SeanWu25/NEJM-AI_Benchmarking_Medical_Language_Models huggingface dataset:
Subject: Electrolytes and Acid-Base Disorders

A 54-year-old woman with CKD stage III, eGFR 45 mL/min, secondary to IgA nephropathy comes to clinic for review. She also has type II diabetes mellitus, obesity with BMI 35 kg/m2, and hypertension. Her laboratory results show BUN 24 mmol/L, creatinine 1.8 mg/dl, Na+ 135 mEq/L, K+ 4.3 mEq/L, C-l 102 mEq/L, HCO3 23 mEq/L. Urine microalbumin/creatinine ratio is 200 mg/g. BP is 122/74 mm Hg while she takes valsartan 160 mg daily, and for her diabetes, she takes dapagliﬂozin and insulin and has an HbA1c of 6.8%. She is endeavoring to make lifestyle changes and lose weight to improve her overall health but asks if you have other suggestions that may reduce the risk of CKD progression..
Question: With regard to acidosis in early-stage CKD, which of the following is correct?
1. Switching to a diet of alkali-producing fruits and vegetables may delay progression to hypobicarbonatemic acidosis
2. In observational studies, up to 40% of patients with CKD stage III have metabolic acidosis
3. Decreases in urine citrate suggest H+ retention in patients with CKD and have been shown to trend closely with changes in serum [HCO3-]
4. Inhibitors of the renin angiotensin system have been shown to be protective against the development of acidosis
Answer: A
Subject: Electrolytes and Acid-Base Disorders

A 66-year-old woman with a history of hypertension, CKD stage IV, and dyslipidemia is seen at renal clinic. On review of her laboratory results, total CO2 has decreased to 20 mEq/L. You advise her to increase her intake of alkali-generating fruits and vegetables, but she is reluctant to make dietary changes. As an alternative, you suggest that she start oral bicarbonate therapy..
Question: Regarding the beneﬁts of alkali therapy in CKD, which of the following is correct?
1. In patients with CKD stage III to stage V, treatment of metabolic acidosis has been associated with reduction in progression to ESKD
2. Bicarbonate therapy has not been associated with improvements in mortality in randomized controlled trials (RCTs)
3. Patients with uncontrolled hypertension and advanced heart failure have been enrolled in RCTs investigating the use of NaHCO3 in CKD
4. In an RCT, treatment with veverimer was associated with improved [HCO3-] but no signiﬁcant improvement in physical function scores
Answer: A
Subject: Electrolytes and Acid-Base Disorders

A 22-year-old woman presents to her primary care physician with weakness and fatigue that has been worsening for the past few months. Her medical history is signiﬁcant for mild depression. She does not smoke cigarettes daily but drinks alcohol on weekends. She is currently not sexually active. She denies recreational drug use. Medications include a daily multivitamin. Family history includes hypertension and diabetes in her mother and father. Physical examination: weight 52 kg, pulse 84 beats/min, BP 110/70 mm Hg, temperature 37 degreeC. Dentition is normal, no pallor, no icterus. Lungs are clear bilaterally. Heart reveals normal S1 and S2, 2/6 ejection systolic murmur at the left sternal border. Abdomen soft, bowel sounds present. Extremities have no edema, strong peripheral pulses. Neurologic examination reveals no focal problems. Leukocyte count 6000/µl; Hemoglobin 12.9 g/dl;        Platelets 189,000/µl; Serum Sodium 142 mEq/L; Potassium 2.9 mEq/L; Chloride 98 mEq/L; Total CO2 38 mEq/L; BUN 8 mg/dl; Creatinine 0.6 mg/dl; Random glucose        98 mg/dl;
Urine toxicology screen results are negative. Electrocardiogram reveals sinus rhythm. Urine electrolytes: spot urine K+ 50 mEq/L, Cl- 8 mEq/L, Na+ 52 mEq/L. Plasma renin activity is elevated. plasma aldosterone concentration is elevated..
Question: On the basis of these ﬁndings, of the following, what is the most likely cause of the patient’s hypokalemic metabolic alkalosis?
1. Glucocorticoid-remediable hyperaldosteronism
2. Surreptitious vomiting
3. Gitelman syndrome
4. Diuretic abuse
Answer: B
Subject: Electrolytes and Acid-Base Disorders

