question stringlengths 66 3.58k | answer stringlengths 1 230 | options dict | meta_info stringclasses 2
values | answer_idx stringclasses 4
values | metamap_phrases listlengths 1 184 |
|---|---|---|---|---|---|
A 66-year-old white man comes to the physician because of a 10-day history of fatigue and lower leg swelling. Over the past 6 months, he has had a 3.6-kg (8-lb) weight loss. He has chronic bronchitis and uses an albuterol inhaler as needed. He has smoked one pack of cigarettes daily for 44 years and drinks one alcoholi... | Membranous nephropathy | {
"A": "Focal segmental glomerulosclerosis",
"B": "Membranous nephropathy",
"C": "Rapidly progressive glomerulonephritis",
"D": "Thin basement membrane disease\n\""
} | step2&3 | B | [
"66 year old white man",
"physician",
"a 10 day history",
"fatigue",
"lower leg swelling",
"past 6 months",
"3.6 kg",
"weight loss",
"chronic bronchitis",
"uses",
"albuterol inhaler as needed",
"smoked one pack",
"cigarettes daily",
"years",
"drinks one alcoholic beverage daily",
"temp... |
An 80-year-old male with known metastatic prostate cancer presents to your office with vague complaints of "achy bones." Strangely, he refers to you using the name of another physician. On physical exam, he is afebrile, but mildly tachycardic at 100 beats/min. Mucous membranes are dry. Cardiac exam shows regular rhythm... | Intravenous normal saline | {
"A": "Pamidronate",
"B": "Intravenous normal saline",
"C": "Calcitonin",
"D": "Hemodialysis"
} | step2&3 | B | [
"80 year old male",
"known metastatic prostate cancer presents",
"office",
"vague complaints",
"achy bones",
"refers",
"using",
"name",
"physician",
"physical exam",
"afebrile",
"mildly tachycardic",
"100 beats/min",
"Mucous membranes",
"dry",
"Cardiac exam shows regular rhythm",
"mu... |
A new drug is designed to treat asthma by inhibiting bronchoconstriction. Experimental assays show that treated animals had markedly reduced acetylcholine binding to muscarinic receptors relative to untreated controls. The drug is most similar to which of the following: | Ipratropium | {
"A": "Cromolyn",
"B": "Zafirlukast",
"C": "Prednisone",
"D": "Ipratropium"
} | step1 | D | [
"new drug",
"designed to treat asthma",
"inhibiting bronchoconstriction",
"Experimental assays show",
"treated animals",
"markedly reduced acetylcholine binding",
"muscarinic receptors relative to untreated controls",
"drug",
"most similar",
"following"
] |
A 34-year-old man presents to the outpatient clinic with a complaint of right-sided jaw pain. The onset of pain was approx. 1 month ago and he is experiencing symptoms 2–3 times a day. Each episode of pain lasts for about 30 seconds. He describes the pain as severe (9 out of 10) with an electric and sharp quality. He d... | Prevention of Na+ influx | {
"A": "Prevention of Na+ influx",
"B": "Decrease the excitatory effects of glutamic acid",
"C": "Increase the frequency of Cl- channel opening",
"D": "Increase the time of Cl- channel opening"
} | step1 | A | [
"year old man presents",
"outpatient clinic",
"complaint of right-sided jaw pain",
"onset",
"pain",
"month",
"experiencing symptoms 23 times",
"day",
"episode of pain",
"about 30 seconds",
"pain",
"severe",
"out",
"10",
"electric",
"sharp quality",
"denies",
"tear production",
"c... |
A 17-year-old African-American male presents to his family physician after noticing red-tinged urine the week before, when he was suffering from a cold. The patient states that he had experienced that before. His father is with him and says that this happens to him on occasion as well. What is the most likely diagnosis... | Sickle cell trait | {
"A": "Acute cystitis",
"B": "Sickle cell trait",
"C": "Acute glomerulonephritis",
"D": "Hemophilia"
} | step1 | B | [
"year old African-American male presents",
"family physician",
"red tinged urine",
"week",
"suffering",
"cold",
"patient states",
"experienced",
"before",
"father",
"happens",
"occasion",
"well",
"most likely diagnosis",
"patient"
] |
A 4-year-old boy is brought to the physician by his mother for a well-child examination. At the visit, the mother says that she is worried about the child's vision because of an “eye condition that runs in the family.” She says that the child is doing well in all activities at his preschool, except one in which he is r... | X-linked recessive | {
"A": "Mitochondrial inheritance",
"B": "Autosomal recessive",
"C": "Y-linked dominant",
"D": "X-linked recessive"
} | step1 | D | [
"4 year old boy",
"brought",
"physician",
"mother",
"well",
"visit",
"mother",
"worried",
"child's vision",
"eye condition",
"runs in",
"family",
"child",
"well",
"activities",
"preschool",
"one",
"required to sort different colored balls",
"color",
"pedigree chart",
"family"... |
A 71-year-old African American man with a history of prostatic adenocarcinoma presents to his oncologist with low back pain. He was diagnosed with non-resectable prostatic adenocarcinoma 4 years ago. He has undergone radiation therapy and chemotherapy. Over the past 3 months, he has developed constant mild non-radiatin... | Normal calcium, normal phosphate, increased alkaline phosphatase, and normal parathyroid hormone | {
"A": "Decreased calcium, increased phosphate, increased alkaline phosphatase, and increased parathyroid hormone",
"B": "Increased calcium, decreased phosphate, increased alkaline phosphatase, and increased parathyroid hormone",
"C": "Normal calcium, normal phosphate, increased alkaline phosphatase, and normal p... | step1 | C | [
"71 year old African American man",
"history of prostatic adenocarcinoma presents",
"oncologist",
"low back pain",
"diagnosed",
"non-resectable prostatic adenocarcinoma",
"years",
"radiation therapy",
"chemotherapy",
"past 3 months",
"non radiating low back pain",
"occasionally wakes",
"slee... |
A 44-year-old Caucasian male presents with a fever, recent weight loss, and a cough productive of bloody sputum. A chest X-ray and CT scan were performed, revealing cavities near the apex of his lungs. The patient is started on rifampin, isoniazid, ethambutol and pyrazinamide. Formation of the cavities in the patient's... | TH1 cells | {
"A": "TH1 cells",
"B": "Toxin secretion by the bacterium",
"C": "B-cells",
"D": "NK cells"
} | step1 | A | [
"year old Caucasian male presents",
"fever",
"recent weight loss",
"cough productive of bloody sputum",
"chest X-ray",
"CT scan",
"performed",
"revealing cavities",
"the apex of",
"lungs",
"patient",
"started",
"rifampin",
"isoniazid",
"ethambutol",
"pyrazinamide",
"Formation",
"ca... |
A 48-year-old man presents to his primary care physician with a 6-month history of increasing joint pain and stiffness. He says that the pain is primarily located in his knees and occurs in sharp bursts that are accompanied by redness and warmth. His past medical history is significant for diabetes though he is not cur... | Hepatocellular carcinoma | {
"A": "Hepatocellular carcinoma",
"B": "Osteosarcoma",
"C": "Pancreatic adenocarcinoma",
"D": "Squamous cell skin carcinoma"
} | step1 | A | [
"48 year old man presents",
"primary care physician",
"month history",
"increasing joint pain",
"stiffness",
"pain",
"knees",
"occurs",
"sharp bursts",
"redness",
"warmth",
"past medical history",
"significant",
"diabetes",
"not currently taking",
"medications",
"suffers",
"occasio... |
A 58-year-old chronic smoker known to have chronic bronchitis for the last 20 years presents to his physician for a scheduled follow-up visit. He mentions that over the last month he has been having difficulty breathing, especially after climbing stairs. He also says that he has had similar episodes in the past, which ... | Diltiazem | {
"A": "Diltiazem",
"B": "Hydralazine",
"C": "Isosorbide mononitrate",
"D": "Losartan"
} | step2&3 | A | [
"58 year old chronic smoker known to",
"chronic bronchitis",
"20 years presents",
"physician",
"scheduled follow-up visit",
"last month",
"difficulty breathing",
"climbing stairs",
"similar episodes",
"past",
"relieved",
"use of inhaled bronchodilators",
"recently",
"breathlessness",
"ce... |
A 70-year-old man presents to the clinic with right-sided chest pain and difficulty breathing for the past 10 days. When it began, the pain was mild, but as time went on, it increased to a level at which the man found it difficult to breathe. Two years ago, he was diagnosed with clear cell carcinoma of the kidney. Vita... | Pleural effusion | {
"A": "Pneumonia",
"B": "Atelectasis",
"C": "Pneumothorax",
"D": "Pleural effusion"
} | step1 | D | [
"70 year old man presents",
"clinic",
"right-sided chest pain",
"difficulty breathing",
"past 10 days",
"began",
"pain",
"mild",
"time",
"increased",
"level",
"man found",
"difficult to",
"Two years",
"diagnosed",
"clear cell carcinoma of the kidney",
"Vital signs include",
"pulse ... |
A 1-month-old boy is brought in by his mother for episodes of “not breathing.” She reports noticing that the patient will occasionally stop breathing while he’s sleeping, and that these episodes have been occurring more frequently. The patient was born at 32 weeks due to placental insufficiency. He was in the neonatal ... | Impaired erythropoietin production | {
"A": "Hemoglobinopathy",
"B": "Impaired erythropoietin production",
"C": "Minor blood group incompatibility",
"D": "Red blood cell membrane defect"
} | step2&3 | B | [
"month old boy",
"brought",
"mother",
"episodes of not breathing",
"reports",
"patient",
"occasionally stop breathing",
"sleeping",
"episodes",
"occurring more frequently",
"patient",
"born",
"weeks",
"placental insufficiency",
"neonatal intensive care unit",
"1 day to",
"placed",
... |
A 63-year-old man presents to his family physician with limited movement in his left shoulder that has progressed gradually over the past 6 years. He previously had pain when moving his shoulder, but the pain subsided a year ago and now he experiences the inability to fully flex, abduct, and rotate his left arm. He had... | Physical therapy | {
