q_id int64 0 1.27k | source_id stringlengths 36 36 | question stringlengths 220 3.66k | cot_ids listlengths 16 16 | cots listlengths 16 16 | parsed_answers listlengths 16 16 | answer stringclasses 4
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|---|---|---|---|---|---|---|
0 | 11798523-ae15-4a7d-8e75-5281282aeadf | Question: A junior orthopaedic surgery resident is completing a carpal tunnel repair with the department chairman as the attending physician. During the case, the resident inadvertently cuts a flexor tendon. The tendon is repaired without complication. The attending tells the resident that the patient will do fine, and... | [
0,
1,
2,
3,
4,
5,
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8,
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11,
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14,
15
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[
"The attending physician's actions are unethical and potentially illegal.",
"Hiding a surgical complication, even a seemingly minor one, is a breach of patient autonomy and informed consent. Patients have the right to know about all aspects of their medical care, including any unexpected events during sur... | [
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"A"
] | B |
1 | 248ec4d4-f0a8-4dea-a192-044d7572c5ef | Question: A 67-year-old man with transitional cell carcinoma of the bladder comes to the physician because of a 2-day history of ringing sensation in his ear. He received this first course of neoadjuvant chemotherapy 1 week ago. Pure tone audiometry shows a sensorineural hearing loss of 45 dB. The expected beneficial e... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
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[
"The patient experienced sensorineural hearing loss after chemotherapy, which primarily affects hair cells in the inner ear.",
"Many chemotherapeutic agents can cause ototoxicity (hearing damage). Of the provided options, the most well-known mechanism of ototoxicity is:",
"**Generation of free radical... | [
"C",
"C",
"C",
"C",
"C",
"C",
"B",
"C",
"C",
"D",
"C",
"C",
"C",
"B",
"C",
"C"
] | D |
2 | 9cee7247-3969-4d30-87ca-a3a281b0c342 | Question: Two weeks after undergoing an emergency cardiac catherization with stenting for unstable angina pectoris, a 61-year-old man has decreased urinary output and malaise. He has type 2 diabetes mellitus and osteoarthritis of the hips. Prior to admission, his medications were insulin and naproxen. He was also start... | [
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2,
3,
4,
5,
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9,
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12,
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15
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[
"The patient presents with new-onset renal dysfunction and skin manifestations along with post-catheterization state, suggesting a possible complication of the procedure.",
"The laboratory findings show leukocytosis with elevated neutrophil count, elevated ESR, and arterial hypertension.",
"Moreover, ... | [
"B",
"B",
"C",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"C",
"B",
"B",
"B",
"B",
"B"
] | B |
3 | 31fa2f2b-ece6-4cb9-bae9-ce3b5674c3d7 | Question: A 39-year-old woman is brought to the emergency department because of fevers, chills, and left lower quadrant pain. Her temperature is 39.1°C (102.3°F), pulse is 126/min, respirations are 28/min, and blood pressure is 80/50 mm Hg. There is blood oozing around the site of a peripheral intravenous line. Pelvic ... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [
[
"The patient presents with classic signs of sepsis (fever, chills, tachycardia, hypotension) and purulent discharge, suggesting a possible pelvic inflammatory disease (PID).",
"The lab findings, especially the low platelet count, fibrinogen level, and elevated D-dimer, point towards disseminated intravasc... | [
"A",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"A",
"A",
"B",
"A",
"D",
"B",
"B",
"B"
] | D |
4 | 5e6ac665-df6c-4f18-a9da-a2da14c074e5 | Question: A 35-year-old man comes to the physician because of itchy, watery eyes for the past week. He has also been sneezing multiple times a day during this period. He had a similar episode 1 year ago around springtime. He has iron deficiency anemia and ankylosing spondylitis. Current medications include ferrous sulf... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [
[
"The patient is presenting with symptoms of allergic conjunctivitis: itchy, watery eyes, and sneezing.",
"This is supported by the seasonal recurrence and lack of other evidence for infection or inflammation.",
"Ketotifen eye drops are antihistamines and the most appropriate treatment for allergic con... | [
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"A",
"B",
"B",
"E",
"B",
"B",
"B",
"B",
"B"
] | B |
5 | 7c935763-6195-4d87-8f6e-901a2202f058 | Question: A 39-year-old man presents to the emergency department because of progressively worsening chest pain and nausea that started at a local bar 30 minutes prior. The pain radiates to the epigastric area. He has a 5-year history of untreated hypertension. He has smoked 1 pack of cigarettes daily for the past 5 yea... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [
[
"The patient presents with classic symptoms of an acute myocardial infarction (MI):",
"* Chest pain radiating to the epigastrium\n* Nausea\n* Diaphoresis\n* Marked distress\n* History of hypertension and smoking\n* Recent cocaine use",
"Cocaine use can cause ischemia and infarction due to its... | [
"B",
"E",
"A",
"D",
"A",
"E",
"D",
"D",
"B",
"D",
"D",
"D",
"A",
"E",
"B",
"B"
] | D |
6 | 35364bfb-187e-4be0-b8d2-55003927dc4c | Question: A 68-year-old male comes to the physician for evaluation of right flank pain. He has a history of diabetes and peripheral artery disease. His blood pressure is 160/90 mm Hg. Physical examination shows abdominal tenderness and right flank tenderness. An ultrasound shows dilation of the right ureter and renal p... | [
0,
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5,
6,
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9,
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13,
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15
] | [
[
"Here's the reasoning process:",
"The patient presents with flank pain, abdominal tenderness, and right flank tenderness along with ultrasound findings of dilated ureter and renal pelvis. This points towards an obstruction in the urinary tract.",
