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 |
|---|---|---|---|---|---|
An 18-year-old male is seen for a routine physical prior to starting college. He will be moving from Ohio to California, away from his family for the first time. His temperature is 36.8 deg C (98.2 deg F), pulse is 74/min, and blood pressure is 122/68 mmHg. BMI is 24. On questioning, he reveals that he has a habit of b... | Bulimia nervosa | {
"A": "Bulimia nervosa",
"B": "Normal behavior variant",
"C": "Hypomania",
"D": "Body dysmorphic disorder"
} | step1 | A | [
"year old male",
"seen",
"routine physical",
"starting college",
"moving",
"Ohio",
"California",
"family",
"first time",
"temperature",
"36",
"deg",
"98",
"deg F",
"pulse",
"74 min",
"blood pressure",
"68 mmHg",
"BMI",
"questioning",
"reveals",
"habit",
"binge",
"times"... |
A 4-year-old boy is brought to the physician because of a progressive headache and neck pain for 2 weeks. During this period, he has had multiple episodes of dizziness and tingling sensations in his arms and hands. A year ago, he underwent closed reduction of a dislocated shoulder that he suffered after a fall. He unde... | Chiari II malformation | {
"A": "Medulloblastoma",
"B": "Intraventricular hemorrhage",
"C": "Chiari II malformation",
"D": "Vestibular schwannoma"
} | step2&3 | C | [
"4 year old boy",
"brought",
"physician",
"progressive headache",
"neck pain",
"2 weeks",
"period",
"multiple episodes of dizziness",
"tingling sensations",
"arms",
"hands",
"year",
"closed reduction",
"dislocated shoulder",
"suffered",
"fall",
"surgical removal",
"sac",
"protube... |
A 16-year-old boy is brought to the physician by his host parents for evaluation of a progressively pruritic rash over his shoulders and buttocks for the past 6 months. He recently came to the United States from Nigeria to attend a year of high school. He reports that it has been increasingly difficult for him to read ... | Onchocerciasis | {
"A": "Lymphatic filariasis",
"B": "Onchocerciasis",
"C": "Cysticercosis",
"D": "Cutaneous larva migrans"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"host parents",
"evaluation",
"pruritic rash",
"shoulders",
"buttocks",
"past 6 months",
"recently",
"United States",
"Nigeria to attend",
"year",
"high school",
"reports",
"difficult",
"to read",
"classes",
"Physical examination shows",
... |
A study is designed to assess the functions of immune components. The investigator obtains a lymph node biopsy from a healthy subject and observes it under a microscope. A photomicrograph of the cross-section of this lymph node is shown. Which of the following immunologic processes most likely occurs in the region labe... | Isotype switching | {
"A": "Macrophage activation",
"B": "Negative selection",
"C": "V(D)J recombination",
"D": "Isotype switching"
} | step1 | D | [
"study",
"designed to assess",
"functions",
"immune components",
"investigator obtains",
"lymph node biopsy",
"healthy subject",
"observes",
"microscope",
"photomicrograph",
"cross-section",
"lymph node",
"shown",
"following immunologic processes",
"likely occurs",
"region labeled",
... |
A 45-year-old man presents to the physician with complaints of fever with rigors, headache, malaise, muscle pains, nausea, vomiting, and decreased appetite for the past 3 days. He informs the physician that he had been backpacking on the Appalachian Trail in the woods of Georgia in the month of June, 2 weeks ago, and h... | Doxycycline | {
"A": "Ceftriaxone",
"B": "Doxycycline",
"C": "Ciprofloxacin",
"D": "Rifampin"
} | step2&3 | B | [
"year old man presents",
"physician",
"complaints",
"fever",
"rigors",
"headache",
"malaise",
"muscle pains",
"nausea",
"vomiting",
"decreased appetite",
"past 3 days",
"informs",
"physician",
"Appalachian Trail",
"woods",
"Georgia",
"month",
"June",
"2 weeks",
"bitten",
"t... |
A 72-year-old woman is brought to the emergency department by her son after he noticed that she was slurring her speech. He also noticed that she appeared to have difficulty using her fork about halfway through dinner when the speech problems started. He brought her to the emergency department immediately and he estima... | Aminocaproic acid | {
"A": "Aminocaproic acid",
"B": "Antivenin",
"C": "Plasma transfusion",
"D": "Protamine sulfate"
} | step1 | A | [
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"emergency department",
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"difficulty using",
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"emergency department immediately",
"estimates",
"only",
"hour",
"passed",
"beginning",
"symptoms",
"i... |
A 10-year-old boy is brought to the pediatric clinic because of persistent sinus infections. For the past 5 years, he has had multiple sinus and upper respiratory infections. He has also had recurrent diarrhea throughout childhood. His temperature is 37.0°C (98.6°F), the heart rate is 90/min, the respirations are 16/mi... | Selective IgA deficiency | {
"A": "Chediak-Higashi syndrome",
"B": "Common variable immunodeficiency",
"C": "Drug-induced IgA deficiency",
"D": "Selective IgA deficiency"
} | step2&3 | D | [
"A 10 year old boy",
"brought",
"pediatric clinic",
"persistent sinus infections",
"past",
"years",
"multiple sinus",
"upper respiratory infections",
"recurrent",
"childhood",
"temperature",
"98",
"heart rate",
"90 min",
"respirations",
"min",
"blood pressure",
"75 mm Hg",
"Labor... |
A 22-year-old male presents to the physician with a 9-year history of recurring acne on his face. He has tried a number of over-the-counter face wash, gels, and supplements over the past few years with temporary relief but no significant lasting effects. The acne has gotten worse over time and now he is especially conc... | Oral isotretinoin | {
"A": "Oral erythromycin",
"B": "Oral isotretinoin",
"C": "Topical isotretinoin",
"D": "Topical salicylic acid"
} | step1 | B | [
"year old male presents",
"physician",
"year history",
"recurring acne",
"face",
"number",
"over-the-counter face wash",
"gels",
"supplements",
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"years",
"temporary relief",
"significant",
"effects",
"acne",
"gotten worse",
"time",
"now",
"concerned about",
"appearance",... |
A 72-year-old man presents with shortness of breath and right-sided chest pain. Physical exam reveals decreased breath sounds and dull percussion at the right lung base. Chest X-ray reveals a right-sided pleural effusion. A thoracentesis was performed, removing 450 mL of light pink fluid. Pleural fluid analysis reveals... | Congestive heart failure | {
"A": "Chylothorax",
"B": "Uremia",
"C": "Sarcoidosis",
"D": "Congestive heart failure"
} | step1 | D | [
"72 year old man presents",
"shortness of breath",
"right-sided chest pain",
"Physical exam reveals decreased breath sounds",
"dull percussion",
"right lung base",
"Chest X-ray reveals",
"right-sided pleural effusion",
"thoracentesis",
"performed",
"removing 450 mL",
"light pink fluid",
"Ple... |
A 63-year-old man presents to the clinic with fever accompanied by shortness of breath. The symptoms developed a week ago and have been progressively worsening over the last 2 days. He reports his cough is productive of thick, yellow sputum. He was diagnosed with chronic obstructive pulmonary disease 3 years ago and ha... | Chest X-ray | {
"A": "Chest X-ray",
"B": "CT scan",
"C": "Bronchoscopy",
"D": "Bronchoprovocation test"
} | step2&3 | A | [
"63 year old man presents",
"clinic",
"fever",
"shortness of breath",
"symptoms",
"week",
"worsening",
"2 days",
"reports",
"cough",
"productive",
"thick",
"yellow",
"diagnosed",
"chronic obstructive pulmonary disease",
"years",
"on treatment ever",
"quit smoking 10 years",
"occa... |
A 26-year-old white man comes to the physician because of increasing generalized fatigue for 6 months. He has been unable to work out at the gym during this period. He has also had cramping lower abdominal pain and diarrhea for the past 5 weeks that is occasionally bloody. His father was diagnosed with colon cancer at ... | Colonoscopy | {
"A": "Colonoscopy",
"B": "Flexible sigmoidoscopy",
"C": "D-xylose absorption test",
"D": "CT scan of the abdomen and pelvis with contrast"
} | step2&3 | A | [
"year old white man",
"physician",
"of increasing generalized fatigue",
"months",
"unable",
"work out",
"period",
"cramping lower abdominal pain",
"diarrhea",
"past",
"weeks",
"occasionally bloody",
"father",
"diagnosed",
"colon cancer",
"age",
"65",
"smoked half",
"pack",
"cig... |
A 47-year-old presents to the clinic with a 3-day history of severe mid-epigastric abdominal pain radiating to the back. The patient has hypertension, diabetes mellitus, and hypertriglyceridemia. Prescription medications include enalapril, metformin, sitagliptin, glargine, lispro, and fenofibrate. The patient has not h... | Acute pancreatitis | {
"A": "Duodenal ulcer",
"B": "Superior mesenteric artery embolism",
"C": "Acute pancreatitis",
"D": "Abdominal aortic aneurysm"
} | step2&3 | C | [
"year old presents",
"clinic",
"3 history",
"severe",
"epigastric abdominal pain radiating",
"back",
"patient",
"hypertension",
"diabetes mellitus",
"hypertriglyceridemia",
"Prescription medications include enalapril",
"metformin",
"sitagliptin",
"glargine",
"lispro",
"fenofibrate",
