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 23-year-old woman presents to her primary care physician for knee pain. The pain started yesterday and has not improved since then. The patient is generally in good health. She attends college and plays soccer for her school's team. Three days ago, she was slide tackled during a game and her leg was struck from the o... | Medial meniscal tear | {
"A": "Anterior cruciate ligament tear",
"B": "Posterior cruciate ligament tear",
"C": "Medial meniscal tear",
"D": "Iliotibial band syndrome"
} | step2&3 | C | [
"23 year old woman presents",
"primary care physician",
"knee pain",
"pain started",
"not improved since then",
"patient",
"good health",
"attends college",
"plays soccer",
"school's team",
"Three days",
"slide",
"game",
"leg",
"struck",
"outside",
"fell",
"sat out",
"rest",
"g... |
A 67-year-old man presents to the emergency department with abdominal pain that started 1 hour ago. The patient has a past medical history of diabetes and hypertension as well as a 40 pack-year smoking history. His blood pressure is 107/58 mmHg, pulse is 130/min, respirations are 23/min, and oxygen saturation is 98% on... | Emergent surgical intervention | {
"A": "Administer labetalol",
"B": "Counsel the patient in smoking cessation",
"C": "Emergent surgical intervention",
"D": "Serial annual abdominal ultrasounds"
} | step2&3 | C | [
"67 year old man presents",
"emergency department",
"abdominal pain",
"started 1 hour",
"patient",
"past medical diabetes",
"hypertension",
"40 pack-year smoking history",
"blood pressure",
"58 mmHg",
"pulse",
"min",
"respirations",
"23 min",
"oxygen saturation",
"98",
"room air",
... |
A 15-year-old boy comes to the physician because of severe muscle cramps and pain for 3 months. He first noticed these symptoms while attending tryouts for the high school football team. Since then, he becomes easily fatigued and has severe muscle pain and swelling after 10 minutes of playing. However, after a brief pe... | Myophosphorylase deficiency | {
"A": "Thyroid hormone deficiency",
"B": "Myophosphorylase deficiency",
"C": "Acid maltase deficiency",
"D": "CTG repeat in the DMPK gene"
} | step1 | B | [
"year old boy",
"physician",
"severe muscle cramps",
"pain",
"months",
"first",
"symptoms",
"attending",
"high football team",
"Since then",
"easily fatigued",
"severe muscle",
"swelling",
"10 minutes",
"playing",
"brief period",
"rest",
"symptoms",
"able to return",
"game",
... |
A 82-year-old man who is currently being managed by the internal medicine service agrees to be examined by medical students as part of their training in physical examination. He is visited by a small group of medical students under the instruction of a preceptor and allows the students to make observations. They find t... | Left heart failure | {
"A": "Left heart failure",
"B": "Long bone fractures",
"C": "Protein C/S deficiency",
"D": "Tall, thin males"
} | step1 | A | [
"year old man",
"currently",
"managed",
"internal medicine service agrees to",
"examined",
"medical students",
"part of",
"training",
"physical examination",
"visited",
"a small group",
"medical students",
"instruction",
"allows",
"students to make observations",
"find",
"crackles",
... |
A 2500-g (5.5-lb) male newborn is delivered at 35 weeks' gestation to a 25-year-old woman, gravida 2, para 1. The pregnancy was complicated by oligohydramnios. Pulse oximetry on room air shows an oxygen saturation of 78%. Examination in the delivery room shows that the newborn's skin appears blue with weak cry and irre... | Voiding cystourethrogram | {
"A": "Voiding cystourethrogram",
"B": "Echocardiography",
"C": "Karyotyping",
"D": "Blood cultures"
} | step2&3 | A | [
"2500",
"male newborn",
"delivered",
"35 weeks",
"gestation",
"year old woman",
"gravida 2",
"para 1",
"pregnancy",
"complicated",
"oligohydramnios",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"Examination",
"delivery shows",
"newborn's skin appears blue",
"weak cry",... |
A 5-year-old girl presents to the physician with increased muscle cramping in her lower extremities after walking extended distances. The young girl is in the 10th percentile for height. Her past medical history is notable only for a cystic hygroma detected shortly after birth. Which of the following findings is most l... | Inferior erosion of the ribs | {
"A": "Barr bodies on buccal smear",
"B": "Endocardial cushion defect",
"C": "Inferior erosion of the ribs",
"D": "Apparent hypertrophy of the calves"
} | step1 | C | [
"5 year old girl presents",
"physician",
"increased muscle cramping",
"lower extremities",
"walking extended distances",
"young girl",
"percentile",
"height",
"past medical history",
"notable only",
"cystic hygroma detected",
"birth",
"following findings",
"most likely",
"patient"
] |
A 30-year-old African American man comes to the doctor's office for an annual checkup. He feels healthy and his only concern is an occasional headache after work. Past medical history is significant for an appendectomy 10 years ago and a fractured arm playing football in high school. His mother has type 2 diabetes mell... | Recommend weight loss, more exercise, and a salt-restricted diet. | {
"A": "Start him on lisinopril.",
"B": "Order a glycosylated hemoglobin test (HbA1c).",
"C": "Start him on hydrochlorothiazide and lisinopril together.",
"D": "Recommend weight loss, more exercise, and a salt-restricted diet."
} | step1 | D | [
"30 year old African American man",
"doctor's office",
"annual checkup",
"feels healthy",
"only concern",
"occasional headache",
"work",
"Past medical history",
"significant",
"appendectomy 10 years",
"fractured arm playing football",
"high school",
"mother",
"type 2 diabetes mellitus",
... |
A 4-year-old girl is brought to the physician with a 3-month history of progressive intermittent pain and swelling involving both knees, right ankle, and right wrist. The patient has been undergoing treatment with acetaminophen and ice packs, both of which relieved her symptoms. The affected joints feel "stuck” and are... | Oligoarticular juvenile idiopathic arthritis | {
"A": "Enthesitis-related arthritis",
"B": "Oligoarticular juvenile idiopathic arthritis",
"C": "Postinfectious arthritis",
"D": "Seronegative polyarticular juvenile idiopathic arthritis"
} | step2&3 | B | [
"4 year old girl",
"brought",
"physician",
"3 month history",
"progressive intermittent pain",
"swelling involving",
"knees",
"right ankle",
"right wrist",
"patient",
"treatment",
"acetaminophen",
"ice packs",
"relieved",
"symptoms",
"affected joints feel",
"difficult to move immedia... |
A 28-year-old woman with a past history of type 1 diabetes presents to your office with a 2-week history of vaginal itching and soreness accompanied by a white, clumpy vaginal discharge which she says resembles cheese curds. Her last HbA1c from a month ago was 7.8%, and her last cervical cytology from 10 months ago was... | Hyphae | {
"A": "Clue cells on saline smear",
"B": "Hyphae",
"C": "Multinucleated giant cells",
"D": "Gram-negative diplococci"
} | step1 | B | [
"year old woman",
"past history of type 1 diabetes presents",
"office",
"2-week history",
"vaginal itching",
"soreness",
"white",
"clumpy vaginal discharge",
"cheese curds",
"last",
"month",
"last cervical cytology",
"10 months",
"reported",
"normal",
"blood pressure",
"76 mmHg",
"... |
A 33-year-old woman comes to the physician for the evaluation of bleeding from her gums for 2 weeks. These episodes occur spontaneously and are self-limiting. She has also had purplish skin lesions over her legs for 2 months. Last week, she had one episode of hematuria and watery diarrhea, both of which resolved withou... | IgG antibodies against platelets | {
"A": "Deficient Von Willebrand factor",
"B": "Shiga-like toxin",
"C": "Consumptive coagulopathy",
"D": "IgG antibodies against platelets"
} | step2&3 | D | [
"year old woman",
"physician",
"evaluation",
"bleeding",
"gums",
"2 weeks",
"episodes occur",
"self limiting",
"skin lesions",
"legs",
"2 months",
"Last week",
"one episode of hematuria",
"watery diarrhea",
"resolved",
"treatment",
"mild asthma",
"brother",
"hemophilia",
"only ... |
A 4-year-old boy is brought to the physician by his mother because of left-sided neck swelling that has slowly progressed over the past 4 weeks. He has no history of serious illness. Temperature is 38°C (100.4°F). Physical examination shows a non-tender, mobile mass in the left submandibular region with overlying eryth... | Color blindness | {
"A": "Acute kidney injury",
"B": "Color blindness",
"C": "Methemoglobinemia",
"D": "Peripheral neuropathy"
} | step1 | B | [
"4 year old boy",
"brought",
"physician",
"mother",
"of left-sided neck swelling",
"slowly progressed",
"past 4 weeks",
"history",
"serious illness",
"Temperature",
"100 4F",
"Physical examination shows",
"non-tender",
"mobile mass",
"left submandibular region",
"erythema",
"biopsy",... |
A 14-year-old boy is brought to the pediatrician by his parents with complaints of extra teeth in his lower and upper jaws. He was born by cesarean section at full term and his birth weight was 3.6 kg (7.9 lb). Until 6 months of age, he was breastfed and after that, solid foods were started. He did not cry immediately ... | CGG | {
"A": "CGG",
"B": "CAG",
"C": "GAA",
"D": "CTG"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatrician",
"parents",
"complaints",
"extra teeth",
"lower",
"upper jaws",
"born by cesarean section",
"full term",
"birth weight",
"3.6 kg",
"months",
"age",
"breastfed",
"solid foods",
"started",
"not cry immediately",
"birth",
"admitted to",
... |
A 28-year-old woman visits her physician with complaints of inability to become pregnant despite frequent unprotected sexual intercourse with her husband for over a year. She breastfed her only child until about 13 months ago, when the couple decided to have a second child. Over the past year, the patient has had only ... | Prolactinoma | {
"A": "Primary ovarian insufficiency",
"B": "Prolactinoma",
