TempoMed-Bench
Collection
Tempo • 2 items • Updated
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0 | 36739483 | 2,023 | 26103502 | 2,015 | A radiation oncology department is replacing paper-based preprocedure safety checklists used for external beam radiotherapy and high–dose-rate (HDR) brachytherapy. The team wants better multidisciplinary communication and faster audits of checklist use. They also plan to auto-populate treatment parameters from the onco... | Implement an EMR-integrated electronic checklist with interlocks, formal documentation, and rapid audit capability; design from a sociotechnical/human–computer interaction perspective and deploy intelligent dynamic items with targeted automation (auto-populated fields, out-of-tolerance alerts) validated by formal risk ... | Implement a basic electronic checklist primarily to enable interlocks and quick audits; pilot test to identify pitfalls, avoid deep EMR integration to prevent tethering during time-critical procedures, and consider portable devices to improve usability. | Retain paper checklists supplemented by verbal time-outs; perform quarterly retrospective audits, and avoid interlocks or automation to preserve workflow flexibility during time-sensitive cases. | Deploy a fully automated hard-stop system that auto-populates all items and removes human verification; omit formal risk analysis and ongoing updates because automation will minimize residual error risk. | I do not know the answer | A | The 2023 AAPM guidance expands technological recommendations to include EMR integration for communication, formal documentation and rapid audits; sociotechnical and human–computer interaction–informed design; and, where appropriate, intelligent dynamic checklists with automation (e.g., auto-populated values and out-of-... |
1 | 36739483 | 2,023 | 26103502 | 2,015 | A large academic radiation oncology department recently upgraded to an integrated image-guided linear accelerator with automated collision-avoidance and gating. The department currently uses a long-standing pretreatment "collision clearance" checklist for physicists and a separate therapist setup checklist that now dup... | Establish formal ownership and maintenance responsibilities for each checklist and incorporate retirement criteria into the routine review, retiring the collision-clearance checklist if it no longer supports clinical practice | Continue semiannual reviews using incident learning data and revise the collision-clearance checklist to reflect the new automated systems while keeping all checklists in use | Retain all legacy checklists to preserve redundancy and add new verification steps to ensure automation is cross-checked in multiple places | Limit checklist changes to ad hoc end-user edits and defer formal review until a serious adverse event necessitates comprehensive revision | I do not know the answer | A | AAPM (2023) recommends two lifecycle elements in addition to routine reviews and continuous improvement: explicitly consider retiring checklists that no longer support clinical practice and clearly define roles and responsibilities for checklist maintenance and periodic review. Option A implements both by assigning own... |
2 | 36933136 | 2,022 | 30171414 | 2,017 | A 67-year-old man with a 40-pack-year smoking history presents with 3 months of progressive dysphagia and 8-kg weight loss. Esophagogastroduodenoscopy reveals a circumferential ulcerated mass in the mid-to-distal esophagus. Biopsy shows moderately differentiated squamous cell carcinoma. PET-CT demonstrates mediastinal ... | Pembrolizumab plus cisplatin plus 5-fluorouracil | Cisplatin plus 5-fluorouracil | Cetuximab plus cisplatin plus 5-fluorouracil | Nivolumab monotherapy | I do not know the answer | A | The 2022 Japan Esophageal Society guideline strongly recommends immune checkpoint inhibitor–based regimens as first-line therapy for unresectable, advanced/recurrent esophageal cancer, including pembrolizumab plus cisplatin plus 5-fluorouracil; nivolumab plus cisplatin plus 5-fluorouracil; and nivolumab plus ipilimumab... |
3 | 36933136 | 2,022 | 30171413 | 2,017 | A 67-year-old man undergoes endoscopic submucosal dissection for a 6-cm superficial esophageal squamous cell carcinoma involving approximately 75% of the esophageal circumference at 30 cm from the incisors. Resection margins are negative. He has no history of esophageal disease and takes no chronic medications. On post... | Initiate an oral prednisolone taper and perform submucosal triamcinolone injections along the mucosal defect | Schedule prophylactic endoscopic balloon dilations at regular intervals beginning within the first 1–2 weeks after resection | Apply topical mitomycin-C to the resection bed to inhibit scar formation | Place a fully covered self-expanding metal stent for several weeks to maintain luminal patency | I do not know the answer | A | Large circumferential mucosal defects after endoscopic resection are at high risk for esophageal stricture. The 2022 Japan Esophageal Society guideline strongly recommends steroid-based prophylaxis—oral prednisolone, submucosal triamcinolone injection, or their combination—to prevent stenosis after endoscopic resection... |
4 | 36933136 | 2,022 | 30171413 | 2,017 | A 64-year-old man presents with 3 months of progressive dysphagia to solids and a 7-kg unintentional weight loss. He has a 30–pack-year smoking history but no major comorbidities. Esophagogastroduodenoscopy reveals a 5-cm ulcerated mid-thoracic esophageal mass; biopsy shows moderately differentiated squamous cell carci... | Docetaxel + cisplatin + 5-fluorouracil (DCF) as neoadjuvant chemotherapy | Cisplatin + 5-fluorouracil (CF) as neoadjuvant chemotherapy | Capecitabine + oxaliplatin (CAPOX) as neoadjuvant chemotherapy | Docetaxel + cisplatin (DC) as neoadjuvant chemotherapy | I do not know the answer | A | For resectable cStage II–III esophageal squamous cell carcinoma scheduled for surgery as primary treatment, the Japan Esophageal Society 2022 guideline strongly recommends preoperative triplet chemotherapy with docetaxel, cisplatin, and 5‑fluorouracil (DCF), based on phase III data (JCOG1109) demonstrating improved out... |
5 | 36920680 | 2,022 | 32132516 | 2,019 | A 64-year-old man with locally advanced, unresectable pancreatic head adenocarcinoma presents with 3 weeks of early satiety, postprandial nonbilious vomiting, and 4-kg weight loss. He completed 6 months of FOLFIRINOX with a partial radiographic response and improved CA 19-9 levels. He lives independently and has an ECO... | Surgical gastrojejunostomy to provide durable bypass | Select either endoscopic duodenal stenting or surgical gastrojejunostomy based on patient preference and facility circumstances | Endoscopic self-expandable metallic duodenal stent placement as first-line palliation in this patient | Nasogastric decompression with initiation of total parenteral nutrition as definitive palliation | I do not know the answer | A | The 2022 Japan Pancreas Society guideline recommends endoscopic gastrointestinal stent insertion for malignant gastric outlet obstruction in unresectable pancreatic cancer, but specifies that surgical gastrojejunostomy is recommended for patients with a prolonged life expectancy. This patient has good performance statu... |
6 | 37056485 | 2,023 | 32837733 | 2,020 | A 28-year-old man collapses 1 hour into a summer road race with confusion and hot, dry skin. In the emergency department, he is intubated for airway protection. Rectal temperature is 41.2°C, blood pressure is 98/62 mm Hg, and heart rate is 132/min. Labs show lactate 5.1 mmol/L and creatinine 1.6 mg/dL. The hospital’s c... | Initiate evaporative plus convective cooling immediately using water mist and fans while applying standard infection-control precautions | Avoid evaporative plus convective cooling because of aerosolization risk and select an alternative cooling method based on facility experience and preparation | Defer active cooling until SARS-CoV-2 testing results are available and provide only passive cooling with IV fluids in the interim | Use evaporative plus convective cooling only if a negative-pressure isolation room and airborne precautions are available; otherwise avoid this method | I do not know the answer | A | The 2023 joint guideline (JAAM/JSEM/JAID/JRS) allows evaporative plus convective cooling after taking normal infection-control measures and emphasizes selecting a method that can be applied quickly at each facility. This reverses 2020 guidance that discouraged evaporative/convective cooling due to aerosolization concer... |
7 | 37063635 | 2,023 | 31040460 | 2,019 | A 32-year-old man with bipolar I disorder is brought to an inpatient psychiatric unit on an involuntary hold for escalating agitation and assaultive behavior. He is shouting, striking at staff, and attempting to kick anyone who approaches. De-escalation and a quiet room were ineffective, and he received intramuscular h... | Place the patient prone on the bed and secure both arms and legs to the bedside with cotton bandages, allowing some free movement; adjust the technique based on the patient’s clinical status | Avoid the prone position; if used only to prevent imminent serious harm, promptly reposition to sitting, standing, or supine and specify in orders that prone restraint should never be used | Use a four-point supine restraint with leather straps tightened to minimize any limb movement until the patient is fully sedated | Seat the patient in a restraint chair with the arms crossed behind the back and wrists bound together to prevent striking | I do not know the answer | A | The 2023 Indian Psychiatric Society guideline permits and describes a prone-position physical restraint technique in which both arms and legs are secured to the bedside using cotton bandages, allowing some free movement, with modifications based on the patient’s condition. In contrast, the 2019 IPS guideline advised th... |
8 | 37063635 | 2,023 | 31040460 | 2,019 | A 32-year-old man with schizophrenia is brought to the emergency department by police for violent, assaultive behavior in a public place. He is pacing, shouting threats, and has attempted to strike staff. Verbal de-escalation has failed. He refuses and spits out offered oral medication. He has a patent peripheral IV pl... | Administer medication via the intramuscular route as the initial parenteral approach | Administer medication via the intravenous route as the initial parenteral approach | Administer medication via the intranasal route as the initial approach | Administer medication via the sublingual/orally disintegrating route as the initial approach | I do not know the answer | A | The 2023 Indian Psychiatric Society guidance on managing acute agitation emphasizes using oral medication before parenteral when feasible and, when parenteral treatment is required, selecting intramuscular administration as the initial route; it specifically states that the intravenous route is no longer advised as an ... |
9 | 37063635 | 2,023 | 35602364 | 2,022 | A 28-year-old man is brought to an emergency psychiatry unit in Delhi by family for escalating agitation. He is pacing, shouting, and attempting to strike staff despite verbal de-escalation and the presence of security. He has no weapons and no acute medical issues on brief assessment. Vitals show blood pressure 158/92... | Initiate rapid tranquilization and, if needed, brief physical restraint with continuous observation; do not use seclusion because it is prohibited under the Mental Health Care Act 2017 | Move the patient into a locked seclusion room until agitation subsides, with periodic nursing checks | Place the patient alone in a quiet room with the door closed as a temporary time-out without dedicated observation | Apply four-point mechanical restraints in the prone position without 1:1 monitoring to minimize staff risk | I do not know the answer | A | The Indian Psychiatric Society 2023 guideline states that seclusion is not permitted in India under the Mental Health Care Act 2017; therefore, seclusion should not be used. Management should proceed with permissible measures such as rapid tranquilization and, if necessary, brief physical restraint with continuous obse... |
10 | 37088423 | 2,023 | 35218978 | 2,022 | A 32-year-old woman presents to an urgent care clinic with 3 days of fever, myalgias, nasal congestion, sore throat, and nonproductive cough after several coworkers were recently ill. She is hemodynamically stable, oxygen saturation is 99% on room air, and physical examination shows mild pharyngeal erythema and clear l... | Perform a point-of-care rapid antigen detection test rather than send a laboratory-based nucleic acid amplification test (NAAT) for diagnosis | Send a laboratory-based NAAT rather than perform a rapid antigen detection test for diagnosis | Defer virologic testing and make a clinical diagnosis, planning serologic testing if symptoms persist beyond 7 days | Obtain a chest CT scan as the initial diagnostic test before pursuing any virologic assay | I do not know the answer | A | For symptomatic patients within 7 days of symptom onset, the 2023 ESCMID guideline suggests using a rapid antigen detection test instead of a laboratory-based NAAT for diagnosis, reflecting updated evidence on antigen test performance early in illness. The opposite preference (NAAT over antigen testing) reflects earlie... |
11 | 36682773 | 2,022 | 29877295 | 2,017 | A 36-year-old man is referred after a worksite health check shows elevated cholesterol. He is not taking any medications. Physical examination reveals no cutaneous xanthomas, and Achilles tendon ultrasonography shows normal thickness bilaterally. Fasting lipid panel demonstrates LDL-C 262 mg/dL, HDL-C 48 mg/dL, and tri... | Classify as probable familial hypercholesterolemia | Diagnose familial hypercholesterolemia | Classify as non-familial hypercholesterolemia | Classify as possible familial hypercholesterolemia | I do not know the answer | A | The 2022 Japan Atherosclerosis Society guideline narrows the family history criterion to first-degree relatives and introduces a “probable FH” category. FH is diagnosed when at least two items are met: untreated LDL-C ≥180 mg/dL, tendon xanthomas/Achilles tendon thickening, or family history of FH or premature CAD in f... |
