question stringlengths 663 1.39k | series stringlengths 3.39k 7.9k | correct_answer stringlengths 6 54 |
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A 45-year-old woman presents with increasing shortness of breath, particularly when lying down, and occasional palpitations. She also reports waking up gasping for air a few times over the past month. She denies chest pain or coughing up blood. Her symptoms have been gradually worsening over the past year. She has ... | [[{"role": "trainee", "result_analysis": "A 45-year-old woman presents with increasing shortness of breath, orthopnea, and palpitations. This suggests a possible cardiac or pulmonary issue. I want to first gather more information about the nature of her shortness of breath to distinguish between these two systems.", "n... | Mitral stenosis |
A 65-year-old female presents to the emergency department complaining of sudden onset, severe substernal chest pain radiating to her left arm and jaw. The pain began about 30 minutes ago while she was gardening. She describes the pain as a crushing pressure. She also reports shortness of breath and nausea. She denies... | [[{"role": "trainee", "result_analysis": "A 65-year-old female presents with sudden onset, severe substernal chest pain radiating to the left arm and jaw, accompanied by shortness of breath and nausea. Given these symptoms, the immediate concern is a cardiac event. The crushing nature of the pain is also concerning. I ... | Myocardial infarction |
A 28-year-old female presents to the clinic complaining of palpitations and atypical chest pain for the past 6 months. She describes the pain as a sharp, non-radiating discomfort in the left chest, unrelated to exertion. She also reports occasional episodes of lightheadedness, but denies syncope. She has no signific... | [[{"role": "trainee", "result_analysis": "The patient is a 28-year-old female with palpitations and atypical chest pain for 6 months. The pain is sharp and non-radiating, unrelated to exertion, which makes cardiac ischemia less likely, but I still need to consider possible cardiac causes before looking for something el... | Mitral Valve Prolapse |
A 65-year-old female presents to the emergency department with acute onset epigastric pain and diaphoresis for the past hour. The pain radiates to her jaw. She also reports feeling lightheaded and nauseous. She has a history of hypertension and hyperlipidemia. Her blood pressure is 150/90 mmHg, heart rate is 100 bpm... | [[{"role": "trainee", "result_analysis": "A 65-year-old female presents with acute onset epigastric pain and diaphoresis. Given the age and symptoms, I am considering both cardiac and gastrointestinal etiologies. My initial differential includes acute coronary syndrome, GERD, and peptic ulcer disease. To start, I want ... | Acute Coronary Syndrome (ACS) |
A 65-year-old female presents to the emergency department with acute onset shortness of breath and cough. She reports the shortness of breath is worse when lying down. She also complains of chest pain radiating to her left arm. Physical examination reveals a blood pressure of 90/60 mmHg, heart rate of 120 bpm, respir... | [[{"role": "trainee", "result_analysis": "The patient is a 65-year-old female with acute onset shortness of breath and cough, worse when lying down. This suggests a respiratory or cardiac issue. I need more information to differentiate between the two. I will start by finding out if the patient has any history of cardi... | Mitral regurgitation |
A 75-year-old male presents with complaints of increasing shortness of breath with exertion and occasional lightheadedness over the past six months. He denies chest pain. He reports fatigue limiting his daily activities. His blood pressure is 110/70 mmHg, heart rate is 80 bpm, respiratory rate is 16 breaths per minu... | [[{"role": "trainee", "result_analysis": "A 75-year-old male presents with increasing shortness of breath with exertion and occasional lightheadedness. He also reports fatigue. Given his age and symptoms, cardiac and pulmonary etiologies are the most likely. Before I dive into specific tests, I'd like to get a more det... | Aortic stenosis |
A 65-year-old woman presents with increasing fatigue and shortness of breath on exertion over the past 6 months. She also notes some swelling in her ankles that has worsened over the same period. She denies chest pain, fever, or cough. Her blood pressure is 110/70 mmHg, heart rate is 80 beats per minute and regular,... | [[{"role": "trainee", "result_analysis": "A 65-year-old woman presents with fatigue, shortness of breath on exertion, and ankle swelling over 6 months. These symptoms suggest possible heart failure, pulmonary issues, or even renal problems. To start, I'd like to know more about the progression of her symptoms. Specific... | Tricuspid stenosis |