"C": "Sheehan’s syndrome",
"D": "Normal findings"
} | step2&3 | B | [
"year old woman visits",
"physician",
"complaints",
"to",
"pregnant",
"frequent unprotected sexual intercourse",
"husband",
"year",
"breastfed",
"only child",
"about",
"months",
"couple",
"to",
"second child",
"past year",
"patient",
"only",
"episodes of menstrual bleeding",
"r... |
A 53-year-old man is admitted to the intensive care unit from the emergency department with severe pancreatitis. Overnight, he starts to develop severe hypoxemia, and he is evaluated by a rapid response team. On exam the patient is breathing very quickly and has rales and decreased breath sounds bilaterally. He is plac... | Intra-alveolar hyaline membrane formation | {
"A": "Decreased lecithin to sphingomyelin ratio",
"B": "Hemosiderin-laden alveolar macrophages",
"C": "Intra-alveolar hyaline membrane formation",
"D": "Large clot in pulmonary artery"
} | step1 | C | [
"year old man",
"admitted to",
"intensive care unit",
"emergency department",
"severe pancreatitis",
"Overnight",
"starts to",
"severe hypoxemia",
"evaluated",
"rapid response team",
"exam",
"patient",
"breathing very",
"rales",
"decreased breath sounds",
"placed",
"50",
"FiO2",
... |
Several weeks after starting a new medication for rheumatoid arthritis, a 44-year-old woman comes to the physician because of painful ulcers in her mouth. Oral examination shows inflammation and swelling of the tongue and oropharynx and ulcers on the buccal mucosa bilaterally. Skin examination shows soft tissue swellin... | Inhibition of dihydrofolate reductase | {
"A": "Inhibition of thymidylate synthase",
"B": "Inhibition of dihydrofolate reductase",
"C": "Inhibition of cyclooxygenase",
"D": "Inhibition of NF-κB"
} | step1 | B | [
"Several weeks",
"starting",
"new medication",
"rheumatoid arthritis",
"year old woman",
"physician",
"of painful",
"mouth",
"examination shows inflammation",
"swelling of",
"tongue",
"oropharynx",
"ulcers",
"buccal mucosa",
"Skin examination shows soft tissue swelling",
"proximal inte... |
A 68-year-old man comes to the physician for a routine health maintenance examination. His wife has noticed that his left eye looks smaller than his right eye. He has had left shoulder and arm pain for 3 months. He has hypertension and coronary artery disease. Current medications include enalapril, metoprolol, aspirin,... | CT scan of the chest | {
"A": "Applanation tonometry",
"B": "Rapid plasma reagin",
"C": "CT scan of the chest",
"D": "Anti-acetylcholine receptor antibodies"
} | step2&3 | C | [
"68 year old man",
"physician",
"routine health maintenance examination",
"wife",
"left eye looks smaller",
"right eye",
"left shoulder",
"arm pain",
"months",
"hypertension",
"coronary artery disease",
"Current medications include enalapril",
"metoprolol",
"aspirin",
"atorvastatin",
"... |
A 28-year-old man is brought to the emergency department after his girlfriend found him twitching and jerking in the yard while gardening. Shortly after he became obtunded, emergency medical services reported 1 episode of emesis during transport. His blood pressure is 85/50 mmHg, pulse is 55/min, and respirations are i... | Atropine and pralidoxime | {
"A": "Atropine",
"B": "Atropine and pralidoxime",
"C": "Lamotrigine",
"D": "Naloxone"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"girlfriend found",
"twitching",
"jerking",
"yard",
"gardening",
"obtunded",
"emergency medical services reported 1 episode of emesis",
"transport",
"blood pressure",
"85 50 mmHg",
"pulse",
"55 min",
"respirations",
"irregular",
"P... |
A 73-year-old female presents to you for an office visit with complaints of getting lost. The patient states that over the last several years, the patient has started getting lost in places that she is familiar with, like in her neighborhood while driving to her church. She has also has difficulty remembering to pay he... | Memantine | {
"A": "Ropinirole",
"B": "Memantine",
"C": "Pramipexole",
"D": "Pergolide"
} | step2&3 | B | [
"year old female presents",
"office visit",
"complaints",
"getting lost",
"patient states",
"last",
"years",
"patient",
"started getting lost",
"places",
"familiar",
"neighborhood",
"driving",
"church",
"difficulty remembering to pay",
"bills",
"denies",
"complaints",
"normal",
... |
A 65-year-old man comes to the physician because of a 10-month history of progressive shortness of breath and a cough productive of a small amount of white phlegm. Bilateral end-expiratory wheezing is heard on auscultation of the chest. Pulmonary function tests show total lung capacity that is 108% of predicted, an FEV... | Smoking cessation | {
"A": "Smoking cessation",
"B": "Salmeterol therapy",
"C": "Fluticasone therapy",
"D": "Alpha-1 antitrypsin therapy"
} | step1 | A | [
"65 year old man",
"physician",
"of a 10 month history",
"progressive shortness",
"breath",
"cough productive",
"small",
"white phlegm",
"Bilateral end",
"heard",
"auscultation",
"chest",
"Pulmonary function tests show total lung capacity",
"predicted",
"FEV1",
"predicted",
"FEV1:FVC... |
A 28-year-old woman survives a plane crash in the Arctic region of Alaska. She is unable to recover any food from the crash site but is able to melt snow into drinking water using a kettle and a lighter. A rescue helicopter finally finds her after 12 days, and she is flown to a hospital. At this time, which of the foll... | Acetoacetate | {
"A": "Acetoacetate",
"B": "Amino acids",
"C": "Cholesterol",
"D": "Free fatty acids"
} | step1 | A | [
"year old woman survives",
"plane",
"Arctic region",
"Alaska",
"unable to recover",
"food",
"site",
"able",
"melt snow",
"drinking water using",
"lighter",
"rescue helicopter",
"finds",
"days",
"flown",
"hospital",
"time",
"following substances",
"mostly responsible",
"supplyin... |
A 31-year-old woman presents to the emergency department with a 2-week history of dry cough and shortness of breath on exertion. She says that she has also been feeling joint pain that has been increasing over time and is worst in the mornings. Finally, she has noticed painful swellings that have been appearing on her ... | Noncaseating granulomas | {
"A": "Acid-fast rods",
"B": "Antibodies to small nuclear ribonucleoproteins",
"C": "Golden-brown fusiform rods",
"D": "Noncaseating granulomas"
} | step1 | D | [
"31 year old woman presents",
"emergency department",
"2-week history",
"dry cough",
"shortness of breath",
"exertion",
"feeling joint pain",
"increasing",
"time",
"worst",
"mornings",
"painful swellings",
"appearing",
"body",
"last month",
"past medical history",
"significant",
"c... |
A 59-year-old man comes to the emergency department because of progressive abdominal swelling and shortness of breath for 1 week. He drinks 12 to 13 alcoholic beverages daily. He appears emaciated. Examination shows pallor, jaundice, hepatomegaly, gynecomastia, and a protuberant abdomen with a fluid wave and shifting d... | Alpha-fetoprotein | {
"A": "S-100 protein",
"B": "Alpha-fetoprotein",
"C": "Cancer antigen 19-9",
"D": "Beta-human chorionic gonadotropin"
} | step1 | B | [
"59 year old man",
"emergency department",
"progressive abdominal swelling",
"shortness of breath",
"1 week",
"drinks",
"alcoholic beverages daily",
"appears emaciated",
"Examination shows pallor",
"jaundice",
"hepatomegaly",
"gynecomastia",
"protuberant abdomen",
"fluid wave",
"shifting... |
An 7-month-old boy is brought to the pediatrician by his parents due to progressively worsening weakness for the last three months. The parents also describe the boy as having an exaggerated response when startled as well as diminishing response to visual stimuli. At birth, the boy was healthy and remained as such for ... | Hexosaminidase A | {
"A": "ß-Glucosidase",
"B": "Hexosaminidase A",
"C": "Hexosaminidase B",
"D": "Arylsulfatase A"
} | step1 | B | [
"month old boy",
"brought",
"pediatrician",
"parents due to",
"worsening weakness",
"three months",
"parents",
"boy",
"exaggerated response",
"diminishing response to visual stimuli",
"birth",
"boy",
"healthy",
"first",
"months",
"life",
"mother",
"pregnancy",
"unremarkable",
"... |
A 68-year-old man presents to the clinic for a regular health checkup. He is hypertensive and was diagnosed with congestive heart failure last year. He has hyperlipidemia but does not take any medication for it. Although he takes his antihypertensive medications regularly, his blood pressure recordings at home tend to ... | Hypokalemia | {
"A": "Hypocalcemia",
"B": "Hypoglycemia",
"C": "Hyperuricemia",
"D": "Hypokalemia"
} | step1 | D | [
"68 year old man presents",
"clinic",
"regular health checkup",
"hypertensive",
"diagnosed",
"congestive heart failure",
"year",
"hyperlipidemia",
"not take",
"medication",
"takes",
"antihypertensive medications",
"blood pressure",
"at home",
"range",
"98",
"90 mm Hg",
"Today",
"... |
A 35-year-old female presents to her PCP at the request of her husband after 3 weeks of erratic behavior. The patient has been staying up all night online shopping on eBay. Despite a lack of sleep, she is "full of energy" during the day at her teaching job, which she believes is "beneath [her], anyway." She has not sou... | Valproate and olanzapine | {
"A": "Valproate and venlafaxine",
"B": "Valproate and olanzapine",
"C": "Haloperidol",
"D": "Electroconvulsive therapy"
} | step2&3 | B | [
"35 year old female presents",
"PCP",
"request",
"husband",
"3 weeks",
"behavior",
"patient",
"night",
"shopping",
"lack",
"sleep",
"full of energy",
"day",
"teaching job",
"not",
"psychiatric",
"past",
"reports",
"episode of self diagnosed depression",
"years",
"patient deni... |
A 10-day-old newborn is undergoing surgery for the removal of a branchial cleft cyst. Histopathology of the cyst shows squamous cells with lymphoid infiltrate and keratinaceous cellular debris embedded in adipose tissue with a high concentration of mitochondria. Which of the following substances is most likely to be fo... | Thermogenin | {
"A": "Thermogenin",
"B": "Leptin",
"C": "Kinesin",
