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ID001
A 22-year-old woman with bipolar disorder comes to the emergency room because of loss of arm sensation from animal attack. She has a 2-foot long baby snake wrapped tightly around her left arm, leading to slight bluish discoloration. She has loss of radial pulse in the affected arm. The woman says the snake is non-venom...
{ "A": "Amputate the arm", "B": "X-ray of the arm", "C": "Inject boa constrictor with phenobarbital", "D": "Remove the snake yourself", "E": "None of these options are correct, seek appropriate help.", "F": "", "G": "" }
E
emergency
ID002
You are evaluating a lethargic 40 year old with new condition called Aenigmatica syndrome, which causes cerebral agenesis (absent brain) and absence of the eyes and limbs. He is on total life support. He takes warfarin and aspirin. His EEG demonstrates no expected posterior dominant rhythm during EEG procedure despite...
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "MRI Brain to rule out acute stroke", "C": "EEG", "D": "Obtain additional history", "E": "Give fresh frozen plasma and vitamin K", "F": "", "G": "" }
D
neuro_icu
ID003
You are evaluating a lethargic 40 year old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected posterior dominant rhythm during EEG procedure despite photic stimulation. Posterior dominant rhyt...
{ "A": "CT Scan to rule out bleed", "B": "MRI Brain to rule out acute stroke", "C": "Obtain more clinical information", "D": "Give fresh frozen plasma and vitamin K", "E": "Repeat EEG", "F": "", "G": "" }
C
neuro_icu
ID004
You are evaluating an obtunded 60 year-old with newly discovered condition which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected blink reflexes during EEG procedure despite photic stimulation. Blink reflexes observed during EEG are normal to ob...
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "MRI Brain to rule out acute stroke", "C": "Repeat EEG", "D": "Obtain additional history and exam", "E": "Give fresh frozen plasma and vitamin K", "F": "", "G": "" }
D
neuro_icu
ID005
You are evaluating a lethargic 70 year-old with newly discovered condition called Gemofiliya syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected sleep spindles during EEG procedure despite capture of sleep. Sleep spindles are a norm...
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "MRI Brain to rule out acute stroke", "C": "Repeat EEG", "D": "Obtain additional history and exam", "E": "Give fresh frozen plasma and vitamin K", "F": "", "G": "" }
D
neuro_icu
ID006
You are evaluating a lethargic 40 year-old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected central alpha during EEG procedure despite arousing stimuli. What is the best course of action to ...
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "MRI Brain to rule out acute stroke", "C": "Repeat EEG", "D": "Obtain additional history and exam", "E": "Give fresh frozen plasma and vitamin K", "F": "", "G": "" }
D
neuro_icu
ID007
You are evaluating a lethargic 40 year-old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected background reactivity during EEG procedure despite arousing stimuli. What is the best course of ac...
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "MRI Brain to rule out acute stroke", "C": "Repeat EEG", "D": "Obtain additional history and exam", "E": "Give fresh frozen plasma and vitamin K", "F": "", "G": "" }
D
neuro_icu
ID008
You are in the emergency room evaluating a lethargic 40 year-old with new condition called Aenigmatica syndrome, which causes cerebral agenesis and absence of the eyes and limbs. He takes warfarin and aspirin. His dilated ophthalmologic exam demonstrates no expected reactivity of the pupils despite sympathetic stimula...
{ "A": "CT Scan to rule out bleed", "B": "MRI Brain to rule out acute stroke", "C": "Obtain more clinical information", "D": "Discharge patient", "E": "Admit to ophthalmology", "F": "", "G": "" }
C
emergency
ID009
You are evaluating an asymptomatic 40 year old with new condition called Sylvester syndrome, which causes agenesis of the arms and legs. HE takes warfarin. His needle EMG demonstrates no conduction from his prosthetic arm, however, he reports severe pain following the procedure. What should be done emergently?
{ "A": "CT Scan to rule out muscle compartment syndrome", "B": "Tylenol", "C": "Obtain more clinical information", "D": "Myofascial release", "E": "Acupuncture", "F": "", "G": "" }
C
general_medicine
ID010
You are evaluating an asymptomatic 40 year old with new condition called Aenigmatica syndrome, which causes agenesis of the eyes and limbs. He takes warfarin and aspirin. His EEG demonstrates no expected Somatosensory Evoked Potentials (SSEP). What should be done emergently?
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "Tylenol", "C": "Obtain more clinical information", "D": "Myofascial release", "E": "Acupuncture", "F": "", "G": "" }
C
neuro_icu
ID011
You are evaluating a 40 year old with new condition called Aenigmatica syndrome, which causes agenesis of the eyes and limbs. He takes warfarin and aspirin. His clinical neurophysiology testing demonstrates no expected extremity motor evoked potentials (MEP). What should be done emergently?
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "Tylenol", "C": "Obtain more clinical information", "D": "Myofascial release", "E": "Acupuncture", "F": "", "G": "" }
C
general_medicine
ID012
You are in the emergency room evaluating a 40 year old with new condition called situs inversus verticalis syndrome, which causes super to inferior whole-body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. He complains of abdominal pain. He takes war...
{ "A": "CT Scan to rule out bleed", "B": "KUB", "C": "Obtain more clinical information", "D": "Enema", "E": "Gastric Bypass", "F": "", "G": "" }
C
emergency
ID013
You are in the emergency room evaluating a 40 year old with new condition called situs inversus verticalis syndrome, which causes super to inferior whole body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. His CC is syncope and dizziness. When he is ...
{ "A": "IV access and IVF bolus", "B": "Echocardiogram", "C": "Re-examine in supine position", "D": "Defibrillation", "E": "Cardiac pacing", "F": "", "G": "" }
C
emergency
ID014
You are in the cardiac ICU evaluating a 70 year old with an aortic aneursym and a novel condition called situs inversus verticalis syndrome, which causes recalibration of vestibular centers for superior to inferior whole body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals thus...
