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The dataset generation failed because of a cast error
Error code: DatasetGenerationCastError
Exception: DatasetGenerationCastError
Message: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 5 new columns ({'question', 'options', 'image', 'image_url', 'no'}) and 3 missing columns ({'step2', 'step1', 'step3'}).
This happened while the json dataset builder was generating data using
hf://datasets/medalpaca/medical_meadow_usmle_self_assessment/step1.json (at revision 447bb42f9948bc95a9536b22432f8f7eea45f499)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)
Traceback: Traceback (most recent call last):
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 2011, in _prepare_split_single
writer.write_table(table)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/arrow_writer.py", line 585, in write_table
pa_table = table_cast(pa_table, self._schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2302, in table_cast
return cast_table_to_schema(table, schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2256, in cast_table_to_schema
raise CastError(
datasets.table.CastError: Couldn't cast
question: string
options: struct<A: string, B: string, C: string, D: string, E: string, F: string, G: string, H: string, I: string>
child 0, A: string
child 1, B: string
child 2, C: string
child 3, D: string
child 4, E: string
child 5, F: string
child 6, G: string
child 7, H: string
child 8, I: string
image: string
image_url: string
no: int64
to
{'step1': Sequence(feature=Value(dtype='int64', id=None), length=-1, id=None), 'step2': Sequence(feature=Value(dtype='int64', id=None), length=-1, id=None), 'step3': Sequence(feature=Value(dtype='int64', id=None), length=-1, id=None)}
because column names don't match
During handling of the above exception, another exception occurred:
Traceback (most recent call last):
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1321, in compute_config_parquet_and_info_response
parquet_operations = convert_to_parquet(builder)
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 935, in convert_to_parquet
builder.download_and_prepare(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1027, in download_and_prepare
self._download_and_prepare(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1122, in _download_and_prepare
self._prepare_split(split_generator, **prepare_split_kwargs)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1882, in _prepare_split
for job_id, done, content in self._prepare_split_single(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 2013, in _prepare_split_single
raise DatasetGenerationCastError.from_cast_error(
datasets.exceptions.DatasetGenerationCastError: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 5 new columns ({'question', 'options', 'image', 'image_url', 'no'}) and 3 missing columns ({'step2', 'step1', 'step3'}).
This happened while the json dataset builder was generating data using
hf://datasets/medalpaca/medical_meadow_usmle_self_assessment/step1.json (at revision 447bb42f9948bc95a9536b22432f8f7eea45f499)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)Need help to make the dataset viewer work? Make sure to review how to configure the dataset viewer, and open a discussion for direct support.
step1 sequence | step2 sequence | step3 sequence | image_url null | image null | no int64 | options dict | question string |
|---|---|---|---|---|---|---|---|
[
4,
7,
9,
11,
18,
21,
30,
32,
34,
36,
40,
42,
44,
47,
53,
56,
62,
68,
77,
80,
85,
88,
89,
100,
105,
113,
114
] | [
25,
26,
33,
53,
60,
76,
80,
87,
107,
114
] | [
5,
21,
34,
41,
63,
66,
67,
88,
96,
102,
113,
118,
130
] | null | null | null | null | null |
null | null | null | null | null | 1 | {
"A": "105-155",
"B": "120-140",
"C": "125-135",
"D": "128-132",
"E": "129-131",
"F": null,
"G": null,
"H": null,
"I": null
} | Serum LDL-cholesterol concentrations are measured in blood samples collected from 25 healthy volunteers. The data follow a normal distribution. The mean and standard deviation for this group are 130 mg/dL and 25 mg/dL, respectively. The standard error of the mean is 5.0. With a 95% confidence level, the true mean for t... |
null | null | null | null | null | 2 | {
"A": "Acute inflammation",
"B": "Fibrinous exudate",
"C": "Fibrous scar",
"D": "Granulation tissue",
"E": "Normal kidney",
"F": null,
"G": null,
"H": null,
"I": null
} | A 48-year-old man dies suddenly of a cardiac arrhythmia. Six weeks ago, he was resuscitated from a cardiac arrest caused by coronary artery disease and developed oliguric renal failure. Five weeks ago (1 week after being resuscitated), his serum urea nitrogen (BUN) concentration was 40 mg/dL, his serum creatinine conce... |
null | null | null | null | null | 3 | {
"A": "5500–9500/mm3",
"B": "<6500/mm3 or >8500/mm3",
"C": "6500–8500/mm3",
"D": "<7500/mm3",
"E": ">9500/mm3",
"F": null,
"G": null,
"H": null,
"I": null
} | In a sample of 100 individuals, the mean leukocyte count is 7500/mm3, with a standard deviation of 1000/mm3. If the leukocyte counts in this population follow a normal (gaussian) distribution, approximately 50% of individuals will have which of the following total leukocyte counts? |
null | null | null | null | null | 4 | {
"A": "Candida albicans",
"B": "Chlamydia trachomatis",
"C": "Herpes simplex virus",
"D": "Human papillomavirus",
"E": "Trichomonas vaginalis",
"F": null,
"G": null,
"H": null,
"I": null
} | A 55-year-old woman comes to the clinic because of a 2-month history of increasingly severe vaginal pain and itching during sexual intercourse. She avoids intercourse with her husband because of the symptoms. She has been in a monogamous relationship with her husband for the past 25 years. She has type 2 diabetes melli... |
null | null | null | null | null | 5 | {
"A": "Asthma",
"B": "Bronchiectasis",
"C": "Chronic pulmonary fibrosis",
"D": "Cystic fibrosis",
"E": "Emphysema",
"F": null,
"G": null,
"H": null,
"I": null
} | A 39-year-old man comes to the physician because of a 6-month history of progressive shortness of breath. He has had a cough productive of white sputum for 2 years. He smoked 1 pack of cigarettes daily for 16 years but quit 10 years ago. He is in mild respiratory distress with pursed lips and a barrel chest; he is usin... |
null | null | null | null | null | 6 | {
"A": "Bipolar disorder, manic, with psychotic features",
"B": "Brief psychotic disorder",
"C": "Delusional disorder",
"D": "Psychotic disorder due to general medical condition",
"E": "Schizophrenia",
"F": null,
"G": null,
"H": null,
"I": null
} | A previously healthy 33-year-old woman is brought to the emergency department by the Secret Service for stalking the president of the USA for 2 months. She claims to be married to the president's twin brother and states that the president just had his twin kidnapped to avoid competition. She speaks rapidly and is diffi... |
null | null | null | null | null | 7 | {
"A": "Antigen recognition",
"B": "Apoptosis of activated lymphocytes",
"C": "B-lymphocyte expansion",
"D": "Macrophage phagocytosis",
"E": "T-lymphocyte activation",
"F": null,
"G": null,
"H": null,
"I": null
} | During an experiment, a mouse is vaccinated with live attenuated bacteria at two different times. The results following immunization are shown in the graph. The subject's serum total antibody concentration (Y-axis) was measured at various time points (X-axis). The response to the first immunization is indicated by Peak... |
null | null | null | null | null | 8 | {
"A": "Magnesium",
"B": "Vitamin A",
"C": "Vitamin B12 (cobalamin)",
"D": "Vitamin C",
