NBME/CMS Analysis Dashboard

Summary

49Files discovered

49Files read

3380Question rows

3414Raw parsed rows

34Duplicate rows collapsed

3339Structurally usable rows

3328Pattern-ready rows

3708Parser warnings

99.3Average parse confidence

Parser Health

Parse Confidence

Confidence band	Questions
high	3353
medium	7
low	20
unknown	0

Top Warnings

Warning	Count
HL_choice_choice_missing_from_ans_ocr	154
ref_stem_match:similarity=1.00,shared_terms=32	84
ref_stem_match:similarity=1.00,shared_terms=25	77
ref_stem_match:similarity=1.00,shared_terms=27	72
ref_stem_match:similarity=1.00,shared_terms=24	71
ref_stem_match:similarity=1.00,shared_terms=30	70
ref_stem_match:similarity=1.00,shared_terms=41	69
ref_stem_match:similarity=1.00,shared_terms=33	67
ref_stem_match:similarity=1.00,shared_terms=28	67
ref_stem_match:similarity=1.00,shared_terms=31	65
trimmed_duple_ans_key_text	64
ref_stem_match:similarity=1.00,shared_terms=37	64

File Quality Triage

All NBME Files

All NBME files ranked by parse clean percentage. Use this to review structural usability first; pattern clean percentage is shown as secondary context.

Source file	Total rows	Parse-clean rows	Parse excluded	Parse Clean %	Pattern Clean %	Recommendation	Top warnings
NBME/NBME_15A.txt	200	198	2	99.0	98.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=41 (9); ref_stem_match:similarity=1.00,shared_terms=37 (9); ref_stem_match:similarity=1.00,shared_terms=20 (9); ref_stem_match:similarity=1.00,shared_terms=24 (9); ref_stem_match:similarity=1.00,shared_terms=28 (7); ref_stem_match:similarity=1.00,shared_terms=43 (7)
NBME/NBME_9A.txt	199	197	2	99.0	98.5	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=38 (12); ref_stem_match:similarity=1.00,shared_terms=48 (10); ref_stem_match:similarity=1.00,shared_terms=45 (8); ref_stem_match:similarity=1.00,shared_terms=47 (8); ref_stem_match:similarity=1.00,shared_terms=44 (6); ref_stem_match:similarity=1.00,shared_terms=37 (5)
NBME/NBME_10A.txt	197	196	1	99.5	100.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=37 (10); ref_stem_match:similarity=1.00,shared_terms=32 (9); ref_stem_match:similarity=1.00,shared_terms=36 (8); ref_stem_match:similarity=1.00,shared_terms=25 (8); ref_stem_match:similarity=1.00,shared_terms=30 (8); ref_stem_match:similarity=1.00,shared_terms=27 (8)
NBME/NBME_12A.txt	200	199	1	99.5	99.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=32 (10); ref_stem_match:similarity=1.00,shared_terms=30 (9); ref_stem_match:similarity=1.00,shared_terms=43 (7); ref_stem_match:similarity=1.00,shared_terms=44 (7); ref_stem_match:similarity=1.00,shared_terms=39 (6); ref_stem_match:similarity=1.00,shared_terms=50 (6)
NBME/NBME_13A.txt	198	197	1	99.5	99.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=40 (10); ref_stem_match:similarity=1.00,shared_terms=43 (9); ref_stem_match:similarity=1.00,shared_terms=35 (9); ref_stem_match:similarity=1.00,shared_terms=33 (8); ref_stem_match:similarity=1.00,shared_terms=32 (7); ref_stem_match:similarity=1.00,shared_terms=41 (7)
NBME/NBME_14A.txt	200	199	1	99.5	100.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=31 (9); ref_stem_match:similarity=1.00,shared_terms=28 (9); ref_stem_match:similarity=1.00,shared_terms=24 (9); ref_stem_match:similarity=1.00,shared_terms=42 (9); ref_stem_match:similarity=1.00,shared_terms=40 (8); ref_stem_match:similarity=1.00,shared_terms=46 (8)
NBME/NBME_11A.txt	199	199	0	100.0	99.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=41 (13); ref_stem_match:similarity=1.00,shared_terms=48 (8); ref_stem_match:similarity=1.00,shared_terms=46 (7); ref_stem_match:similarity=1.00,shared_terms=43 (7); ref_stem_match:similarity=1.00,shared_terms=25 (7); ref_stem_match:similarity=1.00,shared_terms=35 (6)

Worst CMS Files

Worst 10 CMS files by parse clean percentage. Use this to prioritize source cleanup without duplicate or pattern-only penalties driving the ranking.

Source file	Total rows	Parse-clean rows	Parse excluded	Parse Clean %	Pattern Clean %	Recommendation	Top warnings
CMS/EM_3A.txt	50	44	6	88.0	100.0	Usable with cleanup targets	missing_lead_in (6); ref_stem_match:similarity=1.00,shared_terms=35 (3); ref_stem_match:similarity=1.00,shared_terms=61 (3); ref_stem_match:similarity=1.00,shared_terms=41 (3); ref_stem_match:similarity=1.00,shared_terms=51 (2); ref_stem_match:similarity=1.00,shared_terms=34 (2)
CMS/FM_5A.txt	36	33	3	91.7	91.7	Structurally usable	trimmed_duple_ans_key_text (7); missing_lead_in (2); ref_stem_match:similarity=0.84,shared_terms=37 (1); ref_stem_match:similarity=0.76,shared_terms=22 (1); ref_stem_match:similarity=0.63,shared_terms=24 (1); ref_stem_match:similarity=0.16,shared_terms=5 (1)
CMS/Peds_4A.txt	48	45	3	93.8	93.8	Structurally usable	missing_answer_choices (3); missing_lead_in (3); ref_stem_match:similarity=0.89,shared_terms=34 (2); HL_choice_choice_missing_from_ans_ocr (2); ref_stem_match:similarity=1.00,shared_terms=19 (2); ref_stem_match:similarity=1.00,shared_terms=15 (2)
CMS/FM_4A.txt	40	38	2	95.0	97.5	Structurally usable	trimmed_duple_ans_key_text (5); ref_stem_match:similarity=0.80,shared_terms=32 (2); ref_stem_match:similarity=0.64,shared_terms=23 (2); ref_stem_match:similarity=0.94,shared_terms=48 (1); ref_stem_match:similarity=0.94,shared_terms=32 (1); ref_stem_match:similarity=0.95,shared_terms=39 (1)
CMS/Neuro_7A.txt	41	39	2	95.1	95.1	Structurally usable	HL_choice_choice_missing_from_ans_ocr (37); ref_stem_match:similarity=1.00,shared_terms=44 (2); ref_stem_match:similarity=1.00,shared_terms=16 (2); ref_stem_match:similarity=1.00,shared_terms=75 (2); ref_stem_match:similarity=1.00,shared_terms=34 (2); ref_stem_match:similarity=1.00,shared_terms=49 (2)
CMS/PSYCH_4A.txt	48	46	2	95.8	93.8	Structurally usable	trimmed_duple_ans_key_text (6); choices_missing_correct_letter (2); missing_answer_choices (2); missing_lead_in (2); ref_stem_match:similarity=0.99,shared_terms=67 (1); ref_stem_match:similarity=1.00,shared_terms=28 (1)
CMS/PSYCH_6A.txt	48	46	2	95.8	93.8	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=45 (3); ref_stem_match:similarity=1.00,shared_terms=29 (2); ref_stem_match:similarity=1.00,shared_terms=19 (2); ref_stem_match:similarity=1.00,shared_terms=73 (2); ref_stem_match:similarity=0.04,shared_terms=4 (2); ref_answer_stem_mismatch:similarity=0.03,shared_terms=2 (2)
CMS/EM_2A.txt	50	48	2	96.0	96.0	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=40 (3); ref_stem_match:similarity=1.00,shared_terms=44 (3); ref_stem_match:similarity=1.00,shared_terms=52 (3); ref_stem_match:similarity=1.00,shared_terms=21 (3); ref_stem_match:similarity=1.00,shared_terms=61 (2); ref_answer_stem_mismatch:answer_stem_too_short (2)
CMS/OBGYN_8A.txt	41	40	1	97.6	87.8	Structurally usable	HL_choice_choice_missing_from_ans_ocr (24); multiple_correct_ans_markers (4); ref_stem_match:similarity=1.00,shared_terms=38 (2); ref_stem_match:similarity=1.00,shared_terms=33 (2); ref_stem_match:similarity=1.00,shared_terms=11 (1); ref_stem_match:similarity=1.00,shared_terms=20 (1)
CMS/OBGYN_4A.txt	44	43	1	97.7	97.7	Structurally usable	ref_stem_match:similarity=1.00,shared_terms=32 (3); HL_choice_choice_missing_from_ans_ocr (3); ref_stem_match:similarity=1.00,shared_terms=43 (2); ref_stem_match:similarity=1.00,shared_terms=24 (2); ref_stem_match:similarity=1.00,shared_terms=22 (2); ref_stem_match:similarity=1.00,shared_terms=26 (2)

Parser Quality by File

Parser-focused failures ranked by parse usability. Pattern clean percentage is kept here only as secondary context.

