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 5-year-old boy is brought to the emergency department by his parents with complaints of severe muscle cramping and abdominal pain. They live in Virginia. The parents state that about 2 hours before, the child was playing in their outdoor shed when he suddenly ran inside crying, saying he was bitten by a bug. One hour... | Black widow | {
"A": "Brown recluse",
"B": "Black widow",
"C": "Cryptopid centipede",
"D": "Tick"
} | step2&3 | B | [
"5 year old boy",
"brought",
"emergency department",
"parents",
"complaints",
"severe muscle",
"abdominal pain",
"live",
"Virginia",
"parents state",
"2 hours",
"child",
"playing",
"ran",
"crying",
"bitten",
"bug",
"One hour following",
"bite",
"child",
"symptoms",
"crampin... |
A 59-year-old man presents to his primary care provider complaining of bilateral calf cramping with walking for the past 7 months. His pain goes away when he stops walking; however, his condition affects his work as a mail carrier. His medical history is remarkable for type 2 diabetes mellitus, hyperlipidemia, and 25-p... | Revascularization | {
"A": "Heparin",
"B": "Revascularization",
"C": "Amputation",
"D": "Surgical decompression"
} | step2&3 | B | [
"59 year old man presents",
"primary care provider",
"bilateral calf cramping",
"walking",
"past",
"months",
"pain goes",
"stops walking",
"condition affects",
"work",
"mail carrier",
"medical history",
"type 2 diabetes mellitus",
"hyperlipidemia",
"pack-year smoking history",
"ankle-b... |
A 66-year-old female with hypertension and a recent history of acute ST-elevation myocardial infarction (STEMI) 6 days previous, treated with percutaneous transluminal angioplasty (PTA), presents with sudden onset chest pain, shortness of breath, diaphoresis, and syncope. Vitals are temperature 37°C (98.6°F), blood pre... | Immediate transfer to the operating room | {
"A": "Intra-aortic balloon counterpulsation",
"B": "Administer dobutamine 70 mcg/min IV",
"C": "Immediate transfer to the operating room",
"D": "Immediate cardiac catheterization"
} | step2&3 | C | [
"66 year old female",
"hypertension",
"recent history of acute ST-elevation myocardial infarction",
"days previous",
"treated with percutaneous transluminal angioplasty",
"presents",
"sudden onset chest pain",
"shortness of breath",
"diaphoresis",
"syncope",
"temperature",
"98",
"blood press... |
A 5-year-old boy is brought to the physician because of a 5-week history of pain in his left thigh. The mother reports that her son fell from a ladder while playing with friends about a month and a half ago. He had a runny nose 3 weeks ago. He has no history of serious illness. He has reached all developmental mileston... | Limited weight bearing and physical therapy | {
"A": "Oral hydroxyurea",
"B": "Casting and bracing",
"C": "Femoral head pinning",
"D": "Limited weight bearing and physical therapy"
} | step2&3 | D | [
"5 year old boy",
"brought",
"physician",
"5 week history",
"pain",
"left thigh",
"mother reports",
"son fell from",
"ladder",
"playing",
"friends",
"month",
"half",
"runny nose",
"weeks",
"history",
"serious illness",
"reached",
"developmental milestones",
"age",
"immunizati... |
A 69-year-old man presents for a general follow up appointment. He states that he is doing well and wants to be sure he is healthy. The patient’s past medical history is significant for type II diabetes mellitus, peripheral vascular disease, and hypertension. His current medications include metformin, glyburide, lisino... | Begin statin therapy | {
"A": "Increase lisinopril dose",
"B": "Increase metformin dose",
"C": "Begin statin therapy",
"D": "Discontinue metoprolol and start propranolol"
} | step2&3 | C | [
"69 year old man presents",
"general follow up appointment",
"states",
"well",
"to",
"sure",
"healthy",
"patients past medical history",
"significant",
"type II diabetes mellitus",
"peripheral vascular disease",
"hypertension",
"current medications include metformin",
"glyburide",
"lisin... |
A 27-year-old man presents to the emergency department with loss of consciousness. The patient was brought in 20 minutes ago by the supervisor at a homeless shelter who found him passed out next to a bottle of acetaminophen. The patient has a past medical history of HIV, hepatitis C, IV drug abuse, alcohol abuse, suici... | Previous hypotension | {
"A": "Antibiotic use",
"B": "Chronic viral infection",
"C": "Previous hypotension",
"D": "Toxic liver metabolite"
} | step2&3 | C | [
"27 year old man presents",
"emergency department",
"loss of consciousness",
"patient",
"brought",
"20 minutes",
"supervisor",
"homeless shelter",
"found",
"passed out next to",
"bottle",
"acetaminophen",
"patient",
"past medical HIV",
"hepatitis C",
"IV drug abuse",
"alcohol abuse",... |
A father brings his 1-year-old son into the pediatrician's office for a routine appointment. He states that his son is well but mentions that he has noticed an intermittent bulge on the right side of his son's groin whenever he cries or strains for bowel movement. Physical exam is unremarkable. The physician suspects a... | Hydrocele | {
"A": "Hydrocele",
"B": "Varicocele",
"C": "Diaphragmatic hernia",
"D": "Testicular torsion"
} | step1 | A | [
"father",
"1-year-old son",
"pediatrician's office",
"routine appointment",
"states",
"son",
"well",
"intermittent bulge",
"right side",
"son's groin",
"cries",
"strains",
"bowel movement",
"Physical exam",
"unremarkable",
"physician suspects",
"condition",
"caused",
"incomplete ... |
A 42-year-old man comes to the physician because of a 3-week history of rash that began on his right ankle and gradually progressed up his calf. The rash is itchy and mildly painful. He has type 2 diabetes mellitus and hypertension. He does not smoke or drink alcohol. His current medications include metformin, glipizid... | Cutaneous larva migrans | {
"A": "Contact dermatitis",
"B": "Cutaneous larva migrans",
"C": "Tinea",
"D": "Superficial thrombophlebitis"
} | step2&3 | B | [
"year old man",
"physician",
"3 week history",
"rash",
"began",
"right ankle",
"progressed",
"calf",
"rash",
"itchy",
"mildly painful",
"type 2 diabetes mellitus",
"hypertension",
"not smoke",
"drink alcohol",
"current medications include metformin",
"glipizide",
"enalapril",
"re... |
A 64-year-old woman comes to the emergency room because of a sudden weakness in her right arm and leg. She has atrial fibrillation, tinea unguium, gastroesophageal reflux disease, hypertension, and hypercholesterolemia. Current medications include warfarin, enalapril, simvastatin, lansoprazole, hydrochlorothiazide, gri... | Griseofulvin | {
"A": "Simvastatin",
"B": "Enalapril",
"C": "Lansoprazole",
"D": "Griseofulvin"
} | step1 | D | [
"64 year old woman",
"emergency room",
"of",
"sudden weakness",
"right arm",
"leg",
"atrial fibrillation",
"tinea unguium",
"gastroesophageal reflux disease",
"hypertension",
"hypercholesterolemia",
"Current medications include warfarin",
"enalapril",
"simvastatin",
"lansoprazole",
"hy... |
A 70-year-old man is accompanied by his wife to the primary care clinic for hand tremors. He states that he first noticed the tremor of his left hand 1 year ago. Since then, the tremor has been worsening and now he can hardly relax when trying to read. His wife says that she is also worried about his memory. She had to... | Parkinson disease | {
"A": "Essential tremor",
"B": "Parkinson disease",
"C": "Progressive supranuclear palsy",
"D": "Tardive dyskinesia"
} | step2&3 | B | [
"70 year old man",
"wife",
"primary care clinic",
"hand tremors",
"states",
"first",
"tremor of",
"left hand",
"year",
"then",
"tremor",
"worsening",
"now",
"relax",
"to read",
"wife",
"worried",
"memory",
"to take",
"finances",
"weeks",
"learning",
"forgotten to pay",
... |
A 69-year-old woman comes to the physician because of a 3-week history of headache and worsening vision. Ophthalmologic examination shows a visual acuity of 20/120 in the right eye and 20/80 in the left eye. Physical examination shows no other abnormalities. Laboratory studies show a hemoglobin of 14.2 g/dL and total s... | Waldenstrom macroglobulinemia | {
"A": "Multiple myeloma",
"B": "Hyper IgM syndrome",
"C": "Waldenstrom macroglobulinemia",
"D": "Giant cell arteritis"
} | step1 | C | [
"69 year old woman",
"physician",
"of",
"3 week history",
"headache",
"worsening vision",
"Ophthalmologic examination shows",
"visual acuity",
"20/120",
"right eye",
"20/80",
"left eye",
"Physical examination shows",
"abnormalities",
"Laboratory studies show a hemoglobin",
"2 g dL",
... |
A 55-year-old male bodybuilder presents to the emergency department with weakness of his right arm. The patient states he has experienced these symptoms for a few weeks; however, today his hand felt so weak he dropped his cup of tea. The patient has a past medical history of diabetes. He drinks 2-7 alcoholic drinks per... | Apical lung tumor | {
"A": "Apical lung tumor",
"B": "Cerebral infarction",
"C": "Scalenus anticus syndrome",
"D": "Subclavian steal syndrome"
} | step2&3 | A | [
"55 year old male",
"presents",
"emergency department",
"weakness of",
"right arm",
"patient states",
"experienced",
"symptoms",
"weeks",
"today",
"hand felt so weak",
"dropped",
"cup",
"tea",
"patient",
"past medical diabetes",
"drinks 2-7 alcoholic drinks per day",
"smoked 2 pack... |
A 24-year-old woman comes to the emergency department because of abdominal pain, fever, nausea, and vomiting for 12 hours. Her abdominal pain was initially dull and diffuse but has progressed to a sharp pain on the lower right side. Two years ago she had to undergo right salpingo-oophorectomy after an ectopic pregnancy... | Teniae coli | {
"A": "Teniae coli",
"B": "Ileocolic artery",
"C": "Right ureter",
"D": "Epiploic appendages"
} | step1 | A | [
"year old woman",
"emergency department",
"abdominal pain",
"fever",
"nausea",
"vomiting",
"12 hours",
"abdominal pain",
"initially dull",
"diffuse",
"progressed",
"sharp pain",
