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 4-year-old boy is brought to the pediatrician by his mother who is concerned about progressive leg weakness. His mother reports that the patient used to play outside with their neighbors for hours, but for the past few months she has seen him sitting on the sidewalk after 15 minutes because he’s too tired. The patien... | Genetic testing | {
"A": "Acetylcholine receptor antibody level",
"B": "Creatine kinase level",
"C": "Genetic testing",
"D": "Nerve conduction study"
} | step2&3 | C | [
"4 year old boy",
"brought",
"pediatrician",
"mother",
"concerned",
"progressive leg weakness",
"mother reports",
"patient used to play outside",
"neighbors",
"hours",
"past",
"months",
"seen",
"sitting",
"sidewalk",
"15 minutes",
"tired",
"patient",
"legs",
"sleepy",
"patien... |
A 22-year-old female is brought to the emergency department by her friends. She was supposed to attend her first job interview in a few hours when she started having palpitations. Her past medical history is insignificant, and she currently takes no medications. Her vitals show the following: pulse rate is 90/min, resp... | 18 mm Hg | {
"A": "18 mm Hg",
"B": "27 mm Hg",
"C": "36 mm Hg",
"D": "44 mm Hg"
} | step1 | A | [
"year old female",
"brought",
"emergency department",
"friends",
"to attend",
"first job interview",
"hours",
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"palpitations",
"past medical history",
"currently takes",
"medications",
"show",
"following",
"pulse rate",
"90 min",
"respiratory rate",
"min",
"blood pressu... |
A 68-year-old man with hypertension comes to the physician because of fatigue and difficulty initiating urination. He wakes up several times a night to urinate. He does not take any medications. His blood pressure is 166/82 mm Hg. Digital rectal examination shows a firm, non-tender, and uniformly enlarged prostate. Whi... | Terazosin | {
"A": "Phenoxybenzamine",
"B": "Tamsulosin",
"C": "Terazosin",
"D": "α-Methyldopa"
} | step1 | C | [
"68 year old man",
"hypertension",
"physician",
"fatigue",
"difficulty initiating urination",
"wakes up",
"times",
"night to",
"not take",
"medications",
"blood pressure",
"mm Hg",
"Digital rectal examination shows",
"firm",
"non-tender",
"enlarged prostate",
"following",
"most app... |
A 51-year-old woman comes to the physician because of numbness of her legs and toes for 3 months. She has also had fatigue and occasional shortness of breath for the past 5 months. She is a painter. Examination shows pale conjunctivae. Sensation to vibration and position is absent over the lower extremities. She has a ... | Elevated methylmalonic acid levels
" | {
"A": "Poliovirus RNA in cerebrospinal fluid",
"B": "Oligoclonal bands in cerebrospinal fluid",
"C": "Positive rapid plasma reagin test",
"D": "Elevated methylmalonic acid levels\n\""
} | step1 | D | [
"year old woman",
"physician",
"numbness",
"legs",
"toes",
"months",
"fatigue",
"occasional shortness of breath",
"past",
"months",
"painter",
"Examination shows pale conjunctivae",
"Sensation",
"vibration",
"position",
"absent",
"lower extremities",
"broad-based gait",
"patient"... |
A 38-year-old woman makes an appointment with her family physician for a routine check-up after being away due to travel for 1 year. She recently had a screening Pap smear, which was negative for malignancy. Her past medical history is significant for a Pap smear 2 years ago that reported a low-grade squamous intraepit... | HPV 6 | {
"A": "HPV 18",
"B": "HPV 6",
"C": "HPV 31",
"D": "HPV 16"
} | step1 | B | [
"year old woman makes",
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"routine check-up",
"due to travel",
"1 year",
"recently",
"screening Pap smear",
"negative",
"malignancy",
"past medical history",
"significant",
"a Pap smear",
"years",
"reported",
"low-grade squamous intraepithelial lesion",... |
A 19-year-old collegiate football player sustains an injury to his left knee during a game. He was running with the ball when he dodged a defensive player and fell, twisting his left knee. He felt a “pop” as he fell. When he attempts to bear weight on his left knee, it feels unstable, and "gives way." He needs assistan... | Posteromedial aspect of the lateral femoral condyle | {
"A": "Lateral aspect of the lateral femoral condyle",
"B": "Medial aspect of the medial femoral condyle",
"C": "Posteromedial aspect of the lateral femoral condyle",
"D": "Tibial tubercle"
} | step1 | C | [
"year old collegiate football",
"sustains",
"injury",
"left knee",
"game",
"running",
"ball",
"defensive",
"fell",
"twisting",
"left knee",
"felt",
"fell",
"attempts to bear weight",
"left knee",
"feels unstable",
"gives",
"needs assistance to walk",
"field",
"pain",
"localiz... |
A 65-year-old woman is brought to the emergency department by her husband due to difficulty speaking and confusion for 1 hour. She was gardening when she suddenly developed these symptoms. She is not able to respond to the questions despite multiple repetitions. She also appears unsteady with her gait and is able to wa... | CT scan of the head | {
"A": "Aspirin",
"B": "CT scan of the head",
"C": "Echocardiography",
"D": "MRI of the head"
} | step2&3 | B | [
"65 year old woman",
"brought",
"emergency department",
"husband due to difficulty speaking",
"confusion",
"hour",
"gardening",
"symptoms",
"not able to",
"questions",
"multiple repetitions",
"appears unsteady",
"gait",
"able to walk",
"support",
"past medical history includes type 2 d... |
A 45-year-old man presents to the physician with a complaint of recurrent chest pain for the last 2 weeks. He mentions that the pain is not present at rest, but when he walks for some distance, he feels pain like a pressure over the retrosternal region. The pain disappears within a few minutes of stopping the physical ... | Chlamydophila pneumoniae | {
"A": "Chlamydophila pneumoniae",
"B": "Legionella pneumophilia",
"C": "Mycoplasma pneumoniae",
"D": "Rickettsia rickettsii"
} | step1 | A | [
"year old man presents",
"physician",
"complaint of recurrent",
"last",
"weeks",
"pain",
"not present",
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"walks",
"distance",
"feels pain",
"pressure",
"retrosternal region",
"pain",
"minutes",
"stopping",
"physical activity",
"healthy man",
"known medical disorder",
"no... |
An investigator is studying cellular repair mechanisms in various tissues. One of the samples being reviewed is from the anterior horn of the spinal cord of a patient who was involved in a snowboard accident. Pathologic examination of the biopsy specimen shows dispersion of the Nissl bodies, swelling of the neuronal bo... | Central chromatolysis | {
"A": "Neurodegenerative changes",
"B": "Central chromatolysis",
"C": "Reactive astrogliosis",
"D": "Neuronal aging"
} | step1 | B | [
"investigator",
"studying cellular repair mechanisms",
"various tissues",
"One",
"samples",
"reviewed",
"anterior horn",
"spinal cord",
"patient",
"involved",
"snowboard accident",
"Pathologic examination",
"biopsy specimen shows dispersion",
"Nissl bodies",
"swelling",
"neuronal body"... |
Fertilization begins when sperm binds to the corona radiata of the egg. Once the sperm enters the cytoplasm, a cortical reaction occurs which prevents other sperm from entering the oocyte. The oocyte then undergoes an important reaction. What is the next reaction that is necessary for fertilization to continue? | The second meiotic division | {
"A": "Release of a polar body",
"B": "Degeneration of the sperm tail",
"C": "Acrosome reaction",
"D": "The second meiotic division"
} | step1 | D | [
"Fertilization begins",
"sperm binds",
"corona radiata",
"egg",
"sperm enters",
"cytoplasm",
"cortical reaction occurs",
"prevents",
"sperm",
"entering",
"oocyte",
"oocyte then",
"important reaction",
"next reaction",
"fertilization to continue"
] |
A 67-year-old man presents to his primary care provider with bloody urine. He first noticed the blood 1 week ago. He otherwise feels healthy. His past medical history is significant for type 2 diabetes mellitus for 18 years, for which he takes insulin injections. He has smoked 30–40 cigarettes per day for the past 29 y... | Contrast-enhanced CT | {
"A": "Urine cytology",
"B": "Contrast-enhanced CT",
"C": "Prostate-specific antigen",
"D": "Urinary markers"
} | step2&3 | B | [
"67 year old man presents",
"primary care provider",
"bloody urine",
"first",
"blood",
"week",
"feels healthy",
"past medical history",
"significant",
"type 2 diabetes mellitus",
"years",
"takes insulin injections",
"smoked",
"cigarettes",
"day",
"past 29 years",
"drinks alcohol",
... |
A previously healthy 19-year-old woman comes to the physician because of vaginal discharge for 3 days. She describes the discharge as yellow and mucopurulent with a foul odor. She has also noticed vaginal bleeding after sexual activity. She has not had any itching or irritation. Her last menstrual period was 2 weeks ag... | Nucleic acid amplification test
" | {
"A": "Gram stain of cervical swab",
"B": "Colposcopy",
"C": "Pap smear",
"D": "Nucleic acid amplification test\n\""
} | step2&3 | D | [
"healthy",
"year old woman",
"physician",
"of vaginal discharge",
"3 days",
"discharge",
"yellow",
"mucopurulent",
"foul odor",
"vaginal bleeding",
"sexual activity",
"not",
"itching",
"irritation",
"last menstrual period",
"2 weeks",
"sexually active",
"one male partner",
"use c... |
A 35-year-old man with no past medical history presents to his primary care physician with complaints of fatigue. He states that his life has been hectic lately and that everything seems to be falling apart. He is scared that he will lose his job, that his wife will leave him, and that his children will not be able to ... | Escitalopram | {
"A": "Escitalopram",
"B": "Diazepam",
"C": "Risperidone",
"D": "No treatment recommended"
} | step1 | A | [
"35 year old man",
"past medical history presents",
