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stellalisy

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[ "A 68-year-old man comes to the physician for a routine health maintenance examination.", "He has had increasing shortness of breath and a productive cough for the past 1 year.", "He can walk up a flight of stairs without stopping.", "He has hypertension and his only medication is amlodipine.", "He has a history of asthma during childhood.", "He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago.", "He used to work at a shipyard and retired 5 years ago.", "His pulse is 98/min, respirations are 25/min and blood pressure is 134/88 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 93%.", "Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "Cardiac examination shows no murmurs, rubs, or gallops.", "Spirometry shows an FEV1:FVC ratio of 63% and an FEV1 of 65% of predicted.", "His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted." ]

[ "1. A 68-year-old man comes to the physician for a routine health maintenance examination.", "2. He has had increasing shortness of breath and a productive cough for the past 1 year.", "3. He can walk up a flight of stairs without stopping.", "4. He has hypertension and his only medication is amlodipine.", "5. He has a history of asthma during childhood.", "6. He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago.", "7. He used to work at a shipyard and retired 5 years ago.", "8. His pulse is 98/min.", "9. Respirations are 25/min.", "10. Blood pressure is 134/88 mm Hg.", "11. Pulse oximetry on room air shows an oxygen saturation of 93%.", "12. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "13. Cardiac examination shows no murmurs, rubs, or gallops.", "14. Spirometry shows an FEV1:FVC ratio of 63%.", "15. FEV1 is 65% of predicted.", "16. His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted." ]

[ "1. He has had increasing shortness of breath and a productive cough for the past 1 year.", "2. He can walk up a flight of stairs without stopping.", "3. He has hypertension and his only medication is amlodipine.", "4. He has a history of asthma during childhood.", "5. He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago.", "6. He used to work at a shipyard and retired 5 years ago.", "7. His pulse is 98/min, respirations are 25/min and blood pressure is 134/88 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 93%.", "9. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "10. Cardiac examination shows no murmurs, rubs, or gallops.", "11. Spirometry shows an FEV1:FVC ratio of 63% and an FEV1 of 65% of predicted.", "12. His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted." ]

[ "A 9-year-old boy presents to his orthopedic surgeon for ongoing evaluation of his lower extremity deformities.", "Specifically, his hips have been dislocating over the last year despite bracing in hip-knee-ankle-foot orthoses.", "He is paralyzed from below the L2 nerve root and has difficulty with both bladder and bowel incontinence.", "He has had these abnormalities since birth due to a lower back lesion that required surgical closure during infancy." ]

[ "1. A 9-year-old boy presents to his orthopedic surgeon.", "2. His hips have been dislocating over the last year.", "3. He has been wearing hip-knee-ankle-foot orthoses.", "4. He is paralyzed from below the L2 nerve root.", "5. He has difficulty with bladder and bowel incontinence.", "6. He has had these abnormalities since birth.", "7. He had a lower back lesion that required surgical closure during infancy." ]

[ "1. His hips have been dislocating over the last year.", "2. Dislocation occurred despite bracing in hip-knee-ankle-foot orthoses.", "3. He is paralyzed from below the L2 nerve root.", "4. He has difficulty with both bladder incontinence.", "5. He has difficulty with bowel incontinence.", "6. He has had these abnormalities since birth.", "7. The abnormalities are due to a lower back lesion.", "8. The lower back lesion required surgical closure during infancy." ]

[ "Polymerase chain reaction (PCR) has revolutionized the molecular biology field.", "PCR allows for amplification of a single piece of genetic material to produce trillions of idential copies." ]

[ "1. Polymerase chain reaction (PCR) has revolutionized the molecular biology field.", "2. PCR allows for amplification of a single piece of genetic material.", "3. Amplification of a single piece of genetic material produces trillions of identical copies." ]

[ "1. PCR stands for polymerase chain reaction.", "2. PCR allows amplification of genetic material.", "3. PCR can produce trillions of identical copies of the genetic material.", "4. PCR can amplify a single piece of genetic material." ]

[ "An investigator is studying the efficacy of antiviral drugs in infected human cells.", "Harvested human cells are inoculated onto four cell culture plates.", "Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates.", "One healthy and one infected cell set are set aside as controls.", "In comparison with the control plates, the subsequent application of a guanosine analog to the experimental cell sets induces cell death in the virally infected cells but not in the healthy cells." ]

[ "1. An investigator is studying the efficacy of antiviral drugs.", "2. Harvested human cells are inoculated onto four cell culture plates.", "3. Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates.", "4. One healthy and one infected cell set are set aside as controls.", "5. In comparison with the control plates, the subsequent application of a guanosine analog induces cell death in the virally infected cells.", "6. The guanosine analog does not induce cell death in the healthy cells." ]

[ "1. Harvested human cells are inoculated onto four cell culture plates.", "2. Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates.", "3. One healthy and one infected cell set are set aside as controls.", "4. The subsequent application of a guanosine analog to the experimental cell sets induces cell death in the virally infected cells.", "5. The subsequent application of a guanosine analog to the experimental cell sets does not induce cell death in the healthy cells." ]

[ "A 13-year-old boy is brought to the physician because of pain and redness on his back for 2 days.", "He returned yesterday from a vacation to East Africa with his parents, where he took multiple rides on hot air balloons.", "His vital signs are within normal limits.", "Examination shows a tender, nonpruritic, erythematous rash with edema covering the extensor surface of both forearms, the shoulders, and the upper back, with small patches of skin exfoliation.", "The rash becomes pale when pressed and then rapidly regains color.", "The remainder of the examination shows no abnormalities." ]

[ "1. A 13-year-old boy is brought to the physician.", "2. He has had pain and redness on his back for 2 days.", "3. He returned yesterday from a vacation to East Africa with his parents.", "4. He took multiple rides on hot air balloons.", "5. His vital signs are within normal limits.", "6. Examination shows a tender, nonpruritic, erythematous rash with edema.", "7. The rash covers the extensor surface of both forearms, the shoulders, and the upper back.", "8. There are small patches of skin exfoliation.", "9. The rash becomes pale when pressed and then rapidly regains color.", "10. The remainder of the examination shows no abnormalities." ]

[ "1. He returned yesterday from a vacation to East Africa with his parents.", "2. He took multiple rides on hot air balloons during the vacation.", "3. His vital signs are within normal limits.", "4. Examination shows a tender, nonpruritic, erythematous rash with edema covering the extensor surface of both forearms, the shoulders, and the upper back.", "5. Small patches of skin exfoliation are present in the affected areas.", "6. The rash becomes pale when pressed and then rapidly regains color.", "7. The remainder of the examination shows no abnormalities." ]

[ "A 55-year-old man comes to the emergency department because of headache, fever, chills, shortness of breath, and abdominal pain for 1 week.", "He also feels tired and nauseous.", "He returned from a trip to Botswana 2 weeks ago.", "He has type 2 diabetes mellitus.", "He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily.", "His only current medication is metformin.", "His temperature is 39.3°C (102.8°F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 94%.", "Examination shows jaundice.", "A few scattered inspiratory crackles are heard in the thorax.", "The liver is palpated 2 cm below the right costal margin.", "Laboratory studies show: | Hemoglobin 9.2 g/dL | Leukocyte count 9,400/mm3 | Platelet count 90,000/mm3 | Serum | Na+ 137 mEq/L | Cl- 102 mEq/L | K+ 5.2 mEq/L | HCO3- 13 mEq/L | Glucose 69 mg/dL | Lactate dehydrogenase 360 U/L | Creatinine 0.9 mg/dL | Bilirubin | _ Total 4.2 mg/dL | _ Direct 0.8 mg/dL | AST 79 U/L | ALT 90 U/L | Urine | Blood 3+ | Protein trace | RBC 0–1/hpf | WBC 1–2/hpf | Arterial blood gas analysis on room air shows a pH of 7.31." ]

[ "1. A 55-year-old man comes to the emergency department.", "2. He has been experiencing headache, fever, chills, shortness of breath, and abdominal pain for 1 week.", "3. He also feels tired and nauseous.", "4. He returned from a trip to Botswana 2 weeks ago.", "5. He has type 2 diabetes mellitus.", "6. He has smoked one pack of cigarettes daily for the past 30 years.", "7. He drinks a glass of beer daily.", "8. His only current medication is metformin.", "9. His temperature is 39.3°C (102.8°F).", "10. His pulse is 122/min.", "11. His respirations are 28/min.", "12. His blood pressure is 109/84 mm Hg.", "13. Pulse oximetry on room air shows an oxygen saturation of 94%.", "14. Examination shows jaundice.", "15. A few scattered inspiratory crackles are heard in the thorax.", "16. The liver is palpated 2 cm below the right costal margin.", "17. Laboratory studies show a hemoglobin of 9.2 g/dL.", "18. Laboratory studies show a leukocyte count of 9,400/mm3.", "19. Laboratory studies show a platelet count of 90,000/mm3.", "20. Laboratory studies show a serum Na+ of 137 mEq/L.", "21. Laboratory studies show a serum Cl- of 102 mEq/L.", "22. Laboratory studies show a serum K+ of 5.2 mEq/L.", "23. Laboratory studies show a serum HCO3- of 13 mEq/L.", "24. Laboratory studies show a glucose of 69 mg/dL.", "25. Laboratory studies show a lactate dehydrogenase of 360 U/L.", "26. Laboratory studies show a creatinine of 0.9 mg/dL.", "27. Laboratory studies show a total bilirubin of 4.2 mg/dL.", "28. Laboratory studies show a direct bilirubin of 0.8 mg/dL.", "29. Laboratory studies show an AST of 79 U/L.", "30. Laboratory studies show an ALT of 90 U/L.", "31. Laboratory studies show a urine blood of 3+.", "32. Laboratory studies show" ]

[ "1. He feels tired and nauseous.", "2. He returned from a trip to Botswana 2 weeks ago.", "3. He has type 2 diabetes mellitus.", "4. He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily.", "5. His only current medication is metformin.", "6. His temperature is 39.3°C (102.8°F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg.", "7. Pulse oximetry on room air shows an oxygen saturation of 94%.", "8. Examination shows jaundice.", "9. A few scattered inspiratory crackles are heard in the thorax.", "10. The liver is palpated 2 cm below the right costal margin.", "11. Laboratory studies show: Hemoglobin 9.2 g/dL, Leukocyte count 9,400/mm3, Platelet count 90,000/mm3, Serum Na+ 137 mEq/L, Cl- 102 mEq/L, K+ 5.2 mEq/L, HCO3- 13 mEq/L, Glucose 69 mg/dL, Lactate dehydrogenase 360 U/L, Creatinine 0.9 mg/dL, Bilirubin Total 4.2 mg/dL, Bilirubin Direct 0.8 mg/dL, AST 79 U/L, ALT 90 U/L, Urine Blood 3+, Urine Protein trace, Urine RBC 0–1/hpf, Urine WBC 1–2/hpf.", "12. Arterial blood gas analysis on room air shows a pH of 7.31." ]

[ "A population study was conducted to evaluate coronary artery disease in the general population.", "A cohort of 700 patients underwent coronary angiography to evaluate the geographic distribution of coronary arteries throughout the heart." ]

[ "1. A population study was conducted.", "2. The study was to evaluate coronary artery disease in the general population.", "3. A cohort of 700 patients was used.", "4. The patients underwent coronary angiography.", "5. The angiography was to evaluate the geographic distribution of coronary arteries throughout the heart." ]

[ "1. A cohort of 700 patients underwent coronary angiography.", "2. The purpose was to evaluate the geographic distribution of coronary arteries.", "3. The evaluation was conducted throughout the heart." ]

[ "A 24-year-old woman comes to the physician because of intermittent episodes of stabbing facial pain for 4 months.", "The pain occurs over her left cheek, is 9 out of 10 in intensity, radiates towards her mouth, and lasts around half a minute before subsiding.", "These episodes commonly occur when she washes her face, brushes her teeth, or eats a meal.", "She does not have visual disturbances, weakness of her facial muscles, or hearing loss.", "She had a tooth extracted about 2 months ago, but the facial pain has persisted.", "She has hypothyroidism and vitiligo.", "Her mother has major depressive disorder.", "Current medications include levothyroxine and a herbal cream.", "She appears anxious.", "Vital signs are within normal limits.", "Cardiopulmonary examination shows no abnormalities.", "Neurologic examination shows no focal findings." ]

[ "1. Patient is a 24-year-old woman.", "2. Patient has intermittent episodes of stabbing facial pain for 4 months.", "3. Pain occurs over her left cheek.", "4. Pain is 9 out of 10 in intensity.", "5. Pain radiates towards her mouth.", "6. Pain lasts around half a minute before subsiding.", "7. Episodes commonly occur when she washes her face, brushes her teeth, or eats a meal.", "8. Patient does not have visual disturbances, weakness of her facial muscles, or hearing loss.", "9. Patient had a tooth extracted about 2 months ago.", "10. Facial pain has persisted.", "11. Patient has hypothyroidism and vitiligo.", "12. Patient's mother has major depressive disorder.", "13. Current medications include levothyroxine and a herbal cream.", "14. Patient appears anxious.", "15. Vital signs are within normal limits.", "16. Cardiopulmonary examination shows no abnormalities.", "17. Neurologic examination shows no focal findings." ]

[ "1. The pain occurs over her left cheek.", "2. The pain is 9 out of 10 in intensity.", "3. The pain radiates towards her mouth.", "4. The pain lasts around half a minute before subsiding.", "5. The episodes commonly occur when she washes her face.", "6. The episodes commonly occur when she brushes her teeth.", "7. The episodes commonly occur when she eats a meal.", "8. She does not have visual disturbances.", "9. She does not have weakness of her facial muscles.", "10. She does not have hearing loss.", "11. She had a tooth extracted about 2 months ago.", "12. The facial pain has persisted after the tooth extraction.", "13. She has hypothyroidism.", "14. She has vitiligo.", "15. Her mother has major depressive disorder.", "16. Her current medications include levothyroxine and a herbal cream.", "17. She appears anxious.", "18. Vital signs are within normal limits.", "19. Cardiopulmonary examination shows no abnormalities.", "20. Neurologic examination shows no focal findings." ]

[ "A 67-year-old man is brought to the emergency department after the sudden onset of dizziness, blurry vision, and a raspy voice.", "He has type 2 diabetes mellitus, hypercholesterolemia, coronary artery disease, and hypertension.", "He has smoked two packs of cigarettes daily for 30 years.", "He drinks three to four beers daily.", "His current medications include metformin, atenolol, lisinopril, furosemide, and aspirin.", "His temperature is 36.6°C (98°F), pulse is 85/min, respirations are 18/min, and blood pressure is 142/90 mm Hg.", "He is alert and oriented to person, place, and time.", "The pupil on the left is pinpoint.", "There is ptosis of the left eye.", "Horizontal nystagmus is present.", "The gag reflex is diminished.", "When he stands without support, he falls towards his left side.", "There is loss of pain and temperature sensation over the left face and right trunk and limbs." ]

[ "1. Patient is 67 years old.", "2. Patient has sudden onset of dizziness, blurry vision, and raspy voice.", "3. Patient has type 2 diabetes mellitus, hypercholesterolemia, coronary artery disease, and hypertension.", "4. Patient has smoked two packs of cigarettes daily for 30 years.", "5. Patient drinks three to four beers daily.", "6. Patient's current medications include metformin, atenolol, lisinopril, furosemide, and aspirin.", "7. Patient's temperature is 36.6°C (98°F).", "8. Patient's pulse is 85/min.", "9. Patient's respirations are 18/min.", "10. Patient's blood pressure is 142/90 mm Hg.", "11. Patient is alert and oriented to person, place, and time.", "12. Patient's left pupil is pinpoint.", "13. Patient has ptosis of the left eye.", "14. Patient has horizontal nystagmus.", "15. Patient's gag reflex is diminished.", "16. Patient falls towards left side when standing without support.", "17. Patient has loss of pain and temperature sensation over left face and right trunk and limbs." ]

[ "1. He has type 2 diabetes mellitus.", "2. He has hypercholesterolemia.", "3. He has coronary artery disease.", "4. He has hypertension.", "5. He has smoked two packs of cigarettes daily for 30 years.", "6. He drinks three to four beers daily.", "7. His current medications include metformin, atenolol, lisinopril, furosemide, and aspirin.", "8. His temperature is 36.6°C (98°F).", "9. His pulse is 85/min.", "10. His respirations are 18/min.", "11. His blood pressure is 142/90 mm Hg.", "12. He is alert and oriented to person, place, and time.", "13. The pupil on the left is pinpoint.", "14. There is ptosis of the left eye.", "15. Horizontal nystagmus is present.", "16. The gag reflex is diminished.", "17. When he stands without support, he falls towards his left side.", "18. There is loss of pain and temperature sensation over the left face and right trunk and limbs." ]

[ "A 67-year-old woman with a recently found hepatic carcinoma has been an inpatient for more than a week.", "During morning rounds, she was abnormally disoriented to time and place along with a shortened attention span.", "The overnight resident reports that she was coming in and out of this state for the past couple nights.", "The patient was known to drink often, but reported that she has not consumed alcohol in weeks leading up to her admission.", "She is not jaundiced and has no metabolic imbalance upon laboratory tests." ]

[ "1. A 67-year-old woman has been an inpatient for more than a week.", "2. She has a recently found hepatic carcinoma.", "3. During morning rounds, she was abnormally disoriented to time and place along with a shortened attention span.", "4. The overnight resident reports that she was coming in and out of this state for the past couple nights.", "5. The patient was known to drink often.", "6. She reported that she has not consumed alcohol in weeks leading up to her admission.", "7. She is not jaundiced.", "8. She has no metabolic imbalance upon laboratory tests." ]

[ "1. During morning rounds, the patient was abnormally disoriented to time and place.", "2. The patient had a shortened attention span.", "3. The overnight resident reports that the patient was coming in and out of this state for the past couple nights.", "4. The patient was known to drink often.", "5. The patient reported that she has not consumed alcohol in weeks leading up to her admission.", "6. The patient is not jaundiced.", "7. The patient has no metabolic imbalance upon laboratory tests." ]

[ "A 51-year-old man comes to the physician because of recurrent episodes of dizziness, tinnitus, and hearing loss on the left side for 6 weeks.", "These episodes last for hours at a time and are associated with the sensation that the room is spinning.", "He has no history of major medical illness and takes no medications.", "Examination shows horizontal nystagmus to the left.", "Weber test shows lateralization to the right ear.", "The Rinne test is positive bilaterally." ]

[ "1. A 51-year-old man comes to the physician.", "2. He has recurrent episodes of dizziness, tinnitus, and hearing loss on the left side for 6 weeks.", "3. The episodes last for hours at a time.", "4. He has the sensation that the room is spinning.", "5. He has no history of major medical illness.", "6. He takes no medications.", "7. Examination shows horizontal nystagmus to the left.", "8. Weber test shows lateralization to the right ear.", "9. The Rinne test is positive bilaterally." ]

[ "1. The episodes last for hours at a time.", "2. The episodes are associated with the sensation that the room is spinning.", "3. He has no history of major medical illness.", "4. He takes no medications.", "5. Examination shows horizontal nystagmus to the left.", "6. Weber test shows lateralization to the right ear.", "7. The Rinne test is positive bilaterally." ]

[ "A 37-year-old farmer presents to the emergency department with acute onset of complaints of diarrhea, excessive tearing, and increased saliva production.", "He is concerned that he is dehydrated, as he has also been urinating with increased frequency over the past several hours.", "His temperature is 97.6°F (36.4°C), blood pressure is 111/64 mmHg, pulse is 60/min, respirations are 10/min, and oxygen saturation is 98% on room air.", "Physical exam is significant for a moderately agitated and diaphoretic man who demonstrates pinpoint pupils." ]

[ "1. A 37-year-old farmer presents to the emergency department.", "2. Complaints of diarrhea, excessive tearing, and increased saliva production.", "3. He is concerned that he is dehydrated.", "4. He has been urinating with increased frequency over the past several hours.", "5. His temperature is 97.6°F (36.4°C).", "6. Blood pressure is 111/64 mmHg.", "7. Pulse is 60/min.", "8. Respirations are 10/min.", "9. Oxygen saturation is 98% on room air.", "10. Physical exam is significant for a moderately agitated and diaphoretic man.", "11. He demonstrates pinpoint pupils." ]

[ "1. Concerned about dehydration", "2. Increased frequency of urination", "3. Temperature: 97.6°F (36.4°C)", "4. Blood pressure: 111/64 mmHg", "5. Pulse: 60/min", "6. Respirations: 10/min", "7. Oxygen saturation: 98% on room air", "8. Physical exam significant for agitation and diaphoresis", "9. Pinpoint pupils" ]

[ "A 54-year-old woman comes to the emergency department because of sharp chest pain and shortness of breath for 1 day.", "She has been coughing intermittently, which worsens the pain.", "She has osteoporosis, for which she takes raloxifene." ]

[ "1. A 54-year-old woman comes to the emergency department.", "2. She has sharp chest pain and shortness of breath for 1 day.", "3. She has been coughing intermittently.", "4. The coughing worsens the pain.", "5. She has osteoporosis.", "6. She takes raloxifene for her osteoporosis." ]

