MedicalExam.json

[
    {
        "raw_data": {
            "id": 147,
            "question": "A 26-year-old woman presents with purulent vaginal discharge, lower abdominal pain, and fever. She reports having engaged in unprotected sexual intercourse on multiple occasions. Physical examination reveals cervical motion tenderness, right adnexal tenderness, and bilateral abdominal tenderness. In light of this presentation, treatment with which of the following antimicrobial drug regimens should be initiated?",
            "options": {
                "A": " Acyclovir",
                "B": " Ceftriaxone-azithromycin",
                "C": " Metronidazole",
                "D": " Penicillin",
                "E": " Trimethoprim-sulfamethoxazole"
            },
            "answer_idx": "B",
            "explaination": [
                "The correct answer is B. 68% chose this. This patient presents with signs and symptoms consistent with pelvic inflammatory disease (PID), which is caused most commonly by Chlamydia trachomatis and/or Neisseria gonorrhoeae. Azithromycin is a macrolide antibiotic and the first-line drug for treating chlamydia. Ceftriaxone is a third-generation cephaslosporin and the drug of choice for treating gonococcal infections. Although Chlamydia is the most common cause of PID, the two antibiotics are typically given together because of the high rate of coinfection with Chlamydia and N. gonorrhoeae.",
                "A is not correct. 4% chose this. Acyclovir is an antiviral drug used to treat herpes simplex infections. Herpes simplex virus-2 (HSV-2) may cause genital herpes but would not account for the purulent vaginal discharge or signs and symptoms ofpelvic inflammatory disease seen in this patient.",
                "C is not correct. 13% chose this. Metronidazole is the agent of choice for treating vaginitis caused by both Trichomonas vaginalis and Gardnerella vaginalis. These organisms cause vulvovaginitis, associated with genital pruritus and foul-smelling vaginal discharge, but would not cause the signs and symptoms of pelvic inflammatory disease seen in this patient.",
                "D is not correct. 7% chose this. Penicillin is the treatment choice for syphilis infections caused by the spirochete Treponema pallidum. Syphilis is not a cause of pelvic inflammatory disease (PID) and would therefore not present with the physical exam findings seen in this patient.",
                "E is not correct. 8% chose this. Trimethoprim-sulfamethoxazole, also known as Bactrim, is the drug of choice for urinary tract infections (UTIs), typically caused by gram-negative organisms such as Escherichia coli. Sexually transmitteddiseases and UTIs may both present with dysuria, but a UTI would not cause purulent vaginal discharge or the signs and symptoms of pelvic inflammatory disease seen in this patient."
            ],
            "bottom_line": "Bottom Line: PID is caused most commonly by C. trachomatis and/or N. gonorrhoeae. Treatment with both ceftriaxone and azithromycin is typically initiated in patients with PID because of the high rate of coinfection with the two organisms.",
            "total_id": 269,
            "type": "Reproductive"
        },
        "question": " In light of this presentation, treatment with which of the following antimicrobial drug regimens should be initiated?",
        "gpt_extract_mdeical_info": "1. Patient's age: 26.\n2. Patient's gender: Female.\n3. Presenting symptoms: Purulent vaginal discharge, lower abdominal pain, and fever.\n4. Sexual behavior: Engaged in unprotected sexual intercourse on multiple occasions.\n5. Physical examination findings: Cervical motion tenderness, right adnexal tenderness, and bilateral abdominal tenderness.",
        "medical_info_list": {
            "Patient's age": "26.",
            "Patient's gender": "Female.",
            "Presenting symptoms": "Purulent vaginal discharge, lower abdominal pain, and fever.",
            "Sexual behavior": "Engaged in unprotected sexual intercourse on multiple occasions.",
            "Physical examination findings": "Cervical motion tenderness, right adnexal tenderness, and bilateral abdominal tenderness."
        },
        "dataset": "QMAX",
        "id": 0,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm experiencing a bad vaginal discharge, lower abdominal pain, and a fever, especially after having unprotected sex."
            }
        ]
    },
    {
        "raw_data": {
            "id": 90,
            "question": "A 71-year-old man presents to his physician because of a 6-week history of progressive dyspnea, wheezing, and coughing. He has hypertension and a 60-pack-year history of smoking. The patient has difficulty speaking and is breathing using his accessory respiratory muscles. Neck vein distention and tongue swelling are evident. Which of the following is most likely diagnosis?",
            "options": {
                "A": " Gastric adenocarcinoma",
                "B": " Hodgkin lymphoma",
                "C": " Hypertrophic cardiomyopathy",
                "D": " Idiopathic pulmonary fibrosis",
                "E": " Squamous cell carcinoma"
            },
            "answer_idx": "E",
            "explaination": [
                "Lung cancer is the leading malignant cause of superior vena cava syndrome (SVCS), as seen in this patient and demonstrated in the image. Compression of the superior vena cava leads to dilation of the venous collateral circulation and to head and neck edema. Although other malignancies can lead to SVCS, this patient's age and history of smoking make squamous cell carcinoma of the lung the most likely cause. Squamous cell lung carcinoma and small cell lung carcinoma demonstrate strong associations with smoking of 90% and 99%, respectively. Of note, the most common type of lung cancer in nonsmokers is adenocarcinoma of the lung",
                "A is not correct. 4% chose this. Most cases of superior vena cava syndrome are attributed to mediastinal tumors or lymphomas, not to gastrointestinal cancers such as gastric adenocarcinoma.",
                "B is not correct. 5% chose this. Lymphoma, particularly Hodgkin lymphoma, is the leading cause of superior vena cava syndrome in young adults. However, the age and medical history of this patient make this diagnosis unlikely.",
                "C is not correct. 13% chose this. Hypertrophic cardiomyopathy (HCM) can manifeat as sudden death in young athletes as a result of expansion of the interventricular septum and obstruction of the outflow tract. Although dyspnea can be apresenting symptom of HCM, this patient has additional clinical signs suggestive of superior vena cava syndrome, and his smoking history and age make it more likely that lung cancer is the cause.",
                "D is not correct. 19% chose this. Idiopathic pulmonary fibrosis (IPF) is a form of interstitial lung disease that causes progressive dyspnea on exertion and, in some cases, a nonproductive dry cough. Common chest radiographic findings are increased lung markings at the bases and a honeycombing pattern. However, the head and neck edema, in addition to the smoking history, in this patient suggest superior vena cava syndrome secondary to lung cancer rather than IPF."
            ],
            "bottom_line": "Bottom Line: Compression of the superior vena cava leads to dilation of the venous collateral circulation, causing head and neck edema. The patient's age, symptoms, and social history make lung cancer likely.",
            "total_id": 83,
            "type": "Oncology"
        },
        "question": " Which of the following is most likely diagnosis?",
        "gpt_extract_mdeical_info": "1. Patient's age: 71.\n2. Patient's gender: male.\n3. Presenting symptoms: progressive dyspnea, wheezing, coughing.\n4. Medical history: hypertension.\n5. Smoking history: 60-pack-year.\n6. Physical examination:\n    1. Difficulty speaking.\n    2. Breathing using accessory respiratory muscles.\n    3. Neck vein distention.\n    4. Tongue swelling.",
        "medical_info_list": {
            "Patient's age": "71.",
            "Patient's gender": "male.",
            "Presenting symptoms": "progressive dyspnea, wheezing, coughing.",
            "Medical history": "hypertension.",
            "Smoking history": "60-pack-year.",
            "Physical examination": "Difficulty speaking. Breathing using accessory respiratory muscles. Neck vein distention. Tongue swelling."
        },
        "dataset": "QMAX",
        "id": 1,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing increasing shortness of breath, wheezing, and coughing for the past six weeks."
            }
        ]
    },
    {
        "raw_data": {
            "id": 10,
            "question": "A 32-year-old janitor presents with a disease of infectious origin. The organism responsible for his symptoms is revealed with an India ink stain, shown in the image.\nWhat clinical findings would be most likely in this patient?",
            "options": {
                "A": " Diffuse abdominal pain with rebound tenderness",
                "B": " Dull bone pain that worsens on movement",
                "C": " Fever, fatigue, cough, and pleuritic chest pain",
                "D": " Ulcerative cutaneous papules",
                "E": " Urinary frequency and urgency"
            },
            "answer_idx": "C",
            "explaination": [
                "The correct answer is C. 78% chose this. The species shown is Cryptococcus neoformans. Board review guides often emphasize that this species is a causative agent of fungal meningitis in immunocompromised patients (with Blastomyces, Coccidioides, and Histoplasma as causes of fungal pneumonia). Students should note, however, that these are oversimplifications. All the systemic mycoses can cause infection in a number of sites. Althoughmeningoencephalitis is the most common clinical manifestation of cryptococcal disease, it is not the only one. In fact, the initial site of inoculation with Cryptococcus is the lung; meningitis can ensue only after theyeasts have disseminated from this site. Patients present more often with cryptococcal meningitis, in large part because many lung infections are asymptomatic. When an individual does experience symptoms from cryptococcal pneumonia (the second most common clinical manifestation), the symptoms can include fever, fatigue, cough, and pleuritic chest pain. Other less common findings may include hemoptysis, auscultatory rales, or a pleural rub.",
                "A is not correct. 6% chose this. Peritonitis is rare manifestation of the disease.",
                "B is not correct. 6% chose this. These symptoms are indicative of bony involvement. Osteolytic bone lesions are another less common manifestation of disseminated cryptococcosis.",
                "D is not correct. 7% chose this. Cutaneous lesions appear in 10%-15% of cases of disseminated cryptococcosis. They are often seen as a sign of particularly severe disease. Isolated cryptococcal skin lesions without disseminated infection are rare in immunocompetent individuals, but can be seen in patients with HIV.",
                "E is not correct. 3% chose this. These are symptoms of prostatitis. Cryptococcal prostatitis is occasionally seen, albeit less frequently, in cases of disseminated disease."
            ],
            "bottom_line": "Bottom Line: Cryptococcus neoformans, visualized via India ink stain and carried by pigeons, most commonly causesmeningoencephalitis, followed by cryptococcal pneumonia.",
            "total_id": 376,
            "type": "Pulmonary"
        },
        "question": "\nWhat clinical findings would be most likely in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 32 years old.\n2. Patient's occupation: janitor.\n3. Patient's gender: man.\n4. The disease is of infectious origin.\n5. The organism responsible for the symptoms can be revealed with an India ink stain.",
        "medical_info_list": {
            "Patient's age": "32 years old.",
            "Patient's occupation": "janitor.",
            "Patient's gender": "man.",
            "info_1": "The organism responsible for the symptoms can be revealed with an India ink stain."
        },
        "dataset": "QMAX",
        "id": 2,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling unwell and I think it might be due to an infection."
            }
        ]
    },
    {
        "raw_data": {
            "id": 59,
            "question": "A 55-year-old man with a significant smoking history complains of dyspnea and productive cough for 1 week. Physical examination reveals diffuse wheezes, a prolonged expiratory phase, hyperresonance to percussion, and a barrel chest. The patient is afebrile and has a heart rate of 105/min. The physician prescibes a commonly used medication in hopes that it will help to alleviate this patients symptoms. One week later, the patient returns to the office with recent onset of tremors and feels as though his heart is racing. In addition to counseling the patient, what additional tests should be ordered?",
            "options": {
                "A": " Basic metabolic panel",
                "B": " Blood cultures",
                "C": " Chest X-ray",
                "D": " Complete blood count",
                "E": " Urine tox screen"
            },
            "answer_idx": "A",
            "explaination": [
                "The correct answer is A. 48% chose this. Salmeterol and albuterol act selectively at ß2-adrenergic receptors, causing bronchial smooth muscle relaxation. Catecholamines in general promote potassium entry into cells by increasing the activities of the Na-K-ATPase pump, and the Na-K-2Cl (NKCC1) cotransporter. These ß-agonists have been proven in randomized, controlled trials and meta-analyses to improve symptoms and lung function. They are typically prescribed on an as-needed basis rather than regularly scheduled, to decrease exposure in patients with less severe symptoms. Risks of ß-agonist overuse include tremor, tachycardia, and hypokalemia. As this patient is likely presenting with overdose of his albuterol inhaler, it is possible that he has developed hypokalemia, which can be very dangerous. The easiest way to measure serum potassium is through a basic metabolic panel, which quantifies serum sodium, potassium, chloride, bicarbonate, creatinine, BUN, and glucose.",
                "B is not correct. 8% chose this. Blood cultures are useful for detecting infections. This is highly unlikely in this patient given his presentation and recent initiation on a new medication, which is likely a ß-agonist.",
                "C is not correct. 19% chose this. Patients with pre-existing pulmonary conditions are at a heightened risk of developing infections, such as pneumonia. Nonetheless, this patient is not presenting with any symptoms of infection or pneumonia. Although chest X-rays are useful in monitoring the status of chronic lung conditions such as COPD, it is highly unlikely that this patient's COPD has changed significantly since his office visit 1 week ago.",
                "D is not correct. 12% chose this. Complete blood counts are a useful tests for infection. Although this patient is at a heightened risk of infection, such as pneumonia, given his chronic lung condition (COPD), he is not exhibiting any symptoms suggestive of infection. It is far more likely that he is overusing his newly prescribed ß-agonist.",
                "E is not correct. 13% chose this. Although intoxication with a variety of drugs can lead to tremors and tachycardia, it is much more likely that this patient's symptoms are due to his overuse of a ß-agonist, which was recently prescribed to reduce his COPD exacerbations."
            ],
            "bottom_line": "Bottom Line: Bronchodilators are the therapeutic mainstay for patients with COPD. ß-Agonists include albuterol and levalbuterol, which have been proven to improve symptoms and lung function in patients with COPD. Risks of ß-agonist overuse include tremor, reflex tachycardia, and hypokalemia.",
            "total_id": 413,
            "type": "Pulmonary"
        },
        "question": " In addition to counseling the patient, what additional tests should be ordered?",
        "gpt_extract_mdeical_info": "1. Age: 55 years old.\n2. Gender: Male.\n3. Medical history: Significant smoking history.\n4. Presenting symptoms: Dyspnea and productive cough for 1 week.\n5. Physical examination findings:\n   1. Lung examination: Diffuse wheezes, prolonged expiratory phase, hyperresonance to percussion, and a barrel chest.\n   2. Vital signs: Afebrile and heart rate of 105/min.\n6. Treatment: Prescribed medication.\n7. Follow-up symptoms: Tremors and racing heart.",
        "medical_info_list": {
            "Age": "55 years old.",
            "Gender": "Male.",
            "Medical history": "Significant smoking history.",
            "Presenting symptoms": "Dyspnea and productive cough for 1 week.",
            "Lung examination": "Diffuse wheezes, prolonged expiratory phase, hyperresonance to percussion, and a barrel chest.",
            "Vital signs": "Afebrile and heart rate of 105/min.",
            "Treatment": "Prescribed medication.",
            "Follow-up symptoms": "Tremors and racing heart."
        },
        "dataset": "QMAX",
        "id": 3,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing difficulty breathing and a cough that brings up mucus for the past week, and now I'm feeling shaky and like my heart is beating too fast."
            }
        ]
    },
    {
        "raw_data": {
            "id": 113,
            "question": "A 4-year-old boy is brought to a rural clinic because of a 1-week history of intense coughing spells that last 1-2 minutes, occasionally followed by vomiting. On questioning, the patient's mother recalls that he had a cold about 2 weeks ago, but that the coughing has become much worse recently. He has not received any immunizations. His vital signs are within normal limits, and physical examination is unremarkable. Laboratory studies show a WBC count of 22,000/mm³ with 60% lymphocytes. X-ray of the chest isunremarkable. Which of the following is the most likely cause of this patient's symptoms?",
            "options": {
                "A": " Bordetella pertussis",
                "B": " Corynebacterium diphtheriae",
                "C": " Haemophilus influenzae",
                "D": " Mycobacterium tuberculosis",
                "E": " Streptococcus pneumoniae"
            },
            "answer_idx": "A",
            "explaination": [
                "The correct answer is A. 70% chose this. This patient presents with a typical picture of pertussis, or whooping cough, caused by the gram-negative organism Bordetella pertussis. A prodromal phase resembling an upper respiratory tract infection is followed by roughly 1-6 weeks of coughing spells interspersed with a loud \"whooping\" sound caused by inspiration against a narrowed airway. Commonly, the cough is followed by posttussive emesis. A prominent lymphocytosis is often present as well. The pertussis vaccine is a routine childhood immunization, but this patient has not been immunized. Culture using Bordet-Gengou agar is the gold standard in diagnosis.",
                "B is not correct. 6% chose this. The exotoxin of Corynebacterium diphtheriae functions via the inactivation of elongation factor 2, causingpharyngitis and pseudomembrane in the throat.",
                "C is not correct. 14% chose this. Haemophilus influenzae may cause acute and chronic otitis and sinusitis. This organism commonly colonizes patients with chronic pulmonary disease and is associated with exacerbation of bronchitis and frank pneumonia.",
                "D is not correct. 4% chose this. Primary Mycobacterium tuberculosis infection does not present with intense coughing spells and the \"whoop.\" It usually starts with the formation of the Ghon complex and hilar lymphadenopathy.",
                "E is not correct. 6% chose this. Streptococcus pneumoniae multiplies in the alveolar spaces. Most patients have productive cough with blood-tinged sputum. Infection is generally localized to the lower lobes of the lungs."
            ],
            "bottom_line": "Bottom Line: Bordetella pertussis is the most likely causative organism of cough in children who have not been immunized. Infection presents with paroxysmal cough (\"whooping cough\") and intermittent posttussis vomiting.",
            "total_id": 456,
            "type": "Pulmonary"
        },
        "question": " Which of the following is the most likely cause of this patient's symptoms?",
        "gpt_extract_mdeical_info": "1. Patient's age: 4-year-old.\n2. Patient's gender: Male.\n3. Reason for visit: Intense coughing spells for 1-week, occasionally followed by vomiting.\n4. Medical history: Patient had a cold about 2 weeks ago.\n5. Immunization history: Patient has not received any immunizations.\n6. Vital signs: Within normal limits.\n7. Physical examination: Unremarkable.\n8. Laboratory studies:\n        1. WBC count: 22,000/mm³.\n        2. Percentage of lymphocytes in WBC count: 60%.\n9. X-ray of the chest: Unremarkable.",
        "medical_info_list": {
            "Patient's age": "4-year-old.",
            "Patient's gender": "Male.",
            "Reason for visit": "Intense coughing spells for 1-week, occasionally followed by vomiting.",
            "Medical history": "Patient had a cold about 2 weeks ago.",
            "Immunization history": "Patient has not received any immunizations.",
            "Vital signs": "Within normal limits.",
            "Physical examination": "Unremarkable.",
            "WBC count": "22,000/mm³.",
            "Percentage of lymphocytes in WBC count": "60%.",
            "X-ray of the chest": "Unremarkable."
        },
        "dataset": "QMAX",
        "id": 4,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been having intense coughing spells that last a couple of minutes and sometimes make me vomit, especially after having a cold a few weeks ago."
            }
        ]
    },
    {
        "raw_data": {
            "id": 39,
            "question": "A 24-year-old sexually active woman presents to her gynecologist with symptoms of genital itching, burning, and foul-smelling discharge. Samples are taken and \"clue cells\" are observed on microscopic wet mount. What is the mechanism of the drug most appropriate for treating this condition?",
            "options": {
                "A": " Binding of D-ala-D-ala portions of cell-wall precursors",
                "B": " Binding of the 30S ribosomal subunit",
                "C": " Blocking of cross-linking of the cell wall",
                "D": " Formation of intracellular toxic metabolites in bacteria",
                "E": " Inhibition of dihydropteroate synthase"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 47% chose this. This patient presents with symptoms of bacterial vaginosis, which is caused by a polymicrobial bacterial overgrowth in the vagina. Gardnerella vaginalis, a pleomorphic gram-variable rod, is almost always involved",
                "in bacterial vaginosis. Affected females will complain of genital burning, itching, and a whitish-gray vaginal discharge with a fishy smell. Bacterial vaginosis is diagnosed by the presence of \"clue cells\" under the microscope, which are vaginal epithelial cells covered with bacteria. It is treated with metronidazole, an antimicrobial and antiprotozoal agent that acts by inducing the formation of toxic metabolites within the bacterial or protozoal cell. Both an oral formulation and a gel are available for treatment.",
                "A is not correct. 9% chose this. Vancomycin is an antimicrobial that acts by inhibiting cell wall mucopeptide formation by binding the Dalanine-D-alanyl portion of cell-wall precursors. It is used for serious, gram-positive multidrug-resistant organisms, including Staphylococcus aureus and Clostridium difficile. It is not used in the treatment of Gardnerella vaginalis infection.",
                "B is not correct. 17% chose this. Tetracycline is a bacteriostatic antimicrobial that acts by binding to the 30S ribosomal subunit and preventing the attachment of aminoacyl-tRNA. It is used to treat infections caused by Vibrio cholerae, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Francisella tularensis, Helicobacter pylori, Borrelia burgdorferi, and Rickettsia. It is not used in the treatment of Gardnerella vaginalis infection.",
                "C is not correct. 14% chose this. Ampicillin is an aminopenicillin antimicrobial with a wider spectrum than penicillin. The mechanism of all penicillins is blocking the transpeptidase cross-linking of cell walls by binding penicillin-binding proteins. Ampicillin is penicillinase-sensitive but is often combined with clavulanic acid to enhance its spectrum. It isused to treat certain gram-positive and gram-negative infections, including from Haemophilus influenzae,Escherichia coli, Listeria, Proteus, Salmonella, enterococci, and Shigella, but is not used in the treatment of Gardnerella vaginalis infections.",
                "E is not correct. 13% chose this. Sulfamethoxazole is a bacteriostatic antimicrobial that inhibits folate synthesis by inhibitiing dihydropteroate synthase. It is used to treat Nocardia, Chlamydia, and simple urinary tract infections. It is not used in the treatment of Gardnerella vaginalis infections."
            ],
            "bottom_line": "Bottom Line: Bacterial vaginosis is treated with metronidazole, an antimicrobial and antiprotozoal that induces the formation of toxic metabolites within the bacterial or protozoal cell.",
            "total_id": 181,
            "type": "Reproductive"
        },
        "question": " What is the mechanism of the drug most appropriate for treating this condition?",
        "gpt_extract_mdeical_info": "1. Patient's age: 24 years old.\n2. Patient's gender: Female.\n3. Chief complaint: genital itching, burning, and foul-smelling discharge.\n4. Sexual history: sexually active.\n5. Diagnosis: presence of \"clue cells\" on microscopic wet mount.\n6. Potential diagnosis: bacterial vaginosis (based on symptoms and presence of clue cells).\n7. Plan of care: further testing and treatment for bacterial vaginosis.",
        "medical_info_list": {
            "Patient's age": "24 years old.",
            "Patient's gender": "Female.",
            "Chief complaint": "genital itching, burning, and foul-smelling discharge.",
            "Sexual history": "sexually active.",
            "Diagnosis": "presence of \"clue cells\" on microscopic wet mount.",
            "Potential diagnosis": "bacterial vaginosis (based on symptoms and presence of clue cells).",
            "Plan of care": "further testing and treatment for bacterial vaginosis."
        },
        "dataset": "QMAX",
        "id": 5,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing genital itching, burning, and a foul-smelling discharge."
            }
        ]
    },
    {
        "raw_data": {
            "id": 18,
            "question": "A 65-year-old woman who underwent a mastectomy 5 years ago returns to her oncologist for a check-up. She is currently taking exemestane for hormone-responsive breast cancer. What is the normal function of the enzyme targeted by exemestane?",
            "options": {
                "A": " Conversion of androstenedione to testosterone",
                "B": " Conversion of testosterone to dihydrotestosterone",
                "C": " Conversion of testosterone to estradiol",
                "D": " Secretion of follicle-stimulating hormone",
                "E": " Secretion of luteinizing hormone"
            },
            "answer_idx": "C",
            "explaination": [
                "The correct answer is C. 73% chose this. Exemestane is an aromatase inhibitor, preventing conversion of testosterone to estradiol and androstenedione to estrone. It works by forming an irreversible bond with aromatase. Two nonsteroidal aromatase inhibitors are anastrozole and letrozole, which inhibit aromatase via reversible competition. It is used to treat postmenopausal women with hormone-responsive breast cancer. It is often used after 2–3 years of tamoxifen treatment, or in patients who have hormone-responsive breast cancer that advances despite tamoxifen treatment. Unlike premenopausal women, for whom estrogen is predominantly synthesized in the ovary, estrogen in postmenopausal women is largely derived from the adrenal gland, where aromatase converts androgens to estrogen.",
                "A is not correct. 7% chose this. Conversion of androstenedione to testosterone is facilitated by 17β-hydroxysteroid dehydrogenase. It is produced in the adrenal glands and gonads.",
                "B is not correct. 5% chose this. Conversion of testosterone to dihydrotestosterone is facilitated by 5α-reductase. Aromatase, however, converts testosterone into estradiol. 5α-Reductase is produced in men, specifically in the prostate, epididymis, seminal vesicles, and skin. Finasteride, an inhibitor of this enzyme, is used to treat benign prostatic hyperplasia (BPH), prostate cancer, and male pattern baldness. Dutasteride is another drug in its class that is used to treat BPH. Inhibition of this enzyme may actually increase the levels of estradiol.",
                "D is not correct. 9% chose this. Gonadotropic-releasing hormone (GnRH) acts to promote the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. Leuprolide, a GnRH agonist, can be used to treat hormone-responsive prostate or breast cancer. Leuprolide constantly stimulates GnRH receptors, which results in an initial flare of FSH and LH release. However, intermittent pulses of GnRH activity are necessary to maintain proper secretion of these hormones, and their release is soon downregulated.",
                "E is not correct. 6% chose this. GnRH acts to promote the release of FSH and LH from the pituitary gland. Leuprolide, a GnRH agonist, can be used to treat hormone-responsive prostate or breast cancer. Leuprolide constantly stimulates GnRH receptors, which results in an initial flare of FSH and LH release. However, intermittent pulses of GnRH activity are necessary to maintain proper secretion of these hormones, and their release is soon downregulated."
            ],
            "bottom_line": "Bottom Line: Aromatase converts testosterone to estradiol and androstenedione to estrone. Exemestane forms an irreversible bond with aromatase, thereby inhibiting its activity. Exemestane is commonly used to treat hormone-responsive breast cancer in postmenopausal women.",
            "total_id": 16,
            "type": "Oncology"
        },
        "question": " What is the normal function of the enzyme targeted by exemestane?",
        "gpt_extract_mdeical_info": "1. Patient's age: 65 years old\n2. Patient's gender: Female\n3. Past medical history: underwent a mastectomy 5 years ago\n4. Current medication: taking exemestane\n5. Diagnosis: hormone-responsive breast cancer.",
        "medical_info_list": {
            "Patient's age": "65 years old",
            "Patient's gender": "Female",
            "Past medical history": "underwent a mastectomy 5 years ago",
            "Current medication": "taking exemestane",
            "Diagnosis": "hormone-responsive breast cancer."
        },
        "dataset": "QMAX",
        "id": 6,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm here for a check-up."
            }
        ]
    },
    {
        "raw_data": {
            "id": 76,
            "question": "A 35-year-old woman with type 2 diabetes mellitus presents to the emergency department with multiple episodes of vomiting after a late night out at bars with her friends. She is oriented, follows commands, and answers all questions appropriately. On physical examination the patient's face is flushed, and her heart rate is 110/min. Her abdomen is nontender without guarding or rebound. Neurologic examination results and gait are normal. Which of the following diabetes medications is most likely causing this patient's symptoms?",
            "options": {
                "A": " Acarbose",
                "B": " Chlorpropamide",
                "C": " Glargine",
                "D": " Glipizide",
                "E": " Metformin",
                "F": " Pioglitazone",
                "G": " Pramlintide"
            },
            "answer_idx": "B",
            "explaination": [
                "The correct answer is B. 33% chose this. Chlorpropamide is a first-generation sulfonylurea used to treat type 2 diabetes. Sulfonylureas act by increasing pancreatic production of insulin by β islet cells. Although vomiting can occur with alcohol toxicity, this patient is oriented and appropriate without ataxia, making this unlikely. Instead, this patient is presenting with signs of a disulfiram-like reaction after alcohol consumption, which include nausea, vomiting, headache, flushing, and tachycardia. First-generation sulfonylureas, and chlorpropamide in particular, can cause a disulfiram-like reaction when taken with ethanol. Other medications that are known to cause disulfiram-like reactions include metronidazole, procarbazine, and some cephalosporins.",
                "A is not correct. 9% chose this. Acarbose is an α-glucosidase inhibitor that blocks the enzyme responsible for sugar hydrolysis at the intestinal lumen border, mitigating the spike in blood glucose after a meal. The adverse effects of α-glucosidase inhibitors are gastrointestinal disturbances causing abdominal pain and diarrhea.",
                "C is not correct. 7% chose this. Glargine is a long-acting synthetic insulin that provides a continuous baseline level of insulin in the blood. The most important adverse effect associated with this agent is hypoglycemia if this drug is taken in excess. Although hypoglycemia can lead to tachycardia, the physician also expects confusion or altered mental status and shakiness, which this patient does not have.",
                "D is not correct. 15% chose this. Glipizide is a second-generation sulfonylurea that acts by stimulating insulin production by pancreatic β islet cells. The most important adverse effect associated with this agent is hypoglycemia. Second-generation sulfonylureas are much less likely to cause a disulfiram-like reaction than their first-generation kin. Because sulfonylureas are metabolized by the liver and excreted by the kidneys, liver or renal insufficiency is a contraindication to their use.",
                "E is not correct. 18% chose this. Metformin is an oral biguanide that is thought to inhibit gluconeogenesis and increase glycolysis, resulting in decreased blood glucose concentrations. The most serious adverse effect associated with this agent is lactic acidosis. It is also metabolized by the",
                "kidneys and is contraindicated in renal failure.",
                "F is not correct. 11% chose this. Pioglitazone is a thiazolidinedione class agent that increases the responsiveness of cells to insulin. Adverse effects include weight gain, edema, cardiotoxicity, and hepatotoxicity, but it does not cause a disulfiram-like reaction.",
                "G is not correct. 7% chose this. Pramlintide is an amylin mimetic that decreases glucagon. Amylin is a peptide that is normally released by the β cells along with insulin. The adverse effects of pramlintide include hypoglycemia, nausea, vomiting, and weight loss."
            ],
            "bottom_line": "Bottom Line: First-generation sulfonylureas (chlorpropamide and tolbutamide) can cause a disulfiram-like reaction when taken with ethanol.",
            "total_id": 332,
            "type": "Endocrine"
        },
        "question": " Which of the following diabetes medications is most likely causing this patient's symptoms?",
        "gpt_extract_mdeical_info": "1. Patient's age: 35 years old.\n2. Patient's gender: female.\n3. Patient's medical condition: type 2 diabetes mellitus.\n4. Reason for ER visit: multiple episodes of vomiting after a night out at bars.\n5. Mental status: oriented, follows commands, and answers questions appropriately.\n6. Physical examination findings:\n   1. Flushed face.\n   2. Heart rate: 110/min.\n   3. Abdomen: nontender without guarding or rebound.\n   4. Neurologic examination and gait: normal.\n7. Alcohol consumption: implied but not directly stated in the problem.\n8. Vital signs:\n   1. Heart rate: 110/min.\n9. Laboratory studies: not provided in the problem.",
        "medical_info_list": {
            "Patient's age": "35 years old.",
            "Patient's gender": "female.",
            "Patient's medical condition": "type 2 diabetes mellitus.",
            "Reason for ER visit": "multiple episodes of vomiting after a night out at bars.",
            "Mental status": "oriented, follows commands, and answers questions appropriately.",
            "Physical examination findings": "Flushed face.",
            "Heart rate": "110/min.",
            "Abdomen": "nontender without guarding or rebound.",
            "Neurologic examination and gait": "normal.",
            "Alcohol consumption": "implied but not directly stated in the problem.",
            "Laboratory studies": "not provided in the problem."
        },
        "dataset": "QMAX",
        "id": 7,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I went out with my friends last night, and now I've been vomiting multiple times."
            }
        ]
    },
    {
        "raw_data": {
            "id": 30,
            "question": "A 40-year-old woman presents with a chief complaint of progressive dyspnea and a nonproductive cough. She has a 40-pack-year smoking history. X-ray of the chest reveals a honeycomb appearance, and a CT image shows cystic lesions. An electron micrograph of her tissue biopsy is shown.\nThis patient’s defective cells are most likely to stain positive for which of the following?",
            "options": {
                "A": " CD20 ",
                "B": " CD30 ",
                "C": " CD5 ",
                "D": " S-100",
                "E": " TdT"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 43% chose this. This woman has histiocytosis X, a condition characterized by the abnormal proliferation of cells of mononuclear phagocytic origin, which are called histiocytes. The histiocytes that proliferate in this condition are dendritic cells that are related in lineage to Langerhans cells, the dendritic cells of the skin, and for this reason, the disease is also called Langerhans histiocytosis. Patients with this disease can present with hepatosplenomegaly, lymphadenopathy, lung and bone lesions, and cutaneous eruptions. The histiocytes are stellate (dendritic) cells with an oval or irregular pale nucleus, pale cytoplasm, and characteristic cytoplasmic granules (Birbeck granules). Birbeck granules are pathognomonic of Langerhans cell histiocytosis. They are said to resemble tennis rackets, as seen in the electron micrograph in the vignette.",
                "The defective dendritic cells in this disease stain positively for S-100 and CD1a.",
                "A is not correct. 17% chose this. CD20 is a B-lymphocyte marker. It can be helpful in diagnosing B-lymphocyte-derived malignancies such as follicular lymphoma, diffuse large B-cell lymphoma, or chronic lymphocytic leukemia.",
                "B is not correct. 14% chose this. CD30+ cells are found on Reed-Sternberg cells, the characteristic cell of Hodgkin lymphoma.",
                "C is not correct. 16% chose this. CD5+ cells are seen in mantle cell lymphoma, which is caused by the t(11;14) translocation. Mantle cell lymphomas express high levels of cyclin D1 and tend to manifest in men in their 50s and 60s as painless lymphadenopathy. CD5+ cells are also present in chronic lymphocytic leukemia (CLL). In contrast, CLL cells are negative for cyclin D1 and often positive for CD23.",
                "E is not correct. 10% chose this. TdT+ cells are seen in acute lymphocytic leukemia. TdT stands for terminal deoxynucleotidyl transferase, which is a special DNA polymerase expressed in B- and T-lymphocyte precursors."
            ],
            "bottom_line": "Bottom Line: Langerhans cells contain characteristic Birbeck granules. Dendritic cells in Langerhans cell histiocytosisstain positive for S-100 and CD1a.",
            "total_id": 392,
            "type": "Pulmonary"
        },
        "question": "\nThis patient’s defective cells are most likely to stain positive for which of the following?",
        "gpt_extract_mdeical_info": "1. Patient's age: 40 years old.\n2. Patient's gender: Female.\n3. Chief complaint: Progressive dyspnea and nonproductive cough.\n4. Social history: 40-pack-year smoking history.\n5. Chest X-ray results: Honeycomb appearance.\n6. CT image results: Cystic lesions.\n7. Tissue biopsy type: Electron micrograph.",
        "medical_info_list": {
            "Patient's age": "40 years old.",
            "Patient's gender": "Female.",
            "Chief complaint": "Progressive dyspnea and nonproductive cough.",
            "Social history": "40-pack-year smoking history.",
            "Chest X-ray results": "Honeycomb appearance.",
            "CT image results": "Cystic lesions.",
            "Tissue biopsy type": "Electron micrograph."
        },
        "dataset": "QMAX",
        "id": 8,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing increasing difficulty breathing and a persistent cough that doesn't produce any mucus."
            }
        ]
    },
    {
        "raw_data": {
            "id": 75,
            "question": "A 44-year-old man with a history of hypertension, hyperlipidemia, and type 1 diabetes mellitus who takes insulin, lisinopril, and atorvastatin is brought to the emergency department after experiencing several days of abdominal pain and polyuria. His basic metabolic panel shows: Na+: 134 mEq/L K+: 5.1 mEq/L Cl-: 94 mEq/L HCO3 -: 12 mEq/L BUN: 14 mg/dL Cr: 0.8 U/LGlucose: 310 mg/dL Based on the suspected diagnosis, which of the following physical signs is this patient likely to exhibit?",
            "options": {
                "A": " Bleeding from intravenous access sites",
                "B": " Hyperventilation",
                "C": " Jaundice",
                "D": " Miosis",
                "E": " Nystagmus"
            },
            "answer_idx": "B",
            "explaination": [
                "The correct answer is B. 82% chose this. People with poorly controlled type 1 diabetes are highly susceptible to developing diabetic ketoacidosis (DKA). Based on his basic metabolic panel, the patient has a metabolic acidosis with an anion gap. DKA is characterized by hyperglycemia (>300 mg/dL), low bicarbonate levels (<15 mEq/L), acidosis (pH < 7.30), ketonemia, ketonuria, and dehydration. The absolute absence of insulin prevents cells from utilizing glucose. Fat becomes an alternative energy source, and in the process of fat breakdown, ketones are formed. The excess ketones cause an anion-gap metabolic acidosis, and patients with DKA compensate by hyperventilating. The severe dehydration and persistent acidemia have detrimental neurologic effects. Therefore it is common for patients with DKA to have changes in mental status, as well as nausea and vomiting. An infection often may precipitate DKA, so if a diabetic patient presents after a few days of pains or fevers, it is possible that besides the primary complaint, the patient subsequently may have developed DKA.",
                "A is not correct. 3% chose this. Bleeding from intravenous access sites and body orifices is characteristic of disseminated intravascular coagulation (DIC). In DIC the formation of many microthrombi causes depletion of platelets, coagulation factors, and fibrin, resulting in widespread bleeding. DIC can be caused by obstetric complications, gram-negative sepsis, acute promyelocytic leukemia, and burns, but not by diabetic ketoacidosis. The patient has no signs suggestive of DIC.",
                "C is not correct. 6% chose this. Jaundice and liver failure are not associated with diabetic ketoacidosis; however, they will be seen in patients with acetaminophen toxicity. When taken in large doses, acetaminophen causes hepatic necrosis, resulting in nausea, vomiting, diarrhea, jaundice, and liver failure. Treatment is early administration of N-acetylcysteine. The patient has no history of acetaminophen intake.",
                "D is not correct. 4% chose this. Miosis can be seen in opioid use and cholinergic toxicity. This patient is presenting with diabetic ketoacidosis (DKA), and miosis is not seen in DKA.",
                "E is not correct. 5% chose this. The triad of hypersalivation, nystagmus, and tachycardia is characteristic of phencyclidine intoxication. This patient has no history of drug abuse."