12 | 36682773 | 2,022 | 29877295 | 2,017 | A 42-year-old man with genetically confirmed heterozygous familial hypercholesterolemia (LDLR pathogenic variant) is referred for refractory hypercholesterolemia. Despite intensive lifestyle modification and 6 months of maximally tolerated rosuvastatin, ezetimibe, and a PCSK9 inhibitor, his fasting LDL-C is 182 mg/dL. ... | Serum LDL-C exceeds 370 mg/dL in steady state under diet therapy and does not fall below 170 mg/dL with drug therapy, with coronary atherosclerosis evident and xanthoma present | Total cholesterol exceeds 400 mg/dL in steady state under dietary therapy and does not decrease to 250 mg/dL or less with drug therapy, with coronary artery lesions and xanthomas present | Serum LDL-C exceeds 190 mg/dL despite drug therapy, regardless of the presence of coronary atherosclerosis or xanthomas | Non–HDL cholesterol exceeds 220 mg/dL despite drug therapy, with or without coronary atherosclerosis and without the requirement for xanthomas | I do not know the answer | A | The 2022 Japan Atherosclerosis Society guideline refined insurance coverage criteria for lipoprotein apheresis in heterozygous FH to LDL-C–based thresholds: LDL-C >370 mg/dL in steady state under diet therapy and failure to reduce LDL-C below 170 mg/dL with drug therapy, in the presence of coronary atherosclerosis and ... |
13 | 37180564 | 2,023 | 28955381 | 2,017 | A 62-year-old woman with a 4-year history of non-ischemic dilated cardiomyopathy presents for follow-up. She reports exertional dyspnea climbing one flight of stairs but no orthopnea or paroxysmal nocturnal dyspnea. She has been on maximally tolerated guideline-directed medical therapy for the past 6 months, including ... | Offer implantable cardioverter-defibrillator implantation as a reasonable option for primary prevention to reduce the risk of sudden death and all-cause mortality | Recommend implantable cardioverter-defibrillator implantation for primary prevention to reduce total mortality | Continue medical therapy alone without implantable cardioverter-defibrillator implantation because benefit is uncertain in non-ischemic cardiomyopathy | Prescribe a wearable cardioverter-defibrillator for 3 additional months and defer implantable cardioverter-defibrillator consideration | I do not know the answer | A | She has symptomatic non-ischemic heart failure with LVEF ≤35% despite ≥3 months of guideline-directed medical therapy and an expected survival >1 year. The 2023 Korean Society of Heart Failure guideline states that an ICD is reasonable (Class IIa, LOE A) to reduce sudden death and all-cause mortality in this setting, r... |
14 | 37180563 | 2,023 | 36262736 | 2,019 | A 76-year-old man presents with 2 weeks of progressive exertional dyspnea and orthopnea. He has hypertension and type 2 diabetes. On examination, blood pressure is 146/84 mm Hg, heart rate 96/min, and oxygen saturation 93% on room air. Jugular venous pressure is 10 cm H2O, bibasilar crackles are present, and there is 1... | Classify as heart failure with mildly reduced ejection fraction based on symptoms/signs with LVEF 41–49% without requiring elevated natriuretic peptides or structural/diastolic abnormalities | Delay classification as heart failure with mildly reduced ejection fraction until elevated natriuretic peptides and at least one structural or diastolic abnormality are documented | Classify as heart failure with preserved ejection fraction because natriuretic peptides are not elevated and diastolic function is normal | Obtain cardiac MRI to assess myocardial fibrosis before assigning the diagnosis of heart failure with mildly reduced ejection fraction | I do not know the answer | A | Per the 2023 Korean Society of Heart Failure guideline, HF with mildly reduced ejection fraction (HFmrEF) is classified when symptoms/signs of HF are present with LVEF 41–49%, and additional objective evidence (natriuretic peptides or structural/functional abnormalities) is not required. Earlier guidance (2019) require... |
15 | 36995449 | 2,022 | 25620903 | 2,012 | A 62-year-old man presents with 2 months of progressive dysphagia to solids. He has a 30–pack-year smoking history and drinks alcohol daily. Upper endoscopy reveals a 2.5-cm ulcerated lesion in the mid-esophagus. Biopsy shows moderately differentiated squamous cell carcinoma. Endoscopic ultrasound demonstrates tumor in... | Definitive concurrent chemoradiotherapy as a non-surgical curative approach | Neoadjuvant chemotherapy followed by esophagectomy as the preferred curative approach | Endoscopic submucosal dissection alone without additional therapy | Definitive external-beam radiotherapy alone without chemotherapy | I do not know the answer | A | JCOG0502 demonstrated that outcomes of chemoradiotherapy were not inferior to surgery for cStage I esophageal cancer, leading the 2022 Japan Esophageal Society guideline to endorse definitive chemoradiotherapy as a standard non-surgical curative option for cStage I disease. Earlier recommendations (2015) considered che... |
16 | 36995449 | 2,022 | 30171414 | 2,017 | A 69-year-old man presents with progressive dysphagia and 8-kg weight loss over 4 months. Upper endoscopy shows an ulcerated mid-thoracic esophageal mass; biopsy confirms squamous cell carcinoma. PET/CT demonstrates a 6-cm primary tumor with subcarinal and paratracheal lymphadenopathy but no distant metastases (cT3N1M0... | Concurrent cisplatin + 5-fluorouracil with 50.4 Gy in 28 fractions | Concurrent cisplatin + 5-fluorouracil with 60.0 Gy in 30 fractions | Concurrent cisplatin + 5-fluorouracil with 66.0 Gy in 33 fractions | Concurrent cisplatin + 5-fluorouracil with 41.4 Gy in 23 fractions | I do not know the answer | A | The 2022 Japan Esophageal Society guideline recommends using 50.4 Gy with concurrent cisplatin + 5-fluorouracil for definitive chemoradiotherapy in cStage II–III esophageal cancer, citing RTOG 9405/INT0123 and ARTDECO, which showed no improvement in survival or local control with higher radiation doses and increased to... |
17 | 37277507 | 2,023 | 33677649 | 2,021 | A 72-year-old man is on postoperative day 4 after an emergency laparotomy for obstructing sigmoid colon cancer with focal perforation and peritonitis. He has a BMI of 36 kg/m2 and a history of a provoked deep venous thrombosis 3 years ago. He is largely bedbound but is beginning physical therapy. Vital signs are stable... | Administer combined pharmacological (eg, low–molecular-weight heparin) and mechanical prophylaxis with daily in-hospital reassessment; at discharge, continue extended pharmacological prophylaxis tailored to his very high-risk profile for a defined period (eg, several weeks) | Administer pharmacological prophylaxis alone with daily in-hospital reassessment; reserve mechanical methods only if anticoagulation is contraindicated; discontinue prophylaxis at discharge without routine extension | Use mechanical prophylaxis alone throughout the hospital stay due to recent major surgery; begin pharmacological prophylaxis only if VTE occurs; no post-discharge prophylaxis is needed | Provide pharmacological prophylaxis alone during hospitalization and prescribe an oral anticoagulant indefinitely after discharge without mechanical methods | I do not know the answer | A | The ERAS Society 2023 emergency laparotomy guidance recommends that very high-risk patients—common in this population—receive combined pharmacological plus mechanical VTE prophylaxis with daily reassessment in hospital, and that the total duration, including after discharge, be individualized based on risk factors and ... |
18 | 37087198 | 2,023 | 34474810 | 2,021 | A 72-year-old woman with metastatic pancreatic adenocarcinoma has disease progression despite second-line chemotherapy. She has ECOG performance status 3, progressive cachexia, and worsening cholestasis. She is no longer a candidate for disease-directed therapy and asks, "How long do I have?" The oncology team discusse... | Provide an estimate based on your clinical experience, acknowledging uncertainty and the tendency to overestimate, and supplement with input from multiple professionals as needed | Routinely apply validated prognostic scoring tools to improve the accuracy of survival predictions in this setting | Defer providing any survival estimate and rely on the hospice team to address prognostication after enrollment | Base the survival estimate primarily on tumor-type population median survival and line-of-therapy data rather than individual clinical judgement | I do not know the answer | A | ESMO (2023) recommends that clinicians use their own clinical experience to predict survival for patients with advanced incurable cancer likely to live only a few months, while recognizing limitations and a general tendency to overestimate; input from multiple professionals may supplement this judgement. The earlier ap... |
19 | 37309700 | 2,023 | 34409790 | 2,021 | A 62-year-old man with hypertension and obesity presents on day 6 of fever, cough, and dyspnea. SARS-CoV-2 PCR is positive. He requires 3 L/min nasal cannula oxygen and is started on dexamethasone and remdesivir. His wife read about interferon and asks whether it should be added to help him recover faster. According to... | Do not initiate interferon therapy for COVID-19 in this patient | Offer interferon therapy only within an approved clinical trial | Administer interferon beta early (within 7 days of symptom onset) to reduce risk of progression | Add inhaled interferon beta-1a for persistent hypoxemia despite corticosteroids | I do not know the answer | A | The 2023 National Evidence-based Healthcare Collaborating Agency and Korean Academy of Medical Sciences guideline recommends against the use of interferon for patients with COVID-19, reflecting evidence showing no clinical benefit and potential harms. Earlier guidance permitted interferon only within the context of cli... |
20 | 37309700 | 2,023 | 34409790 | 2,021 | A 67-year-old woman presents with 3 days of fever, cough, and myalgias after testing positive for SARS-CoV-2 by PCR. She has type 2 diabetes, chronic kidney disease stage 4, and atrial fibrillation treated with amiodarone and apixaban. She is afebrile, blood pressure is 132/78 mm Hg, pulse is 88/min, respiratory rate i... | Counsel that evidence is insufficient and neither recommend for nor against baloxavir; consider enrollment in a clinical trial if treatment is pursued | Advise against the use of baloxavir for COVID-19 in all patients, regardless of disease severity | Recommend baloxavir for high-risk nonhospitalized adults within 5 days of symptom onset to reduce progression | Administer baloxavir to hospitalized patients requiring supplemental oxygen because it improves outcomes | I do not know the answer | A | The 2023 NECA/KAMS guideline states there is insufficient evidence on the efficacy and safety of baloxavir marboxil in COVID-19 and does not make a recommendation for or against its use. The 2021 guidance recommended against baloxavir regardless of severity. There are no recommendations supporting routine use in outpat... |
21 | 37212982 | 2,023 | 31974683 | 2,020 | A 52-year-old man with metastatic colorectal adenocarcinoma has radiographic progression after standard chemotherapy. The oncology team plans to screen for NTRK gene fusions to determine eligibility for TRK inhibitor therapy. The pathology laboratory can perform several assays, including an RT-PCR panel targeting NTRK1... | RT-PCR should not be used as a screening test for NTRK fusion genes; use a validated NGS-based fusion assay instead | Evidence is insufficient to determine whether RT-PCR should be used as a screening test for NTRK fusions | RT-PCR should be used as the primary screening test for NTRK1/2/3 fusions across solid tumors due to speed and cost | RT-PCR should be reserved as a reflex screening test after a negative NGS result to increase sensitivity | I do not know the answer | A | The 2023 joint guideline (JSMO/JSCO/JSPHO) explicitly advises against using RT-PCR as a screening test for NTRK fusion genes, reflecting its limitations with FFPE RNA quality and unknown fusion partners and the preference for validated NGS-based approaches. The 2020 guideline stated that a recommendation on RT-PCR scre... |
22 | 37254491 | 2,023 | 27433170 | 2,014 | A 34-year-old man presents to establish care for asthma diagnosed in college. He reports brief wheezing and chest tightness with vigorous exercise or during seasonal allergies about once every 3–4 weeks. He has never required urgent care, oral corticosteroids, or hospitalization for asthma. He is a nonsmoker and has no... | As-needed low-dose ICS–formoterol inhaler for symptom relief | As-needed short-acting beta-agonist inhaler without a controller | Twice-daily low-dose ICS–formoterol maintenance with as-needed short-acting beta-agonist | As-needed ipratropium bromide inhaler as the sole reliever | I do not know the answer | A | The 2023 Korean asthma guideline recommends, for adults with mild asthma at steps 1–2, as-needed low-dose ICS–formoterol as the preferred initial regimen (Track 1), because it reduces severe exacerbations compared with SABA-based strategies. If a SABA-based approach (Track 2) is used in step 1, a low-dose ICS should be... |
