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1. A 36-year-old woman with an obstetric history of 1-0-0-1 begins her pregnancy to receive a postpartum examination 6 weeks after delivery Q. At 25 weeks, symptoms of gestational diabetes were treated and she began exercising and dieting. Pregnancy Height: 154cm, weight: 120/80mmHg, pulse: 80/min, respiration: 20/min,... | "```json
{
""answer"": ""④"",
"'reason': "Women who have gestational diabetes at 6 weeks postpartum are advised to perform a 75 g oral glucose tolerance test to see if they continue. This is because gestational diabetes can continue after childbirth.","
""confidence_score"": 9
}
```" | |
2. A 33-year-old nulliparous woman in the 39th week of pregnancy came to the hospital because of pain in her lower abdomen for 3 hours. Blood pressure was 120/80 mmHg, pulse was 82 beats/min, respiration was 20 beats/min, and temperature was 36.5°C. Pelvic examination revealed cervix. The nitrazine test results are 3cm... | ```json
{
"answer": "2",
"reason": "The patient is in the latent phase of labor with no cervical change after 1 hour. Oxytocin is often used to augment labor in such cases to help progress the dilation and contractions. The other options are not appropriate: observation alone may not be sufficient, nifedipine a... | |
3. A 32-year-old woman came to the hospital saying her blood pressure was not controlled. She said she often had difficulty standing up because her legs lost strength for a year. She has been taking medication for high blood pressure and dyslipidemia since two years ago. Her blood pressure is 160/90 mmHg, pulse 80 time... | ```json
{
"answer": "①",
"reason": "The patient's symptoms and lab results suggest primary hyperaldosteronism (Conn's syndrome), characterized by hypertension, hypokalemia, low plasma renin activity, and high aldosterone levels. Adrenal vein sampling (① 부신정맥채혈) is the appropriate test to differentiate between u... | |
4. A 54-year-old woman with a history of obstetric history of 2-0-1-2 came to the hospital after feeling a lump in her lower abdomen. She had surgery and chemotherapy for gastric cancer two years ago. Pelvic examination showed no tenderness and rebound tenderness. This is a computed tomography picture of the abdominal ... | ```json
{
"answer": "⑤",
"reason": "The patient has a history of gastric cancer and presents with an abdominal mass. The elevated CA-125 and CEA levels, along with the history of gastric cancer, suggest a Krukenberg tumor, which is a metastatic ovarian tumor often originating from a primary gastric cancer. The ... | |
5. 36 weeks pregnant, 29-year-old undifferentiated women came to the hospital for prenatal examination. Blood pressure 110/70 mmHg, pulse 80 times/min, respiration 20 times/min, and body temperature 36.1°C. Pelvic examination showed no loss or expansion of the cervix. Ultrasonography showed the fetus head position, pre... | ```json
{
"answer": "⑤",
"reason": "The patient is experiencing oligohydramnios, as indicated by the low amniotic fluid index (AFI) of 1 cm. Additionally, the absence of diastolic flow in the umbilical artery Doppler suggests compromised fetal circulation. In such cases, amnioinfusion (양수주입) can be considered t... | |
6. A 31-year-old delivery woman at 16 weeks of pregnancy came to the hospital for prenatal examination. In the previous pregnancy, vaginal delivery was performed at 32 weeks of early labor. Blood pressure was 120/80 mmHg, pulse 76 times/min, respiration 20 times/min, and body temperature 36.2°C. On ultrasound examinati... | ```json
{
"answer": "④",
"reason": "Given the patient's history of preterm labor at 32 weeks in a previous pregnancy, the use of progesterone is recommended to reduce the risk of recurrent preterm birth. Progesterone has been shown to be effective in preventing preterm labor in women with a history of spontaneo... | |
7. A 34-year-old man came to the emergency room with a stomachache after he slipped and hit a wall while driving a motorcycle an hour ago. His blood pressure is 100/65 mmHg, pulse 114 times/min, respiration 20 times/min, and body temperature 36.1°C. He has tenderness and rebound tenderness in his upper abdomen. Blood t... | ```json
{
"answer": "⑤",
"reason": "The patient has signs of abdominal trauma with elevated amylase and lipase levels, suggesting pancreatic injury. The CT scan likely shows a pancreatic injury, and distal pancreatectomy (⑤ 먼쪽췌장절제) is a common treatment for distal pancreatic injuries when there is ductal disrup... | |
