SeanWu25/NEJM-AI_Benchmarking_Medical_Language_Models huggingface dataset:
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
A 47-year-old woman has ESRD resulting from lupus nephritis. One month ago, she transitioned to in-center hemodialysis from peritoneal dialysis because of ultraﬁltration failure. Four days ago, she experienced a fever to 38.7C, chills, and cough during a scheduled hemodialysis treatment. She did not have dyspnea or hypotension. Your nephrology partner requested blood cultures and ordered intravenous vancomycin. A chest radiograph showed a left lower lobe in-ﬁltrate. The oxygen saturation was 98% on ambient air, and the leukocyte count was 9600/µL. Two days later, the blood cultures return, showing methicillin-sensitive Staphylococcus aureus in both bottles that is sensitive to vancomycin, gentamicin, cefazolin, daptomycin, and linezolid. The patient has improved and is now afebrile. She has no known drug allergies..
Question: Which ONE of the following is the MOST appropriate antibiotic regimen for this patient?
A. Continue vancomycin for at least 4 weeks and monitor trough levels
B. Add gentamicin after every dialysis treatment for synergy
C. Replace vancomycin with cefazolin to complete at least 4 weeks of antibiotics
D. Replace vancomycin with daptomycin to complete 4 weeks of antibiotics
E. Discontinue vancomycin and start oral linezolid to complete 4 weeks of antibiotics
Answer: C
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
A patient from your dialysis center with recently diagnosed vancomycin-resistant Staphylococcus aureus bacteremia is ready for hospital discharge. The patient has received 1 week of antibiotic therapy, and infectious disease consultants have recommended outpatient parenteral anti-infective therapy for several more weeks with daptomycin plus ceftaroline through a separate internal jugular vein access. There is one separate isolation room at your facility that is currently used to treat several patients with hepatitis B virus infection. As a result, the isolation room is not available for this patient..
Question: In addition to strict adherence to standard infection control practices, which ONE of the following additional infection control measures should you recommend for this patient?
A. Dialyze the patient at a station with as few adjacent stations as possible
B. Inform the hospital to cancel the discharge because the patient needs inpatient isolation until she completes the antibiotic course
C. Recommend hand hygiene with soap and water for dialysis staff after contact with this patient
D. Recommend that staff wear reusable gowns when caring for the patient at all times
Answer: A
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
Question: Question 2874:
Which ONE of the following statements regarding antibiotic use in outpatient hemodialysis units in the United States is CORRECT?
A. Patients with CVCs have equivalent rates of intravenous antibiotic use compared with patients with arteriovenous ﬁstulas and grafts
B. First-dose antimicrobial therapy in hemodialysis units accounts for the highest proportion of inappropriate intravenous antibiotic use
C. Over 60% of patients using long-term hemodialysis receive at least one dose of intravenous antibiotics each year
D. Vancomycin is the most commonly pre-scribed intravenous antibiotic
Answer: D
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
A 40-year-old man receiving maintenance hemodialysis is found to have methicillin-resistant Staphylococcus bacteremia after presenting to the dialysis unit with fever. He has a mature arteriovenous ﬁstula that is cannulated by staff using the “buttonhole” technique. Examination of the arteriovenous ﬁstula shows no erythema, tenderness, or purulent discharge from the cannulation sites. The results of his physical examination are otherwise normal. An echocardiogram and magnetic resonance images of the spine are normal. He is treated with vancomycin for 4 weeks, with resolution of his fever. He had a similar episode 6 months ago..
Question: Which ONE of the following is the BEST strategy to prevent recurrent bloodstream infections in this man?
A. Culture his nares and treat with intranasal mupirocin if the culture grows Staphylococcus aureus
B. Evaluate the processes of care in the dialysis facility such as wearing masks, washing hands, and using antiseptics and gloves when accessing the ﬁstula
C. Switch to the “rope ladder” for needle placement in the ﬁstula
D. Focus on patient hygiene such as showering and washing the ﬁstula arm with soap and water before each dialysis treatment
E. Obtain surveillance blood cultures from the ﬁstula at monthly intervals, and treat when the results are positive
Answer: C
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
The medical director of a dialysis unit has oversight of the infection prevention and control program. In putting together the infection prevention and control plan you highlight the essential components and resource requirements of the program during a monthly Quality Assessment and Performance Improvement meeting..
