
-0.026849765330553055,
-0.02842646837234497,
-0.011581429280340672,
-0.1230626329779625,
-0.007649919018149376,
0.020635167136788368,
0.03340424597263336,
0.02418452501296997,
0.029408147558569908,
-0.005211956799030304,
-0.02492932602763176,
-0.011369040235877037,
-0.018963675945997238,
0.04460219293832779,
-0.010798627510666847,
0.011715573258697987,
-0.0413285531103611,
-0.002214541658759117,
-0.018013905733823776,
0.015464749187231064,
-0.006226490251719952,
-0.03609933704137802,
-0.03622199967503548,
0.005295724142342806,
-0.015039227902889252,
0.006820304319262505,
0.040517743676900864,
-0.04232452064752579,
-0.014055623672902584,
-0.06001785770058632,
-0.01990826055407524,
0.07461073249578476,
0.01984698697924614,
-0.027063295245170593,
0.02367493323981762,
-0.0030976112466305494,
0.0023484898265451193,
0.008954801596701145,
-0.0006398752448149025,
0.015740294009447098,
-0.043350815773010254,
0.031898949295282364,
-0.13790754973888397,
0.050444040447473526,
-0.0023741822224110365,
0.015149938873946667,
-0.009583061560988426,
-0.02462872676551342,
0.017129262909293175,
-0.0202350877225399,
0.024326179176568985,
-0.027427781373262405,
-0.014537989161908627,
-0.038875430822372437,
0.03529632091522217,
0.03857847675681114,
-0.006042079534381628,
0.01917937584221363,
-0.06509867310523987,
0.011835125274956226,
0.03861476480960846,
0.0027676939498633146,
0.019827689975500107,
0.004557511769235134,
0.035886168479919434,
0.018613310530781746,
0.0058320569805800915,
0.043506402522325516,
0.024577850475907326,
0.029863625764846802,
-0.037076786160469055,
-0.04506148397922516,
-0.04806838929653168,
0.04996371641755104,
-0.028865862637758255,
-0.005188213661313057,
-0.016678571701049805,
0.04861291125416756,
0.010505921207368374,
-0.11024246364831924,
-0.011982066556811333,
-0.03524215519428253,
-0.03213027864694595,
0.033871401101350784,
0.01628810539841652,
0.004885334521532059,
-0.039826735854148865,
0.00984134804457426,
-0.007458118721842766,
0.05703932046890259,
-0.0048246909864246845,
-0.014401120133697987,
-0.03203930705785751,
0.022757481783628464,
0.0078035444021224976,
0.027749206870794296,
-0.01230045035481453,
-0.025119919329881668,
0.018124399706721306,
0.0006852649385109544,
-0.03591581806540489,
-0.06605800986289978,
-0.054534826427698135,
-0.004155576229095459,
0.044154297560453415,
-0.0077000632882118225,
0.004789417609572411,
-0.007745012175291777,
0.033456381410360336,
0.031465258449316025,
-0.030933870002627373,
-0.012579436413943768,
0.02891589142382145,
-0.04541940614581108,
-0.006821878254413605,
0.05540047213435173,
0.031163841485977173,
0.03210596367716789,
0.06813962012529373,
-5.3985595598810984e-33,
0.08460096269845963,
-0.0008612530073150992,
-0.0035564107820391655,
0.03896802291274071,
-0.04032212123274803,
0.013599504716694355,
-0.01946694776415825,
0.01175166666507721,
0.025303706526756287,
-0.006292729172855616,
0.034150030463933945,
0.037497710436582565,
0.017288390547037125,
-0.0406019389629364,
-0.04365050420165062,
-0.04174943268299103,
0.055938947945833206,
-0.002055108780041337,
0.028516899794340134,
-0.01253682654350996,
0.005891131237149239,
-0.01840704120695591,
0.03729568049311638,
-0.0073067424818873405,
0.06008715182542801,
-0.014818437397480011,
-0.031869370490312576,
-0.014063061214983463,
-0.037587571889162064,
-0.02555595524609089,
0.03055582009255886,
-0.030218414962291718,
-0.05636915564537048,
-0.036545515060424805,
-0.022933946922421455,
-0.05790875107049942,
0.0235881507396698,
-0.007568552158772945,
0.036887168884277344,
0.05118895694613457,
-0.08513245731592178,
-0.026593118906021118,
-0.030938101932406425,
0.006173907779157162,
-0.03762297332286835,
0.040436144918203354,
-0.016728080809116364,
-0.01857953704893589,
-0.06315543502569199,
0.028117969632148743,
-0.06480376422405243,
-0.016393782570958138,
0.02669978328049183,
0.03999032825231552,
-0.021420951932668686,
-0.03382474184036255,
-0.0022751609794795513,
0.005449759773910046,
-0.03234313800930977,
0.03129172325134277,
0.074745312333107,
0.031879350543022156,
0.0071711428463459015,
0.003021018113940954,
-0.00987295713275671,
-0.03325141966342926,
0.0344267264008522,
0.07042893022298813,
0.02078540436923504,
0.03385572507977486,
-0.0050915381871163845,
-0.0013431082479655743,
0.0013946682447567582,
-0.08065912127494812,
0.03455348685383797,
-0.03781672939658165,
0.013759823516011238,
-0.006663529202342033,
0.01231466419994831,
-0.05056235194206238,
-0.05782315135002136,
0.008340380154550076,
0.04596175625920296,
-0.002980574732646346,
-0.0679510161280632,
0.01819061115384102,
0.0031098336912691593,
-0.0453348308801651,
-0.0362398661673069,
-0.021348731592297554,
0.006006496027112007,
0.04090734198689461,
-0.0015738368965685368,
0.009342639707028866,
-0.01068545039743185,
-0.023822849616408348,
-0.05050958693027496,
0.00458521768450737,
-0.0034795578103512526,
-0.001060188515111804,
0.037367966026067734,
-0.01516206469386816,
0.06549786031246185,
-0.0905928760766983,
-0.032200079411268234,
-0.03064878098666668,
0.0124202324077487,
0.015682050958275795,
-0.017105896025896072,
0.02180979959666729,
-0.029368503019213676,
0.01802632585167885,
0.04232925921678543,
0.05188402906060219,
-0.032833851873874664,
0.038887541741132736,
-0.0049969106912612915,
0.028991149738430977,
0.0403379462659359,
0.042241163551807404,
0.047533757984638214,
0.061333779245615005,
0.03678668662905693,
0.033864352852106094,
-0.10149075090885162,
0.007666153367608786,
0.04216935113072395,
0.0872650146484375,
0.02788841724395752,
0.017605822533369064,
-0.031619101762771606,
0.021493013948202133,
2.6114111051356304e-7,
0.011650939472019672,
0.02686239778995514,
0.0005620470037683845,
0.0005290910485200584,
0.007100619375705719,
-0.034665629267692566,
-0.004383491352200508,
0.03017808124423027,
0.004424970131367445,
-0.011876874603331089,
0.0027409580070525408,
-0.05447478964924812,
-0.0023856195621192455,
-0.013488181866705418,
0.023978054523468018,
0.020163901150226593,
0.04326169192790985,
0.01948077604174614,
0.026325223967432976,
0.005895046982914209,
0.06983479857444763,
0.022877512499690056,
-0.05575175955891609,
0.019908497110009193,
-0.030858555808663368,
0.046197228133678436,
0.00014759322220925242,
-0.04394157603383064,
-0.011662565171718597,
-0.03553427755832672,
0.005124586168676615,
0.0766739696264267,
0.022162431851029396,
0.022543158382177353,
-0.07408054172992706,
-0.06709164381027222,
0.036863408982753754,
-0.0347495973110199,
-0.00777449132874608,
0.11330098658800125,
0.021023210138082504,
0.0006704813567921519,
0.05309338495135307,
0.09627073258161545,
-0.05817790701985359,
-0.022405950352549553,
-0.012935567647218704,
0.0012939318548887968,
0.007470129057765007,
0.0038801422342658043,
0.006409331690520048,
-0.005998753942549229,
0.0048036230728030205,
0.048327233642339706,
0.02000582404434681,
0.0066741397604346275,
-0.03257549926638603,
0.05952129513025284,
-0.028745250776410103,
0.000758740643505007,
0.017288053408265114,
0.02790825068950653,
-0.021362796425819397,
-0.007595845498144627,
0.07310368865728378,
-0.035960569977760315,
-0.028386972844600677,
2.0176894466721563e-34,
0.04072160646319389,
-0.050559889525175095,
0.016930589452385902,
-0.031904157251119614,
0.0013103883247822523,
-0.01657009869813919,
0.02875242382287979,
0.03572312742471695,
0.013599014841020107,
-0.04439259693026543,
-0.00649302639067173
] | {
"ds_index": 29,
"similar_dg_indices": [
352634,
507628,
68382,
293742,
681437,
346625,
967073,
172841,
568960,
544411,
846321,
866318,
309329,
621387,
1196521,
270404,
30986,
1112652,
125284,
1171526
]
} |
A 38-year-old man presents to his physician with double vision persisting for a week. When he enters the exam room, the physician notes that the patient has a broad-based gait. The man’s wife informs the doctor that he has been an alcoholic for the last 5 years and his consumption of alcohol has increased significantly over the past few months. She also reports that he has become indifferent to his family members over time and is frequently agitated. She also says that his memory has been affected significantly, and when asked about a particular detail, he often recollects it incorrectly, though he insists that his version is the true one. On physical examination, his vital signs are stable, but when the doctor asks him where he is, he seems to be confused. His neurological examination also shows nystagmus. Which of the following options describes the earliest change in the pathophysiology of the central nervous system in this man? | Decreased α-ketoglutarate dehydrogenase activity in astrocytes | {
"A": "Decreased α-ketoglutarate dehydrogenase activity in astrocytes",
"B": "Increased extracellular concentration of glutamate",
"C": "Increased astrocyte lactate",
"D": "Breakdown of the blood-brain barrier"
} | step2&3 | A | [
"year old man presents",
"physician",
"double vision",
"week",
"enters",
"exam room",
"physician notes",
"patient",
"broad-based gait",
"mans wife informs",
"doctor",
"alcoholic",
"years",
"consumption",
"alcohol",
"increased",
"past",
"months",
"reports",
"indifferent",
"family members",
"time",
"frequently agitated",
"memory",
"affected",
"detail",
"often recollects",
"version",
"true one",
"physical examination",
"vital signs",
"stable",
"doctor",
"to",
"confused",
"neurological examination",
"shows nystagmus",
"following options",
"earliest change",
"pathophysiology",
"central nervous system",
"man"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 38-year-old man presents to his physician with double vision persisting for a week. When he enters the exam room, the physician notes that the patient has a broad-based gait. The man’s wife informs the doctor that he has been an alcoholic for the last 5 years and his consumption of alcohol has increased significantly over the past few months. She also reports that he has become indifferent to his family members over time and is frequently agitated. She also says that his memory has been affected significantly, and when asked about a particular detail, he often recollects it incorrectly, though he insists that his version is the true one. On physical examination, his vital signs are stable, but when the doctor asks him where he is, he seems to be confused. His neurological examination also shows nystagmus. Which of the following options describes the earliest change in the pathophysiology of the central nervous system in this man?
Choose one of the following::
A. Decreased α-ketoglutarate dehydrogenase activity in astrocytes
B. Increased extracellular concentration of glutamate
C. Increased astrocyte lactate
D. Breakdown of the blood-brain barrier | [
0.02002987079322338,
0.006593769881874323,
0.0032551498152315617,
-0.02784569375216961,
-0.01409171987324953,
0.01685492694377899,
-0.03278059884905815,
0.07893365621566772,
0.046566300094127655,
-0.01573685184121132,
0.0778731033205986,
-0.007849608547985554,
0.015257910825312138,
-0.07282497733831406,
0.03018408827483654,
0.029148774221539497,
0.015715161338448524,
0.014155060984194279,
-0.014663251116871834,
0.013587327674031258,
-0.03229374811053276,
-0.028465867042541504,
0.008281531743705273,
-0.049817755818367004,
0.015550890006124973,
-0.03741321340203285,
0.010325958020985126,
-0.02024681307375431,
-0.03988885134458542,
-0.016614627093076706,
-0.0661478340625763,
0.01169067993760109,
0.012939146719872952,
-0.013522402383387089,
0.0000020075847260159208,
-0.004295631777495146,
0.009668685495853424,
-0.020890872925519943,
0.017818234860897064,
0.0024681896902620792,
0.02797417901456356,
0.00761647243052721,
0.05559292063117027,
0.020318491384387016,
-0.03834698721766472,
-0.06715460121631622,
-0.026120036840438843,
0.06985484808683395,
-0.030820108950138092,
0.0401514507830143,
-0.0019957940094172955,
0.023498201742768288,
-0.05427108332514763,
-0.028839202597737312,
0.04426401108503342,
-0.009745122864842415,
0.04211638495326042,
0.009796405211091042,
-0.046727072447538376,
-0.039665598422288895,
-0.021818388253450394,
-0.020096994936466217,
-0.0048535787500441074,
0.03513205051422119,
-0.01709865778684616,
0.012959646061062813,
0.09916344285011292,
0.007689146790653467,
-0.01877136155962944,
-0.025197045877575874,
0.0033591443207114935,
0.0147500429302454,
0.06723003089427948,
0.04799700155854225,
-0.041648756712675095,
0.010872650891542435,
0.03423710912466049,
-0.02283128723502159,
-0.008409262634813786,
-0.0424032025039196,
0.04604578763246536,
-0.019061461091041565,
0.014724791049957275,
0.04295520484447479,
-0.041507553309202194,
-0.04398927465081215,
0.025590024888515472,
0.01396553311496973,
0.033458907157182693,
-0.034452423453330994,
0.05228740721940994,
-0.05612137168645859,
-0.018209651112556458,
0.017745304852724075,
-0.02386343851685524,
-0.015802549198269844,
0.019251003861427307,
0.025675572454929352,
-0.010638715699315071,
-0.051626190543174744,
-0.02426937408745289,
-0.010687079280614853,
-0.022824715822935104,
0.0026131640188395977,
-0.04314766079187393,
0.05983030050992966,
-0.08751794695854187,
0.022176414728164673,
-0.06126217171549797,
0.05817388370633125,
-0.036960847675800323,
0.014707726426422596,
-0.041200459003448486,
0.010984009131789207,
0.04964816942811012,
-0.006154391914606094,
-0.02136952057480812,
-0.014981823973357677,
0.04497873783111572,
-0.0015284087276086211,
-0.03766609728336334,
0.039986371994018555,
0.0035863679368048906,
0.06069965660572052,
-0.016867632046341896,
0.06013473495841026,
-0.026012828573584557,
0.012529694475233555,
0.0569620206952095,
0.04449491575360298,
-0.0020655773114413023,
-0.005190497264266014,
-0.03141295164823532,
0.01344737596809864,
0.04104094207286835,
0.050015367567539215,
0.03814437612891197,
0.08412260562181473,
-0.08735574036836624,
-0.009154507890343666,
-0.024866199120879173,
0.0001036425746860914,
0.035632193088531494,
-0.009976952336728573,
-0.005679711699485779,
0.013256456702947617,
0.0019616775680333376,
-0.03952467069029808,
0.038018856197595596,
0.02477407641708851,
-0.029645323753356934,
-0.012450845912098885,
-0.06022413820028305,
-0.006446302868425846,
0.025422299280762672,
0.04503261670470238,
0.029434317722916603,
0.018627233803272247,
0.013286187313497066,
-0.06259738653898239,
0.01616339012980461,
0.006042477674782276,
0.04071463271975517,
-0.02166585810482502,
0.014532571658492088,
0.014320448972284794,
0.03560589626431465,
-0.001489935559220612,
-0.046300724148750305,
0.06809268146753311,
-0.039190031588077545,
-0.008621877059340477,
-0.015251662582159042,
0.034028079360723495,
-0.009392928332090378,
0.04052591323852539,
-0.04672476649284363,
-0.0032602273859083652,
-0.018419845029711723,
-0.08018703013658524,
-0.01023656502366066,
0.07351188361644745,
0.011892402544617653,
-0.051139410585165024,
-0.006026420276612043,
-0.0015748400473967195,
-0.06250297278165817,
-0.05140767619013786,
0.012764851562678814,
-0.007494604215025902,
0.009895401075482368,
-0.0009677058551460505,
-0.010670316405594349,
-0.00975671224296093,
-0.00792203564196825,
0.03500007838010788,
-0.004257794003933668,
-0.001701911329291761,
-0.0036640295293182135,
-0.012060623615980148,
0.0012758849188685417,
0.0019253658829256892,
-0.01569843664765358,
0.05658387765288353,
-0.020678449422121048,
0.058707345277071,
0.034328777343034744,
-0.014068810269236565,
0.015133973211050034,
0.002280488144606352,
-0.01606292836368084,
0.014990800991654396,
0.0786430686712265,
-0.0027307826094329357,
0.03640943393111229,
0.037994008511304855,
-0.006758622359484434,
-0.015169046819210052,
-0.11335741728544235,
0.038817666471004486,
-0.01214226707816124,
0.002829812467098236,
0.00029104502755217254,
0.013719652779400349,
-0.08357784897089005,
-0.007788714487105608,
0.009724137373268604,
-0.011049392633140087,
-0.043639566749334335,
-0.0916961282491684,
0.01917712576687336,
0.01865513063967228,
-0.050958819687366486,
-0.00978934671729803,
-0.026175962761044502,
0.040192484855651855,
-0.02024175599217415,
-0.029815802350640297,
0.006932027637958527,
0.03712082281708717,
0.034254904836416245,
-0.040687527507543564,
-0.018783165141940117,
-0.030004795640707016,
-0.009528020396828651,
-0.08847744017839432,
0.0009891976369544864,
0.01639626733958721,
-0.03627275675535202,
0.028209323063492775,
-0.022029131650924683,
-0.018780339509248734,
0.011510321870446205,
0.008569702506065369,
-0.001395856961607933,
-0.001055912347510457,
-0.09438306838274002,
0.02933947928249836,
-0.05418196693062782,
-0.014493624679744244,
-0.020701952278614044,
-0.013026488944888115,
-0.023157427087426186,
-0.016078032553195953,
-0.03658893331885338,
-0.028864774852991104,
0.029412513598799706,
0.0044349003583192825,
-0.035410184413194656,
0.03471779450774193,
-0.003643892938271165,
0.06327729672193527,
-0.000013669163308804855,
0.004263918846845627,
-0.00007152229954954237,
0.012975870631635189,
0.060568198561668396,
0.0536133274435997,
0.0516790896654129,
0.004583914764225483,
0.06421060860157013,
0.05425642058253288,
-0.00321972300298512,
0.03365643694996834,
-0.03032839670777321,
0.027549855411052704,
-0.030823130160570145,
-0.02671325020492077,
0.01245442871004343,
-0.013154120184481144,
-0.017987802624702454,
0.030771872028708458,
0.032984256744384766,
-0.005442877300083637,
0.008004598319530487,
0.019170420244336128,
0.02770179882645607,
0.10057234019041061,
-0.015305782668292522,
0.08865571767091751,
0.0005857523647136986,
-0.01543900091201067,
0.03812507167458534,
-0.05870792269706726,
-0.008142298087477684,
0.050530850887298584,
-0.01699690893292427,
-0.031007125973701477,
-0.015756158158183098,
0.05925023555755615,
0.06968817114830017,
-0.005370765458792448,
0.021053669974207878,
0.01465520728379488,
-0.03679262846708298,
-0.027175357565283775,
-0.020015573129057884,
-0.03928927332162857,
-0.038640547543764114,
0.04275384917855263,
-0.008749153465032578,
0.018025273457169533,
-0.014232171699404716,
0.011306590400636196,
0.025338346138596535,
-0.012404728680849075,
0.020281469449400902,
0.0020624496974051,
0.014682354405522346,
0.0337168388068676,
0.012183573096990585,
0.021650459617376328,
-0.02047349326312542,
-0.061815045773983,
-0.012921100482344627,
0.05414619296789169,
0.005048323422670364,
0.051530271768569946,
-0.08279579132795334,
0.0016875752480700612,
0.013279389590024948,
-0.0044397227466106415,
-0.0006213854649104178,
-0.015624270774424076,
0.03585765138268471,
0.03033728338778019,
-0.06652834266424179,
0.007192366756498814,
-0.05299481377005577,
-0.0676770806312561,
-0.022821767255663872,
0.055106841027736664,
-0.024659473448991776,
-0.018565312027931213,
-0.035700876265764236,
-0.010532457381486893,
0.0620206817984581,
0.03162816911935806,
-0.034820958971977234,
-0.003977881744503975,
-0.026473216712474823,
0.0399821400642395,
0.02262592315673828,
0.0801672413945198,
-0.026860712096095085,
-0.04571603611111641,
-0.009711324237287045,
-0.04636791720986366,
-0.007438688538968563,
0.0288773775100708,
-0.04487321898341179,
0.015553013421595097,
-0.05404941365122795,
0.015472661703824997,
-0.01323611382395029,
0.003970491699874401,
0.019667187705636024,
-0.030237916857004166,
-0.16172052919864655,
-0.005382467992603779,
0.03830592334270477,
-0.07857725024223328,
0.050668176263570786,
-0.01459573395550251,
-0.0033005704171955585,
0.0017925846623256803,
0.015690188854932785,
-0.01970088481903076,
0.04689259082078934,
0.03248653560876846,
-0.003928296267986298,
-0.045648593455553055,
-0.010941547341644764,
0.02547064609825611,
-0.007936197333037853,
-0.011884967796504498,
-0.023511720821261406,
-0.018116574734449387,
0.014238330535590649,
0.0511019267141819,
0.004979240242391825,
0.0032420705538243055,
0.0015682557132095098,
0.02996031567454338,
0.030726857483386993,
-0.01255637314170599,
-0.03435065969824791,
-0.004538047127425671,
0.007193088531494141,
0.020821142941713333,
0.0159718319773674,
-0.049201540648937225,
0.038525454699993134,
0.005700082518160343,
0.01720006763935089,
0.024865003302693367,
0.01766732893884182,
-0.05799547955393791,
0.027355210855603218,
-0.014272745698690414,
0.031071431934833527,
-0.0037147137336432934,
-0.010006642900407314,
-0.07024069875478745,
0.004654593300074339,
0.03345644101500511,
0.056246478110551834,
0.028789788484573364,
-0.024877576157450676,
0.02899741940200329,
0.001633804407902062,
-0.037346251308918,
0.039992187172174454,
0.05044793710112572,
0.027758579701185226,
-0.002005563583225012,
-0.04261267930269241,
0.031196335330605507,
0.008602200075984001,
-0.09635834395885468,
0.0458616279065609,
-0.023592542856931686,
0.08293669670820236,
0.02306048758327961,
0.015358943492174149,
0.03140822425484657,
0.006231603212654591,
0.007896313443779945,
0.038971468806266785,
0.05072805657982826,
0.00031331522041000426,
-0.013792398385703564,
-0.007124224677681923,
0.00037423401954583824,
0.002050537383183837,
-0.01171823963522911,
-0.0329594686627388,
-0.0338737927377224,
0.03292218968272209,
0.06846603751182556,
-0.028948752209544182,
0.020087778568267822,
0.021654456853866577,
-0.03810183331370354,
-0.012236095033586025,
-0.00889572687447071,
-0.05871158093214035,
0.05331989750266075,
0.05152735114097595,
-0.040659382939338684,
0.047228775918483734,
0.008185180835425854,
-0.014548291452229023,
0.0008856061031110585,
-0.04769137501716614,
-0.023399343714118004,
-0.10185764729976654,
-0.04671712592244148,
0.02167270891368389,
0.02993076667189598,
0.020299889147281647,
0.08073961734771729,
-0.020883161574602127,
0.022827213630080223,
0.010827663354575634,
-0.006203480064868927,
-0.00575989531353116,
-0.0008014492341317236,
0.032180678099393845,
-0.06922192871570587,
0.035669080913066864,
0.015844903886318207,
-0.018068628385663033,
-0.05280173197388649,
-0.052125100046396255,
-0.01615542359650135,
-0.04334557428956032,
0.023401742801070213,
0.031326863914728165,
-0.04261111840605736,
0.00019795901607722044,
0.014612497761845589,
0.02508215419948101,
-0.0027323628310114145,
-0.03981686756014824,
0.03854362294077873,
-0.015335465781390667,
0.05389567092061043,
-0.0039328932762146,
-0.04406629875302315,
-0.02986571006476879,
-0.015414992347359657,
-0.027581118047237396,
-0.035227276384830475,
0.02393469400703907,
-0.024742210283875465,
-0.018679797649383545,
-0.031139131635427475,
-0.012990327551960945,
0.0032546627335250378,
0.011114832945168018,
0.01713627763092518,
-0.030074330046772957,
0.020899182185530663,
0.02535661682486534,
0.0226641446352005,
-0.005333464592695236,
0.013516995124518871,
-0.01837717369198799,
0.029779551550745964,
-0.0398213267326355,
-0.046164609491825104,
-0.028014475479722023,
-0.0061574941501021385,
-0.014547856524586678,
-0.021052438765764236,
-0.039022624492645264,
-0.06799601018428802,
-0.016019977629184723,
-0.017319731414318085,
0.005437747109681368,
0.03994986042380333,
0.029565900564193726,
-0.01288753841072321,
0.00742377620190382,
0.02542526088654995,
0.0421011857688427,
0.021978264674544334,
0.007462303154170513,
-0.03786326199769974,
-0.013257871381938457,
0.07278365641832352,
0.00724571431055665,
0.0047239866107702255,
0.020003996789455414,
-5.877658731181615e-33,
0.04285098984837532,
-0.007660469971597195,
0.017602499574422836,
-0.04088306054472923,
-0.011789204552769661,
0.046214353293180466,
-0.052410710602998734,
0.010821976698935032,
-0.02479347586631775,
-0.005219179205596447,
-0.004099742509424686,
0.019741181284189224,
0.018038131296634674,
0.043909911066293716,
0.020487751811742783,
-0.058296047151088715,
-0.023874729871749878,
-0.05282289907336235,
-0.027025680989027023,
-0.031647950410842896,
0.007936443202197552,
-0.0003700035158544779,
0.03354210406541824,
-0.0578681081533432,
-0.02867867797613144,
0.0019488234538584948,
0.030905894935131073,
-0.01234602089971304,
-0.08284128457307816,
-0.029340922832489014,
0.022115768864750862,
-0.0065897805616259575,
0.02973366342484951,
-0.027445070445537567,
0.01926395483314991,
-0.08809561282396317,
0.00010127232235390693,
-0.03940553963184357,
0.07607688009738922,
-0.03424782678484917,
-0.10414841026067734,
-0.0009977552108466625,
0.037627384066581726,
-0.007528882008045912,
0.09059362858533859,
-0.017226489260792732,
0.004632705356925726,
-0.036479078233242035,
0.02805793285369873,
-0.027754930779337883,
0.01308535411953926,
-0.021007969975471497,
0.03903011977672577,
0.022034497931599617,
-0.06325943022966385,
-0.003792121773585677,
-0.03331833705306053,
-0.008777663111686707,
-0.04982065036892891,
-0.0050621023401618,
-0.02989315427839756,
0.05461731553077698,
-0.03930865228176117,
-0.015182760544121265,
0.02806694619357586,
-0.006152487359941006,
0.08554936945438385,
0.03780312463641167,
-0.05849430337548256,
-0.003590111620724201,
-0.08503173291683197,
0.029769569635391235,
-0.0015705778496339917,
-0.04827163368463516,
-0.012178405188024044,
-0.06059488654136658,
-0.0076958066783845425,
-0.0247943252325058,
0.0668305829167366,
0.03439846634864807,
-0.04042020067572594,
-0.0231084655970335,
0.013803886249661446,
-0.013470599427819252,
0.009955588728189468,
0.005782926455140114,
-0.03674737364053726,
0.01468911673873663,
-0.036557722836732864,
-0.042804453521966934,
0.11527374386787415,
0.019397001713514328,
0.04427719861268997,
-0.0005897005903534591,
0.017605144530534744,
-0.044568393379449844,
0.01070679072290659,
0.00893990695476532,
0.04783156141638756,
-0.02082708850502968,
0.03377114236354828,
0.0134318508207798,
0.05983728542923927,
0.007158772088587284,
0.031416911631822586,
0.010135541670024395,
-0.003974413964897394,
-0.03279992938041687,
-0.03792720288038254,
0.003621240146458149,
0.03752806410193443,
-0.053434208035469055,
0.06656426191329956,
0.011728985235095024,
-0.047637876123189926,
0.05036459490656853,
0.007157753687351942,
0.029373982921242714,
0.028510764241218567,
0.008034597150981426,
0.012271391227841377,
0.02020542323589325,
0.031249843537807465,
0.01969026029109955,
-0.01406903937458992,
0.0037763279397040606,
0.013863914646208286,
0.06222398206591606,
-0.01300833374261856,
-0.013638200238347054,
0.022039569914340973,
-0.012983458116650581,
2.799229150696192e-7,
0.02286403998732567,
-0.00201611639931798,
-0.013605738058686256,
-0.043621983379125595,
0.056807488203048706,
-0.0594608411192894,
0.0075152539648115635,
0.016617916524410248,
0.0050246864557266235,
-0.013622119091451168,
0.027336137369275093,
0.006197911221534014,
-0.02408018708229065,
-0.029752645641565323,
0.0709831565618515,
0.007076650392264128,
-0.024748031049966812,
-0.03109469823539257,
0.046811848878860474,
0.01374657079577446,
0.02146974764764309,
-0.03040161356329918,
-0.06911429017782211,
-0.024455636739730835,
0.005061286501586437,
-0.010732922703027725,
0.0010955478064715862,
0.006752355489879847,
0.018873225897550583,
0.009408055804669857,
0.009138999506831169,
0.047962237149477005,
0.008971578441560268,
0.07851535826921463,
-0.05556776002049446,
-0.05638943240046501,
-0.035645466297864914,
-0.0042196535505354404,
-0.0734567791223526,
0.02524735778570175,
0.02310892753303051,
0.04107829928398132,
0.0021960027515888214,
0.06400974839925766,
0.01873943954706192,
-0.019867081195116043,
-0.03975481912493706,
0.026666251942515373,
-0.03345337137579918,
0.03000686876475811,
0.039739564061164856,
0.008839807473123074,
0.009221675805747509,
0.04656747728586197,
-0.0032771939877420664,
0.06547808647155762,
-0.005736462771892548,
0.0019681875128299,
0.051341380923986435,
0.017345573753118515,
0.020374029874801636,
-0.03459884226322174,
0.01706661283969879,
-0.07449621707201004,
0.07528188079595566,
-0.07828211039304733,
-0.05563546344637871,
2.0865885684872084e-34,
-0.01823429763317108,
0.01502304058521986,
0.013379557058215141,
-0.060832977294921875,
-0.0423261858522892,
-0.05686074122786522,
-0.007206371054053307,
-0.014349795877933502,
-0.0041496059857308865,
-0.027342503890395164,
-0.05067388713359833
] | {
"ds_index": 30,
"similar_dg_indices": [
425378,
204318,
1035705,
552667,
1128367,
170047,
142891,
319421,
1014532,
975271,
102638,
972805,
707362,
785773,
453598,
467882,
275167,
549097,
1033960,
665691
]
} |
A 69-year-old man is brought by his son to the emergency department with weakness in his right arm and leg. The man insists that he is fine and blames his son for "creating panic". Four hours ago the patient was having tea with his wife when he suddenly dropped his teacup. He has had difficulty moving his right arm since then and cannot walk because his right leg feels stuck. He has a history of hypertension and dyslipidemia, for which he currently takes lisinopril and atorvastatin, respectively. He is allergic to aspirin and peanuts. A computerized tomography (CT) scan shows evidence of an ischemic stroke. Which medication would most likely prevent such attacks in this patient in the future? | Clopidogrel | {
"A": "Alteplase",
"B": "Urokinase",
"C": "Celecoxib",
"D": "Clopidogrel"
} | step1 | D | [
"69 year old man",
"brought",
"son",
"emergency department",
"weakness",
"right arm",
"leg",
"man",
"fine",
"blames",
"son",
"creating panic",
"Four hours",
"patient",
"tea",
"wife",
"dropped",
"difficulty moving",
"right arm",
"then",
"walk",
"right leg feels",
"history of hypertension",
"dyslipidemia",
"currently takes lisinopril",
"atorvastatin",
"allergic",
"aspirin",
"peanuts",
"computerized tomography",
"scan shows evidence",
"ischemic stroke",
"medication",
"most likely prevent",
"attacks",
"patient",
"future"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 69-year-old man is brought by his son to the emergency department with weakness in his right arm and leg. The man insists that he is fine and blames his son for "creating panic". Four hours ago the patient was having tea with his wife when he suddenly dropped his teacup. He has had difficulty moving his right arm since then and cannot walk because his right leg feels stuck. He has a history of hypertension and dyslipidemia, for which he currently takes lisinopril and atorvastatin, respectively. He is allergic to aspirin and peanuts. A computerized tomography (CT) scan shows evidence of an ischemic stroke. Which medication would most likely prevent such attacks in this patient in the future?
Choose one of the following::
A. Alteplase
B. Urokinase
C. Celecoxib
D. Clopidogrel | [
-0.025874698534607887,
-0.057419586926698685,
0.028591983020305634,
0.05013161152601242,
-0.0419122539460659,
0.017275851219892502,
-0.016218923032283783,
0.07184424251317978,
0.03801325708627701,
-0.03169826418161392,
0.05363781377673149,
-0.00996435433626175,
-0.01973145268857479,
-0.02689872309565544,
-0.007194800768047571,
-0.010767758823931217,
0.030902305617928505,
0.037455953657627106,
0.001020819996483624,
-0.023744048550724983,
0.0412973053753376,
0.029424315318465233,
-0.011238845996558666,
0.02114838734269142,
0.020896393805742264,
-0.0006721140816807747,
0.024008631706237793,
-0.07105232775211334,
0.01680188626050949,
-0.03371578827500343,
-0.05051763355731964,
-0.01866341568529606,
-0.019988521933555603,
-0.0666583999991417,
0.0000020388101802382153,
0.010556436143815517,
-0.01108861155807972,
0.034991540014743805,
0.06541668623685837,
-0.08664267510175705,
0.027275769039988518,
-0.04880739003419876,
0.04439892992377281,
0.047560419887304306,
-0.026642926037311554,
-0.027464991435408592,
-0.004799866117537022,
0.1051623523235321,
-0.01881451904773712,
0.022054549306631088,
0.02431379072368145,
-0.044134266674518585,
-0.041215039789676666,
0.00036983282188884914,
0.002005351707339287,
-0.04958046227693558,
-0.016590187326073647,
-0.07775764912366867,
0.017108768224716187,
0.05230563506484032,
-0.008137363940477371,
0.01758149266242981,
0.018108529970049858,
0.03633167967200279,
-0.013207771815359592,
0.04388323426246643,
-0.03058585152029991,
-0.06528220325708389,
-0.017025118693709373,
0.034894008189439774,
-0.017614644020795822,
0.03454688936471939,
0.05460707098245621,
0.0029744391795247793,
-0.024355003610253334,
0.07556413114070892,
0.0420871265232563,
-0.04714342951774597,
-0.002267784671857953,
-0.052564285695552826,
0.054135847836732864,
0.041039735078811646,
-0.018434932455420494,
0.020800696685910225,
0.03271961957216263,
-0.07297664135694504,
0.039014752954244614,
0.01573716290295124,
0.010077401995658875,
-0.047710515558719635,
-0.016641443595290184,
-0.03924112021923065,
0.017459040507674217,
-0.014687624759972095,
-0.014877302572131157,
-0.0030022819992154837,
0.0320085771381855,
0.08031737804412842,
0.0329701192677021,
-0.06736722588539124,
-0.02260381355881691,
0.014406494796276093,
0.03009185940027237,
-0.03435521572828293,
-0.020710604265332222,
-0.0554075613617897,
-0.09205833822488785,
0.01915324665606022,
-0.04004628211259842,
0.10451225936412811,
-0.0311700701713562,
0.06095423549413681,
-0.02659856341779232,
0.01388479582965374,
0.11740190535783768,
-0.0021993578411638737,
0.024770265445113182,
-0.033326201140880585,
0.02005014941096306,
0.050471559166908264,
-0.004536204040050507,
0.018190249800682068,
0.036303065717220306,
0.020635860040783882,
-0.012435301207005978,
0.049899980425834656,
-0.022331181913614273,
0.02883904241025448,
-0.009615994058549404,
-0.004598718602210283,
-0.005656492430716753,
0.020093612372875214,
-0.019051039591431618,
-0.010188701562583447,
0.014091460965573788,
0.03202806040644646,
-0.0028133427258580923,
0.045411333441734314,
-0.016117678955197334,
0.00942152924835682,
0.0031489492394030094,
-0.04150138795375824,
0.048456452786922455,
0.008164594881236553,
0.030804382637143135,
-0.0014366735704243183,
0.014085047878324986,
-0.005878402851521969,
0.013377634808421135,
0.03495020419359207,
0.026036372408270836,
0.004848556127399206,
0.00276745343580842,
0.007718497421592474,
0.03699272498488426,
0.033376891165971756,
0.010979841463267803,
0.006760549731552601,
0.03199860826134682,
-0.0312516987323761,
-0.0032021459192037582,
0.035907238721847534,
0.0061468700878322124,
-0.005318863317370415,
0.013760866597294807,
0.05549759045243263,
-0.004962517414242029,
0.07630597800016403,
-0.00270951259881258,
0.034331150352954865,
-0.062279194593429565,
0.010561789385974407,
-0.0019437306327745318,
-0.019727811217308044,
0.003328563878312707,
-0.03008621372282505,
-0.04119842126965523,
0.030972713604569435,
-0.019324859604239464,
-0.04582953080534935,
-0.03662389516830444,
0.012329526245594025,
0.03586500510573387,
-0.028439391404390335,
-0.030036915093660355,
0.014882422052323818,
-0.006089440546929836,
-0.1081181988120079,
-0.007671409752219915,
0.024467451497912407,
-0.013617990538477898,
0.008073045872151852,
0.01135318260639906,
0.007893452420830727,
-0.000791711441706866,
-0.015670809894800186,
-0.0643409863114357,
0.05629674345254898,
-0.0472455732524395,
0.00920841284096241,
-0.026614833623170853,
0.025942303240299225,
-0.05946534872055054,
0.027470210567116737,
-0.022971687838435173,
0.02706187777221203,
0.011625899001955986,
-0.02784588560461998,
0.07499014586210251,
0.039534103125333786,
-0.043810442090034485,
0.01534099131822586,
0.05323005095124245,
-0.04345139488577843,
0.032963018864393234,
0.051363445818424225,
0.009199252352118492,
0.051149286329746246,
-0.029425114393234253,
-0.009055146016180515,
-0.03722284734249115,
-0.010854516178369522,
0.01861569471657276,
0.010478760115802288,
-0.05250153690576553,
0.00466578546911478,
0.012517493218183517,
0.009105618111789227,
-0.005677085369825363,
-0.05114958807826042,
0.02093706838786602,
0.029193749651312828,
-0.009820782579481602,
-0.0693860650062561,
-0.058610741049051285,
-0.000044524520490085706,
-0.002824488328769803,
-0.04718417301774025,
-0.0010910212295129895,
-0.028995158150792122,
0.022776154801249504,
-0.029208190739154816,
-0.09818048775196075,
-0.024622784927487373,
-0.031057193875312805,
-0.03294176980853081,
-0.0290326289832592,
0.06470926851034164,
-0.006817169021815062,
0.028993865475058556,
-0.02000346966087818,
0.016239937394857407,
-0.018038174137473106,
0.012343897484242916,
-0.008974184282124043,
0.03578624501824379,
-0.0056419637985527515,
0.0241288673132658,
-0.04154133424162865,
-0.013143372721970081,
0.006352206226438284,
0.0023722408805042505,
0.04318984970450401,
-0.0043482473120093346,
-0.008376664482057095,
-0.014016220346093178,
0.026386084035038948,
0.049281325191259384,
-0.01461764145642519,
0.04003613442182541,
0.003685741452500224,
0.006688639055937529,
-0.007861630991101265,
-0.015896495431661606,
-0.015846220776438713,
-0.02796211466193199,
-0.007740241941064596,
0.007692660670727491,
0.0013878088211640716,
0.026506876572966576,
0.034525591880083084,
-0.0065288241021335125,
0.03867509216070175,
0.039644256234169006,
0.032826017588377,
0.004919873550534248,
-0.033086445182561874,
-0.049198854714632034,
0.040908779948949814,
0.05380577966570854,
-0.01740952394902706,
0.03791351243853569,
-0.010511457920074463,
-0.014652651734650135,
-0.024467479437589645,
-0.02269323542714119,
-0.12636975944042206,
0.012098033912479877,
-0.03507470712065697,
-0.014197508804500103,
0.018321944400668144,
0.013776993378996849,
-0.003516861004754901,
0.010613581165671349,
-0.037521954625844955,
0.011032377369701862,
0.08940225839614868,
-0.01277659460902214,
-0.03028389997780323,
0.05755075439810753,
0.07112852483987808,
0.036166079342365265,
-0.0224258191883564,
-0.09882693737745285,
-0.01601417176425457,
-0.01664123497903347,
-0.01980520784854889,
-0.032991923391819,
0.0023415042087435722,
-0.011373164132237434,
0.02792116068303585,
0.030841585248708725,
-0.020696165040135384,
-0.023102398961782455,
0.006162900011986494,
-0.04499655216932297,
0.01779993250966072,
-0.03128207102417946,
-0.04740139842033386,
-0.01913931965827942,
0.0067018019035458565,
-0.004245235584676266,
0.023722896352410316,
0.01740417070686817,
0.026327816769480705,
0.029088594019412994,
0.018981896340847015,
-0.010933632962405682,
-0.027027636766433716,
0.04473287612199783,
-0.013537938706576824,
-0.06920865178108215,
-0.019370045512914658,
-0.007894723676145077,
0.004305846523493528,
-0.03093372844159603,
-0.012777473777532578,
0.023014165461063385,
0.028662029653787613,
-0.023407377302646637,
-0.03929777443408966,
0.03466896712779999,
-0.0008593193488195539,
0.004275549203157425,
-0.0017390778521075845,
-0.015039115212857723,
0.037879396229982376,
-0.03397875279188156,
-0.02943369187414646,
0.03799482062458992,
0.060490455478429794,
0.08942967653274536,
-0.007912800647318363,
-0.026943232864141464,
-0.01749424822628498,
-0.004391621798276901,
0.029781239107251167,
-0.04624228924512863,
-0.04880797863006592,
0.030003929510712624,
0.016088439151644707,
0.024683073163032532,
-0.046889159828424454,
0.06851116567850113,
-0.009153592400252819,
0.004871107637882233,
0.0040633524768054485,
0.0063643790781497955,
-0.016919618472456932,
-0.03099273331463337,
-0.014750365167856216,
-0.10776813328266144,
-0.015164363197982311,
-0.02301814779639244,
-0.05453784018754959,
0.002666210290044546,
0.019466063007712364,
-0.051095616072416306,
0.050033893436193466,
-0.0029906216077506542,
-0.010510834865272045,
-0.05804634094238281,
0.010161715559661388,
-0.04842774197459221,
-0.008784054778516293,
0.006240011192858219,
0.051090043038129807,
-0.04285569116473198,
-0.029672492295503616,
0.045233093202114105,
0.04239661991596222,
-0.019524261355400085,
-0.05517192929983139,
0.01871567592024803,
0.06670104712247849,
-0.032236069440841675,
-0.019155921414494514,
0.04020462930202484,
0.031573038548231125,
0.021087175235152245,
0.02382582612335682,
-0.03605512157082558,
0.01940465159714222,
-0.021240107715129852,
0.06880851089954376,
0.005297868046909571,
0.04034126549959183,
-0.020177774131298065,
0.04163569211959839,
-0.039333853870630264,
0.04341877996921539,
0.0016709923511371017,
-0.05119815841317177,
-0.0785692110657692,
0.036510348320007324,
-0.04814393073320389,
0.03371071442961693,
-0.0006602880312129855,
-0.021219097077846527,
0.029464466497302055,
0.04712033271789551,
-0.022717369720339775,
0.007002867758274078,
0.022298751398921013,
-0.0016899319598451257,
0.010246725752949715,
-0.037908121943473816,
-0.0329396016895771,
-0.04767471179366112,
-0.03632453829050064,
-0.015356604941189289,
0.0005586367333307862,
0.002207090612500906,
-0.007855329662561417,
0.010407826863229275,
0.038824763149023056,
0.032274503260850906,
0.06450275331735611,
0.001958560897037387,
0.04857145994901657,
0.04728187248110771,
-0.024274833500385284,
0.06517861783504486,
-0.03659246489405632,
0.021946806460618973,
-0.02987440675497055,
-0.016152070835232735,
-0.04391294717788696,
-0.008362931199371815,
0.024050237610936165,
0.01671234890818596,
0.010825544595718384,
-0.05186963826417923,
-0.05344519019126892,
0.00836010742932558,
0.014158413745462894,
0.026231883093714714,
0.014369653537869453,
-0.06642495840787888,
0.04053475335240364,
-0.009213702753186226,
0.02195579744875431,
-0.009984000585973263,
-0.020042886957526207,
0.062249213457107544,
-0.04187524691224098,
-0.019662145525217056,
-0.00004183620694675483,
0.011426245793700218,
0.03499872237443924,
0.026243086904287338,
-0.004041573964059353,
-0.07612287253141403,
-0.013122749514877796,
-0.0023738699965178967,
0.010820219293236732,
0.0028477665036916733,
-0.0010177982039749622,
0.013245952315628529,
0.05036657676100731,
0.013616536743938923,
-0.07008874416351318,
0.024848872795701027,
-0.0679008811712265,
-0.018590569496154785,
-0.047094255685806274,
-0.015422298572957516,
0.027532154694199562,
-0.03486007824540138,
0.031072448939085007,
0.047512248158454895,
0.028416702523827553,
0.015956861898303032,
0.015360461547970772,
-0.008026789873838425,
0.018642768263816833,
-0.008680331520736217,
0.0748138502240181,
0.016578590497374535,
0.015894031152129173,
-0.053257182240486145,
0.023203684017062187,
-0.03535927087068558,
-0.01826758123934269,
0.024112096056342125,
0.036995500326156616,
0.022459933534264565,
-0.06058517470955849,
-0.0007050251006148756,
0.022018730640411377,
0.007022891193628311,
-0.02304559201002121,
-0.005170959047973156,
0.0642264112830162,
-0.01836724579334259,
0.03953629359602928,
-0.04163077101111412,
0.023877117782831192,
-0.02171909436583519,
0.10453344881534576,
-0.04013828560709953,
0.018066469579935074,
-0.007390819955617189,
-0.0265825055539608,
-0.03565150126814842,
-0.04885007441043854,
-0.04140708968043327,
-0.0006899001309648156,
-0.005189524497836828,
-0.03924011439085007,
-0.0389057919383049,
0.04079677164554596,
-0.026885341852903366,
-0.031370535492897034,
-0.012385932728648186,
0.02180670201778412,
0.003466482972726226,
-0.05622316151857376,
-0.006534624844789505,
-0.030288459733128548,
-0.022878628224134445,
0.057841941714286804,
0.017057575285434723,
0.037747014313936234,
-0.005755938123911619,
-5.5458934504192715e-33,
0.04426465183496475,
0.020477475598454475,
0.002082245424389839,
-0.10270103067159653,
0.073889821767807,
0.032807357609272,
-0.015403466299176216,
-0.008565354160964489,
-0.07476082444190979,
0.021843230351805687,
-0.05325516685843468,
0.024863246828317642,
0.024621974676847458,
0.038611456751823425,
0.00595811428502202,
-0.11463798582553864,
-0.02476147562265396,
0.04975394904613495,
-0.024078726768493652,
0.010329978540539742,
-0.06212601438164711,
-0.023844562470912933,
-0.01955948770046234,
-0.02101963385939598,
0.012880909256637096,
-0.030332883819937706,
0.0385175496339798,
-0.027673862874507904,
-0.06642939895391464,
0.05156506970524788,
-0.0050091203302145,
0.025387540459632874,
0.016889294609427452,
-0.052960995584726334,
-0.012955927290022373,
-0.005595180671662092,
0.022438285872340202,
-0.061690352857112885,
0.04420420899987221,
-0.041583165526390076,
-0.004568282049149275,
-0.06636399030685425,
0.014112431555986404,
0.06010565534234047,
-0.03066216967999935,
-0.024432366713881493,
-0.03201012685894966,
-0.010389504954218864,
0.028129570186138153,
-0.011274157091975212,
0.015256903134286404,
0.011929200030863285,
0.0456276573240757,
-0.031026344746351242,
-0.016552500426769257,
0.06353795528411865,
-0.005852770060300827,
-0.013543497771024704,
-0.027616210281848907,
-0.01146471407264471,
-0.010911615565419197,
0.02717013843357563,
-0.011549394577741623,
-0.06407123059034348,
-0.05125231668353081,
0.03361857309937477,
-0.009574327617883682,
0.042518794536590576,
-0.0176558755338192,
-0.005129020195454359,
-0.1001562625169754,
0.04794054850935936,
0.02130388468503952,
0.027105115354061127,
-0.047556471079587936,
-0.001939822337590158,
-0.004380999598652124,
0.027958467602729797,
-0.005425401031970978,
0.056309208273887634,
-0.0384255014359951,
-0.013808250427246094,
-0.04971702769398689,
-0.0030091695953160524,
0.01842026598751545,
0.05172623321413994,
-0.0036859845276921988,
0.0007054900052025914,
-0.0028023147024214268,
-0.021713176742196083,
0.08234661817550659,
0.008488521911203861,
0.07497290521860123,
0.01360893901437521,
0.0009387811878696084,
-0.026719804853200912,
0.033843033015728,
-0.010357663035392761,
0.022632060572504997,
-0.021246155723929405,
0.02788630872964859,
-0.002857461804524064,
0.039911914616823196,
-0.014434038661420345,
-0.029362540692090988,
-0.003941296134144068,
-0.002526689786463976,
0.019053388386964798,
-0.021487105637788773,
0.025348056107759476,
-0.03983587026596069,
-0.07785153388977051,
0.005717935971915722,
0.037795502692461014,
-0.0035495893098413944,
0.03747684881091118,
0.030951587483286858,
0.051320645958185196,
0.029198765754699707,
-0.02917918749153614,
-0.004725364502519369,
-0.02740134671330452,
0.017764229327440262,
-0.016881024464964867,
-0.05708473548293114,
-0.01799432747066021,
0.029440758749842644,
0.06602748483419418,
-0.004236135631799698,
-0.07136571407318115,
-0.008989599533379078,
-0.0830359160900116,
2.854017679965182e-7,
0.03285190463066101,
0.007544461637735367,
0.01688254065811634,
-0.01409828569740057,
-0.013334664516150951,
0.009050699882209301,
0.01113521121442318,
0.03484981879591942,
-0.01935960352420807,
-0.007162186317145824,
0.06959233433008194,
-0.029800480231642723,
-0.01143470499664545,
-0.042652055621147156,
0.023950502276420593,
0.019167538732290268,
-0.044644277542829514,
0.011118811555206776,
-0.007046596612781286,
-0.035176146775484085,
0.03785920888185501,
-0.05417130887508392,
-0.010209482163190842,
-0.01168329082429409,
-0.0162512119859457,
0.002123167272657156,
-0.01508841197937727,
-0.05361253395676613,
-0.014154910109937191,
-0.03512892127037048,
0.020981673151254654,
0.058904293924570084,
0.024099815636873245,
0.03764362260699272,
-0.04724191874265671,
-0.053410604596138,
0.0016884894575923681,
0.022619329392910004,
-0.10956422239542007,
0.06514374911785126,
0.014102349057793617,
-0.0169666800647974,
-0.02594914473593235,
0.01731329783797264,
0.03206434100866318,
0.019953874871134758,
-0.05371301248669624,
-0.015589063987135887,
0.013310058042407036,
-0.0018773009069263935,
0.04648123309016228,
0.02678835578262806,
0.009318810887634754,
0.030353505164384842,
0.010641075670719147,
0.0679735466837883,
-0.010714606381952763,
0.017830567434430122,
0.07020801305770874,
-0.0014020176604390144,
0.02408299408853054,
-0.029126359149813652,
0.020066337659955025,
-0.002393490867689252,
0.002005844609811902,
-0.07354941219091415,
-0.060855600982904434,
2.1219261786425823e-34,
-0.02462901547551155,
0.006195123307406902,
-0.043628741055727005,
0.03548425808548927,
0.02143901400268078,
-0.04208960756659508,
0.04611068591475487,
-0.017520174384117126,
-0.007077344227582216,
0.010802777484059334,
-0.047994669526815414
] | {
"ds_index": 31,
"similar_dg_indices": [
868289,
833190,
495431,
851118,
366928,
107391,
510376,
372276,
1172859,
72678,
1171650,
925320,
762446,
232955,
1188788,
237079,
1030831,
582638,
320804,
341718
]
} |
A 70-year-old man presents to a medical clinic reporting blood in his urine and lower abdominal pain for the past few days. He is also concerned about urinary frequency and urgency. He states that he recently completed a cycle of chemotherapy for non-Hodgkin lymphoma. Which medication in the chemotherapy regimen most likely caused his symptoms? | Cyclophosphamide | {
"A": "Methotrexate",
"B": "Rituximab",
"C": "Cyclophosphamide",
"D": "Prednisone"
} | step1 | C | [
"70 year old man presents",
"medical clinic reporting blood",
"urine",
"lower abdominal pain",
"past",
"days",
"concerned",
"urinary frequency",
"urgency",
"states",
"recently completed",
"cycle",
"chemotherapy",
"non-Hodgkin lymphoma",
"medication",
"chemotherapy",
"likely caused",
"symptoms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 70-year-old man presents to a medical clinic reporting blood in his urine and lower abdominal pain for the past few days. He is also concerned about urinary frequency and urgency. He states that he recently completed a cycle of chemotherapy for non-Hodgkin lymphoma. Which medication in the chemotherapy regimen most likely caused his symptoms?
Choose one of the following::
A. Methotrexate
B. Rituximab
C. Cyclophosphamide
D. Prednisone | [
0.05950092151761055,
-0.019408928230404854,
0.003885319922119379,
0.03879086673259735,
-0.03720289468765259,
-0.02702532894909382,
0.01255384273827076,
0.0012264626566320658,
0.0027551078237593174,
-0.022567110136151314,
0.009963713586330414,
0.019273733720183372,
-0.09041694551706314,
-0.03172285109758377,
0.013241065666079521,
0.024208445101976395,
-0.0005041611148044467,
-0.0186769962310791,
-0.03366828337311745,
0.001756320707499981,
-0.02271648682653904,
0.00276748463511467,
-0.006758279167115688,
0.019388455897569656,
0.02552342228591442,
-0.005194038152694702,
0.037484318017959595,
-0.012443846091628075,
-0.03711777180433273,
0.008308976888656616,
0.027541140094399452,
-0.00785671453922987,
-0.02097357250750065,
-0.013635587878525257,
0.0000013759524790657451,
-0.07014989107847214,
0.03507228568196297,
-0.02903571166098118,
0.03552289679646492,
-0.03943568095564842,
0.009702892042696476,
-0.007009588181972504,
0.04270093888044357,
-0.006546484772115946,
0.0006225885590538383,
-0.015491372905671597,
-0.05599384382367134,
0.06985283643007278,
-0.05073878541588783,
0.0313250757753849,
0.017026228830218315,
0.031939782202243805,
-0.03136594593524933,
0.03579126298427582,
0.03794616088271141,
0.011564083397388458,
-0.018009912222623825,
-0.028138985857367516,
0.04908297583460808,
0.004299437161535025,
0.01953705959022045,
0.013468281365931034,
-0.009576018899679184,
-0.01878453977406025,
-0.060729581862688065,
0.0020347253885120153,
-0.010401243343949318,
0.002622121013700962,
0.010500228963792324,
-0.0033478629775345325,
-0.040301363915205,
0.01531143207103014,
0.07659115642309189,
0.05528489872813225,
-0.01934833824634552,
-0.03354887664318085,
0.037947386503219604,
-0.009678485803306103,
0.017388366162776947,
-0.07384469360113144,
-0.0009407908655703068,
0.0009208656847476959,
-0.01224680058658123,
0.047299474477767944,
-0.011923380196094513,
-0.018665865063667297,
0.0034964694641530514,
0.024834733456373215,
0.008004080504179,
-0.058997008949518204,
0.01171508152037859,
-0.03214201703667641,
0.05094224587082863,
0.021404175087809563,
-0.01982726715505123,
0.015869319438934326,
0.022346075624227524,
0.03753096982836723,
0.04541870579123497,
-0.08367063850164413,
-0.056467726826667786,
-0.044344931840896606,
0.007678904104977846,
0.01387367956340313,
-0.04161638021469116,
-0.00240965373814106,
-0.001961209112778306,
0.004761017393320799,
-0.0698116347193718,
0.03494718298316002,
-0.030000699684023857,
0.04377417266368866,
-0.056563641875982285,
0.03820760175585747,
0.08859092742204666,
-0.040540408343076706,
-0.02843817137181759,
0.011980485171079636,
0.03508211672306061,
0.05643196403980255,
0.013742834329605103,
0.011109651997685432,
0.04000552371144295,
0.04164161905646324,
0.050719812512397766,
0.026151759549975395,
-0.04683772847056389,
0.03309040144085884,
0.012005594559013844,
-0.01678737811744213,
0.06794798374176025,
-0.06476572155952454,
-0.02393225207924843,
-0.01619732566177845,
-0.0119916507974267,
0.02984439581632614,
0.02021576091647148,
0.05077564716339111,
-0.04325214773416519,
-0.009435501880943775,
-0.02877258136868477,
-0.04351010173559189,
0.02365625463426113,
0.010637614876031876,
0.03089877963066101,
0.02720412239432335,
-0.012384643778204918,
0.01998668722808361,
0.008300041779875755,
0.016627786681056023,
-0.06014452129602432,
-0.010071462951600552,
0.02044324018061161,
0.004780743736773729,
0.01180974394083023,
-0.012224825099110603,
0.02427724562585354,
-0.03880395367741585,
-0.027219582349061966,
0.02168223448097706,
0.007500286214053631,
-0.06830409169197083,
0.016418419778347015,
-0.040204282850027084,
-0.01110045239329338,
0.008658403530716896,
0.021995915099978447,
0.0696551501750946,
-0.07265065610408783,
0.04390706494450569,
-0.043949246406555176,
0.053596265614032745,
-0.0011000311933457851,
-0.026272637769579887,
-0.017895201221108437,
-0.010125882923603058,
0.0588129498064518,
0.027971860021352768,
-0.005987297743558884,
-0.06337379664182663,
0.011005358770489693,
0.04576805233955383,
-0.03411135450005531,
-0.04499850794672966,
-0.0010548582067713141,
0.05413781851530075,
0.052861809730529785,
-0.05643082037568092,
0.00672964658588171,
-0.030345981940627098,
-0.027052896097302437,
0.007805577013641596,
-0.024176349863409996,
0.02490086853504181,
0.0016746972687542439,
0.005135856103152037,
-0.06285881251096725,
-0.02477744221687317,
0.04130471497774124,
-0.03132965415716171,
-0.02311469055712223,
-0.029114672914147377,
0.008303328417241573,
0.050930142402648926,
-0.030441001057624817,
0.04314858838915825,
0.03029273822903633,
0.013709565624594688,
0.023989276960492134,
-0.026320509612560272,
-0.03965510427951813,
0.020506802946329117,
0.014954933896660805,
-0.015407047234475613,
0.028263898566365242,
0.015489088371396065,
-0.017028888687491417,
-0.03276752680540085,
-0.06572973728179932,
-0.035860832780599594,
-0.030300427228212357,
-0.03285747021436691,
-0.01899605244398117,
0.005744576919823885,
-0.0022222346160560846,
-0.0013480398338288069,
-0.029377879574894905,
0.010519945994019508,
-0.03731005638837814,
-0.0652252808213234,
0.023811833932995796,
0.04697206988930702,
-0.06032567471265793,
-0.018528558313846588,
0.0007903202786110342,
0.02643260732293129,
0.05542896315455437,
-0.03461620956659317,
-0.025324909016489983,
0.011700940318405628,
0.017156077548861504,
-0.04913300275802612,
-0.07009421288967133,
-0.006606787908822298,
0.07296127825975418,
-0.018648039549589157,
-0.02494691126048565,
0.04102228581905365,
-0.03224651515483856,
0.07489437609910965,
-0.042729251086711884,
0.0145622743293643,
-0.005594034679234028,
0.010897657833993435,
0.046417538076639175,
-0.00022343006276059896,
-0.03592805564403534,
0.022942621260881424,
-0.001850475906394422,
-0.02902466617524624,
-0.013195229694247246,
-0.0034217757638543844,
-0.01659359410405159,
-0.016770100221037865,
-0.08373747020959854,
-0.0036458815447986126,
-0.02228749357163906,
0.06387733668088913,
-0.02915784902870655,
0.043180953711271286,
-0.026871537789702415,
0.014290295541286469,
0.03681556507945061,
0.00667186314240098,
-0.06778612732887268,
-0.04987915977835655,
0.01236695982515812,
0.012631269171833992,
0.03244837373495102,
0.023866845294833183,
0.0492263101041317,
0.08863957971334457,
0.004393461626023054,
0.008563760668039322,
0.0333426259458065,
0.013918713666498661,
-0.009045612066984177,
-0.002888892311602831,
0.0498025082051754,
-0.0022666051518172026,
-0.020381029695272446,
0.00932039599865675,
0.03735955432057381,
-0.06476162374019623,
-0.003772398456931114,
-0.01657259277999401,
-0.0888415277004242,
0.05655459687113762,
0.004946475382894278,
0.02268028073012829,
0.04578504338860512,
-0.017831699922680855,
0.003761076834052801,
0.011637644842267036,
-0.01993301883339882,
-0.038538359105587006,
0.07299584150314331,
0.023271668702363968,
-0.00606846297159791,
0.056142210960388184,
0.01042905729264021,
-0.02478870563209057,
0.007830035872757435,
-0.07705618441104889,
-0.03934493660926819,
-0.0548781156539917,
-0.023739513009786606,
0.011068593710660934,
0.0396527461707592,
-0.036935560405254364,
0.005855892784893513,
0.00891898199915886,
-0.005699143745005131,
0.018283801153302193,
0.017779365181922913,
0.026083284988999367,
0.0371309295296669,
0.027060117572546005,
-0.0669122114777565,
-0.004805395845323801,
0.0024080444127321243,
-0.052101995795965195,
-0.021298464387655258,
0.010296505875885487,
0.018627863377332687,
0.03109561838209629,
-0.013401822187006474,
0.04126156121492386,
-0.016024602577090263,
0.061489664018154144,
0.012957749888300896,
-0.03490162640810013,
0.013790914788842201,
-0.021252891048789024,
0.03178161010146141,
0.03057667426764965,
-0.05696481466293335,
-0.030246632173657417,
-0.027761252596974373,
0.008739686571061611,
-0.10878898948431015,
0.019611122086644173,
0.026744771748781204,
-0.02170119620859623,
-0.018092913553118706,
-0.03449752554297447,
0.027963854372501373,
0.025956515222787857,
-0.021730700507760048,
0.013604109175503254,
-0.01626182533800602,
-0.05095647647976875,
0.04295513406395912,
0.048352595418691635,
0.03295126184821129,
-0.0015891825314611197,
0.03452093526721001,
-0.021257726475596428,
-0.023429064080119133,
-0.01789967529475689,
-0.042519718408584595,
-0.002644494641572237,
-0.02644352987408638,
0.07465815544128418,
0.00643058679997921,
0.025820260867476463,
0.047346290200948715,
-0.04889094457030296,
-0.08360347151756287,
-0.04577939584851265,
0.0608220249414444,
-0.020816350355744362,
0.027803311124444008,
-0.029653914272785187,
-0.029593011364340782,
0.032326940447092056,
-0.010704337619245052,
-0.07880271971225739,
0.03900783509016037,
-0.025088800117373466,
-0.026203183457255363,
0.00652002589777112,
0.001513540162704885,
-0.03454872965812683,
-0.021355463191866875,
0.031091682612895966,
-0.06381195783615112,
-0.009403219446539879,
0.028719468042254448,
0.0369560532271862,
0.022295847535133362,
-0.0023502137046307325,
-0.06630681455135345,
0.04436570778489113,
0.04876190423965454,
-0.05548034980893135,
-0.07458796352148056,
0.0021035794634371996,
0.008231664076447487,
0.037946656346321106,
0.013882995583117008,
-0.04929269850254059,
0.0062256078235805035,
0.03622888773679733,
0.056796666234731674,
-0.01207786425948143,
0.023378079757094383,
-0.044661298394203186,
0.03357463330030441,
-0.03994200751185417,
0.08787903189659119,
-0.006600394379347563,
-0.05948818847537041,
-0.06358443200588226,
-0.0016522700898349285,
0.032806310802698135,
0.050759050995111465,
0.05176762863993645,
0.0013257474638521671,
0.009192408993840218,
0.015825634822249413,
-0.015886453911662102,
0.013881987892091274,
0.01841042749583721,
0.007235026452690363,
0.0003166880633216351,
-0.031685613095760345,
-0.028009792789816856,
0.04179295524954796,
-0.046746738255023956,
-0.010442867875099182,
0.04852410778403282,
0.002092974493280053,
-0.002172366948798299,
0.005533484276384115,
-0.04330471158027649,
0.004587220028042793,
0.03492273762822151,
0.00528922351077199,
0.05206941440701485,
0.04305380955338478,
-0.007019969169050455,
0.0006244931719265878,
0.0008571618236601353,
0.014584277756512165,
0.036354295909404755,
0.07822010666131973,
-0.03480691462755203,
0.037472404539585114,
-0.023133812472224236,
-0.08576703071594238,
-0.0008341869688592851,
0.001125892624258995,
-0.020109260454773903,
0.03200097754597664,
-0.06830604374408722,
-0.07115855813026428,
0.06072559580206871,
-0.03766440600156784,
-0.023451441898941994,
0.040491580963134766,
0.041063472628593445,
-0.019144564867019653,
-0.05448700860142708,
-0.008132189512252808,
-0.004711276851594448,
-0.04069361090660095,
-0.04763643816113472,
0.04425019770860672,
0.06309596449136734,
-0.022375449538230896,
0.02973121590912342,
-0.03351983800530434,
-0.08672592043876648,
0.005349595565348864,
0.023624101653695107,
0.01882985606789589,
-0.012901748530566692,
0.010910962708294392,
-0.033815544098615646,
-0.02724304050207138,
-0.02442890778183937,
-0.009087408892810345,
0.01819855533540249,
-0.03913145512342453,
-0.005331931170076132,
-0.006575911305844784,
-0.00580863980576396,
0.058587729930877686,
-0.014324458315968513,
0.06579694896936417,
0.0344473198056221,
0.005724639166146517,
-0.007399959955364466,
0.02731877565383911,
0.028404852375388145,
-0.008875343948602676,
0.03215448558330536,
-0.03167634457349777,
0.00045144683099351823,
0.043861035257577896,
-0.010957881808280945,
-0.04976148158311844,
0.030056001618504524,
0.031524408608675,
0.01515976618975401,
0.01184602826833725,
-0.07888033986091614,
-0.0018505272455513477,
-0.014841478317975998,
0.008792745880782604,
-0.0461568720638752,
-0.01782076433300972,
0.007953646592795849,
0.01964169181883335,
0.04375860467553139,
0.009999879635870457,
-0.0014389681164175272,
-0.049087874591350555,
0.05859692022204399,
-0.006389521528035402,
-0.028635654598474503,
-0.022567231208086014,
0.031166650354862213,
-0.009715324267745018,
0.0050582303665578365,
-0.02154260315001011,
0.01335257850587368,
0.019354142248630524,
0.021691687405109406,
-0.008654436096549034,
0.04303378611803055,
-0.07103899866342545,
-0.030685750767588615,
-0.01151692308485508,
0.022691525518894196,
0.0055708931758999825,
0.029849141836166382,
0.037162069231271744,
-0.005651197861880064,
-0.0839964896440506,
0.1154029369354248,
0.029464328661561012,
0.02179041877388954,
0.05267086252570152,
-4.2507991615565396e-33,
0.055165067315101624,
0.01181984692811966,
0.0005064323777332902,
-0.08605654537677765,
0.037927526980638504,
0.10071150958538055,
-0.05552913621068001,
-0.04745104908943176,
-0.07213012874126434,
0.006837951485067606,
-0.015204062685370445,
-0.03886382654309273,
0.02470415271818638,
0.06560312956571579,
-0.03323208913207054,
0.0104015888646245,
0.009216743521392345,
-0.014142502099275589,
0.003964254166930914,
0.03578435257077217,
0.01455877348780632,
0.046927310526371,
-0.024820001795887947,
-0.025194603949785233,
0.012181107886135578,
-0.04695194214582443,
0.08579272776842117,
0.006002913694828749,
-0.03373229131102562,
0.014400267042219639,
0.019240066409111023,
-0.014754582196474075,
0.007610386237502098,
-0.032708410173654556,
-0.03430628404021263,
-0.030058683827519417,
-0.006271870341151953,
-0.0082899434491992,
0.04356561228632927,
-0.0024100609589368105,
-0.039279837161302567,
-0.019469860941171646,
-0.0019459157483652234,
-0.002581124659627676,
0.045679230242967606,
-0.03877250850200653,
-0.035188011825084686,
-0.009976241737604141,
-0.02831791527569294,
-0.02911376766860485,
0.013552305288612843,
-0.0005642392789013684,
0.0004036438185721636,
-0.019161056727170944,
-0.04696502536535263,
0.05089136213064194,
-0.04344531521201134,
0.005187757778912783,
0.005454018712043762,
0.04630666598677635,
-0.06760961562395096,
0.019351480528712273,
0.07487418502569199,
-0.045448046177625656,
-0.017715206369757652,
-0.023275133222341537,
-0.023764925077557564,
-0.008877203799784184,
-0.01683874987065792,
0.027615977451205254,
-0.03607737272977829,
0.022083543241024017,
-0.04046234115958214,
-0.06157489866018295,
-0.03486500307917595,
-0.0021917771082371473,
0.033681318163871765,
-0.05281868577003479,
0.038349684327840805,
0.037234582006931305,
0.021036304533481598,
0.025093181058764458,
-0.024172184988856316,
-0.00909475889056921,
-0.008633485063910484,
0.0012279119109734893,
0.024053743109107018,
-0.021991247311234474,
0.002860836684703827,
-0.06302215158939362,
0.12074459344148636,
-0.02009170688688755,
0.033159490674734116,
0.03301683068275452,
-0.07578177750110626,
0.016745675355196,
0.036822009831666946,
0.05038611218333244,
0.0022911459673196077,
0.045044682919979095,
-0.002604368608444929,
0.04634863883256912,
0.030220553278923035,
-0.0711362361907959,
-0.05048414319753647,
0.05799247696995735,
0.045584797859191895,
-0.02263605408370495,
0.017678339034318924,
0.011803030967712402,
-0.005156139377504587,
-0.01153726875782013,
0.0013723827432841063,
0.009225357323884964,
0.026096399873495102,
0.024414796382188797,
-0.014543482102453709,
0.011126097291707993,
-0.00039204262429848313,
0.000533903599716723,
0.08101220428943634,
-0.022679297253489494,
0.006026598624885082,
0.0347398966550827,
-0.07300154864788055,
-0.025075865909457207,
-0.03374619409441948,
0.05759187787771225,
0.013753617182374,
-0.012270571663975716,
0.026413772255182266,
-0.033198654651641846,
2.2273567878983158e-7,
0.0308381374925375,
-0.024093758314847946,
-0.02407483384013176,
-0.06948161125183105,
0.035812001675367355,
-0.06195438280701637,
-0.018859947100281715,
0.025028692558407784,
-0.018643774092197418,
-0.006032068282365799,
0.058126382529735565,
-0.0179832112044096,
0.03376642242074013,
-0.057794466614723206,
0.02841184474527836,
-0.01609339751303196,
-0.04837099462747574,
-0.05300024524331093,
0.007064684759825468,
-0.005116899032145739,
0.01842966303229332,
-0.009767584502696991,
-0.055258702486753464,
0.012990602292120457,
0.013191250152885914,
-0.01357187144458294,
-0.04717192053794861,
-0.036667145788669586,
-0.04636295139789581,
-0.016302011907100677,
0.02792484685778618,
-0.031089937314391136,
0.007650013547390699,
0.08399920165538788,
-0.029343126341700554,
-0.01042802631855011,
0.039771825075149536,
0.03746752440929413,
0.008888473734259605,
-0.015395654365420341,
0.007380233611911535,
-0.036850232630968094,
0.02118946798145771,
0.007236723322421312,
0.0035336175933480263,
0.0650903582572937,
-0.03829619288444519,
0.0014273683773353696,
0.030619939789175987,
-0.002014718484133482,
0.019408006221055984,
0.057977344840765,
-0.03723344951868057,
0.062322404235601425,
0.022035881876945496,
0.07817745953798294,
-0.03533836826682091,
0.020778268575668335,
0.02321317419409752,
0.023961959406733513,
-0.029874345287680626,
-0.02070465125143528,
0.009761068969964981,
-0.01687340997159481,
0.09795842319726944,
-0.017843002453446388,
-0.03398554027080536,
8.781416901391403e-35,
-0.015448734164237976,
0.023980768397450447,
0.04033292457461357,
0.005111353471875191,
0.001737285521812737,
-0.018002845346927643,
0.0043149832636117935,
0.013070732355117798,
0.027919869869947433,
-0.05472510680556297,
-0.013079553842544556
] | {
"ds_index": 32,
"similar_dg_indices": [
883307,
612983,
1013134,
159402,
798739,
218925,
211587,
807177,
143250,
698116,
97030,
885055,
914759,
1009968,
130613,
180566,
1047751,
519394,
81700,
33937
]
} |
A 27-year-old man presents to the emergency department after a dog bite. The patient was intoxicated and pulled the dog’s tail while it was eating. The dog belongs to his friend and is back at his friend’s house currently. Physical exam is notable for a dog bite on the patient’s right arm. The wound is irrigated and explored with no retained bodies found. A tetanus vaccination is administered. Which of the following is appropriate management of this patient? | Administer amoxicillin-clavulanic acid | {
"A": "Administer amoxicillin-clavulanic acid",
"B": "Administer trimethoprim-sulfamethoxazole",
"C": "Close the wound with sutures and discharge the patient",
"D": "Discharge the patient with outpatient follow up"
} | step2&3 | A | [
"27 year old man presents",
"emergency department",
"dog bite",
"patient",
"pulled",
"dogs tail",
"eating",
"dog",
"friend",
"back",
"friends house currently",
"Physical exam",
"notable",
"dog bite",
"patients right arm",
"wound",
"irrigated",
"retained bodies found",
"tetanus vaccination",
"administered",
"following",
"appropriate management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old man presents to the emergency department after a dog bite. The patient was intoxicated and pulled the dog’s tail while it was eating. The dog belongs to his friend and is back at his friend’s house currently. Physical exam is notable for a dog bite on the patient’s right arm. The wound is irrigated and explored with no retained bodies found. A tetanus vaccination is administered. Which of the following is appropriate management of this patient?
Choose one of the following::
A. Administer amoxicillin-clavulanic acid
B. Administer trimethoprim-sulfamethoxazole
C. Close the wound with sutures and discharge the patient
D. Discharge the patient with outpatient follow up | [
0.0792420357465744,
-0.0885147973895073,
0.027086280286312103,
-0.01544325239956379,
-0.016136715188622475,
0.040803536772727966,
0.02889624424278736,
0.005003576632589102,
-0.03961274027824402,
-0.049568358808755875,
0.0013392684049904346,
0.03598371893167496,
-0.016178246587514877,
-0.047132886946201324,
0.042545389384031296,
0.02800815738737583,
0.00851308275014162,
0.019705170765519142,
0.04508513584733009,
-0.01860900968313217,
-0.010932321660220623,
0.054619692265987396,
-0.017688902094960213,
0.002832923550158739,
0.021226676180958748,
0.017901182174682617,
-0.012164156883955002,
-0.04215661808848381,
0.03592021018266678,
-0.08860722929239273,
-0.0078119211830198765,
-0.04252210631966591,
-0.0039825355634093285,
-0.04325025901198387,
0.0000018020898551185383,
0.09173951297998428,
0.03030012734234333,
-0.00556145329028368,
0.09516891092061996,
-0.08482306450605392,
-0.009833923541009426,
-0.11372033506631851,
0.02991000935435295,
0.03785955160856247,
-0.02603156864643097,
-0.10069449990987778,
0.01967732235789299,
0.11638575047254562,
0.015912147238850594,
0.02495480515062809,
-0.002750198822468519,
-0.0623820461332798,
-0.022707423195242882,
0.02155138924717903,
-0.04534710571169853,
-0.03366762399673462,
-0.0004232038918416947,
-0.017403872683644295,
-0.026990262791514397,
0.014957431703805923,
0.007665964774787426,
-0.009078098461031914,
-0.006795310415327549,
-0.039312541484832764,
-0.023062173277139664,
0.013464454561471939,
0.010111408308148384,
-0.006029969546943903,
0.010907826013863087,
-0.02759665809571743,
-0.0006327694864012301,
0.03894150257110596,
0.014940383844077587,
0.00839926116168499,
-0.08015607297420502,
0.0092212138697505,
0.05708066374063492,
-0.029301375150680542,
0.023913413286209106,
0.015743058174848557,
-0.012004237622022629,
0.050461094826459885,
0.0018663506489247084,
0.06442941725254059,
-0.07496169209480286,
-0.015802564099431038,
0.016406532377004623,
0.01690354198217392,
-0.013452056795358658,
0.039491791278123856,
-0.0005774882156401873,
-0.01518846396356821,
0.0234981756657362,
0.050796136260032654,
-0.06451015174388885,
-0.02381524257361889,
-0.022397777065634727,
-0.038697946816682816,
0.0020873332396149635,
-0.008669797331094742,
-0.07159391790628433,
-0.03059913031756878,
0.018252607434988022,
0.010490152053534985,
-0.024069450795650482,
-0.05354936793446541,
-0.03929338604211807,
0.03244267776608467,
0.018418967723846436,
0.002478757407516241,
-0.05327921733260155,
0.021528229117393494,
-0.04377426952123642,
-0.00030236560269258916,
0.10249178111553192,
0.01595604047179222,
0.017691288143396378,
-0.005819460842758417,
-0.023888958618044853,
0.012607132084667683,
-0.014663384296000004,
-0.011423489078879356,
-0.025659499689936638,
0.028132501989603043,
-0.009539368562400341,
0.0026984205469489098,
-0.0198791716247797,
0.052614886313676834,
0.007381549570709467,
0.04722358658909798,
0.018655354157090187,
-0.03630442917346954,
-0.04227166250348091,
-0.08707626909017563,
-0.0015871002105996013,
0.0033133402466773987,
0.020991483703255653,
-0.000689722306560725,
-0.05276695638895035,
0.0217115618288517,
-0.005297653377056122,
-0.01833098568022251,
0.040653083473443985,
0.04691816866397858,
-0.0033219228498637676,
-0.010161486454308033,
0.004655247554183006,
-0.025339676067233086,
-0.04782658442854881,
0.011204192414879799,
-0.050381992012262344,
-0.013603052124381065,
-0.04395085200667381,
0.01272666733711958,
0.030613822862505913,
-0.014332624152302742,
0.053528059273958206,
-0.008544635958969593,
0.02909594401717186,
-0.007977716624736786,
-0.03417694941163063,
-0.012580245733261108,
-0.026900792494416237,
-0.05782159045338631,
0.018938586115837097,
-0.00024033353838603944,
0.0067376503720879555,
0.019027460366487503,
-0.007353097200393677,
0.029507406055927277,
-0.04975184053182602,
0.0563630573451519,
0.004557032138109207,
0.05383225157856941,
-0.035282235592603683,
-0.007578141056001186,
-0.04620325192809105,
-0.0912649929523468,
0.010410375893115997,
-0.022364187985658646,
-0.03120468556880951,
0.07889427989721298,
0.013129189610481262,
-0.03706111013889313,
-0.010998883284628391,
-0.02487172931432724,
0.021362973377108574,
-0.01909693330526352,
-0.026896903291344643,
0.05597766861319542,
-0.010177714750170708,
0.011969227343797684,
0.008195442147552967,
0.01945304498076439,
0.026270657777786255,
0.024779796600341797,
-0.04375574737787247,
-0.023037578910589218,
-0.0034642592072486877,
0.05159810930490494,
-0.02343607135117054,
-0.025025347247719765,
-0.046181291341781616,
0.09390953928232193,
-0.039859410375356674,
0.0569787323474884,
-0.051890961825847626,
0.007123935502022505,
0.03192205727100372,
0.0005720748449675739,
0.013356856070458889,
-0.010012907907366753,
0.010891125537455082,
0.005744409281760454,
0.00839504599571228,
0.00862514041364193,
0.014465460553765297,
-0.02352389320731163,
-0.04346108436584473,
0.060744624584913254,
-0.044646672904491425,
0.04236482083797455,
0.005009206011891365,
0.03936206176877022,
0.02992061711847782,
-0.05838671326637268,
0.007795858196914196,
0.002051278483122587,
0.012917546555399895,
-0.010198700241744518,
0.01316496916115284,
-0.011783376336097717,
0.007696297951042652,
-0.02466990053653717,
0.0015570656396448612,
-0.023285849019885063,
0.01448147278279066,
-0.07045247405767441,
0.012368910014629364,
0.005167082417756319,
-0.05258001387119293,
-0.034525223076343536,
-0.056992802768945694,
-0.04039914533495903,
-0.027922654524445534,
-0.047597840428352356,
0.05627792701125145,
-0.019611036404967308,
-0.020838337019085884,
0.023197395727038383,
-0.04592282697558403,
-0.019529573619365692,
-0.00826257560402155,
0.02001735381782055,
-0.0028439804445952177,
-0.02672691084444523,
0.016107160598039627,
-0.03105885721743107,
-0.026373399421572685,
-0.011719253845512867,
0.016662538051605225,
0.007993839681148529,
-0.01684538461267948,
-0.01916215755045414,
0.014413944445550442,
0.00945286825299263,
-0.006812739185988903,
0.008206411264836788,
0.02910464257001877,
0.04349103942513466,
0.03743300214409828,
-0.012196185067296028,
0.021356265991926193,
0.020280269905924797,
-0.02893739379942417,
0.018400464206933975,
-0.07155892252922058,
0.05540331453084946,
0.030277002602815628,
-0.023664070293307304,
0.06588929891586304,
0.03066899999976158,
0.031002379953861237,
0.02941310591995716,
-0.02452094480395317,
-0.04296278953552246,
-0.08785521984100342,
-0.037051744759082794,
0.036962151527404785,
-0.04083156958222389,
0.02326384000480175,
0.00925114843994379,
-0.0037266912404447794,
-0.051156673580408096,
0.0014216749696061015,
0.006150337401777506,
-0.02074465900659561,
-0.03328138589859009,
-0.015070351772010326,
0.019681723788380623,
0.08435292541980743,
0.04561745747923851,
0.01625852659344673,
0.010476179420948029,
0.02189936302602291,
-0.02868734486401081,
0.05007846653461456,
-0.022726356983184814,
0.014367982745170593,
0.045282263308763504,
0.0043601468205451965,
-0.043108392506837845,
-0.031301192939281464,
0.006482144817709923,
-0.004342387896031141,
-0.007560769096016884,
-0.018638666719198227,
-0.01511846948415041,
0.004119583405554295,
-0.016599200665950775,
0.030302487313747406,
-0.0051555330865085125,
0.01744883507490158,
0.02291548065841198,
0.009827345609664917,
-0.013930347748100758,
-0.0025438398588448763,
-0.0009601655183359981,
-0.008567389100790024,
0.04352700337767601,
0.003640628419816494,
-0.01854575425386429,
-0.018895262852311134,
0.0017334196018055081,
0.029922738671302795,
0.04589305818080902,
0.01197584718465805,
-0.05969734862446785,
0.012535721994936466,
0.0351078025996685,
0.008221537806093693,
-0.015323794446885586,
0.005284341052174568,
0.011481164023280144,
-0.01502109132707119,
-0.011000189930200577,
-0.040582433342933655,
0.048458438366651535,
0.006003843154758215,
-0.03703862056136131,
-0.03367771953344345,
0.0002391538000665605,
-0.016670767217874527,
-0.0550951324403286,
-0.0082243075594306,
0.02140207588672638,
-0.0005061765550635755,
-0.0009316389332525432,
-0.014080232940614223,
0.06554175913333893,
-0.015148373320698738,
0.06071801483631134,
-0.0014492602786049247,
0.01298455335199833,
-0.011317330412566662,
0.0005798271740786731,
0.014977778308093548,
-0.034618210047483444,
-0.023503486067056656,
0.03290540352463722,
-0.042005348950624466,
0.05502255633473396,
-0.004937696736305952,
0.08302925527095795,
0.015725575387477875,
0.014033520594239235,
0.01685689017176628,
-0.02403693087399006,
-0.08989255875349045,
-0.04444979876279831,
0.05769166722893715,
-0.08534044027328491,
0.03950817883014679,
0.011595692485570908,
-0.0429818369448185,
0.02252192795276642,
0.03228373825550079,
-0.019314508885145187,
0.060897476971149445,
0.03882217779755592,
-0.02363753691315651,
0.0041146231815218925,
-0.02818978577852249,
0.012449542991816998,
0.05771636217832565,
0.02945195697247982,
0.0310513898730278,
0.0244499109685421,
-0.013392715714871883,
0.05065000802278519,
0.008560926653444767,
0.09446335583925247,
0.010311538353562355,
-0.003909689839929342,
0.017419148236513138,
-0.037919215857982635,
0.02053406834602356,
0.023784058168530464,
0.03092770464718342,
0.052460964769124985,
-0.04006842151284218,
-0.03372291475534439,
0.003291479079052806,
-0.022380761802196503,
0.030197467654943466,
-0.018305150792002678,
0.0606127604842186,
-0.023617219179868698,
-0.03487667068839073,
-0.020164182409644127,
0.00040169304702430964,
0.034001629799604416,
-0.024648042395710945,
-0.11718470603227615,
0.01773684471845627,
-0.037136260420084,
-0.007398714777082205,
0.0018098646542057395,
0.026543445885181427,
0.023898333311080933,
0.018392039462924004,
-0.07225611805915833,
0.03525979444384575,
-0.006767559330910444,
-0.03370926156640053,
0.02521982230246067,
-0.02277366816997528,
-0.05120304971933365,
-0.062235016375780106,
-0.06493020057678223,
-0.03994666412472725,
0.010538790374994278,
0.012266519479453564,
0.02563931979238987,
-0.05030975490808487,
-0.021569954231381416,
0.021207144483923912,
0.038913752883672714,
-0.01851021684706211,
0.05128989741206169,
0.01989022083580494,
-0.02040702849626541,
0.025294926017522812,
-0.022830167785286903,
0.03370156139135361,
0.013521740213036537,
-0.012089871801435947,
0.08495968580245972,
-0.005596787203103304,
0.029672767966985703,
-0.04684823006391525,
-0.009986675344407558,
-0.04708375036716461,
-0.018315229564905167,
-0.0018878434784710407,
-0.029339829459786415,
-0.049293410032987595,
-0.01322865579277277,
-0.013058350421488285,
-0.01500837691128254,
-0.040553752332925797,
0.04000862315297127,
0.026287425309419632,
0.02878989651799202,
0.055958058685064316,
-0.019382575526833534,
-0.007377869915217161,
-0.007508394308388233,
0.01937463879585266,
-0.021591108292341232,
0.0007679677801206708,
0.051097042858600616,
-0.05029205232858658,
-0.018063751980662346,
-0.0010245157172903419,
0.004464983008801937,
0.02909611351788044,
-0.01129933912307024,
-0.005331110209226608,
-0.022115521132946014,
-0.018687739968299866,
0.024213498458266258,
-0.028961142525076866,
-0.0693976879119873,
-0.006136362906545401,
-0.0025417113211005926,
-0.04537266492843628,
0.009103805758059025,
0.0636855885386467,
-0.06099829077720642,
0.02935837022960186,
0.09119372069835663,
0.03154010698199272,
0.0012007046025246382,
0.004270380828529596,
0.010145804844796658,
-0.0381983183324337,
0.05623892694711685,
0.001414855127222836,
-0.04206712171435356,
-0.011498214676976204,
0.05850832536816597,
-0.010895614512264729,
0.02099020592868328,
0.028611090034246445,
0.025008490309119225,
-0.04541337862610817,
-0.009062026627361774,
-0.043738510459661484,
0.032010190188884735,
-0.0019386070780456066,
0.030458182096481323,
0.01940922811627388,
-0.01771365851163864,
0.021978547796607018,
-0.035826925188302994,
0.0006712937611155212,
-0.010556379333138466,
-0.04602866992354393,
0.05523435398936272,
-0.026973191648721695,
0.011624423786997795,
-0.02706732228398323,
0.05405997484922409,
0.001066673779860139,
0.02559608966112137,
-0.022648558020591736,
-0.003187409834936261,
-0.013337640091776848,
-0.040986478328704834,
0.02024286799132824,
0.014941522851586342,
-0.051320478320121765,
-0.07496020942926407,
-0.022285303100943565,
0.051900431513786316,
0.007403017487376928,
-0.04775597155094147,
0.03530866280198097,
-0.02242213860154152,
-0.026104362681508064,
0.08370662480592728,
0.08783010393381119,
0.008863700553774834,
-0.0044893561862409115,
-5.018682030023568e-33,
0.006545086856931448,
-0.03172355890274048,
0.002017207443714142,
-0.08350338786840439,
-0.008125454187393188,
0.05148537456989288,
-0.02370358258485794,
0.010784441605210304,
-0.04428877308964729,
0.02571711875498295,
-0.01021580956876278,
0.037429217249155045,
0.023924600332975388,
0.05736710503697395,
0.059370238333940506,
0.005966674070805311,
0.005207821261137724,
0.00027796512586064637,
-0.01951144076883793,
0.043909505009651184,
-0.004629833158105612,
-0.005403636954724789,
0.04299475625157356,
-0.016978200525045395,
0.007074237335473299,
-0.006213301792740822,
0.028128284960985184,
-0.023848528042435646,
-0.035848259925842285,
-0.027142293751239777,
-0.00022422315669246018,
-0.06323011219501495,
0.02183493971824646,
-0.04067279398441315,
0.012301459908485413,
-0.05265373736619949,
0.0007520054350607097,
-0.05113590881228447,
0.01680256985127926,
-0.0001344111660728231,
-0.026249857619404793,
-0.07169800996780396,
0.03511040657758713,
-0.016378993168473244,
0.007413262035697699,
-0.06558680534362793,
-0.05433903634548187,
0.015746410936117172,
0.0011652437970042229,
-0.06251147389411926,
-0.007401675917208195,
0.021706346422433853,
0.024414103478193283,
-0.033902183175086975,
0.04627414047718048,
-0.035667937248945236,
0.015561353415250778,
0.09231304377317429,
-0.021966321393847466,
-0.04712409898638725,
-0.012400172650814056,
-0.012203303165733814,
0.014697005040943623,
-0.08318590372800827,
-0.03166697919368744,
0.0030492874793708324,
-0.01904134638607502,
-0.004932770971208811,
-0.019976891577243805,
0.0046153306029737,
-0.07805517315864563,
0.062081336975097656,
-0.019660944119095802,
-0.09057042002677917,
-0.0445685051381588,
0.0057680499739944935,
0.012094602920114994,
-0.0039746505208313465,
0.010674313642084599,
0.0271945521235466,
-0.08037307858467102,
0.033255089074373245,
-0.020945727825164795,
0.005354639608412981,
0.051110535860061646,
-0.0008170233340933919,
0.0372224785387516,
-0.04399380832910538,
-0.02844782918691635,
-0.017725015059113503,
0.01333256158977747,
-0.0058861481957137585,
0.03930377587676048,
0.019972439855337143,
0.04253849387168884,
-0.05472563952207565,
-0.01032838225364685,
0.06819627434015274,
-0.005810764152556658,
-0.02761821821331978,
0.01971432752907276,
-0.02598700299859047,
0.05448804795742035,
-0.017309749498963356,
-0.010320940986275673,
-0.028202209621667862,
-0.009938251227140427,
0.01100361067801714,
-0.01626601256430149,
0.0009154534200206399,
0.05143100395798683,
0.026808084920048714,
-0.007027131970971823,
0.1107599288225174,
0.035034824162721634,
0.03533175215125084,
0.04975936934351921,
-0.0052831522189080715,
0.04160427302122116,
-0.028334680944681168,
-0.01922992244362831,
0.04637271165847778,
-0.0057711550034582615,
-0.005552242044359446,
0.011559444479644299,
-0.0054773325100541115,
0.05677393078804016,
0.011524355970323086,
-0.05674613639712334,
-0.02149883285164833,
0.06372221559286118,
-0.0037994456943124533,
2.488058044036734e-7,
0.060246214270591736,
-0.010513417422771454,
-0.012106163427233696,
-0.029716352000832558,
0.03923280909657478,
-0.02816038951277733,
0.03052101656794548,
0.014482950791716576,
0.029523294419050217,
-0.04885253310203552,
0.08247977495193481,
-0.051967453211545944,
-0.013477730564773083,
-0.001613139291293919,
0.013151723891496658,
0.0056280638091266155,
-0.015267860144376755,
-0.019310804083943367,
0.058732010424137115,
-0.04345317929983139,
-0.03933537006378174,
-0.05680924654006958,
-0.02917313389480114,
-0.016557512804865837,
0.018389901146292686,
-0.016657980158925056,
0.010474735870957375,
-0.007853852584958076,
-0.0007061382057145238,
-0.005905540194362402,
0.03351081907749176,
0.03944497928023338,
-0.018664885312318802,
0.05288402736186981,
-0.056337159126996994,
-0.005417746026068926,
-0.00981185119599104,
0.09281979501247406,
-0.050131380558013916,
0.07721308618783951,
-0.004314009565860033,
-0.02500866912305355,
-0.02518393285572529,
0.0002497602254152298,
0.0691942647099495,
-0.03248275816440582,
-0.007767937146127224,
0.051692526787519455,
0.0010916013270616531,
0.0317324697971344,
-0.009409907273948193,
0.025269055739045143,
0.05576526001095772,
0.10025840997695923,
0.017059313133358955,
0.019800394773483276,
-0.0056063709780573845,
0.003017739625647664,
0.040419526398181915,
0.0008321493514813483,
0.018706006929278374,
-0.03437396511435509,
0.031969085335731506,
-0.028889978304505348,
0.04227625951170921,
-0.053006649017333984,
-0.030125752091407776,
1.0948232959322233e-34,
-0.016310540959239006,
-0.051067933440208435,
-0.004249074030667543,
0.03582746535539627,
-0.07122065126895905,
0.02402660809457302,
0.005516554694622755,
-0.03582071512937546,
0.010888705961406231,
-0.03810189291834831,
-0.005789169576019049
] | {
"ds_index": 33,
"similar_dg_indices": [
44915,
1037017,
105769,
63661,
1104085,
558838,
662694,
1098868,
292506,
1115487,
183334,
636295,
954785,
725742,
858187,
746633,
1129877,
369552,
170513,
77198
]
} |
A 19-year-old woman, accompanied by her parents, presents after a one-week history of abnormal behavior, delusions, and unusual aggression. She denies fever, seizures or illicit drug use. Family history is negative for psychiatric illnesses. She was started on risperidone and sent home with her parents. Three days later, she is brought to the emergency department with fever and confusion. She is not verbally responsive. At the hospital, her temperature is 39.8°C (103.6°F), the blood pressure is 100/60 mm Hg, the pulse rate is 102/min, and the respiratory rate is 16/min. She is extremely diaphoretic and appears stiff. She has spontaneous eye-opening but she is not verbally responsive and she is not following commands. Laboratory studies show:
Sodium 142 mmol/L
Potassium 5.0 mmol/L
Creatinine 1.8 mg/dl
Calcium 10.4 mg/dl
Creatine kinase 9800 U/L
White blood cells 14,500/mm3
Hemoglobin 12.9 g/dl
Platelets 175,000/mm3
Urinalysis shows protein 1+, hemoglobin 3+ with occasional leukocytes and no red blood casts. What is the best first step in the management of this condition? | Stop risperidone | {
"A": "Intravenous hydration",
"B": "Paracetamol",
"C": "Stop risperidone",
"D": "Switch risperidone to clozapine"
} | step2&3 | C | [
"year old woman",
"parents",
"presents",
"one-week history",
"abnormal behavior",
"delusions",
"unusual aggression",
"denies fever",
"seizures",
"illicit drug use",
"Family history",
"negative",
"psychiatric illnesses",
"started",
"risperidone",
"sent home",
"parents",
"Three days later",
"brought",
"emergency department",
"fever",
"confusion",
"not",
"responsive",
"hospital",
"temperature",
"blood pressure",
"100 60 mm Hg",
"pulse rate",
"min",
"respiratory rate",
"min",
"extremely diaphoretic",
"appears stiff",
"spontaneous eye opening",
"not",
"responsive",
"not following commands",
"Laboratory studies show",
"Sodium",
"mmol",
"0 mmol",
"1 8 mg dl",
"mg dl Creatine",
"blood cells",
"500",
"Hemoglobin",
"g",
"Urinalysis shows protein 1",
"hemoglobin",
"occasional leukocytes",
"red blood casts",
"best first step",
"management",
"condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 19-year-old woman, accompanied by her parents, presents after a one-week history of abnormal behavior, delusions, and unusual aggression. She denies fever, seizures or illicit drug use. Family history is negative for psychiatric illnesses. She was started on risperidone and sent home with her parents. Three days later, she is brought to the emergency department with fever and confusion. She is not verbally responsive. At the hospital, her temperature is 39.8°C (103.6°F), the blood pressure is 100/60 mm Hg, the pulse rate is 102/min, and the respiratory rate is 16/min. She is extremely diaphoretic and appears stiff. She has spontaneous eye-opening but she is not verbally responsive and she is not following commands. Laboratory studies show:
Sodium 142 mmol/L
Potassium 5.0 mmol/L
Creatinine 1.8 mg/dl
Calcium 10.4 mg/dl
Creatine kinase 9800 U/L
White blood cells 14,500/mm3
Hemoglobin 12.9 g/dl
Platelets 175,000/mm3
Urinalysis shows protein 1+, hemoglobin 3+ with occasional leukocytes and no red blood casts. What is the best first step in the management of this condition?
Choose one of the following::
A. Intravenous hydration
B. Paracetamol
C. Stop risperidone
D. Switch risperidone to clozapine | [
0.04720586910843849,
-0.040390580892562866,
0.06084500998258591,
0.012901859357953072,
0.03347362205386162,
0.03765777498483658,
-0.07728727906942368,
0.05475800484418869,
-0.002352245384827256,
-0.024082455784082413,
0.00554578797891736,
-0.011997873894870281,
-0.03464554622769356,
-0.002586689544841647,
-0.011758819222450256,
-0.020217984914779663,
0.0007235836237668991,
-0.00890289805829525,
-0.007385151460766792,
0.018970197066664696,
-0.02317679114639759,
-0.003651436883956194,
0.01478440873324871,
0.008279122412204742,
0.06979842483997345,
-0.055292610079050064,
-0.006265525706112385,
-0.008734876289963722,
-0.00981087051331997,
-0.039665382355451584,
-0.03762098401784897,
0.00786326639354229,
0.0006234783795662224,
-0.03341337665915489,
0.0000018347104742133524,
-0.01129318866878748,
0.03999010846018791,
-0.0028884606435894966,
0.042962729930877686,
-0.08652421087026596,
-0.04070725291967392,
-0.07345771044492722,
0.04742855578660965,
-0.0016218156088143587,
-0.05362376570701599,
-0.09999678283929825,
-0.012293092906475067,
0.10473505407571793,
-0.03899214044213295,
-0.025960465893149376,
0.03487229347229004,
-0.013098456896841526,
-0.011732921004295349,
-0.018302850425243378,
0.04421412572264671,
-0.03550991788506508,
0.004477320704609156,
-0.0183119960129261,
0.037934619933366776,
-0.007764539681375027,
0.002901503350585699,
-0.007961669936776161,
-0.028466667979955673,
0.011014497838914394,
-0.06589283794164658,
-0.011553225107491016,
0.03636251017451286,
-0.0600091889500618,
0.008193427696824074,
0.04393581673502922,
-0.0254207756370306,
0.039128437638282776,
0.10165902972221375,
0.0580974705517292,
-0.05064120888710022,
-0.018189726397395134,
0.024514704942703247,
-0.032169122248888016,
0.017724106088280678,
-0.010667206719517708,
0.0556347519159317,
0.019944973289966583,
-0.009516469202935696,
-0.0017055708449333906,
0.006641000974923372,
-0.01823713257908821,
-0.009204226545989513,
0.011015418916940689,
0.015613102354109287,
-0.04700475186109543,
-0.04035177826881409,
-0.04785175621509552,
0.008463721722364426,
-0.020363599061965942,
-0.08759810775518417,
0.006985703948885202,
-0.028006916865706444,
-0.04335753247141838,
0.007708581630140543,
-0.03624270483851433,
-0.05024034529924393,
-0.0009003415470942855,
0.040534380823373795,
0.006205943413078785,
-0.027176251634955406,
-0.0056793587282299995,
-0.028260109946131706,
0.014534667134284973,
-0.07764098793268204,
0.0468142107129097,
-0.033755410462617874,
0.03715142607688904,
-0.07666240632534027,
-0.03359336033463478,
0.09402614086866379,
-0.014441028237342834,
-0.02739637903869152,
-0.05253514274954796,
0.02287297695875168,
0.07503218203783035,
-0.00824275054037571,
0.048532634973526,
0.045720286667346954,
0.00438687251880765,
0.002625729888677597,
0.03576814755797386,
-0.03123491071164608,
-0.032837700098752975,
0.029720228165388107,
0.0004349190276116133,
0.007562846411019564,
-0.04372361674904823,
-0.07376381009817123,
-0.003939589019864798,
0.03711199015378952,
0.020770667120814323,
0.03636353835463524,
0.045016951858997345,
-0.06349785625934601,
0.005149088334292173,
0.024367332458496094,
-0.043167147785425186,
0.05134962499141693,
0.017413904890418053,
-0.022961514070630074,
0.04682460054755211,
0.008099944330751896,
0.04376441612839699,
0.01735546812415123,
0.0026920419186353683,
-0.03012598305940628,
-0.0221383236348629,
-0.05307072028517723,
-0.004599563777446747,
-0.04066924378275871,
0.016601040959358215,
0.034144118428230286,
-0.010565103963017464,
-0.012414803728461266,
-0.06978926807641983,
0.03077259659767151,
-0.0008846739656291902,
0.020833030343055725,
-0.005961845628917217,
0.024177752435207367,
0.0383647158741951,
-0.01302233524620533,
0.07142343372106552,
-0.05302320793271065,
0.00899431575089693,
-0.023902306333184242,
-0.014452475123107433,
0.06054024025797844,
0.01690540835261345,
-0.05015772953629494,
0.052494656294584274,
-0.054630160331726074,
-0.04433523118495941,
0.0002551503712311387,
-0.02825387753546238,
0.00561619782820344,
0.010914443992078304,
0.011417907662689686,
-0.013457277789711952,
0.051487259566783905,
0.0003850275825243443,
-0.007476378232240677,
-0.0066040935926139355,
0.000834032369311899,
-0.0063607520423829556,
-0.011388231068849564,
-0.011923305690288544,
-0.0471387542784214,
0.04623635858297348,
-0.042107630521059036,
-0.00032790249679237604,
-0.01762586273252964,
-0.023386137560009956,
0.026696432381868362,
0.044076237827539444,
-0.0014942579437047243,
-0.001077539287507534,
-0.026765935122966766,
0.10377461463212967,
-0.004862395580857992,
0.06880269944667816,
0.02870456501841545,
-0.01960379257798195,
0.01246443297713995,
0.0038516123313456774,
-0.0337841622531414,
0.014387395232915878,
0.028884854167699814,
-0.055024370551109314,
0.0034121249336749315,
0.04975924268364906,
0.040546100586652756,
-0.005095591302961111,
-0.08986461907625198,
-0.0050552114844322205,
-0.022225065156817436,
-0.024166632443666458,
0.004370901267975569,
-0.010901481844484806,
-0.022287407889962196,
-0.047592390328645706,
0.023081813007593155,
0.005492887459695339,
-0.01156586967408657,
-0.059708572924137115,
0.03193945437669754,
0.03212987259030342,
-0.009290002286434174,
-0.023254750296473503,
-0.042440153658390045,
0.024698950350284576,
0.006727873347699642,
-0.05132196843624115,
-0.06226544827222824,
0.061594847589731216,
-0.02587343566119671,
-0.03668319433927536,
-0.04317975044250488,
-0.04884275794029236,
0.006159982178360224,
-0.03243168815970421,
-0.017282770946621895,
0.03673158213496208,
-0.024315547198057175,
0.06334254145622253,
0.015233383513987064,
-0.020360048860311508,
-0.017376616597175598,
0.00006353550270432606,
0.01402418315410614,
0.041213300079107285,
-0.03191256895661354,
-0.0039754100143909454,
-0.016154713928699493,
-0.06723589450120926,
-0.05578377842903137,
-0.03436129167675972,
0.04117351025342941,
-0.07889116555452347,
-0.0905667319893837,
0.01308563631027937,
0.029395751655101776,
0.05210276320576668,
0.01821117289364338,
0.038935016840696335,
0.03552975878119469,
0.01242692582309246,
0.03592553362250328,
-0.0007714608800597489,
-0.048587601631879807,
0.0153826754540205,
0.017328346148133278,
0.09076346457004547,
0.033119723200798035,
-0.019298898056149483,
0.06492364406585693,
0.020532239228487015,
0.029605060815811157,
0.030435344204306602,
0.010565690696239471,
0.020656516775488853,
-0.0678187683224678,
0.03477783501148224,
0.030849212780594826,
0.0008857074426487088,
0.024121573194861412,
0.03265727683901787,
-0.00029116342193447053,
-0.022103583440184593,
-0.033513035625219345,
-0.026009440422058105,
-0.01638299971818924,
0.04513897746801376,
-0.01832454465329647,
0.04018062725663185,
0.04073711484670639,
0.00009042119199875742,
0.03019372746348381,
0.023326095193624496,
-0.007647308986634016,
0.019290529191493988,
0.028930557891726494,
0.04564918577671051,
0.006864585448056459,
0.06160791218280792,
0.03425918519496918,
0.007390743587166071,
0.0017996439710259438,
-0.06281108409166336,
0.01815892942249775,
-0.006615068763494492,
0.05066213011741638,
-0.05284528061747551,
0.0009566975058987737,
-0.008196897804737091,
0.02019519917666912,
0.05844445899128914,
-0.01586734503507614,
-0.022816231474280357,
0.0047596818767488,
-0.024046452715992928,
-0.027513915672898293,
-0.005052381195127964,
-0.07375985383987427,
-0.016693096607923508,
-0.013652353547513485,
-0.011410053819417953,
0.031006915494799614,
0.06357088685035706,
-0.06258432567119598,
-0.024318944662809372,
0.008190937340259552,
0.07790786772966385,
-0.031065426766872406,
0.039445098489522934,
0.019871683791279793,
-0.00802673865109682,
-0.001989418873563409,
0.057409919798374176,
-0.006754419766366482,
-0.022327732294797897,
-0.04202069714665413,
0.02248339168727398,
-0.01797598786652088,
0.015471154823899269,
-0.053316157311201096,
0.049219030886888504,
0.002493128878995776,
-0.027904123067855835,
0.004972407594323158,
-0.04873601347208023,
0.015874015167355537,
-0.024873286485671997,
0.0004790214297827333,
-0.049133699387311935,
-0.00565518531948328,
0.04346545413136482,
-0.04290471225976944,
0.014882189221680164,
-0.009690551087260246,
0.010722406208515167,
0.023443186655640602,
-0.017875410616397858,
-0.05277988687157631,
0.00896444357931614,
-0.0009929045336320996,
-0.02236587181687355,
-0.05913461744785309,
0.08669791370630264,
0.016711002215743065,
-0.05199097469449043,
-0.009200070053339005,
-0.1056753545999527,
-0.08371458202600479,
-0.03967507183551788,
0.027412859722971916,
0.0031946341041475534,
-0.003416127059608698,
-0.027513649314641953,
0.02520938590168953,
-0.007917730137705803,
-0.03610648959875107,
-0.04464397579431534,
0.0847456231713295,
-0.004531911574304104,
-0.02542879432439804,
0.011963064782321453,
0.0033293538726866245,
0.018571972846984863,
0.002816584426909685,
0.01898033916950226,
0.02602287195622921,
-0.056476615369319916,
0.00410859752446413,
0.0915762260556221,
-0.04765179008245468,
-0.007929305545985699,
-0.010799404233694077,
0.060239870101213455,
0.0355985201895237,
-0.014764797873795033,
-0.030628088861703873,
-0.01995949260890484,
0.035601481795310974,
0.027134833857417107,
-0.009209595620632172,
-0.053068339824676514,
0.0696474090218544,
0.008136605843901634,
0.020615097135305405,
0.009565981104969978,
-0.00022706032905261964,
-0.029961416497826576,
-0.010361547581851482,
-0.07129106670618057,
0.010902181267738342,
-0.01589331403374672,
-0.044837936758995056,
-0.059005189687013626,
-0.014571796171367168,
-0.006997551769018173,
0.008232329040765762,
0.058339063078165054,
0.022709939628839493,
0.050830792635679245,
0.04451417177915573,
-0.07916665822267532,
0.04731087014079094,
0.057186562567949295,
-0.07658208906650543,
0.015335268341004848,
-0.023775003850460052,
0.011121283285319805,
0.0013107525883242488,
-0.04442378133535385,
0.028532009571790695,
0.02196400798857212,
0.05694272741675377,
0.013733619824051857,
-0.03267912566661835,
0.027112407609820366,
0.030862748622894287,
0.02902294136583805,
0.034367721527814865,
0.11880562454462051,
0.006854309234768152,
-0.05006837844848633,
0.019433531910181046,
0.015798119828104973,
0.05463982746005058,
0.00008320774213643745,
-0.01403952669352293,
0.015529241412878036,
0.05551823228597641,
0.05672287195920944,
-0.059529419988393784,
0.016757411882281303,
-0.052240367978811264,
-0.04064536467194557,
-0.003143283072859049,
-0.029617374762892723,
-0.06697504967451096,
0.05341441556811333,
-0.008033243007957935,
-0.019871678203344345,
0.0035620788112282753,
0.0349104218184948,
0.030298275873064995,
-0.0018252163426950574,
0.08789831399917603,
-0.01708906516432762,
-0.047044504433870316,
-0.04263557866215706,
0.0008053334313444793,
0.007555880583822727,
-0.021290957927703857,
0.0009749251767061651,
-0.06475166231393814,
-0.02328476309776306,
0.01212981529533863,
-0.027122948318719864,
0.02027875930070877,
0.016363095492124557,
-0.01414995826780796,
-0.010338244028389454,
0.025194482877850533,
0.019291846081614494,
0.015873901546001434,
0.0035952746402472258,
-0.10000287741422653,
-0.06791732460260391,
0.017865311354398727,
-0.010548788122832775,
0.01423234585672617,
-0.026803843677043915,
0.06183740124106407,
0.013170122168958187,
0.029552703723311424,
0.025659726932644844,
-0.009640966542065144,
0.013936065137386322,
-0.01839708350598812,
0.07782862335443497,
-0.022007981315255165,
-0.050207991153001785,
0.05007331818342209,
0.04281395301222801,
-0.030528878793120384,
-0.03014248237013817,
0.036532316356897354,
-0.04238108918070793,
-0.07956849783658981,
0.0010368081275373697,
-0.016131097450852394,
0.01988382823765278,
0.02216864377260208,
0.012017596513032913,
0.020565440878272057,
-0.0027257080655544996,
-0.012389536947011948,
0.015296079218387604,
0.008911491371691227,
-0.005652983207255602,
0.012725322507321835,
0.039421603083610535,
-0.009034885093569756,
0.011161446571350098,
-0.0029312875121831894,
-0.0019399092998355627,
-0.0042687286622822285,
-0.009522391483187675,
-0.03588958457112312,
-0.02685517631471157,
-0.050136540085077286,
-0.04349691420793533,
0.008576302789151669,
-0.0037237207870930433,
0.015113284811377525,
-0.0004968061693944037,
-0.0945078507065773,
0.0646563395857811,
-0.02563393861055374,
-0.015502521768212318,
0.0019809415098279715,
0.013117999769747257,
0.010554840788245201,
0.03111410140991211,
0.022776301950216293,
0.0009166235104203224,
0.004548926372081041,
-4.9826850869235277e-33,
0.03936778008937836,
-0.011658541858196259,
0.0017842932138592005,
-0.03871511295437813,
0.002680098870769143,
0.04135391116142273,
-0.03704141452908516,
0.03534763678908348,
-0.06724466383457184,
0.016139043495059013,
-0.046063948422670364,
0.013079467229545116,
0.007928488776087761,
0.04856288433074951,
-0.021571708843111992,
-0.047163087874650955,
-0.0028802661690860987,
0.026452211663126945,
-0.03139425441622734,
-0.02815384604036808,
-0.01586807705461979,
0.02943624183535576,
0.011183816008269787,
-0.0431135855615139,
-0.013279975391924381,
0.014001390896737576,
-0.007514936849474907,
0.06902679055929184,
0.002789395162835717,
-0.007330421824008226,
0.004525072872638702,
-0.05364753305912018,
0.02725238725543022,
0.014863327145576477,
-0.009223842062056065,
-0.018827497959136963,
-0.017678452655673027,
-0.02808728627860546,
0.057544928044080734,
-0.015414945781230927,
-0.04243328422307968,
0.014994718134403229,
0.08068273216485977,
0.02291463315486908,
0.09515032917261124,
-0.01517796702682972,
-0.015027748420834541,
-0.06292383372783661,
0.042144812643527985,
-0.0035165674053132534,
-0.028843868523836136,
-0.007828968577086926,
0.017821641638875008,
-0.005639402195811272,
-0.034337032586336136,
-0.03791560232639313,
-0.011401648633182049,
-0.0040229689329862595,
-0.005069395061582327,
-0.021277977153658867,
-0.042542025446891785,
-0.01662788726389408,
-0.03375876322388649,
-0.021978536620736122,
-0.03840390220284462,
0.0160295981913805,
0.06607217341661453,
0.007816432043910027,
-0.030949963256716728,
0.005812399554997683,
-0.058799222111701965,
0.037958670407533646,
0.013422372750937939,
-0.030671376734972,
-0.0003500733873806894,
0.02533804066479206,
0.0383010134100914,
-0.01474482100456953,
0.029421674087643623,
0.01859471946954727,
-0.025949353352189064,
-0.02127619832754135,
-0.01934320479631424,
-0.027972538024187088,
0.0074294134974479675,
0.04491454362869263,
-0.020809462293982506,
-0.006808601785451174,
0.007003725040704012,
0.015006528235971928,
0.035613615065813065,
0.027864694595336914,
0.04427339509129524,
-0.006707955151796341,
-0.01072247140109539,
-0.04794016107916832,
0.07278189063072205,
0.03318854048848152,
0.03953545540571213,
-0.016273390501737595,
0.07132308185100555,
-0.007719705812633038,
0.059846632182598114,
-0.03864385560154915,
-0.0047762226313352585,
0.02583276480436325,
-0.015508905053138733,
-0.010767493396997452,
0.021836869418621063,
0.014759029261767864,
0.0474410206079483,
0.00208659702911973,
-0.01659691520035267,
0.07367676496505737,
-0.04312462732195854,
-0.001954075414687395,
0.01965721696615219,
0.0362357459962368,
0.02234932780265808,
-0.0015384253347292542,
-0.0011080713011324406,
0.024350591003894806,
0.03763392195105553,
-0.026419799774885178,
-0.029144659638404846,
-0.0435168631374836,
0.01403103768825531,
0.0768580511212349,
-0.010872939601540565,
-0.045343510806560516,
0.030231010168790817,
-0.003683951450511813,
2.663754798959417e-7,
0.040147196501493454,
-0.019411930814385414,
-0.029143240302801132,
-0.04661974310874939,
0.012803296558558941,
0.03492167219519615,
-0.017418550327420235,
0.04936625063419342,
-0.0098650511354208,
-0.07577186822891235,
0.007433442864567041,
0.024558166041970253,
-0.01196068525314331,
-0.00462931115180254,
0.013765390031039715,
0.0004420996701810509,
0.023914864286780357,
-0.01671624183654785,
0.022063789889216423,
-0.057944927364587784,
-0.03320194035768509,
-0.05689304322004318,
-0.008329570293426514,
-0.020593687891960144,
0.022546203806996346,
-0.03395780548453331,
-0.012779660522937775,
0.007289187982678413,
-0.015377267263829708,
0.03271856904029846,
0.0001373896811855957,
0.05060254782438278,
-0.00022296037059277296,
0.05232036113739014,
-0.043019142001867294,
-0.06406428664922714,
-0.03288062661886215,
0.02870897948741913,
-0.061520565301179886,
0.012747326865792274,
0.01407814770936966,
-0.038099683821201324,
0.018154427409172058,
0.03982451930642128,
0.04163951054215431,
-0.02522318996489048,
-0.016104336827993393,
0.02902178093791008,
-0.005362446419894695,
0.01473198365420103,
-0.025745419785380363,
0.0027891702484339476,
0.02656915783882141,
0.0750538632273674,
0.0021975405979901552,
0.06812724471092224,
-0.012896019034087658,
-0.011021479032933712,
0.03640180081129074,
-0.030064839869737625,
0.002674957737326622,
-0.05020209774374962,
-0.027310030534863472,
-0.0050748782232403755,
0.05008474364876747,
-0.015192994847893715,
0.0020038846414536238,
2.2491922683958073e-34,
-0.022657360881567,
-0.0007063465309329331,
0.04301916062831879,
-0.005356548819690943,
-0.03487992286682129,
-0.019073693081736565,
0.021226176992058754,
0.050282590091228485,
0.004686164669692516,
-0.047496452927589417,
-0.022727368399500847
] | {
"ds_index": 34,
"similar_dg_indices": [
645368,
331346,
251434,
322439,
763949,
865810,
1186862,
181642,
581259,
218574,
1120494,
86228,
639171,
339019,
1023115,
460836,
157475,
338018,
919761,
417489
]
} |
A 35-year-old woman comes to the physician because of a 1-month history of double vision, difficulty climbing stairs, and weakness when trying to brush her hair. She reports that these symptoms are worse after she exercises and disappear after she rests for a few hours. Physical examination shows drooping of her right upper eyelid that worsens when the patient is asked to gaze at the ceiling for 2 minutes. There is diminished motor strength in the upper extremities. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis? | Myasthenia gravis | {
"A": "Myasthenia gravis",
"B": "Polymyositis",
"C": "Amyotrophic lateral sclerosis",
"D": "Multiple sclerosis"
} | step1 | A | [
"35 year old woman",
"physician",
"month history",
"double vision",
"difficulty climbing stairs",
"weakness",
"to brush",
"hair",
"reports",
"symptoms",
"worse",
"exercises",
"rests",
"hours",
"Physical examination shows drooping",
"right upper eyelid",
"worsens",
"patient",
"to gaze",
"2 minutes",
"diminished motor strength",
"upper extremities",
"examination shows",
"abnormalities",
"following",
"most likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 35-year-old woman comes to the physician because of a 1-month history of double vision, difficulty climbing stairs, and weakness when trying to brush her hair. She reports that these symptoms are worse after she exercises and disappear after she rests for a few hours. Physical examination shows drooping of her right upper eyelid that worsens when the patient is asked to gaze at the ceiling for 2 minutes. There is diminished motor strength in the upper extremities. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Myasthenia gravis
B. Polymyositis
C. Amyotrophic lateral sclerosis
D. Multiple sclerosis | [
-0.008495868183672428,
-0.02294786460697651,
0.001792323193512857,
0.026754897087812424,
0.03498484939336777,
0.013642881065607071,
-0.028529180213809013,
0.08038729429244995,
0.030970554798841476,
-0.018948407843708992,
0.08239439874887466,
-0.02589857019484043,
0.02830320969223976,
-0.04607294872403145,
0.016941973939538002,
0.02210078202188015,
0.0063773528672754765,
0.006863239221274853,
-0.008739822544157505,
-0.010252720676362514,
-0.023827092722058296,
-0.0013152732281014323,
0.029905689880251884,
-0.021551785990595818,
0.02218257077038288,
-0.013288778252899647,
0.03013104759156704,
-0.011999616399407387,
-0.01018456183373928,
0.022697588428854942,
-0.004301929846405983,
-0.006060244515538216,
-0.008283187635242939,
-0.04944005608558655,
0.0000016730363086026045,
0.03798520565032959,
0.023221682757139206,
-0.03140366077423096,
0.03906641900539398,
-0.030848750844597816,
0.018505318090319633,
-0.04492887854576111,
0.09070710837841034,
-0.009828089736402035,
-0.030833130702376366,
-0.11538670212030411,
-0.014265375211834908,
0.01800939440727234,
-0.046957530081272125,
-0.0030514481477439404,
0.029893605038523674,
0.05737701430916786,
-0.062026429921388626,
-0.014638873748481274,
0.05903981253504753,
-0.015172581188380718,
-0.023648250848054886,
0.05613858625292778,
-0.05800019949674606,
-0.026167208328843117,
0.00807107612490654,
-0.02355232462286949,
-0.005835726857185364,
0.0313788577914238,
-0.04728997126221657,
-0.00953446701169014,
0.03154555708169937,
-0.02620573155581951,
0.008357439190149307,
-0.0018025566823780537,
-0.007253637537360191,
0.008068121038377285,
0.039001401513814926,
0.0563075952231884,
-0.020084291696548462,
0.06754008680582047,
0.060193050652742386,
-0.027565691620111465,
0.013663728721439838,
-0.02456776611506939,
0.05628819391131401,
0.008380754850804806,
0.015402497723698616,
0.04612767696380615,
-0.06133504956960678,
-0.0659208595752716,
-0.007148958742618561,
0.035317882895469666,
0.01881546527147293,
-0.028702950105071068,
0.0203862227499485,
-0.059243906289339066,
-0.026725180447101593,
0.0008823165553621948,
-0.032357361167669296,
-0.025066599249839783,
-0.0038754765409976244,
-0.06444753706455231,
0.01572262868285179,
-0.00048609875375404954,
0.02296227216720581,
-0.018718769773840904,
0.015219015069305897,
-0.015738660469651222,
-0.07176655530929565,
0.023261990398168564,
-0.04684773460030556,
0.01820807345211506,
-0.03455427661538124,
0.061560921370983124,
0.038295842707157135,
0.017354192212224007,
-0.029094716534018517,
-0.05291535705327988,
0.052176766097545624,
-0.052779365330934525,
-0.019288357347249985,
-0.03910375386476517,
0.01915091462433338,
-0.008871199563145638,
-0.05020400509238243,
0.019235067069530487,
0.03296695277094841,
0.021491985768079758,
-0.04280439764261246,
0.06401138007640839,
0.009250761941075325,
0.007345177698880434,
0.03209831565618515,
-0.016018783673644066,
-0.003998301457613707,
0.008723217062652111,
-0.07381295412778854,
0.038215722888708115,
0.043433934450149536,
0.019803598523139954,
-0.0019012087723240256,
0.06234004348516464,
0.0022208562586456537,
-0.01813259907066822,
-0.017002180218696594,
-0.027048589661717415,
-0.008570415899157524,
0.000222526810830459,
-0.03438979759812355,
0.03700880706310272,
0.02585817314684391,
-0.01411812100559473,
0.03303432837128639,
0.03745810687541962,
-0.007949174381792545,
0.005291340406984091,
-0.05676602944731712,
-0.003106201533228159,
0.03200983256101608,
0.023471461609005928,
-0.004233694635331631,
0.02003571391105652,
-0.006676394958049059,
-0.02928655780851841,
0.005963214207440615,
-0.019666634500026703,
0.08265114575624466,
-0.017343292012810707,
0.03334007039666176,
0.04246503487229347,
0.02540101483464241,
0.029582906514406204,
-0.025701846927404404,
0.05639701709151268,
-0.004770337138324976,
0.033161599189043045,
0.01399089116603136,
0.04909277707338333,
-0.014373178593814373,
0.026638448238372803,
-0.04494336619973183,
-0.02821354754269123,
-0.018739324063062668,
-0.04628492519259453,
-0.017437878996133804,
0.05542246997356415,
0.04488317668437958,
-0.03526899963617325,
0.0076301549561321735,
-0.02313147857785225,
-0.08426450192928314,
-0.049852240830659866,
0.021954242140054703,
-0.03545394912362099,
-0.03403499349951744,
0.01629026234149933,
-0.010048517026007175,
0.03232138231396675,
0.005096639972180128,
0.027089923620224,
-0.031621504575014114,
0.0007730973302386701,
-0.03175453841686249,
-0.007201976142823696,
-0.0029117902740836143,
-0.03339974209666252,
-0.028730841353535652,
0.030251404270529747,
-0.07244689762592316,
0.05782412737607956,
0.01535217184573412,
0.023646123707294464,
0.007817690260708332,
-0.013762131333351135,
-0.012475972063839436,
0.014244085177779198,
0.04732222855091095,
-0.015230565331876278,
0.03114915080368519,
-0.0017376767937093973,
0.00770751154050231,
0.013547252863645554,
-0.1514156609773636,
0.0263090580701828,
-0.010874278843402863,
0.007286307867616415,
-0.021286088973283768,
0.011670200154185295,
-0.028856180608272552,
0.05190429463982582,
0.0208213459700346,
-0.013821684755384922,
-0.0372309572994709,
-0.07910673320293427,
0.0370674803853035,
0.01376457791775465,
-0.08783116191625595,
0.0012063252506777644,
-0.04211805388331413,
-0.015816371887922287,
0.024100741371512413,
-0.020011182874441147,
0.010011833161115646,
-0.004422894679009914,
0.013973051682114601,
-0.006916796788573265,
-0.03417962044477463,
-0.024969322606921196,
-0.004564147442579269,
-0.03613497316837311,
-0.012608859688043594,
-0.0010216233786195517,
-0.0345727801322937,
0.04984184727072716,
0.0006673988536931574,
-0.008709517307579517,
0.05805413797497749,
-0.020500943064689636,
-0.02625991404056549,
0.024732891470193863,
-0.04949799180030823,
0.021856773644685745,
-0.0975012481212616,
-0.04255782812833786,
-0.007127873133867979,
-0.0029725702479481697,
-0.0029223517049103975,
-0.030395906418561935,
-0.06765233725309372,
-0.0031858840957283974,
-0.01630346104502678,
0.026352861896157265,
-0.026800116524100304,
0.03313633054494858,
-0.02617555297911167,
0.0034239236265420914,
0.009464000351727009,
-0.0033688973635435104,
-0.029027150943875313,
0.005642321426421404,
0.016166899353265762,
0.05008038505911827,
0.03385838493704796,
0.045326896011829376,
0.0010725525207817554,
0.03411971032619476,
0.009993738494813442,
-0.011718492954969406,
-0.0009693193132989109,
-0.010974911972880363,
0.004589802585542202,
-0.010711763054132462,
0.008305659517645836,
0.0408543199300766,
-0.010705427266657352,
0.04194486141204834,
0.018344521522521973,
0.0008457608055323362,
-0.01986614428460598,
-0.026817677542567253,
-0.009523368440568447,
0.05657699331641197,
-0.005124482326209545,
0.06375180929899216,
0.046176571398973465,
0.04036640003323555,
-0.016252126544713974,
-0.025932446122169495,
0.011845420114696026,
0.03362637385725975,
-0.012851360253989697,
-0.0007598865195177495,
-0.009657908231019974,
-0.005874865688383579,
0.056920960545539856,
-0.022289710119366646,
-0.0063475617207586765,
0.008010383695363998,
-0.03857967630028725,
-0.030651293694972992,
0.0018776620272547007,
-0.06972859799861908,
0.04212605208158493,
0.06866759806871414,
0.016771188005805016,
0.0028323025908321142,
-0.024632573127746582,
-0.00486330408602953,
0.00023758149472996593,
0.03221101313829422,
0.03070991113781929,
0.026496490463614464,
-0.01759222522377968,
-0.03811583295464516,
-0.015032448805868626,
-0.033349279314279556,
-0.025287503376603127,
-0.011316366493701935,
0.046895384788513184,
0.019212426617741585,
-0.02467626892030239,
0.053770989179611206,
-0.02608647756278515,
0.03174601495265961,
-0.010109208524227142,
-0.01127891056239605,
-0.002740271855145693,
0.05920794606208801,
0.03377913683652878,
-0.012675409205257893,
-0.07320500910282135,
0.030008377507328987,
-0.04843130335211754,
-0.028886964544653893,
-0.060986634343862534,
0.04048528894782066,
-0.007943063043057919,
0.00013025231601204723,
0.0071228547021746635,
-0.05762890353798866,
0.0641259029507637,
0.04835294932126999,
-0.04517662525177002,
-0.048606619238853455,
-0.05226615443825722,
0.017052490264177322,
0.006171097047626972,
0.055696047842502594,
0.00732437102124095,
0.0038613101933151484,
0.006200710311532021,
-0.036327384412288666,
-0.0077763027511537075,
-0.03221435099840164,
-0.06387801468372345,
-0.029694417491555214,
-0.009854535572230816,
0.03025958500802517,
-0.017484819516539574,
-0.02463739737868309,
-0.00599572341889143,
-0.06250657886266708,
-0.09649703651666641,
-0.013906246051192284,
0.04261302202939987,
-0.09324748814105988,
0.017461929470300674,
-0.01573215425014496,
0.025997525081038475,
0.012248799204826355,
-0.00025326141621917486,
0.036716122180223465,
0.01620686613023281,
0.01544368825852871,
-0.04059729725122452,
0.07776711136102676,
-0.008227423764765263,
0.038916487246751785,
-0.005772261880338192,
0.02886250987648964,
0.009318835102021694,
-0.028440749272704124,
0.006864144932478666,
0.08625495433807373,
-0.025505639612674713,
0.03505060449242592,
0.04108254611492157,
0.03923804685473442,
0.07934204488992691,
-0.058856360614299774,
-0.06369386613368988,
-0.05356644466519356,
0.013458548113703728,
0.0053532361052930355,
-0.011185110546648502,
-0.08938442915678024,
0.06172642111778259,
-0.002167733386158943,
0.02758505567908287,
-0.025101499632000923,
-0.00018766951689030975,
-0.023083820939064026,
0.04677515849471092,
-0.0607772022485733,
0.07301068305969238,
-0.009832619689404964,
-0.055226098746061325,
-0.05315381661057472,
0.0074169873259961605,
0.01793464459478855,
0.024168744683265686,
0.011109576560556889,
0.004905988462269306,
0.02932717464864254,
0.04616682976484299,
-0.04993007332086563,
0.07817951589822769,
0.06363946944475174,
-0.006338684353977442,
0.03956759348511696,
-0.010244801640510559,
0.07354708760976791,
0.00042771274456754327,
-0.0651651918888092,
0.013372416608035564,
-0.013729180209338665,
0.09234408289194107,
0.0434759259223938,
0.0489826537668705,
0.006996771786361933,
0.01910918392241001,
0.005218879319727421,
0.025891007855534554,
0.11149470508098602,
0.049486320465803146,
-0.01697450876235962,
0.004380563739687204,
0.004260006360709667,
0.011891757138073444,
-0.00042366646812297404,
-0.0004716052790172398,
-0.04639064148068428,
0.026828214526176453,
-0.0015560176689177752,
-0.035108454525470734,
0.014991617761552334,
-0.015803202986717224,
-0.0396486334502697,
0.037786539644002914,
-0.030651256442070007,
-0.049875665456056595,
0.03445059061050415,
0.01654757373034954,
0.018499039113521576,
-0.05712772160768509,
0.042743049561977386,
0.005829231347888708,
0.01709960587322712,
-0.0301065593957901,
-0.019456898793578148,
-0.08117631822824478,
-0.05688764899969101,
0.030611950904130936,
0.02797672152519226,
0.030584396794438362,
0.05673457682132721,
-0.009238510392606258,
0.028165891766548157,
-0.022883452475070953,
-0.010652519762516022,
-0.001834284164942801,
-0.014220735989511013,
-0.031031940132379532,
0.01937425509095192,
0.013243799097836018,
-0.03801765665411949,
0.010127678513526917,
-0.014631008729338646,
-0.019588526338338852,
-0.015644628554582596,
-0.011788785457611084,
0.07420191168785095,
-0.02614089846611023,
-0.033968254923820496,
0.03507651388645172,
-0.004188471473753452,
0.025720035657286644,
-0.01665312610566616,
-0.00027431684429757297,
0.02715771645307541,
0.02097547985613346,
0.07341716438531876,
0.015571895986795425,
-0.04957498982548714,
0.010679172351956367,
-0.025678830221295357,
0.03039577417075634,
-0.022299913689494133,
0.0814744159579277,
-0.0424080528318882,
-0.050292614847421646,
-0.03438869118690491,
-0.001712061814032495,
0.048783037811517715,
-0.010942742228507996,
0.0099439462646842,
-0.011168884113430977,
-0.00010956558253383264,
-0.021602360531687737,
0.001147693837992847,
0.008298959583044052,
-0.015359107404947281,
-0.006250756327062845,
0.04600973427295685,
-0.06837980449199677,
-0.04903993383049965,
-0.04230130463838577,
-0.038881827145814896,
-0.004415597766637802,
-0.054215412586927414,
0.014259989373385906,
-0.02105347253382206,
0.010373209603130817,
-0.05982321500778198,
-0.012932646088302135,
0.007824137806892395,
0.0006868946948088706,
0.013551929965615273,
0.02657240256667137,
0.019732745364308357,
-0.015159697271883488,
0.036784715950489044,
0.015930207446217537,
0.012518866918981075,
-0.031724244356155396,
0.0389566496014595,
0.03454102575778961,
0.04834297299385071,
0.031029239296913147,
-5.115800638604536e-33,
0.03611578047275543,
0.0013427373487502337,
0.02058061957359314,
-0.05492397025227547,
0.0017503338167443871,
0.09110148996114731,
-0.03387286886572838,
0.010031813755631447,
-0.07746301591396332,
0.0068307314068078995,
0.002778615104034543,
0.02787809818983078,
0.024530161172151566,
0.05429494380950928,
-0.00033398214145563543,
-0.04938758164644241,
-0.04387732967734337,
0.00487199192866683,
-0.029157821089029312,
-0.06549816578626633,
0.0008905524737201631,
-0.025661561638116837,
-0.013344183564186096,
0.005490709096193314,
0.00913926400244236,
-0.012048011645674706,
0.030746610835194588,
-0.0004808250814676285,
0.0006488255457952619,
0.013690865598618984,
-0.009012098424136639,
-0.04931410774588585,
0.02910553477704525,
-0.0007231636554934084,
-0.009168034419417381,
-0.06024578586220741,
0.0033574567642062902,
-0.06336761265993118,
0.0281374529004097,
-0.018225103616714478,
-0.06455458700656891,
0.03282877430319786,
0.045053496956825256,
0.021838337182998657,
0.06928431987762451,
-0.016442283987998962,
0.013387449085712433,
-0.037998925894498825,
-0.0072507355362176895,
-0.00811998825520277,
-0.005715036299079657,
0.018721196800470352,
0.042177606374025345,
0.004831847734749317,
-0.03123953565955162,
-0.030426930636167526,
0.01582808792591095,
0.022199075669050217,
0.016755660995841026,
0.02402857132256031,
-0.05193241685628891,
0.025848573073744774,
0.0041704922914505005,
-0.018903471529483795,
-0.009594938717782497,
0.027224570512771606,
0.06713201850652695,
-0.027652587741613388,
-0.03872116655111313,
-0.019226476550102234,
-0.060063980519771576,
-0.006071947049349546,
-0.01804940402507782,
-0.05633958429098129,
0.01911533623933792,
-0.029690301045775414,
0.011290605179965496,
-0.0017627810593694448,
0.02676510252058506,
0.051082514226436615,
-0.04780431091785431,
-0.0005090822232887149,
-0.051406290382146835,
-0.010163063183426857,
0.017408672720193863,
0.025834327563643456,
-0.021863240748643875,
-0.011650272645056248,
0.012125041335821152,
0.0016190174501389265,
0.06843531131744385,
0.05327248200774193,
0.03155529126524925,
-0.001486430293880403,
-0.001951427897438407,
-0.06876156479120255,
0.0009809040930122137,
0.0035594950895756483,
-0.0001938856003107503,
0.010750798508524895,
0.1118919625878334,
0.004628373309969902,
0.03075924888253212,
0.03181096911430359,
0.001660113804973662,
0.04253200441598892,
-0.018812116235494614,
-0.06655412167310715,
-0.010743682272732258,
0.02161114104092121,
0.010620545595884323,
-0.05320556089282036,
-0.009250863455235958,
0.0897183045744896,
-0.0021633447613567114,
0.00832025520503521,
-0.006893832702189684,
0.07199263572692871,
0.025752505287528038,
0.017411695793271065,
-0.021609807386994362,
0.0042832656763494015,
0.0004477062320802361,
0.004377556033432484,
-0.04317852854728699,
-0.038264885544776917,
0.0005731200217269361,
-0.016858292743563652,
-0.02002478949725628,
-0.03156237676739693,
-0.00899988878518343,
0.0080661466345191,
2.442233153487905e-7,
0.047411851584911346,
0.02649528533220291,
0.002760703442618251,
-0.01760333590209484,
0.004038614220917225,
-0.03539927676320076,
0.014399455860257149,
0.043220676481723785,
0.0029497193172574043,
-0.0003854194947052747,
0.012552089057862759,
0.03985026478767395,
-0.03285839408636093,
-0.0338151790201664,
0.06855437159538269,
0.04783326014876366,
0.027293406426906586,
0.002780841663479805,
-0.003361538052558899,
-0.0058530522510409355,
-0.038232121616601944,
-0.07727136462926865,
-0.08351752907037735,
-0.02804809808731079,
0.029549889266490936,
-0.05923927202820778,
-0.015622185543179512,
-0.021874023601412773,
0.011005965992808342,
0.008674507960677147,
0.03326070308685303,
0.05401407927274704,
-0.009399410337209702,
0.05017746239900589,
-0.04269718378782272,
-0.05916526913642883,
0.02349822036921978,
-0.011465867981314659,
-0.055091988295316696,
0.07099025696516037,
0.030128056183457375,
0.015225758776068687,
0.0008923111599870026,
0.06198020651936531,
0.032575733959674835,
0.02397078089416027,
-0.02172006107866764,
0.05233084037899971,
-0.037168022245168686,
0.02156674675643444,
0.014829907566308975,
0.006654827389866114,
-0.0023775273002684116,
0.04579659923911095,
-0.002728821011260152,
0.05898365005850792,
-0.04382474347949028,
-0.025752274319529533,
0.04297535493969917,
-0.06289900839328766,
-0.013759946450591087,
-0.011134712025523186,
0.004014472011476755,
-0.07881701737642288,
0.09557200223207474,
-0.04652312025427818,
-0.07294061034917831,
1.8741410382444897e-34,
-0.004421687219291925,
-0.008834467269480228,
0.005602315999567509,
-0.0608585923910141,
-0.043512776494026184,
-0.06474924832582474,
-0.0033087756019085646,
0.022503599524497986,
0.017582975327968597,
-0.02916743792593479,
-0.03421498462557793
] | {
"ds_index": 35,
"similar_dg_indices": [
468282,
374295,
8081,
387157,
767406,
72561,
572148,
339887,
705520,
747995,
938637,
1030159,
815760,
355279,
942784,
816837,
867235,
238304,
657373,
873968
]
} |
A 6-year-old male who recently immigrated to the United States from Asia is admitted to the hospital with dyspnea. Physical exam reveals a gray pseudomembrane in the patient's oropharynx along with lymphadenopathy. The patient develops myocarditis and expires on hospital day 5. Which of the following would have prevented this patient's presentation and decline? | Circulating IgG against AB exotoxin | {
"A": "Increased CD4+ T cell count",
"B": "Secretory IgA against viral proteins",
"C": "Increased IgM preventing bacterial invasion",
"D": "Circulating IgG against AB exotoxin"
} | step1 | D | [
"year old male",
"recently",
"United States",
"Asia",
"admitted",
"hospital",
"dyspnea",
"Physical exam reveals",
"gray pseudomembrane",
"patient's oropharynx",
"lymphadenopathy",
"patient",
"myocarditis",
"expires",
"hospital day 5",
"following",
"prevented",
"patient's presentation"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 6-year-old male who recently immigrated to the United States from Asia is admitted to the hospital with dyspnea. Physical exam reveals a gray pseudomembrane in the patient's oropharynx along with lymphadenopathy. The patient develops myocarditis and expires on hospital day 5. Which of the following would have prevented this patient's presentation and decline?
Choose one of the following::
A. Increased CD4+ T cell count
B. Secretory IgA against viral proteins
C. Increased IgM preventing bacterial invasion
D. Circulating IgG against AB exotoxin | [
0.02977021224796772,
-0.041138458997011185,
0.023781148716807365,
0.004031517542898655,
0.019098414108157158,
-0.02100509963929653,
0.009314443916082382,
0.015150146558880806,
0.016521884128451347,
-0.0070403204299509525,
0.0900907814502716,
-0.03303351625800133,
0.0030220269691199064,
-0.0904206931591034,
-0.0030392741318792105,
0.013176040723919868,
0.012871457263827324,
-0.03192587569355965,
-0.03533141687512398,
-0.01954542100429535,
-0.058425530791282654,
0.040911562740802765,
0.005101898219436407,
-0.04005753993988037,
0.06704707443714142,
0.02751294896006584,
0.002001585438847542,
-0.050919145345687866,
-0.010833372361958027,
-0.07864008843898773,
-0.008432183414697647,
-0.015815896913409233,
0.008878984488546848,
-0.09284467250108719,
0.000001722812498883286,
0.0008482920820824802,
0.019271159544587135,
-0.020654847845435143,
-0.0020431431476026773,
-0.038772232830524445,
-0.03389421105384827,
-0.02991591952741146,
0.018635746091604233,
-0.001680578337982297,
-0.057179588824510574,
-0.11250432580709457,
-0.009522511623799801,
0.016479192301630974,
-0.03645870462059975,
-0.00676247151568532,
-0.0064001684077084064,
0.022891392931342125,
-0.043254412710666656,
-0.02897789143025875,
0.03976495563983917,
-0.042231544852256775,
0.0056024231016635895,
-0.005647361744195223,
0.0006193854496814311,
-0.07343178987503052,
0.027165602892637253,
0.05462772399187088,
0.019518598914146423,
0.028140516951680183,
0.03867116570472717,
-0.012350399047136307,
0.052947789430618286,
-0.02703271433711052,
-0.01456556748598814,
0.007028162479400635,
-0.027778904885053635,
0.016628624871373177,
0.03838108479976654,
0.04176648333668709,
-0.017584340646862984,
-0.009601706638932228,
0.06967660039663315,
-0.012311928905546665,
0.02428268827497959,
0.021986255422234535,
0.08309081196784973,
0.024634839966893196,
0.011628110893070698,
0.024309007450938225,
-0.0355769507586956,
-0.0018278940115123987,
0.0007118704961612821,
-0.030586155131459236,
-0.05209806188941002,
0.027977826073765755,
-0.03709686920046806,
-0.07215147465467453,
0.03153044357895851,
0.0064858305267989635,
0.022129252552986145,
0.030186181887984276,
0.032493650913238525,
-0.01485141459852457,
0.05028768256306648,
-0.08107031136751175,
-0.05583035945892334,
-0.05306503176689148,
0.028956621885299683,
0.011482346802949905,
-0.043501727283000946,
-0.09859396517276764,
-0.06301741302013397,
0.018880320712924004,
-0.04357684776186943,
0.06195628643035889,
0.01898946240544319,
0.02597048506140709,
-0.011575201526284218,
0.06375254690647125,
0.0743478313088417,
0.024915380403399467,
-0.02337934635579586,
-0.02233043871819973,
-0.022952765226364136,
0.06995513290166855,
0.021256007254123688,
-0.023894043639302254,
-0.04212753474712372,
0.040545761585235596,
-0.05122584477066994,
-0.008620970882475376,
0.04754989221692085,
-0.0070464396849274635,
0.002758028684183955,
-0.00266261282376945,
0.019260434433817863,
-0.02484014630317688,
0.006916173733770847,
-0.03066709078848362,
0.013948554173111916,
-0.0025044644717127085,
-0.010641844011843204,
0.053352732211351395,
-0.04172171652317047,
0.008916380815207958,
-0.0018507307395339012,
-0.0303056538105011,
0.013294102624058723,
-0.00860715564340353,
-0.04199814423918724,
0.03659217432141304,
0.00008361372601939365,
0.034586720168590546,
0.012658018618822098,
0.0475216805934906,
-0.045123305171728134,
-0.008324701339006424,
-0.029945503920316696,
0.006537431385368109,
0.010633379220962524,
0.05296861380338669,
0.02602485381066799,
-0.030031688511371613,
-0.03713114559650421,
-0.08052994310855865,
0.03032655641436577,
-0.013157384470105171,
-0.006227518897503614,
-0.01930839940905571,
0.04826807230710983,
0.02179262973368168,
0.05944269895553589,
0.019876595586538315,
-0.020957760512828827,
0.0471426285803318,
0.003354001557454467,
0.031164679676294327,
0.001575182774104178,
-0.048173271119594574,
-0.033455248922109604,
0.058441076427698135,
-0.06530706584453583,
-0.06810501962900162,
-0.021098334342241287,
-0.034641243517398834,
0.004328886512666941,
0.06924968957901001,
0.031550332903862,
-0.03803234547376633,
0.03495277091860771,
-0.01248030737042427,
-0.009411812759935856,
-0.01755480095744133,
0.012730973772704601,
-0.01825285702943802,
-0.04941410571336746,
-0.010435441508889198,
0.015727892518043518,
0.0002411618479527533,
-0.00734892999753356,
0.011905028484761715,
-0.012439915910363197,
0.043325699865818024,
-0.025271344929933548,
0.02916356548666954,
-0.0025454857386648655,
-0.055946074426174164,
0.006255406886339188,
0.04539087787270546,
-0.05379476398229599,
0.02850673347711563,
-0.03154749050736427,
-0.015100483782589436,
-0.03476741537451744,
0.00017605125322006643,
-0.019888481125235558,
-0.005185883492231369,
0.037404194474220276,
-0.05229815095663071,
-0.010341963730752468,
0.05240192636847496,
-0.010596553795039654,
-0.03251725062727928,
-0.055630527436733246,
0.04473767429590225,
-0.046955790370702744,
0.024313217028975487,
0.0657217726111412,
0.02433444932103157,
-0.017092030495405197,
-0.017281604930758476,
-0.012874823063611984,
0.010630267672240734,
0.010797668248414993,
-0.08602011203765869,
0.05764517933130264,
-0.0141296973451972,
-0.0011240568710491061,
0.0433758981525898,
-0.04009339213371277,
0.03649565577507019,
-0.10475047677755356,
-0.08067791908979416,
0.02639378234744072,
0.030344609171152115,
-0.0318303219974041,
-0.0028925000224262476,
-0.0026688582729548216,
-0.004612605087459087,
-0.0061261216178536415,
-0.02000712789595127,
0.07474882900714874,
0.00909947045147419,
-0.03560512512922287,
0.05221698433160782,
-0.03697150573134422,
-0.0011327225947752595,
-0.011466625146567822,
-0.027767153456807137,
0.009953636676073074,
0.0646025761961937,
-0.04200980067253113,
0.04610949009656906,
-0.054133351892232895,
-0.039738573133945465,
0.028915639966726303,
0.009377907030284405,
0.025813600048422813,
-0.012879354879260063,
-0.03679022192955017,
-0.019630614668130875,
0.0792727917432785,
-0.0044420454651117325,
-0.01748015359044075,
0.03483351320028305,
0.01262916810810566,
0.03575757145881653,
-0.02264516055583954,
0.0024841001722961664,
-0.014639211818575859,
-0.01122775487601757,
-0.03872910887002945,
0.04908391833305359,
0.015038969926536083,
0.023455921560525894,
0.022707302123308182,
0.033937882632017136,
-0.030088236555457115,
0.01627010479569435,
-0.020239725708961487,
0.010770656168460846,
-0.06581868976354599,
-0.011780951172113419,
0.09459236264228821,
-0.004189732950180769,
-0.009883160702884197,
0.0502823069691658,
0.0056523107923567295,
-0.02838837541639805,
-0.029713885858654976,
-0.06062218174338341,
-0.029839469119906425,
0.026868067681789398,
-0.04281355068087578,
0.0913398340344429,
0.03469792753458023,
0.06302991509437561,
0.003441938664764166,
-0.024144237861037254,
-0.006804882548749447,
0.07445994764566422,
0.010892967693507671,
-0.013360452838242054,
-0.04926929622888565,
0.06565790623426437,
0.06666284799575806,
-0.019447339698672295,
-0.030994592234492302,
0.023774784058332443,
-0.008156316354870796,
0.013527210801839828,
0.02363690733909607,
-0.05696192383766174,
0.03790751099586487,
0.07363903522491455,
0.0031375812832266092,
-0.024164516478776932,
-0.0005231288378126919,
0.003954978659749031,
-0.0025170473381876945,
-0.0249477606266737,
-0.028133900836110115,
0.012617381289601326,
-0.010901577770709991,
-0.03846753016114235,
0.018306758254766464,
-0.016948705539107323,
-0.009524667635560036,
0.004484236240386963,
0.014591200277209282,
0.04917851462960243,
-0.02326027862727642,
0.00769430585205555,
-0.028062375262379646,
0.0574934296309948,
0.0178778488188982,
-0.014476842246949673,
0.00646491814404726,
0.03624238818883896,
0.017036644741892815,
0.0001278013369301334,
-0.06907188892364502,
0.01369249727576971,
0.0013387679355219007,
-0.00802267249673605,
-0.08341610431671143,
0.017174603417515755,
0.023616163060069084,
-0.016800567507743835,
-0.039127424359321594,
0.05535195767879486,
-0.004649578593671322,
0.06322384625673294,
-0.03595849499106407,
0.0017703375779092312,
0.028438767418265343,
0.02280183881521225,
0.018851401284337044,
0.03625153377652168,
0.03588669374585152,
0.0063014645129442215,
0.039007846266031265,
0.031523048877716064,
-0.031338103115558624,
-0.013798873871564865,
0.03483196347951889,
0.02915809117257595,
-0.03609318658709526,
0.04247383028268814,
-0.024645624682307243,
0.05666215345263481,
0.007705246564000845,
-0.06121188402175903,
-0.07795977592468262,
-0.026690654456615448,
0.028064044192433357,
-0.012768760323524475,
0.026745060458779335,
-0.008703064173460007,
-0.038934748619794846,
-0.0013722029980272055,
0.034016285091638565,
-0.03321021795272827,
0.0409475676715374,
0.05101250112056732,
0.0005784822278656065,
0.06287378817796707,
0.011220230720937252,
-0.0029469234868884087,
-0.031098145991563797,
0.016836337745189667,
0.020686542615294456,
-0.026498431339859962,
0.03835343196988106,
0.06046343967318535,
-0.0434889942407608,
-0.014891956932842731,
-0.02227010391652584,
0.059055715799331665,
0.027446657419204712,
0.00808628462255001,
-0.03199528902769089,
-0.06442136317491531,
0.019363807514309883,
-0.0391097366809845,
0.007177252322435379,
-0.021842217072844505,
-0.01577235944569111,
-0.017823515459895134,
0.013968007639050484,
0.004414611496031284,
-0.00855282787233591,
-0.07386983186006546,
-0.044970083981752396,
-0.06585658341646194,
0.010813310742378235,
-0.02911091037094593,
0.07942590862512589,
-0.05167442560195923,
-0.03658316656947136,
-0.014631456695497036,
0.07607072591781616,
-0.017116690054535866,
0.024475082755088806,
-0.009197517298161983,
0.020097026601433754,
-0.028879929333925247,
0.05313955619931221,
0.0476008877158165,
-0.004256738815456629,
0.08725354820489883,
-0.042145177721977234,
-0.019796613603830338,
-0.013410921208560467,
-0.06487122178077698,
-0.0012027292978018522,
-0.014664330519735813,
0.09764465689659119,
0.028610710054636,
0.06367218494415283,
-0.0038279611617326736,
0.00527098448947072,
-0.004032297059893608,
0.02479175291955471,
0.04811211675405502,
0.02202983945608139,
0.009998288005590439,
-0.042353879660367966,
-0.011874547228217125,
0.021471157670021057,
0.02047429047524929,
0.0361337810754776,
0.0050970930606126785,
-0.02222990058362484,
-0.033603131771087646,
-0.023734256625175476,
0.021079586818814278,
0.027385346591472626,
-0.03656937554478645,
0.019197694957256317,
0.023418959230184555,
-0.03606189787387848,
0.04704229533672333,
-0.005337489768862724,
0.010693911463022232,
-0.03231280297040939,
0.0328386090695858,
-0.02694692835211754,
0.029920801520347595,
-0.03971211239695549,
0.01538802869617939,
-0.02890755608677864,
-0.04812941700220108,
0.0004008686519227922,
0.0035815248265862465,
0.00908170361071825,
-0.0026695458218455315,
-0.049056295305490494,
-0.018037496134638786,
-0.017325563356280327,
-0.00743287755176425,
0.013704201206564903,
0.04080803319811821,
-0.030419213697314262,
-0.010718747042119503,
0.01899774931371212,
0.03934379667043686,
-0.007112699095159769,
-0.03263210505247116,
-0.06423461437225342,
-0.008143875747919083,
0.008490427397191525,
0.13667774200439453,
0.003924162592738867,
0.002584167057648301,
0.054100148379802704,
0.009385335259139538,
0.008357122540473938,
-0.01180313527584076,
-0.010020479559898376,
0.022001978009939194,
-0.00630703242495656,
-0.001846105675213039,
-0.031234830617904663,
-0.05177690461277962,
-0.0022516215685755014,
-0.006177111994475126,
0.03310024365782738,
0.08362609893083572,
0.00801583006978035,
-0.026392705738544464,
-0.017660625278949738,
-0.05761701613664627,
-0.03176025673747063,
0.029079414904117584,
-0.0017474496271461248,
0.010830389335751534,
-0.00962827168405056,
-0.04349996894598007,
0.04496929794549942,
0.06233283877372742,
-0.008386928588151932,
-0.004335285630077124,
0.003190430346876383,
0.04359634593129158,
-0.03713855892419815,
-0.008585367351770401,
-0.06696150451898575,
-0.0011691981926560402,
0.0014513919595628977,
-0.03131777420639992,
0.005287887062877417,
0.054670486599206924,
-0.00630889181047678,
-0.04834667593240738,
0.017417743802070618,
-0.022144876420497894,
0.03719543293118477,
0.011102461256086826,
-0.018933342769742012,
0.021931413561105728,
-0.043111786246299744,
-0.001541597070172429,
0.037418704479932785,
-0.03880385309457779,
-0.015330302529036999,
0.0674532949924469,
0.028946513310074806,
0.047912050038576126,
0.004381014034152031,
-5.480551392876907e-33,
0.008069709874689579,
-0.03963693603873253,
0.057011835277080536,
-0.06168085336685181,
0.006179241929203272,
0.06253670156002045,
-0.02904205583035946,
-0.024144837632775307,
-0.05282747000455856,
0.002602360211312771,
0.001400459441356361,
-0.0400443896651268,
0.03421952202916145,
0.019444365054368973,
-0.03676534816622734,
-0.04236195608973503,
-0.007432714570313692,
0.01691015437245369,
-0.017059853300452232,
-0.031196022406220436,
-0.07942349463701248,
-0.013544873334467411,
-0.022026799619197845,
0.015617968514561653,
-0.02388065494596958,
-0.027068229392170906,
0.07534430176019669,
-0.0019299918785691261,
-0.059640832245349884,
-0.0183853842318058,
-0.007085091900080442,
-0.015377799980342388,
0.018059274181723595,
-0.0308010745793581,
0.003600724972784519,
-0.0536503903567791,
0.02102264203131199,
0.015356218442320824,
0.05701800435781479,
-0.018307223916053772,
-0.04901288449764252,
-0.02836531214416027,
0.028241407126188278,
0.031122203916311264,
0.015529458411037922,
-0.012646125629544258,
-0.014754206873476505,
-0.021752534434199333,
0.020604971796274185,
-0.005313817411661148,
0.033295657485723495,
0.05776898190379143,
0.030906405299901962,
0.02268747240304947,
-0.006550852209329605,
-0.07437122613191605,
0.016493968665599823,
0.02327842265367508,
0.019863532856106758,
-0.009774083271622658,
-0.0009022209560498595,
0.008126073516905308,
0.040955472737550735,
-0.03210898116230965,
-0.035966694355010986,
0.012078586965799332,
0.05927249789237976,
0.027843449264764786,
-0.04942689090967178,
0.07894688099622726,
-0.062252484261989594,
-0.0036207204684615135,
-0.005900552961975336,
-0.059546589851379395,
-0.05662975087761879,
-0.056192293763160706,
-0.00309156090952456,
0.0019617201760411263,
0.01077460777014494,
-0.03081522136926651,
-0.07503765821456909,
0.030773047357797623,
0.028183935210108757,
-0.02475055679678917,
-0.036893200129270554,
-0.000047124354750849307,
0.027456466108560562,
0.02028375118970871,
0.0015771728940308094,
-0.026954947039484978,
0.06777969747781754,
0.03368046134710312,
0.03464958444237709,
0.016476290300488472,
-0.005814570002257824,
-0.062334634363651276,
0.08591733127832413,
0.02633064053952694,
-0.030602188780903816,
0.03913768753409386,
0.08120463043451309,
0.022660987451672554,
0.03525931015610695,
-0.041818585246801376,
-0.012253619730472565,
0.005628353450447321,
-0.01490119006484747,
0.0056859878823161125,
-0.02118188887834549,
0.008859889581799507,
-0.008839309215545654,
0.0031782351434230804,
0.009776546619832516,
0.05669667571783066,
-0.01101665385067463,
0.0369265154004097,
-0.01194834802299738,
0.026214079931378365,
0.040431179106235504,
-0.0192082691937685,
-0.009806985966861248,
0.06238819286227226,
-0.03309575095772743,
0.0024824931751936674,
-0.016115287318825722,
-0.02955511026084423,
0.01333666779100895,
0.0667172446846962,
0.0002866823342628777,
-0.02290649339556694,
0.030238110572099686,
0.0036912185605615377,
2.4703209078325017e-7,
0.02316961996257305,
-0.007754041813313961,
-0.010761095210909843,
-0.060244783759117126,
0.015996713191270828,
-0.03903849795460701,
-0.06297633051872253,
-0.016558710485696793,
0.014751894399523735,
-0.00492889853194356,
0.04088592156767845,
0.005103427916765213,
-0.0053421068005263805,
0.012631427496671677,
0.022807592526078224,
0.059126026928424835,
0.01620396599173546,
0.01892349310219288,
0.03405337780714035,
0.04086140915751457,
0.01699073798954487,
0.009261887520551682,
-0.07664044946432114,
-0.01051204465329647,
0.008495768532156944,
-0.005746225826442242,
-0.025573987513780594,
-0.06233948841691017,
-0.01836363971233368,
-0.03869699686765671,
0.048469603061676025,
0.0029826494865119457,
0.044005464762449265,
0.04478897526860237,
-0.04421273618936539,
-0.013928075321018696,
0.02276604436337948,
0.06388668715953827,
-0.005415051709860563,
0.004747292492538691,
0.010132885538041592,
0.003008677391335368,
0.025408294051885605,
0.03729100525379181,
-0.016829565167427063,
0.0643642246723175,
-0.0426461324095726,
-0.03151542693376541,
-0.009298079647123814,
0.044401079416275024,
-0.002788395155221224,
0.02745789662003517,
-0.027716267853975296,
0.03883219510316849,
-0.0070961411111056805,
-0.008620176464319229,
-0.05296673998236656,
-0.0032521975226700306,
0.020462188869714737,
-0.013016839511692524,
0.0013895382871851325,
-0.061521533876657486,
0.026915566995739937,
-0.0010835690191015601,
0.015665264800190926,
-0.04178125783801079,
-0.04091979190707207,
1.7416290753619798e-34,
-0.03410579264163971,
-0.04096691682934761,
-0.030464213341474533,
-0.061109546571969986,
0.025458628311753273,
-0.039097860455513,
0.05458821356296539,
0.03422163054347038,
-0.00977368000894785,
-0.03332911431789398,
-0.030315233394503593
] | {
"ds_index": 36,
"similar_dg_indices": [
69759,
511164,
639528,
5294,
27086,
355231,
525373,
447950,
538670,
114290,
796313,
1144276,
815236,
1210093,
373365,
296072,
1083040,
671436,
501204,
1029812
]
} |
A 12-year-old boy who recently emigrated from Pakistan presents with fever, muscle pain, and weakness of the trunk, abdomen, and legs. The patient’s mother says that he has not been vaccinated. Physical examination reveals fasciculation and flaccid paralysis of the lower limbs. A CSF analysis reveals lymphocytosis with normal glucose and protein levels. A throat swab reveals an RNA virus. Which of the following would most likely be destroyed by the virus in this patient? | Anterior horn of the spinal cord | {
"A": "Posterior horn cells of the spinal cord",
"B": "Myelin sheath of neurons",
"C": "Muscle cells",
"D": "Anterior horn of the spinal cord"
} | step1 | D | [
"year old boy",
"recently",
"Pakistan presents",
"fever",
"muscle pain",
"weakness",
"trunk",
"abdomen",
"legs",
"patients mother",
"not",
"vaccinated",
"Physical examination reveals fasciculation",
"flaccid paralysis of",
"lower limbs",
"CSF analysis reveals lymphocytosis",
"normal glucose",
"protein levels",
"throat swab reveals",
"RNA virus",
"following",
"most likely",
"destroyed",
"virus",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 12-year-old boy who recently emigrated from Pakistan presents with fever, muscle pain, and weakness of the trunk, abdomen, and legs. The patient’s mother says that he has not been vaccinated. Physical examination reveals fasciculation and flaccid paralysis of the lower limbs. A CSF analysis reveals lymphocytosis with normal glucose and protein levels. A throat swab reveals an RNA virus. Which of the following would most likely be destroyed by the virus in this patient?
Choose one of the following::
A. Posterior horn cells of the spinal cord
B. Myelin sheath of neurons
C. Muscle cells
D. Anterior horn of the spinal cord | [
0.051622044295072556,
-0.024031389504671097,
0.05264006555080414,
0.02582675777375698,
0.042304180562496185,
-0.034704484045505524,
-0.03204329311847687,
-0.012032709084451199,
0.023064175620675087,
-0.011815765872597694,
0.03431311249732971,
0.031120533123612404,
0.05115290358662605,
-0.06083068624138832,
0.006698172073811293,
0.00008394241012865677,
0.05598917603492737,
0.024552177637815475,
0.006195425521582365,
0.000751981686335057,
-0.018597928807139397,
0.0565713495016098,
0.027232451364398003,
0.009132173843681812,
0.004664712119847536,
-0.0009890361689031124,
0.0065581523813307285,
0.004975567106157541,
-0.024420810863375664,
-0.07693294435739517,
-0.00708105880767107,
-0.0016226760344579816,
0.037749115377664566,
-0.09870206564664841,
0.000001957681661224342,
0.03647778183221817,
0.026638420298695564,
-0.015889529138803482,
0.01718931272625923,
0.007313824258744717,
0.03390466049313545,
0.046984825283288956,
0.001920154201798141,
0.03589349985122681,
0.009288263507187366,
-0.11226439476013184,
0.02952168509364128,
0.046388834714889526,
-0.024660484865307808,
0.045896511524915695,
0.0008075448567979038,
-0.05384286865592003,
0.009770560078322887,
0.041246186941862106,
0.04454893246293068,
-0.04561985656619072,
-0.0024310159496963024,
0.05064205452799797,
-0.0028768032789230347,
0.013812175951898098,
0.004670619498938322,
0.008820193819701672,
-0.01756993494927883,
-0.035393450409173965,
-0.04409635812044144,
0.0288678165525198,
-0.050062526017427444,
-0.02428027056157589,
0.022286152467131615,
-0.022986644878983498,
-0.004757974296808243,
-0.015840306878089905,
0.04514254629611969,
0.07420811802148819,
-0.042149823158979416,
-0.055989380925893784,
0.038403671234846115,
-0.022263554856181145,
-0.00022274890216067433,
0.026636147871613503,
0.009799969382584095,
0.031534966081380844,
0.022611090913414955,
0.0044145723804831505,
-0.02410397306084633,
-0.06925509870052338,
-0.02778306044638157,
-0.036492619663476944,
-0.05820600315928459,
-0.02222309075295925,
-0.028730325400829315,
-0.028547337278723717,
0.008882218971848488,
0.027263564988970757,
-0.04993555694818497,
0.04862022399902344,
-0.02651854231953621,
-0.030705150216817856,
0.02226029522716999,
-0.09047804772853851,
-0.03339357301592827,
-0.04895105957984924,
0.07391434907913208,
-0.007146688178181648,
-0.0628046840429306,
-0.0467267669737339,
0.012855018489062786,
0.03486018255352974,
-0.017367610707879066,
0.020798107609152794,
-0.017010534182190895,
-0.011940475553274155,
-0.07643767446279526,
0.04173978045582771,
0.10959958285093307,
0.03213261067867279,
-0.05745607987046242,
-0.01758936047554016,
0.009349136613309383,
0.06313323974609375,
-0.052786409854888916,
-0.011943550780415535,
-0.03126160427927971,
0.0760946124792099,
-0.019422009587287903,
0.011044844053685665,
0.04150734841823578,
-0.013239037245512009,
0.011689180508255959,
-0.05713870748877525,
-0.001981627196073532,
-0.05266938358545303,
-0.01384437270462513,
-0.029245246201753616,
-0.0034720911644399166,
-0.025963932275772095,
0.0397866889834404,
0.02374959923326969,
0.026884403079748154,
0.03272869065403938,
-0.04432929679751396,
-0.016268804669380188,
-0.031652387231588364,
0.005560555495321751,
0.010395397432148457,
0.045640453696250916,
-0.046712420880794525,
0.03492328152060509,
0.02207370288670063,
0.059336110949516296,
-0.04236873239278793,
-0.012850099243223667,
0.05551440641283989,
0.0001919319765875116,
0.06300710141658783,
-0.016062792390584946,
0.055864136666059494,
-0.01070056576281786,
-0.03572062775492668,
0.016100017353892326,
0.009949039667844772,
0.0064325109124183655,
0.033707395195961,
-0.03676453232765198,
-0.01414944976568222,
0.01996239647269249,
-0.03142920136451721,
-0.005000191740691662,
0.028557652607560158,
-0.009491058997809887,
-0.03732449188828468,
0.01489974558353424,
0.019510306417942047,
0.05780908092856407,
-0.014427398331463337,
0.00009996723383665085,
-0.030950259417295456,
-0.06915032118558884,
-0.014604814350605011,
0.05723975598812103,
0.022420523688197136,
0.03342286869883537,
-0.0016181059181690216,
0.0013759573921561241,
0.01715962216258049,
-0.01834808848798275,
0.003311679232865572,
-0.002083123428747058,
-0.020983915776014328,
-0.002919898834079504,
-0.06323608011007309,
0.025059180334210396,
0.061831410974264145,
0.02672440931200981,
0.033763252198696136,
0.039775583893060684,
-0.047012511640787125,
-0.013290361501276493,
-0.005923938937485218,
-0.025474900379776955,
0.046873368322849274,
-0.0321790911257267,
-0.039315830916166306,
0.005741008557379246,
-0.04061368852853775,
0.050814900547266006,
-0.04483991488814354,
0.014362160116434097,
-0.04155438393354416,
-0.022576069459319115,
0.0035892012529075146,
0.010411669500172138,
0.02445237711071968,
-0.011946966871619225,
0.01568198949098587,
0.014558523893356323,
0.03117396868765354,
-0.05526196211576462,
-0.055309053510427475,
0.015993809327483177,
-0.00798412598669529,
0.0077352141961455345,
-0.06364830583333969,
0.008980299346148968,
-0.02218080498278141,
0.002146688522771001,
0.003726014168933034,
0.03937254846096039,
-0.019552264362573624,
-0.05806910991668701,
0.08097123354673386,
0.03736204281449318,
-0.011778278276324272,
0.027312234044075012,
-0.004872787278145552,
0.02017034962773323,
0.02510932646691799,
-0.06108695641160011,
-0.013744832947850227,
0.018700210377573967,
-0.001889208098873496,
0.020412223413586617,
-0.020205924287438393,
0.006833819206804037,
0.03365876525640488,
-0.02916375733911991,
-0.02622631937265396,
0.0034346026368439198,
0.010772205889225006,
0.0075125680305063725,
-0.09173556417226791,
0.02807684801518917,
0.030237063765525818,
-0.019451363012194633,
0.0038859155029058456,
0.041602492332458496,
-0.04665643349289894,
0.019087333232164383,
-0.07722052186727524,
-0.05071580410003662,
0.012286954559385777,
-0.0188637413084507,
-0.026804279536008835,
0.008541248738765717,
-0.09594707190990448,
0.018005529418587685,
-0.0021053601521998644,
-0.027367552742362022,
-0.03342079743742943,
0.04653118550777435,
-0.0009301813552156091,
0.02260257862508297,
0.03758468106389046,
0.008670995943248272,
-0.011740813963115215,
-0.026261232793331146,
0.011671602725982666,
0.07092680037021637,
-0.003080163849517703,
-0.009510149247944355,
-0.007091244217008352,
0.05420825257897377,
0.003715954255312681,
0.02688102424144745,
0.009815223515033722,
0.0015597677556797862,
-0.05336325243115425,
-0.031258419156074524,
0.008361388929188251,
-0.03007468394935131,
-0.03530170023441315,
0.04029596224427223,
0.00163969153072685,
-0.08786602318286896,
-0.01458350382745266,
-0.04869759455323219,
-0.07412061095237732,
0.003740717424079776,
-0.03328300639986992,
0.029623281210660934,
0.10000774264335632,
0.03041749633848667,
-0.035023681819438934,
0.04910526052117348,
0.0026748739182949066,
0.03238656744360924,
0.012251141481101513,
-0.040504541248083115,
0.014109796844422817,
0.06673696637153625,
0.07045760005712509,
0.03312592953443527,
-0.034348707646131516,
0.01565590873360634,
-0.022068742662668228,
-0.026152195408940315,
0.01176378782838583,
-0.06494546681642532,
0.02144443616271019,
0.01684202253818512,
-0.045442674309015274,
0.004682391416281462,
-0.04165610298514366,
0.009120067581534386,
0.0002682838821783662,
-0.03183283656835556,
0.008457635529339314,
-0.00003135904262308031,
-0.05586051568388939,
-0.047210000455379486,
0.003136750077828765,
-0.06801626831293106,
-0.04749421402812004,
-0.006780055817216635,
0.010547097772359848,
0.06696586310863495,
-0.020238133147358894,
-0.02504831552505493,
-0.0293013546615839,
0.01710323803126812,
-0.001957120606675744,
0.014625854790210724,
0.006496163550764322,
0.01412815973162651,
0.02635200321674347,
0.017168603837490082,
0.0005823666579090059,
-0.003910444676876068,
0.002667167689651251,
0.008708985522389412,
-0.032444752752780914,
0.03335549682378769,
0.0033738005440682173,
0.02627360075712204,
-0.008576148189604282,
-0.001353213912807405,
-0.02860509231686592,
-0.012457207776606083,
-0.019725853577256203,
0.004675022792071104,
0.0108746737241745,
0.04317929595708847,
-0.024659056216478348,
0.028327956795692444,
-0.0016752704977989197,
-0.04608496278524399,
0.01656920276582241,
-0.029668379575014114,
-0.060151293873786926,
0.003628042759373784,
0.04710549861192703,
0.004362798295915127,
-0.05611944571137428,
0.04387546330690384,
-0.05326953902840614,
0.021387344226241112,
-0.001393984304741025,
-0.020447932183742523,
-0.09169437736272812,
-0.03251422941684723,
0.04904724657535553,
-0.04007415845990181,
0.026412222534418106,
0.02372833713889122,
-0.043124254792928696,
0.03446148335933685,
0.01638631522655487,
-0.037413839250802994,
0.06815431267023087,
0.035374823957681656,
-0.016927653923630714,
-0.014116965234279633,
-0.0240410715341568,
0.006049902644008398,
0.021993733942508698,
0.000027386406145524234,
0.04781759902834892,
0.01727992296218872,
-0.010282554663717747,
0.07791309058666229,
-0.012987552210688591,
0.03925615921616554,
0.03923807665705681,
-0.01890169456601143,
0.01829652115702629,
-0.06162877008318901,
0.03611062467098236,
0.005879910197108984,
-0.04968273639678955,
-0.02308538556098938,
-0.024173978716135025,
-0.06099935248494148,
-0.0037262875121086836,
-0.031038451939821243,
0.019772136583924294,
0.030016280710697174,
0.0025863596238195896,
-0.004086595494300127,
-0.0411284863948822,
-0.039470795542001724,
0.04853493347764015,
0.0311691053211689,
0.021701090037822723,
-0.06055564433336258,
-0.03201728314161301,
0.02063789777457714,
0.0340026430785656,
-0.005105527117848396,
0.010276556015014648,
0.019071517512202263,
0.001163302455097437,
-0.07305235415697098,
0.039556775242090225,
0.01712556555867195,
-0.013076065108180046,
-0.0009053278481587768,
-0.052511315792798996,
-0.04762265086174011,
-0.019950510933995247,
-0.04761030897498131,
0.00401909789070487,
0.020836621522903442,
0.010513097047805786,
-0.031218931078910828,
-0.012567616067826748,
-0.04059247300028801,
0.0106563251465559,
0.030842211097478867,
-0.06584269553422928,
0.0629182830452919,
0.004794326610863209,
0.001584598794579506,
0.06107155978679657,
-0.04506828263401985,
-0.013593836687505245,
0.019705569371581078,
0.01856197603046894,
-0.040205590426921844,
-0.03730660676956177,
0.004016195889562368,
-0.07025910168886185,
-0.01049115601927042,
-0.02292262576520443,
-0.04225081950426102,
0.03381482884287834,
-0.0027607299853116274,
-0.03604371100664139,
0.031692758202552795,
-0.008031406439840794,
0.008535308763384819,
-0.033244092017412186,
0.04627494513988495,
0.02366345189511776,
0.013635285198688507,
-0.008561044931411743,
-0.014805195853114128,
-0.05226559191942215,
-0.04008259251713753,
0.006880702450871468,
0.01916826330125332,
0.006304068490862846,
0.05980757623910904,
0.011509792879223824,
-0.0886165127158165,
-0.0044117094948887825,
-0.016150156036019325,
0.005003664176911116,
-0.04938940703868866,
-0.01745648868381977,
-0.02673017978668213,
-0.013981266878545284,
0.044196464121341705,
-0.019299479201436043,
0.02316252514719963,
-0.05658091977238655,
0.046041909605264664,
-0.0043422868475317955,
0.05035299062728882,
0.026385735720396042,
0.021288899704813957,
0.05731523782014847,
0.06306914985179901,
0.010772529989480972,
0.052676670253276825,
0.009566585533320904,
-0.0124548664316535,
-0.01497762743383646,
-0.04034409672021866,
-0.03250294551253319,
-0.03764869272708893,
0.03096209093928337,
-0.006283624097704887,
0.02332964725792408,
0.03788192942738533,
0.020060138776898384,
-0.08003144711256027,
-0.04622510448098183,
-0.03134218603372574,
-0.025725333020091057,
0.003396417712792754,
0.008816612884402275,
-0.05017590522766113,
0.013136888854205608,
-0.004460445139557123,
0.00644566398113966,
0.01991480216383934,
-0.021321915090084076,
-0.047082822769880295,
-0.0379600003361702,
0.00949473399668932,
-0.026933133602142334,
0.02248496189713478,
0.0181460939347744,
-0.0002219257439719513,
-0.028190303593873978,
-0.013136017136275768,
0.01390726026147604,
0.03491589426994324,
-0.015252048149704933,
-0.004231263883411884,
0.011013105511665344,
0.026707906275987625,
-0.0002338237245567143,
-0.09217343479394913,
-0.03547224774956703,
0.032425377517938614,
-0.011753907427191734,
-0.023741742596030235,
0.057815149426460266,
0.02230576053261757,
0.0033543419558554888,
0.07100251317024231,
-0.010170831345021725,
-0.02548082545399666,
0.015001651830971241,
-5.572644395766125e-33,
0.08588457107543945,
-0.01660224422812462,
0.04016359522938728,
-0.05262744054198265,
0.015371345914900303,
0.0830191895365715,
-0.009716925211250782,
-0.008939366787672043,
-0.07174669951200485,
0.00927464384585619,
-0.025393100455403328,
-0.024540411308407784,
0.03145783394575119,
0.014068007469177246,
0.016249055042862892,
0.009056821465492249,
0.0255568940192461,
-0.00024202835629694164,
-0.01340413000434637,
0.004950159229338169,
0.00045909424079582095,
-0.025362661108374596,
0.08549752086400986,
-0.023937085643410683,
0.014381847344338894,
-0.03444836661219597,
-0.0008568009943701327,
0.05138329789042473,
-0.03802713006734848,
-0.018249452114105225,
0.00859866663813591,
-0.03303753584623337,
-0.03945836052298546,
-0.006605784874409437,
-0.007477387320250273,
-0.07463386654853821,
0.0405673012137413,
-0.005770871415734291,
0.02537202276289463,
-0.015459766611456871,
-0.07323223352432251,
-0.040049463510513306,
0.04955359175801277,
0.005987354088574648,
0.016497652977705002,
0.00245989253744483,
-0.021885579451918602,
-0.02907232753932476,
-0.023926017805933952,
-0.01139163039624691,
0.004917084239423275,
0.01820632629096508,
0.018719399347901344,
-0.011430277489125729,
0.01277137454599142,
0.0007642959826625884,
-0.018986349925398827,
0.04264344647526741,
0.023791050538420677,
0.028141092509031296,
-0.0042495750822126865,
0.08950667828321457,
0.05165519937872887,
-0.01449221558868885,
-0.0006269958685152233,
-0.010346508584916592,
0.04027794674038887,
0.03450516238808632,
-0.02858627587556839,
-0.0022406047210097313,
0.015953484922647476,
0.02034008502960205,
-0.02816755883395672,
-0.0755903571844101,
0.021336209028959274,
-0.002581220120191574,
0.011303391307592392,
0.04276029020547867,
0.020095176994800568,
0.11709897965192795,
-0.11932391673326492,
0.025050925090909004,
0.009080637246370316,
0.010020123794674873,
-0.021857982501387596,
-0.06453298032283783,
-0.023726115003228188,
-0.03768341615796089,
-0.005454064346849918,
-0.034246817231178284,
0.010980326682329178,
0.0077827079221606255,
-0.018438205122947693,
0.02291218936443329,
-0.0452975258231163,
0.051030002534389496,
0.031999245285987854,
0.010797488503158092,
-0.010984758846461773,
0.04284778609871864,
0.028786644339561462,
0.025727875530719757,
0.06462574005126953,
-0.061841726303100586,
-0.06479568779468536,
0.019119244068861008,
-0.020085547119379044,
0.03292209655046463,
-0.0014441133243963122,
0.003074652049690485,
-0.0027141429018229246,
0.04047577455639839,
-0.03629785776138306,
0.10389537364244461,
-0.005677301902323961,
0.003593446221202612,
0.016965797170996666,
-0.01401455793529749,
0.05976061895489693,
0.02366846241056919,
0.033877383917570114,
-0.01671798713505268,
0.001622849958948791,
0.0015439088456332684,
-0.010494833812117577,
-0.016239797696471214,
-0.01799050159752369,
0.07519633322954178,
-0.042778510600328445,
-0.02121809683740139,
0.03136679157614708,
0.010811101645231247,
2.659503479662817e-7,
0.06324520707130432,
0.012179904617369175,
-0.001372216152958572,
-0.04583128169178963,
-0.015307225286960602,
-0.018814707174897194,
-0.012319809757173061,
0.028523223474621773,
-0.026077399030327797,
0.04858167842030525,
0.017888223752379417,
-0.013910462148487568,
0.033477067947387695,
0.039643846452236176,
-0.034942448139190674,
0.049011584371328354,
-0.03264671936631203,
0.0814872607588768,
0.05746125802397728,
0.010674391873180866,
-0.026812829077243805,
-0.016824711114168167,
-0.05154142156243324,
-0.014551045373082161,
-0.018235493451356888,
0.0016978022176772356,
-0.0223518256098032,
-0.006943000480532646,
-0.05438094213604927,
-0.02181030996143818,
-0.01806468330323696,
0.017537003383040428,
0.09949488192796707,
0.029940394684672356,
-0.09529667347669601,
-0.054261110723018646,
0.008190550841391087,
0.07156636565923691,
0.016455823555588722,
0.0219622440636158,
0.04739365354180336,
0.019243991002440453,
0.03570912405848503,
0.07034905254840851,
0.023379230871796608,
0.00891941599547863,
-0.014715760946273804,
0.01674223318696022,
0.015009975992143154,
0.058580078184604645,
0.02184433676302433,
0.021071050316095352,
-0.02056986652314663,
0.0569978803396225,
-0.025166159495711327,
-0.009208698756992817,
-0.05883444473147392,
0.03501448035240173,
-0.029190674424171448,
-0.07393466681241989,
-0.005823519546538591,
-0.031064659357070923,
-0.00895457249134779,
0.03734315186738968,
0.03131328523159027,
0.031183486804366112,
0.012433693744242191,
2.0177420224937068e-34,
-0.013758824206888676,
-0.03369626775383949,
-0.033414192497730255,
0.02305755577981472,
-0.021658562123775482,
-0.00471360282972455,
0.03788338974118233,
0.06159526854753494,
0.021887043491005898,
-0.06734618544578552,
-0.008613363839685917
] | {
"ds_index": 37,
"similar_dg_indices": [
606072,
1053900,
113926,
741435,
936016,
495126,
785707,
683748,
333370,
1058540,
1067554,
640162,
225859,
220855,
744412,
30555,
13611,
378985,
390820,
419170
]
} |
A researcher is studying the properties of an enzyme that adds phosphate groups to glucose. She discovers that the enzyme is present in most body tissues and is located in the cytoplasm of the cells expressing the enzyme. She decides to mix this enzyme under subphysiologic conditions with varying levels of glucose in order to determine the kinetic properties of the enzyme. Specifically, she adds increasing levels of glucose at a saturating concentration of phosphate and sees that the rate at which glucose becomes phosphorylated gets faster at higher levels of glucose. She observes that this rate approaches a maximum speed and calls this speed Y. She then determines the concentration of glucose that is needed to make the enzyme function at half the speed Y and calls this concentration X. Which of the following is most likely true about the properties of this enzyme? | Low X and low Y | {
"A": "High X and high Y",
"B": "High X and low Y",
"C": "Low X and high Y",
"D": "Low X and low Y"
} | step1 | D | [
"researcher",
"studying",
"properties",
"enzyme",
"adds phosphate groups",
"glucose",
"discovers",
"enzyme",
"present",
"body tissues",
"cytoplasm",
"cells",
"enzyme",
"to mix",
"enzyme",
"conditions",
"levels",
"glucose",
"order to",
"kinetic properties",
"enzyme",
"adds increasing levels",
"glucose",
"saturating concentration",
"phosphate",
"sees",
"rate",
"glucose",
"gets faster",
"higher levels",
"glucose",
"observes",
"rate approaches",
"maximum speed",
"calls",
"speed",
"then",
"concentration",
"glucose",
"needed to make",
"enzyme function",
"half",
"speed",
"calls",
"concentration",
"following",
"most likely true",
"properties",
"enzyme"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A researcher is studying the properties of an enzyme that adds phosphate groups to glucose. She discovers that the enzyme is present in most body tissues and is located in the cytoplasm of the cells expressing the enzyme. She decides to mix this enzyme under subphysiologic conditions with varying levels of glucose in order to determine the kinetic properties of the enzyme. Specifically, she adds increasing levels of glucose at a saturating concentration of phosphate and sees that the rate at which glucose becomes phosphorylated gets faster at higher levels of glucose. She observes that this rate approaches a maximum speed and calls this speed Y. She then determines the concentration of glucose that is needed to make the enzyme function at half the speed Y and calls this concentration X. Which of the following is most likely true about the properties of this enzyme?
