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 57-year-old man is brought to the emergency department by a social worker from the homeless shelter. The man was acting strangely and then found unresponsive in his room. The social worker says she noticed many empty pill bottles near his bed. The patient has a past medical history of multiple hospital admissions for... | Liver transplant | {
"A": "Colloid-containing fluids",
"B": "Factor 2, 7, 9, and 10 concentrate",
"C": "Fresh frozen plasma",
"D": "Liver transplant"
} | step2&3 | D | [
"57 year old man",
"brought",
"emergency department",
"social worker",
"homeless shelter",
"man",
"acting",
"then found unresponsive",
"room",
"social worker",
"empty pill bottles",
"bed",
"patient",
"past medical multiple hospital admissions",
"acute pancreatitis",
"dehydration",
"s... |
A 75-year-old man presents to the physician because of bloody urine, which has occurred several times over the past month. He has no dysuria, flank pain, nausea, or vomiting. He has no history of serious illness and takes no medications. He is a 40-pack-year smoker. The vital signs are within normal limits. Physical ex... | Cystoscopy | {
"A": "Chest X-ray",
"B": "Computed tomography (CT) urogram",
"C": "Cystoscopy",
"D": "Ureteroscopy"
} | step2&3 | C | [
"75 year old man presents",
"physician",
"bloody urine",
"occurred several times",
"past",
"dysuria",
"flank pain",
"nausea",
"vomiting",
"history",
"serious illness",
"takes",
"medications",
"40 pack-year smoker",
"vital signs",
"normal limits",
"Physical exam shows",
"abnormaliti... |
A 23-year-old woman with a past medical history significant for cardiac palpitations and hypothyroidism presents with cyclical lower abdominal pain and pelvic pain. Upon further questioning, she endorses difficulty conceiving over the last 12 months. On a review of systems, she endorses occasional pain with intercourse... | Laparoscopy and lesion ablation | {
"A": "NSAIDS",
"B": "Leuprolide",
"C": "Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO)",
"D": "Laparoscopy and lesion ablation"
} | step2&3 | D | [
"23 year old woman",
"past medical history significant",
"cardiac palpitations",
"hypothyroidism presents",
"cyclical lower abdominal pain",
"pelvic pain",
"further questioning",
"difficulty conceiving",
"12 months",
"review of systems",
"occasional pain with intercourse",
"more frequent",
"... |
A 10-year-old girl is brought to the neurologist for management of recently diagnosed seizures. Based on her clinical presentation, the neurologist decides to start a medication that works by blocking thalamic T-type calcium channels. Her parents are cautioned that the medication has a number of side effects including ... | Absence seizures | {
"A": "Absence seizures",
"B": "Complex seizures",
"C": "Simple seizures",
"D": "Status epilepticus"
} | step1 | A | [
"A 10 year old girl",
"brought",
"neurologist",
"management",
"recently diagnosed seizures",
"Based",
"clinical presentation",
"neurologist",
"to start",
"medication",
"works",
"blocking thalamic",
"type calcium channels",
"parents",
"medication",
"number",
"side effects including it... |
A scientist performed an experiment to produce hybrid viruses by mixing two different serotypes of influenza virus, H1N1 and H2N2, in a respiratory epithelium cell line. Several days later, the scientist collected the media and analyzed the viral progeny. She found the following serotypes of virus: H1N1, H2N2, H1N2, an... | Reassortment | {
"A": "Recombination",
"B": "Reassortment",
"C": "Phenotypic mixing",
"D": "Transformation"
} | step1 | B | [
"scientist performed",
"experiment to",
"hybrid viruses",
"mixing two different serotypes",
"influenza virus",
"H1N1",
"H2N2",
"respiratory epithelium cell line",
"Several days later",
"scientist collected",
"media",
"analyzed",
"viral progeny",
"found",
"following serotypes",
"virus",... |
A 56-year-old woman comes to the physician because of a 3-month history of progressive weakness. She has no history of serious illness and takes no medications. Her vital signs are within normal limits. Physical examination shows a violaceous rash over her eyelids and flat-topped erythematous papules over the dorsal su... | Ovarian adenocarcinoma | {
"A": "Pheochromocytoma",
"B": "Hodgkin lymphoma",
"C": "Renal clear cell carcinoma",
"D": "Ovarian adenocarcinoma"
} | step1 | D | [
"year old woman",
"physician",
"3 month history",
"progressive weakness",
"history",
"serious illness",
"takes",
"medications",
"vital signs",
"normal",
"Physical examination shows",
"violaceous rash",
"eyelids",
"flat topped erythematous papules",
"dorsal surface",
"interphalangeal jo... |
A 52-year-old man comes to the physician because of a 5-month history of progressive lethargy, shortness of breath, and difficulty concentrating. His friends have told him that he appears pale. He has smoked half a pack of cigarettes daily for the past 20 years. Neurological examination shows reduced sensation to light... | Gastric carcinoma | {