Question: Which ONE of the following is an essential component of the infection prevention and control program within a dialysis facility?
A. Infection surveillance and use of infection rate data to drive prevention
B. One full-time staff person who is in charge of the infection control program
C. Hiring an epidemiologist to investigate blood-stream infections
D. Use common medication carts to deliver medications to patients
Answer: A
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
Water supplies may be contaminated or disrupted during a natural or civil emergency. Medical directors are often called to determine best options for the outpatient hemodialysis facility when these occur..
Question: Which ONE of the following statements is TRUE about managing potentially contaminated dialysis water supplies in the event of a natural disaster?
A. A tanker truck that has been repurposed from hauling vegetable oil for transporting water is an acceptable source of water for hemodialysis pretreatment systems
B. Water transported by tanker trucks to dialysis facilities should not be chlorinated before the beginning of the haul
C. Water from a well deeper than 30 meters is considered a safe water supply for hemodialysis after a hurricane or ﬂooding
D. During a “Boil-Water Advisory,” dialysis water treatment systems that rely on de-ionization units can be used without additional modiﬁcations
Answer: A
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
An outpatient hemodialysis facility receives an immediate jeopardy citation from a Medicare surveyor after repeated violations are discovered in infection control involving repeated cross-contamination of medical supplies and improper disinfection of treatment surfaces. The facility has previously been cited for poor infection control. Interviews with numerous facility staff, including the medical director, suggest a widespread lack of individual accountability and a tendency to blame others for problems in the unit..
Question: Which ONE of the following issues BEST describes the fundamental problem at this facility?
A. Outdated infection control policies
B. Inadequate stafﬁng
C. Poor patient and staff understanding of hand hygiene
D. High community incidence of healthcare-acquired infections
E. Lack of an effective culture of safety
Answer: E
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
During a review of cultures of dialysate at your hemodialysis center, you note a bacterial con-centration of > 50 colony-forming units/ml (CFU/ml)..
Question: In addition to ongoing retesting, which ONE of the following is the MOST appropriate next step in management?
A. No additional measures are required
B. Withhold dialysis treatments at the center until the bacterial counts are < 25 CFU/ml
C. Perform chemical disinfection
D. Replace the reverse osmosis membrane
Answer: C
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
A 70-year-old man receiving maintenance hemodialysis is seen on dialysis rounds. Pruritic nodules have developed on his trunk and extremities. His primary care physician prescribed a topical corticosteroid cream that has helped with the pruritus, but the nodules continue to reappear. A physical examination shows linearly arranged 3- to 5-mm hyperpigmented nodules with excoriation. His partner has had similar symptoms. You suspect that the lesions are due to bedbug bites..
Question: In addition to symptomatic treatment with topical corticosteroids and oral antihistamines, which ONE of the following is the MOST appropriate management?
A. Dialyze the patient at the far end of the room, and restrict the chair solely for that patient’s use
B. Implement no additional environmental measures at the dialysis facilities
C. Make a mandatory assignment of the patient to an isolation room
D. Use a single 8- to 10-hour application of permethrin 5% cream on the entire body
Answer: A
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
As the medical director you receive a call from an attending nephrologist at your dialysis unit. This nephrologist reports that a 10-year-old patient has received a diagnosis of an active infestation of pediculosis capitis..
Question: In addition to thorough bathing and heat washing of the patient’s affected clothes and linens and use of a topical pediculicide, which ONE of the following is the MOST appropriate management?
