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A 42-year-old man comes to the office for preoperative evaluation prior to undergoing adrenalectomy scheduled in 2 weeks. One month ago, he received care in the emergency department for pain over his right flank following a motor vehicle collision. At that time, blood pressure was 160/100 mm Hg and CT scan of the abdomen showed an incidental 10-cm left adrenal mass. Results of laboratory studies, including complete blood count, serum electrolyte concentrations, and liver function tests, were within the reference ranges. The patient otherwise had been healthy and had never been told that he had elevated blood pressure. He takes no medications. A follow-up visit in the office 2 weeks ago disclosed elevated urinary normetanephrine and metanephrine and plasma aldosterone concentrations. The patient was referred to a surgeon, who recommended the adrenalectomy. Today, vital signs are temperature 36.6°C (97.9°F), pulse 100/min, respirations 14/min, and blood pressure 170/95 mm Hg. Physical examination discloses no significant findings. Initial preoperative preparation should include treatment with which of the following? | [
"Labetalol",
"A loading dose of potassium chloride",
"Nifedipine",
"Phenoxybenzamine"
] | 3D
| {
"content": "Given a text in the form of a short question, a question with long context, a fill in the blank query, or multiple statements. Negate the given text by making minimal changes. Only negate the main question or intent, don't negate the provided context of the question and don't complete the cloze query. Reply with the full question and context. Be concise and don't provide any explanation.\n\nText: A 42-year-old man comes to the office for preoperative evaluation prior to undergoing adrenalectomy scheduled in 2 weeks. One month ago, he received care in the emergency department for pain over his right flank following a motor vehicle collision. At that time, blood pressure was 160/100 mm Hg and CT scan of the abdomen showed an incidental 10-cm left adrenal mass. Results of laboratory studies, including complete blood count, serum electrolyte concentrations, and liver function tests, were within the reference ranges. The patient otherwise had been healthy and had never been told that he had elevated blood pressure. He takes no medications. A follow-up visit in the office 2 weeks ago disclosed elevated urinary normetanephrine and metanephrine and plasma aldosterone concentrations. The patient was referred to a surgeon, who recommended the adrenalectomy. Today, vital signs are temperature 36.6°C (97.9°F), pulse 100/min, respirations 14/min, and blood pressure 170/95 mm Hg. Physical examination discloses no significant findings. Initial preoperative preparation should include treatment with which of the following?\n\nNegated text:",
"role": "user"
} | Initial preoperative preparation should not include treatment with which of the following? | A 42-year-old man comes to the office for preoperative evaluation prior to undergoing adrenalectomy scheduled in 2 weeks. One month ago, he received care in the emergency department for pain over his right flank following a motor vehicle collision. At that time, blood pressure was 160/100 mm Hg and CT scan of the abdomen showed an incidental 10-cm left adrenal mass. Results of laboratory studies, including complete blood count, serum electrolyte concentrations, and liver function tests, were within the reference ranges. The patient otherwise had been healthy and had never been told that he had elevated blood pressure. He takes no medications. A follow-up visit in the office 2 weeks ago disclosed elevated urinary normetanephrine and metanephrine and plasma aldosterone concentrations. The patient was referred to a surgeon, who recommended the adrenalectomy. Today, vital signs are temperature 36.6°C (97.9°F), pulse 100/min, respirations 14/min, and blood pressure 170/95 mm Hg. Physical examination discloses no significant findings. Initial preoperative preparation should include treatment with which of the following?
A. Labetalol
B. A loading dose of potassium chloride
C. Nifedipine
D. Phenoxybenzamine
Answer: D | Initial preoperative preparation should not include treatment with which of the following?
