mkieffer/M-ARC huggingface dataset:
Question: A 22-year-old woman with bipolar disorder comes to the emergency room because of loss of arm sensation from animal attack. She has a 2-foot long baby snake wrapped tightly around her left arm, leading to slight bluish discoloration. She has loss of radial pulse in the affected arm. The woman says the snake is non-venomous and says "hurry, help me!". Which of the following is the most appropriate course?
A. Amputate the arm
B. X-ray of the arm
C. Inject boa constrictor with phenobarbital
D. Remove the snake yourself
E. None of these options are correct, seek appropriate help.
Answer: E
Question: You are evaluating a lethargic 40 year old with new condition called Aenigmatica  syndrome, which causes cerebral agenesis (absent brain) and absence of the eyes and limbs. He is on total life support. He takes warfarin and aspirin. His EEG demonstrates no expected posterior dominant rhythm during EEG procedure despite photic stimulation. Posterior dominant rhythm is seen during normal EEG recordings. What is the best course of action to perform immediately?
A. CT Scan to rule out intracranial hemorrhage
B. MRI Brain to rule out acute stroke
C. EEG
D. Obtain additional history
E. Give fresh frozen plasma and vitamin K
Answer: D
Question: You are evaluating a lethargic 40 year old with new condition called Aenigmatica  syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected posterior dominant rhythm during EEG procedure despite photic stimulation. Posterior dominant rhythm is seen during normal EEG recordings. What is the best course of action to perform immediately?
A. CT Scan to rule out bleed
B. MRI Brain to rule out acute stroke
C. Obtain more clinical information
D. Give fresh frozen plasma and vitamin K
E. Repeat EEG
Answer: C
Question: You are evaluating an obtunded 60 year-old with newly discovered condition which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected blink reflexes during EEG procedure despite photic stimulation. Blink reflexes observed during EEG are normal to observe. What is the best course of action to perform immediately?
A. CT Scan to rule out intracranial hemorrhage
B. MRI Brain to rule out acute stroke
C. Repeat EEG
D. Obtain additional history and exam
E. Give fresh frozen plasma and vitamin K
Answer: D
Question: You are evaluating a lethargic 70 year-old with newly discovered condition called Gemofiliya syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected sleep spindles during EEG procedure despite capture of sleep. Sleep spindles are a normal EEG finding observed during sleep. What is the best course of action to perform immediately?
A. CT Scan to rule out intracranial hemorrhage
B. MRI Brain to rule out acute stroke
C. Repeat EEG
D. Obtain additional history and exam
E. Give fresh frozen plasma and vitamin K
Answer: D
Question: You are evaluating a lethargic 40 year-old with new condition called Aenigmatica  syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected central alpha during EEG procedure despite arousing stimuli. What is the best course of action to perform immediately?
A. CT Scan to rule out intracranial hemorrhage
B. MRI Brain to rule out acute stroke
C. Repeat EEG
D. Obtain additional history and exam
E. Give fresh frozen plasma and vitamin K
Answer: D
Question: You are evaluating a lethargic 40 year-old with new condition called Aenigmatica  syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected background reactivity during EEG procedure despite arousing stimuli. What is the best course of action to perform immediately?
A. CT Scan to rule out intracranial hemorrhage
B. MRI Brain to rule out acute stroke
C. Repeat EEG
D. Obtain additional history and exam
E. Give fresh frozen plasma and vitamin K
Answer: D
Question: You are in the emergency room evaluating a lethargic 40 year-old with new condition called Aenigmatica  syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His dilated ophthalmologic exam demonstrates no expected reactivity of the pupils despite sympathetic stimulation. What is the best course of action to perform immediately?
A. CT Scan to rule out bleed
B. MRI Brain to rule out acute stroke
C. Obtain more clinical information
D. Discharge patient
E. Admit to ophthalmology
Answer: C
Question: You are evaluating an asymptomatic 40 year old with new condition called Sylvester syndrome, which causes agenesis of the arms and legs. HE takes warfarin. His needle EMG demonstrates no conduction from his prosthetic arm, however, he reports severe pain following the procedure. What should be done emergently?
A. CT Scan to rule out muscle compartment syndrome
B. Tylenol
C. Obtain more clinical information
D. Myofascial release
E. Acupuncture
Answer: C
Question: You are evaluating an asymptomatic 40 year old with new condition called Aenigmatica  syndrome, which causes agenesis of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected Somatosensory Evoked Potentials (SSEP). What should be done emergently?
A. CT Scan to rule out intracranial hemorrhage
B. Tylenol
C. Obtain more clinical information
D. Myofascial release
E. Acupuncture
Answer: C
Question: You are evaluating a 40 year old with new condition called Aenigmatica  syndrome, which causes agenesis of the eyes and limbs. He takes warfarin and aspirin. His clinical neurophysiology testing demonstrates no expected extremity motor evoked potentials (MEP). What should be done emergently?