Source file	Parsed rows	Parse-clean rows	Parse Clean %	Pattern Clean %	Skipped expl.	Synthetic rows	Trimmed duplicate keys	Top skip reasons
CMS/EM_3A.txt	50	44	88.0	100.0	0	0	0	missing_answer_key_and_choices (1)
CMS/Medicine_6A.txt	50	45	90.0	90.0	0	0	0	missing_answer_key_and_choices (4)
CMS/FM_5A.txt	36	33	91.7	91.7	0	0	7
CMS/Peds_4A.txt	49	45	91.8	91.8	0	0	1	missing_answer_key_and_choices (1)
CMS/PSYCH_6A.txt	50	46	92.0	90.0	0	0	0	missing_answer_key_and_choices (1)
CMS/Neuro_7A.txt	42	39	92.9	92.9	0	1	0	missing_answer_key_and_choices (6)
CMS/Medicine_5A.txt	49	46	93.9	93.9	1	0	0	missing_answer_key_and_choices (4); starts_with_ocr_zero_choice (1)
CMS/FM_4A.txt	40	38	95.0	97.5	0	0	5
CMS/OBGYN_8A.txt	42	40	95.2	85.7	0	0	0	missing_answer_key_and_choices (3)
CMS/PYSCH_3A.txt	46	44	95.7	95.7	0	0	3	missing_answer_key_and_choices (2)
CMS/PSYCH_4A.txt	48	46	95.8	93.8	0	0	6
CMS/Surgery_8A.txt	49	47	95.9	93.9	0	0	0	missing_answer_key_and_choices (2)

Remaining Cleanup Targets

Cleanup Buckets

Cleanup bucket	Rows
other parser cleanup	22
missing highlighted correct choice text	12
low parse confidence	9
highlighted correct choice recovered	6
missing answer key	2
possible OCR damage	1

Lowest-confidence targets

Source file	Q	Bucket	Recommended action	Confidence	Reasons
CMS/Peds_4A.txt	43	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	0	low parse confidence; missing correct answer text; correct letter not found in choices; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem; incomplete answer choices; ambiguous extracted lead-in
CMS/OBGYN_8A.txt	4	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	32	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/EM_1A.txt	37	low parse confidence	manual parser review recommended	35	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/EM_2A.txt	39	low parse confidence	manual parser review recommended	35	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/FM_2A.txt	44	low parse confidence	manual parser review recommended	35	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/Medicine_4A.txt	20	low parse confidence	manual parser review recommended	35	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/Medicine_3A.txt	29	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	45	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; incomplete answer choices; ambiguous extracted lead-in
CMS/PSYCH_4A.txt	17	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	45	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; incomplete answer choices; ambiguous extracted lead-in
CMS/PSYCH_4A.txt	49	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	45	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; incomplete answer choices; ambiguous extracted lead-in
CMS/Peds_4A.txt	22	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	45	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; incomplete answer choices; ambiguous extracted lead-in
CMS/Peds_4A.txt	42	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	45	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; incomplete answer choices; ambiguous extracted lead-in
CMS/Neuro_7A.txt	26	missing answer key	needs answer key recovery	50	low parse confidence; missing correct answer; missing correct answer text; missing_answer_key warning
CMS/EM_2A.txt	3	low parse confidence	manual parser review recommended	55	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/FM_5A.txt	31	low parse confidence	manual parser review recommended	55	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/Neuro_3A.txt	37	low parse confidence	manual parser review recommended	55	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/Neuro_4A.txt	49	missing answer key	needs answer key recovery	55	low parse confidence; missing correct answer; missing correct answer text; missing_answer_key warning
CMS/OBGYN_4A.txt	12	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	55	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; multiple correct-answer markers; incomplete answer choices
CMS/PEDS_6A.txt	43	missing highlighted correct choice text	repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	55	low parse confidence; missing correct answer text; correct letter not found in choices; choices_missing_correct_letter warning; incomplete answer choices
CMS/PSYCH_6A.txt	39	low parse confidence	manual parser review recommended	55	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem
CMS/PSYCH_6A.txt	40	low parse confidence	manual parser review recommended	55	low parse confidence; reference-answer stem mismatch; ref_answer_stem_mismatch warning; reference stem does not match answer-file stem; duplicate-looking file/question

Reference Repair & File Review

Choice Source

Choice source	Files/questions
reference	3120
ans_file_plus_reference	154
answer_file	106

File Review Priority

File review priority	Files
Structurally usable	48
Usable with cleanup targets	1

Suggested Cleanup Action

Suggested action	Files
manual review recommended	22
repair answer choice OCR from Q_txt_ref or original PDF; correct answer letter may still be valid	12
manual parser review recommended	9
no manual cleanup needed; correct answer choice text was repaired from Q_txt_ref	6
needs answer key recovery	2
review OCR text against source PDF	1

Reference Repair Audit

Shows whether Q_txt_ref files are repairing choices/stems or failing to match.

Source file	Total rows	Matched refs	Missing refs	Correct choice repairs	Still missing correct choice	Missing Q nums
CMS/OBGYN_7A.txt	49	34	15	154	11	11; 12; 20; 23; 27; 28; 33; 34; 35; 37; 38; 42; 43; 44; 50
CMS/FM_4A.txt	40	29	11	154	11	15; 16; 17; 18; 20; 21; 22; 23; 25; 26; 27
CMS/FM_5A.txt	36	31	4	154	11	1; 30; 34; 41
CMS/FM_2A.txt	50	47	2	154	11	31; 45
CMS/Medicine_5A.txt	46	45	1	154	11	47
CMS/Neuro_7A.txt	41	40	1	154	11	unknown_1
CMS/OBGYN_6A.txt	45	44	1	154	11	47
CMS/PSYCH_4A.txt	48	47	1	154	11	26
CMS/PSYCH_6A.txt	48	45	1	154	11	4
CMS/EM_1A.txt	49	48	0	154	11
CMS/EM_2A.txt	50	48	0	154	11
CMS/EM_3A.txt	50	50	0	154	11

Duplicate / Collision Audit

After NBME section mapping, this should mostly show true parser collisions rather than routine Q1-Q50 section repeats.

Source file	Q	Candidates	Collapsed	Retained confidence	Ref status	Candidate summary
CMS/Medicine_6A.txt	2	4	3	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=B,has_correct_text=no,explanation_chars=1066; 2:dropped:confidence=100,warnings=2,choice_source=ans_file_plus_reference,ref=,correct=D,has_correct_text=no,explanation_chars=884; 3:dropped:confidence=32,warnings=2,choice_source=answer_file,ref=,correct=E,has_correct_text=no,explanation_chars=1109; 4:dropped:confidence=47,warnings=1,choice_source=answer_file,ref=,correct=B,has_correct_text=no,explanation_chars=492
CMS/Surgery_6A.txt	3	3	2	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=A,has_correct_text=no,explanation_chars=1414; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=2256; 3:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=2339
CMS/FM_3A.txt	47	2	1	100	matched_reference	1:dropped:confidence=50,warnings=2,choice_source=reference,ref=,correct=,has_correct_text=no,explanation_chars=0; 2:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=D,has_correct_text=no,explanation_chars=2537
CMS/Medicine_5A.txt	1	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=D,has_correct_text=no,explanation_chars=1821; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=D,has_correct_text=no,explanation_chars=1980
CMS/Medicine_5A.txt	6	2	1	100	matched_reference	1:kept:confidence=100,warnings=2,choice_source=ans_file_plus_reference,ref=,correct=C,has_correct_text=no,explanation_chars=1488; 2:dropped:confidence=35,warnings=1,choice_source=answer_file,ref=,correct=D,has_correct_text=no,explanation_chars=1806
CMS/Medicine_5A.txt	7	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=F,has_correct_text=no,explanation_chars=2010; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=A,has_correct_text=no,explanation_chars=2123
CMS/Medicine_6A.txt	10	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=D,has_correct_text=no,explanation_chars=612; 2:dropped:confidence=22,warnings=3,choice_source=answer_file,ref=,correct=E,has_correct_text=no,explanation_chars=1086
CMS/Medicine_8A.txt	3	2	1	92	matched_reference	1:kept:confidence=92,warnings=1,choice_source=reference,ref=,correct=A,has_correct_text=no,explanation_chars=2194; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=E,has_correct_text=no,explanation_chars=2496
CMS/Neuro_5A.txt	2	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=B,has_correct_text=no,explanation_chars=2471; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=3651
CMS/Neuro_7A.txt	34	2	1	100	matched_reference	1:dropped:confidence=50,warnings=2,choice_source=reference,ref=,correct=,has_correct_text=no,explanation_chars=0; 2:kept:confidence=100,warnings=2,choice_source=ans_file_plus_reference,ref=,correct=D,has_correct_text=no,explanation_chars=2530
CMS/OBGYN_5A.txt	3	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=B,has_correct_text=no,explanation_chars=2608; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=3019
CMS/OBGYN_7A.txt	2	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=B,has_correct_text=no,explanation_chars=3642; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=2729
CMS/OBGYN_7A.txt	3	2	1	100	matched_reference	1:dropped:confidence=100,warnings=2,choice_source=reference,ref=,correct=A,has_correct_text=no,explanation_chars=999; 2:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=A,has_correct_text=no,explanation_chars=2625
CMS/OBGYN_8A.txt	3	2	1	100	matched_reference	1:kept:confidence=100,warnings=2,choice_source=ans_file_plus_reference,ref=,correct=D,has_correct_text=no,explanation_chars=6800; 2:dropped:confidence=12,warnings=2,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=3734
CMS/PEDS_5A.txt	2	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=D,has_correct_text=no,explanation_chars=2626; 2:dropped:confidence=35,warnings=1,choice_source=answer_file,ref=,correct=E,has_correct_text=no,explanation_chars=2424
CMS/PEDS_5A.txt	4	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=C,has_correct_text=no,explanation_chars=1466; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=B,has_correct_text=no,explanation_chars=2223
CMS/PEDS_8A.txt	3	2	1	85	matched_reference	1:kept:confidence=85,warnings=2,choice_source=answer_file,ref=,correct=C,has_correct_text=no,explanation_chars=140; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=B,has_correct_text=no,explanation_chars=2743
CMS/PSYCH_6A.txt	35	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=A,has_correct_text=no,explanation_chars=3467; 2:dropped:confidence=100,warnings=1,choice_source=reference,ref=,correct=B,has_correct_text=no,explanation_chars=2490
CMS/PSYCH_6A.txt	46	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=B,has_correct_text=no,explanation_chars=2150; 2:dropped:confidence=100,warnings=1,choice_source=answer_file,ref=,correct=H,has_correct_text=no,explanation_chars=2576
CMS/PYSCH_3A.txt	2	2	1	100	matched_reference	1:kept:confidence=100,warnings=1,choice_source=reference,ref=,correct=D,has_correct_text=no,explanation_chars=5965; 2:dropped:confidence=55,warnings=1,choice_source=answer_file,ref=,correct=A,has_correct_text=no,explanation_chars=4821