"D": "Ubiquitin"
} | step1 | A | [
"A 10 day old newborn",
"surgery",
"the removal of",
"branchial cleft cyst",
"Histopathology",
"shows squamous",
"lymphoid infiltrate",
"cellular debris embedded",
"adipose tissue",
"high concentration",
"mitochondria",
"following substances",
"most likely to",
"found",
"mitochondria"
] |
A 32-year-old physician is cleaning his pool when he splashes the hydrochloric acid in his left eye. He feels immediate pain and burning. His eye starts to tear profusely, and he can barely open it. His medical history is significant for psoriasis. He is farsighted and has glasses for reading and computer work. He uses... | Irrigate with tap water | {
"A": "Call the patient’s ophthalmologist",
"B": "Go to the emergency department immediately",
"C": "Irrigate with alkali solution",
"D": "Irrigate with tap water"
} | step2&3 | D | [
"year old physician",
"cleaning",
"pool",
"splashes",
"hydrochloric acid",
"left eye",
"feels immediate pain",
"burning",
"eye starts to tear",
"open",
"medical history",
"significant",
"psoriasis",
"farsighted",
"glasses",
"reading",
"computer work",
"uses topical calcipotriene",
... |
A previously healthy 31-year-old woman comes to the emergency department because of sudden, severe epigastric pain and vomiting for the past 4 hours. She reports that the pain radiates to the back and began when she was having dinner and drinks at a local brewpub. Her temperature is 37.9°C (100.2°F), pulse is 98/min, r... | Right upper quadrant abdominal ultrasound | {
"A": "Contrast-enhanced abdominal CT scan",
"B": "Right upper quadrant abdominal ultrasound",
"C": "Plain x-ray of the abdomen",
"D": "Blood alcohol level assay"
} | step2&3 | B | [
"healthy 31 year old woman",
"emergency department",
"sudden",
"severe epigastric",
"vomiting",
"past",
"hours",
"reports",
"pain radiates",
"back",
"began",
"dinner",
"drinks",
"local",
"temperature",
"100",
"pulse",
"98 min",
"respirations",
"min",
"blood pressure",
"60 m... |
A 54-year-old man with a history of hyperlipidemia presents to the emergency department complaining of left sided chest pain. He says the pain began 3 hours ago while he was cooking dinner in his kitchen. The pain radiates to his left arm and stomach. He also complains of feeling anxious and heart palpitations. Tempera... | Irreversible ADP receptor antagonism | {
"A": "Antithrombin III activation",
"B": "Direct factor Xa inhibition",
"C": "GPIIb/IIIa inhibition",
"D": "Irreversible ADP receptor antagonism"
} | step1 | D | [
"54 year old man",
"history of hyperlipidemia presents",
"emergency department",
"of left sided chest",
"pain began 3 hours",
"cooking dinner",
"kitchen",
"pain radiates",
"left arm",
"stomach",
"feeling anxious",
"heart palpitations",
"Temperature",
"98",
"blood pressure",
"80 mmHg",
... |
A 43-year-old Caucasian female with a long history of uncontrolled migraines presents to general medical clinic with painless hematuria. She is quite concerned because she has never had symptoms like this before. Vital signs are stable, and her physical examination is benign. She denies any groin pain, flank pain, or c... | Analgesic nephropathy | {
"A": "Analgesic nephropathy",
"B": "Kidney stone",
"C": "Bladder cancer",
"D": "Sickle cell disease"
} | step2&3 | A | [
"year old Caucasian female",
"long history of uncontrolled migraines presents",
"general medical clinic",
"painless hematuria",
"concerned",
"never",
"symptoms",
"Vital",
"stable",
"physical examination",
"benign",
"denies",
"groin pain",
"flank pain",
"costovertebral angle tenderness",
... |
A 38-year-old man comes to the physician because of a 2-week history of abdominal pain and an itchy rash on his buttocks. He also has fever, nausea, and diarrhea with mucoid stools. One week ago, the patient returned from Indonesia, where he went for vacation. Physical examination shows erythematous, serpiginous lesion... | Rhabditiform larvae on stool microscopy | {
"A": "Rhabditiform larvae on stool microscopy",
"B": "Oocysts on acid-fast stool stain",
"C": "Giardia lamblia antibodies on stool immunoassay",
"D": "Branching septate hyphae on KOH preparation"
} | step1 | A | [
"year old man",
"physician",
"2-week history",
"abdominal pain",
"itchy",
"buttocks",
"fever",
"nausea",
"diarrhea",
"mucoid stools",
"One week",
"patient returned",
"Indonesia",
"vacation",
"Physical examination shows erythematous",
"lesions",
"perianal region",
"posterior thighs"... |
A 35-year-old woman comes to the physician because of headaches, irregular menses, and nipple discharge for the past 4 months. Breast examination shows milky white discharge from both nipples. Her thyroid function tests and morning cortisol concentrations are within the reference ranges. A urine pregnancy test is negat... | ↓ ↓ ↑ | {
"A": "↔ ↔ ↔",
"B": "↓ ↓ ↓",
"C": "↓ ↓ ↑",
"D": "↑ ↑ ↔"
} | step1 | C | [
"35 year old woman",
"physician",
"headaches",
"irregular menses",
"nipple discharge",
"past",
"months",
"Breast examination shows milky white discharge from both nipples",
"thyroid function tests",
"morning cortisol concentrations",
"reference ranges",
"urine pregnancy test",
"negative",
... |
A 30-year-old woman visits her local walk-in clinic and reports more than one week of progressive shortness of breath, dyspnea on effort, fatigue, lightheadedness, and lower limb edema. She claims she has been healthy all year round except for last week when she had a low-grade fever, malaise, and myalgias. Upon examin... | Disruption of the dystrophin-glycoprotein complex | {
"A": "Disruption of the dystrophin-glycoprotein complex",
"B": "Fibrofatty replacement of the myocardium",
"C": "IgA antiendomysial antibodies",
"D": "Eosinophilic infiltration"
} | step1 | A | [
"30 year old woman visits",
"local walk-in clinic",
"reports more",
"one week of progressive shortness",
"breath",
"dyspnea on effort",
"fatigue",
"lightheadedness",
"lower limb edema",
"healthy",
"year round",
"week",
"low-grade fever",
"malaise",
"myalgias",
"examination",
"blood p... |
A 46-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has a history of seizures controlled with levetiracetam. She has needed glasses for the past 13 years. Her father died of pancreatic cancer. She is 175 cm (5 ft 9 in) tall and weighs 79 kg (174 lbs); BMI is 25.8... | Coronary artery disease | {
"A": "Optic glioma",
"B": "Squamous cell carcinoma",
"C": "Coronary artery disease",
"D": "Renal angiomyolipoma"
} | step2&3 | C | [
"year old woman",
"physician",
"routine health maintenance examination",
"feels well",
"history",
"seizures controlled",
"levetiracetam",
"needed glasses",
"past",
"years",
"father died of pancreatic cancer",
"5 ft 9",
"tall",
"kg",
"lbs",
"BMI",
"kg/m2",
"Vital signs",
"normal l... |
A 36-year-old man presents to his physician with the complaint of bilateral lower back pain. The pain is 5/10, constant, aching, aggravated by bending forward and lying supine, and is alleviated by resting in a neutral position. The pain appeared 3 days ago after the patient overstrained at the gym. He does not report ... | Maintaining usual activity as tolerated | {
"A": "Bed rest for 3 days",
"B": "Manual traction",
"C": "Maintaining usual activity as tolerated",
"D": "Electromyographic biofeedback"
} | step2&3 | C | [
"36 year old man presents",
"physician",
"complaint of bilateral lower back pain",
"pain",
"5/10",
"constant",
"aching",
"aggravated",
"bending forward",
"lying supine",
"resting",
"neutral position",
"pain appeared 3 days",
"patient",
"not report changes",
"sensation",
"limb weaknes... |
A 16-year-old boy comes to the physician with a 4-day history of sore throat and mild fever. He is on the varsity soccer team at his high school, but has been unable to go to practice for the last few days because he has been very tired and is easily exhausted. He has no history of serious illness and takes no medicati... | Write a medical note that excuses from soccer events | {
"A": "Write a medical note that excuses from soccer events",
"B": "Oral amoxicillin therapy",
"C": "Oral corticosteroid therapy",
"D": "Intravenous acyclovir therapy"
} | step2&3 | A | [
"year old boy",
"physician",
"4-day history",
"sore throat",
"mild fever",
"soccer team",
"high school",
"unable to go to practice",
"days",
"very tired",
"easily exhausted",
"history",
"serious illness",
"takes",
"medications",
"mother",
"type 2 diabetes mellitus",
"appears weak",... |
A 54-year-old woman presents to her primary care physician complaining of watery diarrhea for the last 3 weeks. She reports now having over 10 bowel movements per day. She denies abdominal pain or rash. A basic metabolic profile is notable for the following: Na: 127 mEq/L; K 2.1 mEq/L; Glucose 98 mg/dL. Following addit... | VIPoma | {
"A": "VIPoma",
"B": "Glucagonoma",
"C": "Somatostatinoma",
"D": "Gastrinoma"
} | step1 | A | [
"54 year old woman presents",
"primary care physician",
"watery diarrhea",
"last",
"weeks",
"reports now",
"over 10 bowel movements",
"day",
"denies abdominal pain",
"rash",
"basic metabolic profile",
"notable",
"following",
"Na",
"mEq/L",
"K",
"mEq/L",
"Glucose 98 mg/dL",
"Follo... |
A 16-year-old girl is brought to the physician by her mother because she has not attained menarche. She has no history of serious illness. She is at 50th percentile for height and weight. Examination shows no breast glandular tissue and no pubic hair development. The remainder of the examination shows no abnormalities.... | Serum FSH level | {
"A": "GnRH stimulation test",
"B": "Reassurance",
"C": "Progesterone challenge test",
"D": "Serum FSH level"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"mother",
"not",
"menarche",
"history",
"serious illness",
"50th percentile",
"height",
"weight",
"Examination shows",
"breast glandular tissue",
"pubic hair development",
"examination shows",
"abnormalities",
"urine pregnancy test",
"negati... |