"lower right side",
"Two years",
"to",
"right salpingo-oophorectomy",
"ectopic pregnancy",
"temperature"... |
A 25-year-old man presents to the emergency department after a car accident. He was the front seat restrained driver in a head-on collision. He has no significant past medical history. The patient’s vitals are stabilized and he is ultimately discharged with his injuries appropriately treated. At the patient’s follow up... | Fibular neck fracture | {
"A": "Calcaneal fracture",
"B": "Fibular neck fracture",
"C": "Lisfranc fracture",
"D": "Tibial plateau fracture"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"car accident",
"front",
"restrained driver",
"head",
"collision",
"significant past medical history",
"patients",
"stabilized",
"discharged",
"injuries",
"treated",
"patients follow up primary care appointment",
"unable to lift",
"left ... |
A 25-year-old man with no significant past medical history is brought in by ambulance after a witnessed seizure at home. On physical exam, temperature is 102.3 deg F (39.1 deg C), blood pressure is 90/62 mmHg, pulse is 118/min, and respirations are 25/min. He is unable to touch his chin to his chest and spontaneously f... | Elevated opening pressure, elevated protein, low glucose | {
"A": "Elevated opening pressure, elevated protein, normal glucose",
"B": "Elevated opening pressure, elevated protein, low glucose",
"C": "Normal opening pressure, elevated protein, normal glucose",
"D": "Normal opening pressure, normal protein, normal glucose"
} | step1 | B | [
"year old man",
"significant past medical history",
"brought",
"ambulance",
"witnessed seizure at home",
"physical exam",
"temperature",
"deg F",
"blood pressure",
"90 62 mmHg",
"pulse",
"min",
"respirations",
"min",
"unable to touch",
"chin",
"chest",
"hips",
"passive neck flexi... |
A 25-year-old G1P0 woman at 33 weeks gestation presents to the obstetrician for an episode of postcoital spotting. The patient’s pregnancy is complicated by diet-controlled gestational diabetes. She has no other medical conditions. She takes prenatal vitamins. She denies tobacco, alcohol, or recreational drug use. She ... | Inhibits the 50S ribosome subunit | {
"A": "Disrupts peptidoglycan cross-linking",
"B": "Inhibits DNA gyrase",
"C": "Inhibits the 50S ribosome subunit",
"D": "Inhibits transpeptidase and cell wall synthesis"
} | step1 | C | [
"year old",
"woman",
"weeks presents",
"obstetrician",
"episode of",
"spotting",
"patients pregnancy",
"complicated by diet controlled gestational diabetes",
"medical conditions",
"takes prenatal vitamins",
"denies tobacco",
"alcohol",
"recreational drug use",
"currently sexually active",
... |
A 27-year-old woman comes to the physician because of a 2-day history of severe burning pain with urination, and urinary frequency. She has no history of serious illness. The patient and her husband are currently trying to conceive a child. Her only medication is a prenatal multivitamin. Her temperature is 36.5°C (97.7... | Oral fosfomycin | {
"A": "Reassurance and follow-up in 2 weeks",
"B": "Urinary catheterization",
"C": "Oral fosfomycin",
"D": "Urine culture\n\""
} | step2&3 | C | [
"27 year old woman",
"physician",
"of",
"2-day history",
"severe burning pain",
"urination",
"urinary frequency",
"history",
"serious illness",
"patient",
"husband",
"currently",
"to",
"child",
"only medication",
"prenatal multivitamin",
"temperature",
"36",
"97",
"pulse",
"7... |
A 60-year-old man comes to the physician because of a 2-day history of blood in his urine, lower abdominal pain, and a burning sensation while micturating. Five months ago, he was diagnosed with high-grade non-Hodgkin lymphoma and a deep vein thrombosis of his right popliteal vein. His medications include polychemother... | Mercaptoethane sulfonate | {
"A": "Protamine sulfate",
"B": "Mercaptoethane sulfonate",
"C": "Ciprofloxacin",
"D": "Dexrazoxane"
} | step2&3 | B | [
"60 year old man",
"physician",
"2-day history",
"blood",
"urine",
"lower abdominal pain",
"burning sensation",
"Five months",
"diagnosed",
"high-grade non-Hodgkin lymphoma",
"deep vein",
"right popliteal",
"medications include polychemotherapy",
"3 weeks",
"daily subcutaneous dose",
"... |
A 47-year-old woman is upset with her neighbor for playing music too loudly late at night. Rather than confront her neighbor directly, the woman makes a habit of parking her car in a manner that makes it difficult for her neighbor to park in his spot. Which of the following defense mechanisms is this woman demonstratin... | Passive aggression | {
"A": "Sublimation",
"B": "Regression",
"C": "Acting out",
"D": "Passive aggression"
} | step1 | D | [
"year old woman",
"upset",
"neighbor",
"playing music too",
"late",
"night",
"neighbor directly",
"woman makes",
"habit",
"parking",
"car",
"makes",
"difficult",
"neighbor to park",
"spot",
"following defense mechanisms",
"woman"
] |
A 54-year-old man presents with feelings of sadness and low mood on most days of the week for the past month. He reports an inability to concentrate and also finds it hard to develop an interest in his daily activities. He goes on to tell his physician that he struggles to get sleep at night, and, in the morning, he do... | Fluoxetine | {
"A": "Vortioxetine",
"B": "Fluoxetine",
"C": "Bupropion",
"D": "Vilazodone"
} | step2&3 | B | [
"54 year old man presents",
"feelings of sadness",
"low mood",
"days of the week",
"past month",
"reports",
"to concentrate",
"finds",
"hard to",
"interest",
"daily activities",
"goes",
"physician",
"to",
"sleep",
"night",
"morning",
"energy to get out",
"bed",
"feels",
"hasn... |
A 40-year-old woman residing at an iodine-deficient endemic area presents to the physician with a painless and gradually progressive anterior neck mass. She has occasional dysphagia, but has no history of prior head and neck irradiation. The examination shows a mass that moves with deglutition, suggesting a thyroid mas... | Follicular cells that lack nuclear atypia, with capsular and vascular invasion | {
"A": "Presence of Psammoma bodies",
"B": "Well-differentiated follicular cells without vascular invasion",
"C": "Follicular cells that lack nuclear atypia, with capsular and vascular invasion",
"D": "Hyperplastic parafollicular C cells"
} | step2&3 | C | [
"40 year old woman residing",
"iodine deficient",
"area presents",
"physician",
"painless",
"progressive anterior",
"occasional dysphagia",
"history of prior head and neck irradiation",
"examination shows",
"mass",
"moves",
"deglutition",
"suggesting",
"thyroid mass",
"ultrasound of the ... |
A 15-year-old girl is brought to the physician because she has not yet had her first menstrual period. She reports that she frequently experiences cramping and pain in her legs during school sports. The patient is at the 20th percentile for height and 50th percentile for weight. Her temperature is 37°C (98.6°F), pulse ... | Pathologic fractures | {
"A": "Obsessive-compulsive disorder",
"B": "Pathologic fractures",
"C": "Pulmonary stenosis",
"D": "Severe acne"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"not",
"first menstrual period",
"reports",
"frequently experiences cramping",
"pain in",
"legs",
"school sports",
"patient",
"percentile",
"height",
"50th percentile",
"weight",
"temperature",
"98",
"pulse",
"70 min",
"blood pressure",
... |
A 55-year-old man presents to the urgent clinic complaining of pain in his right foot. He reported that the pain is intense that he had to remove his shoe and sock, and rates the pain level as 6 out of 10. He does not report trauma or recent infection. The past medical history includes hypertension. The medications inc... | Diclofenac alone | {
"A": "Probenecid alone",
"B": "Oral methylprednisolone and meloxicam",
"C": "Colchicine and celecoxib",
"D": "Diclofenac alone"
} | step2&3 | D | [
"55 year old man presents",
"urgent clinic",
"pain",
"right foot",
"reported",
"pain",
"intense",
"to remove",
"shoe",
"sock",
"rates",
"pain level",
"10",
"not report trauma",
"recent infection",
"past medical history includes hypertension",
"medications include hydrochlorothiazide"... |
A 37-year-old man presents to the emergency department for a persistent fever. The patient states he has felt unwell for the past week and has felt subjectively febrile. The patient has a past medical history of a suicide attempt and alcohol abuse. He is not currently taking any medications. The patient admits to using... | Blood cultures | {
"A": "Blood cultures",
"B": "CT scan",
"C": "Ultrasound",
"D": "Vancomycin and gentamicin"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"persistent fever",
"patient states",
"felt unwell",
"past week",
"felt",
"febrile",
"patient",
"past medical",
"suicide attempt",
"alcohol abuse",
"not currently taking",
"medications",
"patient admits",
"using heroin",
"cocaine",
"... |
A 63-year-old man comes to the physician for evaluation of fever and a nonproductive cough for the past 2 weeks. During this period, he has also had fatigue, myalgia, and difficulty breathing. Five weeks ago, he underwent an aortic prosthetic valve replacement due to high-grade aortic stenosis. The patient has a histor... | Staphylococcus epidermidis | {
"A": "Streptococcus gallolyticus",
"B": "Staphylococcus epidermidis",
"C": "Viridans streptococci",
"D": "Streptococcus pyogenes"
} | step2&3 | B | [
"63 year old man",
"physician",
"evaluation",
"fever",
"cough",
"past 2 weeks",
"period",
"fatigue",
"myalgia",
"difficulty breathing",
"Five weeks",
"aortic prosthetic valve replacement due to high-grade",
"stenosis",
"patient",
"history of hypertension",
"asthma",
"type 2 diabetes ... |
A 42-year-old man presents to his primary care provider complaining of insomnia. He describes 3 months of frequent nighttime awakenings and nightmares. Per chart review, he is a combat veteran and was on a military tour in Afghanistan 4 months ago when a car bomb exploded, injuring him and killing his friend; however, ... | Propanolol | {
"A": "Prazosin",