"A": "NSAID prescription for 1–2 weeks",
"B": "Physical therapy",
"C": "Corticosteroid injections",
"D": "Arthroscopic capsular release"
} | step2&3 | B | [
"63 year old man presents",
"family physician",
"limited movement",
"left shoulder",
"progressed",
"past",
"years",
"pain",
"moving",
"shoulder",
"pain",
"year",
"now",
"experiences",
"rotate",
"left arm",
"injury",
"left 10 years",
"fell",
"arms",
"stretched ligaments",
"n... |
A 32-year-old man comes to the emergency department because of sharp chest pain for 3 days. The pain is retrosternal, 8 out of 10 in intensity, increases with respiration, and decreases while sitting upright and leaning forward. He has nausea and myalgia. He has not had fever or a cough. He has asthma and was treated f... | Cardiac tamponade | {
"A": "Papillary muscle rupture",
"B": "Pulmonary infarction",
"C": "Cardiac tamponade",
"D": "Ventricular aneurysm"
} | step2&3 | C | [
"year old man",
"emergency department",
"of sharp chest pain",
"3 days",
"pain",
"retrosternal",
"8 out",
"10",
"intensity",
"increases",
"respiration",
"decreases",
"sitting upright",
"forward",
"nausea",
"myalgia",
"not",
"fever",
"cough",
"asthma",
"treated",
"bronchitis... |
A 48-year-old man comes to the physician because of a 2-day history of an itchy rash. He has no history of skin problems. He had an upper respiratory infection 4 days ago that resolved with acetaminophen and over-the-counter cold medication. He has type I diabetes mellitus well-controlled with insulin. He was also diag... | Cutaneous mast cell activation | {
"A": "Epidermal keratinocyte hyperproliferation",
"B": "Cutaneous Trichophyton rubrum infection",
"C": "Impaired bradykinin degradation",
"D": "Cutaneous mast cell activation"
} | step2&3 | D | [
"48 year old man",
"physician",
"2-day history",
"itchy rash",
"history",
"skin problems",
"upper respiratory infection",
"days",
"resolved",
"acetaminophen",
"over-the-counter cold medication",
"type I diabetes mellitus well-controlled",
"insulin",
"diagnosed",
"hypertension",
"weeks"... |
A 56-year-old man comes to the clinic complaining of back pain for the past 1 month. The pain is described as a dull ache that intensifies intermittently to an 8/10 in severity about 1-2 times a day. It intensified about 2 weeks ago following a fall during a ski trip. He reports that he noticed some pain at his buttock... | Exercise therapy with NSAIDs/acetaminophen | {
"A": "Best rest with return to activity in 1 week",
"B": "Exercise therapy with NSAIDs/acetaminophen",
"C": "Morphine as needed",
"D": "Radiograph of lumbar spine"
} | step2&3 | B | [
"year old man",
"clinic",
"of back pain",
"past",
"month",
"pain",
"described",
"dull ache",
"8/10",
"severity",
"2 times",
"day",
"2 weeks",
"following",
"fall",
"ski trip",
"reports",
"pain",
"buttocks",
"lower back following",
"fall",
"Hot packs",
"Tylenol",
"to",
... |
A 75-year-old man is brought to the emergency department 20 minutes after an episode of being unconscious. He was playing with his 3-year-old granddaughter when he suddenly fell down and was unresponsive for 1-minute. He responded normally after regaining consciousness. He has had episodes of mild chest pain and abdomi... | Calcification of the aortic valve | {
"A": "Fibrosis of the sinus node",
"B": "Asymmetric septal hypertrophy",
"C": "Calcification of the aortic valve",
"D": "Embolus in the pulmonary artery"
} | step2&3 | C | [
"75 year old man",
"brought",
"emergency department 20 minutes",
"episode of",
"unconscious",
"playing",
"year old granddaughter",
"fell",
"unresponsive",
"minute",
"regaining consciousness",
"episodes of mild chest pain",
"abdominal discomfort",
"past",
"months",
"working",
"car",
... |
A 37-year-old male presents to general medical clinic reporting sleeping difficulties. He states that he has daytime sleepiness, having fallen asleep several times while driving his car recently. He sometimes experiences very vivid dreams just before awakening. You ask the patient's wife if she has witnessed any episod... | Enhances release of norepinephrine vesicles | {
"A": "Agonist at the GABA receptor",
"B": "Agonist at the mu opioid receptor",
"C": "Blockade of 5HT reuptake",
"D": "Enhances release of norepinephrine vesicles"
} | step1 | D | [
"year old male presents",
"general medical clinic reporting sleeping difficulties",
"states",
"daytime sleepiness",
"fallen asleep",
"times",
"driving",
"car recently",
"sometimes experiences very vivid dreams",
"awakening",
"patient's wife",
"witnessed",
"episodes",
"husband lost",
"mus... |
A 30-year-old woman is brought to the emergency department by ambulance after being found unconscious in her bedroom by her roommate. The roommate says the patient has type 1 diabetes and takes her insulin regularly. Her pulse is 110/min, the respiratory rate is 24/min, the temperature is 36.6°C (97.9°F), and the blood... | Excessive mobilization of fatty acids | {
"A": "Diminished glucose metabolism",
"B": "Excessive mobilization of fatty acids",
"C": "Fermentation of excess blood sugars",
"D": "Inhibition of HMG-CoA synthase"
} | step1 | B | [
"30 year old woman",
"brought",
"emergency department",
"ambulance",
"found unconscious",
"bedroom",
"roommate",
"roommate",
"patient",
"type 1 diabetes",
"takes",
"insulin",
"pulse",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"97 9F",
"blood pressure",
"95 65 mm ... |
A 75-year-old man presents to the physician with progressive difficulty reading over the past year. Currently, he avoids driving as he has trouble reading road signs. He has no history of a serious illness and takes no medications. The fundoscopic examination shows localized retinal elevation and drusen. A description ... | Macular degeneration | {
"A": "Choroidal melanoma",
"B": "Macular degeneration",
"C": "Open-angle glaucoma",
"D": "Retinal detachment"
} | step2&3 | B | [
"75 year old man presents",
"physician",
"progressive difficulty reading",
"past year",
"Currently",
"driving",
"reading road signs",
"history",
"serious illness",
"takes",
"medications",
"fundoscopic examination shows localized retinal elevation",
"drusen",
"description",
"patients visu... |
A 44-year-old woman comes to her primary care physician with complaints of irritation and a gritty sensation in her eyes for the past few months. She denies any discharge from her eyes. She has no significant past medical or surgical history. She takes multivitamins occasionally but denies use of any other medication. ... | Sjögren's syndrome | {
"A": "Systemic lupus erythematosus (SLE)",
"B": "Sjögren's syndrome",
"C": "Rheumatoid arthritis",
"D": "Fibromyalgia"
} | step1 | B | [
"year old woman",
"primary care physician",
"complaints",
"irritation",
"gritty sensation",
"eyes",
"past",
"months",
"denies",
"discharge from",
"eyes",
"significant past medical",
"surgical history",
"takes multivitamins occasionally",
"denies use of",
"medication",
"further questi... |
The medical student on the pediatric cardiology team is examining a 9-year-old girl who was referred by her primary care physician for unexplained hypertension. She is accompanied by her mother who reveals that the child is generally well but has been significantly less active than her peers for the past year. On exam,... | Webbed neck | {
"A": "Cleft palate",
"B": "Prominent occiput",
"C": "Long philtrum",
"D": "Webbed neck"
} | step2&3 | D | [
"medical student",
"pediatric cardiology team",
"examining",
"year old girl",
"referred by",
"primary care physician",
"unexplained hypertension",
"mother",
"reveals",
"child",
"well",
"active",
"peers",
"past year",
"exam",
"medical student notes",
"thin girl",
"apparent distress ... |
A 45-year-old woman comes to the emergency department complaining of abdominal pain for the past day. The pain is situated in the right upper quadrant, colicky, 8/10, and radiates to the tip of the right shoulder with no aggravating or relieving factors. The pain is associated with nausea but no vomiting. She tried to ... | Cholescintigraphy | {
"A": "Emergency cholecystectomy",
"B": "Cholescintigraphy",
"C": "CT scan",
"D": "Reassurance and close follow up"
} | step2&3 | B | [
"year old woman",
"emergency department",
"abdominal pain",
"past day",
"pain",
"right upper quadrant",
"colicky",
"10",
"radiates",
"tip",
"right shoulder",
"aggravating",
"relieving factors",
"pain",
"associated with nausea",
"vomiting",
"to take",
"counter antacids",
"relieved... |
A 4-year-old girl is brought to the physician because of a 3-week history of generalized fatigue and easy bruising. During the past week, she has also had fever and severe leg pain that wakes her up at night. Her temperature is 38.3°C (100.9°F), pulse is 120/min, and respirations are 30/min. Examination shows cervical ... | Acute lymphoblastic leukemia | {
"A": "Hodgkin lymphoma",
"B": "Hairy cell leukemia",
"C": "Aplastic anemia",
"D": "Acute lymphoblastic leukemia"
} | step2&3 | D | [
"4 year old girl",
"brought",
"physician",
"3 week history",
"generalized fatigue",
"easy bruising",
"past week",
"fever",
"severe leg",
"wakes",
"night",
"temperature",
"3C",
"100 9F",
"pulse",
"min",
"respirations",
"30/min",
"Examination shows cervical",
"axillary lymphadeno... |
A 25-year-old woman comes to the physician because of a 2-day history of a burning sensation when urinating and increased urinary frequency. She is concerned about having contracted a sexually transmitted disease. Physical examination shows suprapubic tenderness. Urinalysis shows a negative nitrite test and positive le... | Staphylococcus saprophyticus | {
"A": "Pseudomonas aeruginosa",
"B": "Klebsiella pneumoniae",
"C": "Proteus mirabilis",
"D": "Staphylococcus saprophyticus"
} | step1 | D | [
"year old woman",
"physician",
