medical_qa.json•504 kB
[
{
"id": "c80bd39487a5f550",
"text": "A junior orthopaedic surgery resident is completing a carpal tunnel repair with the department chairman as the attending physician. During the case, the resident inadvertently cuts a flexor tendon. The tendon is repaired without complication. The attending tells the resident that the patient will do fine, and there is no need to report this minor complication that will not harm the patient, as he does not want to make the patient worry unnecessarily. He tells the resident to leave this complication out of the operative report. Which of the following is the correct next action for the resident to take?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 0
}
},
{
"id": "721c96a14bbaa424",
"text": "A 67-year-old man with transitional cell carcinoma of the bladder comes to the physician because of a 2-day history of ringing sensation in his ear. He received this first course of neoadjuvant chemotherapy 1 week ago. Pure tone audiometry shows a sensorineural hearing loss of 45 dB. The expected beneficial effect of the drug that caused this patient's symptoms is most likely due to which of the following actions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 1
}
},
{
"id": "efc682371c170438",
"text": "Two weeks after undergoing an emergency cardiac catherization with stenting for unstable angina pectoris, a 61-year-old man has decreased urinary output and malaise. He has type 2 diabetes mellitus and osteoarthritis of the hips. Prior to admission, his medications were insulin and naproxen. He was also started on aspirin, clopidogrel, and metoprolol after the coronary intervention. His temperature is 38\u00b0C (100.4\u00b0F), pulse is 93/min, and blood pressure is 125/85 mm Hg. Examination shows mottled, reticulated purplish discoloration of the feet. Laboratory studies show:\nHemoglobin count 14 g/dL\nLeukocyte count 16,400/mm3\nSegmented neutrophils 56%\nEosinophils 11%\nLymphocytes 31%\nMonocytes 2%\nPlatelet count 260,000/mm3\nErythrocyte sedimentation rate 68 mm/h\nSerum\nUrea nitrogen 25 mg/dL\nCreatinine 4.2 mg/dL\nRenal biopsy shows intravascular spindle-shaped vacuoles. Which of the following is the most likely cause of this patient's symptoms?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 2
}
},
{
"id": "6bda266613a4cfea",
"text": "A 39-year-old woman is brought to the emergency department because of fevers, chills, and left lower quadrant pain. Her temperature is 39.1\u00b0C (102.3\u00b0F), pulse is 126/min, respirations are 28/min, and blood pressure is 80/50 mm Hg. There is blood oozing around the site of a peripheral intravenous line. Pelvic examination shows mucopurulent discharge from the cervical os and left adnexal tenderness. Laboratory studies show:\nPlatelet count 14,200/mm3\nFibrinogen 83 mg/mL (N = 200\u2013430 mg/dL)\nD-dimer 965 ng/mL (N < 500 ng/mL)\nWhen phenol is applied to a sample of the patient's blood at 90\u00b0C, a phosphorylated N-acetylglucosamine dimer with 6 fatty acids attached to a polysaccharide side chain is identified. A blood culture is most likely to show which of the following?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 3
}
},
{
"id": "3bdd43fe2100380e",
"text": "A 35-year-old man comes to the physician because of itchy, watery eyes for the past week. He has also been sneezing multiple times a day during this period. He had a similar episode 1 year ago around springtime. He has iron deficiency anemia and ankylosing spondylitis. Current medications include ferrous sulfate, artificial tear drops, and indomethacin. He works as an elementary school teacher. His vital signs are within normal limits. Visual acuity is 20/20 without correction. Physical examination shows bilateral conjunctival injection with watery discharge. The pupils are 3 mm, equal, and reactive to light. Examination of the anterior chamber of the eye is unremarkable. Which of the following is the most appropriate treatment?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 4
}
},
{
"id": "2903528959a6d8d2",
"text": "A 39-year-old man presents to the emergency department because of progressively worsening chest pain and nausea that started at a local bar 30 minutes prior. The pain radiates to the epigastric area. He has a 5-year history of untreated hypertension. He has smoked 1 pack of cigarettes daily for the past 5 years and started abusing cocaine 2 weeks before his emergency room visit. The patient is diaphoretic and in marked distress. What should be the first step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 5
}
},
{
"id": "1052faa3a951b273",
"text": "A 68-year-old male comes to the physician for evaluation of right flank pain. He has a history of diabetes and peripheral artery disease. His blood pressure is 160/90 mm Hg. Physical examination shows abdominal tenderness and right flank tenderness. An ultrasound shows dilation of the right ureter and renal pelvis. Which of the following is the most likely underlying cause of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 6
}
},
{
"id": "8bb89b323e2cee1e",
"text": "A 65-year-old man is brought to the emergency department 30 minutes after the onset of acute chest pain. He has hypertension and asthma. Current medications include atorvastatin, lisinopril, and an albuterol inhaler. He appears pale and diaphoretic. His pulse is 114/min and blood pressure is 130/88 mm Hg. An ECG shows ST-segment depressions in leads II, III, and aVF. Laboratory studies show an increased serum troponin T concentration. The patient is treated for acute coronary syndrome and undergoes percutaneous transluminal coronary angioplasty. At the time of discharge, echocardiography shows a left ventricular ejection fraction of 58%. In addition to aspirin, which of the following drugs should be added to this patient's medication regimen?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 7
}
},
{
"id": "abcefd83875e974e",
"text": "A 37-year-old-woman presents to her primary care physician requesting a new form of birth control. She has been utilizing oral contraceptive pills (OCPs) for the past 8 years, but asks to switch to an intrauterine device (IUD). Her vital signs are: blood pressure 118/78 mm Hg, pulse 73/min and respiratory rate 16/min. She is afebrile. Physical examination is within normal limits. Which of the following past medical history statements would make copper IUD placement contraindicated in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 8
}
},
{
"id": "c51ee9a893815dd6",
"text": "A 23-year-old woman comes to the physician because she is embarrassed about the appearance of her nails. She has no history of serious illness and takes no medications. She appears well. A photograph of the nails is shown. Which of the following additional findings is most likely in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 9
}
},
{
"id": "10ff143f34149de0",
"text": "A 24-year-old G2P1 woman at 39 weeks\u2019 gestation presents to the emergency department complaining of painful contractions occurring every 10 minutes for the past 2 hours, consistent with latent labor. She says she has not experienced vaginal discharge, bleeding, or fluid leakage, and is currently taking no medications. On physical examination, her blood pressure is 110/70 mm Hg, heart rate is 86/min, and temperature is 37.6\u00b0C (99.7\u00b0F). She has had little prenatal care and uses condoms inconsistently. Her sexually transmitted infections status is unknown. As part of the patient\u2019s workup, she undergoes a series of rapid screening tests that result in the administration of zidovudine during delivery. The infant is also given zidovudine to reduce the risk of transmission. A confirmatory test is then performed in the mother to confirm the diagnosis of HIV. Which of the following is most true about the confirmatory test?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 10
}
},
{
"id": "db21da7349a2263c",
"text": "A 72-year-old man comes to the physician because of a 2-month history of fatigue and worsening abdominal pain. During this period, he also has excessive night sweats and shortness of breath on exertion. Over the past 3 months, he has had a 5.6-kg (12-lb) weight loss. He had a myocardial infarction 3 years ago. He has hypertension, diabetes mellitus, and chronic bronchitis. His medications include insulin, aspirin, lisinopril, and an albuterol inhaler. He has smoked half a pack of cigarettes for the past 45 years. Vital signs are within normal limits. The spleen is palpated 6 cm below the left costal margin. Laboratory studies show:\nHemoglobin 6.4 g/dL\nMean corpuscular volume 85 \u03bcm3\nLeukocyte count 5,200/mm3\nPlatelet count 96,000/mm3\nA blood smear is shown. Bone marrow aspiration shows extensive fibrosis and a few scattered plasma cells. A JAK 2 assay is positive. Which of the following is the most appropriate next step in management?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 11
}
},
{
"id": "75e3a6472919abed",
"text": "A 20-year-old man comes to the physician because of worsening gait unsteadiness and bilateral hearing loss for 1 month. He has had intermittent tingling sensations on both cheeks over this time period. He has no history of serious medical illness and takes no medications. Audiometry shows bilateral sensorineural hearing loss. Genetic evaluation shows a mutation of a tumor suppressor gene on chromosome 22 that encodes merlin. This patient is at increased risk for which of the following conditions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 12
}
},
{
"id": "bacceef8798c22bb",
"text": "A 47-year-old executive schedules an appointment his physician for a routine medical check-up. He currently has no complaints and claims to be \u201cas fit as a fiddle.\u201d The physical examination findings are unremarkable, except for a mid-systolic murmur heard in the 2nd left intercostal space that radiates to the carotids on auscultation. The physician instructs the patient to stand from a supine position with the stethoscope still placed on his chest. Which of the following changes would occur with this maneuver?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 13
}
},
{
"id": "e0fc7f72ccd757a1",
"text": "A microbiologist is studying the emergence of a virulent strain of the virus. After a detailed study of the virus and its life cycle, he proposes a theory: Initially, a host cell is co-infected with 2 viruses from the same virus family. Within the host cell, concomitant production of various genome segments from both viruses occurs. Ultimately, the different genome segments from the viruses are packaged into a unique and novel virus particle. The newly formed virus particle is both stable and viable and is a new strain from the virus family that caused the outbreak of infection. Which of the following viruses is capable of undergoing the above-mentioned process?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 14
}
},
{
"id": "9a628441de37cf3d",
"text": "A 59-year-old overweight woman presents to the urgent care clinic with the complaint of severe abdominal pain for the past 2 hours. She also complains of a dull pain in her back with nausea and vomiting several times. Her pain has no relation with food. Her past medical history is significant for recurrent abdominal pain due to cholelithiasis. Her father died at the age of 60 with some form of abdominal cancer. Her temperature is 37\u00b0C (98.6\u00b0F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical exam is unremarkable. However, a CT scan of the abdomen shows a calcified mass near her gallbladder. Which of the following diagnoses should be excluded first in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 15
}
},
{
"id": "feadbc0e71576508",
"text": "A 7-year-old boy is brought to his pediatrician\u2019s office for a follow-up visit. He was diagnosed with asthma when he was 3 years old and has since been on treatment for the condition. He is currently on a \u03b2-agonist inhaler because of exacerbation of his symptoms. He has observed that his symptoms are more prominent in springtime, especially when the new flowers are blooming. His mother has a backyard garden and whenever he goes out to play there, he experiences chest tightness with associated shortness of breath. He has been advised to take more precaution during this seasonal change and to stay away from pollen. He is also being considered for an experimental therapy, which attenuates the activity of certain mediators which cause his asthmatic attack. The targeted mediator favors the class switching of antibodies. A reduction in this mechanism will eventually reduce the exaggerated response observed during his asthmatic attacks, even when exposed to an allergen. Which of the following mediators is described in this experimental study?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 16
}
},
{
"id": "3d17b456d8fb314f",
"text": "A 3-month-old boy is brought the emergency department by his parents after an episode of cyanosis and muscle hypotonia that resolved after 2 minutes. Diagnostic evaluation fails to discover an exact etiology of the boy's symptoms and the episode is classified as a brief resolved unexplained event (BRUE). The risk profile for BRUE in infants remains largely unknown. The pediatrician who saw the boy in the emergency department is trying to identify risk factors for BRUE. She is aware of several confounders, including age, socioeconomic background, and family history of medical illness. She recruits 75 infants under 1 year of age with BRUE and 75 infants without BRUE of the same age, socioeconomic background, and family history of medical illness. She then compares the two groups with regard to history of feeding problems and history of recent upper respiratory infection. Which of the following methods was conducted to control confounding bias in the study?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 17
}
},
{
"id": "5c28b6a3b592eee7",
"text": "A 29-year-old man presents to the emergency department due to central chest pain over the past 3 days which is constant and unrelated to exertion. The pain is sharp, severe, increases when lying down, and improves with leaning forward. The pain also radiates to his shoulders and neck. The patient has no past medical history. He has smoked 10 cigarettes per day for the past 7 years and occasionally drinks alcohol. He presents with vital signs: blood pressure 110/70 mm Hg, regular radial pulse of 95/min, and temperature 37.3\u00b0C (99.1\u00b0F). On physical exam, a scratching sound of to-and-from character is audible over the left sternal border at end-expiration with the patient leaning forward. His chest X-ray is normal and ECG is shown in the picture. Which of the following is the optimal therapy for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 18
}
},
{
"id": "16a3190ec33510c2",
"text": "A 46-year-old man is brought to the emergency department for evaluation of altered mental status. He was found on the floor in front of his apartment. He is somnolent but responsive when aroused. His pulse is 64/min, respiratory rate is 15/min, and blood pressure is 120/75 mm Hg. On physical examination, an alcoholic smell and slurred speech are noted. Neurological exam shows diminished deep tendon reflexes bilaterally and an ataxic gait. His pupils are normal. Blood alcohol concentration is 0.04%. An ECG shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 19
}
},
{
"id": "f198daceccdc651d",
"text": "A 77-year-old woman presents to the emergency room with the complaints of fever, malaise, and night sweats. She recently observed an enlargement of her axillary lymph nodes, which she examines on a weekly basis. She has a remote history of breast cancer in her 60s that was treated with radiation and chemotherapy. She also reports a history of extensive travel to Africa and a 30-pack-year history of smoking. On physical exam, several axillary lymph nodes are palpable with a large non-tender palpable mass in her right axilla measuring 10 x 8 cm. Fine-needle aspiration demonstrates what the pathologist describes as \"a centroblastic and immunoblastic cell presence, suspicious for non-Hodgkin\u2019s lymphoma (NHL)\u2013diffuse large B cell variant\". Which of the following risk factors is responsible for this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 20
}
},
{
"id": "345d474cafde3a37",
"text": "A 3-month-old infant is brought to her pediatrician because she coughs and seems to have difficulty breathing while feeding. In addition, she seems to have less energy compared to other babies and appears listless throughout the day. She was born by cesarean section to a G1P1 woman with no prior medical history and had a normal APGAR score at birth. Her parents say that she has never been observed to turn blue. Physical exam reveals a high-pitched holosystolic murmur that is best heard at the lower left sternal border. The most likely cause of this patient's symptoms is associated with which of the following abnormalities?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 21
}
},
{
"id": "88c2c30652cef0d4",
"text": "A 30-year-old African American woman comes to the physician for the evaluation of a dry cough and chest discomfort for the past 3 days. During this period, the patient has had headaches, muscle aches, joint pain, fever, and chills. Ten days ago, she was hiking with her family in Mississippi. The patient has asthma that is treated with an albuterol inhaler. Her mother has a lung disease treated with methotrexate. The patient has smoked one pack of cigarettes daily for the past 10 years. Her temperature is 38\u00b0C (100.4\u00b0F). Physical examination shows slight wheezes throughout both lung fields. Laboratory studies and urinalysis are positive for polysaccharide antigen. Bronchoalveolar lavage using silver/PAS-staining shows macrophages filled with a dimorphic fungus with septate hyphae. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 22
}
},
{
"id": "728b7dcdbce88cce",
"text": "A 62-year-old patient has been hospitalized for a week due to a stroke. One week into the hospitalization, he develops a fever and purulent cough. His vitals include: heart rate 88/min, respiratory rate 20/min, temperature 38.4\u00b0C (101.1\u00b0F), and blood pressure 110/85 mm Hg. On physical examination, he has basal crackles on the right side of the chest. Chest radiography shows a new consolidation on the same side. Complete blood count is as follows:\nHemoglobin 16 mg/dL\nHematocrit 50%\nLeukocyte count 8,900/mm3\nNeutrophils 72%\nBands 4%\nEosinophils 2%\nBasophils 0%\nLymphocytes 17%\nMonocytes 5%\nPlatelet count 280,000/mm3\nWhat is the most likely causal microorganism?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 23
}
},
{
"id": "6e896141211a9dee",
"text": "A 6-year-old boy is brought to the emergency department by his mother for worsening wheezing and shortness of breath over the past day. He has not had a fever, cough, vomiting, or diarrhea. He has asthma and eczema. He uses a glucocorticoid inhaler and an albuterol inhaler but has missed his medications for the past week while on vacation. He appears uncomfortable. His temperature is 36\u00b0C (96.8\u00b0F), pulse is 120/min, respirations are 40/min, and blood pressure is 100/80. Expiratory and inspiratory wheezing is heard throughout both lung fields. There are moderate intercostal and subcostal retractions and a decreased inspiratory to expiratory ratio. Nebulized albuterol and ipratropium treatments and intravenous methylprednisolone are given in the emergency department for a presumed asthma exacerbation. One hour later, the child is limp and lethargic. Magnesium sulfate is administered. His temperature is 36\u00b0C (96.8\u00b0F), pulse is 150/min, respirations are 22/min, and blood pressure is 100/70. No wheezing is heard on repeat pulmonary examination. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 24
}
},
{
"id": "522c152ad66e13ba",
"text": "A 5-year-old female suffers from recurrent infections by Aspergillus species, Pseudomonas species, and Staphylococcus aureus. The patient's neutrophils are examined in the laboratory and they fail to react during the nitroblue tetrazolium test. Which of the following is most likely dysfunctional in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 25
}
},
{
"id": "c79113d63e5c06d2",
"text": "A 3-year-old boy presents to the emergency department with a \u2018cough-like-a-seal bark\u2019 and a high-pitched inspiratory noise that is audible without a stethoscope. His mother reports that his cough has worsened over the last few hours. The patient's blood pressure is 118/78 mm Hg, pulse is 90/min, respiratory rate is 35/min, and temperature is 38.3\u00b0C (101.1\u00b0F). On physical examination, the boy is sitting and leaning forward in apparent respiratory distress with suprasternal and intercostal retractions. Auscultation reveals inspiratory stridor without wheezing. He has a frequent barking cough and a hoarse voice when he speaks. What is a chest X-ray likely to show?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 26
}
},
{
"id": "c342be05bc95fdb1",
"text": "A 26-year-old woman presents to a gynecologist after a missed period. After performing a complete physical examination and a screening test for pregnancy, her gynecologist informs her that she is pregnant. She is very surprised as she has been taking oral contraceptives regularly. When the gynecologist asks her about the consumption of any other medications, she mentions that she was placed on treatment for pulmonary tuberculosis (TB) 2 months ago. Her current anti-TB regimen includes rifampin, isoniazid, pyrazinamide, and ethambutol. Which of the following mechanisms best explains the failure of oral contraceptives in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 27
}
},
{
"id": "cdc9d18d8742a7d0",
"text": "A 4-year-old previously healthy boy presents with 4 days of intermittent vomiting and 5-6 daily loose stools. His mother noted bloody stools and decreased oral intake of food and water over the last 24 hours. He is normally in daycare; however, he has been home for the past 3 days. On physical exam his temperature is 102.2\u00b0F (39\u00b0C), blood pressure is 140/90 mmHg, pulse is 120/min, respirations are 22/min and O2 saturation is 99% on room air. He has dry mucous membranes. On abdominal exam you note diffuse tenderness to palpation without rebound or guarding. There are no masses, hepatosplenomegaly, and bowel sounds are hyperactive. Ultrasound of the right lower quadrant is negative for appendicitis. Stool is guaiac positive. He receives 15mg/kg acetaminophen and fluids are started. The next day, he complains of lower extremity weakness and tingling. On repeat exam, lower extremity strength is 3/5 with diminished patellar deep tendon reflexes. Which of the following lab findings would most likely be seen in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 28
}
},
{
"id": "5f44ff28e3796edc",
"text": "A 3-week-old male newborn is brought to the physician because of an inward turning of his left forefoot. He was born at 38 weeks' gestation by cesarean section because of breech presentation. The pregnancy was complicated by oligohydramnios. Examination shows concavity of the medial border of the left foot with a skin crease just below the ball of the great toe. The lateral border of the left foot is convex. The heel is in neutral position. Tickling the lateral border of the foot leads to correction of the deformity. The remainder of the examination shows no abnormalities. X-ray of the left foot shows an increased angle between the 1st and 2nd metatarsal bones. Which of the following is the most appropriate next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 29
}
},
{
"id": "b294474adf4d99e3",
"text": "A 42-year-old woman comes to the emergency department because of a 2-day history of right upper abdominal pain and nausea. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); her BMI is 34 kg/m2. Her temperature is 38.5\u00b0C (101.3\u00b0F). Physical examination shows a distended abdomen and right upper quadrant tenderness with normal bowel sounds. Laboratory studies show:\nLeukocyte count 14,000/mm3\nSerum\nTotal bilirubin 1.1 mg/dL\nAST 32 U/L\nALT 40 U/L\nAlkaline phosphatase 68 U/L\nAbdominal ultrasonography is performed, but the results are inconclusive. Cholescintigraphy shows the intrahepatic bile ducts, hepatic ducts, common bile duct, and proximal small bowel. Which of the following is the most likely cause of this patient's symptoms?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 30
}
},
{
"id": "b659d6c8a0671c93",
"text": "A 72-year-old woman is admitted to the intensive care unit for shortness of breath and palpitations. A cardiac catheterization is performed and measurements of the left ventricular volume and pressure at different points in the cardiac cycle are obtained. The patient's pressure-volume loop (gray) is shown with a normal pressure-volume loop (black) for comparison. Which of the following is the most likely underlying cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 31
}
},
{
"id": "56e269cd86c9ae33",
"text": "A 22-year-old woman is brought to the emergency department because of a 2-day history of fever, intermittent rigors, and night sweats. She also has a 1-month history of progressive fatigue. Five weeks ago, she was hospitalized and received intravenous antibiotics for treatment of bacterial meningitis while visiting relatives in Guatemala. Her temperature is 39.4\u00b0C (102.9\u00b0F), pulse is 130/min, and blood pressure is 105/70 mm Hg. Examination shows pallor and scattered petechiae and ecchymoses. Laboratory studies show a hemoglobin concentration of 9.0 g/dL, a leukocyte count of 1,100/mm3 with 30% segmented neutrophils, and a platelet count of 20,000/mm3 . Blood cultures grow coagulase-negative staphylococci. The patient was most likely treated with which of the following antibiotics?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 32
}
},
{
"id": "425d27599825c83b",
"text": "An otherwise healthy 50-year-old man comes to the physician because of a 6-month history of increasingly frequent episodes of upper abdominal pain, nausea, vomiting, and diarrhea. He has had a 3.2-kg (7-lb) weight loss during this time. Physical examination shows bilateral pitting pedal edema. An endoscopy shows prominent rugae in the gastric fundus. Biopsy shows parietal cell atrophy. Which of the following is the most likely underlying cause?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 33
}
},
{
"id": "b12e0a8642434cc7",
"text": "A 27-year-old man presents to the emergency department. He was brought in by staff from the homeless shelter when they found him unresponsive. The patient is a known IV drug abuser but otherwise has an unknown past medical history. He currently attends a methadone clinic. His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 97/48 mmHg, pulse is 140/min, respirations are 29/min, and oxygen saturation is 98% on room air. Initial laboratory values are shown below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 6.3 mEq/L\nHCO3-: 17 mEq/L\nGlucose: 589 mg/dL\n\nThe patient is given treatment. After treatment, his temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 117/78 mmHg, pulse is 100/min, respirations are 23/min, and oxygen saturation is 98% on room air. His laboratory values are seen below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 19 mEq/L\nGlucose: 90 mg/dL\n\nWhich of the following is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 34
}
},
{
"id": "fb9e253344c0b68b",
"text": "A 67-year-old man who was diagnosed with arthritis 16 years ago presents with right knee swelling and pain. His left knee was swollen a few weeks ago, but now with both joints affected, he has difficulty walking and feels frustrated. He also has back pain which makes it extremely difficult to move around and be active during the day. He says his pain significantly improves with rest. He also suffers from dandruff for which he uses special shampoos. Physical examination is notable for pitting of his nails. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 35
}
},
{
"id": "8262da512f90ad3e",
"text": "A 65-year-old woman schedules an appointment with her physician for evaluation of weight loss and weakness. The weakness is more noticeable when climbing stairs and combing hair. The weakness improves after brief exercise. She also has bladder incontinence for the past 4 weeks and was given an anticholinesterase agent with no improvement. What is the most likely cause of the symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 36
}
},
{
"id": "2c8a9eec14f8edf0",
"text": "A 3-month-old boy presents to his pediatrician with persistent diarrhea, oral candidiasis, and signs and symptoms suggestive of respiratory syncytial virus (RSV) pneumonia. His weight is in the 10th percentile. He is being evaluated for an immunodeficiency disease. Laboratory results for the HIV are negative by PCR. Which of the following is the most likely cause of these findings in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 37
}
},
{
"id": "d92d57afd4a1dba0",
"text": "A 53-year-old man with recurrent pancreatic adenocarcinoma is enrolled in a clinical trial for a novel chemotherapeutic agent that his physician believes may be beneficial to his condition. The novel drug was previously tested in a small population and is now undergoing a larger phase 3 trial in preparation for FDA approval. A dose-response trial had the following results:\n\n10 mg dose - 6/59 patients demonstrated improvement\n20 mg dose - 19/49 patients demonstrated improvement\n30 mg dose - 26/53 patients demonstrated improvement\n40 mg dose - 46/51 patients demonstrated improvement\n\nThe same trial also had the following safety profile:\n\n20 mg dose - 5/49 patients had a treatment related adverse event\n40 mg dose - 11/51 patients had a treatment related adverse event\n60 mg dose - 15/42 patients had a treatment related adverse event\n80 mg dose - 23/47 patients had a treatment related adverse event\n100 mg dose - 47/52 patients had a treatment related adverse event\n\nBased on this study, which of the following represents the most likely therapeutic index for this novel chemotherapeutic agent?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 38
}
},
{
"id": "11cf9b1a36e5a118",
"text": "A 67-year-old male is seen by neurology after he was noticed to be speaking strangely by his family. After acute treatment with tissue plasminogen activator (tPA), the patient is able to recover most of his speech. Subsequent neurologic exam finds that the patient is fluent while speaking and is able to comprehend both one and two step instructions. Noticeably the patient remains unable to complete tasks involving verbal repetition. Residual damage to which of the following structures is most likely responsible for this patient's syndrome?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 39
}
},
{
"id": "e524436738174d12",
"text": "A 27-year-old woman presents to the office with concerns about her long struggle with her physical appearance since adolescence. She says she has always been \"large\" and was constantly targeted by her classmates and coworkers for being so. Her main concern at the moment is her acne and unwanted facial hair on her upper lip, for which she often visits a local spa. She has tried numerous diet plans, exercise regimens, and cosmetic products with little to no effect. Recently, she underwent a glucose tolerance test that showed a plasma glucose level of 160 mg/dL (8.9 mmol/L) after 2 hours of a 75 g dose of oral glucose. She has a family history of type 2 diabetes mellitus and a menstrual cycle that occurs every 45 days. Her pulse is 72/min and the blood pressure is 138/80 mm Hg. On physical examination, her height is 160 cm (5 ft 3 in) and her weight is 85 kg (187 lb), and she has severe inflammatory acne over the cheeks and forehead and dark coarse hairs on the back. What is the most likely diagnosis of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 40
}
},
{
"id": "6fea36de558e3e7a",
"text": "\u0410 43-\u0443\u0435\u0430r-old m\u0430n \u0440r\u0435\u0455\u0435nt\u0455 w\u0456th t\u0456ngl\u0456ng \u0430nd numbn\u0435\u0455\u0455 of the low\u0435r l\u0456mb\u0455 for 2 w\u0435\u0435k\u0455. \u041d\u0435 also \u0441om\u0440l\u0430\u0456n\u0455 of \u0440\u0435r\u0455\u0456\u0455t\u0435nt \u0440\u0430\u0456n in his legs wh\u0456\u0441h is not relieved by over-the-counter analgesics. Past medical history is significant for type 2 d\u0456\u0430b\u0435tes mellitus for 2 \u0443\u0435\u0430r\u0455, inconsistently managed with m\u0435tform\u0456n \u0430nd gl\u0456m\u0435\u0440\u0456r\u0456d\u0435. \u041en physical \u0435\u0445\u0430m\u0456n\u0430t\u0456on, th\u0435r\u0435 \u0456\u0455 d\u0435\u0441r\u0435\u0430\u0455\u0435d \u0455\u0435n\u0455\u0430t\u0456on to pain in both lower l\u0456mbs, but deep t\u0435ndon r\u0435fl\u0435\u0445\u0435\u0455 \u0430r\u0435 \u0456nt\u0430\u0441t. \u041d\u0456\u0455 v\u0456t\u0430l \u0455\u0456gn\u0455 include: blood \u0440r\u0435\u0455\u0455ur\u0435 122/84 mm \u041dg, t\u0435m\u0440\u0435r\u0430tur\u0435 36.7\u00b0C (98.1\u00b0F), and r\u0435\u0455\u0440\u0456r\u0430tor\u0443 r\u0430t\u0435 10/m\u0456n. His ankle-brachial pressure index (ABPI) on the right side is 1.1. His blood sugar analyses are as follows:\nFasting 141 mg/ dL\n2 hours Post-Prandial 235 mg/ dL\nHbA1c 8.1%\nWhich of the following is the best measure to prevent the progression of the symptoms present in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 41
}
},
{
"id": "dd28b418a3972138",
"text": "A one-day-old male is evaluated in the hospital nursery for bilious vomiting. The patient has urinated multiple times since birth but has not yet passed meconium. He was born at 38 weeks gestation to a 36-year-old gravida 3 via vaginal delivery. The pregnancy was complicated by gestational diabetes. The patient\u2019s mother received routine prenatal care and declined first trimester screening. She subsequently underwent a quadruple screen at 15 weeks gestation that demonstrated decreased maternal serum alpha-fetoprotein (AFP), increased beta-hCG, decreased unconjugated estriol, and increased inhibin A. Her last ultrasound prior to onset of labor demonstrated an amniotic fluid index (AFI) of 28 cm. The patient\u2019s two older siblings are both healthy. The patient\u2019s temperature is 97.8\u00b0F (36.6\u00b0C), blood pressure is 58/37 mmHg, pulse is 166/min, and respirations are 38/min. On physical exam, the patient is in moderate distress. His abdomen is firm and distended with hypoactive bowel sounds.\n\nWhich of the following is the most likely etiology of this fetus\u2019s presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 42
}
},
{
"id": "a6301bc791cdd187",
"text": "A healthy 23-year-old male is undergoing an exercise stress test as part of his physiology class. If blood were to be sampled at different locations before and after the stress test, which area of the body would contain the lowest oxygen content at both time points?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 43
}
},
{
"id": "79789178b992dcd4",
"text": "A 45-year-old G5P4105 presents to her gynecologist\u2019s office with six months of increasingly heavy periods. She now soaks one super absorbent tampon every two hours for five days each cycle. Her cycles have also become irregular, with intermenstrual bleeding for the last two months. She now experiences significant dysmenorrhea, requiring 400 mg ibuprofen every four hours for the majority of each menses. In addition, she reports new onset mild dyspareunia with intercourse and a \u201cheavy feeling\u201d in her pelvis. She has also noticed increased urinary frequency but denies bowel changes. The patient has a past medical history of obesity and type II diabetes on metformin. Her last child was born four years ago, and she has had five spontaneous vaginal deliveries. At this office visit, temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 137/84 mmHg, pulse is 87/min, and respirations are 14/min. Which of the following physical exam findings is most likely to be present in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 44
}
},
{
"id": "a2c0dc1366ef2fe0",
"text": "A man is brought into the emergency department by the police department. The officer state that the man has been arrested multiple times for public alcohol intoxication, but recently became homeless. On exam, the man is behaving erratically. His vitals are all within normal limits. He appears confused and has a slurred speech. On gait exam, the patient is ataxic and cannot stand without support for more than a few seconds. Labs return with the following values: Na 140, K 4, Cl 106, BUN 8, Cr 2. His ABG has pH 7.3, PaCO2 13mm, PaO2 130mm, HCO3 7. His urinalysis is shown in Figure 1. Blood salicylate levels return as normal. While you await other diagnostic tests, which of the following should be administered next to treat this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 45
}
},
{
"id": "2239005bcac56da6",
"text": "A medical research study is evaluating an investigational novel drug (medication 1) compared with standard therapy (medication 2) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 days post-MI. The following are the results of the trial:\nEndpoints Medication 1 Medication 2 P-Value\nPrimary: death from cardiac causes 134 210 0.03\nSecondary: hyperkalemia 57 70 0.4\nWhat is the number needed to treat (NNT) for the primary endpoint of death from cardiac causes? (Round to the nearest whole number.)",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 46
}
},
{
"id": "f1d6a236562a96bb",
"text": "A 55-year-old man comes to the physician because of a 6-week history of tingling pain in the sole of his right foot when he raises it above chest level during exercises. He reports that he started exercising regularly 2 months ago and that his right calf cramps when he uses the incline feature on the treadmill, forcing him to take frequent breaks. The pain completely disappears after resting for a few minutes. He has an 8-year history of type 2 diabetes mellitus. He has smoked two packs of cigarettes daily for 34 years. His only medication is metformin. His pulse is 82/min, and blood pressure is 170/92 mm Hg. Straight leg raise test elicits pallor and tingling pain in the right foot. There is no pain in the back. His muscle strength is normal. Femoral pulses are palpable; right pedal pulses are absent. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 47
}
},
{
"id": "f3cb87d86adb5f87",
"text": "A 29-year-old primigravid woman at 35 weeks' gestation is admitted to the hospital in labor. She has no history of serious medical illness. She has had an uncomplicated pregnancy. Her last ultrasound at 22 weeks' gestation was normal. On admission, fetal heartbeats cannot be detected by fetal doppler monitor. Ultrasound shows decreased amniotic fluid levels and no evidence of fetal movement, respiration, or heart activity. The patient gives birth to a 2296 g (5 lb 1 oz) male infant. Physical examination shows no signs of life. There are no visible malformations. The placenta is unremarkable. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 48
}
},
{
"id": "2a2e95e4a5912acf",
"text": "A 67-year-old man is hospitalized after several days of fever and increasing shortness of breath. Respiratory viral panel returns positive for influenza A and the patient is started on a standard five day course of oseltamivir. Despite therapy, his shortness of breath continues to worsen and his oxygen saturation decreases to the point where ICU transfer and intubation are required. Chest radiograph shows bilateral infiltrates. Clinical criteria are consistent with development of Acute Respiratory Distress Syndrome (ARDS). After several weeks of supportive therapy, the patient improves with lung function returning to near normal. Which of the following processes is involved in the regeneration of alveolar lining after damage to alveoli occurs?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 49
}
},
{
"id": "b2cdf04dca94b7f1",
"text": "A 65-year-old male is treated for anal carcinoma with therapy including external beam radiation. How does radiation affect cancer cells?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 50
}
},
{
"id": "983907f9588aa6e3",
"text": "A 56-year-old man with a history of hypertension presents to his physician with progressive fatigue and new onset muscle cramps. He has had no recent changes to his medication regimen, which includes hydrochlorothiazide, lisinopril, and amlodipine. His temperature is 98.0\u00b0F (36.7\u00b0C), blood pressure is 174/111 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. The patient's cardiopulmonary and abdominal exams are unremarkable. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 138 mEq/L\nCl-: 100 mEq/L\nK+: 3.3 mEq/L\nHCO3-: 33 mEq/L\nBUN: 20 mg/dL\nGlucose: 129 mg/dL\n\nWhat is the most likely underlying etiology of this patient's hypertension?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 51
}
},
{
"id": "1d625f019398a896",
"text": "A 65-year-old man comes to the physician because of a 1-week history of yellowish discoloration of his skin and generalized pruritus. Examination shows jaundice of the skin and scleral icterus. Urinalysis shows an elevated concentration of bilirubin and a low concentration of urobilinogen. Which of the following is the most likely underlying cause of these findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 52
}
},
{
"id": "3997d3580a7378b3",
"text": "A 72-year-old woman is brought to the physician by her daughter because of a 6-month history of worsening short-term memory deficits and social withdrawal. Treatment with galantamine is initiated. Two weeks later, the patient develops vomiting, mild crampy abdominal pain, and watery, nonbloody diarrhea. Which of the following is the most appropriate pharmacotherapy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 53
}
},
{
"id": "0781daaae55907cd",
"text": "A 61-year-old man with schizophrenia in a locked inpatient psychiatry unit was observed making an unusual smacking motion with his lips, pursing his mouth, and blinking excessively. These symptoms started slowly about 2 weeks ago and have become more pronounced, but they do not seem to bother the patient. He resides in an inpatient psychiatric facility where he has been successfully treated with haloperidol for the past several months. His physical exam and vitals are within normal limits. Which of the following accurately describes his symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 54
}
},
{
"id": "3f4cc649b1886241",
"text": "A 17-year-old football player with no significant past medical history, social history, or family history presents to his pediatrician with itching in his groin. He says this started during summer workouts leading up to this season. He denies having any rash anywhere else on his body. The blood pressure is 123/78 mm Hg, pulse is 67/min, respiratory rate is 15/min, and temperature is 38.1\u00b0C (98.7\u00b0F). Physical examination reveals an erythematous, well-demarcated patch with peripheral scale on the left thigh, pubic region, and perineum. There is no apparent scrotal involvement with the rash. How can you confirm the suspected diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 55
}
},
{
"id": "f2a9e608b332edb8",
"text": "An otherwise healthy 26-year-old man comes to the physician for medication counseling after recently being diagnosed with schizophrenia. Risperidone therapy is initiated. This patient is at increased risk for which of the following adverse effects?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 56
}
},
{
"id": "5ccbfbcffecde053",
"text": "A 15-year-old woman presents with fever, altered mental status and a petechial rash on her lower extremities and back since yesterday evening. She also says she has been nauseous for the past 3 hours and has vomited twice. The patient mentions she has had heavy menstrual bleeding for the past few days. Her blood pressure is 95/80 mm Hg and her temperature is 40.0\u00b0C (104.0\u00b0F). On physical examination, the patient appears diaphoretic. A pelvic examination reveals a tampon in her vagina. Binding and activation of which of the following T cell receptors is responsible for this patient\u2019s most likely condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 57
}
},
{
"id": "2fa336cab2543578",
"text": "A 2-year-old boy is brought to the physician for evaluation of pallor and increasing lethargy for 2 days. One week ago, he experienced abdominal pain, vomiting, and bloody diarrhea that have since subsided. The patient's father states that they returned early from a 6-week roadtrip in Mexico because of these symptoms. His parents have been giving him oral rehydration solution. His immunizations are up-to-date. He appears pale. His temperature is 38.4\u00b0C (101.1\u00b0F), pulse is 130/min, respirations are 35/min, and blood pressure is 95/50 mm Hg. Examination shows scleral icterus. The abdomen is soft and nontender; there is no rebound or guarding. Bowel sounds are hyperactive. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 8.5 g/dL\nMean corpuscular volume 94 \u03bcm3\nLeukocyte count 18,000/mm3\nPlatelet count 45,000/mm3\nProthrombin time 12 sec\nPartial thromboplastin time 34 sec\nSerum\nUrea nitrogen 28 mg/dL\nCreatinine 1.6 mg/dL\nBilirubin\nTotal 2.5 mg/dL\nDirect 0.1 mg/dL\nLactate dehydrogenase 1658 U/L\nA blood smear shows schistocytes. Which of the following is the most likely diagnosis?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 58
}
},
{
"id": "daf6c305dc45a831",
"text": "A 17-year-old girl is referred by her dentist for a suspected eating disorder. She has been visiting the same dentist since childhood and for the past 2 years has had at least 2 visits for dental caries. She eventually admitted to him that she regularly induces vomiting by putting her fingers down her throat. She says she has been doing this for the last few years and purging at least once a week. More recently, she has been inducing emesis more often and even looked into diuretics as she feels that she is gaining more and more weight compared to her \u2018skinny friends\u2019. Her BMI is at the 50th percentile for her age and sex. Which of the following features is most consistent with this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 59
}
},
{
"id": "6dbb9044c1d68f56",
"text": "A 14-year-old girl is brought to the physician by her father because of fever, chills, abdominal pain, and profuse non-bloody diarrhea. Her symptoms began one week ago, when she had several days of low-grade fever and constipation. She returned from Indonesia 2 weeks ago, where she spent the summer with her grandparents. Her temperature is 39.3\u00b0C (102.8\u00b0F). Examination shows diffuse abdominal tenderness and mild hepatosplenomegaly. There is a faint salmon-colored maculopapular rash on her trunk and abdomen. Which of the following is the most likely causal organism?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 60
}
},
{
"id": "d11f9a3d03259161",
"text": "A 22-year-old female college student is treated with metronidazole after presenting to student health services with itching, discharge, and pain in her vagina. At a party shortly afterward she experiences facial flushing, nausea, tachycardia, dyspnea, headache, and abdominal cramps after consuming alcohol. Serum levels of which of the following are likely elevated in this patient following alcohol consumption:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 61
}
},
{
"id": "d563fc1c61c78f14",
"text": "A 23-year-old primigravida presents for a regular prenatal care visit at 16 weeks gestation. She complains of increased fatigability, but is otherwise well. She takes folic acid, iron, and vitamin D supplementation. Her vital signs are as follows: blood pressure, 110/70 mm Hg; heart rate, 86/min; respiratory rate, 13/min; and temperature, 36.6\u2103 (97.9\u2109). The physical examination is unremarkable. The complete blood count results are as below:\nErythrocyte count 3.9 million/mm3\nHb 11.1 g/dL\nHCT 32%\nReticulocyte count 0.2%\nMCV 90 fL\nPlatelet count 210,000/mm3\nLeukocyte count 8,100/mm3\nWhich of the following tests is required to investigate the cause of the patient\u2019s laboratory findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 62
}
},
{
"id": "4a44ffb8786ad85b",
"text": "An 80-year-old man is transferred from a step-down unit to a med-surg floor in the hospital. He had undergone a successful hernia surgery 14 hours ago. Before the surgery, he was pre-treated with atropine, scopolamine, and morphine and recovered well in the PACU after the surgery. There were no complications in the step-down unit and the patient continued to recover. On the med-surg floor, his temperature is 36.8\u00b0C (98.2\u00b0F), the heart rate is 98/min, the respiratory rate is 15/min, the blood pressure is 100/75 mm Hg, the oxygen saturation is 90%. On physical exam, he is a well-developed, obese man. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. His incision site is clean, dry, and intact with an appropriate level of swelling and erythema. During the physical, the patient mentions some discomfort in his abdomen and pelvis and during a records review it is noted that he has not passed urine in the PACU, step-down unit, or since arriving on the med-surg floor. A bladder scan is inconclusive due to body habitus. What is the next best step in the treatment of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 63
}
},
{
"id": "d610b62d4bbf3a39",
"text": "A healthy 19-year-old man presents to his primary care provider complaining of painless \u201cblisters\u201d in his mouth. He reports that he noticed a white film on his tongue and the sides of his mouth 2 days ago while brushing his teeth. The film was easily brushed off. He also complains of a bitter metallic taste in his mouth but otherwise denies pain, burning, dysphagia, or hoarseness. He is otherwise healthy and takes no medications. He is a competitive swimmer and has had 8 sexual partners in the past year. He intermittently uses barrier protection. On exam, he is well-appearing and in no acute distress. His oral examination demonstrates patches of white pseudomembranes that can be wiped away to reveal erythematous mucosa. A medication with which of the following mechanisms of action is most appropriate in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 64