A 52-year-old Caucasian male presents to your office with an 8 mm dark lesion on his back. The lesion, as seen below, has irregular borders and marked internal color variation. Upon excisional biopsy, the presence of which of the following would best estimate the risk of metastasis in this patient’s lesion: | Vertical tumor growth | {
"A": "Palisading nuclei",
"B": "Vertical tumor growth",
"C": "Cellular atypia",
"D": "Increased production of melanosomes"
} | step1 | B | [
"year old Caucasian male presents",
"office",
"mm dark lesion",
"back",
"lesion",
"seen",
"irregular borders",
"marked internal color variation",
"excisional biopsy",
"presence",
"following",
"best estimate",
"risk",
"metastasis",
"patients lesion"
] |
A 5-year-old child is brought to a pediatric clinic by his mother for a rash that started a few days ago. The mother adds that her son has also had a fever and sore throat since last week. His immunizations are up to date. On examination, a rash is present over the trunk and upper extremities and feels like sandpaper t... | Molecular mimicry | {
"A": "Antigenic shift",
"B": "Bacterial tissue invasion",
"C": "Molecular mimicry",
"D": "Toxin-mediated cellular damage"
} | step1 | C | [
"5 year old child",
"brought",
"pediatric clinic",
"mother",
"rash",
"started",
"few days",
"mother adds",
"son",
"fever",
"sore throat",
"week",
"immunizations",
"date",
"examination",
"rash",
"present",
"trunk",
"upper extremities",
"feels",
"touch",
"oropharyngeal examin... |
A 19-year-old man with unknown medical history is found down on a subway platform and is brought to the hospital by ambulance. He experiences two episodes of emesis en route. In the emergency department, he appears confused and is complaining of abdominal pain. His temperature is 37.0° C (98.6° F), pulse is 94/min, blo... | Intravenous potassium chloride | {
"A": "Subcutaneous insulin glargine",
"B": "Intravenous sodium bicarbonate",
"C": "Intravenous potassium chloride",
"D": "Intravenous 5% dextrose and 1/2 isotonic saline"
} | step2&3 | C | [
"year old man",
"unknown medical history",
"found",
"subway platform",
"brought",
"hospital",
"ambulance",
"experiences two episodes of emesis en route",
"emergency department",
"appears confused",
"abdominal pain",
"temperature",
"0",
"98",
"F",
"pulse",
"min",
"blood pressure",
... |
A physiologist is studying various mediators that modulate coronary circulation. He is particularly looking at mediators that are activated via the clotting cascade, primarily activated factor XII. He finds that when the clotting cascade starts, it leads to the activation of factor XII, which in turn activates the enzy... | Kininogen | {
"A": "L-Arginine",
"B": "Arachidonic acid",
"C": "Hydroxytryptophan",
"D": "Kininogen"
} | step1 | D | [
"physiologist",
"studying various mediators",
"modulate coronary circulation",
"looking",
"mediators",
"activated",
"clotting cascade",
"activated factor XII",
"finds",
"clotting cascade starts",
"leads",
"activation",
"factor XII",
"turn activates",
"enzyme kallikrein",
"enzyme activa... |
A 61-year-old man presents with gradually increasing shortness of breath. For the last 2 years, he has had a productive cough on most days. Past medical history is significant for hypertension and a recent admission to the hospital for pneumonia. He uses a triamcinolone inhaler and uses an albuterol inhaler as a rescue... | Inflamed bronchus with hypertrophy and hyperplasia of mucous glands | {
"A": "Permanent bronchial dilation",
"B": "Chronic granulomatous inflammation with bilateral hilar lymphadenopathy",
"C": "Airway hypersensitivity",
"D": "Inflamed bronchus with hypertrophy and hyperplasia of mucous glands"
} | step1 | D | [
"61 year old man presents",
"increasing shortness of breath",
"last",
"years",
"productive cough",
"days",
"Past medical history",
"significant",
"hypertension",
"recent admission to",
"hospital",
"pneumonia",
"uses",
"triamcinolone inhaler",
"uses",
"albuterol inhaler",
"takes lisin... |
A 3-year-old boy is brought to the physician for presurgical evaluation before undergoing splenectomy. One year ago, he was diagnosed with hereditary spherocytosis and has received 6 blood transfusions for severe anemia since then. His only medication is a folate supplement. Immunizations are up-to-date. His temperatur... | Daily penicillin prophylaxis | {
"A": "Vaccination against hepatitis B virus",
"B": "Daily penicillin prophylaxis",
"C": "Daily warfarin prophylaxis",
"D": "Administration of hydroxyurea"
} | step2&3 | B | [
"3 year old boy",
"brought",
"physician",
"evaluation",
"splenectomy",
"One year ago",
"diagnosed",
"hereditary spherocytosis",
"received",
"blood transfusions",
"severe anemia",
"then",
"only medication",
"folate supplement",
"Immunizations",
"date",
"temperature",
"36",
"pulse"... |
A 4-year-old boy presents with a history of recurrent bacterial infections, including several episodes of pneumococcal sepsis. His 2 maternal uncles died after having had similar complaints. Lab investigations reveal an undetectable level of all serum immunoglobulins. Which of the following is the most likely diagnosis... | Bruton agammaglobulinemia | {
"A": "Common variable immunodeficiency",
"B": "Hereditary angioedema",
"C": "Bruton agammaglobulinemia",
"D": "DiGeorge syndrome"
} | step1 | C | [
"4 year old boy presents",
"history of recurrent bacterial infections",
"including several episodes of pneumococcal sepsis",
"2 maternal uncles died",
"similar complaints",
"Lab investigations reveal",
"undetectable level",
"serum immunoglobulins",
"following",
"most likely diagnosis",
"patient"... |
A 63-year-old man is brought to the emergency department for evaluation of abdominal pain. The pain started four days ago and is now a diffuse crampy pain with an intensity of 6/10. The patient has nausea and has vomited twice today. His last bowel movement was three days ago. He has a history of hypertension and recur... | Nasogastric tube placement and bowel rest | {
"A": "Ciprofloxacin and metronidazole",
"B": "Colonoscopy",
"C": "Nasogastric tube placement and bowel rest",
"D": "Surgical bowel decompression"
} | step2&3 | C | [
"63 year old man",
"brought",
"emergency department",
"evaluation",
"abdominal",
"pain started four days",
"now",
"diffuse crampy pain",
"intensity",
"6/10",
"patient",
"nausea",
"vomited twice today",
"last bowel movement",
"three days",
"history of hypertension",
"recurrent constip... |
A 30-year-old man comes to the emergency department because of a painful rash for 2 days. The rash initially appeared on his left lower abdomen and has spread to the rest of the abdomen and left upper thigh over the last 24 hours. Pain is exacerbated with movement. He initially thought the skin rash was an allergic rea... | Inpatient treatment with intravenous acyclovir | {
"A": "Outpatient treatment with oral penicillin V",
"B": "Outpatient treatment with topical permethrin",
"C": "Inpatient treatment with intravenous acyclovir",
"D": "Inpatient treatment with intravenous ceftriaxone\n\""
} | step2&3 | C | [
"30 year old man",
"emergency department",
"of",
"painful rash",
"2 days",
"rash initially appeared",
"left lower abdomen",
"spread",
"rest",
"abdomen",
"left upper thigh",
"24 hours",
"Pain",
"exacerbated",
"movement",
"initially thought",
"skin rash",
"allergic reaction to",
"n... |
A 27-year-old man with seizure disorder is brought to the emergency department by his girlfriend after falling while climbing a building. The girlfriend reports that he was started on a new medication for treatment of depressed mood, low energy, and difficulty sleeping 2 weeks ago by his physician. She says that he has... | Venlafaxine | {
"A": "Lithium",
"B": "Bupropion",
"C": "Venlafaxine",
"D": "Selegiline"
} | step1 | C | [
"27 year old man",
"seizure disorder",
"brought",
"emergency department",
"girlfriend",
"falling",
"climbing",
"building",
"girlfriend reports",
"started",
"new medication",
"treatment",
"depressed mood",
"low energy",
"difficulty sleeping 2 weeks",
"physician",
"unstable emotions",
... |
A 16-year-old boy is brought to the emergency department 20 minutes after collapsing while playing basketball. There is no personal or family history of serious illness. On arrival, there is no palpable pulse and no respiratory effort is seen. He is declared dead. The family agrees to an autopsy. Which of the following... | Interventricular septal hypertrophy | {
"A": "Defect in the atrial septum",
"B": "Postductal narrowing of the aorta",
"C": "Atheromatous plaque rupture",
"D": "Interventricular septal hypertrophy"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department 20 minutes",
"collapsing",
"playing basketball",
"personal",
"family history",
"serious illness",
"arrival",
"palpable pulse",
"respiratory effort",
"seen",
"dead",
"family agrees",
"autopsy",
"following",
"most likely to",
"found",
... |
A 67-year-old man comes to the physician because of worsening lower back pain for 6 weeks. He reports that the pain is most intense with movement and that it sometimes occurs at night. Over the past 3 months, he has noticed a weakened urinary stream. He has not seen any blood in his urine. His only daily medication is ... | Malignancy | {
"A": "Malignancy",
"B": "Osteoporosis",
"C": "Disc herniation",
"D": "Lumbar strain"
} | step1 | A | [
"67 year old man",
"physician",
"of worsening lower back",
"weeks",
"reports",
"pain",
"most intense",
"movement",
"sometimes occurs",
"night",
"past 3 months",
"urinary stream",
"not seen",
"blood in",
"urine",
"only daily medication",
"ibuprofen",
"Examination shows",
"spinal d... |
A 47-year-old woman presents to her primary care physician for a wellness checkup. The patient states that she currently feels well and has no complaints. She has failed multiple times at attempting to quit smoking and has a 40 pack-year smoking history. She drinks 4 alcoholic beverages every night. The patient is curr... | Familial hypocalciuric hypercalcemia | {
"A": "Familial hypocalciuric hypercalcemia",
"B": "Hyperparathyroidism",
"C": "Hypervitaminosis D",
"D": "Renal cell carcinoma"
} | step2&3 | A | [
