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 34-year-old male comes to his family physician with complaints of joint pain that has been present for over 7 weeks. Prior to the onset of his arthritis, he recalls having a gastrointestinal infection which caused mild diarrhea and abdominal cramps. He recovered well and had no issues until his joint pain started. A ... | Sulfasalazine | {
"A": "Diclofenac",
"B": "Sulfasalazine",
"C": "Ketoprofen",
"D": "Ceftriaxone"
} | step2&3 | B | [
"year old male",
"family physician",
"complaints",
"joint pain",
"present",
"weeks",
"Prior to",
"onset",
"arthritis",
"recalls",
"gastrointestinal infection",
"caused mild diarrhea",
"abdominal cramps",
"recovered well",
"issues",
"joint pain started",
"prescription",
"naproxen",
... |
A 22-year-old man presents to the emergency department with a 2-day history of fever and altered mentation. He reports fever without chills and rigors and denies sore throat, abdominal pain, headache, loose stool, burning micturition, or seizures. He has a history of tics and is currently on a low dose of haloperidol. ... | Neuroleptic malignant syndrome | {
"A": "Acute disseminated encephalomyelitis",
"B": "Encephalitis",
"C": "Meningitis",
"D": "Neuroleptic malignant syndrome"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"2-day history",
"fever",
"altered",
"reports fever",
"chills",
"rigors",
"denies sore throat",
"abdominal pain",
"headache",
"loose stool",
"burning micturition",
"seizures",
"history",
"tics",
"currently",
"low",
"haloperidol",
... |
A 10-month-old boy is brought to the physician by his mother for evaluation of abnormal growth and skin abnormalities. His mother has also noticed that his eyes do not fully close when sleeping. He is at the 24th percentile for height, 17th percentile for weight, and 29th percentile for head circumference. Physical exa... | Lamin | {
"A": "Desmin",
"B": "Nesprin",
"C": "Lamin",
"D": "Plectin\n\""
} | step1 | C | [
"A 10 month old boy",
"brought",
"physician",
"mother",
"evaluation",
"abnormal growth",
"skin abnormalities",
"mother",
"eyes",
"not",
"close",
"sleeping",
"percentile",
"height",
"percentile",
"weight",
"percentile",
"head circumference",
"Physical examination shows wrinkled sk... |
A 64-year-old man presents to his primary care physician because of a tremor that he has developed over the last several months. He says that the tremor is worst when he is resting but becomes better when he engages in movements such as picking up the remote for his TV. His wife also says that his movements have become... | Inhibition of the globus pallidus internus | {
"A": "Inhibition of the globus pallidus internus",
"B": "Stimulation of the globus pallidus externus",
"C": "Stimulation of the globus pallidus internus",
"D": "Stimulation of the subthalamic nucleus"
} | step1 | A | [
"64 year old man presents",
"primary care physician",
"tremor",
"months",
"tremor",
"worst",
"resting",
"better",
"movements",
"as picking",
"remote",
"TV",
"wife",
"movements",
"slower",
"months",
"Physical exam reveals increased resistance to passive motion",
"extremities",
"Ga... |
A 49-year-old woman presents to her physician with complaints of breast swelling and redness of the skin over her right breast for the past 1 month. She also mentions that the skin above her right breast appears to have thickened. She denies any pain or nipple discharge. The past medical history is significant for a to... | The inflammation is due to obstruction of dermal lymphatic vessels. | {
"A": "It is a benign lesion.",
"B": "The inflammation is due to obstruction of dermal lymphatic vessels.",
"C": "The lesion expresses receptors for estrogen and progesterone.",
"D": "It shows predominant lymphatic spread."
} | step1 | B | [
"year old woman presents",
"physician",
"complaints of breast swelling",
"redness of",
"skin",
"right breast",
"past",
"month",
"skin",
"right breast appears to",
"thickened",
"denies",
"pain",
"nipple discharge",
"past medical history",
"significant",
"total abdominal hysterectomy",... |
A 36-year-old primigravid woman at 26 weeks' gestation comes to the physician complaining of absent fetal movements for the last 2 days. Pregnancy was confirmed by ultrasonography 14 weeks earlier. She has no vaginal bleeding or discharge. She has a history of type 1 diabetes mellitus controlled with insulin. Vital sig... | Plan for oxytocin administration | {
"A": "Perform cesarean delivery",
"B": "Plan for oxytocin administration",
"C": "Administer magnesium sulfate",
"D": "Perform dilation and curettage\n\""
} | step2&3 | B | [
"36 year old primigravid woman",
"weeks",
"gestation",
"physician",
"absent fetal movements",
"last 2 days",
"Pregnancy",
"confirmed by ultrasonography",
"weeks earlier",
"vaginal bleeding",
"discharge",
"history of type 1 diabetes mellitus controlled",
"insulin",
"Vital signs",
"normal ... |
A 63-year-old man presents to his primary care physician complaining of excessive daytime sleepiness. He explains that this problem has worsened slowly over the past few years but is now interfering with his ability to play with his grandchildren. He worked previously as an overnight train conductor, but he has been re... | Poor oropharyngeal tone | {
"A": "Insufficient sleep duration",
"B": "Circadian rhythm sleep-wake disorder",
"C": "Poor oropharyngeal tone",
"D": "Psychiatric disorder"
} | step1 | C | [
"63 year old man presents",
"primary care physician",
"excessive daytime sleepiness",
"problem",
"worsened slowly",
"past",
"years",
"now interfering",
"ability to play",
"grandchildren",
"worked",
"overnight train conductor",
"retired",
"past",
"years",
"sleeps approximately 8",
"ho... |
A previously healthy 5-year-old boy is brought to the physician with a recurring fever and malaise for 3 weeks. He has also had fatigue and loss of appetite. He initially presented 2 weeks ago with a maculopapular rash that has since resolved. At the time, he was given a prescription for amoxicillin-clavulanate. He den... | Azithromycin therapy | {
"A": "Doxycycline therapy",
"B": "Pyrimethamine therapy",
"C": "Azithromycin therapy",
"D": "Streptomycin therapy"
} | step2&3 | C | [
"healthy",
"year old boy",
"brought",
"physician",
"recurring fever",
"malaise",
"weeks",
"fatigue",
"loss of appetite",
"initially presented 2 weeks",
"maculopapular rash",
"since resolved",
"time",
"given",
"prescription",
"amoxicillin-clavulanate",
"denies sore throat",
"myalgia... |
An 8-year-old girl is brought to the physician by her parents because of difficulty sleeping. One to two times per week for the past 2 months, she has woken up frightened in the middle of the night, yelling and crying. She has not seemed confused after waking up, and she is consolable and able to fall back asleep in he... | Nightmare disorder | {
"A": "Sleep terror disorder",
"B": "Post-traumatic stress disorder",
"C": "Normal development",
"D": "Nightmare disorder"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"parents",
"difficulty sleeping",
"One",
"two",
"week",
"past",
"months",
"woken up frightened",
"middle",
"night",
"crying",
"not",
"confused",
"waking",
"able to fall back asleep",
"parents",
"bed",
"following day",
"more tired",
... |
A 56-year-old man who underwent kidney transplantation 6 months ago, presents to the physician because of fever, dyspnea, non-productive cough, and lethargy. He is on no other medications apart from immunosuppressive therapy. On physical examination, the vital signs include: pulse 110/min, blood pressure 126/76 mm Hg, ... | Trimethoprim-sulfamethoxazole intravenously | {
"A": "Intravenous pentamidine",
"B": "Trimethoprim-sulfamethoxazole intravenously",
"C": "High-dose corticosteroids and bronchodilators",
"D": "Oral dapsone + trimethoprim"
} | step2&3 | B | [
"year old man",
"kidney transplantation",
"months",
"presents",
"physician",
"fever",
"dyspnea",
"non-productive cough",
"lethargy",
"medications",
"immunosuppressive",
"physical examination",
"vital signs include",
"pulse",
"min",
"blood pressure",
"76 mm Hg",
"respirations",
"m... |
A 63-year-old man presents to the clinic complaining of burning bilateral leg pain which has been increasing gradually over the past several months. It worsens when he walks but improves with rest. His past medical and surgical history are significant for hypertension, hyperlipidemia, diabetes, and a 40-pack-year smoki... | Exercise and smoking cessation | {
"A": "Exercise and smoking cessation",
"B": "Femoral-popliteal bypass",
"C": "Lisinopril and atorvastatin",
"D": "Lovenox and atorvastatin"
} | step2&3 | A | [
"63 year old man presents",
"clinic",
"burning bilateral leg pain",
"increasing",
"past",
"months",
"worsens",
"walks",
"improves",
"rest",
"past medical",
"surgical history",
"significant",
"hypertension",
"hyperlipidemia",
"diabetes",
"40 pack-year smoking history",
"temperature"... |
A 30-year-old woman, gravida 2, para 1, comes to the physician because she had a positive pregnancy test at home. During the last two weeks, she has had nausea and two episodes of non-bloody vomiting. She also reports increased urinary frequency. Her pregnancy and delivery of her first child were uncomplicated. Last ye... | Lower spinal surgery | {
"A": "Cochlear implantation",
"B": "Respiratory support",
"C": "Lower spinal surgery",
"D": "Dental treatment"
} | step2&3 | C | [
"30 year old woman",
"gravida 2",
"para 1",
"physician",
"positive pregnancy test at home",
"last two weeks",
"nausea",
"two episodes of non bloody vomiting",
"reports increased urinary frequency",
"pregnancy",
"delivery",
"first child",
"uncomplicated",
"year",
"two episodes of grand-ma... |
A 71-year-old man comes to the physician accompanied by his wife because of a 6-month history of worsening episodic upper abdominal pain and an 8-kg (17.6-lb) weight loss. The pain is dull, nonradiating, worse after eating, and occasionally associated with bloating and diarrhea. His symptoms have not improved despite 4... | CT angiography of the abdomen | {
"A": "Right upper quadrant abdominal ultrasound",