A. Use extra care in the terminal cleaning of the dialysis station, with special attention to the dialysis chair after the patient has completed the dialysis treatment
B. Examine all patients in the facility for head lice because lice may survive for weeks on dialysis equipment and chairs
C. Institute daily hair washing with a shampoo/conditioner or conditioner before and after application of a topical pediculicide
D. Prescribe lindane shampoo for the affected patient
Answer: A
Subject: Infection Control & Prevention in Outpatient Hemodialysis Facilities
You are paged by a nurse from a hemodialysis facility you are covering about an 81-year-old woman with ESRD due to polycystic kidney disease, along with mild cognitive impairment. Her spouse has noted that she has not been eating well for the past 3 days. She has been more confused than usual and has complained of “feeling hot.” The patient has no other speciﬁc complaints and is oriented to place and person. She is not taking any new medications. Her temperature is 37.3C, her pulse is 96/min and regular, and her blood pressure is 102/80 mmHg. The patient is in no respiratory distress but is mildly tachypneic, with a respiratory rate of 22/min. The oxygen saturation is 92% on ambient air. Her weight is equal to the estimated dry weight. The nurse hears crackles at both lung bases. There is no leg edema. The arteriovenous ﬁstula has no erythema or ﬂuctuance..
Question: Which ONE of the following is the next BEST step in this patient’s management?
A. Review the patient’s baseline vital signs
B. Order a 500-ml bolus of intravenous normal saline
C. Lower the patient’s target weight by 1 kg
D. Order empiric vancomycin and ceftriaxone
Answer: A
Subject: Chronic Kidney Disease and Progression
A 65-year-old woman with type 2 diabetes mellitus, obesity, and stage G3a:A1 CKD asks about dietary modiﬁcations to reduce her risk of CKD progression. She currently follows a 2000-calorie diet that is low in sodium, fat, and sugar. She drinks several diet sodas per day..
Question: Which ONE of the following dietary interventions is MOST likely to reduce her risk of CKD progression?
A.        Discontinuation of caffeinated beverages
B.        Discontinuation of milk-containing beverages
C.        Consumption of .2 liters of water per day
D.        Discontinuation of beverages containing artiﬁcial sweeteners
Answer: D
Subject: Chronic Kidney Disease and Progression
A 35-year-old woman of African ancestry who is 12 weeks pregnant with her ﬁrst child is seen in consultation because she is concerned about the potential risks of APOL1 risk variants. Her husband has focal segmental glomerulosclerosis (FSGS) and carries two APOL1 risk variants for CKD. Which ONE of the following should you tell her about the potential impact of APOL1 risk variants on her pregnancy and her child’s risk of kidney disease? A. Her risk of preeclampsia is further increased if she carries two APOL1 risk variants
B..
Question: Her child has a 50% chance for the development of FSGS
C.        About 13% of African Americans carry two high-risk APOL1 variants, and the pene-trance of
associated CKD is ,40%
A.        Her risk of preeclampsia is further increased if she carries two APOL1 risk variants
B.        Her child has a 50% chance for the development of FSGS
C.        About 13% of African Americans carry two high-risk APOL1 variants, and the pene-trance of
D.        Inheritance of other genetic variants in addition to the APOL1 risk variants is required for kidney disease to develop in the child
Answer: C
Subject: Chronic Kidney Disease and Progression
You have been assigned to speak at a regional internal medicine meeting about CKD. You begin your talk with a discussion of the burden of kidney disease in the United States and globally..
Question: Which ONE of the following should you tell the audience?
A.        Over the past decade, the total number of people with CKD in the United States has remained stable
B.        Disability-adjusted life years attributed to CKD have increased in the United States, whereas disability-adjusted life years for cardiovascular disease and cancer have decreased
C.        Deaths due to CKD have remained stable within the United States but have increased worldwide
D.        About 5% of the population in the United States has stage 1-5 CKD
Answer: B
Subject: Chronic Kidney Disease and Progression
An 82-year-old Korean War Veteran returns for follow-up of stage G3b:A1 CKD attributed to hypertension. He has not had a kidney biopsy. He has a history of gout. He served in the U.S. Navy and worked for over 10 years as a welder in the manufacture of naval ships. He has never had his blood lead levels measured. You raise the possibility of lead exposure as a possible con-tributing factor in his kidney disease. The serum creatinine level is 1.8 mg/dl, the urine albumin-to-creatinine ratio is 20 mg/g, and the urine protein-to-creatinine ratio is 130 mg/g..
Question: Which ONE of the following should you tell him regarding lead exposure and kidney disease?