"of",
"2-day history",
"burning sensation",
"increased urinary frequency",
"concerned",
"contracted",
"sexually transmitted disease",
"Physical examination shows suprapubic tenderness",
"Urinalysis shows",
"negative nitrite test",
"positive leukocyte esterases"... |
A 2-day-old male infant is brought to the emergency department by ambulance after his parents noticed that he was convulsing and unresponsive. He was born at home and appeared well initially; however, within 24 hours he became increasingly irritable and lethargic. Furthermore, he stopped feeding and began to experience... | Benzoate administration | {
"A": "Aspartame avoidance",
"B": "Benzoate administration",
"C": "Galactose avoidance",
"D": "Uridine administration"
} | step1 | B | [
"2-day old male infant",
"brought",
"emergency department",
"ambulance",
"parents",
"convulsing",
"unresponsive",
"born at home",
"appeared well initially",
"24 hours",
"irritable",
"lethargic",
"stopped feeding",
"began to experience worsening tachypnea",
"continued",
"hours",
"poin... |
A 33-year-old man presents to his physician with a 3-year history of gradually worsening tics and difficulty walking. He was last seen by the physician 5 years ago for anxiety, and he has been buying anti-anxiety medications from an internet website without a prescription as he cannot afford to pay for doctor’s visits.... | CAG | {
"A": "CCG",
"B": "CGG",
"C": "CAG",
"D": "CTG"
} | step1 | C | [
"year old man presents",
"physician",
"3 year history",
"worsening tics",
"difficulty walking",
"last seen by",
"physician",
"years",
"anxiety",
"buying anti-anxiety medications",
"internet website",
"prescription",
"to pay",
"doctors visits",
"Now",
"patient notes",
"anxiety",
"so... |
A 32-year-old man who recently emigrated from Somalia comes to the physician because of a 4-week history of fever, cough, and chest pain. He has had a 5-kg (11-lb) weight loss over the last 3 months despite no changes in appetite. His temperature is 38.1°C (100.6°F). Physical examination shows enlarged cervical lymph n... | Macrophages | {
"A": "Macrophages",
"B": "Fibroblasts",
"C": "Natural killer cells",
"D": "B cells"
} | step1 | A | [
"year old man",
"recently",
"Somalia",
"physician",
"4 week history",
"fever",
"cough",
"chest pain",
"5 kg",
"weight loss",
"months",
"changes in appetite",
"temperature",
"100",
"Physical examination shows enlarged cervical lymph nodes",
"lungs",
"clear",
"auscultation",
"resul... |
A 1-year-old immigrant girl presents to her pediatrician for a routine well-child check. She has not received any recommended vaccines since birth. She attends daycare and remains healthy despite her daily association with several other children for the past 3 months at a home daycare facility. Which of the following p... | Herd immunity | {
"A": "Herd immunity",
"B": "Genetic drift",
"C": "Tolerance",
"D": "Immune evasion"
} | step1 | A | [
"year old immigrant girl presents",
"pediatrician",
"routine well-child check",
"not received",
"recommended vaccines",
"birth",
"attends daycare",
"healthy",
"daily association",
"several",
"children",
"past 3 months",
"home daycare facility",
"following phenomena",
"not contracted",
... |
A pharmaceutical company has modified one of its existing antibiotics to have an improved toxicity profile. The new antibiotic blocks protein synthesis by first entering the cell and then binding to active ribosomes. The antibiotic mimics the structure of aminoacyl-tRNA. The drug is covalently bonded to the existing gr... | P site | {
"A": "40S small subunit",
"B": "A site",
"C": "E site",
"D": "P site"
} | step1 | D | [
"pharmaceutical company",
"modified one",
"antibiotics to",
"improved toxicity profile",
"new antibiotic blocks protein synthesis",
"first entering",
"cell",
"then binding",
"active ribosomes",
"antibiotic mimics",
"structure",
"aminoacyl-tRNA",
"drug",
"bonded",
"peptide chain",
"pept... |
A previously healthy 22-year-old man comes to the physician because of multiple nodules on his hands that first appeared a few months ago. He works as a computer game programmer. His father died of a myocardial infarction at 37 years of age, and his mother has rheumatoid arthritis. A photograph of the lesions is shown.... | Extravasation of lipoproteins | {
"A": "Fibrinoid necrosis",
"B": "Crystallization of monosodium urate",
"C": "Uncontrolled adipocyte growth",
"D": "Extravasation of lipoproteins"
} | step1 | D | [
"healthy",
"year old man",
"physician",
"of multiple nodules",
"hands",
"first appeared",
"few months",
"works",
"computer programmer",
"father died",
"myocardial infarction",
"years",
"age",
"mother",
"rheumatoid arthritis",
"photograph",
"lesions",
"shown",
"nodules",
"firm",... |
A previously healthy 25-year-old man is brought to the emergency department 30 minutes after collapsing during soccer practice. His father died of sudden cardiac arrest at the age of 36 years. The patient appears well. His pulse is 73/min and blood pressure is 125/78 mm Hg. Cardiac examination is shown. An ECG shows la... | Asymmetric septal hypertrophy | {
"A": "Aortic root dilatation",
"B": "Eccentric left ventricular dilation",
"C": "Asymmetric septal hypertrophy",
"D": "Mitral valve fibrinoid necrosis"
} | step2&3 | C | [
"healthy",
"year old man",
"brought",
"emergency department 30 minutes",
"collapsing",
"soccer practice",
"father died",
"sudden cardiac arrest",
"age",
"36 years",
"patient appears well",
"pulse",
"min",
"blood pressure",
"mm Hg",
"Cardiac examination",
"shown",
"ECG shows large R... |
A 45-year-old man presents with a 3-day history of right-sided flank pain due to a lodged ureteral stone. What changes would be expected to be seen at the level of glomerular filtration? | Increase in Bowman's space hydrostatic pressure | {
"A": "Increase in glomerular capillary oncotic pressure",
"B": "Increase in Bowman's space hydrostatic pressure",
"C": "Increase in filtration fraction",
"D": "No change in filtration fraction"
} | step1 | B | [
"year old man presents",
"3-day history",
"right-sided flank pain",
"ureteral stone",
"changes",
"expected to",
"seen",
"level",
"glomerular filtration"
] |
A 23-year-old man is brought to the emergency department by police at 2:00 AM. They picked him up from a local nightclub, where he was yelling and threatening to fight the staff. A review of his medical record is unremarkable. At the hospital, his behavior continues to be agitated and bizarre. His temperature is 37.0°C... | Cocaine intoxication | {
"A": "Cocaine intoxication",
"B": "Phencyclidine (PCP) intoxication",
"C": "Tetrahydrocannabinol (THC) intoxication",
"D": "Thyrotoxicosis"
} | step2&3 | A | [
"23 year old man",
"brought",
"emergency department",
"police",
"picked",
"local nightclub",
"to fight",
"staff",
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"behavior continues to",
"agitated",
"temperature",
"98",
"blood pressure",
"98 mm Hg",
"heart rate",
"min",... |
A 33-year-old man presents to a physician with a 3-year history of gradually worsening tics and difficulty walking. He was last seen by the physician 5 years ago for anxiety and has been purchasing anti-anxiety medications from an internet website without a prescription because he cannot afford to pay for the office vi... | CAG | {
"A": "CCG",
"B": "GAA",
"C": "CAG",
"D": "CTG"
} | step1 | C | [
"year old man presents",
"physician",
"3 year history",
"worsening tics",
"difficulty walking",
"last seen by",
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"years",
"anxiety",
"purchasing anti-anxiety medications",
"internet website",
"prescription",
"to pay",
"office visits",
"Now",
"anxiety",
"somewhat controlle... |
A 25-year-old woman comes to the physician because of sadness that started 6 weeks after her 9-month-old daughter was born. Since then, she has not returned to work. Her daughter usually sleeps through the night, but the patient still has difficulty staying asleep. She is easily distracted from normal daily tasks. She ... | Major depressive disorder | {
"A": "Disruptive mood dysregulation disorder",
"B": "Adjustment disorder",
"C": "Major depressive disorder",
"D": "Normal behavior"
} | step2&3 | C | [
"year old woman",
"physician",
"sadness",
"started 6 weeks",
"9 month old daughter",
"born",
"Since then",
"not returned to work",
"daughter usually sleeps",
"night",
"patient",
"difficulty staying asleep",
"easily",
"normal daily tasks",
"used",
"cooking",
"only orders delivery",
... |
A 34-year-old woman comes to the physician because of a 3-month history of pain in her right thumb and wrist that radiates to her elbow. It is worse when she holds her infant son and improves with the use of an ice pack. Six months ago, she slipped on a wet floor and fell on her right outstretched hand. Her mother take... | De Quervain tenosynovitis | {
"A": "De Quervain tenosynovitis",
"B": "Swan neck deformity",
"C": "Mallet finger",
"D": "Carpal tunnel syndrome"
} | step2&3 | A | [
"year old woman",
"physician",
"3 month history",
"pain",
"right thumb",
"wrist",
"radiates",
"elbow",
"worse",
"holds",
"infant son",
"improves",
"use of",
"ice pack",
"Six months",
"slipped",
"wet floor",
"fell",
"right",
"hand",
"mother takes methotrexate",
"chronic join... |
A 24-year-old woman comes to the physician because of bothersome hair growth on her face and abdomen over the past 8 years. She does not take any medications. She is 163 cm (5 ft 4 in) tall and weighs 85 kg (187 lb); BMI is 32 kg/m2. Physical examination shows coarse dark hair on the upper lip and periumbilical and per... | Oral contraceptive | {
"A": "Prednisone",
"B": "Leuprolide",
"C": "Ketoconazole",
"D": "Oral contraceptive"
} | step1 | D | [
"year old woman",
"physician",
"of",
"hair growth",
"face",
"abdomen",
"past",
"years",
"not take",
"medications",
"5 ft 4",
"tall",
"85 kg",
"BMI",
"kg/m2",
