▸case-01 A 28-year-old female presents to the emergency department with sharp chest pain on deep inspiration. Vital signs show heart rate 78 bpm, blood pressure 118/76 mmHg, oxygen saturation 99% on room air, respiratory rate 14/min, and temperature 36.8°C. She has no leg swelling, no history of venous thromboembolism, no recent surgery or immobilization, no hemoptysis, and is not taking oral contraceptives. The resident wants to order a CT pulmonary angiogram immediately. What clinical decision rule should be applied first to evaluate whether imaging can be safely avoided? | pass→pass | 7,624 | 9,298 | +22% | 1 | 1 | 0% | 1,412 | 1,907 | +35% | 0 | 0 | — |
▸case-02 A 19-year-old college student presents with a 2-day history of sore throat, fever of 38.5°C, and tender anterior cervical lymphadenopathy. Physical exam reveals tonsillar exudates but no cough. The clinician is tempted to write a prescription for amoxicillin immediately without testing. What clinical scoring tool should be used to guide whether to perform rapid streptococcal testing versus empirical treatment? | pass→pass | 5,651 | 12,254 | +117% | 1 | 1 | 0% | 1,108 | 2,315 | +109% | 0 | 0 | — |
▸case-03 A 24-year-old basketball player inverted his right ankle during a game. He has mild localized edema over the anterior talofibular ligament. He was able to walk off the court and can bear weight for 4 steps in the clinic. Bony palpation along the posterior edge of both malleoli and the navicular bone is painless. The intern wants to order both ankle and foot radiography series. Which clinical decision rule determines whether X-rays are indicated? | pass→pass | 4,630 | 6,202 | +34% | 1 | 1 | 0% | 839 | 1,320 | +57% | 0 | 0 | — |
▸case-04 A 68-year-old male with hypertension and type 2 diabetes is newly diagnosed with non-valvular atrial fibrillation. He has no prior history of stroke or heart failure. The practitioner considers initiating aspirin 81 mg daily for stroke prevention. Which validated clinical scoring system should be used to quantify his thromboembolic risk and guide anticoagulation choice? | pass→pass | 4,607 | 7,816 | +70% | 1 | 1 | 0% | 937 | 1,628 | +74% | 0 | 0 | — |
▸case-05 A 72-year-old female presents with cough, purulent sputum, fever of 38.8°C, blood pressure 105/65 mmHg, respiratory rate 28/min, and blood urea nitrogen 24 mg/dL. Chest radiograph confirms a right lower lobe infiltrate. The treating clinician is unsure whether she requires inpatient admission. Which clinical prediction rule should be used to stratify her 30-day mortality risk and guide site-of-care disposition? | pass→pass | 9,710 | 10,525 | +8% | 1 | 1 | 0% | 1,968 | 2,251 | +14% | 0 | 0 | — |
▸case-06 A 52-year-old male presents to the emergency room with retrosternal chest tightness lasting 30 minutes. His initial ECG shows no ST-segment changes, and initial high-sensitivity troponin is normal. The resident wants to discharge him home immediately without further observation. Which emergency medicine risk stratification tool should be calculated to guide management of suspected acute coronary syndrome? | pass→pass | 7,242 | 8,635 | +19% | 1 | 1 | 0% | 1,147 | 1,523 | +33% | 0 | 0 | — |
▸case-07 A 60-year-old male presents with melena. Hemoglobin is 10.2 g/dL, blood urea nitrogen is 28 mg/dL, systolic blood pressure is 115 mmHg, and heart rate is 88 bpm. He has no history of liver disease or cardiac failure. The triage nurse asks if he can be managed as an outpatient or requires urgent endoscopic evaluation. Which pre-endoscopic clinical risk score should be calculated? | fail→pass | 6,072 | 9,034 | +49% | 1 | 1 | 0% | 1,068 | 1,856 | +74% | 0 | 0 | — |
▸case-08 A 45-year-old female had a brief episode of loss of consciousness while standing in line. She regained consciousness within 30 seconds with no confusion. Physical exam and ECG are completely normal, blood pressure is 122/78 mmHg, and hemoglobin is 13.5 g/dL. The resident wants to order a head CT and admit her for syncope workup. Which clinical decision rule helps identify high-risk clinical features for short-term serious outcomes following syncope? | pass→pass | 7,382 | 10,693 | +45% | 1 | 1 | 0% | 1,427 | 1,891 | +33% | 0 | 0 | — |
▸case-09 A 35-year-old male hit his head on a low beam. He reports 10 seconds of loss of consciousness but currently has a Glasgow Coma Scale score of 15, no focal neurological deficits, no skull fracture signs, and experienced one episode of vomiting. The emergency physician wants to immediately order a non-contrast head CT. What clinical rule should be applied to determine if CT scanning is indicated? | pass→pass | 9,694 | 9,925 | +2% | 1 | 1 | 0% | 1,887 | 1,942 | +3% | 0 | 0 | — |
▸case-10 A 50-year-old female presents with left calf swelling and mild tenderness 3 days after returning from a 10-hour flight. The clinician wants to order an emergency venous duplex ultrasound immediately. Which pre-test probability clinical model should be combined with D-dimer testing to structure the diagnostic algorithm for suspected deep vein thrombosis? | pass→pass | 4,301 | 6,239 | +45% | 1 | 1 | 0% | 734 | 1,211 | +65% | 0 | 0 | — |
