{"_id": "2014_1_1", "text": "Given some infomation about patient. 58-year-old woman with hypertension and obesity presents with exercise-related episodic chest pain radiating to the back.What is the patient's diagnosis? A 58-year-old African-American woman presents to the ER with episodic pressing/burning anterior chest pain that began two days earlier for the first time in her life. The pain started while she was walking, radiates to the back, and is accompanied by nausea, diaphoresis and mild dyspnea, but is not increased on inspiration. The latest episode of pain ended half an hour prior to her arrival. She is known to have hypertension and obesity. She denies smoking, diabetes, hypercholesterolemia, or a family history of heart disease. She currently takes no medications. Physical examination is normal. The EKG shows nonspecific changes.", "level": 1}
{"_id": "2014_3_1", "text": "Given some infomation about patient. 58-year-old female non-smoker with left lung mass on x-ray. Head CT shows a solitary right frontal lobe mass.What is the patient's diagnosis? A 58-year-old nonsmoker white female with mild exertional dyspnea and occasional cough is found to have a left lung mass on chest x-ray. She is otherwise asymptomatic. A neurologic examination is unremarkable, but a CT scan of the head shows a solitary mass in the right frontal lobe.", "level": 1}
{"_id": "2014_4_1", "text": "Given some infomation about patient.2-year-old boy with fever and irritability for 5 days. Physical exam findings include conjunctivitis, strawberry tongue, and desquamation of the fingers and toes. Lab results include low albumin, elevated white blood cell count and C-reactive protein, and urine leukocytes. Echo shows moderate dilation of the coronary arteries.What is the patient's diagnosis? A 2-year-old boy is brought to the emergency department by his parents for 5 days of high fever and irritability. The physical exam reveals conjunctivitis, strawberry tongue, inflammation of the hands and feet, desquamation of the skin of the fingers and toes, and cervical lymphadenopathy with the smallest node at 1.5 cm. The abdominal exam demonstrates tenderness and enlarged liver. Laboratory tests report elevated alanine aminotransferase, white blood cell count of 17,580/mm, albumin 2.1 g/dL, C-reactive protein 4.5 mg, erythrocyte sedimentation rate 60 mm/h, mild normochromic, normocytic anemia, and leukocytes in urine of 20/mL with no bacteria identified. The echocardiogram shows moderate dilation of the coronary arteries with possible coronary artery aneurysm.", "level": 1}
{"_id": "2014_5_1", "text": "Given some infomation about patient.56-year-old woman presents with shortness of breath 3 weeks after surgical mastectomy. Physical exam is significant for right calf tenderness and decreased breath sounds at the right base. Her D-dimer level is elevated.What is the patient's diagnosis? A 56-year-old female on 20th day post-left mastectomy presents to the emergency department complaining of shortness of breath and malaise. The patient says that she has remained in bed for the last two weeks. The physical examination reveals tenderness on the left upper thoracic wall and right calf. The surgical incision shows no bleeding or signs of infection. Pulmonary auscultation is significant for bilateral decreased breath sounds, especially at the right base. Laboratory tests reveal an elevated D-dimer.", "level": 1}
{"_id": "2014_6_1", "text": "Given some infomation about patient.64-year-old woman with uncontrolled diabetes, now with an oozing, painful skin lesion on her left lower leg.What is the patient's diagnosis? 64-year-old obese female with diagnosis of diabetes mellitus and persistently elevated HbA1c. She is reluctant to see a nutritionist and is not compliant with her diabetes medication or exercise. She complains of a painful skin lesion on the left lower leg. She has tried using topical lotions and creams but the lesion has increased in size and is now oozing.", "level": 1}
{"_id": "2014_8_1", "text": "Given some infomation about patient.62-year-old man with progressive memory loss and involuntary leg movements. Brain MRI reveals cortical atrophy, and cortical biopsy shows vacuolar gray matter changes with reactive astrocytosis.What is the patient's diagnosis? A 62-year-old man sees a neurologist for progressive memory loss and jerking movements of the lower extremities. Neurologic examination confirms severe cognitive deficits and memory dysfunction. An electroencephalogram shows generalized periodic sharp waves. Neuroimaging studies show moderately advanced cerebral atrophy. A cortical biopsy shows diffuse vacuolar changes of the gray matter with reactive astrocytosis but no inflammatory infiltration.", "level": 1}