"B": "CT angiography of the abdomen",
"C": "Endoscopic retrograde cholangiography",
"D": "Upper endoscopy"
} | step2&3 | B | [
"71 year old man",
"physician",
"wife",
"of",
"month history",
"worsening episodic upper abdominal pain",
"kg",
"weight loss",
"pain",
"dull",
"worse after eating",
"occasionally associated with bloating",
"diarrhea",
"symptoms",
"not improved",
"weeks",
"treatment",
"omeprazole",
... |
Five days after admission into the ICU for drug-induced acute kidney injury, a 27-year-old woman develops fever. She is currently on a ventilator and sedatives. Hemodialysis is performed via a catheter placed in the right internal jugular vein. Feeding is via a nasogastric tube. An indwelling urinary catheter shows min... | Central catheter-related bacteremia | {
"A": "Catheter-associated urinary tract infection",
"B": "Central catheter-related bacteremia",
"C": "Endocarditis",
"D": "Ventilator-associated pneumonia"
} | step2&3 | B | [
"Five days",
"admission",
"ICU",
"drug-induced acute kidney injury",
"27 year old woman",
"fever",
"currently",
"ventilator",
"sedatives",
"Hemodialysis",
"performed",
"catheter placed",
"right internal jugular vein",
"Feeding",
"nasogastric tube",
"indwelling urinary catheter shows mi... |
A 70-year-old man presents for his annual check-up. He says he feels well except for occasional abdominal pain. He describes the pain as 4/10–5/10 in intensity, diffusely localized to the periumbilical and epigastric regions, radiating to the groin. The pain occurs 1–2 times a month and always subsides on its own. The ... | Abdominal aortic aneurysm | {
"A": "Abdominal aortic aneurysm",
"B": "Acute pancreatitis",
"C": "Acute gastritis",
"D": "Diverticulitis"
} | step1 | A | [
"70 year old man presents",
"annual check-up",
"feels well",
"occasional abdominal pain",
"pain",
"4",
"10",
"intensity",
"localized",
"periumbilical",
"epigastric regions",
"radiating to",
"groin",
"pain occurs",
"times",
"month",
"always",
"patient denies",
"recent history",
... |
Six days after undergoing a left hemicolectomy for colorectal carcinoma, a 59-year-old man collapses in the hospital hallway and is unconscious for 30 seconds. Afterwards, he complains of shortness of breath and chest pain with deep inhalation. He has hypertension and hyperlipidemia. He smoked one pack of cigarettes da... | Dilated right ventricular cavity | {
"A": "Rapid, aberrant contractions of the atria",
"B": "Stenosis of the carotid arteries",
"C": "Dilated right ventricular cavity",
"D": "Reduced regional ventricular wall motion"
} | step2&3 | C | [
"Six days",
"left hemicolectomy",
"colorectal carcinoma",
"59 year old man collapses",
"hospital hallway",
"unconscious",
"30 seconds",
"of shortness",
"breath",
"chest pain",
"deep inhalation",
"hypertension",
"hyperlipidemia",
"smoked one pack",
"cigarettes daily",
"35 years",
"qui... |
A 35-year-old woman presents to her physician with a complaint of pain and stiffness in her hands. She says that the pain began 6 weeks ago a few days after she had gotten over a minor upper respiratory infection. She admits that the pain is worse in the morning, and she occasionally notes subjective fever but has not ... | Prednisone | {
"A": "Anakinra",
"B": "Etanercept",
"C": "Methotrexate",
"D": "Prednisone"
} | step1 | D | [
"35 year old woman presents",
"physician",
"complaint",
"pain",
"stiffness",
"hands",
"pain began",
"weeks",
"few days",
"gotten",
"minor upper respiratory infection",
"admits",
"pain",
"worse",
"morning",
"occasionally notes subjective fever",
"not taken",
"temperature",
"admits... |
A 15-year-old girl is brought to the physician because of abnormal vaginal bleeding for the past 2 months. Apart from the past 2 months, she has had regular menstrual cycles. She had menarche at the age of 13. She has no personal or family history of any serious illnesses. She takes no medications. Her vital signs are ... | Embryonal carcinoma | {
"A": "Corpus luteum cyst",
"B": "Embryonal carcinoma",
"C": "Krukenberg tumor",
"D": "Serous cystadenoma"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"of abnormal vaginal bleeding",
"past",
"months",
"past",
"months",
"regular menstrual cycles",
"menarche at",
"age",
"personal",
"family history",
"serious illnesses",
"takes",
"medications",
"vital signs",
"normal",
"Physical examination... |
A 2-year-old boy presents with a swollen face and irritability. The patient's mother reports his urine was red this morning. 3 weeks ago, he presented to this same clinic with a ‘sandpaper’ rash and a red tongue with patchy hyperplastic fungiform papillae for which he was given broad-spectrum antibiotics. Laboratory te... | I, IV, V | {
"A": "I, II",
"B": "III, IV",
"C": "I, IV, V",
"D": "I, IV, V"
} | step1 | C | [
"2 year old boy presents",
"swollen face",
"irritability",
"patient's mother reports",
"urine",
"red",
"morning",
"weeks",
"presented",
"same clinic",
"rash",
"red tongue",
"patchy hyperplastic fungiform papillae",
"given broad spectrum antibiotics",
"Laboratory tests reveal proteinuria"... |
A 37-year-old woman presents to the general medical clinic with a chief complaint of anxiety. She has been having severe anxiety and fatigue for the past seven months. She has difficulty concentrating and her work has suffered, and she has also developed diarrhea from the stress. She doesn't understand why she feels so... | A drug that blocks dopamine 2 receptors | {
"A": "A drug that stimulates 5-HT1A receptors",
"B": "A drug that blocks 5-HT reuptake",
"C": "A drug that blocks both serotonin and norepinephrine reuptake",
"D": "A drug that blocks dopamine 2 receptors"
} | step1 | D | [
"year old woman presents",
"general medical clinic",
"chief complaint",
"anxiety",
"severe anxiety",
"fatigue",
"past seven months",
"difficulty concentrating",
"work",
"suffered",
"diarrhea",
"stress",
"understand",
"feels so anxious",
"unable to attribute",
"to",
"specific aspect",... |
A 17-year-old female is brought to the emergency room by her parents shortly after a suicide attempt by aspirin overdose. Which of the following acid/base changes will occur FIRST in this patient? | Respiratory alkalosis | {
"A": "Non-anion gap metabolic acidosis",
"B": "Anion gap metabolic acidosis",
"C": "Metabolic alkalosis",
"D": "Respiratory alkalosis"
} | step1 | D | [
"year old female",
"brought",
"emergency room",
"parents",
"suicide attempt",
"aspirin overdose",
"following acid base changes",
"occur FIRST",
"patient"
] |
During a humanitarian medical mission in rural Vietnam, a medical resident encounters a 50-year-old man with a year-long history of a pruritic rash on his upper body and face, along with numbness and tingling sensation of both of his palms. He mostly works on his family’s rice farm, where he also takes care of livestoc... | Leprosy | {
"A": "Cutaneous leishmaniasis",
"B": "Tinea corporis",
"C": "Leprosy",
"D": "Scrofula"
} | step1 | C | [
"medical mission",
"rural Vietnam",
"medical resident encounters",
"50 year old man",
"long history",
"pruritic rash",
"upper body",
"face",
"numbness",
"tingling sensation",
"palms",
"mostly works",
"rice farm",
"takes care",
"livestock",
"physical examination revealed multiple erythe... |
A 21-year-old female is brought to the emergency department by her roommate. Her roommate says that the patient has been acting “strangely” for the past 10 days. She has noticed that the patient has been moving and talking on the phone at all hours of the night. She doesn’t think that the patient sleeps more than one t... | Bipolar I disorder | {
"A": "Major depressive disorder",
"B": "Bipolar I disorder",
"C": "Bipolar II disorder",
"D": "Dysthymic disorder"
} | step1 | B | [
"21-year-old female",
"brought",
"emergency department",
"roommate",
"roommate",
"patient",
"acting",
"past 10 days",
"patient",
"moving",
"talking on",
"phone",
"hours",
"night",
"think",
"patient sleeps more",
"one",
"two hours",
"night",
"spends hours pacing",
"down",
"a... |
An 87-year-old woman is brought to the emergency department 30 minutes after a fall onto a hardwood floor. She landed on her left side and hit the left side of her head. She did not lose consciousness. She has a mild headache over the left temple and severe left hip pain. She has had nasal congestion, a sore throat, an... | Blood loss | {
"A": "Pulmonary embolism",
"B": "Brain herniation",
"C": "Sepsis",
"D": "Blood loss"
} | step2&3 | D | [
"87 year old woman",
"brought",
"emergency department 30 minutes",
"fall",
"floor",
"landed",
"left side",
"hit",
"left side of",
"head",
"not",
"consciousness",
"mild headache",
"left",
"severe left hip pain",
"nasal congestion",
"sore throat",
"productive cough",
"2 days",
"h... |
A 27-year-old male presents with primary complaints of a palpable mass in his scrotum and mild testicular pain. Physical exam reveals an abnormal appearing scrotum around the left testis, as depicted in image A. Which of the following is the most likely etiology of this presentation? | Compression of the left renal vein at the aortic origin of the superior mesenteric artery | {
"A": "Compression of the left renal vein at the aortic origin of the superior mesenteric artery",
"B": "Neisseria gonorrhoeae Infection of the left testis leading to epididymitis",
"C": "Unilateral failure of the left testis to descend into the scrotum",
"D": "Twisting of the spermatic cord secondary to rotat... | step1 | A | [
"27 year old male presents",
"primary complaints",
"palpable mass",
"scrotum",
"mild testicular",
"Physical exam reveals",
"abnormal appearing scrotum",
"left testis",
"image",
"following",
"most likely etiology",
"presentation"
] |
A 30-month-old boy is brought to the emergency department by his parents. He has burns over his left hand. The mother tells the doctor that the child was playing unobserved in the kitchen and accidentally grabbed a hot spoon, which produced the burn. She also says his pediatrician had expressed concern as to the possib... | Forced immersion in hot water | {
"A": "Forced immersion in hot water",
"B": "Burn as a result of poor supervision",