"Physical examination shows coarse dark hair",
"upper lip",
"periumbilical",
"periareolar skin",
"external genitalia app... |
A 45-year-old man is brought to the emergency department 20 minutes after being rescued from a fire in his apartment complex. He thinks he might have briefly lost consciousness while he was trapped in a smoke-filled room before firefighters were able to free him 20 minutes later. He reports headache, dizziness, and occ... | Administration of intravenous hydroxycobalamin | {
"A": "Administration of intravenous dimercaprol",
"B": "Hyperbaric oxygen therapy",
"C": "Administration of methylene blue",
"D": "Administration of intravenous hydroxycobalamin"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department 20 minutes",
"fire",
"apartment complex",
"thinks",
"lost consciousness",
"trapped in",
"smoke filled room",
"firefighters",
"able",
"free",
"20 minutes later",
"reports headache",
"dizziness",
"occasional cough",
"difficulty breathing... |
A 33-year-old man is brought to the emergency department by his mother because of erratic behavior over the past 6 months. He spends most of his time alone in his room because he believes he is being followed by the Secret Service. He was fired from his job 3 months ago after threatening a colleague. He appears suspici... | Warn the person at risk and inform law enforcement | {
"A": "Discuss the diagnosis and therapy plan with the patient's mother",
"B": "Inform security and law enforcement",
"C": "Warn the person at risk and inform law enforcement",
"D": "Request a court order to override the patient's right to confidentiality"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"mother",
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"spends most of",
"time alone",
"room",
"followed by",
"Secret Service",
"fired",
"job 3 months",
"appears suspicious",
"surroundings",
"doctor questions",
"security",
"hospital",
"patient e... |
A 59-year-old man with a history of congestive heart failure presents to his cardiologist for a follow-up visit. His past medical history is notable for diabetes mellitus, hypertension, and obesity. He takes metformin, glyburide, aspirin, lisinopril, and metoprolol. He has a 40 pack-year smoking history and drinks alco... | Decreased sodium reabsorption in the collecting duct | {
"A": "Decreased sodium reabsorption in the thick ascending limb",
"B": "Decreased sodium reabsorption in the distal convoluted tubule",
"C": "Decreased sodium reabsorption in the collecting duct",
"D": "Decreased renin enzyme activity"
} | step1 | C | [
"59 year old man",
"history of congestive heart failure presents",
"cardiologist",
"follow-up visit",
"past medical history",
"notable",
"diabetes mellitus",
"hypertension",
"obesity",
"takes metformin",
"glyburide",
"aspirin",
"lisinopril",
"metoprolol",
"40 pack-year smoking history",
... |
A 3-year-old girl is brought to the emergency department for 2 days of abdominal pain and watery diarrhea. This morning her stool had a red tint. She and her parents visited a circus 1 week ago. The patient attends daycare. Her immunizations are up-to-date. Her temperature is 38°C (100.4°F), pulse is 140/min, and blood... | Undercooked pork | {
"A": "Undercooked pork",
"B": "Undercooked poultry",
"C": "Home-canned food",
"D": "Deli meats"
} | step1 | A | [
"3 year old girl",
"brought",
"emergency department",
"2 days",
"abdominal pain",
"watery diarrhea",
"morning",
"stool",
"red",
"parents visited",
"circus",
"week",
"patient attends daycare",
"immunizations",
"date",
"temperature",
"100 4F",
"pulse",
"min",
"blood pressure",
... |
A 50-year-old man is brought in by ambulance to the emergency department with difficulty breathing and speaking. His wife reports that he might have swallowed a fishbone. While taking his history the patient develops a paroxysmal cough. Visualization of his oropharynx and larynx shows a fishbone lodged in the right pir... | Internal laryngeal nerve | {
"A": "Internal laryngeal nerve",
"B": "Recurrent laryngeal nerve",
"C": "Inferior laryngeal nerve",
"D": "Superior laryngeal nerve"
} | step1 | A | [
"50 year old man",
"brought",
"ambulance",
"emergency department",
"difficulty breathing",
"speaking",
"wife reports",
"swallowed",
"fishbone",
"taking",
"history",
"patient",
"paroxysmal cough",
"Visualization",
"oropharynx",
"larynx shows",
"fishbone",
"right piriform recess",
... |
A 61-year-old male presents to the ER with abdominal discomfort and malaise over the past 2 weeks. He states he is married and monogamous. He has a temperature of 39.4°C (102.9°F) and complains of night sweats as well. On physical exam, he has an enlarged spleen with mild tenderness and pale nail beds. There is mild to... | Tartrate-resistant acid phosphatase (TRAP) | {
"A": "Quantiferon Gold",
"B": "Monospot",
"C": "Tartrate-resistant acid phosphatase (TRAP)",
"D": "CD 25"
} | step1 | C | [
"61 year old male presents",
"ER",
"abdominal discomfort",
"malaise",
"past 2 weeks",
"states",
"married",
"monogamous",
"temperature",
"4C",
"9F",
"night sweats",
"well",
"physical exam",
"enlarged",
"mild tenderness",
"pale nail beds",
"mild tonsillar erythema",
"pulmonary exam... |
A 38-year-old man comes to the emergency department because of epigastric pain and multiple episodes of vomiting for 4 hours. Initially, the vomit was yellowish in color, but after the first couple of episodes it was streaked with blood. He had 2 episodes of vomiting that contained streaks of frank blood on the way to ... | Mucosal tear at the gastroesophageal junction | {
"A": "Transmural tear of the lower esophagus",
"B": "Inflammation of the esophageal wall",
"C": "Mucosal tear at the gastroesophageal junction",
"D": "Neoplastic growth at the gastroesophageal junction"
} | step2&3 | C | [
"year old man",
"emergency department",
"epigastric pain",
"multiple episodes of vomiting",
"4 hours",
"Initially",
"vomit",
"color",
"first couple of episodes",
"streaked",
"blood",
"2 episodes of vomiting",
"contained streaks",
"frank blood",
"hospital",
"hospitalized twice",
"past... |
A 16-year-old girl comes to the physician because of a 3-week history of nausea, increased urinary frequency, and breast tenderness. She has never had a menstrual period. She is actively involved in her school's track and field team. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Her breast ... | Human chorionic gonadotropin | {
"A": "Estriol",
"B": "Thyrotropin",
"C": "Human chorionic gonadotropin",
"D": "Prolactin"
} | step1 | C | [
"year old girl",
"physician",
"3 week history",
"nausea",
"increased urinary frequency",
"breast tenderness",
"never",
"menstrual period",
"involved",
"school's track and field team",
"5 ft 8",
"tall",
"54 kg",
"BMI",
"kg/m2",
"breast",
"pubic hair development",
"Tanner stage",
"... |
A 28-year-old man presents to his primary care provider complaining of intermittent stomach pain, non-bloody diarrhea, and weight loss for the last 3 months. He has occasional abdominal pain and fever. This condition makes studying difficult. He has tried omeprazole and dietary changes with no improvement. Past medical... | Whipple’s disease | {
"A": "Crohn’s disease",
"B": "Giardia lamblia infection",
"C": "Whipple’s disease",
"D": "Wilson’s disease"
} | step2&3 | C | [
"year old man presents",
"primary care provider",
"intermittent stomach",
"non bloody diarrhea",
"weight loss",
"months",
"occasional abdominal pain",
"fever",
"condition makes studying difficult",
"omeprazole",
"dietary changes",
"improvement",
"Past medical history",
"significant",
"oc... |
A 60-year-old woman is brought to the emergency department by her husband because of worsening shortness of breath over the past 2 days. Last week, she had a sore throat and a low-grade fever. She has coughed up white sputum each morning for the past 2 years. She has hypertension and type 2 diabetes mellitus. She has s... | Decreased urinary bicarbonate excretion | {
"A": "Increased urine osmolar gap",
"B": "Decreased urinary bicarbonate excretion",
"C": "Increased urinary pH",
"D": "Decreased urinary chloride concentration"
} | step2&3 | B | [
"60 year old woman",
"brought",
"emergency department",
"husband",
"of worsening shortness",
"breath",
"past 2 days",
"Last week",
"sore throat",
"low-grade fever",
"coughed",
"white sputum",
"morning",
"past",
"years",
"hypertension",
"type 2 diabetes mellitus",
"smoked 2 packs",
... |
A 32-year-old nulliparous woman with polycystic ovary syndrome comes to the physician for a pelvic examination and Pap smear. Last year she had a progestin-releasing intrauterine device placed. Menarche occurred at the age of 10 years. She became sexually active at the age of 14 years. Her mother had breast cancer at t... | Early onset of sexual activity | {
"A": "Early onset of sexual activity",
"B": "Obesity",
"C": "Family history of cancer",
"D": "Polycystic ovary syndrome"
} | step1 | A | [
"year old nulliparous woman",
"polycystic ovary syndrome",
"physician",
"pelvic examination",
"Pap smear",
"year",
"progestin releasing intrauterine device placed",
"Menarche occurred",
"age",
"10",
"sexually active",
"age",
"years",
"mother",
"breast cancer",
"the age of",
"years",
... |
A 17-year-old girl comes to the physician for a scheduled colonoscopy. She was diagnosed with familial adenomatous polyposis at the age of 13 years. Last year, her flexible sigmoidoscopy showed 12 adenomatous polyps (< 6 mm) that were removed endoscopically. Her father and her paternal grandmother were diagnosed with c... | Proctocolectomy with ileoanal anastomosis | {
"A": "Repeat colonoscopy in 6 months",
"B": "Endoscopic biopsy of polyps",
"C": "Proctocolectomy with ileoanal anastomosis",
"D": "Folinic acid (leucovorin) + 5-Fluorouracil + oxaliplatin therapy"
} | step2&3 | C | [
"year old girl",
"physician",
"scheduled colonoscopy",
"diagnosed",
"familial adenomatous polyposis",