8. An 83-year-old woman came to the hospital two months ago after accidentally feeling a lump on her right breast. Her blood pressure is 140/80 mmHg, pulse 80 times/min, respiration 20 times/min, and body temperature is 36.7°C. This is a picture of the breast (photo 1). At 11 o'clock on the right breast, an indetermina... | ```json
{
"answer": "②",
"reason": "Given the description of a palpable mass in the breast with no axillary lymphadenopathy, a breast ultrasound is typically the next step in evaluation. It helps in characterizing the mass (solid vs cystic) and provides additional information that complements mammography. The o... | |
9. A 28-year-old woman came to the hospital five days ago with pain and fever in her left breast. She is breastfeeding after giving birth a month ago. She was unable to breastfeed her breast because it was too painful from yesterday. Her blood pressure is 110/70 mmHg, pulse 95 times/min, respiration 17 times/min, and b... | ```json
{
"answer": "3",
"reason": "The patient is a postpartum woman with symptoms of mastitis, including breast pain, fever, and a palpable mass with warmth. The elevated white blood cell count and C-reactive protein level indicate an infection. Given the acute presentation and the inability to breastfeed due... | |
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11. A 35-year-old man came to the hospital complaining of a fever and swelling in his left arm from two days ago. He reportedly had a wound on his left arm while weeding four days ago, but was not treated. He had sudden fever and chills from two days ago, pain and blisters started to appear as the wound began to swell ... | ```json
{
"answer": "②",
"reason": "The patient's symptoms and lab results suggest toxic shock syndrome. The rapid onset of fever, hypotension, and multi-organ involvement (elevated liver enzymes, renal impairment, and thrombocytopenia) are indicative of this condition. The history of a wound and the presence o... | |
12. A 60-year-old man came to the hospital complaining of a fever for one month. He had a fever every day, and when the fever goes up, he has a headache and body aches. He lost 5 kilograms and has no other symptoms. He is not taking any medicine other than fever reducer. His blood pressure is 130/80 mmHg, pulse 92 time... | ```json
{
"answer": "④",
"reason": "The patient presents with prolonged fever, weight loss, and elevated inflammatory markers (ESR and CRP) without a clear source of infection or abnormal findings on initial imaging and cultures. Infective endocarditis, particularly with culture-negative organisms, is a possibi... | |
13. A 25-year-old man came to the hospital saying he accidentally discovered something wrong with his genitals two days ago. He said he had sex with a woman he didn't know very well about a month ago without using condoms. He said he doesn't have pain in the genital region. This is a photo of the lesion of the genitali... | ```json
{
"answer": "⑤",
"reason": "The symptoms described are consistent with primary syphilis, which typically presents as a painless ulcer (chancre) on the genitals. The patient had unprotected sex a month ago, which aligns with the incubation period for syphilis. Benzathine penicillin is the recommended tre... | |
14. A 32-year-old woman came to the hospital with high blood pressure. She said that she lost menstruation and gained 8 kilograms of weight from six months ago. She is not taking any medication. She is 161 cm tall, 78 kg in weight, and 98 cm in waist size. Her blood pressure is 160/90 mmHg, pulse 88 times/min, respirat... | ```json
{
"answer": "④",
"reason": "The patient presents with symptoms suggestive of Cushing's syndrome, such as hypertension, weight gain, and menstrual irregularities. The 1mg overnight dexamethasone suppression test is used to screen for Cushing's syndrome by assessing cortisol suppression. The other options... | |
15. A 32-year-old woman came to the hospital with a swollen front neck. She gave birth to a baby girl three months ago. She has been having trouble lactating since 2 months ago due to a weight loss of 3kg and poor milking. Her blood pressure is 140/80 mmHg, pulse 96 times/min, respiration 18 times/min, and body tempera... | ```json
{
"answer": "2",
"reason": "The patient is a 32-year-old woman who recently gave birth and presents with symptoms of hyperthyroidism, such as weight loss and reduced milk production. The lab results show low TSH and high free T4, indicating hyperthyroidism. The presence of anti-thyroid peroxidase antibo... | |
16. A 33-year-old woman fell unconscious and was taken to the emergency room. According to her family, she felt tired easily and was thirsty for two months. She lost about 10 kilograms of weight. Her blood pressure is 90/50 mmHg, pulse 110 times/min, respiration 20 times/min, and body temperature 37.3°C. What are the r... | ```json