            ],
            "bottom_line": "Bottom Line: Diabetic ketoacidosis (DKA) manifests as the result of poorly controlled diabetes (predominantly type 1) and is characterized by significant hyperglycemia, ketonuria, and metabolic acidosis. Patients with DKA compensate for acidemia through hyperventilation.",
            "total_id": 331,
            "type": "Endocrine"
        },
        "question": "8 U/LGlucose: 310 mg/dL Based on the suspected diagnosis, which of the following physical signs is this patient likely to exhibit?",
        "gpt_extract_mdeical_info": "1. Patient's age: 44 years old.\n2. Patient's gender: male.\n3. Patient's medical history: hypertension, hyperlipidemia, and type 1 diabetes mellitus.\n4. Medications taken by the patient: insulin, lisinopril, and atorvastatin.\n5. Vital signs:\n   1. Blood sodium level (Na+): 134 mEq/L\n   2. Blood potassium level (K+): 5.1 mEq/L\n   3. Blood chloride level (Cl-): 94 mEq/L\n   4. Blood bicarbonate level (HCO3-): 12 mEq/L\n6. Laboratory studies:\n   1. Blood urea nitrogen (BUN) level: 14 mg/dL\n   2. Creatinine (Cr) level: 0.",
        "medical_info_list": {
            "Patient's age": "44 years old.",
            "Patient's gender": "male.",
            "Patient's medical history": "hypertension, hyperlipidemia, and type 1 diabetes mellitus.",
            "Medications taken by the patient": "insulin, lisinopril, and atorvastatin.",
            "Blood sodium level (Na+)": "134 mEq/L",
            "Blood potassium level (K+)": "5.1 mEq/L",
            "Blood chloride level (Cl-)": "94 mEq/L",
            "Blood bicarbonate level (HCO-)": "12 mEq/L",
            "Blood urea nitrogen (BUN) level": "14 mg/dL",
            "Creatinine (Cr) level": "0."
        },
        "dataset": "QMAX",
        "id": 9,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing abdominal pain and urinating a lot more than usual for several days."
            }
        ]
    },
    {
        "raw_data": {
            "id": 130,
            "question": "A 60-year-old man is found to have a large adenocarcinoma of the stomach. The tumor is centered at the pyloric zone just near the pyloric sphincter, on the lesser curvature. Which of the following signs and symptoms is most likely to be seen in this patient due to the mass effect of the tumor?",
            "options": {
                "A": " Anemia",
                "B": " Constipation",
                "C": " Hoarseness",
                "D": " Jaundice",
                "E": " Periumbilical mass"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 34% chose this. This question tests the concept of mass effect of tumors, as well as anatomy. These two topics are inseparable and are necessary to understanding the etiology of some symptoms seen in the context of neoplasms. The adenocarcinoma impinges on the omental foramen, which is formed partly by the hepatoduodenal ligament. This ligament contains the common bile duct along with the hepatic artery proper and the hepatic portal vein. Obstruction of the common bile duct would lead to cholestasis and subsequently conjugated hyperbilirubinemia.",
                "A is not correct. 19% chose this. Anemia may be a sign of gastrointestinal bleeding (seen with stomach or colonic cancers) or that bone marrow is dysfunctional and/or being replaced with malignant cells. Although anemia may be seen in this patient due to bleeding into the stomach, anemia is not a direct result of mass effect of the tumor.",
                "B is not correct. 16% chose this. Constipation may be a symptom of obstruction of the left colon.",
                "C is not correct. 11% chose this. Persistent hoarseness could be a manifestation of impingement of the recurrent laryngeal nerve. This symptom may be seen with thyroid or lung cancer.",
                "E is not correct. 20% chose this. Although the tumor can metastasize to the periumbilical region to form a subcutaneous nodule, known as a Sister Mary Joseph nodule, the direct mass effect of the tumor does not affect the periumbilical region."
            ],
            "bottom_line": "Bottom Line: The hepatoduodenal ligament contains the common bile duct, the hepatic artery, and the hepatic portal vein.",
            "total_id": 117,
            "type": "Oncology"
        },
        "question": " Which of the following signs and symptoms is most likely to be seen in this patient due to the mass effect of the tumor?",
        "gpt_extract_mdeical_info": "1. Patient's age: 60 years old.\n2. Patient's gender: Male.\n3. Diagnosis: Large adenocarcinoma of the stomach.\n4. Location of the tumor: Centered at the pyloric zone near the pyloric sphincter, on the lesser curvature of the stomach.",
        "medical_info_list": {
            "Patient's age": "60 years old.",
            "Patient's gender": "Male.",
            "Diagnosis": "Large adenocarcinoma of the stomach.",
            "Location of the tumor": "Centered at the pyloric zone near the pyloric sphincter, on the lesser curvature of the stomach."
        },
        "dataset": "QMAX",
        "id": 10,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling like my stomach is full and I get full quickly after eating, even with small meals."
            }
        ]
    },
    {
        "raw_data": {
            "id": 95,
            "question": "A 49-year-old man presents to the emergency department complaining that \"my skin has turned yellow.\" The patient also reports recent weight loss and burning epigastric pain at night. Physical examination reveals the man is significantly jaundiced. He has no abdominal pain and has a negative Murphy's sign. The physician is concerned that he can feel the patient's gallbladder and orders a CT scan. What diagnosis should the physician be most concerned about with this patient's presentation?",
            "options": {
                "A": " Acute hepatitis",
                "B": " Choledocholithiasis",
                "C": " Cholelithiasis",
                "D": " Hemolytic anemia",
                "E": " Pancreatic cancer"
            },
            "answer_idx": "E",
            "explaination": [
                "The correct answer is E. 59% chose this. This patient's physical exam demonstrates Courvoisier sign: jaundice and a palpable, enlarged, nontendergallbladder. This sign is often found in patients with cancer in the head of the pancreas, which is obstructing the gallbladder and keeping it from emptying. Painless jaundice is a sign of intrapancreatic bile duct obstruction. About 95% of malignant pancreatic neoplasms come from exocrine cells. Treatment usually involves resections of the pancreatic head, duodenum, and gallbladder (Whipple procedure).",
                "A is not correct. 7% chose this. Acute hepatitis is associated with tenderness in the right upper quadrant, and it should not produce an enlarged gallbladder.",
                "B is not correct. 16% chose this. Choledocholithiasis is the presence of a stone in the common bile duct. It is a common cause of cholecystitis, which is associated with tenderness in the right upper quadrant. It is often associated with pain while eating, especially fatty foods. Other potential symptoms of choledocholithiasis include jaundice, pruritus, and nausea. However, up to 50% of patients can be asymptomatic. This patient could have choledocholithiasis, but with this presentation a physician should first rule out pancreatic cancer. Choledocholithiasis is usually treated with endoscopic retrograde cholangiopancreatography and papillotomy with stone extraction.",
                "C is not correct. 12% chose this. Cholelithiasis simply refers to stones within the gallbladder. It is generally painless, and does not cause jaundice or an enlarged gallbladder.",
                "D is not correct. 6% chose this. Hemolytic anemia is a cause of painless jaundice, but it is not associated with an enlarged gallbladder."
            ],
            "bottom_line": "Bottom Line: Painless jaundice and palpable gallbladder (Courvoisier sign) are commonly associated with pancreatic cancer.",
            "total_id": 88,
            "type": "Oncology"
        },
        "question": " What diagnosis should the physician be most concerned about with this patient's presentation?",
        "gpt_extract_mdeical_info": "1. Patient's age: 49 years old.\n2. Patient's gender: male.\n3. Chief complaint: skin has turned yellow.\n4. Additional complaints: recent weight loss and burning epigastric pain at night.\n5. Physical examination finding: significant jaundice.\n6. Abdominal examination finding: gallbladder palpable.\n7. Abdominal pain: absent.\n8. Murphy's sign: negative.\n9. Diagnostic test ordered: CT scan.",
        "medical_info_list": {
            "Patient's age": "49 years old.",
            "Patient's gender": "male.",
            "Chief complaint": "skin has turned yellow.",
            "Additional complaints": "recent weight loss and burning epigastric pain at night.",
            "Physical examination finding": "significant jaundice.",
            "Abdominal examination finding": "gallbladder palpable.",
            "Abdominal pain": "absent.",
            "Murphy's sign": "negative.",
            "Diagnostic test ordered": "CT scan."
        },
        "dataset": "QMAX",
        "id": 11,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "\"I've noticed my skin turning yellow, and I've been experiencing weight loss and burning pain in my upper abdomen at night.\""
            }
        ]
    },
    {
        "raw_data": {
            "id": 78,
            "question": "A 65-year-old male immigrant from Africa presents to the emergency department after an episode of gross hematuria. He states that he has seen small amounts of blood in his urine from time to time over the past several months. His physical examination is remarkable only for mild hepatosplenomegaly. A urology consult is called, and the urologist performs a bedside cystoscopy. A large fungating mass is seen adherent to the superior part of the bladder. Results of a biopsy are shown in the image.\n",
            "options": {
                "A": " Cigarette smoking",
                "B": " Exposure to aniline dyes",
                "C": " Helminth infection",
                "D": " Infection with a papillomavirus",
                "E": " Long-term indwelling catheter"
            },
            "answer_idx": "C",
            "explaination": [
                "The correct answer is C. 50% chose this. This patient is suffering from squamous cell carcinoma (SCC) of the bladder. Although this condition is rare in the United States, it is the most common type of bladder cancer in the world. The most common cause ischronic irritation by the eggs of the helminth Schistosoma haematobium, which lodge in the bladder wall.Although smoking has also been linked to an increased risk of SCC of the bladder, in this patient of African descent, helminth infection is the more likely risk factor. Squamous cell carcinoma can be distinguished from transitional cell carcinoma pathologically by its appearance. This specimen shows keratin pearl formation, a common finding in squamous cell cancers. In contrast to the United States, where transitional cell carcinoma of the bladder is the most common type of bladder cancer (it accounts for 95% of cases), countries in which Schistosoma haematobium is endemic have much higher rates of squamous cell carcinoma of the bladder.",
                "A is not correct. 18% chose this. Cigarette smoking is the most common risk factor associated with transitional cell bladder carcinoma. In this case, however, the patient's presentation and pathology are more suggestive of squamous cell carcinoma (SCC). Smoking has also been linked to increased risk of SCC, but helminth infection remains the greater and more common risk factor, particularly outside the United States.",
                "B is not correct. 19% chose this. Aniline dyes are associated with transitional cell carcinoma, the most common type of bladder cancer in the United States. They are not associated with squamous cell carcinoma of the bladder.",
                "D is not correct. 7% chose this. Papillomaviridae such as human papillomavirus are responsible for genital warts and cervical carcinoma. They are not associated with bladder cancers.",
                "E is not correct. 6% chose this. Long-term catheterization is associated with the development of squamous cell carcinoma of the bladder. Based on the patient's history, however, there is no reason to assume this patient has had an indwelling catheter at any time."
            ],
            "bottom_line": "Bottom Line: This patient has bladder cancer caused by long-term irritation from the eggs of the trematode Schistosoma haematobium.",
            "total_id": 71,
            "type": "Oncology"
        },
        "question": "\n",
        "gpt_extract_mdeical_info": "1. Patient's age: 65 years old.\n2. Patient's gender: male.\n3. Patient's country of origin: Africa.\n4. Reason for presentation: an episode of gross hematuria.\n5. Frequency of blood in urine: small amounts from time to time over the past several months.\n6. Remarkable physical examination finding: mild hepatosplenomegaly.\n7. Type of specialist consulted: urologist.\n8. Diagnostic tool used: bedside cystoscopy.\n9. Location and size of bladder mass: adherent to the superior part of the bladder and large and fungating.\n10. Results of biopsy: shown in the image, but not provided in the given text.",
        "medical_info_list": {
            "Patient's age": "65 years old.",
            "Patient's gender": "male.",
            "Patient's country of origin": "Africa.",
            "Reason for presentation": "an episode of gross hematuria.",
            "Frequency of blood in urine": "small amounts from time to time over the past several months.",
            "Remarkable physical examination finding": "mild hepatosplenomegaly.",
            "Type of specialist consulted": "urologist.",
            "Diagnostic tool used": "bedside cystoscopy.",
            "Location and size of bladder mass": "adherent to the superior part of the bladder and large and fungating.",
            "Results of biopsy": "shown in the image, but not provided in the given text."
        },
        "dataset": "QMAX",
        "id": 12,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came to the emergency department because I've been noticing blood in my urine for the past several months."
            }
        ]
    },
    {
        "raw_data": {
            "id": 109,
            "question": "A 35-year-old, slender woman is brought by ambulance to the emergency department unresponsive after a bout of confusion and agitation. Temperature is 39.2°C (102.5°F), blood pressure is 100/70 mm Hg, and pulse is 165/min. The patient has a diffuse goiter and hyperreflexia, and a systolic ejection murmur at the heart's apex. Her husband states she has recently become increasingly anxious, often yelling at him for keeping the apartment too hot. After acute management of ABCs and heart rate control, which of the following is the appropriate medication for long-term management of the patient's condition?",
            "options": {
                "A": " Iodine",
                "B": " Levothyroxine",
                "C": " Methimazole",
                "D": " Radioiodine ablation",
                "E": " Surgical resection"
            },
            "answer_idx": "C",
            "explaination": [
                "The correct answer is C. 53% chose this. This patient is presenting with a medical emergency—an extreme form of thyrotoxicosis known as \"thyroid storm.\" The symptoms of this syndrome are due primarily to increased β-adrenergic outflow stimulated by excessive thyroid hormones. After primary stabilization (propranolol and attention to airway, breathing, and circulation), methimazole is the most appropriate pharmacologic treatment for this condition. Propylthiouracil is an alternative treatment that may be administered to patients who cannot tolerate methimazole or pregnant patients for whom methimazole is contraindicated due to its teratogenicity.  However, propylthiouracil is otherwise avoided due to concerns of hepatotoxicity.  Both agents inhibit the endogenous synthesis of thyroxine.",
                "A is not correct. 5% chose this. Iodine, which decreases the release of preformed thyroxine, can be used as an adjunct to propylthiouracil or methimazole but should not be used until one of these agents is allowed to take effect. In areas of the world where goiters are endemic, supplemental iodine is used to increase thyroid hormone production. Consequently, iodine administration could potentially worsen this patient's condition due to the escape phenomenon that can be seen with iodine administration.",
                "B is not correct. 6% chose this. Levothyroxine, a synthetic form of thyroid hormone used to treat hypothyroidism, is contraindicated in the treatment of thyrotoxicosis. The administration of more thyroid hormone to a patient with symptomatic hyperthyroidism would only worsen the",
                "condition.",
                "D is not correct. 24% chose this. Radioiodine ablation utilizes the radioisotope iodine-131 given orally to restrict and/or destroy the hyperactive thyroid gland. This is a possible treatment for this patient, but antithyroid drugs are typically utilized before more invasive treatments, such as radioiodine ablation or surgical resection, are considered.",
                "E is not correct. 12% chose this. Surgical resection is not routinely used in the most common forms of hyperthyroidisms because of the risk to parathyroid glands and the recurrent laryngeal nerve. Antithyroid drugs would be the most appropriate initial treatment of this patient's underlying condition."
            ],
            "bottom_line": "Bottom Line: After primary stabilization (propranolol and attention to airway, breathing, and circulation), propylthiouracil or methimazole is the most appropriate pharmacologic treatment for \"thyroid storm.\"",
            "total_id": 360,
            "type": "Endocrine"
        },
        "question": " After acute management of ABCs and heart rate control, which of the following is the appropriate medication for long-term management of the patient's condition?",
        "gpt_extract_mdeical_info": "1. Patient's age: 35-year-old.\n2. Patient's gender: Female.\n3. Presenting symptoms: Unresponsive, confusion, agitation, hyperreflexia.\n4. Vital signs:\n   1. Temperature: 39.2°C (102.5°F)\n   2. Blood pressure: 100/70 mm Hg\n   3. Pulse: 165/min\n5. Medical history: Diffuse goiter.\n6. Cardiac exam: Systolic ejection murmur at the heart's apex.\n7. Recent behavioral change: Increasing anxiety, yelling at husband for keeping the apartment too hot.",
        "medical_info_list": {
            "Patient's age": "35-year-old.",
            "Patient's gender": "Female.",
            "Presenting symptoms": "Unresponsive, confusion, agitation, hyperreflexia.",
            "Temperature": "39.2°C (102.5°F)",
            "Blood pressure": "100/70 mm Hg",
            "Pulse": "165/min",
            "Medical history": "Diffuse goiter.",
            "Cardiac exam": "Systolic ejection murmur at the heart's apex.",
            "Recent behavioral change": "Increasing anxiety, yelling at husband for keeping the apartment too hot."
        },
        "dataset": "QMAX",
        "id": 13,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling increasingly anxious and have been getting upset about my apartment feeling too hot."
            }
        ]
    },
    {
        "raw_data": {
            "id": 74,
            "question": "A 7-year-old boy presents for the third time in 1 month because of acute onset cough, dyspnea, and wheezing. His symptoms improve with administration of a short-acting inhaled β2-agonist, which he uses athome as well whenever he begins feeling short of breath. He uses no other medications for his condition.On discharge the boy is prescribed an additional drug that acts by inhibiting a transcription factor required for the synthesis of inflammatory mediators such as tumor necrosis factor-α. Which of the following is a potential adverse effect of the newly prescribed drug if used chronically?",
            "options": {
                "A": " Cardiotoxicity",
                "B": " Headache",
                "C": " Oral thrush",
                "D": " Tachycardia",
                "E": " Tremor"
            },
            "answer_idx": "C",
            "explaination": [
                "This child presented with symptoms consistent with an asthma exacerbation. He was likely prescribed an inhaled corticosteroid (eg, beclomethasone), which acts by inactivating nuclear factor-κB. However, the immune-modulating properties of inhaled steroids also attenuate the local immune response of the oropharynx and upper airways to the extent that oral thrush can develop (shown in the image). Children are especially vulnerable to this.",
                "A is not correct. 9% chose this. The methylxanthines (eg, theophylline) are sometimes used in asthma prophylaxis. They work by inhibiting phosphodiesterase, inhibiting the hydrolysis of cAMP. Adverse effects of chronic therapy may include cardiotoxicity and neurotoxicity. Cardiotoxicity is not a common adverse effect of inhaled corticosteroid therapy, which this child likely received.",
                "B is not correct. 6% chose this. Zileuton is a lipoxygenase inhibitor that is used to manage asthma by preventing leukotriene production; it has no effect on tumor necrosis factor-α. As many as 25% of patients using this drug experience headache.Headache is not a common adverse effect of chronic inhaled corticosteroid use.",
                "D is not correct. 7% chose this. Tachycardia may result from the use of nonspecific β-agonists, but would not be expected to occur in thesetting of chronic inhaled corticosteroid therapy.",
                "E is not correct. 5% chose this. Long-acting β2-agonists (eg, salmeterol) are another prophylactic treatment for chronic asthma. Adverse effects associated with these agents include tremor and arrhythmia."
            ],
            "bottom_line": "Bottom Line: Inhaled corticosteroids are an established therapy for chronic asthma, but their use may attenuate local immune defenses, predisposing patients, particularly children, to oral thrush.",
            "total_id": 425,
            "type": "Pulmonary"
        },
        "question": " Which of the following is a potential adverse effect of the newly prescribed drug if used chronically?",
        "gpt_extract_mdeical_info": "1. Patient age: 7 years old.\n2. Patient gender: Not mentioned.\n3. Chief complaint: Acute onset cough, dyspnea, and wheezing.\n4. Frequency of presentation: Third time in 1 month.\n5. Treatment response: Symptoms improve with administration of a short-acting inhaled β2-agonist.\n6. Home medication: Short-acting inhaled β2-agonist.\n7. Current medication: An additional drug that inhibits a transcription factor required for the synthesis of inflammatory mediators such as tumor necrosis factor-α. \n8. History of medications: None mentioned. \n9. Medical history: None mentioned.\n10. Family history: None mentioned.",
        "medical_info_list": {
            "Patient age": "7 years old.",
            "Patient gender": "Not mentioned.",
            "Chief complaint": "Acute onset cough, dyspnea, and wheezing.",
            "Frequency of presentation": "Third time in 1 month.",
            "Treatment response": "Symptoms improve with administration of a short-acting inhaled β2-agonist.",
            "Home medication": "Short-acting inhaled β2-agonist.",
            "Current medication": "An additional drug that inhibits a transcription factor required for the synthesis of inflammatory mediators such as tumor necrosis factor-α.",
            "History of medications": "None mentioned.",
            "Medical history": "None mentioned.",
            "Family history": "None mentioned."
        },
        "dataset": "QMAX",
        "id": 14,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I keep having episodes of coughing, difficulty breathing, and wheezing that get better when I use my inhaler."
            }
        ]
    },
    {
        "raw_data": {
            "id": 67,
            "question": "A 36-year-old woman presents to her physician because she believes she might be pregnant. She has not had her period for 3 months and has noticed a milky discharge from her breasts. Results of a pregnancy test are negative. This woman's symptoms would most likely be an adverse effect of which of the following drugs?",
            "options": {
                "A": " Bromocriptine",
                "B": " Bupropion",
                "C": " Fluoxetine",
                "D": " Haloperidol",
                "E": " Lithium"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 48% chose this. The woman is suffering from symptoms of hyperprolactinemia. While this can be caused by a pituitary adenoma, it can also be a adverse effect of some medications. Prolactin secretion is normally inhibited by dopamine, therefore drugs that suppress dopamine's effects can result in elevated levels of prolactin. Haloperidol is a typical antipsychotic that is a dopamine antagonist, and taking it can result in the symptoms described in the stem.",
                "A is not correct. 22% chose this. Bromocriptine is a dopamine receptor agonist. It is used in the treatment of hyperprolactinemia.",
                "B is not correct. 9% chose this. Bupropion is a serotonin and dopamine reuptake inhibitor that is used in the treatment of depression, and also to aid in smoking cessation. It does not have the adverse effect of hyperprolactinemia.",
                "C is not correct. 10% chose this. Fluoxetine is a selective serotonin reuptake inhibitor used to treat depression. Its adverse effects include insomnia and sexual dysfunction. It does not cause hyperprolactinemia.",
                "E is not correct. 11% chose this. Lithium is used as a mood stabilizer in the treatment of bipolar disorder. Its mechanism of action is unknown. Its adverse effects include hypothyroidism, tremor, renal dysfunction, and diabetes insipidus. It does not cause hyperprolactinemia."
            ],
            "bottom_line": "Bottom Line: In females, hyperprolactinemia manifests as galactorrhea and amenorrhea with a negative pregnancy test. Prolactin secretion is normally inhibited by dopamine, therefore dopamine antagonists such as antipsychotic medications can result in symptoms of hyperprolactinemia.",
            "total_id": 323,
            "type": "Endocrine"
        },
        "question": " This woman's symptoms would most likely be an adverse effect of which of the following drugs?",
        "gpt_extract_mdeical_info": "1. Patient's gender: female.\n2. Patient's age: 36 years old.\n3. Reason for visit: the patient believes she might be pregnant due to absence of period for 3 months and milky discharge from her breasts.\n4. Pregnancy test result: negative.",
        "medical_info_list": {
            "Patient's gender": "female.",
            "Patient's age": "36 years old.",
            "Reason for visit": "the patient believes she might be pregnant due to absence of period for 3 months and milky discharge from her breasts.",
            "Pregnancy test result": "negative."
        },
        "dataset": "QMAX",
        "id": 15,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I believe I might be pregnant because I haven't had my period for 3 months and I've noticed a milky discharge from my breasts."
            }
        ]
    },
    {
        "raw_data": {
            "id": 84,
            "question": "A 57-year-old man undergoes cavernosography, a radiographic examination that shows the corpora cavernosa and draining veins after injection of contrast into the corpora. The test demonstrates a leak from the dorsal vein to the saphenous vein.Which of the following was the most likely indication for this patient's cavernosography?",
            "options": {
                "A": " Erectile dysfunction",
                "B": " Penile cancer",
                "C": " Priapism",
                "D": " Urinary incontinence",
                "E": " Urinary retention"
            },
            "answer_idx": "A",
            "explaination": [
                "The correct answer is A. 68% chose this. A leak into the dorsal (shown in the image) and saphenous (not shown in the image) veins, whichdemonstrates a venous outflow abnormality, is typically due to insufficient relaxation of the smooth muscle resulting from excessive adrenergic tone or damaged parasympathetic innervation. In a normal erection, blood flow accelerates, increasing the pressure within the intracavernous spaces and blocking penile venous outflow. Abnormalities in venous outflow, such as the leak from the dorsal vein to the external pudendal veins, a tributary of the great saphenous vein, in this patient can result in failure to acquire or maintain a firm erection.",
                "B is not correct. 5% chose this. Penile cancer is rare in developed countries. It is generally a squamous cell carcinoma and is diagnosed by biopsy. Abnormalities in venous blood flow are not normally found in cancer.",
                "C is not correct. 17% chose this. Priapism is a condition in which a penile erection is maintained for >4 hours. It is a medical emergency with many causes, including sickle cell disease, spinal cord lesions, and pharmacologic adverse effects. A leak from the dorsal vein to the saphenous vein would result in failure to acquire or maintain an erection, not failure to return to the flaccid state.",
                "D is not correct. 5% chose this. Urinary incontinence is a common problem, especially in older persons. Causes include detrusor overactivity and neurologic impairment. Abnormal penile blood flow is not normally implicated in urinary incontinence.",
                "E is not correct. 5% chose this. Urinary retention has a number of causes, including outflow obstruction (as seen in benign prostatic hyperplasia) and neurologic impairment. Abnormal penile blood flow is not normally implicated in urinary dysfunction."
            ],
            "bottom_line": "Bottom Line: A penile venous outflow abnormality (such as a leak from the dorsal to the saphenous vein) can result in erectile dysfunction, with a failure to acquire or maintain a firm erection.",
            "total_id": 219,
            "type": "Reproductive"
        },
        "question": "Which of the following was the most likely indication for this patient's cavernosography?",
        "gpt_extract_mdeical_info": "1. Patient's age: 57 years old.\n2. Patient's gender: Male.\n3. Medical test undergone: Cavernosography.\n4. Result of cavernosography: Demonstrated a leak from the dorsal vein to the saphenous vein.",
        "medical_info_list": {
            "Patient's age": "57 years old.",
            "Patient's gender": "Male.",
            "Medical test undergone": "Cavernosography.",
            "Result of cavernosography": "Demonstrated a leak from the dorsal vein to the saphenous vein."
        },
        "dataset": "QMAX",
        "id": 16,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been having issues with my erections that prompted the doctor to order a special imaging test."
            }
        ]
    },
    {
        "raw_data": {
            "id": 16,
            "question": "A 25-year-old woman presents to her primary care physician. On review of symptoms she describes less than a teaspoon of thick white vaginal discharge daily. Vaginal pH is 4.0. Saline microscopy of scant discharge found at the external os identifies epithelial cells with scarce polymorphonuclear leukocytes. What is the best description of this woman's clinical findings?",
            "options": {
                "A": " Bacterial vaginosis",
                "B": " Endometrial cancer",
                "C": " Normal",
                "D": " Trichomoniasis",
                "E": " Vulvovaginal candidiasis"
            },
            "answer_idx": "C",
            "explaination": [
                "The correct answer is C. 34% chose this. Normal vaginal pH is 4.0-4.5. Women normally have 1-4 mL of clear to white to yellowish, mostly odorless vaginal discharge (\"physiologic leukorrhea\") daily. Not all discharge is pathologic.",
                "A is not correct. 21% chose this. Think bacterial vaginosis when the patient presents with foul-smelling discharge, no complaint of painful intercourse (dyspareunia), and elevated pH but not commonly as high as in trichomoniasis. Also look for clue cells, vaginal epithelial cells covered with coccobacilli. Bacterial vaginosis occurs when a reduction in vaginal lactobacilli allows for an increase in other organisms; Gardnerella vaginalis often is involved.",
                "B is not correct. 5% chose this. Endometrial cancer usually occurs in postmenopausal women in their 60s. More than 90% present with abnormal uterine bleeding.",
                "D is not correct. 11% chose this. Trichomoniasis is a common cause of vaginal discharge. Expect a foul-smelling, purulent discharge, acomplaint of painful intercourse, and pH of 5.0-6.0. Microscopy identifies numerous polymorphonuclear leukocytes and motile flagellated parasites. Usual outpatient treatment is with metronidazole.",
                "E is not correct. 29% chose this. Think candidiasis when a patient complains of intense vulvovaginal itchiness (pruritus). Expect a normal pH and look for pseudohyphae on wet mount with 10% potassium hydroxide."
            ],
            "bottom_line": "Bottom Line: Women normally have 1-4 mL of clear to white to yellowish, mostly odorless vaginal discharge (\"physiologic leukorrhea\") daily.",
            "total_id": 161,
            "type": "Reproductive"
        },
        "question": " What is the best description of this woman's clinical findings?",
        "gpt_extract_mdeical_info": "1. Patient's age: 25 years old.\n2. Patient's gender: Female.\n3. Chief complaint: Less than a teaspoon of thick white vaginal discharge daily.\n4. Vaginal pH: 4.0.\n5. Saline microscopy: Scant discharge found at the external os with epithelial cells and scarce polymorphonuclear leukocytes.",
        "medical_info_list": {
            "Patient's age": "25 years old.",
            "Patient's gender": "Female.",
            "Chief complaint": "Less than a teaspoon of thick white vaginal discharge daily.",
            "Vaginal pH": "4.0.",
            "Saline microscopy": "Scant discharge found at the external os with epithelial cells and scarce polymorphonuclear leukocytes."
        },
        "dataset": "QMAX",
        "id": 17,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing a small amount of thick white vaginal discharge every day."
            }
        ]
    },
    {
        "raw_data": {
            "id": 43,
            "question": "A 56-year-old obese man with unknown medical history presents to the emergency department. He was found by his wife on the floor of the bathroom, conscious but disoriented, vomiting, and clutching his abdomen. She is unsure of the name of his one oral medication, but knows he takes it regularly, twice daily. He was recently admitted to another hospital for a cholecystectomy. On examination, the patient is breathing heavily and quickly, but other vital signs are normal. Laboratory test results include: Laboratory tests show: Na+: 142 mEq/L K+: 4.0 mEq/L Cl-: 105 mEq/L HCO3-: 19 mEq/L Blood urea nitrogen: 20 mg/dL Creatinine: 1.6 mg/dL Glucose: 256 mg/dL What drug is the patient most likely taking?",
            "options": {
                "A": " Glyburide ",
                "B": "Insulin",
                "C": " Metformin",
                "D": " Orlistat",
                "E": " Rosiglitazone"
            },
            "answer_idx": "C",
            "explaination": [
                "The correct answer is C. 58% chose this. Given the patient's body habitus and glucose level, a diagnosis of diabetes is extremely likely. The patient is presenting after recent surgery with symptoms consistent with lactic acidosis. His low bicarbonate is concerning for an acidotic state. Calculating the anion gap [Na - (Cl + HCO3-) = anion gap] gives a result of 18. The physiologic range of the anion gap in healthy adults is 8-12 mEq/L. High-anion-gap metabolic acidosis can be caused by multiple conditions and can be remembered by the mnemonic MUDPILES: Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Infection or isoniazid, Lactic acidosis, Ethylene glycol, and Salicylates. Metformin is a biguanide that suppresses hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity. It is known to increase the risk of lactic acidosis, particularly in those with renal impairment (the patient in this case has an elevated creatinine of 1.6 mg/dL), as well as in the postoperative period if it is stopped for an extended period.",
                "A is not correct. 13% chose this. Glyburide is a sulfonylurea that increases pancreatic secretion of insulin by depolarizing the β-cell membranes. Its major adverse effect is hypoglycemia, which could present as loss of consciousness, seizure, or altered mental status. However, the patient's lab values show that he is actually hyperglycemic, making glyburide less likely.",
                "B is not correct. 8% chose this. Insulin as a pharmacologic preparation is not administered orally, but rather is subcutaneously injected. It binds the insulin receptor to increase hepatic glycogen production from glucose and promote protein synthesis in muscle. A major adverse effect of insulin treatment is hypoglycemia, weight gain, and injection-site lipodystrophy, but it is not associated with lactic acidosis.",
                "D is not correct. 10% chose this. Orlistat alters fat metabolism by decreasing pancreatic lipase activity. It is often used for long-term weight management, and causes gastrointestinal adverse effects, such as loose and fatty stools (steatorrhea), diminished absorption of vitamins A, D, K, and E, and headache. It has not been associated with lactic acidosis.",
                "E is not correct. 11% chose this. Rosiglitazone is a thiazolidinedione that increases tissue sensitivity/target cell response to insulin. A major adverse effect of this medication is weight gain and edema, and it has also recently been associated with increased cardiovascular risks. However, it is not known to cause lactic acidosis."
            ],
            "bottom_line": "Bottom Line: Lactic acidosis is a life-threatening condition that may affect those on metformin. Remember that high-anion-gap metabolic acidosis may have several causes that are summarized in the mnemonic MUDPILES.",
            "total_id": 307,
            "type": "Endocrine"
        },
        "question": "6 mg/dL Glucose: 256 mg/dL What drug is the patient most likely taking?",
        "gpt_extract_mdeical_info": "1. Patient's age: 56 years old.\n2. Patient's gender: male.\n3. Patient's medical history: unknown.\n4. Chief complaint: found on the floor of the bathroom, conscious but disoriented, vomiting, and clutching his abdomen.\n5. Patient's medication: Takes one oral medication twice daily but its name is unknown.\n6. Patient's surgical history: Recently admitted to another hospital for a cholecystectomy.\n7. Vital signs:\n   - Breathing heavily and quickly but no other abnormalities.\n8. Laboratory test results:\n   - Na+ (sodium): 142 mEq/L\n   - K+ (potassium): 4.0 mEq/L\n   - Cl- (chloride): 105 mEq/L\n   - HCO3- (bicarbonate): 19 mEq/L\n   - Blood urea nitrogen: 20 mg/dL\n   - Creatinine: 1",
        "medical_info_list": {
            "Patient's age": "56 years old.",
            "Patient's gender": "male.",
            "Patient's medical history": "unknown.",
            "Chief complaint": "found on the floor of the bathroom, conscious but disoriented, vomiting, and clutching his abdomen.",
            "Patient's medication": "Takes one oral medication twice daily but its name is unknown.",
            "Patient's surgical history": "Recently admitted to another hospital for a cholecystectomy.",
            "Vital signs": "Breathing heavily and quickly but no other abnormalities.",
            "Na+ (sodium)": "142 mEq/L",
            "K+ (potassium)": "4.0 mEq/L",
            "Cl- (chloride)": "105 mEq/L",
            "HCO- (bicarbonate)": "19 mEq/L",
            "Blood urea nitrogen": "20 mg/dL",
            "Creatinine": "1"
        },
        "dataset": "QMAX",
        "id": 18,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm feeling disoriented, have been vomiting, and am experiencing abdominal pain."
            }
        ]
    },
    {
        "raw_data": {
            "id": 41,
            "question": "A 23-year-old woman presents to the emergency department complaining of severe, bilateral, lower abdominal pain. Her last menstrual cycle was 8 weeks ago. Her blood pressure is 90/46 mm Hg. Physical examination reveals guarding and severe rebound tenderness. Vaginal ultrasound reveals an empty uterus.Trending a certain hormone is key in identifying this patient's diagnosis. This hormone shares a common subunit with which of the following molecules?",
            "options": {
                "A": " ACTH",
                "B": " ADH",
                "C": " Melanocyte-releasing hormone",
                "D": " Thyroid-stimulating hormone",
                "E": " Thyrotropin-releasing hormone"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 71% chose this. This patient's history of a missed menstrual cycle suggests that she may be pregnant. However, ultrasound reveals an empty uterus. One of the most important concerns in a young woman of reproductive age who presents with acute, severe abdominal pain is ectopic pregnancy. The physical examination findings of abdominal pain with tenderness and rebound suggest peritoneal irritation, in this case most likely from a ruptured ectopic pregnancy. This process could also produce significant bleeding into the peritoneal cavity, leading to hypotension. A pregnancy test, which detects the hormone β-human chorionic gonadotropin (βhCG), either in the urine or in the plasma 8 days after successful fertilization, will be positive. β-hCG is a glycoprotein produced by the fertilized dividing egg during the first trimester, and later by the placenta. This hormone's main function is to maintain the corpus luteum, the main source of progesterone, which is critical in maintaining the pregnancy. It also tends to be trended upward throughout initial days of pregnancy. βhCG has a distinctive α subunit, which it shares with other glycoprotein hormones, including thyroid-stimulating hormone, luteinizing hormone, and follicle-stimulating hormone. All of the glycoproteins with the exception of β-hCG are produced in the anterior pituitary gland.",
                "A is not correct. 10% chose this. ACTH is produced by the anterior pituitary gland from the precursor molecule proopiomelanocortin. It stimulates the production and secretion of adrenal cortical hormones. It does not share any structural homology to the glycoproteins.",
                "B is not correct. 5% chose this. ADH or vasopressin is a hormone synthesized in the hypothalamus but secreted from the posterior pituitary gland. Volume depletion and increased plasma osmolality stimulate its secretion. It promotes the insertion of aquaporin channels into the renal collecting ducts, thus augmenting free water reabsorption.",
                "C is not correct. 7% chose this. Melanocyte-stimulating hormone (MSH) is another product of the precursor proopiomelanocortin. It is believed that this molecule is increased along with ACTH in patients with primary adrenal insufficiency, accounting for the darkening and discoloration of the skin commonly observed in those individuals. MSHdoes not share any structural homology with the glycoproteins.",
                "E is not correct. 7% chose this. Thyrotropin-releasing hormone (TRH) is produced in the hypothalamus. It stimulates the synthesis and release of TSH from the anterior pituitary gland. TRH also stimulates the release of prolactin from the anterior pituitary gland. TRH does not share any structural homology with the glycoproteins."
            ],
            "bottom_line": "Bottom Line: Always consider an ectopic pregnancy in a young woman of reproductive age who presents with acute-onset abdominal pain, with or without rebound tenderness. In an ectopic pregnancy the β-hCG level will be elevated on urine or plasma pregnancy testing.",
            "total_id": 183,
            "type": "Reproductive"
        },
        "question": " This hormone shares a common subunit with which of the following molecules?",
        "gpt_extract_mdeical_info": "1. Patient's age: 23 years old.\n2. Patient's gender: female.\n3. Chief complaint: severe, bilateral, lower abdominal pain.\n4. Menstrual history: last menstrual cycle was 8 weeks ago.\n5. Blood pressure: 90/46 mm Hg.\n6. Physical examination findings: guarding and severe rebound tenderness.\n7. Imaging result: Vaginal ultrasound revealed an empty uterus.\n8. Key hormone for diagnosis: Not specified in the given question.",
        "medical_info_list": {
            "Patient's age": "23 years old.",
            "Patient's gender": "female.",
            "Chief complaint": "severe, bilateral, lower abdominal pain.",
            "Menstrual history": "last menstrual cycle was 8 weeks ago.",
            "Blood pressure": "90/46 mm Hg.",
            "Physical examination findings": "guarding and severe rebound tenderness.",
            "Imaging result": "Vaginal ultrasound revealed an empty uterus.",
            "Key hormone for diagnosis": "Not specified in the given question."
        },
        "dataset": "QMAX",
        "id": 19,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing severe pain in my lower abdomen and I haven't had my period for 8 weeks."
