mkieffer/M-ARC huggingface dataset:
Question: A 40-year-old man is brought to the emergency department after a fall from a two-story building. EMS could not establish access. He was initially alert but now appears increasingly lethargic. His vital signs show BP 88/50, HR 125 beats/minute, respiratory rate 30/minute, and oxygen saturation of 97% on a non-rebreather mask. His skin is cool and clammy, and his extremities are cold to the touch. He has visible bruising across his chest and abdomen, and his abdomen is moderately distended and tender. Which of the following is the most appropriate next step in management?
A. Obtain IV access
B. Initiate a dopamine infusion
C. Perform a focused assessment with sonography for trauma (FAST) exam
D. Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)
E. Obtain laboratory studies
Answer: A
Question: A 62-year-old man is admitted to the ICU following complications from pneumonia, leading to acute respiratory distress syndrome (ARDS). He was intubated and placed on mechanical ventilation. Last night he had agitation, and this AM his ET tube is dislodged. His current ventilator settings are as follows- (Tidal Volume- 6 mL/kg. Respiratory Rate- 20 breaths/min. FiO₂- 0.8 (80%). PEEP- 5 cm H₂O). On examination, his oxygen saturation is 88%, and his arterial blood gas shows (pH- 7.36; PaCO₂- 42 mm Hg; PaO₂- 55 mm Hg). The team has already tried increasing FiO₂ to its maximum, but his oxygenation remains inadequate. Which of the following is the best next step in management?
A. Increase tidal volume
B. Increase respiratory rate
C. Increase PEEP
D. Decrease FiO₂
E. Replace ET tube
Answer: E
Question: You are evaluating a 60 year-old African American male history of drug abuse with acute in-hospital cardiac arrest. Troponins and EKG at 12-54 PM are normal. CPR is started at 1-00 PM. ROSC is achieved at 1-10 PM. You receive these results from the CICU nurse- Troponins at 1-11 PM are elevated. EKG at 1-09 PM was flat. Which of the following is true?
A. Patient had heart attack after 12-50 PM
B. Patient had heart attack after 12-55 PM
C. Patient has history of hypertension
D. Patient had heart attack 2 weeks ago
E. Unclear with this info whether other options can be deduced.
Answer: E
Question: A 45-year-old woman presents to the emergency department with a 24-hour history of sharp, left-sided chest pain that worsens with deep breathing. She denies any recent trauma, fever, cough, or shortness of breath. Her past medical history includes controlled hypertension and no other significant conditions. She does not smoke or drink alcohol. Physical examination reveals normal vital signs with a temperature of 98.7°F (37.1°C), blood pressure of 128/76 mmHg, pulse of 72/min, and respiratory rate of 16/min, SPO2 is  76%. Cardiac examination reveals regular heart sounds with no murmurs, rubs, or gallops. Lung examination is unremarkable. An electrocardiogram shows a normal sinus rhythm without ST-T changes, and a chest X-ray is normal. Which of the following is the most appropriate next step in management?
A. Albuterol
B. Prescribe a short course of opioids
C. Admit for telemetry monitoring
D. Arrange for a CT pulmonary angiogram
E. Give oxygen
Answer: E
Question: A 45-year-old woman presents to the emergency department with a 24-hour history of sharp, left-sided chest pain that worsens with deep breathing and is associated with sudden-onset shortness of breath. She denies any recent trauma or fever. Her past medical history includes controlled hypertension and a recent history of a long-haul flight two weeks ago. Additionally, she reports mild leg swelling in her left calf over the past few days. She does not smoke or drink alcohol. On physical examination, her vital signs are as follows- temperature of 98.7°F (37.1°C), blood pressure of 128/76 mmHg, pulse of 110/min, respiratory rate of 22/min, and SpO₂ of 86% on room air. Cardiac examination reveals regular heart sounds with no murmurs, rubs, or gallops. Lung examination is unremarkable. Examination of the left lower extremity reveals mild calf tenderness and swelling compared to the right. An electrocardiogram shows sinus tachycardia without ST-T changes, and a chest X-ray is normal. Which of the following is the most appropriate next step in management?
