SeanWu25/NEJM-AI_Benchmarking_Medical_Language_Models huggingface dataset:
Subject: Transplantation

A 35-year-old African American woman with ESKD secondary to primary focal segmental glomerulosclerosis received a deceased donor kidney transplant 4 years ago. Her post-transplantation course was uncomplicated. Her panel reactive antibody level at the time of transplantation was 80%, and she received antithymocyte globulin for induction. She is currently maintained on tacrolimus with a target trough of 4 to 6 ng/ml, mycophenolate mofetil 1000 mg twice a day, and prednisone 5 mg daily. Her most recent serum creatinine is 1.1 mg/dl (normal range <1.3 mg/dl). She comes today to the transplantation clinic to discuss whether she needs a third dose of COVID-19 vaccine. She received two doses of mRNA-based COVID vaccine; her last dose was6weeksago.HerantispikeSARS-CoV-2 IgG was checked 2 weeks ago and was undetectable..
Question: Which ONE of the following statements is FALSE regarding her lack of antibody response to vaccine?
1. Her age is a risk factor for not mounting an anti-body response
2. High-dose mycophenolate mofetil may impair the development of an antibody response to vaccination
3. Being a transplantation patient decreases her response to vaccination
4. After a third dose of mRNA vaccine, 25% to 70%of transplant recipients experience antispike SARS-CoV-2 IgG
5. Her induction treatment with antithymocyte globulin does not decrease her response to vaccination
Answer: A
Subject: Transplantation

A 48-year-old woman with a history of ESKD attributed to type 2 diabetes mellitus is being seen in the ofﬁce for transplantation candidacy assessment. She has been on three times a week in-center hemodialysis for the past 2 years. She is on long- and short-acting insulin, which she manages herself. She reports taking her medications regularly. There is no history of heart disease, but she has had two admissions to the hospital for ﬂuid overload that required emergent dialysis. She reports frequently cutting short her dialysis treatments because of scheduling conﬂicts with her job. She is single and lives alone. She does not have conﬁrmed post-transplantation caregivers but indicates that her cousin may be able to help. Her clinic BP measured after 5 minutes of rest is 180/100 mm Hg. Routine laboratory studies show a hemoglobin of 9 g/dl, serum potassium of 6.1 mmol/L, serum sodium of 130 mmol/L, serum calcium of 10.2 mg/dl, and serum phosphorus of 7.8 mg/dl..
Question: Which of the following has been shown in studies to be associated with risk for nonadherence after transplantation?
1. Failure to complete full dialysis treatments for nonmedical reasons
2. Poorly controlled hypertension
3. Poorly controlled hyperphosphatemia on dialysis
4. Hyperkalemia
5. Inadequate social support
Answer: C
Subject: Transplantation

A 73-year-old man with CKD-5 from polycystic kidney disease is in the clinic for a regular follow-up visit. His eGFR from laboratory studies done a week ago was 19 ml/min. He experiences mild fatigue but is otherwise doing well. He is retired but remains active around the house and works regularly in his garden. He has osteoarthritis in his knees and occasionally uses a cane for assistance. His BMI is 35 kg/m2. He has a history of hypertension, which is well controlled with medications, but no other signiﬁcant comorbidities. He is interested in pursuing a kidney transplantation for his progressive CKD. He has not explored the living donor options yet and expresses a desire to not go for living donor kidney transplantation..
Question: Which ONE the following is CORRECT regarding this kidney transplantation for this patient?
1. Wait until patient has an eGFR <10 ml/min to refer him for transplantation evaluation
2. Inform patient that his beneﬁts from transplantation are low, given his age and do not refer for transplantation evaluation
3. Refer patient for transplantation evaluation only if he has a likely living donor option
4. Pre-emptive transplantation should be avoided because elderly patients have a higher risk of death than of progression to dialysis
5. He should be referred for transplantation evaluation now
Answer: E
Subject: Transplantation

A 52-year-old man with a history of ESKD from biopsy-proven AL amyloidosis comes for kidney transplantation evaluation. He had presented 3 years ago with AKI along with hypertension, new-onset lower extremity swelling, and weight gain. His urine protein-to-creatinine ratio was 4.5 g/day. A renal biopsy had revealed AL amyloidosis with lambda light chain restriction. He had no cardiac involvement. He was treated with steroids, chemotherapy, proteosome, inhibitors and stem cell transplantation and went into complete remission 18 months ago. He remains in complete remission..
Question: Which ONE of the following is associated with the best kidney transplant survival in this patient?
1. Treatment of AL amyloidosis with steroids, chemotherapy, and proteosome inhibitors
2. Absence of cardiac involvement
3. Treatment with stem cell transplantation
4. Achievement and duration of complete remission
Answer: D
Subject: Transplantation