... |
An investigator is studying the effects of an antihypertensive drug during pregnancy. Follow-up studies show that the drug can adversely affect differentiation of the ureteric bud into its direct derivatives in fetuses exposed during the first trimester. Which of the following structures is most likely to develop incor... | Collecting ducts | {
"A": "Distal convoluted tubule",
"B": "Collecting ducts",
"C": "Bladder",
"D": "Loop of Henle"
} | step1 | B | [
"investigator",
"studying",
"effects",
"antihypertensive drug",
"pregnancy",
"Follow-up studies show",
"drug",
"affect differentiation",
"ureteric bud",
"direct derivatives",
"fetuses exposed",
"first trimester",
"following structures",
"most likely to",
"affected fetus"
] |
A 56-year-old woman presents to the ER with 12 hours of right colic pain that travels from her groin down her inner thigh. The patient complains of dysuria, hematuria, and reports of “passing gravel” when urinating. She was diagnosed with gout and hypertension 5 years ago. Physical examination is unremarkable. The emer... | Acidic urine | {
"A": "Low specific gravity",
"B": "Alkaline urine",
"C": "Nitrites",
"D": "Acidic urine"
} | step1 | D | [
"year old woman presents",
"ER",
"12 hours",
"right colic pain",
"travels",
"groin",
"inner thigh",
"patient",
"dysuria",
"hematuria",
"reports",
"gravel",
"diagnosed",
"gout",
"hypertension",
"years",
"Physical examination",
"unremarkable",
"emergency department team orders urin... |
A new mother expresses her concerns because her 1-day-old newborn has been having feeding difficulties. The child vomits after every feeding and has had a continuous cough since shortly after birth. The mother denies any greenish coloration of the vomit and says that it is only composed of whitish milk that the baby ju... | Defective formation of the esophagus with gastric connection to the trachea | {
"A": "Obstruction due to failure of rotation of pancreatic tissue",
"B": "Failure of neural crest cells to migrate into the myenteric plexus",
"C": "Failure of recanalization of duodenum",
"D": "Defective formation of the esophagus with gastric connection to the trachea"
} | step1 | D | [
"new mother",
"concerns",
"1-day old newborn",
"feeding difficulties",
"child vomits",
"feeding",
"continuous cough",
"birth",
"mother denies",
"coloration",
"vomit",
"only",
"milk",
"baby",
"child exhibits",
"coughing spells",
"exam",
"time",
"physician",
"childs skin",
"cya... |
An 18-year-old man comes to the physician with his parents for a routine health maintenance examination. He noticed a swelling on his back 7 months ago. He has a history of using intravenous heroin but has not used illicit drugs for the past 2 months. There is no personal or family history of serious illness. Vital sig... | Perform the excision | {
"A": "Perform the excision",
"B": "Refer to the hospital ethics committee",
"C": "Refer him to a methadone clinic",
"D": "Request parental consent\n\""
} | step2&3 | A | [
"year old man",
"physician",
"parents",
"routine health maintenance examination",
"swelling",
"back",
"months",
"history",
"using intravenous heroin",
"not used illicit drugs",
"past 2 months",
"personal",
"family history of serious illness",
"Vital signs",
"normal limits",
"Examinatio... |
A 41-year-old woman is brought to the emergency department with the acute-onset of severe abdominal pain for the past 2 hours. She has a history of frequent episodes of vague abdominal pain, but they have never been this severe. Every time she has had pain, it would resolve after eating a meal. Her past medical history... | Auscultate the abdomen | {
"A": "Elicit shifting dullness of the abdomen",
"B": "Percuss the point of maximal pain",
"C": "Perform light palpation at the point of maximal pain",
"D": "Auscultate the abdomen"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"acute-onset",
"severe abdominal pain",
"past",
"hours",
"history of frequent episodes",
"vague abdominal pain",
"never",
"severe",
"time",
"pain",
"resolve",
"eating",
"meal",
"past medical history",
"vital signs include",
"bl... |
A group of scientists is verifying previous research on DNA replication. In the picture is the theoretical structure for tRNA. Where is the binding site for an amino acid? | A | {
"A": "A",
"B": "B",
"C": "C",
"D": "D"
} | step1 | A | [
"A group",
"scientists",
"verifying previous research",
"DNA replication",
"picture",
"theoretical structure",
"tRNA",
"binding site",
"amino acid"
] |
A 20-year-old college student is brought to the ED after a motor vehicle accident. Primary and secondary surveys reveal no significant compromise to his airway, his cardiovascular system, or to his motor function. However, his conjunctiva appear injected and he maintains combative behavior towards staff. What test will... | Gas chromatography / mass spectrometry (GC/MS) | {
"A": "Polymerase chain reaction",
"B": "Urine immunoassay",
"C": "Western blot",
"D": "Gas chromatography / mass spectrometry (GC/MS)"
} | step2&3 | D | [
"20 year old college student",
"brought",
"ED",
"motor vehicle accident",
"Primary",
"secondary surveys reveal",
"significant compromise",
"airway",
"cardiovascular system",
"motor function",
"conjunctiva appear injected",
"maintains combative behavior",
"staff",
"test",
"confirm potenti... |
A 52-year-old G3P3 presents to her gynecologist complaining of painful intercourse. She reports a 6-month history of intermittent dryness, itching, and burning during intercourse. Upon further questioning, she also reports poor sleep and occasional periods during which she feels very warm and sweats profusely. Her past... | Decreased estrogen, increased FSH, increased LH, increased GnRH | {
"A": "Increased estrogen, decreased FSH, decreased LH, decreased GnRH",
"B": "Decreased estrogen, decreased FSH, decreased LH, increased GnRH",
"C": "Decreased estrogen, increased FSH, increased LH, increased GnRH",
"D": "Normal estrogen, normal FSH, normal LH, normal GnRH"
} | step1 | C | [
"year old",
"presents",
"gynecologist",
"painful intercourse",
"reports",
"month history",
"intermittent dryness",
"itching",
"burning",
"intercourse",
"further questioning",
"reports poor sleep",
"occasional periods",
"feels very warm",
"sweats",
"past medical history",
"significant... |
An otherwise healthy 28-year-old woman comes to the physician because of a 14-day history of a painful red nodules on her legs associated with malaise and mild joint pains. She reports that the nodules were initially smaller and distinct but some have fused together over the past 3–4 days and now appear like bruises. T... | X-ray of the chest | {
"A": "Oral amoxicillin",
"B": "Oral isoniazid",
"C": "X-ray of the chest",
"D": "Stool culture"
} | step2&3 | C | [
"healthy",
"year old woman",
"physician",
"day history",
"painful red nodules",
"legs associated with malaise",
"mild joint pains",
"reports",
"nodules",
"initially smaller",
"fused together",
"past",
"days",
"now appear",
"bruises",
"preceding history",
"fever",
"trauma",
"insec... |
A 2-year-old boy is brought to his pediatrician’s office with complaints of watery diarrhea for the past 2 weeks. He has had a couple of episodes of watery diarrhea in the past, but this is the first time it failed to subside over the course of a few days. His father tells the doctor that the child has frothy stools wi... | Faulty transmembrane ion channel | {
"A": "Faulty transmembrane ion channel",
"B": "Primary ciliary dyskinesia",
"C": "Accumulation of branched chain amino acids",
"D": "Dysfunction of phenylalanine hydroxylase"
} | step2&3 | A | [
"2 year old boy",
"brought",
"pediatricians office",
"complaints",
"watery diarrhea",
"past 2 weeks",
"couple of episodes",
"watery diarrhea",
"past",
"first time",
"failed to",
"course",
"days",
"father",
"doctor",
"child",
"frothy stools",
"foul odor",
"diarrhea",
"parents",
... |
A 21-year-old primigravida woman visits the clinic in her 22nd week of gestation as part of her antenatal care. She has no complaints. Past medical history is unremarkable. Her only medication is a prenatal vitamin. Her temperature is 37.0°C (98.6°F), blood pressure is 110/70 mm Hg, pulse rate is 78/min, and respiratio... | Liver | {
"A": "Yolk sac",
"B": "Liver",
"C": "Aorta-gonad-mesonephros region",
"D": "Spleen"
} | step1 | B | [
"21-year-old primigravida woman visits",
"clinic",
"week",
"gestation",
"part of",
"antenatal care",
"complaints",
"Past medical history",
"unremarkable",
"only medication",
"prenatal vitamin",
"temperature",
"98",
"blood pressure",
"70 mm Hg",
"pulse rate",
"min",
"respiration rat... |
A 73-year-old man presents to the outpatient clinic complaining of chest pain with exertion. He states that resting for a few minutes usually resolves the chest pain. Currently, he takes 81 mg of aspirin daily. He has a blood pressure of 127/85 mm Hg and heart rate of 75/min. Physical examination reveals regular heart ... | Metoprolol and a statin daily. Sublingual nitroglycerin as needed. | {
"A": "Amlodipine daily. Sublingual nitroglycerin as needed.",
"B": "Metoprolol and a statin daily. Sublingual nitroglycerin as needed.",
"C": "Metoprolol and ranolazine daily. Sublingual nitroglycerin as needed.",
"D": "Amlodipine and a statin daily. Sublingual nitroglycerin as needed."