            }
        ]
    },
    {
        "raw_data": {
            "id": 98,
            "question": "During a routine visit to his primary care physician, a 55-year-old man with a history of radiation to his neck for lymphoma as a young man is found to have a singular thyroid nodule. Work-up suggests the nodule to be neoplastic. A section of resected tissue is\nWhat type of thyroid malignancy has this patient developed?",
            "options": {
                "A": " Anaplastic carcinoma",
                "B": " Follicular carcinoma of the thyroid",
                "C": " Medullary carcinoma of the thyroid",
                "D": " Papillary carcinoma",
                "E": " Thyroid lymphoma"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 61% chose this. The patient has papillary adenocarcinoma of the thyroid, which accounts for approximately 80% of thyroid carcinomas. Papillary thyroid carcinoma usually can be cured by resection of the primary tumor. Diagnosis is often made by fine-needle biopsy. The histologic finding in the image is a psammoma body (a concentrically laminated, calcified structure), which is found in approximately 50% of papillary adenocarcinomas of the thyroid. Psammoma bodies are also found in serous papillary cystadenocarcinomas of the ovary, meningiomas, and malignant mesotheliomas.",
                "A is not correct. 7% chose this. Anaplastic carcinoma is a poorly differentiated and aggressive type of thyroid cancer with a poor prognosis. Psammoma bodies are not seen.",
                "B is not correct. 14% chose this. Follicular carcinomas of the thyroid are less common but more malignant than papillary carcinomas of the thyroid. Unlike papillary carcinoma, in which hematogenous metastasis is rare, follicular carcinomas commonly metastasize via the blood to lungs or bones. Histologically, follicular carcinomas tend to form acini or follicles lined with cells that are larger than those found in normal thyroid. Psammoma bodies are not found in follicular carcinoma.",
                "C is not correct. 16% chose this. Medullary carcinoma of the thyroid arises from the C cells of the thyroid, which produce calcitonin. It is a rare cancer of the thyroid and can be associated with multiple endocrine neoplasia (MEN) types 2A and 2B. Histologic examination of a medullary carcinoma would reveal sheets of tumor cells in an amyloid stroma. Psammoma bodies are not found in these tumors.",
                "E is not correct. 2% chose this. Thyroid lymphomas often arise in the setting of Hashimoto thyroiditis, but would not have a psammoma body."
            ],
            "bottom_line": "Bottom Line: Remember PSaMMoma bodies: Papillary thyroid, Serous ovary, Meningioma, and Mesothelioma.",
            "total_id": 350,
            "type": "Endocrine"
        },
        "question": " A section of resected tissue is\nWhat type of thyroid malignancy has this patient developed?",
        "gpt_extract_mdeical_info": "1. Patient age: 55 years old.\n2. Patient gender: Male.\n3. Medical history: the patient had lymphoma in the past and received radiation treatment to the neck as a young man.\n4. Current diagnosis: neoplastic thyroid nodule.\n5. Work-up has been done and confirms the neoplastic nature of the nodule.",
        "medical_info_list": {
            "Patient age": "55 years old.",
            "Patient gender": "Male.",
            "Medical history": "the patient had lymphoma in the past and received radiation treatment to the neck as a young man.",
            "Current diagnosis": "neoplastic thyroid nodule.",
            "info_1": "Work-up has been done and confirms the neoplastic nature of the nodule."
        },
        "dataset": "QMAX",
        "id": 20,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I noticed a lump in my neck during a routine check-up."
            }
        ]
    },
    {
        "raw_data": {
            "id": 22,
            "question": "A 47-year-old woman presents to her physician complaining of weight gain, fatigue, and lethargy. Her appetite has decreased recently and she has been constipated. Physical examination reveals an enlarged, symmetric, and firm thyroid. A thyroid biopsy is significant for a lymphocytic and plasma cell infiltrate with occasional germinal center formation. The follicles contain little colloid, and the follicular epithelial lining shows enlarged epithelial cells containing acidophilic cytoplasm. Which of the following antibodies is most likely to be found in this patient?",
            "options": {
                "A": " Anti-smooth muscle",
                "B": " Anti-TPO antibodies ",
                "C": " Anti-U1 RNP ",
                "D": "Anticentromere",
                "E": " Antimitochondrial"
            },
            "answer_idx": "B",
            "explaination": [
                "The correct answer is B. 75% chose this.",
                "The patient is suffering from Hashimoto thyroiditis, an autoimmune disorder that is a common cause of hypothyroidism. Other classic signs and symptoms of hypothyroidism include cold intolerance, hypoactivity, weakness, diminished reflexes, dry and cool skin, and coarse hair. Laboratory studies would reveal increased thyroid-stimulating hormone levels (the most sensitive laboratory test for primary hypothyroidism) and decreased total triiodothyronine and thyroxine levels. In patients with Hashimoto thyroiditis, the thyroid gland is usually goitrous and firm, and histology reveals a significant lymphocyte and plasma cell infiltrate (as shown in the image) with germinal center formation, colloid-sparse follicles, and Hürthle cells (the acidophilic cells described in the vignette). Patients with Hashimoto thyroiditis frequently have a personal or family history of autoimmune disease, and there is an increased incidence of in the disease among individuals with HLA-DR5 and -B5 haplotypes. Antithyroid peroxidase antibodies (anti-TPO), are associated with Hashimoto thyroiditis. Antithyroglobulin antibodies may also be seen.",
                "A is not correct. 4% chose this. Anti-smooth muscle antibodies may be seen in the setting of autoimmune hepatitis.",
                "C is not correct. 6% chose this. Anti-U1 RNP antibodies are associated with mixed connective tissue disease.",
                "D is not correct. 5% chose this. Anticentromere antibodies are associated with CREST syndrome.",
                "E is not correct. 10% chose this. Antimitochondrial antibodies are associated with primary biliary cirrhosis."
            ],
            "bottom_line": "Bottom Line: Hashimoto thyroiditis is an autoimmune cause of hypothyroidism in which there may be elaboration of antithyroid peroxidase antibodies (anti-TPO) and/or antithyroglobulin antibodies.",
            "total_id": 289,
            "type": "Endocrine"
        },
        "question": " Which of the following antibodies is most likely to be found in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 47 years old.\n2. Patient's gender: female.\n3. Chief complaint: weight gain, fatigue, and lethargy.\n4. Appetite has decreased recently.\n5. Patient has been constipated.\n6. Physical examination findings:\n   1. Thyroid is enlarged.\n   2. Thyroid enlargement is symmetric and firm.\n7. Thyroid biopsy results:\n   1. Lymphocytic and plasma cell infiltrate present.\n   2. Germinal center formation occasionally present.\n   3. Follicles contain little colloid.\n   4. Follicular epithelial lining shows enlarged epithelial cells containing acidophilic cytoplasm.",
        "medical_info_list": {
            "Patient's age": "47 years old.",
            "Patient's gender": "female.",
            "Chief complaint": "weight gain, fatigue, and lethargy.",
            "info_1": "Patient has been constipated.",
            "Physical examination findings": "Thyroid is enlarged. Thyroid enlargement is symmetric and firm.",
            "Thyroid biopsy results": "Lymphocytic and plasma cell infiltrate present. Germinal center formation occasionally present. Follicles contain little colloid. Follicular epithelial lining shows enlarged epithelial cells containing acidophilic cytoplasm."
        },
        "dataset": "QMAX",
        "id": 21,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling tired and lethargic, and I've noticed I'm gaining weight despite having less appetite, and I'm also experiencing constipation."
            }
        ]
    },
    {
        "raw_data": {
            "id": 149,
            "question": "A 52-year-old man presents to the emergency department with severe substernal chest pain radiating to his left arm, together with diaphoresis and dyspnea. He reports that he has never experienced this kind of pain before, that it came on very suddenly about 30 minutes ago, and that he was not doing anything particularly strenuous. His blood pressure is 137/87 mm Hg, his pulse is 96/min, and his respiratory rate is 24/min. An ECG shows ST-segment elevation in leads V3-V6. While in the emergency department he goes into cardiac arrest, and efforts to resuscitate him are unsuccessful. Which of the following is the most likely cause of this patient's death?",
            "options": {
                "A": " Arrhythmia",
                "B": " Cardiogenic shock",
                "C": " Congestive heart failure",
                "D": " Fibrinous pericarditis",
                "E": " Left ventricular rupture"
            },
            "answer_idx": "A",
            "explaination": [
                "The correct answer is A. 67% chose this. This individual is having a myocardial infarction (likely anterolateral given V3-V6 distribution), as suggested by his symptoms and ST-segment elevation on ECG. Sudden cardiac death in the setting of an MI is most commonly caused by ventricular tachyarrhythmias, in particular ventricular fibrillation (VF). These arrhythmias are thought to be a result of the damaged, ischemic myocardium producing a substrate that is capable of abnormal reentry circuits. This results in the loss of coordinated contraction of the heart and perfusion of vital organs. VF is almost universally lethal if not treated; it very rarely reverts spontaneously to sinus rhythm. Immediate defibrillation is indicated, followed by medical treatment with intravenous amiodarone.",
                "B is not correct. 16% chose this. Cardiogenic shock carries a high risk of mortality and is associated with a large infarct. Any type of shock results in inadequate organ perfusion. Patients with cardiogenic shock present with hypotension and tachycardia.",
                "C is not correct. 5% chose this. Congestive heart failure (CHF) is a later sequela of an MI that affects a large area of myocardial tissue. It results from functional myocardium being replaced with nonfunctional scar tissue, decreasing the heart's ability to contract, and leading to decreased ejection fraction. CHF would not present this soon after an MI.",
                "D is not correct. 3% chose this. Fibrinous pericarditis is associated with transmural infarctions and typically occurs 3-5 days post-MI. Some degree of diastolic dysfunction may occur due to inability of the ventricle to fully relax due to the transudate that collects in the pericardial sac. Physical examination typically reveals a friction rub. Dressler syndrome is an autoimmune condition that appears several weeks after an MI and also results in a fibrinous or serofibrinous pericarditis.",
                "E is not correct. 9% chose this. Left ventricular rupture is a complication that usually occurs 3-7 days post-MI, when the ventricular wall is in the dynamic process of resorbing necrotic tissue and building new tissue to fill the defect. If this were the case, the patient would present with the Beck triad (hypotension, increased jugular venous pressure, and distant heart sounds), secondary to hemopericardium. Risk factors for free wall rupture include female sex, age >60 years, and preexisting hypertension."
            ],
            "bottom_line": "Bottom Line: The most common cause of death immediately following an MI is an arrhythmia that leads to cardiac arrest.",
            "total_id": 640,
            "type": "Cardiology"
        },
        "question": " Which of the following is the most likely cause of this patient's death?",
        "gpt_extract_mdeical_info": "1. Age: 52 years old.\n2. Gender: Male.\n3. Chief complaint: Severe substernal chest pain radiating to left arm, diaphoresis, and dyspnea.\n4. Pain characteristics: Sudden onset, severe.\n5. Activity level: Not doing anything particularly strenuous.\n6. Medical history: No previous experience of this kind of pain.\n7. Vital signs:\n   1. Blood pressure: 137/87 mm Hg.\n   2. Pulse: 96/min.\n   3. Respiratory rate: 24/min.\n8. Electrocardiogram result: ST-segment elevation in leads V3-V6.\n9. Cardiac arrest: Occurred while in the emergency department and efforts to resuscitate him were unsuccessful.",
        "medical_info_list": {
            "Age": "52 years old.",
            "Gender": "Male.",
            "Chief complaint": "Severe substernal chest pain radiating to left arm, diaphoresis, and dyspnea.",
            "Pain characteristics": "Sudden onset, severe.",
            "Activity level": "Not doing anything particularly strenuous.",
            "Medical history": "No previous experience of this kind of pain.",
            "Blood pressure": "137/87 mm Hg.",
            "Pulse": "96/min.",
            "Respiratory rate": "24/min.",
            "Electrocardiogram result": "ST-segment elevation in leads V3-V6.",
            "Cardiac arrest": "Occurred while in the emergency department and efforts to resuscitate him were unsuccessful."
        },
        "dataset": "QMAX",
        "id": 22,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm experiencing severe chest pain that started suddenly about half an hour ago and is radiating to my left arm, along with sweating and trouble breathing."
            }
        ]
    },
    {
        "raw_data": {
            "id": 93,
            "question": "A 30-year-old woman comes to the physician complaining that her blood pressure was high when she measured it on a machine at a local drug store. She has no significant medical history. Resting blood pressure is 170/110 mm Hg. Laboratory studies show: Na+: 160 mEq/L K+: 2.3 mEq/L Ca2+: 9.1 mEq/L Fasting glucose: within normal limits pH: 7.5 Which of the following areas of the adrenal gland produces the hormone that is causing this patient's symptoms?",
            "options": {
                "A": " Chromaffin cells",
                "B": " Medulla",
                "C": " Zona fasciculata ",
                "D": "Zona glomerulosa",
                "E": " Zona reticularis"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 79% chose this. Hypernatremia, hypokalemia, and metabolic alkalosis are symptoms of primary aldosteronism (Conn's syndrome), which is due to increased aldosterone secretion by the zona glomerulosa of the adrenals. As a consequence of the increased aldosterone activity in the principal cells of the collecting duct, an increase in sodium reuptake is accompanied by a concurrent increase in potassium excretion. Also, water is passively reabsorbed along with sodium, resulting in hypervolemia and higher blood pressures. SSS and GFR are useful for remembering the hormones secreted by the adrenal cortex and their location from the outside to the inside: aldosterone (Salt) from the zona Glomerulosa, cortisol (Sugar) from the zona Fasciculata, and androgens (Sex) from the zona Reticularis.",
                "A is not correct. 6% chose this. Chromaffin cells are located within the adrenal medulla and are responsible for producing catecholamines (norepinephrine and epinephrine). Excess catecholamines can result in hypertension, but not in the electrolyte disturbances that are seen in this case.",
                "B is not correct. 5% chose this. The adrenal medulla produces catecholamines (norepinephrine and epinephrine). Excess catecholamines would affect blood pressure but would not result in the sodium retention and potassium wasting seen here.",
                "C is not correct. 8% chose this. The zona fasciculata produces cortisol. Excess cortisol, as seen in Cushing's syndrome, would lead to truncal obesity, striae, hyperglycemia, and hypertension.",
                "E is not correct. 2% chose this. The zona reticularis produces lipids and androgens. Excess androgens would lead to acne, hirsutism, and possible virilization."
            ],
            "bottom_line": "Bottom Line: High levels of aldosterone, which is secreted by the zona glomerulosa of the adrenal glands, causes hypernatremia, hypokalemia, hypervolemia, and metabolic alkalosis.",
            "total_id": 346,
            "type": "Endocrine"
        },
        "question": "5 Which of the following areas of the adrenal gland produces the hormone that is causing this patient's symptoms?",
        "gpt_extract_mdeical_info": "1. Patient's demographic information:\n    1. Age: 30 years old\n    2. Gender: Female\n    \n2. Chief complaint: High blood pressure\n\n3. Medical history: None\n\n4. Vital signs:\n    1. Resting blood pressure: 170/110 mm Hg\n    \n5. Laboratory studies:\n    1. Sodium (Na+): 160 mEq/L\n    2. Potassium (K+): 2.3 mEq/L\n    3. Calcium (Ca2+): 9.1 mEq/L\n    4. Fasting glucose: within normal limits\n    5. pH: 7",
        "medical_info_list": {
            "Age": "30 years old",
            "Gender": "Female",
            "Chief complaint": "High blood pressure",
            "Medical history": "None",
            "Resting blood pressure": "170/110 mm Hg",
            "Sodium (Na+)": "160 mEq/L",
            "Potassium (K+)": "2.3 mEq/L",
            "Calcium (Ca+)": "9.1 mEq/L",
            "Fasting glucose": "within normal limits",
            "pH": "7"
        },
        "dataset": "QMAX",
        "id": 23,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm concerned because I found out my blood pressure was high when I checked it at a local drug store."
            }
        ]
    },
    {
        "raw_data": {
            "id": 147,
            "question": "A 34-year-old man presents to his primary care physician complaining of a low-grade fever, drenching sweats at night, and an unintentional 5-kg (12-lb) weight loss over the past 3 months. CT of the chestreveals mediastinal lymphadenopathy. Subsequent biopsy of an involved node is remarkable for the cell shown in the image.\n",
            "options": {
                "A": " Cyclosporine",
                "B": " Hydroxyurea",
                "C": " Imatinib",
                "D": " Isoniazid",
                "E": " Vinblastine"
            },
            "answer_idx": "E",
            "explaination": [
                "The correct answer is E. 49% chose this.",
                "This patient presents with the classic signs and symptoms (night sweats, fever, and weight loss) of Hodgkin lymphoma. The diagnosis is confirmed by the presence of a Reed-Sternberg cell, which is diagnostic of Hodgkin lymphoma. These cells are large, with lobed nuclei that look like owl’s eyes, indicated by the circle in the image. Vinblastine is part of the ABVD regimen (Adriamycin [doxorubicin], Bleomycin, Vinblastine, and Dacarbazine) used to treat Hodgkin lymphoma. It inhibits microtubular formation of the mitotic spindle, so affected cells cannot pass through metaphase. Vinblastine is used to treat both Hodgkin’s and non-Hodgkin lymphomas, as well as many solid tumors. Adverse effects include alopecia, constipation, myelosuppression, and, rarely, neurotoxicity.",
                "A is not correct. 15% chose this. Cyclosporine is an immunosuppressant used in patients who have undergone transplant and patients with autoimmune disorders. It works by inhibiting the production and release of interleukin-2, a cytokine involved in the activation of cytotoxic T lymphocytes. Adverse effects of cyclosporine include gastrointestinal upset, headache, and tremor. Myelosuppression, however, is not a common adverse effect.",
                "B is not correct. 10% chose this. Hydroxyurea is used to treat sickle cell anemia, and to decrease the burden of high WBC counts in acute leukemia and chronic myelogenous leukemia. Hydroxyurea is an anti-metabolite, and although its exact mechanism is unknown, it is believed to affect the synthesis (S) phase of the cell cycle. Its major adverse effect is myelosuppression.",
                "C is not correct. 16% chose this. Imatinib is used to treat chronic myeloid leukemia (CML) and gastrointestinal stromal tumors, and would not be helpful in a patient with Hodgkin lymphoma. Patients with CML present with increased neutrophils and metamyelocytes. Imatinib is a tyrosine kinase inhibitor that specifically targets the continuously active Bcr-Abl receptor in CML, promoting apoptosis in these cells. Adverse effects include weight gain, gastrointestinal distress, musculoskeletal pain, and myelosuppression.",
                "D is not correct. 10% chose this. Isoniazid, along with rifampin, pyrazinamide, streptomycin, and ethambutol, is used to treat tuberculosis. Night sweats, fever, and weight loss are common in tuberculosis; however, the presence of Reed-Sternberg cells in this patient strongly suggests Hodgkin lymphoma. Isoniazid inhibits mycolic acid synthesis, thereby disrupting the Mycobacterium cell wall. Adverse effects include hepatotoxicity, neuropathy, and, in some cases, psychiatric symptoms."
            ],
            "bottom_line": "Bottom Line: The ABVD regimen is used for the treatment of Hodgkin lymphoma. Adverse effects specific to vinblastine include myelosuppression, alopecia, constipation, and neurotoxicity.",
            "total_id": 133,
            "type": "Oncology"
        },
        "question": "\n",
        "gpt_extract_mdeical_info": "1. Patient's age: 34-year-old.\n2. Patient's gender: male.\n3. Chief complaint: low-grade fever, drenching sweats at night, and an unintentional 5-kg (12-lb) weight loss over the past 3 months.\n4. Radiologic findings: CT of the chest reveals mediastinal lymphadenopathy.\n5. Biopsy findings: The cell shown in the image is remarkable.\n6. Pathology: Not mentioned.\n7. Vital signs: Not mentioned.\n8. Laboratory studies: Not mentioned.\n9. Medical history: Not mentioned.\n10. Medications: Not mentioned.\n11. Allergies: Not mentioned.\n12. Family history: Not mentioned.\n13. Social history: Not mentioned.",
        "medical_info_list": {
            "Patient's age": "34-year-old.",
            "Patient's gender": "male.",
            "Chief complaint": "low-grade fever, drenching sweats at night, and an unintentional 5-kg (12-lb) weight loss over the past 3 months.",
            "Radiologic findings": "CT of the chest reveals mediastinal lymphadenopathy.",
            "Biopsy findings": "The cell shown in the image is remarkable.",
            "Pathology": "Not mentioned.",
            "Vital signs": "Not mentioned.",
            "Laboratory studies": "Not mentioned.",
            "Medical history": "Not mentioned.",
            "Medications": "Not mentioned.",
            "Allergies": "Not mentioned.",
            "Family history": "Not mentioned.",
            "Social history": "Not mentioned."
        },
        "dataset": "QMAX",
        "id": 24,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing fevers, night sweats, and some weight loss recently."
            }
        ]
    },
    {
        "raw_data": {
            "id": 58,
            "question": "A 29-year-old woman presents to the gynecologist complaining of a \"fishy\"-smelling vaginal odor noticeable during intercourse. Pelvic examination reveals a homogenous gray-white discharge, and a saline wet mount of vaginal epithelial cells is obtained (see image).\n",
            "options": {
                "A": " Budding yeast and/or hyphal forms",
                "B": " Gram-negative diplococci",
                "C": " Gram-positive rod",
                "D": " Obligate intracellular parasite",
                "E": " Pleomorphic, gram-variable rod"
            },
            "answer_idx": "E",
            "explaination": [
                "The correct answer is E. 53% chose this. The term pleomorphic, gram-variable rod is used to describe Gardnerella vaginalis (indicated by the arrows in the image), which causes vaginosis that is characterized by a gray-white vaginal discharge with a fishyodor. Clue cells on saline wet mount are diagnostic and appear as vaginal epithelial cells covered with bacteria. Inflammatory cells often are present as well.",
                "A is not correct. 10% chose this. Budding yeast and/or hyphal forms are used to describe Candida albicans, a fungus that causes \"yeastinfection,\" a vulvovaginitis that presents with vulvar pruritus, dysuria, and a thick, adherent \"cottage cheese-like\" discharge. The organism is visualized on wet mount after addition of potassium hydroxide.",
                "B is not correct. 10% chose this. The term gram-negative diplococci is used to describe Neisseria gonorrhoeae, which can cause urethritis, cervicitis, and pelvic inflammatory disease. Presenting symptoms often include pain and mucopurulent vaginal discharge. These organisms often are found within surrounding neutrophils.",
                "C is not correct. 11% chose this. The term gram-positive rod is used to describe Lactobacillus, which comprises part of the normal vaginal flora in adults.",
                "D is not correct. 16% chose this. Although Chlamydia trachomatis is a bacterium, it is commonly referred to as an obligate intracellular parasite because it lives on the cell's resources. It can cause urethritis, cervicitis, and pelvic inflammatory disease. Presenting symptoms often include pelvic pain with mucopurulent vaginal discharge, and inclusion bodies within epithelial cells can be seen on Giemsa- or fluorescent antibody-stained smear."
            ],
            "bottom_line": "Bottom Line: Gray-white discharge and fishy odor are common with Gardnerella vaginalis infection.",
            "total_id": 198,
            "type": "Reproductive"
        },
        "question": "\n",
        "gpt_extract_mdeical_info": "1. Patient's age: 29 years old.\n2. Patient's gender: Female.\n3. Chief complaint: \"fishy\" smelling vaginal odor during intercourse.\n4. Pelvic examination findings: Homogenous gray-white discharge.\n5. Saline wet mount of vaginal epithelial cells was obtained.\n6. Imaging: A picture of the saline wet mount was provided.\n7. Possible diagnosis: Bacterial vaginosis.\n8. Further testing: Gram stain of discharge may be necessary to confirm diagnosis.",
        "medical_info_list": {
            "Patient's age": "29 years old.",
            "Patient's gender": "Female.",
            "Chief complaint": "\"fishy\" smelling vaginal odor during intercourse.",
            "Pelvic examination findings": "Homogenous gray-white discharge.",
            "info_1": "Saline wet mount of vaginal epithelial cells was obtained.",
            "Imaging": "A picture of the saline wet mount was provided.",
            "Possible diagnosis": "Bacterial vaginosis.",
            "Further testing": "Gram stain of discharge may be necessary to confirm diagnosis."
        },
        "dataset": "QMAX",
        "id": 25,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing a \"fishy\"-smelling vaginal odor, especially noticeable during intercourse."
            }
        ]
    },
    {
        "raw_data": {
            "id": 15,
            "question": "A 43-year-old woman presents with several weeks of episodic headache, sweating, and tachycardia. Her blood pressure is 185/105 mm Hg; review of her records reveals it was 125/80 mm Hg 1 year ago. CT of her abdomen is shown in the image.\nWhat other condition is this patient at greatest risk of developing?",
            "options": {
                "A": " Gastrinoma",
                "B": " Glucagonoma",
                "C": " Insulinoma",
                "D": " Medullary carcinoma of the thyroid",
                "E": " Neuroblastoma"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 69% chose this. The abdominal CT demonstrates a pheochromocytoma anterior to the left kidney. Pheochromocytoma is a generally benign tumor derived from chromaffin cells of the adrenal medulla that can produce catecholamines (epinephrine and norepinephrine). Pheochromocytoma may be part of multiple endocrine neoplasia (MEN) type IIa syndrome or MEN type IIb syndrome. MEN IIa, or Sipple's syndrome, includes pheochromocytoma, medullary carcinoma of the thyroid, and hyperparathyroidism due to hyperplasia or tumor. MEN type IIb syndrome includes pheochromocytoma, medullary carcinoma of the thyroid, and multiple mucocutaneous neuromas or ganglioneuromas. Both syndromes are linked to the ret oncogene.",
                "A is not correct. 8% chose this. Gastrinoma is a frequently malignant tumor derived from gastrin-producing cells in the pancreas. It typically causes hypergastrinemia, and is associated with Zollinger-Ellison syndrome (a triad of marked gastric hypersecretion of hydrochloric acid, peptic ulcer disease, and hypergastrinemia). It may be seen in the MEN I syndrome.",
                "B is not correct. 6% chose this. Glucagonoma is a rare α cell tumor in the pancreas that results in secondary diabetes mellitus. It may be seen in MEN I syndrome.",
                "C is not correct. 9% chose this. Insulinoma is a β cell tumor of the pancreas, and is the most common islet cell tumor. It typically results in increased insulin secretion, and is associated with MEN type I (Wermer's syndrome).",
                "E is not correct. 8% chose this. Neuroblastoma is a malignant, catecholamine-producing tumor originating in the adrenal medulla that develops in early childhood. It often presents as a large abdominal mass, and is an important cause of childhood hypertension."
            ],
            "bottom_line": "Bottom Line: Pheochromocytoma is an important reversible cause of hypertension in adults, and is characterized by episodic headache, sweating, tachycardia, and hypertension. It may be associated with both MEN IIa syndrome and MEN IIb syndrome.",
            "total_id": 284,
            "type": "Endocrine"
        },
        "question": "\nWhat other condition is this patient at greatest risk of developing?",
        "gpt_extract_mdeical_info": "1. Patient's age: 43-year-old\n2. Patient's gender: female\n3. Presenting symptoms: episodic headache, sweating, and tachycardia\n4. Previous blood pressure: 125/80 mm Hg, 1 year ago\n5. Current blood pressure: 185/105 mm Hg\n6. Radiology study: CT of the abdomen",
        "medical_info_list": {
            "Patient's age": "43-year-old",
            "Patient's gender": "female",
            "Presenting symptoms": "episodic headache, sweating, and tachycardia",
            "Previous blood pressure": "125/80 mm Hg, 1 year ago",
            "Current blood pressure": "185/105 mm Hg",
            "Radiology study": "CT of the abdomen"
        },
        "dataset": "QMAX",
        "id": 26,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing headaches, sweating, and a rapid heartbeat for several weeks."
            }
        ]
    },
    {
        "raw_data": {
            "id": 178,
            "question": "A 78-year-old man taking multiple medications presents to the clinic for continued surveillance after mechanical heart valve replacement. He has been taking warfarin after the valve replacement surgery, as prescribed. He denies any recent change in diet but notes that another doctor started him on a new antimicrobial. Coagulation studies show: Prothrombin time: 14 seconds Partial thromboplastin time: 36 seconds Bleeding time: 5 minutes International Normalized Ratio: 1.05 Which one of the following medications has the patient most likely recently begun taking?",
            "options": {
                "A": " Erythromycin",
                "B": " Griseofulvin",
                "C": " Isoniazid",
                "D": " Ketoconazole",
                "E": " Ritonavir"
            },
            "answer_idx": "B",
            "explaination": [
                "The correct answer is B. 34% chose this. Griseofulvin can be used to treat superficial fungal infections. It is a cytochrome P-450 (CYP450) inducer. Warfarin is an anticoagulant that inhibits the synthesis and γ-carboxylation of the vitamin K-dependent clotting factors II, VII, IX, and X. It is metabolized by the CYP450 system, primarily the CYP2C9 member. Note that the prothrombin time (PT), not the partial thromboplastin time, is used to follow warfarin levels. In this scenario, the INR is 1.05 which is subtherapeutic. This suggests inadequate anticoagulation possibly due to increased warfarin metabolism.",
                "A is not correct. 30% chose this. Erythromycin is an extremely commonly prescribed macrolide antibiotic (two-pack) and a CYP450 antagonist, which",
                "would cause increased levels of warfarin and prolonged PT/International Normalized Ratio.",
                "C is not correct. 15% chose this Isoniazid is an antibiotic used in the treatment of tuberculosis. It is a CYP450 inhibitor and would be expected to increase the warfarin level in this patient.",
                "D is not correct. 13% chose this. Ketoconazole is a commonly prescribed antifungal. It, and the rest of the \"azoles,\" are CYP450 inhibitors.",
                "E is not correct. 8% chose this. Ritonavir is a protease inhibitor used in HIV triple therapy. Protease inhibitors are very potent CYP450 inhibitors. In this patient, HIV is extremely unlikely, and protease inhibitors are not used as monotherapy. This is not the best answer choice."
            ],
            "bottom_line": "Bottom Line: Inducers of CYP450 enzymes cause increased metabolism of warfarin.",
            "total_id": 664,
            "type": "Cardiology"
        },
        "question": "05 Which one of the following medications has the patient most likely recently begun taking?",
        "gpt_extract_mdeical_info": "1. Patient information:\n   1. Age: 78\n   2. Gender: Male\n2. Medical history:\n   1. Mechanical heart valve replacement\n3. Medications:\n   1. Warfarin\n   2. Antimicrobial (unnamed)\n4. Symptoms:\n   1. None reported\n5. Coagulation studies:\n   1. Prothrombin time: 14 seconds\n   2. Partial thromboplastin time: 36 seconds\n   3. Bleeding time: 5 minutes\n   4. International Normalized Ratio: 1",
        "medical_info_list": {
            "Age": "78",
            "Gender": "Male",
            "Medical history": "Mechanical heart valve replacement",
            "Medications": "Warfarin Antimicrobial (unnamed)",
            "Symptoms": "None reported",
            "Prothrombin time": "14 seconds",
            "Partial thromboplastin time": "36 seconds",
            "Bleeding time": "5 minutes",
            "International Normalized Ratio": "1"
        },
        "dataset": "QMAX",
        "id": 27,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm here for a regular check-up after my heart valve replacement and to discuss a new antimicrobial medication I've started."
            }
        ]
    },
    {
        "raw_data": {
            "id": 139,
            "question": "A 47-year-old man is diagnosed with a slow-growing tumor located in the right frontal lobe of his brain. The tumor is surgically excised and the diagnosis is confirmed with hematoxylin-eosin staining, shown in the image.\nWhich of the following is the normal function of the neoplastic cells seen in this histologic image?",
            "options": {
                "A": " Myelination of the central nervous system and peripheral nervous system",
                "B": " Myelination of the central nervous system only",
                "C": " Myelination of the peripheral nervous system only",
                "D": " Phagocytosis in the central nervous system and peripheral nervous system",
                "E": " Phagocytosis in the central nervous system only",
                "F": " Phagocytosis in the peripheral nervous system only"
            },
            "answer_idx": "B",
            "explaination": [
                "The correct answer is B. 67% chose this. The classic histologic appearance of oligodendroglioma is \"fried eggs\" with perinuclear halos and \"chicken wire\" capillary patterning. Oligodendrogliomas are relatively benign tumors that are derived from oligodendrocytes. The tumors primarily affect the frontal lobes of adults, and have a tendency to calcify. Oligodendrocytes normally function to myelinate the central nervous system (CNS). Whereas one Schwann cell myelinates one peripheral nervous system axon, one oligodendrocyte myelinates multiple CNS neurons.",
                "A is not correct. 5% chose this. Myelination in the central nervous system is the role of oligodendrocytes, whereas the peripheral nervous system is myelinated by Schwann cells. Tumors derived from Schwann cells include neurilemmomas and acoustic neuromas. Bilateral acoustic neuromas are frequently associated with neurofibromatosis type 2.",
                "C is not correct. 6% chose this. Oligodendrocytes are not found outside of the central nervous system.",
                "D is not correct. 6% chose this. Microglia are the phagocytic cells of the central nervous system, and macrophages and monocytes are the cells involved in phagocytosis in the rest of the body.",
                "E is not correct. 14% chose this. Microglia have small irregular nuclei with relatively little cytoplasm; they function as phagocytic cells in the central nervous system and do not cause the tumor in the image.",
                "F is not correct. 2% chose this. Monocytes and macrophages do not typically function in the central nervous system and would not produce the tumor in the image."
            ],
            "bottom_line": "Bottom Line: Oligodendrocytes myelinate multiple CNS neurons and have a \"fried egg\" appearance on histology.",
            "total_id": 126,
            "type": "Oncology"
        },
        "question": "\nWhich of the following is the normal function of the neoplastic cells seen in this histologic image?",
        "gpt_extract_mdeical_info": "1. Patient's age: 47.\n2. Patient's gender: male.\n3. Tumor location: right frontal lobe of the brain.\n4. Tumor growth rate: slow-growing.\n5. Diagnostic method: surgical excision.\n6. Diagnostic confirmation method: hematoxylin-eosin staining.",
        "medical_info_list": {
            "Patient's age": "47.",
            "Patient's gender": "male.",
            "Tumor location": "right frontal lobe of the brain.",
            "Tumor growth rate": "slow-growing.",
            "Diagnostic method": "surgical excision.",
            "Diagnostic confirmation method": "hematoxylin-eosin staining."
        },
        "dataset": "QMAX",
        "id": 28,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have a growth in my brain that was recently removed through surgery."
            }
        ]
    },
    {
        "raw_data": {
            "id": 103,
            "question": "A 28-year-old HIV-positive woman presents for prenatal care. She states that she is 17 weeks' pregnant, according to the date of her last menstrual period. She has not yet had any prenatal care. She is otherwise in good health.Which of the following drugs reduces the risk of transmission of HIV to the newborn?",
            "options": {
                "A": " Efavirenz",
                "B": " Indinavir",
                "C": " Maraviroc",
                "D": " Zidovudine"
            },
            "answer_idx": "D",
            "explaination": [
                "The correct answer is D. 59% chose this. Zidovudine is a nucleoside analog that inhibits HIV reverse transcriptase, preventing the incorporation of the viral genome into host DNA. A 1994 randomized, double-blind, placebo-controlled trial involving HIV-infected women at 14-34 weeks' gestation who had CD4+ counts >200/mm3, had no or minimal symptoms,and had not received antiretroviral treatment during their pregnancy demonstrated that of the 425 mothers who completed the trial, the treatment group had their vertical HIV transmission rate reduced by 70%.",
                "A is not correct. 12% chose this. Efavirenz is a non-nucleoside HIV reverse transcriptase inhibitor that prevents the incorporation of the viral genome into host DNA. It has not been shown to decrease vertical transmission rates and in fact is generally not given to pregnant women because of its serious side effect profile. Efavirenz is never used alone (it can be given as part of HAART) and is usually given as part of a chronic treatment rather than as prophylaxis.",
                "B is not correct. 16% chose this. Indinavir is a viral protease inhibitor that inhibits the assembly of new virus particles.",
                "C is not correct. 13% chose this. Marviroc is an entry inhibitor that is a CCR5 receptor antagonist. This prevents the HIV virus from entering host cells."
            ],
            "bottom_line": "Bottom Line:Zidovudine is a nucleoside analog that inhibits HIV reverse transcriptase, preventing the incorporation of the viral genome into host DNA. It is frequently used for general prophylaxis and during pregnancy to reduce the risk of fetal transmission of HIV.",
            "total_id": 764,
            "type": "Muscular"
        },
        "question": "Which of the following drugs reduces the risk of transmission of HIV to the newborn?",
        "gpt_extract_mdeical_info": "1. Patient's gender: Female.\n2. Patient's age: 28 years old.\n3. Patient's HIV status: Positive.\n4. Reason for visit: Prenatal care.\n5. Gestational age: 17 weeks.\n6. Prenatal care history: None.\n7. Patient's overall health: Good.",
        "medical_info_list": {
            "Patient's gender": "Female.",
            "Patient's age": "28 years old.",
            "Patient's HIV status": "Positive.",
            "Reason for visit": "Prenatal care.",
            "Gestational age": "17 weeks.",
            "Prenatal care history": "None.",
            "Patient's overall health": "Good."
        },
        "dataset": "QMAX",
        "id": 29,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm here for my first prenatal care appointment and I want to know how to reduce the risk of transmitting HIV to my baby."
            }
        ]
    },
    {
        "raw_data": {
            "id": 28,
            "question": "A 65-year-old woman comes to the physician for a follow-up examination after blood pressure measurements were\n175/105 mm Hg and 185/110 mm Hg 1 and 3 weeks ago, respectively. She has well-controlled type 2 diabetes\nmellitus. Her blood pressure now is 175/110 mm Hg. Physical examination shows no other abnormalities.\nAntihypertensive therapy is started, but her blood pressure remains elevated at her next visit 3 weeks later. Laboratory\nstudies show increased plasma renin activity; the erythrocyte sedimentation rate and serum electrolytes are within the\nreference ranges. Angiography shows a high-grade stenosis of the proximal right renal artery; the left renal artery\nappears normal. Which of the following is the most likely diagnosis?",
            "options": "(A) Atherosclerosis (B) Congenital renal artery hypoplasia (C) Fibromuscular dysplasia (D) Takayasu arteritis (E) Temporal arteritis",
            "answer": "(A) Atherosclerosis",
            "chatgpt_explaination": "Based on the information provided, the most likely diagnosis is (A) atherosclerosis. Atherosclerosis is a condition in which the arteries become narrowed or blocked due to the accumulation of plaque, which is made up of fat, cholesterol, and other substances. This can cause high blood pressure, as well as other symptoms and complications. The findings on angiography, which show a high-grade stenosis of the proximal right renal artery, support this diagnosis. It is important for the patient to receive appropriate treatment for atherosclerosis in order to manage their symptoms and prevent further complications.",
            "total_id": 18,
            "type": "Step 1",
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "gpt_extract_mdeical_info": "1. Patient's age: 65 years old.\n2. Patient's gender: female.\n3. Blood pressure measurements:\n   - 1 week ago: 175/105 mm Hg.\n   - 3 weeks ago: 185/110 mm Hg.\n4. Medical condition: type 2 diabetes mellitus under control.\n5. Current blood pressure: 175/110 mm Hg.\n6. Physical examination findings: no other abnormalities found.\n7. Antihypertensive therapy started but failed to bring down blood pressure.\n8. Laboratory studies: \n   - Increased plasma renin activity.\n   - Erythrocyte sedimentation rate and serum electrolytes within reference range.\n9. Angiography findings:\n   - High-grade stenosis in the proximal right renal artery.\n   - Left renal artery appears normal.",
        "medical_info_list": {
            "Patient's age": "65 years old.",
            "Patient's gender": "female.",
            "week ago": "175/105 mm Hg.",
            "weeks ago": "185/110 mm Hg.",
            "Medical condition": "type 2 diabetes mellitus under control.",
            "Current blood pressure": "175/110 mm Hg.",
            "Physical examination findings": "no other abnormalities found.",
            "info_1": "Antihypertensive therapy started but failed to bring down blood pressure.",
            "Laboratory studies": "Increased plasma renin activity. Erythrocyte sedimentation rate and serum electrolytes within reference range.",
            "Angiography findings": "High-grade stenosis in the proximal right renal artery. Left renal artery appears normal."