"primary care physician",
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"states",
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"wife",
"leave",
"children",
"not",
"able",
"to go",
"college",
"worries",
"severe",
"began to interfere",
"daily activ... |
A 34-year-old man comes to the physician because of blurry vision and fatigue for 2 months. During this period, he has also had occasional bleeding from his gums after brushing his teeth. One month ago, he was diagnosed with deep vein thrombosis after returning from an overseas business meeting. His pulse is 118/min, r... | Nonreceptor tyrosine kinase | {
"A": "Cytokine receptor",
"B": "Antiapoptotic molecule",
"C": "Nonreceptor tyrosine kinase",
"D": "Serine/threonine kinase"
} | step1 | C | [
"year old man",
"physician",
"blurry vision",
"fatigue",
"months",
"period",
"occasional bleeding",
"gums",
"brushing",
"teeth",
"One month",
"diagnosed",
"deep vein thrombosis",
"returning",
"business meeting",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg"... |
A 23-year-old woman is brought to the emergency department by emergency medical services. She was found trying to hang herself in her kitchen. The patient has a past medical history of drug abuse, alcoholism, anxiety, mania, irritable bowel syndrome, and hypertension. Her current medications include naltrexone, sodium ... | Lamotrigine | {
"A": "Haloperidol",
"B": "Lamotrigine",
"C": "Fluoxetine",
"D": "Diazepam"
} | step2&3 | B | [
"23 year old woman",
"brought",
"emergency department",
"emergency medical services",
"found",
"hang",
"kitchen",
"patient",
"past medical history of drug abuse",
"alcoholism",
"anxiety",
"mania",
"irritable bowel syndrome",
"hypertension",
"current medications include naltrexone",
"so... |
A 6-year-old girl is brought to the physician because of a 4-day history of irritation and redness in both eyes. Her symptoms initially started in the left eye and progressed to involve both eyes within 24 hours. She presents with profuse tearing and reports that her eyes are sticky and difficult to open in the morning... | Supportive therapy | {
"A": "Supportive therapy",
"B": "Topical prednisolone acetate",
"C": "Topical natamycin",
"D": "Topical erythromycin"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"4-day history",
"irritation",
"redness",
"eyes",
"symptoms initially started",
"left eye",
"progressed to",
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"24 hours",
"presents",
"tearing",
"reports",
"eyes",
"difficult to open",
"morning",
"diagnosed",
"asthma",
"years",
... |
A 55-year-old woman comes to the physician because of a 4-month history of a painless lump on her neck. Examination shows a hard nodule on the left side of her neck. A fine-needle aspiration biopsy shows well-differentiated cuboidal cells arranged spherically around colloid. She undergoes thyroidectomy. Histopathologic... | PAX8-PPAR gamma gene rearrangement | {
"A": "Activation mutation in the BRAF gene",
"B": "p53 tumor suppressor gene inactivation",
"C": "Mutation in the RET proto-oncogene",
"D": "PAX8-PPAR gamma gene rearrangement"
} | step1 | D | [
"55 year old woman",
"physician",
"4 month history",
"painless lump",
"neck",
"Examination shows",
"hard nodule",
"left side of",
"neck",
"fine-needle aspiration biopsy shows well-differentiated cuboidal cells arranged",
"colloid",
"thyroidectomy",
"Histopathological examination",
"surgica... |
A 61-year-old man sustains an intracranial injury to a nerve that also passes through the parotid gland. Which of the following is a possible consequence of this injury? | Changes in hearing | {
"A": "Loss of taste from posterior 1/3 of tongue",
"B": "Loss of general sensation in anterior 2/3 of tongue",
"C": "Paralysis of lateral rectus muscle",
"D": "Changes in hearing"
} | step1 | D | [
"61 year old man sustains",
"intracranial injury to",
"nerve",
"passes",
"parotid gland",
"following",
"possible consequence of",
"injury"
] |
A 10-month-old boy is admitted to the pediatric intensive care ward because of progressive dyspnea and fever. For the past 2 weeks, he was unsuccessfully treated for an upper respiratory tract infection with ampicillin. He has a history of neonatal sepsis, frequent respiratory tract infections since the age of 3 months... | Bone marrow transplantation | {
"A": "Periodical prophylactic antibiotic administration",
"B": "Periodical intravenous immune globulin administration",
"C": "Bone marrow transplantation",
"D": "Chemotherapy"
} | step1 | C | [
"A 10 month old boy",
"admitted",
"pediatric intensive care ward",
"progressive dyspnea",
"fever",
"past 2 weeks",
"treated",
"upper respiratory tract infection",
"ampicillin",
"history of neonatal sepsis",
"frequent infections",
"age",
"months",
"recurrent otitis media",
"born full-term... |
A 50-year-old man arrives to the clinic complaining of progressive weakness. He explains that for 3 months he has had difficulty climbing the stairs, which has now progressed to difficulty getting out of a chair. He denies diplopia, dysphagia, dyspnea, muscle aches, or joint pains. He denies weight loss, weight gain, c... | Muscle biopsy | {
"A": "Autoantibodies",
"B": "Electromyography",
"C": "Muscle biopsy",
"D": "Statin cessation"
} | step2&3 | C | [
"50 year old man",
"clinic",
"progressive weakness",
"3 months",
"difficulty climbing",
"stairs",
"now progressed",
"difficulty getting",
"chair",
"denies diplopia",
"dysphagia",
"dyspnea",
"muscle aches",
"joint pains",
"denies weight loss",
"weight gain",
"change in appetite",
"h... |
A 40-year-old man presents with an episode of rectal bleeding. He is concerned because his mother died of colorectal cancer at 50 years of age. He has no further information about his family history. Physical examination and digital rectal examination are normal. He undergoes a colonoscopy and is found to have innumera... | Mutations of the APC gene | {
"A": "Mutation in DNA mismatch repair genes",
"B": "Mutations of the APC gene",
"C": "Inactivation of RB1 gene",
"D": "Inactivation of BRCA1 and BRCA2 genes"
} | step2&3 | B | [
"40 year old man presents",
"episode of rectal bleeding",
"concerned",
"mother died",
"colorectal cancer",
"50 years",
"age",
"further information",
"family history",
"Physical examination",
"digital rectal examination",
"normal",
"colonoscopy",
"found to",
"adenomas",
"the left side o... |
A 28-year-old man presents to his physician with a history of excessive thirst and excessive urination over the last 3 weeks. He mentions that he has to wake up multiple times at night to urinate. A detailed history reveals that he has a known case of bipolar mood disorder and has been taking lithium carbonate for 5 ye... | Image 2 | {
"A": "Image 1",
"B": "Image 2",
"C": "Image 4",
"D": "IMage 5"
} | step1 | B | [
"year old man presents",
"physician",
"history",
"excessive thirst",
"excessive urination",
"weeks",
"to wake up multiple times",
"night to",
"detailed history reveals",
"known case",
"bipolar mood disorder",
"taking lithium carbonate",
"5 years",
"urinary specific gravity",
"1",
"urin... |
An 8-year-old African American girl is brought to the clinic by her mother for her regular blood exchange. They come in every 2–3 months for the procedure. The child is in good health with no symptoms. Her last trip to the emergency department was 6 months ago due to bone pain. She was treated with morphine and oxygen ... | Amino acid substitution | {
"A": "Amino acid deletion",
"B": "Amino acid substitution",
"C": "Trinucleotide repeat",
"D": "Nonsense mutation"
} | step1 | B | [
"year old African American girl",
"brought",
"clinic",
"mother",
"regular blood exchange",
"23 months",
"procedure",
"child",
"good health",
"symptoms",
"last trip",
"emergency department",
"months",
"due to bone pain",
"treated with morphine",
"oxygen",
"blood transfusion",
"takes... |
A 75-year-old woman presents to the emergency department because of a brief loss of consciousness, slurred speech, and facial numbness. Family members report that she complained about feeling chest pain and shortness of breath while on her morning walk. Medical history is noncontributory. Physical examination shows dec... | Mitral valve obstruction | {
"A": "Atrioventricular block",
"B": "Congestive heart failure",
"C": "Mitral valve obstruction",
"D": "Pericarditis"
} | step1 | C | [
"75 year old woman presents",
"emergency department",
"of",
"brief loss",
"consciousness",
"slurred speech",
"facial numbness",
"Family members report",
"about feeling chest pain",
"shortness of breath",
"morning walk",
"Medical history",
"Physical examination shows decreased pupil reactivit... |
A 40-year-old man presents to the office with complaints of fatigue and difficulty breathing for the past few weeks. He also complains of early morning stiffness of his metatarsophalangeal and metacarpophalangeal joints on both sides that lasts for 2 hours. He feels better only after a warm water tub bath every day in ... | Anti-CCP | {
"A": "Anti-CCP",
"B": "Anti-Scl 70",
"C": "Anti-Ro",
"D": "Anti-Jo1"
} | step1 | A | [
"40 year old man presents",
"office",
"complaints",
"fatigue",
"difficulty breathing",
"past",
"weeks",
"early morning stiffness",
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"sides",
"lasts",
"hours",
"feels better only",
"warm water tub bath",
"day",
"morning",
"denies",
"kind",
"rash",
"b... |
A 29-year-old man presents to clinic with a complaint of fatigue that has developed over the past 6 months. Upon questioning, he endorses abdominal pain, non-bloody diarrhea, and decreased appetite over the past year. He denies recent travel outside of the country or eating uncooked meats. On exam, his temperature is 9... | Kidney stones | {
"A": "Colorectal cancer",
"B": "Endocarditis",
"C": "Hemolytic anemia",
"D": "Kidney stones"
} | step1 | D | [
"29 year old man presents",
"clinic",
"complaint",
"fatigue",
