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 65-year-old male prisoner goes on a hunger strike to protest the conditions of his detainment. After 5 days without food, he suffers a seizure for which he is taken into a medical facility. On physical examination, he looks pale and diaphoretic. His blood glucose level is 50 mg/dL. In order to keep a constant supply ... | ß-hydroxybutyric acid | {
"A": "ß-hydroxybutyric acid",
"B": "Fatty acids",
"C": "Glucose-6-phosphate",
"D": "Glycogen"
} | step1 | A | [
"65-year-old male prisoner goes",
"hunger strike to protest",
"conditions",
"5 days",
"food",
"suffers",
"seizure",
"taken",
"medical facility",
"physical examination",
"looks pale",
"diaphoretic",
"blood glucose level",
"50 mg/dL",
"order to keep",
"constant supply",
"energy",
"br... |
A 67-year-old patient comes to the physician because of a 4-month history of weight loss, chest pain, dry cough, and shortness of breath on exertion. He worked as a shipbuilder for 45 years and is now retired. Since the death of his wife 2 years ago, he has lived with his daughter. He has never smoked. His temperature ... | His life expectancy
" | {
"A": "Wish for cardiopulmonary resuscitation",
"B": "Uncertain coverage by health insurance",
"C": "The son's objection",
"D": "His life expectancy\n\""
} | step2&3 | D | [
"67 year old patient",
"physician",
"of",
"4 month history",
"weight loss",
"chest pain",
"dry cough",
"shortness of breath",
"exertion",
"worked",
"years",
"now retired",
"death",
"wife",
"years",
"lived",
"daughter",
"never smoked",
"temperature",
"100",
"pulse",
"85 min"... |
An 8-month-old boy is brought to his pediatrician by his parents with a 12-hour history of fever and coughing. He has also been experiencing intermittent diarrhea and skin abscesses since birth. Otherwise, he has been meeting developmental milestones as expected. Analysis of this patient's sputum reveals acute angle br... | Transforming oxygen into superoxide radicals | {
"A": "Actin polymerization",
"B": "Leukocyte migration",
"C": "Transforming oxygen into superoxide radicals",
"D": "Transforming superoxide radicals into hydrogen peroxide"
} | step1 | C | [
"month old boy",
"brought",
"pediatrician",
"parents",
"12-hour history",
"fever",
"coughing",
"experiencing intermittent diarrhea",
"skin abscesses",
"birth",
"meeting developmental milestones",
"expected",
"Analysis",
"patient's sputum reveals acute angle branching fungi",
"culture sho... |
A 25-year-old man with a genetic disorder presents for genetic counseling because he is concerned about the risk that any children he has will have the same disease as himself. Specifically, since childhood he has had difficulty breathing requiring bronchodilators, inhaled corticosteroids, and chest physiotherapy. He h... | 1% | {
"A": "0.01%",
"B": "0.5%",
"C": "1%",
"D": "50%"
} | step1 | C | [
"year old man",
"genetic disorder presents",
"genetic counseling",
"concerned",
"risk",
"children",
"same disease",
"childhood",
"difficulty breathing",
"bronchodilators",
"inhaled corticosteroids",
"chest physiotherapy",
"diarrhea",
"malabsorption",
"enzyme replacement therapy",
"wife... |
A medical research study is evaluating an investigational novel drug (medication 1) as compared with standard therapy (medication 2) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 da... | 64% | {
"A": "42%",
"B": "57%",
"C": "64%",
"D": "72%"
} | step2&3 | C | [
"medical",
"evaluating",
"investigational novel drug",
"medication 1",
"compared",
"standard therapy",
"medication 2",
"patients presenting",
"emergency department",
"myocardial infarction",
"study enrolled",
"total",
"subjects",
"1 500",
"study arm",
"Follow-up",
"conducted",
"day... |
A 36-year-old male with fluctuating levels of consciousness is brought to the emergency department by ambulance due to a fire in his home. He currently opens his eyes to voice, localizes painful stimuli, responds when asked questions, but is disoriented and cannot obey commands. The patient’s temperature is 99°F (37.2°... | 100% oxygen, hydroxycobalamin, and sodium thiosulfate | {
"A": "Hyperbaric oxygen",
"B": "Intravenous epinephrine",
"C": "Sodium thiosulfate and sodium nitrite",
"D": "100% oxygen, hydroxycobalamin, and sodium thiosulfate"
} | step2&3 | D | [
"36 year old male",
"fluctuating levels of consciousness",
"brought",
"emergency department",
"ambulance due to",
"fire",
"home",
"currently opens",
"eyes to voice",
"localizes painful stimuli",
"asked questions",
"disoriented",
"commands",
"patients temperature",
"blood pressure",
"mm... |
A 75-year-old man presents to the emergency department because of pain in his left thigh and left calf for the past 3 months. The pain occurs at rest, increases with walking, and is mildly improved by hanging the foot off the bed. He has had hypertension for 25 years and type 2 diabetes mellitus for 30 years. He has sm... | Urgent assessment for revascularization | {
"A": "Systemic anticoagulation with heparin",
"B": "Urgent assessment for revascularization",
"C": "Exercise therapy",
"D": "Amputation"
} | step2&3 | B | [
"75 year old man presents",
"emergency department",
"of pain",
"left thigh",
"left calf",
"past 3 months",
"pain occurs",
"rest",
"increases",
"walking",
"mildly improved",
"hanging",
"foot",
"bed",
"hypertension",
"years",
"type 2 diabetes mellitus",
"30 years",
"smoked",
"cig... |
A 72-year-old man presents to the emergency department because of difficulty breathing and sharp chest pain. The chest pain increases in intensity with lying down, and it radiates to the scapular ridge. Approximately 3 weeks ago, he had an anterior ST-elevation myocardial infarction, which was treated with intravenous ... | Dressler’s syndrome | {
"A": "Myocarditis",
"B": "Ventricular aneurysm",
"C": "Aortic dissection",
"D": "Dressler’s syndrome"
} | step2&3 | D | [
"72 year old man presents",
"emergency department",
"difficulty breathing",
"sharp chest pain",
"chest pain increases",
"intensity",
"lying",
"radiates",
"scapular ridge",
"Approximately",
"weeks",
"anterior ST-elevation myocardial infarction",
"treated with intravenous alteplase",
"discha... |
A 2-year-old girl is brought to the emergency department after swallowing a button battery that was lying on the table 1 hour ago. She has no shortness of breath or chest discomfort. Her pulse is 112/min and respirations are 30/min. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination show... | Endoscopic removal of the battery | {
"A": "Administer syrup of ipecac",
"B": "Reassurance and observation",
"C": "Administer chelation therapy",
"D": "Endoscopic removal of the battery"
} | step2&3 | D | [
"2 year old girl",
"brought",
"emergency department",
"swallowing",
"button battery",
"lying",
"table",
"hour",
"shortness of breath",
"chest discomfort",
"pulse",
"min",
"respirations",
"30/min",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"98",
"Physical examinatio... |
A 4-week-old male presents with his parents to the pediatrician for a well-child visit. The patient’s mother reports that the patient was eating well until about one week ago, when he began vomiting after breastfeeding. His mother has tried increasing the frequency of feeds and decreasing the amount of each feed, but t... | Abdominal ultrasound | {
"A": "Abdominal ultrasound",
"B": "Abdominal radiograph",
"C": "Trial of cow's milk-free diet",
"D": "Trial of empiric proton pump inhibitor"
} | step2&3 | A | [
"4 week old male presents",
"parents",
"pediatrician",
"well-child visit",
"patients mother reports",
"patient",
"eating well",
"about one week",
"began vomiting",
"breastfeeding",
"mother",
"increasing",
"frequency",
"feeds",
"decreasing",
"amount",
"feed",
"vomiting",
"to",
"... |
A 72-year-old man being treated for benign prostatic hyperplasia (BPH) is admitted to the emergency department for 1 week of dysuria, nocturia, urge incontinence, and difficulty initiating micturition. His medical history is relevant for hypertension, active tobacco use, chronic obstructive pulmonary disease, and BPH w... | Metabolic acidosis complicated by respiratory acidosis | {
"A": "Metabolic acidosis complicated by respiratory acidosis",
"B": "Metabolic acidosis complicated by respiratory alkalosis",
"C": "Respiratory acidosis complicated by metabolic alkalosis",
"D": "Non-anion gap metabolic acidosis"
} | step1 | A | [
"72 year old man",
"treated",
"benign prostatic hyperplasia",
"admitted",
"emergency department",
"1 week",
"dysuria",
"nocturia",
"urge incontinence",
"difficulty initiating micturition",
"medical history",
"relevant",
"hypertension",
"active tobacco use",
"chronic obstructive pulmonary... |
A 22-year-old male varsity athlete visits the on-campus health services for shortness of breath, fatigue, and lower limb edema with onset 1 week after mild upper respiratory tract infection. Upon physical examination, his blood pressure is 100/68 mm Hg, heart rate is 120/min, respiratory rate is 23/min, and temperature... | Infiltration with lymphocytes | {
"A": "Infiltration with lymphocytes",
"B": "Infiltration with eosinophils",
"C": "Infiltration with neutrophils",
"D": "Infiltration with granulomas"
} | step1 | A | [
"year old male",
"athlete visits",
"health services",
"shortness of breath",
"fatigue",
"lower limb edema",
"onset 1 week",
"mild upper respiratory tract infection",
"physical examination",
"blood pressure",
"100 68 mm Hg",
"heart rate",
"min",
"respiratory rate",
"23 min",
"temperatur... |
A 72-year-old man presents to the outpatient clinic today. He has New York Heart Association class III heart failure. His current medications include captopril 20 mg, furosemide 40 mg, potassium chloride 10 mg twice daily, rosuvastatin 20 mg, and aspirin 81 mg. He reports that he generally feels well and has not had an... | Metoprolol succinate | {
"A": "Losartan",
"B": "Metoprolol tartrate",
"C": "Metoprolol succinate ",
"D": "Digoxin "
} | step2&3 | C | [
"72 year old man presents",
"outpatient clinic today",
"New York Heart Association class III",
"failure",
"current medications include captopril 20 mg",
"furosemide 40 mg",
"potassium chloride 10 mg twice daily",
"rosuvastatin 20 mg",
"aspirin 81 mg",
"reports",
"feels well",
"not",
"recent ... |
A 40-year-old, gravida 2, nulliparous woman, at 14 weeks' gestation comes to the physician because of a 6-hour history of light vaginal bleeding and lower abdominal discomfort. Eight months ago she had a spontaneous abortion at 10 weeks' gestation. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134... | Transvaginal ultrasound | {
"A": "Transvaginal ultrasound",
"B": "Chorionic villus sampling",