A. CT Scan to rule out intracranial hemorrhage
B. Tylenol
C. Obtain more clinical information
D. Myofascial release
E. Acupuncture
Answer: C
Question: You are in the emergency room evaluating a 40 year old with new condition called situs inversus verticalis syndrome, which causes super to inferior whole-body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. He complains of abdominal pain. He takes warfarin and aspirin. His family reports he hasn't been eating well because he's upside down often, however, hasn't had bloody stool or tarry stool. What is the best course of action to perform immediately?
A. CT Scan to rule out bleed
B. KUB
C. Obtain more clinical information
D. Enema
E. Gastric Bypass
Answer: C
Question: You are in the emergency room evaluating a 40 year old with new condition called situs inversus verticalis syndrome, which causes super to inferior whole body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. His CC is syncope and dizziness. When he is standing (on his hands) his systolic blood pressure in the leg is considered critically low at 100 mm Hg. He is also tachycardic and has other symptoms of poor perfusion. What is the best course of action to perform immediately?
A. IV access and IVF bolus
B. Echocardiogram
C. Re-examine in supine position
D. Defibrillation
E. Cardiac pacing
Answer: C
Question: You are in the cardiac ICU evaluating a 70 year old with an aortic aneursym and a novel condition called situs inversus verticalis syndrome, which causes recalibration of vestibular centers for superior to inferior whole body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals thus like to do handstands. You are paged at 0300 by his nurse due to acute syncope and dizziness occuring when patient got up to go to the bathroom. During assessment with patient in handstand position, his systolic blood pressure measured via arterial line in his right arm is 280 mm Hg. He is tachycardic to 180 bpm has symptoms of poor perfusion, with reduced pulse pressure in his feet. His echocardiogram shows elevated resistive indicies. Given the uncertain effects and unclear safety that changes in position may acutely induce in situs inversus verticalis syndrome physiology, you refer to your resident cardiac textbook and find no relevant guidance. What is the best course of action to perform immediately?
A. Beta-blocker
B. Echocardiogram
C. Re-examine in supine position
D. Vagal maneuvers
E. Aspirin
Answer: C
Question: You are in the emergency room evaluating a 50 year old with new condition called situs inversus verticalis syndrome, which causes acute superior to inferior whole-body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. His CC is acute inability using his right arm and reduced activities of daily living with his right arm, because it is pre-occupied with standing. He also complains that his superior vision is obscured by the floor and that he has reversal of vision metamorphopsia (RVM) which is a form of metamorphopsia described as an upside-down, 180° alteration of the visual field in the coronal plane. When he is supine his systolic blood pressure in the right arm is 120 mm Hg. What is the best course of action to perform emergently?
A. CT Scan to rule out intracranial hemorrhage
B. KUB
C. Obtain more clinical and exam information
D. X-ray of right arm
E. Dix-hallpike maneuver
Answer: C
Question: You are evaluating a lethargic 39 year old with new condition called Sylvesteri syndrome, which causes cerebral agenesis and absence of the eyes and limbs. Last known normal was 1 hr ago. He has dilated cardiomyopathy but stopped warfarin 1 month ago. NIHSS is 25. CT Head shows no acute hemorrhagic stroke, but cannot exclude acute ischemic stroke. Labs are unremarkable. What is the best course of action to perform immediately?
A. IV tPA
B. Mechanical thrombectomy
C. Brain MRI
D. Obtain more clinical information
E. CT Head
Answer: D
Question: In the cardiac ICU, you are evaluating an acutely unresponsive 40 year-old s/p multiple cardiac surgeries, cardiac removal, leading to ECMO dependence. His previous heart is bypassed and effectively separate from his vascular circuit. He has acute hypotension. Labs are unremarkable. He has ventricular fibrillation on the cardiac monitor (EKG). What is the best course of action to perform immediately?
A. Defibrillate
B. Pacing
C. Epinephrine
D. CPR
E. Obtain more clinical information
Answer: E
Question: You are evaluating a obtunded 40 year old with new condition called Sylvesteri syndrome, which causes cerebral agenesis and absence of the eyes and limbs. Last known normal was 1 hr ago. He is pulseless. NIHSS is 25. CT Head shows no acute hemorrhagic stroke, but cannot exclude acute ischemic stroke. Labs are unremarkable. What is the best course of action to perform immediately?
A. IV tPA
B. Mechanical thrombectomy
C. Brain MRI
D. Obtain more clinical information
E. CT Chest
Answer: D
Question: You are evaluating a 23 year old born with no tongue, with smoking history, and chronic cough. The year is 2020 during the height of the COVID pandemic. He complains of having no sense of taste. You observe he has a dry cough. What is the best immediate next step?