{"_id": "2014_9_1", "text": "Given some infomation about patient.43-year-old woman with soft, flesh-colored, pedunculated lesions on her neck.What is the patient's diagnosis? A 43-year-old woman visits her dermatologist for lesions on her neck. On examination, multiple lesions are seen. Each lesion is small soft, and pedunculated. The largest lesion is about 4 mm in diameter. The color of different lesions varies from flesh colored to slightly hyperpigmented.", "level": 1}
{"_id": "2014_10_1", "text": "Given some infomation about patient.67-year-old woman status post cardiac catheterization via right femoral artery, now with a cool, pulseless right foot and right femoral bruit.What is the patient's diagnosis? A physician is called to see a 67-year-old woman who underwent cardiac catheterization via the right femoral artery earlier in the morning. She is now complaining of a cool right foot. Upon examination she has a pulsatile mass in her right groin with loss of distal pulses, and auscultation reveals a bruit over the point at which the right femoral artery was entered.", "level": 1}
{"_id": "2014_11_1", "text": "Given some infomation about patient.40-year-old woman with severe right arm pain and hypotension. She has no history of trauma and right arm exam reveals no significant findings.What tests should the patient receive? A 40-year-old woman with no past medical history presents to the ER with excruciating pain in her right arm that had started 1 hour prior to her admission. She denies trauma. On examination she is pale and in moderate discomfort, as well as tachypneic and tachycardic. Her body temperature is normal and her blood pressure is 80/60. Her right arm has no discoloration or movement limitation.", "level": 1}
{"_id": "2014_13_1", "text": "Given some infomation about patient.30-year-old woman who is 3 weeks post-partum, presents with shortness of breath, tachypnea, and hypoxia.What tests should the patient receive? A 30-year-old generally healthy woman presents with shortness of breath that had started 2 hours before admission. She has had no health problems in the past besides 2 natural abortions. She had given birth to a healthy child 3 weeks before. On examination, she is apprehensive, tachypneic and tachycardic, her blood pressure is 110/70 and her oxygen saturation 92%. Otherwise, physical examination is unremarkable. Her chest x-ray and CBC are normal.", "level": 1}
{"_id": "2014_14_1", "text": "Given some infomation about patient.85-year-old man who was in a car accident 3 weeks ago, now with 3 days of progressively decreasing level of consciousness and impaired ability to perform activities of daily living.What tests should the patient receive? An 85-year-old man is brought to the ER because of gradual decrease in his level of consciousness. In the last 3 days he stopped walking and eating by himself. He has had no fever, cough, rash or diarrhea. His daughter recalls that he had been involved in a car accident 3 weeks prior to his admission and had a normal head CT at that time.", "level": 1}
{"_id": "2014_15_1", "text": "Given some infomation about patient.36-year-old woman with amenorrhea, abdominal tenderness, enlarged uterus, and cervical dilation. Urine pregnancy test is negative. Ultrasound reveals an enlarged uterus with multiple cystic areas, which could be consistent with vesicular mole and fibroid degeneration.What tests should the patient receive? A 36-year-old woman presents to the emergency department with 12 weeks of amenorrhea, vaginal spotting that has increased since yesterday, lower abdominal tenderness, nausea and vomiting. The physical exam reveals overall tender abdomen, 18-week sized uterus, and cervical dilation of 2 cm. The complete blood count and biochemical profile are normal. Point of care pregnancy test with cut-off sensitivity of 25 mIU/ml Beta-HCG is negative. The ultrasound reports enlarged uterus (12 cm x 9 cm x 7 cms) with multiple cystic areas in the interior. The differential diagnosis includes vesicular mole vs fibroid degeneration.", "level": 1}