"B": "Propanolol",
"C": "Sertraline",
"D": "Zolpidem"
} | step1 | B | [
"year old man presents",
"primary care provider complaining of insomnia",
"3 months",
"frequent nighttime awakenings",
"nightmares",
"chart review",
"veteran",
"military tour",
"Afghanistan",
"months",
"car bomb",
"killing",
"friend",
"physician",
"patient states",
"not talk",
"chang... |
A 38-year-old man presents with fatigue and weight loss for the past 4 months. He feels tired all the time. He also no longer feels interested in his work. He says he has lost weight and says, "I just don’t want to eat." No significant past medical history. No current medications. Physical examination is unremarkable. ... | Continue sertraline | {
"A": "Replace sertraline with fluoxetine",
"B": "Discontinue sertraline",
"C": "Continue sertraline",
"D": "Add amitriptyline to sertraline"
} | step1 | C | [
"year old man presents",
"fatigue",
"weight loss",
"past",
"months",
"feels tired",
"time",
"longer feels interested",
"work",
"lost weight",
"I",
"to eat",
"significant past medical history",
"current medications",
"Physical examination",
"unremarkable",
"patient",
"started",
"s... |
A 68-year-old man presents to the physician with fever, cough, weakness, night sweats, and poor appetite for the past 6 months. Medical records suggest that he has lost 7.5 kg (16.5 lb) of weight during this period. There is no history of breathlessness, nasal discharge, nasal obstruction, palpitations, chest pain, or ... | Tuberculosis | {
"A": "Chronic histoplasmosis",
"B": "Langerhans cell histiocytosis",
"C": "Tuberculosis",
"D": "Bronchoalveolar carcinoma"
} | step2&3 | C | [
"68 year old man presents",
"physician",
"fever",
"cough",
"weakness",
"night sweats",
"poor appetite",
"past 6 months",
"Medical records suggest",
"lost 7.5 kg",
"weight",
"period",
"history",
"breathlessness",
"nasal discharge",
"nasal obstruction",
"palpitations",
"chest pain",
... |
A 53-year-old man seeks evaluation from his physician with concerns about his blood pressure. He was recently told at a local health fair that he has high blood pressure. He has not seen a physician since leaving college because he never felt the need for medical attention. Although he feels fine, he is concerned becau... | Atorvastatin | {
"A": "Atorvastatin",
"B": "Niacin",
"C": "Gemfibrozil",
"D": "Orlistat"
} | step1 | A | [
"year old man",
"evaluation",
"physician",
"concerns",
"blood pressure",
"recently",
"local health fair",
"high blood pressure",
"not seen",
"physician",
"leaving college",
"never felt",
"need",
"medical attention",
"feels fine",
"concerned",
"father",
"hypertension",
"died due t... |
A 19-year-old woman comes to the physician for a routine examination. She has one sexual partner, with whom she had unprotected sexual intercourse 3 days ago. She does not desire a pregnancy and is interested in a reliable and long-term contraceptive method. She has read in detail about the reliability, adverse-effects... | “I can understand your need for the IUD, but I cannot place it for you due to my religious beliefs. I would be happy to refer you to a colleague who could do it.” | {
"A": "“Prescribing any means of contraception is against my religious beliefs, but as a doctor, I am obliged to place the IUD for you.”",
"B": "“I can understand your need for the IUD, but I cannot place it for you due to my religious beliefs. I would be happy to refer you to a colleague who could do it.”",
"C"... | step1 | B | [
"year old woman",
"physician",
"routine examination",
"one sexual partner",
"unprotected sexual intercourse",
"days",
"not desire",
"pregnancy",
"interested",
"reliable",
"long-term contraceptive method",
"read",
"detail",
"reliability",
"adverse-effects",
"health risks",
"effective ... |
A 30-year-old woman was found lying down and unresponsive by her parents 2 hours ago. She has no significant medical history. Two years ago, the woman discovered that her husband of 8 years was having an extramarital affair; this revelation subsequently resulted in a drawn-out divorce. After the separation, she moved b... | Gram-negative enteric bacillus; catalase-positive, oxidase-negative, turns pink on MacConkey agar | {
"A": "Gram-negative enteric bacillus; catalase-positive, oxidase-negative, turns pink on MacConkey agar",
"B": "Located in the periphery of islets of Langerhans",
"C": "Located in zona fasciculata of the adrenal cortex",
"D": "Gram-negative enteric bacillus; urease-positive, oxidase-positive, can be identifie... | step1 | A | [
"30 year old woman",
"found lying",
"unresponsive",
"parents",
"hours",
"significant medical history",
"Two years",
"woman discovered",
"husband",
"years",
"extramarital affair",
"resulted",
"out divorce",
"separation",
"moved back",
"parents",
"note",
"room",
"sleeps",
"lot",
... |
A 46-year-old female is brought to the emergency department by her husband 1 hour after the onset of chest palpitations. Her symptoms began suddenly while she was drinking coffee and have persisted since then. She has not had shortness of breath, chest pain, dizziness, or loss of consciousness. She has experienced thes... | Administer adenosine intravenously | {
"A": "Administer adenosine intravenously",
"B": "Administer verapamil intravenously",
"C": "Electrical cardioversion",
"D": "Administer diltiazem intravenously"
} | step2&3 | A | [
"year old female",
"brought",
"emergency department",
"husband",
"hour",
"onset",
"chest palpitations",
"symptoms began",
"drinking coffee",
"since then",
"not",
"shortness of breath",
"chest pain",
"dizziness",
"loss of consciousness",
"experienced",
"palpitations",
"resolve",
"... |
A 15-year-old boy is brought to the office by his mother with complaints of facial puffiness and smoky urine. The mother noticed puffiness on her son’s face a week ago, and it has been progressively worsening since then. She also states that her son had a sore throat 3 weeks ago. The patient does not have fever/chills,... | Positive streptozyme test | {
"A": "Normal erythrocyte sedimentation rate",
"B": "Positive streptozyme test",
"C": "Increased C3 level",
"D": "Negative antistreptolysin O (ASO) titer"
} | step1 | B | [
"year old boy",
"brought",
"office",
"mother",
"complaints",
"facial puffiness",
"smoky urine",
"mother",
"puffiness",
"sons face",
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"worsening since then",
"states",
"son",
"sore throat",
"weeks",
"patient",
"not",
"fever/chills",
"changes",
"urinary frequency",
"ab... |
A 32-year-old African American man presents to the office for a routine examination. He has no complaints at this time. Records show that his systolic blood pressure was in the 130–138 range and diastolic blood pressure in the 88–95 range despite counseling on lifestyle modification. He admits that he was not compliant... | Insulin receptor resistance | {
"A": "Autoimmune destruction of pancreatic beta cells",
"B": "Insulin receptor resistance",
"C": "LDL receptor gene mutation",
"D": "Excessive cortisol secretion and activity"
} | step2&3 | B | [
"year old African American man presents",
"office",
"routine examination",
"complaints",
"time",
"Records show",
"systolic blood pressure",
"range",
"diastolic blood pressure",
"range",
"counseling",
"lifestyle modification",
"admits",
"not compliant",
"advice",
"takes",
"medications... |
A 45-year-old man is brought by his wife with a complaint of an ongoing progressive history of memory problems for 6 months. He is an accountant by profession. He has difficulty remembering things and events, which has affected his job. He began using a diary to aid with remembering his agenda. His wife also says that ... | Normal-pressure hydrocephalus | {
"A": "Early-onset Alzheimer’s disease",
"B": "Normal-pressure hydrocephalus",
"C": "Parkinson’s disease",
"D": "Progressive supranuclear palsy"
} | step2&3 | B | [
"year old man",
"brought",
"wife",
"complaint",
"ongoing progressive history",
"memory problems",
"months",
"accountant",
"profession",
"difficulty remembering things",
"events",
"affected",
"job",
"began using",
"diary to aid",
"remembering",
"agenda",
"wife",
"wet",
"pants mu... |
A 69-year-old man presents with granulomatosis with polyangiitis diagnosed about 8 months ago. He was treated appropriately and states that his symptoms are well controlled. He is presenting today for a general follow up visit. His temperature is 99.0°F (37.2°C), blood pressure is 184/104 mmHg, pulse is 88/min, respira... | Hypokalemia and metabolic alkalosis | {
"A": "Hyperkalemia and metabolic acidosis",
"B": "Hypokalemia and metabolic acidosis",
"C": "Hypokalemia and metabolic alkalosis",
"D": "Hypokalemia and normal acid-base status"
} | step2&3 | C | [
"69 year old man presents",
"granulomatosis",
"polyangiitis diagnosed",
"months",
"treated",
"states",
"symptoms",
"well controlled",
"presenting today",
"general follow up visit",
"temperature",
"99",
"blood pressure",
"mmHg",
"pulse",
"88 min",
"respirations",
"min",
"oxygen sa... |
A 55-year-old man comes to the emergency department because of left-sided chest pain and difficulty breathing for the past 30 minutes. His pulse is 88/min. He is pale and anxious. Serum studies show increased cardiac enzymes. An ECG shows ST-elevations in leads I, aVL, and V5-V6. A percutaneous coronary intervention is... | Left coronary artery → left circumflex artery | {
"A": "Left coronary artery → left circumflex artery",
"B": "Right coronary artery → right marginal artery",
"C": "Left coronary artery → posterior descending artery",
"D": "Left coronary artery → left anterior descending artery"
} | step1 | A | [
"55 year old man",
"emergency department",
"left-sided chest pain",
"difficulty breathing",
"past 30 minutes",
"pulse",
"88 min",
"pale",
"anxious",
"Serum studies show increased cardiac enzymes",
"ECG shows ST-elevations",
"leads I",
"aVL",
"V5 V6",
"percutaneous coronary intervention",... |
