NBME Question Dissection Dashboard

Focused mode is on. The dashboard centers on clean questions and the decision fork behind each keyed answer. Full stems, explanations, and answer-choice lists stay out of this page and remain in the CSV files for spot-checking.

Clean Data Summary

49files discovered
2178parsed questions
2039clean rows used
139excluded / suspicious
93.6%overall clean percentage
2039dissection rows
41high-confidence dissections
1medium-confidence dissections

Primary output: question_analysis_output/rules/nbme_dissection.csv. Source rows are in question_analysis_output/source_data, quality reports are in question_analysis_output/quality_reports, and pattern tables are in question_analysis_output/pattern_tables.

Most Reliable Files

Source FileClean RowsTotal RowsClean %Recommendation
NBME/NBME_9A.txt515396.2Use for pattern analysis
CMS/FM 3A.txt5050100.0Use for pattern analysis
CMS/Neuro 6A.txt4949100.0Use for pattern analysis
CMS/OBGYN 5A.txt4949100.0Use for pattern analysis
CMS/PSYCH 5A.txt4949100.0Use for pattern analysis
CMS/FM 2A.txt495098.0Use for pattern analysis
CMS/Medicine 3A.txt495098.0Use for pattern analysis
CMS/Surgery 4A.txt495098.0Use for pattern analysis

Top Exclusion Reasons

Exclusion ReasonRows
low parse confidence98
missing correct answer text82
correct letter not found in choices61
correct_letter_not_found_in_choices warning57
reference-answer stem mismatch33
reference_answer_stem_mismatch warning33
reference stem does not match answer-file stem33
incomplete answer choices31
duplicate-looking file/question26
missing correct answer21

Parser Cleanup Targets

Source FileClean %ExcludedTop WarningsRecommendation
CMS/EM 3A.txt45.512correct_letter_not_found_in_choices (9); reference_stem_match:similarity=0.962,shared_terms=50 (1); reference_stem_ma...Parser cleanup needed
CMS/OBGYN_7A.txt67.316reference_stem_match:similarity=1.000,shared_terms=19 (1); reference_stem_match:similarity=1.000,shared_terms=45 (1);...Use cautiously
CMS/PSYCH_7A.txt75.611trimmed_duplicate_answer_key_text (16); correct_letter_not_found_in_choices (11); multiple_correct_answer_markers (8)...Use cautiously
CMS/FM 4A.txt76.210trimmed_duplicate_answer_key_text (11); missing_answer_key (5); possible_ocr_damage (3); synthetic_question_start (1)...Use cautiously
CMS/NEURO_8A.txt82.15correct_letter_not_found_in_choices (4); reference_stem_match:similarity=0.016,shared_terms=5 (1); reference_stem_mat...Use for pattern analysis
CMS/Medicine 7A.txt87.56reference_stem_match:similarity=1.000,shared_terms=26 (4); reference_stem_match:similarity=1.000,shared_terms=38 (3);...Use for pattern analysis
NBME/NBME_15A.txt88.06trimmed_duplicate_answer_key_text (18); reference_stem_match:similarity=0.044,shared_terms=3 (2); reference_stem_matc...Use for pattern analysis
CMS/FM 5A.txt88.91reference_stem_match:similarity=0.673,shared_terms=33 (1); reference_stem_match:similarity=0.812,shared_terms=26 (1);...Use for pattern analysis