{"_id": "2014_16_1", "text": "Given some infomation about patient.28-year-old female with neck pain and left arm numbness 3 weeks after working with stray animals. Physical exam initially remarkable for slight left arm tremor and spasticity. Three days later she presented with significant arm spasticity, diaphoresis, agitation, difficulty swallowing, and hydrophobia.What tests should the patient receive? A 28-year-old female with neck and shoulder pain and left hand and arm paresthesias three weeks after returning from a trip to California where she attended a stray animal recovery campaign. Her physical exam was unremarkable except for slight tremors and almost imperceptible spasticity. She was prescribed NSAIDS and a topical muscle relaxant. She was brought in to the ER three days later with spastic arm movements, sweating, increasing agitation and anxiety, malaise, difficultly swallowing and marked hydrophobia, and was immediately hospitalized.", "level": 1}
{"_id": "2014_17_1", "text": "Given some infomation about patient.48-year-old man with common variable immunodeficiency presents with abdominal pain and fever. Ultrasound reveals hepatomegaly and free intraperitoneal fluid. A ruptured liver abscess is found and drained during exploratory laparotomy.What tests should the patient receive? A 48-year-old white male with history of common variable immunodeficiency (CVID) with acute abdominal pain, fever, dehydration, HR of 132 bpm, BP 80/40. The physical examination is remarkable for tenderness and positive Murphy sign. Abdominal ultrasound shows hepatomegaly and abundant free intraperitoneal fluid. Exploratory laparotomy reveals a ruptured liver abscess, which is then surgically drained. After surgery, the patient is taken to the ICU.", "level": 1}
{"_id": "2014_18_1", "text": "Given some infomation about patient.6-month-old male with decreased urine output and edema several hours after surgery. He is hypertensive and tachycardic, has a high BUN and creatinine, and urine microscopy reveals red blood cells and granular casts.What tests should the patient receive? A 6-month-old male infant has a urine output of less than 0.2 mL/kg/hr shortly after undergoing major surgery. On examination, he has generalized edema. His blood pressure is 115/80 mm Hg, his pulse is 141/min, and his respirations are 18/min. His blood urea nitrogen is 33 mg/dL, and his serum creatinine is 1.3 mg/dL. Initial urinalysis shows specific gravity of 1.017. Microscopic examination of the urine sample reveals 1 WBC per high-power field (HPF), 18 RBCs per HPF, and 5 granular casts per HPF. His fractional excretion of sodium is 3.3%.", "level": 1}
{"_id": "2014_19_1", "text": "Given some infomation about patient.52-year-old man with history of smoking and heavy drinking, now with progressive dysphagia and 25-pound weight loss.What tests should the patient receive? A 52-year-old African American man with a history of heavy smoking and drinking, describes progressive dysphagia that began several months ago. He first noticed difficulty swallowing meat. His trouble swallowing then progressed to include other solid foods, soft foods, and then liquids. He is able to locate the point where food is obstructed at the lower end of his sternum. He has lost a total of 25 pounds.", "level": 1}
{"_id": "2014_22_1", "text": "Given some infomation about patient.15-year-old girl with right lower quadrant abdominal pain, decreased appetite, and enlarged appendix on abdominal ultrasound.How should the patient be treated? A 15-year-old girl presents to the ER with abdominal pain. The pain appeared gradually and was periumbilical at first, localizing to the right lower quadrant over hours. She has had no appetite since yesterday but denies diarrhea. She has had no sexual partners and her menses are regular. On examination, she has localized rebound tenderness over the right lower quadrant. On an abdominal ultrasound, a markedly edematous appendix is seen.", "level": 1}
{"_id": "2014_23_1", "text": "Given some infomation about patient.63-year-old heavy smoker with productive cough, shortness of breath, tachypnea, and oxygen requirement. Chest x-ray shows hyperinflation with no consolidation.How should the patient be treated? A 63-year-old man presents with cough and shortness of breath. His past medical history is notable for heavy smoking, spinal stenosis, diabetes, hypothyroidism and mild psoriasis. He also has a family history of early onset dementia. His symptoms began about a week prior to his admission, with productive cough, purulent sputum and difficulty breathing, requiring him to use his home oxygen for the past 24 hours. He denies fever. On examination he is cyanotic, tachypneic, with a barrel shaped chest and diffuse rales over his lungs. A chest x-ray is notable for hyperinflation with no consolidation.", "level": 1}