"C": "Thyroid function tests",
"D": "Fetal Doppler ultrasound"
} | step2&3 | A | [
"40 year old",
"gravida 2",
"nulliparous woman",
"weeks",
"gestation",
"physician",
"6-hour history",
"light vaginal bleeding",
"lower abdominal discomfort",
"Eight months",
"spontaneous abortion",
"10 weeks",
"gestation",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
... |
A 34-year-old business executive presents to her primary care provider because of difficulty falling asleep on her trips. She makes 4–5 business trips from California to China every month. Her typical direct Los Angeles to Hong Kong flight leaves Los Angeles at 12:30 a.m. and reaches Hong Kong at 7:00 p.m. (local time)... | Melatonin | {
"A": "Polysomnography",
"B": "Escitalopram",
"C": "Zolpidem",
"D": "Melatonin"
} | step2&3 | D | [
"year old business executive presents",
"primary care provider",
"of difficulty falling asleep",
"trips",
"makes",
"business trips",
"California",
"China",
"month",
"typical direct Los Angeles",
"Hong Kong flight leaves Los Angeles",
"30",
"m",
"reaches Hong Kong",
"m",
"local time",
... |
A 5-week-old infant boy presents to the pediatrician with intermittent vomiting for the last 2 weeks. The mother reports that the vomiting is non-bilious and immediately follows feeding. After vomiting, the baby is hungry and wants to feed again. The frequency of vomiting has been increasing progressively over 2 weeks.... | Pyloromyotomy | {
"A": "Surgical ligation of the fistula and primary end-to-end anastomosis of the esophagus",
"B": "Pyloromyotomy",
"C": "Duodenoduodenostomy",
"D": "Endorectal pull-through procedure"
} | step2&3 | B | [
"5 week old infant boy presents",
"pediatrician",
"intermittent vomiting",
"2 weeks",
"mother reports",
"vomiting",
"non",
"immediately follows feeding",
"vomiting",
"baby",
"hungry",
"to feed",
"frequency of vomiting",
"increasing",
"weeks",
"vital signs",
"normal limits",
"examin... |
A 32-year-old woman with bipolar disorder visits her gynecologist because she believes she is pregnant. A urine pregnancy test is performed which confirms she is pregnant. She has mild bipolar disorder for which she takes lithium and admits that she has been taking it ‘on and off’ for 2 years now but has never had any ... | Taper lithium and provide a prescription for clonazepam as needed | {
"A": "Taper lithium and administer valproate",
"B": "Continue lithium administration through pregnancy and add lamotrigine",
"C": "Taper lithium and administer carbamazepine",
"D": "Taper lithium and provide a prescription for clonazepam as needed"
} | step2&3 | D | [
"year old woman",
"bipolar disorder visits",
"gynecologist",
"pregnant",
"urine pregnancy test",
"performed",
"confirms",
"pregnant",
"mild bipolar disorder",
"takes lithium",
"admits",
"years now",
"never",
"symptoms",
"episodes of relapse",
"not made contact with",
"psychiatrist",
... |
A 4-year-old male is brought by his mother to the emergency room with dyspnea and fever. His mother reports a two-day history of progressive shortness of breath, malaise, and a fever with a maximum temperature of 101.6°F (38.7°C). The child has visited the emergency room three times over the past two years for pneumoni... | Pre-B-cell | {
"A": "Pro-B-cell",
"B": "Pre-B-cell",
"C": "Immature B-cell",
"D": "Mature B-cell"
} | step1 | B | [
"4 year old male",
"brought",
"mother",
"emergency room",
"dyspnea",
"fever",
"mother reports",
"two day history of progressive shortness",
"breath",
"malaise",
"fever",
"maximum temperature",
"child",
"visited",
"emergency room three times",
"past two years",
"pneumonia",
"otitis ... |
A 4-month-old boy is brought to the physician for a well-child examination. He was born at 36 weeks' gestation. The mother has had no prenatal care. His 6-year-old sister has a history of osteosarcoma. He is exclusively breast fed. He is at the 60th percentile for height and weight. Vital signs are within normal limits... | Fundus examination | {
"A": "Screen for galactosemia",
"B": "Visual training exercises",
"C": "Fundus examination",
"D": "Serum rubella titers"
} | step2&3 | C | [
"4 month old boy",
"brought",
"physician",
"well",
"born",
"36 weeks",
"gestation",
"mother",
"prenatal care",
"year old sister",
"history of osteosarcoma",
"breast fed",
"percentile",
"height",
"weight",
"Vital signs",
"normal limits",
"Examination shows inward deviation",
"righ... |
A 38-year-old woman with a history of Crohn’s disease presents with a 3-week history of weight gain. The patient also presents with a 1-month history of abdominal pain, cramping, and bloody diarrhea consistent with worsening of her inflammatory bowel disease. Past medical history is significant for Crohn’s disease diag... | Hypokalemia | {
"A": "Hyperkalemia",
"B": "Normal random blood glucose levels",
"C": "Metabolic acidosis",
"D": "Hypokalemia"
} | step1 | D | [
"year old woman",
"history of Crohns disease presents",
"week history",
"weight gain",
"patient",
"presents",
"month history",
"abdominal pain",
"cramping",
"bloody diarrhea consistent",
"of",
"inflammatory bowel disease",
"medical history",
"significant",
"Crohns disease diagnosed 2 yea... |
A 22-year-old man comes to the physician because of a 2-week history of cough and decreased urination. The cough was initially nonproductive, but in the last few days he has coughed up small amounts of blood-tinged sputum with clots. He has not had any fevers, chills, or weight loss. He has smoked one pack of cigarette... | Fibrin crescents in Bowman space | {
"A": "Neutrophilic infiltration of the capillaries",
"B": "Thinning of the basement membrane",
"C": "Fibrin crescents in Bowman space",
"D": "Enlarged and hypercellular glomeruli"
} | step1 | C | [
"year old man",
"physician",
"2-week history",
"cough",
"decreased urination",
"cough",
"initially",
"last",
"days",
"coughed up small amounts",
"blood tinged sputum",
"clots",
"not",
"fevers",
"chills",
"weight loss",
"smoked one pack",
"cigarettes daily",
"5 years",
"Pulse",
... |
A 27-year-old man is brought to the emergency department after a motorcycle accident 30 minutes ago. He was found at the scene of the accident with a major injury to the anterior chest by a metallic object that was not removed during transport to the hospital. The medical history could not be obtained. His blood pressu... | Right marginal artery | {
"A": "Right marginal artery",
"B": "Left anterior descending artery",
"C": "Posterior descending artery",
"D": "Left coronary artery"
} | step1 | A | [
"27 year old man",
"brought",
"emergency department",
"motorcycle accident 30 minutes",
"found",
"accident",
"major injury to",
"anterior chest",
"metallic object",
"not removed",
"transport",
"hospital",
"medical history",
"not",
"obtained",
"blood pressure",
"80 50 mm Hg",
"pulse... |
A 32-year-old man comes to the physician because of a 2 month history of difficulty sleeping and worsening fatigue. During this time, he has also had difficulty concentrating and remembering tasks at work as well as diminished interest in his hobbies. He has no suicidal or homicidal ideation. He does not have auditory ... | Continue sertraline for 3 more weeks
" | {
"A": "Provide electroconvulsive therapy",
"B": "Augment with phenelzine and continue sertraline",
"C": "Augment with aripiprazole and continue sertraline",
"D": "Continue sertraline for 3 more weeks\n\""
} | step2&3 | D | [
"year old man",
"physician",
"2 month history",
"difficulty sleeping",
"worsening fatigue",
"time",
"difficulty concentrating",
"remembering tasks",
"work",
"diminished interest",
"hobbies",
"suicidal",
"homicidal ideation",
"not",
"auditory",
"visual hallucinations",
"Vital signs",
... |
A 50-year-old man presents with severe chest pain for a week. His pain increases with breathing and is localized to the right. He has tried over-the-counter medications at home, but they did not help. The patient has a 20-pack-year smoking history and currently smokes 2 pack of cigarettes daily, and he drinks 3 to 4 ca... | Above the superior border of the 8th rib in the midaxillary line | {
"A": "Above the superior border of the 7th rib in the midclavicular line",
"B": "Above the superior border of the 5th rib in the midclavicular line",
"C": "Below the inferior border of the 5th rib in the midaxillary line",
"D": "Above the superior border of the 8th rib in the midaxillary line"
} | step1 | D | [
"50 year old man presents",
"severe chest",
"week",
"pain increases",
"breathing",
"localized",
"right",
"over-the-counter medications at home",
"not help",
"patient",
"20 smoking history",
"currently smokes 2 pack",
"cigarettes daily",
"drinks 3",
"4 cans of beer daily",
"dinner",
"... |
A previously healthy 13-year-old girl is brought to the physician by her mother because of a change in behavior. The mother reports that over the past 6 months, her daughter has had frequent mood swings. Sometimes, she is irritable for several days and loses her temper easily. In between these episodes, she behaves “no... | Normal behavior | {
"A": "Borderline personality disorder",
"B": "Normal behavior",
"C": "Major depressive disorder",
"D": "Premenstrual syndrome"
} | step2&3 | B | [
"healthy",
"year old girl",
"brought",
"physician",
"mother",
"change",
"behavior",
"mother reports",
"past 6 months",
"daughter",
"frequent mood swings",
"Sometimes",
"irritable",
"days",
"easily",
"episodes",
"normal",
"spends time",
"friends",
"gymnastics training twice",
... |
A 44-year-old woman with recurrent urinary tract infections is brought to the emergency department by ambulance after sudden onset of severe headache 30 minutes ago. She has a history of occasional, mild headaches in the morning. There is no other history of serious illness. Both her father and her paternal grandmother... | Saccular aneurysm
" | {
"A": "Bacterial infection",
"B": "Hypercoagulable state",
"C": "Cerebral atrophy",
"D": "Saccular aneurysm\n\""
} | step1 | D | [
"year old woman",
"recurrent urinary tract infections",
"brought",
"emergency department",
"ambulance",
"sudden onset",
"severe headache 30 minutes",
"history of occasional",
"mild headaches",
"morning",
"history",
"serious illness",
"father",
"paternal grandmother died of chronic kidney d... |
A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The... | “What is causing your blood pressure to be elevated?” | {
"A": "“Have you been taking your medications as prescribed?”",
"B": "“What is causing your blood pressure to be elevated?”",
"C": "“You are taking your medications as prescribed, aren’t you?”",
"D": "“Would you like us to consider trying a different medication for your blood pressure?”"