A 28-year-old woman, gravida 1, para 0, at 20 weeks' gestation comes to the physician for genetic counseling. Her brother and maternal uncle both have anemia that worsens after taking certain medications. Based on the pedigree shown, what is the probability that her son will be affected by the disease? | 25% | {
"A": "25%",
"B": "0%",
"C": "100%",
"D": "12.5%"
} | step1 | A | [
"year old woman",
"gravida 1",
"para 0",
"20 weeks",
"gestation",
"physician",
"genetic counseling",
"brother",
"maternal uncle",
"anemia",
"worsens",
"taking certain medications",
"Based",
"pedigree shown",
"probability",
"son",
"affected",
"disease"
] |
A 75-year-old woman with late-onset autoimmune diabetes mellitus, rheumatoid arthritis, coronary artery disease, and idiopathic pulmonary fibrosis presents to the ship medic with altered mental status. While on her current cruise to the Caribbean islands, she experienced nausea, vomiting, and diarrhea. She takes aspiri... | Respiratory alkalosis and anion-gap metabolic acidosis | {
"A": "Respiratory acidosis and contraction metabolic alkalosis",
"B": "Respiratory alkalosis and non-contraction metabolic alkalosis",
"C": "Respiratory alkalosis and anion-gap metabolic acidosis",
"D": "Respiratory acidosis and anion-gap metabolic acidosis"
} | step2&3 | C | [
"75 year old woman",
"late-onset autoimmune diabetes mellitus",
"rheumatoid arthritis",
"coronary artery disease",
"idiopathic pulmonary fibrosis presents",
"ship",
"altered mental status",
"current",
"Caribbean islands",
"experienced nausea",
"vomiting",
"diarrhea",
"takes aspirin",
"simv... |
A 31-year-old man is referred to a neurologist due to his gradually increasing eccentric behavior and involuntary movements, especially the movements of his arms and hands. He also has difficulty with his short-term memory. Past medical history is otherwise noncontributory. His father had similar symptoms before he die... | Huntington's disease | {
"A": "Huntington's disease",
"B": "Friedreich ataxia",
"C": "Wilson's disease",
"D": "Neurofibromatosis"
} | step1 | A | [
"31 year old man",
"referred",
"neurologist",
"increasing eccentric behavior",
"involuntary movements",
"movements",
"arms",
"hands",
"difficulty",
"short-term memory",
"Past medical history",
"father",
"similar symptoms",
"died",
"symptoms started",
"age",
"blood pressure",
"mm Hg... |
A 55-year-old man comes to the physician for evaluation prior to parathyroidectomy. A Tc99m-sestamibi scan shows two spots of increased uptake in the superior mediastinum. These spots represent structures that are most likely derived from which of the following embryological precursors? | 3rd branchial pouch | {
"A": "4th branchial pouch",
"B": "3rd branchial pouch",
"C": "2nd branchial arch",
"D": "3rd branchial arch"
} | step1 | B | [
"55 year old man",
"physician",
"evaluation prior to parathyroidectomy",
"Tc99m-sestamibi scan shows two spots",
"increased uptake",
"superior mediastinum",
"spots represent structures",
"most likely derived",
"following embryological precursors"
] |
A 45-year-old obese man presents to his primary care provider for an annual physical. The patient states that he has noticed increased sleepiness during the day at work over the past 6 months in addition to difficulty concentrating and worsening memory. He denies recent weight loss, and is not sure if he snores because... | Sleep apnea | {
"A": "Cor pulmonale",
"B": "Diuretic overuse",
"C": "JAK2 mutation",
"D": "Sleep apnea"
} | step1 | D | [
"year old obese man presents",
"primary care provider",
"annual physical",
"patient states",
"increased sleepiness",
"day",
"work",
"past 6 months",
"difficulty concentrating",
"worsening memory",
"denies recent weight loss",
"not sure",
"snores",
"sleeps",
"past medical history",
"sig... |
A new assay for Lyme disease has been developed. While the assay has been tested extensively in Maine, a group of inventors are planning to test it in Southern California. In comparison to the assay's performance in Maine, testing the assay in Southern California would affect the performance of the assay in which of th... | Greater likelihood that an individual with a negative test will truly not have Lyme disease
" | {
"A": "Decrease negative likelihood ratio of the Lyme disease assay",
"B": "Lower likelihood that a patient without Lyme disease truly has a negative test",
"C": "Decreased positive likelihood ratio of the Lyme disease assay",
"D": "Greater likelihood that an individual with a negative test will truly not have... | step2&3 | D | [
"new assay",
"Lyme disease",
"assay",
"tested",
"Maine",
"a group",
"inventors",
"planning to test",
"Southern California",
"comparison",
"assay's performance",
"Maine",
"testing",
"assay",
"Southern California",
"affect",
"performance",
"assay",
"following"
] |
A 68-year-old male is brought to the emergency department by his wife. An hour earlier, he dropped to the floor and began to violently shake his extremities. He urinated on the carpet and seemed confused for several minutes after. He is now feeling better. He has never experienced an episode like this before, nor does ... | Hypertonic saline | {
"A": "Phenytoin",
"B": "Valproic acid",
"C": "Diazepam",
"D": "Hypertonic saline"
} | step2&3 | D | [
"68 year old male",
"brought",
"emergency department",
"wife",
"hour earlier",
"dropped",
"floor",
"began to",
"shake",
"extremities",
"carpet",
"confused",
"minutes",
"now feeling better",
"never experienced",
"episode",
"think",
"family",
"wife",
"concerned",
"lost",
"kg"... |
One day after undergoing an open colectomy, a 65-year-old man with colon cancer experiences shivers. The procedure was originally scheduled to be done laparoscopically, but it was converted because of persistent bleeding. Besides the conversion, the operation was uneventful. Five years ago, he underwent renal transplan... | Surgical debridement | {
"A": "X-ray of the abdomen and pelvis",
"B": "Vacuum-assisted wound closure device",
"C": "Surgical debridement",
"D": "Intravenous clindamycin therapy"
} | step2&3 | C | [
"One day",
"open colectomy",
"65-year-old man",
"colon cancer experiences shivers",
"procedure",
"scheduled to",
"persistent bleeding",
"conversion",
"operation",
"Five years",
"renal transplantation",
"cystic disease",
"taking prednisolone",
"then",
"history",
"allergy",
"sulfonamid... |
A 2-year-old boy is brought to the physician by his mother because of fever and left ear pain for the past 3 days. He has also been frequently rubbing his left ear since he woke up in the morning. He has a history of atopic dermatitis, and his mother is concerned that his symptoms may be caused by him itching at night.... | Oral azithromycin | {
"A": "Topical hydrocortisone and gentamicin eardrops",
"B": "Oral azithromycin",
"C": "Otic ofloxacin therapy",
"D": "Tympanocentesis"
} | step2&3 | B | [
"2 year old boy",
"brought",
"physician",
"mother",
"fever",
"left ear pain",
"past 3 days",
"frequently rubbing",
"left ear",
"woke up",
"morning",
"history",
"atopic dermatitis",
"mother",
"concerned",
"symptoms",
"caused",
"itching",
"night",
"not",
"flare-ups",
"latest ... |
A 75-year-old Caucasian man presents to the emergency department with abdominal pain. The patient states he was at home eating dinner when he began to experience severe abdominal pain. The patient has a past medical history of diabetes, hypertension, and atherosclerosis. He lives at home alone, smokes cigarettes, and d... | Cigarette smoking | {
"A": "Atherosclerosis",
"B": "Caucasian race",
"C": "Cigarette smoking",
"D": "Family history"
} | step2&3 | C | [
"75 year old Caucasian man presents",
"emergency department",
"abdominal pain",
"patient states",
"at home eating dinner",
"began to experience severe abdominal",
"patient",
"past medical diabetes",
"hypertension",
"atherosclerosis",
"lives at home alone",
"smokes cigarettes",
"drinks 1",
... |
A 74-year-old gentleman presents to his family practitioner with the complaint of an inability to open his left eye since this morning. He also complains of intermittent pain and numbness in his left arm that has been present for the last few days. He denies ocular pain, difficulty swallowing, fatigability, or diplopia... | Loss of hemifacial sweating | {
"A": "Facial asymmetry",
"B": "Loss of hemifacial sweating",
"C": "Tongue deviation to the left side",
"D": "Urinary retention"
} | step2&3 | B | [
"74 year old",
"presents",
"family practitioner",
"complaint",
"to open",
"left eye",
"morning",
"intermittent pain",
"numbness",
"left arm",
"present",
"days",
"denies ocular pain",
"difficulty swallowing",
"fatigability",
"diplopia",
"symptoms",
"constant",
"fluctuation",
"hi... |
A 65-year-old female patient with a past medical history of diabetes mellitus and an allergy to penicillin develops an infected abscess positive for MRSA on the third day of her hospital stay. She is started on an IV infusion of vancomycin at a dose of 1000 mg every 12 hours. Vancomycin is eliminated by first-order kin... | 24 hours | {
"A": "6 hours",
"B": "18 hours",
"C": "24 hours",
"D": "30 hours"
} | step1 | C | [
"65-year-old female patient",
"past medical history of diabetes mellitus",
"allergy to penicillin",
"infected abscess positive",
"MRSA",
"third day",
"hospital",
"started",
"IV infusion of vancomycin",
"dose",
"mg",
"12 hours",
"Vancomycin",
"eliminated",
"first-order kinetics",
"half ... |
A 27-year-old man presents to his primary care physician with concerns about poor sleep quality. The patient states that he often has trouble falling asleep and that it is negatively affecting his studies. He is nervous that he is going to fail out of graduate school. He states that he recently performed poorly at a la... | Cognitive behavioral therapy | {
"A": "Alprazolam during presentations",
"B": "Cognitive behavioral therapy",
"C": "Fluoxetine",
"D": "Propranolol during presentations"
} | step2&3 | B | [
"27 year old man presents",
"primary care physician",
"concerns",
"poor",
"patient states",
"often",
"trouble falling asleep",
"affecting",
"studies",