}
},
{
"id": "0ffc0eed21999082",
"text": "A 56-year-old man presents to the clinic complaining of subacute back pain for the past month. The pain is described as a dull, constant ache that is worse at night. He could not recall any precipitating event except for an amateur weight-lifting competition that he participated in 2 months ago. Past medical history is significant for non-small cell lung cancer that was diagnosed and successfully treated. A PET scan 1 year ago demonstrated no recurrence. Physical exam was unremarkable except for some point tenderness along the lumbosacral area. What is the most likely imaging finding in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 65
}
},
{
"id": "fe69fcc20b36a999",
"text": "A 4-year-old boy is brought to the emergency department because of severe abdominal pain and bilious vomiting for 6 hours. He has not had bowel movements in the past 24 hours. He appears ill. His temperature is 37.8\u00b0C (100\u00b0F) and pulse is 122/min. Examination shows a distended abdomen. There is tenderness to palpation in the lower abdomen; guarding and rebound tenderness are present. Bowel sounds are decreased. An x-ray of the abdomen shows dilated loops of bowel. He has been accompanied by his 14-year-old brother. The surgeon recommends an emergency laparotomy. The parents are away visiting friends and cannot be reached. Which of the following is the most appropriate next best step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 66
}
},
{
"id": "a00014ab5e013803",
"text": "A 3-week-old male newborn is brought to the hospital because of poor weight gain since birth. He was born at 38 weeks' gestation via normal vaginal delivery. He weighed 3005 g (6 lb, 10 oz) at birth and currently weighs 2835 g (6 lb, 4 oz). He has been latching on and breastfeeding well since birth. His mother has a history of Graves' disease and underwent near-total thyroidectomy in the second trimester of her pregnancy after her symptoms could not be controlled with antithyroid drugs. She is currently receiving L-thyroxine therapy. The patient's temperature is 38.9\u00b0C (102\u00b0F), pulse is 176/min, and respirations are 42/min. He appears irritable. Examination shows a diaphoretic infant with a paucity of subcutaneous fat. There is swelling of the neck at the midline. Which of the following is the most likely cause?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 67
}
},
{
"id": "11544b47baee053c",
"text": "A 57-year-old female with a past medical history of alcoholism presents to the emergency room vomiting bright red blood. She is accompanied by her partner, who reports that she had been complaining of black and tarry stools for the past several days. Vital signs are temperature 37 degrees celsius, heart rate 141 beats per minute, blood pressure 90/60, respiratory rate 20, and oxygen saturation 99% on room air. On physical examination, she has splenomegaly and a positive fluid wave. The remainder of her examination is within normal limits. The patient is stabilized with intravenous fluids, and her blood pressure improves. Subsequent emergent upper endoscopy reveals bleeding from the submucosal veins in the lower 1/3 of the esophagus, but no gastric bleed. In the endoscopy suite she also receives IV octreotide. After intervention and resolution of her acute bleed, which of the following pharmacologic agents is indicated?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 68
}
},
{
"id": "0e68a8803f5cf50e",
"text": "A 65-year-old man with a history of hypertension, obesity, and alcoholic cirrhosis is seen in clinic for follow-up. He feels well and currently drinks 5 glasses of wine each night. Medications include atenolol and lisinopril. On physical exam, temperature is 98.1 deg F (36.7 deg C), blood pressure is 151/82 mmHg, pulse is 71/min, and respirations are 14/min. He has spider angiomata on his chest; no asterixis, jaundice, ascites, or peripheral edema is noted. Screening ultrasound reveals a new liver nodule, and follow up CT demonstrates a 2 cm right hepatic lobe lesion with enhancement in the arterial phase. No hypodense attenuation is seen on the venous or delayed phase. What is the next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 69
}
},
{
"id": "853e458e959e65fe",
"text": "A 66-year-old man is brought to the emergency room by his wife due to abdominal distension and persistent somnolence for the past 2 weeks. The patient\u2019s wife says that he has been sleeping much more than usual for the past 5 days. His bowel and bladder habit have not changed. His past medical history is significant for alcoholic liver cirrhosis. His vital signs include: pulse 76/min, respiratory rate 15/min, temperature 38.0\u00b0C (100.4\u00b0F) and blood pressure 122/75 mm Hg. On physical examination, the patient is altered and not responsive to commands. Oriented x 0. The abdomen is significantly distended. Shifting dullness is present and a positive fluid wave can be elicited. Hyperreflexia and asterixis are noted. Laboratory findings are significant for the following:\nLaboratory test\nSodium 140 mEq/L\nPotassium 3.5 mEq/L\nChloride 97 mEq/L\nGlucose 90 mg/dL\nAmmonia 100 \u00b5g/dL (ref: 19-60 \u00b5g/dL)\nArterial blood gas\npH 7.4\npCO2 40 mm Hg\npO2 90 mm Hg\nHCO3 26 mEq/L\nAn abdominal ultrasound shows surface nodularity compatible with cirrhosis but no other changes aside from ascites. An upper GI endoscopy is performed which shows gastric varices with no signs of active bleeding. An MRI of the brain is insignificant. What is the most likely precipitating factor that led to this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 70
}
},
{
"id": "f6707abcf210feb2",
"text": "A 27-year-old man presents to the emergency department after a motor vehicle collision. The patient was the front seat unrestrained driver in a head on collision. The patient\u2019s echocardiogram (ECG) is notable only for sinus tachycardia. His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 107/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient is given 2 liters of Ringer lactate solution and morphine. Initial workup demonstrates that the patient\u2019s pulmonary capillary wedge pressure and troponins are elevated. The patient is currently complaining of chest pain. Physical exam is notable for an uncomfortable young man with bruising over his chest wall. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 71
}
},
{
"id": "8f26e86db256ac49",
"text": "A 56-year-old man presents to the emergency department for progressively worsening fatigue, malaise, fever, and abdominal pain. He reports that his symptoms began approximately 1 week ago and he has noticed episodes of diarrhea. He recently started melatonin and magnesium supplementation in hopes of improving his sleep. Medical history is significant for alcohol use disorder that required multiple hospital admissions for management of acute pancreatitis and cirrhosis. He states that he occasionally injects heroin intravenously. Temperature is 100\u00b0F (37.8\u00b0C), blood pressure is 105/70 mmHg, pulse is 92/min, and respirations are 17/min. Physical examination is significant for scleral icterus, hepatomegaly, ascites, and diffuse abdominal tenderness. Laboratory testing is significant for leukocytosis and metabolic acidosis. A paracentesis is performed and he is admitted into the hospital to receive intravenous cefotaxime and albumin. Ascitic fluid analysis demonstrates a polymorphonuclear cell count of 280 cells/mm^3, serum-ascites albumin gradient of 1.3 g/dL, and a culture positive for Escherichia coli sensitive to cefotaxime and ceftriaxone. On hospital day 2, the nurse reports that the patient is oliguric in the setting of constant fluid intake. Physical examination is unchanged. Laboratory testing is significant for a serum sodium of 131 mEq/L and creatinine of 1.8 mg/dL (it was 0.9 mg/dL on admission). Urine studies are significant for a low urine sodium level, without evidence of blood or protein. Since the hospital admission, he has not been started on any new medications. Which of the following will be the best treatment option for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 72
}
},
{
"id": "b672bf58fb1810a4",
"text": "A 29-year-old woman presents to the clinic after several months of weight loss. She noticed a 6.8 kg (15 lb) unintentional weight loss over the preceding several months. She has not changed her diet or exercise habits. She also reports feuding with her boyfriend over the temperature of their shared apartment, as she always feels warmer than he does. The vital signs include: heart rate 110/min and blood pressure 146/78 mm Hg. The physical exam is notable for warm and slightly moist skin. She also exhibits a fine tremor in her hands when her arms are outstretched. The urine pregnancy test is negative. Which of the following is the best single treatment option for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 73
}
},
{
"id": "0800d108acba4ce3",
"text": "A 21-year-old man comes to the physician because of pruritus and a hypopigmented rash on his upper body for 5 days. He first noticed the symptoms after returning from a business trip last week in the Bahamas. While he was there, he visited a couple of beaches and went hiking with some coworkers. The rash initially started as a single lesion on his upper back but since then has extended to his shoulders. He has a history of type 1 diabetes mellitus controlled with an insulin pump. He works as an office manager and has no known exposure to melanocytotoxic chemicals. He has been sexually active with three female partners over the past year and uses condoms inconsistently. He is 183 cm (6 ft) tall and weighs 80 kg (176 lb); BMI is 23.9 kg/m2. His temperature is 37.2\u00b0C (99\u00b0F), pulse is 78/min, and blood pressure is 130/84 mm Hg. A photograph of the rash is shown. One month ago, his hemoglobin A1C was 7.8%. Which of the following is most likely to confirm the diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 74
}
},
{
"id": "497adcc9be714ba1",
"text": "A 5-year-old female is brought to a speech therapist for continuing work on improving her communication skills. She is only able to verbalize two word sentences and has generalized developmental delay. When she was born it was noticed that she had a high pitched mewing cry and subsequent physical exam revealed microcephaly, prominent epicanthal folds, and a holosystolic murmur best heard in the left 5th intercostal space near the sternum. An abnormality of which of the following chromosomes is most likely responsible for this patient's disorder?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 75
}
},
{
"id": "feebf9da384cdd49",
"text": "A 62-year old female comes to the physician because of vaginal spotting and urinary urgency for the past 4 days. She has had no fever, abdominal pain, or diarrhea. Menopause occurred at 52 years of age. Her last Pap smear 1 year ago was normal. She has hypertension, hypercholesterolemia, and diabetes. Medications include atorvastatin, hydrochlorothiazide, metformin, and aspirin. She is sexually active with her husband. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 95/min, respirations are 12/min, and blood pressure is 155/65 mm Hg. Pelvic exam demonstrates a 4 x 3 cm firm, immobile erythematous mass on the right inner vaginal wall. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 76
}
},
{
"id": "205512e45d4702ea",
"text": "A 59-year-old man is evaluated for progressive joint pain. There is swelling and tenderness over the first, second, and third metacarpophalangeal joints of both hands. His hand radiograph is shown. He has had diabetes mellitus for 2 years which is not well controlled with medications. Lab studies show a transferrin saturation of 88% and serum ferritin of 1,200 ng/mL. Which of the following best represents the etiology of this patient condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 77
}
},
{
"id": "570becd7a563c6ad",
"text": "A newborn is found to be extremely cyanotic immediately after birth. He then develops progressive respiratory failure and is admitted to the neonatal ICU. A single loud S2 heart sound is appreciated as well as a machine-like murmur at the left upper sternal border. Radiography shows an enlarged \"egg-shaped\" heart. The newborn is then taken for a atrial septostomy to alleviate the condition pending definitive surgical correction. Which of the following is the most likely cause of this newborn's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 78
}
},
{
"id": "9b4ae93280d426cb",
"text": "A 25-year-old male involved in a knife fight presents with a penetrating wound to the chest. The patient is unconscious and cannot provide any further history. Vitals show a temperature of 37-0\u00b0C (98.6\u00b0F), blood pressure of 85/55 mm Hg, pulse of 115/min, respirations of 19/min, and oxygen saturation of 92% on room air. On physical examination, the patient is diaphoretic and unresponsive. Extremities are pale and cool. There is a 3-inch long penetrating wound between the 3rd and 4th intercostal space on the left side of the chest, which is bleeding profusely. Transthoracic echocardiography reveals a full thickness penetrating injury to the right ventricular free wall. There are no apparent injuries to any coronary arteries or major branches. The patient is intubated and aggressive fluid resuscitation is initiated, including a blood transfusion. Which of the following is the best definitive surgical approach to take in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 79
}
},
{
"id": "872fdec019b4e987",
"text": "A post-mortem lung examination of a 68-year-old male overweight male with evidence of chronic lower extremity edema, a 60 pack-year smoking history and daily productive cough would be most likely to reveal:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 80
}
},
{
"id": "38bc6eb38915d0be",
"text": "A 54-year-old male makes an appointment with his primary care physician due to chronic fatigue that has left him unable to hike or do other physically demanding activities with his friends. He has well-controlled hypertension and diabetes but has otherwise been healthy. He does not smoke but drinks socially with his friends. Physical exam reveals enlarged nodules that are not tender to palpation. A biopsy is obtained showing a characteristic change in chromosome 18. The regulation of which of the following proteins will be most abnormal in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 81
}
},
{
"id": "55938a9511388e77",
"text": "A 44-year-old African-American woman comes to the physician for a routine examination. She is concerned about cancer because her uncle died of metastatic melanoma 1 year ago. She has no history of serious illness and does not take any medication. She has been working in a law firm for the past 20 years and travels to the Carribean regularly with her husband. Examination of her skin shows no abnormal moles or warts. This woman is at greatest risk of which of the following types of melanoma?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 82
}
},
{
"id": "96eac29007e778a6",
"text": "A 60-year-old woman is brought to the clinic by her daughter for evaluation. The daughter reports that her mother has recently been having difficulty combing her hair in the mornings. The patient\u2019s family history is significant for an ischemic stroke in her father. The patient\u2019s past medical history is positive for diverticulosis. She takes no medication. Her blood pressure is 120/70 mm Hg, heart rate is 75/min, respiratory rate is 14/min, and temperature is 37.6\u00b0C (99.7\u00b0F). On physical examination, the patient\u2019s neck is stiff and she also has bilateral shoulder tenderness; muscle strength is intact. Laboratory work is performed and presented below:\nHemoglobin 12.9 g/dL\nHematocrit 37.7% \nLeukocyte count 5,500/mm3\nNeutrophils 65%\nLymphocytes 30%\nMonocytes 5%\nMean corpuscular volume 82.2 \u03bcm3\nPlatelet count 190,000/mm3\nErythrocyte sedimentation rate 65 mm/h\nC-reactive protein 44 mg/dL\nFor which of the symptoms below should the patient be screened?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 83
}
},
{
"id": "89156ac297ccc767",
"text": "A 30-year-old woman comes to the physician because she has been unable to conceive for 3 years. Analysis of her husband's semen has shown normal sperm counts during this time. The patient also reports episodic pelvic and back pain accompanied by painful diarrhea for 5 years. She has about one such episode on average per month for 4\u20136 days. She has taken ibuprofen for the pain, which has provided some relief. Menses have occurred at regular 29-day intervals since menarche at the age of 14 years and last for 7 days. She is sexually active with her husband and does not use contraception. Vital signs are within normal limits. Pelvic and bimanual examinations are normal; rectal examination is unremarkable. A hysterosalpingogram 6 months prior showed normal results. Which of the following is the most likely underlying mechanism of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 84
}
},
{
"id": "186c7ce22a4ad39c",
"text": "A 55-year-old truck driver is brought to a physician by his wife. She states that her husband developed a fever and began feeling weak 3 days ago, but has refused medical help. He has been unable to go to work because of his symptoms. The patient has been previously hospitalized for a tricuspid valve replacement surgery 1 year ago and takes aspirin daily. The medical history is also relevant for myocardial infarction 3 years ago and hypertension for the past 10 years, for which he takes lisinopril. His blood pressure is 140/80 mm Hg, the pulse is 82/min, the respirations are 18/minute, and the temperature is 37.2\u00b0C (98.9\u00b0F). On examination, several hemorrhages are noted on the nail beds of several fingers. Which of the following findings would be most helpful in establishing a diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 85
}
},
{
"id": "d89343672d13d119",
"text": "A previously healthy 30-year-old woman comes to the physician for the evaluation of pain during sexual intercourse for 6 months. She also reports frequent episodes of crampy pelvic pain that starts one day before menses and lasts for 7 days. Her symptoms are not relieved with pain medication. Menses occur at regular 28-day intervals and last 5 days. Her last menstrual period was 2 weeks ago. She is sexually active with her husband. She uses a combined oral contraceptive pill. Her vital signs are within normal limits. Physical examination shows rectovaginal tenderness. Cervical and urethral swabs are negative. Transvaginal ultrasonography shows no abnormalities. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 86
}
},
{
"id": "389f124981618d5f",
"text": "A 50-year-old man visits his physician after 20 years of not seeking any medical care. He is concerned about his health after a colleague recently had a heart attack. The patient has no active complaints and says he feels healthy; however, he does not exercise regularly and lives a sedentary lifestyle. He is employed as an administrative position at a local college, and is seated at a desk most of the day. His father had a heart attack at age 54 and his mother is still alive with no health concerns. He does not smoke, only drinks socially, and does not use drugs. Today, his blood pressure is 130/90 mm Hg, pulse is 84/min, and respiratory rate is 14/min. Physical examination reveals an obese male with no significant findings. An ECG shows no abnormalities, and laboratory testing shows the following:\nLaboratory test\nSerum glucose (fasting) 105 mg/dL\nSerum electrolytes \nSodium 142 mEq/L\nPotassium 3.9 mEq/L\nChloride 101 mEq/L\nSerum creatinine 0.8 mg/dl\nBlood urea nitrogen 10 mg/dl\nCholesterol, total 250 mg/dL\nHDL-cholesterol 35 mg/dL\nLDL-cholesterol 186 mg/dL\nTriglycerides 170 mg/dL\nUrinalysis \nGlucose negative\nKetones negative\nLeucocytes negative\nNitrites negative \nRed blood cells (RBC) negative \nCasts negative \nWhich of the following lab abnormalities in this patient is an indication for treatment?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 87
}
},
{
"id": "9af1e6ca27b88b63",
"text": "A 26-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision in which she was a restrained passenger. On arrival, she is lethargic and incoherent. She has severe facial lacerations and is in respiratory distress. Her pulse is 130/min, respirations are 29/min, and blood pressure is 90/58 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 70%. Examination shows multiple facial lacerations. There is dullness to percussion and decreased breath sounds over the left lung base. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are normal. The remainder of the examination shows no abnormalities. Her hemoglobin concentration is 12.1 g/dL. An x-ray of the chest shows a fractured left second rib, depression of the left mainstem bronchus, deviation of the nasogastric tube to the right, and a widened mediastinum. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 88
}
},
{
"id": "b17ac6a50da82c6f",
"text": "A 26-year-old G1P0 woman presents to her primary care physician\u2019s office with feelings of anxiety and trouble with sleep. She finds it difficult initiating sleep, occasionally has palpitations, and feels fatigued. She denies having similar symptoms in the past or starting any new medications or illicit drugs. She is currently 10 weeks pregnant and is closely followed by her obstetrician. Her temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 125/70 mmHg, pulse is 105/min, and respirations are 18/min. On physical exam, the patient is mildly diaphoretic. The skin is warm and the thyroid gland is diffusely enlarged with thyroid bruits. Laboratory studies are significant for a thyroid-stimulating hormone level of 0.01 \u00b5U/mL (normal is 0.5-5.0 \u00b5U/mL) and an elevated free thyroxine (FT4) that is inappropriate for her pregnancy. Which of the following is the best treatment option for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 89
}
},
{
"id": "affc0694bff87860",
"text": "A 32-year-old woman comes to the physician because of a 3-week history of intermittent loose stools and a 1.2-kg (2.6-lb) weight loss. She immigrated to the US from Uganda 6 weeks ago. Abdominal examination shows diffuse tenderness with no guarding or rebound. The liver is firm and palpable 3 cm below the right costal margin, and the spleen is palpable just below the left costal margin. Her leukocyte count is 12,800/mm3 (12% eosinophils). Stool culture shows several oval-shaped eggs with lateral spines. Microscopic examination of a liver biopsy specimen shows granulomatous inflammation with periportal fibrosis. Exposure to which of the following is most likely to have played a role in the development of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 90
}
},
{
"id": "7cd2b7cc0790c327",
"text": "A 3-month-old girl is brought to a pediatrician by her parents. She has central cyanosis without signs of respiratory distress or signs of heart failure. An echocardiogram reveals severe pulmonary outflow obstruction, right ventricular hypertrophy, a ventricular septal defect, and an overriding of the aorta. An elective primary surgical repair is planned at 4 months of age. Which of the following statements is true about this girl\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 91
}
},
{
"id": "3478c5c4f43a0d81",
"text": "Six days after undergoing surgical repair of a hip fracture, a previously healthy 79-year-old woman is agitated and confused. She is unarousable during the day, but then is awake and impulsive during the night, requiring frequent reorientation. Her husband says that she usually drinks one to two glasses of wine weekly. Her only current medication is oxycodone for pain. Her vital signs are within normal limits. She is distressed and oriented to person but not to place or time. Neurologic examination shows inattentiveness but no focal deficits. Urine dipstick is normal. Which of the following is the most likely cause of her current condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 92
}
},
{
"id": "37873530fa649533",
"text": "A 54-year-old woman with a past medical history of mental retardation, hypertension, and diabetes presents to the emergency department with a change in her behavior. Her caretakers state that the patient\u2019s gait suddenly became ataxic, and she became less responsive than her normal non-verbal baseline. Her temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 125/68 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for an unremarkable HEENT exam with normal facial features and no signs of airway compromise. Neurological exam is remarkable for new onset spasticity. The patient has 3+ reflexes and a positive Babinski sign. Musculoskeletal exam is only notable for symmetric swelling and deformities of the patient\u2019s hands bilaterally. Additionally, there is a \"clunk\" when posterior force is applied to the head while anterior force is applied to the cervical spine. Which of the following is the most likely risk factor that predisposed this patient to this condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 93
}
},
{
"id": "db8829f0d8e3ff61",
"text": "A 24-year-old man is brought to the emergency department 15 minutes after he sustained a stab wound to the left chest just below the clavicle. On arrival, he has rapid, shallow breathing and appears anxious. His pulse is 135/min, respirations are 30/min and shallow, and palpable systolic blood pressure is 80 mm Hg. He is intubated and mechanically ventilated. Infusion of 0.9% saline is begun. Five minutes later, his pulse is 133/min and blood pressure is 82/45 mm Hg. Examination shows no active external bleeding. There is a 2.5-cm single stab wound to the left chest at the 4th intercostal space at the midclavicular line. Cardiovascular examination shows muffled heart sounds and jugular venous distention. Breath sounds are normal. Further evaluation of this patient is most likely to show which of the following findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 94
}
},
{
"id": "7b16f651d084c8aa",
"text": "A 40-year-old man presents to his primary-care doctor for a follow-up of his hypertension. He is asymptomatic at his office visit and denies any new complaints. He has a 10-year history of hypertension that remains poorly controlled on maximum doses of lisinopril, hydrochlorothiazide, and amlodipine. His past medical history is otherwise unremarkable. He has no smoking history, drinks alcohol occasionally, and denies any illicit drug use. His father required a kidney transplant in his forties. The physical exam is notable for palpable flank masses bilaterally. Laboratory studies show a creatinine of 2.5. The physician orders a renal ultrasound, and the results are shown. Which of the following is the most appropriate test to screen for additional complications of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 95
}
},
{
"id": "9004c638b625f843",
"text": "A 17-year-old female is brought to the emergency room by her father because she has been experiencing shortness of breath and chest pain. She says that the chest pain is worse when she breathes or coughs. Furthermore, on the way to the hospital she noticed that there were specks of blood on a tissue that she coughed into. She has no previous medical history and does not recall anything that could have provoked these symptoms. On presentation her temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 107/65 mmHg, pulse is 102/min, respirations are 21/min, and O2 saturation is 91% on room air. Further testing shows a large filling defect in the pulmonary vessels, and the patient is started on an appropriate treatment intravenously. After drug administration, the effects of the drug are monitored using a standard blood test. Surprisingly, the test results come back within normal parameters. The most likely underlying cause of this patient's symptoms has which of the following modes of inheritance?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 96
}
},
{
"id": "b77674cf86728344",
"text": "A 26-year-old male presents to his primary care physician with complaints of burning with urination, penile discharge, and intermittent fevers. A urethral smear shows gram negative diplococci within white blood cells. The organism grows well when cultured on Thayer-Martin agar. The patient is prescribed a course of ceftriaxone and the infection resolves without further complication. One year later, the patient returns with the same infection. Which of the following best explains this lack of lasting immunity?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 97
}
},
{
"id": "112dccc59c7d646a",
"text": "A 37-year-old man with no significant past medical history is rear-ended in a motor vehicle accident. He reported significant neck pain to emergency responders, but otherwise denies weakness, numbness or tingling in his extremities. His vitals on presentation to the ED are HR 90, BP 140/80, RR 20, SpO2 98%. What is the most appropriate next step upon presentation to the emergency room?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 98
}
},
{
"id": "110fb0a9c42d9676",
"text": "A 43-year-old man with a history of schizophrenia, currently controlled with medication, comes in for an appointment with his internist. He is concerned about abnormal discharge from both nipples over the past 3 months. The fluid is white, and he wonders if it could be milk. On further review of systems, he endorses a diminished sexual drive. The physician suspects that one of the patient's medications may be the culprit for these symptoms. Which of the following medications is NOT likely to be the cause?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 99
}
},
{
"id": "56f9f59e5d2bda9d",
"text": "A 2-day-old male newborn is brought to the physician because of yellowing of the skin and sclerae for 16 hours. He had previously been well. He was born at 38 weeks' gestation via uncomplicated vaginal delivery and weighed 3.1 kg (6 lb 13 oz). The mother has no medical insurance and did not receive prenatal care. The newborn's 4-year-old brother has sickle cell disease. Examination shows jaundice. The abdomen is mildly distended. The liver is palpated 1 cm below the right costal margin and the spleen tip is palpated just below the left costal margin. Laboratory studies show:\nHemoglobin 11 g/dL\nReticulocytes 9%\nLeukocytes 9,100/mm3\nPlatelets 244,000/mm3\nMaternal blood group 0, Rh-negative\nAnti-Rh antibody titer positive\nFetal blood group B, Rh-negative\nSerum\nBilirubin, total 11.3 mg/dL\nDirect 0.3 mg/dL\nWhich of the following is the most likely cause of this patient's condition?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 100
}
},
{
"id": "35bbf5dce61a5767",
"text": "A 65-year old man presents with gradually worsening rigidity of his arms and legs and slowness in performing tasks. He says he has also noticed hand tremors, which increase at rest and decrease with focused movements. On examination, the patient does not swing his arms while walking and has a shortened, shuffling gait. An antiviral drug is prescribed which alleviates the patient\u2019s symptoms. Which of the following drugs was most likely prescribed to this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 101
}
},
{
"id": "2b28ce93d74e62d6",
"text": "The patient is given prophylactic labetalol and magnesium sulfate. Examination shows absent deep tendon reflexes bilaterally. Which of the following is the most appropriate next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 102
}
},
{
"id": "2fcd86455d60ab83",
"text": "A 75-year-old woman is brought by a patrolman to the emergency department because of altered mental status. She was found wandering next to the highway. The patient was unable to answer questions and collapsed in transit. Her vitals are: temperature, 33.0\u00b0C (91.4\u00b0F); pulse, 40/min; respirations,12/min; blood pressure, 80/50 mm Hg; and oxygen saturation, 85% on room air. Physical examination shows decorticate posturing, incomprehensible speech, eyes opening to pain, dry hair, coarse and waxy skin, and non-pitting edema around the face and all extremities. Electrocardiogram shows sinus bradycardia. Laboratory studies show:\nCalcium 9.0 mg/dL\nHematocrit (female) 34%\nPotassium 4.0 mEq/L\nSodium 120 mEq/L\nTSH 110.0 \u00b5U/mL\nThyroxine (T4) 1.2 \u00b5g/dL\nTriiodothyronine (T3) 70 ng/dL\nWhich of the following is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 103
}
},
{
"id": "9975aae6558d0b96",
"text": "A 66-year-old male presents to his primary care physician to discuss his increasing shortness of breathover the last 3 months. He notes that this is particularly obvious when he is mowing his lawn or climbing the stairs in his home. His past medical history is significant for hypertension that is well-controlled with lisinopril. His vital signs are as follows: T 37.6 C, HR 88, BP 136/58, RR 18, SpO2 97% RA. Physical examination is significant for an early diastolic blowing, decrescendo murmur heard best at the left sternal border, a midsystolic murmur heard best at the right upper sternal border, and a late diastolic rumbling murmur heard best at the apex on auscultation. In addition, an S3 heart sound is also present. Bounding pulses are palpated at the radial arteries bilaterally. Which of the following diagnoses is most likely in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 104
}
},
{
"id": "d64de9f01b654d0e",
"text": "A 28-year-old woman presents following a suicide attempt 2 days ago. She says that her attempt was a result of a fight with her boyfriend and that she slit her wrists in an attempt to keep him from breaking up with her. In the past, she has had many turbulent relationships, both romantic and in her family life. Her family members describe her as being very impulsive and frequently acting to manipulate people\u2019s feelings. Since she was admitted to the hospital, she has spit at several staff members and alternated between sobbing and anger. She has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. Which of the following is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 105
}
},
{
"id": "47adb655b4773476",
"text": "A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Preoperative workup included chest radiography which demonstrated an opacification in his right middle lobe. The patient agrees to undergo computed tomography (CT) of his chest without contrast for further evaluation. The radiologist reports an 8 mm nodule in the patient's peripheral right middle lobe that has regular margins and appears calcified. One year later, the patient obtains another chest CT without contrast that reports the nodule size as 10 mm with similar characteristics. What is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 106
}
},
{
"id": "0d4cc6a4b66fd04c",
"text": "A 29-year-old man comes in for evaluation of infertility. He has been trying to conceive for over 2 years with his wife and previous evaluation of his wife's fertility revealed no abnormalities. Physical exam reveals a tall man with long extremities, sparse body hair, gynecomastia, and small testes. Laboratory studies reveal increased serum follicle-stimulating hormone concentration and an increased estradiol:testosterone ratio. Genetic studies reveal a cytogenetic abnormality. If this abnormality was inherited from the patient's father, at which stage of spermatogenesis did this error most likely occur?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 107
}
},
{
"id": "f8171f4d427f81c1",
"text": "A 13-year-old boy presents to the emergency department with severe knee, hip, and groin pain. The patient has a past medical history notable only for obesity and asthma. His temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 124/65 mmHg, pulse is 128/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for an inability of the patient to bear weight on his left leg and limited range of motion of the left hip. Which of the following is the best management for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 108
}
},
{
"id": "d8b8278b102ec831",
"text": "A 28-year-old man comes to the physician because of diarrhea and crampy abdominal pain for 5 weeks. He has had up to 4 bowel movements per day. Several times he noticed mucoid strings with the stool. He has abdominal bloating. Over the past month, has had a 3.2-kg (7-lb) weight loss. He has not had fever, cough, or bloody stools. He had a painful rash on his lower extremity 3 weeks ago that resolved spontaneously. He works as a pharmacy technician. His temperature is 37.3\u00b0C (98.8\u00b0F), pulse is 85/min, and blood pressure is 115/77 mm Hg. The abdomen is soft and nontender. His hemoglobin concentration is 11.9 g/dL, MCV is 79 fL, ferritin is 106 ng/dL, and platelet count is 410,000/mm3; serum concentrations of glucose, creatinine, and electrolytes are within the reference range. This patient's condition is most likely associated with which of the following findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 109
}
},
{
"id": "15c8d2eea2acbc37",
"text": "A 51-year-old man is brought to the emergency department because of a 2-day history of fever, abdominal pain, and confusion. His wife states that he has been unable to recall his birthday or her name. He was diagnosed with hepatitis C 3 years ago but refused treatment. He has been treated twice in the past year for acute pancreatitis. There is no family history of serious illness. His only medication is a calcium supplement. He emigrated from India 15 years ago. He appears ill. His temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 101/min, and blood pressure is 104/68 mm Hg. He is confused and oriented only to person. Examination shows scleral icterus and spider angiomas. There are fine tremors of the hands bilaterally. The abdomen is distended and shifting dullness is present. There is diffuse tenderness to palpation with no guarding. Bowel sounds are absent. Laboratory studies show:\nHemoglobin 12.6 g/dL\nLeukocyte count 13,900/mm3\nPlatelet count 342,000/mm3\nSerum\nAlbumin 2.6 g/dL\nTotal bilirubin 2.56 mg/dL\nAlkaline phosphatase 54 U/L\nAST 17 U/L\nALT 44 U/L\nParacentesis is performed. Ascitic fluid analysis shows an albumin concentration of 0.8 g/dL, glucose concentration of 62 mg/dL, and a leukocyte count of 1900/mm3 with 60% neutrophils. Which of the following is the most likely explanation for these findings?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 110
}
},
{
"id": "ad1d1aa5122c3058",
"text": "An 18-month-old girl is brought to the emergency department because of a cough that her parents are worried about. She has had a runny nose and a low-grade fever for the past 2 days, with some hoarseness and a rough-sounding cough that started this afternoon. This evening she began making some high-pitched sounds when taking breaths, and she seemed to be having some trouble breathing. She is alert and does not appear to be in acute distress. She has a temperature of 38.0\u00b0C (100.4 \u00b0F), with a respiratory rate of 50/min and O2 saturation of 97%. There is audible inspiratory stridor that worsens when she starts to cry during the examination. She has an occasional barking cough. Her pharynx is mildly erythematous with normal tonsils and no exudate. A frontal X-ray of the upper chest airways is obtained (shown in the image). Which of the following is the best step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 111
}
},
{
"id": "9c04d2557a4e49b7",
"text": "A 43-year-old woman presents with complaints of retrosternal burning associated with eating. It has persisted for the past several years but has been getting worse. Her past medical history is unknown and this is her first time seeing a doctor. She states she is otherwise healthy and review of systems is notable for episodic hand pain that is worse in the winter as well as a chronic and severe cough with dyspnea which she attributes to her smoking. Her temperature is 97.7\u00b0F (36.5\u00b0C), blood pressure is 174/104 mmHg, pulse is 80/min, respirations are 22/min, and oxygen saturation is 92% on room air. Physical exam is notable for a young appearing woman with coarse breath sounds. Laboratory studies and urinalysis are ordered and currently pending. Which of the following is the pathophysiology of this patient's chief complaint?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 112
}
},
{
"id": "bb83713ba05cfb9b",
"text": "A 67-year-old man with chronic kidney disease comes to the physician because of worsening fatigue and shortness of breath on exertion for 6 months. He has a 20-year history of poorly-controlled type 2 diabetes mellitus. Current medications include metformin and insulin. His pulse is 105/min. Examination shows conjunctival pallor and bounding pulses. Laboratory studies show:\nHemoglobin 8.6 g/dL\nMean corpuscular volume 90 \u03bcm3\nReticulocyte count 0.5%\nSerum\nFerritin 325 ng/mL\nUrea nitrogen 45 mg/dL\nCreatinine 2.2 mg/dL\nThe patient is prescribed a drug to treat the cause of his current symptoms. The drug's mechanism of action directly involves which of the following signaling pathways?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 113
}
},
{
"id": "f9e92174d59b5f75",
"text": "A 41-year-old man presents to the emergency department with a 6-hour history of muscle cramping, decreased appetite, and diarrhea. He says that these symptoms came on rapidly but does not recall anything that may have triggered the episode. He has never experienced these symptoms before. His past medical history is significant for obesity, sleep apnea, and type 2 diabetes that is well controlled on metformin. He also has gastroesophageal reflux disease for which he occasionally takes antacids. On presentation he is found to have fast, shallow breathing and abdominal pain that is poorly localized. Basic labs as well as an arterial blood gas are obtained and the results are shown below:\n\nNa+: 139 mEq/L\nCl-: 106 mEq/L\nHCO3-: 11 mEq/L\npH: 7.25\npCO2: 22 mmHg\n\nWhich of the following is the most likely cause of the changes seen in this patient's labs?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 114
}
},
{
"id": "6551f83412167e8d",
"text": "A scientist is studying the properties of myosin-actin interactions in a sample of human muscle tissue. She has identified a drug that selectively inhibits phosphate release by the myosin head. If she gives this drug to a sample of human muscle tissue under physiologic conditions, which of the following steps in cross-bridge cycling will most likely be blocked?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 115
}
},
{
"id": "bf7e60e718035cf1",
"text": "A 16-year-old boy with a seizure disorder and cognitive delay is brought to the physician because of progressively worsening right lower extremity weakness for the past 6 months. He does not make eye contact and sits very close to his mother. Physical examination shows a grade 3/6 holosystolic murmur at the cardiac apex. Neurological examination shows decreased strength in the right lower leg with normal strength in the other extremities. Fundoscopic examination shows several multinodular, calcified lesions in the retina bilaterally. A photograph of his skin findings is shown. This patient's condition is most likely due to a mutation in which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 116
}
},
{
"id": "cee5bdaf4a6000aa",
"text": "A 66-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. He endorses diffuse abdominal tenderness. His past medical history is notable for diabetic nephropathy, hypertension, dyslipidemia, depression, and morbid obesity. He also is currently being treated for an outbreak of genital herpes. His temperature is 99.0\u00b0F (37.2\u00b0C), blood pressure is 184/102 mmHg, pulse is 89/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no acute distress. A CT scan of the abdomen with contrast is performed and is unremarkable. The patient is admitted to the observation unit for monitoring of his pain. Notably, the patient's abdominal pain improves after an enema and multiple bowel movements. The patient's evening laboratory values are ordered and return as seen below.\n\nSerum:\nNa+: 141 mEq/L\nCl-: 99 mEq/L\nK+: 4.8 mEq/L\nHCO3-: 11 mEq/L\nBUN: 20 mg/dL\nGlucose: 177 mg/dL\nCreatinine: 3.1 mg/dL\n\nWhich of the following is the most likely etiology of this patient's laboratory derangements?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 117
}
},
{
"id": "74936a6ac64b666b",
"text": "A 56-year-old man comes to the clinic for a check-up. He presents with a 1-year history of worsening shortness of breath and weight loss. He is a former construction worker, and worked in a steel mill when he was in high school. He is an active smoker with a 36-pack-year smoking history. The blood pressure is 130/78 mm Hg, pulse rate is 90/min, respiratory rate is 17/min, and the BMI is 31 kg/m2. The patient is afebrile and the oxygen saturation at rest is 95% on room air. The pulmonary examination reveals a mildly prolonged expiratory phase, and no wheezing or crackles are auscultated. A pulmonary function test is recommended for the patient, and 2 weeks later he returns with a report that shows an FEV1/FVC ratio of 60% and FEV1 of 50% of the predicted value. The lung volumes show a total lung capacity of 110% of predicted value, a residual volume of 115% of predicted value, and a DLCO of 60% of predicted value. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 118
}
},
{
"id": "ed870cd5d8b37f79",
"text": "A 25-year-old zookeeper presents to the office complaining of a dry cough, fever, and chills for the past month. He states that the symptoms come in episodes at the end of the workday and last a few hours. He also mentions that he is fatigued all the time. His job includes taking care of various types of birds. He is otherwise fine and denies recent travel or trauma. Medical history is unremarkable and he does not take any medications. He does not smoke cigarettes or drinks alcohol. Allergies include peanuts, dust, and pollen. Childhood asthma runs in the family. Chest X-ray reveals diffuse haziness in both lower lung fields. A PPD skin test is negative. What is the most appropriate treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 119
}
},
{
"id": "c7e1e4f4e6179b2c",
"text": "A 60-year-old female presents to her gynecologist with vaginal bleeding. She underwent menopause ten years prior. She has a past medical history of hypertension and diabetes mellitus. On physical examination, her uterus is uniformly enlarged. Ultrasound reveals a thickened endometrial stripe and tissue biopsy reveals neoplastic endometrial cells. A workup for metastatic disease is negative and the gynecologist recommends a laparoscopic hysterectomy. During the procedure, the surgeon ligates multiple vessels in order to remove the entire uterus. In the immediate postoperative period, the patient develops left-sided flank pain and oliguria. Serum creatinine is found to be 1.4 mg/dl whereas it was 1.0 mg/dl prior to the operation. Renal ultrasound is normal. Urinalysis is notable for hematuria. Ligation of which of the following vessels most likely contributed to this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 120
}
},
{
"id": "bc331625e40f9301",
"text": "A 40-year-old man presents to the physician with progressive weight loss for the last 3 months. He also says he frequently sweats profusely at night and has a recurring low-grade fever, for which he takes acetaminophen. The patient denies any symptoms like cough, breathlessness, or gastrointestinal symptoms. His temperature is 37.1\u00baC (98.8\u00baF), pulse is 76/min, blood pressure is 116/78 mm Hg, and respiratory rate is 13/min. On physical examination, he has generalized pallor. Bilateral cervical lymphadenopathy is present. Examination of his abdomen reveals non-tender hepatosplenomegaly in the right upper quadrant. Laboratory evaluation confirms the diagnosis of Hodgkin\u2019s lymphoma. Which of the following viral infections is most likely to have played a role in the pathogenesis of this patient\u2019s malignancy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 121
}
},
{
"id": "a97c0b8a7fd7b377",
"text": "A 28-year-old gravida 1 at 32 weeks gestation is evaluated for an abnormal ultrasound that showed fetal microcephaly. Early in the 1st trimester, she had fevers and headaches for 1 week. She also experienced myalgias, arthralgias, and a pruritic maculopapular rash. The symptoms resolved without any medications. A week prior to her symptoms, she had traveled to Brazil where she spent most of the evenings hiking. She did not use any mosquito repellents. There is no personal or family history of chronic or congenital diseases. Medications include iron supplementation and a multivitamin. She received all of the recommended childhood vaccinations. She does not drink alcohol or smoke cigarettes. The IgM and IgG titers for toxoplasmosis were negative. Which of the following is the most likely etiologic agent?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 122
}
},
{
"id": "117bd132e79c12dd",
"text": "A 41-year-old G3P1 woman presents with a sudden onset throbbing headache, tinnitus, nausea, and left-sided weakness. Patient has no significant past medical history and takes no medications. Her last two pregnancies ended with spontaneous abortions before the 10th week of gestation. No significant family history. Her vital signs include: blood pressure 130/90 mm Hg, pulse 58/min, respiratory rate 11/min, and temperature 36.8\u2103 (98.2\u2109). GCS is 14/15. Physical examination shows 3+ deep tendon reflexes and increased muscle tone in the left upper and lower extremities. Laboratory findings are significant for the following:\nPlatelet count 230,000/mm3\nFibrinogen 3.5 g/L\nActivated partial thromboplastin time 70 s\nThrombin time 34 s\n A non-contrast CT of the head is performed and shown in the picture. Which of the following would be the next best diagnostic step in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 123
}
},
{
"id": "670b0251ec2f4e22",