[ "1. She has been coughing intermittently.", "2. The coughing worsens the pain.", "3. She has osteoporosis.", "4. She takes raloxifene for osteoporosis." ]

[ "A previously healthy 18-year-old woman comes to the emergency department because of diarrhea and abdominal cramps since the previous evening.", "She has had around 3–4 episodes of watery stools.", "She feels nauseous and has vomited twice.", "She recollects eating out 2 days ago.", "She has been on a vegan diet for 6 months.", "She takes no medications and has not traveled anywhere recently.", "Her temperature is 36.8°(98.2°F), pulse is 73/min, and blood pressure is 110/70 mm Hg.", "Examination shows dry mucous membranes.", "Abdominal examination is unremarkable." ]

[ "1. A previously healthy 18-year-old woman comes to the emergency department.", "2. She has had diarrhea and abdominal cramps since the previous evening.", "3. She has had around 3–4 episodes of watery stools.", "4. She feels nauseous and has vomited twice.", "5. She recollects eating out 2 days ago.", "6. She has been on a vegan diet for 6 months.", "7. She takes no medications.", "8. She has not traveled anywhere recently.", "9. Her temperature is 36.8°(98.2°F).", "10. Her pulse is 73/min.", "11. Her blood pressure is 110/70 mm Hg.", "12. Examination shows dry mucous membranes.", "13. Abdominal examination is unremarkable." ]

[ "1. She has had around 3–4 episodes of watery stools.", "2. She feels nauseous and has vomited twice.", "3. She recollects eating out 2 days ago.", "4. She has been on a vegan diet for 6 months.", "5. She takes no medications and has not traveled anywhere recently.", "6. Her temperature is 36.8°(98.2°F), pulse is 73/min, and blood pressure is 110/70 mm Hg.", "7. Examination shows dry mucous membranes.", "8. Abdominal examination is unremarkable." ]

[ "A 6-year-old boy is brought to the physician for a well-child examination.", "He has no history of major medical illness.", "His mother says, “Sometimes when my son forgets to flush, his urine leaves dark stains in the toilet.” She is unconcerned because her son already had dark-colored urine as a baby and he has never had any health issues.", "His vital signs are within normal limits.", "Physical examination shows no abnormalities." ]

[ "1. A 6-year-old boy is brought to the physician for a well-child examination.", "2. He has no history of major medical illness.", "3. His mother says, “Sometimes when my son forgets to flush, his urine leaves dark stains in the toilet.”", "4. She is unconcerned because her son already had dark-colored urine as a baby and he has never had any health issues.", "5. His vital signs are within normal limits.", "6. Physical examination shows no abnormalities." ]

[ "1. He has no history of major medical illness.", "2. His mother says, “Sometimes when my son forgets to flush, his urine leaves dark stains in the toilet.”", "3. She is unconcerned because her son already had dark-colored urine as a baby.", "4. He has never had any health issues.", "5. His vital signs are within normal limits.", "6. Physical examination shows no abnormalities." ]

[ "A 72-year-old man presents with a recent episode of slurred speech and numbness in his left arm and left leg 2 hours ago that resolved completely within 45 minutes.", "He says he was having breakfast when he noticed that he had difficulty talking and the left side of his body was numb.", "The patient denies any past similar symptoms.", "Past medical history is significant for type 2 diabetes mellitus, hypertension, and ischemic heart disease.", "He had a coronary artery bypass graft 12 years ago and a percutaneous intervention 3 years ago.", "Current medications are aspirin, metformin, nitrates, and rosuvastatin.", "His vital signs include: blood pressure 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air.", "On physical examination, the patient is alert and oriented.", "Higher mental functions are intact.", "Muscle strength is 5 out of 5l in both upper and lower limbs bilaterally.", "The sensation is intact.", "Cerebellar signs are absent and his gait is normal." ]

[ "1. Patient is 72 years old.", "2. Patient had an episode of slurred speech and numbness in his left arm and left leg 2 hours ago that resolved completely within 45 minutes.", "3. Patient was having breakfast when he noticed difficulty talking and numbness on left side of body.", "4. Patient denies any past similar symptoms.", "5. Patient has past medical history of type 2 diabetes mellitus, hypertension, and ischemic heart disease.", "6. Patient had coronary artery bypass graft 12 years ago and percutaneous intervention 3 years ago.", "7. Patient is currently taking aspirin, metformin, nitrates, and rosuvastatin.", "8. Patient's blood pressure is 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air.", "9. Patient is alert and oriented with higher mental functions intact.", "10. Muscle strength is 5 out of 5 in both upper and lower limbs bilaterally.", "11. Sensation is intact.", "12. Cerebellar signs are absent.", "13. Patient's gait is normal." ]

[ "1. The patient was having breakfast when he noticed difficulty talking and numbness on the left side of his body.", "2. The patient denies any past similar symptoms.", "3. Past medical history includes type 2 diabetes mellitus, hypertension, and ischemic heart disease.", "4. The patient had a coronary artery bypass graft 12 years ago and a percutaneous intervention 3 years ago.", "5. Current medications are aspirin, metformin, nitrates, and rosuvastatin.", "6. Vital signs: blood pressure 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air.", "7. On physical examination, the patient is alert and oriented.", "8. Higher mental functions are intact.", "9. Muscle strength is 5 out of 5 in both upper and lower limbs bilaterally.", "10. Sensation is intact.", "11. Cerebellar signs are absent and gait is normal." ]

[ "A 29-year-old man is brought to the emergency department after being found unresponsive at home.", "The patient's roommate says that the patient had previously been feeling well.", "The patient and his roommate had a celebration the night before, where they drank homemade liquor.", "His temperature is 37°C (98.6°F), pulse is 126/min, respirations are 30/min and shallow, and blood pressure is 84/44 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 96%.", "He is unresponsive to painful stimuli.", "The pupils are 3 mm, equal, round, and reactive to light.", "The lungs are clear to auscultation.", "Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border.", "Laboratory studies show: | Serum | Na+ 146 mmol/L | K+ 7.7 mmol/L | Cl- 111 mmol/L | Urea nitrogen 5.8 mmol/L | Glucose 83 mg/dL | Lactate 11.2 mmol/L | Serum osmolality 379 mosm/kg | Arterial blood gas analysis shows: | pH 6.69 | pCO2 53 mm Hg | pO2 84 mm Hg | HCO3- 4.3 mmol/L | The patient is intubated and fluid resuscitation is begun." ]

[ "1. A 29-year-old man is brought to the emergency department after being found unresponsive at home.", "2. The patient's roommate says that the patient had previously been feeling well.", "3. The patient and his roommate had a celebration the night before, where they drank homemade liquor.", "4. His temperature is 37°C (98.6°F).", "5. Pulse is 126/min.", "6. Respirations are 30/min and shallow.", "7. Blood pressure is 84/44 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 96%.", "9. He is unresponsive to painful stimuli.", "10. The pupils are 3 mm, equal, round, and reactive to light.", "11. The lungs are clear to auscultation.", "12. Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border.", "13. Laboratory studies show: Na+ 146 mmol/L, K+ 7.7 mmol/L, Cl- 111 mmol/L, Urea nitrogen 5.8 mmol/L, Glucose 83 mg/dL, Lactate 11.2 mmol/L, Serum osmolality 379 mosm/kg.", "14. Arterial blood gas analysis shows: pH 6.69, pCO2 53 mm Hg, pO2 84 mm Hg, HCO3- 4.3 mmol/L.", "15. The patient is intubated.", "16. Fluid resuscitation is begun." ]

[ "1. The patient's roommate says that the patient had previously been feeling well.", "2. The patient and his roommate had a celebration the night before, where they drank homemade liquor.", "3. His temperature is 37°C (98.6°F).", "4. His pulse is 126/min.", "5. His respirations are 30/min and shallow.", "6. His blood pressure is 84/44 mm Hg.", "7. Pulse oximetry on room air shows an oxygen saturation of 96%.", "8. He is unresponsive to painful stimuli.", "9. The pupils are 3 mm, equal, round, and reactive to light.", "10. The lungs are clear to auscultation.", "11. Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border.", "12. Laboratory studies show: Serum Na+ 146 mmol/L, K+ 7.7 mmol/L, Cl- 111 mmol/L, Urea nitrogen 5.8 mmol/L, Glucose 83 mg/dL, Lactate 11.2 mmol/L, Serum osmolality 379 mosm/kg.", "13. Arterial blood gas analysis shows: pH 6.69, pCO2 53 mm Hg, pO2 84 mm Hg, HCO3- 4.3 mmol/L.", "14. The patient is intubated and fluid resuscitation is begun." ]

[ "A 22-year-old woman presents with an episodic history of swelling of the face, hands, and neck and a single episode of difficulty swallowing.", "She also has a history of frequent, severe abdominal pain.", "At the time of her visit, her blood pressure is 126/84 mm Hg, heart rate is 82/min, and respiratory rate is 15/min.", "Physical examination is unremarkable except for a swollen right hand as shown in the image below.", "Imaging studies are normal and do not reveal any cause of her pain.", "Her C1 inhibitor level is less than 6% of the reference value." ]

[ "1. Patient is a 22-year-old woman.", "2. Patient has episodic history of swelling of the face, hands, and neck.", "3. Patient has a single episode of difficulty swallowing.", "4. Patient has a history of frequent, severe abdominal pain.", "5. Patient's blood pressure is 126/84 mm Hg.", "6. Patient's heart rate is 82/min.", "7. Patient's respiratory rate is 15/min.", "8. Physical examination is unremarkable except for a swollen right hand.", "9. Imaging studies are normal and do not reveal any cause of her pain.", "10. Patient's C1 inhibitor level is less than 6% of the reference value." ]

[ "1. She has a history of frequent, severe abdominal pain.", "2. At the time of her visit, her blood pressure is 126/84 mm Hg.", "3. At the time of her visit, her heart rate is 82/min.", "4. At the time of her visit, her respiratory rate is 15/min.", "5. Physical examination is unremarkable except for a swollen right hand as shown in the image below.", "6. Imaging studies are normal and do not reveal any cause of her pain.", "7. Her C1 inhibitor level is less than 6% of the reference value." ]

[ "A 60-year-old man calls his hospital and asks to speak to his physician about laboratory test reports ordered because of a 3-month history of abdominal fullness and generalized fatigue.", "The referral note shows that he was constipated for the previous week.", "His abdominal examination had shown distention, and a 7-cm, hard, irregular, nontender mass was palpable on rectal examination.", "His colonoscopy report reveals a low anterior circumferential rectal lesion.", "An MRI of the pelvis shows a rectal mass with involvement of the prostate and seminal vesicles.", "A brief review of the results shows that an endoscopic biopsy confirms the clinical diagnosis of advanced rectal adenocarcinoma.", "His serum carcinoembryonic antigen concentration is 21.0 ng/mL (N < 2.5).", "The physician is tasked with delivering the diagnosis to the patient." ]

[ "1. A 60-year-old man called his hospital.", "2. He asked to speak to his physician about laboratory test reports.", "3. The laboratory test reports were ordered because of a 3-month history of abdominal fullness and generalized fatigue.", "4. The referral note showed that he was constipated for the previous week.", "5. His abdominal examination had shown distention.", "6. A 7-cm, hard, irregular, nontender mass was palpable on rectal examination.", "7. His colonoscopy report revealed a low anterior circumferential rectal lesion.", "8. An MRI of the pelvis showed a rectal mass with involvement of the prostate and seminal vesicles.", "9. A brief review of the results showed that an endoscopic biopsy confirmed the clinical diagnosis of advanced rectal adenocarcinoma.", "10. His serum carcinoembryonic antigen concentration was 21.0 ng/mL (N < 2.5).", "11. The physician was tasked with delivering the diagnosis to the patient." ]

[ "1. The referral note shows constipation for the previous week.", "2. Abdominal examination showed distention.", "3. A 7-cm, hard, irregular, nontender mass was palpable on rectal examination.", "4. Colonoscopy report reveals a low anterior circumferential rectal lesion.", "5. MRI of the pelvis shows a rectal mass with involvement of the prostate and seminal vesicles.", "6. Endoscopic biopsy confirms the clinical diagnosis of advanced rectal adenocarcinoma.", "7. Serum carcinoembryonic antigen concentration is 21.0 ng/mL (N < 2.5).", "8. The physician is tasked with delivering the diagnosis to the patient." ]

[ "A 50-year-old man has a kidney transplantation for end-stage renal disease in the setting of long-standing polycystic kidney disease.", "His postoperative course is uncomplicated.", "He had smoked one pack of cigarettes daily for 20 years but quit 5 years ago.", "He does not drink alcohol or use illicit drugs.", "Current medications include basiliximab, mycophenolate mofetil, and prednisone.", "His vital signs are within normal limits.", "On physical examination, the surgical incisions appear clean and intact." ]

[ "1. A 50-year-old man has a kidney transplantation.", "2. The transplantation is for end-stage renal disease.", "3. The end-stage renal disease is in the setting of long-standing polycystic kidney disease.", "4. His postoperative course is uncomplicated.", "5. He smoked one pack of cigarettes daily for 20 years.", "6. He quit smoking 5 years ago.", "7. He does not drink alcohol.", "8. He does not use illicit drugs.", "9. Current medications include basiliximab, mycophenolate mofetil, and prednisone.", "10. His vital signs are within normal limits.", "11. On physical examination, the surgical incisions appear clean and intact." ]

[ "1. His postoperative course is uncomplicated.", "2. He had smoked one pack of cigarettes daily for 20 years but quit 5 years ago.", "3. He does not drink alcohol or use illicit drugs.", "4. Current medications include basiliximab, mycophenolate mofetil, and prednisone.", "5. His vital signs are within normal limits.", "6. On physical examination, the surgical incisions appear clean and intact." ]

[ "A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation comes to the physician for a prenatal visit.", "She has had no prenatal care.", "She emigrated from China 5 years ago and cannot recall all of her vaccinations.", "She appears well.", "Physical examination shows a uterus consistent in size with a 32-week gestation.", "Serum studies show: | Anti-hepatitis A IgM antibody negative | Anti-hepatitis A IgG antibody positive | Hepatitis B surface antigen negative | Anti-hepatitis B surface antibody positive | Hepatitis B core antigen negative | Anti-hepatitis B core antibody negative | ." ]

[ "1. A 28-year-old woman comes to the physician for a prenatal visit.", "2. She is gravida 1, para 0, at 32 weeks' gestation.", "3. She has had no prenatal care.", "4. She emigrated from China 5 years ago.", "5. She cannot recall all of her vaccinations.", "6. She appears well.", "7. Physical examination shows a uterus consistent in size with a 32-week gestation.", "8. Anti-hepatitis A IgM antibody is negative.", "9. Anti-hepatitis A IgG antibody is positive.", "10. Hepatitis B surface antigen is negative.", "11. Anti-hepatitis B surface antibody is positive.", "12. Hepatitis B core antigen is negative.", "13. Anti-hepatitis B core antibody is negative." ]

[ "1. She has had no prenatal care.", "2. She emigrated from China 5 years ago.", "3. She cannot recall all of her vaccinations.", "4. She appears well.", "5. Physical examination shows a uterus consistent in size with a 32-week gestation.", "6. Serum studies show: Anti-hepatitis A IgM antibody negative.", "7. Serum studies show: Anti-hepatitis A IgG antibody positive.", "8. Serum studies show: Hepatitis B surface antigen negative.", "9. Serum studies show: Anti-hepatitis B surface antibody positive.", "10. Serum studies show: Hepatitis B core antigen negative.", "11. Serum studies show: Anti-hepatitis B core antibody negative." ]

[ "A 58-year-old woman presents to her family physician for an annual checkup.", "During the visit, the patient asks her physician for help quitting smoking cigarettes.", "She has unsuccessfully tried quitting several times previously and has also failed prior attempts with meditation and exercise.", "The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation." ]

[ "1. A 58-year-old woman presents to her family physician for an annual checkup.", "2. The patient asks her physician for help quitting smoking cigarettes.", "3. She has unsuccessfully tried quitting several times previously.", "4. She has also failed prior attempts with meditation and exercise.", "5. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation." ]

[ "1. The patient asks her physician for help quitting smoking cigarettes during the visit.", "2. She has unsuccessfully tried quitting several times previously.", "3. She has also failed prior attempts with meditation and exercise.", "4. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation." ]

[ "A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department because of leg swelling for 2 weeks.", "He has smoked 2 packs of cigarettes daily for the past twenty years.", "His vital signs are within normal limits.", "Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities.", "Cardiac examination shows a regular heart rate and normal heart sounds.", "Auscultation of the lungs shows scattered wheezing without crackles.", "Left ventricular ejection fraction is 60%." ]

[ "1. A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department.", "2. He has smoked 2 packs of cigarettes daily for the past twenty years.", "3. His vital signs are within normal limits.", "4. Physical examination shows jugular venous distention.", "5. Physical examination shows hepatomegaly.", "6. Physical examination shows pitting edema of both lower extremities.", "7. Cardiac examination shows a regular heart rate.", "8. Cardiac examination shows normal heart sounds.", "9. Auscultation of the lungs shows scattered wheezing without crackles.", "10. Left ventricular ejection fraction is 60%." ]

[ "1. He has smoked 2 packs of cigarettes daily for the past twenty years.", "2. His vital signs are within normal limits.", "3. Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities.", "4. Cardiac examination shows a regular heart rate and normal heart sounds.", "5. Auscultation of the lungs shows scattered wheezing without crackles.", "6. Left ventricular ejection fraction is 60%." ]

[ "A young Mediterranean teen brings her 4-year-old little brother to the Emergency Room because of a high temperature.", "Their parents are on their way to the hospital, but, in the meantime, she provides some of the history.", "She explains that he has been running a fever and limping for the past week.", "This morning, she had trouble awakening him, and she noticed some swelling and redness around his right ankle.", "In terms of his past medical history, she knows he has something wrong with his blood.", "He had to receive extra vaccinations as an infant, and he takes an antibiotic everyday.", "On exam in the ED, his temperature is 102.4 deg F (39.1 deg C), blood pressure is 90/60 mmHg, pulse is 123/min, and respirations are 22/min.", "He is lethargic, and his exam is noteworthy for erythema and edema in an area surrounding his distal shin." ]

[ "1. A young Mediterranean teen brings her 4-year-old little brother to the Emergency Room.", "2. Their parents are on their way to the hospital.", "3. She explains that he has been running a fever and limping for the past week.", "4. This morning, she had trouble awakening him.", "5. She noticed some swelling and redness around his right ankle.", "6. In terms of his past medical history, she knows he has something wrong with his blood.", "7. He had to receive extra vaccinations as an infant.", "8. He takes an antibiotic everyday.", "9. On exam in the ED, his temperature is 102.4 deg F (39.1 deg C).", "10. His blood pressure is 90/60 mmHg.", "11. His pulse is 123/min.", "12. His respirations are 22/min.", "13. He is lethargic.", "14. His exam is noteworthy for erythema and edema in an area surrounding his distal shin." ]

[ "1. Their parents are on their way to the hospital.", "2. She explains that he has been running a fever and limping for the past week.", "3. This morning, she had trouble awakening him.", "4. She noticed some swelling and redness around his right ankle.", "5. He has something wrong with his blood.", "6. He had to receive extra vaccinations as an infant.", "7. He takes an antibiotic everyday.", "8. On exam in the ED, his temperature is 102.4 deg F (39.1 deg C).", "9. His blood pressure is 90/60 mmHg.", "10. His pulse is 123/min.", "11. His respirations are 22/min.", "12. He is lethargic.", "13. His exam is noteworthy for erythema and edema in an area surrounding his distal shin." ]

[ "A 47-year-old man comes to the emergency department complaining of weight gain and abdominal discomfort.", "He states that over the past month he has gained 10 lbs.", "This week he began experiencing mild, diffuse abdominal discomfort.", "He denies nausea, vomiting, constipation, or diarrhea.", "The patient has not seen a physician in years and takes no medications.", "He is a truck driver.", "He states that he drinks a 6-pack of beer per night.", "On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave.", "An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites.", "He undergoes a paracentesis that relieves his symptoms.", "Fluid analysis is shown below: | | Serum: | Albumin: 4.0 g/dL | | Ascitic fluid: | Color: Yellow | Leukocyte count: 100/mm^3 with 50% neutrophils | Protein: 2.3 g/dL | Albumin: 1.9 g/dL | | A culture is pending.", "He is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy.", "Upper endoscopy reveals multiple, small non-bleeding esophageal varices." ]

[ "1. A 47-year-old man comes to the emergency department complaining of weight gain and abdominal discomfort.", "2. He states that over the past month he has gained 10 lbs.", "3. This week he began experiencing mild, diffuse abdominal discomfort.", "4. He denies nausea, vomiting, constipation, or diarrhea.", "5. The patient has not seen a physician in years and takes no medications.", "6. He is a truck driver.", "7. He states that he drinks a 6-pack of beer per night.", "8. On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave.", "9. An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites.", "10. He undergoes a paracentesis that relieves his symptoms.", "11. Fluid analysis of serum shows albumin of 4.0 g/dL.", "12. Fluid analysis of ascitic fluid shows color of yellow, leukocyte count of 100/mm^3 with 50% neutrophils, protein of 2.3 g/dL, and albumin of 1.9 g/dL.", "13. A culture is pending.", "14. He is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy.", "15. Upper endoscopy reveals multiple, small non-bleeding esophageal varices." ]