"nervous",
"to fail out",
"graduate school",
"states",
"recently performed poorly",
"lab meeting",
"to present",
"research",
"recur... |
A 56-year-old woman presents to the emergency department with a 1-hour history of persistent nasal bleeding. The bleeding started spontaneously. The patient experienced a similar episode last year. Currently, she has hypertension and takes hydrochlorothiazide and losartan. She is anxious. Her blood pressure is 175/88 m... | Nasal oxymetazoline | {
"A": "Anterior nasal packing with topical antibiotics",
"B": "Intravenous infusion of nitroglycerin",
"C": "Nasal oxymetazoline",
"D": "Silver nitrate cauterization of the bleeding vessel"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"hour history",
"persistent nasal bleeding",
"bleeding started",
"patient experienced",
"similar episode",
"year",
"Currently",
"hypertension",
"takes hydrochlorothiazide",
"losartan",
"anxious",
"blood pressure",
"88 mm Hg",
"examinat... |
A professional musician visits his physician after a morning concert. He complains of painless swelling in his right cheek when he plays his tuba. Physical examination of the patient reveals slight facial asymmetry due to minor swelling on the right side of the face. The skin over the swelling is smooth without any sec... | CN VII – Buccal branch | {
"A": "V2 – Maxillary nerve",
"B": "V3 – Mandibular nerve",
"C": "CN VII – Buccal branch",
"D": "CN VII – Marginal mandibular branch"
} | step1 | C | [
"professional musician visits",
"physician",
"morning",
"painless swelling",
"right cheek",
"plays",
"tuba",
"Physical examination",
"patient reveals slight facial due to minor swelling",
"right side of",
"face",
"skin",
"swelling",
"smooth",
"secondary changes",
"Palpation reveals",
... |
A 67-year-old man comes to the emergency department for evaluation of progressively worsening edema and decreased urine output over the past few days. He has a history of chronic sinus infections and was hospitalized last year for a suspected pneumonia with hemoptysis. Physical exam shows bilateral pitting edema of the... | No deposits | {
"A": "Subendothelial deposits",
"B": "Mesangial deposits",
"C": "Subepithelial deposits",
"D": "No deposits"
} | step1 | D | [
"67 year old man",
"emergency department",
"evaluation",
"worsening edema",
"decreased urine output",
"past",
"days",
"history of chronic sinus infections",
"hospitalized last year",
"suspected pneumonia",
"hemoptysis",
"Physical exam shows bilateral pitting edema of",
"lower extremities",
... |
A 51-year-old man alcoholic presents to the emergency department with persistent vomiting. He was found vomiting forcefully next to an empty bottle of vodka. His medical history is significant for Lyme disease, currently being treated with doxycycline. After a prolonged episode of retching, the patient begins choking a... | Boerhaave syndrome | {
"A": "Esophageal candidiasis",
"B": "Dieulafoy's lesion",
"C": "Boerhaave syndrome",
"D": "Mallory Weiss tear"
} | step2&3 | C | [
"year old man alcoholic presents",
"emergency department",
"persistent vomiting",
"found vomiting",
"next to",
"empty bottle",
"vodka",
"medical history",
"significant",
"Lyme disease",
"currently",
"treated with doxycycline",
"prolonged episode of retching",
"patient begins choking",
"c... |
An 85-year-old woman presents to her physician with complaints of significant weakness and weight loss. She recently has been diagnosed with stage IV breast cancer for which she currently is receiving treatment. She mentions that, despite taking a diet rich in protein and calories, she continues to lose weight. On phys... | Activation of NF-κB | {
"A": "Activation of hormone-sensitive lipase in adipose tissue",
"B": "Increased release of tumor necrosis factor (TNF) from macrophages",
"C": "Activation of NF-κB",
"D": "Suppression of the appetite center in the hypothalamus"
} | step1 | C | [
"85 year old woman presents",
"physician",
"complaints",
"significant weakness",
"weight loss",
"recently",
"diagnosed",
"stage IV breast cancer",
"currently",
"receiving treatment",
"taking",
"diet rich",
"protein",
"calories",
"continues to",
"weight",
"physical examination",
"vi... |
A 74-year-old man is brought to the emergency department because of lower abdominal pain for 3 hours. The pain is sharp, constant, and does not radiate. He has not urinated for 24 hours and he has not passed stool for over 3 days. He was diagnosed with herpes zoster 3 weeks ago and has been taking amitriptyline for pos... | Transurethral catheterization | {
"A": "Observation and NSAIDs administration",
"B": "Transurethral catheterization",
"C": "Finasteride administration",
"D": "IV pyelography"
} | step2&3 | B | [
"74 year old man",
"brought",
"emergency department",
"of lower abdominal pain",
"hours",
"pain",
"sharp",
"constant",
"not radiate",
"not",
"24 hours",
"not passed stool",
"3 days",
"diagnosed",
"herpes zoster",
"weeks",
"taking amitriptyline",
"post-herpetic neuralgia",
"1 week... |
A 57-year-old man presents with a large wound on his right lower leg that has been present for 6 months as shown in the picture. He has had chronically swollen legs for over 10 years. His mother and brother had similar problems with their legs. He had a documented deep vein thrombosis (DVT) in the affected leg 5 years ... | Chronic venous insufficiency | {
"A": "Arterial ulcer",
"B": "Marjolin ulcer",
"C": "Chronic venous insufficiency",
"D": "Kaposi sarcoma"
} | step2&3 | C | [
"57 year old man presents",
"large wound",
"right lower leg",
"present",
"months",
"shown",
"picture",
"swollen legs",
"10 years",
"mother",
"brother",
"similar problems",
"legs",
"documented deep vein thrombosis",
"affected leg",
"years earlier",
"past medical history",
"blood pre... |
A 15-year-old girl is brought into the clinic for a second opinion by her mother. She was recently diagnosed with alopecia areata after having presented to her family doctor with a 2-month history of noticeable bald patches. The mother was concerned because the treatment involved topical steroids. The patient is noted ... | Behavioral therapy | {
"A": "Behavioral therapy",
"B": "Selective serotonin reuptake inhibitors",
"C": "Antipsychotics",
"D": "Lithium"
} | step2&3 | A | [
"year old girl",
"brought",
"clinic",
"second opinion",
"mother",
"recently diagnosed",
"alopecia areata",
"presented",
"family doctor",
"2 month history",
"bald patches",
"mother",
"concerned",
"treatment involved topical steroids",
"patient",
"noted to",
"started high school earlie... |
Seven hours after undergoing left hip arthroplasty for chronic hip pain, a 67-year-old woman reports a prickling sensation in her left anteromedial thigh and lower leg. Neurologic examination shows left leg strength 3/5 on hip flexion and 2/5 on knee extension. Patellar reflex is decreased on the left. Sensation to pin... | Femoral nerve injury | {
"A": "Sural nerve injury",
"B": "Femoral nerve injury",
"C": "Fibular nerve injury",
"D": "S1 radiculopathy"
} | step1 | B | [
"Seven hours",
"left",
"chronic hip pain",
"67 year old woman reports",
"prickling sensation",
"left anteromedial thigh",
"lower leg",
"Neurologic examination shows left leg strength",
"hip flexion",
"2/5",
"knee extension",
"Patellar",
"decreased",
"left",
"Sensation",
"pinprick",
"... |
A 61-year-old man comes to the physician because of a 3-month history of worsening exertional dyspnea and a persistent dry cough. For 37 years he has worked in a naval shipyard. He has smoked 1 pack of cigarettes daily for the past 40 years. Pulmonary examination shows fine bibasilar end-expiratory crackles. An x-ray o... | Bronchogenic carcinoma | {
"A": "Bronchogenic carcinoma",
"B": "Aspergilloma",
"C": "Mycobacterial Infection",
"D": "Malignant mesothelioma"
} | step1 | A | [
"61 year old man",
"physician",
"3 month history",
"worsening exertional dyspnea",
"persistent dry cough",
"years",
"worked",
"smoked 1 pack",
"cigarettes daily",
"past 40 years",
"Pulmonary examination shows fine",
"end-expiratory crackles",
"x-ray of",
"chest shows diffuse bilateral infi... |
A previously healthy 28-year-old woman comes to the physician because of lower abdominal pain and purulent vaginal discharge for the past 5 days. Menses occur at irregular 20 to 40-day intervals and last 4 to 8 days. She is sexually active with a new partner that she met 2 months ago and they use condoms inconsistently... | HIV test | {
"A": "CT scan of the abdomen",
"B": "Colposcopy",
"C": "Pap smear",
"D": "HIV test"
} | step2&3 | D | [
"healthy",
"year old woman",
"physician",
"lower abdominal pain",
"purulent vaginal discharge",
"past 5 days",
"Menses occur",
"irregular 20",
"40 day intervals",
"last 4",
"days",
"sexually active",
"new partner",
"met 2 months",
"use condoms",
"normal pap smear",
"months",
"drink... |
Scientists are developing a new non-steroidal anti-inflammatory drug for osteoarthritis. Their hope is that the new drug will have a higher potency but the same efficacy as ibuprofen in the hope of minimizing gastrointestinal side effects. If ibuprofen is curve C in the figure provided, which of the following would be ... | Curve A | {
"A": "Curve A",
"B": "Curve B",
"C": "Curve C",
"D": "Curve D"
} | step1 | A | [
"Scientists",
"new non-steroidal anti-inflammatory drug",
"osteoarthritis",
"hope",
"new drug",
"higher potency",
"same efficacy",
"ibuprofen",
"hope",
"gastrointestinal side effects",
"ibuprofen",
"curve",
"provided",
"following",
"curve",
"new drug based",
"scientists specification... |
A 48-year-old man presents to the emergency department with shortness of breath. He reports that 6 months ago he was able to walk several miles without stopping. Yesterday, he became short of breath walking from his bed to the bathroom. He also endorses worsening abdominal distension and leg swelling, which he reports ... | Alcohol cessation | {
"A": "Alcohol cessation",
"B": "Antiviral therapy",
"C": "Hormone replacement",
"D": "Vitamin repletion"