"C": "Accidental burns",
"D": "Abusive burn from a hot spoon"
} | step2&3 | A | [
"30 month old boy",
"brought",
"emergency department",
"parents",
"burns",
"left",
"mother",
"doctor",
"child",
"playing",
"kitchen",
"grabbed",
"hot spoon",
"burn",
"pediatrician",
"concern",
"possibility",
"autism spectrum disorder",
"last visit",
"suggested regular follow-up... |
A 75-year-old man is brought to the emergency department for a 5-day-history of worsening dyspnea, orthopnea, and lower leg swelling. He has a history of hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and myocardial infarction 10 years ago. Current medications include metoprolol, lisinopril, ethacryni... | Decreased serum Na+ | {
"A": "Decreased BNP levels",
"B": "Decreased serum Na+",
"C": "Increased VO2",
"D": "Increased heart rate variability"
} | step2&3 | B | [
"75 year old man",
"brought",
"emergency department",
"5-day history",
"worsening dyspnea",
"orthopnea",
"lower leg swelling",
"history of hypertension",
"hyperlipidemia",
"non-alcoholic fatty liver disease",
"myocardial infarction 10 years",
"Current medications include metoprolol",
"lisino... |
You have been asked to quantify the relative risk of developing bacterial meningitis following exposure to a patient with active disease. You analyze 200 patients in total, half of which are controls. In the trial arm, 30% of exposed patients ultimately contracted bacterial meningitis. In the unexposed group, only 1% c... | [30 / (30 + 70)] / [1 / (1 + 99)] | {
"A": "[30 / (30 + 70)] / [1 / (1 + 99)]",
"B": "(30 * 99) / (70 * 1)",
"C": "(70 * 1) / (39 * 99)",
"D": "[1 / (1 + 99)] / 30 / (30 + 70)]"
} | step2&3 | A | [
"to quantify",
"relative risk",
"bacterial meningitis following exposure to",
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"active disease",
"200 patients",
"total",
"half",
"controls",
"trial arm",
"30",
"exposed patients",
"contracted bacterial meningitis",
"unexposed group",
"only",
"contracted",
"disease",
"fol... |
A father brings in his 7-year-old twin sons because they have a diffuse rash. They have several papules, vesicles, pustules, and crusts on their scalps, torso, and limbs. The skin lesions are pruritic. Other than that, the boys appear to be well. The father reports that several children in school have a similar rash. T... | Bacterial superinfection of skin lesions | {
"A": "Bacterial superinfection of skin lesions",
"B": "Pneumonia",
"C": "Encephalitis",
"D": "Cerebellar ataxia"
} | step1 | A | [
"father",
"year old twin sons",
"diffuse rash",
"several papules",
"vesicles",
"pustules",
"crusts",
"scalps",
"torso",
"limbs",
"skin lesions",
"boys appear to",
"well",
"father reports",
"several children in school",
"similar rash",
"family recently returned",
"beach vacation",
... |
A 75-year-old female comes to the physician’s office with complaints of right lower quadrant pain. She has been experiencing these symptoms for the last 6 months and they have progressively gotten worse. An ultrasound reveals a large ovarian mass and abdominal and pelvic CT reveals no metastases. Her serum levels of CA... | Loss of E-cadherin | {
"A": "Intact basement membrane",
"B": "Loss of E-cadherin",
"C": "Seeding via capillaries",
"D": "Increased proliferation of cells with preservation of size and shape"
} | step1 | B | [
"75 year old female",
"physicians office",
"complaints",
"right lower quadrant pain",
"experiencing",
"symptoms",
"months",
"gotten worse",
"ultrasound reveals",
"large ovarian",
"abdominal",
"pelvic CT reveals",
"metastases",
"serum levels",
"CA-125",
"elevated",
"biopsy reveals",
... |
A 36-year-old African American woman G1P0 at 33 weeks gestation presents to the emergency department because "her water broke." Her prenatal history is remarkable for proteinuria in the absence of hypertension during her third trimester check-up. She denies any smoking, alcohol use, sick contacts, abdominal pain, fever... | Growth retardation | {
"A": "Growth retardation",
"B": "Meconium aspiration",
"C": "Microcephaly",
"D": "Stillbirth"
} | step2&3 | A | [
"36 year old African American woman",
"weeks presents",
"emergency department",
"water",
"prenatal history",
"proteinuria",
"absence of hypertension",
"third trimester check-up",
"denies",
"smoking",
"alcohol use",
"sick contacts",
"abdominal pain",
"fever",
"nausea",
"vomiting",
"di... |
A 30-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. Her first pregnancy and delivery were complicated by iron deficiency anemia and pregnancy-induced hypertension. She has had no routine prenatal care during this pregnancy but was diagnosed with oligohydramnios 4 ... | Maternal phenytoin therapy | {
"A": "Maternal phenytoin therapy",
"B": "Fetal posterior urethral valves",
"C": "Maternal diabetes mellitus",
"D": "Maternal alcohol intake"
} | step2&3 | A | [
"30 year old woman",
"gravida 2",
"para 1",
"40 weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"first pregnancy",
"delivery",
"complicated",
"iron deficiency anemia",
"pregnancy-induced hypertension",
"routine care",
"pregnancy",
"diagnosed",
"oligohydramnios",
"weeks... |
A 32-year-old female presents to her obstetrician 3 weeks postpartum for failure to lactate. Of note, she has been unable to tolerate cold environments since the birth of her child. Review of systems is positive for fatigue, lightheadedness, and a 3-pound weight gain over the last 3 weeks. Her delivery was complicated ... | Aldosterone | {
"A": "Antidiuretic hormone",
"B": "Aldosterone",
"C": "Cortisol",
"D": "Luteinizing hormone"
} | step1 | B | [
"year old female presents",
"obstetrician",
"weeks postpartum",
"failure",
"lactate",
"note",
"unable to",
"cold environments",
"birth of",
"child",
"Review",
"systems",
"positive",
"fatigue",
"lightheadedness",
"3 pound weight gain",
"3 weeks",
"delivery",
"complicated",
"plac... |
A 44-year-old woman comes to the physician because of a 2-year history of progressive dysphagia. She initially had symptoms only when consuming solid foods, but for the past 2 months she has also had difficulty swallowing liquids. She describes a feeling of food “getting stuck” in her throat. She was diagnosed with gas... | Esophageal smooth muscle atrophy and fibrosis | {
"A": "Uncoordinated contractions of the esophagus",
"B": "Protrusion of thin tissue membranes into the esophagus",
"C": "Esophageal smooth muscle atrophy and fibrosis",
"D": "Degeneration of upper and lower motor neurons"
} | step2&3 | C | [
"year old woman",
"physician",
"2 year history",
"progressive dysphagia",
"initially",
"symptoms only",
"solid foods",
"past",
"months",
"difficulty swallowing liquids",
"feeling",
"food getting",
"throat",
"diagnosed",
"gastroesophageal reflux disease",
"years",
"episodic pallor of"... |
A 14-year-old boy is brought to the emergency department by his parents for joint pain following the acute onset of a diffuse, pruritic rash for the past 24 hours. A week ago, he was diagnosed with pharyngitis after returning home from summer camp and is currently taking antibiotics. There is no family history of serio... | Discontinue antibiotic | {
"A": "Switch medication to doxycycline",
"B": "Discontinue antibiotic",
"C": "Administer prednisone",
"D": "Perform allergy testing"
} | step2&3 | B | [
"year old boy",
"brought",
"emergency department",
"parents",
"joint pain following",
"acute",
"diffuse",
"pruritic rash",
"past 24 hours",
"week",
"diagnosed",
"pharyngitis",
"returning home",
"summer camp",
"currently taking antibiotics",
"family history",
"serious illness",
"tem... |
A 61-year-old woman comes to the physician because of a 6-day history of cough, shortness of breath, and fever. She also reports that she has had 4 episodes of watery diarrhea per day for the last 3 days. She has chronic bronchitis. She has smoked one pack of cigarettes daily for the past 30 years. Her temperature is 3... | Levofloxacin | {
"A": "Amoxicillin",
"B": "Vancomycin",
"C": "Levofloxacin",
"D": "Cotrimoxazole"
} | step1 | C | [
"61 year old woman",
"physician",
"6-day history",
"cough",
"shortness of breath",
"fever",
"reports",
"4 episodes of watery diarrhea",
"day",
"3 days",
"chronic bronchitis",
"smoked one pack",
"cigarettes daily",
"past 30 years",
"temperature",
"pulse",
"65 min",
"Examination show... |
A 70-year-old woman presents to the office for a yearly physical. She states she has recently started experiencing pain in her legs and her back. Last year, she experienced a fracture of her left arm while trying to lift groceries. The patient states that she does not consume any dairy and does not go outside often bec... | 25-hydroxyvitamin D | {
"A": "25-hydroxyvitamin D",
"B": "1,25-hydroxyvitamin D",
"C": "Pre-vitamin D3",
"D": "Dietary vitamin D2"
} | step2&3 | A | [
"70 year old woman presents",
"office",
"yearly physical",
"states",
"recently started experiencing pain in",
"legs",
"back",
"year",
"experienced",
"fracture of",
"left arm",
"lift",
"patient states",
"not",
"dairy",
"not go outside often",
"pain",
"legs",
"back",
"note",
"t... |
A 3-year-old boy is brought to the physician for evaluation of developmental delay. He could sit alone at 12 months and started walking with support at the age of 2 years. He can name only very few familiar objects and uses simple two-word sentences. He cannot stack more than 2 blocks. His parents report that he does n... | Mitral regurgitation | {
"A": "Acute myeloid leukemia",
"B": "Aortic dissection",
"C": "Hyperuricemia",
"D": "Mitral regurgitation"
} | step2&3 | D | [
"3 year old boy",
"brought",
"physician",
"evaluation",
"developmental delay",
"sit alone",
"12 months",
"started walking with support",
"age",
"years",
"name only very",
"familiar objects",
"uses simple two word sentences",
"stack more",
"blocks",
"parents report",
"not",
"playing... |
A 25-year-old woman is brought to the emergency department because of a 1-day history of lower abdominal pain and vaginal bleeding. Her last menstrual period was 7 weeks ago. A urine pregnancy test is positive. A pelvic ultrasound shows a normal appearing uterus with an empty intrauterine cavity and a minimal amount of... | Increase in deoxyuridine monophosphate | {