23 | 37254491 | 2,023 | 27433170 | 2,014 | A 43-year-old woman with a 15-year history of asthma presents for follow-up due to persistent symptoms despite good adherence to low-dose inhaled budesonide twice daily and correct inhaler technique. She reports wheeze and chest tightness on most days, nighttime awakenings about once weekly, and two urgent-care visits ... | Low-dose ICS–formoterol used for both daily maintenance and as-needed relief (maintenance-and-reliever therapy) | Low-dose ICS/LABA as fixed maintenance therapy with as-needed SABA reliever | Daily montelukast monotherapy with as-needed SABA reliever | High-dose ICS/LABA fixed maintenance therapy with as-needed SABA reliever | I do not know the answer | A | Her symptom pattern and exacerbation history indicate a need for step 3 therapy. The 2023 Korean Academy of Tuberculosis and Respiratory Diseases/Korean Asthma Study Group guideline recommends low-dose ICS–formoterol as both maintenance and reliever (maintenance-and-reliever therapy) at step 3 because it reduces exacer... |
24 | 37254491 | 2,023 | 27433170 | 2,014 | A 38-year-old woman presents for follow-up of asthma. Over the past 6 months, she has had daily wheeze and dyspnea with activity and two exacerbations requiring oral corticosteroids. She currently uses fluticasone-salmeterol 100/50 mcg, 1 puff twice daily, and an albuterol metered-dose inhaler as needed. Pharmacy refil... | Switch to a medium-dose inhaled corticosteroid–formoterol combination used for both daily maintenance and as-needed symptom relief | Increase to medium- to high-dose inhaled corticosteroid–long-acting beta-agonist as fixed maintenance therapy and continue as-needed short-acting beta-agonist | Continue the current regimen and add a nightly leukotriene receptor antagonist while maintaining as-needed short-acting beta-agonist | Switch to high-dose inhaled corticosteroid monotherapy and continue as-needed short-acting beta-agonist | I do not know the answer | A | The 2023 Korean Academy of Tuberculosis and Respiratory Diseases/Korean Asthma Study Group guideline recommends, at step 4, medium-dose ICS–formoterol used as both maintenance and reliever therapy (MART). This patient remains uncontrolled on low-dose ICS/LABA despite verified adherence, correct technique, and addressed... |
25 | 37254491 | 2,023 | 27433170 | 2,014 | A 31-year-old man presents with a 3-month history of episodic wheezing and chest tightness that is worse at night and triggered by dust exposure. He has no smoking history and no history of COPD. Vital signs are normal. Oxygen saturation is 98% on room air. Lung examination reveals mild end-expiratory wheezes without r... | Arrange spirometry with bronchodilator testing within one week and defer inhaled corticosteroid initiation until variable airflow limitation is documented; provide as-needed short-acting beta-agonist for relief | Start a therapeutic trial of low-dose inhaled corticosteroid with as-needed short-acting beta-agonist today and schedule diagnostic spirometry within 1–3 months | Prescribe as-needed short-acting beta-agonist only and defer any diagnostic testing for six months unless symptoms worsen | Begin daily leukotriene receptor antagonist monotherapy today without objective testing and reassess symptom response in four weeks | I do not know the answer | A | The 2023 Korean Academy of Tuberculosis and Respiratory Diseases and Korean Asthma Study Group guideline emphasizes confirming variable expiratory airflow limitation (e.g., bronchodilator response or other objective tests) before initiating controller medication. Therefore, arranging prompt spirometry with bronchodilat... |
26 | 37448895 | 2,023 | 34690000 | 2,022 | A 35-year-old man is evaluated as a deceased organ donor after sudden death from intracranial hemorrhage 16 days after receiving an adenoviral vector–based COVID-19 vaccine. Medical records note new thrombocytopenia (platelet count 62,000/µL) and markedly elevated D-dimer. Fibrinogen is 300 mg/dL and INR is 1.1. CT ven... | Treat the donor as a marginal donor linked to VITT; proceed only after OPO expert committee review (including a virologist, a hematologist, and the treating team) and thorough organ viability assessment with evaluation for thrombi, obtain detailed written informed consent, preferentially select recipients without prior... | Avoid using organs from this donor and consider transplantation only in an emergency after expert counseling of risks and benefits with written informed consent, with notification of the district medical officer per adverse event–after-immunization protocols | Use the organs as standard donors if routine serologies and crossmatches are acceptable; no additional committee review or special consent process is necessary beyond usual practice | Defer any use of these organs until anti–platelet factor 4 antibody testing is repeatedly negative, then proceed with transplantation without classifying the organs as marginal or altering recipient selection | I do not know the answer | A | NOTTO’s 2023 guidance permits considered use of organs from donors with thrombotic events within 4 weeks of adenoviral vector vaccination as marginal donors after structured evaluation: OPO expert committee decision (including a virologist, a hematologist, and the treating team), thorough organ viability assessment wit... |
27 | 37468901 | 2,023 | 32489427 | 2,020 | A 62-year-old woman with a 10-year history of type 2 diabetes presents for routine follow-up. Six months ago, she had a non–ST-elevation myocardial infarction and underwent percutaneous coronary intervention to the right coronary artery. She takes aspirin, high-intensity statin therapy, an ACE inhibitor, and a beta blo... | Start an SGLT2 inhibitor or a GLP-1 receptor agonist now; add metformin later only if HbA1c remains above target | Start metformin plus an SGLT2 inhibitor (or GLP-1 receptor agonist) together now to address cardiovascular risk and glycemia | Start metformin monotherapy now; reserve an SGLT2 inhibitor or GLP-1 receptor agonist for future escalation if HbA1c rises | Start a DPP-4 inhibitor plus metformin now and consider adding an SGLT2 inhibitor or GLP-1 receptor agonist only if cardiovascular symptoms recur | I do not know the answer | A | The 2023 SBD/SBEM/SPD/SPEDM guideline recommends that adults with type 2 diabetes and established ASCVD initiate an SGLT2 inhibitor or a GLP-1 receptor agonist to reduce cardiovascular events and cardiovascular mortality, independent of glycemic status; if HbA1c remains above target, then dual therapy with the AD1 (SGL... |
28 | 37531397 | 2,023 | 30439958 | 2,018 | A 17-year-old notices that a close friend has posted on a group chat, "I can’t do this anymore. Goodbye." The friend has not responded to other peers’ messages for several hours. The student wants to reply in a way that aligns with evidence-informed guidance for young people communicating online about suicide and recal... | Send a supportive private message expressing care, ask how they are feeling without directly asking about suicide, and encourage them to seek professional help | Send a supportive private message and directly ask, “Are you thinking about suicide?” | Post a public reply discouraging self-harm and emphasize that suicide is not the answer | Do not respond to avoid amplifying the post; wait for others or the platform to address it | I do not know the answer | A | The #chatsafe 2.0 guidelines (Orygen and Centre for Youth Mental Health, The University of Melbourne, 2023) excluded the prior item advising young people to directly ask someone online if they are suicidal; thus, directly asking is no longer recommended. A supportive, non-judgmental private message that checks in witho... |
29 | 37546235 | 2,023 | 23268426 | 2,010 | A 5-month-old boy is evaluated for intermittent blood-streaked stools and mucus that began 3 weeks after starting a standard cow’s milk–based formula. He has no history of urticaria, wheezing, or immediate vomiting after feeds. Physical examination is normal, and his weight gain is appropriate. Stool cultures are negat... | Reintroduce cow’s milk at home now after 3 weeks of elimination, using a graded approach over 1–2 days while monitoring for delayed gastrointestinal symptoms | Schedule a hospital-based, medically supervised oral food challenge with cow’s milk to confirm the diagnosis | Continue the elimination diet for an additional 4–6 weeks before attempting any reintroduction | Obtain atopy patch testing and component-resolved diagnostics before proceeding with any reintroduction | I do not know the answer | A | This infant’s presentation (bloody, mucous stools without immediate symptoms and negative milk-specific IgE/skin testing) is most consistent with a non-IgE–mediated cow’s milk allergy (e.g., allergic proctocolitis) that resolved after a short diagnostic elimination diet. The World Allergy Organization 2023 guidance sta... |
30 | 37525390 | 2,023 | 30637993 | 2,019 | A 72-year-old man with ischemic cardiomyopathy (LVEF 25%) and stage 3 chronic kidney disease is hospitalized for acute decompensated heart failure with dyspnea and cool extremities. On admission, systolic blood pressure is 92–96 mm Hg, heart rate 108/min, and oxygen saturation 94% on 2 L/min nasal cannula. Jugular veno... | Consider placement of a pulmonary artery catheter to guide therapy given refractory symptoms despite standard treatment with uncertainty of volume/perfusion status, low systolic blood pressure, worsening renal function, and possible need for inotropes or mechanical circulatory support | Perform pulmonary artery catheterization to determine treatment direction whenever left ventricular filling pressure is difficult to assess in a dyspneic or hypoperfused patient | Continue noninvasive management without invasive hemodynamic monitoring, titrating diuretics and vasodilators based on physical examination and echocardiographic estimates alone | Insert a central venous catheter for CVP monitoring and avoid pulmonary artery catheterization unless endotracheal intubation becomes necessary | I do not know the answer | A | Per the 2023 Korean Society of Heart Failure guideline, hemodynamic assessment using a pulmonary artery catheter can be considered in hospitalized acute heart failure when symptoms are refractory despite standard therapy and there is uncertainty about volume or perfusion status, low systolic blood pressure, worsening r... |
31 | 37525390 | 2,023 | 30637994 | 2,019 | A 76-year-old man with ischemic cardiomyopathy (left ventricular ejection fraction 25%) is hospitalized for acute decompensated heart failure with severe dyspnea, orthopnea, jugular venous distension, bibasilar crackles, and 3+ bilateral leg edema. He received intravenous furosemide 80 mg initially and a repeat 80 mg d... | Add intravenous chlorothiazide to the loop diuretic regimen for sequential nephron blockade | Add spironolactone 25 mg orally daily to augment diuresis | Initiate low-dose dopamine infusion to improve renal perfusion and diuresis | Start tolvaptan to promote free water excretion and reduce congestion | I do not know the answer | A | In acute decompensated heart failure with inadequate response to loop diuretics, the 2023 Korean Society of Heart Failure guideline recommends considering combination therapy with a thiazide (Class IIa, Level C), leveraging sequential nephron blockade (e.g., IV chlorothiazide or oral metolazone) to overcome diuretic re... |
32 | 37525390 | 2,023 | 30637994 | 2,019 | A 72-year-old woman is being discharged after a 5-day hospitalization for acute decompensated heart failure with reduced ejection fraction. She received IV loop diuretics with a net fluid loss of 5 liters and is now euvolemic. Guideline-directed medical therapy was optimized, including initiation of sacubitril/valsarta... | Schedule an in-person clinic evaluation within 7–14 days to assess volume status and medication tolerance | Arrange either a clinic visit within 1–2 weeks or a telephone follow-up within 3 days after discharge | Schedule an in-person clinic evaluation at 3–4 weeks after discharge if symptoms recur | Plan a telephone-only follow-up within 72 hours with no scheduled in-person visit in the first month | I do not know the answer | A | The 2023 Korean Society of Heart Failure guideline recommends an early follow-up evaluation within 1–2 weeks after discharge to assess volume status and drug tolerance (Class I). Earlier guidance (2019) described it as reasonable and allowed phone follow-up within 3 days as an alternative (Class IIa). Therefore, arrang... |
33 | 37554692 | 2,023 | 30637994 | 2,019 | A 76-year-old man with ischemic cardiomyopathy (left ventricular ejection fraction 30%) presents with acute dyspnea and leg swelling. He is afebrile with a blood pressure of 118/68 mm Hg and oxygen saturation of 95% on 2 L nasal cannula. Jugular venous pressure is 14 cm H2O, there are bibasilar crackles, and 2+ pitting... | Initiate a thiazide-type diuretic (e.g., metolazone or intravenous chlorothiazide) in combination with the loop diuretic | Initiate spironolactone to augment diuresis in combination with the loop diuretic | Initiate a vasopressin V2 receptor antagonist (e.g., tolvaptan) in combination with the loop diuretic | Initiate acetazolamide as an add-on diuretic in combination with the loop diuretic | I do not know the answer | A | The 2023 Korean Society of Heart Failure guideline states that for patients with inadequate response to loop diuretics, combination therapy with a thiazide-class agent can be considered (Class IIa, Level C). Earlier guidance (2019) allowed adding a thiazide or spironolactone (Class IIa, Level B), but the updated recomm... |
34 | 37554692 | 2,023 | 30637994 | 2,019 | A 72-year-old man with ischemic cardiomyopathy (left ventricular ejection fraction 28%) is being discharged after hospitalization for acute decompensated heart failure with pulmonary edema. He was treated with intravenous diuretics and is now euvolemic. During hospitalization, guideline-directed medical therapy was opt... | Schedule an in-person clinic evaluation within 1–2 weeks after discharge to assess volume status and drug tolerance | Arrange a telephone follow-up within 3 days of discharge as an alternative to an early clinic visit | Defer clinic follow-up to 3–4 weeks after discharge if the patient remains asymptomatic with home weight monitoring | Arrange a nurse-led phone check at 48 hours and clinic follow-up only if symptoms recur | I do not know the answer | A | The 2023 Korean Society of Heart Failure guideline upgrades the recommendation for early post-discharge follow-up to a Class I recommendation for an in-person evaluation within 1–2 weeks to assess volume status and drug tolerance. The 2019 guideline offered a Class IIa option for phone follow-up within 3 days as an alt... |