"text": "A obstetrician is working in a developing country to help promote maternal health and fetal well being. While there, he delivers a baby who he suspects has congenital hypothyroidism, most likely caused by inadequate maternal iodine intake. Which of the following signs and symptoms would NOT be expected to be observed in this child?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 124
}
},
{
"id": "174944366abd16bf",
"text": "A 33-year-old nurse is referred to an infectious disease specialist after she exhibited a PPD skin test with 17 mm of induration. She denies any cough, shortness of breath, hemoptysis, weight loss, fatigue, fevers, or night sweats over the last several months. Her temperature is 97.0\u00b0F (36.1\u00b0C), blood pressure is 120/81 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air. An initial chest radiograph is unremarkable. Which of the following is the most appropriate management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 125
}
},
{
"id": "423a4d99bcab9376",
"text": "An 81-year-old woman is brought to the emergency room by her son after witnessing the patient fall and hit her head. The son reports that the patient was in her usual state of health until she complained of chest palpitations. This startled her while she was climbing down the stairs and lead to a fall. Past medical history is significant for hypertension and atrial fibrillation. Medications are lisinopril, metoprolol, and warfarin. Temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 152/96 mmHg, pulse is 60/min, respirations are 12/min, and pulse oximetry is 98% on room air. On physical examination, she is disoriented and at times difficult to arouse, the left pupil is 6 mm and non-reactive to light, and the right pupil is 2 mm and reactive to light. A right-sided visual field defect is appreciated on visual field testing. There is 1/5 strength on the right upper and lower extremity; as well as 5/5 strength in the left upper and lower extremity. A computerized tomography (CT) scan of the head is shown. Which of the following most likely explains this patient\u2019s symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 126
}
},
{
"id": "d9ae0fdf7ab9c1d6",
"text": "A 67-year-old man with peripheral neuropathy comes to the physician for a follow-up examination after the results of serum protein electrophoresis showed monoclonal gammopathy. A complete blood count, serum creatinine, and serum electrolyte concentrations are within the reference ranges. A bone marrow biopsy shows 6% monoclonal plasma cells. Further analysis shows that class I major histocompatibility molecules are downregulated in these monoclonal plasma cells. The proliferation of these monoclonal plasma cells is normally prevented by a class of immune cells that lyse abnormal cells without the need for opsonization, priming, or prior activation. Which of the following best describes this class of immune cells?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 127
}
},
{
"id": "f38c8250d6969a58",
"text": "A 47-year-old woman comes to the physician because of progressive muscle weakness for five months. She feels that the muscles in her shoulders and hips have been getting weaker and sometimes feel sore. She now has difficulty getting up from chairs, climbing stairs, and combing her hair. She has also noticed new difficulty with swallowing solid foods, but has no trouble with liquids. She has a 5-year history of hyperlipidemia controlled with fluvastatin. Her maternal uncle died at age 26 from Duchenne's muscular dystrophy and her mother has Hashimoto's thyroiditis. Vital signs are within normal limits. Neurologic examination shows moderate weakness in the arm abductors and hip flexors bilaterally. Deep tendon reflexes are 2+ bilaterally. Laboratory studies show:\nHemoglobin 13.7 g/dL\nLeukocytes 11,200/mm3\nErythrocyte sedimentation rate 33 mm/h\nSerum\nCreatine kinase 212 U/L\nLactate dehydrogenase 164 U/L\nAST 34 U/L\nALT 35 U/L\nWhich of the following is most likely to confirm the diagnosis?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 128
}
},
{
"id": "6102a9584b69718b",
"text": "A 41-year-old man presents to the emergency room with sudden onset of blurry vision one hour ago. He states that he was resting at home when he noticed he had difficulty reading. Currently, he is also starting to see double, and is seeing two images on top of each other. Earlier today, he felt ill with nausea, vomiting, and watery diarrhea, which he attributed to food he had eaten at a picnic the day before. When asked which foods he ate, he lists potato salad, a hamburger, deviled eggs, and pickles made by his neighbor. He also heard that his friend who went to the picnic with him has developed similar symptoms and was seen in another hospital earlier. While in the emergency room, the patient\u2019s temperature is 98.4\u00b0F (36.9\u00b0C), pulse is 75/min, blood pressure is 122/84 mmHg, and respirations are 13/min. Cranial nerve exam is notable for fixed pupillary dilation, and difficulty depressing both eyes. The remainder of his exam is normal. Which of the following is the pathogenesis of this patient\u2019s presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 129
}
},
{
"id": "9a1b874aa175b3bb",
"text": "A 4-week-old female newborn is brought to the physician because of increasing yellowing of her eyes and skin for 2 weeks. The mother has noticed that the girl's stools have become pale over the past week. She was breastfed since birth but her parents switched her to formula feeds recently after reading on the internet that breastfeeding could be the cause of her current symptoms. The patient was delivered vaginally at 38 weeks' gestation. Pregnancy and delivery were uncomplicated. She appears healthy. Vital signs are within normal limits. She is at the 50th percentile for length and at the 60th percentile for weight. Examination shows scleral icterus and jaundice. The liver is palpated 2 cm below the right costal margin. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Serum studies show:\nBilirubin\nTotal 15 mg/dL\nDirect 12.3 mg/dL\nAlkaline phosphatase 2007 U/L\nAST 53 U/L\nALT 45 U/L\n\u03b3-glutamyl transferase 154 U/L\nBlood group A positive\nWhich of the following is the most likely diagnosis?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 130
}
},
{
"id": "513406501503eb51",
"text": "A 43-year-old man comes to the emergency department with nausea, abdominal discomfort, diarrhea, and progressive perioral numbness for the past 24 hours. 3 days ago, he underwent a total thyroidectomy for treatment of papillary thyroid cancer. His only medication is a multivitamin supplement. He appears fatigued. While measuring the patient's blood pressure, the nurse observes a spasm in the patient's hand. Physical examination shows a well-healing surgical wound on the neck. Which of the following ECG findings are most likely in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 131
}
},
{
"id": "bafe2e45d7c683e9",
"text": "A 68-year-old woman presents with left lower quadrant pain that worsens with defecation. She describes the pain as 'crampy'. She also says she has suffered from mild constipation for the past few years. The patient denies any recent weight change or urinary symptoms. Her last menstrual period was 16 years ago. Her body temperature is 37.8\u00b0C (100.0\u00b0F), pulse is 102/min, respiratory rate is 16/min, and blood pressure is 133/87 mm Hg. On physical examination, tenderness to palpation in the left lower quadrant is present. The laboratory studies are presented as follows:\nHemoglobin 13.2 mg/dL\nHematocrit 48%\nLeukocyte count 16,000/mm\u00b3\nNeutrophils 89%\nBands 5%\nEosinophils 0%\nBasophils 0%\nLymphocytes 11%\nMonocytes 0%\nPlatelet count 380,000/mm\u00b3\nWhich of the following is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 132
}
},
{
"id": "b00552feed865320",
"text": "A 67-year-old man presents to his primary care physician for erectile dysfunction. He states that for the past month he has been unable to engage in sexual intercourse with his wife despite having appropriate sexual desire. He also endorses deep and burning buttock and hip pain when walking, which is relieved by rest. The patient states that he does not have erections at night or in the morning. His past medical history is notable for diabetes, coronary artery disease, and hypertension, and he has a 40 pack-year smoking history. Physical exam is notable for weak lower extremity and femoral pulses. Which of the following is the most specific etiology of this patient\u2019s symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 133
}
},
{
"id": "1e20c0ab40d86619",
"text": "A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. Which of the following laboratory findings would you most expect upon analysis of this patient's serum?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 134
}
},
{
"id": "1c160590b972231f",
"text": "A medical researcher is studying the physiology of the immune system in order to better understand the effects of HIV on patients. He isolates a group of cells that are shown by flow cytometry to be positive for the cell surface marker CD8. He then mixes this cell population with a group of infected cells, crosslinks extracellular interactions, and immunoprecipitates the CD8 protein. He identifies a protein bound to CD8 that is composed of two chains from an adjacent cell. Which of the following best describes the primary function of the protein that was most likely identified?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 135
}
},
{
"id": "0fd8b692e0b2e1c2",
"text": "A 61-year-old Caucasian male presents to your office with chest pain. He states that he is worried about his heart, as his father died at age 62 from a heart attack. He reports that his chest pain worsens with large meals and spicy foods and improves with calcium carbonate. He denies dyspnea on exertion and an ECG is normal. What is the most likely cause of this patient's pain?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 136
}
},
{
"id": "f7ef5e9d0e2f3649",
"text": "A 36-year-old woman comes to the clinic because of tearing and a foreign body sensation in her eyes bilaterally, which has gradually worsened over the last several weeks. She also notes having occasional palpitations, nervousness, sweating, and heat intolerance. Her past medical history is unremarkable. She reports a 20-pack-year smoking history and is currently a daily smoker. Physical examination shows an anxious, trembling woman. She has eyelid retraction bilaterally, with an inability to fully close her eyes. Her extraocular motility is limited on upgaze. There is no thyromegaly, and no thyroid nodules are noted. Laboratory studies reveal a thyroid-stimulating hormone level of 0.1 \u03bcU/mL and total T4 of 42 \u03bcg/dL. Thyroid-stimulating immunoglobulin is positive. CT scan of the orbits shows proptosis and marked enlargement of the extraocular muscle with sparing of the tendons. Which of the following would most likely transiently worsen this patient\u2019s eye symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 137
}
},
{
"id": "a790289520b9cbac",
"text": "A 7-year-old boy is brought to a pediatrician by his parents for evaluation of frequent bed wetting during the night. A detailed history reveals that there has been no history of urinary incontinence during the day since the boy was 4 years of age, but that he has never been dry at night continuously for 1 week. There is no history of urinary tract infections, urgency, frequency, or hesitancy. On physical examination, the boy\u2019s vital signs are stable. His neurologic and abdominal examinations are completely normal. His laboratory investigations are as follows:\nUrine-specific gravity (first-morning sample) 1.035\nUrine red blood cells Absent\nUrine pus cells Absent\nUrine culture Negative\nWhich of the following is the next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 138
}
},
{
"id": "8fc36b5a0c2d5fd7",
"text": "A 52-year-old man with a history of gastric cancer that was treated with subtotal gastrectomy dies in a motor vehicle collision. At autopsy, examination of the spinal cord shows unilateral atrophy of the neurons in the area indicated by the arrow. Neurological examination of the patient when he was still alive would most likely have shown which of the following findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 139
}
},
{
"id": "6b56b620b817a665",
"text": "A 24-year-old pregnant woman at 28 weeks gestation presents to the emergency department with complaints of fever with chills and pain in her knee and ankle joints for the past 2 days. She also complains of headaches and difficulty moving her neck. Further questioning reveals that she had a tick bite on her arm while gardening a few days ago. Past medical history is noncontributory. She takes a multivitamin with iron and folate every day and has been receiving regular prenatal care and the pregnancy is progressing normally. On examination, an erythematous rash is seen on her right arm, as shown in the accompanying photograph. Her obstetric examination is normal. Ultrasound of the fetus is reassuring with a normal heartbeat and no gross abnormalities. A specimen is collected to test for Lyme disease. What is the next best step for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 140
}
},
{
"id": "085ff2ae16bb7fcc",
"text": "A 25-year-old woman presents to her physician with a four month history of fatigue and weakness. The weakness has been progressive to the point where she cannot climb stairs and stand from a sitting position. She has only had one menstrual period in the last four months and has never been pregnant. She smokes a pack of cigarettes every day and does not take any medications. Her temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 160/100 mmHg, pulse is 70/min, and respirations are 15/min. She is obese with a significant pannus. Abdominal striae are present. Her laboratory workup is notable for the following:\n\nSerum:\nNa+: 142 mEq/L\nCl-: 102 mEq/L\nK+: 3.9 mEq/L\nHCO3-: 25 mEq/L\nBUN: 20 mg/dL\nGlucose: 314 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.1 mg/dL\nAST: 9 U/L\nALT: 8 U/L\n24-hour urinary cortisol: 470 \u00b5g (< 300 \u00b5g)\nSerum cortisol 30 \u00b5g/mL (5-23 \u00b5g/dL)\nSerum adrenocorticotropin-releasing hormone (ACTH) 2 pg/mL (> 5 pg/mL)\n\nA 48-hour high dose dexamethasone suppression trial shows that her serum cortisol levels do not decrease. What is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 141
}
},
{
"id": "a26a50f78d63e701",
"text": "A 67-year-woman with non-Hodgkin lymphoma comes to the physician because of progressively increasing numbness and tingling in her fingers and toes. Her last cycle of chemotherapy with vincristine was 1 week ago. Physical examination shows decreased sensation to light touch in all distal extremities. Knee and ankle deep tendon reflexes are decreased. Which of the following is the most likely underlying mechanism of this patient\u2019s peripheral neuropathy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 142
}
},
{
"id": "bbaba5751124b32e",
"text": "A 68-year-old man comes to the physician with a 1-week history of painless hematuria. A CT scan of the urinary tract shows areas of bladder wall thickening. Cystoscopy shows several sessile masses with central necrosis arising from the bladder wall. A biopsy specimen of the bladder masses shows moderately differentiated urothelial cells with abundant mitotic figures and nuclear atypia. The patient most likely has a history of exposure to which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 143
}
},
{
"id": "61f5e42fa218f47d",
"text": "A 14-year-old girl comes to the physician with her father for evaluation of her short stature. She feels well overall, but is concerned because all of her friends are taller than her. Her birth weight was normal. Her father reports he had a short stature during his teenage years; he is currently 177 cm (5 ft 10 in) tall. She is at the 2ndpercentile for height and 35th percentile for weight. Breast development is Tanner stage 2. Pubic and axillary hair is absent. An x-ray of the left hand and wrist shows a bone age of 11 years. Which of the following is the most appropriate next best step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 144
}
},
{
"id": "c67da3808fe74df7",
"text": "A 5-year-old boy is brought to the physician because of facial swelling that started 5 days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 107/min, and blood pressure is 94/67 mm Hg. Examination shows pitting edema of the upper and lower extremities as well as periorbital edema. The abdomen is mildly distended. Laboratory studies show:\nHemoglobin 13.1 g/dL\nSerum\nAlbumin 2.1 g/dL\nTotal cholesterol 270 mg/dL\nTriglycerides 175 mg/dL\nUrine\nBlood negative\nGlucose negative\nProtein 4+\nLeukocyte esterase negative\nA renal biopsy of this patient is most likely to show which of the following findings?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 145
}
},
{
"id": "58ab73c04c89c7e9",
"text": "A 60-year-old man is referred to a dermatologist by his family physician for management of a rare case of dermatitis that has not responded to standard therapy with corticosteroids. The patient\u2019s medical history is unremarkable, and he is currently working reduced hours at his job as an accountant. Physical examination reveals confluent scaly patches, plaques, and generalized erythroderma along the torso and lower extremities (see image). There is also a solid skin lesion with a diameter greater than 1 cm. The dermatologist suspects a malignancy and orders a biopsy. Which of the following is the most accurate description of this condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 146
}
},
{
"id": "5dfee593a6383ec8",
"text": "A 35-year-old woman comes to the physician because she has been feeling very stressed over the past several months. During this period, she has found it difficult to relax. She states that her head is full of worries. She works at an accountant's office and reports difficulty in concentrating on her work. She has been working longer shifts because one of her coworkers is on vacation and reports feeling more tired than usual. She is married and frequently fights with her husband. The patient states that in order to deal with her stress, she goes shopping. While shopping, she steals small trivial items and feels immediately relieved thereafter. She discards the objects she steals and has feelings of shame and guilt about her actions. Her husband is concerned about her behavior, but she is unable to stop shoplifting. Her vital signs are within normal limits. On mental status examination, she is oriented to person, place, and time. She reports feeling anxious. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 147
}
},
{
"id": "5fd189f5dd7379f6",
"text": "A 65-year-old man presents to his primary care physician for a change in his behavior over the past few months. Initially, the patient was noted to be behaving inappropriately including using foul language and grabbing people unexpectedly. This has progressed to a worsening of his memory and trouble caring for himself. His temperature is 98.1\u00b0F (36.7\u00b0C), blood pressure is 162/103 mmHg, pulse is 83/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for an elderly man who laughs inappropriately at times and who is a poor historian. When he is engaged in conversation, he exhibits word finding difficulty and is rather inattentive. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 148
}
},
{
"id": "ebab5dbfc813fc03",
"text": "An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8\u00b0C (100.0\u00b0F), pulse is 98/min, and respiratory rate is 16/min. The rash features thin-walled, fluid-filled blisters that rupture easily. Fluid samples from the lesions are sent for analysis to a microbiology lab. The results reveal an infection by the gram-positive bacterium Staphylococcus aureus. The patient is diagnosed with staphylococcal scalded skin syndrome. Which of the following is involved with the primary defense in response to the bacteria and toxins produced by this organism?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 149
}
},
{
"id": "12546d9762f8ae14",
"text": "A 52-year-old man is brought to the emergency department with dry cough, shortness of breath, and low-grade fever that began 6 days ago. He also reports that he has had 3 episodes of watery diarrhea per day for the last 2 days. He appears slightly pale. His temperature is 38.0\u00b0C (100.4\u00b0F), pulse is 65/min, respirations are 15/min, and blood pressure is 140/78 mm Hg. Diffuse crackles are heard over bibasilar lung fields. Laboratory studies show:\nHemoglobin 13.8 g/dL\nLeukocyte count 16,000/mm3\nPlatelet count 150,000/mm3\nSerum\nNa+ 131 mEq/L\nCl-\n102 mEq/L\nK+ 4.7 mEq/L\nHCO3- 26 mEq/L\nUrea nitrogen 18 mg/dL\nCreatinine 1.2 mg/dL\nAn x-ray of the chest shows patchy infiltrates in both lungs. Which of the following is the most appropriate pharmacotherapy?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 150
}
},
{
"id": "f0641eb64ebb76ad",
"text": "A transvaginal ultrasound shows an intrauterine heteroechoic mass with numerous anechoic spaces and no identifiable fetus or amniotic fluid. Both the ovaries are enlarged and have multiple thin-walled, septated cysts with clear content. Which of the following is the most likely cause of the ovarian findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 151
}
},
{
"id": "faca95ed83c4e050",
"text": "A 75-year-old woman is brought to the emergency department by her son because of a 2-day history of fever, headache, malaise, and dry cough. The patient lives with her son and his family and her son reports that other members of the family have had similar symptoms during the past week but that he has not had any symptoms. The result of a polymerase chain reaction test confirms that the woman is infected with a virus that has a helical capsid and a segmented genome. Which of the following is the most likely explanation for the son being free of symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 152
}
},
{
"id": "25070c58af23cf0b",
"text": "A 71-year-old man comes to the physician for a routine visit. His psychiatric history is significant for major depression with psychotic features. He was diagnosed after his wife died from pancreatic cancer four years earlier. Three years ago, he deliberately overdosed on sleeping pills. Today, he feels well but still wakes up frequently at night and cannot sleep through the night. He lives alone in his apartment and has no children. He does not possess a firearm at home but has access to weapons at a local hunting club. The patient currently denies suicidal thoughts or thoughts of self-harm. He takes sertraline and olanzapine. He does not smoke or drink alcohol. Which of the following is the strongest risk factor for suicide in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 153
}
},
{
"id": "9dadacac07d9ae2d",
"text": "A 4-year-old boy is brought to the physician because of a generalized rash for 3 days. During this period, he has had severe itching and was not able to sleep well. He has also had fever, headache, and some muscle pain. Five days ago, he had a runny nose which subsided with over-the-counter medications. He returned from a camping trip 1 week ago. He attends a daycare center. The patient is at the 55th percentile for height and at the 50th percentile for weight. His temperature is 38.2\u00b0C (100.7\u00b0F), pulse is 97/min, and blood pressure is 96/60 mm Hg. Examination of the skin shows several macules, papules, and crusted lesions over his face, trunk, and extremities. There are a few fluid-filled vesicles over his abdomen and back. There is no cervical lymphadenopathy. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 154
}
},
{
"id": "3cf7497feb351dfc",
"text": "A 19-year-old man is brought to the emergency department by ambulance because of unusual behavior that started 3 hours ago while he was at a party. He has a history of major depressive disorder and seasonal allergies. His mother has a history of anxiety. He drinks 5 beers on the weekends. Current medications include amitriptyline and diphenhydramine. The patient does not respond to questions and repeatedly says, \"\"The government is following me everywhere.\"\" His temperature is 37.9\u00b0C (100.2\u00b0F), pulse is 115/min, respirations are 24/min, and blood pressure is 160/89 mm Hg. He is diaphoretic. He is not oriented to place or time. Neurologic examination shows dilated pupils bilaterally and diffuse hyperreflexia. His feet are cold, and capillary refill time is 3 seconds. After the examination, the patient starts screaming and tries to bite the physician. Urine toxicology screening is positive for ethyl glucuronide. Which of the following is the most likely explanation for this patient's symptoms?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 155
}
},
{
"id": "a88346fb79d02277",
"text": "A 22-year-old male presents to the emergency room complaining of neck stiffness. He reports that his neck started \u201clocking\u201d three hours ago. He is now unable to move it. His past medical history is notable for schizophrenia and asthma and he currently takes albuterol as well as another medication whose name he does not remember. His temperature is 99.0\u00b0F (37.2\u00b0C), blood pressure is 130/90 mmHg, pulse is 105/min, and respirations are 18/min. On physical examination, the patient appears anxious and diaphoretic. He speaks in full sentences and is oriented to person, place, and time. The patient\u2019s neck is flexed and rotated to the right approximately 40 degrees. The right sternocleidomastoid and trapezius are firm and contracted. Extraocular movements are full and intact. Upon further questioning, he reports that he took more medication four hours ago because he was hearing voices. Which of the following should most likely be administered to this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 156
}
},
{
"id": "59f24a71e7dbf49e",
"text": "A 13-month-old boy is brought to the physician for a well-child examination. Physical examination shows hepatosplenomegaly. A venous blood sample obtained for routine screening tests is milky. After refrigeration, a creamy supernatant layer appears on top of the sample. Genetic analysis shows a mutation in the apolipoprotein C-II gene (APOC2) on chromosome 19. This patient is at greatest risk for developing which of the following complications?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 157
}
},
{
"id": "31c867c7683fd000",
"text": "A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-Y gastric bypass to treat obesity. He underwent a total thyroidectomy to treat a Hurthle cell lesion 4 days ago. His mother died of lung cancer at age 68. He has smoked 1 pack of cigarettes daily for 22 years. His only current medication is a multivitamin supplement. He appears fatigued. His temperature is 36\u00b0C (96.8\u00b0F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/70 mm Hg. While measuring the patient's blood pressure, the nurse observes spasm of the patient's hand. Physical examination shows a well-healing surgical wound on the neck. The abdomen is mildly tender to palpation with well-healed laparoscopic incisional sites. The remainder of the examination shows no abnormalities. Serum studies show:\nNa+ 138 mEq/L\nK+ 4.2 mEq/L\nCl- 102 mEq/L\nHCO3- 25 mEq/L\nMg2+ 1.7 mEq/L\nPhosphorus 4.3 mg/dL\n25-hydroxyvitamin D 20 ng/mL (N: 20-100 ng/mL)\nParathyroid hormone 115 pg/mL\nTotal bilirubin, serum 0.7 mg/dL\nAlanine aminotransferase, serum 14 U/L\nAspartate aminotransferase, serum 15 U/L\nAlkaline phosphatase, serum 42 U/L\nWhich of the following is the most appropriate initial step in the management of this patient?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 158
}
},
{
"id": "44b7f98d05ea1348",
"text": "A 9-year-old boy is brought to a physician by his mother for evaluation of generalized weakness, increased urination, and increased thirst. The mother mentions that her boy is always tired, and seems to be getting worse. He prefers watching television rather than going out and playing with other kids. Furthermore, he has had frequent episodes of constipation since birth. Except for frequent cravings for salty foods, the boy eats a regular diet. The patient was delivered healthy and is fully immunized. The medical history is unremarkable, and he takes no medications. He has no siblings. His father is a banker and his mother is a librarian. The pulse is 90/min, the blood pressure is 110/75 mm Hg, and the respiratory rate is 15/min. He is in the bottom 10th percentile for height and weight according to his age. The remainder of the physical examination is unremarkable. He recently had a urinalysis that showed elevated urinary calcium excretion.\nAdditional lab testing results are as follows:\nSerum electrolytes\nSodium 135 mEq/L\nPotassium 3.2 mEq/L\nChloride 95 mEq/L\nPlasma renin activity 10 ng/mL/hr (normal, 0.5\u20133.3 ng/mL/hr)\nPlasma aldosterone concentration 20 ng/dL (normal, 2\u20139 ng/dL)\nWhat is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 159
}
},
{
"id": "c43886ae46624072",
"text": "A 5-year-old boy of African descent is presented to the emergency department by his parents. The child is clutching his abdomen and crying about pain in his belly. His mother reports intermittent episodes of jaundice with joint and bone pain since he was 5 months old. At presentation, the patient\u2019s vital signs are within normal limits. Physical examination reveals slight jaundice and pale conjunctiva. The spleen is tender and easily palpable. After a complete blood count with differential and an abdominal ultrasound, the patient is found to have sickle-cell disease with splenic infarct. A partial splenectomy is performed. After the operation, the physician provides vaccines against Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. The picture shows a slide obtained from the resected portion of the patient\u2019s spleen. Dysfunction of the zone marked with which number predisposes the patient to the aforementioned infections?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 160
}
},
{
"id": "32b84a3cc27b72b5",
"text": "A 51-year-old woman presents to her primary care physician complaining of months of dry mouth and dry eyes. She says the dryness has become so severe that she has difficulty swallowing food. She has a history of hypertension, for which she takes hydrochlorothiazide (HCTZ), but she has no other medical problems. Family history is significant for her grandmother having systemic lupus erythematosus. The vital signs include: blood pressure 118/76 mm Hg, heart rate 78/min, and respiratory rate 15/min. On physical exam, she has tender parotid glands bilaterally and dries mucous membranes. The presence of serum anti-Ro and anti-La autoantibodies is confirmed at high titers. In addition to her primary diagnosis, which of the following is this patient most at risk for developing in the future?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 161
}
},
{
"id": "43a023060e5c2eb8",
"text": "A 59-year-old man presents to his primary care provider with fatigue, a progressively worsening cough with flecks of blood, shortness of breath, and dark urine. He reports feeling ill for the past 3 weeks. Past medical history is significant for hypertension and hyperlipidemia. He takes chlorthalidone and atorvastatin. Family history is noncontributory. He has smoked 20\u201330 cigarettes daily for the past 26 years. Anti-glomerular basement membrane serologies are positive. Which of the following is a specific feature for this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 162
}
},
{
"id": "906268bb516477c2",
"text": "A 32-year-old man with HIV infection is brought to the emergency department by his roommate because of a 2-week history of progressively worsening headache and vomiting. Current medications include trimethoprim-sulfamethoxazole, dolutegravir, and tenofovir-emtricitabine. His temperature is 38.5\u00b0C (101.3\u00b0F). Physical examination shows nuchal rigidity. Kernig and Brudzinski signs are present. A lumbar puncture is performed and shows an opening pressure of 32 cm H2O (N: < 20). The pathogen isolated from the cerebrospinal fluid (CSF) can be cultured on Sabouraud agar. Further evaluation of this patient's CSF is most likely to show which of the following additional findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 163
}
},
{
"id": "37f625ad4ccc46a8",
"text": "A 70-year-old woman comes to the physician for the evaluation of back pain. For the past six days, she has had a burning pain in her upper right back and chest. She cannot recall any recent injury and has no prior history of back pain. She has a history of hypertension and gastroesophageal reflux. The patient volunteers at an animal shelter three times a week. She does not smoke or drink alcohol. Current medications include ramipril and pantoprazole. The patient appears healthy and well nourished. Her temperature is 36.9\u00b0C (98.42\u00b0F), pulse is 76/min, and blood pressure is 145/92 mm Hg. Examination shows a long erythematous rash covered with multiple clear vesicles and crusty lesions extending from her back to below her right breast. Which of the following is the most likely underlying mechanism of the disease?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 164
}
},
{
"id": "952490b7abc843dc",
"text": "A type of fatal adrenal cancer has an average survival rate of 3 years after the onset of clinically significant symptoms. It is determined that patients have a 4-year asymptomatic period prior to developing clinical symptoms from this adrenal cancer. A new screening test is developed, and the cancer can now be detected 2 years prior to developing clinical symptoms. A new observational case-control study of screened and unscreened patients measures the median 5-year survival of patients who decline medical and surgical treatment. The screened population has statistically better outcomes. Which step should be undertaken to prevent bias in these conclusions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 165
}
},
{
"id": "33e6d4ead18bb9c2",
"text": "A 60-year-old man presents to the office for shortness of breath. The shortness of breath started a year ago and is exacerbated by physical activity. He has been working in the glass manufacturing industry for 20 years. His vital signs include: heart rate 72/min, respiratory rate 30/min, and blood pressure 130/80 mm Hg. On physical exam, there are diminished respiratory sounds on both sides. On the chest radiograph, interstitial fibrosis with reticulonodular infiltrate is found on both sides, and there is also an eggshell calcification of multiple adenopathies. What is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 166
}
},
{
"id": "8eae8a7ed0b5069f",
"text": "A 43-year-old woman is brought to the emergency department by her brother for severe chest pain. The patient recently lost her husband in a car accident and is still extremely shocked by the event. On physical examination, her blood pressure is 105/67 mm Hg, the heart rate is 96/min and regular, breathing rate is 23/min, and the pulse oximetry is 96%. An S3 heart sound and rales in the lower right and left lung lobes are heard. A 12-lead ECG shows no significant findings. Echocardiography shows an enlarged left ventricle and left atrium. The patient is stabilized and informed about the diagnosis and possible treatment options. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 167
}
},
{
"id": "65b3c793f0dba671",
"text": "A 56-year-old man is brought to the emergency department. He was found unconscious on the street. The staff recognizes him as a local homeless man with a long history of alcoholism. At the hospital, his pulse is 95/min, the blood pressure is 110/70 mm Hg, the respirations are 20/min, and the oxygen saturation is 98% on room air. On physical exam, the unconscious man is covered in bloody vomit with small clots and food particles. He smells of alcohol. A digital exam reveals black tarry stool in the rectal vault. The patient is given oxygen, IV fluids, and an NG-tube is placed and set to intermittent suction. Labs are sent and the patient is prepared for a procedure. Which of the following is the most appropriate next step in his management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 168
}
},
{
"id": "07b2ea249027b3a3",
"text": "An 8-year-old girl comes to the physician because of a 2-day history of hematuria. Two weeks ago, she had a sore throat that resolved without treatment. Physical examination shows 1+ pitting edema of the lower legs and ankles. Urinalysis shows numerous RBCs and 3+ proteinuria. Her antistreptolysin O titer is elevated. Formation of which of the following is most likely involved in the underlying mechanism of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 169
}
},
{
"id": "90e0ec6615b4f761",
"text": "A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0\u00b0F (37.2\u00b0C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The patient is being resuscitated in the trauma bay. Which of the following was most likely to be found on exam?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 170
}
},
{
"id": "6edacfbf00767155",
"text": "A 38-year-old G4P3 presents to her obstetrician\u2019s office for her 20-week anatomy ultrasound. She reports that she feels well and has not experienced any contractions or vaginal bleeding. She also reports good fetal movement. The patient declined prenatal screening earlier in the pregnancy for religious reasons but would now like an anatomy ultrasound to ensure the fetus is growing appropriately. The patient\u2019s previous pregnancies were uncomplicated, and she delivered three healthy babies at full term. On the ultrasound, the technician observes a male fetus with likely intrauterine growth restriction (IUGR). She also notes microcephaly, convex-rounded feet, and clenched fists with overlapping fingers. The technician further notes a medium-sized ventricular septal defect (VSD). The amniotic fluid index (AFI) is 26 cm.\n\nWhich of the following additional findings is most likely to be observed in this fetus?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 171
}
},
{
"id": "1be289a8c0284913",
"text": "An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is talking to someone despite nobody being present in the room. He is easily agitated and attempts to strike a nurse with a remote control to his TV. Subsequently, the patient keeps getting out of bed and trying to walk away despite being a fall risk. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 172
}
},
{
"id": "483df07dd4992fc5",
"text": "A 26-year-old woman comes to the physician because of fatigue, weight loss, and muscle aches during the past 2 months. There is no personal or family history of serious illness. Her only medication is a multivitamin. A metyrapone stimulation test is performed and the results rule out a diagnosis of adrenal insufficiency. Which of the following changes in laboratory findings are most likely to have been observed in this patient following the administration of the drug?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 173
}
},
{
"id": "1f0043dea56b8e05",
"text": "An investigator conducts a study to determine whether earlier detection of glioblastoma multiforme (GBM) in patients increases survival time. One subset of study participants consists of asymptomatic individuals who were diagnosed with GBM after undergoing a screening MRI of the brain. The other subset of study participants was diagnosed with GBM only after they developed symptoms. Results from the study show that the asymptomatic patients who were diagnosed with screening MRI had an average survival time that was 6 weeks longer than that of the patients who were diagnosed after symptom onset. Which of the following statistical biases is most likely to have occurred as a result of the endpoint selected for this study?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 174
}
},
{
"id": "3b58b7e1c659cb20",
"text": "A 23-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was the restrained driver. On questioning by the paramedics, he reported severe chest pain and mild dyspnea. On arrival, he is confused and unable to provide a history. His pulse is 93/min, respirations are 28/min, and blood pressure is 91/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. He is able to move his extremities in response to commands. He opens his eyes spontaneously. Pupils are equal and reactive to light. Examination shows multiple bruises over the trunk and extremities. There is a 3-cm (1.2-in) wound at the left fifth intercostal space at the midclavicular line. There is jugular venous distention. Decreased breath sounds and hyperresonance on percussion are noted on the left. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 175
}
},
{
"id": "58ba6912379c6dd6",
"text": "A novel type of PET radiotracer is being developed to evaluate patients with Parkinson\u2019s disease. A clinical research study has enrolled 1,200 patients, half of whom have the disease. The scan is found to be positive in 590 of the 600 patients with known PD, and positive in 20 of the 600 patients without PD. What is the test\u2019s overall specificity?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 176
}
},
{
"id": "8bff41b73b180278",
"text": "A 55-year-old man presents to a rheumatologist with bilateral wrist and knee pain that has been present for the last 10 years. The patient was a professional athlete who retired at age 50. He also notes morning stiffness in his joints that lasts approx. 50 minutes. He denies joint swelling, color changes in his digits, dryness of mucous membranes, and constitutional symptoms such as fever and chills. On physical exam, the physician notes several non-tender nodules on the left 1st, 3rd, and 4th distal interphalangeal joints. There is also tenderness with palpation at the base of both thumbs. The patient\u2019s knees are enlarged, bilaterally, and he has pain and crepitus on passive range of motion. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 177
}
},
{
"id": "a0f9b1c5e449ec79",
"text": "A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respiratory rate 13/min, temperature 36.8\u00b0C (98.2\u00b0F). A T2-weighted MRI shows a left C5 hemicord lesion. The patient is treated with cervical immobilization, a course of steroids, and physical therapy. What other finding will most likely be seen in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 178
}
},
{
"id": "144a0a36b8a798f4",
"text": "A previously healthy 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has also had a burning sensation on urination and increased urinary frequency for the past 3 days. He has not had urethral discharge. He is sexually active with one female partner and does not use condoms. Vital signs are within normal limits. Physical examination shows a tender right testicle; lifting it provides relief. The penis appears normal, with no discharge at the meatus. Laboratory studies show a normal complete blood count; urinalysis shows 3 WBC/hpf. A Gram stain of a urethral swab shows polymorphonuclear leukocytes but no organisms. Testicular ultrasound shows increased blood flow to the right testicle compared to the left. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 179
}
},
{
"id": "6c2997ff62691063",
"text": "A 4-month-old infant is brought to the office by his parents due to sudden nose bleeding without trauma of any kind. He has a 1-month history of multiple bruising that measures 1 cm in diameter each in the hands and feet, and tiny red spots that appeared in the upper and lower extremities without any trauma either. He has no prior bleeding history nor any relevant family history. The vital signs include: heart rate 190/min, respiratory rate 40/min, blood pressure 99/42 mm Hg, and temperature 36.6 \u00b0C (97.9 \u00b0F). His physical exam shows pale skin color, petechiae in the soft palate and in the upper and lower extremities as well as ecchymosis in the back of the hands and feet.\nThe complete blood count results are as follows:\nHemoglobin 8.9 g/dL\nHematocrit 41%\nLeukocyte count 10,500/mm3\nNeutrophils 53%\nBands 2%\nEosinophils 1%\nBasophils 0%\nLymphocytes 33%\nMonocytes 2%\nPlatelet count 450,000/mm3\nThe coagulation test results are as follows:\nPartial thromboplastin time (activated) 30.0 sec\nProthrombin time 13.6 sec\nInternational normalized ratio 0.99\nFibrinogen 364.9 mg/dL\nThe blood smear shows hypochromia, poikilocytosis, and large platelets, while a platelet aggregation test with ristocetin is normal. The overall bleeding time is increased. What is the most likely cause of this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 180
}
},
{
"id": "d9e83103fb05dca1",
"text": "A 6-year-old boy is brought to the physician by his mother because of a 2-day history of dysuria and increased urinary frequency. Vital signs are within normal limits. Urinalysis shows cloudy, red urine. This patient's clinical presentation is best explained by an infection with a virus with which of the following features?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 181
}
},
{
"id": "d97cf08134c8a269",
"text": "A 13-year-old boy is brought to his pediatrician due to a left breast lump under his nipple. He noticed it last month and felt that it has increased slightly in size. It is tender to touch but has no overlying skin changes. There is no breast discharge. The patient has cryptorchidism as an infant and underwent a successful orchiopexy. In addition, he was recently diagnosed with ADHD and is currently on methylphenidate with improvement in his symptoms. He has a family history of type I diabetes in his father and breast fibroadenoma in his mother. On exam, the patient is at the 82nd percentile for height, 79th percentile for weight, and 80th percentile for BMI. He has tanner IV pubic hair. Testicular volume is 7 mL on each side, and both testes are smooth and freely mobile. Breast exam shows a normal right breast and a 3-centimeter round, firm, and slightly tender discrete mass under the left nipple. Which of the following is the most likely etiology of this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 182
}
},
{
"id": "391e0791dad460a8",
"text": "A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affecting the opposite leg one year ago and was diagnosed with a thrombus in the right femoral vein. On examination, the left leg is erythematous and swollen. Passive dorsiflexion of the left ankle elicits pain in the left calf. Ultrasound of the leg reveals a thrombus in the left popliteal vein. A genetic workup reveals that she has an inherited condition. What is the most likely pathophysiology of this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 183
}
},
{
"id": "7b967815db227c28",
"text": "A 78-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 5 weeks. He had been living independently but came to live with his daughter temporarily after he complained that he was unable to perform some of his daily activities. He has left the front door wide open and tap water running on multiple occasions. He does not sleep well and wakes up 6\u20137 times during the night. He does not leave his room and rarely makes conversation with his daughter. He says that he used to enjoy playing the piano but has not played for several months. He has hypertension treated with amlodipine. Vital signs are within normal limits. Mental status examination shows orientation to person, place, and time and psychomotor retardation. He has a blunted affect. Short- and long-term memory is impaired. Attention and concentration are impaired. Neurologic examination shows no focal findings. Serum concentration of electrolytes, thyroid-stimulating hormone, and vitamin B12 are within the reference range. He is very concerned about his memory lapses. Which of the following is the most appropriate treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 184
}
},
{
"id": "247a8a18f6960ddc",
"text": "A previously healthy 18-month-old boy is brought to the physician by his parents for evaluation of an abdominal mass noticed a few days ago. He appears markedly pale and lethargic. Examination shows a 6-cm, nonmobile mass in the left upper quadrant that crosses the midline. 24-hour urine collection shows elevated homovanillic acid and vanillylmandelic acid. Further evaluation including biopsy confirms the diagnosis of intermediate-risk neuroblastoma. The physician recommends the established standard treatment, which is initiation of neoadjuvant chemotherapy followed by surgical resection, if possible. After a thorough discussion of the risks and benefits of chemotherapy, the likelihood of unresectability without neoadjuvant treatment, and the prognosis without it, the patient's parents steadily refuse chemotherapy because they do not want their son to suffer the side effects. They prefer to take their son home for supportive care only. Which of the following is the most appropriate action by the physician?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 185
}
},
{
"id": "bfc378567835cab8",
"text": "A laboratory primarily involved with studying cellular proofreading mechanisms is investigating the question of whether the ribosome can recognize a mischarged amino acid and still be incorporated into the growing peptide. In order to do so, they biochemically charge a Lys-tRNA with valine instead of lysine and insert the tRNA into the cell. They design an mRNA sequence that contains only codons for lysine. Which of the following will most likely occur?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 186
}
},
{
"id": "e59a2bcd681d492e",
"text": "A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor. Which of the following was the most likely recommended agent?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 187
}
},
{
"id": "88984b528709c667",
"text": "A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He denies any trauma during his practice sessions. On examination of the shoulder joint, severe tenderness was present localized to the greater tuberosity of the left shoulder joint along with biceps tendon tenderness over the bicipital groove. The range of motion was limited to the left side. An X-ray of the joint showed narrowing of the acromiohumeral space with sclerosis and spurring of the acromion. Routine blood test results are normal except for the rheumatoid factor, which is positive. What is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 188