Pattern Overview

Archetypes

Archetype	Questions	Top lead-ins	Common stem cues
Diagnosis	494	most likely diagnosis; most likely causal organism; f the following is the most likely diagnosis; most likely infectious agent; step in diagnosis; which of the following studies is most likely to establish the diagnosis	pulse; pressure; respirations; illness; loss; cough; left; right; weight; takes; tenderness; medications
Next best step / management	461	most appropriate next step in management; most appropriate next step; most appropriate next step in pharmacotherapy; f the following is the most appropriate next step in management; most appropriate management; most appropriate course of action	pulse; pressure; respirations; right; medications; hypertension; tenderness; takes; serum; physician; illness; emergency
Other / unclear	276	[missing]; which of the following abnormalities; which of the following conditions; which of the following sites; which of the following locations; most likely location of the abnormality	pulse; respirations; pressure; serum; left; right; hypertension; medications; takes; cancer; illness; onset
Adverse effect	179	most likely cause of this patient's symptoms; most likely explanation for these findings; most likely cause of these findings; most likely cause of this patient's condition; most likely underlying cause of this patient's symptoms; most likely cause	pulse; hypertension; pressure; progressive; two; illness; laboratory; respirations; vaginal; medications; shortness; diabetes
Mechanism / pathophysiology	163	most likely explanation for these findings; most likely cause of these findings; most likely cause; most likely cause of this patient's symptoms; most likely cause of this patient's condition; most likely underlying cause of these findings	pulse; pressure; serum; two; left; progressive; loss; diarrhea; diabetes; fetal; breath; right
Diagnostic test	143	most appropriate next step in diagnosis; most likely to confirm the diagnosis; most appropriate next step in evaluation; most appropriate next step to confirm the diagnosis; following is the most appropriate next step in diagnosis; most appropriate diagnostic test	pulse; right; left; respirations; loss; pressure; serum; progressive; tenderness; intermittent; weight; hypertension
Treatment selection	92	most appropriate pharmacotherapy; most appropriate treatment; most appropriate treatment for this patient; most appropriate pharmacotherapy at this time; most appropriate pharmacotherapy for this patient; which of the following properties is the most appropriate treatment	pulse; medications; mild; respirations; illness; erythema; pharmacotherapy; pressure; fatigue; intermittent; takes; vomiting
Screening / prevention	91	most appropriate recommendation for this patient; most appropriate recommendation; most appropriate screening test for this patient; which of the following vaccines is most appropriate at this time; most appropriate vaccine to administer at this time; most likely to have prevented her symptoms	illness; screening; hypertension; prevent; takes; age; cancer; medications; right; serum; vaccine; pressure
Initial management	39	most appropriate initial step in management; most appropriate initial pharmacotherapy; most appropriate initial step in diagnosis; most appropriate initial management; most appropriate initial treatment; appropriate initial step in management is administration of which of the following	pulse; hypertension; respirations; medications; sudden; headache; pressure; difficulty; mood; ecg; cardiac; distal
Interpretation of lab/imaging	35	most likely to be increased in this patient; which of the following hormones; which of the following substances is the most likely cause of this patient's symptoms; which of the following laboratory results are most likely in this patient; which of the following laboratory results is most likely to show a greater sencun mui elcmemnse; active range of motion. plain x-rays of the knee show periarticular osteopenia; the joint space is narrowed medially. wisirsmucn om" enunmss8- ss scones asics management	serum; pulse; respirations; brain; three; progressive; irregular; concentrations; medications; concentration; pressure; laboratory
Risk factor	18	greatest risk for which of the following; strongest predisposing factor for this patient's condition; strongest predisposing factor for cerebral infarction in this patient; strongest predisposing factor for osteoarthritis in this patient during the next 10 years; this patient's greatest risk factor for his neurologic condition; which of the following historical findings is the greatest risk factor for osteoporotic fracture in this patient	factor; hypertension; age; mild; treated; vaginal; right; left; eye; neurologic; small; fracture
Ethics / communication	16	most appropriate physician response; most appropriate response; most appropriate response by the physician; necessary to discuss with the patient in order to obtain informed consent for this procedure; most accurate statement concerning the patient's situation; these symptoms are most likely to respond to treatment with which of the following	physician; response; pulse; all; progressive; medications; says; mother; son; vital; treated; health
Complication	13	which of the following complications; which of the following complications is this patient at increased risk; most serious complication of this condition; which of the following obstetric complications; show periosteal new bone formation of the femurs. her symptoms are most likely a complication of which of the following; most likely to decrease this patient's risk for pulmonary complications	fatigue; complications; illness; gestation; fetal; laboratory; pulse; count; pregnancy; cervix; weight
Prognosis	6	which of the following historical findings represents the strongest mortality risk factor for this patient during the next 10 years; most appropriate pharmacotherapy to improve this patient's chances of survival; patient is associated with the worst prognosis; strongest predisposing risk factor for this patient’s in-hospital mortality; which of the following factors is most predictive of a poor prognosis in this patient; most important factor in this patient's history and physical examination in determining his prognosis	serum; exertion; dyspnea

Top Exclusion Reasons

Reason	Questions
duplicate-looking file/question	22
low parse confidence	21
missing correct answer text	14
correct letter not found in choices	12
reference-answer stem mismatch	11
ref_answer_stem_mismatch warning	11
reference stem does not match answer-file stem	11
choices_missing_correct_letter warning	11
incomplete answer choices	8
multiple correct-answer markers	7
ambiguous extracted lead-in	6
missing correct answer	2

Broad Pattern Summary

Archetype	Pattern type	Phrase/feature	Questions	Confidence
Diagnosis	lead_in	most likely diagnosis	431	low
Next best step / management	distractor_family	imaging	380	low
Next best step / management	lead_in	most appropriate next step in management	349	low
Diagnosis	distractor_family	imaging	286	low
Diagnostic test	distractor_family	imaging	212	low
Adverse effect	distractor_family	imaging	129	low
Mechanism / pathophysiology	distractor_family	imaging	121	low
Diagnostic test	distractor_family	lab / culture / serology	116	low
Diagnostic test	lead_in	most appropriate next step in diagnosis	109	low
Next best step / management	distractor_family	cardiovascular medication	107	low
Diagnosis	correct_answer_term	disorder	97	low
Next best step / management	distractor_family	procedure / surgery	91	low
Diagnosis	distractor_family	neoplasm / malignancy	82	low
Next best step / management	stem_cue	pulse	82	low
Next best step / management	distractor_family	antibiotic / antimicrobial	81	low
Diagnosis	stem_cue	pulse	70	low
Next best step / management	distractor_family	lab / culture / serology	68	low
Next best step / management	stem_cue	pressure	57	low
Diagnosis	correct_answer_term	loss	56	low
Next best step / management	distractor_family	intravenous	55	low
Next best step / management	distractor_family	administration	51	low
Diagnostic test	distractor_family	procedure / surgery	49	low
Treatment selection	lead_in	most appropriate pharmacotherapy	49	low
Next best step / management	correct_answer_term	disorder	48	low
Next best step / management	distractor_family	steroid / immunosuppression	48	low

High-Yield Clues

Anchor Clues

Ref	Archetype	Likely anchor clues	Decisive clues
CMS/EM 1A.txt Q1	Next best step / management	shortness breath; pressure; heart; edema; emergency; shortness; breath; hypertension; medications; says
CMS/EM 1A.txt Q2	Other / unclear	pleuritic chest; chest pain; pneumonia; chills; cough; pleuritic; multiple; myeloma; tactile; fremitus
CMS/EM 1A.txt Q3	Mechanism / pathophysiology	ear; loss; hearing; external; auditory; gasoline; exploded; abrasions; right; pulse
CMS/EM 1A.txt Q4	Treatment selection	ecg; pneumonia; renal; failure; dementia; vomiting; produced; abdomen; soft; fingerstick
CMS/EM 1A.txt Q5	Treatment selection	operating outboard; outboard motor; treated; motor; headache; nausea; operating; outboard; progressive; hypertension
CMS/EM 1A.txt Q6	Next best step / management	pulse; treated; pressure; seizure; clammy; skin; hypertension
CMS/EM 1A.txt Q7	Next best step / management	pressure; hypertension; pulse; murmur; x-ray; ecg; upper; back; heard; left	cardiac examination discloses diastolic low-pitched murmur best heard at; there is no peripheral edema chest x-ray and ecg
CMS/EM 1A.txt Q8	Next best step / management	water; girl; breath; air; lungs; fell; off; pulse; respirations; external
CMS/EM 1A.txt Q9	Next best step / management	concentration; lactate; red; hemoglobin; laboratory; serum; tachycardia; feeling; light-headed; stool	fingerstick blood glucose concentration is 92 mg/dl 5 11; fingerstick blood glucose concentration is 92 mg/dl (5
CMS/EM 1A.txt Q10	Other / unclear	communicate; interpreter; malignancy; cough; low-grade; pulse; respirations; x-ray; evidence
CMS/EM 1A.txt Q11	Next best step / management	right lower quadrant; right lower; lower quadrant; abdominal pain; right; quadrant; tenderness; palpation; nausea; negative
CMS/EM 1A.txt Q12	Adverse effect	epigastric; amylase; lipase; three; treated; upper; direct; onset; diffuse; tenderness
CMS/EM 1A.txt Q13	Next best step / management	asthma; albuterol; cough; metered-dose; respiratory; distress; six; progressive; shortness; remainder
CMS/EM 1A.txt Q14	Next best step / management	tenderness; pelvic; emergency; onset; nausea; adnexal; pregnancy; sudden; illness; takes	no cervical motion tenderness
CMS/EM 1A.txt Q15	Next best step / management	testicular pain; tenderness palpation; cremasteric reflex; testicular; testis; tenderness; palpation; cremasteric; reflex; emergency
CMS/EM 1A.txt Q16	Next best step / management	wound; bitten; right; avulsion; injury; unremarkable; takes
CMS/EM 1A.txt Q17	Other / unclear	serum; fatigue; generalized; weakness; dry; mucous; pulse; respirations; studies; takes
CMS/EM 1A.txt Q18	Treatment selection	shortness breath; muscle; diaphoresis; weakness; excessive; decontamination; shortness; breath; oxygen; lacrimation
CMS/EM 1A.txt Q19	Next best step / management	chest pain; leaning forward; friction rub; jugular venous; venous distention; leaning; forward; ecg; left; auscultation
CMS/EM 1A.txt Q20	Diagnostic test	lower abdominal; menstrual period; pelvic; tenderness; menstrual; period; adnexal; dlay; nausea; abdomen
CMS/EM 1A.txt Q21	Diagnosis	left lower extremity; lower extremity held; extremity held external; held external rotation; lower extremity; bear weight; left lower; extremity held; held external; external rotation
CMS/EM 1A.txt Q22	Other / unclear	major depressive; depressive disorder; suicide; plan; suicidal; organized; factors; major; depressive; disorder
CMS/EM 1A.txt Q23	Mechanism / pathophysiology	sunken anterior; dry mucous; parents; water; sunken; anterior; dry; mucous; membranes; hypotension
CMS/EM 1A.txt Q24	Next best step / management	weight loss; heart; palpitations; weight; loss; medications; neck; illness; takes; remainder
CMS/EM 1A.txt Q25	Next best step / management	vaginal bleeding; abdominal pain; postpartum; uterine; bleeding; vaginal; delivery; ultrasonography; echogenic; material