35 | 37204633 | 2,022 | 25183048 | 2,014 | A 62-year-old woman is evaluated after biopsy-proven, well-differentiated, grade 2 (Ki-67 index 4%) ileal neuroendocrine tumor identified during workup for intermittent flushing and watery diarrhea. Contrast-enhanced CT of the abdomen shows a 2.5-cm ileal mass with mesenteric lymphadenopathy and several subcentimeter i... | Order Gallium-68 DOTATATE PET/CT for somatostatin receptor–based whole-body staging | Order 111In-pentetreotide somatostatin receptor scintigraphy (octreoscan) with SPECT/CT | Order 18F-FDG PET/CT for whole-body staging | Order 18F-DOPA PET/CT for neuroendocrine tumor staging | I do not know the answer | A | The 2022 SEOM–GETNE guideline recommends that somatostatin receptor–based functional imaging be part of initial staging for most NETs and identifies 68Ga-DOTATATE PET/CT as the preferred modality due to higher sensitivity for small lymph-node and bone metastases and for detecting occult primaries. Somatostatin receptor... |
36 | 37204633 | 2,022 | 25183048 | 2,014 | A 56-year-old man with a well-differentiated, grade 2 (Ki-67 12%) nonfunctional pancreatic neuroendocrine tumor presents with increasing abdominal discomfort and fatigue. He was diagnosed 3 years ago with liver-dominant metastatic disease and initially responded to a somatostatin analog, but CT performed today shows in... | Temozolomide plus capecitabine administered in 28-day cycles | Streptozocin plus doxorubicin combination chemotherapy | Dacarbazine monotherapy administered every 3 weeks | Carboplatin plus etoposide combination chemotherapy | I do not know the answer | A | The 2022 SEOM–GETNE guideline recommends that when chemotherapy is used for advanced pancreatic NETs (particularly progressive, bulky, or higher-grade G2 disease), preferred options are streptozocin with 5-fluorouracil or temozolomide plus capecitabine, with selection guided by convenience, availability, and patient fa... |
37 | 37204633 | 2,022 | 30535553 | 2,018 | A 60-year-old woman presents with weight loss and abdominal discomfort. CT shows multiple bilobar hepatic masses and a 3.2-cm pancreatic tail lesion. Liver biopsy reveals a well-differentiated neuroendocrine tumor with synaptophysin and chromogranin positivity and a Ki-67 index of 35%. Morphology is organoid with salt-... | Initiate temozolomide plus capecitabine as preferred first-line cytotoxic chemotherapy | Consider temozolomide plus capecitabine only as an alternative to first-line etoposide–platinum | Initiate cisplatin plus etoposide as preferred first-line cytotoxic chemotherapy | Initiate 5-fluorouracil plus irinotecan as preferred first-line cytotoxic chemotherapy | I do not know the answer | A | This patient has a well-differentiated grade 3 neuroendocrine tumor (Ki-67 35%) with features distinguishing it from poorly differentiated NEC (well-differentiated morphology, intact Rb, wild-type p53). The 2022 SEOM–GETNE guideline states that for G3 NETs, adenocarcinoma-like, alkylating-based chemotherapy (e.g., temo... |
38 | 37204633 | 2,022 | 30535553 | 2,018 | A 62-year-old man presents with 3 months of progressive right-sided abdominal pain, early satiety, and 7-kg weight loss. Colonoscopy shows a 4-cm ulcerated mass in the ascending colon. Biopsy reveals poorly differentiated large-cell neuroendocrine carcinoma positive for synaptophysin and chromogranin with a Ki-67 index... | Irinotecan plus cisplatin | Cisplatin or carboplatin plus etoposide | Temozolomide plus capecitabine | FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) | I do not know the answer | A | The 2022 SEOM–GETNE guideline for metastatic extrapulmonary neuroendocrine carcinomas recommends a two-drug platinum regimen as initial therapy and explicitly adds irinotecan plus cisplatin as an acceptable first-line option, alongside cisplatin/carboplatin plus etoposide. Earlier guidance (2019) endorsed platinum–etop... |
39 | 37540408 | 2,022 | 29086250 | 2,017 | A 62-year-old man with IDH–wildtype glioblastoma underwent gross total resection followed by external-beam radiotherapy with concomitant and adjuvant temozolomide. Nine months after completing adjuvant therapy, he reports worsening left arm weakness. MRI shows new nodular, contrast-enhancing lesions both adjacent to th... | Initiate lomustine (CCNU) monotherapy | Refer for clinical trial enrollment as the preferred management approach | Initiate bevacizumab plus irinotecan combination therapy | Initiate temozolomide rechallenge | I do not know the answer | A | SEOM–GEINO 2022 designates lomustine (CCNU) as the most widely accepted standard systemic therapy for recurrent glioblastoma, with other nitrosoureas also having activity (Level II, Grade B). Earlier guidance (2018) emphasized that no standard approach existed and prioritized clinical trial enrollment, with agents such... |
40 | 37129716 | 2,022 | 25193432 | 2,013 | A 63-year-old woman underwent R0 resection of a 7.5-cm jejunal gastrointestinal stromal tumor (GIST) with a mitotic index of 8 per 50 high-power fields. There was no tumor rupture. Staging CT shows no metastatic disease. The multidisciplinary team is meeting to decide on adjuvant therapy and asks which risk-stratificat... | Apply the Joensuu-modified NIH criteria to assign relapse risk and guide the indication for adjuvant imatinib | Apply the Miettinen (AFIP) classification to assign relapse risk and guide the indication for adjuvant imatinib | Use the AJCC 8th edition TNM stage alone to determine the need for adjuvant imatinib | Use a Memorial Sloan Kettering (MSKCC) recurrence nomogram to select candidates for adjuvant imatinib | I do not know the answer | A | SEOM-GEIS 2022 recommends using the NIH modified (Joensuu) criteria to determine relapse risk and guide the indication for adjuvant imatinib because contemporary adjuvant trials were based on these criteria. Earlier guidance (2014) favored the Miettinen/AFIP classification. AJCC TNM stage alone and MSKCC nomograms are ... |
41 | 37129716 | 2,022 | 25193432 | 2,013 | A 60-year-old man presents 4 weeks after complete resection of a 7-cm jejunal gastrointestinal stromal tumor (GIST). Pathology shows a high mitotic index (10 mitoses per 50 high-power fields) and negative margins without tumor rupture. Staging CT demonstrates no metastatic disease. Molecular testing confirms a KIT exon... | Initiate imatinib 400 mg orally once daily | Defer adjuvant imatinib and pursue surveillance or clinical trial enrollment because benefit with 400 mg is uncertain in exon 9–mutant tumors | Initiate imatinib 800 mg orally once daily in the adjuvant setting based on metastatic exon 9 data | Initiate adjuvant sunitinib using a 4-weeks-on/2-weeks-off schedule | I do not know the answer | A | SEOM/GEIS 2022 explicitly states that imatinib 400 mg once daily is acceptable for adjuvant treatment of KIT exon 9–mutant GIST, based on limited evidence suggesting benefit at this dose. Earlier guidance highlighted lack of consensus for 400 mg and did not support 800 mg in the adjuvant setting, as higher dosing was e... |
42 | 37129716 | 2,022 | 25193432 | 2,013 | A 64-year-old man with metastatic gastrointestinal stromal tumor (GIST) harboring a KIT exon 11 mutation presents after radiographic progression on sequential tyrosine kinase inhibitors: imatinib (including dose escalation), sunitinib, and regorafenib. He has ECOG performance status 1, controlled hypertension, and norm... | Start ripretinib 150 mg once daily | Refer for enrollment in an investigational clinical trial as the preferred strategy | Start avapritinib 300 mg once daily | Rechallenge with high-dose imatinib at 800 mg daily | I do not know the answer | A | The 2022 SEOM–GEIS guideline designates ripretinib 150 mg once daily as the standard fourth-line therapy for advanced/metastatic GIST after progression on imatinib, sunitinib, and regorafenib, reflecting regulatory approval (EMA 2021) and efficacy demonstrated in the INVICTUS trial (improved progression-free survival a... |
43 | 37129716 | 2,022 | 27896638 | 2,016 | A 62-year-old woman underwent complete resection of a 6.2-cm gastric submucosal tumor discovered during evaluation for early satiety. Pathology confirms gastrointestinal stromal tumor (GIST) with 3 mitoses per 50 high-power fields, negative margins, and no tumor rupture. Contrast-enhanced CT of chest/abdomen/pelvis sho... | Initiate adjuvant imatinib therapy after recovery from surgery | Observe without adjuvant therapy and schedule surveillance imaging | Defer any systemic therapy until radiographic recurrence is documented | Initiate adjuvant sunitinib therapy after recovery from surgery | I do not know the answer | A | This patient has an intermediate-risk gastric GIST (size ~6 cm, low mitotic index, no rupture) with a KIT exon 11 deletion involving codons 557/558, a genotype associated with higher relapse risk. The 2022 SEOM–GEIS guideline states that clinicians might consider adjuvant imatinib for intermediate-risk patients with KI... |
44 | 37129716 | 2,022 | 27896638 | 2,016 | A 63-year-old man underwent complete resection of a 5.5-cm jejunal gastrointestinal stromal tumor (GIST) with 8 mitoses per 50 high-power fields. Margins are negative, there was no tumor rupture, and staging CT shows no metastases. Molecular testing reveals a KIT exon 11 mutation. He is recovering well and asks whether... | Use the NIH modified risk criteria (Joensuu) to assign relapse risk and guide adjuvant imatinib decisions | Use the AFIP (Miettinen–Lasota) criteria to assign relapse risk and guide adjuvant imatinib decisions | Use AJCC TNM pathologic stage alone to determine the need for adjuvant imatinib | Use a single-institution nomogram or heat-map prediction tool exclusively to guide adjuvant imatinib decisions | I do not know the answer | A | SEOM–GEIS 2022 recommends using the NIH modified risk criteria to assign relapse risk because this system underpins the indication for adjuvant imatinib in contemporary clinical trials. Earlier guidance emphasized AFIP or modified consensus criteria, but the updated recommendation preferentially adopts NIH modified for... |
45 | 37129716 | 2,022 | 27896638 | 2,016 | A 64-year-old man with metastatic gastrointestinal stromal tumor (GIST) originating in the small intestine presents for restaging after radiographic progression on regorafenib. His disease initially harbored a KIT exon 11 mutation and was PDGFRA D842V–negative. He previously received imatinib with dose escalation at pr... | Initiate ripretinib 150 mg orally once daily | Refer for clinical trial enrollment with imatinib rechallenge or pazopanib | Initiate avapritinib 300 mg orally once daily | Initiate cabozantinib 60 mg orally once daily | I do not know the answer | A | Per the 2022 SEOM–GEIS guideline, ripretinib 150 mg daily is established as the standard fourth-line therapy for advanced/metastatic GIST after progression on imatinib, sunitinib, and regorafenib. Earlier guidance (2016) recommended clinical trial enrollment after regorafenib failure, with options such as imatinib rech... |
46 | 37129716 | 2,022 | 27896638 | 2,016 | A 62-year-old woman presents with 3 months of early satiety and unintentional weight loss. CT of the abdomen shows a 7-cm gastric subepithelial mass with multiple hepatic lesions consistent with metastases. Ultrasound-guided core biopsy of a liver lesion demonstrates gastrointestinal stromal tumor (DOG1-positive). Next... | Avapritinib 300 mg orally once daily | Avoid TKI therapy and refer for clinical-trial enrollment | Imatinib 400 mg orally once daily | Sunitinib 50 mg orally daily, 4 weeks on/2 weeks off | I do not know the answer | A | PDGFRA exon 18 D842V–mutant GIST is highly resistant to imatinib and other previously registered TKIs such as sunitinib and regorafenib. The 2022 SEOM/GEIS guideline recommends avapritinib 300 mg once daily for patients with PDGFRA D842V mutations regardless of treatment line, based on data demonstrating meaningful act... |
47 | 37129716 | 2,022 | 27896638 | 2,016 | A 62-year-old man completed 36 months of adjuvant imatinib after R0 resection of an 8-cm jejunal gastrointestinal stromal tumor with a high mitotic rate. Staging CT performed 4 weeks ago showed no evidence of disease. He is asymptomatic and is stopping imatinib today. He asks how closely he should be monitored now that... | Contrast-enhanced abdominal/pelvic CT every 3 months for the next 2 years after stopping imatinib; use PET/CT only to clarify indeterminate CT findings | Close clinical and imaging follow-up restricted to the first 12 months after stopping imatinib | Contrast-enhanced abdominal/pelvic CT every 6 months for the next 2 years after stopping imatinib, then annually thereafter | FDG PET/CT every 3 months for the next 2 years as the primary surveillance modality after stopping imatinib | I do not know the answer | A | Recurrence risk is highest in the period immediately after cessation of adjuvant imatinib. The SEOM-GEIS 2022 guideline recommends close follow-up for the following 2 years with CT every 3 months after stopping imatinib; PET/CT is reserved for clarifying ambiguous CT results. Earlier guidance intensified surveillance o... |
