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stellalisy

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mediQ

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[ "A 56-year-old woman presents to the emergency department with acute onset of pain and redness of the skin of her right arm for the past 3 days.", "She has had type 2 diabetes mellitus for the past 22 years, but she is not compliant with her medications.", "Her temperature is 38.0°C (100.4°F), pulse is 105/min, and blood pressure is 116/74 mm Hg.", "On physical examination, her forearm is tender and erythematous.", "She is diagnosed with acute cellulitis, and intravenous clindamycin is started.", "On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea, fever, and abdominal tenderness without rigidity." ]

[ "1. A 56-year-old woman presents to the emergency department.", "2. She has had type 2 diabetes mellitus for the past 22 years.", "3. She is not compliant with her medications.", "4. Her temperature is 38.0°C (100.4°F).", "5. Her pulse is 105/min.", "6. Her blood pressure is 116/74 mm Hg.", "7. On physical examination, her forearm is tender and erythematous.", "8. She is diagnosed with acute cellulitis.", "9. Intravenous clindamycin is started.", "10. On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea.", "11. She also complains of fever.", "12. She also complains of abdominal tenderness without rigidity." ]

[ "1. She has had type 2 diabetes mellitus for the past 22 years.", "2. She is not compliant with her medications.", "3. Her temperature is 38.0°C (100.4°F).", "4. Her pulse is 105/min.", "5. Her blood pressure is 116/74 mm Hg.", "6. On physical examination, her forearm is tender and erythematous.", "7. She is diagnosed with acute cellulitis.", "8. Intravenous clindamycin is started.", "9. On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea.", "10. The patient complains of fever.", "11. The patient complains of abdominal tenderness without rigidity." ]

[ "A group of researchers attempts to determine the mean fasting triglyceride levels in patients between the ages of 30 and 60 in a suburb of Tampa, FL.", "Over the course of several years, the team manages to obtain the blood levels of a random sample of 10,000 volunteers who fit their inclusion criteria.", "The blood levels are measured and demonstrate a standard deviation of 5." ]

[ "1. A group of researchers attempts to determine the mean fasting triglyceride levels in patients.", "2. The patients are between the ages of 30 and 60.", "3. The research is conducted in a suburb of Tampa, FL.", "4. The team manages to obtain the blood levels of a random sample of 10,000 volunteers.", "5. The volunteers fit the inclusion criteria.", "6. The blood levels are measured.", "7. The blood levels demonstrate a standard deviation of 5." ]

[ "1. The team obtained the blood levels of a random sample of 10,000 volunteers.", "2. The volunteers fit the team's inclusion criteria.", "3. The blood levels were measured.", "4. The blood levels demonstrated a standard deviation of 5." ]

[ "A 14-year-old girl is brought to the physician by her mother for evaluation of several bruises on her lower extremities.", "She has had these bruises for about 6 weeks, and the mother is concerned that she might be bullied at school.", "The patient has had increasing fatigue and paleness over the past several days.", "She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine.", "She appears pale and ill.", "Her temperature is 37.8°C (100.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg.", "The lungs are clear to auscultation.", "Examination shows a soft, nontender abdomen with no organomegaly.", "There are several subcutaneous purple spots on her legs bilaterally.", "Her hemoglobin concentration is 8.4 g/dL, leukocyte count is 2,600/mm3, platelet count is 18,000/mm3, and reticulocyte count is 0.3%.", "Serum electrolyte concentrations are within normal limits." ]

[ "1. Patient is a 14-year-old girl.", "2. Patient has several bruises on her lower extremities for 6 weeks.", "3. Mother is concerned that patient might be bullied at school.", "4. Patient has increasing fatigue and paleness over the past several days.", "5. Patient has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine.", "6. Patient appears pale and ill.", "7. Patient's temperature is 37.8°C (100.1°F).", "8. Patient's pulse is 115/min.", "9. Patient's blood pressure is 100/60 mm Hg.", "10. Lungs are clear to auscultation.", "11. Examination shows a soft, nontender abdomen with no organomegaly.", "12. Patient has several subcutaneous purple spots on her legs bilaterally.", "13. Patient's hemoglobin concentration is 8.4 g/dL.", "14. Patient's leukocyte count is 2,600/mm3.", "15. Patient's platelet count is 18,000/mm3.", "16. Patient's reticulocyte count is 0.3%.", "17. Serum electrolyte concentrations are within normal limits." ]

[ "1. She has had bruises for about 6 weeks.", "2. The mother is concerned that she might be bullied at school.", "3. The patient has had increasing fatigue and paleness over the past several days.", "4. She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine.", "5. She appears pale and ill.", "6. Her temperature is 37.8°C (100.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg.", "7. The lungs are clear to auscultation.", "8. Examination shows a soft, nontender abdomen with no organomegaly.", "9. There are several subcutaneous purple spots on her legs bilaterally.", "10. Her hemoglobin concentration is 8.4 g/dL.", "11. Leukocyte count is 2,600/mm3.", "12. Platelet count is 18,000/mm3.", "13. Reticulocyte count is 0.3%.", "14. Serum electrolyte concentrations are within normal limits." ]

[ "A 51-year-old man comes to the emergency department because of a 3-day history of shortness of breath, fever, and chills.", "He has no history of serious illness.", "His temperature is 39.5°C (103.1°F).", "Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex that radiates to the axilla.", "Crackles are heard in both lower lung fields.", "Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles." ]

[ "1. A 51-year-old man comes to the emergency department.", "2. He has a 3-day history of shortness of breath, fever, and chills.", "3. He has no history of serious illness.", "4. His temperature is 39.5°C (103.1°F).", "5. Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex.", "6. The murmur radiates to the axilla.", "7. Crackles are heard in both lower lung fields.", "8. Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles." ]

[ "1. He has no history of serious illness.", "2. His temperature is 39.5°C (103.1°F).", "3. Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex that radiates to the axilla.", "4. Crackles are heard in both lower lung fields.", "5. Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles." ]

[ "An investigator is studying the maternal and fetal consequences of a recent spike in benzodiazepine addiction in Ireland.", "She is particularly interested in whether benzodiazepine use contributes to oral cleft deformities in newborns exposed to alprazolam, clonazepam, or lorazepam during the first trimester.", "The investigator uses statistical data from the local demographic institute to calculate the number of newly diagnosed cases of oral cleft deformities in Ireland over the past 5 years." ]

[ "1. An investigator is studying the maternal and fetal consequences of a recent spike in benzodiazepine addiction in Ireland.", "2. She is particularly interested in whether benzodiazepine use contributes to oral cleft deformities in newborns exposed to alprazolam, clonazepam, or lorazepam during the first trimester.", "3. The investigator uses statistical data from the local demographic institute.", "4. The investigator is calculating the number of newly diagnosed cases of oral cleft deformities in Ireland over the past 5 years." ]

[ "1. The investigator is interested in benzodiazepine use and oral cleft deformities in newborns.", "2. The focus is on alprazolam, clonazepam, and lorazepam use during the first trimester.", "3. Statistical data from the local demographic institute is used.", "4. The data is used to calculate the number of newly diagnosed cases of oral cleft deformities in Ireland.", "5. The data covers the past 5 years." ]

[ "A 55-year-old woman comes to the office for preventive health care.", "She has recently migrated to the United States from Hong Kong.", "Her past medical history is noncontributory.", "She denies smoking cigarettes or drinking alcohol.", "She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy.", "Her father died of a stroke at 59 years old and her mother died of a heart attack at 66 years old.", "She has 2 daughters who are in good health.", "Temperature is 37°C (98.7°F), blood pressure is 113/85 mm Hg, pulse is 69/min, respiratory rate is 14/min, and BMI is 24 kg/m2.", "Cardiopulmonary and abdominal examinations are negative. | Laboratory test | Complete blood count | Hemoglobin 12.5 g/dL | MCV 88 fl | Leukocytes 5,500/mm3 | Platelets 155,000/mm3 | Basic metabolic panel | Serum Na+ 135 mEq/L | Serum K+ 3.7 mEq/L | Serum Cl- 106 mEq/L | Serum HCO3- 25 mEq/L | BUN 10 mg/dL | Serum creatinine 0.8 mg/dL | Liver function test | Serum bilirubin 0.8 mg/dL | AST 30 U/L | ALT 35 U/L | ALP 130 U/L (20–70 U/L) | ." ]

[ "1. A 55-year-old woman comes to the office for preventive health care.", "2. She has recently migrated to the United States from Hong Kong.", "3. Her past medical history is noncontributory.", "4. She denies smoking cigarettes or drinking alcohol.", "5. She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy.", "6. Her father died of a stroke at 59 years old.", "7. Her mother died of a heart attack at 66 years old.", "8. She has 2 daughters who are in good health.", "9. Temperature is 37°C (98.7°F).", "10. Blood pressure is 113/85 mm Hg.", "11. Pulse is 69/min.", "12. Respiratory rate is 14/min.", "13. BMI is 24 kg/m2.", "14. Cardiopulmonary and abdominal examinations are negative.", "15. Laboratory test: Complete blood count.", "16. Hemoglobin 12.5 g/dL.", "17. MCV 88 fl.", "18. Leukocytes 5,500/mm3.", "19. Platelets 155,000/mm3.", "20. Laboratory test: Basic metabolic panel.", "21. Serum Na+ 135 mEq/L.", "22. Serum K+ 3.7 mEq/L.", "23. Serum Cl- 106 mEq/L.", "24. Serum HCO3- 25 mEq/L.", "25. BUN 10 mg/dL.", "26. Serum creatinine 0.8 mg/dL.", "27. Laboratory test: Liver function test.", "28. Serum bilirubin 0.8 mg/dL.", "29. AST 30 U/L.", "30. ALT 35 U/L.", "31. ALP 130 U/L (20–70 U/L)." ]

[ "1. She has recently migrated to the United States from Hong Kong.", "2. Her past medical history is noncontributory.", "3. She denies smoking cigarettes or drinking alcohol.", "4. She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy.", "5. Her father died of a stroke at 59 years old and her mother died of a heart attack at 66 years old.", "6. She has 2 daughters who are in good health.", "7. Temperature is 37°C (98.7°F), blood pressure is 113/85 mm Hg, pulse is 69/min, respiratory rate is 14/min, and BMI is 24 kg/m2.", "8. Cardiopulmonary and abdominal examinations are negative.", "9. Laboratory test: Complete blood count: Hemoglobin 12.5 g/dL, MCV 88 fl, Leukocytes 5,500/mm3, Platelets 155,000/mm3.", "10. Basic metabolic panel: Serum Na+ 135 mEq/L, Serum K+ 3.7 mEq/L, Serum Cl- 106 mEq/L, Serum HCO3- 25 mEq/L, BUN 10 mg/dL, Serum creatinine 0.8 mg/dL.", "11. Liver function test: Serum bilirubin 0.8 mg/dL, AST 30 U/L, ALT 35 U/L, ALP 130 U/L (20–70 U/L)." ]

[ "A 33-year-old man presents to his primary care practitioner, complaining about the presence of white spots in both of his hands.", "He states that the white spots have expanded in the last few months; they are not tender nor ulcerated.", "His past medical history is relevant for hypothyroidism.", "Upon physical examination, the patient shows hypopigmented macules on both hands and on the back and shoulders adjacent to a patch of skin, with signs of excoriation and scratching.", "Under the Wood’s lamp, the skin lesions on the hands, back, and shoulders show fluorescence.", "There are no signs of inflammation in any of the skin lesions.", "The vital signs of the patient are within normal limits." ]

[ "1. Patient is 33 years old.", "2. Patient complains of white spots in both hands.", "3. White spots have expanded in last few months.", "4. White spots are not tender nor ulcerated.", "5. Patient has past medical history of hypothyroidism.", "6. Physical examination shows hypopigmented macules on both hands, back, and shoulders.", "7. Skin lesions show signs of excoriation and scratching.", "8. Skin lesions show fluorescence under Wood's lamp.", "9. No signs of inflammation in any of the skin lesions.", "10. Patient's vital signs are within normal limits." ]

[ "1. The patient reports that the white spots have expanded in the last few months.", "2. The white spots are not tender nor ulcerated.", "3. The patient has a past medical history of hypothyroidism.", "4. Upon physical examination, the patient shows hypopigmented macules on both hands and on the back and shoulders adjacent to a patch of skin, with signs of excoriation and scratching.", "5. Under the Wood’s lamp, the skin lesions on the hands, back, and shoulders show fluorescence.", "6. There are no signs of inflammation in any of the skin lesions.", "7. The vital signs of the patient are within normal limits." ]

[ "A 3-year-old boy is brought to the emergency department by his mother.", "He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago.", "She had briefly left him lying on his back playing with toys and when she returned he was choking.", "She attempted the Heimlich maneuver with no improvement.", "He has a heart rate is 120/min, respiratory rate is difficult to evaluate, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F).", "A respiratory exam reveals wheezing and decreased breath sounds on the right side.", "A stat chest X-ray is ordered." ]

[ "1. A 3-year-old boy is brought to the emergency department by his mother.", "2. He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago.", "3. She had briefly left him lying on his back playing with toys and when she returned he was choking.", "4. She attempted the Heimlich maneuver with no improvement.", "5. He has a heart rate of 120/min.", "6. He has a blood pressure of 110/65 mm Hg.", "7. He has a temperature of 37.0°C (98.6°F).", "8. His respiratory rate is difficult to evaluate.", "9. A respiratory exam reveals wheezing and decreased breath sounds on the right side.", "10. A stat chest X-ray is ordered." ]

[ "1. He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago.", "2. She had briefly left him lying on his back playing with toys and when she returned he was choking.", "3. She attempted the Heimlich maneuver with no improvement.", "4. His heart rate is 120/min.", "5. His respiratory rate is difficult to evaluate.", "6. His blood pressure is 110/65 mm Hg.", "7. His temperature is 37.0°C (98.6°F).", "8. A respiratory exam reveals wheezing and decreased breath sounds on the right side.", "9. A stat chest X-ray is ordered." ]

[ "A 38-year-old man presents with weakness, loss of appetite, headaches, and irritability.", "He developed these symptoms gradually over the past 4 months.", "He was diagnosed with Crohn’s disease, which was moderate at the time of diagnosis 6 months ago.", "He takes methotrexate 15 mg, which effectively controls his symptoms.", "The patient’s vital signs include: blood pressure 105/70 mm Hg, heart rate 102/min, respiratory rate 16/min, and temperature 36.4℃ (97.5℉).", "On physical examination, the patient is pale.", "His lungs are clear to auscultation.", "His heart sounds are rhythmic; a short early systolic murmur can be heard over the apex of the heart.", "The rest of the exam is unremarkable.", "The patient’s blood test shows the following findings: | Erythrocytes 2.7 x 109/mm3 | Hb 9.3 g/dL | Hct 37% | Mean corpuscular hemoglobin 45.2 pg/cell (2.8 fmol/cell) | Mean corpuscular volume 122 µm3 (122 fL) | Reticulocyte count 0.4% | Total leukocyte count 3050/mm3 | Neutrophils 62% | Lymphocytes 32% | Eosinophils 1% | Monocytes 5% | Basophils 0% | Platelet count 199,000/mm3 | ." ]