A 55-year-old female presents with increasing shortness of breath and fatigue over the past 6 months. She also notes swelling in her ankles that is worse in the evenings. She denies chest pain but reports some abdominal discomfort and fullness. Her vital signs are: blood pressure 110/70 mmHg, heart rate 95 bpm and r... | [[{"role": "trainee", "result_analysis": "The patient is a 55-year-old female presenting with increasing shortness of breath, fatigue, and ankle swelling over the past 6 months. These symptoms suggest possible heart failure or pulmonary issues. To understand the extent of her symptoms and possible triggers, I want to g... | Tricuspid regurgitation |
A 25-year-old male with a history of Tetralogy of Fallot repair in childhood presents with progressive exertional dyspnea and decreased exercise tolerance over the past year. He denies chest pain but reports occasional palpitations and lightheadedness. Physical examination reveals a blood pressure of 110/70 mmHg, hear... | [[{"role": "trainee", "result_analysis": "A 25-year-old male presents with progressive exertional dyspnea, decreased exercise tolerance, occasional palpitations and lightheadedness. Given his age and symptoms, I'll consider cardiac and pulmonary causes first. The history of Tetralogy of Fallot repair is a very importan... | Pulmonary regurgitation |
A 6-year-old boy presents with increasing fatigue and shortness of breath when playing with his friends. His mother reports he can no longer keep up with the other children during activities. He has no history of chest pain or syncope. Physical examination reveals a harsh systolic ejection murmur heard best at the le... | [[{"role": "trainee", "result_analysis": "A 6-year-old boy presents with exertional dyspnea and fatigue. In a child, these symptoms could indicate a respiratory issue, cardiac problem, or even just being out of shape. My initial concern is to determine if this is a respiratory or cardiac issue first and foremost.", "ne... | Pulmonary stenosis |
A 55-year-old male presents with increasing shortness of breath and fatigue over the past 6 months. He also reports waking up at night gasping for air. He denies chest pain. His blood pressure is 110/70 mmHg, heart rate is 95 bpm and regular, respiratory rate is 20 breaths per minute, and temperature is 98.6°F. Phys... | [[{"role": "trainee", "result_analysis": "A 55-year-old male presents with shortness of breath and fatigue over the past 6 months, with nocturnal dyspnea. This sounds like heart failure. My initial thought is to focus on potential cardiac etiologies, though pulmonary conditions also need consideration. Before getting a... | Dilated cardiomyopathy |
A 65-year-old woman presents with increasing shortness of breath and fatigue over the past 6 months. She also notes swelling in her ankles that worsens throughout the day. She denies chest pain. Her medical history is significant for hypertension, for which she takes lisinopril. Physical examination reveals a blood... | [[{"role": "trainee", "result_analysis": "The patient is a 65-year-old woman with increasing shortness of breath, fatigue, and ankle swelling over the past 6 months. This sounds like heart failure. Before I focus only on cardiac etiology, it could also be kidney/liver disease so physical exam will be beneficial to find... | Restrictive cardiomyopathy |
A 12-year-old female presents with shortness of breath on exertion and occasional palpitations. She reports a sore throat about a month ago that resolved without treatment. Vital signs: Blood pressure 100/60 mmHg, heart rate 95 bpm, respiratory rate 20 breaths/min, temperature 98.6°F (37°C). Physical examination reve... | [[{"role": "trainee", "result_analysis": "The patient is a 12-year-old female with shortness of breath on exertion, palpitations, and a recent history of sore throat. An apical systolic murmur radiating to the axilla is concerning for mitral regurgitation. Given the age and history, I'm initially considering causes of ... | Rheumatic heart disease |
