id stringlengths 5 5 | topic stringclasses 6
values | difficulty stringclasses 2
values | question stringlengths 88 217 | expected_answer stringlengths 658 1.8k | evidence_note_indices listlengths 1 5 | evidence_snippets listlengths 1 5 | notes_count int64 1 5 |
|---|---|---|---|---|---|---|---|
q-001 | drug_side_effects | medium | What adverse events have been reported in adolescents taking olanzapine for bipolar affective disorder, and what is the recommended course of action if these events appear? | Olanzapine has been associated with tardive dystonia in adolescent patients with affective illness, presenting as sustained, abnormal contractions of the neck and back muscles that produce twisting movements and abnormal postures. In the documented case, symptoms emerged within the second week of starting olanzapine at... | [
155216
] | [
"The patient developed pain and discomfort in her neck within the second week of being put on tablet olanzapine at a dose of 5 mg per day. This was associated with a sustained and abnormal contraction of the neck muscles that would pull her head to the right in an upward direction."
] | 1 |
q-002 | drug_side_effects | hard | Across multiple clinical notes, which metabolic, endocrine and gynaecological complications have been attributed to mood stabilizers such as lithium and sodium valproate, and how were they managed? | Three complications have been reported: (1) valproate-induced menstrual disturbance — a young woman on sodium valproate 1000 mg/day developed amenorrhea that persisted despite a normal gynecological work-up, prompting a switch to lithium 450 mg/day; (2) lithium-induced hypothyroidism — the same patient subsequently dev... | [
155216
] | [
"The patient developed amenorrhea for which no cause was established after a detailed gynecological evaluation. Keeping in mind the possibility of valproate-induced menstrual disturbance, she was shifted to tablet lithium 450 mg per day."
] | 1 |
q-003 | recovery_time | medium | What is the expected time to recover mobility and pain relief after a wrist or distal-radius fracture treated conservatively versus surgically, based on the cases in the dataset? | Outcomes vary widely with fracture pattern and treatment. Conservative treatment in a cast for a minimally displaced proximal ulnar shaft fracture led to a hypertrophic nonunion by the 3-month clinic visit; an additional 3 months of conservative management produced worsening motion at the nonunion site, i.e. no recover... | [
80176,
108947,
12774
] | [
"Radiographs of the forearm and the elbow revealed an elbow arthrodesis at 90 degrees with retained hardware and a minimally displaced proximal ulnar shaft fracture. A decision was made to treat his ulnar shaft fracture closed in a cast, and he subsequently developed a hypertrophic nonunion. At his clinic visit thr... | 3 |
q-004 | diagnosis_workup | hard | Which triad of clinical features should raise suspicion for normal-pressure hydrocephalus, and which imaging or functional test confirms the diagnosis? | The classic NPH triad consists of gait disturbance, cognitive/memory impairment, and urinary incontinence, typically presenting in older adults (e.g. a 69-year-old male in the dataset presented with all three features simultaneously). Confirmation relies on neuroimaging (CT/MRI of the brain) demonstrating ventriculomeg... | [
60109,
157335
] | [
"We present the case of a 69-year-old male patient who was brought to the outpatient clinic by his daughter as he develop",
"A 60-year-old female patient was admitted to the inpatient treatment section from the outpatient therapy wing of the phy"
] | 2 |
q-005 | drug_side_effects | medium | What were the observed side-effects of using drug metformin in the patients reported in the dataset, and how were they detected? | In the documented case, a 56-year-old man on metformin 500 mg orally twice daily presented with rapidly progressive weakness of all four limbs in a glove-and-stocking distribution four days after a gastrointestinal upset, without sensory deficits. Consciousness and orientation were preserved but he was unable to speak ... | [
2332
] | [
"Our patient did not take any regular medications apart from the hypoglycemic agent metformin 500 mg administered orally twice daily."
] | 1 |
q-006 | drug_side_effects | medium | What were the observed side-effects of using drug warfarin in the patients reported in the dataset, and what monitoring was performed? | Warfarin was used for two distinct indications. (1) A 58-year-old male with a posterior thigh mass suspicious for malignancy had initially been diagnosed with a blood clot and placed on warfarin; despite anticoagulation the mass enlarged over more than a year, prompting pre-embolization followed by surgical resection —... | [
43555,
89642,
37146
] | [
"As per patient, the mass initially was diagnosed as a blood clot on venous doppler, for which he was treated by his prim",
"\\nThe dilemma was therefore a patient with an established pulmonary embolus and a friable clot in the iliac veins, antic",
"\\nShe was started on anticoagulation and 3 weeks later had an... | 3 |
q-007 | drug_side_effects | medium | What were the observed side-effects of using drug amiodarone in the patients reported in the dataset, and how were they detected? | Two adult patients were treated with amiodarone. A 59-year-old male was given IV amiodarone perfusion after a ventricular-fibrillation attack successfully defibrillated at admission; no acute adverse events were documented but long-term amiodarone use requires monitoring of thyroid, liver and pulmonary function as well... | [
149353,
65643
] | [
"Amiodarone perfusion was administered at the time of his first medical contact, and this treatment was continued for 24 ",
"Metoprolol therapy was reduced to 25 mg per day and amiodarone therapy has been added to the medical treatment of the pa"
] | 2 |
q-008 | differential_diagnosis | medium | In patients presenting with recurrent abdominal pain, which conditions should be considered and what features help distinguish them? | Recurrent abdominal pain has many possible causes in the dataset. (1) Pancreatic pseudocyst — a 61-year-old woman with prior pancreatitis, pancreatic stricture and stent placement developed recurrent abdominal pain; CT showed a 14 cm pseudocyst with necrosis, WBC 13,000 and lactic acidosis, and she was managed with EUS... | [
62069,
87882,
117050
] | [
"A 61-year-old female with the past medical history of recurrent pancreatitis, pancreatic stricture, with a history of pancreatic stent placement was admitted secondary to recurrent abdominal pain.",
"\\nThere is a wide differential of potential causes to consider in patients presenting with iron overload.",
"U... | 3 |
q-009 | treatment_outcome | hard | What is the expected outcome and follow-up after an Amyand's hernia (appendix within an inguinal-hernia sac) repair in elderly patients? | Three dataset entries describe the same 88-year-old male with a recurrent right inguinal hernia first repaired in 1977 without mesh, presenting with a 3×3 cm firm nontender right groin mass present for six weeks. CT of abdomen and pelvis showed the appendix within the hernia sac (Amyand's hernia), WBC was normal (4.7 ×... | [
194092,
204092,
184092
] | [
"An 88-year-old male presented in the outpatient surgical setting with a chief complaint of a right groin bulge that had been present for 6 weeks.",
"A computed tomography scan of the abdomen and pelvis was performed to elucidate the cause of the mass in his groin. The imaging was relevant for a right inguinal he... | 3 |
q-010 | treatment_outcome | medium | What is the expected clinical course after surgical repair of a CSF otorrhea leak, and what follow-up is recommended? | CSF otorrhea (cerebrospinal-fluid leakage from the ear) is usually managed by surgical repair of the dural defect. In a 45-year-old female presenting with right-ear fullness precipitated by positional changes, a mastoidectomy was performed for CSF otorrhea caused by arachnoid granulation; follow-up in the outpatient cl... | [
166046,
100551,
46689
] | [
"She underwent mastoidectomy under general anesthesia.",
"The postoperative course was uneventful, and there was no recurrence of CSF otorrhea.",
"Moreover, the small chance of simultaneous CSF otorrhea and rhinorrhea from two separate sources was another point we co"
] | 3 |
q-011 | drug_side_effects | hard | Across patients with different malignancies, what complications of fluorouracil-based chemotherapy (e.g. FOLFOX) have been reported and how were they managed? | Fluorouracil (5-FU)-based regimens, including FOLFOX (oxaliplatin + 5-FU + folinic acid), were used to treat metastatic mucinous adenocarcinoma from a sigmoid-colon/rectal primary in a 62-year-old man and colorectal cancer with liver metastasis in a 78-year-old man. In the latter patient, 5-FU was arterially infused th... | [
148882,
32491
] | [
"FOLFOX (oxaliplatin with fluorouracil and folinic acid) anticancer chemotherapy (related condition: metastatic mucinous adenocarcinoma).",
"He underwent low anterior resection of the rectum and resection of the affected liver segments. He then underwent chemotherapy using fluorouracil that was arterially infused... | 2 |
q-012 | follow_up | medium | What follow-up regimen is recommended for patients after curative treatment of invasive ductal breast cancer? | After curative treatment of invasive ductal breast cancer (lumpectomy of the left breast with axillary lymph-node dissection followed by radiation therapy and seven cycles of adjuvant chemotherapy), patients are typically prescribed an aromatase inhibitor such as Anastrozole for five years and undergo annual clinical e... | [
129465
] | [
"Radiation therapy and seven cycles of adjuvant chemotherapy were administered to her postoperatively, and Anastrozole was prescribed to her for 5 years."
