SeanWu25/NEJM-AI_Benchmarking_Medical_Language_Models huggingface dataset:
Subject: Electrolyte Acid-Base Disorders
You are asked to see a 60-year-old woman with transfusion-dependent myelodysplastic syndrome hospitalized for weakness and newly documented hypokalemic metabolic acidosis. Her medications are ruxolitinib and deferasirox. The physical ex-amination shows a normal BP and pulse, pallor, no edema, and mild diffuse weakness. Laboratory studies show sodium of 138 mEq/L, potassium of 3.4 mEq/L, chloride of 109 mEq/L, total CO2 of 19 mmol/L, BUN of 18 mg/dl, creatinine of 1.3 mg/dl, glucose of 86 mg/dl, calcium of 8.0 mg/dl, magnesium of 1.6 mg/dl, phosphorus of 1.1 mg/dl, albumin of 3.8 g/dl, total protein of 6.6 g/dl, uric acid of 2.8 mg/dl, leukocyte count of 2500/ml, hemoglobin of 6.3 g/dl, and platelet count of 32,000/ml. A urinalysis shows pH 5.0 and trace protein. A venous blood gas shows pH 7.32 and PvCO2 of 36 mmHg. The daily urine ammonium excretion is 40 mmol. The urinary phosphate level is 25 mg/dl, and the urine creatinine level is 100 mg/dl. The urine protein-to-creatinine ratio is 400 mg/g, and the albumin-to-creatinine ratio is 30 mg/g. A urine electrophoresis shows low-molecular weight proteinuria. No monoclonal spike is present on urine and serum electrophoresis..
Question: Which ONE of the following is the MOST likely diagnosis?
A. Hypokalemic distal renal tubule acidosis (type 1)
B. Tumor-induced osteomalacia
C. Spurious hypophosphatemia
D. Bicarbonate loss through the gastrointestinal tract
E. Proximal renal tubular acidosis
Answer: E
Subject: Electrolyte Acid-Base Disorders
A 38-year-old man is seen in consultation for recurrent kidney stones. He has had symptomatic nephrolithiasis, averaging one stone per year, since age 25 years. Analysis of a recently extracted stone shows that is composed of calcium phosphate. Laboratory studies show sodium of 138 mEq/L, potassium of 4.0 mEq/L, chloride of 108 mEq/L, total CO2 of 20 mmol/L, BUN of 13 mg/dl, creatinine of 1.2 mg/dl, calcium of 9.1 mg/dl, and phosphorus of 3.2 mg/dl. A urinalysis shows no protein, glucose, or blood. A 24-hour urine collection shows volume of 2.12 L, pH 6.1, calcium of 124 mg (target level < 250 mg), oxalate of 33 mg (target level 20–40 mg), citrate of 102 mg (target level > 450 mg), uric acid of 392 mg (target level < 800 mg), sodium of 122 mEq (reference range 50–150 mEq), ammonium of 28 mmol (reference range 15–60 mmol), and phosphate of 358 mg (reference range 600–1200 mg)..
Question: Which ONE of the following is the MOST likely diagnosis?
A. Type 4 renal tubular acidosis
B. Proximal renal tubular acidosis (type 2)
C. Dent disease
D. Incomplete distal renal tubular acidosis (type 1)
Answer: D
Subject: Electrolyte Acid-Base Disorders
Question: Question 2638:
Which ONE of the following patients is at an increased risk for profound metabolic alkalosis and hypovolemia in response to hydrochlorothiazide?