Fragment / Synthetic Starts

Source FileSkipped FragmentsSynthetic RowsClean %Top Skip Reasons
CMS/FM 4A.txt14174.4missing_real_question_stem_signal (8); starts_with_ocr_zero_answer_key (5); starts_with_ocr_zero_choice (5); missing_...
NBME/NBME_9A.txt6026.3missing_real_question_stem_signal (24); missing_answer_key_and_choices (19); starts_with_ocr_zero_choice (6)
NBME/NBME_10A.txt5024.6missing_real_question_stem_signal (13); missing_answer_key_and_choices (11); starts_with_ocr_zero_choice (5)
CMS/NEURO_8A.txt4011.4missing_real_question_stem_signal (41); missing_answer_key_and_choices (27); starts_with_ocr_zero_choice (4)
NBME/NBME_12A.txt3025.4missing_real_question_stem_signal (40); missing_answer_key_and_choices (26); starts_with_ocr_zero_choice (3)
CMS/Medicine 5A.txt2081.2missing_answer_key_and_choices (11); missing_real_question_stem_signal (7); starts_with_ocr_zero_choice (2)
CMS/FM 5A.txt2088.9starts_with_answer_choice_discussion (1); starts_with_ocr_zero_choice (1)
NBME/NBME_14A.txt1026.2missing_real_question_stem_signal (29); missing_answer_key_and_choices (19); starts_with_ocr_zero_choice (1)

Question Types Represented

Question TypeClean Questions
Diagnosis490
Next best step / management468
Other / unclear269
Adverse effect190
Mechanism / pathophysiology161
Diagnostic test152
Screening / prevention93
Treatment selection86
Initial management40
Interpretation of lab/imaging32
Ethics / communication19
Risk factor19
Complication13
Prognosis7

Highest-Confidence NBME Dissection Rules

Rows summarize local dataset contrasts only. They do not claim a clue proves an answer or validate medical currency.