        },
        "dataset": "SelfExam",
        "id": 30,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm here for a follow-up because my blood pressure has been high despite starting treatment."
            }
        ]
    },
    {
        "raw_data": {
            "id": 2,
            "question": "A 48-year-old man dies suddenly of a cardiac arrhythmia. Six weeks ago, he was resuscitated from a cardiac arrest\ncaused by coronary artery disease and developed oliguric renal failure. Five weeks ago (1 week after being\nresuscitated), his serum urea nitrogen (BUN) concentration was 40 mg/dL, his serum creatinine concentration was 3.5\nmg/dL, and his urine contained granular casts. Four weeks ago, his oliguria resolved, and his BUN and serum\ncreatinine concentrations returned to normal. Examination of his kidneys at autopsy is most likely to show which of\nthe following?",
            "options": "(A) Acute inflammation (B) Fibrinous exudate (C) Fibrous scar (D) Granulation tissue (E) Normal kidney",
            "answer": "(E) Normal kidney",
            "chatgpt_explaination": "It is difficult to accurately answer this question without more information. Oliguric renal failure can be caused by a number of different conditions, and the specific findings on examination of the kidneys at autopsy would depend on the underlying cause. In general, however, the kidneys may show signs of damage or scarring if the individual had chronic kidney disease or if they experienced a severe episode of acute kidney injury. In some cases, the kidneys may appear normal if the individual's oliguria resolved and their renal function returned to normal before their death. It is also possible that the kidneys could show evidence of acute inflammation if the individual had an infection or other condition that affected their kidneys.",
            "total_id": 0,
            "type": "Step 1",
            "answer_idx": "E"
        },
        "question": " Examination of his kidneys at autopsy is most likely to show which of\nthe following?",
        "gpt_extract_mdeical_info": "1. Patient's age: 48 years old.\n2. Patient's gender: male.\n3. Cause of death: cardiac arrhythmia.\n4. Medical history: resuscitated from cardiac arrest caused by coronary artery disease.\n5. Complication following cardiac arrest: oliguric renal failure.\n6. Serum urea nitrogen (BUN) concentration 5 weeks prior to death: 40 mg/dL.\n7. Serum creatinine concentration 5 weeks prior to death: 3.5 mg/dL.\n8. Urine analysis 5 weeks prior to death: contained granular casts.\n9. Development of oliguria: resolved 4 weeks prior to death.\n10. Recovery of BUN and serum creatinine concentrations: returned to normal 4 weeks prior to death.",
        "medical_info_list": {
            "Patient's age": "48 years old.",
            "Patient's gender": "male.",
            "Cause of death": "cardiac arrhythmia.",
            "Medical history": "resuscitated from cardiac arrest caused by coronary artery disease.",
            "Complication following cardiac arrest": "oliguric renal failure.",
            "Serum urea nitrogen (BUN) concentration 5 weeks prior to death": "40 mg/dL.",
            "Serum creatinine concentration 5 weeks prior to death": "3.5 mg/dL.",
            "Urine analysis 5 weeks prior to death": "contained granular casts.",
            "Development of oliguria": "resolved 4 weeks prior to death.",
            "Recovery of BUN and serum creatinine concentrations": "returned to normal 4 weeks prior to death."
        },
        "dataset": "SelfExam",
        "id": 31,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I recently passed away suddenly from a heart problem, but six weeks ago I was brought back from a cardiac arrest and then had trouble with my kidney function."
            }
        ]
    },
    {
        "raw_data": {
            "id": 27,
            "question": "A 64-year-old man comes to the clinic because of a 2-week history of severe pain and generalized muscle weakness.\nHe has hypercholesteremia and hypertension. Three months ago, he had a myocardial infarction. At that time, he\nbegan atorvastatin therapy. Other medications are clopidogrel, lisinopril, and amiodarone. He is 178 cm (5 ft 10 in)\ntall and weighs 82 kg (180 lb); BMI is 26 kg/m²",
            "options": "(A) Erythrocyte sedimentation rate (B) Serum ALT activity (C) Serum calcium concentration (D) Serum C-reactive protein concentration (E) Serum creatine kinase activity",
            "answer": "(E) Serum creatine kinase activity",
            "chatgpt_explaination": "The most appropriate initial step in diagnosis for this patient would be to measure their serum creatine kinase activity. This is because the patient has a history of muscle weakness and the symptoms they are experiencing may be related to a muscle injury or condition. Elevated levels of creatine kinase in the blood can indicate muscle damage, which can help guide further diagnostic testing and treatment.\n\n\n",
            "total_id": 102,
            "type": "Step 2",
            "answer_idx": "E"
        },
        "question": " He is 178 cm (5 ft 10 in)\ntall and weighs 82 kg (180 lb); BMI is 26 kg/m²",
        "gpt_extract_mdeical_info": "1. Patient's age: 64 years old.\n2. Patient's gender: Not specified in the question.\n3. Chief complaint: Severe pain and generalized muscle weakness for 2 weeks.\n4. Past medical history:\n    1. Hypercholesteremia\n    2. Hypertension\n    3. Myocardial infarction 3 months ago.\n5. Current medications:\n    1. Atorvastatin\n    2. Clopidogrel\n    3. Lisinopril\n    4. Amiodarone.",
        "medical_info_list": {
            "Patient's age": "64 years old.",
            "Patient's gender": "Not specified in the question.",
            "Chief complaint": "Severe pain and generalized muscle weakness for 2 weeks.",
            "Past medical history": "Hypercholesteremia Hypertension Myocardial infarction 3 months ago.",
            "Current medications": "Atorvastatin Clopidogrel Lisinopril Amiodarone."
        },
        "dataset": "SelfExam",
        "id": 32,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing severe pain and generalized muscle weakness for the past two weeks."
            }
        ]
    },
    {
        "raw_data": {
            "id": 48,
            "question": "A 19-year-old man undergoes splenectomy because of crush injuries sustained in a motor vehicle collision. During the operation, two small accessory spleens are seen adjacent to the ruptured spleen. The most likely origin of this patient's congenital anomaly is thickening of an embryologic layer at which of the following sites?",
            "options": "(A) Adjacent to the ventral pancreas (B) Along the lesser curvature of the stomach (C) At the origin of the celiac vessels (D) In a portion of the hepatic diverticulum (E) Within the dorsal mesogastrium",
            "answer": "(E) Within the dorsal mesogastrium",
            "chatgpt_explaination": "As a large language model trained by OpenAI, I do not have the ability to browse the internet or access specific medical information. I am not able to provide a definite answer to this question without further information. Accessory spleens can develop in various locations within the abdomen, and the specific location of the accessory spleens in this patient would depend on a number of factors. It is important for the patient to discuss his specific situation with his doctor to determine the most appropriate course of treatment.",
            "total_id": 27,
            "type": "Step 1",
            "answer_idx": "E"
        },
        "question": " The most likely origin of this patient's congenital anomaly is thickening of an embryologic layer at which of the following sites?",
        "gpt_extract_mdeical_info": "1. Patient age: 19 years old.\n2. Patient gender: Male.\n3. Reason for surgery: Splenectomy due to crush injuries sustained in a motor vehicle collision.\n4. Additional findings during surgery: Two small accessory spleens were seen adjacent to the ruptured spleen.",
        "medical_info_list": {
            "Patient age": "19 years old.",
            "Patient gender": "Male.",
            "Reason for surgery": "Splenectomy due to crush injuries sustained in a motor vehicle collision.",
            "Additional findings during surgery": "Two small accessory spleens were seen adjacent to the ruptured spleen."
        },
        "dataset": "SelfExam",
        "id": 33,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I was in a car accident and had to have my spleen removed."
            }
        ]
    },
    {
        "raw_data": {
            "id": 74,
            "question": "A 27-year-old primigravid woman at 41 weeks' gestation is admitted to the hospital for induction of labor. She has\nreceived cervical ripening agents and is now receiving oxytocin. The cervix is 9 cm dilated and 100% effaced; the\nvertex is at 0 station. Fetal monitoring shows contractions every 3 minutes and a reassuring heart rate. She requests\npain medication. Which of the following is the most likely adverse effect of an intravenous opioid in this patient?",
            "options": "(A) Maternal fever (B) Maternal tachycardia (C) Neonatal acidosis (D) Neonatal arrhythmia (E) Neonatal respiratory depression",
            "answer": "(E) Neonatal respiratory depression",
            "chatgpt_explaination": "The correct answer is (E) Neonatal respiratory depression. Opioids are a class of medications that are commonly used to manage pain, and they work by binding to opioid receptors in the brain and other tissues. However, opioids can also have adverse effects, including respiratory depression, which is a condition in which the body's ability to breathe is impaired. In a pregnant woman who is receiving an intravenous opioid, this could potentially lead to neonatal respiratory depression in the baby. This is particularly concerning in the context of labor and delivery, when the baby is already at risk of respiratory distress due to the physical stresses of being born. Therefore, the use of opioids in this situation should be carefully weighed against the potential risks.",
            "total_id": 145,
            "type": "Step 2",
            "answer_idx": "E"
        },
        "question": " Which of the following is the most likely adverse effect of an intravenous opioid in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 27.\n2. Patient's gender: Female.\n3. Patient's obstetric status: Primigravid.\n4. Gestational age: 41 weeks.\n5. Medical procedure: Induction of labor.\n6. Cervical ripening agents administered: Yes.\n7. Oxytocin administered: Yes.\n8. Cervical dilation: 9 cm.\n9. Cervical effacement: 100%.\n10. Fetal position: Vertex at 0 station.\n11. Frequency of contractions: Every 3 minutes.\n12. Fetal heart rate: Reassuring.\n13. Patient's pain level: Significant, requesting pain medication.",
        "medical_info_list": {
            "Patient's age": "27.",
            "Patient's gender": "Female.",
            "Patient's obstetric status": "Primigravid.",
            "Gestational age": "41 weeks.",
            "Medical procedure": "Induction of labor.",
            "Cervical ripening agents administered": "Yes.",
            "Oxytocin administered": "Yes.",
            "Cervical dilation": "9 cm.",
            "Cervical effacement": "100%.",
            "Fetal position": "Vertex at 0 station.",
            "Frequency of contractions": "Every 3 minutes.",
            "Fetal heart rate": "Reassuring.",
            "Patient's pain level": "Significant, requesting pain medication."
        },
        "dataset": "SelfExam",
        "id": 34,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm in labor and I'm requesting pain medication."
            }
        ]
    },
    {
        "raw_data": {
            "id": 5,
            "question": "A 16-year-old boy is brought to the emergency department because of a 2-day history of fever, nausea, vomiting, headache, chills, and fatigue. He has not had any sick contacts. He underwent splenectomy for traumatic injury at the age of 13 years. He has no other history of serious illness and takes no medications. He appears ill. His temperature is 39.2°C (102.5°F), pulse is 130/min, respirations are 14/min, and blood pressure is 110/60 mm Hg. On pulmonary examination, scattered crackles are heard bilaterally. Abdominal examination shows a well-healed midline scar and mild, diffuse tenderness to palpation. Which of the following is the most appropriate next step in management?",
            "options": "(A) Antibiotic therapy (B) Antiemetic therapy (C) CT scan of the chest (D) X-ray of the abdomen (E) Reassurance",
            "answer": "(A) Antibiotic therapy",
            "chatgpt_explaination": "Based on the information provided, the most appropriate next step in management would be to order diagnostic tests, such as a CT scan of the chest and an x-ray of the abdomen, to help determine the cause of the patient's symptoms. These tests can provide valuable information about the patient's condition and guide further treatment. It may also be appropriate to start the patient on intravenous fluids to help rehydrate him and control his nausea and vomiting with antiemetic therapy. Antibiotic therapy may be necessary if an infection is suspected, but this should be determined after the results of the diagnostic tests are known. Reassurance alone is not likely to be sufficient to treat the patient's symptoms.\n\n\n\n",
            "total_id": 86,
            "type": "Step 2",
            "answer_idx": "A"
        },
        "question": " Which of the following is the most appropriate next step in management?",
        "gpt_extract_mdeical_info": "1. Patient's age: 16 years old.\n2. Patient's gender: Not specified.\n3. Chief complaint: Fever, nausea, vomiting, headache, chills, and fatigue.\n4. Duration of symptoms: 2 days.\n5. History of sick contacts: None.\n6. Past medical history: Splenectomy for traumatic injury at the age of 13 years.\n7. Medications: None.\n8. General appearance: Patient appears ill.\n9. Vital signs:\n    1. Temperature: 39.2°C (102.5°F).\n    2. Pulse: 130/min.\n    3. Respirations: 14/min.\n    4. Blood pressure: 110/60 mm Hg.\n10. Pulmonary examination: Scattered crackles heard bilaterally.\n11. Abdominal examination:\n    1. Midline scar: Well-healed.\n    2. Tenderness: Mild, diffuse.",
        "medical_info_list": {
            "Patient's age": "16 years old.",
            "Patient's gender": "Not specified.",
            "Chief complaint": "Fever, nausea, vomiting, headache, chills, and fatigue.",
            "Duration of symptoms": "2 days.",
            "History of sick contacts": "None.",
            "Past medical history": "Splenectomy for traumatic injury at the age of 13 years.",
            "Medications": "None.",
            "General appearance": "Patient appears ill.",
            "Temperature": "39.2°C (102.5°F).",
            "Pulse": "130/min.",
            "Respirations": "14/min.",
            "Blood pressure": "110/60 mm Hg.",
            "Pulmonary examination": "Scattered crackles heard bilaterally.",
            "Midline scar": "Well-healed.",
            "Tenderness": "Mild, diffuse."
        },
        "dataset": "SelfExam",
        "id": 35,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling feverish, nauseous, and have had a headache, chills, and fatigue for the past two days."
            }
        ]
    },
    {
        "raw_data": {
            "id": 118,
            "question": "A 36-year-old woman with hypertension comes to the office because she thinks she may be “going through early menopause.” She has not had a menstrual period since her most recent office visit 6 months ago. During this time, she also has been “gaining weight around the middle” despite increased exercise; she has had a 6.3-kg (14-lb) weight gain.  She has no other history of major medical illness. Her only medication is lisinopril. She does not smoke, drink alcohol, or use illicit drugs. She is 168 cm (5 ft 6 in) tall and weighs 107 kg (236 lb); BMI is 38 kg/m². Vital signs are within normal limits. Examination shows a uterus consistent in size with a 24-week gestation. Pelvic ultrasonography shows oligohydramnios and a fetus with a misshapen cranium, pericardial effusion, small bladder, and echogenic bowel. The most likely cause of the fetal abnormalities in this patient’s pregnancy is interference with which of the following?",
            "options": "(A) Fetal lung/epithelial differentiation (B) Fetal lung/surfactant development (C) Fetal renal hemodynamics (D) Maternal placental perfusion (E) Maternal prostaglandin synthesis",
            "answer": "(C) Fetal renal hemodynamics",
            "chatgpt_explaination": "Based on the information provided, the most likely cause of the fetal abnormalities seen in this patient's pregnancy is interference with maternal placental perfusion. Placental perfusion is the process by which the placenta receives oxygen and nutrients from the mother and delivers them to the fetus. Abnormalities in this process can lead to fetal abnormalities, including those described in this case (misshapen cranium, pericardial effusion, small bladder, and echogenic bowel). Therefore, the correct answer is option D, \"Maternal placental perfusion.\"",
            "total_id": 80,
            "type": "Step 1",
            "answer_idx": "C"
        },
        "question": " The most likely cause of the fetal abnormalities in this patient’s pregnancy is interference with which of the following?",
        "gpt_extract_mdeical_info": "1. Patient age: 36 years old.\n2. Patient gender: Female.\n3. Medical history: hypertension.\n4. Menstrual history: no period in the past 6 months.\n5. Weight gain: 6.3 kg (14 lb) in the past 6 months.\n6. Major medical illness: none.\n7. Current medication: lisinopril.\n8. Smoking history: none.\n9. Alcohol consumption: none.\n10. Illicit drug use: none.\n11. Height: 168 cm (5 ft 6 in).\n12. Weight: 107 kg (236 lb).\n13. BMI: 38 kg/m².\n14. Vital signs: within normal limits.\n15. Uterus size: consistent with a 24-week gestation.\n16. Pelvic ultrasonography findings: oligohydramnios, misshapen cranium, pericardial effusion, small bladder, and echogenic bowel.",
        "medical_info_list": {
            "Patient age": "36 years old.",
            "Patient gender": "Female.",
            "Medical history": "hypertension.",
            "Menstrual history": "no period in the past 6 months.",
            "Weight gain": "6.3 kg (14 lb) in the past 6 months.",
            "Major medical illness": "none.",
            "Current medication": "lisinopril.",
            "Smoking history": "none.",
            "Alcohol consumption": "none.",
            "Illicit drug use": "none.",
            "Height": "168 cm (5 ft 6 in).",
            "Weight": "107 kg (236 lb).",
            "BMI": "38 kg/m².",
            "Vital signs": "within normal limits.",
            "Uterus size": "consistent with a 24-week gestation.",
            "Pelvic ultrasonography findings": "oligohydramnios, misshapen cranium, pericardial effusion, small bladder, and echogenic bowel."
        },
        "dataset": "SelfExam",
        "id": 36,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I think I may be going through early menopause because I haven't had a menstrual period for the past 6 months and I've been gaining weight around my middle despite exercising more."
            }
        ]
    },
    {
        "raw_data": {
            "id": 25,
            "question": "A healthy 30-year-old woman participates in a study of the relationship between cardiovascular function and posture. Placed in a room with a comfortable temperature (72°F) and humidity (40%), she moves from a standing to a supine position. Which of the following sets of changes is most likely in the reflex control of this woman's cardiovascular\nsystem?",
            "options": "(A) Carotid Sinus Baroreceptor Activity, Atrial Stretch Receptor Activity, and Vagal Efferent Activity to the Heart increase (B) Carotid Sinus Baroreceptor Activity and Atrial Stretch Receptor Activity increase, while Vagal Efferent Activity to the Heart decrease (C) Carotid Sinus Baroreceptor Activity and Vagal Efferent Activity to the Heart increase, while Atrial Stretch Receptor Activity decrease (D) Carotid Sinus Baroreceptor Activity increase, while Atrial Stretch Receptor Activity and Vagal Efferent Activity to the Heart decrease (E) Carotid Sinus Baroreceptor Activity decrease, while Atrial Stretch Receptor Activity and Vagal Efferent Activity to the Heart increase (F) Carotid Sinus Baroreceptor Activity and Vagal Efferent Activity to the Heart  decrease, while Atrial Stretch Receptor Activity increase (G) Carotid Sinus Baroreceptor Activity and Atrial Stretch Receptor Activity decrease, while Vagal Efferent Activity to the Heart increase (H) Carotid Sinus Baroreceptor Activity, Atrial Stretch Receptor Activity, and Vagal Efferent Activity to the Heart decrease",
            "answer": "(A) Carotid Sinus Baroreceptor Activity, Atrial Stretch Receptor Activity, and Vagal Efferent Activity to the Heart increase",
            "chatgpt_explaination": "Based on the information provided, it is most likely that the reflex control of this woman's cardiovascular system will cause a decrease in the activity of the Carotid Sinus Baroreceptor and Vagal Efferent Activity to the Heart, while the Atrial Stretch Receptor Activity increases. This is because when the body is in a supine position, gravity no longer has as strong of an effect on blood flow, allowing blood to pool in the veins and leading to a decrease in heart rate and blood pressure. The Carotid Sinus Baroreceptor and Vagal Efferent Activity to the Heart are both part of the body's reflexive mechanism for regulating blood pressure, so their activity would decrease in response to the decreased blood pressure. Meanwhile, the Atrial Stretch Receptor Activity would increase due to the increased volume of blood in the veins, leading to increased stretch in the atrial walls and stimulating the receptors. The answer is therefore (F) Carotid Sinus Baroreceptor Activity and Vagal Efferent Activity to the Heart decrease, while Atrial Stretch Receptor Activity increase.",
            "total_id": 15,
            "type": "Step 1",
            "answer_idx": "A"
        },
        "question": " Which of the following sets of changes is most likely in the reflex control of this woman's cardiovascular\nsystem?",
        "gpt_extract_mdeical_info": "1. Patient's age: 30 years old\n2. Patient's gender: Female\n3. Study type: Relationship between cardiovascular function and posture\n4. Room conditions:\n    1. Temperature: 72°F\n    2. Humidity: 40%\n5. Patient position changes:\n    1. From standing to supine position.",
        "medical_info_list": {
            "Patient's age": "30 years old",
            "Patient's gender": "Female",
            "Study type": "Relationship between cardiovascular function and posture",
            "Temperature": "72°F",
            "Humidity": "40%",
            "Patient position changes": "From standing to supine position."
        },
        "dataset": "SelfExam",
        "id": 37,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm participating in a study to understand how my heart and blood vessels respond when I change from standing to lying down."
            }
        ]
    },
    {
        "raw_data": {
            "id": 117,
            "question": "A 50-year-old man returns to the office for a follow-up examination. During the past 2 months, he has had increased blood pressure readings during several checks at the office and at home. He says he has felt well. He has major depressive disorder and gout. Medications are fluoxetine and allopurinol. His maternal grandfather had congestive heart failure and the patient's older brother has hypertension. The patient has smoked one-half pack of cigarettes daily for 32 years. He is 180 cm (5 ft 11 in) tall and weighs 95 kg (210 lb); BMI is 29 kg/m². Pulse is 70/min and blood pressure is 152/90 mm Hg. Physical examination discloses no abnormalities. Which of the following medications is contraindicated in this patient?",
            "options": "(A) Amlodipine (B) Doxazosin (C) Hydrochlorothiazide (D) Lisinopril (E) Metoprolol",
            "answer": "(C) Hydrochlorothiazide",
            "chatgpt_explaination": "Based on the information provided, it is not possible to determine which medication is contraindicated for this patient. The decision about which medication is appropriate for a patient should be made by a doctor after conducting a thorough medical evaluation and considering the patient's medical history, current health status, and any other relevant factors. It is also important to note that any changes to a patient's medication regimen should be made with the guidance and approval of a healthcare provider.",
            "total_id": 182,
            "type": "Step 2",
            "answer_idx": "C"
        },
        "question": " Which of the following medications is contraindicated in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 50 years old\n2. Patient's gender: male\n3. Medical history: major depressive disorder and gout\n4. Medications: fluoxetine and allopurinol\n5. Family history: maternal grandfather had congestive heart failure and older brother has hypertension\n6. Smoking status: smoked one-half pack of cigarettes daily for 32 years\n7. Height: 180 cm (5 ft 11 in)\n8. Weight: 95 kg (210 lb)\n9. BMI: 29 kg/m²\n10. Vital signs: pulse is 70/min and blood pressure is 152/90 mm Hg\n11. Physical examination: discloses no abnormalities",
        "medical_info_list": {
            "Patient's age": "50 years old",
            "Patient's gender": "male",
            "Medical history": "major depressive disorder and gout",
            "Medications": "fluoxetine and allopurinol",
            "Family history": "maternal grandfather had congestive heart failure and older brother has hypertension",
            "Smoking status": "smoked one-half pack of cigarettes daily for 32 years",
            "Height": "180 cm (5 ft 11 in)",
            "Weight": "95 kg (210 lb)",
            "BMI": "29 kg/m²",
            "Vital signs": "pulse is 70/min and blood pressure is 152/90 mm Hg",
            "Physical examination": "discloses no abnormalities"
        },
        "dataset": "SelfExam",
        "id": 38,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been having higher blood pressure readings lately, but otherwise, I feel well."
            }
        ]
    },
    {
        "raw_data": {
            "id": 51,
            "question": "A 19-year-old man who is a college freshman comes to the office because of a 4-day history of tender, swollen glands. He also has a 6-day history of fever, malaise, and decreased appetite. His temperature is 38.7°C (101.7°F). Physical examination shows swelling of the parotid glands. Which of the following infectious agents is the most likely cause of these findings?",
            "options": "(A) Epstein-Barr virus (B) Hepatitis B virus (C) Measles virus (D) Mumps virus (E) Rubella virus",
            "answer": "(D) Mumps virus",
            "chatgpt_explaination": "Based on the symptoms described, the most likely cause of the individual's symptoms is the mumps virus (option D). Mumps is a viral infection that affects the salivary glands and can cause swelling of the parotid glands, as well as other symptoms such as fever and malaise. It is highly contagious and is spread through respiratory droplets or saliva. The other options listed (Epstein-Barr virus, hepatitis B virus, measles virus, and rubella virus) are all possible causes of similar symptoms, but mumps is the most likely given the specific symptoms described.",
            "total_id": 30,
            "type": "Step 1",
            "answer_idx": "D"
        },
        "question": " Which of the following infectious agents is the most likely cause of these findings?",
        "gpt_extract_mdeical_info": "1. Patient demographics: \n    1. Age: 19 years old.\n    2. Gender: Male.\n    3. Academic status: College freshman.\n\n2. Chief complaint: Tender, swollen glands for 4 days.\n\n3. Present illness:\n    1. Duration of fever: 6 days.\n    2. Symptoms: Malaise and decreased appetite.\n    3. Current temperature: 38.7°C (101.7°F).\n\n4. Physical exam:\n    1. Swelling location: Parotid glands.\n\n5. Additional medical information:\n    None provided.",
        "medical_info_list": {
            "Age": "19 years old.",
            "Gender": "Male.",
            "Academic status": "College freshman.",
            "Chief complaint": "Tender, swollen glands for 4 days.",
            "Duration of fever": "6 days.",
            "Symptoms": "Malaise and decreased appetite.",
            "Current temperature": "38.7°C (101.7°F).",
            "Swelling location": "Parotid glands.",
            "Additional medical information": "None provided."
        },
        "dataset": "SelfExam",
        "id": 39,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling unwell with a fever and swollen glands for several days."
            }
        ]
    },
    {
        "raw_data": {
            "id": 117,
            "question": "A 38-year-old woman comes to the clinic to discuss results of a biopsy specimen of a mass in the right breast obtained 1 week ago. She has no history of serious illness and takes no medications. Vital signs are within normal limits.  Examination of the right breast shows a well-healing biopsy incision. The remainder of the examination discloses no abnormalities. Results of the biopsy specimen disclose ductal carcinoma in situ. The physician informs the patient he has some bad news to share and tells her the diagnosis. He explains her treatment options, including mastectomy, breast-conserving surgery, radiation therapy, chemotherapy, and any combination of these options. The patient appears afraid but listens attentively before responding, \"You're the doctor. My children are still little. Tell me what I should do.\" In addition to expressing empathy, which of the following is the most appropriate physician response?",
            "options": "(A) \"As the patient, you really should make any decision you feel is best for you.\" (B) \"Before I make recommendations, can you tell me what you understand about your options?\" (C) \"Given the stage of the cancer, I recommend mastectomy.\" (D) \"How important is it to you to keep your breasts?\" (E) \"Would you like to discuss these options further with your family?\" (F) \"Would you like to think your options over and schedule another visit to discuss them further?\" (G) \"You said you have young children. How old are they?\"",
            "answer": "(B) \"Before I make recommendations, can you tell me what you understand about your options?\"",
            "chatgpt_explaination": "The most appropriate physician response in this situation would be option (B) \"Before I make recommendations, can you tell me what you understand about your options?\" This response allows the physician to assess the patient's understanding of her treatment options and to provide additional information and guidance as needed. It also allows the physician to tailor his recommendations to the patient's individual needs and preferences. Options (A) and (D) do not provide enough information or guidance to the patient, while options (C) and (E) may not be appropriate at this stage as they assume that the patient has already made a decision about her treatment. Option (F) may be a good option to consider after the patient has been given more information about her options, but it is not the most appropriate response at this stage in the conversation. Option (G) is not directly related to the patient's treatment options and may not be relevant in this situation.",
            "total_id": 79,
            "type": "Step 1",
            "answer_idx": "B"
        },
        "question": "\" In addition to expressing empathy, which of the following is the most appropriate physician response?",
        "gpt_extract_mdeical_info": "1. Patient's age: 38 years old.\n2. Patient's gender: Female.\n3. Medical history: No history of serious illness.\n4. Medication history: Takes no medications.\n5. Biopsy specimen location: Right breast.\n6. Healing of biopsy incision: Well-healing.\n7. Examination findings: No abnormalities, except for the biopsy incision.\n8. Biopsy result: Ductal carcinoma in situ.\n9. Treatment options discussed: Mastectomy, breast-conserving surgery, radiation therapy, chemotherapy, and any combination of these options.\n10. Patient's concern: Her children are still little.",
        "medical_info_list": {
            "Patient's age": "38 years old.",
            "Patient's gender": "Female.",
            "Medical history": "No history of serious illness.",
            "Medication history": "Takes no medications.",
            "Biopsy specimen location": "Right breast.",
            "Healing of biopsy incision": "Well-healing.",
            "Examination findings": "No abnormalities, except for the biopsy incision.",
            "Biopsy result": "Ductal carcinoma in situ.",
            "Treatment options discussed": "Mastectomy, breast-conserving surgery, radiation therapy, chemotherapy, and any combination of these options.",
            "Patient's concern": "Her children are still little."
        },
        "dataset": "SelfExam",
        "id": 40,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came in to discuss the results of a biopsy of a mass in my right breast that was taken last week."
            }
        ]
    },
    {
        "raw_data": {
            "id": 102,
            "question": "A 3-year-old boy is brought to the office because of a 2-day history of bulging of his left eye. He says his eye hurts. He has no history of major medical illness or recent trauma to the area, and he receives no medications. Vital signs are within normal limits. Physical examination shows exophthalmos of the left eye. MRI of the brain shows a 2-cm mass involving the ocular muscles of the left eye. A biopsy specimen of the mass shows malignant cells, some of which have striations. Which of the following is the most likely diagnosis?",
            "options": "(A) Neuroblastoma (B) Pheochromocytoma (C) Retinoblastoma (D) Rhabdomyosarcoma (E) Thyroid cancer",
            "answer": "(D) Rhabdomyosarcoma",
            "chatgpt_explaination": "Based on the information provided, the most likely diagnosis is (D) rhabdomyosarcoma. This is a type of cancer that affects the soft tissues, including the muscles that control the movement of the eye. The presence of striations in the biopsy specimen, which are indicative of striated muscle tissue, further supports this diagnosis. Pheochromocytoma, neuroblastoma, and thyroid cancer are all types of cancer that can affect different parts of the body and are less likely to be the cause of the symptoms described in the question. Retinoblastoma is a type of cancer that affects the retina, which is a different part of the eye than the ocular muscles.",
            "total_id": 68,
            "type": "Step 1",
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "gpt_extract_mdeical_info": "1. Patient's age: 3 years old.\n2. Patient's gender: Not specified.\n3. History of illness: None.\n4. History of recent trauma to the area: None.\n5. Current medications: None.\n6. Vital signs: Within normal limits.\n7. Physical examination findings: exophthalmos of the left eye.\n8. Imaging test performed: MRI of the brain.\n9. Imaging findings: a 2-cm mass involving the ocular muscles of the left eye.\n10. Biopsy result: Malignant cells were found, some of which have striations.",
        "medical_info_list": {
            "Patient's age": "3 years old.",
            "Patient's gender": "Not specified.",
            "History of illness": "None.",
            "History of recent trauma to the area": "None.",
            "Current medications": "None.",
            "Vital signs": "Within normal limits.",
            "Physical examination findings": "exophthalmos of the left eye.",
            "Imaging test performed": "MRI of the brain.",
            "Imaging findings": "a 2-cm mass involving the ocular muscles of the left eye.",
            "Biopsy result": "Malignant cells were found, some of which have striations."
        },
        "dataset": "SelfExam",
        "id": 41,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I brought my 3-year-old son to the office because his left eye has been bulging and he says it hurts."
            }
        ]
    },
    {
        "raw_data": {
            "id": 31,
            "question": "A 72-year-old man comes to the physician for a health maintenance examination. He has no personal or family history\nof major medical illnesses. He has never smoked cigarettes. Pulse oximetry on room air shows an oxygen saturation\nof 98%. Physical examination shows plethoric skin and splenomegaly. Laboratory studies show:",
            "options": "(A) Erythroid progenitor (B) Hematopoietic stem (C) Lymphatic progenitor (D) Megakaryocyte progenitor (E) Pluripotent stem",
            "answer": "(B) Hematopoietic stem",
            "chatgpt_explaination": "Based on the laboratory values and description of the patient's symptoms, it is likely that the primary hematologic defect in this patient occurred in the megakaryocyte progenitor cells. These are the cells that give rise to megakaryocytes, which are responsible for producing platelets. The high hemoglobin and hematocrit levels, as well as the increased platelet count and the presence of occasional giant platelets on the peripheral blood smear, suggest that the patient may have a condition known as essential thrombocythemia. This is a type of blood cancer in which the bone marrow produces too many platelets, leading to an increased risk of blood clots. The leukocyte alkaline phosphatase levels and the presence of splenomegaly on physical examination also support this diagnosis. Treatment for essential thrombocythemia typically involves medications to reduce the production of platelets and to prevent blood clots. Therefore, the answer to the question is (D) megakaryocyte progenitor.",
            "total_id": 19,
            "type": "Step 1",
            "answer_idx": "B"
        },
        "question": " Laboratory studies show:",
        "gpt_extract_mdeical_info": "1. Patient's age: 72 years old.\n2. Patient's gender: Male.\n3. Medical history: No personal or family history of major medical illnesses.\n4. Smoking history: Patient has never smoked cigarettes.\n5. Oxygen saturation: 98% on room air as shown by pulse oximetry.\n6. Physical examination findings:\n   1. Skin: Plethoric.\n   2. Abdomen: Splenomegaly.",
        "medical_info_list": {
            "Patient's age": "72 years old.",
            "Patient's gender": "Male.",
            "Medical history": "No personal or family history of major medical illnesses.",
            "Smoking history": "Patient has never smoked cigarettes.",
            "Oxygen saturation": "98% on room air as shown by pulse oximetry.",
            "Skin": "Plethoric.",
            "Abdomen": "Splenomegaly."
        },
        "dataset": "SelfExam",
        "id": 42,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came in for a routine health check-up and have no specific complaints."
            }
        ]
    },
    {
        "raw_data": {
            "id": 2,
            "question": "A 45-year-old woman comes to the emergency department because of a 3-day history of progressive shortness of breath, cough productive of blood-tinged sputum, and fever. She also has a 3-month history of numbness of her left leg and tingling in her right arm. She has not had chills. She was diagnosed with asthma 6 months ago; it is well controlled with inhaled budesonide and albuterol as needed. She has no other history of serious illness and takes no other medications. She appears to be in mild respiratory distress. Temperature is 38.1°C (100.6°F), pulse is 105/min and regular, respirations are 24/min, and blood pressure is 145/95 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. Crackles are heard at the right lung base, and there are occasional diffuse wheezes. Cardiac examination shows no abnormalities. On neurologic examination, sensation to pinprick is decreased over the lateral aspect of the left lower extremity and right upper extremity. Muscle strength is 5/5 throughout. Babinski sign is absent. Deep tendon reflexes are 2+ and symmetric. Which of the following is the most appropriate next step in diagnosis?",
            "options": "(A) CT angiography of the chest (B) Determination of serum angiotensin-converting enzyme activity (C) Measurement of serum IgE concentration (D) Mesenteric angiography (E) Serum antiglomerular basement membrane assay (F) Serum antineutrophil cytoplasmic autoantibody assay (G) Sweat chloride testing",
            "answer": "(F) Serum antineutrophil cytoplasmic autoantibody assay",
            "chatgpt_explaination": "The most appropriate next step in diagnosis would be to perform further tests to determine the cause of the patient's symptoms. Based on the information provided, the most appropriate test would be a chest X-ray or computed tomography (CT) scan to assess the condition of the lungs and identify any abnormalities that may be contributing to the patient's symptoms. Options A, D, and G are not directly relevant to the patient's symptoms and do not appear to be the most appropriate next steps in diagnosis. Options B, C, E, and F may be relevant in some cases, but they are not typically used as initial tests in this situation and would not be the most appropriate next steps in diagnosis based on the information provided.",
            "total_id": 83,
            "type": "Step 2",
            "answer_idx": "F"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "gpt_extract_mdeical_info": "1. Patient's age: 45 years old\n2. Patient's gender: female\n3. Reason for ER visit: progressive shortness of breath, cough productive of blood-tinged sputum, and fever\n4. Neurological symptoms: numbness in left leg and tingling in right arm for 3 months\n5. Previous diagnosis: asthma, controlled with inhaled budesonide and albuterol as needed\n6. Medical history: no serious illnesses\n7. Current medications: none\n8. Vital signs:\n   1. Temperature: 38.1°C (100.6°F)\n   2. Pulse: 105/min and regular\n   3. Respirations: 24/min\n   4. Blood pressure: 145/95 mm Hg\n   5. Pulse oximetry on room air: oxygen saturation of 92%\n9. Chest examination: crackles heard at right lung base and occasional diffuse wheezes\n10. Cardiac examination: no abnormalities found\n11. Neurological examination:\n    1. Sensation to pinprick is decreased over the lateral aspect of the left lower extremity and right upper extremity\n    2. Muscle strength is 5/5 throughout\n    3. Babinski sign is absent\n12. Absence of chills noted.",
        "medical_info_list": {
            "Patient's age": "45 years old",
            "Patient's gender": "female",
            "Reason for ER visit": "progressive shortness of breath, cough productive of blood-tinged sputum, and fever",
            "Neurological symptoms": "numbness in left leg and tingling in right arm for 3 months",
            "Previous diagnosis": "asthma, controlled with inhaled budesonide and albuterol as needed",
            "Medical history": "no serious illnesses",
            "Current medications": "none",
            "Temperature": "38.1°C (100.6°F)",
            "Pulse": "105/min and regular",
            "Respirations": "24/min",
            "Blood pressure": "145/95 mm Hg",
            "Pulse oximetry on room air": "oxygen saturation of 92%",
            "Chest examination": "crackles heard at right lung base and occasional diffuse wheezes",
            "Cardiac examination": "no abnormalities found",
            "Neurological examination": "Sensation to pinprick is decreased over the lateral aspect of the left lower extremity and right upper extremity Muscle strength is 5/5 throughout Babinski sign is absent",
            "info_1": "Absence of chills noted."
        },
        "dataset": "SelfExam",
        "id": 43,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing increasing shortness of breath, coughing up blood-tinged sputum, and fever for the past three days, along with a three-month history of numbness in my left leg and tingling in my right arm."