[ "1. The patient has gained 10 lbs over the past month.", "2. The patient began experiencing mild, diffuse abdominal discomfort this week.", "3. The patient denies nausea, vomiting, constipation, or diarrhea.", "4. The patient has not seen a physician in years and takes no medications.", "5. The patient is a truck driver.", "6. The patient drinks a 6-pack of beer per night.", "7. On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave.", "8. An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites.", "9. The patient undergoes a paracentesis that relieves his symptoms.", "10. Fluid analysis shows serum albumin at 4.0 g/dL, ascitic fluid color as yellow, leukocyte count at 100/mm^3 with 50% neutrophils, ascitic fluid protein at 2.3 g/dL, and ascitic fluid albumin at 1.9 g/dL.", "11. A culture is pending.", "12. The patient is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy.", "13. Upper endoscopy reveals multiple, small non-bleeding esophageal varices." ]

[ "An 8-month-old boy is brought to the office by his mother for recurrent infections.", "Over the past 2 months, the boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections.", "His mother is concerned about the health of her child.", "Currently, the child had a runny nose for the last 2 days.", "There is no fever but the mother adds that the boy is not eating very well.", "His mother denies any history of infection during her pregnancy and was tested negative for HIV.", "The patient’s heart rate is 90/min, respiratory rate is 14/min, and temperature is 36.7°C (98.0°F).", "On physical exam, there are decreased lung sounds in the left lower lobe.", "A chest X-ray reveals an absent thymic shadow and fails to show any lung pathology.", "There is no history of similar symptoms in the families of either parent." ]

[ "1. An 8-month-old boy is brought to the office by his mother.", "2. Over the past 2 months, the boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections.", "3. His mother is concerned about the health of her child.", "4. Currently, the child had a runny nose for the last 2 days.", "5. There is no fever.", "6. The mother adds that the boy is not eating very well.", "7. His mother denies any history of infection during her pregnancy.", "8. His mother was tested negative for HIV.", "9. The patient’s heart rate is 90/min.", "10. The patient’s respiratory rate is 14/min.", "11. The patient’s temperature is 36.7°C (98.0°F).", "12. On physical exam, there are decreased lung sounds in the left lower lobe.", "13. A chest X-ray reveals an absent thymic shadow.", "14. The chest X-ray fails to show any lung pathology.", "15. There is no history of similar symptoms in the families of either parent." ]

[ "1. The boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections over the past 2 months.", "2. The mother is concerned about the health of her child.", "3. The child had a runny nose for the last 2 days.", "4. There is no fever, but the boy is not eating very well.", "5. The mother denies any history of infection during her pregnancy and was tested negative for HIV.", "6. The patient’s heart rate is 90/min, respiratory rate is 14/min, and temperature is 36.7°C (98.0°F).", "7. On physical exam, there are decreased lung sounds in the left lower lobe.", "8. A chest X-ray reveals an absent thymic shadow and fails to show any lung pathology.", "9. There is no history of similar symptoms in the families of either parent." ]

[ "A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash on her face for 5 days.", "She was born at term and has been healthy since.", "Her 62-year-old maternal grandmother has bullous pemphigoid.", "Her development is adequate for her age and immunizations are up-to-date.", "She appears healthy and well-nourished.", "Her temperature is 37°C (98.6°F) and pulse is 90/min.", "Examination shows a nontender rash on the right side of the patient's face.", "An image of the patient's lower face is shown.", "The remainder of the examination shows no abnormalities." ]

[ "1. Patient is a 4-year-old girl.", "2. Patient has a nonpruritic, painless rash on her face for 5 days.", "3. Patient was born at term.", "4. Patient has been healthy since birth.", "5. Patient's 62-year-old maternal grandmother has bullous pemphigoid.", "6. Patient's development is adequate for her age.", "7. Patient's immunizations are up-to-date.", "8. Patient appears healthy and well-nourished.", "9. Patient's temperature is 37°C (98.6°F).", "10. Patient's pulse is 90/min.", "11. Examination shows a nontender rash on the right side of the patient's face.", "12. An image of the patient's lower face is shown.", "13. The remainder of the examination shows no abnormalities." ]

[ "1. She was born at term.", "2. She has been healthy since birth.", "3. Her 62-year-old maternal grandmother has bullous pemphigoid.", "4. Her development is adequate for her age.", "5. Her immunizations are up-to-date.", "6. She appears healthy.", "7. She appears well-nourished.", "8. Her temperature is 37°C (98.6°F).", "9. Her pulse is 90/min.", "10. Examination shows a nontender rash on the right side of the patient's face.", "11. An image of the patient's lower face is shown.", "12. The remainder of the examination shows no abnormalities." ]

[ "A 56-year-old man comes to the physician for a routine health maintenance examination.", "He has had mild pain in his left groin for 2 weeks.", "He was admitted to the hospital 1 month ago for myocardial infarction.", "Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents.", "He has hypertension and hypercholesterolemia.", "There is no family history of serious illness.", "He has smoked 2 packs of cigarettes daily for 30 years.", "Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril.", "His temperature is 36.7°C (98°F), pulse is 88/min, and blood pressure is 130/84 mm Hg.", "Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament.", "There is mild erythema of the overlying skin.", "A loud murmur is heard on auscultation of the mass.", "Cardiopulmonary examination shows no abnormalities.", "There is no edema in the lower limbs.", "Femoral and pedal pulses are palpable bilaterally.", "Neurologic examination shows no focal findings." ]

[ "1. A 56-year-old man comes to the physician for a routine health maintenance examination.", "2. He has had mild pain in his left groin for 2 weeks.", "3. He was admitted to the hospital 1 month ago for myocardial infarction.", "4. Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents.", "5. He has hypertension and hypercholesterolemia.", "6. There is no family history of serious illness.", "7. He has smoked 2 packs of cigarettes daily for 30 years.", "8. Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril.", "9. His temperature is 36.7°C (98°F), pulse is 88/min, and blood pressure is 130/84 mm Hg.", "10. Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament.", "11. There is mild erythema of the overlying skin.", "12. A loud murmur is heard on auscultation of the mass.", "13. Cardiopulmonary examination shows no abnormalities.", "14. There is no edema in the lower limbs.", "15. Femoral and pedal pulses are palpable bilaterally.", "16. Neurologic examination shows no focal findings." ]

[ "1. He has had mild pain in his left groin for 2 weeks.", "2. He was admitted to the hospital 1 month ago for myocardial infarction.", "3. Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents.", "4. He has hypertension and hypercholesterolemia.", "5. There is no family history of serious illness.", "6. He has smoked 2 packs of cigarettes daily for 30 years.", "7. Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril.", "8. His temperature is 36.7°C (98°F), pulse is 88/min, and blood pressure is 130/84 mm Hg.", "9. Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament.", "10. There is mild erythema of the overlying skin.", "11. A loud murmur is heard on auscultation of the mass.", "12. Cardiopulmonary examination shows no abnormalities.", "13. There is no edema in the lower limbs.", "14. Femoral and pedal pulses are palpable bilaterally.", "15. Neurologic examination shows no focal findings." ]

[ "A 1-year-old girl is brought to the physician because of fever and crying while passing urine for 2 days.", "She was born at term and has been healthy since.", "Three months ago, she was treated for a urinary tract infection with oral cefixime.", "Her temperature is 39°C (102.2°F), pulse is 144/min, and blood pressure is 85/40 mm Hg.", "Physical examination shows no abnormalities.", "Her leukocyte count is 14,000/mm3.", "Urine dipstick shows leukocyte esterase and nitrites; urinalysis shows WBCs and gram-negative rods.", "Urine culture results are pending.", "Renal ultrasonography shows hydronephrosis of the left kidney.", "Empirical antimicrobial therapy is initiated, following which the patient's symptoms improve." ]

[ "1. A 1-year-old girl is brought to the physician.", "2. She has been having fever and crying while passing urine for 2 days.", "3. She was born at term.", "4. She has been healthy since.", "5. Three months ago, she was treated for a urinary tract infection with oral cefixime.", "6. Her temperature is 39°C (102.2°F).", "7. Her pulse is 144/min.", "8. Her blood pressure is 85/40 mm Hg.", "9. Physical examination shows no abnormalities.", "10. Her leukocyte count is 14,000/mm3.", "11. Urine dipstick shows leukocyte esterase and nitrites.", "12. Urinalysis shows WBCs and gram-negative rods.", "13. Urine culture results are pending.", "14. Renal ultrasonography shows hydronephrosis of the left kidney.", "15. Empirical antimicrobial therapy is initiated.", "16. Following the therapy, the patient's symptoms improve." ]

[ "1. She was born at term and has been healthy since.", "2. Three months ago, she was treated for a urinary tract infection with oral cefixime.", "3. Her temperature is 39°C (102.2°F).", "4. Her pulse is 144/min.", "5. Her blood pressure is 85/40 mm Hg.", "6. Physical examination shows no abnormalities.", "7. Her leukocyte count is 14,000/mm3.", "8. Urine dipstick shows leukocyte esterase and nitrites.", "9. Urinalysis shows WBCs and gram-negative rods.", "10. Urine culture results are pending.", "11. Renal ultrasonography shows hydronephrosis of the left kidney.", "12. Empirical antimicrobial therapy is initiated, following which the patient's symptoms improve." ]

[ "A 69-year-old woman presents to her primary care physician complaining of a new-onset, left-sided, throbbing headache that has lasted for several days.", "She reports that the pain is worsened by eating." ]

[ "1. A 69-year-old woman presents to her primary care physician.", "2. She is complaining of a new-onset, left-sided, throbbing headache.", "3. The headache has lasted for several days.", "4. The pain is worsened by eating." ]

[ "1. She reports", "2. The pain is worsened", "3. By eating" ]

[ "A 32-year old woman presents to the office complaining of progressively worsening shortness of breath for 2 months.", "She was seen multiple times in the past for complications of systemic lupus erythematosus that include anemia, pericarditis, and chronic interstitial lung disease.", "As she does not have medical insurance, she does not regularly follow up with her physician and also is not compliant with her medications.", "She does not drink alcohol, smoke cigarettes, or take illicit drugs.", "Her family history is positive for colon cancer in her father.", "Her temperature is 36.5°C (97.8°F), the blood pressure is 106/70 mm Hg, the pulse is 84/min, and the respirations are 16/min.", "Severe clubbing of her fingernails is noted." ]

[ "1. Patient is a 32-year old woman.", "2. Patient has been experiencing progressively worsening shortness of breath for 2 months.", "3. Patient has a history of systemic lupus erythematosus with complications of anemia, pericarditis, and chronic interstitial lung disease.", "4. Patient does not have medical insurance.", "5. Patient is not compliant with her medications.", "6. Patient does not drink alcohol, smoke cigarettes, or take illicit drugs.", "7. Patient's family history is positive for colon cancer in her father.", "8. Patient's temperature is 36.5°C (97.8°F).", "9. Patient's blood pressure is 106/70 mm Hg.", "10. Patient's pulse is 84/min.", "11. Patient's respirations are 16/min.", "12. Patient has severe clubbing of her fingernails." ]

[ "1. The patient has been seen multiple times in the past for complications of systemic lupus erythematosus including anemia, pericarditis, and chronic interstitial lung disease.", "2. The patient does not have medical insurance.", "3. The patient does not regularly follow up with her physician.", "4. The patient is not compliant with her medications.", "5. The patient does not drink alcohol.", "6. The patient does not smoke cigarettes.", "7. The patient does not take illicit drugs.", "8. The patient's family history is positive for colon cancer in her father.", "9. The patient's temperature is 36.5°C (97.8°F).", "10. The patient's blood pressure is 106/70 mm Hg.", "11. The patient's pulse is 84/min.", "12. The patient's respirations are 16/min.", "13. Severe clubbing of the patient's fingernails is noted." ]

[ "An otherwise healthy 27-year-old woman presents to the emergency department because of worsening headaches and nosebleeds.", "Her blood pressure is 185/115 mm Hg, pulse is 88/min and temperature is 36.9°C (98.4°F).", "She denies the use of nicotine, alcohol, or illicit drugs.", "Family history is irrelevant.", "Physical examination is only positive for abdominal bruits.", "She is given a calcium-channel blocker and a thiazide diuretic, but her blood pressure did not respond adequately.", "Aldosterone-to-renin ratio is < 20." ]

[ "1. Patient is a 27-year-old woman.", "2. Patient presents to the emergency department due to worsening headaches and nosebleeds.", "3. Blood pressure is 185/115 mm Hg.", "4. Pulse is 88/min.", "5. Temperature is 36.9°C (98.4°F).", "6. Patient denies use of nicotine, alcohol, or illicit drugs.", "7. Family history is irrelevant.", "8. Physical examination is only positive for abdominal bruits.", "9. Patient is given a calcium-channel blocker and a thiazide diuretic.", "10. Blood pressure did not respond adequately.", "11. Aldosterone-to-renin ratio is < 20." ]

[ "1. Blood pressure is 185/115 mm Hg.", "2. Pulse is 88/min.", "3. Temperature is 36.9°C (98.4°F).", "4. Denies the use of nicotine, alcohol, or illicit drugs.", "5. Family history is irrelevant.", "6. Physical examination is only positive for abdominal bruits.", "7. Given a calcium-channel blocker and a thiazide diuretic, but blood pressure did not respond adequately.", "8. Aldosterone-to-renin ratio is < 20." ]

[ "A 50-year-old farmer from Jamaica presents to his physician with a wart-like lesion on his left foot.", "He is a plantain farmer and often farms barefoot because of the pleasant climate.", "Physical examination reveals warty, cutaneous nodules that resemble the florets of cauliflower.", "On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted.", "Culture on Sabouraud agar reveals sclerotic bodies." ]

[ "1. A 50-year-old farmer from Jamaica presents to his physician.", "2. He is a plantain farmer.", "3. He often farms barefoot because of the pleasant climate.", "4. Physical examination reveals warty, cutaneous nodules that resemble the florets of cauliflower.", "5. On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted.", "6. Culture on Sabouraud agar reveals sclerotic bodies." ]

[ "1. He is a plantain farmer.", "2. He often farms barefoot.", "3. He farms barefoot because of the pleasant climate.", "4. Physical examination reveals warty, cutaneous nodules.", "5. The nodules resemble the florets of cauliflower.", "6. On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted.", "7. Culture on Sabouraud agar reveals sclerotic bodies." ]

[ "A 52-year-old man comes to the physician because of a 3.6-kg (8-lb) weight loss over the past 3 months and increasing fatigue.", "He was diagnosed with hepatitis C 6 years ago.", "His father died of colon cancer.", "He has smoked one pack of cigarettes daily for 35 years and drinks one beer daily.", "He used cocaine and heroin in the past but stopped 12 years ago.", "He is 176 cm (5 ft 8 in) tall and weighs 71 kg (156 lb); BMI is 22.9 kg/m2.", "His temperature is 37.0°C (98.6°F), pulse is 79/min, and blood pressure is 115/75 mm Hg.", "He appears weak and lethargic.", "Examination shows scleral icterus and scars on both cubital fossae.", "There is reddening of the palms bilaterally.", "There are several telangiectasias over the chest and back.", "The abdomen is soft and nontender.", "The liver is firm and of nodular consistency.", "Laboratory studies show: | Hemoglobin 11.6 g/dL | Mean corpuscular volume 88 μm3 | Leukocyte count 9,600/mm3 | Platelet count 223,000/mm3 | Ultrasonography of the liver shows a solitary lesion." ]

[ "1. A 52-year-old man comes to the physician.", "2. He has experienced a 3.6-kg (8-lb) weight loss over the past 3 months and increasing fatigue.", "3. He was diagnosed with hepatitis C 6 years ago.", "4. His father died of colon cancer.", "5. He has smoked one pack of cigarettes daily for 35 years.", "6. He drinks one beer daily.", "7. He used cocaine and heroin in the past but stopped 12 years ago.", "8. He is 176 cm (5 ft 8 in) tall.", "9. He weighs 71 kg (156 lb); BMI is 22.9 kg/m2.", "10. His temperature is 37.0°C (98.6°F).", "11. His pulse is 79/min.", "12. His blood pressure is 115/75 mm Hg.", "13. He appears weak and lethargic.", "14. Examination shows scleral icterus and scars on both cubital fossae.", "15. There is reddening of the palms bilaterally.", "16. There are several telangiectasias over the chest and back.", "17. The abdomen is soft and nontender.", "18. The liver is firm and of nodular consistency.", "19. Laboratory studies show: Hemoglobin 11.6 g/dL.", "20. Laboratory studies show: Mean corpuscular volume 88 μm3.", "21. Laboratory studies show: Leukocyte count 9,600/mm3.", "22. Laboratory studies show: Platelet count 223,000/mm3.", "23. Ultrasonography of the liver shows a solitary lesion." ]

[ "1. Diagnosed with hepatitis C 6 years ago", "2. Father died of colon cancer", "3. Smokes one pack of cigarettes daily for 35 years", "4. Drinks one beer daily", "5. Used cocaine and heroin in the past, stopped 12 years ago", "6. Height is 176 cm (5 ft 8 in)", "7. Weight is 71 kg (156 lb)", "8. BMI is 22.9 kg/m2", "9. Temperature is 37.0°C (98.6°F)", "10. Pulse is 79/min", "11. Blood pressure is 115/75 mm Hg", "12. Appears weak and lethargic", "13. Scleral icterus and scars on both cubital fossae", "14. Reddening of the palms bilaterally", "15. Several telangiectasias over the chest and back", "16. Abdomen is soft and nontender", "17. Liver is firm and of nodular consistency", "18. Laboratory studies show: Hemoglobin 11.6 g/dL, Mean corpuscular volume 88 μm3, Leukocyte count 9,600/mm3, Platelet count 223,000/mm3", "19. Ultrasonography of the liver shows a solitary lesion" ]

[ "A 63-year-old man comes to the physician for the evaluation of difficulty walking for the last 6 months.", "He reports weakness in his lower legs that improves with exercise and throughout the day.", "Three months ago, he started adding flax seeds to his breakfast because he is frequently constipated.", "He has hypertension and type 2 diabetes mellitus.", "He has smoked 2 packs of cigarettes daily for the last 45 years.", "His current medications include enalapril and metformin.", "Vital signs are within normal limits.", "Examination shows dry mucous membranes.", "Muscle strength in the lower extremities is decreased.", "Sensation to pinprick and light touch is normal.", "Deep tendon reflexes are 1+ bilaterally.", "Active muscle contraction or repeated muscle tapping increases reflex activity." ]

[ "1. A 63-year-old man comes to the physician for the evaluation of difficulty walking for the last 6 months.", "2. He reports weakness in his lower legs that improves with exercise and throughout the day.", "3. Three months ago, he started adding flax seeds to his breakfast because he is frequently constipated.", "4. He has hypertension and type 2 diabetes mellitus.", "5. He has smoked 2 packs of cigarettes daily for the last 45 years.", "6. His current medications include enalapril and metformin.", "7. Vital signs are within normal limits.", "8. Examination shows dry mucous membranes.", "9. Muscle strength in the lower extremities is decreased.", "10. Sensation to pinprick and light touch is normal.", "11. Deep tendon reflexes are 1+ bilaterally.", "12. Active muscle contraction or repeated muscle tapping increases reflex activity." ]

[ "1. Patient reports weakness in lower legs", "2. Weakness improves with exercise and throughout the day", "3. Started adding flax seeds to breakfast three months ago due to frequent constipation", "4. Patient has hypertension", "5. Patient has type 2 diabetes mellitus", "6. Patient has smoked 2 packs of cigarettes daily for the last 45 years", "7. Current medications include enalapril and metformin", "8. Vital signs are within normal limits", "9. Examination shows dry mucous membranes", "10. Muscle strength in lower extremities is decreased", "11. Sensation to pinprick and light touch is normal", "12. Deep tendon reflexes are 1+ bilaterally", "13. Active muscle contraction or repeated muscle tapping increases reflex activity" ]

[ "A 5-year-old boy is brought to the emergency department by his mother because of abdominal pain.", "His mother says that he has not had any fever, vomiting, diarrhea, or dysuria.", "His last bowel movement was 3 days ago and appeared normal.", "The boy is restless and clutches his abdomen.", "His temperature is 37.2°C (99°F), blood pressure is 108/76 mm Hg, pulse is 110/min, respirations are 20/min.", "The abdomen appears mildly distended.", "On auscultation, he has hyperactive bowel sounds.", "The remainder of the examination shows no abnormalities.", "An ultrasound of the abdomen shows no abnormalities." ]

