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 previously healthy 9-year-old boy is brought to the physician by his mother because of a 3-month history of episodic abdominal pain. During this time, he has been more tired than usual. For the past 2 months, he has also had bulky stools that are difficult to flush. His maternal aunt has systemic lupus erythematosus.... | Deficiency of clotting factor II | {
"A": "Deficiency of clotting factor VIII",
"B": "Increased activity of protein S",
"C": "Increased serum anti-phospholipid antibodies",
"D": "Deficiency of clotting factor II"
} | step2&3 | D | [
"healthy",
"year old boy",
"brought",
"physician",
"mother",
"month history",
"episodic abdominal pain",
"time",
"more tired",
"usual",
"past",
"months",
"bulky stools",
"difficult to flush",
"maternal aunt",
"systemic lupus erythematosus",
"boy",
"percentile",
"height",
"5th p... |
An investigator is conducting a study to document the histological changes in the respiratory tree of a chronic smoker. He obtains multiple biopsy samples from the respiratory system of a previously healthy 28-year-old man. Histopathological examination of one sample shows simple cuboidal cells with a surrounding layer... | Terminal bronchiole | {
"A": "Respiratory bronchiole",
"B": "Terminal bronchiole",
"C": "Conducting bronchiole",
"D": "Main stem bronchus"
} | step1 | B | [
"investigator",
"conducting",
"study to document",
"histological changes",
"respiratory tree",
"chronic smoker",
"obtains multiple biopsy samples",
"respiratory system of",
"healthy",
"year old man",
"examination",
"one sample shows simple cuboidal cells",
"surrounding layer",
"smooth musc... |
A 7-year-old boy presents with frequent episodes of blanking out or daydreaming. Each episode lasts for less than 10 seconds. During the episode, he is unaware of what is going on around him and does not respond to questions or calling his name. After the episode, he continues whatever he was doing before. An EEG is pe... | Inhibits voltage-gated calcium channels | {
"A": "Inhibits voltage-gated calcium channels",
"B": "Inhibits release of excitatory amino acid glutamate",
"C": "Inhibits neuronal GABA receptors",
"D": "Potentiates GABA transmission"
} | step1 | A | [
"year old boy presents",
"frequent episodes of blanking out",
"daydreaming",
"episode",
"10 seconds",
"episode",
"unaware",
"not",
"questions",
"calling",
"name",
"episode",
"continues",
"before",
"EEG",
"performed",
"one of",
"episodes",
"shows generalized",
"Hz",
"dome",
... |
An 81-year-old man is brought to the emergency department by staff of an assisted living facility where he resides with fever and a cough that produces yellow-green sputum. His temperature is 39.1°C (102.3°F). Physical examination shows diffuse crackles over the right lung fields. An x-ray of the chest shows consolidat... | Impairs bacterial degradation of piperacillin | {
"A": "Impairs bacterial degradation of piperacillin",
"B": "Inhibits bacterial synthesis of folate",
"C": "Prevents the metabolic breakdown of piperacillin",
"D": "Increases the potency of piperacillin"
} | step1 | A | [
"81 year old man",
"brought",
"emergency department",
"staff",
"assisted living facility",
"resides",
"fever",
"cough",
"yellow",
"temperature",
"Physical examination shows diffuse crackles",
"right lung fields",
"x-ray of",
"chest shows consolidation",
"right lower lobe",
"Sputum cult... |
A 73-year-old woman arrives at the emergency department due to intense central chest pain for 30 minutes this morning. She says the pain was cramping in nature and radiated down her left arm. She has a history of atrial fibrillation and type 2 diabetes mellitus. Her pulse is 98/min, respiratory rate is 19/min, temperat... | Troponin I | {
"A": "Alanine aminotransferase",
"B": "Creatinine-kinase MB",
"C": "Lactate dehydrogenase (LDH)",
"D": "Troponin I"
} | step1 | D | [
"year old woman",
"emergency department due to intense central chest pain",
"30 minutes",
"morning",
"pain",
"cramping",
"nature",
"radiated",
"left arm",
"history of atrial fibrillation",
"type 2 diabetes mellitus",
"pulse",
"98 min",
"respiratory rate",
"min",
"temperature",
"36",
... |
A 63-year-old man comes to the physician because of fatigue and muscle cramps for 6 weeks. He also noticed several episodes of tingling around the mouth and in the fingers and toes. He has osteoarthritis of his knees and hypertension. Current medications include ibuprofen and ramipril. He has smoked one pack of cigaret... | Destruction of parathyroid glands | {
"A": "Vitamin D deficiency",
"B": "Ectopic hormone production",
"C": "Destruction of parathyroid glands",
"D": "Albright hereditary osteodystrophy\n\""
} | step1 | C | [
"63 year old man",
"physician",
"fatigue",
"muscle cramps",
"weeks",
"several episodes of tingling",
"mouth",
"fingers",
"toes",
"osteoarthritis of",
"knees",
"hypertension",
"Current medications include ibuprofen",
"ramipril",
"smoked one pack",
"cigarettes daily",
"35 years",
"fa... |
A new mother brings in her 4-week-old son who has no significant past medical history but she complains of a new, itchy rash on his body. The patient has an older sister who developed similar symptoms when she was around the same age. The patient's blood pressure is 121/78 mm Hg, pulse is 70/min, respiratory rate is 16... | Hot baths that are too long, or too frequent, can dry out the skin. | {
"A": "Hot baths that are too long, or too frequent, can dry out the skin.",
"B": "This condition is caused by the herpes simplex virus.",
"C": "You can expect blisters, fever and large areas of skin that peel or fall away.",
"D": "This condition is usually seen on the scalp, face, ears, and neck."
} | step2&3 | A | [
"new mother",
"week old son",
"significant past medical history",
"new",
"itchy rash",
"body",
"patient",
"older sister",
"similar symptoms",
"same age",
"patient's blood pressure",
"mm Hg",
"pulse",
"70 min",
"respiratory rate",
"min",
"temperature",
"3C",
"99",
"Physical exam... |
A 44-year-old G5P3 presents with a 2-year history of leaking urine upon exerting herself, coughing, and laughing. Her symptoms are only present in the daytime. She denies urgency, nocturia, or painful urination. She has no menstrual cycle disturbances. Her husband is her only sexual partner. She has a 12 pack-year smok... | Cystocele | {
"A": "Rectocele",
"B": "Ovarian mass",
"C": "Purulent cervical discharge",
"D": "Cystocele"
} | step2&3 | D | [
"year old",
"presents",
"year history of leaking urine",
"exerting",
"coughing",
"laughing",
"symptoms",
"only present",
"daytime",
"denies urgency",
"nocturia",
"painful urination",
"menstrual cycle disturbances",
"husband",
"only sexual partner",
"pack-year smoking history",
"3 yea... |
A 31-year-old man comes to the emergency department for acute tearing chest pain that radiates to the back. Despite appropriate therapy, the patient dies. Autopsy shows an increase in mucoid extracellular matrix and loss of smooth muscle cell nuclei in the media of large arteries. Which of the following additional find... | Pectus carinatum | {
"A": "Nasal septum perforation",
"B": "Inferonasal lens dislocation",
"C": "Pes cavus with hammer toes",
"D": "Pectus carinatum"
} | step1 | D | [
"31 year old man",
"emergency department",
"acute tearing chest pain",
"radiates",
"back",
"appropriate therapy",
"patient",
"Autopsy shows",
"increase",
"mucoid extracellular matrix",
"loss of smooth muscle cell nuclei",
"media",
"large arteries",
"following additional findings",
"most ... |
A 46-year-old woman presents to her primary care provider reporting several weeks of fatigue and recent episodes of lightheadedness. She is concerned that she will have an episode while driving. She has never lost consciousness, and reports that there is no associated vertigo or dizziness. She states that she normally ... | Microcytic anemia, increased TIBC, decreased ferritin | {
"A": "Microcytic anemia, increased TIBC, decreased ferritin",
"B": "Microcytic anemia, increased TIBC, increased ferritin",
"C": "Normocytic anemia, decreased TIBC, increased ferritin",
"D": "Normocytic anemia, increased TIBC, increased ferritin"
} | step1 | A | [
"year old woman presents",
"primary care provider reporting several weeks",
"fatigue",
"recent episodes of lightheadedness",
"concerned",
"episode",
"driving",
"never lost consciousness",
"reports",
"associated vertigo",
"dizziness",
"states",
"goes",
"jog 3 times",
"week",
"winded muc... |
A 57-year-old man is sent to the emergency department by his primary care physician for hypertension. He was at a general health maintenance appointment when his blood pressure was found to be 180/115 mmHg; thus, prompting his primary doctor to send him to the emergency room. The patient is otherwise currently asymptom... | Hypertensive emergency | {
"A": "Cushing syndrome",
"B": "Hypertension",
"C": "Hypertensive emergency",
"D": "Hypertensive urgency"
} | step2&3 | C | [
"57 year old man",
"sent",
"emergency department",
"primary care physician",
"hypertension",
"general appointment",
"blood pressure",
"found to",
"mmHg",
"prompting",
"primary doctor to send",
"emergency room",
"patient",
"currently asymptomatic",
"states",
"feels well",
"patient",
... |
A 48-year-old man and his wife present to a psychologist’s office for a therapy session. He was encouraged to visit the psychiatrist 6 months ago by his wife and they have been meeting with the psychologist several times a month ever since. Initially, she was concerned about behavioral changes she observed after he was... | Introjection | {
"A": "Sublimation",
"B": "Conversion",
"C": "Introjection",
"D": "Regression"
} | step1 | C | [
"48 year old man",
"wife present",
"psychologists office",