} | step2&3 | B | [
"year old man presents",
"outpatient clinic",
"chest pain",
"exertion",
"states",
"resting",
"minutes usually resolves",
"chest pain",
"Currently",
"takes 81 mg",
"aspirin daily",
"blood pressure",
"85 mm Hg",
"heart rate of 75 min",
"Physical examination reveals regular heart sounds",
... |
An 8-year-old African-American boy is brought to the emergency room with severe pain in both hands. His mother says that the patient had a fever with a cough a couple of days ago. Family history is positive for an uncle who died from a blood disease. A peripheral blood smear of this patient is shown in the image. Which... | Missense mutation | {
"A": "Frameshift mutation",
"B": "Mismatch repair",
"C": "Silent mutation",
"D": "Missense mutation"
} | step1 | D | [
"year old African-American boy",
"brought",
"emergency room",
"severe",
"hands",
"mother",
"patient",
"fever",
"cough",
"couple",
"days",
"Family history",
"positive",
"uncle",
"died",
"blood disease",
"peripheral blood smear",
"patient",
"shown",
"image",
"following",
"mos... |
A 65-year-old Caucasian man visits the nephrology outpatient clinic for a follow-up appointment. He was previously diagnosed with stage G3a chronic kidney disease (CKD) and albuminuria stage A2. He follows strict dietary recommendations and takes enalapril. He has a history of benign prostatic hyperplasia which has bee... | Addition of patiromer | {
"A": "Addition of furosemide",
"B": "Observation",
"C": "Addition of patiromer",
"D": "Addition of sevelamer"
} | step2&3 | C | [
"65 year old Caucasian man visits",
"nephrology outpatient clinic",
"follow-up appointment",
"diagnosed",
"stage G3a chronic kidney disease",
"albuminuria stage A2",
"follows",
"dietary recommendations",
"takes enalapril",
"history of benign prostatic hyperplasia",
"complicated",
"urinary trac... |
A 5-year-old girl is brought to a medical office for evaluation of persistent abdominal pain that has worsened over the past 24 hours. The mother states that the girl often has constipation which has worsened over the last 3 days. The mother denies that the girl has had bloody stools. The girl has not had a bowel movem... | Malrotation of the gut | {
"A": "Volvulus",
"B": "Malrotation of the gut",
"C": "Pyloric stenosis",
"D": "Meckel’s diverticulum"
} | step1 | B | [
"5 year old girl",
"brought",
"medical office",
"evaluation",
"persistent abdominal",
"worsened",
"past 24 hours",
"mother states",
"girl often",
"constipation",
"worsened",
"3 days",
"mother denies",
"girl",
"bloody stools",
"girl",
"not",
"bowel movement",
"passed flatulence",
... |
A 53-year old man presents for a well physical examination. He reports his diet is suboptimal, but otherwise reports a healthy lifestyle. He has no past medical history and only takes a multivitamin. He has a blood pressure of 116/74 mm Hg and a pulse of 76/min. On physical examination, he is in no acute distress, has ... | Atorvastatin 40 mg | {
"A": "Simvastatin 10 mg daily",
"B": "Ezetimibe 10 mg daily",
"C": "Fenofibrate 145 mg daily",
"D": "Atorvastatin 40 mg"
} | step2&3 | D | [
"year old man presents",
"well physical examination",
"reports",
"diet",
"suboptimal",
"reports",
"healthy lifestyle",
"past medical history",
"only takes",
"multivitamin",
"blood pressure",
"74 mm Hg",
"pulse",
"76 min",
"physical examination",
"acute distress",
"cardiac murmurs",
... |
A 45-year-old man presents to the emergency department with complaints of right-sided weakness and slurring of speech for 1 hour. There is no history of head trauma, myocardial infarction, recent surgery, gastrointestinal or urinary bleeding. He has hypertension, chronic atrial fibrillation, and a 20 pack-year cigarett... | Aspirin | {
"A": "Aspirin",
"B": "Heparin",
"C": "Metoprolol",
"D": "Tissue plasminogen activator"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"complaints",
"right-sided weakness",
"slurring",
"speech",
"1 hour",
"history",
"head trauma",
"myocardial infarction",
"recent surgery",
"gastrointestinal",
"urinary bleeding",
"hypertension",
"chronic atrial fibrillation",
"20 cigaret... |
An 18-month-old girl is brought to the pediatrician’s office for failure to thrive and developmental delay. The patient’s mother says she has not started speaking and is just now starting to pull herself up to standing position. Furthermore, her movement appears to be restricted. Physical examination reveals coarse fac... | Failure of mannose phosphorylation | {
"A": "Failure of mannose phosphorylation",
"B": "Inappropriate degradation of lysosomal enzymes",
"C": "Congenital lack of lysosomal formation",
"D": "Misfolding of nuclear proteins"
} | step1 | A | [
"month old girl",
"brought",
"pediatricians office",
"failure to thrive",
"developmental delay",
"patients mother",
"not started speaking",
"now starting",
"pull",
"up to standing position",
"movement appears to",
"restricted",
"Physical examination reveals coarse facial features",
"restri... |
A 29-year-old man presents to the emergency department with chest pain and fatigue for the past week. The patient is homeless and his medical history is not known. His temperature is 103°F (39.4°C), blood pressure is 97/58 mmHg, pulse is 140/min, respirations are 25/min, and oxygen saturation is 95% on room air. Physic... | Septic emboli | {
"A": "Bacterial meningitis",
"B": "Septic emboli",
"C": "Intracranial hemorrhage",
"D": "Thromboembolic stroke"
} | step2&3 | B | [
"29 year old man presents",
"emergency department",
"chest pain",
"fatigue",
"past week",
"patient",
"homeless",
"medical history",
"not known",
"temperature",
"4C",
"blood pressure",
"97 58 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"95",
"room air",
... |
A 69-year-old man comes to the physician because of a 3-month history of urinary urgency, nocturia, and progressive pain in his lower back. The pain is worse at night and does not respond to ibuprofen. Rectal examination shows an enlarged, asymmetric prostate with a nodular surface. Prostate-specific antigen concentrat... | Flutamide | {
"A": "Leuprolide",
"B": "Flutamide",
"C": "Degarelix",
"D": "Docetaxel"
} | step1 | B | [
"69 year old man",
"physician",
"3 month history",
"urinary urgency",
"nocturia",
"progressive pain in",
"lower back",
"pain",
"worse",
"night",
"not",
"ibuprofen",
"Rectal examination shows",
"enlarged",
"asymmetric prostate",
"nodular surface",
"specific antigen concentration",
"... |
A 49-year-old man presents with an 11-month history of progressive fatigue. He denies any night sweats, weight loss, abdominal pain, nausea, vomiting, change in bowel habits, or bleeding. He has no significant past medical history. His vital signs include: temperature 37.0°C (98.6°F), blood pressure 119/81 mm Hg, pulse... | Imatinib | {
"A": "Hydroxyurea",
"B": "Interferon-α-2b",
"C": "Cytarabine",
"D": "Imatinib"
} | step2&3 | D | [
"year old man presents",
"month history",
"progressive fatigue",
"denies",
"night sweats",
"weight loss",
"abdominal pain",
"nausea",
"vomiting",
"change in bowel habits",
"bleeding",
"significant past medical history",
"vital signs include",
"temperature",
"98",
"blood pressure",
"8... |
A 32-year-old woman is brought to the emergency department by her neighbors 30 minutes after they found her unconscious in her yard. Her neighbors report that she has been spending more time at home by herself because she recently lost her job. On arrival, she is unable to provide a history. She appears anxious. Her pu... | Conversion disorder | {
"A": "Conversion disorder",
"B": "Malingering",
"C": "Somatic symptom disorder",
"D": "Acute hemorrhagic stroke"
} | step1 | A | [
"year old woman",
"brought",
"emergency department",
"neighbors 30 minutes",
"found",
"unconscious",
"yard",
"neighbors report",
"spending more time at home",
"recently lost",
"job",
"arrival",
"unable to provide",
"history",
"appears anxious",
"pulse",
"76 min",
"respirations",
... |
A 12-year-old boy is brought to the physician because of difficulty in walking for 5 months. His mother reports that he has trouble keeping his balance and walking without support. Over the past year, he has started to have difficulty seeing in the dark and his hearing has been impaired. Examination shows marked scalin... | Peroxisomes | {
"A": "Peroxisomes",
"B": "Mitochondria",
"C": "Smooth endoplasmic reticulum",
"D": "Myofilaments"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"of difficulty in walking",
"5 months",
"mother reports",
"keeping",
"balance",
"walking",
"support",
"past year",
"started to",
"difficulty seeing",
"dark",
"hearing",
"impaired",
"Examination shows marked scaling of the skin",
"face",
"fe... |
A 40-year-old man presents with a rash, oral lesions, and vision problems for 5 days. He says the rash started as a burning feeling on his face and the upper part of his torso, but soon red spots appeared in that same distribution. The spots grew in size and spread to his upper extremities. The patient says the spots a... | Biopsy and histopathologic analysis of skin lesions | {
"A": "Gram stain and culture of skin sample",
"B": "Biopsy and histopathologic analysis of skin lesions",
"C": "Direct immunofluorescence analysis of perilesional skin biopsy",
"D": "Flow cytometry"
} | step2&3 | B | [
"40 year old man presents",
"rash",
"oral lesions",
"vision problems",
"5 days",
"rash started",
"burning feeling",
"face",
"upper part of",
"torso",
"red spots appeared",
"same distribution",
"spots",
"size",
"spread",
"upper extremities",
"patient",
"spots",
"painful",
"denie... |
A 2-year-old boy is brought to the physician for the evaluation of fever, difficulty breathing, and coughing for the past week. In the past year, he has had four sinus infections, three upper respiratory tract infections, and an episode of severe bronchiolitis requiring hospitalization. Since birth, he has had multiple... | T cells | {
"A": "B cells",
"B": "T cells",
"C": "B and T cells",
"D": "Leukocyte adhesion\n\""
} | step2&3 | B | [
"2 year old boy",
"brought",
"physician",
"evaluation",
"fever",
"difficulty breathing",
"coughing",
"past week",
"past year",
"four sinus infections",
"three upper respiratory tract infections",
"episode of severe bronchiolitis",
"hospitalization",
"birth",
"multiple episodes of oral th... |
A morbidly obese 43-year-old man presents for elective bariatric surgery after previously failing several non-surgical weight loss plans. After discussing the risks and benefits of several different procedures, a sleeve gastrectomy is performed. During the surgery, the surgeon begins by incising into the right half of ... | Right gastroepiploic artery | {
"A": "Short gastric arteries",
"B": "Splenic artery",
"C": "Right gastric artery",
"D": "Right gastroepiploic artery"
} | step1 | D | [
"obese",
"year old man presents",
"elective bariatric surgery",
"failing several non-surgical weight loss plans",
"discussing",
"risks",
"benefits",
"different procedures",
"sleeve gastrectomy",
"performed",
"surgery",
"surgeon begins",
"the right half of",
"greater curvature",
"stomach"... |