Choose one of the following::
A. High X and high Y
B. High X and low Y
C. Low X and high Y
D. Low X and low Y | [
0.045732177793979645,
-0.05713607370853424,
0.029306165874004364,
0.002009943826124072,
-0.01910414732992649,
-0.03275412693619728,
-0.005435693543404341,
0.004777367692440748,
0.02038574032485485,
-0.018960844725370407,
0.02742358297109604,
0.005538447294384241,
0.010083776898682117,
-0.039133768528699875,
0.01816742680966854,
0.004000740125775337,
0.030075373128056526,
0.010400857776403427,
-0.05250861495733261,
0.0007294573588296771,
0.012180468998849392,
-0.019104579463601112,
-0.009318753145635128,
0.021837469190359116,
0.030278241261839867,
0.009015335701406002,
-0.012851729989051819,
-0.034853577613830566,
-0.0035285509657114744,
0.011796128004789352,
0.000828616670332849,
0.011952204629778862,
-0.03142211213707924,
-0.0476100891828537,
0.0000014134761840978172,
-0.0632520467042923,
0.008577381260693073,
-0.01235033106058836,
-0.01474015973508358,
-0.0041152662597596645,
-0.02509528212249279,
-0.022815287113189697,
0.00007518506026826799,
-0.013723007403314114,
0.05463679879903793,
-0.019313858821988106,
-0.0007011271081864834,
-0.03549366071820259,
-0.04948100075125694,
0.02047831006348133,
-0.029739415273070335,
0.02973899245262146,
-0.013422347605228424,
0.014129137620329857,
0.06017252057790756,
-0.03351188823580742,
0.034302014857530594,
0.01623542606830597,
0.08358857035636902,
0.028736794367432594,
0.014658241532742977,
0.02327275089919567,
0.01078991498798132,
0.018295859917998314,
0.07554399222135544,
0.02967541478574276,
0.05641733482480049,
-0.0006901862216182053,
-0.011019009165465832,
-0.0008055153884924948,
-0.0038898622151464224,
0.02448192797601223,
-0.005023424979299307,
0.05435759574174881,
-0.0395914651453495,
0.025428805500268936,
0.016710160300135612,
-0.03197713568806648,
-0.015559004619717598,
-0.034923262894153595,
-0.059407129883766174,
0.05259648337960243,
0.017493650317192078,
-0.004009446129202843,
-0.018006375059485435,
-0.00967232696712017,
-0.005395548418164253,
-0.037059735506772995,
-0.011924236081540585,
0.024708354845643044,
-0.037984851747751236,
-0.020631225779652596,
-0.024520915001630783,
0.055993661284446716,
0.007747682277113199,
-0.011938505806028843,
-0.008172793313860893,
0.041461605578660965,
0.030720168724656105,
-0.07687979191541672,
0.03144262358546257,
-0.026374543085694313,
0.056230030953884125,
0.02924422360956669,
0.01885208487510681,
0.009799941442906857,
-0.042421795427799225,
-0.020485594868659973,
-0.05788733810186386,
0.03742140904068947,
-0.022354423999786377,
0.013578524813055992,
-0.015553062781691551,
0.09061860293149948,
0.06265321373939514,
0.023442715406417847,
-0.024305880069732666,
0.0035642993170768023,
-0.02334507554769516,
0.017558353021740913,
-0.0868057832121849,
-0.02607288956642151,
-0.010114509612321854,
-0.013643148355185986,
-0.05635892599821091,
0.04659515991806984,
-0.0597384013235569,
0.004621290136128664,
-0.024219250306487083,
-0.0068530007265508175,
-0.009922333993017673,
-0.02099456451833248,
-0.004501178860664368,
0.00880826823413372,
-0.03155118227005005,
0.045589227229356766,
-0.0007094581378623843,
0.07087033987045288,
-0.054004788398742676,
-0.10672063380479813,
-0.0486580915749073,
-0.0285036563873291,
-0.09685385227203369,
-0.02104683220386505,
0.0018116537248715758,
0.08566634356975555,
-0.024526096880435944,
0.013631656765937805,
0.00671683344990015,
0.04901775345206261,
-0.012447133660316467,
0.04238228499889374,
0.040817439556121826,
0.03443729504942894,
0.030729640275239944,
-0.004703921265900135,
-0.07456131279468536,
0.08241619169712067,
0.012897495180368423,
0.03580872341990471,
0.02588501013815403,
-0.030795510858297348,
0.035934410989284515,
-0.026243945583701134,
0.006844882387667894,
0.004504427779465914,
0.002934963908046484,
-0.019435247406363487,
0.008653655648231506,
0.034434787929058075,
0.03500978648662567,
-0.015567736700177193,
0.008523865602910519,
0.010264305397868156,
-0.05578767880797386,
0.06670785695314407,
-0.04908784106373787,
0.016008177772164345,
-0.009593144059181213,
0.029734261333942413,
0.023262636736035347,
0.02263510785996914,
0.09651045501232147,
-0.03351950645446777,
0.0040857670828700066,
-0.01199910044670105,
0.0027319621294736862,
-0.030506255105137825,
0.004979580640792847,
-0.021429453045129776,
-0.0599321648478508,
0.015125054866075516,
-0.016958152875304222,
-0.02580718696117401,
0.01822594925761223,
0.015553421340882778,
-0.0368393138051033,
0.02082786150276661,
0.023025574162602425,
0.02798161655664444,
0.03468764200806618,
0.01734510436654091,
0.03041703999042511,
0.04752776399254799,
-0.04901961609721184,
0.03462632745504379,
0.03605553135275841,
0.01464232336729765,
0.021189603954553604,
-0.06117755174636841,
0.04824528098106384,
-0.003317037131637335,
0.01107383705675602,
0.016842808574438095,
0.02245313487946987,
-0.04771316424012184,
-0.01013100240379572,
-0.008283847942948341,
-0.03879808261990547,
0.05022622272372246,
0.039651673287153244,
0.027064282447099686,
0.014379855245351791,
-0.034344933927059174,
0.024683544412255287,
0.006670056842267513,
-0.04810917004942894,
0.006004977971315384,
-0.03400040417909622,
-0.06685470044612885,
-0.011844923719763756,
-0.03944406658411026,
-0.05745859071612358,
0.0059591131284832954,
-0.004425418097525835,
0.014838083647191525,
0.0772307738661766,
0.009352625347673893,
-0.025342363864183426,
0.048882897943258286,
-0.012927406467497349,
-0.05864018574357033,
-0.0048150611110031605,
0.029737122356891632,
0.0049032182432711124,
0.013073141686618328,
0.028213392943143845,
0.041570547968149185,
-0.038154568523168564,
-0.00390820624306798,
-0.02019435539841652,
-0.016010386869311333,
0.025345874950289726,
0.021089663729071617,
0.014583203941583633,
0.012958100996911526,
-0.03924962505698204,
0.06752915680408478,
0.001959049142897129,
0.006038271356374025,
-0.021302800625562668,
-0.0068579730577766895,
-0.00293771387077868,
0.0071867685765028,
-0.10053858906030655,
-0.0510304756462574,
-0.024886062368750572,
0.08359116315841675,
-0.03438156470656395,
0.016239963471889496,
0.03648892790079117,
-0.022568771615624428,
0.055388517677783966,
-0.014392021112143993,
0.05876316502690315,
-0.013537460938096046,
-0.026862967759370804,
-0.048016030341386795,
0.012048347853124142,
0.007918216288089752,
0.024054666981101036,
0.061819061636924744,
-0.029193943366408348,
0.01744135655462742,
0.002822913695126772,
0.08658291399478912,
0.043350301682949066,
0.011140133254230022,
0.06726221740245819,
0.014518991112709045,
0.01503795851022005,
0.01116087194532156,
0.025953464210033417,
-0.03816637024283409,
0.032995134592056274,
-0.004439188167452812,
-0.00884996633976698,
0.021051602438092232,
-0.008245494216680527,
0.037522222846746445,
0.024276498705148697,
0.03474557027220726,
0.004963976331055164,
-0.028915757313370705,
-0.05892954021692276,
0.02373531647026539,
0.041504934430122375,
-0.03414511680603027,
0.019625823944807053,
0.06914649903774261,
0.06689948588609695,
-0.031385377049446106,
-0.058469001203775406,
0.02693031169474125,
-0.04470977187156677,
-0.039845600724220276,
-0.03824031725525856,
-0.00288113160058856,
0.03257469832897186,
0.008338326588273048,
-0.023036055266857147,
-0.0030779060907661915,
0.012829859741032124,
0.042261768132448196,
0.028600413352251053,
-0.01887933537364006,
0.0013181297108530998,
0.03518974781036377,
-0.02924567647278309,
-0.008851610124111176,
0.023946024477481842,
-0.05485943704843521,
0.00012174199218861759,
0.02166357822716236,
-0.013123135082423687,
-0.01291442010551691,
-0.05203673243522644,
-0.018847204744815826,
-0.037632960826158524,
0.04160456731915474,
-0.0022721642162650824,
-0.0009214768651872873,
-0.01829836703836918,
0.014430439099669456,
0.09212049096822739,
-0.009763688780367374,
-0.05992509052157402,
-0.007786831818521023,
0.024063561111688614,
-0.004695223178714514,
0.017574390396475792,
-0.008963784202933311,
-0.013519507832825184,
-0.05135949328541756,
-0.025802578777074814,
-0.07533961534500122,
-0.009120580740272999,
0.03617216646671295,
-0.052325569093227386,
-0.009026997722685337,
0.07158200442790985,
0.030562685802578926,
0.05490540713071823,
0.013086733408272266,
-0.017986128106713295,
0.010635534301400185,
-0.025028448551893234,
0.01977306231856346,
0.005468797404319048,
-0.03002592734992504,
0.01812976598739624,
0.02121647447347641,
-0.024406859651207924,
0.034892015159130096,
-0.023693477734923363,
-0.032657213509082794,
0.008045378141105175,
0.014648065902292728,
-0.10310807079076767,
-0.015726206824183464,
0.06149154156446457,
-0.030460447072982788,
0.08917709439992905,
-0.05182007700204849,
0.023960543796420097,
0.006763385608792305,
-0.0020255520939826965,
-0.05673709139227867,
0.008793828077614307,
0.03564353287220001,
0.040696948766708374,
0.018589789047837257,
-0.020996052771806717,
-0.05433133244514465,
0.02690824307501316,
-0.0020177047699689865,
0.04268096759915352,
-0.00995142012834549,
-0.016274023801088333,
0.08922846615314484,
-0.011756769381463528,
-0.0324220284819603,
0.013883714564144611,
0.027797881513834,
-0.035886336117982864,
-0.0822603777050972,
-0.060880452394485474,
-0.03913736343383789,
-0.023627733811736107,
0.05308341607451439,
0.03597070649266243,
-0.04130035266280174,
-0.00632158387452364,
-0.010479941964149475,
-0.016171973198652267,
0.017605863511562347,
-0.01831929013133049,
-0.03996836766600609,
-0.0003048850630875677,
-0.04480292275547981,
0.021772334352135658,
0.021059079095721245,
0.02476581372320652,
-0.01498440746217966,
0.027829637750983238,
-0.03760167956352234,
0.013309072703123093,
-0.008220294490456581,
0.035468216985464096,
0.025687552988529205,
-0.03525417298078537,
-0.021270861849188805,
-0.013222742825746536,
0.037171099334955215,
-0.02843424864113331,
0.00750348623842001,
-0.004143652506172657,
0.021586766466498375,
0.03602645546197891,
-0.07922184467315674,
0.027666645124554634,
0.020825108513236046,
0.08887333422899246,
0.015976134687662125,
0.03508971631526947,
0.04256283491849899,
-0.036445725709199905,
0.016732748597860336,
0.006350345443934202,
0.1136537715792656,
-0.038401972502470016,
0.016568634659051895,
-0.05886948108673096,
0.02475995570421219,
0.01076894998550415,
0.0015600827755406499,
-0.06009292230010033,
-0.010863625444471836,
-0.021564140915870667,
-0.0128947664052248,
0.012763487175107002,
0.009489134885370731,
0.005718435160815716,
-0.03484513610601425,
-0.03985399380326271,
0.012243201956152916,
-0.026117196306586266,
-0.029813164845108986,
-0.002321678912267089,
-0.04556569457054138,
-0.01516189519315958,
0.026506440714001656,
-0.03460400179028511,
0.021712135523557663,
-0.022419439628720284,
-0.08895613998174667,
-0.07793476432561874,
-0.007723700255155563,
-0.020670654252171516,
0.023818476125597954,
-0.05903691053390503,
0.027108581736683846,
0.02572258561849594,
-0.042641788721084595,
0.010519158095121384,
0.020069748163223267,
0.006501801311969757,
0.02485721930861473,
0.013265409506857395,
-0.08265435695648193,
0.0442902036011219,
0.01008562557399273,
-0.010153979063034058,
-0.055754221975803375,
-0.05419937148690224,
-0.060447581112384796,
-0.0050291093066334724,
0.06510547548532486,
-0.019058311358094215,
-0.02530018612742424,
0.04941728338599205,
0.007469453848898411,
0.022628488019108772,
0.009973501786589622,
-0.03937893360853195,
0.0229523666203022,
-0.0017743917414918542,
-0.0623127818107605,
-0.0635700672864914,
0.021773047745227814,
-0.007299166638404131,
-0.021399399265646935,
-0.0036716291215270758,
-0.0110377948731184,
-0.0034319853875786066,
-0.04388057067990303,
-0.031134290620684624,
-0.04032028093934059,
-0.02973073534667492,
0.0004467587568797171,
0.0060984413139522076,
-0.017848055809736252,
-0.026425529271364212,
-0.03489317372441292,
0.04201529547572136,
-0.007772908546030521,
0.03891266509890556,
0.024053802713751793,
-0.024174660444259644,
0.07409148663282394,
0.029906881973147392,
-0.0021781129762530327,
-0.10132718086242676,
-0.021719766780734062,
-0.007002053316682577,
0.01080472394824028,
-0.07272563129663467,
-0.02317194826900959,
0.043134912848472595,
-0.018694091588258743,
-0.020640471950173378,
-0.0060340771451592445,
0.0113957729190588,
0.01598106138408184,
0.021651968359947205,
-0.0021992234978824854,
-0.04136522114276886,
-0.0009379972470924258,
-0.01897715963423252,
-0.05353616923093796,
-0.012205141596496105,
0.07717427611351013,
0.014999601058661938,
-0.00030664968653582036,
0.07557286322116852,
-5.0237069010313484e-33,
0.07721177488565445,
-0.061085045337677,
0.02053418941795826,
0.08598455041646957,
-0.017882736399769783,
0.06843037158250809,
-0.07015182822942734,
0.012226494029164314,
-0.03169681504368782,
0.005653890781104565,
0.021550262346863747,
0.018512919545173645,
0.028901105746626854,
-0.003266913117840886,
-0.0064202225767076015,
-0.03422974795103073,
0.00003717212894116528,
0.0025023706257343292,
0.034351203590631485,
-0.04425903782248497,
0.017296135425567627,
-0.003598711686208844,
0.014018204994499683,
0.004838153719902039,
0.027525341138243675,
-0.02352062799036503,
-0.020276876166462898,
-0.03877778723835945,
-0.04162626713514328,
0.04620518907904625,
0.007074994500726461,
0.02756662108004093,
-0.04858097806572914,
-0.04379293695092201,
-0.020500462502241135,
-0.049339164048433304,
0.06520286947488785,
-0.02139408141374588,
-0.019281700253486633,
0.041209809482097626,
-0.033122383058071136,
-0.010475968942046165,
0.05710636079311371,
-0.021418899297714233,
-0.045961178839206696,
0.010790927335619926,
0.013584989123046398,
-0.00949213095009327,
0.0489407442510128,
-0.0016557580092921853,
-0.01919502206146717,
0.0032730770763009787,
0.0180387981235981,
0.02657056599855423,
0.02918856404721737,
-0.0521690733730793,
-0.0039005994331091642,
-0.06243740767240524,
0.01706412248313427,
0.008217268623411655,
0.01652190275490284,
0.04394165053963661,
0.0005369388381950557,
-0.0015027493936941028,
-0.0026055793277919292,
-0.00951508991420269,
0.01554061658680439,
0.10041490197181702,
-0.009602004662156105,
0.01987021416425705,
-0.025852948427200317,
0.008791412226855755,
0.009685512632131577,
-0.025373052805662155,
0.03051162138581276,
-0.027157284319400787,
-0.03829587996006012,
0.048796407878398895,
0.059079043567180634,
-0.037720926105976105,
-0.06787556409835815,
-0.022537434473633766,
-0.06995383650064468,
-0.014722530730068684,
-0.01151113398373127,
0.08589594066143036,
-0.0008167364285327494,
-0.05755346640944481,
-0.026774907484650612,
-0.12377506494522095,
0.053162138909101486,
0.00918479822576046,
0.007328593637794256,
0.03199826180934906,
-0.043424636125564575,
-0.02080984227359295,
0.015605765394866467,
0.05920729041099548,
-0.015632212162017822,
0.017944460734725,
-0.00017845802358351648,
-0.0034050685353577137,
0.046688012778759,
0.01140501257032156,
-0.03627791255712509,
-0.02101694606244564,
-0.039281100034713745,
0.01746230013668537,
0.00592185091227293,
0.021834416314959526,
-0.00024081151059363037,
0.012449052184820175,
0.018167193979024887,
-0.03679708018898964,
0.026091935113072395,
0.008750955574214458,
0.0006459609139710665,
0.06586622446775436,
-0.015040558762848377,
-0.015924299135804176,
0.0536968931555748,
0.08661797642707825,
0.031162284314632416,
0.014762607403099537,
-0.010229243896901608,
-0.04434635862708092,
0.021479425951838493,
0.007453144062310457,
-0.0903693363070488,
0.02495170757174492,
-0.016101744025945663,
0.04260460287332535,
2.467010062900954e-7,
0.009259230457246304,
-0.045414701104164124,
0.05497647076845169,
-0.001119039487093687,
-0.02058516815304756,
-0.05395586043596268,
-0.026545248925685883,
-0.015707580372691154,
-0.0742124542593956,
-0.09916163235902786,
0.03337176516652107,
0.011084746569395065,
0.009883105754852295,
-0.0013846922665834427,
0.04724495857954025,
0.009019255638122559,
0.03900537267327309,
0.03667110949754715,
0.0012824599398300052,
0.0065292916260659695,
-0.040898606181144714,
-0.049440931528806686,
-0.03257644176483154,
0.011488562449812889,
-0.0277895275503397,
0.04494715481996536,
0.027037132531404495,
-0.0038498190697282553,
0.014460897073149681,
0.02224401943385601,
-0.014341373927891254,
0.038735974580049515,
0.0592195950448513,
0.011758300475776196,
-0.013450319878757,
-0.00502368900924921,
0.01903115026652813,
0.001318864757195115,
0.0068770828656852245,
-0.004029268864542246,
0.04836725816130638,
0.02478315494954586,
0.048983607441186905,
-0.0023907795548439026,
0.0009232784505002201,
0.055021680891513824,
0.0023919339291751385,
-0.036336228251457214,
0.04501873999834061,
0.01696898229420185,
0.032327085733413696,
0.014265989884734154,
-0.011734039522707462,
0.053551532328128815,
-0.012632554396986961,
-0.025891393423080444,
-0.048591554164886475,
0.046645160764455795,
0.017403269186615944,
0.03611086681485176,
0.014207102358341217,
-0.005037182476371527,
-0.009974915534257889,
0.01229564193636179,
0.12617036700248718,
-0.014809994958341122,
-0.0015817299718037248,
1.3621428795124524e-34,
-0.006792932283133268,
-0.03608013316988945,
-0.010802783071994781,
-0.037769071757793427,
-0.02452860213816166,
-0.00007911930151749402,
-0.026662960648536682,
-0.013062969781458378,
-0.00509997783228755,
0.002185262506827712,
-0.008855849504470825
] | {
"ds_index": 38,
"similar_dg_indices": [
963838,
969606,
982176,
231155,
673235,
155350,
1164101,
1041805,
1183773,
941684,
861399,
389015,
854790,
638993,
795320,
645884,
459717,
1043067,
217024,
772920
]
} |
A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia? | Sertoli cells | {
"A": "Spermatogonia",
"B": "Allantois",
"C": "Syncytiotrophoblast",
"D": "Sertoli cells"
} | step1 | D | [
"31 year old",
"female",
"40 weeks presents",
"hospital following",
"rush",
"water",
"vagina",
"4",
"dilated",
"80",
"Fetal heart",
"shows",
"pulse",
"min",
"variable decelerations",
"12 hours",
"presentation",
"gives birth",
"oz baby boy",
"APGAR scores",
"8",
"5 minutes",
"following structures",
"responsible",
"inhibition",
"female internal genitalia"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia?
Choose one of the following::
A. Spermatogonia
B. Allantois
C. Syncytiotrophoblast
D. Sertoli cells | [
0.003285157261416316,
-0.021886469796299934,
-0.011250304989516735,
-0.022790012881159782,
-0.010120264254510403,
0.04884864017367363,
0.040170442312955856,
-0.040572285652160645,
0.025793004781007767,
-0.0312562920153141,
0.010093364864587784,
-0.0792604312300682,
-0.0027023456059396267,
-0.03452754393219948,
0.023545945063233376,
0.007489327806979418,
-0.005953972227871418,
0.013063318096101284,
-0.056380435824394226,
-0.022078895941376686,
-0.0044585722498595715,
0.009116632863879204,
-0.0223440732806921,
-0.026494605466723442,
0.10346797108650208,
0.007752496749162674,
-0.02342619188129902,
0.013828716240823269,
-0.05534285306930542,
-0.06914947926998138,
0.023582741618156433,
0.062108565121889114,
-0.0012059807777404785,
-0.025737088173627853,
0.0000020513195977400756,
-0.03023209609091282,
-0.011876421049237251,
0.03476819023489952,
-0.006031215190887451,
0.0019265466835349798,
-0.033872175961732864,
-0.04350399598479271,
0.007512418553233147,
0.007072166074067354,
0.0399586483836174,
-0.05296584218740463,
0.050610680133104324,
0.05076667293906212,
0.019602932035923004,
-0.00613029208034277,
-0.009169664233922958,
0.006771128624677658,
-0.021442072466015816,
0.02602808177471161,
0.09090869873762131,
-0.029675433412194252,
0.003836112329736352,
0.005046836566179991,
0.014117271639406681,
0.026219969615340233,
-0.009650659747421741,
-0.07077468186616898,
-0.0452909842133522,
-0.003645643126219511,
0.03362540900707245,
-0.0017711375840008259,
0.05125660076737404,
-0.12592379748821259,
0.014361359179019928,
-0.05306653305888176,
0.04743541404604912,
-0.022295290604233742,
0.046779386699199677,
0.07318180799484253,
-0.05107693374156952,
-0.04869840294122696,
-0.05954869091510773,
-0.013356438837945461,
0.0014812354929745197,
-0.014023460447788239,
-0.016019172966480255,
0.009406860917806625,
0.010771162807941437,
0.0003404493036214262,
0.07811734825372696,
-0.032632146030664444,
0.08169985562562943,
-0.03129921853542328,
-0.01817326992750168,
0.011533983051776886,
-0.018207354471087456,
-0.061203353106975555,
0.016560841351747513,
0.011686110869050026,
0.019505346193909645,
0.01639527454972267,
-0.004598017316311598,
-0.030331982299685478,
0.031016308814287186,
-0.04300134256482124,
-0.009044112637639046,
0.015085682272911072,
0.059310633689165115,
-0.0008713198476471007,
-0.05368821322917938,
0.04774286225438118,
-0.048105236142873764,
0.06721051037311554,
0.027729254215955734,
0.04773630574345589,
-0.04029705002903938,
-0.0070520550943911076,
0.0013221927220001817,
0.025498639792203903,
0.04451584070920944,
0.017638476565480232,
-0.05727860704064369,
0.002687417669221759,
-0.056770361959934235,
0.007284242659807205,
-0.05043433979153633,
0.05054480955004692,
0.05771738663315773,
0.00915961991995573,
0.0363309420645237,
-0.031307633966207504,
-0.006475586909800768,
0.0020429561845958233,
-0.011483406648039818,
0.016475001350045204,
0.005310192704200745,
-0.013190574944019318,
-0.0164202731102705,
0.05407676473259926,
-0.0395604632794857,
-0.046098493039608,
0.018828194588422775,
-0.007401636335998774,
-0.016708603128790855,
0.044459689408540726,
-0.02446846105158329,
-0.023127054795622826,
0.013536261394619942,
0.03561067581176758,
-0.022367827594280243,
0.023955708369612694,
-0.06543787568807602,
-0.03427748382091522,
0.03518195450305939,
0.03726014122366905,
0.004172517452389002,
0.006172712426632643,
0.05137579143047333,
-0.023235691711306572,
0.033456698060035706,
0.053866997361183167,
-0.00037089749821461737,
0.012147437781095505,
-0.005105962976813316,
-0.050129491835832596,
0.037183281034231186,
-0.03523307293653488,
-0.03837862238287926,
-0.0390663705766201,
0.043830227106809616,
0.0139091145247221,
0.032601624727249146,
0.041516125202178955,
0.023031018674373627,
-0.048063844442367554,
-0.035886432975530624,
-0.06814843416213989,
0.01581355556845665,
0.004031370393931866,
-0.03277914226055145,
0.02162574976682663,
-0.03265738859772682,
0.03180373087525368,
0.022009490057826042,
-0.04281409829854965,
-0.029146665707230568,
0.021886145696043968,
0.0021381250116974115,
-0.019373007118701935,
0.002399842720478773,
0.023772185668349266,
-0.004016601014882326,
-0.0264348816126585,
0.009744296781718731,
-0.009752419777214527,
-0.029864119365811348,
0.07136169821023941,
-0.08534053713083267,
-0.05353569984436035,
0.025859972462058067,
0.049375176429748535,
-0.038866762071847916,
-0.03845352306962013,
0.004911484662443399,
0.05389663577079773,
0.02521718665957451,
0.008710379712283611,
-0.020003022626042366,
0.017467889934778214,
-0.016501164063811302,
-0.007748506031930447,
-0.021643808111548424,
-0.012207498773932457,
-0.018105266615748405,
-0.0019423168851062655,
-0.02004116401076317,
0.027994081377983093,
-0.009397856891155243,
-0.068073570728302,
0.02476636879146099,
-0.009348342195153236,
0.010875153355300426,
-0.003644578391686082,
-0.04366696625947952,
0.00032790127443149686,
0.0316038653254509,
0.023121459409594536,
0.009624960832297802,
0.0072738430462777615,
0.005268419627100229,
0.004060599021613598,
-0.023600315675139427,
0.008614622987806797,
-0.003518224461004138,
-0.07633237540721893,
0.03409387543797493,
0.038064144551754,
-0.01193604152649641,
0.021076245233416557,
0.03510073944926262,
-0.007111018989235163,
0.05141785740852356,
0.01964212767779827,
-0.021028373390436172,
0.03249654546380043,
-0.011447099037468433,
0.02602614089846611,
0.0010490231215953827,
-0.05029177665710449,
0.010906482115387917,
-0.015223350375890732,
-0.0013639876851812005,
0.003769479924812913,
-0.00866751093417406,
0.022724736481904984,
-0.02335933968424797,
-0.013564365915954113,
-0.054140254855155945,
0.04429537430405617,
0.000335458928020671,
0.07702748477458954,
-0.04319917783141136,
0.00551362382248044,
0.003629768267273903,
-0.0608346164226532,
-0.03057398833334446,
0.039238739758729935,
-0.008912556804716587,
-0.03798327594995499,
-0.05866321921348572,
-0.06089705973863602,
-0.05786863714456558,
0.03914150595664978,
-0.035636719316244125,
0.03807612136006355,
0.027137406170368195,
0.02481824904680252,
-0.004947689361870289,
0.03308887407183647,
0.03255501762032509,
0.04396332427859306,
-0.011674505658447742,
0.027222810313105583,
0.05717175453901291,
0.008845741860568523,
0.009050450287759304,
0.0463116392493248,
-0.03647739067673683,
-0.015651974827051163,
-0.010644916445016861,
-0.024093803018331528,
0.01949330046772957,
-0.01309957541525364,
0.07455915212631226,
-0.005522253457456827,
0.0033113013487309217,
-0.00620030052959919,
0.03224090859293938,
-0.038403596729040146,
0.02326297014951706,
0.03528424724936485,
-0.015362945385277271,
0.045867737382650375,
-0.0023460108786821365,
-0.00342541397549212,
-0.0019995393231511116,
0.037331901490688324,
-0.0022785435430705547,
-0.024657180532813072,
-0.010128176771104336,
0.09575728327035904,
0.013638767413794994,
0.05150558799505234,
-0.04224454611539841,
0.028051776811480522,
0.02064274437725544,
-0.038877107203006744,
0.004888041876256466,
0.026813475415110588,
-0.035480648279190063,
-0.021878939121961594,
-0.05392434820532799,
-0.08511821180582047,
-0.012383030727505684,
0.07392911612987518,
0.016143204644322395,
0.016175713390111923,
-0.045939575880765915,
-0.0018365478608757257,
-0.014337684027850628,
0.018168466165661812,
0.029291901737451553,
0.03288563713431358,
0.02445380575954914,
-0.00659662950783968,
-0.0006932930555194616,
0.040968846529722214,
-0.0425332672894001,
-0.04380950704216957,
0.06246750429272652,
0.011192584410309792,
-0.023717867210507393,
-0.0652645081281662,
-0.046631794422864914,
-0.027395885437726974,
0.03627098351716995,
-0.07118826359510422,
-0.03207794949412346,
0.024982424452900887,
0.06510666757822037,
-0.0033923194278031588,
-0.008488218300044537,
0.013284560292959213,
0.006930720992386341,
0.06483618170022964,
-0.07450388371944427,
0.0002839595836121589,
-0.03099498338997364,
-0.022678038105368614,
-0.06586454063653946,
-0.016394535079598427,
0.027299178764224052,
0.03599103167653084,
-0.041925594210624695,
-0.010017488151788712,
-0.007931086234748363,
-0.03792239725589752,
-0.04315223917365074,
0.026544034481048584,
0.02843654341995716,
0.027920998632907867,
0.024927295744419098,
-0.018072819337248802,
-0.00948250200599432,
-0.06686828285455704,
0.0033040258567780256,
0.00808869767934084,
-0.06773804128170013,
0.009131823666393757,
-0.007379953283816576,
-0.03472252935171127,
-0.027887852862477303,
-0.038989707827568054,
-0.07520094513893127,
-0.011847524903714657,
0.06793371587991714,
-0.0012863096781075,
0.05830581858754158,
0.028894562274217606,
-0.07343652844429016,
0.002532503567636013,
-0.0032888022251427174,
-0.00671755475923419,
0.015091042965650558,
0.029495207592844963,
-0.00958809070289135,
-0.025002187117934227,
-0.05239897593855858,
-0.047474347054958344,
0.02934124320745468,
0.0006075195269659162,
-0.07115602493286133,
-0.025005381554365158,
0.004616647493094206,
0.06597129255533218,
-0.029062237590551376,
0.005401619244366884,
0.015272961929440498,
0.050706710666418076,
0.013429121114313602,
-0.007007180247455835,
-0.034484125673770905,
-0.020723838359117508,
0.026506032794713974,
0.10613096505403519,
0.05860770121216774,
-0.04567645490169525,
-0.044280581176280975,
0.016727464273571968,
-0.023408204317092896,
0.04355419799685478,
-0.0057120672427117825,
-0.06418973952531815,
0.04083363711833954,
0.02058803290128708,
0.051865726709365845,
0.007117495872080326,
-0.011499048210680485,
0.0001331499224761501,
0.031341150403022766,
-0.04312717914581299,
0.11986414343118668,
-0.009158957749605179,
0.009835287928581238,
0.03179957717657089,
-0.038899436593055725,
0.01168903149664402,
0.011218959465622902,
0.06358818709850311,
0.008184120059013367,
0.02847294695675373,
-0.025076700374484062,
0.02851911447942257,
0.012598873116075993,
-0.021398324519395828,
0.05022139847278595,
-0.04916001483798027,
0.035421550273895264,
0.0502474382519722,
-0.022287653759121895,
-0.022867433726787567,
-0.030179983004927635,
-0.028268884867429733,
-0.0364006944000721,
0.10090192407369614,
-0.049260105937719345,
-0.0018848668551072478,
-0.004444087855517864,
-0.02662089839577675,
-0.023411013185977936,
-0.02078319527208805,
0.05234164744615555,
0.02616315893828869,
0.0076314969919621944,
-0.10569511353969574,
0.01546627376228571,
0.010042204521596432,
-0.04276205226778984,
-0.10445591062307358,
0.004319143947213888,
-0.034813497215509415,
-0.040522027760744095,
-0.004094311501830816,
0.018731018528342247,
-0.010796058923006058,
-0.0479450449347496,
0.0133372126147151,
-0.009098892100155354,
0.022723864763975143,
-0.04046512022614479,
0.015312742441892624,
-0.0510762520134449,
0.03310933709144592,
0.04133284091949463,
0.026052143424749374,
0.03932937979698181,
0.007204462308436632,
-0.04595150053501129,
-0.001091866404749453,
0.012391998432576656,
0.051476214081048965,
0.001061533926986158,
0.030520619824528694,
-0.013679827563464642,
0.00016997438797261566,
0.04638636112213135,
-0.006034454330801964,
-0.013904103077948093,
0.0005262988270260394,
0.009078064002096653,
-0.008929223753511906,
-0.0034514102153480053,
0.0070482343435287476,
0.058755744248628616,
-0.018688373267650604,
-0.010314935818314552,
0.013527407310903072,
0.013986604288220406,
-0.06172982603311539,
0.021376516669988632,
-0.011191168799996376,
-0.04529605433344841,
-0.029330851510167122,
-0.027105309069156647,
0.022907201200723648,
-0.012461910024285316,
0.012727830559015274,
0.008702901192009449,
0.04780290275812149,
0.01717936433851719,
-0.019678831100463867,
-0.01336691901087761,
-0.016804754734039307,
-0.03558079153299332,
0.006307274103164673,
-0.0058637442998588085,
-0.03715537115931511,
-0.033763330429792404,
-0.0349971242249012,
0.010378004983067513,
0.03437931835651398,
0.028323255479335785,
0.05355483666062355,
-0.07101984322071075,
0.03770659118890762,
0.026403170078992844,
0.05900297686457634,
-0.014723941683769226,
-0.0392693430185318,
-0.030663637444376945,
0.02245653234422207,
0.00008702542254468426,
0.04189089313149452,
-0.00592782674357295,
-0.030012138187885284,
-0.004513821564614773,
0.041785258799791336,
-0.026682252064347267,
-0.018932383507490158,
0.016063058748841286,
0.020463477820158005,
-0.0666794702410698,
-0.025462353602051735,
0.01545405387878418,
-0.07077199220657349,
0.01032202783972025,
-0.048740122467279434,
-0.0006669568247161806,
0.036167874932289124,
0.0024848785251379013,
-5.194685493094327e-33,
-0.008993604220449924,
-0.049382828176021576,
0.0600714273750782,
-0.02818211540579796,
-0.02187325619161129,
0.07839412987232208,
-0.00233068666420877,
0.03123958595097065,
-0.01563362218439579,
0.05205914378166199,
0.015636976808309555,
-0.011104750446975231,
0.029421264305710793,
-0.001814192859455943,
-0.009167585521936417,
-0.005759036168456078,
-0.013123415410518646,
-0.04653824865818024,
-0.01381042879074812,
0.011479209177196026,
0.02473974972963333,
0.03318900987505913,
-0.027223005890846252,
-0.011214789934456348,
0.011406364850699902,
-0.04623282328248024,
-0.008431384339928627,
-0.05706537514925003,
-0.055794112384319305,
0.019114984199404716,
0.0077812159433960915,
-0.029193894937634468,
-0.030116206035017967,
-0.07648265361785889,
0.0027306033298373222,
0.024605054408311844,
-0.022296957671642303,
0.01081679854542017,
0.037502843886613846,
-0.04799764230847359,
0.006515463814139366,
-0.008645412512123585,
0.03794879466295242,
0.008238302543759346,
0.0545763336122036,
-0.06693893671035767,
-0.00745699368417263,
-0.049445755779743195,
0.021671131253242493,
-0.03228232264518738,
-0.07647747546434402,
0.008395553566515446,
-0.02778787538409233,
-0.03573739901185036,
0.007136733271181583,
0.007083322387188673,
-0.04584314301609993,
0.03659500554203987,
0.024758143350481987,
0.017372608184814453,
-0.05364992097020149,
0.04664694890379906,
-0.032398585230112076,
-0.05876191332936287,
0.051416076719760895,
0.003928836900740862,
0.014880797825753689,
0.04624336585402489,
-0.014617973007261753,
-0.005709593649953604,
-0.013159829191863537,
0.06549974530935287,
0.040206339210271835,
-0.1254921704530716,
0.02779894508421421,
-0.029619425535202026,
-0.07164811342954636,
-0.05413540080189705,
0.025740617886185646,
0.040033549070358276,
-0.05344642698764801,
-0.014866022393107414,
-0.0013473795261234045,
0.014845002442598343,
-0.01928067021071911,
-0.07947638630867004,
0.0008532401989214122,
-0.02809789963066578,
0.003480881918221712,
-0.019741613417863846,
0.07371468096971512,
0.020367076620459557,
-0.04426893591880798,
0.006182249169796705,
-0.002427734900265932,
-0.054772160947322845,
0.09196233749389648,
-0.012654691003262997,
0.009936543181538582,
-0.03414135426282883,
0.04264191910624504,
0.019077185541391373,
-0.025881558656692505,
-0.02976144291460514,
-0.002101474441587925,
-0.022392887622117996,
-0.048626288771629333,
-0.002119590761139989,
-0.007546681445091963,
-0.059279654175043106,
-0.060830142349004745,
0.00433478644117713,
0.06677597016096115,
0.0017591449432075024,
-0.03827836364507675,
0.01480958517640829,
0.023670269176363945,
0.03166833519935608,
0.03909315541386604,
0.1002233698964119,
0.059071436524391174,
0.030241351574659348,
0.007818307727575302,
0.03344566002488136,
-0.0031779843848198652,
-0.06713471561670303,
0.054241281002759933,
0.01829352229833603,
-0.035211216658353806,
0.0326891764998436,
0.03139922395348549,
0.037773240357637405,
2.801438370170217e-7,
0.014860935509204865,
0.020133018493652344,
0.03932339325547218,
0.001415117410942912,
0.038768548518419266,
-0.07973958551883698,
0.0066090477630496025,
0.015857363119721413,
-0.007149522192776203,
-0.038753606379032135,
0.03922924026846886,
0.02106236107647419,
0.024720706045627594,
-0.0005551023641601205,
-0.015515436418354511,
0.03586278855800629,
0.025641795247793198,
-0.02214505709707737,
0.0762816071510315,
0.023220323026180267,
-0.065853551030159,
0.006936962250620127,
-0.0312759093940258,
0.001866048900410533,
-0.016512863337993622,
0.02974523790180683,
0.02437765896320343,
0.007818509824573994,
0.037855133414268494,
0.021257467567920685,
-0.01161523349583149,
-0.00486866757273674,
0.008575412444770336,
0.022160770371556282,
-0.04898438602685928,
-0.0422896146774292,
0.03937617316842079,
0.05024217814207077,
0.040444228798151016,
0.03399013355374336,
0.02584395557641983,
0.03002059832215309,
0.01119912788271904,
-0.0055833240039646626,
0.0071588968858122826,
0.02377649024128914,
-0.03891985863447189,
0.0063511584885418415,
0.03785089775919914,
-0.021991603076457977,
0.00781759899109602,
0.03273390978574753,
0.0023701421450823545,
0.09071331471204758,
-0.020283622667193413,
-0.018839335069060326,
0.005028017330914736,
0.04565947502851486,
0.041095178574323654,
0.03128409758210182,
0.009210937656462193,
-0.017339956015348434,
-0.0023505452554672956,
0.02430594339966774,
0.035544246435165405,
-0.004490147344768047,
-0.05134943500161171,
1.9662576658150945e-34,
-0.010085921734571457,
-0.05467669665813446,
-0.016496211290359497,
0.0026660747826099396,
0.018293466418981552,
0.004514213651418686,
-0.006430721376091242,
0.011991594918072224,
-0.0004397862940095365,
0.0044249542988836765,
0.009592311456799507
] | {
"ds_index": 39,
"similar_dg_indices": [
266800,
213307,
1095655,
275010,
887682,
1121932,
800380,
81972,
880110,
355548,
73124,
1035521,
747848,
278092,
801071,
692805,
302919,
736583,
765497,
361440
]
} |
A 43-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath for 1 week. She immigrated to the United States from Korea at the age of 20. She says that her heart is racing and she has never felt these symptoms before. Her cough is dry and is associated with shortness of breath that occurs with minimal exertion. Her past medical history is otherwise unremarkable. She has no allergies and is not currently taking any medications. She is a nonsmoker and an occasional drinker. She denies illicit drug use. Her blood pressure is 100/65 mm Hg, pulse is 76/min, respiratory rate is 23/min, and temperature is 36.8°C (98.2°F). Her physical examination is significant for bibasilar lung crackles and a non-radiating, low-pitched, mid-diastolic rumbling murmur best heard at the apical region. In addition, she has jugular vein distention and bilateral pitting edema in her lower extremities. Which of the following best describes the infectious agent that led to this patient’s condition? | A bacterium that induces complete lysis of the red cells of a blood agar plate with an oxygen-sensitive cytotoxin | {
"A": "A bacterium that induces partial lysis of red cells with hydrogen peroxide",
"B": "A bacterium that induces complete lysis of the red cells of a blood agar plate with an oxygen-sensitive cytotoxin",
"C": "A bacterium that induces heme degradation of the red cells of a blood agar plate",
"D": "A bacterium that requires an anaerobic environment to grow properly"
} | step1 | B | [
"year old woman presents",
"emergency department",
"palpitations",
"dry cough",
"shortness of breath",
"1 week",
"United States",
"Korea",
"age",
"20",
"heart",
"racing",
"never felt",
"symptoms",
"cough",
"dry",
"associated with shortness of breath",
"occurs",
"minimal exertion",
"past medical history",
"unremarkable",
"allergies",
"not currently taking",
"medications",
"nonsmoker",
"occasional drinker",
"denies illicit drug use",
"blood pressure",
"100 65 mm Hg",
"pulse",
"76 min",
"respiratory rate",
"23 min",
"temperature",
"36",
"98",
"physical examination",
"significant",
"lung crackles",
"non radiating",
"low-pitched",
"mid-diastolic rumbling murmur best heard",
"apical region",
"addition",
"jugular vein distention",
"bilateral pitting edema",
"lower extremities",
"following best",
"infectious agent",
"led",
"patients condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 43-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath for 1 week. She immigrated to the United States from Korea at the age of 20. She says that her heart is racing and she has never felt these symptoms before. Her cough is dry and is associated with shortness of breath that occurs with minimal exertion. Her past medical history is otherwise unremarkable. She has no allergies and is not currently taking any medications. She is a nonsmoker and an occasional drinker. She denies illicit drug use. Her blood pressure is 100/65 mm Hg, pulse is 76/min, respiratory rate is 23/min, and temperature is 36.8°C (98.2°F). Her physical examination is significant for bibasilar lung crackles and a non-radiating, low-pitched, mid-diastolic rumbling murmur best heard at the apical region. In addition, she has jugular vein distention and bilateral pitting edema in her lower extremities. Which of the following best describes the infectious agent that led to this patient’s condition?
Choose one of the following::
A. A bacterium that induces partial lysis of red cells with hydrogen peroxide
B. A bacterium that induces complete lysis of the red cells of a blood agar plate with an oxygen-sensitive cytotoxin
C. A bacterium that induces heme degradation of the red cells of a blood agar plate
D. A bacterium that requires an anaerobic environment to grow properly | [
0.0012148295063525438,
-0.009467394091188908,
0.04155399650335312,
0.008782574906945229,
0.054230947047472,
-0.0397644005715847,
-0.05387517064809799,
0.05028747767210007,
-0.007713714148849249,
0.0005214327829889953,
0.030341800302267075,
0.02736355923116207,
0.03248725086450577,
-0.002113328780978918,
0.011695601977407932,
-0.019294608384370804,
0.024379508569836617,
-0.002382213482633233,
0.008464127779006958,
0.013835231773555279,
-0.03278658166527748,
0.014523329213261604,
0.04567386955022812,
0.03195229172706604,
0.0822143629193306,
-0.02261834405362606,
-0.03863852098584175,
-0.008900114335119724,
0.004504205659031868,
-0.03275144100189209,
0.009559953585267067,
-0.03980310261249542,
-0.014763548970222473,
-0.08730289340019226,
0.0000020388733901199885,
0.013195432722568512,
-0.0015157064190134406,
-0.02438981831073761,
0.008296653628349304,
-0.07995200902223587,
0.018852416425943375,
-0.06304288655519485,
0.05408044159412384,
-0.018821367993950844,
-0.055991075932979584,
-0.11312150210142136,
0.011416910216212273,
0.05264440178871155,
-0.04055043309926987,
-0.00680498406291008,
0.02623770944774151,
0.05161384493112564,
-0.057761140167713165,
-0.03230626508593559,
0.056835152208805084,
-0.06401989609003067,
0.0057512265630066395,
-0.030421536415815353,
0.04623178765177727,
-0.015328642912209034,
0.00001677212458162103,
-0.008737721480429173,
-0.00519209261983633,
0.006718174554407597,
-0.003191562369465828,
-0.017404446378350258,
0.015839625149965286,
-0.014530960470438004,
0.016423404216766357,
0.022317521274089813,
-0.025136476382613182,
-0.008978774771094322,
0.04145285114645958,
0.06434636563062668,
-0.044296205043792725,
-0.019520549103617668,
0.07557784020900726,
-0.04314063489437103,
-0.010304695926606655,
0.0056845336221158504,
0.0876270979642868,
0.03808961063623428,
0.013542035594582558,
0.019921159371733665,
-0.029227755963802338,
-0.03217155113816261,
-0.021091485396027565,
-0.01854301244020462,
-0.04790123924612999,
-0.05022483319044113,
-0.05895229056477547,
-0.1026478186249733,
-0.0016739806160330772,
0.03436596691608429,
-0.07485996186733246,
-0.01311478577554226,
0.0410446859896183,
-0.0157150961458683,
0.05573249235749245,
-0.023673903197050095,
-0.054195303469896317,
-0.05965948477387428,
0.017013199627399445,
0.014257400296628475,
-0.03073456883430481,
-0.049378518015146255,
-0.032252080738544464,
0.03333970904350281,
-0.040472034364938736,
0.031624700874090195,
0.006574295461177826,
0.03207964822649956,
-0.04543525353074074,
-0.00210703001357615,
0.07574208080768585,
0.0023082210682332516,
-0.06110921502113342,
-0.09658187627792358,
0.0014706873334944248,
0.06858347356319427,
-0.022342892363667488,
0.004383355379104614,
-0.0023243040777742863,
0.07013862580060959,
0.008701864629983902,
0.009562596678733826,
-0.0004379477759357542,
0.00006964150816202164,
0.02020689845085144,
0.01864561438560486,
-0.003139883978292346,
-0.00035882528754882514,
0.014006308279931545,
0.011986171826720238,
0.050397224724292755,
-0.03378168120980263,
-0.01328153908252716,
0.06461741775274277,
0.019575277343392372,
0.025921111926436424,
-0.03126535192131996,
-0.026662670075893402,
-0.05455166846513748,
-0.03134389594197273,
-0.014874531887471676,
0.05356758087873459,
0.0019152224995195866,
0.006604686379432678,
-0.003313293680548668,
0.028200091794133186,
-0.08143738657236099,
-0.03634773939847946,
-0.06323148310184479,
-0.003254474373534322,
-0.026459673419594765,
0.043612170964479446,
0.03140991926193237,
-0.040026627480983734,
-0.018073981627821922,
-0.04044947028160095,
0.014247847720980644,
-0.014515974558889866,
0.02504541352391243,
-0.025309793651103973,
-0.007022378966212273,
0.011991855688393116,
0.018276948481798172,
0.021990051493048668,
0.009105799719691277,
0.048963747918605804,
-0.005196115933358669,
0.018730370327830315,
0.02683780901134014,
-0.003525388427078724,
-0.007450922392308712,
0.041731998324394226,
-0.037506088614463806,
-0.09554357081651688,
0.025863580405712128,
0.031537093222141266,
-0.01695743203163147,
0.020252114161849022,
0.034877486526966095,
-0.05628035590052605,
0.01733824424445629,
-0.010283502750098705,
0.015329810790717602,
-0.026158452033996582,
-0.018094085156917572,
-0.0558096319437027,
-0.04566251114010811,
0.01549376081675291,
-0.024417856708168983,
0.0038859134074300528,
-0.00845504179596901,
0.004338554106652737,
-0.012966619804501534,
0.010428058914840221,
-0.0028052569832652807,
-0.0011211407836526632,
-0.037870898842811584,
-0.038869451731443405,
-0.008449769578874111,
0.0802738219499588,
-0.08067823946475983,
0.07895210385322571,
-0.02397933043539524,
-0.01244038064032793,
0.009643029421567917,
-0.013230650685727596,
-0.020940344780683517,
0.012903263792395592,
0.05168239772319794,
-0.028633812442421913,
0.008681807667016983,
0.031633101403713226,
0.012771190144121647,
0.03642841801047325,
-0.06331121176481247,
0.005287420470267534,
-0.0044449917040765285,
0.002686877502128482,
0.022041959688067436,
-0.005247947294265032,
-0.02068273536860943,
-0.006435085088014603,
0.01525313314050436,
0.016921961680054665,
0.06289508938789368,
-0.06544617563486099,
0.0620696097612381,
0.023353876546025276,
-0.019215373322367668,
0.0056528993882238865,
-0.06059696897864342,
0.04826520383358002,
0.03882177174091339,
-0.01977647840976715,
0.006449166219681501,
0.08228779584169388,
-0.005480607505887747,
-0.028323275968432426,
-0.010054764337837696,
-0.02203836850821972,
-0.013496383093297482,
0.014277631416916847,
0.008622666820883751,
0.02852049469947815,
-0.025576889514923096,
0.05792815983295441,
0.0061653912998735905,
0.04587416723370552,
0.0027694012969732285,
0.00878821685910225,
0.0001236969546880573,
0.05777772143483162,
-0.04653438925743103,
0.003555404720827937,
-0.02918090485036373,
-0.07681046426296234,
-0.045784905552864075,
-0.009438743814826012,
-0.006134625989943743,
-0.03454194590449333,
-0.0717834085226059,
0.01476096361875534,
-0.0010593744227662683,
-0.019856244325637817,
-0.011847957037389278,
0.0431642159819603,
0.0028918555472046137,
0.01507799793034792,
0.03983457013964653,
-0.011088183149695396,
-0.025637207552790642,
0.010134624317288399,
-0.04566178470849991,
0.060623180121183395,
0.021617602556943893,
-0.0036192911211401224,
0.016698509454727173,
0.008969596587121487,
0.003801654325798154,
0.06158043071627617,
-0.03937564417719841,
-0.012936045415699482,
-0.04621199518442154,
0.01513621024787426,
0.032676517963409424,
-0.013646408915519714,
-0.017528587952256203,
-0.009220633655786514,
-0.001748297130689025,
-0.04003304988145828,
-0.04815680906176567,
-0.08773929625749588,
-0.01609780825674534,
0.02761870063841343,
-0.01833472214639187,
0.09515270590782166,
0.035040806978940964,
0.007726491428911686,
-0.010456802323460579,
0.03447940573096275,
-0.011487264186143875,
0.05972342938184738,
0.01391157228499651,
0.01869504339993,
-0.04566550627350807,
0.034993719309568405,
0.05245722085237503,
0.018812241032719612,
-0.006913568824529648,
0.014270976185798645,
-0.024385379627346992,
-0.010032574646174908,
-0.026883529499173164,
-0.06661777943372726,
0.047793541103601456,
-0.0012405668385326862,
-0.021253108978271484,
0.009592140093445778,
-0.044422660022974014,
-0.06739228218793869,
-0.004241807386279106,
-0.004426626954227686,
-0.012988009490072727,
-0.029370974749326706,
-0.06404829770326614,
-0.03034721501171589,
-0.014340165071189404,
0.00732732517644763,
0.009487718343734741,
0.06717898696660995,
0.009997956454753876,
-0.0030373800545930862,
-0.06953723728656769,
0.01798061467707157,
0.005332613363862038,
0.021970229223370552,
0.018961463123559952,
-0.01851416379213333,
0.030340807512402534,
0.018027134239673615,
-0.006573087070137262,
0.023911792784929276,
-0.0553988441824913,
0.03666209802031517,
0.02885688655078411,
0.03793620318174362,
-0.06765672564506531,
-0.002209828468039632,
0.008363978937268257,
-0.002806962700560689,
-0.01832444779574871,
-0.000006994576324359514,
0.0532657615840435,
0.018430398777127266,
-0.01900375261902809,
-0.005968394689261913,
0.02112729102373123,
0.020396944135427475,
0.03232179954648018,
0.032395269721746445,
-0.00884129200130701,
-0.0013163158437237144,
0.00931159034371376,
0.009393013082444668,
-0.02451607957482338,
0.008599207736551762,
0.06657630950212479,
-0.034752678126096725,
-0.035205062478780746,
0.05305088311433792,
-0.028326721861958504,
0.02456159144639969,
-0.004019619897007942,
-0.03996330127120018,
-0.035159703344106674,
-0.01884450390934944,
0.043109700083732605,
-0.032689373940229416,
-0.003744702087715268,
0.01638147048652172,
-0.0209563709795475,
0.024480070918798447,
-0.005911945831030607,
-0.03428385779261589,
0.024476690217852592,
0.025273440405726433,
0.004051931202411652,
0.016375746577978134,
0.05544184520840645,
-0.04951367899775505,
-0.014206018298864365,
0.02148749865591526,
0.02752869576215744,
-0.07419492304325104,
0.022939514368772507,
0.06241181492805481,
-0.010549205355346203,
0.006690362934023142,
0.011532393284142017,
0.04461359232664108,
0.02441702038049698,
-0.0047645969316363335,
-0.05575709044933319,
-0.03382623568177223,
-0.009384884499013424,
0.037527285516262054,
-0.0060937125235795975,
-0.03670324757695198,
0.04866548627614975,
0.020967597141861916,
0.0005337109323590994,
-0.04704907909035683,
0.013177038170397282,
-0.022894999012351036,
-0.017677951604127884,
-0.0763830840587616,
0.06060483306646347,
0.003949370235204697,
0.03281494602560997,
-0.03484721481800079,
-0.007863541133701801,
0.012442982755601406,
0.04094510152935982,
0.05342569947242737,
0.027044013142585754,
0.03921021893620491,
0.041142333298921585,
-0.044799692928791046,
0.07352843880653381,
0.0646476000547409,
-0.007112526800483465,
-0.008821079507470131,
-0.019782990217208862,
-0.018239304423332214,
-0.04264228045940399,
-0.04007846117019653,
-0.015800217166543007,
0.006911534816026688,
0.05874820798635483,
0.028881676495075226,
0.017695030197501183,
0.008113249205052853,
0.011183946393430233,
-0.0014373981393873692,
-0.016296057030558586,
0.09713959693908691,
0.06768962740898132,
-0.00302692037075758,
0.016444450244307518,
-0.005990950856357813,
0.051607586443424225,
0.04658682644367218,
0.04835569113492966,
-0.045114729553461075,
0.03508831560611725,
-0.0014151178766041994,
-0.07371336966753006,
0.012067567557096481,
0.03185201436281204,
-0.046109676361083984,
0.07824134081602097,
-0.024649815633893013,
-0.07087325304746628,
-0.005228821188211441,
-0.012602844275534153,
-0.009533017873764038,
-0.040404655039310455,
0.022267986088991165,
0.0017093225615099072,
-0.02103174477815628,
0.009137142449617386,
0.015016961842775345,
-0.011116999201476574,
-0.04828673601150513,
-0.005901020485907793,
0.005273463204503059,
0.015474754385650158,
-0.0008247566292993724,
-0.060610413551330566,
-0.0473005548119545,
-0.009612925350666046,
-0.025361638516187668,
0.05994782596826553,
0.022020477801561356,
-0.027668045833706856,
-0.0217889454215765,
-0.04532165825366974,
-0.03423435240983963,
-0.010535163804888725,
0.013224964030086994,
-0.015781421214342117,
-0.005519807804375887,
-0.0037254528142511845,
0.10324694216251373,
0.0002780407958198339,
0.03131634369492531,
0.046334851533174515,
0.007336969021707773,
0.05995006859302521,
0.011555664241313934,
0.0075386096723377705,
0.013964413665235043,
0.027447126805782318,
0.029383564367890358,
-0.020385995507240295,
-0.026839151978492737,
0.044334776699543,
0.026614494621753693,
-0.013275811448693275,
0.04172929748892784,
0.03547528013586998,
-0.0048700906336307526,
-0.026834318414330482,
-0.03134056180715561,
0.021467991173267365,
0.027826961129903793,
-0.005218681879341602,
-0.03563429415225983,
0.02136577107012272,
-0.048200830817222595,
-0.00675635039806366,
0.012914931401610374,
-0.004871767479926348,
-0.011390665546059608,
0.03407914936542511,
0.04638177156448364,
-0.028344061225652695,
0.022850753739476204,
-0.021686408668756485,
-0.026520712301135063,
0.0026276628486812115,
0.022021399810910225,
0.017700258642435074,
0.03557683154940605,
-0.026349874213337898,
-0.04480642452836037,
0.013771085999906063,
0.004111668560653925,
0.05000956729054451,
-0.04369974881410599,
-0.026167631149291992,
0.016587302088737488,
-0.03007260523736477,
0.03988831117749214,
0.02318548783659935,
0.0016854119021445513,
-0.003164737718179822,
0.05681237950921059,
-0.04342718794941902,
0.06750339269638062,
0.03535524755716324,
-5.65581282513871e-33,
0.023292211815714836,
-0.06451485306024551,
0.05521576106548309,
-0.04295474290847778,
0.047770511358976364,
0.10243280231952667,
-0.03802090138196945,
-0.04633946716785431,
-0.08852473646402359,
-0.004543574992567301,
-0.01770700141787529,
-0.03264746442437172,
0.024969864636659622,
0.030508240684866905,
0.00456766365095973,
-0.03317966312170029,
0.015046538785099983,
0.03325429558753967,
-0.05464114248752594,
-0.041172537952661514,
0.03296540305018425,
-0.02438368648290634,
-0.02048361487686634,
-0.022115319967269897,
-0.01673847809433937,
0.007345085497945547,
0.06093030050396919,
0.021710600703954697,
0.002445420017465949,
0.007707856595516205,
0.019458552822470665,
-0.015643741935491562,
0.028523391112685204,
-0.002171737141907215,
0.0022810501977801323,
-0.04310210794210434,
-0.0067548672668635845,
-0.04040544107556343,
0.0490197092294693,
0.0010889839613810182,
0.006047992967069149,
-0.08413441479206085,
0.011943629011511803,
0.028886910527944565,
0.06378179788589478,
-0.0036221055779606104,
-0.009661574847996235,
-0.044498544186353683,
0.04272373393177986,
-0.013350156135857105,
-0.007456682156771421,
0.032437216490507126,
0.042692217975854874,
-0.006086866371333599,
-0.04394760727882385,
-0.04233145713806152,
-0.02599826455116272,
0.037511520087718964,
0.023051531985402107,
-0.0028000527527183294,
0.027903776615858078,
0.04980424419045448,
0.03282109275460243,
-0.03605259582400322,
-0.04509812593460083,
-0.013280821964144707,
0.10605405271053314,
-0.01954551413655281,
-0.06261338293552399,
0.07437827438116074,
-0.07414974272251129,
0.06643184274435043,
-0.018073756247758865,
-0.05740508809685707,
-0.06011129915714264,
-0.01097929384559393,
0.031101711094379425,
0.039297088980674744,
0.0004814236890524626,
0.0039635286666452885,
-0.051166731864213943,
-0.02316179685294628,
-0.006590352859348059,
-0.013820437714457512,
-0.003095629857853055,
0.024029405787587166,
-0.02194444090127945,
-0.018887240439653397,
0.03447380289435387,
0.024727713316679,
0.06321939080953598,
-0.0149705084040761,
0.027659323066473007,
-0.0007757049170322716,
-0.0035213185474276543,
-0.049125105142593384,
0.060500115156173706,
0.017165115103125572,
-0.005959291942417622,
0.04543442279100418,
0.06436245888471603,
0.015308106318116188,
0.051142942160367966,
-0.020546063780784607,
-0.010551362298429012,
0.010256156325340271,
-0.0024524556938558817,
0.012095946818590164,
0.013959823176264763,
0.01563791185617447,
0.02222547121345997,
-0.011666314676404,
-0.07718908786773682,
0.05639445781707764,
0.013163448311388493,
-0.004153803922235966,
0.002386105712503195,
0.01829655095934868,
0.020608510822057724,
0.03494226559996605,
0.037757474929094315,
-0.016154678538441658,
-0.03170700743794441,
0.002108957152813673,
-0.049023717641830444,
-0.00683384295552969,
0.009645559825003147,
0.058691855520009995,
-0.02181403525173664,
-0.04799479991197586,
0.02490183152258396,
0.01375076174736023,
2.753051830950426e-7,
0.051306065171957016,
-0.030026940628886223,
0.01707807369530201,
-0.054268501698970795,
-0.02960280515253544,
-0.013861237093806267,
-0.07590743899345398,
-0.023765938356518745,
-0.012410865165293217,
-0.01512734591960907,
-0.013141042552888393,
0.03233439847826958,
-0.004990602843463421,
0.027176881209015846,
-0.010876580141484737,
-0.0013710657367482781,
-0.02857447788119316,
0.051825590431690216,
0.005868661683052778,
0.017448032274842262,
0.019740622490644455,
0.0010923054069280624,
-0.09449104964733124,
-0.02310444973409176,
0.01998349279165268,
-0.006097639910876751,
-0.024031493812799454,
-0.041934628039598465,
-0.08517460525035858,
-0.01686718314886093,
-0.027079349383711815,
-0.03077360801398754,
0.01946789212524891,
0.051086802035570145,
-0.028810245916247368,
-0.007851426489651203,
0.043646831065416336,
0.060752417892217636,
0.0034345982130616903,
0.007809951901435852,
-0.0012869156198576093,
-0.024217460304498672,
0.01701400615274906,
0.03788463771343231,
0.04785303771495819,
0.04596292972564697,
-0.056742098182439804,
0.042897772043943405,
-0.017282206565141678,
0.053417038172483444,
-0.0293961800634861,
0.028821010142564774,
-0.01252120453864336,
0.026637926697731018,
0.015275312587618828,
0.050095848739147186,
-0.06161177158355713,
-0.006185280159115791,
-0.025756701827049255,
-0.07600877434015274,
-0.008471018634736538,
-0.025034230202436447,
-0.02564748004078865,
-0.010493453592061996,
0.036736346781253815,
-0.06782567501068115,
-0.045039769262075424,
2.516088490338748e-34,
-0.029906176030635834,
-0.04169400781393051,
-0.036490608006715775,
-0.04843415692448616,
-0.01309950090944767,
-0.08581559360027313,
-0.020383890718221664,
0.030701950192451477,
0.005480941850692034,
-0.03039240650832653,
-0.029072582721710205
] | {
"ds_index": 40,
"similar_dg_indices": [
422701,
920099,
631716,
582418,
154669,
1002650,
873086,
1140167,
270196,
843784,
871937,
1092054,
455742,
217898,
424406,
834115,
751655,
384735,
1191048,
855399
]
} |
A male neonate is being examined by a pediatrician. His mother informs the doctor that she had a mild fever with rash, muscle pain, and swollen and tender lymph nodes during the second month of gestation. The boy was born at 39 weeks gestation via spontaneous vaginal delivery with no prenatal care. On physical examination, the neonate has normal vital signs. Retinal examination reveals the findings shown in the image. Which of the following congenital heart defects is most likely to be present in this neonate? | Patent ductus arteriosus | {
"A": "Atrial septal defect",
"B": "Ventricular septal defect",
"C": "Tetralogy of Fallot",
"D": "Patent ductus arteriosus"
} | step2&3 | D | [
"male neonate",
"examined",
"pediatrician",
"mother informs",
"doctor",
"mild fever with rash",
"muscle pain",
"swollen",
"tender lymph nodes",
"second month",
"gestation",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"prenatal care",
"physical examination",
"neonate",
"normal vital signs",
"Retinal examination reveals",
"findings shown",
"image",
"following congenital heart defects",
"most likely to",
"present",
"neonate"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A male neonate is being examined by a pediatrician. His mother informs the doctor that she had a mild fever with rash, muscle pain, and swollen and tender lymph nodes during the second month of gestation. The boy was born at 39 weeks gestation via spontaneous vaginal delivery with no prenatal care. On physical examination, the neonate has normal vital signs. Retinal examination reveals the findings shown in the image. Which of the following congenital heart defects is most likely to be present in this neonate?
Choose one of the following::
A. Atrial septal defect
B. Ventricular septal defect
C. Tetralogy of Fallot
D. Patent ductus arteriosus | [
0.01580912247300148,
-0.07834913581609726,
-0.002298747655004263,
0.008542252704501152,
0.005787684582173824,
0.02214844711124897,
-0.036810312420129776,
0.008515052497386932,
-0.01616615056991577,
-0.01642644964158535,
0.028808483853936195,
-0.03639630228281021,
0.03592154383659363,
-0.036028821021318436,
-0.030361328274011612,
-0.03380172327160835,
0.010976004414260387,
-0.03219251334667206,
-0.016734223812818527,
-0.0043886033818125725,
-0.007353673689067364,
0.025589104741811752,
0.04396180063486099,
-0.03659305348992348,
0.013823115266859531,
0.007732574362307787,
-0.006132959388196468,
0.013017108663916588,
-0.024392759427428246,
-0.05405471846461296,
0.002666323911398649,
0.03603009879589081,
0.009718915447592735,
-0.05609114095568657,
0.0000020753732314915396,
0.02052123285830021,
-0.005276729818433523,
-0.01833353191614151,
0.0216667540371418,
-0.033627599477767944,
-0.01047587115317583,
-0.08557475358247757,
0.026582645252346992,
0.004578762222081423,
-0.05025355517864227,
-0.08671984821557999,
-0.003340959781780839,
0.05382896959781647,
-0.06545083224773407,
-0.018943917006254196,
0.032563500106334686,
0.0674855038523674,
-0.006901035085320473,
0.009902269579470158,
0.04315918684005737,
-0.027590598911046982,
-0.028865572065114975,
0.011991973966360092,
-0.005949385929852724,
0.023424355313181877,
0.006883712951093912,
0.029744232073426247,
0.03621801361441612,
-0.0007911128923296928,
0.016110774129629135,
-0.05960314720869064,
0.02400273084640503,
-0.08296952396631241,
0.011494905687868595,
0.04222699627280235,
-0.012680206447839737,
0.007751818280667067,
0.006332249380648136,
0.04742296785116196,
-0.060228392481803894,
-0.03456015884876251,
0.04535538703203201,
0.05181508883833885,
0.006445417646318674,
-0.012013855390250683,
0.033779896795749664,
-0.014997250400483608,
-0.010095829144120216,
0.018481874838471413,
0.02398565411567688,
-0.07927355915307999,
0.010220278985798359,
-0.0223146490752697,
-0.003588235005736351,
0.017531398683786392,
0.0325399674475193,
-0.06603383272886276,
-0.03504409268498421,
0.007835808210074902,
-0.026373112574219704,
0.03376087546348572,
-0.0665673241019249,
0.044180721044540405,
0.0025493036955595016,
-0.025265466421842575,
-0.009439737536013126,
-0.06744068115949631,
0.008064470253884792,
0.015805890783667564,
-0.04490378126502037,
-0.03549841791391373,
0.0033281883224844933,
0.04850657656788826,
-0.01934701018035412,
0.053271010518074036,
0.014285111799836159,
0.01193846482783556,
-0.01367870531976223,
0.05087637901306152,
0.03979525715112686,
0.009534410201013088,
-0.018575482070446014,
-0.043458543717861176,
0.03117016889154911,
0.03651650995016098,
-0.003837907686829567,
0.007266806438565254,
-0.00878223404288292,
0.027859102934598923,
-0.07369759678840637,
-0.019207850098609924,
0.04396717995405197,
-0.012850429862737656,
-0.025223392993211746,
-0.01569223217666149,
0.013015029020607471,
-0.014920090325176716,
-0.01753552258014679,
0.07071187347173691,
0.033564161509275436,
-0.01982858031988144,
0.005421615671366453,
0.0348644033074379,
-0.028497543185949326,
0.019569240510463715,
-0.010613114573061466,
-0.06247224658727646,
-0.0264013409614563,
0.03455746918916702,
-0.028721239417791367,
0.023111999034881592,
0.0011545810848474503,
0.01344594918191433,
0.04808005690574646,
0.06397217512130737,
0.006301717832684517,
-0.022643180564045906,
-0.0219674501568079,
0.004642939195036888,
-0.019922854378819466,
0.05968138203024864,
0.05028755962848663,
0.01149536482989788,
-0.00537081016227603,
-0.05846352130174637,
0.01975286938250065,
-0.014483192004263401,
0.030741063877940178,
-0.0194576196372509,
-0.002038742881268263,
-0.005327293649315834,
0.039823539555072784,
0.00824760552495718,
-0.034917332231998444,
0.011992423795163631,
-0.014722682535648346,
-0.022475216537714005,
-0.002012180397287011,
-0.02220723032951355,
-0.0013610076857730746,
0.042027849704027176,
-0.03572458401322365,
-0.05921875685453415,
0.037547316402196884,
-0.034006524831056595,
0.04563441872596741,
0.007389616686850786,
0.03407828509807587,
0.005183173809200525,
0.02568480372428894,
0.0018669560085982084,
-0.10650331526994705,
-0.05435516685247421,
0.017243538051843643,
-0.041985608637332916,
-0.04996357858181,
0.018069418147206306,
-0.017293069511651993,
-0.025389667600393295,
0.004462155047804117,
0.07239153236150742,
-0.034100327640771866,
-0.00008973168587544933,
-0.036894820630550385,
0.031432248651981354,
-0.03564387187361717,
-0.02974409982562065,
-0.01928083226084709,
0.014627117663621902,
-0.0289032943546772,
0.039304014295339584,
-0.029870593920350075,
0.04830684885382652,
-0.10682659596204758,
-0.005141625180840492,
0.0316414013504982,
0.0031836091075092554,
0.052557818591594696,
-0.004316792823374271,
0.01447133906185627,
0.04124261066317558,
-0.02483055740594864,
0.033376336097717285,
-0.06916887313127518,
-0.011467852629721165,
-0.03341468423604965,
0.0069222417660057545,
-0.027021484449505806,
0.01878518983721733,
0.011693373322486877,
0.008851906284689903,
0.009514311328530312,
0.03181024268269539,
0.010266121476888657,
-0.06874820590019226,
0.037905775010585785,
0.003590586129575968,
-0.036820948123931885,
0.08842781186103821,
-0.030413290485739708,
0.020131172612309456,
-0.018370209261775017,
-0.04238513484597206,
0.037568625062704086,
-0.057218801230192184,
-0.06813821941614151,
-0.024510633200407028,
-0.028399834409356117,
-0.00951691996306181,
0.03170878067612648,
-0.02273644134402275,
-0.025332137942314148,
0.0017530644545331597,
0.04213116317987442,
0.003373076906427741,
-0.021075589582324028,
0.022156912833452225,
0.02272242307662964,
0.02521168440580368,
0.004276766907423735,
-0.0027011684142053127,
-0.025259869173169136,
0.0163718294352293,
-0.03194614499807358,
-0.06022752448916435,
-0.057792749255895615,
-0.015457886271178722,
-0.01417786255478859,
-0.03270719572901726,
0.010328833013772964,
-0.029773296788334846,
0.006732026115059853,
0.007656096015125513,
0.01831783354282379,
0.04817814379930496,
-0.0012712718453258276,
0.03438015282154083,
0.007983540184795856,
0.003198114223778248,
-0.006677969358861446,
0.02607438527047634,
-0.02658003196120262,
0.029225928708910942,
0.025513168424367905,
0.02580556459724903,
-0.009475979022681713,
0.057934027165174484,
0.009549552574753761,
0.01770542748272419,
-0.004291958641260862,
0.0004260456480551511,
0.02617041952908039,
0.053427137434482574,
0.042623598128557205,
-0.0006860098801553249,
-0.03995765000581741,
0.019823171198368073,
0.04316425323486328,
-0.021277567371726036,
0.03088507615029812,
0.016733866184949875,
-0.04901744797825813,
0.05331731215119362,
-0.04678284749388695,
0.10929380357265472,
-0.041304901242256165,
0.030752724036574364,
0.020517321303486824,
0.011419255286455154,
0.016828620806336403,
0.0404319129884243,
0.05805158242583275,
0.013758055865764618,
-0.03902497887611389,
0.044718511402606964,
0.038841791450977325,
-0.02215135656297207,
0.01273839920759201,
0.015040058642625809,
-0.019294636324048042,
0.0009200664353556931,
-0.06927670538425446,
-0.07145647704601288,
0.0336887501180172,
0.1053057387471199,
0.05991100147366524,
-0.014105791226029396,
-0.04013480618596077,
-0.003765701549127698,
0.020094171166419983,
-0.023837601765990257,
-0.010647943243384361,
0.007157504558563232,
-0.027134785428643227,
-0.04792199283838272,
0.011315777897834778,
-0.027713598683476448,
-0.054786186665296555,
-0.06902903318405151,
0.06380092352628708,
0.057526227086782455,
-0.018440818414092064,
0.028048602864146233,
-0.05342891439795494,
0.012461191043257713,
-0.0034620892256498337,
-0.02950064092874527,
0.013542963191866875,
0.03314029797911644,
0.018929414451122284,
-0.023187942802906036,
-0.030071184039115906,
-0.023745330050587654,
-0.054262835532426834,
0.012378877028822899,
-0.08859747648239136,
-0.009880742989480495,
-0.000023951572075020522,
-0.013380678370594978,
-0.03613175079226494,
0.007574970368295908,
0.021352453157305717,
-0.03375479206442833,
0.029650390148162842,
-0.015787187963724136,
-0.034574754536151886,
0.0318068191409111,
-0.03418363258242607,
0.09481483697891235,
-0.018750770017504692,
-0.011885061860084534,
-0.0015225388342514634,
0.022676710039377213,
0.015061993151903152,
-0.020999787375330925,
0.013591712340712547,
-0.007947473786771297,
0.01816411316394806,
0.008348705247044563,
-0.010758661665022373,
0.035055458545684814,
-0.010744166560471058,
0.022314395755529404,
-0.06771547347307205,
0.006383994128555059,
0.04326590895652771,
-0.04927697405219078,
0.05620582029223442,
0.020870961248874664,
-0.030944280326366425,
0.008969809859991074,
-0.04378161579370499,
-0.017431071028113365,
0.036366939544677734,
0.06816419214010239,
-0.013450808823108673,
0.05091887339949608,
-0.07696797698736191,
-0.02161509543657303,
-0.009328844957053661,
0.051627617329359055,
-0.02851169742643833,
-0.053446635603904724,
0.01500210165977478,
0.0179053395986557,
-0.026962604373693466,
0.02595449425280094,
-0.0007793109980411828,
0.07035905122756958,
0.06293296813964844,
-0.028279753401875496,
-0.042574185878038406,
-0.06679239869117737,
0.011488026939332485,
0.06340643763542175,
-0.015156891196966171,
-0.002780541777610779,
0.0003627287514973432,
0.02727457508444786,
-0.022311313077807426,
0.01368749886751175,
-0.005284999962896109,
-0.07278813421726227,
0.0034988950937986374,
0.007155951112508774,
0.03989347070455551,
-0.012113124132156372,
-0.014390012249350548,
-0.012697076424956322,
-0.03537603095173836,
-0.0004491678555496037,
0.07950090616941452,
0.005614148452877998,
0.013463094830513,
0.02658935822546482,
0.00031959975603967905,
-0.017645925283432007,
0.05297614634037018,
0.0389576219022274,
-0.009457762353122234,
0.013035504147410393,
0.00042885675793513656,
-0.03941850736737251,
0.001727607101202011,
-0.02860189415514469,
-0.01776478998363018,
-0.027133794501423836,
0.022869056090712547,
0.05290917307138443,
-0.03731090575456619,
0.06702256947755814,
0.02923579327762127,
-0.0016830774256959558,
0.0456392876803875,
0.06378226727247238,
-0.03556222468614578,
-0.03625946491956711,
0.0075878603383898735,
0.007091184612363577,
-0.016453249379992485,
0.007453050464391708,
-0.022343099117279053,
-0.026501379907131195,
0.050012677907943726,
-0.08606374263763428,
-0.04134759679436684,
0.0007332841050811112,
-0.026270320639014244,
-0.09741531312465668,
0.038728270679712296,
-0.041464801877737045,
0.002124988939613104,
0.01512082014232874,
-0.021940261125564575,
-0.02307642437517643,
-0.047765765339136124,
0.02510574273765087,
0.009718382731080055,
0.011843382380902767,
-0.033211227506399155,
0.014198108576238155,
-0.04866298288106918,
0.016401711851358414,
0.04098999500274658,
0.010048805736005306,
0.012976963073015213,
0.07060946524143219,
-0.03521187976002693,
-0.022078363224864006,
-0.007165824994444847,
-0.0005234583513811231,
0.01811680756509304,
0.010711172595620155,
-0.014897949062287807,
0.06093953549861908,
-0.014236520044505596,
0.006460489705204964,
-0.02129954844713211,
-0.06425702571868896,
-0.03432239964604378,
-0.036092258989810944,
0.004257149063050747,
0.11614825576543808,
0.044781483709812164,
-0.016763251274824142,
0.018717681989073753,
0.03865036740899086,
0.04192759096622467,
-0.0053107477724552155,
0.0445602647960186,
0.04518035799264908,
-0.005047464277595282,
-0.017000706866383553,
-0.046072158962488174,
-0.03401947394013405,
-0.011264888569712639,
-0.01628413423895836,
0.07264714688062668,
0.04902036115527153,
-0.024243727326393127,
-0.011194844730198383,
-0.06328930705785751,
-0.003864782862365246,
-0.08877639472484589,
0.008957413956522942,
-0.016315940767526627,
0.02501761168241501,
-0.021807245910167694,
-0.032151348888874054,
-0.01381183136254549,
0.08038245886564255,
0.013888971880078316,
-0.0027658746112138033,
0.011744641698896885,
0.048027683049440384,
-0.04719671979546547,
-0.027862271293997765,
0.002723966259509325,
-0.005626845173537731,
-0.02577444352209568,
0.02607109025120735,
0.03648575767874718,
-0.03951980173587799,
0.02497791312634945,
0.006321300286799669,
-0.024346178397536278,
-0.049948662519454956,
0.0347050204873085,
0.03011169470846653,
-0.014824101701378822,
0.028902459889650345,
-0.01586613431572914,
0.0176443662494421,
0.03200883790850639,
0.017593787983059883,
0.00788811407983303,
0.0063642216846346855,
0.0230106133967638,
0.030943166464567184,
0.06910454481840134,
-5.69344186867647e-33,
-0.003785651409998536,
-0.02151690237224102,
0.06398551166057587,
-0.08780352026224136,
0.03495467081665993,
0.07915674149990082,
0.00481679942458868,
-0.02427862584590912,
-0.07676643133163452,
0.002733600093051791,
-0.040709130465984344,
-0.009662921540439129,
0.02459225431084633,
0.05566698685288429,
0.007474199868738651,
-0.0778735876083374,
-0.025859063491225243,
-0.03093549609184265,
-0.02304648607969284,
-0.011281129904091358,
-0.056110505014657974,
-0.02113931253552437,
0.014974917285144329,
-0.047846611589193344,
-0.026685111224651337,
-0.04953659325838089,
0.017720676958560944,
0.03244675323367119,
0.03996945545077324,
0.024051934480667114,
0.0074769421480596066,
-0.03653082996606827,
-0.021693505346775055,
-0.06601870059967041,
-0.04912935569882393,
-0.07601042836904526,
0.019514648243784904,
-0.028540965169668198,
0.03345101326704025,
-0.011866752989590168,
-0.06332339346408844,
0.03598233312368393,
-0.00508269714191556,
0.03899058699607849,
0.05696665868163109,
-0.061068177223205566,
-0.030180959030985832,
-0.022086836397647858,
-0.014589150436222553,
-0.03940124064683914,
0.000605688663199544,
0.02056720294058323,
-0.00903400033712387,
0.014260360039770603,
-0.033501166850328445,
-0.042200539261102676,
-0.024623744189739227,
0.031238894909620285,
-0.008436434902250767,
0.028962483629584312,
0.04814865067601204,
-0.01102984044700861,
0.006454266607761383,
-0.06484584510326385,
-0.002783902920782566,
-0.013413828797638416,
0.06751088798046112,
0.02001325786113739,
-0.02399948239326477,
0.08795075118541718,
-0.037655122578144073,
0.0699772834777832,
-0.003567896317690611,
-0.06680034846067429,
-0.0469062440097332,
-0.036611925810575485,
-0.015645697712898254,
-0.006409585941582918,
-0.004942912142723799,
0.038280945271253586,
-0.06290420144796371,
-0.018429508432745934,
-0.022543704137206078,
0.0003899353905580938,
-0.029966577887535095,
-0.04656202718615532,
0.008468888700008392,
0.009736858308315277,
0.043103914707899094,
-0.009530026465654373,
0.09590572863817215,
-0.0015552493277937174,
-0.011975733563303947,
-0.03208553045988083,
-0.023918315768241882,
-0.02616625651717186,
0.11186109483242035,
0.01006365567445755,
-0.009533056989312172,
0.011892042122781277,
0.11238273233175278,
-0.0017356722382828593,
0.045350123196840286,
-0.0043061221949756145,
-0.007910237647593021,
-0.020093459635972977,
0.006376857403665781,
0.015356950461864471,
-0.06921453773975372,
0.0008049919852055609,
0.019008811563253403,
-0.02834145538508892,
0.04894768074154854,
-0.017943350598216057,
-0.04085404425859451,
0.0031346436589956284,
0.025370411574840546,
0.03160833939909935,
0.005820269696414471,
0.05824928730726242,
0.00527549022808671,
0.03208988904953003,
-0.038271043449640274,
0.0024116558488458395,
-0.020131785422563553,
-0.04736895486712456,
0.011362829245626926,
0.05288189649581909,
0.0038828502874821424,
0.014950500801205635,
0.023645661771297455,
0.042725566774606705,
2.7923010748054367e-7,
0.0024806049186736345,
0.028162656351923943,
-0.0373661071062088,
-0.10019868612289429,
0.029924461618065834,
-0.01874672807753086,
0.006638264283537865,
0.004053790122270584,
0.016386093571782112,
0.028772279620170593,
0.05245506763458252,
0.02144300937652588,
-0.005007595289498568,
-0.006068266928195953,
-0.008533364161849022,
0.03448908030986786,
-0.0011158972047269344,
0.022577309980988503,
0.036928173154592514,
-0.0004710932553280145,
-0.02838439680635929,
0.026927031576633453,
-0.10396236926317215,
0.03204512223601341,
0.012978835962712765,
0.03375445306301117,
-0.03579210862517357,
-0.02517509087920189,
-0.04979919642210007,
0.00832286849617958,
-0.019413096830248833,
0.03724996745586395,
0.06624562293291092,
0.029649846255779266,
-0.03797297179698944,
0.0059251924976706505,
0.0304229985922575,
0.043366413563489914,
-0.007179782725870609,
0.02622172236442566,
-0.015458331443369389,
0.05033471807837486,
0.02434084378182888,
0.012804228812456131,
-0.00799284502863884,
0.030577795580029488,
-0.02365507185459137,
-0.008163519203662872,
0.0221794955432415,
-0.01763652265071869,
-0.025363825261592865,
0.02844160422682762,
0.022068342193961143,
0.06497332453727722,
0.007814747281372547,
-0.007539863232523203,
-0.03442373871803284,
0.002670563291758299,
0.04551750048995018,
0.0011509611504152417,
0.03022029995918274,
-0.05145828053355217,
0.04042912274599075,
0.03620288893580437,
0.05073043331503868,
0.01296736765652895,
-0.04662015289068222,
1.8371722000886095e-34,
-0.029335876926779747,
-0.056363873183727264,
-0.04193752259016037,
-0.022079162299633026,
0.034969352185726166,
-0.03606226295232773,
-0.024404171854257584,
-0.004926580935716629,
-0.014637794345617294,
-0.006278471555560827,
0.005382576957345009
] | {
"ds_index": 41,
"similar_dg_indices": [
141113,
763245,
125515,
942733,
399651,
527415,
334535,
303914,
1124099,
718109,
644443,
449255,
385336,
682557,
252054,
1110829,
824579,
350396,
203818,
174981
]
} |
A 4-year-old boy is brought to the emergency department by his parents. He is lethargic and confused and has a severe headache, vomiting, and a high-grade fever since earlier that day. His mother reports that the child was doing well until 2 days ago when he developed a fever and green nasal discharge. The patient has a history of neonatal sepsis, meningococcemia at 18 months of age, and pneumococcal pneumonia at 2 and 3 years of age. His scheduled vaccinations are up to date. His blood pressure is 70/50 mm Hg, heart rate is 120/min, respiratory rate is 22/min, and temperature is 39.3°C (102.4°F). On examination, the child is lethargic and his skin is pale, with several petechiae over his buttocks. There is a purulent nasal discharge from both nostrils. The lungs are clear to auscultation bilaterally. Heart sounds are normal. There is marked neck rigidity. Cerebrospinal fluid analysis shows the following results:
Opening pressure 100 mm H2O
Appearance cloudy
Protein 500 mg/dL (5 g/L)
White blood cells 2500/μL (polymorphonuclear predominance)
Protein 450 mg/dL (4.5 g/L)
Glucose 31 mg/dL (1.7 mmol/L)
Culture positive for N. meningitidis
Which of the following immunological processes is most likely to be impaired in this child? | Formation of C5-9 complex | {
"A": "Production of IL-2 by Th1 cells",
"B": "Activation of TCRs by MHC-II",
"C": "Formation of C5-9 complex",
"D": "Cleavage of C2 component of complement into C2a and C2b"
} | step1 | C | [
"4 year old boy",
"brought",
"emergency department",
"parents",
"lethargic",
"confused",
"severe headache",
"vomiting",
"high-grade fever since earlier",
"day",
"mother reports",
"child",
"well",
"2 days",
"fever",
"green nasal discharge",
"patient",
"history of neonatal sepsis",
"meningococcemia",
"months",
"age",
"pneumococcal pneumonia",
"3 years",
"age",
"scheduled vaccinations",
"date",
"blood pressure",
"70 50 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"3C",
"4F",
"examination",
"child",
"lethargic",
"skin",
"pale",
"several petechiae",
"buttocks",
"purulent nasal discharge",
"nostrils",
"lungs",
"clear",
"auscultation",
"Heart sounds",
"normal",
"marked neck rigidity",
"Cerebrospinal fluid analysis shows",
"following results",
"Opening pressure 100 mm H2O Appearance cloudy Protein 500 mg/dL",
"5 g/L",
"White blood cells 2500 L",
"predominance",
"Protein 450 mg/dL",
"4.5 g/L",
"Glucose 31 mg/dL",
"1.7 mmol/L",
"Culture positive",
"N",
"meningitidis",
"following immunological processes",
"most likely to",
"impaired",
"child"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 4-year-old boy is brought to the emergency department by his parents. He is lethargic and confused and has a severe headache, vomiting, and a high-grade fever since earlier that day. His mother reports that the child was doing well until 2 days ago when he developed a fever and green nasal discharge. The patient has a history of neonatal sepsis, meningococcemia at 18 months of age, and pneumococcal pneumonia at 2 and 3 years of age. His scheduled vaccinations are up to date. His blood pressure is 70/50 mm Hg, heart rate is 120/min, respiratory rate is 22/min, and temperature is 39.3°C (102.4°F). On examination, the child is lethargic and his skin is pale, with several petechiae over his buttocks. There is a purulent nasal discharge from both nostrils. The lungs are clear to auscultation bilaterally. Heart sounds are normal. There is marked neck rigidity. Cerebrospinal fluid analysis shows the following results:
Opening pressure 100 mm H2O
Appearance cloudy
Protein 500 mg/dL (5 g/L)
White blood cells 2500/μL (polymorphonuclear predominance)
Protein 450 mg/dL (4.5 g/L)
Glucose 31 mg/dL (1.7 mmol/L)
Culture positive for N. meningitidis
Which of the following immunological processes is most likely to be impaired in this child?
Choose one of the following::
A. Production of IL-2 by Th1 cells
B. Activation of TCRs by MHC-II
C. Formation of C5-9 complex
D. Cleavage of C2 component of complement into C2a and C2b | [
0.02634577453136444,
-0.05339605361223221,
0.04130436107516289,
0.025678511708974838,
0.0014462702674791217,
0.00060378632042557,
-0.003270300105214119,
0.030894583091139793,
-0.011762515641748905,
-0.007111932151019573,
0.014630816876888275,
-0.006336331367492676,
0.0664476826786995,
-0.021967917680740356,
0.03862655162811279,
0.011432475410401821,
-0.00781461875885725,
-0.03489923104643822,
-0.03164747729897499,
0.03111816756427288,
-0.021524090319871902,
0.03712659701704979,
0.005470577161759138,
0.0029783814679831266,
0.06715047359466553,
-0.03341472148895264,
-0.03283887729048729,
-0.02508280612528324,
0.03296481817960739,
-0.08937311172485352,
0.014764932915568352,
-0.06114853918552399,
-0.010536707937717438,
-0.09695716202259064,
0.000002076892315017176,
0.0285489559173584,
0.016703322529792786,
-0.01038611400872469,
0.04417712613940239,
-0.053057711571455,
0.01118265837430954,
-0.031395018100738525,
0.04341697320342064,
0.02317935600876808,
-0.044237930327653885,
-0.09676841646432877,
0.009905991144478321,
0.06670361012220383,
-0.01842609979212284,
0.00633326405659318,
0.029295597225427628,
0.04219391942024231,
-0.039600685238838196,
0.0011916024377569556,
0.03331311419606209,
-0.059668682515621185,
-0.00902702659368515,
0.04407288879156113,
0.055586960166692734,
-0.01886705495417118,
-0.012099393643438816,
-0.010713744908571243,
-0.004432876594364643,
-0.05813756585121155,
-0.053133342415094376,
-0.01311770174652338,
0.05966736748814583,
-0.04637664929032326,
0.03581804782152176,
-0.0001507010601926595,
0.01711040921509266,
-0.02650110423564911,
0.039633315056562424,
0.04400710016489029,
-0.02116357907652855,
-0.04614102840423584,
0.02701392024755478,
-0.011944442056119442,
-0.019031384959816933,
0.007264654152095318,
0.05866575241088867,
0.04062454029917717,
0.0037621213123202324,
0.006971269845962524,
0.04124731570482254,
-0.0031919239554554224,
-0.04292060434818268,
-0.038340650498867035,
-0.0028711799532175064,
-0.023410620167851448,
-0.02396431937813759,
-0.06882425397634506,
-0.007463016081601381,
0.05010761320590973,
-0.08624385297298431,
-0.030943380668759346,
0.0048833382315933704,
-0.011765246279537678,
0.04336760938167572,
-0.017930762842297554,
-0.04500684514641762,
-0.07875115424394608,
0.048698075115680695,
0.04540863633155823,
-0.06853725016117096,
-0.057040516287088394,
0.0037876134738326073,
-0.021384194493293762,
-0.027681099250912666,
-0.006466098129749298,
-0.01048356294631958,
-0.014913439750671387,
-0.08713983744382858,
-0.00879700854420662,
0.07560189813375473,
0.03278609737753868,
-0.051523711532354355,
-0.04398932680487633,
-0.008539182133972645,
0.015844713896512985,
0.0011651546228677034,
0.013972255401313305,
0.015976428985595703,
0.05741479992866516,
0.01658906787633896,
0.03590312600135803,
-0.01798425056040287,
-0.037844348698854446,
-0.006641719955950975,
0.016462471336126328,
0.00328105129301548,
-0.0336802639067173,
-0.022227536886930466,
0.0475931391119957,
0.05438590422272682,
0.030027417466044426,
0.03065459057688713,
0.0519406683743,
0.0018834734801203012,
0.04254262521862984,
-0.006821867078542709,
-0.013180823996663094,
-0.038538575172424316,
-0.006589822005480528,
-0.0427747517824173,
0.06953185796737671,
0.00648145517334342,
-0.0037117833271622658,
-0.03703495115041733,
0.009517090395092964,
-0.055414699018001556,
-0.0303504578769207,
-0.021904850378632545,
-0.0032850184943526983,
0.03879161179065704,
-0.008039555512368679,
0.000986039056442678,
-0.02270660735666752,
-0.01344746258109808,
-0.07700709998607635,
0.0496210977435112,
-0.02337772771716118,
-0.012060664594173431,
-0.021010328084230423,
-0.033967290073633194,
0.04792950674891472,
-0.016104556620121002,
-0.004522228613495827,
-0.011170384474098682,
0.026667369529604912,
-0.014894247986376286,
0.006010860204696655,
0.04012911021709442,
-0.041286833584308624,
-0.025783637538552284,
0.02536786161363125,
-0.0688856840133667,
-0.10798851400613785,
0.006008615717291832,
0.02796887792646885,
0.028571199625730515,
0.023230303078889847,
0.07729994505643845,
0.014816676266491413,
0.02508068084716797,
0.0017473084153607488,
0.007935873232781887,
-0.011379311792552471,
0.006551034282892942,
-0.04222797229886055,
-0.031672317534685135,
0.02723022922873497,
-0.016714615747332573,
-0.0015793965430930257,
-0.01417034212499857,
0.039606958627700806,
-0.058922696858644485,
-0.018361764028668404,
0.009001151658594608,
-0.010277513414621353,
0.03627762198448181,
-0.04354832321405411,
0.040637388825416565,
0.05669434741139412,
-0.0697011724114418,
0.0754467099905014,
-0.02338026836514473,
-0.011895755305886269,
-0.041358597576618195,
-0.012949525378644466,
-0.04436276853084564,
-0.02026684209704399,
0.05319458618760109,
-0.037937067449092865,
0.014476570300757885,
-0.013933996669948101,
0.0057727620005607605,
0.029827240854501724,
-0.020143846049904823,
0.011279355734586716,
0.008856119588017464,
0.038777779787778854,
0.01101486012339592,
-0.00014098119572736323,
-0.01266991626471281,
0.01349746622145176,
0.03795582428574562,
0.005669717211276293,
0.0028903919737786055,
-0.060737647116184235,
0.03641527146100998,
0.018131833523511887,
-0.02582838572561741,
0.013250037096440792,
0.0021572548430413008,
0.02460337057709694,
0.021983962506055832,
-0.018178479745984077,
-0.032078709453344345,
0.04680182784795761,
-0.07937223464250565,
0.007686374709010124,
-0.030976882204413414,
-0.005609805230051279,
-0.005072851199656725,
0.01901983842253685,
-0.038322530686855316,
0.04190004616975784,
-0.050200093537569046,
0.042489249259233475,
-0.06536412984132767,
0.00681509543210268,
-0.008199989795684814,
-0.0036560583394020796,
0.004249428398907185,
0.05018403381109238,
-0.03519469127058983,
-0.031857386231422424,
-0.04761044308543205,
-0.08142198622226715,
-0.046815402805805206,
0.013272157870233059,
-0.012686784379184246,
-0.042691320180892944,
-0.10132020711898804,
0.02826937474310398,
0.06227622553706169,
-0.04073662310838699,
0.0033208229579031467,
0.027343610301613808,
0.025072861462831497,
0.05421791598200798,
0.05010240152478218,
-0.006916866172105074,
-0.0068716914393007755,
0.0031870570965111256,
-0.011543160304427147,
0.014520936645567417,
0.03771244361996651,
-0.015732888132333755,
-0.03321582078933716,
0.06743814796209335,
-0.021653344854712486,
0.0763804093003273,
-0.03846722096204758,
0.004137532319873571,
-0.027166327461600304,
-0.03982769697904587,
0.017476847395300865,
-0.017557524144649506,
-0.028566516935825348,
0.01242110040038824,
-0.004294718615710735,
-0.01843428425490856,
0.027399782091379166,
-0.06755389273166656,
-0.02596307173371315,
0.04300986975431442,
-0.014854015782475471,
0.020088212564587593,
0.0048202634789049625,
0.07121679186820984,
-0.019015364348888397,
0.04957510530948639,
0.04233066365122795,
0.05740966275334358,
0.02550509385764599,
-0.0006648054113611579,
-0.01684744656085968,
0.08441765606403351,
0.07778284698724747,
0.012617587111890316,
0.009191916324198246,
0.04568363353610039,
-0.03493644669651985,
0.012315553613007069,
-0.045528825372457504,
-0.06266475468873978,
0.01449055876582861,
-0.006699987221509218,
-0.007209054194390774,
-0.00586882047355175,
-0.050826217979192734,
0.008491719141602516,
-0.02171710692346096,
-0.0104747973382473,
-0.029714956879615784,
-0.001985749462619424,
-0.015297883190214634,
-0.03245468810200691,
-0.0098812161013484,
-0.001296691014431417,
-0.01606115698814392,
0.02151472494006157,
0.015454803593456745,
0.015646450221538544,
-0.03729230910539627,
0.007496141362935305,
-0.023048903793096542,
-0.01303158886730671,
0.025409836322069168,
-0.021959936246275902,
0.03397073596715927,
0.07030720263719559,
-0.01137569360435009,
-0.008564113639295101,
-0.08816062659025192,
-0.0030398492235690355,
-0.014910932630300522,
0.04752373695373535,
-0.07257629930973053,
0.00264654029160738,
-0.015685614198446274,
-0.018863989040255547,
0.0026583848521113396,
-0.0084616020321846,
0.018363408744335175,
0.03723956272006035,
-0.04574442282319069,
-0.015487327240407467,
-0.018771983683109283,
0.04499231278896332,
-0.030578553676605225,
0.08705490827560425,
-0.028547173365950584,
-0.043035998940467834,
-0.036551833152770996,
0.026706872507929802,
-0.00904678925871849,
-0.002066501649096608,
0.012846413068473339,
-0.01258251816034317,
-0.0033910595811903477,
0.007427604869008064,
-0.01353707816451788,
0.026809552684426308,
-0.033297348767519,
-0.06953461468219757,
-0.05745061859488487,
-0.05235907807946205,
0.013781975954771042,
0.027657654136419296,
0.0005045657162554562,
0.0120075773447752,
-0.027601277455687523,
0.0404159240424633,
-0.05665948614478111,
-0.02380487322807312,
0.07713645696640015,
0.01091662049293518,
-0.001375099178403616,
-0.0450330525636673,
-0.03192979469895363,
-0.04740389063954353,
-0.036015529185533524,
0.009140389040112495,
0.03962313383817673,
-0.005367308855056763,
0.04446164146065712,
0.07037553936243057,
-0.00693797180429101,
0.06744576245546341,
-0.007711632177233696,
0.0694708600640297,
0.026335515081882477,
-0.035007067024707794,
-0.021448304876685143,
-0.012494262307882309,
0.022799106314778328,
0.018273593857884407,
-0.0010096272453665733,
-0.03593422472476959,
0.029030580073595047,
-0.03700649365782738,
-0.009348135441541672,
-0.05619177222251892,
-0.008618987165391445,
-0.04808371886610985,
-0.03251351788640022,
-0.046390850096940994,
0.041739579290151596,
0.025008942931890488,
-0.0037627406418323517,
-0.016654863953590393,
-0.021042343229055405,
-0.003997999709099531,
0.04890608787536621,
0.022469548508524895,
0.040201373398303986,
0.03196735307574272,
-0.03063930757343769,
-0.008330772630870342,
0.014118779450654984,
0.07781536132097244,
-0.014525636099278927,
-0.01854114979505539,
-0.026377690955996513,
-0.006233436055481434,
0.00571459298953414,
-0.030922891572117805,
0.06276631355285645,
-0.013402743265032768,
0.06943035870790482,
0.021028287708759308,
0.012350804172456264,
0.005037620197981596,
-0.007450909353792667,
-0.0058800233528018,
-0.01228597853332758,
0.08354947715997696,
0.01975119300186634,
-0.05222426354885101,
0.0046678087674081326,
0.06537296622991562,
0.07016211748123169,
0.025652198120951653,
0.023564618080854416,
-0.040367234498262405,
-0.014226759783923626,
-0.02960306592285633,
-0.059548839926719666,
0.015538154169917107,
-0.015609540045261383,
0.007179807405918837,
0.046830687671899796,
-0.05934280529618263,
-0.04012104496359825,
0.05652447044849396,
-0.04272671043872833,
-0.00490165688097477,
-0.01711377501487732,
0.03899207338690758,
-0.005803470499813557,
-0.029741959646344185,
0.012240718118846416,
-0.03988480940461159,
-0.00830091629177332,
-0.005298740696161985,
0.009134698659181595,
-0.007944601587951183,
-0.027272360399365425,
0.011350172571837902,
-0.07105956971645355,
-0.05850592628121376,
-0.015427745878696442,
0.006452790927141905,
0.07574400305747986,
-0.007412773557007313,
0.0016192261828109622,
0.016360871493816376,
0.042441532015800476,
0.060548633337020874,
-0.03027009405195713,
-0.013165661133825779,
-0.046443477272987366,
0.003960737492889166,
0.027126198634505272,
0.09501831978559494,
0.03965413197875023,
0.04008462652564049,
0.06516151875257492,
-0.007342408876866102,
0.04629465937614441,
0.02173115499317646,
0.026841266080737114,
0.004445880651473999,
0.022590644657611847,
0.007431932259351015,
0.007392286788672209,
-0.008018158376216888,
0.010942804627120495,
0.00013560574734583497,
0.01856290176510811,
0.06824451684951782,
0.022230472415685654,
-0.02668038383126259,
-0.07264164835214615,
0.0013385605998337269,
0.013034984469413757,
0.025363344699144363,
0.048251889646053314,
-0.004754072055220604,
0.008023816160857677,
-0.012325173243880272,
0.009685380384325981,
0.06120365858078003,
-0.006565386429429054,
-0.005817108321934938,
0.01943136937916279,
0.03445231541991234,
0.005479016806930304,
0.014815956354141235,
-0.015052704140543938,
-0.010858193971216679,
0.0060228691436350346,
-0.02080686017870903,
0.012182972393929958,
0.011053851805627346,
-0.05072471499443054,
-0.008359075523912907,
0.04312031716108322,
0.012417664751410484,
-0.0054059321992099285,
-0.052631814032793045,
0.036067746579647064,
0.05151011422276497,
-0.07304359972476959,
-0.025167565792798996,
0.0231026578694582,
0.009135499596595764,
0.010376358404755592,
0.0671294555068016,
0.04550689831376076,
0.038015369325876236,
-0.0030708557460457087,
-5.3551114519647835e-33,
0.047266535460948944,
-0.058480653911828995,
0.061958786100149155,
-0.0038494339678436518,
0.0484909750521183,
0.06717901676893234,
-0.03131011873483658,
-0.030589483678340912,
-0.060010213404893875,
-0.007004026789218187,
-0.008711336180567741,
-0.04026305675506592,
0.021149229258298874,
0.03857067599892616,
0.03372927010059357,
0.014184036292135715,
0.007281649392098188,
0.015088926069438457,
-0.06936382502317429,
-0.06351395696401596,
-0.0006470727967098355,
-0.053034648299217224,
0.04226816073060036,
-0.050874460488557816,
-0.019154317677021027,
-0.06205280125141144,
0.08204557001590729,
-0.011946151964366436,
-0.0307178758084774,
0.02909475564956665,
0.05281106382608414,
-0.07873131334781647,
0.02973795495927334,
0.021580122411251068,
0.02132243476808071,
-0.037379294633865356,
-0.05526962876319885,
-0.0031986236572265625,
0.06825259327888489,
-0.009862222708761692,
-0.0878078043460846,
-0.035278648138046265,
0.05391727760434151,
0.02579084224998951,
0.07247977703809738,
-0.024026768282055855,
-0.011627377942204475,
-0.013064810074865818,
0.005118763539940119,
-0.002405337756499648,
-0.01857130229473114,
0.044758390635252,
0.03808622062206268,
0.04678184911608696,
-0.0014491170877590775,
-0.051834587007761,
-0.018340084701776505,
0.01990397833287716,
0.010369936004281044,
0.0025692773051559925,
0.02947341278195381,
0.023699887096881866,
-0.013045390136539936,
0.03206487372517586,
-0.019027888774871826,
-0.017422592267394066,
0.06290220469236374,
0.04107316955924034,
-0.008956020697951317,
0.006504743359982967,
-0.0428585484623909,
0.01903991773724556,
-0.027150429785251617,
-0.029728349298238754,
0.017801137641072273,
-0.014262339100241661,
0.025071769952774048,
0.014932780526578426,
0.0010704125743359327,
0.033288776874542236,
-0.07038769125938416,
-0.022045865654945374,
0.011518568731844425,
0.0007281258003786206,
-0.01390458270907402,
-0.035562627017498016,
-0.010482918471097946,
-0.015495147556066513,
0.0335516519844532,
-0.015743372961878777,
0.01806715317070484,
-0.025962235406041145,
0.009758754633367062,
0.044359516352415085,
-0.007482709363102913,
-0.01834479533135891,
0.06802739948034286,
0.024763545021414757,
-0.007110963575541973,
-0.007504252716898918,
0.015507148578763008,
-0.01936638168990612,
0.050102561712265015,
-0.042686041444540024,
0.003909492399543524,
-0.014613637700676918,
-0.0025952132418751717,
-0.0226065032184124,
-0.008649368770420551,
0.001581248827278614,
0.0272486824542284,
0.043022602796554565,
-0.05165405571460724,
0.0453425794839859,
-0.008914738893508911,
-0.017455900087952614,
0.030347591266036034,
-0.04606041684746742,
0.024676823988556862,
0.002284181071445346,
0.03373413905501366,
-0.04583358019590378,
-0.005300126038491726,
-0.04304809495806694,
-0.0024233541917055845,
-0.03954778611660004,
0.06780368834733963,
0.07803763449192047,
-0.026061704382300377,
-0.027722802013158798,
0.03284488990902901,
0.049279019236564636,
2.8404733143361227e-7,
0.02800818160176277,
0.022008487954735756,
-0.03223872929811478,
-0.03915939852595329,
0.035152871161699295,
-0.020848050713539124,
-0.04800935462117195,
0.01696234568953514,
0.04266795143485069,
0.0395127609372139,
0.020247861742973328,
-0.013382595963776112,
0.01506068930029869,
0.022561494261026382,
-0.07489828765392303,
-0.042564693838357925,
-0.03925715386867523,
0.054580457508563995,
0.0436827652156353,
0.02134520746767521,
0.019795862957835197,
-0.007070137653499842,
-0.05239727348089218,
-0.013567435555160046,
0.016513636335730553,
-0.04416376352310181,
-0.024144483730196953,
-0.021615780889987946,
0.0012132010888308287,
-0.012087352573871613,
-0.005436214152723551,
0.03460744023323059,
0.05920836701989174,
0.10652995109558105,
-0.04336586222052574,
-0.01070761401206255,
0.009166753850877285,
-0.002513239160180092,
0.02706865966320038,
0.05603048950433731,
-0.01835973933339119,
-0.045649588108062744,
0.017386529594659805,
0.020644202828407288,
-0.02434343285858631,
0.04595116153359413,
-0.022519512102007866,
0.01471052598208189,
-0.000806207477580756,
0.03943796455860138,
-0.02959618717432022,
0.010037314146757126,
-0.030105046927928925,
0.04637756198644638,
-0.034554533660411835,
-0.040311429649591446,
-0.020891208201646805,
-0.008739283308386803,
-0.01178909931331873,
-0.04317445680499077,
0.020196445286273956,
-0.04223091900348663,
0.0073046437464654446,
-0.02527688257396221,
-0.005166876129806042,
-0.04966222494840622,
-0.009014259092509747,
2.0388589060690157e-34,
-0.027698451653122902,
-0.06999609619379044,
-0.0028978195041418076,
-0.04813361167907715,
-0.015459645539522171,
-0.06005028635263443,
0.018461095169186592,
0.02102150209248066,
-0.023565072566270828,
0.014097675681114197,
-0.039771612733602524
] | {
"ds_index": 42,
"similar_dg_indices": [
264542,
162479,
291107,
723573,
619043,
915623,
203841,
616767,
123409,
34179,
849063,
971399,
377619,
659788,
14722,
436290,
1052768,
616645,
161782,
630370
]
} |
A 66-year-old woman with chronic obstructive pulmonary disease is brought to the emergency department because of fever, body aches, malaise, and a dry cough. She has smoked one pack of cigarettes daily for 30 years but quit smoking 1 year ago. She lives with her daughter and her granddaughter, who attends daycare. Her temperature is 38.1°C (101°F). Physical examination shows bilateral conjunctivitis, rhinorrhea, and erythematous tonsils without exudates. Further testing confirms infection with an enveloped orthomyxovirus. Administration of a drug with which of the following mechanisms of action is most appropriate? | Inhibition of neuraminidase | {
"A": "Inhibition of nucleoside reverse transcriptase",
"B": "Inhibition of proton translocation",
"C": "Inhibition of neuraminidase",
"D": "Inhibition of protease"
} | step1 | C | [
"66 year old woman",
"chronic obstructive pulmonary disease",
"brought",
"emergency department",
"fever",
"body aches",
"malaise",
"dry cough",
"smoked one pack",
"cigarettes daily",
"30 years",
"quit smoking 1 year",
"lives with",
"daughter",
"granddaughter",
"attends daycare",
"temperature",
"Physical examination shows bilateral conjunctivitis",
"rhinorrhea",
"erythematous tonsils",
"exudates",
"Further testing confirms infection",
"orthomyxovirus",
"Administration",
"drug",
"of",
"following mechanisms",
"action",
"most appropriate"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 66-year-old woman with chronic obstructive pulmonary disease is brought to the emergency department because of fever, body aches, malaise, and a dry cough. She has smoked one pack of cigarettes daily for 30 years but quit smoking 1 year ago. She lives with her daughter and her granddaughter, who attends daycare. Her temperature is 38.1°C (101°F). Physical examination shows bilateral conjunctivitis, rhinorrhea, and erythematous tonsils without exudates. Further testing confirms infection with an enveloped orthomyxovirus. Administration of a drug with which of the following mechanisms of action is most appropriate?
Choose one of the following::
A. Inhibition of nucleoside reverse transcriptase
B. Inhibition of proton translocation
C. Inhibition of neuraminidase
D. Inhibition of protease | [
0.01676490344107151,
0.013794075697660446,
0.04961438477039337,
-0.01829596236348152,
-0.02953971177339554,
0.013503330759704113,
-0.006447521969676018,
0.05175802856683731,
0.01803002506494522,
-0.03384246677160263,
0.0369078554213047,
0.05819050967693329,
0.021615227684378624,
0.003151093842461705,
0.004239260219037533,
0.05770506337285042,
-0.0065353927202522755,
0.033122073858976364,
-0.05277039483189583,
-0.009141257964074612,
-0.04365427419543266,
0.007733739912509918,
0.009177749045193195,
-0.005209254566580057,
0.08540647476911545,
-0.04255843162536621,
-0.012118077836930752,
0.0002786330587696284,
-0.005552556831389666,
-0.0070452080108225346,
0.040941689163446426,
-0.012665131129324436,
0.01711665652692318,
-0.052073147147893906,
0.000002038695129158441,
-0.023908080533146858,
0.019345363602042198,
0.012795469723641872,
0.06305918842554092,
-0.0751267671585083,
0.0570438951253891,
-0.034065913408994675,
0.016260504722595215,
0.03756174072623253,
-0.058465443551540375,
-0.10466746985912323,
0.03827247768640518,
0.03599819540977478,
-0.029984192922711372,
0.0185406357049942,
-0.014053682796657085,
-0.00788735132664442,
-0.0317816324532032,
0.04024988040328026,
-0.030661486089229584,
-0.04155050218105316,
0.011960949748754501,
0.024930378422141075,
0.03735969588160515,
-0.027337605133652687,
-0.0005808632122352719,
0.022526109591126442,
-0.025504177436232567,
-0.029532229527831078,
0.04476276785135269,
0.027025830000638962,
0.02945065312087536,
-0.04786599054932594,
0.011851432733237743,
-0.010577562265098095,
-0.003348733764141798,
0.01227644830942154,
0.012968222610652447,
0.06764551252126694,
-0.08487969636917114,
-0.044514164328575134,
0.02613116055727005,
-0.07383830100297928,
0.025904152542352676,
0.029724285006523132,
0.07664097845554352,
0.03377602994441986,
-0.012185451574623585,
0.01176771242171526,
-0.03364555537700653,
0.02894337847828865,
-0.00995919480919838,
0.010032497346401215,
0.011783254332840443,
-0.006074789445847273,
-0.03619307279586792,
-0.0901138111948967,
-0.025926096364855766,
0.0006743792910128832,
-0.09263312816619873,
0.011006641201674938,
0.03047066368162632,
0.01948505826294422,
0.04189172014594078,
-0.06642238050699234,
-0.0664750337600708,
-0.0600290447473526,
0.0752255767583847,
-0.00725045520812273,
-0.06665338575839996,
-0.04999617487192154,
-0.004964333958923817,
0.03623965382575989,
-0.0270353052765131,
0.013294553384184837,
0.0022813340183347464,
0.015219028107821941,
-0.06080284342169762,
-0.005766704212874174,
0.0452384278178215,
-0.04257846623659134,
-0.05451764538884163,
-0.015190104953944683,
-0.01838601753115654,
0.0650377944111824,
0.02954946458339691,
-0.004271002486348152,
0.014729210175573826,
0.07777498662471771,
0.020583759993314743,
0.039728570729494095,
0.02645302750170231,
0.01626301370561123,
0.01944526843726635,
0.014991309493780136,
0.05828705057501793,
-0.0002283734065713361,
-0.0064591639675199986,
-0.03267631307244301,
-0.012886387296020985,
0.013006377033889294,
-0.022041210904717445,
0.04065542295575142,
0.036987319588661194,
0.03408944234251976,
0.016032841056585312,
-0.007700735237449408,
-0.024261483922600746,
-0.0021442293655127287,
-0.060381967574357986,
0.02029605023562908,
0.0023788386024534702,
0.01031577866524458,
-0.0071586910635232925,
0.06628953665494919,
-0.09660734981298447,
-0.04307851940393448,
-0.0001301427255384624,
0.021851912140846252,
0.007357914932072163,
0.008093317970633507,
0.04179011285305023,
-0.02595665492117405,
-0.026932260021567345,
-0.02349911257624626,
0.01835605315864086,
-0.01676592417061329,
0.04052402079105377,
-0.034310322254896164,
0.003766852430999279,
0.05087144672870636,
-0.013735480606555939,
0.06444650888442993,
0.017927194014191628,
0.02209012396633625,
-0.07998308539390564,
0.04597768560051918,
-0.0012876864057034254,
0.04450163617730141,
-0.043057698756456375,
-0.040920015424489975,
-0.004170550033450127,
-0.09936158359050751,
-0.038544755429029465,
0.009741750545799732,
-0.03784620761871338,
0.04864925146102905,
-0.011167097836732864,
0.013083057478070259,
0.039417389780282974,
-0.005920527037233114,
0.04644749313592911,
-0.0209208857268095,
-0.0017641944577917457,
-0.051861125975847244,
-0.03348226100206375,
0.02684076875448227,
0.022392917424440384,
-0.012184283696115017,
0.030976805835962296,
0.033576030284166336,
-0.061358604580163956,
-0.11719300597906113,
0.028765013441443443,
0.019893081858754158,
-0.015774577856063843,
-0.07666015625,
-0.018008749932050705,
0.05870220065116882,
0.010844799689948559,
0.08342193812131882,
-0.037659768015146255,
0.010776733048260212,
-0.01666325144469738,
-0.025669889524579048,
-0.004965542815625668,
0.02707812935113907,
0.0012340351240709424,
-0.032962579280138016,
0.008467817679047585,
0.015219545923173428,
0.016115466132760048,
-0.03211602941155434,
-0.0028604459948837757,
-0.029103558510541916,
-0.0379171296954155,
0.05372621864080429,
0.007047660648822784,
0.014589524827897549,
-0.008048785850405693,
-0.038060348480939865,
-0.008880184963345528,
0.03464270010590553,
-0.027313709259033203,
-0.04515870288014412,
0.05557391792535782,
0.019102290272712708,
0.007288225460797548,
0.018284954130649567,
-0.02870437316596508,
0.05755344778299332,
0.0771140307188034,
-0.031138459220528603,
-0.030707230791449547,
0.06351515650749207,
0.0005717595340684056,
-0.002252823207527399,
-0.020202424377202988,
0.007455490995198488,
0.02030753158032894,
-0.01252397894859314,
0.04636556655168533,
0.01496964693069458,
-0.08745644986629486,
0.02753506973385811,
-0.03429466485977173,
0.031096631661057472,
-0.035774338990449905,
0.026027550920844078,
-0.0321616493165493,
0.0952114462852478,
-0.056729044765233994,
-0.02868754416704178,
0.005942447576671839,
-0.047850601375103,
0.010023501701653004,
-0.02115887776017189,
0.0043203262612223625,
-0.02404693327844143,
-0.0692012757062912,
0.03479287028312683,
-0.019713960587978363,
-0.037408772855997086,
-0.035315994173288345,
0.028697187080979347,
-0.014573195949196815,
-0.022398626431822777,
0.038078200072050095,
0.028831331059336662,
-0.005970824975520372,
-0.036667969077825546,
-0.015443610958755016,
0.053554270416498184,
-0.03781120851635933,
-0.011251249350607395,
0.02292194776237011,
-0.023117829114198685,
0.012577874585986137,
0.02997029386460781,
-0.005206449422985315,
0.012457568198442459,
-0.042124826461076736,
-0.05363239347934723,
0.010782438330352306,
-0.007824993692338467,
0.009310207329690456,
0.0313800610601902,
-0.03488529846072197,
-0.01040586270391941,
0.011052611283957958,
-0.048931900411844254,
0.012072163634002209,
0.035574380308389664,
-0.035939957946538925,
0.037407469004392624,
0.06900140643119812,
0.03936043754220009,
-0.05204101279377937,
-0.007022423204034567,
0.0007939089555293322,
-0.06292474269866943,
0.015591542236506939,
-0.004566673189401627,
-0.044376108795404434,
0.011679034680128098,
0.00979201216250658,
-0.02299402840435505,
-0.039140645414590836,
0.03342851996421814,
-0.04118473082780838,
-0.019910257309675217,
0.004794816020876169,
-0.09127041697502136,
0.047074198722839355,
-0.011148777790367603,
-0.024601703509688377,
-0.0672701820731163,
-0.032138027250766754,
0.0009598903125151992,
-0.00037025086930952966,
-0.08233503997325897,
0.022156355902552605,
0.029310589656233788,
-0.06485945731401443,
-0.014464697800576687,
-0.004045768175274134,
0.007737338077276945,
0.03510527312755585,
0.027223335579037666,
-0.002147059887647629,
0.021614983677864075,
-0.031573355197906494,
-0.00737752253189683,
0.001879728282801807,
0.04009813442826271,
0.03066476620733738,
-0.005105182994157076,
0.0013295182725414634,
-0.016015641391277313,
0.02878715470433235,
0.005316738039255142,
-0.021542683243751526,
0.02389821782708168,
-0.008931218646466732,
-0.018846342340111732,
-0.06116190925240517,
0.0172759797424078,
-0.0016674600774422288,
-0.0084886085242033,
-0.006333587691187859,
-0.03774652257561684,
0.047545529901981354,
0.016262834891676903,
0.009602624922990799,
0.0782892107963562,
0.06812142580747604,
0.04036170616745949,
0.0184358898550272,
-0.011967009864747524,
0.0047412170097231865,
0.05266064777970314,
0.030117599293589592,
-0.001989594893530011,
-0.015706093981862068,
0.027921583503484726,
0.03757789731025696,
0.004173368215560913,
-0.00832974724471569,
0.0596807561814785,
0.009011566638946533,
0.014900626614689827,
-0.03057001531124115,
-0.04154019430279732,
-0.08902610838413239,
-0.03554289788007736,
0.02817518822848797,
-0.07720540463924408,
0.03485998511314392,
0.008203172124922276,
-0.006741773337125778,
-0.0019245573785156012,
0.06738750636577606,
-0.03514654561877251,
0.04253509268164635,
0.044666871428489685,
-0.013930653221905231,
0.01958884298801422,
0.012953704223036766,
-0.04625970497727394,
0.0019498954061418772,
-0.0573950856924057,
0.018289854750037193,
-0.0003517986333463341,
0.006216015201061964,
0.03766385093331337,
0.0005311574786901474,
0.08386294543743134,
0.06559468805789948,
0.04682417958974838,
-0.013396450318396091,
0.006337909959256649,
-0.03365340083837509,
-0.003193426877260208,
0.019955335184931755,
-0.008534325286746025,
-0.030176758766174316,
-0.016485566273331642,
0.032875191420316696,
0.029857762157917023,
0.02785717323422432,
-0.05295373126864433,
0.03590187057852745,
-0.04581195116043091,
0.028434522449970245,
-0.05909113585948944,
-0.005857240874320269,
-0.01865335740149021,
-0.0102525744587183,
-0.01953684724867344,
-0.044658832252025604,
-0.004348002839833498,
0.03709564730525017,
-0.00968910101801157,
0.020849717780947685,
0.02513343095779419,
0.03159407153725624,
-0.044444937258958817,
0.05286350101232529,
0.05344940721988678,
-0.08787430077791214,
0.019510913640260696,
-0.057200416922569275,
0.04180431365966797,
-0.0368427038192749,
-0.05419311672449112,
-0.00020388503617141396,
-0.006827616598457098,
0.07006049156188965,
-0.015849748626351357,
-0.023256318643689156,
-0.04524907469749451,
0.018555166199803352,
0.03499702364206314,
-0.08638815581798553,
0.09250171482563019,
0.0710018202662468,
-0.018353130668401718,
0.016473976895213127,
-0.002626370405778289,
0.06618832051753998,
-0.008201773278415203,
0.027869347482919693,
0.011582435108721256,
-0.014253823086619377,
-0.013876032084226608,
-0.020036278292536736,
0.007545780390501022,
0.039083682000637054,
-0.005357424262911081,
0.08488966524600983,
-0.04544848948717117,
-0.06085316464304924,
0.07745268195867538,
-0.01772899739444256,
0.03188509866595268,
-0.010977009311318398,
0.0405421257019043,
0.003609799314290285,
-0.013128922320902348,
-0.003984585404396057,
-0.021852809935808182,
-0.006096760276705027,
-0.016902077943086624,
0.02382437326014042,
0.022078868001699448,
-0.029881371185183525,
-0.006540610920637846,
-0.05724091827869415,
-0.007153484970331192,
-0.029214661568403244,
-0.004496254958212376,
0.08883143961429596,
-0.01746317557990551,
-0.02363138645887375,
0.02104005590081215,
-0.033112816512584686,
0.019323453307151794,
0.00544790830463171,
0.04326397925615311,
-0.0683952197432518,
-0.026620371267199516,
-0.009012816473841667,
0.0598725825548172,
-0.0015016132965683937,
0.0002620240848045796,
0.0484633706510067,
0.05517909675836563,
-0.0005010924651287496,
0.03994636610150337,
0.02456645295023918,
-0.030918244272470474,
0.007812025491148233,
-0.014236580580472946,
-0.02159414067864418,
-0.01055965293198824,
0.009676938876509666,
-0.004165256395936012,
0.0023101279512047768,
0.03580191731452942,
0.00259888987056911,
-0.02073666639626026,
-0.005222029983997345,
-0.0399792455136776,
0.011910144239664078,
-0.002136383904144168,
0.023631637915968895,
-0.022508807480335236,
0.007283723913133144,
0.004496218636631966,
0.04849083349108696,
-0.021963423117995262,
-0.02612343616783619,
-0.012192689813673496,
-0.0841166228055954,
0.020189395174384117,
-0.021056875586509705,
0.011042088270187378,
-0.02064598724246025,
-0.005999318789690733,
-0.018466971814632416,
-0.03183441981673241,
0.028921304270625114,
0.054835278540849686,
-0.04349592700600624,
0.011245900765061378,
0.03903963789343834,
0.029113709926605225,
-0.02525158040225506,
-0.06425090879201889,
0.007591205183416605,
0.004551097750663757,
-0.06943637877702713,
-0.03091806173324585,
0.038011111319065094,
-0.009669718332588673,
0.01724746637046337,
0.033407025039196014,
0.012964206747710705,
0.045374225825071335,
0.0022389525547623634,
-5.328640053868235e-33,
0.0568162277340889,
-0.025782238692045212,
0.0071465736255049706,
-0.02500406838953495,
0.053104594349861145,
0.023494714871048927,
-0.002917411271482706,
-0.038328617811203,
-0.07082047313451767,
0.008486148901283741,
-0.0057589951902627945,
-0.04699239134788513,
0.020461194217205048,
0.0012942285975441337,
-0.038710061460733414,
0.010081948712468147,
-0.04970749467611313,
-0.008079619146883488,
-0.027178281918168068,
-0.003064248710870743,
0.03885382041335106,
-0.002307807095348835,
-0.02347910962998867,
-0.0065882098861038685,
0.01973525620996952,
-0.006236816290766001,
0.04735361039638519,
0.016537358984351158,
-0.050094954669475555,
0.0595298632979393,
0.026677390560507774,
-0.015133138746023178,
0.007034530397504568,
-0.029040439054369926,
0.011598899029195309,
0.030447835102677345,
-0.014374247752130032,
-0.005731567274779081,
0.042798545211553574,
-0.0023229620419442654,
-0.05989072099328041,
-0.022019075229763985,
0.00679095508530736,
0.04463447257876396,
0.039629045873880386,
-0.02974061667919159,
-0.006275050342082977,
-0.05056549608707428,
0.020250573754310608,
0.006009495351463556,
-0.05853306129574776,
0.033655066043138504,
0.06063729152083397,
-0.020476078614592552,
0.021853089332580566,
-0.018645739182829857,
-0.03134346380829811,
0.035828929394483566,
0.05859401077032089,
0.019022952765226364,
-0.03588094189763069,
0.030491622164845467,
0.026671169325709343,
-0.006954921875149012,
-0.0003661566588561982,
-0.01891368441283703,
0.0065248627215623856,
0.021007360890507698,
-0.08336491882801056,
0.028409067541360855,
-0.019860973581671715,
0.03240418806672096,
-0.03406250476837158,
-0.0320061631500721,
-0.02082102745771408,
0.0034442939795553684,
0.009646459482610226,
0.011477643623948097,
-0.032144270837306976,
0.04120819643139839,
-0.07013041526079178,
0.011337161995470524,
0.006919063162058592,
-0.015020250342786312,
-0.021891972050070763,
-0.02363409847021103,
-0.051494743674993515,
-0.009075493551790714,
0.034305207431316376,
0.00904361717402935,
0.006216084584593773,
-0.010413045063614845,
0.02108415961265564,
-0.016655242070555687,
0.00949009321630001,
-0.01328838337212801,
0.04553283005952835,
0.03961953893303871,
-0.04621201753616333,
-0.008113505318760872,
0.019840095192193985,
-0.03394966199994087,
0.07149239629507065,
-0.0389239527285099,
-0.03927011415362358,
0.0013560683000832796,
0.017161918804049492,
-0.012131946161389351,
0.030610229820013046,
0.024426087737083435,
-0.02597552351653576,
0.016991816461086273,
-0.017095908522605896,
0.053658273071050644,
-0.0039277528412640095,
0.05041203647851944,
0.03471042215824127,
0.007794682402163744,
-0.004061253275722265,
-0.013188894838094711,
-0.008170850574970245,
-0.0349285751581192,
0.026623358950018883,
-0.025527341291308403,
-0.03567410632967949,
0.03959864005446434,
0.039571765810251236,
0.043710991740226746,
-0.03046257235109806,
-0.024432435631752014,
0.010980341583490372,
0.050628647208213806,
2.918360166859202e-7,
0.0331110954284668,
-0.004136988893151283,
-0.01275184378027916,
-0.024583855643868446,
-0.03311130777001381,
-0.051546670496463776,
-0.04333708807826042,
0.021669059991836548,
-0.00983242318034172,
-0.005958348512649536,
0.033902641385793686,
-0.026744388043880463,
0.03334623947739601,
-0.01729060895740986,
0.015782834962010384,
-0.017228448763489723,
-0.012370727956295013,
0.013337294571101665,
0.037091419100761414,
-0.003231215523555875,
0.034765273332595825,
0.015690168365836143,
-0.030441056936979294,
-0.007502893451601267,
-0.024264255538582802,
0.01450286153703928,
-0.03582703694701195,
-0.041558414697647095,
-0.016319969668984413,
-0.005287816748023033,
-0.04902442917227745,
0.020513586699962616,
0.05469454079866409,
0.04251238331198692,
-0.046817220747470856,
-0.017518652603030205,
0.012922747991979122,
0.06275970488786697,
-0.03071100264787674,
-0.02447321265935898,
0.01618163101375103,
-0.055834315717220306,
0.02410057559609413,
0.008615563623607159,
-0.011336359195411205,
0.004419081844389439,
-0.023180704563856125,
0.0890931561589241,
-0.008339865133166313,
0.07929070293903351,
0.008595223538577557,
-0.023430796340107918,
-0.0688282772898674,
0.06381269544363022,
0.0010636694496497512,
0.04779506102204323,
-0.05929939076304436,
0.004725291393697262,
0.0021403105929493904,
-0.04767177253961563,
-0.013075150549411774,
-0.11152520775794983,
0.03789753466844559,
-0.042254138737916946,
0.03751145303249359,
0.0014472235925495625,
-0.028128910809755325,
1.9277643584229917e-34,
0.023609532043337822,
-0.06306429207324982,
-0.038937054574489594,
-0.03966304287314415,
-0.003143003210425377,
-0.036196913570165634,
0.05353943258523941,
0.03162934258580208,
0.02736598066985607,
-0.08563734591007233,
-0.012881869450211525
] | {
"ds_index": 43,
"similar_dg_indices": [
4981,
301839,
343224,
339570,
1125276,
633473,
1105402,
271490,
1202731,
533852,
212886,
698402,
416537,
783621,
410730,
14398,
363404,
592914,
338927,
628745
]
} |
A 38-year-old woman undergoes hemithyroidectomy for treatment of localized, well-differentiated papillary thyroid carcinoma. The lesion is removed with clear margins. However, during the surgery, a structure lying directly adjacent to the superior thyroid artery at the upper pole of the thyroid lobe is damaged. This patient is most likely to experience which of the following symptoms? | Voice pitch limitation | {
"A": "Voice pitch limitation",
"B": "Ineffective cough",
"C": "Weakness of shoulder shrug",
"D": "Shortness of breath"
} | step1 | A | [
"year old woman",
"hemithyroidectomy",
"treatment of localized",
"well-differentiated papillary thyroid carcinoma",
"lesion",
"removed",
"clear margins",
"surgery",
"structure lying directly adjacent to",
"superior thyroid artery",
"upper",
"thyroid lobe",
"damaged",
"patient",
"most likely to experience",
"following symptoms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 38-year-old woman undergoes hemithyroidectomy for treatment of localized, well-differentiated papillary thyroid carcinoma. The lesion is removed with clear margins. However, during the surgery, a structure lying directly adjacent to the superior thyroid artery at the upper pole of the thyroid lobe is damaged. This patient is most likely to experience which of the following symptoms?
Choose one of the following::
A. Voice pitch limitation
B. Ineffective cough
C. Weakness of shoulder shrug
D. Shortness of breath | [
-0.002059836173430085,
-0.0427505187690258,
0.014013605192303658,
0.0071670678444206715,
-0.003642697585746646,
0.035481229424476624,
-0.012189164757728577,
0.0420338474214077,
0.03544946387410164,
-0.0023713845293968916,
0.018694214522838593,
0.016121912747621536,
-0.04177805036306381,
-0.02808861993253231,
-0.02430068328976631,
-0.01002744771540165,
-0.06442322582006454,
0.0018818855751305819,
-0.03482167050242424,
0.015316180884838104,
-0.007412855979055166,
0.029682843014597893,
0.024794669821858406,
0.041946399956941605,
0.010265875607728958,
0.04250118508934975,
0.01678471826016903,
0.017719324678182602,
0.00397779094055295,
-0.01977805234491825,
-0.02313607558608055,
0.025008227676153183,
-0.027364451438188553,
-0.031767599284648895,
0.0000015047781971588847,
0.01410179864615202,
0.032832130789756775,
-0.0068933237344026566,
0.0214447770267725,
-0.0021359946113079786,
-0.026350300759077072,
0.008438417688012123,
0.02285449393093586,
0.0005036995862610638,
-0.005229860544204712,
-0.056968528777360916,
-0.003172219032421708,
0.04860588535666466,
-0.014262810349464417,
0.023910628631711006,
-0.0014231493696570396,
-0.011469338089227676,
-0.037123143672943115,
0.03562683239579201,
0.07911720126867294,
0.027173016220331192,
-0.021194761618971825,
-0.04063072055578232,
-0.08854062110185623,
0.018892690539360046,
0.055760275572538376,
-0.024508774280548096,
0.025616012513637543,
0.051075078547000885,
-0.032019343227148056,
0.019917991012334824,
0.015425436198711395,
-0.01051335595548153,
-0.009338225238025188,
-0.02034696936607361,
0.04523381218314171,
0.0023274687118828297,
0.022163862362504005,
0.07120004296302795,
-0.04914264380931854,
-0.03564472496509552,
0.06613144278526306,
-0.04220671206712723,
0.00756702059879899,
-0.006590775214135647,
0.017013749107718468,
-0.0036857209634035826,
-0.04595809429883957,
0.02052350901067257,
-0.037510331720113754,
-0.05739108473062515,
0.041436899453401566,
0.008098401129245758,
-0.025450827553868294,
0.015074417926371098,
-0.03860906511545181,
-0.020804161205887794,
-0.0023589027114212513,
-0.012820209376513958,
0.021137548610568047,
-0.0033145369961857796,
-0.03391474485397339,
-0.00792620424181223,
0.050982486456632614,
-0.07454893738031387,
-0.08009065687656403,
0.007574526127427816,
-0.026592567563056946,
0.00662009185180068,
-0.01883450150489807,
-0.04120178148150444,
-0.03421637788414955,
0.00999706145375967,
-0.006274132058024406,
0.03244683891534805,
-0.027167929336428642,
-0.016905847936868668,
-0.03895493596792221,
0.01467696763575077,
0.10867808759212494,
-0.005187442526221275,
0.025026442483067513,
-0.001812448725104332,
-0.014471732079982758,
0.04831138625741005,
-0.020241092890501022,
0.010716748423874378,
-0.007838300429284573,
-0.01667514257133007,
-0.012843809090554714,
-0.013160200789570808,
0.005667424760758877,
0.008239024318754673,
-0.01217117439955473,
0.04219285026192665,
0.043974973261356354,
0.03666561841964722,
0.013244935311377048,
-0.011240553110837936,
-0.02880869247019291,
-0.0058282529935240746,
0.026143092662096024,
0.052875977009534836,
-0.019180407747626305,
0.009286698885262012,
-0.0005403708200901747,
-0.008200651034712791,
0.000017816097169998102,
0.039428818970918655,
0.019154217094182968,
-0.003556682262569666,
0.012367366813123226,
0.03160909190773964,
0.036265574395656586,
0.07048262655735016,
0.01948043704032898,
-0.01774740405380726,
0.010553417727351189,
-0.004469526465982199,
0.023185739293694496,
0.031270965933799744,
0.03262533247470856,
-0.044022563844919205,
0.04191222041845322,
-0.01841670460999012,
-0.01695980504155159,
0.010018260218203068,
-0.0639074295759201,
-0.022320546209812164,
0.02473892644047737,
0.07542163878679276,
-0.03994140774011612,
0.009313451126217842,
-0.09795516729354858,
0.04511578381061554,
-0.022873319685459137,
0.10137993097305298,
-0.008418534882366657,
0.03920062258839607,
-0.04361120983958244,
0.0501684695482254,
-0.020187361165881157,
-0.009144210256636143,
0.0006974253919906914,
-0.06362532824277878,
-0.05822077393531799,
0.06872372329235077,
-0.02988000586628914,
-0.033846985548734665,
-0.034783970564603806,
0.008279559202492237,
-0.0017644157633185387,
-0.05974176898598671,
0.020082425326108932,
-0.018774911761283875,
-0.044180262833833694,
0.03756967931985855,
-0.0435519814491272,
-0.010749776847660542,
0.012797270901501179,
-0.018199171870946884,
0.0005015453789383173,
-0.07678508758544922,
0.031900472939014435,
0.05375070869922638,
-0.016903487965464592,
-0.008649293333292007,
0.020003510639071465,
0.031020864844322205,
0.00045413131010718644,
0.021412435919046402,
0.04427063837647438,
-0.026646146550774574,
0.009613431990146637,
0.037747472524642944,
-0.0197459664195776,
-0.0020516696386039257,
0.021305831149220467,
-0.010280286893248558,
0.011707674711942673,
0.06703807413578033,
0.023207632824778557,
-0.005342928692698479,
-0.05134160816669464,
0.004382438957691193,
0.017819968983530998,
0.0032257346902042627,
0.004422945901751518,
0.03499916195869446,
0.0279484074562788,
-0.013959524221718311,
-0.053602155297994614,
0.033136505633592606,
-0.0864819884300232,
-0.08305733650922775,
-0.029908442869782448,
0.001954334322363138,
-0.060811690986156464,
0.020313726738095284,
-0.027512414380908012,
0.022298971191048622,
0.034423500299453735,
0.02171987295150757,
0.007749122101813555,
-0.014868092723190784,
-0.013405325822532177,
-0.04072009399533272,
-0.0003417091502342373,
0.023103579878807068,
0.010432321578264236,
-0.0045251729898154736,
-0.03610622510313988,
0.013004890643060207,
-0.0426655076444149,
0.003733509685844183,
-0.038574956357479095,
-0.046339940279722214,
0.011845739558339119,
0.025294139981269836,
-0.01011618785560131,
0.06618232280015945,
-0.11504702270030975,
-0.027195565402507782,
-0.054309818893671036,
-0.069142185151577,
0.04752606153488159,
0.015086283907294273,
-0.021544817835092545,
-0.020235037431120872,
-0.05468227341771126,
-0.03426153212785721,
-0.045857883989810944,
-0.025753943249583244,
-0.012098693288862705,
0.03255145624279976,
0.010879546403884888,
0.04103264957666397,
-0.004999856930226088,
0.021622490137815475,
0.004225423559546471,
-0.009908831678330898,
-0.025993818417191505,
0.03495936840772629,
0.05959653481841087,
0.03449065238237381,
0.05710584670305252,
0.06610504537820816,
0.018135646358132362,
-0.029672862961888313,
0.0109167555347085,
-0.014048351906239986,
0.002762560034170747,
-0.029608214274048805,
0.03368024155497551,
0.01896909810602665,
0.01231184508651495,
-0.014326426200568676,
0.06349725276231766,
-0.034673117101192474,
-0.029216324910521507,
-0.0050199939869344234,
-0.019137345254421234,
-0.011161727830767632,
0.017412759363651276,
0.046215083450078964,
0.017355559393763542,
0.00737892696633935,
0.016883209347724915,
-0.012106074020266533,
0.004592000972479582,
-0.006113301031291485,
0.01106223464012146,
-0.04574701189994812,
-0.023608257994055748,
0.0030160776805132627,
0.01869243010878563,
-0.007507001981139183,
-0.048139020800590515,
-0.0549234040081501,
-0.0538780614733696,
0.02049911953508854,
-0.013464612886309624,
-0.01614064909517765,
0.012443228624761105,
0.04130001366138458,
0.0040708486922085285,
0.07340606302022934,
0.05061276629567146,
0.026898618787527084,
0.0026905459817498922,
-0.024831481277942657,
0.04766331613063812,
-0.011843026615679264,
0.04660157859325409,
-0.006226624362170696,
0.029096221551299095,
0.03477877378463745,
-0.02735815942287445,
-0.04179657995700836,
-0.03084251657128334,
0.023290062323212624,
0.0252592321485281,
0.023115595802664757,
-0.01302538812160492,
0.013584746979176998,
0.020106757059693336,
-0.0031940636690706015,
0.04363448917865753,
0.013044299557805061,
0.0699019804596901,
-0.013300255872309208,
-0.03512715548276901,
0.03134482353925705,
0.06134267523884773,
-0.036946121603250504,
-0.0894593596458435,
0.054003480821847916,
0.02987297996878624,
0.0005652358522638679,
-0.030658049508929253,
0.020223211497068405,
0.06428591907024384,
0.052818022668361664,
-0.08552016317844391,
0.0104366485029459,
0.006385953165590763,
-0.022404586896300316,
0.022569652646780014,
0.011282402090728283,
0.007125350181013346,
-0.042747288942337036,
-0.020789267495274544,
-0.028562389314174652,
0.007786218076944351,
-0.02842794358730316,
-0.035853613168001175,
-0.005997508764266968,
-0.040899667888879776,
0.06073391065001488,
-0.04094288498163223,
0.037044938653707504,
-0.021229933947324753,
-0.030302925035357475,
-0.03502624109387398,
-0.02685258537530899,
0.05060997232794762,
-0.04488570615649223,
0.058406658470630646,
-0.025783997029066086,
-0.05316236615180969,
0.0100778853520751,
0.03684225678443909,
0.0076119485311210155,
0.05351683124899864,
-0.000037779565900564194,
0.012966283597052097,
0.023378601297736168,
0.02551470883190632,
-0.022998742759227753,
-0.004330852068960667,
0.05288376286625862,
-0.07160282880067825,
-0.011180676519870758,
0.027775024995207787,
0.042886339128017426,
-0.025082480162382126,
0.02073865383863449,
0.0028618816286325455,
0.016655992716550827,
0.05003480240702629,
-0.06493574380874634,
-0.10141120851039886,
0.008239904418587685,
-0.061451539397239685,
0.07932572811841965,
0.005054923240095377,
-0.0537947341799736,
-0.006261632312089205,
0.03042622096836567,
-0.0035480924416333437,
0.01544970739632845,
0.022665761411190033,
0.006521981675177813,
0.04011737182736397,
-0.015857405960559845,
0.041176240891218185,
-0.01713547483086586,
-0.03322174400091171,
-0.02244539186358452,
-0.008547845296561718,
0.025608288124203682,
0.0762513056397438,
-0.002234896644949913,
-0.03533763065934181,
0.04880474880337715,
-0.0031464232597500086,
-0.08660686016082764,
0.0530465766787529,
0.020585326477885246,
-0.04401351138949394,
0.09053019434213638,
0.01213889941573143,
0.07208915799856186,
-0.07633527368307114,
-0.04637174308300018,
-0.012371260672807693,
-0.05572620779275894,
0.06327708065509796,
0.08935459703207016,
0.02621607296168804,
-0.056278254836797714,
-0.015407542698085308,
0.03711998090147972,
0.02662435732781887,
0.03866012394428253,
0.017287537455558777,
-0.004066847264766693,
0.01962556689977646,
0.026104126125574112,
0.01595311611890793,
0.004995537456125021,
0.05930047854781151,
0.011721431277692318,
-0.019835175946354866,
-0.03071005269885063,
-0.015169044956564903,
0.01907315105199814,
0.021491805091500282,
-0.05667531117796898,
-0.013445431366562843,
-0.062243763357400894,
-0.07102376222610474,
0.03287013992667198,
0.05041409283876419,
0.016675760969519615,
-0.021365314722061157,
0.042170677334070206,
-0.023022867739200592,
-0.04624224081635475,
-0.018878381699323654,
-0.02288459800183773,
-0.08305470645427704,
-0.0336303636431694,
-0.028645288199186325,
0.02357223816215992,
0.03128189966082573,
0.0689270868897438,
-0.006217005662620068,
0.08648773282766342,
-0.044460028409957886,
-0.014995657838881016,
0.042613618075847626,
-0.0570746473968029,
0.00012165008956799284,
-0.03574548289179802,
0.016560764983296394,
0.00575155159458518,
0.027175376191735268,
-0.06793392449617386,
-0.04858359694480896,
0.03079942986369133,
0.023508131504058838,
0.009117284789681435,
0.011047469452023506,
-0.02703540213406086,
0.025655150413513184,
0.021677827462553978,
-0.03529730439186096,
-0.03498455882072449,
0.02291412651538849,
0.018198110163211823,
0.029275717213749886,
-0.037964269518852234,
-0.0010441713966429234,
-0.07636649161577225,
0.014652571640908718,
-0.01776374876499176,
-0.0035099301021546125,
0.032197169959545135,
0.017199087888002396,
-0.07044173777103424,
-0.07258258014917374,
-0.009581380523741245,
0.00044179134420119226,
-0.02028588205575943,
-0.01836537942290306,
0.014186816290020943,
0.006575613748282194,
-0.03848890960216522,
0.011551962234079838,
0.05685591697692871,
0.01733529008924961,
0.039669811725616455,
-0.0455123595893383,
0.02236948534846306,
0.038010310381650925,
0.014637211337685585,
-0.02014571987092495,
-0.026640934869647026,
-0.02082756534218788,
-0.04210825636982918,
0.022295508533716202,
0.01708149164915085,
0.024440309032797813,
-0.0413561686873436,
0.013479108922183514,
0.016757188364863396,
0.0221297238022089,
0.00624017883092165,
-0.018482740968465805,
-0.05108185485005379,
0.024793043732643127,
-0.01031363382935524,
0.0077805956825613976,
0.05685403570532799,
-0.02192992903292179,
0.050561800599098206,
0.021300600841641426,
0.04832753539085388,
-0.042416006326675415,
-4.860644161395204e-33,
0.006833577062934637,
0.0017127417959272861,
0.01570199243724346,
-0.0063351793214678764,
-0.03373259678483009,
0.06406373530626297,
-0.03831874951720238,
0.004105677828192711,
-0.04541688412427902,
-0.028709212318062782,
0.011363587342202663,
0.00004311067095841281,
0.015582641586661339,
0.0770711824297905,
-0.048877913504838943,
-0.03315134719014168,
0.021706046536564827,
0.0019085864769294858,
-0.017612814903259277,
-0.0015415255911648273,
-0.012500612996518612,
-0.048383940011262894,
0.033252257853746414,
0.032234761863946915,
-0.006456394214183092,
-0.056130584329366684,
0.021154001355171204,
0.008251055143773556,
0.014770310372114182,
-0.0018940864829346538,
0.020102674141526222,
0.0200188085436821,
-0.008039706386625767,
0.023981314152479172,
-0.002111689653247595,
-0.040628399699926376,
0.012976469472050667,
-0.05469118803739548,
-0.010574888437986374,
0.014791887253522873,
-0.04104001820087433,
-0.00042832427425310016,
-0.003996808547526598,
0.005670362152159214,
0.058158665895462036,
-0.01025861594825983,
-0.029402004554867744,
-0.029735948890447617,
-0.033286258578300476,
0.042637899518013,
-0.014944841153919697,
0.03201146423816681,
0.015356707386672497,
-0.03807995468378067,
-0.01681681163609028,
0.035302676260471344,
0.00019025689107365906,
0.06727369874715805,
-0.030165618285536766,
0.003730937372893095,
-0.03305188938975334,
-0.027860770002007484,
-0.015066239982843399,
-0.013727568089962006,
0.004367085639387369,
0.0017881587846204638,
0.03318629041314125,
0.03537110611796379,
-0.05348647013306618,
0.03499995172023773,
-0.12868650257587433,
0.008027845993638039,
-0.020560091361403465,
-0.05357702821493149,
-0.02126767858862877,
-0.0627376139163971,
-0.0015396912349388003,
-0.02437351644039154,
0.0005277421441860497,
0.042585790157318115,
-0.02780790813267231,
0.02682667039334774,
-0.021614203229546547,
-0.0366736501455307,
-0.015406301245093346,
-0.05775626003742218,
0.0206457506865263,
-0.04177946597337723,
-0.015885982662439346,
0.00005447016883408651,
0.1227649599313736,
0.07701393216848373,
0.027905890718102455,
-0.007381845731288195,
0.04144078865647316,
0.008238078095018864,
0.012152456678450108,
0.0055507030338048935,
-0.012663221918046474,
-0.029473211616277695,
0.10158637911081314,
-0.040787991136312485,
0.003219770034775138,
-0.044495511800050735,
-0.01753058284521103,
-0.01754322275519371,
-0.023218058049678802,
0.006462870631366968,
-0.007053094450384378,
0.05011352524161339,
-0.001163011067546904,
-0.005544089246541262,
0.035056646913290024,
0.04570961743593216,
-0.043782807886600494,
0.02170148491859436,
0.02568971738219261,
0.04302586615085602,
0.030733540654182434,
0.021084768697619438,
0.04623410478234291,
0.06018778309226036,
-0.011804468929767609,
-0.02581687830388546,
-0.008607223629951477,
-0.04940757900476456,
0.0659707710146904,
0.02323170192539692,
0.01119650062173605,
-0.020052913576364517,
0.008477134630084038,
0.03739862143993378,
2.4613026994302345e-7,
0.0021377510856837034,
-0.055937524884939194,
0.029845017939805984,
-0.09837977588176727,
0.052753888070583344,
-0.020405547693371773,
0.04142139106988907,
-0.007263363804668188,
-0.002821799833327532,
0.017702540382742882,
0.0026895678602159023,
0.015158086083829403,
-0.0025417059659957886,
-0.01134594064205885,
0.027416681870818138,
-0.01209432166069746,
0.000715909234713763,
-0.008615411818027496,
0.015863824635744095,
-0.0157148614525795,
0.07244230806827545,
-0.06234356760978699,
-0.055671196430921555,
-0.022726209834218025,
-0.02538582682609558,
-0.0046612839214503765,
-0.015171706676483154,
-0.07259385287761688,
-0.034915704280138016,
0.007027267478406429,
-0.06313225626945496,
0.04895181953907013,
0.019005898386240005,
0.03470622003078461,
-0.025267768651247025,
-0.04077218100428581,
0.06336447596549988,
0.055875614285469055,
-0.014103495515882969,
0.042688947170972824,
0.03202119842171669,
0.019337084144353867,
0.008359428495168686,
-0.03586309775710106,
0.020851850509643555,
-0.0840550884604454,
-0.0729495957493782,
-0.03294004872441292,
0.009813599288463593,
-0.004746978636831045,
0.0013049703557044268,
0.005411107093095779,
-0.05191376432776451,
-0.0036945233587175608,
0.004857019055634737,
0.037510793656110764,
-0.070815309882164,
0.04144437983632088,
0.050929054617881775,
-0.013195456936955452,
-0.0005313152214512229,
-0.05373561754822731,
0.020405905321240425,
-0.007282192353159189,
0.01594587042927742,
0.021726422011852264,
-0.03261468932032585,
1.3038655659774037e-34,
-0.031776703894138336,
-0.005804318469017744,
-0.04240841045975685,
-0.009200976230204105,
-0.005879694130271673,
-0.011615387164056301,
0.0875403881072998,
0.0009941603057086468,
0.0084098931401968,
-0.04402372986078262,
-0.011735190637409687
] | {
"ds_index": 44,
"similar_dg_indices": [
477596,
210304,
879062,
78184,
980587,
565772,
389445,
287173,
356413,
178615,
42251,
937730,
359686,
376970,
556494,
986308,
1110525,
598846,
332816,
848593
]
} |
A 27-year-old man presents to the emergency room with persistent fever, nausea, and vomiting for the past 3 days. While waiting to be seen, he quickly becomes disoriented and agitated. Upon examination, he has visible signs of difficulty breathing with copious oral secretions and generalized muscle twitching. The patient’s temperature is 104°F (40°C), blood pressure is 90/64 mmHg, pulse is 88/min, and respirations are 18/min with an oxygen saturation of 90% on room air. When the nurse tries to place a nasal cannula, the patient becomes fearful and combative. The patient is sedated and placed on mechanical ventilation. Which of the following is a risk factor for the patient’s most likely diagnosis? | Spelunking | {
"A": "Contaminated beef",
"B": "Epiglottic cyst",
"C": "Mosquito bite",
"D": "Spelunking"
} | step2&3 | D | [
"27 year old man presents",
"emergency room",
"persistent fever",
"nausea",
"vomiting",
"past 3 days",
"waiting to",
"seen",
"disoriented",
"agitated",
"examination",
"visible signs",
"difficulty breathing",
"copious oral secretions",
"generalized muscle twitching",
"patients temperature",
"blood pressure",
"90 64 mmHg",
"pulse",
"88 min",
"respirations",
"18 min",
"oxygen saturation",
"90",
"room air",
"nurse",
"to place",
"nasal cannula",
"patient",
"fearful",
"combative",
"patient",
"sedated",
"placed",
"mechanical ventilation",
"following",
"a risk factor",
"patients",
"likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old man presents to the emergency room with persistent fever, nausea, and vomiting for the past 3 days. While waiting to be seen, he quickly becomes disoriented and agitated. Upon examination, he has visible signs of difficulty breathing with copious oral secretions and generalized muscle twitching. The patient’s temperature is 104°F (40°C), blood pressure is 90/64 mmHg, pulse is 88/min, and respirations are 18/min with an oxygen saturation of 90% on room air. When the nurse tries to place a nasal cannula, the patient becomes fearful and combative. The patient is sedated and placed on mechanical ventilation. Which of the following is a risk factor for the patient’s most likely diagnosis?
Choose one of the following::
A. Contaminated beef
B. Epiglottic cyst
C. Mosquito bite
D. Spelunking | [
0.01911684311926365,
-0.08735156059265137,
0.022296909242868423,
-0.020935747772455215,
-0.012454631738364697,
0.01679251901805401,
-0.005927590653300285,
0.036104198545217514,
-0.007557069417089224,
-0.01676698587834835,
0.05153864249587059,
-0.0097206374630332,
0.011754469946026802,
-0.034558311104774475,
0.03535781800746918,
0.0007036489550955594,
0.026304058730602264,
-0.012054248712956905,
0.02051594853401184,
0.017769740894436836,
-0.03135264292359352,
0.034686148166656494,
0.01209434773772955,
0.024440569803118706,
0.04601006209850311,
0.005638804752379656,
0.013554822653532028,
-0.03671107068657875,
-0.007722938898950815,
-0.07238863408565521,
-0.020071154460310936,
-0.01865450106561184,
-0.009764273650944233,
-0.055715516209602356,
0.0000021654793727066135,
-0.010982874780893326,
-0.006092587020248175,
-0.028898878023028374,
-0.01098334789276123,
-0.09788893908262253,
0.006070841569453478,
-0.03706803172826767,
0.044399719685316086,
0.006917628459632397,
-0.06414774060249329,
-0.11824415624141693,
0.02083284966647625,
0.05274209752678871,
-0.010750588029623032,
0.025031115859746933,
-0.004463531076908112,
0.042327456176280975,
-0.06856679916381836,
-0.017491105943918228,
0.03049309365451336,
-0.04662327840924263,
-0.008122649043798447,
-0.04010434076189995,
0.049409810453653336,
-0.00560086639598012,
-0.016815124079585075,
0.00857455376535654,
0.01624630205333233,
0.03933750465512276,
-0.013279617764055729,
0.021644173189997673,
0.03141205385327339,
-0.03519747778773308,
0.011882245540618896,
0.008877245709300041,
-0.039219509810209274,
0.04311163350939751,
0.05110860615968704,
0.047286827117204666,
-0.057996924966573715,
0.000030403927667066455,
0.04539082571864128,
-0.039608392864465714,
-0.008710991591215134,
-0.005901203490793705,
0.06817882508039474,
0.08797372132539749,
-0.0006668069399893284,
0.020358184352517128,
-0.00609692744910717,
-0.05087180435657501,
-0.014450312592089176,
-0.025037817656993866,
0.0024990090169012547,
-0.023010779172182083,
-0.04144458472728729,
-0.06658104062080383,
0.008154519833624363,
-0.014263642020523548,
-0.06293852627277374,
0.022364992648363113,
0.01975441724061966,
-0.033723387867212296,
0.0362662747502327,
-0.08839413523674011,
-0.09568115323781967,
-0.054579731076955795,
0.07374630868434906,
-0.011721985414624214,
-0.040724631398916245,
-0.04773351177573204,
-0.07598304748535156,
0.004800688475370407,
-0.06893026828765869,
0.05296138674020767,
0.028141707181930542,
0.013242293149232864,
-0.03225492313504219,
-0.026623742654919624,
0.12059548497200012,
0.02039048820734024,
-0.05533439293503761,
-0.07389374822378159,
-0.0010553938336670399,
0.04220519959926605,
-0.010779857635498047,
0.028775673359632492,
-0.016046015545725822,
0.04775946959853172,
-0.0043816580437123775,
-0.017717653885483742,
-0.0027547520585358143,
0.018052320927381516,
0.0013264224398881197,
0.02740437537431717,
0.021786382421851158,
-0.028319042176008224,
0.018942169845104218,
-0.01955725997686386,
-0.005405302159488201,
-0.0021460221614688635,
0.009500638581812382,
0.06511319428682327,
-0.0507473461329937,
-0.005615197587758303,
0.0030488555785268545,
0.005097306799143553,
0.02549128420650959,
0.023821216076612473,
-0.022260427474975586,
0.02767557092010975,
0.0037503475323319435,
0.006618074141442776,
0.011675667949020863,
0.03205052390694618,
-0.015285584144294262,
-0.06227198243141174,
-0.0259002223610878,
-0.013999498449265957,
0.015393882058560848,
0.052395470440387726,
0.0290179755538702,
-0.020447740331292152,
0.009300105273723602,
-0.040040723979473114,
0.020490406081080437,
-0.03761382773518562,
0.04068940877914429,
-0.02876715175807476,
-0.008112735114991665,
0.043344322592020035,
0.025016194209456444,
0.010785669088363647,
-0.020503530278801918,
0.024549318477511406,
-0.03910057246685028,
0.06160084158182144,
-0.0019645087886601686,
-0.017097635194659233,
-0.02416604571044445,
0.03638587146997452,
-0.02792215906083584,
-0.07708105444908142,
0.009552061557769775,
-0.00696165906265378,
-0.02066994085907936,
0.035605479031801224,
-0.001037399284541607,
0.0023817408364266157,
0.04838458076119423,
-0.02376481704413891,
0.036281436681747437,
-0.01721564121544361,
-0.01562654972076416,
-0.08005408942699432,
-0.04635683074593544,
0.006204299628734589,
-0.05950620770454407,
-0.006841229274868965,
-0.005370078608393669,
0.024903172627091408,
-0.005762969609349966,
-0.053511518985033035,
-0.010318072512745857,
-0.015247348695993423,
-0.027261290699243546,
-0.020981954410672188,
0.019410133361816406,
0.051108863204717636,
-0.023789022117853165,
0.08505727350711823,
-0.01578412391245365,
-0.033094312995672226,
-0.022178225219249725,
-0.054117895662784576,
0.010188167914748192,
0.0027028750628232956,
0.03645278885960579,
-0.02786158211529255,
0.015802280977368355,
0.03623388335108757,
0.0030270845163613558,
-0.011188809759914875,
-0.08808153122663498,
0.004901929758489132,
-0.009296235628426075,
0.006858795881271362,
0.004304403439164162,
0.030496077612042427,
-0.03972357138991356,
-0.03813546523451805,
-0.004511105362325907,
0.004026578273624182,
0.019301900640130043,
-0.08912091702222824,
0.047886934131383896,
0.017447596415877342,
-0.03428077697753906,
-0.00912968534976244,
-0.046480514109134674,
0.035218171775341034,
-0.011122478172183037,
-0.005958915688097477,
-0.022658810019493103,
0.02606666088104248,
-0.03497258946299553,
-0.03803819417953491,
-0.05665501207113266,
-0.041701968759298325,
-0.01811893843114376,
-0.019509047269821167,
0.03136392682790756,
0.045043736696243286,
-0.07580363750457764,
0.09021857380867004,
-0.00420210650190711,
-0.006879350170493126,
-0.018789412453770638,
0.006184501573443413,
0.016322268173098564,
0.008447494357824326,
-0.04144737496972084,
0.0074081276543438435,
-0.02224602736532688,
-0.058611880987882614,
-0.07447499781847,
-0.008075629360973835,
-0.0007410001126118004,
-0.03848733752965927,
-0.03353669121861458,
-0.011724513955414295,
0.022275367751717567,
-0.06251487880945206,
-0.026934349909424782,
0.03295658528804779,
-0.012282132171094418,
0.01895466074347496,
0.026232926174998283,
-0.026970183476805687,
0.020970556885004044,
0.013746345415711403,
-0.05326266586780548,
0.0026631022337824106,
0.036499232053756714,
0.020331373438239098,
0.009179537184536457,
0.011984407901763916,
-0.015619909390807152,
0.0037301830016076565,
-0.03884463012218475,
0.0024653265718370676,
0.009636033326387405,
-0.03522128239274025,
0.04772774130105972,
0.04660293832421303,
0.0029975478537380695,
0.01975945755839348,
0.0030259706545621157,
-0.049453672021627426,
-0.03301435708999634,
-0.06193691864609718,
-0.03302743285894394,
0.0295126810669899,
0.026794392615556717,
0.03527676314115524,
0.024744810536503792,
0.04615962132811546,
-0.00536899222061038,
0.006256437394768,
-0.02438252605497837,
0.03330179676413536,
0.07234243303537369,
-0.016731906682252884,
-0.03807612881064415,
0.03395003080368042,
0.050463080406188965,
-0.034996990114450455,
0.002946588210761547,
0.03870551660656929,
-0.014517328701913357,
-0.036831002682447433,
-0.012571710161864758,
-0.04308757558465004,
-0.010950802825391293,
0.0596475824713707,
0.036039769649505615,
-0.0003836731775663793,
-0.002121879020705819,
-0.02890445478260517,
0.017452090978622437,
-0.028145965188741684,
-0.04686785861849785,
-0.02774876356124878,
-0.02922624722123146,
-0.011040158569812775,
-0.010246878489851952,
0.04692712798714638,
0.003073739120736718,
0.0010878955945372581,
0.03078536130487919,
0.0484006330370903,
-0.027768950909376144,
0.001128011499531567,
-0.03087593987584114,
0.02965100109577179,
0.0352160781621933,
-0.04861428961157799,
0.026367899030447006,
0.022255295887589455,
0.037312865257263184,
-0.012805732898414135,
-0.024799304082989693,
-0.004544324241578579,
0.009436122141778469,
0.00004570296732708812,
-0.05188429355621338,
0.0071937614120543,
0.0005904458230361342,
-0.009630142711102962,
-0.033575814217329025,
-0.028694475069642067,
0.037244219332933426,
0.07938796281814575,
0.009689428843557835,
-0.0027093919925391674,
-0.007910013198852539,
0.04018991068005562,
-0.000008858957698976155,
0.05080478638410568,
-0.011039068922400475,
-0.012600227259099483,
0.003983444068580866,
0.02428855001926422,
-0.02233709767460823,
-0.012823223136365414,
-0.004585950635373592,
-0.0047646560706198215,
-0.013203395530581474,
0.029811279848217964,
-0.0075238230638206005,
0.04248528555035591,
0.009137136861681938,
-0.04682953655719757,
-0.07611442357301712,
-0.0424763485789299,
0.03638697788119316,
-0.009004812687635422,
0.04923229664564133,
-0.0034890086390078068,
0.00748804584145546,
-0.019993145018815994,
-0.0009398795082233846,
-0.025158077478408813,
0.07270677387714386,
0.0770702138543129,
-0.024059688672423363,
0.031032035127282143,
0.026964066550135612,
-0.049108587205410004,
0.014813698828220367,
-0.02470136433839798,
0.03801906481385231,
-0.06430734694004059,
0.047995101660490036,
0.06342743337154388,
-0.00009744562703417614,
0.004391191527247429,
-0.005780941806733608,
0.06071461737155914,
0.022335907444357872,
-0.016737792640924454,
-0.02090352401137352,
-0.02402482181787491,
-0.00841347686946392,
0.012951170094311237,
0.027067985385656357,
-0.010415089316666126,
0.01563412696123123,
-0.02077893167734146,
0.012724080123007298,
-0.022764740511775017,
0.014157965779304504,
-0.06247241422533989,
-0.004502396564930677,
-0.048656217753887177,
0.03899190202355385,
0.007326807826757431,
0.03390376269817352,
-0.06046442687511444,
-0.022206798195838928,
-0.04003579169511795,
0.03905084729194641,
0.04617016389966011,
0.010213419795036316,
0.010443666018545628,
0.021042609587311745,
-0.07185095548629761,
0.06846008449792862,
0.046542759984731674,
-0.015618755482137203,
0.03168465197086334,
-0.06971364468336105,
0.002428287174552679,
-0.03447793051600456,
-0.03204762563109398,
0.026725543662905693,
-0.030131706967949867,
0.10327639430761337,
0.03597266972064972,
0.008671327494084835,
-0.005472003947943449,
0.050954610109329224,
0.02322312258183956,
0.01131817139685154,
0.09104643017053604,
0.009522907435894012,
-0.022756818681955338,
0.05243513360619545,
0.0132581926882267,
0.047219183295965195,
0.015957241877913475,
0.01969381608068943,
0.016514228656888008,
0.043657444417476654,
0.023801429197192192,
0.01162318792194128,
0.02311900071799755,
-0.0208032988011837,
-0.039376139640808105,
0.005305330269038677,
-0.022815285250544548,
-0.07977355271577835,
0.0011305722873657942,
-0.015146305784583092,
0.00031054203282110393,
-0.01604613848030567,
0.0018789165187627077,
-0.03388451412320137,
0.0010718745179474354,
0.01429855078458786,
-0.026260362938046455,
-0.042155057191848755,
-0.03222082555294037,
0.024490226060152054,
0.0076013426296412945,
0.02439654804766178,
0.0271155945956707,
-0.03671177104115486,
-0.06794244050979614,
-0.04171857237815857,
0.00922187976539135,
0.08396339416503906,
0.018428470939397812,
-0.0036716642789542675,
0.03134636580944061,
0.026576722040772438,
0.023099148645997047,
-0.016968239098787308,
-0.02960720844566822,
-0.03985169157385826,
-0.006710350047796965,
0.0027136823628097773,
0.09776666760444641,
0.0013686127495020628,
-0.009267676621675491,
0.05379056558012962,
0.02109718695282936,
0.025517180562019348,
0.045524049550294876,
-0.014505733735859394,
0.049041498452425,
0.00014780847413931042,
0.005787582602351904,
-0.04145436733961105,
-0.026801822707057,
0.022387435659766197,
0.011804196052253246,
-0.01680321805179119,
0.04034499451518059,
0.00889829732477665,
-0.03250595182180405,
-0.07390263676643372,
-0.029853442683815956,
0.002149976557120681,
0.005296659655869007,
0.018548129126429558,
-0.03169417381286621,
-0.007684936281293631,
-0.038597673177719116,
0.045219969004392624,
0.05953969806432724,
-0.007828962057828903,
0.004342432599514723,
-0.01684030331671238,
0.0764964371919632,
-0.050329189747571945,
-0.02093905583024025,
-0.0669993907213211,
-0.03339902684092522,
0.017215410247445107,
-0.009210759773850441,
-0.015691054984927177,
0.024143055081367493,
0.009140207432210445,
-0.008175940252840519,
-0.03995112329721451,
0.01369598787277937,
0.027678638696670532,
-0.01880604214966297,
-0.04437199980020523,
0.028584074229002,
-0.010267836973071098,
-0.001688316697254777,
0.008951178751885891,
0.016069062054157257,
-0.020066827535629272,
0.03732038289308548,
0.041656721383333206,
0.05251770839095116,
0.03535507246851921,
-5.694633158732631e-33,
0.027621237561106682,
-0.050833843648433685,
0.007843383587896824,
-0.025877220556139946,
0.023750530555844307,
0.038394391536712646,
-0.0008254750864580274,
-0.0024054318200796843,
-0.04416622966527939,
-0.02669805847108364,
-0.025026535615324974,
-0.010350795462727547,
0.026212019845843315,
0.00818174984306097,
0.00945790484547615,
-0.08609126508235931,
-0.028265560045838356,
0.04476477950811386,
-0.00522569427266717,
-0.033775802701711655,
0.038709819316864014,
0.006283735856413841,
-0.011934441514313221,
-0.03647866100072861,
-0.009283569641411304,
-0.03670867159962654,
0.07043807953596115,
-0.019668197259306908,
-0.03722730278968811,
-0.001557768089696765,
0.021866008639335632,
-0.029111171141266823,
0.029807398095726967,
-0.0669836476445198,
0.000006171972472657217,
-0.039447423070669174,
0.03401497006416321,
-0.06842455267906189,
0.04771965369582176,
-0.04700899124145508,
-0.02670137956738472,
-0.04996811971068382,
0.06283986568450928,
0.04888266697525978,
0.08109478652477264,
-0.02318411134183407,
-0.006200934294611216,
-0.005936710629612207,
0.03879672288894653,
-0.03755918890237808,
0.021253447979688644,
0.05689646303653717,
0.00886301789432764,
0.03808355703949928,
-0.003458736464381218,
0.027504488825798035,
0.0023608386982232332,
-0.010732050985097885,
0.03163602575659752,
-0.019363755360245705,
-0.025446556508541107,
0.05025491118431091,
-0.006424624007195234,
-0.03435967490077019,
-0.029951931908726692,
0.005890436936169863,
0.037240032106637955,
0.039999667555093765,
-0.09624695032835007,
0.03852793201804161,
-0.0649958997964859,
0.03746660798788071,
0.02558223530650139,
-0.008849128149449825,
-0.03870652616024017,
-0.05129474774003029,
-0.020876793190836906,
0.046531859785318375,
0.02013140544295311,
0.03998321667313576,
-0.057061050087213516,
-0.02461819536983967,
-0.020825551822781563,
-0.0533161461353302,
-0.018308233469724655,
0.027866866439580917,
-0.0005351408617570996,
-0.008730266243219376,
0.00870403554290533,
-0.017301183193922043,
0.08675190806388855,
-0.01138132531195879,
0.0377022884786129,
0.03182656690478325,
0.025727713480591774,
-0.05739930644631386,
0.10759682953357697,
0.02839735895395279,
0.011453832499682903,
-0.0031532696448266506,
0.03133592754602432,
0.01972102001309395,
0.06379597634077072,
-0.029523774981498718,
0.00025319046108052135,
-0.022219089791178703,
-0.0176547821611166,
-0.0034803233575075865,
0.03653097152709961,
-0.002304683206602931,
0.040652696043252945,
-0.03132979944348335,
-0.012674430385231972,
0.047242555767297745,
-0.0017826304538175464,
0.045076362788677216,
0.013341170735657215,
-0.01017673034220934,
0.040335509926080704,
0.012028569355607033,
0.011669442057609558,
0.036777134984731674,
-0.029252033680677414,
-0.016873495653271675,
-0.012340707704424858,
-0.020842818543314934,
0.0370897501707077,
0.0463731475174427,
0.007684952579438686,
-0.06467799097299576,
0.06602724641561508,
0.020085377618670464,
2.9699103265556914e-7,
0.07766983658075333,
-0.015964500606060028,
-0.008624075911939144,
-0.08498240262269974,
-0.00836283341050148,
-0.014139112085103989,
-0.013689295388758183,
0.019832683727145195,
0.03853965550661087,
-0.044649697840213776,
0.0319732241332531,
-0.009407863020896912,
-0.0031647952273488045,
0.04178706929087639,
-0.010224847123026848,
-0.03454368934035301,
0.018323633819818497,
0.040886081755161285,
0.042156580835580826,
-0.02141520380973816,
0.0319514237344265,
-0.016548611223697662,
-0.08769957721233368,
-0.007342617493122816,
0.004754845518618822,
-0.015513946302235126,
-0.008936925791203976,
-0.06972137093544006,
-0.028208479285240173,
0.027537604793906212,
0.050523724406957626,
0.016704918816685677,
0.011691590771079063,
0.0712677389383316,
-0.03366778790950775,
-0.01710309274494648,
0.06702480465173721,
0.07073362916707993,
-0.006401027087122202,
0.0115037951618433,
0.03323463350534439,
-0.01633189432322979,
0.01047084853053093,
-0.002334590768441558,
0.027962254360318184,
0.008130257949233055,
-0.024659281596541405,
0.045348167419433594,
-0.008229609578847885,
0.06603990495204926,
-0.002814442850649357,
0.0073833465576171875,
0.026059821248054504,
0.06857001781463623,
-0.02174600027501583,
0.03892216086387634,
-0.023081988096237183,
-0.018689455464482307,
0.013834298588335514,
-0.02761780470609665,
0.014197724871337414,
-0.09527215361595154,
0.016491074115037918,
-0.026601480320096016,
0.04128439724445343,
-0.01860778219997883,
-0.06664323806762695,
2.403327358026197e-34,
-0.060110919177532196,
-0.03412558138370514,
-0.03504212573170662,
-0.05710528790950775,
0.024331606924533844,
-0.04147963970899582,
0.011349393986165524,
0.053634513169527054,
0.023907510563731194,
-0.05176129937171936,
-0.037646517157554626
] | {
"ds_index": 45,
"similar_dg_indices": [
235192,
936452,
617041,
544377,
1113222,
1014660,
188674,
568380,
354509,
84551,
469511,
1098011,
775567,
396784,
966837,
625872,
54071,
879305,
651706,
468125
]
} |
A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient? | CT angiogram | {
"A": "CT angiogram",
"B": "Intubation",
"C": "Observation and blood pressure monitoring",
"D": "Surgical exploration"
} | step2&3 | A | [
"21-year-old man presents",
"emergency department",
"sustaining",
"stab",
"neck",
"local farmer's market",
"patient",
"healthy",
"pain",
"patient",
"able to",
"history",
"temperature",
"97",
"36 4C",
"blood pressure",
"84 mmHg",
"pulse",
"90 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Physical exam demonstrates",
"3",
"laceration 1",
"inferior",
"mastoid process",
"right side",
"patient's breath sounds",
"clear",
"airway",
"stridor",
"difficulty breathing",
"noted",
"following",
"most appropriate next step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?
Choose one of the following::
A. CT angiogram
B. Intubation
C. Observation and blood pressure monitoring
D. Surgical exploration | [
0.04162248224020004,
-0.025203630328178406,
0.034873370081186295,
-0.015639327466487885,
-0.03660006821155548,
0.01199411042034626,
0.04034944623708725,
0.022293003275990486,
-0.02457013539969921,
-0.04306481033563614,
0.02872767485678196,
0.05121177062392235,
0.03552548587322235,
0.005437906365841627,
-0.002092038979753852,
0.025397351011633873,
0.014475270174443722,
-0.012984883971512318,
-0.00019413471454754472,
0.012891682796180248,
0.02256348356604576,
0.06588783860206604,
-0.01988283544778824,
0.03479679673910141,
-0.018283426761627197,
0.02543797343969345,
0.004642733838409185,
-0.023274630308151245,
0.022530922666192055,
-0.0784759372472763,
-0.04392370954155922,
-0.02230341173708439,
-0.03547876700758934,
-0.05399465933442116,
0.000002003065446842811,
0.02118120715022087,
0.024160144850611687,
-0.03206285834312439,
0.0026592372450977564,
-0.05856969952583313,
0.020029112696647644,
-0.07584240287542343,
0.02201412059366703,
0.01649581640958786,
-0.021088574081659317,
-0.06629230082035065,
0.026051675900816917,
0.07354997098445892,
0.0262807197868824,
-0.01023213192820549,
-0.009912217035889626,
-0.041266560554504395,
-0.045404206961393356,
-0.007468456402420998,
-0.024266447871923447,
0.017856013029813766,
0.008398152887821198,
-0.04848252236843109,
-0.021976105868816376,
0.0323561429977417,
-0.023910798132419586,
0.002030773786827922,
0.002335970290005207,
0.027798796072602272,
-0.02167176827788353,
0.0370129719376564,
0.07129736989736557,
0.001953591126948595,
0.013690345920622349,
-0.009602615609765053,
-0.006254307925701141,
0.03444525972008705,
0.030612170696258545,
0.014468736946582794,
-0.06698290258646011,
0.012849750928580761,
0.03644140809774399,
-0.02011306770145893,
0.011766145005822182,
-0.012195746414363384,
0.0674571767449379,
0.03079412691295147,
-0.02273269183933735,
0.04308318346738815,
-0.048555638641119,
-0.06487493962049484,
-0.024694539606571198,
0.025443149730563164,
0.004231677390635014,
-0.017285363748669624,
-0.05421065166592598,
-0.02834002673625946,
-0.016472209244966507,
0.018839964643120766,
-0.016558071598410606,
-0.0016720819985494018,
-0.03820022568106651,
-0.0702826976776123,
0.0012030110228806734,
-0.07007355242967606,
-0.04129611700773239,
0.008559469133615494,
0.037429504096508026,
0.014053525403141975,
-0.00722235394641757,
-0.1063029021024704,
-0.03904332220554352,
0.02156202867627144,
-0.002546781674027443,
0.040822841227054596,
-0.04129964858293533,
0.03249313682317734,
-0.010410290211439133,
0.02940336801111698,
0.03372781723737717,
0.024968009442090988,
0.007690520957112312,
-0.06069998815655708,
-0.0005599985597655177,
0.056681469082832336,
0.011683880351483822,
-0.02813730388879776,
-0.002793877851217985,
0.011190167628228664,
-0.016402261331677437,
-0.028846606612205505,
0.005495370831340551,
0.012685813009738922,
-0.006308316718786955,
0.056911651045084,
0.005330668296664953,
-0.012742341496050358,
-0.009554779157042503,
-0.06098530441522598,
-0.016908936202526093,
-0.0007304665050469339,
-0.015736503526568413,
0.04683710262179375,
-0.08053008466959,
0.007664022967219353,
-0.04500163346529007,
0.04223271831870079,
0.048913512378931046,
0.03884406387805939,
0.011206508614122868,
-0.017193758860230446,
0.041870757937431335,
-0.03280683979392052,
0.0020629125647246838,
0.013848213478922844,
-0.035778507590293884,
-0.022726815193891525,
-0.037308041006326675,
-0.014865972101688385,
0.0031598154455423355,
0.022508513182401657,
0.019361183047294617,
-0.052227217704057693,
0.020000969991087914,
-0.058321502059698105,
-0.026046494022011757,
-0.000746712030377239,
-0.004672435577958822,
-0.02493910677731037,
-0.020657258108258247,
0.0004900713684037328,
-0.029560396447777748,
0.032082125544548035,
-0.03728419169783592,
0.045622341334819794,
0.004954018630087376,
0.03738989308476448,
0.010576670058071613,
-0.009689929895102978,
-0.02419186197221279,
0.024294903501868248,
-0.0537942610681057,
-0.05295773223042488,
-0.0056768362410366535,
0.004275123588740826,
-0.029867876321077347,
0.026779070496559143,
-0.00664189038798213,
-0.02451433427631855,
0.013039610348641872,
0.0018853363581001759,
-0.003695470979437232,
-0.020602723583579063,
-0.022069737315177917,
-0.0151042016223073,
-0.033006250858306885,
0.010005238465964794,
-0.0655772015452385,
0.02201956696808338,
0.004594598431140184,
-0.015802374109625816,
-0.0221407413482666,
-0.052849896252155304,
-0.014591699466109276,
0.05605895072221756,
-0.014222599565982819,
-0.03440995141863823,
-0.058320339769124985,
0.041949257254600525,
0.004118773620575666,
0.06062781810760498,
-0.023467782884836197,
-0.05002236366271973,
0.03881125524640083,
-0.022619327530264854,
-0.006502198986709118,
-0.031669169664382935,
-0.0025844983756542206,
0.004107428248971701,
-0.006245832424610853,
0.023055514320731163,
-0.013272320851683617,
0.0055312844924628735,
-0.06598905473947525,
0.031401000916957855,
-0.04161672666668892,
0.04105913266539574,
-0.0005358181660994887,
0.054797884076833725,
-0.006712999660521746,
-0.0037585257086902857,
0.008113767951726913,
-0.016590001061558723,
0.00802083034068346,
-0.0457083098590374,
-0.008219652809202671,
0.006966390181332827,
-0.0016608446603640914,
-0.038833338767290115,
-0.030433272942900658,
0.04264000058174133,
-0.007222618442028761,
-0.03423774614930153,
0.01849418506026268,
0.01046879030764103,
-0.05934252217411995,
-0.005547726526856422,
-0.030839893966913223,
-0.03593103215098381,
-0.02964748814702034,
-0.06314108520746231,
-0.011178183369338512,
-0.009305731393396854,
-0.07143886387348175,
0.024848219007253647,
-0.049353450536727905,
0.007506062742322683,
-0.027705568820238113,
0.03279229626059532,
-0.0012559873284772038,
-0.0056631420738995075,
-0.049730513244867325,
-0.019911782816052437,
-0.010200845077633858,
-0.05482857674360275,
-0.010168053209781647,
-0.01674753800034523,
0.03743809089064598,
-0.03322966769337654,
0.015635214745998383,
-0.01386404037475586,
-0.020742611959576607,
0.03224625065922737,
0.02881423570215702,
0.0097743459045887,
-0.0025009072851389647,
-0.00825992226600647,
0.025309784337878227,
0.0005090014892630279,
-0.03486268222332001,
0.02268141694366932,
-0.007287720218300819,
0.033933188766241074,
0.006977164652198553,
-0.012161679565906525,
0.06694819778203964,
0.043899279087781906,
0.011826452799141407,
0.008775616064667702,
-0.008420516736805439,
0.012936783954501152,
-0.05598056688904762,
-0.0656622052192688,
0.05167315527796745,
-0.065315842628479,
0.006380422506481409,
0.005465715192258358,
-0.023993326351046562,
-0.056748516857624054,
-0.03258368745446205,
-0.037607304751873016,
0.025145012885332108,
-0.01390800904482603,
0.016302743926644325,
0.021716143935918808,
0.04594150558114052,
0.03525947779417038,
0.022656816989183426,
-0.00041269187931902707,
0.01388429757207632,
0.00019779814465437084,
0.020063156262040138,
-0.007145938463509083,
-0.016440730541944504,
0.03731224313378334,
0.027018511667847633,
-0.00800330936908722,
0.012525168247520924,
-0.01936793141067028,
-0.01407122053205967,
-0.02891838364303112,
-0.034146394580602646,
-0.020339269191026688,
-0.007161371409893036,
0.025540350005030632,
0.050132524222135544,
0.0248088575899601,
-0.00920509360730648,
0.013037710450589657,
-0.0024781657848507166,
0.014138038270175457,
0.005083189345896244,
-0.022863438352942467,
0.03188159316778183,
0.037796683609485626,
0.03014925867319107,
-0.03142588585615158,
-0.058913253247737885,
0.02161729522049427,
0.03419274091720581,
0.03662331402301788,
0.028155304491519928,
-0.02558651752769947,
-0.009286181069910526,
0.03534401208162308,
0.015375913120806217,
-0.04148555174469948,
-0.017782360315322876,
0.0035783799830824137,
-0.015084909275174141,
-0.005751997232437134,
-0.015701208263635635,
0.04937179759144783,
-0.008872772566974163,
-0.024991579353809357,
-0.045236218720674515,
0.0253984984010458,
-0.012078782543540001,
-0.02361895516514778,
-0.030328666791319847,
-0.0031245157588273287,
0.0035907861310988665,
0.06816007941961288,
-0.03561437129974365,
0.06639469414949417,
0.0029422177467495203,
0.05723584070801735,
-0.03414434939622879,
0.021838312968611717,
0.007209576200693846,
-0.035703953355550766,
0.00004943679959978908,
-0.047165047377347946,
0.01365066971629858,
0.028524653986096382,
-0.025296708568930626,
0.045903462916612625,
-0.055414583534002304,
0.07676765322685242,
0.013714246451854706,
0.038895588368177414,
-0.003586800303310156,
-0.043356046080589294,
-0.06306206434965134,
-0.025054503232240677,
0.049146391451358795,
-0.021922072395682335,
0.04448157548904419,
0.02209779992699623,
-0.004894849378615618,
0.042565807700157166,
0.02871084026992321,
0.011589826084673405,
0.06402689963579178,
0.09829657524824142,
-0.020621152594685555,
-0.047943115234375,
0.00957343727350235,
-0.018598729744553566,
0.03488845378160477,
-0.0015914352843537927,
0.03379972651600838,
-0.015891076996922493,
-0.01093423180282116,
0.047971632331609726,
-0.0485825389623642,
0.03672170639038086,
0.017391838133335114,
-0.011092862114310265,
0.012412875890731812,
-0.0004122587852180004,
-0.11029050499200821,
-0.007555394433438778,
0.007670987397432327,
0.07767757028341293,
0.027681725099682808,
0.038359347730875015,
0.012141886167228222,
-0.010389663279056549,
0.030617915093898773,
-0.0376276969909668,
0.024462221190333366,
-0.0037827431224286556,
-0.021713901311159134,
0.011643650010228157,
-0.035969484597444534,
0.014221841469407082,
-0.02826441451907158,
-0.0780552551150322,
0.04656486213207245,
-0.024860447272658348,
0.047408577054739,
-0.0052061234600842,
-0.012149197049438953,
0.04126787558197975,
0.014333652332425117,
-0.06945735216140747,
0.010269948281347752,
-0.0046549695543944836,
-0.02002735808491707,
0.0007231435156427324,
0.007103470619767904,
0.032234858721494675,
0.0056680357083678246,
-0.03266501799225807,
-0.022221587598323822,
0.00957017857581377,
0.06966771185398102,
0.048981353640556335,
-0.007948613725602627,
-0.0017454796470701694,
0.02942325919866562,
-0.03878568112850189,
-0.0161754060536623,
0.04233262315392494,
0.007307331543415785,
-0.024965370073914528,
0.08289166539907455,
0.028546476736664772,
-0.01178820338100195,
-0.04060373082756996,
-0.00823476817458868,
0.07346025109291077,
0.03460710495710373,
0.025648338720202446,
-0.029747534543275833,
0.005353670101612806,
0.013315204530954361,
-0.04656132310628891,
-0.05792545899748802,
-0.095286525785923,
-0.042434435337781906,
0.025692902505397797,
-0.008098960854113102,
0.003584041027352214,
-0.008017806336283684,
0.025602728128433228,
-0.0448526069521904,
0.023110056295990944,
0.06141723692417145,
-0.010572929866611958,
-0.01955966092646122,
0.020379623398184776,
0.006434116046875715,
-0.016186147928237915,
0.0475485697388649,
0.04487523064017296,
-0.0641145408153534,
-0.0049176947213709354,
-0.0131828673183918,
-0.03600756824016571,
0.06682351231575012,
-0.0047266241163015366,
0.005457931663841009,
0.004376711789518595,
0.06150466576218605,
0.014553124085068703,
0.01495333667844534,
-0.05373662710189819,
-0.05111533775925636,
0.02977348305284977,
-0.022281181067228317,
0.037552665919065475,
0.052921880036592484,
-0.06968078762292862,
0.021992119029164314,
0.06638133525848389,
0.03798263520002365,
-0.041160620748996735,
0.02385929599404335,
0.02980385161936283,
-0.017851999029517174,
0.02473045140504837,
-0.04010951146483421,
-0.040396660566329956,
-0.0043153585866093636,
0.0426836758852005,
-0.02233371138572693,
0.04919774830341339,
0.0353233776986599,
0.0809735506772995,
-0.059540338814258575,
-0.020328564569354057,
-0.02924489602446556,
0.03749432414770126,
-0.006734258495271206,
0.012396987527608871,
0.03730141744017601,
-0.06756661087274551,
0.013445530086755753,
0.04371526464819908,
0.02766554057598114,
0.014871242456138134,
-0.025173448026180267,
0.05934643745422363,
-0.00148573552723974,
-0.025364374741911888,
-0.008102416060864925,
0.014646162278950214,
-0.019429083913564682,
0.005704386625438929,
-0.024025732651352882,
0.026878096163272858,
0.01034155860543251,
-0.07554545998573303,
0.00998400803655386,
0.01703847385942936,
-0.003456685459241271,
0.020014379173517227,
-0.04767105355858803,
0.013826665468513966,
-0.014264415018260479,
-0.06073261424899101,
0.04200219362974167,
-0.001094384933821857,
-0.04506148397922516,
0.10908769816160202,
0.06345298886299133,
-0.0008892189362086356,
0.03638570010662079,
-5.0519845196663325e-33,
0.05159283056855202,
-0.021555382758378983,
0.007607574574649334,
-0.010527647100389004,
-0.03314756602048874,
0.07976910471916199,
0.006626419723033905,
0.007373998407274485,
-0.04740866273641586,
-0.02446753904223442,
-0.012057793326675892,
0.00742103299126029,
0.01728244125843048,
0.049524709582328796,
0.026023225858807564,
-0.04034542664885521,
0.0020877125207334757,
0.01409153826534748,
-0.019952930510044098,
0.005976935848593712,
-0.021556217223405838,
0.0015949761727824807,
0.08531396836042404,
0.01595693826675415,
0.013673903420567513,
-0.02352854236960411,
0.0346190519630909,
0.006460121832787991,
-0.010830073617398739,
0.00711109209805727,
0.004876417573541403,
-0.048910290002822876,
0.036154620349407196,
-0.055270060896873474,
0.0007847409578971565,
-0.05274059623479843,
0.010513894259929657,
-0.013147625140845776,
0.006299113389104605,
-0.015038734301924706,
-0.021410701796412468,
-0.010289995931088924,
-0.00039699231274425983,
0.012950807809829712,
0.02900792472064495,
-0.05247564613819122,
-0.044981494545936584,
-0.003283177735283971,
-0.005751160904765129,
-0.01461583748459816,
0.046033136546611786,
0.02297367714345455,
-0.008172981441020966,
-0.04189296439290047,
0.06185906007885933,
-0.051396533846855164,
0.04230136424303055,
0.03649713844060898,
-0.05969403684139252,
-0.049515049904584885,
-0.033360764384269714,
-0.004875340964645147,
-0.0013737552799284458,
-0.05441278964281082,
-0.10366635769605637,
0.02098817750811577,
-0.00917976163327694,
0.06048723682761192,
-0.03339505195617676,
0.09684949368238449,
-0.05055521801114082,
0.0574769489467144,
0.04213565215468407,
-0.01592242158949375,
-0.008012455888092518,
-0.01590171828866005,
-0.016471605747938156,
0.03959357738494873,
-0.009825056418776512,
0.03389544412493706,
-0.07947930693626404,
0.011817995458841324,
-0.03216489031910896,
-0.02656823955476284,
-0.015236251056194305,
-0.039427779614925385,
0.005447885021567345,
0.03743106499314308,
-0.005106327123939991,
-0.05089697241783142,
0.09156252443790436,
0.0027744844555854797,
0.03797946497797966,
0.03680508956313133,
0.10508447885513306,
-0.06916578114032745,
0.025724800303578377,
0.08258531987667084,
0.005588349420577288,
-0.03418399393558502,
0.013975611887872219,
0.031433507800102234,
0.032425109297037125,
0.006814594380557537,
0.012823221273720264,
-0.06363857537508011,
-0.019210239872336388,
0.02980775386095047,
0.0067703379318118095,
0.0010436474112793803,
0.06299442052841187,
-0.008167334832251072,
0.021832868456840515,
0.0855163186788559,
-0.00024521281011402607,
0.05828274413943291,
0.03040693886578083,
-0.06364032626152039,
0.061725080013275146,
-0.021183885633945465,
-0.008980562910437584,
0.07434298098087311,
-0.014810305088758469,
-0.04464082419872284,
0.0035498745273798704,
-0.025963883846998215,
0.08957613259553909,
0.014005313627421856,
-0.035923536866903305,
-0.07952167838811874,
0.04082585871219635,
0.02600463666021824,
2.521839235214429e-7,
0.04607008397579193,
-0.02628391608595848,
-0.024967383593320847,
-0.07813385128974915,
0.03481505811214447,
-0.028379084542393684,
0.03783930093050003,
0.01106434129178524,
0.0163893960416317,
-0.08560703694820404,
0.07981502264738083,
-0.02758142538368702,
0.01716005429625511,
0.015433910302817822,
0.0042975544929504395,
-0.07118486613035202,
-0.022833742201328278,
0.029410433024168015,
0.026532843708992004,
-0.033813685178756714,
0.01863914728164673,
-0.09578854590654373,
-0.058667562901973724,
-0.0057115438394248486,
-0.012882398441433907,
0.02706473506987095,
0.017232876271009445,
-0.036148469895124435,
-0.01143784262239933,
-0.02630802057683468,
0.036616794764995575,
0.04625261202454567,
0.004118070006370544,
0.0027604850474745035,
-0.01522080134600401,
-0.036847103387117386,
0.04712243005633354,
0.11327283829450607,
-0.013627436943352222,
0.07488113641738892,
-0.023202596232295036,
0.05790206044912338,
0.0009691574960015714,
-0.016871290281414986,
0.06032750755548477,
-0.0486404150724411,
-0.03071674145758152,
0.010760406963527203,
-0.010476878844201565,
0.040602102875709534,
0.0021332919131964445,
0.00907445140182972,
0.017941541969776154,
0.04885094240307808,
0.03274592384696007,
0.002578587969765067,
-0.020761311054229736,
0.02541915513575077,
0.05386069416999817,
0.0005031680921092629,
0.004876997787505388,
-0.013061813078820705,
0.041860681027173996,
-0.00011343690130161121,
0.03852164000272751,
0.007568225264549255,
-0.06162736937403679,
1.5989868536926521e-34,
-0.02262439765036106,
-0.06068141758441925,
-0.013101723045110703,
-0.0398966521024704,
-0.05688365548849106,
-0.010252751410007477,
-0.0020691596437245607,
-0.004931386094540358,
-0.03503148630261421,
-0.06877253949642181,
-0.035748567432165146
] | {
"ds_index": 46,
"similar_dg_indices": [
25977,
218142,
1053584,
342125,
199270,
877557,
1013115,
466167,
1189067,
499823,
1168283,
1192400,
280407,
1148360,
511087,
1194540,
204374,
1191945,
662075,
900946
]
} |
A 13-year-old girl presents to a medical office for the evaluation of a lump on the front of her neck. The patient denies pain, but states that the mass bothers her because “it moves when I swallow”. The physical examination reveals a midline neck mass that is above the hyoid bone but below the level of the mandible. The mass is minimally mobile and feels fluctuant without erythema. The patient is afebrile and all vital signs are stable. A complete blood count and thyroid function tests are performed and are within normal limits. What is the most likely cause of this patient’s presentation? | Cyst formation in a persistent thyroglossal duct | {
"A": "Persistent thyroid tissue at the tongue base",
"B": "Deletion of the 22q11 gene",
"C": "Cyst formation in a persistent thyroglossal duct",
"D": "Lymph node enlargement"
} | step1 | C | [
"year old girl presents",
"medical office",
"evaluation",
"lump",
"front of",
"neck",
"patient denies pain",
"states",
"mass",
"moves",
"I swallow",
"physical examination reveals",
"midline neck mass",
"hyoid bone",
"level",
"mandible",
"mass",
"mobile",
"feels fluctuant",
"erythema",
"patient",
"afebrile",
"vital signs",
"stable",
"complete blood count",
"thyroid function tests",
"performed",
"normal limits",
"most likely cause",
"patients presentation"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 13-year-old girl presents to a medical office for the evaluation of a lump on the front of her neck. The patient denies pain, but states that the mass bothers her because “it moves when I swallow”. The physical examination reveals a midline neck mass that is above the hyoid bone but below the level of the mandible. The mass is minimally mobile and feels fluctuant without erythema. The patient is afebrile and all vital signs are stable. A complete blood count and thyroid function tests are performed and are within normal limits. What is the most likely cause of this patient’s presentation?