"year old woman presents",
"primary care physician",
"wellness checkup",
"patient states",
"currently feels well",
"complaints",
"failed multiple times",
"attempting",
"quit smoking",
"40 pack-year smoking history",
"drinks 4 alcoholic beverages",
"night",
"patient",
"currently taking",
... |
A previously healthy 73-year-old man comes to the physician at his wife's insistence because of a skin lesion on his back. He lives with his wife and works for a high-profile law firm where he represents several major clients. Physical examination shows a 7-mm, brownish-black papule with irregular borders. When the doc... | """I would like to know more about why you don't want to hear your test results.""" | {
"A": "\"\"\"I would like to do further testing to investigate how far this cancer has spread.\"\"\"",
"B": "\"\"\"I don't have to tell you, but I will have to tell your wife so we can plan your therapy.\"\"\"",
"C": "\"\"\"I'll have to consult with the ethics committee to determine further steps.\"\"\"",
"D":... | step1 | D | [
"healthy",
"year old man",
"physician",
"wife's",
"skin lesion",
"back",
"lives with",
"wife",
"works",
"high profile law firm",
"represents several major clients",
"Physical examination shows",
"7-mm",
"black papule",
"irregular borders",
"doctor starts to",
"possible diagnoses",
... |
A 55-year-old man comes to the physician for a follow-up examination. He feels well. He has hyperlipidemia and type 2 diabetes mellitus. He takes medium-dose simvastatin and metformin. Four months ago, fasting serum studies showed a LDL-cholesterol of 136 mg/dL and his medications were adjusted. Vital signs are within ... | Discontinue simvastatin, start pravastatin in 3 weeks | {
"A": "Discontinue simvastatin, start pravastatin in 3 weeks",
"B": "Continue simvastatin, add niacin",
"C": "Discontinue simvastatin, start fenofibrate now",
"D": "Increase the dose of simvastatin"
} | step2&3 | A | [
"55 year old man",
"physician",
"follow-up examination",
"feels well",
"hyperlipidemia",
"type 2 diabetes mellitus",
"takes medium dose simvastatin",
"metformin",
"Four months",
"fasting serum studies showed",
"LDL-cholesterol",
"mg/dL",
"medications",
"adjusted",
"Vital signs",
"norma... |
A 15-year-old girl presents with four days of malaise, painful joints, nodular swelling over her elbows, low-grade fever, and a rash on her chest and left shoulder. Two weeks ago, she complained of a sore throat that gradually improved but was not worked up. She was seen for a follow-up approximately one week later. At... | Penicillin therapy | {
"A": "Penicillin therapy",
"B": "NSAIDS for symptomatic relief",
"C": "Aortic valve replacement",
"D": "Mitral valve repair"
} | step2&3 | A | [
"year old girl presents",
"four days",
"malaise",
"painful joints",
"nodular swelling",
"elbows",
"low-grade fever",
"rash",
"chest",
"left shoulder",
"Two weeks",
"sore throat",
"improved",
"not worked up",
"seen",
"follow-up approximately one week later",
"visit",
"cardiac exam",... |
A 3-year-old girl is brought to the pediatrician by her parents who are concerned that she is not developing normally. They say she does not talk and avoids eye contact. She prefers to sit and play with blocks by herself rather than engaging with other children. They also note that she will occasionally have violent ou... | Autism spectrum disorder | {
"A": "Autism spectrum disorder",
"B": "Cri-du-chat syndrome",
"C": "Oppositional defiant disorder",
"D": "Rett syndrome"
} | step1 | A | [
"3 year old girl",
"brought",
"pediatrician",
"parents",
"concerned",
"not",
"not talk",
"eye contact",
"to sit",
"play",
"blocks",
"engaging",
"children",
"note",
"occasionally",
"violent outbursts",
"inappropriate",
"healthy",
"office",
"patient sits",
"corner",
"room sta... |
An 82-year-old man—a retired physics professor—presents with progressive difficulty walking. He has bilateral knee osteoarthritis and has used a walker for the past several years. For the past 6 months, he has experienced problems walking and maintaining balance and has been wheelchair-bound. He has fallen several time... | Subarachnoid hemorrhage | {
"A": "Diabetes mellitus",
"B": "Epilepsy",
"C": "Hypertension",
"D": "Subarachnoid hemorrhage"
} | step2&3 | D | [
"year old mana retired physics",
"progressive difficulty walking",
"bilateral knee osteoarthritis",
"used",
"walker",
"past",
"years",
"past 6 months",
"problems walking",
"maintaining balance",
"wheelchair-bound",
"fallen",
"times",
"hitting",
"head",
"few times",
"never",
"consci... |
A 44-year-old man presents to his primary care physician for muscle pain and weakness. He says that his muscle pain mainly affects his legs. He also experiences difficulty with chewing gum and has poor finger dexterity. Medical history is significant for infertility and cataracts. On physical exam, the patient's face i... | DMPK gene CTG expansion | {
"A": "DMPK gene CTG expansion",
"B": "Dystrophin gene nonsense mutation",
"C": "Dystrophin gene non-frameshift mutation",
"D": "No genetic abnormality"
} | step1 | A | [
"year old man presents",
"primary care physician",
"muscle pain",
"weakness",
"muscle pain",
"affects",
"legs",
"experiences difficulty",
"chewing",
"poor finger dexterity",
"Medical history",
"significant",
"infertility",
"cataracts",
"physical exam",
"patient's face",
"long",
"na... |
A 10-year-old boy is brought to the pediatric clinic because of a sore throat of 1-week duration. He also has a cough and fever. He has pain when swallowing and sometimes water regurgitates from his nose when drinking. He was diagnosed with acute tonsillitis by his primary care physician 1 month ago, for which he recei... | Corynebacterium diphtheriae | {
"A": "Corynebacterium diphtheriae",
"B": "Haemophilus influenzae b",
"C": "Agranulocytosis",
"D": "Epstein Barr virus"
} | step1 | A | [
"A 10 year old boy",
"brought",
"pediatric clinic",
"sore throat",
"1-week duration",
"cough",
"fever",
"pain",
"swallowing",
"sometimes water regurgitates",
"nose",
"drinking",
"diagnosed",
"acute tonsillitis",
"primary care physician",
"month",
"received",
"week long course",
"... |
A 48-year-old woman comes to the emergency room with chest pain. She describes the pain as a squeezing sensation in her chest with radiation to the left shoulder. The episode began about 15 minutes ago when she was sitting reading a book. She has had this pain before, typically in the evenings, though prior episodes us... | Diltiazem | {
"A": "Clopidogrel",
"B": "Diltiazem",
"C": "Aspirin",
"D": "Enalapril"
} | step2&3 | B | [
"48 year old woman",
"emergency room",
"chest pain",
"pain",
"squeezing sensation",
"chest",
"radiation",
"left shoulder",
"episode began",
"15 minutes",
"sitting reading",
"book",
"pain",
"evenings",
"prior episodes usually resolved",
"couple",
"minutes",
"pulse",
"min",
"bloo... |
A 68-year-old man is brought to the emergency department because of progressive weakness of his lower extremities and urinary incontinence for the past 2 weeks. Over the past 2 months, he has had increasing back pain. His temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 106/60 mm Hg. Examination s... | Elevated prostate-specific antigen | {
"A": "Irregular, asymmetric mole",
"B": "Enlarged left thyroid lobe",
"C": "Bence Jones protein in the urine",
"D": "Elevated prostate-specific antigen"
} | step2&3 | D | [
"68 year old man",
"brought",
"emergency department",
"progressive weakness",
"lower extremities",
"urinary incontinence",
"past 2 weeks",
"past",
"months",
"increasing back pain",
"temperature",
"98",
"pulse",
"88 min",
"blood pressure",
"60 mm Hg",
"Examination shows",
"ataxic ga... |
A 51-year-old African American man with a history of poorly controlled hypertension presents to the emergency room with blurry vision and dyspnea. He reports rapid-onset blurred vision and difficulty breathing 4 hours prior to presentation. He takes lisinopril, hydrochlorothiazide, and spironolactone but has a history ... | Concentrically thickened arteriolar tunica media with abundant nuclei | {
"A": "Anuclear arteriolar thickening",
"B": "Calcific deposits in the arterial media without luminal narrowing",
"C": "Concentrically thickened arteriolar tunica media with abundant nuclei",
"D": "Fibrous atheromatous plaques in the arteriolar intima"
} | step1 | C | [
"year old African American man",
"history of poorly controlled hypertension presents",
"emergency room",
"blurry vision",
"dyspnea",
"reports rapid-onset blurred vision",
"difficulty breathing 4 hours prior to presentation",
"takes lisinopril",
"hydrochlorothiazide",
"spironolactone",
"history",... |
A pharmaceutical company is studying the effect of a novel compound that they have discovered to treat osteoporosis. They perform a randomized controlled clinical trial to study if this compound has an effect on the incidence of hip fractures among osteoporotic patients. They find that there is no statistical differenc... | Type II error | {
"A": "Selection bias",
"B": "Type I error",
"C": "Type II error",
"D": "Type III error"
} | step1 | C | [
"pharmaceutical company",
"studying",
"effect",
"novel compound",
"discovered to treat osteoporosis",
"perform",
"randomized controlled clinical trial to study",
"compound",
"effect",
"incidence of hip fractures",
"patients",
"find",
"statistical difference",
"experimental",
"control gro... |
A 58-year-old woman comes to the physician because of constipation, loss of appetite, and increased urinary frequency for the past 8 weeks. She has a history of hypertension and underwent mastectomy for breast cancer 9 months ago. Her sister has hyperthyroidism and her mother died of complications from breast cancer at... | Zoledronic acid | {
"A": "Denosumab",
"B": "Furosemide",
"C": "Zoledronic acid",
"D": "Prednisone\n\""
} | step2&3 | C | [
"58 year old woman",
"physician",
"constipation",
"loss of appetite",
"increased urinary frequency",
"past",
"weeks",
"history of hypertension",
"mastectomy",
"breast cancer",
"months",
"sister",
"hyperthyroidism",