} | step2&3 | A | [
"48 year old man presents",
"emergency department",
"shortness of breath",
"reports",
"months",
"able to walk several miles",
"stopping",
"short of breath walking",
"bed",
"bathroom",
"worsening abdominal distension",
"leg swelling",
"reports",
"new",
"months",
"patient",
"past medic... |
A 28-year-old patient comes to the physician’s office with complaints of headaches and difficulty seeing out of the corner of her eye. She gave birth to her son 1 year ago. Further visual testing reveals the patient has bitemporal hemianopsia. The patient undergoes brain MRI which shows an anterior pituitary mass, like... | Thyroid stimulating hormone | {
"A": "Prolactin",
"B": "Oxytocin",
"C": "Antidiuretic hormone",
"D": "Thyroid stimulating hormone"
} | step1 | D | [
"year old patient",
"physicians office",
"complaints",
"headaches",
"difficulty out",
"corner",
"eye",
"gave birth",
"son",
"year",
"Further visual testing reveals",
"patient",
"bitemporal hemianopsia",
"patient",
"brain MRI",
"shows",
"anterior",
"likely adenoma",
"patient",
"... |
Several weeks following a kidney transplantation, a 50-year-old Caucasian female presents for evaluation of the transplanted organ. Biopsy shows inflammation involving the endothelial cells of the kidney vasculature and the presence of mononuclear cells in the interstitium. Which cells are most likely responsible for t... | Recipient T-cells | {
"A": "Recipient T-cells",
"B": "Preformed recipient antibodies",
"C": "Donor antibodies",
"D": "Deposition of antibody immune complexes"
} | step1 | A | [
"Several weeks following",
"kidney transplantation",
"50 year old Caucasian female presents",
"evaluation",
"transplanted organ",
"Biopsy shows inflammation involving",
"endothelial",
"kidney vasculature",
"presence of mononuclear cells",
"interstitium",
"cells",
"most likely responsible",
"... |
A 64-year-old woman comes to the physician for her routine health maintenance examination. She feels well. She had cervical cancer and received radiotherapy 8 years ago. Her vital signs are within normal limits. On percussion, the spleen size is 15 cm. Otherwise, the physical examination shows no abnormalities. The lab... | Dasatinib | {
"A": "Allogeneic stem cell transplantation",
"B": "Dasatinib",
"C": "Phlebotomy",
"D": "Rituximab"
} | step2&3 | B | [
"64 year old woman",
"physician",
"routine health maintenance examination",
"feels well",
"cervical cancer",
"received radiotherapy",
"years",
"vital signs",
"normal limits",
"percussion",
"spleen size",
"physical examination shows",
"abnormalities",
"laboratory test results",
"follows",... |
A 17-year-old boy is brought to the emergency department after being stabbed with a knife during an altercation. Physical examination shows a 4-cm stab wound on the right lateral border of the T1 spinous process. An MRI of the spinal cord shows damage to the area of the right lateral corticospinal tract at the level of... | Absence of right-sided motor function below T1 | {
"A": "Absence of left-sided proprioception below T1",
"B": "Absence of right-sided temperature sensation below T1",
"C": "Absence of left-sided fine touch sensation below T1",
"D": "Absence of right-sided motor function below T1"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"stabbed",
"knife",
"altercation",
"Physical examination shows",
"4 cm stab wound",
"right lateral border",
"T1 spinous process",
"MRI of",
"spinal cord shows damage to the area",
"right lateral corticospinal tract",
"level",
"T1",
"Fu... |
A 24-year-old man with type 1 diabetes mellitus is brought to the emergency department because of weakness, abdominal pain, nausea, and one episode of vomiting for 1 day. He has not taken his insulin for 3 days. His pulse is 125/min and respirations are 29/min. Examination shows dry mucous membranes. His breath has a f... | ↓ ↓ ↑ ↑ | {
"A": "↓ ↓ ↑ ↑",
"B": "↓ normal ↓ ↓",
"C": "↓ ↑ normal ↑",
"D": "↓ ↓ ↑ ↓"
} | step1 | A | [
"year old man",
"type 1 diabetes mellitus",
"brought",
"emergency department",
"weakness",
"abdominal pain",
"nausea",
"one episode of vomiting",
"1 day",
"not taken",
"insulin",
"3 days",
"pulse",
"min",
"respirations",
"29 min",
"Examination shows dry mucous membranes",
"breath",... |
A group of researchers is looking to study the effect of body weight on blood pressure in the elderly. Previous work measuring body weight and blood pressure at 2-time points in a large group of healthy individuals revealed that a 10% increase in body weight was accompanied by a 7 mm Hg increase in blood pressure. If t... | Pearson’s correlation | {
"A": "Two-way analysis of variance (ANOVA)",
"B": "Pearson’s correlation",
"C": "Spearman’s correlation",
"D": "Wilcoxon signed-rank test"
} | step1 | B | [
"A group",
"researchers",
"looking to study",
"effect",
"body weight",
"blood pressure",
"elderly",
"Previous work measuring body weight",
"blood pressure",
"time points in",
"group",
"revealed",
"a 10",
"increase",
"body weight",
"mm Hg increase",
"blood pressure",
"researchers",
... |
A 80-year-old man is brought to the emergency department with complaints that he "can’t control his left leg”. His symptoms started a few hours ago. He was outside taking a walk with his wife when suddenly his leg shot out and kicked her. His past medical history is notable for diabetes, hypertension, and a myocardial ... | Right subthalamic nucleus | {
"A": "Left internal capsule",
"B": "Left subthalamic nucleus",
"C": "Right subthalamic nucleus",
"D": "Ventral posterior thalamic nucleus"
} | step1 | C | [
"80 year old man",
"brought",
"emergency department",
"complaints",
"cant control",
"left leg",
"symptoms started",
"few hours",
"outside",
"walk",
"wife",
"leg shot out",
"past medical history",
"notable",
"diabetes",
"hypertension",
"myocardial infarction",
"years",
"smokes 1-2... |
A 23-year-old college student presents with his parents for a follow-up appointment. He was recently diagnosed with schizophrenia and was started on risperidone approx. 2 months ago. He reports a significant improvement since the start of treatment. His parents report that their son’s symptoms of delusions, hallucinati... | Akathisia | {
"A": "Akathisia",
"B": "Generalized anxiety disorder",
"C": "Restless legs syndrome",
"D": "Tardive dyskinesia"
} | step2&3 | A | [
"23 year old college student presents",
"parents",
"follow-up appointment",
"recently diagnosed",
"schizophrenia",
"started",
"risperidone",
"months",
"reports",
"significant improvement",
"start",
"treatment",
"parents report",
"sons symptoms",
"delusions",
"hallucinations",
"parano... |
A 53-year-old woman with type 2 diabetes mellitus is admitted for evaluation of recurrent episodes of nausea, tremors, and excessive sweating. She works as a nurse and reports self-measured blood glucose levels below 50 mg/dL on several occasions. Her family history is positive for borderline personality disorder. The ... | Ask the patient if she is taking any medications other than metformin | {
"A": "Ask the patient if she is taking any medications other than metformin",
"B": "Search the patient's belongings for insulin",
"C": "Measure glycated hemoglobin concentration",
"D": "Measure serum C-peptide concentration"
} | step1 | A | [
"year old woman",
"type 2 diabetes mellitus",
"admitted",
"evaluation of recurrent episodes",
"nausea",
"tremors",
"excessive sweating",
"works",
"nurse",
"reports self measured blood glucose levels",
"50 mg/dL",
"several occasions",
"family history",
"positive",
"borderline personality ... |
A 25-year old Caucasian female presents with symptoms of Graves' disease. Her doctor prescribes medications and sends the patient home. After two months of therapy, the patient returns upset that her exophthalmos has not gone away. Which of the following drugs should the physician have prescribed to treat the exophthal... | Corticosteroids | {
"A": "Propanolol",
"B": "Metropolol",
"C": "PTU",
"D": "Corticosteroids"
} | step1 | D | [
"year old Caucasian female presents",
"symptoms",
"Graves",
"disease",
"doctor",
"medications",
"sends",
"patient home",
"two months",
"therapy",
"patient returns upset",
"exophthalmos",
"not",
"following drugs",
"physician",
"prescribed to treat",
"exophthalmos"
] |
A 42-year-old woman is brought to the emergency department because of intermittent sharp right upper quadrant abdominal pain and nausea for the past 10 hours. She vomited three times. There is no associated fever, chills, diarrhea, or urinary symptoms. She has two children who both attend high school. She appears uncom... | Transabdominal ultrasonography | {
"A": "CT scan of the abdomen",
"B": "Transabdominal ultrasonography",
"C": "Endoscopic retrograde cholangiopancreatography",
"D": "HIDA scan of the biliary tract"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"intermittent sharp right upper quadrant abdominal pain",
"nausea",
"past 10 hours",
"vomited three times",
"associated fever",
"chills",
"diarrhea",
"urinary symptoms",
"two children",
"attend high school",
"appears",
"5 ft 5",
"tal... |
A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date... | MMR vaccine | {
"A": "MMR vaccine",
"B": "Rotavirus vaccine",
"C": "Meningococcal vaccine",
"D": "Gross motor workup and evaluation"
} | step2&3 | A | [
"month old girl",
"brought",
"pediatrician",
"checkup",
"vaccines",
"patients mother",
"to send",
"to daycare",
"worried",
"exposure",
"children",
"potential sources of infection",
"toddler",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"not walk... |
A 72-year-old patient is referred to an ophthalmologist because he has noticed some mild discomfort in his eyes though his vision remains unchanged. He cannot recall when this feeling started. His past medical history is significant for diabetes mellitus and two myocardial infarctions that have led to significant cardi... | It decreases intracellular cyclic AMP levels | {
"A": "It decreases intracellular cyclic AMP levels",
"B": "It increases intracellular calcium levels",