] | 1 |
q-013 | diagnosis_workup | hard | When a patient presents with hip pain, restricted range of motion and gait disturbance, which conditions should be in the differential and how are they distinguished? | The dataset highlights several causes of hip pain with gait disturbance. (1) Steroid-induced osteonecrosis with secondary osteoarthritis — a 36-year-old female had hip pain and restricted range of motion persisting for two months, gait disturbance and a moderate moon face suggesting chronic steroid use; MRI of the hip ... | [
133948,
142862
] | [
"A 36-year old female patient visited our hospital with a chief complaint of pain and restricted range of motion (ROM) in",
"A 48-year-old female patient (gravid 3, para 1) visited the private hospital because of urinary incontinence and lower a"
] | 2 |
q-014 | treatment_outcome | medium | What complications should be anticipated and how are they managed when a patient on chronic peritoneal dialysis presents with fever and cloudy effluent? | Cloudy peritoneal-dialysis effluent with nausea is the hallmark of PD-associated peritonitis, most commonly caused by coagulase-negative staphylococci. A 45-year-old male on automated PD for 7 months presented with cloudy effluent, nausea, general malaise (appearing one day after completing a course of vancomycin), and... | [
62793,
34230
] | [
"A 45-year-old male with end stage renal disease due to chronic glomerulonephritis started automated PD in February 2015 ",
"All possible infectious causes were investigated including peritonitis, catheter related infection and a lupus flair, ne"
] | 2 |
q-015 | drug_side_effects | hard | What are the pulmonary complications and outcomes reported in patients treated with amiodarone for ventricular arrhythmias? | Amiodarone is known to cause pulmonary toxicity (interstitial pneumonitis, organising pneumonia, pulmonary fibrosis) in 5–15% of patients on chronic therapy. In the dataset, a 59-year-old male was successfully defibrillated from ventricular fibrillation and treated with IV amiodarone perfusion plus a vasodilator; no ac... | [
149353,
65643
] | [
"A 59-year old male patient was referred to our hospital after suffering a VF attack and was successfully treated with de",
"Metoprolol therapy was reduced to 25 mg per day and amiodarone therapy has been added to the medical treatment of the pa"
] | 2 |
q-016 | diagnosis_workup | medium | Which clinical features distinguish primary angle-closure glaucoma from secondary angle-closure glaucoma, and what is the initial management? | A 29-year-old woman in her seventh month of pregnancy presented with sudden onset pain and watering in her left eye of 4 days' duration, with a history of radial keratotomy at age 20 for myopia. She had developed secondary angle-closure glaucoma in the left eye following radial keratotomy (probably microperforation lea... | [
89571
] | [
"She developed secondary angle closure glaucoma in left eye following radial keratotomy (probably there was microperforation at the time of radial keratotomy, leading to shallow anterior chamber with formation of peripheral anterior synechiae leading to raised IOP)."
] | 1 |
q-017 | diagnosis_workup | medium | In an elderly patient with visual hallucinations, confusion and diabetes, what diagnoses should be considered and which investigations are most informative? | A 72-year-old woman with diabetes (on 18 units morning and 12 units evening insulin injection) presented with auditory and visual hallucinations and confusion about her surroundings for one month. The differential includes: (1) hyperglycaemia or hypoglycaemia — a fingerstick glucose should be done first; (2) diabetic k... | [
164826
] | [
"A 72-years-old female was brought to psychiatry outpatient department, relatives reported that for last 1 month, she is "
] | 1 |
q-018 | drug_side_effects | hard | What adverse events and complications have been observed in patients receiving cyclophosphamide, mycophenolic acid and rituximab for severe lupus nephritis? | A 39-year-old woman newly diagnosed with SLE after a second-trimester miscarriage was found to have crescentic focal segmental glomerulonephritis (WHO class III lupus nephritis with crescents). She was initially managed with combined cyclophosphamide, corticosteroids and azathioprine, then switched to mycophenolic acid... | [
34230
] | [
"She was initially managed with a combined therapeutic regimen of cyclophosphamide, corticosteroids and azathioprine which was modified due to poor response, to mycophenolic acid with the addition of rituximab."
] | 1 |
q-019 | recovery_time | medium | What is the expected time to symptomatic improvement after tetrabenazine is started for tardive dystonia? | In the documented adolescent case, after the psychotropic medications were stopped because the mood symptoms had remitted, tetrabenazine was introduced and built up to 75 mg/day in divided doses. With this regimen the patient began to show some response with improvement in the abnormal movements of the neck and back mu... | [
155216
] | [
"After the case was seen at our institute, the psychotropic medications were stopped as her mood symptoms had remitted and she was put on tablet tetrabenazine (built up to 75 mg per day in divided doses)."
] | 1 |
q-020 | differential_diagnosis | hard | In a patient with pain in the right hip and right wrist, which systemic conditions should be considered and how are they confirmed? | A 27-year-old man with a history of osteosarcoma of the proximal tibia treated 18 years earlier with chemotherapy, resection and allograft reconstruction, presented in March 2012 with two-month pain in the right hip and right wrist without restriction of range of motion but with localized tenderness in the right medial... | [
43744
] | [
"Plain radiograph of the pelvis revealed a typical 3 cm lytic lesion involving the right proximal medial femur and a 4 cm lytic lesion involving the left ileum."
] | 1 |
q-021 | treatment_outcome | medium | What is the expected time course for bone healing and return to function after a non-displaced scaphoid-waist fracture in a paediatric patient, and what complications should be monitored? | An 8-year-old boy presented to an emergency department in October 2013 with right radial-sided wrist pain after a fall; no fracture was seen on radiographs, he was placed in a removable splint and discharged. He re-presented three years later at age 11 with continued pain, intermittent swelling after minor falls, and a... | [
12774
] | [
"Interval radiographs revealed a right-sided, displaced scaphoid waist fracture."
] | 1 |
q-022 | drug_side_effects | hard | What adverse effects of long-term corticosteroid therapy should be monitored in patients with autoimmune disease, and how do they manifest? | Corticosteroids are used to treat autoimmune diseases such as SLE, but long-term therapy produces well-recognised complications: osteoporosis, avascular necrosis, cushingoid features (moon face, central obesity, striae), hyperglycaemia, hypertension, cataracts, glaucoma, easy bruising, infection susceptibility and adre... | [
133948
] | [
"A 36-year old female patient visited our hospital with a chief complaint of pain and restricted range of motion (ROM) in"
] | 1 |
q-023 | treatment_outcome | medium | What is the expected post-operative course after emergency reduction of an isolated ulnar-head dislocation with impaction on the distal radius? | A 37-year-old right-handed male presented to the emergency department with right wrist pain and decreased range of motion after a friendly grappling match while mildly intoxicated. The forearm was locked in supination with no passive or active pronation, the dorsal ulnar prominence was lost and a palpable tender mass w... | [
188991
] | [
"The forearm was locked in supination, with no passive or active pronation elicited."
] | 1 |
q-024 | diagnosis_workup | medium | In a patient presenting with painless growing mass on the dorsum of the wrist, which diagnoses should be considered and what is the appropriate work-up? | A 75-year-old lady was referred with a painless, slowly growing mass on the dorsum of the right wrist first noticed a year earlier. In an older patient, the differential for a painless dorsal-wrist mass includes: (1) ganglion cyst (most common, transilluminates, arises from the scapholunate joint); (2) giant-cell tumou... | [
149994
] | [
"A 75 year old lady was referred to the orthopaedic outpatients department with a painless, slowly growing mass on the dorsum of the right wrist."
] | 1 |
q-025 | drug_side_effects | hard | What is the expected time to recovery of renal function in patients with sepsis-related acute kidney injury requiring renal replacement therapy, and which complications should be monitored? | A 41-year-old woman with end-stage renal disease on peritoneal dialysis was admitted urgently for renal replacement therapy because of peritonitis, septic state, recurrent septic states with seizures and bacteremia, especially during the first hour of hemodialysis sessions. Management included peritoneal dialysis, hemo... | [
142524
] | [
"A 41-year-old woman with end stage renal disease (ESRD) from ADPKD was referred to our tertiary care center for urgent r"
] | 1 |
q-026 | diagnosis_workup | medium | When a patient presents with sudden onset of pain and watering in one eye, which differential diagnoses should be considered and how should the patient be evaluated? | A 29-year-old woman in her seventh month of pregnancy presented with sudden onset pain and watering in her left eye of four days' duration. The differential includes: (1) acute angle-closure glaucoma (fixed mid-dilated pupil, steamy cornea, IOP elevation, halos around lights); (2) acute anterior uveitis (ciliary flush,... | [
89571
] | [
"Sudden onset of pain and watering in her left eye of 4 days duration."
] | 1 |
q-027 | follow_up | medium | What follow-up and monitoring are recommended after emergency repair of a recurrent inguinal hernia in an elderly patient, and what complications should be watched for? | Three identical dataset entries describe an 88-year-old male with a recurrent right inguinal hernia first repaired in 1977 without mesh, presenting with a six-week history of a right groin bulge and a CT showing the appendix in the hernia sac (Amyand's hernia). He underwent elective open repair. Standard follow-up incl... | [
194092,
204092,
184092
] | [
"He was concerned that a previously repaired right inguinal hernia had recurred from its original tissue repair in 1977.",
"He elected to proceed with surgical intervention for hernia repair.",
"The patient presented to the hospital setting for his elective right inguinal hernia repair."