"E": "Zinc",
"F": null,
"G": null,
"H": null,
"I": null
} | A 53-year-old man comes to the physician because of a dry scaly rash on his body for the past year. He has had a 15-kg (33-lb) weight loss during the past year. He is 178 cm (5 ft 10 in) tall and now weighs 54 kg (120 lb); BMI is 17 kg/m2. His stools have a large volume and float. Which of the following nutrient defici... |
null | null | null | null | null | 9 | {
"A": "↑ ↑",
"B": "↑ no change",
"C": "↑ ↓",
"D": "No change ↑",
"E": "No change no change",
"F": "No change ↓",
"G": "↓ ↑",
"H": "↓ no change",
"I": "↓ ↓"
} | In screening for prostate cancer, the current serum prostate-specific antigen concentration at which biopsy is recommended is 4.1 ng/mL. If the threshold for recommending a biopsy procedure were lowered to 2.0 ng/mL, which of the following changes would occur to the positive and negative predictive values of the test? |
null | null | null | null | null | 10 | {
"A": "Allowing the couple's primary care physician to discuss most of the information with them",
"B": "Allowing the parents time to tell other family members",
"C": "Delaying parental distress until the information is completely disclosed",
"D": "Disclosing the most important information so that it can be un... | In informing a couple that their newborn has Down syndrome, there is a specific, relatively limited amount of information that the consulting physician should give immediately. The rest can be discussed at a later time. Which of the following best explains the purpose of using this approach to disclosure? |
null | null | null | null | null | 11 | {
"A": "A",
"B": "B",
"C": "C",
"D": "D",
"E": "E",
"F": "F",
"G": "G",
"H": "H",
"I": "I"
} | A 25-year-old man volunteers to participate in a study of exercise. The solid curves in the graph show the relationship between right atrial pressure and cardiac output (cardiac function curves). The dashed lines show the relationship between cardiac output and right atrial pressure (vascular function curves). Point X ... |
null | null | null | null | null | 12 | {
"A": "Activation of the α1-adrenergic receptor",
"B": "Conversion of testosterone to dihydrotestosterone",
"C": "Conversion of testosterone to estradiol",
"D": "Inhibition of the α1-adrenergic receptor",
"E": "Production of prostate-specific antigen",
"F": null,
"G": null,
"H": null,
"I": null
} | A 62-year-old man comes to the physician because of a 6-month history of urinary hesitancy and dribbling after urination. He has to urinate two to three times nightly. Physical examination shows a diffusely enlarged, firm, and nontender prostate. Which of the following is most likely to have contributed to the developm... |
null | null | null | null | null | 13 | {
"A": "Decreased hepatic secretion of lecithin",
"B": "Decreased reabsorption of bile salts",
"C": "High ratio of cholesterol to bile acids in bile",
"D": "Infestation with parasites secreting β-glucuronidase",
"E": "Overload of unconjugated bilirubin",
"F": null,
"G": null,
"H": null,
"I": null
} | An 18-year-old woman with sickle cell disease is brought to the emergency department by her parents because of a 2-hour history of severe abdominal pain and nausea. Her parents say that she had a cheeseburger, milk shake, and chocolate bar for lunch. Her temperature is 37°C (98.6°F). Physical examination shows tenderne... |
null | null | null | null | null | 14 | {
"A": "Apo B48",
"B": "Apo C",
"C": "HMG-CoA reductase activity",
"D": "LDL receptor",
"E": "Lipoprotein lipase activity",
"F": null,
"G": null,
"H": null,
"I": null
} | A 45-year-old man is brought to the emergency department 30 minutes after the sudden onset of crushing chest pain. His father, maternal aunt, and paternal uncle all died of myocardial infarctions under the age of 50 years. Physical examination shows tendinous xanthomas on the hands and thickened Achilles tendons. Serum... |
null | null | null | null | null | 15 | {
"A": "Caspase activation",
"B": "Decreased cytochrome c concentration",
"C": "Decreased intracellular Ca2+ concentration",
"D": "Increased glutathione peroxidase activity",
"E": "Increased lysosomal enzyme activity",
"F": null,
"G": null,
"H": null,
"I": null
} | An experimental animal is created in which the germinal centers of the reactive lymph nodes show shrinkage of cells, cytoplasmic budding, no adjacent inflammation, and intact plasma membranes. These cellular findings are most likely caused by which of the following mechanisms? |
null | null | null | null | null | 16 | {
"A": "Greater chance of a Type I error",
"B": "Greater chance of a Type II error",
"C": "Less chance of a Type I error",
"D": "Less chance of a Type II error",
"E": "Impossible to predict",
"F": null,
"G": null,
"H": null,
"I": null
} | Investigators conduct a study that evaluates the effect of finasteride on the incidence of prostate cancer in 500 patients. The investigators recruit an additional 1000 patients for the study. Which of the following effects will this have on the research study? |
null | null | null | null | null | 17 | {
"A": "Astrocytes",
"B": "Ependymal cells",
"C": "Fibroblasts",
"D": "Microglial cells",
"E": "Oligodendrocytes",
"F": null,
"G": null,
"H": null,
"I": null
} | A 76-year-old man dies of a massive cerebral infarction shortly after admission to the hospital. During the past 10 years, he has had several smaller cerebral infarctions and two transient ischemic attacks. Examination of a cerebral cortex specimen obtained at autopsy shows extensive gliosis. This finding is most likel... |
null | null | null | null | null | 18 | {
"A": "W → X",
"B": "W → Y",
"C": "W → Z",
"D": "X → W",
"E": "X → Y",
"F": "X → Z",
"G": "Z → W",
"H": "Z → X",
"I": "Z → Y"
} | A 65-year-old woman is brought to the emergency department because of a 10-minute history of chest tightness and severe pain of her left arm. Physical examination shows jugular venous distention. Crackles are heard over the lung fields. An ECG shows ST-segment elevation greater than 1 mm in leads V4 through V6 and new ... |
null | null | null | null | null | 19 | {
"A": "Calcitriol production by activated macrophages",
"B": "Local resorption of bone by metastases",
"C": "Parathyroid hormone-related peptide secretion",
"D": "Secretion of parathyroid hormone",
"E": "Secretion of thyroid-stimulating hormone",
"F": null,
"G": null,
"H": null,
"I": null
} | A previously healthy 52-year-old woman comes to the physician because of a 2-month history of fatigue, constipation, and frequent urination. Her temperature is 37.1°C (98.8°F), pulse is 80/min, respirations are 14/min, and blood pressure is 140/90 mm Hg. Diffuse crackles are heard bilaterally. Her serum calcium concent... |
null | null | null | null | null | 20 | {
"A": "Aromatic L-amino acid decarboxylase",
"B": "Dopamine β-hydroxylase",
"C": "Monoamine oxidase B",
"D": "Phenylethanolamine N-methyltransferase",
"E": "Tyrosine hydroxylase",
"F": null,
"G": null,
"H": null,
"I": null
} | A 66-year-old man who was recently diagnosed with Parkinson disease comes to the physician for a follow-up examination. Carbidopa-levodopa therapy was initiated at the time of diagnosis. The patient tells the physician that he still has episodes during which he "freezes."He has a clumsy gait, and there is rigidity of h... |
null | null | null | null | null | 21 | {
"A": "Epinephrine Without Doxazosin Increased cAMP/Epinephrine With Doxazosin decreased cAMP",
"B": "Epinephrine Without Doxazosin Increased cAMP/Epinephrine With Doxazosin decreased cGMP",
"C": "Epinephrine Without Doxazosin Increased cGMP/Epinephrine With Doxazosin decreased cAMP",