"A": "Decrease in guanylate",
"B": "Increase in deoxyuridine monophosphate",
"C": "Decrease in phosphoribosyl pyrophosphate",
"D": "Increase in tetrahydrofolate polyglutamate"
} | step1 | B | [
"year old woman",
"brought",
"emergency department",
"1-day history",
"lower abdominal pain",
"vaginal bleeding",
"last menstrual period",
"weeks",
"urine pregnancy test",
"positive",
"pelvic ultrasound shows",
"normal appearing uterus",
"empty intrauterine cavity",
"minimal amount",
"fr... |
A 71-year-old man presents to the physician for a routine health-maintenance examination. He feels well; however, he is concerned about the need for prostate cancer screening. He has a 3-year history of benign prostatic hyperplasia. His symptoms of urinary hesitancy and terminal dribbling of urine are well controlled w... | No screening test is recommended | {
"A": "Prostate ultrasonography every year",
"B": "Serum PSA every year",
"C": "Serum PSA every 2-4 years",
"D": "No screening test is recommended"
} | step2&3 | D | [
"71 year old man presents",
"physician",
"routine health-maintenance examination",
"feels well",
"concerned",
"need",
"prostate cancer screening",
"3 year history of benign prostatic hyperplasia",
"symptoms",
"urinary",
"terminal dribbling of urine",
"well controlled",
"tamsulosin",
"finas... |
A 47-year-old woman presents to the clinic complaining of difficulty swallowing that started 1 month ago. The patient also reports a weight loss of 10 lbs during this time, without a change in her appetite. She denies fatigue, cough, hoarseness, pain, or hemoptysis. The patient has a history of childhood lymphoma, whic... | Thyroid scintigraphy | {
"A": "Levothyroxine",
"B": "Partial thyroidectomy",
"C": "Radioactive iodine",
"D": "Thyroid scintigraphy"
} | step2&3 | D | [
"year old woman presents",
"clinic",
"difficulty swallowing",
"started 1 month",
"patient",
"reports",
"weight loss of 10 lbs",
"time",
"change in",
"appetite",
"denies fatigue",
"cough",
"hoarseness",
"pain",
"hemoptysis",
"patient",
"history of childhood lymphoma",
"treated with ... |
A 2-year-old boy is brought to the physician by his parents for the evaluation of an unusual cough, a raspy voice, and noisy breathing for the last 2 days. During this time, the symptoms have always occurred in the late evening. The parents also report that prior to the onset of these symptoms, their son had a low-grad... | Subglottic larynx | {
"A": "Epiglottis",
"B": "Supraglottic larynx",
"C": "Subglottic larynx",
"D": "Bronchi\n\""
} | step2&3 | C | [
"2 year old boy",
"brought",
"physician",
"parents",
"evaluation",
"unusual cough",
"raspy voice",
"noisy breathing",
"2 days",
"time",
"symptoms",
"always occurred",
"late evening",
"parents",
"report",
"prior to",
"onset",
"symptoms",
"son",
"low-grade fever",
"runny nose",... |
A 9-year-old boy from Eritrea is admitted to the hospital for lethargy and increased work of breathing. He has had recurrent episodes of fever, shortness of breath, and fatigue in the past 3 years. His pulse is 132/min and blood pressure is 90/66 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 82%. Ausc... | Type II hypersensitivity reaction | {
"A": "Amastigote infiltration",
"B": "Beta-myosin heavy chain defect",
"C": "Non-caseating granulomatous inflammation",
"D": "Type II hypersensitivity reaction"
} | step1 | D | [
"year old boy",
"Eritrea",
"admitted",
"hospital",
"lethargy",
"increased work of breathing",
"recurrent episodes of fever",
"shortness of breath",
"fatigue",
"past",
"years",
"pulse",
"min",
"blood pressure",
"90 66 mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
... |
A 52-year-old woman presents to her primary care physician with symptoms of heat intolerance, unintentional weight loss, feelings of anxiety, and excessive energy that hinder her from falling asleep at night. On physical exam, the patient is found to have mildly protuberant eyes bilaterally as well as discoloration and... | Decreased serum TSH | {
"A": "Decreased free T4",
"B": "Decreased serum TSH",
"C": "Increased anti-mitochondrial antibodies",
"D": "Increased serum TSH"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"symptoms of heat intolerance",
"unintentional weight loss",
"feelings",
"anxiety",
"excessive energy",
"falling asleep",
"night",
"physical exam",
"patient",
"found to",
"mildly protuberant eyes",
"discoloration",
"swelling",
"shins... |
A 35-year-old man presents with acute-onset right flank pain. He says that his symptoms began suddenly 6 hours ago and have not improved. He describes the pain as severe, colicky, and ‘coming in waves’. It is localized to the right flank and radiates to the groin. He says he has associated nausea. He denies any fever, ... | Hydrocodone and indomethacin | {
"A": "Emergency percutaneous nephrostomy",
"B": "Hydrocodone and indomethacin",
"C": "24-hour urine chemistry",
"D": "Lithotripsy"
} | step2&3 | B | [
"35 year old man presents",
"acute-onset right flank",
"symptoms began",
"hours",
"not improved",
"pain",
"severe",
"colicky",
"waves",
"localized",
"right flank",
"radiates",
"groin",
"associated nausea",
"denies",
"fever",
"chills",
"dysuria",
"hematuria",
"past medical histo... |
A 22-year-old man is brought to the emergency department by ambulance 1 hour after a motor vehicle accident. He did not require any circulatory resuscitation at the scene, but he was intubated because he was unresponsive. He has no history of serious illnesses. He is on mechanical ventilation with no sedation. His bloo... | Evaluation of brainstem reflexes | {
"A": "Apnea test",
"B": "Cerebral angiography",
"C": "Electroencephalography",
"D": "Evaluation of brainstem reflexes"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"ambulance",
"hour",
"motor vehicle accident",
"not",
"circulatory resuscitation",
"intubated",
"unresponsive",
"history",
"serious illnesses",
"mechanical ventilation",
"sedation",
"blood pressure",
"62 mm Hg",
"pulse",
"68 min",
... |
A 72-year-old woman with a medical history significant for chronic kidney disease stage 4, hypertension, and type 2 diabetes mellitus, presents to the office for a scheduled visit. During her last visit, the physician started discussing with her the possibility of starting her on dialysis for her chronic kidney disease... | Serum intact parathyroid hormone level | {
"A": "Erythrocyte sedimentation rate",
"B": "Serum C-reactive protein level",
"C": "Serum intact parathyroid hormone level",
"D": "Serum vitamin B-12 level"
} | step2&3 | C | [
"72 year old woman",
"medical history significant",
"chronic kidney disease stage 4",
"hypertension",
"type 2 diabetes mellitus",
"presents",
"office",
"scheduled visit",
"last visit",
"physician started discussing",
"possibility",
"starting",
"dialysis",
"chronic kidney disease",
"patie... |
A 44-year-old woman presents to her physician’s office for weakness. She reports having some difficulty placing books on a high shelf and getting up from a seated position. She denies muscle pain or any new rashes. She has noticed a tremor that is worse with action and has been having trouble falling asleep and staying... | Decreased thyroid-stimulating hormone | {
"A": "Anti-Mi-2 antibody positivity",
"B": "Decreased thyroid-stimulating hormone",
"C": "Increased erythrocyte sedimentation rate",
"D": "Normal laboratory results"
} | step2&3 | B | [
"year old woman presents",
"physicians office",
"weakness",
"reports",
"difficulty placing books",
"high",
"getting",
"seated position",
"denies muscle pain",
"new rashes",
"tremor",
"worse",
"action",
"trouble falling asleep",
"asleep",
"lost approximately 10 pounds",
"course of",
... |
A 23-year-old college senior visits the university health clinic after vomiting large amounts of blood. He has been vomiting for the past 36 hours after celebrating his team’s win at the national hockey championship with his varsity friends while consuming copious amounts of alcohol. His personal medical history is unr... | Esophageal tear | {
"A": "Esophageal perforation",
"B": "Esophageal metaplasia",
"C": "Output of the esophageal mucosa",
"D": "Esophageal tear"
} | step2&3 | D | [
"23 year old college senior visits",
"university health clinic",
"vomiting large amounts of blood",
"vomiting",
"past 36 hours",
"teams win",
"national hockey",
"friends",
"copious amounts",
"alcohol",
"personal medical history",
"unremarkable",
"blood pressure",
"mm Hg",
"supine",
"10... |
A 29-year-old G1P0 at 23 weeks of gestation presents to the ED for left flank pain migrating to the groin. The pain is sharp, causing her to have nausea and vomiting. She also endorses urinary frequency, but denies vaginal discharge. There have been no complications in her pregnancy thus far. Her abdominal exam is rema... | Renal ultrasound | {
"A": "Renal radiograph",
"B": "Renal ultrasound",
"C": "Noncontrast CT scan of abdomen and pelvis",
"D": "Exploratory laparoscopy"
} | step2&3 | B | [
"29 year old",
"23 weeks of gestation presents",
"ED",
"left flank pain migrating",
"groin",
"pain",
"sharp",
"causing",
"to",
"nausea",
"vomiting",
"urinary frequency",
"denies vaginal discharge",
"complications",
"pregnancy",
"far",
"abdominal exam",
"left lower quadrant tenderne... |
A 26-year-old female presents to her primary care physician concerned that she has contracted a sexually transmitted disease. She states that she is having severe pain whenever she urinates and seems to be urinating more frequently than normal. She reports that her symptoms started after she began having unprotected se... | Escherichia coli | {
"A": "Proteus mirabilis",
"B": "Klebsiella pneumoniae",
"C": "Escherichia coli",
"D": "Enterobacter cloacae"
} | step1 | C | [
"year old female presents",
"primary care physician concerned",
"contracted",
"sexually transmitted disease",
"states",
"severe pain",
"to",
"more frequently",
"normal",
"reports",
"symptoms started",
"began",
"unprotected sexual intercourse",
"partner earlier",
"week",
"physician obta... |