48 | 37129716 | 2,022 | 27896638 | 2,016 | A 54-year-old man is seen 4 weeks after an R0 resection of a jejunal gastrointestinal stromal tumor (GIST). Ten months earlier, he began neoadjuvant imatinib 400 mg daily for a large, initially unresectable mass. Pretreatment CT showed a 12-cm jejunal lesion without metastases. Pretreatment core biopsy confirmed GIST w... | Administer adjuvant imatinib for 36 months after surgery, using pretreatment risk factors to guide the indication | Administer adjuvant imatinib for 26 months to complete a total of 36 months including the 10 months of neoadjuvant therapy | Administer adjuvant imatinib for 12 months after surgery given the favorable postoperative mitotic index | Administer adjuvant imatinib for 24 months after surgery to balance the preoperative treatment already received | I do not know the answer | A | Preoperative risk features (large size, non-gastric location, and elevated mitotic count before therapy) indicate high recurrence risk. The SEOM–GEIS 2022 guideline specifies that, after neoadjuvant imatinib and surgery, patients who warrant adjuvant therapy should complete 3 years of adjuvant imatinib after the surgic... |
49 | 37326826 | 2,022 | 26497356 | 2,015 | A 37-year-old woman presents with a 3.4-cm palpable mass in the upper outer quadrant of the left breast. Core biopsy shows high-grade invasive ductal carcinoma that is ER-negative, PR-negative, and HER2 0 by immunohistochemistry. Fine-needle aspiration of a palpable axillary node confirms metastatic carcinoma. Staging ... | Administer an anthracycline- and taxane-based neoadjuvant regimen that includes carboplatin (eg, paclitaxel plus carboplatin followed by anthracycline/cyclophosphamide) | Administer sequential anthracyclines followed by taxanes without platinum, reserving platinum for patients with germline BRCA mutations or a strong family history of breast cancer | Avoid platinum in the neoadjuvant setting and add carboplatin only in the adjuvant setting if residual invasive disease remains after surgery | Replace anthracyclines and taxanes with neoadjuvant single-agent cisplatin because it provides comparable efficacy with less toxicity | I do not know the answer | A | The 2022 SEOM–GEICAM–SOLTI guideline states that carboplatin improves pathological complete response and event-free survival and may be considered as part of neoadjuvant chemotherapy for triple-negative breast cancer. Earlier guidance discouraged routine neoadjuvant platinum use except in BRCA-associated cases. Therefo... |
50 | 37326826 | 2,022 | 30443868 | 2,018 | A 43-year-old woman presents with a 3.5-cm, grade 3 invasive ductal carcinoma of the left breast. Core biopsy shows triple-negative disease (ER-/PR-/HER2-). Ultrasound-guided fine-needle aspiration of a palpable axillary node confirms metastatic carcinoma (cT2N1). She is otherwise healthy with no history of autoimmune ... | Administer neoadjuvant anthracycline- and taxane-based chemotherapy with pembrolizumab, followed by adjuvant pembrolizumab after surgery | Administer neoadjuvant sequential anthracycline- and taxane-based chemotherapy without immunotherapy; consider adding carboplatin | Administer neoadjuvant anthracycline- and taxane-based chemotherapy with atezolizumab only if PD-L1 positive; omit adjuvant immunotherapy | Administer neoadjuvant docetaxel–cyclophosphamide without anthracyclines; add pembrolizumab only in the adjuvant setting | I do not know the answer | A | SEOM–GEICAM–SOLTI 2022 recommends adding pembrolizumab to standard neoadjuvant chemotherapy for stage II–III TNBC irrespective of PD-L1 expression and continuing pembrolizumab after surgery, based on improved pathologic complete response and event-free survival in KEYNOTE-522. Earlier guidance (2019) recommended neoadj... |
51 | 37655207 | 2,023 | 25193432 | 2,013 | A 62-year-old man underwent complete resection of a 6-cm ileal gastrointestinal stromal tumor (GIST) discovered after anemia workup. Pathology shows a spindle-cell GIST with 8 mitoses per 50 high-power fields; margins are negative. During surgery, focal tumor capsule rupture with limited spillage was noted and irrigate... | Apply the NIH consensus–modified risk criteria incorporating site, size, mitotic index, and tumor rupture | Apply the Miettinen (AFIP) risk group classification based on site, size, and mitotic index | Use the AJCC TNM staging system for GIST to determine recurrence risk and adjuvant therapy | Use a postoperative nomogram (eg, MSKCC) to estimate recurrence risk and guide adjuvant therapy | I do not know the answer | A | GEIS 2023 recommends using the NIH consensus–modified risk criteria (Joensuu modification) for risk assessment because it is the system most widely used to support recommendations for adjuvant imatinib. Earlier guidance favored the Miettinen (AFIP) classification. AJCC TNM staging and recurrence nomograms are plausible... |
52 | 37655207 | 2,023 | 25193432 | 2,013 | A 62-year-old man presents 4 weeks after complete resection of a 6.5-cm ileal gastrointestinal stromal tumor (GIST). Pathology shows a mitotic index of 8 per 50 high-power fields with negative margins and no tumor rupture. Staging CT shows no metastatic disease. Molecular testing identifies a KIT exon 9 mutation; PDGFR... | Initiate adjuvant imatinib 400 mg daily | No adjuvant systemic therapy; observation with surveillance imaging | Initiate adjuvant imatinib 800 mg daily | Initiate adjuvant sunitinib on a 4-weeks-on/2-weeks-off schedule | I do not know the answer | A | This patient has high-risk GIST (small intestine location with size >5 cm and elevated mitotic index). The GEIS 2023 guideline states that adjuvant imatinib 400 mg daily is indicated for high-risk GIST with imatinib-sensitive mutations and is an option specifically for KIT exon 9–mutant tumors. Earlier guidance (GEIS 2... |
53 | 37701136 | 2,023 | 30948907 | 2,018 | A 62-year-old woman with a solitary 2.5-cm colorectal liver metastasis in segment II is scheduled for an elective left lateral sectionectomy (minor hepatectomy). She has no portal hypertension, a BMI of 28, and well-controlled hypertension. She asks how perioperative outcomes differ among minimally invasive options and... | Compared with laparoscopic minor hepatectomy, robotic surgery has a longer operative time but fewer overall postoperative complications; compared with open minor hepatectomy, it results in a shorter hospital stay and decreased overall morbidity; other perioperative outcomes are similar among approaches. | Compared with laparoscopic minor hepatectomy, robotic surgery has a longer operative time with similar blood loss, overall complication rate, and overall cost; advantages over the open approach have not been demonstrated. | Compared with laparoscopic minor hepatectomy, robotic surgery has a shorter operative time and fewer complications; compared with open minor hepatectomy, hospital stay and morbidity are similar. | Compared with laparoscopic minor hepatectomy, robotic surgery has a longer operative time and greater intraoperative blood loss; compared with open minor hepatectomy, hospital stay is longer without differences in morbidity. | I do not know the answer | A | The 2023 international consensus on robotic liver resection states that for minor hepatectomy, robotic liver resection is as safe and feasible as laparoscopic and open approaches. Relative to laparoscopy, robotic minor hepatectomy typically has a longer operative time but is associated with fewer overall postoperative ... |
54 | 37701136 | 2,023 | 30948907 | 2,018 | A 56-year-old woman with colorectal cancer and three right-lobe liver metastases confined to segments V–VIII is scheduled for a right hepatectomy. She has Child-Pugh class A liver function, a BMI of 27 kg/m2, and no portal hypertension. She is deciding between minimally invasive options and asks how a robotic approach ... | Compared with laparoscopic major hepatectomy, the robotic approach is associated with lower estimated blood loss and a lower conversion rate; compared with open surgery, it yields lower blood loss and a shorter hospital stay but a longer operation time. | Compared with laparoscopic major hepatectomy, the robotic approach has a longer operation time, with similar blood loss, complication rates, and overall cost; there are no clear differences versus open surgery. | Compared with laparoscopic major hepatectomy, the robotic approach has higher estimated blood loss but shorter operation time and lower overall cost; compared with open surgery, outcomes are similar. | Compared with both laparoscopic and open major hepatectomy, the robotic approach yields lower estimated blood loss and shorter hospital stay with shorter operation time than both approaches. | I do not know the answer | A | The 2023 international consensus on robotic liver resection states that for major hepatectomy, robotic surgery results in less estimated blood loss and lower conversion rates than laparoscopy and, compared with open surgery, has less blood loss and a shorter length of stay but a longer operative time. Earlier guidance ... |
55 | 37705676 | 2,023 | 26120552 | 2,015 | A 44-year-old woman is referred to an allergy clinic after developing generalized urticaria, angioedema, and hypotension within 10 minutes of receiving intravenous ceftriaxone for pyelonephritis 6 months ago. She now requires ceftriaxone for culture-proven osteomyelitis. You plan to perform skin prick and intradermal t... | Prepare ceftriaxone at 20 mg/mL for both skin prick and intradermal testing | Prepare ceftriaxone at 2 mg/mL for both skin prick and intradermal testing | Prepare ceftriaxone at 2 mg/mL for skin prick testing and 0.2 mg/mL for intradermal testing | Prepare ceftriaxone undiluted for skin prick testing and 10 mg/mL for intradermal testing | I do not know the answer | A | The 2023 joint German/Austrian guideline increased the recommended non-irritant concentrations for cephalosporin skin testing to 20 mg/mL for both skin prick and intradermal testing to improve sensitivity while remaining non-irritant, with a stated exception that cefepime should be tested at 2 mg/mL. Earlier recommenda... |
56 | 37705676 | 2,023 | 26120552 | 2,015 | A 39-year-old woman develops diffuse urticaria, throat tightness, and hypotension 15 minutes after eating a restaurant meal. She receives intramuscular epinephrine and improves. A serum tryptase level drawn 90 minutes after symptom onset is 8.0 ng/mL. A baseline tryptase obtained 72 hours later is 6.0 ng/mL. She asks w... | Interpret this as not confirming mast cell activation because the increase does not meet the “baseline × 1.2 + 2 ng/mL” (20% + 2) criterion; clinical diagnosis should integrate history and response to treatment. | Interpret this as confirming mast cell activation because the post-reaction tryptase exceeds the baseline; paired sampling without a defined numeric delta is sufficient for interpretation. | Interpret this as excluding mast cell activation because the post-reaction tryptase does not exceed the laboratory upper limit of normal (eg, 11.4 ng/mL). | Interpret this after obtaining another acute sample 6–8 hours after onset to capture the expected peak tryptase before comparing with baseline. | I do not know the answer | A | Per the 2023 DGAKI/DDG/ÄDA and collaborating societies guideline, mast cell activation is supported when the post-reaction tryptase is at least 2 ng/mL plus 20% above baseline (“20% + 2”). With a baseline of 6.0 ng/mL, the threshold is 6.0 × 1.2 + 2 = 9.2 ng/mL; the post-reaction value of 8.0 ng/mL does not meet this. ... |
57 | 37795431 | 2,023 | 29568597 | 2,015 | A 26-year-old man presents 5 days after condom failure during receptive anal intercourse with a partner who later disclosed living with HIV; the partner’s antiretroviral therapy status and viral load are unknown. The patient reports brief rectal bleeding at the time from a known fissure. He is asymptomatic today. A rap... | Do not initiate PEP because exposure occurred >72 hours ago; obtain baseline testing, provide risk-reduction counseling, arrange follow-up testing, and discuss transition to HIV PrEP | Initiate a full 28-day, three-drug PEP regimen now given the high-risk exposure at 5 days, after consulting an experienced HIV clinician | Delay any intervention until the partner’s viral load is confirmed; start PEP only if the viral load is detectable | Initiate a shortened 7-day PEP course because of the delayed presentation and high-risk features | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guidance specifies that PEP should be started as soon as possible and no later than 72 hours after exposure. For presentations beyond 72 hours—even with high-risk features—PEP is not recommended; instead, obtain baseline HIV testing, counsel on prevention, arrange follow... |
58 | 37795427 | 2,023 | 29568644 | 2,017 | A 36-year-old woman with HIV has been on first-line efavirenz/tenofovir disoproxil fumarate/lamivudine for 3 years. She now has confirmed virologic failure with two HIV RNA levels >10,000 copies/mL over the past 3 months. Pharmacy refill records and directly observed pill counts over the last 2 months indicate good adh... | Tenofovir disoproxil fumarate/lamivudine/dolutegravir once daily (TLD) | Zidovudine/lamivudine plus ritonavir-boosted lopinavir twice daily | Zidovudine/lamivudine/dolutegravir once daily | Bictegravir/tenofovir alafenamide/emtricitabine once daily | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline endorses recycling both tenofovir and lamivudine with dolutegravir (TLD) as the second-line regimen of choice after failure of an NNRTI-based first-line regimen, regardless of viral load or NRTI resistance (supported by trials such as NADIA). Earlier guidance (... |
59 | 37795427 | 2,023 | 29568644 | 2,017 | A 42-year-old woman with HIV-1 infection has been on first-line tenofovir disoproxil fumarate (TDF), lamivudine (3TC), and efavirenz for 3 years. Her most recent HIV-1 RNA level is 145,000 copies/mL, and CD4 count is 180 cells/µL. Creatinine is 0.8 mg/dL, hemoglobin is 13.2 g/dL, and hepatitis B surface antigen is nega... | Tenofovir disoproxil fumarate plus lamivudine | Zidovudine plus lamivudine | Abacavir plus lamivudine | Tenofovir alafenamide plus emtricitabine | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline recommends recycling tenofovir (TDF) between first- and second-line regimens instead of switching to zidovudine (AZT), based on randomized trial data (e.g., NADIA) showing non-inferior virologic suppression at 48 weeks and superior suppression by 96 weeks when ... |