"therapy session",
"to visit",
"psychiatrist",
"months",
"wife",
"meeting",
"psychologist",
"times",
"month ever",
"Initially",
"concerned",
"behavioral changes",
"observed",
"passed",
"promotion",
"work",
"felt",
"ne... |
A 57-year-old woman returns to her primary care provider complaining of fever, skin rash, and flank pain. She had just visited her PCP 2 weeks ago complaining of a sore throat and was diagnosed with pharyngitis. She was then given a 10 day prescription for phenoxymethylpenicillin. Today she is on day 6 of her prescript... | Discontinue the triggering medication(s) | {
"A": "Short course of prednisolone",
"B": "Discontinue the triggering medication(s)",
"C": "Renal biopsy",
"D": "Supportive dialysis"
} | step2&3 | B | [
"57 year old woman returns",
"primary care provider",
"of fever",
"skin rash",
"flank pain",
"visited",
"PCP 2 weeks",
"sore throat",
"diagnosed",
"pharyngitis",
"then given a 10 day prescription",
"phenoxymethylpenicillin",
"Today",
"day 6",
"prescription",
"symptoms started",
"Past... |
A 30-year-old G3P1011 seeks evaluation at the obstetrics clinic for lower abdominal pain and vaginal bleeding. She is 15 weeks pregnant based on a first-trimester ultrasound. She had spotting early in the pregnancy, but has had no other problems. On physical examination she appears mildly anxious. Her vital signs are n... | Threatened abortion | {
"A": "Incomplete abortion",
"B": "Inevitable abortion",
"C": "Threatened abortion",
"D": "Complete abortion"
} | step2&3 | C | [
"30 year old",
"evaluation",
"obstetrics clinic",
"lower abdominal pain",
"vaginal bleeding",
"weeks pregnant based",
"first-trimester ultrasound",
"spotting early",
"pregnancy",
"problems",
"physical examination",
"appears mildly anxious",
"vital signs",
"normal",
"heart rate",
"minut... |
An investigator is studying the rate of wound healing by secondary intention. He performs a biopsy of a surgically debrided wound 1 day and 5 days after the initial surgical procedure. The second biopsy shows wound contraction, endothelial cell proliferation, and accumulation of macrophages. The cells responsible for w... | Reticular fibers | {
"A": "Reticular fibers",
"B": "Nucleus pulposus",
"C": "Basal lamina",
"D": "Corneal stroma"
} | step1 | A | [
"investigator",
"studying",
"rate",
"wound healing",
"secondary intention",
"performs",
"biopsy",
"surgically",
"wound 1 day",
"5 days",
"initial surgical procedure",
"second biopsy shows wound contraction",
"endothelial cell proliferation",
"accumulation",
"macrophages",
"cells respon... |
A 42-year-old man is brought to the emergency department by police. He was found obtunded at a homeless shelter. The patient has a past medical history of alcohol abuse, intravenous (IV) drug use, schizophrenia, hepatitis C, and anxiety. His current medications include disulfiram, intramuscular haloperidol, thiamine, a... | Fresh frozen plasma | {
"A": "Desmopressin",
"B": "Factor VIII concentrate",
"C": "Fresh frozen plasma",
"D": "Phytonadione"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"police",
"found obtunded",
"homeless shelter",
"patient",
"past medical history of alcohol abuse",
"intravenous",
"drug use",
"schizophrenia",
"hepatitis C",
"anxiety",
"current medications include disulfiram",
"intramuscular haloperido... |
A 36-year-old Asian G4P3 presents to her physician with a recently diagnosed pregnancy for a first prenatal visit. The estimated gestational age is 5 weeks. She had 2 vaginal deliveries and 1 medical abortion. Her children had birth weights of 4100 g and 4560 g. Her medical history is significant for gastroesophageal r... | Glucose oral tolerance test | {
"A": "Serology for CMV",
"B": "Coagulogram",
"C": "Liver enzyme assessment",
"D": "Glucose oral tolerance test"
} | step2&3 | D | [
"36 year old Asian",
"presents",
"physician",
"recently diagnosed pregnancy",
"first prenatal visit",
"estimated gestational age",
"5 weeks",
"2 vaginal deliveries",
"1 medical abortion",
"children",
"birth weights",
"g",
"g",
"medical history",
"significant",
"gastroesophageal reflux ... |
A 24-year-old woman presents with her husband to a physician with the complaints of fever, cough, and cold for the past 5 days. When the physician asks her if she has taken any medication for her symptoms, she answers, “My husband and I possess great powers to heal sickness. So I tried to cure my symptoms with my power... | Folie à deux | {
"A": "Folie à deux",
"B": "Schizophreniform disorder",
"C": "Culture-specific psychosis",
"D": "Residual phase of schizophrenia"
} | step2&3 | A | [
"year old woman presents",
"husband",
"physician",
"complaints",
"fever",
"cough",
"cold",
"past 5 days",
"physician",
"taken",
"medication",
"symptoms",
"answers",
"husband",
"I possess great powers",
"heal sickness",
"I",
"to cure",
"symptoms",
"power",
"cause",
"not work... |
Four scientists were trying to measure the effect of a new inhibitor X on the expression levels of transcription factor, HNF4alpha. They measured the inhibition levels by using RT-qPCR. In short they converted the total mRNA of the cells to cDNA (RT part), and used PCR to amplify the cDNA quantifying the amplification ... | Enveloped, diploid (+) ssRNA | {
"A": "Nonenveloped, (+) ssRNA",
"B": "Enveloped, circular (-) ssRNA",
"C": "Nonenveloped, ssDNA",
"D": "Enveloped, diploid (+) ssRNA"
} | step1 | D | [
"Four scientists",
"to measure",
"effect",
"new inhibitor",
"expression levels",
"transcription factor",
"measured",
"inhibition levels",
"using RT qPCR",
"short",
"total mRNA",
"cells",
"cDNA",
"RT part",
"used PCR to",
"cDNA quantifying",
"amplification",
"dsDNA binding dye",
"... |
A 25-year-old primigravida is admitted to the hospital at 35 weeks gestation after she was hit in the abdomen by her roommate. She complains of severe dizziness, abdominal pain, and uterine contractions. Her vital signs are as follows: blood pressure 90/50 mm Hg, heart rate 99/min, respiratory rate 20/min, and temperat... | Increase in fundal height | {
"A": "Cessation of uterine contractions",
"B": "Increase in fundal height",
"C": "Emergence of rebound tenderness",
"D": "Appearance of a watery vaginal discharge"
} | step2&3 | B | [
"year old primigravida",
"admitted",
"hospital",
"35 weeks gestation",
"hit",
"abdomen",
"roommate",
"severe dizziness",
"abdominal pain",
"uterine contractions",
"vital signs",
"follows",
"blood pressure 90 50 mm Hg",
"heart rate 99 min",
"respiratory rate 20 min",
"temperature 36",
... |
A 29-year-old internal medicine resident presents to the emergency department with complaints of fevers, diarrhea, abdominal pain, and skin rash for 2 days. He feels fatigued and has lost his appetite. On further questioning, he says that he returned from his missionary trip to Brazil last week. He is excited as he tal... | Schistosoma mansoni | {
"A": "Onchocerca volvulus",
"B": "Vibrio cholerae",
"C": "Schistosoma japonicum",
"D": "Schistosoma mansoni"
} | step1 | D | [
"29 year old internal medicine resident presents",
"emergency department",
"complaints",
"fevers",
"diarrhea",
"abdominal pain",
"skin rash",
"2 days",
"feels fatigued",
"lost",
"appetite",
"further questioning",
"returned",
"missionary trip",
"Brazil",
"week",
"excited",
"talks",
... |
A 55-year-old man presents to the emergency department for fever and altered mental status. The patient was found by his wife in his chair at home. She noticed he responded incoherently to her questions. He has a past medical history of pancreatitis and alcohol abuse and is currently in a rehabilitation program. His te... | Asymptomatic | {
"A": "Asymptomatic",
"B": "Laryngospasm",
"C": "Paresthesias",
"D": "QT prolongation"
} | step2&3 | A | [
"55 year old man presents",
"emergency department",
"fever",
"altered mental status",
"patient",
"found",
"wife",
"chair at home",
"questions",
"past medical",
"alcohol abuse",
"currently",
"rehabilitation program",
"temperature",
"4C",
"blood pressure",
"68 mmHg",
"pulse",
"min"... |
A 27-year-old man is brought to the emergency department with his family because of abdominal pain, excessive urination and drowsiness since the day before. He has had type 1 diabetes mellitus for 2 years. He ran out of insulin 2 days ago. His vital signs at admission include a temperature of 36.8°C (98.24°F), a blood ... | Anion gap < 10 | {
"A": "Anion gap < 10",
"B": "Bicarbonate < 10 mEq/L",
"C": "Increased blood urea nitrogen",
"D": "Disappearance of serum acetone"
} | step2&3 | A | [
"27 year old man",
"brought",
"emergency department",
"family",
"abdominal pain",
"excessive urination",
"drowsiness",
"day",
"type 1 diabetes mellitus",
"years",
"ran out",
"insulin 2 days",
"vital signs",
"admission include",
"temperature",
"36",
"98",
"blood pressure",
"69 mmH... |
A 35-year-old man comes to the physician because of worsening pain in his lower back, knees, and shoulders over the past few years. He used to be able to touch his fingers to his toes while standing; now he has difficulty touching his shins. He is wearing a shirt with dark brown stains around the armpits. Physical exam... | Tyrosine | {
"A": "Homocysteine",
"B": "Tryptophan",
"C": "Tyrosine",
"D": "Ornithine"
} | step1 | C | [
"35 year old man",
"physician",
"of worsening pain in",
"lower back",
"knees",
"shoulders",
"past",
"years",
"used to",
"able to touch",
"fingers",
"toes",
"standing",
"now",
"difficulty touching",
"shins",
"shirt",
"dark brown stains",
"armpits",
"Physical examination shows bl... |
A 31-year-old woman, gravida 1, para 0, at 28 weeks' gestation comes to the obstetrician for a prenatal visit. She has had a tingling pain in the thumb, index finger, and middle finger of her right hand for the past 6 weeks. Physical examination shows decreased sensation to pinprick touch on the thumb, index finger, mi... | Thenar atrophy | {