A.        Only very high whole blood lead levels (.1000 mg/L) are associated with lead nephropathy
B.        Prior lead exposure can cause gout but is not associated with CKD
C.        Even mild elevations in blood lead levels among adults have been associated with an increased risk of  CKD
D.        His CKD is not due to lead because he does not have overt proteinuria
Answer: C
Subject: Chronic Kidney Disease and Progression
Question: Question 2955:
Which ONE of the following statements regarding the public health impact of diabetes mellitus in the United States is CORRECT?
A.        Approximately one out of two cases of CKD is attributed to diabetes
B.        Population efforts to reduce diabetes are unlikely to lower the CKD burden in the United States
C.        The prevalence of CKD is twofold higher among adults with diabetes than in those without diabetes
D.        More timely and effective implementation of CKD care has been shown to reduce adverse kidney disease outcomes in adults with diabetes
Answer: D
Subject: Chronic Kidney Disease and Progression
In the year 2000, the incidence rate of ESRD among Native Americans was 805 per million population, a rate fourfold higher than whites in the United States. By the year 2016, ESRD incidence among Native Americans declined substantially and approached the incidence rates observed in white individuals in the United States..
Question: Which ONE of the following factors has been shown to be associated with this sharp decline in ESRD incidence among Native Americans over the past 16 years?
A.        A population-based approach to diabetes care based in the community and the primary clinical setting
B.        Transfer of diabetes care traditionally as-signed to primary care providers to nephrologists
C.        The use of new glucose-lowering agents
D.        Prescription of fenoﬁbrate in patients with CKD and serum triglyceride levels between 150 and 499 mg/dl
Answer: A
Subject: Chronic Kidney Disease and Progression
A 68-year-old African American man returns for follow-up of type 2 diabetes mellitus and albu-minuria. You inform him that his BP is elevated at 152/90 mmHg. He indicates that he frequently forgets to take his antihypertensive medications. Laboratory studies show a serum creatinine level of 1.0 mg/dl and a urine albumin-to-creatinine ratio of 22 mg/g. The hemoglobin A1c is 9%. His best friend, who is African American, had pro-gressive CKD because of diabetic nephropathy and required initiation of dialysis at age 69. He frequently accompanies his friend to the dialysis facility and has noticed that most of the patients served by the center are African American. He feels helpless and believes that dialysis is in-evitable. He is skeptical about the beneﬁts of glucose lowering and hypertension control..
Question: Which ONE of the following should you tell him about his risk for and therapy of kidney disease?
A.        Tight control of BP and glucose are more effective in white than black adults with type 2 diabetes for prevention of CKD
B.        Regardless of race, control of glucose levels and BP among adults with type 2 diabetes mellitus slows progression of CKD
C.        His cumulative lifetime risk of ESRD is .80%
D.        If he experiences diabetic nephropathy, he can expect more rapid progression of CKD if he has two APOL1 high-risk variants
Answer: B
Subject: Chronic Kidney Disease and Progression
A 65-year-old man with CKD due to diabetic nephropathy is evaluated after a recent decline in GFR from 33 to 28 ml/min per 1.73 m2 over the past year. One week ago, his endocrinologist discontinued metformin and started sitagliptin at a reduced dose (25 mg daily). The patient is concerned about the safety of this medication in the context of his xCKD..
Question: Which ONE of the following should you tell him about the use of incretin-based therapies such as sitagliptin in the setting of CKD?
A.        Incretin-based therapies increase the risk of hypoglycemia
B.        Incretin-based therapies are associated with an increased risk of mortality when used in adults with non–dialysis-dependent CKD
C.        Incretin-based therapies are not associated with an increased risk of hypoglycemia or mortality among adults with non–dialysis-dependent CKD when compared with other glucose-lowering agents
D.        Incretin-based therapies increase the rate of CKD progression
Answer: C
Subject: Chronic Kidney Disease and Progression
A 72-year-old woman with type 2 diabetes mellitus and stage G3b:A3 CKD with an esti-mated GFR (eGFR) of 39 ml/min per 1.73 m2 and a urine albumin-to-creatinine ratio of 400 mg/g 1 year ago returns for follow-up. Laboratory stud-ies on the day of the clinic visit show an eGFR of 29 ml/min per 1.73 m2 and a urine albumin-to-creatinine ratio of 250 mg/g. She takes losartan 100 mg daily, and her BP is 128/65 mmHg. She tells you that her endocrinologist recently started empagliﬂozin to reduce her risk of cardiovascular disease. She wants to know what effects this drug will have on her kidney function..