            }
        ]
    },
    {
        "raw_data": {
            "id": 110,
            "question": "A 45-year-old woman comes to the office for a follow-up examination 2 weeks after she sustained a vertebral fracture at L1. The fracture occurred spontaneously and there is no history of trauma to the area or other fractures. She gained 27 kg (60 lb) during the 6 months before the fracture occurred. Her only medication is hydromorphone as needed for pain. She is 163 cm (5 ft 4 in) tall and now weighs 100 kg (220 lb); BMI is 38 kg/m2. Temperature is 37.0°C (98.6°F), pulse is 86/min, respirations are 12/min, and blood pressure is 145/98 mm Hg. Physical examination shows central obesity and purple striae over the abdomen bilaterally. The lower extremities appear thin. Results of laboratory studies are shown:",
            "options": "(A)  Calcium absorption (B)  Calcium excretion (C)  Osteoblast proliferation (D)  Osteoclast proliferation (E)  Phosphorus absorption (F)  Phosphorus excretion ",
            "answer": "(D)  Osteoclast proliferation",
            "chatgpt_explaination": "Based on the information given, the most likely cause of the fracture in this patient is an increase in osteoclast proliferation. Osteoclasts are cells that break down bone tissue, and an increase in their proliferation can lead to reduced bone density and an increased risk of fractures. In this case, the patient's weight gain, which can cause increased osteoclast activity, and the presence of purple striae on the abdomen, which can be a sign of excess cortisol, suggest that osteoclast proliferation may have contributed to the fracture.",
            "total_id": 74,
            "type": "Step 1",
            "answer_idx": "D"
        },
        "question": " Results of laboratory studies are shown:",
        "gpt_extract_mdeical_info": "1. Patient's age: 45-year-old.\n2. Patient's gender: Female.\n3. Reason for visit: Follow-up examination after sustaining vertebral fracture at L1.\n4. Cause of fracture: Spontaneous, no history of trauma or other fractures.\n5. Weight gain: 27 kg (60 lb) in 6 months prior to fracture.\n6. Current medication: Hydromorphone as needed for pain.\n7. Patient's height: 163 cm (5 ft 4 in).\n8. Patient's weight: 100 kg (220 lb).\n9. Patient's BMI: 38 kg/m2.\n10. Vital signs: Temperature is 37.0°C (98.6°F), pulse is 86/min, respirations are 12/min, and blood pressure is 145/98 mm Hg.\n11. Physical examination findings: Central obesity, purple striae over the abdomen bilaterally, thin lower extremities.",
        "medical_info_list": {
            "Patient's age": "45-year-old.",
            "Patient's gender": "Female.",
            "Reason for visit": "Follow-up examination after sustaining vertebral fracture at L1.",
            "Cause of fracture": "Spontaneous, no history of trauma or other fractures.",
            "Weight gain": "27 kg (60 lb) in 6 months prior to fracture.",
            "Current medication": "Hydromorphone as needed for pain.",
            "Patient's height": "163 cm (5 ft 4 in).",
            "Patient's weight": "100 kg (220 lb).",
            "Patient's BMI": "38 kg/m2.",
            "Vital signs": "Temperature is 37.0°C (98.6°F), pulse is 86/min, respirations are 12/min, and blood pressure is 145/98 mm Hg.",
            "Physical examination findings": "Central obesity, purple striae over the abdomen bilaterally, thin lower extremities."
        },
        "dataset": "SelfExam",
        "id": 44,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm here for a follow-up after experiencing a spontaneous vertebral fracture at L1 two weeks ago, with no history of trauma."
            }
        ]
    },
    {
        "raw_data": {
            "id": 92,
            "question": "A 58-year-old man with chronic obstructive pulmonary disease comes to the clinic with his wife for a follow-up examination. He has smoked one pack of cigarettes daily for 35 years. He has tried to quit smoking twice but was unsuccessful both times. At today’s visit, when the physician asks the patient about smoking cessation, he says he is not ready to do so. The patient’s wife states her husband’s smoking makes her cough and gives her chest tightness. Which of the following is the most appropriate physician statement?",
            "options": "(A) \"Are there any reasons why you might want to quit smoking?\" (B) \"Are you aware that your lung condition is chronic at this point?\" (C) \"I'm sure you don't want your wife to suffer as a result of your smoking.\" (D) \"The majority of your health issues would improve if you quit smoking.\" (E) \"Why haven't you been able to stay off cigarettes?\"",
            "answer": "(A) \"Are there any reasons why you might want to quit smoking?\"",
            "chatgpt_explaination": "The most appropriate physician statement in this scenario would be option (A), \"Are there any reasons why you might want to quit smoking?\" This statement is open-ended and non-judgmental, which may make the patient more receptive to discussing their reasons for continuing to smoke. It also acknowledges the patient's autonomy and allows them to express their own thoughts and feelings about smoking cessation. Options (B), (C), and (D) are all potentially confrontational and could make the patient defensive or less likely to engage in a productive conversation about quitting smoking. Option (E) is also potentially confrontational and focuses on the patient's past failures rather than their potential motivations for quitting.",
            "total_id": 59,
            "type": "Step 1",
            "answer_idx": "A"
        },
        "question": " Which of the following is the most appropriate physician statement?",
        "gpt_extract_mdeical_info": "1. Patient information:\n    1. Age: 58 years old\n    2. Gender: Male\n\n2. Medical history:\n    1. Diagnosis: Chronic obstructive pulmonary disease (COPD)\n    2. Duration of smoking: 35 years\n    3. Smoking history: 1 pack per day\n    4. Previous attempts at smoking cessation: 2 unsuccessful attempts\n\n3. Patient's current health status:\n    1. Smoking status: Still smoking, not ready to quit\n    2. Symptoms reported by patient's wife: None mentioned\n    3. Other relevant medical history: None mentioned",
        "medical_info_list": {
            "Age": "58 years old",
            "Gender": "Male",
            "Diagnosis": "Chronic obstructive pulmonary disease (COPD)",
            "Duration of smoking": "35 years",
            "Smoking history": "1 pack per day",
            "Previous attempts at smoking cessation": "2 unsuccessful attempts",
            "Smoking status": "Still smoking, not ready to quit",
            "Symptoms reported by patient's wife": "None mentioned",
            "Other relevant medical history": "None mentioned"
        },
        "dataset": "SelfExam",
        "id": 45,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've come in for a follow-up examination, but I'm not ready to quit smoking even though my wife says it's affecting her health."
            }
        ]
    },
    {
        "raw_data": {
            "id": 22,
            "question": "A 46-year-old woman comes to the physician because of a 3-day history of intermittent pain with urination and\nincreased urinary frequency. She says that she had one similar episode during the past 6 months. She also has had\nirregular menses, and her last menstrual period occurred 2 months ago. She has not had fever, nausea, vomiting, or\nblood in her urine. She is sexually active with one male partner. Physical examination shows no abnormalities.",
            "options": "(A) Leiomyomata uteri (B) Perimenopause (C) Pregnancy (D) Sexual intercourse",
            "answer": "(D) Sexual intercourse",
            "chatgpt_explaination": "Based on the information provided, it is likely that the patient has a urinary tract infection (UTI). The strongest predisposing risk factor for the development of this condition in this patient is likely to be her sexual activity, as UTIs are commonly caused by bacteria entering the urinary tract through the urethra. Being female also increases the risk of UTIs, as the shorter length of the female urethra makes it easier for bacteria to enter the urinary tract. Therefore, the correct answer is option D, sexual intercourse.",
            "total_id": 12,
            "type": "Step 1",
            "answer_idx": "D"
        },
        "question": "",
        "gpt_extract_mdeical_info": "1. Patient's age: 46.\n2. Patient's gender: female.\n3. Chief complaint: pain with urination and increased urinary frequency.\n4. Duration of symptoms: 3 days.\n5. Similar episode in the past 6 months: yes, one.\n6. Menstrual history: irregular menses, last menstrual period occurred 2 months ago.\n7. Absence of fever, nausea, vomiting, or blood in urine.\n8. Sexual activity: sexually active with one male partner.\n9. Physical examination: no abnormalities found.",
        "medical_info_list": {
            "Patient's age": "46.",
            "Patient's gender": "female.",
            "Chief complaint": "pain with urination and increased urinary frequency.",
            "Duration of symptoms": "3 days.",
            "Similar episode in the past 6 months": "yes, one.",
            "Menstrual history": "irregular menses, last menstrual period occurred 2 months ago.",
            "info_1": "Absence of fever, nausea, vomiting, or blood in urine.",
            "Sexual activity": "sexually active with one male partner.",
            "Physical examination": "no abnormalities found."
        },
        "dataset": "SelfExam",
        "id": 46,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing intermittent pain when I urinate and I've been needing to go more often for the past three days."
            }
        ]
    },
    {
        "raw_data": {
            "id": 46,
            "question": "A 32-year-old woman is brought to the emergency department immediately after being involved in a motor vehicle\ncollision. She was the unrestrained driver. On arrival, she says she has severe pain in her right groin. On\nexamination, any movement of the right hip produces pain. An x-ray of the pelvis shows a completely displaced\nfracture of the femoral neck. In addition to intravenous morphine, which of the following is the most appropriate\nmanagement?",
            "options": "(A) Bed rest (B) Closed reduction followed by traction (C) Hip spica hinge brace (D) Limited weight bearing with use of crutches (E) Operative reduction and internal fixation",
            "answer": "(E) Operative reduction and internal fixation",
            "chatgpt_explaination": "The most appropriate management for a completely displaced fracture of the femoral neck in a 32-year-old woman would be operative reduction and internal fixation. This procedure involves surgically realigning the bones in the hip joint and using screws or pins to hold them in place. This will provide the best chance of a successful recovery and allow the patient to regain full function of their hip. Bed rest, closed reduction and traction, and the use of a hip spica hinge brace are all less effective treatments for this type of fracture. Limited weight bearing with crutches may be recommended after the surgery, but it would not be sufficient as the sole treatment.\n\n\n",
            "total_id": 120,
            "type": "Step 2",
            "answer_idx": "E"
        },
        "question": " In addition to intravenous morphine, which of the following is the most appropriate\nmanagement?",
        "gpt_extract_mdeical_info": "1. Patient's age: 32.\n2. Patient's gender: Female.\n3. Mechanism of injury: Motor vehicle collision.\n4. Patient's restraint use: Unrestrained driver.\n5. Chief complaint: Severe pain in the right groin.\n6. Physical examination finding: Pain with any movement of the right hip.\n7. Imaging result: Completely displaced fracture of the femoral neck seen on X-ray of the pelvis.",
        "medical_info_list": {
            "Patient's age": "32.",
            "Patient's gender": "Female.",
            "Mechanism of injury": "Motor vehicle collision.",
            "Patient's restraint use": "Unrestrained driver.",
            "Chief complaint": "Severe pain in the right groin.",
            "Physical examination finding": "Pain with any movement of the right hip.",
            "Imaging result": "Completely displaced fracture of the femoral neck seen on X-ray of the pelvis."
        },
        "dataset": "SelfExam",
        "id": 47,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have severe pain in my right groin after being in a car accident."
            }
        ]
    },
    {
        "raw_data": {
            "id": 55,
            "question": "A 2-year-old boy is brought to the physician because of failure to thrive. He also has had loose, fatty, foul-smelling stools and a cough during the past 2 weeks. He is at the 30th percentile for height and 10th percentile for weight. Physical examination shows no other abnormalities. Laboratory studies show steatorrhea and a sweat chloride concentration of 80 mmol/L. A chest x-ray shows hyperinflation. Sputum culture grows Haemophilus influenzae and Staphylococcus aureus. Secretion of which of the following substances is most likely to be decreased in this patient?",
            "options": "(A) Bicarbonate (B) Gastric acid (C) Glucagon (D) Insulin (E) Intrinsic factor",
            "answer": "(A) Bicarbonate",
            "chatgpt_explaination": "The most likely answer is (A) bicarbonate. Bicarbonate is a substance that is produced by the pancreas and helps to neutralize stomach acid in the small intestine, where it plays an important role in digestion. In individuals with cystic fibrosis (CF), the thick and sticky mucus that is characteristic of the disorder can obstruct the ducts of the pancreas, leading to a reduction in the secretion of bicarbonate and other digestive enzymes. This can result in steatorrhea, which is the presence of excessive amounts of fat in the stools, as well as malnutrition and failure to thrive.",
            "total_id": 33,
            "type": "Step 1",
            "answer_idx": "A"
        },
        "question": " Secretion of which of the following substances is most likely to be decreased in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 2 years old\n2. Patient's gender: Not specified in the question\n3. Reason for medical visit: Failure to thrive\n4. Symptoms presented:\n    1. Loose, fatty, foul-smelling stools\n    2. Cough\n5. Patient's percentile for height: 30th percentile\n6. Patient's percentile for weight: 10th percentile\n7. Physical examination findings: No other abnormalities\n8. Laboratory study results:\n    1. Steatorrhea\n    2. Sweat chloride concentration of 80 mmol/L\n9. Chest x-ray findings: Hyperinflation\n10. Sputum culture results:\n    1. Haemophilus influenzae\n    2. Staphylococcus aureus",
        "medical_info_list": {
            "Patient's age": "2 years old",
            "Patient's gender": "Not specified in the question",
            "Reason for medical visit": "Failure to thrive",
            "Symptoms presented": "Loose, fatty, foul-smelling stools Cough",
            "Patient's percentile for height": "30th percentile",
            "Patient's percentile for weight": "10th percentile",
            "Physical examination findings": "No other abnormalities",
            "Laboratory study results": "Steatorrhea Sweat chloride concentration of 80 mmol/L",
            "Chest x-ray findings": "Hyperinflation",
            "Sputum culture results": "Haemophilus influenzae Staphylococcus aureus"
        },
        "dataset": "SelfExam",
        "id": 48,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling underweight and have had loose, smelly stools and a cough for the past couple of weeks."
            }
        ]
    },
    {
        "raw_data": {
            "id": 78,
            "question": "A 50-year-old man comes to the office because of a 2-month history of increasing daytime somnolence. He has obstructive sleep apnea for which he has only intermittently used a continuous positive airway pressure device. He is 170 cm (5 ft 7 in) tall and weighs 181 kg (400 lb); BMI is 63 kg/m2. His temperature is 37°C (98.6°F), pulse is 100/min, respirations are 12/min, and blood pressure is 135/80 mm Hg. Physical examination shows a gray-blue tinge to the lips, earlobes, and nail beds. Cardiac examination shows no other abnormalities. Arterial blood gas analysis on room air shows a pH of 7.31, PCO2 of 70 mm Hg, and PO2 of 50 mm Hg. Which of the following additional findings would be most likely in this patient?",
            "options": "(A) Decreased serum bicarbonate concentration (B) Increased hemoglobin concentration (C) Increased total lung capacity (D) Left ventricular hypertrophy",
            "answer": "(B) Increased hemoglobin concentration",
            "chatgpt_explaination": "Based on the information provided, the most likely additional finding in this patient is that they have hypoxemia, or low blood oxygen levels. This is indicated by the low PO2 level in the arterial blood gas analysis, which is typically less than 80 mm Hg in a healthy individual. The patient's obesity and history of obstructive sleep apnea, which can cause difficulty breathing during sleep, may also contribute to their hypoxemia. The gray-blue tinge to their lips, earlobes, and nail beds is a sign of cyanosis, which is often associated with hypoxemia.",
            "total_id": 50,
            "type": "Step 1",
            "answer_idx": "B"
        },
        "question": " Which of the following additional findings would be most likely in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 50 years old.\n2. Patient's gender: Male.\n3. Chief complaint: Increasing daytime somnolence.\n4. Medical history: Obstructive sleep apnea.\n5. Compliance with treatment: Intermittent use of continuous positive airway pressure device.\n6. Patient's height: 170 cm (5 ft 7 in).\n7. Patient's weight: 181 kg (400 lb).\n8. Patient's BMI: 63 kg/m2.\n9. Vital signs:\n     1. Temperature: 37°C (98.6°F).\n     2. Pulse: 100/min.\n     3. Respirations: 12/min.\n     4. Blood pressure: 135/80 mm Hg.\n10. Physical examination findings:\n     1. Gray-blue tinge to the lips, earlobes, and nail beds.\n     2. Cardiac examination normal.\n11. Laboratory studies:\n     1. Arterial blood gas analysis on room air:\n          - pH: 7.31.\n          - PCO2: 70 mm Hg.\n          - PO2: 50 mm Hg.",
        "medical_info_list": {
            "Patient's age": "50 years old.",
            "Patient's gender": "Male.",
            "Chief complaint": "Increasing daytime somnolence.",
            "Medical history": "Obstructive sleep apnea.",
            "Compliance with treatment": "Intermittent use of continuous positive airway pressure device.",
            "Patient's height": "170 cm (5 ft 7 in).",
            "Patient's weight": "181 kg (400 lb).",
            "Patient's BMI": "63 kg/m2.",
            "Temperature": "37°C (98.6°F).",
            "Pulse": "100/min.",
            "Respirations": "12/min.",
            "Blood pressure": "135/80 mm Hg.",
            "Physical examination findings": "Gray-blue tinge to the lips, earlobes, and nail beds. Cardiac examination normal.",
            "Arterial blood gas analysis on room air": "",
            "pH": "7.31.",
            "PCO": "70 mm Hg.",
            "PO": "50 mm Hg."
        },
        "dataset": "SelfExam",
        "id": 49,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling increasingly sleepy during the day for the past two months."
            }
        ]
    },
    {
        "raw_data": {
            "id": 24,
            "question": "A 10-year-old boy is brought to the emergency department in the middle of summer because of fever, headache, and\nphotophobia. Several of his camp mates have had a similar illness. Physical examination shows mild nuchal rigidity.\nA lumbar puncture is performed. Laboratory studies show:",
            "options": "(A) Adenovirus (B) Enterovirus (C) Herpes simplex virus (D) Neisseria meningitidis (E) Streptococcus pneumoniae",
            "answer": "(B) Enterovirus",
            "chatgpt_explaination": "Based on the symptoms and laboratory findings described in the scenario, the most likely cause of the boy's illness is a viral infection. The high percentage of lymphocytes in the cerebrospinal fluid and the presence of mild nuchal rigidity are both consistent with a viral infection. Of the options provided, the adenovirus is the most likely cause of the boy's illness. Adenoviruses can cause a wide range of respiratory, gastrointestinal, and eye infections, and they are a common cause of meningitis. Enteroviruses, herpes simplex viruses, and Streptococcus pneumoniae are all less likely to be the cause of the boy's illness based on the information provided. Neisseria meningitidis is a bacterial infection that can also cause meningitis, but it is typically associated with more severe symptoms and a higher leukocyte count in the cerebrospinal fluid.",
            "total_id": 14,
            "type": "Step 1",
            "answer_idx": "B"
        },
        "question": " Laboratory studies show:",
        "gpt_extract_mdeical_info": "1. Patient's age: 10 years old.\n2. Patient's gender: male.\n3. Reason for hospital visit: fever, headache, and photophobia.\n4. History of exposure: Some of his camp mates have had a similar illness.\n5. Physical examination findings: Mild nuchal rigidity.\n6. Diagnostic procedure performed: Lumbar puncture.",
        "medical_info_list": {
            "Patient's age": "10 years old.",
            "Patient's gender": "male.",
            "Reason for hospital visit": "fever, headache, and photophobia.",
            "History of exposure": "Some of his camp mates have had a similar illness.",
            "Physical examination findings": "Mild nuchal rigidity.",
            "Diagnostic procedure performed": "Lumbar puncture."
        },
        "dataset": "SelfExam",
        "id": 50,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling feverish, have a headache, and am sensitive to light."
            }
        ]
    },
    {
        "raw_data": {
            "id": 14,
            "question": "A 42-year-old man comes to the office as a new patient. Three weeks ago, he was hospitalized for treatment of community-acquired pneumonia and diagnosed with HIV infection. He has no other history of serious illness and takes no medications. Vital signs are within normal limits. Examination shows no abnormalities. CD4+ T-lymphocyte count is 490/mm³, and plasma HIV viral load is 45,000 copies/mL. Results of other laboratory studies are within the reference ranges. Test results for syphilis and hepatitis B and C are negative. The patient agrees to begin antiretroviral therapy. He asks what his long-term prognosis will be. With adherence to the medication regimen, this patient is at greatest risk of death from which of the following?",
            "options": "(A) Cardiovascular disease (B) Chronic kidney disease (C) HIV-related malignancy (D) Non–HIV-related malignancy (E) Opportunistic infection",
            "answer": "(A) Cardiovascular disease",
            "chatgpt_explaination": "It is difficult to predict the long-term prognosis for an individual with HIV infection, as it can vary greatly depending on a number of factors, including the person's age, overall health, and the effectiveness of their antiretroviral therapy. However, with proper treatment and adherence to their medication regimen, this patient's risk of developing AIDS and other serious complications, such as opportunistic infections, may be greatly reduced. It is important for this patient to continue to receive regular medical care and monitoring, and to take their medications as prescribed, in order to maintain their health and reduce their risk of complications. In general, individuals with HIV are at an increased risk of death from opportunistic infections, HIV-related malignancies, and other complications related to the immune system. The correct answer is therefore (E) Opportunistic infection.",
            "total_id": 91,
            "type": "Step 2",
            "answer_idx": "A"
        },
        "question": " With adherence to the medication regimen, this patient is at greatest risk of death from which of the following?",
        "gpt_extract_mdeical_info": "1. Patient information:\n    1. Age: 42\n    2. Gender: Male\n    3. Medical history: None except pneumonia and HIV infection\n    4. Medications: None\n2. Vital signs:\n    1. Within normal limits\n3. Physical examination:\n    1. No abnormalities\n4. Laboratory studies:\n    1. CD4+ T-lymphocyte count: 490/mm³\n    2. HIV viral load: 45,000 copies/mL\n    3. Other test results: Within the reference ranges\n    4. Syphilis test: Negative\n    5. Hepatitis B and C tests: Negative",
        "medical_info_list": {
            "Age": "42",
            "Gender": "Male",
            "Medical history": "None except pneumonia and HIV infection",
            "Medications": "None",
            "Vital signs": "Within normal limits",
            "Physical examination": "No abnormalities",
            "CD+ T-lymphocyte count": "490/mm³",
            "HIV viral load": "45,000 copies/mL",
            "Other test results": "Within the reference ranges",
            "Syphilis test": "Negative",
            "Hepatitis B and C tests": "Negative"
        },
        "dataset": "SelfExam",
        "id": 51,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I recently had pneumonia and just found out I have HIV, and I'm wondering what my long-term prognosis is if I stick to my treatment plan."
            }
        ]
    },
    {
        "raw_data": {
            "id": 94,
            "question": "A 19-year-old man who is in the US Army is brought to the emergency department 45 minutes after he sustained a knife wound to the right side of his chest during an altercation. He has no history of major medical illness and takes no medications. His temperature is 36.9°C (98.4°F), pulse is 110/min, respirations are 24/min, and blood pressure is 114/76 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. On physical examination, the trachea appears to be shifted to the left. Pulmonary examination of the right chest is most likely to show which of the following findings?",
            "options": "(A) Decreased Fremitus, dull Percussion, decreased breath sounds  (B) Decreased Fremitus, hyperresonant Percussion, decreased breath sounds  (C) Decreased Fremitus, hyperresonant Percussion, dull breath sounds  (D) Increased Fremitus, dull Percussion, bronchial breath sounds  (E) Increased Fremitus, dull Percussion, decreased breath sounds ",
            "answer": "(B) Decreased Fremitus, hyperresonant Percussion, decreased breath sounds ",
            "chatgpt_explaination": "Based on the information provided, it is likely that the pulmonary examination of the right chest will show decreased or absent breath sounds and possibly reduced or absent movement of the chest wall. This is because the knife wound to the right side of the chest may have caused a pneumothorax (collapsed lung), which can result in decreased or absent breath sounds on the affected side. Therefore, the correct answer is (A) decreased Fremitus, dull Percussion, decreased breath sounds.",
            "total_id": 61,
            "type": "Step 1",
            "answer_idx": "B"
        },
        "question": " Pulmonary examination of the right chest is most likely to show which of the following findings?",
        "gpt_extract_mdeical_info": "1. Patient's age: 19 years old.\n2. Patient's gender: Male.\n3. Patient's occupation: US Army.\n4. Chief complaint: Knife wound to the right side of chest.\n5. Past medical history: No history of major medical illness.\n6. Current medications: Takes no medications.\n7. Vital signs:\n   1. Temperature: 36.9°C (98.4°F)\n   2. Pulse rate: 110/min\n   3. Respiratory rate: 24/min\n   4. Blood pressure: 114/76 mm Hg\n   5. Oxygen saturation: 94% on room air\n8. Physical examination:\n   1. Trachea appears to be shifted to the left.",
        "medical_info_list": {
            "Patient's age": "19 years old.",
            "Patient's gender": "Male.",
            "Patient's occupation": "US Army.",
            "Chief complaint": "Knife wound to the right side of chest.",
            "Past medical history": "No history of major medical illness.",
            "Current medications": "Takes no medications.",
            "Temperature": "36.9°C (98.4°F)",
            "Pulse rate": "110/min",
            "Respiratory rate": "24/min",
            "Blood pressure": "114/76 mm Hg",
            "Oxygen saturation": "94% on room air",
            "Physical examination": "Trachea appears to be shifted to the left."
        },
        "dataset": "SelfExam",
        "id": 52,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I got stabbed in the right side of my chest during a fight and now I'm having trouble breathing."
            }
        ]
    },
    {
        "raw_data": {
            "id": 41,
            "question": "A 22-year-old primigravid woman at 10 weeks’ gestation comes to the emergency department (ED) because of a 3-\nday history of persistent vomiting. She is treated with intravenous hydration, pyridoxine, and doxylamine. As the\nresident physician prepares the patient for discharge, he asks who will be picking her up from the ED. She says her\nhusband will be arriving soon and asks if the hospital staff can refer to her symptoms as a “stomach flu.” She does\nnot want anyone to mention to her husband that she is pregnant because the pregnancy resulted from an oral\ncontraceptive failure and “he is not expecting this.” Which of the following is the most appropriate next question to\nask this patient?",
            "options": "(A) “Are finances tight at home?” (B) “How do you think he will react?” (C) “Is there somebody else who can pick you up?” (D) “Was there a problem with your birth control?” (E) “Will he try to force you to do something you aren’t comfortable with?”",
            "answer": "(B) “How do you think he will react?”",
            "chatgpt_explaination": "The most appropriate next question to ask this patient is: \"Is there somebody else who can pick you up?\" (Option C). The resident physician should ensure that the patient has a safe way to get home after being discharged from the ED. This is particularly important in this case because the patient may not want her husband to know about her pregnancy. Asking about the patient's finances or her husband's potential reaction to the news of her pregnancy is not directly relevant to her care at this time. Additionally, it is not appropriate for the physician to ask about any potential problems with the patient's birth control or whether her husband may try to force her to do something she is not comfortable with. These questions could be intrusive and could make the patient uncomfortable.",
            "total_id": 115,
            "type": "Step 2",
            "answer_idx": "B"
        },
        "question": "” Which of the following is the most appropriate next question to\nask this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 22-year-old\n2. Patient's gender: female\n3. Patient's obstetric history: primigravid (first pregnancy)\n4. Gestational age: 10 weeks\n5. Presenting complaint: persistent vomiting for 3 days\n6. Treatment: intravenous hydration, pyridoxine, and doxylamine\n7. Concerns regarding disclosure: patient does not want her husband to know she is pregnant as it resulted from an oral contraceptive failure and \"he is not expecting this\"",
        "medical_info_list": {
            "Patient's age": "22-year-old",
            "Patient's gender": "female",
            "Patient's obstetric history": "primigravid (first pregnancy)",
            "Gestational age": "10 weeks",
            "Presenting complaint": "persistent vomiting for 3 days",
            "Treatment": "intravenous hydration, pyridoxine, and doxylamine",
            "Concerns regarding disclosure": "patient does not want her husband to know she is pregnant as it resulted from an oral contraceptive failure and \"he is not expecting this\""
        },
        "dataset": "SelfExam",
        "id": 53,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling really sick with constant vomiting for the past three days."
            }
        ]
    },
    {
        "raw_data": {
            "id": 115,
            "question": "A 15-year-old boy is brought to the office by his parents to discuss results of a biopsy done 3 days ago for a rapidly enlarging neck mass. He first noted the mass 1 month ago. Two weeks ago, he was evaluated for an episode of prolonged epistaxis and was found to have a right ear effusion, which was treated with amoxicillin-clavulanic acid.  He has no other history of serious illness and takes no medications. Height is at the 10th percentile, weight is at the 50th percentile, and BMI is at the 75th percentile. Vital signs are within normal limits. Physical examination shows a right ear effusion and a 4-cm, firm mass in the right posterior triangle of the neck. Results of a biopsy specimen show squamous epithelium with indistinct cell margins, enlarged atypical nuclei, and absent keratin formation. Which of the following infectious agents is the most likely underlying cause of this patient's current condition?",
            "options": "(A) Cytomegalovirus (B) Epstein-Barr virus (C) HIV (D) Human herpesvirus 8",
            "answer": "(B) Epstein-Barr virus",
            "chatgpt_explaination": "It is difficult to determine the most likely underlying cause of the patient's condition without more information. A biopsy of the mass can provide more specific information about the type of cells present and potentially indicate a specific cause. Infectious agents can cause neck masses, but without further information, it is not possible to determine which specific infectious agent may be responsible in this case. It is important for the patient to undergo further testing and evaluation by a medical professional in order to determine the appropriate treatment.",
            "total_id": 77,
            "type": "Step 1",
            "answer_idx": "B"
        },
        "question": " Which of the following infectious agents is the most likely underlying cause of this patient's current condition?",
        "gpt_extract_mdeical_info": "1. Age: 15.\n2. Gender: Male.\n3. Chief complaint: Rapidly enlarging neck mass.\n4. Duration of neck mass: Noted 1 month ago.\n5. Past medical history: No history of serious illness.\n6. Medications: Doesn't take any medications.\n7. Height: 10th percentile.\n8. Weight: 50th percentile.\n9. BMI: 75th percentile.\n10. Vital signs: Within normal limits.\n11. Physical examination findings: Right ear effusion and 4-cm firm mass in the right posterior triangle of the neck.\n12. Laboratory studies: Not mentioned.\n13. Biopsy results: Squamous epithelium with indistinct cell margins, enlarged atypical nuclei, and absent keratin formation.",
        "medical_info_list": {
            "Age": "15.",
            "Gender": "Male.",
            "Chief complaint": "Rapidly enlarging neck mass.",
            "Duration of neck mass": "Noted 1 month ago.",
            "Past medical history": "No history of serious illness.",
            "Medications": "Doesn't take any medications.",
            "Height": "10th percentile.",
            "Weight": "50th percentile.",
            "BMI": "75th percentile.",
            "Vital signs": "Within normal limits.",
            "Physical examination findings": "Right ear effusion and 4-cm firm mass in the right posterior triangle of the neck.",
            "Laboratory studies": "Not mentioned.",
            "Biopsy results": "Squamous epithelium with indistinct cell margins, enlarged atypical nuclei, and absent keratin formation."
        },
        "dataset": "SelfExam",
        "id": 54,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came in because of a rapidly enlarging neck mass that I first noticed a month ago."
            }
        ]
    },
    {
        "raw_data": {
            "id": 38,
            "question": "A 65-year-old man is admitted to the hospital because of a 12-hour history of chest pain. Physical examination shows\nno abnormalities. Serum studies show an increased troponin I concentration. The diagnosis of myocardial infarction\nis made. It is suspected that this patient's condition deteriorated as a result of ischemia-reperfusion injury. The\nincreased serum troponin I concentration in this patient most likely occurred as a result of which of the following\nprocesses?",
            "options": "(A) Increased enzyme secretion (B) Increased enzyme synthesis (C) Karyolysis (D) Lysis of the endoplasmic reticulum (E) Lysis of the plasma membrane (F) Mitochondrial swelling",
            "answer": "(E) Lysis of the plasma membrane",
            "chatgpt_explaination": "The increased serum troponin I concentration in this patient most likely occurred as a result of lysis of the plasma membrane. When the heart muscle is damaged, such as during a heart attack, the cells of the heart can undergo lysis, or destruction. This can cause the release of troponin and other proteins into the bloodstream, leading to an increased concentration of these proteins in the blood. Lysis of the plasma membrane, which is the outermost membrane surrounding a cell, is one possible mechanism for this release of proteins.",
            "total_id": 22,
            "type": "Step 1",
            "answer_idx": "E"
        },
        "question": " The\nincreased serum troponin I concentration in this patient most likely occurred as a result of which of the following\nprocesses?",
        "gpt_extract_mdeical_info": "1. Patient's age: 65 years old.\n2. Patient's gender: Male.\n3. Reason for admission to hospital: 12-hour history of chest pain.\n4. Physical examination: No abnormalities found.\n5. Serum study results: Increased troponin I concentration.\n6. Diagnosis: Myocardial infarction.\n7. Suspected cause of deterioration: Ischemia-reperfusion injury.",
        "medical_info_list": {
            "Patient's age": "65 years old.",
            "Patient's gender": "Male.",
            "Reason for admission to hospital": "12-hour history of chest pain.",
            "Physical examination": "No abnormalities found.",
            "Serum study results": "Increased troponin I concentration.",
            "Diagnosis": "Myocardial infarction.",
            "Suspected cause of deterioration": "Ischemia-reperfusion injury."
        },
        "dataset": "SelfExam",
        "id": 55,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing chest pain for the past 12 hours."
            }
        ]
    },
    {
        "raw_data": {
            "id": 35,
            "question": "A 25-year-old woman comes to the physician because of a long history of pain with menses. The pain occurs on the\nfirst day of her 5-day menstrual period and lasts all day. She rates the pain as 10 on a 10-point scale. The most\nappropriate initial pharmacotherapy to relieve this patient's pain has which of the following mechanisms of action?",
            "options": "(A) Inhibition of estrogen synthesis (B) Inhibition of 11β-hydroxylase activity (C) Inhibition of prostaglandin synthesis (D) Stimulation of follicle-stimulating hormone synthesis (E) Stimulation of luteinizing hormone synthesis",
            "answer": "(C) Inhibition of prostaglandin synthesis",
            "chatgpt_explaination": "The most appropriate initial pharmacotherapy to relieve this patient's pain would have a mechanism of action that involves the inhibition of prostaglandin synthesis. Prostaglandins are chemicals involved in the inflammatory response and are thought to be a primary cause of menstrual pain. By reducing the production of prostaglandins, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help to alleviate the pain and discomfort associated with menstruation. Therefore, the correct answer is (C) Inhibition of prostaglandin synthesis.",
            "total_id": 21,
            "type": "Step 1",
            "answer_idx": "C"
        },
        "question": " The most\nappropriate initial pharmacotherapy to relieve this patient's pain has which of the following mechanisms of action?",
        "gpt_extract_mdeical_info": "1. Patient's age: 25 years old.\n2. Patient's gender: Female.\n3. Symptom: Pain with menses.\n4. Timing of pain: Occurs on the first day of her 5-day menstrual period and lasts all day.\n5. Pain rating: 10 on a 10-point scale.",
        "medical_info_list": {
            "Patient's age": "25 years old.",
            "Patient's gender": "Female.",
            "Symptom": "Pain with menses.",
            "Timing of pain": "Occurs on the first day of her 5-day menstrual period and lasts all day.",
            "Pain rating": "10 on a 10-point scale."
        },
        "dataset": "SelfExam",
        "id": 56,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have been experiencing severe pain during the first day of my menstrual period."
            }
        ]
    },
    {
        "raw_data": {
            "id": 67,
            "question": "A 12-year-old boy is brought to the office by his parents for genetic counseling because of a family history of genetic disorders. He has no symptoms or history of major medical illness. The patient’s maternal grandfather died of Huntington disease at the age of 35 years. Genetic testing of the mother showed 19 triplet repeats on each huntingtin (HTT) allele (N=10–20). The patient’s paternal grandfather had colon cancer at the age of 30 years, and the father had numerous colon polyps at the age of 20 years treated with a colectomy. Genetic testing of the father shows heterozygosity for a frame-shift mutation in the APC gene. Physical examination of the patient shows abnormalities. Based on this patient’s risk for genetic disease, it is most appropriate for the physician to order which of the following genetic tests at this time?",
            "options": "(A) Analysis of triplet repeat sizes of HTT (B) Full sequencing and rearrangement analysis of APC (C) Full sequencing of HTT (D) Specific testing for the APC frame-shift mutation (E) It is not recommended to do predictive genetic testing on a minor",
            "answer": "(D) Specific testing for the APC frame-shift mutation",
            "chatgpt_explaination": "The most appropriate genetic test in this case would be (A) analysis of triplet repeat sizes of HTT. As mentioned in the previous answers, the patient's family history puts them at an increased risk for Huntington disease, which is caused by a mutation in the HTT gene that results in an expanded number of CAG trinucleotide repeats. The severity of the disease is directly related to the number of repeats, and the patient's mother has 19 triplet repeats on each HTT allele, which puts the patient at an increased risk for Huntington disease. Genetic testing can determine the number of repeats in the patient's HTT gene and help guide appropriate medical management. It is important for the patient to undergo genetic counseling to understand their risks and the potential implications of the test results.",
            "total_id": 42,
            "type": "Step 1",
            "answer_idx": "D"
        },
        "question": " Based on this patient’s risk for genetic disease, it is most appropriate for the physician to order which of the following genetic tests at this time?",
        "gpt_extract_mdeical_info": "1. Patient's age: 12 years old.\n2. Patient's gender: Male.\n3. Reason for visit: Genetic counseling.\n4. Family history:\n   - Maternal grandfather died at age 35 of Huntington disease.\n   - Paternal grandfather had colon cancer at age 30.\n   - Father had numerous colon polyps at age 20, treated with colectomy.\n   - Mother tested positive for 19 triplet repeats on each huntingtin allele.\n   - Father is heterozygous for a frame-shift mutation in the APC gene.\n5. Patient's medical history:\n   - No major medical illness.\n6. Physical examination:\n   - Abnormalities present (not specified).",
        "medical_info_list": {
            "Patient's age": "12 years old.",
            "Patient's gender": "Male.",
            "Reason for visit": "Genetic counseling.",
            "Family history": "Maternal grandfather died at age 35 of Huntington disease. Paternal grandfather had colon cancer at age 30. Father had numerous colon polyps at age 20, treated with colectomy. Mother tested positive for 19 triplet repeats on each huntingtin allele. Father is heterozygous for a frame-shift mutation in the APC gene.",
            "Patient's medical history": "No major medical illness.",
            "Physical examination": "Abnormalities present (not specified)."
        },
        "dataset": "SelfExam",
        "id": 57,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm here for genetic counseling because of my family's history of genetic disorders."
