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 64-year-old gentleman with hypertension is started on a new diuretic medication by his primary care physician because of poor blood pressure control on his previous regimen. Before starting, he is warned by his physician that the new medication may have side effects including hypokalemia and metabolic alkalosis. Furt... | NCC inhibitor in distal tubule | {
"A": "Osmotic diuresis",
"B": "NKCC inhibitor in loop of Henle",
"C": "NCC inhibitor in distal tubule",
"D": "ENaC inhibitor in collecting duct"
} | step1 | C | [
"64 year old",
"hypertension",
"started",
"new diuretic medication",
"primary care physician",
"of poor blood pressure control",
"previous regimen",
"starting",
"warned",
"physician",
"new medication",
"side effects including hypokalemia",
"metabolic alkalosis",
"cause alterations",
"met... |
A 66-year-old man presents to the outpatient department complaining of a rash similar to the ones in the image. The skin lesions have been present for about 2 weeks. It is present in the buttocks and both inferior limbs. There is no association of skin lesions with exposure to sunlight or medication use. The patient al... | Virus-induced clonal expansion of autoreactive B lymphocytes | {
"A": "Excessive uroporphyrinogen caused by HCV induced decarboxylase deficiency",
"B": "Defective hepatic removal of IgA caused by chronic HCV",
"C": "Monoclonal expansion of IgM caused by benign neoplasia",
"D": "Virus-induced clonal expansion of autoreactive B lymphocytes"
} | step1 | D | [
"66 year old man presents",
"outpatient department complaining of a rash similar",
"ones",
"image",
"skin lesions",
"present",
"2 weeks",
"present",
"buttocks",
"inferior limbs",
"association",
"skin lesions",
"exposure to sunlight",
"medication use",
"patient",
"reports joint pain aff... |
A 68-year-old man is brought to the emergency department because of fever, progressive weakness, and cough for the past five days. He experienced a similar episode 2 months ago, for which he was hospitalized for 10 days while visiting his son in Russia. He states that he has never fully recovered from that episode. He ... | Outpouching of the hypopharynx
" | {
"A": "Weak tone of the lower esophageal sphincter",
"B": "Formation of a tissue cavity containing necrotic debris",
"C": "Uncoordinated contractions of the esophagus",
"D": "Outpouching of the hypopharynx\n\""
} | step2&3 | D | [
"68 year old man",
"brought",
"emergency department",
"fever",
"progressive weakness",
"cough",
"past five days",
"experienced",
"similar episode",
"months",
"hospitalized",
"10 days",
"visiting",
"son",
"Russia",
"states",
"never",
"recovered",
"episode",
"felt much better",
... |
Benzodiazepines are clinically useful because of their inhibitory effects on the central nervous system. Which of the following correctly pairs the site of action of benzodiazepines with the molecular mechanism by which a they exerts their effects? | GABA-A receptors; increasing the frequency of activation of a chloride ion channel | {
"A": "GABA-A receptors; blocking action of GABA",
"B": "GABA-B receptors; activating a G-protein coupled receptor",
"C": "GABA-A receptors; increasing the duration of activation of a chloride ion channel",
"D": "GABA-A receptors; increasing the frequency of activation of a chloride ion channel"
} | step1 | D | [
"Benzodiazepines",
"useful",
"of",
"inhibitory effects",
"central nervous system",
"following",
"pairs",
"site of action",
"benzodiazepines",
"molecular mechanism",
"exerts",
"effects"
] |
A 57-year-old male with diabetes mellitus type II presents for a routine check-up. His blood glucose levels have been inconsistently controlled with medications and diet since his diagnosis 3 years ago. At this current visit, urinalysis demonstrates albumin levels of 250 mg/day. All prior urinalyses have shown albumin ... | Glomerular basement membrane thickening and mesangial expansion | {
"A": "Normal kidney biopsy, no pathological finding is evident at this time",
"B": "Glomerular basement membrane thickening and mesangial expansion",
"C": "Kimmelstiel-Wilson nodules and tubulointerstitial fibrosis",
"D": "Significant global glomerulosclerosis"
} | step1 | B | [
"57 year old male",
"diabetes mellitus type II presents",
"routine check-up",
"blood glucose levels",
"controlled with medications",
"diet",
"diagnosis",
"years",
"current visit",
"urinalysis demonstrates albumin levels",
"mg/day",
"prior urinalyses",
"shown albumin levels",
"20 mg/day",
... |
A 26-year-old man comes to the physician for evaluation of fatigue, facial rash, hair loss, and tingling of his hands and feet. He has followed a vegetarian diet for the past 3 years and has eaten 8 raw egg whites daily for the past year in preparation for a bodybuilding competition. Physical examination shows conjunct... | Oxaloacetate | {
"A": "Cystathionine",
"B": "Ribulose-5-phosphate",
"C": "Lactate",
"D": "Oxaloacetate"
} | step1 | D | [
"year old man",
"physician",
"evaluation",
"fatigue",
"facial rash",
"hair loss",
"tingling",
"hands",
"feet",
"followed",
"vegetarian diet",
"past",
"years",
"eaten",
"raw egg whites daily",
"past year",
"preparation",
"bodybuilding competition",
"Physical examination shows conj... |
A full-term and healthy infant girl presents to the office for a newborn visit. The baby was born at 40 weeks to a 35-year-old G2P1 mother via cesarean section for breech presentation. She had an unremarkable delivery and hospital course, but family history is significant for a sister with developmental dysplasia of th... | Hip ultrasound at 6 weeks of age | {
"A": "Hip MRI at 6 weeks of age",
"B": "Hip ultrasound at 6 weeks of age",
"C": "Hip radiograph at 6 weeks of age",
"D": "Hip radiograph at 5 months of age"
} | step2&3 | B | [
"full-term",
"healthy infant girl presents",
"office",
"newborn visit",
"baby",
"born",
"40 weeks",
"35 year old",
"mother",
"cesarean section",
"breech presentation",
"unremarkable delivery",
"hospital course",
"family history",
"significant",
"sister",
"developmental dysplasia of t... |
A 26-year-old man comes to the emergency department for evaluation of burning with urination and purulent urethral discharge for the past 3 days. He is sexually active with multiple female partners. Several months ago he was diagnosed with urethritis caused by gram-negative diplococci and received antibiotic treatment ... | Variation of expressed pilus proteins | {
"A": "Expression of beta-lactamase genes",
"B": "Absence of immunogenic proteins",
"C": "Production of enzymes that hydrolyze urea",
"D": "Variation of expressed pilus proteins"
} | step1 | D | [
"year old man",
"emergency department",
"evaluation",
"burning",
"urination",
"purulent urethral discharge",
"past 3 days",
"sexually active",
"multiple female partners",
"months",
"diagnosed",
"urethritis caused",
"gram-negative diplococci",
"received antibiotic treatment",
"complete re... |
A 54-year-old woman comes to the emergency department because of a 5-hour history of diffuse, severe abdominal pain, nausea, and vomiting. She reports that there is no blood or bile in the vomitus. Two weeks ago, she started having mild aching epigastric pain, which improved with eating. Since then, she has gained 1.4 ... | Perforated peptic ulcer | {
"A": "Perforated peptic ulcer",
"B": "Acute mesenteric ischemia",
"C": "Gastroesophageal reflux disease",
"D": "Cholecystolithiasis\n\""
} | step1 | A | [
"54 year old woman",
"emergency department",
"5 hour history",
"diffuse",
"severe abdominal",
"nausea",
"vomiting",
"reports",
"blood",
"bile",
"vomitus",
"Two weeks",
"started",
"mild aching epigastric",
"improved",
"eating",
"then",
"gained 1.4 kg",
"3",
"2 year history",
"... |
A 52-year-old-woman presents to an urgent care clinic with right upper quadrant pain for the past few hours. She admits to having similar episodes of pain in the past but milder than today. Past medical history is insignificant. She took an antacid, but it did not help. Her temperature is 37°C (98.6°F ), respirations a... | No further treatment required | {
"A": "Barium swallow study",
"B": "Endoscopic retrograde cholangiopancreatography",
"C": "Magnetic resonance cholangiopancreatography",
"D": "No further treatment required"
} | step2&3 | D | [
"year old woman presents",
"urgent care clinic",
"right upper quadrant pain",
"past",
"hours",
"admits to",
"similar episodes of pain",
"past",
"milder",
"today",
"Past medical history",
"took",
"antacid",
"not help",
"temperature",
"98",
"respirations",
"min",
"pulse",
"min",
... |
A 67-year-old man presents to your office with a chief complaint of constipation and many other perturbing minor medical concerns. He reports tiring easily, which he attributes to old age and years of persistent pain in his back and ribs. A complete blood count shows low hemoglobin and elevated serum creatinine. A peri... | Bence-Jones proteins in the urine | {
"A": "Early satiety and splenomegaly",
"B": "Smudge cells on peripheral smear",
"C": "Bence-Jones proteins in the urine",
"D": "No additional findings - normal aging explains symptoms"
} | step1 | C | [
"67 year old man presents",
"office",
"chief complaint",
"constipation",
"minor medical concerns",
"reports tiring easily",
"attributes",
"old age",
"years",
"persistent pain",
"back",
"ribs",
"complete blood count shows low hemoglobin",
"elevated serum creatinine",
"peripheral blood sme... |
A 16-year-old girl presents with episodes of sharp pain in her left upper limb. She says her symptoms gradually onset a few months ago and have progressively worsened. She describes her pain as severe and feeling like “someone stabbing me in my arm and then the pain moves down to my hand”. She says the pain is worse af... | Numbness over her left little finger | {
"A": "Numbness over her left thumb",
"B": "Crutch palsy",
"C": "Numbness over her left index finger",
"D": "Numbness over her left little finger"
} | step1 | D | [
"year old girl presents",
"episodes of sharp pain",
"left upper limb",
"symptoms",
"onset",
"few months",
"worsened",
"pain",