"mother died",
"complications",
"breast cancer",
"the age of",
"yea... |
A 61-year-old man is brought to the emergency department because of a 2-day history of fever, chills, and headache. He frequently has headaches, for which he takes aspirin, but says that this headache is more intense. His wife claims that he has also not been responding right away to her. He has a 20-year history of hy... | Streptococcus pneumoniae | {
"A": "Streptococcus agalactiae",
"B": "Staphylococcus aureus",
"C": "Neisseria meningitidis",
"D": "Streptococcus pneumoniae"
} | step2&3 | D | [
"61 year old man",
"brought",
"emergency department",
"2-day history",
"fever",
"chills",
"headache",
"frequently",
"headaches",
"takes aspirin",
"headache",
"more intense",
"wife",
"not",
"right",
"20 year history of hypertension",
"poorly controlled type 2 diabetes mellitus",
"cu... |
A 34-year-old female comes to the ED complaining of epigastric pain and intractable nausea and vomiting for the last 24 hours. Her vitals are as follows: Temperature 38.1 C, HR 97 beats/minute, BP 90/63 mm Hg, RR 12 breaths/minute. Arterial blood gas and labs are drawn. Which of the following sets of lab values is cons... | pH 7.51, PaCO2 50 , serum chloride 81 mEq/L, serum bicarbonate 38 mEq/L | {
"A": "pH 7.39, PaCO2 37 , serum chloride 102 mEq/L, serum bicarbonate 27 mEq/L",
"B": "pH 7.46, PaCO2 26 , serum chloride 102 mEq/L, serum bicarbonate 16 mEq/L",
"C": "pH 7.51, PaCO2 50 , serum chloride 81 mEq/L, serum bicarbonate 38 mEq/L",
"D": "pH 7.31, PaCO2 30 , serum chloride 92 mEq/L, serum bicarbonate... | step1 | C | [
"year old female",
"ED",
"epigastric pain",
"intractable nausea",
"vomiting",
"24 hours",
"follows",
"Temperature",
"97 beats/minute",
"BP 90 63 mm Hg",
"RR",
"breaths/minute",
"Arterial blood gas",
"labs",
"drawn",
"following sets",
"lab values",
"consistent with",
"presentation... |
A 48-year-old man comes to the physician because of worsening shortness of breath and nocturnal cough for the past 2 weeks. On two occasions, his cough was bloody. He had a heart condition as a child that was treated with antibiotics. He emigrated to the US from Kazakhstan 15 years ago. Pulmonary examination shows crac... | Mitral valve stenosis | {
"A": "Aortic valve regurgitation",
"B": "Mitral valve prolapse",
"C": "Mitral valve stenosis",
"D": "Mitral valve regurgitation"
} | step2&3 | C | [
"48 year old man",
"physician",
"of worsening shortness",
"breath",
"nocturnal cough",
"past 2 weeks",
"two occasions",
"cough",
"bloody",
"heart condition",
"child",
"treated with antibiotics",
"Kazakhstan 15 years",
"Pulmonary examination shows crackles",
"lung bases",
"Cardiac exami... |
A 32-year-old woman comes to the emergency department because of a 12-hour history of a severe headache. She does not smoke or use illicit drugs. Her blood pressure at admission is 180/125 mm Hg. Physical examination shows a bruit in the epigastric region. Fundoscopy shows bilateral optic disc swelling. Which of the fo... | CT angiography | {
"A": "Urinary catecholamine metabolites",
"B": "Echocardiography",
"C": "Oral sodium loading test",
"D": "CT angiography"
} | step1 | D | [
"year old woman",
"emergency department",
"of",
"12-hour history",
"severe headache",
"not smoke",
"use illicit",
"blood pressure",
"admission",
"mm Hg",
"Physical examination shows",
"bruit",
"epigastric region",
"Fundoscopy shows bilateral optic disc swelling",
"following investigation... |
A grant reviewer at the National Institutes of Health is determining which of two studies investigating the effects of gastric bypass surgery on fasting blood sugar to fund. Study A is spearheaded by a world renowned surgeon, is a multi-center study planning to enroll 50 patients at each of 5 different sites, and is si... | Study B, because it has a larger sample size | {
"A": "Study A, because it has a superior surgeon",
"B": "Study A, because it is a multi-center trial",
"C": "Study B, because it has a larger sample size",
"D": "Both studies have the same power"
} | step1 | C | [
"grant reviewer",
"National Institutes of Health",
"two studies investigating",
"effects of gastric bypass surgery",
"fasting blood sugar to fund",
"Study",
"world",
"surgeon",
"multi-center study planning",
"50 patients",
"of",
"different sites",
"single blinded",
"Study",
"plans to",
... |
A 48-year-old woman presents to the physician because of facial flushing and weakness for 3 months, abdominal discomfort and bloating for 6 months, and profuse watery diarrhea for 1 year. She reports that her diarrhea was episodic initially, but it has been continuous for the past 3 months. The frequency ranges from 10... | Plasma vasoactive intestinal peptide | {
"A": "Urinary 5-hydroxyindoleacetic acid excretion",
"B": "Plasma gastrin level",
"C": "Plasma vasoactive intestinal peptide",
"D": "Plasma glucagon level"
} | step2&3 | C | [
"48 year old woman presents",
"physician",
"facial flushing",
"weakness",
"months",
"abdominal discomfort",
"bloating",
"months",
"watery diarrhea",
"year",
"reports",
"diarrhea",
"episodic initially",
"continuous",
"past 3 months",
"frequency ranges",
"10",
"bowel movements",
"d... |
A 5-year-old boy is brought to the physician by his parents because of a 4-day history of arthralgias, abdominal pain, and lesions on his arms and legs. Ten days ago, he had an upper respiratory tract infection. A photograph of one of his legs is shown. Further evaluation is most likely to show which of the following? | Hematuria | {
"A": "Genital ulcers",
"B": "Hematuria",
"C": "Tick bite",
"D": "Thrombocytopenia"
} | step1 | B | [
"5 year old boy",
"brought",
"physician",
"parents",
"4-day history",
"arthralgias",
"abdominal pain",
"lesions",
"arms",
"legs",
"Ten days",
"upper respiratory tract infection",
"photograph",
"one",
"legs",
"shown",
"Further evaluation",
"most likely to show",
"following"
] |
A previously healthy 61-year-old man comes to the physician because of a 3-month history of intermittent fever, easy fatiguability, and a 4.4-kg (9.7-lb) weight loss. Physical examination shows conjunctival pallor. The spleen is palpated 5 cm below the left costal margin. Laboratory studies show a leukocyte count of 75... | Chronic myeloid leukemia | {
"A": "Chronic lymphocytic leukemia",
"B": "Essential thrombocythemia",
"C": "Chronic myeloid leukemia",
"D": "Acute promyelocytic leukemia"
} | step1 | C | [
"healthy 61 year old man",
"physician",
"3 month history",
"intermittent fever",
"easy fatiguability",
"4.4 kg",
"weight loss",
"Physical examination shows conjunctival pallor",
"spleen",
"palpated 5 cm",
"left costal margin",
"Laboratory studies show",
"leukocyte count",
"75 300 mm3",
"... |
A 60-year-old woman presents to the emergency department with progressive nausea and vomiting. She reports that approximately one day prior to presentation she experienced abdominal discomfort that subsequently worsened to severe nausea, vomiting, and two episodes of watery diarrhea. She recently noticed that her visio... | Ratio of toxic dose to effective dose close to 1 | {
"A": "High potency",
"B": "Low potency",
"C": "Ratio of toxic dose to effective dose much greater than 1",
"D": "Ratio of toxic dose to effective dose close to 1"
} | step1 | D | [
"60 year old woman presents",
"emergency department",
"progressive nausea",
"vomiting",
"reports",
"approximately one day prior to presentation",
"experienced abdominal discomfort",
"worsened",
"severe nausea",
"vomiting",
"two episodes of watery diarrhea",
"recently",
"vision",
"blurry",
... |
A 23-year-old man who lives in a beach house in Florida visits his twin brother who lives in the Rocky Mountains. They are out hiking and the visitor struggles to keep up with his brother. Which of the following adaptations is most likely present in the mountain-dwelling brother relative to his twin? | Decreased oxygen binding ability of hemoglobin | {
"A": "Decreased mean corpuscular hemoglobin concentration",
"B": "Decreased red blood cell 2,3-diphosphoglycerate",
"C": "Decreased oxygen binding ability of hemoglobin",
"D": "Decreased pulmonary vascular resistance"
} | step1 | C | [
"23 year old man",
"lives",
"beach house",
"Florida visits",
"twin brother",
"lives",
"Rocky Mountains",
"out hiking",
"to keep",
"brother",
"following adaptations",
"most likely present",
"mountain dwelling brother relative to",
"twin"
] |
A 25-year-old G1P0000 presents to her obstetrician’s office for a routine prenatal visit at 32 weeks gestation. At this visit, she feels well and has no complaints. Her pregnancy has been uncomplicated, aside from her Rh negative status, for which she received Rhogam at 28 weeks gestation. The patient has a past medica... | Expectant management | {
"A": "Expectant management",
"B": "Weekly ultrasound",
"C": "Internal cephalic version",
"D": "Caesarean section at 38 weeks"
} | step2&3 | A | [
"year old",
"presents",
"obstetricians office",
"routine prenatal visit",
"weeks gestation",
"visit",
"feels well",
"complaints",
"pregnancy",
"uncomplicated",
"Rh negative status",
"received Rhogam",
"weeks gestation",
"patient",
"past medical mild intermittent asthma",
"migraine head... |
A 54-year-old man with a past medical history significant for hypertension, type 2 diabetes, and chronic obstructive pulmonary disease presents with complaints of nausea and abdominal pain for the past month. The pain is located in the epigastric region and is described as “burning” in quality, often following food int... | Erythromycin | {
"A": "Erythromycin",
"B": "Metformin",
"C": "Omeprazole",
"D": "Ranitidine"
} | step1 | A | [
"54 year old man",
"past medical history significant",
"hypertension",
"type 2 diabetes",
"chronic obstructive pulmonary disease presents",
"complaints",
"nausea",
"abdominal pain",
"past month",
"pain",
"epigastric region",
"described",
"burning",
"quality",
"often following food intake... |