[ "1. Patient is 38 years old.", "2. Patient has weakness, loss of appetite, headaches, and irritability.", "3. Symptoms developed gradually over the past 4 months.", "4. Patient was diagnosed with Crohn's disease 6 months ago.", "5. Disease was moderate at time of diagnosis.", "6. Patient takes methotrexate 15 mg, which effectively controls symptoms.", "7. Blood pressure is 105/70 mm Hg.", "8. Heart rate is 102/min.", "9. Respiratory rate is 16/min.", "10. Temperature is 36.4℃ (97.5℉).", "11. Patient is pale on physical examination.", "12. Lungs are clear to auscultation.", "13. Heart sounds are rhythmic.", "14. Short early systolic murmur can be heard over the apex of the heart.", "15. Rest of exam is unremarkable.", "16. Erythrocytes count is 2.7 x 109/mm3.", "17. Hb is 9.3 g/dL.", "18. Hct is 37%.", "19. Mean corpuscular hemoglobin is 45.2 pg/cell (2.8 fmol/cell).", "20. Mean corpuscular volume is 122 µm3 (122 fL).", "21. Reticulocyte count is 0.4%.", "22. Total leukocyte count is 3050/mm3.", "23. Neutrophils are 62%.", "24. Lymphocytes are 32%.", "25. Eosinophils are 1%.", "26. Monocytes are 5%.", "27. Basophils are 0%.", "28. Platelet count is 199,000/mm3." ]

[ "1. Symptoms developed gradually over the past 4 months.", "2. Diagnosed with Crohn’s disease 6 months ago.", "3. Crohn’s disease was moderate at the time of diagnosis.", "4. Takes methotrexate 15 mg.", "5. Methotrexate effectively controls his symptoms.", "6. Vital signs: blood pressure 105/70 mm Hg, heart rate 102/min, respiratory rate 16/min, temperature 36.4℃ (97.5℉).", "7. Patient is pale on physical examination.", "8. Lungs are clear to auscultation.", "9. Rhythmic heart sounds; a short early systolic murmur can be heard over the apex of the heart.", "10. Rest of the exam is unremarkable.", "11. Blood test findings: Erythrocytes 2.7 x 109/mm3, Hb 9.3 g/dL, Hct 37%, Mean corpuscular hemoglobin 45.2 pg/cell (2.8 fmol/cell), Mean corpuscular volume 122 µm3 (122 fL), Reticulocyte count 0.4%, Total leukocyte count 3050/mm3, Neutrophils 62%, Lymphocytes 32%, Eosinophils 1%, Monocytes 5%, Basophils 0%, Platelet count 199,000/mm3." ]

[ "A 75-year-old man with coronary artery disease and mitral valve stenosis status-post coronary artery bypass graft and mitral bioprosthetic valve replacement is evaluated in the intensive care unit.", "His postsurgical course was complicated by ventilator-associated pneumonia and bilateral postoperative pleural effusions requiring chest tubes.", "He has been weaned from the ventilator and has had his chest tubes removed but has required frequent suctioning to minimize aspirations.", "He has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks.", "He is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole.", "He has a history of prostate cancer status post radical prostatectomy.", "His temperature is 96°F (35.6°C), blood pressure is 95/55 mmHg, pulse is 50/min, and respirations are 20/min.", "On physical exam, he is not alert and oriented but responds with moans when stimulated.", "His laboratory data are listed below: | | Serum: | Na+: 145 mEq/L | Cl-: 110 mEq/L | K+: 3.4 mEq/L | HCO3-: 26 mEq/L | BUN: 10 mg/dL | Glucose: 112 mg/dL | Creatinine: 1.4 mg/dL | Thyroid-stimulating hormone: 10 µU/mL | Ca2+: 11.1 mg/dL | PO4-: 1.0 mg/dL | AST: 6 U/L | ALT: 10 U/L | Albumin: 2.5 mg/dL | Lactate dehydrogenase: 200 U/L (140-280 U/L) | Haptoglobin: 150 mg/dL (30-200 mg/dL) | 1,25-(OH)2 D3: 10 pg/mL (15-75 pg/mL) | Parathyroid hormone: 9 pg/mL (10-60 pg/mL) | | Leukocyte count: 10,000 cells/mm^3 with normal differential | Hemoglobin: 9 g/dL | Hematocrit: 30 % | Platelet count: 165,000 /mm^3 | | His electrocardiogram and chest radiograph are shown in Figures A and B." ]

[ "1. Patient is a 75-year-old man with coronary artery disease and mitral valve stenosis.", "2. Patient has had coronary artery bypass graft and mitral bioprosthetic valve replacement.", "3. Patient's postsurgical course was complicated by ventilator-associated pneumonia and bilateral postoperative pleural effusions requiring chest tubes.", "4. Patient has been weaned from the ventilator and has had his chest tubes removed but has required frequent suctioning to minimize aspirations.", "5. Patient has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks.", "6. Patient is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole.", "7. Patient has a history of prostate cancer status post radical prostatectomy.", "8. Patient's temperature is 96°F (35.6°C).", "9. Patient's blood pressure is 95/55 mmHg.", "10. Patient's pulse is 50/min.", "11. Patient's respirations are 20/min.", "12. Patient is not alert and oriented but responds with moans when stimulated.", "13. Patient's serum Na+ is 145 mEq/L.", "14. Patient's serum Cl- is 110 mEq/L.", "15. Patient's serum K+ is 3.4 mEq/L.", "16. Patient's serum HCO3- is 26 mEq/L.", "17. Patient's serum BUN is 10 mg/dL.", "18. Patient's serum glucose is 112 mg/dL.", "19. Patient's serum creatinine is 1.4 mg/dL.", "20. Patient's serum thyroid-stimulating hormone is 10 µU/mL.", "21. Patient's serum Ca2+ is 11.1 mg/dL.", "22. Patient's serum PO4- is 1.0 mg/dL.", "23. Patient's serum AST is 6 U/L.", "24. Patient's serum ALT is 10 U/L.", "25. Patient's serum albumin is 2.5 mg/dL.", "26. Patient's serum lactate dehydrogenase is 200 U/L (140-280 U/L).", "27. Patient's serum haptoglobin is 150 mg/dL (30-200 mg" ]

[ "1. His postsurgical course was complicated by ventilator-associated pneumonia.", "2. His postsurgical course was complicated by bilateral postoperative pleural effusions requiring chest tubes.", "3. He has been weaned from the ventilator.", "4. He has had his chest tubes removed.", "5. He has required frequent suctioning to minimize aspirations.", "6. He has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks.", "7. He is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole.", "8. He has a history of prostate cancer status post radical prostatectomy.", "9. His temperature is 96°F (35.6°C).", "10. His blood pressure is 95/55 mmHg.", "11. His pulse is 50/min.", "12. His respirations are 20/min.", "13. On physical exam, he is not alert and oriented but responds with moans when stimulated.", "14. Serum: Na+: 145 mEq/L.", "15. Serum: Cl-: 110 mEq/L.", "16. Serum: K+: 3.4 mEq/L.", "17. Serum: HCO3-: 26 mEq/L.", "18. Serum: BUN: 10 mg/dL.", "19. Serum: Glucose: 112 mg/dL.", "20. Serum: Creatinine: 1.4 mg/dL.", "21. Serum: Thyroid-stimulating hormone: 10 µU/mL.", "22. Serum: Ca2+: 11.1 mg/dL.", "23. Serum: PO4-: 1.0 mg/dL.", "24. Serum: AST: 6 U/L.", "25. Serum: ALT: 10 U/L.", "26. Serum: Albumin: 2.5 mg/dL.", "27. Serum: Lactate dehydrogenase: 200 U/L (140-280 U/L).", "28. Serum: Haptoglobin: 150 mg/dL (30-200 mg/dL).", "29. Serum: 1,25-(OH)2 D3: 10 pg/mL (15-75 pg/mL).", "30. Serum: Parathyroid hormone: 9 pg/mL (10-60 pg/mL).", "31. Leukocyte count: 10,000 cells/mm^3 with normal differential.", "32. Hemoglobin: 9 g/dL.", "33. Hematocrit: 30 %.", "34. Platelet count: 165,000 /mm^3.", "35. His electrocardiogram and chest radiograph are shown in Figures A and B." ]

[ "A 35-year-old woman presents for a follow-up.", "The patient was diagnosed with major depressive disorder 16 months ago and has tried multiple medications with no improvement, namely bupropion, fluoxetine, sertraline, and imipramine.", "Upon inquiry, she assures the psychiatrist that she has been fully compliant with her medications so far but stopped her current medications a few weeks back as they did not help either.", "Her husband suggested her to try a herbal preparation for improving her mood.", "She also noted that she felt temporarily better while attending her sister’s wedding last weekend, but she still remains depressed most of the times." ]

[ "1. A 35-year-old woman presents for a follow-up.", "2. The patient was diagnosed with major depressive disorder 16 months ago.", "3. The patient has tried multiple medications with no improvement.", "4. The medications tried were bupropion, fluoxetine, sertraline, and imipramine.", "5. The patient has been fully compliant with her medications so far.", "6. The patient stopped her current medications a few weeks back.", "7. The patient's husband suggested her to try a herbal preparation for improving her mood.", "8. The patient felt temporarily better while attending her sister’s wedding last weekend.", "9. The patient still remains depressed most of the times." ]

[ "1. The patient was diagnosed with major depressive disorder 16 months ago.", "2. The patient has tried multiple medications with no improvement, including bupropion, fluoxetine, sertraline, and imipramine.", "3. The patient has been fully compliant with her medications so far.", "4. The patient stopped her current medications a few weeks back as they did not help.", "5. The patient's husband suggested her to try a herbal preparation for improving her mood.", "6. The patient felt temporarily better while attending her sister’s wedding last weekend.", "7. The patient still remains depressed most of the times." ]

[ "A 17-year-old boy is brought in by paramedics to the emergency department.", "He was found down at a family picnic.", "The boy's parents state that he tried many new foods at the picnic.", "Additionally, because it is springtime, many insects were out while he was playing football.", "His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 33/min, and oxygen saturation is 84% on room air.", "Physical exam is notable for tachycardia and very minimal breath sounds bilaterally.", "No jugular venous distention is noted and an abdominal exam is within normal limits." ]

[ "1. A 17-year-old boy was brought in by paramedics to the emergency department.", "2. He was found down at a family picnic.", "3. The boy's parents state that he tried many new foods at the picnic.", "4. It is springtime.", "5. Many insects were out while he was playing football.", "6. His temperature is 99.5°F (37.5°C).", "7. His blood pressure is 127/68 mmHg.", "8. His pulse is 120/min.", "9. His respirations are 33/min.", "10. His oxygen saturation is 84% on room air.", "11. Physical exam is notable for tachycardia.", "12. Very minimal breath sounds bilaterally.", "13. No jugular venous distention is noted.", "14. Abdominal exam is within normal limits." ]

[ "1. He was found down at a family picnic.", "2. The boy's parents state that he tried many new foods at the picnic.", "3. Many insects were out while he was playing football due to springtime.", "4. His temperature is 99.5°F (37.5°C).", "5. His blood pressure is 127/68 mmHg.", "6. His pulse is 120/min.", "7. His respirations are 33/min.", "8. His oxygen saturation is 84% on room air.", "9. Physical exam is notable for tachycardia.", "10. Physical exam is notable for very minimal breath sounds bilaterally.", "11. No jugular venous distention is noted.", "12. An abdominal exam is within normal limits." ]

[ "A 45-year-old woman comes to the emergency department with her 17-year-old son because she believes she has been poisoned by her ex-husband.", "She reports that her coffee tasted “strange” this morning.", "After breakfast, she then saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car.", "She says that since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son.", "She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her.", "The son also reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide.", "He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet.", "The mother's vital signs are within normal limits.", "Physical examination shows no abnormalities.", "Arterial blood gas analysis on room air shows a pH of 7.4.", "Toxicology screening is negative." ]

[ "1. Patient is a 45-year-old woman.", "2. Patient is accompanied by her 17-year-old son.", "3. Patient believes she has been poisoned by her ex-husband.", "4. Patient reports her coffee tasted “strange” this morning.", "5. Patient saw a black car drive by the house.", "6. Patient's ex-husband drives a black car.", "7. Patient and her ex-husband divorced 3 years ago.", "8. Patient's ex-husband has been seeking revenge.", "9. Patient believes her ex-husband has installed cameras in her apartment to spy on her and their son.", "10. Patient has never seen any of these cameras.", "11. Patient can sometimes hear cameras beeping and feel them recording her when she is alone in the apartment.", "12. Patient's son reports her coffee mug smelled of bitter almonds.", "13. Patient's son suspects the smell was cyanide.", "14. Patient's son agrees with the mother's distrust towards his father.", "15. Patient's son has occasionally heard a camera beeping but has not been able to find any cameras yet.", "16. Patient's vital signs are within normal limits.", "17. Physical examination shows no abnormalities.", "18. Arterial blood gas analysis on room air shows a pH of 7.4.", "19. Toxicology screening is negative." ]

[ "1. She reports that her coffee tasted “strange” this morning.", "2. After breakfast, she saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car.", "3. Since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son.", "4. She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her.", "5. The son reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide.", "6. He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet.", "7. The mother's vital signs are within normal limits.", "8. Physical examination shows no abnormalities.", "9. Arterial blood gas analysis on room air shows a pH of 7.4.", "10. Toxicology screening is negative." ]

[ "A 2-year-old boy is brought to the physician after his adoptive mother observed jerking movements of his arms and legs earlier that morning.", "He was adopted from an orphanage in Albania at 4 months of age.", "He has a history of intellectual disability.", "Examination shows pale skin and light blue eyes.", "There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities." ]

[ "1. A 2-year-old boy was brought to the physician.", "2. His adoptive mother observed jerking movements of his arms and legs earlier that morning.", "3. He was adopted from an orphanage in Albania at 4 months of age.", "4. He has a history of intellectual disability.", "5. Examination shows pale skin and light blue eyes.", "6. There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities." ]