"severe",
"feeling",
"stabbing",
"arm",
"then",
"pain moves",
"hand",
"pain",
"worse",
"physical activity",
"improves",
"rest",
"vision problems",
"... |
A 45-year-old man presents with worsening joint pain and stiffness. Past medical history is significant for rheumatoid arthritis, diagnosed 3 months ago and managed with celecoxib and methotrexate, and occasional gastric reflux, managed with omeprazole. His vitals are a pulse of 80/min, a respiratory rate of 16/min, an... | Tuberculosis screening | {
"A": "Tuberculosis screening",
"B": "Antinuclear antibody (ANA) level",
"C": "Endoscopy",
"D": "Malignancy screening"
} | step1 | A | [
"year old man presents",
"worsening joint",
"stiffness",
"Past medical history",
"significant",
"rheumatoid arthritis",
"diagnosed 3 months",
"managed",
"celecoxib",
"methotrexate",
"occasional gastric reflux",
"managed",
"omeprazole",
"pulse",
"80 min",
"respiratory rate",
"min",
... |
A 78-year-old male comes to the physician’s office for a routine check-up. He complains of increased lower extremity swelling, inability to climb the one flight of stairs in his home, and waking up in the middle of the night 2-3 times gasping for breath. He has had to increase the number of pillows on which he sleeps a... | Digoxin | {
"A": "Metoprolol",
"B": "Furosemide",
"C": "Aspirin",
"D": "Digoxin"
} | step1 | D | [
"year old male",
"physicians office",
"routine check-up",
"increased lower extremity swelling",
"to climb",
"one flight",
"stairs",
"home",
"waking",
"middle",
"night",
"times gasping",
"breath",
"to increase",
"number",
"pillows",
"sleeps",
"night",
"symptoms started",
"months... |
A 68-year-old woman comes to the physician because of lower back pain that began suddenly 2 weeks ago after getting up from her chair. She has hypertension, chronic bilateral knee pain, and a history of breast cancer 15 years ago that was treated with lumpectomy. Her mother has rheumatoid arthritis. Medications include... | Paget disease of bone | {
"A": "Type 1 osteopetrosis",
"B": "Primary biliary cholangitis",
"C": "Paget disease of bone",
"D": "Bone metastases"
} | step2&3 | C | [
"68 year old woman",
"physician",
"lower back pain",
"began",
"2 weeks",
"getting",
"chair",
"hypertension",
"chronic bilateral",
"history of breast cancer",
"years",
"treated with lumpectomy",
"mother",
"rheumatoid arthritis",
"Medications include hydrochlorothiazide",
"acetaminophen"... |
A 4-year-old boy is brought in to his pediatrician by his mother because of several days of fever, irritability, and ear pain. His mother says that she was particularly concerned about his complaints of difficulty hearing and dizziness. Physical exam reveals a bulging tympanic membrane. As the pediatrician does the exa... | Mylohyoid muscle | {
"A": "Cricothyroid muscle",
"B": "Mylohyoid muscle",
"C": "Stylohyoid muscle",
"D": "Stylopharyngeus muscle"
} | step1 | B | [
"4 year old boy",
"brought",
"pediatrician",
"mother",
"days",
"fever",
"irritability",
"ear pain",
"mother",
"concerned",
"complaints",
"difficulty",
"dizziness",
"Physical exam reveals",
"bulging tympanic membrane",
"pediatrician",
"examination",
"medical student",
"lining",
... |
A 23-year-old woman comes to the physician because of right-sided blurry vision and eye pain for 4 days. She has a 6-day history of low-grade fever, headache, and malaise. One year ago, she was diagnosed with Crohn disease. Her only medication is prednisone. Her temperature is 38°C (100.4°F), pulse is 84/min, and blood... | Herpes zoster keratitis | {
"A": "Pseudomonas keratitis",
"B": "Anterior uveitis",
"C": "Herpes zoster keratitis",
"D": "Herpes simplex keratitis"
} | step2&3 | C | [
"23 year old woman",
"physician",
"right-sided blurry vision",
"eye pain",
"4 days",
"6-day history",
"low-grade fever",
"headache",
"malaise",
"One year ago",
"diagnosed",
"Crohn disease",
"only medication",
"prednisone",
"temperature",
"100 4F",
"pulse",
"84 min",
"blood pressu... |
A pathologist examines a tissue specimen in which cells are grouped together in acini with visible ducts between them. He finds a patch of pale cells with a rich blood supply among the highly basophilic and granular cells. A representative micrograph is shown in the image. Which statement is correct about these cells? | There are several different types of cells within the patch that cannot be differentiated by light microscopy. | {
"A": "These cells should be separated from the basophils by a dense capsule.",
"B": "These cells are often found to be damaged in acute pancreatitis with a subsequent increase in serum amylase levels.",
"C": "There are several different types of cells within the patch that cannot be differentiated by light micr... | step1 | C | [
"pathologist",
"tissue specimen",
"cells",
"grouped together",
"acini",
"visible ducts",
"finds",
"patch",
"pale cells",
"rich blood supply",
"highly basophilic",
"granular cells",
"representative micrograph",
"shown",
"image",
"statement",
"correct",
"cells"
] |
A 34-year-old woman presents to the emergency department with prominent hypotension and tachycardia. On examination, she has a low central venous pressure and high cardiac output. Her temperature is 38.9°C (102.0°F). The physician suspects a bacterial infection with a gram-negative bacterium. Samples are sent to the la... | Vitamin B3 (niacin) | {
"A": "Vitamin B2 (riboflavin)",
"B": "Vitamin B3 (niacin)",
"C": "Vitamin B5 (pantothenic acid)",
"D": "Vitamin B6 (pyridoxal phosphate)"
} | step1 | B | [
"year old woman presents",
"emergency department",
"prominent hypotension",
"tachycardia",
"examination",
"low central venous pressure",
"high cardiac output",
"temperature",
"physician suspects",
"bacterial infection with",
"gram-negative bacterium",
"Samples",
"sent",
"lab",
"high volu... |
A public health researcher is invited to participate in a government meeting on immunization policies. Other participants in the meeting include physicians, pediatricians, representatives of vaccine manufacturers, persons from the health ministry, etc. For a specific viral disease, there are 2 vaccines - one is a live ... | LAV requires stricter requirements for cold chain maintenance as compared to a subunit vaccine | {
"A": "LAV has a less potential for immunization errors as compared to a subunit vaccine",
"B": "LAV cannot cause symptomatic infection in a immunocompetent person and, therefore, is as safe as a subunit vaccine",
"C": "LAV is equally safe as a subunit vaccine for administration to a pregnant woman",
"D": "LAV... | step1 | D | [
"public health researcher",
"to",
"government meeting",
"immunization policies",
"participants",
"meeting include physicians",
"pediatricians",
"representatives",
"vaccine manufacturers",
"persons",
"health",
"etc",
"specific viral disease",
"2 vaccines",
"one",
"live attenuated",
"s... |
A 67-year-old man presents to his primary care physician for a decline in his hearing that he noticed over the past week. The patient has a past medical history of hypertension and diabetes mellitus and was recently diagnosed with bladder cancer which is currently appropriately being treated. The patient is a hunter an... | Medication regimen | {
"A": "Medication regimen",
"B": "Otitis externa",
"C": "Otitis media",
"D": "Presbycusis"
} | step2&3 | A | [
"67 year old man presents",
"primary care physician",
"hearing",
"past week",
"patient",
"past medical",
"diabetes mellitus",
"recently diagnosed",
"bladder cancer",
"currently",
"treated",
"patient",
"hunter",
"often goes shooting",
"time",
"recent sick contacts include",
"grandson"... |
A 57-year-old man is rushed to the emergency department by ambulance after being found on the floor gasping for air with severe shortness of breath by his partner. Past medical history is significant for congestive heart failure, hypertension, and hyperlipidemia. He normally takes chlorthalidone, atorvastatin, metoprol... | ↑ Plasma renin and angiotensin II activity, ↓ blood pressure, ↓ renal perfusion pressure, ↑ serum pH | {
"A": "↓ Plasma renin and angiotensin II activity, ↑ blood pressure, normal renal perfusion pressure, ↑ serum pH",
"B": "Normal plasma renin and angiotensin II activity, ↓ blood pressure, ↓ renal perfusion pressure, ↓ serum pH",
"C": "↑ Plasma renin and angiotensin II activity, ↓ blood pressure, ↓ renal perfusio... | step1 | C | [
"57 year old man",
"rushed",
"emergency department",
"ambulance",
"found on",
"floor gasping",
"air",
"severe shortness of breath",
"partner",
"Past medical history",
"significant",
"congestive heart failure",
"hypertension",
"hyperlipidemia",
"takes chlorthalidone",
"atorvastatin",
... |
A 23-year-old man presents to the emergency room following a stab wound to the back. He was in a bar when he got into an argument with another man who proceeded to stab him slightly right of the midline of his back. He is otherwise healthy and does not take any medications. He has one previous admission to the hospital... | Ipsilateral flaccid paralysis at the level of the lesion | {
"A": "Ipsilateral loss of pain and temperature sensation below the lesion",
"B": "Contralateral loss of tactile, vibration, and proprioception below the lesion",
"C": "Contralateral spasticity below the level of the lesion",
"D": "Ipsilateral flaccid paralysis at the level of the lesion"
} | step1 | D | [
"23 year old man presents",
"emergency room following",
"stab",
"back",
"bar",
"got",
"argument",
"man",
"to stab",
"slightly right of",
"midline",
"back",
"healthy",
"not take",
"medications",
"one previous admission to",
"hospital",
"stab",
"leg",
"bar fight",
"years",
"t... |
A 52-year-old man presents to the emergency department with 1-month of progressive dyspnea, decreased exercise tolerance, and inability to sleep flat on his back. He says that he been getting increasingly short of breath over the past few years; however, he attributed these changes to getting older. He started becoming... | Vitamin B1 deficiency | {
"A": "Amyloid production",
"B": "Myosin mutation",
"C": "Turner syndrome",
"D": "Vitamin B1 deficiency"
} | step1 | D | [