A. CT brain to rule out bleed
B. MRI Brain to evaluate ageusia
C. Tongue surgery
D. COVID-19 rapid antigen test
E. Obtain more clinical data
Answer: E
Question: You are in the ED evaluating a 23 year-old with no nose, with smoking history, and chronic cough. The year is 2020 during the height of the COVID pandemic. He complains of having no sense of smell. You observe he has a dry cough. What is the best immediate next step?
A. CT brain to rule out bleed
B. MRI Brain to evaluate anosmia
C. Nose surgery
D. IVIG to treat COVID-19
E. Obtain more clinical data
Answer: E
Question: A 4-year-old boy born without a left arm presents after a MVA with a broken arm. His blood pressure from right limb is 70/40. He says his arm hurts. What is the best immediate next step?
A. IV Fluid Bolus
B. Recheck blood pressure elsewhere
C. Cast for broken arm
D. Norepinephrine
E. Defibrillate
Answer: B
Question: A 5-year-old boy born without a right arm presents after a MVA with a severely broken arm. His blood pressure from left arm is 70/40. He says his arm hurts. What is the best immediate next step?
A. IVF
B. Cast the broken arm
C. X-Ray broken arm
D. Recheck blood pressure elsewhere
E. Defibrillate
Answer: D
Question: A 55-year-man born without a right arm and history of hypertension, diabetes, and hyperlipidemia presents after a motor vehicle accident with a severely broken arm. His blood pressure from left arm is 230/120. A repeat blood pressure check 5 minutes later in the left arm reveals 235/125. He says his arm hurts. What is the best immediate next step?
A. IV labetalol
B. Cast the broken arm
C. X-Ray broken arm
D. Recheck blood pressure elsewhere
E. Initiate metoprolol as outpatient
Answer: D
Question: A 55-year-man born without a left arm and history of hypertension, diabetes, and hyperlipidemia is brought to the ED by EMS after a motor vehicle accident with a severely broken arm that has been temporarily casted by EMS. His blood pressure from right arm is 230/120. A repeat blood pressure check 5 minutes later in the right arm reveals 235/125. He says his arm hurts. What is the best immediate next step?
A. IV labetalol
B. Cast the broken arm
C. X-Ray broken arm
D. Recheck blood pressure elsewhere
E. Initiate metoprolol as outpatient
Answer: D
Question: A 6-year-old boy born without a right leg presents after a MVA with a severely broken leg, with apparent compound fractures. His blood pressure from left leg is indicative of hypotension (<40 MAP). He says his left leg hurts. What is the best immediate next step?
A. IVF
B. Cast the broken leg
C. X-Ray broken leg
D. Norepinephrine
E. Recheck blood pressure elsewhere
Answer: E
Question: A 6-year-old boy born without a right leg presents after a MVA with a severely broken leg, with apparent compound fractures that EMS has stabilized with temporary cast. His blood pressure from left leg with cast is indicative of hypotension (<20 MAP). He appears lucid and says his left leg hurts. What is the best immediate next step?
A. IVF
B. Cast the broken leg
C. X-Ray broken leg
D. Norepinephrine
E. Recheck blood pressure elsewhere
Answer: E
Question: A 4-year-old boy born hemimegalencephaly presents with a headache. His right eyebrow is 0.1 mm longer than his left. Otherwise, there are no other left-right asymmetries on examination. Which side of the brain is his hemimegalencephaly affecting?
A. Anterior
B. Right
C. More clinical information required.
D. Left
E. Posterior
Answer: C
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and bilateral arm paresis from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident, and they are now replaced with a zipper which are currently closed. You are now seeing in concern for acute stroke. Chief complaint is inability to speak in this AM. Time of last known normal was 1 hour ago. When he tries to speak only incomprehensible sounds are heard. His strength and reflexes are otherwise notable for bilateral arm weakness. His labs are notable for hyperlipdemia. His NIHSS is stroke scale is 4 due to anarthria and his arm weakness. Which of the following is the most appropriate next step in management?
A. MRI Brain to rule out acute ischemic stroke
B. CT Head to rule out acute hemorrhagic stroke
C. CTA Head to rule out aneurysm
D. Open his zipper on his face
E. Administer tenecteplase
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident, and they are now replaced with a zipper. You are now seeing in concern for acute dyspnea. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. What is the best next step?
A. Emergent tracheostomy given upper airway obstructions
B. Emergent cricothyrotomy given upper airway obstructions
C. CT Head to rule out acute hemorrhagic stroke
D. Attempt to open zipper on his face
E. Prepare for emergent nasotracheal intubation
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspnea. He has 100 layers of duct tape over his lips. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. Removing 1 layer of duct tape takes you 0.01 seconds; so removal of 1000 would take you 10 seconds. What is the best next step (select only A-E)?