A. A 20-year-old man with glucocorticoid-remediable aldosteronism (GRA)
B. A 23-year-old man with Liddle syndrome
C. An 18-year-old woman with sensorineural hearing loss and goiter
D. A 74-year-old woman with hypertension on no additional medications
Answer: C
Subject: Electrolyte Acid-Base Disorders
A 24-year-old woman with cystic ﬁbrosis is hospitalized for treatment of Pseudomonas pneumonia. Her hospital course is complicated by ileus requiring nasogastric suction. Twelve days into her hospital course, she develops paresthesias and diffuse muscle weakness. Her medications are pancrelipase, fat-soluble vitamins, calcium carbonate, insulin as part, high-dose ceftazidime, and gentamicin. On physical examination, the BP is 110/80 mmHg, and the pulse rate is 102/min. The lung examination shows inspiratory crackles at the right base. There is no edema. Laboratory studies show sodium of 138 mEq/L, potassium of 2.3 mEq/L, chloride of 93 mEq/L, total CO2 of 34 mmol/L, BUN of 39 mg/dl, creatinine of 1.3 mg/dl, calcium of 8.4 mg/dl, magnesium of 1.2 mg/dl, and phosphorus of 3.2 mg/dl. A venous blood gas shows pH 7.43 and PvCO2 of 53 mmHg. The urine sodium is 78 mEq/L, the urine chloride is 68 mEq/L, and the urine potassium is 52 mEq/L..
Question: Which ONE of the following is the MOST likely cause of this woman’s acid-base abnormality?
A. Nasogastric suction
B. Gentamicin
C. Posthypercapnic alkalosis
D. Sodium chloride loss in sweat
E. Ceftazidime
Answer: B
Subject: Electrolyte Acid-Base Disorders
A 33-year-old woman with Sjogren syndrome is referred for evaluation of recurrent calcium phosphate kidney stones. She has had three episodes of symptomatic nephrolithiasis over the past 2 years, the most recent of which was 5 days ago. She passed a 3-mm stone after several hours of symptoms, and chemical analysis conﬁrm that it was com-posed of calcium phosphate. Serum studies show sodium of 139 mEq/L, potassium of 3.8 mEq/L, chloride of 106 mEq/L, total CO2 of 21 mmol/L, BUN of 16 mg/dl, creatinine of 1.1 mg/dl, calcium of 9.3 mg/dl, and phosphorus of 2.8 mg/dl. The urine pH is 6.1. A 24-hour urine collection is signiﬁcant for hypocitraturia (citrate of 158 mg; target level > 450 mg). The daily urine ammonium excretion is 32 mmol (reference range 515–60 mmol/d). A kidney ultrasound shows mild medullary nephrocalcinosis..
Question: Which ONE of the following diagnostic tests is MOST likely to establish the cause of recurrent kidney stone formation in this woman?
A. Ammonium chloride challenge test
B. Fractional excretion of bicarbonate
C. Repeat evaluation of urinary parameters in 2 weeks
D. Urine osmolal gap
Answer: A
Subject: Electrolyte Acid-Base Disorders
A 25-year-old man with a history of type 1 diabetes mellitus is admitted for management of persistent diarrhea and weakness 3 months after undergoing living related kidney transplantation. Admission laboratory studies disclose signiﬁcant hyperkalemia, with a serum potassium level of 6.5 mEq/L. His medications include insulin as part, tacrolimus, mycophenolate mofetil, trimethoprim-sulfamethoxazole at 400/80 mg three times weekly, valganciclovir, and metoprolol. On physical examination, he appears fatigued, but he is alert and oriented. The BP is 130/64 mmHg supine and 96/50 mmHg standing. The pulse rate increases from 80/min supine to 110/min standing. The abdominal examination shows normal bowel sounds and no peritoneal signs. The allograft is nontender and does not have a bruit. There is no edema. Laboratory studies show sodium of 142 mEq/L, potassium of 6.5 mEq/L, chloride of 115 mEq/L, total CO2 of 18 mmol/L, BUN of 40 mg/dl, creatinine of 1.4 mg/dl (increased from 1.2 mg/dl 1 week ago), glucose of 270 mg/d, creatinine kinase of 31 U/L, leukocyte count of 8000/µl, hemoglobin of 9.2 g/dl, and platelet count of 119,000/µl. An arterial blood gas shows pH 7.32, PaCO2 of 32 mmHg, and bicarbonate of 18 mEq/L. The tacrolimus trough is increased at 12 ng/ml. The urinalysis shows speciﬁc gravity of 1.015, 1+ glucose, and no protein, blood, or ketones. An electrocardiogram shows peaked T waves and a prolonged PR interval. A renal trans-plant ultrasound is normal..