} | step2&3 | B | [
"year old man presents",
"family medicine office",
"difficulty keeping",
"blood pressure",
"control",
"past month",
"significant medical",
"coronary artery disease",
"diabetes mellitus",
"prescription",
"losartan",
"atenolol",
"metformin",
"blood pressure",
"100 mm Hg",
"heart rate",
... |
Twenty minutes after delivery by lower segment cesarean section at 38 weeks' gestation, a 4630-g (10-lb 3-oz) male newborn has respiratory distress. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Pregnancy was complicated by gestational diabetes mellitus. His temperature is 36.9°C (98.4°F), pulse is 155/mi... | Supportive care | {
"A": "Supportive care",
"B": "Broad-spectrum antibiotic therapy",
"C": "Continuous positive airway pressure",
"D": "Nitric oxide therapy"
} | step2&3 | A | [
"Twenty minutes",
"delivery",
"lower segment cesarean section",
"weeks",
"gestation",
"g",
"10",
"3 oz",
"male newborn",
"respiratory distress",
"Apgar scores",
"8",
"1",
"5 minutes",
"Pregnancy",
"complicated",
"gestational",
"temperature",
"36",
"98 4F",
"pulse",
"min",
... |
A 27-year-old gravida 2, para 1 presents to her physician at 21 weeks gestation with decreased sensitivity, tingling, and pain in her right hand that is worse at night and is partially relieved by shaking her hand. She developed these symptoms gradually over the past month. She does not report any trauma to her extremi... | Immobilization (for example, splinting) should improve the reported outcome in this patient. | {
"A": "This is a fairly uncommon condition in pregnant women.",
"B": "Pre-pregnancy obesity increases risk of developing this condition during pregnancy.",
"C": "Corticosteroid injections are contraindicated in pregnant women for management of this condition.",
"D": "Immobilization (for example, splinting) sho... | step2&3 | D | [
"27 year old gravida 2",
"para 1 presents",
"physician",
"weeks gestation",
"decreased sensitivity",
"tingling",
"pain in",
"right hand",
"worse",
"night",
"relieved by shaking",
"hand",
"symptoms",
"past month",
"not report",
"trauma",
"extremities",
"neck",
"spine",
"physical... |
A 15-year-old female is brought to the emergency room with high fever and confusion. She complains of chills and myalgias, and physical examination reveals a petechial rash. Petechial biopsy reveals a Gram-negative diplococcus. The patient is at greatest risk for which of the following? | Bilateral adrenal destruction | {
"A": "Bilateral adrenal destruction",
"B": "Pelvic inflammatory disease",
"C": "Septic arthritis",
"D": "Acute endocarditis"
} | step1 | A | [
"year old female",
"brought",
"emergency room",
"high fever",
"confusion",
"chills",
"myalgias",
"physical examination reveals",
"petechial rash",
"biopsy reveals",
"Gram-negative diplococcus",
"patient",
"greatest risk",
"following"
] |
A 65-year-old man with a history of diabetes, hypertension, hyperlipidemia, and obesity is transferred from the cardiac catheterization lab to the cardiac critical care unit after sustaining a massive myocardial infarction. He received a bare metal stent and has now stabilized. However, shortly after being transferred,... | Lidocaine | {
"A": "Quinidine",
"B": "Lidocaine",
"C": "Dofetilide",
"D": "Flecainide"
} | step1 | B | [
"65-year-old man",
"history",
"diabetes",
"hypertension",
"hyperlipidemia",
"obesity",
"transferred",
"cardiac catheterization lab",
"cardiac critical care unit",
"sustaining",
"massive myocardial infarction",
"received",
"bare metal stent",
"now stabilized",
"transferred",
"reports pa... |
A 13-year-old girl is brought to the physician by her father because of a worsening pruritic rash for 2 days. Five weeks ago, she was diagnosed with juvenile myoclonic epilepsy and treatment with lamotrigine was begun. Her immunizations are up-to-date. Her temperature is 38.8°C (101.8°F). Physical examination shows fac... | Increased absolute eosinophil count | {
"A": "Fragmented red blood cells",
"B": "Increased absolute eosinophil count",
"C": "Positive heterophile antibody test",
"D": "Elevated antistreptolysin-O titer"
} | step1 | B | [
"year old girl",
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"treatment",
"lamotrigine",
"begun",
"immunizations",
"date",
"temperature",
"Physical examination shows facial edema",
"confluent morbilliform... |
A 9-year-old boy is brought to his physician for behavioral problems in school. The patient’s parents have noted that he often will “shake his hands” abnormally at times and does so on his own without provocation. This has persisted for the past year. Additionally, the child has made loud grunting sounds in school that... | Excessive hand washing | {
"A": "Auditory hallucinations",
"B": "Cough that occurs only at night",
"C": "Excessive hand washing",
"D": "Poor communication skills"
} | step2&3 | C | [
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"made loud grunting sounds in school",
"students",
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"past medical",
"atopic ... |
A 52-year-old man presents to the Emergency Department because of bilateral leg swelling and puffiness of both eyes in the morning. His symptoms started about 2 weeks ago. He denies smoking or alcohol use and his family history is noncontributory. Today, his vital signs include a temperature of 36.8°C (98.2°F), blood p... | Subendothelial immune complex deposits | {
"A": "Subendothelial immune complex deposits",
"B": "Phospholipase A2 receptor antibodies",
"C": "Normal complement level",
"D": "Few immune complex deposits"
} | step2&3 | A | [
"year old man presents",
"Emergency Department",
"bilateral leg swelling",
"puffiness",
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"morning",
"symptoms started",
"2 weeks",
"denies smoking",
"alcohol use",
"family history",
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"vital signs include",
"temperature",
"36",
"98",
"blood pressure",
"87 mm Hg",
"p... |
A 61-year-old woman presents to her primary care physician complaining of left-sided facial pain that started yesterday. She describes the pain as stinging, burning, and constant. It does not worsen with jaw movement or chewing. Her past medical history includes hyperlipidemia and multiple sclerosis (MS), and she had c... | Oral acyclovir | {
"A": "Carbamazepine",
"B": "Amitriptyline",
"C": "Oral acyclovir",
"D": "Gabapentin"
} | step2&3 | C | [
"61 year old woman presents",
"primary care physician",
"left-sided facial pain",
"started",
"pain",
"stinging",
"burning",
"constant",
"not worsen",
"jaw movement",
"chewing",
"past medical history includes hyperlipidemia",
"multiple sclerosis",
"chickenpox",
"child",
"received",
"s... |
A 38-year-old woman comes to the physician because of a 2-day history of a red, itchy, burning rash on her vulva. She has had three similar episodes over the last two years that have all self-resolved. Genitourinary examination shows a small area of erythema with an overlying cluster of vesicles on the inside surface o... | Sensory neurons | {
"A": "Macrophages",
"B": "Sensory neurons",
"C": "Monocytes",
"D": "Astrocytes"
} | step1 | B | [
"year old woman",
"physician",
"2-day history",
"red",
"itchy",
"burning rash",
"vulva",
"three similar episodes",
"two years",
"self resolved",
"Genitourinary shows",
"small area",
"erythema",
"cluster",
"vesicles",
"surface",
"vulva",
"Latent infection",
"following",
"most li... |
A researcher is studying gamete production and oogenesis. For her experiment, she decides to cultivate primary oocytes just prior to ovulation and secondary oocytes just prior to fertilization. When she examines these gametes, she will find that the primary oocytes and secondary oocytes are arrested in which phases of ... | Prophase I; metaphase II | {
"A": "Metaphase I; metaphase II",
"B": "Metaphase I; prophase II",
"C": "Anaphase I; anaphase II",
"D": "Prophase I; metaphase II"
} | step1 | D | [
"researcher",
"studying gamete production",
"oogenesis",
"experiment",
"to",
"primary oocytes",
"prior to ovulation",
"secondary oocytes",
"prior to fertilization",
"gametes",
"find",
"primary oocytes",
"secondary oocytes",
"arrested",
"phases",
"meiosis"
] |
A 51-year-old woman presents to the primary care clinic complaining of trouble sleeping. She reports that she has episodes of “overheating” and “sweating” during the day and at night. The nightly episodes keep her from staying asleep. She also explains how embarrassing it is when she suddenly becomes hot and flushed du... | Adipose tissue | {
"A": "Adipose tissue",
"B": "Adrenal glands",
"C": "Mammary glands",
"D": "Ovaries"
} | step2&3 | A | [
"year old woman presents",
"primary care clinic",
"trouble sleeping",
"reports",
"episodes of overheating",
"sweating",
"day",
"night",
"episodes keep",
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"embarrassing",
"hot",
"flushed",
"work meetings",
"patient",
"upset",
"states",
"worried",
"marriage",
"well",
"... |
A 67-year-old man comes to the physician because of progressive burning pain and intermittent “electrical shocks” in his right chest for 3 months. Over the last 2 weeks, the pain has increased to an extent that he can no longer tolerate clothing on the affected area. Three months ago, he had a rash around his right nip... | Oral gabapentin | {
"A": "Sublingual nitrates",
"B": "Oral tricyclic antidepressants",
"C": "Oral famciclovir",
"D": "Oral gabapentin"
} | step2&3 | D | [
"67 year old man",
"physician",
"progressive burning pain",
"intermittent electrical",
"right chest",
"3 months",
"last",
"weeks",
"pain",
"increased",
"extent",
"longer",
"clothing",
"affected area",
"Three months",
"rash",
"right",