}
},
{
"id": "9dcaff75a0675414",
"text": "A 17-year-old woman presents to your office concerned that she has not had her menstrual period in 4 months. She states that menses began at age of 13 and has been regular until two months ago. She denies sexual activity, and urine pregnancy test is negative. On exam, she appears well-nourished with a BMI of 21 kg/m^2, but you note that she has enlarged cheeks bilaterally and has calluses on the dorsum of her hands. She says that she has been very stressed with school and has recently been binge eating. What other finding do you expect to see in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 189
}
},
{
"id": "c58783d2f5efbba7",
"text": "A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of \"feeling like my chest is going to explode.\" During these episodes, he also feels shortness of breath, feels shakiness throughout his arms and legs, and sweats so heavily that he needs to change his shirt. He is unsure of any clear precipitating factors but thinks they may occur more often around important exams or when big school projects are due. He shares that, as these episodes continue to recur, he has had mounting anxiety about having one when he is in class or at a restaurant. As a result, he is leaving the house less and less. He has no past medical history; the physical exam is unremarkable. Which of the following is the best medication for the long-term management of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 190
}
},
{
"id": "82554c7393330a42",
"text": "A stillborn infant is delivered at 38 weeks' gestation to a 32-year-old woman. The mother had no prenatal care. Examination of the stillborn shows a small pelvis, shallow intergluteal cleft, and club feet. An x-ray shows the absence of the sacrum and lumbar vertebrae. Which of the following is the strongest predisposing factor for this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 191
}
},
{
"id": "ecc98de05950ea41",
"text": "Please refer to the summary above to answer this question\nThe authors of the study have decided to conduct a follow-up analysis on their data. They decide to stratify their results by CD4+T-lymphocyte count at the time of diagnosis. Among patients with CD4+ cell counts below 200/mm3, cART adherence was a significant predictor of DLBCL risk (RR = 0.52, p = 0.01). However, among patients with CD4+ cell counts above 200/mm3, no relationship was found between DLBCL risk and cART adherence (RR = 0.96, p = 0.36). Which of the following explains for the difference observed between the two strata?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 192
}
},
{
"id": "8fbbe9cb985bef04",
"text": "During a Mycobacterium tuberculosis infection, Th1 cells secrete a factor capable of stimulating phagosome-lysosome fusion within macrophages. In addition, the secreted factors help activate macrophages to produce mediators such as NO, which are capable of destroying the invading pathogen. Furthermore, activation of the macrophages by the secreted factor eventually leads to the formation of a tubercle. Which of the following factors is secreted by Th1 cells and responsible for these actions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 193
}
},
{
"id": "7ba4cb187247cec9",
"text": "A 3-year-old boy is brought to the pediatrician because of abdominal pain and constipation for 3 weeks. His mother says he has been increasingly irritable recently. His vocabulary consists of 50 words and he does not use sentences. Physical examination shows pale conjunctivae and abdominal tenderness. He refers to himself by name but is unable to name body parts or count to three. Peripheral blood smear shows small, pale red blood cells with basophilic stippling. Which of the following processes is most likely impaired in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 194
}
},
{
"id": "30b90d7798427dd2",
"text": "A group of researchers conducted a study to determine whether there is an association between folic acid supplementation before pregnancy and autism spectrum disorder (ASD) in offspring. The researchers retrospectively surveyed 200 mothers with children diagnosed with ASD during the first 4 years of life and 200 mothers with healthy children. All participants were interviewed about their prenatal consumption of folic acid using standardized questionnaires. A 94% response rate was obtained from the surveys. The study ultimately found that folic acid supplementation was associated with lower rates of ASD in offspring (OR = 0.3, p < 0.01). Which of the following type of bias is most likely to have influenced these results?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 195
}
},
{
"id": "987bffba8e22dbc7",
"text": "A student studying pharmacology is a member of a team that is conducting research related to the elimination of multiple anticoagulant medications. His duty as a member of the team is to collect serum samples of the subjects every 4 hours and send them for analysis of serum drug levels. He is also supposed to collect, document and analyze the data. For one of the subjects, he notices that the subject is eliminating 0.5 mg of the drug every 4 hours. Which of the following anticoagulants did this patient most likely consume?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 196
}
},
{
"id": "0533510464b86265",
"text": "A 40-year-old woman presents to her primary care physician for a checkup. She has felt weaker lately and has lost some weight. She denies any urinary issues. Her BUN at her last visit 4 months ago was 45 mg/dL, and her creatinine was 2.0 mg/dL. Her laboratory studies this visit are seen below:\n\nHemoglobin: 8 g/dL\nHematocrit: 29%\nLeukocyte count: 9,500/mm^3 with normal differential\nPlatelet count: 197,000/mm^3\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 5.9 mEq/L\nHCO3-: 17 mEq/L\nBUN: 59 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 2.3 mg/dL\nCa2+: 9.0 mg/dL\n\nWhich of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 197
}
},
{
"id": "0bf5b14de4e57404",
"text": "A 28-year-old woman comes to the obstetrics and gynecology clinic because she has been unsuccessfully trying to conceive with her husband for the last 2 years. He has had 2 children from a previous marriage and has been tested for causes of male infertility. She has had prior abdominal surgery as well as a family history of endocrine abnormalities. Based on this history, a panel of tests are obtained and treatment is started. This treatment will be administered intermittently one week before her normal menstrual cycle. If the most likely drug prescribed in this case was administered in a different manner, which of the following conditions may also be treated by this drug?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 198
}
},
{
"id": "46d44598e99be6b3",
"text": "A 2-year-old girl with recurrent urinary tract infections is brought to the physician for a follow-up examination. Renal ultrasound shows bilateral dilation of the renal pelvis. A voiding cystourethrography shows retrograde flow of contrast into the ureters during micturition. Histologic examination of a kidney biopsy specimen is most likely to show which of the following findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 199
}
},
{
"id": "b9fa41de3a402654",
"text": "An unconscious 55-year-old man is brought to the Emergency Department by ambulance. He had recently lost his job and his house was about to begin foreclosure. His adult children were concerned for his well being and called the police requesting a welfare check. He was found unresponsive in his gurague. There were several empty bottles of vodka around him and one half empty container of antifreeze. A review of his medical records reveals that he was previously in good health. Upon arrival to the ED he regains consciousness. His blood pressure is 135/85 mmHg, heart rate 120/min, respiratory rate 22/min, and temperature 36.5\u00b0C (97.7\u00b0F). On physical exam his speech is slurred and he has difficulty following commands. His abdomen is diffusely tender to palpation with no rebound tenderness. Initial laboratory tests show an elevated serum creatinine (Cr) of 1.9 mg/dL, and blood urea nitrogen (BUN) of 29 mg/dL. Which of the following findings would be expected in this patient\u2019s urine?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 200
}
},
{
"id": "3f931fa5d8d2c496",
"text": "A 17-year-old girl comes to the physician because of an 8-month history of severe acne vulgaris over her face, upper back, arms, and buttocks. Treatment with oral antibiotics and topical combination therapy with benzoyl peroxide and retinoid has not completely resolved her symptoms. Examination shows oily skin with numerous comedones, pustules, and scarring over the face and upper back. Long-term therapy is started with combined oral contraceptive pills. This medication decreases the patient's risk developing of which of the following conditions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 201
}
},
{
"id": "dfae73bf6ff04215",
"text": "A 48-year-old female presents for a follow-up appointment to discuss her ultrasound results. She presented with a lump in her neck 2 weeks ago. On examination, a thyroid nodule was present; the nodule was fixed, immobile, and non-tender. Ultrasound showed a hypoechoic nodule with a size of 2 cm. Histological examination of a fine needle biopsy was performed and cytological examination reported a likely suspicion of neoplasia. CT scan is performed to check for any lesions in the bones and/or lungs, common metastatic sites in this condition. Treatment with radioiodine therapy is planned after near-total thyroidectomy. Considering this tumor, which of the following is the most likely initial metastatic site in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 202
}
},
{
"id": "8a70b63b4c258a00",
"text": "A 39-year-old man presents to his primary care physician because he has been having severe headaches and fever for the last 2 days. He also says his right eyelid has been painlessly swelling and is starting to block his vision from that eye. He recently returned from a tour of the world where he visited Thailand, Ethiopia, and Brazil. Otherwise his past medical history is unremarkable. On presentation, his temperature is 102\u00b0F (38.8\u00b0C), blood pressure is 126/81 mmHg, pulse is 125/min, and respirations are 13/min. Physical exam reveals a nontender swelling of the right eyelid, lymphadenopathy, and an indurated red patch with surrounding erythema and local swelling on his left leg. Which of the following drugs should be used to treat this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 203
}
},
{
"id": "ed787f476cdc8ce8",
"text": "A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 204
}
},
{
"id": "10cced51fdc4811b",
"text": "A 34-year-old woman is assaulted and suffers a number of stab wounds to her abdomen. Bystanders call paramedics and she is subsequently taken to the nearest hospital. On arrival to the emergency department, her vitals are T: 36 deg C, HR: 110 bpm, BP: 100/60, RR: 12, SaO2: 99%. A FAST and abdominal CT are promptly obtained which are demonstrated in Figures A and B, respectively. Her chart demonstrates no other medical problems and vaccinations/boosters up to date. The patient is diagnosed with a Grade V splenic laceration and is immediately brought to the OR for emergent splenectomy. The splenectomy is successfully performed with removal of the damaged spleen (Figure C). Following the operation, the patient should receive which of the following vaccines: (I) H. influenzae (II) Tetanus (III) N. meningitidis (IV) S. pneumoniae (V) Hepatitis B",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 205
}
},
{
"id": "09f02a82df812347",
"text": "Researchers are studying the inheritance pattern of mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, the gene responsible for cystic fibrosis. It is believed that, in addition to the commonly found \u0394F508 mutation, a novel mutation in this gene is found in a particular population under study. Which of the following would most likely suggest that these two loci have a high probability of being closely linked?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 206
}
},
{
"id": "fb2805f7d394c1be",
"text": "A 28-year-old woman returns to the clinic to follow up on a recent abnormal cervical biopsy that demonstrated cervical intraepithelial neoplasia (CIN) I. The patient is quite anxious about the implications of this diagnosis. Her physical examination is within normal limits. Her vital signs do not show any abnormalities at this time. Her past medical, family, and social histories are all non-contributory. Which of the following is the appropriate management of a newly diagnosed CIN I in a 24-year-old patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 207
}
},
{
"id": "bd0ba97a42a1912a",
"text": "A clinical researcher is interested in creating a new drug for HIV patients. Darunavir has been particularly efficacious in recent patients; however, some have experienced an increased incidence of hyperglycemia. A new drug called DN501 is developed with the same mechanism of action as darunavir but fewer side effects. Which of the following is the mechanism of action of DN501?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 208
}
},
{
"id": "488f1727816c2a6f",
"text": "A 58-year-old white man with hypertension and type 2 diabetes mellitus comes to the physician because of a 3-month history of a painless lesion on his lower lip. He has smoked one pack of cigarettes daily for 20 years. He has worked as a fruit picker for the past 25 years. His current medications include captopril and metformin. Examination of the oral cavity shows a single ulcer near the vermillion border. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 209
}
},
{
"id": "dd7ecd58958bbd5b",
"text": "An investigator is studying the effect of drug X on the retinoblastoma (Rb) gene on chromosome 13 in endometrial cells. Endometrial cells obtained from study participants are plated on growth media and the distribution of cell cycle phase is measured with flow cytometry. Drug X, which is known to activate cyclin-dependent kinase 4, is administered to all the cells, and the distribution of cell cycle phase is measured again 1 hour later. Which of the following is most likely to result from the action of drug X on the Rb gene?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 210
}
},
{
"id": "3b4086339a362e64",
"text": "A 65-year-old man presents with painless swelling of the neck over the past week. He also says he has been having intermittent fevers and severe night sweats which require a change of bed sheets the next day. His past medical history is significant for human immunodeficiency virus (HIV) diagnosed 10 years ago with which he admits to not always being compliant with his antiretroviral medication. The patient reports a 20-pack-year smoking history but no alcohol or recreational drug use. A review of systems is significant for a 6 kg (13.2 lb) unintentional weight loss over the past 2 months. The vital signs include: temperature 37.8\u2103 (100.0\u2109) and blood pressure 120/75 mm Hg. On physical examination, there are multiple non-tender swollen lymph nodes averaging 2 cm in diameter that is palpable in the anterior and posterior triangles of the neck bilaterally. Axillary and inguinal lymphadenopathy is present on the right side. A cardiopulmonary exam is unremarkable. The spleen size is 16 cm on percussion. Laboratory studies show the following:\nHemoglobin 9 g/dL\nMean corpuscular volume 88 \u03bcm3\nLeukocyte count 18,000/mm3\nPlatelet count 130,000/mm3\n Serum creatinine 1.1 mg/dL\nSerum lactate dehydrogenase 1,000 U/L\nAn excisional biopsy of a superficial axillary lymph node on the right is performed and a histopathologic analysis confirms the most likely diagnosis. Which of the following is the next best diagnostic step in the workup of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 211
}
},
{
"id": "1c871569cd4f90aa",
"text": "In order to assess the feasibility and evaluate the outcomes of cerclage wiring as a supportive approach to osteosynthesis in femur fractures, a group of orthopedic surgeons studied 14 patients with primary and periprosthetic fractures of the thigh bone. Parameters such as patient demographic, type of implant, number of wires used, fracture union rate, and potential complications were thoroughly recorded and analyzed in all the patients, with a mean duration of patient follow-up of 16 months. Union was achieved in all patients with a mean duration of 90 days, and there were no complications found in patients included in the study. The authors were satisfied with their findings and, due to the prospective nature of their research, submitted their study to a journal as a cohort study (which they noted in the study title as well). However, the journal editor returned the article, suggesting that it should be submitted as a case series instead. The editor made this suggestion to the authors for which of the following reasons?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 212
}
},
{
"id": "ef850ce65faa9633",
"text": "A 67-year-old woman presents from home hospice with a change in her mental status. She has seemed more confused lately and is unable to verbalize her symptoms. Her temperature is 102\u00b0F (38.9\u00b0C), blood pressure is 117/65 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 95% on room air. Physical exam is notable for a right upper quadrant mass that elicits discomfort when palpated. Ultrasound is notable for pericholecystic fluid and gallbladder wall thickening without any gallstones. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 213
}
},
{
"id": "840cb587339ae075",
"text": "A 35-year-old female is brought to the emergency department after being found unconscious. The patient is found to have a blood glucose level of 35 mg/dL. Hgb A1c was found to be 5.1%. C-peptide level was found to be decreased. The patient returned to her baseline after glucose replacement. She states that she has never had an episode like this before. She has no significant past medical history but reports a family history of diabetes in her mother. She states that she has been undergoing a difficult divorce over the past few months. What is the likely cause of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 214
}
},
{
"id": "b9b5177c388b1d82",
"text": "A 45-year-old man presents to the physician with complaints of increased urinary frequency and decreasing volumes for the past 2 months. He does not complain of any pain during urination. He is frustrated that he has to wake up 2 or 3 times per night to urinate even though he tried reducing the amount of water he consumes before bed and made some other dietary changes without any improvement. He has no family history of prostate disease. Physical examination is negative for any suprapubic mass or tenderness, and there is no costovertebral angle tenderness. Which of the following is the best next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 215
}
},
{
"id": "47580655ffed021e",
"text": "A 48-year-old woman with chronic tension headaches comes to the physician because of several episodes of bilateral flank pain and reddish urine within the past month. Current medications include aspirin, which she takes almost daily for headaches. Her temperature is 37.4\u00b0C (99.3\u00b0F) and her blood pressure is 150/90 mm Hg. Physical examination shows costovertebral tenderness to percussion bilaterally. Laboratory studies show a hemoglobin concentration of 10.2 g/dL and serum creatinine concentration of 2.4 mg/dL. Urine studies show:\nUrine\nProtein\n3+\nRBC > 16/hpf\nWBC 2/hpf\nThere are no casts or dysmorphic RBCs visualized on microscopic analysis of the urine. Which of the following is the most likely underlying cause of this patient's hematuria?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 216
}
},
{
"id": "c893ff11bcc52623",
"text": "A 37-year-old primigravid woman at 12 weeks' gestation comes to the emergency department because of vaginal bleeding and dull suprapubic pain for 3 hours. She has had spotting during the last 3 days. Her medications include folic acid and a multivitamin. She has smoked one pack of cigarettes daily for 15 years. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 110/min, and blood pressure is 89/65 mm Hg. Pelvic examination shows a dilated cervical os and a uterus consistent in size with an 11-week gestation. Ultrasonography shows an embryo of 4 cm in crown-rump length and no fetal cardiac activity. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 217
}
},
{
"id": "192933063c083a28",
"text": "A 17-year-old female accidentally eats a granola bar manufactured on equipment that processes peanuts. She develops type I hypersensitivity-mediated histamine release, resulting in pruritic wheals on the skin. Which of the following layers of this patient's skin would demonstrate histologic changes on biopsy of her lesions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 218
}
},
{
"id": "2affe84f11a7fde2",
"text": "A 4-year-old girl is brought to the emergency department with a persistent cough, fever, and vomiting. The past year the child has been admitted to the hospital 3 times with pneumonia. For the past 1 week, the child has been experiencing thick purulent cough and says that her chest feels \u2018heavy\u2019. Her stools have been loose and foul-smelling over the past week. Her parents are also concerned that she has not gained much weight due to her frequent hospital visits. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. On physical exam, the temperature is 39.1\u00b0C (102.4\u00b0F). She appears lethargic and uncomfortable. Crackles are heard in the lower lung bases, with dullness to percussion. A small nasal polyp is also present on inspection. Which of the following is the most likely cause for the girl\u2019s symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 219
}
},
{
"id": "b9519693daa8bf0a",
"text": "A 48-year-old man seeks evaluation at a clinic with a complaint of breathlessness for the past couple of weeks. He says that he finds it difficult to walk a few blocks and has to rest. He also complains of a cough for the past 3 months, which is dry and hacking in nature. The medical history is relevant for an idiopathic arrhythmia for which he takes amiodarone daily. He is a non-smoker and does not drink alcohol. He denies any use of illicit drugs. The vital signs are as follows: heart rate 98/min, respiratory rate 16/min, temperature 37.6\u00b0C (99.68\u00b0F), and blood pressure 132/70 mm Hg. The physical examination is significant for inspiratory crackles over the lung bases. An echocardiogram shows a normal ejection fraction. A chest radiograph is performed and shown below. Which of the following findings will most likely be noted on spirometry?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 220
}
},
{
"id": "1dc2bd5cf399d4d1",
"text": "A 2,300 g (5 lb) male newborn is delivered to a 29-year-old primigravid woman. The mother has HIV and received triple antiretroviral therapy during pregnancy. Her HIV viral load was 678 copies/mL 1 week prior to delivery. Labor was uncomplicated. Apgar scores were 7 and 8 at 1 and 5 minutes respectively. Physical examination of the newborn shows no abnormalities. Which of the following is the most appropriate next step in the management of this infant?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 221
}
},
{
"id": "36bd061463a6de97",
"text": "A 60-year-old woman presents to a physician for worsening shortness of breath and increasing abdominal distention over the last 3 months. She says that the shortness of breath is worse on exertion and improves with rest. While she could previously walk to the nearby store for her groceries, she now has to drive because she gets ''winded'' on the way. The patient was diagnosed with diabetes 5 years ago and is compliant with her medications. The medical history is otherwise unremarkable. The physical examination reveals gross ascites and visibly engorged periumbilical veins. Bilateral pitting edema is noted around the ankles. The finger-prick blood glucose level is 100 mg/dL. What is the mechanism of action of the anti-diabetic medication this patient is most likely taking?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 222
}
},
{
"id": "8e020400d6299b45",
"text": "A 15-year-old girl comes to the physician because of episodic pelvic pain radiating to her back and thighs for 4 months. The pain occurs a few hours before her menstrual period and lasts for 2 days. She has been taking ibuprofen, which has provided some relief. Menses have occurred at regular 28-day intervals since menarche at the age of 12 years and last for 5 to 6 days. She is sexually active with two male partners and uses condoms inconsistently. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 223
}
},
{
"id": "5893fed3e1490f2c",
"text": "A 25-year-old male is hospitalized for acute agitation, photophobia, and dysphagia. His parents report that he has been experiencing flu-like symptoms for one week prior to hospital admission. Five weeks ago, the patient was in Mexico, where he went on several spelunking expeditions with friends. The patient ultimately becomes comatose and dies. Autopsy of brain tissue suggests a viral infection. The likely causal virus spreads to the central nervous system (CNS) in the following manner:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 224
}
},
{
"id": "db080eececfd5a6f",
"text": "A 19-year-old Caucasian male presents to your office with hypopigmented skin. He undergoes a skin biopsy and is found to have an absence of melanocytes in the epidermis. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 225
}
},
{
"id": "221fa5153ccd4027",
"text": "A 51-year-old man presents for a routine check-up. He has no complaints. At his last annual visit, his physical and laboratory tests were unremarkable. His past medical history is significant for hypercholesterolemia, well managed with rosuvastatin, and hypertension, well managed with hydrochlorothiazide. His current medications also include aspirin. The patient is afebrile, and his vital signs are within normal limits. Physical examination is unremarkable. His laboratory tests are significant for the following:\nWBC 29,500/mm3\nHematocrit 26.1%\nHemoglobin 9.1 g/dL\nPlatelet count 298,000/mm3\nA peripheral blood smear and differential shows 92% small normocytic lymphocytes. The patient\u2019s diagnosis in confirmed by bone marrow biopsy and flow cytometry. He is monitored through regular follow-up visits. Three years after the initial diagnosis, the patient presents with swollen cervical and axillary lymph nodes, unintentional weight loss of 4.5 kg (approx. 10 lb), and \u201crib pain\u201d on his right side. On physical examination, there is palpable, firm, non-tender cervical and axillary lymphadenopathy bilaterally. He also has moderate splenomegaly, which, when palpated, elicits pain. Which of the following is the best treatment for this patient\u2019s most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 226
}
},
{
"id": "9aa8b2caac2d506a",
"text": "A 62-year-old woman is evaluated because of a 3-day history of headache, nausea, and decreased urination. Laboratory studies show:\nSerum\nNa+ 136 mEq/L\nK+ 3.2 mEq/L\nCl- 115 mEq/L\nMg2+ 1.4 mEq/L\nUrine\npH 7.0\nArterial blood gas analysis on room air shows a pH of 7.28 and a HCO3- concentration of 14 mEq/L. Prolonged treatment with which of the following drugs would best explain this patient's findings?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 227
}
},
{
"id": "a41db577b0984656",
"text": "A 21-year-old male presents to his primary care provider for fatigue. He reports that he graduated from college last month and returned 3 days ago from a 2 week vacation to Vietnam and Cambodia. For the past 2 days, he has developed a worsening headache, malaise, and pain in his hands and wrists. The patient has a past medical history of asthma managed with albuterol as needed. He is sexually active with both men and women, and he uses condoms \u201cmost of the time.\u201d On physical exam, the patient\u2019s temperature is 102.5\u00b0F (39.2\u00b0C), blood pressure is 112/66 mmHg, pulse is 105/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has tenderness to palpation over his bilateral metacarpophalangeal joints and a maculopapular rash on his trunk and upper thighs. Tourniquet test is negative. Laboratory results are as follows:\n\nHemoglobin: 14 g/dL\nHematocrit: 44%\nLeukocyte count: 3,200/mm^3\nPlatelet count: 112,000/mm^3\n\nSerum:\nNa+: 142 mEq/L\nCl-: 104 mEq/L\nK+: 4.6 mEq/L\nHCO3-: 24 mEq/L\nBUN: 18 mg/dL\nGlucose: 87 mg/dL\nCreatinine: 0.9 mg/dL\nAST: 106 U/L\nALT: 112 U/L\nBilirubin (total): 0.8 mg/dL\nBilirubin (conjugated): 0.3 mg/dL\n\nWhich of the following is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 228
}
},
{
"id": "572735a1fe251c7f",
"text": "Three days after admission to the intensive care unit for septic shock and bacteremia from a urinary tract infection, a 34-year-old woman has persistent hypotension. Her blood cultures are positive for Escherichia coli, for which she has been receiving appropriate antibiotics since admission. She has no history of any serious illness. She does not use illicit drugs. Current medications include norepinephrine, ceftriaxone, and acetaminophen. She appears well. Her temperature is 37.5\u00b0C (99.5\u00b0F), heart rate is 96/min, and blood pressure is 85/55 mm Hg. Examination of the back shows costovertebral tenderness bilaterally. Examination of the thyroid gland shows no abnormalities. Laboratory studies show:\n Hospital day 1 Hospital day 3\nLeukocyte count 18,500/mm3 10,300/mm3\nHemoglobin 14.1 mg/dL 13.4 mg/dL\nSerum\nCreatinine 1.4 mg/dL 0.9 mg/dL\nFasting glucose 95 mg/dL 100 mg/dL\nTSH 1.8 \u00b5U/mL\nT3, free 0.1 ng/dL\nT4, free 0.9 ng/dL\nRepeat blood cultures are negative. A chest X-ray shows no abnormalities. Which of the following is the most appropriate treatment?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 229
}
},
{
"id": "c7f48815d6feadf8",
"text": "An 11-year-old child complains of pain in the leg while playing. Blood pressure in the upper limb is 140/90 mm Hg and lower limbs are 110/70 mm Hg. There is a brachiofemoral delay in the pulse. Auscultation shows a loud S1, loud S2, and S4. There is a presence of an ejection systolic murmur in the interscapular area. Chest X-ray reveals the notching of the ribs. What is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 230
}
},
{
"id": "734ff2f71663ba64",
"text": "A 59-year-old man comes to the emergency department because of excruciating left knee pain for 4 days. He underwent a total knee arthroplasty of his left knee joint 4 months ago. He has hypertension and osteoarthritis. Current medications include glucosamine, amlodipine, and meloxicam. His temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 97/min, and blood pressure is 118/71 mm Hg. Examination shows a tender, swollen left knee joint; range of motion is limited by pain. Analysis of the synovial fluid confirms septic arthritis, and the prosthesis is removed. Which of the following is the most likely causal organism?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 231
}
},
{
"id": "da7940fae6096c06",
"text": "A 47-year-old man presents to the emergency department with fever, fatigue, and loss of appetite for 1 week, followed by right shoulder pain, generalized abdominal pain, and paroxysmal cough. He has had diabetes mellitus for 15 years, for which he takes metformin and gliclazide. His vital signs include a temperature of 38.3\u00b0C (101.0\u00b0F), pulse of 85/min, and blood pressure of 110/70 mm Hg. On examination, he is ill-appearing, and he has a tender liver edge that is palpable approx. 2 cm below the right costal margin. Percussion and movement worsens the pain. Abdominal ultrasonography is shown. Stool is negative for Entamoeba histolytica antigen. Which of the following is the best initial step in management of this patient condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 232
}
},
{
"id": "a50a84da33dd83aa",
"text": "A 36-year-old recent immigrant from India presents with a face similar to that seen in the image A. Examination of his face reveals skin that is thick and contains many lesions. The patient complains that he has experienced a loss of sensation in his toes and fingertips, which has caused him to injure himself often. Biopsy of the skin is likely to reveal bacteria that are:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 233
}
},
{
"id": "03849ab7c67c2f26",
"text": "A 55-year-old man comes to the physician because of a 3-month history of a progressively growing mass in his axilla. During this period, he has had recurrent episodes of low-grade fever lasting for 7 to 10 days, and an 8-kg (18-lb) weight loss. His only medication is a multivitamin. Physical examination shows nontender, right axillary, cervical, and inguinal lymphadenopathy. His serum calcium concentration is 15.1 mg/dL and parathyroid hormone (PTH) concentration is 9 pg/mL. A lymph node biopsy shows granuloma formation and large CD15-positive, CD30-positive cells with bilobed nuclei. Which of the following is the most likely explanation for this patient's laboratory findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 234
}
},
{
"id": "c4b44f98d493729f",
"text": "A 32-year-old man comes to the physician for a pre-employment examination. He recently traveled to Guatemala. He feels well but has not seen a physician in several years, and his immunization records are unavailable. Physical examination shows no abnormalities. Serum studies show:\nAnti-HAV IgM Positive\nAnti-HAV IgG Negative\nHBsAg Negative\nAnti-HBs Positive\nHBcAg Negative\nAnti-HBc Negative\nHBeAg Negative\nAnti-HBe Negative\nAnti-HCV Negative\nWhich of the following best explains this patient's laboratory findings?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 235
}
},
{
"id": "fbef70b6184283a0",
"text": "A 7-month-old male infant is brought to the pediatrician by his mother. She reports that the child develops severe sunburns every time the infant is exposed to sunlight. She has applied copious amounts of sunscreen to the infant but this has not helped the problem. On examination, there are multiple areas of reddened skin primarily in sun exposed areas. The child\u2019s corneas appear irritated and erythematous. Which of the following processes is likely impaired in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 236
}
},
{
"id": "1d8f91eb0735bdd7",
"text": "A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despite no change in his diet or exercise frequency. His past medical history is notable for gout for which he takes allopurinol. He denies any prior thyroid disorder. He runs 4 times per week and eats a balanced diet of mostly fruits and vegetables. He does not smoke and drinks a glass of wine with dinner. His family history is notable for medullary thyroid cancer in his maternal uncle. His temperature is 97.8\u00b0F (36.6\u00b0C), blood pressure is 127/72 mmHg, pulse is 87/min, and respirations are 19/min. On exam, he has a firm, symmetric, and stone-firm thyroid. A biopsy of this patient's lesion would most likely demonstrate which of the following findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 237
}
},
{
"id": "602dc8814e1851f6",
"text": "A group of researchers decided to explore whether the estimates of incidence and prevalence rates of systemic lupus erythematosus (SLE) were influenced by the number of years it took to examine administrative data. These estimates were not only based on hospital discharges, but also on physician billing codes. For study purposes, the researchers labeled incident cases at the initial occurrence of SLE diagnosis in the hospital database, while prevalent cases were those that were coded as harboring SLE at any time, with patients maintaining their diagnosis until death. Which statement is true regarding the relationship between incidence and prevalence rates during the time period that might be chosen for this specific study?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 238
}
},
{
"id": "86bf05c67191dbb3",
"text": "A 48-year-old Caucasian female presents to her primary care physician for evaluation of progressive weakness and shortness of breath. She has had progressive shortness of breath over the last year with an intermittent non-productive cough. In addition, she complains of difficulty raising her arms to brush her hair. Her temperature is 99.6\u00b0F (37.6\u00b0C), pulse is 80/min, blood pressure is 130/85 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. Neurologic exam shows 4/5 strength in the deltoid muscles bilaterally. Diffuse dry crackles are heard on lung auscultation. A faint erythematous rash is noted on the malar cheeks, periorbital areas, lateral proximal thighs, and the elbows. Which of the following tests is most likely to confirm the diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 239
}
},
{
"id": "780c1facc3bde97d",
"text": "A 46-year-old man presents to the physician with a complaint of a cough for 6 months. He has been taking over-the-counter cough medications, but they have not helped much. He adds that he expectorated bloody sputum the previous night. He denies breathlessness but mentions that he frequently experiences fatigue after little physical exertion. There is no past history of any specific medical disorder. His father died of lung cancer at the age of 54 years. His temperature is 37.0\u00b0C (98.6\u00b0F), the pulse rate is 82/min, the blood pressure is 118/80 mm Hg, and the respiratory rate is 18/min. Auscultation of his chest reveals the presence of localized rhonchi over the interscapular region. A plain radiograph of the chest shows a coin-like opacity in the right lung. Further diagnostic evaluation confirms the diagnosis of small cell carcinoma of the lung. If his blood were to be sent for laboratory evaluation, which of the following proteins is most likely to be elevated in his serum?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 240
}
},
{
"id": "e450d992996a119e",
"text": "A 41-year-old man presents to his primary care provider with abdominal pain. He says that the pain \u201ccomes and goes\u201d throughout the day and usually lasts 20-30 minutes per episode. He can point to the spot 1-2 inches above the umbilicus where he feels the pain. He denies any feeling of regurgitation or nighttime cough but endorses nausea. He reports that he used to eat three large meals per day but has found that eating more frequently improves his pain. He tried a couple pills of ibuprofen with food over the past couple days and thinks it helped. He has gained four pounds since his past appointment three months ago. The patient denies any diarrhea or change in his stools. He has no past medical history. He drinks 5-6 beers on the weekend and has a 20 pack-year smoking history. He denies any family history of cancer. On physical exam, he is tender to palpation above the umbilicus. Bowel sounds are present. A stool guaiac test is positive. The patient undergoes endoscopy with biopsy to diagnose his condition.\n\nWhich of the following is most likely to be found on histology?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 241
}
},
{
"id": "abbc87e7ef96e10a",
"text": "A 5-year-old female presents to the pediatrician for a routine office visit. The patient is in kindergarten and doing well in school. She is learning to read and is able to write her first name. Her teacher has no concerns. The patient\u2019s mother is concerned that the patient is a picky eater and often returns home from school with most of her packed lunch uneaten. The patient\u2019s past medical history is significant for moderate persistent asthma, which has required three separate week-long courses of prednisone over the last year and recently diagnosed myopia. The patient\u2019s mother is 5\u20197\u201d, and the patient\u2019s father is 5\u201910\u201d. The patient\u2019s weight and height are in the 55th and 5th percentile, respectively, which is consistent with her growth curve. On physical exam, the patient has a low hairline and a broad chest. Her lungs are clear with a mild expiratory wheeze. The patient\u2019s abdomen is soft, non-tender, and non-distended. She has Tanner stage I breast development and pubic hair.\n\nThis patient is most likely to have which of the following additional findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 242
}
},
{
"id": "4d995f5dfbdd9b6f",
"text": " A 61-year-old man was started on rosuvastatin 40 mg 8 weeks ago and presents today for a follow-up. He complains of pain in his legs and general weakness. On physical exam, he has full range of motion of his extremities but complains of pain. His blood pressure is 126/84 mm Hg and heart rate is 74/min. The decision is made to stop the statin and return to the clinic in 2 weeks to assess any changes in symptoms. After stopping the statin, his muscular symptoms resolve. What is the next best course of action to take regarding his LDL control?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 243
}
},
{
"id": "a0ac43ba40f258f1",
"text": "An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. The remainder is analyzed and is found to contains type II collagen and chondroitin sulfate. Which of the following structures is most likely the origin of this surgical specimen?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 244
}
},
{
"id": "0c989edc50092378",
"text": "A 70-year-old woman is brought to the emergency department for the evaluation of abdominal pain, nausea, and vomiting for 1 day. Computed tomography shows a small bowel perforation. The patient is prepared for emergent exploratory laparotomy. She is sedated with midazolam, induced with propofol, intubated, and maintained on nitrous oxide and isoflurane for the duration of the surgery. A single perforation in the terminal ileum is diagnosed intraoperatively and successfully repaired. The patient is transferred to the intensive care unit. The ventilator is set at an FiO2 of 50%, tidal volume of 1000 mL, respiratory rate of 12/min, and positive end-expiratory pressure of 2.5 cm H2O. Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 76/min, and blood pressure is 111/50 mm Hg. She is responsive to painful stimuli. Lung examination shows bilateral rales. Abdominal examination shows a distended abdomen and intact abdominal surgical incisions. The remainder of the physical examination shows no abnormalities. Arterial blood gas analysis shows:\npH 7.44\npO2 54 mm Hg\npCO2 31 mm Hg\nHCO3- 22 mm Hg\nWhich of the following is the best next step in the management of this patient?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 245
}
},
{
"id": "7f4a99e76b795e47",
"text": "A 43-year-old man with a history of hepatitis C and current intravenous drug use presents with 5 days of fever, chills, headache, and severe back pain. On physical exam, temperature is 100.6 deg F (38.1 deg C), blood pressure is 109/56 mmHg, pulse is 94/min, and respirations are 18/min. He is thin and diaphoretic with pinpoint pupils, poor dentition, and track marks on his arms and legs. A high-pitched systolic murmur is heard, loudest in the left sternal border and with inspiration. He is admitted to the hospital and started on broad-spectrum antibiotics. One of the blood cultures drawn 12 hours ago returns positive for Staphylococcus aureus. Which of the following is the most appropriate next step to confirm the diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 246
}
},
{
"id": "8cec76ef9197a69d",
"text": "A 42-year-old man with AIDS comes to the physician for intermittent fever, nonproductive cough, malaise, decreased appetite, abdominal pain, and a 3.6-kg (8-lb) weight loss over the past month. He has not seen a doctor since he became uninsured 2 years ago. His temperature is 38.3\u00b0C (100.9\u00b0F). Abdominal examination shows mild, diffuse tenderness throughout the lower quadrants. The liver is palpated 2\u20133 cm below the right costal margin, and the spleen is palpated 1\u20132 cm below the left costal margin. His CD4+ T-lymphocyte count is 49/mm3 (N \u2265 500 mm3). Blood cultures grow acid-fast organisms. A PPD skin test shows 4 mm of induration. Which of the following is the most appropriate pharmacotherapy for this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 247
}
},
{
"id": "3f0e6a2a85776445",
"text": "A 49-year-old woman comes to the physician for a scheduled colposcopy. Two weeks ago, she had a routine Pap smear that showed atypical squamous cells. Colposcopy shows an area of white discoloration of the cervix with application of acetic acid solution. Biopsy of this area shows carcinoma-in-situ. Activation of which of the following best explains the pathogenesis of this condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 248
}
},
{
"id": "36f14e8dbabad452",
"text": "A research group has developed a low-cost diagnostic retinal imaging device for cytomegalovirus retinitis in a population of HIV-infected patients. In a pilot study of 50 patients, the imaging test detected the presence of CMV retinitis in 50% of the patients. An ophthalmologist slit lamp examination, which was performed for each patient to serve as the gold standard for diagnosis, confirmed a diagnosis of CMV retinitis in 20 patients that were found to be positive through imaging, as well as 1 patient who tested negative with the device. If the prevalence of CMV retinitis in the population decreases due to increased access to antiretroviral therapy, how will positive predictive value and negative predictive value of the diagnostic test be affected?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 249
}
},
{
"id": "e9884d1af07a57b6",
"text": "A 35-year-old woman is brought into the clinic by a concerned neighbor who says that the patient is often seen setting up bear traps all around her property because of an impending \u2018invasion of the mole people.\u2019 The patient has come to the clinic wearing a garlic necklace. She vaguely explains that the necklace is to mask her scent from the moles tracking her. She has no past psychiatric history and she denies hearing voices or seeing objects. No significant past medical history. Although she has lived in the same community for years, she says she usually keeps to herself and does not have many friends. She holds a regular job at the local hardware store and lives alone. Which of the following is the best initial course of treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 250
}
},
{
"id": "42d2164b8a527c42",
"text": "A 71-year-old man complains of urinary hesitancy and nocturia of increasing frequency over the past several months. Digital rectal exam was positive for a slightly enlarged prostate but did not detect any additional abnormalities of the prostate or rectum. The patient\u2019s serum PSA was measured to be 6 ng/mL. Image A shows a transabdominal ultrasound of the patient. Which of the following medications should be included to optimally treat the patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 251
}
},
{
"id": "0b10d4692c642aee",
"text": "A 30-year-old man presents to his primary care provider complaining of drowsiness at work for the past several months. He finds his work as a computer programmer rewarding and looks forward to coming into the office every day. However, he often falls asleep during meetings even though he usually gets a good night sleep and has limited his exposure to alcohol and caffeine in the evening. His past medical history is noncontributory. His vital signs are within normal limits. Physical examination is unremarkable. The primary care provider recommends keeping a sleep journal and provides a questionnaire for the patient\u2019s wife. The patient returns one month later to report no changes to his condition. The sleep journal reveals that the patient is getting sufficient sleep and wakes up rested. The questionnaire reveals that the patient does not snore nor does he stop breathing during his sleep. A sleep study reveals mean sleep latency of 6 minutes. Which of the following is the best course of treatment for this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 252
}
},
{
"id": "4dba97f84f7e0d8d",
"text": "A 40-year-old man comes to the physician for the evaluation of a painless right-sided scrotal swelling. The patient reports that he first noticed the swelling several weeks ago, but it is not always present. He has hypertension treated with enalapril. His father was diagnosed with a seminoma at the age of 25 years. The patient has smoked a pack of cigarettes daily for the past 20 years. Vital signs are within normal limits. Physical examination shows a 10-cm, soft, cystic, nontender right scrotal mass that transilluminates. The mass does not increase in size on coughing and it is possible to palpate normal tissue above the mass. There are no bowel sounds in the mass, and it does not reduce when the patient is in a supine position. Examination of the testis shows no abnormalities. Which of the following is the most likely cause of the mass?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 253
}
},
{
"id": "5a7904fb4add65b9",
"text": "A 62-year-old man presents to the physician because of incomplete healing of a chest wound. He recently had a triple coronary artery bypass graft 3 weeks ago. His past medical history is significant for type 2 diabetes mellitus and hypertension for the past 25 years. Clinical examination shows the presence of wound dehiscence in the lower 3rd of the sternal region. The wound surface shows the presence of dead necrotic tissue with pus. Computed tomography (CT) of the thorax shows a small fluid collection with fat stranding in the perisurgical soft tissues. What is the most appropriate next step in the management of the patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 254
}
},
{
"id": "299299f8489442c6",
"text": "The Kozak sequence for the Beta-globin gene has a known mutation which decreases, though does not abolish, translation of the Beta-globin mRNA, leading to a phenotype of thalassemia intermedia. What would the blood smear be expected to show in a patient positive for this mutation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 255