"D": "Epinephrine Without... | A study is conducted to assess the effects of epinephrine on total peripheral resistance. An anesthetized experimental animal is injected with a bolus of the drug in both the presence and absence of doxazosin. The results are shown in the graph. Which of the following best represents the signal transduction pathways us... |
null | null | null | null | null | 22 | {
"A": "Leiomyomata uteri",
"B": "Perimenopause",
"C": "Pregnancy",
"D": "Sexual intercourse",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | A 46-year-old woman comes to the physician because of a 3-day history of intermittent pain with urination and increased urinary frequency. She says that she had one similar episode during the past 6 months. She also has had irregular menses, and her last menstrual period occurred 2 months ago. She has not had fever, na... |
null | null | null | null | null | 23 | {
"A": "Change in laundry detergent",
"B": "Exposure to chemicals during motorcycle repair",
"C": "Handling pigeons",
"D": "Pesticide exposure",
"E": "Use of latex gloves",
"F": null,
"G": null,
"H": null,
"I": null
} | A 28-year-old man comes to the physician because of a 2-month history of a rash on his wrists and hands. He is a first-year mortuary science student. He also works on his grandfather's farm each weekend. His hobbies include raising homing pigeons and repairing vintage motorcycles. He recently changed to a different typ... |
null | null | null | null | null | 24 | {
"A": "Adenovirus",
"B": "Enterovirus",
"C": "Herpes simplex virus",
"D": "Neisseria meningitidis",
"E": "Streptococcus pneumoniae",
"F": null,
"G": null,
"H": null,
"I": null
} | A 10-year-old boy is brought to the emergency department in the middle of summer because of fever, headache, and photophobia. Several of his camp mates have had a similar illness. Physical examination shows mild nuchal rigidity. A lumbar puncture is performed. Laboratory studies show: Serum glucose 90 mg/dL Cerebrospin... |
null | null | null | null | null | 25 | {
"A": "Carotid Sinus Baroreceptor Activity ↑ Atrial Stretch Receptor Activity ↑ Vagal Efferent Activity to the Heart ↑",
"B": "Carotid Sinus Baroreceptor Activity ↑ Atrial Stretch Receptor Activity ↑ Vagal Efferent Activity to the Heart ↓",
"C": "Carotid Sinus Baroreceptor Activity ↑ Atrial Stretch Receptor Acti... | 25. A healthy 30-year-old woman participates in a study of the relationship between cardiovascular function and posture. Placed in a room with a comfortable temperature (72°F) and humidity (40%), she moves from a standing to a supine position. Which of the following sets of changes is most likely in the reflex control ... |
null | null | null | null | null | 26 | {
"A": "From the size of the folder you brought, it looks like you've had very thorough examinations in the past.",
"B": "I don't have much experience with chronic fatigue syndrome, but I'm committed to learning as much as I can about it.",
"C": "I'm not familiar with chronic fatigue syndrome, except that many ph... | A 31-year-old woman with a 5-year history of fatigue comes to the physician for an initial visit. She has seen four other physicians for the same condition within the past 6 months, but no abnormalities were found. She gives the physician a large folder that contains her medical records. She says, "I can barely get out... |
null | null | null | null | null | 27 | {
"A": "Biliary atresia",
"B": "Crigler-Najjar syndrome, type I",
"C": "Gilbert syndrome",
"D": "Hemolytic disease of the newborn",
"E": "Physiologic jaundice",
"F": null,
"G": null,
"H": null,
"I": null
} | A 3-week-old girl delivered at term with no complications is brought to the physician by her mother because of a 1- week history of yellow eyes and skin, tan-colored stools, and dark brown urine. The newborn has been breast-feeding without difficulty. She is alert and appears to be in no distress. She is at the 50th pe... |
null | null | null | null | null | 28 | {
"A": "Atherosclerosis",
"B": "Congenital renal artery hypoplasia",
"C": "Fibromuscular dysplasia",
"D": "Takayasu arteritis",
"E": "Temporal arteritis",
"F": null,
"G": null,
"H": null,
"I": null
} | A 65-year-old woman comes to the physician for a follow-up examination after blood pressure measurements were 175/105 mm Hg and 185/110 mm Hg 1 and 3 weeks ago, respectively. She has well-controlled type 2 diabetes mellitus. Her blood pressure now is 175/110 mm Hg. Physical examination shows no other abnormalities. Ant... |
null | null | null | null | null | 29 | {
"A": "Higher LDL concentrations are associated with higher hs-CRP concentrations",
"B": "Higher LDL concentrations are associated with lower hs-CRP concentrations",
"C": "Higher LDL concentrations cause higher hs-CRP concentrations",
"D": "Higher LDL concentrations cause lower hs-CRP concentrations",
"E": n... | Results of a study that examined the impact of risk factors on cardiovascular health are being evaluated. In the study, serum LDL-cholesterol (LDL) concentration is found to have a correlation of 0.6 with serum high-sensitivity C- reactive protein (hs-CRP) concentration. Which of the following statements best describes... |
null | null | null | null | null | 30 | {
"A": "Drug X is more potent than Drugs Y or Z",
"B": "Drug X has greater efficacy than Drugs Y or Z",
"C": "Drug Y is more potent than Drugs X or Z",
"D": "Drug Y has greater efficacy than Drugs X or Z",
"E": "Drug Z is more potent than Drugs X or Y",
"F": "Drug Z has greater efficacy than Drugs X or Y",
... | A pharmaceutical company is developing a new bronchodilator agent. The graph shows concentration-response curves for three investigational drugs (Drugs X, Y, and Z), describing their effect on bronchial smooth muscle relaxation. Based on these data, which of the following best describes the relationship among these thr... |
null | null | null | null | null | 31 | {
"A": "Erythroid progenitor",
"B": "Hematopoietic stem",
"C": "Lymphatic progenitor",
"D": "Megakaryocyte progenitor",
"E": "Pluripotent stem",
"F": null,
"G": null,
"H": null,
"I": null
} | A 72-year-old man comes to the physician for a health maintenance examination. He has no personal or family history of major medical illnesses. He has never smoked cigarettes. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows plethoric skin and splenomegaly. Laboratory studies sho... |
null | null | null | null | null | 32 | {
"A": "Defect in secretin production",
"B": "Excessive gastrin production",
"C": "Excessive transient lower esophageal relaxations",
"D": "Failure of primary esophageal peristalsis",
"E": "Failure of saliva production",
"F": null,
"G": null,
"H": null,
"I": null
} | A 45-year-old man comes to the physician because of a 10-year history of heartburn that occurs after he eats late at night or consumes spicy food. He has had no weight loss or difficulty swallowing. He takes over-the-counter antacids as needed, but they relieve his discomfort only temporarily. Physical examination show... |
null | null | null | null | null | 33 | {
"A": "Occupational exposure",
"B": "Substance use",
"C": "Travel",
"D": "Type of home heating",
"E": "Use of over-the-counter medication",
"F": null,
"G": null,
"H": null,
"I": null
} | A 21-year-old man comes to the emergency department in the winter because of headache, nausea, and dizziness for 4 hours. He has not had fever, chills, or shortness of breath. He has no history of major medical illness. He lives in a basement apartment of a three-story house. He smokes 1½ packs of cigarettes daily. Phy... |