"year old man presents",
"emergency department",
"1-month",
"progressive dyspnea",
"decreased exercise tolerance",
"to sleep flat",
"back",
"getting",
"short of breath",
"past",
"years",
"attributed",
"changes",
"getting older",
"started",
"very concerned",
"unable to climb",
"stai... |
A 29-year-old woman presents to her gynecologist as part of her follow-up for her abnormal pap test a year ago. She has a normal menstrual cycle and has never been pregnant. She does not take oral contraceptive pills, as she is sexually inactive. She denies the use of any illicit drugs. Conventional cytology from her c... | Dysplasia | {
"A": "Hypertrophy",
"B": "Atrophy",
"C": "Dysplasia",
"D": "Anaplasia"
} | step1 | C | [
"29 year old woman presents",
"gynecologist",
"part of",
"follow-up",
"abnormal pap test",
"year",
"normal menstrual cycle",
"never",
"pregnant",
"not take oral contraceptive pills",
"sexually inactive",
"denies",
"use",
"illicit drugs",
"Conventional cytology",
"cervix uteri",
"reve... |
A 42-year-old man presents with unremitting diarrhea that has lasted for 2 weeks. He describes his bowel movements as watery, non-bloody, foul-smelling, and greasy. He also has cramping abdominal pain associated with the diarrhea. He says that his symptoms started right after he returned from a father-son camping trip ... | Giardia lamblia | {
"A": "Campylobacter jejuni",
"B": "Clostridium difficile",
"C": "Giardia lamblia",
"D": "Yersinia enterocolitica"
} | step1 | C | [
"year old man presents",
"diarrhea",
"lasted",
"2 weeks",
"bowel movements",
"watery",
"non bloody",
"smelling",
"greasy",
"cramping abdominal associated with",
"diarrhea",
"symptoms started right",
"returned",
"father son camping trip",
"mountains",
"son",
"similar symptoms",
"vit... |
A 35-year-old woman presents to the emergency department with swelling of her face and abdominal pain. She states she was outside doing yard work when her symptoms began. The patient has a past medical history of recently diagnosed diabetes and hypertension. Her current medications include lisinopril, metformin, and gl... | Danazol | {
"A": "Fresh frozen plasma",
"B": "Ecallantide",
"C": "Danazol",
"D": "Discontinue metformin"
} | step2&3 | C | [
"35 year old woman presents",
"emergency department",
"swelling of",
"face",
"abdominal pain",
"states",
"outside",
"yard work",
"symptoms began",
"patient",
"past medical recently diagnosed diabetes",
"hypertension",
"current medications include lisinopril",
"metformin",
"glipizide",
... |
A 40-year-old man comes to the physician because of a 5-month history of watery diarrhea and episodic crampy abdominal pain. He has no fever, nausea, or vomiting. Over the past 6 months, he has had a 1.8-kg (4-lb) weight loss, despite experiencing no decrease in appetite. His wife has noticed that sometimes his face an... | Dementia | {
"A": "Asphyxia",
"B": "Achlorhydria",
"C": "Dementia",
"D": "Intestinal fistula"
} | step2&3 | C | [
"40 year old man",
"physician",
"5 month history",
"watery diarrhea",
"episodic crampy",
"fever",
"nausea",
"vomiting",
"past 6 months",
"kg",
"4",
"weight loss",
"experiencing",
"decrease in appetite",
"wife",
"sometimes",
"face",
"neck",
"red",
"meals",
"distress",
"year"... |
A 17-year-old boy is brought to the emergency department by his parents because of crushing chest pain, nausea, and vomiting for the past 2 hours. The pain is constant and radiates to his left shoulder. Over the past year, he has been admitted to the hospital twice for deep vein thrombosis. He has a history of learning... | Downward lens subluxation | {
"A": "Downward lens subluxation",
"B": "Macroorchidism",
"C": "Saccular cerebral aneurysms",
"D": "Ascending aortic aneurysm"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"parents",
"crushing chest pain",
"nausea",
"vomiting",
"past",
"hours",
"pain",
"constant",
"radiates",
"left shoulder",
"past year",
"admitted",
"hospital twice",
"deep vein thrombosis",
"history",
"learning",
"held back thre... |
A 7-year-old Caucasian male presents with a temperature of 38°C. During the physical exam, the patient complains of pain when his femur is palpated. The patient's parents state that the fever started a few days after they noticed a honey-colored crusting on the left upper lip of the child's face. Culture of the bacteri... | Staphylococcus aureus | {
"A": "Staphylococcus aureus",
"B": "Staphylococcus saprophyticus",
"C": "Clostridium perfingens",
"D": "Escherichia coli"
} | step1 | A | [
"year old Caucasian male presents",
"temperature",
"physical exam",
"patient",
"pain",
"femur",
"palpated",
"patient's parents state",
"fever started",
"few days",
"honey colored crusting",
"left upper lip of",
"child's face",
"Culture",
"bacteria reveals",
"catalase positive",
"gram... |
A 46-year-old woman complains of chronic cough for the past 3 weeks. She was recently diagnosed with hypertension and placed on an angiotensin receptor blocker therapy (ARBs). Chest X-ray shows large nodular densities bilaterally. Bronchial biopsy showed granulomatous inflammation of the pulmonary artery. Lab investiga... | Granulomatosis with polyangiitis | {
"A": "Microscopic polyangitis",
"B": "Churg-Strauss syndrome",
"C": "Hypertensive medication",
"D": "Granulomatosis with polyangiitis"
} | step1 | D | [
"year old woman",
"chronic cough",
"past",
"weeks",
"recently diagnosed",
"hypertension",
"placed",
"angiotensin receptor",
"therapy",
"ARBs",
"Chest X-ray shows large nodular densities",
"Bronchial biopsy showed granulomatous inflammation of",
"pulmonary artery",
"Lab investigations showe... |
A 32-year-old man comes to the physician because of recurrent episodes of palpitations, chest pain, shortness of breath, sweating, and dizziness over the past 4 months. These episodes are accompanied by intense fear of “losing control” over himself. Most of the episodes have occurred at work in situations when it would... | Depressed mood and feeling of guilt | {
"A": "Preoccupation with an observed flaw in physical appearance",
"B": "Depressed mood and feeling of guilt",
"C": "Fear of spiders and heights",
"D": "Disorganized speech and delusions"
} | step2&3 | B | [
"year old man",
"physician",
"of recurrent episodes",
"palpitations",
"chest pain",
"shortness of breath",
"sweating",
"dizziness",
"past",
"months",
"episodes",
"intense fear",
"control",
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"episodes",
"occurred",
"work",
"unacceptable to leave",
"as",
"team meetings"... |
A 68-year-old woman presents with shortness of breath and left-sided chest pain for a week. She says that her breathlessness is getting worse, and the chest pain is especially severe when she takes a deep breath. The patient denies any similar symptoms in the past. Her past medical history is insignificant except for o... | With the patient in the sitting position, below the tip of the scapula midway between the spine and the posterior axillary line on the superior margin of the eighth rib | {
"A": "With the patient in the sitting position, below the tip of the scapula midway between the spine and the posterior axillary line on the superior margin of the eighth rib",
"B": "With the patient in the sitting position, just above the fifth rib in the anterior axillary line",
"C": "With the patient in the ... | step1 | A | [
"68 year old woman presents",
"shortness of breath",
"left-sided chest pain",
"week",
"breathlessness",
"getting worse",
"chest pain",
"severe",
"takes",
"deep breath",
"patient denies",
"similar symptoms",
"past",
"past medical history",
"occasional heartburn",
"currently",
"not tak... |
A 28-year-old woman presents to the clinic with complaints of occasional low-grade fever and joint pain for 1 month. She also complains of morning stiffness in the proximal interphalangeal joints of both hands, which lasts for 5 to 10 minutes. She recently noticed a pink rash on her nose and cheekbones. Her family hist... | Anti-double stranded DNA (dsDNA) antibodies | {
"A": "Anti-double stranded DNA (dsDNA) antibodies",
"B": "Anti-histone antibodies",
"C": "Anti-topoisomerase (anti-Scl 70) antibodies",
"D": "Anti-Ro antibodies"
} | step1 | A | [
"year old woman presents",
"clinic",
"complaints",
"occasional low-grade fever",
"joint pain",
"month",
"morning stiffness",
"the proximal interphalangeal joints of",
"hands",
"lasts",
"10 minutes",
"recently",
"pink rash",
"nose",
"cheekbones",
"family history",
"significant",
"si... |
A 50-year-old man presents to a physician with recurrent episodes of coughing over the last 3 years. He mentions that his cough has been accompanied by expectoration during 5–6 consecutive months every year for the last 3 years and he experiences breathing difficulty on exertion. He has been a smoker for the last 10 ye... | Hyperplasia of the mucus glands in the airways | {
"A": "Destruction of the pulmonary capillary bed",
"B": "Variable-sized cysts against a background of densely scarred lung tissue",
"C": "Hyperplasia of the mucus glands in the airways",
"D": "Eosinophilic infiltration of the airways"
} | step2&3 | C | [
"50 year old man presents",
"physician",
"recurrent episodes of coughing",
"last",
"years",
"cough",
"expectoration",
"consecutive months",
"year",
"years",
"experiences breathing difficulty",
"exertion",
"smoker",
"10 years",
"family history of allergy",
"prescribed inhaled corticoste... |
A 25-year-old woman comes to the physician for a routine health maintenance examination. Her last visit was 3 years ago. She feels well. One year ago, she underwent a tubectomy after the delivery of her third child. She does not take any medications. Physical examination shows no abnormalities. A Pap smear shows a high... | Loop electrosurgical excision procedure | {
"A": "Laser ablative therapy",
"B": "Loop electrosurgical excision procedure",
"C": "Repeat cytology at 12 months",
"D": "Colposcopy with endometrial sampling"
} | step2&3 | B | [
"year old woman",
"physician",
"routine health maintenance examination",
"last visit",
"3 years",
"feels well",
"One year ago",
"tubectomy",
"delivery",
"third child",