Test-Day RuleArchetypeDecision ForkEvidenceConfidenceRefs
When auscultation of chest discloses mild crackles in left + management question, choose informed decision-making capacity over psychiatric / behavioral.Next best step / managementnext best step vs plausible alternative1highCMS/PSYCH_7A Q81
When they report that he frequently uses his call + management question, choose lorazepam and begin mirtazapine over current regimen for 3 weeks and.Next best step / managementnext best step vs plausible alternative1highCMS/PSYCH_7A Q82
When several benign nevi over upper extremities and upper + diagnosis question, choose illness anxiety disorder over obsessive-compulsive disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q270
When edema and tenderness to palpation behind right + management question, choose medication: antibiotic/antimicr... over referral to urologist.Next best step / managementnext best step vs plausible alternative1highCMS/FM 4A Q15
When palmar erythema and multiple spider angiomata over upper + question, choose 23-valent pneumococcal over haemophi/us inffuenzae type b....Other / unclearcontraindicated therapy vs acceptable therapy1highCMS/FM 4A Q24
When diffuse erythematous macular rash over face trunk + adverse-effect question, choose toxic shock syndrome over infection / inflammation.Adverse effectmedication adverse effect vs disease progression1highNBME_9A Q102
When increased difficulty maintaining rection during sexual + adverse-effect question, choose risperidone therapy over sertraline therapy.Adverse effectmedication adverse effect vs disease progression1highCMS/PSYCH_7A Q161
When lost interest in his usual activities and is + diagnosis question, choose normal-pressure hydrocephalus over frontotemporal dementia.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q491
When onset of headache and light-headedness + screening/prevention question, choose not eating mahimahi over refrigerating cream puff.Screening / preventionscreen now vs reassure1highCMS/Medicine 5A Q47
When 2 f pulse is 130/min and regular respirations + mechanism question, choose impaired thirst over decreased mucociliary clearance.Mechanism / pathophysiologyphysiologic mechanism vs associated condition1highCMS/Medicine 7A Q102
When progressive feelings of anxiety when he + diagnosis question, choose obsessive-compulsive disorder over social anxiety disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q8
When edematous, e!)'lhematous, tender r}qht leg + test-selection question, choose imaging: ultrasound over lab / culture / serology.Diagnostic testnext test vs tempting alternative1highCMS/FM 4A Q20
When patient does not speak english and is accompanied + management question, choose how desires know over treat latent syphilis.Next best step / managementscreen now vs reassure1highCMS/FM 4A Q23
When recent high blood pressure readings + management question, choose cardiovascular medication over cardiovascular medication.Next best step / managementscreen now vs reassure1highCMS/FM 2A Q31
When atypical major depressive disorder treated with + management question, choose phentolamine over psychiatric / behavioral.Next best step / managementcontraindicated therapy vs acceptable therapy1highCMS/PSYCH 4A Q26
When not been able to go to school and + diagnosis question, choose acute stress disorder over post-traumatic stress disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q46
When 4°f), pulse is 78/min, respirations are 20/min + question, choose luteinizing hormone over follicle-stimulating hormone.Other / unclearkeyed answer vs tempting distractor1highNBME_12A Q98
When 0 f pulse 120/min and irregularly irregular respirations + test-selection question, choose ecg over imaging: ultrasound.Diagnostic teststabilize now vs test first1highNBME_9A Q99
When she was restrained front- seat passenger in car + diagnosis question, choose conversion disorder over subdural hematoma.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q21
When difficulty concentrating + diagnosis question, choose adjustment disorder with anxiety over major depressive disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH 6A Q4
When sweaty hands and racing pulse + diagnosis question, choose social anxiety disorder over obsessive-compulsive disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q14
When she is employed as receptionist at local accounting + diagnosis question, choose bipolar disorder over schizophrenia.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q36
When no evidence of hallucinations + diagnosis question, choose brief psychotic disorder over delusional disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q30
When adnexal or ovarian mass + test-selection question, choose procedure: surgery over lab / culture / serology.Diagnostic testnext test vs tempting alternative1highCMS/OBGYN 6A Q47
When serum studies show ast activity of 247 u/l + mechanism question, choose cytomegalovirus over rubella virus.Mechanism / pathophysiologyphysiologic mechanism vs associated condition1highCMS/OBGYN_7A Q47
When positive ppd skin test at a + management question, choose treatment or latent tuberculosi... over imaging.Next best step / managementscreen now vs reassure1highCMS/FM 4A Q21
When hypertension for which he takes amlodipine + diagnosis question, choose delirium over alcohol withdrawal.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q37
When y 39 a42 yearold wom is brought to + diagnosis question, choose delusional disorder over schizophrenia.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q39
When cardiomegaly, cephalization of blood now + question, choose cardiovascular medication over digitalis.Prognosiskeyed answer vs tempting distractor1highCMS/FM 4A Q27
When boyfriend's need for privacy + diagnosis question, choose bipolar disorder, manic over schizophrenia.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q60
When bupropion until 7 months ago + diagnosis question, choose bipolar disorder over cyclothymic disorder.Diagnosisdiagnosis vs mimic1highCMS/PSYCH_7A Q22
When 1-to 2-cm bilateral subpleural densities + diagnosis question, choose asbestosis over sarcoidosis.Diagnosisdiagnosis vs mimic1highNBME_9A Q98
When vaginal bleeding + interpretation question, choose testosterone over follicle-stimulating hormone.Interpretation of lab/imagingkeyed answer vs tempting distractor1highCMS/OBGYN_7A Q37
When pelvic exam: small friable lesion on cervix + management question, choose imaging over imaging.Next best step / managementscreen now vs reassure1highCMS/OBGYN_7A Q34
When no family cancer + question, choose exercising and reducing her cal... over alcohol cessation.Other / unclearcontraindicated therapy vs acceptable therapy1highCMS/FM 5A Q1
When urinalysis is positive for bile + diagnosis question, choose cholangitis over cholecystitis.Diagnosisdiagnosis vs mimic1highCMS/Surgery 8A Q103
When connective tissue + test-selection question, choose imaging over lab: serology/antibody.Diagnostic testnext test vs tempting alternative1highNBME_9A Q27
When sexual dysfunction nightmares + treatment question, choose paroxetine over buspirone.Treatment selectiontreatment choice vs competing therapy1highCMS/PSYCH_7A Q44
When labia majora + diagnosis question, choose neoplasm / malignancy over herpes simplex.Diagnosisdiagnosis vs mimic1highCMS/OBGYN_7A Q44
When item 2 of 2 results of serum lipid + question, choose smoking over weight.Prognosiskeyed answer vs tempting distractor1highCMS/FM 2A Q45
When episodes of sudden anxiety + question, choose imaging over imaging: CT.Other / unclearkeyed answer vs tempting distractor1highCMS/PSYCH_7A Q41
When pulse is 110/min, respirations are 20/min + diagnosis question, choose electrolyte / metabolic over electrolyte / metabolic.Diagnosisstabilize now vs alternate action1mediumCMS/OBGYN_7A Q41