null | null | null | null | null | 34 | {
"A": "Bladder neck",
"B": "Mid ureter",
"C": "Renal calyx",
"D": "Ureteropelvic junction",
"E": "Ureterovesical junction",
"F": null,
"G": null,
"H": null,
"I": null
} | A 56-year-old woman comes to the physician because of a 2-year history of recurrent urinary tract infections accompanied by left flank pain. Physical examination shows no abnormalities. Renal ultrasonography shows left- sided hydronephrosis. A T2-weighted coronal MRI of the abdomen is shown; the arrow indicates the hyd... |
null | null | null | null | null | 35 | {
"A": "Inhibition of estrogen synthesis",
"B": "Inhibition of 11β-hydroxylase activity",
"C": "Inhibition of prostaglandin synthesis",
"D": "Stimulation of follicle-stimulating hormone synthesis",
"E": "Stimulation of luteinizing hormone synthesis",
"F": null,
"G": null,
"H": null,
"I": null
} | A 25-year-old woman comes to the physician because of a long history of pain with menses. The pain occurs on the first day of her 5-day menstrual period and lasts all day. She rates the pain as 10 on a 10-point scale. The most appropriate initial pharmacotherapy to relieve this patient's pain has which of the following... |
null | null | null | null | null | 36 | {
"A": "Folic acid",
"B": "Glucose-6-phosphate dehydrogenase",
"C": "Iron",
"D": "Vitamin B1 (thiamine)",
"E": "Vitamin B6 (pyridoxine)",
"F": null,
"G": null,
"H": null,
"I": null
} | A 35-year-old man is brought to the emergency department 30 minutes after he sustained a cut on his hand while loading cargo at his job. He lives alone and takes most of his meals at a local restaurant. He eats mostly snack foods at the bar and fast food. He drinks four to six 12-oz beers daily and double that amount o... |
null | null | null | null | null | 37 | {
"A": "17α-Hydroxyprogesterone deficiency",
"B": "Increased concentration of müllerian-inhibiting substance",
"C": "Maternal androgen exposure",
"D": "Presence of the sex-determining region Y gene",
"E": "5α-Reductase deficiency",
"F": null,
"G": null,
"H": null,
"I": null
} | A 3800-g (8-lb 6-oz) newborn is delivered vaginally at 39 weeks' gestation after an uncomplicated pregnancy. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. The newborn is crying, has pink skin, and appears vigorous. Physical examination shows a vagina and also a structure that appears to be a penis, with th... |
null | null | null | null | null | 38 | {
"A": "Increased enzyme secretion",
"B": "Increased enzyme synthesis",
"C": "Karyolysis",
"D": "Lysis of the endoplasmic reticulum",
"E": "Lysis of the plasma membrane",
"F": "Mitochondrial swelling",
"G": null,
"H": null,
"I": null
} | A 65-year-old man is admitted to the hospital because of a 12-hour history of chest pain. Physical examination shows no abnormalities. Serum studies show an increased troponin I concentration. The diagnosis of myocardial infarction is made. It is suspected that this patient's condition deteriorated as a result of ische... |
null | null | null | null | null | 39 | {
"A": "(18/1000) – (12/1000)",
"B": "0.85 × (12/1000)",
"C": "0.85 × (18/1000)",
"D": "[0.85 × (18/1000–12/1000)]",
"E": "[(1.2/100) – (1.8/100)]/(1.8/100)",
"F": null,
"G": null,
"H": null,
"I": null
} | A randomized clinical trial is conducted to compare wound healing and cosmetic differences between two surgical procedures for closing skin wounds following cesarean delivery. A total of 1000 women undergoing cesarean delivery during a 6-month period are enrolled in the study, which was 85% of the total number of patie... |
null | null | null | null | null | 40 | {
"A": "Elbow extension",
"B": "Elbow flexion",
"C": "Finger abduction",
"D": "Thumb abduction",
"E": "Wrist flexion",
"F": null,
"G": null,
"H": null,
"I": null
} | A 22-year-old man is brought to the emergency department 15 minutes after diving off a pier into shallow water, striking his forehead on the bottom of the pond. He says that he felt immediate pain in his neck and then lost all ability to move or feel his legs. Physical examination shows that all muscle function above t... |
null | null | null | null | null | 41 | {
"A": "Hyperglycemia caused by increased glucose consumption",
"B": "Hyperglycemia caused by increased glycogen metabolism",
"C": "Hyperglycemia caused by insufficient exogenous insulin",
"D": "Hypoglycemia caused by excess exogenous insulin",
"E": "Hypoglycemia caused by excessive renal glucose loss",
"F"... | A 4-year-old girl with type 1 diabetes mellitus is brought to the emergency department by her father because of a 4- hour episode of restlessness, sweating, and confusion that occurred during the night. Yesterday, he allowed her to eat cupcakes and cotton candy at a county fair. At her bedtime that evening, he increase... |
null | null | null | null | null | 42 | {
"A": "Interventricular septum",
"B": "Left atrium",
"C": "Left ventricle",
"D": "Right atrium",
"E": "Right ventricle",
"F": null,
"G": null,
"H": null,
"I": null
} | A previously healthy 65-year-old woman comes to the physician because of several episodes of fainting during the past 2 months. Each episode lasted several minutes. Her pulse is 82/min, respirations are 20/min, and blood pressure is 135/87 mm Hg. Cardiac examination shows S3 and S4. Echocardiography shows a pedunculate... |
null | null | null | null | null | 43 | {
"A": "1/100",
"B": "1/400",
"C": "1/1000",
"D": "1/4000",
"E": "1/10,000",
"F": null,
"G": null,
"H": null,
"I": null
} | A male newborn is delivered at term to a 28-year-old primigravid woman. Physical examination shows a broad, flat nose; low-set ears; a receding chin; prominent infraorbital folds; and bilateral abdominal masses. The newborn develops cyanosis, difficulty breathing, and polyuria and dies 24 hours after birth. At autopsy,... |
null | null | null | null | null | 44 | {
"A": "Cortical thinning",
"B": "Degenerative changes of the cartilage",
"C": "Inflammation of digital tendons",
"D": "Neutrophilic infiltration of the synovium",
"E": "Thickening of the synovium with pannus",
"F": null,
"G": null,
"H": null,
"I": null
} | A 75-year-old woman comes to the physician because of a 3-year history of pain in her wrists and hands. She says that the pain has become more severe during the past 3 months. She has difficulty buttoning her coat because of the pain. Physical examination shows the findings in the photograph. Which of the following add... |
null | null | null | null | null | 45 | {
"A": "Bile salt metabolism",
"B": "Cholesterol metabolism",
"C": "Cytochrome P450 activity",
"D": "Purine metabolism",
"E": "Urea cycle",
"F": null,
"G": null,
"H": null,
"I": null
} | A previously healthy 64-year-old man is brought to the emergency department 3 hours after the sudden onset of severe flank pain. He has no history of similar pain or serious illness. He takes no medications. He appears to be in distress. His pulse is 100/min, and blood pressure is 168/92 mm Hg. Physical examination sho... |
null | null | null | null | null | 46 | {
"A": "Decreased absorption",
"B": "Decreased distribution",
"C": "Decreased elimination",
"D": "Increased distribution",
"E": "Increased elimination",
"F": "Increased metabolism",
"G": null,
"H": null,
"I": null
} | A 32-year-old woman with hypothyroidism comes to the physician because of a 6-week history of cold intolerance, constipation, and severe fatigue. She also has had a 4.5-kg (10-lb) weight gain during this period. Her current medication is daily levothyroxine. She also started taking calcium carbonate supplements 2 month... |
null | null | null | null | null | 47 | {