{"_id": "2014_24_1", "text": "Given some infomation about patient. 33-year-old male presents with severe abdominal pain one week after a bike accident in which he sustained abdominal trauma. He is hypotensive and tachycardic, and imaging reveals a ruptured spleen and intraperitoneal hemorrhage.How should the patient be treated? A 33-year-old male athlete presented to the ER with acute abdominal pain. Family member says the patient fell off his bike a week earlier and suffered blunt trauma to the left hemi-abdomen, and he has had mild abdominal pain since that day. The patient's history is negative for smoking, drugs, and alcohol. BP: 60/30 mmHg, HR: 140/min. The patient is pale, the physical examination of the abdomen revealed muscle contraction and resistance. Emergency ultrasound and CT scan of the abdomen reveal extended intraperitoneal hemorrhage due to spleen rupture.", "level": 1}
{"_id": "2014_25_1", "text": "Given some infomation about patient.8-year-old boy with decreased level of consciousness 30 minutes after falling from his bike and hitting his head. He was not wearing a helmet. In the ER he was bradycardic and hypertensive, and the neurosurgeon strongly advised immediate treatment.How should the patient be treated? An 8-year-old boy fell from his bike striking his left temple on the pavement. There was no immediate loss of consciousness, and a brief examination at the scene noted his pupils were symmetrical, reactive to the light, and he was moving all four limbs. Half an hour after the fall the child became drowsy, pale, and vomited. He was transferred to the emergency department. Upon arrival the heart rate was 52/min, blood pressure of 155/98. The Glasgow Coma Scale (GCS) was 6/15, the pupils were asymmetrical and movement of the right upper and lower extremities was impaired. The neurosurgical team advised deferring the CT scan in favor of initiating immediate treatment.", "level": 1}
{"_id": "2014_26_1", "text": "Given some infomation about patient.Group traveling to the Amazon rainforest, including 3 pregnant women. All members' immunizations are up-to-date but they require malaria prophylaxis.How should the patient be treated? A group of 14 humanitarian service workers is preparing a trip to the Amazon Rainforest region in Brazil. All the members of the group have traveled on multiple occasions and have up-to-date vaccine certificates. Malaria Chemoprophylaxis is indicated but three of the women are in different stages of pregnancy.", "level": 1}
{"_id": "2014_28_1", "text": "Given some infomation about patient.31-year-old female with amenorrhea, milky nipple discharge, negative urine pregnancy test, and elevated prolactin level.How should the patient be treated? A 31-year-old woman is seen in clinic with amenorrhea. She had menarche at age 14 and has had normal periods since then. However, her last menstrual period was 7 months ago. She also complains of an occasional milky nipple discharge. She is currently taking no mediations and would like to become pregnant soon. Examination shows a whitish nipple discharge bilaterally, but the rest of the examination is normal. Urine human chorionic gonadotropin (hCG) is negative, thyroid stimulating hormone (TSH) is normal, but prolactin is elevated.", "level": 1}
{"_id": "2015_1_1", "text": "Given some infomation about patient.A 44-year-old man with coffee-ground emesis, tachycardia, hypoxia, hypotension and cool, clammy extremities.What is the patient's diagnosis? A 44 yo male is brought to the emergency room after multiple bouts of vomiting that has a \"coffee ground\" appearance. His heart rate is 135 bpm and blood pressure is 70/40 mmHg. Physical exam findings include decreased mental status and cool extremities. He receives a rapid infusion of crystalloid solution followed by packed red blood cell transfusion and is admitted to the ICU for further care.", "level": 1}
{"_id": "2015_2_1", "text": "Given some infomation about patient.A 62-year-old immunosuppressed male with fever, cough and intranuclear inclusion bodies in bronchoalveolar lavageWhat is the patient's diagnosis? A 62 yo male presents with four days of non-productive cough and one day of fever. He is on immunosuppressive medications, including prednisone. He is admitted to the hospital, and his work-up includes bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid examination reveals owl's eye inclusion bodies in the nuclei of infection cells.", "level": 1}
{"_id": "2015_5_1", "text": "Given some infomation about patient.Young adult woman with 2 weeks of fever and migrating joint inflammation.What is the patient's diagnosis? A 31-year-old woman with no previous medical problems comes to the emergency room with a history of 2 weeks of joint pain and fatigue. Initially she had right ankle swelling and difficulty standing up and walking, all of which resolved after a few days. For the past several days she has had pain, swelling and stiffness in her knees, hips and right elbow. She also reports intermittent fevers ranging from 38.2 to 39.4 degrees Celsius and chest pain.", "level": 1}