A 64-year-old patient is evaluated for a kidney trans-plantation. His comorbidities include type 2 diabetes mellitus for the past 5 years, well-controlled hyper-tension for the past 10 years, and obesity. He also recalls a history of passing three kidney stones, the last one being about 2 years ago. He did get a stone analysis during one of these episodes and was told that these were calcium oxalate stones. The cause of his ESKD is biopsy-proven FSGS, which was believed to be secondary to obesity. He started hemodialysis 1 year ago and is tolerating this well. His height is 70 inches, and his weight is 146 kg, with a BMI of 46. He has tried several weight loss treatments, including dietary modiﬁcation and exercise, for the past 2 years. However, he has been unable to lose much weight. He is otherwise active, but your institutional cutoff for BMI is 40. He is frustrated that he cannot undergo transplantation because of his weight..
Question: Which ONE of the following is the BEST approach at this time?
1. Advise him to continue his dietary efforts and return for transplantation evaluation after his BMI is below 40
2. Advise him that because he is doing well on dialysis, he should continue it because the risks of transplantation in his case are too high
3. Refer him for sleeve gastrectomy
4. Start him on orlistat as a weight-reducing agent
Answer: C
Subject: Transplantation

A 72-year-old man with ESKD secondary to diabetic nephropathy is evaluated for a kidney transplantation. He also has a history of hypertension and coronary artery disease, with placement of one stent 3 years ago. His cardiac test results are otherwise unremarkable. He started hemodialysis last month and is tolerating treatments without a problem. He is hepatitis B surface antigen negative, hepatitis B surface anti-body positive, hepatitis C negative, and HIV negative. He does not have any living donors, and the wait time in your center is over 5 years. He is very interested in getting a transplant because of his active lifestyle and desire for travel. He inquiries about receiving a kidney transplant from a hepatitis C–positive donor..
Question: Which ONE of the following is TRUE regarding kidneys from hepatitis C–positive donors?
1. He is a candidate only for kidney from a donor with positive hepatitis C serology but negative hepatitis C NAT
2. He is not a candidate for hepatitis C–positive donor kidney, given his hepatitis C–negative status
3. Kidneys from hepatitis C–positive donors have been shown to have lower graft survival
4. Accepting a kidney from hepatitis C–positive donor may help shorten the time to kidney transplantation
Answer: D
Subject: Transplantation

A 34-year-old man with a history of ESKD secondary to type 1 diabetes mellitus comes for a pretransplantation evaluation. He has been diabetic since age 13 years and is currently on a basal-bolus regimen of long-acting and ultra-short-acting insulin. He is currently awaiting insurance approval for an insulin pump. His blood sugars ﬂuctuate widely during the day, with a range of 40 to 500 mg/dl. His last HbA1C was 9%. His BMI is 26 kg/m2. He maintains hypoglycemic aware-ness but goes into diabetic ketoacidosis frequently. His secondary complications from diabetes include peripheral neuropathy and retinopathy. He has no known coronary artery disease. He is currently on dialysis three times a week through a left upper extremity arteriovenous ﬁstula. He lives with his parents and is currently on disability. He has several family members who are interested in donating a kidney to him..
Question: Which of the following options has been shown in studies to have the best kidney survival?
1. Deceased donor kidney transplantation
2. Living donor kidney transplantation
3. Deceased donor kidney transplantation followed by a pancreas after kidney transplantation
4. Simultaneous kidney and pancreas transplantation
5. Living donor kidney transplantation followed by a pancreas after kidney transplantation
Answer: E
Subject: Hypertension
Question: Question 5624
The prevalence of hypertension in the adult world population is estimated at:
1. 10%–20%
2. 25%–35%
3. 45%–55%
4. 60%–70%
Answer: B
Subject: Hypertension