Question: In addition to therapy with intravenous insulin and calcium, which ONE of the following is the next BEST step in the management of this man’s hyperkalemia?
A. Fludrocortisone
B. Patiromer
C. Isotonic sodium bicarbonate infusion
D. Hemodialysis
Answer: C
Subject: Electrolyte Acid-Base Disorders
You are asked to evaluate a 66-year-oldwoman1 day after admission for management of acute decompensated heart failure for a rising serum creatinine level and persistent hypervolemia. She initially is treated with bumetanide at 3 mg intravenously every 12 hours. Over the initial 24 hours of hospitalization, the urine volume is 3 L. On physical examination, she remains in mild respiratory distress, with a respiratory rate of 24/min. The oxygen saturation is 98% on 2 L/min supplemental oxygen. The BP is 110/60 mmHg, and the pulse rate is 106/min. The jugular venous pressure is 10 cm H2O. The lung examination shows bibasilar crackles. The estimated sodium output from each dose of bumetanide is estimated to be 140 mEq using a spot urine estimation equation. Laboratory studies show sodium of 132 mEq/L, potassium of 3.8 mEq/L, chloride of 89 mEq/L, total CO2 of 30 mmol/L, BUN of 52 mg/dl (increased from 40 mg/dl on admission), creatinine of 2.2 mg/dl (increased from 1.9 mg/dl on admission), and glucose of 67 mg/dl. A urinalysis shows speciﬁc gravity of 1.012, pH 5.4, no protein, and no blood. The urinary sediment shows many hyaline casts..
Question: In addition to ongoing close follow-up of this woman’s kidney function, which ONE of the following is the MOST appropriate management?
A.  Begin isolated ultraﬁltration
B.  Redose intravenous bumetanide only after the serum creatinine is less than or equal to 2.0 mg/dl
C.  Decrease intravenous bumetanide to once daily
D.  Continue current regimen
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 72-year-old man with hepatitis C–related cirrhosis complicated by ascites and grade 2 esophageal varices is admitted for management of increasing ascites and edema. He had been adherent with escalating doses of furosemide and spironolactone. A paracentesis shows no evidence of spontaneous bacterial peritonitis. He is initially treated with intravenous diuretics, but subsequently develops AKI with a rise in the serum creatinine (SCr) level from 0.8 mg/dl on admission to 1.8 mg/dl 3 days later. The kidney function continues to worsen, and oliguria ensues over the next 2 days despite discontinuation of diuretics and treatment with albumin 1 g/kg per day. On physical examination, the BP is 100/65 mmHg. He has modest ascites and 2+ leg edema. Laboratory studies now show serum creatinine of 3.4 mg/dl, albumin 2.6 g/dl, and bilirubin 4.5 mg/dl. The fractional excretion of sodium is 0.05%. The urinalysis is negative for protein, and the urinary sediment shows no casts or cellular elements. An abdominal ultrasound shows moderate ascites. The kidney size and echogenicity are normal. There is no hydronephrosis..
Question: Which ONE of the following is the MOST likely diagnosis?
1. Abdominal compartment syndrome
2. Acute tubular necrosis
3. Prerenal azotemia
4. Hepatorenal síndrome
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

Hepatology consults you to consider initiation of albumin dialysis for a 35-year-old woman with acute hepatic failure due to acetaminophen toxicity. Her course has been complicated by oliguric AKI due to hepatorenal syndrome and hepatic encephalopathy refractory to medical therapy. On physical examination, she is disoriented and lethargic. The BP is 96/60 mmHg. The sclerae are icteric. There are moderate ascites and 1+ leg edema. Serum studies show that the serum creatinine level is 2.8 mg/dl, the albumin is 1.8 g/dl, the bilirubin is 23 mg/dl, and the ammonia is 244 mmol/L (reference range 9–33)..
Question: Which ONE of the following is MOST likely to result from implementation of albumin dialysis compared with standard medical therapy for this patient?