Choose one of the following::
A. Persistent thyroid tissue at the tongue base
B. Deletion of the 22q11 gene
C. Cyst formation in a persistent thyroglossal duct
D. Lymph node enlargement | [
0.059970077127218246,
-0.05535513535141945,
0.04077288508415222,
-0.0028324092272669077,
0.04006785526871681,
0.021952476352453232,
-0.03335557132959366,
0.030243948101997375,
0.042874131351709366,
0.02070527896285057,
0.07498582452535629,
0.013114631175994873,
-0.028520874679088593,
-0.09229835867881775,
-0.02244686149060726,
-0.003239463549107313,
-0.041271667927503586,
0.03646146506071091,
0.04100114107131958,
0.018246561288833618,
0.0005146685871295631,
0.02355003170669079,
0.026631535962224007,
0.01785348914563656,
0.0064043947495520115,
0.025220837444067,
0.013850397430360317,
0.037022147327661514,
-0.0019244735594838858,
-0.0709337443113327,
-0.03198577091097832,
-0.0529947504401207,
-0.054600950330495834,
-0.004569957032799721,
0.000002045058863586746,
-0.009826443158090115,
0.013158976100385189,
-0.027002843096852303,
-0.04029836878180504,
0.010212784633040428,
-0.009764395654201508,
-0.031107155606150627,
-0.004504311364144087,
-0.008296065963804722,
-0.011358276009559631,
-0.052421968430280685,
-0.011580687016248703,
-0.01780048757791519,
-0.010216714814305305,
0.012359551154077053,
-0.006715958472341299,
0.026622595265507698,
-0.046231284737586975,
0.02181401662528515,
0.0816066563129425,
-0.03670715540647507,
-0.0062908027321100235,
0.026429053395986557,
-0.06938225775957108,
0.04355065897107124,
0.03428950533270836,
-0.017496952787041664,
-0.00935001578181982,
0.02296718955039978,
-0.016889415681362152,
0.0050224666483700275,
0.013181496411561966,
-0.016203176230192184,
0.05713946372270584,
0.04882417991757393,
-0.007938611321151257,
-0.0029553386848419905,
0.044923070818185806,
0.015984216704964638,
-0.040574073791503906,
-0.009464211761951447,
0.019094210118055344,
0.021172601729631424,
0.004888241644948721,
0.009817630983889103,
0.09150127321481705,
0.01806732453405857,
-0.010060782544314861,
0.007695392705500126,
-0.0354764461517334,
-0.05452980101108551,
-0.024243824183940887,
0.021370096132159233,
-0.013668127357959747,
-0.018445249646902084,
-0.037107132375240326,
-0.036558423191308975,
0.007027048151940107,
0.06221378594636917,
-0.006812951993197203,
0.006038160994648933,
-0.005601282697170973,
-0.05865142494440079,
0.05626164749264717,
-0.07884005457162857,
-0.04567507281899452,
-0.016291869804263115,
-0.00933409109711647,
0.06678836047649384,
-0.02661171182990074,
-0.019403554499149323,
-0.03849676996469498,
0.019313419237732887,
0.0027632471174001694,
0.04826614260673523,
0.022960957139730453,
0.020446652546525,
-0.029336974024772644,
-0.03791826218366623,
0.02037472277879715,
-0.022312944754958153,
0.017049314454197884,
-0.026702402159571648,
0.03352455049753189,
0.05799759551882744,
0.013493086211383343,
0.05096933990716934,
-0.031831495463848114,
0.028768332675099373,
-0.0005656383000314236,
0.035497769713401794,
0.08870436251163483,
-0.030303338542580605,
0.008952174335718155,
0.012627029791474342,
0.01938105933368206,
-0.015325043350458145,
0.003622721415013075,
0.014103175140917301,
0.021545883268117905,
-0.03123491257429123,
-0.0224312711507082,
0.044510144740343094,
0.004416903480887413,
0.02835707738995552,
-0.008932160213589668,
0.005649258848279715,
-0.014498740434646606,
-0.0018110201926901937,
-0.044005557894706726,
0.019789455458521843,
0.034586936235427856,
0.042533572763204575,
0.04712824150919914,
0.031463004648685455,
-0.006683515850454569,
-0.03164307773113251,
0.012496935203671455,
-0.02294544316828251,
0.04430219531059265,
0.016063280403614044,
0.03343378007411957,
-0.00875010620802641,
0.003646939294412732,
0.013940348289906979,
-0.012871759943664074,
-0.0019329596543684602,
-0.08421846479177475,
0.003758425358682871,
0.02531205303966999,
0.043422117829322815,
0.06123628094792366,
0.011727442964911461,
-0.05687067657709122,
0.07911656051874161,
-0.04645002633333206,
0.05113653838634491,
0.05956287309527397,
0.0049960315227508545,
-0.045025184750556946,
0.02475571259856224,
-0.07290352880954742,
-0.04290565475821495,
-0.0507911778986454,
-0.004070943687111139,
-0.035467132925987244,
-0.0016114794416353106,
0.037012845277786255,
-0.024303240701556206,
-0.049441732466220856,
-0.02107880264520645,
-0.03196859732270241,
0.023555656895041466,
0.00693145114928484,
-0.0033777186181396246,
-0.04313645139336586,
0.012241155840456486,
-0.08136927336454391,
0.034032780677080154,
-0.024886444211006165,
-0.005468993913382292,
-0.05800396949052811,
-0.04723353683948517,
-0.025946151465177536,
0.04101989045739174,
0.021433576941490173,
-0.036222975701093674,
0.020357582718133926,
0.007165646180510521,
-0.018546374514698982,
0.05808204039931297,
0.01434897631406784,
-0.015581060200929642,
-0.0021136810537427664,
0.014013820327818394,
-0.047992490231990814,
-0.015199050307273865,
0.015665695071220398,
-0.04265432432293892,
-0.0006940793828107417,
0.0721401572227478,
0.01720574125647545,
0.003022212302312255,
-0.05003808066248894,
0.07151735574007034,
-0.019657563418149948,
0.0289395060390234,
0.0534597709774971,
0.0014837157214060426,
-0.048508625477552414,
-0.006681694649159908,
-0.001322211348451674,
0.02030855044722557,
-0.021032987162470818,
-0.07224901765584946,
-0.006637983489781618,
0.034655358642339706,
-0.02748471312224865,
0.02547254040837288,
-0.04815952107310295,
0.019170399755239487,
0.006528323050588369,
-0.04885157197713852,
0.026678599417209625,
0.002149448497220874,
0.004512319806963205,
-0.011643217876553535,
0.0032513022888451815,
-0.024580467492341995,
0.015144999139010906,
-0.04020721837878227,
0.007320709526538849,
0.0249620508402586,
-0.038332805037498474,
0.03979804366827011,
-0.024157309904694557,
-0.019929658621549606,
0.01255873590707779,
-0.0070890397764742374,
-0.02630283683538437,
0.06731782108545303,
-0.052587613463401794,
0.014625569805502892,
-0.06223582103848457,
-0.06590757519006729,
0.039822228252887726,
0.031057072803378105,
0.036935772746801376,
-0.01806848682463169,
-0.03503897786140442,
-0.001644336269237101,
-0.05543705075979233,
-0.03609069436788559,
0.01634364388883114,
0.03283444792032242,
-0.019695939496159554,
0.07633579522371292,
0.037799082696437836,
0.03755125775933266,
-0.03834330290555954,
-0.01885378547012806,
-0.022422099485993385,
0.05566241592168808,
0.02303224615752697,
0.018468737602233887,
0.03261510282754898,
0.05851925536990166,
-0.020490122959017754,
0.0012797596864402294,
-0.031587645411491394,
-0.024227241054177284,
-0.012838444672524929,
0.01343997847288847,
0.06184762343764305,
0.004093131050467491,
0.015459228307008743,
0.015493585728108883,
0.02440078929066658,
-0.04328477010130882,
-0.035398729145526886,
-0.0719001293182373,
0.011639034375548363,
0.07904227823019028,
0.007345401216298342,
0.026321550831198692,
0.03216548264026642,
-0.0033187540248036385,
0.011831938289105892,
-0.013647139072418213,
0.0018553469562903047,
0.01761266030371189,
-0.01421371940523386,
-0.05584389343857765,
-0.0629672259092331,
0.030920468270778656,
0.06178909167647362,
0.026543516665697098,
-0.02811436727643013,
0.00423339894041419,
0.00728217838332057,
0.03964705020189285,
-0.031244443729519844,
-0.021082106977701187,
0.03606494516134262,
0.05891348794102669,
-0.008155505172908306,
0.07375993579626083,
0.007519578095525503,
0.002578629879280925,
-0.029802020639181137,
0.0023787913378328085,
0.02058832347393036,
-0.047053731977939606,
0.03040391393005848,
-0.03793174773454666,
0.006860365159809589,
-0.014700421132147312,
-0.017747120931744576,
0.014097845181822777,
-0.01394676137715578,
0.05457107350230217,
-0.02753521502017975,
0.02751898020505905,
-0.030715342611074448,
0.03581947460770607,
-0.010340976528823376,
0.03394683822989464,
-0.016185596585273743,
0.02215960994362831,
-0.006641080603003502,
-0.040247946977615356,
0.034674789756536484,
0.029397808015346527,
-0.02831847220659256,
0.013904493302106857,
-0.06297863274812698,
0.03462900221347809,
0.0070150624960660934,
0.017062177881598473,
-0.04404732957482338,
-0.02511501871049404,
0.024156929925084114,
0.07631564140319824,
-0.04113887995481491,
0.03380291163921356,
0.0159611776471138,
0.03834684193134308,
0.002663348102942109,
0.011164001189172268,
-0.009050202555954456,
0.009252459742128849,
-0.0031094455625861883,
0.010737143456935883,
-0.006355282850563526,
-0.0222479160875082,
-0.01628107577562332,
-0.009695439599454403,
-0.055210430175065994,
0.041382282972335815,
-0.016462314873933792,
0.09111768007278442,
-0.019992779940366745,
-0.014264808036386967,
-0.005877375137060881,
-0.033088915050029755,
0.051095593720674515,
0.019202526658773422,
0.002755990717560053,
-0.019472723826766014,
-0.0315031073987484,
0.00900941900908947,
-0.011929428204894066,
-0.012430945411324501,
0.05664300173521042,
0.04800831526517868,
0.030024390667676926,
0.023541225120425224,
0.05979892611503601,
0.014132571406662464,
-0.008803339675068855,
0.028485074639320374,
-0.011880076490342617,
-0.012816221453249454,
0.0474577322602272,
0.039619144052267075,
-0.0038702550809830427,
-0.05916595458984375,
0.008617243729531765,
0.025497563183307648,
0.07104022055864334,
-0.08380511403083801,
-0.11638958007097244,
0.011730505153536797,
0.015871671959757805,
-0.020799070596694946,
-0.04699729010462761,
-0.06335364282131195,
0.019964823499321938,
0.03176213800907135,
0.0004685797030106187,
-0.026309844106435776,
-0.025817910209298134,
-0.03767816722393036,
-0.040975429117679596,
-0.036339279264211655,
0.03597225993871689,
0.012435960583388805,
0.03950396180152893,
-0.06638789921998978,
0.03411322087049484,
-0.003850386245176196,
0.05696193128824234,
-0.004637329839169979,
-0.037573084235191345,
0.00743750249966979,
0.04744343087077141,
-0.032398443669080734,
0.05325805023312569,
0.08020170778036118,
0.049212802201509476,
0.08667057752609253,
0.05221671611070633,
0.054458484053611755,
-0.04542972892522812,
-0.03235946595668793,
0.003958829678595066,
-0.033515069633722305,
0.018637116998434067,
0.0964478924870491,
0.03375190496444702,
-0.0330597385764122,
-0.015154107473790646,
-0.030218107625842094,
0.017490511760115623,
0.08601154386997223,
0.020931361243128777,
0.004283284302800894,
0.03185248747467995,
0.05641564354300499,
-0.012105184607207775,
0.0645926371216774,
0.075032539665699,
-0.026621637865900993,
0.02959124930202961,
-0.046635568141937256,
-0.10019946843385696,
0.01408600714057684,
-0.012255211360752583,
-0.048777613788843155,
0.003038678551092744,
-0.05019880086183548,
-0.08340740948915482,
0.019427409395575523,
0.038793984800577164,
-0.008789582177996635,
-0.029496178030967712,
0.049643341451883316,
-0.024214787408709526,
-0.026648255065083504,
-0.047214992344379425,
-0.08748805522918701,
-0.029046816751360893,
-0.08652040362358093,
-0.07841061800718307,
0.018762467429041862,
0.04613795876502991,
0.014461780898272991,
0.021121356636285782,
0.044762060046195984,
-0.012796832248568535,
-0.022845670580863953,
0.026843585073947906,
-0.00036716708564199507,
-0.02108360081911087,
-0.03676637262105942,
0.02645844593644142,
-0.018183687701821327,
0.0006164698861539364,
-0.012219315394759178,
-0.07641689479351044,
-0.0063009257428348064,
0.06330100446939468,
0.05828993394970894,
-0.028868915513157845,
-0.032313987612724304,
0.045409660786390305,
-0.017301907762885094,
0.01948104053735733,
-0.07775863260030746,
0.0008626519702374935,
-0.009174124337732792,
0.03580581396818161,
-0.017117269337177277,
0.01430409587919712,
-0.05412567779421806,
0.021457314491271973,
-0.018937237560749054,
0.009481370449066162,
0.055603206157684326,
0.009657519869506359,
-0.08606015890836716,
-0.055052462965250015,
-0.03623519837856293,
-0.013098008930683136,
0.03715471550822258,
-0.021017024293541908,
0.027895165607333183,
0.026133615523576736,
-0.08402764052152634,
-0.049556564539670944,
0.07788437604904175,
0.010959423147141933,
0.021697403863072395,
0.014024422504007816,
-0.010449288412928581,
0.036983031779527664,
-0.02653759904205799,
0.012669840827584267,
-0.0017150667263194919,
-0.0566122867166996,
-0.0029163528233766556,
0.04906041547656059,
0.02163918875157833,
0.021010611206293106,
-0.01945437863469124,
-0.020006267353892326,
-0.018021300435066223,
-0.006496751215308905,
-0.014785249717533588,
-0.03825102373957634,
-0.005980850663036108,
-0.035309549421072006,
-0.009064028970897198,
0.05987633764743805,
-0.07584819197654724,
-0.04938967898488045,
0.027081556618213654,
0.006119952071458101,
0.04077426716685295,
0.017175238579511642,
-5.600044801741808e-33,
0.02098674699664116,
-0.02633795514702797,
0.028933167457580566,
-0.008281135931611061,
0.02266058884561062,
0.04747125506401062,
-0.009006937965750694,
0.009143158793449402,
-0.03734990209341049,
0.008011719211935997,
-0.003677511587738991,
0.009137598797678947,
0.009813165292143822,
0.05788218975067139,
-0.029143333435058594,
0.005111500155180693,
0.022456519305706024,
-0.0421626903116703,
-0.028353795409202576,
-0.0344981849193573,
-0.019931577146053314,
-0.061584435403347015,
0.04399536922574043,
0.002880861982703209,
-0.02815748192369938,
-0.0005078780231997371,
0.03346049413084984,
0.0067764995619654655,
0.000238776599871926,
-0.019375605508685112,
-0.0048774187453091145,
-0.024501750245690346,
0.0047888378612697124,
-0.009919432923197746,
0.0069315070286393166,
-0.045882448554039,
0.00604782160371542,
-0.05800127610564232,
0.004300144501030445,
0.02737632766366005,
-0.015961062163114548,
0.021406864747405052,
0.020752068608999252,
-0.04744093492627144,
0.11356055736541748,
-0.020028311759233475,
0.009042098186910152,
-0.026554571464657784,
-0.046175695955753326,
-0.015568097122013569,
0.032297562807798386,
0.010784944519400597,
0.016570286825299263,
-0.02954123169183731,
0.0069427029229700565,
-0.0854782909154892,
-0.00514379283413291,
0.048980291932821274,
0.03364631533622742,
-0.016487499698996544,
-0.027515536174178123,
-0.022541718557476997,
-0.02765832468867302,
-0.0440383218228817,
-0.024944553151726723,
0.010720678605139256,
0.03196175768971443,
-0.03789285942912102,
-0.09853482246398926,
0.03573077172040939,
-0.04876314476132393,
0.05712046101689339,
-0.00025425845524296165,
-0.060074929147958755,
0.0049107917584478855,
-0.018412820994853973,
-0.03409716486930847,
-0.0008259544847533107,
-0.013899644836783409,
0.07966902107000351,
-0.07438855618238449,
-0.03443828970193863,
-0.030676448717713356,
-0.018441827967762947,
-0.024749962612986565,
-0.035439763218164444,
0.024013349786400795,
-0.022085143253207207,
-0.02181614190340042,
0.04953698441386223,
0.0391252338886261,
-0.020565396174788475,
-0.03308609873056412,
0.0032377177849411964,
0.011325373314321041,
-0.031545255333185196,
0.08003281056880951,
-0.016315925866365433,
0.004148879554122686,
-0.0025512748397886753,
0.06873645633459091,
0.005650539882481098,
0.061627279967069626,
-0.0431206151843071,
-0.00219234568066895,
-0.0012298182118684053,
-0.08504269272089005,
0.026278527453541756,
-0.03205845504999161,
0.0033568411599844694,
-0.0065409173257648945,
0.027858909219503403,
-0.013033374212682247,
0.04355382174253464,
-0.004451102111488581,
-0.013820315711200237,
-0.02796594426035881,
-0.025492774322628975,
0.013312826864421368,
0.034627269953489304,
-0.010267829522490501,
0.0437818244099617,
-0.03398175910115242,
0.012488815933465958,
-0.060566723346710205,
-0.02885400503873825,
0.029286818578839302,
0.04017254337668419,
0.048153750598430634,
-0.016212133690714836,
0.018414020538330078,
0.045729584991931915,
2.8140371455265267e-7,
0.0063116224482655525,
-0.0007583823753520846,
0.03856738284230232,
-0.03478619456291199,
0.060038384050130844,
0.0026095672510564327,
-0.04297861084342003,
0.014949972741305828,
0.05345945060253143,
-0.06615929305553436,
-0.016490869224071503,
0.03143271803855896,
-0.006851532030850649,
0.01694302260875702,
0.039598751813173294,
-0.022796008735895157,
0.01756691001355648,
0.018741542473435402,
0.018671929836273193,
-0.03710455819964409,
0.001258312608115375,
-0.05267951637506485,
-0.025821680203080177,
-0.06730283051729202,
0.01507080439478159,
-0.006596702616661787,
-0.013089359737932682,
-0.0389695018529892,
-0.013090238906443119,
-0.029209891334176064,
-0.003432976547628641,
0.013735391199588776,
0.011425191536545753,
0.024521654471755028,
-0.025800859555602074,
-0.035561420023441315,
0.015241660177707672,
0.05379258096218109,
-0.02768743596971035,
-0.005901184864342213,
0.016033276915550232,
0.0049421885050833225,
0.01017029583454132,
0.0041815186850726604,
-0.011486286297440529,
-0.01709686778485775,
-0.024173032492399216,
-0.000052614661399275064,
-0.023637790232896805,
0.005264035891741514,
-0.02499273046851158,
0.01830148510634899,
0.009479185566306114,
0.027285195887088776,
-0.024037698283791542,
0.018655138090252876,
-0.004337255842983723,
-0.008577321656048298,
0.026533205062150955,
-0.04553789645433426,
0.01686166413128376,
-0.025593841448426247,
0.02958577312529087,
-0.025545427575707436,
-0.04021386429667473,
0.04322353005409241,
-0.011105434969067574,
2.231867961223083e-34,
-0.025161946192383766,
-0.052559856325387955,
-0.009188788942992687,
-0.05712305009365082,
-0.023173974826931953,
-0.02730536088347435,
0.07076448947191238,
0.03866958245635033,
0.050975967198610306,
-0.03222661092877388,
-0.023886138573288918
] | {
"ds_index": 47,
"similar_dg_indices": [
589056,
415501,
815772,
1143529,
141037,
33063,
628131,
277404,
379643,
470614,
861658,
675321,
1192702,
241294,
6794,
257861,
1028711,
109330,
1119812,
485844
]
} |
A 35-year-old woman with a history of Crohn disease presents for a follow-up appointment. She says that lately, she has started to notice difficulty walking. She says that some of her friends have joked that she appears to be walking as if she was drunk. Past medical history is significant for Crohn disease diagnosed 2 years ago, managed with natalizumab for the past year because her intestinal symptoms have become severe and unresponsive to other therapies. On physical examination, there is gait and limb ataxia present. Strength is 4/5 in the right upper limb. A T1/T2 MRI of the brain is ordered and is shown. Which of the following is the most likely diagnosis? | Progressive multifocal encephalopathy (PML) | {
"A": "Sporadic Creutzfeldt-Jakob disease (sCJD)",
"B": "Variant Creutzfeldt-Jakob disease (vCJD)",
"C": "Subacute sclerosing panencephalitis (SSPE)",
"D": "Progressive multifocal encephalopathy (PML)"
} | step1 | D | [
"35 year old woman",
"history of Crohn disease presents",
"follow-up appointment",
"started",
"difficulty walking",
"friends",
"joked",
"appears to",
"walking",
"drunk",
"Past medical history",
"significant",
"Crohn disease diagnosed 2 years",
"managed",
"natalizumab",
"past year",
"intestinal symptoms",
"severe",
"unresponsive",
"therapies",
"physical examination",
"gait",
"limb ataxia present",
"Strength",
"4/5",
"right upper limb",
"T1 T2 MRI of",
"brain",
"ordered",
"shown",
"following",
"most likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 35-year-old woman with a history of Crohn disease presents for a follow-up appointment. She says that lately, she has started to notice difficulty walking. She says that some of her friends have joked that she appears to be walking as if she was drunk. Past medical history is significant for Crohn disease diagnosed 2 years ago, managed with natalizumab for the past year because her intestinal symptoms have become severe and unresponsive to other therapies. On physical examination, there is gait and limb ataxia present. Strength is 4/5 in the right upper limb. A T1/T2 MRI of the brain is ordered and is shown. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Sporadic Creutzfeldt-Jakob disease (sCJD)
B. Variant Creutzfeldt-Jakob disease (vCJD)
C. Subacute sclerosing panencephalitis (SSPE)
D. Progressive multifocal encephalopathy (PML) | [
-0.012676296755671501,
0.010416973382234573,
0.01020340621471405,
0.02624494768679142,
-0.013786480762064457,
0.022311024367809296,
-0.0371893085539341,
0.06889340281486511,
0.05516483634710312,
-0.020992787554860115,
0.043394360691308975,
-0.03101123683154583,
-0.01516058761626482,
0.0013309698551893234,
-0.009719455614686012,
0.03693884238600731,
0.007331410888582468,
-0.02205507643520832,
-0.02434605546295643,
0.0028601197991520166,
-0.043753597885370255,
-0.014009494334459305,
-0.01665692776441574,
-0.005928292404860258,
0.02389739640057087,
-0.013733564876019955,
0.07662702351808548,
-0.06381680071353912,
-0.012753286398947239,
0.01612085849046707,
-0.013973519206047058,
0.029315060004591942,
0.01092848926782608,
0.017346708104014397,
0.000001951864305738127,
0.006342196371406317,
0.030489452183246613,
-0.01059312280267477,
0.04663737863302231,
-0.04931354895234108,
-0.025850890204310417,
0.049764521420001984,
0.04149441048502922,
0.026968272402882576,
-0.03745391592383385,
-0.10000094026327133,
-0.036277081817388535,
0.115340955555439,
-0.06932473182678223,
0.00077598518691957,
0.025956302881240845,
0.002231201156973839,
-0.02903665602207184,
-0.019795844331383705,
0.0467892624437809,
0.0015942113241180778,
-0.008305808529257774,
0.00875502172857523,
-0.0488838367164135,
-0.01625669188797474,
0.025923969224095345,
0.035899896174669266,
0.009418032132089138,
0.016649477183818817,
-0.07028298079967499,
0.017073486000299454,
0.05774152651429176,
-0.024877481162548065,
0.02977379411458969,
-0.004497981164604425,
0.000490854901727289,
0.03269044682383537,
0.05255938321352005,
0.03717753291130066,
-0.017647963017225266,
0.020993519574403763,
0.020398834720253944,
-0.014295244589447975,
-0.013928834348917007,
-0.012905332259833813,
-0.009140786714851856,
0.02403257228434086,
-0.009288199245929718,
0.02676919847726822,
-0.01822182722389698,
0.020343471318483353,
-0.012142373248934746,
0.04503198713064194,
0.01698177307844162,
-0.0621439591050148,
-0.0002337875048397109,
-0.025181790813803673,
0.012191361747682095,
-0.0021174438297748566,
-0.0941009372472763,
0.012426302768290043,
0.015749523416161537,
0.0030540297739207745,
0.05421610549092293,
-0.025063401088118553,
0.01706179790198803,
0.006867480464279652,
0.02721613273024559,
-0.021096741780638695,
-0.037326663732528687,
0.06490593403577805,
-0.061406828463077545,
0.06880832463502884,
-0.023937677964568138,
0.017519405111670494,
0.004083883482962847,
0.018972663208842278,
-0.040483564138412476,
-0.024602388963103294,
0.010547151789069176,
-0.042208924889564514,
-0.02408221736550331,
-0.027229897677898407,
0.04387405142188072,
0.02815132588148117,
-0.03892643377184868,
0.040911715477705,
0.03694785386323929,
0.050227951258420944,
0.009457712061703205,
0.0549209825694561,
0.02687263861298561,
0.017974384129047394,
0.07409903407096863,
0.027241704985499382,
-0.0034692808985710144,
-0.051243096590042114,
-0.049666695296764374,
-0.011329274624586105,
0.041291188448667526,
0.08891911804676056,
0.0364563912153244,
-0.0147568853572011,
0.004858243279159069,
0.0035126677248626947,
-0.021101899445056915,
-0.03362349793314934,
0.04048371687531471,
-0.007215652149170637,
0.02776743471622467,
0.07456980645656586,
-0.004966509062796831,
-0.01818813756108284,
-0.025128666311502457,
0.01444290205836296,
-0.048315610736608505,
-0.022270824760198593,
-0.03351173177361488,
-0.017337258905172348,
0.020117782056331635,
0.03437414392828941,
0.010480289347469807,
-0.045963630080223083,
-0.004576655104756355,
-0.014467866159975529,
0.005414392799139023,
0.015591247007250786,
0.009581927210092545,
-0.00916161946952343,
-0.01557598914951086,
0.043927375227212906,
0.052679385989904404,
0.04853666573762894,
-0.01874108426272869,
0.050255898386240005,
-0.025655072182416916,
0.06237221136689186,
0.0332728773355484,
0.0791802853345871,
0.011260760016739368,
0.026440909132361412,
0.017031198367476463,
-0.07399135828018188,
-0.03734959289431572,
-0.02327946573495865,
-0.006231819745153189,
0.04047281667590141,
0.06621894985437393,
-0.008748016320168972,
-0.02763930894434452,
-0.022254090756177902,
0.02994651533663273,
0.025351686403155327,
-0.03847348690032959,
0.00003153271245537326,
-0.02438337355852127,
0.024519529193639755,
0.02923450618982315,
0.06759349256753922,
-0.041988540440797806,
0.008705809712409973,
-0.036150552332401276,
-0.10211588442325592,
0.02848329208791256,
0.028128599748015404,
-0.003009448992088437,
-0.023157140240073204,
-0.0583329014480114,
-0.024451937526464462,
-0.04837024211883545,
0.05713168531656265,
0.008994895033538342,
0.009169669821858406,
0.015338148921728134,
-0.009203799068927765,
-0.04916348680853844,
0.003402187954634428,
0.02089150808751583,
-0.009525133296847343,
0.012086126022040844,
0.056693900376558304,
0.03217918425798416,
-0.00750544760376215,
-0.07469707727432251,
-0.005173496901988983,
-0.0020779233891516924,
0.01914784498512745,
-0.00880206748843193,
-0.0085806455463171,
-0.04205126687884331,
0.026724807918071747,
0.045159757137298584,
-0.013009385205805302,
-0.004525991156697273,
-0.05461866781115532,
0.011872168630361557,
0.009823603555560112,
-0.050690729171037674,
0.020927153527736664,
-0.07594200223684311,
0.03401745483279228,
-0.010601887479424477,
-0.04399770125746727,
-0.02730117365717888,
0.10309475660324097,
-0.0011139246635138988,
-0.07253905385732651,
-0.03941410034894943,
-0.011571278795599937,
0.03551435470581055,
-0.11541334539651871,
-0.04007991403341293,
0.02996744215488434,
-0.027649840340018272,
0.03401172161102295,
-0.03452782332897186,
0.007018503732979298,
0.01030330266803503,
-0.03237038850784302,
-0.0282929427921772,
0.028949426487088203,
-0.08896920830011368,
0.03700117766857147,
-0.07423555850982666,
-0.06821286678314209,
0.004960052203387022,
0.006497174967080355,
0.02493494562804699,
-0.019142713397741318,
-0.06025504320859909,
-0.000801258662249893,
-0.003278834279626608,
0.0724787637591362,
0.029521988704800606,
0.055550094693899155,
0.026364197954535484,
0.00038922353996895254,
-0.02150990441441536,
0.023201748728752136,
-0.03679453954100609,
-0.012453513219952583,
0.021336376667022705,
0.0702369213104248,
0.03377069532871246,
0.007706466596573591,
0.05547637119889259,
0.010592172853648663,
-0.0025781886652112007,
0.030994554981589317,
0.027016401290893555,
0.01798887364566326,
0.024907011538743973,
-0.0444486178457737,
0.03186539560556412,
-0.04983639344573021,
0.008647182956337929,
0.03459998965263367,
0.004370349459350109,
-0.016385747119784355,
-0.039057034999132156,
0.0070751626044511795,
-0.09580063074827194,
0.07389406114816666,
-0.009685857221484184,
0.020725799724459648,
0.04210822656750679,
0.010624440386891365,
-0.023653289303183556,
-0.028180964291095734,
-0.011709481477737427,
0.07243350148200989,
0.015477395616471767,
-0.03768107295036316,
0.04285186901688576,
0.0728146955370903,
0.04011246934533119,
0.019202733412384987,
-0.013187069445848465,
-0.07598313689231873,
-0.010592635720968246,
0.013959040865302086,
0.015975352376699448,
0.005463806446641684,
-0.030680598691105843,
0.03184966370463371,
-0.023096973076462746,
0.04705488681793213,
-0.024981409311294556,
-0.025017306208610535,
-0.0068534426391124725,
0.019711894914507866,
0.026023875921964645,
-0.025920109823346138,
0.03542673587799072,
0.004109021741896868,
0.023300139233469963,
-0.01990644633769989,
-0.011005589738488197,
0.0007013523718342185,
-0.02965906448662281,
-0.013488223776221275,
0.019070850685238838,
0.029877308756113052,
0.019114818423986435,
0.02189052477478981,
0.014947659336030483,
-0.019135145470499992,
0.008002671413123608,
0.07790310680866241,
0.03279091790318489,
-0.01202901266515255,
-0.04895749315619469,
0.012314517982304096,
-0.017614135518670082,
-0.048927191644907,
-0.07349537312984467,
0.09352962672710419,
-0.026174897328019142,
0.018920769914984703,
0.0011734472354874015,
-0.045323632657527924,
0.0936993658542633,
0.049998898059129715,
-0.0454787015914917,
-0.004530669655650854,
-0.013498954474925995,
0.025472111999988556,
-0.043205104768276215,
0.041139744222164154,
-0.03880653530359268,
-0.0022195654455572367,
0.002394583309069276,
-0.033886753022670746,
-0.026238320395350456,
0.02260655350983143,
-0.05861945077776909,
-0.0146006615832448,
-0.07571232318878174,
0.033353473991155624,
-0.028054513037204742,
-0.0067858318798244,
-0.014818449504673481,
0.012452223338186741,
-0.06473387777805328,
-0.026671601459383965,
0.0393344946205616,
-0.02996068261563778,
-0.01968974620103836,
-0.027039188891649246,
0.017339395359158516,
-0.02527495287358761,
0.012330783531069756,
0.004252319224178791,
0.0434069000184536,
-0.009645981714129448,
-0.048313647508621216,
-0.03485581651329994,
-0.04723699018359184,
-0.026264751330018044,
0.009921146556735039,
0.03530799224972725,
0.03892495855689049,
-0.038155339658260345,
0.026064962148666382,
0.060853876173496246,
0.004392273258417845,
-0.006943507120013237,
-0.09640391170978546,
0.07069725543260574,
0.029563261196017265,
0.025051329284906387,
-0.012212852016091347,
0.006098475307226181,
0.010360431857407093,
-0.02984348125755787,
0.018586639314889908,
-0.023916466161608696,
0.05370011553168297,
-0.01923142559826374,
0.06918647885322571,
-0.037764716893434525,
0.026801256462931633,
-0.06160016730427742,
0.012550771236419678,
-0.017767978832125664,
0.09594675898551941,
-0.05559065192937851,
0.012543532997369766,
-0.10423949360847473,
0.022017067298293114,
0.0007257088436745107,
-0.013138636946678162,
0.06245250254869461,
0.01625984162092209,
0.020637182518839836,
0.0355960875749588,
-0.046404387801885605,
0.029256435111165047,
0.043210264295339584,
0.000791938160546124,
0.003953768406063318,
-0.02095123752951622,
0.0030406713485717773,
-0.0050293137319386005,
-0.05256731063127518,
0.0249123964458704,
0.0386677123606205,
0.050825219601392746,
0.034988027065992355,
0.03269880264997482,
-0.0266264658421278,
0.012838300317525864,
0.006735407747328281,
0.020135458558797836,
0.08778396248817444,
0.017096349969506264,
-0.06166740506887436,
0.0438520722091198,
-0.0023049339652061462,
0.02530749887228012,
0.025872455909848213,
-0.022776152938604355,
-0.03461755812168121,
0.022954046726226807,
0.05962025746703148,
-0.04252326861023903,
0.009117301553487778,
-0.05448777973651886,
-0.00006284304981818423,
0.004266766831278801,
-0.03565919026732445,
-0.05027186870574951,
0.01961974799633026,
0.013825048692524433,
0.037691351026296616,
-0.02839113213121891,
0.015561336651444435,
-0.004594493191689253,
-0.07771210372447968,
0.0021120470482856035,
-0.00964694656431675,
-0.029273884370923042,
-0.0389520488679409,
0.030901161953806877,
0.016184629872441292,
-0.005183232016861439,
0.053532663732767105,
-0.023532027378678322,
-0.02630165033042431,
-0.004449448082596064,
-0.026387009769678116,
-0.03396102413535118,
-0.03119692951440811,
-0.060284458100795746,
-0.030321519821882248,
0.03800715133547783,
-0.027713419869542122,
-0.01094794925302267,
0.008286476135253906,
-0.09188776463270187,
0.04444940388202667,
0.00903762225061655,
0.016660835593938828,
0.011939199641346931,
0.019971812143921852,
-0.027489179745316505,
-0.041289012879133224,
0.02891041524708271,
-0.03482571616768837,
0.004606490954756737,
-0.02382770925760269,
0.007271885871887207,
0.05248348042368889,
-0.013783164322376251,
-0.053308356553316116,
0.021343735978007317,
-0.006411700043827295,
-0.0025365552864968777,
-0.021183013916015625,
0.04812578484416008,
0.003305210033431649,
-0.010134883224964142,
0.010646754875779152,
0.04532572627067566,
-0.0004030810378026217,
0.034952692687511444,
-0.007202489301562309,
-0.06574959307909012,
0.031293243169784546,
0.011952959932386875,
0.03660904988646507,
-0.04240288957953453,
0.01758827082812786,
0.0046678935177624226,
0.03804336488246918,
-0.036641355603933334,
0.0010189912281930447,
-0.024926969781517982,
-0.02547588385641575,
0.005056601949036121,
-0.08023283630609512,
0.014083106070756912,
-0.0583292618393898,
-0.036431554704904556,
-0.05945804715156555,
-0.007588280364871025,
0.03891794756054878,
-0.030628815293312073,
0.01815173029899597,
-0.0013708701590076089,
0.010127595625817776,
-0.0041071209125220776,
-0.0180656760931015,
0.03771248832345009,
0.03160777688026428,
-0.015631571412086487,
0.02221941202878952,
0.003305169055238366,
-0.04123896360397339,
0.011451097205281258,
-4.9805511973348006e-33,
0.025029826909303665,
-0.003560407552868128,
0.01759209670126438,
-0.08913395553827286,
0.020440351217985153,
0.08143465220928192,
-0.04640458896756172,
0.00546223996207118,
-0.03619818016886711,
0.008144816383719444,
-0.011080073192715645,
-0.00015108422667253762,
0.01459974329918623,
0.08457352966070175,
-0.008826851844787598,
0.010211460292339325,
-0.02738545462489128,
-0.021855950355529785,
0.00013585801934823394,
-0.03817477077245712,
-0.002205720404163003,
-0.023961350321769714,
-0.0366317480802536,
-0.0595158226788044,
0.025055190548300743,
-0.005230872891843319,
0.021406056359410286,
0.031263627111911774,
-0.049419697374105453,
0.0006352649652399123,
-0.024238642305135727,
-0.045101214200258255,
0.014619464054703712,
0.000848278752528131,
-0.023819074034690857,
-0.03677012398838997,
-0.0008386598201468587,
-0.03810125216841698,
0.008809078484773636,
-0.023539511486887932,
-0.034919124096632004,
-0.005829429719597101,
0.017897697165608406,
-0.007510993164032698,
0.015333137474954128,
0.013980379328131676,
0.0029699434526264668,
-0.029937822371721268,
0.044450800865888596,
-0.05921099707484245,
0.028283145278692245,
-0.01597673073410988,
0.020462488755583763,
-0.028117693960666656,
-0.016598692163825035,
-0.005564339924603701,
-0.0002704323560465127,
-0.04233676195144653,
0.005491067189723253,
-0.0060941437259316444,
-0.05899688974022865,
-0.0019145444966852665,
-0.004364736378192902,
-0.002966617001220584,
0.008191198110580444,
0.09596382826566696,
-0.0054656630381941795,
-0.009455500170588493,
-0.015198664739727974,
0.014158546924591064,
-0.05215340107679367,
-0.02243666909635067,
0.019009485840797424,
-0.02722052112221718,
0.04032544419169426,
-0.007145364303141832,
0.014358150772750378,
0.025609055534005165,
-0.031027479097247124,
0.06775729358196259,
0.0006780169787816703,
-0.02663768269121647,
-0.057711195200681686,
-0.010694874450564384,
-0.018903328105807304,
-0.037271998822689056,
-0.015951739624142647,
-0.0484684482216835,
0.0032015619799494743,
-0.042742036283016205,
0.07885643094778061,
-0.0209986362606287,
0.047975700348615646,
0.017611920833587646,
-0.043641116470098495,
-0.07819168269634247,
-0.0027963765896856785,
0.017972441390156746,
0.024593548849225044,
0.04161573946475983,
0.06473754346370697,
-0.044507697224617004,
0.03857019171118736,
-0.028277931734919548,
-0.02001146599650383,
0.02005285769701004,
0.013839853927493095,
-0.0198894664645195,
0.021967299282550812,
0.0238071046769619,
0.02452285774052143,
-0.024383507668972015,
0.03087853454053402,
0.054677728563547134,
-0.04204074665904045,
0.03061729483306408,
-0.006206098943948746,
0.05314216390252113,
0.02497028186917305,
0.044622622430324554,
0.0031497932504862547,
0.024203607812523842,
-0.026899293065071106,
-0.013279805891215801,
-0.02187967672944069,
-0.03648686036467552,
0.006367759313434362,
0.08067762851715088,
-0.055683352053165436,
-0.04287773370742798,
0.020260119810700417,
0.036503709852695465,
2.6197608349320944e-7,
0.05171811208128929,
0.039702948182821274,
-0.026224367320537567,
-0.03353999927639961,
0.023296719416975975,
-0.018339576199650764,
0.03058837540447712,
0.028673235327005386,
0.02378196269273758,
0.024662770330905914,
0.021626727655529976,
0.023973511531949043,
-0.023427195847034454,
-0.021068254485726357,
0.05476691201329231,
-0.006433484610170126,
-0.06449880450963974,
0.045727554708719254,
0.020153028890490532,
-0.03828419744968414,
-0.042688384652137756,
-0.03349070996046066,
-0.02354014851152897,
-0.05105096846818924,
-0.006922961212694645,
-0.014763539656996727,
-0.019796941429376602,
-0.0010706138564273715,
0.05087976157665253,
-0.02732613869011402,
0.003322922857478261,
0.035130780190229416,
0.03178303316235542,
-0.010337001644074917,
-0.04609494283795357,
-0.06185099482536316,
-0.015618878416717052,
-0.0074435011483728886,
-0.05089619755744934,
-0.0275241881608963,
0.03177185729146004,
0.011873508803546429,
0.027081595733761787,
0.04578224569559097,
0.030706770718097687,
-0.03758794814348221,
-0.023894580081105232,
0.027634670957922935,
0.027099717408418655,
0.010410433635115623,
0.03556228429079056,
0.017627183347940445,
0.049211833626031876,
-0.029310334473848343,
0.01339278556406498,
0.03622538968920708,
-0.00016865138604771346,
0.00462614418938756,
0.06565236300230026,
-0.02505965158343315,
-0.017262505367398262,
-0.011679568327963352,
0.010618616826832294,
-0.07204541563987732,
0.01719001680612564,
-0.05874412879347801,
-0.04586521163582802,
2.4377151595625568e-34,
-0.015816863626241684,
0.02867189422249794,
0.036075230687856674,
-0.0626826360821724,
-0.029223958030343056,
-0.002343060914427042,
0.03917161002755165,
0.01993689499795437,
-0.010447768494486809,
-0.025356128811836243,
-0.07220447063446045
] | {
"ds_index": 48,
"similar_dg_indices": [
1078531,
71763,
943688,
876160,
1046454,
700463,
1156202,
225994,
355931,
767102,
1136197,
449926,
614393,
370000,
414530,
328381,
786822,
918186,
1131139,
496287
]
} |
A 23-year-old G1 at 10 weeks gestation based on her last menstrual period is brought to the emergency department by her husband due to sudden vaginal bleeding. She says that she has mild lower abdominal cramps and is feeling dizzy and weak. Her blood pressure is 100/60 mm Hg, the pulse is 100/min, and the respiration rate is 15/min. She says that she has had light spotting over the last 3 days, but today the bleeding increased markedly and she also noticed the passage of clots. She says that she has changed three pads since the morning. She has also noticed that the nausea she was experiencing over the past few days has subsided. The physician examines her and notes that the cervical os is open and blood is pooling in the vagina. Products of conception can be visualized in the os. The patient is prepared for a suction curettage. Which of the following is the most likely cause for the pregnancy loss? | Chromosomal abnormalities | {
"A": "Rh immunization",
"B": "Antiphospholipid syndrome",
"C": "Chromosomal abnormalities",
"D": "Trauma"
} | step2&3 | C | [
"23 year old G1",
"10 weeks based",
"last menstrual period",
"brought",
"emergency department",
"husband due to sudden vaginal bleeding",
"mild lower abdominal cramps",
"feeling dizzy",
"weak",
"blood pressure",
"100 60 mm Hg",
"pulse",
"100 min",
"respiration rate",
"min",
"light spotting",
"3 days",
"today",
"bleeding increased markedly",
"passage",
"clots",
"changed three pads",
"morning",
"nausea",
"experiencing",
"past",
"days",
"physician",
"notes",
"cervical os",
"open",
"blood",
"pooling",
"vagina",
"Products of conception",
"visualized",
"os",
"patient",
"prepared",
"suction curettage",
"following",
"most likely cause",
"pregnancy loss"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 23-year-old G1 at 10 weeks gestation based on her last menstrual period is brought to the emergency department by her husband due to sudden vaginal bleeding. She says that she has mild lower abdominal cramps and is feeling dizzy and weak. Her blood pressure is 100/60 mm Hg, the pulse is 100/min, and the respiration rate is 15/min. She says that she has had light spotting over the last 3 days, but today the bleeding increased markedly and she also noticed the passage of clots. She says that she has changed three pads since the morning. She has also noticed that the nausea she was experiencing over the past few days has subsided. The physician examines her and notes that the cervical os is open and blood is pooling in the vagina. Products of conception can be visualized in the os. The patient is prepared for a suction curettage. Which of the following is the most likely cause for the pregnancy loss?
Choose one of the following::
A. Rh immunization
B. Antiphospholipid syndrome
C. Chromosomal abnormalities
D. Trauma | [
0.025375455617904663,
-0.07383450865745544,
-0.003983865957707167,
-0.05692183971405029,
-0.018169904127717018,
0.012827884405851364,
-0.01818273775279522,
-0.006682088598608971,
-0.03828532621264458,
0.015268328599631786,
0.048507388681173325,
0.00003420126813580282,
-0.016585472971200943,
-0.01233082078397274,
0.002080262405797839,
-0.002384031657129526,
-0.03390083834528923,
0.012984473258256912,
-0.03886112943291664,
-0.013046089559793472,
-0.016077660024166107,
0.03132918104529381,
0.008684279397130013,
0.000378681201254949,
0.03328780457377434,
-0.0004779406008310616,
0.013548278249800205,
-0.010167993605136871,
-0.023368170484900475,
-0.027640676125884056,
0.03645053878426552,
-0.02498529851436615,
0.018515203148126602,
-0.015595530159771442,
0.00000182634619250166,
-0.0398833267390728,
-0.0034528577234596014,
-0.043261684477329254,
0.020157992839813232,
0.017667844891548157,
-0.057339247316122055,
-0.01644783467054367,
-0.010842077434062958,
0.022537963464856148,
-0.005047125276178122,
-0.06813402473926544,
-0.02631138265132904,
0.039787471294403076,
-0.029919762164354324,
0.037068966776132584,
0.016797969117760658,
-0.003549860557541251,
-0.03931102156639099,
0.01045254897326231,
0.07489897310733795,
-0.058511655777692795,
-0.027111126109957695,
-0.006044293288141489,
0.012303980067372322,
-0.011181144043803215,
0.044999927282333374,
0.008348232135176659,
0.022872714325785637,
0.012351147830486298,
-0.06934598088264465,
-0.005998510401695967,
0.03668321669101715,
-0.0884348601102829,
-0.017376486212015152,
0.02135181613266468,
0.005359156988561153,
-0.0012704575201496482,
0.01537305861711502,
0.0740506500005722,
-0.07737264782190323,
-0.023718448355793953,
-0.00972071848809719,
0.02128397300839424,
-0.0025052556302398443,
-0.029979214072227478,
0.017244312912225723,
0.024128522723913193,
-0.046404797583818436,
0.05957143008708954,
0.021371057257056236,
-0.0965733602643013,
0.025908710435032845,
-0.009731978178024292,
-0.01967550627887249,
-0.00024719489738345146,
-0.05645693093538284,
0.0019206140423193574,
-0.0044395956210792065,
-0.007303418591618538,
-0.024607442319393158,
0.04325821250677109,
0.03676877170801163,
-0.021619241684675217,
0.05094284191727638,
-0.11630742996931076,
-0.020357098430395126,
0.021045539528131485,
0.060999855399131775,
-0.024245675653219223,
-0.019670257344841957,
-0.038905803114175797,
-0.02695331536233425,
0.005522808525711298,
-0.040358129888772964,
0.052752647548913956,
0.0058464836329221725,
0.019491756334900856,
-0.026284651830792427,
-0.0032452133018523455,
0.06079725921154022,
0.01506027765572071,
-0.012194640934467316,
-0.0616595558822155,
-0.0018017936963588,
0.04949043318629265,
-0.06020083650946617,
0.0428004153072834,
-0.000793350045569241,
-0.013112899847328663,
-0.022536149248480797,
-0.004306148272007704,
0.024985097348690033,
0.021916642785072327,
-0.014664096757769585,
-0.0018431032076478004,
-0.005250512156635523,
-0.004396660719066858,
-0.021888259798288345,
0.06398694217205048,
-0.025449061766266823,
-0.0002586822083685547,
0.009880595840513706,
0.026055965572595596,
-0.025268951430916786,
0.01302869152277708,
-0.04802725091576576,
-0.029495811089873314,
0.003248814959079027,
0.03205404803156853,
-0.021927490830421448,
0.04572872072458267,
-0.028043949976563454,
0.01826443523168564,
0.06044887751340866,
0.03633389621973038,
-0.014960280619561672,
-0.049876514822244644,
-0.036059245467185974,
0.017614848911762238,
0.024678939953446388,
0.056628379970788956,
0.03528740629553795,
-0.015105390921235085,
-0.025737570598721504,
0.00671505369246006,
-0.012452060356736183,
-0.06009279191493988,
-0.019014040008187294,
-0.03577602654695511,
-0.013894636183977127,
0.017577344551682472,
-0.020961696282029152,
0.09845241159200668,
-0.019928861409425735,
0.028479835018515587,
0.01706796884536743,
-0.003173903562128544,
-0.0018162243068218231,
0.04276655986905098,
-0.02989511936903,
0.03718213364481926,
-0.0573485903441906,
0.03785179927945137,
0.02718966454267502,
-0.047001104801893234,
0.006949006114155054,
0.03611011803150177,
0.023321136832237244,
-0.09051855653524399,
0.021358465775847435,
-0.004382301587611437,
-0.014668654650449753,
-0.08249771595001221,
0.00500319292768836,
-0.028811339288949966,
-0.046849366277456284,
0.04777911305427551,
-0.04983820766210556,
-0.015883969143033028,
0.003966877236962318,
0.03078840859234333,
-0.0129294004291296,
0.017175985500216484,
0.011865034699440002,
0.001662935595959425,
-0.006950295530259609,
-0.020300908014178276,
0.049630455672740936,
-0.001385728595778346,
-0.02038845792412758,
0.07479443401098251,
-0.014282329007983208,
0.010562092997133732,
-0.04880545660853386,
-0.013293081894516945,
0.012584907934069633,
0.000503956398461014,
0.02719317376613617,
-0.016168814152479172,
0.014870398677885532,
0.06353145092725754,
0.006914590485394001,
0.007541494444012642,
-0.06565413624048233,
-0.027073612436652184,
0.02827078476548195,
-0.012342738918960094,
-0.023467442020773888,
0.017311012372374535,
0.019626876339316368,
0.011363260447978973,
-0.027585867792367935,
-0.015736563131213188,
-0.020485244691371918,
-0.061993107199668884,
0.046270228922367096,
0.03236522525548935,
-0.022031839936971664,
0.021338995546102524,
0.0012196277966722846,
-0.018813181668519974,
0.004055267199873924,
-0.04993431270122528,
0.0021896061953157187,
-0.016484210267663002,
-0.016716979444026947,
-0.025393733754754066,
-0.07250866293907166,
-0.012675187550485134,
0.012772200629115105,
-0.06330300867557526,
-0.015543867833912373,
0.037386517971754074,
-0.06112257391214371,
0.019610561430454254,
-0.05704183131456375,
-0.009728141129016876,
-0.009973250329494476,
0.012687256559729576,
0.060049884021282196,
0.015778249129652977,
-0.05876035988330841,
0.024130720645189285,
-0.007046930026262999,
-0.013795958831906319,
-0.04986444488167763,
0.006561989430338144,
0.02740711160004139,
-0.018291549757122993,
-0.03676429018378258,
-0.05472267419099808,
-0.024931788444519043,
0.035832591354846954,
-0.04204259812831879,
0.03413357585668564,
0.015606160275638103,
0.03824347257614136,
0.022391078993678093,
0.03054865077137947,
0.0039005987346172333,
0.007856338284909725,
0.03527150675654411,
0.03275218978524208,
0.0301007442176342,
0.018726006150245667,
0.004699078854173422,
0.12619444727897644,
0.023646369576454163,
0.008752651512622833,
0.02146252803504467,
-0.0021254271268844604,
0.01667381264269352,
0.024498114362359047,
0.026867397129535675,
-0.00917745940387249,
0.005342145450413227,
-0.05029595270752907,
0.07039817422628403,
-0.04956616833806038,
-0.06615611165761948,
-0.017718637362122536,
-0.05285268276929855,
0.044540248811244965,
0.007821941748261452,
0.06891267746686935,
-0.012404514476656914,
0.0032536527141928673,
-0.0024054779205471277,
-0.020447982475161552,
0.01747838407754898,
0.036424633115530014,
0.03864612430334091,
0.10944932699203491,
-0.016678113490343094,
0.007215859834104776,
0.02575334906578064,
-0.0235647801309824,
0.03005189634859562,
-0.038888782262802124,
0.017317473888397217,
-0.044546857476234436,
0.01047192420810461,
-0.060958605259656906,
0.010217124596238136,
0.05718228220939636,
0.04462471231818199,
0.04830728843808174,
-0.044118884950876236,
0.034957461059093475,
-0.01727491058409214,
-0.030429156497120857,
-0.01561595220118761,
-0.01700424961745739,
-0.07548604905605316,
-0.029248500242829323,
0.013543134555220604,
-0.03679424151778221,
-0.02872428111732006,
-0.02566692605614662,
0.042449951171875,
0.033547498285770416,
-0.0086244847625494,
0.008428302593529224,
-0.026916518807411194,
-0.006204224191606045,
0.012167648412287235,
-0.05951536074280739,
0.004839713219553232,
0.0010835510911419988,
0.040210526436567307,
0.017775168642401695,
-0.04427911341190338,
0.021264933049678802,
-0.016462761908769608,
0.045259688049554825,
-0.09764613956212997,
-0.01428412925451994,
0.025193799287080765,
-0.011957108974456787,
-0.01989435963332653,
-0.014539898373186588,
0.014540241099894047,
0.0511411689221859,
-0.03082633577287197,
0.013428052887320518,
0.023635132238268852,
-0.006877054926007986,
-0.03829465061426163,
0.08242259919643402,
0.002202462637796998,
-0.0005342345684766769,
0.055214591324329376,
-0.04392293095588684,
-0.0036563093308359385,
-0.02996511571109295,
-0.027948841452598572,
-0.05219745635986328,
-0.00973954051733017,
0.01216492522507906,
-0.009804172441363335,
-0.01672498509287834,
-0.011745285242795944,
-0.05138005316257477,
-0.09101902693510056,
-0.006923693232238293,
0.0637299120426178,
-0.030752666294574738,
0.031611647456884384,
-0.0112988892942667,
-0.04219675809144974,
0.028062527999281883,
0.012518604286015034,
-0.01887117698788643,
0.04949561506509781,
0.028488563373684883,
0.002491162158548832,
0.020778512582182884,
0.03925234451889992,
-0.08198780566453934,
0.03575596958398819,
-0.047408998012542725,
-0.026217246428132057,
-0.0460052452981472,
0.039646487683057785,
0.07760953903198242,
-0.029224667698144913,
0.031997207552194595,
-0.07391040027141571,
0.05976378172636032,
0.027089469134807587,
-0.036409251391887665,
-0.047667041420936584,
-0.019740834832191467,
-0.019129958003759384,
0.02941693738102913,
0.03677218034863472,
-0.045025475323200226,
-0.033576689660549164,
0.0035933328326791525,
0.005137562286108732,
0.0453801192343235,
0.008575948886573315,
-0.017700569704174995,
0.020240290090441704,
0.007816347293555737,
0.055330872535705566,
0.017949547618627548,
-0.0360933393239975,
-0.056903839111328125,
-0.03361128270626068,
-0.01626882329583168,
0.06908855587244034,
0.03400357812643051,
0.010397485457360744,
0.00716469855979085,
-0.0006365444860421121,
-0.01791607029736042,
0.035829611122608185,
0.03840239718556404,
0.07708624750375748,
0.0351695716381073,
-0.06625869125127792,
0.0263090580701828,
-0.051863547414541245,
-0.015209130942821503,
0.0224728025496006,
0.024123037233948708,
0.09219260513782501,
0.04075658321380615,
-0.007530386559665203,
0.028533078730106354,
0.01423855684697628,
-0.015957701951265335,
0.013979590497910976,
0.0947626456618309,
0.02586905099451542,
-0.024997567757964134,
0.08951182663440704,
0.003886573947966099,
0.014609680511057377,
0.00572270667180419,
0.030196888372302055,
-0.020582767203450203,
0.02838350273668766,
-0.05990263447165489,
-0.05303526669740677,
0.01589359901845455,
-0.03779834881424904,
-0.08393095433712006,
-0.0336468368768692,
-0.04284406080842018,
-0.024728357791900635,
0.033923592418432236,
-0.0021241633221507072,
-0.022712763398885727,
-0.01582702063024044,
0.027063407003879547,
-0.06038450077176094,
0.0175780076533556,
-0.006130348425358534,
-0.0076658157631754875,
-0.061688825488090515,
0.016024963930249214,
0.023806262761354446,
0.05434984341263771,
0.042391031980514526,
0.07580048590898514,
-0.05111342668533325,
-0.0012954863486811519,
0.029424605891108513,
0.024372922256588936,
0.06297623366117477,
-0.04860172048211098,
0.002185196615755558,
0.027984745800495148,
0.010293867439031601,
-0.0009421348222531378,
0.00565690454095602,
-0.01538920495659113,
0.007824576459825039,
-0.021334204822778702,
-0.013788007199764252,
0.04115494340658188,
0.04945225268602371,
0.0073082628659904,
0.007165635470300913,
0.026012538000941277,
0.028040722012519836,
-0.0070975711569190025,
-0.008020891807973385,
0.038995761424303055,
-0.03085135668516159,
0.012342359870672226,
-0.02682201936841011,
-0.05150497332215309,
0.04730362072587013,
0.0007525914697907865,
-0.003298209048807621,
0.02377176098525524,
0.054771941155195236,
0.008962511084973812,
-0.024266818538308144,
-0.031904347240924835,
-0.06573645025491714,
0.007596979383379221,
0.00034828094067052007,
-0.013253103941679,
-0.014275825582444668,
-0.024058053269982338,
0.023658359423279762,
0.02622702531516552,
0.023771166801452637,
-0.007381123024970293,
-0.0301496759057045,
0.0548458956182003,
-0.026010662317276,
-0.01088842935860157,
-0.028594784438610077,
-0.015173276886343956,
-0.007200055290013552,
-0.0015113295521587133,
-0.0061213294975459576,
0.0453038327395916,
0.011408268474042416,
0.0059131751768291,
-0.018391812220215797,
0.012859925627708435,
0.0013108380371704698,
0.00024861033307388425,
-0.005188480485230684,
0.0208062082529068,
-0.041125115007162094,
0.026118148118257523,
0.02447807602584362,
0.042681965976953506,
-0.030125180259346962,
0.030940229073166847,
0.025401560589671135,
0.0328192301094532,
0.04458463564515114,
-4.860321635132697e-33,
0.0278670322149992,
-0.045022301375865936,
0.02605556510388851,
-0.01461440697312355,
-0.0017579863779246807,
0.08477526903152466,
-0.02617829479277134,
0.04286821931600571,
-0.02416210249066353,
0.03589340299367905,
-0.020192300900816917,
-0.015596565790474415,
0.01879400946199894,
0.077517569065094,
-0.03544069081544876,
0.003553213784471154,
-0.01216161623597145,
0.008729062974452972,
0.018586380407214165,
0.0027138390578329563,
0.00703255832195282,
0.01012275367975235,
-0.0047679743729531765,
0.005297517869621515,
0.0012225726386532187,
-0.04257453605532646,
0.022019121795892715,
0.023536214604973793,
-0.016239019110798836,
0.004008559510111809,
-0.006253743078559637,
-0.017044661566615105,
-0.02343258075416088,
-0.022688964381814003,
-0.024950630962848663,
-0.043347060680389404,
0.01359506230801344,
-0.06711236387491226,
0.05352884903550148,
-0.006392435170710087,
-0.024757254868745804,
-0.01292478572577238,
0.011550415307283401,
0.0348224863409996,
0.04888211190700531,
-0.04276358708739281,
-0.007743160240352154,
-0.043084193021059036,
-0.013648003339767456,
-0.008058642037212849,
-0.0005093749496154487,
0.0020623088348656893,
0.004574245307594538,
-0.007164400070905685,
0.023373862728476524,
0.00932391919195652,
-0.0620744451880455,
-0.03763526305556297,
0.000784125761128962,
-0.0020600564312189817,
-0.06625140458345413,
0.0472056083381176,
0.007192598655819893,
-0.08164097368717194,
0.006076424848288298,
-0.008443951606750488,
-0.030500659719109535,
0.019388584420084953,
-0.08048083633184433,
-0.02071014605462551,
-0.06492404639720917,
0.014268475584685802,
0.01590791530907154,
-0.015775613486766815,
0.02606428787112236,
-0.01132604293525219,
-0.014584671705961227,
-0.027005409821867943,
0.022008290514349937,
0.007903456687927246,
-0.027644002810120583,
-0.02265685424208641,
-0.0701887384057045,
0.013264777138829231,
-0.024591077119112015,
-0.08832317590713501,
-0.00023374520242214203,
-0.011848400346934795,
-0.015090260654687881,
-0.03577159345149994,
0.10766042023897171,
-0.005167494527995586,
0.002097949618473649,
-0.007403831463307142,
0.012073400430381298,
-0.07091024518013,
0.05682111531496048,
-0.019992342218756676,
0.017042523249983788,
0.006477759685367346,
0.04360280930995941,
0.014455290511250496,
0.028124842792749405,
-0.028018034994602203,
-0.033014748245477676,
0.02264084480702877,
0.0007628967287018895,
0.02986813336610794,
0.012874285690486431,
-0.013391233049333096,
-0.024958616122603416,
-0.04657736420631409,
0.03557523712515831,
-0.024278931319713593,
-0.05482663959264755,
0.04361492022871971,
-0.011185838840901852,
-0.015704339370131493,
0.052363019436597824,
0.07124113291501999,
0.09012479335069656,
-0.042402483522892,
-0.036369115114212036,
0.023323843255639076,
-0.0718459039926529,
-0.0984269455075264,
0.042418722063302994,
0.03171006217598915,
-0.04671954736113548,
0.009099510498344898,
0.025161799043416977,
0.04522865638136864,
2.574411439582036e-7,
0.07757548242807388,
-0.0253130029886961,
-0.011892377398908138,
-0.00008187563071260229,
0.0055358437821269035,
-0.049118220806121826,
0.021308721974492073,
0.027084702625870705,
0.011844918131828308,
0.015795357525348663,
0.05626032128930092,
0.0027058557607233524,
0.030328094959259033,
-0.025336336344480515,
-0.017061520367860794,
0.03488947078585625,
-0.02203579805791378,
0.026898343116044998,
0.050908442586660385,
-0.021806959062814713,
0.04140082001686096,
-0.020791439339518547,
-0.032606471329927444,
-0.04834999889135361,
-0.014850805513560772,
0.07383064180612564,
0.006760886404663324,
-0.039549570530653,
-0.0033583836629986763,
-0.019889554008841515,
0.035445090383291245,
0.0730229839682579,
-0.031606562435626984,
0.029457587748765945,
-0.0011945809237658978,
-0.04332762584090233,
0.07834496349096298,
0.045669350773096085,
0.012356108985841274,
0.017476152628660202,
0.028553524985909462,
0.01939951628446579,
0.047451309859752655,
-0.03132188692688942,
0.03697115182876587,
0.02459023892879486,
-0.05377005413174629,
0.013740700669586658,
0.05289676785469055,
-0.024034416303038597,
0.0027191671542823315,
0.029778102412819862,
-0.006294434890151024,
0.061659857630729675,
-0.016178779304027557,
0.022072141990065575,
-0.09717632830142975,
-0.007705157622694969,
-0.014162135310471058,
0.02538779191672802,
0.0731988251209259,
-0.08140337467193604,
0.003299286589026451,
-0.02954397164285183,
0.05059647932648659,
0.022239727899432182,
-0.07103995978832245,
1.8593727425185827e-34,
-0.05521359667181969,
-0.021424613893032074,
-0.021188775077462196,
0.010478579439222813,
0.0003822174621745944,
-0.013071291148662567,
0.08317017555236816,
0.02661038748919964,
0.03582680970430374,
-0.018983932211995125,
0.022269772365689278
] | {
"ds_index": 49,
"similar_dg_indices": [
892663,
575114,
568090,
933917,
1088746,
1083440,
761026,
98620,
810004,
912848,
1009921,
469082,
630526,
1079627,
1022907,
510747,
182528,
171389,
297379,
495936
]
} |
An 8-month-old boy is brought to a medical office by his mother. The mother states that the boy has been very fussy and has not been feeding recently. The mother thinks the baby has been gaining weight despite not feeding well. The boy was delivered vaginally at 39 weeks gestation without complications. On physical examination, the boy is noted to be crying in his mother’s arms. There is no evidence of cyanosis, and the cardiac examination is within normal limits. The crying intensifies when the abdomen is palpated. The abdomen is distended with tympany in the left lower quadrant. You suspect a condition caused by the failure of specialized cells to migrate. What is the most likely diagnosis? | Hirschsprung disease | {
"A": "Meckel diverticulum",
"B": "DiGeorge syndrome",
"C": "Duodenal atresia",
"D": "Hirschsprung disease"
} | step1 | D | [
"month old boy",
"brought",
"medical office",
"mother",
"mother states",
"boy",
"very fussy",
"not",
"feeding recently",
"mother thinks",
"baby",
"gaining weight",
"not feeding well",
"boy",
"delivered",
"weeks gestation",
"complications",
"physical examination",
"boy",
"noted to",
"crying",
"mothers arms",
"evidence",
"cyanosis",
"cardiac examination",
"normal limits",
"crying",
"abdomen",
"palpated",
"abdomen",
"distended",
"tympany",
"left lower quadrant",
"suspect",
"condition caused",
"failure",
"specialized cells to migrate",
"most likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An 8-month-old boy is brought to a medical office by his mother. The mother states that the boy has been very fussy and has not been feeding recently. The mother thinks the baby has been gaining weight despite not feeding well. The boy was delivered vaginally at 39 weeks gestation without complications. On physical examination, the boy is noted to be crying in his mother’s arms. There is no evidence of cyanosis, and the cardiac examination is within normal limits. The crying intensifies when the abdomen is palpated. The abdomen is distended with tympany in the left lower quadrant. You suspect a condition caused by the failure of specialized cells to migrate. What is the most likely diagnosis?
Choose one of the following::
A. Meckel diverticulum
B. DiGeorge syndrome
C. Duodenal atresia
D. Hirschsprung disease | [
0.03666812554001808,
-0.027994390577077866,
0.012103011831641197,
-0.013025039806962013,
0.026115814223885536,
-0.004674239084124565,
-0.009821044281125069,
0.027273384854197502,
-0.04602019861340523,
-0.004659605678170919,
0.05688293278217316,
-0.04365301504731178,
0.0036156296264380217,
-0.07161682844161987,
0.006860980298370123,
0.004343552514910698,
-0.014394084922969341,
-0.022798364982008934,
-0.033206384629011154,
-0.005867362022399902,
-0.04320729896426201,
0.03701429441571236,
0.011468921788036823,
-0.020494939759373665,
0.037883639335632324,
0.004235655535012484,
0.029264522716403008,
0.009230257011950016,
-0.020191382616758347,
-0.04376821219921112,
0.02576630376279354,
-0.011292156763374805,
-0.017317762598395348,
0.03138698264956474,
0.0000018666503365238896,
0.01646343246102333,
0.00496235815808177,
-0.05102537199854851,
0.026838187128305435,
0.004299971275031567,
0.0038609879557043314,
-0.06838969141244888,
-0.01147821918129921,
0.009499949403107166,
-0.019015004858374596,
-0.0839768648147583,
-0.017313798889517784,
0.05766286700963974,
-0.02235717512667179,
-0.007211762946099043,
0.009397975169122219,
0.04781511425971985,
0.008894306607544422,
0.0006582707283087075,
0.06053620204329491,
-0.014130483381450176,
-0.023750634863972664,
-0.01883445680141449,
0.02333361655473709,
-0.048703212291002274,
0.05894358828663826,
0.027340205386281013,
0.01588890142738819,
0.003829061985015869,
-0.03663015365600586,
-0.01072598248720169,
-0.002427446423098445,
-0.07136072963476181,
0.014393050223588943,
0.02034795470535755,
0.017175378277897835,
-0.022805705666542053,
0.025480402633547783,
0.06790043413639069,
-0.037330273538827896,
-0.03372028470039368,
0.05544307082891464,
0.0327044241130352,
-0.022845558822155,
0.00019285835151094943,
0.08806344866752625,
0.005218145437538624,
-0.01586637832224369,
0.04206480830907822,
-0.030015844851732254,
-0.031185653060674667,
-0.000810566358268261,
-0.04313546046614647,
-0.02167830429971218,
0.007369418628513813,
0.013274705968797207,
-0.03313032165169716,
0.04385283961892128,
0.05454928055405617,
-0.024184178560972214,
0.022508345544338226,
-0.0291892122477293,
-0.04176991805434227,
0.020894814282655716,
-0.11952053755521774,
0.012645146809518337,
-0.07402884215116501,
-0.02479567378759384,
0.033059392124414444,
-0.038242071866989136,
-0.05033435672521591,
-0.020217478275299072,
0.06158854439854622,
-0.04260510578751564,
0.04292707517743111,
0.0017814020393416286,
0.0012801182456314564,
-0.026096802204847336,
0.026296881958842278,
0.0514274425804615,
-0.015160208567976952,
0.009725986048579216,
-0.04585622623562813,
0.02012844942510128,
0.035505879670381546,
0.02692035771906376,
0.03139249607920647,
-0.018876664340496063,
0.03756452351808548,
-0.021834757179021835,
0.032856475561857224,
0.005266137421131134,
0.014142753556370735,
-0.012006240896880627,
0.025334501639008522,
0.0049422322772443295,
-0.003145350608974695,
-0.04840087890625,
0.05093524605035782,
0.02614763379096985,
0.008621856570243835,
0.007893756031990051,
0.042196910828351974,
-0.023651570081710815,
0.024361737072467804,
-0.04098130390048027,
-0.06189347058534622,
-0.031389180570840836,
0.021331045776605606,
-0.07732300460338593,
0.043066106736660004,
-0.007096586283296347,
-0.013576595112681389,
0.030964598059654236,
0.03515123203396797,
-0.04702817648649216,
-0.06118288263678551,
-0.04141877219080925,
0.006940543185919523,
0.009370016865432262,
0.029662609100341797,
0.04132314771413803,
-0.010522331111133099,
0.006807348690927029,
-0.055710650980472565,
0.02724769525229931,
-0.029666153714060783,
0.04774163290858269,
-0.0017861942760646343,
-0.020254790782928467,
0.021984895691275597,
0.049840591847896576,
0.017338596284389496,
-0.05934920534491539,
0.05301649868488312,
-0.020502617582678795,
0.01635420136153698,
0.04535089433193207,
0.010872097685933113,
0.009079968556761742,
0.03146936371922493,
-0.032680608332157135,
-0.042180366814136505,
-0.031062889844179153,
-0.03532348945736885,
0.010865239426493645,
0.03826523199677467,
0.03582513704895973,
0.007074357010424137,
-0.024742279201745987,
-0.039317794144153595,
0.022383907809853554,
0.01659431867301464,
-0.03394896164536476,
-0.02080131322145462,
-0.023950697854161263,
0.043460022658109665,
-0.039655379951000214,
0.010775052942335606,
0.0031772127840667963,
0.06103551387786865,
0.0006095357821322978,
0.03971874713897705,
0.012857959605753422,
0.06595108658075333,
-0.01656683348119259,
-0.05007631704211235,
-0.00704975938424468,
-0.025133846327662468,
-0.051698457449674606,
0.03412482514977455,
-0.04128354415297508,
0.005822158884257078,
-0.031483814120292664,
0.0015287684509530663,
-0.04032585024833679,
0.011237102560698986,
0.021067073568701744,
-0.02343238703906536,
0.007704499177634716,
0.0593220554292202,
0.026495954021811485,
-0.030299121513962746,
-0.05327244848012924,
0.030161451548337936,
-0.028837308287620544,
-0.034499235451221466,
0.022104833275079727,
0.021629219874739647,
0.013922140002250671,
-0.010516632348299026,
0.03883678466081619,
0.004102435894310474,
-0.025118215009570122,
-0.07755779474973679,
0.020644042640924454,
0.015113972127437592,
-0.03571246936917305,
0.0534268394112587,
-0.037250153720378876,
0.060181066393852234,
-0.028964022174477577,
-0.06700186431407928,
0.006258203182369471,
0.001877003931440413,
-0.08461376279592514,
-0.021809618920087814,
-0.041124239563941956,
-0.04225124418735504,
0.02354361303150654,
-0.04602617770433426,
-0.042838726192712784,
0.04648982733488083,
0.019946150481700897,
0.025770561769604683,
-0.013458317145705223,
0.00012790776963811368,
-0.008053453639149666,
0.0033416985534131527,
0.007936211302876472,
0.016893170773983,
-0.031509362161159515,
0.0072788940742611885,
-0.02111176960170269,
-0.04195438325405121,
-0.023739397525787354,
0.013898073695600033,
0.02035392075777054,
-0.06433913856744766,
-0.03290176764130592,
-0.014790579676628113,
-0.0029198885895311832,
0.027801794931292534,
0.023422889411449432,
0.0362548753619194,
-0.005491519812494516,
0.023318149149417877,
0.024033157154917717,
0.024086007848381996,
-0.016416627913713455,
-0.02521635964512825,
0.02188222110271454,
0.03488879278302193,
0.020976576954126358,
0.020048169419169426,
0.007778221275657415,
0.05171837657690048,
-0.03490935266017914,
0.028418442234396935,
0.0013676752569153905,
-0.024126410484313965,
0.0040982370264828205,
0.026107873767614365,
0.057551562786102295,
-0.0287731122225523,
-0.008476749993860722,
0.02855919487774372,
0.03937230631709099,
-0.05416193604469299,
0.016125401481986046,
-0.05370922014117241,
-0.10880914330482483,
0.09360906481742859,
-0.02410423941910267,
0.056923191994428635,
-0.03800239413976669,
0.01992727257311344,
-0.0048398589715361595,
-0.000025295930754509754,
0.025347452610731125,
0.043062228709459305,
0.030635302886366844,
0.0025486296508461237,
-0.049649763852357864,
0.07288399338722229,
0.017605874687433243,
-0.018851658329367638,
-0.004055709112435579,
-0.007665545213967562,
-0.007235738914459944,
0.009166944772005081,
-0.001120193162932992,
-0.059940487146377563,
0.04127888008952141,
0.03971129655838013,
0.051145657896995544,
0.00525884423404932,
0.0011709871469065547,
0.009326892904937267,
-0.005073921754956245,
-0.029071589931845665,
-0.037808939814567566,
0.006355751771479845,
-0.007782540284097195,
-0.03387072682380676,
-0.02145293913781643,
-0.004405781161040068,
-0.031952325254678726,
-0.04205259308218956,
0.04297681525349617,
-0.012588764540851116,
-0.03357201814651489,
-0.003809811780229211,
-0.046003326773643494,
0.01950284279882908,
0.024407660588622093,
-0.03936520963907242,
0.005277043674141169,
0.08163987845182419,
0.026536663994193077,
-0.030980858951807022,
-0.042363665997982025,
-0.005241014529019594,
-0.06127316504716873,
0.021660510450601578,
-0.09415058046579361,
-0.0005121462745591998,
0.027230726554989815,
-0.0036158135626465082,
-0.03608519956469536,
-0.0034239855594933033,
0.02193608507514,
0.03381314128637314,
-0.006575041450560093,
-0.022668495774269104,
0.007877049967646599,
0.02454223483800888,
-0.06360979378223419,
0.05201602354645729,
0.021238787099719048,
0.01299670897424221,
0.026326093822717667,
0.011687559075653553,
-0.017142167314887047,
-0.027256201952695847,
0.012271626852452755,
0.015820808708667755,
-0.061837367713451385,
-0.008061493746936321,
-0.016121573746204376,
0.017221039161086082,
-0.013236123137176037,
-0.02798343636095524,
-0.0852658748626709,
-0.03996475785970688,
0.06388811767101288,
0.03300052136182785,
0.03045605681836605,
0.01119627058506012,
-0.04189566150307655,
-0.008462448604404926,
-0.042810093611478806,
-0.014779522083699703,
0.06934813410043716,
0.0450480692088604,
0.0022903417702764273,
0.02648910880088806,
-0.044621825218200684,
0.007030194625258446,
0.011476365849375725,
0.03823129087686539,
0.005330745130777359,
-0.03465700149536133,
0.05411551520228386,
0.05075781047344208,
-0.036869581788778305,
-0.03866904228925705,
-0.014016751199960709,
0.06836380064487457,
0.057405583560466766,
-0.03506958857178688,
-0.045536451041698456,
-0.045778706669807434,
-0.002424555364996195,
0.024126136675477028,
0.02795758843421936,
0.005946282297372818,
-0.0011694917920976877,
0.01963464356958866,
-0.007277929689735174,
-0.03615379333496094,
0.004204698838293552,
-0.09710880368947983,
0.0113750621676445,
-0.07281433045864105,
0.0864439532160759,
-0.009385526180267334,
0.017883608117699623,
-0.022283094003796577,
-0.022946612909436226,
-0.0269455723464489,
0.0720464363694191,
0.028276005759835243,
0.020956415683031082,
0.011724554933607578,
0.0014129311311990023,
-0.016362730413675308,
0.041564811021089554,
0.0549708716571331,
0.01791856251657009,
0.06693825125694275,
0.05903743952512741,
0.017438169568777084,
0.009257287718355656,
-0.018525050953030586,
0.014878480695188046,
-0.014808833599090576,
0.08303402364253998,
0.0640590563416481,
0.04380856081843376,
-0.062182873487472534,
-0.02145712822675705,
0.014562875032424927,
0.04094180092215538,
0.1055605560541153,
-0.0029710985254496336,
-0.03396027907729149,
-0.0061537823639810085,
0.02520037442445755,
0.03772959113121033,
0.0394616574048996,
-0.00433090515434742,
-0.011005323380231857,
0.021481817588210106,
-0.10294835269451141,
-0.05992034822702408,
0.02886941283941269,
-0.04511142522096634,
-0.07696391642093658,
0.006497932132333517,
-0.014447351917624474,
-0.026173848658800125,
0.01384018175303936,
0.004702459555119276,
0.012075068429112434,
-0.09659499675035477,
0.04563427343964577,
-0.011386050842702389,
0.015586086548864841,
-0.007124419789761305,
-0.012265684083104134,
-0.014229865744709969,
-0.05553485453128815,
0.014655107632279396,
0.039743054658174515,
-0.030851935967803,
0.061788350343704224,
-0.052253358066082,
-0.125987246632576,
0.027065781876444817,
-0.010268012061715126,
0.015721876174211502,
-0.014617460779845715,
-0.013556689955294132,
0.022284306585788727,
0.033032581210136414,
0.019242657348513603,
-0.009548759087920189,
-0.02794954925775528,
-0.07064834982156754,
-0.0038363290950655937,
0.030930574983358383,
0.0874752402305603,
0.03659627214074135,
-0.018527638167142868,
0.03511371463537216,
0.018689798191189766,
0.04482628405094147,
-0.06073404476046562,
0.013199776411056519,
0.046814046800136566,
-0.006649734918028116,
0.0043671755120158195,
-0.026995213702321053,
-0.020368870347738266,
0.03868500143289566,
-0.03323240950703621,
0.021216336637735367,
0.03153636306524277,
-0.006509147118777037,
-0.027627209201455116,
-0.05567033961415291,
-0.022284075617790222,
-0.0486864410340786,
0.020904475823044777,
-0.0029261955060064793,
0.04048388823866844,
-0.03233926743268967,
-0.03306851536035538,
0.009598885662853718,
0.03651297837495804,
0.000053571773605654016,
0.015689056366682053,
0.0049768900498747826,
0.04753606393933296,
-0.0745103657245636,
-0.004966390319168568,
-0.053399305790662766,
0.01572536863386631,
-0.019566122442483902,
0.014523787423968315,
0.04545748233795166,
-0.024091573432087898,
0.002548410790041089,
0.007227608934044838,
0.007218008395284414,
-0.0015723098767921329,
-0.03818541765213013,
0.03189980611205101,
-0.02082008682191372,
0.024512851610779762,
-0.04436764121055603,
0.02397480420768261,
0.06910249590873718,
0.0156968105584383,
-0.04818272590637207,
0.059274617582559586,
0.044018615037202835,
0.024517279118299484,
0.06614476442337036,
-5.4026895858143156e-33,
0.00002989009954035282,
0.005822222214192152,
0.04793496057391167,
-0.054089829325675964,
0.03345490247011185,
0.08400549739599228,
-0.02702118456363678,
0.013959870673716068,
-0.03806495666503906,
0.02107054553925991,
-0.03877749666571617,
-0.031772930175065994,
0.016449838876724243,
0.05758645012974739,
-0.00840330496430397,
-0.024894244968891144,
-0.005196019075810909,
-0.0007453183643519878,
-0.0027205944061279297,
-0.013225685805082321,
-0.04883889853954315,
-0.027727115899324417,
-0.024998201057314873,
0.0031944073271006346,
-0.0007715150131843984,
-0.03965764120221138,
0.042693689465522766,
0.015126140788197517,
0.03611573204398155,
-0.027674010023474693,
0.026276392862200737,
-0.061550259590148926,
-0.012719572521746159,
-0.03777548298239708,
-0.040248315781354904,
-0.05792820081114769,
0.030488627031445503,
0.0015962948091328144,
0.02805609628558159,
0.0028084730729460716,
-0.08665906637907028,
-0.008938128128647804,
0.06712865829467773,
0.00045240402687340975,
0.05542720481753349,
-0.03210563585162163,
-0.008334150537848473,
-0.04301545023918152,
-0.025497911497950554,
-0.04827321693301201,
0.004289982840418816,
0.02902890183031559,
0.001931403181515634,
-0.04298888146877289,
-0.0044650910422205925,
-0.023008519783616066,
-0.015676164999604225,
-0.01078503206372261,
0.018397007137537003,
-0.007364778313785791,
0.036360520869493484,
0.0009036179981194437,
-0.00471879169344902,
-0.05898132547736168,
-0.02373448945581913,
0.0019763638265430927,
0.04064568877220154,
0.0008465648861601949,
-0.07932843267917633,
0.06206335127353668,
-0.03139161318540573,
0.007671023719012737,
0.02602989412844181,
-0.10316143184900284,
-0.02596256509423256,
-0.006402522325515747,
0.02259974740445614,
0.018481697887182236,
0.01851879619061947,
0.041199829429388046,
-0.021323204040527344,
0.023735642433166504,
-0.047222696244716644,
0.009498677216470242,
-0.0029606367461383343,
-0.06186772137880325,
0.0029199449345469475,
-0.026271799579262733,
-0.017095983028411865,
-0.004056183155626059,
0.08396655321121216,
-0.01381266675889492,
-0.006280029658228159,
-0.00894066784530878,
-0.009729547426104546,
-0.05213991552591324,
0.09399623423814774,
0.022955166175961494,
-0.013875864446163177,
0.045536816120147705,
0.07990089803934097,
-0.030058464035391808,
0.015693211928009987,
-0.011374836787581444,
-0.006019841879606247,
0.05185496807098389,
0.00576413469389081,
0.004679979290813208,
-0.02550426870584488,
-0.011878919787704945,
0.0028135546017438173,
-0.032686010003089905,
-0.00265500764362514,
-0.026266641914844513,
-0.04382392764091492,
0.03775918483734131,
0.0005332257715053856,
-0.003380395006388426,
0.005895824171602726,
0.06511402130126953,
0.01726718619465828,
0.04559003561735153,
-0.024169061332941055,
-0.0015859397826716304,
-0.06618934124708176,
-0.0786978155374527,
0.029239676892757416,
0.040599144995212555,
-0.0008329824777320027,
0.019984927028417587,
0.03857297822833061,
0.021560849621891975,
2.709809905354632e-7,
0.045313913375139236,
0.019560188055038452,
-0.03469972312450409,
-0.09326755255460739,
0.028384430333971977,
-0.02836531586945057,
-0.04274551570415497,
0.016964305192232132,
0.03520987927913666,
-0.03057762235403061,
0.05131666362285614,
0.022994833067059517,
0.0036993403919041157,
0.007330537773668766,
0.011099561117589474,
-0.014184555970132351,
0.0011542616412043571,
0.05287987366318703,
0.04963952675461769,
-0.02106362208724022,
0.0400686115026474,
0.06124686449766159,
-0.05678888037800789,
-0.024528490379452705,
0.020665954798460007,
0.011768952943384647,
-0.007457324303686619,
-0.04500656947493553,
0.0335114523768425,
-0.005618444178253412,
-0.00878988392651081,
0.02745218202471733,
0.031390126794576645,
0.008500911295413971,
-0.05124262347817421,
-0.017348885536193848,
0.016482654958963394,
0.018609192222356796,
0.03870365396142006,
-0.01389227993786335,
0.010844090022146702,
0.014417735859751701,
0.06267742067575455,
-0.02340536005795002,
-0.014518538489937782,
-0.015565144829452038,
-0.03618765249848366,
0.010728095658123493,
0.054922886192798615,
0.008388442918658257,
-0.01946491189301014,
0.03273218870162964,
-0.015775246545672417,
0.08311639726161957,
-0.02152007445693016,
0.030308987945318222,
-0.04172004759311676,
-0.0466298945248127,
-0.000586142239626497,
0.016046997159719467,
-0.003128961194306612,
-0.01027632039040327,
0.004435126204043627,
-0.012924679554998875,
0.025860760360956192,
0.01771911233663559,
-0.04069629684090614,
1.9087528035971048e-34,
-0.04084644466638565,
-0.04992770031094551,
0.003017191542312503,
-0.06380270421504974,
0.005370892118662596,
-0.02634536288678646,
0.04220128431916237,
0.036170363426208496,
0.042196113616228104,
-0.030625304207205772,
0.011540662497282028
] | {
"ds_index": 50,
"similar_dg_indices": [
1111150,
677675,
578792,
505888,
183883,
426853,
1189690,
468549,
1071500,
307109,
998233,
179267,
191929,
578146,
642500,
545807,
834350,
406970,
244427,
225009
]
} |
A 60-year-old man seeks evaluation at a medical office due to leg pain while walking. He says the pain starts in his buttocks and extends to his thighs and down to his calves. Previously, the pain resolved with rest, but the pain now persists in his feet, even during rest. His past medical history is significant for diabetes mellitus, hypertension, and cigarette smoking. The vital signs are within normal limits. The physical examination shows an atrophied leg with bilateral loss of hair. Which of the following is the most likely cause of this patient’s condition? | Narrowing and calcification of vessels | {
"A": "Decreased permeability of endothelium",
"B": "Narrowing and calcification of vessels",
"C": "Peripheral emboli formation",
"D": "Weakening of vessel wall"
} | step1 | B | [
"60 year old man",
"evaluation",
"medical office",
"leg pain",
"walking",
"pain starts",
"buttocks",
"extends",
"thighs",
"calves",
"pain resolved",
"rest",
"pain now",
"feet",
"rest",
"past medical history",
"significant",
"diabetes mellitus",
"hypertension",
"cigarette smoking",
"vital signs",
"normal limits",
"physical examination shows",
"atrophied leg",
"bilateral loss",
"following",
"most likely cause",
"patients condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 60-year-old man seeks evaluation at a medical office due to leg pain while walking. He says the pain starts in his buttocks and extends to his thighs and down to his calves. Previously, the pain resolved with rest, but the pain now persists in his feet, even during rest. His past medical history is significant for diabetes mellitus, hypertension, and cigarette smoking. The vital signs are within normal limits. The physical examination shows an atrophied leg with bilateral loss of hair. Which of the following is the most likely cause of this patient’s condition?
Choose one of the following::
A. Decreased permeability of endothelium
B. Narrowing and calcification of vessels
C. Peripheral emboli formation
D. Weakening of vessel wall | [
-0.01231211144477129,
0.01603991910815239,
0.008699772879481316,
0.04483821988105774,
0.00346101145260036,
0.003621508600190282,
0.022110866382718086,
0.06091691553592682,
0.017342282459139824,
-0.000052632734877988696,
0.08436833322048187,
-0.024249674752354622,
0.02107222005724907,
-0.08859427273273468,
0.033583346754312515,
0.02721521630883217,
0.017019769176840782,
0.020658213645219803,
0.03604907914996147,
-0.023601515218615532,
-0.032372090965509415,
0.026317071169614792,
0.05114494264125824,
0.005661674775183201,
-0.004880090709775686,
0.007450976874679327,
0.04735594242811203,
-0.04724457487463951,
0.006489137187600136,
-0.013230442069470882,
-0.018804142251610756,
-0.02453906647861004,
0.010462932288646698,
-0.06821667402982712,
0.000001941798018378904,
-0.0005025977152399719,
0.02560778148472309,
0.009753033518791199,
0.0266354251652956,
-0.045144177973270416,
0.013034921139478683,
0.032526563853025436,
0.05420774221420288,
0.005069661885499954,
-0.005086539313197136,
-0.09177728742361069,
0.02952531911432743,
0.04196507856249809,
-0.025631584227085114,
0.04918399825692177,
-0.0008818789501674473,
-0.01645096018910408,
-0.07217008620500565,
0.021048417314887047,
0.0480063334107399,
-0.006381670478731394,
-0.02563820220530033,
-0.027949929237365723,
-0.038286879658699036,
0.011178669519722462,
0.015356026589870453,
-0.007327308878302574,
0.02078770287334919,
0.00821804441511631,
-0.05095890536904335,
0.01889609545469284,
0.024457231163978577,
-0.03547023981809616,
0.031104305759072304,
-0.0213280338793993,
-0.02284667268395424,
0.03782008960843086,
0.05761696770787239,
0.05858749896287918,
0.022560186684131622,
0.014178278855979443,
0.07786701619625092,
-0.00883418507874012,
-0.04837625101208687,
-0.025366144254803658,
0.008825482800602913,
0.036340899765491486,
0.006949227768927813,
0.051253147423267365,
-0.022295786067843437,
-0.06724230200052261,
0.018030056729912758,
0.040167611092329025,
0.01729702018201351,
-0.055942680686712265,
-0.0007630702457390726,
-0.03536595031619072,
0.01398022286593914,
0.02627762034535408,
-0.05553477630019188,
0.0178669486194849,
-0.0012496242998167872,
0.051380231976509094,
0.05666932836174965,
-0.06251304596662521,
0.03033713437616825,
0.007273653522133827,
0.0435691773891449,
-0.0063552348874509335,
-0.04879611358046532,
-0.020779015496373177,
-0.034915417432785034,
-0.00028996026958338916,
-0.06989766657352448,
0.04501692205667496,
0.01460905559360981,
0.022130664438009262,
-0.023214152082800865,
0.012773003429174423,
0.03503158316016197,
-0.03701554611325264,
-0.006464994978159666,
-0.0710492953658104,
0.024448836222290993,
-0.024190768599510193,
-0.06364033371210098,
0.008609719574451447,
0.0013994923792779446,
0.029462654143571854,
-0.007007312960922718,
0.028004176914691925,
-0.04101205989718437,
0.04444890469312668,
0.05607817694544792,
0.02395004592835903,
0.00003798195757553913,
0.008341742679476738,
-0.032420407980680466,
0.011157488450407982,
0.00116392329800874,
-0.02819216251373291,
0.016032855957746506,
0.06371299922466278,
0.03761253133416176,
0.015325590968132019,
-0.040559325367212296,
-0.006572213489562273,
-0.020679114386439323,
-0.032964594662189484,
0.023429127410054207,
0.010379400104284286,
0.004193978849798441,
0.02569488249719143,
-0.017985686659812927,
0.008261596783995628,
-0.005160126835107803,
0.02078148163855076,
-0.022065533325076103,
0.013684358447790146,
0.014469824731349945,
-0.00016816008428577334,
0.04017950966954231,
0.0175737626850605,
-0.014818095602095127,
0.003794086864218116,
-0.025866152718663216,
-0.031087618321180344,
-0.023001467809081078,
-0.050261642783880234,
0.010098268277943134,
0.006069355644285679,
0.04972529411315918,
0.061203982681035995,
-0.033413663506507874,
0.046473179012537,
-0.049165163189172745,
0.04832972213625908,
-0.01186427567154169,
0.05034748837351799,
-0.08338382095098495,
0.03164909780025482,
0.04001159593462944,
0.02767861634492874,
0.0008855283376760781,
-0.05276094377040863,
-0.00945453904569149,
-0.015280866995453835,
0.044805292040109634,
-0.07915793359279633,
-0.00633865874260664,
0.02755858562886715,
-0.04235292598605156,
0.006541003938764334,
-0.0320361852645874,
0.012969794683158398,
-0.007802837528288364,
0.022318266332149506,
-0.02321125939488411,
0.02908165194094181,
0.022993626073002815,
0.04053013026714325,
-0.00986220221966505,
0.022111641243100166,
-0.044026125222444534,
0.005200420971959829,
-0.017654240131378174,
-0.02226371318101883,
-0.09203077107667923,
0.0015613051364198327,
-0.04593489319086075,
0.045335881412029266,
0.0015355658251792192,
-0.005384071264415979,
0.029881944879889488,
-0.010471557267010212,
-0.036628078669309616,
0.01480383612215519,
0.04843363165855408,
-0.03878109157085419,
0.050149161368608475,
0.03732820600271225,
0.014406071975827217,
0.02414795570075512,
-0.0607755109667778,
0.06492804735898972,
0.0005422825925052166,
-0.04109974950551987,
0.03859433904290199,
-0.008535693399608135,
-0.09541956335306168,
0.0240426417440176,
0.021649451926350594,
-0.025582237169146538,
-0.03173818066716194,
-0.08226191252470016,
0.03533242270350456,
0.02564237080514431,
-0.06298836320638657,
-0.03292131796479225,
-0.06349160522222519,
0.01487602200359106,
0.0030935797840356827,
-0.012209017761051655,
0.039240527898073196,
0.005217653699219227,
-0.030916636809706688,
-0.04237579181790352,
-0.033249083906412125,
-0.06162659078836441,
-0.04267660900950432,
-0.10987096279859543,
-0.007284156512469053,
0.020376985892653465,
-0.05693550035357475,
0.05906561389565468,
-0.049396317452192307,
-0.008232830092310905,
0.07395968586206436,
0.0434744693338871,
-0.001376196974888444,
0.02890252135694027,
-0.010956456884741783,
0.053035229444503784,
-0.024003595113754272,
-0.053798843175172806,
0.013513428159058094,
-0.005124678369611502,
-0.03567729890346527,
0.029375307261943817,
-0.018976762890815735,
0.011156350374221802,
-0.012531685642898083,
0.01413931418210268,
-0.00009216288890456781,
0.039461128413677216,
-0.008185726590454578,
-0.041587259620428085,
0.01658487133681774,
0.01799858920276165,
-0.05343824625015259,
-0.026175344362854958,
-0.039980411529541016,
0.042279601097106934,
0.03199557214975357,
0.020533131435513496,
0.008345460519194603,
0.006928053684532642,
-0.0159891527146101,
-0.003973542712628841,
0.013238465413451195,
-0.042713604867458344,
0.016617104411125183,
0.011967367492616177,
-0.01215342152863741,
0.06151970103383064,
-0.0540056973695755,
0.0022294686641544104,
0.03957343101501465,
-0.009447671473026276,
-0.02831251174211502,
-0.020542755722999573,
-0.08034055680036545,
0.0035034220200031996,
0.0009555026772432029,
0.06259754300117493,
0.06366022676229477,
-0.023999134078621864,
0.0026453842874616385,
-0.0025662558618932962,
-0.027474403381347656,
0.020308159291744232,
0.010971925221383572,
-0.04234036058187485,
0.008584433235228062,
-0.01724901609122753,
0.05366034433245659,
0.004393556620925665,
-0.018114887177944183,
-0.04398176819086075,
-0.010566512122750282,
-0.004861581604927778,
-0.0030528316274285316,
-0.033556874841451645,
0.0247891154140234,
0.05196536332368851,
0.0018139301100745797,
0.05888129398226738,
0.01607701927423477,
0.010348347015678883,
0.002311917021870613,
0.0298713780939579,
0.06580159068107605,
-0.0031162856612354517,
0.004137853160500526,
-0.012254668399691582,
0.024377014487981796,
-0.054398518055677414,
-0.01440420001745224,
0.01930442452430725,
-0.025370769202709198,
0.050149478018283844,
-0.03164052590727806,
0.00014883975381962955,
0.0066812834702432156,
0.0705508440732956,
-0.005118911154568195,
-0.018678342923521996,
-0.01647491566836834,
-0.0040370868518948555,
0.06780198216438293,
0.042389534413814545,
-0.04495649412274361,
0.023795107379555702,
-0.0019912002608180046,
-0.021035311743617058,
-0.0777321383357048,
0.07859781384468079,
0.009058571420609951,
0.041633930057287216,
-0.02123900316655636,
-0.005192894022911787,
0.03633323311805725,
0.02649153210222721,
0.0035513783805072308,
0.024231284856796265,
0.0267044510692358,
0.013802229426801205,
-0.015577781945466995,
0.005217781290411949,
0.021413523703813553,
0.005410656798630953,
-0.031107934191823006,
-0.05273216962814331,
0.006642153020948172,
-0.04804125800728798,
-0.019963130354881287,
-0.020218560472130775,
-0.0920703262090683,
0.06855212897062302,
-0.007957235909998417,
-0.015074956230819225,
0.02556595578789711,
-0.016963941976428032,
-0.05139376223087311,
-0.03025849722325802,
0.05671552196145058,
-0.053681302815675735,
0.032261162996292114,
0.00616412004455924,
-0.009038434363901615,
0.05339585617184639,
0.022228753194212914,
0.013295629993081093,
0.044520195573568344,
0.020274441689252853,
-0.01699148491024971,
-0.004636137280613184,
0.009861226193606853,
0.0069976309314370155,
-0.0025029871612787247,
0.09822792559862137,
-0.02041393145918846,
-0.02365381270647049,
-0.01263279840350151,
0.033792492002248764,
0.009831332601606846,
-0.021751634776592255,
-0.05109112709760666,
0.006496103946119547,
0.11280541121959686,
-0.020006729289889336,
0.0017082324484363198,
0.016870347782969475,
0.027098244056105614,
-0.029060112312436104,
0.03190337494015694,
-0.08989527821540833,
0.011335830204188824,
-0.024552298709750175,
0.012958722189068794,
-0.005689839832484722,
0.010738160461187363,
-0.05800492316484451,
0.03654424101114273,
-0.06677021831274033,
0.10760707408189774,
-0.024216948077082634,
0.007194997742772102,
-0.07952279597520828,
0.03078249655663967,
0.012208332307636738,
0.02704429067671299,
0.04382285103201866,
-0.016560038551688194,
0.023952268064022064,
0.04419397562742233,
-0.05459236353635788,
0.03166944906115532,
0.07879909873008728,
0.024385657161474228,
0.04686907306313515,
-0.05737999826669693,
-0.007124992087483406,
0.02474154904484749,
-0.06196128576993942,
-0.007148681674152613,
0.0010600347304716706,
-0.003090462414547801,
0.028522470965981483,
0.040600307285785675,
-0.0671103373169899,
0.011545512825250626,
0.029022816568613052,
0.040044788271188736,
0.10225304216146469,
0.010834401473402977,
0.01892091892659664,
0.07115078717470169,
-0.01555838342756033,
0.04637044668197632,
0.01607532612979412,
0.01125080231577158,
-0.09405216574668884,
0.004184413235634565,
-0.010364311747252941,
-0.06848572939634323,
0.008711563423275948,
-0.013642084784805775,
-0.0749015361070633,
0.029042018577456474,
-0.08413907140493393,
-0.011640788987278938,
0.03449437767267227,
-0.01922542415559292,
0.04628720507025719,
-0.030026327818632126,
0.039999958127737045,
0.043474938720464706,
0.005323064513504505,
0.012720659375190735,
-0.00793600082397461,
-0.06052915379405022,
-0.023301487788558006,
-0.025282593443989754,
0.042775098234415054,
0.0072136130183935165,
-0.00170861033257097,
-0.03560195490717888,
-0.04954681545495987,
0.04491017386317253,
0.020835841074585915,
0.016695862635970116,
-0.005602963734418154,
-0.03852422907948494,
-0.01802665740251541,
-0.030151767656207085,
-0.05124205723404884,
0.01561759877949953,
0.008089308626949787,
-0.010606559924781322,
0.03042958304286003,
0.016502032056450844,
0.04824424907565117,
-0.04457796737551689,
-0.0343194380402565,
0.018473193049430847,
0.005764853674918413,
0.00717206159606576,
-0.006426628679037094,
-0.01247946172952652,
0.008880176581442356,
-0.022426823154091835,
0.017866965383291245,
-0.0018875886453315616,
-0.04477311670780182,
-0.029555292800068855,
-0.032354384660720825,
0.009153244085609913,
-0.007479179184883833,
0.04676131159067154,
-0.017688049003481865,
-0.026878641918301582,
-0.06158316507935524,
-0.017171403393149376,
0.0016083234222605824,
-0.016992690041661263,
-0.014294710010290146,
0.00183728092815727,
-0.0005740218912251294,
-0.014756538905203342,
0.013944671489298344,
0.005823367275297642,
-0.010203489102423191,
0.0416567325592041,
0.008221016265451908,
-0.028675956651568413,
-0.04130548611283302,
-0.0704505518078804,
-0.03415205702185631,
0.0003946807992178947,
-0.01586480438709259,
-0.043147120624780655,
-0.029058512300252914,
-0.004090159200131893,
-0.0772961974143982,
-0.020423544570803642,
-0.013271361589431763,
-0.05674766004085541,
-0.023400256410241127,
-0.0345088429749012,
0.027346158400177956,
0.003665914759039879,
-0.009606201201677322,
0.040424782782793045,
-0.043961912393569946,
-0.016213271766901016,
0.09278111904859543,
0.03061247244477272,
0.02093113586306572,
0.0013761838199570775,
-4.945230163486483e-33,
0.03450438007712364,
0.00028008161461912096,
0.0018087924690917134,
-0.02575165405869484,
-0.011441485956311226,
0.042025238275527954,
-0.045697201043367386,
-0.029673613607883453,
-0.06546682119369507,
0.04957430809736252,
0.03555309772491455,
0.0005916110239923,
0.025054525583982468,
0.07375646382570267,
0.003952340222895145,
-0.021948669105768204,
0.030260330066084862,
0.008960159495472908,
0.027307674288749695,
-0.02491779625415802,
-0.0010612872429192066,
-0.02800791896879673,
-0.00991565827280283,
-0.028458818793296814,
0.06254886090755463,
-0.0021880546119064093,
0.030117621645331383,
0.005829924717545509,
-0.03044683113694191,
0.007125319913029671,
0.006002875976264477,
-0.036257803440093994,
0.005108656827360392,
-0.05415058508515358,
-0.031028831377625465,
-0.04527129605412483,
0.0033537771087139845,
-0.032012805342674255,
0.019253050908446312,
-0.0023467906285077333,
-0.007103789132088423,
-0.031120479106903076,
-0.02670479193329811,
-0.015296617522835732,
0.05276864394545555,
-0.015176717191934586,
-0.026823293417692184,
-0.0026614267844706774,
0.014834001660346985,
-0.019594063982367516,
0.03927088528871536,
-0.005131707992404699,
0.009820790030062199,
-0.03326374292373657,
-0.05628762021660805,
0.040049925446510315,
-0.007804748602211475,
0.026922326534986496,
0.029959488660097122,
-0.03767470270395279,
-0.02314767986536026,
0.0010029105469584465,
0.01748456247150898,
0.01644773781299591,
-0.02081325836479664,
0.00245846901088953,
-0.03964102640748024,
0.011302622966468334,
-0.051462698727846146,
-0.053899120539426804,
-0.07235206663608551,
0.02388598397374153,
-0.002035640412941575,
-0.07253839820623398,
0.009090732783079147,
0.0067542558535933495,
0.03028270974755287,
0.026343947276473045,
0.039211615920066833,
0.09206931293010712,
-0.02872125804424286,
0.006030672695487738,
-0.012380736880004406,
-0.022125620394945145,
0.002538973931223154,
-0.011657166294753551,
0.03620946779847145,
-0.05806239694356918,
-0.027329370379447937,
-0.037345390766859055,
0.07672800123691559,
0.02949814312160015,
0.05437988415360451,
0.015832899138331413,
-0.025165576487779617,
-0.03438746929168701,
0.024381713941693306,
0.038590025156736374,
-0.007072593085467815,
0.04587557166814804,
0.05169915407896042,
0.01975330151617527,
-0.010614673607051373,
0.02947777509689331,
-0.03774547576904297,
0.008663865737617016,
0.01667463220655918,
-0.04074001684784889,
-0.04066247120499611,
0.04519875347614288,
-0.004308790899813175,
-0.031568072736263275,
-0.0070322356186807156,
0.07066693902015686,
0.01714227721095085,
0.02948635444045067,
-0.015559925697743893,
0.1314365416765213,
-0.002100561745464802,
0.046848755329847336,
-0.006129460409283638,
-0.013834990561008453,
-0.018788745626807213,
-0.023867588490247726,
-0.0579373799264431,
-0.037516385316848755,
-0.00613474240526557,
0.02265143394470215,
-0.05522334203124046,
-0.0005848401342518628,
0.012656137347221375,
-0.046076055616140366,
2.5803973358051735e-7,
0.06454700231552124,
-0.0205361470580101,
0.008027572184801102,
-0.08275076746940613,
0.027508797124028206,
-0.045068103820085526,
0.040874872356653214,
-0.0155046870931983,
-0.027522120624780655,
-0.018447067588567734,
0.03431306034326553,
0.007112300489097834,
-0.014875595457851887,
0.025130413472652435,
0.02306150272488594,
0.03123835287988186,
-0.03735014796257019,
0.025227732956409454,
0.011346192099153996,
0.01811237633228302,
-0.037103455513715744,
-0.04530744254589081,
-0.0693654865026474,
-0.04439292103052139,
0.03883186727762222,
-0.002723681041970849,
-0.0012203468941152096,
-0.037263788282871246,
-0.03750980645418167,
-0.05966776981949806,
0.03806066885590553,
-0.032261922955513,
0.03687351197004318,
0.0039178840816020966,
-0.010264398530125618,
0.012003326788544655,
-0.0469227135181427,
0.04117060452699661,
-0.03436190262436867,
0.019259002059698105,
0.015237508341670036,
0.03463819622993469,
-0.008169633336365223,
0.03163764625787735,
0.03441315144300461,
0.050398655235767365,
-0.05210583284497261,
-0.08822666853666306,
0.039422161877155304,
0.020886775106191635,
0.020471908152103424,
0.019102655351161957,
0.015810713171958923,
0.04418184980750084,
-0.018693698570132256,
0.029300909489393234,
-0.014687013812363148,
-0.01967025175690651,
0.03820040076971054,
-0.02753225900232792,
-0.027651742100715637,
0.025035351514816284,
-0.016679925844073296,
0.0015693878522142768,
0.05116008222103119,
-0.022299164906144142,
-0.05016709864139557,
1.9220731979317108e-34,
-0.012774379923939705,
0.05233278498053551,
0.005325902719050646,
0.01415393315255642,
-0.047207027673721313,
-0.03340489789843559,
-0.0520746186375618,
0.01765594258904457,
0.04818039759993553,
-0.061891358345746994,
-0.02484966814517975
] | {
"ds_index": 51,
"similar_dg_indices": [
371823,
123629,
545977,
1006235,
118956,
153489,
915547,
1168433,
206994,
846035,
693903,
929035,
192264,
64260,
429080,
253561,
423487,
476483,
366843,
281624
]
} |
A 52-year-old man presents to the emergency department with chest pain radiating to his left jaw and arm. He states that he had experienced similar symptoms when playing basketball. The medical history is significant for diabetes mellitus, hypertension, and GERD, for which he takes metformin, hydrochlorothiazide, and pantoprazole, respectively. The blood pressure is 150/90 mm Hg, the pulse is 100/min, and the respirations are 15/min. The ECG reveals ST elevation in leads V3-V6. He is hospitalized for an acute MI and started on treatment. The next day he complains of dizziness and blurred vision. Repeat vital signs were as follows: blood pressure 90/60 mm Hg, pulse 72/min, and respirations 12/min. The laboratory results were as follows:
Serum chemistry
Sodium 143 mEq/L
Potassium 4.1 mEq/L
Chloride 98 mEq/L
Bicarbonate 22 mEq/L
Blood urea nitrogen 26 mg/dL
Creatinine 2.3 mg/dL
Glucose 120 mg/dL
Which of the following drugs is responsible for this patient’s lab abnormalities? | Lisinopril | {
"A": "Digoxin",
"B": "Pantoprazole",
"C": "Lisinopril",
"D": "Nitroglycerin"
} | step1 | C | [
"year old man presents",
"emergency department",
"chest pain radiating to",
"left jaw",
"arm",
"states",
"similar symptoms",
"playing basketball",
"medical history",
"significant",
"diabetes mellitus",
"hypertension",
"GERD",
"takes metformin",
"hydrochlorothiazide",
"pantoprazole",
"blood pressure",
"90 mm Hg",
"pulse",
"100 min",
"respirations",
"min",
"ECG reveals ST elevation",
"leads V3 V6",
"hospitalized",
"acute MI",
"started on treatment",
"next day",
"dizziness",
"blurred vision",
"Repeat vital signs",
"follows",
"blood pressure 90 60 mm Hg",
"pulse 72 min",
"respirations",
"min",
"laboratory results",
"follows",
"Serum",
"mEq/L Potassium",
"98",
"Creatinine",
"Glucose",
"following drugs",
"responsible",
"patients lab abnormalities"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 52-year-old man presents to the emergency department with chest pain radiating to his left jaw and arm. He states that he had experienced similar symptoms when playing basketball. The medical history is significant for diabetes mellitus, hypertension, and GERD, for which he takes metformin, hydrochlorothiazide, and pantoprazole, respectively. The blood pressure is 150/90 mm Hg, the pulse is 100/min, and the respirations are 15/min. The ECG reveals ST elevation in leads V3-V6. He is hospitalized for an acute MI and started on treatment. The next day he complains of dizziness and blurred vision. Repeat vital signs were as follows: blood pressure 90/60 mm Hg, pulse 72/min, and respirations 12/min. The laboratory results were as follows:
Serum chemistry
Sodium 143 mEq/L
Potassium 4.1 mEq/L
Chloride 98 mEq/L
Bicarbonate 22 mEq/L
Blood urea nitrogen 26 mg/dL
Creatinine 2.3 mg/dL
Glucose 120 mg/dL
Which of the following drugs is responsible for this patient’s lab abnormalities?
Choose one of the following::
A. Digoxin
B. Pantoprazole
C. Lisinopril
D. Nitroglycerin | [
-0.007685363292694092,
-0.08336783945560455,
0.03478812798857689,
0.04772825539112091,
0.038507264107465744,
0.033637698739767075,
-0.035742226988077164,
0.03665958717465401,
0.02268042415380478,
0.02373153530061245,
0.034594785422086716,
0.024718357250094414,
0.003508717054501176,
0.0028614336624741554,
0.012695496901869774,
0.00898802001029253,
0.005810351110994816,
0.0022469160612672567,
-0.0012872290099039674,
-0.00943822879344225,
-0.008824850432574749,
0.018772367388010025,
0.045779917389154434,
0.025151973590254784,
0.044028155505657196,
-0.02930273301899433,
0.017325321212410927,
-0.043040573596954346,
-0.02834133617579937,
-0.026393786072731018,
-0.04104437679052353,
-0.0023175436072051525,
-0.029636511579155922,
-0.08431490510702133,
0.0000018271706494488171,
-0.016161199659109116,
0.029080277308821678,
0.004461455158889294,
0.015109416097402573,
-0.06704545766115189,
-0.014200238510966301,
-0.04638257250189781,
0.028594672679901123,
-0.001764311920851469,
-0.03456095978617668,
-0.10548485070466995,
0.003151106182485819,
0.007640269584953785,
-0.025370271876454353,
-0.0063114166259765625,
0.03843140974640846,
0.03917868807911873,
-0.023258423432707787,
-0.01186271384358406,
0.06907464563846588,
-0.05634414032101631,
-0.025184212252497673,
-0.02237144112586975,
0.03210616111755371,
0.05159146711230278,
0.0039512175135314465,
-0.009153295308351517,
-0.006292539183050394,
0.04315076395869255,
0.016694892197847366,
0.02864353358745575,
-0.007823574356734753,
-0.05592833086848259,
0.01740313321352005,
0.013444492593407631,
-0.039908912032842636,
0.03532340005040169,
0.05372793599963188,
0.051829736679792404,
-0.0352562740445137,
-0.02064616046845913,
0.05493191257119179,
-0.0015586530789732933,
-0.028972728177905083,
-0.028064509853720665,
0.04512019455432892,
0.011702319607138634,
-0.03759203478693962,
0.006353206932544708,
-0.0645444467663765,
-0.07847649604082108,
-0.0029629741329699755,
-0.0008362369262613356,
0.003974654246121645,
0.00968752708286047,
-0.032218266278505325,
-0.05184728652238846,
0.024293938651680946,
-0.03245414048433304,
-0.05678733065724373,
0.024981431663036346,
0.02833971381187439,
-0.01679849438369274,
0.011110018007457256,
-0.09815861284732819,
-0.01799801178276539,
-0.0035048290155828,
0.05588837340474129,
0.016881678253412247,
-0.03859291598200798,
0.0035034273751080036,
-0.00797655526548624,
0.04377993196249008,
-0.07155472040176392,
0.0584016852080822,
-0.0074409679509699345,
0.03317025303840637,
-0.03631068393588066,
0.03211801126599312,
0.07734234631061554,
-0.039900317788124084,
-0.013943279162049294,
-0.0295718964189291,
-0.01696065254509449,
0.07932128012180328,
-0.009022732265293598,
0.032010722905397415,
0.02519415132701397,
0.0660068690776825,
0.04484255239367485,
0.005731739569455385,
0.0023626121692359447,
-0.03699921444058418,
-0.010401391424238682,
0.006677358411252499,
0.014621233567595482,
-0.034213315695524216,
-0.025628317147493362,
0.028126750141382217,
0.02221415936946869,
0.01094407495111227,
0.0032314606942236423,
0.08422261476516724,
-0.02533886767923832,
-0.03206947445869446,
0.02141268365085125,
0.0007552371826022863,
0.04648417606949806,
-0.002568436088040471,
0.03152424469590187,
0.027656041085720062,
0.010835354216396809,
0.024100514128804207,
0.004544220864772797,
0.0644407644867897,
-0.040953438729047775,
0.014980601146817207,
-0.01150489691644907,
-0.0025029045064002275,
-0.04297085106372833,
-0.0005776854231953621,
-0.005415225867182016,
0.0029662877786904573,
-0.03194009140133858,
-0.053068868815898895,
0.024912456050515175,
-0.00030382274417206645,
0.03466102108359337,
-0.0015641769859939814,
0.0030674864538013935,
0.016336070373654366,
0.01620943285524845,
0.06269066780805588,
-0.0393439345061779,
0.047308824956417084,
-0.03862505406141281,
0.019114229828119278,
0.0060228402726352215,
0.01794801652431488,
-0.03616972640156746,
0.015326970256865025,
0.01020161435008049,
-0.04510102421045303,
0.005805464927107096,
-0.07038895785808563,
0.0325661227107048,
0.019858554005622864,
0.007021558471024036,
-0.07469839602708817,
0.019953738898038864,
0.01819654554128647,
-0.033737823367118835,
-0.05986722186207771,
0.008528085425496101,
-0.034458745270967484,
-0.006567147094756365,
0.0277424119412899,
-0.06677594035863876,
0.04179402068257332,
0.03144599124789238,
0.01727474108338356,
-0.08205767720937729,
0.04552840813994408,
-0.049459222704172134,
-0.01820025034248829,
-0.03424084931612015,
0.046793024986982346,
-0.057873036712408066,
0.04087677597999573,
-0.05268489941954613,
0.056198298931121826,
0.02419457584619522,
-0.0067758760415017605,
-0.014766784384846687,
0.0018702410161495209,
-0.027133049443364143,
-0.0000149096476889099,
0.04784358665347099,
-0.027785470709204674,
0.04258563369512558,
0.04121396318078041,
0.021945301443338394,
0.0074283527210354805,
-0.09552520513534546,
-0.013647535815834999,
-0.039240773767232895,
-0.03250713273882866,
0.02559119462966919,
0.011968843638896942,
-0.03011765144765377,
0.009628748521208763,
-0.01059629675000906,
0.00622561015188694,
-0.03067314252257347,
-0.07157737761735916,
0.023674312978982925,
0.02492070011794567,
-0.022950557991862297,
-0.009299639612436295,
-0.0687224417924881,
-0.01451148185878992,
0.03466600179672241,
-0.06959264725446701,
0.016742432489991188,
0.04537023976445198,
0.02409203164279461,
-0.05772385001182556,
-0.07045318186283112,
-0.00940931960940361,
0.014096001163125038,
-0.0038177750539034605,
-0.013097521848976612,
0.04203789681196213,
-0.03954465314745903,
0.045277662575244904,
-0.012704125605523586,
-0.008107851259410381,
-0.0044090887531638145,
0.027416283264756203,
0.021355703473091125,
0.03137151151895523,
-0.0377141498029232,
0.04629124328494072,
-0.01194294448941946,
-0.017133815214037895,
0.021716482937335968,
-0.028605233877897263,
0.009716208092868328,
-0.025006072595715523,
-0.03231266140937805,
0.004253998398780823,
0.013170421123504639,
0.01910119131207466,
-0.036323439329862595,
0.02676454931497574,
-0.006070076022297144,
0.007209652103483677,
0.02195492573082447,
0.017585597932338715,
-0.03903914615511894,
0.01781938597559929,
-0.0862877368927002,
0.06840347498655319,
0.040766578167676926,
-0.009703774936497211,
0.055412787944078445,
0.07521573454141617,
0.02447086200118065,
0.03342660516500473,
-0.0037837312556803226,
0.04824933782219887,
-0.060593102127313614,
-0.020636089146137238,
0.027213575318455696,
0.007825513370335102,
-0.02414259873330593,
0.00906310509890318,
0.00808326993137598,
-0.013670305721461773,
0.033036969602108,
-0.04531894996762276,
-0.0447995699942112,
0.08530820161104202,
-0.00809889193624258,
0.08136097341775894,
-0.008404111489653587,
0.010260369628667831,
0.03925064206123352,
0.018749108538031578,
-0.016185641288757324,
0.014853871427476406,
0.07265803962945938,
0.010181194171309471,
-0.013688474893569946,
0.059246983379125595,
0.04905061796307564,
0.004785771016031504,
-0.03485986590385437,
-0.04125010222196579,
-0.006629214622080326,
-0.019894275814294815,
-0.04478653520345688,
-0.05755074694752693,
0.012309408746659756,
-0.011398857459425926,
0.027952080592513084,
0.01714036986231804,
-0.02687116153538227,
-0.039168521761894226,
-0.005904091987758875,
-0.022937621921300888,
0.018559863790869713,
-0.012660502456128597,
-0.08374699205160141,
0.00953689869493246,
0.013969202525913715,
-0.04006490483880043,
0.011027101427316666,
0.04368940740823746,
0.01235205214470625,
0.008709250949323177,
-0.01188788004219532,
0.022856660187244415,
-0.04171429201960564,
0.02582520805299282,
0.011021651327610016,
-0.04149945452809334,
0.025682101026177406,
0.05504610016942024,
0.021786823868751526,
-0.02479095757007599,
-0.07877995818853378,
0.022508643567562103,
0.05223734304308891,
-0.019051963463425636,
-0.10196620970964432,
-0.014297551475465298,
0.010093161836266518,
-0.02290649339556694,
-0.006360424216836691,
-0.058876775205135345,
0.05336999520659447,
-0.027016453444957733,
-0.000022584630642086267,
-0.014980209991335869,
-0.0027512935921549797,
0.03701336309313774,
0.0029031960293650627,
0.03369459509849548,
-0.00012440270802471787,
0.023216916248202324,
0.03214031830430031,
-0.0064911991357803345,
-0.05388786643743515,
-0.008495238609611988,
-0.018867868930101395,
-0.016454461961984634,
-0.0013770352816209197,
0.07022419571876526,
0.012401136569678783,
0.02182277850806713,
0.013610173016786575,
-0.03145049512386322,
-0.09151981770992279,
-0.044463641941547394,
0.04500129073858261,
-0.028590796515345573,
0.009964434430003166,
-0.01248662918806076,
0.003752691438421607,
0.01889418438076973,
-0.022111983969807625,
-0.07845813035964966,
0.010050870478153229,
0.014614623971283436,
0.0031532112043350935,
0.0014525761362165213,
0.014645524322986603,
-0.05014391615986824,
-0.014165789820253849,
0.013482974842190742,
0.0032085950952023268,
-0.050910864025354385,
0.005796721205115318,
0.0693419873714447,
0.0025250825565308332,
-0.03897864744067192,
-0.014691491611301899,
0.05142497271299362,
0.05570978671312332,
-0.04620810225605965,
-0.07549136132001877,
-0.028137603774666786,
0.02040492370724678,
0.08389550447463989,
0.018362658098340034,
-0.04425112158060074,
0.015295997262001038,
-0.005711184348911047,
0.03760863095521927,
-0.0341060608625412,
0.011759290471673012,
-0.054237958043813705,
0.013237991370260715,
-0.05990196764469147,
0.05976478010416031,
-0.05142511427402496,
-0.002404874423518777,
-0.0791286826133728,
-0.020717443898320198,
-0.024117421358823776,
0.06367471814155579,
0.046239592134952545,
0.006160634104162455,
0.04399905726313591,
0.05248648300766945,
-0.050043366849422455,
0.013394040986895561,
0.04781950265169144,
-0.0003808526380453259,
0.029941538348793983,
-0.01165982335805893,
0.03389585763216019,
0.0028632450848817825,
-0.02118827775120735,
-0.015033917501568794,
0.00983242504298687,
0.03272586688399315,
0.015409590676426888,
0.011664491146802902,
0.04106457903981209,
0.02162788063287735,
0.054760511964559555,
0.026308545842766762,
0.08172766119241714,
0.03799193724989891,
0.0038433463778346777,
0.04086032882332802,
-0.02357626147568226,
0.016618790104985237,
-0.008519439026713371,
0.02855478972196579,
-0.04883282631635666,
0.024136070162057877,
-0.010703710839152336,
-0.048118624836206436,
0.018596956506371498,
-0.002278999425470829,
-0.051440391689538956,
0.027246637269854546,
-0.05465301126241684,
-0.07975639402866364,
0.053371839225292206,
-0.02303207479417324,
-0.01596493273973465,
-0.023991938680410385,
0.013324135914444923,
-0.017075028270483017,
-0.006026186514645815,
0.054511163383722305,
-0.043614353984594345,
-0.04868127033114433,
0.007744848262518644,
0.03857071325182915,
0.02317553386092186,
-0.01997491531074047,
0.03140530735254288,
-0.041719358414411545,
-0.06746311485767365,
-0.010454530827701092,
-0.008733157999813557,
0.019090723246335983,
0.025479109957814217,
-0.005294014699757099,
-0.022993335500359535,
-0.01765909232199192,
-0.026897132396697998,
-0.007077859714627266,
-0.005784202367067337,
-0.0597509928047657,
-0.03468683734536171,
-0.003864122787490487,
0.053101688623428345,
-0.013969593681395054,
-0.020616212859749794,
0.0706147775053978,
0.010434365831315517,
0.0213851947337389,
-0.03006993606686592,
0.012367604300379753,
0.02823309786617756,
0.009409887716174126,
0.0304025337100029,
-0.02486135996878147,
-0.032031185925006866,
0.028384890407323837,
0.03157834708690643,
-0.027375098317861557,
-0.013034180738031864,
0.05090407654643059,
-0.021819325163960457,
-0.000004921454547002213,
-0.0496961884200573,
-0.018867963925004005,
0.006119340192526579,
0.01079724170267582,
-0.04095607250928879,
-0.024003569036722183,
0.015055508352816105,
0.018663985654711723,
0.011737801134586334,
0.005358310882002115,
0.0018065726617351174,
0.027249859645962715,
0.08314868807792664,
-0.01180349849164486,
-0.0316455215215683,
-0.0475509837269783,
-0.04290138930082321,
0.015114342793822289,
0.0076063708402216434,
-0.030024787411093712,
0.011414152570068836,
0.014575370587408543,
-0.03480558469891548,
-0.033046528697013855,
0.02985282614827156,
0.01346949115395546,
0.007849643006920815,
-0.07150839269161224,
0.031067781150341034,
-0.01823999546468258,
0.01706749200820923,
-0.03716013580560684,
-0.009303698316216469,
-0.008501648902893066,
0.06096665561199188,
-0.010947922244668007,
0.05167744681239128,
0.02665243297815323,
-4.7893930406880494e-33,
0.035701312124729156,
-0.041414160281419754,
-0.004360052291303873,
-0.024851644411683083,
0.002109546447172761,
0.05710938945412636,
-0.05555574968457222,
-0.02885899692773819,
-0.1119542047381401,
0.026607271283864975,
-0.048855721950531006,
0.022747943177819252,
0.024806661531329155,
0.04305151849985123,
-0.03902117535471916,
-0.09217561036348343,
-0.010769212618470192,
0.03264152631163597,
-0.005384127609431744,
-0.0046975938603281975,
0.011038658209145069,
0.025760937482118607,
0.016715338453650475,
-0.061528630554676056,
-0.020273128524422646,
-0.028906075283885002,
0.052850861102342606,
0.002574264071881771,
-0.01570010930299759,
0.03734889253973961,
0.024554552510380745,
0.02323802188038826,
0.01303374208509922,
-0.041531581431627274,
-0.009942848235368729,
-0.03730606287717819,
0.0076060122810304165,
-0.03446602076292038,
0.03509613126516342,
-0.023612257093191147,
0.026208868250250816,
-0.0121992202475667,
0.020811155438423157,
0.006931261625140905,
0.0242229625582695,
-0.047630999237298965,
-0.03918726369738579,
-0.028841352090239525,
0.004929060116410255,
0.006761886645108461,
0.019564883783459663,
0.02891237661242485,
0.038104988634586334,
0.026069890707731247,
-0.05932844057679176,
-0.01312460470944643,
0.022972900420427322,
0.06333626061677933,
0.023813849315047264,
-0.011839560233056545,
-0.038313332945108414,
0.016800865530967712,
0.026873668655753136,
-0.018168853595852852,
-0.027110926806926727,
0.009737091138958931,
0.05874596908688545,
0.017596526071429253,
-0.02579033561050892,
0.03102959133684635,
-0.09454868733882904,
0.06168299913406372,
0.0010369346709921956,
-0.04547441750764847,
-0.03245842829346657,
0.002121969358995557,
0.04236843064427376,
-0.008545284159481525,
-0.023730311542749405,
0.01491394080221653,
-0.07143261283636093,
-0.0362589992582798,
-0.06064807251095772,
-0.055754873901605606,
0.025886591523885727,
0.04924078658223152,
-0.02364134043455124,
0.005267709493637085,
0.020577825605869293,
-0.0037315667141228914,
0.11133493483066559,
0.019517522305250168,
0.07298064231872559,
-0.004677172750234604,
0.03159939870238304,
-0.01678229309618473,
0.04736270010471344,
0.024005265906453133,
0.012693039141595364,
-0.010612409561872482,
0.09333166480064392,
0.027987828478217125,
0.07193101942539215,
-0.021569445729255676,
-0.03795330598950386,
0.018942788243293762,
-0.011634924449026585,
-0.011715035885572433,
0.030760280787944794,
0.036899108439683914,
-0.0190302561968565,
-0.03136812150478363,
-0.010656033642590046,
0.03544219583272934,
0.007504865061491728,
0.016717111691832542,
0.013858864083886147,
0.03771970421075821,
-0.008559364825487137,
0.018203608691692352,
0.005339688155800104,
-0.020726200193166733,
0.007830983027815819,
-0.024844469502568245,
-0.04095715656876564,
-0.012884918600320816,
0.02656485140323639,
0.07291222363710403,
-0.023715736344456673,
-0.02204083651304245,
0.009667886421084404,
-0.009287919849157333,
2.7283726922178175e-7,
0.037860140204429626,
-0.01913745515048504,
-0.0006430601351894438,
-0.0635060966014862,
0.005520559381693602,
-0.00002535999010433443,
-0.0073329186998307705,
0.03822527453303337,
-0.027219053357839584,
-0.01556530874222517,
0.036945443600416183,
0.018312731757760048,
0.007026836276054382,
-0.057568397372961044,
0.059741634875535965,
-0.03782251849770546,
0.01251049805432558,
0.002330544637516141,
-0.01639377325773239,
-0.006664079613983631,
0.029950711876153946,
-0.05142940953373909,
-0.09587284922599792,
-0.022664066404104233,
0.023783599957823753,
-0.014190912246704102,
-0.02178754284977913,
-0.03442791849374771,
-0.05326639860868454,
0.000833229860290885,
0.016193009912967682,
0.011724511161446571,
0.00934462621808052,
0.050989679992198944,
-0.022206366062164307,
-0.03278060629963875,
0.0320550836622715,
0.03195939213037491,
-0.05902884155511856,
0.021020464599132538,
0.01234432589262724,
-0.04479657858610153,
0.02381807751953602,
-0.01261576171964407,
0.02606484293937683,
0.06688351929187775,
-0.024272093549370766,
-0.0019998266361653805,
-0.022463083267211914,
0.0014473223127424717,
0.018437664955854416,
0.004977663513273001,
0.003646987257525325,
0.06318444013595581,
0.01699983887374401,
0.08482332527637482,
-0.06710926443338394,
-0.003195460420101881,
0.04044652730226517,
-0.011339670047163963,
-0.004376001190394163,
-0.03275495022535324,
0.007362226024270058,
0.033840738236904144,
0.0730319619178772,
-0.05961143970489502,
-0.04625404253602028,
2.3860342749221664e-34,
-0.055273301899433136,
-0.020935362204909325,
0.028354322537779808,
-0.07066500931978226,
0.014965432696044445,
-0.05940554663538933,
-0.014501507394015789,
-0.006355738267302513,
-0.004422797355800867,
-0.05279812961816788,
-0.008033474907279015
] | {
"ds_index": 52,
"similar_dg_indices": [
105144,
917041,
1055064,
153299,
92027,
503299,
915045,
582238,
496770,
409908,
980786,
712916,
237079,
243923,
1139187,
259964,
1097533,
712854,
228758,
46473
]
} |
A 28-year-old woman is brought to the hospital by her boyfriend. She has had three days of fever and headache followed by one day of worsening confusion and hallucinations. She also becomes agitated when offered water. Her temperature is 101°F (38.3°C). Two months prior to presentation, the couple was camping and encountered bats in their cabin. In addition to an injection shortly after exposure, what would have been the most effective treatment for this patient? | A killed vaccine within ten days of exposure | {
"A": "A killed vaccine within ten days of exposure",
"B": "Oseltamivir within one week of exposure",
"C": "Venom antiserum within hours of exposure",
"D": "Doxycycline for one month after exposure"
} | step1 | A | [
"year old woman",
"brought",
"hospital",
"boyfriend",
"three days",
"fever",
"headache followed by one day",
"worsening confusion",
"hallucinations",
"agitated",
"offered water",
"temperature",
"3C",
"Two months prior to presentation",
"couple",
"camping",
"encountered bats",
"injection",
"exposure",
"most effective",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 28-year-old woman is brought to the hospital by her boyfriend. She has had three days of fever and headache followed by one day of worsening confusion and hallucinations. She also becomes agitated when offered water. Her temperature is 101°F (38.3°C). Two months prior to presentation, the couple was camping and encountered bats in their cabin. In addition to an injection shortly after exposure, what would have been the most effective treatment for this patient?
Choose one of the following::
A. A killed vaccine within ten days of exposure
B. Oseltamivir within one week of exposure
C. Venom antiserum within hours of exposure
D. Doxycycline for one month after exposure | [
-0.0033039965201169252,
-0.07370385527610779,
0.04019284248352051,
-0.04702051356434822,
-0.011306595988571644,
-0.023053955286741257,
-0.044701527804136276,
0.014706609770655632,
0.00470513291656971,
-0.03892570734024048,
-0.004981250502169132,
0.045571036636829376,
0.023531049489974976,
-0.028247995302081108,
0.02435416728258133,
-0.025278767570853233,
0.02345249056816101,
0.009404304437339306,
-0.011997411027550697,
0.036172255873680115,
-0.017567241564393044,
0.060166679322719574,
-0.009502044878900051,
0.01259883027523756,
0.07597524672746658,
-0.0413379929959774,
-0.03413447365164757,
0.006508353166282177,
0.04163258895277977,
-0.08703817427158356,
-0.007684450130909681,
-0.05373293533921242,
0.032046426087617874,
-0.08354377746582031,
0.000002005139322136529,
0.01675553061068058,
0.02525983937084675,
-0.02185428887605667,
0.011134267784655094,
-0.04824668914079666,
0.04962073266506195,
-0.08283253759145737,
0.03233667090535164,
0.046970803290605545,
-0.028403034433722496,
-0.09896530956029892,
-0.01708817668259144,
0.013722377829253674,
-0.018781118094921112,
-0.012809340842068195,
0.006478109862655401,
-0.027881955727934837,
-0.0016706123715266585,
0.016084088012576103,
0.048732053488492966,
-0.01787777617573738,
-0.029820747673511505,
-0.03316355496644974,
0.09961459785699844,
-0.005626548547297716,
-0.02119152806699276,
-0.004997446201741695,
0.006335413083434105,
0.005269497167319059,
-0.051475293934345245,
0.02110736072063446,
0.025631999596953392,
-0.046270716935396194,
-0.022871432825922966,
-0.06036185845732689,
-0.10462328046560287,
0.011523012071847916,
0.0049880873411893845,
0.039001885801553726,
-0.09494452178478241,
-0.046346135437488556,
0.019282985478639603,
-0.06643294543027878,
0.002181483432650566,
-0.02687452919781208,
0.04753047972917557,
0.038524214178323746,
0.05677669495344162,
0.05133196711540222,
-0.009701867587864399,
-0.0021561437752097845,
-0.0055372160859405994,
-0.018255598843097687,
-0.03277744725346565,
-0.0010893603321164846,
-0.015795907005667686,
-0.024976788088679314,
0.0016591893509030342,
0.01467856951057911,
-0.07104742527008057,
-0.01955259032547474,
0.024648036807775497,
-0.030470993369817734,
0.006253923289477825,
-0.012791150249540806,
-0.05124956741929054,
-0.04483107477426529,
0.018438709899783134,
-0.04086937755346298,
-0.008315246552228928,
-0.053504571318626404,
-0.030495401471853256,
-0.04808367043733597,
0.0017184189055114985,
0.04161548241972923,
-0.040706854313611984,
0.025604676455259323,
-0.04481177031993866,
-0.0665985643863678,
0.08640845119953156,
0.07821723073720932,
0.006609736941754818,
-0.06353484839200974,
-0.014989286661148071,
0.05285068228840828,
-0.009200033731758595,
0.02519039995968342,
0.00537013029679656,
0.027718350291252136,
0.05501193925738335,
-0.036705248057842255,
-0.03478806093335152,
0.0033358631189912558,
0.030764183029532433,
-0.02867843210697174,
0.0050917151384055614,
-0.034638114273548126,
-0.004754369612783194,
-0.024905841797590256,
-0.024329418316483498,
0.047474220395088196,
-0.003885833779349923,
0.04184408858418465,
0.006388414651155472,
0.050501853227615356,
-0.0022071271669119596,
-0.028818488121032715,
0.02575673907995224,
0.0035713037941604853,
-0.033726517111063004,
0.062090277671813965,
0.003101264126598835,
0.002011567819863558,
-0.0011951024644076824,
0.0062488955445587635,
-0.05159119889140129,
-0.010602481663227081,
-0.07786030322313309,
-0.025232722982764244,
-0.007701048627495766,
0.03770746663212776,
-0.007602974306792021,
-0.012486816383898258,
0.002236985834315419,
0.021156158298254013,
0.011192782782018185,
-0.02897311933338642,
0.03826354071497917,
-0.02223951183259487,
0.01613912731409073,
0.06042486056685448,
0.007477268110960722,
0.08316954970359802,
0.010936124250292778,
0.038334742188453674,
-0.04807135835289955,
-0.023590978235006332,
0.021459877490997314,
0.006270159501582384,
-0.012897736392915249,
0.023799166083335876,
-0.07399574667215347,
-0.04620407521724701,
0.03563232347369194,
0.02514483407139778,
-0.010559279471635818,
0.01383832935243845,
-0.030814209952950478,
-0.04353732243180275,
0.04131932556629181,
-0.02089957520365715,
0.07397913932800293,
-0.0041638207621872425,
0.013390622101724148,
-0.025525951758027077,
-0.026448523625731468,
0.0031344075687229633,
0.011745443567633629,
-0.0072194780223071575,
-0.030178463086485863,
-0.00030651240376755595,
0.02708374708890915,
0.00773752573877573,
-0.001761357532814145,
0.007875814102590084,
0.004372866824269295,
0.03519172966480255,
-0.012986687943339348,
0.06975364685058594,
-0.01816997304558754,
0.03461170569062233,
-0.050393182784318924,
-0.05947893485426903,
-0.047331709414720535,
0.00588083965703845,
-0.0017071712063625455,
0.02483048476278782,
0.06448338180780411,
-0.016527602449059486,
0.013877607882022858,
0.016950249671936035,
0.04615965113043785,
-0.010979242622852325,
-0.05776059627532959,
0.04665815830230713,
-0.00558827118948102,
0.03652072697877884,
-0.0018604020588099957,
0.008824029006063938,
0.012357720173895359,
-0.03802467882633209,
0.004031837452203035,
-0.016824640333652496,
0.08136672526597977,
-0.0370352603495121,
0.07202207297086716,
-0.000072199254645966,
0.0368969589471817,
-0.031235314905643463,
-0.02888799086213112,
0.05235326290130615,
0.015496824868023396,
-0.07415468990802765,
-0.04617215320467949,
0.06571996957063675,
-0.010831235907971859,
-0.01451620738953352,
-0.018184904009103775,
-0.015315604396164417,
0.009445564821362495,
-0.012209969572722912,
0.04152202978730202,
0.010985276661813259,
-0.051062922924757004,
0.03723761439323425,
-0.029622921720147133,
-0.005411972291767597,
-0.022510698065161705,
0.037739597260951996,
-0.031713150441646576,
-0.0230450127273798,
-0.047124944627285004,
-0.018851548433303833,
-0.010212396271526814,
0.013534103520214558,
-0.0068941302597522736,
0.03422045707702637,
0.014198338612914085,
-0.06221778318285942,
-0.02414347231388092,
-0.011698556132614613,
0.06612684577703476,
0.017940528690814972,
-0.007779124658554792,
0.030322741717100143,
0.031867753714323044,
0.010416525416076183,
0.01737697422504425,
0.03222294896841049,
0.015197297558188438,
0.00028098109760321677,
-0.08249209821224213,
0.00898834876716137,
0.020340031012892723,
-0.004344129469245672,
0.018535397946834564,
0.007149556186050177,
-0.0008705969667062163,
0.03504899889230728,
-0.06846287101507187,
0.005678392946720123,
-0.0450127087533474,
-0.011793514713644981,
0.017538974061608315,
0.012954263016581535,
-0.01478777825832367,
-0.0016995090991258621,
-0.02661946974694729,
-0.03285834193229675,
0.007482023909687996,
-0.01890033297240734,
-0.008577186614274979,
0.013449538499116898,
0.018523214384913445,
-0.020372556522488594,
0.013994449749588966,
0.08033068478107452,
-0.0038714881520718336,
0.010593055747449398,
0.03137584775686264,
0.01216484047472477,
-0.010924766771495342,
0.010791773907840252,
-0.027736982330679893,
0.02192138321697712,
0.023901574313640594,
-0.03834592178463936,
-0.0004382440820336342,
0.03441699594259262,
-0.018340453505516052,
-0.01845170184969902,
-0.025447383522987366,
-0.03082147054374218,
0.026678413152694702,
0.020247241482138634,
0.005943347234278917,
-0.019472265616059303,
-0.014193739742040634,
-0.029728984460234642,
-0.011190933175384998,
-0.0548158660531044,
-0.0025746962055563927,
0.0047716377303004265,
-0.07153847813606262,
0.023155147209763527,
-0.02223302610218525,
-0.03770625963807106,
0.02223496325314045,
0.0036732428707182407,
-0.0017193211242556572,
0.013918284326791763,
-0.027056599035859108,
-0.10898927599191666,
0.0452667772769928,
0.014822633005678654,
0.04339158162474632,
-0.02165898308157921,
0.012308172881603241,
-0.008192338980734348,
-0.0006549475365318358,
0.011433182284235954,
-0.04245755448937416,
0.03691307455301285,
-0.06901322305202484,
0.011598149314522743,
0.005474770441651344,
-0.02809869684278965,
0.024454966187477112,
-0.04048817977309227,
-0.004862812347710133,
-0.06599113345146179,
-0.02171969600021839,
-0.0022268863394856453,
0.004483650904148817,
0.014613596722483635,
-0.050567883998155594,
0.05116868019104004,
0.00022666927543468773,
0.04158422350883484,
-0.0297956932336092,
0.028909336775541306,
-0.05522157996892929,
-0.0021650944836437702,
-0.01983383484184742,
0.004336297977715731,
0.0025853123515844345,
-0.0025396079290658236,
0.024114936590194702,
0.007110108621418476,
0.0017810547724366188,
0.031529657542705536,
0.021890688687562943,
-0.09709897637367249,
-0.04687168821692467,
-0.054059162735939026,
0.0469575859606266,
-0.08487556874752045,
0.022029485553503036,
-0.03214448317885399,
-0.03530234098434448,
0.006582754664123058,
-0.010157404467463493,
0.02791159600019455,
0.035899750888347626,
-0.027159197255969048,
0.019016966223716736,
-0.014278097078204155,
0.026031551882624626,
-0.023568809032440186,
0.07862738519906998,
-0.015499102883040905,
0.03843020275235176,
0.00007979758811416104,
0.0037260346580296755,
0.04148541018366814,
-0.040423210710287094,
0.03143599256873131,
0.0675470232963562,
0.05858496576547623,
0.028748393058776855,
-0.08602864295244217,
0.02856205403804779,
-0.03481621295213699,
0.03481268137693405,
0.11501440405845642,
-0.09310391545295715,
-0.0005785530083812773,
-0.005595479626208544,
-0.007190431002527475,
0.025175631046295166,
-0.017794985324144363,
0.03026965819299221,
0.046540722250938416,
-0.007067346479743719,
-0.05882544443011284,
0.008698772639036179,
0.06670684367418289,
0.006866069510579109,
-0.058340884745121,
-0.010033409111201763,
-0.02413942851126194,
0.02784605138003826,
0.04737193137407303,
0.017151588574051857,
0.05941757187247276,
0.022969750687479973,
-0.026014478877186775,
0.03133215010166168,
0.016525499522686005,
-0.0201893150806427,
-0.013234804384410381,
-0.05133461952209473,
0.005131011363118887,
-0.04181821271777153,
-0.0433642640709877,
0.03188731521368027,
0.01907273568212986,
0.027842428535223007,
0.0012213164009153843,
-0.034849170595407486,
0.025925757363438606,
0.011225314810872078,
-0.0049763452261686325,
0.015515667386353016,
0.0818929374217987,
0.002833923790603876,
-0.033352330327034,
0.04335553199052811,
0.016800856217741966,
0.04847080260515213,
0.01607786864042282,
0.07122158259153366,
0.06839960068464279,
-0.012361451983451843,
0.03494708240032196,
-0.004180599935352802,
0.0001733266981318593,
-0.0004144700360484421,
-0.06245199218392372,
0.007681277114897966,
-0.024292362853884697,
-0.020373091101646423,
-0.01823294907808304,
-0.03258872032165527,
0.00673809414729476,
0.04806399345397949,
0.028523724526166916,
-0.01400462631136179,
0.04025746136903763,
0.04957831650972366,
-0.01826527528464794,
-0.014200934208929539,
0.012780497781932354,
0.0019191885367035866,
-0.038966789841651917,
-0.01567060686647892,
-0.008366474881768227,
-0.058927472680807114,
-0.037595123052597046,
0.03398396074771881,
-0.014760960824787617,
0.034898076206445694,
-0.01798233576118946,
0.014994723722338676,
-0.03343600779771805,
-0.031418778002262115,
0.03493200242519379,
0.01101739052683115,
0.009968256577849388,
-0.031895432621240616,
-0.027751462534070015,
-0.03978157043457031,
0.06350284069776535,
0.031773634254932404,
-0.003592046210542321,
0.04516419768333435,
0.02326895296573639,
0.02198927477002144,
0.0231800340116024,
0.0035432367585599422,
0.0034542707726359367,
-0.018810445442795753,
-0.013974388130009174,
0.006976662669330835,
0.003888551378622651,
0.028583211824297905,
0.03018779866397381,
0.022515766322612762,
0.021096106618642807,
0.0274813175201416,
0.02863266132771969,
-0.07381300628185272,
0.024436991661787033,
0.005374513566493988,
0.04699648544192314,
-0.018211737275123596,
-0.032268717885017395,
0.01581593230366707,
-0.02134481817483902,
0.04029616713523865,
0.03192467615008354,
0.030519595369696617,
0.0034663521219044924,
-0.048711635172367096,
0.01109955832362175,
0.010101867839694023,
0.04348029941320419,
0.0064945765770971775,
-0.019001977518200874,
0.012585884891450405,
0.042657531797885895,
-0.05337847024202347,
-0.0404898002743721,
0.01660790666937828,
-0.016555992886424065,
0.0338725782930851,
0.014325929805636406,
0.04726824536919594,
-0.08821289986371994,
-0.05207149684429169,
0.04462172091007233,
-0.0008485832368023694,
-0.019729748368263245,
0.05400976911187172,
-0.07224952429533005,
0.06537552922964096,
0.08339565992355347,
0.08073148131370544,
-0.033777009695768356,
-0.041602883487939835,
-5.979914250075677e-33,
0.03680131211876869,
-0.062321607023477554,
0.01343099307268858,
-0.10624756664037704,
0.04795893281698227,
0.02496604062616825,
0.002255505183711648,
0.0004912487347610295,
-0.051898710429668427,
0.009369179606437683,
0.006092628464102745,
-0.006656005047261715,
0.03490385040640831,
-0.006183046381920576,
0.004403081722557545,
-0.022640900686383247,
-0.011615375056862831,
0.04228229448199272,
-0.0423244945704937,
-0.012988874688744545,
0.024123357608914375,
-0.004420868586748838,
0.019450806081295013,
-0.04578652232885361,
-0.027466434985399246,
-0.02864404208958149,
0.03406628593802452,
-0.004633611999452114,
-0.058590516448020935,
-0.011059447191655636,
0.02173421159386635,
-0.03263268992304802,
0.02023548260331154,
0.01623171754181385,
0.017906637862324715,
-0.01847548596560955,
0.01334497518837452,
-0.010996869765222073,
0.06334462016820908,
-0.04962686449289322,
-0.05043049156665802,
-0.06603758782148361,
0.03458461910486221,
0.019519273191690445,
0.06720280647277832,
-0.006133048329502344,
-0.056660156697034836,
-0.0155172199010849,
0.031245779246091843,
0.017678361386060715,
-0.017309268936514854,
0.01280827447772026,
0.03290725499391556,
-0.03742489218711853,
0.02168050967156887,
-0.004708538297563791,
-0.007418329361826181,
0.0753651037812233,
0.06785345077514648,
0.02201249822974205,
0.013055872172117233,
0.035161811858415604,
0.0007675321539863944,
-0.05204908922314644,
-0.015360027551651001,
-0.02803950570523739,
0.05094493553042412,
0.02141488529741764,
-0.07695702463388443,
-0.0021359820384532213,
-0.030268274247646332,
0.0042155287228524685,
-0.01077995728701353,
-0.024524543434381485,
-0.060309913009405136,
0.04601329565048218,
-0.009927107021212578,
0.023902999237179756,
0.0049816216342151165,
0.04443719610571861,
-0.06331784278154373,
-0.0053910561837255955,
0.001032856060191989,
-0.02073090150952339,
0.017920346930623055,
0.013690082356333733,
0.01665126532316208,
0.003063564421609044,
0.023388898000121117,
-0.011418796144425869,
0.011953302659094334,
0.07294811308383942,
0.005750271491706371,
0.05185050144791603,
0.08391370624303818,
-0.030353376641869545,
0.012834461405873299,
0.039206262677907944,
0.018889516592025757,
-0.017576398327946663,
0.00984168704599142,
-0.005173409823328257,
0.0318380668759346,
0.009883904829621315,
0.0029167134780436754,
-0.03334258869290352,
-0.03183189779520035,
0.01799086481332779,
0.0438697375357151,
-0.018315868452191353,
0.024067627266049385,
-0.009280210360884666,
-0.025244876742362976,
0.07545923441648483,
0.021957961842417717,
-0.002501280978322029,
0.044642895460128784,
-0.0314033180475235,
0.058482009917497635,
-0.05260142683982849,
-0.02068198285996914,
0.036319274455308914,
-0.029224585741758347,
0.001806776039302349,
-0.011650909669697285,
-0.022437628358602524,
0.06093793734908104,
-0.05026165768504143,
-0.03685387223958969,
-0.06064537912607193,
0.04391481354832649,
-0.02954844757914543,
2.6704123001763946e-7,
0.0419415719807148,
0.042616598308086395,
-0.02556711621582508,
-0.00765177421271801,
-0.03626902401447296,
-0.03188944607973099,
-0.016971686854958534,
-0.0011192241217941046,
0.009549904614686966,
-0.029225515201687813,
0.011495672166347504,
-0.01440888736397028,
0.006795267108827829,
0.06312409788370132,
0.04214886203408241,
-0.018427349627017975,
-0.07725951820611954,
-0.020088786259293556,
0.0045614358969032764,
-0.02353721112012863,
-0.049965765327215195,
-0.04005827009677887,
-0.04114309325814247,
0.0055967275984585285,
-0.003825945546850562,
-0.00444497587159276,
-0.01475247461348772,
-0.043013978749513626,
-0.038770418614149094,
0.009614262729883194,
-0.028805144131183624,
0.10725827515125275,
0.006120048463344574,
-0.006812518462538719,
-0.0149246696382761,
-0.05883390083909035,
0.019173327833414078,
0.06894981116056442,
-0.012022187933325768,
0.03279593586921692,
-0.017789389938116074,
-0.02496235817670822,
0.008760152384638786,
-0.020781008526682854,
0.025089234113693237,
-0.022962184622883797,
-0.025750113651156425,
0.11911624670028687,
-0.0457695797085762,
0.03711073100566864,
-0.04556575044989586,
-0.002918837359175086,
-0.012015102431178093,
0.06605233252048492,
-0.004506912548094988,
0.028584059327840805,
-0.0018208203837275505,
0.002093713264912367,
-0.02741129882633686,
-0.03362421691417694,
0.024126090109348297,
-0.03168916702270508,
-0.013255853205919266,
-0.028104402124881744,
0.004561403766274452,
-0.03357506915926933,
0.01995903253555298,
1.5522043596229588e-34,
0.021756727248430252,
-0.039699163287878036,
-0.028191912919282913,
-0.05168355256319046,
-0.0606137290596962,
0.013295995071530342,
0.017650965601205826,
-0.019146664068102837,
0.04534624144434929,
-0.023102683946490288,
0.029935171827673912
] | {
"ds_index": 53,
"similar_dg_indices": [
892540,
873517,
997444,
434436,
246114,
659682,
658879,
800000,
1182005,
979026,
304191,
973567,
1463,
378946,
39267,
16112,
989873,
607879,
1118059,
796208
]
} |
A 60-year-old man comes to the physician for an examination prior to a scheduled cholecystectomy. He has hypertension treated with hydrochlorothiazide. His mother had chronic granulomatous disease of the lung. He works in a glass manufacturing plant. He has smoked two packs of cigarettes daily for 38 years. His vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies are within the reference range. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management? | Request previous chest x-ray | {
"A": "Perform arterial blood gas analysis",
"B": "Perform CT-guided biopsy",
"C": "Measure angiotensin-converting enzyme",
"D": "Request previous chest x-ray"
} | step2&3 | D | [
"60 year old man",
"physician",
"examination prior to",
"scheduled cholecystectomy",
"hypertension treated with hydrochlorothiazide",
"mother",
"chronic granulomatous disease of the lung",
"works",
"glass manufacturing plant",
"smoked two packs",
"cigarettes daily",
"years",
"vital signs",
"normal limits",
"Examination shows",
"abnormalities",
"Laboratory studies",
"reference range",
"x-ray of",
"chest",
"shown",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 60-year-old man comes to the physician for an examination prior to a scheduled cholecystectomy. He has hypertension treated with hydrochlorothiazide. His mother had chronic granulomatous disease of the lung. He works in a glass manufacturing plant. He has smoked two packs of cigarettes daily for 38 years. His vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies are within the reference range. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Perform arterial blood gas analysis
B. Perform CT-guided biopsy
C. Measure angiotensin-converting enzyme
D. Request previous chest x-ray | [
0.04326861724257469,
0.01717677153646946,
0.03874123468995094,
-0.022220555692911148,
-0.012680500745773315,
0.015941783785820007,
-0.005302694160491228,
0.040991149842739105,
0.022005274891853333,
0.012224112637341022,
0.06406184285879135,
0.046098217368125916,
-0.0036089476197957993,
-0.04216516762971878,
-0.039951715618371964,
0.01933722198009491,
-0.019492268562316895,
-0.01087207067757845,
-0.0065057771280407906,
-0.024605948477983475,
-0.0492391362786293,
0.004358929116278887,
0.01191314123570919,
-0.020051030442118645,
0.04204118996858597,
-0.017277469858527184,
0.0411800891160965,
-0.03787218779325485,
0.0025120500940829515,
-0.012394305318593979,
-0.026094358414411545,
-0.023281291127204895,
-0.03284762427210808,
-0.03432784974575043,
0.0000018326443296245998,
-0.025403259322047234,
0.04098649322986603,
0.007209432311356068,
0.03683667257428169,
-0.08355465531349182,
0.044667940586805344,
-0.07228349149227142,
0.018964843824505806,
-0.00409999955445528,
-0.04154084995388985,
-0.09546057879924774,
0.02806478552520275,
0.06010504812002182,
0.007228700909763575,
-0.019591066986322403,
-0.000866586749907583,
0.025079460814595222,
-0.014709020033478737,
0.015224176459014416,
0.017307808622717857,
-0.0819442868232727,
-0.02832329086959362,
0.008633764460682869,
-0.0020355272572487593,
0.03477579355239868,
0.01132338959723711,
0.062497980892658234,
-0.014429803937673569,
0.017322996631264687,
0.004947659093886614,
-0.014199493452906609,
0.029993535950779915,
-0.02096603997051716,
0.010264561511576176,
-0.02090955339372158,
-0.02363918535411358,
0.03446333855390549,
0.03831963241100311,
0.04001060128211975,
-0.03811130300164223,
-0.012719135731458664,
0.05328773707151413,
-0.0484502948820591,
-0.0017028795555233955,
-0.0014793641166761518,
0.05698980391025543,
0.016519388183951378,
-0.03253313899040222,
0.016323862597346306,
-0.013166612945497036,
-0.044727127999067307,
0.007441622205078602,
0.025111665949225426,
0.03047420084476471,
0.01988462172448635,
0.06124364957213402,
-0.07669612020254135,
-0.011869854293763638,
0.018900969997048378,
-0.07280284911394119,
0.02122337371110916,
0.035348713397979736,
0.0541774183511734,
0.027575373649597168,
-0.08677981793880463,
-0.0494149848818779,
-0.02263597957789898,
0.057607706636190414,
0.04356253892183304,
-0.02037929929792881,
-0.017166441306471825,
-0.0399177260696888,
-0.009654910303652287,
-0.043804753571748734,
0.060905687510967255,
0.009646686725318432,
0.013169622048735619,
-0.04325562343001366,
0.006107239052653313,
0.11874880641698837,
-0.02926204353570938,
-0.04824165254831314,
-0.05351424962282181,
0.008210401050746441,
0.04999716952443123,
0.014886599965393543,
0.012387515045702457,
0.018574636429548264,
0.006523001939058304,
-0.017811546102166176,
0.045399971306324005,
0.0008626969065517187,
0.027451306581497192,
0.013420037925243378,
0.05782678723335266,
0.03146900236606598,
-0.002861957298591733,
-0.02406679466366768,
-0.003034544875845313,
0.009743653237819672,
-0.06301925331354141,
-0.030546138063073158,
0.07638820260763168,
-0.02226068452000618,
0.01812002807855606,
0.01019873097538948,
-0.001793988049030304,
0.04994357004761696,
0.003888898529112339,
0.030576389282941818,
-0.0277074184268713,
0.048968181014060974,
0.028079070150852203,
-0.0024277130141854286,
0.033060505986213684,
-0.06453713774681091,
0.017717748880386353,
-0.01862841099500656,
0.015799768269062042,
0.01579335704445839,
0.03484486788511276,
0.010279666632413864,
-0.034927524626255035,
-0.008389751426875591,
-0.046394530683755875,
-0.024183617904782295,
-0.02325049787759781,
0.03263847529888153,
-0.020002078264951706,
-0.0006670822622254491,
-0.017686009407043457,
0.022532351315021515,
0.04648245498538017,
-0.07591614872217178,
0.06104050949215889,
-0.024193383753299713,
0.046636056154966354,
0.01545025035738945,
0.02151036076247692,
-0.012081997469067574,
0.004994234535843134,
-0.002145607490092516,
-0.0446605458855629,
-0.04029693454504013,
-0.024799028411507607,
-0.01895846053957939,
0.06345153599977493,
-0.013940511271357536,
-0.05161353573203087,
0.004029387142509222,
-0.010748920030891895,
-0.029597846791148186,
-0.032069239765405655,
-0.02105516567826271,
-0.04747812822461128,
0.00771693279966712,
0.02122585102915764,
-0.0380522757768631,
-0.018239270895719528,
-0.022200969979166985,
0.043196048587560654,
-0.05336079001426697,
-0.07297977060079575,
0.012105309404432774,
0.051834817975759506,
-0.0502287857234478,
-0.02055048942565918,
-0.03201368451118469,
0.04308382049202919,
-0.01442111749202013,
0.08908867835998535,
-0.024256305769085884,
0.005567568354308605,
0.015521188266575336,
-0.03624071180820465,
-0.006927668582648039,
0.0007310616783797741,
0.01668742671608925,
-0.03156552463769913,
-0.007698786444962025,
0.08265881985425949,
-0.03537456691265106,
-0.0011162228183820844,
-0.059571120887994766,
-0.021915731951594353,
-0.050759509205818176,
0.03523538261651993,
-0.012607991695404053,
0.012358050793409348,
-0.04543989151716232,
-0.06472846865653992,
-0.04863059148192406,
0.020461108535528183,
-0.025984756648540497,
-0.11274715512990952,
0.02430194430053234,
0.0028492589481174946,
-0.031593646854162216,
0.034548573195934296,
-0.06848599761724472,
0.05245986953377724,
-0.010578244924545288,
-0.04555508494377136,
-0.012151002883911133,
-0.01243816688656807,
-0.016277208924293518,
-0.06126430630683899,
-0.018890488892793655,
-0.012850645929574966,
-0.032725777477025986,
-0.022227566689252853,
0.0213663037866354,
0.032134927809238434,
-0.06910918653011322,
0.04767006263136864,
-0.03735142573714256,
-0.002790935570374131,
-0.0007465918315574527,
0.024206196889281273,
-0.023392414674162865,
0.07685808837413788,
-0.04405195266008377,
0.007984639145433903,
-0.02257547713816166,
-0.05754765868186951,
0.03131522610783577,
-0.03846466541290283,
-0.007623017765581608,
-0.00470851780846715,
0.00834830105304718,
-0.01721932739019394,
0.012412400916218758,
-0.004775623325258493,
-0.042327702045440674,
0.019527941942214966,
0.00949573703110218,
-0.015860140323638916,
0.02278774604201317,
0.01407009270042181,
-0.06692549586296082,
-0.03125687688589096,
-0.0026152438949793577,
0.0904555544257164,
0.013160396367311478,
-0.021840572357177734,
0.04360669106245041,
0.08422495424747467,
0.0509859137237072,
0.0268519576638937,
0.03533167764544487,
0.015212939120829105,
-0.0010001775808632374,
-0.012676096521317959,
0.07302989065647125,
0.03231358155608177,
0.009149286895990372,
0.021570289507508278,
0.014903923496603966,
0.0002727470709942281,
0.006065018475055695,
-0.024285636842250824,
-0.02843557484447956,
0.05302849039435387,
-0.041557107120752335,
0.01320946030318737,
-0.02659684792160988,
0.02555982396006584,
-0.044385991990566254,
-0.012156547047197819,
0.0144566735252738,
-0.026599299162626266,
0.024116627871990204,
0.019749846309423447,
-0.034561119973659515,
0.040228553116321564,
0.03397573530673981,
-0.0181729719042778,
-0.046216655522584915,
-0.036396708339452744,
-0.02692362852394581,
-0.010510560125112534,
-0.047914326190948486,
-0.027886757627129555,
0.009907274506986141,
0.008147086016833782,
0.030814016237854958,
0.016499122604727745,
-0.01661831885576248,
0.024726003408432007,
0.01928122527897358,
-0.04286084696650505,
0.03210311383008957,
0.03197433799505234,
-0.017777834087610245,
-0.008727079257369041,
0.010806425474584103,
0.036074671894311905,
-0.006362098269164562,
0.003682390321046114,
0.029941603541374207,
-0.007332941051572561,
-0.0002814129984471947,
-0.040817923843860626,
-0.03761425241827965,
0.06998054683208466,
0.004351844545453787,
-0.0611761175096035,
0.0020498395897448063,
-0.024455662816762924,
0.04114846512675285,
-0.014763581566512585,
-0.03984445333480835,
0.024630101397633553,
-0.021342484280467033,
-0.05358993262052536,
-0.050288405269384384,
0.010167962871491909,
0.015283542685210705,
-0.034214720129966736,
-0.02707361988723278,
-0.009022724814713001,
0.06490179896354675,
0.05715785548090935,
-0.015907268971204758,
0.06806410104036331,
0.03364277631044388,
0.04964222386479378,
0.0025904099456965923,
0.01815684325993061,
0.00536077655851841,
-0.004314418416470289,
0.07117477059364319,
0.02148335799574852,
-0.023649483919143677,
0.008628420531749725,
0.023507829755544662,
0.037617556750774384,
-0.03271405026316643,
0.0704481229186058,
0.006410356145352125,
0.03125889226794243,
0.002856283914297819,
-0.019951703026890755,
-0.09535980969667435,
-0.01191436592489481,
0.04753536731004715,
-0.08666985481977463,
0.061962563544511795,
0.010528264567255974,
-0.0402396135032177,
0.02280859835445881,
0.03580262511968613,
-0.01517592091113329,
0.0015823050634935498,
0.045601069927215576,
0.003311161883175373,
0.023084305226802826,
0.03463490679860115,
-0.050959646701812744,
0.019190559163689613,
0.009563760831952095,
-0.001915767672471702,
-0.04087687283754349,
0.016664812341332436,
0.04319387674331665,
0.03113180212676525,
-0.004474685061722994,
-0.002663134364411235,
0.06924058496952057,
0.05805370211601257,
-0.009421193972229958,
-0.07226579636335373,
-0.01234456431120634,
0.03140698000788689,
0.05948582664132118,
0.00556408055126667,
0.0012855499517172575,
0.026004141196608543,
0.015442568808794022,
0.03296760842204094,
0.011889425106346607,
0.001280505326576531,
-0.06103786826133728,
0.022078119218349457,
-0.05085686221718788,
0.04099180921912193,
0.009160958230495453,
-0.018800022080540657,
-0.03891774266958237,
-0.019489949569106102,
0.005063794087618589,
0.1127975806593895,
0.004074631724506617,
0.008542914874851704,
0.038411013782024384,
0.019445689395070076,
-0.03691989928483963,
0.011660854332149029,
0.05676823481917381,
-0.031348735094070435,
0.04152999445796013,
-0.02987162210047245,
0.016848936676979065,
0.03814646601676941,
-0.02832460217177868,
-0.04018420726060867,
-0.018789514899253845,
0.06245146319270134,
0.014805684797465801,
0.016164662316441536,
-0.04632767662405968,
0.03609210252761841,
0.09436564892530441,
0.0003274066839367151,
0.03745034337043762,
0.011715235188603401,
-0.006932219956070185,
0.011278456076979637,
0.003874399932101369,
0.04018330201506615,
-0.0224527008831501,
0.0646321177482605,
-0.003777233650907874,
0.022978218272328377,
-0.02708764374256134,
0.023200370371341705,
0.019837507978081703,
0.018106702715158463,
-0.058063168078660965,
-0.010491420514881611,
-0.016772067174315453,
-0.07903756946325302,
-0.020285410806536674,
-0.006295308005064726,
-0.000026919589799945243,
-0.0065306974574923515,
0.028151681646704674,
-0.00558083551004529,
0.020607953891158104,
0.04162630811333656,
-0.016107825562357903,
-0.03547195717692375,
-0.08151872456073761,
0.022232502698898315,
0.00524143036454916,
0.010701881721615791,
-0.032864537090063095,
-0.05267273634672165,
-0.016748858615756035,
-0.006245724391192198,
0.019289905205368996,
0.049148403108119965,
-0.0393708162009716,
-0.004677867982536554,
0.047301411628723145,
-0.03438764438033104,
-0.011047007516026497,
0.015685126185417175,
-0.04197530075907707,
-0.06629647314548492,
-0.009965182282030582,
-0.08157079666852951,
0.061224985867738724,
0.04723302274942398,
-0.03601439297199249,
0.07447831332683563,
0.03974594548344612,
0.03734908252954483,
-0.017747873440384865,
0.038791365921497345,
0.015971414744853973,
0.007840726524591446,
-0.005498584825545549,
-0.032706890255212784,
-0.0353371687233448,
-0.0005327962571755052,
-0.0020049961749464273,
-0.022258000448346138,
0.022034669294953346,
0.030974939465522766,
0.013843091204762459,
-0.010625232942402363,
-0.03402813524007797,
-0.040675606578588486,
0.013094412162899971,
-0.009699000976979733,
0.006694397423416376,
-0.0034467466175556183,
-0.0037933634594082832,
0.04179300740361214,
0.04080509394407272,
-0.007206152658909559,
0.018440959975123405,
-0.04697952792048454,
0.041042182594537735,
-0.01659352518618107,
-0.04574635252356529,
-0.05106909200549126,
-0.008946424350142479,
-0.044015370309352875,
-0.03589742258191109,
0.014091071672737598,
0.04456047713756561,
-0.006529118865728378,
-0.03641234710812569,
0.007162328809499741,
0.01221511047333479,
-0.015063953585922718,
0.007988755591213703,
-0.00231834314763546,
0.005830424837768078,
-0.01637669838964939,
-0.030245685949921608,
0.007995780557394028,
-0.0020946115255355835,
-0.013297993689775467,
0.08577771484851837,
0.022910578176379204,
0.05665985867381096,
0.017732923850417137,
-5.443614054296209e-33,
0.018906496465206146,
-0.009790885262191296,
0.044029682874679565,
-0.04233590140938759,
-0.004053175449371338,
0.059622425585985184,
-0.026121605187654495,
-0.02485962212085724,
-0.0763038694858551,
0.011727159842848778,
-0.04777778312563896,
-0.01516380812972784,
0.030466997995972633,
0.04453200474381447,
-0.03657930716872215,
-0.07493533194065094,
-0.018944943323731422,
-0.0051660360768437386,
-0.03557376191020012,
0.01401117816567421,
-0.011563162319362164,
0.011926377192139626,
0.018467392772436142,
-0.056000303477048874,
0.011777144856750965,
0.009460642002522945,
0.04932115972042084,
-0.047957178205251694,
-0.054304949939250946,
0.048783112317323685,
0.0027814891654998064,
0.03242265433073044,
0.026664678007364273,
-0.05011605843901634,
-0.013635564595460892,
0.03529360517859459,
-0.019932355731725693,
-0.053443726152181625,
0.043870531022548676,
0.03535410389304161,
-0.027347993105649948,
-0.012674429453909397,
0.02269224263727665,
0.03301408514380455,
0.018327370285987854,
-0.04719499126076698,
-0.019100133329629898,
-0.029473965987563133,
0.0011063579004257917,
-0.007328085135668516,
-0.017061350867152214,
0.022326942533254623,
0.02551618032157421,
-0.013924160040915012,
-0.03172169625759125,
0.00010375834972364828,
-0.010523935779929161,
-0.005852898117154837,
0.005794573109596968,
0.012013686820864677,
0.008740745484828949,
0.003463535103946924,
0.006485217250883579,
-0.032218076288700104,
-0.0573124885559082,
-0.018654361367225647,
-0.03423738107085228,
0.01822991669178009,
-0.028528159484267235,
0.04103609547019005,
-0.10636091232299805,
0.01139850914478302,
-0.08111228048801422,
-0.09140771627426147,
-0.01584949530661106,
-0.02767612598836422,
0.03517693281173706,
-0.013731610029935837,
0.02442902699112892,
0.031138712540268898,
-0.054810311645269394,
0.026096750050783157,
-0.024016063660383224,
-0.03422297537326813,
-0.043943651020526886,
0.030224425718188286,
-0.007042321376502514,
0.017782436683773994,
-0.0013837643200531602,
0.015867754817008972,
0.10790646076202393,
0.053343817591667175,
0.05478910729289055,
-0.021277323365211487,
0.027121029794216156,
-0.023993873968720436,
0.06133345142006874,
0.03223986178636551,
-0.0005809884169138968,
0.014179298654198647,
0.065445676445961,
0.006590517237782478,
0.015583925880491734,
-0.0064483582973480225,
-0.04724831506609917,
0.005256128963083029,
0.0069031198509037495,
0.014332788996398449,
-0.01001304667443037,
0.02633601985871792,
0.004380304366350174,
-0.005545416381210089,
0.028847340494394302,
0.020255088806152344,
0.014441519975662231,
0.054354406893253326,
0.03291459009051323,
0.0360913909971714,
0.01611403562128544,
-0.04774457961320877,
0.0335250049829483,
0.017738929018378258,
0.006223069503903389,
-0.03324868902564049,
-0.06346144527196884,
-0.0005386358825489879,
0.045185066759586334,
0.0016529589192941785,
0.0009238822967745364,
-0.026610953733325005,
0.0008984113810583949,
0.018334168940782547,
2.7867292828887e-7,
0.024223659187555313,
-0.021624989807605743,
0.020973894745111465,
-0.060955971479415894,
0.02203153446316719,
-0.08311467617750168,
-0.0011046361178159714,
0.02362958714365959,
-0.02701762691140175,
0.007210596930235624,
0.03915441781282425,
-0.006253507919609547,
-0.01700211688876152,
-0.03455999866127968,
0.042214687913656235,
-0.042836375534534454,
-0.020689090713858604,
-0.0021677741315215826,
0.023653442040085793,
-0.006461088079959154,
0.04336034879088402,
-0.02160477638244629,
-0.10427446663379669,
-0.042505159974098206,
-0.025703225284814835,
0.027525674551725388,
-0.008309884928166866,
-0.04158017039299011,
-0.027795003727078438,
-0.012055323459208012,
-0.008599715307354927,
0.02493642270565033,
0.036640893667936325,
0.04035433754324913,
-0.034198250621557236,
-0.018508246168494225,
0.05293785408139229,
0.09137820452451706,
-0.04962395504117012,
-0.0026004521641880274,
0.017679374665021896,
-0.03136032819747925,
-0.007925616577267647,
0.04813772812485695,
0.022991135716438293,
0.03479350358247757,
-0.06874361634254456,
-0.005094422027468681,
-0.009300651960074902,
0.006269269157201052,
-0.005468812305480242,
-0.0026662282180041075,
-0.003627040423452854,
0.07065030187368393,
0.0029705767519772053,
0.06563638895750046,
-0.052070096135139465,
0.03738724812865257,
0.03055690787732601,
-0.001411482342518866,
-0.008386456407606602,
-0.026751788333058357,
0.022591711953282356,
-0.014650163240730762,
0.023137982934713364,
-0.035278741270303726,
-0.04375867545604706,
1.69580190004107e-34,
-0.053456954658031464,
-0.04961824417114258,
-0.02492457628250122,
-0.09386871010065079,
0.006370070856064558,
-0.04616336151957512,
0.014679267071187496,
0.019716467708349228,
0.038586586713790894,
-0.08377394080162048,
-0.02527189813554287
] | {
"ds_index": 54,
"similar_dg_indices": [
1162632,
253371,
44062,
461983,
302555,
551051,
152214,
390735,
1014174,
288991,
125422,
488776,
1149823,
404578,
180378,
132413,
1043166,
647609,
327417,
886706
]
} |
You are examining a 3-day-old newborn who was delivered vaginally without any complications. The newborn presents with vomiting, hyperventilation, lethargy, and seizures. Blood work demonstrates hyperammonemia, elevated glutamine levels, and decreased blood urea nitrogen. A CT scan demonstrates cerebral edema. Defects in which of the following enzymes would result in a clinical presentation similar to this infant? | Carbamoyl phosphate synthetase I | {
"A": "Phenylalanine hydroxylase",
"B": "Branched-chain ketoacid dehydrogenase",
"C": "Cystathionine synthase",
"D": "Carbamoyl phosphate synthetase I"
} | step1 | D | [
"examining",
"3 day old newborn",
"delivered",
"complications",
"newborn presents",
"vomiting",
"hyperventilation",
"lethargy",
"seizures",
"Blood work demonstrates hyperammonemia",
"elevated glutamine levels",
"decreased blood urea nitrogen",
"CT scan demonstrates cerebral edema",
"Defects",
"following enzymes",
"result",
"clinical presentation similar",
"infant"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: You are examining a 3-day-old newborn who was delivered vaginally without any complications. The newborn presents with vomiting, hyperventilation, lethargy, and seizures. Blood work demonstrates hyperammonemia, elevated glutamine levels, and decreased blood urea nitrogen. A CT scan demonstrates cerebral edema. Defects in which of the following enzymes would result in a clinical presentation similar to this infant?
Choose one of the following::
A. Phenylalanine hydroxylase
B. Branched-chain ketoacid dehydrogenase
C. Cystathionine synthase
D. Carbamoyl phosphate synthetase I | [
0.013980305753648281,
-0.03503698110580444,
0.02357390709221363,
-0.01241679023951292,
0.01329234428703785,
0.026802772656083107,
-0.011949303559958935,
0.03555621579289436,
-0.02147609367966652,
-0.03295208886265755,
0.03331312909722328,
-0.028588522225618362,
-0.01211560145020485,
-0.002976586576551199,
0.001319455448538065,
0.021309539675712585,
0.018286118283867836,
0.0029656104743480682,
-0.04905519261956215,
-0.009375735186040401,
-0.027824008837342262,
0.030659589916467667,
0.010415446013212204,
0.002332838252186775,
0.02265845239162445,
0.03320533409714699,
-0.023436013609170914,
-0.003873014124110341,
-0.014835510402917862,
-0.03311353921890259,
0.0027156551368534565,
0.03104366362094879,
0.0037939180620014668,
-0.0605945847928524,
0.0000012215389233460883,
-0.030612170696258545,
-0.027867332100868225,
-0.04808734357357025,
-0.004734381567686796,
-0.028480645269155502,
-0.05161679908633232,
-0.06347517669200897,
-0.008249601349234581,
-0.013956624083220959,
0.008104568347334862,
-0.032393280416727066,
0.028255395591259003,
0.06087525561451912,
0.013598878867924213,
0.0115008894354105,
0.01959083415567875,
0.05379774048924446,
-0.016525572165846825,
0.0019115781178697944,
0.06308214366436005,
-0.04689455032348633,
-0.01608932949602604,
0.04528879001736641,
0.0207593385130167,
0.0018329633167013526,
0.006431863643229008,
0.02016383223235607,
0.032439619302749634,
0.028961019590497017,
-0.04376138746738434,
0.016560379415750504,
0.009652054868638515,
-0.0953550934791565,
-0.012501434423029423,
0.008814536035060883,
-0.02013818919658661,
0.0049642832018435,
0.01698567532002926,
0.08435884863138199,
-0.047418802976608276,
-0.0023377835750579834,
0.029427479952573776,
0.027265019714832306,
-0.027570297941565514,
0.020765651017427444,
-0.0010023280046880245,
-0.0027009197510778904,
-0.03937695547938347,
0.0022562770172953606,
0.04151981323957443,
-0.058055415749549866,
0.022210877388715744,
-0.04859935864806175,
-0.04739711806178093,
0.0044339969754219055,
-0.028470419347286224,
-0.0037583562079817057,
0.04502606391906738,
0.014811425469815731,
-0.036791350692510605,
-0.007188459392637014,
-0.03234792873263359,
-0.024582762271165848,
0.017424795776605606,
-0.04303109273314476,
-0.011060802266001701,
-0.04293273389339447,
0.007350845728069544,
0.028301307931542397,
-0.025806453078985214,
0.0007137690554372966,
-0.0009222053922712803,
-0.0015718641225248575,
-0.03556295856833458,
0.05719058960676193,
-0.00177207391243428,
0.014814215712249279,
-0.08678241819143295,
0.03879881650209427,
0.06473936885595322,
0.017443768680095673,
-0.01598513126373291,
-0.055076438933610916,
-0.014369594864547253,
0.03290729969739914,
0.002931388560682535,
0.06582791358232498,
-0.0029195828828960657,
0.01686139591038227,
-0.05058040842413902,
-0.02198382467031479,
-0.012107222341001034,
0.002816005377098918,
-0.019600551575422287,
0.010762039572000504,
0.022474857047200203,
-0.05589565262198448,
-0.04882868751883507,
0.06150825321674347,
0.024191556498408318,
0.030337510630488396,
0.04433013126254082,
0.04710869491100311,
-0.047592680901288986,
0.0014009485021233559,
-0.0018488735659047961,
-0.05437969043850899,
-0.022705256938934326,
0.007589728105813265,
-0.004397588316351175,
0.056517593562603,
-0.004445529542863369,
-0.018906177952885628,
0.032989658415317535,
0.031315356492996216,
-0.03006458841264248,
-0.04144562780857086,
-0.0028400328010320663,
0.004692999646067619,
0.016488317400217056,
0.04307404160499573,
0.0034412487875670195,
-0.002468697726726532,
-0.013732152990996838,
-0.028848964720964432,
0.04077078029513359,
-0.042779963463544846,
0.03398308902978897,
-0.03802527114748955,
-0.004025546833872795,
0.01589985564351082,
0.00587893184274435,
0.014139143750071526,
-0.05415425822138786,
0.0352192260324955,
-0.01188204437494278,
0.034008756279945374,
0.034504421055316925,
-0.01611005887389183,
-0.027950217947363853,
0.05600317567586899,
-0.03609814867377281,
-0.02424756810069084,
-0.020893195644021034,
-0.015095429494976997,
0.024004019796848297,
-0.011250247247517109,
0.07124677300453186,
-0.0059005082584917545,
0.05372045934200287,
-0.029042018577456474,
0.04094000160694122,
-0.015960680320858955,
-0.0009414148516952991,
-0.03792852535843849,
-0.03370393067598343,
0.030351677909493446,
-0.003001558594405651,
-0.0015728097641840577,
-0.014938193373382092,
0.05536361411213875,
-0.05804000049829483,
0.04378417506814003,
-0.0043169427663087845,
-0.029027270153164864,
0.017702890560030937,
-0.005819128826260567,
0.040418121963739395,
0.014634206891059875,
-0.044271890074014664,
0.09868353605270386,
-0.01784021593630314,
0.020276986062526703,
-0.055264830589294434,
-0.017182575538754463,
0.004104996100068092,
-0.03413667902350426,
0.045810673385858536,
-0.032547611743211746,
0.03362622112035751,
0.021364405751228333,
0.017493190243840218,
-0.01260268222540617,
-0.05263778194785118,
0.034279245883226395,
-0.0029146806336939335,
0.018480347469449043,
-0.009016389027237892,
-0.01149477157741785,
0.008652551099658012,
0.0031497403979301453,
-0.014971927739679813,
0.021741250529885292,
-0.03380615636706352,
-0.06303969025611877,
0.03449956700205803,
-0.005131877958774567,
-0.034143298864364624,
0.03519009053707123,
-0.021737199276685715,
-0.01411454752087593,
0.054009512066841125,
-0.04569169878959656,
-0.02390741929411888,
0.06040782108902931,
-0.05502884462475777,
-0.009472637437283993,
-0.06091807037591934,
-0.03325054422020912,
0.022392332553863525,
0.008401229046285152,
0.004029108211398125,
0.05366566777229309,
-0.05979599803686142,
0.04723159596323967,
-0.011182527057826519,
-0.012741842307150364,
0.009164598770439625,
0.014295609667897224,
-0.0007449675467796624,
0.04587886482477188,
-0.07372427731752396,
0.006260967813432217,
-0.00044253739179112017,
-0.04920705407857895,
-0.045883238315582275,
0.031097905710339546,
0.021736472845077515,
-0.05378474295139313,
-0.06608842313289642,
-0.03242543712258339,
0.03095146454870701,
0.03166680783033371,
-0.013546916656196117,
0.04430016875267029,
0.027254847809672356,
0.05117226392030716,
0.0018773676129058003,
0.001282626180909574,
-0.015988841652870178,
-0.010139821097254753,
-0.019791709259152412,
-0.011632208712399006,
0.026785140857100487,
0.010468642227351665,
-0.0016234077047556639,
0.04986966773867607,
0.01748226396739483,
0.04165222868323326,
0.014169938862323761,
0.03147147595882416,
0.011643755249679089,
0.006122838705778122,
0.05146253854036331,
0.0426911823451519,
-0.002764450153335929,
0.03733343258500099,
0.04262081906199455,
-0.019650757312774658,
0.015903957188129425,
-0.022310422733426094,
-0.07914859801530838,
0.06613325327634811,
0.00039783224929124117,
0.08902893960475922,
-0.04124373570084572,
0.01401881780475378,
0.009067670442163944,
-0.005118913482874632,
-0.02527954988181591,
0.06028508394956589,
0.060772787779569626,
0.02144232764840126,
0.0016837305156514049,
0.08515329658985138,
0.041455235332250595,
-0.01909918338060379,
-0.019332244992256165,
0.0328044667840004,
-0.0068488349206745625,
0.029099266976118088,
-0.05573781207203865,
-0.0830145925283432,
0.01669309101998806,
0.06915056705474854,
0.025363203138113022,
-0.0001884989469544962,
-0.01181614026427269,
-0.0073986174538731575,
0.0013965049292892218,
-0.028873862698674202,
0.0002577973064035177,
0.006293466314673424,
-0.07018131017684937,
-0.06809487193822861,
0.011291836388409138,
-0.045126959681510925,
-0.039455994963645935,
-0.002792548853904009,
0.04125591367483139,
-0.024553239345550537,
-0.021386411041021347,
0.01980295218527317,
-0.03344907984137535,
0.0022324498277157545,
0.00967783760279417,
-0.0025033524725586176,
0.003533212235197425,
0.06076600402593613,
0.06030910462141037,
-0.023586850613355637,
-0.05702761933207512,
0.01417611911892891,
-0.027231115847826004,
0.06444204598665237,
-0.11822287738323212,
-0.03475327044725418,
-0.0016567913116887212,
-0.015603895299136639,
-0.01851852424442768,
-0.04954518750309944,
-0.019503194838762283,
0.02954135276377201,
-0.028560152277350426,
-0.02406320534646511,
0.040954284369945526,
0.05021384730935097,
-0.00812024250626564,
0.07169176638126373,
0.014585223980247974,
0.014161941595375538,
0.012480524368584156,
-0.00792002584785223,
0.014344806782901287,
-0.04122960567474365,
-0.0202389694750309,
0.01814473606646061,
-0.018342049792408943,
0.011793430894613266,
-0.01374127995222807,
-0.010089135728776455,
-0.0009438184788450599,
-0.03515460342168808,
-0.10052580386400223,
-0.04980318620800972,
0.04616190865635872,
-0.011254831217229366,
0.045761022716760635,
-0.003730383003130555,
0.02237319014966488,
-0.0007917343755252659,
-0.04373955726623535,
-0.013747403398156166,
0.05579175800085068,
0.04062352702021599,
0.0069361161440610886,
-0.031130865216255188,
-0.035266440361738205,
-0.002810362260788679,
0.025308219715952873,
0.03576461970806122,
0.05757974088191986,
-0.050574660301208496,
0.016231197863817215,
0.07834547758102417,
-0.0006677579949609935,
0.02539396472275257,
-0.07975824922323227,
0.08435703068971634,
0.035712312906980515,
-0.055216092616319656,
-0.06140366569161415,
-0.041978176683187485,
0.01225318480283022,
0.047890592366456985,
0.08568333834409714,
-0.005727420561015606,
0.02986086718738079,
0.0007529787253588438,
-0.01821344904601574,
-0.026252547279000282,
-0.012679682113230228,
-0.02794000692665577,
0.016011526808142662,
-0.07831837236881256,
0.02537652663886547,
-0.01719377376139164,
-0.007097119465470314,
-0.05563323572278023,
-0.01850510574877262,
-0.03041796386241913,
0.0352601632475853,
0.04342998191714287,
0.0036927165929228067,
0.04821668937802315,
-0.005598034244030714,
-0.008978461846709251,
0.044037673622369766,
0.050787363201379776,
-0.009964696131646633,
-0.012698746286332607,
0.025022633373737335,
0.004799790680408478,
-0.024259012192487717,
-0.04955804720520973,
0.021934574469923973,
0.00383748603053391,
0.06428591161966324,
0.0395238921046257,
0.002697112737223506,
0.06301766633987427,
-0.011840583756566048,
0.05606527626514435,
0.07698149979114532,
0.1320684403181076,
-0.040754057466983795,
-0.037504129111766815,
-0.02032497152686119,
0.009587853215634823,
0.033506665378808975,
-0.011005595326423645,
0.0115712471306324,
-0.04526805132627487,
0.027602264657616615,
-0.045492056757211685,
-0.02468634583055973,
0.019407257437705994,
-0.04356476292014122,
-0.05266638472676277,
0.021403666585683823,
-0.04736125469207764,
-0.007226936053484678,
0.040446359664201736,
-0.005390542559325695,
-0.03151571750640869,
-0.04756533354520798,
0.029112791642546654,
-0.037363503128290176,
0.0083305099979043,
0.010179969482123852,
-0.05476006865501404,
-0.037051402032375336,
0.035661760717630386,
0.03510051965713501,
0.018292054533958435,
-0.049762822687625885,
0.07853041589260101,
-0.053429603576660156,
-0.04035932198166847,
-0.008388807065784931,
0.0354340486228466,
0.006419326178729534,
-0.007075081113725901,
-0.007698052562773228,
-0.00041049867286346853,
0.046584151685237885,
-0.005335571710020304,
-0.021573752164840698,
-0.03552792966365814,
-0.06806307286024094,
-0.031124558299779892,
-0.03036908246576786,
0.08625120669603348,
-0.0049309809692204,
-0.0003939138841815293,
0.061175987124443054,
-0.012567645870149136,
0.049031876027584076,
-0.013026130385696888,
0.009357696399092674,
0.049866270273923874,
-0.039310719817876816,
0.006641259416937828,
-0.06049657613039017,
-0.031764041632413864,
0.007207393180578947,
0.013249941170215607,
0.012562895193696022,
0.015390751883387566,
-0.0012186281383037567,
-0.07438748329877853,
-0.0855407789349556,
-0.013605586253106594,
-0.039571747183799744,
-0.0014322263887152076,
0.013386928476393223,
0.029250493273139,
-0.03932579979300499,
-0.018519112840294838,
-0.00877957884222269,
0.06856369972229004,
0.013722201809287071,
0.008898086845874786,
0.02029821276664734,
0.09536845982074738,
-0.0555727519094944,
0.019209066405892372,
-0.0490606389939785,
-0.024744458496570587,
0.006274597719311714,
-0.004091888666152954,
-0.012800454162061214,
-0.013842648826539516,
-0.01416668202728033,
-0.050730351358652115,
0.01692778244614601,
0.02968367375433445,
-0.004799824673682451,
0.03573022037744522,
-0.02205551415681839,
0.03570397570729256,
-0.031598009169101715,
0.00007166270370362327,
0.03008393757045269,
-0.019930539652705193,
-0.007271719165146351,
0.04013317450881004,
0.0019194699125364423,
0.05743970721960068,
0.052855234593153,
-3.9400656787823145e-33,
0.04957512021064758,
-0.03885210305452347,
0.023658230900764465,
0.012076347135007381,
0.03593408688902855,
0.06989102810621262,
-0.02735835127532482,
0.0029838047921657562,
-0.008606430143117905,
-0.007590840104967356,
-0.01325508113950491,
-0.01594635844230652,
0.02189185842871666,
0.04647450894117355,
0.014005593955516815,
-0.06508053094148636,
0.0018248220440000296,
-0.007379167713224888,
0.0004368952941149473,
0.006703759077936411,
-0.03486253693699837,
-0.0023373516742140055,
0.029582442715764046,
-0.003834088332951069,
-0.017641013488173485,
-0.05934915319085121,
0.02853846363723278,
-0.012927860952913761,
-0.0011444671545177698,
0.05326206237077713,
0.009883108548820019,
-0.02841881848871708,
-0.019852081313729286,
-0.03852982819080353,
-0.031186893582344055,
-0.07928913086652756,
0.01154498104006052,
-0.00937861017882824,
0.029690366238355637,
-0.04053647816181183,
-0.07806810736656189,
-0.015722988173365593,
0.07438862323760986,
0.023488163948059082,
0.0209223460406065,
0.024435821920633316,
-0.031427279114723206,
-0.021681249141693115,
0.027653563767671585,
-0.04035686329007149,
-0.03801095113158226,
0.026246042922139168,
0.005604200065135956,
0.012878532521426678,
-0.028143221512436867,
0.008637278340756893,
-0.005881148856133223,
-0.07031266391277313,
0.04805382713675499,
0.006121507380157709,
0.011316175572574139,
0.011469469405710697,
-0.003504035761579871,
-0.05098623409867287,
-0.02775917574763298,
0.0068237800151109695,
0.03267044201493263,
0.09613717347383499,
-0.06775878369808197,
0.06220512092113495,
-0.035399191081523895,
-0.010820680297911167,
0.0201572235673666,
-0.09329785406589508,
-0.0029817705508321524,
-0.034976039081811905,
0.006772221066057682,
0.048743754625320435,
-0.022130461409687996,
0.08249795436859131,
-0.02494313009083271,
-0.02927224338054657,
-0.06795749813318253,
-0.03664465248584747,
-0.029079655185341835,
0.002897462574765086,
-0.0003469723742455244,
-0.031278908252716064,
0.014222756028175354,
-0.05237741023302078,
0.07440835982561111,
0.04167903587222099,
0.026799583807587624,
0.024044645950198174,
-0.016021767631173134,
-0.03333320841193199,
0.07381173968315125,
0.02204706519842148,
-0.019088342785835266,
-0.010189268738031387,
0.07416558265686035,
-0.017763420939445496,
0.05846920982003212,
-0.04773469269275665,
-0.01595490239560604,
-0.014325398951768875,
-0.022815631702542305,
0.023655405268073082,
0.006962239276617765,
-0.007254175376147032,
0.010701722465455532,
-0.01667439565062523,
0.016115471720695496,
-0.0016775382682681084,
0.0036654635332524776,
0.04712366685271263,
0.05042508989572525,
0.01980617828667164,
-0.0077643683180212975,
-0.0007762113236822188,
0.0544215589761734,
0.07400351762771606,
0.03954846039414406,
-0.001667517120949924,
-0.0214545838534832,
-0.11115894466638565,
0.014238712377846241,
0.02041388675570488,
-0.03338979184627533,
-0.024072010070085526,
0.031070027500391006,
0.040815915912389755,
2.242757801695916e-7,
0.027767887338995934,
0.010713726282119751,
0.003055190434679389,
-0.08147822320461273,
0.01680709235370159,
-0.06889453530311584,
-0.009074109606444836,
0.012022989802062511,
-0.015414119698107243,
-0.028700007125735283,
0.05331661179661751,
0.014865458942949772,
-0.002791089005768299,
0.009183714166283607,
0.029355352744460106,
-0.028805483132600784,
-0.023766979575157166,
0.011032541282474995,
-0.003271772526204586,
0.006934340577572584,
0.014460012316703796,
-0.030100710690021515,
-0.08724185824394226,
-0.02429533563554287,
-0.006986099760979414,
0.017618553712964058,
0.009256348013877869,
-0.012564222328364849,
0.009011993184685707,
-0.00790945254266262,
-0.045316074043512344,
0.07727384567260742,
0.052186425775289536,
0.0536327101290226,
-0.050150662660598755,
-0.011709892190992832,
0.02703479677438736,
0.015946513041853905,
0.021550487726926804,
-0.00594014348462224,
0.026203865185379982,
0.03702281787991524,
0.01625579595565796,
0.04861154034733772,
-0.016132069751620293,
0.03745102509856224,
0.0063713244162499905,
-0.0018596533918753266,
0.04284987971186638,
-0.0059157805517315865,
-0.016124166548252106,
-0.017125830054283142,
0.009469854645431042,
0.052299655973911285,
-0.013089354149997234,
0.0012024969328194857,
-0.02242756448686123,
0.008926519192755222,
0.06303241103887558,
0.010119568556547165,
-0.01697809249162674,
-0.05125269293785095,
0.02905711531639099,
-0.017308300361037254,
0.05397531017661095,
-0.014254110865294933,
-0.04511643201112747,
1.530564932074511e-34,
-0.04337604343891144,
-0.06117456778883934,
0.008485684171319008,
-0.034467436373233795,
0.01696855016052723,
-0.012656919658184052,
-0.02129707671701908,
-0.021776234731078148,
-0.034283675253391266,
-0.0355864055454731,
-0.030779611319303513
] | {
"ds_index": 55,
"similar_dg_indices": [
1105471,
672841,
4970,
69224,
1040046,
866836,
85714,
161181,
627039,
4822,
989266,
363964,
397658,
1004134,
453696,
993816,
725562,
941262,
546761,
359401
]
} |
A 48-year-old man with HIV comes to the physician because of skin lesions over his face and neck for 2 weeks. They are not itchy or painful. He does not have fever or a sore throat. He was treated for candidal esophagitis 3 months ago. He is sexually active with his wife, who knows of his condition, and uses condoms consistently. He is currently receiving triple antiretroviral therapy with lamivudine, abacavir, and efavirenz. He is 175 cm (5 ft 9 in) tall and weighs 58 kg (128 lb); BMI is 18.8 kg/m2. Examination shows multiple skin colored papules over his face and neck with a dimpled center. Cervical lymphadenopathy is present. The remainder of the examination is unremarkable. His hemoglobin concentration is 12.1 g/dL, leukocyte count is 4,900/mm3, and platelet count is 143,000/mm3; serum studies and urinalysis show no abnormalities. CD4+ T-lymphocyte count is 312/mm3 (normal ≥ 500). Which of the following is the most likely cause of this patient's findings? | Poxvirus | {
"A": "Bartonella",
"B": "Papillomavirus",
"C": "Poxvirus",
"D": "Coccidioides\n\""
} | step2&3 | C | [
"48 year old man",
"HIV",
"physician",
"of skin lesions",
"face",
"neck",
"2 weeks",
"not itchy",
"painful",
"not",
"fever",
"sore throat",
"treated",
"candidal esophagitis",
"months",
"sexually active",
"wife",
"condition",
"uses condoms",
"currently receiving triple antiretroviral therapy",
"lamivudine",
"abacavir",
"efavirenz",
"5 ft 9",
"tall",
"58 kg",
"BMI",
"kg/m2",
"Examination shows multiple skin colored papules",
"face",
"neck",
"dimpled center",
"lymphadenopathy",
"present",
"examination",
"unremarkable",
"hemoglobin concentration",
"g/dL",
"leukocyte count",
"4 900 mm3",
"platelet count",
"mm3",
"serum studies",
"urinalysis show",
"abnormalities",
"CD4",
"T-lymphocyte",
"312 mm3",
"normal",
"500",
"following",
"most likely cause",
"patient's findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 48-year-old man with HIV comes to the physician because of skin lesions over his face and neck for 2 weeks. They are not itchy or painful. He does not have fever or a sore throat. He was treated for candidal esophagitis 3 months ago. He is sexually active with his wife, who knows of his condition, and uses condoms consistently. He is currently receiving triple antiretroviral therapy with lamivudine, abacavir, and efavirenz. He is 175 cm (5 ft 9 in) tall and weighs 58 kg (128 lb); BMI is 18.8 kg/m2. Examination shows multiple skin colored papules over his face and neck with a dimpled center. Cervical lymphadenopathy is present. The remainder of the examination is unremarkable. His hemoglobin concentration is 12.1 g/dL, leukocyte count is 4,900/mm3, and platelet count is 143,000/mm3; serum studies and urinalysis show no abnormalities. CD4+ T-lymphocyte count is 312/mm3 (normal ≥ 500). Which of the following is the most likely cause of this patient's findings?