}
},
{
"id": "bf332b275844b024",
"text": "A 68-year-old man from California presents for a routine checkup. He does not have any complaints. He says that he has tried to keep himself healthy and active by jogging and gardening since his retirement at age 50. He adds that he spends his mornings in the park and his afternoons in his garden. He has no significant medical history. The patient denies any smoking history and drinks alcohol occasionally. On physical examination, the following lesion is seen on his scalp (see image). Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 256
}
},
{
"id": "f46d6a703b46db5c",
"text": "A routine newborn screening test for phenylketonuria in a male neonate shows a serum phenylalanine concentration of 44 mg/dL (N < 20). He is started on a special diet and the hyperphenylalaninemia resolves. At a routine well-child examination 4 months later, the physician notices that he has persistent head lag. On examination, he has blue eyes, pale skin, blonde hair, and generalized hypotonia. His serum prolactin level is markedly elevated. Supplementation of which of the following substances is most likely to prevent further complications of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 257
}
},
{
"id": "7ab283dfcd2d8c0b",
"text": "A 36-year-old nursing home worker presents to the clinic with the complaints of breathlessness, cough, and night sweats for the past 2 months. She further expresses her concerns about the possibility of contracting tuberculosis as one of the patients under her care is being treated for tuberculosis. A PPD skin test is done and reads 11 mm on day 3. Chest X-ray demonstrates a cavitary lesion in the right upper lobe. The standard anti-tuberculosis medication regimen is started. At a follow-up appointment 3 months later the patient presents with fatigue. She has also been experiencing occasional dizziness, weakness, and numbness in her feet. Physical exam is positive for conjunctival pallor. Lab work is significant for a hemoglobin level of 10 g/dL and mean corpuscular volume of 68 fl. What is the most likely cause of her current symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 258
}
},
{
"id": "d234254a358ab658",
"text": "A 23-year-old woman is referred to a genetic counselor. She is feeling well but is concerned because her brother was recently diagnosed with hereditary hemochromatosis. All first-degree relatives were encouraged to undergo genetic screening for any mutations associated with the disease. Today, she denies fever, chills, joint pain, or skin hyperpigmentation. Her temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 85/min, respirations are 16/min, and blood pressure is 123/78 mm Hg. Her physical examination is normal. Her serum iron, hemoglobin, ferritin, and AST and ALT concentrations are normal. Gene screening will involve a blood specimen. Which of the following genes would suggest hereditary hemochromatosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 259
}
},
{
"id": "0391916cc2f6a931",
"text": "A 16-year-old girl is brought to the emergency department with constant abdominal pain over the past 8 hours. The pain is in her right lower quadrant (RLQ), which is also where it began. She has had no nausea or vomiting despite eating a snack 2 hours ago. She had a similar episode last month which resolved on its own. Her menstrual cycles are 28\u201330 days apart with 3\u20135 days of vaginal bleeding. Her last menses ended 9 days ago. Her blood pressure is 125/75 mm Hg, the pulse is 78/min, the respirations are 15/min, and the temperature is 37.2\u00b0C (99.0\u00b0F). Abdominal examination shows moderate pain on direct pressure over the RLQ which decreases with the release of pressure. The remainder of the physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 12.5 mg/dL\nLeukocyte count 6000/mm3\nSegmented neutrophils 55%\nLymphocytes 39%\nPlatelet count 260,000/mm3\nSerum \nC-reactive protein 5 mg/L (N < 8 mg/L)\nUrine \nRBC 1-2 phf\nWBC None\nWhich of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 260
}
},
{
"id": "61d39538b482803d",
"text": "A 30-year-old male presents to the emergency department with a complaint of abdominal pain. The patient states he was at a barbecue around noon. Lunch was arranged as a buffet without refrigeration. Within 2 to 3 hours, he had abdominal pain with 3 episodes of watery diarrhea. On exam, vital signs are T 99.1, HR 103, BP 110/55, RR 14. Abdominal exam is significant for pain to deep palpation without any rebounding or guarding. There is no blood on fecal occult testing (FOBT). What is the most likely cause of this patient's presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 261
}
},
{
"id": "81c51b5205ff91aa",
"text": "A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of worsening confusion for the past week. He has a history of major depressive disorder and had an ischemic stroke 4 months ago. Current medications are aspirin and sertraline. He is lethargic and disoriented. His pulse is 78/min, and blood pressure is 135/88 mm Hg. Physical examination shows moist oral mucosa, normal skin turgor, and no peripheral edema. While in the waiting room, he has a generalized, tonic-clonic seizure. Laboratory studies show a serum sodium of 119 mEq/L and an elevated serum antidiuretic hormone concentration. Which of the following sets of additional laboratory findings is most likely in this patient?\n $$$ Serum osmolality %%% Urine sodium %%% Serum aldosterone $$$",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 262
}
},
{
"id": "a5a9cbd55c30f880",
"text": "A 35-year-old woman presents with severe fear reactions to seeing dogs after moving into a new suburban neighborhood. She states that she has always had an irrational and excessive fear of dogs but has been able to avoid it for most of her life while living in the city. When she sees her neighbors walking their dogs outside, she is terrified and begins to feel short of breath. Recently, she has stopped picking up her children from the bus stop and no longer plays outside with her children in order to avoid seeing any dogs. Which of the following would be the best definitive treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 263
}
},
{
"id": "e6fe7fdc9e0cfbe2",
"text": "A 45-year-old man arrives by ambulance to the emergency room after being involved in a very severe construction accident. The patient was found unconscious with a large metal spike protruding from his abdomen by a coworker who was unable to estimate the amount of time the patient went without medical aid. Upon arrival to the ER, the patient was unconscious and unresponsive. His vital signs are BP: 80/40, HR: 120 bpm, RR: 25 bpm, Temperature: 97.1 degrees, and SPO2: 99%.He is taken to the operating room to remove the foreign body and control the bleeding. Although both objectives were accomplished, the patient had an acute drop in his blood pressure during the surgery at which time ST elevations were noted in multiple leads. This resolved with adequate fluid resuscitation and numerous blood transfusions. The patient remained sedated after surgery and continued to have relatively stable vital signs until his third day in the intensive care unit, when he experiences an oxygen desaturation of 85% despite being on a respirator with 100% oxygen at 15 breaths/minute. On auscultation air entry is present bilaterally with the presence of crackles. A 2/6 systolic murmur is heard. Readings from a Swan-Ganz catheter display the following: central venous pressure (CVP): 4 mmHg, right ventricular pressure (RVP) 20/5 mmHg, pulmonary artery pressure (PAP): 20/5 mmHg. Pulmonary capillary wedge pressure (PCWP): 5 mm Hg. A chest x-ray is shown as Image A. The patient dies soon after this episode. What is the most likely direct cause of his death?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 264
}
},
{
"id": "12336bc02f12eb24",
"text": "A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion in the setting of a 20 pound weight loss. He is a 60 pack-year smoker, worked as a shipbuilder 30 years ago, and recently traveled to Ohio to visit family. Chest radiograph shows increased bronchovascular markings, reticular parenchymal opacities, and multiple pleural plaques. Labs are unremarkable except for a slight anemia. Which of the following is the most likely finding on this patient's chest CT?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 265
}
},
{
"id": "38fc859d3615c14a",
"text": "A 60-year-old man presents with a 2-day history of increasing difficulty in breathing with a productive cough. He reports having shortness of breath over the last 6 months, but he has felt worse since he contracted a cold that has been traveling around his office. Today, he reports body aches, headache, and fever along with this chronic cough. His past medical history is significant for prediabetes, which he controls with exercise and diet. He has a 30-pack-year smoking history. His blood pressure is 130/85 mmHg, pulse rate is 90/min, temperature is 36.9\u00b0C (98.5\u00b0F), and respiratory rate is 18/min. Physical examination reveals diminished breath sounds bilateral, a barrel-shaped chest, and measured breathing through pursed lips. A chest X-ray reveals a flattened diaphragm and no signs of consolidation. Pulmonary function testing reveals FEV1/FVC ratio of 60%. Arterial blood gases (ABG) of this patient are most likely to reveal which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 266
}
},
{
"id": "7d6546b7c606ef32",
"text": "A 34-year-old male suffers from inherited hemophilia A. He and his wife have three unaffected daughters. What is the probability that the second daughter is a carrier of the disease?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 267
}
},
{
"id": "cf3adb489568bde7",
"text": "A 76-year-old man is brought to his physician's office by his wife due to progressively worsening hearing loss. The patient reports that he noticed a decrease in his hearing approximately 10 years ago. His wife says that he watches television at an elevated volume and appears to have trouble understanding what is being said to him, especially when there is background noise. He states that he also experiences constant ear ringing and episodes of unsteadiness. On physical examination, the outer ears are normal and otoscopic findings are unremarkable. The patient is unable to repeat the sentence said to him on whisper testing. When a vibrating tuning fork is placed in the middle of the patient's forehead, it is heard equally on both ears. When the vibrating tuning fork is placed by the ear and then on the mastoid process, air conduction is greater than bone conduction. Which of the following structures is most likely impaired in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 268
}
},
{
"id": "877ee34ceee3065e",
"text": "A 13-year-old boy is brought to the emergency department by his mother because of a 6-hour history of severe eye pain and blurry vision. He wears soft contact lenses and has not removed them for 2 days. Ophthalmologic examination shows a deep corneal ulcer, severe conjunctival injection, and purulent discharge on the right. Treatment with topical ciprofloxacin is initiated. A culture of the ocular discharge is most likely to show which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 269
}
},
{
"id": "93a37c9fe72d7087",
"text": "A 31-year-old female patient complains of numbness and tingling in her left hand, weakness, difficulty with walking, dizziness, and bladder dysfunction. She said that about a year ago, she had trouble with her vision, and that it eventually recovered in a few days. On physical exam, bilateral internuclear ophthalmoplegia, hyperreflexia in both patella, and bilateral clonus, are noted. A magnetic resonance imaging (MRI) study was done (Figure 1). If a lumbar puncture is performed in this patient, which of the following would most likely be found in cerebrospinal fluid analysis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 270
}
},
{
"id": "5e0476c201cf3634",
"text": "A 22-year-old primigravida presents for a regular prenatal visit at 16 weeks gestation. She is concerned about the results of a dipstick test she performed at home, which showed 1+ glucose. She does not know if her liquid consumption has increased, but she urinates more frequently than before. The course of her pregnancy has been unremarkable and she has no significant co-morbidities. The BMI is 25.6 kg/cm2 and she has gained 3 kg (6.72 lb) during the pregnancy. The blood pressure is 110/80 mm Hg, the heart rate is 82/min, the respiratory rate is 14/min, and the temperature is 36.6\u2103 (97.9\u2109). The lungs are clear to auscultation, the heart sounds are normal with no murmurs, and there is no abdominal or costovertebral angle tenderness. The laboratory tests show the following results:\nFasting glucose 97 mg/L\nALT 12 IU/L\nAST 14 IU/L\nTotal bilirubin 0.8 mg/dL(15 \u00b5mol/L)\nPlasma creatinine 0.7 mg/dL (61.9 \u00b5mol/L)\nWhich of the following tests are indicated to determine the cause of the abnormal dipstick test results?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 271
}
},
{
"id": "f31b1128da895f40",
"text": "A 9-month-old boy is brought to the physician by his mother because of intermittent watery diarrhea for several months. Pregnancy and delivery were uncomplicated. He was diagnosed with eczematous dermatitis at 3 months old. His height and weight are below the 5th percentile. Immunologic evaluation shows a defect in activated regulatory T cells. A genetic analysis shows a mutation in the FOXP3 gene. This patient is at increased risk for which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 272
}
},
{
"id": "46cd09116a6a20e3",
"text": "A 57-year-old man comes to the physician because of a 3-week history of abdominal bloating and increased frequency of stools. He describes the stools as bulky, foul-smelling, and difficult to flush. He also has a 4-month history of recurrent dull upper abdominal pain that usually lasts for a few days, worsens after meals, and is not relieved with antacids. He has had a 10-kg (22-lb) weight loss in the past 4 months. He has no personal or family history of serious illness. He has smoked 1 pack of cigarettes daily for 37 years. He has a 12-year history of drinking 6 to 8 beers daily. He is 160 cm (5 ft 3 in) tall and weighs 52 kg (115 lb); BMI is 20 kg/m2. His vital signs are within normal limits. Abdominal examination shows mild epigastric tenderness without rebound or guarding. Bowel sounds are normal. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 273
}
},
{
"id": "9c958854b7ce9cfa",
"text": "A 67-year-old white man presents to his primary care provider for an annual examination. He notes a pink bump that has rapidly developed on his forehead over the last month. In the past, he has had significant sun exposure including multiple blistering sunburns. The physical examination reveals a 2 cm dome-shaped plaque with a central keratin plug (as shown in the image). Excisional biopsy of the lesion reveals an exophytic nodule with central invagination, full of keratin. Keratinocyte atypia is minimal. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 274
}
},
{
"id": "08f1efc799caad3a",
"text": "A 56-year-old man presents to his primary care doctor with intermittent chest pain. He reports a 2-month history of exertional chest pain that commonly arises after walking 5 or more blocks. He describes the pain as dull, burning, non-radiating substernal pain. His past medical history is notable for hypercholesterolemia and hypertension. He takes simvastatin and losartan. His temperature is 98.9\u00b0F (37.2\u00b0C), blood pressure is 150/85 mmHg, pulse is 88/min, and respirations are 18/min. On exam, he is well-appearing and in no acute distress. S1 and S2 are normal. No murmurs are noted. An exercise stress test is performed to further evaluate the patient\u2019s pain. Which of the following substances is released locally to increase coronary blood flow during exertion?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 275
}
},
{
"id": "4244db229f0155e6",
"text": "A 69-year-old male with a history of metastatic small cell lung carcinoma on chemotherapy presents to his oncologist for a follow-up visit. He has responded well to etoposide and cisplatin with plans to undergo radiation therapy. However, he reports that he recently developed multiple \u201cspots\u201d all over his body. He denies any overt bleeding from his gums or joint swelling. His past medical history is notable for iron deficiency anemia, osteoarthritis, and paraneoplastic Lambert-Eaton syndrome. He has a 40 pack-year smoking history. His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 130/70 mmHg, pulse is 115/min, and respirations are 20/min. On examination, a rash is noted diffusely across the patient\u2019s trunk and bilateral upper and lower extremities.\n\nResults from a complete blood count are shown below:\nHemoglobin: 11.9 mg/dl\nHematocrit: 35%\nLeukocyte count: 5,000/mm^3\nPlatelet count: 20,000/mm^3\n\nThe oncologist would like to continue chemotherapy but is concerned that the above results will limit the optimal dose and frequency of the regimen. A recombinant version of which of the following is most appropriate in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 276
}
},
{
"id": "d6f2c4c54dbb5ba2",
"text": "A 60-year-old man with a history of osteoarthritis has been awaiting hip replacement surgery for 3 years. During his annual physical, he reports that he has been taking over the counter pain medications, but that no amount of analgesics can relieve his constant pain. Laboratory results reveal that his renal function has deteriorated when compared to his last office visit 2 years ago. Serum creatinine is 2.0 mg/dL, and urinalysis shows 1+ proteinuria. There are no abnormalities seen on microscopy of the urine. A renal biopsy shows eosinophilic infiltration and diffuse parenchymal inflammation. What is the most likely explanation for this patient's deterioration in renal function?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 277
}
},
{
"id": "1bd0804aba177d16",
"text": "A 62-year-old man presents to the emergency department with shortness of breath. The patient says he feels as if he is unable to take a deep breath. The patient has a past medical history of COPD and a 44-pack-year smoking history. The patient has been admitted before for a similar presentation. His temperature is 98.7\u00b0F (37.1\u00b0C), blood pressure is 177/118 mmHg, pulse is 123/min, respirations are 33/min, and oxygen saturation is 80% on room air. The patient is started on 100% oxygen, albuterol, ipratropium, magnesium, and prednisone. The patient claims he is still short of breath. Physical exam reveals bilateral wheezes and poor air movement. His oxygen saturation is 80%. Which of the following is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 278
}
},
{
"id": "ce3273b41ccfe11d",
"text": "A 76-year-old man is brought to the physician by his wife because of low back pain and weakness for the past 4 weeks. He says that the pain is sharp, radiates to his left side, and has a burning quality. He has had a cough occasionally productive of blood-streaked sputum for the past 2 months. He has had 3.2-kg (7.0-lb) weight loss in that time. He is now unable to walk without assistance and has had constipation and difficulty urinating for the past 2 weeks. He has hypertension treated with enalapril. He has smoked 1 pack of cigarettes daily for 60 years. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 75/min, and blood pressure is 150/80 mm Hg. He is oriented to person, place, and time. Neurologic examination shows 3/5 strength of the lower extremities. Deep tendon reflexes are hyperreflexive. Babinski sign is present bilaterally. Sensory examination shows decreased sensation to pinprick below the T4 dermatome. He is unable to lie recumbent due to severe pain. An x-ray of the chest shows multiple round opacities of varying sizes in both lungs. Which of the following is the most appropriate next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 279
}
},
{
"id": "5779703f649a0487",
"text": "A 32-year-old man arrives to his primary care physician to discuss his fear of flying. The patient reports that he has had a fear of flying since being a teenager. He went on a family vacation 15 years ago, and during the flight there was turbulence and a \u201crough landing\u201d. Since then he has avoided flying. He did not go to his cousin\u2019s wedding because it was out of the country. He also was unable to visit his grandmother for her 80th birthday. The last time his job asked him to meet a client out of state, he drove 18 hours instead of flying. Two years ago he promised his fianc\u00e9 they could fly to Florida. Upon arrival at the airport, he began to feel dizzy, lightheaded, and refused to go through security. During the clinic visit, the patient appears anxious and distressed. He recognizes that his fear is irrational. He is upset that it is affecting his relationship with his wife. Additionally, his current job may soon require employees in his sales position to fly to meet potential clients. He is embarrassed to have a conversation with his manager about his fear of flying. Which of the following is the best therapy for the patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 280
}
},
{
"id": "1fa6124092c3299e",
"text": "A 75-year-old man presents to a medical clinic for evaluation of a large, tense, pruritic bulla on his inner thighs, abdomen, and lower abdomen. A skin biopsy is performed, which shows an epidermal basement membrane with immunoglobulin G (IgG) antibodies and linear immunofluorescence. Which of the following is the most likely cell junction to which the antibodies bind?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 281
}
},
{
"id": "fb9a0486e1a5f69d",
"text": "A 16-year-old girl is brought to the physician by her father because of concerns about her behavior during the past 2 years. She does not have friends and spends most of the time reading by herself. Her father says that she comes up with excuses to avoid family dinners and other social events. She states that she likes reading and feels more comfortable on her own. On mental status examination, her thought process is organized and logical. Her affect is flat. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 282
}
},
{
"id": "d59db272a1d1f409",
"text": "Twelve hours after admission to the hospital because of a high-grade fever for 3 days, a 15-year-old boy has shortness of breath. During this period, he has had generalized malaise and a cough productive of moderate amounts of green sputum. For the past 10 days, he has had fever, a sore throat, and generalized aches; these symptoms initially improved, but worsened again over the past 5 days. His temperature is 38.7\u00b0C (101.7\u00b0F), pulse is 109/min, respirations are 27/min, and blood pressure is 100/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. There are decreased breath sounds and crackles heard over the upper right lung field. His hemoglobin concentration is 13.3 g/dL, leukocyte count is 15,000/mm3, and platelet count is 289,000/mm3. An x-ray of the chest shows a right upper-lobe infiltrate. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 283
}
},
{
"id": "0e3e3a4d520f941a",
"text": "An elderly man presents to his physician with complaints of difficulty breathing, easy fatigability, and bilateral leg swelling which began 2 months ago. His breathlessness worsens while walking, climbing the stairs, and lying flat on his back. He also finds it difficult to sleep well at night, as he often wakes up to catch his breath. His pulse is 98/min and blood pressure is 114/90 mm Hg. On examination, he has mild respiratory distress, distended neck veins, and bilateral pitting edema is evident on the lower third of his legs. His respiratory rate is 33/min, SpO2 is 93% in room air, and coarse crepitations are heard over the lung bases. On auscultation, the P2 component of his second heart sound is heard loudest at the second left intercostal space, and an S3 gallop rhythm is heard at the apex. Medication is prescribed for his symptoms which changes his cardiac physiology as depicted with the dashed line recorded post-medication. What is the mechanism of action of the prescribed medication?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 284
}
},
{
"id": "482f53f97e2b9cf2",
"text": "A 30-year-old man presents to his primary care physician with complaints of excessive fatigue and weakness for the last several weeks. He also complains of abdominal pain and constipation for the same duration. On further questioning, he reports that he has lost 8 pounds in the last 2 weeks. Past medical history and family history are insignificant. His temperature is 37.3\u00b0 C (99.2\u00b0 F), respirations are 21/min, pulse is 63/min, and blood pressure is 99/70 mm Hg. On physical examination, he is a tired-appearing, thin male. He has a bronze discoloration to his skin, but he denies being outside in the sun or any history of laying in tanning beds. What is the next best step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 285
}
},
{
"id": "4a4294389901d979",
"text": "A 27-year-old HIV positive female gave birth to a 7lb 2oz (3.2 kg) baby girl. The obstetrician is worried that the child may have been infected due to the mother's haphazard use of her anti-retroviral medications. Which of the following assays would a hospital use detect the genetic material of HIV if the child had been infected?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 286
}
},
{
"id": "b8baebe1420e2c83",
"text": "A 53-year-old man presents to his physician\u2019s office with a persistent cough which he has had over the last few months. He was diagnosed with chronic obstructive pulmonary disease (COPD) the previous year and since then has been on a short-acting \u03b2-agonist to help alleviate his symptoms. Since his diagnosis, he has quit smoking, a habit which he had developed about 30 years ago. He used to smoke about 2 packs of cigarettes daily. Today, he has come in with an increase in his symptoms. He tells his physician that he has been having a fever for the past 3 days, ranging between 37.8\u00b0\u201339\u00b0C (100\u00b0F\u2013102.2\u00b0F). Along with this, he has a persistent cough with copious amounts of greenish-yellow sputum. He has also been having difficulty breathing. On examination, his temperature is 38.6\u00b0C (101.5\u00b0F), the respirations are 22/min, the blood pressure is 110/80 mm Hg, and the pulse is 115/min. Slight crackles and respiratory wheezes are prominent in the lower lung fields. His FEV1 is 57% of his normal predicted value. He is started on oxygen and a dose of oral prednisone. At this time, which of the following should also be considered as a treatment option?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 287
}
},
{
"id": "4587dc2452b14c7f",
"text": "An 8-year-old boy is brought to the physician because of headaches for the past 2 weeks. His headaches tend to occur in the morning and are associated with nausea and vomiting. One month ago, the patient was admitted to the hospital because of fever, irritability, and neck rigidity, and he was successfully treated with antibiotics. His temperature today is 37.5\u00b0C (98.5\u00b0F). An MRI of the brain shows bilateral ventricular enlargement and enlargement of the subarachnoid space. Which of the following is the most likely explanation of the patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 288
}
},
{
"id": "36333b6d98a47b1d",
"text": "A previously healthy 2-year-old boy is brought to the physician because of a 10-day history of unsteady gait, frequent falls, and twitching of the extremities. Physical examination shows bilateral saccadic eye movement in all directions and brief, involuntary muscle contractions of the trunk and limbs. There is an ill-defined, nontender mass in the upper right abdomen. He undergoes surgical resection of the tumor. Histopathologic examination of this mass is most likely to show which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 289
}
},
{
"id": "a24a4dedfe66dfc0",
"text": "In a study, 2 groups are placed on different statin medications, statin A and statin B. Baseline LDL levels are drawn for each group and are subsequently measured every 3 months for 1 year. Average baseline LDL levels for each group were identical. The group receiving statin A exhibited an 11 mg/dL greater reduction in LDL in comparison to the statin B group. Statistical analysis reports a p-value of 0.052. Which of the following best describes the meaning of this p-value?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 290
}
},
{
"id": "261207ec8743a72d",
"text": "A 32-year-old woman presents to the emergency department because she has a cord-like rash on her left calf that is red and painful to touch. She says that she has had multiple such lesions previously. Other medical history reveals that she has had 3 past spontaneous abortions at < 10 weeks of gestational age but has never been diagnosed with any diseases. She drinks socially but has never smoked or used drugs. She has never taken any medications except for over the counter analgesics and antipyretics. Physical exam shows that the cord-like lesion is tender, thick, and hardened on palpation. In addition, she has a lacy mottled violaceous rash on multiple extremities. Which of the following antibodies would most likely be found in this patient's blood?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 291
}
},
{
"id": "6dba165f8f48e932",
"text": "A 28-year-old female visits her physician for workup of a new onset diastolic murmur found on physical examination. Past medical history is insignificant. Her temperature is 37.0 degrees C, blood pressure is 115/75 mm Hg, pulse is 76/min, and respiratory rate is 16/min. The patient denies dyspnea, fatigue, and syncope. Transthoracic echocardiography reveals a large, pedunculated tumor in the left atrium. This patient is most at risk for:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 292
}
},
{
"id": "3199b2c3bb4178bf",
"text": "An 8-year-old girl presents to the emergency department with respiratory distress, facial edema, and a skin rash after eating a buffet dinner with her family. She was born at 39 weeks via spontaneous vaginal delivery, has met all developmental milestones and is fully vaccinated. Past medical history is significant for mild allergies to pet dander and ragweed, as well as a severe peanut allergy. She also has asthma. She normally carries both an emergency inhaler and EpiPen but forgot them today. Family history is noncontributory. The vital signs include: blood pressure 112/87 mm Hg, heart rate 111/min, respiratory rate 25/min, and temperature 37.2\u00b0C (99.0\u00b0F). On physical examination, the patient has severe edema over her face and an audible stridor in both lungs. Of the following options, which is the most appropriate next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 293
}
},
{
"id": "18313cfe1410be77",
"text": "An investigator is studying the cell morphologies of the respiratory tract. He obtains a biopsy from the mainstem bronchus of a patient. On microscopic examination, the biopsy sample shows uniform squamous cells in layers. Which of the following best describes the histologic finding seen in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 294
}
},
{
"id": "cba803eaca281504",
"text": "A 32-year-old female complains to her gynecologist that she has had irregular periods for several years. She has severe facial acne and dense black hairs on her upper lip, beneath her hairline anterior to her ears, and the back of her neck. Ultrasound reveals bilateral enlarged ovaries with multiple cysts. Which of the following is the patient most likely increased risk of developing?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 295
}
},
{
"id": "1a7f2da00f883496",
"text": "A 52-year-old fisherman presents to the clinic for an evaluation of a pigmented lesion on his neck. He states that he first noticed the lesion last year, but he believes that it has been slowly growing in size. Dermatopathology determines that the lesion contains neoplastic cells of melanocytic origin. Which of the following characteristics of the lesion would likely be found on physical examination?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 296
}
},
{
"id": "d23017c4dceb72e2",
"text": "Two days after being admitted to the hospital following a fall, a 77-year-old woman complains of fatigue and headaches. During the fall she sustained a right-sided subdural hematoma. She has hypertension and hyperlipidemia. Her medications prior to admission were hydrochlorothiazide and atorvastatin. Vital signs are within normal limits. Physical and neurologic examinations show no abnormalities. Laboratory studies show:\nSerum\nNa+ 130 mEq/L\nK+ 4.0 mEq/L\nCl- 103 mEq/L\nHCO3- 24 mEq/L\nUrea nitrogen 14 mg/dL\nCreatinine 1.1 mg/dL\nOsmolality 270 mOsmol/kg H2O\nUrine\nSodium 45 mEq/L\nOsmolality 326 mOsmol/kg H2O\nA CT scan of the head shows an unchanged right-sided subdural hematoma. Which of the following is the most appropriate next step in management?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 297
}
},
{
"id": "386d31519f6a2689",
"text": "An 18-month-old girl is brought to the pediatrician by her mother for vaginal bleeding. The mother states that she noticed the bleeding today, which appeared as brown discharge with clots in the patient\u2019s diaper. The mother denies frequent nosebleeds or easy bruising. She also denies any known trauma. She does mention that the patient has been limping and complaining of left leg pain since a fall 2 months ago. On physical exam, there are multiple 2-3 cm hyperpigmented patches on the patient\u2019s trunk. There is bilateral enlargement of the breasts but no pubic hair. The vaginal orifice is normal and clear with an intact hymen. A plain radiograph of the left lower leg shows patchy areas of lytic bone and sclerosis within the femoral metaphysis. Which of the following is associated with the patient\u2019s most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 298
}
},
{
"id": "8c7ef9399ca8b72a",
"text": "A 72-year-old woman is admitted to the hospital for treatment of unstable angina. Cardiac catheterization shows occlusion that has caused a 50% reduction in the diameter of the left circumflex artery. Resistance to blood flow in this vessel has increased by what factor relative to a vessel with no occlusion?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 299
}
},
{
"id": "89c3b44577201f77",
"text": "A 5-year-old boy is brought to the physician because of an irregular gait 3 days after receiving age-appropriate vaccinations. Examination of the lower extremities shows no redness or swelling. When the child stands on his right leg, his left leg drops and his pelvis tilts towards the left. Sensation to light touch is normal in both legs. This patient's symptoms are most likely due to the injection of the vaccine into which of the following locations?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 300
}
},
{
"id": "93d6b4c8619ec18d",
"text": "A 2-year-old boy is brought to the physician because of decreased appetite and abdominal pain for the last several weeks. Physical examination shows a well-appearing toddler with a palpable left-sided abdominal mass that does not cross the midline. A CT of the abdomen shows a large, necrotic tumor on the left kidney. Histological examination of the kidney mass shows primitive blastemal cells and immature tubules and glomeruli. This tissue is most likely derived from the same embryological structure as which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 301
}
},
{
"id": "01fcbf856b963069",
"text": "A 14-year-old boy is brought to the physician because of an increasing difficulty in hearing over the past several months. His mother says they have to speak at a higher volume for him to understand them. He also complains of having difficulty reading his favorite books because he is not able to see the words clearly. His father received a renal transplant in his 20s. The vital signs are within normal limits. The physical examination shows no abnormalities. Laboratory studies show:\nSerum\nUrea nitrogen 15 mg/dL\nCreatinine 1.0 mg/dL\nUrine\nBlood 1+\nProtein 1+\nRBC 15\u201317/hpf\nWBC 1\u20132/hpf\nThe audiometry shows bilateral high-frequency sensorineural hearing loss. The ophthalmologic examination shows anterior lenticonus. Which of the following best explains these findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 302
}
},
{
"id": "58883c3af4e44bf3",
"text": "A 16-year-old female presents to her primary care physician due to lack of menstruation. She has never had a period and is anxious that she is not \u201ckeeping up\u201d with her friends. She states that her breasts began developing when she was 13, and she had a growth spurt around the same time. Review of systems reveals that she has also been getting headaches every few months over the last year with some photosensitivity and nausea each time. Ibuprofen relieves her symptoms. The patient is a competitive ice skater and has never been sexually active. Her mother has a history of migraine headaches, and her older sister has a history of bipolar disorder. Both underwent menarche at age 15. At this visit, the patient\u2019s temperature is 98.6\u00b0F (37.0\u00b0C), pulse is 70/min, blood pressure is 118/65 mmHg, and respirations are 13/min. Her body mass index is 23.8 kg/m^2. Cardiopulmonary and abdominal exams are unremarkable. Both breasts are Tanner IV with no expressable discharge. Pelvic and axillary hair growth is also Tanner IV. The patient is unable to tolerate a full pelvic exam, but the part of the vaginal canal that is examined is unremarkable. Laboratory studies are ordered and are below:\n\nSerum:\nNa+: 139 mEq/L\nK+: 4.1 mEq/L\nCl-: 100 mEq/L\nHCO3-: 24 mEq/L\nUrea nitrogen: 12 mg/dL\nGlucose: 73 mg/dL\nCreatinine: 0.9 mg/dL\nCa2+: 9.7 mg/dL\nMg2+: 1.7 mEq/L\nAST: 11 U/L\nALT: 11 U/L\nFollicle Stimulating Hormone (FSH): 16.2 mIU/mL (4.7-21.5 mIU/ml)\nEstrogen: 240 pg/mL (64-357 pg/mL)\n\nAbdominal ultrasound is performed and shows a normal uterus and ovaries. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 303
}
},
{
"id": "5c79dad782c02fa3",
"text": "A 35-year-old man presents to the emergency room due to shortness of breath that started an hour ago while playing football with some friends. He has had similar episodes in the past when he also had to be rushed to the hospital. Physical examination shows body temperature is 37.2\u00b0C (98.9\u00b0F), pulse rate is 100/min, respiratory rate is 28/min and blood pressure is 110/60 mm Hg. Also, it shows decreased breath sounds on both sides, the peak expiratory flow rate is 200 L/min and SpO2 is 89% on room air. The man is given an initial treatment with nebulization using an inhaled short-acting \u03b2-agonist. An arterial blood gas analysis shows the following:\npH 7.48\nPaO2 59 mm Hg\nPaCO2 26 mm Hg\nHCO3- 26 mEq/L\nAfter administering oxygen by mask, the man\u2019s PaO2 increases to 75 mm Hg. Which of the following is the most likely cause of this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 304
}
},
{
"id": "f00efc0a654ccd61",
"text": "A 48-year-old homeless male is brought to the emergency department, by the police, for altered mental status. Past medical records are unavailable. A physical exam on admission reveals scleral icterus and a flapping tremor of the wrists during extension. The patient is admitted to the hospital and his treatment is started after appropriate investigation. The next morning on rounds, he complains of eleven episodes of diarrhea and near-constant flatulence overnight. His mental status has improved and his hand tremor has resolved. Which of the following medications did this patient most likely receive after admission?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 305
}
},
{
"id": "d0e99d87312fd319",
"text": "A 61-year-old man presents to his primary care provider complaining of abdominal pain and constipation. He reports a 4-day history of steady right lower quadrant pain. He has had one small bowel movement in 4 days. Normally he has a bowel movement once a day. His medical history is notable for poorly controlled hypertension and hyperlipidemia. He takes enalapril, hydrochlorothiazide, aspirin, and atorvastatin. He has a 40 pack-year smoking history and drinks 3-4 beers per day. His diet consists primarily of fast food. His temperature is 101.8\u00b0F (38.8\u00b0C), blood pressure is 160/95 mmHg, pulse is 90/min, and respirations are 16/min. A review of the patient\u2019s medical record reveals colonoscopy results from 1 year ago. Relevant findings included multiple small, pedunculated polyps which were removed, multiple colonic mucosal outpouchings, and no other masses. This patient\u2019s condition is most strongly associated with which of the following disorders?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 306
}
},
{
"id": "6fcd2acb4c341e7f",
"text": "A 67-year-old man is brought to the emergency department with sudden onset of slurred speech. The patient\u2019s eldest daughter says that he couldn\u2019t move his arm during the episode. Past medical history is significant for hypertension and a hemorrhagic stroke 6 years ago, which was treated surgically. After admission, the patient gets increasingly worse and loses consciousness. A noncontrast CT of the head shows a subarachnoid hemorrhage (SAH). The patient is taken to the operating room, where the SAH evacuated, and the vessel is repaired. Postoperatively, the patient is unresponsive. Several days later, a repeat CT of the head shows an enlarging aneurysm in a different vessel in the brain. The patient\u2019s daughter is asked to consent to a non-emergent, life-saving operation since the patient is in a comatose state. She does not consent to the operation even though the physician stresses it would be life-saving. Upon further discussion, the physician finds out that the patient was abusive and neglectful to his children, and the daughter wants \u201cto live in peace.\u201d The patient has no written advanced directive. Which of the following is the most appropriate course of action?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 307
}
},
{
"id": "2a9beb60159edf73",
"text": "A 50-year-old man with congestive heart failure (CHF) was started on an experimental analog of atrial natriuretic peptide. Which of the following would he expect to experience?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 308
}
},
{
"id": "5978b1cbb9b0836e",
"text": "A 56-year-old man is brought to the emergency room after a motor vehicle accident. The patient\u2019s vitals are as follows: blood pressure 80/40 mm Hg, heart rate 111/min, respiratory rate 39/min, and temperature 37.1\u00b0C (98.8\u2109). On physical examination, the patient is unconscious with a GCS of 9/15 and is cyanotic. There are open fractures of the left femur and left tibia, a likely shoulder dislocation, multiple contusions on the limbs and thorax, and a puncture wound on the left side of his chest. There are no breath sounds on the left side and there is hyperresonance to percussion on the left. Preparations are made for an emergency needle thoracostomy to be performed to treat this patient\u2019s likely tension pneumothorax. Which one of the following is the best choice to provide informed consent for this procedure?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 309
}
},
{
"id": "792ab3c8994ac062",
"text": "A group of researchers wants to evaluate how often the human immunodeficiency virus (HIV) is related to high-risk behaviors in female sex workers from their country. An additional aim is to evaluate the association between HIV acquisition and certain sociodemographic factors. The researchers collect data through interviewer-administered questionnaires (for behavioral and sociodemographic data) as well as through clinical and serological evaluation/screening methods for HIV and other sexually transmitted infections. Which of the following could be the main outcome measure of their study?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 310
}
},
{
"id": "067c50d5a1311cb1",
"text": "A 53-year-old man comes to the physician because of a 2-month history of multiple episodes of small amounts of blood in his stools. Examination shows pale conjunctivae. His hemoglobin concentration is 8.3 g/dL and mean corpuscular volume is 72\u03bcm3. Colonoscopy shows a 2.3-cm polypoid mass in the ascending colon. A photomicrograph of a biopsy specimen of the lesion is shown. Which of the following processes is most likely to be involved in the pathogenesis of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 311
}
},
{
"id": "1365883c93bc3d0e",
"text": "A 68-year-old female presents to her primary care physician with a 7-month history of fatigue and low back pain. Her pain is not improved by over the counter analgesics. Laboratory analysis is notable for a calcium level of 11.5 mg/dL, creatinine level of 2.0 mg/dL, and blood urea nitrogen level of 30 mg/dL. Large eosinophilic casts are seen on renal biopsy. Which of the following findings is most likely to be seen on peripheral blood smear?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 312
}
},
{
"id": "d761ee468eec8784",
"text": "A 95-year-old woman who is a resident at a long term care facility, got up from her chair, tripped on a rug, and fell on her right knee. She could not get up without assistance and complained of severe pain in her right hip and buttock. The nurse who evaluated her tried to stand her up, but when the patient tried to stand on her right leg, she dropped her left hip and lost her balance. The nurse then recognized that her patient had a foreshortened right leg fixed in the adducted position and a large swelling in her right buttock. At the receiving hospital, the patient was confused and, though she knew her name, she couldn\u2019t remember the date and insists to leave the hospital immediately to see her family. Past medical history includes diabetes, congestive heart failure, and incontinence. She is currently taking metformin, lisinopril, hydrochlorothiazide, metoprolol, and oxybutynin. Physical exam confirmed the nurse\u2019s findings. Radiographs proved the presence of a right posterior hip dislocation without fractures. What medication is most likely associated with this patient\u2019s confusion?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 313
}
},
{
"id": "ff9500beb387362e",
"text": "A 26-year-old woman comes to the clinic for an annual wellness examination. She is healthy with no prior history of significant illness. She exercises 3-4 times a week and eats a plant-based diet with no carbonated drinks. When asked if anything is bothering her, she reports that she has been having recurring episodes of sneezing, congestion, and itchy eyes for the past year. She denies any fever, sick contacts, cough, headaches, chest pain, urinary symptoms, or constipation/diarrhea during these episodes. She is told to take a medication to alleviate her symptoms as needed. What is the likely mechanism of action of the medication in question?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 314
}
},
{
"id": "4e96c2ae72d6a8b9",
"text": "A 27-year-old woman was referred to a dermatology clinic due to a changing discoloration of her fingers from white to red to blue. Although she has not had any recent changes in her daily routines, she also complains of increasing fatigue, muscle weakness, and weight loss. She has a blood pressure of 126/77 mm Hg, respiratory rate of 14/min, and heart rate of 88/min. Physical examination reveals regular heart and lung sounds. Anti-U1 RNP antibodies and increased creatinine kinase were found in her serum. What is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 315
}
},
{
"id": "f368b627b237ec9e",
"text": "A 32-year-old woman presents to the physician because she feels depressed, has difficulty sleeping, has a poor appetite, and has had a problem concentrating for the past 3 months. During this time, she has also has had low energy and has lost interest in playing the guitar. During high school, the patient went through similar episodes of low mood and poor sleep. At that time, she would repeatedly engage in binge eating and purging behavior, for which she was referred to therapy. There is no evidence of suicidal ideation. Her physician offers to prescribe a medication for her current symptoms. Treatment with which of the following drugs should be avoided in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 316
}
},
{
"id": "c588bc8dc6a9371c",
"text": "A 52-year-old man comes to the physician for an annual physical examination. He reports that his vision has progressively improved over the past 6 months and he no longer needs the glasses he used while driving. He has hypertension and type 2 diabetes mellitus. Current medications include glyburide, hydrochlorothiazide, and enalapril. Examination shows 20/20 vision bilaterally. Fundoscopy shows a few microaneurysms of retinal vessels. Which of the following is the most likely explanation for this patient's improved vision?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 317
}
},
{
"id": "e1dc4406620f901b",
"text": "A 21-year-old woman presents to the emergency room with right arm pain and limited range of motion. She does not recall trauma to the arm. She also complains of diarrhea and nausea. She is sexually active with one male partner and admits to having pain during intercourse. There is vague and diffuse tenderness to palpation in all four abdominal quadrants. No erythema or edema is noted on the right arm. The fecal occult test is negative. Past records show that this patient has been in the ER 7 times in the past year with similar symptoms. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 318
}
},
{
"id": "9876092fd7b2dee8",