"past 6 months",
"questioning",
"abdominal pain",
"non bloody diarrhea",
"decreased appetite",
"past year",
"denies recent travel outside",
"country",
"eating",
"meats",
"exam",
"temperature",
"99",
"blood pressure",
"... |
A 37-year-old male presents to your clinic with shortness of breath and lower extremity edema. He was born in Southeast Asia and emigrated to America ten years prior. Examination demonstrates 2+ pitting edema to the level of his knees, ascites, and bibasilar crackles, as well as an opening snap followed by a mid-to-lat... | Normal or decreased left ventricular end diastolic pressure (LVEDP) | {
"A": "Decreased pulmonary artery systolic pressure (PASP)",
"B": "Increased left ventricular end diastolic pressure (LVEDP)",
"C": "Normal or decreased left ventricular end diastolic pressure (LVEDP)",
"D": "Decreased transmitral gradient"
} | step1 | C | [
"year old male presents",
"clinic",
"shortness of breath",
"lower extremity edema",
"born",
"Southeast Asia",
"to America ten years prior",
"Examination demonstrates 2",
"pitting",
"level of",
"knees",
"ascites",
"crackles",
"opening snap followed by",
"late diastolic murmur",
"patient... |
A 67-year-old man comes to the physician for a follow-up examination after he was diagnosed with mantle cell lymphoma. The physician recommends a chemotherapeutic regimen containing bortezomib. Which of the following best describes the effect of this drug? | Accumulation of ubiquitinated proteins | {
"A": "Stabilization of tubulin polymers",
"B": "Accumulation of ubiquitinated proteins",
"C": "Preventing the relaxation of DNA supercoils",
"D": "Inhibition of tyrosine kinase receptors"
} | step1 | B | [
"67 year old man",
"physician",
"follow-up examination",
"diagnosed",
"mantle cell lymphoma",
"physician recommends",
"chemotherapeutic regimen containing bortezomib",
"following best",
"effect of",
"drug"
] |
A 57-year-old man presents for his yearly wellness visit. He says he has been feeling well and has no complaints. No significant past medical history or current medications. The patient reports a 35-pack-year smoking history but says he quit 5 years ago. His family history is significant for lung cancer in his father w... | Low-dose CT scan (LDCT) of the chest | {
"A": "Chest X-ray",
"B": "ECG",
"C": "Low-dose CT scan (LDCT) of the chest",
"D": "No screening indicated"
} | step2&3 | C | [
"57 year old man presents",
"yearly wellness visit",
"feeling well",
"complaints",
"significant past medical history",
"current medications",
"patient reports",
"35 pack-year smoking history",
"quit 5 years",
"family history",
"significant",
"lung cancer",
"father",
"died",
"age 67",
"... |
A 49-year-old woman presents to her physician with a fever accompanied by chills and burning micturition since the past 5 days. She is an otherwise healthy woman with no significant past medical history and has an active sexual life. On physical examination, her temperature is 39.4°C (103.0°F), pulse rate is 90/min, bl... | Proteus mirabilis | {
"A": "Citrobacter freundii",
"B": "Escherichia coli",
"C": "Enterobacter cloacae",
"D": "Proteus mirabilis"
} | step1 | D | [
"year old woman presents",
"physician",
"fever",
"chills",
"burning micturition",
"past",
"days",
"healthy woman",
"significant past medical history",
"active sexual life",
"physical examination",
"temperature",
"4C",
"pulse rate",
"90 min",
"blood pressure",
"80 mm Hg",
"respirato... |
A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is ba... | Cochlear hair cell degeneration | {
"A": "Accumulation of desquamated keratin debri",
"B": "Stapedial abnormal bone growth",
"C": "Cochlear hair cell degeneration",
"D": "Endolymphatic hydrops"
} | step2&3 | C | [
"72 year old man presents",
"primary care physician",
"worsening hearing loss",
"states",
"hearing began approximately",
"years",
"able",
"hear",
"speaking",
"difficulty",
"understanding",
"background noise",
"current symptoms",
"reports",
"steady ringing in",
"ears",
"times experien... |
An investigator is studying the molecular structure of various proteinogenic L-amino acids. The structure of one of the amino acids being studied is shown. The derivative of this amino acid is most likely to cause which of the following effects in the human body? | Peripheral vasodilation | {
"A": "Ketotic acidosis",
"B": "Skin pigmentation",
"C": "Peripheral vasodilation",
"D": "Respiratory depression"
} | step1 | C | [
"investigator",
"studying",
"molecular structure",
"various",
"amino acids",
"structure",
"one",
"amino acids",
"studied",
"shown",
"derivative",
"amino acid",
"most likely to cause",
"following effects",
"human body"
] |
A 68-year-old man presents to his primary care physician with a 4-week history of back pain. He says that the pain does not appear to be associated with activity and is somewhat relieved by taking an NSAID. Furthermore, he says that he has had increasing difficulty trying to urinate. His past medical history is signifi... | Continuous leuprolide | {
"A": "Continuous leuprolide",
"B": "Imatinib",
"C": "Rituximab",
"D": "Tamsulosin"
} | step1 | A | [
"68 year old man presents",
"primary care physician",
"4 week history of back pain",
"pain",
"not appear to",
"associated with activity",
"somewhat relieved by",
"NSAID",
"increasing difficulty",
"to",
"past medical history",
"significant",
"kidney stones",
"30 pack-year smoking history",
... |
A 29-year-old woman presents with skin lesions on her elbows and forearms. She notes that they first started appearing 2 months ago and have not improved. She describes the lesions as painless and rarely itchy. She denies any similar symptoms in the past, and has no other significant past medical history. Review of sys... | Basal cell hyperplasia, proliferation of subepidermal vasculature, and keratinization | {
"A": "Intracellular edema with detachment at basal level",
"B": "Subepidermal blister (detachment at suprabasal level)",
"C": "Basal cell hyperplasia, proliferation of subepidermal vasculature, and keratinization",
"D": "Nuclear atypia, cellular pleomorphism, and a disorganized structure of cells from basal t... | step1 | C | [
"29 year old woman presents",
"skin lesions",
"elbows",
"forearms",
"notes",
"first started appearing 2 months",
"not improved",
"lesions",
"painless",
"rarely itchy",
"denies",
"similar symptoms",
"past",
"other significant past medical history",
"Review of systems",
"significant",
... |
Two days after delivery, a newborn develops a red, irritated eye with yellow discharge. She was born at 39 weeks' gestation to a 28-year-old woman, gravida 1, para 1. Pregnancy and delivery were uncomplicated. The mother had not seen her gynecologist since her first prenatal visit. The newborn's temperature is 37.2°C (... | Topical erythromycin administered to the infant | {
"A": "IV ceftriaxone administered to the infant",
"B": "Topical erythromycin administered to the infant",
"C": "Oral doxycycline administered to the mother",
"D": "Oral amoxicillin administered to the mother"
} | step2&3 | B | [
"Two days",
"delivery",
"newborn",
"red",
"eye",
"yellow discharge",
"born",
"weeks",
"gestation",
"year old woman",
"gravida 1",
"para 1",
"Pregnancy",
"delivery",
"uncomplicated",
"mother",
"not seen",
"gynecologist",
"first prenatal visit",
"newborn's temperature",
"99",
... |
A 16-year-old boy is brought to the emergency department after losing consciousness. He had no preceding chest pain or palpitations. His father has cataracts and had frontal balding in his twenties but has no history of cardiac disease. His paternal grandfather also had early-onset balding. His pulse is 43/min. Physica... | Anticipation | {
"A": "Pleiotropy",
"B": "Loss of heterozygosity",
"C": "Codominance",
"D": "Anticipation"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"consciousness",
"preceding chest pain",
"palpitations",
"father",
"cataracts",
"frontal balding",
"twenties",
"history of cardiac disease",
"paternal grandfather",
"early balding",
"pulse",
"min",
"Physical examination shows frontal h... |
A 32-year-old primigravida at 35 weeks gestation seeks evaluation at the emergency department for swelling and redness of the left calf, which started 2 hours ago. She reports that the pain has worsened since the onset. The patient denies a history of insect bites or trauma. She has never experienced something like thi... | Estriol | {
"A": "Estriol",
"B": "Progesterone",
"C": "Human placental lactogen",
"D": "Prolactin"
} | step2&3 | A | [
"year old primigravida",
"35 weeks gestation",
"evaluation",
"emergency department",
"swelling",
"redness",
"left calf",
"started 2 hours",
"reports",
"pain",
"worsened",
"onset",
"patient denies",
"history",
"insect bites",
"trauma",
"never experienced",
"past",
"pregnancy",
"... |
A 26-year-old nurse at 8 weeks of gestation presents to the physician with low-grade fever and body ache for the past 2 days. She also complains of a fine pink and itchy rash that appeared 2 nights ago. The rash 1st appeared on her face and spread to her neck. Past medical history is noncontributory. She takes prenatal... | Test for rubella antibodies in her blood | {
"A": "Administer anti-rubella antibodies",
"B": "Admit the patient and place her in isolation",
"C": "Test for rubella antibodies in her blood",
"D": "Termination of pregnancy"
} | step1 | C | [
"year old nurse",
"weeks of gestation presents",
"physician",
"low-grade fever",
"body ache",
"past 2 days",
"fine pink",
"itchy rash",
"appeared 2 nights",
"rash 1st appeared",
"face",
"spread",
"neck",
"Past medical history",
"takes prenatal vitamins",
"folate",
"day",
"sick cont... |
A 55-year-old man with a history of fatigue and exertional dyspnea presents to the urgent care clinic following an acute upper respiratory illness. On physical examination, his pulses are bounding, his complexion is very pale, and scleral icterus is apparent. The spleen is moderately enlarged. Oxygen saturation is 79% ... | Type II–cytotoxic hypersensitivity reaction | {