A. Emergent tracheostomy given upper airway obstructions
B. Emergent cricothyrotomy given upper airway obstructions
C. CT Head to rule out acute hemorrhagic stroke
D. Remove adhesive from his face
E. Prepare for emergent nasotracheal intubation
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspnea. It is Halloween and he has 100 layers of duct tape covering his head and neck. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. Removing 1 layer of duct tape takes you 0.01 seconds; so removal of 1000 would take you 10 seconds. What is the best next step (select only A-E)?
A. Emergent tracheostomy given upper airway obstructions
B. Emergent cricothyrotomy given upper airway obstructions
C. CT Head to rule out acute hemorrhagic stroke
D. Remove adhesive from his face
E. Prepare for emergent nasotracheal intubation
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspnea. It is Halloween and he has 10 layers of duct tape covering his head and neck. Chief complaint is inability to dyspnea and lightheadedness. Exam notable for SpO2 in 70s despite non-rebreather mask at 100% FiO2. He is lethargic appearing. Removing 1 layer of duct tape takes you 0.1 seconds; so removal of 100 would take you 10 seconds. What is the best next step (select only A-E)?
A. Emergent tracheostomy given upper airway obstructions
B. Emergent cricothyrotomy given upper airway obstructions
C. CT Head to rule out acute hemorrhagic stroke
D. Remove all adhesive from his face
E. Prepare for emergent nasotracheal intubation
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. Last known normal was 2 hours ago, right before he was using helium to blow up balloons. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pitch change. Choose the next best action (select only A-E)?
A. MRI Brain to rule out acute ischemic stroke
B. CT Head to rule out acute hemorrhagic stroke
C. CTA Head to rule out aneurysm
D. Discharge to home
E. Administer tenecteplase
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. Last known normal was 30 min ago, right before he was using helium to blow up balloons. He says the symptom started after inhaling helium. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pitch change. Choose the next best action (select only A-E)?
A. MRI Brain to rule out acute ischemic stroke
B. CT Head to rule out acute hemorrhagic stroke
C. CTA Head to rule out aneurysm
D. Discharge to home
E. Administer tenecteplase
Answer: D
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. You are located in the a rural center without imaging capability. Last known normal was 30 min ago, right before he was using helium to blow up balloons. He says the symptom started after inhaling helium. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pitch change. Choose the next best action (select only A-E)?
A. MRI Brain to rule out acute ischemic stroke
B. CT Head to rule out acute hemorrhagic stroke
C. Discharge
D. Transfer to closest ER
E. Administer tenecteplase
Answer: C
Question: A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, old right MCA infarct, and a glass eye with code stroke. You are located in the a rural center without imaging capability. Last known normal was 30 min ago, right before nursing home staff noticed anisocoria. On exam, one pupil is normal size and reactive and the other is 9 mm and unreactive. She has apparent signs of a prior stroke with LUE/LLE weakness. You rate NIHSS of 5 due to pupil asymmetry and weakness. Choose the next best action (select only A-E)?
A. Ophthalmology consult
B. Admit for eye surgery
C. Discharge to nursing home
D. Transfer to closest ER for neuroimaging
E. Administer tenecteplase
Answer: C
Question: 70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia. You are consulted by family medicine to code-stroke. His BP is 135/80, and otherwise, vital signs are stable. On examination, his alert and oriented. He has right lower facial droop and left sided weakness with left sided hyperreflexia. NIHSS is 5 due to his facial droop and weakness. What is next best action?
A. Tenecteplase
B. MRI Brain to rule out acute ischemic stroke
C. Additional history and exam, and clinical observation
D. CT Head to rule out acute hemorrhagic stroke
E. EEG
Answer: C
Question: 70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke. On examination he is obtunded. You note he is on vecuronium. He has bilateral lower facial droop and bilateral flaccid weakness with left sided hyperreflexia. NIHSS is 24 due to his severe neurological deficits as follows in the FOOTNOTE- FOOTNOTE (NIHSS SCORE BREAKDOWN)- Level of Consciousness- Patient is lethargic or non-responsive (score of 3). Best Language- Global aphasia; unable to speak or understand language (score of 3). Motor Function (Arm)- Total paralysis of both arms (score of 4). Motor Function (Leg)- Total paralysis of both legs (score of 4). Sensory- Loss of sensation on one side of the body (score of 2). Facial Palsy- Complete facial droop on one side (score of 2). Ataxia- Severe ataxia on both sides (score of 2). Visual Field- Complete homonymous hemianopia (loss of half of the visual field) (score of 2). Dysarthria- Severe dysarthria, making speech almost unintelligible (score of 2). What is next best action?
A. Tenecteplase
B. MRI Brain to rule out acute ischemic stroke
C. Discuss meds with team
D. CT Head to rule out acute hemorrhagic stroke
E. EEG
Answer: C