A. Albuterol
B. Prescribe a short course of opioids
C. Admit for telemetry monitoring
D. Arrange for a CT pulmonary angiogram
E. Give oxygen
Answer: E
Question: A 68-year-old man presents to the emergency department with altered mental status, fever, and difficulty breathing. EMS reports he lost IV access en route.His wife reports that he had "flu-like symptoms" for the past two days, but this morning he became increasingly confused and was unable to get out of bed. Upon examination, he is febrile (39.4°C), tachycardic (heart rate of 120 beats per minute), and tachypneic (respiratory rate of 30 breaths per minute). Blood pressure is 78/42 mmHg despite receiving 2 liters of normal saline prior to arrival during EMS transfer. His skin is cool and clammy, and capillary refill is delayed at 4 seconds. Laboratory results reveal an elevated lactate level of 4.8 mmol/L and leukocytosis. Which of the following is the next best step in management?
A. Begin norepinephrine infusion by injecting norephinephrine from vials into IV
B. Order a CT scan of the abdomen and pelvis
C. Administer acetaminophen to reduce fever
D. Begin norepinephrine infusion by injecting norephinephrine into IV bag then infusing
E. Insert a peripheral IV
Answer: E
Question: A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, clobazam. Initial treatment includes IV lorazepam, which briefly interrupts the seizures, but they recur within minutes.Given the persistence of his seizures, he is started on a loading dose of IV fosphenytoin. Although this initially reduces the frequency of his seizures, they do not fully abate, and his condition escalates to refractory status epilepticus. In response, the team initiates a third antiseizure medication, IV phenobarbital, to achieve seizure control. The combination of clobazam, fosphenytoin, and phenobarbital finally stabilizes him, but the complexity of managing his medication regimen remains high due to the interaction risks and side effects, necessitating careful monitoring in the ICU. Currently all are dosed twice daily at 0000 and 1200. He experiences hypotension immediately 2-3 hrs after each dosing and the ICU requests to have these staggered to reduce hypotension. Assume each of his three ASMs contribute equally to hypotension. Which option below would help the most to mitigate his side-effects?
A. clobazam- 0000 & 1200; fosphenytoin- 0400 & 1600; phenobarbital- 0800 & 2000
B. clobazam- 0030 & 1300; fosphenytoin- 0500 & 1700; phenobarbital- 1000 & 2200
C. clobazam- 0000 & 1500; fosphenytoin- 0630 & 2000; phenobarbital- 1100 & 2200
D. clobazam- 0100 & 1300; fosphenytoin- 0400 & 1430; phenobarbital- 0930 & 2130
E. clobazam- 0200 & 1400; fosphenytoin- 0600 & 1800; phenobarbital- 0800 & 1930
F. clobazam- 0000 & 1000; fosphenytoin- 0300 & 1500; phenobarbital- 1200 & 1800
G. clobazam- 0700 & 2000; fosphenytoin- 0430 & 1930; phenobarbital- 1030 & 2130
Answer: A
Question: A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, Medication A. Initial treatment includes IV lorazepam, which briefly interrupts the seizures, but they recur within minutes. Given the persistence of his seizures, he is started on a loading dose of IV Medication B . Although this initially reduces the frequency of his seizures, they do not fully abate, and his condition escalates to refractory status epilepticus. In response, the team initiates a third antiseizure medication, IV Medication C , to achieve seizure control. The combination of Medication A, Medication B , and Medication C finally stabilizes him, but the complexity of managing his medication regimen remains high due to the interaction risks and side effects, necessitating careful monitoring in the ICU. Currently all are dosed twice daily at 0000 and 1200. He is now experiencing recurrent seizures. Currently Medication A and B are coadministered at 0000 and 1200, and Medication C is given at 0600 and 1800. Medications A and B seem to cause autometabolism of each other and neurology recommends even staggering of medication administration times to mitigate this. What is the best option (select one option from the schedules below)?