"C": "It increases adenylyl cyclase activity",
"D": "It is produced by cyclooxygenase"
} | step1 | A | [
"72 year old patient",
"referred",
"ophthalmologist",
"mild discomfort",
"eyes",
"vision",
"unchanged",
"recall",
"feeling started",
"past medical history",
"significant",
"diabetes mellitus",
"two myocardial infarctions",
"led",
"significant cardiac dysfunction",
"dyspnea",
"periphe... |
A baby is born after the 32nd gestational week by cesarean delivery. The mother suffered from gestational diabetes; however, she had no other pregnancy-related diseases and was otherwise healthy. The baby has a blood pressure of 100/58 mm Hg, heart rate of 104/min, and oxygen saturation of 88%. The child has tachypnea,... | Neonatal respiratory distress syndrome (NRDS) | {
"A": "Neonatal respiratory distress syndrome (NRDS)",
"B": "Tracheoesophageal fistula",
"C": "Pneumonia",
"D": "Congenital heart anomaly with right-to-left shunt"
} | step1 | A | [
"baby",
"born",
"gestational week",
"cesarean delivery",
"mother suffered",
"gestational diabetes",
"pregnancy diseases",
"healthy",
"baby",
"blood pressure",
"100 58 mm Hg",
"heart rate",
"min",
"oxygen",
"88",
"child",
"tachypnea",
"subcostal",
"intercostal retractions",
"nas... |
Eight days after sigmoid resection for acute diverticulitis, a 61-year-old man has left-sided flank pain. He has been on bowel rest since admission. Other than multiple admissions for alcohol withdrawal, he has no history of serious illness. Current medications include intravenous cefepime and morphine. His temperature... | Impaired activation of factor VII | {
"A": "Resistance of Factor V inactivation",
"B": "Impaired activation of factor VII",
"C": "Decreased synthesis of thrombopoietin",
"D": "Deficiency of folic acid"
} | step2&3 | B | [
"Eight days",
"sigmoid resection",
"acute diverticulitis",
"61 year old man",
"left sided flank pain",
"bowel rest",
"admission",
"Other",
"multiple admissions",
"alcohol withdrawal",
"history",
"serious illness",
"Current medications include intravenous cefepime",
"morphine",
"temperatu... |
An otherwise healthy 14-year-old girl is brought to the emergency room by her father because of excessive thirst, excessive urination, and weight loss. Her symptoms started acutely 5 days ago. Vital signs reveal a temperature of 36.6°C (97.8°F), blood pressure of 100/65 mm Hg, and pulse of 105/min. Physical examination... | Basal-bolus insulin | {
"A": "Metformin",
"B": "Glimepiride",
"C": "Intravenous fluids, insulin infusion, and correction of electrolytes",
"D": "Basal-bolus insulin"
} | step2&3 | D | [
"healthy",
"year old girl",
"brought",
"emergency room",
"father",
"excessive thirst",
"excessive urination",
"weight loss",
"symptoms started",
"days",
"Vital signs reveal",
"temperature",
"36",
"97",
"blood pressure",
"100 65 mm Hg",
"pulse",
"min",
"Physical examination shows"... |
An 8-year old boy is brought to the emergency department because he has been lethargic and has had several episodes of nausea and vomiting for the past day. He has also had increased thirst over the past two months. He has lost 5.4 kg (11.9 lbs) during this time. He is otherwise healthy and has no history of serious il... | Intravenous hydration with 0.9% normal saline and insulin | {
"A": "Intravenous hydration with 0.9% normal saline and insulin",
"B": "Intravenous hydration with 5% dextrose solution and 0.45% normal saline",
"C": "Intravenous hydration with 0.9% normal saline and potassium chloride",
"D": "Intravenous sodium bicarbonate\n\""
} | step2&3 | A | [
"year old boy",
"brought",
"emergency department",
"lethargic",
"several episodes of nausea",
"vomiting",
"past day",
"increased thirst",
"past two months",
"lost 5.4 kg",
"lbs",
"time",
"healthy",
"history",
"serious illness",
"temperature",
"99.5 F",
"blood pressure",
"95 68 mm... |
A 27-year-old woman presents with a history of repeated episodes of discoloration of the fingers over the last 3 years. She mentions that the episodes are usually triggered by exposure to cold, which leads to a sequential white, blue, and red discoloration of her fingers, followed by resolution of the symptoms. During ... | Bilateral symmetrical involvement of the extremities | {
"A": "Calcinosis on the dorsal surface of the forearm",
"B": "Generalized pruritus",
"C": "Telangiectasia over face",
"D": "Bilateral symmetrical involvement of the extremities"
} | step1 | D | [
"27 year old woman presents",
"history of repeated episodes",
"discoloration",
"fingers",
"last",
"years",
"episodes",
"usually triggered by exposure",
"cold",
"leads",
"sequential white",
"blue",
"red discoloration",
"fingers",
"followed by resolution",
"symptoms",
"episode",
"exp... |
A 4-month-old boy is brought to the physician by his parents for a well-child examination. He has cystic fibrosis diagnosed by newborn screening. His parents report frequent feedings and large-volume and greasy stools. His 4-year-old brother has autism. Current medications include bronchodilators, pancreatic enzyme sup... | History of intussusception | {
"A": "Fever of 38.2°C (100.7°F) following previous vaccinations",
"B": "History of cystic fibrosis",
"C": "History of febrile seizures",
"D": "History of intussusception"
} | step2&3 | D | [
"4 month old boy",
"brought",
"physician",
"parents",
"well",
"cystic fibrosis diagnosed",
"newborn screening",
"parents report frequent feedings",
"large volume",
"greasy stools",
"4 year old brother",
"autism",
"Current medications include bronchodilators",
"pancreatic enzyme supplements... |
A 50-year-old woman comes to the physician because of blisters on her forearm that appeared 3 days ago. She also reports pain in her left cheek when eating and pain during sexual intercourse for the past week. She has not been sick for the past 6 months. She has started hiking in the woods on the weekends with her son ... | Pemphigus vulgaris | {
"A": "Lichen planus",
"B": "Dermatitis herpetiformis",
"C": "Bullous pemphigoid",
"D": "Pemphigus vulgaris"
} | step2&3 | D | [
"50 year old woman",
"physician",
"of blisters",
"forearm",
"appeared 3 days",
"reports pain in",
"left cheek",
"eating",
"pain",
"sexual intercourse",
"past week",
"not",
"sick",
"past 6 months",
"started hiking",
"woods",
"weekends",
"son",
"couple months",
"careful to",
"p... |
A 30-year-old man presents to his primary care physician for pain in his left ankle. The patient states that he was at karate practice when he suddenly felt severe pain in his ankle forcing him to stop. The patient has a past medical history notable for type I diabetes and is currently being treated for an episode of a... | Change antibiotics and refrain from athletic activities | {
"A": "Change antibiotics and refrain from athletic activities",
"B": "Ibuprofen and rest",
"C": "Orthopedic ankle brace",
"D": "Rehabilitation exercises and activity as tolerated"
} | step2&3 | A | [
"30 year old man presents",
"primary care physician",
"pain in",
"left ankle",
"patient states",
"karate practice",
"felt severe pain in",
"ankle forcing",
"to stop",
"patient",
"past medical history notable",
"type I diabetes",
"currently",
"treated",
"episode of acute bacterial sinusit... |
An investigator is studying the replication of a virus in denucleated embryonic fibroblasts. After the fibroblasts are infected with the virus, viral proteins are directly translated from the virion's genetic material using fibroblast ribosomes. The resultant large polypeptides are then cleaved into smaller peptides by... | Coxsackievirus | {
"A": "Parvovirus",
"B": "Molluscum contagiosum virus",
"C": "Measles virus",
"D": "Coxsackievirus"
} | step1 | D | [
"investigator",
"studying",
"replication",
"virus",
"embryonic fibroblasts",
"fibroblasts",
"infected",
"virus",
"viral proteins",
"directly translated",
"virion's genetic material using fibroblast ribosomes",
"large polypeptides",
"then cleaved",
"smaller peptides",
"viral proteases to"... |
A 35-year-old man with a past medical history of HIV is hospitalized with a disseminated zoster infection and treated with IV acyclovir. His course of illness worsens on the 4th day after admission and his creatinine level increases to 4.2 mg/dL. Urinalysis shows birefringent needle-shaped crystals. What could have pre... | Adequate initial hydration | {
"A": "Initial administration of glucocorticoids",
"B": "Obtaining a thorough history of patient allergies",
"C": "Adequate initial hydration",
"D": "Initial administration of allopurinol"
} | step1 | C | [
"35 year old man",
"past medical HIV",
"hospitalized",
"disseminated zoster infection",
"treated with IV acyclovir",
"course of illness worsens",
"4th day",
"admission",
"creatinine level increases",
"2 dL",
"Urinalysis shows birefringent needle-shaped crystals",
"prevented",
"deterioration"... |
A 81-year-old man presents to his primary care physician with a 4-month history of shortness of breath. He says that he has slowly lost the ability to do things due to fatigue and now gets winded after walking around the house. He also says that his cough has been getting worse and seems to be producing more sputum. He... | Cardiomegaly and increased bronchial markings | {
"A": "Calcified pleural plaques surrounding the diaphragm",
"B": "Cardiomegaly and increased bronchial markings",
"C": "Hyperinflated lungs and loss of lung markings",
"D": "Perihilar mass with unilateral hilar enlargement"
} | step1 | B | [
"81 year old man presents",
"primary care physician",
"4 month history of shortness",
"breath",
"slowly lost",
"ability to",
"things due",
"fatigue",
"now gets winded",
"walking",
"house",
"cough",
"getting worse",
"to",
"more sputum",
"gained",
"pounds",
"last",
"months",
"pas... |
A 72-year-old man presents to his primary care physician because he feels like his vision has been changing over the last 6 months. In particular, he feels that he cannot see as well out of his right eye as previously. His past medical history is significant for myocardial infarction as well as Lyme disease. On present... | Pancoast tumor | {