"text": "A 22-year-old man presents to a psychiatrist complaining of mood fluctuations. He is accompanied by his mother who reports that the patient recently experienced a 5-day episode of minimal sleep and unusual levels of energy. The patient admits to spending $2,000 of his parent\u2019s money, without asking, on a down payment for a motorcycle. The episode resolved after 5 days, at which point the patient felt guilty and upset. The patient\u2019s medical history is notable for multiple month-long episodes in the past 2 years of feeling sad, sleeping more than usual, being uninterested in his hobbies, and feeling constantly tired and guilty. The patient has a history of severe meningoencephalitis at the age of 17 requiring four days in the intensive care unit. During that episode, he reported seeing monkeys in his hospital room. On exam, he is a well-appearing, cooperative male in no acute distress. He is alert and oriented with a normal affect. He states that he feels sad and guilty about what happens. He denies suicidal ideation. Which of the following is the most likely diagnosis in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 319
}
},
{
"id": "70cc99d4576fb6ec",
"text": "A 32-year-old woman comes to the emergency department because a 5-week history of abdominal pain and bloody diarrhea that has worsened in the past 24 hours. She was diagnosed with ulcerative colitis 1 year ago but has had difficulty complying with her drug regimen. Her temperature is 38.2\u00b0C (100.8\u00b0F), pulse is 120/min, and blood pressure is 92/56 mm Hg. Examination shows a distended, rigid abdomen and hypoactive bowel sounds. Fluid resuscitation is initiated. In addition to complete bowel rest, which of the following is the most appropriate next step in management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 320
}
},
{
"id": "c54a7ef025b52507",
"text": "A 55-year-old man recovering from knee replacement surgery complains of breathlessness in the postoperative ward. He has been confined to bed for the past 5 days and is under observation. He felt a sudden difficulty in breathing and called for the ward nurse. He says that he is unable to take deep breaths and has a sharp pain on the right side of his chest with each inspiration. His temperature is 37.5\u00b0C (99.8\u00b0F), the pulse is 111/min, the respirations are 31/min, and the blood pressure is 85/55 mm Hg. He experiences pain in his right calf on dorsiflexion. There are no other prominent findings on physical examination. His chest X-ray does not show anything significant. The ECG reveals sinus tachycardia. Which of the following is the best course of management at this time?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 321
}
},
{
"id": "c01d3ca61ec2a885",
"text": "A 62-year-old man is brought to his primary care physician by his wife who is concerned about the patient's frequent falls. Approximately 6 months ago, she started noticing that he was walking more slowly than usual. He has fallen more than 6 times in the past month, and she is worried that he will sustain a serious injury if he does not stop falling. The patient is a retired banking executive and was active as a triathlete until the age of 60. He does not smoke and drinks 2-3 alcoholic beverages per day. His family history is notable for normal pressure hydrocephalus in his mother and Alzheimer dementia in his father. His temperature is 97.8\u00b0F (36.6\u00b0C), blood pressure is 131/81 mmHg, pulse is 68/min, and respirations are 19/min. On exam, his movements appear slowed and forced. He shuffles his feet when he walks. Tone is increased in his upper and lower extremities bilaterally. This patient's condition is most strongly associated with which of the following histologic findings on brain autopsy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 322
}
},
{
"id": "7b60ad5584660282",
"text": "A 16-month-old boy is brought to the physician by his mother for a regular check-up. His mother says that he has not yet begun to walk. He is exclusively breastfed. He is at the 20th percentile for length, 10th percentile for weight, and 50th percentile for head circumference. Physical examination shows erosion of the enamel on the lingual surface of the incisors and carious molars. He has frontal bossing. His wrists are widened, his legs appear bowed, and there is beading of the ribs. Which of the following is the most likely underlying cause of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 323
}
},
{
"id": "dcc0e63ecc6d1506",
"text": "A 55-year-old man is brought to the emergency department with altered mental status. The patient is in acute distress and cannot provide history due to disorientation. Temperature is 38.7\u00b0C (101.6\u00b0F), blood pressure is 80/50 mm Hg, pulse is 103/min, respiratory rate is 22/min, and BMI is 20 kg/m2. On examination, his sclera and skin are icteric. On abdominal examination, the patient moans with deep palpation to his right upper quadrant.\nLaboratory test\nComplete blood count\nHemoglobin 14.5 g/dL\nMCV 88 fl\nLeukocytes 16,500/mm3\nPlatelets 170,000/mm3\nBasic metabolic panel\nSerum Na+ 147 mEq/L\nSerum K+ 3.8 mEq/L\nSerum Cl- 106 mEq/L\nSerum HCO3- 25 mEq/L\nBUN 30 mg/dL\nSerum creatinine 1.2 mg/dL\nLiver function test\nTotal bilirubin 2.8 mg/dL\nAST 50 U/L\nALT 65 U/L\nALP 180 U/L\nThe patient is treated urgently with intravenous fluid, dopamine, and broad spectrum antibiotics. The patient\u2019s blood pressure improves to 101/70 mm Hg. On ultrasound of the abdomen, the common bile duct is dilated. What is the best next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 324
}
},
{
"id": "9219cfd0afea4529",
"text": "A 31-year-old woman comes to the physician because of a 5-month history of intermittent flank pain. Over the past 2 years, she has had five urinary tract infections. Her blood pressure is 150/88 mm Hg. Physical examination shows bilateral, nontender upper abdominal masses. Serum studies show a urea nitrogen concentration of 29 mg/dL and a creatinine concentration of 1.4 mg/dL. Renal ultrasonography shows bilaterally enlarged kidneys with multiple parenchymal anechoic masses. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 325
}
},
{
"id": "1b7d87f5bcb70d3b",
"text": "A 39-year-old African-American woman presents to the emergency room with hip pain. She has a past medical history significant for sarcoidosis which was recently diagnosed 6 months ago and is currently being treated. She reports that the pain started 2 weeks ago and is localized to the left hip and groin. The pain has been getting progressively more intense. Her temperature is 98.1\u00b0F (36.7\u00b0C), blood pressure is 122/78 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for pain with manipulation without restriction of range of motion of the hip. Which of the following is the most sensitive test for this condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 326
}
},
{
"id": "f921c4dbd070d72c",
"text": "A 22-year-old man from Nepal presents to the emergency department complaining of swelling and pain in his right testicle. The patient states that he just arrived in the United States to live with his wife, with whom he is monogamous. The patient denies painful urination or urethral discharge, but admits that 10 days ago he \u201cfelt like he had a fever\u201d and the right side of his face was swollen and painful. Which of the following is characteristic of the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 327
}
},
{
"id": "0a068824c6221e52",
"text": "A 27-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. The patient reports severe pelvic pain. Pregnancy has been complicated by gestational diabetes. Pregnancy and delivery of her first child were uncomplicated. Current medications include insulin, folic acid, and a multivitamin. Vital signs are within normal limits. The cervix is 100% effaced and 10 cm dilated; the vertex is at -1 station. The fetal heart rate is reactive with no decelerations. Epidural anesthesia is performed and the patient's symptoms improve. Ten minutes later, the patient has dizziness. Her pulse is 68/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. Intravenous fluid resuscitation is begun. Which of the following is the most likely underlying cause of the patient's hypotension?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 328
}
},
{
"id": "367f6d759d82ad30",
"text": "A 57-year-old woman is brought to the emergency department by ambulance for dysarthria and left-sided facial droop. She is accompanied by her son, who states that the patient had just returned home an hour ago from walking the dog when suddenly the patient stated she felt \u201cstrange.\u201d When her son asked her what was wrong, her speech was slurred and her \"face looked funny.\u201d The son quickly called an ambulance. The paramedic upon arrival noted that the patient had left-sided facial droop. Her medical history includes asthma and sickle cell disease. She takes hydroxyurea, uses oxycodone as needed for pain, and an albuterol inhaler as needed for shortness of breath. The patient\u2019s temperature is 97\u00b0F (36.1\u00b0C), blood pressure is 145/72 mmHg, pulse is 93/min, and respirations are 14/min with an oxygen saturation of 96% on room air. On physical examination, a left-sided facial droop is appreciated. She has trouble articulating her words, and her speech is garbled. She is put on 2 L of oxygen by nasal cannula. Labs are obtained and pending. Which of the following therapies is most likely indicated?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 329
}
},
{
"id": "15c45ebd3106038c",
"text": "A 58-year-old male is hospitalized after sustaining multiple fractures in a severe automobile accident. Soon after hospitalization, he develops respiratory distress with crackles present bilaterally on physical examination. The patient does not respond to mechanical ventilation and 100% oxygen and quickly dies due to respiratory insufficiency. Autopsy reveals heavy, red lungs and histology is shown in Image A. Which of the following is most likely to have been present in this patient shortly before death:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 330
}
},
{
"id": "5b980303d304d533",
"text": "A 6-year-old African American boy is referred to the hospital by his family physician for jaundice, normocytic anemia, and severe bone pain. He has a history of several episodes of mild bone pain in the past treated with over the counter analgesics. On physical examination, the child is icteric with nonspecific pain in his hands. His hands are swollen, tender, and warm. There is no chest pain, abdominal pain, fever, or hematuria. A complete metabolic panel and complete blood count with manual differential are performed:\nTotal bilirubin\n8.4 mg/dL\nWBC\n9,800/mm3\nHemoglobin \n6.5 g/dL\nMCV 82.3 fL\nPlatelet count 465,000/mm3\nReticulocyte 7%\nPeripheral blood smear shows multiple clumps of elongated and curved cells and erythrocytes with nuclear remnant. The patient's hemoglobin electrophoresis result is pictured below. What is the most likely cause of his condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 331
}
},
{
"id": "a60007d9ced3d09e",
"text": "A 55-year-old man presents to the emergency department with complaints of nausea, vomiting, palpitations, and dizziness, which have lasted for the past 3 hours. He was diagnosed with heart failure 1 year ago. During his last visit to his primary care physician, he was doing well and the lab results were normal. He reports that he has been taking low-dose aspirin and digoxin regularly for 1 year, and verapamil was recently added to prevent his frequent migraine headaches. An electrocardiogram is performed urgently and shows paroxysmal atrial tachycardia with block. Suspecting digitalis toxicity, the emergency medicine physician sends blood to the lab for a serum digoxin level, which is 3.7 ng/mL (therapeutic range: 0.8\u20132 ng/mL). Which of the following mechanisms most likely explains the development of digitalis toxicity in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 332
}
},
{
"id": "9f50fb61250235c1",
"text": "A 36-year-old man is brought to the emergency department 25 minutes after being involved in a high speed motor-vehicle collision in which he was an unrestrained passenger. He has acute myeloid leukemia and is currently receiving chemotherapy. On arrival, his temperature is 37\u00b0C (98.6\u00b0F), pulse is 63/min, respirations are 10/min, and blood pressure is 100/70 mm Hg. The pupils are equal and sluggish. There are multiple bruises over the face, trunk, and right upper and lower extremities. There is a 4-cm (1.6-in) laceration over his right cheek. He does not respond to any commands, but does groan. Painful stimuli cause him to open his eyes and withdraw all extremities. There are decreased breath sounds over the right lung base. There is tenderness to palpation over the left chest wall. Cardiac examination shows no abnormalities. The abdomen is soft and shows diffuse tenderness to palpation with no guarding or rebound. There is swelling of the right elbow and wrist. The right lower extremity is shorter than the left lower extremity. There are 2 lacerations around 2 cm (0.8 in) each on the right leg. The right knee is swollen. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 333
}
},
{
"id": "ebd8cd06938772dd",
"text": "A 51-year-old woman was recently diagnosed with type II diabetes. Due to the cumulative effects of diabetes, various health screenings and vaccinations are routinely recommended. Which of the following vaccinations or screening measures are recommended in patients with diabetes?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 334
}
},
{
"id": "ec9868428f523f28",
"text": "A 23-year-old man presents with sudden loss of consciousness while pitching in a baseball game. There is no history of injury. Consciousness is regained after cardiopulmonary resuscitation. Past medical history is negative for any neurological and cardiovascular problems. Physical examination reveals a prominent A wave on the jugular venous pulse and a double apical impulse. There are no audible murmurs. An S4 is present. What is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 335
}
},
{
"id": "de0c6413e10099db",
"text": "A 39-year-old man is brought to the emergency department unconscious following 2 episodes of generalized tonic-clonic seizures. According to the attendants, he has complained of recurrent headaches for the past 2 weeks. There is no history of fever, head trauma, or a seizure disorder. The patient does not smoke cigarettes but reportedly drinks 2 glasses of wine daily. He has multiple sexual partners and history regarding the contraceptive use is unavailable. The patient\u2019s vitals include: blood pressure 137/88 mm Hg, temperature 37.2\u00b0C (99.0\u00b0F). On physical examination, he is obtunded. He grimaces on pain and localizes in response to pain in both upper extremities. Pupils are bilateral 3-mm in diameter and equally round and reactive. Laboratory tests are within normal limits. An MRI of the brain with contrast is shown in the exhibit (see image). A brain biopsy is performed that reveals perivascular clusters of lymphocytes. Which of the following is most associated with this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 336
}
},
{
"id": "e9bb3cade75aa3fc",
"text": "A 22-year-old woman from a rural area who recently discovered she was pregnant is referred for a cardiology consultation due to cyanosis, dyspnea, and a cardiac murmur revealed at the initial prenatal visit. She is gravida 1, para 0 with an estimated gestational age of 19 weeks. She says that the murmur was found in her childhood, and the doctor at that time placed her under observation only. However, she has been lost to follow-up and has not had proper follow up in years. Currently, she complains of dizziness and occasional dyspnea on exertion which has gradually increased during her pregnancy. Prior to her pregnancy, she did not have any symptoms. The vital signs are as follows: blood pressure 125/60 mm Hg, heart rate 81/min, respiratory rate 13/min, and temperature 36.7\u00b0C (98.0\u00b0F). Her examination is significant for acrocyanosis and a fixed splitting of S2 and grade 3/6 midsystolic murmur best heard over the left upper sternal border. Which of the following physiological pregnancy changes is causing the change in this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 337
}
},
{
"id": "3f34e8c5f6b80263",
"text": "A 25-year-old man with a past medical history of constipation and fibromyalgia presents to the emergency department with generalized malaise and severe diarrhea. The patient states that he has not felt well for the past 24 hours and his symptoms are no longer tolerable. He denies taking any medications or illicit drugs and states he is generally healthy. His temperature is 99.3\u00b0F (37.4\u00b0C), blood pressure is 122/88 mmHg, pulse is 107/min, respirations are 19/min, and oxygen saturation is 99% on room air. Physical exam demonstrates an ill appearing young man. Physical exam is notable for rhinorrhea, lacrimation, and piloerection. The patient\u2019s pupils are dilated and reactive to light. During placement of an ultrasound guided IV, multiple scars are noted in the antecubital fossa, and it is noted that it is very difficult to place an IV in this patient. During the exam, he begins actively vomiting. Which of the following could be an appropriate treatment for this patient\u2019s symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 338
}
},
{
"id": "1e37f81dcf374fe8",
"text": "A 45-year-old woman presents to the clinic with her husband to discuss her most recent problem. She and her husband recently bought a new house in the area. While cleaning the house, they discovered a nest of spiders. She reports blacking out and waking up outside the house with a bandage on her arm. Her husband says that she began screaming and ran out of the house, breaking a window, and cutting her arm. The patient says she has tried to enter the house several times over the last several months but can not bring herself to cross the threshold for fear of more spiders. She wants to overcome her extreme and irrational fear. Which of the following is the most effective treatment to overcome this patient\u2019s arachnophobia?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 339
}
},
{
"id": "78f4804607529c54",
"text": "A 67-year-old man is brought to the physician because of increasing forgetfulness, unsteadiness, and falls over the past year. He reports that these symptoms seem to worsen with each fall. Initially, he could not remember directions to his home but now cannot remember recent conversations or appointments he has made. He often repeats questions that he asked shortly before. He has long-standing hypertension, coronary artery disease, and hypercholesterolemia. Current medications include aspirin, carvedilol, enalapril, and atorvastatin. Examination shows a bruise over the left temple and an unsteady gait. On mental status examination, he is oriented to place and person only. Short-term memory is impaired; he can recall 0 out of 5 objects after 10 minutes. Long-term memory is intact. He has no delusions or hallucinations. Muscle strength is decreased in the left lower extremity. The Babinski sign is present on the left. A CT scan of the head is shown. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 340
}
},
{
"id": "f88c64b6db23380a",
"text": "A 28-year-old primigravid woman at 39 weeks gestation is admitted to the hospital in active labor. On examination, the cervix is 100% effaced and 10 cm dilated. After 5 minutes of pushing, there is a prolonged deceleration of the fetal heart rate to 90/min. A decision to perform an episiotomy is made to expedite vaginal delivery. The anesthesiologist locates the ischial spines by palpating the posterolateral vaginal sidewall and administers an anesthetic. Three minutes later, pinching the posterior vulva does not provoke pain. The anesthetized nerve most likely also supplies which of the following structures?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 341
}
},
{
"id": "d23f8a942f0337f4",
"text": "A 55-year-old woman with a history of HIV presents to the emergency department with progressive dyspnea, fever, and dry cough for the past 4 days. She has not been compliant with antiretroviral or prophylactic medication. On evaluation, the patient is in moderate respiratory distress. The temperature is 38.8\u00b0C (102.0\u00b0F), the blood pressure is 124/82 mm Hg, the pulse is 96/min, and the respiratory rate is 20/min. Pulse oximetry is 92% on 4 L oxygen by nasal cannula. Her CD4 count is 180 cells/\u03bcL. IV antibiotics and glucocorticoids are administered. After 30 minutes, the patient develops severe respiratory distress. Repeat vital signs show: temperature 38.3\u00b0C (101.0\u00b0F), blood pressure 80/50 mm Hg, pulse 104/min, respiration rate 32/min and pulse oximetry 85% on nasal cannula. The trachea deviates to the left. Breath sounds are absent on the right side and the neck veins are distended. Telemetry shows sinus tachycardia. Which of the following is the best next step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 342
}
},
{
"id": "ccd7e7b521cc3b4f",
"text": "A 22-year-old woman with polycystic ovarian syndrome comes to the emergency department because of a 1-day history of left lower abdominal pain that began suddenly while she was running. Her last menstrual period was 2 weeks ago. Physical examination shows tenderness to palpation over the left adnexa and rebound tenderness in the left lower quadrant. There is no tenderness in the right lower quadrant. Urine pregnancy test is negative. An ultrasound is ordered to confirm the diagnosis of ruptured ovarian cyst. Visualization of fluid in which of the following locations would be most consistent with this diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 343
}
},
{
"id": "81eeb0e0df613f6f",
"text": "A 47-year-old woman comes to the physician for a follow-up examination. She has noticed trembling of her hands for the past 5 months. These movements are only present when she reaches to pick up an object or answer the phone. She has a history of major depressive disorder but has been off medications for the past 3 years. Her father had Parkinson's disease and died 6 months ago. She drinks a glass of wine daily. She appears anxious. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, and blood pressure is 118/74 mm Hg. A low-frequency tremor is present that worsens as she reaches out for an object. She consistently overshoots her target. There is no tremor present when her arms are held outstretched. There is increased tone in the lower extremities and Babinski's sign is positive bilaterally. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 344
}
},
{
"id": "7d1905522b955fc5",
"text": "A 52-year-old man comes to the physician because of generalized pruritus and raised, erythematous plaques on the skin over his hands, chest, and legs for 6 hours. He reports having clear liquid discharge from his nose and sneezing. He says that his symptoms began suddenly the previous night, 30 minutes after he had dinner at a seafood restaurant. He has had similar symptoms occasionally in the past as well. Four months ago, he had an episode of narrow-angle glaucoma. He takes no medications. His vital signs are within normal limits. Nasal exam shows clear, serous secretions, with edematous and erythematous mucosa and turbinates. Paranasal sinuses are not tender to palpation. Which of the following is the most appropriate pharmacotherapy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 345
}
},
{
"id": "67f9a2f4c3dbe766",
"text": "A 19-year-old man in a 3-month relationship with a woman experiences frequent sexual fantasies about male coworkers. He lives in a conservative community and does not know any openly gay men. Two days ago, he joined a local group considered by many organizations to be a hate group. Together with the other members, he attacked a gay couple on their way home from dinner. Which of the following psychological defense mechanisms is he demonstrating?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 346
}
},
{
"id": "22e27c8ea88fd7ec",
"text": "A 66-year-old woman presents to her primary care provider with several days of left flank pain radiating to the abdomen and groin. The patient states that she has noticed a pink tinge to her urine as well. Of note, she has not had any fevers, but endorses several months of fatigue and constipation. The patient was previously healthy except for mild untreated hypertension. On exam, her temperature is 98.6\u00b0F (37.0\u00b0C), blood pressure is 130/84 mmHg, pulse is 76/min, and respirations are 12/min. On further workup, the patient is found to have calcium oxalate nephrolithiasis with hypercalciuria. Blood studies demonstrate increased parathyroid hormone (PTH) and hypercalcemia. Which of the following is the most likely cause?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 347
}
},
{
"id": "666ef7aaf76888df",
"text": "A 23-year-old woman presents to her psychiatrist concerned about her mood. She has felt tired and unwilling to engage in any activities lately. She states that her limbs feel heavy all the time and that completing any activity takes tremendous effort. She no longer finds any happiness in activities that she previously enjoyed. She also states that she really struggles to sleep and at times can't sleep for several days. The patient is started on appropriate first-line therapy and sent home. She returns 1 week later stating that her symptoms have not improved. She is requesting help as her performance at work and school is suffering. Which of the following is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 348
}
},
{
"id": "0f6788ab2624640c",
"text": "A 16-year-old patient presents to the physician\u2019s office with an absence of menstruations. Her last period was 6 months ago. Since almost a year and a half ago, she intentionally restricted her diet at the expense of carbohydrates, exercised intensively, and lost 18.0 kg (39.7 lb). She had her menarche at the age of 12 and menstruated normally until last year. She is not sexually active. On physical examination, the vital signs include blood pressure 100/60 mm Hg, heart rate 55/min, respiratory rate 12/min, and temperature 35.9\u00b0C (96.6\u00b0F). Her weight is 55.0 kg (121.3 lb), and her height is 166 cm (5 ft 5 in). Physical examination reveals the good development of muscles and decreased adiposity. A bone scan shows decreased calcium mineral deposits. Which statement about this patient\u2019s condition is correct?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 349
}
},
{
"id": "990721539189c9d9",
"text": "A 7-year-old girl is brought to the emergency department with a 10-day history of fever and sore throat that acutely worsened over the past 2 days. Her sore throat is worse on the right side. She has difficulty swallowing and opening her mouth due to pain. She has also noticed a change in the quality of her voice over the last day. Her temperature is 38.2\u00b0C (100.8\u00b0F), pulse is 86/min, respirations are 18/min, and blood pressure is 110/75 mm Hg . Examination shows cervical lymphadenopathy. Oropharyngeal examination shows erythematous tonsils and swelling of the right tonsillar pillar. The uvula is deviated to the left. Laboratory studies show:\nHemoglobin 13.0 g/dL\nHematocrit 39%\nLeukocyte count 12,000/mm3\nPlatelet Count 200,000/mm3\nSerum\nNa+ 138 mEq/L\nCl- 100 mEq/L\nK+ 4.5 mEq/L\nHCO3- 24 mEq/L\nUrea nitrogen 14.0 mg/dL\nCreatinine 1.1 mg/dL\nWhich of the following is the most appropriate next step in management?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 350
}
},
{
"id": "4c499767cf1c03a5",
"text": "A 26-year-old nurse comes to the physician because of a 2-month history of fatigue. She has had a lot of stress at work and has been on sick leave for 2 weeks, but states that she would like to return to work. She has had several episodes of lower abdominal pain. She says, \"\"I know I have cancer.\"\" She requests a diagnostic laparoscopy. She was diagnosed with peptic ulcer disease 6 months ago. Her only medication is omeprazole. The patient appears pale. Her temperature is 36.5\u00b0 C (97.7\u00b0 F), pulse is 120/min, and blood pressure is 90/65 mm Hg. On mental status examination she is tired and has a depressed mood. Physical examination shows pale conjunctivae and dry mucous membranes. There are numerous crusts along the course of her left arm veins. A grade 2/6 systolic ejection murmur is heard along the right-upper sternal border. Abdominal examination shows no abnormalities. There is generalized weakness of the proximal muscles. Laboratory studies show:\nHemoglobin 7.5 g/dL\nMean corpuscular volume 89 \u03bcm3\nReticulocyte count 13.3%\nSerum\nSodium 139 mEq/L\nPotassium 3.9 mEq/L\nCalcium 8.5 mg/dL\nTest of the stool for occult blood is negative. Abdominal ultrasonography show no abnormalities. Which of the following is the most likely diagnosis?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 351
}
},
{
"id": "660b318033c42c3b",
"text": "Five days after undergoing an emergency appendectomy under general inhalational anesthesia while on a trip to Haiti, a 43-year-old woman develops low-grade fever, vomiting, and abdominal pain. During the surgery, she received a transfusion of 1 unit of packed red blood cells. Three days after the surgery, she was stable enough to be transported back to the United States. She has no history of serious illness and takes no medications. Her temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 80/min, and blood pressure is 138/76 mm Hg. Examination shows jaundice of the skin and conjunctivae. Abdominal examination shows moderate tenderness over the liver. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show:\nHemoglobin count 12.0 g/dL\nLeukocyte count 10,400 mm3\nSegmented neutrophils 55%\nBands 1%\nEosinophils 13%\nLymphocytes 28%\nMonocytes 3%\nPlatelet count 160,000 mm3\nSerum\nAlkaline phosphatase 102 U/L\nAspartate aminotransferase 760 U/L\nBilirubin\nTotal 3.8 mg/dL\nDirect 3.1 mg/dL\nAnti-HAV IgG positive\nAnti-HAV IgM negative\nAnti-HBs positive\nHBsAg negative\nAnti-HCV antibodies negative\nAbdominal ultrasonography shows an enlarged liver. A biopsy of the liver shows massive centrilobular necrosis. Which of the following is the most likely underlying cause of this patient's condition?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 352
}
},
{
"id": "cd9d754548e2d0ce",
"text": "A 56-year-old woman comes to the physician because of a 2-week history of fatigue and painless bruising over her arms and trunk. She has also had several episodes of nosebleeds that resolved with compression after a few minutes. She recently completed treatment for a urinary tract infection. She has had no changes in her weight. She has type 2 diabetes mellitus and hypertension. Her last menstrual cycle was 5 years ago. She does not smoke or drink alcohol. Home medications include metformin, amlodipine, and enalapril. Her vital signs are within normal limits. Physical examination shows pale conjunctivae. There are ecchymoses and petechiae over the upper extremities, chest, and back. There is no lymphadenopathy. The remainder of the physical examination is unremarkable. Laboratory studies show:\nHemoglobin 8.7 mg/dL\nLeukocyte count 1100/mm3\nPlatelet count 54,000/mm3\nReticulocyte count 0.1%\nMean corpuscular volume 93 \u03bcm3\nSerum\nTotal bilirubin 1.1 mg/dL\nLDH 80 U/L\nWhich of the following is most likely to confirm the diagnosis?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 353
}
},
{
"id": "ca7e6335afadd1e5",
"text": "A 35-year-old man returns to the clinic to follow up for his chronic stomach pain. At the last visit a few months ago, he explained that he had been experiencing discomfort in his upper abdomen for awhile. He had never vomited up any blood and had not had any substantial weight loss. He did not take any medications, did not smoke, and had no family history of gastric cancer. At that time, the doctor empirically started him on a proton pump inhibitor (PPI). Today, despite the PPI, the patient says he is still experiencing discomfort. Hearing this, the doctor decides to order a urease breath test. What is the most likely cause of this patient's chronic stomach pain?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 354
}
},
{
"id": "98ba9719c1928dae",
"text": "A 32-year-old G1P1 patient presents to her obstetrician after having a positive pregnancy test at home. She reports that she and her husband had been trying to have a child for the past three months. She has no history of sexually transmitted disease, intravenous drug use, or blood transfusions, and she has never traveled outside of the United States. She was up-to-date on all immunizations before her pregnancy. Ultrasound is consistent with an 8-week gestational sac. The patient requests as few tests as possible, although she does not want to compromise the health of her fetus. Which of the following screening tests should be performed on all pregnant women?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 355
}
},
{
"id": "0bf9db5e3dc54653",
"text": "A 29-year-old man is referred by his marriage counselor to the outpatient psychiatry clinic. The patient\u2019s wife is with him and states that her husband is always complaining and critical of others. He was recently fired from his job to which he claims that his boss was jealous of his hard work. He also does not trust his neighbors and thinks they are out to get all the nice things he has. His wife also says that he has begun to doubt her fidelity and believes that even the marriage counselor is on her side. Which of the following psychiatric disorders also belongs to the same cluster of symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 356
}
},
{
"id": "769b850e2aac8a0e",
"text": "A 24-year-old man is brought to the emergency department by the police. He was found unconscious and covered in bruises outside of a local bar. The patient has a past medical history of polysubstance abuse, depression, multiple suicide attempts, neuropathic pain, and schizophrenia. As part of the patient\u2019s initial workup, a head CT is performed which is unremarkable, and an arterial blood gas is performed as seen below:\n\npH: 7.29\nPaCO2: 95 mm Hg\nPaO2: 70 mm Hg\nBicarbonate: 24 mEq/L\n\nWhich of the following is the most likely etiology of this patient\u2019s current presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 357
}
},
{
"id": "a26a7b4dad1b2d90",
"text": "A 3-year-old girl is brought to the emergency department by her parents for an acute arm injury. The mother reports that they were walking in the park and the patient\u2019s dad was swinging the patient in the air by her arms. The dad reports he then heard a click and the patient immediately began to cry. On examination, the patient is holding her right forearm in a pronated position and her elbow slightly flexed. Pain is localized to the lateral aspect of the elbow. She refuses to use the affected limb. She does allow passive flexion and extension with full range of motion but supination is limited and causes pain. Which of the following is the next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 358
}
},
{
"id": "fc9ed83b08f96765",
"text": "A 40-year-old male presents to your office complaining that he is too weak to climb stairs or brush his hair. He denies any headaches or change in vision. A muscle biopsy reveals CD8+ lymphocyte infiltration in the endomysium. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 359
}
},
{
"id": "6d699fff37252253",
"text": "A 6-month-old boy presents to his pediatrician for a wellness examination. The mother reports that her child has difficulty rolling from his back to his front and sitting unsupported. The patient is able to smile and furrow his brow normally, but she has noticed that he has a weak cry and suck. He was born at 38 weeks gestation via a spontaneous vaginal delivery without any complications. The mother said that the patient appeared \"normal\" until the past few weeks. On physical exam, his extraocular muscle movements are intact, and a symmetric smile is seen. He has symmetric flaccid weakness of both his upper and lower extremities. He also has a bell-shaped chest. Deep tendon reflexes are diminished. Which of the following is the most likely cause of this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 360
}
},
{
"id": "a0666a82a2f9998c",
"text": "A 6-day-old male newborn is brought to the physician because he has become increasingly irritable and restless over the past 2 days. During this period, he has had 12 bowel movements. He feeds 10 to 12 times a day. He was born at 38 weeks' gestation and weighed 1800 g (3 lb 15 oz); he currently weighs 1700 g (3 lb 12 oz). His mother has Graves' disease and received propylthiouracil during the last trimester of pregnancy. She has a history of intravenous heroin use. His temperature is 36.9\u00b0C (98.4\u00b0F), pulse is 180/min, and respirations are 50/min. Examination shows mild diaphoresis and a firm 2-cm midline neck swelling. The lungs are clear to auscultation. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 361
}
},
{
"id": "3233b8cbbf9edbb8",
"text": "A previously healthy 29-year-old man comes to the emergency department because of burning with urination for several days. He has also had pain in the right ankle for 3 days and pain and swelling in the left knee for 1 day. Two weeks ago, he had several days of fever and bloody diarrhea, for which he was treated with antibiotics. Examination shows a small left knee effusion and bilateral conjunctival injection. Which of the following is the most likely additional finding in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 362
}
},
{
"id": "192e4a423c495dab",
"text": "A 36-year-old woman comes to the physician because of a painless lump on her neck for 3 months that has increased in size. She appears healthy. Examination shows a 2.5-cm (1-in) firm, irregular swelling on the left side of the neck that moves with swallowing. There is painless cervical lymphadenopathy. Ultrasound of the neck shows a solitary left lobe thyroid mass with increased vascularity and hyperechogenic punctate regions. A fine needle aspiration biopsy is scheduled for the following week. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 363
}
},
{
"id": "6d4982a0d90580ab",
"text": "A 34-year-old man currently staying at an addiction center presents to the staff psychiatrist with diarrhea and painful muscle cramps. He has been discontinuing heroin over the last month as part of his treatment plan. He is HIV positive, hepatitis B (HBV) positive, and was recently treated for an infection with Streptococcus pneumoniae. He reports pain over his abdomen, knees, and shoulder. To comprehensively treat these symptoms, which of the following would be the best therapy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 364
}
},
{
"id": "f7d43f77aca33d60",
"text": "A 26-year-old man presents to his physician with a history of diarrhea and vomiting for the past 24 hours. On physical examination, his temperature is 36.9\u00baC (98.4\u00baF), pulse rate is 110/min, blood pressure is 102/74 mm Hg, and respiratory rate is 16/min. A resident working under the physician plots a Darrow-Yannet diagram for the patient. The diagram is shown in the picture where the green dotted line represents the new fluid status. Which of the following is most likely to show increased secretion in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 365
}
},
{
"id": "85212bca1bd8b28d",
"text": "A 28-year-old female comes to the physician\u2019s office with a complaint of episodic chest pain. She describes the pain as squeezing and tightness in her chest. This pain has been happening every few days for 3 months. She says there is no association of the pain with food or exercise. She is able to climb up to her fourth floor apartment daily without issue. Her only past medical history is migraines for which she takes appropriate medication. Here temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 120/68 mmHg, pulse is 60/min, respirations are 16/min, and oxygen saturation is 98% on room air. She has no known family history. The patient is not in pain on presentation and EKG in the office is normal. 24-hour ECG monitoring shows transient ST elevations during the episodes of pain that resolve completely. The mechanism of this patient\u2019s chest pain is most similar to the mechanism behind which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 366
}
},
{
"id": "10d036de390ae9bd",
"text": "A 22-year-old gravida 1 presents to her physician at 15 weeks gestation for a prenatal appointment. She complains of a rash involving her chest, face, and arms, a watery nasal discharge, and mild bilateral knee pain. She has had these symptoms for about 5 days. The symptoms do not seem to bother her too much, but she is concerned for the baby. She had contact with her younger sister, who also had a rash and was diagnosed with rubella infection about 10 days ago at a family gathering. She cannot confirm her vaccination history. Her vital signs are as follows: blood pressure, 110/70 mmHg; heart rate, 89/min; respiratory rate, 12/min; and temperature, 37.6\u2103 (99.7\u2109). Examination shows a moderately dense maculopapular lacy rash spread over the patient\u2019s trunk, extremities, and face. No lymph node, liver, or spleen enlargement is noted. The knee joints appear normal.\nSerology performed 1 year ago Current serology\nRubella IgM - negative Rubella IgM - negative\nRubella IgG - 1:128 Rubella IgG - 1:64\nRubella IgG avidity - high Rubella IgG avidity - high\nWhat is the proper next step in the management of this woman?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 367
}
},
{
"id": "a8225b49323ed1f0",
"text": "A 20-year-old woman presents with vaginal discharge, pruritus, and painful micturition for the past 5 days. She is sexually active with multiple partners and admits to using barrier protection inconsistently. Her last menstrual period was 2 weeks ago. The patient denies any fever, chills, abdominal pain, menorrhagia, or flank pain. She is afebrile and the vital signs are within normal limits. Speculum examination reveals vaginal erythema with a profuse, greenish-yellow, purulent, malodorous discharge. The vaginal pH is 5.5. Vaginal swab and urine samples are obtained for microscopy and culture, and results are pending. Which of the following is the most likely diagnosis in this patient based on her presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 368
}
},
{
"id": "f69aec18c786d5e2",
"text": "A 47-year-old female undergoes a thyroidectomy for treatment of Graves' disease. Post-operatively, she reports a hoarse voice and difficulty speaking. You suspect that this is likely a complication of her recent surgery. What is the embryologic origin of the damaged nerve that is most likely causing this patient's hoarseness?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 369
}
},
{
"id": "ec73152cbfbc62ca",
"text": "A 15-year-old boy with poorly controlled asthma presents to the emergency room complaining of severe shortness of breath. His mother reports that he had trouble breathing soon after he started playing soccer with some friends and was unable to use his inhaler as it was empty. His family history is notable for emphysema in his paternal uncle and cirrhosis in his maternal grandfather. The child\u2019s temperature is 99.0\u00b0F (37.2\u00b0C), blood pressure is 130/90 mmHg, pulse is 130/min, respirations are 28/min, and oxygen saturation is 91% on room air. Physical examination demonstrates wheezing bilaterally in all lung fields. The child is started on supplemental oxygen and a nebulized bronchodilator. Which of the following is a downstream effect of this medication?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 370
}
},
{
"id": "9e7053e917bfaf83",
"text": "A 55-year-old man presents with a 2-month history of an increasing sensation of fullness in the upper left side of his abdomen. He complains of increasing fatigue and dyspnea. He has no history of serious illness and takes no medications. His temperature is 36.7\u00b0C (98.1\u00b0F), pulse is 90/min, respiratory rate is 18/min, and blood pressure is 125/70 mm Hg. His conjunctivae are pale. The examination of the heart and lungs shows no abnormalities. The splenic margin is palpable 8 cm (3.1 in) below the costal margin. No abnormal lymph nodes are found. Laboratory studies show:\nHemoglobin 8 g/dL\nMean corpuscular volume 90 \u03bcm3\nLeukocyte count 3,000/mm3\nPlatelet count 85,000/mm3\nPeripheral blood smear shows small lymphocytes with cell membrane projections. Bone marrow aspiration is unsuccessful. Cell immunophenotyping is positive for CD25. Which of the following is the most effective pharmacotherapy at this time?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 371
}
},
{
"id": "9b55579a6c8e71f5",
"text": "A 57-year-old man presents to the emergency department with confusion. His symptoms started a few days ago and have been gradually worsening. Initially, the patient had a fever and a cough which has progressed to abdominal pain, diarrhea, and confusion. His temperature is 102\u00b0F (38.9\u00b0C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 94% on room air. Physical exam is notable for localized crackles and decreased breath sounds in the left lower lung field. The patient is confused and is answering questions inappropriately. Laboratory studies are ordered as seen below.\n\nHemoglobin: 12 g/dL\nHematocrit: 36%\nLeukocyte count: 16,500/mm^3 with normal differential\nPlatelet count: 190,000/mm^3\n\nSerum:\nNa+: 130 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 25 mEq/L\nBUN: 20 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the best diagnostic test to guide current therapy in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 372
}
},
{
"id": "837815ad28a1e2a6",
"text": "A 45-year-old man presents to the physician because of a 1-day history of progressive pain and blurry vision in his right eye. He is struggling to open this eye because of the pain. His left eye is asymptomatic. He wears contact lenses. He has bronchial asthma treated with inhaled salbutamol. He works as a kindergarten teacher. The vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), pulse 85/min, and blood pressure 135/75 mm Hg. The examination shows a visual acuity in the left eye of 20/25 and the ability to count fingers at 3 feet in the right eye. A photograph of the right eye is shown. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 373
}
},
{
"id": "0df9dfc65045e376",
"text": "A 50-year-old man presents to his physician with chronic cough, aching joints in his hips and lower back, and malaise over the past 2 months. He describes himself as being \u201cgenerally healthy\u201d before the cough began. Past medical history includes hypertension. The patient takes clopamide and a multivitamin daily. His parents are both well and living in a senior living facility. He does not smoke and only drinks alcohol occasionally. During a review of symptoms, the patient described a hiking trip in and around the desert near Phoenix, Arizona, 4 months ago. At the office, his temperature is 38.6\u00b0C (101.4\u00b0F), heart rate is 102/min, respirations are 20/min, and blood pressure is 120/82 mm Hg. A focused chest exam reveals mild fremetus and dullness with percussion on the right side. A chest X-ray shows a right-sided consolidation of the lower right lung, and a chest CT shows an irregular opacity measuring 3.8 cm x 3.0 cm in the sub-plural region of the right middle lobe, a small right-sided pleural effusion, and mild right-sided hilar adenopathy. A lung biopsy is performed to rule out cancer and reveals necrotic granulomatous inflammation with multinucleated giant cells and spherules with endospores in the surrounding tissues. The laboratory tests show the following results:\nHemoglobin 12.9 mg/dL\nLeukocyte count 9,300/mm3\nPlatelet count 167,000/mm3\nErythrocyte sedimentation rate 43 mm/hr\nPeriodic acid-Schiff and silver methenamine Positive\nAcid-fast stain Negative\n Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 374
}
},
{
"id": "ec02f0615ed21afc",
"text": "A 22-year-old man with sickle cell disease is brought to the emergency room for acute onset facial asymmetry and severe pain. He was in school when his teacher noted a drooping of his left face. His temperature is 99.9\u00b0F (37.7\u00b0C), blood pressure is 122/89 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam is notable for facial asymmetry and 4/5 strength in the patient's upper and lower extremity. A CT scan of the head does not demonstrate an intracranial bleed. Which of the following is the most appropriate treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 375
}
},
{
"id": "cdfcba3723d3e4ea",
"text": "A 3-month-old girl is brought to the physician because of a productive cough for 5 days. Over the past month, she has had several episodes of watery stools. She is exclusively breastfed every 3\u20134 hours for 15\u201320 minutes. She was delivered vaginally at 38 weeks' gestation at home and has not yet been evaluated by a physician. The mother reports that her child is not gaining weight. The mother had no prenatal care. The infant is at the 5th percentile for height and weight. The infant has not received any immunizations. Her temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 155/min, respirations are 45/min, and blood pressure is 88/50 mm Hg. Oral examination shows white plaques covering the tongue and the palate. Rales are heard bilaterally on cardiopulmonary examination. Cervical and inguinal lymphadenopathy is present. Which of the following is most likely to confirm the diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 376
}
},
{
"id": "718de770f57494f3",
"text": "A 30-year-old primigravid woman at 22 weeks' gestation is brought to the emergency department by her husband for lethargy, nausea, and vomiting for 4 days. This morning she became drowsy. She returned from a business trip to Sudan 3 weeks ago. She denies eating any seafood while traveling. Medications include iron supplements and a multivitamin. Her immunizations are up-to-date and she has never received blood products. Her temperature is 38.9\u00b0C (102\u00b0F), pulse is 92/min, and blood pressure is 122/76 mm Hg. She is oriented to person and place. Examination shows jaundice and mild asterixis. Pelvic examination shows a uterus consistent in size with a 22-week gestation. Laboratory studies show:\nHemoglobin 11.2 g/dL\nProthrombin time 18 sec (INR=2.0)\nSerum\nTotal bilirubin 4.4 mg/dL\nAlkaline phosphatase 398 U/L\nAST 4,702 U/L\nALT 3,551 U/L\nLactate dehydrogenase 3,412 U/L\nAnti-nuclear antibody negative\nAnti-smooth muscle antibody negative\nAnti-CMV antibody negative\nAnti-EBV nuclear antigen antibody negative\nAn ELISA for HIV is negative. Which of the following is most likely to confirm the diagnosis?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 377