"A": "Type I–anaphylactic hypersensitivity reaction",
"B": "Type II–cytotoxic hypersensitivity reaction",
"C": "Type III–immune complex-mediated hypersensitivity reaction",
"D": "Type II and II–mixed cytotoxic and immune complex hypersensitivity reaction"
} | step2&3 | B | [
"55 year old man",
"history",
"fatigue",
"exertional dyspnea presents",
"urgent care clinic following",
"acute upper respiratory illness",
"physical examination",
"pulses",
"bounding",
"complexion",
"very pale",
"scleral icterus",
"apparent",
"spleen",
"moderately enlarged",
"Oxygen sa... |
A 57-year-old HIV-positive male with a history of intravenous drug abuse presents to the emergency room complaining of arm swelling. He reports that he developed progressively worsening swelling and tenderness over the right antecubital fossa three days prior. He recently returned from a trip to Nicaragua. His past med... | Gram-positive bacillus | {
"A": "Gram-negative curved bacillus",
"B": "Gram-negative bacillus",
"C": "Gram-positive coccus",
"D": "Gram-positive bacillus"
} | step1 | D | [
"HIV-positive male",
"history of intravenous drug abuse presents",
"emergency room",
"of arm swelling",
"reports",
"worsening swelling",
"tenderness",
"right antecubital fossa three days prior",
"recently returned",
"trip",
"Nicaragua",
"past medical history",
"notable",
"anaphylactoid rea... |
A 69-year-old male presents to the emergency department for slurred speech and an inability to use his right arm which occurred while he was eating dinner. The patient arrived at the emergency department within one hour. A CT scan was performed of the head and did not reveal any signs of hemorrhage. The patient is give... | Fluid restriction | {
"A": "Fluid restriction",
"B": "Oral salt tablets",
"C": "Demeclocycline",
"D": "Conivaptan"
} | step2&3 | A | [
"69 year old male presents",
"emergency department",
"slurred speech",
"to use",
"right arm",
"occurred",
"eating dinner",
"patient arrived",
"emergency department",
"one hour",
"CT scan",
"performed",
"head",
"not reveal",
"signs",
"hemorrhage",
"patient",
"given thrombolytics",
... |
A 70-year-old man with a 2 year history of Alzheimer disease presents is brought in from his nursing facility with altered mental status and recurrent falls during the past few days. Current medications include donepezil and galantamine. His vital signs are as follows: temperature 36.0°C (96.8°F), blood pressure 90/60 ... | Cryoprecipitate, FFP and low dose SC heparin | {
"A": "Start prednisone therapy",
"B": "Cryoprecipitate, FFP and low dose SC heparin",
"C": "Urgent plasma exchange",
"D": "Splenectomy"
} | step2&3 | B | [
"70 year old man",
"2",
"history",
"Alzheimer disease presents",
"brought",
"nursing facility",
"altered mental status",
"recurrent falls",
"past",
"days",
"Current medications include donepezil",
"galantamine",
"vital signs",
"follows",
"temperature 36",
"96",
"blood pressure 90 60 ... |
A 59-year-old woman is brought to the emergency department for the confusion. She was in her usual state of health until about 2 hours ago when she was found trying to cook a frozen pizza in her medicine cabinet. She also complained to her husband that she had a terrible headache. Her past medical history is notable fo... | IV nicardipine | {
"A": "IV lorazepam",
"B": "IV nicardipine",
"C": "IV phenytoin",
"D": "IV vancomycin, ceftriaxone, and ampicillin"
} | step2&3 | B | [
"59 year old woman",
"brought",
"emergency department",
"confusion",
"usual state of health",
"about",
"hours",
"found",
"to cook",
"frozen pizza",
"medicine cabinet",
"husband",
"terrible headache",
"past medical history",
"notable",
"hypertension",
"difficult",
"control",
"mult... |
A 22-year-old man is brought to the emergency department by his father because he is having bizarre thoughts. The patient says that he is being haunted by aliens from outer space. The father is worried as his son has had these symptoms for the past 7 months and lately, it seems to be getting worse. He has become more s... | He has a fixed false belief. | {
"A": "He has a fixed false belief.",
"B": "It is a negative symptom.",
"C": "It falls under the disorganized thinking domain.",
"D": "It is amenable to cognitive behavioral therapy."
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"father",
"bizarre thoughts",
"patient",
"aliens",
"outer space",
"father",
"worried",
"son",
"symptoms",
"past",
"months",
"to",
"getting worse",
"more self",
"not",
"to",
"interest",
"activities",
"plans to",
"others",
... |
A family doctor in a rural area is treating a patient for dyspepsia. The patient had chronic heartburn and abdominal pain for the last 2 months and peptic ulcer disease due to a suspected H. pylori infection. For reasons relating to affordability and accessibility, the doctor decides to perform a diagnostic test in the... | Serology (ELISA testing) | {
"A": "Detection of the breakdown products of urea in biopsy",
"B": "Steiner's stain",
"C": "Culture of organisms from gastric specimen",
"D": "Serology (ELISA testing)"
} | step1 | D | [
"family doctor",
"rural area",
"treating",
"patient",
"dyspepsia",
"patient",
"chronic heartburn",
"abdominal pain",
"months",
"peptic ulcer disease due to a suspected H",
"pylori infection",
"reasons relating",
"affordability",
"accessibility",
"doctor",
"to perform",
"diagnostic te... |
A 32-year-old man comes to the physician with difficulty swallowing for several weeks. Examination of the oropharynx shows lesions on palate and tongue that can be easily scraped off. An image of the lesions is shown. Which of the following is a risk factor for this patient's findings? | Decline in CD4+ T-cells | {
"A": "Decline in CD4+ T-cells",
"B": "Inhalation of salbutamol",
"C": "Chronic nicotine abuse",
"D": "Epstein-Barr virus infection"
} | step1 | A | [
"year old man",
"physician",
"difficulty swallowing",
"weeks",
"Examination",
"oropharynx shows lesions",
"palate",
"tongue",
"easily scraped",
"image",
"lesions",
"shown",
"following",
"a risk factor",
"patient's findings"
] |
A 7-year-old boy presents with difficult left eye-opening in the morning, eye discharge, and irritation. These symptoms developed gradually over the past week. He attends a primary school where recently an outbreak of tonsillitis took place. He had otitis media 2 weeks ago treated with ampicillin. At the presentation, ... | No investigations are required in this case | {
"A": "Bacterial culture of the discharge",
"B": "No investigations are required in this case",
"C": "Scrapings with Gram staining",
"D": "Polymerase chain reaction"
} | step2&3 | B | [
"year old boy presents",
"difficult left opening",
"morning",
"eye discharge",
"irritation",
"symptoms",
"past week",
"attends",
"primary school",
"recently",
"outbreak",
"tonsillitis took place",
"otitis media",
"weeks",
"treated with ampicillin",
"presentation",
"patients vital sig... |
A 32 year-old African American man with a past medical history of sickle cell anemia presents to his primary care physician for a routine check-up. He has no complaints. His physician notes that he likely has an increased susceptibility to infections with certain organisms. Which of the following patient groups has a s... | C3 complement deficiency | {
"A": "C5-9 complement deficiency",
"B": "T-cell deficiency",
"C": "C3 complement deficiency",
"D": "Hemophilia A"
} | step1 | C | [
"year",
"African American man",
"past medical history of sickle cell anemia presents",
"primary care physician",
"routine check-up",
"complaints",
"physician notes",
"likely",
"increased susceptibility to infections",
"certain organisms",
"following patient groups",
"similar pattern",
"incre... |
A 3175-g (7-lb) male newborn is delivered at 39 weeks' gestation to a 29-year-old primigravid woman following a spontaneous vaginal delivery. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Cardiac examination in the delivery room shows a continuous machine-like murmur. An echocardiogram shows a structure wi... | 6th aortic arch | {
"A": "4th aortic arch",
"B": "6th aortic arch",
"C": "1st aortic arch",
"D": "3rd aortic arch"
} | step1 | B | [
"g",
"male newborn",
"delivered",
"weeks",
"gestation",
"29 year old primigravid woman following",
"spontaneous vaginal delivery",
"Apgar scores",
"5 minutes",
"Cardiac examination",
"delivery room shows",
"continuous machine",
"murmur",
"echocardiogram shows",
"structure",
"blood flow... |
A 27-year-old man with a past medical history of type I diabetes mellitus presents to the emergency department with altered mental status. The patient was noted as becoming more lethargic and confused over the past day, prompting his roommates to bring him in. His temperature is 99.0°F (37.2°C), blood pressure is 107/6... | Normal anion gap | {
"A": "Clinically asymptomatic",
"B": "Normal anion gap",
"C": "Normal glucose",
"D": "Vitals stable"
} | step2&3 | B | [
"year",
"man",
"past",
"history of type I diabetes mellitus presents",
"emergency department",
"altered mental status",
"patient",
"noted",
"more lethargic",
"confused",
"past day",
"prompting",
"roommates to",
"temperature",
"99",
"blood pressure",
"68 mmHg",
"pulse",
"min",
"... |
The drug cilostazol is known for its ability to relax vascular smooth muscle and therefore cause vasodilation through its inhibition of phosphodiesterase 3. Given this mechanism of action, what other effect would be expected? | Positive inotropy | {
"A": "Increased left ventricular end-diastolic volume",
"B": "Positive inotropy",
"C": "Angioedema",
"D": "Antiarrhythmic action"
} | step1 | B | [
"drug cilostazol",
"known",
"ability",
"relax vascular smooth muscle",
"cause vasodilation",
"inhibition",
"phosphodiesterase",
"Given",
"mechanism of action",
"effect",
"expected"
] |