] | 3 |
q-028 | drug_side_effects | hard | Across multiple patients, what complications have been reported following cisplatin-based chemotherapy for metastatic adenocarcinoma, and how were they managed? | Although cisplatin is not the regimen in this dataset, fluorouracil-based regimens such as FOLFOX (oxaliplatin, fluorouracil, folinic acid) used to treat metastatic mucinous adenocarcinoma (62-year-old male) and hepatic-arterial-infusion 5-FU for rectal-cancer liver metastasis (78-year-old male) are associated with spe... | [
148882,
32491
] | [
"The biopsy of the spermatic cord showed a metastatic mucinous adenocarcinoma ().",
"He underwent partial resection of segment 6 of the liver and was followed by chemotherapy using FOLFOX6 + bevacizumab pr"
] | 2 |
q-029 | treatment_outcome | medium | What is the expected outcome of intensive insulin therapy and rehabilitation after a haemorrhagic stroke in a patient with diabetes mellitus? | A 49-year-old woman with diabetes mellitus (HbA1c 5.5%, on metformin 500 mg and insulin therapy) was admitted to rehabilitation ten weeks after a haemorrhagic stroke. She had persistent dysphagia (still on Levin-tube feeding), cervical pain rated 4–5/10 on the visual analogue scale, and motor-power grade 1 in the right... | [
160286
] | [
"The patient was transferred to our department of rehabilitation medicine at ten weeks after the onset of a hemorrhagic stroke."
] | 1 |
q-030 | recovery_time | medium | What is the expected time to recover after treatment of an acute hemorrhagic stroke in a young woman with no significant past medical history? | Although the dataset does not provide direct follow-up of a healthy young woman post-haemorrhagic stroke, related cases (49-year-old woman with haemorrhagic stroke transferred to rehabilitation at 10 weeks still on Levin-tube feeding with motor grade 1 in the right limbs) suggest a recovery trajectory of 6–12 months fo... | [
160286
] | [
"The patient had no prior operative history of tracheostomy, and a cranioplasty was performed."
] | 1 |
q-031 | drug_side_effects | hard | What adverse events have been reported in patients receiving typical/atypical antipsychotics for schizophrenia, and what alternative agents have been tried? | Across several cases, long-term antipsychotic therapy for chronic schizophrenia has produced limited improvement of positive and negative symptoms and significant side-effects (sedation, extra-pyramidal symptoms, tardive dyskinesia, weight gain, metabolic syndrome). In a 57-year-old woman (idx 93459) with chronic schiz... | [
93459,
77045,
114921
] | [
"The adverse reaction to clozapine occurred in a 57-year-old married Caucasian woman with a long history of treatment-res",
"Regarding somatoform disorders, pain in the oral cavity started the last three months, only in this specific anatomic ar",
"\\nOn the 15th day of his hospitalization, his symptoms of mani... | 3 |
q-032 | differential_diagnosis | hard | In patients presenting with psychosis and affective symptoms, what is the differential diagnosis between schizophrenia, schizoaffective disorder and bipolar disorder with psychotic features, and how is it established? | Three domains must be distinguished: (1) duration of mood symptoms relative to psychosis (DSM-5 requires ≥2 weeks of psychotic symptoms without mood symptoms for schizophrenia, while schizoaffective requires psychotic symptoms ≥2 weeks in the absence of mood symptoms PLUS mood symptoms present for the majority of the i... | [
93459,
155216
] | [
"The adverse reaction to clozapine occurred in a 57-year-old married Caucasian woman with a long history of treatment-res",
"Her first episode of the affective disorder was that of mania at the age of eleven which was managed with the use of olanzapine tablets."
] | 2 |
q-033 | treatment_outcome | medium | What is the expected time to mood stabilization after switching from a mood-instabilizing agent (e.g. olanzapine) to a true mood stabilizer in adolescents with bipolar disorder? | In the documented adolescent (idx 155216), olanzapine 2.5–10 mg/day was used for bipolar affective disorder from age 11 and produced tardive dystonia; after stopping olanzapine, switching to sodium valproate 1000 mg/day led to mood stabilization within several months, although valproate itself caused amenorrhea requiri... | [
155216
] | [
"The patient responded well to this change in medication, but she developed amenorrhea for which no cause was established after a detailed gynecological evaluation."
] | 1 |
q-034 | diagnosis_workup | hard | Which investigations are recommended when a patient with a known psychiatric disorder presents with new-onset abnormal movements? | New abnormal movements in a patient with a psychiatric history require a broad work-up to exclude organic causes before attributing them to drug-induced movement disorder. Recommended investigations include: (1) detailed drug history (typical/atypical antipsychotics, anti-emetics, lithium, valproate, metoclopramide); (... | [
155216
] | [
"During the course of the illness, the patient has been investigated for the presence of any neurological illness as the cause of her abnormal movements."
] | 1 |
q-035 | drug_side_effects | medium | What are the recommended monitoring parameters and common adverse effects of lithium therapy in patients with bipolar disorder? | Lithium has a narrow therapeutic index (0.6–1.2 mEq/L) and requires monitoring of serum levels every 3–6 months once stable. Common adverse effects include hypothyroidism (5–35% of patients), nephrogenic diabetes insipidus, mild tremor, weight gain, and teratogenicity (Ebstein anomaly in first-trimester exposure). In t... | [
155216
] | [
"The patient was well maintained on this medication for a period of around two years. However, she developed hypothyroidism for which eltroxin was introduced at a dose of 50 micrograms per day."
] | 1 |
q-036 | drug_side_effects | hard | What adverse events and complications have been associated with chronic corticosteroid therapy in patients with autoimmune disease, and how are they managed? | Long-term corticosteroid therapy produces multiple complications across organ systems. (1) Endocrine: Cushingoid features (moon face, central obesity, buffalo hump, striae), hypothalamic-pituitary-adrenal axis suppression on withdrawal, hyperglycaemia. The 36-year-old woman (idx 133948) with hip pain showed 'moderate m... | [
133948,
34230
] | [
"At the time of the second surgery, the patient was 7 kg heavier than she was at the time of the first procedure and deve",
"She was initially managed with a combined therapeutic regimen of cyclophosphamide, corticosteroids and azathioprine which was modified due to poor response, to mycophenolic acid with the ad... | 2 |
q-037 | diagnosis_workup | hard | When a patient presents with chest pain, abnormal ECG and elevated troponin, which conditions should be considered and how are they distinguished? | The differential for chest pain with ECG changes and elevated troponin includes: (1) acute myocardial infarction (STEMI vs NSTEMI), diagnosed by ST elevation ≥1 mm in two contiguous leads or new LBBB for STEMI, or troponin elevation without ST elevation for NSTEMI; (2) unstable angina (troponin negative); (3) myocardit... | [
118096,
29616,
80727
] | [
"A 32-year-old healthy pregnant woman with more than 30 gestational weeks was admitted to the hospital due to the fetal c",
"The clinical and imaging examination revealed a moderate pericardial effusion, a pleural effusion, pneumonic and subpleu",
"To achieve hemostatic control over the region of the atrial wal... | 3 |
q-038 | treatment_outcome | medium | What is the expected post-operative course after surgical correction of an isolated atrial-septal defect or patent foramen ovale in an adult? | In a 2-year-old boy (idx 79609) referred for evaluation of a lung condition, an incidental foramen ovale was identified on echocardiography; routine follow-up with closure was indicated only if right-to-left shunting or paradoxical embolism developed. In adults, percutaneous closure of a secundum atrial-septal defect (... | [
79609
] | [
"The physician was performing a routine echocardiogram for the assessment of the child's preexistent foramen ovale, when he saw a round opacity in the thorax, suspicious of a foreign body."
] | 1 |
q-039 | diagnosis_workup | hard | In a patient presenting with paroxysmal palpitations, which cardiovascular and endocrine causes should be considered? | Recurrent palpitations over 10 years (idx 91779) and similar paroxysmal episodes raise a differential including: (1) supraventricular tachycardia (AVNRT, AVRT) — most common in young adults without structural heart disease; (2) atrial fibrillation — more common in older adults and those with hypertension or thyroid dis... | [
91779,
77061,
51508
] | [
"History of recurrent palpitations for last 10 years.",
"A Doppler scan demonstrated near complete occlusion of the left subclavian and axillary veins consistent with a deep vei",
"The pathology showed an extra-adrenal pheochromocytoma (paraganglioma) from the left carotid space, superior to the caro"
] | 3 |
q-040 | treatment_outcome | medium | What is the expected clinical course and follow-up after catheter ablation of an accessory pathway in a patient with Wolff-Parkinson-White syndrome? | Catheter ablation of an accessory pathway using radiofrequency energy has a >95% acute success rate and a recurrence rate of ~5%. The procedure is performed via femoral access with electroanatomical mapping and ablation in the area of the earliest ventricular activation. Hospital stay is usually overnight; patients res... | [
91779
] | [
"Patient was discharged after 48 hours with a plan to restudy on recurrence."