Common Decision Forks

Decision ForkQuestionsExample Refs
diagnosis vs mimic413NBME_10A Q2; NBME_10A Q37; NBME_10A Q8
next best step vs plausible alternative283NBME_10A Q6; NBME_10A Q9; NBME_10A Q16
medication adverse effect vs disease progression190NBME_10A Q38; NBME_10A Q4; NBME_10A Q7
contraindicated therapy vs acceptable therapy186NBME_10A Q30; NBME_10A Q31; NBME_10A Q39
stabilize now vs alternate action178NBME_10A Q15; NBME_10A Q20; NBME_10A Q21
keyed answer vs tempting distractor169NBME_10A Q19; NBME_10A Q32; NBME_10A Q42
physiologic mechanism vs associated condition161NBME_10A Q1; NBME_10A Q27; NBME_12A Q32
next test vs tempting alternative130NBME_10A Q12; NBME_10A Q14; NBME_10A Q34
screen now vs reassure128NBME_10A Q25; NBME_10A Q28; NBME_10A Q36
treatment choice vs competing therapy65NBME_12A Q30; NBME_12A Q49; NBME_13A Q18
stabilize now vs test first55NBME_10A Q11; NBME_10A Q18; NBME_11A Q12
treat/stabilize now vs test first20NBME_12A Q45; NBME_13A Q2; NBME_13A Q49
primary risk factor vs associated factor19NBME_13A Q23; NBME_9A Q15; CMS/FM 2A Q16
acute complication vs baseline disease13NBME_10A Q13; NBME_12A Q44; NBME_13A Q46
test first vs treat now9NBME_14A Q21; NBME_9A Q18; CMS/EM 2A Q6
reassure/observe vs intervene8NBME_15A Q4; CMS/EM 2A Q2; CMS/Neuro 6A Q28
screen/test now vs reassure8CMS/FM 2A Q40; CMS/FM 5A Q3; CMS/FM 5A Q4
treat empirically vs observe4NBME_11A Q6; CMS/FM 3A Q7; CMS/OBGYN 5A Q30