Decisive Clues

Ref	Archetype	Decisive clues	Correct support	Distractor support
CMS/EM 1A.txt Q1	Next best step / management		shortness; breath; hypertension; edema; pulmonary edema; edema heart; pulmonary edema heart	coronary; artery; edema; pulmonary edema
CMS/EM 1A.txt Q2	Other / unclear		pneumonia; pneumococcal pneumonia; community-acquired pneumonia; tactile; fremitus; x-ray	pneumonia; pneumococcal pneumonia; pneumonia immunocompromised; community-acquired pneumonia; pneumocystis pneumonia
CMS/EM 1A.txt Q3	Mechanism / pathophysiology		ear; antibiotic ear; ear drops; antibiotic ear drops	ear
CMS/EM 1A.txt Q4	Treatment selection
CMS/EM 1A.txt Q5	Treatment selection		headache; nausea; operating; outboard; motor; treated; treated hyperbaric; treated hyperbaric oxygen
CMS/EM 1A.txt Q6	Next best step / management			treated; withdrawal treated; treated benzodiazepines; alcohol withdrawal treated; withdrawal treated benzodiazepines
CMS/EM 1A.txt Q7	Next best step / management	cardiac examination discloses diastolic low-pitched murmur best heard at; there is no peripheral edema chest x-ray and ecg	murmur; heard; dissection murmur; murmur aortic; regurgitation heard; x-ray; ecg; chest x-ray	ecg; ecg elevation; ecg elevation similar; x-ray
CMS/EM 1A.txt Q8	Next best step / management
CMS/EM 1A.txt Q9	Next best step / management	fingerstick blood glucose concentration is 92 mg/dl 5 11; fingerstick blood glucose concentration is 92 mg/dl (5	concentration; hemoglobin concentration; concentration lags; hemoglobin concentration lags; concentration lags behind
CMS/EM 1A.txt Q10	Other / unclear		interpreter; interpreter issuing; interpreter issuing discharge; wait interpreter; waiting interpreter	interpreter
CMS/EM 1A.txt Q11	Next best step / management		right; quadrant; tenderness; palpation; migrate right	right; quadrant; right lower; lower quadrant; right lower quadrant
CMS/EM 1A.txt Q12	Adverse effect		direct; epigastric; epigastric pain	direct; bilirubin; pancreatitis direct; direct bilirubin; bilirubin classic; upper; right upper; upper quadrant
CMS/EM 1A.txt Q13	Next best step / management		albuterol; metered-dose; nebulized albuterol; albuterol asthma; agonists albuterol; asthma; asthma exacerbations; asthma reversible
CMS/EM 1A.txt Q14	Next best step / management	no cervical motion tenderness	tenderness; mass tenderness; adnexal mass tenderness
CMS/EM 1A.txt Q15	Next best step / management		tenderness; palpation; pain tenderness; tenderness palpation; palpation scrotal; cremasteric; reflex; negative cremasteric	tenderness; cremasteric; reflex
CMS/EM 1A.txt Q16	Next best step / management
CMS/EM 1A.txt Q17	Other / unclear		fatigue; oka fatigue; fatigue polyuria; oka fatigue polyuria; fatigue polyuria polydipsia; serum	serum; hyperglycemia serum; serum concentration; cells serum; diuresis hyperglycemia serum
CMS/EM 1A.txt Q18	Treatment selection		diaphoresis; excessive; weakness	shortness; breath
CMS/EM 1A.txt Q19	Next best step / management
CMS/EM 1A.txt Q20	Diagnostic test		tenderness; adnexal	suprapubic; tenderness
CMS/EM 1A.txt Q21	Diagnosis		extremity; lower extremity; rotated lower extremity; held; external; rotation; rotated lower; externally rotated lower	extremity; external; extremity shortening; shortening external; external rotation; rotation; extremity shortening external; weight extremity
CMS/EM 1A.txt Q22	Other / unclear
CMS/EM 1A.txt Q23	Mechanism / pathophysiology		sunken; anterior; dry; mucous; membranes
CMS/EM 1A.txt Q24	Next best step / management		palpitations; heart
CMS/EM 1A.txt Q25	Next best step / management		tenderness; bleeding; uterine bleeding; significant uterine bleeding; vaginal; postpartum vaginal	vaginal; bleeding; vaginal packing; vaginal bleeding; cells vaginal

Correct vs Distractor Patterns

Archetype	Stem cue	Correct family	Distractor family	Contrast signal	Confidence
Next best step / management	abdomen	procedure / surgery	imaging	keyed terms: abdomen; laparotomy; surgical; viscus; perforated \| distractor terms: abdomen; gastrointestinal; x-ray; upper; study	3	medium
Next best step / management	abdomen	imaging	lab / culture / serology	keyed terms: abdomen; infants; gastric; dehydration; stenosis \| distractor terms: metabolic; abdomen; derangements; stenosis; pyloric stenosis	3	medium
Diagnosis	mood	major	adjustment	keyed terms: depressive; neurovegetative; mod; disturbance; disorder \| distractor terms: depressive; disorder; depressed; adjustment; dementia alzheimer	3	medium
Diagnosis	breast	imaging	neoplasm / malignancy	keyed terms: papilloma; benign; breast; bloody; nipple \| distractor terms: abscess; breast; cancer; fibrocystic; carcinoma	3	medium
Diagnosis	breast	imaging	breast	keyed terms: papilloma; benign; breast; bloody; nipple \| distractor terms: abscess; breast; cancer; fibrocystic; carcinoma	3	medium
Next best step / management	water	observation / reassurance	cardiovascular medication	keyed terms: admission; hospital; observation; leads; ards \| distractor terms: pulmonary; antibiotic; drowning; diuretic; corticosteroid	2	medium
Next best step / management	tenderness	imaging	antibiotic / antimicrobial	keyed terms: ultrasonography pelvis; ovary; torsion; ovarian; ultrasonography \| distractor terms: torsion; ceftriaxone; ovarian; hospital; surgical	2	medium
Diagnostic test	right	imaging	lab / culture / serology	keyed terms: urinary; flank; abdomen; hematuria; calcium \| distractor terms: cystoscopy; series; stones; uric; uric acid	2	medium
Diagnostic test	flank	imaging	lab / culture / serology	keyed terms: abdomen; urinary; flank; hematuria; calcium \| distractor terms: serum; x-ray; acid; cystoscopy; series	2	medium
Next best step / management	venous	needle	resuscitation / fluids	keyed terms: pleural; pneumothorax; thoracostomy; lung; space \| distractor terms: pneumothorax; saline; decompression; thoracostomy; thoracotomy	2	medium
Next best step / management	breath	needle	resuscitation / fluids	keyed terms: pleural; pneumothorax; thoracostomy; lung; space \| distractor terms: pneumothorax; saline; decompression; thoracostomy; thoracotomy	2	medium
Diagnostic test	pressure	imaging	lab / culture / serology	keyed terms: head; noncontrast; onset; sah; subarachnoid \| distractor terms: rate; mri; carotid; temporal; eeg	2	medium
Next best step / management	breath sounds	needle	imaging	keyed terms: pneumothorax; tension; needle; tension pneumothorax; air \| distractor terms: pneumothorax; tension; x-ray; diagnostic; tracheal	2	medium
Next best step / management	breath sounds	needle	procedure / surgery	keyed terms: pneumothorax; tension; needle; tension pneumothorax; air \| distractor terms: pneumothorax; tension; x-ray; diagnostic; tracheal	2	medium
Next best step / management	pressure	cardiovascular medication	a-adrenergic	keyed terms: pressure; diabetic; foot; gabapentin; alternative \| distractor terms: inhibitor; agent; blocking; diabetic; diabetic neuropathy	2	medium
Next best step / management	pressure	cardiovascular medication	angiotensin-receptor	keyed terms: pressure; diabetic; foot; gabapentin; alternative \| distractor terms: inhibitor; agent; blocking; diabetic; diabetic neuropathy	2	medium
Mechanism / pathophysiology	diarrhea	lab / culture / serology	imaging	keyed terms: intraepithelial; bowel; small; proximal; celiac \| distractor terms: diarrhea; anemia; folic; concentration; bloating	2	medium
Next best step / management	pubic hair	observation / reassurance	imaging	keyed terms: growth; puberty; begun; follow-up; thelarche \| distractor terms: breast; antibiotic; breast mass; biopsy; thelarche	2	medium
Next best step / management	breast	observation / reassurance	mammography	keyed terms: breast; begun; follow-up; thelarche; young \| distractor terms: antibiotic; biopsy; mammography; breast; breast mass	2	medium
Next best step / management	breast	observation / reassurance	imaging	keyed terms: breast; begun; follow-up; thelarche; young \| distractor terms: antibiotic; biopsy; mammography; breast; breast mass	2	medium
Diagnosis	menstrual period	imaging	appendicitis	keyed terms: bleeding; ectopic; pregnancy; ectopic pregnancy; tenderness \| distractor terms: vaginal; bleeding; vaginal bleeding; appendicitis; abortion	2	medium
Diagnosis	vaginal	imaging	appendicitis	keyed terms: bleeding; ectopic; pregnancy; ectopic pregnancy; tenderness \| distractor terms: vaginal; bleeding; vaginal bleeding; appendicitis; abortion	2	medium
Next best step / management	back pain	imaging	bed	keyed terms: lumbosacral; back; lumbar disc herniation; disc herniation; lumbar \| distractor terms: bed; injection; rest; epidural; mri	2	medium
Other / unclear	medications	lab / culture / serology	imaging	keyed terms: cardiac; endocardilis; procedures; prophylaxis; heart \| distractor terms: antibiotic; valvular; whether; prophylaxis; prophylaxis dental	2	medium
Diagnostic test	chest pain	imaging	lab / culture / serology	keyed terms: angiography; pulmonary; syncope; shortness; suggestive \| distractor terms: mixed; saturation; lower extremity; oxygen saturation; extremity	2	medium