[ "1. A 5-year-old boy is brought to the emergency department by his mother.", "2. His mother says he has not had any fever, vomiting, diarrhea, or dysuria.", "3. His last bowel movement was 3 days ago and appeared normal.", "4. The boy is restless and clutches his abdomen.", "5. His temperature is 37.2°C (99°F).", "6. His blood pressure is 108/76 mm Hg.", "7. His pulse is 110/min.", "8. His respirations are 20/min.", "9. The abdomen appears mildly distended.", "10. On auscultation, he has hyperactive bowel sounds.", "11. The remainder of the examination shows no abnormalities.", "12. An ultrasound of the abdomen shows no abnormalities." ]

[ "1. His mother reports no fever, vomiting, diarrhea, or dysuria.", "2. His last bowel movement was 3 days ago and appeared normal.", "3. The boy is restless and clutches his abdomen.", "4. His temperature is 37.2°C (99°F).", "5. His blood pressure is 108/76 mm Hg.", "6. His pulse is 110/min.", "7. His respirations are 20/min.", "8. The abdomen appears mildly distended.", "9. On auscultation, he has hyperactive bowel sounds.", "10. The remainder of the examination shows no abnormalities.", "11. An ultrasound of the abdomen shows no abnormalities." ]

[ "A 30-year-old woman presents to the emergency department with chest pain.", "She states that she was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain.", "The pain does not radiate and is constant.", "She is worried because she has a marathon next week that she has been training for.", "Her medical history is significant for seasonal allergies.", "She takes no medications except a multivitamin.", "Her mother has asthma.", "She works as a lawyer.", "She denies sick contacts or recent travel.", "She has a glass of wine with dinner but denies tobacco or recreational drug use.", "The patient’s initial temperature is 98°F (36.7°C), blood pressure is 122/78 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air.", "A physical examination is within normal limits.", "Labs are pending." ]

[ "1. Patient is a 30-year-old woman.", "2. Patient presents to the emergency department with chest pain.", "3. Patient states that she was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain.", "4. Pain does not radiate and is constant.", "5. Patient is worried because she has a marathon next week that she has been training for.", "6. Patient's medical history is significant for seasonal allergies.", "7. Patient takes no medications except a multivitamin.", "8. Patient's mother has asthma.", "9. Patient works as a lawyer.", "10. Patient denies sick contacts or recent travel.", "11. Patient has a glass of wine with dinner but denies tobacco or recreational drug use.", "12. Patient's initial temperature is 98°F (36.7°C).", "13. Patient's blood pressure is 122/78 mmHg.", "14. Patient's pulse is 89/min.", "15. Patient's respirations are 14/min with an oxygen saturation of 98% on room air.", "16. Physical examination is within normal limits.", "17. Labs are pending." ]

[ "1. The patient was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain.", "2. The pain does not radiate and is constant.", "3. The patient is worried because she has a marathon next week that she has been training for.", "4. The patient's medical history is significant for seasonal allergies.", "5. The patient takes no medications except a multivitamin.", "6. The patient's mother has asthma.", "7. The patient works as a lawyer.", "8. The patient denies sick contacts or recent travel.", "9. The patient has a glass of wine with dinner but denies tobacco or recreational drug use.", "10. The patient's initial temperature is 98°F (36.7°C), blood pressure is 122/78 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air.", "11. A physical examination is within normal limits.", "12. Labs are pending." ]

[ "A 34-year-old woman, gravida 2, para 1, at 34 weeks' gestation comes to the physician because of a 10-day history of generalized pruritus and a 2-day history of jaundice, dark urine, and pale stools.", "She had developed pruritus at the end of her previous pregnancy, which disappeared after delivery.", "She has had standard prenatal care.", "Medications include folic acid and a multivitamin.", "Her blood pressure is 108/60 mm Hg.", "Examination shows scleral icterus, jaundice, and scratch marks on her upper and lower limbs.", "Pelvic examination shows a uterus consistent in size with a 30-week gestation. | Hemoglobin 11.5 g/dl | Platelet 350,000/mm3 | Prothrombin time 11 seconds (INR=1) | Serum | Total bilirubin 5 mg/dl | Direct bilirubin 4.2 mg/dl | Bile acid | 25 μmol/l (N= 0.3 to 10 μmol/l) | Aspartate aminotransferase 55 U/L | Alanine aminotransferase 45 U/L | There are no abnormalities on abdominopelvic ultrasonography." ]

[ "1. Patient is a 34-year-old woman.", "2. Gravida 2, para 1.", "3. 34 weeks' gestation.", "4. 10-day history of generalized pruritus.", "5. 2-day history of jaundice, dark urine, and pale stools.", "6. Developed pruritus at the end of previous pregnancy, which disappeared after delivery.", "7. Had standard prenatal care.", "8. Medications include folic acid and a multivitamin.", "9. Blood pressure is 108/60 mm Hg.", "10. Examination shows scleral icterus, jaundice, and scratch marks on upper and lower limbs.", "11. Pelvic examination shows uterus consistent in size with 30-week gestation.", "12. Hemoglobin 11.5 g/dl.", "13. Platelet 350,000/mm3.", "14. Prothrombin time 11 seconds (INR=1).", "15. Serum total bilirubin 5 mg/dl.", "16. Direct bilirubin 4.2 mg/dl.", "17. Bile acid 25 μmol/l (N= 0.3 to 10 μmol/l).", "18. Aspartate aminotransferase 55 U/L.", "19. Alanine aminotransferase 45 U/L.", "20. Abdominopelvic ultrasonography shows no abnormalities." ]

[ "1. She developed pruritus at the end of her previous pregnancy.", "2. The pruritus disappeared after delivery.", "3. She has had standard prenatal care.", "4. Her medications include folic acid and a multivitamin.", "5. Her blood pressure is 108/60 mm Hg.", "6. Examination shows scleral icterus, jaundice, and scratch marks on her upper and lower limbs.", "7. Pelvic examination shows a uterus consistent in size with a 30-week gestation.", "8. Hemoglobin is 11.5 g/dl.", "9. Platelet count is 350,000/mm3.", "10. Prothrombin time is 11 seconds (INR=1).", "11. Serum total bilirubin is 5 mg/dl.", "12. Direct bilirubin is 4.2 mg/dl.", "13. Bile acid level is 25 μmol/l (N= 0.3 to 10 μmol/l).", "14. Aspartate aminotransferase level is 55 U/L.", "15. Alanine aminotransferase level is 45 U/L.", "16. There are no abnormalities on abdominopelvic ultrasonography." ]

[ "A mother brings her 17-year-old daughter to your office because of a recent onset dull unilateral pelvic pain that started last week.", "In addition, the daughter also complains of constipation for which she increased her fiber intake, but the dietary changes are not helping her.", "She began menstruating at the age of 13, and her menstrual cycles are regular (about 28 days).", "On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant.", "The pelvic examination is normal except for the presence of the adnexal mass.", "The patient is advised to have an outpatient ultrasound, and then return to the clinic next week.", "After 2 weeks, you learned that the patient visited the emergency department for a sudden onset of abdominal pain that required observation after an abdominal ultrasound was performed.", "The ultrasound showed a large simple cystic mass with increased internal echoes, having a diameter of 10 cm and hyperechogenic vascular walls on the left ovary with a small intraperitoneal collection in the pouch of Douglas." ]

[ "1. A mother brings her 17-year-old daughter to the office.", "2. The daughter has a recent onset of dull unilateral pelvic pain that started last week.", "3. The daughter also complains of constipation.", "4. The daughter increased her fiber intake, but the dietary changes are not helping her.", "5. The daughter began menstruating at the age of 13.", "6. The daughter's menstrual cycles are regular (about 28 days).", "7. On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant.", "8. The pelvic examination is normal except for the presence of the adnexal mass.", "9. The patient is advised to have an outpatient ultrasound.", "10. The patient is to return to the clinic next week.", "11. After 2 weeks, the patient visited the emergency department for a sudden onset of abdominal pain.", "12. An abdominal ultrasound was performed.", "13. The ultrasound showed a large simple cystic mass with increased internal echoes.", "14. The cystic mass has a diameter of 10 cm.", "15. The cystic mass has hyperechogenic vascular walls on the left ovary.", "16. There is a small intraperitoneal collection in the pouch of Douglas." ]

[ "1. The daughter complains of constipation and increased her fiber intake.", "2. The dietary changes are not helping her constipation.", "3. The patient began menstruating at the age of 13.", "4. Her menstrual cycles are regular, about 28 days.", "5. On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant.", "6. The pelvic examination is normal except for the presence of the adnexal mass.", "7. The patient is advised to have an outpatient ultrasound.", "8. The patient is advised to return to the clinic next week.", "9. The patient visited the emergency department for a sudden onset of abdominal pain.", "10. Observation was required after an abdominal ultrasound was performed.", "11. The ultrasound showed a large simple cystic mass with increased internal echoes on the left ovary.", "12. The cystic mass has a diameter of 10 cm.", "13. The cystic mass has hyperechogenic vascular walls.", "14. There is a small intraperitoneal collection in the pouch of Douglas." ]

[ "A 22-year-old woman comes to the clinic complaining of right anterior knee pain.", "She reports that the pain has been present for 3 months and has gradually worsened.", "She says the pain is exacerbated when climbing or descending the stairs.", "She also states the pain is sometimes worse with prolonged periods of sitting.", "She has tried over-the-counter aspirin and ibuprofen without relief.", "She is a soccer player and is worried that the pain is starting to affect her ability to play.", "She reports multiple minor lower extremity injuries due to soccer but denies significant trauma such as known fractures or torn ligaments.", "Her past medical history is unremarkable.", "She had a myringotomy in her left ear as a child.", "On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression." ]

[ "1. A 22-year-old woman comes to the clinic complaining of right anterior knee pain.", "2. She reports that the pain has been present for 3 months and has gradually worsened.", "3. She says the pain is exacerbated when climbing or descending the stairs.", "4. She also states the pain is sometimes worse with prolonged periods of sitting.", "5. She has tried over-the-counter aspirin and ibuprofen without relief.", "6. She is a soccer player and is worried that the pain is starting to affect her ability to play.", "7. She reports multiple minor lower extremity injuries due to soccer but denies significant trauma such as known fractures or torn ligaments.", "8. Her past medical history is unremarkable.", "9. She had a myringotomy in her left ear as a child.", "10. On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression." ]

[ "1. The pain has been present for 3 months.", "2. The pain has gradually worsened.", "3. The pain is exacerbated when climbing or descending the stairs.", "4. The pain is sometimes worse with prolonged periods of sitting.", "5. Over-the-counter aspirin and ibuprofen have been tried without relief.", "6. She is a soccer player.", "7. She is worried that the pain is affecting her ability to play.", "8. She reports multiple minor lower extremity injuries due to soccer.", "9. She denies significant trauma such as known fractures or torn ligaments.", "10. Her past medical history is unremarkable.", "11. She had a myringotomy in her left ear as a child.", "12. On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression." ]

[ "A 25-year-old woman is brought to the emergency department by her husband for abdominal pain.", "The husband answers all questions posed to the patient by the physician.", "Throughout the interview, the patient makes very little eye contact with the physician.", "Her husband asks the physician to prescribe “something for her abdominal pain” so that they can return home.", "Examination of the patient shows mild bruising in the left infraorbital area and a right periorbital hematoma.", "When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex.", "The husband reluctantly leaves the examination room when asked to by the physician.", "While alone with the physician, the patient admits that her husband is responsible for her injuries." ]

[ "1. A 25-year-old woman is brought to the emergency department by her husband.", "2. The husband answers all questions posed to the patient by the physician.", "3. The patient makes very little eye contact with the physician.", "4. Her husband asks the physician to prescribe “something for her abdominal pain”.", "5. Examination of the patient shows mild bruising in the left infraorbital area.", "6. Examination of the patient shows a right periorbital hematoma.", "7. When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex.", "8. The husband reluctantly leaves the examination room when asked to by the physician.", "9. While alone with the physician, the patient admits that her husband is responsible for her injuries." ]

[ "1. The husband answers all questions posed to the patient by the physician.", "2. Throughout the interview, the patient makes very little eye contact with the physician.", "3. Her husband asks the physician to prescribe “something for her abdominal pain” so that they can return home.", "4. Examination of the patient shows mild bruising in the left infraorbital area and a right periorbital hematoma.", "5. When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex.", "6. The husband reluctantly leaves the examination room when asked to by the physician.", "7. While alone with the physician, the patient admits that her husband is responsible for her injuries." ]

[ "A 15-year-old girl comes to the physician because of a 2-month history of progressive fatigue and weakness.", "She also reports recurrent headaches for 2 years, which have increased in severity and frequency.", "Her blood pressure is 185/95 mm Hg.", "Serum studies show a morning renin activity of 130 ng/mL per hour (N=1–4), a morning aldosterone concentration of 60 ng/dL (N=5-30), and a potassium concentration of 2.9 mEq/L." ]

[ "1. A 15-year-old girl comes to the physician.", "2. She has a 2-month history of progressive fatigue and weakness.", "3. She has had recurrent headaches for 2 years.", "4. The headaches have increased in severity and frequency.", "5. Her blood pressure is 185/95 mm Hg.", "6. Serum studies show a morning renin activity of 130 ng/mL per hour (N=1–4).", "7. Serum studies show a morning aldosterone concentration of 60 ng/dL (N=5-30).", "8. Serum studies show a potassium concentration of 2.9 mEq/L." ]

[ "1. Recurrent headaches for 2 years", "2. Increased severity and frequency of headaches", "3. Blood pressure: 185/95 mm Hg", "4. Morning renin activity: 130 ng/mL per hour (N=1–4)", "5. Morning aldosterone concentration: 60 ng/dL (N=5-30)", "6. Potassium concentration: 2.9 mEq/L" ]

[ "A 15-year-old boy is brought to the emergency department by his mother because of severe left testicular pain for 1 hour.", "For the past week, he has also had mild testicular pain and pain on urination.", "He has not had nausea or vomiting.", "He is otherwise healthy.", "His temperature is 39.1°C (102.3°F), pulse is 114/min, and blood pressure is 120/76 mm Hg.", "Examination shows a high-riding, swollen, erythematous tender left testis; lifting the left testis relieves his pain.", "His hemoglobin concentration is 15.6 g/dL, leukocyte count is 14,600/mm3, and platelet count is 290,000/mm3.", "Testicular ultrasound shows increased blood flow to the left testicle when compared to the right and an enlarged left epididymis with decreased echogenicity." ]

[ "1. Patient is a 15-year-old boy.", "2. Patient has had severe left testicular pain for 1 hour.", "3. Patient has had mild testicular pain and pain on urination for the past week.", "4. Patient has not had nausea or vomiting.", "5. Patient is otherwise healthy.", "6. Patient's temperature is 39.1°C (102.3°F).", "7. Patient's pulse is 114/min.", "8. Patient's blood pressure is 120/76 mm Hg.", "9. Examination shows a high-riding, swollen, erythematous tender left testis.", "10. Lifting the left testis relieves his pain.", "11. Patient's hemoglobin concentration is 15.6 g/dL.", "12. Patient's leukocyte count is 14,600/mm3.", "13. Patient's platelet count is 290,000/mm3.", "14. Testicular ultrasound shows increased blood flow to the left testicle when compared to the right.", "15. Testicular ultrasound shows an enlarged left epididymis with decreased echogenicity." ]

[ "1. He has had mild testicular pain for the past week.", "2. He has had pain on urination for the past week.", "3. He has not had nausea.", "4. He has not had vomiting.", "5. He is otherwise healthy.", "6. His temperature is 39.1°C (102.3°F).", "7. His pulse is 114/min.", "8. His blood pressure is 120/76 mm Hg.", "9. Examination shows a high-riding, swollen, erythematous tender left testis.", "10. Lifting the left testis relieves his pain.", "11. His hemoglobin concentration is 15.6 g/dL.", "12. His leukocyte count is 14,600/mm3.", "13. His platelet count is 290,000/mm3.", "14. Testicular ultrasound shows increased blood flow to the left testicle when compared to the right.", "15. Testicular ultrasound shows an enlarged left epididymis with decreased echogenicity." ]

[ "A 27-year-old female presents to the emergency department with complaints of acute-onset fatigue, blurred vision, and rash earlier today.", "Her husband rushed her to emergency department when he noted that she was exhibiting changes in her mental status and had trouble speaking.", "Her vital signs are as follows: T 38.4, HR 87, BP 110/85, RR 14, and SpO2 96%.", "Physical examination reveals petechiae, pallor, and left upper extremity weakness.", "Work-up reveals Hgb 8.5 g/dL, platelets 22,000 cells/uL, normal PT/INR and PTT, absent fibrin split products, elevated fibrinogen, a negative Coombs test, 3.7 mg/dL creatinine, 3.8 mg/dL indirect bilirubin, and LDH 1000 IU/L." ]

[ "1. Patient is a 27-year-old female.", "2. Patient presented to the emergency department with acute-onset fatigue, blurred vision, and rash earlier today.", "3. Patient's husband noted changes in her mental status and difficulty speaking.", "4. Patient's vital signs are T 38.4, HR 87, BP 110/85, RR 14, and SpO2 96%.", "5. Physical examination reveals petechiae, pallor, and left upper extremity weakness.", "6. Work-up reveals Hgb 8.5 g/dL, platelets 22,000 cells/uL, normal PT/INR and PTT.", "7. Work-up reveals absent fibrin split products, elevated fibrinogen, a negative Coombs test.", "8. Work-up reveals 3.7 mg/dL creatinine, 3.8 mg/dL indirect bilirubin, and LDH 1000 IU/L." ]

[ "1. Patient was rushed to the emergency department due to changes in mental status and trouble speaking.", "2. Vital signs: T 38.4, HR 87, BP 110/85, RR 14, SpO2 96%.", "3. Physical examination revealed petechiae, pallor, and left upper extremity weakness.", "4. Hgb level is 8.5 g/dL.", "5. Platelet count is 22,000 cells/uL.", "6. PT/INR and PTT are normal.", "7. Fibrin split products are absent.", "8. Fibrinogen level is elevated.", "9. Coombs test is negative.", "10. Creatinine level is 3.7 mg/dL.", "11. Indirect bilirubin level is 3.8 mg/dL.", "12. LDH level is 1000 IU/L." ]

[ "A 67-year-old African American male presents to his primary care physician for routine follow-up.", "He has a history of poorly controlled hypertension, despite being on lisinopril, hydrochlorothiazide, amlodipine and metoprolol, which he takes regularly.", "His blood pressure during the visit is 170/80.", "He does not have kidney disease.", "His primary care physician decides to start him on methyldopa." ]

[ "1. A 67-year-old African American male presents to his primary care physician for routine follow-up.", "2. He has a history of poorly controlled hypertension.", "3. He is taking lisinopril, hydrochlorothiazide, amlodipine and metoprolol regularly.", "4. His blood pressure during the visit is 170/80.", "5. He does not have kidney disease.", "6. His primary care physician decides to start him on methyldopa." ]

[ "1. The patient has a history of poorly controlled hypertension.", "2. The patient is taking lisinopril, hydrochlorothiazide, amlodipine, and metoprolol regularly.", "3. The patient's blood pressure during the visit is 170/80.", "4. The patient does not have kidney disease.", "5. The primary care physician decides to start the patient on methyldopa." ]

[ "A 2800-g (6-lb 3-oz), 3-day-old newborn is in the intensive care unit for fever, vomiting, tremors, cyanotic episodes, and seizures.", "She was born at 36 weeks to a 25-year-old primigravid woman.", "Spontaneous vaginal delivery was complicated by maternal fever and chorioamnionitis.", "Apgar scores were 6 at 1 minute and 7 at 5 minutes, respectively.", "Shortly after delivery, the child had seizures and high-grade fever with poor feeding and hypotonia.", "She was intubated for respiratory distress.", "Her temperature is 39°C (102.3°F), pulse is 180/min, and respirations are 60/min.", "Physical exam shows grunting breath sounds, an enlarged liver palpable 3 cm below the right costal margin, and lethargy.", "A CT scan of the chest, abdomen, and pelvis shows multiple pulmonary and hepatic granulomas." ]

[ "1. A 2800-g (6-lb 3-oz) newborn is in the intensive care unit.", "2. The newborn is 3 days old.", "3. The newborn has fever, vomiting, tremors, cyanotic episodes, and seizures.", "4. The mother is 25 years old and this is her first pregnancy.", "5. Delivery was spontaneous vaginal delivery.", "6. Delivery was complicated by maternal fever and chorioamnionitis.", "7. Apgar scores were 6 at 1 minute and 7 at 5 minutes, respectively.", "8. Shortly after delivery, the child had seizures and high-grade fever with poor feeding and hypotonia.", "9. The child was intubated for respiratory distress.", "10. The child's temperature is 39°C (102.3°F).", "11. The child's pulse is 180/min.", "12. The child's respirations are 60/min.", "13. Physical exam shows grunting breath sounds.", "14. Physical exam shows an enlarged liver palpable 3 cm below the right costal margin.", "15. Physical exam shows lethargy.", "16. A CT scan of the chest, abdomen, and pelvis shows multiple pulmonary and hepatic granulomas." ]