A 57-year-old woman comes to the emergency department because of severe pain around her right eye, blurred vision in the same eye, and a headache for the past 4 hours. She is nauseous but has not vomited. She can see colored bright circles when she looks at a light source. She is currently being treated for a urinary t... | Perform gonioscopy | {
"A": "Perform ultrasound biomicroscopy",
"B": "Perform gonioscopy",
"C": "Perform fundoscopy",
"D": "Administer topical steroids"
} | step2&3 | B | [
"57 year old woman",
"emergency department",
"of severe pain",
"right eye",
"blurred vision",
"same eye",
"headache",
"past",
"hours",
"nauseous",
"not vomited",
"see colored bright circles",
"looks",
"light source",
"currently",
"treated",
"urinary tract infection",
"trimethoprim-... |
A 48-year-old Caucasian woman presents to her physician for an initial visit. She has no chronic diseases. The past medical history is significant for myomectomy performed 10 years ago for a large uterine fibroid. She had 2 uncomplicated pregnancies and 2 spontaneous vaginal deliveries. Currently, she only takes oral c... | Fasting blood glucose | {
"A": "Abdominal ultrasound",
"B": "Chest CT",
"C": "Fasting blood glucose",
"D": "Colonoscopy"
} | step2&3 | C | [
"48 year old Caucasian woman presents",
"physician",
"initial visit",
"chronic diseases",
"past medical history",
"significant",
"myomectomy performed 10 years",
"large uterine fibroid",
"2 uncomplicated pregnancies",
"2 spontaneous vaginal deliveries",
"Currently",
"only takes oral contracept... |
An investigator is studying a strain of bacteria that retains a blue color after crystal violet dye and acetone are applied. The bacteria are inoculated in a petri dish containing hypotonic saline. After the addition of an antibiotic, the bacteria swell and rupture. This antibiotic most likely belongs to which of the f... | Cephalosporin | {
"A": "Cephalosporin",
"B": "Fluoroquinolone",
"C": "Sulfonamide",
"D": "Tetracycline"
} | step1 | A | [
"investigator",
"studying",
"strain",
"bacteria",
"retains",
"blue color",
"crystal violet dye",
"acetone",
"applied",
"bacteria",
"inoculated",
"petri dish containing hypotonic saline",
"addition",
"antibiotic",
"bacteria swell",
"rupture",
"antibiotic",
"likely",
"following cla... |
Immediately following prolonged delivery of the placenta at 40 weeks gestation, a 32-year-old multiparous woman develops vaginal bleeding. Other than mild asthma, the patient’s pregnancy has been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases,... | Uterine fundal massage | {
"A": "Discontinuing oxytocin",
"B": "Intravenous methylergonovine",
"C": "Manual exploration of the uterus",
"D": "Uterine fundal massage"
} | step2&3 | D | [
"Immediately following prolonged delivery of",
"placenta",
"40 weeks gestation",
"year old multiparous woman",
"vaginal bleeding",
"mild asthma",
"patients pregnancy",
"uncomplicated",
"attended",
"prenatal appointments",
"followed",
"physician's advice",
"screening",
"diseases",
"labora... |
A 17-year-old girl is brought to the physician because she has not had a menstrual period. There is no personal or family history of serious illness. Examination shows normal breast development. Pubic hair is coarse and extends to the inner surface of the thighs. Pelvic examination shows a blind vaginal pouch. Ultrason... | Müllerian duct agenesis | {
"A": "17-alpha-hydroxylase enzyme deficiency",
"B": "Müllerian duct agenesis",
"C": "Androgen insensitivity",
"D": "Pure gonadal dysgenesis"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"not",
"menstrual period",
"personal",
"family history",
"serious illness",
"Examination shows normal",
"Pubic hair",
"coarse",
"extends",
"inner surface of",
"thighs",
"Pelvic examination shows",
"blind vaginal pouch",
"Ultrasonography shows ... |
A 32-year-old man comes to the emergency department because of abdominal pain, a runny nose, and chills for 6 hours. He has also had diarrhea and difficulty sleeping. He appears irritable. His temperature is 37.1°C (98.8°F), pulse is 110/min, and blood pressure is 140/90 mm Hg. Examination shows cool, damp skin with pi... | Heroin | {
"A": "Gamma-hydroxybutyric acid",
"B": "Cannabis",
"C": "Phencyclidine",
"D": "Heroin"
} | step2&3 | D | [
"year old man",
"emergency department",
"abdominal pain",
"runny nose",
"chills",
"hours",
"diarrhea",
"difficulty sleeping",
"appears irritable",
"temperature",
"98",
"pulse",
"min",
"blood pressure",
"90 mm Hg",
"Examination shows cool",
"damp skin",
"piloerection",
"pupils",
... |
A 34-year-old G3P2 undergoes colposcopy at 15 weeks gestation due to high-grade intraepithelial lesion detected on a Pap smear. She has no history of the gynecologic disease and had normal Pap smear results prior to the current pregnancy. The pelvic examination does not reveal any cervical lesions. Colposcopy shows a n... | Perform a diagnostic conization | {
"A": "Perform a diagnostic conization",
"B": "Terminate the pregnancy and perform a radical hysterectomy",
"C": "Observe until 34 weeks of pregnancy",
"D": "Perform radical trachelectomy"
} | step2&3 | A | [
"year old",
"colposcopy",
"weeks gestation",
"high-grade intraepithelial lesion detected",
"a Pap smear",
"history of",
"gynecologic disease",
"normal Pap smear results prior to",
"current pregnancy",
"pelvic examination",
"not reveal",
"cervical lesions",
"Colposcopy shows",
"non deformed... |
A 24-year-old G1P0 presents to her obstetrician at 26 weeks’ gestation complaining of worsening headaches and blurry vision. Her past medical history is notable for hypertension and diabetes mellitus. Her temperature is 98.6°F (37°C), blood pressure is 160/95 mmHg, pulse is 100/min, and respirations are 18/min. On phys... | Labetalol | {
"A": "Labetalol",
"B": "Metoprolol",
"C": "Esmolol",
"D": "Pindolol"
} | step1 | A | [
"year old",
"presents",
"obstetrician",
"weeks gestation",
"of worsening headaches",
"blurry vision",
"past medical history",
"notable",
"hypertension",
"diabetes mellitus",
"temperature",
"98",
"blood pressure",
"95 mmHg",
"pulse",
"100 min",
"respirations",
"min",
"physical exa... |
A 24-year-old woman complains of intermittent fever and joint pain. She says that these symptoms have been present for the past month. Before that, she had no signs or symptoms and was completely healthy. She has also lost her appetite and some weight. A complete blood count (CBC) showed severe pancytopenia. What is th... | Bone marrow examination | {
"A": "Bone marrow examination",
"B": "Repeated CBCs for several weeks and reassess",
"C": "Treatment with corticosteroids",
"D": "Treatment for acute leukemia"
} | step1 | A | [
"year old woman",
"intermittent fever",
"joint pain",
"symptoms",
"present",
"past month",
"signs",
"symptoms",
"completely healthy",
"lost",
"appetite",
"weight",
"complete blood count",
"CBC",
"showed severe pancytopenia",
"next best step",
"evaluating",
"patient"
] |
An 8-year-old boy presents to the emergency department with puffy eyes. The patient’s parents noticed that his eyes were very puffy this morning thus prompting his presentation. They state their son has always been very healthy and other than a rash acquired from wrestling treated with a topical antibiotic has been ver... | Deposition of circulating immune complexes | {
"A": "Autoimmune type IV collagen destruction",
"B": "Deposition of circulating immune complexes",
"C": "IgA-mediated vasculitis",
"D": "IgE-mediated degranulation"
} | step2&3 | B | [
"year old boy presents",
"emergency department",
"puffy eyes",
"patients parents",
"eyes",
"very puffy",
"morning",
"prompting",
"presentation",
"state",
"son",
"always",
"very healthy",
"other",
"rash acquired",
"wrestling treated with",
"topical antibiotic",
"very healthy",
"te... |
A 29-year-old woman, gravida 1, para 0, at 38 weeks' gestation comes to the emergency department for sudden leakage of clear fluid from her vagina. Her pregnancy has been uncomplicated. She has largely been compliant with her prenatal care but missed some appointments. She has a history of chronic hypertension. She dri... | Ascending infection | {
"A": "Ascending infection",
"B": "Sexual intercourse during third trimester",
"C": "β-blocker use",
"D": "Alcohol use"
} | step2&3 | A | [
"29 year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"emergency department",
"sudden leakage",
"clear",
"vagina",
"pregnancy",
"uncomplicated",
"compliant",
"prenatal care",
"missed",
"appointments",
"history of chronic hypertension",
"drinks",
"glass",
"wine",
"we... |
A previously healthy 44-year-old man comes to his physician because of frequent urination and increased thirst for several weeks. Physical examination shows darkened skin and a firm mass in the right upper quadrant. His blood glucose is 220 mg/dL. A photomicrograph of a specimen obtained on liver biopsy is shown. Which... | Defective transferrin receptor binding | {
"A": "Upregulation of erythropoietin production",
"B": "Absence of a serine protease inhibitor",
"C": "Defective transferrin receptor binding",
"D": "Defective serum copper transportation"
} | step1 | C | [
"healthy",
"year old man",
"physician",
"frequent urination",
"increased thirst",
"weeks",
"Physical examination shows darkened skin",
"firm mass",
"right upper quadrant",
"blood glucose",
"mg/dL",
"photomicrograph",
"specimen obtained",
"liver biopsy",
"shown",
"following best",
"pa... |
A 65-year-old woman comes to the clinic for an annual well-check. Her past medical history includes diabetes and hypertension, which are well-controlled with metformin and losartan, respectively. The patient reports a healthy diet consisting of mainly vegetables and lean meat. She denies smoking or alcohol use. She enj... | Actinic keratosis | {
"A": "Actinic keratosis",
"B": "Psoriasis",
"C": "Rosacea",
"D": "Seborrheic keratosis"
} | step1 | A | [
"65 year old woman",
"clinic",
"annual well check",
"past medical history includes diabetes",
"hypertension",
"well-controlled",
"metformin",
"losartan",
"patient reports",
"healthy diet consisting",
"vegetables",