[ "1. He was adopted from an orphanage in Albania at 4 months of age.", "2. He has a history of intellectual disability.", "3. Examination shows pale skin.", "4. Examination shows light blue eyes.", "5. There is a dry rash on the extensor surfaces of the extremities.", "6. There is an eczematous rash on the extensor surfaces of the extremities.", "7. There is a scaly rash on the extensor surfaces of the extremities." ]

[ "A 45-year-old man comes to the physician because of a 4-month history of increased frequency of urination.", "He wakes up several times a night to urinate and feels fatigued during the day.", "He also complains of increased thirst; he drinks multiple liters of water and soda daily and still feels thirsty.", "Vital signs are within normal limits.", "Physical examination shows patches of velvety hyperpigmentation in the axilla and on the posterior neck." ]

[ "1. A 45-year-old man comes to the physician.", "2. He has a 4-month history of increased frequency of urination.", "3. He wakes up several times a night to urinate.", "4. He feels fatigued during the day.", "5. He complains of increased thirst.", "6. He drinks multiple liters of water and soda daily.", "7. He still feels thirsty.", "8. Vital signs are within normal limits.", "9. Physical examination shows patches of velvety hyperpigmentation in the axilla.", "10. Physical examination shows patches of velvety hyperpigmentation on the posterior neck." ]

[ "1. He wakes up several times a night to urinate.", "2. He feels fatigued during the day.", "3. He complains of increased thirst.", "4. He drinks multiple liters of water and soda daily.", "5. He still feels thirsty.", "6. Vital signs are within normal limits.", "7. Physical examination shows patches of velvety hyperpigmentation in the axilla.", "8. Physical examination shows patches of velvety hyperpigmentation on the posterior neck." ]

[ "A 69-year-old man comes to the physician with a 9-month history of worsening shortness of breath on exertion and need to urinate at night.", "He occasionally has palpitations but does not have chest pain.", "The patient had a transient ischemic attack 5 years ago for which he underwent right-sided carotid endarterectomy.", "He has hypertension and type 2 diabetes mellitus.", "Current medications include metformin, lisinopril, aspirin, and simvastatin.", "He appears fatigued.", "His pulse is 61/min, blood pressure is 120/75 mmHg, and respirations are 25/min.", "Pulse oximetry shows an oxygen saturation of 96%.", "Examination shows cold extremities.", "There are no murmurs or rubs on cardiac auscultation.", "Fine, bilateral crackles are heard at the lung bases.", "There is 2+ lower extremity edema.", "An ECG shows sinus rhythm and known T wave inversions in leads V1 to V4." ]

[ "1. Patient is 69 years old.", "2. Patient has 9-month history of worsening shortness of breath on exertion and need to urinate at night.", "3. Patient occasionally has palpitations but does not have chest pain.", "4. Patient had transient ischemic attack 5 years ago and underwent right-sided carotid endarterectomy.", "5. Patient has hypertension and type 2 diabetes mellitus.", "6. Patient is currently taking metformin, lisinopril, aspirin, and simvastatin.", "7. Patient appears fatigued.", "8. Patient's pulse is 61/min.", "9. Patient's blood pressure is 120/75 mmHg.", "10. Patient's respirations are 25/min.", "11. Pulse oximetry shows oxygen saturation of 96%.", "12. Examination shows cold extremities.", "13. No murmurs or rubs on cardiac auscultation.", "14. Fine, bilateral crackles heard at lung bases.", "15. 2+ lower extremity edema.", "16. ECG shows sinus rhythm and known T wave inversions in leads V1 to V4." ]

[ "1. The patient occasionally has palpitations.", "2. The patient does not have chest pain.", "3. The patient had a transient ischemic attack 5 years ago.", "4. The patient underwent right-sided carotid endarterectomy for the transient ischemic attack.", "5. The patient has hypertension.", "6. The patient has type 2 diabetes mellitus.", "7. The patient's current medications include metformin.", "8. The patient's current medications include lisinopril.", "9. The patient's current medications include aspirin.", "10. The patient's current medications include simvastatin.", "11. The patient appears fatigued.", "12. The patient's pulse is 61/min.", "13. The patient's blood pressure is 120/75 mmHg.", "14. The patient's respirations are 25/min.", "15. Pulse oximetry shows an oxygen saturation of 96%.", "16. Examination shows cold extremities.", "17. There are no murmurs on cardiac auscultation.", "18. There are no rubs on cardiac auscultation.", "19. Fine, bilateral crackles are heard at the lung bases.", "20. There is 2+ lower extremity edema.", "21. An ECG shows sinus rhythm.", "22. An ECG shows known T wave inversions in leads V1 to V4." ]

[ "A 22-year-old woman presents to her primary care provider complaining of a facial rash.", "She says the rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer.", "Since that time she has also experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers.", "She denies chest pain, shortness of breath, nausea, or vomiting.", "Vital signs are 99.6°F (37.6°F), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min.", "Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers.", "The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain.", "Complete blood count demonstrates normocytic anemia with thrombocytopenia." ]

[ "1. Patient is a 22-year-old woman.", "2. Patient presents to primary care provider complaining of facial rash.", "3. Patient says rash began 3 weeks ago after hiking in White Mountains of New Hampshire.", "4. Patient has experienced pain in hands and wrists that is worse in the morning and accompanied by subjective fevers.", "5. Patient denies chest pain, shortness of breath, nausea, or vomiting.", "6. Vital signs are 99.6°F (37.6°C), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min.", "7. Examination demonstrates rash on patient's face that spares the nasolabial folds along with oral ulcers.", "8. Metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain.", "9. Complete blood count demonstrates normocytic anemia with thrombocytopenia." ]

[ "1. The rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer.", "2. She has experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers.", "3. She denies chest pain, shortness of breath, nausea, or vomiting.", "4. Vital signs: 99.6°F (37.6°C) temperature, blood pressure 134/82 mmHg, pulse 88/min, and respirations 18/min.", "5. Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers.", "6. The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain.", "7. Complete blood count demonstrates normocytic anemia with thrombocytopenia." ]

[ "A 54-year-old man presents with fever and a painful jaw mass with a yellowish discharge.", "He says that he first noticed the jaw mass 6 weeks ago and that the mass has been progressively increasing in size.", "He reports a history of chronic alcoholism and currently takes more than 6 drinks daily.", "His temperature is 37.9°C (100.2°F).", "On physical examination, there is a 7 × 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis The mass is severely tender on light palpation and has a yellowish malodorous discharge.", "The oral cavity shows signs of very poor dentition.", "Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria." ]

[ "1. Patient is 54 years old.", "2. Patient has fever.", "3. Patient has a painful jaw mass with a yellowish discharge.", "4. Patient first noticed the jaw mass 6 weeks ago.", "5. Mass has been progressively increasing in size.", "6. Patient has a history of chronic alcoholism.", "7. Patient currently takes more than 6 drinks daily.", "8. Patient's temperature is 37.9°C (100.2°F).", "9. Physical examination reveals a 7 × 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis.", "10. Mass is severely tender on light palpation.", "11. Mass has a yellowish malodorous discharge.", "12. Oral cavity shows signs of very poor dentition.", "13. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria." ]

[ "1. He first noticed the jaw mass 6 weeks ago.", "2. The mass has been progressively increasing in size.", "3. He has a history of chronic alcoholism.", "4. He currently takes more than 6 drinks daily.", "5. His temperature is 37.9°C (100.2°F).", "6. On physical examination, there is a 7 × 7 cm mass at the tip of the jaw bone.", "7. Significant surrounding edema and sclerosis are present.", "8. The mass is severely tender on light palpation.", "9. The mass has a yellowish malodorous discharge.", "10. The oral cavity shows signs of very poor dentition.", "11. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria." ]

[ "A 57-year-old homosexual man presents to the emergency department with epigastric pain.", "He has presented multiple times for the same complaint in the past.", "The patient has a past medical history of alcoholism and is homeless.", "He states that his symptoms at this time are constant and occur at all times of the day and are near his baseline.", "He also endorses fatty and foul smelling diarrhea during this time frame." ]

[ "1. A 57-year-old man presents to the emergency department with epigastric pain.", "2. He has presented multiple times for the same complaint in the past.", "3. The patient has a past medical history of alcoholism.", "4. The patient is homeless.", "5. He states that his symptoms at this time are constant.", "6. His symptoms occur at all times of the day.", "7. His symptoms are near his baseline.", "8. He endorses fatty and foul smelling diarrhea during this time frame." ]

[ "1. The patient has presented multiple times for the same complaint in the past.", "2. The patient has a past medical history of alcoholism.", "3. The patient is homeless.", "4. The patient states that his symptoms at this time are constant.", "5. The patient's symptoms occur at all times of the day.", "6. The patient's symptoms are near his baseline.", "7. The patient endorses fatty and foul smelling diarrhea during this time frame." ]

[ "A 6-year-old boy is rushed to the emergency department after being involved in a motor vehicle accident.", "He has abrasions on his left knee and left elbow.", "His wounds are cleaned and a pressure bandage is applied.", "Typically, neutrophils and macrophages are attracted toward the site of injury by various chemical mediators." ]

[ "1. A 6-year-old boy is rushed to the emergency department.", "2. He has abrasions on his left knee and left elbow.", "3. His wounds are cleaned.", "4. A pressure bandage is applied.", "5. Neutrophils and macrophages are typically attracted toward the site of injury.", "6. Various chemical mediators attract neutrophils and macrophages." ]

[ "1. He has abrasions on his left knee.", "2. He has abrasions on his left elbow.", "3. His wounds are cleaned.", "4. A pressure bandage is applied.", "5. Neutrophils are attracted toward the site of injury.", "6. Macrophages are attracted toward the site of injury.", "7. They are attracted by various chemical mediators." ]

[ "A 70-year-old man comes to the emergency department after briefly losing consciousness and collapsing when rising from a chair.", "He did not sustain any injuries from his collapse.", "He has had a two-week history of dizziness upon standing.", "He has smoked one pack of cigarettes daily for 55 years.", "He drinks three beers and two glasses of whiskey daily.", "He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia.", "His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate.", "Physical examination shows conjunctival pallor.", "On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex." ]

[ "1. A 70-year-old man comes to the emergency department.", "2. He briefly lost consciousness and collapsed when rising from a chair.", "3. He did not sustain any injuries from his collapse.", "4. He has had a two-week history of dizziness upon standing.", "5. He has smoked one pack of cigarettes daily for 55 years.", "6. He drinks three beers and two glasses of whiskey daily.", "7. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia.", "8. His blood pressure is 120/80 mm Hg supine.", "9. His blood pressure is 100/70 mm Hg one minute after standing with no change in pulse rate.", "10. Physical examination shows conjunctival pallor.", "11. On cardiac auscultation, there is a plopping sound.", "12. On cardiac auscultation, there is a low-pitched, rumbling mid-diastolic murmur heard best at the apex." ]

[ "1. He did not sustain any injuries from his collapse.", "2. He has had a two-week history of dizziness upon standing.", "3. He has smoked one pack of cigarettes daily for 55 years.", "4. He drinks three beers and two glasses of whiskey daily.", "5. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia.", "6. His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate.", "7. Physical examination shows conjunctival pallor.", "8. On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex." ]

[ "A 6-month-old infant is brought to a pediatrician for his scheduled immunizations.", "The parents deny any specific current complaints, but his facial features differ from those of other children in the family.", "During the physical examination, the pediatrician notes that the infant’s vital signs are stable.", "His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears.", "The pediatrician also notes a single transverse palmar crease on both hands.", "An echocardiogram is performed which suggests that the infant has a congenital heart disease which is the most common form of congenital heart disease seen in children with this particular genetic disorder." ]

[ "1. A 6-month-old infant is brought to a pediatrician for his scheduled immunizations.", "2. The parents deny any specific current complaints.", "3. His facial features differ from those of other children in the family.", "4. During the physical examination, the pediatrician notes that the infant’s vital signs are stable.", "5. His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears.", "6. The pediatrician also notes a single transverse palmar crease on both hands.", "7. An echocardiogram is performed.", "8. The echocardiogram suggests that the infant has a congenital heart disease.", "9. The congenital heart disease is the most common form of congenital heart disease seen in children with this particular genetic disorder." ]

[ "1. The parents deny any specific current complaints.", "2. His facial features differ from those of other children in the family.", "3. The pediatrician notes that the infant’s vital signs are stable.", "4. His facial features include a medial epicanthic fold.", "5. His facial features include a face that appears flat.", "6. His facial features include a flat occiput with low-set ears.", "7. The pediatrician notes a single transverse palmar crease on both hands.", "8. An echocardiogram suggests that the infant has a congenital heart disease.", "9. The congenital heart disease is the most common form seen in children with this particular genetic disorder." ]

[ "A 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months.", "She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year.", "She has had skin problems that are aggravated by exposure to sunlight for the past 18 months.", "She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily.", "Her temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg.", "Examination shows 2+ pretibial edema bilaterally and periorbital edema.", "There are erythematous patches with scaling on both cheeks.", "Laboratory studies show: | Hemoglobin 11.2 g/dL | Leukocyte count 8500/mm3 | Platelet count 130,000/mm3 | Serum | Urea nitrogen 36 mg/dL | Glucose 77 mg/dL | Creatinine 0.9 mg/dL | Albumin 2.6 mg/dL | Total cholesterol 275 mg/dL | Triglycerides 180 mg/dL | Urine | Blood negative | Glucose negative | Protein 4+ | ." ]

[ "1. Patient is a 32-year-old white woman.", "2. Patient has been experiencing fatigue, lethargy, and swelling of the lower legs for 2 months.", "3. Patient has had recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year.", "4. Patient has had skin problems that are aggravated by exposure to sunlight for the past 18 months.", "5. Patient has smoked one pack of cigarettes daily for 13 years.", "6. Patient drinks one alcoholic beverage daily.", "7. Patient's temperature is 37°C (98.6°F).", "8. Patient's pulse is 92/min.", "9. Patient's blood pressure is 115/75 mm Hg.", "10. Examination shows 2+ pretibial edema bilaterally and periorbital edema.", "11. Examination shows erythematous patches with scaling on both cheeks.", "12. Laboratory studies show hemoglobin 11.2 g/dL.", "13. Laboratory studies show leukocyte count 8500/mm3.", "14. Laboratory studies show platelet count 130,000/mm3.", "15. Laboratory studies show serum urea nitrogen 36 mg/dL.", "16. Laboratory studies show serum glucose 77 mg/dL.", "17. Laboratory studies show serum creatinine 0.9 mg/dL.", "18. Laboratory studies show serum albumin 2.6 mg/dL.", "19. Laboratory studies show total cholesterol 275 mg/dL.", "20. Laboratory studies show triglycerides 180 mg/dL.", "21. Laboratory studies show urine blood negative.", "22. Laboratory studies show urine glucose negative.", "23. Laboratory studies show urine protein 4+." ]