"Renal artery stenosis could cause hypertension and pot... | [
"A",
"A",
"C",
"A",
"A",
"A",
"A",
"A",
"A",
"B",
"A",
"D",
"A",
"A",
"A",
"A"
] | C |
7 | b6db6af8-0047-41c9-85ef-7250c8f49197 | Question: A 65-year-old man is brought to the emergency department 30 minutes after the onset of acute chest pain. He has hypertension and asthma. Current medications include atorvastatin, lisinopril, and an albuterol inhaler. He appears pale and diaphoretic. His pulse is 114/min and blood pressure is 130/88 mm Hg. An ... | [
0,
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3,
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5,
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8,
9,
10,
11,
12,
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15
] | [
[
"The patient has been diagnosed with acute coronary syndrome (ACS) and has undergone percutaneous transluminal coronary angioplasty (PTCA).",
"PTCA is a procedure to open blocked coronary arteries. ACS is a condition where blood flow to the heart is reduced, causing chest pain (angina) or heart attack.",
... | [
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C",
"C"
] | C |
8 | e18c905c-70f2-4a44-8517-a16063c55aaa | Question: A 37-year-old-woman presents to her primary care physician requesting a new form of birth control. She has been utilizing oral contraceptive pills (OCPs) for the past 8 years, but asks to switch to an intrauterine device (IUD). Her vital signs are: blood pressure 118/78 mm Hg, pulse 73/min and respiratory rat... | [
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] | [
[
"Copper IUDs are a highly effective form of long-acting reversible contraception (LARC). However, there are certain medical conditions that make them contraindicated.",
"Let's analyze the options:",
"A history of stroke or venous thromboembolism increases the risk of blood clots, which could be exacer... | [
"B",
"C",
"B",
"B",
"A",
"B",
"B",
"B",
"B",
"B",
"A",
"B",
"B",
"B",
"B",
"A"
] | B |
9 | d4290264-c2e9-4fe0-8366-0440fde274c5 | Question: A 23-year-old woman comes to the physician because she is embarrassed about the appearance of her nails. She has no history of serious illness and takes no medications. She appears well. A photograph of the nails is shown. Which of the following additional findings is most likely in this patient?
A. Silvery p... | [
0,
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2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
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15
] | [
[
"The photograph of her nails shows spoon-shaped, concave depressions (koilonychia).",
"This specific nail sign strongly suggests an iron deficiency state.",
"Iron deficiency anemia is associated with symptoms beyond nail changes, but a history of serious illness and regular medication use are less li... | [
"A",
"A",
"A",
"A",
"A",
"A",
"B",
"A",
"A",
"A",
"A",
"A",
"A",
"A",
"D",
"A"
] | A |
10 | 5998c4de-1d9b-4f45-8c34-a62536e9fe4b | Question: A 24-year-old G2P1 woman at 39 weeks’ gestation presents to the emergency department complaining of painful contractions occurring every 10 minutes for the past 2 hours, consistent with latent labor. She says she has not experienced vaginal discharge, bleeding, or fluid leakage, and is currently taking no med... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [
[
"The patient is being treated for potential HIV transmission during labor and delivery.",
"Rapid screening tests for HIV typically detect antibodies against HIV.",
"Confirmatory tests need to be more specific and ensure the presence of the virus itself.",
"HIV confirmatory tests usually involve nu... | [
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D"
] | D |
11 | 6f71d4a7-86f7-4a4e-9066-3ecb8c2dab11 | Question: A 72-year-old man comes to the physician because of a 2-month history of fatigue and worsening abdominal pain. During this period, he also has excessive night sweats and shortness of breath on exertion. Over the past 3 months, he has had a 5.6-kg (12-lb) weight loss. He had a myocardial infarction 3 years ago... | [
0,
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2,
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4,
5,
6,
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8,
9,
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11,
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15
] | [
[
"The patient presents with symptoms suggestive of myelofibrosis, including fatigue, night sweats, weight loss, palpable spleen, anemia (shown by low hemoglobin), and thrombocytopenia (low platelet count).",
"The bone marrow biopsy showing extensive fibrosis and a positive JAK2 assay further confirm the di... | [
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D",
"D"
] | D |
12 | a760bdd6-11e6-415e-97ef-17efbb53ece1 | Question: A 20-year-old man comes to the physician because of worsening gait unsteadiness and bilateral hearing loss for 1 month. He has had intermittent tingling sensations on both cheeks over this time period. He has no history of serious medical illness and takes no medications. Audiometry shows bilateral sensorineu... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [
[
"The patient presents with symptoms that suggest a genetic predisposition to a neurofibromatosis type 2 (NF2).",
"Merlin is a tumor suppressor gene located on chromosome 22, and mutations in this gene are responsible for NF2.",
"NF2 is characterized by bilateral vestibular schwannomas (tumors of the e... | [
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B",
"B"
] | B |
13 | bf50fb73-483c-42ed-9f6d-d76ea8bbf356 | Question: A 47-year-old executive schedules an appointment his physician for a routine medical check-up. He currently has no complaints and claims to be “as fit as a fiddle.” The physical examination findings are unremarkable, except for a mid-systolic murmur heard in the 2nd left intercostal space that radiates to the... | [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [
[
"Let's analyze each option:",
"**A. An increase in right atrial pressure**\nStanding from a supine position increases venous return to the heart. This would lead to an increase in right atrial pressure.",
"**B. An increase in pulmonary capillary wedge pressure**\nPulmonary capillary wedge pressure is ... | [
"D",
"A",
"B",
"D",
"D",
"D",
"A",
"D",
"A",
"D",
"D",
"A",
"D",
"D",
"D",
"A"
] | D |
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