1. Lower serum ammonia level
2. Improved mental status
3. Decreased inpatient mortality risk
4. Increased risk of gastrointestinal bleeding
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 42-year-old woman with alcoholic cirrhosis is admitted to the general medical ward for management of refractory ascites. Her course is complicated by oliguric AKI due to hepatorenal syndrome. She has intermittent encephalopathy that has improved with lactulose therapy. On physical examination, she is currently well oriented. The BP is 96/ 58 mmHg (mean arterial pressure [MAP] 71 mmHg). She has moderate ascites and 21 leg edema. Laboratory studies show sodium 132 mEq/L, potassium 3.6 mEq/L, chloride 100 mEq/L, total carbon dioxide (CO2) 20 mmol/L, BUN 45 mg/dl, and creatinine 2.1 mg/dl (increased from a recent baseline level of 1.1 mg/dl)..
Question: In addition to intravenous albumin, which ONE of the following is the next MOST appropriate step in management?
1. Norepinephrine
2. Midodrine plus octreotide or terlipressin alone
3. Dopamine
4. Transjugular intrahepatic portosystemic shunt
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

The chief quality ofﬁcer at your institution asks for your advice about interventions to reduce the risk of progression of aminoglycoside-induced nephrotoxicity to severe AKI..
Question: Which ONE of the following interventions would you recommend as MOST likely to decrease the risk of progression to severe AKI in patients receiving aminoglycosides?
1. Electronic alerts that identify patients who develop stage 1 AKI
2. Daily measurement of aminoglycoside levels
3. Preferential use of a three times daily dosing regimen
4. Daily serum creatinine  measurements
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

You are asked to see a 63-year-old man in consultation for AKI 2 days after a combined two-vessel coronary artery bypass and mitral valve replacement. His urine volume over the past 12 hours has decreased to 250 ml, and the serum creatinine  level has increased from a baseline of 1.5 mg/dl (2 weeks preoperatively) to 2.2 mg/dl. He was easily extubated postoperatively but remains on 2–3 L/min supplemental oxygen via nasal cannula. His medications before surgery included furosemide 80 g twice daily. On physical examination, he is alert and is not in distress. The BP is 110/78 mmHg. There are decreased breath sounds at the lung bases and trace pretibial edema. A urinalysis shows 21 protein and several muddy brown casts..
Question: Which ONE of the following is MOST likely to predict the development of stage 3 AKI and the impending need for renal replacement therapy  in this man?
1. A fractional excretion of urea > 50%
2. A spot urine albumin-to-creatinine ratio > 30 mg/g
3. Urine volume < 200 ml over 2 hours after 1.5 mg/kg of intravenous furosemide
4. A urine neutrophil gelatinase–associated lipocalin level > 150 ng/ml
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 54-year-old man hospitalized in the intensive care unit (ICU) for the last 4 days in the setting of documented fungemia and septic shock following recent autologous stem cell transplant is seen in consultation for AKI. The MAPs are in the 60- to 65-mmHg range with support from norepinephrine and vasopressin infusions. He is oliguric, with a urine volume of only 150 ml/d for the last 2 days. Review of his medical record shows that his ﬂuid balance is 7 L positive over his ICU stay and 9.5 L positive for his hospital stay. On physical examination, he is intubated and sedated. The lung bases show crackles, and there is 3+ leg and presacral edema. Laboratory studies show sodium 132 mEq/L, potassium 6.1 mEq/L, chloride 96 mEq/L, total CO2 15 mmol/L, BUN 86 mg/dl, and creatinine 6.5 mg/dl (increased from 1.2 mg/dl 10 days ago). The leukocyte count is 2100/µl (with an absolute neutrophil count of 1200/µl), the hemoglobin is 7.3 g/dl, and the platelet count is 102,000/µl. You decide to initiate him on continuous renal replacement therapy for his kidney dysfunction, volume overload, and electrolyte abnormalities..
Question: Which ONE of the following anticoagulation strategies is MOST likely to yield the longest ﬁlter life and the lowest risk of bleeding complications for this patient?