{"_id": "2015_6_1", "text": "Given some infomation about patient.A 46-year-old woman with sweaty hands, exophthalmia, and weight loss despite increased eating.What is the patient's diagnosis? A 46-year-old woman presents with a 9 month history of weight loss (20 lb), sweating, insomnia and diarrhea. She reports to have been eating more than normal and that her heart sometimes races for no reason. On physical examination her hands are warm and sweaty, her pulse is irregular at 110bpm and there is hyperreflexia and mild exophthalmia.", "level": 1}
{"_id": "2015_7_1", "text": "Given some infomation about patient.A 22 year old female presents with changes in appetite and sleeping, fatigue, diminished ability to think or concentrate, anhedonia and feelings of guilt.What is the patient's diagnosis? A 20 yo female college student with no significant past medical history presents with a chief complaint of fatigue. She reports increased sleep and appetite over the past few months as well as difficulty concentrating on her schoolwork. She no longer enjoys spending time with her friends and feels guilty for not spending more time with her family. Her physical exam and laboratory tests, including hemoglobin, hematocrit and thyroid stimulating hormone, are within normal limits.", "level": 1}
{"_id": "2015_9_1", "text": "Given some infomation about patient.A 10 year old child with recent history of pork consumption presents with fever, myalgia, facial edema and eosinophiliaWhat is the patient's diagnosis? A 10 year old child is brought to the emergency room complaining of myalgia, cough, and shortness of breath. Two weeks ago the patient was seen by his pediatrician for low-grade fever, abdominal pain, and diarrhea, diagnosed with a viral illness, and prescribed OTC medications. Three weeks ago the family returned home after a stay with relatives on a farm that raises domestic pigs for consumption. Vital signs: T: 39.5 C, BP: 90/60 HR: 120/min RR: 40/min. Physical exam findings include cyanosis, slight stiffness of the neck, and marked periorbital edema. Lab results include WBC 25,000, with 25% Eosinophils, and an unremarkable urinalysis.", "level": 1}
{"_id": "2015_10_1", "text": "Given some infomation about patient.A 38 year old woman with severe dysmenorrhea, menorrhagia, and menometrorrhagia. PMH of infertility treatment and ectopic pregnancyWhat is the patient's diagnosis? A 38 year old woman complains of severe premenstrual and menstrual pelvic pain, heavy, irregular periods and occasional spotting between periods. Past medical history remarkable for two years of infertility treatment and an ectopic pregnancy at age 26.", "level": 1}
{"_id": "2015_12_1", "text": "Given some infomation about patient.A 44-year-old man complains of severe headache and fever. Nuchal rigidity was found on physical examination.What tests should the patient receive? A 44-year-old man was recently in an automobile accident where he sustained a skull fracture. In the emergency room, he noted clear fluid dripping from his nose. The following day he started complaining of severe headache and fever. Nuchal rigidity was found on physical examination.", "level": 1}
{"_id": "2015_13_1", "text": "Given some infomation about patient.A 5-year-old boy presents with difficulty in breathing, stridor, drooling, fever, dysphagia and voice change.What tests should the patient receive? A 5-year-old boy presents to the emergency department with complaints of progressively worsening dysphagia, drooling, fever and vocal changes. He is toxic-appearing, and leans forward while sitting on his mother's lap. He is drooling and speaks with a muffled \"hot potato\" voice. The parents deny the possibility of foreign body ingestion or trauma, and they report that they are delaying some of his vaccines.", "level": 1}
{"_id": "2015_14_1", "text": "Given some infomation about patient.A young woman in her second gestation presenting with anemia resistant to improvement by iron supplementation, elevated LDH, anisocytosis, poikilocytosis, hemosiderinuria and normal clotting screen.What tests should the patient receive? A 27-year-old woman at 11 weeks gestation in her second pregnancy is found to have a hemoglobin (Hb) of 9.0 g/dL, white blood cell count 6.3 x 109/L, platelet count 119 x 109/L, mean corpuscular volume 109 fL. Further investigations reveal mild iron deficiency. She already receives iron supplementation. The obstetrician repeats the complete blood cell count 2 weeks later. The Hb is 8.9 g/dL, WBC count 7.1 x 109/L, and platelets 108 x 109/L. She describes difficulty swallowing. A reticulocyte count is performed and found elevated at 180 x 109/L. The obstetrician requests a hematology consult. The following additional results were found: Negative DAT, normal clotting screen, elevated LDH (2000 IU/L), normal urea and electrolytes, normal alanine aminotransferase (ALT), anisocytosis, poikilocytosis, no fragments, no agglutination, polychromasia and presence of hemosiderin in the urine.", "level": 1}