            }
        ]
    },
    {
        "raw_data": {
            "id": 6,
            "question": "A previously healthy 33-year-old woman is brought to the emergency department by the Secret Service for stalking\nthe president of the USA for 2 months. She claims to be married to the president's twin brother and states that the\npresident just had his twin kidnapped to avoid competition. She speaks rapidly and is difficult to interrupt. Her\nassociations are often loose. She says, \"I haven't slept for days, but I won't even try to sleep until my husband is\nrescued. God has been instructing me to take over the White House. I can't wait to be reunited with my husband. I hear his voice telling me what to do.\" When asked about drug use, she says she uses only natural substances. She\nrefuses to permit blood or urine tests, saying, \"I don't have time to wait for the results.\" Which of the following is the\nmost likely diagnosis?",
            "options": "(A) Bipolar disorder, manic, with psychotic features (B) Brief psychotic disorder (C) Delusional disorder (D) Psychotic disorder due to general medical condition (E) Schizophrenia",
            "answer": "(A) Bipolar disorder, manic, with psychotic features",
            "chatgpt_explaination": "The most likely diagnosis for this patient is (A) Bipolar disorder, manic, with psychotic features. This disorder is characterized by episodes of mania or hypomania, during which a person may have exaggerated feelings of well-being, racing thoughts, and unusual behaviors, as well as episodes of depression. In this case, the patient's rapid speech, loose associations, and belief in a fictional relationship with the president's brother suggest that she is experiencing a manic episode with psychotic features. Additionally, her refusal to undergo blood or urine tests suggests that she may be resistant to treatment.",
            "total_id": 3,
            "type": "Step 1",
            "answer_idx": "A"
        },
        "question": "\" Which of the following is the\nmost likely diagnosis?",
        "gpt_extract_mdeical_info": "1. Patient's age: 33 years old\n2. Patient's gender: female\n3. Reason for coming to the emergency department: brought in by the Secret Service for stalking the president of USA\n4. Duration of stalking behavior: 2 months\n5. Patient's belief about being married to the president's twin brother: claims to be married to the president's twin brother\n6. Patient's belief about the president's twin being kidnapped to avoid competition: believes that the president just had his twin kidnapped to avoid competition\n7. Patient's speech pattern: speaks rapidly and is difficult to interrupt\n8. Patient's thought organization: her associations are often loose\n9. Patient's sleep pattern: reports not sleeping for days and refusing to sleep until her husband is rescued\n10. Patient's belief about God instructing her to take over the White House: believes that God has been instructing her to take over the White House\n11. Patient's belief about hearing her husband's voice telling her what to do: hears her husband's voice telling her what to do\n12. Patient's history of drug use: reports using only natural substances\n13. Patient's refusal to take blood or urine tests: refuses to permit blood or urine tests, saying she doesn't have time to wait for the results.",
        "medical_info_list": {
            "Patient's age": "33 years old",
            "Patient's gender": "female",
            "Reason for coming to the emergency department": "brought in by the Secret Service for stalking the president of USA",
            "Duration of stalking behavior": "2 months",
            "Patient's belief about being married to the president's twin brother": "claims to be married to the president's twin brother",
            "Patient's belief about the president's twin being kidnapped to avoid competition": "believes that the president just had his twin kidnapped to avoid competition",
            "Patient's speech pattern": "speaks rapidly and is difficult to interrupt",
            "Patient's thought organization": "her associations are often loose",
            "Patient's sleep pattern": "reports not sleeping for days and refusing to sleep until her husband is rescued",
            "Patient's belief about God instructing her to take over the White House": "believes that God has been instructing her to take over the White House",
            "Patient's belief about hearing her husband's voice telling her what to do": "hears her husband's voice telling her what to do",
            "Patient's history of drug use": "reports using only natural substances",
            "Patient's refusal to take blood or urine tests": "refuses to permit blood or urine tests, saying she doesn't have time to wait for the results."
        },
        "dataset": "SelfExam",
        "id": 58,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I feel compelled to stay awake and take action because I believe my husband has been kidnapped and I'm receiving instructions from God to take over the White House."
            }
        ]
    },
    {
        "raw_data": {
            "id": 22,
            "question": "A 62-year-old woman with myasthenia gravis comes to the office because of a 2-week history of falling. She says\nher legs \"give out\" once daily; she falls to the ground but does not hit her head. She took pyridostigmine until\n2 weeks ago when she decided that it no longer worked. Respirations are 30/min. Examination shows a hypophonic\nnasal voice and ptosis bilaterally. Muscle strength is 2/5 in all extremities. The patient is told that she is in imminent\ndanger of respiratory compromise and that she should be admitted to the hospital. She says she knows her breathing\ncould pose a problem, but she hates hospitals and does not want to undergo more tests or therapy. She asks if she\ncan have a prescription for her former medication and if she can go home. Which of the following is the most\nappropriate next step in management?",
            "options": "(A) Assessment of medical decision-making capacity (B) Electromyography and nerve conduction studies (C) Involuntary hospital admission (D) Oxygen therapy by nasal canula (E) Pulmonary function testing",
            "answer": "(A) Assessment of medical decision-making capacity",
            "chatgpt_explaination": "The most appropriate next step in the management of this patient would be an assessment of her medical decision-making capacity. Myasthenia gravis is a autoimmune disorder that affects the ability of the muscles to respond to nerve impulses, causing weakness and rapid fatigue. In severe cases, the weakness can affect the muscles involved in breathing, putting the patient at risk of respiratory compromise. In this case, the patient's symptoms suggest that she is at risk of respiratory failure and should be admitted to the hospital for further evaluation and treatment. However, the patient has expressed her reluctance to undergo further testing and treatment, and it is important to determine whether she has the capacity to make decisions about her own care. If she does not have the capacity to make decisions about her own care, involuntary hospital admission may be necessary to protect her from harm.",
            "total_id": 99,
            "type": "Step 2",
            "answer_idx": "A"
        },
        "question": " Which of the following is the most\nappropriate next step in management?",
        "gpt_extract_mdeical_info": "1. Demographics:\n    1. Age: 62 years old.\n    2. Gender: Female.\n\n2. Medical history:\n    1. Myasthenia gravis.\n    2. Was taking pyridostigmine until 2 weeks ago.\n\n3. Presenting complaint:\n    1. Falling for the last 2 weeks.\n    2. Legs \"give out\" once daily.\n    3. No head injury from falls.\n\n4. Respiratory status:\n    1. Respirations are 30/min.\n    2. Imminent danger of respiratory compromise.\n\n5. Physical examination:\n    1. Hypophonic nasal voice.\n    2. Bilateral ptosis.\n    3. Muscle strength is 2/5 in all extremities.\n\n6. Treatment:\n    1. Patient was advised to be admitted to the hospital.\n    2. Patient refused further tests or therapy.\n    3. Patient requested a prescription for her former medication (pyridostigmine).",
        "medical_info_list": {
            "Age": "62 years old.",
            "Gender": "Female.",
            "Medical history": "Myasthenia gravis. Was taking pyridostigmine until 2 weeks ago.",
            "Presenting complaint": "Falling for the last 2 weeks. Legs \"give out\" once daily. No head injury from falls.",
            "Respiratory status": "Respirations are 30/min. Imminent danger of respiratory compromise.",
            "Physical examination": "Hypophonic nasal voice. Bilateral ptosis. Muscle strength is 2/5 in all extremities.",
            "Treatment": "Patient was advised to be admitted to the hospital. Patient refused further tests or therapy. Patient requested a prescription for her former medication (pyridostigmine)."
        },
        "dataset": "SelfExam",
        "id": 59,
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing falls daily because my legs just \"give out.\""
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 32-year-old man comes to the physician because he has had difficulty focusing on tasks at work and at home during the past 2 months. He works as an automobile mechanic. He has had a lot of energy for work but often is distracted to the point that he does not complete assigned tasks. He frequently stops working on his own tasks to attempt to develop greater efficiency in his shop. He states that he is delighted with his newfound energy and reports that he now needs only 4 hours of sleep nightly. He has no history of psychiatric illness. He always performed well in school. He has a history of drinking alcohol excessively and using methamphetamines and cocaine during his 20s, but he has not consumed alcohol or used illicit drugs for the past 3 years. His temperature is 37°C (98.6°F), pulse is 60/min, and blood pressure is 125/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he describes his mood as \"good.\" He has a labile affect. His speech is rapid in rate but normal in rhythm, and his thought process is organized. Short- and long-term memory are intact. Attention and concentration are fair; he makes no errors when performing serial sevens, and he can repeat seven digits forward and five in reverse sequence. He has had no delusions or hallucinations. Which of the following is the most likely diagnosis?",
            "answer": "Bipolar disorder",
            "options": {
                "A": "Antisocial personality disorder",
                "B": "Attention-deficit/hyperactivity disorder",
                "C": "Bipolar disorder",
                "D": "Borderline personality disorder"
            },
            "answer_idx": "C"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 60,
        "history": [
            {
                "patient": "I've been having trouble focusing on my tasks at work and at home, and despite having a lot of energy and needing only a few hours of sleep, I often get distracted and don't complete what I'm supposed to do.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 40-year-old female secretary comes to the office because of a 2-month history of fatigue, and generalized aching and weakness of the proximal muscles of all four extremities. The patient initially noticed the weakness only while she was getting in and out of her car, but during the past 2 weeks, the weakness has progressed, so that she now has difficulty combing her hair. Since the symptoms began, she also has had aching of the joints in her hands that has responded partially to ibuprofen. She was adopted and family history is unknown. She has two teenaged children who are well. She appears uncomfortable. She is 170 cm (5 ft 7 in) tall and weighs 68 kg(150 lb); BMI is 24 kg/m2 . Vital signs are temperature 37.7°C (99.8°F), pulse 90/min, respirations 20/min, and blood pressure 110/70 mm Hg. The patient is alert and fully oriented. Physical examination discloses cracking of the skin of both hands that involves the tips and lateral sides of several fingers. The muscles of the upper arms and legs are somewhat tender to pressure. Results of serum laboratory studies show a creatine kinase concentration of 600 U/L and a lactate dehydrogenase concentration of 800 U/L. Results of complete blood count are within the reference ranges. Which of the following is the most likely diagnosis?",
            "answer": "Polymyositis",
            "options": {
                "A": "Fibromyalgia",
                "B": "Myasthenia gravis",
                "C": "Polymyositis",
                "D": "Scleroderma"
            },
            "answer_idx": "C"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 61,
        "history": [
            {
                "patient": "I've been feeling fatigued with generalized aching and weakness in my muscles, especially when getting in and out of my car and now even when combing my hair.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 52-year-old woman comes to the emergency department because of a 1-week history of low-grade fever and increasing abdominal cramps that are exacerbated by bowel movements. She began a course of amoxicillin-clavulanate and metronidazole 2 days ago but has had no relief of her symptoms. She has had intermittent constipation for the past 12 years. She has not had nausea, vomiting, urinary symptoms, or bloody stools. She has a 3-year history of hypertension. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy 5 years ago because of leiomyomata uteri. She is 165 cm (5 ft 5 in) tall and weighs 86 kg (190 lb); BMI is 32 kg/m2 . Her temperature is 38.1°C (100.6°F), pulse is 75/min, and blood pressure is 150/80 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft, and there is tenderness to palpation of the left lower quadrant with guarding but no rebound. Bowel sounds are normal. The stool is brown, and test for occult blood is negative. Her hemoglobin concentration is 14.5 g/dL, leukocyte count is 15,000/mm3 , and platelet count is 280,000/mm3 ; serum studies and urinalysis show no abnormalities. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "CT scan of the abdomen with contrast",
            "options": {
                "A": "Test of the stool for Clostridium difficile toxin",
                "B": "Endoscopic retrograde cholangiopancreatography",
                "C": "Pelvic ultrasonography",
                "D": "CT scan of the abdomen with contrast"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 62,
        "history": [
            {
                "patient": "I've been experiencing low-grade fever and increasing abdominal cramps that get worse when I have bowel movements for the past week.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 5-year-old girl is brought to the physician by her parents for evaluation of recurrent injuries. Her parents say that she started walking at the age of 14 months and since then has always seemed clumsier and had more injuries than other children. She has had increasingly frequent chest pain with exertion since starting a soccer program 3 months ago. She usually has pain or swelling of her knees or ankles after practice. She has been wearing glasses for 2 years. Her 16-year-old brother has required two operations for a severe rotator cuff injury he sustained while taking a shower, and she has a maternal cousin who died of a ruptured aortic aneurysm at the age of 26 years. Today, the patient walks with a limp. She is at the 99th percentile for height and 50th percentile for weight. A midsystolic click is heard at the apex. The left ankle is swollen and tender; range of motion is limited by pain. The joints of the upper and lower extremities are hypermobile, including 25 degrees of genu recurvatum, thumbs that may be extended to touch the forearms, and flexibility at the waist, with palms easily touching the floor with straight knees. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "Echocardiography",
            "options": {
                "A": "Skeletal survey",
                "B": "Echocardiography",
                "C": "Bone scan",
                "D": "MRI of the shoulder"
            },
            "answer_idx": "B"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 63,
        "history": [
            {
                "patient": "I keep getting injured more often than other kids, and I've been having chest pain when I play soccer.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 44-year-old woman with a 10-year history of arthritis comes to the office because she has had increasing pain and stiffness in her hands, wrists, and knees during the past several months. She also has had increasing fatigue for the past month, along with a weight loss of 1.8 to 2.2 kg (4 to 5 lb). She has seen numerous physicians for her arthritis in the past and has tried various medications and devices, including copper bracelets from Mexico given to her by friends. Review of her medical records confirms that the initial diagnosis of rheumatoid arthritis is correct. She says, \"I had several drop attacks during the past 3 months.\" She characterizes these attacks as episodes of weakness and loss of feeling in her legs for several minutes. During one of these episodes, she became incontinent. She currently takes aspirin approximately four times daily and ibuprofen occasionally. Physical examination shows facial plethora and swollen and painful metacarpophalangeal and knee joints, bilaterally. There is moderate ulnar deviation of the fingers. The remainder of the examination discloses no abnormalities. Which of the following is the most likely cause of her \"drop attacks?\"",
            "answer": "Atlanto-axial instability",
            "options": {
                "A": "Adrenal insufficiency",
                "B": "Anxiety",
                "C": "Atlanto-axial instability",
                "D": "Cardiac arrhythmia"
            },
            "answer_idx": "C"
        },
        "question": " Which of the following is the most likely cause of her \"drop attacks?\"",
        "dataset": "MMLU",
        "id": 64,
        "history": [
            {
                "patient": "I've been experiencing increasing pain and stiffness in my hands, wrists, and knees, along with episodes of weakness and loss of feeling in my legs that have led to sudden falls.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A male neonate, who was born at 36 weeks' gestation 2 hours ago in the labor and delivery unit of the hospital, now shows signs of respiratory difficulty. The mother, an 18-year-old primigravid woman, smoked one pack of cigarettes daily throughout her pregnancy. She received prenatal care during most of the pregnancy. One episode of chlamydial cervicitis was detected during the last trimester and treated with azithromycin. The neonate was born via cesarean delivery due to fetal heart rate decelerations. The amniotic fluid was stained with light particulate meconium. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. The patient is 50 cm (20 in; 50th percentile) long and weighs 3005 g (6 lb 10 oz; 50th percentile); head circumference is 35 cm (14 in; 50th percentile). The infant's vital signs now are temperature 36.6°C (97.8°F), pulse 150/min, and respirations 70/min. Pulse oximetry on room air shows an oxygen saturation of 95%. Physical examination discloses mild subcostal and intercostal retractions. Chest x-ray shows prominent pulmonary vascular markings and fluid in the intralobar fissures. Which of the following is the most likely diagnosis?",
            "answer": "Transient tachypnea of newborn",
            "options": {
                "A": "Group B streptococcal sepsis",
                "B": "Meconium aspiration syndrome",
                "C": "Respiratory distress syndrome",
                "D": "Transient tachypnea of newborn"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 65,
        "history": [
            {
                "patient": "I'm a newborn baby and I'm having trouble breathing.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 9-year-old boy is brought to the physician because of progressive weakness and a purple-red discoloration over his cheeks and upper eyelids over the past 8 weeks. His symptoms began shortly after a camping trip, and he now is unable to climb stairs, walk long distances, comb his hair, or dress himself. His mother says that she was careful to apply his sunscreen on the trip and can recall no tick bites or exposure to poisonous plants. His only medication is a topical corticosteroid for several dry, scaly patches of the skin. He appears weak and lethargic. He is at the 75th percentile for height and 25th percentile for weight; he has had no change in his weight since his last examination 9 months ago. His temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min. Examination of the skin shows a purple-red discoloration over the cheeks and eyelids, periorbital edema, erythematous plaques and scales over the elbows and knees, and flat-topped red papules over all knuckles. There is generalized weakness and atrophy of the proximal muscles. Which of the following is the most likely diagnosis?",
            "answer": "Dermatomyositis",
            "options": {
                "A": "Dermatomyositis",
                "B": "Duchenne's muscular dystrophy",
                "C": "Eczema",
                "D": "Lyme disease"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 66,
        "history": [
            {
                "patient": "I've been feeling increasingly weak and have noticed a purple-red discoloration on my cheeks and upper eyelids for the past couple of months.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 42-year-old woman comes to the physician because of a 1-year history of vaginal bleeding for 2 to 5 days every 2 weeks. The flow varies from light to heavy with passage of clots. Menses previously occurred at regular 25- to 29-day intervals and lasted for 5 days with normal flow. She has no history of serious illness and takes no medications. She is sexually active with one male partner, and they use condoms inconsistently. Her mother died of colon cancer, and her maternal grandmother died of breast cancer. She is 163 cm (5 ft 4 in) tall and weighs 77 kg (170 lb); BMI is 29 kg/m2 . Her temperature is 36.6°C (97.8°F), pulse is 90/min, respirations are 12/min, and blood pressure is 100/60 mm Hg. The uterus is normal sized. The ovaries cannot be palpated. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is negative. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "Endometrial biopsy",
            "options": {
                "A": "Progesterone challenge test",
                "B": "Colposcopy",
                "C": "Cystoscopy",
                "D": "Endometrial biopsy"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 67,
        "history": [
            {
                "patient": "I've been experiencing vaginal bleeding every two weeks for the past year, and the flow varies from light to heavy with clots.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 37-year-old Anglo-American man is admitted to the hospital for treatment for cocaine dependency. He says he has tried repeatedly to abstain from cocaine use but lives in a part of town where there are heavy drug sales. He did not like his hospital outpatient group but liked his single session at Cocaine Anonymous. Vital signs are temperature 37.0°C (98.6°F), pulse 70/min, respirations 16/min, and blood pressure 125/85 mm Hg. Physical examination shows a thin man with good muscle strength and no focal neurologic deficits. The patient is using insurance coverage through his wife but does not wish for his diagnosis to be disclosed to anyone. He is on probation after a conviction for aggravated robbery 3 years ago. There is also a warrant for his arrest for assault and battery. After listening to his requests and weighing your obligations, you should disclose this patient's diagnosis only to which of the following?",
            "answer": "Insurance company",
            "options": {
                "A": "His Cocaine Anonymous sponsor",
                "B": "His probation officer",
                "C": "His wife",
                "D": "Insurance company"
            },
            "answer_idx": "D"
        },
        "question": " After listening to his requests and weighing your obligations, you should disclose this patient's diagnosis only to which of the following?",
        "dataset": "MMLU",
        "id": 68,
        "history": [
            {
                "patient": "I keep trying to stop using cocaine but I can't, and I'm surrounded by it where I live.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A previously healthy 22-year-old college student is brought to the emergency department by her parents 20 minutes after they observed her having a seizure. After the seizure, she was confused and had difficulty thinking of some words. She has had a headache, cough, and fever for 3 days treated with acetaminophen and dextromethorphan. Her temperature is 38.9°C (102°F). Neurologic examination shows diffuse hyperreflexia. On mental status examination, she is confused and has short-term memory deficits. She has difficulty naming objects and makes literal paraphasic errors. An MRI of the brain shows bitemporal hyperintensities. A lumbar puncture is done; cerebrospinal fluid analysis shows an erythrocyte count of 340/mm3 , a leukocyte count of 121/mm3 (88% monocytes), and a protein concentration of 78 mg/dL. Which of the following is the most likely diagnosis?",
            "answer": "Herpes simplex encephalitis",
            "options": {
                "A": "Bacterial meningitis",
                "B": "Dextromethorphan intoxication",
                "C": "Herpes simplex encephalitis",
                "D": "HIV encephalopathy"
            },
            "answer_idx": "C"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 69,
        "history": [
            {
                "patient": "I've been experiencing a headache, cough, and fever for the past three days, and I just had a seizure.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 57-year-old man comes to the emergency department because of cramping in his hands and feet and numbness and tingling around his lips and in his fingers; these symptoms occurred intermittently for 6 months but have been progressively severe during the past 2 weeks. He also has had a 13-kg (30-lb) weight loss and bulky, foul-smelling stools that do not flush easily. He has a 10-year history of drinking 8 to 10 beers daily. He has been hospitalized twice for severe abdominal pain 4 and 6 years ago. His pulse is 80/min, and blood pressure is 105/65 mm Hg. He appears cachectic and chronically ill. The abdomen is nontender. Deep tendon reflexes are 4+ bilaterally. Chvostek and Trousseau signs are present. His serum calcium concentration is 6.5 mg/dL. Which of the following is the most likely diagnosis?",
            "answer": "Vitamin D deficiency",
            "options": {
                "A": "Hypomagnesemia",
                "B": "Hypoparathyroidism",
                "C": "Osteomalacia",
                "D": "Vitamin D deficiency"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 70,
        "history": [
            {
                "patient": "I've been experiencing cramping in my hands and feet, along with numbness and tingling around my lips and fingers, and these symptoms have been getting worse over the past two weeks.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 52-year-old man comes to the physician with his wife because of a 1-year history of excessive daytime sleepiness. He does not think the symptoms are problematic, but his wife is concerned because he sometimes falls asleep on the sofa early in the evening when guests are present. He also once fell asleep while driving at night and drove off the road, narrowly avoiding injury. His wife says that he has always snored loudly, and over the past year, he has had episodes of choking or gasping for breath while sleeping. He is 178 cm (5 ft 10 in) tall and weighs 105 kg (231 lb); BMI is 33 kg/m2 . His pulse is 76/min, respirations are 14/min, and blood pressure is 150/76 mm Hg. Physical and neurologic examinations show no other abnormalities. Which of the following is most likely to confirm the diagnosis?",
            "answer": "Polysomnography",
            "options": {
                "A": "24-Hour ambulatory ECG monitoring",
                "B": "Multiple sleep latency test",
                "C": "Polysomnography",
                "D": "CT scan of the head"
            },
            "answer_idx": "C"
        },
        "question": " Which of the following is most likely to confirm the diagnosis?",
        "dataset": "MMLU",
        "id": 71,
        "history": [
            {
                "patient": "I've been experiencing excessive daytime sleepiness for the past year, and I've even fallen asleep while driving at night.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A previously healthy 17-year-old girl comes to the physician because of a 2-month history of exercise-induced cough and nasal congestion. She plays field hockey and has noticed she coughs when running up and down the field. The cough is nonproductive and resolves with rest. She has not had chest pain or palpitations. She takes no medications and does not smoke. Her sister has asthma. The patient appears well. Her pulse is 68/min, respirations are 16/min, and blood pressure is 100/75 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Cardiopulmonary examination shows no abnormalities. An x-ray of the chest shows no abnormalities. Spirometry shows an FEV1:FVC ratio of 90% and an FEV1 of 90% of predicted. Which of the following is the most likely diagnosis?",
            "answer": "Asthma",
            "options": {
                "A": "Asthma",
                "B": "Chronic bronchitis",
                "C": "Gastroesophageal reflux disease",
                "D": "Postnasal drip syndrome"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 72,
        "history": [
            {
                "patient": "I've been experiencing a cough and nasal congestion when I exercise, especially while playing field hockey.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 77-year-old man is brought to the physician because of a 12-hour history of word-finding difficulty and weakness and sensory loss of the right arm and leg. He has no history of similar symptoms. He has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Current medications include metformin, lisinopril, and aspirin. He is alert. His pulse is 80/min and irregular, respirations are 16/min, and blood pressure is 170/90 mm Hg. He follows commands but has nonfluent aphasia. There is moderate weakness and decreased sensation of the right upper and lower extremities. Deep tendon reflexes are 2+ bilaterally. Babinski sign is present on the right. His serum glucose concentration is 162 mg/dL. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "CT scan of the head",
            "options": {
                "A": "Carotid duplex ultrasonography",
                "B": "CT scan of the head",
                "C": "EEG",
                "D": "Lumbar puncture"
            },
            "answer_idx": "B"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 73,
        "history": [
            {
                "patient": "I've been having trouble finding words and I'm experiencing weakness and loss of sensation in my right arm and leg since yesterday.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 46-year-old woman, gravida 1, para 1, comes to the office because of a 2-week history of black discharge from her right nipple. The patient had mammography and ultrasonography of the breasts 2 months ago for evaluation of increased glandularity, palpated in the upper outer quadrant of the right breast, noted at her most recent annual examination. The studies showed likely benign findings with recommended follow-up in 6 months. Medical history is otherwise unremarkable and she takes no medications. BMI is 30 kg/m2 . Vital signs are normal. Palpation of the right breast discloses glandularity in the upper outer quadrant but no other masses. There is scant, black discharge from the right nipple. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "Ductography",
            "options": {
                "A": "Ductography",
                "B": "Excisional biopsy of glandular tissue",
                "C": "Repeat mammography",
                "D": "Repeat ultrasonography of the right breast"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 74,
        "history": [
            {
                "patient": "I've been experiencing a black discharge from my right nipple for the past two weeks.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 32-year-old woman, gravida 3, para 2, at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been complicated by mild asthma treated with inhaled bronchodilators. At the beginning of the second stage of labor, the cervix is 100% effaced and 10 cm dilated; the vertex is at -1 station. The fetal heart rate is reactive with no decelerations. After 10 minutes of pushing, there is a prolonged deceleration to 60/min. The patient has the acute onset of shortness of breath, rapidly develops cyanosis, and becomes unresponsive. Her pulse and blood pressure cannot be detected. Immediate resuscitation is started. Five minutes later, there is bleeding from the nose, mouth, and intravenous sites. Which of the following is the most likely diagnosis?",
            "answer": "Amniotic fluid embolism",
            "options": {
                "A": "Amniotic fluid embolism",
                "B": "Intracerebral hemorrhage",
                "C": "Myocardial infarction",
                "D": "Status asmaticus"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 75,
        "history": [
            {
                "patient": "I'm feeling a sudden onset of shortness of breath and have become unresponsive during labor.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 72-year-old woman comes to the physician because of a 2-month history of painless swelling of both ankles. She also reports shortness of breath with exertion and when lying down. She has been awakened from sleep by shortness of breath. She has not had chest pain. Her pulse is 96/min and regular, respirations are 24/min, and blood pressure is 128/76 mm Hg. Jugular venous pressure is 15 cm H2O. Pulmonary examination shows crackles at both lung bases. Cardiac examination shows a regular rhythm and a soft S3. A grade 3/6 holosystolic murmur is heard best at the apex, radiating to the axilla. There is 2+ pitting edema of the lower legs and ankles. Which of the following is most likely to confirm the diagnosis?",
            "answer": "Echocardiography",
            "options": {
                "A": "Measurement of serum troponin I concentration",
                "B": "ECG",
                "C": "Exercise stress test",
                "D": "Echocardiography"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is most likely to confirm the diagnosis?",
        "dataset": "MMLU",
        "id": 76,
        "history": [
            {
                "patient": "I've been experiencing swelling in both ankles and shortness of breath, especially with exertion and when lying down.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 45-year-old woman has a 2-week history of increased anxiety, abdominal discomfort, irritability, and difficulty concentrating; she was robbed at knifepoint in a parking lot 3 weeks ago. She takes levothyroxine for hypothyroidism and uses an over-the-counter inhaler as needed for exercise-induced asthma. Her blood pressure is 140/80 mm Hg, and pulse is 100/min. Examination shows dry skin and hair. She is cooperative but appears anxious, glancing around quickly when a loud noise is heard outside the office. Leukocyte count is 12,000/mm3 , and serum thyroid-stimulating hormone concentration is 5.0 μU/mL. An ECG shows sinus tachycardia. Which of the following is the most likely diagnosis?",
            "answer": "Acute stress disorder",
            "options": {
                "A": "Acute stress disorder",
                "B": "Agoraphobia",
                "C": "Generalized anxiety disorder",
                "D": "Hypothyroidism"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 77,
        "history": [
            {
                "patient": "I've been feeling increasingly anxious and irritable, with abdominal discomfort and difficulty concentrating, especially since I was robbed at knifepoint three weeks ago.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 22-year-old woman comes to the office because of a 3-day history of cold symptoms and a 1-week history of progressive fatigue. Six weeks ago, she received a kidney transplant from a living, related donor. Immediately after the operation, she received monoclonal anti-CD3 therapy. Current medications are azathioprine, cyclosporine, and prednisone. Her temperature is 39°C (102.2°F). Physical examination shows a well-healed surgical scar. Serum studies show that her urea nitrogen and creatinine concentrations have tripled. A diagnosis of allograft rejection is suspected. In addition, this patient's clinical presentation is best explained by an infection with which of the following agents?",
            "answer": "BK virus",
            "options": {
                "A": "Adenovirus",
                "B": "BK virus",
                "C": "Epstein-Barr virus",
                "D": "Herpes simplex virus"
            },
            "answer_idx": "B"
        },
        "question": " In addition, this patient's clinical presentation is best explained by an infection with which of the following agents?",
        "dataset": "MMLU",
        "id": 78,
        "history": [
            {
                "patient": "I've been feeling increasingly tired for the past week and have had cold symptoms for the last three days.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 5-year-old boy is brought to the physician by his mother because of a 2-day history of a low-grade fever, cough, and runny nose. His temperature is 38°C (100.4°F). Examination findings are consistent with a diagnosis of a common cold. The physician refers to a randomized, double-blind, placebo-controlled clinical trial that evaluated the effectiveness of a new drug for the treatment of the common cold. The mean time for resolution of symptoms for patients receiving the new drug was 6.4 days, compared with a mean time of 6.7 days for patients receiving the placebo (p=0.04). Which of the following is the most appropriate interpretation of these study results?",
            "answer": "The findings are clinically insignificant but statistically significant",
            "options": {
                "A": "The findings are clinically and statistically significant",
                "B": "The findings are clinically insignificant but statistically significant",
                "C": "The findings are clinically significant but statistically insignificant",
                "D": "The findings are neither clinically nor statistically significant"
            },
            "answer_idx": "B"
        },
        "question": " Which of the following is the most appropriate interpretation of these study results?",
        "dataset": "MMLU",
        "id": 79,
        "history": [
            {
                "patient": "I've been feeling unwell with a fever, cough, and runny nose for the past couple of days.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 27-year-old nurse comes to the emergency department because of nervousness, dizziness, palpitations, and excess perspiration for the past 3 hours. She has had similar episodes over the past 6 months. The symptoms improve following ingestion of orange juice or soft drinks. She says that she has had a great deal of stress. She has been drinking two alcoholic beverages daily for the past month; before this time, she seldom drank alcohol. Examination shows no abnormalities. Her serum glucose concentration is 30 mg/dL. Intravenous glucose is administered, and the patient's symptoms improve. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "Measurement of serum insulin and C-peptide concentrations",
            "options": {
                "A": "Measurement of serum proinsulin and insulin antibodies",
                "B": "Measurement of serum cortisol and ACTH concentrations",
                "C": "Measurement of serum growth hormone and plasma somatomedin-C concentrations",
                "D": "Measurement of serum insulin and C-peptide concentrations"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 80,
        "history": [
            {
                "patient": "I've been feeling nervous, dizzy, and have been experiencing palpitations and excess sweating, especially over the past 3 hours.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 50-year-old woman comes to the office for the first time because of recurrent abdominal pain. Review of her extensive medical chart, which she has brought with her, discloses that she has a long history of varying physical symptoms. Definitive causes for these symptoms have not been found despite extensive diagnostic studies, consultations with many physicians, and several surgical explorations. She gives dramatic and exaggerated descriptions of her present and past symptoms, and she makes conflicting statements about her history. She has been hospitalized at least 23 times since age 18 years. Which of the following is the most likely diagnosis?",
            "answer": "Somatic symptom disorder",
            "options": {
                "A": "Conversion disorder",
                "B": "Histrionic personality disorder",
                "C": "Occult medical disorder",
                "D": "Somatic symptom disorder"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 81,
        "history": [
            {
                "patient": "I've been experiencing recurrent abdominal pain.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 47-year-old man is brought to the emergency department 2 hours after the sudden onset of shortness of breath, severe chest pain, and sweating. He has no history of similar symptoms. He has hypertension treated with hydrochlorothiazide. He has smoked one pack of cigarettes daily for 30 years. His pulse is 110/min, respirations are 24/min, and blood pressure is 110/50 mm Hg. A grade 3/6, diastolic blowing murmur is heard over the left sternal border and radiates to the right sternal border. Femoral pulses are decreased bilaterally. An ECG shows left ventricular hypertrophy. Which of the following is the most likely diagnosis?",
            "answer": "Aortic dissection",
            "options": {
                "A": "Acute myocardial infarction",
                "B": "Aortic dissection",
                "C": "Esophageal rupture",
                "D": "Mitral valve prolapse"
            },
            "answer_idx": "B"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 82,
        "history": [
            {
                "patient": "I suddenly started feeling short of breath, severe chest pain, and sweating a couple of hours ago.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 67-year-old woman comes to the physician because of easy bruising for 4 months. She has a history of lung cancer treated with radiation therapy 6 months ago. She has a 2-year history of hypertension treated with a thiazide diuretic and an angiotensin-converting enzyme (ACE) inhibitor. Examination, including neurologic examination, shows no abnormalities except for multiple ecchymoses. Her hemoglobin concentration is 13 g/dL, leukocyte count is 5000/mm3 , and platelet count is 35,000/mm3 . A serum antiplatelet antibody assay is negative. Which of the following is the most appropriate next step in diagnosis?",
            "answer": "Bone marrow aspiration",
            "options": {
                "A": "CT scan of the abdomen",
                "B": "CT scan of the chest",
                "C": "Bronchoscopy",
                "D": "Bone marrow aspiration"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most appropriate next step in diagnosis?",
        "dataset": "MMLU",
        "id": 83,
        "history": [
            {
                "patient": "I've been experiencing easy bruising for the past four months.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 30-year-old nulliparous female presents to the office with the complaint of mood changes. She says that for the past several months she has been anxious, hyperactive, and unable to sleep 3 to 4 days prior to the onset of menses. She further reports that on the day her menses begins she becomes acutely depressed, anorectic, irritable, and lethargic. She has no psychiatric history. Physical examination findings are normal. She and her husband have been trying to conceive for over 2 years. History reveals a tuboplasty approximately 1 year ago to correct a closed fallopian tube. The most likely diagnosis is",
            "answer": "adjustment disorder with depressed mood",
            "options": {
                "A": "adjustment disorder with depressed mood",
                "B": "bipolar I disorder, mixed",
                "C": "cyclothymic personality",
                "D": "generalized anxiety disorder"
            },
            "answer_idx": "A"
        },
        "question": " The most likely diagnosis is",
        "dataset": "MMLU",
        "id": 84,
        "history": [
            {
                "patient": "I've been experiencing mood changes, feeling anxious, hyperactive, and unable to sleep before my period, and then feeling depressed, irritable, and lethargic when it starts.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 45-year-old limousine driver comes to the office for an initial appointment because he would like you to fill out and sign a legal document at the request of his attorney. The patient states that he is filing a lawsuit against the limousine company that employs him because he developed post-traumatic stress disorder following a motor vehicle collision. He appears irritable and tense as he provides his history. He relays his symptoms by reading them aloud from a written list. At this time, which of the following is the most appropriate approach toward confirming the underlying diagnosis of this patient?",
            "answer": "Ask the patient to provide a narrative with detailed description of the incident and of his symptoms",
            "options": {
                "A": "Administer amobarbital and then interview the patient",
                "B": "Ask the patient to provide a narrative with detailed description of the incident and of his symptoms",
                "C": "Interview the patient under hypnosis",
                "D": "Interview the patient while paying close attention to his willingness to make eye contact"
            },
            "answer_idx": "B"
        },
        "question": " At this time, which of the following is the most appropriate approach toward confirming the underlying diagnosis of this patient?",
        "dataset": "MMLU",
        "id": 85,
        "history": [
            {
                "patient": "I've been feeling irritable and tense and I need you to fill out and sign a legal document for my lawsuit related to a motor vehicle collision.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 47-year-old man comes to the physician 12 hours after the sudden onset of a severe occipital headache and stiff neck. He has not had any other symptoms and has no history of severe headache. He has hypertension and gastroesophageal reflux disease. Current medications include hydrochlorothiazide and ranitidine. He is oriented to person, place, and time. His temperature is 36.7°C (98.1°F), pulse is 100/min, and blood pressure is 160/90 mm Hg. Range of motion of the neck is decreased due to pain. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis?",
            "answer": "Subarachnoid hemorrhage",
            "options": {
                "A": "Cluster headache",
                "B": "Meningitis",
                "C": "Migraine",
                "D": "Subarachnoid hemorrhage"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 86,
        "history": [
            {
                "patient": "I suddenly developed a severe headache at the back of my head and now my neck feels very stiff.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 3-year-old girl is brought to the physician because of fever and left ear pain for 3 days. She has been treated with amoxicillin for the past 5 days for left otitis media. Her temperature is 38.5°C (101.3°F), pulse is 100/min, respirations are 20/min, and blood pressure is 80/60 mm Hg. Examination shows the left ear displaced forward and laterally from the head. There is edema and tenderness behind the left ear. Otoscopic examination shows a red, dull, left tympanic membrane that does not move. Which of the following is the most likely diagnosis?",
            "answer": "Mastoiditis",
            "options": {
                "A": "Acoustic neuroma",
                "B": "Labyrinthitis",
                "C": "Lateral sinus thrombosis",
                "D": "Mastoiditis"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 87,
        "history": [
            {
                "patient": "I've been having a fever and pain in my left ear for the past three days.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 67-year-old woman has had fatigue, dry skin, brittle hair, swelling of the ankles, and cold intolerance for 1 year; she has gained 9 kg (20 lb) during this period. Her pulse is 55/min, and blood pressure is 150/90 mm Hg. She appears lethargic. Examination shows dry skin and a nontender thyroid gland that is enlarged to two times its normal size. There is mild edema of the ankles bilaterally. The relaxation phase of the Achilles reflex is greatly prolonged. Which of the following is the most likely diagnosis?",
            "answer": "Chronic lymphocytic thyroiditis (Hashimoto disease)",
            "options": {
                "A": "Chronic lymphocytic thyroiditis (Hashimoto disease)",
                "B": "Defect in thyroxine (T4) biosynthesis",
                "C": "Graves disease",
                "D": "Multinodular goiter"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 88,
        "history": [
            {
                "patient": "I've been feeling really tired, my skin is dry, my hair is brittle, I've noticed some swelling in my ankles, and I can't tolerate the cold like I used to.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 54-year-old man comes to the physician because of episodes of fainting for 3 months. He also has had difficulty performing daily tasks because he is easily fatigued. He had a myocardial infarction 12 years ago. His pulse is 40/min, respirations are 18/min, and blood pressure is 138/85 mm Hg. Physical examination shows evidence of cannon a waves. An ECG shows a P-wave rate of 90/min, and an R-wave rate of 40/min, with no apparent relation between the two. Which of the following is the most likely diagnosis?",
            "answer": "Third-degree atrioventricular block",
            "options": {
                "A": "Right bundle branch block",
                "B": "Second-degree atrioventricular block, type I",
                "C": "Second-degree atrioventricular block, type II",
                "D": "Third-degree atrioventricular block"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MMLU",
        "id": 89,
        "history": [
            {
                "patient": "I've been experiencing episodes of fainting and feeling easily fatigued when doing my daily tasks for the past three months.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 61-year-old Caucasian male presents to your office with chest pain. He states that he is worried about his heart, as his father died at age 62 from a heart attack. He reports that his chest pain worsens with large meals and spicy foods and improves with calcium carbonate. He denies dyspnea on exertion and an ECG is normal. What is the most likely cause of this patient's pain?",
            "answer": "Gastroesophageal junction incompetence",
            "options": {
                "A": "Partially occluded coronary artery",
                "B": "Esophageal adenocarcinoma",
                "C": "Umbilical hernia",
                "D": "Gastroesophageal junction incompetence",
                "E": "Intestinal metaplasia at the gastroesophageal junction"
            },
            "meta_info": "step1",
            "answer_idx": "D"
        },
        "question": " What is the most likely cause of this patient's pain?",
        "gpt_extract_mdeical_info": "1. Patient age: 61\n2. Patient gender: Male\n3. Chief complaint: Chest pain\n4. Family history: Father died from a heart attack at age 62\n5. Chest pain worsened by: Large meals and spicy foods\n6. Chest pain improved by: Calcium carbonate\n7. Dyspnea on exertion: Denied\n8. Electrocardiogram (ECG) result: Normal",
        "medical_info_list": {
            "Patient age": "61",
            "Patient gender": "Male",
            "Chief complaint": "Chest pain",
            "Family history": "Father died from a heart attack at age 62",
            "Chest pain worsened by": "Large meals and spicy foods",
            "Chest pain improved by": "Calcium carbonate",
            "Dyspnea on exertion": "Denied",
            "Electrocardiogram (ECG) result": "Normal"
        },
        "id": 90,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm experiencing chest pain that seems to get worse when I eat large meals or spicy foods."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 68-year-old male comes to the physician for evaluation of right flank pain. He has a history of diabetes and peripheral artery disease. His blood pressure is 160/90 mm Hg. Physical examination shows abdominal tenderness and right flank tenderness. An ultrasound shows dilation of the right ureter and renal pelvis. Which of the following is the most likely underlying cause of this patient's condition?",
            "answer": "Common iliac artery aneurysm",
            "options": {
                "A": "Renal artery stenosis",
                "B": "Benign prostatic hyperplasia",
                "C": "Diabetic nephropathy",
                "D": "Common iliac artery aneurysm",
                "E": "Urethral stricture"
            },
            "meta_info": "step1",
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely underlying cause of this patient's condition?",
        "gpt_extract_mdeical_info": "1. Patient's age: 68 years old.\n2. Patient's gender: Male.\n3. Patient's medical history: Diabetes and peripheral artery disease.\n4. Blood pressure: 160/90 mm Hg.\n5. Physical examination findings: Abdominal tenderness and right flank tenderness.\n6. Imaging results: Ultrasound showing dilation of the right ureter and renal pelvis.",
        "medical_info_list": {
            "Patient's age": "68 years old.",
            "Patient's gender": "Male.",
            "Patient's medical history": "Diabetes and peripheral artery disease.",
            "Blood pressure": "160/90 mm Hg.",
            "Physical examination findings": "Abdominal tenderness and right flank tenderness.",
            "Imaging results": "Ultrasound showing dilation of the right ureter and renal pelvis."