}
},
{
"id": "f4dbde7c9db170a4",
"text": "A 36-year-old man is brought to the emergency department because of multiple episodes of nonbilious emesis for 3 days. The vomitus consists of undigested food and he has also had dark brown emesis twice today. He has been having early satiety during this period. He has had progressive severe episodic epigastric pain and dyspepsia for the past week. The pain is partially relieved with food or over-the-counter antacids, but worsens at night and several hours after eating. He has also had a weight gain of 2 kg (4.4 lbs) during this period. His father underwent surgery for colon cancer 3 years ago. He has smoked one pack of cigarettes daily for the last 15 years. He drinks two to three beers daily. His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 106/min and blood pressure is 108/68 mm Hg. Examination shows dry mucous membranes. The abdomen is mildly tender to palpation in the left upper quadrant; there is a tympanitic mass in the epigastrium. A succussion splash is heard with a stethoscope when the patient is rocked back and forth at the hips. Bowel sounds are reduced. Rectal examination is unremarkable. Test of the stool for occult blood is positive. The remainder of the examination shows no abnormalities. Serum studies show:\nNa+ 135 mEq/L\nK+ 3.3 mEq/L\nCl- 97 mEq/L\nUrea nitrogen 46 mg/dL\nGlucose 77 mg/dL\nCreatinine 1.4 mg/dL\nWhich of the following is the underlying cause of this patient's vomiting?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 378
}
},
{
"id": "43aabf3478963ab1",
"text": "A 52-year-old man is brought to the emergency department because of worsening shortness of breath for 6 hours. For the past 5 days, he has had intermittent stabbing pain in the middle of his chest that worsens with lying down or taking deep breaths. He has also had a runny nose and a dry cough for the past 2 weeks. He has hypercholesterolemia and hypertension. He has smoked a pack of cigarettes daily for 34 years. His current medications include atorvastatin, enalapril, and hydrochlorothiazide. He appears pale and sweaty. His temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 105/min, and respirations are 25/min. Blood pressure is 107/72 mm Hg during expiration and 86/65 mm Hg during inspiration. Examination shows jugular venous distention and pitting edema below the knees. Which of the following is the most likely cause of this patient's findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 379
}
},
{
"id": "7d1a4559510cf1b8",
"text": "A 70-year-old obese male presents to the emergency department with shortness of breath and cough of sudden onset. The patient states that his symptoms came on while he was sleeping. The patient has a past medical history of type II diabetes and is currently taking lisinopril, metformin, insulin, and fish oil. On physical exam, you note bipedal edema and jugular venous distention (JVD). An EKG and chest radiographs are obtained (Figures A and B). The patient is started on BIPAP and medical therapy and his symptoms improve rapidly. Lab values are as follows.\n\nSerum:\nNa+: 137 mEq/L\nK+: 3.2 mEq/L\nCl-: 100 mEq/L\nHCO3-: 31 mEq/L\nBUN: 20 mg/dL\nGlucose: 120 mg/dL\nCreatinine: 1.2 mg/dL\nCa2+: 10.9 mg/dL\n\nWhich of the following is the best explanation of this patient's current presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 380
}
},
{
"id": "3b46f8ab2c0dff8a",
"text": "A 23-year-old woman is seen by her primary care physician for fatigue. She says that she has always felt a little short of breath compared to her friends; however, she did not think that it was abnormal until she started trying a new exercise regimen. On physical exam, she is found to have mild conjunctival pallor and a peripheral blood smear is obtained showing echinocytes but no intracellular accumulations. Upon further questioning, she recalls that several relatives have had similar issues with fatigue and pallor in the past. Which of the following is true about the rate limiting enzyme of the biochemical pathway that is affected by this patient's most likely condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 381
}
},
{
"id": "dd7d93b148ecfd84",
"text": "A 32-year-old woman comes to the physician because she feels depressed, has difficulty sleeping, a poor appetite, and low concentration for the past 3 months. During this time, she has also had low energy and lost interest in playing the guitar. During high school, the patient went through similar episodes of low mood and poor sleep. At that time, she would repeatedly engage in binge eating and purging behavior, for which she was referred to therapy. There is no evidence of suicidal ideation. The physician offers to prescribe a medication for her current symptoms. Treatment with which of the following drugs should most be avoided in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 382
}
},
{
"id": "696edb7cb121b65c",
"text": "A 5-month-old boy is brought to the physician with a 3-day history of fever and cough. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times since birth. He was born at 37 weeks' gestation, and the neonatal period was uncomplicated. He is at the 10th percentile for height and 3rd percentile for weight. His temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 126/min, and respirations are 35/min. Examination shows an erythematous scaly rash over his trunk and extremities. The white patches on the tongue and buccal mucosa bleed when scraped. Inspiratory crackles are heard in the right lung base. An X-ray of the chest shows an infiltrate in the right lower lobe and an absent thymic shadow. Which of the following is the most likely definitive treatment for this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 383
}
},
{
"id": "7a0f8e22c90a4199",
"text": "Six days after undergoing an aortic valve replacement surgery, a 68-year-old woman has bluish discolorations around the peripheral intravenous catheters and severe right leg pain. She has a history of hypertension and major depressive disorder. She drinks 3 beers daily. Current medications include hydrochlorothiazide, aspirin, prophylactic unfractionated heparin, and fluoxetine. Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 90/min, and blood pressure is 118/92 mm Hg. Examination shows multiple hematomas on the upper extremities around the peripheral intravenous access sites. There is a healing sternal incision. The lungs are clear to auscultation. Cardiac examination shows an aortic click. The right calf is tender, erythematous and swollen. Laboratory studies show:\nHemoglobin 13.1 g/dL\nLeukocyte count 9,900/mm3\nPlatelet count 48,000/mm3\nProthrombin time 15 seconds\nActivated partial thromboplastin time 40 seconds\nSerum\nUrea nitrogen 19 mg/dL\nCreatinine 1.1 mg/dL\nAlkaline phosphatase 33 U/L\nAST 26 U/L\nALT 33 U/L\n\u03b3-Glutamyl transferase 45 U/L (N=5\u201350 U/L)\nWhich of the following is the most likely underlying mechanism of this patient's symptoms?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 384
}
},
{
"id": "0c3054634aca1482",
"text": "A 55-year-old man with chronic hepatitis B virus infection comes to the physician because of generalized fatigue and a 5.4 kg (12 lb) weight loss over the past 4 months. Physical examination shows hepatomegaly. Laboratory studies show an \u03b1-fetoprotein concentration of 380 ng/ml (N < 10 ng/mL). A CT scan of the abdomen with contrast shows a solitary mass in the left lobe of the liver that enhances in the arterial phase. Which of the following is the most likely underlying pathogenesis of this patient's current condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 385
}
},
{
"id": "471677c69e597d11",
"text": "A 28-year-old woman with no significant past medical history presents to her primary care physician with increased menstrual bleeding over the past three months. She also notes easy bruising and bleeding from her gums when brushing her teeth. She is sexually active with multiple partners and has no history of intravenous drug use. Physical exam is remarkable for petechiae and scattered ecchymoses on the patient's bilateral upper and lower extremities. Urine beta-HCG is negative. Laboratory results are as follows: Hgb 13.0 g/dL, WBCs 6,000/mL, platelets 95,000/mL, PT 13.2s, aPTT 30s. Peripheral blood smear shows normocytic, normochromic red blood cells and few platelets with no morphologic abnormalities. Which diagnostic study should be performed next?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 386
}
},
{
"id": "ec2218e02254671e",
"text": "A 6-year-old boy is brought in by his parents to a pediatrician\u2019s office for persistent fever. His temperature has ranged from 38.6\u00b0C\u201339.5\u00b0C (101.5\u00b0F\u2013103.1\u00b0F) over the past week. He was diagnosed with a gene defect on chromosome 7, which has caused dysfunction in a transmembrane protein. This defect has resulted in several hospitalizations for various respiratory infections. At the present time, he is struggling with a cough with thick purulent sputum. A sputum sample is sent for culture and the patient is started on vancomycin.The pediatrician tells the patient\u2019s family that there is a collection of mucus in the respiratory tree which increases the patient's chances of future infections. He will have to undergo chest physiotherapy and they should report any signs of infection immediately to a medical professional. Which of the following pathogens will most likely infect this patient in adulthood?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 387
}
},
{
"id": "da4d66420963e26f",
"text": "An 8-week-old male presents with his mother to the pediatrician for a well visit. The patient has been breastfed since birth, and usually feeds for 30 minutes every 2-3 hours. The patient\u2019s mother is concerned that her milk production is not keeping up with the patient\u2019s nutritional requirements. She reports that about two weeks ago the patient began regurgitating breastmilk through his nose and mouth after some feeds. She reports that he seems mildly upset during the episodes of regurgitation but usually settles down quickly and is hungry again soon afterwards. The patient\u2019s mother has already tried limiting the volume of each feed, which seems to have reduced the frequency of the regurgitation. She denies any diarrhea, hematochezia, or family history of food allergies. Her older son had a similar problem with vomiting that resolved around 12 months of age. Four weeks ago, the patient\u2019s height and weight were in the 40th and 34th percentiles, respectively. His height and weight are now respectively in the 37th and 36th percentiles. On physical exam, the patient is cooing in his mother\u2019s lap and smiles reciprocally with her. He lifts his head and shoulders off the examination table when placed in the supine position. His abdomen is soft, non-tender and non-distended. Bowel sounds are normoactive.\n\nWhich of the following is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 388
}
},
{
"id": "399d6d665894ec7d",
"text": "A 27-year-old gentleman is brought into the ED after being stabbed in the back by a knife. In addition to the pain from the wound, he complains of weakness in his left leg. Upon physical examination you find that he has no other visible injuries; however, he has 2/5 strength in the left lower extremity. Complete neurologic exam also finds a deficit in vibration sense and light touch on the left lower extremity as well as a loss of pain and temperature sensation in the right lower extremity. Which of the following lesions would result in the syndrome described?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 389
}
},
{
"id": "66e9a9eb0a73aeef",
"text": "A 58-year-old African American man presents for his yearly wellness visit. He says he has been unsuccessful at losing weight and would like help. His last colonoscopy was 8 years previously, which was normal. Past medical history is significant for obstructive sleep apnea (OSA) and hypertension. Current medications are isosorbide dinitrate/hydralazine and aspirin 81 mg orally daily. He is also on CPAP to manage his OSA. The patient denies any history of smoking or recreational drug use and drinks 1 or 2 beers on weekends. Family history is significant for prostate cancer in his father and hypertension and diabetes mellitus type 2 in his mother. His vital signs include: temperature 36.8\u00b0C (98.2\u00b0F), pulse 97/min, respiratory rate 16/min, blood pressure 120/75 mm Hg. BMI is 30 kg/m2. Physical examination is unremarkable. Fasting blood glucose is 90 mg/dL. Which of the following preventative screening tests would be most appropriate for this patient at this time?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 390
}
},
{
"id": "65e2f4ae08012a0f",
"text": "A 34-year-old patient is brought to the emergency room after a motor vehicle accident. An EKG shows sinus tachycardia and chest radiograph reveals an enlarged cardiac silhouette. While observing sinus tachycardia on the patient's telemetry, you note that the radial pulse cannot be palpated during inspiration. What should be the next step in management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 391
}
},
{
"id": "a6b6c1682be4e5b9",
"text": "A previously healthy 60-year-old man comes to his physician because of progressively worsening shortness of breath for the past 2 months. He does not experience shortness of breath at rest. He also occasionally has a dry cough. He has not had fever, chills, or night sweats. He has smoked a pack of cigarettes daily for the past 40 years. He drinks a beer daily and occasionally more on weekends. He does not use illicit drugs. He is 183 cm (6 ft 0 in) tall and weighs 66 kg (145 lbs); BMI is 19.7 kg/m2. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 94/min, respirations are 21/min, and blood pressure is 136/88 mm Hg. Lung auscultation reveals a prolonged expiratory phase and end-expiratory wheezing. Spirometry shows an FEV1:FVC ratio of 62%, an FEV1 of 60% of predicted, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 392
}
},
{
"id": "37db3155e9cecee4",
"text": "A 29-year-old G1P0 woman is giving birth at 38 weeks gestation to a boy via vaginal delivery. As soon as the infant is clear of the vagina, a congenital malformation of the abdomen is observed. The infant is removed from the delivery room for further evaluation. Visual inspection shows loops of intestine protruding out of his abdomen on the right side. His APGAR scores are 7 at 1 minute and 9 at 5 minutes. His heart rate is 125/min, and his respirations are 45/min. All reflexes appear normal. There are no other visible defects. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 393
}
},
{
"id": "a6c2684ea7c46a42",
"text": "A 54-year-old woman presents with fatigue, malaise, and shortness of breath over the past 5 months. Past medical history is significant for rheumatoid arthritis diagnosed 23 years ago for which she takes naproxen as needed. Her vital signs include: temperature 36.9\u00b0C (98.4\u00b0F), blood pressure 135/88 mm Hg, pulse 92/min. Physical examination is significant for conjunctival pallor and bilateral ulnar deviation of the metacarpophalangeal joints. Laboratory findings are significant for the following:\nHemoglobin 9.2 g/dL\nMean corpuscular volume 76 fL\nLeukocyte count 7,000/mm3\nPlatelet count 220,000/mm3\nSerum ferritin 310 ng/mL\nErythrocyte sedimentation rate 85 mm/h\nWhich of the following is a feature of this patient's anemia?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 394
}
},
{
"id": "99a1b34264fe8d49",
"text": "A six-year-old boy with a history of asthma currently uses an albuterol inhaler as needed to manage his asthma symptoms. His mother brings him into your office because she feels she has had to increase the patient\u2019s use of his inhaler to four times per week for the past month. She also reports that he has woken up three times during the night from his symptoms this month. The boy reports that he is upset because he can\u2019t always keep up with his friends in the playground. His past medical history is significant for allergic rhinitis. The patient\u2019s temperature is 98\u00b0F (36.6\u00b0C), blood pressure is 110/70 mmHg, pulse is 88/min, and respirations are 18/min with an oxygen saturation of 98% O2 on room air. Auscultation of his lungs reveals bilateral late expiratory wheezes.\n\nWhat changes should be made to his current asthma treatment regimen?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 395
}
},
{
"id": "187483715626d20e",
"text": "A 25-year-old woman comes to the office complaining of pelvic pain and feeling \u201coff\u201d for the past few weeks. She has not had any changes in diet or lifestyle but reports weight loss despite an increase in appetite. In addition, she has been experiencing chest palpitations, increased frequency of diarrhea, and heat intolerance. Physical exam of her thyroid is unremarkable but her TSH was found to be 0.21 mIU/L. A complex structure in her right ovary was detected on ultrasound. Her symptoms can be explained by which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 396
}
},
{
"id": "16f205d24336dc58",
"text": "An otherwise healthy 15-year-old boy presents to the emergency department with extreme fatigue and shortness of breath. His temperature is 36.5\u00b0C (97.7\u00b0F), the blood pressure is 100/60 mm Hg and the pulse is 100/min. Past medical history is noncontributory and he takes no medication. His father and aunt both suffer from mild anemia. On examination, he is very pale and his spleen is enlarged. His hemoglobin is 5 g/dL and platelet count is slightly reduced. His peripheral blood smear is shown in the picture. Over the next 2 weeks, the patient recovers, and his hemoglobin is 11 g/dL. Which of the following best represents the pattern of inheritance of this patient underlying disorder?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 397
}
},
{
"id": "371b1063eff28971",
"text": "A 65-year-old male presents to the emergency department from his home complaining of dyspnea. He is alert and oriented. The following arterial blood gas readings are drawn: pH: 7.33 (Normal: 7.35-7.45), pCO2: 70 mmHg (Normal: 35-45 mmHg), HCO3 33 (Normal: 21-26 mEq/L) Which of the following is most likely to have produced this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 398
}
},
{
"id": "deda30b3c6d8d982",
"text": "A 23-year-old man is admitted to the hospital with fever, chest discomfort, tachypnea, pain, needle-like sensations in the upper extremities, and profuse sweating. He also complains of a gradual decrease in vision over the past 3 months. He is a bodybuilding competitor and has a competition coming up in 1 week. The man reports that his symptoms appeared suddenly, 30 minutes after he took 2 foreign-manufactured fat-burning pills instead of the 1 he usually takes. His blood pressure is 140/90 mm Hg, heart rate is 137/min, respiratory rate is 26/min, and temperature is 39.9\u00b0C (103.8\u00b0F). Physical examination reveals a reddish maculopapular rash over the patient\u2019s trunk, diminished lung and heart sounds, tenderness to palpation in his abdomen, and rotational bilateral nystagmus with an alternating gaze-dependent fast component. Ophthalmologic examination shows bilateral cataracts. The patient\u2019s total blood count is as follows:\nErythrocytes 4.4 x 109/mm3\nHb 12 g/dL\nTotal leukocyte count 3750/mm3\nNeutrophils 57%\nLymphocyte 37%\nEosinophil 1%\nMonocyte 5%\nBasophil 0%\nPlatelet count 209,000/mm3\nWhich of the following statements best describes the pathogenesis of this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 399
}
},
{
"id": "2045b29659abdd81",
"text": "A 23-year-old woman comes to the physician because of progressive fatigue and painful swelling of her right knee for 3 weeks. She works as a professional ballet dancer and says, \u201cI'm always trying to be in shape for my upcoming performances.\u201d She is 163 cm (5 ft 4 in) tall and weighs 45 kg (99 lb); BMI is 17 kg/m2. Physical examination shows tenderness and limited range of motion in her right knee. Oral examination shows bleeding and swelling of the gums. There are diffuse petechiae around hair follicles on her abdomen and both thighs. Laboratory studies show a prothrombin time of 12 seconds, an activated partial thromboplastin time of 35 seconds, and a bleeding time of 11 minutes. Arthrocentesis of the right knee shows bloody synovial fluid. The patient\u2019s condition is most likely associated with a defect in a reaction that occurs in which of the following cellular structures?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 400
}
},
{
"id": "eeaa2d19985e4b93",
"text": "A 24-year-old woman comes to the physician because she had unprotected intercourse with her boyfriend the previous day. She has had regular menses since menarche at the age of 12. Her last menstrual period was 3 weeks ago. She has no history of serious illness but is allergic to certain jewelry and metal alloys. She takes no medications. A urine pregnancy test is negative. She does not wish to become pregnant until she finishes college in six months. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 401
}
},
{
"id": "27b6cdbb4560eb51",
"text": "A 27-year-old woman with a history of bipolar disorder presents for a 3-month follow-up after starting treatment with lithium. She says she has been compliant with her medication but has experienced no improvement. The patient has no other significant past medical history and takes no other medications. She reports no known allergies. The patient is afebrile, and her vital signs are within normal limits. A physical examination is unremarkable. The patient is switched to a different medication. The patient presents 2 weeks later with an acute onset rash on her torso consisting of targetoid lesions with a vesicular center. She says the rash developed 2 days ago which has progressively worsened. She also says that 1 week ago she developed fever, lethargy, myalgia, and chills that resolved in 3 days. Which of the following drugs was this patient most likely prescribed?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 402
}
},
{
"id": "c37c53c6297ab043",
"text": "A 6-year-old boy is brought to the physician by his mother because of a 6-month history of mild episodic abdominal pain. The episodes occur every 1\u20132 months and last for a few hours. The pain is located in the epigastrium, radiates to his back, and is occasionally associated with mild nausea. His mother is concerned that his condition might be hereditary because his older sister was diagnosed with congenital heart disease. He is otherwise healthy and has met all developmental milestones. He is at the 75th percentile for height and the 65th percentile for weight. Physical examination shows no abdominal distention, guarding, or rebound tenderness. Which of the following congenital conditions would best explain this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 403
}
},
{
"id": "196fdf84b1c8c135",
"text": "A healthy, full-term 1-day-old female is being evaluated after birth and is noted to have a cleft palate and a systolic ejection murmur at the second left intercostal space. A chest radiograph is obtained which reveals a boot-shaped heart and absence of a thymus. An echocardiogram is done which shows pulmonary stenosis with a hypertrophic right ventricular wall, ventricular septal defect, and overriding of the aorta. Which of the following additional features is expected to be seen in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 404
}
},
{
"id": "5b98fb4e326a7ad3",
"text": "A 58-year-old male with a history of obesity and hypertension presents to his primary care physician for a follow-up visit. He reports that he feels well and has no complaints. He currently takes hydrochlorothiazide. His temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 135/80 mmHg, pulse is 86/min, and respirations are 17/min. His BMI is 31 kg/m2. Results of a lipid panel are: Total cholesterol is 280 mg/dl, triglycerides are 110 mg/dl, HDL cholesterol is 40 mg/dl, and LDL cholesterol is 195 mg/dl. Her physician considers starting her on atorvastatin. Which of the following will most likely decrease after initiating this medication?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 405
}
},
{
"id": "6a06cc70a8c83cb7",
"text": "A 54-year-old man presents with the acute onset of seizures and hallucinations. The patient\u2019s wife says that he had been on a camping trip a few months earlier to study bats but otherwise has not traveled recently. Past medical history is significant for hypertension, managed medically with hydralazine and enalapril. The patient\u2019s condition rapidly deteriorates, and he passes away. An autopsy is performed and a histologic stained section of the brain is shown in the image. Which of the following receptors are targeted by the pathogen most likely responsible for this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 406
}
},
{
"id": "67844fe21542f5a1",
"text": "A 60-year-old female patient with a history of hypertension presents to an outpatient office for regular check-up and is found to have hypertriglyceridemia. Her physician prescribes high-dose niacin and recommends taking the medication along with aspirin. The side effect the physician is trying to avoid is thought to be mediated by what mechanism?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 407
}
},
{
"id": "cd736fcc3c88251b",
"text": "A 42-year-old man comes to the physician after elevated liver function tests were found after a routine screening. He has had occasional headaches over the past year, but otherwise feels well. The patient reports that he was involved in a severe car accident 30 years ago. He does not smoke or drink alcohol. He has never used illicit intravenous drugs. He takes no medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8\u00b0C (100\u00b0F), pulse is 100/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 14 g/dL\nLeukocyte count 10,000/mm3\nPlatelet count 146,000/mm3\nSerum\nGlucose 150 mg/dL\nAlbumin 3.2 g/dL\nTotal bilirubin 1.5 mg/dL\nAlkaline phosphatase 75 U/L\nAST 95 U/L\nALT 73 U/L\nHIV negative\nHepatitis B surface antigen negative\nHepatitis C antibody positive\nHCV RNA positive\nHCV genotype 1\nA liver biopsy is performed and shows mononuclear infiltrates that are limited to portal tracts and periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 408
}
},
{
"id": "16e40dd00daf4190",
"text": "A 44-year-old woman with hypothyroidism comes to the physician because of a 1-month history of tingling in her feet and poor balance. Her only medication is levothyroxine. Physical examination shows conjunctival pallor and an ataxic gait. Proprioception and sense of vibration are decreased in her toes bilaterally. Laboratory studies show macrocytic anemia and normal thyroid hormone levels. Histological evaluation of tissue samples obtained by esophagogastroduodenoscopy reveals atrophic changes of the gastric body and fundus with normal antral mucosa. Which of the following structures is most likely being targeted by antibodies in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 409
}
},
{
"id": "54e536db097143be",
"text": "A 26-year-old female complains of frequent, large volume urination. This negatively affects her sleep, as she has to frequently wake up at night to urinate. She also complains of increased thirst. Her past medical history is significant for bipolar disorder that is treated with lithium for 3 years. Serum osmolality is 425 mOsm/kg, and urine osmolality is 176 mOsm/kg. Which of the following best explains this patient\u2019s serum and urine osmolality?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 410
}
},
{
"id": "7c9eeabf26ae7850",
"text": "An 8-year-old girl presents to her pediatrician with intensely pruritic lesions over her buttocks, as shown. These lesions occur intermittently but have worsened over time. Her medical history is remarkable for iron deficiency, for which she is on ferrous sulfate. The patient has also experienced intermittent episodes of mild diarrhea, previously diagnosed as lactose intolerance. Her height is at the 30th percentile and weight is at the 25th percentile for age and sex. An immunoglobulin A (IgA) tissue transglutaminase titer is 5 times the upper limit of normal. Which of the following is the most likely cause of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 411
}
},
{
"id": "96079712a018b84e",
"text": "A 64-year-old man comes to the emergency department because of a 2-day history of lower back pain, fever, and chills. He has had nausea but no vomiting during this time. He has hypertension, chronic kidney disease, and type 2 diabetes mellitus. Three months ago, he underwent amputation of his left third toe because of a non-healing ulcer. He has smoked a pack of cigarettes daily for 48 years. Current medications include hydrochlorothiazide, metoprolol, and insulin. His temperature is 39.4\u00b0C (102.9\u00b0F), pulse is 102/min, blood pressure is 150/94 mm Hg, and respirations are 18/min. Examination shows a 1-cm (0.4-in) round ulcer on the sole of his right foot. There is costovertebral angle tenderness on the left side. The abdomen is soft. Laboratory studies show:\nHemoglobin 11.5 g/dL\nLeukocyte count 19,000/mm3\nSerum\nNa+ 140 mEq/L\nCl\u2212 102 mEq/L\nK+ 5.0 mEq/L\nHCO3\u2212 25 mEq/L\nUrea nitrogen 65 mg/dL\nCreatinine 2.4 mg/dL\nGlucose 240 mg/dL\nUrine\nBlood 1+\nProtein 1+\nWBC 100/hpf\nNitrite 2+\nWBC casts numerous\nUrine and blood samples for culture and sensitivity tests are obtained. Which of the following is the most appropriate next step in management?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 412
}
},
{
"id": "dd3ab72ae15df154",
"text": "A 56-year-old man with a history of pancreatic cancer presents to the surgical intensive care unit following a pancreaticoduodenectomy. Over the next 3 days, the patient's drainage output is noted to exceed 1 liter per day. In the early morning of postoperative day 4, the nurse states that the patient is difficult to arouse. His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 107/88 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. His skin and mucous membranes are dry on physical exam. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 154 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 27 mEq/L\nBUN: 20 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.1 mg/dL\n\nWhich of the following is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 413
}
},
{
"id": "297644af2601b58a",
"text": "A 46-year-old woman comes to the physician because of a 3-day history of diarrhea, moderate abdominal pain, and weakness. Her symptoms began on the return flight from a 2-week yoga retreat in India, where she stayed at a resort. She was mildly nauseous as she boarded the flight, and diarrhea followed immediately after eating the in-flight meal. Since then, she has had up to five watery stools daily. She has a 1-year history of gastroesophageal reflux disease and is allergic to shellfish. Her only medication is ranitidine. She appears lethargic. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 70/min, and blood pressure is 115/72 mm Hg. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are hyperactive. Which of the following is the most likely pathogen?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 414
}
},
{
"id": "b1e898676e1ec65a",
"text": "A research group has created a novel screening test for a rare disorder. A robust clinical trial is performed in a group of 100 subjects comparing the new screening test against the gold standard. The results are given in the table below:\nScreening test\\gold standard Disease present Disease absent\nPositive 45 15\nNegative 5 35\nWhich of the following is most correct regarding the statistical power of this new screening test?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 415
}
},
{
"id": "9ee6745e4102adec",
"text": "A 25-year-old woman presents to her new family physician for a follow-up appointment. She previously presented with itching, as well as frequent and painful urination. A vaginal swab was taken and sent to the laboratory to confirm the diagnosis. Diplococci were seen on Gram stain and were grown on Thayer-Martin agar. When discussing her infection, the patient says that she uses safe sex practices. Her history is significant for meningitis and for infection with Streptococcus pneumoniae. The physician discusses that the reason behind these infections comes from a defect in the innate immune system. Which of the following best describes the component that is likely deficient in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 416
}
},
{
"id": "344b775b4dcfdd55",
"text": "A 55-year-old woman with papillary thyroid carcinoma underwent total thyroidectomy. She has no significant medical history. On postoperative day 1, she develops perioral numbness and a tingling sensation, along with paresthesia of the hands and feet. The physical examination reveals that she is anxious and confused. Her pulse is 90/min, the blood pressure is 110/80 mm Hg, the respirations are 22/min, and the temperature is 36.7\u00b0C (98.0\u00b0F). Latent tetany (carpal spasm) is evident in the right arm. This is observed when the sphygmomanometer cuff pressure is raised above the systolic blood pressure and held for 3 minutes. The laboratory test results are as follows:\nSerum calcium 6.7 mg/dL\nSerum sodium 143 mEq/L\nSerum potassium 4.4 mEq/L\nSerum creatinine 0.9 mg/dL\nBlood urea 16 mg/dL\nSerum magnesium 1.1 mEq/L\nWhat is the most likely cause of this condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 417
}
},
{
"id": "0db70d66718427f0",
"text": "A 16-year-old boy is brought to the physician by his parents for the evaluation of fatigue for several weeks. The parents report that their son quit doing sports at school because of low energy. The patient's academic performance has declined recently. He spends most of his time in the basement playing video games and eating bowls of cereal. He has no history of serious illness. His mother has Hashimoto's thyroiditis and his father has major depressive disorder. The patient does not smoke or drink alcohol. His vital signs are within normal limits. Examination shows conjunctival pallor, inflammation and fissuring of the corners of the mouth, and concavity of the finger nails. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 11.5 g/dL\nMean corpuscular volume 76 \u03bcm3\nPlatelet count 290,000/mm3\nRed cell distribution width 18% (N = 13%\u201315%)\nLeukocyte count 7,000/mm3\nWhich of the following is the most appropriate initial step in treatment?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 418
}
},
{
"id": "7d207633d1cb6642",
"text": "A 78-year-old man is brought to the emergency department because of a 1-day history of painful enlarging bruises and skin ulceration over his thighs and external genitalia. He has type 2 diabetes mellitus, mitral regurgitation, and atrial fibrillation. Three days ago, he was started on treatment with warfarin. His only other medications are metformin and lisinopril. His temperature is 37.8\u00b0C (100.0\u00b0F), pulse is 108/min and irregularly irregular, and blood pressure is 155/89 mm Hg. Examination of the skin shows large purpura, hemorrhagic bullae, and areas of skin necrosis over his anterior legs, gluteal region, and penis. This patient is most likely to benefit from treatment with which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 419
}
},
{
"id": "bebf68e0f4a30a74",
"text": "A 15-year-old boy is brought to the physician for evaluation of a learning disability. His teachers have reported hyperactivity during class, difficulties with social interaction, and poor scores on reading and writing assessments. Molecular analysis shows an increased number of CGG trinucleotide repeats. Which of the following findings are most likely to be seen on physical examination of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 420
}
},
{
"id": "463bb64dafa7a3ca",
"text": "A 65-year-old woman presented to the emergency room due to progressive dyspnea. She is a known hypertensive but is poorly compliant with medications. The patient claims to have orthopnea, paroxysmal nocturnal dyspnea, and easy fatigability. On physical examination, the blood pressure is 80/50 mm Hg. There is prominent neck vein distention. An S3 gallop, bibasilar crackles, and grade 3 bipedal edema were also detected. A 2d echo was performed, which showed a decreased ejection fraction (32%). Which of the following drugs should not be given to this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 421
}
},
{
"id": "340c10a9e4df2adc",
"text": "A 49-year-old woman is brought to the emergency department with progressive dyspnea and cough which she developed approx. 8 hours ago. 2 weeks ago she had a prophylactic ovariectomy because of a family history of ovarian cancer. She is known to have type 2 diabetes mellitus and stage 1 hypertension, but she does not take her antihypertensives because she is not concerned about her blood pressure. Also, she has a history of opioid abuse. She takes metformin 1000 mg and aspirin 81 mg. She has been smoking 1 pack of cigarettes per day for 22 years. Her vital signs are as follows: blood pressure 155/80 mm Hg, heart rate 101/min, respiratory rate 31/min, and temperature 37.9\u2103 (100.2\u2109). Blood saturation on room air is 89%. On examination, the patient is dyspneic and acrocyanotic. Lung auscultation reveals bilateral rales over the lower lobes. A cardiac examination is significant for S2 accentuation best heard in the second intercostal space at the left sternal border and S3 presence. There is no leg edema. Neurological examination is within normal limits. Arterial blood gases analysis shows the following results:\npH 7.49\nPaO2 58 mm Hg\nPaCO2 30 mm Hg\nHCO3- 22 mEq/L\nBased on the given data, which of the following could cause respiratory failure in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 422
}
},
{
"id": "05a59daab09b6b49",
"text": "A 27-year-old woman presents to the emergency department with acute onset bloody diarrhea. The patient has had severe abdominal pain throughout her entire life with occasional episodes of bloody diarrhea. She has recently lost 7 pounds and has felt generally ill for the past 2 days. She has a past medical history of generalized seizures with her most recent one having occurred 5 days ago. One month ago, the patient was treated for impetigo. The patient admits to occasional cocaine use and binge drinking. Her temperature is 98.7\u00b0F (37.1\u00b0C), blood pressure is 107/58 mmHg, pulse is 127/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical exam is notable for diffuse abdominal tenderness and guaiac positive stools. Laboratory values are ordered as seen below.\n\nHemoglobin: 9 g/dL\nHematocrit: 30%\nLeukocyte count: 9,400/mm^3 with normal differential\nPlatelet count: 199,000/mm^3\n\nSerum:\nNa+: 139 mEq/L\nCl-: 101 mEq/L\nK+: 4.9 mEq/L\nHCO3-: 25 mEq/L\nBUN: 37 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.8 mg/dL\nAST: 62 U/L\nALT: 80 U/L\nBlood alcohol: .15 g/dL\n\nUrine:\nColor: Yellow\nProtein: Positive\nCocaine: Positive\nMarijuana: Positive\n\nWhich of the following is the best explanation for this patient's laboratory findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 423
}
},
{
"id": "6bd447f0ec3ae449",
"text": "A 45-year-old Caucasian male presents to a gastroenterologist complaining of heartburn and difficulty swallowing. He recalls that he has been told by his primary care physician that he suffers from gastroesophageal reflux disease (GERD). The gastroenterologist decides to perform an upper endoscopy with biopsy. Which of the following findings would be consistent with Barrett's esophagus?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 424
}
},
{
"id": "54bddb7814dfe17a",
"text": "A 16-year-old female patient with a history of mental retardation presents to your clinic with her mother. The mother states that she wants her daughter to have a bilateral tubal ligation after she recently discovered her looking at pornographic materials. She states that her daughter is not capable of understanding the repercussions of sexual intercourse, and that she does not want her to be burdened with a child that she would not be able to raise. Upon discussions with the patient, it is clear that she is not able to understand that sexual intercourse can lead to pregnancy. What should your next step be?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 425
}
},
{
"id": "c812fbd326bc1f40",
"text": "A 51-year-old man presents to his primary care provider complaining of malaise. He returned from a research trip to Madagascar 2 weeks ago and has since developed a worsening fever with a maximum temperature of 102.2\u00b0F (39\u00b0C). He also reports some swelling around his neck and groin. He works as a zoologist and was in rural Madagascar studying a rare species of lemur. His past medical history is notable for hypertension and gout. He takes lisinopril and allopurinol. His temperature is 101.9\u00b0F (38.3\u00b0C), blood pressure is 145/85 mmHg, pulse is 110/min, and respirations are 22/min. On exam, he has painful erythematous cervical, axillary, and inguinal lymphadenopathy. Black hemorrhagic eschars are noted on his fingertips bilaterally. The pathogen responsible for this patient\u2019s condition produces a virulence factor that has which of the following functions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 426
}
},
{
"id": "56b156bc0fedb29d",
"text": "A 45-year-old African-American male presents to the family medicine physician to assess the status of his diabetes. After reviewing the laboratory tests, the physician decides to write the patient a prescription for miglitol and states that it must be taken with the first bite of the meal. Which of the following bonds will no longer be cleaved when the patient takes miglitol?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 427
}
},
{
"id": "e3f8cb20fa282d0c",
"text": "A previously healthy 24-year-old man comes to the physician 1 day after the onset of burning pain, swelling, and multiple blisters over the left index finger. He works as a dental assistant and is concerned about not being able to work. The patient wonders if the symptoms might be related to a hunting trip he returned from 1 week ago because he remembers seeing a lot of poison oak. He is sexually active with one female partner, and they do not use condoms. His father has a history of thromboangiitis obliterans. He has smoked one pack of cigarettes daily for 5 years. He drinks two to four beers on social occasions. Vital signs are within normal limits. Physical examination shows swelling and erythema of the pulp space of the left index finger; there are multiple 3-mm vesicles. Laboratory studies show a leukocyte count of 12,000 cells/mm3. In addition to supportive therapy, which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 428
}
},
{
"id": "bb9dd63cffd59a0c",
"text": "A 63-year-old man presents to the ambulatory medical clinic with symptoms of dysphagia and \u2018heartburn\u2019, which he states have become more troublesome over the past year. His past medical history is significant for hypertension and GERD. He takes lisinopril for hypertension and has failed multiple different therapies for his GERD. On physical exam, he is somewhat tender to palpation over his upper abdomen. Barium swallow demonstrates a subdiaphragmatic gastroesophageal junction, with herniation of the gastric fundus into the left hemithorax. Given the following options, what is the most appropriate next step in the management of this patient\u2019s underlying condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 429
}
},
{
"id": "98da358e78a0d7d0",
"text": "A 63-year-old man is admitted to the intensive care unit for hemodynamic instability. Several days prior, he had been swimming in the Gulf coast when he stepped on a sharp rock and cut his right foot. Three days ago, the patient presented to the emergency room after noticing painful redness spreading along his skin up from his right foot and was subsequently admitted for antibiotic treatment. Currently, his temperature is 101.8\u00b0F (38.8\u00b0C), blood pressure is 84/46 mmHg with a mean arterial pressure of 59 mmHg, pulse is 104/min, and respirations are 14/min. His telemetry shows sinus tachycardia. His blood cultures are pending, but Gram stain demonstrated gram-negative bacilli. Which of the following best describes the form of shock and the skin exam?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 430
}
},
{
"id": "f9c4062b083fc87c",
"text": "A 24-year-old female presents to the emergency department with a chief complaint of an inability to urinate. She states that this has been one of many symptoms she has experienced lately. At times she has had trouble speaking and has noticed changes in her vision however these episodes occurred over a month ago and have resolved since then. Two days ago she experienced extreme pain in her face that was exacerbated with brushing her teeth and plucking out facial hairs. The patient has no relevant past medical history, however, the patient admits to being sexually abused by her boyfriend for the past year. Her current medications include ibuprofen for menstrual cramps. On physical exam it is noted that leftward gaze results in only the ipsilateral eye gazing leftward. The patient's initial workup is started in the emergency department. Her vital signs are within normal limits and you note a pale and frightened young lady awaiting further care. Which of the following is the best initial test for this patient's chief complaint?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 431
}
},
{
"id": "03bb0716b520627f",
"text": "A 54-year-old woman is brought to the physician by her brother for confusion and agitation. She is unable to personally give a history. Her brother says she has a problem with alcohol use and that he found an empty bottle of vodka on the counter at her home. She appears disheveled. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 85/min, and blood pressure is 140/95 mm Hg. On mental status examination, she is confused and oriented only to person. She recalls 0 out of 3 words after 5 minutes. She cannot perform serial sevens and is unable to repeat seven digits forward and five in reverse sequence. Neurologic examination shows horizontal nystagmus on lateral gaze. She has difficulty walking without assistance. Laboratory studies show:\nHemoglobin 11 g/dL\nMean corpuscular volume 110 \u03bcm3\nPlatelet count 280,000/mm3\nWhich of the following is most appropriate initial treatment for this patient?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 432
}
},
{
"id": "0cc97d615b2fb510",
"text": "An 18-year-old woman makes an appointment with a gynecologist for her first gynecologic examination. She did not disclose her past medical history, but her sexual debut occurred with her boyfriend 3 weeks ago. She is now complaining of a yellow-green, diffuse, malodorous vaginal discharge that she noticed 1 week ago for the first time. She also reported mild pelvic and abdominal pain. cervical motion tenderness was noted during the pelvic examination. The gynecologist also noticed a pink and inflamed nulliparous cervix with a preponderance of small red punctate spots. There was a frothy white discharge with a malodorous odor in the vaginal vault. A wet mount was prepared for a light microscopic examination, which revealed numerous squamous cells and motile organisms. The gynecologist concluded that this was a sexually-transmitted infection. What is the causative organism?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 433
}
},
{
"id": "8049edfe8a97604f",
"text": "A 70-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 3 years. Initially, he used to forget his children's names or forget to lock the house door. During the past year, he has gotten lost twice while returning from the grocery store and was unable to tell passersby his address. One time, he went to the park with his granddaughter and returned home alone without realizing he had forgotten her. His daughter says that over the past year, he has withdrawn himself from social gatherings and avoids making conversation. He does not sleep well at night. His daughter has hired a helper to cook and clean his home. On mental status examination, he is oriented only to person. He describes his mood as fair. Short- and long-term memory deficits are present. He appears indifferent about his memory lapses and says this is normal for someone his age. The most appropriate initial pharmacotherapy for this patient is a drug that acts on which of the following neurotransmitters?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 434
}
},
{
"id": "703f13c4a220f3df",
"text": "A 45-year-old mechanic presents to the emergency department complaining of acute-onset shortness of breath while repairing a plowing tractor for his neighbor. The patient denies having any history of asthma or respiratory symptoms, and does not smoke. His temperature is 99.8\u00b0F (37.7\u00b0C), pulse is 65/min, blood pressure is 126/86 mmHg, and respirations are 20/min. His oxygen saturation is 97%. On exam, he is pale and diaphoretic. His pupils are contracted. Diffuse wheezes are noted in all lung fields. What is the best treatment for his condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 435
}
},
{
"id": "1cbfe12aa990ea5f",
"text": "A 3-year-old male is brought in to his pediatrician by his mother because she is concerned that he is not growing appropriately. Physical examination is notable for frontal bossing and shortened upper and lower extremities. His axial skeleton appears normal. He is at the 7th percentile for height and 95th percentile for head circumference. He demonstrates normal intelligence and is able to speak in three-word sentences. He first sat up without support at twelve months and started walking at 24 months. Genetic analysis reveals an activating mutation in a growth factor receptor. Which of the following physiologic processes is most likely disrupted in this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 436