A 65-year-old man presents with the sudden onset of severe weakness and fever developing over the previous 24 hours. The patient had been followed up by his primary care physician before admission, and earlier laboratory values and BP have all been normal. Relevant medical history is that the patient has had difﬁculty urinating, with urinary retention and nocturia. Previous workup has revealed benign prostatic hypertrophy. Early on the day of admission the patient awoke feeling weak and warm and experienced burning on urination. His temperature was elevated, and he came to the emergency department. Physical examination shows a patient who is pale and confused. Weight 55 kg, pulse 120 beats/min, BP 70/50 mm Hg, temperature 40 degrees C. Lungs are clear bilaterally. Heart reveals normal S1 and S2, abdomen is soft with some supra-pubic tenderness and right ﬂank pain tenderness. Peripheral pulses are noted to be weak, extremities are cold, and skin is mottled. Neurologic examination is noteworthy for a depressed mental status. Initial laboratory values: Leukocyte count 12,000/µl; Hemoglobin 13.3 g/dl; Platelets 120,000/µl;        Serum Sodium 138 mEq/L;        Potassium 4.0 mEq/L; Chloride 103 mEq/L; Total CO2 6 mEq/L; BUN 45 mg/dl;        Creatinine 2.0 mg/dl;mRandom glucose        98 mg/dl. Workup reveals arterial blood gases with PO2 90 mm Hg, pH 7.06, PCO2 18 mm Hg, [HCO3-] 5 mEq/L, and serum lactate 20 mEq/L. The patient is given broad-spectrum antibiotics and because of the low pH [HCO3-] is administered (5% dextrose in half normal saline with 75 mEq/L NaHCO3)
Over the next 2 days, the patient’s hemodynamics stabilize, and arterial blood gases show PO2 92 mm Hg, pH 7.47, PCO2 48 mm Hg, [HCO3-] 34 mEq/L. Urine pH is 8..
Question: On the basis of the patient’s course, which of the following is true regarding the patient’s metabolic alkalosis?
1. It is due to Gitelman syndrome that was not apparent on admission
2. It is due to primary hyperaldosteronism that was not apparent on admission
3. It was generated by metabolism of retained lactate to bicarbonate and is now maintained by volume contraction
4. It was generated by metabolism of retained lactate to bicarbonate and should spontaneously correct
Answer: D
Subject: Electrolytes and Acid-Base Disorders

A 45-year-old woman presents with new onset of hypertension but is otherwise healthy. Physical examination results are is noteworthy for a BP of 160/105 mm Hg and are otherwise normal, with no evidence of volume depletion or edema. Initial lab results: Leukocyte count: 5,000/µl; Hemoglobin 13.9 g/dl; Platelets 230,000/µl; Serum Sodium         145 mEq/L; Potassium 2.5 mEq/L; Chloride 97 mEq/L; Total CO2 34 mEq/L; BUN 8 mg/dl; Creatinine 0.6 mg/dl; Random glucose 98 mg/dl
A random plasma renin is low, and a plasma aldosterone is high..
Question: On the basis of these ﬁndings, what is the most likely diagnosis?
1. Gitelman syndrome
2. Renovascular hypertension
3. Primary hyperaldosteronism
4. Liddle disease
Answer: C
Subject: Electrolytes and Acid-Base Disorders

A 35-year old man presents with new onset of hyper-tension but is otherwise healthy. History was noncontributory with the exception of extensive use of chewing tobacco. The results of physical examination are noteworthy for a BP of 155/110 mm Hg and are otherwise normal, with no evidence of volume depletion or edema. Laboratory values: Leukocyte count 5,500/µl;        Hemoglobin 14.2 g/dl; Platelets         200,000/µl; Serum Sodium 145 mEq/L; Potassium 2.3 mEq/L; Chloride 96 mEq/L; Total CO2 35 mEq/L; BUN 8 mg/dl; Creatinine  0.6 mg/dl; Random glucose 98 mg/dl
Random plasma renin and aldosterone are low. Cortisol levels are normal..
Question: On the basis of these ﬁndings, what is the most likely diagnosis?
1. Surreptitious diuretic abuse
2. Syndrome of apparent mineralocorticoid excess due to glycyrrhizic acid
3. Primary hyperaldosteronism
4. Villous adenoma
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

Your hospital CEO is concerned about the high cost and length of stay of patients who experience AKI. She asks you about possible measures to decrease length of stay among AKI patients..
Question: Of the following, what single measure has been recently shown to decrease AKI-related length of stay?
1. Fewer measurements of serum creatinine, particularly after procedures
2. Use of cystatin C rather than serum creatinine
3. Implementation of hospital-wide clinical support system that alerts clinicians that the patient has AKI
4. Use of artiﬁcial intelligence–driven algorithms to deter-mine dosage of antibiotics
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