[ "1. The baby was born at 36 weeks gestation.", "2. The mother was 25 years old at the time of birth.", "3. It was the mother's first pregnancy.", "4. The delivery was through spontaneous vaginal delivery.", "5. The mother had a fever during delivery.", "6. The mother had chorioamnionitis during delivery.", "7. The baby's Apgar score at 1 minute was 6.", "8. The baby's Apgar score at 5 minutes was 7.", "9. The baby experienced seizures shortly after birth.", "10. The baby had a high-grade fever shortly after birth.", "11. The baby had poor feeding shortly after birth.", "12. The baby had hypotonia shortly after birth.", "13. The baby was intubated due to respiratory distress.", "14. The baby's temperature was 39°C (102.3°F).", "15. The baby's pulse was 180/min.", "16. The baby's respirations were 60/min.", "17. The baby had grunting breath sounds during the physical exam.", "18. The baby had an enlarged liver palpable 3 cm below the right costal margin.", "19. The baby was lethargic during the physical exam.", "20. A CT scan showed multiple pulmonary and hepatic granulomas." ]

[ "A 45-year-old woman presents to her primary care practitioner requesting a routine checkup for a job application.", "Her family history is negative for malignancies and inheritable diseases.", "She has been married for 15 years and has 2 healthy children.", "Her past medical history is negative for surgical procedures and cardiovascular disease; however, she used to work as a radiology technician.", "Her only complaints at the moment are neck pain and hoarseness.", "Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs.", "In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal.", "She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia.", "After some discussion, the patient opts for surgical treatment." ]

[ "1. A 45-year-old woman presents to her primary care practitioner requesting a routine checkup for a job application.", "2. Her family history is negative for malignancies and inheritable diseases.", "3. She has been married for 15 years and has 2 healthy children.", "4. Her past medical history is negative for surgical procedures and cardiovascular disease.", "5. She used to work as a radiology technician.", "6. Her only complaints at the moment are neck pain and hoarseness.", "7. Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs.", "8. In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal.", "9. She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia.", "10. After some discussion, the patient opts for surgical treatment." ]

[ "1. Her family history is negative for malignancies and inheritable diseases.", "2. She has been married for 15 years and has 2 healthy children.", "3. Her past medical history is negative for surgical procedures and cardiovascular disease.", "4. She used to work as a radiology technician.", "5. Her only complaints at the moment are neck pain and hoarseness.", "6. Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs.", "7. In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal.", "8. She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia.", "9. After some discussion, the patient opts for surgical treatment." ]

[ "A 65-year-old man comes to the physician because of progressive shortness of breath and a worsening cough for the past month.", "He also reports occasional bloody sputum.", "He has lost about 7 kg (15.4 lb) of weight over the past 4 months despite having no change in appetite.", "He has smoked 2 packs of cigarettes daily for 15 years but stopped smoking at the age of 55.", "Physical examination shows reduced breath sounds throughout both lungs.", "An x-ray of the chest is shown." ]

[ "1. A 65-year-old man comes to the physician.", "2. He has progressive shortness of breath and a worsening cough for the past month.", "3. He reports occasional bloody sputum.", "4. He has lost 7 kg (15.4 lb) of weight over the past 4 months.", "5. He has no change in appetite.", "6. He smoked 2 packs of cigarettes daily for 15 years.", "7. He stopped smoking at the age of 55.", "8. Physical examination shows reduced breath sounds throughout both lungs.", "9. An x-ray of the chest is shown." ]

[ "1. He reports occasional bloody sputum.", "2. He has lost about 7 kg (15.4 lb) of weight over the past 4 months.", "3. He has had no change in appetite.", "4. He has smoked 2 packs of cigarettes daily for 15 years.", "5. He stopped smoking at the age of 55.", "6. Physical examination shows reduced breath sounds throughout both lungs.", "7. An x-ray of the chest is shown." ]

[ "A 67-year-old man comes to the physician due to exertional dyspnea and lower extremity swelling for the last 4 weeks.", "The patient has been a smoker for the last 45 years and has been diagnosed with COPD.", "He has no history of diabetes mellitus or ischemic heart disease.", "He is non-compliant with his medications for COPD.", "The patient is a retired social worker and spends most of his time at home.", "His temperature is 37.2°C (98.9°F), blood pressure is 135/115 mm Hg, pulse is 90/min, and respirations are 22/min.", "Oxygen saturation on room air is 92%.", "Physical examination reveals a barrel-shaped chest, distension of neck veins, and 3+ bilateral pitting edema of his lower extremities.", "The liver is palpated 6 cm below the costal margin and is tender to palpation.", "Application of pressure on the upper abdomen causes persistent distension of jugular veins.", "Lungs are clear to auscultation.", "Chest X-ray shows enlarged main pulmonary arteries.", "ECG shows right bundle branch block and right ventricular hypertrophy." ]

[ "1. A 67-year-old man comes to the physician due to exertional dyspnea and lower extremity swelling for the last 4 weeks.", "2. The patient has been a smoker for the last 45 years and has been diagnosed with COPD.", "3. He has no history of diabetes mellitus or ischemic heart disease.", "4. He is non-compliant with his medications for COPD.", "5. The patient is a retired social worker and spends most of his time at home.", "6. His temperature is 37.2°C (98.9°F).", "7. Blood pressure is 135/115 mm Hg.", "8. Pulse is 90/min.", "9. Respirations are 22/min.", "10. Oxygen saturation on room air is 92%.", "11. Physical examination reveals a barrel-shaped chest.", "12. Distension of neck veins is present.", "13. 3+ bilateral pitting edema of his lower extremities is present.", "14. The liver is palpated 6 cm below the costal margin and is tender to palpation.", "15. Application of pressure on the upper abdomen causes persistent distension of jugular veins.", "16. Lungs are clear to auscultation.", "17. Chest X-ray shows enlarged main pulmonary arteries.", "18. ECG shows right bundle branch block and right ventricular hypertrophy." ]

[ "1. The patient has been a smoker for the last 45 years.", "2. The patient has been diagnosed with COPD.", "3. The patient has no history of diabetes mellitus.", "4. The patient has no history of ischemic heart disease.", "5. The patient is non-compliant with his medications for COPD.", "6. The patient is a retired social worker.", "7. The patient spends most of his time at home.", "8. The patient's temperature is 37.2°C (98.9°F).", "9. The patient's blood pressure is 135/115 mm Hg.", "10. The patient's pulse is 90/min.", "11. The patient's respirations are 22/min.", "12. The patient's oxygen saturation on room air is 92%.", "13. Physical examination reveals a barrel-shaped chest.", "14. Physical examination reveals distension of neck veins.", "15. Physical examination reveals 3+ bilateral pitting edema of the lower extremities.", "16. The liver is palpated 6 cm below the costal margin.", "17. The liver is tender to palpation.", "18. Application of pressure on the upper abdomen causes persistent distension of jugular veins.", "19. Lungs are clear to auscultation.", "20. Chest X-ray shows enlarged main pulmonary arteries.", "21. ECG shows right bundle branch block.", "22. ECG shows right ventricular hypertrophy." ]

[ "A 13-year-old African-American girl is brought to the physician for right shoulder pain that has worsened over the past month.", "She has had many episodes of joint and bone pain and recurrent painful swelling in her hands and feet.", "Physical examination shows tenderness of the right anterior humerus without swelling or skin changes.", "Active and passive range of motion of the right shoulder is decreased and there is pain with movement.", "The leukocyte count is 4600/mm3.", "An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing." ]

[ "1. Patient is a 13-year-old African-American girl.", "2. Patient has right shoulder pain that has worsened over the past month.", "3. Patient has had many episodes of joint and bone pain.", "4. Patient has had recurrent painful swelling in her hands and feet.", "5. Physical examination shows tenderness of the right anterior humerus without swelling or skin changes.", "6. Active and passive range of motion of the right shoulder is decreased and there is pain with movement.", "7. Leukocyte count is 4600/mm3.", "8. X-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing." ]

[ "1. She has had many episodes of joint and bone pain.", "2. She has had recurrent painful swelling in her hands and feet.", "3. Physical examination shows tenderness of the right anterior humerus.", "4. There is no swelling or skin changes in the right anterior humerus.", "5. Active range of motion of the right shoulder is decreased.", "6. Passive range of motion of the right shoulder is decreased.", "7. There is pain with movement of the right shoulder.", "8. The leukocyte count is 4600/mm3.", "9. An x-ray of the right shoulder shows subchondral lucency of the humeral head.", "10. An x-ray of the right shoulder shows sclerosis of the humeral head.", "11. An x-ray of the right shoulder shows joint space narrowing." ]

[ "A 4-month-old male presents to the emergency department with severe cough, wheezing, and cyanosis.", "You suspect bronchiolitis of viral etiology and you administer an anti-viral medication." ]

[ "1. A 4-month-old male presents to the emergency department.", "2. The patient has severe cough.", "3. The patient has wheezing.", "4. The patient has cyanosis.", "5. The diagnosis is suspected to be bronchiolitis of viral etiology.", "6. An anti-viral medication is administered." ]

[ "1. Bronchiolitis is suspected.", "2. The suspected bronchiolitis is of viral etiology.", "3. An anti-viral medication is administered." ]

[ "A 43-year-old woman presents to the clinic complaining of “spotting.” She states that over the past 5 months she has had intermenstrual bleeding.", "Additionally, her menses last more than a week with the first 4 days consisting of heavy bleeding.", "She denies abdominal pain but reports feeling an increasing “pressure-like\" discomfort.", "She denies dysuria, dyspareunia, or dyschezia.", "Prior to 5 months ago, her menstrual periods were only 4 days long and consisted of moderate bleeding.", "Her periods normally occur every 28 days.", "She is frustrated because she feels like she needs to wear a pad all the time.", "The patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation.", "Her last menstrual period was 1 week ago.", "She is sexually active with her husband and denies a history of sexually transmitted diseases.", "She has never had an abnormal pap smear.", "Her last pap smear and test for human papillomavirus was 4 years ago.", "The patient has hypothyroidism treated with levothyroxine.", "On physical examination, the thyroid is normal in size without masses or tenderness.", "Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness.", "Speculum exam is unremarkable." ]

[ "1. Patient is 43 years old.", "2. Patient presents to clinic complaining of “spotting.”", "3. Patient has had intermenstrual bleeding for the past 5 months.", "4. Patient's menses last more than a week with the first 4 days consisting of heavy bleeding.", "5. Patient denies abdominal pain but reports feeling an increasing “pressure-like\" discomfort.", "6. Patient denies dysuria, dyspareunia, or dyschezia.", "7. Prior to 5 months ago, patient's menstrual periods were only 4 days long and consisted of moderate bleeding.", "8. Patient's periods normally occur every 28 days.", "9. Patient feels like she needs to wear a pad all the time.", "10. Patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation.", "11. Patient's last menstrual period was 1 week ago.", "12. Patient is sexually active with her husband.", "13. Patient denies a history of sexually transmitted diseases.", "14. Patient has never had an abnormal pap smear.", "15. Patient's last pap smear and test for human papillomavirus was 4 years ago.", "16. Patient has hypothyroidism treated with levothyroxine.", "17. On physical examination, thyroid is normal in size without masses or tenderness.", "18. Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness.", "19. Speculum exam is unremarkable." ]

[ "1. Her menses last more than a week with the first 4 days consisting of heavy bleeding.", "2. She denies abdominal pain but reports feeling an increasing “pressure-like\" discomfort.", "3. She denies dysuria, dyspareunia, or dyschezia.", "4. Prior to 5 months ago, her menstrual periods were only 4 days long and consisted of moderate bleeding.", "5. Her periods normally occur every 28 days.", "6. She is frustrated because she feels like she needs to wear a pad all the time.", "7. The patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation.", "8. Her last menstrual period was 1 week ago.", "9. She is sexually active with her husband and denies a history of sexually transmitted diseases.", "10. She has never had an abnormal pap smear.", "11. Her last pap smear and test for human papillomavirus was 4 years ago.", "12. The patient has hypothyroidism treated with levothyroxine.", "13. On physical examination, the thyroid is normal in size without masses or tenderness.", "14. Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness.", "15. Speculum exam is unremarkable." ]

[ "A 19-year-old woman comes to the physician because of a 1-week history of fatigue and yellow discoloration of her eyes.", "Four weeks ago, she had a sore throat and was diagnosed with a viral infection that self-resolved.", "She has no history of serious medical illness.", "Her only medication is an oral contraceptive.", "She appears tired.", "Her pulse is 94/min, and blood pressure is 125/75 mm Hg.", "Physical examination shows scleral icterus.", "The liver edge is palpable 2 cm below the right costal margin and the spleen tip is palpable 4 cm below the left costal margin.", "Skin examination shows no rashes.", "Her hemoglobin concentration is 9.5 g/dL, and the direct antiglobulin test is positive." ]

[ "1. A 19-year-old woman comes to the physician.", "2. She has a 1-week history of fatigue.", "3. She has yellow discoloration of her eyes.", "4. Four weeks ago, she had a sore throat.", "5. She was diagnosed with a viral infection that self-resolved.", "6. She has no history of serious medical illness.", "7. Her only medication is an oral contraceptive.", "8. She appears tired.", "9. Her pulse is 94/min.", "10. Her blood pressure is 125/75 mm Hg.", "11. Physical examination shows scleral icterus.", "12. The liver edge is palpable 2 cm below the right costal margin.", "13. The spleen tip is palpable 4 cm below the left costal margin.", "14. Skin examination shows no rashes.", "15. Her hemoglobin concentration is 9.5 g/dL.", "16. The direct antiglobulin test is positive." ]

[ "1. Four weeks ago, she had a sore throat and was diagnosed with a viral infection that self-resolved.", "2. She has no history of serious medical illness.", "3. Her only medication is an oral contraceptive.", "4. She appears tired.", "5. Her pulse is 94/min, and blood pressure is 125/75 mm Hg.", "6. Physical examination shows scleral icterus.", "7. The liver edge is palpable 2 cm below the right costal margin and the spleen tip is palpable 4 cm below the left costal margin.", "8. Skin examination shows no rashes.", "9. Her hemoglobin concentration is 9.5 g/dL, and the direct antiglobulin test is positive." ]

[ "A 67-year-old female is admitted to the hospital with enterococcus endocarditis and is treated with penicillin and gentamicin.", "During her admission, she develops worsening pulmonary edema secondary to valvular insufficiency and requires therapy with IV furosemide." ]

[ "1. A 67-year-old female is admitted to the hospital.", "2. She has enterococcus endocarditis.", "3. She is treated with penicillin and gentamicin.", "4. During her admission, she develops worsening pulmonary edema.", "5. The pulmonary edema is secondary to valvular insufficiency.", "6. She requires therapy with IV furosemide." ]

[ "1. During her admission, the patient develops worsening pulmonary edema.", "2. The pulmonary edema is secondary to valvular insufficiency.", "3. The patient requires therapy with IV furosemide." ]

[ "A 75-year-old male is brought to the emergency room by his daughter due to slurred speech and a drooping eyelid on the right side.", "This morning, he had difficulty eating his breakfast and immediately called his daughter for help.", "She says that his voice also seems different.", "His temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 90/min, respirations are 21/min, and pulse oximetry is 98% on room air.", "On physical exam, he is oriented to time and place.", "There is right-sided nystagmus and he has difficulty with point-to-point movement." ]

[ "1. A 75-year-old male is brought to the emergency room by his daughter.", "2. He has slurred speech and a drooping eyelid on the right side.", "3. This morning, he had difficulty eating his breakfast.", "4. He called his daughter for help.", "5. His daughter says his voice also seems different.", "6. His temperature is 99°F (37.2°C).", "7. His blood pressure is 120/78 mmHg.", "8. His pulse is 90/min.", "9. His respirations are 21/min.", "10. His pulse oximetry is 98% on room air.", "11. On physical exam, he is oriented to time and place.", "12. There is right-sided nystagmus.", "13. He has difficulty with point-to-point movement." ]

[ "1. He had difficulty eating his breakfast this morning.", "2. He immediately called his daughter for help.", "3. His daughter says that his voice seems different.", "4. His temperature is 99°F (37.2°C).", "5. His blood pressure is 120/78 mmHg.", "6. His pulse is 90/min.", "7. His respirations are 21/min.", "8. His pulse oximetry is 98% on room air.", "9. On physical exam, he is oriented to time and place.", "10. There is right-sided nystagmus.", "11. He has difficulty with point-to-point movement." ]

[ "You are conducting an experiment on a cell line in your laboratory.", "You introduce a molecule into the tissue culture dish containing the cell line that binds to a transmembrane protein.", "As a result, the affected cell initiates a process characterized by karyorrhexis, membrane blebbing, and pyknosis." ]

[ "1. You are conducting an experiment on a cell line in your laboratory.", "2. You introduce a molecule into the tissue culture dish containing the cell line.", "3. The molecule binds to a transmembrane protein.", "4. As a result, the affected cell initiates a process.", "5. The process is characterized by karyorrhexis.", "6. The process is characterized by membrane blebbing.", "7. The process is characterized by pyknosis." ]

[ "1. A molecule was introduced into a tissue culture dish.", "2. The tissue culture dish contains a cell line.", "3. The molecule binds to a transmembrane protein.", "4. The affected cell initiates a process.", "5. The process is characterized by karyorrhexis.", "6. The process is characterized by membrane blebbing.", "7. The process is characterized by pyknosis." ]

[ "A 45-year-old woman comes to the physician because of a 6-month history of progressive irritability, palpitations, heat intolerance, frequent bowel movements, and a 6.8-kg (15-lb) weight loss.", "She also has a smooth, uniformly enlarged mass at the front of her neck and protuberant eyes with lid retraction.", "Laboratory investigations show undetectable levels of thyroid stimulating hormone, elevated levels of free T3 and T4, and a raised titer of TSH receptor autoantibodies (TRAbs).", "Therapy is initiated with radioactive iodine-131." ]

[ "1. A 45-year-old woman comes to the physician.", "2. She has a 6-month history of progressive irritability, palpitations, heat intolerance, frequent bowel movements, and a 6.8-kg (15-lb) weight loss.", "3. She has a smooth, uniformly enlarged mass at the front of her neck and protuberant eyes with lid retraction.", "4. Laboratory investigations show undetectable levels of thyroid stimulating hormone.", "5. Laboratory investigations show elevated levels of free T3 and T4.", "6. Laboratory investigations show a raised titer of TSH receptor autoantibodies (TRAbs).", "7. Therapy is initiated with radioactive iodine-131." ]

[ "1. The patient has a smooth, uniformly enlarged mass at the front of her neck.", "2. The patient has protuberant eyes with lid retraction.", "3. Laboratory investigations show undetectable levels of thyroid stimulating hormone.", "4. Laboratory investigations show elevated levels of free T3.", "5. Laboratory investigations show elevated levels of free T4.", "6. Laboratory investigations show a raised titer of TSH receptor autoantibodies (TRAbs).", "7. Therapy is initiated with radioactive iodine-131." ]

[ "A 56-year-old woman comes to the emergency department because of severe abdominal pain associated with nausea and vomiting for 12 hours.", "The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula.", "The patient has gastroesophageal reflux disease.", "She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago.", "She has smoked one pack of cigarettes daily for 35 years.", "Current medications include levothyroxine, omeprazole, and a multivitamin.", "The patient appears uncomfortable.", "Her temperature is 38.1°C (100.6°F), pulse is 93/min, and blood pressure is 140/85 mm Hg.", "Abdominal examination shows tenderness to deep palpation in the right upper quadrant.", "The patient's leukocyte count is 10,300/mm3.", "Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts.", "Laparoscopic cholecystectomy is performed.", "Pathological examination shows acute cholecystitis.", "There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels." ]

[ "1. A 56-year-old woman comes to the emergency department because of severe abdominal pain associated with nausea and vomiting for 12 hours.", "2. The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula.", "3. The patient has gastroesophageal reflux disease.", "4. She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago.", "5. She has smoked one pack of cigarettes daily for 35 years.", "6. Current medications include levothyroxine, omeprazole, and a multivitamin.", "7. The patient appears uncomfortable.", "8. Her temperature is 38.1°C (100.6°F), pulse is 93/min, and blood pressure is 140/85 mm Hg.", "9. Abdominal examination shows tenderness to deep palpation in the right upper quadrant.", "10. The patient's leukocyte count is 10,300/mm3.", "11. Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts.", "12. Laparoscopic cholecystectomy is performed.", "13. Pathological examination shows acute cholecystitis.", "14. There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels." ]

[ "1. The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula.", "2. The patient has gastroesophageal reflux disease.", "3. She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago.", "4. She has smoked one pack of cigarettes daily for 35 years.", "5. Current medications include levothyroxine, omeprazole, and a multivitamin.", "6. The patient appears uncomfortable.", "7. Her temperature is 38.1°C (100.6°F), pulse is 93/min, and blood pressure is 140/85 mm Hg.", "8. Abdominal examination shows tenderness to deep palpation in the right upper quadrant.", "9. The patient's leukocyte count is 10,300/mm3.", "10. Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts.", "11. Laparoscopic cholecystectomy is performed.", "12. Pathological examination shows acute cholecystitis.", "13. There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels." ]