A 5-year-old boy is brought in by his parents for recurrent abdominal pain. The child has been taken out of class 5 times this past week for abdominal pain that resulted in him being sent home. The mother reports that her son's stools have remained unchanged during this time and are brown in color, without blood, and w... | Begin cognitive behavioral therapy | {
"A": "Increase oral hydration and fiber intake",
"B": "Check the stool for fecal red blood cells and leukocytes",
"C": "Begin treatment with ciprofloxacin",
"D": "Begin cognitive behavioral therapy"
} | step2&3 | D | [
"5 year old boy",
"brought",
"parents",
"recurrent abdominal pain",
"child",
"taken out",
"class 5 times",
"past week",
"abdominal pain",
"resulted",
"sent home",
"mother reports",
"son's stools",
"unchanged",
"time",
"brown",
"color",
"blood",
"normal consistency",
"scent",
... |
A 40-year-old woman comes to the physician for the evaluation of a 4-month history of reddening of the nose and cheeks. She has no itching or pain. She first noticed the redness while on a recent holiday in Spain, where she stayed at the beach and did daily wine tastings. She has tried several brands of sunscreen, stop... | Topical metronidazole | {
"A": "Topical corticosteroids",
"B": "Topical benzoyl peroxide",
"C": "Oral isotretinoin",
"D": "Topical metronidazole"
} | step2&3 | D | [
"40 year old woman",
"physician",
"evaluation",
"month history",
"nose",
"cheeks",
"itching",
"pain",
"first",
"redness",
"recent holiday",
"Spain",
"beach",
"daily wine",
"brands",
"sunscreen",
"stopped",
"outside",
"middle",
"day",
"not drunk alcohol",
"trip",
"facial r... |
A 25-year-old previously healthy woman presents to her PCP reporting cessation of menses for the past 6 months. Previously, her period occurred regularly, every 30 days. She also complains of decreased peripheral vision, most noticeably when she is driving her car. She denies any recent sexual activity and a pregnancy ... | Decreased bone density | {
"A": "Breast mass",
"B": "Decreased bone density",
"C": "Enlarged thyroid",
"D": "Renal failure"
} | step1 | B | [
"year old",
"healthy woman presents",
"PCP reporting cessation of menses",
"past 6 months",
"period occurred",
"30 days",
"decreased peripheral vision",
"most",
"driving",
"car",
"denies",
"recent sexual activity",
"pregnancy test",
"negative",
"further work-up",
"physical findings",
... |
A 13-year-old boy is brought to the physician because of bleeding from his lips earlier that day. He has a history of recurrent nosebleeds since childhood. His father has a similar history of recurrent nosebleeds. He is at the 60th percentile for height and weight. Examination shows multiple, small dilated capillaries ... | High-output cardiac failure | {
"A": "Glaucoma",
"B": "Renal cell carcinoma",
"C": "High-output cardiac failure",
"D": "Gastrointestinal polyps"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"of bleeding",
"lips earlier",
"day",
"history",
"recurrent nosebleeds",
"childhood",
"father",
"similar history",
"recurrent nosebleeds",
"percentile",
"height",
"weight",
"Examination shows multiple",
"small dilated capillaries",
"lips",
... |
A 22-year-old G1P1 has an uncomplicated vaginal delivery and delivers a newborn boy at 39 + 1 weeks. The APGAR scores are 8 and 9 at 1 and 5 minutes, respectively. Shortly after the delivery, the child is put on his mother’s chest for skin-to-skin and the mother is encouraged to initiate breastfeeding. Which of the fol... | Lactotropes | {
"A": "Thyrotropes",
"B": "Lactotropes",
"C": "Corticotropes",
"D": "Somatotropes"
} | step1 | B | [
"year old G1P1",
"uncomplicated vaginal",
"delivers",
"newborn boy",
"1 weeks",
"APGAR scores",
"5 minutes",
"delivery",
"child",
"put",
"mothers chest",
"skin",
"mother",
"to initiate breastfeeding",
"following cels",
"hormone responsible",
"establishing lactation",
"process"
] |
A 28-year-old man presents to the physician because of dizziness and palpitations for the past 12 hours and fever, malaise, headache, and myalgias for the past week. The patient traveled into the woods of Massachusetts 4 weeks ago. He has no known chronic medical conditions, and there is no history of substance use. Hi... | Spirochete infection | {
"A": "Mycoplasma infection",
"B": " Spirochete infection",
"C": "Viral infection transmitted by Aedes aegypti mosquito bite",
"D": "Sexually transmitted bacterial infection"
} | step2&3 | B | [
"year old man presents",
"physician",
"dizziness",
"palpitations",
"past 12 hours",
"fever",
"malaise",
"headache",
"myalgias",
"past week",
"patient traveled",
"woods",
"Massachusetts",
"weeks",
"known chronic medical conditions",
"history of substance use",
"temperature",
"3C",
... |
A 4-year-old boy is presented to the clinic by his mother due to a peeling erythematous rash on his face, back, and buttocks which started this morning. Two days ago, the patient’s mother says his skin was extremely tender and within 24 hours progressed to desquamation. She also says that, for the past few weeks, he wa... | Staphylococcus aureus | {
"A": "Bacillus anthracis",
"B": "Clostridium sp.",
"C": "Streptococcus sp.",
"D": "Staphylococcus aureus"
} | step1 | D | [
"4 year old boy",
"presented",
"clinic",
"mother due to",
"peeling erythematous rash",
"face",
"back",
"buttocks",
"started",
"morning",
"Two days",
"patients mother",
"skin",
"extremely tender",
"24 hours progressed",
"desquamation",
"past",
"weeks",
"very irritable",
"cried m... |
A 12-month-old boy presents for a routine checkup. The patient immigrated from the Philippines with his parents a few months ago. No prior immunization records are available. The patient’s mother claims that he had a series of shots at 6 months of age which gave him a severe allergic reaction with swelling of the tongu... | Intramuscular influenza vaccine | {
"A": "Measles, mumps, and rubella (MMR) vaccine",
"B": "Intramuscular influenza vaccine",
"C": "Varicella vaccine",
"D": "Intranasal influenza vaccine"
} | step2&3 | B | [
"month old boy presents",
"routine checkup",
"patient",
"Philippines",
"parents",
"few months",
"prior immunization records",
"available",
"patients mother",
"series",
"shots",
"months",
"age",
"gave",
"severe allergic",
"swelling of",
"tongue",
"face",
"remembers",
"same react... |
A 37-year-old man is brought to the emergency department by a friend after he was found lying unconscious outside his front door. The friend reports that they were “pretty drunk” the previous night, and she had dropped her friend off at his home and driven off. When she came back in the morning, she found him passed ou... | Immersion of affected extremities in warm water | {
"A": "Debridement of the affected tissue",
"B": "Intra-arterial administration of tissue plasminogen activator",
"C": "Intravenous administration of warmed crystalloid",
"D": "Immersion of affected extremities in warm water"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"friend",
"found lying unconscious outside",
"front door",
"friend reports",
"drunk",
"previous night",
"dropped",
"friend",
"home",
"driven",
"back",
"morning",
"found",
"passed out",
"next to",
"arrival",
"conscious",
"coop... |
A 16-year-old woman presents to the emergency department for evaluation of acute vomiting and abdominal pain. Onset was roughly 3 hours ago while she was sleeping. She has no known past medical history. Her family history is positive for hypothyroidism and diabetes mellitus in her maternal grandmother. On examination, ... | Administer IV fluids and insulin | {
"A": "Administer IV fluids and insulin",
"B": "Discontinue metformin; initiate basal-bolus insulin",
"C": "Discontinue metformin; initiate insulin aspart at mealtimes",
"D": "Discontinue sitagliptin; initiate basal-bolus insulin"
} | step2&3 | A | [
"year old woman presents",
"emergency department",
"evaluation",
"acute vomiting",
"abdominal",
"Onset",
"hours",
"sleeping",
"known past medical history",
"family history",
"positive",
"hypothyroidism",
"diabetes mellitus",
"maternal grandmother",
"examination",
"found to",
"fruity ... |
A 4-year-old African-American girl is brought to the physician because of multiple episodes of bilateral leg pain for 4 months. The pain is crampy in nature, lasts up to an hour, and occurs primarily before her bedtime. Occasionally, she has woken up crying because of severe pain. The pain is reduced when her mother ma... | Reassurance | {
"A": "Antinuclear antibody",
"B": "Pramipexole therapy",
"C": "X-ray of the lower extremities",
"D": "Reassurance"
} | step2&3 | D | [
"4 year old African-American girl",
"brought",
"physician",
"of multiple episodes",
"bilateral leg pain",
"4 months",
"pain",
"crampy",
"nature",
"lasts",
"hour",
"occurs",
"bedtime",
"Occasionally",
"woken up crying",
"severe pain",
"pain",
"reduced",
"mother massages",
"legs"... |
A 37-year-old man makes an appointment with his primary care physician because he has been feeling tired and is no longer able to play on a recreational soccer team. He also says his coworkers have commented that he appears pale though he has not noticed any changes himself. He says that he has been generally healthy a... | Nematode | {
"A": "Double-stranded virus",
"B": "Nematode",
"C": "Mosquito-born protozoa",
"D": "Single-stranded virus"
} | step1 | B | [
"year old man makes",
"appointment",
"primary care physician",
"feeling tired",
"longer able to play",
"recreational soccer team",
"coworkers",
"commented",
"appears pale",
"not",
"changes",
"healthy",
"only notable event",
"happened",
"year",
"world",
"Based",
"clinical suspicion"... |
A 53-year-old male presents to your office for a regularly scheduled check-up. The patient was diagnosed with type II diabetes mellitus two years ago. To date, diet, exercise, and metformin have failed to control his elevated blood glucose. Past medical history is also significant for hypertension. The patient does not... | Inhibits degradation of endogenous incretins | {
"A": "Inhibits degradation of endogenous incretins",
"B": "Inhibits alpha-glucosidases at the intestinal brush border",
"C": "Activates transcription of PPARs to increase peripheral sensitivity to insulin",
"D": "Increases secretion of insulin in response to oral glucose loads and delays gastric emptying"
} | step1 | A | [
"year old male presents",
"office",
"scheduled check-up",
"patient",
"diagnosed",
"type II diabetes mellitus two years",
"date",
"diet",
"exercise",
"metformin",
"failed to control",
"elevated blood glucose",
"Past medical history",
"significant",
"hypertension",
"patient",
"not smok... |
A 67-year-old woman presents with her husband because of left leg pain and swelling of 3 days’ duration. He has a history of type 2 diabetes mellitus and recent hospitalization for congestive heart failure exacerbation. On physical examination, the left calf is 4 cm greater in circumference than the right. Pitting edem... | Deep venous thrombosis | {
"A": "Superficial venous thrombophlebitis",
"B": "Erythema nodosum",
"C": "Deep venous thrombosis",
"D": "Ruptured popliteal cyst"
} | step2&3 | C | [
"67 year old woman presents",
"husband",
"left leg pain",
"swelling",
"3 days duration",
"history of type 2 diabetes mellitus",
"recent hospitalization",