[ "1. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year.", "2. She has had skin problems that are aggravated by exposure to sunlight for the past 18 months.", "3. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily.", "4. Her temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg.", "5. Examination shows 2+ pretibial edema bilaterally and periorbital edema.", "6. There are erythematous patches with scaling on both cheeks.", "7. Laboratory studies show: Hemoglobin 11.2 g/dL, Leukocyte count 8500/mm3, Platelet count 130,000/mm3, Serum Urea nitrogen 36 mg/dL, Glucose 77 mg/dL, Creatinine 0.9 mg/dL, Albumin 2.6 mg/dL, Total cholesterol 275 mg/dL, Triglycerides 180 mg/dL, Urine Blood negative, Glucose negative, Protein 4+." ]

[ "A 60-year-old man presents to the clinic with his wife for “weird breathing” during the night.", "The patient’s wife says that his breathing pattern is irregular but he does not snore.", "The patient says he is not aware of these symptoms.", "Past medical history is remarkable for an NSTEMI when he was 50 years old.", "He spends a night at the sleep lab where his tidal volume is monitored overnight and a tracing is shown in the image below." ]

[ "1. A 60-year-old man presents to the clinic with his wife.", "2. The patient's wife reports that his breathing pattern is irregular.", "3. The patient does not snore.", "4. The patient is not aware of these symptoms.", "5. The patient's past medical history is remarkable for an NSTEMI when he was 50 years old.", "6. The patient spends a night at the sleep lab.", "7. The patient's tidal volume is monitored overnight.", "8. An image of the tracing is shown below." ]

[ "1. The patient's wife reports irregular breathing pattern.", "2. The patient does not snore.", "3. The patient denies awareness of the reported symptoms.", "4. Past medical history includes an NSTEMI at age 50.", "5. The patient spent a night at a sleep lab.", "6. Tidal volume was monitored overnight.", "7. A tracing was shown in an image." ]

[ "A 72-year-old man with a history of chronic kidney disease presents to his primary care physician complaining of recurrent chest pain with activity.", "The patient used to have chest pain when he mowed his lawn.", "Now he gets chest pain whenever he walks short distances such as to get his mail.", "The pain resolves on its own when the patient sits and rests.", "His temperature is 98.2°F (36.8°C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for an obese man who is in no distress.", "An initial ECG is unchanged from a previous ECG.", "The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins." ]

[ "1. Patient is 72 years old.", "2. Patient has a history of chronic kidney disease.", "3. Patient presents to primary care physician with recurrent chest pain with activity.", "4. Patient used to have chest pain when mowing lawn.", "5. Patient now gets chest pain when walking short distances such as to get mail.", "6. Pain resolves on its own when patient sits and rests.", "7. Patient's temperature is 98.2°F (36.8°C).", "8. Patient's blood pressure is 157/98 mm Hg.", "9. Patient's pulse is 80/min.", "10. Patient's respirations are 15/min.", "11. Patient's oxygen saturation is 98% on room air.", "12. Patient is obese and in no distress.", "13. Initial ECG is unchanged from previous ECG.", "14. Patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins." ]

[ "1. The patient used to have chest pain when he mowed his lawn.", "2. Now he gets chest pain whenever he walks short distances such as to get his mail.", "3. The pain resolves on its own when the patient sits and rests.", "4. His temperature is 98.2°F (36.8°C).", "5. Blood pressure is 157/98 mm Hg.", "6. Pulse is 80/min.", "7. Respirations are 15/min.", "8. Oxygen saturation is 98% on room air.", "9. Physical exam is notable for an obese man who is in no distress.", "10. An initial ECG is unchanged from a previous ECG.", "11. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins." ]

[ "A 55-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer.", "She has a medical history of hypertension for which she takes lisinopril.", "She denies any surgical history.", "Her family history is notable for breast cancer in her maternal grandmother.", "She is visibly anxious during the encounter, but physical examination is otherwise unremarkable.", "Her primary concern today is which surgical approach will be chosen to remove her breast cancer." ]

[ "1. A 55-year-old woman presents to the surgical oncology clinic as a new patient.", "2. She has a medical history of hypertension.", "3. She takes lisinopril for her hypertension.", "4. She denies any surgical history.", "5. Her family history is notable for breast cancer in her maternal grandmother.", "6. She is visibly anxious during the encounter.", "7. Physical examination is otherwise unremarkable.", "8. Her primary concern today is which surgical approach will be chosen to remove her breast cancer." ]

[ "1. She has a medical history of hypertension.", "2. She takes lisinopril for her hypertension.", "3. She denies any surgical history.", "4. Her family history includes breast cancer in her maternal grandmother.", "5. She is visibly anxious during the encounter.", "6. Physical examination is otherwise unremarkable.", "7. Her primary concern today is which surgical approach will be chosen to remove her breast cancer." ]

[ "A 14-year-old female is seeing her pulmonologist in clinic after a recent asthma exacerbation.", "She has been adherent to her original controller medication so the physician prescribes an additional new drug which prevents IgE binding to mast cells." ]

[ "1. A 14-year-old female is seeing her pulmonologist in clinic.", "2. The visit is due to a recent asthma exacerbation.", "3. She has been adherent to her original controller medication.", "4. The physician prescribes an additional new drug.", "5. The new drug prevents IgE binding to mast cells." ]

[ "1. The patient has been adherent to her original controller medication.", "2. The physician prescribes an additional new drug.", "3. The new drug prevents IgE binding to mast cells." ]

[ "A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building.", "The patient is responding coherently to questions but reports pain secondary to a burn on his leg.", "He states he also has a headache and feels dizzy.", "His temperature is 98.5°F (36.9°C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air.", "Physical exam is notable for a confused young man with dry and flushed skin.", "Cardiopulmonary exam reveals a normal S1 and S2 as well as clear breath sounds bilaterally.", "The patient’s neurological exam is within normal limits.", "Towards the end of his exam, the patient begins vomiting.", "Dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg." ]

[ "1. A 24-year-old man is brought in to the emergency room. ", "2. He was retrieved by firefighters from a burning building. ", "3. He is responding coherently to questions. ", "4. He reports pain secondary to a burn on his leg. ", "5. He also has a headache and feels dizzy. ", "6. His temperature is 98.5°F (36.9°C). ", "7. His blood pressure is 129/66 mmHg. ", "8. His pulse is 126/min. ", "9. His respirations are 14/min. ", "10. His oxygen saturation is 99% on room air. ", "11. He is a confused young man with dry and flushed skin. ", "12. Cardiopulmonary exam reveals a normal S1 and S2. ", "13. Breath sounds are clear bilaterally. ", "14. His neurological exam is within normal limits. ", "15. Towards the end of his exam, he begins vomiting. ", "16. Dermatologic exam reveals a superficial burn covering 1% of his body over his right leg." ]

[ "1. The patient is responding coherently to questions.", "2. The patient reports pain secondary to a burn on his leg.", "3. The patient states he also has a headache and feels dizzy.", "4. The patient's temperature is 98.5°F (36.9°C).", "5. The patient's blood pressure is 129/66 mmHg.", "6. The patient's pulse is 126/min.", "7. The patient's respirations are 14/min.", "8. The patient's oxygen saturation is 99% on room air.", "9. Physical exam is notable for a confused young man with dry and flushed skin.", "10. Cardiopulmonary exam reveals a normal S1 and S2.", "11. Cardiopulmonary exam reveals clear breath sounds bilaterally.", "12. The patient's neurological exam is within normal limits.", "13. Towards the end of his exam, the patient begins vomiting.", "14. Dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg." ]

[ "A 29-year-old female presents to her psychiatrist with concerns that she may be \"OCD.\" She explains that she has become extremely obsessed with making sure that her fruits and vegetables are completely sanitized by first rinsing with water for exactly 60 seconds and then boiling for exactly 60 minutes.", "She refuses to eat any fruits or vegetables that did not undergo this process, which she began doing about 3 months ago." ]

[ "1. A 29-year-old female presents to her psychiatrist.", "2. She has concerns that she may be \"OCD.\"", "3. She rinses fruits and vegetables with water for exactly 60 seconds.", "4. She boils fruits and vegetables for exactly 60 minutes.", "5. She refuses to eat any fruits or vegetables that did not undergo this process.", "6. She began this process about 3 months ago." ]

[ "1. She refuses to eat fruits or vegetables.", "2. The fruits or vegetables must undergo a specific process.", "3. She began this process about 3 months ago." ]

[ "A 73-year-old male is brought to his family practitioner by his daughter with the complaints of a spinning sensation for the past 4 weeks.", "He says that the room appears to be continuously spinning.", "This has progressively worsened over the last 4 weeks to the point that he has become bed bound and cannot walk without support.", "These spinning sensations are present throughout the day and do not change with position.", "They are associated with nausea and vomiting.", "He denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness.", "He has a blood pressure of 133/80 mm Hg, heart rate of 80/min, respiratory rate of 12/min, and temperature of 36.7°C (98.2°F).", "His extraocular eye movements are normal in all directions, but a vertical nystagmus is present that does not disappear despite repetitive testing.", "Hearing tests are within normal limits." ]

[ "1. Patient is 73 years old.", "2. Patient was brought to family practitioner by daughter.", "3. Patient has been experiencing a spinning sensation for 4 weeks.", "4. Spinning sensation has progressively worsened over 4 weeks.", "5. Patient has become bed bound and cannot walk without support.", "6. Spinning sensation is present throughout the day and does not change with position.", "7. Spinning sensation is associated with nausea and vomiting.", "8. Patient denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness.", "9. Patient's blood pressure is 133/80 mm Hg.", "10. Patient's heart rate is 80/min.", "11. Patient's respiratory rate is 12/min.", "12. Patient's temperature is 36.7°C (98.2°F).", "13. Patient's extraocular eye movements are normal in all directions.", "14. Patient has vertical nystagmus that does not disappear despite repetitive testing.", "15. Patient's hearing tests are within normal limits." ]

[ "1. The patient experiences continuous spinning sensations in the room.", "2. The spinning sensations have worsened progressively over the last 4 weeks.", "3. The patient has become bed bound due to the spinning sensations and cannot walk without support.", "4. The spinning sensations are present throughout the day and do not change with position.", "5. The spinning sensations are associated with nausea and vomiting.", "6. The patient denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness.", "7. The patient's blood pressure is 133/80 mm Hg.", "8. The patient's heart rate is 80/min.", "9. The patient's respiratory rate is 12/min.", "10. The patient's temperature is 36.7°C (98.2°F).", "11. The patient's extraocular eye movements are normal in all directions.", "12. A vertical nystagmus is present in the patient and does not disappear despite repetitive testing.", "13. Hearing tests for the patient are within normal limits." ]

[ "A 79-year-old man presents to the emergency room after a syncopal event.", "The patient has a history of hyperlipidemia for which he is taking atorvastatin.", "On physical examination, his vital signs are stable, but on cardiac auscultation, you detect a crescendo-decrescendo systolic murmur loudest on the right upper sternal border radiating to the neck." ]

[ "1. A 79-year-old man presents to the emergency room.", "2. The patient has a history of hyperlipidemia.", "3. The patient is taking atorvastatin.", "4. Vital signs are stable.", "5. Cardiac auscultation reveals a crescendo-decrescendo systolic murmur.", "6. The murmur is loudest on the right upper sternal border.", "7. The murmur radiates to the neck." ]

[ "1. The patient has a history of hyperlipidemia.", "2. The patient is taking atorvastatin for hyperlipidemia.", "3. The patient's vital signs are stable on physical examination.", "4. A crescendo-decrescendo systolic murmur is detected on cardiac auscultation.", "5. The murmur is loudest on the right upper sternal border.", "6. The murmur radiates to the neck." ]

[ "A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis.", "The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital and contacts the qualifying subjects to ask them about exposure to the particular pesticide.", "Using the data he compiles, he is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide." ]

[ "1. A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis.", "2. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital.", "3. The researcher contacts the qualifying subjects to ask them about exposure to the particular pesticide.", "4. The researcher compiles data from the records and the subjects' responses.", "5. The researcher is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide." ]

[ "1. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital.", "2. The researcher contacts the qualifying subjects to ask them about exposure to the particular pesticide.", "3. The researcher uses the data to calculate an estimate for the relative and absolute risk for developing chronic bronchitis.", "4. The study focuses on people who have been exposed to a particular pesticide." ]

[ "A 49-year-old woman presents to her primary care physician due to fatigue and shortness of breath.", "She finds herself being short of breath when climbing the stairs or walking uphill.", "Approximately 1 year ago, she was able to partake in long-distance running and weightlifting.", "Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep.", "She emigrated from Mexico to the United States 3 years ago.", "Her temperature is 98°F (36.7°C), blood pressure is 100/62 mmHg, pulse is 135/min and irregularly irregular, and respirations are 21/min.", "On physical exam her speech is hoarse.", "She has bilateral crackles heard in the lung bases." ]

[ "1. Patient is a 49-year-old woman.", "2. Patient presents to primary care physician due to fatigue and shortness of breath.", "3. Patient finds herself being short of breath when climbing stairs or walking uphill.", "4. Approximately 1 year ago, patient was able to partake in long-distance running and weightlifting.", "5. Two weeks ago, patient noticed blood-tinged sputum after severely coughing during sleep.", "6. Patient emigrated from Mexico to the United States 3 years ago.", "7. Patient's temperature is 98°F (36.7°C).", "8. Patient's blood pressure is 100/62 mmHg.", "9. Patient's pulse is 135/min and irregularly irregular.", "10. Patient's respirations are 21/min.", "11. On physical exam, patient's speech is hoarse.", "12. Patient has bilateral crackles heard in the lung bases." ]

[ "1. She finds herself being short of breath when climbing the stairs or walking uphill.", "2. Approximately 1 year ago, she was able to partake in long-distance running and weightlifting.", "3. Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep.", "4. She emigrated from Mexico to the United States 3 years ago.", "5. Her temperature is 98°F (36.7°C).", "6. Her blood pressure is 100/62 mmHg.", "7. Her pulse is 135/min and irregularly irregular.", "8. Her respirations are 21/min.", "9. On physical exam her speech is hoarse.", "10. She has bilateral crackles heard in the lung bases." ]