Choose one of the following::
A. Bartonella
B. Papillomavirus
C. Poxvirus
D. Coccidioides
" | [
0.04270840808749199,
-0.030811559408903122,
0.03693860396742821,
0.027466636151075363,
0.014579114504158497,
-0.005884790793061256,
-0.015089582651853561,
0.00254692486487329,
0.0026763337664306164,
0.011629241518676281,
0.04279649257659912,
-0.014829308725893497,
0.011428311467170715,
-0.028550265356898308,
0.026254167780280113,
0.0021453951485455036,
-0.013978899456560612,
0.040718503296375275,
0.031213605776429176,
-0.004745257552713156,
-0.005865393206477165,
-0.01071818545460701,
0.02750568464398384,
0.03297552838921547,
0.05466834828257561,
-0.010794254019856453,
-0.0535643994808197,
0.014392443001270294,
-0.02282368391752243,
-0.06461958587169647,
-0.044270001351833344,
-0.02215563878417015,
-0.04504014924168587,
-0.07832387834787369,
0.0000019276421880931593,
-0.011418463662266731,
0.054134879261255264,
-0.049029067158699036,
0.030570918694138527,
0.009747643955051899,
0.03930268809199333,
-0.011517120525240898,
0.07456766068935394,
-0.01296867523342371,
-0.03681163862347603,
-0.14096872508525848,
-0.012056397274136543,
0.037809107452631,
0.01227046549320221,
0.03981095179915428,
-0.0010550443548709154,
-0.003019697032868862,
-0.011910304427146912,
0.028669435530900955,
0.05021011456847191,
-0.07155200839042664,
0.0303662046790123,
0.018297800794243813,
-0.038429588079452515,
-0.014808554202318192,
0.013423307798802853,
-0.038358770310878754,
-0.0067217182368040085,
-0.023541394621133804,
0.008835205808281898,
-0.0022481661289930344,
-0.006928393617272377,
-0.04279602691531181,
0.005000406410545111,
-0.014669693075120449,
0.018203066661953926,
-0.026442090049386024,
0.01841549761593342,
0.044144388288259506,
-0.015486991964280605,
-0.030105242505669594,
0.030133578926324844,
0.014280426315963268,
-0.04370849207043648,
0.004618717357516289,
0.03238186612725258,
0.061904337257146835,
0.005396784283220768,
0.05260884761810303,
0.014400291256606579,
-0.07709139585494995,
-0.0028925135266035795,
-0.005298040807247162,
0.030016710981726646,
-0.013211974874138832,
-0.04339378699660301,
-0.08302273601293564,
-0.015337296761572361,
0.04943923279643059,
-0.02554553933441639,
0.028664927929639816,
0.03921494632959366,
-0.033210597932338715,
0.04559262841939926,
-0.06523142755031586,
-0.03762452304363251,
-0.027464235201478004,
-0.024933934211730957,
0.054007820785045624,
-0.06389587372541428,
-0.0068422905169427395,
-0.031808167695999146,
-0.012656682170927525,
-0.002188067650422454,
0.0073796105571091175,
0.06399992853403091,
0.007600271608680487,
-0.03247092664241791,
-0.0330914743244648,
0.08508627861738205,
-0.027624599635601044,
-0.05526497960090637,
0.01280317921191454,
0.03056936338543892,
0.048149771988391876,
-0.0023265795316547155,
0.0059531815350055695,
-0.009339946322143078,
-0.011242898181080818,
0.02853447012603283,
0.0028874960262328386,
0.06640695780515671,
-0.020482409745454788,
-0.014920713379979134,
-0.001954201841726899,
0.024144448339939117,
-0.05301695689558983,
-0.025724416598677635,
-0.032763876020908356,
0.006582779344171286,
0.008922017179429531,
0.006962595507502556,
0.04409712553024292,
0.04250236973166466,
0.03468633070588112,
-0.037886619567871094,
0.023348186165094376,
-0.026450565084815025,
-0.0024696080945432186,
-0.023981012403964996,
0.01768486015498638,
0.008896521292626858,
0.04846777766942978,
0.01169534120708704,
0.038118112832307816,
-0.01592801883816719,
0.028817588463425636,
0.04067130386829376,
-0.00690832082182169,
0.008956088684499264,
0.004209689795970917,
0.00026555225485935807,
-0.02474645897746086,
-0.032320115715265274,
-0.01617460697889328,
-0.015219764783978462,
-0.02512049488723278,
-0.028658369556069374,
-0.027484634891152382,
-0.013430808670818806,
0.059267520904541016,
0.006936540827155113,
0.02855650708079338,
0.015207147225737572,
0.015433750115334988,
-0.036499153822660446,
0.04517021402716637,
0.0028082721401005983,
-0.01175000425428152,
-0.054024238139390945,
-0.03392423689365387,
-0.05317184329032898,
-0.041142888367176056,
-0.022508148103952408,
0.007480370346456766,
0.04897407069802284,
0.04539407417178154,
0.04162656143307686,
-0.06399256736040115,
-0.034390706568956375,
0.02678256668150425,
-0.02271861769258976,
-0.04126078262925148,
-0.01843055710196495,
-0.003151246113702655,
-0.0008185565238818526,
0.01293620839715004,
-0.0032273009419441223,
-0.016134990379214287,
-0.04240838438272476,
0.026557106524705887,
-0.0790138989686966,
-0.0852917805314064,
0.018644265830516815,
0.025475790724158287,
0.04991696774959564,
-0.08622881770133972,
-0.007175660226494074,
0.03822442144155502,
-0.04099661111831665,
0.08296088874340057,
-0.0457485094666481,
0.027847712859511375,
-0.03828740119934082,
-0.011901765130460262,
-0.0032282783649861813,
-0.014709754846990108,
0.02423417940735817,
-0.06324058026075363,
0.02698475681245327,
-0.005939371883869171,
-0.02777455560863018,
0.025660788640379906,
0.001279601245187223,
0.02278519794344902,
-0.021069176495075226,
-0.005109471268951893,
0.042246658354997635,
0.009520952589809895,
-0.02589900605380535,
-0.002944687381386757,
0.014555547386407852,
-0.005014762282371521,
0.04335934668779373,
-0.06335959583520889,
0.038991983979940414,
0.050751108676195145,
-0.06512451171875,
0.02227873168885708,
-0.027225276455283165,
0.02215634472668171,
-0.009488842450082302,
-0.04666164144873619,
0.013690642081201077,
-0.03329337388277054,
-0.017329730093479156,
0.044446688145399094,
0.006377647630870342,
0.00038639275589957833,
-0.0033133779652416706,
-0.022071335464715958,
-0.049039337784051895,
0.00514511251822114,
-0.028377331793308258,
0.07280126214027405,
-0.024012522771954536,
0.003509443486109376,
0.03383385390043259,
0.006194073241204023,
-0.0105958953499794,
0.07850189507007599,
0.002152024768292904,
0.020865796133875847,
-0.037618253380060196,
-0.05933346599340439,
-0.03178107738494873,
-0.03209029138088226,
-0.016082091256976128,
-0.00026930856984108686,
-0.018642159178853035,
-0.0034857471473515034,
-0.023581331595778465,
-0.10337287187576294,
-0.026121893897652626,
0.04118409380316734,
-0.032438188791275024,
0.05749383196234703,
0.0269644632935524,
-0.0015409097541123629,
-0.03627018630504608,
-0.02071022056043148,
-0.022787468507885933,
0.10122311115264893,
0.04007601737976074,
-0.01749446801841259,
0.0131921311840415,
0.016278652474284172,
-0.03046196885406971,
0.02727179415524006,
0.00448098499327898,
-0.023232189938426018,
-0.01705564744770527,
-0.011465054005384445,
0.045811936259269714,
0.02474146895110607,
-0.02209429442882538,
-0.01635744236409664,
0.023775050416588783,
-0.034469831734895706,
-0.04645869508385658,
-0.03698766604065895,
-0.009426984935998917,
0.035324517637491226,
-0.007298897486180067,
0.06855086237192154,
0.031040668487548828,
0.008875621482729912,
-0.018006164580583572,
-0.0022091432474553585,
0.011020769365131855,
0.012040280736982822,
0.030433863401412964,
-0.0021667093969881535,
-0.010531144216656685,
0.0089742885902524,
0.08031854778528214,
0.01836187019944191,
-0.0181190874427557,
0.009596772491931915,
0.0328935831785202,
-0.06129361689090729,
0.03394521027803421,
-0.038499653339385986,
0.023539137095212936,
-0.011005989275872707,
-0.037248000502586365,
0.022690333425998688,
-0.023099588230252266,
0.012631149962544441,
-0.0006704458501189947,
0.011974531225860119,
0.014878730289638042,
-0.00019542034715414047,
-0.00009501240128884092,
-0.014481554739177227,
-0.0011570334900170565,
-0.04206619784235954,
-0.030795646831393242,
0.024733377620577812,
0.053948476910591125,
0.044323939830064774,
-0.01976821757853031,
0.05413280427455902,
-0.047147106379270554,
-0.0025368337519466877,
0.011479704640805721,
-0.030473679304122925,
-0.011823585256934166,
-0.022693468257784843,
-0.0012344609713181853,
-0.0044583906419575214,
-0.026340318843722343,
0.05007725954055786,
0.04484076425433159,
0.0241550263017416,
-0.07816005498170853,
0.046424780040979385,
0.005446810740977526,
-0.027112148702144623,
-0.017671823501586914,
0.0015421579591929913,
0.023608841001987457,
0.02576802298426628,
-0.028824470937252045,
0.021161803975701332,
-0.006914715748280287,
-0.02545393630862236,
-0.022709006443619728,
0.05088624358177185,
-0.028225596994161606,
0.004823070019483566,
0.010856636799871922,
-0.04439699649810791,
-0.03476223722100258,
-0.024918347597122192,
0.0025246255099773407,
-0.06664411723613739,
-0.025065694004297256,
0.057797592133283615,
-0.04913598299026489,
-0.032690271735191345,
-0.009486360475420952,
-0.07568642497062683,
-0.09773730486631393,
-0.031160548329353333,
0.041556425392627716,
-0.03054937906563282,
0.03499482199549675,
-0.0245409794151783,
-0.08453992754220963,
0.038436610251665115,
0.0066134692169725895,
-0.060230765491724014,
0.08538779616355896,
0.010954446159303188,
0.011518840678036213,
-0.022273866459727287,
0.05024193972349167,
-0.00537200178951025,
-0.025219274684786797,
0.0366709940135479,
-0.008968566544353962,
-0.02763267047703266,
0.06413593888282776,
0.07047799974679947,
0.024851160123944283,
0.035609155893325806,
-0.07114340364933014,
0.05017317831516266,
0.09600304812192917,
-0.05804915726184845,
-0.034845709800720215,
-0.023179441690444946,
-0.011152155697345734,
0.03411209583282471,
-0.03435618430376053,
-0.04280925169587135,
0.03064177744090557,
0.013598190620541573,
-0.00978657603263855,
-0.03499255329370499,
-0.018530601635575294,
-0.015799429267644882,
-0.018472939729690552,
-0.03453527390956879,
0.04859137162566185,
0.03800906240940094,
-0.019356239587068558,
-0.03536538407206535,
-0.007947225123643875,
0.03178068995475769,
0.04613044485449791,
-0.023413164541125298,
-0.002087072003632784,
0.010374289005994797,
0.01709633879363537,
-0.03535173460841179,
0.014915001578629017,
0.0645853653550148,
-0.002438315888866782,
0.025678429752588272,
0.022810237482190132,
0.036896903067827225,
-0.04307611286640167,
-0.011542391031980515,
-0.03554373234510422,
-0.025312064215540886,
0.007274541538208723,
0.07077287137508392,
0.010649638250470161,
-0.04806506633758545,
0.03754162788391113,
0.0016156653873622417,
-0.02398105338215828,
0.08200297504663467,
0.0048598418943583965,
0.02794024534523487,
0.038792070001363754,
0.012629043310880661,
-0.02674955502152443,
0.06979147344827652,
-0.0030050547793507576,
-0.02316652052104473,
0.009194985963404179,
0.018549051135778427,
-0.06898831576108932,
0.013195594772696495,
-0.014453854411840439,
-0.03874202072620392,
-0.016795139759778976,
-0.09634881466627121,
-0.052449457347393036,
0.04373052343726158,
-0.017706768587231636,
-0.03021312691271305,
0.03549109771847725,
0.0778547152876854,
0.024165065959095955,
-0.011299463920295238,
-0.007856201380491257,
-0.007483372930437326,
-0.044075772166252136,
-0.08277249336242676,
-0.058013029396533966,
0.005331068765372038,
0.028168095275759697,
0.0276502575725317,
-0.049912210553884506,
-0.028654959052801132,
0.004526594653725624,
-0.025746803730726242,
0.05162650719285011,
0.016863413155078888,
-0.05282948911190033,
-0.019845303148031235,
-0.055501922965049744,
-0.007170424330979586,
-0.04278794303536415,
0.006521668750792742,
0.010553237050771713,
0.01870308257639408,
0.03584951534867287,
0.0013090224238112569,
0.03500464931130409,
-0.011359820142388344,
0.08829953521490097,
0.0217173770070076,
0.016578733921051025,
-0.04490453377366066,
0.02817818894982338,
-0.04388411343097687,
0.0430702306330204,
0.006559086497873068,
0.03134303539991379,
-0.06581781059503555,
0.0381573811173439,
-0.004414441529661417,
-0.020964769646525383,
0.0520637221634388,
0.04072576388716698,
-0.07638655602931976,
0.006734627299010754,
-0.009305819869041443,
0.021841978654265404,
0.026406092569231987,
0.005514528602361679,
-0.027127953246235847,
0.058611366897821426,
-0.045274682343006134,
-0.024738261476159096,
0.055899541825056076,
0.025108447298407555,
-0.03939105197787285,
0.024393068626523018,
0.015445275232195854,
0.02877744473516941,
-0.04862299561500549,
-0.02618219517171383,
0.03408249467611313,
-0.07659148424863815,
-0.010804670862853527,
0.06696147471666336,
0.02463826723396778,
-0.02270972728729248,
0.0019556155893951654,
-0.013982372358441353,
-0.03988729417324066,
0.0113742770627141,
-0.0715935155749321,
0.03491910174489021,
0.046313125640153885,
-0.024450620636343956,
-0.026255108416080475,
0.018050212413072586,
-0.008342654444277287,
-0.00716831348836422,
0.08662359416484833,
0.01454109326004982,
0.06356324255466461,
0.024655109271407127,
-4.745622406509228e-33,
0.029843105003237724,
-0.024215981364250183,
0.061467695981264114,
0.00002264341492264066,
-0.024318020790815353,
0.06238206475973129,
-0.017802724614739418,
-0.00773708475753665,
-0.06527792662382126,
0.029492752626538277,
0.02172037586569786,
-0.025371165946125984,
0.020451584830880165,
0.05471106618642807,
-0.007704765535891056,
0.051365677267313004,
-0.010542601346969604,
-0.0035893325693905354,
-0.05409667640924454,
0.005962786730378866,
-0.03738598898053169,
-0.015451307408511639,
0.027555052191019058,
-0.0064647919498384,
-0.018133224919438362,
0.01498410850763321,
0.07014435529708862,
0.016437947750091553,
-0.019818929955363274,
0.000432062050094828,
-0.027667343616485596,
-0.05514290928840637,
0.007412384729832411,
0.03528866171836853,
-0.017459644004702568,
-0.05611912161111832,
-0.005708150565624237,
-0.02511950023472309,
0.037473998963832855,
0.07042859494686127,
-0.013475591316819191,
-0.010189564898610115,
0.006616570055484772,
0.015144898556172848,
0.07255222648382187,
-0.041974037885665894,
-0.012709696777164936,
-0.02280215173959732,
-0.07483532279729843,
0.022560808807611465,
0.024355817586183548,
0.03606708347797394,
0.06259214878082275,
-0.0038372473791241646,
-0.03556331619620323,
-0.035708390176296234,
-0.02852657437324524,
0.06372050195932388,
-0.006135495379567146,
-0.027150724083185196,
-0.05787625536322594,
-0.03430860862135887,
0.03517104312777519,
-0.01534280925989151,
-0.06009748950600624,
-0.012207145802676678,
0.05843242630362511,
-0.03171439841389656,
-0.04921929910778999,
-0.026954248547554016,
-0.06526048481464386,
0.057568326592445374,
-0.07971762120723724,
-0.07781249284744263,
-0.039624106138944626,
0.009961489588022232,
0.05802544951438904,
-0.024642787873744965,
0.013219623826444149,
0.023145761340856552,
-0.027806218713521957,
-0.008576521649956703,
0.019485678523778915,
0.024742381647229195,
-0.04247869551181793,
0.010732031427323818,
0.027007058262825012,
-0.056151192635297775,
0.01097843423485756,
-0.0016504761297255754,
0.057277828454971313,
0.024726802483201027,
-0.015022768639028072,
-0.010759029537439346,
-0.047713395208120346,
-0.025676997378468513,
0.03607876971364021,
0.012543909251689911,
0.009462456218898296,
0.022662928327918053,
0.03529169410467148,
0.06417840719223022,
-0.004915732424706221,
-0.013265452347695827,
-0.03975249454379082,
0.0027540535666048527,
-0.04696745425462723,
0.013462631031870842,
-0.02001790888607502,
0.02321496047079563,
-0.0005607795319519937,
0.022924352437257767,
-0.023731281980872154,
0.10425549000501633,
0.02340255118906498,
0.009299683384597301,
-0.006432586815208197,
0.03426458686590195,
0.007131228689104319,
0.00823564175516367,
0.05408867821097374,
-0.05602722987532616,
0.01563817448914051,
0.013543318025767803,
-0.04185697063803673,
0.002396629424765706,
0.017463548108935356,
0.020765788853168488,
-0.04780250042676926,
0.01849805936217308,
0.04702020063996315,
0.023911012336611748,
2.673185974799708e-7,
0.03222726657986641,
-0.008001240901648998,
-0.01293204165995121,
-0.03316432237625122,
0.03141680732369423,
-0.0004984816769137979,
-0.028329888358712196,
-0.031614258885383606,
-0.011573847383260727,
0.014710390008985996,
-0.007387544959783554,
0.04572014510631561,
-0.003964320756494999,
0.005944473203271627,
0.03456494212150574,
0.0016101212240755558,
-0.0033900171983987093,
0.01981271244585514,
0.029978835955262184,
0.03806758671998978,
0.012847461737692356,
-0.02886543795466423,
-0.03242740407586098,
-0.03359732776880264,
0.057347800582647324,
0.01785878837108612,
-0.008332611061632633,
0.010735597461462021,
-0.08089339733123779,
-0.017260055989027023,
0.01797313056886196,
-0.016537409275770187,
0.05883107706904411,
0.08853355050086975,
-0.046313513070344925,
0.019672147929668427,
-0.007665632758289576,
0.06445330381393433,
0.01748032309114933,
0.05175039544701576,
0.025410208851099014,
-0.03337918594479561,
0.007454330567270517,
0.025039607658982277,
-0.010273176245391369,
0.012652209959924221,
-0.034880951046943665,
-0.02960956282913685,
0.019784636795520782,
0.035487107932567596,
-0.016165679320693016,
0.0414934940636158,
-0.002556722844019532,
0.05747786536812782,
-0.04237665608525276,
-0.013351935893297195,
-0.053153980523347855,
0.020372848957777023,
0.018854692578315735,
-0.02845117636024952,
0.01950397901237011,
-0.003660836722701788,
0.014432229101657867,
0.030293865129351616,
-0.01564604975283146,
0.02187386341392994,
-0.018358377739787102,
1.8008539016286385e-34,
-0.0022274795919656754,
-0.04930483177304268,
0.018433528020977974,
-0.018353193998336792,
-0.06177442893385887,
-0.05526714399456978,
0.027496982365846634,
0.043866127729415894,
-0.010371800512075424,
-0.014664752408862114,
-0.0262770876288414
] | {
"ds_index": 56,
"similar_dg_indices": [
581926,
915524,
925934,
524605,
537751,
1158742,
848778,
239685,
786448,
338862,
760363,
547965,
850949,
311906,
1053928,
912116,
213843,
412378,
389976,
1044739
]
} |
A 55-year-old man comes to the physician because of fatigue and worsening abdominal pain for 4 weeks. He also reports excessive night sweats and a 5.4-kg (12-lb) weight loss during this time. He has a neck swelling for 4 days. Physical examination shows a nontender, enlarged, and fixed supraclavicular lymph node. There is splenomegaly. A CT scan of the thorax and abdomen shows massively enlarged axillary, mediastinal, and cervical lymph nodes. Analysis of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis? | Diffuse large B-cell lymphoma | {
"A": "Adult T-cell lymphoma",
"B": "Burkitt lymphoma",
"C": "Diffuse large B-cell lymphoma",
"D": "Hodgkin lymphoma"
} | step1 | C | [
"55 year old man",
"physician",
"fatigue",
"worsening abdominal",
"weeks",
"reports excessive night sweats",
"5.4 kg",
"weight loss",
"time",
"neck swelling",
"4 days",
"Physical examination shows",
"nontender",
"enlarged",
"fixed supraclavicular",
"splenomegaly",
"CT scan",
"thorax",
"abdomen shows massively enlarged axillary",
"mediastinal",
"cervical lymph nodes",
"Analysis",
"shows lymphocytes",
"high proliferative index",
"stain positive",
"CD20",
"following",
"most likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 55-year-old man comes to the physician because of fatigue and worsening abdominal pain for 4 weeks. He also reports excessive night sweats and a 5.4-kg (12-lb) weight loss during this time. He has a neck swelling for 4 days. Physical examination shows a nontender, enlarged, and fixed supraclavicular lymph node. There is splenomegaly. A CT scan of the thorax and abdomen shows massively enlarged axillary, mediastinal, and cervical lymph nodes. Analysis of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Adult T-cell lymphoma
B. Burkitt lymphoma
C. Diffuse large B-cell lymphoma
D. Hodgkin lymphoma | [
0.04816294088959694,
-0.0350109301507473,
0.020703988149762154,
0.025438953191041946,
-0.007270019501447678,
-0.004562512505799532,
-0.01750478520989418,
0.037754956632852554,
0.011232144199311733,
0.02203880250453949,
0.020721642300486565,
0.023826606571674347,
-0.022986633703112602,
-0.04447450861334801,
-0.024579910561442375,
0.03907746449112892,
-0.06147436052560806,
0.02153283916413784,
-0.01806657761335373,
0.0011329205008223653,
-0.04110162332653999,
0.03736009821295738,
0.030505098402500153,
-0.019812725484371185,
-0.0010980907827615738,
-0.005873550195246935,
0.04269849509000778,
-0.02372746542096138,
-0.008242098614573479,
-0.036748506128787994,
-0.020316576585173607,
-0.044118840247392654,
-0.03648000955581665,
-0.04762190580368042,
0.0000018701746284932597,
-0.017052780836820602,
0.06389980018138885,
-0.043151360005140305,
0.03844767436385155,
0.0035471783485263586,
0.047235507518053055,
0.031046487390995026,
0.03517001494765282,
0.003635652828961611,
-0.003884916426613927,
-0.10198855400085449,
-0.027358252555131912,
0.04085191711783409,
-0.05823518708348274,
0.00405746279284358,
0.02581518515944481,
0.009958047419786453,
0.014545118436217308,
-0.0012311667669564486,
0.049109578132629395,
-0.04846375808119774,
0.009979313239455223,
0.022207504138350487,
0.012107066810131073,
-0.036035116761922836,
0.04403817281126976,
0.002968203043565154,
0.008707216009497643,
-0.037459563463926315,
-0.026204660534858704,
0.008063576184213161,
0.039368487894535065,
-0.030696166679263115,
0.036418601870536804,
0.006695860996842384,
0.028827833011746407,
-0.01757071726024151,
0.09467559307813644,
0.03255491703748703,
0.007951329462230206,
-0.03344612941145897,
0.042993027716875076,
-0.029856804758310318,
-0.005840558558702469,
-0.02927730605006218,
0.06158657744526863,
0.02863871492445469,
0.008061054162681103,
0.043459244072437286,
-0.01818000338971615,
-0.033253323286771774,
-0.028552919626235962,
-0.02919219806790352,
-0.005208795890212059,
-0.009126146323978901,
-0.014682887122035027,
-0.054859135299921036,
0.047405920922756195,
0.05148820951581001,
-0.04977992922067642,
0.0317838191986084,
0.0270039364695549,
-0.017314475029706955,
0.026097552850842476,
-0.04965534806251526,
-0.04099315404891968,
-0.04428791254758835,
0.007624519057571888,
0.04010303318500519,
-0.05905146896839142,
-0.03939267620444298,
-0.0056656901724636555,
0.014573036693036556,
-0.027377959340810776,
0.015237118117511272,
0.04052630439400673,
0.023985842242836952,
-0.04529091715812683,
-0.012372232973575592,
0.10496606677770615,
-0.025259943678975105,
-0.05502646043896675,
0.008490868844091892,
0.001628149882890284,
0.048603132367134094,
-0.005841394420713186,
-0.000135260313982144,
0.01797952689230442,
0.038691528141498566,
0.02136070281267166,
0.012074988335371017,
0.06290757656097412,
-0.01317080482840538,
0.009220562875270844,
-0.0014496147632598877,
0.025218188762664795,
-0.015922578051686287,
0.0362061969935894,
-0.018172230571508408,
0.013111034408211708,
-0.030705535784363747,
-0.010031545534729958,
0.018872523680329323,
0.04916070029139519,
0.020376473665237427,
-0.05161619931459427,
-0.010531339794397354,
-0.037962656468153,
-0.023877764120697975,
-0.014840207062661648,
0.02184969000518322,
-0.023204034194350243,
0.042608946561813354,
-0.0036255272570997477,
0.03460829332470894,
-0.04840204492211342,
-0.056642379611730576,
-0.0011353523004800081,
-0.009408218786120415,
0.019463079050183296,
0.027621066197752953,
0.04744942486286163,
-0.009410707280039787,
-0.013631031848490238,
-0.01433952059596777,
0.0023415081668645144,
-0.00614382466301322,
-0.014538710005581379,
-0.002051832154393196,
-0.0053452239371836185,
0.03845812752842903,
-0.006196538917720318,
0.020330730825662613,
-0.037744246423244476,
0.04632176086306572,
-0.03804819658398628,
0.009042512625455856,
0.018818257376551628,
-0.010271601378917694,
0.00025888459640555084,
0.0037727749440819025,
-0.04759284853935242,
-0.09849364310503006,
-0.03091556206345558,
-0.012327517382800579,
-0.012715100310742855,
0.01719731092453003,
0.03029746748507023,
-0.03575287386775017,
-0.016456978395581245,
0.010606669820845127,
0.0010717689292505383,
-0.04642467945814133,
0.009498050436377525,
-0.048365164548158646,
-0.018974382430315018,
0.00957960169762373,
-0.013043670915067196,
0.04433851316571236,
-0.03391032665967941,
0.00815736036747694,
-0.06031518056988716,
-0.057338595390319824,
0.0014870248269289732,
0.02125002257525921,
0.003456242149695754,
-0.04358212277293205,
-0.014603570103645325,
0.0347445122897625,
-0.018701428547501564,
0.06360024958848953,
-0.05569872260093689,
0.03097846731543541,
-0.02438194304704666,
-0.015026206150650978,
-0.017732298001646996,
0.004096207208931446,
0.020319268107414246,
-0.022186191752552986,
0.019169650971889496,
0.04830985516309738,
-0.008254612796008587,
-0.03214334696531296,
-0.060406722128391266,
0.035388555377721786,
-0.05042029544711113,
-0.025650817900896072,
-0.02466426230967045,
0.006904974114149809,
0.0067507303319871426,
-0.028294121846556664,
0.03428884968161583,
0.011595438234508038,
0.0339495874941349,
-0.07001330703496933,
0.021947968751192093,
0.0385470911860466,
-0.04200083762407303,
0.034964095801115036,
-0.10011108964681625,
0.04967619851231575,
-0.046762678772211075,
-0.06159667298197746,
0.027569279074668884,
0.013574151322245598,
-0.06501558423042297,
-0.049949198961257935,
-0.018748687580227852,
0.010799234732985497,
0.01222639624029398,
-0.006027931813150644,
-0.08452623337507248,
0.046159807592630386,
-0.01956087537109852,
0.05022465065121651,
-0.09173562377691269,
0.022129299119114876,
0.024181019514799118,
-0.02547639235854149,
-0.009030435234308243,
0.034229159355163574,
-0.009836172685027122,
0.01742265559732914,
-0.06963811069726944,
-0.029468165710568428,
-0.018380096182227135,
-0.036813121289014816,
-0.001662579015828669,
0.01127304695546627,
-0.03941546753048897,
0.012807830236852169,
-0.006223241798579693,
-0.014314034022390842,
0.0018219428602606058,
0.013146149925887585,
-0.0055146231316030025,
0.07836205512285233,
0.010791760869324207,
-0.016510507091879845,
-0.032193560153245926,
-0.05563456565141678,
0.010468760505318642,
0.08507286757230759,
0.029809214174747467,
-0.01351124793291092,
0.003996999002993107,
0.05632944405078888,
0.0010113413445651531,
0.020281752571463585,
-0.00773116759955883,
-0.03685957193374634,
-0.009606999345123768,
-0.021252257749438286,
0.047409214079380035,
0.027388693764805794,
-0.014292138628661633,
0.030140994116663933,
0.02484722062945366,
-0.045559436082839966,
-0.03627633675932884,
-0.027494966983795166,
-0.07229180634021759,
0.054574154317379,
0.004505462013185024,
0.03061630204319954,
0.03296953812241554,
0.02713540755212307,
-0.019954945892095566,
0.022490093484520912,
0.009240238927304745,
0.04097875580191612,
0.03417087346315384,
0.00082092743832618,
-0.004080523271113634,
0.04811541363596916,
0.07427194714546204,
0.03233076632022858,
-0.008132818154990673,
-0.03932589665055275,
-0.008114558644592762,
-0.06941009312868118,
-0.0017069020541384816,
-0.015111368149518967,
0.04257436469197273,
-0.008812965825200081,
-0.023404745385050774,
0.01970037631690502,
0.01695619337260723,
-0.0004371080140117556,
0.0016962828813120723,
-0.0377027653157711,
0.02714467979967594,
0.04516660049557686,
-0.03089589811861515,
0.0015467179473489523,
0.03075249306857586,
-0.06839578598737717,
0.004542027600109577,
0.004378051962703466,
0.044571783393621445,
0.054437194019556046,
-0.021503662690520287,
0.03938216343522072,
-0.021377557888627052,
0.010775811038911343,
0.029669281095266342,
-0.014701979234814644,
0.025710124522447586,
0.008088120259344578,
0.014368643052875996,
-0.015583881177008152,
-0.0669969767332077,
0.0028703920543193817,
-0.036958809942007065,
-0.01017555221915245,
-0.07280666381120682,
0.05031935125589371,
0.011486342176795006,
0.00525949290022254,
-0.024648630991578102,
-0.005345184355974197,
0.06091204285621643,
0.06842727214097977,
-0.026283010840415955,
0.012923456728458405,
-0.021279452368617058,
0.00004627096132026054,
-0.06619279831647873,
0.051773298531770706,
0.01426036935299635,
-0.027723325416445732,
0.01627899706363678,
-0.052738580852746964,
-0.011671374551951885,
-0.0023362371139228344,
0.026324454694986343,
-0.07852691411972046,
-0.003779660677537322,
0.06304370611906052,
-0.046904902905225754,
0.017111383378505707,
-0.00501614436507225,
-0.03216308355331421,
-0.06016291677951813,
-0.023404086008667946,
0.06277389079332352,
-0.0024477450642734766,
0.008146081119775772,
-0.0274218637496233,
-0.090560682117939,
0.014267713762819767,
0.010299296118319035,
-0.013637292198836803,
0.0779552310705185,
0.012256268411874771,
0.01182117685675621,
-0.0004236407403368503,
0.01853831112384796,
-0.019538534805178642,
-0.02079853042960167,
0.01699247397482395,
-0.0660320445895195,
-0.014933827333152294,
0.06759507954120636,
0.06625793874263763,
0.007871966809034348,
-0.013624121434986591,
0.002520343754440546,
0.059914980083703995,
0.05813106521964073,
-0.06965350359678268,
-0.019021999090909958,
-0.0017734018620103598,
-0.009922686032950878,
0.007191705983132124,
-0.0023323234636336565,
-0.05261620879173279,
0.016734687611460686,
0.0030112415552139282,
0.01723029464483261,
-0.03895930200815201,
-0.010034016333520412,
-0.04150204360485077,
-0.016360407695174217,
-0.0034888910595327616,
0.08736816793680191,
0.03908617049455643,
0.006657779682427645,
-0.01260694395750761,
-0.0221798587590456,
0.0601452961564064,
0.06435584276914597,
0.0013918939512223005,
0.0028613239992409945,
0.021092113107442856,
0.029574362561106682,
-0.024785565212368965,
0.04375794902443886,
0.04571403190493584,
0.014311335049569607,
0.04906759783625603,
0.012004032731056213,
-0.01747710630297661,
-0.006980905309319496,
-0.017800839617848396,
-0.055456385016441345,
-0.0049793533980846405,
0.03659910336136818,
0.03629821166396141,
0.059476107358932495,
-0.09503181278705597,
0.015184666961431503,
-0.030264850705862045,
-0.014525456354022026,
0.059754543006420135,
0.0499308779835701,
0.016451098024845123,
0.04082018509507179,
0.027126578614115715,
-0.0013738624984398484,
0.0515279546380043,
0.04670308902859688,
0.0031892466358840466,
0.011916079558432102,
-0.04061915725469589,
-0.06918507814407349,
0.0011990484781563282,
0.00014942300913389772,
-0.08397092670202255,
0.009117385372519493,
0.005333346780389547,
-0.01875540055334568,
0.018422815948724747,
0.01018623635172844,
-0.0024531129747629166,
-0.019944000989198685,
0.05652567371726036,
0.01651277206838131,
-0.04118632897734642,
0.006470404099673033,
-0.02037309855222702,
-0.0322454608976841,
-0.11653105169534683,
-0.0754578486084938,
0.02992422506213188,
0.02568909153342247,
-0.03202040493488312,
-0.027847617864608765,
-0.04163379594683647,
-0.0030856181401759386,
-0.000034780841815518215,
0.06471224129199982,
-0.028085770085453987,
-0.013383105397224426,
-0.03358595818281174,
-0.02727019600570202,
0.03963741287589073,
-0.02986733242869377,
0.004153834655880928,
-0.0350298136472702,
0.05177712067961693,
-0.009167899377644062,
0.03162350133061409,
0.04841543734073639,
-0.0016303021693602204,
0.05540844053030014,
0.011556128971278667,
-0.007601962890475988,
-0.043882764875888824,
0.024510420858860016,
-0.0051687913946807384,
0.04299941286444664,
0.025336269289255142,
0.005247797351330519,
-0.05169176682829857,
0.014587292447686195,
-0.0005548344342969358,
-0.007641148753464222,
0.07828427106142044,
0.06239233911037445,
-0.050938282161951065,
-0.01707998476922512,
0.01672692969441414,
0.0059449328109622,
-0.0042320741340518,
0.016264259815216064,
-0.04501202329993248,
0.014780910685658455,
-0.0406721755862236,
0.004895264282822609,
0.058235157281160355,
0.01725718192756176,
0.0019278314430266619,
-0.029165511950850487,
-0.029285665601491928,
-0.007629304192960262,
-0.03728189691901207,
-0.004244281444698572,
-0.003228174289688468,
-0.027856433764100075,
-0.015209373086690903,
0.02305225096642971,
0.04617917165160179,
0.011736062355339527,
-0.022387772798538208,
-0.02672739513218403,
0.0024665019009262323,
0.0001237370743183419,
-0.026487763971090317,
0.011253845877945423,
0.011812702752649784,
-0.015375242568552494,
0.00572674535214901,
0.056902673095464706,
0.015152327716350555,
-0.039245445281267166,
0.04500455781817436,
0.03959888592362404,
0.0061099715530872345,
0.03303052857518196,
-5.499032735465726e-33,
0.03773323819041252,
-0.030132485553622246,
0.03530281409621239,
-0.02811405062675476,
0.014463876374065876,
0.07448506355285645,
-0.03282447159290314,
-0.04265075922012329,
-0.039070334285497665,
-0.0003403326845727861,
-0.009842980653047562,
-0.04441206529736519,
0.019203118979930878,
0.0391935259103775,
-0.05414914712309837,
0.01241825520992279,
0.022303849458694458,
-0.004919034894555807,
-0.018834592774510384,
0.006859824527055025,
0.0065021212212741375,
-0.0007878889446146786,
0.013885896652936935,
-0.0665014460682869,
-0.013906087726354599,
0.028162842616438866,
0.0893588662147522,
0.015528513118624687,
0.004005109891295433,
0.011388913728296757,
-0.014173975214362144,
-0.01852637156844139,
0.032242897897958755,
0.012471748515963554,
0.0054725888185203075,
-0.08743088692426682,
-0.028852429240942,
-0.02870970033109188,
0.03803059458732605,
0.06598997116088867,
-0.02821819670498371,
-0.01451353169977665,
0.03423284366726875,
-0.014156520366668701,
0.045420922338962555,
-0.030345136299729347,
-0.025584835559129715,
-0.020838996395468712,
-0.08035862445831299,
-0.05211221054196358,
0.02837858535349369,
0.02804156020283699,
0.014883873052895069,
-0.02123137190937996,
-0.03196311369538307,
-0.10501428693532944,
-0.022705789655447006,
0.06802374869585037,
0.006446527782827616,
-0.012742913328111172,
-0.0038920084480196238,
0.03434241563081741,
0.07539071887731552,
-0.001981728244572878,
-0.03301839157938957,
-0.0040860166773200035,
0.04614093899726868,
-0.043164271861314774,
-0.07306716591119766,
0.019371120259165764,
-0.05624179542064667,
0.02452857233583927,
-0.05538430064916611,
-0.038946960121393204,
0.017774904146790504,
-0.023126574233174324,
0.03592527657747269,
0.002940352074801922,
0.08529762923717499,
0.021927393972873688,
-0.019142448902130127,
0.03251074254512787,
0.011830544099211693,
-0.010347124189138412,
-0.04955544322729111,
-0.05477988347411156,
0.016272002831101418,
-0.03362641856074333,
0.00874303188174963,
-0.006995850708335638,
0.05769845470786095,
0.002663935534656048,
-0.0062075089663267136,
0.007452497258782387,
-0.050571855157613754,
0.004997659008949995,
0.024776050820946693,
0.0007248647161759436,
0.003144322196021676,
0.018974626436829567,
0.050778843462467194,
0.05580832436680794,
0.019946707412600517,
-0.02817428484559059,
-0.06009593605995178,
0.013015583157539368,
-0.02177775837481022,
-0.0005365829565562308,
-0.0034046524669975042,
0.024047542363405228,
-0.006276165135204792,
0.0027981800958514214,
0.0026748133823275566,
-0.004306710325181484,
0.01687821000814438,
-0.010985935106873512,
-0.0071334149688482285,
0.015893127769231796,
0.035671718418598175,
0.009883207269012928,
0.05221400037407875,
-0.018041204661130905,
-0.03676621988415718,
0.006921935360878706,
-0.05112545192241669,
-0.017689280211925507,
0.028446616604924202,
0.05212056636810303,
-0.0058415536768734455,
-0.04165451228618622,
0.06659538298845291,
0.018222808837890625,
2.6975811806551064e-7,
0.015594703145325184,
-0.024793284013867378,
-0.039317820221185684,
-0.10015818476676941,
0.06655742228031158,
-0.0015887760091573,
-0.018771560862660408,
0.0043373387306928635,
-0.017135556787252426,
0.038807954639196396,
0.029587382450699806,
0.007891734130680561,
-0.002459086710587144,
-0.014596403576433659,
0.009839065372943878,
-0.032954614609479904,
0.005349224433302879,
0.05654574930667877,
0.03879568725824356,
0.027130914852023125,
-0.012970966286957264,
0.007604053709656,
-0.05521989241242409,
-0.04684821143746376,
0.0546792596578598,
-0.027046751230955124,
-0.03172134980559349,
-0.0427401028573513,
-0.050644584000110626,
-0.04142095148563385,
0.04798022657632828,
-0.02882939763367176,
0.0812835842370987,
0.07986585795879364,
-0.040604833513498306,
-0.022231006994843483,
0.011102861724793911,
0.07040819525718689,
0.023858873173594475,
0.026470711454749107,
0.026611482724547386,
-0.05971768498420715,
0.02528783120214939,
0.03360888361930847,
0.00812031514942646,
0.01006853673607111,
-0.0509825237095356,
0.03211569786071777,
0.0004964523832313716,
-0.00008015309140319005,
-0.04976668953895569,
0.04416739195585251,
-0.03860818222165108,
0.0714528039097786,
-0.01683107204735279,
0.0280985739082098,
-0.09541404247283936,
0.023328246548771858,
0.018868347629904747,
-0.04253607615828514,
-0.0023349523544311523,
-0.03016437031328678,
0.01626490242779255,
0.04353903979063034,
0.012149267829954624,
0.03402802348136902,
-0.059239037334918976,
1.800832090698301e-34,
-0.029340824112296104,
-0.018245797604322433,
-0.011554419063031673,
-0.027480928227305412,
-0.06210887059569359,
-0.053246572613716125,
0.06350146979093552,
0.07403213530778885,
0.032314807176589966,
-0.05924045294523239,
-0.05528278276324272
] | {
"ds_index": 57,
"similar_dg_indices": [
114305,
578142,
1084936,
692008,
657878,
325762,
380679,
752255,
243594,
517549,
755115,
933404,
1100705,
577034,
241601,
385078,
809480,
269639,
449161,
480015
]
} |
A 26-year-old G1P0 woman at 32-weeks gestation presents for follow-up ultrasound. She was diagnosed with gestational diabetes during her second trimester, but admits to poor glucose control and non-adherence to insulin therapy. Fetal ultrasound reveals an asymmetric, enlarged interventricular septum, left ventricular outflow tract obstruction, and significantly reduced ejection fraction. Which of the following is the most appropriate step in management after delivery? | Medical management | {
"A": "Emergent open fetal surgery",
"B": "Cardiac magnetic resonance imaging",
"C": "Cardiac catheterization",
"D": "Medical management"
} | step2&3 | D | [
"year old",
"woman",
"weeks presents",
"follow-up ultrasound",
"diagnosed",
"gestational diabetes",
"second trimester",
"admits",
"poor glucose control",
"non",
"insulin therapy",
"Fetal reveals",
"asymmetric",
"enlarged interventricular septum",
"left ventricular outflow tract obstruction",
"reduced ejection fraction",
"following",
"most appropriate step",
"management",
"delivery"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 26-year-old G1P0 woman at 32-weeks gestation presents for follow-up ultrasound. She was diagnosed with gestational diabetes during her second trimester, but admits to poor glucose control and non-adherence to insulin therapy. Fetal ultrasound reveals an asymmetric, enlarged interventricular septum, left ventricular outflow tract obstruction, and significantly reduced ejection fraction. Which of the following is the most appropriate step in management after delivery?
Choose one of the following::
A. Emergent open fetal surgery
B. Cardiac magnetic resonance imaging
C. Cardiac catheterization
D. Medical management | [
0.013410193845629692,
-0.009946376085281372,
-0.013773585669696331,
-0.026462510228157043,
0.017730675637722015,
0.030589928850531578,
-0.05280878394842148,
-0.002695912029594183,
-0.04292226955294609,
0.017713496461510658,
0.044559817761182785,
-0.06219311058521271,
0.015502716414630413,
0.04907377436757088,
-0.0019704082515090704,
-0.045668475329875946,
-0.025406615808606148,
-0.02736828103661537,
-0.07485662400722504,
-0.018694650381803513,
-0.02717028371989727,
0.05373244360089302,
0.0017189241480082273,
-0.026588814333081245,
0.031156904995441437,
-0.0391298346221447,
-0.010966955684125423,
-0.010391592048108578,
-0.023139972239732742,
-0.05221472308039665,
0.035923946648836136,
0.018964583054184914,
0.004471114370971918,
-0.04638040065765381,
0.0000018588556258691824,
-0.0072842249646782875,
0.002131644869223237,
0.02407032623887062,
-0.01320288609713316,
-0.036621786653995514,
-0.021694712340831757,
-0.09528481960296631,
0.003009605221450329,
0.025217970833182335,
-0.03425705432891846,
-0.02222168631851673,
0.04636216163635254,
0.07816585898399353,
0.013202966190874577,
-0.057599179446697235,
0.042717963457107544,
-0.030005130916833878,
-0.001740919309668243,
0.004679610952734947,
0.015680905431509018,
-0.05076868459582329,
-0.010443037375807762,
-0.03138386085629463,
-0.007937537506222725,
0.058848802000284195,
0.01287568174302578,
0.01990470290184021,
0.025189394131302834,
0.0287440437823534,
0.007383679039776325,
-0.03648750111460686,
0.09547832608222961,
-0.10594397038221359,
-0.032383088022470474,
0.007188604678958654,
0.076364666223526,
-0.010819449089467525,
-0.005513770505785942,
0.02848592773079872,
-0.013091952539980412,
-0.025697464123368263,
0.006779423449188471,
-0.04467953369021416,
-0.0013005337677896023,
0.015098785050213337,
0.033177003264427185,
-0.010360135696828365,
-0.04115419462323189,
0.035729892551898956,
0.02395758032798767,
-0.08609206974506378,
0.026981573551893234,
-0.009512136690318584,
0.003622538410127163,
0.06224234402179718,
-0.0481494665145874,
-0.039723534137010574,
-0.0067476266995072365,
0.004156334325671196,
0.009353059343993664,
0.042966328561306,
0.020916637033224106,
0.04253469780087471,
-0.013671701774001122,
-0.006763353943824768,
-0.02492259256541729,
0.0149176474660635,
0.08335372805595398,
-0.018522068858146667,
0.03431742638349533,
0.020491672679781914,
-0.01353548839688301,
-0.005042575299739838,
-0.00730531569570303,
0.03421766310930252,
0.006038240622729063,
-0.011927858926355839,
0.0038448998238891363,
0.020924927666783333,
0.03867142274975777,
-0.009651468135416508,
0.030675390735268593,
-0.0496378056704998,
-0.03882436081767082,
0.021765416488051414,
0.014870187267661095,
0.06118578091263771,
0.05038529634475708,
0.0035898624919354916,
-0.003644197713583708,
-0.0029908616561442614,
0.01875077374279499,
-0.016419844701886177,
-0.020744144916534424,
0.04864483326673508,
0.014121816493570805,
0.02810228243470192,
-0.015726717188954353,
0.06331971287727356,
0.049775876104831696,
-0.010180827230215073,
0.014572297222912312,
-0.010644562542438507,
-0.017909610643982887,
0.009932703338563442,
0.012663498520851135,
-0.05260129272937775,
-0.019976278766989708,
0.0366906076669693,
-0.0035420411732047796,
0.012752722948789597,
-0.04752054810523987,
0.00790543481707573,
0.009617009200155735,
0.0509907491505146,
0.0037737556267529726,
-0.016038935631513596,
-0.029731551185250282,
0.003253905801102519,
-0.01820237562060356,
0.03131292387843132,
-0.010759033262729645,
0.038537368178367615,
0.0049408553168177605,
-0.06221187859773636,
-0.009049983695149422,
-0.012528213672339916,
-0.039297547191381454,
0.01359512098133564,
0.027560899034142494,
-0.05572587996721268,
0.0384022481739521,
0.04075232520699501,
-0.05882929265499115,
0.003936639055609703,
0.00418033916503191,
-0.0013815595302730799,
0.04846892133355141,
0.033991847187280655,
-0.004999099299311638,
0.014934374950826168,
-0.05267803370952606,
-0.09383976459503174,
0.011717908084392548,
-0.088783398270607,
-0.036159686744213104,
0.011694761924445629,
0.024393994361162186,
-0.036471180617809296,
0.04554802551865578,
-0.009800342842936516,
-0.0659669041633606,
0.02635086514055729,
-0.03702380508184433,
-0.04358280450105667,
-0.03778514266014099,
-0.004088168032467365,
0.020879339426755905,
-0.0019814856350421906,
0.00616045854985714,
0.05950099974870682,
-0.035378433763980865,
0.05753382667899132,
0.00007608419400639832,
0.09730079025030136,
-0.03989071771502495,
-0.033811621367931366,
-0.03237520158290863,
0.006051818840205669,
-0.01169632188975811,
-0.00925352144986391,
-0.03544789180159569,
0.01597682386636734,
-0.018611134961247444,
-0.0006299664964899421,
-0.021144626662135124,
0.0019399035954847932,
-0.009118733927607536,
-0.03759697079658508,
0.047375570982694626,
0.041336365044116974,
0.00945946667343378,
0.04312676563858986,
-0.0026507903821766376,
-0.008584928698837757,
-0.014637663960456848,
0.010177826508879662,
0.04005198925733566,
0.010649872943758965,
0.017338307574391365,
-0.02649855986237526,
0.015007219277322292,
0.01738491654396057,
0.027743399143218994,
-0.020513786002993584,
0.03982788324356079,
-0.022525154054164886,
0.015827002003788948,
0.08709683269262314,
-0.007052059751003981,
0.014628143049776554,
0.013034915551543236,
-0.05840333551168442,
0.01579289883375168,
0.02254723384976387,
-0.08730414509773254,
-0.05452973395586014,
-0.05711618438363075,
-0.009513404220342636,
0.0006995114963501692,
-0.04074648395180702,
0.01886056922376156,
0.006652839481830597,
-0.011897123418748379,
0.008663825690746307,
-0.02986047975718975,
-0.03261743113398552,
-0.03691434860229492,
0.027014678344130516,
0.026628797873854637,
0.015683742240071297,
-0.01919293776154518,
0.007538792677223682,
0.06517574191093445,
-0.013640567660331726,
0.013533989898860455,
-0.0510404072701931,
-0.0030143852345645428,
-0.027843009680509567,
0.02225300669670105,
-0.060995008796453476,
0.018660832196474075,
0.016810325905680656,
0.011463142931461334,
0.03390594571828842,
0.04577965289354324,
-0.023788809776306152,
0.00019429638632573187,
0.03473120182752609,
-0.018894420936703682,
0.02298462577164173,
-0.011158919893205166,
0.05967450141906738,
0.03112586960196495,
0.0040589491836726665,
0.023003574460744858,
0.11304096132516861,
0.060703177005052567,
0.041440170258283615,
0.04114910587668419,
-0.014533797279000282,
-0.0050477986223995686,
0.07314258068799973,
0.05167531967163086,
-0.047611165791749954,
0.003440047614276409,
0.01209261454641819,
0.03221751004457474,
-0.013126613572239876,
-0.003922327887266874,
0.01584337279200554,
-0.056973736733198166,
0.042301010340452194,
-0.03632083162665367,
0.05526840686798096,
-0.07251416146755219,
0.033000677824020386,
0.02384359762072563,
0.009387588128447533,
-0.0009010162320919335,
0.022573372349143028,
0.07145405560731888,
0.09154300391674042,
-0.017851512879133224,
0.05599711835384369,
0.005970285274088383,
-0.04721294716000557,
0.0049177310429513454,
-0.014810629189014435,
-0.003194664139300585,
-0.040300849825143814,
-0.046798571944236755,
-0.07877064496278763,
-0.018122386187314987,
0.026547081768512726,
0.0496722087264061,
0.015442600473761559,
-0.01973535493016243,
-0.017153063789010048,
-0.032773856073617935,
-0.028751332312822342,
-0.03049611486494541,
-0.034519538283348083,
-0.025630628690123558,
-0.044893477112054825,
0.011878175660967827,
-0.016505425795912743,
-0.03004951775074005,
-0.023823214694857597,
0.013178408145904541,
-0.035440295934677124,
-0.01745503768324852,
0.034142524003982544,
-0.06616216152906418,
0.041391145437955856,
0.017976781353354454,
-0.08343446999788284,
0.0069480109959840775,
0.03222821280360222,
0.0473351813852787,
-0.037191614508628845,
-0.020464496687054634,
0.024424470961093903,
-0.0038504116237163544,
0.04046652466058731,
-0.08483393490314484,
-0.03531867638230324,
0.024075668305158615,
-0.04131679981946945,
-0.02647811360657215,
-0.02197090908885002,
-0.03464169800281525,
0.03750154748558998,
-0.025333181023597717,
-0.03704351559281349,
-0.01778077520430088,
0.006866720970720053,
-0.04520275071263313,
-0.006854197941720486,
0.04597849026322365,
-0.016661152243614197,
0.04413092881441116,
-0.011603129096329212,
-0.02402579039335251,
0.017206436023116112,
0.01606103591620922,
0.038018736988306046,
0.024556243792176247,
0.048102207481861115,
0.010937151499092579,
0.008271531201899052,
-0.014004159718751907,
-0.025956029072403908,
-0.03293594717979431,
0.0016455147415399551,
0.01517510786652565,
-0.06864827871322632,
0.03778278827667236,
0.06140420585870743,
-0.041105400770902634,
0.005993701983243227,
0.0010476356837898493,
-0.04322769120335579,
0.00009101197792915627,
0.03951194882392883,
0.01515843067318201,
0.01974734105169773,
-0.02387423813343048,
-0.0511755608022213,
0.01083351206034422,
-0.0010336927371099591,
-0.02623407356441021,
-0.10421904176473618,
-0.028312470763921738,
0.045861728489398956,
-0.007861397229135036,
-0.03366890177130699,
0.012313980609178543,
0.028334295377135277,
-0.0004905764362774789,
-0.01212103571742773,
-0.006940052378922701,
-0.02338903211057186,
0.03338352218270302,
0.10437996685504913,
-0.005666372831910849,
-0.05336380377411842,
-0.011749670840799809,
-0.013121897354722023,
0.04573312774300575,
-0.016876157373189926,
0.037261713296175,
-0.003798874095082283,
-0.00011759682092815638,
-0.05176442861557007,
0.012805329635739326,
0.0056555382907390594,
-0.041758570820093155,
-0.032417505979537964,
-0.022154655307531357,
-0.01771174930036068,
0.058470819145441055,
0.031360890716314316,
0.0010892461286857724,
-0.010240940377116203,
0.02066166326403618,
0.012678409926593304,
-0.02080926112830639,
0.0833718553185463,
0.023818491026759148,
0.09591592848300934,
-0.00022814566909801215,
-0.034001268446445465,
0.0033691299613565207,
0.041065629571676254,
-0.026458164677023888,
0.008848626166582108,
0.06797274947166443,
0.02283874899148941,
-0.0006435791729018092,
0.08688456565141678,
0.006681871600449085,
0.012124036438763142,
-0.018666179850697517,
0.08197938650846481,
0.009192356839776039,
-0.025981102138757706,
-0.02666710875928402,
-0.024790562689304352,
0.014482037164270878,
-0.055069129914045334,
0.03016854077577591,
0.06047026813030243,
0.022341838106513023,
-0.09164988249540329,
-0.0005161475273780525,
0.010401789098978043,
0.005027886480093002,
-0.07543639838695526,
0.07863546907901764,
-0.023312876001000404,
-0.012195582501590252,
0.04866597428917885,
0.030234582722187042,
0.006977214012295008,
0.001190228620544076,
0.017600081861019135,
0.007537154480814934,
0.03608725965023041,
0.006374833639711142,
-0.00028349694912321866,
-0.042334798723459244,
0.05407781898975372,
0.003506595501676202,
-0.0248229019343853,
0.01967059075832367,
0.02413678541779518,
-0.08324598520994186,
-0.032844386994838715,
-0.010773653164505959,
-0.0007482911460101604,
-0.0077780927531421185,
-0.0067742434330284595,
-0.02946915291249752,
0.05571708083152771,
-0.0052025397308170795,
-0.012607555836439133,
-0.021809402853250504,
-0.04318103939294815,
-0.052489351481199265,
-0.081522136926651,
-0.043530333787202835,
0.05920607969164848,
-0.01672990620136261,
-0.008127281442284584,
-0.028917765244841576,
0.046910274773836136,
0.04146497696638107,
-0.041127003729343414,
0.0449676439166069,
-0.01633331924676895,
0.0005126495962031186,
-0.0013678122777491808,
-0.00591556029394269,
-0.007950380444526672,
-0.012509298510849476,
0.051974646747112274,
0.045362688601017,
-0.005818190984427929,
-0.0017132647335529327,
0.010637275874614716,
-0.032062675803899765,
0.018432745710015297,
-0.03735551983118057,
0.039815206080675125,
-0.0010710560018196702,
0.07331907004117966,
-0.04580388590693474,
-0.03254649043083191,
0.014462435618042946,
0.029982399195432663,
0.018057819455862045,
0.036815669387578964,
-0.01747925765812397,
0.02861824817955494,
-0.05161094665527344,
0.02565724216401577,
-0.04269056022167206,
-0.0066919391974806786,
-0.02136140502989292,
-0.027762288227677345,
0.043945059180259705,
-0.015332280658185482,
0.0613504983484745,
0.017126500606536865,
0.02302861586213112,
-0.022049471735954285,
-0.00962171982973814,
-0.005199451930820942,
-0.049926288425922394,
0.028203722089529037,
0.026795092970132828,
0.007367976941168308,
0.027316302061080933,
-0.005917159840464592,
0.006230839528143406,
-0.06356514990329742,
-0.00913151539862156,
0.0030313730239868164,
0.044682372361421585,
-5.341638449994437e-33,
-0.050782449543476105,
0.007126186974346638,
0.04053077474236488,
-0.011571714654564857,
0.014227895997464657,
0.07171012461185455,
0.032465215772390366,
0.009097299538552761,
-0.027928685769438744,
0.024469543248414993,
-0.022358784452080727,
-0.03110295534133911,
0.016965782269835472,
0.058313000947237015,
-0.03342639282345772,
-0.02246924489736557,
0.011195722036063671,
0.020650820806622505,
0.025720752775669098,
0.024420564994215965,
-0.035517968237400055,
0.006098107434809208,
-0.014142896048724651,
-0.006302982568740845,
-0.0330326110124588,
0.028141824528574944,
-0.008191259577870369,
0.067031130194664,
0.03751832991838455,
0.008790172636508942,
0.007199372164905071,
-0.011364382691681385,
-0.020874587818980217,
-0.03574143722653389,
-0.014607379212975502,
0.014376608654856682,
0.022422200068831444,
-0.03476714342832565,
0.02089732699096203,
-0.009374555200338364,
-0.010274982079863548,
-0.027013270184397697,
0.03995325788855553,
0.036055516451597214,
-0.03673853725194931,
-0.044620949774980545,
-0.019061880186200142,
-0.027206869795918465,
0.014777058735489845,
-0.0260473545640707,
-0.05645464360713959,
0.013465181924402714,
-0.018895097076892853,
-0.01767894998192787,
-0.03607502952218056,
-0.029775496572256088,
-0.02445255219936371,
-0.006807398051023483,
0.012679385021328926,
-0.014326706528663635,
0.03192579373717308,
-0.03038068674504757,
-0.030141223222017288,
-0.032142482697963715,
-0.0034212495665997267,
-0.014739224687218666,
0.03206151723861694,
0.025362716987729073,
-0.06020364537835121,
0.005816117860376835,
-0.0854574516415596,
0.007844231091439724,
0.008651819080114365,
-0.07573768496513367,
0.020508207380771637,
-0.044050946831703186,
-0.016493819653987885,
-0.006470874883234501,
-0.0861181989312172,
0.01886794902384281,
-0.019977601245045662,
-0.009636994451284409,
-0.024107644334435463,
0.004976966883987188,
-0.05837272107601166,
-0.03554925695061684,
0.0019494988955557346,
-0.04307999834418297,
0.008124664425849915,
-0.004182905424386263,
0.07900650054216385,
0.016346542164683342,
0.038212236016988754,
-0.04144907742738724,
0.01908721961081028,
-0.042369116097688675,
0.06010153889656067,
0.012484228238463402,
0.021476471796631813,
0.0008353232406079769,
0.10429343581199646,
-0.04065738990902901,
0.0508200079202652,
0.027167251333594322,
-0.002694724127650261,
-0.031107118353247643,
-0.035784024745225906,
0.041243888437747955,
-0.007572602480649948,
0.021496104076504707,
-0.015119957737624645,
0.041677623987197876,
0.030234619975090027,
-0.03526122495532036,
-0.07920364290475845,
0.04243086650967598,
0.04116635397076607,
0.03613191843032837,
0.02787780575454235,
0.02406204305589199,
-0.016393721103668213,
0.0045712608844041824,
0.0036099019926041365,
-0.0059315916150808334,
-0.05715047940611839,
-0.05145817622542381,
0.06654716283082962,
0.0022106245160102844,
-0.06808122992515564,
0.021581539884209633,
0.014372981153428555,
0.030262798070907593,
2.7244539069215534e-7,
0.03828417509794235,
0.007507492322474718,
0.020730135962367058,
0.025252707302570343,
0.03427081182599068,
-0.042783599346876144,
0.021657705307006836,
0.027032801881432533,
-0.031252577900886536,
0.03973051905632019,
0.08168082684278488,
0.015206058509647846,
-0.016964465379714966,
-0.03770273178815842,
-0.013622703962028027,
-0.015865670517086983,
-0.03166837617754936,
-0.0024948050267994404,
-0.002433305373415351,
-0.020871533080935478,
0.0020229967776685953,
0.01595359854400158,
-0.064302958548069,
-0.03431994840502739,
-0.08202588558197021,
0.04622203856706619,
0.003998601343482733,
-0.014776497147977352,
0.00313609279692173,
-0.016199028119444847,
-0.005569136701524258,
0.08936335146427155,
0.055112846195697784,
-0.052428096532821655,
-0.010595832020044327,
-0.03586982190608978,
0.019083300605416298,
0.040338173508644104,
-0.06678252667188644,
-0.0531776025891304,
-0.012363535352051258,
0.04219022020697594,
0.023180965334177017,
-0.038087014108896255,
0.028854478150606155,
-0.006097602657973766,
-0.06990284472703934,
0.0167537871748209,
0.031051939353346825,
-0.08839528262615204,
-0.011752915568649769,
0.05212129279971123,
-0.023232096806168556,
0.09363695979118347,
-0.003815778996795416,
0.03562812879681587,
-0.0740516260266304,
0.0364486500620842,
0.006364737171679735,
0.04514921456575394,
-0.00895978044718504,
-0.04364187270402908,
0.0367942750453949,
0.056784406304359436,
-0.01258012279868126,
0.0038047165144234896,
-0.04682190343737602,
1.6942811042246937e-34,
-0.005358487833291292,
-0.05170784518122673,
-0.030353741720318794,
0.008599206805229187,
0.029826097190380096,
0.009767651557922363,
0.004264111630618572,
-0.02577332779765129,
0.0023767719976603985,
-0.05027073994278908,
0.013455661945044994
] | {
"ds_index": 58,
"similar_dg_indices": [
972333,
150370,
592353,
364886,
1165304,
304463,
851651,
601715,
167399,
143499,
1145708,
26556,
519037,
794717,
457524,
699297,
1036870,
607261,
1002992,
233513
]
} |
A recent study attempted to analyze whether increased "patient satisfaction" driven healthcare resulted in increased hospitalization. In this hospital, several of the wards adopted new aspects of "patient satisfaction" driven healthcare, whereas the remainder of the hospital continued to use existing protocols. Baseline population characteristics and demographics were collected at the start of the study. At the end of the following year, hospital use was assessed and compared between the two groups. Which of the following best describes this type of study? | Prospective cohort | {
"A": "Prospective cohort",
"B": "Retrospective case-control",
"C": "Prospective case-control",
"D": "Cross-sectional study"
} | step1 | A | [
"recent study attempted to",
"increased",
"patient satisfaction",
"driven healthcare resulted",
"increased hospitalization",
"hospital",
"several",
"wards adopted new aspects",
"patient satisfaction",
"driven healthcare",
"hospital continued to use",
"protocols",
"Baseline population",
"demographics",
"collected",
"start",
"study",
"end",
"following year",
"hospital use",
"assessed",
"compared",
"two groups",
"following best",
"type",
"study"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A recent study attempted to analyze whether increased "patient satisfaction" driven healthcare resulted in increased hospitalization. In this hospital, several of the wards adopted new aspects of "patient satisfaction" driven healthcare, whereas the remainder of the hospital continued to use existing protocols. Baseline population characteristics and demographics were collected at the start of the study. At the end of the following year, hospital use was assessed and compared between the two groups. Which of the following best describes this type of study?
Choose one of the following::
A. Prospective cohort
B. Retrospective case-control
C. Prospective case-control
D. Cross-sectional study | [
0.05257655307650566,
0.042013004422187805,
-0.004359313752502203,
-0.05743914470076561,
-0.059576503932476044,
0.005711421836167574,
0.05366836488246918,
0.007517722435295582,
-0.05684478208422661,
0.0011638097930699587,
0.056357696652412415,
-0.03617259860038757,
0.012379075400531292,
-0.022136682644486427,
-0.0021023317240178585,
0.0006960235768929124,
0.00836609024554491,
0.04946465790271759,
-0.02200889214873314,
0.043871667236089706,
-0.05066318437457085,
-0.0019481702474877238,
0.0022528350818902254,
0.0041559431701898575,
-0.009061092510819435,
0.01369954738765955,
-0.06693188101053238,
-0.01804623007774353,
-0.020390059798955917,
-0.06382027268409729,
0.08363129943609238,
0.03274912014603615,
0.010369904339313507,
-0.02789449319243431,
0.0000016809916587590124,
0.01869896985590458,
-0.036480363458395004,
0.010819182731211185,
0.007106910925358534,
-0.00153387023601681,
0.07835697382688522,
-0.008708820678293705,
0.01723967306315899,
0.0081785898655653,
0.008426443673670292,
-0.08706536889076233,
0.002870433032512665,
-0.02863544598221779,
-0.03532472252845764,
-0.02787228487432003,
0.015204356983304024,
-0.05824219062924385,
-0.10701721906661987,
-0.032108161598443985,
-0.02820727974176407,
0.018176404759287834,
-0.004887415561825037,
-0.03288887068629265,
0.039181530475616455,
-0.024993283674120903,
0.005083432886749506,
0.0016862943302839994,
-0.028306953608989716,
0.0015714126639068127,
0.022522402927279472,
-0.017184404656291008,
0.004857583902776241,
0.004453236237168312,
0.033569566905498505,
-0.004167144652456045,
0.06532823294401169,
0.03783787041902542,
0.04939212650060654,
0.018487632274627686,
-0.003211033996194601,
0.021755244582891464,
0.007537320256233215,
-0.07932109385728836,
0.010298753157258034,
-0.038567304611206055,
-0.03711823746562004,
0.08409467339515686,
0.012186748906970024,
0.013716441579163074,
-0.05761084705591202,
-0.07713623344898224,
-0.004744234960526228,
-0.015848036855459213,
-0.05385719984769821,
-0.01714973896741867,
0.047168172895908356,
0.01280620414763689,
-0.057698022574186325,
0.002990634413436055,
-0.020106224343180656,
-0.028105340898036957,
0.08360260725021362,
0.0038616973906755447,
0.10262467712163925,
0.0019532148726284504,
-0.02784661389887333,
-0.019168464466929436,
-0.0027413649950176477,
0.007457008585333824,
0.05888659134507179,
-0.019606737419962883,
-0.002641502767801285,
-0.048969708383083344,
-0.021894890815019608,
0.0700562447309494,
-0.009769455529749393,
0.01696295477449894,
0.001422817469574511,
0.0433625690639019,
0.05066218599677086,
0.016467314213514328,
-0.02951802685856819,
-0.01823626644909382,
-0.013696654699742794,
0.02422112412750721,
-0.03521459549665451,
0.03212409466505051,
-0.029200484976172447,
0.04666758328676224,
0.00855265837162733,
0.02571083977818489,
0.007443051785230637,
0.051970649510622025,
-0.006266526412218809,
0.04008106887340546,
0.06256122142076492,
-0.008367732167243958,
0.013278022408485413,
0.023410329595208168,
-0.021909315139055252,
0.012532180175185204,
0.013646061532199383,
-0.007735612336546183,
-0.06171506270766258,
-0.010268311947584152,
0.038870587944984436,
-0.03185700625181198,
-0.009587562642991543,
-0.034581176936626434,
0.05134190618991852,
0.002011189004406333,
-0.023401224985718727,
0.029897920787334442,
0.017592063173651695,
0.051256828010082245,
-0.04190336912870407,
-0.009980239905416965,
-0.007087158504873514,
0.007373768836259842,
-0.019783329218626022,
0.03112179972231388,
0.01993379555642605,
0.0001205845910590142,
-0.007739707361906767,
-0.011798962019383907,
-0.02295849472284317,
-0.01712903566658497,
0.01644122041761875,
0.017302509397268295,
0.018072159960865974,
0.021132342517375946,
0.039608556777238846,
0.012863298878073692,
-0.05378754064440727,
0.02355332486331463,
-0.08538637310266495,
0.06435215473175049,
-0.03545184060931206,
0.07996528595685959,
-0.048976656049489975,
0.04175304248929024,
0.012754274532198906,
0.021444953978061676,
-0.058609459549188614,
-0.045900821685791016,
-0.020400896668434143,
0.023590531200170517,
-0.005132273305207491,
-0.04685216024518013,
0.027208076789975166,
0.02278420701622963,
0.003686319338157773,
-0.09345246851444244,
-0.00582102220505476,
-0.02585255354642868,
-0.007852958515286446,
-0.026316089555621147,
-0.01685529574751854,
-0.016499802470207214,
0.016224004328250885,
0.03590722754597664,
-0.017926590517163277,
-0.018464263528585434,
-0.05513331666588783,
0.015293346717953682,
0.014557966962456703,
-0.058350589126348495,
0.030988659709692,
0.04651518166065216,
-0.012575700879096985,
0.0032336742151528597,
0.006780650001019239,
-0.059797197580337524,
-0.032464709132909775,
-0.0004953010939061642,
0.024743929505348206,
0.007668306585401297,
-0.05207768455147743,
0.034822769463062286,
-0.0009396460955031216,
-0.014054850675165653,
-4.3009899286516884e-7,
0.046287376433610916,
-0.09594130516052246,
-0.01655915006995201,
-0.03198842331767082,
-0.012426000088453293,
0.007198844105005264,
0.009558063000440598,
-0.020275983959436417,
0.05078926309943199,
-0.0007101669907569885,
-0.03511420264840126,
-0.005149575881659985,
0.021968241780996323,
0.00936190877109766,
0.026293661445379257,
-0.0155245466157794,
0.024350645020604134,
0.00011026294669136405,
0.02951514720916748,
0.06020689755678177,
-0.012469773180782795,
-0.0424451008439064,
-0.014543488621711731,
0.010555935092270374,
0.016131624579429626,
0.004474262706935406,
-0.0057910773903131485,
0.04873311147093773,
0.007141323760151863,
0.05363684147596359,
0.010199327953159809,
0.02676505595445633,
0.014120036736130714,
-0.03871047496795654,
-0.06752685457468033,
0.015251968055963516,
-0.03600107133388519,
-0.012534955516457558,
0.06370294094085693,
-0.07125350832939148,
0.0031750844791531563,
0.03123791143298149,
-0.04020577669143677,
0.08212114125490189,
-0.020220059901475906,
-0.034457117319107056,
0.025297746062278748,
-0.007923811674118042,
-0.062471937388181686,
-0.025152266025543213,
-0.06069405749440193,
0.01689492166042328,
0.018683936446905136,
-0.021091800183057785,
0.014281628653407097,
0.04269152134656906,
0.01639452390372753,
-0.008847163990139961,
0.014637366868555546,
-0.044153518974781036,
0.06110916659235954,
0.031706154346466064,
0.012508156709372997,
0.05654860660433769,
0.03016684576869011,
-0.03837359696626663,
-0.0046875495463609695,
-0.028546106070280075,
0.024880439043045044,
0.033152781426906586,
0.020113222301006317,
-0.022906463593244553,
-0.023851454257965088,
-0.016845783218741417,
-0.04746668040752411,
0.035987187176942825,
-0.06656818091869354,
0.04772819206118584,
0.016227077692747116,
0.007177726365625858,
0.022089239209890366,
0.021317917853593826,
-0.01706407032907009,
0.020469948649406433,
-0.007207989692687988,
-0.03094879724085331,
0.00041232179501093924,
-0.06044037267565727,
-0.055331841111183167,
0.05360153689980507,
-0.051436908543109894,
-0.012900696136057377,
-0.029472822323441505,
0.043381307274103165,
-0.0077108172699809074,
0.0010268781334161758,
0.00042275054147467017,
-0.0017612011870369315,
0.03296799212694168,
-0.06248950958251953,
0.020250452682375908,
-0.007477648090571165,
0.05505584925413132,
0.03804197162389755,
-0.0010546586709097028,
-0.044267889112234116,
0.06228887662291527,
0.05441742017865181,
-0.029500285163521767,
0.022172246128320694,
-0.009225764311850071,
-0.02498723566532135,
-0.01938682049512863,
-0.04068392515182495,
0.0033165046479552984,
-0.0459388829767704,
-0.01514680776745081,
0.005493863485753536,
-0.06613782048225403,
-0.036570869386196136,
0.029841165989637375,
-0.039846017956733704,
0.030100559815764427,
-0.002665000967681408,
0.0029912854079157114,
-0.038367487490177155,
-0.026942431926727295,
0.037589993327856064,
-0.011210988275706768,
-0.05740189924836159,
0.07251441478729248,
-0.00883984100073576,
-0.0015689159044995904,
-0.028763415291905403,
0.07101363688707352,
0.00555273937061429,
-0.021671360358595848,
-0.05469095706939697,
-0.04583828151226044,
0.019492918625473976,
-0.02118375338613987,
-0.029275571927428246,
0.025951635092496872,
0.011337432079017162,
0.04596898332238197,
0.0033714231103658676,
0.07798709720373154,
-0.02151094563305378,
0.0008905432187020779,
-0.026612410321831703,
0.007644123397767544,
-0.04624361917376518,
0.005372602958232164,
-0.04002198576927185,
-0.02248680219054222,
0.051244139671325684,
0.011390654370188713,
-0.03170883283019066,
0.041818197816610336,
-0.026054417714476585,
-0.0004665230808313936,
-0.0688672661781311,
-0.011559884063899517,
0.02115941420197487,
-0.03495285287499428,
0.08120909333229065,
-0.0162048377096653,
0.014343556016683578,
-0.016667019575834274,
0.007218091282993555,
-0.03730052337050438,
0.03945076838135719,
-0.01847502402961254,
-0.021135419607162476,
-0.014141549356281757,
0.11029298603534698,
0.03819628059864044,
0.06788595765829086,
-0.02364513650536537,
-0.02854447066783905,
-0.00025931731215678155,
0.03731221705675125,
-0.01157229021191597,
-0.015358075499534607,
-0.018259450793266296,
-0.04003404080867767,
0.022317025810480118,
-0.0004815773863811046,
0.01834108866751194,
0.027586020529270172,
0.020531272515654564,
-0.03804012015461922,
0.03467494249343872,
0.052584826946258545,
-0.013258710503578186,
-0.002334999619051814,
0.027208279818296432,
0.05826554074883461,
-0.008514137007296085,
0.017514297738671303,
0.030082203447818756,
-0.017111482098698616,
-0.05588489770889282,
0.04508901759982109,
0.001663419185206294,
0.01035766676068306,
-0.03784727677702904,
0.01123250462114811,
-0.014972692355513573,
0.058754608035087585,
0.012323197908699512,
-0.023012330755591393,
-0.02072448655962944,
0.035090941935777664,
-0.025739358738064766,
0.029954945668578148,
0.004754518158733845,
-0.009517539292573929,
0.0518544539809227,
0.008456208743155003,
-0.03037125989794731,
0.014775031246244907,
0.02489144168794155,
-0.030998121947050095,
-0.014175204560160637,
0.02000943385064602,
-0.03006213903427124,
-0.00725949602201581,
0.0512501522898674,
-0.045287635177373886,
-0.023529065772891045,
-0.018763087689876556,
0.07123614847660065,
0.017026586458086967,
-0.04716164246201515,
-0.044332992285490036,
0.029994754120707512,
0.07381360977888107,
0.0077469125390052795,
-0.08275330811738968,
0.021072572097182274,
-0.02111831121146679,
0.059283237904310226,
0.055539991706609726,
0.01779819093644619,
-0.0026702051982283592,
0.018963370472192764,
0.07596555352210999,
-0.049663979560136795,
-0.06854322552680969,
0.02870018407702446,
-0.03152164816856384,
-0.052885644137859344,
0.02813499979674816,
-0.01567518152296543,
-0.030356772243976593,
0.02443648688495159,
-0.01707998663187027,
-0.018124381080269814,
-0.07752370834350586,
-0.045344434678554535,
0.03634214028716087,
0.013573936186730862,
-0.02772267535328865,
0.014292060397565365,
-0.03488969802856445,
-0.0017768520629033446,
-0.00401918264105916,
-0.04505080357193947,
-0.060530032962560654,
-0.00018523508333601058,
0.006574701983481646,
-0.08156876266002655,
-0.03435593470931053,
0.03688928112387657,
-0.04024720937013626,
-0.0024217849131673574,
-0.061969175934791565,
-0.026284903287887573,
-0.0028287675231695175,
0.06760653108358383,
0.019178839400410652,
-0.013331680558621883,
-0.007307795807719231,
0.017069807276129723,
-0.011392961256206036,
0.013810493052005768,
-0.0034761358983814716,
0.09179667383432388,
0.004064355976879597,
-0.013185934163630009,
-0.0010903567308560014,
0.007034342736005783,
-0.021654583513736725,
0.04030442610383034,
0.005822985898703337,
-0.054599370807409286,
-0.0002047550369752571,
-0.08353056013584137,
-0.08587605506181717,
0.012038098648190498,
-0.04436280578374863,
0.027505481615662575,
-0.00036652537528425455,
-0.01001983042806387,
-0.02378920651972294,
-0.007625536527484655,
0.016681337729096413,
-0.006220682058483362,
0.0016903753858059645,
0.027448264881968498,
-0.07550361752510071,
0.017376398667693138,
-0.031427204608917236,
-0.027633104473352432,
-0.11204182356595993,
0.07361262291669846,
-0.011027740314602852,
0.07329832762479782,
0.07806988060474396,
0.006539295427501202,
0.004492046311497688,
-0.032056331634521484,
-0.020492903888225555,
0.0039681317284703255,
0.050840187817811966,
-0.018560882657766342,
0.040978219360113144,
-0.02190525270998478,
0.025075295940041542,
-0.019505593925714493,
0.02359750121831894,
-0.029746895655989647,
-0.022166067734360695,
0.06297964602708817,
0.013729259371757507,
-0.003937210887670517,
0.054831914603710175,
-5.276589164013824e-33,
0.011838877573609352,
-0.012715817429125309,
0.020397603511810303,
-0.0689033716917038,
-0.05135301873087883,
0.04843990504741669,
0.00989796407520771,
-0.002885214053094387,
-0.023439282551407814,
-0.05304178595542908,
-0.027152899652719498,
0.018137268722057343,
0.007062687538564205,
0.027472058311104774,
0.03498285636305809,
-0.028284244239330292,
0.011213960126042366,
-0.04646424204111099,
0.000507419987116009,
-0.024885013699531555,
-0.04239547252655029,
0.003152992110699415,
0.004742385819554329,
0.0007690545753575861,
-0.004320103209465742,
-0.02359103225171566,
0.016316089779138565,
-0.006277657579630613,
-0.01223619282245636,
0.006531677674502134,
0.05181458964943886,
-0.03261787071824074,
0.026396218687295914,
-0.05632622167468071,
0.0367131382226944,
0.04629923030734062,
0.014730465598404408,
-0.04589160904288292,
0.005039638839662075,
0.01064212340861559,
-0.05035492405295372,
-0.0011965073645114899,
0.004634298384189606,
-0.004979679826647043,
0.006730058696120977,
-0.05224581062793732,
-0.03666305169463158,
-0.03625907748937607,
0.0483122318983078,
0.027144234627485275,
0.022422930225729942,
0.011002634651958942,
-0.04005644470453262,
0.06036447733640671,
-0.03812386840581894,
-0.0012292970204725862,
-0.04064624011516571,
0.05156326666474342,
-0.031328123062849045,
0.0010816734284162521,
0.05412814021110535,
-0.013691450469195843,
-0.004326388239860535,
0.026036344468593597,
-0.00855020061135292,
-0.037687454372644424,
-0.025870388373732567,
0.046555161476135254,
-0.024018043652176857,
0.04664424806833267,
-0.02895205095410347,
0.03899113088846207,
-0.0007473539444617927,
0.026246298104524612,
-0.033526770770549774,
-0.031360164284706116,
0.004687773063778877,
0.002221587812528014,
0.005112760234624147,
-0.001993139274418354,
0.02611229009926319,
-0.0033805961720645428,
0.014632127247750759,
-0.03031097911298275,
-0.0583479143679142,
-0.029408587142825127,
-0.010023802518844604,
-0.05209251865744591,
0.030134908854961395,
0.008164748549461365,
0.0312353428453207,
-0.016507603228092194,
0.05477459356188774,
0.00675580371171236,
0.03743324428796768,
0.00671745091676712,
0.01206657662987709,
0.02791706658899784,
-0.03377552330493927,
0.01112030167132616,
0.0014404988614842296,
0.05021271854639053,
0.0019380324520170689,
0.07087128609418869,
0.03995854780077934,
0.03317732363939285,
-0.0476510189473629,
-0.03356340900063515,
-0.05876656994223595,
0.03338371217250824,
0.07140246778726578,
-0.025018785148859024,
0.02446269802749157,
-0.09519942104816437,
-0.012147773988544941,
0.04412410408258438,
0.04315682500600815,
0.05531497672200203,
0.011129703372716904,
-0.03261946514248848,
-0.07452650368213654,
0.013641414232552052,
-0.022784698754549026,
0.024745531380176544,
0.00001711652112135198,
0.032522883266210556,
0.01580963470041752,
0.03543878719210625,
0.013412841595709324,
0.03097165748476982,
0.019002864137291908,
-0.01465635932981968,
2.56069426995964e-7,
-0.016798555850982666,
-0.016810202971100807,
-0.03788144513964653,
0.000917834579013288,
0.03744686767458916,
-0.07086294889450073,
0.00871851947158575,
0.0012604256626218557,
0.04725920408964157,
0.0003978671447839588,
0.09675987809896469,
-0.09607493877410889,
-0.025164281949400902,
0.022303327918052673,
0.014209550805389881,
-0.029671398922801018,
-0.005582889541983604,
-0.023451080545783043,
-0.000034228971344418824,
-0.04661884158849716,
0.035857193171978,
-0.016258148476481438,
-0.058611899614334106,
0.02360614202916622,
-0.07109202444553375,
0.06690597534179688,
0.008911652490496635,
-0.004038019105792046,
-0.03865886107087135,
0.051753681153059006,
0.01069121714681387,
0.029207034036517143,
0.013752666302025318,
0.024646367877721786,
-0.017785197123885155,
-0.05367663502693176,
-0.0014360224595293403,
0.024742379784584045,
0.018604375422000885,
0.04980476200580597,
0.051693037152290344,
0.002920630155131221,
-0.0026252130046486855,
-0.01493670605123043,
0.020764591172337532,
-0.04652322456240654,
0.03795710206031799,
-0.017423393204808235,
-0.03960350900888443,
-0.009479069150984287,
0.08878769725561142,
0.008930076844990253,
-0.044198255985975266,
0.060108304023742676,
0.012470491230487823,
0.073550745844841,
-0.0005343178636394441,
0.05076727643609047,
0.060014523565769196,
0.054272085428237915,
-0.02139342948794365,
-0.03115037828683853,
0.041378527879714966,
-0.047924529761075974,
-0.03527868911623955,
0.002611056435853243,
0.012711436487734318,
1.0630180233421964e-34,
0.022931750863790512,
-0.01348490733653307,
-0.006792089436203241,
-0.04967820271849632,
-0.02251441404223442,
-0.0007762937457300723,
-0.02128717117011547,
0.00442608492448926,
0.03189462050795555,
0.025238288566470146,
-0.0157364159822464
] | {
"ds_index": 59,
"similar_dg_indices": [
673157,
1166555,
776948,
1071711,
1019096,
205506,
397156,
784613,
264776,
781939,
553842,
850706,
764795,
692959,
1161471,
399441,
65331,
323353,
655552,
968118
]
} |
A new screening test utilizing a telemedicine approach to diagnosing diabetic retinopathy has been implemented in a diabetes clinic. An ophthalmologist’s exam was also performed on all patients as the gold standard for diagnosis. In a pilot study of 500 patients, the screening test detected the presence of diabetic retinopathy in 250 patients. Ophthalmologist exam confirmed a diagnosis of diabetic retinopathy in 200 patients who tested positive in the screening test, as well as 10 patients who tested negative in the screening test. What is the sensitivity, specificity, positive predictive value, and negative predictive value of the screening test? | Sensitivity = 95%, Specificity = 83%, PPV = 80%, NPV = 96% | {
"A": "Sensitivity = 83%, Specificity = 95%, PPV = 80%, NPV = 96%",
"B": "Sensitivity = 83%, Specificity = 95%, PPV = 96%, NPV = 80%",
"C": "Sensitivity = 80%, Specificity = 95%, PPV = 96%, NPV = 83%",
"D": "Sensitivity = 95%, Specificity = 83%, PPV = 80%, NPV = 96%"
} | step2&3 | D | [
"new screening test",
"telemedicine approach",
"diagnosing diabetic retinopathy",
"implemented",
"diabetes clinic",
"ophthalmologists exam",
"performed",
"patients",
"gold",
"diagnosis",
"pilot study",
"500 patients",
"screening test detected",
"presence",
"diabetic retinopathy",
"patients",
"Ophthalmologist exam confirmed",
"diagnosis",
"diabetic retinopathy",
"200 patients",
"tested positive",
"screening test",
"10 patients",
"tested negative",
"screening test",
"sensitivity",
"specificity",
"positive predictive value",
"negative predictive value of",
"screening test"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A new screening test utilizing a telemedicine approach to diagnosing diabetic retinopathy has been implemented in a diabetes clinic. An ophthalmologist’s exam was also performed on all patients as the gold standard for diagnosis. In a pilot study of 500 patients, the screening test detected the presence of diabetic retinopathy in 250 patients. Ophthalmologist exam confirmed a diagnosis of diabetic retinopathy in 200 patients who tested positive in the screening test, as well as 10 patients who tested negative in the screening test. What is the sensitivity, specificity, positive predictive value, and negative predictive value of the screening test?
Choose one of the following::
A. Sensitivity = 83%, Specificity = 95%, PPV = 80%, NPV = 96%
B. Sensitivity = 83%, Specificity = 95%, PPV = 96%, NPV = 80%
C. Sensitivity = 80%, Specificity = 95%, PPV = 96%, NPV = 83%
D. Sensitivity = 95%, Specificity = 83%, PPV = 80%, NPV = 96% | [
-0.019009366631507874,
-0.08531305938959122,
-0.010172747075557709,
-0.023178018629550934,
0.014388593845069408,
0.020843686535954475,
0.024486131966114044,
0.04711340740323067,
0.08234153687953949,
0.01146218366920948,
0.05150971934199333,
0.023940136656165123,
0.0028105040546506643,
0.04233190417289734,
-0.027342308312654495,
0.041964493691921234,
-0.06618336588144302,
0.045072752982378006,
-0.003339828923344612,
0.026400642469525337,
0.017824796959757805,
-0.022936716675758362,
-0.015631191432476044,
0.057741306722164154,
-0.02205009013414383,
0.022564508020877838,
0.03758891671895981,
-0.044474925845861435,
0.029820237308740616,
-0.0322013758122921,
0.029284175485372543,
-0.04761182889342308,
-0.053601596504449844,
-0.039286307990550995,
0.0000020578770545398584,
-0.05021632835268974,
0.009333775378763676,
-0.010144204832613468,
0.014836912043392658,
-0.029058586806058884,
0.00014126925088930875,
-0.03614417463541031,
0.06372583657503128,
0.029739581048488617,
-0.01916472427546978,
0.026226837188005447,
0.030910074710845947,
-0.04321189224720001,
-0.033747345209121704,
0.04808162525296211,
0.006569630466401577,
0.09260185062885284,
-0.00011066302977269515,
-0.0015811928315088153,
-0.05460077151656151,
-0.010084261186420918,
-0.005108951590955257,
0.03591030463576317,
-0.0236688069999218,
-0.04107420891523361,
0.02259507030248642,
0.02399435080587864,
0.021609507501125336,
0.032299090176820755,
-0.03927099332213402,
0.010743629187345505,
-0.013530738651752472,
-0.03521551191806793,
-0.002607957925647497,
0.004046907648444176,
0.013162252493202686,
-0.022685028612613678,
-0.022010616958141327,
0.04057012498378754,
-0.005858194082975388,
0.03525122255086899,
0.014461688697338104,
-0.02240658923983574,
-0.010914950631558895,
0.0021573477424681187,
-0.03821919858455658,
0.04142014682292938,
0.012381060048937798,
-0.016642730683088303,
-0.00010376731370342895,
0.00212105643004179,
-0.0015110543463379145,
0.02463385835289955,
-0.011574632488191128,
0.049577340483665466,
0.03588152304291725,
-0.018148548901081085,
-0.014710860326886177,
0.020439140498638153,
-0.025584068149328232,
-0.06857898831367493,
-0.007140385452657938,
0.023482749238610268,
0.05227014794945717,
0.029601117596030235,
0.04504919797182083,
0.011270906776189804,
-0.0058000232093036175,
-0.023240672424435616,
-0.02435368113219738,
0.008440845645964146,
0.0171820018440485,
0.008698626421391964,
-0.030111093074083328,
0.02965204045176506,
0.007147650234401226,
0.025971800088882446,
-0.011642025783658028,
-0.030820749700069427,
0.07674094289541245,
-0.02209634520113468,
-0.047049086540937424,
-0.005823852494359016,
0.01890488713979721,
-0.05550390109419823,
-0.04662063345313072,
0.02849717251956463,
0.028384922072291374,
0.00586827052757144,
-0.05407136678695679,
0.018041560426354408,
0.0035414956510066986,
-0.009110432118177414,
-0.02525247260928154,
-0.04088626056909561,
0.04781134054064751,
-0.016147298738360405,
0.004520353861153126,
0.036918364465236664,
0.033000655472278595,
0.05345682054758072,
-0.0324854739010334,
-0.019446002319455147,
0.020998500287532806,
-0.012481344863772392,
-0.008726824074983597,
0.029178844764828682,
-0.009863208048045635,
-0.0025009005330502987,
-0.018356015905737877,
0.014829697087407112,
0.022171059623360634,
0.07169909030199051,
0.02619364857673645,
0.014206474646925926,
0.10563161969184875,
-0.07113900035619736,
-0.002718208823353052,
0.014844032004475594,
0.018612638115882874,
-0.0099859070032835,
-0.034986257553100586,
0.02350613847374916,
-0.017388954758644104,
-0.0007673072395846248,
0.0372047945857048,
-0.030331460759043694,
0.04482410475611687,
0.02680559642612934,
-0.008885149843990803,
0.028950372710824013,
0.011303023435175419,
0.0032569640316069126,
-0.05085940286517143,
0.03019791841506958,
-0.034826260060071945,
-0.011278395541012287,
0.010077321901917458,
-0.011855543591082096,
-0.03092845529317856,
0.027852097526192665,
0.07036708295345306,
-0.06236804649233818,
-0.00528924074023962,
-0.0032082509715110064,
-0.039760567247867584,
-0.01261193212121725,
0.07668330520391464,
-0.017239799723029137,
-0.07631362974643707,
0.004181802272796631,
-0.0651642456650734,
-0.027916520833969116,
0.04312739148736,
-0.015385456383228302,
-0.007688606157898903,
-0.0064217098988592625,
-0.0010923325316980481,
-0.011222572065889835,
0.013846945017576218,
-0.0009263719548471272,
-0.013208562508225441,
0.039600640535354614,
-0.012461925856769085,
-0.0002638096339069307,
-0.02343904972076416,
-0.05349808186292648,
0.03506673499941826,
-0.011897504329681396,
-0.015099897980690002,
0.03893968462944031,
0.028107665479183197,
0.029304558411240578,
-0.026345521211624146,
-0.08038874715566635,
-0.01459257397800684,
-0.0015423550503328443,
0.02568061463534832,
-0.004230171907693148,
0.035508204251527786,
0.017276229336857796,
0.043510857969522476,
0.030242204666137695,
-0.007070544175803661,
0.08546574413776398,
0.018848733976483345,
-0.006729652639478445,
0.017089765518903732,
0.01533261314034462,
0.0192827507853508,
0.00007955836917972192,
-0.02807861752808094,
0.012539613991975784,
-0.02165129967033863,
-0.014184508472681046,
0.03792347013950348,
-0.0214186180382967,
-0.03163139149546623,
-0.018271442502737045,
-0.024416577070951462,
-0.05515246093273163,
0.06717359274625778,
0.006837231572717428,
-0.012211408466100693,
-0.06905659288167953,
-0.012214590795338154,
0.010961522348225117,
-0.034736502915620804,
0.034327782690525055,
-0.038297656923532486,
-0.016223691403865814,
-0.024511093273758888,
0.00326637364923954,
-0.009791605174541473,
0.022387303411960602,
-0.0005055228830315173,
0.004170873202383518,
-0.010431810282170773,
-0.02235415205359459,
-0.015780270099639893,
-0.017889631912112236,
-0.05643660947680473,
0.03935233876109123,
-0.05718196555972099,
-0.006669715046882629,
-0.03796469047665596,
-0.05663973093032837,
-0.006055931560695171,
-0.02104838751256466,
0.032152604311704636,
-0.02623727358877659,
0.0222619641572237,
-0.04442659392952919,
-0.007239817641675472,
0.020408308133482933,
-0.03750213235616684,
0.026059607043862343,
0.008664343506097794,
0.02477908506989479,
-0.003624910721555352,
0.01876094751060009,
0.009995635598897934,
0.0173931997269392,
0.010277840308845043,
-0.009210608899593353,
0.05799625813961029,
0.011198198422789574,
0.046113643795251846,
-0.04146995395421982,
-0.034463535994291306,
0.05031692609190941,
0.09223581850528717,
-0.04457760602235794,
0.028051313012838364,
0.03592415899038315,
0.00786516722291708,
-0.037672340869903564,
0.022563328966498375,
-0.03529918193817139,
-0.019634632393717766,
0.020922498777508736,
-0.11236821115016937,
0.035060491412878036,
0.007407751400023699,
-0.03146857023239136,
-0.000731500331312418,
0.06097346916794777,
0.04566828906536102,
-0.006272043101489544,
-0.03979828208684921,
-0.05302669107913971,
0.035479068756103516,
-0.045047905296087265,
0.025924893096089363,
-0.051514897495508194,
0.00957633275538683,
-0.005359816364943981,
-0.014963274821639061,
0.04285035654902458,
-0.031100325286388397,
-0.033376194536685944,
-0.0850086584687233,
0.04623756930232048,
-0.010373841971158981,
0.03777410089969635,
-0.0071873655542731285,
-0.04375885799527168,
0.052725665271282196,
0.02351933717727661,
0.020606715232133865,
-0.04129352048039436,
-0.017502984032034874,
0.024640660732984543,
-0.05295451357960701,
-0.0366186760365963,
-0.012850574217736721,
-0.028963174670934677,
-0.016265232115983963,
0.006091074086725712,
-0.026022041216492653,
-0.0005383660900406539,
0.010817531496286392,
0.07985766977071762,
-0.0034800139255821705,
0.010241521522402763,
-0.01792462170124054,
0.0010237912647426128,
-0.030394770205020905,
0.006468295585364103,
-0.010305145755410194,
-0.022521434351801872,
-0.04817609488964081,
0.028196658939123154,
-0.023320849984884262,
0.050854653120040894,
-0.0602288655936718,
0.05517518147826195,
0.02135580964386463,
0.00036272761644795537,
0.03140929713845253,
-0.0133339399471879,
-0.00783342495560646,
-0.06119891628623009,
-0.03051677718758583,
0.024424562230706215,
0.013293099589645863,
0.006933166645467281,
-0.08237132430076599,
-0.007146923802793026,
-0.036704570055007935,
0.02994442544877529,
-0.0670192614197731,
-0.035073354840278625,
0.015765761956572533,
-0.011749669909477234,
-0.032838739454746246,
-0.007626708596944809,
0.10364106297492981,
0.01189845334738493,
-0.015812505036592484,
-0.04591592773795128,
0.006549150217324495,
0.015042062848806381,
-0.11971975117921829,
-0.01302705891430378,
-0.03900105878710747,
-0.07201343774795532,
0.022761622443795204,
0.023492077365517616,
0.0038134853821247816,
-0.015367517247796059,
-0.015141901560127735,
0.014873314648866653,
0.023853324353694916,
0.012637305073440075,
0.0008356759790331125,
0.053762685507535934,
-0.022417720407247543,
0.04118175432085991,
0.025172365829348564,
-0.012579570524394512,
-0.012479271739721298,
-0.04035963863134384,
-0.060891713947057724,
0.018939711153507233,
-0.0003765291185118258,
-0.07736595720052719,
0.015874601900577545,
0.08308778703212738,
0.020304853096604347,
-0.135768860578537,
0.039342042058706284,
0.007052091881632805,
0.028495686128735542,
0.016271540895104408,
-0.06899236887693405,
-0.09697215259075165,
0.04311304911971092,
-0.0469619557261467,
0.08498203009366989,
0.033194124698638916,
-0.01484011858701706,
0.008292914368212223,
0.026160020381212234,
-0.0023474611807614565,
0.0706557109951973,
0.026584971696138382,
-0.030581209808588028,
-0.0009443371091037989,
-0.051067154854536057,
0.011067868210375309,
-0.006472217384725809,
0.021334858611226082,
-0.016664687544107437,
-0.020662205293774605,
-0.008957293815910816,
0.009461450390517712,
0.08037547022104263,
0.015889011323451996,
0.0295831561088562,
-0.016515860334038734,
-0.028084557503461838,
0.0278388112783432,
-0.01713741570711136,
-0.03951307386159897,
0.030429992824792862,
-0.04026414826512337,
0.060623254626989365,
0.02183709479868412,
-0.058824267238378525,
0.025715632364153862,
0.022083958610892296,
0.003190008457750082,
0.051471929997205734,
0.06624633818864822,
0.031279463320970535,
-0.05296352133154869,
0.027334602549672127,
0.020343376323580742,
-0.003622032469138503,
-0.03395994380116463,
-0.0671529620885849,
0.024751819670200348,
0.01455723401159048,
0.0010015746811404824,
0.025912892073392868,
0.021204084157943726,
-0.05473506078124046,
-0.03741595521569252,
0.003550151363015175,
0.00014324544463306665,
-0.02306167036294937,
0.03455111384391785,
0.03561713546514511,
-0.011580709367990494,
0.026096919551491737,
0.017135562375187874,
-0.026612233370542526,
-0.0024570049718022346,
-0.017525795847177505,
-0.04760054871439934,
-0.0738031417131424,
0.01636628806591034,
-0.013593324460089207,
0.019673924893140793,
0.01214873231947422,
0.10468481481075287,
0.023911399766802788,
-0.00797237828373909,
-0.0023731295950710773,
0.0014543001307174563,
0.02621862106025219,
-0.024458911269903183,
-0.004966044798493385,
0.006885027978569269,
-0.009492053650319576,
0.051798880100250244,
-0.011886579915881157,
-0.053215496242046356,
-0.0022105679381638765,
-0.11771635711193085,
-0.012652513571083546,
0.046422094106674194,
0.04309236630797386,
0.009532096795737743,
0.07610280066728592,
0.033307015895843506,
-0.005419974680989981,
-0.03338700160384178,
-0.014828009530901909,
-0.007476833648979664,
0.022719312459230423,
0.07087768614292145,
-0.0137244937941432,
0.0062335580587387085,
-0.01953909918665886,
-0.01818656735122204,
0.055385470390319824,
-0.009540082886815071,
0.020775659009814262,
0.034514009952545166,
-0.04624894633889198,
0.022239014506340027,
-0.0011101526906713843,
0.01745966263115406,
-0.022519944235682487,
-0.0546250082552433,
-0.010602357797324657,
0.016803346574306488,
-0.023417087271809578,
0.038454364985227585,
-0.008231565356254578,
-0.047236472368240356,
0.025725310668349266,
0.007872339338064194,
-0.03643002733588219,
-0.06445319950580597,
-0.031645141541957855,
-0.05455692857503891,
-0.0026540111284703016,
0.026249704882502556,
0.06992020457983017,
-0.06387568265199661,
0.005173776764422655,
-0.005695226136595011,
-0.03122226893901825,
-0.030693380162119865,
0.05282912775874138,
0.013671401888132095,
0.018391339108347893,
0.02553698420524597,
-0.002168112201616168,
0.03714265301823616,
0.021597828716039658,
0.006095805671066046,
-0.06413459032773972,
0.02936101332306862,
-0.013700482435524464,
0.030059434473514557,
-0.018459469079971313,
-5.65336706220503e-33,
0.028199493885040283,
-0.04834435135126114,
0.027277253568172455,
0.020185096189379692,
0.031621817499399185,
0.08037120848894119,
0.02296263724565506,
0.020950468257069588,
0.001045799464918673,
0.04957344010472298,
0.027196107432246208,
0.0038924964610487223,
-0.013247623108327389,
0.08807916194200516,
-0.034820206463336945,
-0.05870679020881653,
0.010865967720746994,
0.062275517731904984,
0.020343860611319542,
-0.05240472033619881,
-0.07849708199501038,
-0.01764696091413498,
-0.009191103279590607,
-0.01078818365931511,
-0.056243885308504105,
0.019984368234872818,
-0.029436150565743446,
-0.016839003190398216,
0.014658859930932522,
0.02759378030896187,
0.01594718173146248,
0.024219943210482597,
0.0223986953496933,
0.05305878445506096,
0.04842605069279671,
0.03918076306581497,
-0.013808598741889,
-0.05249427631497383,
-0.036388885229825974,
0.019512487575411797,
-0.03784944862127304,
0.05154521390795708,
-0.03310973942279816,
-0.044250015169382095,
-0.07276643812656403,
0.0058592213317751884,
0.02348652109503746,
-0.0004846327647101134,
-0.054754067212343216,
-0.014735660515725613,
0.04704781994223595,
0.0094130365177989,
0.0735066682100296,
-0.02094293013215065,
0.004940403159707785,
0.10891712456941605,
0.008271684870123863,
0.0047056167386472225,
0.02182834967970848,
0.026800164952874184,
0.007684051524847746,
-0.04474008083343506,
-0.020938362926244736,
0.04326902702450752,
-0.006444791331887245,
0.031116319820284843,
0.037585992366075516,
-0.06089052930474281,
-0.0010330647928640246,
-0.05417795851826668,
-0.059875525534152985,
-0.06356024742126465,
0.032650914043188095,
0.057820774614810944,
-0.053875718265771866,
-0.0027536472771316767,
-0.01665543019771576,
0.005630409345030785,
-0.05252322182059288,
-0.022716205567121506,
0.011790384538471699,
-0.02666398696601391,
-0.03393084555864334,
-0.005301438271999359,
0.04395867511630058,
-0.005502132698893547,
-0.00676931906491518,
-0.029328877106308937,
0.06358493864536285,
-0.0013948152773082256,
0.030868230387568474,
0.04432820901274681,
0.039883293211460114,
-0.034686796367168427,
0.06725391000509262,
0.0016692953649908304,
0.0014602791052311659,
-0.036838747560977936,
-0.005125242285430431,
-0.04802580922842026,
0.009862523525953293,
0.019465848803520203,
0.038259200751781464,
0.011400915682315826,
0.0023672934621572495,
-0.033593930304050446,
-0.01993907056748867,
-0.02890562266111374,
-0.021706681698560715,
0.017490435391664505,
0.05875086784362793,
0.014779673889279366,
-0.02475874312222004,
0.025461044162511826,
0.013486458919942379,
0.020182989537715912,
0.01842569001019001,
0.100279800593853,
0.003869476728141308,
-0.0357409305870533,
-0.017449896782636642,
-0.025022471323609352,
0.005483228713274002,
-0.03518080711364746,
-0.03699484467506409,
0.006040563341230154,
-0.013792523182928562,
0.05616071820259094,
-0.05750948190689087,
0.022280443459749222,
-0.02960827387869358,
-0.014101591892540455,
2.7872331997969013e-7,
0.026071710512042046,
0.03880279138684273,
-0.014073380269110203,
-0.01690324768424034,
-0.00774057162925601,
0.015191433019936085,
0.03731878846883774,
-0.035227809101343155,
0.012225491926074028,
0.006377790123224258,
0.04548323526978493,
-0.060495525598526,
-0.02412652038037777,
-0.03240617737174034,
0.0069587696343660355,
-0.04023837670683861,
-0.0021728556603193283,
-0.008727343752980232,
0.0135169867426157,
-0.010027388110756874,
0.029066480696201324,
-0.014162696897983551,
-0.018748251721262932,
-0.026573877781629562,
-0.008401612751185894,
-0.05966976657509804,
-0.009250073693692684,
-0.04669652134180069,
0.0035099221859127283,
0.003166254609823227,
0.049981046468019485,
0.025183966383337975,
0.05289774015545845,
0.0887463316321373,
-0.01661410927772522,
-0.04683887958526611,
-0.019831154495477676,
0.002944649662822485,
-0.01820167526602745,
0.04880266636610031,
-0.008623262867331505,
-0.001291659427806735,
0.05480879545211792,
-0.05548617243766785,
0.027249615639448166,
-0.027158107608556747,
-0.00805529486387968,
-0.0001836941810324788,
0.020307762548327446,
-0.05561675876379013,
0.039514537900686264,
-0.03736088052392006,
-0.05922148376703262,
0.03380304574966431,
0.02357104979455471,
0.05321725085377693,
-0.0434877835214138,
-0.040292784571647644,
0.014277508482336998,
-0.027045808732509613,
0.0170346200466156,
-0.033491864800453186,
0.052770890295505524,
-0.03892816603183746,
-0.007634715177118778,
-0.05965307354927063,
-0.020751439034938812,
2.073223289553855e-34,
0.05754055455327034,
0.028610320761799812,
-0.00497464882209897,
-0.06465285271406174,
0.03203826770186424,
-0.03491285443305969,
-0.007240520790219307,
-0.0680306926369667,
0.013280005194246769,
-0.01557123102247715,
0.00808767881244421
] | {
"ds_index": 60,
"similar_dg_indices": [
902996,
1066217,
1143010,
1040746,
902983,
587930,
175483,
211350,
512003,
132961,
190279,
493585,
615568,
995949,
195426,
881957,
628904,
698621,
622361,
666803
]
} |
A healthy 22-year-old male participates in a research study you are leading to compare the properties of skeletal and cardiac muscle. You conduct a 3-phased experiment with the participant. In the first phase, you get him to lift up a 2.3 kg (5 lb) weight off a table with his left hand. In the second phase, you get him to do 20 burpees, taking his heart rate to 150/min. In the third phase, you electrically stimulate his gastrocnemius with a frequency of 50 Hz. You are interested in the tension and electrical activity of specific muscles as follows: Biceps in phase 1, cardiac muscle in phase 2, and gastrocnemius in phase 3. What would you expect to be happening in the phases and the respective muscles of interest? | Increase of tension in all phases | {
"A": "Recruitment of small motor units at the start of experiments 1 and 2",
"B": "Recruitment of large motor units followed by small motor units in experiment 1",
"C": "Fused tetanic contraction at the end of all three experiments",
"D": "Increase of tension in all phases"
} | step1 | D | [
"healthy",
"year old male",
"research study",
"leading to compare",
"properties",
"skeletal",
"cardiac muscle",
"conduct",
"3-phased experiment",
"participant",
"first phase",
"to lift",
"kg",
"5",
"weight",
"table",
"left hand",
"second phase",
"to",
"20",
"taking",
"heart rate",
"min",
"third phase",
"electrically",
"gastrocnemius",
"frequency",
"50 Hz",
"interested",
"tension",
"electrical",
"specific muscles",
"follows",
"Biceps",
"phase 1",
"cardiac muscle",
"phase 2",
"gastrocnemius",
"phase 3",
"to",
"phases",
"muscles",
"interest"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A healthy 22-year-old male participates in a research study you are leading to compare the properties of skeletal and cardiac muscle. You conduct a 3-phased experiment with the participant. In the first phase, you get him to lift up a 2.3 kg (5 lb) weight off a table with his left hand. In the second phase, you get him to do 20 burpees, taking his heart rate to 150/min. In the third phase, you electrically stimulate his gastrocnemius with a frequency of 50 Hz. You are interested in the tension and electrical activity of specific muscles as follows: Biceps in phase 1, cardiac muscle in phase 2, and gastrocnemius in phase 3. What would you expect to be happening in the phases and the respective muscles of interest?
Choose one of the following::
A. Recruitment of small motor units at the start of experiments 1 and 2
B. Recruitment of large motor units followed by small motor units in experiment 1
C. Fused tetanic contraction at the end of all three experiments
D. Increase of tension in all phases | [
0.017001470550894737,
-0.03870546817779541,
-0.00889584794640541,
0.028869014233350754,
-0.0055663795210421085,
-0.0032840531785041094,
0.052714284509420395,
0.023762844502925873,
-0.021603375673294067,
-0.00020742131164297462,
-0.013202346861362457,
-0.027977295219898224,
0.03293542191386223,
-0.016541242599487305,
-0.005643393844366074,
0.01543754804879427,
0.014501669444143772,
-0.008349459618330002,
-0.013607206754386425,
-0.026873107999563217,
-0.024402650073170662,
-0.023877164348959923,
-0.023207873106002808,
0.00046865185140632093,
0.04049777612090111,
0.021160664036870003,
-0.057839132845401764,
0.012191010639071465,
0.01804703287780285,
-0.03751145303249359,
-0.010681794956326485,
0.07389301061630249,
-0.028069796040654182,
0.019902970641851425,
0.0000019065569176746067,
-0.017815254628658295,
0.016278600320219994,
0.022913672029972076,
0.0231269970536232,
-0.01754312962293625,
0.05876586213707924,
0.03142205998301506,
0.0011518035316839814,
-0.021923264488577843,
-0.020970553159713745,
-0.03669598326086998,
-0.017942557111382484,
-0.01987190917134285,
-0.010390362702310085,
0.013135124929249287,
-0.01687784120440483,
0.06875865161418915,
-0.08306577801704407,
-0.04157840088009834,
0.058767158538103104,
0.005353189073503017,
-0.0032046965789049864,
-0.02330159582197666,
0.07518012821674347,
0.044380489736795425,
-0.025889236479997635,
-0.008003583177924156,
-0.011774681508541107,
0.06278137117624283,
0.04942663013935089,
0.007720704656094313,
-0.03705758601427078,
-0.03394265100359917,
-0.0040978663600981236,
0.009807446971535683,
0.025670433416962624,
0.05383096635341644,
0.04247308894991875,
0.047154609113931656,
-0.0019354071700945497,
0.049282703548669815,
-0.011163029819726944,
-0.021597588434815407,
-0.012440944090485573,
-0.028046967461705208,
-0.008443675003945827,
0.024203967303037643,
-0.006390959024429321,
-0.04361795261502266,
-0.02980608120560646,
0.006074868142604828,
0.025965768843889236,
-0.02709982544183731,
0.04510118067264557,
0.030963663011789322,
0.01094752550125122,
-0.07099057734012604,
0.029060622677206993,
-0.006904971320182085,
0.0014316780725494027,
0.0010344961192458868,
0.00768683897331357,
-0.08665310591459274,
0.06248108297586441,
-0.04602210968732834,
-0.07913107424974442,
-0.0026012887246906757,
0.056272510439157486,
-0.01156284473836422,
0.006951292511075735,
-0.017419680953025818,
-0.05722643435001373,
0.021303815767169,
-0.0298064723610878,
0.10149160027503967,
-0.052870869636535645,
-0.0075616901740431786,
0.02521197311580181,
0.05003136023879051,
0.0001965148840099573,
-0.01616864837706089,
-0.04258454591035843,
-0.012832709588110447,
0.002515566535294056,
0.01435831654816866,
-0.07836131006479263,
-0.013601765967905521,
-0.01650942489504814,
0.025991378352046013,
0.018577871844172478,
0.03096858039498329,
-0.02600589394569397,
0.05490631237626076,
0.014370210468769073,
0.00907156616449356,
-0.015830038115382195,
-0.05959340184926987,
-0.022604966536164284,
0.003698884742334485,
-0.002521843183785677,
-0.04382287338376045,
0.002494296757504344,
0.05337616801261902,
-0.028542229905724525,
-0.0643845796585083,
0.029199933633208275,
-0.025576433166861534,
0.030598249286413193,
0.008722642436623573,
0.020031210035085678,
0.053213100880384445,
0.01336451806128025,
0.09885399788618088,
0.01537261251360178,
0.031773488968610764,
-0.013621412217617035,
0.07405370473861694,
-0.013812755234539509,
0.020650815218687057,
-0.012132295407354832,
0.03280682489275932,
0.032978374511003494,
0.02513122372329235,
-0.0024957258719950914,
-0.015234099701046944,
0.007525320164859295,
-0.021301519125699997,
0.017078693956136703,
-0.007682221010327339,
0.003754223231226206,
0.00019999805954284966,
-0.00018870661733672023,
-0.05494038760662079,
0.01991245336830616,
0.03695463016629219,
-0.01716897077858448,
0.006287987809628248,
0.009429416619241238,
0.12248241901397705,
0.01709599234163761,
0.04377512261271477,
-0.04073551297187805,
0.024999096989631653,
-0.07377316057682037,
-0.018148621544241905,
0.06727597862482071,
0.04449563845992088,
-0.033099785447120667,
-0.010002711787819862,
-0.005261578597128391,
0.021017014980316162,
-0.05204241722822189,
-0.03173154592514038,
-0.041589103639125824,
-0.029978254809975624,
-0.014846604317426682,
-0.027851618826389313,
-0.0192461758852005,
-0.012979468330740929,
0.06684431433677673,
0.060252148658037186,
-0.01350157056003809,
-0.018422596156597137,
-0.002102489583194256,
-0.015108905732631683,
0.02840728685259819,
0.006127148400992155,
-0.010477789677679539,
-0.0060538542456924915,
-0.034412235021591187,
-0.017369505017995834,
0.03713883459568024,
0.001242264756001532,
0.03868333250284195,
-0.006638027261942625,
0.006916182115674019,
0.05607003718614578,
0.002650681184604764,
-0.03674174100160599,
-0.033522509038448334,
-0.04175666719675064,
-0.005460616201162338,
0.014235350303351879,
-0.0814601331949234,
0.013415630906820297,
-0.028040817007422447,
0.019926900044083595,
0.06384924799203873,
-0.016389621421694756,
-0.08986662328243256,
0.026164164766669273,
-0.02212705835700035,
0.008824164047837257,
-0.006478955037891865,
-0.0530991293489933,
0.0026792087592184544,
-0.007490007672458887,
-0.030472436919808388,
-0.015355518087744713,
-0.03771621361374855,
-0.0024106092751026154,
0.04303673282265663,
0.013277718797326088,
-0.019982414320111275,
0.050348713994026184,
0.009661017917096615,
-0.057808175683021545,
-0.0006046026246622205,
-0.048014797270298004,
-0.006432788912206888,
0.005885711871087551,
0.030898986384272575,
0.07186399400234222,
-0.03741849586367607,
0.015124613419175148,
-0.027722053229808807,
-0.01164072286337614,
-0.03276192396879196,
0.05811529979109764,
0.002822991693392396,
0.05733904615044594,
-0.030706755816936493,
0.024179119616746902,
-0.04226800426840782,
-0.10994571447372437,
0.0344729907810688,
-0.048135336488485336,
-0.07173913717269897,
-0.006831237580627203,
-0.0320780873298645,
-0.007041598204523325,
-0.03430086001753807,
0.006019622553139925,
0.018363354727625847,
0.05330715328454971,
0.030600838363170624,
-0.005320425610989332,
0.012441817671060562,
-0.026604747399687767,
-0.0030367623548954725,
-0.0006306713912636042,
-0.006642433814704418,
0.0092158243060112,
0.007100379094481468,
0.013531291857361794,
0.02668140083551407,
0.06593833863735199,
-0.027748102322220802,
0.004366246052086353,
-0.005511624738574028,
0.09050851315259933,
0.08134954422712326,
-0.00810189638286829,
0.05677609145641327,
0.017921142280101776,
0.05114436894655228,
0.026672102510929108,
0.03432324901223183,
-0.06302399188280106,
0.011487456038594246,
0.032594796270132065,
0.02841646783053875,
0.06603790074586868,
0.041012439876794815,
0.006501213181763887,
0.04332413524389267,
0.05165988579392433,
0.01011734176427126,
-0.010035979561507702,
-0.04626305401325226,
-0.003155582118779421,
-0.011014989577233791,
-0.0785125344991684,
-0.02547427825629711,
0.06048007309436798,
0.07932744920253754,
-0.0018051320221275091,
-0.009380402974784374,
0.007183965761214495,
-0.009732119739055634,
-0.03585243225097656,
0.006351990159600973,
-0.048094578087329865,
0.011293171904981136,
-0.00016463163774460554,
0.01575714722275734,
0.02453812025487423,
0.041340820491313934,
0.020287999883294106,
-0.013492551632225513,
0.008464121259748936,
0.049546901136636734,
0.030913295224308968,
0.04251500219106674,
-0.03532782196998596,
0.00015901593724265695,
0.03273078426718712,
-0.0017073587514460087,
-0.0021625410299748182,
0.020535800606012344,
-0.006390504539012909,
-0.021929258480668068,
-0.052579864859580994,
-0.018257202580571175,
0.02834201231598854,
-0.014609928242862225,
-0.039765190333127975,
-0.01225406676530838,
0.05501808226108551,
0.011163370683789253,
-0.04585449770092964,
-0.03934353590011597,
0.03575432300567627,
0.03442571312189102,
-0.04523657262325287,
0.05487024039030075,
-0.03926350176334381,
-0.04763740301132202,
-0.021995503455400467,
-0.06657145917415619,
-0.02065329998731613,
-0.004602602683007717,
0.051207851618528366,
-0.03189234435558319,
-0.017468443140387535,
0.021127751097083092,
0.0005458699888549745,
0.033394355326890945,
0.07619647681713104,
-0.07664719223976135,
0.007677736692130566,
-0.013681241311132908,
-0.019193988293409348,
-0.010590076446533203,
-0.048271723091602325,
0.014072912745177746,
0.010015642270445824,
-0.009519257582724094,
0.02929975651204586,
-0.009341667406260967,
-0.05025085434317589,
-0.000119178177556023,
-0.0006893663667142391,
-0.08109083026647568,
-0.013361399061977863,
0.026386573910713196,
-0.01641164720058441,
0.05294117331504822,
0.0020758400205522776,
0.03751156106591225,
0.006311744451522827,
0.04698078706860542,
-0.012470419518649578,
-0.021560857072472572,
0.04778728261590004,
0.005363098345696926,
0.03835083171725273,
-0.04341467469930649,
-0.06763593852519989,
0.040775466710329056,
-0.019108230248093605,
0.0014375970931723714,
-0.005120602902024984,
0.020075125619769096,
0.08705737441778183,
0.0022498120088130236,
0.00902086403220892,
-0.004320287611335516,
-0.011364971287548542,
0.006666967179626226,
-0.007222667336463928,
-0.04591650143265724,
-0.04270379990339279,
-0.05202639475464821,
0.016376417130231857,
0.052482299506664276,
-0.033174145966768265,
-0.01841680333018303,
-0.030730877071619034,
0.019680695608258247,
0.07144191116094589,
-0.012003612704575062,
-0.04668987914919853,
0.035351816564798355,
-0.06986718624830246,
-0.00605706637725234,
0.016944756731390953,
-0.019912678748369217,
-0.02849382907152176,
-0.026469197124242783,
-0.042572882026433945,
0.07623988389968872,
0.05558514595031738,
-0.0067314631305634975,
0.0015489960787817836,
-0.03909851238131523,
-0.008356139063835144,
0.007730091921985149,
0.09114663302898407,
-0.02304634265601635,
0.019641412422060966,
-0.01898292638361454,
-0.007197174243628979,
0.054932259023189545,
0.011993510648608208,
-0.0049946121871471405,
-0.027452632784843445,
0.0598280169069767,
0.04374430701136589,
0.08264081925153732,
0.05262210965156555,
-0.014887621626257896,
0.042878229171037674,
0.040858443826436996,
0.10596194863319397,
-0.0022949951235204935,
0.07824288308620453,
-0.05603261664509773,
0.013735664077103138,
0.02862270548939705,
0.026168854907155037,
-0.06963591277599335,
-0.04307299479842186,
0.03219042345881462,
0.0006650649011135101,
0.029386740177869797,
0.01784273236989975,
0.016075918450951576,
-0.06473053246736526,
-0.01539018377661705,
-0.06617660075426102,
-0.07140590250492096,
-0.016605067998170853,
0.01221380103379488,
-0.009610870853066444,
0.02735486999154091,
-0.006096294615417719,
-0.01883201114833355,
0.03614389896392822,
-0.004549376200884581,
-0.006191488355398178,
-0.027407096698880196,
-0.06259987503290176,
-0.03270644694566727,
0.003692525438964367,
0.007901631295681,
0.031961891800165176,
-0.02123621664941311,
-0.011420776136219501,
-0.014367037452757359,
0.0427137166261673,
0.027279643341898918,
0.032010894268751144,
-0.04296218976378441,
-0.04941001906991005,
0.00428065424785018,
-0.012370635755360126,
0.009153498336672783,
-0.05549433454871178,
-0.05068303272128105,
-0.017531191930174828,
0.014202986843883991,
0.07285572588443756,
-0.0035541094839572906,
0.01981172524392605,
0.0032583598513156176,
-0.00007295365503523499,
0.0017005738336592913,
0.04366077855229378,
-0.005077983718365431,
-0.01104317232966423,
-0.01877284049987793,
-0.006953136064112186,
-0.035362083464860916,
-0.06214432045817375,
-0.0025372367817908525,
0.02834087796509266,
-0.006915689446032047,
0.1072305366396904,
0.0450667142868042,
-0.08187787234783173,
-0.09221183508634567,
0.011899260804057121,
0.007674704771488905,
0.01587715744972229,
-0.0037959956098347902,
-0.010915392078459263,
-0.0024524577893316746,
-0.06778134405612946,
0.1036219447851181,
0.029653513804078102,
-0.008249619044363499,
0.022918596863746643,
-0.013640944845974445,
0.04400250315666199,
-0.01288466528058052,
-0.016573958098888397,
-0.023561453446745872,
-0.058891162276268005,
0.027086783200502396,
0.018819518387317657,
0.039963435381650925,
-0.04546729475259781,
-0.03146371617913246,
-0.05481795221567154,
-0.025348616763949394,
-0.010434029623866081,
0.05122159421443939,
0.03873506560921669,
-0.007644670084118843,
-0.0274188295006752,
0.05509009212255478,
-0.03034391440451145,
-0.062379203736782074,
-0.029189592227339745,
0.028186358511447906,
0.020308973267674446,
0.005449251271784306,
-0.02920617163181305,
0.01681460253894329,
-5.651631371327644e-33,
0.03305116295814514,
-0.023405246436595917,
0.006178844254463911,
-0.0399547815322876,
-0.03352290391921997,
0.03770827874541283,
-0.07531296461820602,
0.018111886456608772,
0.0018638574983924627,
-0.00004090966103831306,
-0.016323022544384003,
-0.019713927060365677,
0.03490467369556427,
-0.0035124770365655422,
0.021559301763772964,
-0.07797803729772568,
-0.016193736344575882,
-0.008359810337424278,
0.009440130554139614,
-0.016836034134030342,
-0.03637253865599632,
0.03459000959992409,
-0.009798983111977577,
-0.04410649091005325,
0.009436095133423805,
0.009773154743015766,
-0.04422910884022713,
-0.03507265821099281,
-0.07174906879663467,
-0.008638565428555012,
-0.0051566073670983315,
-0.005991191137582064,
0.004385023377835751,
-0.05343983322381973,
-0.01748587004840374,
-0.009239554405212402,
-0.0017654610564932227,
-0.0007467783289030194,
-0.00391707569360733,
-0.008784998208284378,
-0.013993431814014912,
0.012621704488992691,
0.038125839084386826,
-0.012419737875461578,
0.011322466656565666,
-0.04291937127709389,
0.008645900525152683,
-0.005832586903125048,
0.06164019927382469,
-0.06195538863539696,
-0.008895156905055046,
-0.0093579376116395,
-0.018231969326734543,
0.011074555106461048,
-0.00006139410834293813,
-0.01449330523610115,
-0.014887985773384571,
-0.03965386748313904,
0.05344243720173836,
-0.01350952498614788,
0.0339365229010582,
0.02334187552332878,
-0.010790163651108742,
0.0028366707265377045,
-0.006442256271839142,
-0.016964273527264595,
-0.010642475448548794,
0.07459785044193268,
-0.020021287724375725,
0.007316023111343384,
-0.042145974934101105,
0.05294206365942955,
0.02426248975098133,
-0.016119539737701416,
-0.0059872400015592575,
-0.012132298201322556,
-0.04608161747455597,
0.03632446378469467,
0.09010285139083862,
-0.008908171206712723,
-0.11541251093149185,
-0.015528404153883457,
0.03920472413301468,
-0.013534042984247208,
0.015064855106174946,
-0.010452781803905964,
-0.028292518109083176,
-0.022761382162570953,
-0.027103224769234657,
-0.07207922637462616,
0.05110016092658043,
-0.029561739414930344,
-0.015134815126657486,
0.03082587569952011,
0.05475326627492905,
-0.04972337186336517,
0.050165172666311264,
-0.026888391003012657,
0.011335574090480804,
0.005293829366564751,
0.09312359243631363,
0.003325175726786256,
0.030610958114266396,
0.030288023874163628,
0.025353554636240005,
-0.04222342371940613,
-0.05136996507644653,
0.012936212122440338,
-0.00024895532988011837,
0.01534479670226574,
0.03358878195285797,
0.00008370370778720826,
0.015074633993208408,
-0.013322613202035427,
0.016462553292512894,
-0.002225081901997328,
0.012610825709998608,
0.015169595368206501,
-0.02757015824317932,
0.05150937661528587,
-0.02912123315036297,
0.07174912095069885,
-0.01386076956987381,
0.052354421466588974,
-0.009291653521358967,
-0.06540897488594055,
0.01879631169140339,
0.037497635930776596,
-0.055024079978466034,
-0.047714754939079285,
-0.004617683589458466,
0.004068932496011257,
2.800808260872145e-7,
-0.018664712086319923,
-0.009780812077224255,
0.0002501111594028771,
0.02272975817322731,
-0.008004283532500267,
-0.005907448008656502,
-0.032250240445137024,
0.014177675358951092,
0.008056357502937317,
-0.029522525146603584,
0.05439296364784241,
0.018450792878866196,
0.010461422614753246,
-0.009801496751606464,
0.0166500024497509,
-0.11670771986246109,
0.04462515562772751,
0.030535869300365448,
-0.008213301189243793,
0.007666083052754402,
-0.020933061838150024,
-0.031809233129024506,
-0.061878353357315063,
0.0046179513446986675,
-0.04353520646691322,
0.026451891288161278,
-0.00540351215749979,
0.012952308170497417,
-0.029199136421084404,
-0.0040757241658866405,
0.008231247775256634,
-0.030276305973529816,
0.025555137544870377,
0.06477263569831848,
-0.028465965762734413,
0.002077791839838028,
0.008941699750721455,
0.038618817925453186,
0.018633337691426277,
-0.019127054139971733,
0.01549526397138834,
0.028716271743178368,
0.02692965231835842,
0.05153730511665344,
0.01830819807946682,
-0.03312152996659279,
-0.00490679731592536,
0.020245246589183807,
-0.006986512802541256,
-0.010387536138296127,
0.03291608765721321,
-0.022973787039518356,
0.0009252314921468496,
0.0542011596262455,
0.014957539737224579,
0.009715883061289787,
-0.039418283849954605,
0.061965201050043106,
0.04097742587327957,
0.0352611318230629,
-0.05574960634112358,
-0.050967007875442505,
0.019704598933458328,
0.02445247210562229,
0.04879393056035042,
-0.06291565299034119,
-0.060787588357925415,
2.537870262906241e-34,
-0.037114664912223816,
-0.007292445749044418,
-0.009184679947793484,
0.001901684096083045,
-0.004276663530617952,
-0.013159438967704773,
-0.01332024484872818,
0.030192798003554344,
0.013539640232920647,
-0.057624123990535736,
-0.01260689739137888
] | {
"ds_index": 61,
"similar_dg_indices": [
1096111,
462130,
694045,
648909,
4329,
426588,
161068,
712809,
908874,
672704,
500732,
1071193,
451332,
454324,
64805,
1182784,
738726,
441509,
904632,
745034
]
} |
A 20-year-old male comes into your office two days after falling during a pick up basketball game. The patient states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patient injured? | Medial collateral ligament | {
"A": "Posterior cruciate ligament",
"B": "Anterior cruciate ligament",
"C": "Medial collateral ligament",
"D": "Lateral collateral ligament"
} | step2&3 | C | [
"20 year old male",
"office two days",
"falling",
"pick",
"basketball game",
"patient states",
"lateral aspect of",
"knee",
"knee",
"exam",
"patient's appears",
"same size",
"left knee",
"swelling",
"effusion",
"patient",
"intact sensation",
"strength",
"lower extremities",
"patient's",
"laxity",
"varus stress test",
"more lax",
"valgus stress test",
"compared",
"left knee",
"Lachman's test",
"posterior drawer test",
"firm endpoints",
"laxity",
"following structures",
"patient injured"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 20-year-old male comes into your office two days after falling during a pick up basketball game. The patient states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patient injured?
Choose one of the following::
A. Posterior cruciate ligament
B. Anterior cruciate ligament
C. Medial collateral ligament
D. Lateral collateral ligament | [
-0.028893042355775833,
-0.09242673218250275,
-0.04244397580623627,
0.0782526284456253,
-0.04684639349579811,
-0.005099955480545759,
0.030835308134555817,
0.07534870505332947,
0.041342560201883316,
-0.005609550047665834,
0.08981043845415115,
-0.06609075516462326,
0.05774599686264992,
-0.06191135197877884,
0.059183571487665176,
0.026458673179149628,
-0.03061329945921898,
-0.00833836104720831,
-0.0020066811703145504,
-0.0346590019762516,
-0.014127139933407307,
0.015081793069839478,
-0.013966448605060577,
-0.0049644093960523605,
0.00788603164255619,
0.04294285550713539,
0.01254329178482294,
-0.019965797662734985,
0.016573507338762283,
-0.02328237146139145,
-0.007493896875530481,
0.03481713682413101,
-0.028149481862783432,
-0.08660202473402023,
0.0000018505539856050746,
0.0021488708443939686,
-0.011024675332009792,
-0.04545119032263756,
0.009975822642445564,
-0.028513478115200996,
-0.022707872092723846,
-0.06933130323886871,
-0.011306715197861195,
-0.034806136041879654,
0.011581363156437874,
-0.07336745411157608,
-0.02214515395462513,
0.053511764854192734,
-0.0646306499838829,
0.049708280712366104,
0.012675270438194275,
0.01697441376745701,
-0.02128060720860958,
-0.007231920957565308,
0.07652232050895691,
-0.08713007718324661,
-0.021939733996987343,
0.04936546832323074,
-0.009342764504253864,
0.0014706720830872655,
-0.02081248164176941,
-0.04672090709209442,
0.01653793267905712,
0.020417166873812675,
-0.0865318551659584,
0.03455036133527756,
0.04567587748169899,
-0.023452278226614,
0.032884061336517334,
0.009009597823023796,
0.060003072023391724,
0.02849441207945347,
0.04649076983332634,
0.0506269745528698,
-0.002754493383690715,
-0.0015547382645308971,
0.08643695712089539,
0.004193006549030542,
0.01807001233100891,
-0.06051318719983101,
-0.0003931853570975363,
0.0452657975256443,
-0.031132061034440994,
0.005212211515754461,
-0.01753678359091282,
-0.1252753734588623,
0.03879162669181824,
0.01222683023661375,
-0.016887612640857697,
0.03922007977962494,
0.028467610478401184,
-0.05287391319870949,
0.014414059929549694,
0.011117180809378624,
-0.05354195833206177,
-0.04668149724602699,
-0.02686072140932083,
-0.04418647289276123,
0.043909065425395966,
-0.059744592756032944,
0.024517802521586418,
0.014657692052423954,
0.022510774433612823,
0.0031502079218626022,
-0.03671467304229736,
0.013408320024609566,
-0.03516385331749916,
0.008373631164431572,
-0.04299315810203552,
0.06695272028446198,
-0.010437261313199997,
0.008882272988557816,
0.02909245528280735,
0.025851400569081306,
-0.0010960750514641404,
0.012536072172224522,
-0.010759872384369373,
-0.03477943688631058,
0.011002988554537296,
0.01690582185983658,
-0.07669687271118164,
0.0038099263329058886,
0.03270682692527771,
0.023709872737526894,
-0.020854545757174492,
0.021602977067232132,
-0.03286384046077728,
-0.0005831769667565823,
-0.00944308377802372,
0.026778461411595345,
0.024236008524894714,
0.02155190333724022,
-0.0328194797039032,
0.042707186192274094,
-0.011809295043349266,
-0.010218457318842411,
0.017853615805506706,
0.06430327147245407,
-0.04926832392811775,
-0.024352530017495155,
0.005772571079432964,
-0.06500092893838882,
0.0037583999801427126,
0.00009436985419597477,
0.040776096284389496,
0.020053796470165253,
-0.011688997969031334,
-0.001923455623909831,
-0.0009141560876742005,
0.023451946675777435,
-0.04238735884428024,
0.017659632489085197,
-0.004415648058056831,
0.011766218580305576,
0.0053334347903728485,
0.023317202925682068,
0.029779672622680664,
-0.03424698859453201,
-0.020935771986842155,
-0.027565907686948776,
-0.006054764613509178,
-0.02121908776462078,
-0.020573563873767853,
-0.04562775790691376,
-0.01446138508617878,
0.008970030583441257,
-0.040695201605558395,
0.04323238134384155,
0.0018084467155858874,
0.026646645739674568,
-0.06851286441087723,
0.05923585966229439,
-0.0019113927846774459,
0.026829801499843597,
-0.026018578559160233,
0.041926223784685135,
-0.004887960385531187,
-0.06034279242157936,
-0.014401914551854134,
-0.03745676949620247,
0.004363159649074078,
0.04132792726159096,
0.035247523337602615,
-0.03233857452869415,
-0.025567676872015,
-0.007190742529928684,
-0.043662115931510925,
-0.031283073127269745,
-0.02728447876870632,
-0.045597631484270096,
-0.07085741311311722,
0.03880070149898529,
-0.05895503982901573,
0.023222794756293297,
0.02212604135274887,
0.044229816645383835,
-0.0009399185655638576,
0.0583924725651741,
-0.012928652577102184,
0.02814817614853382,
-0.036429256200790405,
0.012942323461174965,
0.041669249534606934,
0.009604545310139656,
-0.05479424446821213,
0.026847224682569504,
-0.002162674441933632,
0.019537925720214844,
0.026087114587426186,
0.002842563670128584,
0.04392625018954277,
0.029764387756586075,
0.022772980853915215,
-0.03371410071849823,
0.03737790137529373,
0.03230983391404152,
0.022708894684910774,
0.015633124858140945,
-0.09285739064216614,
0.02490314096212387,
0.007010847330093384,
-0.03171157464385033,
0.02556135691702366,
0.0072860498912632465,
-0.03664779290556908,
0.04471351206302643,
0.012501214630901814,
0.00791588332504034,
-0.05310610309243202,
-0.03285190090537071,
0.035021908581256866,
-0.003165953094139695,
0.01010950468480587,
0.0341481938958168,
-0.029561296105384827,
0.0017853120807558298,
0.005119387060403824,
-0.03616628050804138,
0.01602054387331009,
0.04089821130037308,
-0.012986548244953156,
-0.07206619530916214,
-0.008835447952151299,
-0.043052781373262405,
0.020069144666194916,
-0.024253007024526596,
0.004047732800245285,
0.023305250331759453,
-0.01715865731239319,
0.0542348213493824,
-0.07105419039726257,
-0.021584682166576385,
0.018399115651845932,
0.03497437760233879,
0.009609929285943508,
0.021987194195389748,
-0.010151236318051815,
0.012983956374228,
-0.035948123782873154,
-0.04485563933849335,
-0.0011945522855967283,
-0.0418279729783535,
0.005631632171571255,
-0.019476432353258133,
0.012450442649424076,
-0.00808420218527317,
-0.021067755296826363,
0.047323692589998245,
0.018493009731173515,
-0.008521784096956253,
0.010159341618418694,
-0.012624181807041168,
0.03010478988289833,
-0.003811115166172385,
-0.0153631791472435,
0.005255933851003647,
0.005517682526260614,
0.02578645758330822,
0.02255934663116932,
0.019934585317969322,
0.016254575923085213,
0.09056287258863449,
-0.02731826715171337,
-0.009312895126640797,
0.014097592793405056,
-0.014402210712432861,
-0.005521208047866821,
-0.010630771517753601,
-0.005675906781107187,
-0.007677177898585796,
-0.01002119667828083,
-0.03480435535311699,
0.045021284371614456,
-0.026751309633255005,
-0.034448232501745224,
-0.032981012016534805,
0.0053681847639381886,
0.023772628977894783,
-0.005175490397959948,
0.06542503088712692,
0.009689823724329472,
0.018085531890392303,
0.027219515293836594,
0.00984626542776823,
0.01862398348748684,
0.03031672164797783,
0.010393678210675716,
-0.03518395870923996,
0.010255790315568447,
-0.0303844902664423,
0.04404425993561745,
0.0026316014118492603,
-0.019383275881409645,
-0.04697374999523163,
-0.020521080121397972,
0.011753244325518608,
-0.010773713700473309,
-0.05264770984649658,
-0.011007585562765598,
0.014556488022208214,
0.020681461319327354,
0.06299121677875519,
0.0016511694993823767,
0.01818954572081566,
0.016920562833547592,
0.008396035060286522,
0.030772047117352486,
0.0076462882570922375,
0.012455182150006294,
0.00662958063185215,
0.00889475829899311,
-0.030776411294937134,
-0.031443070620298386,
0.030920138582587242,
0.0898408517241478,
0.01713811233639717,
-0.017650576308369637,
-0.027381442487239838,
-0.019951488822698593,
0.001182460691779852,
-0.0073982649482786655,
-0.04285070300102234,
-0.011708912439644337,
0.03640678524971008,
0.06649485230445862,
0.0068791829980909824,
-0.09556660056114197,
0.027708500623703003,
-0.012188181281089783,
-0.001911620725877583,
-0.08023323863744736,
-0.0033709800336509943,
-0.03818477317690849,
0.03316759690642357,
-0.030879748985171318,
0.04098223149776459,
0.020881403237581253,
0.0688394159078598,
-0.01761501654982567,
-0.007301244419068098,
-0.0169600211083889,
0.05214225873351097,
-0.019604936242103577,
0.061087530106306076,
0.022610196843743324,
-0.021397901698946953,
-0.03796735778450966,
-0.005519791506230831,
-0.013597238808870316,
0.007296091876924038,
-0.013852209784090519,
0.02579416148364544,
-0.030456507578492165,
0.006264971569180489,
-0.04393325001001358,
0.025282995775341988,
-0.004857417196035385,
0.01741708070039749,
-0.1039198487997055,
-0.02372853085398674,
0.042240116745233536,
-0.030084092170000076,
0.034956399351358414,
0.012316225096583366,
-0.01257789134979248,
0.04979891702532768,
-0.012613807804882526,
0.021876482293009758,
-0.005985214840620756,
0.050032228231430054,
-0.006020323373377323,
-0.03524791821837425,
-0.026748504489660263,
0.02366560883820057,
0.01238817349076271,
0.03096456453204155,
0.016021599993109703,
0.012808655388653278,
0.004120126366615295,
0.04371710866689682,
-0.026403112336993217,
0.04485366493463516,
-0.04525327682495117,
0.024803636595606804,
-0.01135025080293417,
-0.030617544427514076,
-0.07866371423006058,
-0.003301263554021716,
-0.02895813249051571,
-0.014548197388648987,
0.039249058812856674,
-0.03825296089053154,
0.026650702580809593,
0.0024719377979636192,
0.03815339505672455,
0.060353707522153854,
0.006139275152236223,
-0.042569179087877274,
0.015006639994680882,
-0.025096049532294273,
0.05563301965594292,
-0.01495183352380991,
0.0067959679290652275,
-0.03848107159137726,
-0.006679332349449396,
-0.029869943857192993,
0.05150897055864334,
0.03312619403004646,
-0.016113676130771637,
0.021883472800254822,
0.03174596279859543,
-0.06649018824100494,
0.044090766459703445,
0.07036187499761581,
-0.00858354289084673,
0.003188976552337408,
-0.038269203156232834,
0.000013565011613536626,
0.0234769806265831,
-0.003178233513608575,
-0.03653036430478096,
0.03581490367650986,
0.07272703945636749,
0.007402070797979832,
0.030137592926621437,
-0.09789443016052246,
-0.0006261638482101262,
-0.022049320861697197,
0.009756794199347496,
0.0685986801981926,
0.01422926876693964,
0.054876696318387985,
0.0476115457713604,
0.04108699411153793,
-0.006045273505151272,
0.0014711183030158281,
-0.033417314291000366,
0.026115888729691505,
-0.011867035180330276,
0.020544683560729027,
-0.0147743234410882,
0.013155702501535416,
-0.0628407895565033,
-0.07839583605527878,
0.02479424700140953,
-0.045844946056604385,
-0.04440600425004959,
-0.06453811377286911,
-0.0022336069960147142,
-0.031999945640563965,
-0.06858991086483002,
0.007079625967890024,
-0.004056043457239866,
0.016333740204572678,
0.005054729990661144,
-0.036597758531570435,
-0.03935058414936066,
0.013789140619337559,
-0.014290749095380306,
0.010698403231799603,
0.045705728232860565,
0.022808806970715523,
-0.011665372177958488,
-0.03817061334848404,
0.01001909002661705,
0.04727938398718834,
0.04515068605542183,
-0.015237856656312943,
0.06479717046022415,
-0.01295615267008543,
0.05288755148649216,
-0.01972358487546444,
-0.03220152482390404,
-0.02688717469573021,
-0.015410429798066616,
0.06540700048208237,
-0.0454925037920475,
0.04390973970293999,
0.07725406438112259,
-0.019800884649157524,
0.007825247012078762,
0.027961373329162598,
0.006842156406491995,
0.03263881057500839,
0.020202921703457832,
0.0691336914896965,
-0.054313044995069504,
0.013608656823635101,
-0.03506409004330635,
-0.03602844104170799,
-0.03261903300881386,
0.02764909900724888,
0.03479449450969696,
0.04178719222545624,
0.010531775653362274,
-0.01143869198858738,
-0.022127578034996986,
-0.04001964256167412,
0.009488321840763092,
0.0029913492035120726,
-0.005919874645769596,
-0.021874645724892616,
-0.013339361175894737,
-0.023704439401626587,
-0.044492240995168686,
0.033232513815164566,
-0.013196630403399467,
0.01978006400167942,
0.007299021817743778,
0.029805554077029228,
-0.05579131096601486,
-0.022203955799341202,
-0.06790779531002045,
0.025830231606960297,
-0.04556518420577049,
0.017482353374361992,
-0.010673092678189278,
-0.0036867379676550627,
0.0005867599393241107,
-0.07051018625497818,
-0.02842009626328945,
0.024853728711605072,
-0.023547986522316933,
-0.0029800646007061005,
-0.008537109941244125,
0.004705998580902815,
-0.0040772357024252415,
0.004204174503684044,
0.06739769876003265,
-0.002948505338281393,
-0.007256455719470978,
0.0866343304514885,
-0.0069055818021297455,
0.03235975652933121,
-0.014356587082147598,
-5.717509013483602e-33,
0.06047568470239639,
-0.017517026513814926,
0.017298918217420578,
-0.06570655852556229,
0.008839353919029236,
0.1336880773305893,
-0.03542844578623772,
-0.0033909459598362446,
-0.047905199229717255,
-0.0036987625062465668,
0.04795299097895622,
0.012199745513498783,
0.02750767022371292,
0.026796067133545876,
0.06450332701206207,
-0.046420224010944366,
-0.005879523232579231,
-0.009935039095580578,
-0.016925698146224022,
-0.047708284109830856,
-0.029787607491016388,
-0.022724296897649765,
0.0448877215385437,
-0.058689408004283905,
0.002813055645674467,
-0.10225021094083786,
0.03410043194890022,
-0.001313219079747796,
-0.08766031265258789,
0.00012636651808861643,
0.012945806607604027,
-0.0576479472219944,
0.03560261428356171,
-0.02185184136033058,
0.01869654841721058,
-0.05144964158535004,
-0.004582163877785206,
-0.03810086473822594,
0.010002394206821918,
0.00026873580645769835,
-0.06972052156925201,
-0.011671089567244053,
-0.004373292904347181,
-0.02314968779683113,
0.02999836951494217,
-0.05115731433033943,
-0.0360928475856781,
0.02570391446352005,
0.06466368585824966,
-0.03055291250348091,
-0.017840448766946793,
0.02690337412059307,
-0.018225453794002533,
-0.004873321391642094,
-0.033666498959064484,
0.01001092791557312,
-0.002789350226521492,
-0.013100693933665752,
-0.009081739000976086,
-0.02004658617079258,
-0.01430518552660942,
0.00797615759074688,
-0.025267353281378746,
-0.05307278409600258,
-0.05048947036266327,
0.008514144457876682,
0.01181090623140335,
0.0636729747056961,
-0.028729042038321495,
-0.03073089011013508,
-0.08636441826820374,
0.041634026914834976,
0.042098838835954666,
-0.018477819859981537,
0.005513290408998728,
-0.05720805004239082,
-0.02057367004454136,
0.021533489227294922,
0.08389365673065186,
0.013749675825238228,
-0.06538181006908417,
0.004628809634596109,
-0.10403933376073837,
-0.031545430421829224,
0.024164145812392235,
-0.041868917644023895,
0.012646838091313839,
-0.05361029878258705,
0.01637093722820282,
-0.048457469791173935,
0.07038906216621399,
-0.0012798076495528221,
0.018840234726667404,
0.07963690906763077,
0.08731415867805481,
-0.05790925398468971,
0.0424884632229805,
0.03731079772114754,
0.010293635539710522,
0.02890832908451557,
0.013139384798705578,
0.027661172673106194,
0.009773021563887596,
-0.020184766501188278,
-0.03465509042143822,
-0.011861326172947884,
-0.03721889480948448,
-0.005156108643859625,
0.005550774745643139,
0.0078612444922328,
0.026800962164998055,
-0.06353647261857986,
0.031062539666891098,
0.02460525929927826,
0.03377358987927437,
0.07322743535041809,
0.01496192067861557,
0.027701273560523987,
0.05285649001598358,
0.03358995169401169,
-0.012399458326399326,
0.04229969531297684,
-0.02590777538716793,
-0.0003965315409004688,
-0.007449995260685682,
-0.03653373196721077,
0.07532382011413574,
0.00668113399296999,
-0.037361860275268555,
-0.005540103185921907,
0.02163204923272133,
0.03185175731778145,
2.581493561137904e-7,
0.004699490033090115,
-0.02953551895916462,
-0.006886308081448078,
-0.06681348383426666,
-0.0007732310914434493,
-0.032280415296554565,
0.024561116471886635,
0.03310749679803848,
0.038493528962135315,
-0.02080574259161949,
0.015356097370386124,
0.007571582682430744,
0.024559393525123596,
0.04449794813990593,
0.02871621586382389,
-0.009415018372237682,
0.033227305859327316,
-0.016539327800273895,
0.0018151166150346398,
0.0032426558900624514,
-0.005701447371393442,
-0.06435497850179672,
-0.08729902654886246,
-0.00373551482334733,
0.008851172402501106,
0.005810197442770004,
-0.02455567941069603,
-0.016942335292696953,
0.02270345948636532,
-0.029986653476953506,
-0.014013870619237423,
-0.00788408424705267,
-0.009809396229684353,
0.08232082426548004,
-0.026513760909438133,
-0.01028362289071083,
0.012689362280070782,
0.040180955082178116,
-0.011021051555871964,
0.05962257459759712,
-0.013008639216423035,
-0.019837839528918266,
0.018162881955504417,
0.03339529410004616,
0.06389884650707245,
0.041440095752477646,
-0.005136045627295971,
0.004101464990526438,
-0.033642616122961044,
0.013712500222027302,
0.03287831321358681,
-0.01667807623744011,
0.034733325242996216,
0.05609246343374252,
-0.009166272357106209,
0.0030994100961834192,
-0.03156432509422302,
0.036971330642700195,
0.041317958384752274,
0.03972107544541359,
0.0013211342738941312,
0.044344689697027206,
0.03661716356873512,
-0.009138739667832851,
0.04248587787151337,
-0.08606944978237152,
-0.07328703254461288,
2.0405332967527162e-34,
-0.03963218256831169,
-0.0010469892295077443,
0.03651507571339607,
-0.02575036697089672,
0.0036177807487547398,
0.005998081061989069,
-0.008415419608354568,
0.015437123365700245,
0.0015840547857806087,
-0.038698725402355194,
-0.030137669295072556
] | {
"ds_index": 62,
"similar_dg_indices": [
1026157,
164737,
193617,
825293,
1186717,
909666,
675161,
108057,
840581,
513675,
2029,
674923,
181041,
346022,
432795,
87268,
1118812,
134200,
12316,
471207
]
} |
A 4-year-old boy is brought to the physician because of swelling around his eyes for 4 days. The swelling is most severe in the morning and milder by bedtime. Ten days ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 103/min, and blood pressure is 88/52 mm Hg. Examination shows 3+ pitting edema of the lower extremities and periorbital edema. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin 15.3 g/dL
Leukocyte count 10,500/mm3
Platelet count 480,000/mm3
Serum
Urea nitrogen 36 mg/dL
Glucose 67 mg/dL
Creatinine 0.8 mg/dL
Albumin 2.6 mg/dL
Urine
Blood negative
Glucose negative
Protein 4+
RBC none
WBC 0–1/hpf
Fatty casts numerous
Protein/creatinine ratio 6.8 (N ≤0.2)
Serum complement concentrations are within the reference ranges. Which of the following is the most appropriate next step in management?" | Prednisone therapy | {
"A": "Enalapril therapy",
"B": "Furosemide therapy",
"C": "Anti-streptolysin O levels",
"D": "Prednisone therapy"
} | step2&3 | D | [
"4 year old boy",
"brought",
"physician",
"of swelling",
"eyes",
"4 days",
"swelling",
"most severe",
"morning",
"milder",
"bedtime",
"Ten days",
"sore throat",
"resolved",
"temperature",
"98",
"pulse",
"min",
"blood pressure",
"88",
"mm Hg",
"Examination shows 3",
"pitting edema of",
"lower extremities",
"periorbital edema",
"examination shows",
"abnormalities",
"Laboratory studies show",
"g",
"mm3 Platelet count",
"mg",
"mg",
"Creatinine",
"8",
"Urine",
"negative",
"RBC",
"WBC",
"hpf",
"casts numerous Protein/creatinine ratio",
"N 0.2",
"Serum complement concentrations",
"reference ranges",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 4-year-old boy is brought to the physician because of swelling around his eyes for 4 days. The swelling is most severe in the morning and milder by bedtime. Ten days ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 103/min, and blood pressure is 88/52 mm Hg. Examination shows 3+ pitting edema of the lower extremities and periorbital edema. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin 15.3 g/dL
Leukocyte count 10,500/mm3
Platelet count 480,000/mm3
Serum
Urea nitrogen 36 mg/dL
Glucose 67 mg/dL
Creatinine 0.8 mg/dL
Albumin 2.6 mg/dL
Urine
Blood negative
Glucose negative
Protein 4+
RBC none
WBC 0–1/hpf
Fatty casts numerous
Protein/creatinine ratio 6.8 (N ≤0.2)
Serum complement concentrations are within the reference ranges. Which of the following is the most appropriate next step in management?"
Choose one of the following::
A. Enalapril therapy
B. Furosemide therapy
C. Anti-streptolysin O levels
D. Prednisone therapy | [
0.047879282385110855,
-0.1065208688378334,
0.03552495315670967,
-0.02373688295483589,
-0.011090654879808426,
-0.0262915026396513,
-0.006188482511788607,
0.033693939447402954,
-0.007740809582173824,
0.00801472831517458,
0.04746154323220253,
-0.027472183108329773,
0.013571723364293575,
0.024456007406115532,
-0.019955234602093697,
0.005933619104325771,
-0.03105122782289982,
-0.030941929668188095,
-0.046902772039175034,
0.010609741322696209,
0.00043461742461659014,
0.030035706236958504,
0.018193062394857407,
0.009838942438364029,
0.040817104279994965,
-0.02102399244904518,
-0.012710117734968662,
-0.024006063118577003,
0.009085727855563164,
-0.045780669897794724,
-0.02489531971514225,
-0.037538155913352966,
-0.016576560214161873,
-0.11872845888137817,
0.0000019683341179188574,
0.015150199644267559,
0.03926664963364601,
-0.00949153397232294,
0.056417692452669144,
0.023981982842087746,
-0.02934049814939499,
-0.09338697791099548,
0.0775483250617981,
0.004168221261352301,
-0.023468971252441406,
-0.08652889728546143,
-0.01804717630147934,
0.0509042888879776,
-0.03841039910912514,
-0.015883056446909904,
0.027584059163928032,
0.006358438171446323,
0.01606140285730362,
0.0015473638195544481,
0.038248948752880096,
-0.07924773544073105,
0.004636126104742289,
0.04756363481283188,
0.07771150767803192,
-0.02890133671462536,
0.0017691242974251509,
-0.006118830759078264,
0.03311656415462494,
-0.01921616867184639,
-0.021283328533172607,
-0.009981353767216206,
0.025627736002206802,
-0.03641378507018089,
0.017491906881332397,
0.023951532319188118,
0.024448378011584282,
-0.019831081852316856,
0.02588496170938015,
0.06087411567568779,
-0.026537472382187843,
-0.008008940145373344,
0.056534621864557266,
-0.015781480818986893,
0.01116121094673872,
-0.008669109083712101,
0.03541531413793564,
0.011026417836546898,
-0.049114782363176346,
0.051442403346300125,
-0.02472224459052086,
-0.05767245218157768,
-0.020330185070633888,
0.002259901026263833,
-0.008102385327219963,
0.011269191280007362,
-0.001016833120957017,
-0.06504376232624054,
0.008899051696062088,
0.047001175582408905,
-0.05497889593243599,
-0.030541012063622475,
-0.026507550850510597,
0.0035848200786858797,
0.031581953167915344,
0.005357564426958561,
-0.037699513137340546,
-0.03584880754351616,
0.014484856277704239,
0.06435965746641159,
-0.041739337146282196,
-0.06258741766214371,
0.0016670457553118467,
-0.03449849411845207,
-0.010458346456289291,
0.02696642465889454,
0.00888250581920147,
0.013558495789766312,
-0.04645838215947151,
-0.008718660101294518,
0.058212943375110626,
-0.0007507818518206477,
-0.03933056816458702,
-0.012303954921662807,
0.015602640807628632,
0.06372271478176117,
0.0428861565887928,
0.0104055842384696,
0.03618847578763962,
-0.020153330639004707,
-0.05564247816801071,
0.019438324496150017,
0.02797733247280121,
0.003189338371157646,
-0.026645585894584656,
0.010860082693397999,
0.029877448454499245,
-0.004772806074470282,
-0.04567640274763107,
0.01958976686000824,
0.07261954247951508,
0.043507978320121765,
-0.00026374595472589135,
0.06648515164852142,
0.018398845568299294,
0.016614407300949097,
-0.002614336321130395,
-0.010013634338974953,
-0.016822027042508125,
-0.009553255513310432,
-0.018396001309156418,
0.003287107218056917,
0.009682636708021164,
0.037384312599897385,
-0.019033333286643028,
0.0347500778734684,
-0.04897518828511238,
-0.047203317284584045,
-0.045120712369680405,
0.02039947174489498,
-0.03271922096610069,
0.01645047776401043,
0.01697177067399025,
-0.035348836332559586,
0.0028872450347989798,
-0.09225019812583923,
0.010273351334035397,
-0.06316159665584564,
0.03264622390270233,
-0.004947712179273367,
-0.012796653434634209,
0.03954669088125229,
-0.032054245471954346,
0.061191558837890625,
-0.07810569554567337,
0.017616404220461845,
-0.032973069697618484,
0.034668631851673126,
0.02860291302204132,
-0.045687273144721985,
-0.032914526760578156,
-0.009360024705529213,
-0.06813924759626389,
-0.08598332107067108,
-0.08641725778579712,
-0.016068264842033386,
0.06590672582387924,
0.03713236749172211,
0.09129446744918823,
-0.02011774480342865,
-0.00794111005961895,
0.02852189913392067,
0.022764895111322403,
-0.036101289093494415,
-0.02339460887014866,
-0.03636956587433815,
-0.02529992163181305,
-0.0019068748224526644,
-0.018624261021614075,
0.001500320853665471,
-0.014130091294646263,
-0.012368252500891685,
-0.03953339159488678,
-0.035960547626018524,
0.016250092536211014,
0.028491374105215073,
0.03603729233145714,
-0.03832143172621727,
0.016523541882634163,
0.02403097040951252,
-0.008428229950368404,
0.0570419505238533,
-0.004828759469091892,
0.013940381817519665,
-0.037570420652627945,
-0.02053399197757244,
-0.049937404692173004,
-0.011396944522857666,
0.06344634294509888,
-0.05430181324481964,
0.029285907745361328,
-0.0031573744490742683,
-0.007002546917647123,
0.00980182271450758,
-0.06919882446527481,
0.03446303680539131,
-0.03603203222155571,
0.03973527252674103,
-0.027588915079832077,
0.0132938576862216,
0.026286430656909943,
-0.0002773425658233464,
0.05870805308222771,
0.02549341320991516,
-0.05086369812488556,
-0.0694119930267334,
0.00439082458615303,
0.004405321087688208,
-0.006309128366410732,
0.006739167496562004,
-0.03818864747881889,
0.019890831783413887,
0.023976018652319908,
-0.06590115278959274,
0.009027860127389431,
-0.009108563885092735,
-0.038313597440719604,
-0.04142892360687256,
-0.07174763828516006,
-0.02292654849588871,
0.00510276947170496,
-0.001768602291122079,
0.014080442488193512,
0.06557109206914902,
-0.03697764128446579,
0.040704529732465744,
-0.05236220359802246,
-0.007303699851036072,
-0.022677460685372353,
0.021166618913412094,
-0.04630438610911369,
0.08740829676389694,
0.0035523574333637953,
-0.015919262543320656,
0.009340308606624603,
-0.028698615729808807,
-0.042323242872953415,
-0.013251764699816704,
-0.009059124626219273,
-0.011245285160839558,
-0.029059607535600662,
-0.013530107215046883,
0.013489624485373497,
0.000060479473177110776,
-0.007887676358222961,
0.0386684313416481,
-0.011451268568634987,
0.06348185986280441,
0.046669378876686096,
0.041063375771045685,
-0.027695851400494576,
-0.018919793888926506,
-0.037432461977005005,
0.042561549693346024,
-0.00199801754206419,
-0.002028750255703926,
0.03340461477637291,
0.06819073110818863,
-0.012322836555540562,
0.05836014822125435,
-0.02133447490632534,
-0.012695500627160072,
-0.0030028538312762976,
-0.02747533470392227,
0.03876393660902977,
-0.003570875385776162,
-0.04508037865161896,
0.016829073429107666,
0.011401595547795296,
-0.022633645683526993,
-0.019483979791402817,
-0.05475702881813049,
-0.013125363737344742,
0.027531372383236885,
0.009119316004216671,
0.036339059472084045,
0.027810215950012207,
0.06413521617650986,
0.0060588037595152855,
0.01726783625781536,
-0.0032507115975022316,
0.0026582027785480022,
0.02239624597132206,
-0.019459454342722893,
-0.024134347215294838,
0.050086330622434616,
0.032162539660930634,
-0.0035176489036530256,
-0.01629948429763317,
0.00932819489389658,
0.015240292996168137,
-0.0049847629852592945,
-0.02787626162171364,
-0.07334445416927338,
0.036193959414958954,
0.01748480461537838,
-0.013490336015820503,
0.012827202677726746,
-0.0038343064952641726,
0.029455790296196938,
0.0021150854881852865,
-0.048243362456560135,
-0.036793339997529984,
-0.016498206183314323,
-0.015083766542375088,
-0.040340159088373184,
0.0009226411348208785,
-0.04715453088283539,
-0.01525184791535139,
0.02192443236708641,
0.07030555605888367,
0.012562589719891548,
-0.018077777698636055,
0.04827320575714111,
-0.021853262558579445,
0.05207874998450279,
0.008679470978677273,
-0.01246915478259325,
0.019594520330429077,
0.02606913447380066,
-0.005013032350689173,
-0.052935488522052765,
-0.07865635305643082,
0.023842958733439445,
-0.04029490053653717,
0.04247806966304779,
-0.04876204580068588,
0.019019238650798798,
-0.01494373008608818,
-0.019732875749468803,
-0.013768868520855904,
-0.04534197226166725,
0.032823365181684494,
0.05008769407868385,
-0.027879903092980385,
0.03400949388742447,
0.03144388273358345,
0.040340762585401535,
-0.02178819850087166,
0.002429757034406066,
0.017744438722729683,
-0.014826089143753052,
-0.011130968108773232,
0.01232299953699112,
-0.007270029280334711,
-0.005767277907580137,
0.040258701890707016,
-0.03237510845065117,
-0.016003238037228584,
0.03143668547272682,
0.0026132992934435606,
0.018027937039732933,
-0.016261782497167587,
-0.054013900458812714,
-0.07157738506793976,
-0.03985137492418289,
0.01750762015581131,
-0.016703493893146515,
0.007872055284678936,
-0.02010602317750454,
-0.03738948330283165,
0.029138773679733276,
-0.016585025936365128,
-0.02707841247320175,
0.06565669178962708,
0.018806826323270798,
0.01275715697556734,
-0.01327687967568636,
-0.03396787866950035,
-0.031170906499028206,
0.005224105902016163,
0.05860888212919235,
0.02493336983025074,
-0.0356733463704586,
0.012309130281209946,
0.08778857439756393,
-0.007065948098897934,
0.008526483550667763,
-0.01978081464767456,
0.022631242871284485,
0.032640811055898666,
-0.07144670933485031,
-0.05970505625009537,
-0.004714337643235922,
0.03850996866822243,
0.053813040256500244,
0.00523828249424696,
-0.04814419522881508,
0.053028348833322525,
-0.0029053096659481525,
0.026644425466656685,
-0.023496992886066437,
-0.013937006704509258,
-0.017293956130743027,
-0.0480993278324604,
-0.07387197762727737,
0.025105396285653114,
0.04930468276143074,
-0.04152635484933853,
-0.020316986367106438,
0.002679755911231041,
0.008188051171600819,
0.04367754980921745,
-0.0018390878103673458,
0.018137982115149498,
0.03930484876036644,
0.02785654179751873,
-0.020244082435965538,
0.02006608247756958,
0.03827689588069916,
-0.03594142571091652,
0.023365138098597527,
0.011701920069754124,
0.009510335512459278,
-0.006657327990978956,
-0.01629042625427246,
0.010596366599202156,
0.011338441632688046,
0.07426010072231293,
0.07063436508178711,
0.05975264683365822,
-0.0007129429723136127,
0.01122543029487133,
0.052242767065763474,
0.015522351488471031,
0.08605248481035233,
0.027148233726620674,
-0.05759504437446594,
0.0019551021978259087,
0.04794888570904732,
0.020015036687254906,
-0.007390184793621302,
0.0113758509978652,
0.07300352305173874,
0.006906143389642239,
-0.0514301061630249,
-0.06304293870925903,
0.022941024973988533,
-0.03443874418735504,
-0.011066189967095852,
0.014737533405423164,
-0.06745464354753494,
-0.07103138417005539,
0.011719661764800549,
0.017226632684469223,
-0.024660587310791016,
-0.04133830592036247,
0.09998387098312378,
-0.00818380806595087,
-0.04476861655712128,
0.0295440461486578,
-0.02509659342467785,
-0.012558689340949059,
-0.008828339166939259,
-0.051864974200725555,
0.01217616070061922,
-0.005548079498112202,
0.0024916415568441153,
-0.08816740661859512,
-0.0277856457978487,
-0.02812335081398487,
0.01187971793115139,
0.0016361376037821174,
-0.023706993088126183,
-0.012105916626751423,
0.030301541090011597,
0.022522112354636192,
0.057094886898994446,
-0.020577330142259598,
-0.023998713120818138,
-0.06602468341588974,
-0.002943348838016391,
-0.00047704248572699726,
0.07789167761802673,
0.04131753742694855,
-0.0022378454450517893,
0.0687507912516594,
0.05359111726284027,
0.04017342999577522,
-0.0424245223402977,
0.025510970503091812,
0.03940972685813904,
0.003063211450353265,
0.035492394119501114,
0.029819505289196968,
-0.026237884536385536,
0.0459558442234993,
0.017364079132676125,
-0.00774765620008111,
0.06059308722615242,
0.06159742549061775,
-0.03919064253568649,
-0.09011989086866379,
-0.006067496724426746,
-0.006402995903044939,
0.023405183106660843,
0.014547552913427353,
0.004880821797996759,
0.011220366694033146,
-0.02681010402739048,
-0.006500403396785259,
0.037421971559524536,
0.00929293967783451,
-0.010843368247151375,
0.010817499831318855,
0.05387064814567566,
-0.029970690608024597,
-0.017686376348137856,
-0.034913212060928345,
0.006394153460860252,
0.005459893494844437,
0.001981576671823859,
0.030953526496887207,
0.057150308042764664,
-0.026979828253388405,
-0.03655965253710747,
-0.014523838646709919,
-0.014211563393473625,
-0.027030933648347855,
-0.00788960512727499,
0.006541988346725702,
0.05775468423962593,
-0.04582686349749565,
-0.027529675513505936,
0.05677212402224541,
0.05279143527150154,
-0.01769561693072319,
0.11631239205598831,
0.026402946561574936,
0.03370530530810356,
0.02809375710785389,
-5.4069577323337544e-33,
0.0582701712846756,
-0.009570544585585594,
0.018971560522913933,
-0.04723144322633743,
0.03867952153086662,
0.13165269792079926,
-0.030631577596068382,
0.003256102092564106,
-0.08793692290782928,
-0.002328526461496949,
-0.0029941771645098925,
-0.030347701162099838,
0.01319196354597807,
0.057203274220228195,
0.017470644786953926,
-0.01990494690835476,
-0.019244173541665077,
0.0149071104824543,
-0.07358654588460922,
-0.0070261042565107346,
-0.04624277725815773,
-0.04957200214266777,
0.04111148789525032,
-0.018740825355052948,
-0.05153509974479675,
-0.016061551868915558,
0.05944981798529625,
-0.018869439139962196,
0.04269610345363617,
0.03828372806310654,
0.018871761858463287,
-0.052869729697704315,
0.050718046724796295,
0.03495502099394798,
0.014548731036484241,
-0.03303467109799385,
-0.037358690053224564,
-0.016499318182468414,
0.060291923582553864,
0.005571870598942041,
-0.10292879492044449,
0.0359162762761116,
0.04859595745801926,
-0.005378854926675558,
0.04180220514535904,
-0.030878985300660133,
-0.034916192293167114,
-0.019566692411899567,
-0.02301771193742752,
-0.006055671721696854,
-0.02256622165441513,
0.03290518373250961,
0.013475668616592884,
-0.024515731260180473,
-0.024853738024830818,
-0.020228492096066475,
0.033051516860723495,
0.014050866477191448,
-0.012570206075906754,
0.009179755114018917,
-0.028163161128759384,
-0.027657782658934593,
-0.049135155975818634,
-0.01461415272206068,
-0.04690292850136757,
0.03678366541862488,
0.050189342349767685,
0.007273974362760782,
-0.08781976997852325,
0.010608144104480743,
-0.05891313776373863,
-0.01410557609051466,
0.0038544912822544575,
-0.042467258870601654,
-0.011484554968774319,
-0.0340038426220417,
0.006926266476511955,
0.004116436932235956,
0.030854767188429832,
-0.0030043378937989473,
-0.07282261550426483,
-0.004178784321993589,
-0.02621963806450367,
-0.007398766931146383,
0.013012757524847984,
0.0389278419315815,
0.0006779950927011669,
-0.008965491317212582,
0.01131859328597784,
0.006973843090236187,
0.018675638362765312,
0.01873600296676159,
0.04201226308941841,
0.031054342165589333,
0.007890078239142895,
-0.04222087934613228,
0.05673745647072792,
0.03379637002944946,
-0.014719503000378609,
-0.011101743206381798,
0.008532599546015263,
-0.0006946283974684775,
0.08228983730077744,
-0.0461508110165596,
-0.020686598494648933,
0.01905806176364422,
-0.030523328110575676,
-0.003933745436370373,
-0.02223852463066578,
0.01420880202203989,
0.013510284945368767,
0.012590765953063965,
-0.0056137945502996445,
0.05617895349860191,
0.01175529696047306,
0.004005456808954477,
0.026183079928159714,
-0.00008588654600316659,
0.029331877827644348,
-0.026503032073378563,
-0.02407478168606758,
-0.0036272278521209955,
0.03603318706154823,
-0.03320881724357605,
-0.02159421518445015,
-0.038527585566043854,
0.04301222041249275,
0.023089749738574028,
-0.02307998761534691,
0.011067773215472698,
0.03211011365056038,
0.02045311965048313,
2.8422914510883857e-7,
0.011358419433236122,
-0.003697820473462343,
-0.03833731263875961,
-0.09048959612846375,
0.03949321061372757,
-0.026782158762216568,
-0.017500637099146843,
-0.014118626713752747,
0.02875237911939621,
-0.044089335948228836,
0.034246280789375305,
-0.0042974152602255344,
-0.01729309745132923,
-0.05500335991382599,
0.02468452788889408,
-0.019438717514276505,
-0.0010179218370467424,
-0.006919749081134796,
0.00853287149220705,
0.01829841360449791,
0.010695982724428177,
-0.005626871716231108,
-0.04593634977936745,
-0.011320789344608784,
-0.01176941953599453,
-0.030712859705090523,
0.00028911096160300076,
-0.04023554548621178,
-0.0044695911929011345,
0.007272403687238693,
-0.009152865037322044,
0.06264029443264008,
0.062450189143419266,
0.0906248539686203,
-0.0293950904160738,
0.013590434566140175,
0.01596183516085148,
0.02132810279726982,
-0.0030581222381442785,
0.028541745617985725,
-0.01790771447122097,
-0.017658226191997528,
0.005879837088286877,
-0.014854210428893566,
0.010888786986470222,
0.04814786836504936,
-0.033359404653310776,
0.025915177538990974,
0.04039134830236435,
0.030344486236572266,
-0.03426728770136833,
0.04213764891028404,
-0.05320969223976135,
0.04492180421948433,
-0.011723658069968224,
-0.00034552253782749176,
-0.05172434076666832,
-0.01984589174389839,
0.05349116399884224,
-0.06322117894887924,
0.0025340644642710686,
-0.023922650143504143,
0.048132408410310745,
-0.020221587270498276,
-0.026033468544483185,
-0.022465819492936134,
-0.018462298437952995,
2.2056431873514667e-34,
0.0025406675413250923,
-0.10806802660226822,
0.010918582789599895,
-0.05320353806018829,
-0.02058272436261177,
-0.030965346843004227,
-0.0015226972755044699,
0.04500557482242584,
-0.002417363692075014,
-0.03405708447098732,
-0.03630480542778969
] | {
"ds_index": 63,
"similar_dg_indices": [
543754,
857821,
1147760,
295315,
1207817,
922765,
1203189,
731115,
999095,
970404,
910557,
763876,
567823,
533509,
709048,
58880,
330292,
689926,
289815,
702563
]
} |
An 18-year-old man comes to the clinic with his mom for “pins and needles” of both of his arms. He denies any past medical history besides a recent anterior cruciate ligament (ACL) tear that was repaired 1 week ago. The patient reports that the paresthesias are mostly located along the posterior forearms, left more than the right. What physical examination finding would you expect from this patient? | Loss of wrist extension | {
"A": "Loss of arm abduction",
"B": "Loss of finger abducton",
"C": "Loss of forearm flexion and supination",
"D": "Loss of wrist extension"
} | step1 | D | [
"year old man",
"clinic",
"mom",
"pins",
"needles",
"arms",
"denies",
"past medical history",
"recent anterior cruciate ligament",
"tear",
"repaired 1 week",
"patient reports",
"paresthesias",
"mostly",
"posterior forearms",
"left more",
"right",
"physical examination finding",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An 18-year-old man comes to the clinic with his mom for “pins and needles” of both of his arms. He denies any past medical history besides a recent anterior cruciate ligament (ACL) tear that was repaired 1 week ago. The patient reports that the paresthesias are mostly located along the posterior forearms, left more than the right. What physical examination finding would you expect from this patient?
Choose one of the following::
A. Loss of arm abduction
B. Loss of finger abducton
C. Loss of forearm flexion and supination
D. Loss of wrist extension | [
0.0015489667421206832,
-0.07109164446592331,
0.004353726282715797,
0.060312870889902115,
-0.020400261506438255,
0.017376700416207314,
-0.017591241747140884,
0.03846011683344841,
-0.0027607695665210485,
0.03813481703400612,
0.05912576988339424,
-0.012886347249150276,
0.040325991809368134,
-0.05683201923966408,
0.01662582717835903,
0.0483870729804039,
-0.03399493917822838,
0.04116333648562431,
-0.003254628973081708,
-0.007610122207552195,
-0.021044937893748283,
0.03204204514622688,
-0.023161757737398148,
0.01842602714896202,
-0.011358496733009815,
0.008527001366019249,
0.00998155027627945,
-0.010727014392614365,
-0.04124012216925621,
-0.04691921919584274,
-0.043842658400535583,
-0.02204163186252117,
-0.025413133203983307,
-0.06645067781209946,
0.0000020746078916999977,
0.00008975146192824468,
0.014731774106621742,
-0.01764480397105217,
0.03120359778404236,
-0.044754281640052795,
0.02177610993385315,
-0.03650090470910072,
0.08527067303657532,
-0.017325177788734436,
-0.03662145137786865,
-0.1163564920425415,
-0.013329646550118923,
0.02144523710012436,
-0.04102800786495209,
0.01816965453326702,
-0.011069503612816334,
0.058987926691770554,
-0.08776238560676575,
0.0008645213674753904,
0.00284938863478601,
-0.03601707145571709,
-0.04854846000671387,
-0.03193147853016853,
0.028371205553412437,
-0.011811753734946251,
-0.010895752348005772,
-0.011875326745212078,
0.025629770010709763,
0.05087289214134216,
-0.009693880565464497,
0.03822040930390358,
-0.009899354539811611,
-0.01877930946648121,
0.02833564020693302,
-0.029098961502313614,
0.010340834967792034,
0.04009154811501503,
0.04616095870733261,
0.00958266668021679,
-0.0453755147755146,
0.003855079645290971,
0.0404549241065979,
0.04491284117102623,
-0.00924430601298809,
-0.01822679489850998,
0.02463231049478054,
0.04604879394173622,
0.01725545898079872,
0.016424672678112984,
-0.014757426455616951,
-0.05495013669133186,
0.02432054840028286,
-0.010914197191596031,
0.052886173129081726,
-0.004183955490589142,
0.01800277642905712,
-0.025861049070954323,
0.024981370195746422,
-0.004291180986911058,
-0.06331712752580643,
-0.0023084664717316628,
-0.005047927610576153,
-0.03675989806652069,
0.009468749165534973,
-0.0274750255048275,
-0.011107883416116238,
0.005391014274209738,
-0.019495807588100433,
-0.0047255223616957664,
-0.027765672653913498,
-0.015778183937072754,
-0.056518469005823135,
0.0750759169459343,
-0.02837814763188362,
0.04568132758140564,
0.01117210928350687,
0.03300078585743904,
-0.023253832012414932,
0.009294926188886166,
0.04806068167090416,
-0.04565107822418213,
0.008120618760585785,
-0.03185369819402695,
0.03510735183954239,
0.038648635149002075,
-0.06755395978689194,
0.05766059458255768,
-0.003709204727783799,
0.023497555404901505,
0.002359480829909444,
0.005818563513457775,
0.020036885514855385,
-0.010090218856930733,
0.036550600081682205,
0.040745146572589874,
-0.003367167664691806,
-0.03758322075009346,
-0.01097144652158022,
0.029448039829730988,
0.008038862608373165,
-0.024668682366609573,
0.02343308925628662,
0.07254942506551743,
0.026083705946803093,
-0.007401522248983383,
-0.0017905260901898146,
0.030656637623906136,
0.05662969872355461,
0.017812512814998627,
-0.015881435945630074,
0.037232812494039536,
0.03721984103322029,
0.005804307293146849,
-0.0058953179977834225,
0.033135801553726196,
-0.048909593373537064,
0.0011547747999429703,
-0.014972222037613392,
0.0042720031924545765,
-0.01785936951637268,
0.01916358433663845,
-0.013996986672282219,
-0.02338634431362152,
-0.0687275156378746,
0.02653827890753746,
0.017324743792414665,
-0.02032582275569439,
0.01748325489461422,
-0.025185639038681984,
0.007506994996219873,
-0.002641247818246484,
-0.0007959675276651978,
-0.009662339463829994,
-0.0026078291703015566,
0.059035252779722214,
-0.0819915235042572,
0.04262487217783928,
0.019341466948390007,
-0.013497095555067062,
-0.06374216824769974,
0.09742151945829391,
-0.06896736472845078,
-0.04772745817899704,
0.021828370168805122,
-0.038631271570920944,
-0.0179731585085392,
0.003899092087522149,
0.009399216622114182,
-0.029869185760617256,
0.06762050092220306,
-0.0037727775052189827,
-0.007428367622196674,
-0.05647219717502594,
-0.03323419392108917,
-0.017842810600996017,
-0.046799249947071075,
-0.014448276720941067,
-0.11173572391271591,
0.02862069196999073,
0.028065837919712067,
0.013186144642531872,
-0.053814809769392014,
-0.021131936460733414,
-0.021195445209741592,
-0.010173612274229527,
-0.003680971683934331,
-0.043095674365758896,
-0.032805055379867554,
0.029382476583123207,
-0.03845333307981491,
0.05757591873407364,
-0.01890173740684986,
0.005407003685832024,
0.05629660189151764,
0.039425045251846313,
0.008285152725875378,
0.01348901353776455,
0.03574404865503311,
0.004719005431979895,
-0.011477479711174965,
0.014050532132387161,
0.003103096503764391,
-0.03907804191112518,
-0.1094464361667633,
0.022781454026699066,
-0.021376509219408035,
-0.01980338990688324,
0.055257827043533325,
0.05594422295689583,
-0.0809524729847908,
0.022860625758767128,
0.060598138719797134,
0.0011585181346163154,
-0.03364473208785057,
-0.039786286652088165,
0.0468185730278492,
0.014024551957845688,
0.0015433661174029112,
-0.035195209085941315,
-0.01865312084555626,
0.03540552780032158,
0.01013611163944006,
0.011668591760098934,
0.06707505136728287,
-0.011260690167546272,
0.00491337152197957,
-0.053336381912231445,
-0.03090609796345234,
-0.05394790694117546,
0.054306890815496445,
-0.0514369010925293,
0.041194308549165726,
0.03021925315260887,
-0.0035991459153592587,
0.04156849905848503,
-0.007144233211874962,
0.020626133307814598,
-0.017890525981783867,
0.033721551299095154,
0.0015842946013435721,
0.01598583534359932,
0.0047910516150295734,
0.047052688896656036,
-0.08371905982494354,
-0.04323394596576691,
-0.03792181238532066,
-0.022639751434326172,
0.03415047377347946,
0.019010119140148163,
0.025207430124282837,
0.020048242062330246,
-0.014688043855130672,
-0.03634604066610336,
0.021036241203546524,
0.024123918265104294,
-0.028531285002827644,
0.051514845341444016,
0.013950709253549576,
-0.03567062318325043,
-0.05304783955216408,
0.03162963315844536,
-0.02409493364393711,
0.029172170907258987,
0.03713955357670784,
0.028520677238702774,
0.03784357011318207,
0.023856932297348976,
-0.036587994545698166,
-0.003541438840329647,
0.0038000186905264854,
-0.009170380420982838,
-0.004935402888804674,
0.009336293675005436,
-0.010348284617066383,
0.013266301713883877,
-0.00046014817780815065,
0.024750858545303345,
0.04730406776070595,
-0.027042990550398827,
-0.016749702394008636,
-0.039882536977529526,
-0.07958050817251205,
0.0717550665140152,
-0.023638317361474037,
0.02577507682144642,
0.036668628454208374,
-0.019318852573633194,
0.02455374225974083,
-0.012522151693701744,
0.015872646123170853,
0.0315169058740139,
0.05182596668601036,
-0.04503844678401947,
0.013507048599421978,
0.032056279480457306,
0.04847882315516472,
-0.0007800769526511431,
0.009307998232543468,
-0.055248621851205826,
-0.009517700411379337,
-0.012134465388953686,
0.017934780567884445,
-0.04464028403162956,
0.009486589580774307,
0.007164360024034977,
-0.010491516441106796,
0.04950185865163803,
0.0116667989641428,
0.0018354657804593444,
-0.01629704050719738,
0.001482842373661697,
-0.008013071492314339,
0.009569409303367138,
0.05279297009110451,
0.03119635581970215,
0.0208064466714859,
-0.08984124660491943,
-0.017595656216144562,
-0.012748491950333118,
0.03979504853487015,
-0.023136230185627937,
0.019899284467101097,
-0.023983199149370193,
-0.020413970574736595,
0.02909446880221367,
0.011793765239417553,
-0.013063455931842327,
-0.025573868304491043,
0.037293966859579086,
-0.005590187385678291,
-0.009202052839100361,
-0.05680100992321968,
0.011523433029651642,
0.011741410940885544,
-0.0438377782702446,
-0.06594903767108917,
0.025308523327112198,
-0.024409592151641846,
-0.00538881728425622,
-0.017862306907773018,
-0.013949573040008545,
0.032365188002586365,
0.03298003599047661,
-0.05343156307935715,
0.020405294373631477,
-0.045877210795879364,
0.05308244377374649,
0.0029853624291718006,
0.05364910513162613,
-0.051780637353658676,
-0.03109552338719368,
-0.0283658429980278,
-0.050108082592487335,
-0.03961728885769844,
0.013981536030769348,
-0.06768771260976791,
0.012225164100527763,
-0.05325058102607727,
0.05261259153485298,
-0.016704577952623367,
-0.005701248534023762,
0.00771343894302845,
0.006377323996275663,
-0.11111513525247574,
-0.03435368835926056,
0.057998981326818466,
-0.048919446766376495,
0.0033370177261531353,
-0.013551331125199795,
0.016043536365032196,
0.0062074544839560986,
0.06319545209407806,
-0.014926494099199772,
0.003476409474387765,
0.042504433542490005,
-0.035674892365932465,
-0.009453029371798038,
-0.09571921080350876,
0.0215693898499012,
0.025054560974240303,
0.034604594111442566,
0.011020333506166935,
0.014578728005290031,
-0.003256272990256548,
0.06781845539808273,
-0.0027834081556648016,
-0.006601748522371054,
0.00272446614690125,
0.03935388848185539,
0.024514738470315933,
-0.07015004009008408,
-0.017013924196362495,
-0.019674625247716904,
-0.01721622236073017,
-0.06858180463314056,
0.036677539348602295,
-0.01343107782304287,
-0.04536432400345802,
0.010112766176462173,
0.014946780167520046,
0.0027902706060558558,
0.02484734356403351,
-0.021731337532401085,
0.04376688599586487,
-0.0588524267077446,
0.06377163529396057,
0.02835911512374878,
0.0009179863845929503,
-0.07333385199308395,
0.008715358562767506,
-0.030938562005758286,
0.07364682853221893,
0.035077374428510666,
-0.026136603206396103,
0.03541205823421478,
0.03746332973241806,
-0.06387364119291306,
0.05590154230594635,
0.1022564023733139,
0.004068161826580763,
0.08094565570354462,
0.01348112802952528,
0.020395277068018913,
-0.04110918939113617,
0.008155502378940582,
-0.03553970903158188,
-0.020338183268904686,
0.027684921398758888,
0.045453522354364395,
0.05478660762310028,
-0.01797967217862606,
0.016706185415387154,
-0.04603489488363266,
0.04432965815067291,
0.05476551502943039,
0.00527146877720952,
0.04898100718855858,
0.010449540801346302,
0.034734878689050674,
0.0009921444579958916,
0.011377640999853611,
-0.004549555946141481,
-0.01593097113072872,
0.043948814272880554,
0.05958830937743187,
-0.01880510151386261,
0.010074099525809288,
-0.028610780835151672,
-0.07213286310434341,
0.016431834548711777,
-0.07121742516756058,
0.0014205098850652575,
0.0059151556342840195,
0.0001230921334354207,
-0.005632537882775068,
-0.0027887672185897827,
0.04132771119475365,
-0.04318433254957199,
0.014733272604644299,
-0.00005867908475920558,
-0.018470384180545807,
-0.05873988941311836,
-0.023770807310938835,
0.003023550845682621,
0.0023379973135888577,
0.046520255506038666,
0.0667956992983818,
-0.024796759709715843,
-0.004506061784923077,
0.005570122040808201,
-0.0028036010917276144,
0.005118966568261385,
0.0001466868561692536,
-0.004234711639583111,
-0.044547148048877716,
-0.01072428748011589,
-0.03554672375321388,
0.0042938957922160625,
-0.05688713863492012,
-0.06611858308315277,
0.06463766098022461,
-0.01937783509492874,
0.02996053174138069,
-0.01021897979080677,
-0.054380472749471664,
-0.008244495838880539,
0.0027423647698014975,
0.029153406620025635,
-0.024679001420736313,
0.0007801074534654617,
0.03298768028616905,
-0.023150412365794182,
0.026857592165470123,
-0.013321403414011002,
-0.06059935316443443,
0.007360422518104315,
0.006597889121621847,
0.03309817612171173,
0.05087868124246597,
0.06087552383542061,
0.0024860117118805647,
-0.027852224186062813,
-0.047242794185876846,
-0.04259577393531799,
0.02049565687775612,
-0.006939173210412264,
0.02810366451740265,
0.013786138966679573,
-0.014286190271377563,
-0.020295819267630577,
0.041913729161024094,
-0.04574289917945862,
0.0038946860004216433,
0.007287237327545881,
0.020046832039952278,
-0.1148337721824646,
-0.016795862466096878,
-0.030803130939602852,
-0.02008398063480854,
-0.05066702142357826,
-0.011312582530081272,
0.04010075703263283,
-0.03892490267753601,
0.010862833820283413,
0.0074379937723279,
-0.02492687664926052,
0.055520955473184586,
-0.06352446228265762,
-0.02254902757704258,
-0.006013716571033001,
-0.018763424828648567,
0.04522474855184555,
0.06787727028131485,
0.019842732697725296,
-0.054805513471364975,
-0.013680567964911461,
0.08225011825561523,
0.07179691642522812,
0.001318241935223341,
-0.03998422622680664,
-5.39225486939886e-33,
0.025355109944939613,
-0.024896344169974327,
0.019533680751919746,
-0.05790514126420021,
0.006059452425688505,
0.05537956953048706,
-0.03128689527511597,
-0.0213682409375906,
-0.019041862338781357,
0.002754985122010112,
-0.01922440528869629,
0.015936441719532013,
0.026417529210448265,
0.06443658471107483,
0.05822717398405075,
-0.0824795663356781,
0.009625798091292381,
0.012744465842843056,
-0.005122059490531683,
0.014736155979335308,
-0.05370982363820076,
-0.009936422109603882,
0.009337147697806358,
-0.03219873458147049,
0.02754518948495388,
-0.048051998019218445,
0.03261253610253334,
-0.0053471666760742664,
-0.048858270049095154,
-0.005922261159867048,
-0.028115032240748405,
-0.08561364561319351,
0.03562285751104355,
-0.002011404838413,
0.004941252525895834,
-0.06349992007017136,
0.030171090736985207,
-0.04868585243821144,
0.011810478754341602,
0.026742160320281982,
-0.0038175731897354126,
-0.018924925476312637,
0.07537220418453217,
-0.005822255276143551,
0.03292246535420418,
-0.03844655677676201,
0.0006347376038320363,
0.032317180186510086,
0.02768326923251152,
-0.004102018196135759,
0.06268393993377686,
0.018383650109171867,
0.012035454623401165,
-0.05754190310835838,
0.021633194759488106,
-0.016403725370764732,
-0.008284890092909336,
0.0417310930788517,
0.01628567837178707,
-0.004320409614592791,
-0.002591164782643318,
0.01387470867484808,
0.0013692728243768215,
-0.02185928076505661,
-0.028314124792814255,
0.021169286221265793,
0.016549836844205856,
0.0108762476593256,
-0.08516938984394073,
0.012805012986063957,
-0.05588962510228157,
0.028281306847929955,
-0.04981411248445511,
-0.06957025080919266,
-0.005897687282413244,
0.01273056399077177,
-0.013144916854798794,
0.03612125664949417,
0.0025310490746051073,
0.12018316239118576,
-0.015043315477669239,
-0.016715247184038162,
-0.06408488750457764,
-0.039259131997823715,
0.045559704303741455,
-0.03499055653810501,
0.030069071799516678,
-0.02797352895140648,
-0.000024202734493883327,
-0.053595758974552155,
0.031864233314991,
0.010020638816058636,
-0.001575653674080968,
0.019392065703868866,
0.0502396821975708,
-0.06865528225898743,
0.006944999098777771,
0.010027561336755753,
0.007537787314504385,
-0.020909976214170456,
0.04987616091966629,
-0.00524488091468811,
0.024061577394604683,
0.002466661622747779,
0.009590993635356426,
-0.005738354288041592,
-0.06214708834886551,
0.004053017590194941,
-0.04994490370154381,
0.026232430711388588,
0.013487029820680618,
-0.06409549713134766,
-0.006339929532259703,
0.0371304526925087,
0.02223973721265793,
0.051185477524995804,
-0.0003473677788861096,
0.0495840422809124,
0.0065127527341246605,
0.020442718639969826,
0.008813119493424892,
0.02856646664440632,
-0.034662678837776184,
-0.007502639200538397,
-0.03834081068634987,
-0.028507119044661522,
0.05574771389365196,
0.00567778293043375,
-0.013029322028160095,
-0.012982543557882309,
0.03907706215977669,
-0.04722653701901436,
2.6810232611751417e-7,
-0.016726860776543617,
-0.029687393456697464,
0.02064432203769684,
-0.05988266319036484,
0.015063632279634476,
-0.023958494886755943,
0.005107777658849955,
0.02839403599500656,
0.02505318447947502,
-0.052569642663002014,
0.051240596920251846,
0.03150464966893196,
-0.01839260756969452,
0.023170718923211098,
0.022122440859675407,
0.01728137955069542,
-0.014527120627462864,
0.025645805522799492,
0.016940180212259293,
-0.003915336914360523,
-0.004051937256008387,
-0.08211109042167664,
-0.05514625459909439,
-0.03001861274242401,
-0.006889283657073975,
-0.032532740384340286,
-0.013798520900309086,
-0.028783360496163368,
-0.03348604962229729,
-0.04278552159667015,
0.07039389759302139,
-0.00995965488255024,
0.026797283440828323,
0.06511770188808441,
-0.03663209453225136,
-0.0030224029906094074,
-0.0034432648681104183,
0.03282519429922104,
-0.04587269201874733,
0.047381721436977386,
-0.014086589217185974,
-0.017769353464245796,
0.014542938210070133,
0.01904592663049698,
0.050591569393873215,
-0.04831909388303757,
0.00270189275033772,
-0.06276194751262665,
-0.03107226826250553,
0.04542948678135872,
0.014773188158869743,
-0.009359660558402538,
0.017153630033135414,
0.04101292043924332,
0.02056485414505005,
-0.008390492759644985,
-0.031614501029253006,
0.020856479182839394,
0.061000045388936996,
0.028394469991326332,
0.036493923515081406,
-0.005948695819824934,
0.07377123087644577,
-0.0417923629283905,
-0.014177097007632256,
-0.05004133656620979,
-0.037285249680280685,
1.5647698661791462e-34,
-0.030568914487957954,
0.018881019204854965,
0.013172258622944355,
-0.04845409095287323,
-0.01804557628929615,
-0.028882179409265518,
0.0471954420208931,
0.026273036375641823,
0.044054169207811356,
-0.002668114146217704,
-0.004691665060818195
] | {
"ds_index": 64,
"similar_dg_indices": [
718382,
288909,
776440,
85772,
731460,
182820,
1191003,
1060687,
859640,
614949,
538747,
1164020,
752510,
995253,
318331,
866660,
785812,
195483,
555666,
819875
]
} |
A 9-year-old girl is resuscitated after the administration of an erroneous dose of intravenous phenytoin for recurrent seizures. This incident is reported to the authorities. A thorough investigation reveals various causative factors leading to the event. One important finding is a verbal misunderstanding of the dose of phenytoin between the ordering senior resident and the receiving first-year resident during the handover of the patient. To minimize the risk of this particular error in the future, the most appropriate management is to implement which of the following? | Closed-loop communication | {
"A": "Closed-loop communication",
"B": "Near miss",
"C": "Root cause analysis",
"D": "Sentinel event"
} | step2&3 | A | [
"year old girl",
"resuscitated",
"administration",
"erroneous dose",
"intravenous phenytoin",
"recurrent seizures",
"incident",
"reported",
"authorities",
"investigation reveals various",
"factors leading",
"event",
"One important finding",
"verbal",
"dose",
"phenytoin",
"ordering senior resident",
"receiving first year resident",
"handover",
"patient",
"To",
"risk",
"error",
"future",
"most appropriate management",
"to",
"following"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 9-year-old girl is resuscitated after the administration of an erroneous dose of intravenous phenytoin for recurrent seizures. This incident is reported to the authorities. A thorough investigation reveals various causative factors leading to the event. One important finding is a verbal misunderstanding of the dose of phenytoin between the ordering senior resident and the receiving first-year resident during the handover of the patient. To minimize the risk of this particular error in the future, the most appropriate management is to implement which of the following?