At a board meeting for a local community hospital, the chief of cardiothoracic surgery asks you if there is any way to identify patients undergoing kidney “angina” similar to cardiac patients..
Question: Based on published data, which of the following biomarkers has the best chance of identifying incipient acute tubular necrosis in a patient undergoing cardiac bypass?
A.        Neutrophil gelatinase-associated lipocalin (NGAL)
B.        Kidney injury molecule (KIM)-1
C.         (Urinary tissue inhibitor of metalloproteinases-2) • (insulin-like growth factor-binding protein 7) (TIMP-2) • (IGFBP7)
D.        n-acetyl-beta-d-glucosaminidase (NAG)
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

In your role as an internal medicine consultant at a community hospital, you are asked to see a patient for preoperative clearance for open reduction and internal ﬁxation of a fractured hip. The patient is a 69-year-old white man who was admitted overnight to a surgical intensive care unit (ICU). He has a medical history of type 2 diabetes mellitus and cardio-vascular disease, and he underwent angioplasty 4 years prior. He is a smoker. On examination he is morbidly obese and is normotensive. He has a serum creatinine of 0.82 mg/dl and a microalbumin-to-creatinine ratio of  ~800 mg/g..
Question: Which clinical feature is characteristic of patients who experienced AKI in recently published ASSESS-AKI?
A.        Smoking status
B.         Obesity
C.        Proteinuria
D.        Ethnicity
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

You are consulting on a 49-year-old woman who was recently discharged from the hospital after an admission for sepsis and AKI in the setting of diverticulitis. She has a medical his-tory of mild asthma and seasonal allergies but has been otherwise healthy. Her baseline creatinine before admission was 0.7 mg/dl. She presented to hospital with 4 days of severe abdominal pain and oligoanuria. She was hypotensive on presentation and was treated with continuous venovenous hemo-ﬁltration for 2 days. Her creatinine was 1.9 mg/dl by the time of discharge. She asks you, what are the chances of her having CKD and ever needing dialysis again..
Question: Which of the following best predicts her risk of CKD?
A.        Having had kidney replacement therapy (KRT) for 2 days
B.        Oligoanuria on presentation to the hospital
C.        Creatinine at the time of discharge
D.        Creatinine and urine protein 3 months after discharge
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

You are consulting on a 62-year-old woman who had AKI in the setting of upper gastrointestinal bleeding from a perforated peptic ulcer. Her creatinine increased from a baseline of 0.7 to 2.3 mg/dl and is 1.8 mg/dl before discharge. Her creatinine 1 year later is 1.5 mg/dl, with estimated GFR of 37 ml/min per 1.73 m2..
Question: Which of the following is true regarding the effect of AKI on mortality?
A.        Mortality is increased with severe (i.e., stage 3 AKI) but not stages 1 and 2
B.        The increased long-term mortality associated with AKI is due to dialysis complications
C.        Mortality is increased in a graded fashion with worsening AKI
D.        Mortality is increased only in KRT-requiring AKI
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 24-year-old man presents to the emergency department with septic shock from Escherichia coli bacteremia related to urinary source. His vital signs are as follows: temperature 38 degree C, heart rate 119 beats/min, BP 82/43 mm Hg, respirations 19/min. Physical examination results are signiﬁcant for ill appearance, tachycardia, and cool peripheries. His laboratory results are as follows: creatinine 1.1 mg/dl, sodium 134 mmol/L, calcium 7.2 mg/dl, potassium 4.5 mmol/L, albumin 3 g/dl, chloride 98 mmol/L, arterial pH 7.29, bicarbonate 14 mEq/L, pCO2 30 mm Hg, BUN 22 mg/dl..
Question: What is the preferred resuscitative ﬂuid based on recent studies?
A.        5% dextrose in water with 150-mEq sodium bicarbonate
B.        0.9% sodium chloride
C.        0.45% sodium chloride
D.        Lactated Ringer’s
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 75-year-old woman with diabetes, hypertension, current tobacco use, and peripheral artery disease is admitted to the hospital with chest pain. Cardiology is recommending a cardiac catheterization because of her risk stratiﬁcation. She is scheduled to undergo the procedure tomorrow..
Question: What strategies can you implement to prevent AKI?
A.        Check urine sodium and risk-stratify for risk of contrast-induced-AKI
B.        Delay cardiac catheterization due to high risk of having CI-AKI
C.        Give 0.9% sodium chloride before and after cardiac catheterization
D.        Give D5 with 150-mEq sodium bicarbonate before cardiac catheterization
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

