question stringlengths 738 1.52k | series stringlengths 3.89k 8.56k | correct_answer stringlengths 6 54 |
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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": "A 12-year-old female presents with shortness of breath on exertion and palpitations. An important piece of information here is whether she has any known heart conditions from birth. That will differentiate between congenital and acquired condition which in turn greatly helps in... | Rheumatic heart disease |
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. This sounds like possible heart failure. I want to perform a physical examination.", "next_interaction_reason": "A physical examination will give me more details abo... | Tricuspid regurgitation |
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. This immediately raises concern for a cardiac arrhythmia or structural heart disease. Given the syncope during exertion, it is less likely to be vasovagal syncope, which often occurs af... | Arrhythmogenic right ventricular cardiomyopathy (ARVC) |
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": "A 28-year-old female presents with palpitations and atypical chest pain. Palpitations could be due to cardiac arrhythmia or anxiety, while atypical chest pain is less likely cardiac but can be musculoskeletal, psychological or rarely cardiac. The lack of radiation and relations... | Mitral Valve Prolapse |
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": "The patient is a 75-year-old male presenting with exertional dyspnea, lightheadedness, and fatigue. Given his age and symptoms, I suspect a cardiovascular cause. The differential could include valve disorders, heart failure, or arrhythmias. To start narrowing down the possibili... | Aortic stenosis |
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. My initial thoughts are that this could be cardiac in origin, or possibly related to a gastrointestinal issue. Given her age and the potential severity of cardiac issues, I want to rule that out fir... | 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": "A 65-year-old female presents with acute onset shortness of breath and cough. The shortness of breath is worse when lying down. Given the respiratory distress, my initial concern is for a cardiopulmonary problem. I need to rule out both cardiac and pulmonary etiologies. First, ... | Mitral regurgitation |
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": "The patient is a 65-year-old female presenting with increasing fatigue, shortness of breath on exertion, and ankle swelling over the past 6 months. These symptoms suggest possible heart failure. Given the lack of chest pain, fever, or cough, I'll start by focusing on potential ... | Tricuspid stenosis |
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 is presenting with increasing shortness of breath, orthopnea, and palpitations, all of which have been gradually worsening over the past year. I want to start by clarifying the nature of the palpitations. Sudden onset and offset palpitations are common for S... | Mitral stenosis |
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": "The patient is a 25-year-old male with a history of Tetralogy of Fallot repair, presenting with progressive exertional dyspnea and decreased exercise tolerance. This history of congenital heart disease is very important. I need to first assess his current cardiac function throu... | Pulmonary regurgitation |
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 increasing shortness of breath and fatigue over the past 6 months, as well as paroxysmal nocturnal dyspnea. This sounds like heart failure. The differential could include heart failure due to various causes, pulmonary issues, or even anemia. I s... | Dilated cardiomyopathy |
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": "The patient is a 65-year-old female with sudden onset, severe substernal chest pain radiating to the left arm and jaw, accompanied by shortness of breath and nausea. This presentation is highly concerning for a cardiac event, specifically acute myocardial infarction (AMI). Give... | Myocardial infarction |
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. These symptoms in a child could point towards a cardiac or respiratory issue, or even anemia. The key will be to determine the cause of these symptoms. Before diving into complicated tests, I'd like to explore the d... | Pulmonary stenosis |
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": "The patient is a 35-year-old male experiencing exertional chest pain, shortness of breath, palpitations, and dizziness. I would start by exploring cardiac causes, but will keep pulmonary and musculoskeletal issues on the list. I will also rule out anxiety and panic disorders. I... | Hypertrophic cardiomyopathy (HCM) |
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": "A 65-year-old woman presents with increasing shortness of breath and fatigue over 6 months, plus ankle swelling. This points towards a possible heart failure. I'll begin by asking about her medications to exclude any drug-induced contributions to her symptoms. Since she takes L... | Restrictive cardiomyopathy |
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": "A 65-year-old woman is experiencing palpitations, shortness of breath, and lightheadedness. These symptoms, along with the rapid heart rate, suggest a possible arrhythmia. The key here will be to differentiate between the various types of tachycardias. I need more details regar... | Atrial flutter |
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": "A 75-year-old female presents with palpitations and dizziness for the past 24 hours, along with increased shortness of breath. These symptoms can point to a few possibilities like cardiac arrhythmia or even dehydration or anxiety. The very first thing I should do is inquire mor... | Atrial fibrillation |
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, which suggests a possible cardiac arrhythmia. The first thing I need to determine is the patient's current cardiac rhythm. So I'll ask for the ECG.", "next_interaction_reason": "The ECG is essent... | Ventricular tachycardia |
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 collapsed during a swim meet after feeling lightheaded. She regained consciousness quickly and has no significant past medical history. The key here is syncope during exertion, which is concerning. I want to determine if there were any seizure-like activiti... | Long QT syndrome |
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 of sudden onset. My immediate concern is to determine the underlying cause of these symptoms. Rapid heart rate suggests some sort of arrythmia. I should start by gathering further information to better assess the situa... | Wolff-Parkinson-White syndrome |
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, is now unresponsive and pulseless. My immediate concern is a cardiac arrest. The differential at this point includes ventricular fibrillation, asystole, pulseless electrical activity (PEA), and vent... | 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. The key here is the sudden onset. The differential includes cardiac arrhythmias (SVT, atrial fibrillation, sinus tachycardia, ventricular tachycardia) and non-cardiac causes like panic attack or hyperth... | Supraventricular tachycardia (SVT) |
A 35-year-old female presents with sharp, central chest pain that started two days ago. The pain worsens with deep breaths and lying down, but improves when she sits up and leans forward. She also reports pain radiating to her left trapezius ridge. She denies any recent illness or trauma. Her vital signs are: blood p... | [[{"role": "trainee", "result_analysis": "The patient is a 35-year-old female presenting with sharp, central chest pain that started two days ago. The description of the pain worsening with deep breaths and lying down is interesting. My initial differential includes cardiac, pulmonary, and musculoskeletal causes. Befor... | Pericarditis |
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 presents with dizziness, lightheadedness, near-syncope, and decreased exercise tolerance. His heart rate is 48 bpm, which is bradycardic. Given these symptoms, a cardiac conduction issue is high on my differential. First step is physical exam.", "next_interac... | First-degree atrioventricular (AV) block |
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 is presenting with progressive shortness of breath and chest pain. This could stem from a number of cardiac, pulmonary, or even musculoskeletal issues. I need more details to narrow the possibilities down. Let's start with pain characteristics.", "next_inte... | Pericardial effusion with cardiac tamponade |
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. My initial thought is orthostatic hypotension, but I need to consider other possibilities like cardiac issues, medication side effects, or dehydration. The fatigue also needs to be ad... | Sick sinus syndrome |
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