1. Regional citrate anticoagulation
2. Unfractionated heparin-infused preﬁlter
3. No anticoagulation
4. Regional unfractionated heparin-protamine
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 32-year-old kidney transplant recipient is evaluated in the emergency department for cough, fever, and hypotension. On physical examination, she is in moderate distress. She is febrile to 39.0 C. The BP is 95/60 mmHg, and the heart rate is 110–120/min. She has decreased lung sounds localized to the left base with a corresponding area of egophony. There is no peripheral edema. A urinary catheter is placed, and the initial urine output is 0.5 ml/kg per hour. Mycophenolate mofetil is held, and she is started on “stress dose” corticosteroids. Laboratory studies show sodium 138 mEq/L, potassium 3.9 mEq/L, chloride 98 mEq/L, total CO2 18 mmol/L, BUN 18 mg/dl, creatinine 1.1 mg/dl (increased from 0.9 mg/dl 2 weeks ago), leukocyte count 17,600/µl, hemoglobin 8.2 g/dl, and platelet count 293,000/µl. A chest radiograph shows a dense left lower lobe inﬁltrate..
Question: In addition to an appropriately targeted anti-biotic regimen, which ONE of the following is the MOST appropriate initial management strategy for this patient?
1. Intravenous isotonic crystalloid and/or albumin to achieve a goal MAP of >70 mmHg
2. Intravenous vasopressors to achieve a goal MAP > 70 mmHg
3. Transfusion with 2 U packed red blood cells targeting a central venous oxygen saturation of > 70%
4. Intravenous isotonic crystalloid solution and/or albumin tailored to her hemodynamic status with addition of vasopressors if unresponsive to ﬂuids/albumin
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 75-year-old man with type 2 diabetes mellitus is admitted to the ICU for management of community- acquired pneumonia. His course is complicated by septic shock and acute respiratory distress syndrome. He requires mechanical ventilator support and vasopressor infusions to maintain the MAP > 65 mmHg. Serial laboratory studies reveal that the hemoglobin level has slowly drifted down from 9.8 to 7.9 g/dl. He does not have evidence of active bleeding..
Question: Which ONE of the following is the MOST likely outcome when using a transfusion threshold of hemoglobin less than or equal to 9 g/dl versus a hemoglobin less than or equal to 7 g/dl in this patient?
1. Improved survival
2. Decreased risk of AKI
3. Decreased duration of mechanical intubation
4. Increased risk for acute lung injury
5. Decreased requirement for vasoactive drugs
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 72-year-old woman is hospitalized for treatment of urosepsis. She requires resuscitation with 6 L ﬂuids over the initial 48 hours of hospitalization..
Question: On the basis of published retrospective cohort studies, resuscitation with which ONE of the following types of intravenous ﬂuids is LEAST likely to be associated with the development of severe AKI in this patient?
1. 0.9% Saline
2. Isotonic balanced electrolyte solution
3. 5% dextrose in water (D5W) with sodium bicarbonate at 100 mEq/L
4. Hydroxyethyl starch
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 56-year-old man with a history of head and neck cancer currently undergoing chemotherapy is admitted to the ICU with presumed sepsis. He presented with a fever to 38.9C and purulent sputum emanating from his tracheostomy tube. Despite 3 L intravenous ﬂuid resuscitation with lactated ringers, he remains hypotensive with blood pressures of 85/60 and a heart rate of 110–120/min. He is supported with mechanical ventilation using the assist control mode with a fraction of inspired oxygen of 0.4 with 5 mmHg of positive end expiratory pressure. Given his persistent hypotension, the decision is made to start him on a vasoactive medication. His care team debates the relative merits of norepinephrine versus vasopressin..
Question: Which ONE of the following outcomes is MOST likely to be associated with use of nor-epinephrine versus vasopressin in this patient?
1. Increased risk of AKI
2. Decreased number of AKI-free days
3. Increased risk of RRT
4. Decreased mortality risk
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology
Question: Question 5455
In which ONE of the following clinical scenarios is remote ischemic preconditioning MOST likely to be useful in preventing the development of AKI?
1. Coronary artery bypass surgery
2. Open abdominal aortic aneurysm repair
3. Radiocontrast exposure
4. Aortic valve replacement surgery
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 67-year-old woman is hospitalized for the treatment of pneumonia complicated by sepsis and stage 1 AKI. She is enrolled in a clinical trial of intravenous alkaline phosphatase therapy for patients with sepsis..