The chief medical ofﬁcer of your multispecialty clinic wishes to improve quality of care using standardized performance measures and wants to benchmark your hypertension control rates. To plan this initiative, you are asked to present an outline of the scale of the problem to be addressed..
Question: With regard to current epidemiological trends in hypertension, which ONE of the following is TRUE?
1. Using the deﬁnition of hypertension from the 2017 AHA/ACC guideline, the prevalence of hypertension in the United States is estimated to be 35%
2. According to the most recent US National Health and Nutrition Examination Survey (NHANES), data from 2017 to 2018, rates of hypertension control have decreased
3. Hypertension is estimated to affect 22.4% of adults in the United States aged 40–59 years
4. Despite increasing prevalence, death rates attributed to hypertension have fallen in recent years
Answer: B
Subject: Hypertension

A 62-year-old woman is referred for evaluation of stage 3a chronic kidney disease. She has no history of hypertension or cardiac disease. She is taking thyroid replacement and an aromatase inhibitor. Her BP is 136/84 mm Hg as the average of three readings taken 1 minute apart by automated BP measurement with heart rate 72 bpm. Her body mass index (BMI) is 27.4 kg/m2. Her examination results are otherwise normal, and she appears euvolemic. Laboratory studies show sodium of 137 mEq/L, potassium of 4.0 mEq/L, chloride of 99 mEq/L, total CO2 of 28 mmol/L, BUN of 20 mg/dl, and creatinine of 1.2 mg/dl with eGFR 51 ml/min per 1.73 m2 body surface area. A urinalysis shows no protein, cells, or casts. Based on this reading, she asks if you consider her BP to be elevated and how it should be further assessed..
Question: The US Preventive Services Task Force recommends which of the following approaches to hypertension screening in the general population?
1. Careful ofﬁce measurement with return for repeated measurements if BP is elevated
2. Careful ofﬁce measurement followed by out-of-ofﬁce measurement if BP is elevated
3. Initial testing with ambulatory BP monitoring
4. Initial testing with home BP monitoring
Answer: B
Subject: Hypertension

Differences in hypertension control rates in patients of different racial and ethnic minorities may be due to socioeconomic and healthcare disparities, or biologic differences in response to treatment..
Question: Based on an NHANES analysis of antihypertensive drug use and BP control rates by race and ethnicity covering data from 2005 to 2012, which of the following statements is accurate regarding racial and ethnic disparities in hypertension treatment and control?
1. Hypertension treatment and control rates improved for all racial and ethnic groups
2. Black patients had lower control rates owing to lower intensity of treatment by their providers
3. Black patients had the lowest hypertension control rates
4. Differences in hypertension control were caused by economic disparities across racial and ethnic groups
Answer: A
Subject: Hypertension

An 83-year-old man returns for evaluation of his primary hypertension, which is treated with two agents. His home readings have been running 135/66 mm Hg, based on the average of 28 home readings taken twice daily over the prior 2 weeks. He lives independently with his spouse and is active in his local community, including tutoring of middle school students twice a week. He is taking full doses of lisinopril 40 mg daily and amlodipine 10 mg daily. His BP is 136/62 mm Hg as the average of three readings taken 1 minute apart by automated BP measurement with heart rate 72 bpm. His BMI is 24.4 kg/m2. His examination results are otherwise normal, and he appears euvolemic..
Question: Which of the following statements is accurate regarding treatment of hypertension in patients aged 80 years and older in SPRINT?
1. This cohort was not included in SPRINT, so we have no trial data to apply
2. Further post-hoc analysis indicates potential harm from intensive treatment of this subgroup
3. Gait speed was a predictor of beneﬁts from intensive treatment
4. D. Patients with high cognitive function showed beneﬁt, whereas those with low function did not
Answer: D
Subject: Hypertension

A 32-year-old man returns for reevaluation of stage 1 hypertension diagnosed 12 months ago and treated with recommendations for lifestyle modiﬁcation. He has multiple risk factors for future cardiovascular disease (CVD), including daily smoking, obesity, glucose intolerance, sedentary lifestyle, and family history of premature CVD. He was advised to make lifestyle modiﬁcations, including smoking cessation, regular exercise, and weight loss. He has been under stress with his job and has not been able to ﬁnd time to exercise or change his diet. With the stress he has continued to smoke. He was seen for a 6-month follow-up visit with similar concerns, but despite good intentions, his circumstances have not improved. His BP is 136/78 mm Hg as the average of three readings taken 1 minute apart by automated BP measurement with heart rate 72 bpm. His BMI is 36.4 kg/m2. His examination results are notable for abdominal obesity and are otherwise normal. Because he is younger than 40 years, the ACC/AHA pooled cohorts ASCVD 10-year risk calculator does not apply..
Question: Which of the following statements is accurate concerning approach to stage 1 hypertension in young adults under age 40 years?
1. Inasmuch as young adults have low 10-year ASCVD risk scores, observation is the best approach
2. Lifestyle modiﬁcation alone should be encouraged at follow-up visits until the age of 40 years
3. After 6 months of lifestyle changes, all patients with continued stage 1 hypertension should be prescribed medication
4. After 6 months of lifestyle therapy, drug treatment should be considered for patients with a history of premature birth or multiple cardiovascular risk factors
Answer: D
Subject: Hypertension