"A": "Cellular",
"B": "Complement",
"C": "Humoral",
"D": "Phagocytic cell",
"E": "Toll-like receptor",
"F": null,
"G": null,
"H": null,
"I": null
} | A 71-year-old woman comes to the physician because of a 5-day history of a painful rash. The rash began as a burning sensation over the right lower side of her chest. Three days ago, small, flat, painful macules appeared that rapidly progressed to vesicular lesions. During this period, the pain has continually increase... |
null | null | null | null | null | 48 | {
"A": "Adjacent to the ventral pancreas",
"B": "Along the lesser curvature of the stomach",
"C": "At the origin of the celiac vessels",
"D": "In a portion of the hepatic diverticulum",
"E": "Within the dorsal mesogastrium",
"F": null,
"G": null,
"H": null,
"I": null
} | A 19-year-old man undergoes splenectomy because of crush injuries sustained in a motor vehicle collision. During the operation, two small accessory spleens are seen adjacent to the ruptured spleen. The most likely origin of this patient's congenital anomaly is thickening of an embryologic layer at which of the followin... |
null | null | null | null | null | 49 | {
"A": "Blockade of dopamine receptors",
"B": "Decreased activity of dopamine transporters",
"C": "Enhancement of the effect of postsynaptic γ-aminobutyric acid (GABA)",
"D": "Increased GABA transaminase activity",
"E": "Inhibition of glutamate release",
"F": "Inhibition of serotonin reuptake",
"G": "Open... | A 48-year-old man comes to the physician requesting treatment for alcohol withdrawal. He reports a 30-year history of consuming 6 to 10 beers daily. He has had two citations for driving while intoxicated. He has previously experienced alcohol-associated seizures and withdrawal symptoms. His vital signs are within norma... |
null | null | null | null | null | 50 | {
"A": "Create an exercise regimen for the patient",
"B": "Explore barriers to diet adherence",
"C": "Increase the patient's insulin dosage",
"D": "Increase the patient's metformin dosage",
"E": "Measure the patient's blood glucose concentration",
"F": "Order measurement of the patient's microalbumin concen... | A 48-year-old woman with type 2 diabetes mellitus comes to the physician for a follow-up examination. Current medications are metformin and once-daily insulin. She travels frequently and works long hours. She says that her meals are usually fast food. She leads a sedentary lifestyle. She often forgets to measure her bl... |
null | null | null | null | null | 51 | {
"A": "Epstein-Barr virus",
"B": "Hepatitis B virus",
"C": "Measles virus",
"D": "Mumps virus",
"E": "Rubella virus",
"F": null,
"G": null,
"H": null,
"I": null
} | A 19-year-old man who is a college freshman comes to the office because of a 4-day history of tender, swollen glands. He also has a 6-day history of fever, malaise, and decreased appetite. His temperature is 38.7°C (101.7°F). Physical examination shows swelling of the parotid glands. Which of the following infectious a... |
null | null | null | null | null | 52 | {
"A": "Bradykinin",
"B": "Histamine",
"C": "Leukotriene B4",
"D": "Nitric oxide",
"E": "Prostaglandin E2",
"F": null,
"G": null,
"H": null,
"I": null
} | A 38-year-old woman who is a veteran comes to the emergency department because of a 4-hour history of a sensation of tightness in her throat and swelling of her face, lips, and tongue. She has not had itching. During the past 3 weeks, she has had two similar, milder episodes that resolved without treatment within 24 to... |
null | null | null | null | null | 53 | {
"A": "Cremasteric artery",
"B": "Pampiniform plexus",
"C": "Testicular artery",
"D": "Testicular vein",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | A 58-year-old man comes to the physician because of a 6-month history of an enlarging mass in his left scrotum. Physical examination shows a soft, nontender, 2-cm mass in the left scrotum inferior to the inguinal canal; the right testis is normal. Scrotal ultrasonography is done; longitudinal color Doppler images throu... |
null | null | null | null | null | 54 | {
"A": "Nondisjunction",
"B": "Recombination",
"C": "Sister chromatid exchange",
"D": "Telomere breakage",
"E": "Transposon insertion",
"F": null,
"G": null,
"H": null,
"I": null
} | A 48-year-old woman comes to the physician because of a 2-month history of fatigue and poor appetite; she has had a 3-kg (6.6-lb) weight loss during this period. Abdominal examination shows moderate splenomegaly. Laboratory studies show a leukocyte count of 185,000/mm3 (65% segmented neutrophils with 6% blasts and prom... |
null | null | null | null | null | 55 | {
"A": "Bicarbonate",
"B": "Gastric acid",
"C": "Glucagon",
"D": "Insulin",
"E": "Intrinsic factor",
"F": null,
"G": null,
"H": null,
"I": null
} | A 2-year-old boy is brought to the physician because of failure to thrive. He also has had loose, fatty, foul-smelling stools and a cough during the past 2 weeks. He is at the 30th percentile for height and 10th percentile for weight. Physical examination shows no other abnormalities. Laboratory studies show steatorrhe... |
null | null | null | null | null | 56 | {
"A": "Elbow extension",
"B": "Finger abduction",
"C": "Shoulder abduction",
"D": "Thumb flexion",
"E": "Wrist flexion",
"F": null,
"G": null,
"H": null,
"I": null
} | A 19-year-old man is admitted to the hospital 1 hour after he was involved in a motor vehicle collision in which he sustained fractures to the right clavicle, multiple ribs, and the left hip. He was traveling at 40 mph when he was thrown from his motorcycle and struck a tree. He did not lose consciousness. He has no hi... |
null | null | null | null | null | 57 | {
"A": "Factor VII (proconvertin)",
"B": "Fibrinogen",
"C": "Glycoprotein IIb-IIIa",
"D": "Granule storage pool",
"E": "von Willebrand factor",
"F": null,
"G": null,
"H": null,
"I": null
} | A 10-year-old boy is brought to the physician because of a 3-week history of nosebleeds and easy bruisability. His older brother has had similar episodes. He is at the 30th percentile for height and weight. Physical examination shows nasal and gingival bleeding and several ecchymoses over the trunk and upper and lower ... |
null | null | null | null | null | 58 | {
"A": "Height of P waves in lead I of the patient's ECG",
"B": "Height of R waves in lead V1 of the patient's ECG",
"C": "Hematocrit",
"D": "Pulmonary vascular resistance",
"E": "Right ventricular diastolic compliance",
"F": "Right ventricular wall thickness",
"G": null,
"H": null,
"I": null
} | A previously healthy 45-year-old woman who works as a park ranger comes to the physician because of a 1-week history of shortness of breath, even at rest. She has lived in the mountains at 10,000 feet above sea level for 2 years; the physician’s office is located at sea level. Her pulse is 85/min, respirations are 18/m... |
null | null | null | null | null | 59 | {
"A": "ATP",
"B": "Folic acid",
"C": "Peptidoglycan",
"D": "Protein",
"E": "RNA",
"F": null,
"G": null,
"H": null,
"I": null
} | A 25-year-old woman comes to the physician because of a 4-month history of cough and unintentional weight loss. Rhonchi are heard posteriorly over the right upper thorax. A chest x-ray shows an 8-cm cavity in the right upper lobe and hilar lymphadenopathy. Ziehl-Neelsen staining of an induced sputum specimen shows acid... |
null | null | null | null | null | 60 | {
"A": "Coronary",
"B": "Falciform",
"C": "Gastrohepatic",
"D": "Hepatoduodenal",
"E": "Triangular",
"F": null,
"G": null,
"H": null,
"I": null