NBME Rule Candidates

Rules are candidate heuristics from repeated answer-choice contrasts. Treat low-confidence rows as review prompts, not facts.

Rule candidate	Decision frame	Clue pattern	Correct family	Tempting distractor	Evidence	Confidence	Priority	Refs
Local pattern: vaginal bleeding + next best step / management -> supportive care / reassurance over cardiovascular medication.	no_treatment_reassurance	vaginal bleeding	supportive care / reassurance	cardiovascular medication; coagulation profile; intravenous administration of magnesium sulfate	3	medium	medium	CMS/OBGYN 5A Q30; CMS/OBGYN 6A Q4; CMS/OBGYN_7A Q36
Local pattern: comes physician lesion + next best step / management -> procedure: surgery over imaging.	treatment_threshold_met	comes physician lesion	procedure: surgery	imaging; procedure: biopsy	2	medium	medium	CMS/Medicine 3A Q42; CMS/Medicine 5A Q32
Local pattern: vaginal bleeding + next best step / management -> imaging over dilatation and curettage.	contraindication_or_adverse_effect	vaginal bleeding	imaging	dilatation and curettage; lab / culture / serology	2	medium	medium	CMS/OBGYN 4A Q35; CMS/OBGYN_7A Q38

Decision Contrast Rules

Decision frame	Stem trigger	Correct family	Tempting distractor	Evidence	Confidence	Rule	Refs
next_best_test_after_initial_clue	he smoked one and one-half packs of cigarettes daily	imaging	cardiac stress scintigraphy	2	medium	When 'he smoked one and one-half packs of cigarettes daily' appears, local explanations/choice text favor imaging over cardiac stress scintigraphy; keyed terms: subclavian steal, vertigo lightheadedness, upper extremity, subclavian artery \| distractor terms: cardiac stress, observes myocardial, myocardial perfusion, perfusion rest; weakened by local missing/negative features: no abnormalities, not recall any trauma to his left arm, not had any other symptoms, no history of serious illness and takes no. Close-distractor signal: choice-specific explanation shares local terms: left arm, plays tennis, cardiac stress.	CMS/Neuro 4A Q22; NBME_15A Q40
diagnostic_cluster_vs_mimic	he does not drink alcohol or use illicit drugs	bipolar disorder	schizophrenia	2	medium	When 'he does not drink alcohol or use illicit drugs' appears, local explanations/choice text favor bipolar disorder over schizophrenia; keyed terms: bipolar disorder, type bipolar, type bipolar disorder, thinking evidenced \| distractor terms: delusions hallucinations, hallucinations disorganized, chronic course, course delusions; weakened by local missing/negative features: not drink alcohol or use illicit drugs, no medications, without evidence of residual symptoms or impaired functionality, and/or negative, no other abnormalities. Close-distractor signal: choice-specific explanation shares local terms: messiah police, lawyer brought, department police.	CMS/PSYCH 5A Q13; CMS/PYSCH 3A Q23
treatment_threshold_met	being stabbed in anterior neck 30 minutes ago	procedure: airway/support	tracheostomy	2	medium	When 'being stabbed in anterior neck 30 minutes ago' appears, local explanations/choice text favor procedure: airway/support over tracheostomy; keyed terms: airway obstruction, endotracheal intubation, obstruction immediate, immediate life-threatening \| distractor terms: securing airway, airway via, via laryngoscopy, laryngoscopy unsuccessful; weakened by local missing/negative features: not be possible if hematoma overlies the. Close-distractor signal: choice-specific explanation shares local terms: department stabbed, stabbed anterior, anterior neck.	CMS/Surgery 3A Q6; CMS/Surgery_5A Q3
diagnostic_cluster_vs_mimic	mild weakness of right lower extremity	meningioma	schwannoma	2	medium	When 'mild weakness of right lower extremity' appears, local explanations/choice text favor meningioma over schwannoma; keyed terms: meningioma benign, benign central, central nervous, nervous system \| distractor terms: benign tumors, tumors arise, arise schwann, schwann cells; weakened by local missing/negative features: for primary lesion is negative. Close-distractor signal: choice-specific explanation shares local terms: department simple, simple partial, partial seizure.	CMS/Neuro 5A Q3; CMS/Neuro 6A Q37
diagnostic_cluster_vs_mimic	mild weakness of right lower extremity	meningioma	astrocytoma	2	medium	When 'mild weakness of right lower extremity' appears, local explanations/choice text favor meningioma over astrocytoma; keyed terms: meningioma benign, benign central, central nervous, nervous system \| distractor terms: primary cns, cns neoplasm, neoplasm benign, benign pilocytic; weakened by local missing/negative features: for primary lesion is negative. Close-distractor signal: choice-specific explanation shares local terms: department simple, simple partial, partial seizure.	CMS/Neuro 5A Q3; CMS/Neuro 6A Q37
diagnostic_cluster_vs_mimic	simple partial seizure	meningioma	schwannoma	2	medium	When 'simple partial seizure' appears, local explanations/choice text favor meningioma over schwannoma; keyed terms: meningioma benign, benign central, central nervous, nervous system \| distractor terms: benign tumors, tumors arise, arise schwann, schwann cells; weakened by local missing/negative features: for primary lesion is negative. Close-distractor signal: choice-specific explanation shares local terms: department simple, simple partial, partial seizure.	CMS/Neuro 5A Q3; CMS/Neuro 6A Q37
diagnostic_cluster_vs_mimic	simple partial seizure	meningioma	astrocytoma	2	medium	When 'simple partial seizure' appears, local explanations/choice text favor meningioma over astrocytoma; keyed terms: meningioma benign, benign central, central nervous, nervous system \| distractor terms: primary cns, cns neoplasm, neoplasm benign, benign pilocytic; weakened by local missing/negative features: for primary lesion is negative. Close-distractor signal: choice-specific explanation shares local terms: department simple, simple partial, partial seizure.	CMS/Neuro 5A Q3; CMS/Neuro 6A Q37
no_treatment_reassurance	hyperthyroidism treated with propylthiouracil and tachycardia controlled with labetalol	supportive care / reassurance	intravenous administration of magnesium sulfate	1	low	When 'hyperthyroidism treated with propylthiouracil and tachycardia controlled with labetalol' appears, local explanations/choice text favor supportive care / reassurance over intravenous administration of magnesium sulfate; keyed terms: cesarean delivery, placenta previa, third trimester, vaginal bleeding \| distractor terms: preeclampsia hypertension, hypertension proteinuria, proteinuria end-organ, end-organ dysfunction; weakened by local missing/negative features: no abnormalities, no contractions, no decelerations and normal variability, normal variability, not typically cause vaginal bleeding. Close-distractor signal: choice-specific explanation shares local terms: vaginal bleeding, comes physician, biopsy specimen.	CMS/OBGYN_7A Q36
no_treatment_reassurance	hyperthyroidism treated with propylthiouracil and tachycardia controlled with labetalol	supportive care / reassurance	amnioinfusion	1	low	When 'hyperthyroidism treated with propylthiouracil and tachycardia controlled with labetalol' appears, local explanations/choice text favor supportive care / reassurance over amnioinfusion; keyed terms: cesarean delivery, placenta previa, third trimester, vaginal bleeding \| distractor terms: refers process, process instilling, instilling fluid, fluid uterus; weakened by local missing/negative features: no abnormalities, no contractions, no decelerations and normal variability, normal variability, not used in treatment of placenta previa. Close-distractor signal: choice-specific explanation shares local terms: fetal heart, comes physician, vaginal bleeding.	CMS/OBGYN_7A Q36
contraindication_or_adverse_effect	she is receiving maintenance chemotherapy and trimethoprim-sulfamethoxazole prophylaxis	herpes zoster	leukemic relapse	1	low	When 'she is receiving maintenance chemotherapy and trimethoprim-sulfamethoxazole prophylaxis' appears, local explanations/choice text favor herpes zoster over leukemic relapse; keyed terms: herpes zoster, varicella zoster, zoster virus, varicella zoster virus \| distractor terms: leukemia cutis, rash form, form leukemia, cutis leukemia; weakened by local missing/negative features: not vesicles. Close-distractor signal: choice-specific explanation shares local terms: leukemia cutis, girl remission, remission lymphoblastic.	CMS/Peds 4A Q1
contraindication_or_adverse_effect	she is receiving maintenance chemotherapy and trimethoprim-sulfamethoxazole prophylaxis	herpes zoster	imaging	1	low	When 'she is receiving maintenance chemotherapy and trimethoprim-sulfamethoxazole prophylaxis' appears, local explanations/choice text favor herpes zoster over imaging; keyed terms: herpes zoster, varicella zoster, zoster virus, varicella zoster virus \| distractor terms: toxic epidermal, epidermal necrolysis, necrolysis ten, ten cutaneous; weakened by local missing/negative features: without spreading would be highly uncharacteristic of ten. Close-distractor signal: choice-specific explanation shares local terms: drug reaction, girl remission, remission lymphoblastic.	CMS/Peds 4A Q1
treatment_threshold_met	hypertension treated with hydrochlorothiazide and osteoarthritis treated with acetamino	antibiotic / antimicrobial	assess booster phenomenon	1	low	When 'hypertension treated with hydrochlorothiazide and osteoarthritis treated with acetamino' appears, local explanations/choice text favor antibiotic / antimicrobial over assess booster phenomenon; keyed terms: benign murmurs, otherwise healthy, apparent factors, factors cardiac \| distractor terms: recommended torsades, torsades pointes, pointes congenital, congenital long; weakened by local missing/negative features: no sick contacts, no abnormalities, not smoke cigarettes, not to play competitive sports. Close-distractor signal: choice-specific explanation shares local terms: ppd skin, woman comes, comes physician.	NBME_12A Q45