"A": "Drug use",
"B": "Facial nerve damage",
"C": "Pancoast tumor",
"D": "Syphilis"
} | step1 | C | [
"72 year old man presents",
"primary care physician",
"feels",
"vision",
"changing",
"months",
"feels",
"see",
"well",
"right eye",
"past medical history",
"significant",
"myocardial infarction",
"Lyme disease",
"presentation",
"found to",
"droopy right eyelid",
"persistent constri... |
A 5-year-old boy is brought to the emergency department after he fell on the playground in kindergarten and was unable to get up. His right leg was found to be bent abnormally at the femur, and he was splinted on site by first responders. His past medical history is significant for multiple prior fractures in his left ... | Increased adenylyl cyclase activity | {
"A": "Decreased collagen hydroxylation",
"B": "Increased adenylyl cyclase activity",
"C": "Mutation in neurofibromin",
"D": "Non-accidental trauma"
} | step1 | B | [
"5 year old boy",
"brought",
"emergency department",
"fell",
"playground",
"kindergarten",
"unable to get",
"right leg",
"found to",
"bent",
"femur",
"splinted on site",
"first responders",
"past medical history",
"significant",
"multiple prior fractures",
"left humerus",
"femur",
... |
A 32-year-old woman is brought to the emergency department after she started convulsing in the office. She has no previous history of seizures and recovers by the time she arrives at the emergency department. She says that over the last 2 days she has also experienced insomnia, abdominal pain, and dark urine. Her past ... | Porphobilinogen deaminase | {
"A": "Aminolevulinate synthase",
"B": "Ferrochelatase",
"C": "Porphobilinogen deaminase",
"D": "Uroporphyrinogen decarboxylase"
} | step1 | C | [
"year old woman",
"brought",
"emergency department",
"started convulsing",
"office",
"previous history",
"seizures",
"recovers",
"time",
"emergency department",
"last 2 days",
"insomnia",
"abdominal pain",
"dark urine",
"past medical history",
"significant",
"asthma",
"not experien... |
A 3-year-old is brought to the pediatrician by his mother because she is concerned about recent changes to his behavior. She states that he has seemed to regress in his motor development and has been having occasional brief episodes of uncontrollable shaking. During the subsequent work up, a muscle biopsy is obtained w... | There is a 100% he will be affected, but the severity may be different | {
"A": "There is a 100% he will be affected, but the severity may be different",
"B": "He will be unaffected",
"C": "There is a 100% he will be affected, and the severity will be the same",
"D": "There is a 50% chance he will be affected"
} | step1 | A | [
"3 year old",
"brought",
"pediatrician",
"mother",
"concerned",
"recent changes",
"behavior",
"states",
"to regress",
"motor development",
"occasional brief episodes of",
"shaking",
"subsequent work up",
"muscle biopsy",
"obtained",
"demonstrates red",
"fibers",
"presumptive diagno... |
A group of researchers studying the relationship between major depressive disorder and unprovoked seizures identified 36 patients via chart review who had been rehospitalized for unprovoked seizures following discharge from an inpatient psychiatric unit and 105 patients recently discharged from the same unit who did no... | 2.5 | {
"A": "0.36",
"B": "1.95",
"C": "2.5",
"D": "0.17"
} | step1 | C | [
"A group",
"researchers studying",
"relationship",
"major depressive disorder",
"seizures identified 36 patients",
"chart review",
"seizures following discharge",
"inpatient",
"patients recently discharged",
"same unit",
"not experience",
"seizures",
"results",
"study show",
"seizure",
... |
A 56-year-old man of Nepalese origin presents to a clinic complaining of skin rashes that have been troubling him for years. On examination, there are numerous poorly demarcated skin lesions present on all parts of the body. There is also evidence of significant facial thickening, eyebrow loss, and symmetrical sensory ... | Dapsone | {
"A": "Dapsone",
"B": "Flucloxacillin",
"C": "Isoniazid",
"D": "Prednisone"
} | step1 | A | [
"year old man",
"Nepalese origin presents",
"a clinic complaining of skin rashes",
"years",
"examination",
"numerous poorly demarcated skin lesions present",
"parts",
"body",
"evidence",
"significant facial thickening",
"eyebrow loss",
"symmetrical sensory neuropathy",
"glove",
"stocking d... |
A 16-year-old girl comes to the physician because of episodic lower abdominal pain for 5 months. The pain starts to occur a few hours before her menses and lasts for 2–3 days. Ibuprofen helped reduce the pain in the first months but has no effect now. She has missed a couple of days at school because of severe pain. Me... | Oral contraceptive pill | {
"A": "Diagnostic laparoscopy",
"B": "Ceftriaxone and doxycycline therapy",
"C": "Oral contraceptive pill",
"D": "Urinalysis"
} | step2&3 | C | [
"year old girl",
"physician",
"episodic lower abdominal pain",
"months",
"pain starts to occur",
"few hours",
"menses",
"lasts",
"23 days",
"Ibuprofen helped",
"pain",
"first months",
"no effect now",
"missed",
"couple",
"days",
"school",
"severe pain",
"Menarche",
"age",
"ye... |
A medical examiner was called to investigate the death of a 75-year-old type 1 diabetic Caucasian male who was a retired physician. His caretaker discovered his body in the bedroom with an empty syringe and a small bottle of lispro lying on the nightstand. She explains that his wife of 50 years passed away six months a... | Glucose: 25 mg/dL, high insulin and absent C-peptide levels | {
"A": "Glucose: 25 mg/dL, high insulin and high C-peptide levels",
"B": "Glucose: 25 mg/dL, high insulin and absent C-peptide levels",
"C": "Glucose: 95 mg/dL, low insulin and low C-peptide levels",
"D": "Glucose: 95 mg/dL, high insulin and C-peptide levels"
} | step1 | B | [
"medical examiner",
"called to investigate",
"death",
"75 year old type 1 diabetic Caucasian male",
"retired physician",
"caretaker discovered",
"body",
"bedroom",
"empty syringe",
"small bottle",
"lispro lying",
"wife",
"50 years passed",
"six months",
"children",
"family",
"extreme... |
A 52-year-old woman makes a follow-up appointment with her primary care physician for evaluation of her diabetes medications. Specifically, she complains that she has been experiencing flushing, nausea, and palpitations after drinking a glass of wine with dinner after she started the latest regimen for her diabetes. Sh... | Weight gain | {
"A": "Hepatotoxicity",
"B": "Lactic acidosis",
"C": "Urinary tract infection",
"D": "Weight gain"
} | step1 | D | [
"year old woman makes",
"follow-up appointment",
"primary care physician",
"evaluation",
"diabetes medications",
"experiencing flushing",
"nausea",
"palpitations",
"drinking",
"glass",
"wine",
"dinner",
"started",
"latest regimen",
"diabetes",
"warned",
"side-effect",
"one",
"med... |
A 3-year-old girl is brought to the physician by her mother two days after the sudden onset of a rash. The mother says that the rash developed an hour after she bathed the child in lukewarm water. Two weeks ago, the patient was diagnosed with a skin infection and was treated with penicillin V. She has been otherwise he... | Multiple injuries in different stages of healing | {
"A": "Multiple injuries in different stages of healing",
"B": "Positive Nikolsky's sign",
"C": "Malar rash with sparing of the nasolabial folds",
"D": "Ulcers of the oral mucosa\n\""
} | step2&3 | A | [
"3 year old girl",
"brought",
"physician",
"mother two days",
"sudden onset",
"rash",
"mother",
"rash",
"hour",
"bathed",
"child",
"water",
"Two weeks",
"patient",
"diagnosed",
"skin infection",
"treated with penicillin V",
"healthy",
"missed",
"well-child examinations",
"liv... |
An 2-year-old girl with a history of SS-hemoglobin is brought to her pediatrician by her mother, who noted an abdominal mass. On exam, the girl's spleen is palpably enlarged, and her palms and conjunctiva are noted to be extremely pale. Serum haptoglobin levels are normal. Which of the following is the most likely caus... | Extravascular hemolysis | {
"A": "Decreased red blood cell production",
"B": "Extravascular hemolysis",
"C": "Complement-mediated hemolysis",
"D": "Hemolytic uremic syndrome"
} | step2&3 | B | [
"2 year old girl",
"a history",
"SS hemoglobin",
"brought",
"pediatrician",
"mother",
"noted",
"abdominal mass",
"exam",
"girl's spleen",
"enlarged",
"palms",
"conjunctiva",
"noted to",
"extremely pale",
"Serum haptoglobin levels",
"normal",
"following",
"most likely cause",
"p... |
A 19-year-old woman comes to the physician because of a delayed menstrual period. She has had regular menses since menarche at age 11. Her last menstrual period was 7 weeks ago. She is sexually active with two male partners. A urine pregnancy test is positive. An ultrasound of the pelvis shows a viable intrauterine pre... | Blockage of progesterone receptor | {
"A": "Inhibition of dihydrofolate reductase",
"B": "Blockage of progesterone receptor",
"C": "Activation of prostaglandin E1 receptors",
"D": "Agonist at oxytocin receptors"
} | step1 | B | [
"year old woman",
"physician",
"delayed menstrual",
"regular menses",
"menarche at age",
"last menstrual period",
"weeks",
"sexually active",
"two male partners",
"urine pregnancy test",
"positive",
"ultrasound",
"pelvis shows",
"viable intrauterine pregnancy",
"estimated gestational age... |
A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his med... | Reassurance | {
"A": "Cystourethroscopy",
"B": "Transrectal prostate biopsy",
"C": "Reassurance",
"D": "Repeat PSA test"
} | step2&3 | C | [
"97 year old man visits",
"urology clinic 5 days",
"experiencing urinary retention",
"emergency visit",
"patient",
"history of hypertension",
"type II diabetes mellitus",
"stroke",
"dyslipidemia",
"past myocardial infarction",
"severe osteoarthritis",
"right",
"not compliant",
"medications... |
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