A 43-year-old woman presents to her primary care provider with shortness of breath. She reports a 4-month history of progressively worsening difficulty breathing with associated occasional chest pain. She is a long-distance runner but has had trouble running recently due to her breathing difficulties. Her past medical ... | Right ventricular hypertrophy with a dilated pulmonary artery | {
"A": "Biventricular dilatation with a decreased ejection fraction",
"B": "Left atrial dilatation with mitral valve stenosis",
"C": "Left ventricular dilatation with an incompetent aortic valve",
"D": "Right ventricular hypertrophy with a dilated pulmonary artery"
} | step1 | D | [
"year old woman presents",
"primary care provider",
"shortness of breath",
"reports",
"4 month history",
"worsening difficulty breathing with associated occasional chest pain",
"long distance",
"trouble running recently due to",
"breathing difficulties",
"past medical history",
"notable",
"wel... |
A 23-year-old man presents to the physician with nausea, vomiting, constipation, and abdominal pain for the past 24 hours. He has also developed difficulty in swallowing and blurring of vision. He also complains of significant dryness of his mouth and throat. When asked about his diet, he reports that he has been savin... | Blockade of release of acetylcholine at neuromuscular junctions | {
"A": "Blockade of release of acetylcholine at neuromuscular junctions",
"B": "Inactivation of acetylcholinesterase at neuromuscular junctions",
"C": "Competitive antagonism of acetylcholine at postsynaptic receptors",
"D": "Prolonged depolarization of NM receptors"
} | step1 | A | [
"23 year old man presents",
"physician",
"nausea",
"vomiting",
"constipation",
"abdominal pain",
"past 24 hours",
"difficulty in swallowing",
"blurring of vision",
"significant dryness",
"mouth",
"throat",
"diet",
"reports",
"saving money",
"eating dented",
"old canned goods",
"phy... |
A 55-year-old woman comes to the physician because of involuntary rhythmic shaking of both hands for several months. More recently, she also noticed involuntary head nodding movements. The shaking seems to improve after having one or two glasses of wine. Her father had similar symptoms starting at the age of 60. Neurol... | Hyperthyroidism | {
"A": "Motion sickness",
"B": "Restless legs syndrome",
"C": "Sleepwalking",
"D": "Hyperthyroidism"
} | step1 | D | [
"55 year old woman",
"physician",
"involuntary rhythmic shaking",
"hands",
"months",
"recently",
"involuntary head nodding movements",
"shaking",
"to",
"one",
"two glasses",
"wine",
"father",
"similar symptoms starting",
"age of 60",
"Neurologic examination shows",
"symmetric hand tr... |
A 72-year-old woman is brought to the emergency department 4 hours after the sudden onset of shortness of breath and dizziness. Her blood pressure is 88/56 mm Hg. Examination shows crackles at both lung bases and an S3 gallop. The extremities are cold to the touch. Serum studies show a urea nitrogen concentration of 15... | Accumulation of NADH | {
"A": "Catecholamine stimulation of glycolysis",
"B": "Increased activity of HMG-CoA lyase",
"C": "Defective mitochondrial oxygen utilization",
"D": "Accumulation of NADH"
} | step1 | D | [
"72 year old woman",
"brought",
"emergency department",
"hours",
"sudden onset of shortness",
"breath",
"dizziness",
"blood pressure",
"88",
"mm Hg",
"Examination shows crackles",
"lung bases",
"S3 gallop",
"extremities",
"cold to",
"touch",
"Serum studies show",
"urea nitrogen con... |
A previously healthy 24-year-old woman comes to the physician because of fever, headache, myalgia, photophobia, and a nonproductive cough for 2 days. Three weeks ago, she received a parrot as a birthday present. Her temperature is 38.5°C (101.3°F). Pulmonary examination shows crackles at both lung bases. Her leukocyte ... | Chlamydophila psittaci | {
"A": "Chlamydophila psittaci",
"B": "Leptospira interrogans",
"C": "Babesia microti",
"D": "Francisella tularensis"
} | step1 | A | [
"healthy",
"year old woman",
"physician",
"fever",
"headache",
"myalgia",
"photophobia",
"nonproductive cough",
"2 days",
"Three weeks",
"received",
"parrot",
"present",
"temperature",
"Pulmonary examination shows crackles",
"lung bases",
"leukocyte count",
"mm3",
"x-ray of",
"... |
A 71-year-old woman presents to the emergency department with a headache for the past 30 minutes. She says that this is the worst headache of her life and that it came on suddenly after she hit her head. She says that she has also been experiencing visual problems with double vision when she looks to the left or the ri... | Central herniation | {
"A": "Bilateral uncal herniation",
"B": "Central herniation",
"C": "Subfalcine herniation",
"D": "Tonsillar herniation"
} | step1 | B | [
"71 year old woman presents",
"emergency department",
"headache",
"past 30 minutes",
"worst headache",
"life",
"hit",
"head",
"experiencing visual problems",
"double",
"looks",
"left",
"right",
"Visual examination reveals",
"right eye",
"move right past",
"midline",
"left eye",
"... |
A 58-year-old man comes to the physician because of intermittent throbbing headaches over the past year. The headaches are worse when he wakes up and are not accompanied by other symptoms. The patient also reports trouble concentrating on daily tasks at work. His wife has been complaining lately about his snoring durin... | Nocturnal upper airway obstruction | {
"A": "Low circulating free thyroxine levels",
"B": "Nocturnal upper airway obstruction",
"C": "Hypophyseal neoplasm",
"D": "Low synaptic serotonin levels"
} | step2&3 | B | [
"58 year old man",
"physician",
"of intermittent throbbing headaches",
"past year",
"headaches",
"worse",
"wakes up",
"not",
"symptoms",
"patient",
"reports",
"concentrating",
"daily tasks",
"work",
"wife",
"snoring",
"sleep",
"attributes",
"chronic sinusitis",
"history of hype... |
A 75-year-old man presents to the emergency department for abdominal pain. The patient states the pain started this morning and has been worsening steadily. He decided to come to the emergency department when he began vomiting. The patient has a past medical history of obesity, diabetes, alcohol abuse, and hypertension... | CT scan | {
"A": "Barium enema",
"B": "Colonoscopy",
"C": "CT scan",
"D": "Sigmoidoscopy"
} | step2&3 | C | [
"75 year old man presents",
"emergency department",
"abdominal pain",
"patient states",
"pain started",
"morning",
"worsening",
"to",
"emergency department",
"began vomiting",
"patient",
"past medical",
"diabetes",
"alcohol abuse",
"hypertension",
"current medications include captopril... |
A 24-year-old man is brought to the emergency department by his brother because of a 3-hour history of lethargy and confusion. The brother says that 2 days ago, the patient ate several large-capped mushrooms he had foraged in the woods. After eating the mushrooms, he developed severe, bloody diarrhea that has since res... | Messenger RNA synthesis | {
"A": "Messenger RNA synthesis",
"B": "Microtubule polymerization",
"C": "Parasympathetic activation",
"D": "Cell depolarization"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"brother",
"hour history",
"lethargy",
"confusion",
"brother",
"2 days",
"patient ate",
"large capped mushrooms",
"woods",
"eating",
"mushrooms",
"severe",
"bloody",
"since resolved",
"pulse",
"min",
"respirations",
"min",
... |
A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and i... | Listen to the patient’s wife’s wishes and withdraw care | {
"A": "Listen to the patient’s wife’s wishes and withdraw care",
"B": "Listen to the patient’s daughter’s wishes and continue all care",
"C": "Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated",
"D": "Call other family members and consult them for t... | step1 | A | [
"76 year old man",
"brought",
"hospital",
"stroke",
"Head CT",
"done",
"emergency department",
"shows intracranial hemorrhage",
"arrival",
"ED",
"non responsive",
"withdraws only",
"pain",
"not open",
"eyes",
"transferred to",
"medical ICU",
"further management",
"intubated",
"... |
A 43-year-old woman walks into the clinic for an annual check-up appointment with her family physician. When asked about any changes in her life, she states that she lost her job about 6 months ago. Since then, she has lived with her boyfriend who is also unemployed. She frequently uses laxatives and takes some over th... | Codeine | {
"A": "Ketamine",
"B": "Codeine",
"C": "Alprazolam",
"D": "Clonazepam"
} | step1 | B | [
"year old woman walks",
"clinic",
"annual check-up appointment",
"family physician",
"changes",
"life",
"states",
"lost",
"job",
"6 months",
"then",
"lived",
"boyfriend",
"unemployed",
"frequently uses laxatives",
"takes",
"over the counter medications to help",
"sleep",
"blood p... |
A 42-year-old woman comes to the clinic with a complaint of a severely itchy and painful rash on her hands and legs for a day. On further questioning, she revealed that she loves nature and goes on trekking to the woods frequently. She just returned from a similar trip, 2 days ago. On physical examination, a prominent ... | Type IV hypersensitivity reaction | {
"A": "Type IV hypersensitivity reaction",
"B": "Type III hypersensitivity reaction",
"C": "Type I hypersensitivity reaction",
"D": "Type II hypersensitivity reaction"
} | step1 | A | [
"year old woman",
"clinic",
"complaint",
"severely itchy",
"painful rash",
"hands",
"legs",
"day",
"further questioning",
"revealed",
"loves nature",
"goes",
"trekking",
"woods frequently",
"returned",
"similar trip",
"2 days",
"physical examination",
"prominent rash",
"multipl... |
A 6-year-old boy presents to his primary care physician with hip pain that started this morning. The patient claims the pain is severe and is stopping him from skateboarding. The patient recently recovered from a upper respiratory infection that he caught from his siblings but has otherwise been healthy. The patient ha... | Ibuprofen and rest | {