Choose one of the following::
A. Closed-loop communication
B. Near miss
C. Root cause analysis
D. Sentinel event | [
0.05096147209405899,
-0.03389083966612816,
0.02425570785999298,
0.01554813515394926,
0.009379829280078411,
0.020693611353635788,
0.0053031365387141705,
-0.008187192492187023,
-0.0017482182011008263,
-0.021466407924890518,
0.0653763934969902,
-0.05061013251543045,
-0.02196909859776497,
0.007566103246062994,
0.03839946538209915,
0.017894690856337547,
0.02211175300180912,
0.013560316525399685,
-0.021537207067012787,
0.0047445353120565414,
0.029081961140036583,
0.057957760989665985,
-0.038737665861845016,
-0.019291849806904793,
-0.04362667724490166,
0.008429698646068573,
0.023490341380238533,
0.0063279471360147,
0.003061677096411586,
-0.04374348744750023,
0.015808135271072388,
-0.040090613067150116,
-0.0010112036252394319,
-0.05616956949234009,
0.0000024540875074308133,
0.021996868774294853,
0.03954743221402168,
0.008240348659455776,
-0.05500069260597229,
-0.03049439936876297,
0.012241696938872337,
-0.06472951918840408,
0.00654189009219408,
-0.0027898570988327265,
0.021746275946497917,
-0.03996606916189194,
0.004841641057282686,
0.09540699422359467,
0.005677737761288881,
-0.029454044997692108,
0.02442442812025547,
0.04442935809493065,
-0.011498541571199894,
0.006649980321526527,
0.02873191423714161,
-0.0795593410730362,
-0.018117615953087807,
0.0028821006417274475,
0.03396660462021828,
-0.03405500203371048,
0.00568743608891964,
-0.023607756942510605,
0.010386115871369839,
0.003936298191547394,
-0.04501977935433388,
0.0022626295685768127,
-0.043509889394044876,
-0.027949318289756775,
-0.04569251835346222,
-0.0016821313183754683,
-0.004133868031203747,
0.055499762296676636,
0.039405085146427155,
0.035628680139780045,
-0.061545442789793015,
0.0005539332050830126,
-0.005156510975211859,
-0.051945921033620834,
-0.043585747480392456,
-0.04216684028506279,
-0.031743720173835754,
0.010774796828627586,
0.011125310324132442,
0.01626730151474476,
-0.011604567058384418,
0.04276544600725174,
0.004726848565042019,
-0.008399952203035355,
-0.025446483865380287,
0.013446551747620106,
-0.01319691352546215,
0.0002464885183144361,
0.015019633807241917,
-0.026877889409661293,
-0.027461418882012367,
0.0012176323216408491,
0.00249282643198967,
-0.02020738087594509,
0.0408942848443985,
-0.08845442533493042,
0.0012181373313069344,
-0.042515452951192856,
0.054646383970975876,
-0.032608356326818466,
-0.009754788130521774,
-0.008900628425180912,
-0.024380190297961235,
0.06764229387044907,
-0.026771264150738716,
0.03627682477235794,
0.015088497661054134,
0.029921332374215126,
-0.023326348513364792,
-0.014534949325025082,
0.08522692322731018,
0.02859313413500786,
-0.022693289443850517,
-0.03733257204294205,
-0.0591106116771698,
0.04516373947262764,
-0.0014719866449013352,
0.047080691903829575,
-0.05030536651611328,
-0.030338991433382034,
-0.0006853114464320242,
0.00859923753887415,
-0.029131725430488586,
0.03637637197971344,
0.005555810406804085,
-0.018302641808986664,
0.014728020876646042,
-0.02315155416727066,
0.017070218920707703,
0.02264397405087948,
-0.00626401649788022,
0.0621037520468235,
0.008479391224682331,
0.09260864555835724,
-0.022665686905384064,
-0.02577778324484825,
-0.004942805971950293,
-0.01402186881750822,
0.026494136080145836,
0.016173185780644417,
-0.0564897283911705,
-0.008327942341566086,
0.029840322211384773,
-0.020921939983963966,
0.02261568419635296,
0.04589035362005234,
-0.037801895290613174,
-0.049677133560180664,
0.013530761003494263,
-0.01592063158750534,
0.03263147175312042,
0.015982236713171005,
-0.024866806343197823,
-0.03245582431554794,
0.011353197507560253,
-0.022487979382276535,
0.026726802811026573,
-0.005151646677404642,
0.022755218669772148,
-0.052874259650707245,
0.03287121281027794,
0.010919105261564255,
0.01815507933497429,
0.01812843792140484,
0.017852522432804108,
0.046759702265262604,
-0.042936697602272034,
0.03584912791848183,
-0.024614593014121056,
0.04042069613933563,
-0.04655002802610397,
-0.020571233704686165,
-0.06474969536066055,
-0.04712526500225067,
-0.024643510580062866,
-0.07533684372901917,
-0.04097156599164009,
0.0034266437869518995,
-0.014850937761366367,
-0.000011615835319389589,
0.03797343373298645,
-0.04387800768017769,
-0.013977712020277977,
0.009173523634672165,
0.012771275825798512,
0.02972155250608921,
-0.021883253008127213,
-0.027258602902293205,
-0.01885516569018364,
0.048325315117836,
-0.023928383365273476,
-0.012282172217965126,
-0.007901445031166077,
0.04526674747467041,
0.01584904082119465,
-0.03207050636410713,
-0.013222758658230305,
0.07269246131181717,
-0.04122642055153847,
0.08391452580690384,
-0.02103620208799839,
0.07193709909915924,
0.00870539154857397,
-0.04422442242503166,
0.0074896663427352905,
0.009723023511469364,
-0.017463840544223785,
-0.008016382344067097,
0.00933012180030346,
-0.01016719825565815,
0.015662355348467827,
0.020928815007209778,
0.010791836306452751,
0.03185071051120758,
-0.07246775925159454,
0.06148351728916168,
0.0023671581875532866,
0.015158670023083687,
-0.0275075975805521,
0.019682472571730614,
-0.05501028895378113,
-0.05620132386684418,
-0.01190077606588602,
-0.008081899024546146,
-0.03791018947958946,
-0.007560156751424074,
0.039047788828611374,
0.0009000988793559372,
0.04738426208496094,
-0.0041668107733130455,
0.006610117852687836,
-0.019934620708227158,
-0.022439580410718918,
-0.049000512808561325,
-0.018510691821575165,
0.01805960200726986,
0.033118072897195816,
-0.045408934354782104,
-0.062795490026474,
-0.02918221987783909,
-0.00030068893101997674,
-0.025576261803507805,
0.05033373460173607,
0.06976883113384247,
0.015709934756159782,
0.016628652811050415,
0.002335699973627925,
0.007097652181982994,
-0.07241317629814148,
0.016309412196278572,
-0.018982058390975,
0.024832788854837418,
-0.01761586219072342,
0.0049390061758458614,
-0.029029646888375282,
-0.0029373313300311565,
0.00494994455948472,
0.02504536882042885,
0.06323567777872086,
-0.020989345386624336,
-0.022708354517817497,
0.022739913314580917,
0.018797481432557106,
0.0191777553409338,
-0.035190775990486145,
0.005054009612649679,
-0.0022568965796381235,
0.045053061097860336,
-0.01714954525232315,
-0.0014053076738491654,
-0.04922311007976532,
0.05200725793838501,
-0.01216240506619215,
-0.04443275183439255,
-0.0030835620127618313,
-0.021088991314172745,
0.08879566192626953,
0.02462567575275898,
0.05147853493690491,
0.0025576348416507244,
-0.005437825806438923,
0.03393279388546944,
-0.021294327452778816,
-0.0720498189330101,
-0.0061446065083146095,
-0.010424051433801651,
-0.06338734924793243,
0.01771235652267933,
-0.0018299916991963983,
-0.004054430406540632,
0.024181021377444267,
0.042960140854120255,
0.02036403864622116,
0.010379425249993801,
-0.01751457341015339,
0.008854529820382595,
0.028914907947182655,
-0.005395524203777313,
0.0021960383746773005,
-0.004135487601161003,
-0.0020867774728685617,
-0.03636987507343292,
0.08562306314706802,
-0.0027978767175227404,
-0.06360455602407455,
0.01730753853917122,
0.05766595900058746,
-0.005136618856340647,
0.019887467846274376,
-0.023319587111473083,
-0.011907262727618217,
0.03322315588593483,
0.017236599698662758,
-0.042488835752010345,
-0.018574444577097893,
0.05945444107055664,
0.01330369058996439,
-0.0009413889492861927,
0.003851350862532854,
0.022262251004576683,
0.003269476117566228,
-0.08993341028690338,
-0.020191095769405365,
-0.005294940434396267,
-0.08524487167596817,
-0.04118941351771355,
0.004327057860791683,
-0.037244513630867004,
-0.03131380304694176,
-0.031091293320059776,
0.008105363696813583,
-0.002411110792309046,
0.02630254440009594,
-0.013387591578066349,
-0.03253016248345375,
0.0465511716902256,
0.012022045440971851,
-0.053147707134485245,
-0.01566048339009285,
-0.004777878988534212,
0.026478134095668793,
-0.06216035783290863,
0.005256265867501497,
0.03249676525592804,
0.0065732114017009735,
0.0036857970990240574,
-0.00940772145986557,
0.05358356237411499,
-0.002961918944492936,
0.001432178309187293,
0.04458853602409363,
-0.07053673267364502,
0.014467672444880009,
-0.06612996011972427,
0.04614286124706268,
-0.0347709059715271,
0.021622806787490845,
0.07988794147968292,
-0.0014898087829351425,
-0.009270553477108479,
0.03490164503455162,
-0.024217193946242332,
-0.01966710388660431,
-0.02857702597975731,
-0.06469754874706268,
0.0681067407131195,
-0.037239283323287964,
-0.026655521243810654,
-0.02201753482222557,
0.004816543310880661,
-0.003883395344018936,
0.01901036873459816,
-0.0016375631093978882,
-0.08059857785701752,
-0.06616699695587158,
-0.0229368694126606,
-0.014881388284265995,
-0.012983172200620174,
0.045294106006622314,
-0.0471760630607605,
0.0473167710006237,
-0.021480077877640724,
0.02306012250483036,
-0.02129722386598587,
-0.00804560724645853,
-0.00983058474957943,
0.06147335469722748,
-0.03827272355556488,
-0.04094459116458893,
0.0580044649541378,
0.013652190566062927,
0.04752768576145172,
0.07160408794879913,
0.03184458613395691,
-0.036635756492614746,
0.015362273901700974,
0.03288012742996216,
-0.00977674312889576,
-0.00013508509437087923,
0.005538011901080608,
-0.021779069676995277,
0.009757617488503456,
0.019068675115704536,
-0.06352081894874573,
0.011297383345663548,
0.041805706918239594,
-0.020937658846378326,
0.00010635540093062446,
-0.03947223722934723,
0.03823800012469292,
0.03335072100162506,
-0.019784828647971153,
0.009222119115293026,
-0.02772362530231476,
0.015934152528643608,
-0.06518527120351791,
-0.009028049185872078,
-0.005372471176087856,
0.001979677239432931,
-0.08855469524860382,
-0.052813541144132614,
-0.05564609915018082,
0.08234052360057831,
0.026928087696433067,
-0.025234267115592957,
0.03221303969621658,
0.09596312046051025,
-0.054605111479759216,
0.0377621129155159,
0.013151022605597973,
-0.010970164090394974,
0.049840811640024185,
0.001989328768104315,
0.05176013335585594,
-0.02871960774064064,
-0.06314687430858612,
-0.0034493806306272745,
-0.022059595212340355,
0.05175274237990379,
0.008212685585021973,
0.0020569690968841314,
0.03341745585203171,
-0.010343580506742,
0.04506150633096695,
-0.022838562726974487,
0.07317060977220535,
0.02465570531785488,
-0.04031306877732277,
-0.005008874926716089,
0.022193830460309982,
0.07779783010482788,
-0.013212188147008419,
-0.008274368941783905,
0.018607569858431816,
0.03109230287373066,
0.04894720017910004,
-0.002490486716851592,
0.0199393592774868,
-0.005720839835703373,
0.03331023454666138,
0.023897428065538406,
0.034526363015174866,
0.007258059456944466,
0.048736054450273514,
-0.048045046627521515,
-0.04559671878814697,
0.025305069983005524,
0.047488220036029816,
-0.022967936471104622,
-0.020899223163723946,
0.043300870805978775,
-0.03320784866809845,
0.0013497592881321907,
-0.05330425873398781,
-0.0158662311732769,
0.002139517804607749,
-0.011771108955144882,
-0.021118342876434326,
-0.03103720396757126,
0.05281342566013336,
-0.0269754808396101,
-0.0031939528416842222,
0.018198436126112938,
-0.000940365600399673,
0.02114657312631607,
-0.007116193417459726,
-0.017502103000879288,
-0.008936263620853424,
0.023403963074088097,
0.007495053578168154,
-0.033630866557359695,
-0.07397688180208206,
0.006186032202094793,
-0.016457144170999527,
-0.0005939236143603921,
-0.002500031841918826,
0.05487051606178284,
0.0441308356821537,
0.004450206644833088,
-0.0071096220053732395,
0.024178456515073776,
0.10361462086439133,
-0.029228299856185913,
0.06168048828840256,
-0.017412414774298668,
-0.06216738373041153,
-0.02760048396885395,
0.0498967282474041,
-0.016868898645043373,
-0.07098035514354706,
-0.053353872150182724,
0.00450038630515337,
-0.03155754879117012,
-0.00976636167615652,
-0.013943909667432308,
-0.0016220660181716084,
0.014471673406660557,
-0.04269584268331528,
0.02142418548464775,
0.011753998696804047,
0.024936063215136528,
0.014532117173075676,
-0.019409820437431335,
0.01704857125878334,
-0.009473240934312344,
0.058459360152482986,
-0.03657912090420723,
0.046683818101882935,
-0.03697647154331207,
0.006186471786350012,
0.03332555294036865,
-0.013365916907787323,
0.007923226803541183,
-0.04262208193540573,
-0.05426264926791191,
-0.039850637316703796,
-0.015134945511817932,
-0.0011226736241951585,
0.005121368914842606,
-0.013442962430417538,
0.0065727378241717815,
0.0009587194654159248,
0.027379943057894707,
-0.03374950960278511,
0.009791012853384018,
0.02356012538075447,
-0.0019938251934945583,
0.04088974744081497,
0.07278960943222046,
0.033341482281684875,
-0.024537142366170883,
-6.360080510733128e-33,
0.013525432907044888,
-0.027488453313708305,
-0.021461255848407745,
-0.020995913073420525,
0.022203832864761353,
0.04089416563510895,
-0.004287442658096552,
0.034811947494745255,
-0.004768766462802887,
0.010929989628493786,
0.002513090381398797,
0.003082282142713666,
0.004360571503639221,
0.022953305393457413,
0.06094517186284065,
-0.08656252920627594,
-0.04419064149260521,
0.01311543956398964,
-0.0010980156948789954,
-0.002814125269651413,
0.03219336271286011,
0.05404573306441307,
0.0786593034863472,
-0.02278188429772854,
0.03442985936999321,
-0.007420322857797146,
0.03719288110733032,
-0.0030137014109641314,
-0.050605323165655136,
0.00737055903300643,
0.07865045964717865,
-0.006148356478661299,
0.008820109069347382,
-0.016122370958328247,
-0.054421909153461456,
-0.029716122895479202,
0.038920532912015915,
0.004297558683902025,
0.0011351574212312698,
-0.0409197174012661,
-0.0928235799074173,
-0.015730932354927063,
0.07348604500293732,
-0.004462201148271561,
0.01103427167981863,
-0.014509894885122776,
-0.04031877964735031,
-0.00030610221438109875,
-0.0105897793546319,
-0.04082582890987396,
-0.010997608304023743,
-0.0035252664238214493,
0.009515771642327309,
-0.035284776240587234,
0.013609114103019238,
-0.02233060449361801,
0.005922332871705294,
0.0037733656354248524,
-0.014814356341958046,
-0.03536364436149597,
-0.05088844522833824,
0.009324182756245136,
-0.027211051434278488,
-0.033384840935468674,
-0.05595174431800842,
0.016871225088834763,
0.02088766172528267,
0.0922868475317955,
-0.042441535741090775,
0.013905026949942112,
-0.09355320036411285,
-0.005636777728796005,
0.02215687371790409,
-0.007741683628410101,
-0.00392885971814394,
-0.006088146939873695,
-0.03984000161290169,
-0.004660467151552439,
-0.03285710886120796,
0.08153679221868515,
-0.0356573760509491,
-0.028173435479402542,
-0.05653291940689087,
-0.057211603969335556,
0.012253698892891407,
0.02264985628426075,
-0.02557390369474888,
0.015254867263138294,
0.006954872980713844,
-0.06225178390741348,
-0.007264826912432909,
0.03424635902047157,
0.020773710682988167,
-0.020836900919675827,
0.04049427807331085,
-0.09768381714820862,
0.03603479266166687,
0.029453257098793983,
-0.009554943069815636,
0.003112751292064786,
-0.012958112172782421,
0.017986932769417763,
0.028369715437293053,
-0.020869489759206772,
0.006371069699525833,
0.006585272494703531,
-0.02582397870719433,
0.036971379071474075,
0.05470705032348633,
0.0009075793204829097,
0.02588883973658085,
-0.07998482882976532,
0.045074883848428726,
0.007321122568100691,
-0.001476203091442585,
0.06474718451499939,
0.04763462767004967,
0.04262653738260269,
-0.006180903408676386,
-0.029838208109140396,
0.012791922315955162,
-0.04494307562708855,
0.04673011600971222,
-0.0003797365934588015,
-0.03937550261616707,
0.004429308231920004,
-0.04235338792204857,
0.0008670556708239019,
0.024002082645893097,
0.015222004614770412,
0.03708065301179886,
-0.01530512236058712,
3.256844536281278e-7,
0.04077795892953873,
0.047075651586055756,
0.045775867998600006,
-0.047301311045885086,
0.02773134782910347,
-0.04474316164851189,
-0.03197971731424332,
0.028160512447357178,
-0.02275601588189602,
-0.06164500489830971,
0.07101856917142868,
-0.04996262118220329,
0.027653567492961884,
0.005468687042593956,
0.00568508030846715,
-0.055688560009002686,
-0.0655476450920105,
-0.03675569221377373,
0.0027422388084232807,
-0.07634449005126953,
0.01612807996571064,
-0.040555041283369064,
-0.013577938079833984,
-0.036308057606220245,
-0.005128440912812948,
0.03248424455523491,
0.017241140827536583,
-0.04332614690065384,
0.02891860529780388,
0.06201186031103134,
0.06138506531715393,
0.05425000935792923,
0.006564033683389425,
0.06893659383058548,
-0.00034128487459383905,
-0.08072767406702042,
0.032699331641197205,
0.019370347261428833,
-0.09842977672815323,
0.05343809351325035,
-0.011453169398009777,
-0.07513450086116791,
0.018274664878845215,
0.01694810576736927,
-0.0062953936867415905,
-0.005596520379185677,
-0.011493107303977013,
0.024078747257590294,
-0.011326629668474197,
-0.011435138061642647,
0.08573012053966522,
0.011715416796505451,
-0.036956530064344406,
0.06349340826272964,
-0.00917400885373354,
0.06937393546104431,
-0.028310732915997505,
-0.0002355280303163454,
0.09296290576457977,
0.01679319329559803,
0.02393501065671444,
-0.062170762568712234,
0.04028000310063362,
-0.05789405107498169,
-0.026290081441402435,
-0.01749997027218342,
0.01577123813331127,
2.3658908476061322e-34,
-0.03709052503108978,
-0.056483250111341476,
-0.003581749042496085,
-0.0973493680357933,
0.05724485591053963,
-0.0002910652256105095,
0.06961210072040558,
-0.03455526381731033,
-0.00048061064444482327,
-0.000613886455539614,
-0.030863117426633835
] | {
"ds_index": 65,
"similar_dg_indices": [
154745,
830939,
800683,
749016,
706157,
1176422,
106055,
511272,
352874,
791863,
424036,
584965,
373758,
490353,
984207,
116711,
918945,
789284,
1204911,
386653
]
} |
You are the team physician for an NBA basketball team. On the morning of an important playoff game, an EKG of a star player, Mr. P, shows findings suspicious for hypertrophic cardiomyopathy (HCM). Mr. P is an otherwise healthy, fit, professional athlete.
The playoff game that night is the most important of Mr. P's career. When you inform the coach that you are thinking of restricting Mr. P's participation, he threatens to fire you. Later that day you receive a phone call from the owner of the team threatening a lawsuit should you restrict Mr. P's ability to play. Mr. P states that he will be playing in the game "if it's the last thing I do."
Which of the following is the most appropriate next step? | Educate Mr. P about the risks of HCM | {
"A": "Consult with a psychiatrist to have Mr. P committed",
"B": "Call the police and have Mr. P arrested",
"C": "Allow Mr. P to play against medical advice",
"D": "Educate Mr. P about the risks of HCM"
} | step1 | D | [
"team physician",
"NBA basketball",
"morning",
"important",
"game",
"EKG",
"star",
"Mr",
"shows findings suspicious",
"hypertrophic cardiomyopathy",
"Mr",
"healthy",
"fit",
"professional athlete",
"game",
"night",
"the most important",
"Mr",
"P",
"areer.",
"nform ",
"oach ",
"hinking ",
"estricting r.",
"'",
"rticipation, ",
" f re y",
"ter t",
"y y",
"ceive a",
"one call f",
"ner o",
"am t",
"strict M . ",
"s",
"lity to pl y. M",
" P",
"t tes th",
"ying in",
"e \"i",
" thi g I d .",
"owing is ",
" app opriate nex ste ?"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: You are the team physician for an NBA basketball team. On the morning of an important playoff game, an EKG of a star player, Mr. P, shows findings suspicious for hypertrophic cardiomyopathy (HCM). Mr. P is an otherwise healthy, fit, professional athlete.
The playoff game that night is the most important of Mr. P's career. When you inform the coach that you are thinking of restricting Mr. P's participation, he threatens to fire you. Later that day you receive a phone call from the owner of the team threatening a lawsuit should you restrict Mr. P's ability to play. Mr. P states that he will be playing in the game "if it's the last thing I do."
Which of the following is the most appropriate next step?
Choose one of the following::
A. Consult with a psychiatrist to have Mr. P committed
B. Call the police and have Mr. P arrested
C. Allow Mr. P to play against medical advice
D. Educate Mr. P about the risks of HCM | [
0.03758596256375313,
0.014293950982391834,
0.024905506521463394,
-0.007969972677528858,
-0.021291954442858696,
0.02490060217678547,
-0.07331159710884094,
0.05261246860027313,
0.01908920146524906,
0.008583394810557365,
0.053168829530477524,
0.03995659202337265,
0.0031900866888463497,
-0.06520941108465195,
0.02788209170103073,
0.052232880145311356,
-0.013187074102461338,
-0.008257422596216202,
0.07829459756612778,
-0.029622536152601242,
-0.004388157278299332,
0.031630683690309525,
0.03517211228609085,
0.014828846789896488,
0.0037786473985761404,
-0.029937783256173134,
0.0810350775718689,
-0.009967413730919361,
0.024419017136096954,
-0.038962699472904205,
-0.08522208780050278,
0.011087377555668354,
0.00771962758153677,
-0.09425579756498337,
0.0000017971384522752487,
-0.006648688111454248,
0.0501423217356205,
-0.02473551407456398,
0.023222409188747406,
-0.04760053753852844,
-0.03753689303994179,
-0.07296954095363617,
0.03527070954442024,
0.02291191555559635,
-0.030630622059106827,
-0.03376789391040802,
-0.009614101611077785,
0.010847039520740509,
-0.008208957500755787,
0.0514242947101593,
-0.01299442071467638,
0.018565211445093155,
-0.01825917325913906,
-0.029664313420653343,
-0.03296913206577301,
-0.053405098617076874,
0.017458252608776093,
-0.0020124497823417187,
0.028107518330216408,
-0.02706778421998024,
0.07680436968803406,
0.00847011897712946,
-0.028311001136898994,
0.043394818902015686,
-0.027676060795783997,
-0.007345861755311489,
0.05293343588709831,
0.011777201667428017,
0.06545469909906387,
-0.005396555177867413,
0.03131350502371788,
0.04233301803469658,
0.04833930358290672,
0.03907326981425285,
0.023128727450966835,
-0.003807853441685438,
0.06687132269144058,
0.015150167979300022,
0.01105019636452198,
0.00038875616155564785,
0.03266987204551697,
0.06968531757593155,
-0.03077532723546028,
0.049074310809373856,
-0.021796340122818947,
-0.07287820428609848,
0.014972695149481297,
0.015559103339910507,
-0.016153067350387573,
0.04737796634435654,
0.007498460356146097,
-0.07896146178245544,
0.0347333662211895,
0.011982591822743416,
-0.022182056680321693,
0.016685733571648598,
0.002223616000264883,
0.03328820690512657,
0.025256294757127762,
-0.07859842479228973,
-0.05246942862868309,
0.024570029228925705,
0.10674968361854553,
-0.02160102128982544,
0.024390356615185738,
-0.07687123119831085,
-0.09900470077991486,
0.04245685786008835,
-0.014488634653389454,
0.08321749418973923,
-0.007304214872419834,
0.012400016188621521,
0.024674274027347565,
0.015542089007794857,
0.03740135580301285,
0.024958744645118713,
-0.01928764581680298,
-0.04170200973749161,
0.011097507551312447,
0.09007847309112549,
-0.0013008108362555504,
-0.025771670043468475,
-0.031258173286914825,
0.022044168785214424,
0.0013349611544981599,
-0.023490628227591515,
-0.004771629814058542,
-0.005439225118607283,
0.01907273754477501,
0.041548699140548706,
0.016464050859212875,
-0.021827910095453262,
0.001479541533626616,
0.04219479858875275,
0.03724532574415207,
0.04754021763801575,
0.0001728813658701256,
0.030563663691282272,
-0.028345715254545212,
-0.0009279094520024955,
-0.034337278455495834,
-0.06553319096565247,
0.0018615712178871036,
-0.023849574849009514,
-0.009246774949133396,
-0.017828652635216713,
-0.021919822320342064,
0.017046242952346802,
-0.01710556074976921,
0.05237216874957085,
-0.044001854956150055,
-0.021679723635315895,
-0.01896069385111332,
-0.006615985184907913,
-0.010070063173770905,
0.06414307653903961,
-0.02209765464067459,
-0.037989649921655655,
0.004738187417387962,
-0.08702532202005386,
-0.014936423860490322,
-0.014386034570634365,
0.0016673492500558496,
0.03256818279623985,
0.008941153064370155,
0.012050953693687916,
0.017343448475003242,
0.01061866246163845,
-0.04717894643545151,
0.07084599882364273,
-0.049404170364141464,
0.02564358152449131,
-0.054936088621616364,
0.021315712481737137,
0.017870189622044563,
0.015311559662222862,
-0.04637918993830681,
-0.07759532332420349,
0.0002574609825387597,
0.011352901346981525,
-0.058914799243211746,
0.016803398728370667,
-0.033229682594537735,
-0.031247003003954887,
-0.004948269575834274,
-0.0258464515209198,
-0.03604404628276825,
0.0031319831032305956,
-0.056830909103155136,
0.008012388832867146,
-0.00020165579917374998,
-0.009610425680875778,
-0.027049189433455467,
0.012179012410342693,
0.022232644259929657,
0.017037255689501762,
0.019099384546279907,
0.03513980284333229,
0.011000208556652069,
0.02900521829724312,
-0.015178604982793331,
-0.008075248450040817,
-0.02507733553647995,
0.04630995914340019,
-0.057422708719968796,
-0.01194852776825428,
0.022662267088890076,
-0.006960016209632158,
-0.0037698186933994293,
0.010316552594304085,
-0.019990907981991768,
0.05296282842755318,
0.023474717512726784,
-0.022283609956502914,
0.021711556240916252,
0.04709969460964203,
0.02027052454650402,
0.00841302890330553,
-0.0952446237206459,
0.028847238048911095,
-0.04621746018528938,
0.03051029145717621,
-0.023634864017367363,
0.0031093533616513014,
-0.051408715546131134,
-0.08620424568653107,
-0.005537192802876234,
-0.009633919224143028,
-0.037248991429805756,
-0.029000353068113327,
0.0123716089874506,
0.03137780353426933,
-0.006180678028613329,
-0.0036839486565440893,
-0.006092685740441084,
0.040265846997499466,
-0.020751861855387688,
-0.049345023930072784,
0.00009366326412418857,
0.010755470022559166,
-0.026639260351657867,
-0.04201655462384224,
-0.015476146712899208,
0.03736093267798424,
-0.03613991662859917,
0.04702486842870712,
-0.010024302639067173,
-0.019744571298360825,
-0.004848504438996315,
0.0028241605032235384,
-0.022764794528484344,
0.034786347299814224,
-0.026836613193154335,
0.03243400901556015,
-0.0453232079744339,
0.041048165410757065,
0.008805269375443459,
0.03650221601128578,
-0.07830291241407394,
-0.015404715202748775,
0.06286504864692688,
-0.019624454900622368,
-0.017699694260954857,
0.023578062653541565,
-0.0050467937253415585,
-0.0459262989461422,
0.05790950357913971,
0.027933644130825996,
0.012194576673209667,
0.005600678268820047,
-0.019425585865974426,
-0.041646722704172134,
0.024819547310471535,
-0.00896431040018797,
-0.03480682522058487,
0.022239839658141136,
-0.0625472292304039,
0.09911596029996872,
0.035635512322187424,
-0.017141811549663544,
0.022758977487683296,
0.03650232031941414,
0.03866734728217125,
0.022184068337082863,
0.03191347047686577,
0.039047516882419586,
0.0021216042805463076,
0.013602714985609055,
-0.004706111270934343,
-0.007468927185982466,
-0.03667306527495384,
0.003766941372305155,
0.004616850987076759,
-0.012636271305382252,
-0.00844098161906004,
-0.04131893441081047,
-0.09344235062599182,
-0.02175787091255188,
-0.041937775909900665,
0.06331408768892288,
0.0814463347196579,
0.03947320953011513,
0.023849865421652794,
0.012496879324316978,
0.005769460462033749,
-0.011232780292630196,
-0.03331157937645912,
0.015946166589856148,
-0.004445810802280903,
-0.0033623389899730682,
0.019655298441648483,
0.013801097869873047,
-0.010640569031238556,
-0.022968778386712074,
-0.014041497372090816,
-0.005011814646422863,
0.0463004894554615,
-0.08022210001945496,
0.00600767694413662,
0.00619273679330945,
0.03420182690024376,
0.023433838039636612,
-0.013054517097771168,
-0.015787696465849876,
0.05441853776574135,
-0.012867436744272709,
-0.028610726818442345,
0.025297444313764572,
0.057166315615177155,
0.0017274398123845458,
-0.0009603639482520521,
-0.0007262481958605349,
-0.008441144600510597,
0.036165282130241394,
0.025498392060399055,
0.0488281324505806,
-0.01740122213959694,
-0.07645270228385925,
-0.024671277031302452,
0.027701126411557198,
0.004714303649961948,
-0.004920999053865671,
-0.0023674119729548693,
0.013985421508550644,
-0.04270287603139877,
-0.024831699207425117,
-0.03395891562104225,
0.07009448111057281,
-0.05634281411767006,
-0.09178336709737778,
-0.049021173268556595,
-0.04387330263853073,
0.027697715908288956,
-0.04271363466978073,
0.008213995955884457,
-0.007448607124388218,
0.011121898889541626,
0.05671006441116333,
0.008899012580513954,
0.008761405013501644,
0.0339989997446537,
0.052851080894470215,
0.030320972204208374,
-0.002253339858725667,
-0.013918805867433548,
0.001334928092546761,
0.014476671814918518,
0.022809142246842384,
-0.059042513370513916,
0.025604931637644768,
0.002412343630567193,
0.04336795583367348,
-0.021739769726991653,
0.045025601983070374,
-0.04326675087213516,
0.019698912277817726,
0.04845433309674263,
0.018796974793076515,
-0.02401665411889553,
-0.05620788037776947,
0.04085896164178848,
-0.06529153883457184,
0.019346775487065315,
0.01335118804126978,
-0.02611936256289482,
-0.05751490965485573,
0.004973108414560556,
-0.03744148463010788,
0.015154472552239895,
0.06997217237949371,
0.003725682385265827,
0.07758242636919022,
-0.04066665098071098,
0.023116478696465492,
0.028732435777783394,
-0.011628310196101665,
0.041664086282253265,
-0.036306776106357574,
0.027018031105399132,
0.015790974721312523,
-0.016082556918263435,
-0.007746733259409666,
0.015824176371097565,
0.06074516847729683,
0.03752866014838219,
-0.07322889566421509,
0.01171888131648302,
-0.009078232571482658,
0.016774747520685196,
0.017116183415055275,
-0.07049841433763504,
-0.014107940718531609,
-0.006299392785876989,
-0.02012774348258972,
0.039174921810626984,
-0.016042830422520638,
0.015248717740178108,
-0.04674627259373665,
0.03420500084757805,
0.01056558545678854,
-0.01939437724649906,
0.015895767137408257,
0.01806062087416649,
-0.04586367309093475,
-0.03655364736914635,
-0.008537507615983486,
0.08412408828735352,
0.03371230885386467,
-0.009083176963031292,
-0.016737518832087517,
0.034645434468984604,
0.011505108326673508,
0.040849026292562485,
0.0368959940969944,
-0.030944226309657097,
0.07384733855724335,
-0.05539456754922867,
-0.016918238252401352,
0.04275316745042801,
-0.008941230364143848,
-0.02065027505159378,
0.05134091153740883,
0.057532213628292084,
-0.005106653552502394,
0.023364895954728127,
-0.031164074316620827,
0.011614780873060226,
0.03882449120283127,
0.00781970750540495,
0.05327983573079109,
0.020186858251690865,
0.0734902024269104,
0.04081176593899727,
0.007303479593247175,
0.07114004343748093,
-0.01352397259324789,
0.018468046560883522,
0.07460206747055054,
0.005844541825354099,
-0.031134743243455887,
0.009881862439215183,
0.023348458111286163,
0.03874216601252556,
0.008665810339152813,
-0.03157946839928627,
-0.027343448251485825,
-0.036915477365255356,
-0.03206087276339531,
0.03148789331316948,
-0.002568615134805441,
-0.01486322283744812,
-0.03391227126121521,
-0.023827973753213882,
0.007148437201976776,
0.03856685385107994,
0.05298633128404617,
0.007891000248491764,
-0.03392913565039635,
0.0006681132363155484,
0.03263717144727707,
0.010010968893766403,
0.015818752348423004,
-0.0657850131392479,
-0.04869694262742996,
-0.004623019602149725,
-0.05098554491996765,
0.0014355243183672428,
0.0007381749455817044,
-0.016636697575449944,
0.02530977688729763,
-0.006353463977575302,
0.03023248165845871,
-0.030653009191155434,
-0.07436198741197586,
-0.07386145740747452,
-0.04741121828556061,
-0.04083991050720215,
0.10033756494522095,
0.03838295862078667,
-0.07871799916028976,
0.007078981027007103,
0.007258599158376455,
-0.0014136184472590685,
0.03163822740316391,
-0.009341270662844181,
-0.03981447592377663,
-0.027778781950473785,
0.025818699970841408,
-0.018664926290512085,
-0.016481386497616768,
-0.007870344445109367,
0.018145326524972916,
-0.01782907359302044,
0.008346478454768658,
0.01519372034817934,
0.01743854023516178,
-0.041060321033000946,
-0.03755906969308853,
-0.03685148432850838,
-0.0555303692817688,
0.00399320712313056,
0.00683166366070509,
0.014781836420297623,
-0.04175259545445442,
0.005968466401100159,
0.04608303681015968,
0.00856250710785389,
-0.019536849111318588,
0.004344419110566378,
-0.023001857101917267,
-0.01656331680715084,
0.02064771018922329,
-0.07158073782920837,
0.021026913076639175,
-0.012246960774064064,
-0.06260958313941956,
-0.008473915979266167,
0.017259694635868073,
-0.014765285886824131,
-0.04997720196843147,
-0.08490554988384247,
0.05005819723010063,
-0.03486879542469978,
-0.022515704855322838,
-0.034676000475883484,
-0.006007015239447355,
-0.012133773416280746,
-0.0027217562310397625,
0.06053557246923447,
0.03577333316206932,
0.0042179422453045845,
0.08087476342916489,
0.029504496604204178,
-0.017920080572366714,
0.004267274402081966,
-5.2785658312331286e-33,
0.0541929192841053,
-0.033727798610925674,
0.03698582574725151,
-0.07763046026229858,
-0.03702818229794502,
0.03813077509403229,
-0.020630689337849617,
-0.036927297711372375,
-0.010314789600670338,
0.017043350264430046,
-0.019974350929260254,
0.007049468345940113,
0.00985515397042036,
0.00891333632171154,
0.015585117042064667,
-0.0844675824046135,
-0.042681317776441574,
0.01806567795574665,
-0.03226083517074585,
-0.009139596484601498,
-0.04713955521583557,
0.003142776433378458,
-0.020083533599972725,
-0.039705533534288406,
-0.03173619508743286,
0.008215408772230148,
-0.023049872368574142,
0.003916094079613686,
-0.05065535381436348,
-0.005143864545971155,
0.031906913965940475,
-0.020022587850689888,
0.019261719658970833,
-0.07712303102016449,
0.026257051154971123,
0.03183651715517044,
0.023908361792564392,
-0.013069258071482182,
0.001421252149157226,
-0.036984652280807495,
-0.02935153804719448,
-0.024029113352298737,
0.009714814834296703,
0.018348082900047302,
-0.00599818816408515,
-0.09115907549858093,
-0.03736915439367294,
0.015067223459482193,
-0.02317219041287899,
-0.0699894055724144,
-0.044463496655225754,
0.04824993759393692,
-0.014419293031096458,
0.020347008481621742,
-0.021135590970516205,
-0.005380210001021624,
-0.015052157454192638,
0.03089955449104309,
-0.01108431164175272,
0.0018579205498099327,
0.013269939459860325,
-0.048537224531173706,
-0.025180889293551445,
-0.0017805714160203934,
0.01665940135717392,
0.02884979546070099,
-0.016939479857683182,
0.03288409858942032,
-0.0522499643266201,
0.028126684948801994,
-0.0880955383181572,
0.05523645877838135,
-0.013563700020313263,
-0.032344549894332886,
-0.01284274272620678,
-0.018661601468920708,
-0.03352706506848335,
0.0043220678344368935,
0.04469494894146919,
0.010479167103767395,
-0.06902088224887848,
0.04037711024284363,
-0.04960125684738159,
-0.03833640739321709,
0.017187654972076416,
-0.014087759889662266,
-0.009557871147990227,
-0.02171236090362072,
-0.014708890579640865,
-0.035439662635326385,
0.018010936677455902,
0.03546033799648285,
0.03365665301680565,
0.023884722962975502,
0.04651160538196564,
0.0038721016608178616,
0.04075999930500984,
0.005084048956632614,
-0.02852436900138855,
0.026971613988280296,
0.03838478773832321,
-0.004990090616047382,
0.04748984053730965,
-0.04299940541386604,
-0.016039859503507614,
-0.005238791927695274,
0.001567327999509871,
-0.03313001990318298,
0.028063012287020683,
0.015347802080214024,
0.01357201300561428,
0.009354943409562111,
0.015015834011137486,
0.00885259360074997,
-0.004153972491621971,
0.0233761053532362,
0.009495832957327366,
-0.026652120053768158,
0.02490183338522911,
-0.028716683387756348,
-0.01821553148329258,
0.09391889721155167,
0.028086520731449127,
-0.010714181698858738,
-0.012822168879210949,
0.046551663428545,
0.08682279288768768,
0.07868802547454834,
-0.03338799625635147,
-0.030776942148804665,
0.004598935134708881,
-0.009416692890226841,
2.606852547160088e-7,
0.001078259781934321,
-0.06767808645963669,
-0.06316488981246948,
-0.07601906359195709,
-0.012400944717228413,
0.0413697250187397,
0.005824394058436155,
0.03967598080635071,
0.035387761890888214,
-0.030882351100444794,
0.11856883764266968,
-0.03935767337679863,
-0.005810650531202555,
-0.03758642077445984,
0.038144420832395554,
-0.03605518862605095,
0.005079225637018681,
0.018827874213457108,
0.0553056038916111,
-0.009123534895479679,
0.04769530147314072,
-0.006291065365076065,
-0.04166095703840256,
-0.014624061062932014,
0.01179312914609909,
0.016770821064710617,
0.031228719279170036,
-0.01280433963984251,
0.015253756195306778,
-0.02815263159573078,
0.04642290249466896,
-0.04775899648666382,
-0.004676442127674818,
0.024518484249711037,
-0.03626604378223419,
-0.003662449773401022,
0.013606120832264423,
0.05828065425157547,
-0.05071738734841347,
0.020998051390051842,
-0.004106986336410046,
-0.018606169149279594,
0.026059843599796295,
0.02782692387700081,
0.014035935513675213,
-0.02680528350174427,
-0.0662546455860138,
-0.0034427742939442396,
-0.055707547813653946,
-0.015752654522657394,
-0.02492782659828663,
0.020719006657600403,
-0.031994257122278214,
0.05839399993419647,
-0.0059070647694170475,
0.051795389503240585,
-0.03188972920179367,
0.02104564569890499,
0.023012345656752586,
0.022131048142910004,
-0.015117389149963856,
-0.0018681398360058665,
0.02210242673754692,
0.04384130239486694,
0.05124729126691818,
-0.04175408184528351,
0.014510881155729294,
1.858012199643002e-34,
-0.05175646021962166,
-0.027745060622692108,
-0.008939454331994057,
-0.0534331314265728,
-0.017909908667206764,
0.006598183885216713,
0.0210061464458704,
0.016207650303840637,
0.027788858860731125,
-0.05333970859646797,
-0.009065210819244385
] | {
"ds_index": 66,
"similar_dg_indices": [
1047684,
589842,
440357,
590949,
656075,
1182617,
293248,
673345,
215150,
773423,
34258,
530465,
758988,
300301,
1195056,
891122,
153115,
155102,
238323,
914509
]
} |
A 37-year-old woman presents to the emergency department complaining of generalized malaise, weakness, headache, nausea, vomiting, and diarrhea; she last felt well roughly two days ago. She is otherwise healthy, and takes no medications. Her vital signs are: T 38.0, HR 96 beats per minute, BP 110/73, and O2 sat 96% on room air. Examination reveals a somewhat ill-appearing woman; she is drowsy but arousable and has no focal neurological deficits. Initial laboratory studies are notable for hematocrit 26%, platelets of 80,000/mL, and serum creatinine of 1.5 mg/dL. Which of the following is the most appropriate treatment at this time? | Plasma exchange therapy | {
"A": "High-dose glucocorticoids",
"B": "Cyclophosphamide and rituximab",
"C": "Vancomycin and cefepime",
"D": "Plasma exchange therapy"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"generalized malaise",
"weakness",
"headache",
"nausea",
"vomiting",
"diarrhea",
"last felt well",
"two days",
"healthy",
"takes",
"medications",
"vital signs",
"T",
"0",
"96 beats per minute",
"BP",
"O2 sat 96",
"room air",
"Examination reveals",
"somewhat ill appearing woman",
"drowsy",
"focal neurological deficits",
"Initial laboratory studies",
"notable",
"hematocrit",
"platelets",
"80",
"mL",
"serum creatinine",
"mg dL",
"following",
"most appropriate treatment",
"time"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 37-year-old woman presents to the emergency department complaining of generalized malaise, weakness, headache, nausea, vomiting, and diarrhea; she last felt well roughly two days ago. She is otherwise healthy, and takes no medications. Her vital signs are: T 38.0, HR 96 beats per minute, BP 110/73, and O2 sat 96% on room air. Examination reveals a somewhat ill-appearing woman; she is drowsy but arousable and has no focal neurological deficits. Initial laboratory studies are notable for hematocrit 26%, platelets of 80,000/mL, and serum creatinine of 1.5 mg/dL. Which of the following is the most appropriate treatment at this time?
Choose one of the following::
A. High-dose glucocorticoids
B. Cyclophosphamide and rituximab
C. Vancomycin and cefepime
D. Plasma exchange therapy | [
0.053489699959754944,
-0.043081045150756836,
0.033662065863609314,
-0.023217398673295975,
-0.01740645244717598,
0.004393475130200386,
-0.030579624697566032,
0.06422002613544464,
-0.023124847561120987,
-0.023593280464410782,
0.044843703508377075,
0.010845609940588474,
-0.04455829784274101,
-0.005646129138767719,
0.01828916184604168,
-0.0019540342036634684,
-0.006372604984790087,
0.009892006404697895,
-0.025846706703305244,
0.0028910571709275246,
-0.024550920352339745,
0.026009319350123405,
0.0015436450485140085,
0.013395830057561398,
0.04483647644519806,
-0.008920812048017979,
0.00273868883959949,
0.004375038202852011,
-0.013319326564669609,
-0.040388323366642,
-0.0054630315862596035,
-0.021781692281365395,
-0.012404458597302437,
-0.07838989049196243,
0.0000018273974546900718,
-0.0038669744972139597,
0.01205124706029892,
-0.016509661450982094,
0.029114659875631332,
-0.04076561704277992,
-0.02845197543501854,
-0.06757738441228867,
0.0381099171936512,
0.02382075786590576,
-0.005537241231650114,
-0.08502945303916931,
-0.0067665413953363895,
0.09084184467792511,
-0.01943260245025158,
-0.024222852662205696,
0.023799046874046326,
0.033869292587041855,
-0.044084008783102036,
-0.02086029201745987,
0.054091498255729675,
-0.047009196132421494,
-0.029132582247257233,
-0.032924067229032516,
0.07029455155134201,
-0.018155325204133987,
0.04145035892724991,
-0.01967562921345234,
0.019251756370067596,
0.007546418346464634,
-0.02907928265631199,
0.007442084606736898,
0.004415307659655809,
-0.06884611397981644,
-0.014277906157076359,
0.03740806132555008,
-0.05117158591747284,
0.033305294811725616,
0.06661427021026611,
0.08323666453361511,
-0.054897356778383255,
-0.04503001272678375,
0.055452778935432434,
-0.07335282117128372,
-0.010257366113364697,
-0.00272005470469594,
0.06283055990934372,
0.04411937668919563,
-0.023560352623462677,
0.05370495095849037,
-0.0627647265791893,
-0.05820314586162567,
0.001813369570299983,
-0.019105006009340286,
-0.019543541595339775,
-0.028484497219324112,
-0.052242446690797806,
-0.05454619601368904,
0.02327195554971695,
-0.01280479971319437,
-0.050079990178346634,
-0.022749921306967735,
0.021741455420851707,
0.005721762776374817,
0.020869653671979904,
-0.01103401742875576,
-0.0446462482213974,
0.0029850974678993225,
0.03855661302804947,
0.006286397576332092,
-0.011810970492661,
-0.05123450607061386,
0.009886135347187519,
-0.017503870651125908,
-0.04595118388533592,
0.05169445276260376,
-0.015136415138840675,
0.04924759641289711,
-0.06994184106588364,
0.011743699200451374,
0.11376673728227615,
0.01837432011961937,
-0.027618536725640297,
-0.05229106545448303,
-0.007907737977802753,
0.08287713676691055,
0.0024370963219553232,
0.025079598650336266,
0.05395069345831871,
0.000227249605813995,
0.002154028508812189,
0.027148766443133354,
-0.009380374103784561,
0.021357838064432144,
0.04301529377698898,
-0.028409045189619064,
-0.009693336673080921,
-0.03069257363677025,
-0.04266374930739403,
0.015800971537828445,
0.02673930674791336,
0.030509522184729576,
0.028333624824881554,
0.030503137037158012,
-0.029375817626714706,
-0.0034373202361166477,
-0.030406365171074867,
-0.049938153475522995,
0.025990622118115425,
0.015927191823720932,
-0.03185950964689255,
0.039668936282396317,
-0.0029256874695420265,
0.013429475016891956,
0.007777969352900982,
0.0183140616863966,
-0.018534675240516663,
-0.0476420558989048,
0.00435536727309227,
0.010269164107739925,
-0.008766994811594486,
0.04518257826566696,
-0.005183879751712084,
-0.036144305020570755,
-0.013963826932013035,
-0.03953256458044052,
0.004344284068793058,
-0.037832263857126236,
0.0268421471118927,
-0.010433272458612919,
0.001838349038735032,
0.045420266687870026,
-0.01615506038069725,
0.10499202460050583,
-0.0888424888253212,
0.021112989634275436,
-0.0038465727120637894,
-0.0068007041700184345,
0.02506636083126068,
0.01904766634106636,
-0.02196425385773182,
0.019605573266744614,
-0.04239071533083916,
-0.022706570103764534,
0.012134270742535591,
-0.0507572777569294,
-0.0007931147702038288,
0.05609393119812012,
0.0023081633262336254,
-0.052165623754262924,
0.010853583924472332,
-0.015988873317837715,
0.05337003991007805,
-0.027255041524767876,
-0.020617429167032242,
-0.02994157373905182,
-0.018809553235769272,
0.016614003106951714,
-0.012437564320862293,
0.031183145940303802,
0.009839478880167007,
0.008732904680073261,
-0.038489386439323425,
-0.022240890190005302,
0.045938316732645035,
0.015049186535179615,
-0.012808861210942268,
-0.0020877309143543243,
0.0024123494513332844,
0.09633579105138779,
-0.032546836882829666,
0.07040216773748398,
0.01749868132174015,
0.009923741221427917,
0.016865061596035957,
0.015671556815505028,
-0.023662133142352104,
0.009585006162524223,
0.04951789975166321,
-0.02906562201678753,
0.01926538161933422,
0.03895917534828186,
0.0334719680249691,
-0.00025450310204178095,
-0.08899324387311935,
0.022010769695043564,
-0.02404305338859558,
0.011543266475200653,
-0.0735560953617096,
-0.01246330514550209,
0.037302806973457336,
-0.012666065245866776,
0.03159858658909798,
0.00851972121745348,
-0.02772197686135769,
-0.07162163406610489,
0.038159772753715515,
0.053315527737140656,
-0.025600602850317955,
-0.013390431180596352,
-0.03486311063170433,
0.007962838746607304,
0.014920610934495926,
-0.03713323548436165,
-0.03191368281841278,
0.05136838182806969,
-0.009246558882296085,
-0.04448584467172623,
-0.0849207192659378,
-0.016308065503835678,
0.02616160921752453,
-0.03870779275894165,
-0.0033669129479676485,
0.05125071853399277,
-0.06552005559206009,
0.06130857393145561,
-0.036959633231163025,
-0.00902470387518406,
-0.04725343734025955,
-0.012645687907934189,
0.00036526028998196125,
0.02276439592242241,
-0.029212653636932373,
-0.01937725953757763,
-0.03716467693448067,
-0.04555924981832504,
-0.02056390605866909,
0.01458888128399849,
0.020308250561356544,
-0.045286525040864944,
-0.08003442734479904,
-0.0027060597203671932,
0.0033308109268546104,
0.04437485337257385,
-0.027614416554570198,
0.04024706408381462,
0.01957005076110363,
0.011992204934358597,
0.03968993201851845,
0.030946623533964157,
-0.03697188198566437,
-0.02033526450395584,
0.015753155574202538,
0.05930192396044731,
0.03214576095342636,
-0.02515314519405365,
0.04044454172253609,
0.05526179447770119,
0.027996614575386047,
0.053560756146907806,
0.01653517410159111,
-0.013403353281319141,
-0.052677661180496216,
0.00238268100656569,
0.013744155876338482,
-0.026775959879159927,
0.018585845828056335,
0.018015705049037933,
0.0009025944746099412,
-0.060570843517780304,
-0.03864140063524246,
-0.04872773215174675,
-0.030675312504172325,
0.042510226368904114,
-0.016923531889915466,
0.045996665954589844,
0.019736140966415405,
0.06055265665054321,
-0.005293597467243671,
0.02643350139260292,
-0.007980095222592354,
0.03514355793595314,
0.04274696484208107,
0.012786174193024635,
0.012145441956818104,
0.07850121706724167,
0.02582227624952793,
0.0016368385404348373,
-0.023610437288880348,
-0.02538333088159561,
0.003278234973549843,
-0.02738676592707634,
0.010059887543320656,
-0.043561264872550964,
0.03581768274307251,
-0.00740042282268405,
0.03569675609469414,
0.03354842960834503,
-0.02630186825990677,
-0.01963055692613125,
0.0013875295408070087,
-0.03899369016289711,
-0.02611381560564041,
-0.006142906378954649,
-0.1168312057852745,
-0.027790268883109093,
-0.015594410710036755,
-0.004985537379980087,
0.0159467700868845,
0.04653867334127426,
0.037350479513406754,
-0.013925324194133282,
-0.006288856267929077,
0.03513811528682709,
-0.009001048281788826,
0.022487344220280647,
0.029979713261127472,
-0.06969359517097473,
0.014457094483077526,
-0.0028992858715355396,
0.010773898102343082,
-0.023830128833651543,
-0.07667329907417297,
0.029618382453918457,
-0.010196198709309101,
0.04415186867117882,
-0.08279598504304886,
0.020116448402404785,
0.0026353136636316776,
-0.02905484475195408,
0.015596292912960052,
-0.06937283277511597,
-0.00977719109505415,
0.06680191308259964,
-0.030214371159672737,
0.02139410190284252,
0.016915934160351753,
0.058980319648981094,
-0.01960677094757557,
0.007698368281126022,
0.008322758600115776,
0.01260731928050518,
0.02945992350578308,
-0.04211452975869179,
-0.04630415514111519,
0.017027730122208595,
-0.028375830501317978,
-0.019316133111715317,
-0.0378861203789711,
0.07657142728567123,
-0.01815502531826496,
-0.04101177677512169,
0.005899643991142511,
-0.06136917322874069,
-0.0661764144897461,
-0.034239429980516434,
0.031206969171762466,
-0.0165170319378376,
0.016859037801623344,
-0.028942909091711044,
-0.0013251779600977898,
0.020456083118915558,
-0.024391286075115204,
-0.045182567089796066,
0.06162206456065178,
-0.023897146806120872,
0.0014088877942413092,
-0.008041741326451302,
0.011447700671851635,
-0.012625407427549362,
0.030107637867331505,
0.011854691430926323,
0.03201018273830414,
-0.041061874479055405,
-0.009488188661634922,
0.08641418814659119,
-0.005535285919904709,
0.013242519460618496,
-0.03868095576763153,
0.04627558961510658,
0.012638828717172146,
-0.021554412320256233,
-0.022939953953027725,
-0.026846924796700478,
0.05409187451004982,
0.05168500915169716,
0.019919924437999725,
-0.04788580536842346,
0.04440862312912941,
-0.00031989390845410526,
0.03815244510769844,
-0.0012994930148124695,
0.008808586746454239,
0.0009895296534523368,
0.012723245657980442,
-0.06663872301578522,
0.053004082292318344,
0.009053372777998447,
-0.05976175516843796,
-0.06434983760118484,
-0.011056076735258102,
-0.0050416612066328526,
0.051726482808589935,
0.05738167092204094,
0.04233109951019287,
0.05423351004719734,
0.01991654373705387,
-0.0382668673992157,
0.04138059541583061,
0.023962028324604034,
-0.04810916632413864,
0.02692902460694313,
-0.0305719543248415,
-0.025413183495402336,
-0.0392637774348259,
-0.06745987385511398,
-0.013984260149300098,
0.026192711666226387,
0.09058237820863724,
-0.008887732401490211,
-0.03634488582611084,
0.03302837908267975,
0.03371753171086311,
0.06105167791247368,
0.008705206215381622,
0.08635611087083817,
0.01329871453344822,
-0.06942597776651382,
0.024530772119760513,
-0.014433804899454117,
0.06582663208246231,
-0.0136732691898942,
-0.001110969576984644,
0.04398892819881439,
0.03631994128227234,
0.004459926392883062,
-0.06877179443836212,
0.01980137825012207,
-0.029329555109143257,
-0.05990678817033768,
0.007409313227981329,
-0.04773087799549103,
-0.0665678083896637,
-0.005197928752750158,
-0.030214253813028336,
-0.000383770908229053,
-0.019213387742638588,
0.03262513875961304,
0.0005122876027598977,
0.002358892932534218,
0.07342766225337982,
-0.003985783085227013,
-0.048018768429756165,
-0.02856413461267948,
-0.043349288403987885,
0.017667623236775398,
-0.01714254543185234,
0.025428596884012222,
-0.08379238098859787,
-0.03934452310204506,
0.023839302361011505,
-0.0003944812051486224,
0.030031422153115273,
-0.028739245608448982,
-0.02442283369600773,
-0.003356217872351408,
0.016599511727690697,
0.015317833982408047,
0.021892238408327103,
0.015570737421512604,
-0.08087056130170822,
-0.0017130172345787287,
-0.039296623319387436,
-0.0003485760826151818,
0.006755176931619644,
0.0022905149962753057,
0.07374142110347748,
0.04123707115650177,
0.030521290376782417,
0.01067398488521576,
0.011618467979133129,
0.017392778769135475,
-0.03581215813755989,
0.08021554350852966,
-0.0072370488196611404,
-0.05408798158168793,
0.021650485694408417,
0.045142922550439835,
-0.04687222093343735,
0.01959248259663582,
0.05736222118139267,
-0.017789466306567192,
-0.0634264200925827,
-0.018357591703534126,
0.03248020261526108,
0.0188472718000412,
-0.002440736163407564,
0.0012707978021353483,
-0.01855037733912468,
0.006537127308547497,
0.031174639239907265,
0.003565690014511347,
-0.009672913700342178,
0.004701315890997648,
-0.019303619861602783,
0.07179325819015503,
-0.009773763827979565,
0.008347690105438232,
-0.005098332185298204,
-0.02046702802181244,
-0.005558331031352282,
-0.021144002676010132,
-0.024089518934488297,
0.007880022749304771,
-0.02619718387722969,
-0.03331514447927475,
0.004177789203822613,
0.040854740887880325,
0.015813494101166725,
-0.03628210723400116,
-0.047045547515153885,
0.06358564645051956,
-0.02207024209201336,
0.0012327564181759953,
0.0301494337618351,
0.06411286443471909,
0.000529896526131779,
0.05909936875104904,
0.01996256597340107,
0.005789749324321747,
0.008062666282057762,
-5.310171568248878e-33,
0.06906366348266602,
-0.005487646907567978,
0.0004907686379738152,
-0.06038021296262741,
0.02788134291768074,
0.07797595113515854,
-0.03184185549616814,
0.004461972042918205,
-0.04474243149161339,
0.019178248941898346,
-0.04577384144067764,
-0.012110763229429722,
0.011120423674583435,
0.05173034965991974,
-0.024600932374596596,
-0.049163706600666046,
-0.0003698033979162574,
0.03219425305724144,
-0.0468720979988575,
0.029620127752423286,
-0.003475282806903124,
0.001414241618476808,
-0.00481787184253335,
-0.04702473059296608,
-0.018590718507766724,
0.01273380033671856,
0.03703402355313301,
0.03424949198961258,
-0.01023633498698473,
0.024453766644001007,
0.008898867294192314,
0.0001192729760077782,
0.033856213092803955,
0.01894354820251465,
-0.008242690935730934,
-0.03897443786263466,
-0.007247963920235634,
-0.045882128179073334,
0.052442532032728195,
-0.03060850501060486,
-0.029721278697252274,
-0.06481674313545227,
0.060214921832084656,
0.0205858014523983,
0.04916752129793167,
-0.03576590493321419,
-0.0374043807387352,
-0.04417157173156738,
0.03156762570142746,
0.00921439565718174,
-0.01051421370357275,
0.0017396054463461041,
-0.02208886481821537,
-0.022405600175261497,
-0.009274200536310673,
-0.01815199665725231,
0.00251444592140615,
0.006924100685864687,
0.032015878707170486,
-0.00956935528665781,
-0.06489857286214828,
0.013148779049515724,
-0.014569785445928574,
-0.06253151595592499,
-0.032091107219457626,
0.010406287387013435,
0.05149424076080322,
0.035100068897008896,
-0.08354777842760086,
0.03863583877682686,
-0.08447219431400299,
0.0026734997518360615,
0.008081194944679737,
-0.012272752821445465,
0.005239975173026323,
-0.01855987124145031,
0.034318942576646805,
0.004493057262152433,
0.017683755606412888,
0.019289525225758553,
-0.0304279625415802,
-0.007038878742605448,
-0.05595661699771881,
-0.01614926941692829,
0.009347623214125633,
-0.003357085632160306,
-0.03450482338666916,
-0.01721413992345333,
-0.007894014939665794,
0.010151348076760769,
0.07703609019517899,
0.011049258522689342,
0.05389665439724922,
0.03789757937192917,
0.01083210576325655,
-0.04462148994207382,
0.025374900549650192,
0.041107483208179474,
0.012540647760033607,
-0.006058822385966778,
0.05777745321393013,
0.018155019730329514,
0.08247146755456924,
-0.041148871183395386,
-0.038775358349084854,
0.020229989662766457,
-0.008334354497492313,
0.008497404865920544,
0.034756723791360855,
0.0059591904282569885,
-0.009254618547856808,
-0.006566458847373724,
-0.013897115364670753,
0.046638499945402145,
-0.019828327000141144,
0.03470820188522339,
0.03441516309976578,
0.0031154844909906387,
0.024962417781352997,
0.0007511478033848107,
0.007942686788737774,
0.012606033124029636,
0.05037159100174904,
0.005773401353508234,
-0.031914811581373215,
-0.061980295926332474,
0.03396964445710182,
0.04797779768705368,
-0.0009219016064889729,
-0.03676706552505493,
0.0354730449616909,
0.0031614971812814474,
2.6521678364588297e-7,
0.02745985984802246,
-0.03766394034028053,
-0.01816435530781746,
-0.07963347434997559,
0.022471748292446136,
-0.04220752418041229,
-0.016183625906705856,
0.032136913388967514,
0.0028237123042345047,
-0.018857454881072044,
0.06157281622290611,
-0.003136794315651059,
0.0098312608897686,
-0.032622773200273514,
0.006851347163319588,
-0.021001804620027542,
-0.0343288779258728,
-0.01377393864095211,
0.03269078955054283,
-0.03980529308319092,
-0.009825475513935089,
-0.03898441791534424,
-0.03565449267625809,
-0.038210511207580566,
-0.016248710453510284,
-0.017597921192646027,
0.016938257962465286,
-0.04142950475215912,
-0.01445567887276411,
0.025599712505936623,
0.0023128699976950884,
0.10433957725763321,
0.015021736733615398,
0.03361476957798004,
-0.04063479229807854,
-0.05340781435370445,
0.04612644016742706,
0.06029399484395981,
-0.01736527867615223,
0.022159377112984657,
-0.00912527833133936,
-0.015153298154473305,
0.02818494662642479,
0.01885688304901123,
0.039996370673179626,
0.000346027227351442,
-0.030857551842927933,
0.043754301965236664,
0.009292411617934704,
0.013166479766368866,
-0.018039915710687637,
0.02346084453165531,
-0.03677423670887947,
0.07969140261411667,
-0.0023834567982703447,
0.05863169580698013,
-0.0008114010561257601,
0.013753307051956654,
0.028783487156033516,
0.008802124299108982,
-0.00658514816313982,
-0.04738430306315422,
-0.025774773210287094,
-0.029186571016907692,
0.06936867535114288,
-0.055224575102329254,
-0.0480043925344944,
2.0682262906191585e-34,
-0.03148745745420456,
-0.04489867389202118,
0.02902127243578434,
-0.040214087814092636,
-0.034274328500032425,
-0.0182920191437006,
0.009891889058053493,
0.009940050542354584,
0.011558913625776768,
-0.0821446105837822,
-0.030936360359191895
] | {
"ds_index": 67,
"similar_dg_indices": [
557084,
116545,
465778,
1009641,
786473,
882056,
601800,
1083139,
214238,
703701,
433695,
698881,
1061427,
1040277,
512272,
992634,
888195,
46723,
601274,
602139
]
} |
A 5-week-old infant born at 36 weeks' gestation is brought to the physician for a well-child examination. Her mother reports that she previously breastfed her for 15 minutes every 2 hours but now feeds her for 40 minutes every 4 hours. The infant has six wet diapers and two stools daily. She currently weighs 3500 g (7.7 lb) and is 52 cm (20.4 in) in length. Vital signs are with normal limits. Cardiopulmonary examination shows a grade 4/6 continuous murmur heard best at the left infraclavicular area. After confirming the diagnosis via echocardiography, which of the following is the most appropriate next step in management of this patient? | Indomethacin infusion | {
"A": "Prostaglandin E1 infusion",
"B": "Indomethacin infusion",
"C": "Surgical ligation",
"D": "Percutaneous surgery"
} | step2&3 | B | [
"5 week old infant born",
"36 weeks",
"gestation",
"brought",
"physician",
"well",
"mother reports",
"breastfed",
"15 minutes",
"2 hours",
"now feeds",
"40 minutes",
"4 hours",
"infant",
"six wet diapers",
"two stools daily",
"currently",
"3500 g",
"20",
"length",
"Vital signs",
"normal limits",
"Cardiopulmonary examination shows",
"grade",
"6 continuous murmur heard best",
"left infraclavicular area",
"confirming",
"diagnosis",
"echocardiography",
"following",
"most appropriate next step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 5-week-old infant born at 36 weeks' gestation is brought to the physician for a well-child examination. Her mother reports that she previously breastfed her for 15 minutes every 2 hours but now feeds her for 40 minutes every 4 hours. The infant has six wet diapers and two stools daily. She currently weighs 3500 g (7.7 lb) and is 52 cm (20.4 in) in length. Vital signs are with normal limits. Cardiopulmonary examination shows a grade 4/6 continuous murmur heard best at the left infraclavicular area. After confirming the diagnosis via echocardiography, which of the following is the most appropriate next step in management of this patient?
Choose one of the following::
A. Prostaglandin E1 infusion
B. Indomethacin infusion
C. Surgical ligation
D. Percutaneous surgery | [
0.0019763903692364693,
-0.03499473258852959,
-0.002076794859021902,
-0.005585991311818361,
-0.0004792213439941406,
0.03544561564922333,
-0.04991598054766655,
0.00504921842366457,
-0.0662650465965271,
0.003912108484655619,
0.057462483644485474,
-0.0466952919960022,
0.02496369741857052,
0.0024533765390515327,
-0.013492508791387081,
0.0019919616170227528,
-0.01520958635956049,
-0.017966942861676216,
-0.01865757443010807,
-0.008602499961853027,
-0.0447976179420948,
0.013221538625657558,
0.02160709910094738,
-0.06713616102933884,
0.02289765514433384,
0.004243341740220785,
0.021241936832666397,
0.005945130251348019,
-0.05388033762574196,
-0.08025016635656357,
0.03028913587331772,
0.005399499554187059,
0.004751801956444979,
-0.007297676056623459,
0.000002175516328861704,
-0.0014540102565661073,
0.00458242604508996,
0.03282827138900757,
-0.001877833972685039,
-0.016764797270298004,
-0.0014201701851561666,
-0.1135869026184082,
0.018356245011091232,
-0.001426216447725892,
-0.006175301503390074,
-0.0414290577173233,
0.030188966542482376,
0.02029493823647499,
-0.009196232073009014,
-0.01775393821299076,
0.01976245827972889,
0.024750225245952606,
-0.04233628883957863,
-0.012950709089636803,
0.03227723389863968,
-0.08433382213115692,
-0.021874213591217995,
0.03845108672976494,
0.05156564712524414,
0.04847489669919014,
-0.007295722607523203,
0.05176421254873276,
0.03827234357595444,
0.038619887083768845,
0.0007619364187121391,
-0.052928242832422256,
0.056708116084337234,
-0.08065124601125717,
0.006466242019087076,
0.04334946349263191,
0.04883904010057449,
0.02280944399535656,
0.017015991732478142,
0.05115408077836037,
-0.024041691794991493,
-0.013881211169064045,
0.027668021619319916,
-0.018099980428814888,
-0.027973804622888565,
-0.009958742186427116,
0.061833396553993225,
0.005162077955901623,
-0.04949268698692322,
0.038012322038412094,
0.013121716678142548,
-0.0624270923435688,
0.02264832891523838,
-0.02851211093366146,
-0.0038614843506366014,
0.007662550546228886,
0.032638587057590485,
-0.001231076312251389,
-0.005712352693080902,
0.02687695063650608,
-0.018078450113534927,
0.033491794019937515,
-0.01237980742007494,
0.021557852625846863,
0.01507733017206192,
-0.021842967718839645,
-0.042712852358818054,
-0.026115939021110535,
-0.004661891143769026,
0.021955687552690506,
0.008122535422444344,
-0.032047733664512634,
0.009850685484707355,
-0.023302752524614334,
-0.04961606487631798,
0.08416663855314255,
-0.004639890976250172,
0.0036722393706440926,
0.009822218678891659,
0.006423294078558683,
0.0029093229677528143,
-0.0008224628982134163,
-0.006061871070414782,
-0.054875172674655914,
-0.016241107136011124,
0.03810783103108406,
0.0011209126096218824,
0.0004488909326028079,
0.06153329834342003,
0.023327654227614403,
-0.024833129718899727,
0.03143410384654999,
0.03551056981086731,
-0.009641441516578197,
-0.02123265713453293,
0.018392134457826614,
-0.006863174960017204,
0.016285866498947144,
-0.009294647723436356,
0.05426357686519623,
0.06887802481651306,
-0.01769106462597847,
0.019560938701033592,
0.021224530413746834,
0.000742988777346909,
0.025751709938049316,
-0.02343152090907097,
-0.09200237691402435,
-0.026225117966532707,
0.0047110519371926785,
-0.0425904206931591,
0.014307726174592972,
0.0052297418005764484,
0.03681343421339989,
0.013854678720235825,
0.05437451973557472,
0.012515195645391941,
-0.02076644077897072,
-0.007573225069791079,
0.01963409222662449,
0.01293360535055399,
0.029514217749238014,
0.048035480082035065,
0.01227395050227642,
0.028444970026612282,
-0.10776642709970474,
-0.012902142480015755,
-0.03255017101764679,
-0.039821427315473557,
0.009869713336229324,
0.027042096480727196,
0.00022695779625792056,
0.029823562130331993,
0.049309585243463516,
-0.0374147854745388,
0.016899053007364273,
-0.007591702044010162,
0.005389180965721607,
0.02382846362888813,
0.029865175485610962,
0.05530652031302452,
0.00023058190708979964,
-0.08636312931776047,
-0.06722630560398102,
-0.01861710473895073,
-0.06737332791090012,
-0.003366056364029646,
0.009705988690257072,
0.014374134130775928,
-0.010421345010399818,
0.002119238255545497,
-0.05655167996883392,
-0.049390759319067,
-0.04284273460507393,
-0.051176346838474274,
-0.017956838011741638,
-0.049205176532268524,
0.021383732557296753,
0.013026891276240349,
0.028408538550138474,
0.010073680430650711,
0.07481222599744797,
-0.02918555960059166,
-0.020998552441596985,
-0.02121208980679512,
0.07657188922166824,
-0.034185394644737244,
-0.02483321912586689,
0.03647428750991821,
-0.009416412562131882,
-0.017766153439879417,
0.0181282926350832,
-0.02606666274368763,
0.02827017568051815,
0.017320768907666206,
0.018378332257270813,
-0.02370990253984928,
0.008972921408712864,
-0.02898399718105793,
0.011439735069870949,
0.013273753225803375,
0.020831109955906868,
-0.013961393386125565,
0.023897670209407806,
-0.03665680065751076,
0.025245467200875282,
-0.06417529284954071,
-0.01953834295272827,
-0.06020798534154892,
0.00015392382920254022,
0.011734317056834698,
-0.016700467094779015,
0.04491865634918213,
0.031157268211245537,
0.02357727289199829,
-0.038048818707466125,
0.05970058962702751,
0.022217363119125366,
-0.027178023010492325,
0.05438359081745148,
-0.002032927703112364,
0.03201797977089882,
-0.015816910192370415,
-0.04823988676071167,
0.03069533221423626,
0.03217767924070358,
-0.06825098395347595,
-0.06206420436501503,
-0.02569033019244671,
-0.030209125950932503,
-0.0050696381367743015,
-0.052177637815475464,
0.022086935117840767,
0.05137450993061066,
0.007153921294957399,
-0.005702328868210316,
0.007586823310703039,
-0.022314295172691345,
-0.03025536797940731,
0.019534461200237274,
0.020026778802275658,
0.003182830289006233,
0.02652091532945633,
-0.027099398896098137,
-0.005950369872152805,
-0.030086522921919823,
-0.011830760166049004,
-0.0071169063448905945,
-0.014057034626603127,
-0.05735766887664795,
0.03281598165631294,
-0.032453205436468124,
-0.027178103104233742,
0.04914670065045357,
0.03385324031114578,
0.029998427256941795,
0.01894260197877884,
-0.011563057079911232,
0.03801997750997543,
0.04391857236623764,
-0.012471712194383144,
-0.024323850870132446,
0.02555873990058899,
0.0426274836063385,
0.04191381111741066,
-0.015651891008019447,
0.03013518452644348,
0.03159769997000694,
0.02216537855565548,
0.07110260426998138,
0.02331918478012085,
-0.014771395362913609,
-0.0023653379175812006,
0.019765619188547134,
0.013855015859007835,
-0.030871326103806496,
0.012897022999823093,
0.012349395081400871,
-0.013279261067509651,
-0.012845957651734352,
0.0011207901407033205,
-0.008085623383522034,
-0.04470203071832657,
0.0198614913970232,
-0.018365442752838135,
0.09210161119699478,
-0.051124248653650284,
0.023071588948369026,
0.029992230236530304,
0.031079862266778946,
-0.005372477695345879,
0.012831814587116241,
0.05916078761219978,
0.050604626536369324,
-0.030589265748858452,
0.042175520211458206,
0.009421460330486298,
-0.0438358336687088,
0.004581835120916367,
0.01276372466236353,
0.011160886846482754,
-0.007535503711551428,
-0.04185432940721512,
-0.08324156701564789,
0.02787085808813572,
0.07020189613103867,
0.08026555925607681,
-0.041813068091869354,
-0.03062305971980095,
0.01165340282022953,
-0.02683243900537491,
-0.022200733423233032,
-0.06697823852300644,
-0.0006216773181222379,
-0.06722963601350784,
-0.047919269651174545,
-0.001131151570007205,
-0.033703725785017014,
-0.035861436277627945,
-0.001928149489685893,
0.014048109762370586,
-0.01287001371383667,
-0.015021055936813354,
-0.020481249317526817,
-0.07085735350847244,
0.05650227516889572,
0.012573348358273506,
-0.07739517837762833,
-0.018064917996525764,
0.039485134184360504,
0.04630390927195549,
-0.026192769408226013,
-0.036593131721019745,
0.033139441162347794,
-0.021411282941699028,
0.02319508045911789,
-0.08789552003145218,
-0.012741629034280777,
0.017900945618748665,
-0.0041297730058431625,
-0.022276006639003754,
-0.017327914014458656,
0.00971525814384222,
0.0007563131512142718,
0.025577489286661148,
-0.0012053241953253746,
0.0027325765695422888,
0.01408615242689848,
-0.020175889134407043,
0.029037540778517723,
-0.007241252809762955,
-0.004384535830467939,
0.0360286645591259,
-0.0008576832478865981,
-0.002913425210863352,
0.02680326998233795,
-0.012894204817712307,
0.04441045597195625,
-0.07507314532995224,
0.019001057371497154,
-0.018347665667533875,
-0.0038807233795523643,
-0.008295804262161255,
-0.016313813626766205,
-0.04798915982246399,
0.00407168036326766,
0.007118341512978077,
-0.02348935231566429,
0.04529862850904465,
0.03215055912733078,
0.01461169496178627,
0.02574443817138672,
-0.018109308555722237,
-0.0681639164686203,
0.04817860573530197,
0.06241770461201668,
-0.0055014207027852535,
-0.0016383749898523092,
-0.047147318720817566,
-0.025741085410118103,
0.0006284379633143544,
0.031615037471055984,
0.0359044186770916,
-0.02484113909304142,
-0.009666316211223602,
0.02548701874911785,
-0.011737709864974022,
-0.041387658566236496,
-0.03321770951151848,
0.04382369667291641,
0.007223581429570913,
0.012486152350902557,
-0.01884414628148079,
-0.033356502652168274,
0.03495670482516289,
0.05389035865664482,
0.03461013361811638,
-0.003343516029417515,
-0.05058378726243973,
-0.010611062869429588,
0.021351875737309456,
-0.031642135232686996,
0.02276453748345375,
-0.03739825636148453,
0.01568271405994892,
-0.057356443256139755,
0.04964245855808258,
-0.008882715366780758,
-0.009269006550312042,
-0.03410766273736954,
-0.026976799592375755,
-0.015578514896333218,
0.07836411148309708,
0.05948429927229881,
-0.0011740110348910093,
0.011711237952113152,
0.022834567353129387,
0.008124222047626972,
0.04411766305565834,
0.04300633445382118,
0.03205269202589989,
0.07114943116903305,
-0.00497081596404314,
-0.05091748759150505,
-0.027831722050905228,
0.011376515962183475,
0.007088232785463333,
-0.036233920603990555,
0.0701274424791336,
0.02263053134083748,
0.04468642547726631,
0.14709007740020752,
0.0200797189027071,
0.03028535097837448,
0.0051909638568758965,
0.046635206788778305,
-0.013079307973384857,
-0.05018864944577217,
-0.055787473917007446,
0.04185773432254791,
-0.014774984680116177,
-0.010181480087339878,
0.0200448427349329,
-0.028946084901690483,
0.07652150839567184,
-0.10469821095466614,
-0.04301581531763077,
0.012111046351492405,
0.027927428483963013,
-0.1029278039932251,
0.08363296091556549,
0.01700758747756481,
-0.06896105408668518,
0.010484645143151283,
0.006743696518242359,
-0.014039898291230202,
-0.03244970366358757,
0.01904936693608761,
0.018575066700577736,
0.012500664219260216,
-0.006642549764364958,
0.014571032486855984,
-0.020495960488915443,
0.021028032526373863,
-0.011038320139050484,
-0.002540270797908306,
0.004665020387619734,
0.014134803786873817,
-0.07379133254289627,
-0.05468074232339859,
-0.0011347504332661629,
-0.03290815278887749,
-0.009677104651927948,
-0.020765164867043495,
-0.020584946498274803,
0.0413958840072155,
-0.009640537202358246,
-0.011274250224232674,
-0.00921227503567934,
-0.052049946039915085,
-0.0799233540892601,
-0.04910658299922943,
-0.0022115453612059355,
0.08939851075410843,
-0.020070822909474373,
-0.0507831797003746,
0.014872799627482891,
0.03995674103498459,
0.050606537610292435,
-0.03008752129971981,
-0.0045215473510324955,
0.0314921997487545,
-0.030034849420189857,
-0.0023131079506129026,
-0.022091558203101158,
-0.032907165586948395,
0.003986711148172617,
0.030004041269421577,
0.040416330099105835,
0.01485502254217863,
-0.00865304097533226,
-0.034466419368982315,
-0.06349792331457138,
-0.033731792122125626,
-0.013489119708538055,
0.016305115073919296,
-0.023069709539413452,
0.02395559847354889,
-0.007086538709700108,
-0.0412321537733078,
-0.012848751619458199,
0.01147698238492012,
0.005694136023521423,
0.01929342932999134,
0.017969390377402306,
0.06397366523742676,
-0.07352844625711441,
0.039602551609277725,
0.005223732441663742,
-0.00356371165253222,
-0.030658980831503868,
-0.012015996500849724,
0.03895338624715805,
0.012949514202773571,
0.01939420960843563,
-0.008888167329132557,
0.03196189925074577,
-0.013469619676470757,
-0.0019567895215004683,
-0.0103635648265481,
-0.05664486438035965,
0.0401635505259037,
0.015252535231411457,
0.01592247560620308,
0.02537880279123783,
-0.010204081423580647,
0.008600224740803242,
-0.00029498100047931075,
-0.004825456067919731,
0.021428706124424934,
0.044667694717645645,
-5.735220039930648e-33,
0.015123862773180008,
-0.009092182852327824,
0.06378691643476486,
-0.01211748830974102,
0.021690042689442635,
0.10253641754388809,
0.005261342506855726,
0.002027663169428706,
-0.033094070851802826,
0.010781081393361092,
-0.05520195886492729,
-0.0349561907351017,
0.013421204872429371,
0.04265577718615532,
0.04269473999738693,
-0.08279971778392792,
-0.012877506203949451,
-0.004537378903478384,
0.01004234328866005,
0.00124673405662179,
-0.059518396854400635,
-0.04796840250492096,
0.023468274623155594,
-0.00919867493212223,
-0.026996459811925888,
0.0013061119243502617,
-0.037202030420303345,
0.014017398469150066,
0.019833646714687347,
0.022036876529455185,
-0.0009932542452588677,
-0.01354657020419836,
0.019494889304041862,
-0.010690995492041111,
-0.03577110171318054,
-0.03509611636400223,
0.0018953963881358504,
0.0030981949530541897,
0.036685675382614136,
0.00028659639065153897,
-0.042906150221824646,
-0.012910053133964539,
0.07035192847251892,
0.015359158627688885,
0.0004194834327790886,
-0.0464530847966671,
-0.03400566428899765,
-0.04482533782720566,
0.024931252002716064,
-0.04534114897251129,
-0.025114132091403008,
0.027466677129268646,
-0.04441508278250694,
-0.060560669749975204,
-0.003655589185655117,
-0.048064399510622025,
-0.024968761950731277,
0.0004678434052038938,
-0.0483652800321579,
0.0009111897670663893,
-0.02640075981616974,
-0.01980760507285595,
-0.02011546865105629,
-0.06047562137246132,
-0.006444255821406841,
-0.019621387124061584,
0.06670535355806351,
0.05481599643826485,
-0.005384732503443956,
0.09098723530769348,
-0.04907572641968727,
0.009287766180932522,
0.01142163760960102,
-0.08692408353090286,
0.010777396149933338,
-0.042544666677713394,
0.0046791210770606995,
0.0026936151552945375,
-0.024453410878777504,
0.0672936737537384,
-0.007603488862514496,
0.0184654388576746,
-0.0739588513970375,
-0.004923202563077211,
-0.04334099218249321,
-0.058063484728336334,
-0.020311305299401283,
0.021959377452731133,
0.015150940045714378,
0.010553039610385895,
0.09591515362262726,
0.02719864808022976,
0.02856919914484024,
-0.006922733038663864,
0.02432132698595524,
-0.023594381287693977,
0.07110750675201416,
0.007330464664846659,
0.0042557003907859325,
0.001989729469642043,
0.09382152557373047,
-0.02983918972313404,
0.07077302783727646,
-0.006018264684826136,
0.0039250594563782215,
0.0035257746931165457,
0.018648624420166016,
0.0023304177448153496,
-0.02914099581539631,
0.005684318020939827,
0.022861380130052567,
-0.0006734110065735877,
0.053645603358745575,
-0.006632475648075342,
-0.016464373096823692,
0.024721186608076096,
0.018588148057460785,
0.03695425018668175,
0.017144860699772835,
0.04297459498047829,
-0.024827590212225914,
0.04344242066144943,
-0.003637308022007346,
0.022596679627895355,
-0.043986719101667404,
-0.03813929110765457,
0.02911444939672947,
0.0492086187005043,
-0.01581604778766632,
0.031761571764945984,
0.02016644924879074,
0.03887782618403435,
2.9909799081906385e-7,
0.0130083616822958,
0.035956915467977524,
0.003652377286925912,
-0.09674779325723648,
0.03251342847943306,
-0.03284669294953346,
-0.009315275587141514,
-0.009244266897439957,
0.01005836296826601,
0.016960758715867996,
0.049843501299619675,
0.018924281001091003,
-0.01759769208729267,
-0.0013050241395831108,
0.006649392656981945,
-0.02280348911881447,
-0.035443779081106186,
0.015646057203412056,
0.028792358934879303,
-0.018962951377034187,
-0.023494040593504906,
-0.009034369140863419,
-0.07657696306705475,
-0.023314425721764565,
-0.030119355767965317,
0.02016974426805973,
0.0010371882235631347,
-0.02396523766219616,
-0.024442927911877632,
-0.016024192795157433,
-0.11894917488098145,
0.06926554441452026,
0.05777200311422348,
-0.06020465865731239,
-0.03156862035393715,
-0.015414168126881123,
0.020920896902680397,
0.049495089799165726,
-0.04267473518848419,
-0.006975890602916479,
-0.007518219295889139,
0.1044003814458847,
0.01662776619195938,
0.021245870739221573,
0.03599730134010315,
0.01905655302107334,
-0.019307062029838562,
-0.0008641472668386996,
0.006807676982134581,
-0.05269122123718262,
0.023223528638482094,
0.0083764111623168,
-0.016132978722453117,
0.05993557348847389,
0.006497860886156559,
-0.005084716249257326,
-0.06102200597524643,
0.0447758212685585,
0.09651533514261246,
0.02745695598423481,
-0.009771076031029224,
-0.06449732184410095,
0.03039545938372612,
0.05468597263097763,
0.05049223452806473,
-0.038134098052978516,
-0.005435680039227009,
2.123055525656585e-34,
-0.019894618541002274,
-0.07792414724826813,
-0.01635594852268696,
-0.05197259411215782,
0.0009928211802616715,
-0.010834388434886932,
-0.0662413239479065,
0.01061931625008583,
0.002006295369938016,
-0.05987047404050827,
0.013719198293983936
] | {
"ds_index": 68,
"similar_dg_indices": [
607343,
496250,
872735,
1102250,
721721,
811089,
318202,
82651,
611331,
589030,
672955,
599686,
19263,
439373,
550603,
319415,
863479,
421387,
878132,
1005567
]
} |
A 51-year-old woman comes to the physician because of a 1-day history of right flank pain and bloody urine. Over the past 2 weeks, she has also developed progressive lower extremity swelling and a 3-kg (7-lb) weight gain. She has a history of chronic hepatitis B infection, which was diagnosed 10 years ago. She frequently flies from California to New York for business. She appears fatigued. Her pulse is 98/min, respirations are 18/min, and blood pressure is 135/75 mm Hg. Examination shows periorbital edema, a distended abdomen, and 2+ edema of the lower extremities. The lungs are clear to auscultation. A CT scan of the abdomen shows a nodular liver with ascites, a large right kidney with abundant collateral vessels, and a filling defect in the right renal vein. Urinalysis shows 4+ protein, positive glucose, and fatty casts. Which of the following is the most likely underlying cause of this patient's renal vein findings? | Loss of antithrombin III | {
"A": "Acquired factor VIII deficiency",
"B": "Loss of antithrombin III",
"C": "Impaired estrogen degradation",
"D": "Antiphospholipid antibodies"
} | step2&3 | B | [
"year old woman",
"physician",
"1-day history",
"right flank pain",
"bloody urine",
"past 2 weeks",
"progressive lower extremity swelling",
"3 kg",
"weight gain",
"history of chronic hepatitis B infection",
"diagnosed 10 years",
"frequently flies",
"California",
"New York",
"business",
"appears fatigued",
"pulse",
"98 min",
"respirations",
"min",
"blood pressure",
"75 mm Hg",
"Examination shows periorbital edema",
"distended abdomen",
"2",
"edema of",
"lower extremities",
"lungs",
"clear",
"auscultation",
"CT scan",
"abdomen shows",
"nodular liver",
"ascites",
"large right",
"abundant collateral",
"filling defect in",
"right renal vein",
"Urinalysis shows 4",
"protein",
"positive glucose",
"casts",
"following",
"most likely underlying cause",
"patient's renal findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 51-year-old woman comes to the physician because of a 1-day history of right flank pain and bloody urine. Over the past 2 weeks, she has also developed progressive lower extremity swelling and a 3-kg (7-lb) weight gain. She has a history of chronic hepatitis B infection, which was diagnosed 10 years ago. She frequently flies from California to New York for business. She appears fatigued. Her pulse is 98/min, respirations are 18/min, and blood pressure is 135/75 mm Hg. Examination shows periorbital edema, a distended abdomen, and 2+ edema of the lower extremities. The lungs are clear to auscultation. A CT scan of the abdomen shows a nodular liver with ascites, a large right kidney with abundant collateral vessels, and a filling defect in the right renal vein. Urinalysis shows 4+ protein, positive glucose, and fatty casts. Which of the following is the most likely underlying cause of this patient's renal vein findings?
Choose one of the following::
A. Acquired factor VIII deficiency
B. Loss of antithrombin III
C. Impaired estrogen degradation
D. Antiphospholipid antibodies | [
0.014487821608781815,
0.02193259261548519,
0.006128122564405203,
-0.015699829906225204,
0.029394159093499184,
-0.010130714625120163,
-0.029680361971259117,
0.04683879762887955,
-0.022507747635245323,
-0.01705680601298809,
0.02544427290558815,
-0.0019710459746420383,
-0.007985916920006275,
0.015971485525369644,
0.004377728793770075,
0.0013148658908903599,
-0.017860550433397293,
-0.02611764520406723,
-0.02573048137128353,
-0.0007990977028384805,
-0.054132476449012756,
0.025197666138410568,
0.02412104792892933,
0.024642610922455788,
0.018346227705478668,
0.028872767463326454,
0.012212613597512245,
0.015329607762396336,
-0.011267338879406452,
-0.017438936978578568,
-0.0018572731642052531,
-0.02030133455991745,
0.017705857753753662,
-0.08510930836200714,
0.0000017907294704855303,
-0.04318873956799507,
0.015280431136488914,
-0.014816968701779842,
-0.04161845147609711,
-0.009181967005133629,
0.034138843417167664,
-0.058067746460437775,
0.049080222845077515,
-0.001100663561373949,
-0.002823798218742013,
-0.07515395432710648,
0.021319063380360603,
0.0821419432759285,
-0.08134882897138596,
-0.017075425013899803,
0.02064901776611805,
0.03470344841480255,
-0.023440610617399216,
0.005111057311296463,
0.08399316668510437,
-0.10106008499860764,
-0.03891307860612869,
0.0637936219573021,
-0.001537384930998087,
0.03977258503437042,
0.02851155586540699,
0.014970602467656136,
0.04062739387154579,
-0.01261818315833807,
-0.0660218745470047,
0.0546010285615921,
0.026423119008541107,
-0.038439325988292694,
0.020812759175896645,
0.031201770529150963,
-0.0032854657620191574,
-0.025186581537127495,
0.05247524008154869,
0.05835701897740364,
-0.0625014528632164,
-0.0011011820752173662,
0.10944563895463943,
-0.016508031636476517,
0.015239715576171875,
-0.0030469042249023914,
0.054437305778265,
0.024546829983592033,
-0.025278260931372643,
0.03617038205265999,
0.002259403234347701,
-0.13365714251995087,
0.02819051221013069,
-0.025738224387168884,
-0.03315898776054382,
-0.023307140916585922,
-0.03888382390141487,
-0.04945950210094452,
0.012544184923171997,
0.06233111768960953,
-0.057371340692043304,
-0.00027866062009707093,
0.025431469082832336,
0.029210953041911125,
0.06393907964229584,
-0.056137602776288986,
-0.012941418215632439,
0.003454930381849408,
-0.0626479908823967,
0.03962461277842522,
-0.04412657767534256,
-0.019316237419843674,
-0.03732981160283089,
0.028191497549414635,
-0.045941002666950226,
0.021749397739768028,
0.019193144515156746,
0.017583198845386505,
-0.036854662001132965,
-0.007366916164755821,
0.04187213256955147,
-0.03594433143734932,
-0.03151026368141174,
-0.037873268127441406,
0.02217796817421913,
0.040254030376672745,
0.017817353829741478,
0.07033611088991165,
0.0059193335473537445,
0.031358037143945694,
-0.03733646869659424,
0.000016952186342678033,
0.054224394261837006,
-0.027556587010622025,
-0.010501527227461338,
0.06265348941087723,
0.00941597018390894,
0.023341502994298935,
-0.011966263875365257,
0.028498543426394463,
0.01925162598490715,
-0.01295580342411995,
-0.0011400108924135566,
0.038716789335012436,
-0.00043222459498792887,
0.0360247828066349,
-0.020561588928103447,
-0.017996102571487427,
-0.01873117871582508,
-0.009089590981602669,
0.03443154692649841,
-0.0106409452855587,
0.01974549889564514,
0.022870736196637154,
0.01723099686205387,
0.03166155517101288,
-0.047723472118377686,
-0.020938949659466743,
-0.04333127290010452,
-0.01354251243174076,
-0.004439475946128368,
0.02820952609181404,
0.011073228903114796,
-0.048262819647789,
-0.003910075407475233,
-0.04225914180278778,
-0.011227172799408436,
-0.03679464012384415,
0.0256369486451149,
-0.04482383280992508,
0.002149103209376335,
0.000513987266458571,
0.003108929144218564,
0.059747714549303055,
-0.008733298629522324,
0.04669293388724327,
-0.011658884584903717,
0.06976716965436935,
0.025873512029647827,
0.00899220909923315,
-0.021311432123184204,
0.002460725838318467,
-0.016798973083496094,
-0.05220218747854233,
0.024079713970422745,
-0.00400771526619792,
0.01660148799419403,
0.002203544834628701,
0.011569918133318424,
-0.040938667953014374,
0.01766393706202507,
0.01263058464974165,
0.010189679451286793,
-0.0245062205940485,
-0.0009873491944745183,
-0.045067716389894485,
-0.032145626842975616,
-0.022821076214313507,
0.004472833592444658,
0.0008461784454993904,
-0.0014156405813992023,
0.00710817938670516,
-0.04250004142522812,
-0.0012555791763588786,
0.026673708111047745,
-0.01011804211884737,
-0.05941608548164368,
-0.032000139355659485,
0.017662594094872475,
0.037088409066200256,
-0.02549932897090912,
0.061590541154146194,
0.017666954547166824,
0.03187812492251396,
0.012866199016571045,
-0.010404099710285664,
0.0370204783976078,
0.0026542602572590113,
0.07545609027147293,
-0.010643957182765007,
0.03867995738983154,
0.039536647498607635,
0.0270825382322073,
-0.009670671075582504,
-0.0653628334403038,
0.007497736252844334,
-0.011295011267066002,
-0.01525704376399517,
-0.05259104073047638,
-0.00791209191083908,
-0.03612202778458595,
0.045195721089839935,
0.01343416329473257,
0.019717302173376083,
-0.027596287429332733,
-0.0829748809337616,
0.027590136975049973,
0.036425042897462845,
-0.05448552221059799,
0.043986450880765915,
-0.05877523869276047,
0.028151394799351692,
0.04677881672978401,
-0.006401970982551575,
0.03607384115457535,
0.029575766995549202,
-0.0009794869692996144,
-0.05672059953212738,
-0.04181337729096413,
-0.014216793701052666,
0.023186763748526573,
-0.009233933873474598,
-0.05653735622763634,
0.04640093818306923,
-0.03558860719203949,
0.06596846133470535,
-0.014351852238178253,
-0.012068022042512894,
0.03568871319293976,
0.013693705201148987,
0.012320039793848991,
0.025557074695825577,
-0.06646678596735,
0.03040114790201187,
0.0081167658790946,
-0.024808267131447792,
-0.01650528609752655,
-0.008825297467410564,
-0.01065794937312603,
0.0026312856934964657,
-0.033147696405649185,
-0.004220129922032356,
-0.00292723486199975,
-0.00860398355871439,
-0.009725064970552921,
0.023929959163069725,
-0.0016473438590765,
0.044993944466114044,
0.025792598724365234,
0.022277116775512695,
-0.047915659844875336,
-0.017954358831048012,
-0.056313592940568924,
0.05658412352204323,
0.011540498584508896,
0.04091925919055939,
-0.013734851032495499,
0.045894671231508255,
0.007688054349273443,
0.05032135546207428,
-0.0009207187104038894,
-0.03333084285259247,
-0.002383212558925152,
0.03684574365615845,
0.04789474606513977,
-0.025797536596655846,
0.018052589148283005,
-0.03329953923821449,
0.028507592156529427,
-0.05559508875012398,
-0.044694285839796066,
-0.0270739383995533,
-0.07045399397611618,
-0.009036505594849586,
0.0022732135839760303,
0.044389646500349045,
0.026865344494581223,
0.014064756222069263,
-0.033373817801475525,
0.04194115847349167,
-0.01683029904961586,
0.033287473022937775,
0.028197916224598885,
-0.02803982049226761,
-0.025122523307800293,
-0.008027009665966034,
0.015279196202754974,
0.021390540525317192,
-0.019246893003582954,
-0.014052526094019413,
0.0384855642914772,
-0.06086636334657669,
-0.03237682208418846,
-0.07162854820489883,
0.02478669211268425,
0.02202705293893814,
-0.00897202268242836,
0.03126467764377594,
-0.016860391944646835,
-0.0404215008020401,
0.00520911393687129,
0.011105638928711414,
0.0037232309114187956,
-0.035481516271829605,
-0.07190661132335663,
-0.03503280133008957,
0.028713403269648552,
0.0011298018507659435,
-0.020893504843115807,
0.04115137830376625,
0.04781360924243927,
-0.006899022497236729,
-0.04617343097925186,
0.051722802221775055,
-0.017243696376681328,
0.042408961802721024,
0.004735379479825497,
-0.016559867188334465,
0.020074088126420975,
0.044240813702344894,
0.029447633773088455,
0.006573327351361513,
-0.023335833102464676,
0.01907174661755562,
0.0068519446067512035,
0.018042277544736862,
-0.08387859910726547,
-0.0016353440005332232,
-0.004120527766644955,
0.010429772548377514,
-0.009425267577171326,
-0.009776049293577671,
0.021209923550486565,
0.036472391337156296,
-0.0009762138943187892,
0.025959067046642303,
0.050291649997234344,
-0.0035802379716187716,
-0.014682562090456486,
0.024133650586009026,
0.021773023530840874,
0.029239177703857422,
0.029821455478668213,
0.011833944357931614,
0.014412191696465015,
-0.04540771618485451,
0.020670559257268906,
-0.007068750448524952,
-0.06516334414482117,
0.06422074884176254,
-0.01605638861656189,
-0.00822018925100565,
0.04420985281467438,
-0.07308181375265121,
-0.06754155457019806,
-0.03253215178847313,
0.0921345204114914,
-0.08606747537851334,
0.0062149143777787685,
-0.01235916931182146,
-0.027142157778143883,
0.014859325252473354,
-0.007075022906064987,
-0.05430750548839569,
0.05852508917450905,
0.009015568532049656,
-0.017791561782360077,
0.03754528984427452,
0.018254844471812248,
-0.04059631749987602,
-0.010086889378726482,
0.005705618765205145,
-0.008792739361524582,
-0.05852445587515831,
0.036083564162254333,
0.07563241571187973,
0.0035737892612814903,
0.00770947802811861,
-0.03604120388627052,
0.041468340903520584,
0.056277189403772354,
-0.05351168289780617,
-0.10592955350875854,
-0.01939079537987709,
0.013163107447326183,
0.029831718653440475,
0.056338634341955185,
-0.08130016177892685,
0.058383893221616745,
0.01858915202319622,
0.0653499886393547,
-0.046131595969200134,
-0.010625366121530533,
-0.03036949411034584,
-0.00011793615703936666,
-0.07189332693815231,
0.04383760690689087,
0.005023164674639702,
-0.015180472284555435,
-0.0561947226524353,
0.01413307897746563,
0.014784643426537514,
0.01227209810167551,
0.054664481431245804,
-0.00656051654368639,
0.0220947228372097,
0.00913398526608944,
-0.019343560561537743,
0.0724380686879158,
0.05406977981328964,
-0.02746058627963066,
0.013816320337355137,
-0.04816140979528427,
0.019515465945005417,
-0.003221864113584161,
-0.01705821417272091,
-0.008127654902637005,
0.023070912808179855,
0.04424893110990524,
0.02841397188603878,
0.041186243295669556,
-0.051926761865615845,
-0.008263860829174519,
0.06897082179784775,
0.004596215672791004,
0.03954848274588585,
0.0188449714332819,
-0.016537033021450043,
0.00884994212538004,
0.07325910776853561,
-0.01439990010112524,
0.02177540771663189,
0.021047119051218033,
-0.04211648181080818,
0.029795048758387566,
-0.0010284663876518607,
-0.09454389661550522,
0.01239036861807108,
0.05012299492955208,
-0.07548833638429642,
0.023832453414797783,
-0.04987739026546478,
-0.08122077584266663,
0.013238317333161831,
-0.04096842184662819,
0.004898696672171354,
-0.008953950367867947,
0.04252590611577034,
-0.014531705528497696,
-0.05705494433641434,
0.002181762596592307,
0.011609560810029507,
-0.05688191577792168,
-0.06696516275405884,
-0.019761070609092712,
0.04156195744872093,
0.013777684420347214,
0.013765350915491581,
-0.07325917482376099,
-0.059392839670181274,
0.01029303576797247,
0.0060505797155201435,
0.026196885854005814,
-0.01790548674762249,
-0.02369549125432968,
0.028582947328686714,
-0.022732052952051163,
-0.026351217180490494,
0.0060269893147051334,
-0.014718342572450638,
-0.02364487200975418,
0.03255785256624222,
0.008736253716051579,
0.053252652287483215,
0.01223008707165718,
0.007055170834064484,
0.025592753663659096,
0.027962395921349525,
0.03092058189213276,
-0.001642425311729312,
0.03940252959728241,
0.03878576308488846,
-0.017716243863105774,
0.014789978973567486,
-0.04354148730635643,
-0.07445093989372253,
0.014450403861701488,
0.007480270694941282,
-0.02968982793390751,
0.008123781532049179,
0.05865219980478287,
-0.012453394010663033,
-0.006643746048212051,
-0.013044793158769608,
-0.023677047342061996,
0.014178168028593063,
-0.0021595400758087635,
-0.015736933797597885,
0.044162455946207047,
-0.05494793504476547,
0.004106575157493353,
0.0452226921916008,
-0.001922230003401637,
-0.03610742837190628,
0.02691967785358429,
0.074039027094841,
-0.020131682977080345,
-0.010637599974870682,
-0.0395050048828125,
0.018704280257225037,
0.007838522084057331,
-0.0076134093105793,
0.0026491223834455013,
0.05297126993536949,
0.0017823615344241261,
-0.019939472898840904,
0.03329286351799965,
0.01408865675330162,
-0.043196093291044235,
0.022936709225177765,
-0.05573577061295509,
-0.013914698734879494,
-0.03300446271896362,
0.05052683502435684,
0.06454047560691833,
0.012643716298043728,
-0.04245661944150925,
0.05090047046542168,
-0.01978747360408306,
0.03494850546121597,
0.04745794087648392,
-5.278781828320092e-33,
0.03923634812235832,
-0.015617438592016697,
0.035104088485240936,
-0.057159945368766785,
0.044720057398080826,
0.08758195489645004,
-0.02669365331530571,
-0.023059353232383728,
-0.09271547198295593,
0.014483473263680935,
-0.018015902489423752,
-0.03312711417675018,
0.035121239721775055,
0.05902174487709999,
-0.009116142988204956,
-0.07778625190258026,
0.01804092340171337,
0.0275503508746624,
-0.03798437863588333,
-0.001269126427359879,
-0.01564701274037361,
-0.018839556723833084,
-0.015246869996190071,
-0.058634694665670395,
-0.009400381706655025,
0.02612278424203396,
0.0377315878868103,
0.0490143708884716,
0.021489370614290237,
0.02093157358467579,
0.0015077093848958611,
-0.04016479104757309,
0.003312160260975361,
0.020856652408838272,
-0.049226824194192886,
-0.02781466767191887,
0.013051370158791542,
-0.07653489708900452,
0.016845444217324257,
0.009361973032355309,
-0.049463335424661636,
-0.054042231291532516,
0.014384127222001553,
0.0197216235101223,
0.004280334338545799,
0.015000923536717892,
-0.05213778838515282,
-0.009072912856936455,
-0.003968731500208378,
0.015160261653363705,
-0.016624145209789276,
0.03245678171515465,
-0.00022280486882664263,
-0.03218688443303108,
-0.019755901768803596,
0.04207611829042435,
0.004137251526117325,
0.032752711325883865,
-0.026857053861021996,
0.017453700304031372,
-0.06775040179491043,
-0.012305965647101402,
0.0452284961938858,
-0.03199224919080734,
-0.04226256534457207,
-0.010576875880360603,
0.056610431522130966,
0.010790153406560421,
-0.0635826364159584,
0.0023496428038924932,
-0.10128874331712723,
0.022683149203658104,
-0.03894892707467079,
-0.1250215321779251,
-0.0004469233099371195,
-0.019866975024342537,
0.04553830251097679,
0.03103639744222164,
0.002267021220177412,
0.030738698318600655,
0.005716637242585421,
-0.026667065918445587,
-0.051306504756212234,
-0.0190567746758461,
0.00775191793218255,
-0.07407502830028534,
0.004938235506415367,
-0.0644848570227623,
-0.015861235558986664,
0.0285072922706604,
0.07956170290708542,
0.03510861098766327,
0.041281890124082565,
-0.021703384816646576,
-0.034971658140420914,
0.004835483618080616,
0.05206400156021118,
0.014091107062995434,
0.0022641157265752554,
0.037482962012290955,
0.025623731315135956,
0.028285440057516098,
0.0030005851294845343,
0.014808203093707561,
-0.035323359072208405,
0.06004907935857773,
0.012852014042437077,
-0.03479395806789398,
-0.004608117043972015,
0.04150523245334625,
-0.02928990311920643,
-0.03168704733252525,
-0.05447470769286156,
0.04395471513271332,
0.02112486958503723,
0.027487264946103096,
-0.027145883068442345,
0.02899058349430561,
0.030635284259915352,
0.06488513201475143,
0.008963219821453094,
-0.004447272978723049,
-0.003489749738946557,
0.0223868265748024,
-0.0639541819691658,
-0.05186322331428528,
-0.0038020778447389603,
0.009479695931077003,
0.01396147534251213,
-0.006590835750102997,
0.01577986776828766,
0.023084234446287155,
2.715987079682236e-7,
0.044491056352853775,
-0.04573998600244522,
-0.002098922384902835,
-0.07808583229780197,
0.024635404348373413,
-0.014454592019319534,
0.005325391422957182,
-0.008699080906808376,
0.010006267577409744,
0.008487205021083355,
0.016503462567925453,
0.028175748884677887,
-0.032451435923576355,
-0.021832110360264778,
0.045262716710567474,
0.010583663359284401,
-0.013293755240738392,
0.015734367072582245,
0.04174017161130905,
0.006473390851169825,
-0.004207105841487646,
-0.009243789128959179,
-0.07637862861156464,
-0.055027224123477936,
-0.008231408894062042,
0.03602418676018715,
-0.037181563675403595,
-0.03488728776574135,
-0.05813290551304817,
-0.004930878523737192,
-0.06150259077548981,
0.04011830314993858,
0.014118463732302189,
0.016648411750793457,
-0.03115801140666008,
-0.0023018578067421913,
0.015801070258021355,
0.04943058267235756,
-0.01538806315511465,
0.0016641245456412435,
-0.004657697398215532,
0.0034724886063486338,
0.029400432482361794,
0.026758333668112755,
0.06646985560655594,
0.04610779881477356,
-0.05813584104180336,
-0.013004137203097343,
0.016242386773228645,
0.01958365924656391,
-0.0008779307245276868,
0.04277556762099266,
-0.01675489731132984,
0.03487641364336014,
-0.01808473840355873,
0.08519867807626724,
-0.08089262992143631,
-0.013243500143289566,
-0.016464650630950928,
-0.043755631893873215,
0.02021883800625801,
0.007486277725547552,
0.02107977494597435,
0.013200793415307999,
0.046223778277635574,
-0.00847939494997263,
-0.060766782611608505,
2.141465328393897e-34,
-0.026439452543854713,
-0.014725567772984505,
0.015560083091259003,
-0.005809280555695295,
0.003435945138335228,
-0.03136517107486725,
-0.006009233184158802,
-0.017360059544444084,
-0.0008780527859926224,
-0.037292495369911194,
-0.02064032293856144
] | {
"ds_index": 69,
"similar_dg_indices": [
57702,
286373,
1206953,
1086737,
427328,
460075,
115270,
617916,
146423,
466472,
1028538,
808688,
113742,
1128177,
1112795,
199845,
82453,
1030269,
742213,
1199125
]
} |
A 57-year-old man comes to the physician for a follow-up evaluation of chronic, retrosternal chest pain. The pain is worse at night and after heavy meals. He has taken oral pantoprazole for several months without any relief of his symptoms. Esophagogastroduodenoscopy shows ulcerations in the distal esophagus and a proximally dislocated Z-line. A biopsy of the distal esophagus shows columnar epithelium with goblet cells. Which of the following microscopic findings underlie the same pathomechanism as the cellular changes seen in this patient? | Squamous epithelium in the bladder | {
"A": "Squamous epithelium in the bladder",
"B": "Paneth cells in the duodenum",
"C": "Branching muscularis mucosa in the jejunum",
"D": "Disorganized squamous epithelium in the endocervix"
} | step1 | A | [
"57 year old man",
"physician",
"follow-up evaluation of chronic",
"retrosternal chest pain",
"pain",
"worse",
"night",
"heavy meals",
"taken oral pantoprazole",
"months",
"relief",
"symptoms",
"Esophagogastroduodenoscopy shows ulcerations",
"distal esophagus",
"dislocated Z-line",
"biopsy of",
"distal esophagus shows columnar epithelium",
"cells",
"following microscopic findings",
"same",
"cellular changes seen",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 57-year-old man comes to the physician for a follow-up evaluation of chronic, retrosternal chest pain. The pain is worse at night and after heavy meals. He has taken oral pantoprazole for several months without any relief of his symptoms. Esophagogastroduodenoscopy shows ulcerations in the distal esophagus and a proximally dislocated Z-line. A biopsy of the distal esophagus shows columnar epithelium with goblet cells. Which of the following microscopic findings underlie the same pathomechanism as the cellular changes seen in this patient?
Choose one of the following::
A. Squamous epithelium in the bladder
B. Paneth cells in the duodenum
C. Branching muscularis mucosa in the jejunum
D. Disorganized squamous epithelium in the endocervix | [
0.00690351240336895,
-0.040535617619752884,
0.018541306257247925,
0.009161083959043026,
0.00564440106973052,
0.02784055657684803,
-0.015912359580397606,
0.0436311773955822,
-0.03319988027215004,
-0.006224424112588167,
0.030882155522704124,
0.0581723228096962,
0.02687588334083557,
-0.03916150704026222,
0.019083669409155846,
0.025634128600358963,
-0.05131494253873825,
0.058384716510772705,
-0.015747452154755592,
-0.009939904324710369,
0.0012818765826523304,
0.020545080304145813,
0.0017613529926165938,
0.04638972505927086,
0.046991411596536636,
-0.009902979247272015,
-0.009569684974849224,
-0.05197257176041603,
0.013512922450900078,
-0.01991945505142212,
0.0046525755897164345,
0.010415574535727501,
-0.07472805678844452,
-0.00827622227370739,
0.0000018838951518773683,
-0.02701951190829277,
-0.04291399568319321,
0.03269612416625023,
-0.025057008489966393,
-0.042813628911972046,
-0.010146373882889748,
-0.034728698432445526,
-0.03587189316749573,
-0.06294718384742737,
0.006309029646217823,
-0.10307657718658447,
0.008204050362110138,
0.03498094528913498,
0.005369708873331547,
-0.0029908232390880585,
0.01189583633095026,
-0.029575299471616745,
0.05444354563951492,
0.00040228472789749503,
0.09637370705604553,
0.005481555126607418,
-0.04272887855768204,
-0.06555773317813873,
-0.026154503226280212,
0.028650296851992607,
0.023681385442614555,
-0.012770142406225204,
0.02170916460454464,
0.021350828930735588,
0.04239983484148979,
0.0522552989423275,
-0.013227135874330997,
-0.03043314628303051,
0.05124954134225845,
0.00994950532913208,
0.027253106236457825,
-0.03187268599867821,
-0.014933774247765541,
0.02944920025765896,
-0.02109321393072605,
-0.012439697049558163,
0.05406269058585167,
-0.03018377348780632,
-0.014502033591270447,
-0.019095296040177345,
0.10367447882890701,
-0.014307702891528606,
-0.015650052577257156,
-0.010075455531477928,
-0.025820957496762276,
-0.046990156173706055,
-0.019960789009928703,
-0.04218606650829315,
0.009539039805531502,
-0.020007727667689323,
0.05438697338104248,
-0.04607226327061653,
-0.00651053199544549,
0.031217999756336212,
-0.009703689254820347,
0.026680490002036095,
0.06497392803430557,
-0.0187210775911808,
0.040952928364276886,
-0.08046018332242966,
-0.03946975991129875,
-0.03448115289211273,
0.013315021060407162,
0.03379370644688606,
-0.04061298072338104,
-0.015993334352970123,
-0.024836743250489235,
0.05108373984694481,
-0.03409816697239876,
0.03154716268181801,
-0.014561225660145283,
-0.02061573602259159,
0.007932395674288273,
0.05973213165998459,
0.07271912693977356,
-0.04698087275028229,
-0.0224008746445179,
-0.01980668306350708,
0.031653992831707,
0.08741799741983414,
-0.013936907984316349,
-0.005935389082878828,
-0.033148329704999924,
0.06217970699071884,
0.036613091826438904,
0.022515220567584038,
-0.008952291682362556,
-0.04732733964920044,
-0.03424607962369919,
0.018284961581230164,
0.0029038614593446255,
-0.02825978770852089,
-0.07469590753316879,
0.036523398011922836,
-0.047020722180604935,
-0.03988785669207573,
-0.025153277441859245,
0.07237247377634048,
-0.026225494220852852,
0.00010887109237955883,
-0.0680331364274025,
-0.027548348531126976,
0.004532376769930124,
-0.008137169294059277,
0.009056809358298779,
0.003926881588995457,
0.001069084508344531,
0.044042475521564484,
-0.016955412924289703,
0.0541171059012413,
-0.057116661220788956,
0.015467146411538124,
-0.017055604606866837,
-0.007897425442934036,
-0.005764291156083345,
-0.004961793776601553,
0.03307525813579559,
-0.027601486071944237,
-0.012860110029578209,
-0.04860410839319229,
0.018401725217700005,
0.03521418571472168,
0.03853828087449074,
-0.02680327370762825,
-0.0439804270863533,
0.02185293845832348,
0.038575198501348495,
0.05634527653455734,
-0.012734517455101013,
0.06991035491228104,
-0.009120949544012547,
-0.0023801263887435198,
0.0014829895226284862,
-0.029757503420114517,
0.0007918272167444229,
0.05914849042892456,
0.0020224275067448616,
0.04432162642478943,
-0.0411318764090538,
-0.056665245443582535,
0.07061617076396942,
0.03836822137236595,
0.020423932000994682,
-0.059918686747550964,
-0.009355777874588966,
0.023409169167280197,
-0.0138294892385602,
-0.021438350901007652,
0.015390395186841488,
0.0238302331417799,
0.03038199245929718,
0.07354693114757538,
-0.07079320400953293,
0.006759969517588615,
0.005429742392152548,
-0.014239885844290257,
-0.052990660071372986,
-0.03750179335474968,
-0.043903011828660965,
0.0023196451365947723,
-0.06496691703796387,
0.008718871511518955,
0.024028107523918152,
0.024100009351968765,
-0.03590651601552963,
0.025072958320379257,
-0.021176213398575783,
-0.03262520954012871,
-0.003100101836025715,
0.014320971444249153,
0.0019000617321580648,
-0.04970534145832062,
0.016772018745541573,
0.00832249317318201,
0.0008570411009714007,
0.06152524799108505,
0.04229479283094406,
0.0017194754909723997,
-0.017020775005221367,
0.030285945162177086,
-0.02443169616162777,
-0.06592398136854172,
0.09872328490018845,
-0.0074732243083417416,
-0.043519314378499985,
0.011247633025050163,
-0.06227701157331467,
0.008763416670262814,
-0.04165469482541084,
-0.043516531586647034,
0.011837019585072994,
-0.010345127433538437,
-0.021202389150857925,
0.019988013431429863,
-0.03654402866959572,
0.03863748535513878,
-0.02787036821246147,
-0.021679624915122986,
0.010715244337916374,
0.031657733023166656,
-0.02940249815583229,
-0.0034314398653805256,
-0.060086995363235474,
0.026119010522961617,
0.008731105364859104,
0.007050991524010897,
0.0015933559043332934,
0.02995697408914566,
0.002836075145751238,
0.04070122912526131,
-0.024580204859375954,
-0.04686002805829048,
-0.01160870399326086,
0.0023404473904520273,
-0.0024821353144943714,
0.0019312228541821241,
-0.039815884083509445,
0.04577913507819176,
-0.006231370382010937,
-0.03466673940420151,
0.0503697395324707,
0.05919370800256729,
0.02850177139043808,
-0.023319043219089508,
-0.004955622833222151,
-0.039023034274578094,
-0.032518740743398666,
0.019342299550771713,
0.029991773888468742,
0.008297305554151535,
-0.015247015282511711,
0.050101228058338165,
-0.03277890011668205,
0.015056425705552101,
-0.02198909781873226,
-0.02638128213584423,
0.008941324427723885,
0.06826227158308029,
-0.013716919347643852,
0.0545242503285408,
0.004288468509912491,
0.02715359814465046,
-0.04139890521764755,
0.020482853055000305,
-0.0024425305891782045,
0.021459229290485382,
-0.05938531458377838,
-0.053367581218481064,
0.054401054978370667,
-0.013284738175570965,
0.002821154659613967,
0.014426378533244133,
0.019906729459762573,
-0.0389205738902092,
0.01573050580918789,
-0.033750541508197784,
-0.04012443125247955,
0.0888344869017601,
-0.0321260429918766,
0.10791116207838058,
-0.05883209779858589,
0.008760028518736362,
0.025555646046996117,
-0.02615402638912201,
-0.027769794687628746,
-0.032332323491573334,
0.03140104562044144,
0.004651438910514116,
-0.0649513453245163,
0.014472697861492634,
0.04101190343499184,
0.004321093205362558,
-0.05874834209680557,
-0.011073101311922073,
0.01775667816400528,
-0.00843517854809761,
-0.03089631348848343,
-0.06011049076914787,
0.014021231792867184,
-0.04550815001130104,
0.009689327329397202,
0.025593241676688194,
-0.000492465915158391,
-0.003365760901942849,
-0.0037863680627197027,
-0.023285189643502235,
0.030640983954072,
0.039727479219436646,
0.044215861707925797,
-0.006138431839644909,
0.04278791323304176,
0.0366872102022171,
0.042670875787734985,
-0.010461965575814247,
0.010156743228435516,
0.008723544888198376,
-0.039922166615724564,
0.02271636761724949,
-0.04428732395172119,
0.01679793745279312,
0.02037523314356804,
-0.0374818854033947,
0.003876039758324623,
0.08670557290315628,
0.007601208984851837,
-0.018622271716594696,
-0.05374772474169731,
-0.004320302978157997,
0.016261504963040352,
-0.003263187827542424,
-0.022909535095095634,
-0.0046048350632190704,
0.02433442883193493,
-0.03136537969112396,
-0.031668271869421005,
-0.013059758581221104,
0.02289009466767311,
0.06172763928771019,
-0.013008004985749722,
0.05889773741364479,
0.035126835107803345,
0.007569427601993084,
-0.030149739235639572,
0.010055921040475368,
0.02320685423910618,
0.03147060424089432,
-0.01668505370616913,
0.011658228002488613,
-0.02971648797392845,
-0.02590048313140869,
-0.02668764628469944,
-0.016436103731393814,
-0.03700791299343109,
0.017572922632098198,
0.02289733849465847,
0.048924438655376434,
0.012129717506468296,
0.04294280335307121,
-0.08205356448888779,
-0.042980168014764786,
0.02974303625524044,
0.01600114442408085,
0.002236143220216036,
-0.04802802950143814,
-0.04604283347725868,
0.03589622303843498,
-0.02612028270959854,
-0.04284470155835152,
0.01735061965882778,
0.04146966338157654,
-0.010806456208229065,
-0.017959263175725937,
0.015343396924436092,
-0.06047789752483368,
-0.013782643713057041,
-0.032422956079244614,
-0.031271617859601974,
-0.015477714128792286,
0.04714049771428108,
0.09804364293813705,
-0.012545955367386341,
-0.04866987094283104,
0.03640265017747879,
0.05318740755319595,
0.033339112997055054,
-0.02974892593920231,
-0.10217872262001038,
-0.026911135762929916,
0.01959807239472866,
0.06543610244989395,
0.021810222417116165,
-0.0849032774567604,
0.0006402927101589739,
0.04085804894566536,
0.029688794165849686,
-0.032534170895814896,
0.020112045109272003,
-0.07807385176420212,
-0.015027048997581005,
-0.049703873693943024,
0.07061252743005753,
-0.05996519699692726,
0.01325247623026371,
-0.039894621819257736,
0.03887733444571495,
-0.03670547157526016,
0.05039883404970169,
-0.0232018381357193,
0.028486764058470726,
-0.011209708638489246,
0.02562721073627472,
-0.055459462106227875,
-0.017623357474803925,
0.08287229388952255,
-0.014509137719869614,
0.03269176185131073,
0.07780055701732635,
0.04941759258508682,
-0.029721295461058617,
-0.025098619982600212,
0.01427960954606533,
-0.010952250100672245,
0.030275395140051842,
0.06631254404783249,
0.07877124845981598,
-0.0807749330997467,
-0.008457512594759464,
-0.0040573496371507645,
-0.028015995398163795,
0.049420807510614395,
0.062183283269405365,
0.02933393605053425,
-0.03072129189968109,
0.038635991513729095,
0.034978147596120834,
0.0009336031507700682,
0.054121505469083786,
-0.022592365741729736,
-0.007014480885118246,
-0.02795509248971939,
-0.03985590487718582,
0.01407883781939745,
0.029699871316552162,
-0.04944435879588127,
0.02715739794075489,
0.004290959797799587,
-0.07781558483839035,
0.03873777762055397,
0.028017403557896614,
-0.03017384186387062,
-0.03228624910116196,
0.017622724175453186,
-0.028880802914500237,
-0.032611869275569916,
-0.042999159544706345,
-0.03672844544053078,
-0.009695567190647125,
-0.03231458365917206,
-0.014406869187951088,
0.06082732975482941,
0.019471555948257446,
0.032691217958927155,
-0.03191504254937172,
-0.058186426758766174,
0.03462272509932518,
-0.008822285570204258,
0.0685969889163971,
0.013322873041033745,
-0.0006659848149865866,
-0.009192720986902714,
0.05189518630504608,
-0.02570573054254055,
0.0031450726091861725,
0.05043497309088707,
-0.023254742845892906,
0.04645167291164398,
0.005981404334306717,
0.014558701775968075,
0.04767061397433281,
-0.03080923669040203,
0.047445595264434814,
0.02851768583059311,
0.013447370380163193,
-0.018138671293854713,
0.004034990444779396,
-0.010013135150074959,
0.016537543386220932,
-0.028287889435887337,
-0.01443411409854889,
0.019011570140719414,
0.0054243472404778,
0.01681055687367916,
-0.024383125826716423,
0.03755025193095207,
0.005852678790688515,
-0.08189429342746735,
-0.003914749249815941,
-0.03512584790587425,
-0.015523359179496765,
0.007937711663544178,
-0.028793517500162125,
-0.039557311683893204,
-0.03506867587566376,
-0.042613353580236435,
0.05437711998820305,
0.026916995644569397,
-0.00040667824214324355,
0.03350897133350372,
0.00564203504472971,
0.035167545080184937,
0.02031686156988144,
0.011636740528047085,
-0.05375691130757332,
-0.013182433322072029,
-0.008263754658401012,
-0.022933775559067726,
-0.03711549937725067,
0.00415189191699028,
0.009813912212848663,
-0.07481378316879272,
-0.00923345610499382,
0.01221317145973444,
-0.030710313469171524,
0.03784190118312836,
0.004928583279252052,
-0.02283804677426815,
-0.011148284189403057,
0.007610932923853397,
-0.005356515757739544,
0.005535058211535215,
-0.043843962252140045,
0.05332077294588089,
-0.0021831525955349207,
0.04285367950797081,
0.03732854500412941,
-5.283247604827263e-33,
0.04923490434885025,
0.006901702377945185,
0.026677701622247696,
-0.031474947929382324,
-0.029797092080116272,
-0.006445441860705614,
-0.05453135818243027,
-0.00864005833864212,
-0.09058159589767456,
0.00498656602576375,
-0.0044937049970030785,
0.012362864799797535,
0.014717590063810349,
0.0019240666879341006,
-0.05494476482272148,
-0.05485837534070015,
0.0022111921571195126,
-0.022537896409630775,
-0.004337141755968332,
-0.0003945622011087835,
-0.026340724900364876,
-0.014196355827152729,
-0.0034300731495022774,
-0.07545207440853119,
-0.010338131338357925,
-0.05374500900506973,
0.0809125304222107,
0.0007671950152143836,
-0.0070261298678815365,
-0.011073165573179722,
0.008034273982048035,
-0.036352865397930145,
0.009746236726641655,
-0.08022145926952362,
-0.014997527003288269,
-0.06477678567171097,
0.030856670811772346,
0.016723956912755966,
0.017401862889528275,
0.015528488904237747,
0.019422627985477448,
-0.010181492194533348,
-0.036006469279527664,
0.0007501927320845425,
0.0031749780755490065,
-0.01643751561641693,
-0.013538871891796589,
-0.015596689656376839,
-0.017018375918269157,
0.03425922617316246,
-0.0011193797690793872,
0.02049497701227665,
-0.017581498250365257,
-0.0018753109034150839,
-0.03763389214873314,
-0.058195266872644424,
0.02934683859348297,
0.05550701543688774,
0.09763597697019577,
0.01602456346154213,
0.03312528505921364,
0.011024675332009792,
0.024352002888917923,
-0.049746036529541016,
-0.021132182329893112,
-0.0045916433446109295,
0.01221107505261898,
-0.025568852201104164,
-0.045933835208415985,
0.02836182713508606,
-0.03138546645641327,
-0.007884799502789974,
-0.03604317083954811,
-0.012175584211945534,
-0.016191581264138222,
0.039223939180374146,
0.010087295435369015,
0.015800191089510918,
-0.04267783463001251,
0.010544578544795513,
-0.05303017795085907,
-0.009914602153003216,
0.020018447190523148,
-0.03963170945644379,
0.00942942313849926,
-0.039868954569101334,
0.022574294358491898,
-0.004676216747611761,
0.016473857685923576,
-0.02323678694665432,
0.11366932839155197,
-0.016777783632278442,
0.019602952525019646,
-0.006061118096113205,
0.024229586124420166,
-0.016601888462901115,
0.01738668978214264,
0.0096672298386693,
0.004732300061732531,
0.02462068200111389,
0.0510266087949276,
0.016906797885894775,
-0.016094477847218513,
0.03735988959670067,
-0.003317168215289712,
0.034313879907131195,
0.02818228490650654,
0.01816161535680294,
-0.01785297878086567,
0.04400564730167389,
-0.0063708326779305935,
-0.030845122411847115,
-0.002384756924584508,
0.016306806355714798,
-0.009035877883434296,
0.02910318225622177,
0.0033536870032548904,
0.015896445140242577,
-0.0034521494526416063,
0.056922607123851776,
0.04278067499399185,
-0.02760329470038414,
0.01771536096930504,
-0.021480467170476913,
-0.02283785119652748,
-0.03369002416729927,
0.03826536610722542,
0.0336303748190403,
0.03853518143296242,
-0.034293871372938156,
-0.02894909307360649,
-0.008032764308154583,
2.8778771365978173e-7,
0.03665529936552048,
-0.0247621051967144,
0.018883459270000458,
-0.02394253946840763,
0.029538460075855255,
-0.014525050297379494,
-0.032986830919981,
0.02009865641593933,
-0.02861526980996132,
-0.05932061746716499,
0.04217614233493805,
0.039264991879463196,
0.000988087267614901,
-0.03769741207361221,
0.03373533859848976,
-0.021018458530306816,
0.006121899001300335,
0.06820835173130035,
-0.012930409051477909,
0.04785764589905739,
0.05241493135690689,
-0.01168644055724144,
-0.06886544078588486,
0.014757592231035233,
0.04077515751123428,
0.04415307566523552,
-0.041853465139865875,
-0.04760058969259262,
0.03479495644569397,
-0.02305781841278076,
-0.040629975497722626,
-0.00289598829112947,
0.015424729324877262,
0.03345151245594025,
-0.03454367816448212,
0.0109362518414855,
0.06247681751847267,
0.03663057088851929,
-0.003495332784950733,
0.005570414010435343,
0.05164385959506035,
-0.044449977576732635,
0.058539312332868576,
-0.02662871778011322,
-0.06795661151409149,
0.0369444377720356,
0.006548481062054634,
0.05721106007695198,
-0.0010899517219513655,
0.03141607344150543,
0.058436375111341476,
-0.018385808914899826,
-0.0189729742705822,
0.03303776681423187,
0.016157707199454308,
0.08875823020935059,
-0.05450759083032608,
-0.03529611974954605,
0.04027017205953598,
0.07006509602069855,
-0.007104434538632631,
-0.028691822662949562,
0.005151082761585712,
-0.04933979734778404,
0.07913638651371002,
-0.01386360265314579,
-0.07609333097934723,
2.3215092777891194e-34,
-0.050223447382450104,
-0.012569528073072433,
0.000986177008599043,
-0.07876550406217575,
-0.01028025709092617,
-0.029227226972579956,
0.047151725739240646,
-0.014574565924704075,
0.01279224082827568,
-0.023347433656454086,
-0.016003461554646492
] | {
"ds_index": 70,
"similar_dg_indices": [
1154100,
1066777,
442587,
826072,
102228,
1008405,
1122803,
1126850,
44915,
8295,
778769,
1000492,
698351,
502663,
496586,
483883,
1164919,
673300,
885414,
491215
]
} |
A 37-year-old woman comes to the physician because of a 6-month history of weight loss, bloating, and diarrhea. She does not smoke or drink alcohol. Her vital signs are within normal limits. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Physical examination shows bilateral white spots on the temporal half of the conjunctiva, dry skin, and a hard neck mass in the anterior midline that does not move with swallowing. Urinalysis after a D-xylose meal shows an increase in renal D-xylose excretion. Which of the following is most likely to have prevented this patient's weight loss? | Pancreatic enzyme replacement | {
"A": "Gluten-free diet",
"B": "Pancreatic enzyme replacement",
"C": "Tetracycline therapy",
"D": "Lactose-free diet"
} | step1 | B | [
"year old woman",
"physician",
"of",
"month history",
"weight loss",
"bloating",
"diarrhea",
"not smoke",
"drink alcohol",
"vital signs",
"normal limits",
"5 ft 8",
"tall",
"54 kg",
"BMI",
"kg/m2",
"Physical examination shows bilateral white spots",
"temporal half",
"conjunctiva",
"dry skin",
"hard neck mass",
"anterior midline",
"not move",
"swallowing",
"Urinalysis",
"a D xylose meal shows",
"increase",
"renal",
"xylose excretion",
"following",
"most likely to",
"prevented",
"patient's weight loss"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 37-year-old woman comes to the physician because of a 6-month history of weight loss, bloating, and diarrhea. She does not smoke or drink alcohol. Her vital signs are within normal limits. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Physical examination shows bilateral white spots on the temporal half of the conjunctiva, dry skin, and a hard neck mass in the anterior midline that does not move with swallowing. Urinalysis after a D-xylose meal shows an increase in renal D-xylose excretion. Which of the following is most likely to have prevented this patient's weight loss?
Choose one of the following::
A. Gluten-free diet
B. Pancreatic enzyme replacement
C. Tetracycline therapy
D. Lactose-free diet | [
0.06066732481122017,
0.027273403480648994,
0.05753901228308678,
0.003176614176481962,
0.042940396815538406,
-0.027040153741836548,
-0.01956811174750328,
0.060154788196086884,
0.058811578899621964,
0.004765548277646303,
0.04801134020090103,
0.03319305181503296,
-0.020031170919537544,
-0.034508686512708664,
0.009064705111086369,
0.05168619379401207,
-0.013971816748380661,
0.013736201450228691,
-0.026444226503372192,
-0.011120662093162537,
-0.04781631752848625,
0.008655271492898464,
0.020721901208162308,
-0.013021515682339668,
0.008881268091499805,
-0.004630942363291979,
0.000992341199889779,
0.0006689582369290292,
-0.05949652940034866,
-0.0493457205593586,
-0.011785733513534069,
-0.021526847034692764,
0.0019358983263373375,
-0.0390753298997879,
0.0000016318959978889325,
-0.0514378696680069,
0.004983203485608101,
-0.01048014685511589,
-0.015083575621247292,
-0.0024595155846327543,
-0.05095447227358818,
-0.0534801110625267,
0.06000752002000809,
0.00889828335493803,
0.022148115560412407,
-0.04967515543103218,
0.014075109735131264,
0.03233424201607704,
-0.009848696179687977,
-0.0027127026114612818,
0.025901366025209427,
0.006095289718359709,
-0.0377836674451828,
0.022206682711839676,
0.07864212989807129,
-0.0041899122297763824,
-0.030016742646694183,
0.05520082637667656,
-0.034449320286512375,
0.007755886763334274,
0.05046255141496658,
0.027834391221404076,
-0.011581292375922203,
-0.008670039474964142,
-0.05459974706172943,
0.03047291375696659,
0.03795231133699417,
-0.09021193534135818,
-0.0007843509665690362,
0.011119033209979534,
-0.010716397315263748,
0.013538951054215431,
0.01993677020072937,
0.06700669974088669,
-0.0011923472629860044,
-0.03915610909461975,
0.05482565239071846,
-0.05995035171508789,
0.006408768706023693,
-0.019578473642468452,
0.03625979647040367,
0.01570870541036129,
0.018884073942899704,
0.008559707552194595,
-0.03467710316181183,
0.021541625261306763,
0.017328841611742973,
-0.047148365527391434,
-0.021663382649421692,
-0.036296214908361435,
-0.032058194279670715,
-0.06481780111789703,
0.006491155829280615,
0.08942913264036179,
-0.031882986426353455,
-0.001654942985624075,
0.04367982968688011,
0.0073924860917031765,
0.08192310482263565,
-0.05152488127350807,
0.0008738285396248102,
-0.035069528967142105,
0.018709005787968636,
0.03711027652025223,
-0.008158523589372635,
0.06032739207148552,
-0.00253794202581048,
-0.02070619724690914,
-0.008975963108241558,
0.06438916176557541,
0.002821567701175809,
0.029657414183020592,
-0.059758491814136505,
-0.0015418032417073846,
0.06429078429937363,
-0.004344610031694174,
0.016898998990654945,
-0.020636800676584244,
-0.020833685994148254,
0.052900172770023346,
0.022570107132196426,
0.07586631923913956,
0.0019237998640164733,
0.014862184412777424,
-0.03650437667965889,
0.06639913469552994,
0.08320790529251099,
0.022150631994009018,
-0.004174230620265007,
0.0023341327905654907,
0.020421015098690987,
-0.007832854054868221,
-0.029596250504255295,
-0.013826356269419193,
-0.010983736254274845,
0.01949041709303856,
-0.00408229511231184,
0.042925361543893814,
-0.021951384842395782,
-0.0502738319337368,
-0.051042892038822174,
-0.03214595466852188,
-0.027949132025241852,
-0.03328510373830795,
-0.02768733538687229,
0.043789152055978775,
0.014024855569005013,
0.03525376319885254,
0.03009869158267975,
0.06742698699235916,
-0.02705642580986023,
0.014383881352841854,
-0.014021598733961582,
0.029665697365999222,
0.03315107151865959,
-0.019798951223492622,
0.012340974994003773,
-0.025345440953969955,
0.0033058561384677887,
0.015807650983333588,
0.01845049485564232,
-0.027124827727675438,
-0.0183806624263525,
-0.017510773614048958,
-0.011455061845481396,
0.029561610892415047,
0.025227561593055725,
0.04716820642352104,
-0.04181937873363495,
0.049318138509988785,
-0.021933212876319885,
0.015516234561800957,
0.038097627460956573,
0.028135178610682487,
-0.010249593295156956,
0.020435886457562447,
-0.007442102301865816,
-0.06104777753353119,
-0.0015073093818500638,
0.00007927975821075961,
0.022384323179721832,
0.06757152080535889,
0.013114403933286667,
-0.0509403757750988,
0.02151506394147873,
0.0008434218470938504,
-0.03630078583955765,
-0.008564225398004055,
0.009375447407364845,
-0.0116733955219388,
0.0045549627393484116,
-0.029656168073415756,
0.0056834835559129715,
-0.004785560071468353,
-0.013417771086096764,
0.03382426127791405,
-0.0837445855140686,
0.04036928713321686,
0.057933636009693146,
-0.02514910325407982,
0.029399683699011803,
-0.006652121897786856,
0.005831081885844469,
0.02968296781182289,
-0.06072290986776352,
0.06344734877347946,
0.02166488952934742,
0.012424747459590435,
-0.02087896503508091,
-0.0345599427819252,
0.014419903978705406,
0.00290847709402442,
0.0687037780880928,
-0.03736200928688049,
0.022306542843580246,
0.0035496598575264215,
0.028820080682635307,
0.02132231369614601,
-0.04196019843220711,
0.06824012845754623,
-0.030255910009145737,
0.043586477637290955,
0.00010083235974889249,
-0.018759040161967278,
-0.006397734396159649,
-0.05160637944936752,
0.005085513461381197,
-0.005107826087623835,
-0.042761389166116714,
-0.056148651987314224,
0.0659073069691658,
0.041595350950956345,
-0.0750473216176033,
0.07085700333118439,
-0.05381185561418533,
0.015470054931938648,
0.03408908471465111,
-0.033106666058301926,
0.012976819649338722,
0.03780718147754669,
-0.009359458461403847,
-0.015581997111439705,
-0.04788992553949356,
-0.02537219412624836,
0.001373369013890624,
-0.041368089616298676,
-0.013862993568181992,
0.022330647334456444,
-0.0812801644206047,
0.08832267671823502,
-0.03143356367945671,
-0.03984291851520538,
0.03616723418235779,
0.005601845216006041,
-0.011760235764086246,
0.0522458516061306,
-0.05293456092476845,
0.018732288852334023,
-0.05719028785824776,
-0.04755513742566109,
-0.008116500452160835,
0.024899039417505264,
0.030420823022723198,
0.01560252532362938,
-0.056022677570581436,
-0.03927953541278839,
-0.0057951295748353004,
0.05467682704329491,
0.00454571982845664,
0.0020284918136894703,
0.015247889794409275,
0.03323131799697876,
0.010463301092386246,
0.047201450914144516,
-0.020207902416586876,
-0.029789621010422707,
-0.046175118535757065,
0.039542704820632935,
0.04508016258478165,
0.0032213968224823475,
0.018565690144896507,
0.04429842159152031,
0.009093052707612514,
0.015005539171397686,
0.03227628767490387,
-0.025073641911149025,
-0.01843709871172905,
0.00773120392113924,
0.08332967013120651,
0.001463076681829989,
0.036678314208984375,
-0.03860025480389595,
0.009312332607805729,
-0.04839716851711273,
-0.038340531289577484,
0.03544522449374199,
-0.0858672484755516,
0.023184850811958313,
-0.01971011608839035,
0.025994326919317245,
0.030280357226729393,
0.020597541704773903,
-0.03971724957227707,
0.008065476082265377,
-0.05554141849279404,
0.0393979549407959,
-0.03074171021580696,
-0.02424231357872486,
0.029382841661572456,
0.02607000805437565,
0.0603010430932045,
0.02407269924879074,
-0.012949878349900246,
-0.005287389736622572,
0.007197363302111626,
-0.03911567106842995,
-0.033859796822071075,
-0.02778865396976471,
0.07365241646766663,
-0.015610279515385628,
0.011535718105733395,
0.004407586995512247,
-0.02795722335577011,
-0.022773029282689095,
0.0071697230450809,
0.022161200642585754,
-0.022311324253678322,
0.0034503168426454067,
-0.09321878105401993,
-0.017527533695101738,
-0.010436712764203548,
0.011928108520805836,
-0.01753157377243042,
0.027144258841872215,
0.028285477310419083,
0.01435136143118143,
-0.020663371309638023,
0.03449888899922371,
-0.02324105054140091,
0.04536440223455429,
-0.0010815361747518182,
0.015155219472944736,
0.039471689611673355,
0.03957155719399452,
0.06854528188705444,
-0.052133746445178986,
-0.018641643226146698,
0.015924744307994843,
-0.04432538151741028,
0.048431508243083954,
-0.09427377581596375,
-0.04232870414853096,
0.00013554930046666414,
-0.015613497234880924,
-0.03396792709827423,
-0.01937570981681347,
-0.014631244353950024,
0.020924178883433342,
-0.06586520373821259,
-0.013156546279788017,
0.03224807605147362,
0.0187685489654541,
-0.009747475385665894,
0.009463845752179623,
0.037481583654880524,
0.019738376140594482,
0.010220969095826149,
-0.006493273191154003,
0.003658343805000186,
-0.041915569454431534,
-0.007809128612279892,
-0.0020397754851728678,
-0.04233189672231674,
0.06327316910028458,
-0.022710680961608887,
0.0062682777643203735,
0.01019381731748581,
-0.029091641306877136,
-0.07149581611156464,
-0.034559424966573715,
0.03967658802866936,
-0.009862811304628849,
0.019611746072769165,
-0.036395203322172165,
-0.0465397834777832,
-0.01214821357280016,
-0.01591871865093708,
-0.03724180534482002,
0.056127097457647324,
-0.030636349692940712,
0.017134057357907295,
0.021407349035143852,
0.033980268985033035,
-0.015334337018430233,
0.015044091269373894,
0.0029491137247532606,
-0.01750602014362812,
-0.04827248677611351,
0.01499455701559782,
0.0931059941649437,
0.031814102083444595,
-0.014339081943035126,
0.03028472140431404,
0.03854997083544731,
0.07303456217050552,
-0.10416191071271896,
-0.09569433331489563,
0.00031942440546117723,
0.03397463262081146,
-0.026214631274342537,
0.03097815439105034,
-0.07326165586709976,
0.02337135188281536,
-0.004984868690371513,
0.041412293910980225,
-0.02275884337723255,
-0.018192889168858528,
0.005725824274122715,
0.010561950504779816,
-0.09998514503240585,
0.042223766446113586,
-0.01610834151506424,
-0.02163788489997387,
-0.02279253862798214,
0.012316571548581123,
0.0235093105584383,
0.013764438219368458,
0.024928007274866104,
0.018791815266013145,
0.02366233989596367,
0.02819669432938099,
-0.0717657282948494,
0.022686315700411797,
0.035699497908353806,
0.014193655923008919,
0.03126725181937218,
0.0030363639816641808,
-0.0032183381263166666,
-0.006786557845771313,
-0.030585721135139465,
0.013898845762014389,
-0.04112254083156586,
0.03257225826382637,
-0.006747537292540073,
0.05438729375600815,
-0.02827984094619751,
-0.011376162059605122,
0.05735643580555916,
0.054664742201566696,
0.0716109573841095,
0.011723984964191914,
0.019220400601625443,
0.02584904246032238,
0.053058259189128876,
0.03292175009846687,
0.008883828297257423,
0.04378814622759819,
-0.06492283940315247,
-0.010946232825517654,
-0.05998096242547035,
-0.033638909459114075,
0.01632768288254738,
0.03532695770263672,
-0.06318648159503937,
0.02458670549094677,
-0.05058896541595459,
-0.05065217986702919,
0.052206430584192276,
-0.04478852450847626,
-0.0007954201428219676,
-0.0617898553609848,
0.09884896874427795,
0.011142449453473091,
0.0017862216336652637,
-0.0195310078561306,
-0.0338766947388649,
-0.04854823648929596,
-0.09940222650766373,
-0.0331016480922699,
0.02024061232805252,
-0.03924505412578583,
-0.011279748752713203,
-0.03651716932654381,
-0.04888159781694412,
0.016504665836691856,
0.04257003590464592,
0.0011536941165104508,
-0.021591320633888245,
-0.04196001961827278,
-0.036995287984609604,
0.005620065610855818,
0.02678881213068962,
0.028241246938705444,
-0.0367322638630867,
-0.04979589954018593,
-0.005433302838355303,
0.010420679114758968,
0.04900680482387543,
0.044233813881874084,
-0.005474282428622246,
0.05145445093512535,
-0.021916864439845085,
0.024396264925599098,
-0.0403280071914196,
0.007807495538145304,
0.008487374521791935,
-0.004988932516425848,
0.0014667077921330929,
-0.037863846868276596,
-0.04359028860926628,
0.00928408745676279,
-0.028610434383153915,
0.0022213654592633247,
0.029854977503418922,
0.017587384209036827,
-0.11112916469573975,
-0.019968777894973755,
-0.031760651618242264,
-0.013964511454105377,
0.036112137138843536,
0.015989990904927254,
-0.031846124678850174,
0.005604589823633432,
-0.0008036307990550995,
0.02065565623342991,
0.06329631060361862,
0.0006522973417304456,
-0.014228511601686478,
-0.037517376244068146,
0.07803698629140854,
-0.010010981932282448,
-0.006285024341195822,
-0.03586331754922867,
-0.03198478743433952,
-0.015909044072031975,
-0.052742160856723785,
0.028264205902814865,
-0.001762673375196755,
-0.009678838774561882,
-0.05876827985048294,
0.01987476460635662,
-0.018745265901088715,
0.009992665611207485,
0.025529608130455017,
0.009167476557195187,
0.044604409486055374,
-0.027997788041830063,
0.009054979309439659,
0.061810534447431564,
-0.0002835926425177604,
-0.0211868267506361,
0.005287799518555403,
0.04260622337460518,
0.02252231165766716,
0.041969455778598785,
-4.409024007255081e-33,
0.06478219479322433,
-0.031158633530139923,
0.04585292190313339,
-0.013374828733503819,
0.054845113307237625,
0.08942652493715286,
-0.01160325575619936,
-0.016963094472885132,
-0.04032077640295029,
0.04365752264857292,
0.02340085618197918,
-0.019266633316874504,
0.0286537017673254,
0.05603833869099617,
-0.05472864583134651,
0.0011371839791536331,
0.0008010390447452664,
0.009033353999257088,
-0.0062087588012218475,
-0.009393195621669292,
-0.023682300001382828,
-0.030307957902550697,
-0.04152316227555275,
-0.028056683018803596,
0.0001417837047483772,
-0.0020351046696305275,
0.07530075311660767,
0.006017015781253576,
-0.040851082652807236,
-0.017227778211236,
-0.03200722485780716,
-0.0010209920583292842,
-0.01338324323296547,
-0.007750263437628746,
-0.03791110962629318,
-0.018048733472824097,
0.001250720932148397,
-0.043426718562841415,
0.048399120569229126,
-0.0198289155960083,
-0.027610035613179207,
0.004311967175453901,
0.027391713112592697,
0.000787074095569551,
0.050152380019426346,
0.009905178099870682,
-0.02884170226752758,
-0.0018148943781852722,
-0.014273113571107388,
0.021656757220625877,
-0.023121869191527367,
0.009508504532277584,
0.030399417504668236,
0.006649315822869539,
-0.033588163554668427,
-0.04501353204250336,
0.013053327798843384,
-0.005119532812386751,
0.06707920879125595,
-0.015474227257072926,
-0.044279858469963074,
-0.0115374606102705,
-0.008543250150978565,
-0.04226529970765114,
-0.035489410161972046,
-0.019813716411590576,
0.0634080320596695,
0.03480685502290726,
0.03483140096068382,
0.0077855708077549934,
-0.11107838898897171,
-0.0024336054921150208,
-0.008200899697840214,
-0.09764939546585083,
0.014614008367061615,
-0.03514307737350464,
-0.0016763386083766818,
-0.029278011992573738,
-0.07596061378717422,
0.007733261678367853,
-0.030491571873426437,
-0.00942525826394558,
0.04405868798494339,
0.00717209093272686,
-0.04191933199763298,
0.00931326113641262,
0.00017151211795862764,
-0.022185439243912697,
-0.06091831624507904,
0.0037513154093176126,
0.09009455144405365,
0.009908957406878471,
0.004803141579031944,
0.018871434032917023,
-0.027917535975575447,
-0.053118109703063965,
0.048199087381362915,
-0.016609521582722664,
0.0027724113315343857,
0.030576949939131737,
0.06463154405355453,
0.04049013555049896,
-0.005299222655594349,
-0.01274497713893652,
-0.038467369973659515,
0.03968539088964462,
0.002708357758820057,
-0.0016371698584407568,
0.033432915806770325,
-0.02164297178387642,
-0.05032361298799515,
0.011903461068868637,
-0.016447946429252625,
0.06556898355484009,
0.014851781539618969,
0.06843981891870499,
0.00016736863472033292,
-0.0003698157088365406,
0.04304900020360947,
0.019520249217748642,
0.003784897970035672,
-0.023202616721391678,
0.026549536734819412,
-0.0005592107190750539,
-0.04323823004961014,
-0.062366653233766556,
0.015711097046732903,
0.021059397608041763,
-0.011370320804417133,
-0.019417455419898033,
0.05468552187085152,
-0.01374861504882574,
2.60041758792795e-7,
0.012197181582450867,
-0.027203071862459183,
-0.002452973974868655,
-0.02871784009039402,
0.021995922550559044,
-0.03513946384191513,
-0.03236505016684532,
0.006455093156546354,
-0.018719790503382683,
-0.04356255754828453,
0.033711712807416916,
-0.01096605509519577,
-0.04744939133524895,
-0.014236345887184143,
0.10235417634248734,
0.013986469246447086,
0.02654915116727352,
-0.04543924704194069,
0.010979543440043926,
0.001228251145221293,
-0.047902435064315796,
-0.025029977783560753,
-0.0683334693312645,
-0.05545671656727791,
0.006198694929480553,
-0.0031869520898908377,
-0.016953743994235992,
-0.020761728286743164,
-0.0345243439078331,
-0.016428621485829353,
0.025846408680081367,
0.03516577556729317,
0.06481720507144928,
0.004104409366846085,
-0.04825695604085922,
-0.03322887793183327,
-0.02215113490819931,
0.03319782763719559,
-0.020233914256095886,
-0.015225918963551521,
0.006449414417147636,
-0.005073661915957928,
0.007704423740506172,
0.08261657506227493,
-0.011458077467978,
0.04179038852453232,
-0.03328422084450722,
0.012384221889078617,
-0.002021301770582795,
-0.023475147783756256,
0.012184266932308674,
0.028884239494800568,
0.003090956946834922,
0.0857333391904831,
-0.03437249734997749,
0.046425286680459976,
-0.020922478288412094,
0.007999452762305737,
0.01813586615025997,
-0.04283273592591286,
-0.01992289535701275,
-0.0016061341157183051,
0.002098232973366976,
-0.01267254538834095,
0.026303445920348167,
-0.05944876745343208,
-0.04049716517329216,
2.1657429601582234e-34,
-0.014727115631103516,
-0.05845265835523605,
0.011509406380355358,
-0.06522120535373688,
-0.011330894194543362,
-0.031229766085743904,
-0.017148779705166817,
0.0008410632144659758,
0.035192158073186874,
-0.04193064197897911,
-0.01590699888765812
] | {
"ds_index": 71,
"similar_dg_indices": [
282692,
581684,
433285,
341428,
676444,
396891,
72613,
92808,
571432,
1111173,
624060,
1128052,
637338,
1200668,
116201,
455878,
1042238,
51390,
326812,
638427
]
} |
A 52-year-old man presents for a routine checkup. Past medical history is remarkable for stage 1 systemic hypertension and hepatitis A infection diagnosed 10 years ago. He takes aspirin, rosuvastatin, enalapril daily, and a magnesium supplement every once in a while. He is planning to visit Ecuador for a week-long vacation and is concerned about malaria prophylaxis before his travel. The physician advised taking 1 primaquine pill every day while he is there and for 7 consecutive days after leaving Ecuador. On the third day of his trip, the patient develops an acute onset headache, dizziness, shortness of breath, and fingertips and toes turning blue. His blood pressure is 135/80 mm Hg, heart rate is 94/min, respiratory rate is 22/min, temperature is 36.9℃ (98.4℉), and blood oxygen saturation is 97% in room air. While drawing blood for his laboratory workup, the nurse notes that his blood has a chocolate brown color. Which of the following statements best describes the etiology of this patient’s most likely condition? | It is a type B adverse drug reaction. | {
"A": "The patient’s condition is due to consumption of water polluted with nitrates.",
"B": "This condition resulted from primaquine overdose.",
"C": "The condition developed because of his concomitant use of primaquine and magnesium supplement.",
"D": "It is a type B adverse drug reaction."
} | step1 | D | [
"year old man presents",
"routine checkup",
"Past medical history",
"stage 1 systemic hypertension",
"hepatitis A infection diagnosed 10 years",
"takes aspirin",
"rosuvastatin",
"enalapril daily",
"magnesium supplement",
"planning to visit Ecuador",
"week long vacation",
"concerned",
"malaria prophylaxis",
"travel",
"physician",
"taking 1 primaquine pill",
"day",
"7 consecutive days",
"leaving Ecuador",
"third day",
"trip",
"patient",
"acute headache",
"dizziness",
"shortness of breath",
"fingertips",
"toes turning blue",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"98",
"blood oxygen saturation",
"97",
"room air",
"drawing blood",
"laboratory workup",
"nurse notes",
"blood",
"chocolate brown color",
"following statements best",
"etiology",
"patients",
"likely condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 52-year-old man presents for a routine checkup. Past medical history is remarkable for stage 1 systemic hypertension and hepatitis A infection diagnosed 10 years ago. He takes aspirin, rosuvastatin, enalapril daily, and a magnesium supplement every once in a while. He is planning to visit Ecuador for a week-long vacation and is concerned about malaria prophylaxis before his travel. The physician advised taking 1 primaquine pill every day while he is there and for 7 consecutive days after leaving Ecuador. On the third day of his trip, the patient develops an acute onset headache, dizziness, shortness of breath, and fingertips and toes turning blue. His blood pressure is 135/80 mm Hg, heart rate is 94/min, respiratory rate is 22/min, temperature is 36.9℃ (98.4℉), and blood oxygen saturation is 97% in room air. While drawing blood for his laboratory workup, the nurse notes that his blood has a chocolate brown color. Which of the following statements best describes the etiology of this patient’s most likely condition?
Choose one of the following::
A. The patient’s condition is due to consumption of water polluted with nitrates.
B. This condition resulted from primaquine overdose.
C. The condition developed because of his concomitant use of primaquine and magnesium supplement.
D. It is a type B adverse drug reaction. | [
0.029887765645980835,
-0.04799342527985573,
0.029819035902619362,
0.0031071731355041265,
0.0247734896838665,
-0.010776071809232235,
-0.03527374193072319,
0.044982556253671646,
-0.024616090580821037,
0.008695726282894611,
-0.01178224477916956,
0.059666216373443604,
0.009734803810715675,
-0.03355545923113823,
0.01786261796951294,
0.03492147475481033,
-0.005401059985160828,
-0.035199202597141266,
-0.024271909147500992,
0.018266696482896805,
-0.031667836010456085,
0.03780031576752663,
0.02109377831220627,
0.028960194438695908,
0.07040894031524658,
-0.039137836545705795,
0.0034393935929983854,
-0.01958727464079857,
-0.0004611052281688899,
-0.006386784370988607,
-0.021401768550276756,
-0.006854628678411245,
-0.05863839387893677,
-0.10864422470331192,
0.0000018845554450308555,
-0.024930458515882492,
0.008685064502060413,
0.006728628184646368,
0.06466852128505707,
-0.03965524956583977,
0.019092222675681114,
-0.034822799265384674,
0.06534717231988907,
0.018122965469956398,
-0.06738416850566864,
-0.025835523381829262,
-0.020219136029481888,
0.08965586870908737,
-0.04856615886092186,
-0.011028869077563286,
0.015841687098145485,
0.06003785505890846,
-0.03014131635427475,
-0.01182093471288681,
0.0634913370013237,
-0.09883032739162445,
0.0036047447938472033,
-0.00851777009665966,
0.040793538093566895,
0.01866311952471733,
0.020885257050395012,
-0.005743957590311766,
0.008239831775426865,
0.02403753437101841,
-0.055100250989198685,
-0.0314292386174202,
0.010981408879160881,
-0.03679914027452469,
-0.005245923064649105,
0.0007484546513296664,
-0.06037009507417679,
0.0061254194006323814,
0.03700339049100876,
0.0828898698091507,
-0.05155568569898605,
-0.001161700813099742,
0.0469878688454628,
-0.018107658252120018,
-0.025551173835992813,
-0.03637626767158508,
0.12816591560840607,
0.06452980637550354,
0.014138755388557911,
0.05245332419872284,
-0.012618345208466053,
-0.02670392021536827,
0.005231678951531649,
0.0043419101275503635,
-0.0339907631278038,
-0.01833363063633442,
0.009280510246753693,
-0.04078023135662079,
0.0020688988734036684,
-0.00796054769307375,
-0.03409236669540405,
-0.010026181116700172,
0.057781413197517395,
-0.008400908671319485,
0.05200258642435074,
-0.048731811344623566,
0.009530327282845974,
-0.0031614755280315876,
-0.02541309781372547,
0.027693478390574455,
-0.027986811473965645,
-0.06849304586648941,
-0.05631031468510628,
-0.028642525896430016,
-0.03644409030675888,
0.020412052050232887,
-0.012979862280189991,
0.0004554104816634208,
-0.048829078674316406,
-0.054701756685972214,
0.08680497854948044,
0.024668360128998756,
-0.014512378722429276,
-0.07007227092981339,
0.0036552194505929947,
0.026419200003147125,
0.006270578596740961,
0.01943286322057247,
-0.011853434145450592,
0.0017805066891014576,
-0.003670313861221075,
0.021432960405945778,
-0.049006957560777664,
0.012370034120976925,
0.009722699411213398,
-0.010056499391794205,
0.02449878305196762,
-0.04282071441411972,
-0.049878764897584915,
-0.002806885400786996,
0.016303371638059616,
0.046792369335889816,
0.006726035848259926,
0.06761419773101807,
-0.02563146874308586,
-0.03009810484945774,
0.011104137636721134,
-0.024612847715616226,
0.04814611002802849,
0.007990221492946148,
0.024184182286262512,
0.036654144525527954,
0.026928439736366272,
0.05213755741715431,
-0.012713968753814697,
0.04652915522456169,
-0.0023320030886679888,
-0.029913978651165962,
-0.032729826867580414,
-0.008555657230317593,
-0.009477817453444004,
0.04223666340112686,
0.02675706334412098,
0.0029395415913313627,
0.00468994677066803,
-0.04637475684285164,
0.01623346284031868,
-0.03353416547179222,
0.04573260247707367,
-0.02424432709813118,
-0.04730752110481262,
0.007649718318134546,
0.01992041803896427,
0.033767081797122955,
-0.0026560265105217695,
0.024210186675190926,
-0.004752642009407282,
0.00696077523753047,
0.02573188953101635,
0.036410145461559296,
-0.03831024840474129,
-0.044554002583026886,
-0.048537954688072205,
-0.03067086450755596,
0.022365596145391464,
-0.023558348417282104,
-0.017141068354249,
0.04565303400158882,
0.022708022966980934,
-0.035136766731739044,
-0.02497611939907074,
0.009763697162270546,
-0.0007792635005898774,
-0.020074594765901566,
0.01199230458587408,
-0.010275982320308685,
-0.005939034279435873,
0.0025466950610280037,
0.02259061112999916,
0.0005659564631059766,
-0.030034005641937256,
0.004128583241254091,
-0.03255577012896538,
-0.022451063618063927,
-0.0031458947341889143,
-0.03432032838463783,
-0.02417309582233429,
0.024500714614987373,
0.011996113695204258,
0.022979937493801117,
-0.06361059844493866,
0.07382743060588837,
0.0358302928507328,
-0.0002798739878926426,
-0.017973940819501877,
-0.031256645917892456,
-0.03245146572589874,
0.0058033037930727005,
0.0711541473865509,
-0.06434786319732666,
0.020606916397809982,
0.01060585305094719,
-0.011965212412178516,
-0.002537577413022518,
-0.06352156400680542,
0.04074352607131004,
0.0010245433077216148,
-0.02558942139148712,
-0.016122711822390556,
-0.014982849359512329,
-0.08481261134147644,
0.0005589866195805371,
0.020533213391900063,
0.04932517185807228,
-0.008068450726568699,
-0.0548316165804863,
0.05109291523694992,
0.022678343579173088,
-0.025140458717942238,
-0.02796447090804577,
-0.039221420884132385,
0.05107627063989639,
0.026626281440258026,
-0.04063975065946579,
-0.006321836728602648,
0.03303074091672897,
-0.004538220353424549,
-0.04575369134545326,
-0.06574089825153351,
-0.03462108597159386,
-0.040994901210069656,
0.0064824470318853855,
-0.019517667591571808,
0.019826266914606094,
-0.06168794259428978,
0.03545822948217392,
0.014849266968667507,
0.039554137736558914,
-0.05438951402902603,
0.02678588218986988,
-0.031056158244609833,
-0.007445485331118107,
-0.056608788669109344,
0.013090199790894985,
-0.05365205556154251,
-0.011786828748881817,
-0.041960179805755615,
0.039451707154512405,
-0.010359877720475197,
-0.017396247014403343,
-0.02968049794435501,
-0.015397599898278713,
0.04969495162367821,
-0.022898050025105476,
-0.03580999746918678,
0.03342727571725845,
-0.02312745712697506,
0.027462681755423546,
0.006008290685713291,
0.025391830131411552,
-0.025494074448943138,
0.010610999539494514,
-0.03864890709519386,
0.034167565405368805,
0.023618094623088837,
0.0010775674600154161,
0.03214040771126747,
0.06366147845983505,
0.034019600600004196,
0.04609373211860657,
-0.0035515374038368464,
0.036031968891620636,
-0.02384166233241558,
0.018671846017241478,
0.028455480933189392,
-0.012423189356923103,
-0.03666863963007927,
0.006459237076342106,
0.0014796245377510786,
-0.048933595418930054,
-0.02052934467792511,
-0.014081989414989948,
-0.05547525733709335,
0.0784115418791771,
-0.011179178021848202,
0.014207872562110424,
0.08382120728492737,
0.01761576347053051,
0.033044829964637756,
0.02478770911693573,
-0.008328362368047237,
0.05401897430419922,
0.08234242349863052,
0.010437309741973877,
0.006075327284634113,
0.06714006513357162,
0.03946870192885399,
-0.011684447526931763,
-0.003858707845211029,
-0.021203577518463135,
0.004660965409129858,
-0.025939734652638435,
-0.0014802165096625686,
-0.02260425128042698,
0.05498385801911354,
0.026228243485093117,
0.006555464584380388,
0.03741440176963806,
-0.006046596448868513,
-0.04477618262171745,
0.039087411016225815,
-0.04200220853090286,
0.0054485914297401905,
-0.003942085895687342,
-0.12609629333019257,
-0.042329855263233185,
-0.02007957547903061,
-0.004765835124999285,
0.023180214688181877,
0.05220283195376396,
0.026242729276418686,
-0.01096835546195507,
-0.023441918194293976,
0.005196104291826487,
-0.029919657856225967,
-0.008807527832686901,
0.02333947829902172,
-0.035988952964544296,
0.052042316645383835,
0.02655327133834362,
-0.03000009059906006,
-0.012868106365203857,
-0.048118624836206436,
0.01762949675321579,
0.05770903453230858,
0.027783840894699097,
-0.05870845541357994,
-0.0020675049163401127,
0.00664674723520875,
-0.025798894464969635,
0.0007674419321119785,
-0.05441742390394211,
0.03214843198657036,
-0.007430641446262598,
0.010234623216092587,
-0.01697406731545925,
0.025665592402219772,
0.016648324206471443,
-0.05270275101065636,
0.045100901275873184,
0.009235270321369171,
0.009041192010045052,
0.009816756471991539,
-0.015960197895765305,
-0.05534721165895462,
-0.024328092113137245,
0.015352408401668072,
-0.010623046196997166,
-0.011398144997656345,
0.04673811048269272,
-0.016044946387410164,
0.019315196201205254,
0.03776763007044792,
-0.0665520653128624,
-0.08145017176866531,
-0.044857025146484375,
0.04594733566045761,
-0.06974609941244125,
0.007921186275780201,
-0.0020398306660354137,
-0.027455003932118416,
-0.008160721510648727,
-0.01375289261341095,
-0.05463137477636337,
0.048144202679395676,
-0.03891345486044884,
0.016441548243165016,
-0.021828899160027504,
-0.01176672987639904,
-0.031805142760276794,
0.00115099735558033,
0.012266207486391068,
0.0402652807533741,
-0.04080960154533386,
0.017190078273415565,
0.06813477724790573,
0.020877210423350334,
-0.006726888474076986,
-0.05270454287528992,
0.0855497494339943,
0.11166465282440186,
-0.08202539384365082,
0.0017945246072486043,
-0.017636161297559738,
0.03194845840334892,
0.08079667389392853,
-0.008894604630768299,
-0.08239468187093735,
0.061391256749629974,
0.004361615050584078,
0.0472063347697258,
-0.0013939988566562533,
0.01150884386152029,
-0.045938409864902496,
0.03587763383984566,
-0.06182108819484711,
0.06501136720180511,
0.03466160595417023,
-0.00012358726235106587,
-0.05765477195382118,
-0.02715195342898369,
-0.03254124894738197,
0.040798235684633255,
0.048802196979522705,
0.006741390097886324,
0.045924458652734756,
-0.010541684925556183,
-0.017568571493029594,
0.04511512443423271,
0.03783033788204193,
-0.0422237329185009,
0.014202897436916828,
-0.000663835322484374,
-0.02020379900932312,
-0.004745836835354567,
-0.039106227457523346,
-0.012263674288988113,
0.01288475003093481,
0.03849947080016136,
0.02197226509451866,
0.01777074858546257,
0.023456614464521408,
-0.02209734544157982,
0.08379693329334259,
0.01425092201679945,
0.06759120523929596,
0.05367724597454071,
0.0027686806861311197,
0.049120839685201645,
-0.007267854176461697,
0.04666771739721298,
0.023069636896252632,
0.028501736000180244,
-0.08175975829362869,
0.044233404099941254,
-0.02851743809878826,
-0.037657517939805984,
0.014539319090545177,
-0.02850426360964775,
-0.045718029141426086,
-0.009109732694923878,
-0.07023623585700989,
-0.07214275747537613,
0.033584900200366974,
-0.02690000832080841,
-0.05685726925730705,
0.02390453964471817,
0.051756083965301514,
-0.020490383729338646,
-0.009932068176567554,
0.008659595623612404,
-0.00002280144690303132,
-0.02562291920185089,
-0.023713242262601852,
0.07780701667070389,
0.026556996628642082,
-0.05630975589156151,
0.041598569601774216,
-0.0679410994052887,
-0.037491314113140106,
0.018414629623293877,
-0.004733444657176733,
0.024884067475795746,
-0.026634223759174347,
-0.0011360463686287403,
0.0019375273259356618,
-0.04656647518277168,
0.008034644648432732,
0.002875265898182988,
-0.012919165194034576,
-0.023699874058365822,
-0.002899439772590995,
-0.02528601884841919,
0.047807060182094574,
-0.0019801300950348377,
-0.015578050166368484,
0.08872680366039276,
0.0234342310577631,
0.01605844497680664,
0.03860471397638321,
0.011604643426835537,
0.0329265259206295,
-0.011818289756774902,
0.08180001378059387,
-0.028274444863200188,
-0.03964496776461601,
0.032256558537483215,
0.02103039249777794,
-0.008233692497015,
0.02674972265958786,
0.03816696256399155,
0.007078852970153093,
-0.022087641060352325,
-0.08260023593902588,
0.007121927570551634,
0.010134079493582249,
0.0013489044504240155,
-0.031288955360651016,
0.025749647989869118,
0.014811278320848942,
0.02752942405641079,
0.041204653680324554,
-0.015503340400755405,
-0.022794516757130623,
0.0012989448150619864,
0.05355747044086456,
-0.01016787439584732,
-0.043681319802999496,
-0.036909252405166626,
-0.005511965602636337,
-0.015601851046085358,
0.042422402650117874,
-0.014343326911330223,
-0.016618531197309494,
-0.02655072882771492,
0.0006042362656444311,
-0.017759719863533974,
-0.012745697051286697,
0.015735292807221413,
-0.02563079260289669,
0.010385368950664997,
0.03547653928399086,
-0.003787491237744689,
0.023564429953694344,
0.0055425893515348434,
-0.013241609558463097,
0.008106411434710026,
0.08904262632131577,
0.0021339221857488155,
0.03316812589764595,
0.010124354623258114,
-5.212431417029913e-33,
0.05640567094087601,
-0.04358068108558655,
0.003201750572770834,
-0.10325712710618973,
0.04445229470729828,
0.07631796598434448,
-0.06485745310783386,
-0.03489954024553299,
-0.04711395129561424,
0.04120015352964401,
-0.04469862952828407,
-0.01942325569689274,
0.023650260642170906,
0.05396479740738869,
-0.020965764299035072,
-0.01454850472509861,
0.014195936731994152,
0.047985877841711044,
-0.013213097117841244,
-0.012467578984797001,
-0.007404443807899952,
0.013398935087025166,
-0.005300214048475027,
-0.037933845072984695,
-0.023202134296298027,
-0.019010700285434723,
0.050699882209300995,
0.017117908224463463,
-0.04714178666472435,
0.021565791219472885,
0.03133620694279671,
-0.012755640782415867,
0.027878381311893463,
0.010145461186766624,
-0.010362334549427032,
-0.061243291944265366,
0.0265559833496809,
-0.05273344740271568,
0.05376189574599266,
-0.019974207505583763,
-0.0445210300385952,
-0.04792796075344086,
0.017246440052986145,
0.022688796743750572,
0.03453243896365166,
-0.01379143726080656,
-0.04629522189497948,
-0.039774589240550995,
0.0019553995225578547,
-0.03244660049676895,
0.012830411083996296,
0.0014570822240784764,
0.047817032784223557,
0.0006102801417000592,
-0.010231510736048222,
0.06086704507470131,
-0.020761072635650635,
-0.005576051771640778,
0.008649968542158604,
-0.02260267175734043,
-0.02449118345975876,
0.026437150314450264,
0.028269687667489052,
0.02311074361205101,
-0.014838863164186478,
-0.03380781039595604,
0.018688803538680077,
0.03239642456173897,
-0.09517543017864227,
0.06749851256608963,
-0.08149061352014542,
-0.005373591091483831,
-0.04011118784546852,
-0.043773919343948364,
-0.046849384903907776,
-0.02628718689084053,
0.04220705106854439,
0.03085748851299286,
0.011611073277890682,
-0.0008010868332348764,
-0.04580822214484215,
-0.025088956579566002,
0.0071521638892591,
-0.02899777889251709,
-0.013842997141182423,
0.015194152481853962,
0.005493649747222662,
-0.010280308313667774,
-0.01893649622797966,
-0.05345940589904785,
0.06827680766582489,
0.025113698095083237,
0.03602444753050804,
0.021058524027466774,
-0.04457487165927887,
0.010444284416735172,
-0.011077340692281723,
0.011774823069572449,
0.028061391785740852,
0.00819655042141676,
0.014278566464781761,
0.05828094109892845,
0.020311586558818817,
-0.04144725576043129,
-0.027492860332131386,
0.01702573522925377,
0.008602777495980263,
-0.044010505080223083,
-0.025006074458360672,
0.021527450531721115,
0.04499607905745506,
-0.00424277363345027,
-0.0009100525639951229,
0.04330670088529587,
0.011256570927798748,
0.014813024550676346,
0.04398313909769058,
0.07250906527042389,
0.008336223661899567,
0.005362257827073336,
0.03582492098212242,
-0.0053438106551766396,
0.01760409027338028,
0.03072163462638855,
-0.07166590541601181,
-0.021576091647148132,
-0.010808657854795456,
0.03353366255760193,
-0.031831949949264526,
-0.034957125782966614,
0.019922690466046333,
-0.018458306789398193,
2.742580420544982e-7,
0.03400025889277458,
0.0011954711517319083,
-0.002005999907851219,
-0.07047344744205475,
-0.010919900611042976,
0.0036560159642249346,
-0.023882877081632614,
0.007767261937260628,
-0.017235668376088142,
-0.0205882228910923,
0.0037951439153403044,
0.007627325598150492,
-0.007317953743040562,
-0.004544290713965893,
0.020557396113872528,
-0.023440631106495857,
-0.03204653784632683,
-0.01908017508685589,
-0.022170303389430046,
-0.007951266132295132,
-0.01259083766490221,
0.009795992635190487,
-0.07600650191307068,
-0.02462124638259411,
0.0287951547652483,
0.03599924594163895,
0.00191470084246248,
-0.02866848185658455,
-0.08241728693246841,
-0.0012084001209586859,
-0.004907499998807907,
0.02006310410797596,
0.018305113539099693,
0.0912695825099945,
-0.008147785440087318,
-0.01640656776726246,
0.002535640960559249,
0.04162761569023132,
-0.018705841153860092,
0.04209427908062935,
0.016724789515137672,
-0.03957671299576759,
0.03702940419316292,
-0.015823086723685265,
0.018465200439095497,
0.053983259946107864,
-0.074018195271492,
-0.019737854599952698,
0.042554259300231934,
0.002616735640913248,
0.03164356201887131,
0.029903994873166084,
-0.04661699756979942,
0.057503584772348404,
0.025183411315083504,
0.08481718599796295,
-0.038130663335323334,
-0.019067343324422836,
0.018964972347021103,
-0.00966744776815176,
0.005695737898349762,
-0.053086671978235245,
0.007914790883660316,
-0.027976201847195625,
0.029147041961550713,
-0.05428043380379677,
-0.038092583417892456,
2.5657880241495297e-34,
-0.03833187371492386,
-0.009925764985382557,
0.014824924059212208,
-0.04766877740621567,
0.012360626831650734,
-0.06201133131980896,
0.011340201832354069,
-0.002088734181597829,
0.013962365686893463,
-0.0449480302631855,
-0.014673052355647087
] | {
"ds_index": 72,
"similar_dg_indices": [
570422,
942978,
928234,
215714,
11484,
1052216,
713289,
1126938,
946042,
1133332,
546765,
1059959,
541418,
1150394,
96066,
700363,
453719,
709088,
872446,
449891
]
} |
A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the emergency department for sudden leakage of clear vaginal fluid. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of serious illness. She does not drink alcohol or smoke cigarettes. Current medications include vitamin supplements. Her temperature is 37.2°C (98.9°F), pulse is 70/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Speculum examination demonstrates clear fluid in the cervical canal. The fetal heart rate is reactive at 160/min with no decelerations. Tocometry shows uterine contractions. Nitrazine testing is positive. She is started on indomethacin. Which of the following is the most appropriate next step in management? | Administer betamethasone and ampicillin | {
"A": "Administer betamethasone, ampicillin, and proceed with cesarean section",
"B": "Administer ampicillin and perform amnioinfusion",
"C": "Administer betamethasone and ampicillin",
"D": "Administer betamethasone, ampicillin, and proceed with induction of labor"
} | step2&3 | C | [
"31 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"emergency department",
"sudden leakage",
"clear vaginal",
"pregnancy",
"uncomplicated",
"first child",
"born",
"term",
"vaginal delivery",
"history",
"serious illness",
"not drink alcohol",
"smoke cigarettes",
"Current medications include vitamin supplements",
"temperature",
"98 9F",
"pulse",
"70 min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Speculum examination demonstrates clear fluid",
"cervical canal",
"fetal heart rate",
"reactive",
"min",
"decelerations",
"shows uterine contractions",
"testing",
"positive",
"started",
"indomethacin",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the emergency department for sudden leakage of clear vaginal fluid. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of serious illness. She does not drink alcohol or smoke cigarettes. Current medications include vitamin supplements. Her temperature is 37.2°C (98.9°F), pulse is 70/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Speculum examination demonstrates clear fluid in the cervical canal. The fetal heart rate is reactive at 160/min with no decelerations. Tocometry shows uterine contractions. Nitrazine testing is positive. She is started on indomethacin. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Administer betamethasone, ampicillin, and proceed with cesarean section
B. Administer ampicillin and perform amnioinfusion
C. Administer betamethasone and ampicillin
D. Administer betamethasone, ampicillin, and proceed with induction of labor | [
0.007423512637615204,
-0.04336520656943321,
-0.0061375112272799015,
-0.06919030100107193,
-0.0031721496488898993,
-0.003347566118463874,
-0.02480996772646904,
0.009022981859743595,
-0.07541558891534805,
0.002323914784938097,
0.0259102713316679,
-0.023537445813417435,
-0.0009698843932710588,
-0.003153534373268485,
0.010894663631916046,
0.004172319080680609,
-0.023137815296649933,
0.004029428120702505,
-0.020088018849492073,
-0.008697252720594406,
-0.018236033618450165,
0.03172898292541504,
0.007499078754335642,
-0.029027586802840233,
0.07517717033624649,
-0.013654075562953949,
-0.0013430975377559662,
-0.0056340801529586315,
0.00039195024874061346,
-0.07027144730091095,
0.032253146171569824,
0.005910917185246944,
0.01735277660191059,
-0.02646363526582718,
0.0000021148482574062655,
-0.024286821484565735,
0.026100773364305496,
-0.03317588195204735,
0.026344170793890953,
-0.045802388340234756,
-0.05672944337129593,
-0.08540169894695282,
0.002181192860007286,
0.004646869841963053,
-0.03713659569621086,
-0.0717470645904541,
-0.005111454986035824,
0.013028821907937527,
-0.017972610890865326,
-0.0013347712811082602,
0.024355366826057434,
0.012948776595294476,
0.003635233035311103,
0.019816724583506584,
0.07796942442655563,
-0.10941872000694275,
-0.013681325130164623,
0.026448490098118782,
0.028238989412784576,
-0.010442648082971573,
0.019044753164052963,
0.0051198736764490604,
0.008125231601297855,
-0.03256252408027649,
-0.04145228490233421,
-0.0004731940571218729,
0.02448396570980549,
-0.12329637259244919,
0.00014318762987386435,
0.013976204209029675,
0.008668874390423298,
0.008594303391873837,
0.019631031900644302,
0.05978597700595856,
-0.09534706175327301,
-0.0168492179363966,
-0.04868093878030777,
-0.019707128405570984,
-0.04275013506412506,
0.00431021535769105,
0.06516679376363754,
0.02605534717440605,
-0.02524728886783123,
0.03848367556929588,
0.031038861721754074,
-0.0325910858809948,
0.01771511696279049,
0.002114960690960288,
0.016620023176074028,
0.0056153154000639915,
-0.06934201717376709,
-0.012338798493146896,
0.0037497994489967823,
0.010182326659560204,
-0.03953472897410393,
0.008099284023046494,
-0.014998704195022583,
-0.036377400159835815,
0.02735050953924656,
-0.07337724417448044,
-0.027686821296811104,
-0.015535952523350716,
0.08501110225915909,
-0.007097799796611071,
0.009576365351676941,
-0.011884006671607494,
0.00827679131180048,
0.0032519567757844925,
-0.028447138145565987,
0.021834133192896843,
0.013810028322041035,
0.034081943333148956,
-0.03119775839149952,
-0.029230821877717972,
0.055671561509370804,
0.008818164467811584,
-0.0032674982212483883,
-0.05674528330564499,
-0.036246780306100845,
0.05753035470843315,
-0.01296004094183445,
0.04575857147574425,
0.04998612776398659,
-0.010414192453026772,
-0.004910716321319342,
0.01501429546624422,
0.029730001464486122,
0.017662834376096725,
-0.024971922859549522,
-0.008778865449130535,
0.027345949783921242,
-0.014890954829752445,
-0.06010116636753082,
0.05850214138627052,
0.01941261626780033,
-0.005235284101217985,
-0.008827264420688152,
-0.020197521895170212,
-0.03935066983103752,
0.050315361469984055,
0.024648403748869896,
-0.06153666228055954,
0.017575616016983986,
0.03389149531722069,
-0.037978190928697586,
0.04064549505710602,
-0.021537186577916145,
-0.01653178408741951,
0.028612488880753517,
0.0435311533510685,
-0.023426545783877373,
-0.04353620111942291,
-0.008551407605409622,
-0.0020071552135050297,
0.0012220406206324697,
0.03337660804390907,
0.02560706064105034,
-0.019586285576224327,
-0.002435774775221944,
-0.03673306480050087,
0.014926833100616932,
-0.02818870358169079,
-0.01044168695807457,
-0.016896238550543785,
-0.004419094882905483,
0.01605505868792534,
0.029492732137441635,
0.11229465901851654,
-0.05615155026316643,
0.015461998991668224,
-0.00645740469917655,
-0.0335666760802269,
0.04564155638217926,
0.006297687068581581,
-0.0008421724196523428,
0.007169525604695082,
-0.05222523957490921,
-0.07249448448419571,
0.022209281101822853,
-0.05662243068218231,
-0.004482060670852661,
0.01909838244318962,
0.00812471378594637,
-0.03462640941143036,
0.040547773241996765,
-0.015760425478219986,
0.006339460611343384,
-0.009847503155469894,
-0.0355079285800457,
-0.053066324442625046,
-0.032189659774303436,
0.02020992338657379,
-0.05304890125989914,
0.011047353968024254,
-0.009906155988574028,
0.06569977849721909,
-0.009158460423350334,
0.02256479114294052,
-0.0011461048852652311,
0.07093513011932373,
-0.01919792778789997,
-0.059012025594711304,
0.039728760719299316,
0.0602487251162529,
-0.035034582018852234,
0.04463664069771767,
-0.061774689704179764,
0.034283194690942764,
-0.05836864188313484,
-0.010829761624336243,
-0.01665659248828888,
0.017983870580792427,
0.01702914573252201,
-0.06195627897977829,
0.039852678775787354,
0.04364533722400665,
0.01978261023759842,
0.024161703884601593,
-0.06586199253797531,
0.0022220327518880367,
-0.0012233371380716562,
0.024410104379057884,
-0.016067130491137505,
-0.011702613905072212,
0.008775966241955757,
-0.04844922944903374,
0.023854995146393776,
0.0028279696125537157,
0.028280261904001236,
-0.06094881892204285,
0.04285404086112976,
0.022325677797198296,
0.004815659951418638,
0.032743535935878754,
0.02117197960615158,
0.018508967012166977,
0.06625434011220932,
-0.057399850338697433,
-0.03490153327584267,
0.018699297681450844,
-0.06450005620718002,
-0.011047447100281715,
-0.0653938576579094,
-0.02625264599919319,
0.012931272387504578,
-0.02010926604270935,
-0.03641262277960777,
0.02677544392645359,
-0.010163797996938229,
0.051701560616493225,
0.0009304913110099733,
0.003421788103878498,
-0.06800392270088196,
-0.00843878649175167,
0.012682120315730572,
0.026171889156103134,
-0.026682181283831596,
-0.013193312101066113,
0.009242281317710876,
-0.04428446292877197,
0.01002275850623846,
0.014715786091983318,
0.0323670394718647,
-0.045754894614219666,
-0.02135409601032734,
-0.024739064276218414,
0.02679939940571785,
0.04727928340435028,
-0.007829229347407818,
0.040941331535577774,
0.06075914204120636,
0.008307558484375477,
0.03846641257405281,
0.03234393522143364,
-0.01723567210137844,
-0.0018612530548125505,
0.003968226257711649,
0.05230143666267395,
0.004599845968186855,
-0.02762843854725361,
0.017805829644203186,
0.10796697437763214,
-0.0029129646718502045,
0.027407757937908173,
0.012147814966738224,
0.04814634472131729,
0.014170542359352112,
0.05220242217183113,
0.03352721780538559,
-0.04284296929836273,
0.017672112211585045,
0.004726595710963011,
0.018266474828124046,
-0.017310911789536476,
-0.0005664456402882934,
-0.013971619307994843,
-0.050898585468530655,
0.02613700181245804,
-0.023616723716259003,
0.05660571902990341,
-0.036757275462150574,
0.03649693727493286,
0.01535106636583805,
0.0165006835013628,
0.022458355873823166,
0.024669861420989037,
0.0583675391972065,
0.07447807490825653,
-0.002778958063572645,
0.03969935327768326,
-0.016568122431635857,
-0.04183327779173851,
0.005977581720799208,
0.03464418649673462,
0.017464742064476013,
-0.02289912849664688,
0.00877360813319683,
-0.06337932497262955,
0.017873410135507584,
0.03277431055903435,
0.04492118954658508,
-0.0039534238167107105,
-0.06959564238786697,
-0.004317195154726505,
-0.02178324945271015,
-0.039037588983774185,
-0.04087788984179497,
-0.049708686769008636,
-0.06122109293937683,
-0.052837952971458435,
-0.03739461675286293,
-0.008275388740003109,
-0.04238494113087654,
-0.0025921673513948917,
0.043397415429353714,
-0.009940801188349724,
-0.028517287224531174,
0.010502929799258709,
-0.03339717164635658,
0.03337941691279411,
0.0528329461812973,
-0.06427078694105148,
0.0052791377529501915,
-0.004351709503680468,
0.05953425541520119,
0.011639037169516087,
0.014624219387769699,
0.038658495992422104,
0.01570506952702999,
0.04093393310904503,
-0.11388155817985535,
-0.014453334733843803,
0.02869292162358761,
-0.025280484929680824,
-0.04019559919834137,
-0.010584070347249508,
-0.010139686055481434,
0.05450715869665146,
-0.0149260638281703,
0.012207766063511372,
0.00556404422968626,
-0.009432150982320309,
-0.04415251314640045,
0.026695283129811287,
-0.02963162027299404,
0.010931034572422504,
0.03996796905994415,
-0.038802508264780045,
-0.032818447798490524,
-0.03217582404613495,
-0.051766011863946915,
-0.0030412664636969566,
0.016716504469513893,
0.0038273218087852,
0.026845542713999748,
-0.005859267432242632,
-0.041369274258613586,
-0.06797091662883759,
-0.062295615673065186,
-0.006689595989882946,
0.050375621765851974,
-0.019932515919208527,
0.023944973945617676,
-0.004577989224344492,
-0.040150418877601624,
0.03416132554411888,
-0.02926081232726574,
-0.053685784339904785,
0.07107367366552353,
0.007653097156435251,
0.013147429563105106,
0.05516316741704941,
0.02159845270216465,
-0.0667094811797142,
0.02383922040462494,
0.025274546816945076,
0.028231944888830185,
-0.0756625309586525,
0.025345584377646446,
0.05801975354552269,
-0.03433998301625252,
0.055887866765260696,
-0.05156369134783745,
0.08749130368232727,
0.027102909982204437,
-0.03555280715227127,
-0.04280531033873558,
-0.03633176162838936,
0.010044618509709835,
0.11428328603506088,
0.01619114726781845,
-0.04961960017681122,
0.0057894340716302395,
0.01196050550788641,
-0.015032530762255192,
-0.02982601337134838,
0.001772961113601923,
-0.03038604184985161,
-0.039164986461400986,
-0.03754542022943497,
0.06642042845487595,
0.006178049370646477,
-0.0458354689180851,
-0.0776587575674057,
0.00030778584186919034,
-0.044138967990875244,
0.06480932235717773,
0.04274474456906319,
0.02542838640511036,
0.009637576527893543,
0.024461837485432625,
0.025370463728904724,
0.05163143202662468,
0.07349709421396255,
0.05411634221673012,
0.019317135214805603,
-0.013269015587866306,
0.020327329635620117,
-0.06259229779243469,
0.008810018189251423,
-0.008585421368479729,
0.005811684764921665,
0.06652051955461502,
0.009755201637744904,
-0.021973105147480965,
0.0691489577293396,
0.009505543857812881,
0.009261202067136765,
-0.023011600598692894,
0.11880972981452942,
0.030348295345902443,
-0.025489356368780136,
0.007274280302226543,
0.006955963559448719,
0.027273867279291153,
-0.030003244057297707,
0.10265429317951202,
-0.00785957369953394,
0.02847546711564064,
-0.08867046236991882,
-0.03466571494936943,
0.022172225639224052,
-0.026827514171600342,
-0.07638300955295563,
0.037688419222831726,
-0.03691268339753151,
-0.0010927024995908141,
0.007857122458517551,
0.024489615112543106,
0.00501876138150692,
0.0033212867565453053,
0.02930518053472042,
-0.028627488762140274,
0.03000004030764103,
-0.016126781702041626,
-0.03816044703125954,
-0.026027046144008636,
0.014593337662518024,
-0.00696920370683074,
-0.004480381496250629,
0.011713022366166115,
0.033868301659822464,
-0.0629388689994812,
-0.02417668327689171,
0.015782013535499573,
0.016401374712586403,
0.03066783770918846,
-0.032742321491241455,
0.004181797616183758,
0.049006588757038116,
-0.005685022100806236,
-0.0005523904110305011,
-0.010272789746522903,
0.036959923803806305,
-0.043825216591358185,
-0.045804042369127274,
0.017160365357995033,
0.015984416007995605,
0.04354219138622284,
0.007241488434374332,
0.0112643176689744,
0.008818602189421654,
0.05904761329293251,
-0.01465058047324419,
0.03299731761217117,
-0.0008331167628057301,
-0.009703261777758598,
0.012742701917886734,
-0.04402991384267807,
-0.06044765189290047,
0.012947537004947662,
0.03841673955321312,
-0.0043291752226650715,
-0.031099170446395874,
0.060098521411418915,
0.011759216897189617,
-0.01748340204358101,
0.004157349467277527,
-0.01585177145898342,
0.026000851765275,
0.01739652082324028,
0.042297471314668655,
-0.04755248874425888,
-0.019123010337352753,
0.011939634568989277,
-0.0006539491005241871,
0.030069716274738312,
0.040976569056510925,
-0.01939406804740429,
0.06697188317775726,
-0.009729964658617973,
-0.01235269196331501,
-0.026955386623740196,
-0.03118179738521576,
-0.017160844057798386,
0.003925148397684097,
0.01796906255185604,
0.02263927273452282,
0.003663446754217148,
-0.005566717591136694,
-0.0037763386499136686,
0.039699893444776535,
-0.012084555812180042,
-0.030194668099284172,
-0.02814837545156479,
0.06014746055006981,
-0.04397580400109291,
0.02752739004790783,
0.033295322209596634,
-0.0280381478369236,
0.0010738368146121502,
0.012526579201221466,
-0.022307327017188072,
0.035664983093738556,
0.026921378448605537,
-5.5151046819773434e-33,
-0.006960111204534769,
-0.022347865626215935,
0.05979583039879799,
-0.02260247804224491,
0.02335418201982975,
0.10819359123706818,
-0.013811563141644001,
0.0288003571331501,
-0.016531337052583694,
0.04865140840411186,
-0.02431582845747471,
-0.027788503095507622,
0.018409671261906624,
0.041985731571912766,
-0.04214448481798172,
-0.009327644482254982,
-0.007587549276649952,
-0.007637154310941696,
0.024754691869020462,
0.020053209736943245,
0.005270530004054308,
0.0009903599275276065,
0.0042801122181117535,
-0.004055515863001347,
-0.010257785208523273,
-0.047009970992803574,
0.012691625393927097,
0.03915878385305405,
-0.01675999164581299,
0.00782581977546215,
-0.0024172840639948845,
-0.03418490290641785,
0.0034637227654457092,
-0.014630568213760853,
-0.01857534423470497,
-0.009295073337852955,
0.0008503863937221467,
-0.041236650198698044,
0.06107291206717491,
0.005780056118965149,
-0.04696113243699074,
-0.02973019704222679,
0.03732221573591232,
0.02064412459731102,
0.029041659086942673,
-0.056757599115371704,
-0.017764989286661148,
-0.024028301239013672,
-0.004318574909120798,
-0.08532766252756119,
-0.02308492735028267,
0.004718011245131493,
-0.008801640011370182,
-0.054180607199668884,
0.00021242827642709017,
-0.03156399354338646,
-0.03980633616447449,
-0.02410544641315937,
0.0020678159780800343,
-0.007952099665999413,
-0.07186421751976013,
0.004891876131296158,
-0.005770343821495771,
-0.08805350959300995,
-0.00702705979347229,
-0.019001949578523636,
0.040850069373846054,
0.0025957750622183084,
-0.046067412942647934,
0.017243415117263794,
-0.05589338392019272,
0.016095388680696487,
-0.02804584428668022,
-0.08329620957374573,
0.04169897362589836,
-0.020555121824145317,
-0.00033575977431610227,
-0.03835394233465195,
-0.03174615651369095,
0.07120013982057571,
-0.027309847995638847,
-0.01279302965849638,
-0.07325360178947449,
0.012190040200948715,
-0.019459879025816917,
-0.08058386296033859,
-0.015064220875501633,
0.010561846196651459,
0.02073601447045803,
0.016827546060085297,
0.10398422181606293,
0.00901032704859972,
-0.002219967544078827,
0.00010729526547947899,
0.02996838465332985,
-0.034617334604263306,
0.031076766550540924,
0.030645692721009254,
0.01673276536166668,
0.015676364302635193,
0.0758170560002327,
-0.008346893824636936,
0.025911960750818253,
-0.04758637025952339,
-0.03237581625580788,
0.029412196949124336,
-0.02220132201910019,
0.042524468153715134,
0.011527584865689278,
-0.016958439722657204,
-0.025584092363715172,
0.004141594748944044,
0.011202413588762283,
0.014470997266471386,
-0.05581815540790558,
0.022617876529693604,
0.022737806662917137,
0.03495432063937187,
0.03959310054779053,
0.0658186823129654,
0.05207534506917,
-0.021795153617858887,
0.02206955850124359,
0.050798315554857254,
-0.0449356809258461,
-0.0583515539765358,
0.04052823409438133,
0.024624742567539215,
-0.02531229704618454,
0.013596979901194572,
0.02176062762737274,
0.06350573897361755,
2.971454193811951e-7,
0.05476392060518265,
0.01415091473609209,
-0.04199396073818207,
0.012307925149798393,
0.044831760227680206,
-0.05047710984945297,
-0.012511849403381348,
0.016105851158499718,
0.03644026815891266,
0.004203549586236477,
0.036974236369132996,
0.0008487688028253615,
-0.01061481237411499,
-0.007761721033602953,
-0.002741532400250435,
-0.031701426953077316,
-0.006177340168505907,
-0.042444974184036255,
0.01737215742468834,
-0.04557495191693306,
0.009836522862315178,
0.005360752809792757,
-0.03957708552479744,
-0.06800049543380737,
-0.004385302308946848,
0.01610901579260826,
0.03306692838668823,
-0.027907337993383408,
-0.0153504628688097,
0.026031140238046646,
0.01059752143919468,
0.06023704260587692,
-0.02146952413022518,
0.013328885659575462,
-0.0016609091544523835,
-0.031123563647270203,
0.03297703340649605,
0.05197526514530182,
-0.010578911751508713,
-0.02819005586206913,
-0.018740447238087654,
0.02735835313796997,
0.023982835933566093,
0.0010905007366091013,
-0.006914731580764055,
0.017583243548870087,
-0.059844259172677994,
0.053740400820970535,
-0.004670838825404644,
-0.03847822919487953,
0.0022587256971746683,
0.033325981348752975,
-0.03309881314635277,
0.11232980340719223,
0.0019389827502891421,
0.014978419989347458,
-0.05457235500216484,
0.017131665721535683,
0.019890446215867996,
-0.01903681457042694,
-0.0019208145095035434,
-0.06788629293441772,
-0.004934846423566341,
-0.015387313440442085,
0.01994086615741253,
-0.01298728957772255,
-0.03219655156135559,
2.1400731022721417e-34,
-0.025716383010149002,
-0.0882321149110794,
0.010334930382668972,
-0.01149347610771656,
0.0019334338139742613,
0.013363360427320004,
0.01418174710124731,
0.014237897470593452,
0.028426427394151688,
-0.04001615196466446,
0.04607657343149185
] | {
"ds_index": 73,
"similar_dg_indices": [
700363,
274583,
25554,
1110755,
873197,
768969,
645996,
898727,
125463,
6796,
851303,
510044,
95967,
667614,
792466,
628131,
1111355,
1052177,
26509,
543061
]
} |
A 16-year-old girl is brought to the emergency department by her friends who say that she took a whole bottle of her mom’s medication. They do not know which medication it was she ingested. The patient is slipping in and out of consciousness and is unable to offer any history. Her temperature is 39.6°C (103.2°F), the heart rate is 135/min, the blood pressure is 178/98 mm Hg, and the respiratory rate is 16/min. On physical examination, there is significant muscle rigidity without tremor or clonus. Which of the following is the best course of treatment for this patient? | Dantrolene | {
"A": "Naloxone",
"B": "Dantrolene",
"C": "Fenoldopam",
"D": "Cyproheptadine"
} | step1 | B | [
"year old girl",
"brought",
"emergency department",
"friends",
"took",
"whole bottle",
"moms medication",
"not",
"medication",
"ingested",
"patient",
"slipping",
"out",
"consciousness",
"unable to",
"history",
"temperature",
"heart rate",
"min",
"blood pressure",
"98 mm Hg",
"respiratory rate",
"min",
"physical examination",
"significant muscle",
"tremor",
"clonus",
"following",
"best course",
"treatment",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 16-year-old girl is brought to the emergency department by her friends who say that she took a whole bottle of her mom’s medication. They do not know which medication it was she ingested. The patient is slipping in and out of consciousness and is unable to offer any history. Her temperature is 39.6°C (103.2°F), the heart rate is 135/min, the blood pressure is 178/98 mm Hg, and the respiratory rate is 16/min. On physical examination, there is significant muscle rigidity without tremor or clonus. Which of the following is the best course of treatment for this patient?