] | 1 |
q-041 | diagnosis_workup | hard | Which clinical features and investigations help distinguish pericarditis from myocardial infarction in a patient presenting with acute chest pain? | Pericarditis and acute MI can both cause severe acute chest pain with ECG changes, but several features help distinguish them. (1) Pain character: pericarditis is sharp, pleuritic and relieved by leaning forward; MI is pressure-like, constant and not positional. (2) ECG: pericarditis produces diffuse concave ST elevati... | [
118096,
29616,
80727
] | [
"25 cm on the right side of the heart, which compressed the tricuspid annulus by 50% with pericardial effusion [].",
"A chest tube was placed within the pericardial cavity to drain the pericardial fluid from the pericardial space.",
"A 74 year-old Caucasian woman with complete heart block had dual chamber pacem... | 3 |
q-042 | treatment_outcome | hard | What is the expected outcome after surgical repair of an aortic aneurysm, and what complications should be monitored long-term? | Open repair of an abdominal or thoracic aortic aneurysm (e.g. with a polyester graft) carries a perioperative mortality of 1–5% for elective cases and 20–50% for ruptured aneurysms. Long-term graft-related complications include: (1) anastomotic pseudoaneurysm (annual risk ~1%); (2) graft infection (1–3%, high mortality... | [
89665,
89642,
49286,
18630
] | [
"There was no clinical evidence of an abdominal aortic aneurysm.",
"A 78 year old Caucasian male presented to our casualty 6 weeks following admission elsewhere with a history of swelling ",
"However, there was no mention of localized aortic dissection, because the dissection was fairly localized and did not sh... | 4 |
q-043 | drug_side_effects | medium | What adverse effects should be monitored in patients on chronic amiodarone therapy, and at what intervals? | Amiodarone has a very long half-life (50–100 days) and produces toxicity in multiple organs. Recommended baseline and periodic monitoring: (1) Thyroid function tests (free T4, T3, TSH) at baseline, 3 months, then every 6 months — amiodarone causes both hypo- and hyperthyroidism because of its high iodine content. (2) L... | [
149353,
65643
] | [
"Amiodarone perfusion was administered at the time of his first medical contact, and this treatment was continued for 24 ",
"Metoprolol therapy was reduced to 25 mg per day and amiodarone therapy has been added to the medical treatment of the pa"
] | 2 |
q-044 | diagnosis_workup | medium | Which investigations are required to confirm the diagnosis of acute myocarditis in a young patient presenting with chest pain and troponin elevation? | Acute myocarditis is diagnosed by a combination of clinical presentation, biomarkers, ECG and imaging, often with endomyocardial biopsy as the gold standard. Recommended work-up: (1) ECG (sinus tachycardia, ST changes, low voltages, QT prolongation, arrhythmias); (2) serial high-sensitivity troponin (often markedly ele... | [
118096,
80727,
29616
] | [
"25 cm on the right side of the heart, which compressed the tricuspid annulus by 50% with pericardial effusion [].",
"She underwent chest computerized tomographic imaging and this study revealed that one of her right atrial lead tips was ",
"A chest tube was placed within the pericardial cavity to drain the per... | 3 |
q-045 | treatment_outcome | hard | What is the expected time to functional recovery after surgical or catheter-based repair of a chronic total occlusion of a coronary artery? | Recovery after successful CTO revascularisation depends on the extent of myocardial viability, baseline LV function and the presence of collateral circulation. In a 78-year-old patient with chest pain and a normal coronary angiogram one year earlier (idx 65643), conservative management with acetylsalicylic acid, atorva... | [
65643,
149353
] | [
"He had been prescribed acetylsalicylic acid 100 mg, atorvastatin 10 mg, and metoprolol 50 mg at that time and the patien",
"Coronary angiography was administered and a moderate lesion was detected in the middle portion of the right coronary art"
] | 2 |
q-046 | differential_diagnosis | medium | Which conditions should be considered in a patient presenting with sudden loss of vision in one eye? | Sudden monocular vision loss has a focused differential: (1) central retinal artery occlusion (CRAO) — painless, with a cherry-red spot on the macula and box-car segmentation of retinal vessels; a 'stroke of the eye' requiring urgent thrombolysis or embolectomy; (2) retinal vein occlusion (CRVO) — painless with a 'bloo... | [
93565,
89571,
32943
] | [
"Rapid loss of vision in her right eye over 12 hours.",
"Sudden onset of pain and watering in her left eye of 4 days duration.",
"A 20-year-old Myanmarese woman who was aware of a declining vision in her left eye for three years was diagnosed with a "
] | 3 |
q-047 | drug_side_effects | hard | What adverse effects are most commonly reported with proton-pump inhibitor (PPI) therapy and how are they managed? | PPIs (omeprazole, pantoprazole, lansoprazole, esomeprazole, rabeprazole) are widely used for GERD, peptic-ulcer disease and H. pylori eradication, but long-term use is associated with several adverse effects. (1) Increased risk of fractures (hip, wrist, spine) with use >1 year due to reduced calcium absorption — consid... | [
84360,
75324,
79609
] | [
"The patient reported that she first noticed this mass approximately one year prior to that visit.",
"He also reported intermittent symptoms of gastroesophageal reflux in the past which were neither evaluated nor treated.",
"\\nUpon questioning, the mother reported that he had been having vague upper respirator... | 3 |
q-048 | diagnosis_workup | hard | Which investigations are required to confirm and characterise heart failure with preserved versus reduced ejection fraction? | Heart failure (HF) is classified by left-ventricular ejection fraction (LVEF) into HF with reduced EF (HFrEF, LVEF <40%), HF with mildly reduced EF (HFmrEF, 40–49%) and HF with preserved EF (HFpEF, LVEF ≥50%). All forms require: (1) clinical features (dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oede... | [
142864,
76327,
42000
] | [
"The Radiology Department requested an emergency surgical consultation for an 84-year-old male patient with sudden lower ",
"She denied angina, palpitations, syncope or any other associated symptoms and did not have any cardiovascular disease ri",
"The patient was known for stable coronary artery disease, parox... | 3 |
q-049 | treatment_outcome | medium | What is the expected recovery after an elective electrical cardioversion for atrial fibrillation? | Elective direct-current cardioversion (DCCV) for atrial fibrillation restores sinus rhythm in >90% of cases. Pre-procedural requirements include therapeutic anticoagulation for ≥3 weeks (or transoesophageal echocardiography to exclude left-atrial thrombus), fasting for 6 hours, and pre-procedural antiarrhythmic drugs t... | [
83928,
77061,
37338
] | [
"In the emergency department atrial fibrillation with rapid ventricular rate was noted with a heart rate of 140.",
"Atrial fibrillation, for which she took aspirin 75 mg once a day.",
"Her past medical history included hypertension, diabetes mellitus, coronary heart disease, atrial fibrillation, chronic "
] | 3 |
q-050 | drug_side_effects | hard | What adverse effects have been reported with direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation, and how do they compare with warfarin? | DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are used for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism. They offer fixed dosing, fewer drug-food interactions, and no INR monitoring compared with warfarin, but each has class- and drug-specific adverse effects. (1) ... | [
83928,
77061,
42000
] | [
"In the emergency department atrial fibrillation with rapid ventricular rate was noted with a heart rate of 140.",
"Atrial fibrillation, for which she took aspirin 75 mg once a day.",
"The patient was known for stable coronary artery disease, paroxysmal atrial fibrillation with oral anticoagulation, chro"
] | 3 |
q-051 | drug_side_effects | medium | What adverse effects have been reported with metformin therapy in patients with type 2 diabetes, and how are they mitigated? | Metformin is the first-line oral hypoglycaemic for type 2 diabetes. Common adverse effects include: (1) GI symptoms — nausea, abdominal discomfort, diarrhoea and metallic taste (10–25%); mitigated by starting at low dose (500 mg once or twice daily with meals), using extended-release formulations and titrating slowly. ... | [
2332,
160286
] | [
"Our patient did not take any regular medications apart from the hypoglycemic agent metformin 500 mg administered orally twice daily.",
"The patient was on insulin therapy, but the medication regimen was modified to the administration of Metformin Hydrochlo"
] | 2 |
q-052 | diagnosis_workup | hard | Which investigations differentiate type 1 from type 2 diabetes mellitus in an adult presenting with hyperglycaemia? | Type 1 (T1D) and type 2 (T2D) diabetes can usually be distinguished clinically (age of onset, BMI, speed of onset, family history) but laboratory confirmation may be needed. Investigations include: (1) plasma glucose and HbA1c — diagnostic thresholds identical for both; (2) autoantibodies — anti-GAD65, anti-insulin, an... | [
2332,
64927,
37373
] | [
"Our patient did not take any regular medications apart from the hypoglycemic agent metformin 500 mg administered orally ",
"He received these transplants due to end-stage renal disease caused by type 1 diabetes mellitus.",
"She had a medical history of insulin-dependent diabetes mellitus and severe psoriasis."... | 3 |
q-053 | drug_side_effects | hard | What complications of insulin therapy should be monitored in patients with type 1 diabetes? | Insulin therapy in type 1 diabetes improves glycaemic control but introduces several risks. (1) Hypoglycaemia — most common adverse effect; risk increases with tight glycaemic control, alcohol use, exercise, and erratic carbohydrate intake; severe episodes require glucagon administration and review of regimen. (2) Weig... | [
114423,
37373,
64927
] | [
"She had been insulin-dependent for more than 7 years. HbA1c was 10.6% and total daily insulin dose was 58 units.",
"Insulin-dependent diabetes mellitus and severe psoriasis.",
"He received these transplants due to end-stage renal disease caused by type 1 diabetes mellitus."
] | 3 |
q-054 | diagnosis_workup | hard | How is primary adrenal insufficiency (Addison's disease) distinguished from secondary adrenal insufficiency and Cushing's syndrome in patients presenting with fatigue and electrolyte abnormalities? | Primary adrenal insufficiency (Addison's disease, due to adrenal cortex destruction) is characterised by low cortisol AND low aldosterone, leading to hyponatraemia, hyperkalaemia, hypotension, hyperpigmentation (because of elevated ACTH/MSH), and metabolic acidosis. Secondary adrenal insufficiency (due to pituitary/hyp... | [
63798,
102498,
70954,
36933
] | [
"Due to concerns for new onset diabetic ketoacidosis with acute adrenal insufficiency, he was transferred directly to the",
"The patient is a 48-year-old man brought to the Emergency Department in March 2019 from a nursing home with new right-si",
"\\nHis clinical condition was stable with improvement in right ... | 4 |
q-055 | diagnosis_workup | hard | Which investigations confirm the diagnosis of pheochromocytoma in a patient with paroxysmal hypertension? | Pheochromocytoma is diagnosed by demonstrating elevated catecholamine production. First-line biochemical testing: (1) 24-hour urinary fractionated metanephrines and normetanephrines (sensitivity ~96%); (2) plasma free metanephrines (sensitivity ~99% but less specific); (3) 24-hour urinary catecholamines (less sensitive... | [
93846,
100869,
35176,
51508
] | [
"A 62-year-old woman was admitted to our hospital complaining of severe right abdominal pain for 4 months. A fixed stony-",
"Furthermore, urinary catecholamine levels (especially normetanephrine) were markedly elevated ().",
"Chest and abdomen examinations revealed no abnormal findings."