treatment_threshold_met	hypertension treated with hydrochlorothiazide and osteoarthritis treated with acetamino	antibiotic / antimicrobial	provide clearance to begin volunteer work	1	low	When 'hypertension treated with hydrochlorothiazide and osteoarthritis treated with acetamino' appears, local explanations/choice text favor antibiotic / antimicrobial over provide clearance to begin volunteer work; keyed terms: benign murmurs, otherwise healthy, apparent factors, factors cardiac \| distractor terms: bicuspid aortic, aortic valve, valve congenital, congenital valve; weakened by local missing/negative features: no sick contacts, no abnormalities, not smoke cigarettes. Close-distractor signal: choice-specific explanation shares local terms: ppd skin, volunteer work, woman comes.	NBME_12A Q45
diagnostic_cluster_vs_mimic	laboratory studies show: leukocyte count segmented neutrophils lymphocytes erythrocyte	necrotizing otitis externa	chronic otitis media with effusion	1	low	When 'laboratory studies show: leukocyte count segmented neutrophils lymphocytes erythrocyte' appears, local explanations/choice text favor necrotizing otitis externa over chronic otitis media with effusion; keyed terms: otitis externa, external ear, ear canal, external ear canal \| distractor terms: chronic middle, middle ear, ear pain, pain retrotympanic; weakened by local missing/negative features: no history of ear problems, not seen on this patient. Close-distractor signal: choice-specific explanation shares local terms: left ear, ear pain, ear canal.	CMS/Medicine 5A Q9
diagnostic_cluster_vs_mimic	laboratory studies show: leukocyte count segmented neutrophils lymphocytes erythrocyte	necrotizing otitis externa	fungal otitis externa	1	low	When 'laboratory studies show: leukocyte count segmented neutrophils lymphocytes erythrocyte' appears, local explanations/choice text favor necrotizing otitis externa over fungal otitis externa; keyed terms: otitis externa, external ear, ear canal, external ear canal \| distractor terms: similarly exam, exam bacterial, bacterial subacute, subacute indolent; weakened by local missing/negative features: no history of ear problems, less likely than bacterial cause. Close-distractor signal: choice-specific explanation shares local terms: left ear, ear canal, man comes.	CMS/Medicine 5A Q9
contraindication_or_adverse_effect	multiple over-the-counter topical preparations have provided only temporary resolution	imaging	medication: antibiotic/antimicrobial	1	low	When 'multiple over-the-counter topical preparations have provided only temporary resolution' appears, local explanations/choice text favor imaging over medication: antibiotic/antimicrobial; keyed terms: defect cell-mediated, cell-mediated immunity, defect cell-mediated immunity, esophageal candidiasis \| distractor terms: factor developing, developing vulvovaginal, vulvovaginal candidiasis, candidiasis treated; weakened by local missing/negative features: no adnexal tenderness or masses, not explain her long-term. Close-distractor signal: choice-specific explanation shares local terms: treated azithromycin, woman comes, comes physician.	NBME_15A Q15
contraindication_or_adverse_effect	multiple over-the-counter topical preparations have provided only temporary resolution	imaging	combined hypogammaglobulinemia	1	low	When 'multiple over-the-counter topical preparations have provided only temporary resolution' appears, local explanations/choice text favor imaging over combined hypogammaglobulinemia; keyed terms: defect cell-mediated, cell-mediated immunity, defect cell-mediated immunity, esophageal candidiasis \| distractor terms: x-linked agammaglobulinemia, seen conditions, conditions x-linked, agammaglobulinemia x-linked; weakened by local missing/negative features: no adnexal tenderness or masses, not typically demonstrate susceptibility to viral or fungal. Close-distractor signal: choice-specific explanation shares local terms: x-linked agammaglobulinemia, woman comes, comes physician.	NBME_15A Q15
treatment_threshold_met	over-the-counter analgesics and nonsteroidal anti-inflammatory drugs has not relieved	cardiovascular medication	procedure: surgery	1	low	When 'over-the-counter analgesics and nonsteroidal anti-inflammatory drugs has not relieved' appears, local explanations/choice text favor cardiovascular medication over procedure: surgery; keyed terms: primary dysmenorrhea, dysmenorrhea defined, defined menstrual, menstrual pain \| distractor terms: primary dysmenorrhea, aid multiple, multiple intra-abdominal, intra-abdominal pathologies; weakened by local missing/negative features: no abnormalities, not relieved pain, not associated with any underlying pathology. Close-distractor signal: choice-specific explanation shares local terms: anti-inflammatory drugs, primary dysmenorrhea, apreviously healthy.	CMS/PEDS_7A Q22
treatment_threshold_met	over-the-counter analgesics and nonsteroidal anti-inflammatory drugs has not relieved	cardiovascular medication	narcotic analgesic therapy	1	low	When 'over-the-counter analgesics and nonsteroidal anti-inflammatory drugs has not relieved' appears, local explanations/choice text favor cardiovascular medication over narcotic analgesic therapy; keyed terms: primary dysmenorrhea, dysmenorrhea defined, defined menstrual, menstrual pain \| distractor terms: over-the-counter analgesics, analgesics effective, effective contraceptive, contraceptive significantly; weakened by local missing/negative features: no abnormalities, not relieved pain, not be appropriate at this time, not been effective. Close-distractor signal: choice-specific explanation shares local terms: over-the-counter analgesics, apreviously healthy, brought physician.	CMS/PEDS_7A Q22
contraindication_or_adverse_effect	hypertension controlled with lisinopril and hyperlipidemia controlled with lovastatin	imaging	delusional disorder	1	low	When 'hypertension controlled with lisinopril and hyperlipidemia controlled with lovastatin' appears, local explanations/choice text favor imaging over delusional disorder; keyed terms: dopamine concentration, concentration leads, dopamine concentration leads, pramipexole increases \| distractor terms: one delusions, delusions fixed, fixed false, false beliefs; weakened by local missing/negative features: no history of psychiatric illness, without other psychotic symptoms, not demonstrate one circumscribed delusion. Close-distractor signal: choice-specific explanation shares local terms: wife says, examinat ion, man parkinson.	CMS/PSYCH 5A Q3
contraindication_or_adverse_effect	hypertension controlled with lisinopril and hyperlipidemia controlled with lovastatin	imaging	major depressive disorder	1	low	When 'hypertension controlled with lisinopril and hyperlipidemia controlled with lovastatin' appears, local explanations/choice text favor imaging over major depressive disorder; keyed terms: dopamine concentration, concentration leads, dopamine concentration leads, pramipexole increases \| distractor terms: five depressed, depressed mood, mood anhedonia, anhedonia guilt; weakened by local missing/negative features: no history of psychiatric illness, not related to underlying medical condition or. Close-distractor signal: choice-specific explanation shares local terms: wife says, examinat ion, man parkinson.	CMS/PSYCH 5A Q3
treatment_threshold_met	undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy under gen	imaging	knowledge patient-controlled analgesia	1	low	When 'undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy under gen' appears, local explanations/choice text favor imaging over knowledge patient-controlled analgesia; keyed terms: recurrent necrotizing, necrotizing infections, infections chronic, chronic inflammation \| distractor terms: cancer-related death, death united, united states, states divided; no repeated missing/negative feature extracted. Close-distractor signal: choice-specific explanation shares local terms: patient-controlled analgesia, woman disoriented, disoriented undergoing.	NBME_13A Q38
treatment_threshold_met	undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy under gen	imaging	risk-management committee prepare	1	low	When 'undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy under gen' appears, local explanations/choice text favor imaging over risk-management committee prepare; keyed terms: recurrent necrotizing, necrotizing infections, infections chronic, chronic inflammation \| distractor terms: neuroendocrine tumor, tumor secretes, secretes substances, substances serotonin; no repeated missing/negative feature extracted. Close-distractor signal: choice-specific explanation shares local terms: woman disoriented, disoriented undergoing, undergoing total.	NBME_13A Q38
diagnostic_cluster_vs_mimic	laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes	drug-induced neutropenia	imaging	1	low	When 'laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes' appears, local explanations/choice text favor drug-induced neutropenia over imaging; keyed terms: adverse effect, drug-induced neutropenia, propylthiouracil methimazole, exhibits hyperthyroidism \| distractor terms: radioactive iodine, due myelosuppressive, myelosuppressive effects, effects radioactive; weakened by local missing/negative features: no further details, no skin orjoint abnormalities, not radioactive iodine therapy. Close-distractor signal: choice-specific explanation shares local terms: radioactive iodine, department fever, fever chills.	CMS/Medicine 4A Q33
diagnostic_cluster_vs_mimic	laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes	drug-induced neutropenia	thyroid storm 45% 1400/mm3 5% 95%	1	low	When 'laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes' appears, local explanations/choice text favor drug-induced neutropenia over thyroid storm 45% 1400/mm3 5% 95%; keyed terms: adverse effect, drug-induced neutropenia, propylthiouracil methimazole, exhibits hyperthyroidism \| distractor terms: thyroid storm, potential complication, complication hyperthyroidism, hyperthyroidism stress; weakened by local missing/negative features: no further details, no skin orjoint abnormalities, not emergently treated. Close-distractor signal: choice-specific explanation shares local terms: thyroid storm, department fever, fever chills.	CMS/Medicine 4A Q33