"age",
"years",
"flexible sigmoidoscopy showed",
"adenomatous polyps",
"6 mm",
"removed",
"father",
"paternal grandmother",
"diagnosed",
"colon cancer",
"age",
"years",
"patient ap... |
A codon is an mRNA sequence consisting of 3 nucleotides that codes for an amino acid. Each position can be made up of any 4 nucleotides (A, U, G, C); therefore, there are a total of 64 (4 x 4 x 4) different codons that can be created but they only code for 20 amino acids. This is explained by the wobble phenomenon. One... | CUA | {
"A": "AUG",
"B": "CCC",
"C": "CCA",
"D": "CUA"
} | step1 | D | [
"codon",
"mRNA sequence consisting",
"nucleotides",
"codes",
"amino acid",
"position",
"made",
"nucleotides",
"U",
"G",
"total",
"64",
"4",
"4",
"different codons",
"created",
"only code",
"20 amino acids",
"phenomenon",
"One codon",
"leucine",
"following",
"codon coding"... |
A researcher is conducting a study to compare fracture risk in male patients above the age of 65 who received annual DEXA screening to peers who did not receive screening. He conducts a randomized controlled trial in 900 patients, with half of participants assigned to each experimental group. The researcher ultimately ... | Increased probability of rejecting the null hypothesis when it is truly false | {
"A": "Decreased significance level of results",
"B": "Wider confidence intervals of results",
"C": "Increased probability of rejecting the null hypothesis when it is truly false",
"D": "Increased external validity of results"
} | step2&3 | C | [
"researcher",
"conducting",
"study to compare fracture risk",
"male patients",
"age",
"65",
"received annual DEXA screening",
"peers",
"not receive screening",
"conducts",
"randomized controlled trial",
"900 patients",
"half",
"participants assigned",
"experimental group",
"researcher"... |
A 25-year-old woman with bipolar disorder and schizophrenia presents to the emergency room stating that she is pregnant. She says that she has been pregnant since she was 20 years old and is expecting a baby now that she is breathing much harder and feeling more faint with chest pain caused by deep breaths. Her hospita... | Ventilation-perfusion scan | {
"A": "CT angiogram",
"B": "D-dimer",
"C": "Ultrasound",
"D": "Ventilation-perfusion scan"
} | step2&3 | D | [
"year old woman",
"bipolar disorder",
"schizophrenia presents",
"emergency room stating",
"pregnant",
"pregnant",
"20 years old",
"baby now",
"breathing",
"harder",
"feeling more faint",
"chest pain caused",
"deep breaths",
"hospital medical shows multiple negative pregnancy tests",
"pas... |
A 71-year-old man comes to the physician because of a 2-week history of fatigue and a cough productive of a blood-tinged phlegm. Over the past month, he has had a 5.0-kg (11-lb) weight loss. He has hypertension and type 2 diabetes mellitus. Eight months ago, he underwent a kidney transplantation. The patient does not s... | Trimethoprim/sulfamethoxazole | {
"A": "Vancomycin",
"B": "Piperacillin/tazobactam",
"C": "Trimethoprim/sulfamethoxazole",
"D": "Erythromycin"
} | step2&3 | C | [
"71 year old man",
"physician",
"2-week history",
"fatigue",
"cough productive of",
"blood tinged phlegm",
"past month",
"5 0 kg",
"weight loss",
"hypertension",
"type 2 diabetes mellitus",
"Eight months",
"kidney transplantation",
"patient",
"not smoke",
"current medications include l... |
A 61-year-old-male underwent deceased donor liver transplantation 3 weeks ago. During his follow up visit he complains of nausea and abdominal pain. He has been taking all of his medications as prescribed. He has a history of alcohol abuse and his last drink was one year ago. He does not smoke cigarettes and lives at h... | CD8+ T lymphocytes reacting against donor MHCs | {
"A": "CD8+ T lymphocytes reacting against donor MHCs",
"B": "CD4+ T lymphocytes reacting against recipient APCs",
"C": "Pre-existing recipient antibodies",
"D": "Grafted T lymphocytes reacting against host"
} | step1 | A | [
"61 year old male",
"deceased donor",
"weeks",
"follow up visit",
"nausea",
"abdominal pain",
"taking",
"medications",
"prescribed",
"history of alcohol abuse",
"last drink",
"one year ago",
"not smoke cigarettes",
"lives at home",
"wife",
"physical examination temperature",
"98",
... |
A 45-year-old male patient with a history of recurrent nephrolithiasis and chronic lower back pain presents to the ER with severe, sudden-onset, upper abdominal pain. The patient is febrile, hypotensive, and tachycardic, and is rushed to the OR for exploratory laporotomy. Surgery reveals that the patient has a perforat... | A gastrin-secreting tumor of the pancreas | {
"A": "A gastrin-secreting tumor of the pancreas",
"B": "Cytomegalovirus infection",
"C": "H. pylori infection",
"D": "Chronic NSAID use"
} | step1 | A | [
"year old male patient",
"history of recurrent nephrolithiasis",
"chronic lower back pain presents",
"ER",
"severe",
"sudden-onset",
"upper abdominal pain",
"patient",
"febrile",
"hypotensive",
"tachycardic",
"rushed",
"exploratory",
"Surgery reveals",
"patient",
"perforated gastric ul... |
A 32-year-old woman comes to the physician because of pain and stiffness in both of her hands for the past 3 weeks. The pain is most severe early in the day and does not respond to ibuprofen. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Examination shows swelling... | Prednisone | {
"A": "Methotrexate",
"B": "Colchicine",
"C": "Sulfasalazine",
"D": "Prednisone"
} | step1 | D | [
"year old woman",
"physician",
"pain",
"stiffness",
"hands",
"past",
"weeks",
"pain",
"most severe early",
"day",
"not",
"ibuprofen",
"history",
"serious illness",
"takes",
"medications",
"Vital signs",
"normal limits",
"Examination shows swelling",
"tenderness",
"wrists",
... |
A peripheral artery is found to have 50% stenosis. Therefore, compared to a normal artery with no stenosis, by what factor has the flow of blood been decreased? | 16 | {
"A": "2",
"B": "4",
"C": "16",
"D": "32"
} | step1 | C | [
"peripheral artery",
"found to",
"50",
"stenosis",
"compared",
"normal artery",
"stenosis",
"factor",
"flow",
"blood",
"decreased"
] |
A 23-year-old woman presents to her physician requesting the chickenpox vaccine. She is also complaining of nausea, malaise, and moderate weight gain. She developed these symptoms gradually over the past 2 weeks. She reports no respiratory or cardiovascular disorders. Her last menstruation was about 6 weeks ago. She ha... | Confirm pregnancy with serum beta-hCG and if positive, postpone administration of the vaccine until after completion of the pregnancy. | {
"A": "Schedule the vaccination.",
"B": "Confirm pregnancy with serum beta-hCG and if positive, schedule the patient for pregnancy termination.",
"C": "Confirm pregnancy with serum beta-hCG and if positive, postpone administration of the vaccine until after completion of the pregnancy.",
"D": "Confirm pregnanc... | step2&3 | C | [
"23 year old woman presents",
"physician requesting",
"chickenpox vaccine",
"nausea",
"malaise",
"moderate weight gain",
"symptoms",
"past 2 weeks",
"reports",
"respiratory",
"cardiovascular disorders",
"last menstruation",
"about",
"weeks",
"one sexual partner",
"uses",
"natural pla... |
A 20-year-old Caucasian male presents with recurrent nosebleeds. Complete history reveals his father died in his 40's after an intracranial hemorrhage and two of his father's five siblings have also had recurrent nosebleeds. Which of the following would you expect to find in this patient? | Mucosal arteriovenous malformations | {
"A": "Retinal hemangioblastoma",
"B": "Renal cell carcinoma",
"C": "Mucosal arteriovenous malformations",
"D": "Vestibular schwannoma"
} | step1 | C | [
"20 year old Caucasian male presents",
"recurrent nosebleeds",
"Complete history reveals",
"father died",
"40's",
"intracranial hemorrhage",
"two",
"father's five siblings",
"recurrent nosebleeds",
"following",
"to find",
"patient"
] |
A 55-year-old man presents with a bilateral lower leg edema. The patient reports it developed gradually over the past 4 months. The edema is worse in the evening and improves after sleeping at night or napping during the day. There are no associated pain or sensitivity changes. The patient also notes dyspnea on usual e... | Echocardiography | {
"A": "Doppler color ultrasound of the lower extremity",
"B": "Soft tissue ultrasound of the lower extremities",
"C": "T4 and thyroid-stimulating hormone assessment",
"D": "Echocardiography"
} | step2&3 | D | [
"55 year old man presents",
"bilateral lower leg edema",
"patient reports",
"past",
"months",
"edema",
"worse",
"evening",
"improves",
"sleeping",
"night",
"napping",
"day",
"associated pain",
"sensitivity changes",
"patient",
"notes dyspnea on usual exertion",
"as working",
"gar... |
A 39-year-old G3P0 woman presents for preconception counseling and evaluation. The patient’s past medical history reveals hypertension and type 1 diabetes. She is currently on an insulin pump and medications for hypertension including labetalol. Her blood pressure is 130/85 mm Hg; pulse, 76/min; and BMI, 26 kg/m2. Her ... | Age | {
"A": "Chronic hypertension",
"B": "Diabetes",
"C": "Age",
"D": "Hypercoagulable state"
} | step2&3 | C | [
"year old",
"woman presents",
"preconception counseling",
"evaluation",
"patients past medical history reveals hypertension",
"type 1 diabetes",
"currently",
"insulin pump",
"medications",
"hypertension including labetalol",
"blood pressure",
"85 mm Hg",
"pulse",
"76 min",
"BMI",
"kg/m... |
A 71-year-old woman comes to the physician because of palpitations and shortness of breath that started 3 days ago. She has hypertension and congestive heart failure. Her pulse is 124/min, and blood pressure is 130/85 mm Hg. Cardiac examination shows an irregularly irregular rhythm without any murmurs. An ECG shows a n... | Direct inhibition of thrombin | {