"axilla",
"resolved",
"week later",
"patie... |
A 51-year-old woman is brought to the emergency department because of an aggressive cough with copious amounts of thick, foamy, yellow-green sputum. She says she has had this cough for about 11 years with exacerbations similar to her presentation today. She also reports that her cough is worse in the morning. She was e... | Bronchiectasis | {
"A": "Tuberculosis",
"B": "Alpha-1-antitrypsin deficiency",
"C": "Bronchiectasis",
"D": "Chronic obstructive pulmonary disease"
} | step1 | C | [
"year old woman",
"brought",
"emergency department",
"aggressive cough",
"copious amounts",
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"foamy",
"yellow-green sputum",
"cough",
"years",
"exacerbations similar",
"presentation today",
"reports",
"cough",
"worse",
"morning",
"evaluated multiple times",
"past",
"recur... |
A 30-year-old woman presents to her primary care provider complaining of intermittent fever and loss of appetite for the past 2 weeks. She is also concerned about painful genital lesions. Past medical history is noncontributory. She takes oral contraceptives and a multivitamin daily. She has had two male sexual partner... | Genital herpes | {
"A": "Syphilis",
"B": "Gonorrhea",
"C": "Genital herpes",
"D": "Trichomoniasis"
} | step1 | C | [
"30 year old woman presents",
"primary care provider",
"intermittent fever",
"loss of appetite",
"past 2 weeks",
"concerned",
"painful genital lesions",
"Past medical history",
"takes oral contraceptives",
"multivitamin daily",
"two male sexual partners",
"lifetime",
"uses condoms",
"admit... |
A 23-year-old woman comes to the emergency department because of increasing abdominal pain with associated nausea and vomiting. The symptoms began suddenly after having intercourse with her partner six hours ago. There is no associated fever, diarrhea, vaginal bleeding, or discharge. Menarche was at the age of 13 years... | Decreased ovarian blood flow on doppler | {
"A": "Echogenic tubal ring",
"B": "Decreased ovarian blood flow on doppler",
"C": "Complex, echogenic intrauterine mass",
"D": "Distended fallopian tube with incomplete septations"
} | step2&3 | B | [
"23 year old woman",
"emergency department",
"of increasing abdominal pain with associated nausea",
"vomiting",
"symptoms began",
"intercourse",
"partner six hours",
"associated fever",
"diarrhea",
"vaginal bleeding",
"discharge",
"Menarche",
"age",
"years",
"last menstrual period",
"4... |
A 17-year-old girl presents with significant weight loss over the last few months. There is a positive family history of Hodgkin lymphoma and hyperthyroidism. Her blood pressure is 100/65 mm Hg, pulse rate is 60/min, and respiratory rate is 17/min. Her weight is 41 kg and height is 165 cm. On physical examination, the ... | Amenorrhea | {
"A": "Amenorrhea",
"B": "Dental caries",
"C": "Abdominal striae",
"D": "Parotid gland enlargement"
} | step1 | A | [
"year old girl presents",
"significant weight loss",
"last",
"months",
"positive family history of Hodgkin lymphoma",
"hyperthyroidism",
"blood pressure",
"100 65 mm Hg",
"pulse rate",
"60 min",
"respiratory rate",
"min",
"weight",
"kg",
"height",
"physical examination",
"patient",
... |
A 61-year-old woman comes to the emergency department because of a 2-hour history of headache, nausea, blurred vision, and pain in the left eye. She has had similar symptoms in the past. Her vital signs are within normal limits. The left eye is red and is hard on palpation. The left pupil is mid-dilated and nonreactive... | Epinephrine | {
"A": "Acetazolamide",
"B": "Epinephrine",
"C": "Pilocarpine",
"D": "Apraclonidine"
} | step1 | B | [
"61 year old woman",
"emergency department",
"of",
"2-hour history",
"headache",
"nausea",
"blurred vision",
"pain in",
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"similar symptoms",
"past",
"vital signs",
"normal limits",
"left eye",
"red",
"hard",
"palpation",
"left pupil",
"dilated",
"nonreactive",
"lig... |
Two hours after undergoing a left femoral artery embolectomy, an obese 63-year-old woman has severe pain, numbness, and tingling of the left leg. The surgery was without complication and peripheral pulses were weakly palpable postprocedure. She has type 2 diabetes mellitus, peripheral artery disease, hypertension, and ... | Reperfusion injury | {
"A": "Deep vein thrombosis",
"B": "Reperfusion injury",
"C": "Rhabdomyolysis",
"D": "Cholesterol embolism"
} | step2&3 | B | [
"Two hours",
"left",
"obese 63 year old woman",
"severe pain",
"numbness",
"tingling",
"left leg",
"surgery",
"complication",
"peripheral pulses",
"palpable postprocedure",
"type 2 diabetes mellitus",
"peripheral artery disease",
"hypertension",
"hypercholesterolemia",
"admission",
"... |
A regional academic medical center has 10 cases of adenovirus in the span of a week among its ICU patients. A committee is formed to investigate this outbreak. They are tasked with identifying the patients and interviewing the care providers to understand how adenovirus could have been spread from patient to patient. T... | Root cause analysis | {
"A": "Failure mode and effects analysis",
"B": "Root cause analysis",
"C": "Algorithmic analysis",
"D": "Heuristic analysis"
} | step1 | B | [
"regional academic medical center",
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"tasked",
"patients",
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"care providers to understand",
"adenovirus",
"spread",
"patient",
"patient",
"committee",
"review... |
A 9-year-old boy who recently emigrated from sub-Saharan Africa is brought to the physician because of a 2-day history of fever, chills, and productive cough. His mother reports that he has had several episodes of painful swelling of his fingers during infancy that resolved with pain medication. His immunization status... | Bacterial clearance | {
"A": "Bacterial clearance",
"B": "Immunoglobulin A action",
"C": "Respiratory burst",
"D": "T cell differentiation"
} | step1 | A | [
"year old boy",
"recently",
"sub-Saharan Africa",
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"chills",
"productive cough",
"mother reports",
"several episodes of painful swelling",
"fingers",
"infancy",
"resolved",
"pain medication",
"immunization status",
"unknown",
"temper... |
A 78-year-old man is brought to the physician by his daughter for a follow-up examination. The daughter noticed that he has gradually become more forgetful and withdrawn over the last year. He frequently misplaces his car keys and forgets the names of his neighbors, whom he has known for 30 years. He has difficulty rec... | Donepezil | {
"A": "Donepezil",
"B": "Thiamine",
"C": "Acetazolamide",
"D": "Memantine\n\""
} | step2&3 | A | [
"year old man",
"brought",
"physician",
"daughter",
"follow-up examination",
"daughter",
"more forgetful",
"withdrawn",
"year",
"frequently",
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"names",
"neighbors",
"known",
"30 years",
"difficulty recalling",
"address",
"telephone number",
"recently",
"episo... |
A 45-year-old man with a 5-year history worsening shortness of breath and cough comes to the physician for a follow-up examination. He has never smoked. His pulse is 75/min, blood pressure is 130/65 mm Hg, and respirations are 25/min. Examination shows an increased anteroposterior diameter of the chest. Diminished brea... | Hepatocellular carcinoma | {
"A": "Hepatocellular carcinoma",
"B": "Pulmonary fibrosis",
"C": "Bronchogenic carcinoma",
"D": "Bronchiolitis obliterans"
} | step1 | A | [
"year old man",
"history worsening shortness of breath",
"cough",
"physician",
"follow-up examination",
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"75 min",
"blood pressure",
"65 mm Hg",
"respirations",
"min",
"Examination shows",
"increased anteroposterior diameter of",
"chest",
"Diminished",
"wheezi... |
A 61-year-old obese man with recently diagnosed hypertension returns to his primary care provider for a follow-up appointment and blood pressure check. He reports feeling well with no changes to since starting his new blood pressure medication 1 week ago. His past medical history is noncontributory. Besides his blood p... | Captopril | {
"A": "Verapamil",
"B": "Hydralazine",
"C": "Captopril",
"D": "Hydrochlorothiazide"
} | step2&3 | C | [
"61 year old obese man",
"recently diagnosed hypertension returns",
"primary care provider",
"follow-up appointment",
"blood pressure check",
"reports feeling well",
"changes",
"since starting",
"new blood pressure medication 1 week",
"past medical history",
"blood medication",
"takes atorvast... |
A startup is working on a novel project in which they claim they can replicate the organelle that is defective in MELAS syndrome. Which of the following metabolic processes must they be able to replicate if their project is to mimic the metabolic processes of this organelle? | Fatty acid (beta) oxidation | {
"A": "Glycolysis",
"B": "Fatty acid (beta) oxidation",
"C": "Hexose monophaste shunt",
"D": "Cholesterol synthesis"
} | step1 | B | [
"startup",
"working",
"novel project",
"replicate",
"organelle",
"defective",
"MELAS syndrome",
"following metabolic processes",
"able to replicate",
"project",
"to",
"metabolic processes",
"organelle"
] |
A 53-year-old man with a history of hypertension, hyperlipidemia, and obesity presents to you in clinic for a yearly physical. His current medication regimen includes a beta blocker, angiotensin converting enzyme inhibitor, and a statin. You review his recent lab work and note that despite being on a maximum statin dos... | Aspirin | {
"A": "Diphenhydramine",
"B": "Aspirin",
"C": "Coenzyme Q10",