"A": "Radiography",
"B": "MRI",
"C": "Aspiration and broad spectrum antibiotics",
"D": "Ibuprofen and rest"
} | step2&3 | D | [
"year old boy presents",
"primary care physician",
"hip pain",
"started",
"morning",
"patient",
"pain",
"severe",
"stopping",
"skateboarding",
"patient recently recovered",
"upper respiratory infection",
"caught",
"siblings",
"healthy",
"patient",
"past medical",
"temperature",
"... |
An investigator is studying the incidence of sickle cell trait in African American infants. To identify the trait, polymerase chain reaction testing is performed on venous blood samples obtained from the infants. Which of the following is required for this laboratory technique? | Initial sequence of the 3' end of a DNA strand | {
"A": "RNA-dependent DNA polymerase",
"B": "Ligation of Okazaki fragments",
"C": "Initial sequence of the 3' end of a DNA strand",
"D": "Complete genome DNA sequence"
} | step1 | C | [
"investigator",
"studying",
"incidence",
"sickle cell trait",
"African American infants",
"To",
"trait",
"polymerase chain reaction testing",
"performed",
"venous blood samples obtained",
"infants",
"following",
"required",
"laboratory technique"
] |
A previously healthy 20-year-old woman comes to the physician because of recurrent abdominal cramps, bloating, and diarrhea for 4 months. She describes her stools as greasy, foul-smelling, and difficult to flush. During this time she has had a 6-kg (13.2-lb) weight loss. She has no personal or family history of serious... | Hypersensitivity to gliadin
" | {
"A": "Exocrine pancreatic insufficiency",
"B": "Tropheryma whipplei infection",
"C": "Bacterial overgrowth in the small intestine",
"D": "Hypersensitivity to gliadin\n\""
} | step2&3 | D | [
"healthy 20 year old woman",
"physician",
"recurrent abdominal cramps",
"bloating",
"diarrhea",
"months",
"stools",
"greasy",
"foul-smelling",
"difficult to flush",
"time",
"kg",
"weight loss",
"personal",
"family history",
"serious illness",
"Physical examination shows pallor",
"c... |
A 27-year-old man presents to the emergency room complaining of shortness of breath and productive cough for a few days. He says that his sputum is mostly yellow with tiny red specks. He denies fever, chills, recent weight loss, or joint pain. He has no history of recent travel or sick contacts. His medical history is... | Basement membrane antibodies | {
"A": "Pulmonary embolism",
"B": "Heart failure",
"C": "Basement membrane antibodies",
"D": "Ruptured alveolar bleb"
} | step2&3 | C | [
"27 year old man presents",
"emergency room",
"of shortness",
"breath",
"productive cough",
"days",
"sputum",
"mostly yellow",
"red",
"denies fever",
"chills",
"recent weight loss",
"joint pain",
"history of recent travel",
"sick contacts",
"medical history",
"unremarkable",
"smoke... |
An investigator is studying the clearance of respiratory particles in healthy non-smokers. An aerosol containing radio-labeled particles that are small enough to reach the alveoli is administered to the subjects via a non-rebreather mask. A gamma scanner is then used to evaluate the rate of particle clearance from the ... | Macrophages | {
"A": "Goblet cells",
"B": "Type I pneumocytes",
"C": "Macrophages",
"D": "Neutrophils"
} | step1 | C | [
"investigator",
"studying",
"clearance",
"respiratory particles",
"healthy non-smokers",
"aerosol containing radio labeled particles",
"small",
"to reach",
"alveoli",
"administered",
"subjects",
"non-rebreather mask",
"gamma scanner",
"then used to evaluate",
"rate",
"particle clearanc... |
A 35-year-old woman, gravida 4, para 3, at 34 weeks' gestation comes to the physician for a prenatal visit. She feels well. She does not note any contractions or fluid from her vagina. Her third child was delivered spontaneously at 35 weeks' gestation; pregnancy and delivery of her other two children were uncomplicated... | Observation | {
"A": "Cesarean section",
"B": "External cephalic version",
"C": "Observation",
"D": "Intravenous penicillin"
} | step2&3 | C | [
"35 year old woman",
"gravida 4",
"para 3",
"weeks",
"gestation",
"physician",
"prenatal visit",
"feels well",
"not note",
"contractions",
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"vagina",
"third child",
"delivered",
"35 weeks",
"gestation",
"pregnancy",
"delivery",
"two children",
"uncomplicated",
"Vital ... |
A 25-year-old woman gives birth to a male child at 30 weeks of gestation. Pregnancy was complicated by polyhydramnios diagnosed on ultrasonography at 26 weeks of gestation. The baby is born vaginally weighing 1.2 kg (2.64 lb). Because he does not cry immediately after birth, endotracheal intubation is attempted to secu... | Fourth and sixth branchial arches | {
"A": "First branchial arch",
"B": "Second branchial arch",
"C": "Third branchial arch",
"D": "Fourth and sixth branchial arches"
} | step2&3 | D | [
"year old woman gives birth",
"male",
"30 weeks of gestation",
"Pregnancy",
"complicated",
"polyhydramnios diagnosed",
"ultrasonography",
"weeks of gestation",
"baby",
"born",
"weighing 1.2 kg",
"2 64",
"not cry immediately",
"birth",
"endotracheal intubation",
"attempted to secure",
... |
An 19-year-old woman presents to her primary care physician because she has been feeling increasingly lethargic over the last 6 months. Specifically, she says that she feels tired easily and has been cold even though she is wearing lots of layers. Her medical history is significant for seasonal allergies but is otherwi... | Follicles with colloid | {
"A": "Blood vessels",
"B": "Follicles with colloid",
"C": "Lymphatic ducts",
"D": "Neutrophilic invasion"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"feeling",
"lethargic",
"months",
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"cold",
"lots",
"layers",
"medical history",
"significant",
"seasonal allergies",
"unremarkable",
"prompted",
"hard time swallowing",
"difficulty drinking liquids",
"Physical ... |
A 72-year-old man arrives at the emergency department 30 minutes after developing rapid onset right-sided weakness and decreased sensation on the right side of his body. The patient’s wife also reports that he has had difficulty forming sentences. His wife adds that these symptoms were at their maximum within a few min... | It will be 16 times greater | {
"A": "It will be 4 times greater",
"B": "It will be 8 times greater",
"C": "It will be 16 times greater",
"D": "No change"
} | step1 | C | [
"72 year old man",
"emergency department 30 minutes",
"rapid onset right-sided weakness",
"decreased sensation",
"right side of",
"body",
"patients wife",
"reports",
"difficulty forming sentences",
"wife adds",
"symptoms",
"maximum",
"few minutes",
"incident",
"began to resolve almost",
... |
A 39-year-old African American woman is admitted to the hospital following a seizure with a severe post-ictal headache. She was diagnosed with breast cancer 1 year ago when she presented with a hard, rock-like, immobile mass with irregular borders accompanied by changes in the breast skin, including erythema and dimpli... | ER, PR, HER2 negative | {
"A": "Progesterone receptor (PR) positive",
"B": "ER, PR, HER2 negative",
"C": "PR, ER, HER2 positive",
"D": "HER2 positive"
} | step1 | B | [
"year old African American woman",
"admitted",
"hospital following",
"seizure",
"severe post ictal headache",
"diagnosed",
"breast cancer",
"year",
"presented",
"hard",
"rock",
"immobile mass",
"irregular borders",
"changes",
"breast skin",
"including erythema",
"dimpling",
"ipsila... |
A 13-year-old boy is brought to the physician because of a 1-month history of progressive difficulty breathing through his nose and a 2-week history of recurrent severe nosebleeds. When he holds the right nostril shut, he is unable to breathe nasally and his sense of smell is reduced. He has a 6-year history of asthma,... | CT scan of head with contrast | {
"A": "Coagulation tests",
"B": "Sweat chloride test",
"C": "Punch biopsy of the mass",
"D": "CT scan of head with contrast"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"month history",
"progressive difficulty breathing",
"nose",
"2-week history",
"recurrent severe nosebleeds",
"holds",
"right nostril",
"unable to",
"sense of smell",
"reduced",
"year history of asthma",
"well controlled",
"inhaled albuterol",
... |
A 20-year-old man comes to the emergency room because of palpitations and mild dyspnea for the last 2 hours. He has had similar episodes in the past that resolved within 20 minutes, but they have been worsening since he started training for his first marathon 1 month ago. Ten years ago, he was treated for streptococcal... | Bicuspid aortic valve | {
"A": "Asymmetric septal hypertrophy",
"B": "Antistreptolysin O antibodies",
"C": "Myxomatous degeneration",
"D": "Bicuspid aortic valve"
} | step2&3 | D | [
"20 year old man",
"emergency room",
"palpitations",
"mild dyspnea",
"hours",
"similar episodes",
"past",
"resolved",
"20 minutes",
"worsening",
"started training",
"first marathon",
"month",
"Ten years",
"treated",
"streptococcal pharyngitis",
"a 10 day course",
"penicillin",
"m... |
A 71-year-old man comes to the physician for a routine health maintenance examination. He feels well. He goes for a 30-minute walk three times a week and does not experience any shortness of breath or chest or leg pain on exertion. He has not had any weakness, numbness, or vision disturbance. He has diabetes that is we... | Left carotid endarterectomy | {
"A": "Left carotid endarterectomy",
"B": "Reassurance",
"C": "Carotid artery stenting",
"D": "Bilateral carotid endarterectomy"
} | step2&3 | A | [
"71 year old man",
"physician",
"routine health maintenance examination",
"feels well",
"goes",
"30-minute walk three times",
"week",
"not experience",
"shortness of breath",
"chest",
"leg pain",
"exertion",
"not",
"weakness",
"numbness",
"vision disturbance",
"diabetes",
"well con... |