{
"answer": "④",
"reason": "The patient presents with symptoms and lab findings consistent with diabetic ketoacidosis (DKA): high blood glucose (338 mg/dL), high anion gap metabolic acidosis (pH 7.10, HCO3 6 mmol/L), presence of ketones in urine (4+), and elevated anion gap. The symptoms of fatigue, wei... | |
17. A 72-year-old woman came to the hospital complaining of a sudden back pain two weeks ago. The pain got better when she was lying down, and she got worse when she stood up or sitting down. She said she lost about 3 cm in height and gained 5 kg in the past year. She is a waist X-rayer (Pictures 1 and 2). The results ... | ```json
{
"answer": "③",
"reason": "The patient's symptoms and history suggest a vertebral compression fracture. The sudden onset of back pain, worsening with standing or sitting, and improvement when lying down, along with a decrease in height, are indicative of a compression fracture. The lab results do not s... | |
18. An 6-year-old man came to the hospital two years ago complaining of gradual swelling in his left finger. He has been suffering from intermittent swelling and pain in his toes and fingers since five years ago, and then heals on his own." This is a picture of his hand (photo). The results of blood test are as follows... | ```json
{
"answer": "④",
"reason": "The patient presents with symptoms and lab findings suggestive of chronic gout, including elevated uric acid levels and renal impairment (elevated creatinine). Febuxostat is a xanthine oxidase inhibitor used to lower uric acid levels in patients with gout, especially when the... | |
19. A 65-year-old woman came to the hospital two years ago complaining of pain in both knees. Knee pain worsens when activated. In the examination, swelling and tenderness of the right knee are observed. It is a knee X-ray player (photo 1). The results of the blood test are as follows. What is the diagnosis?
Hemoglob... | ```json
{
"answer": "③",
"reason": "The patient's symptoms and test results are consistent with osteoarthritis (골관절염). The age of the patient, the bilateral knee pain that worsens with activity, and the presence of swelling and tenderness in the knee are typical of osteoarthritis. The X-ray would likely show jo... | |
20. A 42-year-old woman came to the hospital six months ago complaining of swelling and pain in both her hands and right knee. This is a picture of her hand (photo 1). The results of the test are as follows. What about her treatment?
Blood: Hemoglobin 10.2 g/dL, White blood cells 8,300/mm3
Platelet 224,000/mm3
0.8 m... | ```json
{
"answer": "3",
"reason": "The patient presents with symptoms and lab findings suggestive of rheumatoid arthritis, including joint swelling, elevated rheumatoid factor, and high C-reactive protein levels. Methotrexate is a common disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid art... | |
21. A 32-year-old man came to the hospital two days ago to have bloody excrement in bright red like half a glass of soju. He is not taking any medication and has no family history of colorectal cancer. His blood pressure is 110/70 mmHg, pulse 66 times/min, respiration 16 times/min, and body temperature 37.1°C. What are... | ```json
{
"answer": "⑤",
"reason": "The patient presents with fresh red blood in the stool, which suggests a lower gastrointestinal source of bleeding, such as the rectum or sigmoid colon. A sigmoidoscopy (rectosigmoidoscopy) is appropriate to directly visualize and assess these areas for potential sources of b... | |
22. A 42-year-old man came to the hospital with upper stomachache from 1 day ago. He drank almost every day for 10 years and drank more than 3 bottles of soju every day for the past week. His blood pressure is 110/70 mmHg, pulse 86 times/min, respiration 18 times/min, and body temperature is 37.0°C. On auscultation of ... | ```json
{
"answer": "1",
"reason": "The patient's symptoms and laboratory findings are indicative of acute pancreatitis. The history of heavy alcohol consumption, abdominal pain, decreased bowel sounds, and elevated levels of amylase and lipase are classic signs of acute pancreatitis.",
"confidence_score": ... | |
23. A 30-year-old woman came to the hospital with a fever from three weeks ago. She has persistent fever and body aches, and from three days ago, she starts to feel short of breath when going up the stairs. Her blood pressure is 100/60 mmHg, pulse 110 times/min, respiration 20 times/min, and body temperature 38.1°C. Sy... | ```json
{
"answer": "3",
"reason": "The patient presents with symptoms and signs suggestive of infective endocarditis, such as fever, a new heart murmur, and skin lesions. The transthoracic echocardiogram (TTE) did not show vegetation, but it is less sensitive than transesophageal echocardiogram (TEE) for detec... | |