Choose one of the following::
A. Naloxone
B. Dantrolene
C. Fenoldopam
D. Cyproheptadine | [
0.025729328393936157,
-0.015587330795824528,
0.047787368297576904,
0.02466006763279438,
0.012355935759842396,
-0.008852573111653328,
-0.06117887794971466,
0.047613468021154404,
0.022635966539382935,
-0.03552846238017082,
0.03865731507539749,
0.008805306628346443,
-0.022281749173998833,
-0.024745531380176544,
0.012395177967846394,
0.020525000989437103,
-0.005150997079908848,
0.007731459569185972,
-0.005526379682123661,
0.01023385114967823,
0.0049217273481190205,
0.014148532412946224,
0.015123668126761913,
-0.005793890915811062,
0.06084181368350983,
-0.008417762815952301,
0.0030636910814791918,
-0.017253000289201736,
0.01260302122682333,
-0.040674325078725815,
-0.04031135514378548,
-0.016961436718702316,
0.006786101032048464,
-0.03358832746744156,
0.0000016114324807858793,
0.025753967463970184,
0.006587781012058258,
-0.020395172759890556,
0.02511514164507389,
-0.09618522226810455,
-0.013466316275298595,
-0.078715980052948,
0.029670797288417816,
0.0034491990227252245,
-0.047440726310014725,
-0.0924309641122818,
0.002034716075286269,
0.05281205475330353,
-0.027773169800639153,
0.007705557160079479,
0.026870666071772575,
0.013476785272359848,
-0.03261883929371834,
0.02777981199324131,
0.03096754103899002,
-0.0815906673669815,
-0.014330891892313957,
-0.006924348883330822,
0.021471256390213966,
0.03955331817269325,
0.018298448994755745,
0.011939449235796928,
-0.022272873669862747,
0.0010462041245773435,
-0.04309029504656792,
0.019778672605752945,
-0.006165556609630585,
-0.05360432341694832,
-0.005840310826897621,
0.00500323623418808,
-0.04972551390528679,
0.05351568013429642,
0.07926325500011444,
0.04468006640672684,
-0.047905683517456055,
0.022388920187950134,
-0.002847963711246848,
-0.03424074128270149,
0.043513018637895584,
-0.015598244033753872,
0.03669555485248566,
0.03584930673241615,
-0.022173017263412476,
0.003220390062779188,
-0.033125679939985275,
-0.023798875510692596,
-0.029738405719399452,
0.024419991299510002,
0.0005339382914826274,
-0.05652347579598427,
-0.04474576562643051,
-0.013280566781759262,
0.022605372592806816,
-0.012380494736135006,
-0.07013613730669022,
0.007161486893892288,
-0.01836850866675377,
-0.03630569577217102,
0.028433917090296745,
-0.06514765322208405,
-0.023100072517991066,
-0.014343715272843838,
0.1018216609954834,
-0.014990377239882946,
-0.0419011116027832,
-0.028591416776180267,
-0.0038578480016440153,
0.027518179267644882,
-0.06618034839630127,
0.07782257348299026,
-0.03962867334485054,
0.02958202175796032,
-0.06610134989023209,
-0.008256333880126476,
0.10386278480291367,
0.0014754763105884194,
0.006108114030212164,
-0.07079137116670609,
0.01833997666835785,
0.08089087903499603,
-0.033176127821207047,
0.06407063454389572,
0.05220730975270271,
0.02008138597011566,
-0.030418992042541504,
0.025441955775022507,
-0.001176742953248322,
0.0045836977660655975,
0.04585584998130798,
0.030728068202733994,
0.004237647633999586,
-0.016805099323391914,
-0.02051127329468727,
-0.0024337233044207096,
0.025888433679938316,
0.0032171050552278757,
0.018635546788573265,
0.03430481255054474,
-0.06971720606088638,
-0.01357972715049982,
0.011064941063523293,
-0.04914779216051102,
0.0523955337703228,
0.04586974158883095,
-0.053775034844875336,
0.010947608388960361,
0.009069971740245819,
0.008072592318058014,
0.015302391722798347,
0.01813778467476368,
-0.0511644221842289,
-0.031431954354047775,
0.024423247203230858,
-0.0051486133597791195,
0.011962803080677986,
0.0014124067965894938,
0.015066900290548801,
0.012025079689919949,
0.0015771040925756097,
-0.011388435028493404,
0.020654531195759773,
-0.015288329683244228,
0.02650451846420765,
0.0016694280784577131,
0.031658727675676346,
0.001018154202029109,
-0.022378545254468918,
0.03906599059700966,
-0.0071570188738405704,
0.0329558290541172,
-0.09199898689985275,
0.008967275731265545,
0.0718718022108078,
0.037453677505254745,
0.005689546931535006,
0.028069082647562027,
-0.03401464596390724,
-0.06424102187156677,
-0.028667401522397995,
-0.07980111986398697,
-0.020749052986502647,
0.016961149871349335,
-0.011301085352897644,
-0.02849183790385723,
0.05402566120028496,
-0.026187241077423096,
-0.025785859674215317,
-0.03367803618311882,
0.011028073728084564,
-0.023354073986411095,
-0.030039433389902115,
-0.023230556398630142,
-0.02426283434033394,
0.0593770407140255,
0.012620537541806698,
0.011229852214455605,
-0.042452093213796616,
0.01734244078397751,
-0.023578982800245285,
0.03232936933636665,
-0.03529805317521095,
0.030451912432909012,
-0.0021313782781362534,
0.07372386753559113,
-0.029228845611214638,
0.037709277123212814,
-0.025826331228017807,
-0.04029436409473419,
0.04156268388032913,
-0.013934665359556675,
-0.05346382036805153,
0.04333053529262543,
0.03417595848441124,
-0.04174211993813515,
0.021686354652047157,
0.0323566272854805,
0.021441565826535225,
-0.008273230865597725,
-0.1263919472694397,
0.01041324157267809,
-0.02179279923439026,
0.024590065702795982,
-0.0230436772108078,
0.023584524169564247,
-0.04528918117284775,
-0.032261595129966736,
0.03376692533493042,
0.012430098839104176,
-0.011954699642956257,
-0.04664019122719765,
0.0547696053981781,
0.012630404904484749,
0.02393883652985096,
-0.039457354694604874,
-0.07591061294078827,
0.002875595586374402,
0.03428613394498825,
-0.0421682670712471,
-0.03419883921742439,
0.03350872918963432,
0.020441265776753426,
-0.07437865436077118,
-0.05824758857488632,
-0.07651270180940628,
0.014675519429147243,
-0.037697646766901016,
0.008792664855718613,
0.04565419629216194,
-0.040330491960048676,
0.025357745587825775,
0.011180947534739971,
-0.02198350615799427,
-0.03388123959302902,
0.011732743121683598,
-0.008978799916803837,
0.030911974608898163,
-0.02473747916519642,
0.0018167661037296057,
-0.015630323439836502,
-0.020710088312625885,
-0.0037398873828351498,
-0.03839000314474106,
0.04602988809347153,
-0.05741485580801964,
-0.05692407488822937,
0.016076384112238884,
0.014141963794827461,
0.05124460533261299,
0.020044704899191856,
0.041994377970695496,
0.01019227970391512,
-0.033988431096076965,
0.05455629527568817,
0.023751771077513695,
-0.03432174772024155,
-0.02626856602728367,
-0.0051523842848837376,
0.028814712539315224,
-0.00806682649999857,
-0.006535484455525875,
0.06641720235347748,
0.0464615561068058,
0.04750896617770195,
0.03774205595254898,
0.021304238587617874,
0.023147357627749443,
-0.08385445177555084,
0.015076737850904465,
0.05025358870625496,
-0.03304772451519966,
0.017098816111683846,
0.03413492441177368,
-0.04422818496823311,
-0.01617659069597721,
-0.02563389204442501,
-0.029245363548398018,
-0.02340104430913925,
0.029435621574521065,
-0.026991399005055428,
0.011391079053282738,
0.057019758969545364,
0.04436187073588371,
0.05103455111384392,
0.00016202898405026644,
-0.019760603085160255,
0.020768247544765472,
0.05242784693837166,
0.011772096157073975,
-0.03966740891337395,
0.011371147818863392,
0.025546403601765633,
-0.011799857951700687,
0.007308125030249357,
-0.05430663377046585,
-0.008611751720309258,
0.03511609137058258,
0.023613864555954933,
-0.07126535475254059,
0.00008240689930971712,
0.0022376705892384052,
0.04161209240555763,
0.036623433232307434,
-0.009892892092466354,
0.0034790984354913235,
-0.015261716209352016,
-0.005661980248987675,
-0.04449355974793434,
-0.01386607438325882,
-0.07117509096860886,
-0.019969969987869263,
-0.004855195991694927,
-0.04995078220963478,
0.02490876242518425,
0.06681184470653534,
0.006270274054259062,
0.010441661812365055,
0.0006592911668121815,
0.015448319725692272,
-0.01782824844121933,
0.06765028834342957,
0.016361813992261887,
-0.037871699780225754,
0.011185212060809135,
0.017729369923472404,
0.013711566105484962,
-0.018904991447925568,
-0.03592603653669357,
0.036966245621442795,
-0.001803496154025197,
0.012399493716657162,
-0.07255285233259201,
0.017831681296229362,
-0.0016787763452157378,
0.005095433909446001,
-0.02041987143456936,
-0.041954804211854935,
0.017427723854780197,
0.006764950696378946,
-0.006612814497202635,
0.004910558927804232,
0.020003395155072212,
0.06836041063070297,
0.04742708057165146,
-0.0008232095278799534,
-0.0037094205617904663,
-0.018716217949986458,
0.012803645804524422,
-0.009134141728281975,
-0.060736674815416336,
0.013670402579009533,
0.0026623562444001436,
0.023821139708161354,
-0.03078235499560833,
0.06588844954967499,
-0.0013080816715955734,
-0.02641749568283558,
0.005499396473169327,
-0.061941877007484436,
-0.08907552063465118,
-0.04455551132559776,
0.027267761528491974,
-0.024440504610538483,
0.0039018942043185234,
-0.024549661204218864,
0.011784080415964127,
-0.0057780202478170395,
0.005259325727820396,
-0.04400084540247917,
0.06148489564657211,
0.017014922574162483,
-0.0013124097604304552,
-0.0324447825551033,
0.019559264183044434,
-0.007671175990253687,
0.03463321179151535,
0.017501188442111015,
0.0891769602894783,
-0.017223043367266655,
-0.007265625521540642,
0.043508131057024,
-0.024683866649866104,
-0.006398453377187252,
0.03605877235531807,
0.01743132993578911,
0.007648761384189129,
-0.00805537961423397,
-0.06437060981988907,
-0.05349452421069145,
0.00858756061643362,
0.011753971688449383,
0.021620050072669983,
-0.04718253016471863,
0.03288757801055908,
0.0044153775088489056,
0.008898215368390083,
-0.0206499844789505,
0.020758338272571564,
-0.000217554290429689,
0.021424055099487305,
-0.07694776356220245,
0.014816260896623135,
-0.023233968764543533,
-0.01761426217854023,
-0.09983377903699875,
-0.05073060467839241,
-0.03742124140262604,
0.011871465481817722,
0.02312043495476246,
-0.005211424082517624,
0.038024380803108215,
0.09116347879171371,
-0.07377003878355026,
0.019747892394661903,
0.016358505934476852,
0.0008106593159027398,
0.03432080149650574,
-0.041215743869543076,
0.022242527455091476,
0.0016333364183083177,
-0.04174640774726868,
0.03702221438288689,
0.014960190281271935,
0.06673649698495865,
-0.004065944813191891,
-0.00017283220950048417,
0.06620863825082779,
0.028452495113015175,
0.04351801052689552,
-0.007215957157313824,
0.11020027101039886,
0.04623224213719368,
-0.024178722873330116,
0.014408750459551811,
0.04137879237532616,
0.07413387298583984,
-0.012798345647752285,
0.02998458594083786,
0.03196949139237404,
0.03520122170448303,
0.02254154160618782,
-0.0294174924492836,
0.007331468164920807,
-0.004439724143594503,
-0.05390062555670738,
-0.00011229931260459125,
0.01169353537261486,
-0.01996920071542263,
-0.01299403514713049,
-0.032721199095249176,
-0.015345272608101368,
-0.05536840483546257,
0.03430590033531189,
-0.022847676649689674,
0.004526956472545862,
0.05204251408576965,
-0.042978595942258835,
-0.03402327001094818,
-0.03867380693554878,
0.02542949840426445,
0.023157771676778793,
-0.031047554686665535,
-0.007779686711728573,
-0.03354860842227936,
0.013779222965240479,
0.010461750440299511,
0.002564139198511839,
0.00685384264215827,
-0.009303848259150982,
0.002490223618224263,
0.007712977938354015,
0.021508967503905296,
-0.047754060477018356,
0.05516902729868889,
0.002488088561221957,
-0.09024496376514435,
-0.08391073346138,
0.008463332429528236,
0.03450937569141388,
0.0022767100017517805,
0.0033907119650393724,
0.06893724948167801,
0.03668169677257538,
0.026553427800536156,
0.013689404353499413,
-0.02740113064646721,
0.03798925131559372,
-0.04284967854619026,
0.02634596824645996,
-0.008410702459514141,
-0.06631923466920853,
-0.0050470768474042416,
0.06285347789525986,
-0.03592155501246452,
-0.017752140760421753,
0.010930013842880726,
0.011760938912630081,
-0.02617490291595459,
-0.056864507496356964,
-0.00006197666516527534,
0.031373124569654465,
0.009621473960578442,
-0.00047061830991879106,
-0.013486988842487335,
0.0005677086883224547,
0.018413720652461052,
0.011643257923424244,
0.010195606388151646,
-0.007988053373992443,
0.009884769096970558,
0.06595909595489502,
-0.01494970079511404,
-0.02544374018907547,
-0.0021477562841027975,
-0.012980031780898571,
-0.010607471689581871,
0.005515023600310087,
-0.016804469749331474,
-0.0020553518552333117,
-0.002874451456591487,
-0.04835653305053711,
0.01969064027070999,
0.011335276067256927,
-0.026634253561496735,
0.004251987207680941,
-0.08625395596027374,
0.04053093492984772,
-0.022530123591423035,
-0.013815069571137428,
0.023838449269533157,
-0.04097236692905426,
-0.020203346386551857,
0.03341156989336014,
0.041474923491477966,
0.002842632122337818,
0.00755190197378397,
-4.76846189440372e-33,
0.05972383916378021,
-0.011461514048278332,
-0.03227259963750839,
-0.03738868981599808,
0.037604790180921555,
0.0415361225605011,
-0.012576168403029442,
0.04651756212115288,
-0.04677873104810715,
0.014701016247272491,
-0.043074361979961395,
-0.0009194915182888508,
0.022221919149160385,
0.03053666092455387,
0.03225082904100418,
-0.0745307058095932,
-0.061765529215335846,
0.030100475996732712,
-0.011242888867855072,
-0.009963740594685078,
-0.0026967760641127825,
0.03844121843576431,
0.06001830846071243,
-0.012484900653362274,
0.02309819683432579,
-0.008994956500828266,
0.030490603297948837,
0.0658586323261261,
-0.03256756439805031,
-0.0019528950797393918,
-0.018278662115335464,
-0.02627885714173317,
0.026436958461999893,
-0.02879689820110798,
-0.021686481311917305,
-0.06318788230419159,
0.010125529021024704,
-0.038189101964235306,
0.03781042993068695,
-0.05241016298532486,
-0.03629167377948761,
-0.024891074746847153,
0.09424721449613571,
0.01235225424170494,
0.0570252500474453,
-0.013695795089006424,
-0.019949205219745636,
-0.010765694081783295,
0.013826851733028889,
-0.004765859805047512,
0.023856261745095253,
0.011922290548682213,
-0.016536444425582886,
-0.02379360981285572,
0.027621543034911156,
-0.04392236843705177,
0.010665598325431347,
0.0030151752289384604,
0.01522261556237936,
-0.03730328381061554,
-0.08425894379615784,
0.04526539519429207,
-0.03937746584415436,
-0.04941042512655258,
-0.028207065537571907,
0.006548978388309479,
0.008293046616017818,
0.028341544792056084,
-0.0651727169752121,
0.01836465299129486,
-0.08014598488807678,
0.07840196043252945,
0.023751460015773773,
-0.05098201334476471,
0.006779505405575037,
-0.01910359412431717,
0.014402426779270172,
-0.025639109313488007,
0.001321289804764092,
0.04417356103658676,
-0.06491918861865997,
0.02167370356619358,
-0.04402097314596176,
-0.03388836234807968,
0.012264680117368698,
0.026469571515917778,
-0.034475117921829224,
0.02674628607928753,
0.005931305233389139,
0.0036863507702946663,
0.014548911713063717,
0.014807785861194134,
0.01599089987576008,
-0.016779908910393715,
0.05056264251470566,
-0.07203073054552078,
0.050414469093084335,
0.05257672816514969,
0.034203577786684036,
-0.02571282722055912,
0.06087566912174225,
0.007222502026706934,
0.05366898700594902,
-0.033745959401130676,
-0.05061372369527817,
0.020253315567970276,
-0.023023327812552452,
0.057260140776634216,
0.06900244206190109,
0.006620024796575308,
0.030045583844184875,
-0.03388366103172302,
0.016419358551502228,
0.026839720085263252,
-0.034701135009527206,
0.023070868104696274,
0.03391880542039871,
0.022501274943351746,
0.028112728148698807,
0.011300037615001202,
0.0028206713031977415,
0.03593479469418526,
0.031389277428388596,
-0.005308058112859726,
-0.023147089406847954,
-0.05239833891391754,
0.035049617290496826,
0.05123992636799812,
-0.006115713156759739,
-0.03486553207039833,
0.04693523049354553,
0.0203262846916914,
2.505007898889744e-7,
0.04209300875663757,
0.011413704603910446,
0.021243205294013023,
-0.045470431447029114,
-0.014811194501817226,
-0.0013361830497160554,
-0.02813180536031723,
0.0344584695994854,
0.02819695696234703,
-0.08550276607275009,
0.039735082536935806,
-0.00831181276589632,
0.014156412333250046,
-0.008002321235835552,
0.03718296065926552,
-0.01921016536653042,
0.02224288135766983,
-0.03253379091620445,
-0.007903761230409145,
-0.07333061844110489,
-0.036952801048755646,
-0.04378068447113037,
-0.013746696524322033,
-0.027816148474812508,
0.008116530254483223,
-0.03642502427101135,
0.005705287214368582,
-0.052227988839149475,
-0.001317767659202218,
-0.0016175463097169995,
0.02031358703970909,
0.06525874882936478,
-0.022492822259664536,
0.002364097163081169,
-0.036086682230234146,
-0.05384033918380737,
0.011991789564490318,
0.07521861791610718,
-0.07384363561868668,
-0.005293387919664383,
0.01739884912967682,
-0.022172264754772186,
0.02625432424247265,
0.017702026292681694,
0.06781522929668427,
0.035532768815755844,
-0.02367541752755642,
0.023223116993904114,
-0.013279583305120468,
0.003947311080992222,
0.04191278666257858,
0.00006648583803325891,
0.013490510173141956,
0.10254228115081787,
-0.017557116225361824,
0.0559786781668663,
-0.012821296229958534,
-0.0072683063335716724,
0.04517678916454315,
-0.043063051998615265,
-0.018714342266321182,
-0.007541766855865717,
0.018328044563531876,
-0.034629665315151215,
0.02685176394879818,
-0.03831373527646065,
-0.023616980761289597,
1.780195851151009e-34,
-0.03444265201687813,
-0.06183470040559769,
0.01858573965728283,
-0.03068181686103344,
0.0010992747265845537,
-0.006040090229362249,
0.05386839061975479,
0.02753310836851597,
-0.0009671165025793016,
-0.08232972770929337,
-0.029014956206083298
] | {
"ds_index": 74,
"similar_dg_indices": [
214259,
169347,
442266,
187081,
235168,
173145,
13627,
749510,
708983,
163511,
1095380,
310263,
671404,
926128,
11337,
275994,
837425,
963229,
513135,
805980
]
} |
A 68-year-old woman is brought to the emergency department because of fever, productive cough, and dyspnea for 3 days. She has had upper back pain for 3 months, which is worse after activity. She takes ibuprofen for pain relief. She has no history of smoking. The temperature is 39.5°C (103.1°F), the blood pressure is 100/70 mm Hg, the pulse is 95/min, and the respirations are 22/min. Lung auscultation shows rales in the left lower lobe area. Painful lymph nodes (1 × 1 cm) are palpated in the left axillary and cervical regions. There is point tenderness along several thoracic vertebrae. Laboratory studies are pending. A skull X-ray and lung window thoracic computed tomography scan are shown. Which of the following disorders most likely played a role in this patient’s acute condition? | Multiple myeloma | {
"A": "Metastatic breast cancer",
"B": "Multiple myeloma",
"C": "Paget’s disease",
"D": "Primary hyperparathyroidism"
} | step2&3 | B | [
"68 year old woman",
"brought",
"emergency department",
"fever",
"productive cough",
"dyspnea",
"3 days",
"upper back pain",
"months",
"worse",
"activity",
"takes ibuprofen",
"pain relief",
"history of smoking",
"temperature",
"blood pressure",
"100 70 mm Hg",
"pulse",
"95 min",
"respirations",
"min",
"Lung auscultation shows rales",
"left lower lobe area",
"Painful lymph nodes",
"1",
"1",
"palpated",
"left axillary",
"cervical regions",
"point tenderness",
"thoracic vertebrae",
"Laboratory studies",
"skull X-ray",
"lung window",
"computed tomography scan",
"shown",
"following disorders",
"likely played",
"role",
"patients acute condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 68-year-old woman is brought to the emergency department because of fever, productive cough, and dyspnea for 3 days. She has had upper back pain for 3 months, which is worse after activity. She takes ibuprofen for pain relief. She has no history of smoking. The temperature is 39.5°C (103.1°F), the blood pressure is 100/70 mm Hg, the pulse is 95/min, and the respirations are 22/min. Lung auscultation shows rales in the left lower lobe area. Painful lymph nodes (1 × 1 cm) are palpated in the left axillary and cervical regions. There is point tenderness along several thoracic vertebrae. Laboratory studies are pending. A skull X-ray and lung window thoracic computed tomography scan are shown. Which of the following disorders most likely played a role in this patient’s acute condition?
Choose one of the following::
A. Metastatic breast cancer
B. Multiple myeloma
C. Paget’s disease
D. Primary hyperparathyroidism | [
0.009251126088202,
-0.02923908270895481,
0.027287792414426804,
0.024587925523519516,
0.03317061811685562,
-0.008829320780932903,
-0.013652452267706394,
0.06800418347120285,
-0.018648484721779823,
-0.03868429362773895,
0.019062772393226624,
0.043562792241573334,
0.03908316791057587,
-0.06694304198026657,
0.018296414986252785,
-0.02827298268675804,
-0.027555642649531364,
0.003306539263576269,
0.03156014531850815,
0.017749058082699776,
-0.03780512511730194,
0.04396543279290199,
0.021036218851804733,
0.019570931792259216,
0.054489392787218094,
-0.032865166664123535,
0.00958141777664423,
-0.0035730923991650343,
0.04062960669398308,
-0.016982369124889374,
-0.0016685723094269633,
-0.056092750281095505,
-0.030726855620741844,
-0.07275918871164322,
0.00000230327691497223,
-0.004981431178748608,
-0.008463271893560886,
-0.015271715819835663,
0.003351170802488923,
-0.039765555411577225,
-0.005497018340975046,
0.025744721293449402,
0.039929721504449844,
-0.02260337956249714,
-0.0657847449183464,
-0.0845172330737114,
-0.018994059413671494,
0.07608210295438766,
-0.04431863874197006,
-0.03132278844714165,
0.027027742937207222,
0.04085589945316315,
-0.025479769334197044,
0.008184208534657955,
0.07841747999191284,
-0.04946049302816391,
-0.021533159539103508,
0.004982739221304655,
0.020117076113820076,
0.009079997427761555,
0.01187495980411768,
0.009534689597785473,
0.0032863228116184473,
-0.007955888286232948,
-0.04785409942269325,
0.051403630524873734,
0.03362882137298584,
-0.003012110013514757,
0.03773631900548935,
0.026671184226870537,
-0.03394179791212082,
-0.030323214828968048,
0.013482177630066872,
0.001144004869274795,
-0.05570556968450546,
-0.07687187194824219,
0.07168268412351608,
-0.018128691241145134,
0.007034465670585632,
-0.015581785701215267,
0.12492948770523071,
0.02752074971795082,
0.01709592342376709,
0.031065816059708595,
0.025875182822346687,
-0.09892411530017853,
-0.048118941485881805,
0.00521556893363595,
0.017778392881155014,
-0.022299783304333687,
-0.013986718840897083,
-0.0700269341468811,
-0.006831004284322262,
0.034815117716789246,
-0.08649503439664841,
0.008556955493986607,
0.012587428092956543,
-0.008603444322943687,
0.03775257617235184,
-0.0752367302775383,
-0.03075818158686161,
-0.06655281037092209,
0.03128835931420326,
0.05165887251496315,
-0.01686199940741062,
-0.03252069279551506,
-0.04393342509865761,
0.022027410566806793,
-0.027039730921387672,
0.02170889638364315,
0.0033219107426702976,
0.018778039142489433,
-0.08473800867795944,
-0.030581219121813774,
0.06486013531684875,
0.013189181685447693,
-0.06263226270675659,
-0.06292830407619476,
0.0315997339785099,
0.04691270738840103,
0.04863537475466728,
0.001336066983640194,
0.011527175083756447,
0.05466488376259804,
0.00591386528685689,
-0.012283842079341412,
-0.002963436534628272,
-0.011197016574442387,
0.00896558165550232,
0.0432298481464386,
0.033402618020772934,
0.0008261218899860978,
-0.013045619241893291,
0.018978320062160492,
0.028202947229146957,
-0.05872540920972824,
-0.020519502460956573,
0.021522294729948044,
0.050660550594329834,
0.017347799614071846,
-0.006423987913876772,
-0.012879591435194016,
-0.007157405838370323,
-0.025192100554704666,
-0.02994692698121071,
0.012680997140705585,
0.026700472459197044,
-0.016777314245700836,
0.0036372896283864975,
0.025186531245708466,
-0.09890394657850266,
-0.05505344271659851,
-0.0593254528939724,
-0.0040687453001737595,
0.01989324390888214,
0.015017472207546234,
-0.0009751144680194557,
-0.05219290032982826,
0.01653897762298584,
-0.036636848002672195,
-0.006005196366459131,
0.01656705141067505,
-0.007877569645643234,
-0.006217263173311949,
-0.021656308323144913,
0.03248927369713783,
-0.02565954253077507,
0.044743116945028305,
-0.031111307442188263,
0.03936631977558136,
-0.06114472821354866,
0.057821307331323624,
0.030054500326514244,
-0.025840260088443756,
-0.03329276293516159,
0.006839874666184187,
-0.010789075866341591,
-0.03779793530702591,
-0.029621094465255737,
-0.013987413607537746,
-0.0006188179831951857,
0.010799333453178406,
0.03944043442606926,
-0.025677744299173355,
0.02989373914897442,
-0.018029306083917618,
0.03284779563546181,
-0.0038501149974763393,
0.0012606377713382244,
-0.06436413526535034,
-0.02604074962437153,
0.04015723988413811,
-0.03849601373076439,
0.05850483477115631,
-0.0232232678681612,
0.023412935435771942,
-0.04864412918686867,
-0.05084557086229324,
-0.010258802212774754,
0.025770079344511032,
-0.039094191044569016,
0.0040449537336826324,
-0.03402700275182724,
0.05260811373591423,
-0.011284416541457176,
0.09994032233953476,
-0.02560267224907875,
-0.01179286278784275,
0.02291978895664215,
0.0030395020730793476,
-0.013468125835061073,
-0.018320243805646896,
0.028814809396862984,
-0.045269813388586044,
-0.0011797751067206264,
0.016447987407445908,
-0.041137225925922394,
0.0011574669042602181,
-0.044859614223241806,
0.0018203859217464924,
-0.028016813099384308,
0.007222985848784447,
0.010973436757922173,
0.010998829267919064,
-0.08410242944955826,
-0.01677006110548973,
-0.014785515144467354,
0.01122216321527958,
-0.0022556765470653772,
-0.06274489313364029,
-0.011742942035198212,
0.0127403624355793,
-0.011941620148718357,
-0.017170174047350883,
-0.09766176342964172,
0.08321058005094528,
-0.037602659314870834,
-0.04107041656970978,
0.013824624009430408,
0.04747045040130615,
-0.05926322191953659,
-0.06133478134870529,
-0.01705615594983101,
-0.0189755130559206,
-0.014685436151921749,
-0.03334200009703636,
0.006962284445762634,
0.02954247035086155,
-0.05699903517961502,
0.06021997332572937,
-0.017711888998746872,
0.025439031422138214,
0.040404364466667175,
-0.0010418996680527925,
-0.0019676988013088703,
0.04058065637946129,
-0.07794471830129623,
-0.009436693042516708,
-0.07409358769655228,
-0.11365772783756256,
0.014400307089090347,
-0.04581567645072937,
0.03839007765054703,
0.00154149963054806,
-0.02818283997476101,
0.06739860773086548,
0.012793097645044327,
-0.021454039961099625,
0.0032776258885860443,
0.00033633247949182987,
-0.03307884931564331,
0.04418176785111427,
0.0508296824991703,
-0.0024951312225311995,
-0.06226525083184242,
-0.014228979125618935,
-0.02352140098810196,
0.051068101078271866,
0.0007180672837421298,
0.01918039470911026,
0.003300204174593091,
0.024566620588302612,
-0.029504571110010147,
0.023300854489207268,
-0.03477086126804352,
-0.012824413366615772,
-0.008079923689365387,
-0.022197149693965912,
0.022777190431952477,
0.05188233032822609,
0.0038205755408853292,
0.05280545726418495,
0.013577117584645748,
-0.016574658453464508,
-0.007377915550023317,
-0.0678403377532959,
-0.052106909453868866,
0.015038699842989445,
0.03440399095416069,
0.05380453169345856,
0.031567271798849106,
0.029339566826820374,
-0.027852218598127365,
0.043654538691043854,
0.01807255484163761,
0.022713035345077515,
0.006321597378700972,
0.004517708905041218,
-0.027546601369976997,
0.060233619064092636,
0.05035457760095596,
0.016638336703181267,
-0.020087620243430138,
0.01927250251173973,
-0.03141922503709793,
-0.011181971058249474,
-0.03658612072467804,
-0.0509565994143486,
0.019294265657663345,
-0.01924971491098404,
-0.019547132775187492,
0.0430205762386322,
-0.019606079906225204,
-0.030476223677396774,
-0.023374302312731743,
-0.04393162205815315,
0.0015900362050160766,
0.011944588273763657,
0.002315536141395569,
-0.01888290047645569,
0.03924073278903961,
-0.01764552854001522,
0.0627344623208046,
0.016584744676947594,
0.009526381269097328,
0.031194550916552544,
-0.02523111365735531,
-0.008625985123217106,
0.024163808673620224,
0.06317605823278427,
0.0048584467731416225,
-0.024479307234287262,
-0.01897997222840786,
0.030463024973869324,
-0.01302951481193304,
0.0034192921593785286,
-0.04257705435156822,
0.03244568780064583,
-0.013090584427118301,
-0.024922531098127365,
-0.06947491317987442,
0.013594185002148151,
0.0011516152881085873,
-0.006437223870307207,
-0.012111416086554527,
-0.03146107867360115,
0.05631197243928909,
0.058485496789216995,
-0.019404763355851173,
0.01986430585384369,
-0.036113888025283813,
0.008121740072965622,
-0.029887020587921143,
0.01303227711468935,
0.002246325835585594,
-0.0495922826230526,
-0.015307221561670303,
-0.016137588769197464,
0.00403963215649128,
-0.01685994677245617,
0.019842661917209625,
-0.018124738708138466,
-0.046783216297626495,
0.03115498274564743,
-0.007799733895808458,
0.04764968156814575,
-0.0352722592651844,
-0.022167308256030083,
-0.02374364249408245,
-0.029223889112472534,
0.035371553152799606,
0.02022051252424717,
-0.009479274041950703,
-0.0013229323085397482,
-0.022060399875044823,
0.05732538178563118,
0.029537949711084366,
0.01630459353327751,
0.03683697432279587,
0.006351296324282885,
-0.03355439752340317,
0.018549703061580658,
0.0637221485376358,
-0.007201130036264658,
-0.03530988097190857,
0.03731490299105644,
-0.02182481810450554,
-0.01139119453728199,
0.07792877405881882,
0.04822684824466705,
0.00009119495371123776,
0.061141397804021835,
0.015016140416264534,
0.04272295907139778,
0.030383635312318802,
-0.027083199471235275,
-0.06730390340089798,
-0.004575642757117748,
-0.004065391141921282,
-0.039575058966875076,
-0.03546326234936714,
-0.0031765198800712824,
0.040495239198207855,
0.04103858023881912,
-0.026787254959344864,
-0.03748243674635887,
0.004713703412562609,
-0.052041567862033844,
-0.0174107626080513,
-0.00850168988108635,
0.04245436564087868,
-0.00032151082996279,
0.0018637105822563171,
-0.06237247586250305,
-0.02136826515197754,
-0.005444462411105633,
0.062463972717523575,
0.03514185547828674,
0.0019345716573297977,
0.03523866832256317,
0.05204237997531891,
-0.08902265131473541,
0.0032593042124062777,
0.09391821920871735,
-0.020709693431854248,
0.0150372926145792,
-0.004694727249443531,
-0.016479793936014175,
-0.005074437242001295,
-0.046195175498723984,
-0.014046275056898594,
-0.043409574776887894,
0.029059998691082,
0.04739147797226906,
0.061318084597587585,
-0.06568508595228195,
0.032516151666641235,
-0.04542524740099907,
-0.051930271089076996,
0.09580523520708084,
0.06329638510942459,
-0.008445989340543747,
-0.0012942482717335224,
0.05768434703350067,
0.030219726264476776,
0.06082277372479439,
0.03951181471347809,
0.014871851541101933,
0.04052004590630531,
-0.006578051019459963,
-0.08378101140260696,
0.008719486184418201,
-0.008873509243130684,
-0.05594534054398537,
0.029814867302775383,
-0.010386276058852673,
-0.03328857570886612,
0.02102777548134327,
0.024700766429305077,
0.06688179075717926,
-0.009184504859149456,
0.034350890666246414,
-0.018473077565431595,
-0.04302583262324333,
0.004561813548207283,
-0.03736284747719765,
0.004767800681293011,
-0.04838873818516731,
-0.016729839146137238,
0.02220861427485943,
0.03213856369256973,
-0.02218315191566944,
-0.031476862728595734,
-0.024806225672364235,
0.006798049435019493,
-0.00933312438428402,
0.08095155656337738,
0.008871047757565975,
0.01612907275557518,
0.00890278723090887,
0.0013399728341028094,
-0.03787850961089134,
-0.0061812554486095905,
0.021939236670732498,
-0.038115035742521286,
0.036943890154361725,
0.023802563548088074,
0.08817700296640396,
0.03648246452212334,
0.00411770585924387,
0.05375940352678299,
-0.015137705020606518,
0.024257861077785492,
-0.03604649752378464,
0.05757191777229309,
0.007617705501616001,
0.04854784905910492,
-0.045581940561532974,
0.012478339485824108,
-0.04786733537912369,
0.030398493632674217,
-0.00931736920028925,
0.02782462351024151,
0.04474431648850441,
0.048539187759160995,
-0.042118173092603683,
-0.0012860881397500634,
-0.00439339829608798,
-0.02080519124865532,
0.03525842726230621,
-0.005373641848564148,
-0.004803969990462065,
-0.010768555104732513,
-0.06071643531322479,
-0.022558650001883507,
0.02339949831366539,
-0.007217027246952057,
0.016202734783291817,
0.05268295109272003,
0.01771405152976513,
0.0008865438867360353,
0.0056742276065051556,
0.01150695700198412,
-0.011884290724992752,
-0.019005045294761658,
-0.031936053186655045,
-0.006237446796149015,
0.01456280518323183,
-0.003278271062299609,
-0.06431234627962112,
0.03406691923737526,
0.0084331464022398,
-0.0025145774707198143,
-0.02772168256342411,
0.02248845063149929,
0.004292485769838095,
-0.04454443231225014,
-0.016016822308301926,
0.028020378202199936,
0.005154498387128115,
-0.05752776563167572,
0.08162106573581696,
-0.003970768768340349,
0.03635093942284584,
0.038100339472293854,
-5.7241086795795e-33,
0.0390569232404232,
-0.05158725753426552,
0.0700259879231453,
-0.023570993915200233,
0.05575339496135712,
0.06880973279476166,
-0.029408708214759827,
-0.04459622874855995,
-0.0835471972823143,
-0.0019425761420279741,
-0.015116269700229168,
-0.03854314982891083,
0.03444388136267662,
0.001286094426177442,
-0.009562542662024498,
-0.023591479286551476,
0.021104685962200165,
-0.011387952603399754,
-0.029039613902568817,
0.0012524263001978397,
0.023558735847473145,
-0.021583175286650658,
0.021063201129436493,
-0.044492315500974655,
0.011505906470119953,
-0.016711397096514702,
0.06347765773534775,
-0.036845698952674866,
0.005776612088084221,
0.00011653558613033965,
-0.006323418579995632,
-0.048290714621543884,
0.04086912423372269,
-0.011013215407729149,
-0.021129658445715904,
-0.04085750877857208,
-0.014361144043505192,
-0.04541120305657387,
0.04181016609072685,
0.03998642787337303,
-0.01535055972635746,
-0.02369067445397377,
0.007663826923817396,
0.021844863891601562,
0.1057666540145874,
-0.015484744682908058,
-0.00945229735225439,
0.0007289562490768731,
-0.0017880781088024378,
-0.03099043108522892,
0.02099531888961792,
0.03401384502649307,
0.04126850515604019,
-0.025609318166971207,
-0.024479275569319725,
-0.041391223669052124,
-0.008512964472174644,
0.05851033702492714,
0.01302388682961464,
-0.01266622357070446,
0.022126633673906326,
0.03373018279671669,
0.032335683703422546,
-0.053168170154094696,
-0.0622846893966198,
-0.016893170773983,
0.04718446359038353,
-0.02483191341161728,
-0.07190366089344025,
0.043005697429180145,
-0.043689899146556854,
0.04973600059747696,
-0.046031441539525986,
-0.03492883965373039,
-0.030133865773677826,
0.01797419972717762,
0.034423649311065674,
0.022030005231499672,
0.026730529963970184,
0.04688481613993645,
0.0008532410720363259,
0.02781347930431366,
-0.033476829528808594,
-0.011819920502603054,
-0.019711894914507866,
-0.00003835005918517709,
0.0250657070428133,
0.016543524339795113,
0.0226181261241436,
0.037691082805395126,
0.05315995216369629,
-0.01615246757864952,
-0.00797199085354805,
-0.012346862815320492,
-0.004052569158375263,
-0.0366542786359787,
0.04178042709827423,
0.027397679165005684,
0.013744950294494629,
0.022953281179070473,
0.04429635778069496,
-0.017907096073031425,
0.011371287517249584,
-0.013032399117946625,
-0.005342213436961174,
0.005629704799503088,
0.00744445389136672,
0.016358742490410805,
0.026489946991205215,
0.015474196523427963,
0.01603805087506771,
-0.002404243918135762,
-0.020425956696271896,
0.035509999841451645,
0.03842838108539581,
0.012940802611410618,
-0.007211427669972181,
0.013987859711050987,
0.019254935905337334,
0.027292771264910698,
0.024350309744477272,
-0.05358082428574562,
-0.0468895323574543,
-0.009982249699532986,
-0.07618644088506699,
-0.03943730518221855,
0.04481721296906471,
0.019433273002505302,
0.05203210562467575,
-0.05967070907354355,
0.02540094591677189,
0.03459295630455017,
3.0170915010785393e-7,
0.03376317024230957,
0.012490861117839813,
0.012359976768493652,
-0.07699181139469147,
0.021428033709526062,
0.004471257328987122,
-0.012179534882307053,
0.03129905089735985,
0.02059248462319374,
0.014279999770224094,
-0.048294465988874435,
0.03720422089099884,
-0.0025723380967974663,
0.015429479070007801,
-0.011943472549319267,
-0.022105926647782326,
-0.024686800315976143,
0.059883564710617065,
0.01843692734837532,
-0.016020070761442184,
-0.003438940504565835,
-0.04234614223241806,
-0.05904103070497513,
-0.01738707907497883,
0.021829824894666672,
0.015425236895680428,
-0.034249819815158844,
-0.09017319977283478,
-0.033886928111314774,
-0.05584321916103363,
0.036286212503910065,
-0.022111760452389717,
0.01024657767266035,
0.03594827651977539,
-0.009559695608913898,
0.014213462360203266,
0.03174380213022232,
0.0506075955927372,
-0.012856394983828068,
-0.02060779556632042,
0.012913189828395844,
-0.08008554577827454,
0.013855591416358948,
0.014777896925807,
0.0017643006285652518,
0.05253323167562485,
-0.045385099947452545,
0.016343707218766212,
-0.014828572981059551,
0.0709637850522995,
-0.02887490950524807,
0.026166878640651703,
0.012088926509022713,
0.006785166449844837,
0.0059269145131111145,
0.03934246674180031,
-0.07043468952178955,
-0.035863615572452545,
0.0017345214728266,
-0.05201306939125061,
0.027449725195765495,
0.004115298390388489,
0.01017056219279766,
-0.0104602612555027,
-0.003618932794779539,
0.01259249821305275,
-0.0341036356985569,
2.174767404776929e-34,
-0.04417063668370247,
-0.03491898998618126,
-0.0348154753446579,
-0.04757806286215782,
-0.058388251811265945,
-0.08285556733608246,
0.05062771588563919,
0.04663359746336937,
0.043397773057222366,
-0.017481762915849686,
-0.05293137952685356
] | {
"ds_index": 75,
"similar_dg_indices": [
188048,
318205,
324901,
7900,
1152686,
14555,
433144,
1065155,
926929,
179800,
247424,
673707,
1101641,
999749,
123086,
750762,
674655,
362485,
296589,
100413
]
} |
A 22-year-old woman presents to the emergency department with a 2-day history of severe blistering. She says that she woke up 2 days ago with a number of painful blisters in her mouth and has since been continuing to develop blisters of her cutaneous skin all over her body and the mucosa of her mouth. She has no past medical history and has never experienced these symptoms before. Physical exam reveals a diffuse vesicular rash with painful, flaccid blisters that separate easily with gentle rubbing. The function of which of the following proteins is most likely disrupted in this patient? | Cadherin | {
"A": "Cadherin",
"B": "Collagen",
"C": "Integrin",
"D": "Keratin"
} | step1 | A | [
"year old woman presents",
"emergency department",
"2-day history",
"severe blistering",
"woke up 2 days",
"number",
"painful blisters",
"mouth",
"since",
"continuing to",
"blisters of",
"cutaneous",
"body",
"the mucosa of",
"mouth",
"past medical history",
"never experienced",
"symptoms",
"Physical exam reveals",
"diffuse vesicular",
"painful",
"flaccid blisters",
"separate easily",
"gentle",
"function",
"following proteins",
"most likely disrupted",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 22-year-old woman presents to the emergency department with a 2-day history of severe blistering. She says that she woke up 2 days ago with a number of painful blisters in her mouth and has since been continuing to develop blisters of her cutaneous skin all over her body and the mucosa of her mouth. She has no past medical history and has never experienced these symptoms before. Physical exam reveals a diffuse vesicular rash with painful, flaccid blisters that separate easily with gentle rubbing. The function of which of the following proteins is most likely disrupted in this patient?
Choose one of the following::
A. Cadherin
B. Collagen
C. Integrin
D. Keratin | [
0.028247006237506866,
-0.09812022745609283,
0.05039465054869652,
-0.013969924300909042,
-0.006705610081553459,
0.013443836942315102,
0.006547530181705952,
0.024706289172172546,
0.04985780641436577,
-0.02581601031124592,
0.04590662941336632,
0.021417897194623947,
0.01691354624927044,
0.023584038019180298,
0.004683491308242083,
0.06642629951238632,
-0.010267588309943676,
0.03234991803765297,
0.002874579979106784,
0.002701393561437726,
0.006125499494373798,
0.010184714570641518,
0.034263864159584045,
0.0313069224357605,
0.020471546798944473,
0.003783407388255,
-0.00865095853805542,
-0.09366126358509064,
0.03405334800481796,
-0.01318809948861599,
-0.02361246384680271,
0.00043884478509426117,
0.024695195257663727,
-0.05550094693899155,
0.0000017509909184809658,
-0.015498438850045204,
-0.03137616440653801,
-0.01701243780553341,
0.010243179276585579,
-0.007806738838553429,
-0.09288111329078674,
-0.08280213922262192,
0.025914937257766724,
0.022376293316483498,
0.022023342549800873,
-0.08963758498430252,
0.008433872833848,
0.0024382953997701406,
-0.048201750963926315,
-0.010773765854537487,
0.012477146461606026,
-0.01509698573499918,
-0.0031011998653411865,
0.04143654927611351,
0.10051214694976807,
-0.052893079817295074,
0.020321764051914215,
-0.0191128458827734,
0.03336112201213837,
-0.04481567442417145,
0.0029329757671803236,
0.003600064432248473,
-0.02509250119328499,
-0.02428419515490532,
0.05988378822803497,
-0.002101519610732794,
0.030039701610803604,
-0.05730360001325607,
0.02159138210117817,
0.006222826428711414,
0.03996667265892029,
-0.04968176782131195,
0.006399241741746664,
0.058676887303590775,
-0.009802662767469883,
0.036661602556705475,
0.0565221793949604,
0.020943060517311096,
0.00753908883780241,
-0.004305647220462561,
0.013187460601329803,
0.04039004445075989,
0.034882478415966034,
0.023692451417446136,
0.004367398098111153,
-0.04995346441864967,
-0.025759076699614525,
-0.05296503007411957,
-0.04424223676323891,
-0.0019089429406449199,
-0.02049735188484192,
-0.043099746108055115,
0.00975167378783226,
0.066221684217453,
-0.06992801278829575,
-0.0327288843691349,
0.01816387102007866,
-0.05792995169758797,
0.06174418330192566,
-0.02679830603301525,
-0.020238423720002174,
-0.030920665711164474,
-0.031417008489370346,
0.0690101832151413,
-0.00972489733248949,
-0.05601229518651962,
-0.013431687839329243,
0.03135425224900246,
0.012588166631758213,
0.05411180853843689,
0.019198916852474213,
0.024864325299859047,
-0.002926208544522524,
0.005062189418822527,
0.08268430829048157,
0.01815764233469963,
-0.01594719849526882,
0.005194509867578745,
0.003528804751113057,
0.058117300271987915,
-0.03827332705259323,
-0.024526702240109444,
-0.012865699827671051,
0.018644889816641808,
-0.041587937623262405,
-0.003973337821662426,
0.024250859394669533,
-0.03668736293911934,
0.004680963233113289,
-0.028391119092702866,
0.014780184254050255,
-0.04371078684926033,
0.004646720364689827,
0.035933736711740494,
0.0006559735047630966,
0.03609897941350937,
0.0038226761389523745,
0.017671115696430206,
-0.01372975017875433,
0.0575333870947361,
-0.04883231222629547,
-0.03582112118601799,
-0.0579647421836853,
-0.025381743907928467,
0.015611161477863789,
0.05634720250964165,
-0.03779785707592964,
0.04654408246278763,
-0.020757175981998444,
0.026775415986776352,
-0.04169174283742905,
-0.01949281245470047,
-0.0030205524526536465,
0.00778735987842083,
0.017962440848350525,
0.013593246228992939,
0.07877955585718155,
-0.04546727240085602,
-0.007563819643110037,
-0.03665102273225784,
0.033018808811903,
-0.07631605118513107,
0.01639355532824993,
-0.041525717824697495,
-0.01878097467124462,
-0.0017340184422209859,
-0.024968797340989113,
0.042437843978405,
0.056621797382831573,
0.02110878750681877,
-0.07695341855287552,
-0.024557072669267654,
-0.005095775239169598,
-0.02972036600112915,
-0.07931850105524063,
0.013501503504812717,
-0.08830790966749191,
-0.010630504228174686,
0.010533060878515244,
0.04350867494940758,
0.015597161836922169,
0.0016864902572706342,
0.07334846258163452,
-0.05576809123158455,
-0.02828824333846569,
0.01986834406852722,
0.052098821848630905,
-0.006110538262873888,
0.02839634194970131,
0.0015015271492302418,
-0.015302898362278938,
0.03256767988204956,
0.03326408937573433,
-0.031607065349817276,
-0.01895902119576931,
0.003606479847803712,
-0.09431108087301254,
-0.027734695002436638,
0.009488598443567753,
-0.03876371681690216,
0.02982691489160061,
-0.002290003001689911,
0.014664994552731514,
0.06440268456935883,
-0.05570549517869949,
0.0365254208445549,
-0.0007938016206026077,
0.004636080004274845,
-0.021914353594183922,
-0.022722825407981873,
-0.0267792921513319,
0.012342367321252823,
0.07467502355575562,
-0.02455000765621662,
0.006818557623773813,
0.01288458053022623,
0.018961716443300247,
0.04434801638126373,
-0.042673781514167786,
-0.01675293780863285,
-0.020471971482038498,
0.011886147782206535,
0.012379630468785763,
-0.030818907544016838,
0.01486467756330967,
0.017527738586068153,
-0.006811658386141062,
0.010598386637866497,
-0.010033641010522842,
-0.04591762274503708,
0.014573612250387669,
0.055321890860795975,
-0.015610483475029469,
-0.010264093987643719,
-0.001043906668201089,
-0.003490311559289694,
0.037608761340379715,
-0.018321380019187927,
-0.015966376289725304,
0.05567546188831329,
-0.016450272873044014,
0.012006807141005993,
-0.059374820441007614,
-0.016280123963952065,
0.027132686227560043,
-0.0148250637575984,
-0.06471671164035797,
0.0029389129485934973,
-0.053185537457466125,
0.015331263653934002,
-0.04780188947916031,
-0.00928774755448103,
0.02925119362771511,
0.043369125574827194,
-0.03170134127140045,
0.024439014494419098,
-0.014988662675023079,
-0.012845082208514214,
-0.03599998354911804,
-0.04698646068572998,
-0.0005640036542899907,
0.013536354526877403,
0.03811829537153244,
-0.021925989538431168,
-0.0828598141670227,
-0.021603526547551155,
-0.03601619973778725,
0.02979113906621933,
-0.037637315690517426,
0.03918350860476494,
-0.004160119686275721,
0.04308529198169708,
0.02537001483142376,
0.03106011264026165,
0.018117768689990044,
-0.01629682071506977,
-0.018821677193045616,
0.05091468617320061,
0.043260615319013596,
-0.00583392009139061,
0.013513387180864811,
-0.003369396086782217,
-0.06635213643312454,
0.04913673177361488,
-0.02704983949661255,
-0.008996227756142616,
0.012495490722358227,
-0.011736225336790085,
0.023289889097213745,
-0.04083381965756416,
-0.023724086582660675,
-0.013926347717642784,
0.008345899172127247,
-0.033759064972400665,
-0.010914616286754608,
-0.033013105392456055,
0.0144383879378438,
-0.0327877551317215,
0.0026492089964449406,
0.04015227034687996,
0.05298329517245293,
0.016008557751774788,
-0.034360166639089584,
-0.00032909962465055287,
-0.04523131251335144,
0.0609612911939621,
-0.02827378548681736,
-0.011924009770154953,
0.005111597944051027,
0.031904514878988266,
0.06984206289052963,
0.02463441714644432,
-0.04993060231208801,
0.009781861677765846,
0.019616350531578064,
-0.004081896506249905,
-0.036628738045692444,
-0.08384864777326584,
0.032740067690610886,
0.02957461029291153,
0.03207077085971832,
0.016825174912810326,
-0.0204409658908844,
-0.03600427880883217,
0.013580083847045898,
0.009686446748673916,
-0.006407477427273989,
0.029016319662332535,
-0.015628483146429062,
-0.007028462365269661,
0.017207589000463486,
-0.028896374627947807,
-0.0034263383131474257,
0.07368069887161255,
0.03993334248661995,
0.04584398493170738,
-0.03733393922448158,
0.00165955675765872,
0.01763926073908806,
0.011809518560767174,
0.04935145378112793,
-0.005628947634249926,
0.05909036472439766,
0.042018380016088486,
0.024632396176457405,
-0.059773605316877365,
-0.005377763416618109,
0.034021731466054916,
-0.04066798463463783,
0.03849940001964569,
-0.04586532711982727,
0.024509768933057785,
0.00801350362598896,
0.0004834831051994115,
-0.032890353351831436,
0.00044577373773790896,
-0.01776294969022274,
0.02987736463546753,
-0.039734333753585815,
-0.03810920566320419,
0.001869512489065528,
0.007271876093000174,
-0.033906709402799606,
0.013400225900113583,
0.050473373383283615,
-0.0029402475338429213,
0.026855777949094772,
0.009673859924077988,
0.027546318247914314,
-0.021302400156855583,
0.029395202174782753,
-0.054024893790483475,
-0.08757541328668594,
0.05609464272856712,
-0.008944838307797909,
-0.03592779114842415,
-0.005798439960926771,
-0.02040139213204384,
-0.04921113699674606,
-0.04480617865920067,
0.05800300091505051,
0.0009026003535836935,
0.03465203568339348,
-0.022127540782094002,
-0.05363871529698372,
-0.02380327507853508,
0.010308900848031044,
0.008401667699217796,
0.07433666288852692,
0.02311711758375168,
-0.0032678295392543077,
-0.028233615681529045,
-0.004181963857263327,
0.003299353877082467,
-0.02899998426437378,
0.012731975875794888,
0.03302254155278206,
-0.01184763666242361,
0.040895719081163406,
0.06453436613082886,
0.01921027898788452,
-0.014234284870326519,
-0.06521127372980118,
0.049381062388420105,
0.0733148604631424,
-0.05329335853457451,
-0.03051283024251461,
-0.016331607475876808,
0.006552450358867645,
0.005284299608319998,
0.008605536073446274,
-0.09020620584487915,
0.01846746914088726,
0.0008711557020433247,
0.03281116113066673,
-0.013399848714470863,
0.006622253451496363,
-0.02903544344007969,
-0.03608744964003563,
-0.06682495772838593,
0.014834566041827202,
-0.04102841019630432,
-0.049330588430166245,
-0.030253997072577477,
0.05775904655456543,
0.024975385516881943,
0.04629964008927345,
-0.03737708553671837,
0.0273089949041605,
0.073835089802742,
-0.01849963329732418,
-0.04701848700642586,
0.015361640602350235,
0.09931227564811707,
-0.05553363263607025,
-0.036014363169670105,
-0.014865399338304996,
-0.007958052679896355,
-0.06245798245072365,
-0.0436720997095108,
0.002384718507528305,
0.038787826895713806,
0.04004204645752907,
0.05105672404170036,
0.011427233926951885,
-0.03195502236485481,
0.025488732382655144,
0.0028143306262791157,
-0.018918605521321297,
0.11014807224273682,
0.03364334627985954,
-0.0025477546732872725,
0.0011027081636711955,
-0.009335922077298164,
0.04520802199840546,
0.009177758358418941,
0.00418309448286891,
-0.03173692524433136,
-0.0261087603867054,
0.0014519813703373075,
-0.06308723986148834,
0.01598900370299816,
-0.004525155294686556,
-0.07354651391506195,
0.016110053285956383,
-0.055679548531770706,
-0.017482493072748184,
-0.013603082858026028,
-0.022772613912820816,
-0.037735629826784134,
-0.08660119026899338,
0.06915707886219025,
-0.013285430148243904,
-0.06654831022024155,
-0.02222428098320961,
0.01663493923842907,
-0.033276259899139404,
-0.019511746242642403,
-0.015552923083305359,
0.05929654464125633,
0.0083251241594553,
0.00923706591129303,
-0.02251937985420227,
-0.033477459102869034,
0.01922650821506977,
0.003088055644184351,
0.03426118940114975,
0.006587844341993332,
-0.050139959901571274,
-0.012531548738479614,
0.03307253122329712,
0.030607720836997032,
-0.011388052254915237,
-0.020053280517458916,
-0.005033464636653662,
0.03942086175084114,
0.056064706295728683,
0.0732293501496315,
0.04979602247476578,
0.02805979549884796,
0.07485383749008179,
-0.020092150196433067,
0.02389773353934288,
-0.019358724355697632,
0.0343920961022377,
0.0017336942255496979,
-0.002244554925709963,
0.005957378074526787,
0.006938546895980835,
0.003137816907837987,
0.000706905615516007,
0.0031136651523411274,
-0.018548477441072464,
-0.0018285262631252408,
0.026762068271636963,
-0.06784030050039291,
-0.025131776928901672,
-0.029573647305369377,
0.019800715148448944,
0.07475905865430832,
0.026797110214829445,
-0.016034618020057678,
-0.022464729845523834,
-0.03520163521170616,
0.001755719305947423,
0.01501479372382164,
0.03807783126831055,
-0.023121783509850502,
-0.016993090510368347,
0.051370229572057724,
0.039853114634752274,
0.0099556315690279,
-0.013313759118318558,
0.002601640997454524,
-0.02810334600508213,
-0.00547566544264555,
-0.05361185967922211,
0.05666819587349892,
-0.04142021760344505,
-0.09874577075242996,
-0.012248796410858631,
0.00965496338903904,
0.016446873545646667,
0.01457956526428461,
0.016904717311263084,
0.05467167869210243,
-0.0802285224199295,
-0.030594931915402412,
0.03796929121017456,
0.006842826958745718,
-0.018618950620293617,
0.06756815314292908,
0.038450274616479874,
0.02030097134411335,
0.07845105975866318,
-5.423967135590153e-33,
0.04488359019160271,
-0.041384972631931305,
0.046259697526693344,
-0.024648023769259453,
-0.01336786150932312,
0.07037404179573059,
-0.01840147376060486,
-0.03263165056705475,
-0.03242229297757149,
0.03057480975985527,
0.00038154449430294335,
-0.021731149405241013,
0.002464689314365387,
0.009792447090148926,
0.036288194358348846,
-0.041152969002723694,
-0.013073287904262543,
0.016251498833298683,
-0.06139243766665459,
-0.011433581821620464,
-0.0054299430921673775,
-0.003805757500231266,
-0.007797276601195335,
0.005476995371282101,
-0.058551955968141556,
-0.021726075559854507,
0.052513692528009415,
-0.008151737041771412,
0.00231223925948143,
0.022254319861531258,
0.031088123098015785,
-0.0471775196492672,
-0.021968983113765717,
-0.0045347861014306545,
0.001117170206271112,
-0.04052837938070297,
0.026629740372300148,
0.007706189528107643,
-0.0157871562987566,
0.016635039821267128,
-0.10001441836357117,
-0.008663907647132874,
-0.02032449096441269,
-0.004852280952036381,
0.0029555519577115774,
-0.012326438911259174,
-0.011062350124120712,
-0.00712728314101696,
-0.016377320513129234,
0.07036644965410233,
-0.04402298852801323,
0.018332790583372116,
0.03826448693871498,
0.013118504546582699,
0.021848537027835846,
-0.004696270450949669,
0.009058436378836632,
0.01724616438150406,
-0.039340462535619736,
0.02189905196428299,
0.003929407335817814,
-0.03371058776974678,
-0.05763152241706848,
-0.04001797363162041,
-0.028102874755859375,
0.024934940040111542,
0.023207347840070724,
0.03683346137404442,
0.008505378849804401,
0.04215070977807045,
-0.08153125643730164,
0.07371127605438232,
-0.01463710330426693,
-0.04648962989449501,
-0.01843898370862007,
0.0019480999326333404,
0.027641458436846733,
0.02499067410826683,
-0.020673789083957672,
-0.01255280151963234,
-0.036775656044483185,
-0.017412960529327393,
0.029911398887634277,
0.014767867513000965,
0.0017295507714152336,
0.07138282060623169,
0.01233559101819992,
-0.04212085157632828,
-0.0016303473385050893,
-0.0555340051651001,
0.034506428986787796,
0.028339611366391182,
-0.007115555927157402,
-0.004724218975752592,
0.007874079048633575,
-0.016887418925762177,
0.04783583804965019,
-0.008446576073765755,
-0.021982310339808464,
-0.05786464735865593,
0.0028853644616901875,
0.05446372181177139,
-0.0015351001638919115,
-0.06810978055000305,
-0.05088274925947189,
-0.0059711504727602005,
-0.044346991926431656,
-0.030001910403370857,
-0.027320941910147667,
-0.021197937428951263,
0.00017738062888383865,
0.009876878932118416,
-0.01489152479916811,
0.07422273606061935,
0.03450603783130646,
-0.006342875771224499,
0.016405586153268814,
0.011820790357887745,
0.039101433008909225,
0.05832068249583244,
0.09396553039550781,
-0.004637981299310923,
0.022425370290875435,
-0.03424788638949394,
-0.025450754910707474,
-0.0769551694393158,
0.030156945809721947,
0.06412481516599655,
-0.010720660910010338,
0.009621551260352135,
0.042693596333265305,
0.04675471782684326,
2.551726367983065e-7,
0.02641318365931511,
0.021649770438671112,
-0.05109946429729462,
-0.04382091760635376,
0.023768538609147072,
-0.011051409877836704,
0.021749449893832207,
-0.0007452273275703192,
-0.009869877249002457,
-0.03107709251344204,
0.04093024507164955,
-0.03343727067112923,
-0.0048909555189311504,
-0.03799604997038841,
0.03352656960487366,
0.015661191195249557,
-0.033899884670972824,
-0.00042208380182273686,
0.026392951607704163,
0.026508348062634468,
-0.015323772095143795,
-0.017852354794740677,
-0.053530868142843246,
-0.0026461537927389145,
0.06586483865976334,
-0.003934859298169613,
0.005520174279808998,
-0.022874338552355766,
-0.026803456246852875,
-0.007814237847924232,
-0.016847461462020874,
0.013450957834720612,
0.032413095235824585,
0.07738851755857468,
-0.037687674164772034,
-0.022271856665611267,
-0.0008265196811407804,
0.018701929599046707,
0.07571234554052353,
0.09106791764497757,
0.009085845202207565,
0.05541367083787918,
0.018462006002664566,
0.024095142260193825,
-0.05678602680563927,
0.0041808574460446835,
-0.05926350876688957,
0.05796957388520241,
0.017795585095882416,
0.014305134303867817,
0.01140862237662077,
0.04453365504741669,
-0.013127622194588184,
0.04351549968123436,
0.007135306019335985,
-0.02165847271680832,
-0.013165430165827274,
0.05371679738163948,
0.02307792194187641,
-0.004141746088862419,
-0.007273760158568621,
-0.0014201430603861809,
-0.011646467261016369,
-0.024232978001236916,
0.018406009301543236,
-0.058331724256277084,
-0.048813145607709885,
1.9768518086518804e-34,
-0.002017966704443097,
-0.06452053040266037,
0.00994377676397562,
0.0023953223135322332,
-0.02153712511062622,
-0.0351477786898613,
-0.010048115625977516,
0.0397721529006958,
-0.08425235003232956,
-0.05270091071724892,
-0.008388914167881012
] | {
"ds_index": 76,
"similar_dg_indices": [
967417,
290866,
370476,
387981,
693962,
1005070,
160238,
999337,
1148902,
1000314,
344551,
1085700,
839951,
696737,
232975,
931466,
1050413,
508040,
660312,
704353
]
} |
A 3-week-old boy is brought to the emergency department by his parents because of a 3-day history of progressive lethargy and difficulty feeding. He was born at term and did not have difficulty feeding previously. His temperature is 39.4°C (103°F), pulse is 220/min, respirations are 45/min, and blood pressure is 50/30 mm Hg. Pulse oximetry on 100% oxygen shows an oxygen saturation of 97%. Examination shows dry mucous membranes, delayed capillary refill time, and cool skin with poor turgor. Despite multiple attempts by the nursing staff, they are unable to establish peripheral intravenous access. Which of the following is the most appropriate next step in management? | Intraosseous cannulation | {
"A": "Intramuscular epinephrine",
"B": "Internal jugular vein cannulation",
"C": "Intraosseous cannulation",
"D": "Ultrasound-guided antecubital vein cannulation"
} | step2&3 | C | [
"3 week old boy",
"brought",
"emergency department",
"parents",
"3-day history",
"progressive lethargy",
"difficulty feeding",
"born",
"term",
"not",
"difficulty feeding",
"temperature",
"4C",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"50 30 mm Hg",
"Pulse oximetry",
"100",
"oxygen shows",
"oxygen saturation",
"97",
"Examination shows dry mucous membranes",
"delayed capillary refill time",
"cool skin",
"poor turgor",
"multiple attempts",
"nursing staff",
"unable to establish peripheral intravenous access",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 3-week-old boy is brought to the emergency department by his parents because of a 3-day history of progressive lethargy and difficulty feeding. He was born at term and did not have difficulty feeding previously. His temperature is 39.4°C (103°F), pulse is 220/min, respirations are 45/min, and blood pressure is 50/30 mm Hg. Pulse oximetry on 100% oxygen shows an oxygen saturation of 97%. Examination shows dry mucous membranes, delayed capillary refill time, and cool skin with poor turgor. Despite multiple attempts by the nursing staff, they are unable to establish peripheral intravenous access. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Intramuscular epinephrine
B. Internal jugular vein cannulation
C. Intraosseous cannulation
D. Ultrasound-guided antecubital vein cannulation | [
0.05563703551888466,
-0.08989731222391129,
0.03464110568165779,
-0.026233932003378868,
-0.026111921295523643,
0.0007686486351303756,
-0.021301234140992165,
0.03370122238993645,
-0.032459840178489685,
-0.046184640377759933,
0.030894499272108078,
-0.0316874198615551,
0.06150480732321739,
0.009404070675373077,
-0.010851718485355377,
-0.0017889653099700809,
0.009940147399902344,
-0.03965560346841812,
-0.0063523282296955585,
0.007628166116774082,
-0.008770843036472797,
0.07166532427072525,
-0.00011514883226482198,
-0.009292792528867722,
0.024911321699619293,
-0.0023248407524079084,
-0.008744736202061176,
-0.017676347866654396,
-0.027102306485176086,
-0.08546977490186691,
0.01003098115324974,
0.00009300933015765622,
-0.016325585544109344,
-0.04643409326672554,
0.0000020970999230485177,
0.024719100445508957,
0.010378418490290642,
-0.0009596920572221279,
0.0026152352802455425,
-0.07113752514123917,
0.014406559988856316,
-0.11807293444871902,
0.06082835793495178,
0.008121815510094166,
-0.035947464406490326,
-0.05684614181518555,
0.042354073375463486,
0.06524942070245743,
-0.03173179179430008,
-0.021260792389512062,
0.007527552545070648,
0.08494260907173157,
-0.010541087947785854,
0.0036953287199139595,
0.015730731189250946,
-0.07586316764354706,
-0.043654195964336395,
0.000039915190427564085,
0.07286396622657776,
-0.010379987768828869,
-0.009330624714493752,
0.03288540616631508,
0.039270106703042984,
0.023187624290585518,
0.007831192575395107,
0.010009960271418095,
-0.014568525366485119,
-0.056709568947553635,
-0.01943742297589779,
-0.0032961999531835318,
-0.03389371559023857,
0.031080132350325584,
0.01840388774871826,
0.028446299955248833,
-0.06222838535904884,
-0.01748354360461235,
0.04955339804291725,
-0.036162540316581726,
-0.029415179044008255,
0.00253833900205791,
0.060108304023742676,
0.03808201104402542,
-0.03201327100396156,
0.06525076180696487,
-0.022427303716540337,
-0.04383835941553116,
0.012862233445048332,
-0.02500644139945507,
0.0037370999343693256,
0.029825586825609207,
-0.01039107795804739,
-0.03612755984067917,
0.00678446376696229,
-0.030062653124332428,
-0.044625476002693176,
0.02799910120666027,
-0.03295069560408592,
0.025600377470254898,
0.0038819340988993645,
-0.04184361547231674,
-0.01670488342642784,
-0.06406361609697342,
0.031808193773031235,
0.007338258903473616,
0.011651208624243736,
-0.08349309861660004,
-0.013645422644913197,
-0.009214532561600208,
-0.034920115023851395,
0.04103055223822594,
0.0008354573510587215,
0.0149300005286932,
-0.03278719633817673,
0.006074591539800167,
0.03265387564897537,
0.001959343673661351,
0.02323092147707939,
-0.062251437455415726,
0.009692776948213577,
0.024050947278738022,
0.02640274353325367,
0.02498599886894226,
0.034991469234228134,
0.009926398284733295,
-0.06702958047389984,
-0.0035531246103346348,
0.040760863572359085,
0.0422712117433548,
-0.02193247340619564,
0.034176673740148544,
0.00024543487234041095,
-0.0357065424323082,
-0.021331822499632835,
0.01406848058104515,
0.013340271078050137,
-0.011539722792804241,
0.019992370158433914,
0.011511300690472126,
-0.04394327104091644,
0.01764790341258049,
0.004410879220813513,
-0.04475888982415199,
0.019761139526963234,
0.04984869062900543,
-0.05108901858329773,
0.003600209252908826,
0.036054350435733795,
-0.035560570657253265,
0.008360887877643108,
0.04299980401992798,
-0.02177250012755394,
-0.07645441591739655,
-0.035064056515693665,
-0.00841051060706377,
-0.014055845327675343,
0.02453293278813362,
0.03897073119878769,
-0.026632528752088547,
0.008337745442986488,
-0.08474715799093246,
0.004927434492856264,
-0.023377105593681335,
0.02805476076900959,
-0.018952617421746254,
0.013179521076381207,
0.039426546543836594,
0.013983442448079586,
0.06611732393503189,
-0.05362002179026604,
0.021475771442055702,
-0.027563266456127167,
0.05792460963129997,
0.034360237419605255,
-0.03205685317516327,
0.01789124868810177,
-0.003564760321751237,
-0.06492301821708679,
-0.11673294752836227,
-0.0035102227702736855,
-0.011047424748539925,
0.019961237907409668,
0.022428316995501518,
0.014625119045376778,
0.011452789418399334,
0.042757004499435425,
-0.02597217634320259,
0.044238340109586716,
-0.015645558014512062,
-0.056400541216135025,
-0.037247877568006516,
-0.028077473863959312,
0.00010319654393242672,
-0.038527555763721466,
0.040474649518728256,
0.004413721617311239,
0.032286036759614944,
-0.01730758510529995,
-0.024594761431217194,
-0.0005443234695121646,
0.05487978085875511,
-0.0045427847653627396,
-0.02948695421218872,
-0.04174722731113434,
0.04265700653195381,
-0.028426626697182655,
0.06695133447647095,
-0.015107695013284683,
0.01785256154835224,
0.023518461734056473,
-0.009164463728666306,
-0.02538134530186653,
-0.00298289000056684,
-0.0028632301837205887,
-0.01490468718111515,
-0.010284634307026863,
0.002408420667052269,
-0.008406052365899086,
0.04854699969291687,
-0.05133320763707161,
0.036525338888168335,
-0.044933341443538666,
0.014537287876009941,
0.012804096564650536,
0.03405851125717163,
-0.04976946860551834,
-0.006050864700227976,
0.0371994748711586,
0.03322363272309303,
-0.005287144333124161,
-0.044512927532196045,
0.05186094343662262,
0.014881283044815063,
0.005165239330381155,
0.018810968846082687,
-0.018067272379994392,
0.011831514537334442,
-0.014416024088859558,
-0.03620580583810806,
0.01373914536088705,
0.03907803073525429,
-0.08085238188505173,
-0.01935802586376667,
-0.05096128210425377,
-0.047397878021001816,
-0.0275067500770092,
-0.023774858564138412,
0.021985473111271858,
0.0399198904633522,
-0.03345758840441704,
0.02385859005153179,
-0.0076395682990550995,
-0.0030727365519851446,
-0.07277174293994904,
-0.0037851035594940186,
0.024078186601400375,
0.01635145954787731,
0.028797054663300514,
-0.018439460545778275,
-0.00886603631079197,
-0.00446745939552784,
-0.038122083991765976,
-0.027796713635325432,
0.038224026560783386,
-0.06639204919338226,
0.0008957829559221864,
-0.0276932530105114,
0.02480020374059677,
0.004591501783579588,
0.007786869537085295,
0.06400991976261139,
0.037721164524555206,
0.013795323669910431,
0.03352824226021767,
0.026971792802214622,
-0.005009484011679888,
-0.006595547776669264,
-0.025854909792542458,
0.01414935290813446,
-0.004537418484687805,
-0.01359818410128355,
0.030208546668291092,
0.03247629478573799,
0.010001213289797306,
0.03552381321787834,
0.004269561264663935,
0.024534236639738083,
-0.025028733536601067,
-0.00042384673724882305,
0.05912451073527336,
-0.06300871819257736,
-0.014461581595242023,
0.035928964614868164,
-0.02047785557806492,
-0.0008611329831182957,
0.021240446716547012,
-0.0734553411602974,
-0.04207853600382805,
-0.0060914964415133,
0.004377186298370361,
0.03345045819878578,
-0.02099771238863468,
0.013743760995566845,
0.012750264257192612,
0.013983772136271,
-0.0051208846271038055,
0.016918549314141273,
0.08898375928401947,
0.0035179604310542345,
-0.037468090653419495,
0.06157886981964111,
0.03804396092891693,
-0.03210412710905075,
0.005677154287695885,
0.04142646864056587,
-0.00113258371129632,
-0.009770331904292107,
-0.008379251696169376,
-0.05838990584015846,
0.0157626923173666,
0.039617087692022324,
0.04730783402919769,
-0.03258064389228821,
-0.01775832660496235,
-0.03989842161536217,
0.0023825615644454956,
-0.043462757021188736,
-0.07705653458833694,
-0.06284891813993454,
-0.03708885982632637,
-0.0695018544793129,
-0.014573187567293644,
-0.00807693786919117,
-0.03693260997533798,
0.021310430020093918,
0.049245934933423996,
-0.013159622438251972,
0.01808103546500206,
-0.010138755664229393,
-0.024326739832758904,
0.0617547370493412,
0.03892286866903305,
-0.08143647015094757,
-0.01271055918186903,
0.007343835197389126,
0.02431683987379074,
-0.022321762517094612,
-0.03591740503907204,
0.004335066769272089,
-0.013500805012881756,
0.010670364834368229,
-0.06863030791282654,
0.007817317731678486,
0.007179717533290386,
-0.036982644349336624,
-0.022309260442852974,
-0.022962631657719612,
-0.041256774216890335,
0.02420583739876747,
0.01970546878874302,
0.03712495416402817,
0.03653784841299057,
0.04452463611960411,
-0.015290163457393646,
0.008081994019448757,
0.0000954941933741793,
0.019976045936346054,
-0.012480592355132103,
-0.017862020060420036,
-0.03195006772875786,
-0.006675952114164829,
0.01387201901525259,
0.02113923244178295,
-0.036517221480607986,
0.0027339314110577106,
0.0049207089468836784,
0.0051914700306952,
-0.021951286122202873,
-0.041527580469846725,
-0.07003194093704224,
-0.01822262816131115,
0.0030690920539200306,
-0.010693824850022793,
0.03800496831536293,
-0.004059761296957731,
0.04002539813518524,
-0.018927915021777153,
-0.005812867544591427,
-0.046202078461647034,
0.08471280336380005,
0.060000378638505936,
-0.02903989516198635,
0.008965767920017242,
-0.028017915785312653,
-0.03876729682087898,
0.001257925876416266,
0.055275604128837585,
0.08837835490703583,
-0.042608827352523804,
-0.03429238498210907,
0.08109310269355774,
-0.0028178717475384474,
0.0576217919588089,
-0.004054110497236252,
0.030965538695454597,
0.037361204624176025,
-0.028169238939881325,
-0.05442207306623459,
-0.031875401735305786,
0.05521010980010033,
0.08959976583719254,
0.02967035584151745,
-0.0008253070409409702,
-0.005299079697579145,
-0.032150998711586,
-0.019996313378214836,
-0.07148326188325882,
0.04316733032464981,
-0.01141774095594883,
-0.015968283638358116,
-0.07974054664373398,
0.0018713041208684444,
-0.009871196933090687,
-0.03603525459766388,
-0.06185897812247276,
0.0001794182026060298,
-0.043225664645433426,
0.043192308396101,
0.04292595759034157,
0.0057980772107839584,
0.017056653276085854,
0.019015781581401825,
-0.03992203623056412,
0.039301492273807526,
-0.0016736022662371397,
0.019105922430753708,
-0.005376340355724096,
-0.0036845391150563955,
0.004166006576269865,
-0.011219688691198826,
-0.005928840022534132,
0.015038751997053623,
-0.006423864047974348,
0.06493043154478073,
0.030885104089975357,
0.056041840463876724,
0.023447047919034958,
0.023029157891869545,
0.05184665694832802,
0.012506231665611267,
0.07385843247175217,
-0.02067321166396141,
-0.05561085417866707,
0.004073916468769312,
0.010847808793187141,
0.010028149001300335,
-0.018819350749254227,
0.025016166269779205,
0.08063868433237076,
0.061578523367643356,
-0.02640848606824875,
-0.040568120777606964,
0.013152260333299637,
-0.03722507506608963,
-0.022899627685546875,
0.07494999468326569,
-0.03693906590342522,
-0.0056343721225857735,
0.04293569549918175,
0.014100811444222927,
-0.021593894809484482,
-0.02339146099984646,
0.031245728954672813,
-0.0013555001933127642,
0.013077186420559883,
0.050441924482584,
-0.02906760759651661,
-0.0028802407905459404,
0.03365909308195114,
-0.0037638447247445583,
0.005822656210511923,
-0.023706208914518356,
0.02944505400955677,
-0.05915813520550728,
-0.07549706101417542,
-0.006273673381656408,
-0.01849205605685711,
0.022861042991280556,
-0.014616498723626137,
-0.05366956815123558,
0.06987845152616501,
0.015037652105093002,
0.04260127991437912,
0.0008224488119594753,
-0.05198625847697258,
-0.08008594810962677,
-0.022659417241811752,
-0.028163501992821693,
0.07149423658847809,
0.03107941895723343,
0.01878073439002037,
0.040393244475126266,
0.044438306242227554,
0.03691478818655014,
-0.014487751759588718,
-0.02650800533592701,
0.03683600574731827,
-0.030716413632035255,
0.028725245967507362,
-0.04366268962621689,
-0.06623740494251251,
0.0009068243089132011,
0.015540113672614098,
-0.02121552638709545,
0.04427717253565788,
0.02516927570104599,
0.023711685091257095,
-0.08534211665391922,
-0.024228569120168686,
-0.03607368469238281,
0.05235186219215393,
-0.007101827766746283,
0.03595304861664772,
-0.008627152070403099,
-0.02767270803451538,
0.010808385908603668,
0.019557295367121696,
0.007273774594068527,
0.03766936436295509,
0.013232279568910599,
0.03639597073197365,
-0.03578714653849602,
0.010029573924839497,
-0.0113937146961689,
-0.003609521547332406,
0.015672700479626656,
-0.007624143734574318,
0.03595145419239998,
-0.013375889509916306,
-0.0068114460445940495,
-0.007725296076387167,
-0.009113039821386337,
0.027386069297790527,
-0.031195230782032013,
0.005257864017039537,
-0.05791260302066803,
0.05787024274468422,
-0.015509252436459064,
-0.04350863769650459,
0.0480867363512516,
0.006314592435956001,
-0.0013298639096319675,
0.05680563300848007,
-0.0016348338685929775,
0.01653437316417694,
0.0243337731808424,
-5.646641765150388e-33,
0.0311263520270586,
-0.01147251296788454,
0.00770681444555521,
-0.019497692584991455,
0.021214084699749947,
0.10673408210277557,
0.015796935185790062,
0.025889048352837563,
-0.055155668407678604,
-0.011342881247401237,
-0.04965555667877197,
-0.031995080411434174,
0.027793630957603455,
0.026742203161120415,
0.024593211710453033,
-0.04485310614109039,
-0.020272282883524895,
0.03176715970039368,
-0.008661559782922268,
0.014010058715939522,
-0.027941130101680756,
-0.001627977006137371,
0.0260220505297184,
0.014104963280260563,
-0.003058617701753974,
-0.08317644149065018,
0.04847826436161995,
0.012866238132119179,
0.009946353733539581,
0.021654069423675537,
0.02278265170753002,
-0.09520740061998367,
0.03684692084789276,
-0.005791306495666504,
-0.03909638524055481,
-0.028730403631925583,
-0.009713483043015003,
0.013563078828155994,
0.021884996443986893,
-0.053525518625974655,
-0.09042460471391678,
0.00843380019068718,
0.07725642621517181,
0.019230175763368607,
0.07410561293363571,
-0.03159794211387634,
-0.05643095448613167,
-0.005364120937883854,
-0.0043800403364002705,
0.004745503421872854,
0.013800772838294506,
0.0680558979511261,
-0.014710311777889729,
-0.05714689940214157,
0.027263188734650612,
-0.005275345873087645,
0.015336220152676105,
-0.05877542495727539,
0.0035373084247112274,
-0.04609936103224754,
-0.022571738809347153,
0.009198111481964588,
-0.037818171083927155,
-0.0731486901640892,
-0.07519593089818954,
0.002342830179259181,
0.020477380603551865,
0.07729751616716385,
-0.06414307653903961,
0.07384752482175827,
-0.03806838393211365,
0.014629358425736427,
0.0203566737473011,
-0.0807926207780838,
-0.04354916512966156,
-0.023639949038624763,
0.018395928665995598,
0.0280203428119421,
-0.03159414976835251,
0.06271255016326904,
-0.044155314564704895,
-0.006955723278224468,
-0.03852975741028786,
-0.005510649643838406,
-0.0524560771882534,
-0.01843647100031376,
-0.011733826249837875,
-0.01693459041416645,
0.04454067349433899,
-0.02986009046435356,
0.06269185990095139,
-0.008568836376070976,
0.037193868309259415,
0.03529844433069229,
0.030177125707268715,
-0.04291357845067978,
0.06918121129274368,
0.07234518229961395,
-0.013119017705321312,
-0.014296703040599823,
0.010065289214253426,
-0.011389914900064468,
0.035401709377765656,
-0.009169281460344791,
-0.0047630006447434425,
-0.003733861492946744,
-0.049997929483652115,
-0.0005670692771673203,
0.026597455143928528,
-0.013700105249881744,
0.04615171626210213,
-0.015138985589146614,
-0.01269742101430893,
0.04604920744895935,
-0.005400023423135281,
0.03200668841600418,
0.0351923443377018,
0.025264397263526917,
0.018465764820575714,
-0.030317069962620735,
-0.03155367448925972,
0.04942856356501579,
0.004389035049825907,
0.017320940271019936,
-0.008358517661690712,
-0.02165876515209675,
0.010627714917063713,
0.04229199141263962,
-0.02256122976541519,
0.009529060684144497,
0.04392244666814804,
0.031475797295570374,
2.8702334020636044e-7,
0.049806807190179825,
0.01649359054863453,
-0.010818339884281158,
-0.07167346775531769,
-0.018796497955918312,
-0.05310792475938797,
-0.029880858957767487,
0.011627303436398506,
0.0033517919946461916,
-0.061326764523983,
0.06967209279537201,
-0.01205599494278431,
-0.014042836613953114,
0.020008256658911705,
-0.025403091683983803,
-0.07570041716098785,
0.029481319710612297,
0.037455715239048004,
0.03405467048287392,
-0.050289932638406754,
0.014007335528731346,
-0.03446882218122482,
-0.04898900166153908,
-0.01460381131619215,
-0.019083067774772644,
-0.015501960180699825,
0.04540209844708443,
-0.016292739659547806,
0.008643195964396,
0.006774320732802153,
0.00925943162292242,
0.04499608278274536,
0.049019090831279755,
0.010987306013703346,
-0.030835136771202087,
0.007439770270138979,
0.014098222367465496,
0.04932677000761032,
-0.03807147592306137,
-0.004433288238942623,
-0.001028618193231523,
0.04347766563296318,
0.0014295823639258742,
-0.021666208282113075,
0.0020864771213382483,
0.013138238340616226,
-0.011281966231763363,
0.013192570768296719,
0.0691259503364563,
0.030710967257618904,
0.027523592114448547,
0.013083952479064465,
0.006497844122350216,
0.0665854960680008,
-0.02036149613559246,
-0.005688043311238289,
-0.030978597700595856,
-0.007823752239346504,
0.0719405934214592,
0.012988455593585968,
0.02756355330348015,
-0.05007617175579071,
0.03487997129559517,
0.015438806265592575,
0.011246467009186745,
0.036451783031225204,
-0.06022043153643608,
1.9494251377242963e-34,
-0.0313027985394001,
-0.10981450229883194,
-0.008044229820370674,
-0.040576498955488205,
0.01289282739162445,
-0.020069628953933716,
0.0049097491428256035,
0.03426152095198631,
-0.009026660583913326,
-0.0557430125772953,
0.010057555511593819
] | {
"ds_index": 77,
"similar_dg_indices": [
111139,
446245,
417060,
544319,
662716,
428831,
277880,
958310,
400419,
794206,
524962,
106925,
1032023,
939842,
660353,
1039057,
328739,
158477,
360968,
1166460
]
} |
A previously healthy 10-year-old boy is brought to the emergency room by his mother 5 hours after the onset of abdominal pain and nausea. Over the past 2 weeks, he has also had progressive abdominal pain and a 4-kg (8.8-lb) weight loss. The mother reports that her son has been drinking more water than usual during this period. Last week he wet his bed three times despite being completely toilet-trained since 3 years of age. His temperature is 37.8°C (100°F), pulse is 128/min, respirations are 35/min, and blood pressure is 95/55 mm Hg. He appears lethargic. Physical examination shows deep and labored breathing and dry mucous membranes. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. Serum laboratory studies show:
Na+ 133 mEq/L
K+ 5.9 mEq/L
Cl- 95 mEq/L
HCO3- 13 mEq/L
Urea nitrogen 25 mg/dL
Creatinine 1.0 mg/dL
Urine dipstick is positive for ketones and glucose. Further evaluation is most likely to reveal which of the following?" | Decreased total body potassium | {
"A": "Decreased total body potassium",
"B": "Increased total body sodium",
"C": "Increased arterial pCO2",
"D": "Hypervolemia"
} | step2&3 | A | [
"healthy 10 year old boy",
"brought",
"emergency room",
"mother",
"hours",
"onset",
"abdominal",
"nausea",
"past 2 weeks",
"progressive abdominal pain",
"4 kg",
"8.8",
"weight loss",
"mother reports",
"son",
"drinking more water",
"usual",
"period",
"Last week",
"wet",
"bed three times",
"completely toilet trained since",
"years",
"age",
"temperature",
"pulse",
"min",
"respirations",
"35 min",
"blood pressure",
"95 55 mm Hg",
"appears lethargic",
"Physical examination shows deep",
"labored breathing",
"dry mucous membranes",
"abdomen",
"soft",
"diffuse tenderness",
"palpation",
"guarding",
"Serum laboratory studies show",
"Na",
"mEq/L K",
"5",
"Cl",
"HCO3",
"Urea mg Creatinine 1 0 mg dL Urine dipstick",
"positive",
"ketones",
"glucose",
"Further evaluation",
"most likely to reveal",
"following"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A previously healthy 10-year-old boy is brought to the emergency room by his mother 5 hours after the onset of abdominal pain and nausea. Over the past 2 weeks, he has also had progressive abdominal pain and a 4-kg (8.8-lb) weight loss. The mother reports that her son has been drinking more water than usual during this period. Last week he wet his bed three times despite being completely toilet-trained since 3 years of age. His temperature is 37.8°C (100°F), pulse is 128/min, respirations are 35/min, and blood pressure is 95/55 mm Hg. He appears lethargic. Physical examination shows deep and labored breathing and dry mucous membranes. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. Serum laboratory studies show:
Na+ 133 mEq/L
K+ 5.9 mEq/L
Cl- 95 mEq/L
HCO3- 13 mEq/L
Urea nitrogen 25 mg/dL
Creatinine 1.0 mg/dL
Urine dipstick is positive for ketones and glucose. Further evaluation is most likely to reveal which of the following?"
Choose one of the following::
A. Decreased total body potassium
B. Increased total body sodium
C. Increased arterial pCO2
D. Hypervolemia | [
0.05022769048810005,
-0.010538700968027115,
0.04319235309958458,
-0.014675991609692574,
0.030873993411660194,
-0.01559013407677412,
-0.032073624432086945,
0.038562942296266556,
-0.008454755879938602,
-0.024284880608320236,
0.020191699266433716,
-0.0034194025211036205,
-0.03867032751441002,
-0.004371285438537598,
-0.000796180684119463,
0.028376055881381035,
0.008572357706725597,
-0.00989578478038311,
-0.022372903302311897,
0.02431824989616871,
-0.024046458303928375,
0.001129628042690456,
0.020844142884016037,
0.02959974855184555,
0.05265549570322037,
-0.013767196796834469,
0.004565151873975992,
-0.008574568666517735,
-0.022258829325437546,
-0.07217125594615936,
0.040391214191913605,
-0.015904443338513374,
-0.05486864596605301,
-0.022449910640716553,
0.0000019147253169649048,
-0.009852372109889984,
0.0070700133219361305,
-0.01272115670144558,
0.0034360585268586874,
-0.04897790029644966,
-0.020031822845339775,
-0.06154804676771164,
0.01910051330924034,
-0.005545435938984156,
-0.017268020659685135,
-0.07455935329198837,
0.061617691069841385,
0.0501689650118351,
0.01065818965435028,
-0.014096022583544254,
0.044767722487449646,
-0.0011306414380669594,
-0.023724641650915146,
0.0025389553047716618,
0.0888344943523407,
-0.03869055211544037,
-0.0200406052172184,
0.029635565355420113,
0.0059049734845757484,
-0.012143433094024658,
0.05445137992501259,
-0.00902626570314169,
0.007863578386604786,
-0.0024307300336658955,
-0.07936757057905197,
0.0354570634663105,
-0.014851546846330166,
-0.08852342516183853,
0.017933355644345284,
0.04642786085605621,
-0.03705815598368645,
-0.024277400225400925,
0.08920997381210327,
0.06779872626066208,
-0.050836458802223206,
-0.03826446086168289,
0.03750193864107132,
-0.01692490465939045,
-0.01994452066719532,
-0.00956934317946434,
0.06920167803764343,
0.0296714436262846,
-0.01600094512104988,
0.015099304728209972,
0.034220512956380844,
-0.039976660162210464,
-0.015200680121779442,
-0.0446871854364872,
-0.03688301146030426,
-0.0189184732735157,
-0.020199423655867577,
-0.03202899545431137,
0.031445905566215515,
0.009197973646223545,
-0.04548300430178642,
0.010018626227974892,
-0.011844444088637829,
-0.03705215081572533,
0.05651416629552841,
-0.07900246232748032,
0.004078420344740152,
-0.028358306735754013,
0.001671789214015007,
0.02774393931031227,
-0.04489454627037048,
-0.003791443072259426,
-0.009505153633654118,
0.03588661551475525,
-0.05735538527369499,
0.04188394919037819,
-0.014858020469546318,
0.03119497187435627,
-0.0712614357471466,
-0.010050980374217033,
0.07283181697130203,
-0.003878626972436905,
-0.014975293539464474,
-0.054584257304668427,
0.010983994230628014,
0.08674818277359009,
0.019157711416482925,
0.06449650973081589,
0.026254966855049133,
0.039680853486061096,
0.0009200785425491631,
0.035496972501277924,
0.035835497081279755,
-0.021765494719147682,
0.0024567677173763514,
0.04539310932159424,
0.00841524824500084,
-0.039322733879089355,
-0.02217802219092846,
0.04630068689584732,
0.013231939636170864,
-0.02654316835105419,
0.007807725574821234,
0.04949691891670227,
-0.011732486076653004,
0.009377814829349518,
-0.007038645911961794,
0.0010212394408881664,
-0.0020642669405788183,
0.004255922045558691,
0.015078336000442505,
0.022526713088154793,
0.016639413312077522,
0.0015921741724014282,
0.0289666298776865,
0.017107585445046425,
-0.04046137258410454,
-0.01487398985773325,
-0.012113334611058235,
0.0008895113714970648,
-0.028611691668629646,
-0.011142149567604065,
0.006521664094179869,
-0.015751462429761887,
0.011026139371097088,
-0.05301607772707939,
0.019419396296143532,
-0.01565542444586754,
-0.02751752734184265,
-0.011776088736951351,
-0.038644466549158096,
0.013303183019161224,
0.04570288211107254,
0.04093718156218529,
-0.04207659885287285,
0.057166725397109985,
-0.0316946841776371,
0.02088366448879242,
0.07791724056005478,
0.014306810684502125,
0.003132380312308669,
0.010301613248884678,
0.004648581147193909,
-0.020050007849931717,
-0.028184445574879646,
-0.005997123662382364,
0.04175598919391632,
0.013283926993608475,
0.03488240763545036,
-0.022890064865350723,
0.012647025287151337,
-0.009245316497981548,
0.032464854419231415,
-0.01551351509988308,
-0.013148038648068905,
-0.03484342247247696,
0.0035800596233457327,
0.039659708738327026,
-0.005401374772191048,
0.0037882754113525152,
0.006959342397749424,
0.016376737505197525,
-0.047499626874923706,
0.03021419048309326,
0.026220591738820076,
0.005767314229160547,
-0.009816914796829224,
0.006380156613886356,
0.019674409180879593,
0.04947570711374283,
-0.05280626565217972,
0.06336532533168793,
0.015271254815161228,
0.003369912737980485,
-0.024048777297139168,
-0.030233100056648254,
-0.014921670779585838,
-0.021359462291002274,
0.03594353795051575,
-0.027135293930768967,
-0.0006394631927832961,
0.02559843100607395,
0.0414973683655262,
-0.007014709059149027,
-0.05554012581706047,
0.046977728605270386,
-0.017706692218780518,
0.0187629796564579,
-0.020186398178339005,
-0.014466335996985435,
-0.020046168938279152,
0.00011723747593350708,
0.006436161696910858,
0.032631441950798035,
-0.02106703445315361,
-0.07575058192014694,
0.04452531039714813,
0.01574472337961197,
-0.02456803247332573,
0.03885873034596443,
-0.06365960091352463,
0.01070259790867567,
0.02693239040672779,
-0.06526439636945724,
-0.009565637446939945,
0.08517174422740936,
-0.03376667946577072,
-0.02329728752374649,
-0.0770963579416275,
-0.06252510845661163,
0.0005045115831308067,
-0.0007568770670332015,
-0.005858512595295906,
0.06647322326898575,
-0.04725684970617294,
0.06378426402807236,
-0.042055193334817886,
-0.000847727875225246,
-0.0006548355449922383,
0.004271471872925758,
0.009935964830219746,
0.006648751441389322,
-0.02685069479048252,
0.0049318536184728146,
0.017820004373788834,
-0.06021210551261902,
-0.08272755146026611,
-0.00005164245158084668,
0.030379580333828926,
-0.04132400080561638,
-0.04815240949392319,
0.01278275903314352,
0.00975241232663393,
-0.00833459198474884,
0.022397000342607498,
0.010191171430051327,
0.011587736196815968,
0.04475203901529312,
0.02831435017287731,
0.03272753953933716,
-0.04250608757138252,
-0.0029443164821714163,
-0.0330982506275177,
0.04265604913234711,
0.04004726931452751,
-0.0006213342421688139,
0.022600477561354637,
0.08601268380880356,
0.0012280145892873406,
0.05960516259074211,
0.00651240861043334,
0.012618102133274078,
-0.03428536653518677,
0.006859763991087675,
0.07099626958370209,
0.012934127822518349,
0.010329518467187881,
0.002640823135152459,
0.011894122697412968,
-0.07940775156021118,
-0.03134309500455856,
-0.04447179660201073,
-0.09683399647474289,
0.06738785654306412,
-0.010558132082223892,
0.04131274297833443,
0.02144613116979599,
0.0007558672223240137,
0.01850525103509426,
0.049197424203157425,
0.03234196826815605,
0.013246051035821438,
0.03933122754096985,
0.0022516767494380474,
-0.026181627064943314,
0.05112351477146149,
0.008729353547096252,
0.013568107970058918,
-0.03224947303533554,
-0.04261244088411331,
0.046149805188179016,
-0.03663596510887146,
-0.035289183259010315,
-0.0648748129606247,
0.022999688982963562,
-0.025197289884090424,
0.002780308248475194,
0.03970014303922653,
-0.03498726710677147,
-0.028542958199977875,
-0.03392776474356651,
-0.00924729835242033,
-0.009833364747464657,
0.020759452134370804,
-0.06915035098791122,
-0.04546765610575676,
-0.006188230589032173,
0.029838692396879196,
0.01697496697306633,
0.03370486944913864,
0.03594345226883888,
-0.049147337675094604,
-0.04935920611023903,
0.05191529914736748,
-0.06041717529296875,
0.04799787700176239,
0.02839871123433113,
-0.015204585157334805,
0.024806348606944084,
0.06971950083971024,
-0.004689858295023441,
-0.028629662469029427,
-0.08255039900541306,
-0.013071365654468536,
-0.02613728493452072,
0.04731953516602516,
-0.10511139780282974,
-0.01854534260928631,
0.01658177562057972,
0.006851981859654188,
-0.026886440813541412,
-0.01414305716753006,
0.034797318279743195,
-0.014028285630047321,
-0.038853880017995834,
0.02136087603867054,
0.020131049677729607,
0.050272561609745026,
-0.03817374259233475,
0.040021177381277084,
0.019163331016898155,
0.028320888057351112,
-0.018535394221544266,
0.006920639891177416,
0.007630007341504097,
-0.03627742826938629,
-0.02434023842215538,
0.01895510032773018,
-0.038773313164711,
0.034529730677604675,
-0.014826936647295952,
0.010922697372734547,
0.010019848123192787,
-0.0568266399204731,
-0.08498446643352509,
-0.060449033975601196,
0.046253547072410583,
0.005517009645700455,
-0.022596212103962898,
-0.007739039603620768,
-0.03296605125069618,
0.003777789883315563,
-0.03703124821186066,
-0.05497008189558983,
0.059474069625139236,
-0.007725696079432964,
-0.0035318327136337757,
-0.0008629853837192059,
-0.02603544294834137,
-0.03405756875872612,
0.017545565962791443,
0.031033512204885483,
0.005913327913731337,
-0.059401676058769226,
0.025518612936139107,
0.08423307538032532,
-0.0121119050309062,
-0.006960699334740639,
-0.04707121104001999,
0.07131676375865936,
0.05829444155097008,
-0.03031894564628601,
-0.06354424357414246,
-0.015233181416988373,
0.05183219909667969,
0.05766960605978966,
0.024410774931311607,
-0.04798140004277229,
0.023809297010302544,
0.004717262461781502,
0.01630842499434948,
-0.04515092074871063,
-0.02044498175382614,
-0.030680907890200615,
-0.005161304958164692,
-0.10814235359430313,
0.07843684405088425,
-0.014084176160395145,
-0.0022993653547018766,
-0.04377101734280586,
-0.008504088036715984,
-0.006928392220288515,
0.023624897003173828,
0.07884950935840607,
0.006994547788053751,
0.013892495073378086,
0.051158659160137177,
-0.043934132903814316,
0.036486849188804626,
0.03177332505583763,
0.018821006640791893,
-0.01707928068935871,
0.018503457307815552,
-0.0005048902239650488,
0.030696365982294083,
0.001350112957879901,
0.06039445102214813,
-0.021892808377742767,
-0.0028980106581002474,
0.02734959125518799,
0.03267142176628113,
-0.007499183062463999,
0.0029823898803442717,
0.04612249135971069,
0.053593698889017105,
0.10720739513635635,
-0.024247867986559868,
-0.05165810137987137,
-0.0146560650318861,
0.08794555068016052,
0.052816253155469894,
0.02330552414059639,
0.07285201549530029,
-0.015096493065357208,
0.03610975295305252,
-0.022926177829504013,
-0.07674159854650497,
0.013865425251424313,
-0.015331489033997059,
-0.05206096172332764,
0.030415669083595276,
-0.042510855942964554,
-0.09379995614290237,
0.00956158060580492,
-0.05154472589492798,
0.002634391188621521,
-0.05357810854911804,
0.05268504470586777,
-0.0030332941096276045,
-0.03393537923693657,
0.017647450789809227,
-0.07468848675489426,
-0.017657170072197914,
-0.057074591517448425,
-0.021630238741636276,
0.02553660422563553,
-0.03596680983901024,
0.021953631192445755,
-0.04277731105685234,
-0.09863597899675369,
0.019260086119174957,
0.026415541768074036,
0.008192126639187336,
-0.007624917197972536,
-0.03477349504828453,
0.013744055293500423,
0.026979617774486542,
-0.0018295221962034702,
0.005246784538030624,
0.008641303516924381,
-0.07659314572811127,
-0.014960356056690216,
0.011154885403811932,
0.06217004358768463,
0.04500959441065788,
-0.010511297732591629,
0.07982631772756577,
-0.0031230663880705833,
0.06439688056707382,
-0.03669333830475807,
0.029550354927778244,
0.039747241884469986,
-0.020924605429172516,
0.001978696323931217,
-0.03149158135056496,
-0.050782788544893265,
0.02977270632982254,
0.006968787871301174,
-0.02800651267170906,
0.037053704261779785,
0.04299689084291458,
-0.08031412959098816,
-0.05261724442243576,
-0.02226945199072361,
-0.015274124220013618,
-0.003153696423396468,
0.019579462707042694,
-0.008756836876273155,
-0.03741675615310669,
-0.023845940828323364,
-0.025540664792060852,
0.057401325553655624,
-0.015393296256661415,
0.020445795729756355,
0.025685444474220276,
0.06497257202863693,
-0.029919827356934547,
0.030907584354281425,
-0.052142433822155,
-0.041211310774087906,
0.011894626542925835,
-0.009477699175477028,
0.024090252816677094,
0.018445005640387535,
-0.03986740857362747,
-0.046048425137996674,
0.052467238157987595,
0.03632136434316635,
-0.01941935159265995,
0.004097409080713987,
-0.04515410214662552,
0.02642231062054634,
-0.01209391187876463,
0.03707835078239441,
0.011475427076220512,
-0.014795835129916668,
-0.011468132957816124,
0.031136294826865196,
-0.029779313132166862,
0.027772080153226852,
0.03866405040025711,
-5.0120548132788225e-33,
0.043414156883955,
-0.03186977282166481,
0.01997166872024536,
-0.020860886201262474,
0.06836692243814468,
0.09041781723499298,
-0.04807422682642937,
0.005748431663960218,
-0.051328349858522415,
0.0315808430314064,
-0.049537722021341324,
-0.043150655925273895,
0.01412536296993494,
0.026657361537218094,
0.006646687630563974,
-0.036366648972034454,
0.048788126558065414,
0.01032391656190157,
-0.01236910093575716,
0.009964082390069962,
0.0008909987518563867,
-0.008211425505578518,
-0.028140200302004814,
-0.017109733074903488,
0.001706184004433453,
-0.014369955286383629,
0.05866999179124832,
0.028558803722262383,
0.007314729504287243,
0.0027106059715151787,
0.014760646969079971,
-0.028561022132635117,
0.001489310641773045,
0.021740101277828217,
-0.043121520429849625,
-0.02204158902168274,
-0.02723122574388981,
0.0014048037119209766,
0.056214697659015656,
-0.03553264960646629,
-0.0056607844308018684,
-0.007724601775407791,
0.06284096091985703,
0.00020804205269087106,
0.06978841871023178,
0.0011212911922484636,
-0.059456855058670044,
-0.03379843756556511,
-0.005248037166893482,
-0.016035811975598335,
0.014767047017812729,
0.014447114430367947,
0.007666059769690037,
-0.019290756434202194,
-0.014293192885816097,
0.0038750593084841967,
0.0182558074593544,
-0.03878840431571007,
0.04827424883842468,
-0.00014130912313703448,
-0.04675436019897461,
0.04070886969566345,
0.013374757952988148,
-0.03763270005583763,
-0.0577479787170887,
0.012810466811060905,
0.06569791585206985,
0.04070507362484932,
-0.04335536062717438,
0.015135200694203377,
-0.08379746228456497,
-0.0176613200455904,
0.0006642343359999359,
-0.08269646018743515,
0.0014291721163317561,
-0.03341739997267723,
0.040553562343120575,
0.025548983365297318,
0.005055175628513098,
0.04866332188248634,
-0.019288042560219765,
-0.03570249676704407,
-0.02976607158780098,
-0.013048896566033363,
-0.0112996194511652,
-0.017794745042920113,
-0.0002577314153313637,
-0.04244859889149666,
-0.0036790133453905582,
0.003896179376170039,
0.09939780086278915,
-0.0021878397092223167,
0.029217658564448357,
0.009920771233737469,
0.029052160680294037,
-0.006682747509330511,
0.07815592736005783,
0.034922000020742416,
-0.016266724094748497,
0.007264560088515282,
0.035900313407182693,
-0.008227163925766945,
0.04699002578854561,
-0.037641491740942,
-0.030963607132434845,
0.029846306890249252,
-0.006308603100478649,
0.018447570502758026,
0.013998506590723991,
0.01633499376475811,
-0.000587027461733669,
0.009389529936015606,
-0.031268104910850525,
0.0082090487703681,
-0.01721237599849701,
0.0343928225338459,
0.014796493574976921,
-0.0060279048047959805,
0.023451894521713257,
0.06219234690070152,
0.01627231389284134,
-0.010425700806081295,
-0.002984546357765794,
-0.015228471718728542,
-0.05150950700044632,
-0.08071700483560562,
-0.02399383671581745,
0.06608560681343079,
-0.025901662185788155,
0.006773451808840036,
0.04656200483441353,
-0.021920301020145416,
2.8791990303034254e-7,
0.02258257567882538,
0.0025559370405972004,
-0.03930456191301346,
-0.10729479044675827,
0.0008472629706375301,
-0.028553782030940056,
-0.011104119010269642,
0.014606398530304432,
-0.008671634830534458,
-0.017869072034955025,
0.04824966564774513,
0.018857434391975403,
-0.019597714766860008,
0.014406540431082249,
0.017473025247454643,
-0.015892216935753822,
-0.0181083083152771,
0.009035000577569008,
0.02684023045003414,
-0.012490403838455677,
0.01049288921058178,
-0.03784613683819771,
-0.0700189471244812,
-0.05026916787028313,
0.007264221552759409,
-0.055674877017736435,
-0.021703990176320076,
0.0008352422737516463,
-0.02142206020653248,
-0.013535909354686737,
-0.024357935413718224,
0.043088480830192566,
0.025055453181266785,
-0.004521352704614401,
-0.05008240416646004,
0.0006563941133208573,
0.0329262875020504,
0.02899252250790596,
-0.0031306149903684855,
-0.017652954906225204,
-0.006327040493488312,
-0.03396967053413391,
0.02030777372419834,
0.011889981105923653,
0.03705286607146263,
0.03967401385307312,
0.00007587427535327151,
0.03933889791369438,
0.03580688312649727,
0.015630045905709267,
-0.03843438997864723,
0.01526921708136797,
-0.002440013224259019,
0.05953621491789818,
-0.035246893763542175,
0.05885729566216469,
-0.023508090525865555,
-0.04249284788966179,
0.0031581453513354063,
-0.026417361572384834,
-0.011232174932956696,
-0.0013111196458339691,
0.00007308182830456644,
-0.00410212017595768,
0.0011911261826753616,
-0.01842074654996395,
-0.028820469975471497,
2.2403239441205705e-34,
-0.046772513538599014,
-0.028604697436094284,
0.02531076781451702,
-0.08069662749767303,
0.02901555597782135,
-0.026381995528936386,
0.001882284414023161,
0.02245781198143959,
0.0002267281524837017,
-0.04809226468205452,
-0.01924428716301918
] | {
"ds_index": 78,
"similar_dg_indices": [
521150,
1116922,
171224,
747556,
407022,
441948,
1171588,
1081052,
245294,
50386,
1085776,
953872,
871024,
78460,
417544,
406906,
112337,
992680,
405138,
1127305
]
} |
A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival? | Spironolactone | {
"A": "Spironolactone",
"B": "Amiloride",
"C": "Hydrochlorothiazide",
"D": "Acetazolamide"
} | step1 | A | [
"70 year old Caucasian male visits",
"office",
"treatment",
"New York Heart association class IV",
"congestive",
"failure",
"following medications",
"add",
"man's drug regimen",
"order to",
"overall survival"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival?
Choose one of the following::
A. Spironolactone
B. Amiloride
C. Hydrochlorothiazide
D. Acetazolamide | [
0.03634967654943466,
-0.00385976186953485,
0.010597970336675644,
0.015603124164044857,
-0.016333824023604393,
0.014409216120839119,
-0.0027550237718969584,
0.012289809063076973,
0.05540714040398598,
-0.019236277788877487,
0.06211108714342117,
-0.006965345703065395,
0.0188387893140316,
-0.035337742418050766,
0.0030034238006919622,
-0.015686431899666786,
-0.017730562016367912,
0.013357231393456459,
-0.009710037149488926,
-0.034323688596487045,
-0.021656224504113197,
-0.00794698391109705,
0.0050445436500012875,
-0.014467348344624043,
0.05445661023259163,
-0.011150105856359005,
0.029162589460611343,
-0.04519083723425865,
-0.010759809985756874,
-0.04400703310966492,
0.00853232853114605,
0.05128775164484978,
0.020103320479393005,
-0.07862742990255356,
0.0000014972595181461656,
-0.05054616928100586,
0.026112381368875504,
0.010264434851706028,
0.013197378255426884,
-0.07162598520517349,
0.004134197719395161,
-0.06280114501714706,
-0.002589839044958353,
0.007513366173952818,
-0.010696723125874996,
-0.019319042563438416,
-0.029792072251439095,
0.022960016503930092,
-0.01242208480834961,
-0.0026005073450505733,
0.024154389277100563,
0.03876783326268196,
-0.016188083216547966,
0.001253242022357881,
0.009396466426551342,
-0.055951282382011414,
-0.01241049263626337,
0.022812383249402046,
0.055614348500967026,
0.018616337329149246,
0.0035821173805743456,
0.02447882667183876,
0.0008225817582570016,
0.025530286133289337,
0.09352866560220718,
0.0023725945502519608,
0.014368131756782532,
-0.015426892787218094,
-0.016815610229969025,
-0.011413157917559147,
0.02633691392838955,
0.1078508123755455,
0.02852095104753971,
0.0901813730597496,
-0.019310882315039635,
-0.06880168616771698,
0.019670912995934486,
-0.04377736896276474,
0.010873773135244846,
-0.038866039365530014,
0.002342868596315384,
0.009586607106029987,
-0.030160101130604744,
0.0036541770678013563,
0.003381004324182868,
-0.06901095062494278,
0.02743927761912346,
0.010382774285972118,
0.04391273483633995,
0.007135242689400911,
-0.05242586508393288,
-0.059599511325359344,
0.03299781307578087,
0.018250474706292152,
-0.005885304883122444,
0.0038159331306815147,
0.008394391275942326,
0.05572731792926788,
0.02009373903274536,
-0.07761707901954651,
-0.014118485152721405,
0.010728850960731506,
0.0434705913066864,
0.0063958908431231976,
-0.016956789419054985,
-0.03467858210206032,
0.00579645624384284,
-0.052645254880189896,
-0.058247677981853485,
0.06615223735570908,
-0.008629268035292625,
0.03074614517390728,
-0.01657125912606716,
0.09247002750635147,
0.1060141921043396,
-0.027619702741503716,
-0.07293649017810822,
-0.01282254047691822,
0.021684126928448677,
0.051717620342969894,
-0.0037304251454770565,
-0.0016345926560461521,
0.006547975819557905,
0.029494935646653175,
0.0006621822831220925,
0.02732980251312256,
0.005364120472222567,
0.020301537588238716,
0.013808418065309525,
-0.06309065222740173,
0.05208880081772804,
-0.025485511869192123,
-0.03391745686531067,
-0.022889787331223488,
0.008472876623272896,
-0.027633722871541977,
-0.007710282225161791,
0.05198360234498978,
-0.07266516238451004,
-0.030995050445199013,
-0.011758716776967049,
-0.02237783558666706,
-0.03866429254412651,
-0.011427488178014755,
0.030894456431269646,
-0.006241570692509413,
0.0072348453104496,
0.04922397434711456,
0.009837575256824493,
0.04855811595916748,
0.012173424474895,
0.0631934106349945,
0.0187526922672987,
0.013294768519699574,
0.04132775589823723,
0.034886397421360016,
-0.012334255501627922,
-0.05195684731006622,
-0.040425509214401245,
-0.032250478863716125,
0.035906266421079636,
-0.03497321903705597,
0.02353927679359913,
-0.03379056230187416,
0.009954907931387424,
0.015187311917543411,
0.05148179829120636,
0.0781923308968544,
-0.0376209057867527,
0.0507325753569603,
-0.0558614544570446,
-0.011610564775764942,
-0.02032390981912613,
-0.04798009619116783,
0.0005785487010143697,
0.011175609193742275,
0.018095342442393303,
-0.04108383134007454,
0.019496824592351913,
-0.03535890951752663,
0.01699046976864338,
-0.0020168989431113005,
-0.0685674399137497,
-0.03026488795876503,
0.002115435665473342,
0.009168238379061222,
-0.01757178083062172,
-0.008988681249320507,
0.009525390341877937,
-0.050426702946424484,
0.01070221047848463,
0.018741322681307793,
-0.042073845863342285,
-0.010430920869112015,
0.011391907930374146,
0.03209083527326584,
-0.015482091344892979,
-0.06356872618198395,
0.005525312386453152,
-0.027263930067420006,
-0.013356542214751244,
-0.015227175317704678,
0.00699955876916647,
0.06816958636045456,
-0.05138576775789261,
0.047758959233760834,
0.033147718757390976,
0.03632427752017975,
0.026120930910110474,
-0.01328128669410944,
0.05162191018462181,
0.03918106481432915,
0.04034977778792381,
-0.06458448618650436,
0.017445554956793785,
0.04924723505973816,
-0.018901612609624863,
0.03884686157107353,
-0.05398643761873245,
-0.026569398120045662,
-0.05016046762466431,
0.018028590828180313,
0.014292547479271889,
0.020663060247898102,
0.0012278491631150246,
-0.024235432967543602,
-0.032979078590869904,
0.006208111997693777,
-0.03110756166279316,
-0.04742782562971115,
0.042680125683546066,
0.01630600355565548,
-0.037042614072561264,
0.04502451419830322,
-0.040215086191892624,
0.0017103200079873204,
0.01859206147491932,
-0.00249089696444571,
0.01547673624008894,
0.018865808844566345,
0.024436386302113533,
-0.058805983513593674,
-0.04939212650060654,
-0.024232110008597374,
0.031198812648653984,
-0.009794066660106182,
0.01127670519053936,
0.011401920579373837,
-0.026422223076224327,
0.05024097487330437,
-0.0037845070473849773,
-0.008206082507967949,
-0.020744647830724716,
0.04516104981303215,
-0.012029058299958706,
0.05013187229633331,
-0.049021657556295395,
0.026303939521312714,
-0.030254000797867775,
-0.022918736562132835,
-0.008358168415725231,
-0.014679941348731518,
-0.006998816970735788,
-0.0057904827408492565,
-0.029426567256450653,
-0.018858402967453003,
0.028780361637473106,
0.014725135639309883,
-0.013608848676085472,
0.03155592828989029,
0.0051981424912810326,
-0.04782318323850632,
0.02515324391424656,
0.0031116711907088757,
-0.020925581455230713,
-0.007723323535174131,
0.008562054485082626,
-0.009613105095922947,
0.010757314041256905,
0.014316960237920284,
0.041991181671619415,
0.03781025484204292,
0.0007503611268475652,
0.009723084978759289,
0.050570953637361526,
0.005775528959929943,
-0.0240176972001791,
-0.030388128012418747,
0.046123236417770386,
-0.05989236757159233,
-0.03521468862891197,
0.04360108822584152,
-0.005783873610198498,
-0.015313869342207909,
0.012604070827364922,
0.019331932067871094,
-0.027522440999746323,
0.02293997071683407,
-0.03892124071717262,
0.02906380221247673,
0.005912572145462036,
0.03741884604096413,
-0.008798112161457539,
-0.00888066180050373,
-0.011773740872740746,
-0.014629637822508812,
0.054847605526447296,
-0.01840924099087715,
-0.07205457985401154,
0.052574336528778076,
0.059593863785266876,
0.0019308668561279774,
-0.0005612917011603713,
-0.06549030542373657,
-0.030070070177316666,
-0.015098299831151962,
-0.06230933591723442,
-0.015408775769174099,
0.03295780345797539,
-0.00904824398458004,
0.0477997362613678,
-0.02379126287996769,
-0.006685716565698385,
-0.013034333474934101,
-0.010798622854053974,
-0.03628180921077728,
-0.020377734676003456,
0.007882149890065193,
-0.04982047528028488,
-0.023376574739813805,
-0.01796209253370762,
0.0047487434931099415,
-0.010049816220998764,
-0.009723477996885777,
0.026396360248327255,
-0.004477796144783497,
-0.00699203833937645,
0.037407323718070984,
-0.0687042847275734,
0.04641447216272354,
0.007516687735915184,
-0.05239865183830261,
-0.008434335701167583,
0.0417960062623024,
-0.011146742850542068,
-0.0042534139938652515,
-0.02485273964703083,
-0.018090760335326195,
0.027906285598874092,
-0.026400413364171982,
-0.02177494764328003,
0.0345207117497921,
-0.0014098022365942597,
-0.0235312357544899,
-0.026195868849754333,
-0.024677183479070663,
0.051959697157144547,
0.03451424837112427,
-0.000257490057265386,
0.01818224787712097,
0.02526828832924366,
0.012721529230475426,
0.04200677573680878,
0.02223779447376728,
0.025966906920075417,
0.037266068160533905,
0.05251573398709297,
0.019444391131401062,
-0.01579817198216915,
0.0013924813829362392,
0.03328590840101242,
0.01661539077758789,
0.027082012966275215,
0.07352083176374435,
0.003664192045107484,
0.00504640955477953,
0.02487342804670334,
-0.08953365683555603,
-0.07032427936792374,
-0.018814928829669952,
0.060747046023607254,
-0.04840569570660591,
0.054734691977500916,
-0.024372415617108345,
0.020357651636004448,
-0.00024082385061774403,
-0.004961477592587471,
-0.08147477358579636,
0.02373531647026539,
0.022321388125419617,
0.010681592859327793,
0.051227420568466187,
0.004578458145260811,
-0.04672461748123169,
-0.02269633114337921,
0.03350561857223511,
-0.001614378415979445,
0.00680718757212162,
0.030290398746728897,
0.03438551723957062,
0.04517240822315216,
-0.03497068211436272,
-0.01340030413120985,
0.05969569459557533,
0.020944884046912193,
-0.03661327064037323,
-0.034804437309503555,
-0.036825280636548996,
0.05405871570110321,
0.03986142575740814,
0.031075069680809975,
-0.07654999196529388,
-0.0014675479615107179,
-0.011151252314448357,
0.07003962993621826,
0.013327409513294697,
0.002917263889685273,
-0.08277825266122818,
0.05143836885690689,
-0.07864651083946228,
0.0388459749519825,
0.022086462005972862,
-0.030425885692238808,
-0.024253245443105698,
-0.028016099706292152,
-0.03687665984034538,
0.10517094284296036,
0.0013575173215940595,
-0.00023813886218704283,
0.01830347813665867,
0.02911568060517311,
0.04743877053260803,
0.009088399820029736,
0.04029346629977226,
-0.07164447754621506,
0.057830482721328735,
-0.06022622808814049,
-0.049536287784576416,
0.03784630075097084,
-0.055758219212293625,
-0.05900419130921364,
0.05793120339512825,
0.05614481121301651,
-0.03877035528421402,
-0.019779721274971962,
0.010302986949682236,
0.02709416300058365,
0.05790264904499054,
-0.009481885470449924,
0.0234344694763422,
0.06279993057250977,
0.029782196506857872,
-0.016528215259313583,
-0.012564636766910553,
0.014041714370250702,
-0.054520804435014725,
-0.033824410289525986,
0.009115601889789104,
-0.01634601317346096,
0.006284452974796295,
0.012485210783779621,
0.010803201235830784,
0.01980742998421192,
-0.044731464236974716,
-0.01459517888724804,
0.004786824807524681,
-0.07269161939620972,
0.05340981483459473,
-0.03562554717063904,
-0.04166366904973984,
0.018092773854732513,
-0.004960301332175732,
-0.012719355523586273,
0.01552249863743782,
0.0395248718559742,
-0.012298054993152618,
-0.05346221104264259,
-0.007830020040273666,
0.048278506845235825,
0.02994910068809986,
-0.01196094136685133,
-0.06264394521713257,
-0.07247835397720337,
-0.007983257062733173,
0.011962804943323135,
0.019123787060379982,
0.0014011989114806056,
-0.006282202899456024,
-0.014331866055727005,
0.0059844935312867165,
-0.04017796739935875,
-0.016298413276672363,
-0.03306669369339943,
-0.017882756888866425,
-0.08559893071651459,
-0.028678052127361298,
-0.02745077945291996,
0.06369849294424057,
0.013327439315617085,
0.00042144389590248466,
0.062243517488241196,
0.024610966444015503,
-0.019493700936436653,
0.022928865626454353,
-0.0118193868547678,
0.0350138321518898,
-0.03548356145620346,
0.046533238142728806,
-0.04867472127079964,
-0.046306535601615906,
-0.017381712794303894,
0.017440786585211754,
-0.015475018881261349,
-0.0012441518483683467,
-0.013492908328771591,
0.027501031756401062,
-0.012353423982858658,
-0.039290741086006165,
-0.031800683587789536,
-0.0026541489642113447,
0.012296199798583984,
-0.005097534507513046,
-0.04741106554865837,
0.03269791230559349,
0.02154911682009697,
0.0751371681690216,
0.023591220378875732,
-0.0005510687478817999,
-0.06589619815349579,
0.09465952962636948,
-0.06443312764167786,
-0.04052427411079407,
-0.04438510537147522,
-0.0035193306393921375,
-0.00646551139652729,
-0.025213414803147316,
0.026319893077015877,
0.039636287838220596,
0.009537389501929283,
0.018181631341576576,
-0.023960240185260773,
-0.005242764949798584,
0.01687425933778286,
0.013570529408752918,
-0.004195593297481537,
0.04152917116880417,
-0.04070517420768738,
-0.010840199887752533,
0.006289063952863216,
-0.0634976252913475,
-0.007452881895005703,
0.030304664745926857,
0.012750828638672829,
0.0211479514837265,
0.043314576148986816,
-5.5566301219460946e-33,
0.0211592186242342,
-0.013607765547931194,
-0.0015083522303029895,
-0.07880625873804092,
0.013150890357792377,
0.04351744428277016,
-0.02680768445134163,
-0.05788537114858627,
-0.07503114640712738,
0.013105558231472969,
0.006706846412271261,
0.019643103703856468,
0.03544183447957039,
0.03614157810807228,
-0.030105572193861008,
-0.029701614752411842,
-0.03476366773247719,
0.028765307739377022,
-0.010451841168105602,
0.0017972581554204226,
-0.05737588554620743,
0.03991609439253807,
-0.014744679443538189,
-0.043500807136297226,
0.026612723246216774,
-0.02155880071222782,
0.07033293694257736,
0.0003213052114006132,
0.002526248339563608,
0.03140590712428093,
-0.022681018337607384,
0.035888541489839554,
-0.011396045796573162,
-0.037295274436473846,
0.0021626397501677275,
-0.02426891215145588,
0.02005704678595066,
0.0006157316383905709,
0.00733432499691844,
-0.045678023248910904,
0.0003235173353459686,
-0.03109857253730297,
-0.004492486361414194,
0.045421112328767776,
0.019740499556064606,
-0.045759525150060654,
-0.017465095967054367,
-0.011038245633244514,
0.03817997872829437,
0.04777183756232262,
-0.025018498301506042,
0.042236171662807465,
0.02613271400332451,
0.025264063850045204,
-0.09488384425640106,
0.020430300384759903,
-0.0022215249482542276,
0.0018025574972853065,
0.04263768717646599,
0.01671580784022808,
-0.04385466128587723,
0.019384702667593956,
0.012914865277707577,
-0.01332335639744997,
-0.04526795446872711,
-0.018270393833518028,
-0.017970502376556396,
0.0117595000192523,
-0.029475364834070206,
0.032483819872140884,
-0.08887594938278198,
-0.0005774444434791803,
0.030221877619624138,
-0.00041537085780873895,
-0.06900406628847122,
0.002415783004835248,
0.04736974835395813,
0.008196431212127209,
0.06430555880069733,
-0.009439738467335701,
-0.09879899770021439,
-0.009657069109380245,
-0.014132476411759853,
-0.039009883999824524,
0.00300607574172318,
0.02779574878513813,
-0.03411412984132767,
-0.001027091988362372,
0.04984872788190842,
-0.0346868634223938,
0.07155885547399521,
0.03264499828219414,
0.05016971379518509,
0.018935352563858032,
-0.0045569525100290775,
-0.03454962000250816,
0.0480474978685379,
0.009374018758535385,
0.013580180704593658,
0.010259310714900494,
0.060540176928043365,
0.06101563572883606,
0.08987096697092056,
-0.019759295508265495,
-0.05801847204566002,
-0.014413292519748211,
0.019920354709029198,
0.0031189441215246916,
-0.026222243905067444,
0.0065801190212368965,
-0.010251116938889027,
-0.032413300126791,
0.023585814982652664,
0.021097613498568535,
-0.036121807992458344,
0.04157383739948273,
0.012289539910852909,
0.0658254474401474,
0.013260483741760254,
-0.028588207438588142,
0.004286447539925575,
0.005650289356708527,
0.03132836893200874,
0.009162656962871552,
-0.058157745748758316,
0.00659100990742445,
0.03059128299355507,
0.08859282732009888,
-0.01824844256043434,
-0.017251497134566307,
-0.010532001033425331,
-0.03661365061998367,
2.380344739094653e-7,
-0.02100210450589657,
-0.05952991172671318,
-0.028189262375235558,
-0.05784796550869942,
0.006798113696277142,
-0.04765300452709198,
-0.006817102897912264,
0.02118842490017414,
-0.028999829664826393,
-0.0014455605996772647,
0.09657246619462967,
-0.04451991990208626,
0.0013340559089556336,
-0.06347624957561493,
0.09000924974679947,
-0.019210094586014748,
-0.007201673462986946,
-0.039161328226327896,
0.0016068278346210718,
-0.008105349726974964,
0.07378535717725754,
0.02755994163453579,
-0.059618301689624786,
-0.00036742465454153717,
-0.008773050270974636,
-0.009141056798398495,
-0.026988435536623,
-0.05667861923575401,
-0.05021810159087181,
0.019937345758080482,
0.004709918051958084,
0.00605084327980876,
0.019962407648563385,
0.05641014128923416,
-0.040129803121089935,
-0.04601690545678139,
0.02572675421833992,
0.06660174578428268,
-0.0492662638425827,
-0.023795193061232567,
-0.023862913250923157,
0.020156869664788246,
-0.007018920034170151,
0.0332934744656086,
-0.0057703121565282345,
0.05678877234458923,
-0.04367012903094292,
-0.008305425755679607,
-0.031132562085986137,
-0.02147820219397545,
0.028479482978582382,
0.01930312067270279,
-0.031197886914014816,
0.09648628532886505,
0.024849293753504753,
0.061977241188287735,
-0.04234674945473671,
0.030747344717383385,
0.056605421006679535,
0.005998765584081411,
-0.009852548129856586,
-0.055528901517391205,
-0.012092315591871738,
-0.025903047993779182,
0.055039796978235245,
-0.049424175173044205,
-0.044375184923410416,
1.4032066624420174e-34,
-0.006991138681769371,
-0.014954980462789536,
0.019492290914058685,
-0.023602861911058426,
0.07765358686447144,
0.0006868422497063875,
0.03755245730280876,
0.004582589957863092,
-0.007626562379300594,
-0.06835911422967911,
-0.06171783432364464
] | {
"ds_index": 79,
"similar_dg_indices": [
3673,
1070242,
463609,
10612,
554897,
790537,
640949,
1041129,
603680,
531894,
694379,
109944,
1091012,
1104819,
791554,
1199883,
1066607,
1006626,
1127909,
1185258
]
} |
Several hours after vaginal delivery, a male newborn delivered at full-term develops tachycardia and tachypnea. His blood pressure is within normal limits. Pulse oximetry on room air shows an oxygen saturation of 79% in the right hand and 61% in the left foot. Physical examination shows bluish discoloration of the face and trunk, supraclavicular and intercostal retractions, and a machine-like murmur over the precordium. Bedside echocardiography shows pulmonary and systemic circulation are in parallel rather than in series. What is the most appropriate pharmacotherapy for this patient? | Alprostadil | {
"A": "Sildenafil",
"B": "Alprostadil",
"C": "Metoprolol",
"D": "Indomethacin"
} | step1 | B | [
"Several hours",
"vaginal delivery",
"male newborn delivered",
"full-term",
"tachycardia",
"tachypnea",
"blood pressure",
"normal limits",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"right hand",
"61",
"left foot",
"Physical examination shows",
"discoloration",
"face",
"trunk",
"supraclavicular",
"intercostal retractions",
"machine",
"murmur",
"precordium",
"echocardiography shows pulmonary",
"systemic circulation",
"in parallel",
"in series",
"most appropriate pharmacotherapy",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Several hours after vaginal delivery, a male newborn delivered at full-term develops tachycardia and tachypnea. His blood pressure is within normal limits. Pulse oximetry on room air shows an oxygen saturation of 79% in the right hand and 61% in the left foot. Physical examination shows bluish discoloration of the face and trunk, supraclavicular and intercostal retractions, and a machine-like murmur over the precordium. Bedside echocardiography shows pulmonary and systemic circulation are in parallel rather than in series. What is the most appropriate pharmacotherapy for this patient?
Choose one of the following::
A. Sildenafil
B. Alprostadil
C. Metoprolol
D. Indomethacin | [
-0.0025660505052655935,
-0.053667545318603516,
0.007549856323748827,
-0.022253531962633133,
0.002840797882527113,
0.03071833774447441,
-0.038189783692359924,
0.002745953155681491,
-0.10280410200357437,
-0.018322233110666275,
0.016403386369347572,
-0.07296711951494217,
0.00008102213905658573,
0.05929377302527428,
0.014267811551690102,
-0.03400903940200806,
-0.0021174552384763956,
0.0034171196166425943,
-0.05341493710875511,
-0.014714379794895649,
0.01832066848874092,
0.03242902457714081,
0.006059962324798107,
-0.017397580668330193,
0.052456438541412354,
-0.021324219182133675,
-0.02076912671327591,
-0.015676632523536682,
-0.049234434962272644,
-0.03124561905860901,
-0.002355868462473154,
0.0495130755007267,
0.003223970765247941,
-0.0006889327196404338,
0.0000019480869468679884,
0.0026988834142684937,
-0.00586938951164484,
0.025452660396695137,
0.05107573792338371,
-0.09696117043495178,
0.07047776877880096,
-0.07509477436542511,
0.009803417138755322,
0.023539245128631592,
-0.04421618580818176,
-0.10011457651853561,
0.009571149945259094,
0.04429632052779198,
-0.02219739928841591,
-0.01680631935596466,
0.03289024531841278,
0.053473759442567825,
-0.017605068162083626,
0.0008032541372813284,
0.04097282513976097,
-0.05746115371584892,
-0.043614089488983154,
0.004637895151972771,
0.059269968420267105,
0.013729491271078587,
-0.03038148209452629,
-0.005627709906548262,
0.017459796741604805,
-0.026481151580810547,
0.038753826171159744,
-0.057103995233774185,
0.01236148364841938,
-0.08275345712900162,
-0.03628390282392502,
0.04989319294691086,
0.03259266912937164,
0.013898132368922234,
0.024177195504307747,
0.05001743510365486,
-0.05665144324302673,
-0.044656988233327866,
0.0018321012612432241,
0.018692409619688988,
-0.01913866028189659,
-0.006728086620569229,
0.04654955863952637,
0.004646359942853451,
-0.04704508185386658,
0.028499936684966087,
0.05105271935462952,
-0.07644232362508774,
0.03862173482775688,
-0.008391853421926498,
0.05089268088340759,
0.025957254692912102,
0.007754229474812746,
-0.004301308188587427,
0.01274880487471819,
-0.030346857383847237,
-0.03714652732014656,
0.051010992377996445,
-0.03691302612423897,
-0.05056212469935417,
0.0038344375789165497,
-0.02621978148818016,
0.017065484076738358,
-0.019545208662748337,
-0.0019306789617985487,
0.0007133653853088617,
-0.03715553507208824,
0.011791836470365524,
-0.01714703068137169,
-0.022037066519260406,
-0.06727507710456848,
0.050619952380657196,
0.0047011664137244225,
0.027699390426278114,
0.010159998200833797,
0.01975133642554283,
0.03134089335799217,
-0.043005552142858505,
-0.050176363438367844,
-0.012991601601243019,
-0.026837995275855064,
0.03827808424830437,
0.02520650252699852,
0.05405719578266144,
0.048678021878004074,
0.013602999970316887,
0.01633145473897457,
-0.02568291313946247,
0.06251154094934464,
-0.016616355627775192,
-0.050230998545885086,
0.011943281628191471,
0.0022335408721119165,
-0.022858876734972,
-0.04000842198729515,
0.051141273230314255,
0.01022616121917963,
-0.014329862780869007,
0.03626272827386856,
0.025655563920736313,
0.03660602495074272,
0.02171860821545124,
0.03922197222709656,
-0.026092400774359703,
0.0172038022428751,
0.0398719422519207,
-0.025707459077239037,
0.03024056926369667,
-0.004350672941654921,
-0.0023310910910367966,
0.0044763823971152306,
0.04058041423559189,
0.029042216017842293,
0.017264941707253456,
-0.03514320030808449,
-0.008063520304858685,
-0.03757655248045921,
-0.0026193764060735703,
0.013877700082957745,
0.032516784965991974,
-0.010762355290353298,
-0.07893839478492737,
-0.00006863779708510265,
0.016538318246603012,
0.01180282887071371,
-0.0295064989477396,
0.02156347781419754,
-0.02655036188662052,
0.023456966504454613,
0.06333822011947632,
0.014899243600666523,
-0.00044098543003201485,
-0.040425583720207214,
-0.009804855100810528,
0.04685995355248451,
0.030315261334180832,
-0.01546100527048111,
-0.0265823844820261,
-0.046084072440862656,
-0.07500776648521423,
0.029239287599921227,
-0.09831526130437851,
-0.00048205044004134834,
0.0033514807000756264,
0.03945343196392059,
-0.025205252692103386,
0.018196118995547295,
-0.029248462989926338,
-0.005137683358043432,
-0.040143635123968124,
0.013802780769765377,
-0.04259592667222023,
-0.002270575612783432,
-0.029157456010580063,
-0.00627710297703743,
0.021781064569950104,
0.010872877202928066,
0.0520600825548172,
-0.051059089601039886,
-0.02229844219982624,
-0.011646297760307789,
0.06631079316139221,
-0.031173773109912872,
-0.009761557914316654,
-0.06790077686309814,
0.032310109585523605,
-0.04774997755885124,
0.017355050891637802,
-0.017782172188162804,
0.007261579390615225,
-0.00981161929666996,
0.0333285853266716,
-0.0232772808521986,
0.013239707797765732,
-0.03627316281199455,
-0.05312974750995636,
0.008548668585717678,
0.038421474397182465,
0.009715369902551174,
0.03200351074337959,
-0.0279570072889328,
-0.007642095908522606,
0.00002674591087270528,
-0.007591017987579107,
0.032554991543293,
0.006018932443112135,
-0.006825304590165615,
-0.0092987772077322,
0.025628969073295593,
0.03968429937958717,
0.023283695802092552,
-0.0519179031252861,
0.03736159950494766,
-0.010828976519405842,
0.0010147690773010254,
0.038657501339912415,
-0.033233001828193665,
0.015058869495987892,
0.023627599701285362,
-0.015148347243666649,
0.01822781190276146,
0.07973475754261017,
-0.06533273309469223,
0.0008050070609897375,
-0.04966190829873085,
-0.05876949429512024,
0.008186143822968006,
-0.03804232180118561,
-0.01776794344186783,
0.03713420033454895,
-0.0018710957374423742,
-0.0049593811854720116,
0.05461655929684639,
0.0065350946970283985,
-0.073748379945755,
0.056703511625528336,
0.015138422138988972,
0.009781958535313606,
-0.017093496397137642,
-0.027307109907269478,
0.0365464948117733,
-0.05486036464571953,
-0.03932014852762222,
-0.026174137368798256,
0.04471428692340851,
-0.08080150932073593,
0.0002860566310118884,
-0.015891343355178833,
-0.005237578880041838,
0.03989230841398239,
0.012581661343574524,
0.03691014647483826,
0.02058439701795578,
-0.004471695516258478,
-0.0004727316845674068,
0.007188352756202221,
-0.023224378004670143,
-0.002138212788850069,
-0.02049989067018032,
0.05523350462317467,
-0.0015785311115905643,
-0.02737855724990368,
-0.001344703952781856,
0.05830521881580353,
0.03215780854225159,
0.05663787201046944,
0.033654145896434784,
0.031443506479263306,
-0.06003381311893463,
0.06704972684383392,
0.06362426280975342,
0.015344740822911263,
0.009077203460037708,
0.04227445274591446,
0.019589625298976898,
0.002271408447995782,
0.052283432334661484,
0.018262790516018867,
0.0013458632165566087,
0.041843388229608536,
-0.03274007514119148,
0.011979964561760426,
-0.0698431134223938,
0.00680207833647728,
0.009541524574160576,
0.016651833429932594,
0.0028952036518603563,
-0.013345303013920784,
0.10336977988481522,
0.03506925702095032,
-0.06932071596384048,
0.06520398706197739,
-0.004179623443633318,
-0.032144613564014435,
-0.014781148172914982,
-0.04078338295221329,
0.0016521746292710304,
-0.014297392219305038,
-0.020305272191762924,
-0.08963242918252945,
0.016631240025162697,
0.009317651391029358,
0.050669461488723755,
-0.05413525551557541,
-0.043259575963020325,
-0.0007354862173087895,
-0.01642518676817417,
-0.029045388102531433,
-0.019082527607679367,
-0.02603611722588539,
-0.04100939631462097,
-0.009977897629141808,
-0.039031803607940674,
0.0017343579092994332,
-0.0014369158307090402,
-0.029990674927830696,
-0.00007628916500834748,
-0.04370737820863724,
0.007094182074069977,
0.0074309660121798515,
-0.07362262904644012,
0.029948465526103973,
0.02154134027659893,
-0.060228969901800156,
0.0009440878056921065,
0.03416085243225098,
0.038106098771095276,
-0.00268791732378304,
-0.013890759088099003,
0.02001355029642582,
0.07776782661676407,
0.011306791566312313,
-0.12224095314741135,
-0.03157474845647812,
0.02670968323945999,
-0.012931525707244873,
-0.02906024642288685,
-0.04202145338058472,
0.04270968213677406,
-0.045393627136945724,
0.03390868008136749,
0.009058219380676746,
-0.0226930920034647,
0.00840429775416851,
-0.010851535014808178,
0.010094837285578251,
-0.036108262836933136,
0.028517790138721466,
0.016273578628897667,
-0.02510196901857853,
-0.02900633029639721,
-0.003237856086343527,
-0.013257668353617191,
0.04106758162379265,
0.02576962299644947,
0.03489975258708,
-0.00784423016011715,
0.02792983688414097,
-0.048983655869960785,
-0.020947087556123734,
-0.06426254659891129,
-0.02332686446607113,
0.01584867388010025,
-0.011344454251229763,
0.045896291732788086,
0.008520212955772877,
-0.020538436248898506,
-0.004714678507298231,
-0.001430393778719008,
-0.059608928859233856,
0.05729764327406883,
0.016234230250120163,
-0.008411075919866562,
0.014523319900035858,
-0.01907356083393097,
-0.04205308482050896,
-0.022886015474796295,
0.048198629170656204,
-0.0021839216351509094,
-0.07989323884248734,
0.015669941902160645,
0.033662956207990646,
-0.007456491701304913,
0.040671102702617645,
0.009128649719059467,
0.05330292508006096,
0.013887505978345871,
-0.0027369363233447075,
-0.011392589658498764,
-0.0502038300037384,
0.03350510448217392,
0.13377857208251953,
0.008513767272233963,
0.0026650652289390564,
-0.04280044138431549,
0.030070194974541664,
-0.027816042304039,
-0.05445646122097969,
0.04989391937851906,
-0.03435317799448967,
0.031195897608995438,
-0.07030026614665985,
0.03800449147820473,
-0.0203218013048172,
-0.03164577856659889,
-0.028474148362874985,
0.0026427980046719313,
-0.06700249761343002,
0.0885629653930664,
0.048362117260694504,
0.002054453594610095,
0.009981872513890266,
0.01580492965877056,
-0.026732267811894417,
0.003625523764640093,
0.05413945019245148,
0.021438170224428177,
0.031483590602874756,
-0.055536411702632904,
0.03100728802382946,
-0.02999413199722767,
0.0030774243641644716,
0.013878402300179005,
-0.05335815250873566,
0.040150683373212814,
0.012840025126934052,
0.006669993046671152,
0.05100695416331291,
0.02175789885222912,
0.04217357560992241,
-0.0064935763366520405,
0.08733278512954712,
-0.00904848426580429,
-0.057161785662174225,
-0.03795558959245682,
0.011144492775201797,
-0.018091704696416855,
-0.018171509727835655,
-0.007976764813065529,
-0.025304146111011505,
0.04602213576436043,
-0.0787164717912674,
-0.04319893196225166,
0.0074845291674137115,
-0.025461234152317047,
-0.061308640986680984,
0.06700843572616577,
0.014454708434641361,
0.01881887950003147,
0.017977150157094002,
0.001359079615212977,
0.0082002067938447,
-0.020785082131624222,
0.016374245285987854,
0.006698402110487223,
0.0035007097758352757,
0.036655351519584656,
-0.023736407980322838,
0.004105797968804836,
0.0735606923699379,
0.051161959767341614,
0.008870874531567097,
-0.03425991162657738,
0.036432184278964996,
-0.05859082192182541,
-0.02819627709686756,
0.014780850149691105,
0.0005943841533735394,
-0.0019261287525296211,
0.030279988422989845,
-0.03211364150047302,
0.029973793774843216,
0.01044475194066763,
-0.02581479400396347,
-0.02141348086297512,
-0.03319519758224487,
-0.04445398226380348,
0.004073833581060171,
-0.008263669908046722,
0.036067020148038864,
-0.01025593001395464,
-0.023566022515296936,
0.03839550539851189,
0.010587126947939396,
0.0643853023648262,
-0.04005884379148483,
-0.018567904829978943,
0.0030036394018679857,
-0.01012102235108614,
-0.013634080067276955,
-0.0444389283657074,
-0.0468718521296978,
-0.00004975729461875744,
0.05448586866259575,
0.024302830919623375,
0.025484569370746613,
-0.00893238466233015,
0.010673575103282928,
-0.027063678950071335,
-0.025639643892645836,
-0.04565797001123428,
-0.015160932205617428,
-0.014056391082704067,
0.05579977482557297,
-0.05072356015443802,
-0.019632613286376,
0.015480203554034233,
0.005967209581285715,
0.021489987149834633,
0.03384019434452057,
0.004974538926035166,
0.07432025671005249,
-0.0461302325129509,
0.008953334763646126,
-0.0028558664489537477,
-0.04214010387659073,
-0.02501288615167141,
0.007005395833402872,
0.03223026916384697,
-0.06176194176077843,
0.016795413568615913,
0.07312209159135818,
0.00014726928202435374,
0.020254099741578102,
0.04665355384349823,
0.0037630023434758186,
-0.0492408312857151,
0.04702570661902428,
0.005376684479415417,
0.04765147343277931,
-0.028744949027895927,
-0.0360586941242218,
-0.013994956389069557,
0.03215209022164345,
0.045914068818092346,
0.037224721163511276,
0.03610973060131073,
-4.919901933646109e-33,
-0.015795530751347542,
0.004118740558624268,
0.016283519566059113,
-0.002852459903806448,
0.041310228407382965,
0.07806205004453659,
0.03471197187900543,
-0.002729322761297226,
-0.022949906066060066,
0.013279737904667854,
-0.06808599084615707,
-0.03483646363019943,
0.010104071348905563,
0.05194360017776489,
-0.010962901636958122,
-0.03661131486296654,
-0.02409222349524498,
-0.03150372579693794,
0.04026223346590996,
0.02634759247303009,
-0.05019911751151085,
0.024362405762076378,
0.019707221537828445,
0.030010823160409927,
0.007901500910520554,
-0.02655625343322754,
-0.012165466323494911,
0.01879485696554184,
-0.012124120257794857,
0.01916220597922802,
0.00007184297282947227,
-0.031550344079732895,
-0.022398393601179123,
-0.01090442668646574,
-0.046647731214761734,
-0.03428487852215767,
0.02277461811900139,
0.05612826347351074,
0.0345609076321125,
-0.022532276809215546,
-0.022889550775289536,
0.022399112582206726,
0.07546108216047287,
0.02609861083328724,
0.0403464250266552,
-0.04370247945189476,
-0.038384899497032166,
-0.051744360476732254,
0.007930764928460121,
-0.043819017708301544,
0.014094974845647812,
0.03111831471323967,
-0.007219631224870682,
-0.07284846156835556,
-0.042048130184412,
-0.009410375729203224,
-0.029030336067080498,
-0.0031492526177316904,
-0.020849386230111122,
-0.013756707310676575,
-0.006101683713495731,
0.011214752681553364,
0.009937526658177376,
-0.05598067119717598,
-0.01284401211887598,
-0.02512371353805065,
0.07743888348340988,
0.08811812102794647,
-0.02286907285451889,
0.07888457924127579,
-0.04415658861398697,
0.01945103146135807,
-0.023344680666923523,
-0.0914570540189743,
-0.04085497185587883,
-0.006769516039639711,
0.009091595187783241,
-0.0005708259996026754,
-0.04743761196732521,
0.06404224783182144,
-0.0038287905044853687,
-0.006116647273302078,
-0.036897946149110794,
-0.008464470505714417,
-0.047338277101516724,
-0.011254840530455112,
0.006312609184533358,
-0.008171681314706802,
0.018332337960600853,
-0.01927737519145012,
0.07148680835962296,
-0.015534969046711922,
0.049674779176712036,
-0.04163831099867821,
0.0142600666731596,
-0.05772886052727699,
0.03724119812250137,
0.05333153158426285,
0.04098911210894585,
-0.03314366191625595,
0.10429182648658752,
-0.04739411920309067,
0.048651114106178284,
0.0031402313616126776,
0.011063233017921448,
-0.0362326018512249,
-0.010549197904765606,
0.02404174581170082,
-0.03802310302853584,
0.0222330279648304,
0.005705502349883318,
-0.03458089753985405,
0.04146194830536842,
-0.004293892998248339,
-0.04947717487812042,
0.004734447225928307,
0.0377141572535038,
0.07072382420301437,
0.021137220785021782,
-0.003788204398006201,
0.010912259109318256,
0.024188784882426262,
0.003995824139565229,
0.029024964198470116,
-0.06023290753364563,
-0.025069070979952812,
0.022525867447257042,
0.06571802496910095,
-0.02673078514635563,
0.03562726080417633,
0.030256759375333786,
0.006290297489613295,
2.8588959821718163e-7,
0.018234046176075935,
0.04152962565422058,
-0.03067306987941265,
-0.08514749258756638,
0.028619349002838135,
-0.02626967243850231,
-0.01398527529090643,
0.016125226393342018,
-0.01257365196943283,
-0.02483772300183773,
0.05450081452727318,
0.02259245701134205,
0.019866321235895157,
-0.029461108148097992,
-0.01361092459410429,
-0.00998828187584877,
-0.025393910706043243,
-0.006596085615456104,
0.013448182493448257,
-0.03013034723699093,
-0.017476612702012062,
-0.015031686052680016,
-0.05327237397432327,
0.009730595164000988,
-0.01332052331417799,
0.030081801116466522,
0.04834447056055069,
-0.00693894550204277,
-0.05142565444111824,
0.012431095354259014,
-0.04847072437405586,
0.006415921729058027,
0.015649564564228058,
-0.02553269825875759,
-0.016597477719187737,
-0.007051826920360327,
0.0461137630045414,
0.019704457372426987,
-0.04043722525238991,
-0.0022971825674176216,
0.00004051201540278271,
0.04103068634867668,
0.025499252602458,
0.03403418883681297,
-0.000008328965122927912,
0.04779863730072975,
-0.03941025212407112,
-0.05674689635634422,
0.021275775507092476,
-0.05140643194317818,
0.07642896473407745,
0.03288044035434723,
0.01588711142539978,
0.09150690585374832,
0.0005448023439384997,
-0.0013707035686820745,
-0.03617342934012413,
0.013769727200269699,
0.05279483273625374,
0.016673989593982697,
-0.005475928541272879,
-0.06747496873140335,
-0.008207134902477264,
0.00761776277795434,
0.028930477797985077,
0.031730081886053085,
-0.04562681168317795,
2.1657870411963793e-34,
0.0003427849733270705,
-0.05694388598203659,
-0.010719295591115952,
-0.04653060436248779,
0.027266457676887512,
-0.017092298716306686,
-0.017016446217894554,
-0.016145989298820496,
-0.009196014143526554,
-0.04900062084197998,
0.024813517928123474
] | {
"ds_index": 80,
"similar_dg_indices": [
610376,
319432,
572963,
724455,
402950,
392056,
689309,
582880,
929949,
1058110,
708970,
904045,
1108784,
170155,
945612,
745582,
195762,
626450,
67446,
312965
]
} |
A 5-year-old male visits his pediatrician for a check-up. His height corresponds to the 99th percentile for his age, and pubic hair is present upon physical examination. Serum renin and potassium levels are high, as is 17-hydroxyprogesterone. Which of the following is likely deficient in this patient? | 21-hydroxylase | {
"A": "17a-hydroxylase",
"B": "21-hydroxylase",
"C": "Aromatase",
"D": "5a-reductase"
} | step1 | B | [
"5 year old male visits",
"pediatrician",
"check-up",
"height",
"99th percentile",
"age",
"pubic hair",
"present",
"physical examination",
"Serum renin",
"potassium levels",
"high",
"17-hydroxyprogesterone",
"following",
"likely deficient",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 5-year-old male visits his pediatrician for a check-up. His height corresponds to the 99th percentile for his age, and pubic hair is present upon physical examination. Serum renin and potassium levels are high, as is 17-hydroxyprogesterone. Which of the following is likely deficient in this patient?
Choose one of the following::
A. 17a-hydroxylase
B. 21-hydroxylase
C. Aromatase
D. 5a-reductase | [
0.03397500887513161,
-0.05893847346305847,
-0.011820327490568161,
0.02910851314663887,
-0.014514225535094738,
0.0020651454105973244,
0.012003441341221333,
0.006244894582778215,
-0.024563847109675407,
-0.004371765069663525,
0.08481709659099579,
-0.02393823117017746,
-0.003996061626821756,
-0.09881617873907089,
-0.031892675906419754,
0.02934940718114376,
-0.019933415576815605,
-0.001592436688952148,
0.05222592502832413,
-0.03089224547147751,
-0.021598901599645615,
-0.006305762100964785,
0.013524402864277363,
-0.05305158346891403,
-0.005713635589927435,
0.002262670313939452,
0.05297490581870079,
-0.01344416942447424,
-0.023664643988013268,
0.004886483307927847,
0.02610785886645317,
0.027811776846647263,
0.01664428785443306,
-0.08078476786613464,
0.000001533894874228281,
-0.040163151919841766,
0.0305568128824234,
0.01138713862746954,
0.03892026096582413,
0.011205109767615795,
-0.050877299159765244,
-0.039021994918584824,
-0.01927614025771618,
0.0011778083862736821,
0.05621860921382904,
-0.013687727972865105,
0.006886472459882498,
0.018760962411761284,
-0.01206220779567957,
-0.00650792894884944,
0.006964204832911491,
0.06608936935663223,
-0.009065634571015835,
0.04675566405057907,
0.10149703919887543,
-0.03479185327887535,
-0.02448851987719536,
0.043989796191453934,
0.01634869910776615,
0.04033539816737175,
0.025268705561757088,
-0.014336972497403622,
0.003644287120550871,
0.028003759682178497,
-0.0340980589389801,
0.007149045355618,
0.06957114487886429,
-0.04169916734099388,
0.0026917990762740374,
-0.012247433885931969,
-0.00595116289332509,
0.08315659314393997,
0.03605073690414429,
0.05832335725426674,
-0.04937507584691048,
-0.0019212504848837852,
-0.00018666427058633417,
-0.02098512090742588,
-0.016435913741588593,
-0.006087791174650192,
-0.007360037416219711,
-0.0008938254904933274,
-0.007526817731559277,
0.020607206970453262,
0.019937664270401,
-0.018040362745523453,
0.033841196447610855,
-0.012734330259263515,
-0.039879411458969116,
0.0023186092730611563,
-0.03433912619948387,
-0.041348669677972794,
0.012076055631041527,
-0.0046137189492583275,
-0.013189852237701416,
-0.011248779483139515,
-0.011288544163107872,
-0.061995550990104675,
0.08477704226970673,
-0.04790369048714638,
-0.021337086334824562,
-0.014993911609053612,
0.019645344465970993,
-0.006134231574833393,
-0.03849268704652786,
0.04803811013698578,
0.01987931691110134,
-0.01312197558581829,
-0.01487113256007433,
0.04809775948524475,
0.02629786543548107,
0.013260283507406712,
-0.021483205258846283,
0.041154470294713974,
0.07214392721652985,
0.009122646413743496,
-0.039255283772945404,
-0.02654569409787655,
-0.0014918993692845106,
0.006395568139851093,
-0.012936295941472054,
0.05086708813905716,
-0.016774583607912064,
-0.012507542967796326,
-0.025158163160085678,
0.06768143177032471,
-0.028432205319404602,
0.001637741457670927,
0.00014795958122704178,
-0.007897399365901947,
0.02885730005800724,
-0.027223117649555206,
-0.008219968527555466,
-0.002889330731704831,
-0.034390199929475784,
-0.008436220698058605,
0.03449741378426552,
0.08075609058141708,
-0.0003647888370323926,
-0.02814541570842266,
-0.018711749464273453,
-0.06542086601257324,
-0.0105869360268116,
0.0193893201649189,
0.014016637578606606,
0.05514249578118324,
-0.022215377539396286,
-0.02041667141020298,
0.042777832597494125,
0.03818494826555252,
0.0290710236877203,
0.0033359015360474586,
0.06340096890926361,
-0.02248375490307808,
0.014144445769488811,
0.022206991910934448,
0.001515798270702362,
0.0025747984182089567,
0.01999484933912754,
-0.03243551403284073,
0.012987149879336357,
-0.05498802289366722,
-0.02053724229335785,
-0.03035820834338665,
0.010153699666261673,
-0.000763992196880281,
0.04293661564588547,
0.00681986752897501,
-0.06852246075868607,
0.06261026859283447,
0.005093799903988838,
0.022104568779468536,
-0.0051242271438241005,
-0.011321044526994228,
-0.029764771461486816,
0.10633976012468338,
0.017874419689178467,
0.0018488529603928328,
-0.01723337732255459,
-0.012750010006129742,
-0.0009441297734156251,
0.017810696735978127,
0.02520556002855301,
-0.023879509419202805,
-0.044081881642341614,
0.024370701983571053,
-0.040533535182476044,
-0.027388373389840126,
0.024106215685606003,
-0.028879113495349884,
-0.04639299213886261,
0.02299421653151512,
-0.04246613755822182,
-0.033353205770254135,
0.010319375433027744,
0.03167328983545303,
0.005738215986639261,
-0.026656238362193108,
-0.024525899440050125,
-0.014996571466326714,
0.04279184713959694,
-0.010470699518918991,
0.0068955556489527225,
0.038941558450460434,
-0.04501297324895859,
0.01852589100599289,
0.0072878762148320675,
0.03807941824197769,
-0.016420681029558182,
-0.028585974127054214,
0.02466634474694729,
0.03148094192147255,
0.06405019760131836,
-0.046381670981645584,
0.025844700634479523,
0.027183009311556816,
-0.004290893208235502,
0.012132290750741959,
-0.0871044471859932,
0.03309565410017967,
0.010331894271075726,
-0.05123952403664589,
-0.008979523554444313,
0.00886704120784998,
-0.06385531276464462,
-0.012412362731993198,
-0.02448216825723648,
0.0055961087346076965,
-0.051123492419719696,
-0.06956188380718231,
0.03474312275648117,
0.02554282359778881,
-0.04727883264422417,
0.0018073739483952522,
0.013744146563112736,
-0.06252816319465637,
0.06456427276134491,
-0.027898237109184265,
0.0032077094074338675,
0.001138594700023532,
-0.02232218347489834,
-0.008697409182786942,
-0.049408551305532455,
-0.03406631574034691,
0.030373163521289825,
-0.03121677041053772,
0.008606044575572014,
0.016629943624138832,
-0.0650155320763588,
0.038802389055490494,
-0.029597120359539986,
-0.01702900603413582,
0.00678807869553566,
0.06730395555496216,
0.012614733539521694,
0.04119643568992615,
-0.06454264372587204,
0.011118590831756592,
-0.0775921568274498,
-0.007836869917809963,
-0.01423240453004837,
0.03477775678038597,
-0.0048925913870334625,
0.003275069408118725,
-0.02304822765290737,
-0.035115696489810944,
-0.019495761021971703,
0.07859504967927933,
-0.03489074483513832,
0.03635405749082565,
0.01632526144385338,
-0.013302012346684933,
0.00010277343972120434,
0.015040510334074497,
-0.045476458966732025,
0.03504170849919319,
-0.005120634101331234,
0.023017656058073044,
0.052615366876125336,
0.03073403425514698,
0.013856219127774239,
0.06468106806278229,
0.012102643959224224,
-0.004060143139213324,
0.03799339756369591,
-0.0250217504799366,
0.02149900794029236,
0.04777975752949715,
0.05983329191803932,
0.030887048691511154,
-0.05236773565411568,
-0.009409694001078606,
0.04852360486984253,
-0.01992345042526722,
0.009769698604941368,
0.023288553580641747,
-0.01044474821537733,
0.03703782334923744,
-0.02027193084359169,
0.025234689936041832,
0.01003533136099577,
0.028420142829418182,
-0.014828220941126347,
-0.02177213318645954,
0.022443214431405067,
0.00636858819052577,
0.05732418969273567,
-0.02047945186495781,
0.004351761192083359,
0.024898424744606018,
0.028996948152780533,
-0.0032123581040650606,
-0.00514617282897234,
0.0033351138699799776,
-0.020830167457461357,
0.007240427192300558,
-0.03553200513124466,
-0.01674610748887062,
0.032150886952877045,
0.09499340504407883,
0.02373741939663887,
-0.0015047159977257252,
-0.009112169034779072,
-0.003799211932346225,
-0.025348402559757233,
-0.047581568360328674,
0.009335859678685665,
0.060813058167696,
-0.07222632318735123,
0.0005282755009829998,
-0.0037504357751458883,
-0.02495587058365345,
-0.04358082637190819,
-0.03822648152709007,
0.017989251762628555,
0.03633229807019234,
-0.02931693196296692,
-0.021131731569767,
-0.035510119050741196,
0.011688967235386372,
0.010800794698297977,
-0.05152243748307228,
-0.000881126441527158,
-0.03461430221796036,
0.0609484501183033,
-0.017074303701519966,
-0.04809631034731865,
-0.049587395042181015,
-0.006593650672584772,
0.004212937317788601,
-0.052531708031892776,
0.03893403708934784,
0.012550837360322475,
-0.004473415669053793,
-0.03255632519721985,
0.00010963057866320014,
0.05443479120731354,
0.021918846294283867,
-0.02734760008752346,
0.017723258584737778,
0.004731707740575075,
0.06322809308767319,
-0.006507072132080793,
0.04257083311676979,
0.033116813749074936,
0.018150528892874718,
-0.008523794822394848,
-0.0074851359240710735,
-0.026698676869273186,
-0.02217712812125683,
-0.042388562113046646,
-0.0029243251774460077,
0.006911539006978273,
0.008386081084609032,
-0.018939180299639702,
0.01957966946065426,
0.013483689166605473,
-0.06648574024438858,
-0.09936434030532837,
-0.009596302174031734,
0.06173189729452133,
-0.013273796997964382,
0.08558572828769684,
0.007467476651072502,
0.0019595895428210497,
-0.0018666207324713469,
-0.03899839520454407,
-0.04370390251278877,
-0.02480534091591835,
0.03327876701951027,
0.0307333804666996,
-0.008060560561716557,
-0.055346742272377014,
-0.00860076118260622,
0.016348015516996384,
0.09614593535661697,
0.024909067898988724,
-0.0013467217795550823,
0.005660826340317726,
0.052525799721479416,
0.002607631031423807,
0.0004662901919800788,
-0.05729842931032181,
0.07021263241767883,
0.03552006185054779,
-0.05184226855635643,
-0.031130461022257805,
0.00559039693325758,
0.03365103527903557,
0.03290233016014099,
-0.007523604203015566,
-0.04753978177905083,
-0.021167056635022163,
-0.021182337775826454,
-0.011381153017282486,
0.022350691258907318,
-0.023618552833795547,
-0.08267629146575928,
0.032496776431798935,
-0.06105857342481613,
0.05461836978793144,
0.0025598674546927214,
0.0032583086285740137,
-0.008184813894331455,
-0.00769673241302371,
0.00813273899257183,
0.10099691152572632,
0.005673663690686226,
0.006139811128377914,
0.03794596344232559,
0.021115822717547417,
-0.04643014818429947,
0.02682626061141491,
0.07778255641460419,
-0.049600545316934586,
0.05947062745690346,
-0.06754659861326218,
0.027841858565807343,
0.03025645576417446,
-0.05070526897907257,
-0.00638082018122077,
-0.0025294346269220114,
0.038041844964027405,
0.001694719772785902,
-0.049269214272499084,
-0.028635414317250252,
0.01502962876111269,
0.06937335431575775,
0.03951472416520119,
0.09317728132009506,
-0.04368545487523079,
0.028245393186807632,
0.025550927966833115,
-0.007388385944068432,
-0.015490970574319363,
-0.01765289530158043,
-0.02550802379846573,
-0.022428574040532112,
-0.00048632186371833086,
-0.060473453253507614,
-0.02901080995798111,
0.020460935309529305,
-0.03138573467731476,
-0.06270013004541397,
-0.019274728372693062,
-0.023772703483700752,
-0.015685444697737694,
0.0072505236603319645,
-0.001011599670164287,
-0.05715019628405571,
-0.04892024025321007,
0.02645227499306202,
-0.00835090596228838,
0.007814745418727398,
-0.019787481054663658,
-0.035815831273794174,
-0.06646041572093964,
-0.030332813039422035,
0.014041691087186337,
0.027878684923052788,
0.0063702939078211784,
0.026399636641144753,
-0.010731388814747334,
-0.02211328223347664,
-0.00956178829073906,
0.015850093215703964,
-0.007004635874181986,
-0.003012377768754959,
0.010906381532549858,
-0.030129030346870422,
-0.02374529279768467,
0.05315419286489487,
-0.016256682574748993,
0.01163787767291069,
0.0005010643508285284,
0.02507251873612404,
0.007983394898474216,
0.011005488224327564,
0.008776133880019188,
-0.02854313515126705,
0.028229976072907448,
0.01905701868236065,
-0.02126837894320488,
-0.02130725048482418,
0.004001149442046881,
0.1045718565583229,
-0.07019747048616409,
0.012496406212449074,
-0.052340492606163025,
-0.033696115016937256,
-0.02586817741394043,
-0.038457609713077545,
-0.01435790490359068,
-0.024772170931100845,
-0.0014844536781311035,
-0.03591718524694443,
-0.06271509826183319,
-0.012988771311938763,
-0.017306314781308174,
-0.030723080039024353,
-0.008545240387320518,
-0.032548096030950546,
-0.04318694397807121,
0.026161987334489822,
0.023995256051421165,
0.044253040105104446,
0.035155825316905975,
-0.005346503108739853,
-0.021155640482902527,
0.06129992753267288,
0.03206725791096687,
-0.026406418532133102,
-0.06307321786880493,
-0.025065025314688683,
-0.005846390035003424,
0.03719675913453102,
-0.02065505087375641,
-0.001273542526178062,
-0.018129751086235046,
-0.018535066395998,
-0.013318048790097237,
-0.02142280898988247,
0.016106203198432922,
-0.029094496741890907,
-0.031027670949697495,
0.03392065316438675,
-0.09198391437530518,
-0.002174482448026538,
0.02196083776652813,
-0.051176443696022034,
0.015480360947549343,
0.04366770759224892,
0.005447509232908487,
0.04834245145320892,
0.023833274841308594,
-5.025614875299527e-33,
0.020298853516578674,
-0.0515543669462204,
0.0029259994626045227,
-0.029109155759215355,
0.032979778945446014,
0.07245046645402908,
-0.01602841541171074,
0.0009279771475121379,
-0.007715144194662571,
0.02085833065211773,
0.0128294313326478,
0.022132379934191704,
0.03195083886384964,
0.054755233228206635,
0.01740690879523754,
-0.03373551368713379,
0.004118826240301132,
-0.06443443149328232,
0.052618615329265594,
-0.02391822263598442,
0.0188737902790308,
0.009052710607647896,
0.02897886373102665,
0.03827955946326256,
0.0053284610621631145,
-0.09337392449378967,
0.06647074222564697,
-0.005643089767545462,
-0.03717980533838272,
0.007571847643703222,
0.04051877185702324,
0.029748905450105667,
-0.015127395279705524,
0.0028736074455082417,
-0.01710178144276142,
-0.04176829755306244,
-0.018300602212548256,
-0.038107044994831085,
0.020875530317425728,
-0.03168540447950363,
-0.023180384188890457,
0.03777080029249191,
0.057918988168239594,
0.01954360492527485,
0.06503693014383316,
-0.09807809442281723,
-0.007225333247333765,
-0.022352972999215126,
-0.020156338810920715,
-0.031242650002241135,
-0.03589688614010811,
-0.0071067530661821365,
-0.005271106027066708,
0.012193880043923855,
-0.004959995858371258,
0.09388409554958344,
-0.011622507125139236,
0.02417062409222126,
-0.024876616895198822,
0.01695186272263527,
-0.026233434677124023,
0.005660748574882746,
0.025392573326826096,
-0.014718079939484596,
-0.0006022530142217875,
-0.008990672416985035,
-0.0065360404551029205,
0.04037308320403099,
-0.035046305507421494,
0.013372281566262245,
-0.0584716722369194,
-0.023735051974654198,
0.00886538065969944,
-0.07137206196784973,
0.03967415541410446,
-0.0031287248712033033,
-0.040254607796669006,
-0.009893840178847313,
0.05068100243806839,
0.09059149771928787,
-0.08640719950199127,
-0.022892646491527557,
-0.06337156146764755,
-0.024469446390867233,
-0.021637527272105217,
-0.013074894435703754,
-0.009279966354370117,
-0.07391361147165298,
0.0037971579004079103,
-0.05448535457253456,
0.04384014755487442,
0.04282725229859352,
-0.0036022060085088015,
0.04869547486305237,
-0.005593364126980305,
-0.030565006658434868,
0.1013866439461708,
-0.006140767131000757,
-0.020488746464252472,
-0.02132261171936989,
0.06581657379865646,
0.009723409079015255,
0.07708379626274109,
-0.03775722160935402,
-0.02496708743274212,
-0.0077578541822731495,
-0.030175480991601944,
-0.017762470990419388,
-0.02802235446870327,
-0.021198473870754242,
-0.011762095615267754,
0.03876085951924324,
0.027496615424752235,
0.02025967836380005,
-0.0325910858809948,
0.0263160802423954,
0.034623704850673676,
0.07071737200021744,
0.03330452740192413,
0.055215977132320404,
0.01919523812830448,
0.04251312464475632,
0.029598407447338104,
-0.03476135432720184,
0.0011852507013827562,
-0.04667680710554123,
0.0327673964202404,
0.0635504350066185,
-0.04092482104897499,
0.02683253586292267,
0.034880176186561584,
-0.037262313067913055,
2.394607179212471e-7,
0.005991301964968443,
-0.018565524369478226,
-0.014112396165728569,
-0.14144955575466156,
0.04446885362267494,
-0.0955505520105362,
-0.004205003380775452,
-0.019562706351280212,
0.021310869604349136,
-0.03754020109772682,
0.07548869401216507,
-0.013352119363844395,
-0.010860888287425041,
0.02928624302148819,
0.05640446022152901,
0.005623725708574057,
0.010669632814824581,
-0.05352293327450752,
0.0552901029586792,
0.01764935813844204,
0.015751400962471962,
-0.032301776111125946,
-0.0680602565407753,
-0.034693118184804916,
0.031215468421578407,
-0.022852009162306786,
-0.01985829323530197,
-0.02874319814145565,
-0.024859579280018806,
0.005615704692900181,
0.024896733462810516,
0.011220639571547508,
0.05257313326001167,
0.05844969302415848,
-0.03768862038850784,
-0.019612617790699005,
0.017506638541817665,
0.048324037343263626,
-0.02102089859545231,
0.011209201999008656,
-0.03976484015583992,
0.0742780864238739,
-0.01843903586268425,
0.060502756386995316,
-0.013944909907877445,
0.006923251785337925,
0.002811094280332327,
0.0004026234964840114,
-0.0018971414538100362,
-0.03209463506937027,
0.031420379877090454,
-0.01132554467767477,
0.01634346693754196,
0.07632439583539963,
-0.025765834376215935,
0.00980026088654995,
0.0012347507290542126,
0.023470217362046242,
0.04221503809094429,
0.04195944592356682,
-0.04512901231646538,
-0.05846473202109337,
-0.0024314611218869686,
0.01758859120309353,
0.06102632358670235,
0.023113856092095375,
-0.01685219630599022,
1.2868456934744432e-34,
-0.03554292023181915,
-0.024969855323433876,
-0.003499926533550024,
-0.06593291461467743,
0.020772168412804604,
0.031157398596405983,
-0.010370255447924137,
-0.013454420492053032,
-0.014357469975948334,
-0.05228135734796524,
-0.003063066629692912
] | {
"ds_index": 81,
"similar_dg_indices": [
516102,
647625,
727197,
992493,
765103,
380886,
1080222,
1023663,
815603,
129426,
982931,
611548,
502232,
1075447,
36819,
391321,
280920,
930323,
748052,
431762
]
} |
A 41-year-old African American woman presents with her husband to her primary care doctor for evaluation of depression and anxiety. She reports a 2-week history of rapid onset sadness with no clear inciting factor. She is accompanied by her husband who notes that she has had at least three similar episodes that have occurred over the past two years. He also notes that she has been “more emotional” lately and seems confused throughout the day. She has had to leave her job as a librarian at her child’s elementary school. Her past medical history is notable for two diagnostic laparoscopies for recurrent episodes of abdominal pain of unknown etiology. Her family history is notable for psychosis in her mother and maternal grandfather. Her temperature is 99°F (37.2°C), blood pressure is 125/75 mmHg, pulse is 75/min, and respirations are 17/min. On exam, she is disheveled and appears confused and disoriented. Her attention span is limited and she exhibits emotional lability. This patient’s condition is most likely due to a defect in an enzyme that metabolizes which of the following compounds? | Porphobilinogen | {
"A": "Coproporphyrinogen III",
"B": "Hydroxymethylbilane",
"C": "Porphobilinogen",
"D": "Protoporphyrin IX"
} | step1 | C | [
"year old African American woman presents",
"husband",
"primary care doctor",
"evaluation",
"depression",
"anxiety",
"reports",
"2-week history",
"rapid onset sadness",
"clear",
"factor",
"husband",
"notes",
"three similar episodes",
"occurred",
"past two years",
"notes",
"more emotional",
"confused",
"day",
"to leave",
"job",
"librarian",
"childs elementary school",
"past medical history",
"notable",
"two diagnostic laparoscopies",
"recurrent episodes of abdominal pain",
"unknown etiology",
"family history",
"notable",
"psychosis",
"mother",
"maternal grandfather",
"temperature",
"blood pressure",
"75 mmHg",
"pulse",
"75 min",
"respirations",
"min",
"exam",
"appears confused",
"disoriented",
"attention span",
"limited",
"exhibits emotional lability",
"patients condition",
"most likely due to",
"defect",
"enzyme",
"following compounds"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 41-year-old African American woman presents with her husband to her primary care doctor for evaluation of depression and anxiety. She reports a 2-week history of rapid onset sadness with no clear inciting factor. She is accompanied by her husband who notes that she has had at least three similar episodes that have occurred over the past two years. He also notes that she has been “more emotional” lately and seems confused throughout the day. She has had to leave her job as a librarian at her child’s elementary school. Her past medical history is notable for two diagnostic laparoscopies for recurrent episodes of abdominal pain of unknown etiology. Her family history is notable for psychosis in her mother and maternal grandfather. Her temperature is 99°F (37.2°C), blood pressure is 125/75 mmHg, pulse is 75/min, and respirations are 17/min. On exam, she is disheveled and appears confused and disoriented. Her attention span is limited and she exhibits emotional lability. This patient’s condition is most likely due to a defect in an enzyme that metabolizes which of the following compounds?