A 28-year-old woman is brought to the emergency department after being resuscitated in the field. Her husband is with her and recalls seeing pills beside her when he was in the bathroom. He reveals she has a past medical history of depression and was recently given a prescription for smoking cessation. On physical exam... | The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf. | {
"A": "The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.",
"B": "The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.",
"C": "The patient’s adult daughter may be appointed as her h... | step2&3 | A | [
"year old woman",
"brought",
"emergency department",
"resuscitated in the field",
"husband",
"recalls seeing pills",
"bathroom",
"reveals",
"past medical history of depression",
"recently given",
"prescription",
"smoking cessation",
"physical exam",
"right-sided scalp hematoma",
"deep",
... |
An 8-year-old girl is brought to the emergency department because of a 2-day history of low-grade fever, itchy rash, and generalized joint pain. The rash initially started in the antecubital and popliteal fossae and then spread to her trunk and distal extremities. One week ago, she was diagnosed with acute sinusitis an... | Serum sickness-like reaction | {
"A": "Serum sickness-like reaction",
"B": "Stevens-Johnson syndrome",
"C": "Pemphigus vulgaris",
"D": "Drug reaction with eosinophilia and systemic symptoms"
} | step1 | A | [
"year old girl",
"brought",
"emergency department",
"2-day history",
"low-grade fever",
"itchy rash",
"generalized joint",
"rash initially started",
"antecubital",
"popliteal fossae",
"then spread",
"trunk",
"distal extremities",
"One week",
"diagnosed",
"acute sinusitis",
"started",... |
A 7-year-old boy presents to the clinic with his mother, who notes that the way in which he plays has changed and that he has been limping, favoring his left leg. When asked, the patient states that his left knee hurts. He is afebrile and vital signs are stable. The patient is well nourished and meeting all development... | Legg-Calvé-Perthes disease (LCPD) | {
"A": "Rickets",
"B": "Legg-Calvé-Perthes disease (LCPD)",
"C": "Slipped capital femoral epiphysis",
"D": "Juvenile idiopathic arthritis (JIA)"
} | step1 | B | [
"year old boy presents",
"clinic",
"mother",
"notes",
"plays",
"changed",
"limping",
"favoring",
"left leg",
"patient states",
"left knee",
"afebrile",
"vital signs",
"stable",
"patient",
"well nourished",
"meeting",
"developmental milestones",
"physical examination",
"knee",
... |
A 57-year-old man presents to the clinic for a chronic cough over the past 4 months. The patient reports a productive yellow/green cough that is worse at night. He denies any significant precipitating event prior to his symptoms. He denies fever, chest pain, palpitations, weight changes, or abdominal pain, but endorses... | 3200 mL | {
"A": "2000 mL",
"B": "3200 mL",
"C": "3500 mL",
"D": "4500 mL"
} | step1 | B | [
"57 year old man presents",
"clinic",
"chronic cough",
"past",
"months",
"patient reports",
"productive yellow/green cough",
"worse",
"night",
"denies",
"significant precipitating event prior to",
"symptoms",
"denies fever",
"chest pain",
"palpitations",
"weight changes",
"abdominal ... |
A 17-year-old man presents to his primary care physician concerned about excessive sleepiness that has persisted his entire life. He notes that he has been having difficulty with his job as a waiter because he often falls asleep suddenly during the day. He also experiences a sensation of dreaming as he goes to sleep ev... | Begin inhibitor of dopamine reuptake | {
"A": "Continuous positive airway pressure at night",
"B": "Begin inhibitor of dopamine reuptake",
"C": "Recommend scheduling regular naps and more time for sleep at night",
"D": "Recommend to abstain from activities at night that expose the patient to blue light"
} | step2&3 | B | [
"year old man presents",
"primary care physician concerned",
"excessive sleepiness",
"entire life",
"notes",
"difficulty",
"job",
"waiter",
"often falls asleep",
"day",
"experiences",
"sensation",
"dreaming",
"goes to sleep",
"feels awake",
"sleeps",
"10",
"day",
"feels tired",
... |
A 38-year-old woman presents to her primary care physician for a new patient appointment. She states that she feels well and has no current complaints. The patient recently started seeing a specialist for treatment for another medical condition but otherwise has had no medical problems. The patient lives alone and drin... | Medication | {
"A": "Alcohol",
"B": "Bacterial infection",
"C": "Medication",
"D": "Viral infection"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"new patient appointment",
"states",
"feels well",
"current complaints",
"patient recently started seeing",
"specialist",
"treatment",
"medical condition",
"medical problems",
"patient lives alone",
"drinks 2 alcoholic beverages",
"night... |
A 67-year-old woman is brought to the emergency department by her husband because of a 1-hour history of severe groin pain, nausea, and vomiting. She has had a groin swelling that worsens with standing, coughing, and straining for the past 3 months. Her pulse is 120/min. Examination shows pallor; there is swelling, ery... | Lacunar ligament and femoral vein | {
"A": "Linea alba and conjoint tendon",
"B": "Inferior epigastric artery and rectus sheath",
"C": "Conjoint tendon and inguinal ligament",
"D": "Lacunar ligament and femoral vein"
} | step1 | D | [
"67 year old woman",
"brought",
"emergency department",
"husband",
"hour history",
"severe groin",
"nausea",
"vomiting",
"groin swelling",
"worsens",
"standing",
"coughing",
"straining",
"past 3 months",
"pulse",
"min",
"Examination shows pallor",
"swelling",
"erythema",
"tende... |
A 35-year-old woman presents to her dermatologist with complaints of discoloration of the skin on her hands and wrists. She says her symptoms started about 6-months ago. Around this time, she recalls moving into her new house with her husband and children. She had to quit her job to relocate and says she is having diff... | Symptoms are ego-dystonic | {
"A": "Symptoms are ego-dystonic",
"B": "The condition is readily treatable",
"C": "The condition is associated with early onset dementia",
"D": "The condition rarely affects daily functioning"
} | step2&3 | A | [
"35 year old woman presents",
"dermatologist",
"complaints of discoloration",
"skin",
"hands",
"wrists",
"symptoms started",
"months",
"time",
"recalls moving",
"new house",
"husband",
"children",
"to quit",
"job",
"difficulty maintaining",
"clean",
"happy household",
"admits to"... |
A 2800-g (6-lb 3-oz) male newborn is born at 39 weeks’ gestation to a 22-year-old woman, gravida 2, para 2, after an uncomplicated labor and delivery. The mother did not receive prenatal care. She traveled to Brazil to visit relatives during the first trimester of her pregnancy. She has bipolar disorder treated with li... | Use of mosquito repellant | {
"A": "Avoid consumption of undercooked meat",
"B": "Use of mosquito repellant",
"C": "Daily intake of prenatal vitamins",
"D": "Discontinuation of mood stabilizer"
} | step2&3 | B | [
"2800 g",
"oz",
"male newborn",
"born",
"weeks gestation",
"year old woman",
"gravida 2",
"para 2",
"uncomplicated labor",
"delivery",
"mother",
"not receive prenatal care",
"traveled",
"Brazil to visit relatives",
"first trimester",
"pregnancy",
"bipolar disorder treated with lithiu... |
An otherwise healthy 47-year-old woman comes to the physician for the evaluation of a 4-month history of worsening fatigue and constipation. She has also noticed that her cheeks appear fuller and her voice has become hoarse. Her temperature is 36.3°C (97.3°F) and pulse is 59/min. Examination of the neck shows a painles... | Lymphocytic infiltration, Hürthle cells, and germinal centers | {
"A": "Large, irregular nuclei, nuclear grooves, and Psammoma bodies",
"B": "Spindle cells, pleomorphic giant cells, and mitotic figures",
"C": "Multinucleated giant cells, macrophages, and degenerated follicular cells",
"D": "Lymphocytic infiltration, Hürthle cells, and germinal centers"
} | step1 | D | [
"healthy",
"year old woman",
"physician",
"evaluation",
"month history",
"worsening fatigue",
"constipation",
"cheeks appear",
"voice",
"hoarse",
"temperature",
"36 3C",
"97",
"pulse",
"59 min",
"Examination of",
"neck shows",
"painless",
"mildly enlarged thyroid gland",
"skin"... |
A 62-year-old woman presents with abdominal pain and blood in her urine. Since the acute onset of symptoms 3 days ago, there has been no improvement. She describes the pain as moderate, sharp and burning in character, non-radiating, and localized to the suprapubic region. She also has noted some mild urinary frequency ... | A thiol given concurrently with an antineoplastic agent to help reduce inflammation of the transitional epithelium of the bladder | {
"A": "Agent that binds to an intracellular receptor and results in the transactivation of genes that promote gluconeogenesis and has anti-inflammatory effects",
"B": "A thiol given concurrently with an antineoplastic agent to help reduce inflammation of the transitional epithelium of the bladder",
"C": "Monoclo... | step2&3 | B | [
"62 year old woman presents",
"abdominal pain",
"blood in",
"urine",
"acute onset of symptoms 3 days",
"improvement",
"pain",
"moderate",
"sharp",
"burning",
"character",
"non radiating",
"localized",
"suprapubic region",
"noted",
"mild urinary frequency",
"urgency",
"past 5 days",... |
A 5-year-old boy is brought to the physician by his parents because of a 6-week history of increased tiredness, irritability, and worsening leg pain. His parents report that he has been reluctant to walk recently because of the pain in his legs. Examination shows conjunctival pallor and diffuse petechiae. There are pal... | t(12;21) | {
"A": "t(12;21)",
"B": "t(15;17)",
"C": "t(8;14)",
"D": "t(14;18)"
} | step1 | A | [
"5 year old boy",
"brought",