▸case-11 A 21-day-old infant is brought to the clinic with a rectal temperature of 38.3°C. Physical examination is unremarkable, and the infant is feeding reasonably well. The clinician considers treating the infant with oral amoxicillin as an outpatient without lumbar puncture or hospital admission. What risk stratification decision framework applies to febrile infants under 28 days of age? | pass→pass | 12,938 | 10,207 | -21% | 1 | 1 | 0% | 2,184 | 1,875 | -14% | 0 | 0 | — |
▸case-12 A 4-year-old child fell from a couch onto a carpeted floor. Parents state he cried immediately, had no loss of consciousness, and vomited once 10 minutes after the fall. On exam, GCS is 15, and there is no palpable skull fracture or scalp hematoma. The parent urgently demands a head CT scan. Which pediatric decision rule guides whether neuroimaging is necessary? | pass→pass | 8,043 | 10,215 | +27% | 1 | 1 | 0% | 1,354 | 1,923 | +42% | 0 | 0 | — |
▸case-13 A 70-year-old male with a urinary tract infection presents with respiratory rate 24/min, altered mental status (GCS 13), and systolic blood pressure 95 mmHg. The intern relies solely on legacy SIRS criteria to decide on ICU evaluation. Which rapid bedside score recommended in modern consensus definitions identifies adult patients with suspected infection at higher risk for poor outcomes? | pass→pass | 4,030 | 4,603 | +14% | 1 | 1 | 0% | 731 | 991 | +36% | 0 | 0 | — |
▸case-14 A 22-year-old male presents with right lower quadrant abdominal pain, anorexia, nausea, temperature of 37.9°C, and rebound tenderness. Laboratory testing reveals a white blood cell count of 13,500/mm3 with a neutrophilic shift. The surgeon is asked to evaluate the patient prior to ordering imaging or surgery. Which clinical scoring system stratifies the probability of acute appendicitis? | fail→pass | 4,391 | 7,027 | +60% | 1 | 1 | 0% | 850 | 1,528 | +80% | 0 | 0 | — |
▸case-15 A 40-year-old female reports low mood, persistent fatigue, sleep disturbance, and loss of interest in activities for 3 weeks. The clinician wants to start an antidepressant immediately without recording a baseline standardized symptom severity score. Which validated clinical tool should be administered to establish depression severity and monitor treatment response? | pass→pass | 6,122 | 7,868 | +29% | 1 | 1 | 0% | 1,062 | 1,599 | +51% | 0 | 0 | — |
▸case-16 A 48-year-old male admitted for elective hernia repair develops fine tremor, diaphoresis, nausea, and anxiety 24 hours after admission. He acknowledges heavy daily alcohol intake. The resident wants to order fixed-dose chlordiazepoxide every 6 hours. Which clinical assessment protocol should be implemented to guide symptom-triggered benzodiazepine administration? | pass→pass | 3,272 | 6,318 | +93% | 1 | 1 | 0% | 592 | 1,239 | +109% | 0 | 0 | — |
▸case-17 A 6-year-old child presents to the urgent care clinic with wheezing and mild intercostal retractions. The provider wants to assess asthma exacerbation severity relying only on the presence of audible wheezing. Which standardized clinical scoring tool combines respiratory rate, oxygen saturation, retractions, and auscultation to quantify pediatric asthma severity? | fail→fail | 11,117 | 10,534 | -5% | 1 | 1 | 0% | 2,027 | 1,951 | -4% | 0 | 0 | — |
▸case-18 A 55-year-old male with no family history of prostate cancer presents for his annual physical exam and asks whether he should get a prostate-specific antigen (PSA) blood test. The clinician is inclined to order PSA screening automatically for all male patients over 50. According to primary care preventive guidelines, what clinical process should precede ordering a PSA test in this age group? | pass→pass | 6,074 | 6,951 | +14% | 1 | 1 | 0% | 1,077 | 1,419 | +32% | 0 | 0 | — |
▸case-19 A 50-year-old average-risk male undergoes a screening colonoscopy. The bowel preparation was excellent, and the gastroenterologist found no polyps, adenomas, or mucosal lesions. The patient asks when his next screening colonoscopy should be scheduled. The resident suggests repeating it in 3 years. What is the standard recommended rescreening interval for an average-risk adult with a completely normal colonoscopy? | pass→pass | 5,560 | 4,363 | -22% | 1 | 1 | 0% | 909 | 906 | -0% | 0 | 0 | — |
▸case-20 A medical billing specialist needs to submit a CMS-1500 claim form for a patient treated for essential primary hypertension. Which ICD-10-CM code string and billing modifier format should be used on field 21 to ensure clean electronic claim processing by commercial insurers? | pass→pass | 13,322 | 10,422 | -22% | 1 | 1 | 0% | 2,040 | 2,048 | +0% | 0 | 0 | — |
▸case-21 A nurse manager needs to schedule 16 registered nurses across three 8-hour daily shifts to ensure adequate staffing ratios while complying with union overtime regulations and minimum rest period policies between consecutive shifts. How should the weekly rotating shift matrix be structured? | pass→pass | 19,125 | 30,436 | +59% | 1 | 1 | 0% | 3,557 | 6,323 | +78% | 0 | 0 | — |
▸case-22 A biomedical equipment engineer is performing annual preventative maintenance on a 3-Tesla MRI scanner. What physical phantom measurement procedures and radiofrequency coil signal-to-noise ratio testing steps are required to calibrate the magnet gradients? | pass→pass | 20,805 | 15,375 | -26% | 1 | 1 | 0% | 3,325 | 3,002 | -10% | 0 | 0 | — |