[ "You are on your first day of a pathology rotation and the attending pathologist gives you a biopsy specimen to examine.", "She says it is from the antrum of the stomach of a 32-year-old man who has been complaining of abdominal pain for the past 6 months.", "The patient states the pain gets worse when eating.", "On endoscopy, there was a single ulcerated lesion with a 'punched out' appearance." ]

[ "1. You are on your first day of a pathology rotation.", "2. The attending pathologist gives you a biopsy specimen to examine.", "3. The biopsy specimen is from the antrum of the stomach.", "4. The patient is a 32-year-old man.", "5. The patient has been complaining of abdominal pain for the past 6 months.", "6. The patient states the pain gets worse when eating.", "7. On endoscopy, there was a single ulcerated lesion.", "8. The lesion had a 'punched out' appearance." ]

[ "1. The sample is from the antrum of the stomach.", "2. The patient is a 32-year-old man.", "3. The patient has been complaining of abdominal pain for the past 6 months.", "4. The pain worsens when eating.", "5. Endoscopy revealed a single ulcerated lesion with a 'punched out' appearance." ]

[ "A 40-year-old man is brought into the emergency department by his wife complaining of intense lower right abdominal pain.", "An abdominal CT scan was performed which noted a dilated appendix with a thickened wall and the accumulation of extraluminal fluid.", "A quick history is taken while the OR is prepped for surgery.", "Past medical history is noncontributory and the patient takes no medications.", "Social history reveals a sedentary lifestyle.", "The patient admits to regularly drinking several beers and several shots of vodka every night.", "He had to stop drinking 2 days ago due to the intense abdominal pain.", "The patient is brought into the OR and the inflamed and necrotic appendix is removed.", "He is admitted to the hospital for overnight monitoring.", "Later that night, the patient begins to hallucinate." ]

[ "1. A 40-year-old man is brought into the emergency department by his wife.", "2. The patient is complaining of intense lower right abdominal pain.", "3. An abdominal CT scan was performed.", "4. The CT scan noted a dilated appendix with a thickened wall and the accumulation of extraluminal fluid.", "5. A quick history is taken while the OR is prepped for surgery.", "6. Past medical history is noncontributory.", "7. The patient takes no medications.", "8. Social history reveals a sedentary lifestyle.", "9. The patient admits to regularly drinking several beers and several shots of vodka every night.", "10. The patient had to stop drinking 2 days ago due to the intense abdominal pain.", "11. The patient is brought into the OR.", "12. The inflamed and necrotic appendix is removed.", "13. The patient is admitted to the hospital for overnight monitoring.", "14. Later that night, the patient begins to hallucinate." ]

[ "1. An abdominal CT scan was performed", "2. The CT scan noted a dilated appendix with a thickened wall", "3. The CT scan noted the accumulation of extraluminal fluid", "4. A quick history is taken while the OR is prepped for surgery", "5. Past medical history is noncontributory", "6. The patient takes no medications", "7. Social history reveals a sedentary lifestyle", "8. The patient admits to regularly drinking several beers and several shots of vodka every night", "9. The patient had to stop drinking 2 days ago due to intense abdominal pain", "10. The patient is brought into the OR", "11. The inflamed and necrotic appendix is removed", "12. The patient is admitted to the hospital for overnight monitoring", "13. Later that night, the patient begins to hallucinate" ]

[ "A 34-year-old woman presents with sudden onset flank pain for the past day.", "She describes the pain as intermittent and radiating to her groin.", "She denies any similar symptoms in the past.", "No significant past medical history.", "The patient currently does not take any medications.", "Family history is significant for her mother who died of a pancreatic tumor at the age of 53.", "Laboratory analysis reveals: | Serum calcium 12 mg/dL | Serum phosphorus 2.2 mg/dL | Serum parathyroid hormone 105 pg/mL | ." ]

[ "1. A 34-year-old woman presents with sudden onset flank pain for the past day.", "2. She describes the pain as intermittent and radiating to her groin.", "3. She denies any similar symptoms in the past.", "4. No significant past medical history.", "5. The patient currently does not take any medications.", "6. Family history is significant for her mother who died of a pancreatic tumor at the age of 53.", "7. Laboratory analysis reveals serum calcium 12 mg/dL.", "8. Laboratory analysis reveals serum phosphorus 2.2 mg/dL.", "9. Laboratory analysis reveals serum parathyroid hormone 105 pg/mL." ]

[ "1. The patient describes the pain as intermittent.", "2. The pain is radiating to her groin.", "3. The patient denies any similar symptoms in the past.", "4. There is no significant past medical history.", "5. The patient currently does not take any medications.", "6. Family history is significant for her mother who died of a pancreatic tumor at the age of 53.", "7. Laboratory analysis reveals: Serum calcium 12 mg/dL.", "8. Laboratory analysis reveals: Serum phosphorus 2.2 mg/dL.", "9. Laboratory analysis reveals: Serum parathyroid hormone 105 pg/mL." ]

[ "As a public health practitioner, you are charged with choosing which blood test to use for the screening of a new infectious disease.", "You want to ensure that as many cases of this disease as possible are picked up by this initial screening test." ]

[ "1. As a public health practitioner, you are charged with choosing which blood test to use.", "2. The blood test is for the screening of a new infectious disease.", "3. You want to ensure that as many cases of this disease as possible are picked up by this initial screening test." ]

[ "1. The goal is to detect as many cases of the disease as possible.", "2. The focus is on the initial screening test.", "3. The emphasis is on maximizing the number of cases detected." ]

[ "A 25-year-old man is brought into the hospital by his family because they are concerned that he has post-traumatic stress disorder.", "The patient is a marine and was deployed to Afghanistan 2 years ago.", "He was able to successfully reintegrate with society upon his return; however, for the last 2 weeks, he has been having recurrent nightmares and avoiding news coverage on the war.", "He has become more and more detached from his family and friends and, on the few times he does interact with them, he has angry outbursts.", "The patient is afebrile, and his vital signs are within normal limits.", "Physical examination is unremarkable." ]

[ "1. A 25-year-old man is brought into the hospital by his family.", "2. The family is concerned that he has post-traumatic stress disorder.", "3. The patient is a marine.", "4. The patient was deployed to Afghanistan 2 years ago.", "5. The patient was able to successfully reintegrate with society upon his return.", "6. For the last 2 weeks, the patient has been having recurrent nightmares.", "7. The patient has been avoiding news coverage on the war.", "8. The patient has become more and more detached from his family and friends.", "9. On the few times the patient does interact with them, he has angry outbursts.", "10. The patient is afebrile.", "11. The patient's vital signs are within normal limits.", "12. Physical examination is unremarkable." ]

[ "1. The patient is a marine.", "2. The patient was deployed to Afghanistan 2 years ago.", "3. The patient was able to successfully reintegrate with society upon his return.", "4. For the last 2 weeks, the patient has been having recurrent nightmares.", "5. For the last 2 weeks, the patient has been avoiding news coverage on the war.", "6. The patient has become more and more detached from his family and friends.", "7. The patient has angry outbursts when interacting with family and friends.", "8. The patient is afebrile.", "9. The patient's vital signs are within normal limits.", "10. Physical examination is unremarkable." ]

[ "A 4-year-old girl is brought to the pediatrician because of throat pain for 2 days.", "She had frequent episodes of oral thrush as a baby and has been treated for vaginal yeast infection twice in the past year.", "Physical examination shows white patches on the tongue and palate.", "Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding.", "Leukocyte count is within normal range.", "Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue." ]

[ "1. A 4-year-old girl is brought to the pediatrician because of throat pain for 2 days.", "2. She had frequent episodes of oral thrush as a baby.", "3. She has been treated for vaginal yeast infection twice in the past year.", "4. Physical examination shows white patches on the tongue and palate.", "5. Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding.", "6. Leukocyte count is within normal range.", "7. Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue." ]

[ "1. She had frequent episodes of oral thrush as a baby.", "2. She has been treated for vaginal yeast infection twice in the past year.", "3. Physical examination shows white patches on the tongue and palate.", "4. Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding.", "5. Leukocyte count is within normal range.", "6. Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue." ]

[ "A 55-year-old male with chronic dyspnea is intubated and started on mechanical ventilation for respiratory failure.", "Pressure-volume scalars on the ventilator show decreased change in volume for each unit change in pressure as compared to normal values." ]

[ "1. Patient is 55 years old.", "2. Patient is male.", "3. Patient has chronic dyspnea.", "4. Patient is intubated.", "5. Patient is on mechanical ventilation for respiratory failure.", "6. Pressure-volume scalars on the ventilator show decreased change in volume for each unit change in pressure.", "7. Decreased change in volume for each unit change in pressure is compared to normal values." ]

[ "1. Pressure-volume scalars are used on the ventilator.", "2. The pressure-volume scalars show decreased change in volume for each unit change in pressure.", "3. The decreased change in volume is compared to normal values." ]

[ "A 6-year-old African-American boy presents with severe pain and swelling of both his hands and wrists.", "His symptoms onset 2 days ago and have not improved.", "He also has had diarrhea for the last 2 days and looks dehydrated.", "This patient has had two similar episodes of severe pain in the past.", "Physical examination reveals pallor, jaundice, dry mucous membranes, and sunken eyes." ]

[ "1. Patient is a 6-year-old African-American boy.", "2. Patient has severe pain and swelling of both hands and wrists.", "3. Symptoms onset 2 days ago and have not improved.", "4. Patient has had diarrhea for the last 2 days.", "5. Patient looks dehydrated.", "6. Patient has had two similar episodes of severe pain in the past.", "7. Physical examination reveals pallor.", "8. Physical examination reveals jaundice.", "9. Physical examination reveals dry mucous membranes.", "10. Physical examination reveals sunken eyes." ]

[ "1. Symptoms onset 2 days ago", "2. Symptoms have not improved", "3. Diarrhea for the last 2 days", "4. Patient looks dehydrated", "5. Patient has had two similar episodes of severe pain in the past", "6. Physical examination reveals pallor", "7. Physical examination reveals jaundice", "8. Physical examination reveals dry mucous membranes", "9. Physical examination reveals sunken eyes" ]

[ "A 45-year-old woman presents to her primary care physician with complaints of weight loss and anxiety.", "She says that over the past 6 months she has lost 10 pounds even though she has had an increased appetite.", "In addition, she describes 3 episodes where it felt like her heart was \"pounding out of her chest.\" Her temperature is 99.3°F (37.4°C), pulse is 106/min and regular, blood pressure is 141/80 mmHg, and respirations are 18/min.", "Physical exam is significant for mild bilateral proptosis and 3+ deep tendon reflexes bilaterally." ]

[ "1. A 45-year-old woman presents to her primary care physician.", "2. She has complaints of weight loss and anxiety.", "3. She has lost 10 pounds over the past 6 months.", "4. She has had an increased appetite.", "5. She has had 3 episodes where it felt like her heart was \"pounding out of her chest.\"", "6. Her temperature is 99.3°F (37.4°C).", "7. Her pulse is 106/min and regular.", "8. Her blood pressure is 141/80 mmHg.", "9. Her respirations are 18/min.", "10. Physical exam is significant for mild bilateral proptosis.", "11. Physical exam is significant for 3+ deep tendon reflexes bilaterally." ]

[ "1. The patient has lost 10 pounds over the past 6 months.", "2. The patient has had an increased appetite.", "3. The patient has experienced 3 episodes of feeling like her heart was \"pounding out of her chest.\"", "4. The patient's temperature is 99.3°F (37.4°C).", "5. The patient's pulse is 106/min and regular.", "6. The patient's blood pressure is 141/80 mmHg.", "7. The patient's respirations are 18/min.", "8. The patient has mild bilateral proptosis.", "9. The patient has 3+ deep tendon reflexes bilaterally." ]

[ "A 58-year-old woman is brought to the emergency department by her husband because of increasing confusion and generalized fatigue over the past week.", "During this period, she has had muscle cramps, headaches, nausea, and vomiting.", "Six days ago, she underwent resection of a parasagittal meningioma.", "She tolerated the procedure well without complications and was discharged two days ago.", "She has hypercholesterolemia and hypertension.", "Current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide.", "She is oriented only to person and place.", "Her temperature is 37°C (98.6°F), pulse is 89/min, respiratory rate is 14/min, and blood pressure is 142/88 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 97%.", "The remainder of the examination shows no abnormalities.", "Serum studies show: | Serum | Na+ 126 mEq/L | K+ 3.6 mEq/L | Cl- 107 mEq/L | Urea nitrogen 16 mg/dL | Glucose 87 mg/dL | Creatinine 0.9 mg/dL | Osmolality 255 mOsmol/kg H2O | Urine | Osmolality 523 mOsmol/kg H2O | Sodium 44 mEq/L | ." ]

[ "1. A 58-year-old woman is brought to the emergency department by her husband.", "2. She has increasing confusion and generalized fatigue over the past week.", "3. She has had muscle cramps, headaches, nausea, and vomiting.", "4. Six days ago, she underwent resection of a parasagittal meningioma.", "5. She tolerated the procedure well without complications and was discharged two days ago.", "6. She has hypercholesterolemia and hypertension.", "7. Current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide.", "8. She is oriented only to person and place.", "9. Her temperature is 37°C (98.6°F).", "10. Her pulse is 89/min.", "11. Her respiratory rate is 14/min.", "12. Her blood pressure is 142/88 mm Hg.", "13. Pulse oximetry on room air shows an oxygen saturation of 97%.", "14. The remainder of the examination shows no abnormalities.", "15. Serum Na+ is 126 mEq/L.", "16. Serum K+ is 3.6 mEq/L.", "17. Serum Cl- is 107 mEq/L.", "18. Serum urea nitrogen is 16 mg/dL.", "19. Serum glucose is 87 mg/dL.", "20. Serum creatinine is 0.9 mg/dL.", "21. Serum osmolality is 255 mOsmol/kg H2O.", "22. Urine osmolality is 523 mOsmol/kg H2O.", "23. Urine sodium is 44 mEq/L." ]

[ "1. The patient has had muscle cramps, headaches, nausea, and vomiting.", "2. Six days ago, the patient underwent resection of a parasagittal meningioma.", "3. The patient tolerated the procedure well without complications and was discharged two days ago.", "4. The patient has hypercholesterolemia and hypertension.", "5. The patient's current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide.", "6. The patient is oriented only to person and place.", "7. The patient's temperature is 37°C (98.6°F), pulse is 89/min, respiratory rate is 14/min, and blood pressure is 142/88 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 97%.", "9. The remainder of the examination shows no abnormalities.", "10. Serum studies show: Serum Na+ 126 mEq/L, K+ 3.6 mEq/L, Cl- 107 mEq/L, Urea nitrogen 16 mg/dL, Glucose 87 mg/dL, Creatinine 0.9 mg/dL, Osmolality 255 mOsmol/kg H2O.", "11. Urine Osmolality is 523 mOsmol/kg H2O and Sodium is 44 mEq/L." ]

[ "A 55-year-old man comes to the emergency department because of left arm pain after falling from a ladder.", "Physical examination shows tenderness along the proximal left humerus.", "An x-ray of the left arm and shoulder shows a nondisplaced proximal humerus fracture." ]

[ "1. A 55-year-old man comes to the emergency department.", "2. The man has left arm pain after falling from a ladder.", "3. Physical examination shows tenderness along the proximal left humerus.", "4. An x-ray of the left arm and shoulder is performed.", "5. The x-ray shows a nondisplaced proximal humerus fracture." ]

[ "1. Physical examination shows tenderness along the proximal left humerus.", "2. An x-ray of the left arm shows a nondisplaced proximal humerus fracture.", "3. An x-ray of the shoulder shows a nondisplaced proximal humerus fracture." ]

[ "A 62-year-old African American man is admitted to the emergency department with a 24-hour history of intense epigastric pain that radiates to the back with nausea and vomiting.", "His medical history is relevant for hypertension, heart failure (HF), chronic obstructive pulmonary disease (COPD), and radicular pain, all under control with amlodipine, furosemide, ipratropium, and gabapentin.", "He drinks occasionally at family gatherings and has never smoked cigarettes.", "His vital signs are recorded as follows: blood pressure of 130/80 mm Hg, a heart rate of 78/min, a respiratory rate of 18/min, and a body temperature of 36.6°C (97.9°F).", "Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue and intense pain to touch but no signs of peritoneal irritation." ]

[ "1. Patient is a 62-year-old African American man.", "2. Patient has a 24-hour history of intense epigastric pain radiating to the back with nausea and vomiting.", "3. Patient's medical history is relevant for hypertension, HF, COPD, and radicular pain.", "4. Patient is taking amlodipine, furosemide, ipratropium, and gabapentin.", "5. Patient drinks occasionally at family gatherings and has never smoked cigarettes.", "6. Patient's blood pressure is 130/80 mm Hg.", "7. Patient's heart rate is 78/min.", "8. Patient's respiratory rate is 18/min.", "9. Patient's body temperature is 36.6°C (97.9°F).", "10. Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue and intense pain to touch.", "11. Abdominal examination shows no signs of peritoneal irritation." ]

[ "1. His medical history includes hypertension, heart failure (HF), chronic obstructive pulmonary disease (COPD), and radicular pain.", "2. His conditions are under control with amlodipine, furosemide, ipratropium, and gabapentin.", "3. He drinks occasionally at family gatherings.", "4. He has never smoked cigarettes.", "5. His blood pressure is 130/80 mm Hg.", "6. His heart rate is 78/min.", "7. His respiratory rate is 18/min.", "8. His body temperature is 36.6°C (97.9°F).", "9. Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue.", "10. He experiences intense pain to touch but no signs of peritoneal irritation." ]

[ "A 62-year-old woman presents to the emergency department complaining of intense pain in her right knee that started 12 hours ago.", "Her past medical history is significant for hemochromatosis, managed with biweekly phlebotomy.", "Her vitals include: blood pressure of 130/70 mm Hg, pulse of 82/min, respiratory rate of 18/min, and temperature of 36.5°C (97.7°F).", "Physical examination reveals an erythematous, warm, and severely tender right knee with a restricted range of motion.", "An arthrocentesis is performed, and synovial fluid analysis is significant for a neutrophil count of 3,200 cells/μL, a negative Gram stain, and the following result under polarized light microscopy (see image)." ]

[ "1. A 62-year-old woman presents to the emergency department.", "2. She is complaining of intense pain in her right knee that started 12 hours ago.", "3. Her past medical history is significant for hemochromatosis, managed with biweekly phlebotomy.", "4. Her vitals include: blood pressure of 130/70 mm Hg, pulse of 82/min, respiratory rate of 18/min, and temperature of 36.5°C (97.7°F).", "5. Physical examination reveals an erythematous, warm, and severely tender right knee with a restricted range of motion.", "6. An arthrocentesis is performed.", "7. Synovial fluid analysis is significant for a neutrophil count of 3,200 cells/μL.", "8. Synovial fluid analysis is also significant for a negative Gram stain.", "9. Synovial fluid analysis is also significant for the following result under polarized light microscopy (see image)." ]

[ "1. Past medical history includes hemochromatosis managed with biweekly phlebotomy.", "2. Vitals: blood pressure 130/70 mm Hg, pulse 82/min, respiratory rate 18/min, temperature 36.5°C (97.7°F).", "3. Physical examination reveals erythematous, warm, and severely tender right knee with restricted range of motion.", "4. Arthrocentesis performed.", "5. Synovial fluid analysis shows neutrophil count of 3,200 cells/μL.", "6. Synovial fluid analysis shows negative Gram stain.", "7. Synovial fluid analysis shows result under polarized light microscopy." ]

[ "A 52-year-old man with a history of mild chronic obstructive pulmonary disease (COPD) has been using albuterol as needed to manage his COPD without any other maintenance medications.", "Recently, he has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough.", "He denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses.", "The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min.", "His physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left.", "Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value." ]

[ "1. Patient is a 52-year-old man.", "2. Patient has a history of mild chronic obstructive pulmonary disease (COPD).", "3. Patient has been using albuterol as needed to manage his COPD without any other maintenance medications.", "4. Patient has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough.", "5. Patient denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses.", "6. Temperature is 36.7°C (98.0°F).", "7. Blood pressure is 126/74 mm Hg.", "8. Heart rate is 74/min.", "9. Respiratory rate is 14/min.", "10. Physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left.", "11. Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value." ]

[ "1. He has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough.", "2. He denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses.", "3. Vital signs: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min.", "4. Physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left.", "5. Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value." ]

[ "A 24 year-old male presented to his physician with a homogenous, painless testicular swelling that he noticed for the past two weeks.", "After ultrasound and blood tests, he subsequently underwent a radical inguinal orchiectomy and pathology was consistent with seminoma." ]

[ "1. A 24 year-old male presented to his physician.", "2. He had a homogenous, painless testicular swelling.", "3. He noticed the swelling for the past two weeks.", "4. He underwent an ultrasound and blood tests.", "5. He subsequently underwent a radical inguinal orchiectomy.", "6. Pathology was consistent with seminoma." ]