"meat",
"denies smoking",
"alcohol use",
"taking walks",
"husband",
"s... |
A 65-year-old man comes to the physician for a routine health maintenance examination. He feels well. His most recent examination 2 years ago included purified protein derivative (PPD) skin testing and showed no abnormalities. He is a retired physician and recently came back from rural China where he completed a volunt... | Liver injury | {
"A": "Optic neuropathy",
"B": "Liver injury",
"C": "Hyperuricemia",
"D": "Nephrotoxicity"
} | step1 | B | [
"65 year old man",
"physician",
"routine health maintenance examination",
"feels well",
"most recent examination",
"years",
"included purified protein derivative",
"skin testing",
"showed",
"abnormalities",
"retired physician",
"recently",
"back",
"rural China",
"completed",
"voluntary... |
A 21-year-old gravida 1 presents to her physician’s office for an antepartum visit at 11 weeks gestation. She has complaints of malaise, occasional nausea, and changes in food preferences. Her vital signs include: blood pressure 100/70 mm Hg, heart rate 90/min, respiratory rate 14/min, and temperature 36.8℃ (98.2℉). Ex... | Increase in plasma volume | {
"A": "Decreased iron transport across the intestinal wall",
"B": "Increase in plasma volume",
"C": "Insufficient iron intake",
"D": "Failure of purine and thymidylate synthesis"
} | step2&3 | B | [
"21-year-old gravida 1 presents",
"physicians office",
"antepartum visit",
"weeks gestation",
"complaints",
"malaise",
"occasional nausea",
"changes",
"food preferences",
"vital signs include",
"blood pressure 100 70 mm Hg",
"heart rate 90 min",
"respiratory rate",
"min",
"temperature 36... |
The study is performed in an attempt to determine whether there is an association between maternal exposure to 2nd-hand smoke and low birth weight. A total of 1,000 women who have given birth to at least 1 child are placed into 1 of 2 groups according to the birth weight of their 1st child. Each group includes 500 wome... | Odds ratio | {
"A": "Odds ratio",
"B": "Rate ratio",
"C": "Absolute risk",
"D": "Risk difference"
} | step2&3 | A | [
"study",
"performed",
"attempt to",
"association",
"maternal exposure",
"2nd hand smoke",
"low birth weight",
"total",
"women",
"given birth",
"child",
"placed",
"2 groups according",
"birth weight of",
"1st child",
"group includes 500 women",
"1st child either",
"500",
"500",
... |
A 50-year-old woman is brought to the emergency department following a motor vehicle accident. She is awake but slow to respond. Her breath smells of alcohol. The emergency medical technician reports that her blood pressure has been dropping despite intravenous fluids. Ultrasound reveals a hypoechoic rim around the spl... | Calcium gluconate | {
"A": "Calcium gluconate",
"B": "Lorazepam",
"C": "Thiamine",
"D": "Sodium bicarbonate"
} | step2&3 | A | [
"50 year old woman",
"brought",
"emergency department following",
"motor vehicle accident",
"awake",
"slow to",
"breath smells of alcohol",
"emergency medical technician reports",
"blood pressure",
"dropping",
"intravenous fluids",
"Ultrasound reveals",
"rim",
"spleen",
"suspicious",
"... |
A 72-year-old man presents to the ED complaining of worsening abdominal pain over the last few hours. He also reports nausea, but denies fever, vomiting, or changes in the appearance of his bowel movements. His medical history is significant for type 2 diabetes mellitus, hypertension, coronary artery disease, stroke, a... | Acute mesenteric ischemia | {
"A": "Peptic ulcer perforation",
"B": "Acute cholecystitis",
"C": "Acute mesenteric ischemia",
"D": "Diabetic ketoacidosis"
} | step2&3 | C | [
"72 year old man presents",
"ED",
"worsening abdominal",
"last",
"hours",
"reports nausea",
"denies fever",
"vomiting",
"changes in",
"appearance",
"bowel movements",
"medical history",
"significant",
"type 2 diabetes mellitus",
"hypertension",
"coronary artery disease",
"stroke",
... |
A 72-year-old multiparous woman comes to the physician for the evaluation of episodes of involuntary urine leakage for the past 6 months. She loses small amounts of urine without warning after laughing or sneezing. She also sometimes forgets the names of her grandchildren and friends. She is retired and lives at an ass... | Urethral hypermobility | {
"A": "Detrusor-sphincter dyssynergia",
"B": "Urethral hypermobility",
"C": "Impaired detrusor contractility",
"D": "Loss of sphincter control"
} | step1 | B | [
"72 year old multiparous woman",
"physician",
"evaluation of episodes",
"involuntary urine leakage",
"past 6 months",
"small amounts",
"urine",
"warning",
"laughing",
"sneezing",
"sometimes forgets",
"names",
"grandchildren",
"friends",
"retired",
"lives",
"assisted-living facility",... |
A 45-year-old woman presents to the office complaining of fatigue and unintentional weight loss. On examination, there is a palpable firm lymph node in the cervical area. Biopsy of the lymph node reveals Hodgkin’s lymphoma. The patient agrees to start the standard chemotherapy regimen. A few months later, after the com... | Drug-induced interstitial lung disease | {
"A": "Drug-induced interstitial lung disease",
"B": "Metastatic spread to the lungs",
"C": "Development of chronic obstructive pulmonary disease",
"D": "Development of bacterial pneumonia due to immunocompromised state"
} | step2&3 | A | [
"year old woman presents",
"office",
"fatigue",
"unintentional weight loss",
"examination",
"palpable firm lymph node",
"cervical area",
"Biopsy of",
"reveals Hodgkins lymphoma",
"patient agrees to start",
"standard chemotherapy regimen",
"few months later",
"completion",
"successful cours... |
A 47-year-old woman comes to the emergency department after coughing up 2 cups of bright red blood. A CT angiogram of the chest shows active extravasation from the right bronchial artery. A coil embolization is planned to stop the bleeding. During this procedure, a catheter is first inserted into the right femoral arte... | Thoracic aorta, right posterior intercostal artery, right bronchial artery | {
"A": "Thoracic aorta, right subclavian artery, right internal thoracic artery, right bronchial artery",
"B": "Thoracic aorta, right posterior intercostal artery, right bronchial artery",
"C": "Thoracic aorta, right superior epigastric artery, right bronchial artery",
"D": "Thoracic aorta, left ventricle, left... | step1 | B | [
"year old woman",
"emergency department",
"coughing up",
"cups",
"bright red blood",
"CT angiogram of",
"chest shows active extravasation",
"right bronchial artery",
"coil embolization",
"planned to stop",
"bleeding",
"procedure",
"catheter",
"first inserted",
"right femoral artery",
"... |
A 53-year-old farmer presents to the clinic for evaluation of a pigmented lesion on his arm. He states that he first noticed the lesion last year, but he believes that it has been slowly growing in size. He otherwise does not have any complaints and is generally healthy. Which of the following findings on physical exam... | Different pigmentation throughout the lesion | {
"A": "Different pigmentation throughout the lesion",
"B": "Hyperpigmented lesion with smooth borders",
"C": "Symmetrical ovoid lesion",
"D": "Tenderness to palpation"
} | step2&3 | A | [
"year old farmer presents",
"clinic",
"evaluation",
"pigmented lesion",
"arm",
"states",
"first",
"lesion",
"year",
"slowly",
"size",
"not",
"complaints",
"healthy",
"following findings",
"physical exam",
"suggest",
"malignant diagnosis"
] |
A 72-year-old man comes to the physician because of fatigue and a 5-kg (11-lb) weight loss over the past 6 months despite a good appetite. He takes no medications. He does not smoke or use illicit drugs. Physical examination shows hepatosplenomegaly and diffuse, nontender lymphadenopathy. Laboratory studies show a hemo... | Chronic lymphocytic leukemia | {
"A": "Chronic myelogenous leukemia",
"B": "Acute myelogenous leukemia",
"C": "Follicular lymphoma",
"D": "Chronic lymphocytic leukemia"
} | step1 | D | [
"72 year old man",
"physician",
"fatigue",
"5 kg",
"weight loss",
"past 6 months",
"good appetite",
"takes",
"medications",
"not smoke",
"use illicit",
"Physical examination shows hepatosplenomegaly",
"diffuse",
"nontender lymphadenopathy",
"Laboratory studies show a hemoglobin concentra... |
A 15-year-old adolescent presents to his pediatrician with progressive easy fatigability and exercises intolerance over the last several months. The patient was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. There is no history ... | Anterior movement of ventricular septum during systole | {
"A": "Decreased right ventricular end-diastolic dimension",
"B": "Anterior movement of ventricular septum during systole",
"C": "Goose-neck deformity of left ventricular outflow tract",
"D": "Increased left ventricular shortening fraction"
} | step2&3 | B | [
"year old adolescent presents",
"pediatrician",
"progressive easy fatigability",
"exercises intolerance",
"months",
"patient",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"history",
"palpitation",
"dyspnea",
"l... |
A one-week-old boy is brought to the emergency department by his mother, who recently immigrated to the United States and does not have health insurance. He was born at home, and has not received any medical care since birth. The mother states the boy has become irritable and has been feeding poorly. In the last day, s... | Toxoid vaccine given to mother pre-natally | {
"A": "Conjugated polysaccharide vaccine given to infant at birth",
"B": "Toxoid vaccine given to mother pre-natally",
"C": "Improved maternal nutrition",
"D": "Genetic counseling"
} | step1 | B | [
"one-week old boy",
"brought",
"emergency department",
"mother",
"recently",
"United States",
"not",
"health insurance",
"born at home",
"not received",
"medical care",
"birth",
"mother states",
"boy",
"irritable",
"feeding poorly",
"last day",
"stiff",
"apparent muscle spasms",
... |
Given the mRNA sequence shown below, if translation were to start at the first base, what would the tRNA anticodon be for the last amino acid translated in the chain?