"D": "Acetaminophen"
} | step1 | B | [
"year old man",
"history of hypertension",
"hyperlipidemia",
"obesity presents",
"clinic",
"yearly physical",
"current medication regimen includes",
"beta blocker",
"angiotensin converting enzyme inhibitor",
"statin",
"review",
"recent lab work",
"note",
"maximum statin dose",
"LDL chole... |
A 2-week-old newborn is brought to the physician for a follow-up examination. He was born at term and the pregnancy was uncomplicated. His mother says he has been feeding well and passing adequate amounts of urine. He appears healthy. He is at the 60th percentile for length and 40th percentile for weight. His temperatu... | Outpatient follow-up | {
"A": "Amoxicillin therapy",
"B": "Prostaglandin E1 therapy",
"C": "Outpatient follow-up",
"D": "Cardiac catheterization"
} | step2&3 | C | [
"2 week old newborn",
"brought",
"physician",
"follow-up examination",
"born",
"term",
"pregnancy",
"uncomplicated",
"mother",
"feeding well",
"passing adequate amounts",
"urine",
"appears healthy",
"percentile",
"length",
"percentile",
"weight",
"temperature",
"3C",
"99",
"p... |
A 55-year-old man comes to the emergency department because of severe chest pain for the past hour. The patient describes the pain as located in the middle of his chest, tearing in quality, and radiating to his back. He has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. He has smoked a pack of... | Hypertension | {
"A": "Diabetes mellitus",
"B": "Age",
"C": "Hypertension",
"D": "History of smoking"
} | step2&3 | C | [
"55 year old man",
"emergency department",
"of severe chest pain",
"past hour",
"patient",
"pain",
"middle",
"chest",
"tearing",
"quality",
"radiating to",
"back",
"history of hypertension",
"hyperlipidemia",
"type 2 diabetes mellitus",
"smoked",
"pack",
"cigarettes daily",
"past... |
An 8-year-old boy is brought to the pediatrician because his mother is concerned about recent behavioral changes. His mother states that she has started to notice that he is slurring his speech and seems to be falling more than normal. On exam, the pediatrician observes the boy has pes cavus, hammer toes, and kyposcoli... | GAA | {
"A": "CGG",
"B": "GAA",
"C": "CAG",
"D": "GCC"
} | step1 | B | [
"year old boy",
"brought",
"pediatrician",
"mother",
"concerned",
"recent behavioral changes",
"mother states",
"started to",
"slurring",
"speech",
"to",
"falling more",
"normal",
"exam",
"pediatrician observes",
"boy",
"pes cavus",
"hammer toes",
"Based",
"findings",
"pediat... |
A 32-year-old woman presents to her primary care physician for recent onset headaches, weight loss, and restlessness. Her symptoms started yesterday, and since then she has felt sweaty and generally uncomfortable. The patient’s past medical history is unremarkable except for a recent viral respiratory infection which r... | Discontinue current medications | {
"A": "Decrease dose of current medications",
"B": "Discontinue current medications and add ibuprofen",
"C": "Discontinue medications and add T3",
"D": "Discontinue current medications"
} | step2&3 | D | [
"year old woman presents",
"primary care physician",
"recent onset headaches",
"weight loss",
"restlessness",
"symptoms started",
"since then",
"felt sweaty",
"patients past medical history",
"unremarkable",
"recent infection",
"resolved",
"patient",
"not currently",
"medications",
"te... |
A 26-year-old woman comes to the physician because of recurrent thoughts that cause her severe distress. She describes these thoughts as gory images of violent people entering her flat with criminal intent. She has had tremors and palpitations while experiencing these thoughts and must get up twenty to thirty times at ... | Sertraline | {
"A": "Olanzapine",
"B": "Venlafaxine",
"C": "Risperidone",
"D": "Sertraline"
} | step2&3 | D | [
"year old woman",
"physician",
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"cause",
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"thoughts",
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"criminal intent",
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"palpitations",
"experiencing",
"thoughts",
"get",
"twenty",
"thirty times",
"night to check",
"door",
"windows"... |
A 41-year-old man presents to a New Mexico emergency department with a 12 hour history of shortness of breath and a nonproductive cough. He says that last week he experienced fevers, chills, fatigue, and myalgias but assumed that he simply had a cold. The symptoms went away after 3 days and he felt fine for several day... | Decreased serum albumin level | {
"A": "Binding to sialic acid residues in human cells",
"B": "Cerebral spinal fluid pleocytosis",
"C": "Decreased serum albumin level",
"D": "Widened mediastinum on chest radiograph"
} | step1 | C | [
"year old man presents",
"New Mexico emergency department",
"12 hour history of shortness",
"breath",
"nonproductive cough",
"last week",
"experienced fevers",
"chills",
"fatigue",
"myalgias",
"assumed",
"cold",
"symptoms",
"3 days",
"felt fine",
"days",
"started experiencing shortne... |
A 62-year-old woman with a history of subarachnoid hemorrhage is brought to the emergency department because of shortness of breath and sharp chest pain that worsens on inspiration. She underwent surgery for a hip fracture 3 weeks ago. Her pulse is 110/min, respirations are 20/min, and blood pressure is 112/74 mm Hg. P... | Activation of antithrombin III | {
"A": "Inhibition of vitamin K epoxide reductase",
"B": "Inhibition of adenosine diphosphate receptors",
"C": "Activation of plasminogen",
"D": "Activation of antithrombin III"
} | step1 | D | [
"62 year old woman",
"history of subarachnoid hemorrhage",
"brought",
"emergency department",
"of shortness",
"breath",
"sharp chest pain",
"worsens",
"inspiration",
"surgery",
"hip fracture 3 weeks",
"pulse",
"min",
"respirations",
"20 min",
"blood pressure",
"74 mm Hg",
"Pulse ox... |
A 17-year-old girl is brought to the emergency department by her friends who were at a party with her and found her unconscious in the bathroom. They admit that alcohol was present at the party. The patient's blood pressure is 118/78 mm Hg, pulse is 40/min, respiratory rate is 16/min, and temperature is 36.7°C (98.1°F)... | Overdose of heroin | {
"A": "Alcohol poisoning",
"B": "Overdose of heroin",
"C": "Overdose of cocaine",
"D": "3,4-methylenedioxy-methamphetamine (MDMA) ingestion"
} | step2&3 | B | [
"year old girl",
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"emergency department",
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"party",
"found",
"unconscious",
"bathroom",
"admit",
"alcohol",
"present",
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"patient's blood pressure",
"mm Hg",
"pulse",
"40 min",
"respiratory rate",
"min",
"temperature",
"36",
"98",
"physical examin... |
A 44-year-old woman presents with increased thirst and frequent urination that started 6 months ago and have progressively worsened. Recently, she also notes occasional edema of the face. She has no significant past medical history or current medications. The patient is afebrile and the rest of the vital signs include:... | Enalapril | {
"A": "Enalapril",
"B": "Insulin",
"C": "Furosemide",
"D": "Mannitol"
} | step2&3 | A | [
"year old woman presents",
"increased thirst",
"frequent urination",
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"months",
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"Recently",
"notes occasional edema of the face",
"significant past medical history",
"current medications",
"patient",
"afebrile",
"rest",
"vital signs include",
"blood pressure",
"80... |
A 3-week-old newborn is brought to the pediatrician by his mother. His mother is concerned about her son’s irritability and vomiting, particularly after breastfeeding him. The infant was born at 39 weeks via spontaneous vaginal delivery. His initial physical was benign. Today the newborn appears mildly jaundiced with p... | Galactose-1-phosphate uridyl transferase | {
"A": "Galactokinase",
"B": "Galactose-1-phosphate uridyl transferase",
"C": "Aldose reductase",
"D": "Glucose-6-phosphate dehydrogenase"
} | step1 | B | [
"3 week old newborn",
"brought",
"pediatrician",
"mother",
"mother",
"concerned",
"sons irritability",
"vomiting",
"breastfeeding",
"infant",
"born",
"weeks",
"spontaneous vaginal delivery",
"initial physical",
"benign",
"Today",
"newborn appears mildly jaundiced",
"palpable hepato... |
A 43-year-old man visits his physician’s office for a routine check-up. He tells his physician that he is otherwise healthy, except for persistent headaches that he gets every morning. Upon further questioning, he reveals that he has been changing glove sizes quite frequently over the past couple of years. His wedding ... | Anterior pituitary gland | {
"A": "Anterior pituitary gland",
"B": "Posterior pituitary gland",
"C": "Pancreas",
"D": "Liver"
} | step2&3 | A | [
"year old man visits",
"physicians office",
"routine check-up",
"physician",
"healthy",
"persistent headaches",
"gets",
"morning",
"further questioning",
"reveals",
"changing glove sizes",
"frequently",
"past couple",
"years",
"wedding ring",
"fit",
"thought",
"probably due to",
... |
Two days after being admitted for acute myocardial infarction, a 61-year-old man has sharp, substernal chest pain that worsens with inspiration and improves when leaning forward. Cardiac examination shows a scratchy sound best heard over the left sternal border. Histopathological examination of the affected tissue is m... | Neutrophilic infiltration | {
"A": "Neutrophilic infiltration",
"B": "Coagulative necrosis",
"C": "Collagenous scar tissue",
"D": "Granulation tissue with macrophages"