An investigator is studying the affinity of hemoglobin for oxygen in different clinical settings. An illustration of an oxygen-hemoglobin dissociation curve is shown. Curve A shows the test results of one of the research participants and curve B shows a normal oxygen-hemoglobin dissociation curve. Which of the followin... | Polycythemia | {
"A": "Temperature of 39.1°C (102.4°F)",
"B": "Sickled red blood cells",
"C": "Serum pH of 7.1",
"D": "Polycythemia"
} | step1 | D | [
"investigator",
"studying",
"affinity",
"hemoglobin",
"oxygen",
"different clinical",
"oxygen hemoglobin dissociation curve",
"shown",
"Curve",
"shows",
"test results",
"one",
"research participants",
"curve",
"shows",
"normal oxygen hemoglobin dissociation curve",
"following",
"mo... |
A 24-year-old obese woman presents with a severe right-sided frontotemporal headache that started 2 days ago. There is no improvement with over-the-counter pain medications. Yesterday, the pain was so intense that she stayed in bed all day in a dark, quiet room instead of going to work. This morning she decided to come... | Amitriptyline | {
"A": "Sumatriptan",
"B": "Methysergide",
"C": "Gabapentin",
"D": "Amitriptyline"
} | step2&3 | D | [
"year old obese woman presents",
"severe right-sided frontotemporal headache",
"started 2 days",
"improvement",
"over-the-counter pain medications",
"pain",
"so intense",
"bed all day",
"dark",
"quiet room",
"to work",
"morning",
"to",
"episode of vomiting",
"experienced",
"similar typ... |
In a community of 5,000 people, 40 people from 40 different households develop an infection with a new strain of influenza virus with an incubation period of 7 days. The total number of people in these households is 150. Ten days later, 90 new cases of the same disease are reported from these same households. Twenty-fi... | (90/110) × 100 | {
"A": "(115/150) × 100",
"B": "(115/1024) × 100",
"C": "(90/110) × 100",
"D": "(90/5000) × 100"
} | step1 | C | [
"community",
"5",
"people",
"40 people",
"different households",
"infection",
"a new strain",
"influenza virus",
"incubation period",
"7 days",
"total number",
"people",
"households",
"Ten days later",
"90 new cases",
"same disease",
"reported",
"same households",
"Twenty-five",
... |
A 22-year-old woman is brought to the emergency department by campus police for bizarre behavior. She was arrested while trying to break into her university's supercomputer center and was found crying and claiming she needs access to the high-powered processors immediately. Her boyfriend arrived at the hospital and rep... | Sertraline | {
"A": "Alprazolam",
"B": "Lithium",
"C": "Sertraline",
"D": "Valproate"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"police",
"bizarre behavior",
"arrested",
"to break",
"university's supercomputer center",
"found crying",
"needs access",
"high powered processors immediately",
"boyfriend arrived",
"hospital",
"reports",
"past week",
"night working... |
You would like to conduct a study investigating potential risk factors that predispose patients to develop cirrhosis. Using a registry of admitted patients over the last 10 years at your local hospital, you isolate all patients who have been diagnosed with cirrhosis. Subsequently, you contact this group of patients, as... | Case-control study | {
"A": "Meta-analysis",
"B": "Case-control study",
"C": "Cross-sectional study",
"D": "Randomized controlled trial"
} | step1 | B | [
"to conduct",
"study investigating potential risk factors",
"patients to",
"cirrhosis",
"Using",
"registry",
"admitted patients",
"last 10 years",
"local hospital",
"isolate",
"patients",
"diagnosed",
"cirrhosis",
"contact",
"group",
"patients",
"to complete",
"survey assessing",
... |
An 18-year-old female presents to general medical clinic with the report of a rape on her college campus. The patient was visiting a local fraternity, and after having a few drinks, awakened to find another student having intercourse with her. Aside from the risk of unintended pregnancy and sexually transmitted infecti... | Suicidality | {
"A": "Attention Deficit Hyperactivity Disorder",
"B": "Suicidality",
"C": "Schizoaffective Disorder",
"D": "Schizophrenia"
} | step1 | B | [
"year old female presents",
"general medical clinic",
"report",
"rape",
"college",
"patient",
"visiting",
"local",
"few drinks",
"to find",
"student",
"intercourse",
"risk of unintended pregnancy",
"sexually transmitted infections",
"patient",
"higher risk of",
"following"
] |
A 58-year-old man complains of ascending weakness, palpitations, and abdominal pain. He has a history of hypertension, type II diabetes mellitus, diabetic retinopathy, and end-stage renal disease requiring dialysis. He denies any recent infection. Physical examination is notable for decreased motor strength in both his... | Peaked T-waves and shortened QT interval | {
"A": "S wave in lead I, Q wave in lead III, and inverted T wave in lead III",
"B": "ST-segment elevation in leads II, III, and aVF",
"C": "Peaked T-waves and shortened QT interval",
"D": "Diffuse PR segment depression and ST-segment deviations"
} | step2&3 | C | [
"58 year old man",
"ascending weakness",
"palpitations",
"abdominal pain",
"history of hypertension",
"type II diabetes mellitus",
"diabetic retinopathy",
"end-stage renal disease requiring dialysis",
"denies",
"recent infection",
"Physical examination",
"notable",
"decreased motor strength"... |
After learning in a lecture that cesarean section rates vary from < 0.5% to over 30% across countries, a medical student wants to investigate if national cesarean section rates correlate with national maternal mortality rates worldwide. For his investigation, the student obtains population data from an international re... | Ecological study | {
"A": "Case series",
"B": "Meta-analysis",
"C": "Ecological study",
"D": "Prospective cohort study\n\""
} | step1 | C | [
"learning",
"lecture",
"cesarean section rates",
"0.5",
"30",
"countries",
"medical student",
"to investigate",
"national cesarean section rates",
"national maternal mortality rates",
"investigation",
"student obtains population data",
"international registry",
"contains",
"cesarean sect... |
A 34-year-old woman presents to the fertility clinic with her husband for infertility workup. The patient reports that they have been having unprotected intercourse for 14 months without any successful pregnancy. She is G1P1, with 1 child from a previous marriage. Her menstrual cycle is regular and without pain. Physic... | Elevated aromatase levels | {
"A": "Decreased luteinizing hormone (LH) levels",
"B": "Defective fibrillin",
"C": "Elevated aromatase levels",
"D": "Elevated homocysteine levels"
} | step1 | C | [
"year old woman presents",
"fertility clinic",
"husband",
"infertility workup",
"patient reports",
"unprotected intercourse",
"months",
"successful pregnancy",
"G1P1",
"1 child",
"previous marriage",
"menstrual cycle",
"regular",
"pain",
"Physical",
"pelvic examinations",
"unremarkab... |
A 65-year-old man comes to the physician because of a 10-day history of episodic retrosternal pain, shortness of breath, and palpitations. The episodes occur when he climbs stairs or tries to walk briskly on his treadmill. The symptoms resolve when he stops walking. The previous evening he felt dizzy and weak during su... | Increased left ventricular oxygen demand | {
"A": "Increased left ventricular oxygen demand",
"B": "Lymphocytic infiltration of the myocardium",
"C": "Critical transmural hypoperfusion of the myocardium",
"D": "Increased release of endogenous insulin"
} | step2&3 | A | [
"65 year old man",
"physician",
"of a 10 day history",
"episodic retrosternal pain",
"shortness of breath",
"palpitations",
"episodes occur",
"climbs stairs",
"to walk",
"treadmill",
"symptoms resolve",
"stops walking",
"previous evening",
"felt dizzy",
"weak",
"episode",
"reports",
... |
A 62-year-old male is rushed to the emergency department (ED) for what he believes is his second myocardial infarction (MI). His medical history is significant for severe chronic obstructive pulmonary disease (COPD) and a prior MI at the age of 58. After receiving aspirin, morphine, and face mask oxygen in the field, t... | Metoprolol, because it is a selective ß1 > ß2 blocker | {
"A": "Propranolol, because it is a non-selective ß-blocker",
"B": "Metoprolol, because it is a selective ß1 > ß2 blocker",
"C": "Atenolol, because it is a selective ß2 > ß1 blocker",
"D": "Labetalol, because it is a selective ß1 > ß2 blocker"
} | step1 | B | [
"62 year old male",
"rushed",
"emergency department",
"second myocardial infarction",
"medical history",
"significant",
"severe chronic obstructive pulmonary disease",
"prior MI",
"age",
"58",
"receiving aspirin",
"morphine",
"face mask oxygen in the field",
"patient",
"ED tachycardic",
... |
A 55-year-old woman presents to a primary care clinic for a physical evaluation. She works as a software engineer, travels frequently, is married with 2 kids, and drinks alcohol occasionally. She does not exercise regularly. She currently does not take any medications except for occasional ibuprofen or acetaminophen. S... | Body mass index | {
"A": "Age",
"B": "Body mass index",
"C": "Menopause",
"D": "Occupation"
} | step2&3 | B | [
"55 year old woman presents",
"primary care clinic",
"physical evaluation",
"works",
"software engineer",
"travels frequently",
"married",
"kids",
"drinks alcohol occasionally",
"not exercise",
"currently",
"not take",
"medications",
"occasional ibuprofen",
"acetaminophen",
"currently"... |
A 8-month-old boy is brought to the emergency department by his mother and father due to decreasing activity and excessive sleepiness. The patient was born at full-term in the hospital with no complications. The patient's parents appear incredibly worried as their son has had no medical issues in the past. They show yo... | Child abuse | {
"A": "Child abuse",
"B": "Vitamin K deficiency",
"C": "Osteogenesis imperfecta",
"D": "Bacterial meningitis"
} | step1 | A | [
"month old boy",
"brought",
"emergency department",
"mother",
"father due to decreasing activity",
"excessive sleepiness",
"patient",
"born",