[ "A 60-year-old man presents to the physician for a follow-up examination.", "During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.", "He has no complaints other than fatigue for several months.", "He has no history of serious illness and takes no medications.", "The vital signs are within the normal range.", "On percussion, spleen size is 15 cm (5.9 in).", "Otherwise, the physical examination shows no abnormalities.", "The laboratory test results are as follows: | Hemoglobin 10 g/dL | Mean corpuscular volume 88 μm3 | Leukocyte count 65,000/mm3 | Platelet count 500,000/mm3 | The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "The molecular studies document the BCR-ABL1 rearrangement." ]

[ "1. A 60-year-old man presents to the physician for a follow-up examination.", "2. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.", "3. He has no complaints other than fatigue for several months.", "4. He has no history of serious illness and takes no medications.", "5. The vital signs are within the normal range.", "6. On percussion, spleen size is 15 cm (5.9 in).", "7. Otherwise, the physical examination shows no abnormalities.", "8. The laboratory test results are as follows: Hemoglobin 10 g/dL.", "9. The laboratory test results are as follows: Mean corpuscular volume 88 μm3.", "10. The laboratory test results are as follows: Leukocyte count 65,000/mm3.", "11. The laboratory test results are as follows: Platelet count 500,000/mm3.", "12. The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "13. The molecular studies document the BCR-ABL1 rearrangement." ]

[ "1. Splenomegaly was detected on the abdominal exam during the previous visit.", "2. The splenomegaly has been confirmed by abdominal ultrasound.", "3. The patient has been experiencing fatigue for several months.", "4. The patient has no complaints other than fatigue.", "5. The patient has no history of serious illness.", "6. The patient takes no medications.", "7. The vital signs are within the normal range.", "8. Spleen size on percussion is 15 cm (5.9 in).", "9. Otherwise, the physical examination shows no abnormalities.", "10. Laboratory test results: Hemoglobin 10 g/dL.", "11. Laboratory test results: Mean corpuscular volume 88 μm3.", "12. Laboratory test results: Leukocyte count 65,000/mm3.", "13. Laboratory test results: Platelet count 500,000/mm3.", "14. Peripheral blood smear shows a predominance of neutrophils.", "15. Peripheral blood smear shows the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "16. Molecular studies document the BCR-ABL1 rearrangement." ]

[ "A 45-year-old man presents to the outpatient unit with a complaint of lower extremity edema for the past few weeks.", "He has also been observing puffiness of the face lately.", "The urinalysis shows 4+ proteinuria.", "The serum creatinine is 3.5 mg/dL, and antinuclear antibodies are absent.", "The biopsy findings are given in the picture." ]

[ "1. A 45-year-old man presents to the outpatient unit.", "2. Complaint is lower extremity edema for the past few weeks.", "3. Puffiness of the face has been observed lately.", "4. Urinalysis shows 4+ proteinuria.", "5. Serum creatinine is 3.5 mg/dL.", "6. Antinuclear antibodies are absent.", "7. Biopsy findings are given in the picture." ]

[ "1. He has been observing puffiness of the face lately.", "2. The urinalysis shows 4+ proteinuria.", "3. The serum creatinine is 3.5 mg/dL.", "4. Antinuclear antibodies are absent.", "5. The biopsy findings are given in the picture." ]

[ "A 2-year-old male is brought to his pediatrician by his parents because of a lack of testes in his scrotum.", "Physical examination confirms that testes are absent from the scrotal sac and palpable masses are found bilaterally around the inguinal canal." ]

[ "1. A 2-year-old male is brought to his pediatrician by his parents.", "2. The reason for the visit is a lack of testes in his scrotum.", "3. Physical examination confirms that testes are absent from the scrotal sac.", "4. Palpable masses are found bilaterally around the inguinal canal." ]

[ "1. Physical examination confirms testes are absent from the scrotal sac.", "2. Palpable masses are found bilaterally around the inguinal canal." ]

[ "A 23-year-old man presents to the emergency department by ambulance after being rescued from a burning house.", "The patient was intubated in the field and is maintaining his oxygen saturation above 98%.", "Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area.", "His weight is 70 kg." ]

[ "1. A 23-year-old man presents to the emergency department by ambulance.", "2. The patient was intubated in the field.", "3. The patient is maintaining his oxygen saturation above 98%.", "4. Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area.", "5. His weight is 70 kg." ]

[ "1. The patient was intubated in the field.", "2. The patient is maintaining his oxygen saturation above 98%.", "3. Physical exam reveals partial or full-thickness burns.", "4. The burns are across an estimated 30% of his total body surface area.", "5. The patient's weight is 70 kg." ]

[ "A 28-year-old G1P0 primigravida woman at 28 weeks estimated gestational age presents for routine prenatal care.", "She has no complaints and says she can feel her baby move and respond to outside sounds.", "The patient has no significant past medical or family history.", "Currently, she is taking a prenatal multivitamin which contains iron and folic acid.", "Her blood type is A (-) negative, and her husband is A (+) positive.", "The patient says she stopped drinking alcohol 2 years ago and denies any history of smoking or recreational drug use.", "Her pulse is 90/min, blood pressure is 114/68 mm Hg, and respiratory rate is 18/min.", "She has gained 9.0 kg (19.8 lb) over the course of the pregnancy.", "Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis.", "Occasional movements are observed in the abdomen.", "There is no guarding or tenderness to palpation.", "Fetal heart sounds can be auscultated.", "The remainder of the examination is unremarkable.", "The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM)." ]

[ "1. Patient is a 28-year-old G1P0 primigravida woman.", "2. Patient is at 28 weeks estimated gestational age.", "3. Patient has no complaints.", "4. Patient can feel her baby move and respond to outside sounds.", "5. Patient has no significant past medical or family history.", "6. Patient is taking a prenatal multivitamin which contains iron and folic acid.", "7. Patient's blood type is A (-) negative.", "8. Patient's husband's blood type is A (+) positive.", "9. Patient stopped drinking alcohol 2 years ago.", "10. Patient denies any history of smoking or recreational drug use.", "11. Patient's pulse is 90/min.", "12. Patient's blood pressure is 114/68 mm Hg.", "13. Patient's respiratory rate is 18/min.", "14. Patient has gained 9.0 kg (19.8 lb) over the course of the pregnancy.", "15. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis.", "16. Occasional movements are observed in the abdomen.", "17. There is no guarding or tenderness to palpation.", "18. Fetal heart sounds can be auscultated.", "19. The remainder of the examination is unremarkable.", "20. Patient is administered an injection of RhO(D) immunoglobulin (RhoGAM)." ]

[ "1. The patient has no complaints.", "2. The patient can feel her baby move and respond to outside sounds.", "3. The patient has no significant past medical history.", "4. The patient has no significant family history.", "5. The patient is taking a prenatal multivitamin containing iron and folic acid.", "6. The patient's blood type is A (-) negative.", "7. The patient's husband's blood type is A (+) positive.", "8. The patient stopped drinking alcohol 2 years ago.", "9. The patient denies any history of smoking or recreational drug use.", "10. The patient's pulse is 90/min.", "11. The patient's blood pressure is 114/68 mm Hg.", "12. The patient's respiratory rate is 18/min.", "13. The patient has gained 9.0 kg (19.8 lb) over the course of the pregnancy.", "14. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis.", "15. Occasional movements are observed in the abdomen.", "16. There is no guarding or tenderness to palpation.", "17. Fetal heart sounds can be auscultated.", "18. The remainder of the examination is unremarkable.", "19. The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM)." ]

[ "A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months.", "He has had an active sexual life in the past.", "He reports that early morning erections are present every other day.", "He has a history of hypertension and diabetes mellitus.", "His wife recently filed for divorce.", "He has smoked one pack of cigarettes daily for 25 years.", "His only medications are enalapril and metformin.", "Physical examination shows no abnormalities." ]

[ "1. A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months.", "2. He has had an active sexual life in the past.", "3. He reports that early morning erections are present every other day.", "4. He has a history of hypertension.", "5. He has a history of diabetes mellitus.", "6. His wife recently filed for divorce.", "7. He has smoked one pack of cigarettes daily for 25 years.", "8. His only medications are enalapril and metformin.", "9. Physical examination shows no abnormalities." ]

[ "1. He has had an active sexual life in the past.", "2. He reports that early morning erections are present every other day.", "3. He has a history of hypertension and diabetes mellitus.", "4. His wife recently filed for divorce.", "5. He has smoked one pack of cigarettes daily for 25 years.", "6. His only medications are enalapril and metformin.", "7. Physical examination shows no abnormalities." ]

[ "A 49-year-old G4P4 woman comes to the clinic complaining of repeated leakage of fluid from her vagina for the past 5 months.", "She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot.", "Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine.", "Her last menstrual period was 1 year ago.", "She is currently sexually active with multiple partners with inconsistent condom use.", "She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors.", "Physical examination is significant for a bulge at the anterior vaginal wall." ]

[ "1. A 49-year-old G4P4 woman comes to the clinic.", "2. She has been experiencing repeated leakage of fluid from her vagina for the past 5 months.", "3. She noticed an increase in episodes following her cold last week.", "4. She was coughing and sneezing a lot during her cold.", "5. Her past medical history is significant for Crohn disease.", "6. Her Crohn disease is well controlled with sulfasalazine.", "7. Her last menstrual period was 1 year ago.", "8. She is currently sexually active with multiple partners.", "9. Her condom use is inconsistent.", "10. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors.", "11. Physical examination is significant for a bulge at the anterior vaginal wall." ]

[ "1. She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot.", "2. Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine.", "3. Her last menstrual period was 1 year ago.", "4. She is currently sexually active with multiple partners with inconsistent condom use.", "5. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors.", "6. Physical examination is significant for a bulge at the anterior vaginal wall." ]

[ "A 24-year-old woman presents to a physician with recurrent episodes of palpitations, shortness of breath, and perspiration.", "The episodes are self-limited and are usually preceded by specific social circumstances that she does not enjoy.", "There is no significant past medical history.", "After a complete history and physical examination, the physician diagnoses an anxiety disorder.", "He explains that anxiety is associated with the stimulation of the sympathetic nervous system which produces several symptoms related to anxiety such as tachycardia." ]

[ "1. A 24-year-old woman presents to a physician.", "2. She has recurrent episodes of palpitations, shortness of breath, and perspiration.", "3. The episodes are self-limited.", "4. The episodes are usually preceded by specific social circumstances that she does not enjoy.", "5. There is no significant past medical history.", "6. The physician diagnoses an anxiety disorder.", "7. Anxiety is associated with the stimulation of the sympathetic nervous system.", "8. The sympathetic nervous system produces several symptoms related to anxiety such as tachycardia." ]

[ "1. The episodes are self-limited.", "2. The episodes are usually preceded by specific social circumstances that she does not enjoy.", "3. There is no significant past medical history.", "4. After a complete history and physical examination, the physician diagnoses an anxiety disorder.", "5. Anxiety is associated with the stimulation of the sympathetic nervous system.", "6. Stimulation of the sympathetic nervous system produces several symptoms related to anxiety.", "7. Symptoms related to anxiety include tachycardia." ]

[ "A 14-year-old boy is brought to the office by his parents because he states that for the past 2 months he has been feeling constantly tired, and also noticed a dull pain in the pit of his stomach.", "The patient has no relevant family history.", "The vital signs include a heart rate of 105/min, a respiratory rate of 16/min, a temperature of 37.0°C (98.6°F), and a blood pressure of 111/66 mm Hg.", "On physical exam, the abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process.", "The complete blood count results are as follows: | Hemoglobin 17.6 g/dL | Hematocrit 64% | RBC 6.02 x 1012/L | Leukocyte count | 26,300/mm3 | Neutrophils 55% | Bands 2% | Eosinophils 1% | Basophils 0% | Lymphocytes 29% | Monocytes 2% | Platelet count 480,000/mm³ | Erythropoietin < 1.0 mU/mL | The coagulation test results are as follows: | Partial thromboplastin time (activated) 30.9 s | Prothrombin time 14.0 s | The abdominal Doppler ultrasound imaging is shown in the picture." ]

[ "1. Patient is a 14-year-old boy.", "2. Patient has been feeling constantly tired for the past 2 months.", "3. Patient has noticed a dull pain in the pit of his stomach.", "4. Patient has no relevant family history.", "5. Heart rate is 105/min.", "6. Respiratory rate is 16/min.", "7. Temperature is 37.0°C (98.6°F).", "8. Blood pressure is 111/66 mm Hg.", "9. Abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process.", "10. Hemoglobin is 17.6 g/dL.", "11. Hematocrit is 64%.", "12. RBC is 6.02 x 1012/L.", "13. Leukocyte count is 26,300/mm3.", "14. Neutrophils are 55%.", "15. Bands are 2%.", "16. Eosinophils are 1%.", "17. Basophils are 0%.", "18. Lymphocytes are 29%.", "19. Monocytes are 2%.", "20. Platelet count is 480,000/mm³.", "21. Erythropoietin is < 1.0 mU/mL.", "22. Partial thromboplastin time (activated) is 30.9 s.", "23. Prothrombin time is 14.0 s.", "24. Abdominal Doppler ultrasound imaging is shown in the picture." ]

[ "1. The patient has no relevant family history.", "2. Vital signs: heart rate 105/min, respiratory rate 16/min, temperature 37.0°C (98.6°F), blood pressure 111/66 mm Hg.", "3. Physical exam findings: distended abdomen with hepatomegaly 5 cm underneath the xiphoid process.", "4. Complete blood count results: Hemoglobin 17.6 g/dL, Hematocrit 64%, RBC 6.02 x 1012/L, Leukocyte count 26,300/mm3, Neutrophils 55%, Bands 2%, Eosinophils 1%, Basophils 0%, Lymphocytes 29%, Monocytes 2%, Platelet count 480,000/mm³, Erythropoietin < 1.0 mU/mL.", "5. Coagulation test results: Partial thromboplastin time (activated) 30.9 s, Prothrombin time 14.0 s.", "6. The abdominal Doppler ultrasound imaging is shown in the picture." ]

[ "A 17-year-old girl is presented to the clinic by her mom for hair loss.", "Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes, 1st appearing several months ago.", "The girl has noticed no other symptoms, though the spots of hair loss are sometimes sore.", "On further questioning, the girl shares that she has been very stressed lately about getting good grades and applying to colleges.", "She knows she needs to do well on all of her homework in order to get into a good college, so she has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'.", "The physical exam shows an anxious-appearing, somewhat quiet girl.", "There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths.", "There is no discernible pattern to the hair loss." ]