"A": "Inhibition of thrombocyte phosphodiesterase III",
"B": "Irreversible inhibition of GPIIb/IIIa complex",
"C": "Direct inhibition of factor Xa",
"D": "Direct inhibition of thrombin"
} | step1 | D | [
"71 year old woman",
"physician",
"palpitations",
"shortness of breath",
"started 3 days",
"hypertension",
"congestive heart failure",
"pulse",
"min",
"blood pressure",
"85 mm Hg",
"Cardiac examination shows",
"irregular rhythm",
"murmurs",
"ECG shows",
"narrow complex tachycardia",
... |
A 5-year-old African American female has experienced recurrent respiratory infections. To determine how well her cell-mediated immunity is performing, a Candida skin injection is administered. After 48 hours, there is no evidence of induration at the injection site. Of the following cell types, which one would have med... | T-cells | {
"A": "Basophils",
"B": "T-cells",
"C": "Mast cells",
"D": "Fibroblasts"
} | step1 | B | [
"5 year old African American female",
"recurrent respiratory infections",
"To",
"well",
"cell-mediated immunity",
"performing",
"Candida skin injection",
"administered",
"48 hours",
"evidence",
"induration",
"injection site",
"following cell types",
"one",
"mediated",
"reaction"
] |
A 62-year-old man comes to the physician for an annual health maintenance examination. He has a history of stable angina, gout, and hypertension. His medications include lisinopril and aspirin. He has smoked a pack of cigarettes daily for 20 years. He drinks 5–6 beers on the weekends. His blood pressure is 150/85 mm Hg... | HMG-CoA reductase inhibitor | {
"A": "HMG-CoA reductase inhibitor",
"B": "Cholesterol absorption inhibitor",
"C": "Proprotein convertase subtilisin kexin 9 inhibitor",
"D": "Bile acid resin"
} | step1 | A | [
"62 year old man",
"physician",
"annual health maintenance examination",
"history",
"stable angina",
"gout",
"hypertension",
"medications include lisinopril",
"aspirin",
"smoked",
"pack",
"cigarettes daily",
"20 years",
"drinks",
"beers",
"weekends",
"blood pressure",
"85 mm Hg",
... |
A 45-year-old woman comes to the pediatrician’s office with her 17-year-old daughter. She tells the physician that she developed Sjögren’s syndrome when she was her daughter’s age, and that she is concerned about her daughter developing the same condition. The girl appears to be in good health, with no signs or symptom... | Anti-SS-B (anti-La) antibodies | {
"A": "Anti-cyclic citrullinated antibodies",
"B": "Anti-SS-B (anti-La) antibodies",
"C": "Anti-histone antibodies",
"D": "Anti-topoisomerase (anti-Scl 70) antibodies"
} | step1 | B | [
"year old woman",
"pediatricians office",
"year old daughter",
"physician",
"syndrome",
"daughters age",
"concerned",
"daughter",
"same condition",
"girl appears to",
"good health",
"signs",
"symptoms",
"disease",
"pathology",
"following antibodies",
"most likely",
"positive",
"d... |
A 40-year-old male presents to his primary care physician complaining of upper abdominal pain. He reports a four-month history of crampy epigastric pain that improves with meals. His past medical history is significant for hypertension that has been well controlled by lisinopril. He does not smoke and drinks alcohol oc... | 11 | {
"A": "5",
"B": "10",
"C": "11",
"D": "17"
} | step1 | C | [
"40 year old male presents",
"primary care physician",
"upper abdominal pain",
"reports",
"four month history",
"crampy epigastric pain",
"improves",
"meals",
"past medical history",
"significant",
"hypertension",
"well controlled by lisinopril",
"not smoke",
"drinks alcohol occasionally",... |
A group of microbiological investigators is studying bacterial DNA replication in E. coli colonies. While the cells are actively proliferating, the investigators stop the bacterial cell cycle during S phase and isolate an enzyme involved in DNA replication. An assay of the enzyme's exonuclease activity determines that ... | DNA polymerase I | {
"A": "DNA ligase",
"B": "Telomerase",
"C": "DNA polymerase I",
"D": "Primase"
} | step1 | C | [
"A group",
"microbiological investigators",
"studying bacterial DNA replication",
"E",
"coli colonies",
"cells",
"proliferating",
"investigators stop",
"bacterial cell cycle",
"phase",
"isolate",
"enzyme involved",
"DNA replication",
"assay",
"enzyme's exonuclease activity",
"active",
... |
A 33-year-old woman comes to the physician because of a 3-week history of fatigue and worsening shortness of breath on exertion. There is no family history of serious illness. She does not smoke. She takes diethylpropion to control her appetite and, as a result, has had a 4.5-kg (10-lb) weight loss during the past 5 mo... | Hyperplasia of pulmonary vascular walls | {
"A": "Hyperplasia of pulmonary vascular walls",
"B": "Blockade of the right bundle branch",
"C": "Fibrosis of pulmonary interstitium",
"D": "Calcification of the pulmonary valve"
} | step1 | A | [
"year old woman",
"physician",
"3 week history",
"fatigue",
"worsening shortness of breath",
"exertion",
"family history",
"serious illness",
"not smoke",
"takes diethylpropion to control",
"appetite",
"result",
"4.5 kg",
"10",
"weight loss",
"past",
"months",
"5 ft 4",
"tall",
... |
An investigator is studying the outcomes of a malaria outbreak in an endemic region of Africa. 500 men and 500 women with known malaria exposure are selected to participate in the study. Participants with G6PD deficiency are excluded from the study. The clinical records of the study subjects are reviewed and their peri... | Glutamic acid substitution in the β-globin chain | {
"A": "Inherited defect in erythrocyte membrane ankyrin protein",
"B": "Defective X-linked ALA synthase gene",
"C": "Inherited mutation affecting ribosome synthesis",
"D": "Glutamic acid substitution in the β-globin chain"
} | step1 | D | [
"investigator",
"studying",
"outcomes",
"malaria outbreak",
"region",
"Africa",
"500 men",
"500 women",
"known malaria exposure",
"selected to",
"study",
"Participants",
"G6PD deficiency",
"excluded",
"study",
"clinical records of",
"study subjects",
"reviewed",
"peripheral blood... |
A 45-year-old man comes to his primary care provider for a routine visit. The patient mentions that while he was cooking 5 days ago, he accidentally cut himself with a meat cleaver and lost the skin at the tip of his finger. After applying pressure and ice, the bleeding stopped and he did not seek treatment. The patien... | Deposition of type III collagen | {
"A": "Deposition of type I collagen",
"B": "Deposition of type III collagen",
"C": "Epithelial cell migration from the wound borders",
"D": "Neutrophil migration into the wound"
} | step1 | B | [
"year old man",
"primary care provider",
"routine visit",
"patient",
"cooking 5 days",
"cut",
"meat cleaver",
"lost",
"skin",
"tip",
"finger",
"applying pressure",
"ice",
"bleeding stopped",
"not",
"treatment",
"patient",
"healthy",
"not take",
"daily medications",
"patients ... |
An otherwise healthy 56-year-old woman comes to the physician because of a 3-year history of intermittent upper abdominal pain. She has had no nausea, vomiting, or change in weight. Physical examination shows no abnormalities. Laboratory studies are within normal limits. Abdominal ultrasonography shows a hyperechogenic... | Gallbladder carcinoma | {
"A": "Hepatocellular carcinoma",
"B": "Pyogenic liver abscess",
"C": "Gallbladder carcinoma",
"D": "Acute pancreatitis"
} | step1 | C | [
"healthy",
"year old woman",
"physician",
"3 year history",
"intermittent upper",
"nausea",
"vomiting",
"change in weight",
"Physical examination shows",
"abnormalities",
"Laboratory studies",
"normal limits",
"Abdominal ultrasonography shows",
"rim",
"calcification of",
"gallbladder w... |
An excisional biopsy is performed and the diagnosis of superficial spreading melanoma is confirmed. The lesion is 1.1 mm thick. Which of the following is the most appropriate next step in management? | Surgical excision with 1-2 cm safety margins and sentinel lymph node study | {
"A": "Surgical excision with 0.5-1 cm safety margins only",
"B": "Surgical excision with 1-2 cm safety margins only",
"C": "Surgical excision with 1-2 cm safety margins and sentinel lymph node study",
"D": "Surgical excision with 0.5-1 cm safety margins and sentinel lymph node study"
} | step2&3 | C | [
"excisional biopsy",
"performed",
"diagnosis",
"superficial spreading melanoma",
"confirmed",
"lesion",
"1",
"mm thick",
"following",
"most appropriate next step",
"management"
] |
A 52-year-old man comes to the physician for a routine health maintenance examination. He has not seen a physician for 10 years. He works as a telemarketer and does not exercise. Cardiac examination shows a dull, low-pitched sound during late diastole that is best heard at the apex. The sound is loudest in the left lat... | Concentric left ventricular hypertrophy | {
"A": "Concentric left ventricular hypertrophy",
"B": "Dilation of both ventricles",
"C": "Fusion of mitral valve leaflets",
"D": "Right bundle branch block"
} | step1 | A | [
"year old man",
"physician",
"routine health maintenance examination",
"not seen",
"physician",
"10 years",
"works",
"not exercise",
"Cardiac examination shows",
"dull",
"low-pitched sound",
"late",
"best heard",
"apex",
"sound",
"loudest",
"left lateral decubitus position",
"end-e... |
A 42-year-old woman comes to the physician because of vaginal discharge for 3 days. She has no dysuria, dyspareunia, pruritus, or burning. The patient is sexually active with two male partners and uses condoms inconsistently. She often douches between sexual intercourse. Pelvic examination shows thin and off-white vagi... | Treat the patient with metronidazole | {
"A": "Treat the patient with ceftriaxone and azithromycin",
"B": "Treat the patient and partners with metronidazole",
"C": "Treat the patient with metronidazole",
"D": "Treat patient and partners with topical ketoconazole"
} | step2&3 | C | [