"congestive exacerbation",
"physical examination",
"left calf",
"4",
"greater",
"circumference",
"right",
"Pitting edema",
"present"... |
A 52-year-old woman presents to the emergency room complaining of chest pain. She reports a 4-hour history of dull substernal pain radiating to her jaw. Her history is notable for hypertension, diabetes mellitus, and alcohol abuse. She has a 30 pack-year smoking history and takes lisinopril and metformin but has an all... | ADP receptor inhibitor | {
"A": "Thrombin inhibitor",
"B": "Vitamin K epoxide reductase inhibitor",
"C": "ADP receptor inhibitor",
"D": "Cyclooxygenase activator"
} | step1 | C | [
"year old woman presents",
"emergency room",
"of chest pain",
"reports",
"4-hour history",
"dull substernal pain radiating",
"jaw",
"history",
"notable",
"hypertension",
"diabetes mellitus",
"alcohol abuse",
"30 pack-year smoking history",
"takes lisinopril",
"metformin",
"allergy",
... |
A 72-year-old woman presents with left lower limb swelling. She first noticed her left leg was swollen about 2 weeks ago. She denies any pain and initially thought the swelling would subside on its own. Past medical history is significant for hypertension and hyperlipidemia. She is a smoker with a 35 pack-year history ... | Perforator veins | {
"A": "Giacomini vein",
"B": "Perforator veins",
"C": "Accessory saphenous vein",
"D": "Deep femoral vein"
} | step1 | B | [
"72 year old woman presents",
"left lower limb swelling",
"first",
"left leg",
"swollen",
"2 weeks",
"denies",
"pain",
"initially thought",
"swelling",
"Past medical history",
"significant",
"hypertension",
"hyperlipidemia",
"smoker",
"35 pack-year history",
"occasional drinker",
"... |
A 22-year-old man comes to the physician because of headaches and blurry vision for the past 6 months. He also reports frequent episodes of vomiting over the last month. His father has died of renal cell carcinoma at the age of 37 years. Examination shows 20/40 vision bilaterally. Fundoscopic examination shows bilatera... | Hemangioblastoma | {
"A": "Medulloblastoma",
"B": "Oligodendroglioma",
"C": "Hemangioblastoma",
"D": "Ependymoma"
} | step1 | C | [
"year old man",
"physician",
"headaches",
"blurry vision",
"past 6 months",
"reports frequent episodes of vomiting",
"last month",
"father",
"died",
"renal cell carcinoma",
"age",
"years",
"Examination shows 20/40 vision",
"Fundoscopic examination shows bilateral optic disc swelling",
"g... |
A 30-year-old man presents to his psychiatrist for a follow-up visit. He was diagnosed with schizophrenia 6 months ago and has been taking fluphenazine. He says that his symptoms are well controlled by the medication, and he no longer has auditory hallucinations. The psychiatrist also notes that his delusions and other... | Choreoathetoid movements of face | {
"A": "Resting tremors",
"B": "Crossing and uncrossing legs constantly",
"C": "Reduced spontaneous movements while walking ",
"D": "Choreoathetoid movements of face"
} | step2&3 | D | [
"30 year old man presents",
"psychiatrist",
"follow-up visit",
"diagnosed",
"schizophrenia 6 months",
"taking fluphenazine",
"symptoms",
"well controlled by",
"medication",
"longer",
"auditory hallucinations",
"psychiatrist",
"notes",
"delusions",
"psychotic symptoms",
"improved",
"p... |
An 8-year-old boy and his 26-year-old babysitter are brought into the emergency department with severe injuries caused by a motor vehicle accident. The child is wheeled to the pediatric intensive care unit with a severe injury to his right arm, as well as other external and internal injuries. He is hemorrhaging and fou... | Amputate the child’s arm at the elbow joint | {
"A": "Amputate the child’s arm at the elbow joint",
"B": "Wait for the child to gain consciousness to obtain his consent to amputate his arm",
"C": "Wait for the child’s babysitter to recover from her injuries to obtain her consent to amputate the child’s arm",
"D": "Obtain an emergency court order from a jud... | step2&3 | A | [
"year old boy",
"year old babysitter",
"brought",
"emergency department",
"severe injuries caused",
"motor vehicle accident",
"child",
"wheeled",
"pediatric intensive care unit",
"severe injury",
"right",
"external",
"internal injuries",
"hemorrhaging",
"found to",
"unstable",
"trans... |
A 55-year-old man comes to the physician because of difficulties achieving an erection for the past year. A medication is prescribed that inhibits cyclic GMP phosphodiesterase type 5. Which of the following is the most likely site of action of the prescribed drug? | Corpus cavernosum | {
"A": "Corpus cavernosum",
"B": "Prostate smooth muscle",
"C": "Corpus spongiosum",
"D": "Pudendal nerve"
} | step1 | A | [
"55 year old man",
"physician",
"difficulties",
"erection",
"past year",
"medication",
"prescribed",
"inhibits cyclic GMP",
"following",
"most likely site of action",
"prescribed drug"
] |
A 65-year-old woman undergoes an abdominal hysterectomy. She develops pain and discharge at the incision site on the fourth postoperative day. The past medical history is significant for diabetes of 12 years duration, which is well-controlled on insulin. Pus from the incision site is sent for culture on MacConkey agar,... | Pseudomonas aeruginosa | {
"A": "Staphylococcus aureus",
"B": "Enterococcus faecalis",
"C": "Streptococcus pyogenes",
"D": "Pseudomonas aeruginosa"
} | step1 | D | [
"65 year old woman",
"abdominal hysterectomy",
"pain",
"discharge",
"incision site",
"fourth postoperative day",
"past medical history",
"significant",
"diabetes",
"years duration",
"well-controlled",
"insulin",
"Pus",
"incision site",
"sent",
"culture",
"MacConkey agar",
"shows wh... |
A 40-year-old woman comes to the emergency department because of difficulty walking for the past 4 hours. She first noticed her symptoms after getting up this morning and her foot dragging while walking. She feels tired. She has a history of chronic sinusitis. Six months ago, she was diagnosed with asthma. Current medi... | Eosinophilic granulomatosis with polyangiitis
" | {
"A": "Granulomatosis with polyangiitis",
"B": "Goodpasture syndrome",
"C": "Excessive glucocorticoid use",
"D": "Eosinophilic granulomatosis with polyangiitis\n\""
} | step2&3 | D | [
"40 year old woman",
"emergency department",
"of difficulty walking",
"past",
"hours",
"first",
"symptoms",
"getting",
"morning",
"foot dragging",
"walking",
"feels tired",
"history",
"chronic sinusitis",
"Six months",
"diagnosed",
"asthma",
"Current medications include",
"albute... |
A 21-year-old medical student is studying different types of necrosis and tissue injuries. In the pathology laboratory, he observes different dead tissues under the microscope and notices the changes that are occurring as a function of time. After serial observations, he deduced that coagulation necrosis is...? | Characterized by the preservation of cellular shape | {
"A": "The result of hydrolytic enzymes",
"B": "Characterized by the preservation of cellular shape",
"C": "Characteristic of brain ischemia",
"D": "Commonly associated with acute pancreatic necrosis"
} | step1 | B | [
"21-year-old medical student",
"studying different types",
"necrosis",
"tissue injuries",
"pathology laboratory",
"observes different dead tissues",
"microscope",
"changes",
"occurring",
"function",
"time",
"serial observations",
"coagulation necrosis"
] |
A 35-year-old male presents to the emergency room with difficulty breathing. He is accompanied by his wife who reports that they were eating peanuts while lying in bed on their backs when he suddenly started coughing profusely. He has a significant cough and has some trouble breathing. His past medical history is notab... | Superior segment of right inferior lobe | {
"A": "Inferior segment of left inferior lobe",
"B": "Anterior segment of right superior lobe",
"C": "Inferior segment of right inferior lobe",
"D": "Superior segment of right inferior lobe"
} | step1 | D | [
"35 year old male presents",
"emergency room",
"difficulty breathing",
"wife",
"reports",
"eating peanuts",
"lying in bed",
"backs",
"started coughing",
"significant cough",
"trouble breathing",
"past medical history",
"notable",
"obesity",
"obstructive sleep apnea",
"seasonal allergie... |
A 28-year-old woman, gravida 1, para 0, at 10 weeks gestation comes to the physician for her first prenatal visit. Today, she feels well. She has no history of serious illness. Her pulse is 75/min and blood pressure is 110/74 mm Hg. Examination shows no abnormalities. Ultrasonography shows a pregnancy consistent in siz... | ↑ normal normal ↑ | {
"A": "↑ normal normal ↑",
"B": "↓ normal normal ↓",
"C": "Normal normal normal normal",
"D": "↓ ↓ normal ↓"
} | step1 | A | [
"year old woman",
"gravida 1",
"para 0",
"10 weeks gestation",
"physician",
"first prenatal visit",
"Today",
"feels well",
"history",
"serious illness",
"pulse",
"75 min",
"blood pressure",
"74 mm Hg",
"Examination shows",
"abnormalities",
"Ultrasonography shows",
"pregnancy consis... |
A 4-day-old boy is monitored in the well baby nursery. He was born to a G1P1 mother at 36 weeks gestation. The child is doing well, and the mother is recovering from vaginal delivery. On physical exam, there is an arousable infant who is crying vigorously and is mildly cyanotic. A red reflex is noted bilaterally on oph... | Indomethacin | {
"A": "Betamethasone",
"B": "Folic acid",
"C": "Indomethacin",
"D": "Prostaglandins"
} | step2&3 | C | [
"4 day old boy",
"monitored",
"well baby nursery",
"born",
"G1P1 mother",
"36 weeks gestation",
"child",
"well",
"mother",
"recovering from vaginal delivery",
"physical exam",
"infant",
"crying vigorously",
"mildly cyanotic",
"red reflex",
"noted",
"ophthalmologic exam",
"infant's ... |
A 17-year-old girl is brought to the physician for the evaluation of fatigue for the past 6 months. During this period, she has had a 5-kg (11-lbs) weight loss. She states that she has no friends. When she is not in school, she spends most of her time in bed. She has no history of serious illness. Her mother has major ... | Bulimia nervosa | {
"A": "Milk-alkali syndrome",
"B": "Anorexia nervosa",
"C": "Major depressive disorder",
"D": "Bulimia nervosa"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"evaluation",
"fatigue",
"past 6 months",
"period",
"5 kg",
"lbs",
"weight loss",
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"friends",
"not",
"school",
"spends most of",
"time",
"bed",
"history",
"serious illness",
"mother",
"major depressive disorder",
"appears pa... |
A study is performed to determine the prevalence of a particular rare fungal pneumonia. A sample population of 100 subjects is monitored for 4 months. Every month, the entire population is screened and the number of new cases is recorded for the group. The data from the study are given in the table below:
Time point Ne... | The prevalence at the conclusion of the study is 25%. | {
"A": "The prevalence at time point 2 months is 2%.",
"B": "The prevalence at time point 3 months is 11%.",
"C": "The prevalence and the incidence at time point 2 months are equal.",
"D": "The prevalence at the conclusion of the study is 25%."