[ "1. A 17-year-old girl is presented to the clinic by her mom.", "2. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes.", "3. The hair loss 1st appeared several months ago.", "4. The girl has noticed no other symptoms.", "5. The spots of hair loss are sometimes sore.", "6. The girl has been very stressed lately about getting good grades and applying to colleges.", "7. She knows she needs to do well on all of her homework in order to get into a good college.", "8. She has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'.", "9. The physical exam shows an anxious-appearing, somewhat quiet girl.", "10. There is diffuse hair loss and thinning across her scalp.", "11. There are many different hair shafts of different lengths.", "12. There is no discernible pattern to the hair loss." ]

[ "1. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes.", "2. The hair loss first appeared several months ago.", "3. The girl has noticed no other symptoms.", "4. The spots of hair loss are sometimes sore.", "5. The girl has been very stressed lately about getting good grades and applying to colleges.", "6. She has sometimes had to stay up late into the night to rewrite her homework over and over again.", "7. The physical exam shows an anxious-appearing, somewhat quiet girl.", "8. There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths.", "9. There is no discernible pattern to the hair loss." ]

[ "In a town with a hepatitis B prevalence of 4%, a new screening test is introduced as part of a study.", "The first round of the study detects cases of hepatitis B using the new test, which has a sensitivity of 99% and a specificity of 77%.", "In the second round of the study, the same test is used again in a different population with a hepatitis B prevalence of 29%." ]

[ "1. In a town, the hepatitis B prevalence is 4%.", "2. A new screening test is introduced as part of a study.", "3. The first round of the study uses the new test.", "4. The new test has a sensitivity of 99%.", "5. The new test has a specificity of 77%.", "6. The second round of the study uses the same test.", "7. The second round of the study is in a different population.", "8. The hepatitis B prevalence in the second population is 29%." ]

[ "1. The first round of the study detects cases of hepatitis B.", "2. The new test has a sensitivity of 99%.", "3. The new test has a specificity of 77%.", "4. The same test is used again in a different population in the second round of the study.", "5. The hepatitis B prevalence in the second round of the study is 29%." ]

[ "A 5-year-old girl is brought to the physician for a well-child examination.", "Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area.", "The girl has otherwise been feeling well.", "She is at the 45th percentile for height and 51st percentile for weight.", "Vital signs are within normal limits.", "Pelvic examination shows erythema of the vulva and perianal region.", "There is no vaginal discharge." ]

[ "1. A 5-year-old girl is brought to the physician for a well-child examination.", "2. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area.", "3. The girl has otherwise been feeling well.", "4. She is at the 45th percentile for height.", "5. She is at the 51st percentile for weight.", "6. Vital signs are within normal limits.", "7. Pelvic examination shows erythema of the vulva and perianal region.", "8. There is no vaginal discharge." ]

[ "1. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area.", "2. The girl has otherwise been feeling well.", "3. She is at the 45th percentile for height.", "4. She is at the 51st percentile for weight.", "5. Vital signs are within normal limits.", "6. Pelvic examination shows erythema of the vulva and perianal region.", "7. There is no vaginal discharge." ]

[ "A 25-year-old man comes to the emergency department because of left flank pain for 2 hours.", "The pain is colicky in nature and he describes it as 8 out of 10 in intensity.", "He has nausea and has vomited once.", "He had a similar episode 6 months ago for which he took naproxen.", "There is no personal or family history of serious illness.", "He is a second-year medical student and has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days.", "He does not smoke or drink alcohol.", "He takes no medications.", "His temperature is 37.3°C (99.1°F), pulse is 98/min, and blood pressure is 124/78 mm Hg.", "The abdomen is soft and nontender.", "Examination of the back shows no costovertebral angle tenderness.", "The remainder of the examination shows no abnormalities.", "Urinalysis is unremarkable." ]

[ "1. A 25-year-old man comes to the emergency department.", "2. He has left flank pain for 2 hours.", "3. The pain is colicky in nature.", "4. He describes the pain as 8 out of 10 in intensity.", "5. He has nausea and has vomited once.", "6. He had a similar episode 6 months ago for which he took naproxen.", "7. There is no personal or family history of serious illness.", "8. He is a second-year medical student.", "9. He has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days.", "10. He does not smoke or drink alcohol.", "11. He takes no medications.", "12. His temperature is 37.3°C (99.1°F).", "13. His pulse is 98/min.", "14. His blood pressure is 124/78 mm Hg.", "15. The abdomen is soft and nontender.", "16. Examination of the back shows no costovertebral angle tenderness.", "17. The remainder of the examination shows no abnormalities.", "18. Urinalysis is unremarkable." ]

[ "1. The pain is colicky in nature.", "2. He describes the pain as 8 out of 10 in intensity.", "3. He has nausea.", "4. He has vomited once.", "5. He had a similar episode 6 months ago for which he took naproxen.", "6. There is no personal history of serious illness.", "7. There is no family history of serious illness.", "8. He is a second-year medical student.", "9. He has been consuming more coffee and energy drinks than normal for the past 2 days.", "10. He does not smoke.", "11. He does not drink alcohol.", "12. He takes no medications.", "13. His temperature is 37.3°C (99.1°F).", "14. His pulse is 98/min.", "15. His blood pressure is 124/78 mm Hg.", "16. The abdomen is soft and nontender.", "17. Examination of the back shows no costovertebral angle tenderness.", "18. The remainder of the examination shows no abnormalities.", "19. Urinalysis is unremarkable." ]

[ "An otherwise healthy 6-year-old boy presents for a follow-up visit to his pediatrician's office for persistent nocturnal enuresis.", "He has never been dry at night and throughout the last year the pediatrician has seen him multiple times for this issue.", "He and his family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success.", "His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age, but the patient often sleeps over at a friend's house and is very bothered by this problem.", "He has 1 soft stool a day, denies abdominal pain, dysuria, or frequency, and has been continent during the day since 3 years of age.", "He has a completely normal physical exam, urinalysis, and basic metabolic panel." ]

[ "1. Patient is a 6-year-old boy.", "2. Patient presents for follow-up visit for persistent nocturnal enuresis.", "3. Patient has never been dry at night.", "4. Pediatrician has seen patient multiple times for this issue in the last year.", "5. Patient and family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success.", "6. Patient's two older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age.", "7. Patient often sleeps over at a friend's house and is very bothered by this problem.", "8. Patient has 1 soft stool a day.", "9. Patient denies abdominal pain, dysuria, or frequency.", "10. Patient has been continent during the day since 3 years of age.", "11. Patient has a completely normal physical exam.", "12. Patient has a completely normal urinalysis.", "13. Patient has a completely normal basic metabolic panel." ]

[ "1. He has never been dry at night.", "2. Throughout the last year, the pediatrician has seen him multiple times for this issue.", "3. He and his family have tried not drinking liquids 2 hours before bed.", "4. They have tried bed wetting alarms.", "5. They have tried a reward sticker chart with limited success.", "6. His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age.", "7. The patient often sleeps over at a friend's house.", "8. He is very bothered by this problem.", "9. He has 1 soft stool a day.", "10. He denies abdominal pain, dysuria, or frequency.", "11. He has been continent during the day since 3 years of age.", "12. He has a completely normal physical exam.", "13. He has a completely normal urinalysis.", "14. He has a completely normal basic metabolic panel." ]

[ "A 41-year-old woman presents with acute right flank pain for the past 6 hours.", "She says the pain is severe, colicky, ‘comes in waves’, and is localized to the right flank.", "She also has associated nausea and vomiting.", "The patient is afebrile, and her vital signs are within normal limits.", "On physical examination, she is writhing in pain and moaning.", "There is severe right costovertebral angle tenderness.", "Gross hematuria is present on urinalysis.", "A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction.", "Aggressive IV fluid hydration is started, and ondansetron is administered." ]

[ "1. Patient is a 41-year-old woman.", "2. Patient has had acute right flank pain for the past 6 hours.", "3. Patient describes the pain as severe, colicky, and ‘coming in waves’.", "4. Pain is localized to the right flank.", "5. Patient has associated nausea and vomiting.", "6. Patient is afebrile.", "7. Vital signs are within normal limits.", "8. On physical examination, patient is writhing in pain and moaning.", "9. Severe right costovertebral angle tenderness is present.", "10. Urinalysis reveals gross hematuria.", "11. Noncontrast CT of abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction.", "12. Aggressive IV fluid hydration is started.", "13. Ondansetron is administered." ]

[ "1. The patient reports severe, colicky pain localized to the right flank.", "2. The pain comes in waves.", "3. The patient experiences associated nausea and vomiting.", "4. The patient is afebrile.", "5. Vital signs are within normal limits.", "6. On physical examination, the patient is writhing in pain and moaning.", "7. Severe right costovertebral angle tenderness is present.", "8. Gross hematuria is present on urinalysis.", "9. A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction.", "10. Aggressive IV fluid hydration is started.", "11. Ondansetron is administered." ]

[ "A 36-year-old female presents with a 6-month history of stiffness in her joints.", "She reports bilateral knee pain that is worse in the morning prior to activity and stiffness of the fingers in both hands.", "Anti-CCP antibody tests are positive.", "Over several months, the patient's symptoms prove unresponsive to NSAIDs and methotrexate, and the decision is made to begin infliximab." ]

[ "1. A 36-year-old female presents.", "2. She has a 6-month history of stiffness in her joints.", "3. She reports bilateral knee pain.", "4. The knee pain is worse in the morning prior to activity.", "5. She has stiffness of the fingers in both hands.", "6. Anti-CCP antibody tests are positive.", "7. The patient's symptoms are unresponsive to NSAIDs and methotrexate.", "8. The decision is made to begin infliximab." ]

[ "1. The patient reports bilateral knee pain.", "2. The knee pain is worse in the morning prior to activity.", "3. The patient experiences stiffness of the fingers in both hands.", "4. Anti-CCP antibody tests are positive.", "5. The patient's symptoms are unresponsive to NSAIDs.", "6. The patient's symptoms are unresponsive to methotrexate.", "7. The decision is made to begin infliximab." ]

[ "A 55-year-old man presents to the emergency department with chest pain that started 1 hour ago and has not been improving.", "He has a past medical history of diabetes, hypertension, and obesity.", "His temperature is 98.5°F (36.9°C), blood pressure is 147/68 mmHg, pulse is 130/min, respirations are 13/min, and oxygen saturation is 100% on room air.", "Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema.", "The patient is given nitroglycerin, and his chest pain improves." ]

[ "1. A 55-year-old man presents to the emergency department with chest pain.", "2. The chest pain started 1 hour ago and has not been improving.", "3. The patient has a past medical history of diabetes, hypertension, and obesity.", "4. His temperature is 98.5°F (36.9°C).", "5. His blood pressure is 147/68 mmHg.", "6. His pulse is 130/min.", "7. His respirations are 13/min.", "8. His oxygen saturation is 100% on room air.", "9. Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema.", "10. The patient is given nitroglycerin.", "11. His chest pain improves." ]

[ "1. Past medical history of diabetes", "2. Past medical history of hypertension", "3. Past medical history of obesity", "4. Temperature: 98.5°F (36.9°C)", "5. Blood pressure: 147/68 mmHg", "6. Pulse: 130/min", "7. Respirations: 13/min", "8. Oxygen saturation: 100% on room air", "9. Physical exam notable for jugular venous distension", "10. Physical exam notable for bilateral lower extremity pitting edema", "11. Patient given nitroglycerin", "12. Patient's chest pain improves" ]

[ "An investigator is studying energy metabolism in athletes.", "Baseline serum lactate levels at rest are recorded and repeat levels are obtained directly after a 1000-meter sprint.", "Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint." ]

[ "1. An investigator is studying energy metabolism in athletes.", "2. Baseline serum lactate levels at rest are recorded.", "3. Repeat levels are obtained directly after a 1000-meter sprint.", "4. Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint." ]

[ "1. Baseline serum lactate levels are recorded at rest.", "2. Repeat serum lactate levels are obtained directly after a 1000-meter sprint.", "3. Serum lactate levels are significantly increased after the sprint compared to the baseline measurements." ]

[ "A scientist is studying the development of CD8+ T cells.", "In his experiments, he uses a radioactive isotope to mark a population of T cells.", "Once injected into the thymus, these cells bind tightly to MHC I self-antigen complexes.", "Later in the experiment, the scientist cannot find any marked cells in the peripheral blood." ]

[ "1. A scientist is studying the development of CD8+ T cells.", "2. In his experiments, he uses a radioactive isotope to mark a population of T cells.", "3. The marked cells are injected into the thymus.", "4. The marked cells bind tightly to MHC I self-antigen complexes.", "5. Later in the experiment, the scientist cannot find any marked cells in the peripheral blood." ]

[ "1. In his experiments, he uses a radioactive isotope to mark a population of T cells.", "2. The radioactive isotope is injected into the thymus.", "3. The marked cells bind tightly to MHC I self-antigen complexes.", "4. The scientist cannot find any marked cells in the peripheral blood later in the experiment." ]

[ "A 65-year-old woman who has smoked 2 packs per day for forty years comes to your practice complaining of a chronic cough, dyspnea, hemoptysis, and difficulty rising from a chair." ]

[ "1. Patient is 65 years old.", "2. Patient has smoked 2 packs per day for 40 years.", "3. Patient is complaining of a chronic cough.", "4. Patient is complaining of dyspnea.", "5. Patient is complaining of hemoptysis.", "6. Patient is complaining of difficulty rising from a chair." ]

[ "1. The patient is a 65-year-old woman.", "2. She has smoked 2 packs per day for forty years.", "3. She complains of a chronic cough.", "4. She complains of dyspnea.", "5. She complains of hemoptysis.", "6. She complains of difficulty rising from a chair." ]

[ "A 16-month-old boy is brought to the pediatrician after his parents noticed the appearance of a rash on his face, torso, and limbs.", "The boy has been ill for almost 2 weeks, initiating with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks.", "Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities with a reticular pattern (as shown in the photograph)." ]

[ "1. A 16-month-old boy is brought to the pediatrician.", "2. His parents noticed the appearance of a rash on his face, torso, and limbs.", "3. The boy has been ill for almost 2 weeks.", "4. The illness initiated with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks.", "5. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities.", "6. The rash has a reticular pattern (as shown in the photograph)." ]

[ "1. The boy has been ill for almost 2 weeks.", "2. The illness initiated with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks.", "3. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities.", "4. The rash has a reticular pattern." ]

[ "A 27-year-old woman presents to a neurologist complaining of facial pain.", "She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes.", "The pain is severe enough to completely stop her from her activities.", "She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer.", "Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome.", "She takes an oral contraceptive pill.", "Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min.", "On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive.", "Her pupils are 2 mm and reactive to light bilaterally.", "Fundoscopic examination is unremarkable.", "Her strength and range of motion are full and symmetric in her upper and lower extremities." ]