[ "1. Ultrasound was performed.", "2. Blood tests were conducted.", "3. A radical inguinal orchiectomy was performed.", "4. Pathology results were consistent with seminoma." ]

[ "A 31-year-old man comes to the physician because of diarrhea, bloating, nausea, and vomiting for the past week.", "He describes his stool as greasy, frothy, and soft; it is not red or darkened.", "The patient went on a hiking trip in Brazil 3 weeks ago.", "He has no history of serious illness and takes no medications.", "The patient appears dehydrated.", "His vital signs are normal.", "Examination shows dry mucous membranes and diffuse abdominal tenderness.", "Microscopy of the stool reveals egg-shaped cysts with prominent two-layered cell wall and multiple nuclei." ]

[ "1. A 31-year-old man comes to the physician.", "2. He has had diarrhea, bloating, nausea, and vomiting for the past week.", "3. He describes his stool as greasy, frothy, and soft.", "4. His stool is not red or darkened.", "5. He went on a hiking trip in Brazil 3 weeks ago.", "6. He has no history of serious illness.", "7. He takes no medications.", "8. The patient appears dehydrated.", "9. His vital signs are normal.", "10. Examination shows dry mucous membranes.", "11. Examination shows diffuse abdominal tenderness.", "12. Microscopy of the stool reveals egg-shaped cysts.", "13. The egg-shaped cysts have a prominent two-layered cell wall.", "14. The egg-shaped cysts have multiple nuclei." ]

[ "1. The patient describes his stool as greasy, frothy, and soft.", "2. The patient's stool is not red or darkened.", "3. The patient went on a hiking trip in Brazil 3 weeks ago.", "4. The patient has no history of serious illness.", "5. The patient takes no medications.", "6. The patient appears dehydrated.", "7. The patient's vital signs are normal.", "8. Examination shows dry mucous membranes.", "9. Examination shows diffuse abdominal tenderness.", "10. Microscopy of the stool reveals egg-shaped cysts.", "11. The egg-shaped cysts have a prominent two-layered cell wall.", "12. The egg-shaped cysts have multiple nuclei." ]

[ "A 48-year-old man presents to the clinic feeling depressed after a string of failed business projects.", "His team noticed that he seems less engaged than he once used to be and this is reflecting in his work.", "He has no previous psychiatric history and symptoms of depressed mood have been ongoing for the past 6 months.", "A patient health questionnaire 9 (PHQ-9) was administered and the patient scored 10.", "The patient is started on venlafaxine." ]

[ "1. A 48-year-old man presents to the clinic feeling depressed.", "2. His team noticed that he seems less engaged than he once used to be.", "3. This is reflecting in his work.", "4. He has no previous psychiatric history.", "5. Symptoms of depressed mood have been ongoing for the past 6 months.", "6. A patient health questionnaire 9 (PHQ-9) was administered.", "7. The patient scored 10.", "8. The patient is started on venlafaxine." ]

[ "1. His team noticed that he seems less engaged than he once used to be.", "2. This is reflecting in his work.", "3. He has no previous psychiatric history.", "4. Symptoms of depressed mood have been ongoing for the past 6 months.", "5. A patient health questionnaire 9 (PHQ-9) was administered.", "6. The patient scored 10 on the PHQ-9.", "7. The patient is started on venlafaxine." ]

[ "A researcher is performing an experiment where she is using bacteria to clone copies of a mutated gene that she plans on introducing to cells.", "In order to perform this, she has created a small, circular segment of double-stranded DNA that includes the gene of interest as well as a gene for antibiotic resistance.", "After introducing this segment of DNA to competent bacteria, she plates the bacteria on media containing the antibiotic." ]

[ "1. A researcher is performing an experiment.", "2. The researcher is using bacteria to clone copies of a mutated gene.", "3. The researcher plans on introducing the mutated gene to cells.", "4. The researcher has created a small, circular segment of double-stranded DNA.", "5. The segment of DNA includes the gene of interest and a gene for antibiotic resistance.", "6. The researcher has introduced the segment of DNA to competent bacteria.", "7. The researcher has plated the bacteria on media containing the antibiotic." ]

[ "1. She has created a small, circular segment of double-stranded DNA.", "2. The segment of DNA includes the gene of interest.", "3. The segment of DNA includes a gene for antibiotic resistance.", "4. She introduces the segment of DNA to competent bacteria.", "5. She plates the bacteria on media containing the antibiotic." ]

[ "A 27-year-old woman presents to the emergency department with altered mental status.", "Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago and promptly brought her in.", "She was unconscious with lacerations on her wrists.", "The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts.", "Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history.", "She is currently vomiting and her gait seems ataxic.", "Initial laboratory values are unremarkable.", "An arterial blood gas analysis reveals the following findings. | | Arterial blood gas | pH: 7.50 | pO2: 105 mmHg | pCO2: 20 mmHg | Bicarbonate: 24 mEq/L | | ." ]

[ "1. A 27-year-old woman presents to the emergency department with altered mental status.", "2. Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago and promptly brought her in.", "3. She was unconscious with lacerations on her wrists.", "4. The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts.", "5. Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history.", "6. She is currently vomiting and her gait seems ataxic.", "7. Initial laboratory values are unremarkable.", "8. An arterial blood gas analysis reveals a pH of 7.50.", "9. An arterial blood gas analysis reveals a pO2 of 105 mmHg.", "10. An arterial blood gas analysis reveals a pCO2 of 20 mmHg.", "11. An arterial blood gas analysis reveals a bicarbonate of 24 mEq/L." ]

[ "1. Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago.", "2. She was unconscious with lacerations on her wrists.", "3. The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts.", "4. Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history.", "5. She is currently vomiting and her gait seems ataxic.", "6. Initial laboratory values are unremarkable.", "7. Arterial blood gas analysis reveals the following findings: pH: 7.50, pO2: 105 mmHg, pCO2: 20 mmHg, Bicarbonate: 24 mEq/L." ]

[ "A 33-year-old Asian American man presents to his primary care provider in February with pain in his fingers.", "His symptoms started 2 years ago and have gradually progressed.", "He initially attributed his symptoms to stress at work as a social worker.", "He has tried using ibuprofen, acetaminophen, and naproxen, but these medications did not improve his pain.", "He also reports that there have been at least 3 instances in the past 2 months in which his fingers became extremely painful and turned white before turning pale blue.", "These instances occurred when the patient was walking outside.", "His past medical history is notable for gastroesophageal reflux disease and gout.", "He takes omeprazole and allopurinol.", "His temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 90/min, and respirations are 18/min.", "Physical examination reveals loss of skin fold wrinkles and indurated skin on the palmar side of the digits.", "Finger range of motion is limited." ]

[ "1. Patient is 33-year-old Asian American man.", "2. Patient presents to primary care provider in February with pain in fingers.", "3. Symptoms started 2 years ago and have gradually progressed.", "4. Patient initially attributed symptoms to stress at work as a social worker.", "5. Patient has tried ibuprofen, acetaminophen, and naproxen, but these medications did not improve pain.", "6. At least 3 instances in past 2 months in which fingers became extremely painful and turned white before turning pale blue.", "7. These instances occurred when patient was walking outside.", "8. Patient's past medical history is notable for gastroesophageal reflux disease and gout.", "9. Patient takes omeprazole and allopurinol.", "10. Patient's temperature is 99°F (37.2°C).", "11. Patient's blood pressure is 120/78 mmHg.", "12. Patient's pulse is 90/min.", "13. Patient's respirations are 18/min.", "14. Physical examination reveals loss of skin fold wrinkles and indurated skin on palmar side of digits.", "15. Finger range of motion is limited." ]

[ "1. Symptoms started 2 years ago", "2. Symptoms have gradually progressed", "3. Initially attributed symptoms to stress at work as a social worker", "4. Tried using ibuprofen, acetaminophen, and naproxen", "5. Medications did not improve his pain", "6. At least 3 instances in the past 2 months of extremely painful and white fingers turning pale blue", "7. Instances occurred when walking outside", "8. Past medical history includes gastroesophageal reflux disease and gout", "9. Takes omeprazole and allopurinol", "10. Temperature is 99°F (37.2°C)", "11. Blood pressure is 120/78 mmHg", "12. Pulse is 90/min", "13. Respirations are 18/min", "14. Physical examination reveals loss of skin fold wrinkles and indurated skin on the palmar side of the digits", "15. Finger range of motion is limited" ]

[ "A 3-year-old boy is brought to the physician because of a 1-day history of abdominal pain and frequent urination.", "His mother reports that the patient has wet his bed overnight and that his urine smelled odd this morning.", "He has been toilet trained for 4 months and has had very few accidents since then.", "His last bowel movement was 3 days ago.", "He was born at term after a normal gestation and has reached all developmental milestones.", "His parents divorced 4 months ago and the patient's father has moved away.", "The patient began preschool 6 weeks ago.", "During this period, he has had two upper respiratory infections that resolved without treatment.", "His 12-year-old brother has type 1 diabetes mellitus.", "Vital signs are within normal limits.", "Physical examination of the abdomen shows mild suprapubic tenderness.", "Urine dipstick is positive for leukocyte esterase, nitrite, and blood; urinalysis shows white blood cells and gram-negative rods." ]

[ "1. Patient is a 3-year-old boy.", "2. Patient has a 1-day history of abdominal pain and frequent urination.", "3. Patient's mother reports he wet his bed overnight and his urine smelled odd this morning.", "4. Patient has been toilet trained for 4 months and has had very few accidents since then.", "5. Patient's last bowel movement was 3 days ago.", "6. Patient was born at term after a normal gestation and has reached all developmental milestones.", "7. Patient's parents divorced 4 months ago and the patient's father has moved away.", "8. Patient began preschool 6 weeks ago.", "9. Patient has had two upper respiratory infections that resolved without treatment.", "10. Patient's 12-year-old brother has type 1 diabetes mellitus.", "11. Vital signs are within normal limits.", "12. Physical examination of the abdomen shows mild suprapubic tenderness.", "13. Urine dipstick is positive for leukocyte esterase, nitrite, and blood.", "14. Urinalysis shows white blood cells and gram-negative rods." ]

[ "1. The patient has wet his bed overnight.", "2. His urine smelled odd this morning.", "3. He has been toilet trained for 4 months.", "4. He has had very few accidents since then.", "5. His last bowel movement was 3 days ago.", "6. He was born at term after a normal gestation.", "7. He has reached all developmental milestones.", "8. His parents divorced 4 months ago.", "9. The patient's father has moved away.", "10. The patient began preschool 6 weeks ago.", "11. During this period, he has had two upper respiratory infections that resolved without treatment.", "12. His 12-year-old brother has type 1 diabetes mellitus.", "13. Vital signs are within normal limits.", "14. Physical examination of the abdomen shows mild suprapubic tenderness.", "15. Urine dipstick is positive for leukocyte esterase, nitrite, and blood.", "16. Urinalysis shows white blood cells and gram-negative rods." ]

[ "A 37-year-old male presents with difficulty eating solids and drinking water; which has been progressively worse over the past year.", "He has noticed that he is regurgitating food that appears undigested and has also been having difficulty belching.", "He said that lifting his neck seems to help him keep his food down.", "He is currently on omeprazole for his acid reflux; however, his heartburn still persists.", "An esophagogastroduodenoscopy (EGD) is performed that shows no evidence of mechanical obstruction or esophageal inflammation." ]

[ "1. Patient is 37 years old.", "2. Patient has difficulty eating solids and drinking water.", "3. Symptoms have been progressively worse over the past year.", "4. Patient regurgitates food that appears undigested.", "5. Patient has difficulty belching.", "6. Lifting neck helps patient keep food down.", "7. Patient is currently on omeprazole for acid reflux.", "8. Heartburn still persists.", "9. An EGD is performed.", "10. EGD shows no evidence of mechanical obstruction.", "11. EGD shows no evidence of esophageal inflammation." ]

[ "1. He is regurgitating undigested food.", "2. He is having difficulty belching.", "3. Lifting his neck seems to help him keep his food down.", "4. He is currently on omeprazole for acid reflux.", "5. His heartburn still persists despite omeprazole.", "6. An esophagogastroduodenoscopy (EGD) shows no evidence of mechanical obstruction or esophageal inflammation." ]

[ "A 56-year-old man comes to the emergency department for chest pain that started 1 hour ago.", "He has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus.", "He appears diaphoretic and distressed.", "An ECG shows P waves independent of QRS complexes.", "The QRS interval is 0.11 seconds with normal morphology." ]

[ "1. A 56-year-old man comes to the emergency department for chest pain.", "2. The chest pain started 1 hour ago.", "3. He has a history of hypertension.", "4. He has a history of hyperlipidemia.", "5. He has a history of type 2 diabetes mellitus.", "6. He appears diaphoretic and distressed.", "7. An ECG shows P waves independent of QRS complexes.", "8. The QRS interval is 0.11 seconds.", "9. The QRS morphology is normal." ]

[ "1. He has a history of hypertension.", "2. He has a history of hyperlipidemia.", "3. He has a history of type 2 diabetes mellitus.", "4. He appears diaphoretic.", "5. He appears distressed.", "6. An ECG shows P waves independent of QRS complexes.", "7. The QRS interval is 0.11 seconds.", "8. The QRS interval has normal morphology." ]

[ "A 29-year-old pregnant woman is brought to the emergency department complaining of the sudden onset of severe, sharp pelvic pain.", "She is at 6 weeks’ gestation.", "The patient is bleeding heavily from the vagina and feels very dizzy.", "Substantial pain is noted in the lower right quadrant, which intensified towards the end of the physical exam.", "On examination, there is evidence of abdominal and cervical motion tenderness.", "Her blood pressure is 71/37 mm Hg, respiratory rate is 21/min, pulse is 117/min, and temperature is 38.4°C (101.1°F)." ]

[ "1. A 29-year-old pregnant woman is brought to the emergency department.", "2. She is complaining of the sudden onset of severe, sharp pelvic pain.", "3. She is at 6 weeks’ gestation.", "4. The patient is bleeding heavily from the vagina.", "5. She feels very dizzy.", "6. Substantial pain is noted in the lower right quadrant.", "7. The pain intensified towards the end of the physical exam.", "8. On examination, there is evidence of abdominal and cervical motion tenderness.", "9. Her blood pressure is 71/37 mm Hg.", "10. Her respiratory rate is 21/min.", "11. Her pulse is 117/min.", "12. Her temperature is 38.4°C (101.1°F)." ]

[ "1. The patient is at 6 weeks’ gestation.", "2. The patient is bleeding heavily from the vagina.", "3. The patient feels very dizzy.", "4. Substantial pain is noted in the lower right quadrant.", "5. The pain intensified towards the end of the physical exam.", "6. On examination, there is evidence of abdominal and cervical motion tenderness.", "7. The patient's blood pressure is 71/37 mm Hg.", "8. The patient's respiratory rate is 21/min.", "9. The patient's pulse is 117/min.", "10. The patient's temperature is 38.4°C (101.1°F)." ]

[ "A 24-year-old man presents to his primary care physician with heel pain that has been persistent for 3 weeks now.", "He is bothered by the feeling of significant pressure and swelling in his ankle.", "He is also having difficulty walking due to pain in his hip.", "Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon.", "Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces.", "This patient also appears to have a low to moderate kyphosis of his spine.", "He has no family history of any bone or rheumatological diseases." ]

[ "1. A 24-year-old man presents to his primary care physician.", "2. He has heel pain that has been persistent for 3 weeks.", "3. He is bothered by the feeling of significant pressure and swelling in his ankle.", "4. He is having difficulty walking due to pain in his hip.", "5. Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon.", "6. Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces.", "7. This patient also appears to have a low to moderate kyphosis of his spine.", "8. He has no family history of any bone or rheumatological diseases." ]

[ "1. He is bothered by the feeling of significant pressure and swelling in his ankle.", "2. He is also having difficulty walking due to pain in his hip.", "3. Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon.", "4. Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces.", "5. This patient also appears to have a low to moderate kyphosis of his spine.", "6. He has no family history of any bone or rheumatological diseases." ]

[ "A 51-year-old man comes to his physician with chronic sinusitis and rhinorrhea for which he uses mometasone nasal spray.", "He is seeking a refill on this prescription, noting that, although it has not fully relieved his nasal symptoms over the past 2 years, it has helped minimize the severity of those symptoms.", "On auscultation, there are faint crackles in the bilateral lung fields and an indentation at the nasal bridge.", "The patient also notes occasional hemoptysis and hematuria.", "He has no significant medical history and takes no other medications.", "Family history is significant for rheumatoid arthritis.", "The physician is suspicious for granulomatosis with polyangiitis and a nasal mucosal biopsy is obtained which confirms the diagnosis.", "The patient is started immediately on prednisone and cyclophosphamide." ]

[ "1. Patient is 51 years old.", "2. Patient has chronic sinusitis and rhinorrhea.", "3. Patient uses mometasone nasal spray.", "4. Patient is seeking a refill on the prescription.", "5. Prescription has not fully relieved nasal symptoms over the past 2 years, but has helped minimize severity.", "6. On auscultation, faint crackles in bilateral lung fields and indentation at nasal bridge.", "7. Patient notes occasional hemoptysis and hematuria.", "8. Patient has no significant medical history.", "9. Patient takes no other medications.", "10. Family history is significant for rheumatoid arthritis.", "11. Physician is suspicious for granulomatosis with polyangiitis.", "12. Nasal mucosal biopsy is obtained which confirms diagnosis.", "13. Patient is started immediately on prednisone and cyclophosphamide." ]

[ "1. The patient is seeking a refill on a prescription.", "2. The prescription has not fully relieved his nasal symptoms over the past 2 years.", "3. The prescription has helped minimize the severity of those symptoms.", "4. Faint crackles are heard in the bilateral lung fields on auscultation.", "5. There is an indentation at the nasal bridge.", "6. The patient experiences occasional hemoptysis.", "7. The patient experiences occasional hematuria.", "8. The patient has no significant medical history.", "9. The patient takes no other medications.", "10. Family history is significant for rheumatoid arthritis.", "11. The physician is suspicious for granulomatosis with polyangiitis.", "12. A nasal mucosal biopsy is obtained.", "13. The nasal mucosal biopsy confirms the diagnosis of granulomatosis with polyangiitis.", "14. The patient is started immediately on prednisone and cyclophosphamide." ]

[ "A 28-year-old man presents to a clinic for a health check-up.", "He says that he feels great and has not seen a physician for approximately 10 years.", "He is concerned about his health because his 3 older brothers have recently developed cardiac problems.", "His medical history is significant for an appendectomy 16 years ago.", "He works out twice a week and eats a low-salt, well-balanced diet.", "He drinks alcohol socially on the weekend, but does not use tobacco or drugs.", "The pulse is 80/min, respirations are 14/min, and the blood pressure is 129/80 mm Hg.", "The physical examination is unremarkable." ]

[ "1. A 28-year-old man presents to a clinic for a health check-up.", "2. He says that he feels great and has not seen a physician for approximately 10 years.", "3. His 3 older brothers have recently developed cardiac problems.", "4. His medical history is significant for an appendectomy 16 years ago.", "5. He works out twice a week.", "6. He eats a low-salt, well-balanced diet.", "7. He drinks alcohol socially on the weekend.", "8. He does not use tobacco or drugs.", "9. The pulse is 80/min.", "10. Respirations are 14/min.", "11. The blood pressure is 129/80 mm Hg.", "12. The physical examination is unremarkable." ]

[ "1. He feels great and has not seen a physician for approximately 10 years.", "2. He is concerned about his health because his 3 older brothers have recently developed cardiac problems.", "3. His medical history is significant for an appendectomy 16 years ago.", "4. He works out twice a week and eats a low-salt, well-balanced diet.", "5. He drinks alcohol socially on the weekend, but does not use tobacco or drugs.", "6. The pulse is 80/min, respirations are 14/min, and the blood pressure is 129/80 mm Hg.", "7. The physical examination is unremarkable." ]

[ "A 17-year-old boy presents for a psychotherapy session after finding out that his girlfriend has been carrying on another relationship with someone else.", "He expresses rage and complains of difficulty focusing on his upcoming high school comedy club routines and upcoming track meet.", "His therapist, while explaining the concept of defense mechanisms, describes some hypothetical examples related to the situation." ]

[ "1. A 17-year-old boy presents for a psychotherapy session.", "2. He found out that his girlfriend has been carrying on another relationship with someone else.", "3. He expresses rage.", "4. He complains of difficulty focusing on his upcoming high school comedy club routines.", "5. He complains of difficulty focusing on his upcoming track meet.", "6. His therapist explains the concept of defense mechanisms.", "7. His therapist describes some hypothetical examples related to the situation." ]

[ "1. He expresses rage.", "2. He complains of difficulty focusing on his upcoming high school comedy club routines.", "3. He complains of difficulty focusing on his upcoming track meet.", "4. His therapist explains the concept of defense mechanisms.", "5. The therapist describes some hypothetical examples related to the situation." ]