"not take",
"medications",
"Physical examination shows",
"abnormalities",
"Pap smear shows",
"high-grade squamous intr... |
A 36-year-old man presents to his physician with an acute burning retrosternal sensation with radiation to his jaw. This sensation began 20 minutes ago when the patient was exercising at the gym. It does not change with position or with a cough. The patient’s vital signs include: blood pressure is 140/90 mm Hg, heart r... | Exercise stress testing | {
"A": "Blood test for CPK-MB",
"B": "Chest radiography",
"C": "CT angiography",
"D": "Exercise stress testing"
} | step2&3 | D | [
"36 year old man presents",
"physician",
"acute burning retrosternal sensation",
"radiation",
"jaw",
"sensation began 20 minutes",
"patient",
"exercising",
"not change",
"position",
"cough",
"patients vital signs include",
"blood pressure",
"90 mm Hg",
"heart rate",
"84 min",
"respir... |
A 58-year-old woman with a past medical history significant for major depressive disorder and generalized anxiety syndrome presents after having undergone menopause 3 years earlier. Today, she complains of intolerable hot flashes and irritability at work and at home. The remainder of the review of systems is negative. ... | Known or suspected personal history of breast cancer | {
"A": "Family history of breast cancer",
"B": "Known or suspected personal history of breast cancer",
"C": "Family history of endometrial cancer",
"D": "Failure of symptomatic control with SSRI/SNRI"
} | step2&3 | B | [
"58 year old woman",
"past medical history significant",
"major depressive disorder",
"generalized anxiety syndrome presents",
"menopause",
"years earlier",
"Today",
"hot flashes",
"irritability",
"work",
"at home",
"of",
"review",
"systems",
"negative",
"Physical examination reveals",... |
A 34-year-old man comes to the physician for a 1-week history of fever and generalized fatigue. Yesterday, he developed a rash all over his body. Two months ago, he had a painless lesion on his penis that resolved a few weeks later without treatment. He has asthma. Current medications include an albuterol inhaler. He i... | Ibuprofen | {
"A": "Ceftriaxone",
"B": "Ibuprofen",
"C": "Epinephrine",
"D": "Phenylephrine"
} | step2&3 | B | [
"year old man",
"physician",
"1-week history",
"fever",
"generalized fatigue",
"rash",
"body",
"Two months",
"painless lesion",
"penis",
"resolved",
"few weeks later",
"treatment",
"asthma",
"Current medications include",
"albuterol inhaler",
"currently sexually active",
"different... |
A pharmaceutical company is testing a new antidepressant. During phase I of the drug trial, healthy volunteers are recruited, and the effects of the drug on the cardiovascular system are studied. A graphical representation of the volume-pressure relationship of the left ventricle of the heart is given below with the da... | Gq-coupled receptor activation | {
"A": "Selective AT1 receptor blockade",
"B": "Gs-coupled receptor activation",
"C": "Gq-coupled receptor activation",
"D": "M2 receptor activation"
} | step1 | C | [
"pharmaceutical company",
"testing",
"new antidepressant",
"phase I",
"drug trial",
"healthy volunteers",
"effects of",
"drug",
"cardiovascular system",
"studied",
"graphical representation of",
"volume pressure relationship",
"left ventricle",
"heart",
"given",
"dashed line representi... |
A baby is delivered at 39 weeks without complications. Upon delivery, there are obvious craniofacial abnormalities, including micrognathia, cleft lip, and cleft palate. On further inspection, downward slanting eyes and malformed ears are seen. The child has an APGAR score of 9 and 9 at 1 and 5 minutes respectively. The... | Mutation in the TCOF1 gene | {
"A": "Trisomy 18",
"B": "Mutation of the SOX9 gene",
"C": "Microdeletion at chromosome 22q14",
"D": "Mutation in the TCOF1 gene"
} | step1 | D | [
"baby",
"delivered",
"weeks",
"complications",
"delivery",
"craniofacial abnormalities",
"including micrognathia",
"cleft lip",
"cleft palate",
"further inspection",
"downward",
"eyes",
"malformed ears",
"seen",
"child",
"APGAR score",
"9",
"5 minutes",
"signs",
"cyanosis",
"... |
A 46-year-old woman with a history of type II diabetes mellitus is started on lisinopril for newly diagnosed hypertension by her primary care physician. At a follow-up appointment several weeks later, she reports decreased urine output, and she is noted to have generalized edema. Her creatinine is elevated compared to ... | Renal efferent arteriole vasodilation; decreased GFR | {
"A": "Renal afferent arteriole vasoconstriction; decreased GFR",
"B": "Renal efferent arteriole vasoconstriction; increased GFR",
"C": "Renal efferent arteriole vasodilation; decreased GFR",
"D": "Renal efferent arteriole vasodilation; no change in GFR"
} | step1 | C | [
"year old woman",
"history of type II diabetes mellitus",
"started",
"lisinopril",
"newly diagnosed hypertension",
"primary care physician",
"follow-up appointment",
"weeks later",
"reports decreased urine output",
"noted to",
"generalized edema",
"creatinine",
"elevated compared",
"baseli... |
A 20-year-old female with type I diabetes mellitus presents to the emergency department with altered mental status. Her friend said that she has been out late either studying for upcoming tests or attending prayer group meetings. As far as the friend can recollect, the patient appeared to be in her usual state of healt... | Hyperkalemia is independent of the patient's total body potassium stores | {
"A": "Hyponatremia is independently associated with a poor prognosis",
"B": "Hyperkalemia is independent of the patient's total body potassium stores",
"C": "Hyperglycemia to this magnitude supports hyperglycemic hyperosmolar nonketotic syndrome",
"D": "Hypochloremia to this magnitude supports a pure anion-ga... | step2&3 | B | [
"20 year old female",
"type I diabetes mellitus presents",
"emergency department",
"altered mental status",
"friend",
"out late",
"studying",
"tests",
"attending prayer group",
"friend",
"recollect",
"patient appeared to",
"usual state of health",
"only two days",
"prescribed trimethopri... |
A 34-year-old woman visits the physician with complaints of difficulty swallowing and recurrent vomiting for the past 6 months. She even noticed food particles in her vomit a few hours after eating her meals. She has lost about 3.0 kg (6.6 lb) over the past 4 months. Her history is significant for a trip to Argentina l... | Barium XR | {
"A": "Biopsy",
"B": "Surgery",
"C": "Barium XR",
"D": "Antibiotic therapy"
} | step2&3 | C | [
"year old woman visits",
"physician",
"complaints",
"difficulty swallowing",
"recurrent vomiting",
"past 6 months",
"food particles",
"vomit",
"few hours",
"eating",
"meals",
"lost",
"3.0 kg",
"6.6",
"past",
"months",
"history",
"significant",
"trip",
"Argentina",
"year",
"... |
A 35-year-old woman presents to the emergency room with severe right lower quadrant abdominal pain. She has a history of tubal ligation 3 years ago and a history of chlamydia treated 15 years ago. She usually has very regular periods, but her last menstrual period was 10 weeks ago. On exam, she is afebrile, HR 117, blo... | Laparotomy | {
"A": "Serial beta-hCG levels",
"B": "Azithromycin",
"C": "Methotrexate",
"D": "Laparotomy"
} | step2&3 | D | [
"35 year old woman presents",
"emergency room",
"severe right lower quadrant abdominal pain",
"history of tubal ligation",
"years",
"history",
"chlamydia treated",
"years",
"usually",
"very regular periods",
"last menstrual period",
"10 weeks",
"exam",
"afebrile",
"blood pressure",
"88... |
A 47-year-old female comes to the emergency department because of increasing back pain for the past 2 weeks. She is unable to perform her daily chores. One month ago, she fell and hurt her back while working outside in the garden. The pain subsided with over-the-counter acetaminophen. She underwent a left mastectomy 1 ... | MRI of the spine | {
"A": "Serum protein electrophoresis",
"B": "X-rays of the spine",
"C": "Vancomycin and nafcillin therapy",
"D": "MRI of the spine"
} | step2&3 | D | [
"year old female",
"emergency department",
"of increasing back pain",
"past 2 weeks",
"unable to perform",
"daily chores",
"One month",
"fell",
"back",
"working outside",
"garden",
"pain",
"over-the-counter acetaminophen",
"left mastectomy",
"year",
"breast cancer",
"type 2 diabetes ... |
A 67-year-old woman comes to the clinic complaining of progressive fatigue over the past 4 months. She noticed that she is feeling increasingly short of breath after walking the same distance from the bus stop to her home. She denies chest pain, syncope, lower extremity edema, or a cough. She denies difficulty breathin... | < 1% | {
"A": "< 1%",
"B": "0%",
"C": ">5%",
"D": ">7%"
} | step1 | A | [
"67 year old woman",
"clinic",
"progressive fatigue",
"past",
"months",
"feeling",
"short of breath",
"walking",
"same distance",
"bus stop",
"home",
"denies chest pain",
"syncope",
"lower extremity edema",
"cough",
"denies difficulty breathing",
"sitting",
"increased dyspnea",
"... |
A 54-year-old man comes to the emergency department because of worsening shortness of breath, bilateral leg swelling, and constant chest pain which is not related to exertion for the last 2 weeks. The patient underwent an aortic valve replacement surgery for chronic aortic regurgitation 1 year ago, and his postoperativ... | Low voltage and beat-to-beat variations in the height of QRS complexes | {
"A": "Diffuse concave ST elevation and PR depression",
"B": "S wave in lead I, Q wave with T-wave inversion in lead III",
"C": "Right atrial enlargement, right ventricular enlargement, and right axis deviation",
"D": "Low voltage and beat-to-beat variations in the height of QRS complexes"
} | step2&3 | D | [
"54 year old man",
"emergency department",
"of worsening shortness",
"breath",
"bilateral leg swelling",
"constant chest",
"not related",
"exertion",
"last",
"weeks",
"patient",
"aortic valve replacement surgery",
"chronic",
"regurgitation 1 year",
"postoperative course",
"uncomplicate... |