"A": "Palmar nodule",
"B": "Thenar atrophy",
"C": "Wrist drop",
"D": "Hypothenar weakness"
} | step1 | B | [
"31 year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"obstetrician",
"prenatal visit",
"tingling pain in",
"thumb",
"index finger",
"middle finger of",
"right hand",
"past",
"weeks",
"Physical examination shows decreased sensation",
"touch",
"thumb",
"index finger",
... |
A 25-year-old man comes to the physician because of a severe headache for 1 hour. Every day of the past week, he has experienced 3–4 episodes of severe pain over his left forehead. Each episode lasts around 30–45 minutes, and he reports pacing around restlessly during these episodes. He has been using acetaminophen for... | Oxygen therapy | {
"A": "Carbamazepine",
"B": "Oxycodone",
"C": "Naproxen",
"D": "Oxygen therapy"
} | step2&3 | D | [
"year old man",
"physician",
"of",
"severe headache",
"hour",
"day",
"the past week",
"experienced",
"episodes of severe pain",
"left forehead",
"episode",
"minutes",
"reports pacing",
"episodes",
"using acetaminophen",
"episodes",
"provided only minimal relief",
"works",
"financ... |
A 45-year-old woman presents to her primary care provider for wrist pain. She reports a 4-month history of gradually worsening pain localized to the radial side of her right wrist. The pain is dull, non-radiating, and intermittent. Her past medical history is notable for rheumatoid arthritis and von Willebrand disease.... | Extensor pollicis brevis | {
"A": "Abductor pollicis brevis",
"B": "Adductor pollicis",
"C": "Extensor pollicis brevis",
"D": "Opponens pollicis"
} | step1 | C | [
"year old woman presents",
"primary care provider",
"wrist pain",
"reports",
"4 month history",
"worsening pain localized",
"radial side",
"right wrist",
"pain",
"dull",
"non radiating",
"intermittent",
"past medical history",
"notable",
"rheumatoid arthritis",
"von Willebrand disease"... |
A 25-year-old primigravida is admitted to the hospital at 36 weeks gestation with a severe frontal headache. The initial assessment shows her vital signs to be as follows: blood pressure, 170/90 mm Hg; heart rate, 85/min; respiratory rate; 15/min; and temperature, 36.9℃ (98.4℉). The fetal heart rate is 159/min. The pat... | Magnesium sulfate | {
"A": "Diazepam",
"B": "Phenytoin",
"C": "Magnesium sulfate",
"D": "Lamotrigine"
} | step2&3 | C | [
"year old primigravida",
"admitted",
"hospital",
"36 weeks gestation",
"severe frontal",
"initial assessment shows",
"vital signs to",
"follows",
"blood pressure",
"90 mm Hg",
"heart rate",
"85 min",
"respiratory rate",
"min",
"temperature",
"36",
"98",
"fetal heart rate",
"min",... |
An investigator studying the effects of dietary salt restriction on atrial fibrillation compares two published studies, A and B. In study A, nursing home patients without atrial fibrillation were randomly assigned to a treatment group receiving a low-salt diet or a control group without dietary salt restriction. When s... | Study A allows for better control of confounding variables | {
"A": "Study B allows for better control over selection bias",
"B": "Study A allows for better control of confounding variables",
"C": "Study B results can be analyzed using a chi-square test",
"D": "Study A results can be analyzed using a t-test"
} | step1 | B | [
"investigator studying",
"effects",
"dietary restriction",
"atrial fibrillation compares two published studies",
"study",
"nursing home patients",
"atrial fibrillation",
"assigned",
"a treatment group receiving",
"low-salt diet",
"a control group",
"dietary restriction",
"study",
"began",
... |
A 66-year-old man is brought to the emergency department because of fever, chills, and altered mental status for 3 days. According to his daughter, he has had a productive cough during this period. He has type 2 diabetes, hypertension, hypercholesterolemia, peripheral neuropathic pain, and a history of deep vein thromb... | Disseminated intravascular coagulation | {
"A": "Disseminated intravascular coagulation",
"B": "Thrombotic thrombocytopenic purpura",
"C": "Immune thrombocytopenic purpura",
"D": "Adverse effect of warfarin\n\""
} | step2&3 | A | [
"66 year old man",
"brought",
"emergency department",
"fever",
"chills",
"altered mental status",
"3 days",
"daughter",
"productive cough",
"period",
"type 2 diabetes",
"hypertension",
"hypercholesterolemia",
"peripheral neuropathic pain",
"history of deep vein thromboses",
"Current me... |
A 40-year-old sexually active woman with type 2 diabetes mellitus is admitted to a hospital 2 weeks after an uncomplicated cholecystectomy for pain, itching, and erythema at the incision site. Labs show a hemoglobin A1c of 6.5%, and wound cultures reveal mixed enteric bacteria. She is treated with appropriate antibioti... | Self-inflicted wound contamination with fecal matter | {
"A": "Colonization with methicillin-resistant Staphylococcus aureus (MRSA)",
"B": "Poor wound healing due to vitamin C deficiency",
"C": "Recurrent infections due to an immune deficiency syndrome",
"D": "Self-inflicted wound contamination with fecal matter"
} | step2&3 | D | [
"40 year old sexually active woman with type 2 diabetes mellitus",
"admitted",
"hospital 2 weeks",
"uncomplicated cholecystectomy",
"pain",
"itching",
"erythema",
"incision site",
"Labs show",
"hemoglobin A1c",
"wound cultures reveal mixed enteric bacteria",
"treated with appropriate antibioti... |
An 8-year-old boy has a known genetic condition in which the substitution of thymine for adenine in the 6th codon of the beta globin gene leads to a single-point substitution mutation that results in the production of the amino acid valine in place of glutamic acid. The patient comes to the clinic regularly for blood t... | Bone marrow hyperplasia | {
"A": "Bone marrow hyperplasia",
"B": "Hemoglobinuria",
"C": "Hemosiderin",
"D": "Increased serum haptoglobin"
} | step1 | A | [
"year old boy",
"known genetic condition",
"substitution",
"thymine",
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"glutamic acid",
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"blood transfusions",
"most likely laboratory finding",
... |
A 65-year-old woman presents with complaints of difficulty sleeping due to discomfort in her legs for the past 6 months. She is unable to describe the discomfort, but says it is an unpleasant, creeping and crawling feeling that is not painful. She feels an irresistible urge to move her legs to decrease the discomfort. ... | Ropinirole | {
"A": "Haloperidol",
"B": "Lithium",
"C": "Propranolol",
"D": "Ropinirole"
} | step2&3 | D | [
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"feels",
"to move",
"legs to decrease",
"discomfort",
"sensation",
"legs often occurs",
"night",
"lying in bed",... |
A three-year-old girl presents to general pediatrics clinic for a well-child visit. Her mother reports that she has been growing and developing normally but because of new behaviors she has noticed with her child, she is concerned of possible abuse by the child's stepfather. Vital signs are stable and the physical exam... | Simulating intercourse | {
"A": "Simulating intercourse",
"B": "Masturbation",
"C": "Cross-dressing",
"D": "Asking questions about reproduction"
} | step1 | A | [
"three year old girl presents",
"general pediatrics clinic",
"well-child visit",
"mother reports",
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"child",
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"possible abuse",
"child's stepfather",
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"stable",
"physical examination",
"normal limits",
"child",
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"abuse",
"fo... |
An otherwise healthy 65-year-old man comes to the physician for a follow-up visit for elevated blood pressure. Three weeks ago, his blood pressure was 160/80 mmHg. Subsequent home blood pressure measurements at days 5, 10, and 15 found: 165/75 mm Hg, 162/82 mm Hg, and 170/80 mmHg, respectively. He had a cold that was t... | Decrease in arterial compliance | {
"A": "Decrease in arterial compliance",
"B": "Increase in aldosterone production",
"C": "Decrease in baroreceptor sensitivity",
"D": "Medication-induced vasoconstriction"
} | step1 | A | [
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"10",
"found",
"75 mm Hg",
"mm Hg",
"80 mmHg",
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"treated with over-the-counter medication",
... |
A 14-year-old boy is brought to the emergency department from school after falling in gym class. He was unable to stand after the accident and has a painful and swollen knee. On presentation he says that he has never had an incident like this before; however, he does suffer from hard to control nosebleeds and prolonged... | Binds to subendothelial collagen | {
"A": "Binds to a nucleotide derivative",
"B": "Binds to subendothelial collagen",
"C": "Catalyzes the conversion of factor X",
"D": "It is a cofactor for an epoxide reductase"
} | step1 | B | [
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"prolonged bleeding",
"minor cuts",
"Based",
"presentation",
"... |
An 81-year-old woman is brought to the physician by her son because of worsening forgetfulness and disorientation over the past 2 years. She has to be reminded of her grandchildren's names and frequently forgets her current address. She lives with her son. She has occasional episodes of urinary incontinence. She appear... | Galantamine | {
"A": "Acetazolamide",
"B": "Levodopa and carbidopa",
"C": "Thiamine",
"D": "Galantamine"
} | step1 | D | [
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"frequently forgets",
"current address",
"lives with",
"son",