5'----GCACCGGCCUGACUAUAA---3' | 3' CGG 5' | {
"A": "3' GCG 5'",
"B": "3' GAU 5'",
"C": "5' CGG 3'",
"D": "3' CGG 5'"
} | step1 | D | [
"Given",
"mRNA sequence shown",
"translation",
"to start",
"first base",
"tRNA anticodon",
"last amino acid translated",
"chain",
"5",
"3"
] |
A 7-year-old boy is brought to a new pediatrician to establish care. He presents with a history of extensive eczema, recurrent respiratory, skin, and gastrointestinal infections, and significant thrombocytopenia. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines a... | Wiskott-Aldrich syndrome | {
"A": "Wiskott-Aldrich syndrome",
"B": "Severe combined immunodeficiency syndrome",
"C": "Chediak-Higashi syndrome",
"D": "Hyper-IgE disease"
} | step2&3 | A | [
"year old boy",
"brought",
"new pediatrician to establish care",
"presents",
"history of extensive eczema",
"recurrent respiratory",
"skin",
"gastrointestinal infections",
"significant thrombocytopenia",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines"... |
A 9-year-old boy is brought to the physician by his mother for evaluation of diffuse bone pain in his right leg. His family immigrated to the United States 6 months ago from northern Canada. He is below the 5th percentile for height and at the 10th percentile for weight. Physical examination shows tenderness to palpati... | Glucocerebrosidase | {
"A": "α-Galactosidase A",
"B": "Arylsulfatase A",
"C": "Galactocerebrosidase",
"D": "Glucocerebrosidase"
} | step1 | D | [
"year old boy",
"brought",
"physician",
"mother",
"evaluation",
"diffuse bone",
"right leg",
"family",
"United States",
"months",
"northern Canada",
"5th percentile",
"height",
"percentile",
"weight",
"Physical examination shows tenderness",
"palpation",
"right distal femur",
"he... |
A 55-year-old man comes to the physician because of intermittent palpitations that occur when he is stressed, exercising, or when he drinks alcohol. Physical examination shows an irregularly irregular pulse. An ECG shows irregular QRS complexes without any discrete P waves. Pharmacotherapy with carvedilol is initiated ... | Hypotension | {
"A": "Hypotension",
"B": "Bradycardia",
"C": "Hyperglycemia",
"D": "Bronchospasm"
} | step1 | A | [
"55 year old man",
"physician",
"intermittent palpitations",
"occur",
"stressed",
"exercising",
"drinks alcohol",
"Physical examination shows",
"irregular pulse",
"ECG shows irregular QRS complexes",
"discrete P waves",
"Pharmacotherapy",
"carvedilol",
"initiated",
"condition",
"Compar... |
When hepatitis D was injected into an immunocompromised mouse, there was no detectable hepatitis D RNA in the blood at any time point during the next several months. When co-injected with hepatitis B, hepatitis D RNA was was detected in the blood. Which of the following best describes this phenomenon? | Complementation | {
"A": "Recombination",
"B": "Reassortment",
"C": "Complementation",
"D": "Transduction"
} | step1 | C | [
"hepatitis D",
"injected",
"immunocompromised mouse",
"detectable hepatitis D RNA",
"blood",
"time point",
"next",
"months",
"co injected",
"hepatitis B",
"hepatitis D RNA",
"detected",
"blood",
"following best",
"phenomenon"
] |
A 33-year-old woman comes to the physician because of a 4-day history of fever, anterior neck pain, and throat swelling. She has no history of serious illness. Her temperature is 38.1°C (100.6°F) and pulse is 109/min. Physical examination shows diaphoresis and a fine tremor of the outstretched hands. The thyroid gland ... | Noncaseating granulomas with multinucleated giant cells | {
"A": "Follicular epithelial cell hyperplasia",
"B": "Concentric intracellular lamellar calcifications",
"C": "Lymphocytic infiltration with germinal follicle formation",
"D": "Noncaseating granulomas with multinucleated giant cells"
} | step1 | D | [
"year old woman",
"physician",
"4-day history",
"fever",
"anterior neck pain",
"throat swelling",
"history",
"serious illness",
"temperature",
"100",
"pulse",
"min",
"Physical examination shows diaphoresis",
"fine tremor of",
"hands",
"thyroid gland",
"enlarged",
"firm",
"tender"... |
A 43-year-old woman was admitted to the hospital for anticoagulation following a pulmonary embolism. She was found to have a deep venous thrombosis on further workup after a long plane ride coming back from visiting China. She denies any personal history of blood clots in her past, but she says that her mother has als... | Discontinue heparin and warfarin | {
"A": "Continue heparin and warfarin until INR is therapeutic for 24 hours",
"B": "Discontinue heparin; continue warfarin",
"C": "Discontinue heparin and warfarin",
"D": "Continue heparin and warfarin, and administer vitamin K"
} | step2&3 | C | [
"year old woman",
"admitted",
"hospital",
"anticoagulation following",
"pulmonary embolism",
"found to",
"deep venous thrombosis",
"further workup",
"long plane",
"back",
"visiting China",
"denies",
"personal history",
"blood clots",
"past",
"mother",
"to",
"treated",
"pulmonary ... |
A 68-year-old woman is brought to the emergency department by ambulance after she was found down by her daughter. She lives alone in her apartment so it is unclear when she began to develop symptoms. Her medical history is significant for cardiac arrhythmias, diabetes, pericarditis, and a stroke 2 years ago. On present... | Intravenous fluids | {
"A": "Antibiotic administration",
"B": "Intravenous fluids",
"C": "Relieve obstruction",
"D": "Vasopressors"
} | step1 | B | [
"68 year old woman",
"brought",
"emergency department",
"ambulance",
"found",
"daughter",
"lives alone",
"apartment",
"began to",
"symptoms",
"medical history",
"significant",
"cardiac arrhythmias",
"diabetes",
"pericarditis",
"stroke",
"years",
"presentation",
"temperature",
"... |
A 19-year-old woman presents to her gynecologist for evaluation of amenorrhea and occasional dull right-sided lower abdominal pain that radiates to the rectum. She had menarche at 11 years of age and had regular 28-day cycles by 13 years of age. She developed menstrual cycle irregularity approximately 2 years ago and h... | A transvaginal ultrasound would provide a better resolution of the suspected pathology, but a transabdominal ultrasound can still be used to assess this patient | {
"A": "No imaging is indicated for this patient because the diagnosis can be made on the basis of the clinical examination",
"B": "A transvaginal ultrasound would provide a better resolution of the suspected pathology, but a transabdominal ultrasound can still be used to assess this patient",
"C": "Increased ant... | step2&3 | B | [
"year old woman presents",
"gynecologist",
"evaluation",
"amenorrhea",
"occasional dull right-sided lower abdominal pain",
"radiates",
"rectum",
"menarche at",
"years",
"age",
"regular",
"day cycles",
"years",
"age",
"menstrual cycle irregularity approximately",
"years",
"not",
"me... |
A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time? | Pneumocystis jirovecii | {
"A": "Aspergillus fumigatus",
"B": "Mycobacterium tuberculosis",
"C": "Pneumocystis jirovecii",
"D": "Cytomegalovirus"
} | step1 | C | [
"year old man",
"physician",
"follow-up examination",
"diagnosed",
"HIV infection 2 weeks",
"CD4",
"lymphocyte count",
"mm3",
"N",
"500",
"interferon-gamma release assay",
"negative",
"Prophylactic treatment",
"following pathogens",
"most appropriate",
"time"
] |
A 58-year-old department store manager comes to his doctor’s office complaining that he had recently been waking up in the middle of the night with abdominal pain. This has happened several nights a week in the past month. He has also been experiencing occasional discomfort in the afternoon. The patient's appetite has ... | In the pyloric channel within 3 cm of the pylorus | {
"A": "In the pyloric channel within 3 cm of the pylorus",
"B": "Along the lesser curve at the incisura angularis",
"C": "Proximal gastroesophageal ulcer near the gastroesophageal junction",
"D": "In the body"
} | step1 | A | [
"58 year old department",
"doctors office",
"recently",
"waking up",
"middle",
"night",
"abdominal pain",
"happened",
"nights",
"week",
"past",
"experiencing occasional discomfort",
"afternoon",
"patient's appetite",
"suffered",
"result",
"pain",
"experiencing",
"clothes hang",
... |
An otherwise healthy 49-year-old man presents to his primary care physician for follow-up for a high HbA1C. 3 months ago, his HbA1c was 8.9% on routine screening. Today, after lifestyle modifications, it is 8.1% and his serum glucose is 270 mg/dL. Which of the following is the best initial therapy for this patient's co... | Metformin | {
"A": "Metformin",
"B": "Metformin added to an insulin secretagogue",
"C": "Metformin added to a glucagon-like peptide 1 (GLP-1) agonist",
"D": "Metformin added to a dipeptidyl peptidase-4 (DPP-4) inhibitor"
} | step2&3 | A | [
"healthy",
"year old man presents",
"primary care physician",
"follow-up",
"high",
"months",
"routine screening",
"Today",
"lifestyle modifications",
"8.1",
"serum glucose",
"mg/dL",
"following",
"best initial therapy",
"patient's"
] |
A 9-year-old boy is brought to the physician by his parents because of right-sided shoulder pain for 1 day. He has not had chills or sweating. Over the past year, he was treated twice in the emergency department for painful swelling of his hands and feet. He emigrated with his family from Kenya 2 years ago. His tempera... | Nuclear remnants in erythrocytes | {