"physician",
"parents",
"week history",
"increased tiredness",
"irritability",
"worsening leg pain",
"parents report",
"reluctant to walk recently",
"pain",
"legs",
"Examination shows conjunctival pallor",
"diffuse petechiae",
"palpable",
"nontender posteri... |
A 37-year-old man comes to the physician because of fever, night sweats, malaise, dyspnea, and a productive cough with bloody sputum for 4 days. He was diagnosed with HIV infection 15 years ago and has not been compliant with his medication regimen. Physical examination shows diminished breath sounds over the left lung... | Cryptococcus neoformans | {
"A": "Cocciodioides immitis",
"B": "Histoplasma capsulatum",
"C": "Blastomyces dermatitidis",
"D": "Cryptococcus neoformans"
} | step1 | D | [
"year old man",
"physician",
"fever",
"night sweats",
"malaise",
"dyspnea",
"productive cough",
"bloody sputum",
"4 days",
"diagnosed",
"HIV infection",
"years",
"not",
"compliant",
"medication regimen",
"Physical examination shows diminished breath sounds",
"left lung fields",
"x-... |
A 47-year-old man presents with a history of a frequent unpleasant crawling sensation in both of his legs accompanied by an urge to move his legs for the last 6 months. He continuously moves his legs to provide him with partial relief from the unpleasant feelings in his legs. The symptoms are especially severe during t... | Iron deficiency anemia | {
"A": "Iron deficiency anemia",
"B": "Pulmonary tuberculosis",
"C": "Zinc deficiency",
"D": "Liver failure"
} | step1 | A | [
"year old man presents",
"history",
"frequent",
"crawling sensation",
"legs",
"to move",
"legs",
"months",
"moves",
"legs to provide",
"partial relief",
"feelings",
"legs",
"symptoms",
"severe",
"night",
"lying",
"bed",
"returning",
"work",
"symptoms occur 35 days per week",
... |
A 4-year-old girl is brought to the physician because of worsening jaundice that started 8 days ago. She has had similar episodes in the past. Her father underwent a splenectomy during adolescence. Physical examination shows mild splenomegaly. Laboratory studies show:
Hemoglobin 10.1 g/dL
WBC count 7200/mm3
Mean corpus... | Eosin-5-maleimide binding test | {
"A": "Osmotic fragility test",
"B": "Coombs test",
"C": "Eosin-5-maleimide binding test",
"D": "Hemoglobin electrophoresis"
} | step1 | C | [
"4 year old girl",
"brought",
"physician",
"worsening jaundice",
"started",
"days",
"similar episodes",
"past",
"father",
"splenectomy",
"adolescence",
"Physical examination shows mild splenomegaly",
"Laboratory studies show",
"Hemoglobin",
"g",
"WBC",
"Mean corpuscular volume",
"c... |
A 72-year-old obese man presents as a new patient to his primary care physician because he has been feeling tired and short of breath after recently moving to Denver. He is a former 50 pack-year smoker and has previously had deep venous thrombosis. Furthermore, he previously had a lobe of the lung removed due to lung c... | High altitude | {
"A": "High altitude",
"B": "Hypoventilation",
"C": "Pulmonary fibrosis",
"D": "V/Q mismatch"
} | step1 | A | [
"72 year old obese man presents",
"new patient",
"primary care physician",
"feeling tired",
"short of breath",
"recently moving",
"former 50 pack-year smoker",
"deep venous thrombosis",
"lobe of",
"lung removed due to lung cancer",
"family history of",
"progressive",
"lung disease",
"Labor... |
A 27-year old gentleman presents to the primary care physician with the chief complaint of "feeling down" for the last 6 weeks. He describes trouble falling asleep at night, decreased appetite, and recent feelings of intense guilt regarding the state of his personal relationships. He says that everything "feels slower"... | Electroconvulsive therapy | {
"A": "Psychotherapy",
"B": "Citalopram",
"C": "Electroconvulsive therapy",
"D": "Sertraline"
} | step2&3 | C | [
"27 year old",
"presents",
"primary care physician",
"chief complaint",
"feeling",
"last",
"weeks",
"trouble falling asleep",
"night",
"decreased appetite",
"recent feelings of intense guilt",
"state",
"personal relationships",
"feels slower",
"used to",
"similar four week period",
"... |
A 27-year-old man presents to the emergency department after being hit by a car while riding his bike. The patient was brought in with his airway intact, vitals stable, and with a C-collar on. Physical exam is notable for bruising over the patient’s head and a confused man with a Glasgow coma scale of 11. It is noticed... | Head elevation, sedation, mannitol, hyperventilation | {
"A": "Head elevation, norepinephrine, mannitol, hyperventilation",
"B": "Head elevation, sedation, mannitol, hyperventilation",
"C": "Lower head, sedation, hypertonic saline, hyperventilation",
"D": "Lower head, sedation, hypertonic saline, hypoventilation"
} | step2&3 | B | [
"27 year old man presents",
"emergency department",
"hit by",
"car",
"bike",
"patient",
"brought",
"airway intact",
"stable",
"collar",
"Physical exam",
"notable",
"bruising",
"patients head",
"confused man",
"Glasgow coma scale",
"11",
"patient",
"very irregular pattern",
"bre... |
A 27-year-old G0P0 female presents to her OB/GYN for a preconception visit to seek advice before becoming pregnant. A detailed history reveals no prior medical or surgical history, and she appears to be in good health currently. Her vaccination history is up-to-date. She denies tobacco or recreational drug use and admi... | Administer measles, mumps, rubella (MMR) vaccination | {
"A": "Begin 400 mcg folic acid supplementation",
"B": "Recommend inactivated influenza vaccination",
"C": "Administer measles, mumps, rubella (MMR) vaccination",
"D": "Obtain varicella zoster titer"
} | step2&3 | C | [
"27 year old",
"female presents",
"OB/GYN",
"preconception visit to",
"advice",
"pregnant",
"detailed history reveals",
"prior medical",
"surgical history",
"appears to",
"good health currently",
"vaccination history",
"date",
"denies tobacco",
"recreational drug use",
"admits",
"dri... |
A 22-year-old female college student presents to the emergency department due to severe pain in her stomach after an evening of heavy drinking with her friends. The pain is located in the upper half of the abdomen, is severe in intensity, and has an acute onset. She claims to have consumed a dozen alcoholic drinks. Her... | Anxiety induced hyperventilation | {
"A": "Alcohol induced respiratory depression",
"B": "Anxiety induced hyperventilation",
"C": "Renal failure induced electrolyte imbalance",
"D": "Weight loss induced electrolyte imbalance"
} | step1 | B | [
"year old female college student presents",
"emergency department due to severe pain in",
"stomach",
"evening",
"heavy drinking",
"friends",
"pain",
"upper half",
"abdomen",
"severe",
"intensity",
"acute onset",
"to",
"alcoholic drinks",
"past medical history",
"unremarkable",
"recen... |
A 16-year-old boy presents with shortness of breath after prolonged exposure to cold air during a recent hike with his friends. Past medical history is significant for asthma, untreated because he doesn't like using medications. The patient says he is a non-smoker and occasionally drinks alcohol. On physical examinatio... | Phosphoinositol system | {
"A": "Cyclic guanosine monophosphate (cGMP) system",
"B": "Arachidonic acid system",
"C": "Phosphoinositol system",
"D": "Tyrosine kinase system"
} | step1 | C | [
"year old boy presents",
"shortness of breath",
"prolonged exposure to cold air",
"recent",
"friends",
"Past medical history",
"significant",
"asthma",
"untreated",
"using medications",
"patient",
"non-smoker",
"occasionally drinks alcohol",
"physical examination",
"temperature",
"98",... |
A multicentric, ambidirectional cohort study (i.e. a study that combines elements of both prospective and retrospective cohort studies) was designed in order to evaluate the relationship between nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) and exposure to patients in intensive-care units o... | 2.33 | {
"A": "0.18",
"B": "0.43",
"C": "1.66",
"D": "2.33"
} | step1 | D | [
"multicentric",
"cohort study",
"i.e",
"study",
"combines elements",
"prospective",
"retrospective cohort studies",
"designed",
"order to evaluate",
"relationship",
"nasal colonization",
"methicillin-resistant Staphylococcus aureus",
"exposure to patients",
"intensive-care units",
"terti... |
A 45-year-old man presents to the emergency department with abdominal distension. The patient states he has had gradually worsening abdominal distension with undulating pain, nausea, and vomiting for the past several months. The patient does not see a physician typically and has no known past medical history. He works ... | Echinococcus granulosus | {
"A": "Echinococcus granulosus",
"B": "Enterobius vermicularis",
"C": "Necator americanus",
"D": "Taenia solium"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"abdominal distension",
"patient states",
"worsening abdominal",
"pain",
"nausea",
"vomiting",
"past",
"months",
"patient",
"not see",
"physician",
"known past medical history",
"works",
"farmer",
"livestock",
"breeds dogs",
"tempe... |
A 49-year-old man presents to his physician complaining of weakness and fatigue. On exam, you note significant peripheral edema. Transthoracic echocardiogram is performed and reveals a preserved ejection fraction with impaired diastolic relaxation. A representative still image is shown in Image A. Which of the followin... | Hemochromatosis | {
"A": "Previous treatment with doxorubicin",
"B": "Hemochromatosis",
"C": "History of myocardial infarction",
"D": "History of a recent viral infection"
} | step1 | B | [
"year old man presents",
"physician",
"weakness",
"fatigue",
"exam",
"note significant peripheral edema",
"Transthoracic echocardiogram",
"performed",
"reveals",
"preserved ejection fraction",
"impaired diastolic relaxation",
"representative",
"image",
"shown",
"Image",
"following",
... |
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