A. Labetalol
B. A loading dose of potassium chloride
C. Nifedipine
D. Phenoxybenzamine
Answer: A | |||
A 36-year-old male presents to the office with a 3-week history of low back pain. He denies any recent trauma but says that he climbs in and out of his truck numerous times a day for his job. Examination of the patient in the prone position reveals a deep sacral sulcus on the left, a posterior inferior lateral angle on the right, and a lumbosacral junction that springs freely on compression. The most likely diagnosis is | [
"left-on-left sacral torsion",
"left-on-right sacral torsion",
"right unilateral sacral flexion",
"right-on-right sacral torsion"
] | 3D
| {
"content": "Given a text in the form of a short question, a question with long context, a fill in the blank query, or multiple statements. Negate the given text by making minimal changes. Only negate the main question or intent, don't negate the provided context of the question and don't complete the cloze query. Reply with the full question and context. Be concise and don't provide any explanation.\n\nText: A 36-year-old male presents to the office with a 3-week history of low back pain. He denies any recent trauma but says that he climbs in and out of his truck numerous times a day for his job. Examination of the patient in the prone position reveals a deep sacral sulcus on the left, a posterior inferior lateral angle on the right, and a lumbosacral junction that springs freely on compression. The most likely diagnosis is\n\nNegated text:",
"role": "user"
} | The most likely diagnosis is not | A 36-year-old male presents to the office with a 3-week history of low back pain. He denies any recent trauma but says that he climbs in and out of his truck numerous times a day for his job. Examination of the patient in the prone position reveals a deep sacral sulcus on the left, a posterior inferior lateral angle on the right, and a lumbosacral junction that springs freely on compression. The most likely diagnosis is
A. left-on-left sacral torsion
B. left-on-right sacral torsion
C. right unilateral sacral flexion
D. right-on-right sacral torsion
Answer: D | The most likely diagnosis is not
A. left-on-left sacral torsion
B. left-on-right sacral torsion
C. right unilateral sacral flexion
D. right-on-right sacral torsion
Answer: B | |||
A previously healthy 32-year-old woman comes to the physician 8 months after her husband was killed in a car crash. Since that time, she has had a decreased appetite and difficulty falling asleep. She states that she is often sad and cries frequently. She has been rechecking the door lock five times before leaving her house and has to count exactly five pieces of toilet paper before she uses it. She says that she has always been a perfectionist but these urges and rituals are new. Pharmacotherapy should be targeted to which of the following neurotransmitters? | [
"Dopamine",
"Glutamate",
"Norepinephrine",
"Serotonin"
] | 3D
| {
"content": "Given a text in the form of a short question, a question with long context, a fill in the blank query, or multiple statements. Negate the given text by making minimal changes. Only negate the main question or intent, don't negate the provided context of the question and don't complete the cloze query. Reply with the full question and context. Be concise and don't provide any explanation.\n\nText: A previously healthy 32-year-old woman comes to the physician 8 months after her husband was killed in a car crash. Since that time, she has had a decreased appetite and difficulty falling asleep. She states that she is often sad and cries frequently. She has been rechecking the door lock five times before leaving her house and has to count exactly five pieces of toilet paper before she uses it. She says that she has always been a perfectionist but these urges and rituals are new. Pharmacotherapy should be targeted to which of the following neurotransmitters?\n\nNegated text:",
"role": "user"
} | Pharmacotherapy should not be targeted to which of the following neurotransmitters? | A previously healthy 32-year-old woman comes to the physician 8 months after her husband was killed in a car crash. Since that time, she has had a decreased appetite and difficulty falling asleep. She states that she is often sad and cries frequently. She has been rechecking the door lock five times before leaving her house and has to count exactly five pieces of toilet paper before she uses it. She says that she has always been a perfectionist but these urges and rituals are new. Pharmacotherapy should be targeted to which of the following neurotransmitters?
A. Dopamine
B. Glutamate
C. Norepinephrine
D. Serotonin
Answer: D | Pharmacotherapy should not be targeted to which of the following neurotransmitters?