        },
        "id": 91,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came in because I've been experiencing pain in my right side, particularly in my flank area."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. Which of the following laboratory findings would you most expect upon analysis of this patient's serum?",
            "answer": "Increased PTH, decreased calcium, increased phosphate, decreased calcitriol",
            "options": {
                "A": "Increased PTH, decreased calcium, increased phosphate, decreased calcitriol",
                "B": "Decreased PTH, increased calcium, increased phosphate, increased calcitriol",
                "C": "Increased PTH, increased calcium, decreased phosphate, decreased calcitriol",
                "D": "Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol",
                "E": "Normal PTH, normal calcium, normal phosphate, normal calcitriol"
            },
            "meta_info": "step1",
            "answer_idx": "A"
        },
        "question": " Which of the following laboratory findings would you most expect upon analysis of this patient's serum?",
        "gpt_extract_mdeical_info": "1. Patient's age: 55-year-old.\n2. Patient's gender: Male.\n3. Patient's medical history: Chronic glomerulonephritis due to IgA nephropathy.\n4. Reason for visit: Bone pain.",
        "medical_info_list": {
            "Patient's age": "55-year-old.",
            "Patient's gender": "Male.",
            "Patient's medical history": "Chronic glomerulonephritis due to IgA nephropathy.",
            "Reason for visit": "Bone pain."
        },
        "id": 92,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm experiencing bone pain."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 65-year-old male is treated for anal carcinoma with therapy including external beam radiation. How does radiation affect cancer cells?",
            "answer": "Induces breaks in double-stranded DNA",
            "options": {
                "A": "Induces the formation of thymidine dimers",
                "B": "Induces the formation of disulfide bonds",
                "C": "Induces G/T and A/C pair formation",
                "D": "Induces deamination of cytosine",
                "E": "Induces breaks in double-stranded DNA"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " How does radiation affect cancer cells?",
        "gpt_extract_mdeical_info": "1. Patient's age: 65 years old.\n2. Patient's gender: male.\n3. Diagnosis: anal carcinoma.\n4. Treatment: therapy including external beam radiation.",
        "medical_info_list": {
            "Patient's age": "65 years old.",
            "Patient's gender": "male.",
            "Diagnosis": "anal carcinoma.",
            "Treatment": "therapy including external beam radiation."
        },
        "id": 93,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm concerned about how the radiation treatment I'm receiving is impacting the cancer cells in my body."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 56-year-old man presents to the clinic complaining of subacute back pain for the past month. The pain is described as a dull, constant ache that is worse at night. He could not recall any precipitating event except for an amateur weight-lifting competition that he participated in 2 months ago. Past medical history is significant for non-small cell lung cancer that was diagnosed and successfully treated. A PET scan 1 year ago demonstrated no recurrence. Physical exam was unremarkable except for some point tenderness along the lumbosacral area. What is the most likely imaging finding in this patient?",
            "answer": "Lytic lesions of the lumbar spine",
            "options": {
                "A": "Blastic lesions of the lumbar spine",
                "B": "Bulging disc impinging on lumbar spinal nerve",
                "C": "Lytic lesions of the lumbar spine",
                "D": "Narrowing of the lumbar disc space",
                "E": "Sacroilitis and fusion of the lumbar spine"
            },
            "meta_info": "step1",
            "answer_idx": "C"
        },
        "question": " What is the most likely imaging finding in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 56 years old.\n2. Patient's gender: male.\n3. Chief complaint: subacute back pain for the past month.\n4. Pain description: dull, constant ache that is worse at night.\n5. Possible precipitating event: amateur weight-lifting competition 2 months ago.\n6. Past medical history: non-small cell lung cancer that was diagnosed and successfully treated.\n7. PET scan results from 1 year ago: no recurrence of cancer detected.\n8. Physical exam findings: point tenderness along the lumbosacral area.",
        "medical_info_list": {
            "Patient's age": "56 years old.",
            "Patient's gender": "male.",
            "Chief complaint": "subacute back pain for the past month.",
            "Pain description": "dull, constant ache that is worse at night.",
            "Possible precipitating event": "amateur weight-lifting competition 2 months ago.",
            "Past medical history": "non-small cell lung cancer that was diagnosed and successfully treated.",
            "PET scan results from 1 year ago": "no recurrence of cancer detected.",
            "Physical exam findings": "point tenderness along the lumbosacral area."
        },
        "id": 94,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing a dull, constant ache in my back that gets worse at night for the past month."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 5-year-old female suffers from recurrent infections by Aspergillus species, Pseudomonas species, and Staphylococcus aureus. The patient's neutrophils are examined in the laboratory and they fail to react during the nitroblue tetrazolium test. Which of the following is most likely dysfunctional in this patient?",
            "answer": "Respiratory burst",
            "options": {
                "A": "Lymphocytes",
                "B": "Immunoglobulin class switching",
                "C": "Superoxide dismutase",
                "D": "Myeloperoxidase",
                "E": "Respiratory burst"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " Which of the following is most likely dysfunctional in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 5-year-old.\n2. Patient's gender: female.\n3. Medical history: Recurrent infections by Aspergillus species, Pseudomonas species, and Staphylococcus aureus.\n4. Laboratory study: Neutrophils failed to react during the nitroblue tetrazolium test.",
        "medical_info_list": {
            "Patient's age": "5-year-old.",
            "Patient's gender": "female.",
            "Medical history": "Recurrent infections by Aspergillus species, Pseudomonas species, and Staphylococcus aureus.",
            "Laboratory study": "Neutrophils failed to react during the nitroblue tetrazolium test."
        },
        "id": 95,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I keep getting infections over and over again."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 67-year-old man who was diagnosed with arthritis 16 years ago presents with right knee swelling and pain. His left knee was swollen a few weeks ago, but now with both joints affected, he has difficulty walking and feels frustrated. He also has back pain which makes it extremely difficult to move around and be active during the day. He says his pain significantly improves with rest. He also suffers from dandruff for which he uses special shampoos. Physical examination is notable for pitting of his nails. Which of the following is the most likely diagnosis?",
            "answer": "Psoriatic arthritis",
            "options": {
                "A": "Psoriatic arthritis",
                "B": "Arthritis mutilans",
                "C": "Rheumatoid arthritis",
                "D": "Familial mediterranean fever",
                "E": "Mixed connective tissue disease"
            },
            "meta_info": "step2&3",
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "gpt_extract_mdeical_info": "1. Patient's age: 67 years old.\n2. Patient's gender: male.\n3. Patient's medical history: arthritis diagnosed 16 years ago.\n4. Patient's chief complaints: right knee swelling and pain, left knee swelling (few weeks ago), difficulty walking, frustration, back pain making it difficult to be active during the day, pain improves with rest, and dandruff.\n5. Physical examination findings: pitting of nails.",
        "medical_info_list": {
            "Patient's age": "67 years old.",
            "Patient's gender": "male.",
            "Patient's medical history": "arthritis diagnosed 16 years ago.",
            "Patient's chief complaints": "right knee swelling and pain, left knee swelling (few weeks ago), difficulty walking, frustration, back pain making it difficult to be active during the day, pain improves with rest, and dandruff.",
            "Physical examination findings": "pitting of nails."
        },
        "id": 96,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm experiencing swelling and pain in my right knee, difficulty walking due to both knees being affected, and back pain that improves with rest."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A post-mortem lung examination of a 68-year-old male overweight male with evidence of chronic lower extremity edema, a 60 pack-year smoking history and daily productive cough would be most likely to reveal:",
            "answer": "Reid Index > 50%",
            "options": {
                "A": "Hypereosinophilia",
                "B": "Reid Index > 50%",
                "C": "Non-caseating granulomas",
                "D": "Evidence of a necrotizing infection",
                "E": "Keratin pearls"
            },
            "meta_info": "step1",
            "answer_idx": "B"
        },
        "question": "Which one would be most likely to reveal?",
        "gpt_extract_mdeical_info": "1. Patient's age: 68\n2. Patient's gender: male\n3. Patient's weight: overweight\n4. Medical history: chronic lower extremity edema\n5. Smoking history: 60 pack-years\n6. Presenting symptom: daily productive cough. \n7. The lung examination was conducted post-mortem.",
        "medical_info_list": {
            "Patient's age": "68",
            "Patient's gender": "male",
            "Patient's weight": "overweight",
            "Medical history": "chronic lower extremity edema",
            "Smoking history": "60 pack-years",
            "Presenting symptom": "daily productive cough.",
            "info_1": "The lung examination was conducted post-mortem."
        },
        "id": 97,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have a daily productive cough and swelling in my legs."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 23-year-old woman comes to the physician because she is embarrassed about the appearance of her nails. She has no history of serious illness and takes no medications. She appears well. A photograph of the nails is shown. Which of the following additional findings is most likely in this patient?",
            "answer": "Silvery plaques on extensor surfaces",
            "options": {
                "A": "Silvery plaques on extensor surfaces",
                "B": "Flesh-colored papules in the lumbosacral region",
                "C": "Erosions of the dental enamel",
                "D": "Pallor of the conjunctival mucosa",
                "E": "Holosystolic murmur at the left lower sternal border"
            },
            "meta_info": "step1",
            "answer_idx": "A"
        },
        "question": " Which of the following additional findings is most likely in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 23 years old.\n2. Patient's gender: female.\n3. Reason for visit: patient is embarrassed about the appearance of her nails.\n4. Medical history: patient has no history of serious illness.\n5. Current medication: patient takes no medications.\n6. Physical appearance: patient appears well.\n7. Photograph of patient's nails shows an abnormality.",
        "medical_info_list": {
            "Patient's age": "23 years old.",
            "Patient's gender": "female.",
            "Reason for visit": "patient is embarrassed about the appearance of her nails.",
            "Medical history": "patient has no history of serious illness.",
            "Current medication": "patient takes no medications.",
            "Physical appearance": "patient appears well.",
            "info_1": "Photograph of patient's nails shows an abnormality."
        },
        "id": 98,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I am embarrassed about the appearance of my nails."
            }
        ]
    },
    {
        "raw_data": {
            "question": "An otherwise healthy 26-year-old man comes to the physician for medication counseling after recently being diagnosed with schizophrenia. Risperidone therapy is initiated. This patient is at increased risk for which of the following adverse effects?",
            "answer": "Gynecomastia",
            "options": {
                "A": "Agranulocytosis",
                "B": "Shortened QT interval",
                "C": "Gynecomastia",
                "D": "Hypothyroidism",
                "E": "Weight loss"
            },
            "meta_info": "step1",
            "answer_idx": "C"
        },
        "question": " This patient is at increased risk for which of the following adverse effects?",
        "gpt_extract_mdeical_info": "1. Patient's age: 26 years old.\n2. Patient's gender: male.\n3. Patient's medical condition: schizophrenia.\n4. Medication prescribed: risperidone.",
        "medical_info_list": {
            "Patient's age": "26 years old.",
            "Patient's gender": "male.",
            "Patient's medical condition": "schizophrenia.",
            "Medication prescribed": "risperidone."
        },
        "id": 99,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been having some troubling experiences that led me to seek medical help, and I'm here to discuss the medication I was prescribed."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 72-year-old woman is admitted to the intensive care unit for shortness of breath and palpitations. A cardiac catheterization is performed and measurements of the left ventricular volume and pressure at different points in the cardiac cycle are obtained. The patient's pressure-volume loop (gray) is shown with a normal pressure-volume loop (black) for comparison. Which of the following is the most likely underlying cause of this patient's symptoms?",
            "answer": "Increased ventricular wall stiffness",
            "options": {
                "A": "Mitral valve regurgitation",
                "B": "Increased systemic vascular resistance",
                "C": "Increased ventricular wall stiffness",
                "D": "Impaired left ventricular contractility",
                "E": "Aortic stenosis"
            },
            "meta_info": "step1",
            "answer_idx": "C"
        },
        "question": " Which of the following is the most likely underlying cause of this patient's symptoms?",
        "gpt_extract_mdeical_info": "1. Patient's age: 72 years old.\n2. Patient's gender: Female.\n3. Reason for admission: Shortness of breath and palpitations.\n4. Procedure performed: Cardiac catheterization.\n5. Measurement obtained: Left ventricular volume and pressure at different points in the cardiac cycle.\n6. The patient's pressure-volume loop: Shown in gray.\n7. Normal pressure-volume loop: Shown in black for comparison.",
        "medical_info_list": {
            "Patient's age": "72 years old.",
            "Patient's gender": "Female.",
            "Reason for admission": "Shortness of breath and palpitations.",
            "Procedure performed": "Cardiac catheterization.",
            "Measurement obtained": "Left ventricular volume and pressure at different points in the cardiac cycle.",
            "The patient's pressure-volume loop": "Shown in gray.",
            "Normal pressure-volume loop": "Shown in black for comparison."
        },
        "id": 100,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing shortness of breath and palpitations."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 65-year-old woman schedules an appointment with her physician for evaluation of weight loss and weakness. The weakness is more noticeable when climbing stairs and combing hair. The weakness improves after brief exercise. She also has bladder incontinence for the past 4 weeks and was given an anticholinesterase agent with no improvement. What is the most likely cause of the symptoms?",
            "answer": "Paraneoplastic syndrome from small cell carcinoma of the lung",
            "options": {
                "A": "Botulism",
                "B": "Duchenne muscular dystrophy",
                "C": "Hypothyroidism",
                "D": "Myasthenia gravis",
                "E": "Paraneoplastic syndrome from small cell carcinoma of the lung"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " What is the most likely cause of the symptoms?",
        "gpt_extract_mdeical_info": "1. Patient's age: 65-year-old woman.\n2. Patient's chief complaints: weight loss and weakness.\n3. Description of weakness: more noticeable when climbing stairs and combing hair; improves after brief exercise.\n4. Duration of bladder incontinence: 4 weeks.\n5. Initial treatment for bladder incontinence: anticholinesterase agent.\n6. Response to anticholinesterase agent: no improvement.\n7. Patient's gender: Female.",
        "medical_info_list": {
            "Patient's age": "65-year-old woman.",
            "Patient's chief complaints": "weight loss and weakness.",
            "Description of weakness": "more noticeable when climbing stairs and combing hair; improves after brief exercise.",
            "Duration of bladder incontinence": "4 weeks.",
            "Initial treatment for bladder incontinence": "anticholinesterase agent.",
            "Response to anticholinesterase agent": "no improvement.",
            "Patient's gender": "Female."
        },
        "id": 101,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing weight loss and weakness, especially when climbing stairs and combing my hair, and I've also had some trouble with bladder control recently."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 17-year-old female accidentally eats a granola bar manufactured on equipment that processes peanuts. She develops type I hypersensitivity-mediated histamine release, resulting in pruritic wheals on the skin. Which of the following layers of this patient's skin would demonstrate histologic changes on biopsy of her lesions?",
            "answer": "Dermis",
            "options": {
                "A": "Stratum corneum",
                "B": "Stratum granulosum",
                "C": "Stratum spinosum",
                "D": "Stratum basale",
                "E": "Dermis"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " Which of the following layers of this patient's skin would demonstrate histologic changes on biopsy of her lesions?",
        "gpt_extract_mdeical_info": "1. Patient's age: 17.\n2. Patient's gender: female.\n3. Patient accidentally ate a granola bar that was manufactured on equipment that processes peanuts.\n4. Patient developed type I hypersensitivity-mediated histamine release.\n5. Patient presented with pruritic wheals on the skin.",
        "medical_info_list": {
            "Patient's age": "17.",
            "Patient's gender": "female.",
            "info_1": "Patient presented with pruritic wheals on the skin."
        },
        "id": 102,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have itchy bumps on my skin after eating a granola bar."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 15-year-old woman presents with fever, altered mental status and a petechial rash on her lower extremities and back since yesterday evening. She also says she has been nauseous for the past 3 hours and has vomited twice. The patient mentions she has had heavy menstrual bleeding for the past few days. Her blood pressure is 95/80 mm Hg and her temperature is 40.0°C (104.0°F). On physical examination, the patient appears diaphoretic. A pelvic examination reveals a tampon in her vagina. Binding and activation of which of the following T cell receptors is responsible for this patient’s most likely condition?",
            "answer": "Variable β-sequence of the T cell receptor",
            "options": {
                "A": "B7 receptor",
                "B": "Variable β-sequence of the T cell receptor",
                "C": "CD40",
                "D": "CD3",
                "E": "IgCAM"
            },
            "meta_info": "step1",
            "answer_idx": "B"
        },
        "question": " Binding and activation of which of the following T cell receptors is responsible for this patient’s most likely condition?",
        "gpt_extract_mdeical_info": "1. Patient's age: 15 years old.\n2. Patient's gender: Female.\n3. Presenting symptoms: Fever, altered mental status, and petechial rash on lower extremities and back.\n4. Duration of symptoms: Fever and rash since yesterday evening, nausea and vomiting for the past 3 hours.\n5. Menstrual history: Heavy menstrual bleeding for the past few days.\n6. Vital signs: Blood pressure 95/80 mm Hg, temperature 40.0°C (104.0°F).\n7. Pelvic examination findings: Tampon in patient's vagina.",
        "medical_info_list": {
            "Patient's age": "15 years old.",
            "Patient's gender": "Female.",
            "Presenting symptoms": "Fever, altered mental status, and petechial rash on lower extremities and back.",
            "Duration of symptoms": "Fever and rash since yesterday evening, nausea and vomiting for the past 3 hours.",
            "Menstrual history": "Heavy menstrual bleeding for the past few days.",
            "Vital signs": "Blood pressure 95/80 mm Hg, temperature 40.0°C (104.0°F).",
            "Pelvic examination findings": "Tampon in patient's vagina."
        },
        "id": 103,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling feverish with a change in my mental state and a rash on my legs and back, and I've also been feeling nauseous with some vomiting."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 47-year-old executive schedules an appointment his physician for a routine medical check-up. He currently has no complaints and claims to be “as fit as a fiddle.” The physical examination findings are unremarkable, except for a mid-systolic murmur heard in the 2nd left intercostal space that radiates to the carotids on auscultation. The physician instructs the patient to stand from a supine position with the stethoscope still placed on his chest. Which of the following changes would occur with this maneuver?",
            "answer": "A reduction in diastolic filling time",
            "options": {
                "A": "An increase in right atrial pressure",
                "B": "An increase in left ventricular end-diastolic pressure",
                "C": "An increase in pulmonary capillary wedge pressure",
                "D": "A reduction in the slope of the pacemaker potential",
                "E": "A reduction in diastolic filling time"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " Which of the following changes would occur with this maneuver?",
        "gpt_extract_mdeical_info": "1. Patient's age: 47 years old.\n2. Patient's gender: man.\n3. Reason for his appointment: routine medical check-up.\n4. Patient's current condition: claims to be \"as fit as a fiddle.\"\n5. Physical examination finding: mid-systolic murmur heard in the 2nd left intercostal space that radiates to the carotids on auscultation.\n6. Physician's instruction: asked patient to stand from a supine position with the stethoscope still placed on his chest.",
        "medical_info_list": {
            "Patient's age": "47 years old.",
            "Patient's gender": "man.",
            "Reason for his appointment": "routine medical check-up.",
            "Patient's current condition": "claims to be \"as fit as a fiddle.\"",
            "Physical examination finding": "mid-systolic murmur heard in the 2nd left intercostal space that radiates to the carotids on auscultation.",
            "Physician's instruction": "asked patient to stand from a supine position with the stethoscope still placed on his chest."
        },
        "id": 104,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have no complaints and feel as fit as a fiddle."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 43-year-old man with a history of schizophrenia, currently controlled with medication, comes in for an appointment with his internist. He is concerned about abnormal discharge from both nipples over the past 3 months. The fluid is white, and he wonders if it could be milk. On further review of systems, he endorses a diminished sexual drive. The physician suspects that one of the patient's medications may be the culprit for these symptoms. Which of the following medications is NOT likely to be the cause?",
            "answer": "Bromocriptine",
            "options": {
                "A": "Metoclopramide",
                "B": "Haloperidol",
                "C": "Bromocriptine",
                "D": "Fluphenazine",
                "E": "Risperidone"
            },
            "meta_info": "step1",
            "answer_idx": "C"
        },
        "question": " Which of the following medications is NOT likely to be the cause?",
        "gpt_extract_mdeical_info": "1. Patient's age: 43\n2. Patient's gender: Male\n3. Patient's medical history: Schizophrenia\n4. Patient's current condition: Controlled with medication\n5. Chief complaint: Abnormal discharge from both nipples over the past 3 months\n6. Characteristics of the nipple discharge: White in color\n7. Patient's concern: Whether the discharge could be milk\n8. Other symptoms: Diminished sexual drive\n9. Suspected cause of symptoms: One of the patient's medications.",
        "medical_info_list": {
            "Patient's age": "43",
            "Patient's gender": "Male",
            "Patient's medical history": "Schizophrenia",
            "Patient's current condition": "Controlled with medication",
            "Chief complaint": "Abnormal discharge from both nipples over the past 3 months",
            "Characteristics of the nipple discharge": "White in color",
            "Patient's concern": "Whether the discharge could be milk",
            "Other symptoms": "Diminished sexual drive",
            "Suspected cause of symptoms": "One of the patient's medications."
        },
        "id": 105,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm concerned about an abnormal discharge from my nipples that I've noticed over the past few months, and I've also been experiencing a lower sexual drive."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 44-year-old African-American woman comes to the physician for a routine examination. She is concerned about cancer because her uncle died of metastatic melanoma 1 year ago. She has no history of serious illness and does not take any medication. She has been working in a law firm for the past 20 years and travels to the Carribean regularly with her husband. Examination of her skin shows no abnormal moles or warts. This woman is at greatest risk of which of the following types of melanoma?",
            "answer": "Acral lentiginous",
            "options": {
                "A": "Desmoplastic",
                "B": "Nodular",
                "C": "Acral lentiginous",
                "D": "Lentigo maligna",
                "E": "Superficial spreading"
            },
            "meta_info": "step1",
            "answer_idx": "C"
        },
        "question": " This woman is at greatest risk of which of the following types of melanoma?",
        "gpt_extract_mdeical_info": "1. Patient's age: 44.\n2. Patient's gender: Female.\n3. Patient's ethnicity: African-American.\n4. Reason for consultation: Routine examination.\n5. Family history: Her uncle died of metastatic melanoma 1 year ago.\n6. Medical history: No history of serious illness.\n7. Current medication: Does not take any medication.\n8. Occupation: Working in a law firm for the past 20 years.\n9. Travel history: Travels to the Caribbean regularly with her husband.\n10. Skin examination result: No abnormal moles or warts found.",
        "medical_info_list": {
            "Patient's age": "44.",
            "Patient's gender": "Female.",
            "Patient's ethnicity": "African-American.",
            "Reason for consultation": "Routine examination.",
            "Family history": "Her uncle died of metastatic melanoma 1 year ago.",
            "Medical history": "No history of serious illness.",
            "Current medication": "Does not take any medication.",
            "Occupation": "Working in a law firm for the past 20 years.",
            "Travel history": "Travels to the Caribbean regularly with her husband.",
            "Skin examination result": "No abnormal moles or warts found."
        },
        "id": 106,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I am concerned about cancer because my uncle died of metastatic melanoma a year ago."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 26-year-old woman presents to a gynecologist after a missed period. After performing a complete physical examination and a screening test for pregnancy, her gynecologist informs her that she is pregnant. She is very surprised as she has been taking oral contraceptives regularly. When the gynecologist asks her about the consumption of any other medications, she mentions that she was placed on treatment for pulmonary tuberculosis (TB) 2 months ago. Her current anti-TB regimen includes rifampin, isoniazid, pyrazinamide, and ethambutol. Which of the following mechanisms best explains the failure of oral contraceptives in this patient?",
            "answer": "Induction of CYP3A4 by rifampin leading to decreased serum levels of ethinylestradiol and progesterone",
            "options": {
                "A": "Induction of CYP3A4 by rifampin leading to decreased serum levels of ethinylestradiol and progesterone",
                "B": "Induction of CYP2A6 by rifampin leading to increased inactivation of ethinylestradiol",
                "C": "Induction of CYP2E1 by isoniazid leading to decreased serum levels of progesterone",
                "D": "Interference with the intestinal absorption of the oral contraceptive by pyrazinamide",
                "E": "Increased renal elimination of the progesterone component of the oral contraceptive by ethambutol"
            },
            "meta_info": "step1",
            "answer_idx": "A"
        },
        "question": " Which of the following mechanisms best explains the failure of oral contraceptives in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's demographic information: \n   1.1 Age: 26 years old.\n   1.2 Gender: Female.\n2. Reason for visit: Missed period.\n3. Physical examination: Performed and the patient was found to be pregnant.\n4. Medical history:\n   4.1 Oral contraceptive use: Regularly used, but patient still became pregnant.\n   4.2 Pulmonary tuberculosis: Patient was placed on treatment for pulmonary tuberculosis 2 months ago.\n5. Medications: Patient is currently taking rifampin, isoniazid, pyrazinamide, and ethambutol for tuberculosis treatment.\n6. Diagnosis: Pregnancy despite oral contraceptive use and tuberculosis treatment.",
        "medical_info_list": {
            "Age": "26 years old.",
            "Gender": "Female.",
            "Reason for visit": "Missed period.",
            "Physical examination": "Performed and the patient was found to be pregnant.",
            "Oral contraceptive use": "Regularly used, but patient still became pregnant.",
            "Pulmonary tuberculosis": "Patient was placed on treatment for pulmonary tuberculosis 2 months ago.",
            "Medications": "Patient is currently taking rifampin, isoniazid, pyrazinamide, and ethambutol for tuberculosis treatment.",
            "Diagnosis": "Pregnancy despite oral contraceptive use and tuberculosis treatment."
        },
        "id": 107,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came to the gynecologist because I missed my period."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0°F (37.2°C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The patient is being resuscitated in the trauma bay. Which of the following was most likely to be found on exam?",
            "answer": "Miosis",
            "options": {
                "A": "Ataxia",
                "B": "Conjunctival injection",
                "C": "Miosis",
                "D": "Mydriasis",
                "E": "Nystagmus"
            },
            "meta_info": "step2&3",
            "answer_idx": "C"
        },
        "question": " Which of the following was most likely to be found on exam?",
        "gpt_extract_mdeical_info": "1. Patient age: 25.\n2. Patient gender: Male.\n3. Chief complaint: Altered mental status.\n4. Past medical history: Unknown.\n5. Vital signs:\n\t- Temperature: 99.0°F (37.2°C).\n\t- Blood pressure: 104/64 mmHg.\n\t- Pulse: 70/min.\n\t- Respirations: 5/min.\n\t- Oxygen saturation: 91% on room air.\n6. Physical location: Found down in the middle of the street.\n7. Current location: Trauma bay.",
        "medical_info_list": {
            "Patient age": "25.",
            "Patient gender": "Male.",
            "Chief complaint": "Altered mental status.",
            "Past medical history": "Unknown.",
            "Temperature": "99.0°F (37.2°C).",
            "Blood pressure": "104/64 mmHg.",
            "Pulse": "70/min.",
            "Respirations": "5/min.",
            "Oxygen saturation": "91% on room air.",
            "Physical location": "Found down in the middle of the street.",
            "Current location": "Trauma bay."
        },
        "id": 108,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I feel confused and not like myself; I was found lying in the street and now I'm in the hospital."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 54-year-old male makes an appointment with his primary care physician due to chronic fatigue that has left him unable to hike or do other physically demanding activities with his friends. He has well-controlled hypertension and diabetes but has otherwise been healthy. He does not smoke but drinks socially with his friends. Physical exam reveals enlarged nodules that are not tender to palpation. A biopsy is obtained showing a characteristic change in chromosome 18. The regulation of which of the following proteins will be most abnormal in this patient?",
            "answer": "Caspase-9",
            "options": {
                "A": "Caspase-8",
                "B": "Caspase-9",
                "C": "CD15",
                "D": "Cyclin-dependent kinase 4",
                "E": "Ras pathway transcription factors"
            },
            "meta_info": "step1",
            "answer_idx": "B"
        },
        "question": " The regulation of which of the following proteins will be most abnormal in this patient?",
        "gpt_extract_mdeical_info": "1. Patient's age: 54.\n2. Patient's gender: male.\n3. Patient's symptoms: chronic fatigue that has left him unable to hike or do other physically demanding activities with his friends.\n4. Patient's medical history: hypertension and diabetes which are well-controlled.\n5. Patient's lifestyle: does not smoke but drinks socially with his friends.\n6. Physical examination finding: enlarged nodules that are not tender to palpation.\n7. Biopsy result: a characteristic change in chromosome 18.",
        "medical_info_list": {
            "Patient's age": "54.",
            "Patient's gender": "male.",
            "Patient's symptoms": "chronic fatigue that has left him unable to hike or do other physically demanding activities with his friends.",
            "Patient's medical history": "hypertension and diabetes which are well-controlled.",
            "Patient's lifestyle": "does not smoke but drinks socially with his friends.",
            "Physical examination finding": "enlarged nodules that are not tender to palpation.",
            "Biopsy result": "a characteristic change in chromosome 18."
        },
        "id": 109,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling chronically fatigued and can't keep up with hiking or other physical activities like I used to."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 39-year-old man presents to the emergency department because of progressively worsening chest pain and nausea that started at a local bar 30 minutes prior. The pain radiates to the epigastric area. He has a 5-year history of untreated hypertension. He has smoked 1 pack of cigarettes daily for the past 5 years and started abusing cocaine 2 weeks before his emergency room visit. The patient is diaphoretic and in marked distress. What should be the first step in management?",
            "answer": "Reassurance and continuous monitoring",
            "options": {
                "A": "Diltiazem",
                "B": "Labetalol",
                "C": "Nitroglycerin",
                "D": "Propranolol",
                "E": "Reassurance and continuous monitoring"
            },
            "meta_info": "step2&3",
            "answer_idx": "E"
        },
        "question": " What should be the first step in management?",
        "gpt_extract_mdeical_info": "1. Patient age: 39 years old.\n2. Patient gender: male.\n3. Chief complaint: progressively worsening chest pain and nausea that started 30 minutes prior and radiates to the epigastric area.\n4. Medical history: untreated hypertension for 5 years.\n5. Social history: Patient smokes 1 pack of cigarettes daily for the past 5 years and started abusing cocaine 2 weeks before the emergency room visit.\n6. Presenting symptoms: diaphoresis and marked distress.",
        "medical_info_list": {
            "Patient age": "39 years old.",
            "Patient gender": "male.",
            "Chief complaint": "progressively worsening chest pain and nausea that started 30 minutes prior and radiates to the epigastric area.",
            "Medical history": "untreated hypertension for 5 years.",
            "Social history": "Patient smokes 1 pack of cigarettes daily for the past 5 years and started abusing cocaine 2 weeks before the emergency room visit.",
            "Presenting symptoms": "diaphoresis and marked distress."
        },
        "id": 110,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came to the emergency department because I've been experiencing progressively worsening chest pain and nausea that started at a bar about half an hour ago."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 68-year-old man comes to the physician with a 1-week history of painless hematuria. A CT scan of the urinary tract shows areas of bladder wall thickening. Cystoscopy shows several sessile masses with central necrosis arising from the bladder wall. A biopsy specimen of the bladder masses shows moderately differentiated urothelial cells with abundant mitotic figures and nuclear atypia. The patient most likely has a history of exposure to which of the following?",
            "answer": "Aromatic amines",
            "options": {
                "A": "Ionizing radiation",
                "B": "Aromatic amines",
                "C": "Aflatoxins",
                "D": "Vinyl chloride",
                "E": "Radon"
            },
            "meta_info": "step1",
            "answer_idx": "B"
        },
        "question": " The patient most likely has a history of exposure to which of the following?",
        "gpt_extract_mdeical_info": "1. Patient age: 68.\n2. Patient gender: male.\n3. Chief complaint: painless hematuria for 1 week.\n4. Imaging findings: areas of bladder wall thickening seen on CT scan of the urinary tract.\n5. Cystoscopy findings: several sessile masses with central necrosis arising from the bladder wall.\n6. Biopsy results: moderately differentiated urothelial cells with abundant mitotic figures and nuclear atypia.",
        "medical_info_list": {
            "Patient age": "68.",
            "Patient gender": "male.",
            "Chief complaint": "painless hematuria for 1 week.",
            "Imaging findings": "areas of bladder wall thickening seen on CT scan of the urinary tract.",
            "Cystoscopy findings": "several sessile masses with central necrosis arising from the bladder wall.",
            "Biopsy results": "moderately differentiated urothelial cells with abundant mitotic figures and nuclear atypia."
        },
        "id": 111,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing blood in my urine for the past week."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 67-year-old man with transitional cell carcinoma of the bladder comes to the physician because of a 2-day history of ringing sensation in his ear. He received this first course of neoadjuvant chemotherapy 1 week ago. Pure tone audiometry shows a sensorineural hearing loss of 45 dB. The expected beneficial effect of the drug that caused this patient's symptoms is most likely due to which of the following actions?",
            "answer": "Cross-linking of DNA",
            "options": {
                "A": "Inhibition of thymidine synthesis",
                "B": "Inhibition of proteasome",
                "C": "Hyperstabilization of microtubules",
                "D": "Generation of free radicals",
                "E": "Cross-linking of DNA"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " The expected beneficial effect of the drug that caused this patient's symptoms is most likely due to which of the following actions?",
        "gpt_extract_mdeical_info": "1. Patient's age: 67 years old.\n2. Patient's gender: Male.\n3. Patient's medical history: Transitional cell carcinoma of the bladder.\n4. Reason for visit: Ringing sensation in his ear for 2 days.\n5. Treatment received: Neoadjuvant chemotherapy.\n6. Time since receiving chemotherapy: 1 week ago.\n7. Result of pure tone audiometry: Sensorineural hearing loss of 45 dB.",
        "medical_info_list": {
            "Patient's age": "67 years old.",
            "Patient's gender": "Male.",
            "Patient's medical history": "Transitional cell carcinoma of the bladder.",
            "Reason for visit": "Ringing sensation in his ear for 2 days.",
            "Treatment received": "Neoadjuvant chemotherapy.",
            "Time since receiving chemotherapy": "1 week ago.",
            "Result of pure tone audiometry": "Sensorineural hearing loss of 45 dB."
        },
        "id": 112,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been experiencing a ringing sensation in my ear for the past two days."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures?",
            "answer": "Inferior mesenteric artery",
            "options": {
                "A": "Inferior vena cava",
                "B": "Superior mesenteric artery",
                "C": "Inferior mesenteric artery",
                "D": "Celiac artery",
                "E": "Splenic artery"
            },
            "meta_info": "step1",
            "answer_idx": "C"
        },
        "question": " Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures?",
        "gpt_extract_mdeical_info": "1. Patient's age: 10 years old.\n2. Patient's gender: female.\n3. Patient's medical condition: Turner's syndrome.\n4. Imaging study performed on: abdomen.\n5. Abnormality found on imaging: poles of the kidneys fused inferiorly.",
        "medical_info_list": {
            "Patient's age": "10 years old.",
            "Patient's gender": "female.",
            "Patient's medical condition": "Turner's syndrome.",
            "Imaging study performed on": "abdomen.",
            "Abnormality found on imaging": "poles of the kidneys fused inferiorly."