You are chief quality ofﬁcer for your institution. It has been brought to your attention that there is a rising incidence of AKI after cardiac surgeries, which has led to longer hospital length of stay, increased complications, and mortality. After reviewing the data, you want to initiate possible interventions that can lower the risk but also be cost effective..
Question: What strategy has been suggested by the PrevAKI randomized controlled trial to prevent AKI in this setting and be cost effective?
A.        Work with Information Technology on developing E-alerts for surgeons alerting them to patients at high risk of AKI
B.        Implement the KDIGO AKI bundle with use of (TIMP-2) • (IGFBP7)
C.        Develop smart order sets with automatic preoperative and postoperative hydration with intravenous 0.9% saline solution
D.        Provide education to surgeons on the nephrotoxicity of loop diuretics
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 74-year-old man without known CKD disease undergoes transcatheter aortic valve replacement because of symptomatic severe aortic stenosis. The procedure is uneventful. On postoperative day 2, his serum creatinine is 1.2 mg/dl (baseline 0.8 mg/dl) and he is asymptomatic. The next day his serum creatinine is 1.0 mg/dl and he is discharged with a clinical appointment scheduled for the following week..
Question: Which ONE of the following statements is correct concerning transcatheter aortic valve replacement and AKI?
A.        AKI after transcatheter aortic valve replacement is rare, occurring in <10% of patients
B.        The volume of iodinated contrast media used during the procedure is associated with the development of AKI
C.        At 30 days after hospital discharge, fewer than a third of the patients have not fully recovered kidney function and still have acute kidney disease
D.        Increased length of stay was observed in AKI patients; however, long-term follow-up demonstrated similar 7-        year mortality in AKI versus non-AKI patients
E.         AKI stages 1 and 2 occur with equal frequency in patients undergoing transcatheter aortic valve replacement, whereas <10% of patients experience AKI stage 3
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 59-year-old woman presents to the emergency room with chest pain and promptly receives a diagnosis of ST-elevation myocardial infarction. Her clinical condition quickly deteriorates, she experiences a mean arterial pressure < 60 mm Hg, she has cold extremities, and she is confused..
Question: Her urine output 24 hours after admission is 200 ml, an equivalent of 0.12 ml/kg per h.
Which ONE of the following statements is correct regarding AKI development in cardiogenic shock?
A.        Using a serum creatinine criterion is more sensitive than urine output criterion in the diagnosis of AKI in cardio-genic shock
B.        In patients with cardiogenic shock who undergo coronary angiography, the amount of iodinated contrast medium is not associated with the development of AKI
C.        AKI stage 1 patients have increased risk of death when compared with non-AKI patients
D.        More than 20% of patients with cardiogenic shock require KRT
E.        In patients with cardiogenic shock, those with higher values of central venous pressure and lower values of mean arterial pressure are more prone to the development of AKI
Answer: E
Subject: Acute Kidney Injury & Critical Care Nephrology

You are consulted by the Department of Cardiovascular Surgery at your institution because the department wants to incorporate new technologies in their practice that could reduce complications after cardiac surgeries. Which ONE of the following statements regarding prevention of cardiovascular surgery-associated AKI is MOST accurate? A. The urinary test (TIMP-2) • (IGFBP7) can be applied in patients undergoing cardiopulmonary bypass as a screening tool to select those at high risk for AKI who might beneﬁt from an AKI bundle; this strategy has been demonstrated to reduce the prevalence of severe AKI
B..
Question: Current guidelines recommend the use of (TIMP-2) • (IGFBP7) in patients undergoing cardiac surgery to enable early detection of those in whom AKI will develop
C        The use of cell cycle arrest biomarker neutrophil gelatinase-associated lipocalin (NGAL) can discriminate cardiac surgery patients at higher risk for AKI who might beneﬁt from measures such as early dialysis initiation
A.        The urinary test (TIMP-2) • (IGFBP7) can be applied in patients undergoing cardiopulmonary bypass as a screening tool to select those at high risk for AKI who might beneﬁt from an AKI bundle; this strategy has been demonstrated to reduce the prevalence of severe AKI
B.        Current guidelines recommend the use of (TIMP-2) • (IGFBP7) in patients undergoing cardiac surgery to enable early detection of those in whom AKI will develop
D.        In patients without CKD undergoing elective cardiac surgery, a measured renal functional reserve cutoff value of < 30 ml/min per 1.73 m2 is applied to discriminate patients at risk for the development of AKI
E.        Despite growing evidence of its potential role in preventing cardiac surgery-associated AKI, the urinary test (TIMP-2) • (IGFBP7) still lacks approval by the US Food and Drug Administration
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