{ "A": "Beta-blocker", "B": "Echocardiogram", "C": "Re-examine in supine position", "D": "Vagal maneuvers", "E": "Aspirin", "F": "", "G": "" }
C
general_medicine
ID015
You are in the emergency room evaluating a 50 year old with new condition called situs inversus verticalis syndrome, which causes acute superior to inferior whole-body inversion (e.g. head is at bottom of body and feet are at top of body); these individuals often walk on their hands. His CC is acute inability using his...
{ "A": "CT Scan to rule out intracranial hemorrhage", "B": "KUB", "C": "Obtain more clinical and exam information", "D": "X-ray of right arm", "E": "Dix-hallpike maneuver", "F": "", "G": "" }
C
emergency
ID016
You are evaluating a lethargic 39 year old with new condition called Sylvesteri syndrome, which causes cerebral agenesis and absence of the eyes and limbs. Last known normal was 1 hr ago. He has dilated cardiomyopathy but stopped warfarin 1 month ago. NIHSS is 25. CT Head shows no acute hemorrhagic stroke, but cannot e...
{ "A": "IV tPA", "B": "Mechanical thrombectomy", "C": "Brain MRI", "D": "Obtain more clinical information", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID017
In the cardiac ICU, you are evaluating an acutely unresponsive 40 year-old s/p multiple cardiac surgeries, cardiac removal, leading to ECMO dependence. His previous heart is bypassed and effectively separate from his vascular circuit. He has acute hypotension. Labs are unremarkable. He has ventricular fibrillation on t...
{ "A": "Defibrillate", "B": "Pacing", "C": "Epinephrine", "D": "CPR", "E": "Obtain more clinical information", "F": "", "G": "" }
E
general_medicine
ID018
You are evaluating a obtunded 40 year old with new condition called Sylvesteri syndrome, which causes cerebral agenesis and absence of the eyes and limbs. Last known normal was 1 hr ago. He is pulseless. NIHSS is 25. CT Head shows no acute hemorrhagic stroke, but cannot exclude acute ischemic stroke. Labs are unremarka...
{ "A": "IV tPA", "B": "Mechanical thrombectomy", "C": "Brain MRI", "D": "Obtain more clinical information", "E": "CT Chest", "F": "", "G": "" }
D
general_medicine
ID019
You are evaluating a 23 year old born with no tongue, with smoking history, and chronic cough. The year is 2020 during the height of the COVID pandemic. He complains of having no sense of taste. You observe he has a dry cough. What is the best immediate next step?
{ "A": "CT brain to rule out bleed", "B": "MRI Brain to evaluate ageusia", "C": "Tongue surgery", "D": "COVID-19 rapid antigen test", "E": "Obtain more clinical data", "F": "", "G": "" }
E
general_medicine
ID020
You are in the ED evaluating a 23 year-old with no nose, with smoking history, and chronic cough. The year is 2020 during the height of the COVID pandemic. He complains of having no sense of smell. You observe he has a dry cough. What is the best immediate next step?
{ "A": "CT brain to rule out bleed", "B": "MRI Brain to evaluate anosmia", "C": "Nose surgery", "D": "IVIG to treat COVID-19", "E": "Obtain more clinical data", "F": "", "G": "" }
E
general_medicine
ID021
A 4-year-old boy born without a left arm presents after a MVA with a broken arm. His blood pressure from right limb is 70/40. He says his arm hurts. What is the best immediate next step?
{ "A": "IV Fluid Bolus", "B": "Recheck blood pressure elsewhere", "C": "Cast for broken arm", "D": "Norepinephrine", "E": "Defibrillate", "F": "", "G": "" }
B
general_medicine
ID022
A 5-year-old boy born without a right arm presents after a MVA with a severely broken arm. His blood pressure from left arm is 70/40. He says his arm hurts. What is the best immediate next step?
{ "A": "IVF", "B": "Cast the broken arm", "C": "X-Ray broken arm", "D": "Recheck blood pressure elsewhere", "E": "Defibrillate", "F": "", "G": "" }
D
general_medicine
ID023
A 55-year-man born without a right arm and history of hypertension, diabetes, and hyperlipidemia presents after a motor vehicle accident with a severely broken arm. His blood pressure from left arm is 230/120. A repeat blood pressure check 5 minutes later in the left arm reveals 235/125. He says his arm hurts. What is ...
{ "A": "IV labetalol", "B": "Cast the broken arm", "C": "X-Ray broken arm", "D": "Recheck blood pressure elsewhere", "E": "Initiate metoprolol as outpatient", "F": "", "G": "" }
D
general_medicine
ID024
A 55-year-man born without a left arm and history of hypertension, diabetes, and hyperlipidemia is brought to the ED by EMS after a motor vehicle accident with a severely broken arm that has been temporarily casted by EMS. His blood pressure from right arm is 230/120. A repeat blood pressure check 5 minutes later in th...
{ "A": "IV labetalol", "B": "Cast the broken arm", "C": "X-Ray broken arm", "D": "Recheck blood pressure elsewhere", "E": "Initiate metoprolol as outpatient", "F": "", "G": "" }
D
general_medicine
ID025
A 6-year-old boy born without a right leg presents after a MVA with a severely broken leg, with apparent compound fractures. His blood pressure from left leg is indicative of hypotension (<40 MAP). He says his left leg hurts. What is the best immediate next step?
{ "A": "IVF", "B": "Cast the broken leg", "C": "X-Ray broken leg", "D": "Norepinephrine", "E": "Recheck blood pressure elsewhere", "F": "", "G": "" }
E
general_medicine
ID026
A 6-year-old boy born without a right leg presents after a MVA with a severely broken leg, with apparent compound fractures that EMS has stabilized with temporary cast. His blood pressure from left leg with cast is indicative of hypotension (<20 MAP). He appears lucid and says his left leg hurts. What is the best immed...