[ "1. A 27-year-old woman presents to a neurologist.", "2. She complains of facial pain.", "3. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain.", "4. The pain happens over 10 seconds to 3 minutes.", "5. The pain is severe enough to completely stop her from her activities.", "6. She is worried whenever she goes out that another attack will happen.", "7. She is sad that this has limited her ability to work as a lawyer.", "8. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome.", "9. She takes an oral contraceptive pill.", "10. Her temperature is 98.6°F (37°C).", "11. Her blood pressure is 130/75 mmHg.", "12. Her pulse is 75/min.", "13. Her respirations are 18/min.", "14. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive.", "15. Her pupils are 2 mm and reactive to light bilaterally.", "16. Fundoscopic examination is unremarkable.", "17. Her strength and range of motion are full and symmetric in her upper and lower extremities." ]

[ "1. She reports developing intermittent burning unilateral facial pain over the past 6 months.", "2. The pain lasts for 10 seconds to 3 minutes.", "3. The pain is severe enough to completely stop her from her activities.", "4. She is worried about another attack happening whenever she goes out.", "5. She is sad that the pain has limited her ability to work as a lawyer.", "6. Her past medical history includes irritable bowel syndrome and polycystic ovarian syndrome.", "7. She takes an oral contraceptive pill.", "8. Her temperature is 98.6°F (37°C).", "9. Her blood pressure is 130/75 mmHg.", "10. Her pulse is 75/min.", "11. Her respirations are 18/min.", "12. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive.", "13. Her pupils are 2 mm and reactive to light bilaterally.", "14. Fundoscopic examination is unremarkable.", "15. Her strength and range of motion are full and symmetric in her upper and lower extremities." ]

[ "A 26-year-old man comes to the physician because of high-grade fever, fatigue, nausea, and headache for 4 days.", "The headache is constant and feels like a tight band around his head.", "He also reports that his eyes hurt while looking at bright lights.", "He has been taking acetaminophen and using cold towels to help relieve his symptoms.", "He works as an assistant for a nature camp organization but has been unable to go to work for 3 days.", "His immunization records are unavailable.", "His temperature is 38.5°C (101.3°F), pulse is 92/min, and blood pressure is 108/74 mm Hg.", "He is oriented to time, place, and person.", "There is no rash or lymphadenopathy.", "Flexion of the neck results in flexion of the knee and hip.", "A lumbar puncture is done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O, leukocyte count of 93/mm3 (78% lymphocytes), a glucose concentration of 64 mg/dL, and a protein concentration of 50 mg/dL." ]

[ "1. Patient is a 26-year-old male.", "2. Patient has high-grade fever, fatigue, nausea, and headache for 4 days.", "3. Headache is constant and feels like a tight band around his head.", "4. Eyes hurt while looking at bright lights.", "5. Patient has been taking acetaminophen and using cold towels to help relieve his symptoms.", "6. Patient works as an assistant for a nature camp organization.", "7. Patient has been unable to go to work for 3 days.", "8. Patient's immunization records are unavailable.", "9. Patient's temperature is 38.5°C (101.3°F).", "10. Patient's pulse is 92/min.", "11. Patient's blood pressure is 108/74 mm Hg.", "12. Patient is oriented to time, place, and person.", "13. No rash or lymphadenopathy present.", "14. Flexion of the neck results in flexion of the knee and hip.", "15. Lumbar puncture done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O.", "16. Leukocyte count of 93/mm3 (78% lymphocytes).", "17. Glucose concentration of 64 mg/dL.", "18. Protein concentration of 50 mg/dL." ]

[ "1. The patient reports a constant headache that feels like a tight band around his head.", "2. The patient's eyes hurt when looking at bright lights.", "3. The patient has been taking acetaminophen and using cold towels to relieve his symptoms.", "4. The patient has been unable to go to work for 3 days.", "5. The patient's immunization records are unavailable.", "6. The patient's temperature is 38.5°C (101.3°F).", "7. The patient's pulse is 92/min.", "8. The patient's blood pressure is 108/74 mm Hg.", "9. The patient is oriented to time, place, and person.", "10. There is no rash or lymphadenopathy.", "11. Flexion of the neck results in flexion of the knee and hip.", "12. A lumbar puncture is done.", "13. Cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O.", "14. Cerebrospinal fluid analysis shows a leukocyte count of 93/mm3 (78% lymphocytes).", "15. Cerebrospinal fluid analysis shows a glucose concentration of 64 mg/dL.", "16. Cerebrospinal fluid analysis shows a protein concentration of 50 mg/dL." ]

[ "A 4-year-old girl presents to the pediatrician’s office for a physical examination prior to starting preschool.", "She was born at 39 weeks gestation via spontaneous vaginal delivery.", "She is up to date on all vaccines and is meeting all developmental milestones.", "Past medical history is noncontributory.", "She takes no medications but does take a chewable vitamin daily.", "She lives with her parents and older brother in a house.", "Today, her blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0°C (98.6°F).", "On physical exam, she appears well developed and pleasant.", "She sits listening to the conversation and follows directions.", "Palpation of the heart reveals a mild parasternal heave.", "Auscultation reveals a normal S1 but the S2 is split and remains split during inhalation and exhalation.", "Additionally, there is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side and a very soft diastolic rumble." ]

[ "1. Patient is a 4-year-old girl.", "2. Patient was born at 39 weeks gestation via spontaneous vaginal delivery.", "3. Patient is up to date on all vaccines and is meeting all developmental milestones.", "4. Patient's past medical history is noncontributory.", "5. Patient takes no medications but does take a chewable vitamin daily.", "6. Patient lives with her parents and older brother in a house.", "7. Patient's blood pressure is 110/65 mm Hg.", "8. Patient's heart rate is 90/min.", "9. Patient's respiratory rate is 22/min.", "10. Patient's temperature is 37.0°C (98.6°F).", "11. On physical exam, patient appears well developed and pleasant.", "12. Patient sits listening to the conversation and follows directions.", "13. Palpation of the heart reveals a mild parasternal heave.", "14. Auscultation reveals a normal S1.", "15. Auscultation reveals S2 is split and remains split during inhalation and exhalation.", "16. Auscultation reveals a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side.", "17. Auscultation reveals a very soft diastolic rumble." ]

[ "1. She was born at 39 weeks gestation", "2. She was born via spontaneous vaginal delivery", "3. She is up to date on all vaccines", "4. She is meeting all developmental milestones", "5. Past medical history is noncontributory", "6. She takes no medications", "7. She takes a chewable vitamin daily", "8. She lives with her parents and older brother in a house", "9. Today, her blood pressure is 110/65 mm Hg", "10. Her heart rate is 90/min", "11. Her respiratory rate is 22/min", "12. Her temperature is 37.0°C (98.6°F)", "13. On physical exam, she appears well developed and pleasant", "14. She sits listening to the conversation", "15. She follows directions", "16. Palpation of the heart reveals a mild parasternal heave", "17. Auscultation reveals a normal S1", "18. The S2 is split and remains split during inhalation and exhalation", "19. There is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side", "20. There is a very soft diastolic rumble" ]

[ "A 24-year-old man is brought to the emergency department after his head was hit with a bat during a baseball game.", "His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes.", "The patient initially refused to go to the hospital and sat on the bench for the remainder of the game.", "He initially appeared fine but became increasingly confused.", "He appears lethargic but opens his eyes to loud verbal commands.", "He is oriented to person and place.", "His temperature is 37.1 (98.8°F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg.", "Examination shows an area of soft-tissue swelling over the left temporal region.", "A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "A CT scan of the head is shown.", "After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds.", "He withdraws from painful stimuli.", "On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light.", "The right pupil is 3 mm in diameter and reacts normally to light.", "His respiratory rate is 10/min and he is intubated in the emergency department." ]

[ "1. A 24-year-old man was brought to the emergency department.", "2. His head was hit with a bat during a baseball game.", "3. His teammates state he was unresponsive after the incident but regained consciousness after 15 minutes.", "4. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game.", "5. He initially appeared fine but became increasingly confused.", "6. He appears lethargic but opens his eyes to loud verbal commands.", "7. He is oriented to person and place.", "8. His temperature is 37.1 (98.8°F).", "9. His pulse is 78/min.", "10. His respiratory rate is 16/min.", "11. His blood pressure is 148/87 mm Hg.", "12. Examination shows an area of soft-tissue swelling over the left temporal region.", "13. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "14. A CT scan of the head is shown.", "15. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds.", "16. He withdraws from painful stimuli.", "17. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light.", "18. The right pupil is 3 mm in diameter and reacts normally to light.", "19. His respiratory rate is 10/min.", "20. He is intubated in the emergency department." ]

[ "1. His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes.", "2. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game.", "3. He initially appeared fine but became increasingly confused.", "4. He appears lethargic but opens his eyes to loud verbal commands.", "5. He is oriented to person and place.", "6. His temperature is 37.1 (98.8°F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg.", "7. Examination shows an area of soft-tissue swelling over the left temporal region.", "8. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "9. A CT scan of the head is shown.", "10. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds.", "11. He withdraws from painful stimuli.", "12. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light.", "13. The right pupil is 3 mm in diameter and reacts normally to light.", "14. His respiratory rate is 10/min and he is intubated in the emergency department." ]

[ "A 58-year-old woman comes to the physician for a routine follow-up examination.", "She has a history of type 2 diabetes mellitus, hypertension, and asthma.", "Last year, she received laser photocoagulation for proliferative retinopathy.", "Her current medications include metformin, lisinopril, and an albuterol inhaler.", "Her mother died of complications from diabetes.", "She drinks 1 glass of wine daily with dinner and does not smoke.", "Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg.", "Cardiopulmonary examination is unremarkable.", "There is decreased sensation to monofilament testing of the plantar surfaces of both feet." ]

[ "1. A 58-year-old woman comes to the physician for a routine follow-up examination.", "2. She has a history of type 2 diabetes mellitus, hypertension, and asthma.", "3. Last year, she received laser photocoagulation for proliferative retinopathy.", "4. Her current medications include metformin, lisinopril, and an albuterol inhaler.", "5. Her mother died of complications from diabetes.", "6. She drinks 1 glass of wine daily with dinner and does not smoke.", "7. Her temperature is 37.2°C (99°F).", "8. Her pulse is 92/min.", "9. Her respirations are 14/min.", "10. Her blood pressure is 152/98 mm Hg.", "11. Cardiopulmonary examination is unremarkable.", "12. There is decreased sensation to monofilament testing of the plantar surfaces of both feet." ]

[ "1. She has a history of type 2 diabetes mellitus, hypertension, and asthma.", "2. Last year, she received laser photocoagulation for proliferative retinopathy.", "3. Her current medications include metformin, lisinopril, and an albuterol inhaler.", "4. Her mother died of complications from diabetes.", "5. She drinks 1 glass of wine daily with dinner and does not smoke.", "6. Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg.", "7. Cardiopulmonary examination is unremarkable.", "8. There is decreased sensation to monofilament testing of the plantar surfaces of both feet." ]

[ "A 4-year-old boy is brought to the physician by his mother because of a rash on his hands and feet for the past two weeks.", "It is intensely pruritic, especially at night.", "He has not had fever, headache, or diarrhea.", "His mother has a history of eczema.", "The child was due for an appointment later in the week to follow up on any potentially missing vaccinations.", "His temperature is 37.8°C (100.1°F).", "Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes.", "The remainder of the examination shows no abnormalities." ]

[ "1. A 4-year-old boy is brought to the physician by his mother.", "2. The boy has had a rash on his hands and feet for the past two weeks.", "3. The rash is intensely pruritic, especially at night.", "4. The boy has not had fever, headache, or diarrhea.", "5. The boy's mother has a history of eczema.", "6. The boy was due for an appointment later in the week to follow up on any potentially missing vaccinations.", "7. The boy's temperature is 37.8°C (100.1°F).", "8. Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes.", "9. The remainder of the examination shows no abnormalities." ]

[ "1. It is intensely pruritic, especially at night.", "2. He has not had fever, headache, or diarrhea.", "3. His mother has a history of eczema.", "4. The child was due for an appointment later in the week to follow up on any potentially missing vaccinations.", "5. His temperature is 37.8°C (100.1°F).", "6. Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes.", "7. The remainder of the examination shows no abnormalities." ]

[ "A 32-year-old man comes with his wife to the primary care physician because she is concerned about his drinking behavior.", "Specifically, he drinks 7 drinks every day and has abandoned many social activities that he previously enjoyed.", "In addition, he starts drinking in the morning because he feels shaky when he does not have a drink.", "When asked about his behavior, the man says that he knows that he probably should drink less but feels that he is not motivated enough to change.", "He says that perhaps the topic should be addressed again next year." ]

[ "1. A 32-year-old man comes with his wife to the primary care physician.", "2. His wife is concerned about his drinking behavior.", "3. He drinks 7 drinks every day.", "4. He has abandoned many social activities that he previously enjoyed.", "5. He starts drinking in the morning.", "6. He feels shaky when he does not have a drink.", "7. When asked about his behavior, he says he knows he should drink less.", "8. He feels he is not motivated enough to change.", "9. He suggests the topic should be addressed again next year." ]

[ "1. He drinks 7 drinks every day.", "2. He has abandoned many social activities.", "3. He starts drinking in the morning because he feels shaky without a drink.", "4. He knows he should drink less but feels unmotivated to change.", "5. He suggests addressing the topic again next year." ]

[ "An 18-month-old boy is brought to the emergency department 25 minutes after an episode of loss of consciousness.", "The child began crying after his 4-year-old brother snatched a toy from him.", "The brief shrill cry was followed by a period of expiration; he then turned blue, became unconscious, and briefly lost his muscle tone, before he stiffened and had jerky movements of his arms and legs for 15 seconds.", "After this episode, he immediately regained consciousness.", "He had a similar episode 2 weeks ago when his father refused to give him a juice box.", "He has been healthy and has met all his developmental milestones.", "Vital signs are within normal limits.", "He is alert and active.", "Cardiopulmonary examination shows no abnormalities.", "Neurologic examination shows no focal findings." ]

[ "1. An 18-month-old boy was brought to the emergency department 25 minutes after an episode of loss of consciousness.", "2. The episode began when the child's 4-year-old brother snatched a toy from him.", "3. The child had a brief shrill cry, followed by a period of expiration.", "4. He then turned blue, became unconscious, and briefly lost his muscle tone.", "5. He then had jerky movements of his arms and legs for 15 seconds.", "6. After this episode, he immediately regained consciousness.", "7. Two weeks ago, he had a similar episode when his father refused to give him a juice box.", "8. He has been healthy and has met all his developmental milestones.", "9. His vital signs are within normal limits.", "10. He is alert and active.", "11. Cardiopulmonary examination shows no abnormalities.", "12. Neurologic examination shows no focal findings." ]