Common Distractor Traps

Distractor TrapQuestionsExample Refs
same decision category as the keyed answer65NBME_10A Q42; NBME_14A Q34; NBME_15A Q23
plausible option in the same choice set9CMS/EM 1A Q43; CMS/EM 2A Q25; CMS/EM 2A Q38
local explanation discusses this option, but no known drug allergies weakens it4NBME_15A Q38; NBME_9A Q3; CMS/EM 1A Q29
local explanation discusses this option, but no change in appetite weakens it3NBME_12A Q5; NBME_9A Q18; CMS/Neuro 7A Q30
local explanation discusses this option, but not smoke cigarettes weakens it3NBME_14A Q18; NBME_15A Q42; CMS/Surgery 4A Q21
local explanation discusses this option, but no murmurs or gallops weakens it3NBME_9A Q13; CMS/Medicine 4A Q39; CMS/Medicine 7A Q40
local explanation discusses this option, but no trauma weakens it3NBME_9A Q16; CMS/PEDS 6A Q28; CMS/Surgery 5A Q13
local explanation discusses this option, but no murmurs weakens it3CMS/EM 2A Q47; CMS/FM 2A Q22; CMS/FM 3A Q11
shares local stem terms: pulmonary3CMS/Medicine 6A Q25; CMS/Medicine 7A Q19; CMS/PEDS 6A Q11
local explanation discusses this option, but no focal findings weakens it3CMS/Medicine 7A Q8; CMS/Neuro 5A Q17; CMS/PYSCH 3A Q14
local explanation discusses this option, but no distress weakens it2NBME_10A Q19; CMS/PEDS 8A Q12
local explanation discusses this option, but no edema weakens it2NBME_11A Q33; NBME_13A Q47
local explanation discusses this option, but without assistance weakens it2NBME_12A Q29; CMS/Neuro 7A Q10
local explanation discusses this option, but not had any other symptoms weakens it2NBME_13A Q21; CMS/Medicine 7A Q42
local explanation discusses this option, but urine toxicology screening is negative weakens it2NBME_14A Q26; CMS/PSYCH_7A Q41
local explanation discusses this option, but no psychiatric illness weakens it2NBME_15A Q4; CMS/PSYCH 6A Q32
local explanation discusses this option, but no guarding weakens it2CMS/EM 1A Q20; CMS/EM 2A Q22
local explanation discusses this option, but not drink alcohol weakens it2CMS/Medicine 4A Q9; CMS/Surgery 5A Q14
local explanation discusses this option, but no lymphadenopathy weakens it2CMS/Medicine 5A Q39; CMS/Surgery 8A Q6
shares local stem terms corpuscular, mean, volume but is weaker because of no red meat2CMS/PEDS 6A Q24; CMS/Peds 4A Q8
local explanation discusses this option, but not drink alcohol or use illicit drugs weakens it2CMS/PSYCH 4A Q27; CMS/PSYCH 5A Q13
local explanation discusses this option, but no seizure disorder weakens it2CMS/PSYCH 4A Q34; CMS/Surgery 4A Q20
local explanation discusses this option, but no proven efficacy in ocd weakens it2CMS/PSYCH 5A Q25; CMS/PSYCH 5A Q35
shares local stem terms benign, cancer, enlarged but is weaker because of no masses are palpated1NBME_10A Q1
shares local stem terms diak-higashi but is weaker because of no adenopathy1NBME_10A Q2

Manual Review Queue

Short references only. Open question_analysis_output/rules/nbme_dissection.csv or question_analysis_output/source_data/questions.csv for full row-level review.