You have been assigned by the head of the Emergency Department to create a ﬂowchart for diuretic use in acute heart failure. Which ONE of the following statements represents the approach endorsed by current guidelines?.
Question: A.        Furosemide dose should not exceed 300 mg in 24 hours
B        If decongestive goals are not met with the use of furosemide, the next pharmacologic step consists of adding a thiazide or thiazide-like agent such as metolazone or chlorthalidone
A.        Furosemide dose should not exceed 300 mg in 24 hours
C.        In patients with residual interstitial congestion (rales, pitting edema, pleural effusion) and a predominant phenotype of tissue edema, the use of the selective V2 antagonist tolvaptan or of a sodium-glucose linked transporter-2 inhibitor may promote aquaresis, decreasing intravascular compartment osmolality and increasing plasma reﬁlling
D.        After 6 hours of the ﬁrst dose of loop diuretic if urine output is <100 ml/hour, the dose should be increased by 30%
E.        When continuous infusion of furosemide is used, a bolus loading dose should be avoided to reduce the risk of ototoxicity
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 38-year-old-man with untreated hepatitis C virus infection and known cirrhosis, diabetes, and hypertension presents with oliguric AKI with creatinine of 1.4 mg/dl (baseline is 0.8 mg/dl), altered mental status, hypotension, and fever..
Question: Which ONE of the following would EXCLUDE the diagnosis of hepatorenal syndrome outlined by the International Club of Ascites in patients with cirrhosis and ascites?
A.        Serum creatinine <1.5 mg/dl
B.        Treated bacterial sepsis
C.        Untreated spontaneous bacterial peritonitis with septic shock
D.        Fractional urinary sodium excretion <1%
E.        No improvement in serum creatinine after ascitic drainage
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

You have been treating a 48-year-old man with severe hypertension, metabolic syndrome, gout with lisinopril, chlorthalidone, and amlodipine. You are aware that he has had several admissions for alcohol-related pancreatitis and recurrent hepatitis and blood pressure has been steadily decreasing. He calls to tell you that his weight is increasing but his BP is “at target” even though he no longer takes his medication..
Question: Which ONE of the following statements is incorrect about the pathogenesis of the hepatorenal syndrome?
A.        Plasma angiotensin concentrations are increased
B.        Visceral sympathetic nervous system activity is increased
C.        Portal blood ﬂow is reduced
D.        Systemic BP pressure is reduced
E.        Plasma vasopressin concentrations are increased
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 94-year-old man is admitted with cirrhosis, ascites, and a 40-pound weight loss in the setting of hepatocellular cancer. He is oliguric, though not anuric, and his creatinine is 1.4. mg/dl. You do not have access to a prior baseline creatinine yet. He is severely anemic, and his phosphorus is 2.8 mg/dl. He has marked asterixis, and you are asked if this is due to hepatic encephalopathy, or could it possibly be uremia. Your medical student wishes to know the best way to measure the kidney function..
Question: Which ONE of the following statements is correct about using serum creatinine to assess renal function patients with hepatorenal syndrome?
A.        Estimated GFR measurements are an accurate measure of renal function
B.        The proportion of renal tubular creatinine secretion is increased
C.        Cystatin C is a better marker for renal function than serum creatinine
D.        Increasing bilirubin increases serum creatinine measurement
E.         Muscle wasting increases creatinine production
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 49-year-old man has a long-standing history of ethanol-related cirrhosis. He has marked ascites and requires repeated paracentesis. He presents with upper gastrointestinal bleeding in a setting of known esophageal varices. He experiences AKI, and his creatinine remains elevated despite control of bleeding and restoration of hemodynamic parameters..
Question: Which ONE of the following treatments has the greatest impact on survival of patients with hepatorenal syndrome?
A.        Continuous renal replacement therapy
B.        Octreotide and midodrine
C.        Terlipressin and albumin
D.        Treatment with molecular adsorbent recirculating system (MARS)
E.        Liver transplantation
Answer: E