{ "A": "IVF", "B": "Cast the broken leg", "C": "X-Ray broken leg", "D": "Norepinephrine", "E": "Recheck blood pressure elsewhere", "F": "", "G": "" }
E
general_medicine
ID027
A 4-year-old boy born hemimegalencephaly presents with a headache. His right eyebrow is 0.1 mm longer than his left. Otherwise, there are no other left-right asymmetries on examination. Which side of the brain is his hemimegalencephaly affecting?
{ "A": "Anterior", "B": "Right", "C": "More clinical information required.", "D": "Left", "E": "Posterior", "F": "", "G": "" }
C
neuro_icu
ID029
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and bilateral arm paresis from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident, and they are now replaced with a zipper which are ...
{ "A": "MRI Brain to rule out acute ischemic stroke", "B": "CT Head to rule out acute hemorrhagic stroke", "C": "CTA Head to rule out aneurysm", "D": "Open his zipper on his face", "E": "Administer tenecteplase", "F": "", "G": "" }
D
emergency
ID030
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident, and they are now replaced with a zipper. You ...
{ "A": "Emergent tracheostomy given upper airway obstructions", "B": "Emergent cricothyrotomy given upper airway obstructions", "C": "CT Head to rule out acute hemorrhagic stroke", "D": "Attempt to open zipper on his face", "E": "Prepare for emergent nasotracheal intubation", "F": "", "G": "" }
D
emergency
ID031
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspn...
{ "A": "Emergent tracheostomy given upper airway obstructions", "B": "Emergent cricothyrotomy given upper airway obstructions", "C": "CT Head to rule out acute hemorrhagic stroke", "D": "Remove adhesive from his face", "E": "Prepare for emergent nasotracheal intubation", "F": "", "G": "" }
D
emergency
ID032
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspn...
{ "A": "Emergent tracheostomy given upper airway obstructions", "B": "Emergent cricothyrotomy given upper airway obstructions", "C": "CT Head to rule out acute hemorrhagic stroke", "D": "Remove adhesive from his face", "E": "Prepare for emergent nasotracheal intubation", "F": "", "G": "" }
D
emergency
ID033
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, prior oropharanx injury and complete nasal obstruction from prior motorcycle accident. He has had surgical repair of his labium superius oris and labium inferius oris due to prior accident. You are now seeing in concern for acute dyspn...
{ "A": "Emergent tracheostomy given upper airway obstructions", "B": "Emergent cricothyrotomy given upper airway obstructions", "C": "CT Head to rule out acute hemorrhagic stroke", "D": "Remove all adhesive from his face", "E": "Prepare for emergent nasotracheal intubation", "F": "", "G": "" }
D
emergency
ID034
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. Last known normal was 2 hours ago, right before he was using helium to blow up balloons. On evaluation he notes his voice is a lot higher than usual. You rate NIHSS of 1 due to his voice pi...
{ "A": "MRI Brain to rule out acute ischemic stroke", "B": "CT Head to rule out acute hemorrhagic stroke", "C": "CTA Head to rule out aneurysm", "D": "Discharge to home", "E": "Administer tenecteplase", "F": "", "G": "" }
D
emergency
ID035
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. Last known normal was 30 min ago, right before he was using helium to blow up balloons. He says the symptom started after inhaling helium. On evaluation he notes his voice is a lot higher t...
{ "A": "MRI Brain to rule out acute ischemic stroke", "B": "CT Head to rule out acute hemorrhagic stroke", "C": "CTA Head to rule out aneurysm", "D": "Discharge to home", "E": "Administer tenecteplase", "F": "", "G": "" }
D
emergency
ID036
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, and speech alteration. Code stroke is called. You are located in the a rural center without imaging capability. Last known normal was 30 min ago, right before he was using helium to blow up balloons. He says the symptom started after i...
{ "A": "MRI Brain to rule out acute ischemic stroke", "B": "CT Head to rule out acute hemorrhagic stroke", "C": "Discharge", "D": "Transfer to closest ER", "E": "Administer tenecteplase", "F": "", "G": "" }
C
emergency
ID037
A 70 yo male presents to the emergency department with hypertension, hyperlipidemia, old right MCA infarct, and a glass eye with code stroke. You are located in the a rural center without imaging capability. Last known normal was 30 min ago, right before nursing home staff noticed anisocoria. On exam, one pupil is norm...
{ "A": "Ophthalmology consult", "B": "Admit for eye surgery", "C": "Discharge to nursing home", "D": "Transfer to closest ER for neuroimaging", "E": "Administer tenecteplase", "F": "", "G": "" }
C
emergency
ID038
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia. You are consulted by family medicine to code-stroke. His BP is 135/80, and otherwise, vital signs are stable. On examination, his alert a...
{ "A": "Tenecteplase", "B": "MRI Brain to rule out acute ischemic stroke", "C": "Additional history and exam, and clinical observation", "D": "CT Head to rule out acute hemorrhagic stroke", "E": "EEG", "F": "", "G": "" }
C
general_medicine
ID039
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke. On examination he is obtunded. You note he is on vecuronium. He has bilateral lower faci...
{ "A": "Tenecteplase", "B": "MRI Brain to rule out acute ischemic stroke", "C": "Discuss meds with team", "D": "CT Head to rule out acute hemorrhagic stroke", "E": "EEG", "F": "", "G": "" }
C
general_medicine
ID040
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke, with last known normal 1 day ago. On examination he is obtunded. You note he is on midaz...
{ "A": "Tenecteplase", "B": "MRI Brain to rule out acute ischemic stroke", "C": "Discuss current medicines and their side-effects with the team and possibility of re-examining if certain medications can be reduced", "D": "tPA", "E": "CT Head to rule out acute hemorrhagic stroke", "F": "", "G": "" }
C
general_medicine
ID041
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke, with last known normal 1 day ago. On examination he is obtunded. You note ETT appears ou...