A 35-year-old male presents to the clinic complaining of occasional chest pain and shortness of breath, particularly during exercise. He also reports occasional palpitations and dizziness. He denies syncope. His father died suddenly at age 40 from an unknown cause. His blood pressure is 120/80 mmHg, heart rate is 88 ... | [[{"role": "trainee", "result_analysis": "A 35-year-old male is presenting with exertional chest pain, shortness of breath, palpitations, and dizziness. The differential is broad at this stage. I'm thinking about cardiac issues, but also pulmonary and even anxiety-related possibilities need to be considered. Given the ... | Hypertrophic cardiomyopathy (HCM) |
A 65-year-old woman presents to the emergency department complaining of palpitations and shortness of breath for the past 2 hours. She also notes some lightheadedness but denies chest pain or syncope. She has a history of hypertension and hypothyroidism, both well-controlled with medication. Physical examination rev... | [[{"role": "trainee", "result_analysis": "The patient is a 65-year-old woman presenting with palpitations, shortness of breath, and lightheadedness. The symptoms suggest a possible cardiac arrhythmia. Before going to the ECG results I want to know if she has any allergies or recent illness.", "next_interaction_reason":... | Atrial flutter |
A 25-year-old male presents to the emergency department with palpitations and lightheadedness that began suddenly while playing basketball. He reports a brief episode of syncope just prior to arrival. He denies chest pain or shortness of breath. His blood pressure is 110/70 mmHg, heart rate is 110 bpm and regular, re... | [[{"role": "trainee", "result_analysis": "A 25-year-old male presents with palpitations, lightheadedness, and syncope during exertion. Syncope during exertion is concerning. I want to start by gathering information regarding any family history.", "next_interaction_reason": "Family history of sudden cardiac death or sim... | Arrhythmogenic right ventricular cardiomyopathy (ARVC) |
A 75-year-old female presents to the emergency department with palpitations and dizziness for the past 24 hours. She also notes increased shortness of breath, especially with exertion. She denies chest pain. Her past medical history includes hypertension and type 2 diabetes. Physical examination reveals a blood pres... | [[{"role": "trainee", "result_analysis": "The patient is a 75-year-old female presenting with palpitations, dizziness, and increased shortness of breath. These symptoms are concerning and could point towards a cardiac arrhythmia or heart failure. I need to investigate further, starting with the vitals and any immediate... | Atrial fibrillation |
A 65-year-old male with a history of coronary artery disease presents to the emergency department after collapsing at home. His wife witnessed the event and reports he clutched his chest before becoming unresponsive. On arrival, the patient is unresponsive and pulseless. His blood pressure is unobtainable, respirator... | [[{"role": "trainee", "result_analysis": "A 65-year-old male with a history of coronary artery disease collapsed at home, clutching his chest and becoming unresponsive. Now he's pulseless and apneic in the ED. This presentation is extremely concerning for a life-threatening cardiac event. The first thing I need to know... | Ventricular fibrillation |
A 25-year-old female presents to the emergency department complaining of sudden onset palpitations and dizziness. She describes the palpitations as "fluttering" in her chest. The episode began approximately 30 minutes ago and has been continuous. She denies chest pain, shortness of breath, or syncope. She has no sig... | [[{"role": "trainee", "result_analysis": "A 25-year-old female presents with sudden onset palpitations and dizziness. Palpitations can be due to a number of cardiac or non-cardiac etiologies, and the sudden onset suggests a possible arrhythmia. Dizziness is concerning and could be related to decreased cardiac output fr... | Supraventricular tachycardia (SVT) |
A 65-year-old male with a history of coronary artery disease presents to the emergency department with palpitations and dizziness. He describes a sudden onset of rapid heartbeats about 30 minutes ago. He also feels lightheaded and short of breath. His blood pressure is 90/60 mmHg, heart rate is 170 beats per minute ... | [[{"role": "trainee", "result_analysis": "A 65-year-old male presents with palpitations, dizziness, and shortness of breath, suggesting a possible arrhythmia. The patient's history of coronary artery disease makes a cardiac etiology more likely, but I need more information to narrow down the possibilities. I think the ... | Ventricular tachycardia |