Choose one of the following::
A. Coproporphyrinogen III
B. Hydroxymethylbilane
C. Porphobilinogen
D. Protoporphyrin IX | [
0.043957535177469254,
0.007236756384372711,
0.03671642020344734,
-0.011015169322490692,
0.05065913498401642,
0.04011862725019455,
-0.02250407077372074,
0.04264139384031296,
0.05330536514520645,
-0.03502263128757477,
0.012714085169136524,
0.03235090523958206,
-0.018774257972836494,
0.014035740867257118,
-0.01563144475221634,
-0.0004453535075299442,
-0.02073548547923565,
0.08170352131128311,
-0.02998846024274826,
0.00992224644869566,
-0.04711123928427696,
0.03854344040155411,
0.05018891394138336,
0.008000332862138748,
0.02029048092663288,
-0.020696178078651428,
0.018812958151102066,
0.014140905812382698,
0.0061894794926047325,
-0.01674678549170494,
-0.030264345929026604,
0.01617077738046646,
-0.03318927809596062,
-0.05260094255208969,
0.0000022634949345956556,
-0.012454868294298649,
-0.029338175430893898,
-0.007497288286685944,
-0.022730378434062004,
-0.09924193471670151,
0.008517203852534294,
-0.08929307758808136,
0.027636371552944183,
-0.02251138910651207,
0.012771233916282654,
-0.0867580845952034,
0.014898397959768772,
0.03220190107822418,
-0.005177466198801994,
0.003637960646301508,
0.018370207399129868,
0.05097031593322754,
-0.023809801787137985,
-0.0008931499323807657,
0.09022223204374313,
-0.00743030896410346,
0.02907407097518444,
-0.002686921274289489,
0.009121963754296303,
-0.05015215277671814,
0.0017444584518671036,
-0.04917371645569801,
-0.02624151110649109,
0.04708471894264221,
-0.009590555913746357,
0.013244979083538055,
0.03935462608933449,
-0.0860242173075676,
0.009487400762736797,
0.02883051708340645,
0.009340133517980576,
0.04304724186658859,
0.06773292273283005,
0.09933106601238251,
-0.055854592472314835,
0.001268330030143261,
0.03371560573577881,
0.01583576574921608,
-0.01889791712164879,
-0.002429890213534236,
0.08463102579116821,
0.012282461859285831,
0.004229582380503416,
0.016833646222949028,
0.03964472934603691,
0.002478474983945489,
-0.010095720179378986,
-0.009822681546211243,
-0.0038792218547314405,
-0.04671349376440048,
-0.05780632421374321,
-0.046785350888967514,
0.05617727339267731,
-0.015408148057758808,
-0.08575000613927841,
0.013753405772149563,
-0.020287467166781425,
-0.04170163348317146,
-0.022977571934461594,
-0.02220577746629715,
-0.04775480553507805,
0.006897876504808664,
-0.028948122635483742,
0.006591447629034519,
-0.027284853160381317,
0.02218846045434475,
-0.0011016437783837318,
-0.0010366607457399368,
-0.0606263242661953,
0.038671743124723434,
0.003855631221085787,
0.059831757098436356,
-0.04555722698569298,
0.005799715872853994,
0.05280887335538864,
-0.033967796713113785,
-0.04793310537934303,
-0.05877411365509033,
-0.04638834297657013,
0.07112675160169601,
-0.02775111421942711,
0.034472186118364334,
0.016271378844976425,
0.036667779088020325,
0.029309106990695,
0.02675182744860649,
-0.03227291628718376,
-0.0453033372759819,
0.023579798638820648,
-0.03520502895116806,
0.02229916676878929,
-0.045370668172836304,
-0.06397328525781631,
0.008120467886328697,
-0.0006507363286800683,
0.023441556841135025,
0.05209530517458916,
0.05299864336848259,
-0.08807896077632904,
-0.04564454406499863,
0.00809031818062067,
-0.043520670384168625,
-0.006119667086750269,
0.015689870342612267,
-0.020627513527870178,
0.033750660717487335,
0.02101162262260914,
-0.023392481729388237,
0.013088248670101166,
0.007160979323089123,
-0.02817440591752529,
0.013870193623006344,
-0.02863054908812046,
-0.012258706614375114,
0.02761334739625454,
0.03366357833147049,
0.029206277802586555,
-0.012659185566008091,
-0.026960404589772224,
-0.0038200959097594023,
0.05246215686202049,
-0.025022165849804878,
0.023049527779221535,
-0.04516543447971344,
0.011605164036154747,
-0.01875521056354046,
0.07146117836236954,
0.020180169492959976,
-0.026802169159054756,
0.05085228383541107,
-0.01597720943391323,
-0.011996833607554436,
0.006320035085082054,
0.003555309260264039,
-0.07277052849531174,
0.057753320783376694,
-0.03956310823559761,
0.02353525348007679,
-0.004336141515523195,
-0.005696731619536877,
-0.017874334007501602,
-0.015933794900774956,
-0.017717013135552406,
-0.015936627984046936,
-0.06433693319559097,
-0.035381972789764404,
0.014695840887725353,
0.005370223894715309,
0.010300101712346077,
-0.009328320622444153,
0.011427953839302063,
0.01581363007426262,
-0.02664525806903839,
-0.020044416189193726,
-0.055825088173151016,
-0.01060812920331955,
-0.029716957360506058,
0.019355567172169685,
0.0025497160386294127,
0.00426738103851676,
-0.0475771501660347,
0.0365106500685215,
0.01088569313287735,
0.09684578329324722,
-0.06796487420797348,
0.07246657460927963,
0.026017986238002777,
-0.0048550795763731,
0.023314662277698517,
-0.01518728956580162,
0.012201370671391487,
-0.002245123265311122,
0.044825706630945206,
-0.038162726908922195,
0.03559650853276253,
0.026177415624260902,
0.040454763919115067,
0.028516683727502823,
-0.06531223654747009,
0.06183546036481857,
-0.01892564259469509,
-0.030919460579752922,
0.0491706058382988,
-0.017870290204882622,
-0.0544891282916069,
-0.04250338673591614,
0.019312575459480286,
-0.014873301610350609,
0.012374685145914555,
-0.036430809646844864,
0.046671491116285324,
0.03907358646392822,
-0.04196165129542351,
0.02121841162443161,
-0.02884182706475258,
0.005772644653916359,
0.035901520401239395,
-0.040482986718416214,
-0.028606222942471504,
0.07054059952497482,
0.024481087923049927,
0.03406911715865135,
-0.05523792654275894,
-0.05179159715771675,
0.04491220414638519,
0.008139087818562984,
-0.020593980327248573,
0.040054380893707275,
-0.031134627759456635,
0.05684517323970795,
0.011886188760399818,
0.00040303668356500566,
0.01741202548146248,
0.020464390516281128,
0.02043011225759983,
0.07125017791986465,
-0.051920000463724136,
0.0075021847151219845,
-0.02274402230978012,
-0.04466468095779419,
-0.05166766047477722,
0.04816652461886406,
0.009079352021217346,
-0.06703581660985947,
-0.08051035553216934,
-0.015638407319784164,
0.003905221354216337,
0.029715394601225853,
0.007123753894120455,
0.014520994387567043,
0.007646914571523666,
-0.005912687163800001,
0.009519888088107109,
-0.007880170829594135,
-0.02062932960689068,
0.02230963483452797,
-0.0038029567804187536,
0.057099584490060806,
0.07915137708187103,
-0.03553096950054169,
0.019241489470005035,
0.029368937015533447,
-0.016100410372018814,
0.01191793754696846,
0.0033317995257675648,
0.02476728893816471,
-0.06132684648036957,
-0.002845521317794919,
0.049395039677619934,
0.04060310497879982,
0.007061302661895752,
0.007957967929542065,
0.002559640211984515,
-0.040770623832941055,
-0.01920395717024803,
-0.019601641222834587,
-0.04304073378443718,
0.0883370116353035,
-0.05389765650033951,
0.08213578164577484,
-0.010223501361906528,
-0.012379102408885956,
0.01835789531469345,
-0.008610621094703674,
0.026640044525265694,
0.06337764114141464,
0.02496902085840702,
-0.025461584329605103,
-0.04489120841026306,
0.04279422387480736,
0.018093066290020943,
0.008873790502548218,
-0.01873180828988552,
-0.020940661430358887,
-0.00978994369506836,
-0.013047871179878712,
0.019250229001045227,
-0.07823080569505692,
0.033560968935489655,
0.003591111395508051,
0.01371818594634533,
-0.015110984444618225,
-0.019015081226825714,
-0.006284414324909449,
-0.011524560861289501,
-0.02554170787334442,
0.005388373043388128,
0.03437582403421402,
-0.04809129610657692,
-0.021700942888855934,
-0.010268040932714939,
-0.012736966833472252,
0.011482791043817997,
0.04761549085378647,
-0.016033053398132324,
-0.06864754110574722,
-0.04807167500257492,
0.008724506944417953,
-0.04993541166186333,
-0.024174848571419716,
0.045229338109493256,
-0.0031058683525770903,
0.0277415681630373,
0.07022421061992645,
0.0009156511514447629,
-0.022303974255919456,
-0.046111077070236206,
0.02255619876086712,
-0.024140264838933945,
0.009536060504615307,
-0.05107817426323891,
-0.0036469269543886185,
-0.013901220634579659,
-0.006506639998406172,
0.01717817783355713,
-0.059721581637859344,
0.05944984778761864,
-0.025106290355324745,
-0.005477655213326216,
-0.022373966872692108,
0.019633453339338303,
0.03267337381839752,
-0.006821737624704838,
0.025013167411088943,
0.02596738189458847,
0.038621686398983,
0.00663392897695303,
0.0036577251739799976,
-0.059268418699502945,
-0.03261573240160942,
-0.025171581655740738,
0.0010721998987719417,
-0.03744940087199211,
0.08642769604921341,
-0.015679707750678062,
-0.018009867519140244,
0.04672332853078842,
-0.04956081137061119,
-0.10319216549396515,
-0.01873192936182022,
0.053659211844205856,
-0.024101121351122856,
0.022984258830547333,
-0.021472491323947906,
0.009400693699717522,
0.005944558419287205,
-0.013132943771779537,
-0.020689846947789192,
0.03949390724301338,
0.008486556820571423,
-0.008190921507775784,
0.02052507922053337,
-0.03340580314397812,
0.00999333057552576,
0.004729518201202154,
-0.01529728900641203,
-0.019988473504781723,
-0.06340144574642181,
0.03565851226449013,
0.0733552798628807,
0.023916402831673622,
-0.03594302386045456,
-0.03640734404325485,
0.07004517316818237,
0.07722587883472443,
-0.021714331582188606,
-0.06602828949689865,
-0.0009984979405999184,
0.05185313522815704,
0.034962479025125504,
0.03983764350414276,
-0.057233747094869614,
0.01906818151473999,
0.01339617371559143,
0.05291813984513283,
-0.042366765439510345,
0.017754072323441505,
-0.06988268345594406,
0.0749717727303505,
-0.10981698334217072,
0.058909256011247635,
-0.04361690953373909,
-0.02019166387617588,
-0.018370000645518303,
0.016863439232110977,
-0.007370178122073412,
0.04939224570989609,
0.014684651978313923,
0.02052609995007515,
0.061783138662576675,
0.06223852187395096,
-0.03848351538181305,
0.029874444007873535,
0.0928696021437645,
-0.038534946739673615,
0.02894212119281292,
0.049194782972335815,
-0.009291496127843857,
-0.03219658508896828,
-0.014042125083506107,
-0.03768731653690338,
0.02446984127163887,
0.042054854333400726,
0.0029610078781843185,
-0.03324465826153755,
-0.017490191385149956,
0.007544900756329298,
0.0201878622174263,
0.05568171665072441,
0.13228510320186615,
0.01949996128678322,
0.051344819366931915,
0.006579951383173466,
0.017770985141396523,
0.025896461680531502,
-0.01951139234006405,
-0.02871161885559559,
-0.06484129279851913,
0.0506448894739151,
0.02917555160820484,
-0.016189897432923317,
0.022873055189847946,
-0.03014099784195423,
-0.027565661817789078,
0.0033596204593777657,
-0.06607963889837265,
-0.05641305819153786,
0.02328144572675228,
-0.039422571659088135,
-0.03677993640303612,
-0.00047077200724743307,
0.03906204178929329,
0.01376624871045351,
0.005872081965208054,
0.04010537639260292,
0.025522181764245033,
-0.041527483612298965,
-0.017704680562019348,
-0.002862813649699092,
0.028428178280591965,
-0.011894360184669495,
-0.025868605822324753,
-0.03450547158718109,
-0.07259856164455414,
0.007433407008647919,
0.0017119348049163818,
0.026968151330947876,
0.0036791402380913496,
-0.02746869996190071,
-0.009793026372790337,
-0.018298542127013206,
-0.029937220737338066,
-0.005508780479431152,
-0.08958236873149872,
-0.031187521293759346,
-0.018928619101643562,
-0.0006763094570487738,
0.07458687573671341,
-0.014534971676766872,
-0.03839009255170822,
0.036559153348207474,
0.023811619728803635,
0.03449690714478493,
-0.0016184179112315178,
-0.020760299637913704,
0.04850490763783455,
-0.0346829816699028,
0.04885345697402954,
-0.041691042482852936,
-0.03216687589883804,
0.03459201753139496,
0.009375358000397682,
-0.03444491699337959,
-0.00007434475992340595,
0.0018162318738177419,
-0.058704473078250885,
-0.037182360887527466,
-0.046754706650972366,
0.01639956422150135,
-0.028906501829624176,
0.022946106269955635,
-0.026944870129227638,
-0.02881450764834881,
-0.00444022985175252,
-0.031089890748262405,
-0.004500841721892357,
-0.019518420100212097,
0.03328009322285652,
-0.0337679497897625,
0.0542970709502697,
-0.06416019797325134,
0.06526146084070206,
-0.03483528643846512,
-0.04457172006368637,
-0.02483547106385231,
0.021837808191776276,
-0.01691943034529686,
0.005680854432284832,
0.005586699582636356,
-0.05795431137084961,
-0.01022806204855442,
0.02094910852611065,
0.02911340445280075,
-0.02295662648975849,
-0.02705112285912037,
0.010137076489627361,
-0.015490098856389523,
0.03064958192408085,
0.0055944472551345825,
-0.02406536042690277,
0.00625623669475317,
0.04738764464855194,
-0.04329819604754448,
0.024829424917697906,
0.02913082391023636,
-5.5094053710857785e-33,
0.04556634649634361,
-0.03066219389438629,
0.01488411147147417,
-0.06285587698221207,
0.003795637981966138,
0.05699753388762474,
-0.03640254586935043,
-0.058013275265693665,
-0.03132634609937668,
0.046469058841466904,
0.0008047707960940897,
0.016692446544766426,
0.014687887392938137,
0.04335017874836922,
-0.01239156536757946,
-0.03609365597367287,
0.012928472831845284,
0.012218251824378967,
0.0029028283897787333,
-0.021016806364059448,
-0.030296534299850464,
0.043018847703933716,
-0.014397475868463516,
0.00536107225343585,
-0.005372552201151848,
0.010632466524839401,
0.029303260147571564,
0.003316321410238743,
0.01598997786641121,
0.03709402307868004,
0.0004997039213776588,
0.004305512178689241,
0.03775985166430473,
-0.0009120977483689785,
-0.004453458823263645,
-0.06038960441946983,
-0.011526493355631828,
-0.02394808456301689,
0.006540892645716667,
-0.03278477117419243,
-0.04994823411107063,
-0.007740330416709185,
0.04362963140010834,
0.010372120887041092,
0.05985003337264061,
0.004501465708017349,
-0.021470248699188232,
-0.03580523654818535,
0.01568676345050335,
-0.011601495556533337,
0.02089979499578476,
0.01577969267964363,
0.035017214715480804,
0.014829030260443687,
-0.04017656296491623,
0.014000799506902695,
-0.013853458687663078,
-0.020196154713630676,
0.05168798193335533,
-0.02436198852956295,
-0.01130738016217947,
0.014838756062090397,
-0.03847236931324005,
-0.03182452917098999,
-0.0412881076335907,
0.020828673616051674,
0.0677245557308197,
0.04561610892415047,
-0.013956790789961815,
0.03409440442919731,
-0.08868976682424545,
0.012461495585739613,
-0.005979552399367094,
-0.07422593981027603,
-0.01482672430574894,
-0.00519529776647687,
0.08244691789150238,
0.02115045115351677,
0.006869248580187559,
0.01766141690313816,
-0.010507863014936447,
-0.040378931909799576,
-0.02558969520032406,
-0.021801436319947243,
-0.014021002687513828,
0.05501285567879677,
-0.009794095531105995,
-0.03565681725740433,
0.00842333771288395,
-0.02979540079832077,
0.052275195717811584,
0.0473920963704586,
0.01272754929959774,
0.005740501452237368,
-0.02120206132531166,
-0.05823478102684021,
0.06306086480617523,
0.05164789780974388,
0.012071831151843071,
-0.02113940380513668,
0.045846857130527496,
0.01209963671863079,
0.03625090792775154,
-0.016240937635302544,
0.006899599451571703,
0.01570812240242958,
-0.03741249069571495,
-0.026251956820487976,
-0.011421236209571362,
0.01133419293910265,
-0.0010612288024276495,
-0.024768995121121407,
-0.005025485064834356,
0.047686535865068436,
-0.042705610394477844,
0.034594837576150894,
0.04135595262050629,
0.02220616303384304,
0.04676339402794838,
0.05750000476837158,
0.03352699056267738,
0.009617447853088379,
0.012969430536031723,
-0.019283166155219078,
-0.05343560874462128,
-0.04849470406770706,
0.013491855934262276,
0.04581846296787262,
-0.012502782978117466,
-0.009356747381389141,
0.045726384967565536,
-0.031934164464473724,
3.125083196664491e-7,
-0.025650929659605026,
-0.0060996138490736485,
-0.007647665683180094,
-0.05303792655467987,
0.019248707219958305,
-0.045194897800683975,
-0.00831606425344944,
0.027914155274629593,
-0.03278380632400513,
-0.05602450668811798,
0.03499841317534447,
0.004949113354086876,
0.010341069661080837,
0.007325919810682535,
0.05265141651034355,
0.017416542395949364,
0.015078104101121426,
-0.020618991926312447,
-0.020871497690677643,
0.004464787896722555,
-0.029516857117414474,
0.017843008041381836,
-0.0380311980843544,
-0.004067383240908384,
0.013787900097668171,
0.03594940900802612,
-0.043764110654592514,
-0.02445390447974205,
-0.03178073465824127,
0.023987216874957085,
-0.0160252433270216,
0.027795162051916122,
0.0035178654361516237,
0.028689756989479065,
-0.038509126752614975,
-0.08771471679210663,
0.023645425215363503,
-0.009904557839035988,
-0.030599575489759445,
0.029377978295087814,
0.031078200787305832,
0.0158824659883976,
-0.02754376456141472,
0.06537354737520218,
-0.015548939816653728,
0.02895093336701393,
-0.05309811607003212,
0.01898062229156494,
-0.006337164901196957,
-0.018536008894443512,
0.002229375299066305,
0.0008173595415428281,
0.0014255677815526724,
0.08421047776937485,
-0.006595585960894823,
0.05084919556975365,
0.0033664717338979244,
-0.020080797374248505,
0.03904475271701813,
-0.02439824491739273,
-0.0029118566308170557,
-0.020283935591578484,
-0.03770111873745918,
-0.02480257675051689,
0.04547332227230072,
-0.07251312583684921,
-0.047585178166627884,
3.0212323920206635e-34,
0.0030536921694874763,
0.006973577663302422,
0.005544974002987146,
-0.04637306556105614,
-0.0017278053564950824,
-0.02913295477628708,
-0.05354031175374985,
-0.006520070601254702,
-0.015395982190966606,
-0.04329772666096687,
-0.04630061239004135
] | {
"ds_index": 82,
"similar_dg_indices": [
1051873,
521352,
102022,
883998,
683032,
662377,
584256,
458397,
398488,
982739,
1064772,
1080561,
220369,
1053454,
443266,
491140,
275563,
505530,
622346,
1114482
]
} |
A 32-year-old woman presents to her primary care physician for a general wellness appointment. The patient has no complaints currently and just wants to be sure that she is in good health. The patient has a past medical history of asthma, hypertension, and anxiety. Her current medications include albuterol, fluticasone, hydrochlorothiazide, lisinopril, and fexofenadine. Her temperature is 99.5°F (37.5°C), blood pressure is 165/95 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 98% on room air. On exam, you note a healthy young woman with a lean habitus. Cardiac exam reveals a S1 and S2 heart sound with a normal rate. Pulmonary exam is clear to auscultation bilaterally with good air movement. Abdominal exam reveals a bruit, normoactive bowel sounds, and an audible borborygmus. Neurological exam reveals cranial nerves II-XII as grossly intact with normal strength and reflexes in the upper and lower extremities. Which of the following is the best next step in management? | Ultrasound with doppler | {
"A": "Raise lisinopril dose",
"B": "Add furosemide",
"C": "Ultrasound with doppler",
"D": "No additional management needed"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"general wellness appointment",
"patient",
"complaints currently",
"to",
"sure",
"good health",
"patient",
"past medical",
"hypertension",
"anxiety",
"current medications include albuterol",
"fluticasone",
"hydrochlorothiazide",
"lisinopril",
"fexofenadine",
"temperature",
"99",
"blood pressure",
"95 mmHg",
"pulse",
"70 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"exam",
"note",
"healthy young woman",
"Cardiac exam reveals",
"S1",
"S2 heart",
"normal",
"Pulmonary exam",
"clear",
"auscultation",
"good air movement",
"Abdominal exam reveals",
"bruit",
"bowel sounds",
"borborygmus",
"Neurological exam reveals cranial nerves II XII",
"intact",
"normal strength",
"reflexes",
"upper",
"lower extremities",
"following",
"best next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 32-year-old woman presents to her primary care physician for a general wellness appointment. The patient has no complaints currently and just wants to be sure that she is in good health. The patient has a past medical history of asthma, hypertension, and anxiety. Her current medications include albuterol, fluticasone, hydrochlorothiazide, lisinopril, and fexofenadine. Her temperature is 99.5°F (37.5°C), blood pressure is 165/95 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 98% on room air. On exam, you note a healthy young woman with a lean habitus. Cardiac exam reveals a S1 and S2 heart sound with a normal rate. Pulmonary exam is clear to auscultation bilaterally with good air movement. Abdominal exam reveals a bruit, normoactive bowel sounds, and an audible borborygmus. Neurological exam reveals cranial nerves II-XII as grossly intact with normal strength and reflexes in the upper and lower extremities. Which of the following is the best next step in management?
Choose one of the following::
A. Raise lisinopril dose
B. Add furosemide
C. Ultrasound with doppler
D. No additional management needed | [
0.04340316727757454,
0.006484555080533028,
0.02863074094057083,
0.02507263794541359,
0.017278606072068214,
0.00806126743555069,
-0.05657850578427315,
0.06279514729976654,
0.01670316979289055,
-0.006453468464314938,
0.00668331841006875,
-0.029882997274398804,
0.003359992289915681,
-0.01654098927974701,
-0.010919062420725822,
-0.01891264319419861,
-0.007038393523544073,
0.03139982745051384,
0.0076277838088572025,
-0.014675130136311054,
-0.048512402921915054,
0.007587315980345011,
-0.01757805049419403,
-0.005971528124064207,
0.05549579858779907,
-0.00857910793274641,
0.038250382989645004,
-0.03234792500734329,
0.008493402972817421,
-0.018267955631017685,
-0.008449939079582691,
-0.011518431827425957,
-0.024812854826450348,
-0.027724651619791985,
0.0000019224237348680617,
-0.015188259072601795,
0.009022177197039127,
0.006132834125310183,
0.04530104249715805,
-0.07316409051418304,
0.005279191303998232,
-0.07340721786022186,
0.03147070109844208,
0.0005094585358165205,
-0.061045415699481964,
-0.11165504902601242,
0.015567298047244549,
0.08199898898601532,
-0.017232032492756844,
-0.02836494706571102,
0.0005419313674792647,
0.03902919590473175,
-0.043887168169021606,
0.010027437470853329,
0.009008549153804779,
-0.05415667966008186,
-0.033044490963220596,
-0.06948278844356537,
0.00010828582890098915,
0.014303591102361679,
0.010453397408127785,
-0.0133597357198596,
-0.0054192813113331795,
0.04737478122115135,
-0.02908860705792904,
0.01572127640247345,
0.05584985762834549,
-0.03518062084913254,
-0.005676994565874338,
0.012001949362456799,
-0.005565275438129902,
0.09397681802511215,
0.042221371084451675,
0.06111234053969383,
-0.0550660640001297,
-0.03823591396212578,
0.028596829622983932,
-0.0831989198923111,
-0.000566612055990845,
0.01426634006202221,
0.08965970575809479,
0.016898896545171738,
-0.044904932379722595,
0.024133926257491112,
-0.009469120763242245,
-0.04289504140615463,
0.004957627970725298,
0.03699078410863876,
0.03181297704577446,
-0.028789600357413292,
0.013950729742646217,
-0.08626072108745575,
0.01859123259782791,
0.023797839879989624,
-0.07024403661489487,
0.004036483820527792,
0.026477806270122528,
0.02044590562582016,
0.027090568095445633,
0.008993970230221748,
-0.06500519067049026,
0.007143813651055098,
0.02009650692343712,
-0.02455674111843109,
-0.018986240029335022,
-0.014836553484201431,
-0.020826108753681183,
0.0060392580926418304,
-0.05336937680840492,
0.07337048649787903,
0.040745995938777924,
0.028244366869330406,
-0.036173850297927856,
0.009840773418545723,
0.08592554181814194,
-0.02857237681746483,
-0.04785987734794617,
-0.09927384555339813,
-0.010744715109467506,
0.07810842245817184,
0.028465015813708305,
0.028613438829779625,
0.06466247886419296,
0.039423998445272446,
-0.0020064052660018206,
0.025033049285411835,
0.004368252120912075,
0.005291768349707127,
0.03545219823718071,
0.0003495527198538184,
-0.002016916638240218,
-0.018354631960392,
-0.02900543622672558,
-0.0007332571549341083,
0.022382846102118492,
-0.023083552718162537,
0.009796119295060635,
0.03764691948890686,
-0.0406038872897625,
0.00016024392971303314,
0.00980285182595253,
-0.03853461891412735,
0.019504554569721222,
0.01853959821164608,
-0.035990241914987564,
0.017160257324576378,
0.026711052283644676,
0.00629575876519084,
0.01235444750636816,
0.01045811828225851,
-0.013624187558889389,
-0.037110231816768646,
-0.0038926084525883198,
-0.014335380867123604,
-0.008830951526761055,
0.05001449957489967,
0.02040904015302658,
-0.03024212270975113,
-0.017116615548729897,
-0.0573575496673584,
0.016654422506690025,
-0.012846102006733418,
0.02837441861629486,
0.013914371840655804,
0.043560825288295746,
0.0498628206551075,
0.06179220601916313,
0.06125486269593239,
-0.046036433428525925,
0.06499063968658447,
-0.01990717090666294,
0.05836160480976105,
0.019952166825532913,
0.0013406232465058565,
-0.009889953769743443,
0.019795438274741173,
-0.033066704869270325,
-0.03035629540681839,
-0.03677603229880333,
-0.052501775324344635,
-0.0015466950135305524,
0.06372815370559692,
0.013593882322311401,
-0.03135140612721443,
-0.019410930573940277,
-0.019395435228943825,
-0.013834177516400814,
-0.026710007339715958,
-0.005041664000600576,
-0.03811993449926376,
-0.031214915215969086,
-0.018546273931860924,
-0.0401858389377594,
0.034142836928367615,
-0.04195293411612511,
0.014039085246622562,
-0.03221063315868378,
-0.011907202191650867,
-0.024520035833120346,
0.046280164271593094,
-0.029768886044621468,
-0.02453826181590557,
-0.043230313807725906,
0.03549658879637718,
-0.03716946020722389,
0.056228842586278915,
0.0018715455662459135,
-0.011111664585769176,
0.007050648797303438,
0.005621305666863918,
0.006764241494238377,
0.002444569719955325,
0.034348104149103165,
-0.04995780810713768,
-0.0009720395901240408,
0.03700637072324753,
0.008065635338425636,
0.019411129876971245,
-0.06834685057401657,
0.002885023597627878,
-0.04056694731116295,
0.009616028517484665,
0.0023975311778485775,
0.001290050451643765,
-0.037238240242004395,
-0.04376376420259476,
-0.010241957381367683,
0.0011053221533074975,
-0.001036265166476369,
-0.08328934013843536,
0.056437525898218155,
0.01068943552672863,
-0.03974781930446625,
0.008693523705005646,
-0.047676462680101395,
0.022479519248008728,
0.009804781526327133,
-0.004058212041854858,
-0.010275553911924362,
0.08950226753950119,
-0.0046223122626543045,
-0.026423225179314613,
-0.07146352529525757,
-0.0432639978826046,
-0.028550339862704277,
-0.042210351675748825,
-0.010433088056743145,
0.03118659183382988,
-0.07034631073474884,
0.0511455200612545,
-0.015917131677269936,
-0.004619101528078318,
-0.05207618698477745,
0.0030382468830794096,
-0.03868711367249489,
0.041372429579496384,
-0.04876000061631203,
0.0074311718344688416,
-0.07769347727298737,
-0.06492813676595688,
0.0075429389253258705,
-0.009273654781281948,
-0.005580484867095947,
-0.07905195653438568,
-0.031071551144123077,
-0.022972986102104187,
0.0260036438703537,
-0.01770995743572712,
-0.0065865665674209595,
0.041184332221746445,
0.015043702907860279,
0.01868506334722042,
0.013236098922789097,
0.01699444092810154,
-0.04044988006353378,
-0.021929914131760597,
0.019692620262503624,
0.10054782032966614,
0.04155475273728371,
0.01860705390572548,
0.04709235206246376,
0.02221526764333248,
0.009144699200987816,
0.01659396104514599,
0.027118202298879623,
0.011738062836229801,
-0.039112918078899384,
-0.00033676650491543114,
0.057320743799209595,
-0.0016563276294618845,
0.0031720753759145737,
0.06289021670818329,
0.016086500138044357,
-0.0017408523708581924,
-0.045354366302490234,
-0.02142876572906971,
-0.03499528393149376,
0.05518593266606331,
-0.016445977613329887,
0.042022448033094406,
-0.007851528003811836,
0.05923004820942879,
-0.02335469238460064,
-0.00044531654566526413,
0.011667122133076191,
0.0015857304679229856,
0.06109558045864105,
0.03524007275700569,
-0.006920895539224148,
0.036616187542676926,
0.04573699086904526,
-0.013827822171151638,
0.007834997959434986,
-0.010249672457575798,
-0.011558963917195797,
0.012521620839834213,
-0.02596542239189148,
-0.04213717579841614,
0.021043973043560982,
0.05169902741909027,
0.026755550876259804,
0.019993828609585762,
0.00012825516751036048,
-0.023175926879048347,
0.00806280318647623,
-0.0565473809838295,
-0.005331095308065414,
-0.02385934628546238,
-0.026260357350111008,
-0.019618405029177666,
0.010340165346860886,
0.020898250862956047,
-0.006076384801417589,
0.009201490320265293,
-0.011328782886266708,
-0.030540063977241516,
-0.0011764091905206442,
0.013492838479578495,
-0.040345072746276855,
0.07936698198318481,
0.027915405109524727,
-0.060393545776605606,
-0.009157628752291203,
0.06374303251504898,
0.028427891433238983,
-0.019133295863866806,
-0.05788751691579819,
0.05096697434782982,
-0.012758864089846611,
-0.0026486730203032494,
-0.07402509450912476,
0.06698819994926453,
0.005121105350553989,
-0.01664368435740471,
-0.014772734604775906,
-0.043586745858192444,
0.04901700094342232,
0.06344858556985855,
-0.0233098566532135,
0.012968992814421654,
-0.05317822843790054,
0.05916402116417885,
-0.009322514757514,
0.018386131152510643,
0.023335911333560944,
-0.009505447000265121,
0.047456130385398865,
-0.025923559442162514,
-0.03874790668487549,
0.010061477310955524,
-0.022392479702830315,
0.0017113606445491314,
-0.05344443395733833,
0.07344409823417664,
-0.010834835469722748,
-0.003347947960719466,
-0.008241488598287106,
-0.07087014615535736,
-0.0957539901137352,
-0.023988209664821625,
0.04165930673480034,
-0.03410789370536804,
0.03933435678482056,
-0.02702595666050911,
0.004543912597000599,
0.008068326860666275,
0.025185300037264824,
-0.034046780318021774,
0.04255436733365059,
0.011272992938756943,
-0.005343074910342693,
0.005313138011842966,
0.0037644165568053722,
-0.0033269773703068495,
0.0074307480826973915,
0.018462374806404114,
0.025654509663581848,
-0.05700455605983734,
0.016934966668486595,
0.07167074084281921,
-0.03457537293434143,
0.00015488566714338958,
-0.020096637308597565,
0.05448319762945175,
0.05045148357748985,
-0.029025480151176453,
-0.029307518154382706,
-0.010566998273134232,
0.04668314382433891,
0.026005003601312637,
0.010281111113727093,
-0.05681624263525009,
0.020797450095415115,
-0.00016318514826707542,
0.06310296058654785,
-0.025315431877970695,
0.032770246267318726,
-0.01960454136133194,
0.053720735013484955,
-0.05853481963276863,
0.056881822645664215,
-0.006913173012435436,
-0.06138103827834129,
-0.0664222240447998,
-0.0007091355510056019,
-0.003775722347199917,
0.09410632401704788,
0.06782670319080353,
0.012414958328008652,
0.04771530628204346,
0.05236672982573509,
-0.03316148743033409,
0.049159787595272064,
0.043806251138448715,
-0.026470789685845375,
0.07150118798017502,
-0.003498873906210065,
0.009807140566408634,
-0.01277607399970293,
-0.03742630034685135,
-0.01770739257335663,
0.015873396769165993,
0.06980615109205246,
0.02960756979882717,
-0.0218608807772398,
0.013469588942825794,
0.04497247189283371,
0.049646489322185516,
0.004075637087225914,
0.11142721772193909,
0.03802334889769554,
-0.02357967384159565,
-0.0053164842538535595,
0.04142042249441147,
0.030083531513810158,
-0.041911568492650986,
0.02364680916070938,
0.04448307305574417,
0.05182131379842758,
0.017254726961255074,
-0.01801661029458046,
0.024918675422668457,
-0.033553220331668854,
-0.05276542529463768,
0.023851759731769562,
0.001292778761126101,
-0.05904893949627876,
0.006363532971590757,
0.024437885731458664,
0.00015622864884790033,
-0.0025475171860307455,
0.026884211227297783,
-0.0007505679386667907,
0.02075379155576229,
0.06607066094875336,
-0.005028079729527235,
-0.04288414865732193,
0.005265768151730299,
-0.03638305887579918,
0.028640318661928177,
0.052451446652412415,
-0.004924733657389879,
-0.05945172905921936,
-0.007397519890218973,
-0.004098027013242245,
-0.020471744239330292,
0.011215228587388992,
0.016953688114881516,
-0.034025076776742935,
-0.006044249515980482,
0.01010024081915617,
0.004038539249449968,
0.010813996195793152,
-0.012031268328428268,
-0.084850013256073,
-0.019224822521209717,
-0.013279633596539497,
0.02543829381465912,
-0.041356317698955536,
-0.030726149678230286,
0.04917989298701286,
-0.008305935189127922,
0.022668441757559776,
-0.0005753429140895605,
0.004907817579805851,
0.0025694454088807106,
-0.00011472140613477677,
0.06760453432798386,
-0.01977689377963543,
-0.02906930260360241,
0.007415995467454195,
0.04414576664566994,
-0.017647890374064445,
-0.01113987062126398,
0.030332915484905243,
-0.00212973915040493,
-0.046783141791820526,
-0.016028860583901405,
0.024094827473163605,
0.013988380320370197,
0.0007264683372341096,
0.024105854332447052,
-0.02610761485993862,
-0.024553082883358,
0.00020328220853116363,
0.04801122471690178,
0.0003757136291824281,
0.010796047747135162,
-0.023265592753887177,
0.06936752051115036,
-0.07691081613302231,
-0.005568685941398144,
-0.039717964828014374,
-0.014143608510494232,
-0.04124811664223671,
-0.05838070064783096,
-0.016716279089450836,
-0.012582707218825817,
-0.009826211258769035,
-0.0612342543900013,
0.005762742832303047,
0.02793913148343563,
0.021589402109384537,
-0.015012756921350956,
-0.048424411565065384,
0.011561747640371323,
-0.012404024600982666,
-0.004442180506885052,
0.02346746250987053,
-0.013148206286132336,
0.008716138079762459,
0.03743622824549675,
0.017432110384106636,
0.009090889245271683,
0.001889323233626783,
-5.1946043105157235e-33,
0.022129056975245476,
-0.015249566175043583,
0.01720874197781086,
-0.03464974835515022,
0.010663001798093319,
0.06452220678329468,
-0.025344960391521454,
-0.015594751574099064,
-0.06654047220945358,
0.0016835127025842667,
-0.03086901642382145,
-0.004455130081623793,
0.027959689497947693,
0.07100002467632294,
-0.030768537893891335,
-0.08714951574802399,
0.00037395788240246475,
0.0044843656942248344,
-0.03260781615972519,
-0.01950191892683506,
-0.04097748547792435,
0.009460477158427238,
0.01080904807895422,
-0.047282133251428604,
-0.0017770895501598716,
0.036121267825365067,
0.04488912597298622,
0.04465877637267113,
-0.03367344290018082,
0.018444454297423363,
0.0019444019999355078,
0.004493143875151873,
0.04814184457063675,
0.012641261331737041,
-0.0035543108824640512,
-0.055635374039411545,
-0.006109863054007292,
-0.03326701745390892,
0.021331166848540306,
-0.024122387170791626,
-0.015789736062288284,
-0.027962062507867813,
0.0636112168431282,
0.023010052740573883,
0.060760464519262314,
-0.05959799885749817,
-0.02016427367925644,
-0.06137346103787422,
0.03546623885631561,
-0.040223732590675354,
-0.02373799867928028,
0.017969509586691856,
0.015068311244249344,
0.01811927556991577,
-0.040154583752155304,
-0.014940707944333553,
-0.01925087161362171,
0.005413861013948917,
0.005166776478290558,
-0.014032467268407345,
-0.0061412169598042965,
0.019083667546510696,
-0.025754351168870926,
-0.05511743202805519,
-0.06519469618797302,
-0.013766549527645111,
0.03330305218696594,
0.010032924823462963,
-0.07698957622051239,
0.0294649600982666,
-0.09943748265504837,
-0.011477447114884853,
-0.013865356333553791,
-0.04433249682188034,
-0.04492861032485962,
0.013753672130405903,
0.03411363810300827,
0.021076258271932602,
-0.015749288722872734,
0.053228992968797684,
-0.03801262006163597,
0.00598933408036828,
-0.03891623765230179,
-0.03362646698951721,
-0.027493411675095558,
0.036398086696863174,
-0.02512340620160103,
-0.004850841127336025,
0.02221367508172989,
0.0009151261183433235,
0.0712781772017479,
0.009320077486336231,
0.029340028762817383,
-0.009982088580727577,
0.051033470779657364,
-0.07927173376083374,
0.07356444746255875,
0.024906747043132782,
0.029003774747252464,
-0.004069302696734667,
0.11573471873998642,
0.00041048109414987266,
0.04818178340792656,
0.004241549875587225,
-0.010860022157430649,
0.014306770637631416,
-0.029549945145845413,
0.008953138254582882,
0.01425848063081503,
0.016690438613295555,
0.0067871552892029285,
-0.008142683655023575,
-0.000647635490167886,
0.061172083020210266,
-0.038492072373628616,
0.015460294671356678,
0.03633253276348114,
0.07046881318092346,
0.04335382580757141,
0.01449218112975359,
-0.025764064863324165,
0.03093818575143814,
0.023908119648694992,
-0.002676987089216709,
-0.043236974626779556,
-0.029649002477526665,
0.03713162988424301,
0.03402331471443176,
0.005503857508301735,
-0.051303111016750336,
0.02716919407248497,
0.01993088237941265,
2.762050428373186e-7,
0.0235782191157341,
-0.027935437858104706,
0.0024607263039797544,
-0.025075353682041168,
0.02949575148522854,
-0.03673248738050461,
-0.0076071713119745255,
0.018907619640231133,
0.007842387072741985,
-0.019111011177301407,
0.04034417122602463,
0.0058140321634709835,
-0.042036108672618866,
-0.013350759632885456,
0.05189516767859459,
-0.05739962309598923,
-0.005884350277483463,
-0.026684969663619995,
0.017609763890504837,
-0.05397556722164154,
0.008706978522241116,
-0.04498721659183502,
-0.04836956784129143,
-0.06450995802879333,
0.007163044530898333,
0.007879364304244518,
-0.004670282360166311,
-0.03741920739412308,
-0.030484458431601524,
0.02287817746400833,
0.04343661293387413,
0.006009368225932121,
0.025829177349805832,
0.010607036761939526,
-0.03097221627831459,
-0.047844164073467255,
-0.0037826772313565016,
0.07313433289527893,
-0.0771402046084404,
-0.014345080591738224,
0.022395653650164604,
0.026668326929211617,
0.0073982058092951775,
0.0072655160911381245,
0.02137148194015026,
-0.018962541595101357,
-0.06013289466500282,
0.009418817237019539,
0.0033943848684430122,
-0.01271362416446209,
0.010184387676417828,
-0.019495883956551552,
-0.011862765066325665,
0.07512222230434418,
0.008591358549892902,
0.06988281011581421,
-0.01833445020020008,
0.011239186860620975,
0.04738818109035492,
-0.005870128981769085,
-0.007556424476206303,
-0.05469582974910736,
0.01941646635532379,
-0.046661410480737686,
0.03709114342927933,
-0.07937444001436234,
-0.05576595291495323,
2.3199120289221916e-34,
-0.044094160199165344,
-0.051587268710136414,
0.015066172927618027,
-0.071254663169384,
-0.004375802353024483,
-0.016292551532387733,
0.02709224820137024,
0.04172519966959953,
-0.0019096311880275607,
-0.048948727548122406,
-0.060455746948719025
] | {
"ds_index": 83,
"similar_dg_indices": [
523160,
1198384,
982760,
887264,
249023,
208764,
991005,
779612,
61438,
160346,
457112,
165316,
217729,
1120904,
396876,
335277,
371401,
440571,
922413,
152550
]
} |
A 46-year-old man comes to the emergency department because of a 10-day history of right upper quadrant abdominal pain. He has also been feeling tired and nauseous for the past 6 weeks. On examination, scleral icterus is present. Abdominal examination shows tenderness to palpation in the right upper quadrant. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies show:
Aspartate aminotransferase 1780 U/L
Alanine aminotransferase 2520 U/L
Hepatitis A IgM antibody Negative
Hepatitis B surface antigen Negative
Hepatitis B surface antibody Negative
Hepatitis B core IgM antibody Positive
Hepatitis C antibody Positive
Hepatitis C RNA Negative
Which of the following is the best course of action for this patient?" | Supportive therapy | {
"A": "Ribavirin and interferon",
"B": "Supportive therapy",
"C": "Emergency liver transplantation",
"D": "Pegylated interferon-alpha"
} | step1 | B | [
"year old man",
"emergency department",
"a 10 day history",
"right upper quadrant abdominal pain",
"feeling tired",
"nauseous",
"past",
"weeks",
"examination",
"scleral icterus",
"present",
"Abdominal examination shows tenderness",
"palpation",
"right upper quadrant",
"liver edge",
"palpated 2 cm",
"right costal margin",
"Laboratory studies show",
"U",
"2520",
"Hepatitis A",
"antibody",
"Positive",
"RNA",
"following",
"best course",
"action",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 46-year-old man comes to the emergency department because of a 10-day history of right upper quadrant abdominal pain. He has also been feeling tired and nauseous for the past 6 weeks. On examination, scleral icterus is present. Abdominal examination shows tenderness to palpation in the right upper quadrant. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies show:
Aspartate aminotransferase 1780 U/L
Alanine aminotransferase 2520 U/L
Hepatitis A IgM antibody Negative
Hepatitis B surface antigen Negative
Hepatitis B surface antibody Negative
Hepatitis B core IgM antibody Positive
Hepatitis C antibody Positive
Hepatitis C RNA Negative
Which of the following is the best course of action for this patient?"
Choose one of the following::
A. Ribavirin and interferon
B. Supportive therapy
C. Emergency liver transplantation
D. Pegylated interferon-alpha | [
0.042538370937108994,
-0.014251777902245522,
0.02816285938024521,
-0.025636566802859306,
-0.005772860255092382,
0.0003919455630239099,
-0.007923759520053864,
0.038401756435632706,
0.000502631242852658,
-0.023083927109837532,
0.018385402858257294,
-0.013429601676762104,
0.007657605689018965,
0.02244064398109913,
-0.01177351363003254,
0.036632392555475235,
-0.03486717492341995,
-0.027257386595010757,
-0.06594710797071457,
0.0060789929702878,
-0.053166620433330536,
0.01714354008436203,
0.0247146338224411,
0.01007003802806139,
0.022203531116247177,
-0.004496600478887558,
0.03402150422334671,
0.021032311022281647,
-0.008229348808526993,
-0.04211041331291199,
0.03236894682049751,
-0.023032916709780693,
-0.02581675350666046,
-0.0529070720076561,
0.0000018721709693636512,
0.010802472941577435,
0.021900948137044907,
-0.059054456651210785,
0.008797104470431805,
-0.04158051311969757,
0.06414202600717545,
-0.01713612675666809,
0.009791377000510693,
-0.008911272510886192,
-0.00007566339627373964,
-0.02502591721713543,
0.033810071647167206,
0.07824590802192688,
-0.04785097762942314,
-0.013865567743778229,
0.008477379567921162,
0.018816016614437103,
0.00018386333249509335,
-0.010493003763258457,
0.03958864137530327,
-0.1067323386669159,
-0.0480935163795948,
0.012355423532426357,
-0.028438372537493706,
0.050016000866889954,
0.03871062397956848,
0.003535756841301918,
0.006984653417021036,
-0.020684868097305298,
-0.013506781309843063,
0.009069190360605717,
-0.027210190892219543,
-0.06262819468975067,
0.05812282860279083,
0.0016168857691809535,
0.02880994975566864,
-0.04393365979194641,
0.019404683262109756,
0.054749224334955215,
-0.06738196313381195,
-0.026863981038331985,
0.08045753836631775,
-0.0005126012838445604,
-0.00009938505536410958,
0.012316936627030373,
0.1278296262025833,
0.04310581833124161,
-0.01997254602611065,
0.016417773440480232,
0.0042857336811721325,
-0.052550677210092545,
0.020139086991548538,
-0.028884142637252808,
0.009455520659685135,
-0.0018663459923118353,
0.01824238710105419,
-0.03730880841612816,
-0.018315408378839493,
0.05038220435380936,
-0.06050333380699158,
-0.022819384932518005,
0.02992563508450985,
-0.03298391401767731,
0.021460572257637978,
-0.09410643577575684,
-0.011551694944500923,
0.014954550191760063,
-0.012072540819644928,
0.02691417932510376,
-0.03885568678379059,
0.006319254171103239,
-0.01594119518995285,
0.048541050404310226,
-0.028297655284404755,
0.01749449037015438,
0.03164234384894371,
0.010804218240082264,
0.005512384697794914,
0.031733181327581406,
0.055062435567379,
-0.023251470178365707,
-0.030247217044234276,
-0.0345405712723732,
0.01965882070362568,
0.0751814916729927,
0.004165833815932274,
0.043937187641859055,
-0.0014839620562270284,
0.044710490852594376,
0.011729750782251358,
0.023964405059814453,
0.007949784398078918,
-0.026892736554145813,
0.003871422028169036,
0.024784276261925697,
0.014085817150771618,
0.0240872111171484,
-0.031656038016080856,
0.04017150029540062,
0.03410721570253372,
-0.04742387682199478,
-0.015488466247916222,
-0.0024294983595609665,
0.0036946041509509087,
0.042692139744758606,
-0.024698037654161453,
-0.017365233972668648,
-0.006282408721745014,
0.02749621868133545,
0.044213924556970596,
0.004138341639190912,
0.007893177680671215,
-0.06096845120191574,
-0.006473009008914232,
0.028431199491024017,
-0.04651228338479996,
-0.029350845143198967,
-0.042487140744924545,
0.0036723928060382605,
-0.0286983922123909,
0.02760961465537548,
-0.047607600688934326,
-0.0596611388027668,
-0.030377324670553207,
-0.02930833399295807,
0.014950347132980824,
-0.024646010249853134,
0.08734782785177231,
-0.04957219585776329,
-0.02938232198357582,
-0.0035034294705837965,
0.006008489988744259,
0.07614598423242569,
-0.0035876971669495106,
0.019193479791283607,
-0.0030599029269069433,
0.034245748072862625,
0.03945854306221008,
0.004189754836261272,
-0.011892875656485558,
-0.0014872181927785277,
-0.010936832055449486,
-0.04913696274161339,
-0.03385555371642113,
0.026976056396961212,
-0.01206002663820982,
-0.010124553926289082,
0.014806616120040417,
-0.024066833779215813,
-0.018031932413578033,
0.013124346733093262,
0.023638244718313217,
-0.0515877865254879,
-0.026064949110150337,
-0.03717682510614395,
-0.005782988853752613,
0.004520195070654154,
-0.0089073171839118,
0.025796113535761833,
-0.0037682747934013605,
0.008820361457765102,
-0.04396578669548035,
-0.06372161954641342,
0.020790131762623787,
-0.00043143698712810874,
-0.04398541525006294,
-0.0576949305832386,
0.03554212674498558,
0.03375076875090599,
-0.04664679616689682,
0.0204196535050869,
-0.04891160503029823,
0.02365333028137684,
0.011864342726767063,
-0.015963083133101463,
0.025226499885320663,
-0.05325525999069214,
0.032783906906843185,
0.010308063589036465,
0.02979586273431778,
0.0826033353805542,
-0.020943734794855118,
-0.028281494975090027,
-0.04632297158241272,
0.008783828467130661,
-0.03828297182917595,
0.025933559983968735,
-0.04365305230021477,
-0.006812356878072023,
-0.008969576098024845,
0.009606163948774338,
-0.0026560367550700903,
-0.0030560048762708902,
0.01782175339758396,
-0.0719229131937027,
0.03612164035439491,
0.0165359228849411,
-0.020268302410840988,
0.0579439252614975,
-0.05059049278497696,
-0.006287023890763521,
0.02367829903960228,
-0.006389879155904055,
0.02678978443145752,
0.05387692525982857,
-0.040606915950775146,
-0.06672663241624832,
-0.009970548562705517,
0.015079118311405182,
0.05687752366065979,
-0.024080796167254448,
-0.0737588182091713,
0.04218364134430885,
-0.01525186374783516,
0.06135431304574013,
-0.008506217040121555,
0.011198453605175018,
-0.004959540907293558,
-0.005455681588500738,
0.009911849163472652,
-0.012654917314648628,
-0.09325676411390305,
0.00883452408015728,
-0.009800760075449944,
0.018910003826022148,
-0.006075865123420954,
-0.004450240172445774,
0.03557104617357254,
-0.02637353539466858,
0.006552118342369795,
-0.012435381300747395,
-0.005697638727724552,
-0.049429189413785934,
-0.008018548600375652,
0.03645646944642067,
-0.0101741598919034,
0.03549642115831375,
0.0036739232018589973,
0.02975907362997532,
-0.05870606377720833,
-0.011479721404612064,
-0.02269658073782921,
0.033858731389045715,
0.0015292904572561383,
-0.018304327502846718,
0.02200675569474697,
0.04044625908136368,
-0.0032498049549758434,
0.05018637329339981,
0.011306097730994225,
0.002010814845561981,
-0.005084010306745768,
-0.08217068761587143,
0.04782300442457199,
-0.07283048331737518,
0.006986828986555338,
0.01657691039144993,
0.0043183318339288235,
-0.045736752450466156,
-0.04057860001921654,
-0.03736890107393265,
-0.09689749032258987,
0.05350260064005852,
-0.02313673123717308,
0.02050667814910412,
0.0005892284098081291,
-0.011722679249942303,
-0.056504108011722565,
0.013394186273217201,
0.018582485616207123,
0.04328841716051102,
0.030084848403930664,
0.002551811281591654,
-0.019278094172477722,
-0.0048058489337563515,
0.018047653138637543,
0.005910313222557306,
-0.04985766112804413,
-0.030687985941767693,
0.014608658850193024,
-0.06798073649406433,
-0.015576038509607315,
-0.03450317308306694,
0.023189455270767212,
-0.04233229160308838,
0.017042074352502823,
0.035878151655197144,
-0.02399020455777645,
-0.0625271275639534,
0.004653797950595617,
-0.0043543861247599125,
0.014133911579847336,
0.00534789590165019,
-0.026197193190455437,
-0.05614533647894859,
0.01950712315738201,
-0.07997038215398788,
-0.04144882783293724,
0.05395929515361786,
0.0400213897228241,
-0.06391479820013046,
-0.039757322520017624,
0.016086431220173836,
-0.05094257369637489,
0.013868359848856926,
0.00010592232865747064,
0.013432604260742664,
0.02824503742158413,
0.043301161378622055,
-0.013848169706761837,
-0.009315799921751022,
-0.04082396626472473,
0.02551347389817238,
0.03177136182785034,
0.002068881643936038,
-0.06069653853774071,
0.042532555758953094,
0.016824262216687202,
-0.00764019601047039,
-0.02186666987836361,
-0.047905370593070984,
0.02178715541958809,
0.032752443104982376,
-0.05243844538927078,
0.06543147563934326,
0.0267292782664299,
0.016199108213186264,
0.006621120031923056,
0.0494159571826458,
0.015987137332558632,
0.038020338863134384,
0.0622265450656414,
0.0016830447129905224,
0.006760710850358009,
0.0004791214596480131,
-0.023318367078900337,
-0.00019959782366640866,
-0.007078527007251978,
0.03610692918300629,
-0.027801157906651497,
-0.018248293548822403,
-0.001793922041542828,
-0.04927301034331322,
-0.1288294643163681,
-0.02545776776969433,
0.07689931243658066,
-0.04682670161128044,
-0.006284680217504501,
0.02485458180308342,
-0.0561460517346859,
0.03573662415146828,
-0.027767403051257133,
-0.019445937126874924,
0.09340061992406845,
0.033324118703603745,
-0.00576369883492589,
-0.008407223038375378,
-0.0960998386144638,
-0.03557401895523071,
-0.007806919980794191,
-0.017273522913455963,
-0.020549818873405457,
-0.03620930016040802,
0.01094988826662302,
0.058278609067201614,
0.004142190795391798,
0.008810373023152351,
0.012467955239117146,
0.10044082999229431,
0.036496736109256744,
-0.02784237638115883,
-0.05633040517568588,
-0.012149486690759659,
0.04376659169793129,
0.04538960009813309,
0.057388998568058014,
-0.040664006024599075,
0.014180806465446949,
0.010145974345505238,
0.05529550462961197,
-0.07793117314577103,
0.0102933244779706,
-0.08076336979866028,
-0.0038474842440336943,
-0.08855932950973511,
0.060969363898038864,
0.01343319471925497,
-0.012148072943091393,
-0.045205745846033096,
0.004584897309541702,
0.026496779173612595,
0.01607578620314598,
0.039027560502290726,
0.02874739095568657,
0.020552942529320717,
-0.012550842016935349,
0.008188947103917599,
0.0383436419069767,
0.03763636201620102,
-0.010606449097394943,
-0.0025690968614071608,
0.02877385914325714,
0.05876344069838524,
-0.0044670249335467815,
-0.016960205510258675,
-0.001674653496593237,
-0.0003038103168364614,
0.013444204814732075,
0.0424814373254776,
0.05050187557935715,
-0.034528009593486786,
-0.01749778911471367,
0.0495440699160099,
0.005423419177532196,
0.007847907021641731,
0.029425421729683876,
-0.04086267575621605,
0.024555470794439316,
0.060496993362903595,
0.005646001547574997,
0.016762493178248405,
0.06829869002103806,
0.07244420051574707,
0.007423013914376497,
0.0010319034336134791,
-0.04832237958908081,
0.0181235633790493,
-0.011022143997251987,
-0.05400743708014488,
0.014616705477237701,
-0.07413186132907867,
-0.04106350615620613,
0.026810046285390854,
-0.012611068785190582,
-0.0009461595909669995,
-0.04312904179096222,
0.0333973728120327,
-0.01892542466521263,
-0.0383748859167099,
-0.023086851462721825,
0.0038046904373914003,
-0.033676713705062866,
-0.05042934790253639,
0.025894958525896072,
0.02519935742020607,
0.02368137054145336,
-0.02580472268164158,
-0.060971006751060486,
-0.1157817542552948,
0.030291782692074776,
-0.005023670848459005,
0.01920984499156475,
-0.029206879436969757,
0.0026403397787362337,
0.004768619313836098,
0.028744755312800407,
-0.05127233266830444,
0.008548453450202942,
0.04102379456162453,
-0.04885856434702873,
0.026316506788134575,
0.026568178087472916,
0.042453423142433167,
0.014313025400042534,
0.026615092530846596,
0.023969044908881187,
0.026128003373742104,
0.05063514783978462,
0.0011132207000628114,
-0.008058221079409122,
0.02183951623737812,
0.016638385131955147,
0.01951960287988186,
-0.03444906696677208,
-0.06135926395654678,
0.04013082757592201,
0.018366331234574318,
0.009817773476243019,
-0.0038962853141129017,
0.05192551389336586,
-0.02088005281984806,
-0.023511620238423347,
0.01798413321375847,
0.02083412930369377,
0.01961628906428814,
0.014213371090590954,
0.00013055458839517087,
0.014474903233349323,
-0.010795545764267445,
-0.028236282989382744,
0.0257045216858387,
-0.012402815744280815,
-0.030227411538362503,
-0.007633821573108435,
0.04892794415354729,
-0.0301392562687397,
-0.03463338688015938,
-0.037330057471990585,
0.01668325439095497,
-0.04487895965576172,
-0.028886448591947556,
-0.006511840969324112,
0.014759918674826622,
-0.0007190268370322883,
-0.003011723281815648,
0.019891882315278053,
0.031902510672807693,
-0.020837336778640747,
0.009190845303237438,
-0.017459964379668236,
-0.006141501944512129,
-0.0132012739777565,
0.03223599120974541,
0.03085479699075222,
-0.024639174342155457,
-0.01165903639048338,
0.07261305302381516,
-0.030501853674650192,
0.019502505660057068,
-0.003841911908239126,
-5.762858483512372e-33,
0.016638372093439102,
-0.003246002597734332,
0.0509454645216465,
-0.07123975455760956,
0.014174721203744411,
0.0758698433637619,
-0.04221991077065468,
-0.02440771274268627,
-0.07398644089698792,
0.014266506768763065,
-0.005772544536739588,
-0.01108831912279129,
0.03698468580842018,
0.0531323105096817,
-0.023902960121631622,
-0.02625252865254879,
-0.0061466810293495655,
0.02607087232172489,
-0.0371939055621624,
0.024866905063390732,
-0.011564256623387337,
-0.058638300746679306,
0.010333478450775146,
-0.04264086112380028,
-0.0327131524682045,
-0.007844805717468262,
0.06148604676127434,
0.027453023940324783,
-0.011763358488678932,
0.010176322422921658,
-0.0026293869595974684,
-0.05882700905203819,
0.01764427125453949,
0.020853888243436813,
0.00462735490873456,
0.022191151976585388,
0.03149726986885071,
-0.02065107226371765,
-0.02464565448462963,
0.046813756227493286,
0.004084568936377764,
-0.10324385017156601,
0.00898591335862875,
0.008214125409722328,
-0.005178926512598991,
-0.015290046110749245,
-0.0058143772184848785,
-0.001684308284893632,
-0.020702198147773743,
-0.03819587081670761,
0.01438871305435896,
0.05016639456152916,
0.01466055866330862,
-0.06717029213905334,
-0.01236642524600029,
0.045143093913793564,
0.011876055039465427,
0.030037781223654747,
-0.01379457488656044,
0.022333815693855286,
-0.07047805190086365,
0.023797882720828056,
0.04494544491171837,
-0.03743370249867439,
-0.05931483581662178,
-0.011931153014302254,
-0.012470235116779804,
-0.002931535942479968,
-0.04164712876081467,
-0.014290780760347843,
-0.06507503241300583,
0.0067288838326931,
-0.10393545776605606,
-0.14159399271011353,
-0.018028127029538155,
-0.02440033107995987,
0.07366064190864563,
0.037797655910253525,
0.008519466035068035,
0.023675570264458656,
-0.0040444848127663136,
-0.018136681988835335,
-0.05601188540458679,
0.006907202769070864,
0.003357894951477647,
-0.07387350499629974,
-0.004318432882428169,
-0.02959132194519043,
0.028088940307497978,
-0.01764089986681938,
0.08731359243392944,
0.026854416355490685,
0.04622019827365875,
0.0014492046320810914,
0.015432589687407017,
0.01742849498987198,
0.006839169654995203,
0.06917069852352142,
0.008709348738193512,
0.02858029305934906,
0.012667167000472546,
-0.030668800696730614,
-0.020636899396777153,
-0.02418976090848446,
-0.01939871720969677,
0.004115154035389423,
0.035831525921821594,
0.012006442062556744,
-0.010014011524617672,
0.0070212893187999725,
0.021689297631382942,
0.005860431119799614,
-0.018079102039337158,
0.06415926665067673,
-0.0003935404238291085,
0.08522439748048782,
0.006606957875192165,
0.010241850279271603,
0.007183877285569906,
0.05379527807235718,
0.05568527430295944,
-0.024850016459822655,
-0.018285561352968216,
0.004637459293007851,
-0.022494258359074593,
-0.018221823498606682,
-0.0000020808781755476957,
0.0003063416515942663,
-0.057657528668642044,
-0.02266569249331951,
0.03643597289919853,
-0.010246346704661846,
2.86584111108823e-7,
0.027755962684750557,
-0.016598859801888466,
0.017254943028092384,
-0.040198471397161484,
0.0075954957865178585,
-0.03143040090799332,
0.05742558836936951,
0.0010203637648373842,
-0.0233699232339859,
0.018117597326636314,
0.053525619208812714,
0.03424062579870224,
-0.011124725453555584,
-0.04440769925713539,
0.088747039437294,
-0.01260167546570301,
-0.03022618591785431,
0.05405517667531967,
0.081680528819561,
-0.0046645598486065865,
0.004566085524857044,
-0.020256394520401955,
-0.0425165593624115,
-0.0621689110994339,
0.0006659000064246356,
0.037263769656419754,
0.008241931907832623,
0.0011127827456220984,
-0.030165404081344604,
0.04461241513490677,
-0.08400654047727585,
0.03635109215974808,
0.017344491556286812,
0.04912519082427025,
-0.027932532131671906,
-0.018723979592323303,
0.021199429407715797,
0.052952129393815994,
-0.026518389582633972,
-0.008800252340734005,
0.0014278461458161473,
-0.026046935468912125,
0.04067420959472656,
0.045466624200344086,
0.028462810441851616,
0.0373721718788147,
-0.023180020973086357,
0.07700983434915543,
-0.008562172763049603,
0.009479088708758354,
-0.04755237326025963,
0.03465406596660614,
0.0007923797238618135,
0.06444162875413895,
0.022771818563342094,
0.03500991687178612,
-0.06210388243198395,
0.009797357022762299,
-0.008517785929143429,
0.06251632422208786,
0.020150894299149513,
0.02566436305642128,
0.025231050327420235,
-0.00895860604941845,
0.01171127799898386,
-0.055869292467832565,
-0.051723528653383255,
2.0900167875587863e-34,
-0.0003943939518649131,
-0.025822730734944344,
0.022445019334554672,
-0.03841382637619972,
-0.008976899087429047,
-0.01591164991259575,
0.01999657042324543,
-0.028762517496943474,
0.015006810426712036,
-0.006673603784292936,
-0.0121401222422719
] | {
"ds_index": 84,
"similar_dg_indices": [
897092,
686786,
551485,
1045984,
139796,
532438,
845269,
1130371,
1209831,
16375,
717918,
809225,
875709,
945634,
946155,
219817,
426573,
979047,
882201,
540116
]
} |
A 5-year-old boy who recently emigrated from Nigeria is brought to the emergency department because of a 2-day history of lower leg weakness, swallowing difficulty, and drooling of saliva. He has not yet received any childhood vaccinations. Two days after admission, the patient develops shortness of breath. Pulse oximetry shows an oxygen saturation of 64%. Despite resuscitative efforts, the patient dies of respiratory failure. At autopsy, examination of the spinal cord shows destruction of the anterior horn cells. Neurological examination of this patient would have most likely shown which of the following findings? | Hyporeflexia | {
"A": "Positive Babinski sign",
"B": "Hyporeflexia",
"C": "Myoclonus",
"D": "Pronator drift"
} | step1 | B | [
"5 year old boy",
"recently",
"Nigeria",
"brought",
"emergency department",
"of",
"2-day history",
"lower leg weakness",
"swallowing difficulty",
"drooling",
"saliva",
"not",
"received",
"childhood vaccinations",
"Two days",
"admission",
"patient",
"shortness of breath",
"Pulse oximetry shows",
"oxygen saturation",
"64",
"resuscitative efforts",
"patient dies",
"respiratory failure",
"autopsy",
"examination",
"spinal cord shows destruction of",
"anterior horn cells",
"Neurological examination",
"patient",
"most likely shown",
"following findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 5-year-old boy who recently emigrated from Nigeria is brought to the emergency department because of a 2-day history of lower leg weakness, swallowing difficulty, and drooling of saliva. He has not yet received any childhood vaccinations. Two days after admission, the patient develops shortness of breath. Pulse oximetry shows an oxygen saturation of 64%. Despite resuscitative efforts, the patient dies of respiratory failure. At autopsy, examination of the spinal cord shows destruction of the anterior horn cells. Neurological examination of this patient would have most likely shown which of the following findings?
Choose one of the following::
A. Positive Babinski sign
B. Hyporeflexia
C. Myoclonus
D. Pronator drift | [
0.03614192083477974,
-0.04095805063843727,
0.04037066549062729,
0.010518846102058887,
0.05086328089237213,
0.021544139832258224,
-0.024915173649787903,
0.04387328401207924,
0.003702135058119893,
-0.007861059159040451,
0.043334901332855225,
-0.03329586982727051,
0.04915555939078331,
-0.09502768516540527,
0.02505313977599144,
-0.006293287500739098,
0.02421615645289421,
0.0024652627762407064,
-0.013232743367552757,
-0.007484047207981348,
-0.03366883844137192,
0.07875102013349533,
0.03665890172123909,
-0.0006006275652907789,
0.022263797000050545,
0.02618098072707653,
0.01459152065217495,
-0.022327953949570656,
-0.016404984518885612,
-0.010014831088483334,
-0.012627224437892437,
-0.02409987337887287,
-0.0437617227435112,
-0.055197734385728836,
0.000002155542460968718,
0.07074280828237534,
-0.012531484477221966,
-0.015933489426970482,
0.0020375021267682314,
-0.0058101327158510685,
0.02378982864320278,
0.003602386452257633,
-0.02180458791553974,
0.0157833993434906,
-0.02907145954668522,
-0.07102595269680023,
0.012644431553781033,
0.09844374656677246,
0.02057901956140995,
0.03443286195397377,
0.025274233892560005,
0.022494591772556305,
0.026677459478378296,
-0.01639191061258316,
0.07517600059509277,
0.0040107611566782,
-0.022343916818499565,
0.025321155786514282,
-0.04394368454813957,
-0.062449563294649124,
0.01712992787361145,
-0.027340449392795563,
-0.0010479218326508999,
-0.0033430177718400955,
-0.07696246355772018,
0.026252923533320427,
0.050100937485694885,
-0.05429373309016228,
0.008206154219806194,
-0.01908489689230919,
-0.08765805512666702,
-0.028391927480697632,
0.07981809228658676,
0.060934994369745255,
-0.0020711817778646946,
-0.05206475034356117,
0.026942213997244835,
0.018427833914756775,
-0.0029144086875021458,
-0.036151520907878876,
0.0592624768614769,
0.019276844337582588,
-0.01894194819033146,
0.04652313143014908,
0.008779858238995075,
-0.08925607055425644,
0.0021815893705934286,
-0.021972723305225372,
-0.054642707109451294,
0.02801615558564663,
-0.0032799681648612022,
-0.006056221667677164,
-0.004880412481725216,
0.030929652974009514,
-0.06252570450305939,
0.0273542832583189,
-0.03926829248666763,
-0.05745096504688263,
0.04718998447060585,
-0.09019217640161514,
0.012359985150396824,
-0.081350177526474,
0.01734449900686741,
0.01760353520512581,
-0.07006832212209702,
-0.06299930065870285,
-0.050013840198516846,
0.034182120114564896,
-0.014411278069019318,
0.008884458802640438,
0.015249073505401611,
0.005559766199439764,
-0.04103264585137367,
0.0015748969744890928,
0.0409216545522213,
0.030244130641222,
-0.0203436017036438,
-0.03824266791343689,
0.02982822060585022,
0.03545382618904114,
-0.017301645129919052,
-0.021944815292954445,
-0.02434576116502285,
0.04108407348394394,
-0.004588959738612175,
-0.005624299868941307,
0.025890566408634186,
0.0035468298010528088,
0.0025473199784755707,
-0.005612773820757866,
-0.0056449295952916145,
-0.01185622438788414,
-0.03886530175805092,
0.022615091875195503,
0.013168461620807648,
0.03954298049211502,
0.03071776032447815,
0.04200216382741928,
0.0010895899031311274,
0.012011533603072166,
-0.027748089283704758,
-0.008208333514630795,
0.0003293826011940837,
-0.003006057580932975,
-0.018074026331305504,
0.03461804613471031,
0.0002488195605110377,
-0.003151398617774248,
-0.0023604303132742643,
0.007997470907866955,
-0.04220520332455635,
-0.05645975470542908,
-0.050248369574546814,
-0.01873886212706566,
0.019213927909731865,
-0.002095844829455018,
0.053939078003168106,
-0.015650013461709023,
-0.022908898070454597,
-0.01663130708038807,
0.023576904088258743,
0.014902392402291298,
-0.021487291902303696,
-0.02882085181772709,
0.01849718578159809,
0.056836146861314774,
0.011495959013700485,
-0.005787182599306107,
0.030866876244544983,
0.027037881314754486,
-0.050813958048820496,
0.016899634152650833,
0.0074677313677966595,
-0.01708216406404972,
-0.024816453456878662,
0.05646289885044098,
-0.06811705231666565,
-0.07394100725650787,
-0.028688594698905945,
-0.01829604245722294,
0.019672734662890434,
0.02148076705634594,
0.042866602540016174,
-0.01697327382862568,
0.03189950808882713,
-0.01863192766904831,
-0.0421200729906559,
0.03135140985250473,
0.032967232167720795,
-0.010275345295667648,
0.00366538786329329,
0.050037626177072525,
-0.04414854571223259,
0.047294724732637405,
0.02424706146121025,
0.03702850639820099,
-0.027709152549505234,
0.0611894391477108,
-0.02243695966899395,
-0.01303929090499878,
0.008528752252459526,
0.013473914936184883,
-0.021419063210487366,
-0.025401102378964424,
-0.028224479407072067,
0.07010621577501297,
-0.03467708081007004,
-0.013595322147011757,
-0.05462491139769554,
0.012201344594359398,
-0.03672356903553009,
0.003980977926403284,
0.04947277158498764,
-0.008386568166315556,
0.006323119625449181,
0.0041138604283332825,
0.030363302677869797,
-0.01720772683620453,
-0.053303588181734085,
0.0770619586110115,
-0.010603558272123337,
-0.05121311545372009,
-0.006839040666818619,
0.025002945214509964,
-0.04851824790239334,
0.05625871568918228,
0.026029366999864578,
0.023197835311293602,
-0.01818271167576313,
-0.05867714807391167,
0.03579387813806534,
0.013853833079338074,
-0.0008800220093689859,
0.023928266018629074,
-0.040059953927993774,
-0.017292652279138565,
-0.0326513834297657,
-0.06270169466733932,
-0.010452307760715485,
0.03225361928343773,
-0.016621660441160202,
-0.021104933694005013,
-0.04468727111816406,
-0.032673437148332596,
-0.03888927027583122,
-0.03831518441438675,
0.05002644658088684,
0.00549389747902751,
0.016312018036842346,
0.01914151757955551,
-0.030086863785982132,
-0.010452210903167725,
0.05408662185072899,
0.043237246572971344,
-0.023374229669570923,
0.008187917992472649,
-0.07619819045066833,
0.04895956814289093,
-0.06454325467348099,
-0.0841343030333519,
0.01012379303574562,
-0.019252369180321693,
0.009955639950931072,
-0.049230754375457764,
-0.07597015053033829,
0.01627020351588726,
0.03587880730628967,
-0.0448603592813015,
-0.01343065220862627,
0.04413989931344986,
-0.0077049341052770615,
0.020703928545117378,
0.04573176056146622,
0.03234357759356499,
-0.03506378456950188,
-0.014689856208860874,
-0.012006477452814579,
0.052279479801654816,
0.0161618459969759,
-0.02537219040095806,
-0.01658388040959835,
0.0471181683242321,
0.0217593926936388,
0.015046833083033562,
-0.024666141718626022,
0.011409437283873558,
-0.011224672198295593,
0.007444475311785936,
0.02233434095978737,
-0.03630806505680084,
-0.06457559019327164,
0.05714191496372223,
0.02507619746029377,
-0.04757580906152725,
0.03413322567939758,
-0.03931739926338196,
-0.04982047528028488,
0.07039916515350342,
0.0359407514333725,
0.05998735502362251,
0.03956710174679756,
0.052679769694805145,
0.030976634472608566,
0.006433459930121899,
0.0046598599292337894,
0.0891721248626709,
0.011940060183405876,
0.04643452540040016,
-0.03468054160475731,
0.0375833734869957,
0.08189825713634491,
0.024803677573800087,
0.002248787321150303,
0.010655867867171764,
-0.007160677574574947,
0.0020299172028899193,
-0.05328739061951637,
-0.10745241492986679,
-0.0005051328334957361,
0.027578430250287056,
-0.024648699909448624,
0.047461193054914474,
-0.016162291169166565,
0.00038921093801036477,
-0.03596987947821617,
-0.01336576696485281,
0.011460538022220135,
-0.023365477100014687,
0.005233266856521368,
-0.0015777184162288904,
0.00946393609046936,
0.06279494613409042,
-0.012817401438951492,
-0.01587098278105259,
0.06062988564372063,
0.028423579409718513,
0.008209574967622757,
-0.04144294559955597,
-0.0003419425629545003,
0.017157861962914467,
0.01719294860959053,
-0.008859542198479176,
-0.018254397436976433,
0.002522482303902507,
0.03707605227828026,
-0.0060936929658055305,
-0.05615752190351486,
-0.026429666206240654,
-0.03579017147421837,
-0.0014740523183718324,
-0.031058546155691147,
0.04095660522580147,
-0.024671487510204315,
0.011440102942287922,
-0.020042771473526955,
0.005258026998490095,
0.031703248620033264,
0.013472190126776695,
0.01693485490977764,
-0.026679642498493195,
0.00354794436134398,
0.04762904718518257,
-0.0289809238165617,
0.01684631034731865,
0.01706819236278534,
-0.058385949581861496,
-0.021035384386777878,
-0.04675301909446716,
-0.0028902674093842506,
0.008591433987021446,
-0.010346049442887306,
-0.006659765262156725,
-0.03425224870443344,
0.018203796818852425,
-0.03599611669778824,
0.027343332767486572,
-0.010665462352335453,
-0.014285066165030003,
-0.07668250054121017,
-0.06077662110328674,
0.05302048847079277,
0.0020593293011188507,
0.022717319428920746,
-0.007537142839282751,
-0.02232278510928154,
0.0549614354968071,
0.005158592481166124,
0.025997795164585114,
0.05293407663702965,
0.032096318900585175,
-0.02063470333814621,
-0.038144178688526154,
0.04307195916771889,
-0.012658248655498028,
0.013405101373791695,
-0.013261591084301472,
0.012143067084252834,
-0.008557925932109356,
0.014786163344979286,
0.054509129375219345,
-0.05352740362286568,
0.08780008554458618,
-0.0050173173658549786,
0.01016663946211338,
0.01588241383433342,
-0.04309471324086189,
-0.006819369271397591,
-0.025583185255527496,
0.02508840523660183,
0.005025940947234631,
-0.004224317613989115,
-0.04390416666865349,
-0.023791329935193062,
0.00802240613847971,
0.028862126171588898,
-0.0409146286547184,
-0.01433596108108759,
-0.04850352182984352,
-0.007126784883439541,
-0.03502209484577179,
0.06645537912845612,
-0.052364692091941833,
-0.01029185950756073,
-0.09826089441776276,
-0.016674840822815895,
-0.03673411160707474,
0.06155749782919884,
-0.022380109876394272,
0.050636060535907745,
0.033718258142471313,
0.019369594752788544,
-0.008933063596487045,
0.020850488916039467,
0.025387393310666084,
-0.0031792449299246073,
-0.020889269188046455,
-0.006364724133163691,
-0.0072649880312383175,
-0.041769303381443024,
-0.04517684876918793,
0.022833481431007385,
-0.00797312706708908,
0.019667651504278183,
0.032448384910821915,
0.0532914474606514,
-0.020072760060429573,
-0.016077114269137383,
0.013560086488723755,
0.032747942954301834,
0.1242080107331276,
0.0005396115593612194,
0.007795114070177078,
0.041256215423345566,
-0.007105235941708088,
0.02788560278713703,
0.006469371262937784,
-0.05374682694673538,
0.01844952628016472,
0.003950498532503843,
0.011306102387607098,
-0.0761871263384819,
0.00024296272022183985,
-0.06519395858049393,
-0.06794937700033188,
0.01741641014814377,
0.02866019867360592,
0.00731777586042881,
0.020352566614747047,
-0.014653116464614868,
-0.010478518903255463,
-0.031855493783950806,
0.03042413666844368,
0.002443913370370865,
-0.003835742361843586,
0.014529796317219734,
-0.023752478882670403,
-0.04158830642700195,
-0.0518280491232872,
-0.008260593749582767,
-0.006151397246867418,
-0.030185969546437263,
0.06568495184183121,
-0.03919575735926628,
-0.06942843645811081,
0.03070709854364395,
-0.023140888661146164,
0.038573842495679855,
-0.02215132676064968,
-0.0061261304654181,
-0.027926359325647354,
0.009609870612621307,
0.03547537326812744,
-0.0006405633175745606,
0.01358999777585268,
-0.01521800085902214,
0.021809950470924377,
-0.029514355584979057,
0.08474722504615784,
0.038647137582302094,
-0.046071041375398636,
0.06779246777296066,
0.031552042812108994,
0.038310106843709946,
-0.017225362360477448,
-0.00291488878428936,
0.012424163520336151,
-0.007399127818644047,
-0.00911589153110981,
-0.017717894166707993,
-0.05437066778540611,
0.005195988807827234,
0.013896363787353039,
0.017682502046227455,
0.040899261832237244,
0.01094825379550457,
-0.03137281909584999,
-0.05151880159974098,
-0.0037181288935244083,
-0.03961411118507385,
0.02367052435874939,
0.0017828649142757058,
0.03028334490954876,
-0.029704593122005463,
-0.05515490844845772,
-0.01030574832111597,
0.004722367972135544,
-0.009264462627470493,
0.013989174738526344,
-0.0009241567458957434,
0.05429500341415405,
-0.03775012493133545,
0.048852015286684036,
-0.028316369280219078,
0.01923748478293419,
0.014157268218696117,
-0.04351808503270149,
0.027385614812374115,
-0.021405193954706192,
-0.02011040411889553,
-0.04989097639918327,
0.03462836146354675,
0.023320097476243973,
-0.0379071868956089,
-0.005763991270214319,
-0.03553645685315132,
0.07647159695625305,
-0.034303996711969376,
-0.01890401914715767,
0.03973637893795967,
-0.010604447685182095,
0.0138519536703825,
0.014257342554628849,
-0.00164997938554734,
-0.007050688844174147,
0.006917043589055538,
-5.7094917746690095e-33,
0.05857415124773979,
-0.05706741288304329,
0.017654579132795334,
-0.030899766832590103,
0.0013875868171453476,
0.05752668157219887,
-0.029695693403482437,
0.020299723371863365,
-0.05936644971370697,
-0.003312072716653347,
-0.017760761082172394,
-0.013858349062502384,
0.016980094835162163,
0.02171238698065281,
0.03673023730516434,
0.022502081468701363,
-0.013449721969664097,
-0.011013633571565151,
-0.04813218489289284,
-0.04428678750991821,
0.021658746525645256,
0.0015780412359163165,
0.0351654477417469,
-0.01945381984114647,
0.018075870350003242,
-0.02359723299741745,
0.01646323688328266,
0.014922484755516052,
-0.04384227469563484,
-0.013049374334514141,
0.044725943356752396,
-0.06218831613659859,
-0.017470072954893112,
-0.06265848875045776,
-0.025844721123576164,
-0.06515426188707352,
0.018499502912163734,
0.041046783328056335,
0.08420076221227646,
-0.07962749153375626,
-0.06635177135467529,
-0.024142993614077568,
0.11555678397417068,
0.007620229851454496,
0.08504506945610046,
-0.017910979688167572,
-0.043821368366479874,
-0.038540106266736984,
-0.0044776746071875095,
-0.04814870283007622,
0.013217919506132603,
0.013835038989782333,
0.02728111483156681,
-0.00820508599281311,
0.0190719123929739,
-0.03796761482954025,
0.0028680649120360613,
-0.008550294674932957,
0.06738563627004623,
-0.01611701212823391,
0.016078047454357147,
0.05169863626360893,
0.009667161852121353,
-0.034451719373464584,
-0.0345398411154747,
0.032350149005651474,
0.09893131256103516,
0.04028195142745972,
-0.045417170971632004,
-0.02315562590956688,
0.010561752133071423,
0.004968373570591211,
0.027672480791807175,
-0.0536331869661808,
-0.06654297560453415,
0.023149609565734863,
0.05271398648619652,
0.044481173157691956,
0.05970747023820877,
0.09219245612621307,
-0.07430920004844666,
0.011600697413086891,
-0.012041176669299603,
0.01313112210482359,
0.031062234193086624,
-0.020349374040961266,
-0.010182336904108524,
0.006718134507536888,
-0.010543704964220524,
-0.029840154573321342,
0.035633385181427,
-0.006828607525676489,
0.014560174196958542,
0.02009342424571514,
0.0765804797410965,
-0.012112608179450035,
0.07496368885040283,
0.025189140811562538,
-0.010229232721030712,
-0.02866387367248535,
0.05583788454532623,
0.04121077433228493,
0.015603398904204369,
-0.026883943006396294,
-0.05474918708205223,
-0.021745214238762856,
-0.006695413030683994,
-0.0020279802847653627,
0.028978997841477394,
0.02413831651210785,
0.028879284858703613,
-0.026568813249468803,
0.021731436252593994,
0.06925752758979797,
-0.03582974895834923,
0.03463189676403999,
0.014789635315537453,
-0.04078562557697296,
0.016889996826648712,
0.01791592873632908,
0.015906082466244698,
-0.05049343779683113,
-0.026054952293634415,
-0.01763305999338627,
-0.04331233724951744,
-0.048236001282930374,
-0.0086600873619318,
0.04312743619084358,
-0.04191518947482109,
0.04002571105957031,
0.04762459546327591,
0.04596554487943649,
2.8653670369749307e-7,
0.023395961150527,
0.01737450808286667,
-0.04432539641857147,
-0.030395742505788803,
0.02465592324733734,
-0.0026513368356972933,
0.006310438737273216,
-0.014447732828557491,
-0.003245441010221839,
0.05597594752907753,
0.024574248120188713,
0.005328499712049961,
0.05033097416162491,
-0.014256836846470833,
-0.06702876836061478,
-0.044917088001966476,
-0.044818978756666183,
0.04083491861820221,
0.04409750923514366,
-0.00919293612241745,
-0.025346996262669563,
-0.009107813239097595,
-0.04537682980298996,
-0.03616222366690636,
-0.0017721342155709863,
0.046051543205976486,
-0.03057250753045082,
-0.05150904506444931,
-0.007724385242909193,
-0.0381065309047699,
0.032286450266838074,
0.035243719816207886,
0.026211580261588097,
0.08051649481058121,
-0.06997879594564438,
-0.06305282562971115,
-0.016761215403676033,
0.014195437543094158,
0.009225387126207352,
0.0015726073179394007,
0.026628056541085243,
-0.017490901052951813,
0.04547874256968498,
-0.011773000471293926,
-0.0023125880397856236,
0.04088664427399635,
-0.014271391555666924,
-0.013995347544550896,
-0.007342278026044369,
0.05169273912906647,
-0.011688757687807083,
0.02235475368797779,
-0.024071313440799713,
0.004398789722472429,
-0.027125626802444458,
-0.04060210660099983,
-0.010156580246984959,
-0.0010135103948414326,
0.041189633309841156,
-0.01172548346221447,
0.0033644309733062983,
-0.04565970227122307,
0.013324093073606491,
-0.015049781650304794,
-0.012232664972543716,
-0.028101777657866478,
-0.04577362909913063,
2.3698889059313704e-34,
-0.02219557948410511,
-0.03640338033437729,
-0.0037712017074227333,
-0.037433601915836334,
-0.009607188403606415,
-0.01629907637834549,
0.09178905189037323,
0.01704423315823078,
-0.01784634031355381,
-0.035587240010499954,
-0.030993107706308365
] | {
"ds_index": 85,
"similar_dg_indices": [
1087964,
33635,
633954,
843314,
529460,
912698,
896923,
528896,
1190873,
503002,
1156481,
655925,
609490,
866018,
1150105,
609568,
678969,
29225,
76425,
1204377
]
} |
A 30-year-old woman is brought to the urgent care clinic by her husband. She complains of numbness around her lips and a tingling sensation in her hands and feet. She underwent near-total thyroidectomy for an enlarged thyroid gland a month ago. Vital signs include: blood pressure is 130/70 mm Hg, pulse is 72/min, respiratory rate is 16/min, and temperature is 37.0°C (98.6°F). A surgical incision scar is present in the anterior aspect of the neck. The attending physician inflates the blood pressure cuff above 150 mm Hg and observes the patient a couple of minutes while measuring her blood pressure. The patient develops sudden stiffness and tingling in her hand. Blood test results are as follows:
Hemoglobin (Hb%) 10.2 g/dL
White blood cell count 7000/mm3
Platelet count 160,000/mm3
Calcium, serum (Ca2+) 6.0 mg/dL
Albumin 4 g/dL
Alanine aminotransferase (ALT), serum 15 U/L
Aspartate aminotransferase (AST), serum 8 U/L
Serum creatinine 0.5 mg/dL
Urea 27 mg/dL
Sodium 137 mEq/L
Potassium 4.5 mEq/L
Magnesium 2.5 mEq/L
Urinalysis shows no white or red blood cells and leukocyte esterase is negative. Which of the following is the next best step in the management of this patient? | Serum parathyroid hormone (PTH) level | {
"A": "CT scan abdomen with pancreatic protocol",
"B": "Serum vitamin D level",
"C": "24-hour urinary calcium",
"D": "Serum parathyroid hormone (PTH) level"
} | step1 | D | [
"30 year old woman",
"brought",
"urgent care clinic",
"husband",
"numbness",
"lips",
"tingling",
"hands",
"feet",
"total thyroidectomy",
"enlarged thyroid gland",
"month",
"Vital signs include",
"blood pressure",
"70 mm Hg",
"pulse",
"72 min",
"respiratory rate",
"min",
"temperature",
"98",
"surgical scar",
"present",
"anterior aspect",
"neck",
"attending physician",
"blood pressure cuff",
"mm Hg",
"observes",
"patient",
"couple",
"minutes",
"measuring",
"blood pressure",
"patient",
"sudden stiffness",
"tingling",
"hand",
"Blood test results",
"follows",
"Hemoglobin",
"Hb",
"g",
"White blood cell count",
"Platelet",
"Calcium",
"serum",
"Ca2",
"6 0 mg/dL Albumin 4 g",
"Alanine aminotransferase",
"ALT",
"serum",
"U/L Aspartate aminotransferase",
"AST",
"serum",
"U",
"creatinine 0.5",
"dL",
"Sodium",
"Potassium",
"Magnesium 2",
"Urinalysis shows",
"white",
"red blood cells",
"leukocyte esterase",
"negative",
"following",
"next best step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 30-year-old woman is brought to the urgent care clinic by her husband. She complains of numbness around her lips and a tingling sensation in her hands and feet. She underwent near-total thyroidectomy for an enlarged thyroid gland a month ago. Vital signs include: blood pressure is 130/70 mm Hg, pulse is 72/min, respiratory rate is 16/min, and temperature is 37.0°C (98.6°F). A surgical incision scar is present in the anterior aspect of the neck. The attending physician inflates the blood pressure cuff above 150 mm Hg and observes the patient a couple of minutes while measuring her blood pressure. The patient develops sudden stiffness and tingling in her hand. Blood test results are as follows:
Hemoglobin (Hb%) 10.2 g/dL
White blood cell count 7000/mm3
Platelet count 160,000/mm3
Calcium, serum (Ca2+) 6.0 mg/dL
Albumin 4 g/dL
Alanine aminotransferase (ALT), serum 15 U/L
Aspartate aminotransferase (AST), serum 8 U/L
Serum creatinine 0.5 mg/dL
Urea 27 mg/dL
Sodium 137 mEq/L
Potassium 4.5 mEq/L
Magnesium 2.5 mEq/L
Urinalysis shows no white or red blood cells and leukocyte esterase is negative. Which of the following is the next best step in the management of this patient?
Choose one of the following::
A. CT scan abdomen with pancreatic protocol
B. Serum vitamin D level
C. 24-hour urinary calcium
D. Serum parathyroid hormone (PTH) level | [
0.024604521691799164,
-0.0673997551202774,
0.035315580666065216,
0.009400742128491402,
0.015329340472817421,
0.007001832127571106,
-0.05515670031309128,
0.06730802357196808,
-0.0027985547203570604,
0.03725266084074974,
0.004875716287642717,
0.013975261710584164,
-0.01906861923635006,
-0.0058210790157318115,
-0.0328344888985157,
0.03829041123390198,
-0.034310221672058105,
-0.02775174379348755,
-0.011330443434417248,
-0.002744236495345831,
-0.03894748538732529,
0.024156810715794563,
0.03522321581840515,
0.033039242029190063,
0.059658486396074295,
0.022567076608538628,
0.006124020088464022,
0.003576210467144847,
0.012465182691812515,
-0.06906507164239883,
-0.060092754662036896,
-0.02024952881038189,
-0.03349316492676735,
-0.07665732502937317,
0.0000016075674693638575,
-0.011346257291734219,
0.008956527337431908,
-0.027820678427815437,
0.0023402750957757235,
-0.053059328347444534,
-0.018415722995996475,
-0.08617936074733734,
0.06079397723078728,
0.022688288241624832,
-0.044840797781944275,
-0.062264177948236465,
0.012496814131736755,
0.044506706297397614,
-0.01615949533879757,
0.0004336880811024457,
0.012060110457241535,
0.03916303440928459,
-0.04090059548616409,
0.009013442322611809,
0.057178251445293427,
-0.06845445185899734,
-0.009979267604649067,
-0.018145829439163208,
0.021125607192516327,
0.06729552149772644,
0.027549250051379204,
-0.010139018297195435,
0.024443982169032097,
0.033119697123765945,
-0.07770450413227081,
0.0293292049318552,
-0.009432223625481129,
-0.02439878322184086,
-0.01070327777415514,
0.01472050603479147,
0.004845582880079746,
0.01915682852268219,
0.07571723312139511,
0.052251558750867844,
-0.043015651404857635,
-0.023274900391697884,
0.038098618388175964,
-0.030362078920006752,
-0.008418697863817215,
-0.00877375528216362,
0.03375454619526863,
0.0434354729950428,
-0.033863238990306854,
0.02429898828268051,
-0.021280504763126373,
-0.06216053664684296,
0.026747478172183037,
-0.009979546070098877,
-0.03620374947786331,
0.0033892334904521704,
-0.05056330934166908,
0.0032496657222509384,
0.04030328989028931,
0.00039607941289432347,
-0.042271047830581665,
-0.010453887283802032,
0.003499429440125823,
-0.03983095660805702,
0.025397460907697678,
-0.0720168948173523,
-0.061507876962423325,
0.02042095549404621,
0.033287547528743744,
0.002710363594815135,
-0.0012435370590537786,
-0.03493315353989601,
-0.01188914105296135,
0.0015275611076503992,
-0.05264855921268463,
0.04203397035598755,
-0.027522914111614227,
0.02710028924047947,
-0.05079042539000511,
0.00017171289073303342,
0.11368734389543533,
0.019450362771749496,
0.025563886389136314,
-0.030348757281899452,
-0.0006356991361826658,
0.08407413214445114,
0.008708924986422062,
0.05344501882791519,
0.02872367575764656,
-0.02920551784336567,
-0.014894554391503334,
0.016167376190423965,
0.02598945051431656,
0.02274548076093197,
-0.01822841539978981,
0.005348921287804842,
0.027382029220461845,
-0.03723908215761185,
-0.0028484154026955366,
0.009137723594903946,
0.04079100862145424,
0.007046482991427183,
0.04068154841661453,
0.06233686953783035,
-0.012688880786299706,
0.018329644575715065,
0.002235690364614129,
0.02810933254659176,
0.05450268089771271,
0.04015045985579491,
0.007317211013287306,
0.02552078105509281,
0.016312673687934875,
0.048029959201812744,
0.0030157514847815037,
0.02195146679878235,
-0.033614594489336014,
-0.028783787041902542,
-0.03189745917916298,
0.016482284292578697,
-0.02335357666015625,
0.005258875899016857,
0.007797323167324066,
-0.04599904268980026,
0.012245941907167435,
-0.05938537418842316,
0.010790667496621609,
-0.03508906811475754,
-0.0038953120820224285,
-0.03548311069607735,
0.0018108320655301213,
0.04714440554380417,
-0.02086026221513748,
0.06661079078912735,
-0.0851067528128624,
0.03957601264119148,
-0.040463317185640335,
0.06240105256438255,
0.03748135641217232,
0.031961895525455475,
-0.05702454596757889,
0.02030298113822937,
-0.049263209104537964,
-0.02447476238012314,
-0.01343581359833479,
-0.08540932089090347,
-0.014243891462683678,
0.05105651542544365,
-0.014946614392101765,
-0.033657245337963104,
0.019222887232899666,
0.012963653542101383,
-0.009446781128644943,
-0.058923497796058655,
-0.031050438061356544,
-0.030186941847205162,
-0.02848278358578682,
0.0049695479683578014,
-0.011220335029065609,
0.004551276098936796,
0.00888041965663433,
0.021236484870314598,
-0.031879864633083344,
-0.045799270272254944,
0.015672890469431877,
0.002171566477045417,
0.018972603604197502,
-0.02170521207153797,
-0.035796258598566055,
0.07133782655000687,
-0.031092846766114235,
0.04221641272306442,
0.012079045176506042,
-0.02974681742489338,
0.0017746080411598086,
0.05020096153020859,
-0.05719417333602905,
0.009724474512040615,
0.02655578777194023,
-0.06908588111400604,
0.026218077167868614,
0.035052113234996796,
0.007632788270711899,
0.0036084612365812063,
-0.09237657487392426,
0.03745599091053009,
-0.005928078666329384,
-0.010234478861093521,
-0.023926494643092155,
0.007250490598380566,
-0.02844064310193062,
-0.01837005466222763,
0.029858889058232307,
0.008467528037726879,
-0.04870813339948654,
-0.07103095948696136,
0.010064195841550827,
0.027146831154823303,
0.0009055589907802641,
-0.025538403540849686,
-0.06461168825626373,
-0.001016676309518516,
0.002390634035691619,
-0.0652184709906578,
-0.015063152648508549,
0.040878985077142715,
-0.033308543264865875,
-0.04688708856701851,
-0.05678344890475273,
-0.06209840252995491,
-0.0007251481874845922,
0.044684264808893204,
0.010927600786089897,
0.054203782230615616,
-0.06275226920843124,
0.055372025817632675,
-0.02801874279975891,
-0.004363298881798983,
-0.026616256684064865,
0.01575988158583641,
-0.005492934491485357,
0.08326782286167145,
-0.031527794897556305,
0.01497621275484562,
-0.004749781917780638,
-0.06118946522474289,
0.010077457875013351,
-0.02174180932343006,
0.016211984679102898,
-0.011293837800621986,
-0.0444486103951931,
-0.023752054199576378,
-0.012448973022401333,
-0.04851454496383667,
-0.04399729147553444,
0.06301873177289963,
0.02893207222223282,
0.03265378996729851,
0.04008844494819641,
0.01658417284488678,
-0.013603751547634602,
-0.023777753114700317,
-0.033111218363046646,
0.03543364629149437,
0.037220776081085205,
-0.0024695852771401405,
0.0379902645945549,
0.10286035388708115,
0.042936328798532486,
0.03327176347374916,
-0.01015766616910696,
-0.006871769670397043,
-0.021008385345339775,
0.024525901302695274,
0.06087500974535942,
0.017866667360067368,
0.0004517016641329974,
-0.005812690127640963,
0.032302577048540115,
-0.0616888590157032,
-0.033318474888801575,
-0.042712483555078506,
-0.02701556496322155,
0.012522297911345959,
0.03801533952355385,
0.00997233111411333,
0.018107431009411812,
0.020725663751363754,
0.028642212972044945,
0.00030225541559047997,
-0.0013404377968981862,
0.014817100949585438,
0.06463679671287537,
0.0292600616812706,
-0.009942440316081047,
0.030020562931895256,
0.05046902596950531,
-0.020145483314990997,
-0.049348026514053345,
-0.08432681113481522,
0.003932496067136526,
0.016883255913853645,
0.016601139679551125,
-0.04800448566675186,
0.008943495340645313,
0.004897099919617176,
-0.015445933677256107,
0.09211106598377228,
0.036431875079870224,
0.016509149223566055,
0.010166705586016178,
-0.02358466014266014,
0.012049700133502483,
-0.019834572449326515,
-0.0037328992038965225,
-0.026529254391789436,
0.012795377522706985,
-0.027449602261185646,
0.0005812257877551019,
0.0422782301902771,
-0.02804422192275524,
-0.006605788134038448,
0.038075562566518784,
-0.0037155256140977144,
0.0031579160131514072,
0.04862285032868385,
0.008078536950051785,
-0.036661166697740555,
0.026844637468457222,
0.013852137140929699,
0.016098713502287865,
-0.0031802549492567778,
-0.020070156082510948,
0.034403473138809204,
0.08265811949968338,
-0.008269472979009151,
-0.0664370059967041,
0.04382329434156418,
0.007712448015809059,
-0.0005836114287376404,
-0.032332710921764374,
-0.01844860427081585,
-0.0006366034504026175,
0.06572291254997253,
-0.06609920412302017,
0.009747947566211224,
0.013768677599728107,
0.011511322110891342,
0.036124665290117264,
-0.01666213572025299,
-0.021140243858098984,
-0.02549014613032341,
0.005497683770954609,
-0.04502400383353233,
-0.04073774814605713,
-0.015666790306568146,
-0.045520883053541183,
-0.010927951894700527,
-0.03197652846574783,
0.0940890982747078,
0.0004740618169307709,
-0.001743849366903305,
-0.013241449370980263,
-0.0887705609202385,
-0.09171696752309799,
-0.026867760345339775,
0.03501106798648834,
-0.010969380848109722,
0.021053556352853775,
-0.020197751000523567,
-0.04529384523630142,
0.021594027057290077,
0.03030761331319809,
-0.03821441903710365,
0.04847423732280731,
-0.008702469058334827,
-0.002812402555719018,
0.0033684889785945415,
0.023391148075461388,
0.010096145793795586,
0.01630164496600628,
0.05847987160086632,
0.017299888655543327,
-0.045387353748083115,
-0.004967928864061832,
0.1095583587884903,
-0.015320218168199062,
0.013825902715325356,
-0.01109206210821867,
0.03981412574648857,
0.07559917867183685,
-0.027675988152623177,
-0.02007526159286499,
-0.017204269766807556,
-0.014235191978514194,
0.060721974819898605,
0.05178931728005409,
-0.04902157932519913,
0.02249945141375065,
-0.008186391554772854,
-0.016652768477797508,
0.012046263553202152,
0.009664070792496204,
0.043501146137714386,
-0.004976379685103893,
-0.06578125804662704,
0.042933281511068344,
-0.0071710082702338696,
-0.07102138549089432,
-0.0592506006360054,
-0.007739047519862652,
0.017224261537194252,
0.027384070679545403,
0.02067972719669342,
-0.018905561417341232,
0.021977433934807777,
0.029897859320044518,
-0.03831235319375992,
0.04841901361942291,
0.0353635810315609,
-0.010666202753782272,
0.04806021973490715,
-0.006335993763059378,
0.010706770233809948,
-0.006622387561947107,
-0.060546066612005234,
-0.0008587160264141858,
0.0039029764011502266,
0.07438686490058899,
0.05525771901011467,
0.0632295086979866,
0.02018999122083187,
0.021797657012939453,
0.07164540141820908,
0.013391036540269852,
0.06782771646976471,
0.014949987642467022,
-0.01493255328387022,
0.045383986085653305,
0.03934213146567345,
0.019669339060783386,
-0.014579911716282368,
0.004095469601452351,
0.06004001200199127,
0.02289954386651516,
-0.002853031037375331,
-0.027239995077252388,
0.019427649676799774,
-0.032647307962179184,
-0.03373603895306587,
0.004817862529307604,
-0.045869626104831696,
-0.04212210699915886,
-0.0006174352020025253,
0.008480988442897797,
-0.0013580814702436328,
0.027094855904579163,
0.04140990972518921,
-0.010580793023109436,
-0.03510765731334686,
0.03962495177984238,
-0.05221467465162277,
-0.04888829216361046,
-0.02670566737651825,
-0.08021952956914902,
0.018470631912350655,
0.038378793746232986,
0.04493393003940582,
-0.055226415395736694,
0.025749705731868744,
-0.02161557786166668,
-0.020925773307681084,
0.009571574628353119,
-0.021778011694550514,
-0.011585671454668045,
0.005441268905997276,
0.009062550961971283,
0.016766158863902092,
0.022153446450829506,
-0.05285504460334778,
-0.07615329325199127,
-0.018045589327812195,
0.0073923515155911446,
0.034671586006879807,
0.013235104270279408,
0.004872464574873447,
0.05199291929602623,
0.009523080661892891,
0.019380977377295494,
-0.008143536746501923,
0.03754351660609245,
0.012384455651044846,
0.009723125025629997,
0.023565594106912613,
-0.008113520219922066,
-0.057627469301223755,
-0.011946935206651688,
0.03645357862114906,
-0.04494268819689751,
0.053586605936288834,
0.0817234069108963,
-0.023935016244649887,
-0.07616590708494186,
-0.019890038296580315,
-0.02260780707001686,
0.019061915576457977,
0.008095919154584408,
0.01420004852116108,
0.0029479707591235638,
-0.0031993985176086426,
0.009235435165464878,
0.04156646504998207,
-0.00009973208943847567,
0.035221461206674576,
0.015650523826479912,
0.06268623471260071,
-0.03418882563710213,
-0.01796477474272251,
-0.00967803318053484,
-0.03208077698945999,
0.0058354041539132595,
0.005971596110612154,
0.009752117097377777,
0.006394145544618368,
0.021153561770915985,
-0.0465007945895195,
0.03394123166799545,
0.025331957265734673,
0.04293319582939148,
0.012818592600524426,
-0.0683024674654007,
0.004419019911438227,
0.018830174580216408,
-0.034583985805511475,
-0.0076681519858539104,
0.0391816645860672,
-0.009863680228590965,
0.06282094120979309,
0.017502926290035248,
0.03882362321019173,
0.002163110300898552,
-4.4054835652071983e-33,
0.0260938573628664,
-0.01878572255373001,
-0.0033557869028300047,
0.011087529361248016,
-0.01201254315674305,
0.08180560171604156,
-0.057175539433956146,
0.02331598661839962,
-0.054222993552684784,
0.004989958833903074,
-0.03582668676972389,
-0.003957872278988361,
0.022181089967489243,
0.05770184472203255,
-0.006053986493498087,
-0.06300994753837585,
-0.000553042278625071,
0.03783947601914406,
-0.021815145388245583,
-0.003767178626731038,
-0.06381630897521973,
-0.018591731786727905,
0.025578245520591736,
0.009652698412537575,
0.00658663222566247,
-0.01621495932340622,
0.027121080085635185,
0.00592719716951251,
-0.016350263729691505,
-0.007425310555845499,
0.026151452213525772,
-0.004129098262637854,
0.029758622869849205,
0.0027296137996017933,
0.004096555523574352,
-0.05887848138809204,
-0.028720207512378693,
-0.06529325246810913,
0.03859364613890648,
-0.03538798168301582,
-0.030252981930971146,
0.0018601834308356047,
0.0729985386133194,
-0.0016527638072147965,
0.05046987906098366,
-0.013472683727741241,
-0.04004409909248352,
-0.04955827817320824,
-0.011466612108051777,
-0.026856401935219765,
0.021090159192681313,
0.01074280682951212,
-0.0006452254601754248,
-0.028852129355072975,
-0.020265359431505203,
-0.013000423088669777,
0.0014377160696312785,
0.015085062012076378,
-0.020563406869769096,
-0.042462605983018875,
-0.05202309787273407,
0.027049435302615166,
-0.03592533618211746,
-0.03071500174701214,
-0.022506214678287506,
0.035191502422094345,
0.02962644398212433,
0.04632388427853584,
-0.05261029303073883,
0.036765918135643005,
-0.12100663036108017,
0.0002581858716439456,
0.010703422129154205,
0.0014669930096715689,
-0.032002486288547516,
-0.08065074682235718,
-0.001229217043146491,
-0.0037153391167521477,
0.0073001086711883545,
0.031187888234853745,
-0.02998686581850052,
0.003465204732492566,
-0.02928698994219303,
-0.03930193558335304,
-0.009885349310934544,
-0.0019277898827567697,
-0.005313686095178127,
-0.02874026633799076,
-0.009019383229315281,
0.010442721657454967,
0.08732061833143234,
0.023694371804594994,
0.06750686466693878,
-0.006624184083193541,
0.050241000950336456,
-0.017213474959135056,
0.0026735637802630663,
0.026508033275604248,
0.020742520689964294,
-0.03901738300919533,
0.06418721377849579,
-0.040129054337739944,
0.056263864040374756,
-0.025586312636733055,
-0.034639790654182434,
-0.007313333917409182,
-0.0538252517580986,
0.03633798286318779,
0.009462439455091953,
0.03459484130144119,
0.014218810945749283,
-0.018158722668886185,
-0.018727164715528488,
0.04628753662109375,
-0.03435894474387169,
0.013473549857735634,
0.03205318748950958,
0.0073822541162371635,
0.03485940024256706,
0.007978145964443684,
0.007351846434175968,
0.024320922791957855,
0.042934250086545944,
-0.035982999950647354,
-0.03148466348648071,
-0.047047194093465805,
0.06123649328947067,
0.05429775267839432,
-0.039462484419345856,
-0.006393367890268564,
0.030014533549547195,
0.01242953259497881,
2.5775452172638325e-7,
0.010578093118965626,
-0.028351712971925735,
0.011926798149943352,
-0.10683013498783112,
0.04164832457900047,
0.003903378499671817,
-0.027056248858571053,
-0.004689380060881376,
0.020080385729670525,
-0.04767798259854317,
0.05297441408038139,
0.015178272500634193,
0.0026974983047693968,
-0.02508828602731228,
0.033062029629945755,
-0.03263779357075691,
-0.005345195531845093,
-0.03749662637710571,
0.027393490076065063,
-0.041856568306684494,
0.02171728014945984,
-0.08170615136623383,
-0.06557303667068481,
-0.02340739034116268,
-0.02459716983139515,
-0.06280646473169327,
0.015105750411748886,
-0.06160660460591316,
-0.03556498885154724,
-0.010553764179348946,
-0.009793663397431374,
0.03907700628042221,
0.002691841684281826,
0.03279111534357071,
-0.028893034905195236,
-0.04268788918852806,
0.03786842152476311,
0.053441520780324936,
-0.05516567453742027,
0.031446803361177444,
0.019129464402794838,
0.004823377821594477,
0.02113802172243595,
0.00026576872915029526,
0.038107890635728836,
-0.025282589718699455,
-0.057424623519182205,
-0.031145643442869186,
0.011445294134318829,
0.007716312073171139,
-0.0023592321667820215,
0.02470981515944004,
-0.013071798719465733,
0.026624351739883423,
-0.005839253310114145,
0.04257208853960037,
-0.07024411857128143,
-0.003425891511142254,
0.05778149515390396,
-0.016949478536844254,
-0.0008700619800947607,
-0.051249679177999496,
0.0512782447040081,
0.00038409672561101615,
0.011313687078654766,
-0.02276882342994213,
-0.024933386594057083,
1.7354010216012852e-34,
-0.015286274254322052,
-0.07330857962369919,
0.005373196676373482,
-0.023723332211375237,
-0.018261458724737167,
-0.030641645193099976,
-0.002340522827580571,
0.025672512128949165,
-0.003905892837792635,
-0.08403080701828003,
-0.0467093400657177
] | {
"ds_index": 86,
"similar_dg_indices": [
899239,
662694,
1064656,
388790,
1206355,
112313,
893509,
217387,
498737,
415530,
338963,
105736,
480443,
1107953,
1131229,
1161371,
145595,
23330,
591333,
1042911
]
} |
A woman with coronary artery disease is starting to go for a walk. As she begins, her heart rate accelerates from a resting pulse of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her chest. She stops walking to rest and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement? | Increasing the heart rate decreases the relative amount of time spent during diastole | {
"A": "Increasing the heart rate increases the amount of time spent during each cardiac cycle",
"B": "Increasing the heart rate decreases the relative amount of time spent during diastole",
"C": "Perfusion of the myocardium takes place primarily during systole",
"D": "Perfusion of the myocardium takes place equally throughout the cardiac cycle"
} | step1 | B | [
"woman",
"coronary artery disease",
"starting to go",
"walk",
"begins",
"heart rate accelerates",
"resting pulse",
"60",
"reaches",
"rate",
"point",
"begins to feel",
"chest",
"stops walking to rest",
"resolves",
"last",
"months",
"following",
"true statement"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A woman with coronary artery disease is starting to go for a walk. As she begins, her heart rate accelerates from a resting pulse of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her chest. She stops walking to rest and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement?
Choose one of the following::
A. Increasing the heart rate increases the amount of time spent during each cardiac cycle
B. Increasing the heart rate decreases the relative amount of time spent during diastole
C. Perfusion of the myocardium takes place primarily during systole
D. Perfusion of the myocardium takes place equally throughout the cardiac cycle | [
-0.018717000260949135,
-0.02951846830546856,
-0.003486814210191369,
0.030873700976371765,
-0.002464946825057268,
-0.007145015522837639,
-0.07212050259113312,
0.03338123485445976,
0.03021264262497425,
0.03306053206324577,
0.09378007054328918,
0.03235509619116783,
0.04194159433245659,
-0.07585474103689194,
-0.05597488209605217,
0.012918511405587196,
0.026645150035619736,
0.016691075637936592,
0.01632089354097843,
0.003808585461229086,
-0.007389299105852842,
0.006615990307182074,
0.021361012011766434,
-0.01724362187087536,
0.03306873142719269,
-0.044371988624334335,
0.027005011215806007,
-0.04531187564134598,
0.027988817542791367,
-0.025176990777254105,
0.019326653331518173,
-0.004153755959123373,
0.0004638167447410524,
-0.020442379638552666,
0.0000019100928057014244,
-0.025195730850100517,
-0.006039591506123543,
0.022744687274098396,
-0.002096818294376135,
-0.05245530977845192,
-0.005360733717679977,
-0.02658781036734581,
0.056844741106033325,
0.03632529824972153,
-0.02860061638057232,
-0.06578116118907928,
-0.03774823248386383,
0.020266076549887657,
-0.010110266506671906,
0.022214524447917938,
-0.001524190534837544,
0.03869404271245003,
-0.09325684607028961,
-0.020563818514347076,
-0.040237508714199066,
-0.037551261484622955,
0.01666962169110775,
-0.01685062237083912,
-0.0017913759220391512,
0.0323399119079113,
-0.013628736138343811,
0.03244705870747566,
-0.005007981788367033,
0.06585702300071716,
0.05298736318945885,
-0.006073368713259697,
0.027224930003285408,
-0.02274913340806961,
-0.0009028331842273474,
0.007748480420559645,
0.008361956104636192,
0.07115507870912552,
0.06937535107135773,
0.0473497100174427,
-0.0026161042042076588,
-0.012303215451538563,
0.002380040008574724,
-0.055285628885030746,
-0.0024993005208671093,
0.005076032597571611,
-0.022343924269080162,
0.04757009819149971,
0.0007475658203475177,
0.015556463971734047,
-0.09332718700170517,
-0.06596620380878448,
-0.026383385062217712,
0.0006677607889287174,
-0.00028479917091317475,
-0.03836260363459587,
0.008003060705959797,
-0.08069922029972076,
-0.005239519756287336,
-0.001995014725252986,
-0.01739470660686493,
0.015315981581807137,
-0.016666259616613388,
0.07936692982912064,
0.0459941141307354,
-0.03852231428027153,
-0.06117052957415581,
0.0024090518709272146,
0.051011525094509125,
0.02297826111316681,
0.024511953815817833,
-0.0038685675244778395,
-0.03005201183259487,
0.06696905195713043,
-0.042061734944581985,
0.07585351169109344,
-0.04907970875501633,
0.025081653147935867,
0.02885841205716133,
0.06857011467218399,
0.029963195323944092,
-0.013013423420488834,
-0.07317887246608734,
-0.03439369425177574,
0.030680857598781586,
0.09343540668487549,
-0.07457993179559708,
-0.0005103184375911951,
0.007012306712567806,
0.017514141276478767,
-0.03297039493918419,
0.06906048953533173,
-0.010960987769067287,
0.04602612182497978,
0.03355161100625992,
-0.0061155883595347404,
0.0043351235799491405,
-0.0297083742916584,
-0.017812849953770638,
0.0047021894715726376,
0.015257949940860271,
-0.05733184888958931,
-0.0488380528986454,
0.06629898399114609,
-0.019461248070001602,
-0.019805755466222763,
-0.00214972160756588,
-0.07818397879600525,
-0.0035726644564419985,
-0.015509236603975296,
0.03613944351673126,
0.09010475128889084,
0.023715633898973465,
0.025569310411810875,
-0.005560884717851877,
0.050543639808893204,
-0.01699676737189293,
0.06353927403688431,
-0.026121970266103745,
0.04369901493191719,
0.001576170208863914,
0.04144469276070595,
0.07504492253065109,
0.03655814379453659,
0.015406697988510132,
-0.015061335638165474,
0.03365711867809296,
-0.015677854418754578,
-0.020120594650506973,
0.012288653291761875,
0.04134362190961838,
-0.010381330735981464,
0.09946882724761963,
0.06467403471469879,
-0.02580038085579872,
0.04978909343481064,
-0.027757633477449417,
-0.02477457746863365,
0.007631791289895773,
0.04037436842918396,
0.0020100472029298544,
0.029614321887493134,
-0.049027107656002045,
-0.01035845372825861,
-0.02983180619776249,
0.005745035596191883,
0.013345818966627121,
0.06552885472774506,
-0.006123632192611694,
-0.08073113113641739,
-0.00622364180162549,
0.013426059857010841,
-0.026787487789988518,
-0.04359420761466026,
-0.013018905185163021,
-0.04991256073117256,
-0.06296465545892715,
0.015111053362488747,
-0.0069430009461939335,
-0.017035435885190964,
-0.0039633470587432384,
0.04215296730399132,
-0.058604102581739426,
0.003951393533498049,
-0.0022211819887161255,
0.013397928327322006,
-0.028519025072455406,
-0.008648722432553768,
-0.033642109483480453,
-0.007774049416184425,
-0.01703682914376259,
0.014928597025573254,
-0.022629011422395706,
0.012637089937925339,
0.07157371938228607,
-0.020377207547426224,
0.04792269319295883,
0.054711319506168365,
0.01931891217827797,
-0.04100341722369194,
0.02315017394721508,
0.015940820798277855,
-0.033089619129896164,
0.05270148068666458,
-0.09285175055265427,
0.04276802018284798,
-0.013864342123270035,
0.056623879820108414,
0.01019236259162426,
0.004449185915291309,
-0.015013535507023335,
0.02068752981722355,
-0.01537801418453455,
-0.01778029464185238,
-0.017394885420799255,
-0.10498398542404175,
0.02430412918329239,
0.007237351033836603,
-0.041208844631910324,
0.011194704100489616,
-0.055609628558158875,
0.08237571269273758,
-0.008240927942097187,
-0.036631304770708084,
0.027129091322422028,
0.026819251477718353,
-0.020057974383234978,
-0.011435584165155888,
-0.006799744907766581,
0.014822151511907578,
-0.015224779956042767,
-0.025188619270920753,
-0.02826566994190216,
0.008164016529917717,
-0.017413459718227386,
-0.009004163555800915,
-0.01745631918311119,
-0.0017276564612984657,
0.002128572203218937,
0.020089412108063698,
0.016135552898049355,
0.060112424194812775,
-0.003118932479992509,
0.05902217701077461,
-0.03225488215684891,
-0.041448913514614105,
0.005116030108183622,
-0.009826505556702614,
-0.02723531797528267,
0.014053929597139359,
-0.04210911691188812,
-0.026981541886925697,
0.007026146166026592,
0.010183903388679028,
-0.001733922166749835,
0.013597283512353897,
0.02547234669327736,
-0.06377740204334259,
0.010633219964802265,
-0.0033695483580231667,
0.006349082570523024,
0.010864492505788803,
-0.028314433991909027,
0.06338353455066681,
0.03648015484213829,
0.01181090623140335,
0.03871357813477516,
0.049528516829013824,
-0.017739901319146156,
0.04383175075054169,
-0.014130695722997189,
0.01850755326449871,
0.00965408980846405,
-0.03220805153250694,
0.035986240953207016,
-0.03434273600578308,
-0.013408445753157139,
0.017671087756752968,
0.02035626210272312,
-0.018393289297819138,
-0.019099662080407143,
0.014350324869155884,
-0.01789284311234951,
-0.02623039297759533,
0.0039413971826434135,
0.07554157078266144,
0.0044265310280025005,
0.030309945344924927,
-0.008430144749581814,
-0.02568180114030838,
-0.045200690627098083,
0.032109420746564865,
-0.027773674577474594,
-0.02750757895410061,
0.035862356424331665,
0.049903638660907745,
0.09479887038469315,
-0.023506714031100273,
-0.013080243021249771,
-0.06505630165338516,
-0.03835086524486542,
0.015514044091105461,
-0.050990212708711624,
-0.0482429563999176,
0.025878390297293663,
0.053419653326272964,
0.0380123071372509,
0.004996992647647858,
-0.023403184488415718,
0.03226534277200699,
-0.002118045464158058,
0.017720669507980347,
0.016157200559973717,
-0.017429539933800697,
-0.0174629595130682,
-0.009901138022542,
0.02710905112326145,
-0.006007091142237186,
0.01290429849177599,
0.025011690333485603,
-0.07590086758136749,
0.024841168895363808,
-0.04024192690849304,
0.004572915844619274,
-0.03911616653203964,
0.045012254267930984,
-0.008945699781179428,
-0.05745052546262741,
-0.036434393376111984,
-0.006815503817051649,
-0.009674635715782642,
0.003660141956061125,
-0.04472941905260086,
-0.02233038656413555,
0.04564892128109932,
-0.04745480418205261,
-0.02115008421242237,
0.028140166774392128,
-0.02956043742597103,
-0.019129164516925812,
-0.040716614574193954,
-0.000468206824734807,
0.03486930951476097,
0.0533638559281826,
-0.041368693113327026,
-0.016741430386900902,
-0.0035732234828174114,
0.03921697661280632,
0.011777546256780624,
0.06645061820745468,
-0.041873712092638016,
0.0064425538294017315,
-0.010388909839093685,
0.009297112934291363,
-0.021778510883450508,
-0.009918746538460255,
-0.009747822768986225,
0.0008204157347790897,
-0.06010708957910538,
0.07618390023708344,
-0.004726262763142586,
0.006930605974048376,
-0.0013506528921425343,
-0.024032698944211006,
-0.04884186387062073,
0.007247084751725197,
0.0527416355907917,
-0.012934652157127857,
0.02868841402232647,
-0.004474352579563856,
-0.002997370669618249,
0.02961815521121025,
0.030590906739234924,
-0.044866546988487244,
-0.0028676430229097605,
0.05204949900507927,
0.03346611186861992,
0.03277333825826645,
0.034860871732234955,
-0.06281915307044983,
0.005835438147187233,
0.02776608057320118,
-0.005418369546532631,
-0.011377930641174316,
-0.003050650702789426,
0.04913833737373352,
0.02810162864625454,
-0.0397411473095417,
0.017174983397126198,
0.00044699740828946233,
0.028433863073587418,
0.014079765416681767,
-0.048234567046165466,
0.03619363158941269,
-0.013346902094781399,
-0.002228274941444397,
0.007173636928200722,
-0.0010070413118228316,
0.025434313341975212,
-0.003926099743694067,
0.017521992325782776,
0.06488179415464401,
0.003597147995606065,
-0.023318974301218987,
0.005168532487004995,
-0.01765398494899273,
0.052796605974435806,
0.02383003942668438,
0.04430703818798065,
-0.021374210715293884,
-0.011718298308551311,
-0.030166860669851303,
0.09904105216264725,
-0.032614272087812424,
0.002902633510529995,
-0.03395334631204605,
0.053123876452445984,
-0.007065970450639725,
0.06399676948785782,
0.04558296129107475,
-0.04441327601671219,
-0.015089358203113079,
-0.03540865704417229,
-0.0509352833032608,
0.01873856410384178,
-0.06621924787759781,
-0.004656813107430935,
-0.024809183552861214,
0.06037940829992294,
0.011149758473038673,
0.010315191932022572,
0.08695963025093079,
0.02068312093615532,
-0.014851433224976063,
-0.01965700276196003,
0.05010721832513809,
0.026935959234833717,
0.035257477313280106,
0.06185027211904526,
-0.010868486948311329,
0.03416500613093376,
0.009870856069028378,
-0.02133951336145401,
-0.08717089891433716,
0.021262720227241516,
-0.03154326602816582,
0.012280024588108063,
0.004535027779638767,
0.03326815739274025,
-0.06667158752679825,
-0.015380709432065487,
-0.027266087010502815,
-0.0585801936686039,
0.016673492267727852,
0.027780544012784958,
-0.03668341413140297,
-0.054751984775066376,
-0.012066847644746304,
-0.01631109043955803,
0.024842267856001854,
-0.02461361512541771,
-0.0012540435418486595,
-0.09027719497680664,
-0.057523567229509354,
-0.03336801007390022,
0.050218358635902405,
0.03297721594572067,
-0.07702299952507019,
0.007193765603005886,
0.002710851142182946,
0.004954454023391008,
0.012712274678051472,
-0.0033912232611328363,
-0.01720632053911686,
-0.011640842072665691,
-0.0005039778188802302,
-0.054413411766290665,
-0.012257680296897888,
-0.020816583186388016,
-0.018503129482269287,
-0.0698695257306099,
-0.035224974155426025,
-0.03919506072998047,
0.08839204162359238,
-0.020225543528795242,
0.022210758179426193,
-0.006848963443189859,
-0.014296826906502247,
0.010596303269267082,
-0.022458935156464577,
-0.00814807042479515,
0.014836096204817295,
0.004977267235517502,
0.04282835125923157,
0.005962013266980648,
0.002435512375086546,
-0.0395122691988945,
-0.02550397627055645,
0.005799978040158749,
0.06190036982297897,
0.021580351516604424,
0.006660143844783306,
-0.026217089965939522,
-0.04267004132270813,
-0.00785777997225523,
-0.008158042095601559,
-0.0067411018535494804,
-0.021482665091753006,
-0.017264312133193016,
-0.010417726822197437,
0.02585839107632637,
0.013328787870705128,
-0.014506805688142776,
0.005841877311468124,
0.032883211970329285,
0.045556824654340744,
-0.050027139484882355,
-0.04479651525616646,
-0.022175313904881477,
-0.06443268060684204,
-0.02939765341579914,
0.011702368035912514,
-0.021402016282081604,
-0.0337882936000824,
0.038235537707805634,
-0.043394554406404495,
0.0022267932072281837,
-0.010683947242796421,
0.07979049533605576,
0.004282247740775347,
0.005112264771014452,
-0.027125563472509384,
-0.00742902047932148,
-0.004528507124632597,
-0.051923900842666626,
-0.0534774512052536,
-0.030495107173919678,
0.07322334498167038,
-0.07429084926843643,
0.03752576559782028,
-0.010245127603411674,
-5.8027466802556186e-33,
0.0408359095454216,
0.01599639467895031,
0.024640202522277832,
-0.049126576632261276,
-0.02491595968604088,
0.05870949104428291,
-0.05312249809503555,
0.007393496576696634,
-0.031977858394384384,
0.04543541371822357,
-0.04416384547948837,
0.005824947729706764,
0.03425413742661476,
0.038266390562057495,
-0.016459031030535698,
-0.0604468435049057,
0.031137535348534584,
0.008237446658313274,
-0.013876593671739101,
-0.03923424333333969,
-0.01675625704228878,
-0.02878347970545292,
0.0014440972590819001,
-0.08995891362428665,
0.009009427390992641,
0.014246910810470581,
0.011109746061265469,
-0.016756968572735786,
-0.03420906141400337,
-0.0094505799934268,
0.012788171879947186,
0.007437717169523239,
-0.0018821903504431248,
-0.06430526077747345,
0.005214381497353315,
-0.08121808618307114,
0.011842693202197552,
-0.034745343029499054,
0.00917789526283741,
0.010588676668703556,
-0.054071880877017975,
0.0035960101522505283,
-0.009307775646448135,
0.022343486547470093,
0.016858017072081566,
-0.02317771688103676,
0.008182770572602749,
-0.022211197763681412,
0.021438831463456154,
-0.07211491465568542,
-0.0312491524964571,
0.00043243757681921124,
0.0068231369368731976,
0.003081518691033125,
-0.06047388166189194,
-0.05469297617673874,
-0.02755393274128437,
0.014648639596998692,
-0.0008500777184963226,
-0.010232744738459587,
0.06601613759994507,
0.006588655989617109,
-0.013534176163375378,
-0.010913084261119366,
-0.025182483717799187,
-0.016395708546042442,
-0.037532202899456024,
0.0038383735809475183,
-0.04403083398938179,
0.12448731809854507,
-0.10130253434181213,
0.10090779513120651,
0.015050427988171577,
0.015529835596680641,
-0.009371981024742126,
-0.061542101204395294,
0.019557982683181763,
-0.009019897319376469,
0.021658115088939667,
-0.036036714911460876,
-0.04439283162355423,
0.01893208734691143,
-0.034979693591594696,
-0.03179061785340309,
0.004051522351801395,
0.05668996274471283,
-0.013990474864840508,
-0.0021790440659970045,
0.0056639863178133965,
-0.024514835327863693,
0.02506505511701107,
0.032113898545503616,
0.006889662239700556,
-0.011700008995831013,
0.005029972642660141,
-0.019276725128293037,
0.03851837292313576,
-0.04333816468715668,
0.03816308453679085,
0.02985510788857937,
0.05575353279709816,
0.03469926491379738,
0.021271133795380592,
0.022026030346751213,
-0.00665777875110507,
0.01661091297864914,
-0.02855967916548252,
0.008491093292832375,
-0.011881876736879349,
0.03321891278028488,
0.00867935735732317,
0.013025114312767982,
0.046487219631671906,
-0.0433349646627903,
-0.047323692589998245,
-0.010480977594852448,
-0.019799167290329933,
0.06699178367853165,
0.015104956924915314,
0.026724476367235184,
0.008236903697252274,
0.06783263385295868,
0.016784945502877235,
0.043803758919239044,
-0.010640107095241547,
-0.031558047980070114,
0.0216229110956192,
0.0570879802107811,
-0.09686002135276794,
-0.0526404045522213,
0.00017450509767513722,
0.011060167104005814,
2.734531676651386e-7,
-0.03945012763142586,
-0.02015286684036255,
0.014369689859449863,
-0.03826837241649628,
-0.011627151630818844,
-0.025127366185188293,
-0.01994209922850132,
-0.0025680377148091793,
0.013968887738883495,
-0.0028754195664077997,
0.015668410807847977,
0.002909838454797864,
-0.027150854468345642,
0.023172646760940552,
0.07531217485666275,
0.0010770568624138832,
0.005452863406389952,
0.03795796260237694,
0.01747727580368519,
-0.013444740325212479,
-0.03146151080727577,
-0.00037733998033218086,
-0.06539927423000336,
-0.015262392349541187,
0.03151861950755119,
0.007643579505383968,
0.00378131540492177,
-0.004472602158784866,
-0.01793513260781765,
-0.011344797909259796,
-0.008660058490931988,
0.029218174517154694,
0.03827446326613426,
-0.047593582421541214,
-0.021391384303569794,
-0.03249819204211235,
0.03454386815428734,
0.03231089562177658,
-0.008372223936021328,
0.04835063964128494,
-0.007173716556280851,
0.05871454253792763,
-0.007811489515006542,
0.05149711295962334,
0.08696409314870834,
-0.01893138699233532,
-0.026609765365719795,
-0.029508983716368675,
0.02055748924612999,
0.005582688841968775,
0.04185480996966362,
0.012153293937444687,
0.0026190041098743677,
0.07830971479415894,
0.011171439662575722,
0.06130484864115715,
-0.07770972698926926,
0.01393410935997963,
0.019603494554758072,
-0.012828023172914982,
0.009472624398767948,
-0.015313356183469296,
-0.01111985370516777,
0.05147331580519676,
0.07749335467815399,
-0.04686766862869263,
-0.05002525448799133,
1.5054303603366602e-34,
-0.0051826657727360725,
-0.005824557039886713,
-0.04414525628089905,
-0.03267230466008186,
-0.01915845088660717,
-0.055467650294303894,
-0.008215350098907948,
0.032214585691690445,
0.005369056481868029,
-0.028182154521346092,
-0.03236374258995056
] | {
"ds_index": 87,
"similar_dg_indices": [
295820,
83457,
1038708,
493853,
953684,
778196,
935061,
65967,
303625,
487703,
3287,
122224,
643419,
1090042,
176698,
1057541,
1110031,
600724,
168897,
245328
]
} |
A 22-year-old female presents to her physician for evaluation of a vaginal discharge, itching, and irritation. She recently started a new relationship with her boyfriend, who is her only sexual partner. He does not report any genitourinary symptoms. She takes oral contraceptives and does not use barrier contraception. The medical history is unremarkable. The vital signs are within normal limits. A gynecologic examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant odor and numerous punctate red maculae on the ectocervix. The remainder of the exam is normal. Which of the following organisms will most likely be revealed on wet mount microscopy? | Motile round or oval-shaped microorganisms | {
"A": "Budding yeasts cells and/or pseudohyphae",
"B": "Epithelial cells covered by numerous bacterial cells",
"C": "Motile round or oval-shaped microorganisms",
"D": "Chains of cocci"
} | step2&3 | C | [
"year old female presents",
"physician",
"evaluation",
"vaginal discharge",
"itching",
"irritation",
"recently started",
"new relationship",
"boyfriend",
"only sexual partner",
"not report",
"genitourinary symptoms",
"takes oral contraceptives",
"not use",
"barrier contraception",
"medical history",
"unremarkable",
"vital signs",
"normal limits",
"gynecologic examination reveals",
"thin",
"yellow",
"frothy vaginal discharge",
"musty",
"odor",
"numerous punctate red maculae",
"ectocervix",
"exam",
"normal",
"following organisms",
"most likely",
"revealed",
"wet mount microscopy"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 22-year-old female presents to her physician for evaluation of a vaginal discharge, itching, and irritation. She recently started a new relationship with her boyfriend, who is her only sexual partner. He does not report any genitourinary symptoms. She takes oral contraceptives and does not use barrier contraception. The medical history is unremarkable. The vital signs are within normal limits. A gynecologic examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant odor and numerous punctate red maculae on the ectocervix. The remainder of the exam is normal. Which of the following organisms will most likely be revealed on wet mount microscopy?
Choose one of the following::
A. Budding yeasts cells and/or pseudohyphae
B. Epithelial cells covered by numerous bacterial cells
C. Motile round or oval-shaped microorganisms
D. Chains of cocci | [
0.04759791120886803,
0.004015548620373011,
0.019174519926309586,
-0.07371599227190018,
0.019608652219176292,
-0.023342447355389595,
0.06904502958059311,
0.0033408645540475845,
0.0013049583649262786,
-0.03439585492014885,
0.006000431254506111,
-0.023600662127137184,
-0.02541447803378105,
-0.03152996301651001,
0.038790278136730194,
0.023110779002308846,
-0.011546490713953972,
0.06393852084875107,
-0.060340046882629395,
0.006650722585618496,
0.0006995823350735009,
-0.027777059003710747,
0.024601269513368607,
-0.011262157000601292,
0.050998348742723465,
0.005597566720098257,
-0.038647569715976715,
0.02995895966887474,
-0.004839083179831505,
-0.03465282917022705,
0.0647769421339035,
0.044563595205545425,
0.019015459343791008,
-0.013487613759934902,
0.000001971353412955068,
0.001548280008137226,
0.010009191930294037,
-0.04171130806207657,
0.010805112309753895,
-0.02420014701783657,
-0.04004671797156334,
-0.02185356430709362,
0.06947959214448929,
-0.01213204674422741,
0.020030785351991653,
-0.07964828610420227,
-0.009994556196033955,
-0.011573636904358864,
0.0038139515090733767,
0.027112092822790146,
-0.00042011094046756625,
0.03045872412621975,
-0.05938386917114258,
0.006130943540483713,
0.0548982210457325,
0.06602994352579117,
0.0039722248911857605,
0.02930322103202343,
-0.013759923167526722,
-0.010327670723199844,
-0.009733476676046848,
-0.06151742860674858,
-0.006164218299090862,
0.0032584755681455135,
0.01992598921060562,
0.007104597985744476,
0.04710088670253754,
-0.04844774305820465,
0.03249594196677208,
-0.021808570250868797,
0.03002156689763069,
0.01595478504896164,
0.0259606521576643,
0.07681304216384888,
-0.04735332727432251,
0.016239114105701447,
-0.00035469792783260345,
0.004344453103840351,
-0.05498477816581726,
0.029399681836366653,
0.01560555212199688,
0.03562181442975998,
0.0029131302144378424,
0.05283086374402046,
0.00582454539835453,
-0.04428473860025406,
0.018478253856301308,
-0.007836547680199146,
0.021958259865641594,
-0.033667273819446564,
-0.033425431698560715,
-0.09028162062168121,
0.04487970471382141,
0.07707387953996658,
-0.03981490433216095,
-0.023953525349497795,
-0.013217243365943432,
-0.059142060577869415,
0.02060607820749283,
0.0020021258387714624,
0.006394878029823303,
-0.04736455902457237,
-0.003912367392331362,
0.042506661266088486,
-0.04738090932369232,
0.01596015691757202,
-0.028512204065918922,
0.02173667773604393,
0.03021451085805893,
-0.011659655719995499,
0.036465879529714584,
0.003928953316062689,
0.003755914978682995,
0.018677793443202972,
0.03580498695373535,
-0.013464927673339844,
-0.03536486253142357,
-0.030879883095622063,
-0.019628096371889114,
0.04168122261762619,
-0.011988711543381214,
0.020794516429305077,
0.0018405074952170253,
0.03711061552166939,
0.03873885050415993,
0.013095628470182419,
-0.00038992223562672734,
-0.004153544083237648,
0.023982826620340347,
0.033495329320430756,
-0.013028295710682869,
0.005051623564213514,
-0.027035009115934372,
0.013661797158420086,
-0.016703085973858833,
0.030234187841415405,
0.011600691825151443,
-0.008894052356481552,
0.017294691875576973,
0.03857949748635292,
-0.024442849680781364,
0.0002413649344816804,
-0.006424072198569775,
0.0036487372126430273,
-0.02107708528637886,
0.041036900132894516,
0.020300956442952156,
0.03639309108257294,
0.021888447925448418,
-0.001934650121256709,
0.00510600209236145,
-0.013377120718359947,
-0.04890410602092743,
-0.0083049600943923,
-0.0038456683978438377,
0.044456738978624344,
0.01711982861161232,
-0.05353621020913124,
-0.05260077491402626,
-0.011960008181631565,
0.019445866346359253,
-0.05009534955024719,
0.01798558235168457,
-0.02121221274137497,
-0.01230594702064991,
0.0249937754124403,
0.05465682968497276,
0.06647725403308868,
-0.03239553049206734,
0.03157917037606239,
-0.020278070122003555,
-0.03308451175689697,
0.010441482998430729,
-0.02655661292374134,
-0.05705439671874046,
0.011803056113421917,
-0.04019897058606148,
-0.04648614302277565,
0.017512036487460136,
0.0017236019484698772,
0.009695152752101421,
0.09314842522144318,
0.01776210218667984,
-0.058942534029483795,
-0.050799183547496796,
-0.010842680931091309,
0.010245594196021557,
-0.02763126790523529,
-0.010423588566482067,
-0.043781887739896774,
-0.02562570758163929,
0.04407329484820366,
-0.10093681514263153,
-0.052920591086149216,
-0.0069747199304401875,
0.04439597949385643,
0.0014650934608653188,
-0.039988305419683456,
0.01871606893837452,
0.001223827712237835,
0.010519743897020817,
-0.07333482801914215,
0.08310100436210632,
0.06763842701911926,
-0.052366118878126144,
0.021404406055808067,
-0.0869109034538269,
-0.0024235944729298353,
-0.04520893096923828,
-0.00381227838806808,
0.024170417338609695,
-0.0013745237374678254,
0.01810922846198082,
-0.03672351315617561,
-0.023344779387116432,
0.05252287909388542,
0.028265561908483505,
0.061463482677936554,
-0.02910834364593029,
0.05501750856637955,
0.033549100160598755,
-0.010682753287255764,
0.021456582471728325,
-0.022542480379343033,
0.026462243869900703,
-0.018760915845632553,
0.012919063679873943,
0.0008066814043559134,
0.044156432151794434,
-0.06705440580844879,
-0.002456287620589137,
0.026616916060447693,
-0.03487441688776016,
0.03156188130378723,
0.008008189499378204,
0.014572744257748127,
0.013682067394256592,
0.04059717059135437,
-0.031870607286691666,
0.024687033146619797,
-0.012570423074066639,
0.021492570638656616,
-0.005334191024303436,
-0.006301475688815117,
-0.006792166270315647,
-0.021672870963811874,
-0.019512806087732315,
0.01867690123617649,
0.004000799730420113,
0.027609292417764664,
-0.031016364693641663,
0.012289714068174362,
0.004585214424878359,
0.014608077704906464,
0.04075426608324051,
0.0780082494020462,
-0.0010884965304285288,
-0.03255436196923256,
-0.0035931693855673075,
-0.06609004735946655,
-0.020044976845383644,
0.03288444131612778,
-0.008857198990881443,
-0.03589257225394249,
-0.03717844560742378,
-0.03752211481332779,
0.005055243615061045,
-0.03461024910211563,
-0.01388669665902853,
0.015043523162603378,
0.03248199447989464,
0.03314359858632088,
0.010199746116995811,
0.015741214156150818,
0.011290083639323711,
0.011100329458713531,
-0.01421126164495945,
0.060823291540145874,
0.04320693761110306,
0.002465476980432868,
-0.0073172603733837605,
0.031053638085722923,
-0.03972241282463074,
-0.0005768967675976455,
-0.0036434349603950977,
0.01102540735155344,
-0.01225962396711111,
0.013649668544530869,
0.0340290367603302,
-0.007246584631502628,
-0.015394795686006546,
-0.05625179782509804,
0.006325434893369675,
-0.02443085052073002,
-0.07639207690954208,
-0.02388915792107582,
0.024243347346782684,
0.03459193930029869,
-0.011463452130556107,
0.10342514514923096,
-0.020286506041884422,
-0.016413100063800812,
-0.06060147285461426,
-0.0212971493601799,
0.054045092314481735,
0.01882278174161911,
-0.016203168779611588,
0.0359446220099926,
0.014738879166543484,
0.0191106665879488,
-0.04573342204093933,
0.0002880438987631351,
0.001596810994669795,
0.0767495185136795,
-0.011654842644929886,
-0.01297933142632246,
0.014117743819952011,
-0.053003940731287,
0.054741207510232925,
0.030396264046430588,
0.04975986108183861,
-0.010336561128497124,
-0.017163867130875587,
-0.0000054519809964403976,
-0.02024111896753311,
-0.0030807284638285637,
0.007921439595520496,
0.04644723981618881,
-0.00012859104026574641,
0.01129393931478262,
-0.02979072369635105,
0.034633684903383255,
-0.06360316276550293,
0.015544923953711987,
0.03106691874563694,
0.008291797712445259,
-0.08163220435380936,
-0.03391478210687637,
-0.04538913071155548,
-0.038872383534908295,
0.03847481682896614,
-0.01673717051744461,
-0.011901101097464561,
-0.014889445155858994,
0.05677606165409088,
0.027223192155361176,
-0.06968239694833755,
0.03177961707115173,
-0.034511733800172806,
0.066016785800457,
-0.06326133757829666,
0.00021650854614563286,
-0.016313107684254646,
-0.033191610127687454,
-0.018301134929060936,
0.03604520112276077,
0.0026283615734428167,
0.04738089442253113,
-0.029511786997318268,
-0.018000755459070206,
-0.03710991516709328,
-0.022723784670233727,
-0.04045125097036362,
0.021421292796730995,
0.010037231259047985,
-0.033523079007864,
-0.008857140317559242,
-0.024933286011219025,
-0.04684671387076378,
-0.07827642560005188,
0.013533812947571278,
-0.04624953120946884,
-0.04728249832987785,
0.023413704708218575,
-0.023940853774547577,
0.026814527809619904,
-0.016848962754011154,
-0.028201067820191383,
-0.025089029222726822,
-0.04368741437792778,
0.04509337618947029,
-0.05180748924612999,
0.0361604318022728,
-0.030292026698589325,
-0.049188025295734406,
0.012014941312372684,
-0.08708372712135315,
-0.02349199540913105,
0.02171773836016655,
-0.0037608069833368063,
0.019692886620759964,
-0.055724382400512695,
-0.023671122267842293,
-0.08105778694152832,
0.012057189829647541,
0.03328767791390419,
-0.01652456820011139,
-0.029994705691933632,
0.03367707133293152,
0.07712190598249435,
-0.015344460494816303,
0.08919793367385864,
-0.03313058614730835,
0.020886274054646492,
0.038586847484111786,
-0.04350415617227554,
-0.05478523299098015,
-0.05043553560972214,
-0.021393485367298126,
0.1184033676981926,
0.004204713739454746,
-0.0698399692773819,
0.0024449110496789217,
0.037939850240945816,
-0.040507592260837555,
-0.022475089877843857,
-0.03600951284170151,
-0.04635520651936531,
-0.04834901914000511,
0.02396523579955101,
0.06054600700736046,
0.024331994354724884,
-0.03823765739798546,
0.002164561068639159,
0.0033323729876428843,
0.003184230998158455,
0.045745763927698135,
0.035289306193590164,
0.032132115215063095,
0.05884281545877457,
-0.06145362928509712,
-0.00601555360481143,
0.06499258428812027,
0.08640395104885101,
0.048131756484508514,
0.05327901989221573,
0.0007288845954462886,
0.014493514783680439,
-0.034656595438718796,
-0.03147708624601364,
-0.06214063987135887,
0.012034844607114792,
0.06316019594669342,
0.04495707526803017,
-0.02772197127342224,
-0.018602829426527023,
-0.03122866339981556,
-0.05866798385977745,
0.00930370856076479,
0.09921792149543762,
-0.052982885390520096,
-0.03444746136665344,
0.018922876566648483,
0.019757667556405067,
0.034787993878126144,
0.010111549869179726,
0.051559749990701675,
-0.011872300878167152,
0.012035433202981949,
-0.023638073354959488,
-0.016217505559325218,
0.023839322850108147,
-0.04491898790001869,
-0.039889898151159286,
0.031233467161655426,
-0.03953373804688454,
0.034555740654468536,
0.0004251942737028003,
-0.03562973812222481,
-0.01470157690346241,
-0.020936472341418266,
0.03852818161249161,
-0.01627418026328087,
0.006777736824005842,
0.0073278192430734634,
-0.007211251184344292,
-0.06457638740539551,
-0.020519668236374855,
-0.011775830760598183,
-0.005703370552510023,
0.02639271318912506,
0.03831486403942108,
-0.021587148308753967,
-0.020697899162769318,
0.023352455347776413,
-0.00026618290576152503,
0.07626213133335114,
-0.003950841259211302,
-0.04084569215774536,
-0.004287344869226217,
-0.03647565841674805,
0.012439770624041557,
-0.023839440196752548,
0.039033498615026474,
0.00674409931525588,
-0.00003804610969382338,
-0.0166799146682024,
-0.047705069184303284,
-0.008028820157051086,
-0.04894993081688881,
0.02932758629322052,
-0.0046152388677001,
0.0198118407279253,
-0.023284250870347023,
0.01446857675909996,
-0.024655189365148544,
-0.008124761283397675,
0.01657380349934101,
-0.014544565230607986,
-0.024985408410429955,
0.04023991525173187,
0.008199915289878845,
-0.03188261389732361,
0.06020689383149147,
0.04514869675040245,
0.054709773510694504,
-0.052979081869125366,
-0.07014183700084686,
0.021533463150262833,
0.017280666157603264,
0.03308456391096115,
-0.04252476990222931,
0.01001854706555605,
-0.045812252908945084,
-0.002085298765450716,
0.017098121345043182,
0.02834574691951275,
0.00641203485429287,
-0.03864078223705292,
0.07634689658880234,
-0.05682128295302391,
0.010295554995536804,
-0.04246918857097626,
0.02366451919078827,
-0.04528302326798439,
0.010756565257906914,
0.030381040647625923,
-0.006791372317820787,
0.016824522987008095,
-0.004651927389204502,
-0.013537481427192688,
0.004982200916856527,
0.02381717972457409,
-0.05211016163229942,
0.05095400661230087,
0.04648304358124733,
-0.06310483813285828,
-0.0038014082238078117,
0.0459461472928524,
-0.03442574664950371,
0.009505861438810825,
0.06939101964235306,
0.005253934301435947,
0.025699647143483162,
0.02509124018251896,
-5.236083465394411e-33,
-0.01873464696109295,
-0.07063060998916626,
0.029033249244093895,
-0.008270226418972015,
0.053389206528663635,
0.10965965688228607,
-0.030349597334861755,
-0.007278965786099434,
-0.05290135741233826,
0.012841017916798592,
0.005397834349423647,
0.009100283496081829,
0.032394763082265854,
0.06786882877349854,
-0.0370904877781868,
0.045046865940093994,
0.0058406502939760685,
-0.02553579770028591,
-0.06831134855747223,
0.02290097437798977,
0.009457659907639027,
-0.013952958397567272,
0.0012157432502135634,
-0.053411711007356644,
-0.009869801811873913,
-0.03390244394540787,
0.04631325975060463,
0.0011951775522902608,
-0.0809689313173294,
-0.0024079536087810993,
-0.0053601255640387535,
-0.06226328760385513,
0.022822732105851173,
0.03958337381482124,
-0.0022865813225507736,
-0.018346399068832397,
-0.04244857653975487,
-0.014548155479133129,
0.0026262595783919096,
0.05156087130308151,
-0.03246619552373886,
-0.03179837763309479,
0.025005456060171127,
-0.00620878953486681,
0.05863339453935623,
-0.06530668586492538,
0.01928761415183544,
0.00030275003518909216,
0.005568255204707384,
-0.01535275112837553,
-0.0055909715592861176,
0.016318827867507935,
0.024926908314228058,
-0.018190933391451836,
0.007706162054091692,
0.025595758110284805,
-0.001006446429528296,
0.04035413637757301,
0.030169909819960594,
0.026332039386034012,
-0.007404143922030926,
0.023852672427892685,
0.03995396941900253,
-0.05612955614924431,
-0.02529950439929962,
0.02041560597717762,
0.06490317732095718,
-0.039204176515340805,
-0.031207187101244926,
-0.011987953446805477,
-0.08246728032827377,
0.01786515861749649,
-0.035940974950790405,
-0.11019761860370636,
0.022000065073370934,
0.06013399362564087,
0.003340332768857479,
-0.0461677722632885,
0.00788236502557993,
-0.012461626902222633,
-0.060318723320961,
-0.049528565257787704,
-0.023738708347082138,
0.013072660192847252,
-0.004355127457529306,
-0.04730399698019028,
0.015195338986814022,
-0.02177898772060871,
0.014759484678506851,
-0.034069184213876724,
0.052780792117118835,
0.00788277667015791,
-0.05746347829699516,
0.04165859520435333,
-0.02693442441523075,
-0.07899708300828934,
0.09844765812158585,
0.0033296579495072365,
-0.002752850530669093,
0.05143999308347702,
0.05448528006672859,
0.03666844591498375,
0.010659794323146343,
-0.01106499694287777,
-0.0024080518633127213,
0.018780969083309174,
-0.037103019654750824,
0.010769548825919628,
-0.05043858662247658,
-0.024560503661632538,
0.010505023412406445,
0.006188754923641682,
-0.012516803108155727,
0.05284809321165085,
0.015850018709897995,
-0.005177277140319347,
0.0016755179967731237,
0.08166196197271347,
0.0868244618177414,
0.033725328743457794,
0.024191560223698616,
-0.023900270462036133,
-0.02694888599216938,
0.026402125135064125,
-0.0035210493952035904,
-0.042009834200143814,
0.035294000059366226,
0.053526949137449265,
-0.04206271842122078,
0.055016130208969116,
0.029509875923395157,
-0.002052765339612961,
2.6797130203704e-7,
0.0206197090446949,
-0.035786379128694534,
-0.006158819422125816,
-0.008412648923695087,
0.020586274564266205,
-0.04606024920940399,
-0.022165052592754364,
-0.014886956661939621,
-0.03192135691642761,
-0.015078929252922535,
0.002063095336779952,
-0.01843884028494358,
-0.02469155751168728,
0.00893607921898365,
0.03302725777029991,
0.006602711044251919,
-0.013719039037823677,
-0.029680566862225533,
0.033923108130693436,
0.019623376429080963,
0.009764720685780048,
-0.015888165682554245,
-0.012509371154010296,
-0.03490057215094566,
0.006716649513691664,
-0.00020260849851183593,
-0.00453121867030859,
-0.027333758771419525,
0.0018237369367852807,
0.03119434043765068,
0.013832790777087212,
0.015682410448789597,
0.01746954768896103,
0.07217971980571747,
-0.0034312885254621506,
-0.045050885528326035,
0.060414403676986694,
0.05672944337129593,
0.05646882206201553,
0.06281115114688873,
-0.0014664920745417476,
0.02944309450685978,
-0.0164345633238554,
0.03507187217473984,
-0.007852134294807911,
0.02928302064538002,
-0.02302187867462635,
0.038414593786001205,
-0.032563529908657074,
-0.01757584698498249,
-0.027199961245059967,
0.036496467888355255,
-0.019498037174344063,
0.09069769084453583,
-0.01378873735666275,
0.02922666072845459,
-0.024289339780807495,
0.01165248453617096,
-0.03760422393679619,
-0.024397732689976692,
-0.020900577306747437,
-0.030868906527757645,
-0.006561489310115576,
-0.03335447609424591,
0.031478166580200195,
-0.07866183668375015,
-0.04009576886892319,
1.8243365823793475e-34,
-0.0034458469599485397,
-0.03710589557886124,
0.009553806856274605,
-0.005021479446440935,
-0.06790528446435928,
-0.024734511971473694,
0.06465006619691849,
0.007208432536572218,
0.009987026453018188,
0.03570011258125305,
-0.004219709429889917
] | {
"ds_index": 88,
"similar_dg_indices": [
1210471,
954407,
805991,
192006,
298344,
780839,
193240,
823502,
656545,
1202377,
148290,
357509,
376238,
1195311,
798869,
973340,
1108873,
775864,
71421,
890495
]
} |
A 53-year-old woman with hypertension and hyperlipidemia comes to the physician because of generalized reddening of her skin and itching for the past 2 weeks. Her symptoms occur every evening before bedtime and last for about 30 minutes. Three months ago, atorvastatin was stopped after she experienced progressively worsening neck and back pain. Statin therapy was reinitiated at lower doses 3 weeks ago but had to be stopped again after her musculoskeletal symptoms recurred. Her menses occur irregularly at 2–3 month intervals and last for 3–4 days. She has smoked one pack of cigarettes daily for the past 30 years. Her current medications include lisinopril and niacin. Her brother died of colonic adenocarcinoma, and her father died of small cell lung cancer. She is 169 cm (5 ft 6 in) tall and weighs 83 kg (183 lb); BMI is 29 kg/m2. Her vital signs are within normal limits. Physical examination shows no abnormalities. Serum lipid studies show:
Total cholesterol 247 mg/dL
HDL-cholesterol 39 mg/dL
LDL-cholesterol 172 mg/dL
Triglycerides 152 mg/dL
Which of the following is the most appropriate next step in management?" | Administer ibuprofen | {
"A": "Administer ibuprofen",
"B": "Measure urine hydroxyindoleacetic acid levels",
"C": "Measure urine metanephrine levels",
"D": "Switch niacin to fenofibrate"
} | step2&3 | A | [
"year old woman",
"hypertension",
"hyperlipidemia",
"physician",
"generalized reddening",
"skin",
"itching",
"past 2 weeks",
"symptoms occur",
"evening",
"bedtime",
"last",
"30 minutes",
"Three months",
"atorvastatin",
"stopped",
"experienced",
"worsening neck",
"back pain",
"Statin therapy",
"lower doses",
"weeks",
"to",
"stopped",
"musculoskeletal symptoms recurred",
"menses occur",
"23 month intervals",
"last",
"days",
"smoked one pack",
"cigarettes daily",
"past 30 years",
"current medications include lisinopril",
"niacin",
"brother died",
"colonic adenocarcinoma",
"father died of small cell lung cancer",
"5 ft 6",
"tall",
"83 kg",
"BMI",
"29 kg/m2",
"vital signs",
"normal limits",
"Physical examination shows",
"abnormalities",
"Serum lipid studies show",
"Total cholesterol",
"mg/dL HDL",
"Triglycerides",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 53-year-old woman with hypertension and hyperlipidemia comes to the physician because of generalized reddening of her skin and itching for the past 2 weeks. Her symptoms occur every evening before bedtime and last for about 30 minutes. Three months ago, atorvastatin was stopped after she experienced progressively worsening neck and back pain. Statin therapy was reinitiated at lower doses 3 weeks ago but had to be stopped again after her musculoskeletal symptoms recurred. Her menses occur irregularly at 2–3 month intervals and last for 3–4 days. She has smoked one pack of cigarettes daily for the past 30 years. Her current medications include lisinopril and niacin. Her brother died of colonic adenocarcinoma, and her father died of small cell lung cancer. She is 169 cm (5 ft 6 in) tall and weighs 83 kg (183 lb); BMI is 29 kg/m2. Her vital signs are within normal limits. Physical examination shows no abnormalities. Serum lipid studies show:
Total cholesterol 247 mg/dL
HDL-cholesterol 39 mg/dL
LDL-cholesterol 172 mg/dL
Triglycerides 152 mg/dL
Which of the following is the most appropriate next step in management?"
Choose one of the following::
A. Administer ibuprofen
B. Measure urine hydroxyindoleacetic acid levels
C. Measure urine metanephrine levels
D. Switch niacin to fenofibrate | [
0.03798885643482208,
0.004714749287813902,
0.03795873373746872,
0.0007654711371287704,
0.03820565342903137,
0.016388729214668274,
-0.007920429110527039,
0.05234489589929581,
0.01607370562851429,
-0.00320109399035573,
0.03860604017972946,
0.04620787873864174,
-0.017585555091500282,
-0.02164607308804989,
-0.03084537386894226,
0.014923283830285072,
-0.059587955474853516,
0.012499745935201645,
0.02129489742219448,
-0.018301084637641907,
-0.036004386842250824,
0.01928812637925148,
0.03356589004397392,
-0.00552918529137969,
0.00705696688964963,
-0.024677470326423645,
0.04386832192540169,
-0.07298281043767929,
-0.005403369665145874,
-0.0023191256914287806,
0.002114820061251521,
-0.04806250333786011,
-0.009645383805036545,
-0.04267657548189163,
0.000002019535486397217,
-0.0452628917992115,
0.02193688601255417,
0.043497174978256226,
0.06307093054056168,
-0.04407437890768051,
0.058248840272426605,
-0.0674629732966423,
0.05002252385020256,
0.0007503264350816607,
-0.0139768710359931,
-0.09108268469572067,
0.0008650830714032054,
0.0019264667062088847,
0.003578889649361372,
-0.006995887961238623,
0.011029712855815887,
0.007293188478797674,
-0.03560023009777069,
0.025631779804825783,
0.04252573102712631,
-0.032658398151397705,
-0.029870009049773216,
-0.020156774669885635,
-0.009237145073711872,
0.03234460577368736,
0.030427023768424988,
0.011267582885921001,
-0.008521310053765774,
0.034194618463516235,
-0.037063032388687134,
0.011485220864415169,
0.004230645019561052,
-0.03900839388370514,
0.013003240339457989,
0.02614094316959381,
-0.002741633914411068,
0.03289489820599556,
0.051376137882471085,
0.050196077674627304,
-0.031824786216020584,
0.00524258753284812,
0.05141059681773186,
-0.055021271109580994,
-0.025914093479514122,
-0.004310618154704571,
0.06125134602189064,
0.017158517614006996,
-0.03529762104153633,
0.014850868843495846,
0.027918804436922073,
-0.05920448526740074,
0.004960225895047188,
0.013070552609860897,
-0.0010967347770929337,
-0.05716187134385109,
0.03702078387141228,
-0.05352310463786125,
-0.015263506211340427,
0.0016573099419474602,
-0.06125236302614212,
0.018898457288742065,
0.05667627230286598,
0.027912242338061333,
0.05194476246833801,
-0.036201778799295425,
-0.021466081961989403,
-0.00350684835575521,
0.025381097570061684,
0.032858576625585556,
-0.039531026035547256,
-0.005748402327299118,
-0.008538135327398777,
-0.02224581502377987,
-0.06288449466228485,
0.05480765178799629,
0.034542229026556015,
0.008694968186318874,
-0.05414481833577156,
0.024172678589820862,
0.06706461310386658,
-0.021767545491456985,
-0.03573979437351227,
-0.07369597256183624,
-0.03440744802355766,
0.03823532909154892,
0.012353524565696716,
0.037695299834012985,
0.07949060201644897,
-0.005862957797944546,
-0.0019579550717025995,
0.04579926282167435,
-0.004210709128528833,
-0.0027172137051820755,
0.027014385908842087,
0.022876251488924026,
0.026975426822900772,
0.0231319647282362,
-0.031920984387397766,
0.00666466262191534,
0.02432374656200409,
-0.015243399888277054,
-0.001875858986750245,
0.04979706555604935,
-0.004881259053945541,
0.003992180339992046,
-0.009004076011478901,
-0.037897102534770966,
0.002776234643533826,
-0.04209369048476219,
0.023111682385206223,
-0.007740720175206661,
0.016648069024086,
0.03933844715356827,
-0.010923140682280064,
0.015166319906711578,
0.010564293712377548,
0.009350957348942757,
0.018237940967082977,
0.014054405502974987,
0.02058311365544796,
0.014216492883861065,
0.0044947597198188305,
-0.01381317712366581,
0.0012619270710274577,
-0.03415433689951897,
0.0024417045060545206,
-0.0016786493360996246,
0.006896534934639931,
0.02257751114666462,
0.048591166734695435,
0.045212626457214355,
0.0137663334608078,
0.07294954359531403,
-0.05539219453930855,
0.0673903152346611,
-0.03394440561532974,
0.02593136578798294,
0.03503947705030441,
0.026318704709410667,
-0.04935579001903534,
-0.040272265672683716,
-0.026308679953217506,
0.04375942796468735,
-0.013796701095998287,
-0.036145903170108795,
0.0016585702542215586,
0.028576349839568138,
0.049863893538713455,
-0.04774982109665871,
-0.023924147710204124,
0.02695566602051258,
-0.02244449593126774,
-0.04395873099565506,
-0.0032587640453130007,
-0.026251614093780518,
0.01213917788118124,
-0.007287538610398769,
-0.013441580347716808,
-0.0016218540258705616,
-0.01656957156956196,
0.01225702092051506,
-0.04994313418865204,
-0.036732278764247894,
-0.02580290287733078,
0.009221112355589867,
-0.032163914293050766,
-0.01600751094520092,
-0.02934330888092518,
0.01887105591595173,
-0.03593381494283676,
0.0352649949491024,
0.004984735976904631,
0.00862516276538372,
0.05515240505337715,
-0.014586253091692924,
0.015073801390826702,
-0.01739162765443325,
0.04708030819892883,
-0.05480751767754555,
0.044667769223451614,
0.02150137722492218,
-0.00028928450774401426,
0.06329543143510818,
-0.04442617669701576,
-0.012730594724416733,
-0.024821678176522255,
0.022606607526540756,
-0.009480704553425312,
-0.022440360859036446,
-0.053787801414728165,
-0.028528433293104172,
-0.03272351622581482,
-0.0014165547909215093,
0.0029838166665285826,
-0.05347505956888199,
0.047534551471471786,
0.04678957909345627,
-0.05214238166809082,
-0.011083895340561867,
-0.05685683712363243,
-0.02477537840604782,
0.06121330335736275,
-0.0706174373626709,
0.013109974563121796,
-0.035742852836847305,
-0.03812410309910774,
0.010071877390146255,
-0.08183236420154572,
-0.03742342069745064,
-0.03934159502387047,
-0.016867389902472496,
-0.0471532829105854,
0.06214947625994682,
-0.08630383759737015,
0.027985868975520134,
-0.02045746147632599,
0.0019334547687321901,
0.006131737492978573,
0.012754800729453564,
-0.02034500055015087,
0.09686513245105743,
-0.05274062603712082,
0.0009766767034307122,
-0.0432492159307003,
-0.07107691466808319,
-0.02503163181245327,
-0.010189458727836609,
-0.010572869330644608,
-0.02151154913008213,
-0.018052948638796806,
-0.02029247023165226,
-0.008410525508224964,
-0.005857427604496479,
-0.026258954778313637,
-0.0072334446012973785,
-0.004243936389684677,
-0.007056122645735741,
0.015761367976665497,
0.023531598970294,
-0.052924878895282745,
-0.03239808976650238,
-0.05349542573094368,
0.05877651274204254,
0.0481339693069458,
0.024892836809158325,
0.034290462732315063,
0.037935953587293625,
0.05924026668071747,
0.00808949489146471,
0.009593319147825241,
-0.016864869743585587,
-0.02994260936975479,
-0.0472063310444355,
0.04946809262037277,
0.006237777881324291,
-0.007389427628368139,
-0.011345070786774158,
0.013562608510255814,
-0.009121819399297237,
-0.02804521843791008,
-0.018514052033424377,
0.010767729952931404,
0.04922657459974289,
-0.03894846513867378,
0.049038223922252655,
0.01990324817597866,
0.022466560825705528,
-0.034167852252721786,
0.00734137324616313,
0.005930248647928238,
-0.012112588621675968,
0.0855589210987091,
0.044029150158166885,
-0.031131653115153313,
-0.006923268083482981,
0.05088292807340622,
0.02224421501159668,
-0.030565457418560982,
-0.03558073565363884,
0.006515019573271275,
-0.04520215094089508,
-0.01686115749180317,
-0.006296560168266296,
0.04985082149505615,
-0.021294450387358665,
0.04565007984638214,
0.018791943788528442,
-0.016919462010264397,
-0.006517533678561449,
0.015442309901118279,
0.015811948105692863,
0.011826897040009499,
0.01075607631355524,
-0.07870716601610184,
-0.011828092858195305,
-0.013979746960103512,
-0.004174207802861929,
0.019346939399838448,
0.0336126834154129,
-0.009034253656864166,
-0.012007299810647964,
0.011854611337184906,
0.05117454379796982,
-0.03893251344561577,
0.04419081285595894,
0.02350666932761669,
-0.030775515362620354,
0.048669204115867615,
0.00017583469161763787,
-0.006997998803853989,
-0.002435047645121813,
-0.0537886843085289,
0.03721409663558006,
0.00837667565792799,
-0.008463569916784763,
-0.09271740168333054,
0.03155698999762535,
0.02276114746928215,
-0.005745106376707554,
-0.013359064236283302,
-0.07250340282917023,
0.062467534095048904,
-0.02736027166247368,
-0.014910098165273666,
0.03374040871858597,
0.04351207986474037,
0.004322505556046963,
-0.04274483770132065,
0.023103665560483932,
-0.000964903156273067,
0.056448742747306824,
0.03194984048604965,
-0.009491827338933945,
-0.012869897298514843,
-0.036756083369255066,
-0.03123351000249386,
-0.04427856579422951,
-0.021333543583750725,
0.08158372342586517,
0.002562315436080098,
0.01022852212190628,
0.0028318397235125303,
-0.04768997058272362,
-0.06335239857435226,
-0.018542934209108353,
0.055083900690078735,
-0.06133842468261719,
0.015187622047960758,
-0.02038899064064026,
-0.03524509444832802,
-0.0005832823226228356,
-0.0014478451339527965,
-0.04718342423439026,
0.05972682312130928,
-0.03337673842906952,
0.009584770537912846,
-0.01329672522842884,
0.026479598134756088,
-0.030638156458735466,
-0.023525753989815712,
0.011522524058818817,
-0.036972980946302414,
-0.05942083150148392,
0.04067524895071983,
0.05095916613936424,
0.03835342079401016,
-0.030722955241799355,
-0.017716940492391586,
0.01836601085960865,
0.09663407504558563,
-0.03060648776590824,
-0.06279253214597702,
0.026219118386507034,
0.07086852937936783,
0.04353782907128334,
0.06234509125351906,
-0.0180613175034523,
0.03494208678603172,
0.0028889616951346397,
0.06575223058462143,
-0.010439185425639153,
0.018329784274101257,
-0.05388796329498291,
0.054191384464502335,
-0.048802122473716736,
0.07235109061002731,
-0.01752978377044201,
-0.04284149408340454,
-0.028896614909172058,
-0.005132789257913828,
0.019448967650532722,
0.07609009742736816,
0.012606935575604439,
-0.0029478457290679216,
0.05620452016592026,
0.05869409069418907,
-0.017761874943971634,
0.025488415732979774,
0.051332976669073105,
0.030862458050251007,
0.052093736827373505,
-0.013759222812950611,
0.01247197762131691,
0.045987069606781006,
-0.00846219714730978,
0.00843977089971304,
-0.008087310940027237,
0.024824555963277817,
0.017257705330848694,
-0.008077336475253105,
0.010842366144061089,
0.029103990644216537,
0.09584986418485641,
0.00043663333053700626,
0.05328705534338951,
0.00870081689208746,
-0.007552135735750198,
0.019548462703824043,
0.0575178861618042,
0.013702599331736565,
0.026324687525629997,
0.028131503611803055,
-0.06854201853275299,
0.04081099107861519,
-0.05484646558761597,
-0.03524173051118851,
0.01988852024078369,
0.02827918529510498,
-0.04585454985499382,
0.027214426547288895,
-0.04874321073293686,
-0.04711969941854477,
0.0414048433303833,
-0.046807534992694855,
0.007429270539432764,
0.021194452419877052,
0.05349009484052658,
0.021937014535069466,
-0.010564000345766544,
0.000023912612959975377,
-0.027918251231312752,
-0.06850088387727737,
-0.021645136177539825,
-0.008178292773663998,
0.04270846024155617,
0.019591888412833214,
-0.04993788152933121,
-0.06213606521487236,
-0.03709898144006729,
0.0200889203697443,
0.01888395845890045,
0.012446570210158825,
-0.03036922961473465,
-0.0367630235850811,
0.02857290208339691,
-0.06515134871006012,
-0.0411725677549839,
0.003699250752106309,
-0.01756064034998417,
-0.016427408903837204,
-0.04462927207350731,
-0.046489499509334564,
0.026220884174108505,
-0.036237090826034546,
0.01784129999577999,
0.047218240797519684,
-0.008329500444233418,
0.00803969893604517,
0.002636481774970889,
0.014687657356262207,
-0.02993519976735115,
-0.0012131407856941223,
0.03273366764187813,
-0.025446627289056778,
-0.0319162979722023,
0.002808517310768366,
-0.010761549696326256,
-0.03112122043967247,
-0.006552189122885466,
0.04089762642979622,
0.02422361448407173,
0.014202531427145004,
-0.04332636669278145,
-0.009107095189392567,
0.01994483545422554,
0.0019832185935229063,
-0.015605238266289234,
0.024981213733553886,
0.020877284929156303,
0.003642501076683402,
-0.010282394476234913,
0.02712058275938034,
-0.003024384146556258,
0.019872166216373444,
0.0713440552353859,
-0.003720948938280344,
-0.00650038942694664,
-0.007831321097910404,
-0.041356004774570465,
-0.03213394805788994,
-0.013659664429724216,
-0.0053394692949950695,
0.01720556989312172,
-0.02861332893371582,
-0.07729513198137283,
-0.013588298112154007,
0.005944601260125637,
0.0018764045089483261,
0.015153824351727962,
-0.02778739109635353,
0.04191761463880539,
-0.04572172090411186,
-0.008226792328059673,
-0.006382095627486706,
-0.022236434742808342,
-0.031873516738414764,
0.06418702751398087,
0.0037690282333642244,
0.04115752875804901,
0.02620656229555607,
-4.81325226993188e-33,
0.04140941798686981,
-0.019424736499786377,
0.014870108105242252,
-0.007256404962390661,
0.0298396497964859,
0.05340909957885742,
-0.02029450610280037,
-0.02590148337185383,
-0.032549843192100525,
0.09315314143896103,
-0.04550788924098015,
-0.010665848851203918,
0.018088998273015022,
0.06947043538093567,
-0.06740563362836838,
-0.07534056156873703,
-0.010335643775761127,
0.007929668761789799,
-0.0027499026618897915,
-0.020054340362548828,
-0.008070414885878563,
0.008059301413595676,
-0.047330502420663834,
-0.04367666691541672,
0.013948257081210613,
0.07201069593429565,
0.06334096193313599,
0.007899012416601181,
-0.038951288908720016,
0.0657641589641571,
0.026475675404071808,
0.03677517548203468,
0.04044763743877411,
0.0030036973766982555,
-0.005769317504018545,
0.016297245398163795,
-0.02452692948281765,
-0.0765569806098938,
0.04525942727923393,
0.010277059860527515,
0.044725216925144196,
-0.046797554939985275,
0.060716766864061356,
0.026335623115301132,
0.03622342646121979,
-0.034909795969724655,
-0.044708624482154846,
-0.0583808496594429,
-0.005921557545661926,
-0.023843105882406235,
-0.03056447021663189,
0.018829884007573128,
0.038412906229496,
-0.004206486511975527,
-0.033197615295648575,
0.01546723023056984,
-0.029998822137713432,
0.007658675312995911,
0.022325782105326653,
-0.02155902050435543,
-0.04215604439377785,
-0.02049148827791214,
0.00015059894940350205,
-0.02566397935152054,
-0.06371676921844482,
-0.01945553347468376,
-0.026693329215049744,
0.02601461485028267,
-0.0015596352750435472,
-0.011079134419560432,
-0.11211317777633667,
0.012012499384582043,
-0.07883881032466888,
-0.0731259435415268,
-0.062384553253650665,
0.03550907224416733,
0.03705723583698273,
-0.00003679705332615413,
0.008669497445225716,
0.0011024180566892028,
0.00024085037875920534,
-0.006413933355361223,
-0.038141947239637375,
0.0032698572613298893,
-0.044207584112882614,
0.022885890677571297,
-0.007390079088509083,
-0.023859508335590363,
-0.01958509162068367,
0.027414852753281593,
0.11469577252864838,
-0.0012453871313482523,
0.01989569514989853,
-0.03752424567937851,
0.003640851704403758,
-0.0464317724108696,
0.06351608037948608,
-0.006263091694563627,
0.01294953003525734,
0.000738909759093076,
0.11057572066783905,
0.016022395342588425,
0.007987914606928825,
0.018197115510702133,
-0.04388425499200821,
0.02201058715581894,
0.024281470105051994,
-0.033570822328329086,
0.013239420019090176,
0.009736987762153149,
-0.028902720659971237,
-0.0282173790037632,
0.0022665297146886587,
0.02646682597696781,
-0.006910546217113733,
0.03002440184354782,
0.009275960735976696,
0.09701680392026901,
0.01523242425173521,
0.016981253400444984,
0.0410597138106823,
-0.014169212430715561,
-0.007521532010287046,
-0.05632542446255684,
-0.09001214802265167,
-0.024016709998250008,
-0.0005033478373661637,
0.022534837946295738,
0.0011127610923722386,
-0.019961243495345116,
0.011381578631699085,
0.002058007987216115,
2.7908490096706373e-7,
0.012143567204475403,
-0.010021325200796127,
0.01162828877568245,
-0.05606355518102646,
0.022577807307243347,
-0.04750032722949982,
-0.012266341596841812,
0.030126823112368584,
-0.06255505979061127,
0.02368580363690853,
0.03216724097728729,
-0.01715158298611641,
-0.04502583295106888,
-0.059528764337301254,
0.03630070388317108,
-0.01136173214763403,
-0.028382988646626472,
0.012902089394629002,
0.011170197278261185,
-0.013969575986266136,
0.03865107521414757,
-0.003173034405335784,
-0.03275517001748085,
-0.07053614407777786,
0.00954078882932663,
0.05745314806699753,
-0.008119933307170868,
-0.04629701003432274,
-0.0707908645272255,
-0.020912494510412216,
-0.011116627603769302,
0.023842941969633102,
0.01598312519490719,
-0.000275751284789294,
0.00005316347233019769,
-0.05458822846412659,
-0.0017402439843863249,
0.0915030911564827,
-0.017354691401124,
0.019948892295360565,
0.07618936896324158,
0.008770092390477657,
-0.010081016458570957,
0.02546418271958828,
0.032837122678756714,
-0.005237644072622061,
-0.08308501541614532,
-0.03289642184972763,
0.04557861387729645,
-0.038505952805280685,
-0.016125284135341644,
0.006362082902342081,
-0.010267836041748524,
0.09444610029459,
-0.03386158123612404,
0.0979771539568901,
-0.043319664895534515,
0.018707318231463432,
0.002994597190991044,
-0.020511329174041748,
-0.0096852146089077,
-0.04000849276781082,
-0.016183899715542793,
0.00013700948329642415,
0.05596375837922096,
-0.050429847091436386,
-0.042914871126413345,
2.1586415508290664e-34,
-0.041679929941892624,
-0.0062516131438314915,
0.0014020927483215928,
-0.04749659448862076,
-0.0006929736118763685,
-0.04215194657444954,
-0.02596423216164112,
0.03258306905627251,
0.03318050876259804,
-0.055973608046770096,
-0.034525349736213684
] | {
"ds_index": 89,
"similar_dg_indices": [
446585,
796635,
1083741,
225218,
604922,
924205,
828441,
617236,
782985,
955604,
964983,
608265,
1134693,
255102,
821782,
1182106,
253310,
737601,
172768,
1123443
]
} |
Five days after undergoing right knee arthroplasty for osteoarthritis, a 68-year-old man has severe pain in this right knee preventing him from participating in physical therapy. On the third postoperative day when the dressing was changed, the surgical wound appeared to be intact, slightly swollen, and had a clear secretion. He has a history of diabetes, hyperlipidemia, and hypertension. Current medications include metformin, enalapril, and simvastatin. His temperature is 37.3°C (99.1°F), pulse is 94/min, and blood pressure is 130/88 mm Hg. His right knee is swollen, erythematous, and tender to palpation. There is pain on movement of the joint. The medial parapatellar skin incision appears superficially opened in its proximal and distal part with yellow-green discharge. There is blackening of the skin on both sides of the incision. Which of the following is the next best step in the management of this patient? | Surgical debridement | {
"A": "Surgical debridement",
"B": "Nafcillin therapy",
"C": "Removal of prostheses",
"D": "Antiseptic dressing\n\""
} | step2&3 | A | [
"Five days",
"right knee arthroplasty",
"osteoarthritis",
"68 year old man",
"severe pain in",
"right knee preventing",
"participating",
"physical therapy",
"third postoperative day",
"dressing",
"changed",
"surgical wound appeared to",
"intact",
"slightly swollen",
"clear secretion",
"history",
"diabetes",
"hyperlipidemia",
"hypertension",
"Current medications include metformin",
"enalapril",
"simvastatin",
"temperature",
"3C",
"99",
"pulse",
"min",
"blood pressure",
"88 mm Hg",
"right knee",
"swollen",
"erythematous",
"tender",
"palpation",
"pain on movement",
"joint",
"medial parapatellar skin incision appears",
"opened",
"proximal",
"distal part",
"yellow-green discharge",
"skin",
"sides",
"incision",
"following",
"next best step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Five days after undergoing right knee arthroplasty for osteoarthritis, a 68-year-old man has severe pain in this right knee preventing him from participating in physical therapy. On the third postoperative day when the dressing was changed, the surgical wound appeared to be intact, slightly swollen, and had a clear secretion. He has a history of diabetes, hyperlipidemia, and hypertension. Current medications include metformin, enalapril, and simvastatin. His temperature is 37.3°C (99.1°F), pulse is 94/min, and blood pressure is 130/88 mm Hg. His right knee is swollen, erythematous, and tender to palpation. There is pain on movement of the joint. The medial parapatellar skin incision appears superficially opened in its proximal and distal part with yellow-green discharge. There is blackening of the skin on both sides of the incision. Which of the following is the next best step in the management of this patient?
Choose one of the following::
A. Surgical debridement
B. Nafcillin therapy
C. Removal of prostheses
D. Antiseptic dressing
" | [
0.021136386319994926,
-0.018874287605285645,
-0.013301054015755653,
-0.023956894874572754,
-0.01557916309684515,
0.003980772104114294,
-0.016883159056305885,
0.06477280706167221,
0.0025787344202399254,
-0.00273600104264915,
0.01056498009711504,
0.02604351006448269,
0.06197173893451691,
0.057076822966337204,
-0.005553627852350473,
0.06370097398757935,
-0.034911662340164185,
-0.016111580654978752,
-0.06187004595994949,
-0.00950310006737709,
-0.07195448875427246,
0.015644125640392303,
0.009766265749931335,
0.037342555820941925,
0.07039192318916321,
0.004919942002743483,
0.02282235398888588,
-0.01925366371870041,
0.02814466319978237,
-0.015788791701197624,
-0.05359094217419624,
0.007574422284960747,
0.010082820430397987,
-0.09098228812217712,
0.0000020198451693431707,
-0.016678383573889732,
0.08735403418540955,
-0.011035935021936893,
0.00907579343765974,
-0.04730318486690521,
0.0021201707422733307,
-0.11645965278148651,
0.08861786872148514,
0.00034341024002060294,
-0.012880266644060612,
-0.1289268136024475,
0.006181163713335991,
0.03518490120768547,
-0.015622186474502087,
0.026039788499474525,
0.01782277226448059,
-0.03379843384027481,
0.006437378004193306,
0.02646416425704956,
-0.029370784759521484,
-0.03292696550488472,
-0.03051714040338993,
0.0032079119700938463,
0.02316226251423359,
-0.01258710864931345,
-0.009273548610508442,
0.02914545312523842,
0.0023115482181310654,
0.003486949484795332,
-0.028116224333643913,
-0.002560438821092248,
0.042623814195394516,
-0.011021822690963745,
0.020381009206175804,
-0.036707766354084015,
0.05791870877146721,
0.01843518577516079,
0.01860988698899746,
0.06333976984024048,
-0.021999694406986237,
-0.008989249356091022,
0.07288425415754318,
0.0024868061300367117,
0.00844475720077753,
-0.01042561698704958,
-0.024658899754285812,
0.014539618045091629,
-0.03905804827809334,
0.07603064179420471,
0.022144220769405365,
-0.04402857646346092,
0.01982012577354908,
0.009481450542807579,
0.00821248535066843,
0.007870320230722427,
0.029053302481770515,
0.012932626530528069,
0.022984491661190987,
0.011143732815980911,
-0.04457184299826622,
-0.004971986636519432,
-0.019404850900173187,
-0.016769375652074814,
0.01787245273590088,
-0.07252087444067001,
0.0011709403479471803,
0.0107975322753191,
0.06730960309505463,
0.0037777419202029705,
-0.013577582314610481,
-0.00447479821741581,
-0.02907499112188816,
-0.03741930425167084,
0.005092991981655359,
-0.0074028209783136845,
0.007294291630387306,
0.04677238687872887,
0.030086301267147064,
0.043870460242033005,
0.08078283071517944,
-0.055607933551073074,
0.002337677637115121,
-0.04051157459616661,
-0.00010457973985467106,
0.06653042137622833,
-0.018765786662697792,
-0.00250154547393322,
0.028421267867088318,
-0.036748405545949936,
-0.005319476593285799,
-0.040651585906744,
0.025986194610595703,
0.046704765409231186,
0.006351032294332981,
0.07653604447841644,
0.04260648041963577,
-0.014766907319426537,
-0.037930235266685486,
0.049003761261701584,
-0.033309392631053925,
0.059545617550611496,
0.03766493871808052,
0.06053781881928444,
0.000053913296142127365,
-0.001015590620227158,
0.0340413860976696,
0.025429174304008484,
0.008341973647475243,
0.006819060072302818,
-0.004816596861928701,
-0.016713306307792664,
0.0013324730098247528,
0.0076589868403971195,
-0.048814717680215836,
0.032019853591918945,
-0.04189671576023102,
-0.023181738331913948,
-0.08666639029979706,
0.029905032366514206,
-0.05594382807612419,
0.0015575540019199252,
0.008304355666041374,
-0.072199247777462,
0.029188022017478943,
-0.014347839169204235,
-0.010705358348786831,
-0.023344026878476143,
-0.04164653643965721,
-0.04647442698478699,
-0.009619127959012985,
-0.029984313994646072,
-0.025332387536764145,
0.05035105347633362,
0.007877936586737633,
0.07250230759382248,
-0.046499188989400864,
0.07569858431816101,
-0.016024144366383553,
-0.010357442311942577,
-0.09916935116052628,
-0.03730394318699837,
-0.03849073871970177,
-0.038121942430734634,
0.002586741466075182,
0.000017284644854953513,
0.013679741881787777,
0.004142834804952145,
0.021192297339439392,
-0.04738455265760422,
0.003971719648689032,
0.00923344399780035,
-0.0026595788076519966,
-0.0050008585676550865,
-0.028231024742126465,
-0.007493000011891127,
-0.029553305357694626,
-0.015614858828485012,
-0.0489099957048893,
-0.004360079299658537,
0.01617910899221897,
0.0440584160387516,
-0.022374184802174568,
0.015190262347459793,
0.01983325555920601,
0.02882002852857113,
-0.0313330739736557,
-0.041168760508298874,
-0.02649039961397648,
0.04826582223176956,
-0.017142152413725853,
0.04707369953393936,
-0.001118064159527421,
-0.021143972873687744,
-0.017078837379813194,
0.01107058022171259,
-0.011447691358625889,
-0.010600912384688854,
0.00847364217042923,
-0.054987240582704544,
0.04248480871319771,
0.04708556458353996,
0.010408046655356884,
0.02555888518691063,
-0.04090846702456474,
0.02032984048128128,
-0.00860271230340004,
-0.014158211648464203,
0.0061892494559288025,
0.010116188786923885,
-0.0323176234960556,
-0.017135513946413994,
0.05595535784959793,
-0.027779648080468178,
-0.004562754184007645,
-0.003854128997772932,
0.018621232360601425,
0.03256486728787422,
0.03941769152879715,
0.0011506180744618177,
-0.05973976105451584,
0.0356462225317955,
0.00230063172057271,
-0.06662342697381973,
0.009639054536819458,
0.01920907571911812,
-0.03970888629555702,
0.015300527215003967,
0.00024920745636336505,
-0.02005361020565033,
0.06334539502859116,
-0.03322245925664902,
-0.013204921968281269,
0.03817877918481827,
-0.039397090673446655,
0.05834949389100075,
-0.04200116917490959,
-0.0407751202583313,
-0.025397974997758865,
0.03370998799800873,
-0.031350597739219666,
0.09402713179588318,
0.01700510084629059,
-0.021415429189801216,
0.06538768857717514,
-0.03319253399968147,
0.010775058530271053,
-0.029081860557198524,
0.017235111445188522,
-0.018217720091342926,
-0.01388957817107439,
-0.015269945375621319,
-0.035614583641290665,
-0.015978362411260605,
0.009586055763065815,
0.01691858097910881,
0.017422448843717575,
0.015468988567590714,
-0.010117171332240105,
0.006936145946383476,
-0.025120344012975693,
0.034277819097042084,
-0.011978034861385822,
0.0034245767164975405,
0.004830438178032637,
-0.019085204228758812,
0.09467810392379761,
0.08039070665836334,
-0.016791444271802902,
0.04120175912976265,
0.006833966821432114,
-0.017171697691082954,
-0.005524580832570791,
-0.02251129038631916,
0.006011740770190954,
-0.0028738360852003098,
-0.03538531810045242,
-0.0166885145008564,
-0.025446295738220215,
-0.017883608117699623,
0.00011980565614067018,
-0.02551317773759365,
0.01672573946416378,
-0.05217963457107544,
-0.023907005786895752,
0.046887654811143875,
0.05225898697972298,
0.03971939906477928,
-0.023142855614423752,
-0.014542922377586365,
0.035205792635679245,
0.00035496012424118817,
0.051363810896873474,
-0.0002513927756808698,
0.027533866465091705,
-0.03245924785733223,
0.009668894112110138,
-0.02113952860236168,
-0.05059963837265968,
-0.03976164758205414,
-0.028515182435512543,
-0.00036329857539385557,
-0.015818243846297264,
-0.02672100067138672,
0.027372190728783607,
-0.015702024102211,
0.026278240606188774,
0.040010418742895126,
-0.00012069090735167265,
0.047069352120161057,
0.037564538419246674,
0.011402669362723827,
0.02894405461847782,
-0.037977565079927444,
0.020730257034301758,
0.034242261201143265,
0.012543633580207825,
-0.06068357825279236,
0.003390002064406872,
0.036231253296136856,
0.055435847491025925,
-0.002416810020804405,
0.02532285638153553,
0.008584875613451004,
0.01847883313894272,
0.059031710028648376,
0.04112875834107399,
-0.019365791231393814,
0.03591005876660347,
0.020792696624994278,
0.011671115644276142,
0.018122991546988487,
-0.13005241751670837,
0.02515396475791931,
0.015782682225108147,
-0.059903938323259354,
-0.08900871127843857,
0.030606189742684364,
-0.01699018105864525,
0.012452335096895695,
0.009100663475692272,
-0.00784732773900032,
0.03071841597557068,
0.050441842526197433,
-0.025099877268075943,
0.057082388550043106,
0.0747324526309967,
0.012353830970823765,
0.012048876844346523,
-0.02045494131743908,
0.023372123017907143,
-0.040694449096918106,
-0.01679268106818199,
0.0002877824008464813,
0.00815424695611,
-0.0016010598046705127,
-0.03989766538143158,
-0.026056569069623947,
0.030424583703279495,
0.05178014561533928,
0.005176236853003502,
0.02903778664767742,
-0.0012038316344842315,
-0.03699011355638504,
-0.07249888777732849,
0.004275796003639698,
0.04196791350841522,
-0.018309924751520157,
0.04283040389418602,
-0.02776513807475567,
-0.03380874916911125,
0.08435934036970139,
0.037810299545526505,
-0.006642164196819067,
0.024532202631235123,
0.0028530657291412354,
-0.005265247542411089,
0.014822571538388729,
-0.07452594488859177,
-0.00719801802188158,
0.011168187484145164,
0.08120692521333694,
-0.06681579351425171,
-0.001680962392129004,
0.0055540394969284534,
0.04715082421898842,
-0.0004984542028978467,
0.001787126180715859,
-0.02056235633790493,
0.018801432102918625,
0.03906118869781494,
-0.016903745010495186,
-0.04518985375761986,
0.028607022017240524,
-0.0010527457343414426,
0.007965917699038982,
0.056376878172159195,
-0.01327975932508707,
0.012128253467381,
-0.010822653770446777,
0.026841644197702408,
0.0034244454000145197,
0.027234559878706932,
-0.006349162198603153,
-0.051362693309783936,
-0.03606892377138138,
0.011483984999358654,
0.02130036987364292,
-0.05116531252861023,
-0.04172509163618088,
0.01963026262819767,
0.0005591000663116574,
0.017034554854035378,
-0.004435888025909662,
-0.022010818123817444,
0.030670370906591415,
0.03143616393208504,
-0.030284391716122627,
0.005516964476555586,
0.10163602232933044,
-0.04930337890982628,
0.008508430793881416,
-0.023185476660728455,
0.015433582477271557,
-0.022862350568175316,
0.004786729346960783,
-0.062413305044174194,
0.05326325446367264,
0.016609525308012962,
0.025967242196202278,
0.038768623024225235,
-0.05396491289138794,
0.02211386151611805,
-0.0019471477717161179,
-0.02916511707007885,
0.043851714581251144,
-0.0037147323600947857,
0.05344577506184578,
-0.008257756941020489,
0.07173144817352295,
0.027183884754776955,
-0.030812405049800873,
-0.047351378947496414,
0.1076400950551033,
-0.032439928501844406,
0.016468917950987816,
0.0015168329700827599,
0.005083270836621523,
-0.03234928473830223,
-0.03291632980108261,
0.026529952883720398,
-0.1090339720249176,
-0.049104105681180954,
0.04349314048886299,
-0.019090373069047928,
0.02094828151166439,
0.043004341423511505,
0.07818765193223953,
0.023582909256219864,
-0.03961712121963501,
0.022801704704761505,
-0.023068126291036606,
-0.040340352803468704,
0.02738267369568348,
0.01930406503379345,
-0.004887791350483894,
0.00011666403588606045,
-0.014848648570477962,
-0.0804816484451294,
-0.02115006558597088,
-0.01363549754023552,
-0.020999453961849213,
0.02844744175672531,
-0.02650417760014534,
-0.0051970165222883224,
0.04793916642665863,
0.008119148202240467,
0.0014253343688324094,
0.007303668651729822,
-0.017356857657432556,
-0.012230167165398598,
-0.014162080362439156,
-0.033038198947906494,
-0.0036772883031517267,
0.06445503234863281,
0.028945520520210266,
0.04042399302124977,
0.046690933406353,
-0.005713988561183214,
0.02185845375061035,
0.03393567353487015,
-0.013728695921599865,
-0.025863708928227425,
-0.013333589769899845,
-0.030792422592639923,
-0.02893022820353508,
0.010218353010714054,
0.04792553186416626,
0.002624084474518895,
-0.03870777040719986,
0.10106364637613297,
0.05004720389842987,
-0.05057686194777489,
0.006227001082152128,
-0.019262507557868958,
-0.003681838046759367,
0.02829572558403015,
-0.0025573614984750748,
0.048919763416051865,
-0.003160856431350112,
-0.013416847214102745,
-0.014824279583990574,
-0.026375332847237587,
0.02439553290605545,
0.015661785379052162,
0.10639443248510361,
-0.04969161003828049,
0.014751340262591839,
-0.06044965982437134,
0.0208835918456316,
0.0013583360705524683,
-0.000728739716578275,
-0.005651438143104315,
-0.0056358580477535725,
0.03504800423979759,
-0.0023885639384388924,
-0.004809358157217503,
0.0132460817694664,
-0.08550898730754852,
-0.041328392922878265,
-0.062429849058389664,
0.015620111487805843,
0.014698412269353867,
-0.02678687870502472,
0.03076418861746788,
0.03571629896759987,
-0.04934227466583252,
0.0989307388663292,
0.014214158989489079,
0.0030563618056476116,
0.020494574680924416,
-5.075156452056917e-33,
0.008082610554993153,
0.006644354201853275,
-0.004965762607753277,
-0.06542438268661499,
-0.007372002117335796,
0.10056868940591812,
-0.031093914061784744,
-0.037904951721429825,
-0.04735434055328369,
0.00020737481827381998,
0.008088828064501286,
-0.012792167253792286,
0.0073237004689872265,
0.07978581637144089,
0.004241619259119034,
-0.0010396231664344668,
-0.0207291878759861,
0.017951039597392082,
-0.0011416313936933875,
-0.0036086472682654858,
-0.051771167665719986,
-0.01619473472237587,
0.011785423383116722,
-0.0035101796966046095,
-0.0062372866086661816,
-0.020771969109773636,
0.042164772748947144,
-0.044610150158405304,
-0.017131347209215164,
0.0021644635125994682,
0.006366663612425327,
-0.03928762674331665,
0.05895690619945526,
0.025677986443042755,
0.005021204240620136,
-0.008063443005084991,
0.01754392497241497,
-0.020649263635277748,
0.012010815553367138,
0.05504283681511879,
-0.02115696109831333,
-0.04040854796767235,
0.028632238507270813,
-0.035895947366952896,
-0.038553137332201004,
-0.016662999987602234,
-0.08330216258764267,
0.011214898899197578,
0.022526413202285767,
-0.0487712062895298,
-0.01448343601077795,
0.015256591141223907,
0.011466206051409245,
-0.03546547517180443,
-0.02383374609053135,
0.011990019120275974,
0.01140393503010273,
0.03285079076886177,
-0.013715488836169243,
-0.01697077788412571,
-0.013906212523579597,
-0.015673920512199402,
-0.04274686798453331,
-0.03383743762969971,
-0.027621909976005554,
0.005478892009705305,
-0.03340554237365723,
0.03556203469634056,
-0.024909837171435356,
-0.005920706316828728,
-0.1320025473833084,
-0.008878576569259167,
0.008521896786987782,
-0.07796057313680649,
-0.04245434328913689,
-0.07302726060152054,
0.013333293609321117,
-0.026568086817860603,
0.010301881469786167,
-0.02908448688685894,
-0.015007534064352512,
-0.0019761172588914633,
-0.07579447329044342,
-0.02346603386104107,
-0.0034104411024600267,
0.02086210623383522,
0.04266278073191643,
-0.024552006274461746,
-0.007843028753995895,
-0.012642575427889824,
0.03167598322033882,
-0.022738002240657806,
0.03114778734743595,
0.014252781867980957,
0.06867248564958572,
-0.05658987909555435,
-0.0005119202542118728,
0.0431968979537487,
0.004956915974617004,
0.013783484697341919,
-0.04713847115635872,
0.006468562409281731,
-0.008261432871222496,
0.024864207953214645,
-0.06853675842285156,
-0.007931572385132313,
-0.05905812233686447,
0.009223786182701588,
-0.01032532099634409,
0.038428664207458496,
0.0047726621851325035,
-0.03641616180539131,
0.019219765439629555,
0.04666632041335106,
0.016828782856464386,
0.06800613552331924,
0.013973276130855083,
0.04442431405186653,
0.03663299232721329,
0.013868835754692554,
0.018231434747576714,
-0.034878212958574295,
0.00034881828469224274,
-0.05593367666006088,
-0.007407025899738073,
-0.02725202962756157,
0.023260124027729034,
0.019231196492910385,
-0.03938824310898781,
0.031796567142009735,
0.045107174664735794,
-0.017819833010435104,
2.890844541525439e-7,
0.0019317632541060448,
-0.025549113750457764,
-0.05817139148712158,
-0.0941116064786911,
0.037546779960393906,
-0.021411115303635597,
0.03239685297012329,
-0.041066743433475494,
0.0015084188198670745,
-0.039636917412281036,
0.013388723134994507,
-0.022095229476690292,
-0.007077312096953392,
-0.006473795510828495,
0.034502893686294556,
-0.06755930930376053,
-0.027932075783610344,
-0.04161672294139862,
-0.0013554084580391645,
0.0005252558039501309,
0.02520805597305298,
-0.011642588302493095,
-0.06177319213747978,
0.028906820341944695,
-0.03647224232554436,
0.03431694954633713,
0.01954769901931286,
-0.03526318445801735,
-0.02288331463932991,
-0.0513375960290432,
-0.016390414908528328,
0.013642172329127789,
-0.002031708136200905,
0.0025895664002746344,
0.02080526575446129,
0.010998377576470375,
0.012728399597108364,
0.08709626644849777,
-0.010910909622907639,
0.0476960763335228,
-0.01676059328019619,
-0.021663125604391098,
-0.0057311877608299255,
0.007768377661705017,
0.034606095403432846,
0.010784718208014965,
-0.09373848885297775,
-0.039487238973379135,
0.02247854508459568,
0.04128137603402138,
0.027945252135396004,
0.00763862207531929,
-0.031192032620310783,
0.02081739902496338,
0.001372780418023467,
-0.016906578093767166,
-0.07345691323280334,
-0.018415628001093864,
-0.0007963395910337567,
-0.041525907814502716,
-0.04657873883843422,
0.010589217767119408,
0.04106278344988823,
-0.045518919825553894,
0.011842379346489906,
-0.07598015666007996,
-0.00972301047295332,
1.6747410361184175e-34,
0.035214684903621674,
-0.041804470121860504,
-0.008319342508912086,
0.012713010422885418,
-0.05233516916632652,
-0.02528306469321251,
-0.016306454315781593,
0.032870903611183167,
0.037485551089048386,
-0.056908972561359406,
-0.015235040336847305
] | {
"ds_index": 90,
"similar_dg_indices": [
1046182,
767896,
688500,
1181706,
984110,
195891,
504561,
523462,
1113330,
85336,
315772,
593118,
30551,
938500,
254335,
508031,
754019,
355049,
264146,
37917
]
} |
A 53-year-old woman comes to the physician in February because of a 1-day history of fever, chills, headache, and dry cough. She also reports malaise and generalized muscle aches. She works as a teacher at a local high school, where there was recently an outbreak of influenza. She has a history of intermittent asthma, for which she takes albuterol as needed. She declined the influenza vaccine offered in the fall because her sister told her that a friend developed a flulike illness after receiving the vaccine. She is worried about possibly becoming ill and cannot afford to miss work. Her temperature is 37.9°C (100.3°F), heart rate is 58/min, and her respirations are 12/min. Physical examination is unremarkable. Her hemoglobin concentration is 14.5 g/dL, leukocyte count is 9,400/mm3, and platelet count is 280,000/mm3. In addition to analgesia, which of the following is the most appropriate next step in management? | Oseltamivir | {
"A": "Supportive therapy only",
"B": "Amantadine",
"C": "Inactivated influenza vaccine",
"D": "Oseltamivir"
} | step2&3 | D | [
"year old woman",
"physician",
"February",
"1-day history",
"fever",
"chills",
"headache",
"dry cough",
"reports malaise",
"generalized muscle aches",
"works",
"teacher",
"local high school",
"recently",
"outbreak",
"influenza",
"history of intermittent asthma",
"takes albuterol as needed",
"influenza vaccine offered",
"fall",
"sister",
"friend",
"flulike illness",
"receiving",
"vaccine",
"worried",
"possibly",
"ill",
"to miss work",
"temperature",
"100",
"heart rate",
"58 min",
"respirations",
"min",
"Physical examination",
"unremarkable",
"hemoglobin concentration",
"g/dL",
"leukocyte count",
"400 mm3",
"platelet count",
"mm3",
"analgesia",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 53-year-old woman comes to the physician in February because of a 1-day history of fever, chills, headache, and dry cough. She also reports malaise and generalized muscle aches. She works as a teacher at a local high school, where there was recently an outbreak of influenza. She has a history of intermittent asthma, for which she takes albuterol as needed. She declined the influenza vaccine offered in the fall because her sister told her that a friend developed a flulike illness after receiving the vaccine. She is worried about possibly becoming ill and cannot afford to miss work. Her temperature is 37.9°C (100.3°F), heart rate is 58/min, and her respirations are 12/min. Physical examination is unremarkable. Her hemoglobin concentration is 14.5 g/dL, leukocyte count is 9,400/mm3, and platelet count is 280,000/mm3. In addition to analgesia, which of the following is the most appropriate next step in management?