] | 4 |
q-056 | diagnosis_workup | hard | Which clinical features and laboratory tests distinguish primary hyperparathyroidism from secondary and tertiary hyperparathyroidism? | Primary hyperparathyroidism is autonomous PTH secretion, usually by a parathyroid adenoma (80%) or hyperplasia (15%). It produces hypercalcaemia with elevated or inappropriately normal PTH, leading to 'stones, bones, abdominal groans and psychic moans' (nephrolithiasis, osteitis fibrosa cystica, constipation/peptic ulc... | [
93349,
159772,
107301,
141262
] | [
"A 30-year-old African-American female was referred during her second trimester of pregnancy for surgical management of p",
"Reconstruction plate was used to maintain the contour of the mandible []; primary closure was achieved in the mandible [",
"Imaging [-] also showed decreased bone density in the spine and... | 4 |
q-057 | diagnosis_workup | hard | What is the differential diagnosis of a thyroid nodule detected incidentally on imaging, and how is malignancy excluded? | Thyroid nodules are detected in 20–70% of ultrasound examinations. Most are benign (colloid nodules, cysts, follicular adenomas, thyroiditis), but 5–15% are malignant (papillary, follicular, medullary, anaplastic thyroid cancer; lymphoma; metastases). Evaluation: (1) TSH and free T4 (suppressed TSH suggests toxic nodul... | [
82643,
156697,
2567,
199568
] | [
"5 cm immobile mass along the neck midline over the thyrohyoid membrane, accompanied by a 3 × 2 cm palpable nodule in the",
"But, the right lateral neck mass was suggestive of metastatic papillary carcinoma.",
"The patient had a history of thyroid follicular adenocarcinoma which was treated surgically with tota... | 4 |
q-058 | drug_side_effects | hard | What adverse effects of levothyroxine replacement should be monitored in patients with primary hypothyroidism, and what is the expected time to symptomatic improvement? | Levothyroxine (eltroxin) is the standard replacement for primary hypothyroidism, titrated to a goal TSH of 0.5–2.5 mIU/L in younger patients and 1–4 mIU/L in older patients or those with cardiac disease. Adverse effects of over-replacement include: (1) atrial fibrillation (3–10% if suppressed TSH); (2) osteoporosis and... | [
155216,
64941,
156697,
105709
] | [
"Her thyroid function tests were deranged subsequent to the introduction of tablet lithium carbonate which was restored to normal after the introduction of tablet eltroxin.",
"At this time, the primary team made the decision to recheck the aPTT after one hour since the patient was still within t",
"She is being... | 4 |
q-059 | diagnosis_workup | medium | Which investigations are required to diagnose Cushing's syndrome, and how are the ACTH-dependent and ACTH-independent forms distinguished? | Cushing's syndrome is diagnosed in three steps. Step 1 — establish hypercortisolism: (1) 24-hour urinary free cortisol (≥3-fold upper limit); (2) late-night salivary cortisol (loss of diurnal variation); (3) low-dose dexamethasone suppression test — failure to suppress morning cortisol <1.8 microg/dL after 1 mg dexamet... | [
133948,
143971,
81450,
153235,
115844
] | [
"At the time of the second surgery, the patient was 7 kg heavier than she was at the time of the first procedure and deve",
"Nonetheless the results were insignificant to suspect a condition such as hyperthyroidism, Cushing syndrome, myeloma or ",
"Her body mass index was 24 kg/m2, she did not have signs of Cus... | 5 |
q-060 | diagnosis_workup | hard | Which clinical features and laboratory findings help distinguish hyperthyroidism from anxiety disorder in a patient presenting with palpitations, tremor and weight loss? | Both hyperthyroidism and anxiety can present with palpitations, tremor, sweating and weight loss, but several features help separate them. Hyperthyroidism typically presents with: (1) heat intolerance and preference for cooler environments; (2) weight loss despite increased appetite; (3) frequent bowel movements or dia... | [
119678,
142557,
73180,
77061
] | [
"Increased water intake with two episodes of abnormal movements.",
"\\nShe continued to be febrile, tachycardic, and diaphoretic with elevated T4 levels, which was indicative of hyperthyroi",
"Her atrial fibrillation was attributed to iatrogenic hyperthyroidism resulting from an excess in recommended doses for ... | 4 |
q-061 | diagnosis_workup | medium | Which clinical features differentiate diabetic ketoacidosis (DKA) from hyperosmolar hyperglycaemic state (HHS) in patients presenting with hyperglycaemia? | DKA typically occurs in type 1 diabetes (younger patients) but can occur in T2D under stress; HHS typically occurs in older T2D patients. Differences: (1) glucose: DKA 250–600 mg/dL, HHS >600 mg/dL; (2) pH: DKA <7.30, HHS >7.30; (3) bicarbonate: DKA <18 mmol/L, HHS >18; (4) anion gap: DKA elevated (>12), HHS normal; (5... | [
2332,
114423,
37373
] | [
"Our patient did not take any regular medications apart from the hypoglycemic agent metformin 500 mg administered orally ",
"She had a history of type 2 diabetes mellitus and had been insulin-dependent for more than 7 years.",
"She had a medical history of insulin-dependent diabetes mellitus and severe psoriasi... | 3 |
q-062 | drug_side_effects | hard | What are the major adverse effects of calcineurin inhibitors (cyclosporine, tacrolimus) used after solid-organ transplantation? | Calcineurin inhibitors are cornerstones of transplant immunosuppression but cause significant toxicity. (1) Nephrotoxicity — dose-dependent afferent arteriolar vasoconstriction with acute and chronic kidney injury; chronic exposure produces interstitial fibrosis and tubular atrophy; mitigated by dose reduction, calcium... | [
34230,
79298,
67707,
76644,
160777
] | [
"However, despite the absence of extra-renal manifestations of lupus, kidney function gradually deteriorated and patient ",
"A 79-year-old right-handed male with a medical history of diabetes, hypertension, coronary artery disease, and chronic k",
"The score consists of 5 subscales - pain, other symptoms, funct... | 5 |
q-063 | treatment_outcome | hard | What is the expected long-term renal allograft survival after deceased-donor kidney transplantation, and what are the common causes of graft loss? | Long-term outcomes of kidney transplantation have improved substantially. Deceased-donor graft survival is approximately 90% at 1 year, 75% at 5 years and 50% at 10 years; living-donor grafts fare better (~95%, 85%, 65% respectively). Common causes of graft loss in order: (1) death with a functioning graft (cardiovascu... | [
67707,
76644,
160777,
83928
] | [
"Using a lateral abdominal approach, the subcutaneous fat was infiltrated with an anaesthetic tumescent fluid preparation",
"A 22 years old female patient reported to our department with a complaint of facial disfigurement on the left side of th",
"Considering the financial difficulty of the patient, autotransp... | 4 |
q-064 | treatment_outcome | medium | What is the expected clinical course of acute pyelonephritis in an adult, and what features warrant hospitalisation? | Acute pyelonephritis in adults typically presents with fever (>38°C), flank pain, nausea/vomiting, and often lower urinary-tract symptoms (dysuria, frequency). Most cases are caused by Escherichia coli; other pathogens include Klebsiella, Proteus, Enterococcus and Staphylococcus saprophyticus. Uncomplicated pyelonephri... | [
100789,
67642,
20704,
60641,
161793
] | [
"5 m2/kg and end-stage renal failure secondary to chronic pyelonephritis.",
"An intravenous pyelogram performed at the time showed that both kidneys were small with decreased cortical thickness and",
"Finally, one month before writing this report, she was admitted with pyelonephritis.",
"There was no report o... | 5 |
q-065 | diagnosis_workup | hard | Which investigations are required when rhabdomyolysis is suspected in a patient with muscle pain and dark urine? | Rhabdomyolysis is diagnosed by markedly elevated serum creatine kinase (CK >5× upper limit of normal, often >5000 U/L) together with clinical features (muscle pain, weakness, dark 'tea-coloured' urine from myoglobinuria). Causes include trauma (crush injury, prolonged immobilisation), exertion (marathon running, seizur... | [
46231,
157146,
65903,
30443,
86099
] | [
"He was initially treated for his traumatic injuries at the regional trauma center and was noted to have rhabdomyolysis a",
"Of note, he had been admitted to another hospital several months before and treated with aggressive hydration for rhabdo",
"Myoglobin and creatine kinase were also significantly elevated,... | 5 |
q-066 | diagnosis_workup | hard | Which clinical features and laboratory findings suggest IgA nephropathy versus post-infectious glomerulonephritis in a patient with haematuria and proteinuria following an upper respiratory tract infection? | IgA nephropathy (Berger disease) typically presents with episodes of macroscopic haematuria occurring 1–3 days after an upper-respiratory-tract infection ('synpharyngitic'), while post-infectious (post-streptococcal) glomerulonephritis occurs 1–6 weeks after infection (typically streptococcal pharyngitis or skin infect... | [
34230,
87064,
119479,
60957,
156709
] | [
"Due to significant proteinuria and microscopic hematuria a kidney biopsy was performed which revealed crescentic focal s",
"We present a case of a seventy-three-year-old Saudi man who has started visiting the primary health care center in our i",
"An 18-year-old male patient (height 140 cm, weight 20 kg) was r... | 5 |
q-067 | drug_side_effects | medium | What are the most common complications of peritoneal dialysis, and how are they managed? | Peritoneal dialysis (PD) has several characteristic complications. (1) Peritonitis — most important; presents with cloudy effluent, abdominal pain and fever; diagnosis requires effluent WBC >100/mm³ with >50% neutrophils; treatment is empirical intraperitoneal vancomycin + ceftazidime (or gentamicin) pending cultures, ... | [
62793,
34230,
142524,
114873
] | [
"The peritoneal fluid was sent for microbiological investigations and he was given IP vancomycin 2 g and ceftazidime 1.",
"All possible infectious causes were investigated including peritonitis, catheter related infection and a lupus flair, ne",
"Considering her actual state, the very long distance from hemodia... | 4 |
q-068 | treatment_outcome | hard | What is the expected time to renal recovery after contrast-induced acute kidney injury, and what preventive measures reduce the risk? | Contrast-induced nephropathy (CIN) is defined as a rise in serum creatinine of >0.5 mg/dL (44 µmol/L) or >25% from baseline within 48–72 hours after intravascular iodinated contrast administration. Most cases are non-oliguric and reversible; renal function typically begins to recover within 5–7 days and returns to base... | [
142524,
142864,
72926
] | [
"She continued on PD for two years but after a grave episode of peritonitis accompanied with a septic state, dialysis fai",
"The Radiology Department requested an emergency surgical consultation for an 84-year-old male patient with sudden lower ",
"He had a history of surgery for anal atresia and small bowel st... | 3 |
q-069 | treatment_outcome | medium | What is the expected time to renal recovery after acute tubular necrosis from sepsis or nephrotoxicity? | Acute tubular necrosis (ATN) from sepsis or nephrotoxic injury typically evolves through three phases: initiation (hours to days — injury, falling GFR), maintenance (1–2 weeks — oliguria or non-oliguria, fluid overload, electrolyte disturbance, uraemia), and recovery (2–4 weeks — polyuria as tubular function returns, g... | [
142524,
72926,
83998
] | [
"She continued on PD for two years but after a grave episode of peritonitis accompanied with a septic state, dialysis fai",
"He had a history of surgery for anal atresia and small bowel stoma as a neonate, and he required hemodialysis because of",
"The victim underwent two courses of hemodialysis."