[ "A 39-year-old woman is brought to the emergency room by her fiancé for severe abdominal pain for the past 5 hours.", "She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away.", "Ibuprofen also did not help.", "She reports recurrent abdominal pain that would self-resolve in the past but states that “this one is way worse.” Her past medical history is significant for diabetes and an appendectomy 2 years ago.", "The patient endorses nausea and 1 episode of emesis, but denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness.", "She used to smoke marijuana in college and drinks about 2 beers a week.", "A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness.", "Her vitals are within normal limits.", "Laboratory values are shown below: | | Hemoglobin: 12 g/dL | Hematocrit: 34% | Leukocyte count: 4,900/mm^3 with normal differential | Platelet count: 160,000/mm^3 | | Serum: | Na+: 138 mEq/L | Cl-: 98 mEq/L | K+: 4.8 mEq/L | HCO3-: 25 mEq/L | Glucose: 123 mg/dL | Ca2+: 6.9 mg/dL | AST: 387 U/L | ALT: 297 U/L | ALP: 168 U/L | Lipase: 650 U/L (Normal 0 – 160 U/L) | | ." ]

[ "1. Patient is a 39-year-old woman.", "2. She was brought to the emergency room by her fiancé.", "3. She has been experiencing severe abdominal pain for the past 5 hours.", "4. She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away.", "5. Ibuprofen did not help.", "6. She has had recurrent abdominal pain in the past that would self-resolve.", "7. She states that “this one is way worse.”", "8. Her past medical history is significant for diabetes and an appendectomy 2 years ago.", "9. She endorses nausea and 1 episode of emesis.", "10. She denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness.", "11. She used to smoke marijuana in college.", "12. She drinks about 2 beers a week.", "13. Physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness.", "14. Her vitals are within normal limits.", "15. Hemoglobin: 12 g/dL", "16. Hematocrit: 34%", "17. Leukocyte count: 4,900/mm^3 with normal differential", "18. Platelet count: 160,000/mm^3", "19. Serum Na+: 138 mEq/L", "20. Serum Cl-: 98 mEq/L", "21. Serum K+: 4.8 mEq/L", "22. Serum HCO3-: 25 mEq/L", "23. Serum Glucose: 123 mg/dL", "24. Serum Ca2+: 6.9 mg/dL", "25. AST: 387 U/L", "26. ALT: 297 U/L", "27. ALP: 168 U/L", "28. Lipase: 650 U/L (Normal 0 – 160 U/L)" ]

[ "1. The patient felt sudden, sharp, 10/10 pain at the epigastric region after watching TV after dinner.", "2. Ibuprofen did not help with the pain.", "3. The patient has a history of recurrent abdominal pain that would self-resolve in the past.", "4. The patient's past medical history includes diabetes and an appendectomy 2 years ago.", "5. The patient endorses nausea and 1 episode of emesis.", "6. The patient denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness.", "7. The patient used to smoke marijuana in college and drinks about 2 beers a week.", "8. A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness.", "9. Laboratory values show: Hemoglobin: 12 g/dL, Hematocrit: 34%, Leukocyte count: 4,900/mm^3 with normal differential, Platelet count: 160,000/mm^3, Serum: Na+: 138 mEq/L, Cl-: 98 mEq/L, K+: 4.8 mEq/L, HCO3-: 25 mEq/L, Glucose: 123 mg/dL, Ca2+: 6.9 mg/dL, AST: 387 U/L, ALT: 297 U/L, ALP: 168 U/L, Lipase: 650 U/L (Normal 0 – 160 U/L)." ]

[ "A 50-year-old man is evaluated for a 2-year history of intermittent, nonproductive, chronic cough, as well as mild dyspnea with exertion.", "He has a 20-pack-year history of smoking and is a current smoker.", "His medical history is significant for hypertension and type 2 diabetes mellitus, which he has controlled with diet and exercise.", "He also takes lisinopril.", "On physical examination, blood pressure is 125/76 mm Hg, pulse rate is 78/min, respiratory rate is 15/min, oxygen saturation is 98% (breathing room air), and his BMI is 25 kg/m2.", "There is no jugular venous distention.", "Heart sounds are normal, and there is no murmur.", "Auscultation of the lungs reveals faint, bilateral wheezing.", "No peripheral edema is noted.", "The remainder of the examination is normal." ]

[ "1. Patient is a 50-year-old man.", "2. Patient has a 2-year history of intermittent, nonproductive, chronic cough.", "3. Patient has mild dyspnea with exertion.", "4. Patient has a 20-pack-year history of smoking.", "5. Patient is a current smoker.", "6. Patient has a medical history of hypertension.", "7. Patient has a medical history of type 2 diabetes mellitus.", "8. Patient has controlled diabetes mellitus with diet and exercise.", "9. Patient takes lisinopril.", "10. Patient's blood pressure is 125/76 mm Hg.", "11. Patient's pulse rate is 78/min.", "12. Patient's respiratory rate is 15/min.", "13. Patient's oxygen saturation is 98% (breathing room air).", "14. Patient's BMI is 25 kg/m2.", "15. Patient has no jugular venous distention.", "16. Patient's heart sounds are normal.", "17. Patient has no murmur.", "18. Auscultation of the lungs reveals faint, bilateral wheezing.", "19. Patient has no peripheral edema.", "20. The remainder of the examination is normal." ]

[ "1. He has a 20-pack-year history of smoking", "2. He is a current smoker", "3. His medical history is significant for hypertension", "4. His medical history is significant for type 2 diabetes mellitus", "5. He has controlled his diabetes with diet and exercise", "6. He takes lisinopril", "7. His blood pressure is 125/76 mm Hg", "8. His pulse rate is 78/min", "9. His respiratory rate is 15/min", "10. His oxygen saturation is 98% (breathing room air)", "11. His BMI is 25 kg/m2", "12. There is no jugular venous distention", "13. Heart sounds are normal", "14. There is no murmur", "15. Auscultation of the lungs reveals faint, bilateral wheezing", "16. No peripheral edema is noted", "17. The remainder of the examination is normal" ]

[ "A 51-year-old woman presents with bilateral hand tremors.", "She has had these tremors for several years, and her symptoms have gradually worsened over time.", "The tremors are restricted to her hands and are most prominent when she is holding a cup of tea or a pen.", "The tremors get worse when she is under stress or exhausted, and they are starting to disrupt her work routine.", "She denies walking difficulties, speech problems, and weakness.", "Her past medical history is significant for a recent hospitalization for an asthma exacerbation.", "Current medications include salmeterol, medium-dose fluticasone, and a daily multivitamin.", "The patient denies smoking but drinks alcohol socially.", "The patient is afebrile and her vital signs are within normal limits.", "On physical examination, her hands have a noticeable tremor when in use and remain still while resting in her lap." ]

[ "1. Patient is 51 years old.", "2. Patient has bilateral hand tremors.", "3. Patient has had tremors for several years.", "4. Symptoms have gradually worsened over time.", "5. Tremors are restricted to hands.", "6. Tremors are most prominent when holding a cup of tea or a pen.", "7. Tremors get worse when under stress or exhausted.", "8. Tremors are starting to disrupt work routine.", "9. Patient denies walking difficulties, speech problems, and weakness.", "10. Patient has past medical history of recent hospitalization for asthma exacerbation.", "11. Current medications include salmeterol, medium-dose fluticasone, and daily multivitamin.", "12. Patient denies smoking.", "13. Patient drinks alcohol socially.", "14. Patient is afebrile.", "15. Vital signs are within normal limits.", "16. Hands have noticeable tremor when in use.", "17. Hands remain still when resting in lap." ]

[ "1. The patient has had tremors for several years.", "2. Her symptoms have gradually worsened over time.", "3. The tremors are restricted to her hands.", "4. The tremors are most prominent when she is holding a cup of tea or a pen.", "5. The tremors worsen when she is under stress or exhausted.", "6. The tremors are starting to disrupt her work routine.", "7. She denies walking difficulties, speech problems, and weakness.", "8. Her past medical history includes a recent hospitalization for an asthma exacerbation.", "9. Her current medications include salmeterol, medium-dose fluticasone, and a daily multivitamin.", "10. The patient denies smoking but drinks alcohol socially.", "11. The patient is afebrile.", "12. Her vital signs are within normal limits.", "13. On physical examination, her hands have a noticeable tremor when in use and remain still while resting in her lap." ]

[ "A 39-year-old female was involved in a head-on collision motor vehicle accident." ]

[ "1. A 39-year-old female was involved.", "2. Head-on collision motor vehicle accident." ]

[ "1. Age of the patient: 39 years old", "2. Gender of the patient: female", "3. Involvement in a motor vehicle accident", "4. Type of motor vehicle accident: head-on collision" ]

[ "A previously healthy 2-month-old boy is brought to the physician because of a 10-day history of poor feeding.", "He used to feed for 20 minutes but now needs 40 minutes.", "He struggles to breathe and sweats while feeding.", "He was born at 38 weeks' gestation.", "He is at the 20th percentile for length and 10th percentile for weight.", "His vital signs are within normal limits.", "Pulse oximetry on room air shows an oxygen saturation of 98%.", "A grade 3/6 holosystolic murmur is heard at the left lower sternal border.", "An ECG shows left-axis deviation.", "An x-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings.", "Doppler echocardiography confirms the presence of an intracardiac shunt." ]

[ "1. Patient is a 2-month-old boy.", "2. Patient has a 10-day history of poor feeding.", "3. Patient used to feed for 20 minutes, but now needs 40 minutes.", "4. Patient struggles to breathe and sweats while feeding.", "5. Patient was born at 38 weeks' gestation.", "6. Patient is at the 20th percentile for length.", "7. Patient is at the 10th percentile for weight.", "8. Patient's vital signs are within normal limits.", "9. Pulse oximetry on room air shows an oxygen saturation of 98%.", "10. Grade 3/6 holosystolic murmur is heard at the left lower sternal border.", "11. ECG shows left-axis deviation.", "12. X-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings.", "13. Doppler echocardiography confirms the presence of an intracardiac shunt." ]

[ "1. He used to feed for 20 minutes but now needs 40 minutes.", "2. He struggles to breathe and sweats while feeding.", "3. He was born at 38 weeks' gestation.", "4. He is at the 20th percentile for length and 10th percentile for weight.", "5. His vital signs are within normal limits.", "6. Pulse oximetry on room air shows an oxygen saturation of 98%.", "7. A grade 3/6 holosystolic murmur is heard at the left lower sternal border.", "8. An ECG shows left-axis deviation.", "9. An x-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings.", "10. Doppler echocardiography confirms the presence of an intracardiac shunt." ]

[ "A 14-year-old boy is brought to the physician for a follow-up examination.", "He has allergic rhinitis and his only medication is cetirizine.", "He is at the 60th percentile for height and above the 95th percentile for weight and BMI.", "Vital signs are within the normal limits.", "Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast.", "There are no changes in the skin or nipple.", "The right breast is unremarkable.", "There is no palpable axillary lymphadenopathy.", "Axillary and pubic hair is present.", "Examination of the penis and testis shows no abnormalities.", "Neurologic examination shows no focal findings." ]

[ "1. Patient is 14 years old.", "2. Patient has allergic rhinitis.", "3. Patient's only medication is cetirizine.", "4. Patient is at the 60th percentile for height.", "5. Patient is above the 95th percentile for weight and BMI.", "6. Vital signs are within the normal limits.", "7. Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast.", "8. There are no changes in the skin or nipple.", "9. The right breast is unremarkable.", "10. There is no palpable axillary lymphadenopathy.", "11. Axillary and pubic hair is present.", "12. Examination of the penis and testis shows no abnormalities.", "13. Neurologic examination shows no focal findings." ]

[ "1. He has allergic rhinitis.", "2. His only medication is cetirizine.", "3. He is at the 60th percentile for height.", "4. He is above the 95th percentile for weight and BMI.", "5. Vital signs are within the normal limits.", "6. Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast.", "7. There are no changes in the skin or nipple.", "8. The right breast is unremarkable.", "9. There is no palpable axillary lymphadenopathy.", "10. Axillary and pubic hair is present.", "11. Examination of the penis and testis shows no abnormalities.", "12. Neurologic examination shows no focal findings." ]

[ "A 54-year-old woman presents to her primary care physician complaining of a lump in her right breast.", "She first noticed it 1 month ago.", "Now she is worried that it may have grown.", "She claims that the lump is not painful or itchy, and she denies any abnormal nipple bleeding or discharge.", "She has a family history of breast cancer, including both her mother and older sister.", "Physical examination reveals a firm, immobile lump in the upper right breast.", "A mammogram is performed, which identifies an irregular mass with a fibrotically stranded border.", "A biopsy is performed that is positive for invasive ductal carcinoma.", "The patient is started on radiation induction therapy and scheduled for a modified radical mastectomy.", "Following tumor gene testing, the patient is found to be positive or the HER-2/neu oncogene." ]

[ "1. A 54-year-old woman presents to her primary care physician.", "2. She is complaining of a lump in her right breast.", "3. She first noticed it 1 month ago.", "4. Now she is worried that it may have grown.", "5. She claims that the lump is not painful or itchy.", "6. She denies any abnormal nipple bleeding or discharge.", "7. She has a family history of breast cancer.", "8. Her mother and older sister both have breast cancer.", "9. Physical examination reveals a firm, immobile lump in the upper right breast.", "10. A mammogram is performed.", "11. The mammogram identifies an irregular mass with a fibrotically stranded border.", "12. A biopsy is performed.", "13. The biopsy is positive for invasive ductal carcinoma.", "14. The patient is started on radiation induction therapy.", "15. The patient is scheduled for a modified radical mastectomy.", "16. Following tumor gene testing, the patient is found to be positive for the HER-2/neu oncogene." ]

[ "1. She first noticed the lump 1 month ago.", "2. She is worried that the lump may have grown.", "3. The lump is not painful or itchy.", "4. She denies abnormal nipple bleeding or discharge.", "5. She has a family history of breast cancer.", "6. Her mother and older sister had breast cancer.", "7. Physical examination reveals a firm, immobile lump in the upper right breast.", "8. A mammogram identifies an irregular mass with a fibrotically stranded border.", "9. A biopsy is positive for invasive ductal carcinoma.", "10. The patient is started on radiation induction therapy.", "11. The patient is scheduled for a modified radical mastectomy.", "12. Tumor gene testing shows the patient is positive for the HER-2/neu oncogene." ]

[ "A 48-year-old man presents to his primary care physician concerned about his weight.", "He states he has been gaining weight though does not feel he has changed his diet.", "The patient also states he has felt fatigued lately and not himself.", "He denies taking any medications or using any illicit substances at baseline.", "His temperature is 99.2°F (37.3°C), blood pressure is 177/108 mmHg, pulse is 100/min, respirations are 18/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for an obese man with striae on his abdomen.", "A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level; however, a high dose of dexamethasone when administered results in no attenuation of cortisol release.", "A CT scan of the abdomen is within normal limits." ]

[ "1. A 48-year-old man presents to his primary care physician concerned about his weight.", "2. He states he has been gaining weight though does not feel he has changed his diet.", "3. The patient also states he has felt fatigued lately and not himself.", "4. He denies taking any medications or using any illicit substances at baseline.", "5. His temperature is 99.2°F (37.3°C).", "6. Blood pressure is 177/108 mmHg.", "7. Pulse is 100/min.", "8. Respirations are 18/min.", "9. Oxygen saturation is 98% on room air.", "10. Physical exam is notable for an obese man with striae on his abdomen.", "11. A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level.", "12. A high dose of dexamethasone when administered results in no attenuation of cortisol release.", "13. A CT scan of the abdomen is within normal limits." ]

[ "1. The patient has been gaining weight.", "2. The patient does not feel he has changed his diet.", "3. The patient has been feeling fatigued lately.", "4. The patient denies taking any medications or using any illicit substances at baseline.", "5. The patient's temperature is 99.2°F (37.3°C).", "6. The patient's blood pressure is 177/108 mmHg.", "7. The patient's pulse is 100/min.", "8. The patient's respirations are 18/min.", "9. The patient's oxygen saturation is 98% on room air.", "10. Physical exam is notable for an obese man with striae on his abdomen.", "11. A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level.", "12. A high dose of dexamethasone when administered results in no attenuation of cortisol release.", "13. A CT scan of the abdomen is within normal limits." ]

[ "Advances in molecular biology have identified important factors and sequences required for transcription and translation of mRNA as well as multiple diseases associated with mutations.", "The Kozak sequence is one such finding from this research." ]

[ "1. Advances in molecular biology have identified important factors and sequences required for transcription and translation of mRNA.", "2. Advances in molecular biology have identified multiple diseases associated with mutations.", "3. The Kozak sequence is one finding from this research." ]

[ "1. The Kozak sequence is a finding from research." ]

[ "A 3-week-old male infant is brought to the physician by his parents because they noticed that his head has been tilted to the left since birth.", "Physical examination shows the head turned toward the left side and the chin rotated toward the right.", "He cries during an attempt to rotate the head to the right.", "There is a firm, well-circumscribed mass on the left lower side of the neck." ]

[ "1. A 3-week-old male infant is brought to the physician by his parents.", "2. His parents noticed that his head has been tilted to the left since birth.", "3. Physical examination shows the head turned toward the left side.", "4. The chin is rotated toward the right.", "5. He cries during an attempt to rotate the head to the right.", "6. There is a firm, well-circumscribed mass on the left lower side of the neck." ]

[ "1. Physical examination shows the head turned toward the left side.", "2. Physical examination shows the chin rotated toward the right.", "3. He cries during an attempt to rotate the head to the right.", "4. There is a firm, well-circumscribed mass on the left lower side of the neck." ]

[ "A 13-month-old boy was brought to the clinic due to failure-to-thrive and mental impairment.", "Retinal findings are shown in the picture.", "The parents are healthy, but they previously had a child who died at 14 months of age." ]

[ "1. A 13-month-old boy was brought to the clinic.", "2. The reason for the visit was failure-to-thrive and mental impairment.", "3. Retinal findings are shown in the picture.", "4. The parents are healthy.", "5. The parents previously had a child who died at 14 months of age." ]

[ "1. Retinal findings are shown in the picture.", "2. The parents are healthy.", "3. The parents previously had a child who died at 14 months of age." ]

[ "A 24-year-old woman who is 16 weeks pregnant comes to your office requesting a referral for an abortion.", "Upon questioning she states that she is scared that her baby will be \"deformed\" because on routine screening she was found to have an elevated level of alpha-fetoprotein." ]

[ "1. A 24-year-old woman has come to the office.", "2. She is 16 weeks pregnant.", "3. She is requesting a referral for an abortion.", "4. She is scared that her baby will be \"deformed\".", "5. She had a routine screening which showed an elevated level of alpha-fetoprotein." ]

[ "1. The patient is scared about her baby being \"deformed.\"", "2. The patient had routine screening.", "3. The routine screening showed an elevated level of alpha-fetoprotein." ]

[ "A previously healthy 45-year-old man is brought to the emergency department after being found by a search and rescue team in the mountains.", "He has been without food or water for 30 hours.", "His temperature is 37°C (98.6°F), pulse is 123/min, respirations are 20/min, and blood pressure is 90/55 mm Hg.", "Physical examination shows decreased skin turgor and dry mucous membranes." ]

[ "1. A 45-year-old man was brought to the emergency department.", "2. He was found by a search and rescue team in the mountains.", "3. He had been without food or water for 30 hours.", "4. His temperature was 37°C (98.6°F).", "5. His pulse was 123/min.", "6. His respirations were 20/min.", "7. His blood pressure was 90/55 mm Hg.", "8. Physical examination showed decreased skin turgor.", "9. Physical examination showed dry mucous membranes." ]

[ "1. He has been without food for 30 hours.", "2. He has been without water for 30 hours.", "3. His temperature is 37°C (98.6°F).", "4. His pulse is 123/min.", "5. His respirations are 20/min.", "6. His blood pressure is 90/55 mm Hg.", "7. Physical examination shows decreased skin turgor.", "8. Physical examination shows dry mucous membranes." ]

[ "A 14-year-old Caucasian male presents with painful erythematous and honey-colored crusted lesions around his mouth.", "Culture of the lesions reveals gram-positive cocci in clusters.", "Further analysis reveals bacteria that are beta-hemolytic, coagulase positive, catalase positive, and appear golden on the blood agar plate." ]

[ "1. Patient is a 14-year-old Caucasian male.", "2. Patient has painful erythematous and honey-colored crusted lesions around his mouth.", "3. Culture of the lesions reveals gram-positive cocci in clusters.", "4. Further analysis reveals bacteria that are beta-hemolytic.", "5. Further analysis reveals bacteria that are coagulase positive.", "6. Further analysis reveals bacteria that are catalase positive.", "7. Further analysis reveals bacteria that appear golden on the blood agar plate." ]

[ "1. Culture of the lesions reveals gram-positive cocci in clusters.", "2. Further analysis reveals bacteria that are beta-hemolytic.", "3. Further analysis reveals bacteria that are coagulase positive.", "4. Further analysis reveals bacteria that are catalase positive.", "5. Further analysis reveals bacteria that appear golden on the blood agar plate." ]