} | step2&3 | D | [
"study",
"performed to",
"prevalence",
"rare fungal pneumonia",
"sample population",
"100 subjects",
"monitored",
"months",
"month",
"entire population",
"screened",
"number",
"new cases",
"recorded",
"group",
"data",
"study",
"given",
"table",
"Time point New cases",
"fungal... |
A 53-year-old woman comes to the physician because of a 3-year history of increasing weakness of her extremities and neck pain that is worse on coughing or sneezing. She first noticed weakness of her right upper extremity 3 years ago, which progressed to her right lower extremity 2 years ago, her left lower extremity 1... | Foramen magnum meningioma | {
"A": "Foramen magnum meningioma",
"B": "Cerebellar astrocytoma",
"C": "Multiple sclerosis",
"D": "Cerebral glioblastoma multiforme\n\""
} | step2&3 | A | [
"year old woman",
"physician",
"3 year history",
"increasing weakness",
"extremities",
"neck pain",
"worse",
"coughing",
"sneezing",
"first",
"weakness",
"right upper extremity",
"years",
"progressed",
"right lower extremity",
"years",
"left lower extremity",
"year",
"left upper ... |
A 3-year-old girl is brought to her pediatrician because of a nosebleed that will not stop. Her parents say that she started having a nosebleed about 1 hour prior to presentation. Since then they have not been able to stop the bleeding. Her past medical history is remarkable for asthma, and she has a cousin who has bee... | Mutation in glycoprotein IIb/IIIa | {
"A": "Decreased levels of von Willebrand factor",
"B": "Mutation in glycoprotein Ib",
"C": "Mutation in glycoprotein IIb/IIIa",
"D": "Production of antibodies against ADAMTS13"
} | step1 | C | [
"3 year old girl",
"brought",
"pediatrician",
"nosebleed",
"not stop",
"parents",
"started",
"nosebleed",
"hour",
"presentation",
"Since then",
"not",
"able to stop",
"bleeding",
"past medical history",
"asthma",
"cousin",
"diagnosed",
"hemophilia",
"Physical exam reveals diffu... |
A 57-year-old man presents to his primary care physician with a 2-month history of right upper and lower extremity weakness. He noticed the weakness when he started falling far more frequently while running errands. Since then, he has had increasing difficulty with walking and lifting objects. His past medical history ... | Mutation in SOD1 | {
"A": "HLA-B8 haplotype",
"B": "HLA-DR2 haplotype",
"C": "Mutation in SOD1",
"D": "Viral infection"
} | step1 | C | [
"57 year old man presents",
"primary care physician",
"2 month history",
"right upper",
"lower extremity weakness",
"weakness",
"started falling far",
"frequently",
"running errands",
"then",
"increasing difficulty",
"walking",
"lifting objects",
"past medical history",
"significant only... |
A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper a... | It arises from hepatocytes | {
"A": "Liver biopsy is required for diagnosis in a majority of patients",
"B": "It arises from the bile duct epithelium",
"C": "It arises from hepatocytes",
"D": "Daughter cysts are usually present on abdominal ultrasound"
} | step2&3 | C | [
"year old African American presents",
"emergency department",
"abdominal pain",
"fatigue",
"weight loss over",
"past 3 months",
"a long standing history of",
"hepatitis B virus infection complicated",
"cirrhosis",
"examination",
"jaundice",
"leg edema",
"palpable mass",
"right upper abdomi... |
A 6-year-old boy presents to the office to establish care after recently being assigned to a shelter run by the local child protective services authority. The nurse who performed the vitals and intake says that, when offered an age-appropriate book to read while waiting for the physician, the patient said that he has n... | Child neglect | {
"A": "Child neglect",
"B": "No abuse",
"C": "Active abuse",
"D": "Passive abuse"
} | step1 | A | [
"year old boy presents",
"office to establish care",
"recently",
"assigned",
"shelter run",
"local child protective services authority",
"nurse",
"performed",
"intake",
"offered",
"age appropriate book to read",
"waiting",
"physician",
"patient",
"never attended",
"school",
"sort",
... |
Researchers are investigating oncogenes, specifically the KRAS gene that is associated with colon, lung, and pancreatic cancer. They have established that the gain-of-function mutation in this gene increases the chance of cancer development. They are also working to advance the research further to study tumor suppresso... | Rb | {
"A": "JAK2",
"B": "Her2/neu",
"C": "Rb",
"D": "BCL-2"
} | step1 | C | [
"Researchers",
"investigating oncogenes",
"KRAS gene",
"associated with colon",
"lung",
"pancreatic cancer",
"established",
"gain-of-function mutation",
"gene increases",
"chance",
"cancer development",
"working to advance",
"research further to study tumor suppressor genes",
"genes",
"c... |
The success of a new treatment designed to deter people from smoking was evaluated by a team of researchers. However, the heaviest and most committed smokers in the study group were less interested in quitting and subsequently dropped out of the study. Nonetheless, the researchers continued with their research (disrega... | Attrition bias | {
"A": "Ascertainment bias",
"B": "Exclusion bias",
"C": "Detection bias",
"D": "Attrition bias"
} | step1 | D | [
"success",
"new treatment designed to",
"people",
"smoking",
"evaluated",
"team",
"researchers",
"heaviest",
"committed smokers",
"study group",
"less interested",
"quitting",
"dropped out",
"study",
"researchers continued",
"research",
"dropped out",
"resulted",
"false conclusio... |
A 45-year-old man presents to the emergency department with complaint off dizziness and nausea for the past hour. He says that he can feel his heartbeat racing. He also reports of generalized weakness that began in the morning. He was diagnosed with end-stage renal disease 2 years ago and currently on dialysis, but he ... | Antagonizes the membrane action of hyperkalemia | {
"A": "Antagonizes the membrane action of hyperkalemia",
"B": "Blocks B adrenergic receptors",
"C": "Prevents platelet aggregation",
"D": "Increase potassium loss from the gastrointestinal tract"
} | step1 | A | [
"year old man presents",
"emergency department",
"complaint",
"dizziness",
"nausea",
"past hour",
"feel",
"heartbeat racing",
"reports",
"generalized weakness",
"began",
"morning",
"diagnosed",
"end-stage renal disease",
"years",
"currently",
"dialysis",
"missed",
"last dialysis ... |
A 38-year-old G1P0 woman presents to her obstetrician for a prenatal visit. She reports feeling well and has no acute concerns. She is currently at 28 weeks gestation previously confirmed by ultrasound. She takes her folate supplements daily. On physical exam, the uterus is soft and globular. The top of the uterine fun... | Cigarette smoking | {
"A": "Aneuploidy",
"B": "Cigarette smoking",
"C": "Fetal congenital heart disease",
"D": "Fetal infection"
} | step2&3 | B | [
"year old",
"woman presents",
"obstetrician",
"prenatal visit",
"reports feeling well",
"acute concerns",
"currently",
"weeks gestation",
"confirmed by ultrasound",
"takes",
"folate supplements daily",
"physical exam",
"uterus",
"soft",
"globular",
"top of",
"uterine fundus",
"foun... |
A 7-day-old female newborn is brought to the physician because of lethargy, vomiting, poor feeding, and diarrhea for 4 days. She was born at 39 weeks' gestation. Vital signs are within normal limits. Bilateral cataracts and icterus are present. Examination shows jaundice of the skin, and the liver is palpated 5-cm belo... | Galactose-1-phosphate | {
"A": "Sphingomyelin",
"B": "Uric acid",
"C": "Branched-chain amino acids",
"D": "Galactose-1-phosphate"
} | step1 | D | [
"day old female newborn",
"brought",
"physician",
"lethargy",
"vomiting",
"poor feeding",
"diarrhea",
"4 days",
"born",
"weeks",
"gestation",
"Vital signs",
"normal limits",
"Bilateral cataracts",
"icterus",
"present",
"Examination shows jaundice",
"skin",
"liver",
"palpated 5 ... |
An 82-year-old man is brought to the emergency department after he was found down by his daughter. On presentation, he is alert and oriented with no obvious signs of trauma. He says that he felt lightheaded shortly before passing out and that he has been feeling extremely fatigued over the last few weeks. He has a know... | Mucin-producing glands with squamous components | {
"A": "Mucin-producing glands with squamous components",
"B": "Pleomorphic giant cells",
"C": "Psammoma bodies",
"D": "Small dark blue cells that stain for chromogranin"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"found",
"daughter",
"presentation",
"alert",
"oriented",
"signs",
"trauma",
"felt lightheaded",
"before passing out",
"feeling extremely fatigued",
"weeks",
"known diagnosis",
"colorectal adenocarcinoma",
"surgically removed 2 month... |
A 54-year-old woman comes to the physician because of lower back pain, night sweats, and a 5-kg (11-lb) weight loss during the past 4 weeks. She has rheumatoid arthritis treated with adalimumab. Her temperature is 38°C (100.4°F). Physical examination shows tenderness over the T10 and L1 spinous processes. Passive exten... | Surface glycolipids that prevent phagolysosome fusion | {
"A": "Polysaccharide capsule that prevents phagocytosis",