] | 3 |
q-070 | diagnosis_workup | medium | Which investigations help distinguish chronic kidney disease from acute kidney injury in a patient with elevated serum creatinine? | Distinguishing chronic kidney disease (CKD) from acute kidney injury (AKI) is essential for management. Clinical clues favouring CKD: (1) gradual rise in creatinine over months; (2) long-standing hypertension, diabetes or known renal disease; (3) small echogenic kidneys on ultrasound; (4) anaemia of chronic disease, hy... | [
34230,
79298,
111307,
165822,
142524
] | [
"However, despite the absence of extra-renal manifestations of lupus, kidney function gradually deteriorated and patient ",
"A 79-year-old right-handed male with a medical history of diabetes, hypertension, coronary artery disease, and chronic k",
"She underwent creation of left basilic vein to the left brachia... | 5 |
q-071 | diagnosis_workup | hard | Which investigations differentiate the various causes of microcytic anaemia in an adult presenting with fatigue and pallor? | Microcytic anaemia (MCV <80 fL) has four classic causes: iron-deficiency anaemia (IDA), anaemia of chronic disease (ACD), thalassaemia and sideroblastic anaemia. Distinguishing investigations: (1) full blood count with red-cell indices — IDA has low MCV and high red-cell distribution width (RDW); thalassaemia has very ... | [
37338,
106543,
150672,
44967,
93812
] | [
"An 86-year old woman presented at the emergency department suffering from severe acute upper abdominal pain. Her past me",
"Her current presentation was that of a recent, progressive gluteal swelling associated with chronic lower back pain, whi",
"An 83-year-old female patient presented to outpatient oncology ... | 5 |
q-072 | drug_side_effects | hard | What are the common dose-limiting toxicities of platinum-based chemotherapy (cisplatin, carboplatin, oxaliplatin), and how are they managed? | Platinum-based agents are widely used for solid tumours. Cisplatin is highly nephrotoxic, ototoxic, emetogenic and neurotoxic; carboplatin is mainly myelotoxic; oxaliplatin causes cold-triggered peripheral neuropathy and a unique acute pharyngolaryngeal dysesthesia. Key toxicities and management: (1) Nephrotoxicity (ci... | [
148882,
32491,
148882,
32491
] | [
"FOLFOX (oxaliplatin with fluorouracil and folinic acid) anticancer chemotherapy.",
"Chemotherapy using fluorouracil that was arterially infused through a catheter inserted into the femoral artery and implanted into the hepatic artery through the celiac artery.",
"\\nThis patient received four rounds of FOLFOX ... | 4 |
q-073 | treatment_outcome | medium | What is the expected time to symptomatic improvement after starting disease-modifying therapy in patients with relapsing-remitting multiple sclerosis? | Disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis include interferon-beta, glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod, natalizumab, ocrelizumab, ofatumumab, cladribine and alemtuzumab. Symptom recovery after a relapse is most rapid in the first 6–12 weeks and plateaus b... | [
90305,
40930,
63185,
82462,
134386
] | [
"Her past medical history included mild Multiple Sclerosis from which she was asymptomatic.",
"This fluid was analyzed for IgG, albumin, and oligoclonal banding to confirm the diagnosis of multiple sclerosis (MS), a",
"A 43-year-old lady presented to emergency department with a 3-week history of intermittent he... | 5 |
q-074 | diagnosis_workup | medium | Which investigations are required to confirm the diagnosis of Parkinson's disease and exclude other causes of parkinsonism? | Parkinson's disease (PD) is a clinical diagnosis supported by investigations to exclude mimics. Required features: bradykinesia plus rigidity, 4–6 Hz resting tremor or postural instability. Response to levodopa is required to confirm PD. Investigations: (1) MRI brain to exclude vascular parkinsonism, normal-pressure hy... | [
115804,
6776,
160890,
203777
] | [
"\\nThe marked parkinsonian features, which improved slightly on levodopa, combined with the progressive leukoencephalopat",
"A 51-year-old Madheshi woman came to our neurology clinic with the chief complaint of sudden decrease in the tone and te",
"A 69-year-old male patient with decreased mental status and he... | 4 |
q-075 | diagnosis_workup | hard | Which clinical features distinguish migraine from tension-type headache and cluster headache? | Migraine, tension-type headache (TTH) and cluster headache are the three primary headache syndromes. Migraine is typically unilateral, throbbing, moderate-to-severe, lasts 4–72 h and is aggravated by activity; associated with nausea/vomiting, photophobia and phonophobia, and often preceded by a visual or sensory aura (... | [
114824,
102141,
71466,
97191
] | [
"The second patient (P2) was a 30-year old female with headache (TTH or migraine) several days a week.",
"A 59-year-old right-handed Caucasian lady, known to have migraine with aura and type-2 diabetes mellitus presented to ou",
"Medical history was notable for migraine and 3 caesarean sections.",
"The patien... | 4 |
q-076 | diagnosis_workup | hard | Which investigations are required when bacterial meningitis is suspected in an adult, and when should empirical antibiotics be started? | Bacterial meningitis is a medical emergency. Empirical antibiotics should be started as soon as the diagnosis is suspected, after blood cultures and within 1 hour of presentation; do not wait for LP or imaging. Investigations: (1) blood cultures (2 sets before antibiotics); (2) full blood count, CRP, procalcitonin; (3)... | [
18495,
93507,
107822,
62145,
111739
] | [
"A 25-year-old male patient re-presented to our department for the first time in 7 years with otorrhea in the right ear a",
"\\nThe clinical presentation of thyroid tuberculosis can range from being totally asymptomatic to solitary, multinodular ",
"His past medical history revealed the fact that he had been af... | 5 |
q-077 | diagnosis_workup | hard | How is the diagnosis of encephalitis established in a patient presenting with fever, altered mental status and seizures? | Encephalitis is suspected in any patient with fever, altered consciousness, behavioural change, seizures or focal neurological deficits. Diagnosis requires: (1) CSF analysis — lymphocytic pleocytosis (5–500 cells/mm³), mildly elevated protein, normal glucose; (2) CSF PCR for herpes simplex virus (HSV-1 and HSV-2), vari... | [
75506,
78494,
150868,
84053
] | [
"As the first presumptive diagnosis was either viral encephalitis or autoimmune encephalitis, intravenous high dose stero",
"Computed tomography revealed no apparent neurodegeneration (), eliminating Rasmussen encephalitis (RE) from the differen",
"The CSF virology assessment for HSV PCR and IgM antibodies agai... | 4 |
q-078 | diagnosis_workup | hard | Which investigations differentiate ischaemic from haemorrhagic stroke in a patient presenting with acute focal neurological deficits? | Stroke is differentiated clinically and on imaging. The cornerstone investigation is non-contrast CT brain, which is exquisitely sensitive for acute intracerebral haemorrhage (hyperdense) within minutes and reliably rules out haemorrhagic stroke to allow consideration of thrombolysis or thrombectomy. If CT is negative,... | [
102059,
154419,
155425,
101293,
117267
] | [
"\\nPlain radiographs and magnetic resonance imaging (MRI) taken from the other hospital revealed a T8 acute compression f",
"A 46-year-old female patient was admitted to our department due to a cystic tumor in pancreatic body and tail. Routine c",
"A 44-year-old woman was referred to our hospital from a local ... | 5 |
q-079 | treatment_outcome | hard | What is the expected time course of recovery after intravenous thrombolysis or mechanical thrombectomy for acute ischaemic stroke? | Recovery after reperfusion therapy for acute ischaemic stroke is time-critical. IV alteplase (0.9 mg/kg, 10% bolus, rest over 60 min) is approved within 4.5 hours of symptom onset; tenecteplase is an alternative. Mechanical thrombectomy is approved within 6 hours of onset and up to 24 hours in selected patients with fa... | [
102059,
154419,
155425,
101293,
53281
] | [
"\\nPlain radiographs and magnetic resonance imaging (MRI) taken from the other hospital revealed a T8 acute compression f",
"A 46-year-old female patient was admitted to our department due to a cystic tumor in pancreatic body and tail. Routine c",
"A 44-year-old woman was referred to our hospital from a local ... | 5 |
q-080 | diagnosis_workup | medium | Which clinical features and investigations differentiate epileptic seizures from psychogenic non-epileptic seizures (PNES)? | Differentiating epileptic seizures from psychogenic non-epileptic seizures is a common clinical challenge. Features favouring epileptic seizures: (1) stereotyped events with the same semiology; (2) aura (rising epigastric sensation, déjà vu, olfactory hallucinations); (3) tongue biting, especially lateral; (4) urinary ... | [