Question: Which ONE of the following outcomes would MOST likely be associated with treatment with intravenous alkaline phosphatase in this patient on the basis of currently available published literature?
1. Decreased rate of progression to stage 2 AKI
2. Higher levels of urinary kidney injury marker-1
3. Higher levels of C-reactive protein
4. Decreased mortality
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

You are asked to see a 68-year-old man with pneumonia admitted to the ICU with respiratory failure for persistent oliguria. Over the past 24 hours, the urine output has decreased to 480 ml (0.3 ml/kg per hour), despite prompt initiation of appropriate antibiotics. On physical examination, he is intubated and sedated. The temperature is 38.6C, the BP is 105/85 mm Hg, and the pulse is 110/min. The central venous pressure is 7 cm H2O. Crackles are present at the right lung base. There is no edema. Mechanical ventilation is currently provided with 7cmH2O of positive end expiratory pressure, a tidal volume of 6 ml/kg, and an a fraction of inspired oxygen of 0.5. Laboratory studies show sodium 139 mEq/L, potassium 4.3 mEq/L, chloride 103 mEq/L, total CO2 20 mmol/L, BUN 26 mg/dl, and creatinine 1.4 mg/dl (increased from 1.1 mg/dl 2 days ago)..
Question: Which ONE of the following is the MOST appropriate next step in management on the basis of the Fluid and Catheter Treatment Trial Lite Fluid Management Protocol?
1. Give a ﬂuid bolus and reassess in 1 hour
2. Give dopamine 1 µg/kg per minute
3. Give intravenous furosemide 20 mg and reassess in 4 hours
4. No intervention and reassess in 4 hours
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

A 55-year-old woman with advanced AIDS is admitted for management of sepsis due to biliary tract obstruction and acute cholangitis. On physical examination, she is jaundiced and febrile to 38.4C. The MAP is persistently < 65 mmHg despite appropriate administration of ﬂuid boluses. There are crackles present in the left lower lung zone. There is no edema. Laboratory studies show sodium 130 mEq/L, potassium 3.2 mEq/L, chloride 96 mEq/L, total CO2 14 mmol/L, BUN 10 mg/dl, creatinine 1.3 mg/dl (unchanged from 10 days ago), total bilirubin 8.6 mg/dl (direct 8.3 mg/dl), alkaline phosphatase 834 mg/dl (reference range 538–126 U/L), alanine aminotransferase 186 U/L (reference range 50–35), and aspartate aminotransferase 152 U/L (reference range 50–35). The leukocyte count is 1500/µl, the hemoglobin is 8.6 g/dl, and the platelet count is 127,000/µl. A urinalysis shows trace protein, 3+ bilirubinuria, and many hyaline casts. The urine albumin-to-creatinine ratio is 43mg/g (urine albumin 56mg/dl). The intensivist asks you about whether a urine tissue inhibitor of metalloproteinase-2 X  IGF binding protein-7 would be helpful in predicting this woman’s risk for the development of AKI..
Question: Which ONE of the following ﬁndings decreases the utility of measuring urine tissue inhibitor of metalloproteinase-2 X IGF binding protein-7 product in the early detection of AKI in this woman?
1. Her age
2. Her bilirubinuria
3. Her critical illness status
4. Her albuminuria
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 65-year-old woman is evaluated for the acute onset of oliguria following cardiac bypass surgery. She has a baseline serum creatinine (SCr) of 1.0 mg/dl and a urine albumin-to-creatinine ratio of 28 mg/g. On postoperative day 1, she develops hypotension requiring vasopressor support. The urine output is recorded to be < 0.1 ml/kg per hour for a consecutive period of 3 hours before improving to 0.4 ml/kg per hour over the next 3 hours. The a serum creatinine on postoperative day 2 is 1.2 mg/dl..
Question: Which ONE of her clinical parameters is MOST highly associated with an increased risk for mortality?
1. Severe oliguria lasting over 3 hours
2. Her baseline SCr level
3. Her baseline level of albuminuria
4. Her SCr level on postoperative day 2
Answer: A