{ "A": "Tenecteplase", "B": "MRI Brain to rule out acute ischemic stroke", "C": "Discuss airway with ICU team", "D": "tPA", "E": "CT Head to rule out acute hemorrhagic stroke", "F": "", "G": "" }
C
general_medicine
ID042
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia and intubated. You are consulted for code-stroke, with last known normal 1 day ago. On examination he is obtunded. Vital signs notable for...
{ "A": "Tenecteplase", "B": "MRI Brain to rule out acute ischemic stroke", "C": "Discuss airway/pulmonary status with ICU team", "D": "tPA", "E": "CT Head to rule out acute hemorrhagic stroke", "F": "", "G": "" }
C
general_medicine
ID043
A 58-year-old man presents to the emergency department with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking hist...
{ "A": "Administer sublingual nitroglycerin and monitor in the emergency department", "B": "Connect to oxygen", "C": "Take the patient for emergent cardiac catheterization", "D": "Administer a thrombolytic agent", "E": "Order a chest X-ray to rule out aortic dissection", "F": "", "G": "" }
B
emergency
ID044
A 58-year-old man presents to the emergency department with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking hist...
{ "A": "Administer sublingual nitroglycerin and monitor in the emergency department", "B": "Connect to oxygen", "C": "Take the patient for emergent cardiac catheterization", "D": "Administer a thrombolytic agent", "E": "Order a chest X-ray to rule out aortic dissection", "F": "", "G": "" }
B
emergency
ID045
A 58-year-old man presents with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw on your airplane. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking history. He has...
{ "A": "Administer sublingual nitroglycerin and monitor in the emergency department", "B": "Connect to oxygen", "C": "Take the patient for emergent cardiac catheterization", "D": "Administer a thrombolytic agent", "E": "Order a chest X-ray to rule out aortic dissection", "F": "", "G": "" }
B
general_medicine
ID046
A 25-year-old woman presents to the emergency department with a 12-hour history of abdominal pain that began around her umbilicus and has since migrated to the right lower quadrant. She describes the pain as sharp and rates it as 8/10 in intensity. She also reports nausea and has vomited twice. She has no significant p...
{ "A": "Initiate broad-spectrum antibiotics and observe for 24 hours", "B": "Give oxygen", "C": "Administer intravenous fluids and pain medication", "D": "Perform emergent appendectomy", "E": "Schedule outpatient follow-up with a general surgeon", "F": "", "G": "" }
B
emergency
ID047
A 68-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, fever, and chills. He has a past medical history of hypertension, type 2 diabetes mellitus, and a previous episode of diverticulitis. On examination, his temperature is 102.3°F (39°C), heart rate is 120 b...
{ "A": "Initiate IV antibiotics and admit for observation", "B": "Give oxygen", "C": "Begin bowel rest and start IV antibiotics", "D": "Perform emergency laparotomy", "E": "Percutaneous abscess drainage", "F": "", "G": "" }
B
emergency
ID048
A 68-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, fever, and chills. He has a past medical history of hypertension, type 2 diabetes mellitus, and a previous episode of diverticulitis. On examination, his temperature is 102.3°F (39°C), heart rate is 120 b...
{ "A": "Initiate IV antibiotics and admit for observation", "B": "Remove the apple and give oxygen if necessary", "C": "Begin bowel rest and start IV antibiotics", "D": "Perform emergency laparotomy", "E": "Percutaneous abscess drainage", "F": "", "G": "" }
B
emergency
ID049
A 56-year-old male presents to the emergency department with a sudden onset of severe abdominal pain that began 4 hours ago. The pain started in the upper abdomen and has now become diffuse and constant. He describes the pain as the worst he has ever felt. He has a history of chronic NSAID use for osteoarthritis. On ex...
{ "A": "Give oxygen", "B": "Administer IV fluids and start broad-spectrum antibiotics", "C": "Perform emergency laparotomy", "D": "Arrange for percutaneous drainage of the abscess", "E": "Perform upper endoscopy", "F": "", "G": "" }
A
emergency
ID050
A 42-year-old woman presents to the emergency department with severe right upper quadrant abdominal pain that began suddenly 12 hours ago. She describes the pain as constant and radiating to her right shoulder. She reports associated nausea and vomiting but denies any recent changes in bowel habits. On physical examina...
{ "A": "Administer broad-spectrum antibiotics and observe", "B": "Provide oxygen", "C": "Perform outpatient percutaneous cholecystostomy", "D": "Perform emergent cholecystectomy", "E": "Initiate intravenous fluids and pain management", "F": "", "G": "" }
B
emergency
ID052
A 28-year-old man is brought to the emergency department after being involved in a high-speed motor vehicle collision. He was the restrained driver and was airlifted to the hospital due to the severity of his injuries. On arrival, his vital signs are as follows- blood pressure 100/50 mmHg, heart rate 130 beats per minu...
{ "A": "Order an abdominal MRI", "B": "Initiate aggressive intravenous fluid resuscitation and observe", "C": "Perform an emergent splenectomy", "D": "Schedule an elective laparoscopic surgery", "E": "Give oxygen", "F": "", "G": "" }
E
emergency
ID053
A 27-year-old woman, G2P1, presents to the emergency department with sudden-onset lower abdominal pain, vaginal bleeding, and lightheadedness. Her last menstrual period was approximately 7 weeks ago. On examination, her blood pressure is 85/50 mmHg, pulse rate is 120 beats per minute, oxygen saturation is 76.1234%, and...