treatment_threshold_met	laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes	cardiovascular medication	infection / inflammation	1	low	When 'laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes' appears, local explanations/choice text favor cardiovascular medication over infection / inflammation; keyed terms: complications kawasaki, high-dose aspirin, lymph node, node multisystem \| distractor terms: children fever, fever viral, viral illness, illness appear; weakened by local missing/negative features: without injection adjacent to corneal limbus, rapid streptococcal testing is negative, without suspicion for serious bacterial illness or kawasaki. Close-distractor signal: choice-specific explanation shares local terms: previously healthy, healthy month-old, month-old boy.	NBME_14A Q47
treatment_threshold_met	laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes	cardiovascular medication	10-day course of oral amoxicillin	1	low	When 'laboratory studies show hematocrit leukocyte count segmented neutrophils lymphocytes' appears, local explanations/choice text favor cardiovascular medication over 10-day course of oral amoxicillin; keyed terms: complications kawasaki, high-dose aspirin, lymph node, node multisystem \| distractor terms: suspected bacterial, bacterial infection, infection pneumonia, pneumonia otitis; weakened by local missing/negative features: without injection adjacent to corneal limbus, rapid streptococcal testing is negative, not indicated as cause is not infectious. Close-distractor signal: choice-specific explanation shares local terms: previously healthy, healthy month-old, month-old boy.	NBME_14A Q47
treatment_threshold_met	her only medication is hydrocodone-acetaminophen hydrocodone 5 mg/acetaminophen 500	switch to intravenous morphine	add oral gabapentin to medication regimen	1	low	When 'her only medication is hydrocodone-acetaminophen hydrocodone 5 mg/acetaminophen 500' appears, local explanations/choice text favor switch to intravenous morphine over add oral gabapentin to medication regimen; keyed terms: gastric malignancy, peptic ulcer, chronic gastritis, microcytic anemia \| distractor terms: first-line diagnostic, diagnostic potential, potential cholecystitis, cholecystitis characteristic; weakened by local missing/negative features: not have fever or right upper quadrant pain. Close-distractor signal: choice-specific explanation shares local terms: upper gastrointestinal, bilateral mastectomy, woman metastatic.	NBME_14A Q32
treatment_threshold_met	her only medication is hydrocodone-acetaminophen hydrocodone 5 mg/acetaminophen 500	switch to intravenous morphine	add oral ketorolac to medication regimen	1	low	When 'her only medication is hydrocodone-acetaminophen hydrocodone 5 mg/acetaminophen 500' appears, local explanations/choice text favor switch to intravenous morphine over add oral ketorolac to medication regimen; keyed terms: gastric malignancy, peptic ulcer, chronic gastritis, microcytic anemia \| distractor terms: small bowel, tissue biopsy, water-soluble contrast, contrast small; weakened by local missing/negative features: not offer opportunity to sample tissue through. Close-distractor signal: choice-specific explanation shares local terms: small bowel, upper gastrointestinal, bilateral mastectomy.	NBME_14A Q32
mechanism_from_pathophysiology	laboratory studies show hematocrit leukocyte count segmented neutrophils basophils	imaging	vitamin k deficiency	1	low	When 'laboratory studies show hematocrit leukocyte count segmented neutrophils basophils' appears, local explanations/choice text favor imaging over vitamin k deficiency; keyed terms: factor viii, viii deficiency, factor viii deficiency, deficiency hemophilia \| distractor terms: unlikely child, child given, given dose, dose vitamin; weakened by local missing/negative features: unlikely because this child was given dose. Close-distractor signal: choice-specific explanation shares local terms: circumcision site, twelve undergoing, undergoing circumcision.	CMS/PEDS 5A Q39
mechanism_from_pathophysiology	laboratory studies show hematocrit leukocyte count segmented neutrophils basophils	imaging	sepsis	1	low	When 'laboratory studies show hematocrit leukocyte count segmented neutrophils basophils' appears, local explanations/choice text favor imaging over sepsis; keyed terms: factor viii, viii deficiency, factor viii deficiency, deficiency hemophilia \| distractor terms: unlikely fever, infection infections, infections sepsis, sepsis newborn; weakened by local missing/negative features: without fever or signs of infection, unlikely diagnosis in this patient without fever or. Close-distractor signal: choice-specific explanation shares local terms: circumcision site, twelve undergoing, undergoing circumcision.	CMS/PEDS 5A Q39
next_best_test_after_initial_clue	hemoglobin leukocyte count segmented neutrophils bands lymphocytes monocytes serum	primary ciliary dyskinesia	imaging	1	low	When 'hemoglobin leukocyte count segmented neutrophils bands lymphocytes monocytes serum' appears, local explanations/choice text favor primary ciliary dyskinesia over imaging; keyed terms: primary ciliary, ciliary dyskinesia, situs inversus, primary ciliary dyskinesia \| distractor terms: disorders impaired, impaired attachment, attachment leukocytes, leukocytes vascular; weakened by local missing/negative features: not to place or time, normal marginated position outside of blood. Close-distractor signal: choice-specific explanation shares local terms: four admission, admission hospital, hospital myocardial.	NBME_12A Q25
next_best_test_after_initial_clue	hemoglobin leukocyte count segmented neutrophils bands lymphocytes monocytes serum	primary ciliary dyskinesia	complement deficiency	1	low	When 'hemoglobin leukocyte count segmented neutrophils bands lymphocytes monocytes serum' appears, local explanations/choice text favor primary ciliary dyskinesia over complement deficiency; keyed terms: primary ciliary, ciliary dyskinesia, situs inversus, primary ciliary dyskinesia \| distractor terms: particularly terminal, terminal complement, complement proteins, proteins prevents; weakened by local missing/negative features: not to place or time. Close-distractor signal: choice-specific explanation shares local terms: four admission, admission hospital, hospital myocardial.	NBME_12A Q25
contraindication_or_adverse_effect	hypertension treated with lisinopril and hyperlipidemia treated with atorvastatin	pons	internal capsule	1	low	When 'hypertension treated with lisinopril and hyperlipidemia treated with atorvastatin' appears, local explanations/choice text favor pons over internal capsule; keyed terms: strokes ischemic, inferior cerebellar, cerebral infarctions, infarctions known \| distractor terms: internal capsule; no repeated missing/negative feature extracted. Close-distractor signal: same local choice set; no choice-specific distractor explanation found.	CMS/Neuro 6A Q31
contraindication_or_adverse_effect	hypertension treated with lisinopril and hyperlipidemia treated with atorvastatin	pons	medulla	1	low	When 'hypertension treated with lisinopril and hyperlipidemia treated with atorvastatin' appears, local explanations/choice text favor pons over medulla; keyed terms: strokes ischemic, inferior cerebellar, cerebral infarctions, infarctions known \| distractor terms: not extracted; no repeated missing/negative feature extracted. Close-distractor signal: same local choice set; no choice-specific distractor explanation found.	CMS/Neuro 6A Q31
contraindication_or_adverse_effect	lisinopril and 20-year history of hypercholesterolemia treated with atorvastatin	increased serum troponin! concentration	presence of s, gallop	1	low	When 'lisinopril and 20-year history of hypercholesterolemia treated with atorvastatin' appears, local explanations/choice text favor increased serum troponin! concentration over presence of s, gallop; keyed terms: cardiac biomarkers, myocardial infarction, serum troponin, troponin concentration \| distractor terms: suggestive ventricular, ventricular hypertrophy, hypertrophy diastolic, diastolic dysfunction; weakened by local missing/negative features: no abnormalities except for s, not associated with acute myocardial infarction. Close-distractor signal: choice-specific explanation shares local terms: t-wave inversion, inversion anterior, anterior lateral.	CMS/Medicine 8A Q18
contraindication_or_adverse_effect	lisinopril and 20-year history of hypercholesterolemia treated with atorvastatin	increased serum troponin! concentration	chest pain pattern	1	low	When 'lisinopril and 20-year history of hypercholesterolemia treated with atorvastatin' appears, local explanations/choice text favor increased serum troponin! concentration over chest pain pattern; keyed terms: cardiac biomarkers, myocardial infarction, serum troponin, troponin concentration \| distractor terms: presented consistent, consistent cardiac, cardiac angina, angina substernal; weakened by local missing/negative features: no abnormalities except for s. Close-distractor signal: choice-specific explanation shares local terms: department episode, episode shortness, shortness breath.	CMS/Medicine 8A Q18
contraindication_or_adverse_effect	ultrasonography confirms absence offetal cardiac activity in otherwise normal-ap	imaging	cesarean delivery	1	low	When 'ultrasonography confirms absence offetal cardiac activity in otherwise normal-ap' appears, local explanations/choice text favor imaging over cesarean delivery; keyed terms: fetal demise, intrauterine fetal, intrauterine fetal demise, delivery antepartum \| distractor terms: deliver fetuses, fetuses arrest, arrest labor, labor cephalopelvic; weakened by local missing/negative features: no fetal heart tones are heard on doppler, no glucose or protein, no contractions, not effaced, not typically required in intrauterine fetal demise. Close-distractor signal: choice-specific explanation shares local terms: comes physician, cervix closed, closed effaced.	CMS/OBGYN 5A Q26