}
},
{
"id": "3ca647309a3b516b",
"text": "A 59-year-old woman comes to the physician 2 weeks after noticing a lump in her left breast. Examination of the left breast shows a firm, nontender mass close to the nipple. Mammography shows an irregular calcified mass. A core needle biopsy shows invasive ductal carcinoma. Genetic analysis of this patient's cancer cells is most likely to show overexpression of which of the following genes?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 437
}
},
{
"id": "a6efee965109b817",
"text": "A 45-year-old man comes to his primary-care doctor with his wife for a 4-week history of constipation. The patient reports that his bowel habits have changed from every day to every 3 or 4 days. He also now has to strain to pass stool. On further questioning, his wife has also noticed that he has seemed fatigued, with little interest in going on their usual afternoon walks. Medical history is notable for hypertension and hyperlipidemia, both managed medically. He was last seen for follow-up of these conditions 1 month ago. Physical examination is unremarkable. Which of the following is the cellular target of the medicine that is most likely responsible for this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 438
}
},
{
"id": "0f3f14a1fd12f344",
"text": "A 23-year-old man presents to the office for a circular, itchy rash over the abdomen that has been slowly getting worse for the past 2 weeks. The patient has a medical history of chronic dermatitis and chronic sinusitis for which he has prescriptions of topical hydrocortisone and fexofenadine. He smokes one-half pack of cigarettes every day. His vital signs include: blood pressure 128/76 mm Hg, heart rate 78/min, and respirations 12/min. On physical examination, the patient appears tired but oriented. Examination of the skin reveals a 2 x 2 cm round and erythematous, annular plaque on the abdomen 3 cm to the left of the umbilicus. There are no vesicles, pustules, or papules. Auscultation of the heart reveals a 1/6 systolic murmur. Breath sounds are mildly coarse at the bases. A KOH preparation from the skin scraping confirms the presence of hyphae. Which of the following is the next best step in the management of this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 439
}
},
{
"id": "3ccc0479f1431e55",
"text": "A 12-year-old boy is brought to the emergency department for the evaluation of persistent bleeding from his nose over the past hour. The bleeding started spontaneously. He has no history of a similar episode. He takes no medications. There is no history of abnormal bleeding in the family. His vital signs are within normal limits. On examination, he is pressing a gauze against his left nostril while hyperextending his head. The gauze is stained with blood and upon withdrawal of the gauze blood slowly drips out of his left nostrils. There is no bleeding from the right nostril. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate initial therapy?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 440
}
},
{
"id": "fb257a57d8798e27",
"text": "A 40-year-old female presents to your office complaining of a tender neck and general lethargy. Upon further questioning, she reports decreased appetite, fatigue, constipation, and jaw pain. Her pulse is 60 bpm and her blood pressure is 130/110 mm Hg. Biopsy of her thyroid reveals granulomatous inflammation and multinucleate giant cells surrounding fragmented colloid. Which of the following likely precipitated the patient\u2019s condition:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 441
}
},
{
"id": "e39e43b8204a2447",
"text": "A 24-year-old man is brought to the emergency room by the police after a fall. The patient smells of alcohol and is slurring his words. You find out that he has recently been fired from his job as a salesperson for months of tardiness and poor performance. The police tell you that his girlfriend, who was there at the time of the fall, mentioned that the patient has been struggling with alcohol for at least a year. Upon physical examination, the patient becomes agitated and starts yelling. He accuses his ex-boss of being a cocaine addict and says he couldn\u2019t keep up sales percentages compared to someone using cocaine. Which of the following psychiatric defense mechanisms is the patient demonstrating?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 442
}
},
{
"id": "7384d6270457f3cf",
"text": "A 65-year-old woman presents to a physician with painful ankles for 2 days. Her symptoms began 1 week ago with a severe fever (40\u2103 (104\u2109)) for 3 days. When the fever subsided, she developed a maculopapular rash over the trunk and extremities with painful wrists and fingers. She also reports abdominal pain, nausea, vomiting, and headaches. Last week she returned from a trip to Africa where she spent several weeks, mostly in rural areas. Her temperature is 37.5\u2103 (99.5\u2109); pulse is 75/min; respiratory rate is 13/min, and blood pressure is 115/70 mm Hg. A maculopapular rash is observed over the trunk and limbs. Both ankles are swollen and painful to active and passive motion. The abdomen is soft without organomegaly. Laboratory studies show the following:\nLaboratory test\nHemoglobin 11.4 g/d\nMean corpuscular volume 90 \u00b5m3\nLeukocyte count 4,500/mm3\nSegmented neutrophils 70%\nLymphocytes 15%\nPlatelet count 250,000/mm3\nRing-form trophozoites are absent on the peripheral blood smear. Which of the following organisms is the most likely cause of this patient\u2019s illness?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 443
}
},
{
"id": "08c51aa23ed34a8e",
"text": "A 61-year-old man complaining of unexplained bleeding by from the mouth is escorted to the emergency department by corrections officers. Upon examination patient states he feels nauseated as he begins to retch violently and vomit bright red blood. His past medical history is remarkable for cirrhosis secondary to alcohol abuse and untreated hepatitis C. His current blood pressure is 90/50 mm Hg, heart rate is 128/min, and oxygen saturation in room air is 88%. On further questioning, he states that he is scared to die and wants everything done to save his life. IV fluids are initiated and packed RBCs are ordered. You begin to review his labs and notice and he has elevated beta-hydroxybutyrate, ammonia, and lactate. What would be the appropriate response to the patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 444
}
},
{
"id": "92077530724d2f76",
"text": "Three days after undergoing a laparoscopic Whipple's procedure, a 43-year-old woman has swelling of her right leg. She does not have pain. She has nausea but has not vomited. She was diagnosed with pancreatic cancer 1 month ago. She has been using an incentive spirometer every 6 hours since recovering from her surgery. Prior to admission, her only medications were a multivitamin and an herbal weight-loss preparation. She appears uncomfortable. Her temperature is 38\u00b0C (100.4\u00b0F), pulse is 90/min, and blood pressure is 118/78 mm Hg. Examination shows mild swelling of the right thigh to the ankle; there is no erythema or pitting edema. Homan's sign is negative. The abdomen is soft and shows diffuse tenderness to palpation. There are five abdominal laparoscopic incisions with no erythema or discharge. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 445
}
},
{
"id": "07f18fe771f47beb",
"text": "A 36-year-old man presents to a physician after having a transient loss of consciousness while resting after dinner the previous night. His symptoms only lasted for a few seconds and resolved spontaneously. This is the third time he experienced such an episode. He says that he recently started having nightmares. His father died of sudden cardiac death at the age of 45 years without a history of hypertension or any chronic cardiac disorder. A complete physical examination was normal. A 12-lead electrocardiogram showed ST-segment elevations in V1, V2, and V3, and the presence of incomplete right bundle branch block (RBBB). After a complete diagnostic evaluation, Brugada syndrome was diagnosed. He has prescribed a class I anti-arrhythmic drug, which is a sodium channel blocker that slows phase 0 depolarization in ventricular muscle fibers. The drug also blocks potassium channels and prolongs action potential duration, but it does not shorten phase 3 repolarization. The drug also has mild anticholinergic and alpha-blocking activity. If taken in high doses, which of the following are the most likely side effects of the drug?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 446
}
},
{
"id": "f5fb3b2e693fa1f0",
"text": "A 52-year-old man is brought to the emergency department for recurrent vomiting that began 5 hours ago. He describes the vomitus as bloody and containing black specks. He drinks 10\u201312 beers daily and has not seen a physician in 15 years. He appears pale. His temperature is 36.7\u00b0C (98.1\u00b0F), pulse is 122/min, and blood pressure is 85/59 mm Hg. Physical examination shows decreased radial pulses, delayed capillary refill, multiple spider angiomata, and a distended abdomen. He is oriented to person but not to place or time. Which of the following is most likely decreased in this patient in response to his current condition compared to a healthy adult?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 447
}
},
{
"id": "cafe478c90c3c1b5",
"text": "A 69-year-old male with a longstanding history of hypertension and high cholesterol presents with abdominal pain and \u2018bruising on his feet\u2019. The patient states that his symptoms started about a week ago and have steadily worsened. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the umbilical region. Past medical history is significant for 2 transient ischemic attacks 6 months prior, characterized by a sudden right-sided weakness and trouble speaking but recovered fully within 30 minutes. Current medications are sildenafil 100 mg orally as needed. Patient reports a 30-pack-year smoking history and heavy alcohol use on the weekends. Review of systems is significant for decreased appetite and feeling easily full. Vitals are temperature 37\u00b0C (98.6\u00b0F), blood pressure 155/89 mm Hg, pulse 89/min, respirations 16/min, and oxygen saturation 98% on room air. On physical examination, the patient is alert and cooperative. The cardiac exam is normal. Lungs are clear to auscultation. Carotid bruit present on the right. The abdomen is soft and nontender. Bowel sounds present. A pulsatile abdominal mass is felt in the lower umbilical region. Patient\u2019s feet have the following appearance seen in the picture. Abdominal ultrasound reveals the presence of an abdominal aortic aneurysm (AAA). Contrast CT reveals a small, unruptured AAA (diameter 4.1 cm). High flow supplemental oxygen and fluid resuscitation are initiated. Morphine sulfate and metoprolol are administered. Which of the following is the best course of treatment for this patient?\n ",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 448
}
},
{
"id": "e6b50c40258d9dd9",
"text": "A 38-year-old woman undergoes a partial thyroidectomy for an enlarged thyroid gland compressing the trachea. During surgery, a young surgeon ligates the inferior thyroid arteries as close to the poles as possible to prevent intraoperative hemorrhage. 2 weeks later, the patient presents to the outpatient clinic with hoarseness. What could be the most likely cause of her hoarseness?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 449
}
},
{
"id": "0c91793004c0e15d",
"text": "A 17-year-old man presents to his family physician for an evaluation about the size of his penis. He feels increasingly anxious during physical education (PE) class as he has noticed that the size of his penis is significantly smaller when compared to his peers. Based on the physical examination, he is Tanner stage 1. The weight and height are 60 kg (132 lb) and 175 cm (5 ft 9 in), respectively. The cardiopulmonary examination is normal; however, the patient has difficulty identifying coffee grounds by smell. Which of the following explains the pathophysiology underlying this patient\u2019s disorder?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 450
}
},
{
"id": "745b01cf058ea9a8",
"text": "A 63-year-old man is aiming to improve his health by eating a well balanced diet, walking daily, and quitting smoking following a 45-year smoking history. While on his daily walks he notices a strong cramping pain in his calves that consistently appears after a mile of walking. He sees his physician and a diagnosis of peripheral artery disease with intermittent claudication is made. To improve his symptoms, cilostazol is prescribed. What is the mechanism of action of this medication?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 451
}
},
{
"id": "c3d94cde6b9b1102",
"text": "A 37-year-old man comes to the emergency department with the chief complaint of a high fever for several days. In addition to the fever, he has had malaise, chest pain, and a dry cough. He recently went on vacation to South America but has returned to his job delivering packages. He has several friends who recently had influenza. Hi temperature is 102.8\u00b0F (39.3 \u00b0C), blood pressure is 137/80 mmHg, pulse is 104/min, respirations are 19/min, and oxygen saturation is 98%. Chest exam reveals a deep noise found bilaterally in the lung bases. Chest radiograph reveals a wider area of opacity near the heart and bilateral lung infiltrates. Which of the following is characteristic of the most likely organism responsible for this patient's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 452
}
},
{
"id": "141bbcad1d6a15b2",
"text": "A 34-year-old man presents to the emergency department complaining of headache, fever, chills, cough, shortness of breath, and chest pain for the past 4 days. He smokes 2 packs per day and drinks 2\u20133 beers every day. He denies any previous medical problems except for seasonal allergies for which he takes diphenhydramine on occasions. At the hospital, the vital signs include: temperature 40.0\u00b0C (104.0\u00b0F), blood pressure 140/80 mm Hg, heart rate 98/min, and respiratory rate 28/min. On physical exam, he is thin and poorly kept. His clothes appear dirty. Small scars are visible in the decubitus region of both arms. The lung sounds are equal with bilateral crackles, and heart auscultation reveals a systolic murmur that radiates to the left axilla. Petechiae are seen on the hard palate and palms of his hands. A chest X-ray and blood cultures are ordered. What is the most likely organism causing his symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 453
}
},
{
"id": "2abce47c3c2706c3",
"text": "A 42-year-old man presents to a neurologist for evaluation of severe headache. He started experiencing episodic headaches and palpitations 3 months ago; however, he thought that these symptoms were simply related to the stress of moving and starting a new job. He has continued to experience these intermittent headaches and has also noticed that he sweats profusely during these episodes. On presentation his temperature is 99.1\u00b0F (37.3\u00b0C), blood pressure is 163/112 mmHg, pulse is 112/min, and respirations are 15/min. Physical exam reveals pallor and perspiration but is otherwise unremarkable. The most likely cause of this patient's symptoms is produced by cells located in which region of the histology slide shown in figure A?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 454
}
},
{
"id": "d8860e28dc6be5c3",
"text": "A 62-year-old woman presents to the emergency department for vision changes. About 90 minutes ago she was on the couch watching television with her husband when she suddenly noticed that she couldn't see the screen normally. She also felt a little dizzy. She has never had anything like this happen before. Her general physical exam is unremarkable. Her neurologic exam is notable for loss of vision in the right visual field of both eyes with macular sparing, though extraocular movements are intact. A computed tomography (CT) scan of the head shows no acute intracranial process. Angiography of the brain will most likely show a lesion in which of the following vessels?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 455
}
},
{
"id": "7fb53552fcd22301",
"text": "A three-day-old, full-term infant born by uncomplicated vaginal delivery is brought to a pediatrician by his mother, who notes that her son's skin appears yellow. She reports that the child cries several times per day, but sleeps 7-8 hours at night, uninterrupted. She has been breastfeeding the infant but feels the latch has been poor and is unsure how much milk he has been consuming but feels it is not enough. A lactation consult was called for the patient and it was noted that despite proper instruction the observed latch was still poor. When asked the mother stated that the baby is currently making stools 2 times per day. Which of the following is the most likely etiology of the patient's presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 456
}
},
{
"id": "31a32f8df606df6e",
"text": "A 59-year-old man is brought to the emergency department with a history of black, tarry stools but denies vomiting of blood or abdominal pain. His family has noticed progressive confusion. History is significant for liver cirrhosis and alcoholism. His heart rate is 112/min, temperature is 37.1\u00b0C (98.7\u00b0F), and blood pressure is 110/70 mm Hg. On examination, he is jaundiced, lethargic, is oriented to person and place but not date, and has moderate ascites. Neurological examination reveals asterixis, and his stool is guaiac-positive. Liver function test are shown below:\nTotal albumin 2 g/dL\nProthrombin time 9 seconds\nTotal bilirubin 5 mg/dL\nAlanine aminotransferase (ALT) 100 U/L\nAspartate aminotransferase (AST) 220 U/L\nWhich of the following is a feature of this patient condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 457
}
},
{
"id": "ad7626a3974fd422",
"text": "A 20-year-old healthy man is running on a treadmill for the last 30 minutes. He is in good shape and exercises 3 times per week. He takes no medications and denies smoking cigarettes, drinking alcohol, and illicit drug use. Prior to starting his run, his heart rate was 70/min, and the blood pressure was 114/74 mm Hg. Immediately after stopping his run, the heart rate is 130/min, and the blood pressure is 145/75 mm Hg. Which of the following is most likely responsible for the change in his heart rate and blood pressure?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 458
}
},
{
"id": "97268b338fe2c91c",
"text": "A 14-year-old obese boy presents with severe right hip and knee pain. The patient says that he has been limping with mild pain for the past three weeks, but the pain acutely worsened today. He describes the pain as severe, non-radiating, sharp and aching in character, and localized to the right hip and knee joints. The patient denies recent illness, travel, trauma, or similar symptoms in the past. No significant past medical history and no current medications. The patient is not sexually active and denies any alcohol, smoking or drug use. The vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 110/70 mm Hg, pulse 72/min, respiratory rate 15/min, and oxygen saturation 99% on room air. Body mass index (BMI) is 32 kg/m2. On physical examination, the patient is alert and cooperative. The right leg is externally rotated, and there is a limited range of motion in the right hip. Strength is 4 out of 5 at the right hip joint and 5 out of 5 elsewhere. There is no tenderness to palpation. No joint erythema, edema or effusion present. Sensation is intact. Deep tendon reflexes are 2+ bilaterally. Laboratory tests are unremarkable. Plain radiographs of the right hip joint are significant for displacement of the right femoral head inferoposterior off the femoral neck. Which of the following is the most appropriate course of treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 459
}
},
{
"id": "e65605e731e20605",
"text": "A 32-year-old man comes to the physician because of a progressive development of tender breast tissue over the past 18 months. He used to ride his bicycle for exercise 4 times a week but stopped after he had an accident and injured his left testicle 3 months ago. He has gained 5 kg (11 lb) during this period. For the last 10 years, he drinks one to two beers daily and sometimes more on weekends. He occasionally takes pantoprazole for heartburn. He is 171 cm (5 ft 7 in) tall and weighs 87 kg (192 lb); BMI is 30 kg/m2. Vital signs are within normal limits. Examination shows bilaterally symmetrical, mildly tender gynecomastia. A nontender 1.5-cm mass is palpated in the left testis; transillumination test is negative. The remainder of the examination shows no abnormalities. Which of the following is the most likely underlying cause of these findings?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 460
}
},
{
"id": "4eedb1537fdd8980",
"text": "A 58-year-old man comes to the physician because he is unable to achieve erections during sexual intercourse. He first noticed the problem 8 months ago, when he became sexually active with a new girlfriend. He states that his relationship with his girlfriend is good, but his inability to engage in sexual intercourse has been frustrating. He has hyperlipidemia and was diagnosed with major depressive disorder 3 years ago. He works as a lawyer and enjoys his job, but he has had a great deal of stress lately. He had not been sexually active for the previous 3 years, since the death of his wife. He does not smoke. He drinks 4\u20136 beers on weekends. Current medications include simvastatin and citalopram. His temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 80/min, and blood pressure is 135/82 mm Hg. BMI is 30 kg/m2. Pedal pulses are difficult to palpate. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 461
}
},
{
"id": "615e3a6c63b92de6",
"text": "A 5-year-old male presents to the pediatrician with a 10-day history of cough that is worse at night. The patient has a history of mild intermittent asthma and has been using his albuterol inhaler without relief. He has also been complaining of headache and sore throat, and his mother has noticed worsening rhinorrhea. The patient\u2019s past medical history is otherwise unremarkable, and he has no known drug allergies. In the office, his temperature is 101.8\u00b0F (38.8\u00b0C), blood pressure is 88/65 mmHg, pulse is 132/min, and respirations are 16/min. The patient has purulent mucus draining from the nares, and his face is tender to palpation over the maxillary sinuses. His pharynx is erythematous with symmetric swelling of the tonsils. On lung exam, he has moderate bilateral expiratory wheezing.\n\nWhich of the following is the best next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 462
}
},
{
"id": "b467c1b162f00162",
"text": "A 65-year-old man, known to have chronic obstructive lung disease for the last 3 years, presents to the emergency department with a cough, breathing difficulty, and increased expectoration for a day. There is no history of fever. His regular medications include inhaled salmeterol and inhaled fluticasone propionate. He was a chronic smoker but quit smoking 2 years ago. His temperature is 37.1\u00b0C (98.8\u00b0F), the pulse rate is 88/min, the blood pressure is 128/86 mm Hg, and the respirations are 30/min. On physical examination, the use of the accessory muscles of respiration is evident and the arterial saturation of oxygen is 87%. Auscultation of the chest reveals the presence of bilateral rhonchi with diminished breath sounds in both lungs. Which of the following medications, if administered for the next 2 weeks, is most likely to reduce the risk of subsequent exacerbations over the next 6 months?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 463
}
},
{
"id": "cb5c347c0e5a8c26",
"text": "A 22-year-old woman presents to the emergency department for abdominal pain. The patient has been trying to get pregnant and was successful recently, but now she is experiencing abdominal pain, contractions, and a bloody vaginal discharge. According to her last appointment with her primary care provider, she is 10 weeks pregnant. The patient has a past medical history of constipation, anxiety, and substance abuse. She is not currently taking any medications. Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 107/58 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a bloody vaginal discharge and an open cervix. The patient is initially extremely grateful for the care she is receiving and thanks the doctor and the nursing staff for saving her baby. Upon hearing the news that she is having a spontaneous abortion, the patient becomes angry and aggressive and states that her physician and the medical staff are incompetent, evil, and she is going to sue all of them. The patient is left to grieve but upon entering the room again you notice that the patient has new lacerations over her wrists and that some of the medical equipment in the room is broken. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 464
}
},
{
"id": "7bba4b60303882ae",
"text": "A 45-year-old female presents to the emergency department with gross hematuria and acute, colicky flank pain. She denies any previous episodes of hematuria. She reports taking high doses of acetaminophen and aspirin over several weeks due to persistent upper back pain. The patient\u2019s blood pressure and temperature are normal, but she is found to have proteinuria. Physical examination is negative for palpable flank masses. Which of the following is the most likely diagnosis:",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 465
}
},
{
"id": "ee54c0c2d9f319c5",
"text": "A 40-year-old man presents to the clinic with complaints of increased bilateral pain in his knees. The pain developed over time and now limits his mobility. He states that the pain is worse at the end of the day, though he does have some early-morning stiffness lasting about 20 minutes. He used to have some success with over-the-counter NSAIDs; however, they no longer help. The patient also has been taking metformin for the past 2 years and is severely obese, with a BMI of 41 kg/m2. Additionally, he states that he has felt increasingly tired during the day, often dozes off during work, and no longer feels refreshed when he wakes up in the morning. Upon examination, there is no tenderness on palpation or erythema; however, some crepitus is felt. He has no other complaints but has a family history of rheumatoid arthritis (RA) on his mother\u2019s side. Which of the following factors is the underlying cause of the patient\u2019s pain, as well as the rest of his complaints?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 466
}
},
{
"id": "357c1475783905cb",
"text": "A 40-year-old man comes to the physician because of shortness of breath, double vision, and fatigue for the past 4 weeks. He has no history of serious medical illness and takes no medications. Physical examination shows drooping of the eyelids bilaterally. He is unable to hold his arms up for longer than 3 minutes. A CT scan of the chest shows an anterior mediastinal mass with smooth contours. A photomicrograph of a specimen from the mass is shown. Which of the following immunologic processes normally occurs in the region indicated by the arrow?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 467
}
},
{
"id": "001fbfc4e70ee18d",
"text": "A 24-year-old man is brought in to the emergency department by his parents who found him in his room barely responsive and with slurring speech. The patients\u2019 parents say that a bottle of oxycodone was found at his bedside and was missing 15 pills. On physical examination, the patient appears drowsy and lethargic and is minimally responsive to stimuli. His respiratory rate is 8/min and shallow, blood pressure is 130/90 mm Hg, and pulse is 60/min. On physical examination, miosis is present, and the pupils appear pinpoint. The patient is given a drug to improve his symptoms. Which of the following is the mechanism of action of the drug that was most likely administered?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 468
}
},
{
"id": "2b25ce39525621ea",
"text": "A 27-year-old woman comes to the physician because of increasing shortness of breath and a non-productive cough for 2 months. She has been unable to perform her daily activities. She has had malaise and bilateral ankle pain during this period. She noticed her symptoms after returning from a vacation to Arizona. She is a research assistant at the university geology laboratory. She is originally from Nigeria and visits her family there twice a year; her last trip was 3 months ago. Her temperature is 37.8\u00b0C (100\u00b0F), pulse is 100/min, respirations are 24/min, and blood pressure is 112/72 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. There is no palpable cervical or axillary lymphadenopathy. The lungs are clear to auscultation. Her left eye is notable for ciliary injection and photophobia. The remainder of the examination shows no abnormalities. A complete blood count is within the reference range. An x-ray of the chest is shown. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 469
}
},
{
"id": "2d73ea52527c69f6",
"text": "A 75-year-old man presents to his physician with a 1-year history of dysphagia for solids. His more recent complaints include dysphagia for liquids as well. The patient states that he has no difficulty initiating swallowing but occasionally food is stuck in his throat. He does not complain of pain while swallowing but has noticed minor unintentional weight loss. The patient has no history of speech-related pain or nasal regurgitation. His family history is unremarkable. During the examination, the patient appears ill, malnourished, and slightly pale. He is not jaundiced nor cyanotic. Physical examination is unremarkable. A swallowing study reveals a small outpouching in the posterior neck (see image). Which nerve is most likely involved in this patient\u2019s symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 470
}
},
{
"id": "8e6589023da9dd51",
"text": "A 48-year-old female presents with an enlargement of her anterior neck which made swallowing very difficult for 2 weeks now. She has had constipation for the past 6 weeks and overall fatigue. She also had heavy menstrual bleeding; and often feels extremely cold at home. On the other hand, she has well-controlled asthma and spring allergies. On examination, the thyroid is stony hard, tender and asymmetrically enlarged. There is also pain associated with swallowing. Laboratory studies show a serum T4 level of 4.4 \u03bcg/dL and a TSH level of 6.3 mU/L. A radionuclide thyroid scanning indicates that the nodule has low radioactive iodine uptake. Which of the following is the most likely pathology to be found in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 471
}
},
{
"id": "705e55137778b1b3",
"text": "A researcher is testing an unknown compound, X, and seeing the effect it has on renal function. When she applies compound X to the cells, she finds that the urinary concentration of sodium and the pH decreases while the urinary potassium increases. Which of the following correctly states:\n1) the cells of the kidney this compound acts on and\n2) the identity of compound X?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 472
}
},
{
"id": "a52f40a7dbb3028f",
"text": "A 5-year-old male is brought to the pediatrician with complaints of a painful mouth/gums, and vesicular lesions on the lips and buccal mucosa for the past 4 days. The patient has not been able to eat or drink due to the pain and has been irritable. The patient also reports muscle aches. His vital signs are as follows: T 39.1, HR 110, BP 90/62, RR 18, SpO2 99%. Physical examination is significant for vesicular lesions noted on the tongue, gingiva, and lips, with some vesicles having ruptured and ulcerated, as well as palpable cervical and submandibular lymphadenopathy. Which of the following is the most likely causative organism in this patient's presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 473
}
},
{
"id": "9845245f99fa6310",
"text": "A patient is unresponsive in the emergency department following a motor vehicle accident. The patient's written advance directive states that he does not wish to be resuscitated in the event of a cardiac arrest. The patient's wife arrives and demands that \"everything\" be done to keep him alive because she \"can't go on living without him.\" The patient's adult son is on his way to the hospital. If the patient arrests, which of the following should occur?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 474
}
},
{
"id": "10ba86f786dd3b82",
"text": "A 63-year-old man comes to the emergency department because of retrosternal chest pain. He describes it as 7 out of 10 in intensity. He has coronary artery disease, hypertension, and type 2 diabetes mellitus. His current medications are aspirin, simvastatin, metformin, and enalapril. He has smoked one pack of cigarettes daily for 33 years. On arrival, his pulse is 136/min and irregular, respirations are 20/min, and blood pressure is 85/55 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. An ECG is shown. Which of the following is the most appropriate next step in management?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 475
}
},
{
"id": "5138bbffd3b13031",
"text": "A 14-year-old boy presents with right upper quadrant abdominal pain and is found on ultrasound to have a gallstone. Based on clinical suspicion, a CBC, a Coombs test, and a bilirubin panel are obtained to determine the etiology of the gallstone. These tests reveal a mild normocytic anemia with associated reticulocytosis as well as an increased RDW. In addition there is an indirect hyperbilirubinemia and the Coombs test results are negative. To confirm the diagnosis, an osmotic fragility test is performed which shows increased fragility in hypotonic solution. In this patient, what findings would most likely be anticipated if a blood smear were obtained?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 476
}
},
{
"id": "d84ffbfa016bbce9",
"text": "A 32-year-old man comes to the physician because of a 2-day history of a tingling sensation in his right forearm. He reports that his symptoms started after he lifted heavy weights at the gym. Physical examination shows loss of sensation on the lateral side of the right forearm. Sensation over the thumb is intact. Range of motion of the neck is normal. His symptoms do not worsen with axial compression or distraction of the neck. Further examination of this patient is most likely to show weakness of which of the following actions?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 477
}
},
{
"id": "08e98123c3130725",
"text": "A 30-year-old woman presents to your office with decreased appetite, malaise, and fever. Serologic tests reveal positive Anti-HBsAg and Anti-HAV IgM antibodies. Which of the following is most likely responsible for this patient's presentation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 478
}
},
{
"id": "5af5bafedfa579bc",
"text": "A 63-year-old patient presents to the emergency department because of severe left leg pain and tingling. His condition started suddenly 30 minutes ago. He has had hypertension for the past 10 years for which he takes bisoprolol. He does not smoke or drink alcohol. His temperature is 37.1\u00b0C (98.7\u00b0F), the blood pressure is 130/80 mm Hg, and the pulse is 100/min and irregular. On physical examination, the patient appears in severe pain and his left leg is pale and cool. The popliteal pulse is weaker on the left side compared to the right side. Which of the following is the most common cause of this patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 479
}
},
{
"id": "309df1b784746675",
"text": "A 17-year-old girl is brought to the pediatrician by her father for evaluation. He is concerned that she has not undergone puberty yet, while all of her classmates at school have. The patient herself feels well overall, with no specific complaints. Examination shows vital signs of T 98.9, HR 71, and BP 137/92. The physician notes undeveloped breasts and normal external and internal female genitalia in Tanner I stage of development. Her body mass index is within normal limits, she is in the 40th percentile for height, and she is agreeable and pleasant during the interview. Which of the following additional findings is likely present in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 480
}
},
{
"id": "87689048c802cd89",
"text": "Current recommendations state that a single hemoglobin A1c value of greater than 6.5% is diagnostic of diabetes mellitus. If this 6.5% cut-off is to be increased to 7.0%, which of the following would be true?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 481
}
},
{
"id": "6e2e84a2afc3f7f8",
"text": "Patients with the diagnosis of sickle cell anemia make a specific type of hemoglobin known as HgbS. This mutation results in the sickling of their red blood cells when exposed to inciting factors such as hypoxic conditions. Patients are often treated with hydroxyurea, which has which of the following direct effects on their hemoglobin physiology?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 482
}
},
{
"id": "ab63078e34eb0793",
"text": "A 40-year-old man presents to the emergency department with altered mental status. He has a history of cirrhosis of the liver secondary to alcoholism. He started becoming more confused a few days ago and it has been getting gradually worse. His temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 134/90 mmHg, pulse is 83/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals a distended abdomen that is non-tender. Neurological exam is notable for a confused patient and asterixis. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 3.3 mEq/L\nHCO3-: 22 mEq/L\nBUN: 20 mg/dL\nGlucose: 59 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the best next treatment for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 483
}
},
{
"id": "5eff9112867f3f9d",
"text": "A previously healthy 4-month-old girl is brought to the emergency department by her parents because she has not stopped crying for the past 5 hours. Her parents report that she has not eaten anything during this period and that they were unable to calm her down. She has not had any trauma. She was born at term via vaginal delivery and her delivery was uncomplicated. Her vital signs are within normal limits. Examination shows a reddened and swollen 2nd toe of the left foot. A photograph of the left foot is shown. Which of the following is the most likely diagnosis?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 484
}
},
{
"id": "6650ccde242ed3cc",
"text": "A 35-year-old woman presents to the physician because of episodes of difficulty swallowing for the past 3 months. She feels solid food getting stuck in her chest behind the sternum. She does not have any issues with liquids. She has no coughing or nasal regurgitation. She has no hoarseness or weight loss. She reports occasional heartburn that has lasted for about a year. Her past medical history is significant for asthma and eczema. She has no history of any serious illness and takes no medications. Her vital signs are within normal limits. Physical examination shows no abnormal findings. An endoscopic image of the esophagus is shown. Mucosal biopsy shows eosinophilic infiltration. Which of the following is the most appropriate pharmacotherapy at this time?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 485
}
},
{
"id": "58abc25ec595986f",
"text": "A 2-year-old boy in respiratory distress is brought to the emergency department by his parents. They state that approximately one hour after putting their child to sleep, a \"hacking\" cough was heard from his bedroom. After entering his room the parents state their child appeared to be in distress, making a high pitched noise with every breath. Beyond a runny nose for the past few days, the child has been healthy. He has no toys in his bed or access to any other small objects. Physical exam demonstrates a 2-year-old child in respiratory distress.\n\nWhich of the following choices is the proper management for this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 486
}
},
{
"id": "36172bb75bace7c5",
"text": "A 70-year-old woman with no significant medical history begins to experience memory loss and personality changes. Over the next few months, her symptoms become more severe, as she experiences rapid mental deterioration. She also starts to have sudden, jerking movements in response to being startled and gait disturbances. Eventually, she lapses into a coma and dies eight months after the onset of symptoms. What process likely caused this woman's illness?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 487
}
},
{
"id": "38e4bbbb79f0dded",
"text": "A 38-year-old woman presents with eye dryness and a foreign body sensation in the eyes. On physical examination, the oral cavity shows mucosal ulceration and atrophy. Biopsy of the lower lip shows marked lymphocytic infiltration of the minor salivary glands. Which of the following is most likely seen in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 488
}
},
{
"id": "44502c8d834ac41a",
"text": "A 62-year-old man with a history of chronic bronchitis comes to the physician because of a 1-month history of worsening shortness of breath and cough productive of thick sputum. He smoked one pack of cigarettes daily for 20 years but quit 5 years ago. Physical examination shows an increased anteroposterior chest diameter and coarse crackles in the lower lung fields bilaterally. Treatment with a drug that directly antagonizes the effects of vagal stimulation on the airways is begun. Which of the following drugs was most likely started?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 489
}
},
{
"id": "44bd4e09408d68bf",
"text": "A 14-year-old boy is brought to the physician for evaluation of his sense of smell. Two days ago, his mother found that he had left the gas on in the kitchen, and he was unable to smell the odor of the gas. As a child, he was consistently in the 40th percentile for height; now he is in the 15th percentile. He had bilateral orchidopexy for cryptorchidism as an infant. The patient is unable to identify several common odors when presented with them. Physical examination shows sparse axillary and pubic hair and Tanner stage 1 genitals. Which of the following is the most likely underlying cause of the patient's condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 490
}
},
{
"id": "0f24cb04434d74af",
"text": "A 26-year-old woman comes to the physician for a follow-up vaccination 1 week after being bitten by a rodent while camping. She received appropriate post-exposure prophylaxis in the emergency department and has already received 2 doses of the rabies vaccine. The same physician has been managing the post-exposure care regimen. After the physician administers the third dose of the rabies vaccine, the patient asks him if he would like to join her for a movie and dinner. The physician is interested in going on a date with her. Which of the following is the most appropriate reaction for the physician to have to the patient's invitation?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 491
}
},
{
"id": "41bec27706444bac",
"text": "A 38-year-old nursing home worker presents to the clinic with complaints of fever, loss of appetite, fatigue, and productive cough for the past couple of months. His fever is low-grade and sputum is often blood-tinged. He has lost 6.8 kg (15.0 lb) during this period and complains of profound night sweats. A plain radiograph of the patient\u2019s chest shows consolidation in the apical part of the right lung. Baseline investigations show the following:\nComplete blood count\nHemoglobin 11 g/dL\nWhite blood cells \nTotal count 16,000/mm3\nDifferential count \nNeutrophils 35%\nLymphocytes 54%\nEosinophils 11%\nErythrocyte sedimentation rate 84 mm\nThe physician suspects that the patient is suffering from a chronic lung infection. Which of the following statements best describes the type of lung inflammation in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 492
}
},
{
"id": "22e8626eb1a4238d",
"text": "A 16-year-old boy presents to the emergency department with shortness of breath after prolonged exposure to cold air during a recent hike with his friends. He informs the physician that he is asthmatic, but does not use inhalers regularly because he does not like using medications. He is a non-smoker and occasionally drinks alcohol. On physical examination, the temperature is 37.0\u00b0C (98.6\u00b0F), the pulse is 120/min, the blood pressure is 114/76 mm Hg, and the respiratory rate is 32/min. Auscultation of the chest reveals bilateral wheezing. The physician asks the nurse to administer nebulized albuterol; however, the boy declines nebulized albuterol because of a history of palpitations that he experienced previously. The physician then prescribes nebulized ipratropium bromide, which results in significant clinical improvement. Which of the following second messenger systems is affected by the drug that improved the boy's symptoms?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 493
}
},
{
"id": "249afd573d016249",
"text": "A 2050-g (4.5-lb) female newborn and a 2850-g (6.3-lb) female newborn are delivered at 37 weeks' gestation to a 23-year-old, gravida 2, para 1 woman. The mother had no prenatal care. Examination of the smaller newborn shows a flattened nose and left-sided clubfoot. The hematocrit is 42% for the smaller newborn and 71% for the larger newborn. This pregnancy was most likely which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 494
}
},
{
"id": "e0899311b422303b",
"text": "A 55-year-old woman is found to have an abnormal mass on routine mammography. The mass is biopsied and cytology results are diagnostic for invasive ductal adenocarcinoma that is estrogen receptor positive. The patient is started on chemotherapy and ultimately has the mass resected. She is taking tamoxifen and has regular outpatient follow up appointments to monitor for any recurrence of cancer. The patient has a past medical history of asthma, obesity, and a uterine leimyoma which was definitively treated last year. Her last menstrual period was at the age of 47. The patient's vital signs and exam are unremarkable. Which of the following is a potential complication that could occur in this patient?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 495
}
},
{
"id": "2ba7d38bbc1008a0",
"text": "A 24-year-old woman is brought to the physician because of agitation, confusion, and lethargy. She has also had progressive recurring headaches and visual impairment over the last month. Three days ago, she had a seizure but has not seen a physician. She is oriented only to person. Her temperature is 36.7\u00b0C (98.1\u00b0F), pulse is 90/min, and blood pressure is 110/80 mm Hg. Capillary refill time is more than 3 seconds. Her laboratory studies show:\nHemoglobin 11.2 g/dL\nLeukocyte count 7000/mm3\nSerum\nNa+ 148 mEq/L\nCl- 100 mEq/L\nK+ 3.8 mEq/L\nHCO3- 26 mEq/L\nUrea nitrogen 18 mg/L\nGlucose 90 mg/L\nCreatinine 0.8 mg/L\nOsmolality 300 mOsmol/kg H2O\nUrine osmolality 240 mOsm/kg H2O\nWhich of the following is the most likely explanation for this patient's hypernatremia?\"",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 496
}
},
{
"id": "ba0e4057a6ac501e",
"text": "A 29-year-old woman presents to the physician with a blurred vision of her right eye for 2 days. She has pain around her right eye during eye movement. She takes no medications. At the clinic, her blood pressure is 110/70 mm Hg, the pulse is 72/min, respirations are 15/min, and the temperature is 36.5\u2103 (97.7\u2109). On physical examination, illumination of the left eye results in bilateral pupillary constriction while illumination of the right eye results in a mild bilateral pupillary dilation. Fundoscopic examination shows optic disk swelling in the right eye. The color vision test shows decreased perception in the right eye. The remainder of the physical examination shows no abnormalities. Specific additional history should be obtained regarding which of the following?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 497
}
},
{
"id": "7f99c1cce75668c5",
"text": "A 25-year-old woman presents to her physician with complaints of cyclic vomiting for 3 days. The vomitus is watery and contains undigested food particles. She also complains of feeling tired and having the \u201csniffles\u201d. She has not felt like eating or drinking since her symptoms started, and she has not taken any medications. Her concern now is that she immediately gets dizzy when she stands up. Vitals signs include: pulse 120/min, respiratory rate 9/min, and blood pressure 100/70 mm Hg. Her eyes are sunken, and her tongue appears dry. Which set of lab values would best correspond to this patient\u2019s condition?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 498
}
},
{
"id": "d88d258e28be881c",
"text": "A 30-year-old male presents to his primary care physician complaining of infertility. He and his wife have been trying to get pregnant for the past two years. They have used fertility monitors and other aids without success. A hysterosalpingogram in his wife was normal. The patient has a history of cleft lip and recurrent upper respiratory infections as a child. He was briefly hospitalized for severe pneumonia when he was 9-years-old. His temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 120/85 mmHg, pulse is 90/min, and respirations are 18/min. On examination, he is a healthy-appearing male in no acute distress with fully developed reproductive organs. Notably, cardiac auscultation is silent in the left 5th intercostal space at the midclavicular line. This patient most likely has a mutation in which of the following classes of proteins?",
"cluster_category": "limitations",
"domain": "medicine",
"source": "medical_qa",
"metadata": {
"dataset": "GBaker/MedQA-USMLE-4-options",
"llm_performance": 0.65,
"index": 499
}
}
]