"occasional episodes of urinary incontinence",
"appears well nour... |
A 2-day-old female infant undergoes a newborn examination by her pediatrician. The physician adducts both of the patient's hips and exerts a posterior force on her knees; this results in an abnormally increased amount of translation of the left lower extremity in comparison to the contralateral side. The physician then... | Deformation | {
"A": "Malformation",
"B": "Deformation",
"C": "Sequence",
"D": "Mutation"
} | step1 | B | [
"2-day old female infant",
"newborn examination",
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"increased amount",
"translation",
"left lower extremity",
"contralateral side",
"physician then",
"hips",
"exerts",
"anterior for... |
A 3-year-old boy is brought to the pediatrician by his parents because of swelling and tenderness of his left upper arm. According to the father, the boy was running in the garden when he fell and injured his arm 2 days ago. His mother had been on a business trip the past week. The boy's father and 18-year-old brother ... | Notify Child Protective Services | {
"A": "Notify Child Protective Services",
"B": "Arrange for surgical treatment",
"C": "Screen for defective type I collagen",
"D": "Hospitalize the boy for further evaluation"
} | step2&3 | A | [
"3 year old boy",
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"days",
"mother",
"business trip",
"past week",
"boy's father",
"year old brother",
"taking care",
"patient",
... |
A 36-year-old woman is brought to the emergency department because of lightheadedness, weakness, and abdominal pain for 6 hours. Over the past 3 days, she has also had severe nausea, vomiting, and watery diarrhea. She was diagnosed with pulmonary sarcoidosis 2 years ago. Current medications include prednisone. Her temp... | Decreased corticotropin-releasing hormone | {
"A": "Increased cortisol",
"B": "Decreased corticotropin-releasing hormone",
"C": "Decreased norepinephrine",
"D": "Increased adrenocorticotropic hormone"
} | step1 | B | [
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"days",
"severe nausea",
"vomiting",
"watery diarrhea",
"diagnosed",
"pulmonary sarcoidosis 2 years",
"Current medications include prednisone",
"temperature",
"pu... |
A 59-year-old woman presents to her primary care physician for trouble sleeping. The patient states that when she goes to bed at night she has an urge to get up out of bed and walk around. The patient often wakes her husband when she does this which irritates him. She states that there is a perpetual uneasiness and fee... | Iron studies | {
"A": "Alprazolam",
"B": "Ferrous sulfate",
"C": "Iron studies",
"D": "Pramipexole"
} | step2&3 | C | [
"59 year old woman presents",
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"patient states",
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"patient often wakes",
"husband",
"states",
"uneasiness",
"feeling",
"need to move",
"night",
"relieved by getting",
"walking",
"patien... |
A 4-year-old boy is brought by his mother to the emergency room for malaise, dizziness, and sleepiness. The mother owns a dry cleaning shop and found her son in the back room with an open canister of carbon tetrachloride, one of their cleaning fluids. The boy reports feeling nauseous and has a mild headache. He has a h... | Hepatocytes | {
"A": "Bone marrow",
"B": "Gastric mucosa",
"C": "Hepatocytes",
"D": "Myocardium"
} | step1 | C | [
"4 year old boy",
"brought",
"mother",
"emergency room",
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"back room",
"open canister",
"carbon tetrachloride",
"one",
"cleaning fluids",
"boy reports feeling nauseous",
"mild headache",
"history"... |
A 73-year-old male is brought into the ED unconscious with cold, clammy skin. His blood pressure is 65 over palpable. There is no signs of blood loss. You recognize the patient is in acute shock and blood is drawn for investigation as resuscitation is initiated. Which of the following might you expect in your laborator... | Increased blood lactate | {
"A": "Increased arterial pH",
"B": "Increased serum ketones",
"C": "Decreased hemoglobin",
"D": "Increased blood lactate"
} | step1 | D | [
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"acute shock",
"blood",
"drawn",
"investigation",
"resuscitation",
"initiated",
"following",
"laboratory investigation",
"patient"
] |
A 65-year-old woman presents to the clinic for a routine checkup. She has unintentionally lost 4.5 kg (9.9 lb) in the past month but denies any other complaints. Her pulse rate is 90/min, respiratory rate is 18/min, temperature is 37.0°C (98.6°F), and blood pressure is 150/70 mm Hg. An irregularly irregular rhythm is h... | Toxic multinodular goiter | {
"A": "Graves’ disease",
"B": "Hashimoto’s thyroiditis",
"C": "Subacute granulomatous thyroiditis",
"D": "Toxic multinodular goiter"
} | step1 | D | [
"65 year old woman presents",
"clinic",
"routine checkup",
"lost 4.5 kg",
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"denies",
"complaints",
"pulse rate",
"90 min",
"respiratory rate",
"min",
"temperature",
"98",
"blood pressure",
"70 mm Hg",
"irregular rhythm",
"heard",
"auscultation of",
"heart",
"Neck e... |
A 79-year-old man presents to the emergency department with abdominal pain. The patient describes the pain as severe, tearing, and radiating to the back. His history is significant for hypertension, hyperlipidemia, intermittent claudication, and a 60 pack-year history of smoking. He also has a previously diagnosed stab... | Surgery | {
"A": "Abdominal CT with contrast",
"B": "Abdominal CT without contrast",
"C": "Abdominal MRI",
"D": "Surgery"
} | step2&3 | D | [
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"emergency department",
"abdominal pain",
"patient",
"pain",
"severe",
"tearing",
"radiating to",
"back",
"history",
"significant",
"hypertension",
"hyperlipidemia",
"intermittent claudication",
"60 pack-year history of smoking",
"diagnosed stable abdominal aor... |
A 66-year old man comes to the physician because of fatigue for 6 months. He says that he wakes up every morning feeling tired. Most days of the week he feels sleepy during the day and often takes an afternoon nap for an hour. His wife says he snores in the middle of the night. He has a history of heart failure and atr... | In-laboratory polysomnography | {
"A": "ENT evaluation",
"B": "Overnight pulse oximetry",
"C": "In-laboratory polysomnography",
"D": "Echocardiography"
} | step2&3 | C | [
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"morning feeling tired",
"days of the week",
"feels sleepy",
"day",
"often takes",
"afternoon nap",
"hour",
"wife",
"snores",
"middle",
"night",
"history of heart failure",
"atrial fibrillation",
"medications inc... |
A previously healthy 48-year-old man comes to the physician because of a 2-week history of a nonpruritic rash on his right forearm. The rash began as pustules and progressed to form nodules and ulcers. He works as a gardener. Physical examination shows right axillary lymphadenopathy and the findings in the photograph. ... | Sporothrix schenckii | {
"A": "Pseudomonas aeruginosa",
"B": "Bartonella henselae",
"C": "Blastomyces dermatitidis",
"D": "Sporothrix schenckii"
} | step1 | D | [
"healthy 48 year old man",
"physician",
"2-week history",
"nonpruritic rash",
"right forearm",
"rash began",
"pustules",
"progressed to form nodules",
"ulcers",
"works",
"gardener",
"Physical examination shows right",
"findings",
"photograph",
"following",
"most likely causal organism"... |
A 3-year-old boy is brought to the physician because of arm pain following a fall that took place 5 hours ago. According to his mother, the boy was running in the yard when he fell and injured his right arm. The boy is crying and clutching his arm. During the past year, he has been brought in 4 other times for extremit... | Type 1 collagen defect
" | {
"A": "Non-accidental injury",
"B": "Type 2 collagen defect",
"C": "Type 3 collagen defect",
"D": "Type 1 collagen defect\n\""
} | step2&3 | D | [
"3 year old boy",
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"physician",
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"hours",
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"right arm",
"boy",
"crying",
"arm",
"past year",
"brought",
"other times",
"extremity pain following falls",
"diagnosed",
... |
An investigator is studying the immunologic response to a Staphylococcus aureus toxin in a mouse model. Fourteen days after injecting mice with this toxin, he isolates antibodies against neutrophil proteinase 3 in their sera. A patient with high concentrations of these antibodies would most likely present with which of... | Nasal mucosal ulcerations and hematuria | {
"A": "Polyneuropathy and melena",
"B": "Visual impairment and jaw claudication",
"C": "Nasal mucosal ulcerations and hematuria",
"D": "Genital ulcers and anterior uveitis"
} | step1 | C | [
"investigator",
"studying",
"immunologic response",
"Staphylococcus aureus toxin",
"mouse",
"Fourteen days",
"injecting mice",
"toxin",
"isolates antibodies",
"neutrophil proteinase 3",
"sera",
"patient",
"high concentrations",
"antibodies",
"most likely present",
"following clinical f... |
A 32-year-old woman presents to her gynecologist’s office complaining of increasing fatigue. She mentions that she has been feeling this way over the past few months especially since her menstrual periods started becoming heavier than usual. She denies any abdominal pain, except for cramps during menstruation which are... | Ultrasound of the pelvis | {
"A": "Blood transfusion",
"B": "Ultrasound of the pelvis",
"C": "Vitamin B12 levels",
"D": "Iron supplementation"
} | step2&3 | B | [
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"gynecologists office",