60 | 37795427 | 2,023 | 29568644 | 2,017 | A 45-year-old man with HIV presents after two consecutive viral load measurements of 25,000 and 32,000 copies/mL despite 6 months of enhanced adherence counseling while taking tenofovir, lamivudine, and efavirenz. He has never received a protease inhibitor. He denies cough, night sweats, or weight loss and is not recei... | Darunavir/ritonavir–boosted protease inhibitor regimen | Atazanavir/ritonavir–boosted protease inhibitor regimen | Lopinavir/ritonavir–boosted protease inhibitor regimen | Fosamprenavir/ritonavir–boosted protease inhibitor regimen | I do not know the answer | A | The SAHCS 2023 guideline emphasizes selecting darunavir/ritonavir as the favored protease inhibitor for second-line therapy, with atazanavir/ritonavir as an alternative, and recommends against lopinavir in almost all circumstances due to inferior tolerability, twice-daily dosing, and adverse lipid effects. Lopinavir/ri... |
61 | 37795427 | 2,023 | 29568644 | 2,017 | A 34-year-old man in South Africa is newly diagnosed with HIV infection during routine screening. He is antiretroviral therapy–naive and has no significant medical history. He takes no medications. Physical examination is unremarkable. Laboratory studies show HIV-1 RNA of 85,000 copies/mL and CD4 count of 310 cells/µL.... | Tenofovir disoproxil fumarate/lamivudine/dolutegravir fixed-dose combination once daily | Tenofovir disoproxil fumarate/emtricitabine/efavirenz fixed-dose combination once daily | Tenofovir disoproxil fumarate/emtricitabine/rilpivirine fixed-dose combination once daily | Abacavir/lamivudine/dolutegravir fixed-dose combination once daily | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline consolidates first-line antiretroviral therapy around a dolutegravir-based fixed-dose combination of tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) as the regimen of choice for most people living with HIV. This patient has no contraindications to T... |
62 | 37795427 | 2,023 | 29568644 | 2,017 | A 34-year-old man with HIV returns to clinic after stopping antiretroviral therapy 9 months ago due to loss to follow-up. Before defaulting, he had achieved viral suppression on a fixed-dose combination of tenofovir disoproxil fumarate/emtricitabine/efavirenz. He reports no prior treatment-limiting adverse effects and ... | Start once-daily tenofovir disoproxil fumarate/lamivudine/dolutegravir fixed-dose combination (TLD) | Restart his previous once-daily tenofovir disoproxil fumarate/emtricitabine/efavirenz fixed-dose combination | Start tenofovir disoproxil fumarate/lamivudine plus atazanavir/ritonavir as a boosted protease inhibitor–based regimen | Start dual therapy with dolutegravir plus lamivudine without tenofovir | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline advises that most patients who return to care after stopping ART can be re-initiated on TLD (tenofovir disoproxil fumarate/lamivudine/dolutegravir), barring contraindications or need for third-line therapy. Earlier guidance (2017) recommended restarting the sam... |
63 | 37795427 | 2,023 | 29568644 | 2,017 | A 34-year-old man in South Africa presents to initiate antiretroviral therapy 2 weeks after an HIV diagnosis. He feels well and denies cough, weight loss, fevers, or night sweats. He is afebrile with normal vital signs and a BMI of 19 kg/m^2. CD4+ T-cell count is 150 cells/µL, and HIV RNA is 520,000 copies/mL. He is ab... | Obtain a sputum nucleic acid amplification test (e.g., Xpert MTB/RIF Ultra) now despite a negative symptom screen and send a urine lipoarabinomannan (LAM) assay based on expanded indications | Use a four-symptom screen alone and order sputum Xpert and TB culture only if symptoms are present; send urine LAM only if CD4+ <100 cells/µL | Perform a chest radiograph as the sole screening test and forgo sputum molecular testing in the absence of symptoms | Send three serial acid-fast bacilli (AFB) smears without NAAT and defer urine LAM testing in ambulatory patients | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline broadened baseline TB screening at ART initiation by recommending consideration of sputum NAAT (e.g., Xpert MTB/RIF Ultra) even when the four-symptom screen is negative, and it expanded the indications for urine LAM beyond the earlier restrictive threshold. In ... |
64 | 37795427 | 2,023 | 29568644 | 2,017 | A 28-year-old man newly diagnosed with HIV presents to initiate antiretroviral therapy. He is sexually active with women and reports inconsistent condom use but denies dysuria, urethral discharge, testicular pain, or genital ulcers. Physical examination is unremarkable. Baseline HIV labs have been obtained. According t... | Syphilis serology plus nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae | Syphilis serology only; test for Chlamydia trachomatis and Neisseria gonorrhoeae only if symptoms develop | Defer all STI screening until 3 months after ART initiation to avoid overtesting in asymptomatic patients | Herpes simplex virus type 2 serology and Trichomonas vaginalis wet mount; omit chlamydia and gonorrhoea testing in the absence of symptoms | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society update recommends including syphilis serology and NAAT for Chlamydia trachomatis and Neisseria gonorrhoeae at baseline even when asymptomatic. Earlier guidance (2017) recommended only syphilis serology without routine asymptomatic CT/NG testing. Deferring screening or su... |
65 | 37795427 | 2,023 | 33101723 | 2,020 | A 37-year-old woman has been on first-line antiretroviral therapy with tenofovir disoproxil fumarate (TDF), lamivudine (3TC), and efavirenz for 3 years. She presents for evaluation after two HIV-1 RNA levels of 42,000 and 38,000 copies/mL obtained 3 months apart despite documented adherence counseling and pharmacy refi... | Switch to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) once daily, recycling TDF and 3TC with dolutegravir | Switch to zidovudine/lamivudine plus dolutegravir (AZT + 3TC + DTG), replacing TDF with AZT to ensure a fully active NRTI | Switch to tenofovir alafenamide/emtricitabine plus boosted atazanavir (TAF/FTC + atazanavir/ritonavir) | Switch to boosted lopinavir plus zidovudine/lamivudine (lopinavir/ritonavir + AZT + 3TC) | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline recommends recycling the NRTI backbone and initiating TLD (tenofovir disoproxil fumarate/lamivudine/dolutegravir) as the preferred second-line regimen after failure of an NNRTI-based first-line regimen containing TDF + 3TC/FTC, even when NRTI resistance (eg, K6... |
66 | 37795427 | 2,023 | 33101723 | 2,020 | A 39-year-old man with HIV presents for routine follow-up. He has been on tenofovir disoproxil fumarate/lamivudine plus lopinavir/ritonavir for 18 months after failure of an NNRTI-based first-line regimen. He reports bothersome diarrhea and has developed hypertriglyceridemia. HIV-1 RNA is undetectable and CD4 count is ... | Substitute darunavir/ritonavir for lopinavir/ritonavir while maintaining the current NRTI backbone | Continue lopinavir/ritonavir as the protease inhibitor component with no change | Substitute atazanavir/ritonavir for lopinavir/ritonavir while continuing daily omeprazole | Increase lopinavir/ritonavir to double the standard dose to improve antiretroviral coverage | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline recommends avoiding lopinavir/ritonavir in almost all circumstances; its sole recommended use is when a patient requires a protease inhibitor together with rifampicin-based tuberculosis therapy, where double-dosed lopinavir/ritonavir remains the only PI option.... |
67 | 37795427 | 2,023 | 33101723 | 2,020 | A 34-year-old man with HIV returns to clinic after a 9-month interruption of antiretroviral therapy. He previously received tenofovir disoproxil fumarate/emtricitabine/efavirenz but had multiple episodes of disengagement from care and poor adherence. He has never had documented virologic failure on an integrase inhibit... | Tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) | Zidovudine/lamivudine/dolutegravir | Bictegravir/tenofovir alafenamide/emtricitabine | Dolutegravir/lamivudine dual therapy | I do not know the answer | A | The 2023 Southern African HIV Clinicians Society guideline recommends that most adults who return to care after stopping ART can be re-initiated on tenofovir/lamivudine/dolutegravir (TLD), provided there is no contraindication to these drugs and a more robust third-line regimen is not required. This represents a shift ... |
68 | 37793979 | 2,023 | 34352984 | 2,021 | A 36-year-old Korean man with no significant past medical history presents for a routine health maintenance visit. He is not taking any medications. He has no family history of diabetes, does not smoke, and exercises regularly. BMI is 23 kg/m2 and blood pressure is 118/72 mm Hg. He is asymptomatic. He asks whether he s... | Initiate annual diabetes screening now using one of the recommended tests (fasting plasma glucose, HbA1c, or 2-hour plasma glucose during a 75-g oral glucose tolerance test). | Defer diabetes screening until age 40, then begin annual screening using fasting plasma glucose, HbA1c, or a 2-hour 75-g oral glucose tolerance test. | Do not screen unless additional risk factors (eg, BMI ≥25 kg/m2 or family history) are present; if screening is performed, repeat every 3 years. | Screen now using a random (nonfasting) plasma glucose test and repeat annually. | I do not know the answer | A | The 2023 Korean Diabetes Association guideline recommends annual diabetes screening for all adults aged ≥35 years and for adults aged ≥19 years with risk factors, using fasting plasma glucose, HbA1c, or 2-hour plasma glucose during a 75-g OGTT. This asymptomatic 36-year-old without risk factors meets the age criterion ... |
69 | 37793979 | 2,023 | 34352984 | 2,021 | A 56-year-old woman with a 9-year history of type 2 diabetes mellitus presents for follow-up. Despite adherence to maximized metformin (1,000 mg twice daily), an SGLT2 inhibitor, and a sulfonylurea for the past 6 months, her glycated hemoglobin remains 9.1%. She reports no polyuria, polydipsia, or weight loss. She has ... | Initiate a glucagon-like peptide-1 receptor agonist as the first injectable therapy | Initiate basal insulin as the first injectable option, considered equivalent to GLP-1 receptor agonists and premixed insulin | Initiate twice-daily premixed insulin as the first injectable therapy | Initiate basal–bolus insulin with rapid-acting insulin before meals plus a basal insulin at bedtime | I do not know the answer | A | The 2023 Korean Diabetes Association guideline recommends that when injectable-based combination therapy is needed after inadequate control on oral agents, GLP-1 receptor agonists are preferred over basal insulin. This preference reflects evidence for effective glucose lowering with reduced risk of hypoglycemia and fav... |
70 | 37793979 | 2,023 | 34352984 | 2,021 | A 60-year-old woman with a 12-year history of type 2 diabetes mellitus presents for lipid management 3 months after an ischemic stroke treated with carotid stenting. She has been adherent to atorvastatin 40 mg nightly without adverse effects. Before starting statin therapy, her LDL-C was 150 mg/dL. Her current fasting ... | LDL-C <55 mg/dL with at least a 50% reduction from baseline | LDL-C <70 mg/dL without a specified percent reduction | LDL-C <70 mg/dL with at least a 30% reduction from baseline | LDL-C <100 mg/dL with at least a 50% reduction from baseline | I do not know the answer | A | The 2023 Korean Diabetes Association guideline recommends that patients with established cardiovascular disease achieve LDL-C <55 mg/dL and at least a 50% reduction from baseline. Earlier guidance targeted <70 mg/dL for very-high-risk patients with diabetes and CVD. This patient’s current LDL-C (68 mg/dL) meets the old... |
71 | 37793979 | 2,023 | 34352984 | 2,021 | A 62-year-old man with type 2 diabetes mellitus and ischemic cardiomyopathy presents for follow-up. He has New York Heart Association class II symptoms and is on lisinopril, carvedilol, spironolactone, and furosemide. His diabetes regimen is metformin 1,000 mg twice daily. Blood pressure is 118/70 mm Hg. Laboratory stu... | Initiate an SGLT2 inhibitor with proven heart failure benefit now and plan to continue it long-term barring contraindication, irrespective of HbA1c | Make no change now because HbA1c is at goal; if intensification is needed later, prioritize adding an SGLT2 inhibitor due to heart failure | Initiate a GLP-1 receptor agonist now for cardiovascular protection and defer SGLT2 inhibitor therapy until HbA1c rises above target | Make no changes to antihyperglycemic therapy and reassess glycemic control and heart failure status in 3 months | I do not know the answer | A | The 2023 Korean Diabetes Association guideline directs that SGLT2 inhibitors with proven heart failure benefits should be used first in patients with heart failure regardless of HbA1c and maintained if tolerated. This patient has HFrEF and adequate renal function for SGLT2 initiation, so adding an SGLT2 inhibitor now i... |