"A": "Teardrop-shaped erythrocytes",
"B": "Nuclear remnants in erythrocytes",
"C": "Fragmentation of erythrocytes",
"D": "Erythrocytes with no central pallor"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"parents",
"right-sided shoulder pain",
"1 day",
"not",
"chills",
"sweating",
"past year",
"treated twice",
"emergency department",
"painful swelling of",
"hands",
"feet",
"family",
"Kenya",
"years",
"temperature",
"4C",
"99",
"pulse"... |
A 60-year-old man with a history of coronary artery disease and hyperlipidemia presents to his internist for a follow-up visit 3 weeks after visiting an urgent care center for symptoms of cough, fever, and difficulty breathing. He had been prescribed erythromycin in addition to his usual regimen of rosuvastatin and asp... | Myalgia due to decreased rosuvastatin metabolism in the presence of erythromycin | {
"A": "Unstable angina due to decreased rosuvastatin metabolism in the presence of erythromycin",
"B": "Myalgia due to decreased rosuvastatin metabolism in the presence of erythromycin",
"C": "Metabolic acidosis due to decreased aspirin metabolism in the presence of erythromycin",
"D": "Tinnitus due to decreas... | step1 | B | [
"year old man",
"history of coronary artery disease",
"hyperlipidemia presents",
"internist",
"follow-up visit 3 weeks",
"urgent care center",
"symptoms",
"cough",
"fever",
"difficulty breathing",
"prescribed erythromycin in addition to",
"usual regimen",
"rosuvastatin",
"aspirin",
"pote... |
A 15-year-old girl is brought into her pediatrician's office by her mother because the mother thinks her daughter has attention issues. The mother explains that her daughter started high school four months ago and had lackluster grades in a recent progress report despite having earned consistent top marks in middle sch... | Normal behavior | {
"A": "Oppositional defiant disorder",
"B": "Normal behavior",
"C": "Conduct disorder",
"D": "Antisocial personality disorder"
} | step2&3 | B | [
"year old girl",
"brought",
"pediatrician's office",
"mother",
"mother thinks",
"daughter",
"attention issues",
"mother",
"daughter started high school four months",
"grades",
"recent progress report",
"earned consistent top marks",
"middle school",
"mother",
"daughter never talks",
"h... |
A 47-year-old alcoholic man presents to the office for a 72-hour history of intense right hemithorax pain. He also complains of fever, chills, and sweating that started 10 days ago, as well as persistent coughing with abundant malodorous sputum. Chest radiography shows a round consolidation with hydro-aerial levels in ... | Lung abscess | {
"A": "Bronchopulmonary sequestration",
"B": "Lung abscess",
"C": "Tuberculosis",
"D": "Lung cancer"
} | step1 | B | [
"year old alcoholic man presents",
"office",
"72-hour history",
"intense right hemithorax pain",
"fever",
"chills",
"sweating",
"started 10 days",
"persistent",
"abundant",
"sputum",
"Chest radiography shows",
"round consolidation",
"levels",
"middle third",
"right hemithorax",
"Sput... |
A 9-year-old boy is brought to the clinic by his parents for an annual wellness examination. He is a relatively healthy boy who was born at term via vaginal delivery. He is meeting his developmental milestones and growth curves and is up-to-date on his immunizations. The father complains that he is picky with his food ... | Defect of the septum secundum | {
"A": "Defect of the septum secundum",
"B": "Failure of the septum primum to fuse with the endocardial cushions",
"C": "Inflammation of the visceral and parietal pericardium",
"D": "Physiologic conditions outside the heart"
} | step1 | A | [
"year old boy",
"brought",
"clinic",
"parents",
"annual wellness examination",
"relatively healthy boy",
"born",
"term",
"vaginal delivery",
"meeting",
"developmental milestones",
"growth curves",
"date",
"immunizations",
"father",
"food",
"rather eat pizza",
"patient denies",
"t... |
A 24-year-old woman presents to the emergency department with palpitations for the last hour. This is her 3rd emergency department visit in the last 8 weeks due to the same complaint. She denies fever, shortness of breath, nasal discharge, bowel changes, weight loss, and heat intolerance. She has asthma that is poorly ... | Verapamil | {
"A": "Adenosine",
"B": "Amiodarone",
"C": "Digoxin",
"D": "Verapamil"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"palpitations",
"hour",
"3rd emergency visit",
"weeks",
"same complaint",
"denies fever",
"shortness of breath",
"nasal discharge",
"bowel changes",
"weight loss",
"heat intolerance",
"asthma",
"poorly controlled",
"regular inhaler use... |
One day after a 4700-g (10-lb 6-oz) male newborn is delivered to a 28-year-old primigravid woman, he has bluish discoloration of his lips and fingernails. Oxygen saturation on room air is 81%. Examination shows central cyanosis. A continuous machine-like murmur is heard over the left upper sternal border. A single S2 h... | Elevated fasting blood glucose | {
"A": "Elevated serum TSH",
"B": "Prenatal phenytoin intake",
"C": "Positive rapid plasma reagin test",
"D": "Elevated fasting blood glucose"
} | step1 | D | [
"One",
"One day",
"g",
"10",
"6 oz",
"male newborn",
"delivered",
"year old primigravid woman",
"discoloration",
"lips",
"fingernails",
"Oxygen saturation",
"room air",
"81",
"Examination shows central cyanosis",
"continuous machine",
"murmur",
"heard",
"left upper sternal border... |
A 16-year-old boy with a history of severe, persistent asthma presents to the emergency department with severe shortness of breath and cough. He states that he was outside playing basketball with his friends, forgot to take his inhaler, and began to have severe difficulty breathing. On exam, he is in clear respiratory ... | Pulsus paradoxus | {
"A": "Inspiratory stridor",
"B": "Increased breath sounds",
"C": "Friction rub",
"D": "Pulsus paradoxus"
} | step1 | D | [
"year old boy",
"history of severe",
"persistent asthma presents",
"emergency department",
"severe shortness of breath",
"cough",
"states",
"outside playing basketball",
"friends",
"forgot to take",
"inhaler",
"began to",
"severe difficulty breathing",
"exam",
"clear respiratory distress... |
A 3670-g (8 lb 1 oz) male newborn is delivered to a 26-year-old primigravid woman. She received adequate prenatal care and labor was uncomplicated. She has chronic hepatitis B infection and gastroesophageal reflux disease. Her only medication is ranitidine. She admits to smoking cannabis and one half-pack of cigarettes... | Cannabis use | {
"A": "Ranitidine use",
"B": "Hepatitis B infection",
"C": "Seropositive for cytomegalovirus",
"D": "Cannabis use"
} | step2&3 | D | [
"g",
"8",
"1 oz",
"male newborn",
"delivered",
"year old primigravid woman",
"received adequate prenatal care",
"labor",
"uncomplicated",
"chronic",
"gastroesophageal reflux disease",
"only medication",
"ranitidine",
"admits",
"smoking cannabis",
"one half pack",
"cigarettes daily",
... |
A 35-year-old male is picked up by paramedics presenting with respiratory depression, pupillary constriction, and seizures. Within a few minutes, the male dies. On autopsy, fresh tracks marks are seen on both arms. Administration of which of the following medications would have been appropriate for this patient? | Naloxone | {
"A": "Methadone",
"B": "Naloxone",
"C": "Flumazenil",
"D": "Buproprion"
} | step1 | B | [
"35 year old male",
"picked",
"paramedics presenting",
"respiratory depression",
"pupillary constriction",
"seizures",
"few minutes",
"male",
"autopsy",
"fresh tracks marks",
"seen",
"arms",
"Administration of",
"following medications",
"appropriate",
"patient"
] |
A 3900-g (8.6-lb) newborn is delivered at 38 week' gestation to a 27-year-old woman, gravida 3, para 2, via spontaneous vaginal delivery. Immediately after delivery, he spontaneously cries, grimaces, and moves all four extremities. Over the next five minutes, he becomes cyanotic, dyspneic, and tachypneic. Mask ventilat... | Intubation and mechanical ventilation
" | {
"A": "Extracorporeal life support",
"B": "Surfactant administration",
"C": "Surgical repair",
"D": "Intubation and mechanical ventilation\n\""
} | step2&3 | D | [
"newborn",
"delivered",
"week",
"gestation",
"27 year old woman",
"gravida 3",
"para 2",
"spontaneous vaginal delivery",
"Immediately",
"delivery",
"cries",
"grimaces",
"moves",
"four extremities",
"next five minutes",
"cyanotic",
"dyspneic",
"tachypneic",
"Mask ventilation",
"... |
A 17-year-old boy is being seen by student health for a sports physical. He denies any recent injuries. He reports that he is doing well in his classes. He fractured his left collar bone 3 years ago, which required open reduction and internal fixation. He has not had any other surgeries. He takes no medications. His fa... | Suppression | {
"A": "Denial",
"B": "Displacement",
"C": "Repression",
"D": "Suppression"
} | step2&3 | D | [
"year old boy",
"seen",
"student health",
"sports physical",
"denies",
"recent injuries",
"reports",
"well",
"classes",
"fractured",
"left collar bone",
"years",
"required open reduction",
"internal fixation",
"not",
"surgeries",
"takes",
"medications",
"father",
"paternal gran... |
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