} | A 34-year-old man is brought to the emergency department 30 minutes after being hit by a motor vehicle while walking. His temperature is 36°C (96.8°F), pulse is 140/min, respirations are 24/min, and blood pressure is 90/60 mm Hg. During an exploratory laparotomy, a large laceration is found that includes the right and ... |
null | null | null | null | null | 61 | {
"A": "Staphylococcus aureus, contaminant",
"B": "Staphylococcus aureus, pathogen",
"C": "Staphylococcus epidermidis, contaminant",
"D": "Staphylococcus epidermidis, pathogen",
"E": "Streptococcus pneumoniae, contaminant",
"F": "Streptococcus pneumoniae, pathogen",
"G": "Streptococcus sanguis, contaminan... | A 1-month-old boy is brought to the emergency department because of a 1-day history of fever and cough. His temperature is 38.2°C (100.8°F), pulse is 140/min, and respirations are 54/min. Physical examination shows intercostal retractions. Wheezes are heard in all lung fields. A blood culture grows coagulase-negative, ... |
null | null | null | null | null | 62 | {
"A": "",
"B": "",
"C": "",
"D": "",
"E": "",
"F": "",
"G": null,
"H": null,
"I": null
} | A study is conducted to determine the effects on humans of replacing a portion of dietary carbohydrates with various fatty acids. The serum concentrations of total cholesterol, LDL-cholesterol, and HDL-cholesterol are measured. For every 1% energy increase in dietary trans-18:1 fatty acid, which of the following sets o... |
null | null | null | null | null | 63 | {
"A": "20 mg/h",
"B": "100 mg/h",
"C": "0.22 L/h",
"D": "2 L/h",
"E": "22 L/h",
"F": null,
"G": null,
"H": null,
"I": null
} | A new drug, Drug X, is being investigated to determine its pharmacokinetic properties in humans. A male participant who weighs 85 kg (187 lb) with 50 L of total body water begins treatment with an intravenous infusion of Drug X at the rate of 100 mg/h. This drug is known to distribute in total body water. The plasma co... |
null | null | null | null | null | 64 | {
"A": "Bowman capsule",
"B": "Glomerulus",
"C": "Interstitium",
"D": "Proximal tubule",
"E": "Renal vein",
"F": null,
"G": null,
"H": null,
"I": null
} | A 78-year-old woman is admitted to the intensive care unit because of diverticulitis complicated by Escherichia coli sepsis. Treatment with ciprofloxacin is started. Three days later, her serum creatinine concentration has increased from 0.7 mg/dL on admission to 1.3 mg/dL. Urinalysis shows muddy brown casts. The most ... |
null | null | null | null | null | 65 | {
"A": "Aspiration pneumonia",
"B": "Guillain-Barré syndrome",
"C": "Insufficient dose of prednisone",
"D": "Motor neuron disease",
"E": "Pyridostigmine overdose",
"F": null,
"G": null,
"H": null,
"I": null
} | A 34-year-old woman with myasthenia gravis comes to the emergency department because of a 2-day history of increasing weakness, shortness of breath, and abdominal cramping. Current medications are prednisone and pyridostigmine. Her temperature is 37°C (98.6°F), pulse is 45/min, and respirations are 25/min and shallow. ... |
null | null | null | null | null | 66 | {
"A": "High Risk for Early Spontaneous Abortions & high Risk for Liveborn Child With Aneuploidy",
"B": "High Risk for Early Spontaneous Abortions & low Risk for Liveborn Child With Aneuploidy",
"C": "Low Risk for Early Spontaneous Abortions & high Risk for Liveborn Child With Aneuploidy",
"D": "Low Risk for Ea... | A 35-year-old woman comes to the office because she has had three first-trimester spontaneous abortions during the past 3 years. Physical examination shows no abnormalities. Laboratory studies show no endocrine abnormalities. Chromosomal analysis shows a paracentric inversion of the long arm of chromosome 1. Which of t... |
null | null | null | null | null | 67 | {
"A": "Analysis of triplet repeat sizes of HTT",
"B": "Full sequencing and rearrangement analysis of APC",
"C": "Full sequencing of HTT",
"D": "Specific testing for the APC frame-shift mutation",
"E": "It is not recommended to do predictive genetic testing on a minor",
"F": null,
"G": null,
"H": null,
... | A 12-year-old boy is brought to the office by his parents for genetic counseling because of a family history of genetic disorders. He has no symptoms or history of major medical illness. The patient’s maternal grandfather died of Huntington disease at the age of 35 years. Genetic testing of the mother showed 19 triplet... |
null | null | null | null | null | 68 | {
"A": "Anti-citrullinated peptide antibody",
"B": "Antimitochondrial antibody assay",
"C": "Human leukocyte antigen-DQ2 antibody assay",
"D": "Precursor of the erythroid cell line",
"E": "Precursor of the thrombopoietic line",
"F": null,
"G": null,
"H": null,
"I": null
} | A 53-year-old woman comes to the office because of a 6-year history of stiffness and pain of her hands. She has difficulty buttoning her clothes because of the symptoms. She takes no medications. Physical examination shows the findings in the photograph. An abnormality of which of the following is most likely to confir... |
null | null | null | null | null | 69 | {
"A": "Decreased intracellular metabolism of biogenic amines",
"B": "Decreased monoamine oxidase activity",
"C": "Decreased presynaptic receptor activation",
"D": "Increased intracellular metabolism of biogenic amines",
"E": "Increased presynaptic receptor activation",
"F": "Increased release of biogenic a... | A 25-year-old man comes to the office because of a 4-hour history of irritability, restlessness, tremor, and palpitations. He is a known user of amphetamines. His pulse is 120/min, respirations are 25/min, and blood pressure is 150/100 mm Hg. Physical examination shows no abnormalities. The most likely cause of this pa... |
null | null | null | null | null | 70 | {
"A": "Campylobacter jejuni",
"B": "Escherichia coli",
"C": "Rotavirus",
"D": "Salmonella enterica serovar enteritidis",
"E": "Yersinia pestis",
"F": null,
"G": null,
"H": null,
"I": null
} | A 5-year-old girl is brought to the office by her mother because of a 6-hour history of bloody diarrhea. She is interactive and in no acute distress. Her blood pressure is 90/55 mm Hg. Abdominal examination shows normoactive bowel sounds. Stool cultures are obtained, and the patient's mother is advised to give the girl... |
null | null | null | null | null | 71 | {
"A": "Allow the patient's husband to serve as an interpreter",
"B": "Consult the hospital ethics committee",
"C": "Explain to the husband that information cannot be provided until the hospital interpreter arrives in the morning",
"D": "Use a telephone interpreter service",
"E": null,
"F": null,
"G": nul... | A 78-year-old woman is admitted to the hospital because of a 1-week history of jaundice. CT scan of the abdomen shows a mass suggestive of pancreatic cancer. Three hours later, the on-call physician enters the patient's room to discuss the prognosis and obtain consent for a biopsy scheduled for the next morning. On ent... |
null | null | null | null | null | 72 | {
"A": "Deficiency of terminal complement",
"B": "Hypogammaglobulinemia",
"C": "Impaired T-lymphocyte function",
"D": "Inhibition of tumor necrosis factor α function",
"E": "Neutropenia",
"F": null,
"G": null,
"H": null,
"I": null
} | A 4-year-old boy develops fever 3 weeks after being admitted to the hospital for induction chemotherapy for treatment of acute lymphoblastic leukemia. Chemotherapy medications are L-asparaginase, dexamethasone, doxorubicin, and vincristine. His temperature is 38.2°C (100.8°F), pulse is 122/min, and respirations are 24/... |
null | null | null | null | null | 73 | {
"A": "Inferior mesenteric vein",
"B": "Inferior vena cava",