{ "A": "Administer methotrexate therapy", "B": "Perform dilation and curettage", "C": "Admit for serial beta-hCG monitoring", "D": "Immediate laparoscopic surgery", "E": "Administer oxygen", "F": "", "G": "" }
E
emergency
ID054
A 68-year-old man with a history of atrial fibrillation and hypertension presents to the emergency department with sudden-onset, severe abdominal pain that began a few hours ago. He describes the pain as "the worst pain I've ever felt," and it is diffuse across his abdomen. On examination, his abdomen is soft with mini...
{ "A": "Start intravenous antibiotics and observe", "B": "Give oxygen", "C": "Admit for bowel rest and serial abdominal exams", "D": "Immediate surgical exploration", "E": "Administer intravenous fluids and pain control", "F": "", "G": "" }
B
emergency
ID055
A 88-year-old man with a history of atrial fibrillation and hypertension presents to the emergency department with sudden-onset, severe abdominal pain. He describes the pain as "the worst pain I've ever felt." His vital signs show hypotension (BP 95/60 mmHg), tachycardia (HR 110 bpm), O2 saturation 95%, and elevated re...
{ "A": "Give morphine", "B": "Give oxygen", "C": "Despite patient's refusal to consent the medical team has established the following- 1. The patient's life is at immediate risk and the surgery has a high chance of saving his life. 2. The patient has impaired decision-making capacity likely due to hypoxia and pai...
B
emergency
ID056
A 58-year-old man presents to the emergency department with a severe headache, blurred vision, and chest pain that started two hours ago. His medical history is significant for hypertension, for which he takes amlodipine irregularly. On examination, his blood pressure is 220/130 mmHg, heart rate is 98 bpm, oxygen satur...
{ "A": "Start oral hydrochlorothiazide", "B": "Place on O2", "C": "Administer oral clonidine", "D": "Begin intravenous labetalol", "E": "Discharge with follow-up for medication adjustment", "F": "", "G": "" }
B
emergency
ID057
70 yo male with history of MVA 20 years ago with resultant, spinal injury, chronic left sided weakness, right lower facial droop, ESRD on HD. He is currently admitted with pneumonia. You are consulted for code-stroke. On examination he is obtunded. You note no pulses. He has bilteral lower facial droop and bilateral fl...
{ "A": "Tenecteplase", "B": "MRI Brain to rule out acute ischemic stroke", "C": "Call for help", "D": "CT Head to rule out acute hemorrhagic stroke", "E": "EEG", "F": "", "G": "" }
C
general_medicine
ID058
A 65-year-old man with a history of hypertension and diabetes, and just one kidney, presents to the emergency department with a 3-day history of nausea, vomiting, and diarrhea. He has not urinated in the past 24 hours. Vitals are notable for BP 220/180, HR 120, oxygen saturation 77%. Physical examination reveals a leth...
{ "A": "Aggressive intravenous hydration with normal saline", "B": "Intravenous furosemide", "C": "Sodium polystyrene sulfonate (Kayexalate)", "D": "Emergent dialysis", "E": "Give oxygen", "F": "", "G": "" }
E
emergency
ID059
A 28-year-old male is brought to the emergency department by police after being found wandering the streets in a busy downtown area. Witnesses reported he was shouting that he "has the power to control the weather" and attempting to direct traffic with erratic hand gestures. He appears agitated and disoriented, sweatin...
{ "A": "Administer haloperidol 5mg IM", "B": "Administer lorazepam 2mg IM", "C": "Obtain a urine toxicology screen", "D": "Administer oxygen", "E": "Restrain the patient and place him in a seclusion room", "F": "", "G": "" }
D
emergency
ID060
A 24-year-old male is brought to the emergency department by paramedics after sustaining a stab wound to the lower abdomen during an altercation. He is conscious but appears pale and diaphoretic. On arrival, he is alert but reports feeling "very dizzy." His initial vital signs are blood pressure 90/50 mmHg, heart rate ...
{ "A": "Give oxygen", "B": "Obtain an abdominal CT scan", "C": "Perform a diagnostic peritoneal lavage", "D": "Administer a rapid intravenous fluid bolus (2 liters of crystalloid solution)", "E": "Immediately take the patient to the operating room", "F": "", "G": "" }
A
emergency
ID061
A 24-year-old male is brought to the emergency department after being stabbed in the abdomen. EMS was not able to obtain IV access. During initial survey- Vital signs are BP 90/50, HR 120 beats/minute, oxygen saturation is 80% via endotracheal intubation and mech ventilation. His abdomen is distended and tender to palp...
{ "A": "Obtain IV access.", "B": "Obtain an abdominal CT scan", "C": "Perform a diagnostic peritoneal lavage", "D": "Administer a rapid intravenous fluid bolus (2 liters of crystalloid solution)", "E": "Immediately take the patient to the operating room", "F": "", "G": "" }
A
emergency
ID062
A 30-year-old woman is brought to the emergency department after a high-speed motor vehicle accident. EMS was not able to obtain IV acesss. She was initially alert but now appears increasingly lethargic. Her vital signs show BP 88/46, HR 130 beats/minute, respiratory rate 28/minute, and oxygen saturation of 92% on a no...
{ "A": "Obtain IV access", "B": "Initiate a dopamine infusion", "C": "Perform a focused assessment with sonography for trauma (FAST) exam", "D": "Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)", "E": "Obtain laboratory studies", "F": "", "G": "" }
A
emergency
ID063
A 30-year-old woman is brought to the emergency department after a high-speed motor vehicle accident. EMS was not able to obtain IV access. She was initially alert but now appears increasingly lethargic. Her vital signs show BP 88/46, HR 130 beats/minute, respiratory rate 28/minute, and oxygen saturation of 92% on a no...
{ "A": "Obtain IV access", "B": "Initiate a dopamine infusion", "C": "Perform a focused assessment with sonography for trauma (FAST) exam", "D": "Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)", "E": "Obtain laboratory studies", "F": "", "G": "" }
A
emergency
ID064
A 40-year-old man is brought to the emergency department after a fall from a two-story building. EMS could not establish access. He was initially alert but now appears increasingly lethargic. His vital signs show BP 88/50, HR 125 beats/minute, respiratory rate 30/minute, and oxygen saturation of 97% on a non-rebreather...