} | step1 | A | [
"Two days",
"admitted",
"acute myocardial infarction",
"61 year old man",
"sharp",
"chest pain",
"worsens",
"inspiration",
"improves",
"forward",
"Cardiac examination shows",
"scratchy sound best heard",
"left sternal border",
"Histopathological examination",
"affected tissue",
"most l... |
A 42-year-old man comes to the physician because of a 6-week history of intermittent fever, abdominal pain, bloody diarrhea, and sensation of incomplete rectal emptying. He also has had a 4.5-kg (10-lb) weight loss over the past 3 months. Abdominal examination shows diffuse tenderness. Colonoscopy shows circumferential... | Non-polypoid dysplasia | {
"A": "Unifocal lesion",
"B": "Late p53 mutation",
"C": "Non-polypoid dysplasia",
"D": "Low-grade lesion"
} | step1 | C | [
"year old man",
"physician",
"week history",
"intermittent fever",
"abdominal pain",
"bloody diarrhea",
"sensation",
"incomplete rectal emptying",
"4.5 kg",
"10",
"weight loss over",
"past 3 months",
"Abdominal examination shows diffuse tenderness",
"Colonoscopy shows circumferential eryth... |
A 5-year-old boy presents to his pediatrician along with his parents due to episodes of “staring into space.” This symptom occurs several times a day and lasts only a few seconds. During these episodes, the boy does not respond to verbal or physical stimulation, and his parents deny him falling down or shaking. After t... | Ethosuximide | {
"A": "Ethosuximide",
"B": "Levetiracetam",
"C": "Lamotrigine",
"D": "Zonisamide"
} | step2&3 | A | [
"5 year old boy presents",
"pediatrician",
"parents due to episodes of staring",
"space",
"symptom occurs several times",
"day",
"lasts only",
"few seconds",
"episodes",
"boy",
"not",
"verbal",
"physical stimulation",
"parents deny",
"falling",
"shaking",
"episode",
"boy returns",
... |
A 45 year-old gentleman presents to his primary care physician complaining of wrist pain and is diagnosed with carpal tunnel syndrome. Upon further questioning, the patient admits that he has recently been outgrowing his gloves and shoes and has had to purchase a new hat as well due to increased head size. Upon exam, h... | IGF-1 level | {
"A": "Hydroxyproline level",
"B": "Alkaline Phosphatase level",
"C": "Cortisol level",
"D": "IGF-1 level"
} | step1 | D | [
"year old",
"presents",
"primary care physician",
"wrist pain",
"diagnosed",
"carpal tunnel syndrome",
"further questioning",
"patient admits",
"recently",
"gloves",
"shoes",
"to purchase",
"new hat",
"well",
"increased head",
"exam",
"found to",
"new mild hypertension",
"basic l... |
A 59-year-old male with a history of hypertension presents with chest pain and hoarseness. Patient reports that his hoarseness onset gradually approximately 2 weeks ago and has steadily worsened. He states that approximately 2 hours ago he had sudden onset chest pain which has not improved. The patient describes the ch... | Transthoracic echocardiography | {
"A": "Chest X-ray",
"B": "EKG",
"C": "Transthoracic echocardiography",
"D": "Cardiac troponins"
} | step2&3 | C | [
"59 year old male",
"history of hypertension presents",
"chest pain",
"hoarseness",
"Patient reports",
"hoarseness onset",
"approximately",
"weeks",
"worsened",
"states",
"approximately",
"hours",
"sudden onset chest pain",
"not improved",
"patient",
"chest pain",
"severe",
"sharp"... |
A 25-year-old G1P0 woman at an estimated gestational age of 9 weeks presents for her first prenatal visit following a positive home pregnancy test. She says she missed 2 periods but assumed it was due to stress at work. She has decided to continue with the pregnancy. Her past medical history is significant for migraine... | Valproic acid | {
"A": "Acetaminophen",
"B": "Sumatriptan",
"C": "Valproic acid",
"D": "Albuterol"
} | step1 | C | [
"year old",
"woman",
"estimated gestational age",
"weeks presents",
"first prenatal visit following",
"positive home",
"missed 2 periods",
"assumed",
"due to stress",
"work",
"to continue",
"pregnancy",
"past medical history",
"significant",
"migraine headaches",
"seizures",
"asthma"... |
A 4-day-old newborn is brought to the physician because of a generalized rash for 1 day. He was born at term. The mother had no prenatal care and has a history of gonorrhea, which was treated 4 years ago. The newborn is at the 50th percentile for head circumference, 60th percentile for length, and 55th percentile for w... | Erythema toxicum | {
"A": "Acropustulosis",
"B": "Erythema toxicum",
"C": "Pustular melanosis",
"D": "Congenital syphilis"
} | step2&3 | B | [
"4 day old newborn",
"brought",
"physician",
"of",
"generalized rash",
"1 day",
"born",
"term",
"mother",
"prenatal care",
"history",
"gonorrhea",
"treated 4 years",
"newborn",
"50th percentile",
"head circumference",
"percentile",
"length",
"percentile",
"weight",
"temperatu... |
A hospitalized 45-year-old man has had mild flank pain since awakening 3 hours ago. He also reports a new generalized rash. Two weeks ago, he was diagnosed with pulmonary tuberculosis. Current medications include isoniazid, pyrazinamide, rifampin, ethambutol, and pyridoxine. His temperature is 38.3°C (100.9°F), pulse i... | Discontinue rifampin | {
"A": "Initiate hemodialysis",
"B": "Administer ciprofloxacin",
"C": "Discontinue rifampin",
"D": "Perform renal biopsy"
} | step2&3 | C | [
"hospitalized",
"year old man",
"mild flank",
"awakening 3 hours",
"reports",
"new generalized rash",
"Two weeks",
"diagnosed",
"pulmonary tuberculosis",
"Current medications include isoniazid",
"pyrazinamide",
"rifampin",
"ethambutol",
"pyridoxine",
"temperature",
"3C",
"100 9F",
... |
A 26-year-old woman comes to the emergency department with fever, abdominal pain, and nausea for the past 7 hours. The pain started in the right lower abdomen but has now progressed to diffuse abdominal pain. Her temperature is 39.5°C (103.1°F). Physical examination shows generalized abdominal tenderness with rebound, ... | Ampicillin and sulbactam | {
"A": "Vancomycin and azithromycin",
"B": "Piperacillin",
"C": "Cefazolin and doxycycline",
"D": "Ampicillin and sulbactam"
} | step1 | D | [
"year old woman",
"emergency department",
"fever",
"abdominal pain",
"nausea",
"past",
"hours",
"pain started",
"right lower abdomen",
"now progressed to diffuse abdominal pain",
"temperature",
"Physical examination shows generalized abdominal tenderness",
"guarding",
"decreased bowel soun... |
A 67-year-old male presents to his primary care physician for evaluation of fever and an unintended weight loss of 25 pounds over the last 4 months. He also has decreased appetite and complains of abdominal pain located in the right upper quadrant. The patient has not noticed any changes in stool or urine. He emigrated... | Acute angle branching fungus | {
"A": "Acute angle branching fungus",
"B": "Curved gram-negative bacteria",
"C": "Enveloped DNA virus",
"D": "Trematode from undercooked fish"
} | step1 | A | [
"67 year old male presents",
"primary care physician",
"evaluation",
"fever",
"unintended weight loss of 25 pounds",
"last",
"months",
"decreased appetite",
"abdominal pain",
"right upper quadrant",
"patient",
"not",
"changes in stool",
"urine",
"Malaysia",
"United States one year prio... |
A 24-year-old man is brought to the emergency department 30 minutes after being involved in a high-speed motor vehicle collision in which he was a restrained driver. On arrival, he is alert and oriented. His pulse is 112/min, respirations are 29/min, and blood pressure is 100/60 mm Hg. The pupils are equal and reactive... | Bilateral periorbital ecchymosis | {
"A": "Cranial nerve XII palsy",
"B": "Bilateral periorbital ecchymosis",
"C": "Numbness of upper cheek area",
"D": "Retroauricular ecchymosis\n\""
} | step2&3 | B | [
"year old man",
"brought",
"emergency department 30 minutes",
"involved",
"high speed motor vehicle collision",
"restrained driver",
"arrival",
"alert",
"oriented",
"pulse",
"min",
"respirations",
"29 min",
"blood pressure",
"100 60 mm Hg",
"pupils",
"equal",
"reactive to light",
... |
A 30-year-old man comes to the physician after receiving a high blood pressure reading of 160/90 mm Hg at an annual employee health check-up. During the past few months, the patient has had occasional headaches and mild abdominal pain, both of which were relieved with ibuprofen. He has also had several episodes of hear... | Phenoxybenzamine | {
"A": "Phenoxybenzamine",
"B": "Resection of adrenal mass",
"C": "Propranolol",
"D": "Metoprolol"
} | step2&3 | A | [
"30 year old man",
"physician",
"receiving",
"high blood pressure reading",
"90 mm Hg",
"annual employee health check-up",
"past",
"months",
"patient",
"occasional headaches",
"mild abdominal",
"relieved",
"ibuprofen",
"several episodes of heart palpitations",
"history",
"serious illne... |
A 35-year-old man is brought to the emergency department 40 minutes after spilling hot oil over himself in a kitchen accident. Examination shows multiple tense blisters over the abdomen, anterior chest, and anterior and posterior aspects of the right upper extremity and right thigh. On deroofing the blisters, the skin ... | 36% | {
"A": "9%",
"B": "18%",
"C": "45%",
"D": "36%"
} | step1 | D | [
"35 year old man",
"brought",
"emergency department 40 minutes",
"spilling hot oil",
"kitchen accident",
"Examination shows multiple tense blisters",
"abdomen",
"anterior chest",
"anterior",
"posterior aspects",
"right upper extremity",
"right thigh",
"blisters",
"skin",
"tender",
"mot... |
A 36-year-old man is brought to the emergency department by his girlfriend because of increasing confusion for the past 6 hours. He drinks large amounts of alcohol daily and occasionally uses illicit drugs. He is lethargic and oriented only to person. Physical examination shows jaundice, hepatomegaly, and scattered pet... | Excretion of NH4 | {