72 | 37708093 | 2,023 | 16421500 | 2,005 | A 38-year-old board-certified clinical radiation oncology physicist works at a community hospital that is expanding stereotactic services. The hospital’s quality office plans to arrange an external peer review of physics operations before the service launches. The physicist did not request the review and asks how to pr... | Proceed with an employer-initiated peer review provided safeguards are in place: the incumbent confirms the reviewer’s experience overlaps the clinical scope and manages conflicts; the employer verifies the reviewer is a QMP and empowers independent professional judgment; all parties review peer-review guidance; the re... | Decline an employer-initiated peer review and proceed only if the incumbent voluntarily initiates and coordinates the review as a peer-to-peer process that is not used by the employer as an employee evaluation instrument. | Proceed with an employer-initiated review but withhold reviewer compensation to avoid payer–payee bias, route all communications solely through the employer, and provide the report to the employer without direct distribution to the incumbent. | Allow the employer to select an experienced dosimetrist or service engineer as a cost-saving reviewer and provide the final report to the incumbent only after the employer has reviewed and approved it. | I do not know the answer | A | The 2023 AAPM Medical Physics Practice Guideline on clinical physics peer review allows employer-initiated reviews when specific safeguards ensure independence and transparency: incumbent confirmation of reviewer scope overlap and conflict management, employer verification that the reviewer is a QMP and empowerment of ... |
73 | 37708093 | 2,023 | 16421500 | 2,005 | A 47-year-old board-certified therapeutic medical physicist works in a hospital radiation oncology department that completed ASTRO’s APEx practice accreditation 2 months ago and an on-site Radiation Physics Center (RPC) audit last year. The department chair asks whether these recent reviews can be used to meet the phys... | Conduct a physicist peer review, using the recent APEx/RPC reports to inform and streamline the process but not as a complete substitute | Accept the recent APEx or RPC review as fully satisfying the peer review requirement and forgo an additional physicist peer review | Replace the peer review with an internal self-assessment by the incumbent physicist using APEx/ROPA checklists | Defer the physicist peer review until the next accreditation cycle because repeating review within 3 years provides minimal additional value | I do not know the answer | A | AAPM’s 2023 guidance states that for accredited clinical programs, the most recent accreditation review (e.g., ASTRO APEx, ACR ROPA) may inform and streamline the physicist peer review process but is not a complete substitute; a peer review should still be performed. Earlier guidance (2005 TG-103) allowed recent ACR/AC... |
74 | 37708093 | 2,023 | 16421500 | 2,005 | A medical physicist reviewer completes an on‑site peer review of a community hospital’s radiation oncology physics program. After the exit discussion, the hospital administrator emails requesting a written report of the review. The incumbent physicist is copied on the email thread. According to the American Association... | Provide an executive‑summary stakeholder report directly to the administrator upon request and provide a copy of this stakeholder report to the incumbent physicist; label all documents “Privileged and Confidential Peer Review.” | Send the full written report only to the incumbent physicist and advise the incumbent to share a summary with the administrator and medical director; label the document “Privileged and Confidential Peer Review.” | Provide the full detailed peer review report directly to the administrator and medical director without sharing it with the incumbent physicist to avoid conflicts of interest; a confidentiality label is not necessary. | Decline to provide any written report to stakeholders and instruct that only the incumbent physicist may communicate findings verbally to administration to preserve confidentiality. | I do not know the answer | A | AAPM (2023) specifies that the reviewer must provide a written report to the incumbent physicist and, if stakeholders request a report, provide an executive‑summary stakeholder report and also give a copy to the incumbent; all reports should be labeled “Privileged and Confidential Peer Review.” Earlier guidance emphasi... |
75 | 37708093 | 2,023 | 16421500 | 2,005 | A radiation oncology department undergoes an external medical physics peer review. During on-site observation, the reviewer notes that several frail patients require manual two-person transfers onto the treatment couch because the department lacks mechanical transfer aids and has no formal policy or training program fo... | Classify as a major recommendation because it represents a scenario that could potentially result in harm to patients or staff | Classify as a major recommendation only if analysis shows it could lead to a delivered dose error greater than 5% | Classify as a minor recommendation because it does not affect regulatory compliance or generally accepted dose-delivery guidelines | Do not include the issue in the recommendations and consider it outside the scope of the physics peer review | I do not know the answer | A | The 2023 AAPM peer review guidance defines major recommendations as items that do not meet applicable regulations or minimum practice guidelines, or scenarios that could potentially result in harm to patients or staff; references to national guidance (e.g., AAPM MPPGs, ACR Technical Standards) should be included when a... |
76 | 37804479 | 2,022 | 32240526 | 2,018 | A 39-year-old woman presents with progressive low back pain and weight loss. She reports regular monthly menses. Examination is unremarkable other than mild lumbar tenderness. Imaging reveals multiple sclerotic lesions in the lumbar spine and pelvis without visceral disease. Core biopsy of a bone lesion shows invasive ... | Ovarian function suppression (e.g., goserelin) plus a CDK4/6 inhibitor (e.g., ribociclib) plus a nonsteroidal aromatase inhibitor (e.g., letrozole) | Ovarian function suppression plus tamoxifen | Ovarian function suppression plus palbociclib plus fulvestrant | Tamoxifen monotherapy without ovarian function suppression | I do not know the answer | A | The 2022 Japanese Breast Cancer Society guideline recommends ovarian function suppression combined with a CDK4/6 inhibitor and a nonsteroidal aromatase inhibitor as first-line endocrine therapy for premenopausal patients with HR-positive, HER2-negative metastatic breast cancer, reflecting data such as MONALEESA-7 showi... |
77 | 37804479 | 2,022 | 32240526 | 2,018 | A 66-year-old postmenopausal woman presents with back pain and an incidentally noted right breast mass. Core biopsy of the breast lesion reveals invasive ductal carcinoma that is estrogen receptor–positive (90%), progesterone receptor–positive (40%), and HER2-negative (IHC 0). Staging PET-CT demonstrates multiple hyper... | Letrozole plus a CDK4/6 inhibitor | Anastrozole alone | Exemestane plus everolimus | Tamoxifen alone | I do not know the answer | A | The 2022 Japanese Breast Cancer Society guideline strongly recommends combining a nonsteroidal aromatase inhibitor (e.g., letrozole or anastrozole) with a CDK4/6 inhibitor as first-line endocrine therapy for postmenopausal patients with HR-positive, HER2-negative metastatic breast cancer, reflecting superior efficacy o... |
78 | 37804479 | 2,022 | 32240526 | 2,018 | A 56-year-old woman presents with newly diagnosed de novo metastatic breast cancer involving the liver and lymph nodes. Core biopsy of the breast mass shows invasive ductal carcinoma that is estrogen receptor–negative, progesterone receptor–negative, and HER2 IHC 3+ with confirmatory amplification on in situ hybridizat... | Initiate trastuzumab plus pertuzumab plus a taxane as first-line therapy | Initiate trastuzumab emtansine as first-line therapy | Initiate trastuzumab plus a taxane without pertuzumab as first-line therapy | Initiate tucatinib, trastuzumab, and capecitabine as first-line therapy | I do not know the answer | A | The 2022 Japanese Breast Cancer Society guideline weakly does not recommend trastuzumab emtansine (T-DM1) as first-line therapy for HER2-positive metastatic breast cancer, reflecting evidence that T-DM1 was not superior to trastuzumab-based chemotherapy in first line (eg, MARIANNE) and the established overall survival ... |
79 | 37793084 | 2,023 | 28548315 | 2,017 | A 68-year-old man with intermediate-risk prostate cancer begins intensity-modulated radiotherapy on a linear accelerator at a community cancer center. An in vivo portal dosimetry check on the first fraction shows a 2% deviation from planned dose at isocenter, within the department’s action threshold. The lead clinical ... | Use the site’s well‑commissioned treatment planning system (TPS) beam models and TPS calculations as the primary reference dataset for all modeled dosimetric parameters | Use the site’s original linac commissioning measurement dataset as the primary reference, with an annual verification that it agrees with the TPS to maintain linkage | Use the vendor’s golden beam data as the primary reference for all beams and energies without additional site-specific validation | Use the department’s annual absolute dose calibration measurements (e.g., TG‑51 dose to water) as the primary reference for all routine dosimetric tests | I do not know the answer | A | AAPM’s 2023 Medical Physics Practice Guideline on linear accelerator performance tests designates the well‑commissioned clinical TPS beam models (and by extension TPS calculations) as the Primary Reference Dataset for ongoing comparisons of modeled dosimetric parameters, because clinical treatments are based on TPS dos... |
80 | 37793084 | 2,023 | 28548315 | 2,017 | A 68-year-old man with intermediate-risk prostate cancer is scheduled to begin external-beam radiotherapy at a community center that performs annual quality assurance on its linear accelerator this week. The medical physicist measures photon output at multiple gantry angles using a solid phantom and a Farmer chamber. T... | Require outputs at all gantry angles within 1% of the IEC 0° output, allow up to 2% at IEC 180° if a gantry mount is unavailable, and omit electron head-down measurements if electrons are not clinically used near 180° | Require outputs at all measured gantry angles within 2% of the IEC 0° output for both photons and electrons, with measurements performed at head-up and head-down angles regardless of clinical use | Require outputs within 1% of each angle’s baseline (rather than IEC 0°) and measure only the clinically used angles for both photons and electrons | Accept up to 2% deviation at all angles and up to 3% at IEC 180° due to gravitational effects; perform electron measurements at head-down only if the couch and immobilization allow, irrespective of clinical use | I do not know the answer | A | The 2023 AAPM guidance tightens the annual action limit for photon and electron output constancy versus gantry angle to 1% relative to the IEC 0° output at most angles, with a specific allowance of up to 2% at IEC 180° when a gantry-mounted setup is not available. It also clarifies that electrons need not be tested at ... |
81 | 37793084 | 2,023 | 28548315 | 2,017 | A 45-year-old lead medical physicist is performing the annual linear accelerator QA for photon and electron off-axis factors (OAF) versus gantry angle. Because a 2D detector array is not available, a single-point ion chamber measurement is used 5 cm off-axis relative to the IEC gantry 0° baseline. For a 6 MV photon bea... | Investigate and repeat/correct the 90° photon measurement that exceeds a 1% action limit; accept the 180° photon result up to 2% without an array; and do not add electron head-down testing because those angles are not used clinically | Accept all photon results as within a 2% tolerance at all gantry angles using single-point measurements, and consider the annual test satisfactory without further action | Require all photon angles, including 180°, to meet a 1% limit and repeat the 180° measurement until ≤1%; also add electron head-down testing regardless of clinical use | Defer action and repeat the entire test only with a 2D array, as single-point measurements are not acceptable for this evaluation | I do not know the answer | A | The 2023 AAPM guidance tightens the action limit for annual photon and electron OAF versus gantry angle testing to 1% relative to IEC gantry 0° for most angles, while allowing up to 2% at gantry 180° if an array is not available due to practical difficulty at that orientation. In addition, electrons need not be tested ... |
82 | 37793084 | 2,023 | 28548315 | 2,017 | A 67-year-old woman is scheduled to begin whole-breast irradiation today using 6-MV tangents that require a 60° electronic (collimator-shaped) wedge. As part of the morning daily QA, the therapist measures the steepest electronic wedge setting using a 10 × 10 cm field in solid water. The annual device baseline wedge fa... | Withhold wedge-based treatments and investigate/adjust the system, because the collimator-shaped wedge output deviates by more than 2% from the annually established device baseline. | Proceed with wedge-based treatments, because a deviation up to 3% from baseline is acceptable on days the collimator-shaped wedge is used. | Proceed after only confirming functional wedge motion without an output measurement, because daily functional verification is sufficient for collimator-shaped wedges. | Proceed if the measurement is within 2% of yesterday’s value, regardless of agreement with the annually established device baseline. | I do not know the answer | A | The 2023 AAPM guidance tightens the daily output constancy action limit for collimator-shaped (electronic) wedges to 2% relative to the annually established device baseline for the steepest wedge angle; values outside this limit require investigation and correction before using wedge-based treatments. Earlier guidance ... |