"B": "Surface glycolipids that prevent phagolysosome fusion",
"C": "Proteins that bind to the Fc region of immunoglobulin G",
"D": "Protease that cleaves immunoglobulin A"
} | step1 | B | [
"54 year old woman",
"physician",
"lower back pain",
"night sweats",
"5 kg",
"weight loss",
"past 4 weeks",
"rheumatoid arthritis treated with adalimumab",
"temperature",
"100 4F",
"Physical examination shows tenderness",
"T10",
"L1 spinous processes",
"Passive extension",
"right hip cau... |
A 48-year-old woman presents to her primary care physician for a wellness visit. She states she is generally healthy and currently has no complaints. She drinks 1 alcoholic beverage daily and is currently sexually active. Her last menstrual period was 1 week ago and it is regular. She smokes 1 pack of cigarettes per da... | Varenicline and nicotine gum | {
"A": "Bupropion",
"B": "Colonoscopy",
"C": "Varenicline and nicotine gum",
"D": "Weight loss, exercise, and nutrition consultation"
} | step2&3 | C | [
"48 year old woman presents",
"primary care physician",
"wellness visit",
"states",
"healthy",
"currently",
"complaints",
"drinks 1 alcoholic beverage daily",
"currently sexually active",
"last menstrual period",
"1 week",
"regular",
"smokes 1 pack",
"cigarettes",
"day",
"to quit",
"... |
A 55-year-old male presents to his primary care physician complaining of right hip pain for the past eight months. He also reports progressive loss of hearing over the same time period. Radiographic imaging reveals multiple areas of expanded bony cortices and coarsened trabeculae in his right hip and skull. Laboratory ... | Immature woven bone with collagen fibers arranged irregularly | {
"A": "Immature woven bone with collagen fibers arranged irregularly",
"B": "Mature lamellar bone with collagen fibers arranged in lamellae",
"C": "Chondroblasts and chondrocytes forming a cartilaginous matrix",
"D": "Large pleomorphic cells with numerous atypical mitotic figures and “lacey” osteoid formation"... | step1 | A | [
"55 year old male presents",
"primary care physician",
"right hip pain",
"past eight months",
"reports progressive loss of hearing",
"same time period",
"Radiographic imaging reveals multiple areas of expanded bony cortices",
"coarsened trabeculae",
"right hip",
"skull",
"Laboratory analysis rev... |
A 28-year-old woman comes to the physician because she has not had a menstrual period for 3 months. Menarche occurred at the age of 12 years and menses occurred at regular 30-day intervals until they became irregular 1 year ago. She is 160 cm (5 ft 3 in) tall and weighs 85 kg (187 lb); BMI is 33.2 kg/m2. Physical exam ... | Endometrial carcinoma | {
"A": "Cervical carcinoma",
"B": "Choriocarcinoma",
"C": "Mature cystic teratoma",
"D": "Endometrial carcinoma"
} | step1 | D | [
"year old woman",
"physician",
"not",
"menstrual period",
"months",
"Menarche occurred",
"age",
"years",
"menses occurred",
"regular 30 day intervals",
"irregular",
"year",
"5 ft",
"tall",
"85 kg",
"BMI",
"kg/m2",
"Physical exam shows nodules",
"pustules",
"jaw line",
"dark h... |
A 33-year-old woman with Crohn’s disease colitis presents to her physician after 2 days of photophobia and blurred vision. She has had no similar episodes in the past. She has no abdominal pain or diarrhea and takes mesalazine, azathioprine, and prednisone as maintenance therapy. Her vital signs are within normal range... | Increasing dose of prednisone | {
"A": "Adding infliximab",
"B": "Discontinuing sulfasalazine",
"C": "Increasing dose of prednisone",
"D": "No modification of therapy at this time"
} | step2&3 | C | [
"year old woman",
"Crohns disease colitis presents",
"physician",
"2 days",
"photophobia",
"blurred vision",
"similar episodes",
"past",
"abdominal pain",
"diarrhea",
"takes mesalazine",
"azathioprine",
"prednisone",
"maintenance therapy",
"vital signs",
"normal range",
"Examination ... |
A 55-year-old woman with type 2 diabetes mellitus is admitted to the hospital because of a 2-day history of fever, breathlessness, and cough productive of large quantities of green sputum. She drinks 8 beers daily. Her temperature is 39°C (102.2°F), pulse is 110/min, respirations are 28/min, and blood pressure is 100/6... | Lipid A | {
"A": "Lecithinase",
"B": "Lipooligosaccharide",
"C": "Teichoic acid",
"D": "Lipid A"
} | step1 | D | [
"55 year old woman",
"type 2 diabetes mellitus",
"admitted",
"hospital",
"2-day history",
"fever",
"breathlessness",
"cough productive",
"large quantities",
"green sputum",
"drinks",
"beers daily",
"temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"100 60 mm... |
A 6-month-old male presents for a routine visit to his pediatrician. Two months ago, the patient was seen for tachypnea and wheezing, and diagnosed with severe respiratory syncytial virus (RSV) bronchiolitis. After admission to the hospital and supportive care, the patient recovered and currently is not experiencing an... | “Your child has a greater than 20% chance of developing asthma” | {
"A": "“There is no clear relationship between RSV and the development of asthma.”",
"B": "“Your child has a less than 5% chance of developing asthma”",
"C": "“Your child has a greater than 20% chance of developing asthma”",
"D": "“Your child’s risk of asthma is less than the general population.”"
} | step2&3 | C | [
"month old male presents",
"routine visit",
"pediatrician",
"Two months",
"patient",
"seen",
"tachypnea",
"wheezing",
"diagnosed",
"severe respiratory syncytial virus",
"bronchiolitis",
"admission to",
"hospital",
"supportive care",
"patient recovered",
"currently",
"not experiencing... |
A 12-year-old boy is brought to an outpatient clinic by his mother, who noticed that her son’s urine has been dark for the past 4 days. She initially attributed this to inadequate hydration, so she monitored her son’s fluid intake and encouraged him to drink more water. However, she noticed that the color of the urine ... | Elevated level of serum IgA | {
"A": "24-hour urinary protein of more than 4 g",
"B": "Elevated level of serum IgA",
"C": "Elevated IgM-IgG immune complex rheumatoid factor",
"D": "Elevated levels of serum IgG and C3 protein"
} | step1 | B | [
"year old boy",
"brought",
"outpatient clinic",
"mother",
"sons urine",
"dark",
"past 4 days",
"initially attributed",
"inadequate hydration",
"monitored",
"sons fluid intake",
"to drink more water",
"color of",
"urine kept getting darker",
"began to",
"cola",
"boys medical history",... |
A 7-month-old boy is brought to the ED by his mother because of abdominal pain. Two weeks ago, she noticed he had a fever and looser stools, but both resolved after a few days. One week ago, he began to experience periodic episodes during which he would curl up into a ball, scream, and cry. The episodes lasted a few mi... | Air contrast enema | {
"A": "Supportive care",
"B": "Air contrast enema",
"C": "Abdominal CT scan",
"D": "Broad-spectrum antibiotics"
} | step2&3 | B | [
"month old boy",
"brought",
"ED",
"mother",
"abdominal pain",
"Two weeks",
"fever",
"looser stools",
"resolved",
"days",
"One",
"began to experience periodic episodes",
"curl",
"ball",
"scream",
"cry",
"episodes lasted",
"few minutes",
"occasionally followed by vomiting",
"even... |
A 25-year-old man visits a local clinic while volunteering abroad to rebuild homes after a natural disaster. He reports that he has been experiencing an intermittent rash on his feet for several weeks that is associated with occasional itching and burning. He states that he has been working in wet conditions in work bo... | Cell arrest at metaphase | {
"A": "Cell arrest at metaphase",
"B": "Disruption of fungal cell membrane",
"C": "Inhibition of cell wall synthesis",
"D": "Inhibition of DNA synthesis"
} | step1 | A | [
"year old man visits",
"local clinic",
"volunteering",
"to",
"homes",
"natural disaster",
"reports",
"experiencing",
"intermittent rash",
"feet",
"several weeks",
"associated with occasional itching",
"burning",
"states",
"working",
"wet conditions",
"work boots",
"often",
"not",... |
A 58-year-old male presents to his primary care doctor with the complaint of vision changes over the last several months. The patient's past medical history is notable for schizophrenia which has been well-controlled for the last 25 years on chlorpromazine. Which of the following is likely to be seen on ophthalmoscopy? | Corneal deposits | {
"A": "Retinitis pigmentosa",
"B": "Glaucoma",
"C": "Retinal hemorrhage",
"D": "Corneal deposits"
} | step1 | D | [
"58 year old male presents",
"primary care doctor",
"complaint",
"vision changes",
"months",
"patient's past",
"notable",
"schizophrenia",
"well-controlled",
"years",
"chlorpromazine",
"following",
"likely to",
"seen",
"ophthalmoscopy"
] |
A 40-year-old woman presents with a ‘tingling’ feeling in the toes of both feet that started 5 days ago. She says that the feeling varies in intensity but has been there ever since she recovered from a stomach flu last week. Over the last 2 days, the tingling sensation has started to spread up her legs. She also report... | Nerve conduction studies | {
"A": "Transthoracic echocardiography",
"B": "Serum hemoglobin concentration",
"C": "Nerve conduction studies",