"A": "Excretion of NH4",
"B": "Excretion of free iron",
"C": "Activation of GABA receptors",
"D": "Production of NH3"
} | step1 | A | [
"36 year old man",
"brought",
"emergency department",
"girlfriend",
"increasing confusion",
"past",
"hours",
"drinks large amounts",
"alcohol daily",
"occasionally uses illicit drugs",
"lethargic",
"oriented only",
"person",
"Physical examination shows jaundice",
"hepatomegaly",
"scatt... |
A 48-year-old homeless male presents to the ED because he hasn’t felt well recently. He states that he has been feeling nauseous and extremely weak over the past few days. He has several previous admissions for alcohol intoxication and uses heroin occasionally. His temperature is 100.9°F (38.3°C), blood pressure is 127... | Alcoholic hepatitis | {
"A": "Acute cholangitis",
"B": "Alcoholic hepatitis",
"C": "Acute viral hepatitis",
"D": "Hereditary hemochromatosis"
} | step1 | B | [
"48 year old homeless male presents",
"ED",
"hasnt felt well recently",
"states",
"feeling nauseous",
"extremely weak",
"past",
"days",
"several previous admissions",
"alcohol intoxication",
"uses heroin occasionally",
"temperature",
"100 9F",
"3C",
"blood pressure",
"mmHg",
"pulse",... |
A 23-year-old woman presents to your office for a gynecological exam. She says that she has been in good health and has no complaints. She has been in a steady monogamous relationship for the past year. Physical examination was unremarkable. Screening tests are performed and return positive for gonorrhea. You treat her... | Treat her partner for gonorrhea and chlamydia | {
"A": "Treatment with penicillin G for potential co-infection with syphilis",
"B": "Treat her partner for gonorrhea and chlamydia",
"C": "Inform her that her partner is likely cheating on her",
"D": "Perform an abdominal ultrasonography in order to rule out pelvic inflammatory disease"
} | step2&3 | B | [
"23 year old woman presents",
"office",
"gynecological exam",
"good health",
"complaints",
"steady monogamous relationship",
"past year",
"Physical examination",
"unremarkable",
"Screening tests",
"performed",
"return positive",
"gonorrhea",
"treat",
"intramuscular",
"ceftriaxone",
"... |
A 63-year-old man with high blood pressure, dyslipidemia, and diabetes presents to the clinic for routine follow-up. He has no current complaints and has been compliant with his chronic medications. His blood pressure is 132/87 mm Hg and his pulse is 75/min and regular. On physical examination, you notice that he has x... | Fibrates can potentiate the risk of myositis when given with statins | {
"A": "Fibrates can cause significant skin flushing and pruritus",
"B": "Fibrates can potentiate the risk of myositis when given with statins",
"C": "Fibrates can increase the risk of cataracts",
"D": "Fibrates inhibit the rate-limiting step in cholesterol synthesis"
} | step2&3 | B | [
"63 year old man",
"high blood pressure",
"dyslipidemia",
"diabetes presents",
"clinic",
"routine follow-up",
"current complaints",
"compliant",
"chronic medications",
"blood pressure",
"87 mm Hg",
"pulse",
"75 min",
"regular",
"physical examination",
"xanthelasmas",
"of",
"eyelids... |
A 61-year-old woman comes to the physician for a follow-up examination 1 week after undergoing right-sided radical mastectomy and axillary lymph node dissection for breast cancer. She says that she has been unable to comb her hair with her right hand since the surgery. Physical examination shows shoulder asymmetry. She... | Long thoracic nerve | {
"A": "Upper trunk of the brachial plexus",
"B": "Long thoracic nerve",
"C": "Suprascapular nerve",
"D": "Thoracodorsal nerve"
} | step1 | B | [
"61 year old woman",
"physician",
"follow-up examination 1 week",
"right sided radical mastectomy",
"axillary lymph node dissection",
"breast cancer",
"unable to comb",
"hair",
"right hand",
"surgery",
"Physical examination shows shoulder asymmetry",
"unable to",
"right arm",
"90 degrees",... |
A 53-year-old woman comes to the physician because of intermittent heaviness and paresthesia of the right arm for the past 2 months. She has also had multiple episodes of lightheadedness while painting a mural for the past 2 weeks. During these episodes, she was nauseated and had blurred vision. Her symptoms resolved a... | Reversed blood flow in the right vertebral artery | {
"A": "Adverse effect of medications",
"B": "Reversed blood flow in the right vertebral artery",
"C": "Compression of neurovascular structures in the neck",
"D": "Infarction of the middle cerebral artery"
} | step2&3 | B | [
"year old woman",
"physician",
"intermittent heaviness",
"paresthesia of",
"right arm",
"past",
"months",
"multiple episodes of lightheadedness",
"painting",
"mural",
"past 2 weeks",
"episodes",
"nauseated",
"blurred vision",
"symptoms resolved",
"drank",
"juice",
"hypertension",
... |
A 31-year-old physician notices that her senior colleague has been arriving late for work for the past 2 weeks. The colleague recently lost his wife to cancer and has been taking care of his 4 young children. Following the death of his wife, the department chair offered him extended time off, but he declined. Resident ... | Inform the local Physician Health Program | {
"A": "Advise resident physicians to report future misconduct to the department chair",
"B": "Alert the State Licensing Board",
"C": "Confront the colleague in private",
"D": "Inform the local Physician Health Program"
} | step2&3 | D | [
"31 year old physician",
"senior",
"late",
"work",
"past 2 weeks",
"recently lost",
"wife",
"cancer",
"taking care",
"4 young children",
"Following",
"death",
"wife",
"department chair offered",
"extended time",
"Resident physicians",
"noted",
"discussed",
"recent changes",
"mi... |
A 42-year-old woman comes to the physician because of a 10-month history of joint pain and stiffness in her wrists and fingers. The symptoms are worse in the morning and improve with activity. Physical examination shows swelling and warmth over the MCP and wrist joints in both hands. An x-ray of the hands is shown. Syn... | Proliferation of granulation tissue | {
"A": "Monosodium urate crystals",
"B": "Calcium pyrophosphate crystals",
"C": "Noncaseating granulomas",
"D": "Proliferation of granulation tissue"
} | step1 | D | [
"year old woman",
"physician",
"a 10 month history",
"joint pain",
"stiffness",
"wrists",
"fingers",
"symptoms",
"worse",
"morning",
"activity",
"Physical examination shows swelling",
"warmth",
"MCP",
"wrist joints",
"hands",
"x-ray",
"hands",
"shown",
"Synovial",
"affected j... |
A 26-year-old female presents to your office due to one week of “feeling unwell.” She complains of a headache and non-productive cough over the last several days, which have both worsened today. She does not have any history of serious infection and is not currently taking any medication. On physical exam, her temperat... | Non-gram staining bacteria | {
"A": "Gram-negative organism",
"B": "Non-gram staining bacteria",
"C": "DNA virus",
"D": "RNA virus"
} | step1 | B | [
"year old female presents",
"office due to one week",
"feeling unwell",
"headache",
"non-productive cough",
"days",
"worsened today",
"not",
"history",
"serious infection",
"not currently taking",
"medication",
"physical exam",
"temperature",
"blood pressure",
"mmHg",
"pulse",
"90 ... |
A 61-year-old man comes to the physician because of several episodes of dark urine over the past 2 weeks. He does not have dysuria or flank pain. He works in a factory that produces dyes. Since an accident at work 5 years ago, he has had moderate hearing loss bilaterally. He takes no medications. He has smoked a pack o... | Radical cystectomy | {
"A": "Transurethral resection of tumor with intravesical chemotherapy",
"B": "Radiation therapy",
"C": "Radical cystectomy",
"D": "Palliative polychemotherapy\n\""
} | step2&3 | C | [
"61 year old man",
"physician",
"of several episodes",
"dark urine",
"past 2 weeks",
"not",
"dysuria",
"flank pain",
"works",
"factory",
"dyes",
"accident at work",
"years",
"moderate hearing loss",
"takes",
"medications",
"smoked",
"pack",
"cigarettes daily",
"29 years",
"dr... |
An 8-year-old boy is brought to the physician by his parents because of fever for 3 days. During the period, he has had fatigue, severe burning with urination, and increased urination. The mother reports that his urine has red streaks and a “strange” odor. He has taken acetaminophen twice a day for the past two days wi... | Renal papilla | {
"A": "Renal tubules",
"B": "Renal papilla",
"C": "Renal interstitium",
"D": "Mucosa of the bladder\n\""
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"parents",
"fever",
"3 days",
"period",
"fatigue",
"severe burning",
"urination",
"increased urination",
"mother reports",
"urine",
"red streaks",
"odor",
"taken acetaminophen twice a day",
"past two days",
"improvement",
"symptoms",
"mul... |
A 27-year-old woman presents to her primary care physician for a concern about her pregnancy. This is her first pregnancy, and she is currently at 33 weeks gestation. She states that she has experienced diffuse swelling of her ankles and legs and is concerned that it is abnormal. Otherwise, she has no concerns. The pat... | Spot protein to creatinine ratio | {
"A": "A 24 hour urine protein",
"B": "Echocardiography",
"C": "Reassurance and followup in 1 week",
"D": "Spot protein to creatinine ratio"
} | step2&3 | D | [
"27 year old woman presents",
"primary care physician",
"concern",
"pregnancy",
"first pregnancy",