"C": "Left colic vein",
"D": "Middle colic artery",
"E": "Pulmonary vein",
"F": "Superior mesenteric artery",
"G": "Superior vena cava",
"H": null,
"I": null
} | A 65-year-old woman comes to the office for a follow-up examination 1 year after she underwent operative resection of the right colon and chemotherapy for stage III colon cancer. She reports fatigue. Physical examination shows no abnormalities. A staging CT scan of the chest and abdomen shows five new 2- to 3-cm masses... |
null | null | null | null | null | 74 | {
"A": "Dihydrofolate reductase",
"B": "Methionine synthase",
"C": "Pyruvate decarboxylase",
"D": "Thiamine pyrophosphate",
"E": "Thymidylate synthase",
"F": null,
"G": null,
"H": null,
"I": null
} | A 6-year-old boy with acute lymphoblastic leukemia is brought to the office for a follow-up examination. He is receiving high-dose methotrexate therapy. A drug is added to the patient's medication regimen to decrease the toxicity of this therapy to normal cells. The beneficial effect of this new drug on normal cells is... |
null | null | null | null | null | 75 | {
"A": "G protein-linked receptors",
"B": "Ligand-gated ion channels",
"C": "Nuclear receptors",
"D": "Receptor tyrosine kinases",
"E": "σ Receptors",
"F": null,
"G": null,
"H": null,
"I": null
} | A 4082-g (9-lb) male newborn is delivered in the hospital at 40 weeks' gestation to a 28-year-old primigravid woman. Pregnancy and delivery were uncomplicated. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Examination of the newborn's tongue shows a small blind pit in the midline located near the intersec... |
null | null | null | null | null | 76 | {
"A": "Cathelicidin-related antimicrobial peptide",
"B": "Lysozyme",
"C": "Major basic protein",
"D": "Myeloperoxidase",
"E": "α-Defensin",
"F": null,
"G": null,
"H": null,
"I": null
} | An investigator is studying how mice respond to filarial parasitic infections. Mice deficient in a specific protein found in eosinophils (Group X) are compared with wild-type mice (Group Y). Biopsies of lymph nodes from Group X mice show more adult worms than lymph nodes from Group Y mice. Group X mice most likely lack... |
null | null | null | null | null | 77 | {
"A": "Eczema",
"B": "Folliculitis",
"C": "Hidradenitis",
"D": "Keratosis pilaris",
"E": "Urticaria",
"F": null,
"G": null,
"H": null,
"I": null
} | A 14-year-old girl is brought to the office by her mother because of a 3-month history of red bumps on her skin. The patient says the bumps are not itchy or painful but that she finds them embarrassing. She has no history of major medical illness and takes no medications. Her vital signs are within normal limits. Physi... |
null | null | null | null | null | 78 | {
"A": "Decreased serum bicarbonate concentration",
"B": "Increased hemoglobin concentration",
"C": "Increased total lung capacity",
"D": "Left ventricular hypertrophy",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | A 50-year-old man comes to the office because of a 2-month history of increasing daytime somnolence. He has obstructive sleep apnea for which he has only intermittently used a continuous positive airway pressure device. He is 170 cm (5 ft 7 in) tall and weighs 181 kg (400 lb); BMI is 63 kg/m2. His temperature is 37°C (... |
null | null | null | null | null | 79 | {
"A": "Parathyroid Hormone downregulated, Serum 1,25 syntheses Calcium increased, Serum Dihydroxycholecalciferol decreased",
"B": "Parathyroid Hormone downregulated, Serum 1,25 syntheses Calcium increased, Serum Dihydroxycholecalciferol increased",
"C": "Parathyroid Hormone downregulated, Serum Calcium decreased... | An obese 35-year-old man comes to the office for a follow-up examination. He has chronic kidney disease and was told to keep a record of his meals until this follow-up visit. His daily diet consists of chocolate milk and a peanut butter sandwich for breakfast; pizza and cola for lunch; a chocolate bar as a snack; and a... |
null | null | null | null | null | 80 | {
"A": "",
"B": "",
"C": "",
"D": "",
"E": "",
"F": "",
"G": null,
"H": null,
"I": null
} | 80. A 65-year-old woman has congestive heart failure for which she is treated with an appropriate drug regimen including an ACE inhibitor. Because of insufficient improvement in her symptoms of dyspnea on exertion and edema, the physician prescribes a second agent that results in hyperkalemia. This adverse effect most ... |
null | null | null | null | null | 81 | {
"A": "Arginine vasoreceptor 2 in the proximal tubular cells",
"B": "K+–H+ exchange in the distal tubule",
"C": "Proximal tubule carbonic anhydrase",
"D": "Urea reabsorption in the medullary collecting ducts",
"E": "Water reabsorption in the ascending loop of Henle",
"F": null,
"G": null,
"H": null,
... | A 60-year-old woman is nearing the completion of a half marathon. Because she experiences esophageal regurgitation, she does not drink any liquid during the race. This woman's physical state at the end of the race will most likely activate which of the following renal segments at this time? |
null | null | null | null | null | 82 | {
"A": "Atrial septal defect",
"B": "Coarctation of the aorta",
"C": "Mitral stenosis",
"D": "Persistent truncus arteriosus",
"E": "Transposition of the great arteries",
"F": null,
"G": null,
"H": null,
"I": null
} | An investigator is studying heart development in an experimental animal model. The animal model is genetically modified so that no cardiac neural crest cells develop. This animal model is most likely to have which of the following cardiac abnormalities? |
null | null | null | null | null | 83 | {
"A": "Gastroduodenal",
"B": "Left gastric",
"C": "Left hepatic",
"D": "Right gastric",
"E": "Right hepatic",
"F": null,
"G": null,
"H": null,
"I": null
} | A 78-year-old woman undergoes an outpatient laparoscopic cholecystectomy. During the procedure, ligation of the cystic artery is planned. It is most appropriate to ligate this artery at its junction with which of the following arteries? |
null | null | null | null | null | 84 | {
"A": "Epstein-Barr virus infection",
"B": "Gonococcal pharyngitis",
"C": "HIV infection",
"D": "Lymphogranuloma venereum infection",
"E": "Streptococcal pharyngitis",
"F": null,
"G": null,
"H": null,
"I": null
} | A 32-year-old man comes to the office because of a 2-week history of fever and throat pain. He is 173 cm (5 ft 8 in) tall and weighs 63 kg (140 lb); BMI is 21 kg/m2. His pulse is 110/min, respirations are 16/min, and blood pressure is 98/68 mm Hg. Physical examination shows scattered 2- to 4-cm lymph nodes in the neck,... |
null | null | null | null | null | 85 | {
"A": "",
"B": "",
"C": "",
"D": "",
"E": "",
"F": "",
"G": null,
"H": null,
"I": null
} | A 65-year-old woman with a history of rheumatic mitral valve disease is brought to the emergency department 30 minutes after the sudden onset of right-sided weakness and inability to speak. Neurologic examination shows weakness of the right lower side of the face and difficulty swallowing. Muscle strength is 3/5 on the... |
null | null | null | null | null | 86 | {
"A": "Ask the patient how much he is eating and drinking during the holidays",
"B": "Explain the hazards of untreated reflux in the presence of Barrett esophagus",
"C": "Order an upper endoscopy",
"D": "Refer the patient to a gastroenterologist",
"E": "Switch the omeprazole to pantoprazole",
"F": null,
... | A 51-year-old man with a 10-year history of gastroesophageal reflux and suspected Barrett esophagus comes to the office because his omeprazole dose "doesn't work around the Christmas holidays."He states that he prides himself on having a large appetite and "holding his liquor"during the holidays. He currently takes the... |