{"_id": "2015_19_1", "text": "Given some infomation about patient.A 66-year-old female smoker presents with worsening dyspnea, productive chronic cough, moderate respiratory distress and unintentional weight loss.What tests should the patient receive? A 66yo female with significant smoking history and chronic cough for the past two years presents with recent, progressive shortness of breath. She is in moderate respiratory distress after walking from the waiting room to the examination room. Physical exam reveals mildly distended neck veins, a barrel-shaped chest, and moderate inspiratory and expiratory wheezes. She has smoked 1 to 2 packs per days for the past 47 years.", "level": 1}
{"_id": "2015_20_1", "text": "Given some infomation about patient.An 89-year-old man with progressive change in personality, poor memory, and myoclonic jerks.What tests should the patient receive? An 89-year-old man was brought to the emergency department by his wife and son after six months of progressive changes in cognition and personality. He began to have poor memory, difficulty expressing himself, and exhibited unusual behaviors, such as pouring milk onto the table and undressing immediately after getting dressed. He is unable to dress, bathe, use the toilet, or walk independently. On examination the patient's temperature was 36.5\u00b0C (97.7\u00b0F), the heart rate 61 bpm in an irregular rhythm, the blood pressure 144/78 mm Hg, and the respiratory rate 18 bpm. The patient was alert and oriented to self and city but not year. He frequently interrupted the examiner. He repeatedly reached out to grab things in front of him, including the examiner's tie and face. He could not spell the word \"world\" backward, could not follow commands involving multiple steps and was unable to perform simple calculations. His speech was fluent, but he often used similar-sounding word substitutions. He could immediately recall three out of three words but recalled none of them after 5 minutes. Examination of the cranial nerves revealed clinically significant paratonic rigidity. Myoclonic jerks were seen in the arms, with symmetrically brisk reflexes. The reflexes in the legs were normal.", "level": 1}
{"_id": "2015_21_1", "text": "Given some infomation about patient.A 32-year-old male presents with diarrhea and foul-smelling stools. Stool smear reveals protozoan parasites.How should the patient be treated? A 32-year-old male presents to your office complaining of diarrhea, abdominal cramping and flatulence. Stools are greasy and foul-smelling. He also has loss of appetite and malaise. He recently returned home from a hiking trip in the mountains where he drank water from natural sources. An iodine-stained stool smear revealed ellipsoidal cysts with smooth, well-defined walls and 2+ nuclei.", "level": 1}
{"_id": "2015_23_1", "text": "Given some infomation about patient.An 18-year-old male returned from Asia a week ago. He presents with high fever, severe headache and joint pain. His blood analysis reveals leukopenia, increased hematocrit and thrombocytopenia.How should the patient be treated? An 18-year-old male returning from a recent vacation in Asia presents to the ER with a sudden onset of high fever, chills, facial flushing, epistaxis and severe headache and joint pain. His complete blood count reveals leukopenia, increased hematocrit concentration and thrombocytopenia.", "level": 1}
{"_id": "2015_24_1", "text": "Given some infomation about patient.A 31 year old male presents with productive cough, chest pain, fever and chills. On exam he has audible wheezing with decreased breath sounds and dullness to percussion.How should the patient be treated? A 31 yo male with no significant past medical history presents with productive cough and chest pain. He reports developing cold symptoms one week ago that were improving until two days ago, when he developed a new fever, chills, and worsening cough. He has right-sided chest pain that is aggravated by coughing. His wife also had cold symptoms a week ago but is now feeling well. Vitals signs include temperature 103.4, pulse 105, blood pressure 120/80, and respiratory rate 15. Lung exam reveals expiratory wheezing, decreased breath sounds, and egophany in the left lower lung field.", "level": 1}