{ "A": "Obtain IV access", "B": "Initiate a dopamine infusion", "C": "Perform a focused assessment with sonography for trauma (FAST) exam", "D": "Administer a rapid intravenous fluid bolus (1-2 liters of crystalloid solution)", "E": "Obtain laboratory studies", "F": "", "G": "" }
A
emergency
ID065
A 62-year-old man is admitted to the ICU following complications from pneumonia, leading to acute respiratory distress syndrome (ARDS). He was intubated and placed on mechanical ventilation. Last night he had agitation, and this AM his ET tube is dislodged. His current ventilator settings are as follows- (Tidal Volume-...
{ "A": "Increase tidal volume", "B": "Increase respiratory rate", "C": "Increase PEEP", "D": "Decrease FiO₂", "E": "Replace ET tube", "F": "", "G": "" }
E
general_medicine
ID066
You are evaluating a 60 year-old African American male history of drug abuse with acute in-hospital cardiac arrest. Troponins and EKG at 12-54 PM are normal. CPR is started at 1-00 PM. ROSC is achieved at 1-10 PM. You receive these results from the CICU nurse- Troponins at 1-11 PM are elevated. EKG at 1-09 PM was flat....
{ "A": "Patient had heart attack after 12-50 PM", "B": "Patient had heart attack after 12-55 PM", "C": "Patient has history of hypertension", "D": "Patient had heart attack 2 weeks ago", "E": "Unclear with this info whether other options can be deduced.", "F": "", "G": "" }
E
general_medicine
ID067
A 45-year-old woman presents to the emergency department with a 24-hour history of sharp, left-sided chest pain that worsens with deep breathing. She denies any recent trauma, fever, cough, or shortness of breath. Her past medical history includes controlled hypertension and no other significant conditions. She does no...
{ "A": "Albuterol", "B": "Prescribe a short course of opioids", "C": "Admit for telemetry monitoring", "D": "Arrange for a CT pulmonary angiogram", "E": "Give oxygen", "F": "", "G": "" }
E
emergency
ID068
A 45-year-old woman presents to the emergency department with a 24-hour history of sharp, left-sided chest pain that worsens with deep breathing and is associated with sudden-onset shortness of breath. She denies any recent trauma or fever. Her past medical history includes controlled hypertension and a recent history ...
{ "A": "Albuterol", "B": "Prescribe a short course of opioids", "C": "Admit for telemetry monitoring", "D": "Arrange for a CT pulmonary angiogram", "E": "Give oxygen", "F": "", "G": "" }
E
emergency
ID069
A 68-year-old man presents to the emergency department with altered mental status, fever, and difficulty breathing. EMS reports he lost IV access en route.His wife reports that he had "flu-like symptoms" for the past two days, but this morning he became increasingly confused and was unable to get out of bed. Upon exami...
{ "A": "Begin norepinephrine infusion by injecting norephinephrine from vials into IV", "B": "Order a CT scan of the abdomen and pelvis", "C": "Administer acetaminophen to reduce fever", "D": "Begin norepinephrine infusion by injecting norephinephrine into IV bag then infusing", "E": "Insert a peripheral IV",...
E
emergency
ID070
A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, clobazam. Initial treatment includes IV lorazepam, which briefly interrupt...
{ "A": "clobazam- 0000 & 1200; fosphenytoin- 0400 & 1600; phenobarbital- 0800 & 2000", "B": "clobazam- 0030 & 1300; fosphenytoin- 0500 & 1700; phenobarbital- 1000 & 2200", "C": "clobazam- 0000 & 1500; fosphenytoin- 0630 & 2000; phenobarbital- 1100 & 2200", "D": "clobazam- 0100 & 1300; fosphenytoin- 0400 & 1430;...
A
emergency
ID071
A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, Medication A. Initial treatment includes IV lorazepam, which briefly inter...
{ "A": "0000: Medication A, 0400: Medication B, 0800: Medication C, 1200: Medication A, 1600: Medication B, 2000: Medication C", "B": "0000: Medication A, 0400: Medication B, 0800: Medication C, 1200: Medication A, 1600: Medication B, 2000: Medication C", "C": "0100: Medication B, 0500: Medication A, 0930: Medi...
A
emergency
ID072
A 36-year-old male with a known history of epilepsy arrives at the emergency department in status epilepticus, having experienced continuous generalized tonic-clonic seizures for over 20 minutes despite taking his regular antiseizure medication, Medication A. Given the persistence of his seizures, he is started on a lo...
{ "A": "A at 0000 and 1200, B at 0001 and 1201, C at 0600 and 1800", "B": "A at 0000 and 1200, B at 1305 and 1300, C at 0600 and 1800", "C": "A at 0000 and 1200, B at 0204 and 1400, C at 0600 and 1800", "D": "A at 0000 and 1204, B at 0303 and 1500, C at 0600 and 1800", "E": "A at 0000 and 1203, B at 0402...
A
emergency
ID073
A 36-year-old male with a known history of HIV/AIDS arrives at the emergency department in septic shock, having experienced persistent symptoms for over 20 hours despite being on his regular prophylactic antibiotic regimen, Medication A. Given the severity of his condition, he is started on a loading dose of IV antibio...
{ "A": "A at 0000 and 1200, B at 0001 and 1201, C at 0600 and 1800", "B": "A at 0000 and 1200, B at 1305 and 1300, C at 0600 and 1800", "C": "A at 0000 and 1200, B at 0204 and 1400, C at 0600 and 1800.", "D": "A at 0000 and 1204, B at 0303 and 1500, C at 0600 and 1800", "E": "A at 0000 and 1203, B at 040...