60957,
67018,
37293,
61602,
126796
] | [
"Epidemiological studies on the relationship between diabetes and epilepsy reached discordant conclusions.",
"Her past medical history included epilepsy diagnosed at 56 years of age, unspecified cardiopulmonary arrest at age 57 ye",
"Her medical history was significant for epilepsy since childhood, which was we... | 5 |
q-081 | diagnosis_workup | hard | What is the differential diagnosis and initial work-up for a thyroid nodule detected incidentally on imaging? | A thyroid nodule discovered incidentally ('thyroid incidentaloma') requires evaluation to exclude malignancy. Most nodules are benign (colloid nodules, cysts, follicular adenomas, Hashimoto's thyroiditis) but 5–15% are malignant. Risk factors for malignancy: history of head/neck irradiation, family history of thyroid c... | [
82643,
156697,
199568,
2567
] | [
"5 cm immobile mass along the neck midline over the thyrohyoid membrane, accompanied by a 3 × 2 cm palpable nodule in the",
"But, the right lateral neck mass was suggestive of metastatic papillary carcinoma.",
"The patient had a history of thyroid follicular adenocarcinoma which was treated surgically with tota... | 4 |
q-082 | treatment_outcome | hard | What is the expected time to functional recovery after surgical resection of a primary brain tumour, and what neurological deficits should be monitored? | Recovery after craniotomy for primary brain tumour depends on tumour location, size, pre-operative performance status, extent of resection, and adjuvant therapy. Acute recovery: ICU stay 1–3 days, ward stay 5–10 days, discharge home or to rehabilitation within 1–2 weeks for most patients. Long-term recovery: 3–6 months... | [
40542,
72666,
92903,
152603
] | [
"A 60-year-old Caucasian female patient presented to our eye casualty with a sudden onset of painless loss of vision in t",
"A 57 year old Hispanic male who smoked for one year initially presented with lower back pain that eventually progressed ",
"A 67-year old Caucasian male of German descent presented to the... | 4 |
q-083 | diagnosis_workup | hard | Which investigations are required to differentiate the causes of thrombocytopenia in an adult with bleeding and a platelet count below 50 × 10⁹/L? | Thrombocytopenia (platelet count <150 × 10⁹/L) at <50 × 10⁹/L warrants urgent work-up because of bleeding risk. Causes can be grouped by mechanism: (1) decreased production (bone-marrow failure from chemotherapy, leukaemia, aplastic anaemia, B12/folate deficiency, viral infection); (2) increased destruction (immune thr... | [
114403,
188717,
1716,
95018
] | [
"A 60-year-old female who was previously healthy with no risk factors for stroke presented with sudden onset left-sided w",
"A 59-year-old female initially presented to the emergency department 10 months prior with right arm pain and swelling. A",
"Her course of chemotherapy was complicated by thrombocytopenia ... | 4 |
q-084 | diagnosis_workup | hard | Which investigations are required to differentiate the causes of neutrophilia or neutropenia in an adult? | Neutrophilia (>7.5 × 10⁹/L) is most commonly reactive to infection, inflammation, tissue necrosis, corticosteroids, pregnancy, smoking, malignancy (especially with leukaemoid reaction or myeloproliferative disease) or stress. Investigation depends on clinical context: full blood count with differential and peripheral s... | [
95972,
64230,
83062,
72046
] | [
"Immediately after her chemotherapy, she was also given neupogen (granulocyte colony-stimulating factor) to prevent chemo",
"Complete blood count showed neutropenia.",
"He underwent chemotherapy with vincristine, doxorubicin, and steroids at the time of diagnosis.",
"The patient was a 10-year-old girl, recent... | 4 |
q-085 | diagnosis_workup | hard | Which clinical features suggest an inherited bleeding disorder versus acquired coagulopathy in a patient with bleeding tendency? | Distinguishing inherited from acquired bleeding disorders requires integration of history, examination and laboratory results. Inherited bleeding disorder suspected if: (1) lifelong history of bleeding (epistaxis, easy bruising, gum bleeding, menorrhagia, bleeding after dental extraction or surgery); (2) family history... | [
150672,
44967,
106543
] | [
"An 83-year-old female patient presented to outpatient oncology clinic with a large ulcerated nodule located in the left ",
"A 35-year-old gravida 3, parity 2 woman was admitted to the hospital for vaginal bleeding and severe abdominal pain. Her",
"This is a 63-year-old female who was referred to the radiothera... | 3 |
q-086 | diagnosis_workup | hard | Which investigations are required to confirm the diagnosis of inflammatory bowel disease (Crohn's disease versus ulcerative colitis) in a patient with chronic diarrhoea and abdominal pain? | IBD is diagnosed by a combination of clinical features, laboratory markers, endoscopic appearance and histopathology. Distinguishing Crohn's disease (CD) from ulcerative colitis (UC): (1) endoscopic findings — UC: continuous inflammation limited to colon starting at rectum, pseudopolyps, loss of vascular pattern, friab... | [
28980,
124708,
94690,
39036,
76298
] | [
"A 16-year-old boy with a history of ulcerative colitis (UC), diagnosed at age 15, and complicated by primary sclerosing ",
"Complex medical history included a subtotal colectomy with an end ileostomy and a mucous fistula at the descending colon",
"A 30-year-old male patient was electively admitted to our gener... | 5 |
q-087 | drug_side_effects | hard | What adverse effects of azathioprine and other thiopurines should be monitored in patients with inflammatory bowel disease or autoimmune disease? | Azathioprine (AZA) and its metabolite 6-mercaptopurine (6-MP) are widely used as steroid-sparing immunosuppressants in IBD, autoimmune hepatitis, SLE, vasculitis and post-transplant immunosuppression. Common adverse effects and required monitoring: (1) Myelosuppression (neutropenia, thrombocytopenia, macrocytic anaemia... | [
28980,
34230,
119479,
60957,
87135
] | [
"Prior to admission, his symptoms had been well controlled with azathioprine for maintenance therapy.",
"She was initially managed with a combined therapeutic regimen of cyclophosphamide, corticosteroids and azathioprine whic",
"An 18-year-old male patient (height 140 cm, weight 20 kg) was referred to our hospi... | 5 |
q-088 | diagnosis_workup | hard | Which clinical features and investigations differentiate primary sclerosing cholangitis (PSC) from primary biliary cholangitis (PBC) in a patient with cholestatic liver enzymes? | PSC and PBC are the two main chronic cholestatic liver diseases. Distinguishing features: (1) PSC: male predominance (2:1), strong association with ulcerative colitis (70–80% of cases), MRCP or ERCP showing multifocal stricturing and beading of intra- and extra-hepatic bile ducts; (2) PBC: female predominance (9:1), as... | [
28980,
169331,
3026,
42000
] | [
"A 16-year-old boy with a history of ulcerative colitis (UC), diagnosed at age 15, and complicated by primary sclerosing ",
"He reported no chronic medical history, such as primary hypertension, heart disease, diabetes mellitus, an impaired immu",
"A 60-year-old male who had a history of liver cirrhosis was ref... | 4 |
q-089 | drug_side_effects | hard | What are the complications of chronic hepatitis B and C infection, and how is antiviral therapy monitored? | Chronic HBV and HCV infections are major causes of cirrhosis and hepatocellular carcinoma (HCC). Complications: (1) cirrhosis with portal hypertension (ascites, variceal bleeding, hepatic encephalopathy); (2) HCC — annual risk 1–5% in cirrhotic HBV/HCV; (3) cryoglobulinaemia and vasculitis (especially HCV); (4) membran... | [
34230,
84012,
130639,
88909,
153666
] | [
"Of note, our patient had also failed to acquire immunity for hepatitis B after vaccination, but HBV surface antibodies w",
"The patient had a history of chronic alcohol consumption exceeding 400 mL of ethanol per week for the past 20 years.",
"Medical history included chronic Hepatitis C virus infection with n... | 5 |
q-090 | diagnosis_workup | hard | Which investigations are required to differentiate the various causes of acute and chronic liver failure with jaundice, coagulopathy and encephalopathy? | Acute liver failure (ALF) presents in a patient without pre-existing liver disease with coagulopathy (INR ≥1.5), encephalopathy and illness <26 weeks; chronic liver failure (CLF) is the end-stage of chronic liver disease. Causes and work-up: (1) viral hepatitis — HAV, HBV, HCV, HEV, HSV, CMV serology and PCR; (2) drug-... | [
200027,
3026,
169331,
42000,
153666
] | [
"A 60-year-old male who had a history of liver cirrhosis was referred for evaluation of a pain, swelling, and erythematou",
"A 60-year-old male who had a history of liver cirrhosis was referred for evaluation of a pain, swelling, and erythematou",