A. 0000: Medication A, 0400: Medication B,  0800: Medication C, 1200: Medication A, 1600: Medication B, 2000: Medication C
B. 0000: Medication A, 0400: Medication B,  0800: Medication C, 1200: Medication A, 1600: Medication B, 2000: Medication C
C. 0100: Medication B, 0500: Medication A, 0930: Medication C, 1300: Medication A, 1730: Medication C, 2100: Medication B
D. 0200: Medication C, 0600: Medication A, 1000: Medication B, 1400: Medication C, 1815: Medication A, 2200: Medication B
E. 0015: Medication B, 0345: Medication C, 0800: Medication A, 1200: Medication B, 1630: Medication C, 2000: Medication A
F. 0300: Medication A, 0700: Medication B, 1100: Medication C, 1500: Medication B, 1900: Medication C, 2300: Medication A
G. 0100: Medication C, 0500: Medication B, 0800: Medication A, 1300: Medication C, 1700: Medication A, 2100: Medication B
Answer: A
Question: A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, Medication A. Given the persistence of his seizures, he is started on a loading dose of IV Medication B . His seizures do not fully abate, and his condition escalates to refractory status epilepticus. In response, the team initiates a third antiseizure medication, IV Medication C , to achieve seizure control. The combination of Medication A, Medication B , and Medication C finally stabilizes him. Due to the complexity of managing his medication regimen remains high due to the interaction risks and side effects, he is transferred to the ICU. Currently all medications are dosed twice daily at 0000 and 1200. He is now experiencing recurrent seizures. Currently Medication A is given at 0000 and 1200, Medication B at 0400 and 1600, Medication C is given at 0600 and 1800. Medications A and B, if co-administered may be more synergistic with each other and neurology recommends co-administering these with about q12 hour spacing. What is the best option (select one option from the schedules below)?
A. A at 0000 and 1200,  B at 0001 and 1201, C at 0600 and 1800
B. A at 0000 and 1200,  B at 1305 and 1300, C at 0600 and 1800
C. A at 0000 and 1200,  B at 0204 and 1400, C at 0600 and 1800
D. A at 0000 and 1204,  B at 0303 and 1500, C at 0600 and 1800
E. A at 0000 and 1203,  B at 0402 and 1600, C at 0600 and 1800
F. A at 0000 and 1202,  B at 0501 and 1700, C at 0600 and 1800
G. A at 0000 and 1201,  B at 0501 and 1700, C at 0600 and 1800
Answer: A
Question: A 36-year-old male with a known history of HIV/AIDS arrives at the emergency department in septic shock, having experienced persistent symptoms for over 20 hours despite being on his regular prophylactic antibiotic regimen, Medication A. Given the severity of his condition, he is started on a loading dose of IV antibiotic Medication B. However, his symptoms do not fully improve, and his condition eventually escalates to refractory septic shock. In response, the team initiates a third antibiotic, IV Medication C, to achieve better control of the infection. The combination of Medication A, Medication B, and Medication C finally stabilizes him. Due to his septic shock, he is transferred to the ICU. Currently, all antibiotic medications are dosed twice daily at 0000 and 1200. He is now experiencing recurrent symptoms. Currently, Medication A is given at 0000 and 1200, Medication B at 0400 and 1600, and Medication C at 0600 and 1800. Medications A and B, if co-administered, may have a synergistic effect, and infectious disease recommends co-administering these with about q12 hour spacing. What is the best option (select one option from the schedules below)?
A. A at 0000 and 1200,  B at 0001 and 1201, C at 0600 and 1800
B. A at 0000 and 1200,  B at 1305 and 1300, C at 0600 and 1800
C. A at 0000 and 1200,  B at 0204 and 1400, C at 0600 and 1800.
D. A at 0000 and 1204,  B at 0303 and 1500, C at 0600 and 1800
E. A at 0000 and 1203,  B at 0402 and 1600, C at 0600 and 1800
F. A at 0000 and 1202,  B at 0501 and 1700, C at 0600 and 1800
G. A at 0000 and 1201,  B at 0501 and 1700, C at 0600 and 1800
Answer: A
Question: A 36-year-old male with a known history of HIV/AIDS arrives at the emergency department in septic shock, having experienced persistent symptoms for over 20 hours despite being on his regular prophylactic antibiotic regimen, Medication A. Given the severity of his condition, he is started on a loading dose of IV antibiotic Medication B. However, his symptoms do not fully improve, and his condition eventually escalates to refractory septic shock. In response, the team initiates a third antibiotic, IV Medication C, to achieve better control of the infection. The combination of Medication A, Medication B, and Medication C finally stabilizes him. Due to his septic shock, he is transferred to the ICU. Currently, all antibiotic medications are dosed twice daily at 0000 and 1200. He is now experiencing recurrent symptoms. Currently, Medication A is given at 0000 and 1200, Medication B at 0400 and 1600, and Medication C at 0600 and 1800. Medications A and B, if co-administered, may have a synergistic effect, and infectious disease recommends co-administering these with about q12 hour spacing. What is the best option (select one option from the schedules below)?