Choose one of the following::
A. Supportive therapy only
B. Amantadine
C. Inactivated influenza vaccine
D. Oseltamivir | [
0.043569497764110565,
-0.011768554337322712,
0.021954338997602463,
-0.0062296208925545216,
0.025609293952584267,
-0.008643921464681625,
-0.030965372920036316,
0.027044711634516716,
0.00929779652506113,
-0.013909424655139446,
0.009550448507070541,
0.02781161293387413,
0.01825108379125595,
-0.041061654686927795,
-0.014051503501832485,
-0.027866078540682793,
-0.012031897902488708,
0.0033954516984522343,
0.023735079914331436,
0.0029885657131671906,
-0.04303370416164398,
0.03062358871102333,
0.013596713542938232,
0.010015977546572685,
0.07618477940559387,
-0.0128861702978611,
0.01516851969063282,
-0.019355859607458115,
0.04210703447461128,
-0.045299381017684937,
0.005008968058973551,
-0.06254226714372635,
0.02125503309071064,
-0.1150938868522644,
0.0000021563230347965145,
0.0016251810593530536,
0.02678528241813183,
-0.004290126264095306,
0.04113512858748436,
-0.05005868151783943,
0.012226994149386883,
-0.05239000543951988,
0.06038658693432808,
0.02607503905892372,
-0.06605936586856842,
-0.08071688562631607,
-0.027938099578022957,
0.059158798307180405,
-0.016997914761304855,
-0.017411991953849792,
-0.012155628763139248,
-0.0044700708240270615,
-0.052129942923784256,
0.005914631765335798,
0.003999367356300354,
-0.08395172655582428,
-0.01699727401137352,
-0.047100577503442764,
0.08434848487377167,
0.02317051589488983,
0.006522143259644508,
0.005669369827955961,
-0.006877904292196035,
0.0023402259685099125,
-0.05289992690086365,
0.05477585271000862,
0.07432504743337631,
-0.018788890913128853,
0.0020446476992219687,
-0.012064158916473389,
-0.02351279929280281,
0.05274880304932594,
0.05761842057108879,
0.019327593967318535,
-0.0412750244140625,
-0.020317694172263145,
0.06406023353338242,
-0.11549489945173264,
0.030386604368686676,
0.006350396666675806,
0.10038027912378311,
0.04556872695684433,
0.0009762760018929839,
0.053615838289260864,
-0.014165232889354229,
-0.0687154084444046,
-0.01998814195394516,
-0.004686682019382715,
-0.014762955717742443,
-0.016058659180998802,
0.012908819131553173,
-0.08346182852983475,
0.01722925715148449,
0.04091262444853783,
-0.07631468772888184,
-0.014567914418876171,
0.033201370388269424,
-0.012075205333530903,
0.014914066530764103,
-0.04348263517022133,
-0.09349582344293594,
-0.027139555662870407,
0.06479410082101822,
-0.016180813312530518,
0.004928150679916143,
-0.07128427922725677,
-0.03945580869913101,
-0.0450519360601902,
-0.039255063980817795,
0.046484749764204025,
0.012147159315645695,
0.010969544760882854,
-0.08460773527622223,
0.011906983330845833,
0.119471475481987,
0.03880719467997551,
-0.03635416179895401,
-0.09497085958719254,
-0.017640097066760063,
0.06886066496372223,
0.010113701224327087,
-0.004368377849459648,
0.04579123854637146,
0.010911733843386173,
0.0060394820757210255,
0.015964219346642494,
-0.030390271916985512,
0.021281125023961067,
0.027500441297888756,
-0.0007764643523842096,
0.016738450154662132,
-0.028140850365161896,
0.012298461981117725,
-0.0024528587237000465,
0.03423303738236427,
-0.019490087404847145,
0.00012255187903065234,
0.056430961936712265,
-0.014183959923684597,
0.01171924639493227,
-0.01501111313700676,
-0.04149466007947922,
-0.02574022114276886,
0.0037000251468271017,
-0.011104173958301544,
0.06629524379968643,
-0.01629805751144886,
0.017878247424960136,
-0.01777462847530842,
-0.0028080008924007416,
-0.04749942570924759,
-0.07403701543807983,
-0.0019385921768844128,
0.009179682470858097,
-0.0019652340561151505,
0.05193265527486801,
0.018870577216148376,
-0.047918740659952164,
-0.020427953451871872,
-0.004498955328017473,
0.011135779321193695,
-0.02746501751244068,
0.07012121379375458,
0.01597628742456436,
0.03887586668133736,
0.04066501557826996,
0.005378813482820988,
0.06523717194795609,
-0.0532589852809906,
0.022885706275701523,
-0.03924582153558731,
0.030238643288612366,
0.012542161159217358,
-0.016696324571967125,
0.0034995560999959707,
0.011540908366441727,
-0.051088593900203705,
-0.09213791787624359,
0.0027570065576583147,
-0.020124167203903198,
-0.014327354729175568,
0.04200061410665512,
-0.006342811975628138,
-0.030590489506721497,
-0.008243102580308914,
-0.013930674642324448,
0.021900327876210213,
0.00943044200539589,
-0.04825715720653534,
-0.059385355561971664,
-0.06068141758441925,
-0.03489743545651436,
-0.035927675664424896,
0.03077743388712406,
-0.009515887126326561,
-0.013440946117043495,
0.006343672052025795,
-0.012662393040955067,
0.0009616176248528063,
0.037080712616443634,
-0.004150588996708393,
-0.03346458077430725,
-0.030106687918305397,
0.07891137897968292,
-0.0475415401160717,
0.0636320412158966,
-0.010192026384174824,
-0.015786031261086464,
0.015526899136602879,
-0.010243254713714123,
0.029659122228622437,
0.01734236627817154,
0.060914330184459686,
-0.048942066729068756,
0.041058965027332306,
0.008959193713963032,
0.02109968103468418,
-0.009776453487575054,
-0.07295447587966919,
0.00114106060937047,
-0.03808094188570976,
0.029509028419852257,
-0.01907568983733654,
0.010869655758142471,
-0.032647378742694855,
-0.04029747098684311,
0.00992255937308073,
0.007131082471460104,
0.02033124677836895,
-0.05246911570429802,
0.05914252623915672,
0.03811851143836975,
0.02471167966723442,
-0.03690005838871002,
-0.03858407586812973,
0.03325055167078972,
0.010247407481074333,
-0.035090599209070206,
-0.03193683177232742,
0.07954230904579163,
-0.01562497392296791,
-0.050194378942251205,
-0.06360364705324173,
-0.03391382843255997,
0.01964144967496395,
0.017857477068901062,
0.03848900645971298,
0.04283032938838005,
-0.07595660537481308,
0.062466640025377274,
-0.04058431088924408,
0.0046318694949150085,
-0.04281206056475639,
-0.017451319843530655,
-0.006110090762376785,
0.04942183569073677,
-0.044924236834049225,
-0.042716942727565765,
-0.05863553658127785,
-0.032489653676748276,
0.01849796250462532,
-0.0009248641435988247,
-0.028523942455649376,
-0.028186818584799767,
-0.08440044522285461,
0.020740576088428497,
0.01923888735473156,
0.0008831961895339191,
-0.017532913014292717,
0.06655911356210709,
0.010753520764410496,
0.008328950963914394,
0.0420043058693409,
-0.019631946459412575,
-0.04210202768445015,
-0.0037624691613018513,
-0.005409443750977516,
0.04519335553050041,
0.0021039224229753017,
0.008123518899083138,
0.01866220124065876,
0.028301015496253967,
0.008261414244771004,
0.023739339783787727,
-0.008019437082111835,
-0.010806180536746979,
-0.03698911890387535,
-0.046209387481212616,
0.04443531855940819,
-0.04521702229976654,
0.009587139822542667,
0.04535211995244026,
-0.008991611190140247,
-0.032300710678100586,
-0.052303750067949295,
-0.07711482793092728,
-0.024811502546072006,
0.0026433004532009363,
-0.02715328522026539,
0.038204170763492584,
0.048478417098522186,
0.06711328029632568,
-0.03687874600291252,
0.0360441580414772,
-0.003887076862156391,
0.03543300926685333,
0.02781200408935547,
0.014680883847177029,
-0.013023334555327892,
0.06822414696216583,
0.05293525382876396,
0.012357239611446857,
0.020559662953019142,
0.000900762272067368,
-0.05660169571638107,
-0.01388444472104311,
-0.010728505440056324,
-0.02199241705238819,
0.02777501381933689,
-0.0028838873840868473,
-0.0038499501533806324,
0.01814057119190693,
-0.0069189597852528095,
-0.003465746296569705,
0.010920329950749874,
-0.06032616272568703,
-0.03704751282930374,
-0.006434732116758823,
-0.054820042103528976,
0.011418546549975872,
-0.012792741879820824,
-0.025280935689806938,
0.017340615391731262,
0.04430365934967995,
0.009363756515085697,
-0.0015519269509240985,
-0.042057376354932785,
-0.02719035930931568,
-0.0011478561209514737,
0.07064717262983322,
0.008284746669232845,
-0.043196603655815125,
0.010790352709591389,
0.006268322467803955,
-0.03642262890934944,
0.0018166503868997097,
-0.0627916231751442,
0.03359207883477211,
-0.00329433660954237,
0.00438125291839242,
-0.051801081746816635,
0.053869690746068954,
0.03271830081939697,
-0.02519322745501995,
-0.017456861212849617,
-0.025537140667438507,
0.00030759433866478503,
0.05433101952075958,
-0.01632833108305931,
0.02476421184837818,
0.018188998103141785,
0.03344099968671799,
-0.006140025332570076,
0.015091835521161556,
-0.01576360873878002,
-0.02351471409201622,
0.026957901194691658,
-0.029852591454982758,
-0.05071316659450531,
0.05319247394800186,
0.026584673672914505,
-0.02988792210817337,
0.002046699170023203,
0.044798243790864944,
0.0038304582703858614,
-0.004525735974311829,
-0.003438537009060383,
-0.0678032636642456,
-0.05629416182637215,
-0.04596414044499397,
0.03351385518908501,
-0.05229977145791054,
-0.0025776817928999662,
-0.011031088419258595,
0.01314200833439827,
0.0144284563139081,
0.01530564483255148,
0.002489535603672266,
0.04943707585334778,
0.009854207746684551,
-0.009492019191384315,
0.00909026525914669,
0.04357083514332771,
-0.06271272152662277,
0.02073480188846588,
-0.011001013219356537,
0.03176618367433548,
-0.044654082506895065,
0.03374657407402992,
0.06301108002662659,
-0.011449848301708698,
0.009446859359741211,
-0.011492813006043434,
0.04276101291179657,
0.05336693301796913,
-0.02706053853034973,
-0.02323153242468834,
0.0012595251901075244,
0.00863492488861084,
0.006261539179831743,
-0.015184302814304829,
-0.028640413656830788,
0.01891201362013817,
-0.018982306122779846,
0.04073084890842438,
-0.030919596552848816,
0.025202596560120583,
-0.025957610458135605,
0.0022638782393187284,
-0.08153605461120605,
0.02646210789680481,
0.022648563608527184,
0.013459608890116215,
-0.026258543133735657,
-0.04730604961514473,
-0.006892997305840254,
0.03818749263882637,
0.062178559601306915,
0.0019324098248034716,
0.027236009016633034,
0.014570064842700958,
-0.06067674607038498,
0.08772653341293335,
0.06632478535175323,
-0.07155819982290268,
0.048504263162612915,
-0.05998522788286209,
-0.007137089967727661,
0.006267343647778034,
-0.02831595577299595,
-0.03248303756117821,
0.011281103827059269,
0.03211783990263939,
-0.012980994768440723,
-0.03289586305618286,
-0.0007504465756937861,
0.0049654594622552395,
0.02761915698647499,
-0.055740807205438614,
0.07936867326498032,
0.07208099961280823,
0.012940964661538601,
0.008258882910013199,
0.014676702208817005,
0.07575567811727524,
-0.007690356578677893,
0.039754509925842285,
0.06500314176082611,
0.031180353835225105,
0.04161345958709717,
-0.019069179892539978,
0.01249784231185913,
-0.020507002249360085,
-0.036787766963243484,
0.0183747299015522,
-0.026282846927642822,
-0.02663218043744564,
-0.013332216069102287,
-0.010099395178258419,
-0.003151818411424756,
0.006882315967231989,
0.031693268567323685,
-0.013372416608035564,
0.0033809517044574022,
0.0632195696234703,
-0.0009081301395781338,
-0.05072818696498871,
0.004242004361003637,
-0.029476037248969078,
0.0038596494123339653,
0.001401682966388762,
-0.03311553969979286,
-0.05939492955803871,
-0.03790711238980293,
-0.030298979952931404,
-0.01927347108721733,
0.07605057954788208,
-0.016920827329158783,
-0.009161791764199734,
-0.013162718154489994,
-0.015460693277418613,
-0.0005156954284757376,
-0.001362900249660015,
0.032707493752241135,
-0.061574965715408325,
0.0026702273171395063,
-0.023799315094947815,
0.04815129563212395,
-0.028144946321845055,
0.05597493797540665,
0.02321789599955082,
0.010832535102963448,
0.026564115658402443,
0.04352329298853874,
0.010634203441441059,
0.006664589513093233,
-0.011137926019728184,
0.033362459391355515,
-0.00995940063148737,
-0.022213462740182877,
0.010674378834664822,
0.05467924848198891,
-0.029019488021731377,
0.008852380327880383,
0.00040069277747534215,
-0.008173479698598385,
-0.04293331876397133,
-0.006074192002415657,
0.04327123239636421,
0.014378859661519527,
-0.007558758370578289,
-0.007107192650437355,
0.011764315888285637,
0.007615357171744108,
0.03684724122285843,
0.0026668887585401535,
0.004263496026396751,
-0.013566079549491405,
-0.008920600637793541,
0.04284650832414627,
-0.06506069004535675,
0.03778969496488571,
0.019894912838935852,
-0.002353143412619829,
-0.00117305142339319,
-0.017446938902139664,
0.028998777270317078,
0.011359008029103279,
-0.03886759653687477,
-0.030016304925084114,
-0.026358552277088165,
0.03573482111096382,
-0.02366682142019272,
-0.06494775414466858,
-0.019102759659290314,
0.026053478941321373,
-0.019490331411361694,
-0.031936582177877426,
0.06879935413599014,
0.049814410507678986,
0.02630755305290222,
0.07808906584978104,
0.00445691030472517,
0.0179904755204916,
-0.010259580798447132,
-5.731896696995682e-33,
0.04274410754442215,
-0.02773863822221756,
0.0003204215026926249,
-0.09619251638650894,
0.024247413501143456,
0.09118951857089996,
-0.015393215231597424,
-0.026325831189751625,
-0.09416516125202179,
-0.0016344465548172593,
-0.01039848942309618,
-0.010245050303637981,
0.030236076563596725,
0.04020385816693306,
0.0014605228789150715,
-0.027571015059947968,
-0.004558260552585125,
0.015580285340547562,
-0.03776882216334343,
0.005496165249496698,
-0.025204118341207504,
-0.02452954463660717,
0.018870418891310692,
-0.01359050814062357,
-0.012444580905139446,
-0.012021836824715137,
0.03906204178929329,
0.025028547272086143,
-0.0044168331660330296,
0.015507146716117859,
0.012853838503360748,
-0.00567309046164155,
0.057596150785684586,
0.0010796730639413,
-0.00761569244787097,
-0.04499715939164162,
-0.009763726033270359,
-0.048549577593803406,
0.03677169978618622,
-0.022364260628819466,
-0.023709295317530632,
-0.08324144035577774,
0.06271291524171829,
0.03756283223628998,
0.05448383465409279,
-0.024714240804314613,
-0.028930095955729485,
-0.008645977824926376,
0.03665490075945854,
-0.04358523339033127,
-0.020815934985876083,
0.02796359360218048,
-0.027606938034296036,
0.010795515030622482,
-0.0070495265536010265,
-0.0026306973304599524,
-0.018264148384332657,
0.06961425393819809,
0.02917192317545414,
-0.0008933176286518574,
0.027540316805243492,
0.039159175008535385,
-0.015352974645793438,
-0.03873638063669205,
-0.03221398964524269,
-0.010620323941111565,
0.04675953462719917,
0.009130901657044888,
-0.11742351949214935,
0.010483168065547943,
-0.052140217274427414,
-0.002268504351377487,
-0.011939940974116325,
-0.010632483288645744,
0.023750213906168938,
0.0008372525917366147,
0.011746025644242764,
0.03103921189904213,
-0.028987396508455276,
0.05217354744672775,
-0.043072596192359924,
0.04764910787343979,
0.000222463408135809,
-0.027776643633842468,
-0.012344746850430965,
0.000908774440176785,
-0.032231222838163376,
-0.005845091305673122,
0.019129479303956032,
-0.006484631448984146,
-0.0009856934193521738,
0.010830329731106758,
0.02774788998067379,
0.013612928800284863,
0.0049616810865700245,
-0.033124953508377075,
0.06915393471717834,
0.05423082783818245,
0.033560555428266525,
0.02034137211740017,
0.02091648057103157,
-0.01989057846367359,
0.041992828249931335,
-0.00637087132781744,
-0.02654370851814747,
0.018397169187664986,
-0.05401161313056946,
0.01665549725294113,
0.054436344653367996,
-0.0065452237613499165,
0.01832948811352253,
-0.012945124879479408,
-0.04555576667189598,
0.05465870723128319,
0.010264525189995766,
0.009688212536275387,
0.036137282848358154,
0.00663276482373476,
0.05182584002614021,
-0.02531658299267292,
0.02256091497838497,
0.022756796330213547,
0.011594106443226337,
-0.006255729123950005,
-0.018252316862344742,
-0.0020998690742999315,
0.046938005834817886,
0.03914376348257065,
-0.010510805062949657,
-0.06653042882680893,
0.04031515121459961,
0.017868997529149055,
2.8236146931703843e-7,
0.05564779043197632,
-0.031534988433122635,
-0.01028942596167326,
-0.05291341245174408,
0.0036956570111215115,
-0.04026063531637192,
-0.02245154045522213,
0.016752781346440315,
0.009053799323737621,
-0.018687674775719643,
0.06680083274841309,
-0.03424381464719772,
-0.00767100416123867,
-0.006988865323364735,
0.03444644436240196,
0.012975399382412434,
-0.011833840981125832,
0.04007500410079956,
0.01912088505923748,
-0.03715208172798157,
0.037742920219898224,
-0.013607355765998363,
-0.04957176372408867,
-0.023897849023342133,
-0.019202740862965584,
0.03132270276546478,
0.0019263302674517035,
-0.05953557789325714,
-0.022148186340928078,
-0.009829999879002571,
0.038155268877744675,
0.024306701496243477,
0.03411823883652687,
0.01822514645755291,
-0.03499101102352142,
-0.014893914572894573,
-0.005776001140475273,
0.08816467225551605,
-0.0348418690264225,
-0.0007161317043937743,
-0.0006105192005634308,
-0.03577418252825737,
0.0182746984064579,
-0.00867446232587099,
0.02419140562415123,
-0.029126396402716637,
-0.0635094866156578,
0.05436079204082489,
-0.026365119963884354,
0.05563771724700928,
-0.017799610272049904,
0.021207043901085854,
-0.034075845032930374,
0.06589905917644501,
-0.0015470696380361915,
0.04751107841730118,
-0.043307654559612274,
0.00602647615596652,
-0.026172874495387077,
-0.04680287837982178,
0.01327813882380724,
-0.0669412687420845,
0.020980864763259888,
-0.03164258226752281,
0.03177937865257263,
-0.054575663059949875,
0.008517843671143055,
1.7419446450856527e-34,
-0.02926422283053398,
-0.0508904904127121,
-0.01048976182937622,
-0.0015608061803504825,
-0.037572670727968216,
-0.03895026817917824,
0.008674262091517448,
0.05358244851231575,
0.05329781398177147,
-0.04228973761200905,
-0.04054733365774155
] | {
"ds_index": 91,
"similar_dg_indices": [
786285,
339727,
252407,
234368,
1183569,
133040,
1204327,
25282,
370501,
211690,
1173259,
384507,
473975,
1182106,
125553,
882670,
416703,
791553,
674422,
235075
]
} |
Red-green color blindness, an X-linked recessive disorder, has an incidence of 1/200 in males in a certain population. What is the probability of a phenotypically normal male and female having a child with red-green color blindness? | 1/400 | {
"A": "1/200",
"B": "199/200",
"C": "1/100",
"D": "1/400"
} | step1 | D | [
"Red-green color blindness",
"X-linked recessive disorder",
"incidence",
"200",
"males",
"certain population",
"probability",
"normal male",
"female",
"child",
"red-green color blindness"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Red-green color blindness, an X-linked recessive disorder, has an incidence of 1/200 in males in a certain population. What is the probability of a phenotypically normal male and female having a child with red-green color blindness?
Choose one of the following::
A. 1/200
B. 199/200
C. 1/100
D. 1/400 | [
-0.010795164853334427,
-0.03366414085030556,
-0.019854729995131493,
0.008833257481455803,
-0.017911406233906746,
0.008157297037541866,
-0.0220472514629364,
0.015467124991118908,
-0.025232940912246704,
-0.01729590632021427,
0.009361011907458305,
-0.001536067808046937,
0.00946242455393076,
0.0044961897656321526,
-0.03686440736055374,
-0.006939603015780449,
-0.047423627227544785,
0.012878062203526497,
-0.03332843631505966,
-0.044381823390722275,
0.009094723500311375,
0.02349322848021984,
0.0412728376686573,
0.0004582670808304101,
0.006147853564471006,
-0.003686200361698866,
0.039462681859731674,
-0.012416904792189598,
-0.025344708934426308,
0.02183876745402813,
0.016769172623753548,
0.031066417694091797,
-0.004317048005759716,
-0.058593347668647766,
0.0000015658279153285548,
-0.04073288291692734,
0.050267793238162994,
0.01381777599453926,
0.07537950575351715,
0.0032927189022302628,
-0.0740634873509407,
0.04100925102829933,
-0.05078629404306412,
0.0059607080183923244,
0.0424056202173233,
-0.005082359537482262,
0.029108714312314987,
0.05235183238983154,
-0.03869044408202171,
-0.04411622881889343,
0.002123175421729684,
0.038888245820999146,
0.059621527791023254,
0.03061547502875328,
0.08571956306695938,
-0.00909632258117199,
-0.03163125738501549,
0.025714298710227013,
0.029461873695254326,
0.004316957201808691,
0.002038625767454505,
0.03413550928235054,
0.005520761013031006,
0.03752441704273224,
-0.03373712673783302,
-0.03153841942548752,
0.04066582769155502,
-0.006969854235649109,
0.012709206901490688,
0.021238774061203003,
0.07678776234388351,
0.04046359285712242,
-0.023524882271885872,
0.0639137327671051,
-0.04691430553793907,
0.004148081410676241,
0.019793516024947166,
0.04532612860202789,
-0.02341589517891407,
-0.03144684061408043,
-0.03702393174171448,
-0.05217161402106285,
0.013110523112118244,
0.0070215328596532345,
0.03469138219952583,
0.03704841434955597,
0.021367058157920837,
0.028394116088747978,
0.0036361811216920614,
-0.034998003393411636,
0.0643540769815445,
-0.04150044918060303,
-0.031699299812316895,
-0.02205345407128334,
-0.015081160701811314,
0.020201416686177254,
-0.008063966408371925,
-0.006839938927441835,
0.05511782318353653,
-0.04032856971025467,
0.039495185017585754,
0.06359981000423431,
0.014123265631496906,
0.011998157016932964,
-0.059338074177503586,
0.026666387915611267,
-0.011531404219567776,
0.007711790502071381,
0.027843959629535675,
0.0231886338442564,
-0.04342075437307358,
-0.0038907891139388084,
-0.06116124615073204,
-0.0342332161962986,
0.01300564780831337,
-0.013646199367940426,
0.03527761623263359,
-0.014223664999008179,
0.018024059012532234,
-0.04300660640001297,
0.015335801988840103,
0.0250257421284914,
-0.05052540451288223,
-0.02555483765900135,
-0.05413888767361641,
0.009531094692647457,
0.01954679563641548,
-0.017039677128195763,
-0.04291246086359024,
-0.058585748076438904,
0.05307522043585777,
-0.05347946286201477,
-0.018300989642739296,
0.030378954485058784,
-0.028247026726603508,
0.028689637780189514,
-0.02019173838198185,
0.02008979022502899,
0.026056498289108276,
-0.025048265233635902,
-0.004089690744876862,
0.02650834061205387,
-0.030555250123143196,
-0.03479498252272606,
-0.08502925932407379,
0.030346037819981575,
0.010364285670220852,
0.002373279305174947,
0.04759629815816879,
0.028022265061736107,
-0.017051421105861664,
0.013151376508176327,
0.008699052035808563,
-0.011310686357319355,
0.027432812377810478,
0.02666071243584156,
-0.007671732921153307,
0.06676041334867477,
0.03481284901499748,
-0.09200505912303925,
0.015713347122073174,
-0.037155866622924805,
0.012143658474087715,
-0.034633979201316833,
-0.031958747655153275,
-0.014962643384933472,
0.01163430791348219,
-0.025255898013710976,
0.025987550616264343,
0.02381720580160618,
0.03672133386135101,
0.007829198613762856,
0.015000112354755402,
-0.04567090421915054,
-0.02356627583503723,
0.04330158606171608,
-0.028020646423101425,
-0.0528498999774456,
0.02590271271765232,
-0.012268374674022198,
-0.051343221217393875,
-0.015715217217803,
-0.0029201300349086523,
0.01791931502521038,
-0.02273641899228096,
0.01002003438770771,
-0.069314144551754,
-0.006233849097043276,
-0.007014887407422066,
0.016345717012882233,
-0.03394816815853119,
0.0018973664846271276,
0.00771778030321002,
-0.02837129682302475,
-0.007113965693861246,
0.02523357793688774,
0.04714782163500786,
-0.030326683074235916,
-0.025694552809000015,
0.007138857152312994,
0.047392167150974274,
-0.07005824893712997,
0.04431449621915817,
-0.017980266362428665,
-0.007819602265954018,
0.023738175630569458,
-0.0042235711589455605,
0.01263419445604086,
-0.053085681051015854,
-0.04142078012228012,
-0.009271427989006042,
0.020437009632587433,
0.045793045312166214,
-0.03985898569226265,
0.002276175655424595,
0.04768659546971321,
-0.028018711134791374,
-0.007285065948963165,
-0.018620315939188004,
0.0011257381411269307,
0.01918097585439682,
-0.030309753492474556,
0.03455180674791336,
0.010559088550508022,
-0.07460474222898483,
0.01781623438000679,
0.007467699237167835,
-0.046427514404058456,
-0.007278718985617161,
-0.043308112770318985,
-0.007688405457884073,
0.011511499993503094,
-0.07801833748817444,
0.08426528424024582,
0.016002435237169266,
-0.008525869809091091,
0.015155195258557796,
0.015060773119330406,
0.004426333587616682,
-0.10196613520383835,
-0.04337863624095917,
0.009535891935229301,
-0.001572932698763907,
0.03650394827127457,
0.01313316822052002,
-0.05132297798991203,
0.0224460382014513,
0.008523188531398773,
-0.0303935669362545,
0.052010178565979004,
0.01724730059504509,
0.011501709930598736,
-0.01563282124698162,
0.03282836824655533,
0.006754196248948574,
-0.0371302105486393,
-0.06899431347846985,
0.04750596359372139,
-0.1109084039926529,
0.06760021299123764,
-0.07348142564296722,
0.006182810291647911,
0.008837993256747723,
-0.020090172067284584,
-0.0124761201441288,
-0.03850890323519707,
0.0670204684138298,
0.06008442863821983,
-0.01129534374922514,
0.03551389276981354,
0.0037129749543964863,
0.009684604592621326,
-0.039080407470464706,
-0.0028910664841532707,
-0.005077913869172335,
0.04495277628302574,
0.07284361124038696,
0.015724830329418182,
0.03418588265776634,
0.0150847677141428,
-0.02035384625196457,
0.020556379109621048,
0.0003290143795311451,
-0.04077117145061493,
0.002914734883233905,
-0.058576568961143494,
0.043510306626558304,
-0.013764746487140656,
-0.008706498891115189,
0.0351288765668869,
-0.008071811869740486,
0.03927990421652794,
0.017993910238146782,
-0.03313721343874931,
0.03820214420557022,
0.00436885841190815,
0.036782681941986084,
0.0047926027327775955,
-0.030524320900440216,
-0.00635250099003315,
0.04141908511519432,
0.0340995229780674,
-0.01654357649385929,
-0.0336468443274498,
0.001828196458518505,
0.022583045065402985,
0.029294094070792198,
-0.007309664040803909,
-0.02119079977273941,
-0.00627820985391736,
0.04444597661495209,
-0.0380924791097641,
0.035165224224328995,
-0.007108416873961687,
-0.009233684279024601,
-0.028131214901804924,
-0.02735540084540844,
-0.04814552143216133,
0.04960768669843674,
0.06480413675308228,
-0.003928476944565773,
-0.012469868175685406,
0.020627779886126518,
0.01424475945532322,
0.009423010051250458,
-0.029419509693980217,
-0.0334913395345211,
0.036374129354953766,
0.02101125568151474,
-0.0094631128013134,
-0.003415376413613558,
-0.01675410196185112,
-0.021994220092892647,
-0.0931745395064354,
-0.010085289366543293,
-0.03656306862831116,
-0.001904522068798542,
0.016291428357362747,
-0.058994874358177185,
-0.036461248993873596,
-0.0046467543579638,
0.0021729054860770702,
0.016933439299464226,
0.0030732990708202124,
0.01139688491821289,
-0.005167896393686533,
-0.0029853263404220343,
-0.05984126403927803,
0.0025213053449988365,
0.028136033564805984,
0.005403418093919754,
0.0067203594371676445,
0.019727056846022606,
-0.004572488367557526,
-0.00806435476988554,
0.016880465671420097,
0.024985624477267265,
0.0011682466138154268,
-0.023294314742088318,
0.018117403611540794,
-0.037391629070043564,
0.06672260910272598,
-0.047365132719278336,
0.06772615760564804,
0.043460309505462646,
0.025070620700716972,
-0.001785133732482791,
0.06038159877061844,
-0.043196506798267365,
-0.017456665635108948,
-0.016347046941518784,
-0.02068108692765236,
0.027271529659628868,
-0.033598192036151886,
0.028135575354099274,
-0.02229953184723854,
-0.02176038548350334,
-0.013705894351005554,
-0.06708309054374695,
-0.0232003852725029,
0.01506783440709114,
-0.05827624350786209,
0.0334634855389595,
0.06141320616006851,
-0.03053463250398636,
-0.00744546577334404,
-0.04092692956328392,
-0.006663253530859947,
-0.058185916393995285,
-0.008593058213591576,
-0.010398805141448975,
0.01350455917418003,
-0.0703006237745285,
-0.0044892048463225365,
0.03254357725381851,
0.03349299728870392,
0.010884477756917477,
0.0029289093799889088,
0.03828554227948189,
0.016513146460056305,
-0.02863471396267414,
-0.03703192248940468,
-0.021233858540654182,
0.09415905922651291,
-0.013870428316295147,
-0.04143340513110161,
0.06475149840116501,
0.011989597231149673,
0.006047440227121115,
0.0010850303806364536,
0.02250732108950615,
-0.0431811548769474,
-0.01217454019933939,
-0.004255183506757021,
0.01276592817157507,
0.03866862878203392,
-0.03481597080826759,
-0.08153686672449112,
0.013065453618764877,
-0.004907678812742233,
0.003390385303646326,
0.060989465564489365,
0.021457359194755554,
0.0233635101467371,
-0.008351626805961132,
-0.061367131769657135,
0.01920311525464058,
-0.0056167724542319775,
-0.008215769194066525,
0.004549726843833923,
0.02342366985976696,
0.012860072776675224,
-0.023179128766059875,
0.07401143014431,
-0.05995185300707817,
0.0425836555659771,
-0.013706236146390438,
-0.012753390707075596,
-0.017555605620145798,
-0.032706908881664276,
0.020825987681746483,
0.027099929749965668,
0.0276592168956995,
0.0339922197163105,
-0.08387956768274307,
-0.009938275441527367,
-0.008136492222547531,
0.06164999306201935,
0.063682921230793,
0.0249530877918005,
-0.009049622341990471,
-0.01373146940022707,
-0.0072955964133143425,
-0.0028668385930359364,
0.01358755026012659,
-0.0035576249938458204,
0.013094118796288967,
-0.02118437923491001,
-0.03672856464982033,
-0.027193449437618256,
-0.029845766723155975,
0.013039832003414631,
-0.0663941279053688,
-0.04069209098815918,
-0.016213251277804375,
-0.08639786392450333,
0.06064736843109131,
0.060954246670007706,
-0.011445811949670315,
-0.05546360835433006,
-0.031023990362882614,
0.034329283982515335,
-0.024761738255620003,
0.018224138766527176,
-0.009584848769009113,
0.02646033465862274,
-0.006325840018689632,
-0.06594227254390717,
0.06000737100839615,
0.027406170964241028,
-0.020328640937805176,
0.05950205773115158,
-0.012761817313730717,
0.0572088323533535,
-0.007593436632305384,
0.010340474545955658,
-0.0718178078532219,
-0.02583955228328705,
0.016498200595378876,
-0.020813599228858948,
-0.01633448339998722,
0.0075422958470880985,
-0.0010854534339159727,
-0.06578930467367172,
-0.014357371255755424,
-0.050159305334091187,
-0.010438679717481136,
0.04695753753185272,
0.10238901525735855,
-0.04024496674537659,
0.06729196757078171,
-0.026631085202097893,
0.02807002142071724,
0.014613812789320946,
-0.01357486192137003,
0.030778445303440094,
-0.007690405938774347,
-0.007372853811830282,
0.0085526118054986,
-0.07138078659772873,
-0.017901595681905746,
-0.0698544904589653,
0.06657978892326355,
-0.005809744354337454,
0.03198999911546707,
-0.01639130525290966,
-0.027141837403178215,
-0.016400961205363274,
-0.1334511786699295,
-0.014162613078951836,
-0.01776915043592453,
-0.009089305996894836,
0.011659837327897549,
0.03681586682796478,
0.027779588475823402,
0.09213920682668686,
0.04091582074761391,
0.004256956744939089,
-0.04264768213033676,
-0.004407907370477915,
0.006042725872248411,
-0.050941530615091324,
-0.07528223097324371,
-0.012561923824250698,
0.038397159427404404,
0.023907862603664398,
0.037832245230674744,
-0.09190104156732559,
0.03543780371546745,
0.0026191656943410635,
-0.031134746968746185,
-0.06199457123875618,
0.003029783256351948,
0.02978019043803215,
0.06279048323631287,
0.029090572148561478,
-0.08198238164186478,
0.004334513563662767,
0.04996462166309357,
-0.06514643132686615,
0.016574347391724586,
0.027041926980018616,
0.02266569435596466,
-0.0007040740456432104,
0.0631924644112587,
-5.926031793085891e-33,
-0.006637066137045622,
-0.04733651131391525,
0.01960325427353382,
-0.036444734781980515,
0.009021108038723469,
0.07060990482568741,
-0.015932846814393997,
-0.052575867623090744,
-0.02225278690457344,
0.01834806054830551,
-0.006686787120997906,
0.008510777726769447,
0.012931828387081623,
0.056307949125766754,
-0.056232769042253494,
0.03370671346783638,
-0.054937440901994705,
-0.03601818159222603,
0.05497254431247711,
-0.08566951751708984,
0.014794478192925453,
0.002779398113489151,
-0.03194098547101021,
-0.01882925070822239,
-0.004662244115024805,
-0.04061354324221611,
0.03919585049152374,
-0.007123191375285387,
0.018847083672881126,
0.013490955345332623,
-0.006929128430783749,
0.004087993875145912,
-0.024546893313527107,
-0.05219078063964844,
0.024294525384902954,
0.04271913319826126,
-0.00653946865350008,
-0.01766437478363514,
-0.04555998370051384,
-0.04384462535381317,
-0.04787418618798256,
0.07820522785186768,
0.05901062488555908,
0.02817687951028347,
0.026595132425427437,
-0.06803518533706665,
0.03937652334570885,
-0.008221081458032131,
-0.03467557951807976,
0.10554270446300507,
-0.02802240662276745,
0.012910518795251846,
0.052910029888153076,
0.05236552655696869,
-0.049703143537044525,
-0.01924019493162632,
-0.009330698288977146,
-0.011373929679393768,
0.041301827877759933,
0.01415929850190878,
-0.009705965407192707,
0.01610611565411091,
0.03133021295070648,
0.01382779236882925,
0.03983151167631149,
-0.028046369552612305,
0.022614236921072006,
0.03893395513296127,
-0.08895311504602432,
-0.002399466000497341,
-0.024149863049387932,
-0.034157875925302505,
-0.00880135502666235,
0.011702255345880985,
0.003384104697033763,
-0.010829489678144455,
-0.031651776283979416,
-0.0051360041834414005,
0.04759180545806885,
0.027878012508153915,
-0.03380030393600464,
0.00433805026113987,
-0.015732407569885254,
0.006707036402076483,
-0.04246196150779724,
0.06730417907238007,
0.0017903263214975595,
-0.03249620273709297,
0.00883325282484293,
-0.029031286016106606,
0.03894134983420372,
0.03406393155455589,
0.012844815850257874,
0.02751975692808628,
-0.11030994355678558,
0.007576273754239082,
0.07876546680927277,
0.007551946677267551,
-0.008191965520381927,
-0.02186664752662182,
0.057910364121198654,
0.05250466242432594,
0.02768091857433319,
-0.01496668066829443,
-0.014055382460355759,
0.002933151787146926,
-0.021098626777529716,
-0.011717602610588074,
-0.07306624948978424,
-0.012480814941227436,
-0.003185776760801673,
-0.009976841509342194,
0.06320013105869293,
0.044365715235471725,
-0.057513296604156494,
0.008108672685921192,
0.01718197576701641,
-0.004696888383477926,
0.01734194904565811,
-0.003500839229673147,
0.005237808916717768,
-0.01877916418015957,
-0.037848636507987976,
-0.01690555177628994,
-0.012817855924367905,
-0.012487196363508701,
0.008662696927785873,
-0.00610607024282217,
-0.06246444582939148,
0.016872409731149673,
0.020849192515015602,
-0.041949111968278885,
2.424259832878306e-7,
0.004687828477472067,
-0.023986313492059708,
-0.015066089108586311,
0.019909055903553963,
0.02301890030503273,
-0.07270537316799164,
-0.020891601219773293,
0.04975943639874458,
0.07953793555498123,
-0.01779453083872795,
0.04030122607946396,
0.0592770017683506,
-0.040342409163713455,
0.010407832451164722,
0.0011120786657556891,
0.06509611755609512,
0.041655078530311584,
0.0702730193734169,
0.03187636286020279,
0.05032045766711235,
0.007407308090478182,
0.019579222425818443,
-0.0029477791395038366,
0.030076216906309128,
0.0233205184340477,
-0.0031530780252069235,
-0.057622719556093216,
-0.01901063323020935,
-0.0012188497930765152,
-0.004266990814357996,
-0.05861340090632439,
-0.003091308055445552,
0.03056998737156391,
0.06517868489027023,
-0.007296175695955753,
0.0020593691151589155,
-0.020237997174263,
0.006167974788695574,
-0.009365841746330261,
0.0436396487057209,
0.041253820061683655,
0.00994255393743515,
0.030014121904969215,
0.033031657338142395,
-0.02589903399348259,
0.061189211905002594,
0.0012258546194061637,
0.008486385457217693,
-0.03826913982629776,
-0.06010621041059494,
0.03269887715578079,
-0.005817059427499771,
0.01406770572066307,
0.0166498813778162,
-0.03616253286600113,
-0.0026596798561513424,
-0.026172760874032974,
-0.05119000002741814,
0.023840149864554405,
0.0057415422052145,
-0.019546836614608765,
-0.030541792511940002,
0.0360754132270813,
0.04623378813266754,
0.0080164959654212,
0.05008448287844658,
0.008726577274501324,
1.2475839525682384e-34,
-0.04274028539657593,
0.03073076717555523,
-0.03816618025302887,
-0.04120877757668495,
0.045212678611278534,
0.015013240277767181,
0.022257274016737938,
-0.03886880725622177,
0.05915563553571701,
0.01604970544576645,
-0.019643336534500122
] | {
"ds_index": 92,
"similar_dg_indices": [
407359,
450815,
755920,
584947,
718614,
627665,
1017485,
159433,
863041,
11711,
1116376,
711212,
574325,
104217,
805499,
567145,
1198535,
388084,
284014,
359346
]
} |
A 45-year-old man is transferred to the intensive care unit from the emergency department for acute respiratory failure. He was rushed to the hospital after developing progressive respiratory distress over the last 24 hours. His medical history is significant for long-standing severe persistent asthma, hypertension, and several bouts of community and hospital-acquired pneumonia. His medications include amlodipine, lisinopril, inhaled fluticasone, salmeterol, and oral prednisone. He is a lifelong non-smoker and drinks alcohol occasionally on the weekends. He works as a sales executive and went to Hawaii a month ago. In the emergency department, he was started on broad-spectrum antibiotics and bronchodilators. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilator support. Chest X-ray shows multiple nodules bilaterally in the lower lobes. Flexible bronchoscopy is performed and the bronchoalveolar lavage sample from the medial segment of the right lower lobe shows neutrophils, and the fungal preparation shows Aspergillus fumigatus. A video-assisted thoracoscopy is performed and biopsy from the right lower lobe is taken which shows plugging of the terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. Which of the following is the most likely mechanism responsible for the biopsy findings? | Defects in the immune response | {
"A": "Defects in the immune response",
"B": "Aspergillus fumigatus suppresses the production of IgA",
"C": "Aspergillus fumigatus suppresses the production of IgM",
"D": "Suppression of the innate immune system by Aspergillus fumigatus"
} | step1 | A | [
"year old man",
"transferred",
"intensive care unit",
"emergency department",
"acute respiratory failure",
"rushed",
"hospital",
"progressive respiratory distress",
"24 hours",
"medical history",
"significant",
"long standing severe persistent asthma",
"hypertension",
"several bouts",
"community",
"hospital-acquired pneumonia",
"medications include amlodipine",
"lisinopril",
"inhaled fluticasone",
"salmeterol",
"oral prednisone",
"lifelong non-smoker",
"drinks alcohol occasionally",
"weekends",
"works",
"sales executive",
"to Hawaii",
"month",
"emergency department",
"started",
"broad spectrum antibiotics",
"bronchodilators",
"respiratory failure",
"worsens",
"day 2",
"admission",
"mechanical ventilator support",
"Chest X-ray shows multiple nodules",
"lower lobes",
"Flexible bronchoscopy",
"performed",
"bronchoalveolar lavage sample",
"medial segment",
"right lower lobe shows neutrophils",
"fungal preparation shows Aspergillus fumigatus",
"video-assisted thoracoscopy",
"performed",
"biopsy",
"right lower lobe",
"taken",
"shows plugging",
"terminal bronchioles",
"mucus",
"inflammatory cells",
"fungal vascular invasion",
"following",
"most likely mechanism responsible",
"biopsy findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 45-year-old man is transferred to the intensive care unit from the emergency department for acute respiratory failure. He was rushed to the hospital after developing progressive respiratory distress over the last 24 hours. His medical history is significant for long-standing severe persistent asthma, hypertension, and several bouts of community and hospital-acquired pneumonia. His medications include amlodipine, lisinopril, inhaled fluticasone, salmeterol, and oral prednisone. He is a lifelong non-smoker and drinks alcohol occasionally on the weekends. He works as a sales executive and went to Hawaii a month ago. In the emergency department, he was started on broad-spectrum antibiotics and bronchodilators. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilator support. Chest X-ray shows multiple nodules bilaterally in the lower lobes. Flexible bronchoscopy is performed and the bronchoalveolar lavage sample from the medial segment of the right lower lobe shows neutrophils, and the fungal preparation shows Aspergillus fumigatus. A video-assisted thoracoscopy is performed and biopsy from the right lower lobe is taken which shows plugging of the terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. Which of the following is the most likely mechanism responsible for the biopsy findings?
Choose one of the following::
A. Defects in the immune response
B. Aspergillus fumigatus suppresses the production of IgA
C. Aspergillus fumigatus suppresses the production of IgM
D. Suppression of the innate immune system by Aspergillus fumigatus | [
0.006078534293919802,
-0.015124169178307056,
0.024605121463537216,
-0.014243506826460361,
0.008561198599636555,
-0.005756603088229895,
0.008639667183160782,
0.028914673253893852,
-0.025995535776019096,
-0.017881253734230995,
0.006428949534893036,
-0.014209726825356483,
0.0136442631483078,
0.017496421933174133,
0.021904122084379196,
0.0634242594242096,
0.005599792581051588,
-0.00554050225764513,
-0.06629440188407898,
-0.0018834916409105062,
-0.029419170692563057,
0.039045996963977814,
0.04264772683382034,
0.022213494405150414,
0.04331832751631737,
0.005226218141615391,
-0.02676083892583847,
-0.04362007603049278,
0.023438839241862297,
0.030525751411914825,
0.010648524388670921,
-0.05972636118531227,
-0.026888910681009293,
-0.040520016103982925,
0.000002183245442211046,
0.01987493596971035,
-0.026562580838799477,
0.0014717356534674764,
-0.0015489105135202408,
-0.05489806458353996,
-0.01684551127254963,
-0.0024076763074845076,
0.033771708607673645,
0.009831606410443783,
-0.0767679437994957,
-0.06636445224285126,
0.0024014192167669535,
0.07684189081192017,
-0.014842943288385868,
0.015768645331263542,
-0.003763927612453699,
0.008704063482582569,
-0.08218640089035034,
-0.013773544691503048,
-0.003988420125097036,
0.002324657514691353,
0.009734278544783592,
-0.05545329302549362,
0.04902752488851547,
-0.03479969874024391,
-0.004365299362689257,
0.00045914240763522685,
0.028967931866645813,
-0.01658717542886734,
0.02251398377120495,
0.03632904961705208,
0.0620226189494133,
-0.03907221928238869,
0.046231064945459366,
0.01306542195379734,
-0.039922844618558884,
0.0010656459489837289,
0.0058690933510661125,
-0.0002048986207228154,
-0.04343686252832413,
0.05723324045538902,
0.049089495092630386,
-0.0073295230977237225,
-0.0036031112540513277,
0.0331469401717186,
0.09361937642097473,
0.026546290144324303,
-0.0064279246143996716,
0.01931685581803322,
0.012246469967067242,
-0.06522124260663986,
-0.04734007269144058,
0.0010115872137248516,
0.010270081460475922,
-0.03847586363554001,
0.004950816743075848,
-0.08149034529924393,
0.01051460113376379,
0.045166097581386566,
-0.06110260263085365,
0.0034830966033041477,
0.057367563247680664,
0.056548912078142166,
0.05161606892943382,
-0.032763611525297165,
-0.030068885535001755,
-0.055679842829704285,
-0.005744533147662878,
0.021058235317468643,
-0.026784975081682205,
-0.014078449457883835,
-0.0429275818169117,
-0.026332302019000053,
0.01586202159523964,
0.029428819194436073,
0.04082925245165825,
0.008097678422927856,
0.010581931099295616,
0.032605648040771484,
0.016842519864439964,
-0.023576265200972557,
-0.03998515382409096,
-0.05573749542236328,
-0.0024588170927017927,
0.04941563680768013,
0.04749085009098053,
-0.029788311570882797,
-0.06406697630882263,
0.07867933064699173,
0.021634772419929504,
0.03454618528485298,
0.01431167870759964,
-0.010640589520335197,
-0.030330270528793335,
0.056308064609766006,
-0.004845861345529556,
0.013298633508384228,
0.009406753815710545,
0.014587467536330223,
0.012238303199410439,
0.006945876870304346,
-0.0018520429730415344,
0.03715777397155762,
0.032000668346881866,
0.0376373790204525,
0.01381438598036766,
-0.003957679495215416,
-0.01844644546508789,
0.03186280280351639,
0.010013888590037823,
0.006553398910909891,
0.020682958886027336,
0.025581317022442818,
0.016976850107312202,
0.008614115417003632,
-0.0797213464975357,
-0.03549978882074356,
-0.04788246378302574,
-0.00595687422901392,
-0.03919629007577896,
-0.00514876889064908,
-0.0032933680340647697,
-0.04882961884140968,
-0.040552012622356415,
-0.044570937752723694,
0.006840886548161507,
-0.029623378068208694,
0.04747147485613823,
-0.035402361303567886,
-0.0160922072827816,
0.012966102920472622,
0.08331026881933212,
0.019435448572039604,
-0.08084939420223236,
0.011086784303188324,
-0.02299400046467781,
0.06092248857021332,
0.001997641520574689,
-0.009492284618318081,
-0.05567925423383713,
0.019496291875839233,
-0.03374825417995453,
-0.08431690186262131,
-0.02265636809170246,
0.02636147104203701,
-0.015963582322001457,
0.04868410900235176,
0.0328821986913681,
-0.03054198995232582,
0.023196041584014893,
0.014026674441993237,
0.06047593802213669,
-0.01819482073187828,
0.035822056233882904,
-0.06382229924201965,
0.009686119854450226,
0.012833327986299992,
-0.040225427597761154,
0.025557400658726692,
-0.026807624846696854,
0.028124205768108368,
-0.01687532849609852,
-0.017496639862656593,
-0.002112774411216378,
0.0047394223511219025,
-0.006971246562898159,
-0.02442057617008686,
-0.003031462663784623,
0.03857806697487831,
-0.01965188980102539,
0.06266152113676071,
-0.06529274582862854,
-0.04854496940970421,
-0.0798841118812561,
-0.017820408567786217,
-0.07896111905574799,
-0.014983616769313812,
0.0437806211411953,
-0.03692224994301796,
0.0016127342823892832,
0.018795054405927658,
-0.029234476387500763,
0.017040397971868515,
-0.022973939776420593,
-0.034719303250312805,
-0.01829472742974758,
-0.012859775684773922,
0.03924424201250076,
0.02123921737074852,
-0.030464816838502884,
0.004832953214645386,
0.002689097775146365,
0.005987141281366348,
0.013482571579515934,
-0.06693625450134277,
0.029608655720949173,
-0.03326214477419853,
0.03507918491959572,
-0.0020056082867085934,
-0.055922966450452805,
0.09039419889450073,
0.006323658861219883,
0.01723509654402733,
0.005891127977520227,
0.08323311060667038,
-0.036591872572898865,
-0.007622134406119585,
-0.061599284410476685,
-0.03944060951471329,
-0.0208912156522274,
-0.003181939944624901,
-0.029906250536441803,
0.025387737900018692,
-0.04339005425572395,
0.07490026205778122,
-0.018555715680122375,
-0.0014909550081938505,
0.0005469323950819671,
0.02266096882522106,
-0.0048158676363527775,
0.039862871170043945,
-0.049509916454553604,
0.027203626930713654,
0.01954023912549019,
-0.030588915571570396,
0.027001164853572845,
-0.01841895282268524,
0.0019987064879387617,
0.009823357686400414,
-0.029360219836235046,
0.0018939313013106585,
0.043344978243112564,
-0.041002944111824036,
-0.017046412453055382,
0.016925757750868797,
-0.039690371602773666,
0.01179884746670723,
0.006156190764158964,
-0.002008179435506463,
-0.0546080619096756,
0.0015497570857405663,
-0.01960367150604725,
0.04957803338766098,
-0.012472772970795631,
0.014313135296106339,
0.0015371065819635987,
-0.012520345859229565,
-0.025607390329241753,
0.050719767808914185,
-0.01912088505923748,
0.007487107068300247,
-0.011383534409105778,
-0.01831085793673992,
0.011799161322414875,
0.023622162640094757,
-0.019286256283521652,
0.0028309873305261135,
-0.017144422978162766,
-0.003049804363399744,
-0.017085228115320206,
-0.0698237344622612,
-0.005571421701461077,
-0.002799641340970993,
-0.021856192499399185,
0.10832422226667404,
-0.011562640778720379,
0.05463865026831627,
-0.04531809315085411,
0.01511972863227129,
-0.006901173386722803,
0.02946827933192253,
0.0065058316104114056,
-0.01220506802201271,
-0.048897527158260345,
0.024503886699676514,
0.013333831913769245,
-0.01070401817560196,
-0.0015373935457319021,
0.05574293062090874,
-0.04559860751032829,
0.016088152304291725,
-0.0075311968103051186,
-0.08417701721191406,
0.04390329867601395,
0.0016271843342110515,
0.01029285229742527,
0.00383371370844543,
-0.012590330094099045,
-0.03647652640938759,
-0.013691849075257778,
-0.05209580063819885,
-0.0011109438491985202,
-0.003415459766983986,
0.029732100665569305,
0.03653498366475105,
0.02443983033299446,
0.026754681020975113,
0.007325123064219952,
0.005885146092623472,
0.026470864191651344,
0.053442154079675674,
-0.021827908232808113,
0.006851333659142256,
-0.04252643883228302,
0.07691797614097595,
0.0491667315363884,
-0.05284997820854187,
0.005885204300284386,
0.024818703532218933,
-0.0016145659610629082,
0.00551681499928236,
-0.05238515883684158,
0.015447353944182396,
0.012346568517386913,
0.02145632542669773,
-0.04159793257713318,
-0.005387213081121445,
0.0281990934163332,
-0.031218720600008965,
-0.020099373534321785,
0.004184773191809654,
0.08169834315776825,
0.04103789106011391,
-0.02497784048318863,
0.04731263592839241,
-0.012039430439472198,
0.04086527228355408,
-0.0005199023871682584,
0.027146918699145317,
0.009903904050588608,
-0.049139250069856644,
0.0030534453690052032,
0.0018384435679763556,
-0.01672217808663845,
-0.029891647398471832,
0.09390705078840256,
-0.02957499772310257,
-0.04516042396426201,
0.018149105831980705,
-0.014336355030536652,
0.1115986555814743,
-0.009036951698362827,
-0.010379167273640633,
-0.07637928426265717,
-0.04663445055484772,
0.03978797048330307,
-0.024333802983164787,
0.008456551469862461,
-0.012995925731956959,
-0.019870292395353317,
0.05584970489144325,
0.008028765209019184,
0.013146966695785522,
0.025652403011918068,
0.04150088503956795,
0.0018044471507892013,
-0.010778296738862991,
0.01350746862590313,
-0.09772656857967377,
-0.026532363146543503,
-0.019510924816131592,
0.032439135015010834,
-0.09040677547454834,
0.08007058501243591,
0.07822710275650024,
0.002435927977785468,
0.07944588363170624,
-0.030345022678375244,
0.01894586905837059,
0.04695392772555351,
0.008233750239014626,
-0.058106135576963425,
-0.008879725821316242,
0.0030724501702934504,
0.055841825902462006,
0.06751670688390732,
-0.016610024496912956,
0.04969240352511406,
0.017338624224066734,
-0.008365077897906303,
-0.024585813283920288,
0.004709142260253429,
-0.04444452375173569,
-0.031795911490917206,
-0.05253463611006737,
-0.0025161795783787966,
-0.05802279710769653,
-0.014125163666903973,
-0.05076918378472328,
-0.03852781653404236,
-0.010967264883220196,
0.06563758105039597,
-0.003428563941270113,
0.04076298698782921,
0.02165759541094303,
0.021621087566018105,
-0.0460418164730072,
0.008465423248708248,
0.06678427755832672,
-0.04802456870675087,
0.022933917120099068,
-0.023164819926023483,
0.014536207541823387,
0.017576202750205994,
-0.03702352195978165,
-0.034529924392700195,
-0.021848151460289955,
0.007367183454334736,
0.04978609085083008,
0.07375513017177582,
-0.009968223050236702,
-0.006095340009778738,
-0.012473762966692448,
-0.005009879823774099,
0.08040999621152878,
0.048316072672605515,
-0.0011411202140152454,
-0.008448636159300804,
0.029182998463511467,
0.03297016769647598,
0.0071269916370511055,
0.019827047362923622,
0.008284362964332104,
-0.011250659823417664,
-0.007523136213421822,
-0.021536892279982567,
0.01318400725722313,
-0.007306037470698357,
-0.01210053451359272,
0.0002160615404136479,
0.027177607640624046,
-0.011133143678307533,
-0.0028745229355990887,
-0.008862319402396679,
0.007002673577517271,
-0.01696244813501835,
0.029237497597932816,
-0.024151263758540154,
-0.04184819012880325,
0.03531002998352051,
-0.018313361331820488,
0.022211235016584396,
-0.019375480711460114,
0.05221083015203476,
0.019686860963702202,
0.014855054207146168,
-0.008160988800227642,
-0.09424325078725815,
-0.03965725377202034,
-0.022041283547878265,
-0.01882266439497471,
0.08560968935489655,
0.00705278106033802,
-0.013306086882948875,
0.009318564087152481,
0.034069452434778214,
0.02692025899887085,
-0.003065499709919095,
0.033626146614551544,
-0.01988271065056324,
0.018653826788067818,
0.03959501534700394,
0.03993377462029457,
-0.011009963229298592,
0.019796621054410934,
0.05621751397848129,
-0.0007358664879575372,
0.06516394764184952,
-0.018877051770687103,
0.06275341659784317,
0.029132744297385216,
0.0379115529358387,
0.013804270885884762,
0.004906149581074715,
-0.019402429461479187,
0.015151103027164936,
-0.008232983760535717,
-0.030884359031915665,
0.03553800284862518,
0.011396723799407482,
-0.03597037494182587,
-0.020632673054933548,
-0.04565589874982834,
-0.003341727191582322,
-0.007658254820853472,
0.025714576244354248,
-0.02647983469069004,
0.02639840357005596,
-0.03041914664208889,
0.08252403140068054,
0.038777247071266174,
0.012098238803446293,
-0.00449484633281827,
0.014272810891270638,
0.05359574779868126,
-0.049333345144987106,
-0.004713280592113733,
-0.06344196200370789,
0.06257449835538864,
-0.01612864062190056,
-0.03786920756101608,
-0.05396242439746857,
0.07453041523694992,
-0.004008961375802755,
-0.022727899253368378,
0.015036650002002716,
0.024890264496207237,
0.017600974068045616,
-0.0383700467646122,
0.035890914499759674,
-0.008803003467619419,
-0.07381168752908707,
-0.027505753561854362,
0.026088690385222435,
0.01029319316148758,
-0.0253940150141716,
0.10265886038541794,
0.04563436657190323,
0.07518859952688217,
0.012193371541798115,
-5.54730734971812e-33,
0.02906022034585476,
-0.08198187500238419,
0.03592986986041069,
0.02438279241323471,
0.017297130078077316,
0.056777793914079666,
-0.010951196774840355,
-0.060677092522382736,
-0.07738303393125534,
-0.03106260858476162,
-0.006339685991406441,
-0.027317095547914505,
0.01160342525690794,
0.03381601348519325,
-0.017824191600084305,
-0.03943193331360817,
0.0003388097102288157,
0.01944444328546524,
-0.07860802859067917,
-0.011170473881065845,
-0.019336719065904617,
-0.015597979538142681,
-0.036974526941776276,
-0.09095881879329681,
-0.033217769116163254,
-0.0071895611472427845,
0.07693848758935928,
-0.015449171885848045,
-0.03127235174179077,
0.03280327096581459,
0.024266526103019714,
-0.0276044812053442,
0.01632891781628132,
-0.04891093075275421,
0.0021566483192145824,
-0.05574348196387291,
-0.017222143709659576,
-0.0002710326516535133,
0.055164482444524765,
0.026248613372445107,
-0.04005299508571625,
-0.023754503577947617,
0.003412264632061124,
0.045309487730264664,
0.0584188848733902,
-0.03936748951673508,
0.011036036536097527,
-0.007897110655903816,
-0.001684796530753374,
0.013090924359858036,
0.007391145918518305,
0.0467667430639267,
0.04173853620886803,
0.019389331340789795,
-0.0359148234128952,
0.02170066349208355,
0.01664850488305092,
0.039106182754039764,
-0.011193348094820976,
0.015028494410216808,
0.00273984600789845,
0.020521843805909157,
0.04922041296958923,
-0.029865793883800507,
-0.05184835195541382,
0.007487133145332336,
0.08615612983703613,
-0.023910176008939743,
-0.08079460263252258,
-0.03959321230649948,
-0.07188168168067932,
-0.0027812307234853506,
-0.03152747452259064,
-0.015131078660488129,
-0.014772930182516575,
0.04412730038166046,
0.04878715053200722,
0.008221220225095749,
-0.0222424678504467,
0.020332559943199158,
-0.0029415148310363293,
-0.0014190507354214787,
-0.004985854960978031,
-0.02573496289551258,
-0.03201305493712425,
0.024245144799351692,
0.011493590660393238,
0.029282880946993828,
0.03338653966784477,
-0.005689308512955904,
0.04395775869488716,
-0.0005891044856980443,
0.007206824142485857,
-0.0017872415482997894,
-0.013457330875098705,
-0.0472179539501667,
0.09102129191160202,
0.010167045518755913,
-0.013907265849411488,
-0.0041336845606565475,
0.03838254138827324,
-0.003930526785552502,
-0.00594779197126627,
-0.04757186770439148,
-0.006839278154075146,
-0.006650493945926428,
0.02852102927863598,
0.020566800609230995,
-0.016750166192650795,
0.010887295007705688,
0.01025548204779625,
0.00015167811943683773,
-0.018941326066851616,
0.02969854138791561,
0.002576530911028385,
0.03836989775300026,
-0.013565457426011562,
0.0010978459613397717,
0.05002578720450401,
0.0384272038936615,
0.012664434500038624,
-0.05738544836640358,
0.011801185086369514,
-0.026458801701664925,
-0.07805716246366501,
-0.010163385421037674,
0.019315971061587334,
0.04063820093870163,
-0.02158469706773758,
-0.041286028921604156,
0.015244532376527786,
0.004337103106081486,
3.1925480925565353e-7,
0.07650002092123032,
-0.03603602945804596,
-0.022018421441316605,
-0.04617339372634888,
0.009123418480157852,
-0.023066841065883636,
-0.04841722920536995,
-0.0568876788020134,
0.003914515022188425,
0.02808186411857605,
-0.009882203303277493,
0.0061951023526489735,
-0.024530908092856407,
-0.022875141352415085,
0.0015194435836747289,
-0.06252045184373856,
0.0443420447409153,
-0.009138358756899834,
-0.01030766498297453,
0.03889486566185951,
0.024642130360007286,
0.012135762721300125,
-0.06156938150525093,
0.017499463632702827,
0.02736535295844078,
-0.025591189041733742,
-0.03289417549967766,
-0.07491271942853928,
-0.016744522377848625,
-0.03948047384619713,
-0.025387417525053024,
-0.01991811767220497,
0.03096916899085045,
0.03902140259742737,
-0.013224934227764606,
0.029088428243994713,
0.013520254753530025,
0.017691021785140038,
-0.011874807067215443,
-0.053864408284425735,
-0.0303183700889349,
-0.0004977897042408586,
0.02653764933347702,
0.010429486632347107,
-0.0486486554145813,
0.03594056889414787,
-0.03453338146209717,
0.01178860291838646,
-0.0047557116486132145,
0.08210588246583939,
0.004270180594176054,
0.015369265340268612,
-0.03510467708110809,
0.0480872243642807,
0.003664815565571189,
0.0326826311647892,
-0.06462426483631134,
-0.03411995992064476,
-0.00763687863945961,
-0.05533575639128685,
0.002705319318920374,
-0.051744747906923294,
0.02434392087161541,
-0.10514802485704422,
-0.05232852324843407,
0.01231544278562069,
-0.08028706163167953,
2.4754044471857964e-34,
-0.0017958451062440872,
-0.07118714600801468,
-0.013765513896942139,
-0.0028050639666616917,
0.003098167944699526,
-0.061630845069885254,
-0.03600236028432846,
0.06423869729042053,
0.003464530222117901,
-0.0036272637080401182,
-0.03294053673744202
] | {
"ds_index": 93,
"similar_dg_indices": [
27770,
1196543,
472353,
48805,
583558,
327873,
688652,
846489,
570962,
1150220,
667876,
1201399,
432492,
249516,
540182,
1125929,
1122418,
364113,
1040857,
233466
]
} |
A 70-year-old man comes to the physician because of a 4-month history of epigastric pain, nausea, and weakness. He has smoked one pack of cigarettes daily for 50 years and drinks one alcoholic beverage daily. He appears emaciated. He is 175 cm (5 ft 9 in) tall and weighs 47 kg (103 lb); BMI is 15 kg/m2. He is diagnosed with gastric cancer. Which of the following cytokines is the most likely direct cause of this patient’s examination findings? | IL-6 | {
"A": "TGF-β",
"B": "IL-6",
"C": "IL-2",
"D": "TNF-β"
} | step1 | B | [
"70 year old man",
"physician",
"4 month history",
"epigastric pain",
"nausea",
"weakness",
"smoked one pack",
"cigarettes daily",
"50 years",
"drinks one alcoholic beverage daily",
"appears emaciated",
"5 ft 9",
"tall",
"kg",
"BMI",
"kg/m2",
"diagnosed",
"gastric cancer",
"following cytokines",
"most likely direct cause of",
"patients examination findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 70-year-old man comes to the physician because of a 4-month history of epigastric pain, nausea, and weakness. He has smoked one pack of cigarettes daily for 50 years and drinks one alcoholic beverage daily. He appears emaciated. He is 175 cm (5 ft 9 in) tall and weighs 47 kg (103 lb); BMI is 15 kg/m2. He is diagnosed with gastric cancer. Which of the following cytokines is the most likely direct cause of this patient’s examination findings?
Choose one of the following::
A. TGF-β
B. IL-6
C. IL-2
D. TNF-β | [
0.032804250717163086,
-0.004868833348155022,
0.04552391171455383,
-0.0050661563873291016,
-0.006671234965324402,
0.039685554802417755,
-0.005553041584789753,
0.05165230482816696,
0.07265269756317139,
-0.051448579877614975,
0.0037843084428459406,
0.061517857015132904,
-0.02709588222205639,
-0.045233938843011856,
-0.0013068869011476636,
0.04266108199954033,
-0.014692258089780807,
-0.018419746309518814,
0.022492041811347008,
0.003516858210787177,
-0.028047772124409676,
0.03673414885997772,
0.0124146593734622,
0.016587819904088974,
-0.01902853325009346,
-0.0012611288111656904,
0.017615392804145813,
-0.0934385359287262,
-0.04126324504613876,
-0.014280666597187519,
-0.02802504599094391,
-0.04090870916843414,
-0.063649021089077,
-0.01920691505074501,
0.000002020076180997421,
-0.027737189084291458,
-0.02805861458182335,
-0.02129525877535343,
0.035369839519262314,
-0.033820558339357376,
0.04924137890338898,
0.018234310671687126,
0.024290896952152252,
0.008228825405240059,
-0.028916306793689728,
-0.0970718115568161,
-0.035687901079654694,
0.046462032943964005,
0.04204975441098213,
0.0557575449347496,
0.0053099775686860085,
-0.012249041348695755,
-0.05421208590269089,
-0.01232490036636591,
0.04529673978686333,
0.022237565368413925,
0.02743874117732048,
-0.05324048176407814,
-0.0021427220199257135,
-0.019242625683546066,
0.05378168076276779,
0.000530045130290091,
0.010232620872557163,
-0.02525779977440834,
-0.05148250237107277,
0.029826024547219276,
-0.0050088283605873585,
-0.018570318818092346,
0.06888987123966217,
-0.03576424717903137,
-0.002894472563639283,
0.0010027698008343577,
0.03304901346564293,
0.02522755041718483,
0.004566911142319441,
0.015356836840510368,
0.06603510677814484,
-0.04188479855656624,
-0.005943095777183771,
-0.014004197902977467,
0.032553527504205704,
0.04329661279916763,
-0.0023316824808716774,
-0.0021215593442320824,
-0.015764746814966202,
-0.0432237833738327,
-0.006748490035533905,
-0.00666038179770112,
-0.035500891506671906,
-0.014323529787361622,
-0.0046357763931155205,
-0.01769428513944149,
0.008411510847508907,
0.046577949076890945,
-0.047965627163648605,
0.003032037988305092,
0.01815560832619667,
0.016742467880249023,
0.05170942842960358,
-0.06036755442619324,
-0.13050493597984314,
-0.04541362449526787,
0.05125827342271805,
0.04837516322731972,
-0.051422033458948135,
-0.02430688962340355,
-0.01913987286388874,
0.03440774232149124,
-0.08735374361276627,
0.024392815306782722,
-0.014888589270412922,
-0.03116307035088539,
-0.12132066488265991,
0.06857504695653915,
0.08001221716403961,
-0.009661060757935047,
-0.06889568269252777,
-0.001535140909254551,
0.018747501075267792,
0.03465425223112106,
0.07586061209440231,
0.01696247048676014,
-0.008388461545109749,
0.04841848462820053,
0.010458752512931824,
-0.0013092417502775788,
-0.006109466310590506,
0.01460802648216486,
0.022022118791937828,
-0.050148189067840576,
0.04108384996652603,
-0.02165735512971878,
0.01135658286511898,
-0.030043592676520348,
0.022828049957752228,
0.017431121319532394,
0.013613438233733177,
0.05422015115618706,
-0.038783807307481766,
-0.004896343685686588,
-0.04837479069828987,
-0.02513847127556801,
-0.0021849002223461866,
0.01859295554459095,
-0.006324262358248234,
0.01783154159784317,
-0.0024571800604462624,
0.042236994951963425,
0.0020946073345839977,
0.027232423424720764,
-0.022782474756240845,
-0.019212840124964714,
0.03649340569972992,
0.02115030214190483,
0.020732875913381577,
-0.010094977915287018,
0.019593654200434685,
-0.01615232788026333,
0.022172730416059494,
-0.03615910932421684,
0.027641113847494125,
-0.05072087049484253,
0.012234481982886791,
-0.007543033920228481,
-0.013672864064574242,
0.03063184581696987,
0.04345325380563736,
0.009712014347314835,
-0.015261420980095863,
0.07284043729305267,
-0.03827362507581711,
0.04223432391881943,
0.0028830834198743105,
-0.007468646392226219,
-0.0063874670304358006,
-0.005935063119977713,
0.018759021535515785,
0.019374655559659004,
-0.015740755945444107,
-0.005796216893941164,
0.00156921346206218,
0.04541274160146713,
0.015434086322784424,
-0.033754002302885056,
0.02392449602484703,
-0.004884442314505577,
0.061196401715278625,
-0.015950482338666916,
0.01310324389487505,
-0.030156446620821953,
0.04899873211979866,
0.06418929994106293,
0.0015998055459931493,
-0.032074350863695145,
-0.009864182211458683,
0.04321233555674553,
-0.08582498133182526,
-0.07072828710079193,
0.01149022951722145,
-0.03736886382102966,
-0.0212470181286335,
-0.019556507468223572,
0.015646180137991905,
-0.01684470660984516,
0.0004033530130982399,
0.06372034549713135,
0.005856924224644899,
-0.012607758864760399,
0.01922190934419632,
-0.03755826875567436,
0.0028502822387963533,
-0.026730375364422798,
0.02604679949581623,
0.017213139683008194,
0.01624048314988613,
0.0053748139180243015,
0.03411782532930374,
-0.036612946540117264,
-0.03224576264619827,
0.0047988551668822765,
-0.03805398941040039,
-0.03894424065947533,
0.023480307310819626,
0.010829045437276363,
0.1013796478509903,
-0.08978600054979324,
-0.022418219596147537,
-0.006760552059859037,
-0.006712005008012056,
-0.06503233313560486,
0.033142685890197754,
0.05791264772415161,
-0.05206990987062454,
0.006088375113904476,
-0.010257303714752197,
0.04860871285200119,
0.019955074414610863,
-0.061835505068302155,
-0.027239151298999786,
0.035321686416864395,
-0.05103273689746857,
-0.017826566472649574,
-0.08778341859579086,
-0.006905455142259598,
-0.008190607652068138,
-0.0053319246508181095,
-0.03996508568525314,
0.029933800920844078,
-0.07896044850349426,
0.06585336476564407,
-0.05498502403497696,
0.021058058366179466,
0.04006873443722725,
0.009372558444738388,
0.024616800248622894,
0.02535083144903183,
-0.024713119491934776,
0.013759576715528965,
-0.011090603657066822,
-0.04859238490462303,
-0.005675069987773895,
0.013383420184254646,
-0.032791413366794586,
-0.011044880375266075,
-0.039340659976005554,
-0.023022901266813278,
-0.018387241289019585,
-0.046184785664081573,
-0.040146224200725555,
0.00785812921822071,
-0.021693339571356773,
-0.004331513773649931,
0.0010710939532145858,
0.025033341720700264,
-0.021456778049468994,
-0.06376475840806961,
-0.0036568883806467056,
0.02251543290913105,
0.025079743936657906,
-0.004384336527436972,
-0.014708766713738441,
0.032100848853588104,
-0.00019330473151057959,
0.041522394865751266,
0.021285852417349815,
-0.004922742489725351,
0.05848482996225357,
-0.015900788828730583,
0.09193091839551926,
-0.03101179748773575,
0.03243512287735939,
0.011495794169604778,
0.04503180459141731,
-0.05342346429824829,
-0.023116640746593475,
-0.04664050415158272,
-0.08710163831710815,
0.0533452071249485,
0.02051391638815403,
-0.006238746922463179,
-0.03261181339621544,
-0.0071238260716199875,
-0.0313173346221447,
0.02707543596625328,
-0.024229612201452255,
-0.02743605710566044,
0.011996066197752953,
-0.0115452129393816,
0.011696262285113335,
0.05232375115156174,
0.04039215296506882,
0.015340667217969894,
-0.047604095190763474,
0.014795124530792236,
-0.056454066187143326,
0.0004021736385766417,
-0.026646947488188744,
-0.008421827107667923,
0.021436741575598717,
-0.08534956723451614,
0.02753015048801899,
0.0018868085462599993,
0.003938905894756317,
-0.05335583910346031,
-0.0098860003054142,
0.0037738182581961155,
0.06265942007303238,
0.04572659730911255,
0.012643123045563698,
0.023852379992604256,
0.013696664944291115,
0.01661340706050396,
0.03796156868338585,
-0.016429787501692772,
0.06174645200371742,
0.08684968948364258,
0.0051006143912673,
-0.00032199383713304996,
-0.03261776268482208,
0.028616229072213173,
0.020500216633081436,
-0.02254832349717617,
0.038181427866220474,
0.042099256068468094,
0.00847399141639471,
-0.017722075805068016,
-0.012164142914116383,
-0.01272433903068304,
-0.024766849353909492,
0.004760207142680883,
-0.07797564566135406,
0.01476985588669777,
0.02054358832538128,
-0.01628006622195244,
-0.04599853977560997,
0.020784908905625343,
0.051944226026535034,
0.033991605043411255,
-0.07621034979820251,
0.013151443563401699,
0.039192818105220795,
0.006844437215477228,
-0.039774589240550995,
0.055614154785871506,
0.030324336141347885,
-0.0049920822493731976,
0.011822322383522987,
-0.022374717518687248,
0.002495558001101017,
-0.037471454590559006,
0.0013006795197725296,
-0.02453242987394333,
-0.031399812549352646,
0.06027407571673393,
-0.027197662740945816,
0.004214917309582233,
0.027327997609972954,
0.04151488095521927,
-0.12193937599658966,
-0.017106281593441963,
0.05376889556646347,
0.00793832540512085,
0.014541033655405045,
-0.023377573117613792,
-0.028521239757537842,
-0.03941220045089722,
0.03391258046030998,
-0.03088727779686451,
0.07071848958730698,
0.020411549136042595,
-0.010165386833250523,
-0.045022040605545044,
0.029486417770385742,
-0.0354369692504406,
-0.02652069739997387,
-0.03518293425440788,
-0.06997288018465042,
-0.05377517640590668,
0.043811600655317307,
0.05496767535805702,
0.043772801756858826,
-0.0016259095864370465,
0.010644919238984585,
-0.015092449262738228,
0.05189758166670799,
-0.030038245022296906,
-0.0767623782157898,
0.03490891307592392,
0.03075503744184971,
-0.0013957160990685225,
-0.00566449761390686,
-0.04031725227832794,
0.010101341642439365,
0.00966701004654169,
0.01235182210803032,
-0.017126264050602913,
-0.003331240499392152,
-0.0674719288945198,
-0.003356275614351034,
-0.03896019980311394,
0.07801420986652374,
-0.038481369614601135,
-0.0003696235944516957,
-0.010271637700498104,
-0.028308140113949776,
0.03692528232932091,
0.021534591913223267,
0.00651186378672719,
0.014315638691186905,
0.01454278826713562,
0.007969032041728497,
-0.03728945553302765,
0.01327477116137743,
0.04131769388914108,
-0.024407625198364258,
0.06934043765068054,
-0.020737122744321823,
0.029652412980794907,
-0.0008407701388932765,
-0.03857939690351486,
-0.0007176409708335996,
-0.010641236789524555,
0.03837718814611435,
0.025735344737768173,
0.04801037535071373,
-0.10397110879421234,
0.018572285771369934,
0.032995373010635376,
0.05250163748860359,
0.047724489122629166,
0.008213956840336323,
0.014156846329569817,
-0.0012150016846135259,
0.012804292142391205,
0.026887686923146248,
0.03176727145910263,
0.011393744498491287,
-0.016552045941352844,
0.012624496594071388,
-0.03712281212210655,
-0.005972906481474638,
0.0021944448817521334,
0.0002562053850851953,
-0.05056127905845642,
-0.014912922866642475,
-0.031221527606248856,
-0.030432801693677902,
-0.035682737827301025,
-0.03117651864886284,
-0.03294111043214798,
-0.012780762277543545,
0.014133499003946781,
-0.012245357036590576,
-0.07334841042757034,
-0.021705718711018562,
-0.006400321144610643,
-0.03951152786612511,
-0.06879019737243652,
0.04745589569211006,
0.07608652859926224,
0.015484209172427654,
-0.013399835675954819,
-0.026400340721011162,
-0.01411415170878172,
-0.002570810029283166,
0.009420769289135933,
0.04735959321260452,
-0.024427177384495735,
-0.0009546528453938663,
-0.019044896587729454,
0.020341886207461357,
0.03426549583673477,
0.01220034807920456,
-0.004082236438989639,
-0.006037574261426926,
0.0437823049724102,
0.010079491883516312,
0.028402619063854218,
0.05188427120447159,
0.030597249045968056,
0.04845302179455757,
-0.025792188942432404,
-0.004558486398309469,
-0.013864070177078247,
-0.00038011037395335734,
-0.01549022737890482,
0.023138344287872314,
0.008180830627679825,
-0.014635343104600906,
0.01265625562518835,
0.00444322545081377,
-0.004972470924258232,
0.005840604193508625,
0.054825615137815475,
-0.004365292843431234,
-0.011187510564923286,
0.001245108898729086,
-0.03384016826748848,
0.010216008871793747,
-0.0005386716220527887,
0.011207322590053082,
-0.024357106536626816,
-0.034408316016197205,
0.011790464632213116,
0.01225489191710949,
0.04245377704501152,
0.0031856053974479437,
-0.00708640506491065,
-0.060033682733774185,
0.017778649926185608,
-0.04211151599884033,
0.011077933013439178,
-0.04373873025178909,
0.019369343295693398,
-0.03710441663861275,
-0.00450346851721406,
0.008765378035604954,
0.04358793422579765,
-0.03145204856991768,
-0.020814890041947365,
-0.017103806138038635,
0.04231441020965576,
-0.019537799060344696,
0.019601278007030487,
0.002003486268222332,
0.03744952380657196,
0.011535564437508583,
-0.014726837165653706,
0.0634019747376442,
-0.014304189011454582,
-0.07360156625509262,
0.04721323773264885,
-0.020429223775863647,
0.04133341833949089,
0.02183612436056137,
-5.198337974447523e-33,
0.01901952736079693,
-0.0420917347073555,
0.01088150404393673,
-0.059456244111061096,
0.0150682982057333,
0.016187628731131554,
-0.009477832354605198,
-0.04764692857861519,
0.0027713379822671413,
0.05772337689995766,
-0.023410668596625328,
-0.01793224737048149,
0.011094000190496445,
0.009958134964108467,
-0.03479710966348648,
-0.01790483295917511,
0.032333362847566605,
-0.008398666977882385,
-0.03536589816212654,
0.02558094821870327,
-0.007321426644921303,
0.006192376837134361,
-0.05210791155695915,
-0.022670606151223183,
0.030278027057647705,
-0.01564420945942402,
0.07118584960699081,
-0.019208870828151703,
-0.03116717003285885,
0.0364750437438488,
0.03270776569843292,
0.02094489336013794,
0.00340927648358047,
-0.01541395764797926,
0.038840923458337784,
-0.03347024694085121,
-0.004575709812343121,
-0.034948669373989105,
0.03274514898657799,
0.050424497574567795,
-0.01300924364477396,
-0.0396542102098465,
0.03533495217561722,
0.016618305817246437,
0.01335333101451397,
0.00601778132840991,
-0.029033001512289047,
0.004580984823405743,
-0.022028008475899696,
-0.03122137486934662,
0.026011407375335693,
0.023975983262062073,
0.030852681025862694,
0.03681844472885132,
-0.03457532823085785,
-0.00835501216351986,
-0.02854495868086815,
0.01624608226120472,
0.0709439143538475,
-0.0009001011494547129,
-0.04095679894089699,
-0.005196146201342344,
0.0377841480076313,
-0.00025867525255307555,
0.022182077169418335,
0.021129045635461807,
-0.04781641438603401,
-0.030701100826263428,
-0.0632554367184639,
0.056822970509529114,
-0.0853569433093071,
-0.0010529401479288936,
-0.008059870451688766,
-0.010248463600873947,
-0.07161549478769302,
-0.018807530403137207,
0.03446764498949051,
0.009333737194538116,
0.032175853848457336,
-0.0039991349913179874,
-0.03466123342514038,
-0.015453226864337921,
0.04912177845835686,
-0.00590323144569993,
-0.04781358316540718,
-0.03592325747013092,
0.021632926538586617,
-0.060725148767232895,
-0.008050867356359959,
-0.04236108437180519,
0.11563696712255478,
-0.06778314709663391,
0.009555449709296227,
-0.01277227234095335,
-0.024108590558171272,
-0.03823034092783928,
0.09844610095024109,
-0.016307787969708443,
-0.048446204513311386,
-0.0007207914022728801,
0.0380634181201458,
0.016398340463638306,
0.06168048456311226,
-0.09930263459682465,
-0.026235496625304222,
-0.010578921996057034,
-0.012096237391233444,
-0.0406939759850502,
0.0012295485939830542,
-0.011258657090365887,
-0.011282224208116531,
0.006127178203314543,
0.014706699177622795,
-0.009885975159704685,
0.001754429074935615,
0.0606321357190609,
-0.0011809510178864002,
-0.0035518913064152002,
-0.002630887320265174,
-0.00082329724682495,
0.04981091246008873,
-0.0304491575807333,
0.0038119961973279715,
-0.018598631024360657,
-0.04580218717455864,
-0.027757247909903526,
0.025675004348158836,
0.008584389463067055,
-0.03607344999909401,
-0.04331313818693161,
0.04241492599248886,
0.02517981268465519,
2.761445614396507e-7,
0.054751206189394,
-0.02654799446463585,
-0.028717709705233574,
-0.09152752161026001,
0.031706977635622025,
-0.052406590431928635,
0.018445691093802452,
0.015755491331219673,
-0.05480705574154854,
0.041104499250650406,
0.05486713722348213,
-0.047456834465265274,
0.00564371095970273,
-0.02496970444917679,
-0.004115412477403879,
0.05627242475748062,
-0.021922947838902473,
0.011246219277381897,
0.04123949632048607,
0.02697541005909443,
0.0347730815410614,
0.032091088593006134,
-0.06110304221510887,
0.003994486760348082,
0.045162372291088104,
-0.028712786734104156,
-0.027778668329119682,
-0.052270665764808655,
-0.0375828891992569,
0.027654500678181648,
0.04686044156551361,
-0.0408409908413887,
0.056220605969429016,
0.08104939013719559,
-0.020789355039596558,
-0.018299899995326996,
0.035439781844615936,
0.03055228292942047,
0.0264654029160738,
0.030329858884215355,
0.048345450311899185,
0.0069665745832026005,
0.04872363433241844,
-0.016238538548350334,
-0.01097924169152975,
-0.03506791591644287,
-0.03787914663553238,
0.021716581657528877,
0.020295562222599983,
0.015987984836101532,
-0.050336435437202454,
0.04461419954895973,
-0.019181059673428535,
0.08752080053091049,
0.0032374777365475893,
0.042878732085227966,
-0.03063085488975048,
0.03304661065340042,
0.002742684679105878,
-0.04785025492310524,
-0.05067680776119232,
-0.025812529027462006,
-0.0023764309007674456,
-0.017255345359444618,
0.07848963141441345,
0.04734010994434357,
-0.04616048187017441,
1.410837388612155e-34,
-0.044682037085294724,
-0.005371743347495794,
0.015622922219336033,
-0.012425313703715801,
0.006515082903206348,
-0.04906878247857094,
0.011823588982224464,
0.030225351452827454,
0.04370191693305969,
-0.07681369036436081,
-0.012611337006092072
] | {
"ds_index": 94,
"similar_dg_indices": [
492952,
403636,
513590,
809480,
1120268,
981347,
212046,
302701,
167319,
487756,
811512,
216701,
454768,
15861,
974289,
421836,
342935,
748733,
1099223,
394766
]
} |
A 40-year-old woman comes to the physician because of a 1-week history of fatigue, dark urine, and a feeling of heaviness in her legs. Two weeks ago, she returned from a vacation to Brazil, where she spent most of her days exploring the city of Rio de Janeiro on foot. She also gained 3 kg (7 lb) during her vacation. She has systemic lupus erythematosus. Her only medication is hydroxychloroquine. Her temperature is 37.5°C (99.5°F), pulse is 78/min, and blood pressure is 162/98 mm Hg. Physical examination shows 2+ pretibial edema bilaterally. Urinalysis shows:
Blood 3+
Protein 1+
RBC 6–8/hpf with dysmorphic features
RBC casts numerous
WBC 8/hpf
WBC casts rare
Bacteria negative
Which of the following is the most likely cause of this patient's leg findings?" | Salt retention | {
"A": "Venous insufficiency",
"B": "Lymphatic obstruction",
"C": "Renal protein loss",
"D": "Salt retention"
} | step2&3 | D | [
"40 year old woman",
"physician",
"1-week history",
"fatigue",
"dark urine",
"feeling of heaviness",
"legs",
"Two weeks",
"returned",
"vacation",
"Brazil",
"spent most",
"days",
"city",
"Rio de",
"foot",
"gained 3 kg",
"vacation",
"systemic lupus erythematosus",
"only medication",
"hydroxychloroquine",
"temperature",
"99",
"pulse",
"min",
"blood pressure",
"98 mm Hg",
"Physical examination shows 2",
"edema",
"Urinalysis shows",
"Blood",
"Protein 1",
"RBC 68 hpf",
"dysmorphic features",
"casts numerous WBC",
"hpf",
"casts rare Bacteria negative",
"following",
"most likely cause",
"patient",
"eg indings?"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 40-year-old woman comes to the physician because of a 1-week history of fatigue, dark urine, and a feeling of heaviness in her legs. Two weeks ago, she returned from a vacation to Brazil, where she spent most of her days exploring the city of Rio de Janeiro on foot. She also gained 3 kg (7 lb) during her vacation. She has systemic lupus erythematosus. Her only medication is hydroxychloroquine. Her temperature is 37.5°C (99.5°F), pulse is 78/min, and blood pressure is 162/98 mm Hg. Physical examination shows 2+ pretibial edema bilaterally. Urinalysis shows:
Blood 3+
Protein 1+
RBC 6–8/hpf with dysmorphic features
RBC casts numerous
WBC 8/hpf
WBC casts rare
Bacteria negative
Which of the following is the most likely cause of this patient's leg findings?"
Choose one of the following::
A. Venous insufficiency
B. Lymphatic obstruction
C. Renal protein loss
D. Salt retention | [
0.019528936594724655,
-0.031133312731981277,
0.008142274804413319,
0.034126441925764084,
0.050835371017456055,
-0.00993536040186882,
-0.035386648029088974,
0.06329012662172318,
0.008350447751581669,
0.022294793277978897,
0.023184509947896004,
0.02055099979043007,
-0.00037185571272857487,
0.005563273094594479,
0.020594311878085136,
0.03594990074634552,
-0.0226043201982975,
-0.0177740678191185,
-0.04155198112130165,
0.010163427330553532,
-0.04693470895290375,
0.01000417023897171,
0.047205761075019836,
-0.0020415508188307285,
0.06655743718147278,
-0.011043239384889603,
0.022457877174019814,
-0.010135280899703503,
0.033823028206825256,
0.0012887637130916119,
-0.030423859134316444,
-0.010599073022603989,
0.019025003537535667,
-0.09808795899152756,
0.000002148291969206184,
-0.012334764003753662,
0.002540100831538439,
-0.05816034600138664,
0.027150603011250496,
-0.061033669859170914,
-0.001325112534686923,
-0.028776265680789948,
0.07719770818948746,
-0.0048835864290595055,
-0.041504211723804474,
-0.07238354533910751,
-0.01786329410970211,
0.06307026743888855,
-0.0826648399233818,
0.03866608813405037,
0.03478219732642174,
0.01640183851122856,
-0.04715169221162796,
0.009916229173541069,
0.08864978700876236,
-0.03030399978160858,
-0.02113310992717743,
0.010729178786277771,
0.030922090634703636,
-0.0317169651389122,
0.003450255375355482,
-0.031290944665670395,
0.01442069374024868,
-0.01454979833215475,
-0.09784894436597824,
-0.004183000884950161,
0.017480652779340744,
-0.06127430498600006,
0.03468374162912369,
0.02719114162027836,
-0.023584702983498573,
-0.040395647287368774,
0.04218641668558121,
0.06410887092351913,
0.005376643035560846,
-0.04525827616453171,
0.04423440620303154,
-0.010588068515062332,
0.012386207468807697,
-0.014239217154681683,
0.04411691427230835,
0.0616731271147728,
-0.007812867872416973,
0.057424161583185196,
0.002956737531349063,
-0.04396548867225647,
0.012618932873010635,
0.023262495175004005,
-0.02407270297408104,
-0.01703370176255703,
-0.0012460340512916446,
-0.023189391940832138,
0.005191123113036156,
0.05392081290483475,
-0.04937300086021423,
-0.023646490648388863,
0.029965421184897423,
0.02929823100566864,
0.05019832029938698,
0.009080374613404274,
-0.011197997257113457,
-0.0019994189497083426,
0.03508828580379486,
0.017808683216571808,
-0.061881016939878464,
-0.02195575088262558,
-0.03815009817481041,
-0.020809702575206757,
-0.033437322825193405,
0.03501465544104576,
0.013324297964572906,
0.00890558771789074,
-0.03243882954120636,
0.0015178740723058581,
0.037245262414216995,
-0.00880617555230856,
-0.0532657653093338,
-0.04426824674010277,
0.034410376101732254,
0.017650581896305084,
-0.004608145449310541,
0.04448547586798668,
0.038040440529584885,
-0.006903455592691898,
0.0025221314281225204,
0.029045596718788147,
0.02255956083536148,
0.02479003556072712,
0.00470269750803709,
-0.007173027377575636,
0.013222457841038704,
-0.06188857927918434,
-0.0177982896566391,
0.042986009269952774,
0.04356716200709343,
0.010280792601406574,
0.06635259091854095,
0.029561294242739677,
0.01903177984058857,
0.008168565109372139,
-0.024090131744742393,
-0.05504041537642479,
-0.03320276364684105,
-0.016366252675652504,
0.014881442300975323,
0.030721742659807205,
0.015472399070858955,
0.034483592957258224,
-0.047434475272893906,
0.03213367611169815,
-0.01611308753490448,
-0.038399919867515564,
-0.07440148293972015,
0.0011756708845496178,
0.0014120712876319885,
0.010440066456794739,
0.03227368742227554,
-0.03421898931264877,
-0.012560666538774967,
-0.04242441803216934,
0.0005772620206698775,
-0.04560265690088272,
-0.01937156356871128,
-0.027070097625255585,
0.009137377142906189,
0.017207983881235123,
-0.008491654880344868,
0.07913482189178467,
-0.02551455795764923,
0.020643046125769615,
-0.02740987204015255,
0.03194679319858551,
0.012434744276106358,
0.0240178145468235,
-0.029316112399101257,
0.0075018093921244144,
0.021619167178869247,
-0.024061067029833794,
0.009131106548011303,
-0.051082320511341095,
0.006674022879451513,
0.014602522365748882,
0.05445892736315727,
-0.05190463364124298,
0.021571064367890358,
0.029794124886393547,
-0.009806100279092789,
-0.018938226625323296,
-0.04712658002972603,
-0.004642354790121317,
-0.03259603679180145,
-0.035455264151096344,
0.010510757565498352,
0.008435104042291641,
-0.0410684235394001,
0.013846431858837605,
-0.019472351297736168,
0.02784830518066883,
0.024998314678668976,
-0.04627326875925064,
0.009624996222555637,
-0.03045537881553173,
-0.011681881733238697,
0.0705142617225647,
-0.04059240594506264,
0.08160202205181122,
0.015254853293299675,
-0.006163574755191803,
-0.0172259621322155,
-0.016118314117193222,
-0.008456404320895672,
-0.0003583236248232424,
0.04922343045473099,
-0.03430648893117905,
0.03823769837617874,
0.0009703589603304863,
-0.0007613678462803364,
-0.011354614049196243,
-0.08246850967407227,
0.0217108353972435,
-0.0056952848099172115,
-0.03421200066804886,
-0.032468531280756,
-0.017735814675688744,
-0.04104400798678398,
0.025057002902030945,
0.037240415811538696,
-0.011546703055500984,
-0.0407998226583004,
-0.038991980254650116,
0.04122030362486839,
0.022168250754475594,
-0.030685996636748314,
-0.005182507447898388,
-0.0363304503262043,
0.05962609127163887,
0.025426814332604408,
-0.051006533205509186,
-0.010238834656774998,
0.05444755032658577,
-0.023410428315401077,
-0.001630417536944151,
-0.026079798117280006,
-0.02456400729715824,
0.016536828130483627,
-0.02714446559548378,
-0.020296340808272362,
0.04074598103761673,
-0.03846845030784607,
0.07645270973443985,
-0.04177658632397652,
0.0010712726507335901,
0.00968637503683567,
0.040328819304704666,
-0.0014029104495421052,
0.030870400369167328,
-0.005472659133374691,
0.01406601071357727,
-0.04466896504163742,
-0.03462253883481026,
-0.03575494885444641,
0.017262941226363182,
-0.03220951929688454,
0.005482414271682501,
-0.03369065746665001,
-0.008330343291163445,
0.016747960820794106,
-0.02157708816230297,
0.012402152642607689,
0.024378899484872818,
0.009012818336486816,
0.04073893278837204,
0.027295401319861412,
-0.0014158831909298897,
-0.0768379345536232,
-0.01815573312342167,
-0.030378539115190506,
0.04993391036987305,
0.03702704235911369,
0.026209166273474693,
0.005573224741965532,
0.06028183549642563,
0.01342557929456234,
0.07098719477653503,
-0.0031207541469484568,
0.0025503116194158792,
0.0071605802513659,
0.04489823430776596,
0.019857771694660187,
0.03811939060688019,
-0.057323895394802094,
-0.012692836113274097,
0.0402548611164093,
-0.0029342775233089924,
-0.08061341196298599,
-0.029344454407691956,
-0.06255736947059631,
-0.018115947023034096,
0.010672821663320065,
0.03195371478796005,
0.07332470268011093,
0.05149320885539055,
-0.023956244811415672,
0.014991123229265213,
-0.022619815543293953,
0.0662168338894844,
0.02698746882379055,
0.03216015547513962,
0.019830558449029922,
0.02137269638478756,
0.02238527126610279,
0.001365161850117147,
-0.0150052634999156,
-0.02013395167887211,
0.01291751954704523,
-0.02188052609562874,
0.040344998240470886,
-0.033871546387672424,
0.022038284689188004,
0.00919370073825121,
0.0034050189424306154,
0.04198731109499931,
0.0006836508982814848,
-0.0063329702243208885,
0.010683770291507244,
-0.033863432705402374,
0.011471136473119259,
-0.013771015219390392,
-0.0637398362159729,
-0.031327709555625916,
0.014911878854036331,
-0.10314048081636429,
0.014883373863995075,
0.06593134999275208,
0.020505966618657112,
0.01308489590883255,
-0.024971332401037216,
0.025583013892173767,
-0.001195289776660502,
0.038135744631290436,
-0.019174205139279366,
-0.024061325937509537,
0.04251676797866821,
0.009537870064377785,
-0.0006772953784093261,
-0.013055156916379929,
-0.10230657458305359,
0.04566827043890953,
0.025562874972820282,
0.02019764482975006,
-0.1074223741889,
0.062335096299648285,
-0.007617268245667219,
0.013847644440829754,
0.012755199335515499,
-0.046526189893484116,
0.00816927570849657,
0.021795980632305145,
-0.010164063423871994,
-0.010729989968240261,
0.03796185925602913,
0.003021880518645048,
-0.03700818493962288,
0.0072682383470237255,
0.006279220338910818,
0.04070570319890976,
0.0025716417003422976,
0.001677555963397026,
-0.023874690756201744,
-0.04061957448720932,
0.005602053366601467,
-0.03799499198794365,
-0.05305194482207298,
0.07266030460596085,
0.00975392758846283,
-0.032838720828294754,
0.012105532921850681,
-0.0733070820569992,
-0.050543829798698425,
-0.030169453471899033,
0.027595078572630882,
-0.057562489062547684,
-0.027704082429409027,
-0.030319875106215477,
-0.032896123826503754,
0.020219020545482635,
-0.027639074251055717,
-0.03559355437755585,
0.04229872301220894,
-0.05048937350511551,
-0.006076223216950893,
-0.021380968391895294,
-0.020979074761271477,
-0.030068472027778625,
-0.029316578060388565,
0.07910533249378204,
-0.023974966257810593,
-0.043292198330163956,
0.01964118890464306,
0.0895499438047409,
0.015276527032256126,
0.010344455018639565,
-0.0618160106241703,
0.04111972451210022,
0.08036252111196518,
-0.06909414380788803,
0.001702265115454793,
-0.01492952648550272,
0.035445839166641235,
0.04001401737332344,
0.034544456750154495,
-0.07640011608600616,
0.041443128138780594,
-0.03056596778333187,
0.016712680459022522,
-0.021102886646986008,
-0.013801997527480125,
-0.03758412227034569,
0.008101286366581917,
-0.08604370057582855,
0.05935564264655113,
-0.0055443840101361275,
-0.01930699311196804,
-0.03709893301129341,
0.003380436450242996,
0.03771282359957695,
0.0128459632396698,
0.06257464736700058,
0.02319076657295227,
0.03808533400297165,
0.01931801810860634,
-0.010343259200453758,
0.0281729307025671,
0.08091553300619125,
-0.045881204307079315,
-0.03240537270903587,
-0.028159677982330322,
-0.050620343536138535,
-0.006861661560833454,
-0.03726489469408989,
-0.03281092271208763,
0.05225038528442383,
0.023243721574544907,
0.02667253650724888,
0.03760652616620064,
-0.047477271407842636,
0.007383290212601423,
0.015352523885667324,
0.03217781335115433,
0.08525954186916351,
0.012513335794210434,
0.0038498968351632357,
0.04085259139537811,
0.03987973928451538,
0.04704960063099861,
0.05895300582051277,
-0.000642067810986191,
-0.04478634521365166,
0.011491394601762295,
-0.009014032781124115,
-0.04008307680487633,
0.020086564123630524,
-0.045282214879989624,
-0.035693876445293427,
0.004124692175537348,
-0.08375274389982224,
-0.04356978088617325,
-0.010185588151216507,
-0.03537517786026001,
0.0016428297385573387,
-0.03147333115339279,
0.05370905622839928,
0.02641995996236801,
-0.055196363478899,
0.03437073528766632,
0.04950946941971779,
-0.024323543533682823,
-0.053073544055223465,
-0.04547729715704918,
0.07009738683700562,
0.003349074861034751,
0.05097556859254837,
-0.06960278004407883,
-0.06840888410806656,
-0.025528836995363235,
0.018824804574251175,
0.015195268206298351,
0.006439865566790104,
-0.015134894289076328,
-0.00015087253996171057,
-0.012259867042303085,
-0.0035845846869051456,
-0.02815985679626465,
0.023026997223496437,
-0.0775284469127655,
0.02213357575237751,
0.010960036888718605,
0.01871011033654213,
0.0542747788131237,
0.021668188273906708,
0.07273434102535248,
0.006742455065250397,
0.013167336583137512,
0.034921083599328995,
0.03557826578617096,
0.003990625496953726,
-0.006886584684252739,
0.051408540457487106,
-0.004392484202980995,
-0.03904275223612785,
0.02207920514047146,
0.019479401409626007,
0.019881416112184525,
0.0708949938416481,
0.05003741756081581,
-0.03612830489873886,
-0.04102892428636551,
-0.020434807986021042,
0.005889200605452061,
0.02881515398621559,
0.000996950431726873,
-0.047388240694999695,
-0.0015858410624787211,
-0.026700852438807487,
0.010457838885486126,
0.045760829001665115,
-0.022539595142006874,
-0.04937153309583664,
0.04795355722308159,
0.013736235909163952,
-0.014283997006714344,
-0.01951114647090435,
-0.008946658112108707,
0.007155201397836208,
0.015000118874013424,
-0.01355230063199997,
0.01879480853676796,
-0.03669034689664841,
-0.021800359711050987,
-0.04125848785042763,
-0.0033256926108151674,
-0.006777861621230841,
-0.029763955622911453,
-0.03474896773695946,
-0.007511668838560581,
0.03740109130740166,
-0.031122781336307526,
0.01688646711409092,
0.03906133025884628,
0.03158734738826752,
-0.010259277187287807,
0.0928531065583229,
0.0009290007874369621,
0.004218081012368202,
0.01861904188990593,
-5.5893764558241265e-33,
0.05342848226428032,
-0.04379396513104439,
0.03751207888126373,
-0.05200878158211708,
0.04969893395900726,
0.12589965760707855,
-0.06002825126051903,
-0.028163837268948555,
-0.06109340116381645,
0.013293728232383728,
0.025127144530415535,
-0.044119782745838165,
0.022195933386683464,
0.07246006280183792,
-0.03622549772262573,
0.018362093716859818,
0.02244662493467331,
0.02090221457183361,
-0.04037557542324066,
-0.02541111595928669,
0.010212244465947151,
-0.013847768306732178,
-0.011822087690234184,
-0.0013369899243116379,
-0.007853563874959946,
-0.05760097876191139,
0.049275632947683334,
0.014420145191252232,
0.0026685278862714767,
0.005675995722413063,
0.04320699721574783,
-0.041542403399944305,
0.037884682416915894,
0.02035488747060299,
-0.008427913300693035,
-0.03750865161418915,
-0.032830528914928436,
-0.031740207225084305,
0.032266415655612946,
0.030409811064600945,
0.012043223716318607,
-0.0433054156601429,
0.0070702326484024525,
-0.023248247802257538,
0.01462977658957243,
0.00525687774643302,
-0.07244999706745148,
-0.02617449313402176,
0.04192167520523071,
-0.0593164786696434,
-0.0005799359641969204,
0.025086358189582825,
0.024750851094722748,
0.005051117390394211,
-0.04493063688278198,
0.025994494557380676,
-0.007496439386159182,
0.051360566169023514,
-0.019452791661024094,
-0.0004563595284707844,
-0.0645952895283699,
-0.02479727193713188,
0.03779714182019234,
-0.03615468367934227,
-0.04801706597208977,
0.013835612684488297,
0.019206583499908447,
0.0004200303228572011,
-0.03194325789809227,
0.036785971373319626,
-0.10047858208417892,
0.010863867588341236,
-0.02299005538225174,
-0.01825014501810074,
0.007859397679567337,
0.003278004704043269,
-0.0032491711899638176,
0.029819190502166748,
0.005723064765334129,
0.010587936267256737,
-0.0010937423212453723,
0.003869316540658474,
0.001715582562610507,
0.004478048533201218,
-0.013392827473580837,
0.024585600942373276,
0.010250847786664963,
-0.05774667114019394,
-0.018524985760450363,
-0.02563617192208767,
0.03420175239443779,
-0.0018075450789183378,
0.03878990560770035,
0.003424837486818433,
-0.035899434238672256,
-0.05496015399694443,
0.0026863489765673876,
0.0036275291349738836,
0.012639536522328854,
0.06285356730222702,
0.023371759802103043,
0.0017198603600263596,
0.024875061586499214,
-0.029596619307994843,
-0.03599061071872711,
0.02272346429526806,
0.013291631825268269,
-0.038133591413497925,
-0.0066286236979067326,
0.03728708624839783,
0.017611945047974586,
-0.009205900132656097,
-0.034330517053604126,
0.09608414769172668,
0.031112072989344597,
-0.02458421140909195,
0.0069932593032717705,
0.06829410791397095,
0.03799089044332504,
0.027389708906412125,
0.034401725977659225,
-0.002234139945358038,
0.035992346704006195,
0.012074646539986134,
-0.05504528060555458,
-0.07138960063457489,
0.020758841186761856,
0.09251464158296585,
-0.02997054159641266,
-0.033267151564359665,
0.02811630442738533,
-0.007053648587316275,
2.9427758363453904e-7,
0.05428028479218483,
-0.028081614524126053,
-0.045059144496917725,
-0.0858665481209755,
0.03655354306101799,
0.001883582677692175,
-0.023321544751524925,
0.009554474614560604,
-0.012032193131744862,
0.016142943874001503,
0.0024613644927740097,
0.006069735158234835,
-0.01325725857168436,
-0.01738003082573414,
0.018732884898781776,
0.004064830485731363,
-0.018128730356693268,
-0.06921762973070145,
0.013410557992756367,
-0.0029718896839767694,
-0.07276802510023117,
-0.0006468963692896068,
-0.03662683814764023,
-0.04889244586229324,
0.04563313350081444,
-0.02763223461806774,
0.002957180142402649,
-0.05053814873099327,
-0.08395042270421982,
-0.06279396265745163,
0.041691508144140244,
-0.054614946246147156,
0.02485969103872776,
0.04615014046430588,
-0.006772896274924278,
0.018514014780521393,
-0.012606377713382244,
0.055726855993270874,
-0.02688870020210743,
0.024380557239055634,
-0.00865505076944828,
-0.05852343142032623,
0.007398958783596754,
0.014901774935424328,
0.03478117659687996,
0.05121048167347908,
-0.06104996055364609,
-0.0049513839185237885,
0.008977062068879604,
0.006377842277288437,
0.019605880603194237,
0.022370297461748123,
-0.01038435846567154,
0.023651331663131714,
0.0018185286317020655,
0.02453003264963627,
-0.07107874006032944,
-0.0005499340477399528,
0.0010468115797266364,
-0.03903650864958763,
-0.02529752068221569,
-0.021140845492482185,
0.019914092496037483,
-0.0186292864382267,
0.054593123495578766,
-0.07521772384643555,
-0.023028546944260597,
2.4453710256997677e-34,
-0.01970611698925495,
0.004344187676906586,
0.051589127629995346,
-0.01548589114099741,
-0.02929476462304592,
-0.05186665803194046,
-0.024307066574692726,
0.028151798993349075,
0.023215021938085556,
-0.03167980536818504,
-0.024408655241131783
] | {
"ds_index": 95,
"similar_dg_indices": [
329826,
1184875,
429307,
875287,
643555,
714748,
617993,
288146,
1009091,
149713,
188813,
608924,
473437,
581508,
859829,
359889,
207293,
421082,
96740,
423705
]
} |
A 67-year-old woman with advanced bladder cancer comes to the physician for a follow-up examination. She is currently undergoing chemotherapy with an agent that forms cross-links between DNA strands. Serum studies show a creatinine concentration of 2.1 mg/dL and a blood urea nitrogen concentration of 30 mg/dL. Urine dipstick of a clean-catch midstream specimen shows 2+ protein and 1+ glucose. Prior to initiation of chemotherapy, her laboratory values were within the reference range. In addition to hydration, administration of which of the following would most likely have prevented this patient's current condition? | Amifostine | {
"A": "Mesna",
"B": "Amifostine",
"C": "Rasburicase",
"D": "Leucovorin"
} | step1 | B | [
"67 year old woman",
"advanced bladder",
"physician",
"follow-up examination",
"currently",
"chemotherapy",
"agent",
"forms cross-links",
"DNA strands",
"Serum studies show",
"creatinine concentration",
"2",
"mg dL",
"blood urea nitrogen concentration",
"mg/dL",
"Urine",
"clean-catch",
"specimen shows 2",
"protein",
"1",
"glucose",
"Prior to initiation",
"chemotherapy",
"laboratory values",
"reference range",
"hydration",
"administration",
"following",
"most likely",
"prevented",
"patient's current condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 67-year-old woman with advanced bladder cancer comes to the physician for a follow-up examination. She is currently undergoing chemotherapy with an agent that forms cross-links between DNA strands. Serum studies show a creatinine concentration of 2.1 mg/dL and a blood urea nitrogen concentration of 30 mg/dL. Urine dipstick of a clean-catch midstream specimen shows 2+ protein and 1+ glucose. Prior to initiation of chemotherapy, her laboratory values were within the reference range. In addition to hydration, administration of which of the following would most likely have prevented this patient's current condition?
Choose one of the following::
A. Mesna
B. Amifostine
C. Rasburicase
D. Leucovorin | [
0.0536179356276989,
-0.019719330593943596,
0.0036937559489160776,
-0.02307514101266861,
-0.030380219221115112,
-0.01574932038784027,
-0.017649609595537186,
0.0071830786764621735,
-0.013135544955730438,
-0.026885133236646652,
0.01852201484143734,
-0.013547247275710106,
-0.02944585494697094,
-0.0630558431148529,
-0.014294656924903393,
0.04765338450670242,
-0.0030908917542546988,
-0.002021492226049304,
-0.05342778190970421,
-0.0027444674633443356,
-0.005946220364421606,
0.01410590298473835,
0.009296933189034462,
-0.013971928507089615,
0.03149693086743355,
0.04787467047572136,
0.04857724905014038,
0.022598475217819214,
-0.05504349619150162,
-0.01950269192457199,
0.014310740865767002,
0.02311290241777897,
-0.014830035157501698,
-0.07804609090089798,
0.0000012176584505141363,
-0.060248006135225296,
0.02467762865126133,
-0.016993489116430283,
-0.005503551103174686,
-0.03012034296989441,
-0.0415685661137104,
0.007104416377842426,
0.021151861175894737,
0.030373189598321915,
0.010392948053777218,
0.03627878427505493,
-0.017751021310687065,
0.07230598479509354,
-0.02110915631055832,
0.02108321338891983,
0.007581900805234909,
0.02867645025253296,
0.04323842376470566,
0.005240411963313818,
0.04680237919092178,
-0.033100426197052,
-0.009674875997006893,
0.03942829743027687,
0.011197445914149284,
0.016603179275989532,
0.06754545867443085,
0.01773928850889206,
0.010936520993709564,
0.009668421000242233,
-0.06536412984132767,
0.028073035180568695,
0.00517816049978137,
-0.05096059292554855,
0.007684637792408466,
0.009849797002971172,
-0.04110007733106613,
0.0527656227350235,
0.03997404873371124,
0.04318961501121521,
0.004501228220760822,
0.032168690115213394,
0.04419456422328949,
-0.0701185017824173,
0.021950790658593178,
-0.016113147139549255,
-0.05539911612868309,
0.0077788205817341805,
-0.03348415344953537,
0.0297849178314209,
-0.029668863862752914,
-0.011550208553671837,
-0.009029634296894073,
-0.024954942986369133,
-0.030636368319392204,
0.013829297386109829,
-0.027155138552188873,
-0.05455761402845383,
0.001871011103503406,
0.04427425563335419,
-0.033094622194767,
-0.020828163251280785,
0.009176568128168583,
0.017599552869796753,
0.047567568719387054,
-0.06151310354471207,
-0.007679660804569721,
-0.018846048042178154,
0.03549376502633095,
0.025777125731110573,
-0.05360234156250954,
0.002800093265250325,
-0.0279217679053545,
0.02597012184560299,
-0.04383573308587074,
0.04872738569974899,
0.024261198937892914,
0.028557641431689262,
-0.04426388069987297,
0.04536037519574165,
0.07763931900262833,
-0.0013284124433994293,
-0.01284203864634037,
-0.010036855936050415,
0.027139270678162575,
0.07738672196865082,
0.015472565777599812,
0.024739615619182587,
-0.015395057387650013,
0.00731241749599576,
0.006633311975747347,
0.02174535021185875,
-0.018367022275924683,
0.04508150368928909,
0.013179265893995762,
-0.04576796293258667,
0.05122413486242294,
-0.04462595656514168,
0.000056871002016123384,
-0.04465605691075325,
-0.034857381135225296,
0.017740461975336075,
0.032201603055000305,
0.04518093541264534,
-0.027644967660307884,
-0.02224157191812992,
-0.04193459823727608,
-0.06876210123300552,
-0.005603244062513113,
0.0295933336019516,
0.007938557304441929,
0.024356575682759285,
0.001593896304257214,
-0.001537027768790722,
0.02384374290704727,
0.016778530552983284,
-0.03066219575703144,
-0.01834704726934433,
0.06641537696123123,
0.0010027161333709955,
0.011451859958469868,
-0.0011149469064548612,
-0.018450206145644188,
-0.03467113897204399,
0.021728774532675743,
0.01704479195177555,
0.03134436160326004,
-0.056737836450338364,
-0.018308328464627266,
-0.05069230869412422,
0.009057325311005116,
0.04662172496318817,
0.01304527185857296,
0.038747794926166534,
-0.037736520171165466,
0.03420853242278099,
-0.0388059988617897,
0.011547497473657131,
0.026267357170581818,
0.003691510995849967,
0.0027950876392424107,
0.043913666158914566,
0.060679174959659576,
0.02225003018975258,
-0.004576251842081547,
-0.037626754492521286,
0.004357661120593548,
0.058682672679424286,
-0.018779568374156952,
-0.039903976023197174,
0.04072481021285057,
0.03449994698166847,
0.040540002286434174,
-0.023240091279149055,
-0.004799943882972002,
-0.030058719217777252,
-0.01128012128174305,
0.023567691445350647,
-0.025782691314816475,
-0.0018773275660350919,
0.000525078852660954,
0.0290913674980402,
-0.015376128256320953,
-0.04082269221544266,
0.027741363272070885,
-0.03674851730465889,
0.024835145100951195,
0.010168071836233139,
-0.007963081821799278,
0.06611301749944687,
-0.061489831656217575,
0.05859005078673363,
0.027718430384993553,
0.01897221803665161,
-0.006487811449915171,
-0.015666428953409195,
-0.006569601129740477,
0.033540278673172,
0.021030297502875328,
-0.026046765968203545,
0.0490301139652729,
0.007478212937712669,
-0.010038317181169987,
-0.04510781168937683,
-0.07590252161026001,
0.031000832095742226,
-0.0055650328285992146,
-0.0005457812803797424,
0.0003776135272346437,
-0.004608042072504759,
-0.002953544957563281,
-0.019323570653796196,
-0.04252079129219055,
0.014471275731921196,
-0.05713062733411789,
-0.053361281752586365,
0.004721181467175484,
0.007445966824889183,
-0.0635731965303421,
0.014259200543165207,
-0.03185689076781273,
0.042792223393917084,
0.04933076724410057,
-0.022359156981110573,
-0.05928288772702217,
0.04065665602684021,
-0.005470762494951487,
-0.06519141048192978,
-0.07666181772947311,
-0.008886797353625298,
0.029992517083883286,
0.011367798782885075,
0.029479211196303368,
0.044163428246974945,
-0.06529200077056885,
0.052555590867996216,
-0.043956365436315536,
-0.012858516536653042,
0.002346542663872242,
-0.0033748135901987553,
-0.005632919259369373,
0.02371273562312126,
-0.0701458603143692,
0.017920346930623055,
-0.024569638073444366,
0.0021879421547055244,
-0.006961807608604431,
0.02693627029657364,
-0.00898592360317707,
-0.016241997480392456,
-0.07953254878520966,
-0.020106995478272438,
0.006653115153312683,
0.04784750938415527,
-0.052589599043130875,
0.03425693139433861,
0.028335442766547203,
-0.012731486931443214,
0.03720984235405922,
0.013600423000752926,
-0.03603632003068924,
-0.05646880716085434,
-0.01616281270980835,
0.0010559033835306764,
0.035195209085941315,
-0.007443833164870739,
0.0586019866168499,
0.08532401919364929,
-0.012474984861910343,
-0.007391359657049179,
0.016785457730293274,
0.03512866795063019,
0.01661490835249424,
-0.014868499711155891,
0.06324141472578049,
-0.0014078865060582757,
0.010387912392616272,
0.0003214348980691284,
0.023916594684123993,
-0.017800187692046165,
-0.003947040997445583,
-0.02122260071337223,
-0.07236220687627792,
0.005204976070672274,
0.005477836821228266,
-0.0003069794038310647,
0.0247596874833107,
0.06698809564113617,
-0.011753416620194912,
0.0007550286245532334,
-0.03304404392838478,
0.006174909882247448,
0.03139001876115799,
0.01590188592672348,
0.019851092249155045,
0.03814825788140297,
0.010225019417703152,
-0.012090234085917473,
-0.0624566487967968,
-0.0052354950457811356,
-0.05684075132012367,
-0.03726295009255409,
-0.016227172687649727,
0.007648972328752279,
0.02277042716741562,
0.007237698882818222,
0.018070651218295097,
0.04945801943540573,
0.03596121817827225,
-0.010307975113391876,
0.01367846131324768,
0.004588086623698473,
0.001192823750898242,
0.06372544914484024,
-0.07095801085233688,
-0.002080808626487851,
0.007326218765228987,
-0.023067882284522057,
0.002115246606990695,
-0.02015220932662487,
-0.03496503829956055,
0.010416234843432903,
0.005790577735751867,
0.033017948269844055,
0.0002000504027819261,
0.062294475734233856,
0.02975388616323471,
-0.01732317917048931,
0.033599771559238434,
-0.0006416353862732649,
0.06451041251420975,
-0.005799656268209219,
-0.05008993670344353,
-0.0187890212982893,
-0.007156699895858765,
-0.010363857261836529,
-0.0939306765794754,
0.01685572974383831,
0.0046591367572546005,
-0.024882717058062553,
-0.003032750217244029,
0.03139929845929146,
-0.01336639653891325,
0.06039663404226303,
-0.05886261537671089,
0.013987568207085133,
0.03002646565437317,
0.0215423833578825,
0.031092196702957153,
0.018046800047159195,
0.029181068763136864,
0.010144783183932304,
0.05577724054455757,
-0.0020226275082677603,
-0.01933418959379196,
-0.012647016905248165,
-0.014338832348585129,
0.031144391745328903,
-0.03371669724583626,
0.07282216846942902,
-0.005537429358810186,
-0.009371594525873661,
0.008082330226898193,
-0.05591905117034912,
-0.11840065568685532,
-0.04381212219595909,
0.06482123583555222,
-0.044455915689468384,
0.04686631262302399,
-0.0648411363363266,
-0.007200142368674278,
0.03463157266378403,
-0.021179640665650368,
-0.08404678851366043,
0.06179686263203621,
-0.01823122613132,
-0.003053020453080535,
0.006470959167927504,
0.03534160181879997,
-0.04058101400732994,
0.03302990272641182,
0.0074980552308261395,
0.024593723937869072,
-0.024231158196926117,
0.015565291047096252,
0.04769694060087204,
-0.0008666462381370366,
-0.030269788578152657,
-0.051047008484601974,
0.03154692426323891,
0.016561433672904968,
-0.06563733518123627,
-0.02578931301832199,
-0.01286238431930542,
0.018643705174326897,
0.03143838047981262,
0.0514540933072567,
-0.06807823479175568,
0.03356042504310608,
0.009705298580229282,
0.010978532023727894,
-0.009233911521732807,
-0.008285094052553177,
-0.01857559196650982,
-0.015495087020099163,
-0.061117760837078094,
0.025332016870379448,
-0.05058066174387932,
-0.018698861822485924,
-0.06820501387119293,
-0.0050818296149373055,
-0.011101041920483112,
0.033163730055093765,
0.009366069920361042,
-0.0031505462247878313,
0.032050542533397675,
-0.01676078513264656,
-0.021175293251872063,
0.022398026660084724,
0.04382670670747757,
-0.05931388959288597,
0.02278711088001728,
-0.044924475252628326,
-0.017626993358135223,
0.06551992893218994,
-0.08579502999782562,
0.020313778892159462,
0.05474432557821274,
0.04730244353413582,
-0.005711750593036413,
0.024374376982450485,
0.024625301361083984,
0.02534819394350052,
0.06241915747523308,
0.038942545652389526,
0.03437378257513046,
0.009754037484526634,
0.02733476832509041,
-0.04162699729204178,
0.013078990392386913,
0.014788758009672165,
-0.01296559814363718,
0.05860508605837822,
0.0004897048347629607,
-0.00946778804063797,
-0.031946055591106415,
-0.04799412190914154,
0.014702454209327698,
-0.02373095415532589,
-0.02607548050582409,
-0.008239136077463627,
-0.0514555498957634,
-0.06816614419221878,
0.04103760048747063,
-0.0078840721398592,
-0.04862600564956665,
-0.016437890008091927,
0.020430248230695724,
-0.0431191585958004,
-0.036674220114946365,
0.002447118517011404,
-0.05527797341346741,
-0.04985542222857475,
-0.0509464405477047,
-0.028518760576844215,
0.026813406497240067,
-0.033515334129333496,
0.020510779693722725,
-0.004586939234286547,
-0.0417599231004715,
-0.012793153524398804,
0.03689686581492424,
-0.018663903698325157,
-0.01855042204260826,
0.008093536831438541,
-0.07081986963748932,
0.015779586508870125,
0.02575608715415001,
0.004980022553354502,
0.012515087611973286,
-0.11981215327978134,
-0.023682409897446632,
-0.049203403294086456,
-0.007427901960909367,
0.051686447113752365,
-0.015496408566832542,
0.07813587039709091,
0.0006962712504900992,
0.0008953845826908946,
-0.017852552235126495,
0.00996228028088808,
0.032622080296278,
-0.05319609493017197,
-0.006460951641201973,
-0.05286981165409088,
-0.04494954273104668,
-0.023955009877681732,
-0.013426873832941055,
-0.06332274526357651,
0.013556419871747494,
0.027411872521042824,
-0.04897027462720871,
-0.03721797838807106,
-0.028786737471818924,
-0.050661198794841766,
0.006781710311770439,
0.03603420406579971,
-0.019567806273698807,
-0.028215492144227028,
0.026296913623809814,
0.052378732711076736,
0.05791293457150459,
0.008481759577989578,
0.010218242183327675,
-0.040513742715120316,
0.020235994830727577,
0.02263426035642624,
-0.010685748420655727,
-0.07758796215057373,
-0.012160621583461761,
0.020305071026086807,
-0.057956263422966,
-0.05166096240282059,
0.0005019238451495767,
-0.013470686972141266,
-0.05587000772356987,
0.01048594992607832,
0.04696323350071907,
-0.0009664282551966608,
0.01630348712205887,
-0.005232725292444229,
0.03909910470247269,
-0.05127964913845062,
-0.015305731445550919,
0.049622904509305954,
-0.048471659421920776,
-0.019233085215091705,
0.05644480884075165,
0.013328568078577518,
0.00444662943482399,
0.03567923605442047,
-4.259140028659593e-33,
0.05717455595731735,
-0.03490258753299713,
0.0022391686215996742,
-0.012700977735221386,
0.013065975159406662,
0.07268574088811874,
-0.0755624920129776,
0.005449042655527592,
-0.052374258637428284,
0.00009424574818694964,
0.018934216350317,
0.035616252571344376,
0.029292216524481773,
0.030020806938409805,
-0.06455335766077042,
-0.033700987696647644,
0.013737901113927364,
-0.020873231813311577,
0.002594142686575651,
0.02858186513185501,
-0.013673678040504456,
0.021472685039043427,
-0.06096074730157852,
0.003521483391523361,
0.029351549223065376,
-0.03523042052984238,
0.04876619577407837,
-0.003918986767530441,
-0.04850824922323227,
0.024460097774863243,
0.034552231431007385,
0.00656350702047348,
-0.021482691168785095,
-0.0074279154650866985,
0.002478499198332429,
0.019065070897340775,
-0.015752064064145088,
-0.024482863023877144,
0.05011998489499092,
-0.008868069387972355,
-0.05736437067389488,
-0.0005732905119657516,
0.05151404067873955,
-0.005223436746746302,
0.0021697739139199257,
-0.010885877534747124,
0.00104971241671592,
0.02935529127717018,
-0.013785967603325844,
-0.0324079692363739,
-0.015293635427951813,
0.0034398704301565886,
-0.006248097866773605,
0.024307547137141228,
-0.03866389021277428,
0.009784452617168427,
0.014582858420908451,
-0.0052802381105721,
0.03680096194148064,
0.03565783426165581,
-0.05598187446594238,
0.028898874297738075,
0.033267680555582047,
-0.05514480173587799,
-0.0470498725771904,
-0.017159616574645042,
-0.035371653735637665,
0.029424479231238365,
-0.024488957598805428,
-0.015264973044395447,
-0.03831857815384865,
-0.041204676032066345,
-0.00040942238410934806,
-0.028514044359326363,
-0.008682005107402802,
-0.007023388985544443,
0.00878364872187376,
0.0005227096262387931,
0.0666932463645935,
0.07867663353681564,
-0.034396059811115265,
-0.010918434709310532,
-0.03491084277629852,
-0.007630423177033663,
-0.03359655290842056,
0.0023184858728200197,
-0.023353448137640953,
-0.02461722493171692,
-0.023132137954235077,
-0.041407760232686996,
0.0996408611536026,
0.08031757920980453,
0.057526517659425735,
0.043347422033548355,
-0.005189890041947365,
0.04485131427645683,
0.030080363154411316,
0.031938448548316956,
-0.03108108416199684,
0.030128872022032738,
0.07691626995801926,
-0.00037197154597379267,
0.10137421637773514,
-0.06766903400421143,
-0.04134230688214302,
-0.011346871964633465,
0.03337719663977623,
-0.004495021887123585,
0.03806772828102112,
0.003274344839155674,
0.0004156684153713286,
0.023430079221725464,
-0.008597515523433685,
-0.03589003533124924,
0.015408010222017765,
0.06847904622554779,
0.023293117061257362,
0.045617297291755676,
0.013269741088151932,
-0.012223288416862488,
0.046646859496831894,
0.04205494746565819,
0.08751946687698364,
0.009814734570682049,
-0.024742864072322845,
-0.0705258920788765,
0.010863714851439,
0.07845102995634079,
-0.028430325910449028,
-0.011982719413936138,
0.0072985864244401455,
0.05688828229904175,
2.284073303826517e-7,
0.05747241899371147,
-0.033436015248298645,
-0.03354792296886444,
-0.054140303283929825,
0.024116279557347298,
-0.06694543361663818,
-0.029069798067212105,
-0.034731425344944,
-0.02631245367228985,
-0.010738018900156021,
0.0867123156785965,
-0.01947348564863205,
0.007469420786947012,
-0.055800095200538635,
0.0757024884223938,
-0.03410593420267105,
0.03142271190881729,
-0.06325115263462067,
0.05269685387611389,
-0.011674375273287296,
0.0329056978225708,
-0.05449385195970535,
-0.05424630641937256,
-0.011277507059276104,
-0.034442074596881866,
-0.025830646976828575,
-0.01866995543241501,
-0.040849097073078156,
-0.0014877866487950087,
-0.007064112927764654,
-0.0011080787517130375,
0.04367915913462639,
0.03264859318733215,
0.08055028319358826,
-0.0584576390683651,
-0.020566919818520546,
0.021373627707362175,
0.040247026830911636,
0.0004371769609861076,
-0.03299481421709061,
0.008061499334871769,
0.021434161812067032,
0.01655997708439827,
0.025936711579561234,
-0.034433428198099136,
0.05456123501062393,
-0.014971718192100525,
-0.02953503653407097,
0.009854436852037907,
0.03181295096874237,
0.01936887390911579,
0.029435712844133377,
-0.05131528899073601,
0.061143793165683746,
0.02688273787498474,
0.06688734889030457,
-0.029020069167017937,
0.024336248636245728,
0.047257523983716965,
0.028498277068138123,
-0.01796497404575348,
-0.04571182653307915,
0.01358445268124342,
-0.013197403401136398,
0.10730583220720291,
-0.062027882784605026,
-0.012349608354270458,
9.72236798680099e-35,
-0.03761129826307297,
-0.020704254508018494,
0.04512195661664009,
-0.002840436762198806,
-0.0006836206302978098,
0.02710341475903988,
-0.009804249741137028,
0.014045332558453083,
0.009945053607225418,
-0.0766696184873581,
-0.013618001714348793
] | {
"ds_index": 96,
"similar_dg_indices": [
748606,
1153528,
733732,
1109119,
550851,
19145,
752756,
564532,
208391,
707963,
727717,
788939,
78342,
1182960,
845876,
1125013,
358575,
315208,
1198177,
473130
]
} |
A 57-year-old post-menopausal woman comes to the physician because of intermittent, bloody post-coital vaginal discharge for the past month. She does not have pain with intercourse. Eleven years ago, she had LSIL on a routine Pap smear and testing for high-risk HPV strains was positive. Colposcopy showed CIN 1. She has not returned for follow-up Pap smears since then. She is sexually active with her husband only, and they do not use condoms. She has smoked half a pack of cigarettes per day for the past 25 years and does not drink alcohol. On speculum exam, a 1.4 cm, erythematous exophytic mass with ulceration is noted on the posterior wall of the upper third of the vagina. Which of the following is the most probable histopathology of this mass? | Squamous cell carcinoma | {
"A": "Squamous cell carcinoma",
"B": "Basal cell carcinoma",
"C": "Melanoma",
"D": "Sarcoma botryoides"
} | step2&3 | A | [
"57 year old post-menopausal woman",
"physician",
"of intermittent",
"bloody post-coital vaginal discharge",
"past month",
"not",
"pain with intercourse",
"Eleven years",
"LSIL",
"routine Pap smear",
"testing",
"high-risk HPV strains",
"positive",
"Colposcopy showed CIN 1",
"not returned",
"follow-up Pap smears",
"then",
"sexually active",
"husband only",
"not use condoms",
"smoked half",
"pack",
"cigarettes",
"day",
"past",
"years",
"not drink alcohol",
"speculum exam",
"erythematous exophytic mass",
"ulceration",
"noted",
"posterior wall of",
"upper third of",
"vagina",
"following",
"most probable histopathology",
"mass"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 57-year-old post-menopausal woman comes to the physician because of intermittent, bloody post-coital vaginal discharge for the past month. She does not have pain with intercourse. Eleven years ago, she had LSIL on a routine Pap smear and testing for high-risk HPV strains was positive. Colposcopy showed CIN 1. She has not returned for follow-up Pap smears since then. She is sexually active with her husband only, and they do not use condoms. She has smoked half a pack of cigarettes per day for the past 25 years and does not drink alcohol. On speculum exam, a 1.4 cm, erythematous exophytic mass with ulceration is noted on the posterior wall of the upper third of the vagina. Which of the following is the most probable histopathology of this mass?
Choose one of the following::
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Sarcoma botryoides | [
0.028363525867462158,
-0.025061337277293205,
0.024171998724341393,
-0.03720136731863022,
0.023172160610556602,
0.00901395920664072,
0.0062563191168010235,
-0.011422082781791687,
0.030065609142184258,
-0.012961727567017078,
0.08130498975515366,
0.00827228557318449,
0.005170868244022131,
-0.02215683087706566,
-0.004866758827120066,
0.065902478992939,
-0.02374354749917984,
0.04750044271349907,
-0.03753435239195824,
-0.002814748091623187,
-0.04099622368812561,
-0.022240014746785164,
0.04040693864226341,
0.03408670797944069,
0.04411228373646736,
0.02887476421892643,
-0.0333443246781826,
0.027503810822963715,
-0.005227046087384224,
-0.02274876832962036,
0.05593619868159294,
-0.004724869038909674,
-0.0054145269095897675,
-0.03767991065979004,
0.0000017507214806755655,
-0.06811606138944626,
0.03245246037840843,
-0.06797406077384949,
0.046278271824121475,
0.001208881731145084,
-0.019495436921715736,
0.028602786362171173,
0.03484532982110977,
0.02757193334400654,
0.032273177057504654,
-0.08892549574375153,
-0.006922950502485037,
-0.006071079056710005,
-0.0007232382777146995,
0.026077283546328545,
-0.012254461646080017,
-0.0045088822953403,
-0.03532130643725395,
0.005453534424304962,
0.0910196453332901,
0.029916632920503616,
0.028263524174690247,
-0.006388287525624037,
-0.07109717279672623,
-0.04510997608304024,
0.03851522132754326,
-0.04673273116350174,
-0.016854532063007355,
0.018741555511951447,
-0.02696356363594532,
-0.024914907291531563,
0.06745366007089615,
-0.03025692328810692,
0.017216231673955917,
-0.01839415729045868,
0.042902637273073196,
-0.020434483885765076,
0.029033856466412544,
0.05770730599761009,
-0.05603785067796707,
0.01508096419274807,
0.01768016628921032,
-0.02297179587185383,
-0.0077084437943995,
0.03657156601548195,
0.0745534747838974,
0.055739160627126694,
-0.02178107760846615,
0.05116023123264313,
-0.004029282368719578,
-0.05215080827474594,
0.024259228259325027,
0.01758551597595215,
0.04422242194414139,
-0.014963062480092049,
-0.007190972566604614,
-0.0539587140083313,
0.020740719512104988,
0.04912419244647026,
-0.01701126992702484,
-0.00841472763568163,
0.0063263424672186375,
-0.030849570408463478,
0.05759409815073013,
-0.05426374077796936,
-0.011307998560369015,
-0.01215654332190752,
0.01787855289876461,
0.04273686558008194,
-0.036718592047691345,
-0.008779987692832947,
-0.019327454268932343,
0.019312933087348938,
0.008115559816360474,
0.023385677486658096,
0.0572846494615078,
0.011978372000157833,
-0.004299032501876354,
-0.00804310105741024,
0.08223160356283188,
-0.02835753932595253,
-0.08933006972074509,
-0.0522368922829628,
0.004465712700039148,
0.07134772092103958,
-0.03449799492955208,
0.011148717254400253,
-0.019368045032024384,
0.048021648079156876,
0.03773890435695648,
0.045242637395858765,
0.017196595668792725,
-0.049049556255340576,
0.04070363938808441,
-0.003193840617313981,
0.01424867007881403,
0.0333360955119133,
-0.028034072369337082,
0.017244020476937294,
0.01635059155523777,
0.005024309270083904,
-0.022402336820960045,
-0.010078761726617813,
0.03299722075462341,
0.05936247482895851,
-0.038699500262737274,
-0.013320502825081348,
0.020702818408608437,
-0.004293546080589294,
-0.0185339767485857,
0.023757953196763992,
-0.022582881152629852,
0.03107837587594986,
0.038734760135412216,
0.023661043494939804,
-0.0345165878534317,
-0.03151186183094978,
-0.016475627198815346,
0.004605167079716921,
0.011476120911538601,
0.0014468420995399356,
0.016713378950953484,
-0.05223130062222481,
0.0014451444149017334,
-0.0145492572337389,
0.007889116182923317,
-0.02762129157781601,
-0.00243891729041934,
0.00107574334833771,
0.015891017392277718,
0.048189375549554825,
0.03028811886906624,
0.0759199783205986,
-0.052685197442770004,
0.039814263582229614,
-0.03703607991337776,
-0.008300497196614742,
0.015038685873150826,
0.000824875955004245,
-0.04587525129318237,
-0.02379954606294632,
-0.048250820487737656,
-0.014296788722276688,
-0.004651125054806471,
0.060803089290857315,
0.005491142626851797,
0.03585514798760414,
0.018070928752422333,
-0.0974443256855011,
-0.0076230172999203205,
0.012464284896850586,
0.031852979212999344,
-0.0656295195221901,
-0.005706730764359236,
-0.06297218799591064,
-0.010646365582942963,
0.051522236317396164,
-0.05593007802963257,
-0.010419021360576153,
-0.002294104779139161,
0.04021727666258812,
-0.028903838247060776,
-0.04321466013789177,
-0.002495083026587963,
0.036264702677726746,
0.00263163261115551,
-0.06077340990304947,
0.07258477807044983,
0.03842761367559433,
-0.03895669803023338,
0.026632174849510193,
-0.04704378545284271,
0.011636237613856792,
-0.05900163948535919,
-0.061179257929325104,
-0.011237064376473427,
-0.007980707101523876,
0.02804630436003208,
-0.06149763613939285,
0.03731748089194298,
0.05338555946946144,
-0.005159318912774324,
0.055508989840745926,
-0.0009685051045380533,
-0.0019354328978806734,
0.03018888458609581,
-0.03498305007815361,
0.02151178941130638,
0.02114485576748848,
-0.0014407809358090162,
-0.04050188511610031,
-0.04749102145433426,
-0.0026428932324051857,
0.019678199663758278,
-0.05769123509526253,
0.029043911024928093,
0.05208567529916763,
-0.041136253625154495,
0.046447768807411194,
0.012264972552657127,
0.009982838295400143,
0.019176431000232697,
0.015221083536744118,
0.040693603456020355,
-0.01089156698435545,
-0.045721281319856644,
0.03349898010492325,
-0.009572680108249187,
0.004949387162923813,
-0.04163271188735962,
-0.0329749695956707,
-0.04136421158909798,
0.0042271800339221954,
-0.029354678466916084,
0.027704931795597076,
-0.03733506798744202,
-0.0007532138261012733,
0.020036229863762856,
-0.0031863010954111814,
0.025899041444063187,
0.03950784355401993,
-0.052542850375175476,
0.030699817463755608,
-0.03852642700076103,
-0.07962902635335922,
0.010727808810770512,
0.004377695266157389,
-0.008731745183467865,
-0.031655412167310715,
0.00506041431799531,
-0.062160927802324295,
-0.014566448517143726,
-0.012752082198858261,
-0.007840954698622227,
0.008595182560384274,
-0.017549099400639534,
0.05143444240093231,
0.0022766103502362967,
0.024186890572309494,
-0.03392704203724861,
-0.02277209982275963,
-0.010976651683449745,
0.08286832273006439,
0.0644911453127861,
0.029827259480953217,
0.03849325701594353,
0.05579344928264618,
-0.028310643509030342,
0.004621794912964106,
0.013276288285851479,
-0.005983765237033367,
-0.0034328745678067207,
-0.02531096339225769,
0.03448302298784256,
0.031325411051511765,
0.03325025737285614,
-0.03206762298941612,
0.010208256542682648,
-0.05374663323163986,
-0.06948258727788925,
-0.03690546005964279,
-0.0455893836915493,
0.03364769369363785,
-0.04099918156862259,
0.056478630751371384,
0.013858861289918423,
-0.030528150498867035,
-0.0480334535241127,
-0.02096780762076378,
-0.010727569460868835,
0.010240854695439339,
0.0031854831613600254,
0.058966949582099915,
0.005767999682575464,
-0.022242484614253044,
-0.01129383035004139,
0.009566081687808037,
0.00523154204711318,
-0.015762843191623688,
0.012593794614076614,
-0.043775927275419235,
0.0007970649749040604,
-0.09821818768978119,
0.07285919040441513,
0.0038885860703885555,
0.030241169035434723,
0.023986464366316795,
-0.031078455969691277,
-0.025230996310710907,
-0.033090170472860336,
0.0003767609305214137,
0.023491866886615753,
0.03926226496696472,
-0.012285563163459301,
-0.018328730016946793,
-0.025744719430804253,
-0.05772718787193298,
-0.0498264878988266,
0.002995277289301157,
0.03341028094291687,
0.0036782154347747564,
-0.08113891631364822,
0.0051453979685902596,
-0.015465757809579372,
0.013002016581594944,
0.06809067726135254,
-0.02939973957836628,
-0.022282157093286514,
-0.003477382240816951,
0.05620545521378517,
-0.0016355318948626518,
-0.07657741755247116,
0.06701315194368362,
-0.01981700398027897,
0.017532432451844215,
-0.07431064546108246,
0.027625728398561478,
0.0024640385527163744,
-0.02258238010108471,
-0.03977322578430176,
0.04344639554619789,
0.021703090518712997,
0.02862645499408245,
-0.0060998499393463135,
0.009107483550906181,
-0.007693938445299864,
-0.015369937755167484,
-0.05709369108080864,
0.046473730355501175,
0.006331264041364193,
0.008889229036867619,
0.048948053270578384,
-0.02084515243768692,
0.004969743080437183,
-0.02896568924188614,
0.0026805505622178316,
-0.05121661722660065,
-0.040553539991378784,
0.0056038894690573215,
-0.025691941380500793,
-0.008577932603657246,
0.01022973470389843,
-0.011565722525119781,
-0.028029071167111397,
-0.021205082535743713,
0.074964739382267,
-0.01758217066526413,
0.05225592851638794,
-0.012355162762105465,
-0.06732025742530823,
0.037268735468387604,
-0.03799927234649658,
-0.01985221356153488,
0.02919764257967472,
0.019646666944026947,
0.0022826271597296,
0.01427135244011879,
0.007158411201089621,
-0.04800665006041527,
0.01771646924316883,
-0.011837559752166271,
-0.04905864596366882,
-0.03988313674926758,
0.05129430070519447,
0.07059311866760254,
-0.024053391069173813,
0.0396345816552639,
-0.013479991815984249,
0.03921876847743988,
0.05854225158691406,
-0.09910961240530014,
-0.04694543033838272,
-0.033552635461091995,
-0.04415102303028107,
0.07136900722980499,
0.01606413535773754,
-0.017417065799236298,
0.004376609809696674,
0.02281590737402439,
0.02030002325773239,
-0.02280323952436447,
-0.0018671428551897407,
-0.03780898079276085,
-0.01647139899432659,
-0.021472256630659103,
0.05071565881371498,
-0.0158955417573452,
-0.03565247729420662,
0.003517986973747611,
0.018835144117474556,
0.024187728762626648,
0.060265250504016876,
0.0163678377866745,
0.018001899123191833,
0.016621937975287437,
-0.012699484825134277,
-0.0149631816893816,
0.0368608795106411,
0.074420265853405,
0.057009514421224594,
0.06973429769277573,
0.032975878566503525,
0.05607232451438904,
-0.042690735310316086,
0.00005062037234893069,
-0.04598459601402283,
0.021163804456591606,
0.04066130891442299,
0.0752110630273819,
-0.02313566394150257,
-0.05964043363928795,
0.01177375391125679,
-0.06021902337670326,
0.00021921965526416898,
0.0921216756105423,
-0.032750099897384644,
0.029334431514143944,
0.026998434215784073,
0.015686385333538055,
0.008672546595335007,
0.036467295140028,
0.06995155662298203,
-0.016982220113277435,
0.01252948958426714,
-0.019521549344062805,
-0.05994957685470581,
0.024426408112049103,
-0.01881990022957325,
-0.06317386776208878,
-0.024143481627106667,
0.003467331640422344,
-0.040032271295785904,
0.010663589462637901,
-0.027660096064209938,
-0.04763999581336975,
-0.017813371494412422,
0.05103721097111702,
-0.02413925714790821,
-0.005709805991500616,
-0.07031618058681488,
0.0049260822124779224,
-0.050611577928066254,
-0.05425041913986206,
-0.009088980965316296,
0.028554175049066544,
0.045566536486148834,
0.000498179579153657,
-0.03431736305356026,
0.0002843136026058346,
0.01413747388869524,
-0.01126831118017435,
0.06002799794077873,
-0.0116442134603858,
-0.03701389208436012,
-0.003920834045857191,
-0.0674717053771019,
-0.015365355648100376,
-0.03457692638039589,
0.04221649840474129,
0.03136829659342766,
-0.0004106474225409329,
0.0006258907960727811,
0.0038446318358182907,
0.021675100550055504,
-0.03620412200689316,
0.06886450201272964,
0.02270796336233616,
-0.005650464445352554,
-0.05765753611922264,
0.010329868644475937,
-0.020967166870832443,
0.0004819101595785469,
-0.02456628903746605,
0.0018380690598860383,
-0.04146667942404747,
0.03664093464612961,
-0.014603004790842533,
-0.023335237056016922,
0.005675002466887236,
0.03747919946908951,
-0.0173196978867054,
-0.03180105239152908,
-0.062281083315610886,
-0.016549915075302124,
0.011522091925144196,
0.025317205116152763,
-0.028152434155344963,
0.030420273542404175,
-0.04988303780555725,
-0.026906589046120644,
0.014207598753273487,
0.02276734448969364,
-0.013200011104345322,
-0.005331782158464193,
0.0015503981849178672,
-0.011542970314621925,
-0.005858028773218393,
-0.03316390514373779,
0.023078933358192444,
-0.08473361283540726,
0.009097283706068993,
0.014765963889658451,
0.05304773524403572,
-0.005389479920268059,
-0.037439409643411636,
-0.02308223955333233,
0.0006631097057834268,
-0.01803096942603588,
0.0014109481126070023,
0.043833062052726746,
0.041349101811647415,
-0.04441105201840401,
0.039281319826841354,
0.04701763764023781,
-0.03204374387860298,
-0.024364598095417023,
0.07267628610134125,
-0.006185105536133051,
0.02427017316222191,
0.006569114979356527,
-4.519054319253878e-33,
-0.008298942819237709,
-0.055208589881658554,
0.03482804447412491,
-0.06762942671775818,
0.005735720973461866,
0.054983943700790405,
-0.03578690066933632,
0.0281368475407362,
-0.05707988142967224,
0.032395053654909134,
0.003462974214926362,
-0.01528637669980526,
0.04180285707116127,
0.03268054500222206,
-0.05051717907190323,
0.032658372074365616,
0.0015351134352385998,
-0.019099660217761993,
-0.03559401258826256,
-0.02944941632449627,
-0.006272512022405863,
-0.008153070695698261,
-0.007586274296045303,
-0.0648837462067604,
-0.019837886095046997,
0.026865841820836067,
0.0659886971116066,
-0.007536958437412977,
-0.025878313928842545,
-0.0305173397064209,
0.014696639962494373,
-0.025378715246915817,
0.021227480843663216,
0.016500085592269897,
-0.007841276936233044,
-0.015947427600622177,
-0.0131542282178998,
-0.045037150382995605,
0.03272594138979912,
0.03814574331045151,
-0.020568206906318665,
-0.023190924897789955,
0.04358331114053726,
0.03132902830839157,
0.023071585223078728,
-0.05684909597039223,
0.00871611014008522,
-0.00921767856925726,
-0.004712849389761686,
-0.05085118114948273,
0.00467304140329361,
0.007588118314743042,
0.043553005903959274,
-0.006716841831803322,
-0.052667926996946335,
-0.0019086891552433372,
-0.05038876086473465,
0.07265545427799225,
0.01230556983500719,
0.015575217083096504,
-0.008922932669520378,
0.0015293136239051819,
0.02733783982694149,
-0.058228738605976105,
-0.0025286441668868065,
-0.00018122736946679652,
0.0315718799829483,
-0.041318606585264206,
-0.042288441210985184,
0.015185956843197346,
-0.0422966405749321,
0.0553901381790638,
-0.06037003546953201,
-0.09797174483537674,
0.02410394884645939,
0.02788820117712021,
0.000540129141882062,
-0.0357755571603775,
0.06450773030519485,
-0.006213664542883635,
-0.02787214331328869,
-0.056544698774814606,
-0.05048491433262825,
0.037582848221063614,
-0.04335492476820946,
-0.05639355629682541,
0.0323140025138855,
-0.07696103304624557,
0.012514039874076843,
-0.029143689200282097,
0.10300392657518387,
0.038225434720516205,
-0.05078032612800598,
0.007518038619309664,
-0.025941895321011543,
-0.07300596684217453,
0.04714528098702431,
0.0063390666618943214,
-0.03184470906853676,
0.02119235321879387,
0.05469974875450134,
0.04457959160208702,
-0.03422192484140396,
-0.07877011597156525,
-0.013171660713851452,
0.01869916170835495,
-0.00004011354030808434,
-0.008667733520269394,
-0.0438232384622097,
-0.007748854346573353,
0.019636614248156548,
0.037565089762210846,
0.03121800906956196,
0.03867325931787491,
0.014156998135149479,
0.028575710952281952,
-0.019837472587823868,
0.06262852996587753,
0.03424188867211342,
0.06162705644965172,
0.07755732536315918,
-0.059869565069675446,
0.030621714890003204,
0.05202256515622139,
-0.02863921783864498,
-0.015717631205916405,
0.007250657305121422,
0.015692874789237976,
-0.030795715749263763,
0.028082258999347687,
0.02212948352098465,
0.036572474986314774,
2.457675236655632e-7,
0.022078273817896843,
-0.03892317786812782,
0.03236796334385872,
-0.03855524957180023,
0.019707316532731056,
-0.048330292105674744,
-0.0004414838913362473,
-0.009270775131881237,
-0.016594145447015762,
-0.020327704027295113,
-0.004954805597662926,
0.030768515542149544,
-0.01934390887618065,
-0.023447560146450996,
0.017689049243927002,
0.011168940924108028,
0.020953895524144173,
0.029894128441810608,
0.034811943769454956,
0.07792872935533524,
0.020523330196738243,
-0.027236970141530037,
-0.022509030997753143,
-0.01370014064013958,
0.005304388701915741,
0.06722462922334671,
0.01939964108169079,
-0.042020488530397415,
-0.062346212565898895,
0.0025250844191759825,
-0.013189095072448254,
-0.01931138150393963,
0.012712609954178333,
0.04527820274233818,
-0.02422039769589901,
0.0015395160298794508,
0.03459874540567398,
0.033369578421115875,
0.07351512461900711,
0.0006537220906466246,
0.02393856830894947,
0.0009254355682060122,
0.01531354058533907,
0.003392578335478902,
-0.006666811183094978,
0.014574349857866764,
-0.044941384345293045,
0.010018068365752697,
0.001983379013836384,
0.023574359714984894,
-0.03356126695871353,
0.010578097775578499,
-0.01429278776049614,
0.09529867023229599,
-0.009276768192648888,
0.029342683032155037,
-0.03988407552242279,
0.03930096700787544,
-0.020494047552347183,
-0.025323349982500076,
0.015556070022284985,
-0.04985373839735985,
-0.006355513818562031,
0.006935398560017347,
0.0401434525847435,
-0.015771744772791862,
-0.04392033442854881,
1.8257618692797195e-34,
-0.04742194339632988,
-0.017811136320233345,
-0.015418484807014465,
-0.03426747024059296,
-0.07215171307325363,
-0.014167813584208488,
0.07344195991754532,
0.028911380097270012,
-0.007268325425684452,
-0.0029534902423620224,
-0.002855096710845828
] | {
"ds_index": 97,
"similar_dg_indices": [
48289,
176721,
935942,
1066119,
582672,
398274,
1184205,
279025,
808309,
1202558,
894194,
143875,
903264,
466472,
19326,
1149031,
264914,
702940,
1194191,
733599
]
} |
Three days after starting a new drug for malaria prophylaxis, a 19-year-old college student comes to the physician because of dark-colored urine and fatigue. He has not had any fever, dysuria, or abdominal pain. He has no history of serious illness. Physical examination shows scleral icterus. Laboratory studies show a hemoglobin of 9.7 g/dL and serum lactate dehydrogenase of 234 U/L. Peripheral blood smear shows poikilocytes with bite-shaped irregularities. Which of the following drugs has the patient most likely been taking? | Primaquine | {
"A": "Primaquine",
"B": "Dapsone",
"C": "Ivermectin",
"D": "Doxycycline"
} | step1 | A | [
"Three days",
"starting",
"new",
"malaria",
"year old college student",
"physician",
"dark-colored urine",
"fatigue",
"not",
"fever",
"dysuria",
"abdominal pain",
"history",
"serious illness",
"Physical examination shows scleral icterus",
"Laboratory studies show a hemoglobin",
"g/dL",
"serum lactate dehydrogenase",
"234 U L",
"Peripheral blood smear shows poikilocytes",
"bite shaped irregularities",
"following drugs",
"patient",
"likely",
"taking"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Three days after starting a new drug for malaria prophylaxis, a 19-year-old college student comes to the physician because of dark-colored urine and fatigue. He has not had any fever, dysuria, or abdominal pain. He has no history of serious illness. Physical examination shows scleral icterus. Laboratory studies show a hemoglobin of 9.7 g/dL and serum lactate dehydrogenase of 234 U/L. Peripheral blood smear shows poikilocytes with bite-shaped irregularities. Which of the following drugs has the patient most likely been taking?
Choose one of the following::
A. Primaquine
B. Dapsone
C. Ivermectin
D. Doxycycline | [
0.04559317231178284,
-0.06589709967374802,
0.04631403088569641,
0.020181942731142044,
0.0018381165573373437,
0.004463150631636381,
0.008589895442128181,
0.01656699739396572,
-0.012704852968454361,
0.012137566693127155,
0.008139482699334621,
0.04468204453587532,
-0.0198079664260149,
-0.06410140544176102,
0.04765090346336365,
0.0778183788061142,
-0.02046855539083481,
-0.018455354496836662,
-0.06202201917767525,
0.016415756195783615,
-0.01604069210588932,
0.01703975535929203,
0.03934416547417641,
0.014824523590505123,
0.042474668473005295,
-0.054284848272800446,
-0.013875746168196201,
-0.014484938234090805,
-0.01837550476193428,
0.007527727168053389,
0.018632039427757263,
0.0019121546065434813,
-0.0511251799762249,
-0.08501701802015305,
0.0000011990093753411202,
-0.01949901506304741,
0.03720185160636902,
-0.002555547282099724,
0.04201163724064827,
-0.03705566003918648,
0.018140222877264023,
-0.04821024835109711,
0.05037202686071396,
-0.02180919237434864,
-0.023484669625759125,
0.015201525762677193,
-0.024543924257159233,
0.07526007294654846,
-0.07091280072927475,
0.010149824433028698,
0.03909064829349518,
0.05599074438214302,
-0.007752369623631239,
0.0037667190190404654,
0.09923847764730453,
-0.05965610221028328,
-0.025933878496289253,
0.01580832339823246,
0.007297582924365997,
0.015339343808591366,
0.014049147255718708,
-0.015002816915512085,
-0.03999714180827141,
-0.019373176619410515,
-0.034546297043561935,
-0.04163782298564911,
0.03250529244542122,
-0.0626705214381218,
0.014974548481404781,
-0.010370288044214249,
-0.026281172409653664,
-0.009579140692949295,
0.052011650055646896,
0.056515857577323914,
0.0017577334074303508,
0.027037471532821655,
0.04596943035721779,
-0.01804002933204174,
-0.016526462510228157,
-0.053397901356220245,
0.08624094724655151,
0.03605126962065697,
0.003482011379674077,
0.08010216057300568,
-0.017887547612190247,
-0.0038385684601962566,
-0.004638737067580223,
0.025027398020029068,
-0.0038356459699571133,
-0.011483293026685715,
0.06879793107509613,
-0.016944333910942078,
0.03595637530088425,
0.015174194239079952,
-0.02451983094215393,
0.006837617605924606,
0.02689516544342041,
-0.022784577682614326,
0.03325091674923897,
-0.06328785419464111,
0.04176141321659088,
-0.034180622547864914,
-0.014028186909854412,
0.05993705987930298,
-0.050929680466651917,
0.0020449720323085785,
0.02075919881463051,
-0.00938516203314066,
-0.026331087574362755,
0.027850227430462837,
-0.006958785932511091,
0.01098617259413004,
-0.016387198120355606,
-0.01700894720852375,
0.08693558722734451,
-0.042728520929813385,
-0.015310202725231647,
0.014044699259102345,
-0.02530663274228573,
-0.00620468333363533,
-0.010845205746591091,
0.02698335610330105,
0.003911697771400213,
0.014880443923175335,
0.012616407126188278,
0.018603093922138214,
-0.017258763313293457,
0.022884506732225418,
-0.02008715644478798,
-0.010462595149874687,
0.0015803348505869508,
-0.04092787578701973,
-0.049801990389823914,
0.02709147334098816,
0.002162272110581398,
0.04125386103987694,
0.04102477431297302,
0.04925552383065224,
-0.05329947918653488,
-0.03139752894639969,
0.020740624517202377,
-0.024347007274627686,
0.02970746159553528,
0.006582840345799923,
0.01574886590242386,
0.015023523010313511,
-0.009988666512072086,
-0.007555743679404259,
-0.009868346154689789,
0.04934125021100044,
-0.006512381136417389,
0.0007925613317638636,
0.014355223625898361,
-0.0036430014297366142,
-0.006100154016166925,
-0.020382119342684746,
-0.002071681432425976,
-0.0041646347381174564,
-0.01981283351778984,
-0.023171434178948402,
0.030019527301192284,
-0.018878672271966934,
0.06678406894207001,
-0.00666531128808856,
-0.03598620370030403,
0.03345200791954994,
0.019871138036251068,
0.03386980667710304,
-0.03412795439362526,
0.007279080804437399,
-0.028635350987315178,
-0.0034675542265176773,
0.03132794052362442,
0.005446590483188629,
-0.042798954993486404,
0.000784832052886486,
-0.003209759248420596,
-0.033706557005643845,
0.0007105092518031597,
-0.055705029517412186,
0.027990752831101418,
0.040106236934661865,
0.054206255823373795,
-0.03137391060590744,
-0.025669587776064873,
0.013475253246724606,
-0.013086778111755848,
-0.03760095313191414,
0.04719933494925499,
0.019223948940634727,
-0.0011205322807654738,
-0.007512595970183611,
-0.019510462880134583,
0.026263825595378876,
-0.018240880221128464,
0.011209815740585327,
-0.07838965952396393,
-0.005813469644635916,
0.03191916272044182,
-0.010023262351751328,
-0.0621490478515625,
-0.0006993114948272705,
0.021894579753279686,
0.05611809715628624,
-0.08385732769966125,
0.0711965560913086,
0.014032194390892982,
0.016044633463025093,
-0.06063316389918327,
0.015371943823993206,
-0.050071846693754196,
-0.016646312549710274,
0.059797488152980804,
-0.030924860388040543,
0.032372504472732544,
0.02102511003613472,
-0.001009437721222639,
-0.007963648065924644,
-0.03657318279147148,
0.0234527550637722,
0.0024315945338457823,
-0.0673171877861023,
-0.011180969886481762,
-0.01001235656440258,
-0.03885268047451973,
-0.009006201289594173,
0.02762545645236969,
0.026462655514478683,
-0.03829733654856682,
-0.05428143963217735,
0.05111504718661308,
0.004898899234831333,
-0.028918061405420303,
-0.0022940230555832386,
-0.0259660966694355,
0.015540428459644318,
0.054677192121744156,
-0.035633888095617294,
-0.020996849983930588,
0.05117051675915718,
0.04620818793773651,
-0.033661581575870514,
-0.06538431346416473,
0.010341919958591461,
0.06315965950489044,
0.020500535145401955,
-0.019855832681059837,
0.018077302724123,
-0.04146891087293625,
0.029662203043699265,
-0.018866581842303276,
-0.01888171024620533,
-0.005882857833057642,
0.020357202738523483,
-0.03329002857208252,
0.020263997837901115,
-0.07746034115552902,
0.01587132178246975,
-0.0044762627221643925,
-0.00969698280096054,
-0.022546695545315742,
0.029343755915760994,
0.03974599391222,
-0.037375763058662415,
-0.04914606362581253,
-0.00511829974129796,
-0.01902741938829422,
0.01674586907029152,
-0.06338858604431152,
0.06666044145822525,
-0.012111596763134003,
-0.00742217106744647,
0.014408511109650135,
0.020754924044013023,
-0.044842638075351715,
0.007410512771457434,
-0.05013135075569153,
0.023437853902578354,
0.01000089943408966,
-0.02909063547849655,
0.010453959926962852,
0.09188778698444366,
0.0014594235690310597,
0.05234595388174057,
0.03082289732992649,
0.03391231968998909,
-0.02995412051677704,
-0.0447213388979435,
0.039817895740270615,
0.024499882012605667,
-0.05435514450073242,
-0.0046381340362131596,
-0.0005942644202150404,
0.008612435311079025,
0.038763243705034256,
-0.0024492244701832533,
-0.05675893649458885,
0.07489917427301407,
-0.020805723965168,
0.020141538232564926,
0.03948909416794777,
0.025480132550001144,
0.008871408179402351,
0.013565531000494957,
-0.006753407884389162,
0.046980418264865875,
0.043624699115753174,
-0.007377917878329754,
-0.0052871606312692165,
0.017210733145475388,
0.012121785432100296,
-0.011795138008892536,
0.015170080587267876,
-0.011301551945507526,
-0.02162916585803032,
-0.02356807515025139,
0.010450252331793308,
-0.028391964733600616,
0.04135821387171745,
-0.011170398443937302,
0.019520387053489685,
-0.012287492863833904,
-0.020256420597434044,
-0.017891552299261093,
0.023960938677191734,
-0.01573597826063633,
0.017765050753951073,
0.045291781425476074,
-0.123866505920887,
-0.026520835235714912,
-0.01778317615389824,
-0.05654570460319519,
0.02026207372546196,
0.0507812425494194,
0.0475502610206604,
0.03195067495107651,
-0.02906895987689495,
0.030761508271098137,
-0.04763628542423248,
0.023785075172781944,
0.02293325401842594,
-0.0029345378279685974,
0.02537716180086136,
0.018374113366007805,
-0.019481448456645012,
-0.051668014377355576,
-0.08938191086053848,
-0.008500988595187664,
0.031962305307388306,
0.03612050414085388,
-0.08945897221565247,
-0.016326507553458214,
0.009665737859904766,
-0.025927335023880005,
0.030910270288586617,
-0.08411763608455658,
0.026144908741116524,
-0.0025829256046563387,
0.006962810643017292,
-0.008396378718316555,
0.02284551039338112,
0.021250689402222633,
-0.023592282086610794,
0.03953985869884491,
0.009572602808475494,
-0.00034775197855196893,
0.010793336667120457,
-0.023067722097039223,
0.0006201358046382666,
-0.006264957133680582,
0.006540267262607813,
0.001668489770963788,
0.040465082973241806,
0.04531048238277435,
-0.01254558190703392,
-0.02064986526966095,
0.03325966000556946,
-0.046893153339624405,
-0.10188687592744827,
-0.07732424139976501,
0.05810924619436264,
-0.04818322882056236,
0.0013804922346025705,
-0.012212386354804039,
0.0013082140358164907,
-0.00020924894488416612,
-0.04798224940896034,
-0.060209788382053375,
0.01804487034678459,
-0.024925069883465767,
0.024551399052143097,
0.012949359603226185,
0.017386676743626595,
-0.02510686032474041,
-0.009359285235404968,
0.030271127820014954,
0.0038274608086794615,
-0.01558226440101862,
0.00481163477525115,
0.061431270092725754,
0.0004749998915940523,
0.014261609874665737,
-0.016786767169833183,
0.06486313045024872,
0.08734874427318573,
-0.06545238941907883,
-0.053451620042324066,
-0.04375381022691727,
0.05359473451972008,
0.09547337889671326,
0.0131354546174407,
-0.06413007527589798,
0.024717113003134727,
0.032539963722229004,
0.028648482635617256,
-0.013329020701348782,
-0.0033058130647987127,
-0.05371423810720444,
0.0027046550530940294,
-0.07702533900737762,
0.08372250944375992,
-0.00835207849740982,
-0.02982822246849537,
-0.08749247342348099,
-0.019366206601262093,
-0.00788833200931549,
0.03259224072098732,
0.016703005880117416,
0.0015251279110088944,
0.042992785573005676,
0.0072977845557034016,
-0.05439998209476471,
-0.01029951125383377,
0.05040058121085167,
-0.07492292672395706,
-0.004191544372588396,
0.0003903282340615988,
0.02130776271224022,
0.026773827150464058,
-0.051025357097387314,
-0.022636128589510918,
0.013034516014158726,
-0.0030667621176689863,
0.01618684083223343,
-0.0014234064146876335,
0.014287183992564678,
-0.0490320585668087,
0.05111902207136154,
0.0015542557230219245,
0.09631940722465515,
0.026068922132253647,
-0.008409527130424976,
0.0019869571551680565,
-0.006114835385233164,
0.042287636548280716,
0.026938721537590027,
-0.007714156527072191,
-0.1051676869392395,
0.020161986351013184,
-0.030565638095140457,
-0.07462317496538162,
0.009431441314518452,
-0.03909803926944733,
-0.04724731296300888,
0.02624848112463951,
-0.028863828629255295,
-0.038415178656578064,
0.09384780377149582,
-0.029284300282597542,
-0.03751404955983162,
0.0037783964071422815,
0.06750720739364624,
0.0017699248855933547,
-0.034103699028491974,
-0.006034516729414463,
-0.018329858779907227,
-0.04068312793970108,
-0.05471925437450409,
0.02588612586259842,
0.028315095230937004,
-0.053524199873209,
0.027384987100958824,
-0.025317607447504997,
-0.07649067789316177,
0.023312054574489594,
-0.007790336851030588,
0.032137878239154816,
0.0002204773190896958,
0.006025622598826885,
-0.0169826690107584,
0.02121785469353199,
0.019260864704847336,
0.008928279392421246,
-0.002020502695813775,
-0.033599406480789185,
0.008001784794032574,
-0.020422419533133507,
-0.0007043553050607443,
0.009595198556780815,
-0.061261169612407684,
0.07946614176034927,
0.03185335546731949,
0.008704597130417824,
0.032037898898124695,
-0.012183924205601215,
0.034300386905670166,
-0.00006600016786251217,
0.06648670136928558,
-0.0392007976770401,
-0.028482593595981598,
0.03230072557926178,
0.041457004845142365,
0.025032611563801765,
0.03483351320028305,
0.026774588972330093,
-0.009023052640259266,
-0.020603403449058533,
-0.0507289357483387,
0.010179243050515652,
0.00761853251606226,
0.004521199967712164,
-0.052595559507608414,
0.011321207508444786,
0.021449364721775055,
-0.002668336732313037,
0.0189199298620224,
0.013881789520382881,
-0.030912868678569794,
-0.004395178519189358,
0.07350412756204605,
0.01973443105816841,
-0.03990895673632622,
-0.024124875664711,
0.009853099472820759,
-0.003460838459432125,
-0.004169648978859186,
-0.06605330854654312,
-0.015501623973250389,
-0.018764201551675797,
0.0469059981405735,
-0.012944607995450497,
0.004139402415603399,
-0.03770238533616066,
-0.042552266269922256,
0.01634877361357212,
0.023752935230731964,
-0.03441065177321434,
0.013088680803775787,
0.017571300268173218,
0.01609126664698124,
0.0034417465794831514,
0.06616531312465668,
0.028188209980726242,
0.04752561077475548,
0.013102112337946892,
-4.080606681340673e-33,
0.09149672836065292,
-0.029400141909718513,
0.00037255906499922276,
-0.07513105124235153,
0.044899094849824905,
0.06491386890411377,
-0.03545291721820831,
-0.014979728497564793,
-0.10121346265077591,
0.02944636344909668,
-0.018938954919576645,
-0.011274770833551884,
0.02453877218067646,
0.045195091515779495,
-0.023378973826766014,
0.01887659728527069,
-0.021767660975456238,
0.036972641944885254,
-0.018361583352088928,
0.002685962012037635,
-0.009708540514111519,
0.004256368149071932,
0.0056869350373744965,
-0.009139620698988438,
0.0029046523850411177,
-0.0663018524646759,
0.06624279916286469,
0.00737577211111784,
-0.0783921405673027,
0.02855532057583332,
0.020386191084980965,
-0.0421743243932724,
0.007004401180893183,
0.029628301039338112,
-0.029496924951672554,
-0.07185937464237213,
0.036006513983011246,
-0.0011254578130319715,
0.051371343433856964,
0.014205727726221085,
-0.04834284260869026,
-0.04909152910113335,
0.02399282343685627,
0.015101009979844093,
0.032912738621234894,
-0.012059061788022518,
-0.04200490564107895,
-0.0014848675346001983,
-0.021480731666088104,
-0.0403326079249382,
0.02621564082801342,
0.02120540477335453,
0.03558898717164993,
-0.03347865119576454,
-0.03210729733109474,
-0.002192189684137702,
0.014947840943932533,
-0.006458057090640068,
0.01066780835390091,
0.024911830201745033,
-0.0720384493470192,
0.022015558555722237,
0.016014961525797844,
0.02336462214589119,
-0.04981506988406181,
0.003984380979090929,
0.021717289462685585,
0.01720745861530304,
-0.02861439622938633,
0.007856478914618492,
-0.08628953993320465,
0.007992176339030266,
-0.03740234673023224,
-0.09688284993171692,
-0.00010760600707726553,
0.019922973588109016,
0.0762443095445633,
-0.010645362548530102,
0.03227386623620987,
0.028222423046827316,
-0.04588710144162178,
-0.010500360280275345,
-0.018577510491013527,
-0.04829771816730499,
0.013544656336307526,
0.019831666722893715,
-0.014803530648350716,
-0.007759063504636288,
-0.011858697980642319,
-0.06149155646562576,
0.040425729006528854,
0.021555308252573013,
0.025394022464752197,
0.012585945427417755,
-0.028278570622205734,
0.0200228039175272,
-0.04206717014312744,
0.04668178781867027,
0.010721760801970959,
0.0021437492687255144,
0.022601168602705002,
0.041714251041412354,
0.0162388626486063,
-0.03532904386520386,
-0.0416245199739933,
0.029308529570698738,
0.0011253108968958259,
-0.03331413120031357,
0.005339087452739477,
0.012372606433928013,
0.0036198978777974844,
-0.026940222829580307,
0.030046872794628143,
0.05694844201207161,
0.02309202216565609,
0.03472869098186493,
0.029353663325309753,
0.016000954434275627,
-0.01752084121108055,
-0.01979273185133934,
0.025169435888528824,
0.0014944860013201833,
0.0027560170274227858,
-0.01238333247601986,
-0.06278306990861893,
-0.018491294234991074,
-0.008375532925128937,
0.09143944084644318,
-0.021124890074133873,
-0.02492010034620762,
0.014994699507951736,
-0.019907424226403236,
2.278483179907198e-7,
0.023013997822999954,
0.009788833558559418,
-0.04515254870057106,
-0.028446167707443237,
0.016930343583226204,
-0.00942907202988863,
0.010043005459010601,
0.015013876371085644,
-0.026292825117707253,
-0.0014432689640671015,
0.016754789277911186,
0.01057713758200407,
0.018730776384472847,
-0.05610630661249161,
0.0064496309496462345,
-0.011274078860878944,
0.008663386106491089,
-0.059403080493211746,
-0.03600610792636871,
-0.0032872608862817287,
-0.07063483446836472,
0.002258368767797947,
-0.04109381511807442,
-0.003021321026608348,
0.02583192102611065,
-0.0652063712477684,
-0.014813940040767193,
-0.011439341120421886,
-0.04940057918429375,
0.011392679996788502,
0.03697817772626877,
0.008670675568282604,
0.012960582040250301,
0.11768652498722076,
-0.04623320326209068,
-0.011467000469565392,
-0.00038131498149596155,
0.029487457126379013,
-0.020491762086749077,
0.03921248018741608,
-0.006009039469063282,
-0.04397035762667656,
0.01450625341385603,
0.041433561593294144,
-0.02271820232272148,
0.12363599240779877,
-0.03477418050169945,
0.005279534496366978,
0.04469747841358185,
-0.01024673879146576,
0.02159220166504383,
0.00799240916967392,
-0.04022379219532013,
0.060335367918014526,
0.021284237504005432,
0.026328468695282936,
0.0027331672608852386,
0.013344136998057365,
0.022911738604307175,
-0.02395157888531685,
-0.000311170588247478,
-0.03871231898665428,
0.007634577341377735,
-0.03282144293189049,
0.07447077333927155,
-0.05671515315771103,
-0.00787321012467146,
1.4353037423210863e-34,
-0.026566514745354652,
-0.0020517674274742603,
0.05715435743331909,
-0.023915288969874382,
-0.02121582254767418,
-0.03951282426714897,
0.05659898743033409,
-0.021007098257541656,
0.014521868899464607,
-0.06619548797607422,
-0.007234121672809124
] | {
"ds_index": 98,
"similar_dg_indices": [
125553,
1209050,
335079,
26115,
189255,
464891,
494547,
1160515,
25477,
106200,
21540,
635413,
630647,
142769,
247326,
373982,
142385,
536833,
800415,
879493
]
} |
You are reviewing raw data from a research study performed at your medical center examining the effectiveness of a novel AIDS screening examination. The study enrolled 250 patients with confirmed AIDS, and 240 of these patients demonstrated a positive screening examination. The control arm of the study enrolled 250 patients who do not have AIDS, and only 5 of these patients tested positive on the novel screening examination. What is the NPV of this novel test? | 245 / (245 + 10) | {
"A": "245 / (245 + 10)",
"B": "245 / (245 + 5)",
"C": "240 / (240 + 5)",
"D": "240 / (240 + 15)"
} | step2&3 | A | [
"reviewing raw data",
"research study performed",
"medical center examining",
"effectiveness",
"novel AIDS screening examination",
"study enrolled",
"patients",
"confirmed AIDS",
"patients",
"positive screening examination",
"control arm",
"study enrolled",
"patients",
"not",
"AIDS",
"only",
"patients tested positive",
"novel screening examination",
"NPV",
"novel test"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: You are reviewing raw data from a research study performed at your medical center examining the effectiveness of a novel AIDS screening examination. The study enrolled 250 patients with confirmed AIDS, and 240 of these patients demonstrated a positive screening examination. The control arm of the study enrolled 250 patients who do not have AIDS, and only 5 of these patients tested positive on the novel screening examination. What is the NPV of this novel test?
Choose one of the following::
A. 245 / (245 + 10)
B. 245 / (245 + 5)
C. 240 / (240 + 5)
D. 240 / (240 + 15) | [
0.008757914416491985,
-0.047317977994680405,
-0.027040081098675728,
0.005133434198796749,
-0.04731590673327446,
0.011093665845692158,
-0.01620573364198208,
-0.029584724456071854,
-0.02161240391433239,
0.028599603101611137,
0.04932374879717827,
-0.013521702960133553,
0.01571190170943737,
0.009478053078055382,
0.015726212412118912,
0.04093332588672638,
-0.0105618666857481,
0.019816739484667778,
0.05720888078212738,
0.022351177409291267,
-0.07104969769716263,
-0.03419215977191925,
-0.004728688858449459,
0.018936948850750923,
0.028523966670036316,
0.024987192824482918,
-0.038589250296354294,
-0.0016775662079453468,
-0.007895990274846554,
-0.10479491949081421,
0.032581113278865814,
-0.00918936263769865,
0.01857343502342701,
-0.04407602176070213,
0.0000016536757811991265,
-0.04216323420405388,
0.031853511929512024,
0.004179296549409628,
0.044388409703969955,
0.02091072127223015,
0.09891726821660995,
0.036952197551727295,
-0.01598462648689747,
-0.010555821470916271,
0.013861223123967648,
-0.1007266640663147,
-0.011397168040275574,
0.019138755276799202,
-0.024419531226158142,
0.03691793978214264,
-0.018432321026921272,
0.05540433153510094,
-0.07467160373926163,
-0.023182600736618042,
-0.05213820934295654,
-0.13886363804340363,
0.02509341761469841,
0.007559155113995075,
0.001405428978614509,
0.015574797987937927,
-0.016723569482564926,
0.015422413125634193,
-0.009517579339444637,
-0.0020661719609051943,
0.004307711496949196,
0.04546738415956497,
0.021089544519782066,
-0.013809708878397942,
-0.0011317526223137975,
-0.018481168895959854,
0.05085233226418495,
0.07406755536794662,
0.04280460253357887,
0.017566541209816933,
-0.000102067700936459,
-0.03157342970371246,
-0.021924564614892006,
-0.03858907148241997,
-0.015970095992088318,
-0.014000681228935719,
-0.049389567226171494,
0.00014337569882627577,
0.006253802217543125,
-0.035993076860904694,
-0.011585838161408901,
-0.07617627829313278,
-0.002625437453389168,
0.0030284933745861053,
0.021222403272986412,
0.0379067100584507,
0.016736283898353577,
-0.00862060859799385,
0.03771459683775902,
-0.012659366242587566,
-0.007852179929614067,
0.01859172061085701,
0.07555520534515381,
-0.02943870797753334,
0.06853984296321869,
-0.054188620299100876,
-0.034268103539943695,
-0.023397397249937057,
-0.03463473170995712,
0.01939142681658268,
-0.04757954552769661,
-0.03992389142513275,
-0.02877393551170826,
0.02219666913151741,
-0.01187185663729906,
0.0577494315803051,
0.004813794512301683,
-0.02843262255191803,
-0.013019777834415436,
0.03293636068701744,
0.05156182870268822,
0.014197226613759995,
0.009019310586154461,
-0.015498691238462925,
0.013937361538410187,
0.008913649246096611,
-0.04761388525366783,
0.02285929024219513,
-0.0007329525542445481,
0.040127091109752655,
0.02183450013399124,
0.060308583080768585,
0.0080643305554986,
0.009932640008628368,
0.00018687914416659623,
-0.01894831471145153,
0.03296298906207085,
-0.07192586362361908,
0.010162188671529293,
-0.016374632716178894,
0.025943493470549583,
0.020975476130843163,
-0.005845633335411549,
0.006651121657341719,
-0.016371168196201324,
0.046984389424324036,
-0.03200628608465195,
-0.006096904166042805,
-0.010369228199124336,
0.0014555983943864703,
0.014876720495522022,
0.030056660994887352,
-0.021457713097333908,
0.01205508317798376,
0.013007125817239285,
0.048895955085754395,
-0.016441620886325836,
-0.0036641915794461966,
0.025532711297273636,
-0.014580531977117062,
0.01667599007487297,
0.03147992491722107,
0.01583976298570633,
-0.03981458768248558,
0.0038102674297988415,
-0.04469938203692436,
-0.019677329808473587,
-0.06448985636234283,
-0.047640446573495865,
-0.04287054389715195,
0.03975744917988777,
0.025369839742779732,
-0.006293498910963535,
0.019872955977916718,
-0.018598679453134537,
0.0014922405825927854,
-0.06626720726490021,
0.017628047615289688,
-0.0008909989846870303,
0.013913569040596485,
0.0023686583153903484,
0.035586219280958176,
-0.013772815465927124,
-0.040575265884399414,
-0.028471391648054123,
0.009193180128932,
-0.02236790768802166,
-0.03492105007171631,
-0.034190356731414795,
0.024031657725572586,
-0.11381541192531586,
0.008980294689536095,
-0.05885512754321098,
-0.03012685477733612,
-0.03146548569202423,
-0.0002051173069048673,
-0.027299590408802032,
0.03217903524637222,
-0.01348112616688013,
0.0002670484536793083,
-0.003717932617291808,
0.01530960202217102,
-0.04025672748684883,
-0.1200125515460968,
-0.007943776436150074,
-0.010517144575715065,
0.039326898753643036,
-0.06558287143707275,
0.09742290526628494,
-0.015813926234841347,
-0.0036692877765744925,
0.04362236335873604,
-0.003984094597399235,
-0.0035258703865110874,
-0.07148244231939316,
-0.016049910336732864,
0.06533665955066681,
0.0004950244328938425,
-0.0058511607348918915,
-0.004828213714063168,
0.014905842952430248,
-0.032140009105205536,
-0.027473336085677147,
0.01163081731647253,
-0.04321393370628357,
-0.028525734320282936,
0.005308131221681833,
0.01622873917222023,
-0.04452545568346977,
0.022208189591765404,
-0.07514548301696777,
0.016209209337830544,
-0.009988894686102867,
-0.020210597664117813,
-0.016550812870264053,
-0.03793524578213692,
0.027218185365200043,
0.0473647266626358,
-0.002528729382902384,
0.0559200681746006,
0.0023476823698729277,
-0.049504559487104416,
0.06678586453199387,
-0.006602419074624777,
-0.03306189924478531,
-0.10579501837491989,
0.02141333371400833,
0.02670353092253208,
0.000008494453140883707,
0.037936706095933914,
-0.018775487318634987,
-0.000013109239262121264,
-0.07199563086032867,
0.01560948882251978,
-0.01638343743979931,
0.027680786326527596,
-0.007247905246913433,
-0.0015837997198104858,
0.04355968162417412,
0.017724083736538887,
0.016955189406871796,
0.019080504775047302,
-0.0959080383181572,
0.02746770530939102,
0.0010297324042767286,
-0.018136724829673767,
-0.04499145224690437,
0.01657249964773655,
-0.07996891438961029,
0.018237078562378883,
-0.0275369081646204,
-0.031622059643268585,
-0.045873451977968216,
-0.036254316568374634,
0.01603083312511444,
0.06344868987798691,
-0.0031719785183668137,
-0.012186029925942421,
-0.002061473671346903,
-0.004107069689780474,
-0.003152664750814438,
-0.02869085967540741,
-0.007463167887181044,
0.018989218398928642,
0.01983889751136303,
0.0117786331102252,
0.06162130832672119,
0.02002725750207901,
-0.029403844848275185,
-0.0019020059844478965,
0.005661406088620424,
-0.017656395211815834,
0.08059591799974442,
-0.06459943950176239,
0.00009564358333591372,
0.02989443764090538,
0.03316760063171387,
-0.014492630958557129,
0.010129623115062714,
0.0029017296619713306,
0.0041268072091042995,
0.005649120546877384,
-0.03586243838071823,
0.03144383057951927,
0.0042704250663518906,
0.04512886330485344,
0.059119947254657745,
0.029370341449975967,
-0.020070962607860565,
0.005576117895543575,
-0.013718976639211178,
-0.012657568790018559,
0.006110048852860928,
-0.04077872633934021,
-0.008548332378268242,
-0.007182572036981583,
0.06195618584752083,
-0.010315371677279472,
0.01658870093524456,
0.02223592810332775,
-0.0059168366715312,
-0.051227327436208725,
-0.0069144354201853275,
0.007185833528637886,
-0.03171392157673836,
-0.013298192992806435,
0.013021575286984444,
0.01391233317553997,
0.013763802126049995,
0.007584447506815195,
-0.010602685622870922,
-0.05344826728105545,
-0.011867617256939411,
0.026178764179348946,
-0.018451489508152008,
0.020829632878303528,
-0.029095251113176346,
-0.02692071720957756,
-0.03846751153469086,
-0.030071882531046867,
0.027239158749580383,
-0.025404347106814384,
-0.02295331470668316,
0.04328352212905884,
-0.0266937967389822,
0.0064267911948263645,
-0.014435648918151855,
0.016360865905880928,
-0.009218014776706696,
-0.04438464716076851,
0.04394615814089775,
-0.019581139087677002,
-0.018654441460967064,
0.048756808042526245,
0.06770037114620209,
-0.014198796823620796,
0.007035861723124981,
0.05640096217393875,
-0.000048945919843390584,
-0.006084824912250042,
-0.038204025477170944,
-0.05304427817463875,
0.027170637622475624,
-0.02212107554078102,
0.018290294334292412,
-0.023215146735310555,
-0.020829711109399796,
0.03130514547228813,
-0.037059053778648376,
0.12354014813899994,
-0.046059317886829376,
0.04020865634083748,
-0.028459051623940468,
0.01582617498934269,
-0.014467477798461914,
0.03878062590956688,
-0.03709852322936058,
-0.004163538571447134,
0.03258805349469185,
-0.010548856109380722,
-0.01466696709394455,
-0.07961158454418182,
0.010674353688955307,
-0.05268373340368271,
-0.14316396415233612,
-0.009025545790791512,
0.04413105919957161,
-0.03587740287184715,
0.07006006687879562,
0.005484200082719326,
0.007748348172754049,
-0.027017692103981972,
-0.06805935502052307,
-0.0725914016366005,
-0.050240177661180496,
0.059412211179733276,
-0.007832778617739677,
0.008178247138857841,
0.004873915109783411,
0.0000814783779787831,
0.028715789318084717,
-0.026717130094766617,
-0.007656529080122709,
0.01612655259668827,
0.03480831906199455,
0.018219683319330215,
-0.04261278733611107,
0.07768723368644714,
-0.035196635872125626,
0.08124300837516785,
-0.017799289897084236,
-0.01859274134039879,
0.028676683083176613,
0.036627158522605896,
-0.04256274923682213,
0.070249043405056,
-0.0197797529399395,
-0.042229268699884415,
0.009951481595635414,
-0.0077252816408872604,
0.07536198198795319,
0.062056828290224075,
-0.011540411040186882,
-0.029167979955673218,
-0.01950201578438282,
-0.01869264245033264,
0.032610874623060226,
0.04724237322807312,
0.004634329583495855,
0.009090703912079334,
-0.05658121034502983,
-0.002164249774068594,
0.04914597049355507,
0.03458345681428909,
0.01204916276037693,
0.03945224732160568,
0.01760011725127697,
0.02594686858355999,
0.03762391582131386,
0.034143172204494476,
-0.030728455632925034,
0.03584973141551018,
-0.03948602452874184,
0.0043601845391094685,
0.04370542988181114,
-0.03783588483929634,
0.00123240752145648,
0.06786826252937317,
0.07845531404018402,
0.011476018466055393,
-0.02191387489438057,
0.03365937992930412,
-0.029887715354561806,
0.024907197803258896,
-0.002798435976728797,
0.03635851666331291,
0.026617754250764847,
0.03911977261304855,
0.03277936205267906,
0.017277833074331284,
0.0426919125020504,
-0.01347305066883564,
-0.02243400551378727,
-0.022543637081980705,
0.008039738051593304,
-0.02028130181133747,
-0.005030239000916481,
0.022387126460671425,
0.007201007567346096,
-0.008516838774085045,
-0.00046980383922345936,
-0.07233235239982605,
-0.036146778613328934,
-0.02461991086602211,
-0.016256727278232574,
-0.10285638272762299,
-0.01868053898215294,
0.0017407231498509645,
-0.02826087549328804,
-0.007833517156541348,
-0.02652081847190857,
-0.003049252089112997,
-0.062140703201293945,
0.020424647256731987,
-0.00010273955558659509,
0.036056309938430786,
0.031454119831323624,
0.026812497526407242,
0.015757562592625618,
0.02385910227894783,
-0.017646413296461105,
0.0014699912862852216,
-0.03348296508193016,
-0.002112697809934616,
-0.005995934829115868,
-0.06334597617387772,
-0.024585913866758347,
0.015523851849138737,
-0.029687335714697838,
0.027172844856977463,
-0.03212171792984009,
0.04256922006607056,
-0.053448669612407684,
-0.0028179411310702562,
0.09342294931411743,
0.04561363533139229,
0.03646675869822502,
0.013093115761876106,
-0.005307088606059551,
-0.007354013156145811,
0.03172553703188896,
0.07184533774852753,
-0.0107863899320364,
0.016707027330994606,
-0.046182457357645035,
-0.06484731286764145,
-0.027597185224294662,
-0.007871369831264019,
-0.008821487426757812,
-0.00953718088567257,
0.01218439918011427,
-0.028583521023392677,
-0.08811452984809875,
0.0003812764189206064,
-0.03375581279397011,
-0.01408777292817831,
0.011504804715514183,
-0.026993567124009132,
-0.003967481665313244,
-0.03923272341489792,
-0.01420536544173956,
0.07729126513004303,
0.012091932818293571,
0.008946381509304047,
-0.053811002522706985,
0.007638760842382908,
-0.013392970897257328,
-0.04196244478225708,
-0.09935349225997925,
0.03341490402817726,
0.002260092878714204,
0.0290669072419405,
0.054279427975416183,
0.002292497782036662,
-0.0034636834170669317,
0.07956241816282272,
-0.016396287828683853,
0.004015944432467222,
-0.00590043468400836,
-0.024716703221201897,
0.04534689709544182,
-0.014690644107758999,
-0.07383187860250473,
-0.03551362454891205,
0.009997006505727768,
-0.049398019909858704,
-0.009426211938261986,
0.06400997191667557,
0.05100635066628456,
0.012273290194571018,
-0.00043979802285321057,
-5.449857031325029e-33,
0.018207283690571785,
-0.05111708864569664,
0.03927570953965187,
-0.05462457239627838,
-0.01310808677226305,
-0.0023608801420778036,
-0.0562916174530983,
-0.0447789691388607,
-0.012082744389772415,
-0.023006225004792213,
-0.001419891370460391,
0.02819036692380905,
0.027122637256979942,
0.023472214117646217,
-0.005055912304669619,
-0.030529554933309555,
-0.022533956915140152,
0.02610841765999794,
0.019057519733905792,
-0.034129511564970016,
-0.016348043456673622,
0.05186530947685242,
0.05532186105847359,
0.005404945462942123,
0.035034772008657455,
-0.02602713368833065,
0.04440293088555336,
-0.0023154073860496283,
-0.014815262518823147,
-0.0024215460289269686,
0.03660493344068527,
-0.06814339011907578,
0.006792483385652304,
-0.034490641206502914,
0.03192572295665741,
-0.027122868224978447,
0.012325572781264782,
-0.018733248114585876,
0.03846749663352966,
0.015981081873178482,
-0.03887330740690231,
-0.014647145755589008,
0.04427965730428696,
-0.007508464157581329,
0.030196068808436394,
-0.05754309147596359,
0.011757123284041882,
-0.02217755652964115,
0.025180254131555557,
0.04585367813706398,
-0.042579662054777145,
-0.029112668707966805,
0.002720684977248311,
0.07504161447286606,
-0.026825295761227608,
0.025439990684390068,
-0.0394221730530262,
0.024557286873459816,
-0.013536893762648106,
-0.006720595993101597,
0.02356342040002346,
0.012887028977274895,
0.02446100115776062,
-0.017468901351094246,
-0.008746512234210968,
-0.008266407996416092,
0.026393789798021317,
-0.01003147941082716,
-0.028067590668797493,
0.007106929551810026,
-0.037424225360155106,
0.0035460316576063633,
0.01371936034411192,
-0.010194679722189903,
-0.0022721935529261827,
0.0011240277672186494,
-0.01867624558508396,
0.02142052724957466,
0.014615288004279137,
0.017737334594130516,
-0.02854783833026886,
-0.028236251324415207,
0.016414130106568336,
-0.0022136059124022722,
-0.024364162236452103,
-0.13537774980068207,
-0.022372042760252953,
-0.07791706919670105,
0.045206040143966675,
-0.010881968773901463,
0.043468233197927475,
0.029730822890996933,
0.02209584414958954,
0.00268716923892498,
-0.009346148930490017,
0.03729882463812828,
0.048780407756567,
0.02266295999288559,
-0.02689300663769245,
-0.029460156336426735,
0.037067413330078125,
0.06394848972558975,
0.059726618230342865,
-0.012484760023653507,
0.03085375390946865,
0.006128634326159954,
-0.023356176912784576,
0.02865651249885559,
-0.004347351845353842,
0.0028114402666687965,
0.020688654854893684,
0.0005782981752417982,
-0.0051057287491858006,
0.04986287280917168,
-0.04267575219273567,
0.025330286473035812,
0.011715070344507694,
-0.0005721502238884568,
0.00782112404704094,
-0.004829532466828823,
0.0332782082259655,
0.07569742202758789,
0.011850484646856785,
0.010091079398989677,
0.017949791625142097,
0.01344264019280672,
0.0673384889960289,
0.02604452520608902,
-0.02812950499355793,
-0.0002639676386024803,
0.013236882165074348,
0.014181381091475487,
2.552813498368778e-7,
0.028532393276691437,
-0.046871721744537354,
0.010031788609921932,
0.002205689437687397,
0.0072701359167695045,
-0.045227594673633575,
-0.09881296008825302,
0.03480599820613861,
0.0725434273481369,
-0.023734455928206444,
0.05975094437599182,
-0.042658451944589615,
-0.04116019979119301,
0.006838183384388685,
-0.004761572927236557,
0.006217137444764376,
0.05707158148288727,
0.04908305034041405,
0.007654287852346897,
0.010273720137774944,
0.00718559417873621,
-0.01187752652913332,
-0.021753838285803795,
-0.020540842786431313,
-0.03201848268508911,
-0.017617007717490196,
-0.014621182344853878,
-0.006469441577792168,
-0.046672988682985306,
0.0297421682626009,
0.08783725649118423,
0.012051500380039215,
0.05667436122894287,
0.08274135738611221,
-0.06359699368476868,
0.037003010511398315,
-0.03892238810658455,
0.08347821235656738,
0.02057304047048092,
0.062113918364048004,
0.020162956789135933,
-0.015793954953551292,
0.01651606895029545,
0.04488756135106087,
0.004451016895473003,
-0.05651477724313736,
0.022221418097615242,
0.0019576530903577805,
-0.030612003058195114,
-0.03563637286424637,
0.02580912411212921,
0.005766342859715223,
0.05202557146549225,
0.03667377680540085,
-0.04313097521662712,
0.013835362158715725,
-0.00188895792234689,
0.06716577708721161,
0.0579674169421196,
0.08493796736001968,
0.028082838281989098,
-0.02297072485089302,
0.03444923087954521,
0.022522209212183952,
0.012640723958611488,
-0.01736346445977688,
0.015563270077109337,
1.7297664547345117e-34,
-0.020850233733654022,
-0.006746816448867321,
0.011556080542504787,
-0.0014234243426471949,
-0.017735017463564873,
-0.004545774310827255,
0.010060000233352184,
-0.0023241222370415926,
-0.03451944515109062,
-0.004017563536763191,
-0.014534550718963146
] | {
"ds_index": 99,
"similar_dg_indices": [
991980,
763683,
744798,
661016,
998253,
177187,
908756,
387652,
1148607,
1158470,
1073111,
206571,
799826,
1069095,
1101041,
524549,
940847,
381857,
962376,
312694
]
} |
Subsets and Splits