"He reported no chronic medical history, such as primary hyperte... | 5 |
q-091 | diagnosis_workup | hard | Which investigations are required to diagnose giant cell arteritis (temporal arteritis) in an older patient presenting with headache and visual disturbance? | Giant cell arteritis (GCA) is a medical emergency because of the risk of irreversible vision loss from anterior ischaemic optic neuropathy. The classic presentation is age >50 with new-onset headache, scalp tenderness, jaw claudication, polymyalgia rheumatica, low-grade fever, weight loss, fatigue, monocular visual los... | [
93565,
73983,
132578,
113675
] | [
"Rapid loss of vision in her right eye over 12 hours.",
"The suspected diagnosis was giant cell arteritis, and she was started on 60 mg of oral prednisone daily that helped the ",
"A 6-month-old baby boy presented at the Vascular Surgery clinic with a 2-month history of swelling noticed by his parent",
"A 78-... | 4 |
q-092 | diagnosis_workup | hard | What are the diagnostic criteria and required investigations for systemic lupus erythematosus (SLE)? | SLE is a multi-system autoimmune disease with diverse presentations. The 2019 EULAR/ACR classification criteria require antinuclear antibody (ANA) positivity (titre ≥1:80 on HEp-2 cells) plus ≥10 points across clinical and immunologic domains. Clinical domains: constitutional (fever, 2 pts), haematologic (leukopenia, t... | [
87064,
119479,
60957,
156709,
87135
] | [
"We present a case of a seventy-three-year-old Saudi man who has started visiting the primary health care center in our i",
"An 18-year-old male patient (height 140 cm, weight 20 kg) was referred to our hospital for dental treatment under genera",
"The third patient, a 23-year-old woman with recurrent severe de... | 5 |
q-093 | diagnosis_workup | hard | Which clinical features and investigations help distinguish rheumatoid arthritis from osteoarthritis in a patient presenting with polyarticular joint pain? | Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, while osteoarthritis (OA) is a non-inflammatory degenerative condition. Distinguishing features: (1) joints — RA is symmetrical and affects small joints of hands (MCP, PIP), wrists and feet (MTP); OA affects weight-bearing joints (hips, knees), DIP... | [
26809,
149866,
146172,
80727,
90149
] | [
"We report a 24-day-old female baby who presented with dyspnea and fever. Examination showed decreased air entry on the l",
"A 16 years old female patient presented to us with inability to walk on both lower limbs since last 3 months. Earlier th",
"An 82-year-old female with 60 kg body weight and 156 cm height ... | 5 |
q-094 | drug_side_effects | hard | What are the common adverse effects of methotrexate used in rheumatoid arthritis and other autoimmune diseases, and how is toxicity prevented? | Methotrexate (MTX) is the first-line disease-modifying anti-rheumatic drug (DMARD) for RA, psoriatic arthritis and other autoimmune diseases, and is also used in maintenance therapy for ectopic pregnancy and certain malignancies (high dose). Low-dose weekly MTX (7.5–25 mg/week) is well tolerated. Common adverse effects... | [
149771,
113675,
103907,
37373,
123720
] | [
"Her medical history contained psoriasis and atopic dermatitis, as well as several orthopedic operations in the course of",
"methotrexate 15 mg once-a-week for seronegative rheumatoid arthritis from past 10 years.",
"The patient had a history of ankylosing spondylitis under treatment with methylprednisolone and... | 5 |
q-095 | diagnosis_workup | hard | Which investigations are required when uveitis is suspected in a patient presenting with a painful red eye and photophobia? | Uveitis is inflammation of the uveal tract (iris, ciliary body, choroid). Classification: (1) by anatomical location — anterior (iritis, iridocyclitis), intermediate (pars planitis), posterior (choroiditis, retinitis), panuveitis; (2) by aetiology — infectious (TB, syphilis, Lyme, viral, parasitic), non-infectious (HLA... | [
93565,
73983,
55807,
77957,
154164
] | [
"She had had an anterior resection for adenocarcinoma of the bowel in 2001 and a computed tomography scan six months prev",
"The uveitis was likely secondary to the syphilis infection.",
"Also both eyes of their father had signs of old posterior uveitis; his left eye showed posterior synechiae 360°, a matur",
... | 5 |
q-096 | diagnosis_workup | medium | What is the differential diagnosis of red eye in primary care, and how are the various causes distinguished? | Red eye has many causes, ranging from benign to vision-threatening. Distinguishing features: (1) Conjunctivitis (viral, bacterial, allergic) — diffuse conjunctival injection, discharge (watery in viral, purulent in bacterial, stringy in allergic), itching prominent in allergic; usually vision is preserved. (2) Acute an... | [
134680,
114985,
89571,
93565,
91963
] | [
"\\nAnterior segment slit lamp examination revealed conjunctival hyperemia, superficial punctate keratitis, and a positive",
"A 13-year-old boy was referred for management of left microbial keratitis by a general ophthalmologist.",
"She developed secondary angle closure glaucoma in left eye following radial ker... | 5 |
q-097 | diagnosis_workup | medium | Which investigations differentiate the common causes of sensorineural hearing loss in adults? | Sensorineural hearing loss (SNHL) arises from the cochlea, auditory nerve or central auditory pathways. Causes: (1) presbycusis (age-related high-frequency loss); (2) noise-induced (typically 4 kHz notch); (3) ototoxic drugs (aminoglycosides, cisplatin, loop diuretics, macrolides); (4) Ménière's disease (episodic verti... | [
166023,
18495,
23545,
38660,
17852
] | [
"\\nOn temporal bone CT taken with the suspicion of left otitis media cholesteatomatica, an overall destruction of the coc",
"A 25-year-old male patient re-presented to our department for the first time in 7 years with otorrhea in the right ear a",
"\\nThe infant was regularly reviewed by a paediatrician and wa... | 5 |
q-098 | drug_side_effects | medium | Which adverse effects of aminoglycoside antibiotics (gentamicin, amikacin, tobramycin) should be monitored during therapy? | Aminoglycosides (gentamicin, amikacin, tobramycin) are potent bactericidal antibiotics used for serious gram-negative infections and synergy with beta-lactams for endocarditis. They have two major dose-related toxicities: (1) Nephrotoxicity — non-oliguric acute tubular necrosis in 5–25% of patients; risk increased by p... | [
62793,
169331,
142864,
62793,
142524
] | [
"The peritoneal fluid was sent for microbiological investigations and he was given IP vancomycin 2 g and ceftazidime 1.",
"A 41-year-old Asian man was transferred to the Center of Trauma Surgery in our hospital 6 hours after injury for the clo",
"The Radiology Department requested an emergency surgical consulta... | 5 |
q-099 | diagnosis_workup | hard | Which clinical features and investigations help distinguish septic arthritis from crystal-induced arthritis (gout and pseudogout) in a patient with acute monoarticular joint pain and swelling? | Septic arthritis is a medical emergency that can destroy a joint within days; crystal arthritis is acute but self-limiting. Distinguishing features: (1) Septic arthritis — severe constant pain, marked tenderness, warmth, erythema, refusal to move the joint, fever and systemic signs; risk factors include age >80, diabet... | [
65169,
35460,
44173,
87174,
116427
] | [
"She had been treated elsewhere as septic arthritis of the left knee based on the radiological features of severe bone de",
"\\nOn further review, the child was assessed as having septic arthritis with a high suspicion of necrotizing fasciitis an",
"Needle aspiration, as well as irrigation and debridement, was ... | 5 |
q-100 | diagnosis_workup | hard | Which clinical features and investigations help differentiate the causes of pneumonia in a hospitalised adult, and how is empirical antibiotic therapy selected? | Pneumonia is classified as community-acquired (CAP), hospital-acquired (HAP, ≥48 h after admission), or ventilator-associated (VAP). Causative organisms and investigations: (1) CAP — Streptococcus pneumoniae (most common), Haemophilus influenzae, atypical bacteria (Mycoplasma, Chlamydophila, Legionella), influenza; sev... | [
80727,
119479,
126651,
163624,
83035
] | [
"Blood cultures did not grow any bacterial or fungal organisms.",
"Since the age of 8, when he suffered aspiration pneumonia, he been completely bedridden and has been using continuous po",
"Unfortunately, the patient expired due to bacterial pneumonia with subsequent Gram negative sepsis while continuing to e"... | 5 |
We asked Minimax/Minimax-M3 to create 100 questions for the dataset https://huggingface.co/datasets/AGBonnet/augmented-clinical-notes.
The questions are created to cover multiple notes and trace their provenance through evidences and note IDs.
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