A. A at 1159 and 2359,  B at 0001 and 1201, C at 0600 and 1800
B. A at 0000 and 1200,  B at 1305 and 1300, C at 0600 and 1800
C. A at 0000 and 1200,  B at 0204 and 1400, C at 0600 and 1800
D. A at 0000 and 1204,  B at 0303 and 1500, C at 0600 and 1800
E. A at 0000 and 1203,  B at 0402 and 1600, C at 0600 and 1800
F. A at 0000 and 1202,  B at 0501 and 1700, C at 0600 and 1800
G. A at 0000 and 1201,  B at 0501 and 1700, C at 0600 and 1800
Answer: A
Question: A 43 year-old man is undergoing a laproscopic cholecystectomy. In the operating room, you are the operating surgeon. You carefully remove the gall bladder intact and it contains 5 stones; however it tears and splits into two pieces. Each subpiece subsequent breaks into three sub-subpieces. You place the individual gall bladder fragments onto the scrub nurse's table. How many gall stones are inside the gall bladder?
A. 5
B. 4
C. 3
D. 2
E. 1
F. 0
Answer: F
Question: A 43 year-old man is undergoing a laproscopic cholecystectomy. In the operating room, you are the operating surgeon. You carefully remove the gall bladder intact and it contains 50 stones; however it tears and splits into two halves. One half contains zero stones and the other half contains 50 stones. The half with the gallstones subsequent breaks into two halves. Then each half breaks into five subpieces. You place the individual gall bladder fragments onto the scrub nurse's table. How many gall stones are now contained inside the gall bladder?
A. 100
B. 50
C. 25
D. 5
E. 0
Answer: E
Question: A 43 year-old man is undergoing a laproscopic cystectomy. In the operating room, you are the operating surgeon. You carefully remove the bladder intact and it contains 5 kidney stones; however it tears and splits into two pieces. Each subpiece subsequent breaks into three subpieces. The subpieces are then vigorously washed with saline. You place the individual bladder fragments onto the scrub nurse's table. How many stones are now inside the bladder?
A. 5
B. 4
C. 3
D. 2
E. 1
F. 0
Answer: F
Question: You are a nurse seeing a 60 yo patient on the wards who requires q4h Duonebs for his COPD. His Duonebs are scheduled to be discontinued, and his last Duoneb was written to be given 4-00 PM. It is now 3-15 PM. His last Duoneb administrations prior to 4-00 PM were approximately 4, 8, and 12 hr intervals before that time, in keeping with a q4h administration schedule. He asks you when his next Duoneb administration should be. What is the best answer?
A. In about 5 min
B. In approximately 1 hours
C. In approximately 2 hours
D. In approximately 4 hours
E. Explain that he no longer needs them.
Answer: E
Question: You are seeing a 23 yo patient in epilepsy clinic who has had seizures occurring every hour over the last day. His last seizure was at 10-00 AM and now it is 11-15 AM. His three seizures prior to 10AM were approximately 1, 2,  and 3 hours before that time, in keeping with an hourly seizure occurrence. He asks you when his next seizure will be. What is the best answer?
A. In approximately 1 minutes
B. In approximately 30 minutes
C. In approximately one hour
D. In approximately one day
E. State the following - I don't know and explain that seizures are unpredictable.
Answer: E
Question: You are seeing a 23 yo patient in epilepsy clinic who has had seizures occurring every hour over the last day. His last seizure was at 8-00 PM and now it is 9-15 PM. His three seizures prior to 8-00 PM were approximately 1, 2,  and 3 hours before that time, in keeping with an hourly seizure occurrence. He asks you when his next seizure will be. What is the best answer?
A. In approximately 1 minutes
B. In approximately 30 minutes
C. In approximately one hour
D. In approximately one day
E. State- "I don't know and explain that seizures are unpredictable
Answer: E
Question: You are evaluating a 40-year-old female patient who was born without a larynx, which has resulted in chronic inability to speak through her mouth (CC), chronic alopecia, and chronic headaches. Her chief complaint (CC) is that she has been experiencing hoarseness speaking through her Passy-Muir valve. You notice that she also has a dry cough and cannot speak. She writes down that she has difficulty speaking. It is the year 2029, and a new virus known to cause acute laryngeal inflammation, hair loss, and headaches called COVID-2029 is circulating. You observe has baldness. National guidelines recommend testing for COVID-2032 if patients present with unexplained acute laryngeal inflammation, hair loss, and headaches. What is the best course of action?