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"months",
"menstrual periods started",
"heavier",
"usual",
"denies",
"abdominal pain",
"except for cramps",
"menstruation",
"sometimes severe",
"never required medical care",
"past except for oc... |
A 5-year-old boy is brought to the clinic for recurrent bedwetting. The child has an intellectual disability; thus, the mother is providing most of the history. She states that the child constantly drinks fluids and has a difficult time making it to the bathroom as often as he needs. Therefore, he sometimes wets himsel... | Defect of Na+/K+/2Cl- cotransporter at the thick ascending loop of Henle | {
"A": "Defect of NaCl reabsorption at the distal collecting tube",
"B": "Defect of Na+/K+/2Cl- cotransporter at the thick ascending loop of Henle",
"C": "Generalized reabsorptive defect in the proximal collecting tube",
"D": "Hereditary deficiency of 11B-hydroxysteroid dehydrogenase"
} | step1 | B | [
"5 year old boy",
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"states",
"child constantly drinks fluids",
"difficult time making",
"bathroom",
"often",
"needs",
"sometimes wets",
"day",
"night",
"bedwetti... |
A 3-week-old newborn is brought to the emergency department by his parents because of 4 episodes of vomiting that occurred that morning. The parents report that the vomit was yellowish-green with no blood in it. The patient was born at 38 weeks' gestation via vaginal delivery and has generally been healthy. He has pass... | Upper gastrointestinal contrast series | {
"A": "Laparoscopy",
"B": "Upper gastrointestinal contrast series",
"C": "Emergent exploratory laparotomy",
"D": "Flexible sigmoidoscopy"
} | step2&3 | B | [
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"blood",
"patient",
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"gestation",
"vaginal delivery",
"healthy",
"passed normal stools",
"day",
"family histo... |
A 36-year-old woman comes to the physician because of a 2-week history of progressively worsening pain on the outer side of her left elbow. She does not recall any trauma to the area. The patient plays badminton recreationally. Examination shows tenderness over the lateral surface of the left distal humerus. The pain i... | Repeated wrist extension | {
"A": "Excessive stress to bone",
"B": "Bursal inflammation",
"C": "Repeated wrist extension",
"D": "Repeated wrist flexion"
} | step1 | C | [
"36 year old woman",
"physician",
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"left elbow",
"not recall",
"trauma",
"area",
"patient plays badminton",
"Examination shows tenderness",
"lateral surface of",
"left distal humerus",
"pain",
"forearm",
"resistance",
"following",
"m... |
A 12-year-old girl is brought to an oncologist, as she was recently diagnosed with a rare form of cancer. Cytogenetic studies reveal that the tumor is responsive to vinblastine, which is a cell-cycle specific anticancer agent. It acts on the M phase of the cell cycle and inhibits the growth of cells. Which of the follo... | Cyclin-dependent activation of CDK1 (CDC2) takes place upon the entry of a cell into M phase of the cell cycle. | {
"A": "Cyclin-dependent activation of CDK1 (CDC2) takes place upon the entry of a cell into M phase of the cell cycle.",
"B": "EGF from a blood clot stimulates the growth and proliferation of cells in the healing process.",
"C": "Inhibitors of DNA synthesis act in the M phase of the cell cycle.",
"D": "Replica... | step1 | A | [
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"cell cycle",
"inhibits",
"growth of cells",
"following statements best",
... |
A 12-year-old boy presents to the pediatrician for a routine checkup. He and his family immigrated from Pakistan to the United States when he was 9 years of age. Per his mother, he had measles when he was 4 years of age and a high fever following a sore throat at the age 7. He received all appropriate vaccinations when... | Reversal of left-to-right shunting | {
"A": "Acute endocarditis",
"B": "Extra-cardiac left-to-right shunting",
"C": "Mitral stenosis",
"D": "Reversal of left-to-right shunting"
} | step1 | D | [
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"arrived",
"United States",
"takes",
... |
A 68-year-old man seeks evaluation at an office with a complaint of breathlessness of several months duration. He is able to do his daily tasks, but says that he is not as efficient as before. His breathlessness has been progressive with the recent onset of a dry cough. The past medical history is significant for a car... | Amiodarone | {
"A": "Amiodarone",
"B": "Lidocaine",
"C": "Sotalol",
"D": "Verapamil"
} | step1 | A | [
"68 year old man",
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"before",
"breathlessness",
"progressive",
"recent onset",
"dry cough",
"past medical history",
"significant",
"cardiac arrhythmia",
"treated wi... |
A child with which of the following diseases would have the highest morbidity from being outside during a hot summer day? | Cystic fibrosis | {
"A": "Tay-Sachs disease",
"B": "Cystic fibrosis",
"C": "Cerebral palsy",
"D": "Asthma"
} | step1 | B | [
"child",
"following diseases",
"highest morbidity",
"outside",
"hot summer day"
] |
An investigator is studying bone metabolism and compares the serum studies and bone biopsy findings of a cohort of women 25–35 years of age with those from a cohort of women 55–65 years of age. Which of the following processes is most likely to be increased in the cohort of older women? | Expression of RANK ligand | {
"A": "Expression of RANK ligand",
"B": "Demineralization of bone with normal osteoid matrix",
"C": "Urinary excretion of cyclic AMP",
"D": "Urinary excretion of osteocalcin"
} | step1 | A | [
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"compares",
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"following processes",
"most likely to",
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"cohort",
"older women"
] |
An 82-year-old man comes to the physician complaining of frequent urination, especially at night, and difficulty initiating urination. However, he points out that his symptoms have improved slightly since he started terazosin 2 months ago. He has a history of stable angina. Other medications include nitroglycerin, meto... | Finasteride | {
"A": "Finasteride",
"B": "Oxybutynin",
"C": "Tadalafil",
"D": "Tamsulosin"
} | step2&3 | A | [
"year old man",
"physician",
"of frequent urination",
"night",
"difficulty initiating urination",
"points out",
"symptoms",
"improved slightly",
"started terazosin",
"months",
"history",
"stable angina",
"medications include nitroglycerin",
"metoprolol",
"aspirin",
"blood pressure",
... |
A 53-year-old woman with rheumatoid arthritis comes to the physician for a follow-up examination one week after being discharged from the hospital. While she was in the hospital, she received acetaminophen and erythropoietin. This patient most likely has which of the following additional conditions? | Anemia of chronic disease | {
"A": "Factor VIII deficiency",
"B": "Vitamin K deficiency",
"C": "Anemia of chronic disease",
"D": "Immune thrombocytopenic purpura"
} | step1 | C | [
"year old woman",
"rheumatoid arthritis",
"physician",
"follow-up examination one week",
"discharged from",
"hospital",
"hospital",
"received acetaminophen",
"erythropoietin",
"patient",
"likely",
"following additional conditions"
] |
A 24-year-old man presents to the emergency department after an altercation at a local bar. The patient was stabbed in the abdomen with a 6 inch kitchen knife in the epigastric region. His temperature is 97°F (36.1°C), blood pressure is 97/68 mmHg, pulse is 127/min, respirations are 19/min, and oxygen saturation is 99%... | Exploratory laparotomy | {
"A": "Diagnostic peritoneal lavage",
"B": "Exploratory laparoscopy",
"C": "Exploratory laparotomy",
"D": "Focused assessment with sonography in trauma (FAST) exam"
} | step2&3 | C | [
"year old man presents",
"emergency department",
"altercation",
"local",
"patient",
"stabbed",
"abdomen",
"inch kitchen knife",
"epigastric region",
"temperature",
"36",
"blood pressure",
"97 68 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"99",
"room air"... |
A 68-year-old man is brought to the emergency department 30 minutes after collapsing on the street. On arrival, he is obtunded. His pulse is 110/min and blood pressure is 250/120 mm Hg. A CT scan of the head shows an intracerebral hemorrhage involving bilateral thalamic nuclei and the third ventricle. Cortical detectio... | Olfactory | {
"A": "Gustatory",
"B": "Visual",
"C": "Olfactory",
"D": "Proprioception"
} | step1 | C | [
"68 year old man",
"brought",
"emergency department 30 minutes",
"collapsing",
"street",
"arrival",
"obtunded",
"pulse",
"min",
"blood pressure",
"mm Hg",
"CT scan of",
"head shows",
"intracerebral hemorrhage involving bilateral thalamic nuclei",
"third ventricle",
"Cortical detection ... |
Which of the following events is likely to occur in the germinal center? | Isotype switching | {
"A": "Development of early pro-B cells",
"B": "Development of immature B cells",
"C": "Isotype switching",
"D": "Formation of double-positive T cells"
} | step1 | C | [
"following events",
"likely to occur",
"germinal center"
] |
A 2-week-old infant is brought to the physician by her father because of a 1-week history of vaginal discharge. The discharge was initially clear, but now he notices that it is tinged with blood. The father is also concerned about “bruises” on his daughter's back and buttocks. Both parents work so that the infant spend... | Reassurance | {
"A": "Reassurance",
"B": "Ceftriaxone and doxycycline therapy",
"C": "Leuprolide therapy",