83 | 37793084 | 2,023 | 28548315 | 2,017 | A 68-year-old man is scheduled to start head-and-neck IMRT tomorrow. During routine monthly linear accelerator QA, a medical physicist measures gantry and collimator angle indicator accuracy at the cardinal angles using a calibrated digital inclinometer. The differences between the mechanical level and the readouts are... | Fail the monthly test because the 0.6°–0.7° discrepancies exceed the 0.5° action limit; initiate adjustment/calibration and verify the separate imaging gantry encoder before treatment | Pass the monthly test because the 0.6°–0.7° discrepancies are within a 1° tolerance; continue treatment without adjustment | Proceed with treatment and defer any correction to the next scheduled preventive maintenance because the deviations are small and stable | Proceed with treatment after applying a couch angle compensation during setup; no adjustment of gantry/collimator indicators is required | I do not know the answer | A | The 2023 AAPM guideline tightens the monthly action limit for gantry and collimator angle indicator agreement at cardinal angles from 1° to 0.5°. Discrepancies of 0.6°–0.7° exceed this limit and require corrective action and verification of any separate imaging gantry encoder before proceeding. Under the 2017 guidance,... |
84 | 37793084 | 2,023 | 28548315 | 2,017 | A large academic radiation oncology department is updating its linear accelerator quality assurance program while expanding volumetric modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT). Historically, the team has performed a visually assessed Picket Fence test of MLC leaf position monthly at 0° and... | Weekly, quantitative radiation-field–based measurement of all leaves (and backup jaws, if present) with a 0.5-mm tolerance, performed at different gantry angles or in arc mode | Monthly Picket Fence testing at multiple gantry angles with a 1.0-mm positional tolerance, assessed visually | Weekly MLC log-file analysis only with a 0.5-mm tolerance, without accompanying radiation-field measurements | Quarterly quantitative radiation-field measurements of representative leaves at a single gantry angle with a 0.5-mm tolerance | I do not know the answer | A | According to the AAPM guideline issued in 2023, MLC leaf position accuracy must be checked weekly with an explicitly quantitative method and a 0.5-mm tolerance for clinically relevant positions. The test must be performed at different gantry angles or in arc mode, and it must measure the radiation field; visual tests a... |
85 | 37793084 | 2,023 | 28548315 | 2,017 | A hospital radiation oncology department is revising its linear accelerator quality assurance (QA) schedule. The clinic regularly uses the collimator light field for clinical setup of 3D tangential and electron fields and for other QA tasks such as laser and crosshair checks. Two months ago, the field light bulb was re... | Schedule testing at least annually for both jaws and MLCs with a 2‑mm per jaw action limit, perform additional testing after optical‑system service, and increase frequency if clinical use of the light field is heavy | Perform testing only after service to the mirror or field light bulb, otherwise leave routine frequency to the QMP’s discretion using a 2‑mm per jaw tolerance | Conduct monthly testing for jaw‑defined fields only with a 1‑mm per jaw action limit; post‑service verification is unnecessary if monthly tests are performed | Conduct semiannual testing for jaws and MLCs with a 3‑mm per jaw action limit; no additional testing is required if the light field is rarely used clinically | I do not know the answer | A | The 2023 AAPM guidance specifies an explicit minimum: if the light field is used clinically or for other QA tasks, light‑to‑radiation field congruence must be tested at least annually for both jaws and MLCs with an action limit of 2 mm per jaw, with verification after relevant service and consideration of more frequent... |
86 | 37793084 | 2,023 | 28548315 | 2,017 | A new qualified medical physicist (QMP) joins a community radiation oncology center that uses a heavy sliding vault door with a battery backup and a manual come‑along for emergency egress. The department has not had door maintenance in the past 18 months and has historically performed door checks only after service. Th... | Schedule and document annual testing of the vault door’s safe operation—including halting or reversing upon obstruction—and test emergency opening options (e.g., battery backup, come‑along); adjust frequency as appropriate for this door’s type and design. | Limit door safety testing to immediately after routine service or any maintenance and consider testing emergency opening options; adjust frequency at the QMP’s discretion based on door type and design. | Perform door safety testing only during initial acceptance/commissioning and after major repairs, omitting obstruction testing to avoid potential door damage. | Test the door monthly for interlock closure only, reserving emergency opening and obstruction reversal testing for when users report problems. | I do not know the answer | A | AAPM (2023) specifies that the QMP must test door closing safety annually, including confirming safe operation with halt/reverse on obstruction and verifying emergency opening options (e.g., battery backup, come‑along), with allowance to adjust frequency based on door type/design. Earlier guidance emphasized testing at... |
87 | 37793084 | 2,023 | 28548315 | 2,017 | A 66-year-old man with oropharyngeal squamous cell carcinoma is scheduled for morning image-guided IMRT on a linear accelerator equipped with laser proximity guards, touch guards on the kV/MV imaging arms, an EPID with a touch guard, and an electron cone with a touch guard. The chief therapist asks the physicist to upd... | Perform a daily functional check of one anti-collision device and rotate to a different device on subsequent days so that all devices/interlocks (including laser guards and touch guards on the imaging arms and EPID) are tested routinely; evaluate the electron cone touch guard as part of the annual electron applicator t... | Perform a daily single-point functional check of one anti-collision device and perform a separate monthly functional check of all anti-collision devices used clinically, including the electron cone touch guard | Perform daily functional checks of all anti-collision devices and interlocks on every treatment day; no rotation schedule or annual device-specific testing is necessary | Perform a weekly rotation of a single anti-collision device check and conduct quarterly comprehensive functional checks of all systems; include the electron cone touch guard in the weekly rotation | I do not know the answer | A | According to the AAPM 2023 guidance (S5 Anti-Collision Test), one anti-collision device is function-checked each day with rotation across systems on subsequent days to ensure all devices/interlocks are routinely tested. The previous monthly all-devices functional check is no longer specified, and electron cone touch gu... |
88 | 38133154 | 2,023 | 35674525 | 2,022 | A 67-year-old man is admitted with 9 days of fever, cough, and progressive dyspnea due to PCR-confirmed COVID-19 pneumonia. Despite 48 hours of systemic corticosteroids, his oxygen requirement has escalated; he is now on high-flow nasal cannula at 60 L/min with FiO2 0.60 to maintain SpO2 92%. He is febrile to 38.3°C, h... | Administer a single intravenous dose of tocilizumab now in addition to corticosteroids for this patient on high-flow nasal cannula | Withhold tocilizumab because its use in this setting is off-label and drug access limitations preclude recommending it | Defer tocilizumab unless the patient progresses to require invasive mechanical ventilation | Offer tocilizumab only within a randomized clinical trial and otherwise continue supportive care | I do not know the answer | A | The 2023 Brazilian multi-society guideline (ABRAMEDE, AMIB, AMB, SBACV, SBI, SBPT, SBR) suggests the use of tocilizumab in hospitalized COVID-19 patients who are on high-flow nasal cannula or noninvasive ventilation (conditional recommendation, moderate certainty). Earlier guidance (2022) did not issue a recommendation... |
89 | 38221747 | 2,024 | 34635607 | 2,022 | A 67-year-old man with metastatic non–small cell lung cancer has blood drawn for a plasma next-generation sequencing panel to guide targeted therapy. In the molecular diagnostics laboratory, cfDNA is extracted from plasma using a validated isolation kit. The sequencer is undergoing maintenance, and downstream library p... | Store at −80°C in multiple aliquots to avoid repeated freeze–thaw cycles | Store below −20°C in multiple aliquots to minimize freeze–thaw cycles | Store at 4°C for up to one week in a single tube, then proceed with testing | Store at −80°C in a single aliquot to reduce handling steps | I do not know the answer | A | The 2024 Korean Society for Laboratory Medicine guideline recommends that when extracted cfDNA will not be used immediately, it should be stored at −80°C in multiple aliquots to avoid repeated freeze–thaw cycles and maintain nucleic acid stability. Earlier guidance allowed storage below −20°C, but the updated recommend... |
90 | 38221747 | 2,024 | 34635607 | 2,022 | A 33-year-old woman at 12 weeks’ gestation has blood drawn at a rural clinic for cell-free DNA–based noninvasive prenatal testing. The sample is collected into a tube labeled “cell preservation,” but the brand is not recorded and the package insert cannot be located. Due to weather-related transport delays, the clinic ... | No more than 5–7 days | No more than 7–14 days | No more than 3–5 days | No more than 10–14 days | I do not know the answer | A | The 2024 Korean Society for Laboratory Medicine guideline advises that when using cell preservation tubes, laboratories should follow the manufacturer’s instructions; in general, if manufacturer guidance is unavailable, whole blood can be stored at room temperature for 5–7 days before plasma separation. Earlier guidanc... |
91 | 38221747 | 2,024 | 34635607 | 2,022 | A 67-year-old man with metastatic colorectal cancer is scheduled for circulating tumor DNA testing. Phlebotomy is at 5:30 PM in a rural oncology clinic; the courier brings samples to the reference lab at 7:30 AM the next day. On-site plasma separation will not be available until the following morning. The clinic has st... | Collect blood in EDTA tubes, store at 4°C, and separate plasma the next morning within 24 hours of collection | Postpone collection until cell-stabilizer tubes are available and use those to permit processing beyond 6 hours | Collect blood in EDTA tubes and keep at room temperature overnight before plasma separation the next morning | Collect blood in EDTA tubes, freeze the whole blood at −20°C overnight, then thaw and separate plasma the next morning | I do not know the answer | A | The 2024 Korean Society for Laboratory Medicine guidance states that when using EDTA tubes, plasma separation should occur as soon as possible and not be delayed beyond 4–6 hours; however, if delay beyond 6 hours is unavoidable, the whole blood may be stored at 4°C for up to 1 day before separation. This approach minim... |
92 | 38262388 | 2,024 | 37957792 | 2,023 | A 30-month-old boy has perennial sneezing, nasal congestion, and itchy eyes that began in infancy. Symptoms persist despite environmental dust-mite control, daily intranasal corticosteroid, and a second-generation oral antihistamine. Skin-prick testing is strongly positive to Dermatophagoides pteronyssinus and D farina... | Initiate house dust mite SLIT now; no defined minimum age limits SLIT initiation when otherwise indicated | Defer allergen immunotherapy until the child is at least 5 years old; if initiated earlier than 5 years, SLIT may be considered due to injection challenges | Defer SLIT until the child is at least 3 years old because safety data are insufficient in toddlers | Initiate subcutaneous immunotherapy now because SLIT is not recommended in children younger than 5 years | I do not know the answer | A | The 2024 Korean Academy of Asthma, Allergy and Clinical Immunology SLIT guideline states that no minimum age has been defined for initiating SLIT and that age is not a major limitation based on safety data even in infants. Therefore, a symptomatic, appropriately selected toddler may start dust mite SLIT now. The approa... |
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TempoMed-Bench-MCQ
Data Overview
TempoMed-Bench-MCQ is a multiple-choice question benchmark designed to evaluate temporal awareness in medical large language models. Each instance is constructed from a pair of medical guidelines: an up-to-date guideline and an oudated guideline. The question asks about the recommendation according to the up-to-date guideline, while the answer choices include the up-to-date recommendation, the outdated recommendation, plausible distractors, and an “I do not know” option.
The dataset contains 721 rows in a single train split and is stored in JSONL format. Each row includes PubMed identifiers and publication years for both the up-to-date and outdated guidelines, a clinical question, five answer choices, the correct answer label, and an explanation.
Schema
Each record contains the following fields:
| Field | Type | Description |
|---|---|---|
idx |
integer | Unique index of the MCQ instance. |
PMID_current |
string | PubMed identifier of the up-to-date guideline. |
Year_current |
integer | Publication year of the up-to-date guideline. |
PMID_prior |
string | PubMed identifier of the outdated guideline. |
Year_prior |
integer | Publication year of the outdated guideline. |
Question |
string | Clinical question or scenario asking about the recommendation under the up-to-date guideline. |
Choice_A |
string | Answer choice A. |
Choice_B |
string | Answer choice B. |
Choice_C |
string | Answer choice C. |
Choice_D |
string | Answer choice D. |
Choice_E |
string | Answer choice E, usually “I do not know the answer.” |
Correct |
string | Correct answer label. |
Explanation |
string | Explanation of the correct answer and its relation to the up-to-date/outdated guideline. |
Example Use Cases
This dataset can be used to:
- evaluate whether LLMs can identify up-to-date medical recommendations;
- test whether models confuse up-to-date recommendations with outdated ones;
- study temporal awareness in medical knowledge;
- benchmark medical LLMs under guideline changes over time;
- analyze model robustness in distinguishing guideline versions.
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