A 62-year-old man presents to his primary care physician for a follow-up appointment. The patient was the front seat driver in a head-on collision which resulted in a femur and pelvic fracture which was treated appropriately. The patient spent 3 weeks in the hospital and was then discharged 2 weeks ago. The patient has... | Neurologic damage | {
"A": "Atherosclerotic change",
"B": "Increased prolactin",
"C": "Medication changes",
"D": "Neurologic damage"
} | step2&3 | D | [
"62 year old man presents",
"primary care physician",
"follow-up appointment",
"patient",
"front",
"driver",
"head",
"collision",
"resulted",
"femur",
"pelvic fracture",
"treated",
"patient spent 3 weeks",
"hospital",
"then discharged 2 weeks",
"patient",
"past medical diabetes",
"... |
A 32-year-old woman, gravida 2 para 1, at 31 weeks' gestation is brought to the emergency department because of confusion. Three days ago, she developed diffuse abdominal pain, malaise, nausea, and vomiting. She has a 2-year history of gastroesophageal reflux disease. Four months ago, she spent 2 weeks in Belize for he... | Acute fatty liver of pregnancy | {
"A": "Preeclampsia",
"B": "Acute fatty liver of pregnancy",
"C": "Intrahepatic cholestasis of pregnancy",
"D": "Acute viral hepatitis B"
} | step2&3 | B | [
"year old woman",
"gravida 2 para 1",
"31 weeks",
"estation ",
"rought ",
"mergency department ",
"onfusion.",
"hree ays ",
"iffuse bdominal ",
"alaise,",
"ausea,",
"omiting.",
"- ear istory of gastroesophageal reflux disease.",
"our onths ",
"pent weeks ",
"elize ",
"revious p... |
A 38-year-old woman presents with worsening fatigue and difficulty talking for the last few hours. Past medical history is significant for type 2 diabetes mellitus, managed with metformin and insulin. Additional current medications are a pill to ''calm her nerves'' that she takes when she has to perform live on stage f... | Masking of sympathetic nervous system dependent symptoms | {
"A": "Masking of sympathetic nervous system dependent symptoms",
"B": "Increased GABAergic activity",
"C": "Direct opiate mu receptor stimulation",
"D": "Hyperosmolar nonketotic coma"
} | step1 | A | [
"year old woman presents",
"worsening fatigue",
"difficulty talking",
"hours",
"Past medical history",
"significant",
"type 2 diabetes mellitus",
"managed",
"metformin",
"insulin",
"Additional current medications",
"pill to",
"calm",
"nerves",
"takes",
"to perform live",
"stage",
"... |
A 15-year-old boy is brought to the emergency room for evaluation of malaise, dyspnea, and yellow skin and sclera. On examination, he is tachycardic, tachypneic, and the O2 saturation is less than 90%. The levels of unconjugated bilirubin and hemoglobinemia are increased, and there is an increased number of reticulocyt... | Hemolytic anemia | {
"A": "Acute leukemia",
"B": "Sideropenic anemia",
"C": "Hemolytic anemia",
"D": "Aplastic anemia"
} | step1 | C | [
"year old boy",
"brought",
"emergency room",
"evaluation",
"malaise",
"dyspnea",
"yellow skin",
"sclera",
"examination",
"tachycardic",
"tachypneic",
"O2 saturation",
"less than 90",
"levels",
"unconjugated bilirubin",
"hemoglobinemia",
"increased",
"increased number",
"reticuloc... |
A 12-year-old boy presents to the emergency department with severe abdominal pain and nausea. He first began to have diffuse abdominal pain 15 hours prior to presentation. Since then, the pain has moved to the right lower quadrant. On physical exam he has tenderness to light palpation with rebound tenderness. Lifting h... | T10 | {
"A": "C6",
"B": "T4",
"C": "T10",
"D": "L1"
} | step1 | C | [
"year old boy presents",
"emergency department",
"severe abdominal",
"nausea",
"first began to",
"diffuse abdominal",
"hours prior to presentation",
"then",
"pain",
"moved to",
"right lower quadrant",
"physical exam",
"tenderness",
"light palpation",
"rebound tenderness",
"Lifting",
... |
A 48-year-old woman is admitted to the hospital with sepsis and treated with gentamicin. One week after her admission, she develops oliguria and her urine shows muddy brown casts on light microscopy. Days later, her renal function begins to recover, but she complains of weakness and develops U waves on EKG as shown in ... | Hypokalemia | {
"A": "Hypocalcemia",
"B": "Hypokalemia",
"C": "Hyponatremia",
"D": "Hypoglycemia"
} | step1 | B | [
"48 year old woman",
"admitted",
"hospital",
"sepsis",
"treated with gentamicin",
"One week",
"admission",
"oliguria",
"urine shows muddy brown casts",
"light microscopy",
"Days later",
"renal function begins to recover",
"weakness",
"U waves",
"EKG",
"shown",
"Image",
"laboratory ... |
A plain CT scan of the patient's head is performed immediately and the result is shown. His temperature is 37.1°C (98.8°F), pulse is 101/min and blood pressure is 174/102 mm Hg. Which of the following is the most appropriate next step in management? | Intravenous alteplase therapy | {
"A": "Decompressive surgery",
"B": "Intravenous labetalol therapy",
"C": "Oral aspirin therapy",
"D": "Intravenous alteplase therapy"
} | step2&3 | D | [
"CT scan of",
"patient's head",
"performed immediately",
"result",
"shown",
"temperature",
"98",
"pulse",
"min",
"blood pressure",
"mm Hg",
"following",
"most appropriate next step",
"management"
] |
A 58-year-old Caucasian male is being treated for atrial fibrillation and angina complains of dyspnea on exertion. On exam, his heart rate 104-115/min and irregularly irregular at rest. He has no chest pain. You believe his rate control for atrial fibrillation is suboptimal and the likely cause of his dyspnea. You are ... | Hypotension | {
"A": "Diarrhea",
"B": "Shortening of action potential length at the AV node",
"C": "Hypotension",
"D": "Torsades de pointes"
} | step1 | C | [
"58 year old Caucasian male",
"treated",
"atrial fibrillation",
"angina",
"dyspnea",
"exertion",
"exam",
"heart rate",
"min",
"irregular",
"rest",
"chest pain",
"rate control",
"atrial fibrillation",
"suboptimal",
"likely cause",
"dyspnea",
"considering adding verapamil",
"curren... |
A 3-month-old male presents to the pediatrician with his mother for a well child visit. The patient drinks 4 ounces of conventional cow’s milk formula every three hours. He usually stools once per day, and urinates up to six times per day. His mother reports that he regurgitates a moderate amount of formula through his... | Counsel on positioning and thickening feeds | {
"A": "Obtain abdominal ultrasound",
"B": "Counsel on positioning and thickening feeds",
"C": "Provide reassurance",
"D": "Switch to hydrolyzed formula"
} | step2&3 | B | [
"3 month old male presents",
"pediatrician",
"mother",
"well child visit",
"patient drinks 4 ounces",
"conventional cows",
"three hours",
"usually stools",
"day",
"six times",
"day",
"mother reports",
"regurgitates",
"moderate amount",
"formula",
"nose",
"mouth",
"feeds",
"not",
... |
An 18-month-old boy is brought to the emergency department after losing consciousness. His mother states that he was running with other kids in the park when he suddenly fell down and became unresponsive for less than 1 minute. He has not had any immunizations due to their religious beliefs. The parents report that he ... | Morphine, oxygen, IV fluids, and beta blockers | {
"A": "Morphine, oxygen, nitroglycerin, and aspirin",
"B": "Morphine, oxygen, IV fluids, and beta blockers",
"C": "Observation and reassurance",
"D": "Antibiotics and supportive care"
} | step2&3 | B | [
"month old boy",
"brought",
"emergency department",
"consciousness",
"mother states",
"running",
"kids",
"park",
"fell",
"unresponsive",
"1 minute",
"not",
"immunizations due to",
"religious beliefs",
"parents report",
"plays",
"children",
"tires easily",
"difficulty feeding",
... |
A 28-year-old man is admitted to the emergency department with a gunshot wound to the abdomen. He complains of weakness and diffuse abdominal pain. Morphine is administered and IV fluids are started by paramedics at the scene. On admission, the patient’s blood pressure is 90/60 mm Hg, heart rate is 103/min, respiratory... | Exploratory laparotomy | {
"A": "Exploratory laparotomy",
"B": "Focused assessment with sonography for trauma (FAST)",
"C": "Abdominal X-ray",
"D": "Diagnostic peritoneal lavage"
} | step2&3 | A | [
"year old man",
"admitted",
"emergency department",
"gunshot",
"abdomen",
"weakness",
"diffuse abdominal",
"Morphine",
"administered",
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"started",
"paramedics",
"admission",
"patients blood pressure",
"90 60 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"t... |
A 34-year-old woman presents with fatigue, depressed mood, weight gain, and constipation. She gradually developed these symptoms over the past 6 months. She is G2P2 with the last pregnancy 9 months ago. She had a complicated delivery with significant blood loss requiring blood transfusions. She used to have a regular 2... | Free T4 | {
"A": "Free T4",
"B": "Total T3",
"C": "MCV",
"D": "TSH"
} | step2&3 | A | [
"year old woman presents",
"fatigue",
"depressed mood",
"weight gain",
"constipation",
"symptoms",
"past 6 months",
"pregnancy",
"months",
"complicated delivery",
"significant blood loss requiring blood transfusions",
"used to",
"regular",
"day cycle",
"notes",
"recently",
"irregular... |
A 74-year-old right-handed woman was referred to the hospital due to concerns of a stroke. In the emergency department, the initial vital signs included blood pressure of 159/98 mm Hg, heart rate of 88/min, and respiratory rate of 20/min. She exhibited paucity of speech and apathy to her condition, although she complie... | Right anterior cerebral artery | {
"A": "Right anterior cerebral artery",
"B": "Right middle cerebral artery stem (M1)",
"C": "Inferior division of the right middle cerebral artery",
"D": "Inferior division of the left middle cerebral artery"
} | step2&3 | A | [
"74 year old right-handed woman",
"referred to",
"hospital due to concerns",
"stroke",
"emergency department",
"initial vital included blood pressure",
"159 98 mm Hg",
"heart rate",
"88 min",
"respiratory rate",
"20 min",
"exhibited",
"speech",
"apathy",
"condition",
"complied",
"phy... |