"D": "Fluconazole therapy"
} | step2&3 | A | [
"2 week old infant",
"brought",
"physician",
"father",
"1-week history",
"vaginal discharge",
"discharge",
"initially clear",
"now",
"tinged",
"blood",
"father",
"concerned",
"bruises",
"daughter's back",
"buttocks",
"parents work so",
"infant spends most of",
"time",
"daycare"... |
An 11-year-old boy is brought to the physician for a follow-up examination. He has been having difficulties with his schoolwork over the past 4 years. He has a seizure disorder treated with valproic acid. He was able to walk independently at the age of 3 years and was able to use a fork and spoon at the age of 4 years.... | Optic glioma | {
"A": "Optic glioma",
"B": "Glaucoma",
"C": "Renal cell carcinoma",
"D": "Giant cell astrocytoma\n\""
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"follow-up examination",
"difficulties",
"past",
"years",
"seizure disorder treated with valproic acid",
"able to walk",
"age",
"years",
"able to use",
"fork",
"spoon",
"age",
"years",
"percentile",
"height",
"percentile",
"weight",
"si... |
A 54-year-old woman presents with increasing shortness of breath on exertion for the past few months. She also complains of associated fatigue and some balance issues. The patient denies swelling of her feet and difficulty breathing at night or while lying down. Physical examination is significant for conjunctival pall... | Methylmalonyl-CoA | {
"A": "Methionine",
"B": "Cysteine",
"C": "Homocysteine",
"D": "Methylmalonyl-CoA"
} | step1 | D | [
"54 year old woman presents",
"increasing shortness of breath",
"exertion",
"past",
"months",
"associated fatigue",
"balance issues",
"patient denies swelling of",
"feet",
"difficulty breathing",
"night",
"lying",
"Physical examination",
"significant",
"conjunctival pallor",
"periphera... |
A 41-year-old construction worker presents to the office complaining of a progressively worsening breathlessness for the last 2 months. He has no other complaints. His medical history is significant for hypertension being treated with lisinopril-hydrochlorothiazide and gastroesophageal reflux disease being treated with... | Bronchogenic carcinoma | {
"A": "Mesothelioma",
"B": "Bronchogenic carcinoma",
"C": "Hepatocellular carcinoma",
"D": "Aortic aneurysm"
} | step2&3 | B | [
"year old construction worker presents",
"office",
"worsening breathlessness",
"months",
"complaints",
"medical history",
"significant",
"hypertension",
"treated with lisinopril-hydrochlorothiazide",
"gastroesophageal reflux disease",
"treated with pantoprazole",
"30 pack-year smoking history"... |
A 28-year-old woman is brought to the emergency department by her friends. She is naked except for a blanket and speaking rapidly and incoherently. Her friends say that she was found watering her garden naked and refused to put on any clothes when they tried to make her do so, saying that she has accepted how beautiful... | Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase | {
"A": "Inhibit the reuptake norepinephrine and serotonin from the presynaptic cleft",
"B": "Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase",
"C": "Increase the concentration of dopamine and norepinephrine at the synaptic cleft",
"D": "Modulate the activity of Ƴ-aminobutyric aci... | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"friends",
"naked",
"blanket",
"speaking rapidly",
"friends",
"found watering",
"garden naked",
"refused to put",
"clothes",
"to make",
"so",
"accepted",
"beautiful",
"out",
"friends",
"purchased",
"new car",
"not",
"conc... |
A 25-year-old woman presents with intense vaginal pruritus and pain for the past week. She says the pain is worse when she urinates. Her last menstrual period was 4 weeks ago. She is sexually active, has a single partner, and uses condoms infrequently. She denies any recent history of fevers, chills, abdominal or flank... | Oral fluconazole for the patient alone | {
"A": "Oral fluconazole for the patient alone",
"B": "Oral fluconazole for the patient and her sexual partner",
"C": "Oral metronidazole for the patient and her sexual partner",
"D": "A single dose of azithromycin"
} | step1 | A | [
"year old woman presents",
"intense vaginal pruritus",
"pain",
"past week",
"pain",
"worse",
"last menstrual period",
"4 weeks",
"sexually active",
"single partner",
"uses condoms infrequently",
"denies",
"recent history",
"fevers",
"chills",
"abdominal",
"flank pain",
"menstrual i... |
A 28-year-old man presents to the office complaining of a sore throat, difficulty swallowing, and difficulty opening his mouth for the past 5 days. He states that he had symptoms like this before and "was given some antibiotics that made him feel better". He is up to date on his immunizations. On examination, his tempe... | Lemierre syndrome | {
"A": "Lemierre syndrome",
"B": "Infectious mononucleosis",
"C": "Whooping cough",
"D": "Diphtheria"
} | step1 | A | [
"year old man presents",
"office",
"sore throat",
"difficulty swallowing",
"difficulty opening",
"mouth",
"past 5 days",
"states",
"symptoms",
"given",
"antibiotics",
"made",
"feel better",
"date",
"immunizations",
"examination",
"temperature",
"bilateral cervical lymphadenopathy",... |
A healthy 48-year-old presents for a well-patient visit. He has no symptoms and feels well. Past medical history is significant for asthma, chronic sinusitis, and nasal polyps. He occasionally takes diphenhydramine for allergies. Both of his parents and an elder brother are in good health. Today, his blood pressure is ... | Have you had a reaction to aspirin in the past? | {
"A": "Yes, aspirin therapy is recommended.",
"B": "Yes, but only every other day.",
"C": "No, because all chronic sinusitis carries aspirin-complications.",
"D": "Have you had a reaction to aspirin in the past?"
} | step2&3 | D | [
"healthy 48 year old presents",
"well patient visit",
"symptoms",
"feels well",
"Past medical history",
"significant",
"asthma",
"chronic sinusitis",
"nasal polyps",
"occasionally takes diphenhydramine",
"allergies",
"parents",
"elder brother",
"good health",
"Today",
"blood pressure",... |
A 24-day-old neonate is brought to the emergency department by his parents with high-grade fever, inability to feed, and lethargy. Since his birth, he was active and energetic, feeding every 2-3 hours and making 6-8 wet diapers every day until 2 days ago when he vomited twice, developed diarrhea, and slowly became leth... | Dura layer | {
"A": "Denticulate ligament",
"B": "Dura layer",
"C": "Pia layer",
"D": "Anterior Longitudinal Ligament"
} | step1 | B | [
"day old neonate",
"brought",
"emergency department",
"parents",
"high-grade fever",
"to feed",
"lethargy",
"birth",
"active",
"energetic",
"feeding",
"2",
"hours",
"making",
"wet diapers",
"day",
"2 days",
"vomited twice",
"diarrhea",
"slowly",
"lethargic",
"boy",
"born"... |
Five days after undergoing an open abdominal aortic aneurysm repair, a 68-year-old woman has crampy abdominal pain. During this period, she has also had two episodes of loose, bloody stools. Her surgery was complicated by severe blood loss requiring the administration of vasopressors and multiple transfusions. Cefazoli... | Ischemic colitis | {
"A": "Postoperative ileus",
"B": "Pseudomembranous colitis",
"C": "Ischemic colitis",
"D": "Abdominal aortic aneurysm rupture"
} | step2&3 | C | [
"Five days",
"open abdominal aortic aneurysm repair",
"68 year old woman",
"crampy abdominal pain",
"period",
"two episodes of loose",
"bloody",
"surgery",
"complicated",
"severe blood loss",
"administration",
"vasopressors",
"multiple transfusions",
"Cefazolin",
"administered",
"perio... |
A 55-year-old woman comes to the emergency room 30 minutes after the sudden onset of chest pain radiating to the left shoulder. Prior to the onset of her symptoms, she was lying in bed because of a migraine headache. Episodes of similar chest pain usually resolved after a couple of minutes. She has smoked one pack of c... | Diltiazem
" | {
"A": "Ramipril",
"B": "Clopidogrel",
"C": "Propranolol",
"D": "Diltiazem\n\""
} | step1 | D | [
"55 year old woman",
"emergency room 30 minutes",
"sudden onset of chest pain radiating",
"left shoulder",
"Prior to",
"onset",
"symptoms",
"lying in bed",
"of",
"migraine headache",
"Episodes",
"similar chest pain usually resolved",
"couple",
"minutes",
"smoked one pack",
"cigarettes ... |
A 34-year-old woman, gravida 2, para 2, is admitted to the hospital because of shortness of breath and fatigue 2 weeks after delivery of a full-term female newborn. She has no history of major medical illness. Cardiac examination on admission shows an S3 gallop and a grade 2/6 holosystolic murmur heard best at the apex... | Mitral annular dilatation | {
"A": "Mitral annular dilatation",
"B": "Myxomatous mitral valve degeneration",
"C": "Mitral valve leaflet fibrosis",
"D": "Mitral annular calcification"
} | step1 | A | [
"year old woman",
"gravida 2",
"para 2",
"admitted",
"hospital",
"of shortness",
"breath",
"fatigue 2 weeks",
"delivery",
"full term female newborn",
"history of major medical illness",
"Cardiac examination on admission shows",
"S3 gallop",
"grade",
"6 holosystolic murmur heard best",
... |
A 31-year-old woman presents to the physician for a routine health maintenance examination. She feels well and has no current complaints. She has no history of serious illness and takes no medications. The vital signs include: blood pressure 185/110 mm Hg, pulse 75/min, and respiration rate 12/min. Her high blood press... | Percutaneous transluminal angioplasty | {
"A": "Dietary salt restriction",
"B": "Percutaneous transluminal angioplasty",
"C": "Surgical endarterectomy",
"D": "Calorie restriction and weight loss"
} | step2&3 | B | [
"31 year old woman presents",
"physician",