{"_id": "2015_25_1", "text": "Given some infomation about patient.10-year-old boy with progressive right knee and left leg pain and edema, lethargy and an osteolytic lesion. No history of trauma, fever, tachycardia, or urinary incontinence.How should the patient be treated? A 10-year-old boy comes to the emergency department for evaluation of right knee pain. The child's guardians stated that he had been complaining of knee pain for the past 4 days and it had been getting progressively worse. There was no history of trauma. The day before the visit the boy developed a fever, and over the past day he has become increasingly lethargic. On physical examination blood pressure was 117/75 mm Hg, HR 138 bpm, temperature 38.1 C (100.5 F), respiration 28 bpm, oxygen saturation 97%. There was edema and tenderness of the right thigh and knee, as well as effusion and extremely limited range of motion. Sensation and motor tone were normal. Plain radiography and CT showed an osteolytic lesion.", "level": 1}
{"_id": "2015_26_1", "text": "Given some infomation about patient.An obese 28 yo female with non-ruptured ectopic pregnancy and history of adhesions.How should the patient be treated? A 28 yo female G1P0A0 is admitted to the Ob/Gyn service for non-ruptured ectopic pregnancy. Past medical history is remarkable for obesity, a non-complicated appendectomy at age 8, infertility treatment for the past 3 years, and pelvic laparoscopy during which minor right Fallopian tube adhesions were cauterized. Her LMP was 8 weeks prior to admission. Beta HCG is 100 mIU. The attending physician usually treats unruptured ecoptic pregnancies laparoscopically but is concerned about the patient's obesity and history of adhesions.", "level": 1}
{"_id": "2015_27_1", "text": "Given some infomation about patient.A 15 yo girl with fatigue, pale skin, low hemoglobin and ferritin.How should the patient be treated? A 15 yo girl accompanied by her mother is referred for evaluation by the school. The girl has more than expected absences in the last three month, appears to be constantly tired and sleepy in class. Her mother assures the girl is well fed, and getting the proper sleep at night but admits the girls tires easily when they go out on weekend hikes. Physical examination: BP: 90/60. HR 130/min the only remarkable findings are extremely pale skin and mucosae. Grade 3/6 systolic murmur. Lab tests report Hb: 4.2 g/dL, MCV 61.8 fL, serum iron < 1.8 umol/L and ferritin of 2 ng/mL. Fecal occult blood is negative.", "level": 1}
{"_id": "2015_28_1", "text": "Given some infomation about patient.An 8-year-old boy presents with a swollen right knee, lower extremity pain and fever. The parents report no history of trauma. The parents noticed a tick bite several months earlier.How should the patient be treated? A previously healthy 8-year-old boy presents with a complaint of right lower extremity pain and fever. He reports limping for the past two days. The parents report no previous trauma, but do remember a tick bite during a summer visit to Maryland several months ago. They do not remember observing erythema migrans. On examination, the right knee is tender and swollen. Peripheral WBC count and SRP are slightly elevated.", "level": 1}
{"_id": "2015_29_1", "text": "Given some infomation about patient.A 4-year-old girl with persistent high fever, skin rash, strawberry tongue, swollen red hands, and bilateral nonexudative conjunctivitis.How should the patient be treated? A 4-year-old girl presents with persistent fever for the past week. The parents report a spike at 104\u00b0F. The parents brought the child to the emergency room when they noticed erythematous rash on the girl's trunk. Physical examination reveals strawberry red tongue, red and cracked lips, and swollen red hands. The whites of both eyes are red with no discharge.", "level": 1}
{"_id": "2015_30_1", "text": "Given some infomation about patient.A 47 year old male who fell on his outstretched left arm presents with pain, swelling, and inability to bend the arm. The x-ray, shows posterior elbow dislocation.How should the patient be treated? A 47 year old male who fell on his outstretched left arm presents with pain and bruising on the inside and outside of the elbow, swelling, and inability to bend the arm. On the x-ray, the ulna has dislocated posteriorly from the trochlea of the humerus. The radius has dislocated from the capitulum of the humerus.", "level": 1}