"full-term",
"hospital",
"complications",
"patient's parents appear",
"worried",
"son",
"medical issues",
"past",
"show",
"videos",
"child... |
A 42-year-old woman comes to the physician because of a 2-month history of generalized itching and worsening fatigue. There is no personal or family history of serious illness. She takes eye drops for dry eyes. She occasionally takes acetaminophen for recurrent headaches. She drinks one alcoholic beverage daily. Vital ... | Dual-energy x-ray absorptiometry | {
"A": "Dual-energy x-ray absorptiometry",
"B": "Administer N-acetylcysteine",
"C": "Serum electrophoresis",
"D": "Chest x-ray"
} | step2&3 | A | [
"year old woman",
"physician",
"2 month history",
"generalized itching",
"worsening fatigue",
"personal",
"family history",
"serious illness",
"takes eye",
"dry",
"occasionally takes acetaminophen",
"recurrent headaches",
"drinks one alcoholic beverage daily",
"Vital signs",
"normal limi... |
A 75-year-old man presents to the physician with difficulty breathing for the last 2 months. He denies any cough, fever, or chest pain. His past medical history is significant for hypertension for which he takes chlorothiazide. He has worked in the construction industry, applying insulation to roofs for over 20 years. ... | Pulmonary fibrosis | {
"A": "Normal aging",
"B": "Alpha-1 antitrypsin deficiency",
"C": "Asthma",
"D": "Pulmonary fibrosis"
} | step1 | D | [
"75 year old man presents",
"physician",
"difficulty breathing",
"months",
"denies",
"cough",
"fever",
"chest pain",
"past medical history",
"significant",
"hypertension",
"takes chlorothiazide",
"worked",
"construction industry",
"applying insulation",
"roofs",
"over 20 years",
"d... |
A 14-year-old boy presents to an urgent care clinic complaining of a runny nose that has lasted for a few weeks. He also reports sneezing attacks that last up to an hour, nasal obstruction, and generalized itching. He has similar episodes each year during the springtime that prevent him from going out with his friends ... | Atopic dermatitis | {
"A": "Allergic contact dermatitis",
"B": "Atopic dermatitis",
"C": "Irritant contact dermatitis",
"D": "Systemic lupus erythematosus"
} | step1 | B | [
"year old boy presents",
"urgent care clinic",
"runny nose",
"lasted",
"weeks",
"reports sneezing attacks",
"last",
"hour",
"nasal obstruction",
"generalized itching",
"similar episodes",
"year",
"prevent",
"out",
"friends",
"out",
"sports",
"younger brother",
"history of asthma"... |
A 26-year-old G2P1 undergoes labor induction at 40 weeks gestation. The estimated fetal weight was 3890 g. The pregnancy was complicated by gestational diabetes treated with insulin. The vital signs were as follows: blood pressure 125/80 mm Hg, heart rate 91/min, respiratory rate 21/min, and temperature 36.8℃ (98.2℉). ... | 5% dextrose | {
"A": "5% dextrose",
"B": "Intravenous regular insulin",
"C": "Erythrocyte mass",
"D": "Subcutaneous insulin"
} | step2&3 | A | [
"year old",
"labor induction",
"40 weeks gestation",
"estimated fetal",
"g",
"pregnancy",
"complicated",
"gestational diabetes treated with insulin",
"vital signs",
"follows",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature 36",
"98",
"b... |
A 33-year-old man is brought to the emergency department by his partner for 24 hours of fever, severe headache, and neck stiffness. His companion also comments that he has been vomiting several times in the past 8 hours and looks confused. His personal medical history is unremarkable. Upon examination, his blood pressu... | Prophylaxis with rifampin for close contacts | {
"A": "Addition of ampicillin",
"B": "Prophylaxis with rifampin for close contacts",
"C": "Initiation of amphotericin",
"D": "Initiation rifampin, isoniazid, pyrazinamide, and ethambutol"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"partner",
"24 hours",
"fever",
"severe headache",
"neck stiffness",
"companion",
"comments",
"vomiting several times",
"past 8 hours",
"looks confused",
"personal medical history",
"unremarkable",
"examination",
"blood pressure",
... |
A 43-year-old male presents to a clinic for routine follow-up. He was diagnosed with hepatitis B several months ago. He does not have any complaints about his health, except for poor appetite. The general physical examination is normal. The laboratory investigation reveals mildly elevated aminotransferases. Which of th... | HbsAg +, Anti-HbsAg -, Anti-HbcAg IgM -, Anti-HbcAg IgG +, HbeAg +, Anti-HbeAg - | {
"A": "HbsAg -, Anti-HbsAg -, Anti-HbcAg IgM +, Anti-HbcAg IgG -, HbeAg -, Anti-HbeAg +",
"B": "HbsAg +, Anti-HbsAg -, Anti-HbcAg IgM -, Anti-HbcAg IgG +, HbeAg +, Anti-HbeAg -",
"C": "HbsAg -, Anti-HbsAg +, Anti-HbcAg IgM -, Anti-HbcAg IgG -, HbeAg -, Anti-HbeAg -",
"D": "HbsAg -, Anti-HbsAg +, Anti-HbcAg IgM... | step1 | B | [
"year old male presents",
"clinic",
"routine follow-up",
"diagnosed",
"hepatitis B",
"months",
"not",
"complaints",
"health",
"poor appetite",
"general physical examination",
"normal",
"laboratory investigation reveals mildly elevated aminotransferases",
"following findings",
"patient",
... |
A 32-year-old man comes to the physician with involuntary lip smacking and hand and leg movements for the past two weeks. The movements are causing him difficulty walking and functioning at work. He has bipolar disorder treated with fluphenazine. Three months ago, he was hospitalized because of a manic episode, and his... | Weaker dopamine antagonism | {
"A": "Weaker acetylcholine antagonism",
"B": "Weaker acetylcholine agonism",
"C": "Weaker dopamine antagonism",
"D": "Weaker histamine agonism"
} | step2&3 | C | [
"year old man",
"physician",
"involuntary lip smacking",
"hand",
"leg movements",
"past two weeks",
"movements",
"causing",
"difficulty walking",
"functioning",
"work",
"bipolar disorder treated with fluphenazine",
"Three months",
"hospitalized",
"manic episode",
"dosage",
"adjusted"... |
A 37-year-old-woman presents to the emergency room with complaints of fever and abdominal pain. Her blood pressure is 130/74 mmHg, pulse is 98/min, temperature is 101.5°F (38.6°C), and respirations are 23/min. The patient reports that she had a laparoscopic cholecystectomy 4 days ago but has otherwise been healthy. She... | Wound infection | {
"A": "Pulmonary atelectasis",
"B": "Residual gallstones",
"C": "Urinary tract infection",
"D": "Wound infection"
} | step2&3 | D | [
"year old woman presents",
"emergency room",
"complaints",
"fever",
"abdominal pain",
"blood pressure",
"74 mmHg",
"pulse",
"98 min",
"temperature",
"respirations",
"23 min",
"patient reports",
"laparoscopic cholecystectomy",
"days",
"healthy",
"visiting",
"family",
"Nebraska",
... |
A 16-year-old girl comes to the physician because she is worried about gaining weight. She reports that at least twice a week, she eats excessive amounts of food but feels ashamed about losing control soon after. She is very active in her high school's tennis team and goes running daily to lose weight. She has a histor... | Bulimia nervosa | {
"A": "Obsessive-compulsive disorder",
"B": "Bulimia nervosa",
"C": "Anorexia nervosa",
"D": "Body dysmorphic disorder"
} | step1 | B | [
"year old girl",
"physician",
"worried about gaining weight",
"reports",
"twice",
"week",
"eats excessive amounts",
"food",
"feels ashamed",
"control",
"very active",
"high tennis team",
"goes running daily to",
"weight",
"history",
"cutting",
"forearms",
"metal tab",
"soda",
"... |
A 37-year-old woman presents to the emergency department with a chief complaint of severe pain in her face. She states that over the past week she has experienced episodic and intense pain in her face that comes on suddenly and resolves on its own. She states she feels the pain over her cheek and near her eye. The pain... | Carbamazepine | {
"A": "Alprazolam",
"B": "Carbamazepine",
"C": "High flow oxygen",
"D": "Regular outpatient follow up"
} | step2&3 | B | [
"year old woman presents",
"emergency department",
"chief complaint",
"severe pain",
"face",
"states",
"past week",
"episodic",
"intense pain",
"face",
"resolves",
"states",
"feels",
"pain",
"cheek",
"eye",
"pain",
"so severe",
"causes",
"eyes to tear",
"very self conscious",... |
A 45-year-old man with type 2 diabetes mellitus presents to his family physician for a follow-up appointment. He is currently using a 3-drug regimen consisting of metformin, sitagliptin, and glipizide. Despite this therapeutic regimen, his most recent hemoglobin A1c level is 8.1%. Which of the following is the next bes... | Discontinue glipizide; initiate insulin glargine 10 units at bedtime | {
"A": "Discontinue glipizide; initiate insulin glargine 10 units at bedtime",
"B": "Discontinue metformin; initiate insulin aspart at mealtimes",
"C": "Discontinue sitagliptin; initiate basal-bolus insulin",
"D": "Discontinue metformin; initiate insulin glargine 10 units at bedtime"
} | step2&3 | A | [
"year old man",
"type 2 diabetes mellitus presents",
"family physician",
"follow-up appointment",
"currently using",
"3 drug regimen consisting",
"metformin",
"sitagliptin",
"glipizide",
"therapeutic regimen",
"most recent hemoglobin level",
"8.1",
"following",
"next best step",
"patient... |
A 35-year-old woman has been trying to conceive with her 37-year-old husband for the past 4 years. After repeated visits to a fertility clinic, she finally gets pregnant. Although she missed most of her antenatal visits, her pregnancy was uneventful. A baby girl is born at the 38th week of gestation with some abnormali... | Acute lymphoblastic leukemia | {
"A": "Acute lymphoblastic leukemia",
"B": "Chronic myelogenous leukemia",
"C": "Immotile cilia syndrome",
"D": "Macroorchidism"
} | step1 | A | [
"35 year old woman",
"to",
"year old husband",
"past",
"years",
"repeated visits",
"fertility",
"gets pregnant",
"missed most",
"antenatal visits",
"pregnancy",
"baby girl",
"born",
"week",
"gestation",
"abnormalities",
"flat face",
"upward",
"eyes",
"short neck",
"tongue",
... |
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