null | null | null | null | null | 87 | {
"A": "Cysteine",
"B": "Glutamine",
"C": "Methionine",
"D": "Phenylalanine",
"E": "Tyrosine",
"F": null,
"G": null,
"H": null,
"I": null
} | A 60-year-old man comes to the office because of weakness, tingling of his hands and feet, irritability, and forgetfulness for 4 months. Physical examination shows pallor, weakness, and spasticity. Deep tendon reflexes are increased. Sensation to vibration is absent in the lower extremities. Laboratory studies show meg... |
null | null | null | null | null | 88 | {
"A": "Aortic hiatus",
"B": "Central tendon of the diaphragm",
"C": "Fibrous pericardium",
"D": "Pleuroperitoneal fold",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | A 1928-g (4-lb 4-oz) female newborn is delivered in the hospital at 35 weeks' gestation to a 24-year-old primigravid woman. The pregnancy was complicated by a lack of prenatal care. Apgar scores are 3 and 5 at 1 and 5 minutes, respectively. Examination of the newborn shows cyanosis, grunting, and chest retractions. An ... |
null | null | null | null | null | 89 | {
"A": "Angiomyolipoma",
"B": "Metastatic melanoma",
"C": "Nephroblastoma",
"D": "Oncocytoma",
"E": "Urothelial carcinoma",
"F": null,
"G": null,
"H": null,
"I": null
} | A 68-year-old man with alcohol use disorder comes to the office because of a 3-month history of intermittent blood in his urine; he has had no pain. He is a retired laboratory technician from a company that produces naphthylamine. He has smoked 1½ packs of cigarettes daily for 45 years. A CT scan of the abdomen shows a... |
null | null | null | null | null | 90 | {
"A": "Coxsackievirus",
"B": "Mumps virus",
"C": "Staphylococcus aureus",
"D": "Staphylococcus epidermidis",
"E": "Viridans streptococcus",
"F": null,
"G": null,
"H": null,
"I": null
} | A 12-year-old girl is brought to the office because of a 2-day history of chest pain. She also had a 3-day history of fever that has since resolved. When she lies down, the pain worsens and she has shortness of breath. Her temperature is 37°C (98.6°F). A friction rub is heard. Which of the following is the most likely ... |
null | null | null | null | null | 91 | {
"A": "Collagen",
"B": "Double-stranded DNA",
"C": "Nucleolar protein",
"D": "Phospholipid",
"E": "Proteins in neutrophil cytoplasm",
"F": null,
"G": null,
"H": null,
"I": null
} | A 32-year-old man comes to the office because of a 1-day history of cough productive of small amounts of blood and a 2-day history of shortness of breath and swelling of his ankles. He also has a 2-week history of progressive fatigue and episodes of dark urine. He has no history of major medical illness and takes no me... |
null | null | null | null | null | 92 | {
"A": "Are there any reasons why you might want to quit smoking?",
"B": "Are you aware that your lung condition is chronic at this point?",
"C": "I'm sure you don't want your wife to suffer as a result of your smoking.",
"D": "The majority of your health issues would improve if you quit smoking.",
"E": "Why ... | A 58-year-old man with chronic obstructive pulmonary disease comes to the clinic with his wife for a follow-up examination. He has smoked one pack of cigarettes daily for 35 years. He has tried to quit smoking twice but was unsuccessful both times. At today’s visit, when the physician asks the patient about smoking ces... |
null | null | null | null | null | 93 | {
"A": "Anterior pituitary gland",
"B": "Bowman capsule",
"C": "Glomerulus",
"D": "Hypophysial portal system",
"E": "Loop of Henle",
"F": "(F) Supraoptic nucleus",
"G": null,
"H": null,
"I": null
} | A 26-year-old man comes to the office because of a 1-week history of increased urinary frequency accompanied by excessive thirst. He says he has been urinating hourly. Physical examination shows no abnormalities. Serum chemistry studies are within the reference ranges. Urine osmolality is 50 mOsmol/kg H2O. After admini... |
null | null | null | null | null | 94 | {
"A": "Decreased fremitus, dull percussion, decreased breath sounds",
"B": "Decreased fremitus, hyperresonant percussion, decreased breath sounds",
"C": "Decreased fremitus, hyperresonant percussion, dull breath sounds",
"D": "Increased fremitus, dull percussion, bronchial breath sounds",
"E": "Increased fre... | A 19-year-old man who is in the US Army is brought to the emergency department 45 minutes after he sustained a knife wound to the right side of his chest during an altercation. He has no history of major medical illness and takes no medications. His temperature is 36.9°C (98.4°F), pulse is 110/min, respirations are 24/... |
null | null | null | null | null | 95 | {
"A": "↑ renal blood flow, ↑ glomerular ultrafiltration pressure, ↓ glomerular filtration rate",
"B": "↑ renal blood flow, ↓ glomerular ultrafiltration pressure, ↑ glomerular filtration rate",
"C": "↑ renal blood flow, ↓ glomerular ultrafiltration pressure, ↓ glomerular filtration rate",
"D": "↓ renal blood fl... | A 45-year-old man comes to the office for a follow-up examination 1 month after routine urinalysis showed an increased protein concentration. He has a 15-year history of type 2 diabetes mellitus and a 10-year history of hypertension. Current medications include hydrochlorothiazide, insulin, and metformin. His blood pre... |
null | null | null | null | null | 96 | {
"A": "11β-Hydroxylase",
"B": "21α-Hydroxylase",
"C": "3α-Hydroxysteroid dehydrogenase",
"D": "3β-Hydroxysteroid dehydrogenase",
"E": "5α-Reductase",
"F": "(F) 17α-Reductase",
"G": null,
"H": null,
"I": null
} | A 3438-g (7-lb 9-oz) female newborn is delivered in the hospital at term to a 24-year-old primigravid woman after an uncomplicated pregnancy. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Examination of the newborn shows ambiguous genitalia. Results of a blood analysis show markedly increased serum concent... |
null | null | null | null | null | 97 | {
"A": "Antithrombin III deficiency",
"B": "Factor V Leiden mutation",
"C": "Glanzmann thrombasthenia",
"D": "Protein C deficiency",
"E": "von Willebrand disease",
"F": null,
"G": null,
"H": null,
"I": null
} | A 27-year-old woman comes to the emergency department because of a 1-hour history of severe shortness of breath. She has just returned from a cross-country flight. She has a history of borderline hypertension. Her temperature is 36.9°C (98.5°F), pulse is 113/min, respirations are 28/min, and blood pressure is 138/85 mm... |
null | null | null | null | null | 98 | {
"A": "Calcium",
"B": "Chloride",
"C": "Magnesium",
"D": "Potassium",
"E": "Sodium",
"F": null,
"G": null,
"H": null,
"I": null
} | A 17-year-old boy is brought to the clinic for a follow-up examination. He has been evaluated for three episodes of full-body weakness at the ages of 13, 16, and 17 years. Each episode occurred when he lay down after playing in a football scrimmage. The weakness improved spontaneously during the next 6 hours; he was as... |
null | null | null | null | null | 99 | {
"A": "Diet",
"B": "Family illness",
"C": "Recent travel",
"D": "Trauma",
"E": "Unintended weight loss",
"F": null,
"G": null,
"H": null,
"I": null
} | A 20-year-old woman is brought to the urgent care center because of a 2-month history of progressive weakness of her arms. She also has a 1-week history of moderate back pain and headache. Her only medication is ibuprofen as needed for pain. Muscle strength is 3/5 in the upper extremities. Sensation to pinprick is decr... |
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