A 75-year-old female presents to the clinic complaining of lightheadedness and near-syncope, especially when standing up quickly. These episodes have been occurring for the past few months and are becoming more frequent. She also reports increasing fatigue and difficulty completing her usual daily activities. She den... | [[{"role": "trainee", "result_analysis": "A 75-year-old female presents with lightheadedness and near-syncope, especially when standing. This sounds like either a cardiovascular or neurological problem. First, I want to focus on possible cardiovascular causes, specifically orthostatic hypotension. Before getting any te... | Sick sinus syndrome |
A 65-year-old male presents to the clinic complaining of dizziness and lightheadedness, particularly upon standing. He reports occasional episodes of near-syncope but denies any loss of consciousness. He also notes decreased exercise tolerance over the past few months. His past medical history includes hypertension a... | [[{"role": "trainee", "result_analysis": "A 65-year-old male is presenting with dizziness, lightheadedness upon standing, near-syncope, and decreased exercise tolerance. These symptoms, especially the dizziness and near-syncope, suggest a cardiovascular issue, possibly related to his heart rate or blood pressure. The l... | First-degree atrioventricular (AV) block |
A 25-year-old male presents to the emergency department complaining of palpitations and dizziness that started suddenly about an hour ago. He denies any chest pain or shortness of breath. He reports a similar episode a year ago that resolved spontaneously. He has no significant medical history and takes no medications... | [[{"role": "trainee", "result_analysis": "A 25-year-old male presents with palpitations and dizziness that started suddenly about an hour ago. My initial thought is to rule out cardiac arrhythmia or something else related to heart function because of the dizziness. To get a better handle on what kind of palpitations he... | Wolff-Parkinson-White syndrome |
A 15-year-old female presents to the emergency department after collapsing during a swim meet. She reports feeling lightheaded just before losing consciousness. She regained consciousness spontaneously within a minute. She denies any chest pain, palpitations, or shortness of breath. She has no significant past medi... | [[{"role": "trainee", "result_analysis": "A 15-year-old female presenting with syncope after exertion (swimming) is concerning. Syncopal events during exercise can point towards cardiac abnormalities. Given the patient's age and the exertion-related nature of the syncope, I want to first rule out common causes such as ... | Long QT syndrome |
A 55-year-old female presents to the emergency department with progressive shortness of breath and chest pain for the past week. The pain is sharp and worsens with deep breaths and lying down, but improves when sitting upright. She also reports fatigue and some swelling in her ankles. Her blood pressure is 90/60 mmHg,... | [[{"role": "trainee", "result_analysis": "A 55-year-old female presents with progressive shortness of breath and chest pain. Given the limited information, the differential is broad but includes cardiac, pulmonary, and musculoskeletal etiologies. Shortness of breath could be related to cardiac failure or a pulmonary is... | Pericardial effusion with cardiac tamponade |
A 62-year-old male with a history of hypertension presents to the emergency department complaining of increasing shortness of breath and chest discomfort for the past 2 hours. He also reports feeling lightheaded. His symptoms began gradually and have worsened progressively. He denies any fever, cough, or recent traum... | [[{"role": "trainee", "result_analysis": "A 62-year-old male presents with increasing shortness of breath and chest discomfort. He also reports lightheadedness. There are several possible causes of these symptoms, including cardiac, pulmonary, and musculoskeletal issues. I want to first check about any other medical hi... | Cardiac tamponade |
A 68-year-old male presents to the emergency department with sudden onset of severe lower back pain radiating to the abdomen. He describes the pain as a "ripping" sensation. He has a history of hypertension and hyperlipidemia. Physical examination reveals pallor, diaphoresis, and a palpable pulsatile mass in the midl... | [[{"role": "trainee", "result_analysis": "A 68-year-old male is presenting with sudden onset of severe lower back pain radiating to the abdomen. The key words are 'sudden onset', 'severe', and 'radiating'. I need more information to prioritize my differentials. My immediate thought is some type of vascular emergency gi... | Ruptured abdominal aortic aneurysm |
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