After the release of the 2017 ACC/AHA BP guideline, several international guidelines have been released. As with the United States guideline, updated guidelines from the European Society of Cardiology/European Society of Hypertension, the World Health Organization, the American Diabetes Association, and the Kidney Disease Improving Global Outcomes Collaborative trend to lower thresholds for treatment and lower BP targets, although some differences persist..
Question: Which of the following hypertension guidelines advises the lowest target BP?
1. 2017 ACC/AHA blood pressure guideline
2. 2018 ESC/ESH hypertension guideline
3. 2021 WHO hypertension guideline
4. 2022 ADA Standards of medical care in diabetes
5. 2021 KDIGO hypertension guideline
Answer: E
Subject: Hypertension

A 63-year-old woman is prescribed pazopanib for the treatment of renal cell carcinoma. Her in-ofﬁce BP before starting the pazopanib was 118/74 mm Hg without antihypertensive medication. However, her BP was found to be 164/88 mm Hg 3 weeks into treatment. Routine blood work revealed a stable serum creatinine level and normal complete blood count..
Question: Which of the following is the most likely mechanism for hypertension induced by vascular endothelial growth factor (VEGF) inhibitors?
1. Increased vascular resistance via impaired angiogenesis
2. Glomerular capillary injury from thrombotic microangiopathy
3. Increase in aldosterone release from the adrenal cortex
4. Stimulation of collecting duct renin
Answer: A
Subject: Hypertension

A 33-year-old man undergoes whole genome single nucleotide polymorphism (SNP) genotyping for a research study. He was given his results and sets up a clinic visit to discuss his risk for hypertension from an SNP in the promoter region of uromodulin..
Question: Which mechanism explains how SNPs in the promoter region of uromodulin may predispose to hypertension?
1. Decreased activity of Na-K-Cl cotransporter 2 (NKCC)
2. Increased prorenin receptor activity in the collecting duct
3. Endocytosis of transient receptor potential vanilloid 5 (TRPV5) in the distal convoluted tubule
4. Reduced urinary activation of claudin-19
Answer: C
Subject: Hypertension

A 65-year-old woman with a medical history of hypothyroidism and obesity is seen in clinic for an annual evaluation. She has just returned from a 2-week vacation at the beach, where she admits to eating out frequently, often choosing fried and high-salt foods..
Question: Which mechanism of hypertension is associated with a high-salt diet?
1. Reduction in tubuloglomerular feedback signaling
2. Altered gut microbiota
3. Activation of brain renin-angiotensin system
4. Impaired prorenin receptor binding in the collecting duct
Answer: B
Subject: Hypertension

A 72-year-old man with CKD stage 3, eGFR 40 ml/min per 1.73 m2, prior CABG, and hypertension comes for a follow-up visit. He is currently treated with carvedilol 12.5 mg twice daily, losartan 75 mg daily, and amlodipine 10 mg daily. In clinic, his BP is above goal at 146/ 88 mm Hg. On examination, he has trace lower limb edema, which he attributes to eating potato chips at the weekend. He admits to a high-salt diet and to eating processed and preprepared foods on a daily basis..
Question: Which of the following is true regarding salt-sensitive hypertension?
1. In a model of salt-sensitive hypertension, spironolactone was less effective for BP control than losartan in rats consuming a high-salt diet
2. High-salt diet promotes the development of Th17 cells, which upregulate renal sodium reabsorption
3. In hypertensive patients with high salt intake, increased dietary potassium intake does not affect BP
4. In micropuncture experiments, SGLT2 inhibition that leads to a decrease in glomerular capillary pressure is invariably associated with an acute decrease in GFR
Answer: B
Subject: Hypertension