"routine health maintenance examination",
"feels well",
"current complaints",
"history",
"serious illness",
"takes",
"medications",
"vital signs include",
"blood pressure",
"mm Hg",
"pulse 75 min",
"respiration rate",
"min",
"high blood pressu... |
A 57-year-old man is brought to the emergency department after having chest pain for the last hour. He rates his pain as 8/10, dull in character, and says it is associated with sweating and shortness of breath. He has a history of diabetes and hypercholesterolemia. His current medication list includes amlodipine, aspir... | Percutaneous coronary intervention | {
"A": "Echocardiography",
"B": "Metoprolol",
"C": "Observation",
"D": "Percutaneous coronary intervention"
} | step2&3 | D | [
"57 year old man",
"brought",
"emergency department",
"chest pain",
"hour",
"rates",
"pain",
"8/10",
"dull",
"character",
"associated with sweating",
"shortness of breath",
"history",
"diabetes",
"hypercholesterolemia",
"current medication list includes amlodipine",
"aspirin",
"ato... |
A 67-year-old man comes to the physician because of a 4-month history of fatigue and weight loss. Physical examination shows jaundice. The liver is palpated 3 cm below the right costal margin. Serum studies show an elevated alpha-fetoprotein and a prolonged prothrombin time. Genetic analysis of a liver biopsy specimen ... | Dietary aflatoxin exposure | {
"A": "Alcoholism",
"B": "Hepatitis C infection",
"C": "Dietary aflatoxin exposure",
"D": "Hemochromatosis\n\""
} | step1 | C | [
"67 year old man",
"physician",
"4 month history",
"fatigue",
"weight loss",
"Physical examination shows jaundice",
"liver",
"palpated 3 cm",
"right costal margin",
"Serum studies show",
"elevated alpha-fetoprotein",
"prolonged prothrombin time",
"Genetic of",
"liver biopsy specimen shows"... |
The patient declines the use of oxytocin or any other further testing and decides to await a spontaneous delivery. Five weeks later, she comes to the emergency department complaining of vaginal bleeding for 1 hour. Her pulse is 110/min, respirations are 18/min, and blood pressure is 112/76 mm Hg. Pulse oximetry on room... | Thromboplastin in maternal circulation | {
"A": "Decreased synthesis of coagulation factors",
"B": "Separation of the placenta from the uterus",
"C": "Thromboplastin in maternal circulation",
"D": "Amniotic fluid in maternal circulation"
} | step2&3 | C | [
"patient",
"use of oxytocin",
"further testing",
"to",
"spontaneous delivery",
"Five weeks later",
"emergency department",
"vaginal bleeding",
"1 hour",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"76 mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"... |
An 81-year-old man comes to the physician because of increased exertional dyspnea and dizziness over the past 8 weeks. He has hypertension for which he takes lisinopril. He has smoked one pack of cigarettes daily for the past 50 years. Physical examination shows weak peripheral pulses. Cardiac examination is shown. Whi... | Aortic stenosis | {
"A": "Mitral regurgitation",
"B": "Aortic stenosis",
"C": "Tricuspid stenosis",
"D": "Aortic regurgitation"
} | step1 | B | [
"81 year old man",
"physician",
"increased exertional",
"dizziness",
"past",
"weeks",
"hypertension",
"takes lisinopril",
"smoked one pack",
"cigarettes daily",
"past 50 years",
"Physical examination shows weak peripheral pulses",
"Cardiac examination",
"shown",
"following",
"most like... |
A 62-year-old man presents to the emergency department concerned about a large amount of blood in his recent bowel movement. He states he was at home when he noticed a large amount of red blood in his stool. He is not experiencing any pain and otherwise feels well. The patient has a past medical history of diabetes and... | Increase fiber and fluid intake | {
"A": "Increase fiber and fluid intake",
"B": "Reduce red meat consumption",
"C": "Sigmoid colon resection",
"D": "Sitz baths"
} | step2&3 | A | [
"62 year old man presents",
"emergency department concerned",
"large amount",
"blood",
"recent bowel movement",
"states",
"at home",
"large amount",
"red blood",
"stool",
"not experiencing",
"pain",
"feels well",
"patient",
"past medical diabetes",
"obesity",
"temperature",
"98 9F"... |
A 31-year-old female with a history of anxiety has a panic attack marked by dizziness, weakness, and blurred vision. Which of the following most likely accounts for the patient’s symptoms? | Decreased cerebral blood flow | {
"A": "Oxygen toxicity",
"B": "Increased arterial CO2",
"C": "Decreased cerebral blood flow",
"D": "Decreased respiratory rate"
} | step1 | C | [
"31 year old female",
"history",
"anxiety",
"panic attack marked",
"dizziness",
"weakness",
"blurred vision",
"following",
"likely accounts",
"patients symptoms"
] |
A 24-year-old woman is brought into the emergency department by an ambulance after swallowing a bottle of pain medication in a suicide attempt. According to her parents, she recently had a fight with her boyfriend and was acting very depressed. She claims to not remember what she had taken. Further inquiry reveals she ... | Aspirin | {
"A": "Acetaminophen",
"B": "Aspirin",
"C": "Indomethacin",
"D": "Gabapentin"
} | step1 | B | [
"year old woman",
"brought",
"emergency department",
"ambulance",
"swallowing",
"bottle",
"pain medication",
"suicide attempt",
"parents",
"recently",
"fight",
"boyfriend",
"acting very depressed",
"to not remember",
"taken",
"Further inquiry reveals",
"experiencing nausea",
"feeli... |
A 44-year-old woman presents to her primary care physician’s office with episodes of pain in her right hand. She says that the pain is most significant at night and awakens her from sleep numerous times. When she experiences this pain, she immediately puts her hand under warm running water or shakes her hand. She has a... | Nerve conduction studies | {
"A": "Magnetic resonance imaging",
"B": "Nerve conduction studies",
"C": "Nerve biopsy",
"D": "Tinel test"
} | step2&3 | B | [
"year old woman presents",
"primary care physicians office",
"episodes of pain",
"right hand",
"pain",
"most significant",
"night",
"sleep numerous times",
"experiences",
"pain",
"immediately puts",
"hand",
"warm running water",
"shakes",
"hand",
"episodes of numbness",
"affected han... |
A 27-year-old woman comes to the physician because of poor sleep for the past 8 months. She has been gradually sleeping less because of difficulty initiating sleep at night. She does not have trouble maintaining sleep. On average, she sleeps 4–5 hours each night. She feels tired throughout the day but does not take nap... | Triazolam | {
"A": "Doxepin",
"B": "Triazolam",
"C": "Flurazepam",
"D": "Suvorexant"
} | step1 | B | [
"27 year old woman",
"physician",
"of poor sleep",
"past",
"months",
"sleeping less",
"difficulty initiating sleep",
"night",
"not",
"maintaining sleep",
"average",
"sleeps",
"hours",
"night",
"feels tired",
"day",
"not take naps",
"recently diagnosed",
"social anxiety disorder",... |
A previously healthy 16-year-old boy comes to the physician because of a pruritic rash on the chest that has become progressively larger over the past 10 days. It is not painful. He is sexually active with two female partners and uses condoms inconsistently. He works part-time as a lifeguard. He has no family history o... | Topical miconazole | {
"A": "Topical erythromycin",
"B": "Phototherapy",
"C": "Topical miconazole",
"D": "Topical hydrocortisone"
} | step2&3 | C | [
"healthy",
"year old boy",
"physician",
"of",
"rash",
"chest",
"larger",
"past 10 days",
"not painful",
"sexually active",
"two female partners",
"uses condoms",
"works part-time",
"lifeguard",
"family history",
"serious illness",
"not smoke",
"drinks",
"beers",
"weekends",
"... |
A 56-year-old man was brought to the emergency department by his wife when he passed out for 5 seconds after dinner at home. He says that he recalls feeling lightheaded moments prior to passing out and also had some palpitations. Otherwise, he has been feeling fatigued recently and has had some shortness of breath. His... | Decreased rate of phase 0 depolarization and increased action potential duration | {
"A": "Decreased rate of phase 0 depolarization and increased action potential duration",
"B": "Normal rate of phase 0 depolarization and decreased action potential duration",
"C": "Normal rate of phase 0 depolarization and increased action potential duration",
"D": "Normal rate of phase 0 depolarization and n... | step1 | A | [
"year old man",
"brought",
"emergency department",
"wife",
"passed out",
"seconds",
"dinner at home",
"recalls feeling lightheaded",
"prior to",
"out",
"palpitations",
"feeling fatigued recently",
"shortness of breath",
"previous medical history",
"significant",
"diabetes",
"well con... |
A 20-year-old female presents complaining of a persistent nonproductive cough and headache that has gradually developed over the past week. Chest radiograph demonstrates bilateral diffuse interstitial infiltrates. No pathologic organisms are noted on Gram stain of the patient’s sputum. Which of the following findings i... | Clumping of red blood cells after the patient’s blood is drawn and transferred into a chilled EDTA-containing vial | {
"A": "Clumping of red blood cells after the patient’s blood is drawn and transferred into a chilled EDTA-containing vial",
"B": "Alpha hemolysis and optochin sensitivity noted with colonies of the causative organism visualized on blood agar",
"C": "Clumping of red blood cells after the patient’s blood is drawn ... | step1 | A | [
"20 year old female presents complaining of",
"persistent",
"cough",
"headache",
"past week",
"Chest radiograph demonstrates bilateral diffuse interstitial infiltrates",
"pathologic organisms",
"noted",
"Gram stain",