contraindication_or_adverse_effect	ultrasonography confirms absence offetal cardiac activity in otherwise normal-ap	imaging	dilatation and curettage	1	low	When 'ultrasonography confirms absence offetal cardiac activity in otherwise normal-ap' appears, local explanations/choice text favor imaging over dilatation and curettage; keyed terms: fetal demise, intrauterine fetal, intrauterine fetal demise, delivery antepartum \| distractor terms: elective abortion, abortion remove, remove remaining, remaining fetal; weakened by local missing/negative features: no fetal heart tones are heard on doppler, no glucose or protein, no contractions, not effaced. Close-distractor signal: choice-specific explanation shares local terms: comes physician, cervix closed, closed effaced.	CMS/OBGYN 5A Q26
contraindication_or_adverse_effect	gastroesophageal reflux disease treated with omeprazole and hypertension treated	urethral hypermobility	constipation	1	low	When 'gastroesophageal reflux disease treated with omeprazole and hypertension treated' appears, local explanations/choice text favor urethral hypermobility over constipation; keyed terms: pelvic floor, stress urinary, urinary incontinence, multiparous women \| distractor terms: urinary incontinence, lead urinary, incontinence via, via direct; weakened by local missing/negative features: no history of gynecologic illness, no abnormalities, no blood, no history of constipation, less likely as cause of her urinary incontinence. Close-distractor signal: choice-specific explanation shares local terms: urinary incontinence, loss urine, previously healthy.	NBME_10A Q26
contraindication_or_adverse_effect	gastroesophageal reflux disease treated with omeprazole and hypertension treated	urethral hypermobility	hydrochlorothiazide therapy	1	low	When 'gastroesophageal reflux disease treated with omeprazole and hypertension treated' appears, local explanations/choice text favor urethral hypermobility over hydrochlorothiazide therapy; keyed terms: pelvic floor, stress urinary, urinary incontinence, multiparous women \| distractor terms: possible urinary, urinary incontinence, incontinence diuretic, diuretic action; weakened by local missing/negative features: no history of gynecologic illness, no abnormalities, no blood. Close-distractor signal: choice-specific explanation shares local terms: urinary incontinence, loss urine, previously healthy.	NBME_10A Q26
unstable_patient_stabilization	cardiac examination discloses hyperdynamic precordium and grade 3/6 holosystolic	chordae tendineae rupture	imaging	1	low	When 'cardiac examination discloses hyperdynamic precordium and grade 3/6 holosystolic' appears, local explanations/choice text favor chordae tendineae rupture over imaging; keyed terms: chordae tendineae, tendineae rupture, myocardial infarction, mitral valve \| distractor terms: given successful, successful coronary, coronary reperfusion, reperfusion thrombolytics; weakened by local missing/negative features: no routine medications, no clubbing, not present on previous examinations, less likely given successful initial coronary reperfusion with. Close-distractor signal: choice-specific explanation shares local terms: myocardial infarction, coronary unit, sudden onset.	NBME_11A Q12
unstable_patient_stabilization	cardiac examination discloses hyperdynamic precordium and grade 3/6 holosystolic	chordae tendineae rupture	left ventricular free wall rupture	1	low	When 'cardiac examination discloses hyperdynamic precordium and grade 3/6 holosystolic' appears, local explanations/choice text favor chordae tendineae rupture over left ventricular free wall rupture; keyed terms: chordae tendineae, tendineae rupture, myocardial infarction, mitral valve \| distractor terms: another potentially, potentially life-threatening, life-threatening complication, complication myocardial; weakened by local missing/negative features: no routine medications, no clubbing, not present on previous examinations. Close-distractor signal: choice-specific explanation shares local terms: myocardial infarction, man recovering, recovering coronary.	NBME_11A Q12
treatment_threshold_met	laboratory studies show leukocyte count segmented neutrophils bands lymphocytes	metformin	cardiovascular medication	1	low	When 'laboratory studies show leukocyte count segmented neutrophils bands lymphocytes' appears, local explanations/choice text favor metformin over cardiovascular medication; keyed terms: pneumonia elevated, elevated creatinine, creatinine indicating, indicating kidney \| distractor terms: cardiovascular medication; no repeated missing/negative feature extracted. Close-distractor signal: choice-specific explanation shares local terms: mild shortness, shortness breath, mild shortness breath.	CMS/Medicine_6A Q40
treatment_threshold_met	laboratory studies show leukocyte count segmented neutrophils bands lymphocytes	metformin	atenolol	1	low	When 'laboratory studies show leukocyte count segmented neutrophils bands lymphocytes' appears, local explanations/choice text favor metformin over atenolol; keyed terms: pneumonia elevated, elevated creatinine, creatinine indicating, indicating kidney \| distractor terms: not extracted; no repeated missing/negative feature extracted. Close-distractor signal: same local choice set; no choice-specific distractor explanation found.	CMS/Medicine_6A Q40
contraindication_or_adverse_effect	laboratory studies show leukocyte count segmented neutrophils lymphocytes serum	imaging	catatonia	1	low	When 'laboratory studies show leukocyte count segmented neutrophils lymphocytes serum' appears, local explanations/choice text favor imaging over catatonia; keyed terms: autonomic dysfunction, dopamine antagonism, muscle rigidity, neuroleptic malignant \| distractor terms: malignant catatonia, neurobehavioral marked, marked inability, inability move; weakened by local missing/negative features: without speaking or following commands, no abnormalities, not fix or follow visual stimuli or gaze, not follow commands, lack of preceding psychiatric symptoms or stereotyped movements. Close-distractor signal: choice-specific explanation shares local terms: leukocyte count, malignant catatonia, department psychiatric.	CMS/PYSCH 3A Q10
contraindication_or_adverse_effect	laboratory studies show leukocyte count segmented neutrophils lymphocytes serum	imaging	malingering	1	low	When 'laboratory studies show leukocyte count segmented neutrophils lymphocytes serum' appears, local explanations/choice text favor imaging over malingering; keyed terms: autonomic dysfunction, dopamine antagonism, muscle rigidity, neuroleptic malignant \| distractor terms: defined falsification, falsification obtain, obtain gain, gain another; weakened by local missing/negative features: without speaking or following commands, no abnormalities, not fix or follow visual stimuli or gaze, not follow commands, no clear secondary gain that he might obtain. Close-distractor signal: choice-specific explanation shares local terms: leukocyte count, department psychiatric, psychiatric hospital.	CMS/PYSCH 3A Q10
treatment_threshold_met	undergoing pancreaticoduodenectomy for injuries sustained from gunshot wound to	enteral tube feedings	total parenteral nutrition	1	low	When 'undergoing pancreaticoduodenectomy for injuries sustained from gunshot wound to' appears, local explanations/choice text favor enteral tube feedings over total parenteral nutrition; keyed terms: enteral tube, tube feedings, providing nutrition, enteral feeding \| distractor terms: parenteral nutrition, forms intravenous, intravenous nutrition, nutrition routes; weakened by local missing/negative features: no nutrients should be given at this time. Close-distractor signal: choice-specific explanation shares local terms: parenteral nutrition, woman remains, remains intensive.	CMS/Surgery 4A Q12
treatment_threshold_met	undergoing pancreaticoduodenectomy for injuries sustained from gunshot wound to	enteral tube feedings	no nutrients should be given at	1	low	When 'undergoing pancreaticoduodenectomy for injuries sustained from gunshot wound to' appears, local explanations/choice text favor enteral tube feedings over no nutrients should be given at; keyed terms: enteral tube, tube feedings, providing nutrition, enteral feeding \| distractor terms: surgical healing, healing requires, requires nutritional, nutritional provision; weakened by local missing/negative features: absence of adequate nutrition, not appropriate next step. Close-distractor signal: choice-specific explanation shares local terms: woman remains, remains intensive, intensive unit.	CMS/Surgery 4A Q12
screening_age_or_risk_threshold	urine toxicology screening on admission was positive for a-tetrahydrocannabinol	patient-controlled morphine	cardiovascular medication	1	low	When 'urine toxicology screening on admission was positive for a-tetrahydrocannabinol' appears, local explanations/choice text favor patient-controlled morphine over cardiovascular medication; keyed terms: pain control, postoperative pain, pain medication, control vital \| distractor terms: provide lasting, control pain, improve pain, pain temporarily; weakened by local missing/negative features: not seem to provide lasting benefit, not provide lasting pain control or is an. Close-distractor signal: choice-specific explanation shares local terms: provide lasting, control pain, eight involved.	NBME_12A Q26

Top Source Files

Source file	Questions
NBME/NBME_12A.txt	200
NBME/NBME_14A.txt	200
NBME/NBME_15A.txt	200
NBME/NBME_11A.txt	199
NBME/NBME_9A.txt	199
NBME/NBME_13A.txt	198
NBME/NBME_10A.txt	197
CMS/EM_2A.txt	50
CMS/EM_3A.txt	50
CMS/FM_2A.txt	50