        },
        "id": 113,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I had an imaging study done and they found something unusual with my kidneys."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 65-year-old man is brought to the emergency department 30 minutes after the onset of acute chest pain. He has hypertension and asthma. Current medications include atorvastatin, lisinopril, and an albuterol inhaler. He appears pale and diaphoretic. His pulse is 114/min and blood pressure is 130/88 mm Hg. An ECG shows ST-segment depressions in leads II, III, and aVF. Laboratory studies show an increased serum troponin T concentration. The patient is treated for acute coronary syndrome and undergoes percutaneous transluminal coronary angioplasty. At the time of discharge, echocardiography shows a left ventricular ejection fraction of 58%. In addition to aspirin, which of the following drugs should be added to this patient's medication regimen?",
            "answer": "Clopidogrel",
            "options": {
                "A": "Nifedipine",
                "B": "Enoxaparin",
                "C": "Clopidogrel",
                "D": "Spironolactone",
                "E": "Propranolol\n\""
            },
            "meta_info": "step2&3",
            "answer_idx": "C"
        },
        "question": " In addition to aspirin, which of the following drugs should be added to this patient's medication regimen?",
        "gpt_extract_mdeical_info": "1. Patient's age: 65 years old.\n2. Patient's gender: Not specified. \n3. Reason for visit: Acute chest pain.\n4. Time of onset for chest pain: 30 minutes ago.\n5. Patient's medical history: Hypertension and asthma.\n6. Current medications: Atorvastatin, lisinopril, and an albuterol inhaler.\n7. Patient's appearance: Pale and diaphoretic.\n8. Vital signs: \n   1. Pulse: 114/min.\n   2. Blood pressure: 130/88 mm Hg.\n9. ECG results: ST-segment depressions in leads II, III, and aVF.\n10. Laboratory studies: Increased serum troponin T concentration.\n11. Diagnosis: Acute coronary syndrome.\n12. Treatment: Percutaneous transluminal coronary angioplasty.\n13. Echocardiography results: Left ventricular ejection fraction of 58%.\n14. Discharge status: Not specified.",
        "medical_info_list": {
            "Patient's age": "65 years old.",
            "Patient's gender": "Not specified.",
            "Reason for visit": "Acute chest pain.",
            "Time of onset for chest pain": "30 minutes ago.",
            "Patient's medical history": "Hypertension and asthma.",
            "Current medications": "Atorvastatin, lisinopril, and an albuterol inhaler.",
            "Patient's appearance": "Pale and diaphoretic.",
            "Pulse": "114/min.",
            "Blood pressure": "130/88 mm Hg.",
            "ECG results": "ST-segment depressions in leads II, III, and aVF.",
            "Laboratory studies": "Increased serum troponin T concentration.",
            "Diagnosis": "Acute coronary syndrome.",
            "Treatment": "Percutaneous transluminal coronary angioplasty.",
            "Echocardiography results": "Left ventricular ejection fraction of 58%.",
            "Discharge status": "Not specified."
        },
        "id": 114,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I came to the emergency department because I suddenly started having chest pain."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 5-year-old female is brought to a speech therapist for continuing work on improving her communication skills. She is only able to verbalize two word sentences and has generalized developmental delay. When she was born it was noticed that she had a high pitched mewing cry and subsequent physical exam revealed microcephaly, prominent epicanthal folds, and a holosystolic murmur best heard in the left 5th intercostal space near the sternum. An abnormality of which of the following chromosomes is most likely responsible for this patient's disorder?",
            "answer": "5",
            "options": {
                "A": "5",
                "B": "7",
                "C": "13",
                "D": "18",
                "E": "21"
            },
            "meta_info": "step1",
            "answer_idx": "A"
        },
        "question": " An abnormality of which of the following chromosomes is most likely responsible for this patient's disorder?",
        "gpt_extract_mdeical_info": "1. Age: 5 years old\n2. Gender: Female\n3. Reason for visit: Continuing work on improving communication skills\n4. Speech development: Only able to verbalize two-word sentences\n5. General development: Generalized developmental delay\n6. Birth history: High-pitched mewing cry\n7. Physical examination: Microcephaly, prominent epicanthal folds, holosystolic murmur\n8. Location of murmur: Left 5th intercostal space near the sternum",
        "medical_info_list": {
            "Age": "5 years old",
            "Gender": "Female",
            "Reason for visit": "Continuing work on improving communication skills",
            "Speech development": "Only able to verbalize two-word sentences",
            "General development": "Generalized developmental delay",
            "Birth history": "High-pitched mewing cry",
            "Physical examination": "Microcephaly, prominent epicanthal folds, holosystolic murmur",
            "Location of murmur": "Left 5th intercostal space near the sternum"
        },
        "id": 115,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I'm having trouble speaking and can only say two-word sentences."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 14-year-old girl is brought to the physician by her father because of fever, chills, abdominal pain, and profuse non-bloody diarrhea. Her symptoms began one week ago, when she had several days of low-grade fever and constipation. She returned from Indonesia 2 weeks ago, where she spent the summer with her grandparents. Her temperature is 39.3°C (102.8°F). Examination shows diffuse abdominal tenderness and mild hepatosplenomegaly. There is a faint salmon-colored maculopapular rash on her trunk and abdomen. Which of the following is the most likely causal organism?",
            "answer": "Salmonella typhi",
            "options": {
                "A": "Giardia lamblia",
                "B": "Schistosoma mansoni",
                "C": "Campylobacter jejuni",
                "D": "Salmonella typhi",
                "E": "Clostridium perfringens"
            },
            "meta_info": "step1",
            "answer_idx": "D"
        },
        "question": " Which of the following is the most likely causal organism?",
        "gpt_extract_mdeical_info": "1. Patient's age: 14 years old.\n2. Patient's gender: Female.\n3. Chief complaint: Fever, chills, abdominal pain, and profuse non-bloody diarrhea.\n4. Duration of symptoms: Symptoms began one week ago.\n5. Additional symptoms: Low-grade fever, constipation, diffuse abdominal tenderness, and mild hepatosplenomegaly.\n6. Recent travel history: Returned from Indonesia 2 weeks ago.\n7. Rash: Faint salmon-colored maculopapular rash on trunk and abdomen.\n8. Vital signs: Temperature of 39.3°C (102.8°F).\n9. Laboratory studies: None mentioned in the given information.",
        "medical_info_list": {
            "Patient's age": "14 years old.",
            "Patient's gender": "Female.",
            "Chief complaint": "Fever, chills, abdominal pain, and profuse non-bloody diarrhea.",
            "Duration of symptoms": "Symptoms began one week ago.",
            "Additional symptoms": "Low-grade fever, constipation, diffuse abdominal tenderness, and mild hepatosplenomegaly.",
            "Recent travel history": "Returned from Indonesia 2 weeks ago.",
            "Rash": "Faint salmon-colored maculopapular rash on trunk and abdomen.",
            "Vital signs": "Temperature of 39.3°C (102.8°F).",
            "Laboratory studies": "None mentioned in the given information."
        },
        "id": 116,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling feverish with chills, abdominal pain, and a lot of diarrhea since last week."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 43-year-old man comes to the emergency department with nausea, abdominal discomfort, diarrhea, and progressive perioral numbness for the past 24 hours. 3 days ago, he underwent a total thyroidectomy for treatment of papillary thyroid cancer. His only medication is a multivitamin supplement. He appears fatigued. While measuring the patient's blood pressure, the nurse observes a spasm in the patient's hand. Physical examination shows a well-healing surgical wound on the neck. Which of the following ECG findings are most likely in this patient?",
            "answer": "QT prolongation",
            "options": {
                "A": "Torsade de pointes",
                "B": "QT prolongation",
                "C": "U waves",
                "D": "Peaked T waves",
                "E": "PR prolongation"
            },
            "meta_info": "step1",
            "answer_idx": "B"
        },
        "question": " Which of the following ECG findings are most likely in this patient?",
        "gpt_extract_mdeical_info": "1. Age: 43-year-old\n2. Gender: male\n3. Chief complaint: nausea, abdominal discomfort, diarrhea, and progressive perioral numbness\n4. Medical history: total thyroidectomy for treatment of papillary thyroid cancer\n5. Medication: multivitamin supplement\n6. Appearance: fatigued\n7. Vital signs: blood pressure measurement with spasm in the patient's hand\n8. Physical examination: well-healing surgical wound on the neck",
        "medical_info_list": {
            "Age": "43-year-old",
            "Gender": "male",
            "Chief complaint": "nausea, abdominal discomfort, diarrhea, and progressive perioral numbness",
            "Medical history": "total thyroidectomy for treatment of papillary thyroid cancer",
            "Medication": "multivitamin supplement",
            "Appearance": "fatigued",
            "Vital signs": "blood pressure measurement with spasm in the patient's hand",
            "Physical examination": "well-healing surgical wound on the neck"
        },
        "id": 117,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I've been feeling nauseous with abdominal discomfort, diarrhea, and a numbness around my mouth that's been getting worse since yesterday."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affecting the opposite leg one year ago and was diagnosed with a thrombus in the right femoral vein. On examination, the left leg is erythematous and swollen. Passive dorsiflexion of the left ankle elicits pain in the left calf. Ultrasound of the leg reveals a thrombus in the left popliteal vein. A genetic workup reveals that she has an inherited condition. What is the most likely pathophysiology of this patient’s condition?",
            "answer": "Resistance to clotting factor degradation",
            "options": {
                "A": "Elevated serum homocysteine",
                "B": "Thrombin inhibitor deficiency",
                "C": "Deficiency in protein C",
                "D": "Auto-antibodies directed against phospholipids",
                "E": "Resistance to clotting factor degradation"
            },
            "meta_info": "step1",
            "answer_idx": "E"
        },
        "question": " What is the most likely pathophysiology of this patient’s condition?",
        "gpt_extract_mdeical_info": "1. Patient's age: 35.\n2. Patient's gender: female.\n3. Main symptom: unilateral leg swelling with redness and pain on left side.\n4. Medical history: a previous episode of thrombus in the right femoral vein one year ago.\n5. Medications: none.\n6. Recent travel: denied.\n7. Physical examination findings: erythematous and swollen left leg, pain in left calf upon passive dorsiflexion of left ankle.\n8. Diagnostic result: ultrasound showing a thrombus in the left popliteal vein.\n9. Genetic workup result: positive for an inherited condition.",
        "medical_info_list": {
            "Patient's age": "35.",
            "Patient's gender": "female.",
            "Main symptom": "unilateral leg swelling with redness and pain on left side.",
            "Medical history": "a previous episode of thrombus in the right femoral vein one year ago.",
            "Medications": "none.",
            "Recent travel": "denied.",
            "Physical examination findings": "erythematous and swollen left leg, pain in left calf upon passive dorsiflexion of left ankle.",
            "Diagnostic result": "ultrasound showing a thrombus in the left popliteal vein.",
            "Genetic workup result": "positive for an inherited condition."
        },
        "id": 118,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I have developed painful swelling and redness in my left leg earlier today."
            }
        ]
    },
    {
        "raw_data": {
            "question": "A 2-year-old girl with recurrent urinary tract infections is brought to the physician for a follow-up examination. Renal ultrasound shows bilateral dilation of the renal pelvis. A voiding cystourethrography shows retrograde flow of contrast into the ureters during micturition. Histologic examination of a kidney biopsy specimen is most likely to show which of the following findings?",
            "answer": "Cortical thinning with tubular atrophy",
            "options": {
                "A": "Diffuse interstitial infiltration with T lymphocytes",
                "B": "Glomerular crescents with macrophages",
                "C": "Matrix expansion with mesangial proliferation",
                "D": "Cortical thinning with tubular atrophy",
                "E": "Thickened glomerular capillary loops"
            },
            "meta_info": "step1",
            "answer_idx": "D"
        },
        "question": " Histologic examination of a kidney biopsy specimen is most likely to show which of the following findings?",
        "gpt_extract_mdeical_info": "1. Patient's age: 2 years old.\n2. Patient's gender: female.\n3. Medical history: recurrent urinary tract infections.\n4. Radiology findings: bilateral dilation of the renal pelvis on renal ultrasound and retrograde flow of contrast into the ureters during micturition on voiding cystourethrography.",
        "medical_info_list": {
            "Patient's age": "2 years old.",
            "Patient's gender": "female.",
            "Medical history": "recurrent urinary tract infections.",
            "Radiology findings": "bilateral dilation of the renal pelvis on renal ultrasound and retrograde flow of contrast into the ureters during micturition on voiding cystourethrography."
        },
        "id": 119,
        "dataset": "MedQA",
        "history": [
            {
                "doctor": "Hello, I'm your doctor. How can I help you today?",
                "state": "O",
                "patient": "I keep getting urinary tract infections and my doctor is checking on my kidneys."
            }
        ]
    },
    {
        "zid": "d95f1158-fa4b-4229-98c5-40f4dc2bacec",
        "raw_data": {
            "question": "A 3.5 kg male infant born at term after an uncomplicated pregnancy and delivery develops respiratory distress sholy after bih and requires mechanical ventilation. The chest radiograph reveals a normal cardiothymic silhouette but a diffuse ground glass appearance to the lung fields. Surfactant replacement fails to improve gas exchange. Over the first week life, the hypoxemia worsens. Results of routing culture and echocardiographic findings are negative. A term female sibling died at 1 month of age with respiratory distress. Which of the following is the most likely diagnosis?",
            "answer": "Neonatal pulmonary alveolar proteinosis",
            "options": {
                "A": "Neonatal pulmonary alveolar proteinosis",
                "B": "Meconium aspiration",
                "C": "Total anomalous pulmonary venous return",
                "D": "Disseminated herpes simplex infection"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 120,
        "history": [
            {
                "patient": "I'm experiencing difficulty breathing shortly after birth and my condition is not improving despite treatment.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "9a704b1d-b36c-4f55-b1f1-89af27e8c346",
        "raw_data": {
            "question": "A 27 years old pregnant lady comes with severe jaundice and altered sensorium. On examination, the patient is deeply icteric, not responding to commands and pelvic sonogram reveals intrauterine fetal death. Serum bilirubin levels are 28.8 mg/dL (direct = 18.6 mg/dL), AST levels are 1063 and ALT levels are 1191. The viral markers are as follows. What is the likely diagnosis?Anti-HAV IgGReactiveAnti-HAV IgMNonreactiveHbSAgNon reactiveAnti-HbSAgNonreactiveAnti-HBc IgMNonreactiveAnti-HBc IgGReactiveAnti-HCV IgGNonreactiveAnti-HEV IgMReactiveAnti-HEV IgGNon reactive",
            "answer": "Fulminant hepatitis due to hepatitis E infection",
            "options": {
                "A": "Acute hepatitis E superimposed on chronic liver failure due to hepatitis B",
                "B": "Fulminant hepatitis due to hepatitis B infection",
                "C": "Acute hepatitis E with chronic hepatitis A",
                "D": "Fulminant hepatitis due to hepatitis E infection"
            },
            "answer_idx": "D"
        },
        "question": " What is the likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 121,
        "history": [
            {
                "patient": "I'm feeling extremely unwell with intense yellowing of my skin and eyes, and I'm having trouble staying alert and responding to people around me.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "18d0dc33-09df-4256-b62f-51390ede8e4d",
        "raw_data": {
            "question": "A 50-year-old male presented with complains of ptosis, difficulty in chewing and occasional difficulty in swallowing. There is no history of diplopia or visual loss. On examination, there is symmetric ptosis and mild restriction of extraocular muscle movement with finger abduction test 60deg. Nerve conduction study shows decremental response in orbicularis only. ERG revealed a myopathic pattern. Anti-AchR radioimmunoassay was negative. The most probable diagnosis would be:",
            "answer": "Generalized myasthenia gravis",
            "options": {
                "A": "Ocular myasthenia gravis",
                "B": "Generalized myasthenia gravis",
                "C": "As anti-ACHR is negative you will consider an alternative diagnosis",
                "D": "Chronic progressive external ophthalmoplegia (CPEO)"
            },
            "answer_idx": "B"
        },
        "question": " The most probable diagnosis would be:",
        "dataset": "MedMCQA",
        "id": 122,
        "history": [
            {
                "patient": "I have been experiencing drooping eyelids, difficulty in chewing, and occasional trouble swallowing.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "36dd849c-4867-4ca6-8f5e-c8419e4634bb",
        "raw_data": {
            "question": "A boy presented with a history of fever, headache and vomiting since 3 days and disorientation since I day. On examination, neck rigidity was positive. He also had 1 episode of generalized tonic clonic seizures (GTC) and then he became unconscious. CECT was found to be normal. CSF examination reveals a cell count of 300 cells/mm3 (polymorphs: 50-70%), protein 70 mg/dL, sugar 50 mg/dL (blood: 95 mg/dL). Which of the following is the most likely diagnosis?",
            "answer": "Pyogenic meningitis",
            "options": {
                "A": "Pyogenic meningitis",
                "B": "Tubercular meningitis",
                "C": "Herpes encephalitis",
                "D": "Cerebral malaria"
            },
            "answer_idx": "A"
        },
        "question": " Which of the following is the most likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 123,
        "history": [
            {
                "patient": "I've been experiencing fever, headache, vomiting, disorientation, and a seizure recently.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "4f2920dd-315c-4f5a-9208-80a4c443ceab",
        "raw_data": {
            "question": "A 50 years old lady, who has a known diagnosis of bronchial asthma, presented to the AIIMS emergency with complaints of severe breathlessness, diaphoresis and wheezing. On examination, you find that the patient is conscious with a respiratory rate of 30 per minute, blood pressure of 96/64 mm Hg and a pulse rate of 144 per minute. An aerial blood gas analysis showed a pH of 7.2, p02 of 50 mm Hg and pCO, of 70 mm Hg. How will you manage the patient?",
            "answer": "Ventilation with continuous positive airway pressure",
            "options": {
                "A": "Ventilation with continuous positive airway pressure",
                "B": "Oxygen supplementation by nasal mask",
                "C": "Mechanical ventilation with controlled ventilation",
                "D": "Intubation"
            },
            "answer_idx": "A"
        },
        "question": " How will you manage the patient?",
        "dataset": "MedMCQA",
        "id": 124,
        "history": [
            {
                "patient": "I came to the emergency room because I'm experiencing severe breathlessness, sweating a lot, and hearing a wheezing sound when I breathe.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "26f30f24-dcd8-453d-8553-9ee82ad496e1",
        "raw_data": {
            "question": "A 62 years old woman presented with acute onset confusion and bumping into th ings. On examination, she was ale, oriented with fluent speech and normal comprehension. Fuher examination revealed impaired writing (acalculia), right-left confusion, impaired arithmetic abilities, difficulty in finger identification. MRI demonstrated foci of coical and sub coical increase T2 signals and areas of leptomeningeal enhancement. Most likely diagnosis:",
            "answer": "Gerstmann's syndrome",
            "options": {
                "A": "Gerstmann's syndrome",
                "B": "Millard-Gubler syndrome",
                "C": "Anton syndrome",
                "D": "Korsakoff's psychosis"
            },
            "answer_idx": "A"
        },
        "question": " Most likely diagnosis:",
        "dataset": "MedMCQA",
        "id": 125,
        "history": [
            {
                "patient": "I am feeling confused and keep bumping into things.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "fda4a6bd-3eb5-4641-88da-513b72c1d320",
        "raw_data": {
            "question": "A young healthy male patient presented with abdominal pain and history of altered bowel habits from the last 6 months. On CT examination, there was dilated distal pa of ileum, thickened ileocecal junction with thickened cecum with presence of sacculations on the antimesenteric border. The vascularity of adjoining mesentery is also increased and there is surrounding mesentery fat. Which of the following is not a differential diagnosis?",
            "answer": "Ischemic bowel disease",
            "options": {
                "A": "Ulcerative colitis",
                "B": "Crohn's disease",
                "C": "Tuberculosis",
                "D": "Ischemic bowel disease"
            },
            "answer_idx": "D"
        },
        "question": " Which of the following is not a differential diagnosis?",
        "dataset": "MedMCQA",
        "id": 126,
        "history": [
            {
                "patient": "I've been experiencing abdominal pain and changes in my bowel habits for the last six months.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "0ab83c33-04bd-468e-804e-50dce1bdfa19",
        "raw_data": {
            "question": "A 55 years old male patient presents with 4 cm x 5 cm lump in right neck. FNAC assessment revealed it to be a squamous cell carcinoma. Clinical assessment of the oral cavity, pharynx, hypopharynx and larynx did not yield any tumor. Whole body PET scan did not show any increased uptake except for the neck mass. A diagnosis of unknown primary was made. According to AJCC system of classification, the TNM status of the tumor would be:",
            "answer": "TxN2aMx",
            "options": {
                "A": "T1N2M0",
                "B": "TON2aMO",
                "C": "T1N2aMO",
                "D": "TxN2aMx"
            },
            "answer_idx": "D"
        },
        "question": " According to AJCC system of classification, the TNM status of the tumor would be:",
        "dataset": "MedMCQA",
        "id": 127,
        "history": [
            {
                "patient": "I have a lump in my right neck.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "74af945a-56c6-4b18-935d-388c29f19a56",
        "raw_data": {
            "question": "An 8–day old breast–fed baby presents with vomiting, poor feeding and loose stools. On examination the heart rate is 190/minute, blood pressure 50/30 mmHg, respiratory rate 72 breaths/minute and capillary refill time of 4 seconds. Investigations show hemoglobin level of 15 g/dl. Na 120 mEq/l, K 6.8 mEq/l, Cl 81 meq/l, bicarbonate 15 mEq/l, urea 30 mg/dl and creatinine 0.6 mg/dl. the most likely diagnosis is –",
            "answer": "Acute tubular necrosis",
            "options": {
                "A": "Congenital adrenal hyperplasia",
                "B": "Acute tubular necrosis",
                "C": "Congenital hypertrophic pyloric stenosis",
                "D": "Galactosemia"
            },
            "answer_idx": "B"
        },
        "question": " the most likely diagnosis is –",
        "dataset": "MedMCQA",
        "id": 128,
        "history": [
            {
                "patient": "I've been vomiting, not feeding well, and having loose stools.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "849108f1-8775-44ab-982d-c8907f399efc",
        "raw_data": {
            "question": "A 16-year old girl was brought with primary amenorrhea. Her mother mentioned that she staed developing breast at the age of 12. She was prescribed OCPs 2 years back by a doctor with no effect. She was having normal stature and was a football player. On examination, breasts were well developed (Tanner's stage 5) and pubic hair was minimal (Tanner's stage 1). What is the most probable diagnosis?",
            "answer": "Androgen insensitivity",
            "options": {
                "A": "Premature ovarian failure",
                "B": "Turner's syndrome",
                "C": "Miillerian agenesis",
                "D": "Androgen insensitivity"
            },
            "answer_idx": "D"
        },
        "question": " What is the most probable diagnosis?",
        "dataset": "MedMCQA",
        "id": 129,
        "history": [
            {
                "patient": "I'm concerned because I haven't started menstruating yet.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "f2bb0a0b-b19d-41d8-9435-36d7eab51d07",
        "raw_data": {
            "question": "A 55-year-old male presents with renal failure. He gives a history of mild bone pains for the last 7 years. X-ray pelvis shows osteolytic lesions. Serum electrophoresis reveals a M spike. Peripheral blood evaluation showed rouleaux formation of RBCs with 35% plasma cells. Bone marrow examination showed a increase in plasma cells with aberrant antigen expression. The most likely diagnosis is:",
            "answer": "Multiple myeloma",
            "options": {
                "A": "Multiple myeloma",
                "B": "Monoclonal gammopathy with unknown significance",
                "C": "Smouldering myeloma",
                "D": "Plasma cell leukemia"
            },
            "answer_idx": "A"
        },
        "question": " The most likely diagnosis is:",
        "dataset": "MedMCQA",
        "id": 130,
        "history": [
            {
                "patient": "I've been experiencing mild bone pains for several years.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "13c88190-2ea3-4939-87e3-5d4752552fcf",
        "raw_data": {
            "question": "A 6 days old neonate weighing 2800 gm (bih weight 3200 gm) was brought with the complaints of fever, poor feeding and poor activity. There was no history of vomiting or diarrhea. Axillary temperature was 39degC with depressed fontenalle, sunken eyes, decreased urine output and decreased skin turgor. Her mother has the history of decreased milk production. What is your diagnosis?",
            "answer": "Neonatal sepsis",
            "options": {
                "A": "Neonatal sepsis",
                "B": "Galactosemia",
                "C": "Fever & dehydration",
                "D": "Acute renal failure"
            },
            "answer_idx": "A"
        },
        "question": " What is your diagnosis?",
        "dataset": "MedMCQA",
        "id": 131,
        "history": [
            {
                "patient": "I'm feeling feverish, not feeding well, and my energy is low.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "d3b541c9-d300-4ced-9a2c-c64eaa672ff0",
        "raw_data": {
            "question": "A 6–month old boy weighing 3.2 kg presents with recurrent vomiting and polyuria. Investigations show blood area 60 mg/dl creatinine 0.7 mg/dL, calcium 12.8 mg/dL, phosphate 3 mg/dL, pH 7.45, bicarbonate 25 mEq/L and PTH 140 pg ml (normal <60 pg/ml). Daily urinary calcium excretion is reduced. Ultrasound abdomen show bilateral nephrocalcinosis. The most likely diagnosis is –",
            "answer": "Mutation of the calcium sensing receptor",
            "options": {
                "A": "Bartter syndrome",
                "B": "Mutation of the calcium sensing receptor",
                "C": "Ps eudo–ps eudohypoparathyroidism",
                "D": "Parathyroid adenoma"
            },
            "answer_idx": "B"
        },
        "question": " The most likely diagnosis is –",
        "dataset": "MedMCQA",
        "id": 132,
        "history": [
            {
                "patient": "I've been experiencing recurrent vomiting and peeing a lot.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "38eb248f-7849-45e2-ac3c-6cb74c930f3e",
        "raw_data": {
            "question": "A Young Male complained of intermittent pain , swelling and discharge at the base of spine. He also had episodes of fever and repeated abscesses that had burst spontaneously , in recent past. By occupation , he is a jeep driver. On physical examination, diagnosis of pilonidal sinus was made. Which flap-based procedure is used for pilonidal sinus surgery?",
            "answer": "Rhomboid flap",
            "options": {
                "A": "Rhomboid flap",
                "B": "Circular flap",
                "C": "Free flap",
                "D": "Rotational flap"
            },
            "answer_idx": "A"
        },
        "question": " Which flap-based procedure is used for pilonidal sinus surgery?",
        "dataset": "MedMCQA",
        "id": 133,
        "history": [
            {
                "patient": "I've been experiencing intermittent pain, swelling, and discharge at the base of my spine, along with episodes of fever and repeated abscesses that have burst on their own.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "0f49668c-7988-48a6-ba11-ad49aa561259",
        "raw_data": {
            "question": "A man presents it n rashes on face and also complains of decreased mental function. He is also having few macular lesions on his skin. On CT scan, intracranial calcification was seen. His wife is normal. His 10-year old daughter is also normal but his 6-year old son is also having similar skin lesions. What would be the most likely diagnosis?",
            "answer": "Autosomal dominant inheritance",
            "options": {
                "A": "Neurofibrornatosis-1",
                "B": "Neurofibromatosis-2",
                "C": "Xeroderma pigmentosum",
                "D": "Autosomal dominant inheritance"
            },
            "answer_idx": "D"
        },
        "question": " What would be the most likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 134,
        "history": [
            {
                "patient": "I have rashes on my face, decreased mental function, and some spots on my skin.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "f1cbc766-a7ea-44ec-ba8b-997ffc3a028a",
        "raw_data": {
            "question": "3.5 kg term male baby, born of uncomplicated pregnancy, developed, respiratory distress at birth, not responded to surfactant, ECHO finding revealed nothing abnormal, X–ray showed ground glass appearance and culture negative. Apgars 4 and 5 at 1 and 5 minutes. History of one month female sibling died before. What is the diagnosis ?",
            "answer": "Neonatal pulmonary alveolar proteinosis",
            "options": {
                "A": "TAPVC",
                "B": "Meconium aspiration",
                "C": "Neonatal pulmonary alveolar proteinosis",
                "D": "Diffuse herpes simplex infection"
            },
            "answer_idx": "C"
        },
        "question": " What is the diagnosis ?",
        "dataset": "MedMCQA",
        "id": 135,
        "history": [
            {
                "patient": "I'm having trouble breathing since I was born.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "ccca9015-2ce5-40cf-bed4-187f9428d984",
        "raw_data": {
            "question": "A 55 yr old patient presented to the opd with complaint of pain in back. On examination his limbs seemed to be bent with overlying warm and thick skin. Patient also complain of decreased hearing over a few days. On biochemical analysis his serum ALP was raised. X-ray obtained showed the following features. Most probable diagnosis?",
            "answer": "Pagets disease",
            "options": {
                "A": "Osteoporosis",
                "B": "Osteopetrosis",
                "C": "Pagets disease",
                "D": "Renal osteodystrophy"
            },
            "answer_idx": "C"
        },
        "question": " Most probable diagnosis?",
        "dataset": "MedMCQA",
        "id": 136,
        "history": [
            {
                "patient": "I came in because I've been experiencing pain in my back and I've noticed that my hearing has decreased over the past few days.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "ce7d3beb-17f5-416a-9584-6fdf807f4d99",
        "raw_data": {
            "question": "A 24 years old female presented with patchy hair loss in the right temporal and occipital region. Examination revealed non- scarring alopecia with multiple small broken hairs. Scrapings from scalp showed mild inflammation, peri-follicular hemorrhage and surrounding mild lymphocytic infiltration. What is the most likely diagnosis?",
            "answer": "Trichotillomania",
            "options": {
                "A": "Alopecia areata",
                "B": "Androgenic alopecia",
                "C": "Loose anagen hair",
                "D": "Trichotillomania"
            },
            "answer_idx": "D"
        },
        "question": " What is the most likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 137,
        "history": [
            {
                "patient": "I've been experiencing hair loss in patches on the right side of my head.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "234d826f-4a7b-4fd1-9799-b1a3602355fe",
        "raw_data": {
            "question": "A 25 years old unidentified male from roadside was brought by police to emergency room with disorientation, altered sensorium and vomiting. He had a BP of 90/70 mm Hg, hea rate of 110/min, temperature -36.4degC and respiratory rate of 11/min. On examination, he had bilateral pin-point pupils. What is the most probable diagnosis?",
            "answer": "Opioid poisoning",
            "options": {
                "A": "Pontine hemorrhage",
                "B": "Hypothermia",
                "C": "Dhatura poisonine",
                "D": "Opioid poisoning"
            },
            "answer_idx": "D"
        },
        "question": " What is the most probable diagnosis?",
        "dataset": "MedMCQA",
        "id": 138,
        "history": [
            {
                "patient": "I'm feeling confused, disoriented, and I've been vomiting.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "4cbe210a-0779-4ba7-b599-e9b89fa5a0b1",
        "raw_data": {
            "question": "A 5-year-old child from a rural area presented to the OPD with pustular lesions on the lower legs. The cuture from the lesion showed hemolytic colonies on the blood agar which were Gram-positive cocci. Which of the following reactions would help to provisionally confirm the diagnosis of group A streptococcal pyoderma?",
            "answer": "Bacitracin sensitivity",
            "options": {
                "A": "Optochin sensitivity",
                "B": "Bacitracin sensitivity",
                "C": "Catalase positivity",
                "D": "Bile solubility"
            },
            "answer_idx": "B"
        },
        "question": " Which of the following reactions would help to provisionally confirm the diagnosis of group A streptococcal pyoderma?",
        "dataset": "MedMCQA",
        "id": 139,
        "history": [
            {
                "patient": "I have some sores with pus on my lower legs.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "605c9835-95d4-4a5e-b400-09bf38e75e4c",
        "raw_data": {
            "question": "An adolescent school girl complaints of dropping objects from hands, it gets precipitated during morning and during exams. There is no history of loss of consciousness and her cousin sister has been diagnosed with epilepsy. EEG was done and was suggestive of epileptic spikes. What is the diagnosis?",
            "answer": "Juvenile myoclonic epilepsy",
            "options": {
                "A": "Juvenile myoclonic epilepsy",
                "B": "Atypical absence",
                "C": "Choreo - athetoid epilepsy",
                "D": "Centrotemporal spikes"
            },
            "answer_idx": "A"
        },
        "question": " What is the diagnosis?",
        "dataset": "MedMCQA",
        "id": 140,
        "history": [
            {
                "patient": "I've been dropping objects from my hands, especially in the morning and during exams.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "20f29076-98f9-479b-a77b-96fae28d5689",
        "raw_data": {
            "question": "A 48 years old female presents with seizure, recurrent gross hematuria and left flank abdominal pain. Abdominal CT reveals left perinephric hematoma with 3 cm angiomyolipoma along with multiple right renal angiomyolipoma measuring 1.5 to 6.5 cm. What would be the most probable diagnosis?",
            "answer": "Tuberous sclerosis",
            "options": {
                "A": "VHL syndrome",
                "B": "Autosomal dominant polycystic kidney disease",
                "C": "Tuberous sclerosis",
                "D": "Hereditary angiolipoma"
            },
            "answer_idx": "C"
        },
        "question": " What would be the most probable diagnosis?",
        "dataset": "MedMCQA",
        "id": 141,
        "history": [
            {
                "patient": "I've been experiencing seizures, seeing blood in my urine, and feeling pain in my left side.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "f9739409-2790-47a9-80b7-98c70f0bcc16",
        "raw_data": {
            "question": "A two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –",
            "answer": "Rett's syndrome",
            "options": {
                "A": "Asperger's syndrome",
                "B": "Rett's syndrome",
                "C": "Fragile x–syndrome",
                "D": "Colarad syndrome"
            },
            "answer_idx": "B"
        },
        "question": " The most likely diagnosis is –",
        "dataset": "MedMCQA",
        "id": 142,
        "history": [
            {
                "patient": "I'm concerned because my two-year-old daughter has been showing unusual repetitive hand movements, seems to be struggling with her language and communication, has episodes where she stops breathing for a bit, isn't interacting well with others, and her head growth has slowed down since she was six months old.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "b3eb29e7-c094-4225-8379-8e4341a621a6",
        "raw_data": {
            "question": "A patient comes to ED with fever and headache. On examination he has neck stiffness. CSF analysis was done:- Parameter Finding Normal range Glucose (mg/dl) 55 50-80 Protein (g/L) 0.50 0.18-0.45 ICT (cmH2O) 35 5-20 WBC 25 (predominantly lymphocytes) <5 Most likely diagnosis is-",
            "answer": "Coxsackie",
            "options": {
                "A": "TB",
                "B": "N. Gonorrhea",
                "C": "Cryptococcus",
                "D": "Coxsackie"
            },
            "answer_idx": "D"
        },
        "question": "45 ICT (cmH2O) 35 5-20 WBC 25 (predominantly lymphocytes) <5 Most likely diagnosis is-",
        "dataset": "MedMCQA",
        "id": 143,
        "history": [
            {
                "patient": "I came to the emergency department because I have a fever and a headache.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "baacab5b-7e28-4b0d-b78e-73253e5c7dde",
        "raw_data": {
            "question": "A young marathon runner is paicipating in a marathon competition. After running for 100 m, he develops at the anteromedial aspect of tibia which was mild to sta with, but increased on fuher running. X ray was normal. The doctor ordered a bonescan. What is the likely diagnosis?",
            "answer": "Shin splint",
            "options": {
                "A": "Lisfranc fracture",
                "B": "Jones fracture",
                "C": "Shin splint",
                "D": "Nutcracker fracture"
            },
            "answer_idx": "C"
        },
        "question": " What is the likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 144,
        "history": [
            {
                "patient": "I started feeling pain at the anteromedial aspect of my tibia after running 100 meters, which got worse as I continued running.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "b0f5d8eb-eda4-48a2-ad59-d158d8132c16",
        "raw_data": {
            "question": "A pregnant female delivered a baby with normal expulsion of an intact placenta. After half hour she staed bleeding per vaginaly. On examination she was hypotensive and boggy mass is palpated per abdomen. USG showed retained placental tissues. what is the likely diagnosis?",
            "answer": "Placenta succenturiata",
            "options": {
                "A": "Placenta succenturiata",
                "B": "Adenomyosis",
                "C": "Placenta accreta",
                "D": "Membranous placenta"
            },
            "answer_idx": "A"
        },
        "question": " what is the likely diagnosis?",
        "dataset": "MedMCQA",
        "id": 145,
        "history": [
            {
                "patient": "I just had a baby and now I'm bleeding vaginally and feeling very weak.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "da743fb8-1db4-4fee-9e20-351d78dc60c9",
        "raw_data": {
            "question": "Presented edema, oliguria and frothy urine. He has no past history of similar complaints. On examination, his urine was positive for 3+ proteinuria, no RBCs/WBCs and no casts. His serum albumin was 2.5 gm/L and serum creatinine was 0.5 mg/dL. The most likely diagnosis is:",
            "answer": "Minimal change disease",
            "options": {
                "A": "Minimal change disease",
                "B": "IgA nephropathy",
                "C": "Interstitial nephritis",
                "D": "Membranous nephropathy"
            },
            "answer_idx": "A"
        },
        "question": " The most likely diagnosis is:",
        "dataset": "MedMCQA",
        "id": 146,
        "history": [
            {
                "patient": "I've been experiencing swelling, producing less urine than usual, and my urine is foamy.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "cfb81145-9c8a-41bf-975a-bd76f75be629",
        "raw_data": {
            "question": "Hypereosinophilic syndrome is a disease characterized by elevated eosinophil count in the blood for at least 6 months, without any recognizable cause, with involve-ment of either hea, nervous system or bone marrow. What should be the eosinophil count for diagnosis?",
            "answer": ">1500/ mm3",
            "options": {
                "A": ">500/mm3",
                "B": ">1000/ mm3",
                "C": ">1500/ mm3",
                "D": ">2000/ mm3"
            },
            "answer_idx": "C"
        },
        "question": " What should be the eosinophil count for diagnosis?",
        "dataset": "MedMCQA",
        "id": 147,
        "history": [
            {
                "patient": "I've been feeling unwell and I'm concerned about my high eosinophil count that has persisted for some time.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "c6f6754f-21ac-49d0-b8cd-8bf25049d813",
        "raw_data": {
            "question": "Elderly female present with pain and swelling in the thigh. Xray shows multiple lytic lesions in distal femur with no periosteal reaction. Aspirate from the swelling shows homogenous serosanguinous fluid with RBCs. Which investigation can confirm the diagnosis?",
            "answer": "S. PTH levels",
            "options": {
                "A": "S. Calcium levels",
                "B": "S. PTH levels",
                "C": "MRI",
                "D": "CD1a IHC"
            },
            "answer_idx": "B"
        },
        "question": " Which investigation can confirm the diagnosis?",
        "dataset": "MedMCQA",
        "id": 148,
        "history": [
            {
                "patient": "I came in because I'm experiencing pain and swelling in my thigh.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    },
    {
        "zid": "7d3de981-356d-475d-b469-5cdfa0190f93",
        "raw_data": {
            "question": "A young girl with the diagnosis of acute promyelocytic leukemia (APML) was treated medically. On day 3 of treatment, she developed tachypnea and fever. Chest X-ray shows bilateral pulmonary infiltrates. Which of the follow ing drug should be given next?",
            "answer": "Doxorubicin",
            "options": {
                "A": "Dexamethasone",
                "B": "Cytarabine",
                "C": "Dacarbazine",
                "D": "Doxorubicin"
            },
            "answer_idx": "D"
        },
        "question": " Which of the follow ing drug should be given next?",
        "dataset": "MedMCQA",
        "id": 149,
        "history": [
            {
                "patient": "I'm breathing fast and have a fever.",
                "state": "O",
                "doctor": "Hello, I'm your doctor. How can I help you today?"
            }
        ]
    }
]