"year old woman",
"physician",
"of vaginal discharge",
"3 days",
"dysuria",
"dyspareunia",
"pruritus",
"burning",
"patient",
"sexually active",
"two male partners",
"uses condoms",
"often douches",
"sexual intercourse",
"Pelvic examination shows thin",
"off white vaginal discharge",
... |
A 31-year-old man comes to the physician because of a 2-day history of nausea, abdominal discomfort, and yellow discoloration of the eyes. Six weeks ago, he had an episode of fever, joint pain, swollen lymph nodes, and an itchy rash on his trunk and extremities that persisted for 1 to 2 days. He returned from a backpac... | Hepatitis B | {
"A": "Hepatitis B",
"B": "Borrelia burgdorferi",
"C": "Hepatitis A",
"D": "Campylobacter jejuni"
} | step1 | A | [
"31 year old man",
"physician",
"2-day history",
"nausea",
"abdominal discomfort",
"yellow",
"eyes",
"Six weeks",
"episode of fever",
"joint pain",
"swollen lymph nodes",
"itchy",
"trunk",
"extremities",
"2 days",
"returned",
"trip",
"Colombia two months",
"temperature",
"Physi... |
A 49-year-old woman comes to the physician because of difficulty walking and dizziness for the past 2 weeks. She has also had fatigue, heartburn, and diarrhea for 4 months. The stools are foul-smelling and do not flush easily. Over the past 4 months, she has had a 2.2-kg (5-lb) weight loss. Her only medication is an ov... | Inactivation of pancreatic enzymes | {
"A": "Inactivation of pancreatic enzymes",
"B": "T. whipplei infiltration of intestinal villi",
"C": "Intestinal inflammatory reaction to gluten",
"D": "Small intestine bacterial overgrowth"
} | step2&3 | A | [
"year old woman",
"physician",
"difficulty walking",
"dizziness",
"past 2 weeks",
"fatigue",
"heartburn",
"diarrhea",
"months",
"stools",
"smelling",
"not flush easily",
"past",
"months",
"2.2 kg",
"5",
"weight loss",
"only medication",
"over-the-counter antacid",
"mother",
"... |
A 58-year-old woman is brought to the emergency department 30 minutes after developing acute confusion, severe headache, and vomiting. Physical examination shows left-sided numbness. A CT scan of her head shows a large intraparenchymal hemorrhage. Despite appropriate treatment, the patient dies. Autopsy shows multiple ... | Muscle weakness | {
"A": "Paroxysmal diaphoresis",
"B": "Abdominal striae",
"C": "Muscle weakness",
"D": "Peripheral edema"
} | step1 | C | [
"58 year old woman",
"brought",
"emergency department 30 minutes",
"acute confusion",
"severe headache",
"vomiting",
"Physical examination shows left-sided numbness",
"CT scan of",
"head shows",
"large intraparenchymal hemorrhage",
"appropriate treatment",
"patient",
"Autopsy shows multiple ... |
A 13-year-old African American boy with sickle cell disease is brought to the emergency department with complaints of abdominal pain over the last 24 hours. The pain is situated in the right upper quadrant and is sharp in nature with a score of 8/10 and radiates to tip of the right scapula. He also complains of anorexi... | Chronic hemolysis | {
"A": "Increased cholesterol secretion",
"B": "Impaired gallbladder emptying",
"C": "Decreased bile salt absorption",
"D": "Chronic hemolysis"
} | step2&3 | D | [
"year old African American boy",
"sickle cell disease",
"brought",
"emergency department",
"complaints",
"abdominal pain",
"last 24 hours",
"pain",
"right upper quadrant",
"sharp",
"nature",
"score",
"8/10",
"radiates to tip",
"right scapula",
"anorexia",
"nausea",
"past 2 days",
... |
A 21-year-old woman presents with irregular menses, acne, and increased body hair growth. She says her average menstrual cycle lasts 36 days and states that she has heavy menstrual bleeding. She had her menarche at the age of 13 years. Her blood pressure is 125/80 mm Hg, heart rate is 79/min, respiratory rate is 14/min... | Insulin resistance | {
"A": "Insulin resistance",
"B": "Aldosterone hyperproduction",
"C": "Adrenaline hypersecretion",
"D": "Hypoestrogenism"
} | step1 | A | [
"21-year-old woman presents",
"irregular menses",
"acne",
"increased hair",
"average menstrual cycle",
"36 days",
"states",
"heavy menstrual bleeding",
"menarche at",
"age",
"years",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36"... |
A 70-year-old man is brought to the emergency department by his wife because of progressive confusion for the past 2 weeks. He has also had a 4.5-kg (10-lb) weight loss and fatigue during the last 6 months. Physical examination shows enlarged lymph nodes in the right axilla and faint expiratory wheezing in the right mi... | Neuron-specific enolase | {
"A": "Neurofilament",
"B": "Napsin A",
"C": "S-100",
"D": "Neuron-specific enolase"
} | step1 | D | [
"70 year old man",
"brought",
"emergency department",
"wife",
"progressive confusion",
"past 2 weeks",
"4.5 kg",
"10",
"weight loss",
"fatigue",
"months",
"Physical shows enlarged lymph nodes",
"right axilla",
"faint expiratory wheezing",
"right middle lung field",
"only oriented to pe... |
An otherwise healthy 17-year-old girl comes to the physician because of multiple patches on her face, hands, abdomen, and feet that are lighter than the rest of her skin. The patches began to appear 3 years ago and have been gradually increasing in size since. There is no associated itchiness, redness, numbness, or pai... | Autoimmune destruction of melanocytes | {
"A": "Absence of tyrosinase activity",
"B": "Infection with Mycobacterium leprae",
"C": "Infection with Malassezia globosa",
"D": "Autoimmune destruction of melanocytes"
} | step1 | D | [
"healthy",
"year old girl",
"physician",
"of multiple patches",
"face",
"hands",
"abdomen",
"feet",
"lighter",
"rest",
"skin",
"patches began to appear 3 years",
"increasing in size",
"associated itchiness",
"redness",
"numbness",
"pain",
"India",
"years",
"image",
"lesions",... |
A 9-year-old boy is brought to the emergency department by his parents after a 2-day history of fever, productive cough, and severe dyspnea. The parents report that the boy had no health problems at birth but developed respiratory problems as an infant that have continued throughout his life, including recurrent pulmon... | Adenovirus | {
"A": "Adenovirus",
"B": "Rhinovirus",
"C": "Human immunodeficiency virus-1",
"D": "Coxsackie A virus"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"parents",
"2-day history",
"fever",
"productive cough",
"severe dyspnea",
"parents report",
"boy",
"health problems",
"birth",
"respiratory problems",
"infant",
"continued",
"life",
"including recurrent pulmonary infections",
"Vit... |
A 56-year-old woman presents to the emergency department with severe pain in her legs. She has had these pains in the past but access to a doctor was not readily available in her remote village back home. She and her family have recently moved to the United States. She is seen walking to her stretcher with a broad-base... | Loss of vibration sensation | {
"A": "Negative Romberg sign",
"B": "Painless ulcerated papules",
"C": "Bell's Palsy",
"D": "Loss of vibration sensation"
} | step1 | D | [
"year old woman presents",
"emergency department",
"severe pain in",
"legs",
"pains",
"past",
"access",
"doctor",
"not",
"available",
"remote village back home",
"family",
"recently moved to",
"United States",
"seen walking",
"stretcher",
"broad-based gait",
"Ophthalmic examination... |
A 26-year-old man comes to the physician for a follow-up examination. Two weeks ago, he was treated in the emergency department for head trauma after being hit by a bicycle while crossing the street. Neurological examination shows decreased taste on the right anterior tongue. This patient's condition is most likely cau... | Eyelid closure | {
"A": "Uvula movement",
"B": "Facial sensation",
"C": "Eyelid closure",
"D": "Tongue protrusion"
} | step1 | C | [
"year old man",
"physician",
"follow-up examination",
"Two weeks",
"treated",
"emergency department",
"head trauma",
"hit",
"bicycle",
"crossing",
"street",
"Neurological examination shows decreased taste",
"right",
"patient's condition",
"most likely caused",
"damage",
"cranial nerv... |
A 45-year-old male presents to his primary care physician complaining of drainage from his left great toe. He has had an ulcer on his left great toe for over eight months. He noticed increasing drainage from the ulcer over the past week. His past medical history is notable for diabetes mellitus on insulin complicated b... | Otitis externa | {
"A": "Otitis externa",
"B": "Gastroenteritis",
"C": "Waterhouse-Friedrichsen syndrome",
"D": "Rheumatic fever"
} | step1 | A | [
"year old male presents",
"primary care physician",
"drainage",
"left great toe",
"ulcer",
"left great toe",
"over eight months",
"increasing drainage",
"ulcer",
"past week",
"past medical history",
"notable",
"diabetes mellitus",
"insulin complicated",
"peripheral neuropathy",
"retino... |
A 69-year-old woman comes to the physician because of a 4-month history of cough with blood-tinged sputum and a 4.5-kg (10-lb) weight loss. She has smoked one pack of cigarettes daily for 38 years. Auscultation of the lungs shows wheezing in the right lung field. An x-ray of the chest shows an irregular lesion with a c... | Mediastinal invasion | {
"A": "High mitotic activity",
"B": "High nucleus to cytoplasmic ratio",
"C": "Mediastinal invasion",
"D": "Poor cellular differentiation\n\""
} | step1 | C | [
"69 year old woman",
"physician",
"4 month history",
"cough",
"blood-tinged sputum",
"4.5 kg",
"10",
"weight loss",
"smoked one pack",
"cigarettes daily",
"years",
"Auscultation",
"lungs shows wheezing",
"right lung field",
"x-ray of",
"chest shows",
"irregular lesion",
"central ca... |
A 44-year-old woman presents to the emergency department with confusion starting this morning. Her husband states that she initially complained of abdominal pain, diarrhea, and fatigue after eating. She has vomited 3 times and progressively became more confused. Her past medical history is notable for morbid obesity, d... | Dumping syndrome | {