"currently",
"weeks gestation",
"states",
"diffuse swelling",
"ankles",
"legs",
"concerned",
"abnormal",
"concerns",
"patient",
"past medical",
"diabetes",
"temperature",
"98",
"3... |
A 72-year-old woman is brought to the emergency department with fever, myalgia, and cough for 3 days. She lives in an assisted living facility and several of her neighbors have had similar symptoms. She has hypertension treated with lisinopril. She has not been vaccinated against influenza. Her temperature is 38.9°C (1... | Discontinue ceftriaxone and azithromycin | {
"A": "Start treatment with oseltamivir",
"B": "Discontinue ceftriaxone and azithromycin",
"C": "Discontinue ceftriaxone and continue azithromycin to complete 7-day course",
"D": "Repeat sputum culture"
} | step2&3 | B | [
"72 year old woman",
"brought",
"emergency department",
"fever",
"myalgia",
"cough",
"3 days",
"lives in",
"assisted living facility",
"several",
"neighbors",
"similar symptoms",
"hypertension treated with lisinopril",
"not",
"vaccinated",
"influenza",
"temperature",
"pulse",
"mi... |
A 32-year-old male presents presents for a new patient visit. He states that he is in good health but has had decreasing exercise tolerance and increased levels of shortness of breath over the past 5 years. He believed that it was due to aging; he has not seen a doctor in 10 years. On auscultation, you note an early di... | Congenital bicuspid aortic valve | {
"A": "Syphilis",
"B": "Connective tissue disease",
"C": "Myxomatous degeneration",
"D": "Congenital bicuspid aortic valve"
} | step2&3 | D | [
"year old male presents presents",
"new patient visit",
"states",
"good health",
"decreasing exercise tolerance",
"increased levels of shortness",
"breath",
"past",
"years",
"due to aging",
"not seen",
"doctor",
"10 years",
"auscultation",
"note",
"early diastolic",
"blowing murmur",... |
A 56-year-old woman presents to the emergency department with several episodes in which she felt "dizzy." She has had these symptoms on and off for the past year and can recall no clear exacerbating factor or time of day when her symptoms occur. She has a perpetual sensation of fullness in her ear but otherwise has no ... | Sensorineural hearing loss | {
"A": "Conductive hearing loss",
"B": "Gradually improving symptoms",
"C": "Sensorineural hearing loss",
"D": "Vertical nystagmus"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"several episodes",
"felt",
"dizzy",
"symptoms",
"past year",
"recall",
"clear exacerbating factor",
"time of day",
"symptoms occur",
"sensation",
"fullness",
"ear",
"symptoms currently",
"temperature",
"97",
"36 4C",
"blood pres... |
A 3-year-old recent immigrant is diagnosed with primary tuberculosis. Her body produces T cells that do not have IL-12 receptors on their surface, and she is noted to have impaired development of Th1 T-helper cells. Which of the following cytokines would benefit this patient? | Interferon-gamma | {
"A": "IL-4",
"B": "IL-17",
"C": "Interferon-gamma",
"D": "TGF-beta"
} | step1 | C | [
"3 year old recent immigrant",
"diagnosed",
"primary tuberculosis",
"body",
"T cells",
"not",
"IL-12 receptors",
"surface",
"noted to",
"impaired development",
"Th1 T-helper cells",
"following cytokines",
"benefit",
"patient"
] |
A 33-year-old woman presents to the emergency department with weakness. She states that at the end of the day she feels so fatigued and weak that she can hardly care for herself. She currently feels this way. The patient has had multiple illnesses recently and has been traveling, hiking, and camping. Her temperature is... | Myasthenia gravis | {
"A": "Amyotrophic lateral sclerosis",
"B": "Lambert-Eaton syndrome",
"C": "Myasthenia gravis",
"D": "Tick paralysis"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"weakness",
"states",
"end",
"day",
"feels so fatigued",
"weak",
"care",
"currently feels",
"patient",
"multiple illnesses recently",
"traveling",
"hiking",
"camping",
"temperature",
"98",
"36",
"blood pressure",
"84 mmHg",
"... |
A 35-year-old patient with no significant past medical history arrives to the ED with abdominal cramps, nausea, and vomiting. He has had no recent travel or chemical exposures; however, three other members of his family also arrived concurrently to the ED with abdominal cramps, nausea, and vomiting. When asked about th... | Cereulide | {
"A": "Exotoxin A",
"B": "Cereulide",
"C": "Toxin B",
"D": "Shiga toxin"
} | step1 | B | [
"35 year old patient",
"significant past",
"ED",
"abdominal cramps",
"nausea",
"vomiting",
"recent travel",
"chemical exposures",
"three",
"members",
"family",
"arrived",
"ED",
"abdominal cramps",
"nausea",
"vomiting",
"recent activities",
"recall",
"shared",
"lunch",
"fried ... |
Please refer to the summary above to answer this question
Which of the following is the most likely diagnosis?"
"Patient Information
Age: 66 years
Gender: M, self-identified
Ethnicity: African-American
Site of Care: office
History
Reason for Visit/Chief Concern: “I need to go to the bathroom all the time.”
History of P... | Benign prostatic hyperplasia | {
"A": "Neurogenic bladder",
"B": "Prostate cancer",
"C": "Urethral stricture",
"D": "Benign prostatic hyperplasia"
} | step2&3 | D | [
"refer",
"summary above to answer",
"question",
"following",
"most likely diagnosis",
"Patient Age",
"66 years Gender",
"M",
"self identified Ethnicity",
"African-American Site of Care",
"office History Reason for Visit",
"Concern",
"I need to go",
"bathroom",
"time",
"History of Prese... |
A 29-year-old G2P2 female gives birth to a healthy baby boy at 39 weeks of gestation via vaginal delivery. Immediately after the delivery of the placenta, she experiences profuse vaginal hemorrhage. Her prior birthing history is notable for an emergency cesarean section during her first pregnancy. She did not receive a... | Chorionic villi attaching to the myometrium | {
"A": "Chorionic villi attaching to the decidua basalis",
"B": "Chorionic villi attaching to the myometrium",
"C": "Chorionic villi invading into the myometrium",
"D": "Placental implantation over internal cervical os"
} | step1 | B | [
"29 year old",
"female gives birth",
"healthy baby boy",
"weeks of gestation",
"vaginal delivery",
"Immediately",
"of",
"placenta",
"experiences",
"vaginal hemorrhage",
"prior",
"history",
"notable",
"emergency cesarean section",
"first pregnancy",
"not receive",
"prenatal",
"pregn... |
A 35-year-old woman is started on a new experimental intravenous drug X. In order to make sure that she is able to take this drug safely, the physician in charge of her care calculates the appropriate doses to give to this patient. Data on the properties of drug X from a subject with a similar body composition to the p... | 600 mg | {
"A": "150 mg",
"B": "300mg",
"C": "450 mg",
"D": "600 mg"
} | step1 | D | [
"35 year old woman",
"started",
"new experimental intravenous",
"order to make sure",
"able to take",
"drug",
"physician",
"charge",
"care calculates",
"appropriate doses to give",
"patient",
"Data",
"properties",
"drug",
"subject",
"similar body composition",
"patient",
"provided"... |
A 4-year-old Caucasian boy is brought by his mother to the pediatrician with a red and swollen elbow. He was playing outside a few days prior to presentation when he fell and lightly scraped his elbow on the sidewalk. He was born at 34 weeks’ gestation and was in the neonatal ICU for 2 days. He has a history of easy br... | Neutrophils with abundant peroxidase-positive granules | {
"A": "Absence of dark blue cytoplasmic staining upon nitroblue tetrazolium administration",
"B": "Macrocytic erythrocytes and acanthocytes",
"C": "Neutrophils with abundant peroxidase-positive granules",
"D": "Neutrophils with peroxidase-negative granules"
} | step1 | C | [
"4 year old Caucasian boy",
"brought",
"mother",
"pediatrician",
"red",
"swollen elbow",
"playing outside",
"few days prior to presentation",
"fell",
"lightly scraped",
"elbow",
"sidewalk",
"born",
"weeks gestation",
"neonatal ICU",
"2 days",
"history",
"easy bruising",
"bleeding... |
A 16-year-old boy is brought to the physician because of a lesion that has been growing on his jaw over the past several months. He recently immigrated to the USA from Kenya with his family. Physical examination shows a 3-cm solid mass located above the left mandible. There is cervical lymphadenopathy. Biopsy of the ma... | Activation of transcription | {
"A": "Activation of transcription",
"B": "Defect in DNA repair",
"C": "Impairment of receptor function",
"D": "Inhibition of cell cycle arrest"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"lesion",
"jaw",
"past",
"months",
"recently",
"USA",
"Kenya",
"family",
"Physical examination shows",
"3",
"solid mass",
"left mandible",
"cervical",
"Biopsy",
"mass shows sheets",
"lymphocytes",
"reactive histiocytes",
"abundant",
"... |
A scientist is studying the mechanism by which the gastrointestinal system coordinates the process of food digestion. Specifically, she is interested in how distension of the lower esophagus by a bolus of food changes responses in the downstream segments of the digestive system. She observes that there is a resulting r... | Vasoactive intestinal polypeptide | {
"A": "Ghrelin",
"B": "Neuropeptide-Y",
"C": "Secretin",
"D": "Vasoactive intestinal polypeptide"
} | step1 | D | [
"scientist",
"studying",
"mechanism",
"gastrointestinal system coordinates",
"process",
"food digestion",
"interested",
"distension",
"lower esophagus",
"bolus of food changes responses",
"downstream segments",
"digestive system",
"observes",
"resulting relaxation",
"opening",
"lower e... |
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