RefConfidenceReason To InspectDecision ForkDecisive Clue
CMS/EM 1A Q1lowparser_warningstabilize now vs alternate actionrespiratory distress
CMS/EM 1A Q10lowparser_warningkeyed answer vs tempting distractorshe understands some english but does not speak
CMS/EM 1A Q11lowparser_warningcontraindicated therapy vs acceptable therapyurine pregnancy test is negative
CMS/EM 1A Q12lowparser_warningmedication adverse effect vs disease progressionlaboratory studies show: leukocyte count serum bilirubin
CMS/EM 1A Q13lowparser_warning; generic_distractor_contraststabilize now vs alternate actiononly medication is albuterol by metered-dose inhaler
CMS/EM 1A Q14lowparser_warningcontraindicated therapy vs acceptable therapyno cervical motion tenderness
CMS/EM 1A Q15lowparser_warningnext best step vs plausible alternativetenderness palpation
CMS/EM 1A Q16lowparser_warningscreen now vs reassureshe was bitten on right forearm by another
CMS/EM 1A Q17lowparser_warningstabilize now vs alternate actiongeneralized weakness and fatigue
CMS/EM 1A Q18lowparser_warningstabilize now vs alternate actiondiaphoresis excessive lacrimation and 2-mm pupils that
CMS/EM 1A Q19lowparser_warningstabilize now vs alternate actionno jugular venous distention or lower extremity edema
CMS/EM 1A Q2lowparser_warningstabilize now vs alternate actionnasal congestion and sneezing
CMS/EM 1A Q20lowparser_warningnext test vs tempting alternative3-dlay nausea, decreased appetite
CMS/EM 1A Q21lowparser_warningdiagnosis vs mimic4-hour pain in her left leg after
CMS/EM 1A Q22lowparser_warningcontraindicated therapy vs acceptable therapymajor depressive disorder treated with fluoxetine
CMS/EM 1A Q23lowparser_warning; generic_distractor_contrastphysiologic mechanism vs associated conditionsunken anterior fontanel and dry mucous membranes
CMS/EM 1A Q24lowparser_warningnext best step vs plausible alternativetemperature is 38
CMS/EM 1A Q25lowparser_warningcontraindicated therapy vs acceptable therapyno rebound tenderness or guarding
CMS/EM 1A Q26lowparser_warningnext test vs tempting alternative1-hour nausea and sharp
CMS/EM 1A Q27lowparser_warningstabilize now vs alternate actiontemperature is 40
CMS/EM 1A Q28lowparser_warningnext best step vs plausible alternativemultiple loops of distended small bowel with air-fluid
CMS/EM 1A Q29lowparser_warningnext test vs tempting alternativehad occasional loose stools but does not report
CMS/EM 1A Q3lowparser_warningphysiologic mechanism vs associated conditioncan of gasoline exploded 5 feet from him
CMS/EM 1A Q30lowparser_warningdiagnosis vs mimicmild narrowing of right palpebral fissure
CMS/EM 1A Q32lowparser_warningstabilize now vs alternate actionglucose abnormality
CMS/EM 1A Q33lowparser_warningnext best step vs plausible alternativetenderness and swelling of right elbow but no
CMS/EM 1A Q34lowparser_warningphysiologic mechanism vs associated conditionno horizontal eye movements spontaneously or on doll
CMS/EM 1A Q35lowparser_warningstabilize now vs alternate actionpulse is 130/min, respirations are 28/min
CMS/EM 1A Q36lowparser_warningnext test vs tempting alternativetenderness over lumbar paraspinal muscles on palpation
CMS/EM 1A Q38lowparser_warningstabilize now vs alternate actionpulmonary emboli
CMS/EM 1A Q39lowparser_warningmedication adverse effect vs disease progressionrespiratory distress
CMS/EM 1A Q4lowparser_warningtreatment choice vs competing therapyglucose abnormality
CMS/EM 1A Q40lowparser_warning; generic_distractor_contraststabilize now vs alternate action2 mg/dl 106 1 mol/l ecg shows sinus
CMS/EM 1A Q42lowparser_warning; missing_disqualifying_cluenext best step vs plausible alternativeprogressive redness and swelling of his right knee
CMS/EM 1A Q43lowparser_warning; missing_disqualifying_clue; generic_distractor_contraststabilize now vs test firstmedications are metformin and insulin
CMS/EM 1A Q44lowparser_warningnext test vs tempting alternativeno ulcers
CMS/EM 1A Q45lowparser_warningnext best step vs plausible alternativeno seizures
CMS/EM 1A Q46lowparser_warningstabilize now vs test firstrespiratory distress
CMS/EM 1A Q48lowparser_warningstabilize now vs alternate actionno exit wound
CMS/EM 1A Q49lowparser_warningnext best step vs plausible alternativeno palpable pulses distal to femoral artery
CMS/EM 1A Q5lowparser_warning; generic_distractor_contrasttreatment choice vs competing therapyhypertension treated with hydrochlorothiazide and low back
CMS/EM 1A Q50lowparser_warningstabilize now vs alternate actionswelling, discoloration
CMS/EM 1A Q6lowparser_warningnext best step vs plausible alternativeno known drug allergies
CMS/EM 1A Q7lowparser_warningnext best step vs plausible alternativesystolic murmur
CMS/EM 1A Q8lowparser_warningstabilize now vs alternate actionshe fell off sailboat into freshwater lake
CMS/EM 1A Q9lowparser_warningstabilize now vs alternate actionglucose abnormality
CMS/EM 2A Q1lowparser_warningstabilize now vs test firstecg shows sinus tachycardia and st-segment elevations throughout
CMS/EM 2A Q10lowparser_warningtreat/stabilize now vs test firstjumping from third-story apartment window in suicide attempt
CMS/EM 2A Q11lowparser_warningtest first vs treat nowswollen erythematous
CMS/EM 2A Q12lowparser_warningnext test vs tempting alternativenot had fever trauma to head or sensitivity