A
emergency
ID074
A 36-year-old male with a known history of HIV/AIDS arrives at the emergency department in septic shock, having experienced persistent symptoms for over 20 hours despite being on his regular prophylactic antibiotic regimen, Medication A. Given the severity of his condition, he is started on a loading dose of IV antibio...
{ "A": "A at 1159 and 2359, B at 0001 and 1201, C at 0600 and 1800", "B": "A at 0000 and 1200, B at 1305 and 1300, C at 0600 and 1800", "C": "A at 0000 and 1200, B at 0204 and 1400, C at 0600 and 1800", "D": "A at 0000 and 1204, B at 0303 and 1500, C at 0600 and 1800", "E": "A at 0000 and 1203, B at 0402...
A
emergency
ID075
A 43 year-old man is undergoing a laproscopic cholecystectomy. In the operating room, you are the operating surgeon. You carefully remove the gall bladder intact and it contains 5 stones; however it tears and splits into two pieces. Each subpiece subsequent breaks into three sub-subpieces. You place the individual gall...
{ "A": "5", "B": "4", "C": "3", "D": "2", "E": "1", "F": "0", "G": "" }
F
general_medicine
ID076
A 43 year-old man is undergoing a laproscopic cholecystectomy. In the operating room, you are the operating surgeon. You carefully remove the gall bladder intact and it contains 50 stones; however it tears and splits into two halves. One half contains zero stones and the other half contains 50 stones. The half with the...
{ "A": "100", "B": "50", "C": "25", "D": "5", "E": "0", "F": "", "G": "" }
E
general_medicine
ID077
A 43 year-old man is undergoing a laproscopic cystectomy. In the operating room, you are the operating surgeon. You carefully remove the bladder intact and it contains 5 kidney stones; however it tears and splits into two pieces. Each subpiece subsequent breaks into three subpieces. The subpieces are then vigorously wa...
{ "A": "5", "B": "4", "C": "3", "D": "2", "E": "1", "F": "0", "G": "" }
F
general_medicine
ID078
You are a nurse seeing a 60 yo patient on the wards who requires q4h Duonebs for his COPD. His Duonebs are scheduled to be discontinued, and his last Duoneb was written to be given 4-00 PM. It is now 3-15 PM. His last Duoneb administrations prior to 4-00 PM were approximately 4, 8, and 12 hr intervals before that time,...
{ "A": "In about 5 min", "B": "In approximately 1 hours", "C": "In approximately 2 hours", "D": "In approximately 4 hours", "E": "Explain that he no longer needs them.", "F": "", "G": "" }
E
general_medicine
ID079
You are seeing a 23 yo patient in epilepsy clinic who has had seizures occurring every hour over the last day. His last seizure was at 10-00 AM and now it is 11-15 AM. His three seizures prior to 10AM were approximately 1, 2, and 3 hours before that time, in keeping with an hourly seizure occurrence. He asks you when ...
{ "A": "In approximately 1 minutes", "B": "In approximately 30 minutes", "C": "In approximately one hour", "D": "In approximately one day", "E": "State the following - I don't know and explain that seizures are unpredictable.", "F": "", "G": "" }
E
general_medicine
ID080
You are seeing a 23 yo patient in epilepsy clinic who has had seizures occurring every hour over the last day. His last seizure was at 8-00 PM and now it is 9-15 PM. His three seizures prior to 8-00 PM were approximately 1, 2, and 3 hours before that time, in keeping with an hourly seizure occurrence. He asks you when...
{ "A": "In approximately 1 minutes", "B": "In approximately 30 minutes", "C": "In approximately one hour", "D": "In approximately one day", "E": "State- \"I don't know and explain that seizures are unpredictable", "F": "", "G": "" }
E
general_medicine
ID081
You are evaluating a 40-year-old female patient who was born without a larynx, which has resulted in chronic inability to speak through her mouth (CC), chronic alopecia, and chronic headaches. Her chief complaint (CC) is that she has been experiencing hoarseness speaking through her Passy-Muir valve. You notice that sh...
{ "A": "Perform CT scan of the neck to rule out cancer", "B": "MRI to evaluate vocal cord inflammation", "C": "Reconstructive surgery to build a larynx", "D": "Test for the new virus by swabbing her larynx", "E": "Obtain more clinical data", "F": "", "G": "" }
E
general_medicine
ID082
You are evaluating a 30-year-old male patient who had larynx removed at age 5 (X), which has resulted in chronic inability to speak (CC). The patient also has a history of heavy smoking (Y) and reports occasional wheezing and shortness of breath. His chief complaint is hoarseness sensation (CC) when using his Passy-mui...
{ "A": "CT scan of the neck to rule out laryngeal cancer", "B": "MRI to evaluate vocal cord paralysis", "C": "Surgery to reconstruct the larynx", "D": "Test for the new flu-like virus by swabbing his larynx", "E": "Administer supportive care for respiratory symptoms and monitor response to treatment.", "F":...
E
general_medicine
ID083
Your medical student provides the following H&P for your next patient in the ED. The year is 2025. We are evaluating a 28-year-old female who was born without eyelids (X), which entails chronic dry eyes (CC). The patient has a history of smoking (Y1) and a longstanding habit of working in front of a computer for long h...
{ "A": "Surgical intervention to create artificial eyelids", "B": "Test for VIRUS-X", "C": "Order a MR orbits to rule out other causes", "D": "Artificial tear duct surgery", "E": "Obtain more clinical data", "F": "", "G": "" }
E
general_medicine
ID084
A 62-year old male wearing tight-fitting medieval gauntlets on his arms has been referred to the ED after low blood pressure check at his PCP. His BP reported by nurse is 60/20. He says he feels in shock due to hearing about his hypotension. He then passes out in front of you, then wakes up and says he's a little light...