A 65-year-old woman, with end-stage renal disease (ESRD) on hemodialysis, presents with pain, swelling and discoloration of her right leg and foot. She says that she started twice-weekly hemodialysis 2 weeks ago and has had no issues until 1 week ago when she noticed a warm, painful swelling of the back of her right le... | Heparin/PF4 enzyme-linked immunosorbent assay (ELISA) | {
"A": "Heparin/PF4 enzyme-linked immunosorbent assay (ELISA)",
"B": "Functional assay for factor VIII",
"C": "Serotonin release assay",
"D": "Flow cytometry for CD55"
} | step2&3 | A | [
"65 year old woman",
"end-stage renal disease",
"hemodialysis",
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"discoloration",
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"right leg",
"right foot",
"finishing",
... |
A 62-year-old man is brought to the emergency room because of pain in his right hip. He was found lying on the floor several hours after falling onto his right side. Ten years ago, he received a renal transplant from a living related donor. He has a 4-year history of type 2 diabetes. Current medications include prednis... | Administer intravenous insulin and glucose | {
"A": "Administer nebulized albuterol",
"B": "Administer intravenous insulin and glucose",
"C": "Initiate hemodialysis",
"D": "Administer intravenous sodium bicarbonate"
} | step2&3 | B | [
"62 year old man",
"brought",
"emergency room",
"of pain in",
"right hip",
"found lying",
"floor",
"hours",
"falling",
"right side",
"Ten years",
"received",
"renal transplant from",
"living related donor",
"4 year history",
"type 2 diabetes",
"Current medications include prednisone"... |
After an initial assessment in the emergency department, the patient is sent for an urgent CT scan of the head. CT scan reveals a mild hypodensity in the left cerebellum. What is the most likely etiology/cause? | Arterial dissection | {
"A": "Arterial dissection",
"B": "Cardiac emboli",
"C": "Carotid stenosis",
"D": "Lacunar infarction"
} | step2&3 | A | [
"initial assessment",
"emergency department",
"patient",
"sent",
"urgent CT scan of",
"head",
"reveals",
"mild",
"left cerebellum",
"most likely etiology cause"
] |
A 56-year-old female presents for initial evaluation by a rheumatologist with a chief complaint of back and joint pain. She says that she has been having mild pain for years, but that the pain has become worse over the course of the last 6 months. She clarifies that the pain is most severe in the mornings just after wa... | Anti-Ro and anti-La antibodies | {
"A": "Anti-centromere antibody",
"B": "Anti-cyclic citrullinated peptide (CCP) antibody",
"C": "Anti-Jo1 and anti-Mi2 antibodies",
"D": "Anti-Ro and anti-La antibodies"
} | step1 | D | [
"year old female presents",
"initial evaluation",
"rheumatologist",
"chief complaint of back",
"joint pain",
"mild pain",
"years",
"pain",
"worse",
"course of",
"months",
"clarifies",
"pain",
"most severe",
"mornings",
"waking",
"to",
"day",
"mouth feels dry",
"difficulty eatin... |
A 50-year-old man presents with a rapid onset of severe, right periorbital pain, an ipsilateral throbbing headache, and blurred vision for the past hour. The patient says he was out walking with his friend when he felt short of breath. His friend gave him a puff of his rescue inhaler because it often relives his breath... | Get an urgent ophthalmology consultation. | {
"A": "Administer systemic steroids.",
"B": "Get an urgent ophthalmology consultation.",
"C": "Add latanoprost.",
"D": "Perform emergency iridotomy."
} | step1 | B | [
"50 year old man presents",
"rapid onset",
"severe",
"right periorbital",
"ipsilateral throbbing headache",
"blurred vision",
"past hour",
"patient",
"out walking",
"friend",
"felt short of breath",
"friend gave",
"puff",
"inhaler",
"often",
"breathlessness",
"patient's eye started",... |
A 47-year-old woman comes to the physician for a follow-up examination. She has type 1 diabetes mellitus, end-stage renal disease, and was recently started on erythropoietin for anemia. Her last hemodialysis session was yesterday. Current medications also include insulin, calcitriol, and sevelamer. She appears well. He... | Erythropoietin therapy | {
"A": "Calcitriol therapy",
"B": "Erythropoietin therapy",
"C": "Autonomic neuropathy",
"D": "Hypervolemia"
} | step2&3 | B | [
"year old woman",
"physician",
"follow-up examination",
"type 1 diabetes mellitus",
"end-stage renal disease",
"recently started",
"erythropoietin",
"anemia",
"last hemodialysis session",
"Current medications",
"include insulin",
"calcitriol",
"sevelamer",
"appears well",
"pulse",
"68 ... |
A 68-year-old man with alcohol use disorder is brought to the physician by his sister for frequent falls and an unsteady gait over the past 2 months. He has not seen a physician in 10 years. He appears emaciated and inattentive. He is oriented to person only. Physical examination shows a wide-based gait with slow, shor... | Small vessel hemorrhage in mammillary bodies | {
"A": "Small vessel hemorrhage in mammillary bodies",
"B": "Depigmentation of the substantia nigra",
"C": "Widespread atrophy of cerebral cortex",
"D": "Atrophy of the caudate and putamen"
} | step1 | A | [
"68 year old man",
"alcohol use disorder",
"brought",
"physician",
"sister",
"frequent falls",
"unsteady gait",
"past",
"months",
"not seen",
"physician",
"10 years",
"appears emaciated",
"inattentive",
"oriented to person only",
"Physical examination shows",
"wide-based gait",
"sl... |
A 57-year-old woman comes to the physician because of increasing wrinkles on her face and sagging skin. She says that her skin used to be smooth and firm. Examination shows diffuse xerosis and mild atrophy, laxity, and fine wrinkles on the periorbital skin. Which of the following processes is most likely involved in th... | Decrease in elastin fiber assembly | {
"A": "Decrease in elastin fiber assembly",
"B": "Increase in fibroblast activity",
"C": "Increase in lipofuscin deposition",
"D": "Decreased crosslinking of collagen fibrils"
} | step1 | A | [
"57 year old woman",
"physician",
"of increasing wrinkles",
"face",
"sagging skin",
"skin used to",
"smooth",
"firm",
"Examination shows diffuse xerosis",
"mild atrophy",
"laxity",
"fine wrinkles",
"periorbital skin",
"following processes",
"most likely involved",
"development",
"pat... |
A 35-year-old woman presents with an inability to move her right arm or leg. She states that symptoms onset acutely 2 hours ago. Past medical history is significant for long-standing type 1 diabetes mellitus, well-managed with insulin. The patient reports a 15-pack-year smoking history. Family history is significant fo... | Elevated creatinine | {
"A": "Normal PTT and PT",
"B": "Elevated creatinine",
"C": "Elevated reticulocyte count",
"D": "Elevated bilirubin"
} | step2&3 | B | [
"35 year old woman presents",
"to move",
"right arm",
"leg",
"states",
"symptoms onset",
"hours",
"Past medical history",
"significant",
"long standing type 1 diabetes mellitus",
"well managed",
"insulin",
"patient reports",
"pack-year smoking history",
"Family history",
"significant",... |
A 77-year-old male presents to the emergency department because of shortness of breath and chest discomfort. The patient states his ability to withstand activity has steadily declined, and most recently he has been unable to climb more than one flight of stairs without having to stop to catch his breath. On physical ex... | A paradoxically split S2 | {
"A": "A wide and fixed split S2",
"B": "A constant, machine-like murmur heard between the scapulae",
"C": "A paradoxically split S2",
"D": "A diastolic murmur heard at the cardiac apex"
} | step2&3 | C | [
"year old male presents",
"emergency department",
"of shortness",
"breath",
"chest discomfort",
"patient states",
"ability to",
"activity",
"most recently",
"unable to climb",
"one flight",
"stairs",
"to stop to catch",
"breath",
"physical exam",
"patient",
"harsh crescendo-decrescen... |
A 3-year-old boy is brought to the family physician by his parents. They are concerned that he has had multiple nosebleeds in the last 6 months and is always sick compared to other children. During this time period they have also noticed the formation of multiple bruises on his extremities and dry-itching skin on his h... | Wiskott-Aldrich Syndrome | {
"A": "X-linked Agammaglobulinemia",
"B": "Severe Combined Immunodefiency",
"C": "Wiskott-Aldrich Syndrome",
"D": "Hyperimmunoglobulin E syndrome"
} | step1 | C | [
"3 year old boy",
"brought",
"family physician",
"parents",
"concerned",
"multiple nosebleeds",
"months",
"always sick compared",
"children",
"time period",
"formation",
"multiple bruises",
"extremities",
"dry itching skin",
"hands",
"feet",
"elbow",
"physical exam",
"physician n... |
A 24-year-old, gravida 1, para 1 woman develops lower abdominal pain and fevers 4 days after undergoing a cesarean delivery under general anesthesia for prolonged labor. Since delivery, she has had malodorous lochia and difficulty breastfeeding due to breast pain. She has not had any shortness of breath or chest pain. ... | Endometritis | {
"A": "Endometritis",
"B": "Pyelonephritis",
"C": "Normal postpartum fever",
"D": "Chorioamnionitis"
} | step2&3 | A | [
"year old",
"gravida 1",
"para 1 woman",
"lower abdominal pain",
"fevers 4 days",
"cesarean delivery",
"general anesthesia",
"prolonged labor",
"delivery",
"lochia",
"difficulty breastfeeding due to breast pain",
"not",
"shortness of breath",
"chest pain",
"received intravenous intrapart... |
A 67-year-old woman is brought to the emergency department by her caretakers for a change in behavior. The patient lives in a nursing home and was noted to have abnormal behavior, urinary incontinence, and trouble walking. The patient has been admitted to the hospital before for what seems to be negligence from her car... | Osmotic demyelination | {
"A": "Central nervous system infection",
"B": "Cerebral edema",
"C": "Diarrhea and flora destruction",
"D": "Osmotic demyelination"
} | step2&3 | D | [
"67 year old woman",
"brought",
"emergency department",
"caretakers",
"change",
"behavior",