A. Dopamine
B. Glutamate
C. Norepinephrine
D. Serotonin
Answer: C | |||
A 44-year-old man comes to the office because of a 3-day history of sore throat, nonproductive cough, runny nose, and frontal headache. He says the headache is worse in the morning and ibuprofen does provide some relief. He has not had shortness of breath. Medical history is unremarkable. He takes no medications other than the ibuprofen for pain. Vital signs are temperature 37.4°C (99.4°F), pulse 88/min, respirations 18/min, and blood pressure 120/84 mm Hg. Examination of the nares shows erythematous mucous membranes. Examination of the throat shows erythema and follicular lymphoid hyperplasia on the posterior oropharynx. There is no palpable cervical adenopathy. Lungs are clear to auscultation. Which of the following is the most likely cause of this patient's symptoms? | [
"Allergic rhinitis",
"Epstein-Barr virus",
"Mycoplasma pneumoniae",
"Rhinovirus"
] | 3D
| {
"content": "Given a text in the form of a short question, a question with long context, a fill in the blank query, or multiple statements. Negate the given text by making minimal changes. Only negate the main question or intent, don't negate the provided context of the question and don't complete the cloze query. Reply with the full question and context. Be concise and don't provide any explanation.\n\nText: A 44-year-old man comes to the office because of a 3-day history of sore throat, nonproductive cough, runny nose, and frontal headache. He says the headache is worse in the morning and ibuprofen does provide some relief. He has not had shortness of breath. Medical history is unremarkable. He takes no medications other than the ibuprofen for pain. Vital signs are temperature 37.4°C (99.4°F), pulse 88/min, respirations 18/min, and blood pressure 120/84 mm Hg. Examination of the nares shows erythematous mucous membranes. Examination of the throat shows erythema and follicular lymphoid hyperplasia on the posterior oropharynx. There is no palpable cervical adenopathy. Lungs are clear to auscultation. Which of the following is the most likely cause of this patient's symptoms?\n\nNegated text:",
"role": "user"
} | Which of the following is NOT the most likely cause of this patient's symptoms? | A 44-year-old man comes to the office because of a 3-day history of sore throat, nonproductive cough, runny nose, and frontal headache. He says the headache is worse in the morning and ibuprofen does provide some relief. He has not had shortness of breath. Medical history is unremarkable. He takes no medications other than the ibuprofen for pain. Vital signs are temperature 37.4°C (99.4°F), pulse 88/min, respirations 18/min, and blood pressure 120/84 mm Hg. Examination of the nares shows erythematous mucous membranes. Examination of the throat shows erythema and follicular lymphoid hyperplasia on the posterior oropharynx. There is no palpable cervical adenopathy. Lungs are clear to auscultation. Which of the following is the most likely cause of this patient's symptoms?
A. Allergic rhinitis
B. Epstein-Barr virus
C. Mycoplasma pneumoniae
D. Rhinovirus
Answer: D | Which of the following is NOT the most likely cause of this patient's symptoms?
A. Allergic rhinitis
B. Epstein-Barr virus
C. Mycoplasma pneumoniae
D. Rhinovirus
Answer: A | |||
A 22-year-old male marathon runner presents to the office with the complaint of right-sided rib pain when he runs long distances. Physical examination reveals normal heart and lung findings and an exhalation dysfunction at ribs 4-5 on the right. Which of the following muscles or muscle groups will be most useful in correcting this dysfunction utilizing a direct method? | [
"anterior scalene",
"latissimus dorsi",
"pectoralis minor",
"quadratus lumborum"
] | 2C
| {
"content": "Given a text in the form of a short question, a question with long context, a fill in the blank query, or multiple statements. Negate the given text by making minimal changes. Only negate the main question or intent, don't negate the provided context of the question and don't complete the cloze query. Reply with the full question and context. Be concise and don't provide any explanation.\n\nText: A 22-year-old male marathon runner presents to the office with the complaint of right-sided rib pain when he runs long distances. Physical examination reveals normal heart and lung findings and an exhalation dysfunction at ribs 4-5 on the right. Which of the following muscles or muscle groups will be most useful in correcting this dysfunction utilizing a direct method?\n\nNegated text:",
"role": "user"
} | A 22-year-old male marathon runner presents to the office with the complaint of right-sided rib pain when he runs long distances. Physical examination reveals normal heart and lung findings and an exhalation dysfunction at ribs 4-5 on the right. Which of the following muscles or muscle groups will be least useful in correcting this dysfunction utilizing a direct method? | A 22-year-old male marathon runner presents to the office with the complaint of right-sided rib pain when he runs long distances. Physical examination reveals normal heart and lung findings and an exhalation dysfunction at ribs 4-5 on the right. Which of the following muscles or muscle groups will be most useful in correcting this dysfunction utilizing a direct method?
A. anterior scalene
B. latissimus dorsi
C. pectoralis minor
D. quadratus lumborum
Answer: C | A 22-year-old male marathon runner presents to the office with the complaint of right-sided rib pain when he runs long distances. Physical examination reveals normal heart and lung findings and an exhalation dysfunction at ribs 4-5 on the right. Which of the following muscles or muscle groups will be least useful in correcting this dysfunction utilizing a direct method?
A. anterior scalene
B. latissimus dorsi
C. pectoralis minor
D. quadratus lumborum
Answer: A |
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