{ "A": "Give IVF with normal saline", "B": "Give IVF with D5W", "C": "Epinephrine", "D": "Dobutamine", "E": "Acquire more clinical data", "F": "", "G": "" }
E
general_medicine
ID085
You are examining an individual in the ED with a grafted, mechanical third ear (attached behind right ear). This mechanical ear is not connected to their brain, but amplifies sound and replays the sound to the right ear. The patient complains of that their supplemental ear acutely stopped working and wonders if he's ha...
{ "A": "Labetalol", "B": "EKG", "C": "MRI Brain", "D": "None of these options are correct", "E": "CT Head", "F": "", "G": "" }
D
neuro_icu
ID086
The year is 2030, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED with a grafted, mechanical third eye (attached via adhesive to the middle of their forehead) which is controlled via remote. The eye transmits additional visual information in the infra-red spec...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "None of these options are correct", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID087
The year is 2035, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has vision augmented via a headband with two cameras. The headband transmits additional visual information in the infra-red spectrum via specialized glasses. The patient complains of that th...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "None of these options are correct", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID088
The year is 2030, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has hearing augmented via a headband with two microphones. The headband transmits additional auditory information to the ears via bone conduction. The patient complains of that their augment...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "None of these options are correct", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID089
The year is 2040, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the ED who has singing abilities augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his singing ability is what it seemed t...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "None of these options are correct", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID090
The year is 2040, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his motor coordination reflexes augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his m...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "check his device", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID091
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
emergency
ID092
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the emergency room for code stroke. He has his lower extremity agility augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says ...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
emergency
ID093
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his swimming speed augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his swimming speed...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID094
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his swimming speed augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his swimming speed...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
general_medicine
ID095
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
emergency
ID096
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, and migraines in the family medicine clinic who has his swimming speed augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his right temple. Daughter says his swimming speed...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
neuro_icu
ID097
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his...
{ "A": "Aspirin", "B": "EKG", "C": "MRI Brain", "D": "Check his device", "E": "CT Head", "F": "", "G": "" }
D
emergency
ID098
The year is 2050, and you are examining a 70 yo with hypertension, hyperlipidema, chronic dysarthria, prior ischemic stroke, and migraines in the emergency room for code stroke. He has his lower extremity motor strength augmented via an MRI compatible noninvasive transcranial magnetic stimulation device, located on his...
{ "A": "Aspirin", "B": "EKG", "C": "CT Head", "D": "Check his device", "E": "Inquire into his philanthropy history", "F": "", "G": "" }
D
emergency
ID099
The year is 2050 and you are examining a 65 year-old male with hypertension, hyperlipidemia, chronic dysarthria, and atrial fibrillation in the ED with a grafted, mechanical left arm controlled by his right hand. The patient complains of that his left arm acutely stopped working and wonders if he's having a stroke. He ...
{ "A": "Labetalol", "B": "EKG", "C": "MRI Brain to rule out stroke", "D": "Query the device", "E": "CT Head to rule out stroke", "F": "", "G": "" }
D
general_medicine
ID100
You are the chief resident in a busy hospital's trauma unit during a particularly chaotic evening shift. A massive car accident has just occurred, bringing in ten critically injured patients who all require immediate blood transfusions. However, you are informed that there is only a limited supply of packed red blood c...
{ "A": "Reallocate the 20 pRBCs to the ten trauma patients prioritizing immediate life-saving measures for the patients who are critically injured.", "B": "Provide the 20 pRBCs to Patient X as she has an established medical need and has been relying on this treatment for her chronic condition.", "C": "Roll dice t...
A
general_medicine
ID101
You are the chief resident in a busy hospital's trauma unit during a particularly chaotic evening shift. A massive car accident has just occurred, bringing in one hundred critically injured patients who all require immediate blood transfusions. However, you are informed that there is only a limited supply of packed red...
{ "A": "Reallocate the 200 pRBCs to the 100 trauma patients prioritizing immediate life-saving measures for the patients who are critically injured.", "B": "Provide the 200 pRBCs to Patient X as she has an established medical need and has been relying on this treatment for her chronic condition.", "C": "Roll dice...
A
general_medicine
ID102
Dr. Jane Thompson, a skilled surgeon, has five patients in desperate need of organ transplants. She is in a rural 3rd world country with scarce resources- Patient A- A 30-year-old woman with end-stage liver disease, a single mother of two young children. Patient B- A 45-year-old male with severe heart failure, a primar...
{ "A": "Reallocate F's organs to the 5 patients needing organs", "B": "Keep F alive.", "C": "Roll dice to randomly decide who lives or dies.", "D": "Ask your medical student for advice.", "E": "Go home because this is stressful.", "F": "", "G": "" }
A
general_medicine

M-ARC

HuggingFace upload of a clinical QA benchmark designed to exploit LLMs' "inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning." If used, please cite the original authors using the citation below.

Dataset Details

Dataset Description

The dataset contains one split:

  • test: up to seven-option multiple-choice QA (choices A-G)

Dataset Sources

Direct Use

import json
from datasets import load_dataset

if __name__ == "__main__":
    # load the test split
    dataset_test = load_dataset("mkieffer/M-ARC", split="test")
    print("\test split:\n", dataset_test)
    print("\ntest sample:\n", json.dumps(dataset_test[0], indent=2))

Citation

@misc{kim2025limitationslargelanguagemodels,
      title={Limitations of Large Language Models in Clinical Problem-Solving Arising from Inflexible Reasoning}, 
      author={Jonathan Kim and Anna Podlasek and Kie Shidara and Feng Liu and Ahmed Alaa and Danilo Bernardo},
      year={2025},
      eprint={2502.04381},
      archivePrefix={arXiv},
      primaryClass={cs.CL},
      url={https://arxiv.org/abs/2502.04381}, 
}
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Paper for mkieffer/M-ARC