"patient lives in a nursing home",
"noted to",
"abnormal behavior",
"urinary incontinence",
"walking",
"patient",
"admitted",
"hospital",
"to",
"negligence",
"caretakers",
"Laboratory values... |
A 3-year-old boy is brought to the emergency department because of increasing shortness of breath for 2 days. He is at 30th percentile for height and at 25th percentile for weight. His temperature is 37.1°C (98.8°F), pulse is 144/min, respirations are 40/min, and blood pressure is 80/44 mm Hg. Bilateral crackles are he... | Polycythemia | {
"A": "Polycythemia",
"B": "Secondary hypertension",
"C": "Thrombocytosis",
"D": "Myocardial ischemia"
} | step2&3 | A | [
"3 year old boy",
"brought",
"emergency department",
"of increasing shortness",
"breath",
"2 days",
"percentile",
"height",
"percentile",
"weight",
"temperature",
"98",
"pulse",
"min",
"respirations",
"40 min",
"blood pressure",
"80",
"mm Hg",
"Bilateral crackles",
"heard",
... |
A 33-year-old man presents to the emergency room for diarrhea. He states it is profuse and watery and has not been improving over the past week. He is generally healthy; however, he was recently hospitalized during spring break and treated for alcohol intoxication and an aspiration pneumonia. While on spring break, the... | Vancomycin | {
"A": "Ciprofloxacin and metronidazole",
"B": "Metronidazole",
"C": "No treatment indicated",
"D": "Vancomycin"
} | step2&3 | D | [
"year old man presents",
"emergency room",
"diarrhea",
"states",
"watery",
"not",
"improving",
"past week",
"healthy",
"recently hospitalized",
"spring break",
"treated",
"alcohol intoxication",
"aspiration pneumonia",
"spring break",
"patient",
"camping",
"admits eating",
"chick... |
A 30-year-old woman, gravida 1, para 0, at 30 weeks' gestation is brought to the emergency department because of progressive upper abdominal pain for the past hour. The patient vomited once on her way to the hospital. She states that she initially had dull stomach pain about 6 hours ago, but now the pain is located in ... | Appendicitis | {
"A": "HELLP syndrome",
"B": "Nephrolithiasis",
"C": "Acute cholangitis",
"D": "Appendicitis"
} | step2&3 | D | [
"30 year old woman",
"gravida 1",
"para 0",
"30 weeks",
"gestation",
"brought",
"emergency department",
"of progressive upper abdominal pain",
"past hour",
"patient vomited",
"hospital",
"states",
"initially",
"dull stomach pain",
"hours",
"now",
"pain",
"upper abdomen",
"more se... |
An 8-year-old female is given omalizumab for the treatment of bronchial asthma. Omalizumab treats asthma through which mechanism? | Inhibition of IgE binding to mast cells | {
"A": "Inhibition of IgE binding to mast cells",
"B": "Inhibition of leukotriene binding to receptor",
"C": "Inhibition of phosphodiesterase breakdown of cAMP",
"D": "Mediating type IV hypersensitivity reaction"
} | step1 | A | [
"year old female",
"given omalizumab",
"treatment",
"bronchial asthma",
"treats asthma",
"mechanism"
] |
A 49-year-old man seeks evaluation at an urgent care clinic with a complaint of palpitations for the past few hours. He denies any chest pain, shortness of breath, or sweating. He is anxious and appears worried. His medical history is unremarkable with the exception of mild bronchial asthma. He only uses medications du... | Selective β1-receptor antagonist | {
"A": "Selective β1-receptor antagonist",
"B": "Non-selective β-receptor antagonist",
"C": "α-receptor agonist",
"D": "β-receptor agonist"
} | step1 | A | [
"year old man",
"evaluation",
"urgent care clinic",
"complaint",
"palpitations",
"past",
"hours",
"denies",
"chest pain",
"shortness of breath",
"sweating",
"anxious",
"appears worried",
"medical history",
"unremarkable",
"exception",
"mild bronchial asthma",
"only uses medications... |
A 26-year-old female college student is brought back into the university clinic for acting uncharacteristically. The patient presented to the same clinic 6 weeks ago with complaints of depressed mood, insomnia, and weightloss. She had been feeling guilty for wasting her parent’s money by doing so poorly at the universi... | Her diagnosis of unipolar depression is incorrect. | {
"A": "Her diagnosis of unipolar depression is incorrect.",
"B": "Her new symptoms need to last at least 7 days.",
"C": "The patient may have a history of mania.",
"D": "The patient may have psychotic features."
} | step1 | A | [
"year old female college student",
"brought back",
"university clinic",
"patient presented",
"same clinic",
"weeks",
"complaints",
"depressed mood",
"insomnia",
"weightloss",
"feeling guilty",
"wasting",
"parents money",
"so poorly",
"university",
"felt drained",
"2 weeks",
"presen... |
A 13-year-old boy has been suspended 5 times this year for arguing with teachers. He has presented a pattern of negativism and hostility that has lasted for about 8 months. When asked about the suspensions, he admits that he loses his temper easily and often blames the principal for not being fair to him. He usually fi... | Hostile and disobedient behavior towards authority | {
"A": "Hostile and disobedient behavior towards authority",
"B": "Killing and/or harming small animals",
"C": "Physical aggression",
"D": "Violating the rights of others"
} | step1 | A | [
"year old boy",
"suspended 5 times",
"year",
"teachers",
"presented",
"pattern",
"negativism",
"hostility",
"lasted",
"months",
"suspensions",
"admits",
"easily",
"often blames",
"principal",
"not",
"fair",
"usually finds",
"argument",
"finishing",
"homework",
"home",
"go... |
A 32-year-old woman patient presents to her family physician with recurrent retrosternal chest pain. She has had similar episodes for the past 7 months along with difficulty swallowing solid as well as liquid food. She recently completed an 8-week course of a proton pump inhibitor, but she is still bothered by the feel... | Manometry | {
"A": "Electrocardiogram",
"B": "Upper GI endoscopy",
"C": "Manometry",
"D": "Additional therapy with proton pump inhibitors"
} | step2&3 | C | [
"year old woman patient presents",
"family physician",
"recurrent retrosternal",
"similar episodes",
"past",
"months",
"difficulty swallowing solid",
"liquid food",
"recently completed",
"week course",
"proton pump inhibitor",
"feeling",
"food gets stuck",
"food pipe",
"pain",
"not rel... |
A 49-year-old sexually active woman presents with dysuria and urinary frequency. She denies any previous urinary tract infections (UTIs), but she says that her mother has had frequent UTIs. Her medical history includes type 2 diabetes mellitus, hypertension, cervical cancer, and hypercholesterolemia. She currently smok... | The causative organism is Pseudomonas aeruginosa | {
"A": "The causative organism is Candida albicans",
"B": "The causative organism is Pseudomonas aeruginosa",
"C": "The patient has an indwelling catheter",
"D": "The patient has nephrolithiasis"
} | step2&3 | B | [
"year old sexually active woman presents",
"dysuria",
"urinary frequency",
"denies",
"previous urinary tract infections",
"mother",
"frequent UTIs",
"medical history includes type 2 diabetes mellitus",
"hypertension",
"cervical cancer",
"hypercholesterolemia",
"currently smokes 1 pack",
"cig... |
A 58-year-old woman with a history of nephrolithiasis presents with fever and acute-onset right flank pain. The patient says that 2 days ago she developed sudden-onset right flank pain and nausea which has progressively worsened. She describes the pain as severe, colicky, localized to the right flank, and radiating to ... | Admit to hospital for percutaneous nephrostomy and IV antibiotics | {
"A": "Discharge home with oral antibiotics",
"B": "Admit to hospital for IV antibiotics",
"C": "Administer potassium citrate",
"D": "Admit to hospital for percutaneous nephrostomy and IV antibiotics"
} | step2&3 | D | [
"58 year old woman",
"history of nephrolithiasis presents",
"fever",
"acute-onset right flank",
"patient",
"2 days",
"sudden-onset right flank",
"nausea",
"worsened",
"pain",
"severe",
"colicky",
"localized",
"right flank",
"radiating to",
"groin",
"morning",
"woke",
"fever",
"... |
An investigator is developing a new vaccine. After injecting the agent, the immune response is recorded by measuring vaccine-specific antibodies at subsequent timed intervals. To induce the maximum immunogenic response, this vaccine should have which of the following properties? | Weakened live microorganisms | {
"A": "Foreign intact polysaccharide bound to protein",
"B": "Chemically inactivated microorganism",
"C": "Foreign intact polysaccharide",
"D": "Weakened live microorganisms"
} | step1 | D | [
"investigator",
"new vaccine",
"injecting",
"agent",
"immune response",
"recorded",
"measuring vaccine specific antibodies",
"subsequent timed intervals",
"To induce",
"maximum immunogenic response",
"vaccine",
"following properties"
] |
A 34-year-old woman with a seizure disorder comes to the physician because of fever, fatigue, and a productive cough with foul-smelling sputum for 2 weeks. Her temperature is 38.3°C (100.9°F). Physical examination shows dullness to percussion over the right lung fields. An x-ray of the chest shows a cavitary infiltrate... | Periodontal infection | {
"A": "Recent hospitalization",
"B": "Intravenous drug use",
"C": "Crowded housing situation",
"D": "Periodontal infection"
} | step1 | D | [
"year old woman",
"seizure disorder",
"physician",
"fever",
"fatigue",
"productive cough",
"foul-smelling sputum",
"2 weeks",
"temperature",
"3C",
"100 9F",
"Physical examination shows dullness",
"percussion",
"right lung fields",
"x-ray of",
"chest shows",
"infiltrate",
"air-fluid... |
A 27-year-old man presents to the clinic for his annual health check-up. He currently complains of fatigue for the past few months. He has no significant past medical history. He admits to being sexually active with men and also is an intravenous drug user. He has never received a hepatitis B vaccine. His blood pressur... | Convalescent (window) period | {
"A": "Acute infection",
"B": "Chronic infection",
"C": "Immune from vaccine",
"D": "Convalescent (window) period"
} | step2&3 | D | [