Question: Which ONE of the following is CORRECT regarding the effects of empagliﬂozin on kidney function?
A.        The annual decline in eGFR over the next several years is anticipated to be more rapid
B.        The risk of kidney stones is increased with the use of empagliﬂozin
C.        The risk of ESRD is increased with the use of empagliﬂozin
D.        The initial decline in eGFR will be accom-panied by a slower rate of eGFR decline over time
Answer: D
Subject: Chronic Kidney Disease and Progression
A 55-year-old man is evaluated in follow-up care for stage G3b:A2 CKD. He is accompanied by his brother, who tells you that the patient uses marijuana on occasion. He is concerned that this use will worsen his brother’s kidney function..
Question: Which ONE of the following should you tell them about the effects of marijuana on CKD incidence and progression?
A.        Daily but not occasional marijuana use is associated with CKD incidence and progression
B.        Daily use of marijuana is associated with a faster decline in kidney function
C.        Marijuana use is associated with increased urine albumin excretion
D.        Marijuana use is not associated with CKD incidence or progression
Answer: D
Subject: Chronic Kidney Disease and Progression
The director of a community health center is updating the center’s anti-drug and anti-tobacco campaign. She asks your opinion whether it is correct to highlight cigarette smoking, cocaine, heroin, and methamphetamine use as risk factors for kidney disease..
Question: Which ONE of the following should you tell her?
A.        Yes, cigarette smoking, cocaine, metham-phetamine, and heroin use are all associated with an increased risk of kidney failure
B.        No, because only cocaine use is associated with kidney disease
C.        No, because the risk of kidney disease consequent to illicit drug use is restricted to patients with diabetes and hypertension
D.        No, because methamphetamine and heroin use have no impact on CKD progression
Answer: A
Subject: Chronic Kidney Disease and Progression
A 49-year-old woman with stage G3b:A3 CKD due to diabetic nephropathy is evaluated in follow-up care. You review her laboratory studies with her and begin to explain the signiﬁcance of a fourfold increase in the urine-to-creatinine ratio over the past 3 years. She notes that her BP has been better controlled after an increase in her enalapril dose 3 months ago. She would like to repeat the albumin-to-creatinine ratio today..
Question: Which ONE of the following should you tell her about the signiﬁcance of the albumin-to-creatinine ratio and its measurement?
A.        Declines in the albumin-to-creatinine ratio are not associated with a reduced risk of ESRD
B.        The recommended frequency of albumin-to-creatinine ratios is every 3 months
C.        Currently, progression of CKD is clinically categorized only by changes in the albumin-to-creatinine ratio
D.        A fourfold increase in the albumin-to-creatinine ratio may indicate a higher risk of ESRD
Answer: D
Subject: Chronic Kidney Disease and Progression
A 55-year-old woman with type 2 diabetes mellitus and stage G3a:A3 CKD is referred for worsening albuminuria. Over the past year, the urine albumin-to-creatinine ratio has increased from 212 mg/g to 362 mg/g. Her medications include losartan 100 mg daily and simvastatin 20 mg daily. Her BP is at goal, with a resting BP of 128/75 mmHg in clinic measured with an auto-mated device after she rested for 5 minutes, which is consistent with previous measurements over the past 2 years. She has no edema. A 24-hour urine revealed a daily urinary sodium excretion of 248 mmol. Laboratory studies show a serum sodium of 138 mEq/L, potassium of 4.9 mEq/L, chloride of 100 mEq/L, total CO2 of 24 mmol/L, BUN of 18 mg/dl, creatinine of 1.3 mg/dl, calcium of 9.0 mg/dl, phosphorus of 2.6 mg/dl, 25-hydroxyvitamin D level of 25 ng/ml, and parathyroid hormone of 56 pg/ml..
Question: In addition to continued losartan, which ONE of the following is the MOST appropriate management of the increased albuminuria?
A.        Cholecalciferol 1000 units daily
B.        A 2-gram sodium-restricted diet
C.        Paricalcitol 1 mg daily
D.        Lisinopril 5 mg daily
Answer: B