"D": "Serum calcium concentration"
} | step1 | C | [
"40 year old woman presents",
"tingling feeling",
"toes",
"feet",
"started 5 days",
"feeling varies",
"intensity",
"ever",
"recovered",
"stomach flu",
"week",
"last 2 days",
"tingling sensation",
"started to spread up",
"legs",
"reports feeling weak",
"legs",
"past 2 days",
"past... |
А 60-уеаr-old Ніѕраnіс mаn рrеѕеntѕ to thе offісе for а rеgulаr hеаlth сhесkuр. Не hаѕ bееn wаіtіng for his hір rерlасеmеnt ѕurgеrу for osteoarthritis, whісh he was diagnosed for the past 5 уеаrѕ. Не admits to having taken high doses of painkillers for hip pain management, but now they don’t provide any pain relief. Ні... | Analgesic nephropathy | {
"A": "Chronic pyelonephritis",
"B": "Acute tubular necrosis",
"C": "Membranous nephropathy",
"D": "Analgesic nephropathy"
} | step1 | D | [
" 60 r old n mn",
"th",
"h bn",
"h",
"osteoarthritis",
"diagnosed",
"past",
"r",
"admits",
"taken high doses",
"painkillers",
"hip",
"now",
"provide",
"pain relief",
"include",
"blood",
"70 mm g",
"ul",
"mn",
"36",
"98",
"rt 10 mn",
"physical",
"thr",
"h",
"labora... |
A 29-year-old woman is hospitalized due to depression and suicidal ideation. She has a 5-year history of chaotic relationships that last only a few short weeks or months. Each relationship has left her feeling abandoned, empty, and extremely upset. During these periods, the patient confesses to shopping and making big ... | Borderline personality disorder | {
"A": "Major depressive disorder (MDD)",
"B": "Bipolar I disorder",
"C": "Borderline personality disorder",
"D": "Factitious disorder"
} | step1 | C | [
"29 year old woman",
"hospitalized due to depression",
"suicidal ideation",
"5 year history",
"relationships",
"last only",
"few short weeks",
"months",
"relationship",
"left",
"feeling abandoned",
"empty",
"extremely upset",
"periods",
"patient",
"shopping",
"making big purchases",
... |
A 63-year-old man is brought to the emergency department by his wife because she is concerned he is having another stroke. The patient says he woke up with right-sided facial weakness and drooping. Past medical history is significant for a recent case of shingles treated with acyclovir, and a stroke, diagnosed 10 years... | Decreased salivation | {
"A": "Decreased salivation",
"B": "Partial hearing loss",
"C": "Complete loss of taste to the tongue",
"D": "Wrinkled forehead"
} | step1 | A | [
"63 year old man",
"brought",
"emergency department",
"wife",
"concerned",
"stroke",
"patient",
"woke up",
"right-sided facial weakness",
"Past medical history",
"significant",
"recent case",
"shingles treated with acyclovir",
"stroke",
"diagnosed 10 years",
"recovered",
"residual fu... |
A 65-year-old male with diffuse large B cell lymphoma is treated with a chemotherapy regimen including 6-mercaptopurine. Administration of which of the following agents would increase this patient’s risk for mercaptopurine toxicity? | Allopurinol | {
"A": "Dexrazoxane",
"B": "Mesna",
"C": "Allopurinol",
"D": "Amifostine"
} | step1 | C | [
"65-year-old male",
"diffuse large B cell lymphoma",
"treated with",
"chemotherapy regimen including 6-mercaptopurine",
"Administration",
"following agents",
"increase",
"patients risk",
"mercaptopurine toxicity"
] |
A 55-year-old man comes to the physician because of weight loss and increased urinary frequency for the past month. He has also noticed blood in the urine, usually towards the end of voiding. He emigrated to the U.S. from Kenya 5 years ago. He has smoked one pack of cigarettes daily for 35 years. Physical examination s... | Elevated mean pulmonary artery pressure | {
"A": "Calcified cysts in the liver",
"B": "Elevated mean pulmonary artery pressure",
"C": "Atrophy of the retina with sclerosing keratitis",
"D": "Peripheral nonpitting edema"
} | step1 | B | [
"55 year old man",
"physician",
"weight loss",
"increased urinary frequency",
"past month",
"blood in",
"urine",
"usually",
"end",
"voiding",
"emigrated",
"U",
"Kenya",
"years",
"smoked one pack",
"cigarettes daily",
"35 years",
"Physical examination shows",
"palpable",
"spleno... |
A 62-year-old woman is brought to the emergency department because of sudden loss of vision in her right eye that occurred 50 minutes ago. She does not have eye pain. She had several episodes of loss of vision in the past, but her vision improved following treatment with glucocorticoids. She has coronary artery disease... | Central retinal artery occlusion | {
"A": "Central serous retinopathy",
"B": "Acute angle-closure glaucoma",
"C": "Vitreous hemorrhage",
"D": "Central retinal artery occlusion"
} | step2&3 | D | [
"62 year old woman",
"brought",
"emergency department",
"of sudden loss",
"vision",
"right eye",
"occurred 50 minutes",
"not",
"eye pain",
"several episodes of loss",
"vision",
"past",
"vision improved following treatment",
"glucocorticoids",
"coronary artery disease",
"hypertension",
... |
A male child is presented at the pediatric clinic for a well-child visit by his mother who reports previously normal developmental milestones. The child was born at 40 weeks with no complications during pregnancy or birth. The mother notes that the child is able to sit momentarily propped up with his hand. The infant i... | Babbling | {
"A": "Babbling",
"B": "Cooing",
"C": "Saying words such as apple and cat, though limited to around 4 different words",
"D": "Two-word combinations"
} | step2&3 | A | [
"male child",
"presented",
"pediatric clinic",
"well-child visit",
"mother",
"reports",
"normal developmental milestones",
"child",
"born",
"40 weeks",
"complications",
"pregnancy",
"birth",
"mother notes",
"child",
"able to sit",
"hand",
"infant",
"able to sit",
"support",
"... |
A 14-year-old boy is brought to a child psychiatry office by his father, who is concerned about his grades and teachers’ comments that he has “problems focusing.” He has a B- average. The boy's teachers in math, social studies, and English say that he often appears to not be listening in class, instead talking to class... | Reduced interest | {
"A": "Attention deficit hyperactivity disorder (ADHD)",
"B": "Intellectual disability",
"C": "Mood disorder",
"D": "Reduced interest"
} | step1 | D | [
"year old boy",
"brought",
"child psychiatry office",
"father",
"concerned",
"grades",
"teachers comments",
"problems focusing",
"a B",
"average",
"boy's teachers",
"math",
"social studies",
"English",
"often appears to not",
"listening",
"class",
"talking",
"classmates",
"maki... |
A 65-year-old male who is being treated for depression visits your emergency room complaining of being unable to urinate. In addition, the patient complains of tachycardia and dry mouth. He has no history of benign prostatic hyperplasia and reports of only being on one psychiatric medication. What type of psychiatric m... | Tricyclic antidepressant | {
"A": "Monoamine oxidase inhibitor",
"B": "Aminoketone",
"C": "Selective serotonin reuptake inhibitor",
"D": "Tricyclic antidepressant"
} | step1 | D | [
"65 year old male",
"treated",
"depression visits",
"emergency room",
"unable to",
"addition",
"patient",
"tachycardia",
"dry mouth",
"history of benign prostatic hyperplasia",
"reports",
"only",
"one psychiatric medication",
"type",
"psychiatric",
"cause",
"side effect profile"
] |
A previously healthy 5-year-old boy is brought to the emergency department because of a 1-day history of high fever. His temperature prior to arrival was 40.0°C (104°F). There is no family history of serious illness. Development has been appropriate for his age. He is administered rectal acetaminophen. While in the wai... | Intravenous administration of lorazepam | {
"A": "Intravenous administration of lorazepam",
"B": "Intravenous administration of phenobarbital",
"C": "Obtain blood cultures",
"D": "Intravenous administration of fosphenytoin"
} | step2&3 | A | [
"healthy",
"year old boy",
"brought",
"emergency department",
"1-day history",
"high fever",
"temperature prior to arrival",
"40",
"family history",
"serious illness",
"Development",
"appropriate",
"age",
"administered rectal acetaminophen",
"waiting room",
"unresponsive",
"starts je... |
A 21-year-old man with a recent history of traumatic right femur fracture status post open reduction and internal fixation presents for follow-up. The patient says his pain is controlled with the oxycodone but he says he has been severely constipated the past 4 days. No other past medical history. Current medications a... | Opiates increase fluid absorption from the lumen leading to hard stools | {
"A": "Opiates increase the production and secretion of pancreatic digestive enzymes",
"B": "Opiates increase fluid absorption from the lumen leading to hard stools",
"C": "Opiates decrease the sympathetic activity of the gut wall",
"D": "Opiates activate the excitatory neural pathways in the gut"
} | step1 | B | [
"21-year-old man",
"recent history of traumatic right femur fracture",
"open reduction",
"internal fixation presents",
"follow-up",
"patient",
"pain",
"controlled",
"oxycodone",
"severely constipated",
"past",
"days",
"past medical history",
"Current medications",
"oxycodone",
"ibuprof... |
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