[ "1. The child began crying after his 4-year-old brother snatched a toy from him.", "2. The brief shrill cry was followed by a period of expiration.", "3. He then turned blue, became unconscious, and briefly lost his muscle tone.", "4. He stiffened and had jerky movements of his arms and legs for 15 seconds.", "5. After this episode, he immediately regained consciousness.", "6. He had a similar episode 2 weeks ago when his father refused to give him a juice box.", "7. He has been healthy and has met all his developmental milestones.", "8. Vital signs are within normal limits.", "9. He is alert and active.", "10. Cardiopulmonary examination shows no abnormalities.", "11. Neurologic examination shows no focal findings." ]

[ "A 67-year-old woman presents to the ophthalmologist with complaints of worsening visual loss.", "She states that her vision is blurry.", "Driving has become difficult, particularly at night, as she experiences substantial glare and sees halos around lights.", "On physical examination, there is absence of a red reflex." ]

[ "1. A 67-year-old woman presents to the ophthalmologist.", "2. She has complaints of worsening visual loss.", "3. She states that her vision is blurry.", "4. Driving has become difficult, particularly at night.", "5. She experiences substantial glare.", "6. She sees halos around lights.", "7. On physical examination, there is absence of a red reflex." ]

[ "1. The patient states that her vision is blurry.", "2. Driving has become difficult for the patient, particularly at night.", "3. The patient experiences substantial glare and sees halos around lights.", "4. On physical examination, there is absence of a red reflex." ]

[ "A 30-year-old woman comes to the physician because of headaches and nausea for the past 3 weeks.", "The headaches are holocranial and last up to several hours.", "During this period, she has also had a swishing sound in both ears, which decreases when she turns her head to either side.", "She has had multiple episodes of blurring of vision and double vision for the past 2 weeks.", "She has vomited twice in the past week.", "She has nodular cystic acne and polycystic ovarian disease.", "Current medications include an oral contraceptive, metformin, and isotretinoin.", "She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2.", "Her temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg.", "She is oriented to time, place, and person.", "Examination shows acne over her cheeks and back.", "Hirsutism is present.", "Visual acuity is 20/20 in both eyes.", "There is esotropia of the left eye." ]

[ "1. Patient is a 30-year-old woman.", "2. Patient has had headaches and nausea for the past 3 weeks.", "3. Headaches are holocranial and last up to several hours.", "4. Patient has had a swishing sound in both ears, which decreases when she turns her head to either side.", "5. Patient has had multiple episodes of blurring of vision and double vision for the past 2 weeks.", "6. Patient has vomited twice in the past week.", "7. Patient has nodular cystic acne and polycystic ovarian disease.", "8. Current medications include an oral contraceptive, metformin, and isotretinoin.", "9. Patient is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2.", "10. Patient's temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg.", "11. Patient is oriented to time, place, and person.", "12. Examination shows acne over her cheeks and back.", "13. Hirsutism is present.", "14. Visual acuity is 20/20 in both eyes.", "15. There is esotropia of the left eye." ]

[ "1. The headaches are holocranial and last up to several hours.", "2. She has a swishing sound in both ears, which decreases when she turns her head to either side.", "3. She has had multiple episodes of blurring of vision and double vision for the past 2 weeks.", "4. She has vomited twice in the past week.", "5. She has nodular cystic acne and polycystic ovarian disease.", "6. Current medications include an oral contraceptive, metformin, and isotretinoin.", "7. She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2.", "8. Her temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg.", "9. She is oriented to time, place, and person.", "10. Examination shows acne over her cheeks and back.", "11. Hirsutism is present.", "12. Visual acuity is 20/20 in both eyes.", "13. There is esotropia of the left eye." ]

[ "A 64-year-old woman with knee osteoarthritis comes to the physician for a follow-up examination.", "She reports significantly improved pain control since starting celecoxib 1 month ago." ]

[ "1. A 64-year-old woman comes to the physician for a follow-up examination.", "2. She has knee osteoarthritis.", "3. She has been taking celecoxib for 1 month.", "4. She reports significantly improved pain control since starting celecoxib." ]

[ "1. Patient started taking celecoxib 1 month ago.", "2. Patient reports significantly improved pain control since starting celecoxib." ]

[ "A 48-year-old woman is admitted to the hospital and requires anticoagulation.", "She is administered a drug that binds tightly to antithrombin III." ]

[ "1. A 48-year-old woman is admitted to the hospital.", "2. The woman requires anticoagulation.", "3. She is administered a drug.", "4. The drug binds tightly to antithrombin III." ]

[ "1. A drug is administered to her.", "2. The drug binds tightly to antithrombin III." ]

[ "A 20-year-old woman comes to the physician because of a 2-day history of low-grade fever and painful lesions on her left index finger.", "Two weeks ago, she had a painful rash on the right labia majora that resolved without treatment.", "Physical examination shows tender lymphadenopathy of the left epitrochlear and right inguinal region.", "A photograph of the left index finger is shown." ]

[ "1. A 20-year-old woman comes to the physician.", "2. She has a 2-day history of low-grade fever.", "3. She has painful lesions on her left index finger.", "4. Two weeks ago, she had a painful rash on the right labia majora.", "5. The rash resolved without treatment.", "6. Physical examination shows tender lymphadenopathy of the left epitrochlear region.", "7. Physical examination shows tender lymphadenopathy of the right inguinal region.", "8. A photograph of the left index finger is shown." ]

[ "1. Two weeks ago, she had a painful rash on the right labia majora.", "2. The painful rash resolved without treatment.", "3. Physical examination shows tender lymphadenopathy of the left epitrochlear region.", "4. Physical examination shows tender lymphadenopathy of the right inguinal region.", "5. A photograph of the left index finger is shown." ]

[ "A 37-year-old man comes to the emergency department because of unsteady gait that started after waking up that morning.", "He has no fever, chills, headache, or myalgia.", "He works as a logger in Washington.", "His younger sister has multiple sclerosis.", "The patient appears pale.", "He is alert and responsive.", "His temperature is 37°C (98.9°F), pulse is 100/min, respirations are 11/min, and blood pressure is 136/86 mm Hg.", "Examinations shows intact cranial nerves.", "There is bilateral flaccid paralysis of his lower extremities.", "Lower extremity deep tendon reflexes are absent.", "The patient develops tachypnea and is admitted to the intensive care unit.", "Assisted breathing is started because of respiratory weakness." ]

[ "1. A 37-year-old man comes to the emergency department.", "2. His gait became unsteady after waking up that morning.", "3. He has no fever, chills, headache, or myalgia.", "4. He works as a logger in Washington.", "5. His younger sister has multiple sclerosis.", "6. The patient appears pale.", "7. He is alert and responsive.", "8. His temperature is 37°C (98.9°F).", "9. His pulse is 100/min.", "10. His respirations are 11/min.", "11. His blood pressure is 136/86 mm Hg.", "12. Examinations shows intact cranial nerves.", "13. There is bilateral flaccid paralysis of his lower extremities.", "14. Lower extremity deep tendon reflexes are absent.", "15. The patient develops tachypnea.", "16. He is admitted to the intensive care unit.", "17. Assisted breathing is started because of respiratory weakness." ]

[ "1. He has no fever, chills, headache, or myalgia.", "2. He works as a logger in Washington.", "3. His younger sister has multiple sclerosis.", "4. The patient appears pale.", "5. He is alert and responsive.", "6. His temperature is 37°C (98.9°F), pulse is 100/min, respirations are 11/min, and blood pressure is 136/86 mm Hg.", "7. Examinations shows intact cranial nerves.", "8. There is bilateral flaccid paralysis of his lower extremities.", "9. Lower extremity deep tendon reflexes are absent.", "10. The patient develops tachypnea and is admitted to the intensive care unit.", "11. Assisted breathing is started because of respiratory weakness." ]

[ "A 43-year-old man presents requesting a sleep aid for long-standing insomnia.", "He says he has been having trouble falling asleep for as long as he can remember, but it has become increasingly worse after he and his wife moved to their new house.", "He claims that his new neighbors are jealous of his huge swimming pool and are trying to sabotage it while he sleeps.", "His wife even had to cancel the housewarming party that was planned for the neighbors because of her husband’s behavior.", "When probed further on this topic, the patient accuses the physician of being angry and hostile." ]

[ "1. A 43-year-old man presents requesting a sleep aid for long-standing insomnia.", "2. He has been having trouble falling asleep for as long as he can remember.", "3. His insomnia has become increasingly worse after he and his wife moved to their new house.", "4. He claims that his new neighbors are jealous of his huge swimming pool and are trying to sabotage it while he sleeps.", "5. His wife had to cancel the housewarming party that was planned for the neighbors.", "6. When probed further on this topic, the patient accuses the physician of being angry and hostile." ]

[ "1. The patient has been having trouble falling asleep for as long as he can remember.", "2. The sleep troubles have become worse after the patient and his wife moved to their new house.", "3. The patient claims that his new neighbors are jealous of his huge swimming pool.", "4. The patient believes that his neighbors are trying to sabotage his swimming pool while he sleeps.", "5. The patient's wife had to cancel the housewarming party planned for the neighbors due to her husband's behavior.", "6. When probed further on this topic, the patient accuses the physician of being angry and hostile." ]

[ "A 22-year-old man presents to the emergency room after an altercation with the police.", "The police were called because the man was acting erratically in public.", "On physical examination, the patient is disoriented, does not respond to questioning, and appears to be reacting to internal stimuli.", "Laboratory tests are performed, which are all within normal limits, including a toxicology screen.", "The patient becomes aggressive and is given a medication to address his acute psychotic episode.", "An hour later, he is found in a sustained rigid posture in his bed, with his eyes in a fixed upward gaze." ]

[ "1. A 22-year-old man presents to the emergency room.", "2. The police were called because the man was acting erratically in public.", "3. On physical examination, the patient is disoriented.", "4. The patient does not respond to questioning.", "5. The patient appears to be reacting to internal stimuli.", "6. Laboratory tests are performed.", "7. The laboratory tests are all within normal limits.", "8. A toxicology screen is performed.", "9. The patient becomes aggressive.", "10. The patient is given a medication to address his acute psychotic episode.", "11. An hour later, the patient is found in a sustained rigid posture in his bed.", "12. The patient's eyes are in a fixed upward gaze." ]

[ "1. The police were called because the man was acting erratically in public.", "2. On physical examination, the patient is disoriented.", "3. The patient does not respond to questioning.", "4. The patient appears to be reacting to internal stimuli.", "5. Laboratory tests are performed.", "6. The laboratory tests are all within normal limits.", "7. The laboratory tests include a toxicology screen.", "8. The patient becomes aggressive.", "9. The patient is given a medication to address his acute psychotic episode.", "10. An hour later, the patient is found in a sustained rigid posture in his bed.", "11. The patient's eyes are in a fixed upward gaze." ]

[ "A 42-year-old man is brought to the emergency department by his wife with chills and a temperature of 38.5°C (101.3°F) for the past 2 days.", "The patient’s wife mentions that he recently injured his leg 5 days ago, after which she noticed that his calf was swollen, red, and painful.", "She says there was no pus, but that her husband was in excruciating pain.", "His vital signs include: temperature 38.9°C (102.1°F), blood pressure 110/75 mm Hg, and respiratory rate 18/min.", "On physical examination, there is a tender mass over the left calf which is red and inflamed.", "Blood and wound cultures are taken.", "The patient is started on empiric antibiotics with vancomycin, but shows no improvement.", "Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin." ]

[ "1. Patient is 42 years old.", "2. Patient has had chills and a temperature of 38.5°C (101.3°F) for the past 2 days.", "3. Patient injured his leg 5 days ago.", "4. Patient's calf was swollen, red, and painful.", "5. Patient was in excruciating pain.", "6. Patient's vital signs include temperature 38.9°C (102.1°F), blood pressure 110/75 mm Hg, and respiratory rate 18/min.", "7. Physical examination reveals a tender mass over the left calf which is red and inflamed.", "8. Blood and wound cultures are taken.", "9. Patient is started on empiric antibiotics with vancomycin.", "10. Patient shows no improvement.", "11. Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin." ]

[ "1. The patient injured his leg 5 days ago.", "2. The patient's wife noticed swelling, redness, and pain in his calf after the injury.", "3. There was no pus present in the calf.", "4. The patient was in excruciating pain.", "5. The patient's temperature is 38.9°C (102.1°F).", "6. The patient's blood pressure is 110/75 mm Hg.", "7. The patient's respiratory rate is 18/min.", "8. A tender mass is found over the left calf during physical examination.", "9. The mass is red and inflamed.", "10. Blood and wound cultures are taken.", "11. The patient is started on empiric antibiotics with vancomycin.", "12. The patient shows no improvement with the antibiotics.", "13. Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin." ]

[ "A 63-year-old man presents to the emergency department with the sudden onset of excruciating chest pain, which he describes as a tearing sensation", "He was diagnosed with essential hypertension 20 years ago, but he is not compliant with his medications", "On physical examination, the temperature is 37.1°C (98.8°F), heart rate is 95/min, and blood pressure is 195/90 mm Hg in the right arm and 160/80 mm Hg in the left arm", "The pulses are absent in his right leg and diminished in his left leg", "A chest X-ray shows a widened mediastinum." ]

[ "A 63-year-old man presents to the emergency department.", "He is experiencing sudden, excruciating chest pain.", "He describes the pain as a tearing sensation.", "He was diagnosed with essential hypertension 20 years ago.", "He is not compliant with his hypertension medications.", "His physical examination reveals a temperature of 37.1°C (98.8°F).", "His heart rate is 95 beats per minute.", "His blood pressure is 195/90 mm Hg in the right arm.", "His blood pressure is 160/80 mm Hg in the left arm.", "The blood pressure difference between his arms is 35/10 mm Hg.", "His right leg pulses are absent.", "His left leg pulses are diminished.", "A chest X-ray shows a widened mediastinum." ]

[ "1. Diagnosed with essential hypertension 20 years ago", "2. Non-compliant with medications", "3. Temperature is 37.1°C (98.8°F)", "4. Heart rate is 95/min", "5. Blood pressure is 195/90 mm Hg in the right arm", "6. Blood pressure is 160/80 mm Hg in the left arm", "7. Absent pulses in right leg", "8. Diminished pulses in left leg", "9. Chest X-ray shows widened mediastinum" ]