24. A 45-year-old man came to the hospital six months ago complaining of shortness of breath when he walks on a flat ground. He has been taking blood pressure drop pills for three years. His blood pressure is 135/85 mmHg, 64 beats/min, 18 beats/min breaths and 36.5°C body temperature. Chest auscultation reveals systoli... | ```json
{
"answer": "③",
"reason": "The patient presents with symptoms and echocardiographic findings suggestive of hypertrophic obstructive cardiomyopathy (HOCM), characterized by a thickened interventricular septum and a pressure gradient in the left ventricular outflow tract. Carvedilol, a beta-blocker, is o... | |
25. A 56-year-old man came to the hospital because his blood pressure was high. He has been taking blood pressure-lowering drugs for high blood pressure since 3 years ago. He did not miss taking medication and is exercising regularly. His blood pressure is 154/102 mmHg, pulse 52 times/min, respiration 16 times/min, and... | ```json
{
"answer": "⑤",
"reason": "The patient is on maximum doses of losartan and amlodipine, yet his blood pressure remains uncontrolled. The heart rate is low, suggesting that adding a beta-blocker like bisoprolol may not be ideal. Spironolactone is typically used for resistant hypertension, but the potassi... | |
26. A 55-year-old man came to the hospital with shortness of breath and increasing severity from 3 months ago. His blood pressure is 152/46 mmHg, pulse 84 times/min, respiration 22 times/min, and body temperature 36.2°C. On chest auscultation, a 3/6 degree diastolic noise can be heard in the space between the third ri... | ```json
{
"answer": "2",
"reason": "The patient's symptoms and examination findings are indicative of aortic regurgitation. The diastolic murmur heard at the left sternal border, especially when the patient is sitting up and leaning forward, is characteristic of aortic regurgitation. The wide pulse pressure (15... | |
27. A 41-year-old woman came to the hospital complaining of a dry cough from two months ago. She usually coughs when sleeping at night. She said she enjoyed late-night snacks and soda for six months. She is not taking any special medication. She is a non-smoker. She is 156 centimeters tall and weighs 80 kilograms. Hear... | ```json
{
"answer": "④",
"reason": "The patient's symptoms, such as dry cough occurring mainly at night when lying down, along with a history of consuming late-night snacks and carbonated drinks, suggest gastroesophageal reflux disease (GERD). The 24-hour ambulatory esophageal pH monitoring (option ④) is a diag... | |
28. A 68-year-old man came to the hospital complaining of shortness of breath for three months. He is okay when he is still but he gets short of breath when he walks fast or up stairs. He is a 20-pack-year-old former smoker. His blood pressure is 130/70 mmHg, pulse 86 times/min, respiration 20 times/min, and body tempe... | ```json
{
"answer": "④",
"reason": "The patient's symptoms and test results suggest interstitial lung disease. The reduced FVC and FEV1 with a normal FEV1/FVC ratio, along with decreased diffusion capacity, are indicative of a restrictive lung disease pattern, which is consistent with interstitial lung disease.... | |
29. A 74-year-old woman came to the hospital two hours ago out of breath. She reportedly had severe pain in her front chest for five hours five days ago, but did not go to the hospital. Her blood pressure is 102/60 mmHg, pulse 100 times/min, respiration 28 times/min, and body temperature 36.5°C. On chest auscultation, ... | ```json
{
"answer": "①",
"reason": "The patient presents with symptoms and signs suggestive of heart failure and possibly a recent myocardial infarction, as indicated by elevated troponin levels and BNP. The presence of a systolic murmur and S3 gallop suggests possible valvular dysfunction or heart failure. An ... | |
30. A 50-year-old man came to the hospital with pain in his left chest from a week ago. It hurts more when he inhales heavily or yawns, and he feels short of breath when climbing stairs from two days ago. He is a 30-pack-year-old smoker. His blood pressure is 130/80 mmHg, pulse 88 times/min, respiration 18 times/min, a... | ```json
{
"answer": "④",
"reason": "The patient's pleural effusion analysis shows a high level of carcinoembryonic antigen (CEA) at 529 ng/mL, which is significantly elevated and suggests a malignant pleural effusion. The presence of lymphocyte predominance in the pleural fluid and the patient's smoking history... |
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