"27 year old man presents",
"clinic",
"annual health",
"currently",
"fatigue",
"past",
"months",
"significant past medical history",
"admits to",
"sexually active with men",
"intravenous drug user",
"never received",
"hepatitis B vaccine",
"blood pressure",
"98 mm Hg",
"respiratory rat... |
A 45-year-old construction worker presents to his primary care physician with a painful and swollen wrist joint. A joint aspiration shows crystals, which are shown in the accompanying picture. Which of the following is the most likely diagnosis? | Monosodium urate crystals | {
"A": "Monosodium urate crystals",
"B": "Hydroxyapatite crystals",
"C": "Calcium pyrophosphate crystals",
"D": "Charcot Leyden crystals"
} | step1 | A | [
"year old construction worker presents",
"primary care physician",
"painful",
"swollen",
"joint aspiration shows crystals",
"shown",
"picture",
"following",
"most likely diagnosis"
] |
A 62-year-old man presents with epigastric pain over the last 6 months. He says the pain gets worse with food, especially coffee. He also complains of excessive belching. He says he has tried omeprazole recently, but it has not helped. No significant past medical history or current medications. On physical examination,... | Give amoxicillin, clarithromycin, and omeprazole | {
"A": "Start famotidine and erythromycin",
"B": "Observation",
"C": "Give amoxicillin, clarithromycin, and omeprazole",
"D": "Give amoxicillin, erythromycin and omeprazole"
} | step1 | C | [
"62 year old man presents",
"epigastric pain",
"last",
"months",
"pain gets worse",
"food",
"coffee",
"excessive belching",
"omeprazole recently",
"not helped",
"significant past medical history",
"current medications",
"physical examination",
"epigastric tenderness present",
"deep palpa... |
A 68-year-old man comes to the emergency room with difficulty in breathing. He was diagnosed with severe obstructive lung disease a few years back. He uses his medication but often has to come to the emergency room for intravenous therapy to help him breathe. He was a smoker for 40 years smoking two packs of cigarettes... | Low ventilation, normal perfusion and low V/Q ratio | {
"A": "Higher ventilation and perfusion with lower V/Q ratio",
"B": "Low ventilation, normal perfusion and low V/Q ratio",
"C": "Medium ventilation and perfusion, V/Q that equals 0.8",
"D": "Normal ventilation, low or nonexistent perfusion and infinite V/Q ratio"
} | step1 | B | [
"68 year old man",
"emergency room",
"difficulty",
"breathing",
"diagnosed",
"severe obstructive lung disease",
"few years back",
"uses",
"medication",
"often",
"to",
"emergency room",
"intravenous therapy to help",
"smoker",
"40 years smoking two packs",
"cigarettes",
"day",
"foll... |
A 67-year-old African American male presents to the emergency room complaining of nausea and right flank pain. He reports that these symptoms have worsened over the past two days. His past medical history is notable for congestive heart failure, hypertension, hyperlipidemia, and diabetes mellitus. He currently takes as... | Inhibition of ribosomal 30S subunit | {
"A": "Inhibition of ribosomal 30S subunit",
"B": "Inhibition of ribosomal 50S subunit",
"C": "Inhibition of dihydropteroate synthase",
"D": "Inhibition of DNA gyrase"
} | step1 | A | [
"67 year old African American male presents",
"emergency room",
"nausea",
"right flank pain",
"reports",
"symptoms",
"worsened",
"past two days",
"past medical history",
"notable",
"congestive heart failure",
"hypertension",
"hyperlipidemia",
"diabetes mellitus",
"currently takes aspirin... |
A 21-year-old woman comes to the physician because of a 1-week history of shortness of breath and dry cough. Eight weeks ago, she received a lung transplant from an unrelated donor. Current medications include prednisone, cyclosporine, and azathioprine. Her temperature is 37.8°C (100.1°F). Physical examination is unrem... | Donor MHC class II antigen | {
"A": "Donor ABO antigen",
"B": "Donor MHC class II antigen",
"C": "Streptococcal C polysaccharide antigen",
"D": "CMV glycoprotein B antigen"
} | step1 | B | [
"21-year-old woman",
"physician",
"of",
"1-week history",
"shortness",
"breath",
"dry cough",
"Eight weeks",
"received",
"lung transplant",
"unrelated donor",
"Current medications include prednisone",
"cyclosporine",
"azathioprine",
"temperature",
"100",
"Physical examination",
"un... |
An investigator is developing a new intravenous medication that acts as a selective agonist at β-2 receptors. In addition to causing bronchodilation, this drug is most likely to have which of the following effects? | Bladder detrusor relaxation | {
"A": "Decreased skeletal glycogenolysis",
"B": "Increased gastrointestinal peristalsis",
"C": "Peripheral vasoconstriction",
"D": "Bladder detrusor relaxation"
} | step1 | D | [
"investigator",
"new intravenous medication",
"acts",
"selective agonist",
"receptors",
"causing bronchodilation",
"drug",
"most likely to",
"following effects"
] |
A 42-year-old female with a history of systemic lupus erythematous (SLE) has a 3-year history of daily prednisone (20 mg) use. Due to long-term prednisone use, she is at increased risk for which of the following? | Pathologic fractures | {
"A": "Weight loss",
"B": "Pancreatic insufficiency",
"C": "Systolic hypertension",
"D": "Pathologic fractures"
} | step1 | D | [
"year old female",
"history",
"systemic lupus erythematous",
"3 year history",
"daily prednisone",
"20 mg",
"use",
"long-term prednisone use",
"increased risk",
"following"
] |
A 17-year-old girl comes to the physician for an annual health maintenance examination. She feels well. She has no history of serious illness and her only medication is an oral contraceptive. Her mother was diagnosed with breast cancer at the age of 42 years. She is currently sexually active with 1 male partner and use... | Nucleic acid amplification testing | {
"A": "Nucleic acid amplification testing",
"B": "PAP smear",
"C": "Rapid plasma reagin test",
"D": "Herpes simplex virus 2 serology"
} | step2&3 | A | [
"year old girl",
"physician",
"annual health maintenance examination",
"feels well",
"history",
"serious illness",
"only medication",
"oral contraceptive",
"mother",
"diagnosed",
"breast cancer",
"age",
"years",
"currently sexually active",
"male partner",
"uses condoms",
"immunizati... |
A 74-year-old man presents to the emergency department with sudden-onset abdominal pain that is most painful around the umbilicus. The pain began 16 hours ago and has no association with meals. He has not been vomiting, but he has had several episodes of bloody loose bowel movements. He was hospitalized 1 week ago for ... | Mesenteric angiography | {
"A": "Mesenteric angiography",
"B": "CT scanning",
"C": "Plain abdominal X-rays",
"D": "Colonoscopy"
} | step2&3 | A | [
"74 year old man presents",
"emergency department",
"sudden abdominal",
"painful",
"umbilicus",
"pain began",
"hours",
"association",
"meals",
"not",
"vomiting",
"several episodes of bloody loose bowel movements",
"hospitalized 1 week",
"acute myocardial infarction",
"diabetes mellitus",... |
A previously healthy 24-year-old male is brought to the emergency department because of fevers, congestion, and chest pain for 3 days. The chest pain is exacerbated by deep inspiration. He takes no medications. His temperature is 37.5°C (99.5°F), blood pressure is 118/75 mm Hg, pulse is 130/min, and respirations are 12... | Picornavirus | {
"A": "Togavirus",
"B": "Paramyxovirus",
"C": "Orthomyxovirus",
"D": "Picornavirus"
} | step1 | D | [
"healthy",
"year old male",
"brought",
"emergency department",
"fevers",
"congestion",
"chest pain",
"3 days",
"chest pain",
"exacerbated",
"deep inspiration",
"takes",
"medications",
"temperature",
"99",
"blood pressure",
"75 mm Hg",
"pulse",
"min",
"respirations",
"min",
... |
A 56-year-old man comes to the physician because of chest pain and shortness of breath for 3 days. The pain is present at rest and worsens with deep inspiration. His temperature is 37.2°C (99°F), pulse is 102/min, respirations are 23/min, and blood pressure is 135/88 mm Hg. Examination shows decreased breath sounds at ... | Prolonged immobilization | {
"A": "Oropharyngeal dysphagia",
"B": "Infliximab use",
"C": "Prolonged immobilization",
"D": "Congestive heart failure"
} | step2&3 | C | [
"year old man",
"physician",
"chest pain",
"shortness of breath",
"3 days",
"pain",
"present",
"rest",
"worsens",
"deep inspiration",
"temperature",
"pulse",
"min",
"respirations",
"23 min",
"blood pressure",
"88 mm Hg",
"Examination shows decreased breath sounds",
"left lower lo... |
A concerned father brings his 2 year-old son to the clinic for evaluation. In the past 24 hours, the child has had multiple episodes of painless bloody stools. On physical examination, the child's vital signs are within normal limits. There is mild generalized discomfort on palpation of the abdomen but no rebound or gu... | Stomach | {
"A": "Stomach",
"B": "Pancreas",
"C": "Gallbladder",
"D": "Liver"
} | step1 | A | [
"father",
"2 year old son",
"clinic",
"evaluation",
"past 24 hours",
"child",
"multiple episodes of painless bloody stools",
"physical examination",
"child's vital signs",
"normal limits",
"mild generalized discomfort",
"palpation of",
"abdomen",
"guarding",
"technetium-99m",
"pertechn... |
A previously healthy 5-year-old boy is brought to the emergency department because of abdominal pain and vomiting for 6 hours. His mother immediately brought him after noticing that he had gotten into the medicine cabinet. The mother is 5 months' pregnant. He appears uncomfortable. His temperature is 37.2°C (99°F), pul... | Deferoxamine | {
"A": "Deferoxamine",
"B": "Sodium bicarbonate",
"C": "Activated charcoal",
"D": "Calcium EDTA"
} | step2&3 | A | [
"healthy",
"year old boy",
"brought",
"emergency department",
"abdominal pain",
"vomiting",
"hours",
"mother immediately brought",
"gotten",
"medicine cabinet",
"mother",
"5 months",
"regnant.",
"ppears ",
"emperature ",
"ulse ",
"in ",
"lood pressure ",
"0/ 0 m Hg.",
"xaminat... |
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