"patients sputum",
"following findings",
"most likely to",
"found",
"labo... |
A 45-year-old male is brought into the emergency department by emergency medical services. The patient has a history of substance abuse and was found down in his apartment lying on his right arm. He was last seen 24 hours earlier by his mother who lives in the same building. He is disoriented and unable to answer any q... | Hyperkalemia | {
"A": "Hypocalcemia",
"B": "Hypercalcemia",
"C": "Hyperkalemia",
"D": "Hypokalemia"
} | step2&3 | C | [
"year old male",
"brought",
"emergency department",
"emergency medical services",
"patient",
"history of substance abuse",
"found",
"apartment lying",
"right arm",
"last seen 24 hours earlier",
"mother",
"lives",
"same building",
"disoriented",
"unable to answer",
"questions",
"48",
... |
A 28-year-old primigravid woman at 38 weeks' gestation is brought to the emergency department in active labor. She has not had regular prenatal care. She has a history of HIV infection but is not currently on antiretroviral therapy. Her previous viral load is unknown. Treatment with intravenous zidovudine is begun to r... | Elongation of viral DNA | {
"A": "Integration of viral genome",
"B": "Cleavage of viral polypeptides",
"C": "Elongation of viral DNA",
"D": "Fusion of virus with T cells"
} | step1 | C | [
"year old primigravid woman",
"weeks",
"gestation",
"brought",
"emergency department",
"active labor",
"not",
"regular prenatal care",
"history",
"HIV infection",
"not currently",
"antiretroviral therapy",
"previous viral load",
"unknown",
"Treatment",
"intravenous zidovudine",
"begu... |
You are the attending physician on duty on an inpatient hospitalist team. A 48-year-old patient with a history of COPD and atrial fibrillation on warfarin is admitted to your service for management of a COPD exacerbation. Four days into her admission, routine daily lab testing shows that patient has an INR of 5. She is... | Tell the patient that a mistake was made and explain why it happened | {
"A": "Tell the patient that a mistake was made and explain why it happened",
"B": "Do not tell the patient about the mistake as no harm was done",
"C": "Do not tell the patient about the mistake because she is likely to sue for malpractice",
"D": "Do not tell the patient about the mistake because you did not ... | step1 | A | [
"attending physician",
"inpatient hospitalist team",
"48 year old patient",
"history",
"COPD",
"atrial fibrillation",
"warfarin",
"admitted",
"service",
"management",
"COPD exacerbation",
"Four days",
"admission",
"routine daily lab testing shows",
"patient",
"INR",
"blood",
"stool... |
A 5-year-old boy is brought to the emergency department by a neighbor who saw him struck by a car. The man reports that the boy is intellectually disabled, and his parents frequently leave him unattended at home for most of the day. He walks around the neighborhood and sometimes has difficulty finding his way home. Tod... | Neglect | {
"A": "Physical abuse",
"B": "Sexual abuse",
"C": "Psychological abuse",
"D": "Neglect"
} | step2&3 | D | [
"5 year old boy",
"brought",
"emergency department",
"neighbor",
"saw",
"struck by",
"car",
"man reports",
"boy",
"disabled",
"parents frequently leave",
"home",
"day",
"walks",
"neighborhood",
"sometimes",
"difficulty finding",
"home",
"Today",
"struck by",
"car",
"sped",
... |
A 29-year-old man presents to the clinic with several days of flatulence and greasy, foul-smelling diarrhea. He says that he was on a camping trip last week after which his symptoms started. When asked further about his camping activities, he reports collecting water from a stream but did not boil or chemically treat t... | Giardiasis | {
"A": "Giardiasis",
"B": "C. difficile colitis",
"C": "Irritable bowel syndrome",
"D": "Traveler’s diarrhea due to Norovirus"
} | step2&3 | A | [
"29 year old man presents",
"clinic",
"several days",
"flatulence",
"greasy",
"smelling diarrhea",
"camping trip",
"week",
"symptoms started",
"further",
"camping activities",
"reports collecting water",
"stream",
"not boil",
"chemically treat",
"water",
"patient",
"reports nausea"... |
A 34-year-old woman, otherwise healthy, is brought into the emergency department after being struck by a motor vehicle. She experienced heavy bleeding and eventually expires due to her injuries. She does not have a past medical history and was not taking any medications. She appears to be a good candidate for organ don... | An organ donor network | {
"A": "The physician",
"B": "An organ donor network",
"C": "A hospital representative",
"D": "The organ recipient"
} | step1 | B | [
"year old woman",
"healthy",
"brought",
"emergency department",
"struck by",
"motor vehicle",
"experienced heavy bleeding",
"expires due to",
"injuries",
"not",
"past medical history",
"not taking",
"medications",
"appears to",
"good candidate",
"organ donation",
"following",
"talk... |
A 55-year-old Caucasian woman visits her family physician for a checkup and to discuss her laboratory results from a previous visit. The medical history is significant for obesity, hypothyroidism, and chronic venous insufficiency. The medications include thyroxine and a multivitamin. In her previous visit, she complain... | No further renal tests are required | {
"A": "Renal arteriography",
"B": "Urine protein electrophoresis",
"C": "Renal computed tomography",
"D": "No further renal tests are required"
} | step2&3 | D | [
"55 year old Caucasian woman visits",
"family physician",
"checkup",
"to discuss",
"laboratory results",
"previous visit",
"medical history",
"significant",
"obesity",
"hypothyroidism",
"chronic venous insufficiency",
"medications include thyroxine",
"multivitamin",
"previous visit",
"hu... |
A 40-year-old man presents to a community health center for a routine check-up. The medical history is significant for a major depressive disorder that began around the time he arrived in the United States from India, his native country. For the last few months, he has been living in the local homeless shelter and also... | Quantiferon testing | {
"A": "Chest X-ray",
"B": "Low-dose computerized tomography (CT) Scan",
"C": "Pulmonary function test",
"D": "Quantiferon testing"
} | step2&3 | D | [
"40 year old man presents",
"community health center",
"routine check-up",
"medical history",
"significant",
"major depressive disorder",
"began",
"time",
"arrived",
"United States",
"India",
"native country",
"last",
"months",
"living",
"local homeless shelter",
"reports",
"incarc... |
A 65-year-old woman comes to the physician because of a 8-month history of worsening difficulties swallowing food and retrosternal chest discomfort. She reports that she sometimes has a feeling of “food getting stuck” in her throat and hears a “gurgling sound” from her throat while eating. She says that she occasionall... | Barium esophagram | {
"A": "Barium esophagram",
"B": "Serology and PCR",
"C": "Esophagogastroduodenoscopy",
"D": "Esophageal pH monitoring"
} | step2&3 | A | [
"65 year old woman",
"physician",
"month history",
"worsening difficulties swallowing food",
"retrosternal chest discomfort",
"reports",
"sometimes",
"feeling",
"food getting",
"throat",
"hears",
"gurgling sound",
"throat",
"eating",
"occasionally coughs",
"pieces",
"undigested food"... |
A 42-year-old woman comes to the physician because of frequent episodes of headaches and tinnitus over the past 3 months. One week ago, she had a brief episode of left arm weakness and numbness that lasted for 2 minutes before spontaneously resolving. She is otherwise healthy and takes no medications. She has smoked on... | Fibromuscular dysplasia | {
"A": "Fibromuscular dysplasia",
"B": "Polyarteritis nodosa",
"C": "Atherosclerotic plaques",
"D": "Congenital renal hypoplasia"
} | step1 | A | [
"year old woman",
"physician",
"frequent episodes",
"headaches",
"tinnitus",
"past 3 months",
"One week",
"brief episode of left arm weakness",
"numbness",
"lasted",
"minutes",
"resolving",
"healthy",
"takes",
"medications",
"smoked one half pack",
"cigarettes daily",
"years",
"p... |
A 78-year-old male with a 35-pack-year smoking history, hyperlipidemia, and peripheral vascular disease is at home eating dinner with his wife when he suddenly has acute onset, crushing chest pain. He lives in a remote rural area, and, by the time the paramedics arrive 30 minutes later, he is pronounced dead. What is t... | Ventricular fibrillation | {
"A": "Ventricular septum rupture",
"B": "Cardiac tamponade",
"C": "Heart block",
"D": "Ventricular fibrillation"
} | step2&3 | D | [
"year old male",
"35 pack",
"smoking history",
"hyperlipidemia",
"peripheral vascular disease",
"at home eating dinner",
"wife",
"acute onset",
"crushing chest pain",
"lives",
"remote rural area",
"time",
"paramedics",
"30 minutes later",
"dead",
"most likely cause of",
"patient's de... |
A 29-year-old woman presents for an annual flu shot. She has no symptoms. Past medical history is significant for mild rheumatoid arthritis, diagnosed 3 years ago and managed with celecoxib and methotrexate. Current medications also include a daily folate-containing multivitamin. She also had 2 elective cesarean sectio... | C-reactive protein (CRP) | {
"A": "C-reactive protein (CRP)",
"B": "Anti-cyclic citrullinated peptide (anti-CCP)",
"C": "Erythrocyte sedimentation rate (ESR)",
"D": "Complete blood count"
} | step1 | A | [
"29 year old woman presents",
"annual flu shot",
"symptoms",
"Past medical history",
"significant",
"mild rheumatoid arthritis",
"diagnosed 3 years",
"managed",
"celecoxib",
"methotrexate",
"Current medications",
"include",
"daily folate containing multivitamin",
"2 elective cesarean secti... |
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