A 68-year-old woman is admitted to the medical intensive care unit with respiratory distress of sudden onset. She has been exposed to Covid-19 by a family member. She has received two Covid mRNA vaccines and a booster. She also has a history of well-controlled hypertension and heart failure. Medications include lisinopril 20 mg daily, aspirin 81 mg daily, carvedilol 12.5 mg twice daily, and furosemide 20 mg daily. She uses bilevel positive airway pressure. Her BP is 148/78 mm Hg, heart rate 88 bpm, chest sounds rhonchi bilaterally systolic ejection murmur present, no edema. Family is concerned that patient may require intubation and want the physicians to stop the lisinopril because they are afraid this will worsen her Covid-19 symptoms..
Question: Which ONE of the following is the MOST appropriate next step in management?
1. Stop lisinopril and switch to losartan 100 mg daily
2. Stop lisinopril and switch to amlodipine 10 mg daily
3. Continue current medications
4. Stop lisinopril because upregulation of ACE2 by lisinopril will exacerbate Covid-19 symptoms
Answer: C
Subject: Hypertension

A 56-year-old man has hypertension and hyperlipidemia. He has no other signiﬁcant medical problems but has a strong family history of coronary artery disease and is concerned about reducing his risk for CVD. He takes rosuvastatin 5 mg at night, amlodipine 5 mg and losartan 50 mg both in the morning. He has read in the news that if he takes his medications at night he will be able to reduce his risk of CVD substantially..
Question: Which ONE of the following is the MOST appropriate response by the physician?
1. He should take all his BP medications at night because this will reduce the risk of CVD by 50%
2. He should take all his BP medications in the morning because this will reduce the risk of CVD by 50%
3. He should take all his BP medications with his statin to improve compliance
4. He should continue taking his medications as prescribed and ensure he is compliant
Answer: D
Subject: Hypertension

A 56-year-old woman with hypertension, hyperlipidemia and type 2 diabetes mellitus (DM) comes for a scheduled ofﬁce visit. She feels well without complaints. She restricts dietary sodium and goes to the gym 3 times per week, doing aerobic exercise for 30 minutes each time. She is unable to lose weight and is frustrated. Her BMI is 36, BP is 144/96 mm Hg, and the rest of her physical examination results are unremarkable..
Question: Which ONE of the following is the MOST accurate regarding weight loss for this patient?
1. Physical activity and exercise training reduce obesity, and a 2%–3% reduction in weight will lower BP, but reductions of at least 5%–10% are desired within 6 months to yield improvements in the major CVD risk factors
2. Once weight loss is achieved it is usually easy to maintain
3. A 5%–10% reduction in weight is associated with 10 mm Hg reduction in systolic BP (SBP)
4. Weight loss in the ﬁrst 2 months of pharmacologic therapy is predictive of changes noted at 1 year
5. Medications including orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, and semiglutide are ineffective for weight loss
Answer: A
Subject: Hypertension

A 59-year-old man is referred to you for management of difﬁcult to control hypertension. He has type 2 DM, CVD, and CKD stage 4. His estimated GFR is 27 ml/min per 1.73 m2 and 1.4 grams of albuminuria/day, based on microalbumin-to-creatinine ratio. He tells you that he has never been able to control his BP despite taking multiple medication..
Question: Based on the SPRINT data, all of the following are associated with failure to achieve intensive SBP target EXCEPT:
1. Younger age
2. Baseline SBP >140 mm Hg
3. Greater number of antihypertensive medications
4. Macroalbuminuria
5. Preexisting CKD
Answer: A
Subject: Hypertension

A 65-year-old man who is an established patient in your practice wants to continue doing telemedicine visits even though your practice is now back in the ofﬁce. His medical history is signiﬁcant for longstanding hypertension with intermittent poor control, stage 3 CKD, and hyperlipidemia..
Question: Which ONE of the following is the MOST accurate regarding use of telemedicine (TM) visits for care of patients with hypertension?
1. The most effective approach is to use TM based on telemonitoring of BP and tracking of additional vital and nonvital signs with data exchange between patients and a case manager through the web, emails, text messaging, or video consultation, integrated with education on lifestyle, risk factors, and proper use of antihypertensive medications
2. TM is not accredited for the treatment of patients with hypertension
3. Use of TM for treatment of patients with hypertension should be limited to those with well controlled hypertension
4. Use of TM for treatment of patients with hypertension should be limited to those on less than 3 medications
Answer: A