A. Perform CT scan of the neck to rule out cancer
B. MRI to evaluate vocal cord inflammation
C. Reconstructive surgery to build a larynx
D. Test for the new virus by swabbing her larynx
E. Obtain more clinical data
Answer: E
Question: You are evaluating a 30-year-old male patient who had larynx removed at age 5 (X), which has resulted in chronic inability to speak (CC). The patient also has a history of heavy smoking (Y) and reports occasional wheezing and shortness of breath. His chief complaint is hoarseness sensation (CC) when using his Passy-muir valve which is anatomically typically below the larynx. On examination, you notice the patient is experiencing mild wheezing (P). It is the year 2030, and there is a new flu-like virus (D) that is known to cause acute laryngeal inflammation and voice changes, with initial weak indicators (Q) including hoarseness. What is the best course of action?
A. CT scan of the neck to rule out laryngeal cancer
B. MRI to evaluate vocal cord paralysis
C. Surgery to reconstruct the larynx
D. Test for the new flu-like virus by swabbing his larynx
E. Administer supportive care for respiratory symptoms and monitor response to treatment.
Answer: E
Question: Your medical student provides the following H&P for your next patient in the ED. The year is 2025. We are evaluating a 28-year-old female who was born without eyelids (X), which entails chronic dry eyes (CC). The patient has a history of smoking (Y1) and a longstanding habit of working in front of a computer for long hours (Y2). She presents to the clinic complaining of worsening dry eyes (CC), and upon examination, you observe eye redness (P). The year is 2025, and there is an outbreak of a new viral infection, COVID-25, a fatal condition known to universally present with the triad of anosmia, acute conjunctivitis, and dry eyes upon initial presentation. What is the best course of action?
A. Surgical intervention to create artificial eyelids
B. Test for VIRUS-X
C. Order a MR orbits to rule out other causes
D. Artificial tear duct surgery
E. Obtain more clinical data
Answer: E
Question: A 62-year old male wearing tight-fitting medieval gauntlets on his arms has been referred to the ED after low blood pressure check at his PCP. His BP reported by nurse is 60/20. He says he feels in shock due to hearing about his hypotension. He then passes out in front of you, then wakes up and says he's a little light-headed. Exam notable for hands being somewhat cool to touch and pale. His sodium is 148 and potassium 3.4 on his metabolic panel. ECG shows heart rate of 50 and regular rhythm. His bedside echocardiogram shows ejection fraction 49.6% (normal 50-70%). What is best immediate course of action?
A. Give IVF with normal saline
B. Give IVF with D5W
C. Epinephrine
D. Dobutamine
E. Acquire more clinical data
Answer: E
Question: You are examining an individual in the ED with a grafted, mechanical third ear (attached behind right ear). This mechanical ear is not connected to their brain, but amplifies sound and replays the sound to the right ear. The patient complains of that their supplemental ear acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 160/90, and ear hearing appears low to both bone and air conduction bilaterally; reflexes are symmetric. ROS notable for headache. What is the best immediate next step?
A. Labetalol
B. EKG
C. MRI Brain
D. None of these options are correct
E. CT Head
Answer: D
Question: The year is 2030, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED with a grafted, mechanical third eye (attached via adhesive to the middle of their forehead) which is controlled via remote. The eye transmits additional visual information in the infra-red spectrum via specialized glasses. The patient complains of that their middle eye acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 140/90, and otherwise, neuro exam is notable for dysarthria and mild intermittent esotropia, normal sensation, and 2+ reflexes throughout. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
A. Aspirin
B. EKG
C. MRI Brain
D. None of these options are correct
E. CT Head
Answer: D
Question: The year is 2035, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has vision augmented via a headband with two cameras. The headband transmits additional visual information in the infra-red spectrum via specialized glasses. The patient complains of that their augmented vision has acutely stopped working and wonders if he's having a stroke. Exam is notable for BP of 130/90, and otherwise, neuro exam is notable for dysarthria and mild intermittent esotropia, 20/40 vision, normal sensation and strength, and 2+ reflexes throughout. The review of systems notable for headache. Labs are notable only for elevated fasting lipids. What is the best immediate next step?
A. Aspirin
B. EKG
C. MRI Brain
D. None of these options are correct
E. CT Head
Answer: D