"A": "Dumping syndrome",
"B": "Insulin overdose",
"C": "Malnutrition",
"D": "Propranolol overdose"
} | step2&3 | A | [
"year old woman presents",
"emergency department",
"confusion starting",
"morning",
"husband states",
"initially",
"abdominal pain",
"diarrhea",
"fatigue",
"eating",
"vomited 3 times",
"more confused",
"past medical history",
"notable",
"morbid obesity",
"diabetes",
"hypertension",
... |
A 69-year-old man is brought to the emergency department because of severe epigastric pain and vomiting that started 30 minutes ago while gardening. His pulse is 55/min, respirations are 30/min, and blood pressure is 90/50 mm Hg. Physical examination shows diaphoresis and jugular venous distention. Crackles are heard i... | Proximal right coronary artery | {
"A": "Proximal right coronary artery",
"B": "Left circumflex artery",
"C": "Left anterior descending artery",
"D": "Posterior interventricular artery"
} | step1 | A | [
"69 year old man",
"brought",
"emergency department",
"severe epigastric",
"vomiting",
"started 30 minutes",
"gardening",
"pulse",
"55 min",
"respirations",
"30/min",
"blood pressure",
"90 50 mm Hg",
"Physical examination shows diaphoresis",
"jugular venous distention",
"Crackles",
"... |
An HIV-positive patient with a CD4+ count of 45 is receiving recommended first-line treatment for a case of cytomegalovirus retinitis. Coadministration with which of the following agents would be most likely to precipitate a deficiency of neutrophils in this patient? | Zidovudine | {
"A": "Foscarnet",
"B": "Zidovudine",
"C": "Efavirenz",
"D": "Raltegravir"
} | step1 | B | [
"HIV-positive patient",
"CD4",
"count",
"receiving recommended first-line treatment",
"case",
"cytomegalovirus retinitis",
"Coadministration",
"following agents",
"most likely to precipitate",
"deficiency",
"neutrophils",
"patient"
] |
An investigator studying the immunologic profile of various cells notices that the blood of a test subject agglutinates upon addition of a serum containing antibodies against P blood group antigens. Infection with which of the following pathogens would most likely be prevented by these antibodies? | Parvovirus B19 | {
"A": "Parvovirus B19",
"B": "Babesia microti",
"C": "Plasmodium vivax",
"D": "Influenza virus"
} | step1 | A | [
"investigator studying",
"immunologic profile",
"various cells",
"blood",
"test subject",
"addition",
"serum containing antibodies",
"blood group antigens",
"Infection",
"of the following pathogens",
"most likely",
"prevented",
"antibodies"
] |
A 3-month-old boy is brought to the physician by his parents for the evaluation of a rash on his scalp and forehead. The parents report that the rash has been present for several weeks. They state that the rash is sometimes red and scaly, especially when it is cold. The patient was born at 36 weeks' gestation and has g... | Seborrheic dermatitis | {
"A": "Atopic dermatitis",
"B": "Seborrheic keratosis",
"C": "Allergic contact dermatitis",
"D": "Seborrheic dermatitis"
} | step2&3 | D | [
"3 month old boy",
"brought",
"physician",
"parents",
"evaluation",
"rash",
"scalp",
"forehead",
"parents report",
"rash",
"present",
"weeks",
"state",
"rash",
"sometimes red",
"scaly",
"cold",
"patient",
"born",
"36 weeks",
"gestation",
"healthy",
"father",
"psoriasis"... |
A 25-year-old woman has dysuria, pyuria, increased frequency of urination, and fever of 1-day duration. She is sexually active. Urine cultures show gram-positive bacteria in clusters that are catalase-positive and coagulase-negative. The patient is started on trimethoprim-sulfamethoxazole. Which of the following charac... | Resistance to novobiocin | {
"A": "Beta hemolysis",
"B": "Sensitivity to novobiocin",
"C": "Sensitivity to bacitracin",
"D": "Resistance to novobiocin"
} | step1 | D | [
"year old woman",
"dysuria",
"pyuria",
"increased frequency of urination",
"fever",
"1-day duration",
"sexually active",
"Urine cultures show gram-positive bacteria",
"clusters",
"catalase positive",
"coagulase negative",
"patient",
"started",
"trimethoprim-sulfamethoxazole",
"following ... |
A 27-year-old man presents to the emergency department with dizziness. He states he has experienced a sustained sensation of the room spinning that is low grade and constant since this morning. The patient occasionally feels nauseous and has been taking diphenydramine to sleep which helps with his symptoms. The patient... | Labyrinthitis | {
"A": "Benign paroxysmal positional vertigo",
"B": "Labyrinthitis",
"C": "Vertebrobasilar stroke",
"D": "Vestibular neuritis"
} | step2&3 | B | [
"27 year old man presents",
"emergency department",
"dizziness",
"states",
"experienced",
"sustained sensation",
"room",
"low grade",
"constant",
"morning",
"patient occasionally feels nauseous",
"taking",
"to sleep",
"helps",
"symptoms",
"patient",
"healthy",
"medical conditions",... |
A 72-year-old man presents to his primary care physician complaining of increasing difficulty sleeping over the last 3 months. He reports waking up frequently during the night because he feels an urge to move his legs, and he has a similar feeling when watching television before bed. The urge is relieved by walking aro... | Colonoscopy | {
"A": "Dopamine uptake scan of the brain",
"B": "Colonoscopy",
"C": "Trial of reduction in caffeine intake",
"D": "Trial of pramipexole"
} | step2&3 | B | [
"72 year old man presents",
"primary care physician",
"increasing difficulty sleeping",
"last",
"months",
"reports waking",
"frequently",
"night",
"feels",
"to move",
"legs",
"similar feeling",
"watching television",
"bed",
"relieved by walking",
"legs",
"patients wife",
"notes",
... |
A 38-year-old man comes to the physician because of upper abdominal discomfort for 2 weeks. He has had 3–4 episodes of vomiting during this period. Over the last year, he has had frequent episodes of abdominal pain at night that were relieved by eating. He underwent a right shoulder surgery 6 weeks ago. He has no histo... | Penetrating duodenal ulcer | {
"A": "Penetrating duodenal ulcer",
"B": "Acute pancreatitis",
"C": "Echinococcus granulosus",
"D": "Entamoeba histolytica"
} | step2&3 | A | [
"year old man",
"physician",
"of upper abdominal discomfort",
"2 weeks",
"episodes of vomiting",
"period",
"last year",
"frequent episodes of abdominal pain",
"night",
"relieved by eating",
"right",
"weeks",
"history",
"serious illness",
"smoked one pack",
"cigarettes daily",
"years"... |
A 22-year-old primigravid woman comes to the physician for her initial prenatal visit at 12 weeks' gestation. She has had generalized fatigue and shortness of breath over the past 2 months. She has also had a tingling sensation in her toes for the past month. Three years ago, she was treated for gonorrhea. She follows ... | Vitamin B12 supplementation | {
"A": "Calcium supplementation",
"B": "Vitamin B12 supplementation",
"C": "Thyroxine supplementation",
"D": "Penicillin G therapy"
} | step2&3 | B | [
"year old primigravid woman",
"physician",
"initial prenatal visit",
"weeks",
"gestation",
"generalized fatigue",
"shortness of breath",
"past",
"months",
"tingling sensation",
"toes",
"past month",
"Three years",
"treated",
"gonorrhea",
"follows",
"vegan diet",
"age",
"years",
... |
A 36-year-old woman comes to the physician to discuss contraceptive options. She is currently sexually active with one male partner, and they have not been using any contraception. She has no significant past medical history and takes no medications. She has smoked one pack of cigarettes daily for 15 years. She is alle... | Combined oral contraceptive pill | {
"A": "Diaphragm with spermicide",
"B": "Progestin-only pill",
"C": "Intrauterine device",
"D": "Combined oral contraceptive pill"
} | step2&3 | D | [
"36 year old woman",
"physician to discuss contraceptive options",
"currently sexually active",
"one male partner",
"not",
"using",
"contraception",
"significant past medical history",
"takes",
"medications",
"smoked one pack",
"cigarettes daily",
"years",
"allergic",
"latex",
"copper"... |
A 68-year-old man is brought to the emergency department because of a severe headache, nausea, and vomiting for 30 minutes. Forty-five minutes ago, he fell and struck his head, resulting in loss of consciousness for 1 minute. After regaining consciousness, he felt well for 15 minutes before the headache began. On arriv... | Bleeding between dura mater and skull | {
"A": "Cerebrospinal fluid production/absorption mismatch",
"B": "Rupture of bridging veins",
"C": "Acute insufficiency of cerebral blood flow",
"D": "Bleeding between dura mater and skull"
} | step1 | D | [
"68 year old man",
"brought",
"emergency department",
"severe headache",
"nausea",
"vomiting",
"30 minutes",
"Forty-five",
"fell",
"struck",
"head",
"resulting in loss of consciousness",
"1 minute",
"regaining consciousness",
"felt well",
"15 minutes",
"headache began",
"arrival",
... |
Three days after undergoing coronary bypass surgery, a 67-year-old man becomes unresponsive and hypotensive. He is intubated, mechanically ventilated, and a central line is inserted. Vasopressin and noradrenaline infusions are begun. A Foley catheter is placed. Six days later, he has high unrelenting fevers. He is curr... | Central line-associated blood stream infection | {
"A": "Central line-associated blood stream infection",
"B": "Catheter-associated urinary tract infection",
"C": "Bowel ischemia",
"D": "Surgical site infection"
} | step2&3 | A | [
"Three days",
"coronary bypass surgery",
"67 year old man",
"unresponsive",
"hypotensive",
"intubated",
"ventilated",
"central line",
"inserted",
"Vasopressin",
"noradrenaline infusions",
"begun",
"Foley catheter",
"placed",
"Six days later",
"high",
"fevers",
"currently receiving ... |
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