"A": "Colorectal carcinoma",
"B": "Gastric carcinoma",
"C": "De Quervain thyroiditis",
"D": "Type 2 diabetes mellitus"
} | step1 | B | [
"year old man",
"physician",
"5 month history",
"progressive lethargy",
"shortness of breath",
"difficulty concentrating",
"friends",
"appears pale",
"smoked half",
"pack",
"cigarettes daily",
"past 20 years",
"Neurological examination shows reduced",
"light",
"toes",
"Laboratory studi... |
A 70-year-old man comes to the physician for the evaluation of an 8-week history of blood in his stool. Two months ago, he had an episode of bronchitis and was treated with amoxicillin. Since then, he has noticed blood in his stool and on the toilet paper occasionally. The patient has had intermittent constipation for ... | Diverticulosis | {
"A": "Colorectal carcinoma",
"B": "Diverticulosis",
"C": "Hemorrhoids",
"D": "Pseudomembranous colitis\n\""
} | step2&3 | B | [
"70 year old man",
"physician",
"evaluation",
"week history",
"blood",
"stool",
"Two months",
"episode of bronchitis",
"treated with amoxicillin",
"Since then",
"blood in",
"stool",
"toilet paper occasionally",
"patient",
"intermittent constipation",
"past",
"years",
"Six months",
... |
An overweight 57-year-old woman comes to her primary care physician for a routine checkup. She has no current complaints and takes no medications. Her mother and brother have type 2 diabetes mellitus and hypertension. Vital signs show a blood pressure of 145/95 mmHg, temperature of 37°C (98.6°F), and a pulse of 85/minu... | Digital fundus photography now, then yearly follow-up | {
"A": "Albumin-to-creatinine ratio after 5 years, then yearly follow-up",
"B": "Monofilament test after 5 years, then yearly follow-up",
"C": "Fasting lipid profile every 5 years",
"D": "Digital fundus photography now, then yearly follow-up"
} | step2&3 | D | [
"overweight 57 year old woman",
"primary care physician",
"routine checkup",
"current complaints",
"takes",
"medications",
"mother",
"brother",
"type 2 diabetes mellitus",
"hypertension",
"Vital signs show",
"blood pressure",
"95 mmHg",
"temperature",
"98",
"pulse",
"85 minute",
"l... |
A 27-year-old man comes to the physician because of a 4-month history of unintentional weight gain, fatigue, and decreased sexual desire. There is no personal or family history of serious illness. His blood pressure is 149/88 mm Hg. Physical examination shows central obesity and abdominal striae. He has a prominent sof... | Abdominal CT | {
"A": "CRH stimulation test",
"B": "Chest CT",
"C": "Abdominal CT",
"D": "Brain MRI"
} | step1 | C | [
"27 year old man",
"physician",
"4 month history",
"unintentional weight gain",
"fatigue",
"decreased sexual desire",
"personal",
"family history",
"serious illness",
"blood pressure",
"88 mm Hg",
"Physical examination shows central obesity",
"abdominal striae",
"prominent soft tissue bulg... |
A 59-year-old woman comes to the physician because of worsening shortness of breath for the past two weeks. Physical examination shows decreased breath sounds at both lung bases. The abdomen is distended and there is shifting dullness with a positive fluid wave. Ultrasound of the abdomen shows a large collection of per... | Ovarian fibroma | {
"A": "Serous cystadenoma",
"B": "Endometrioma",
"C": "Dermoid cyst",
"D": "Ovarian fibroma"
} | step1 | D | [
"59 year old woman",
"physician",
"of worsening shortness",
"breath",
"past two weeks",
"Physical examination shows decreased breath sounds",
"lung bases",
"abdomen",
"distended",
"shifting dullness",
"positive fluid wave",
"Ultrasound of",
"abdomen shows",
"large collection",
"peritonea... |
A 39-year-old woman presents to her primary care physician because she has been experiencing intermittent abdominal pain for the last 2 weeks. She says that the pain is squeezing in nature, is located in the right upper quadrant, and is particularly severe after eating a meal. After a diagnosis is made, the patient ask... | Contains large blood vessels and large lymphatic vessels | {
"A": "Connective tissue that envelops the other layers",
"B": "Contains cells that primarily absorb nutrients",
"C": "Contains large blood vessels and large lymphatic vessels",
"D": "Contracts to generate peristaltic waves"
} | step1 | C | [
"year old woman presents",
"primary care physician",
"experiencing intermittent abdominal pain",
"weeks",
"pain",
"squeezing",
"nature",
"right upper quadrant",
"severe",
"eating",
"meal",
"diagnosis",
"made",
"patient",
"pain gets worse after eating",
"physician",
"food",
"detecte... |
A 41-year-old man comes to the physician because of a 7-month history of sleep disturbances, restlessness, and difficulty acquiring erections. He started a new job as a project coordinator 8 months ago. He has difficulty falling asleep and lies awake worrying about his family, next day's meetings, and finances. He can ... | Buspirone | {
"A": "Escitalopram",
"B": "Clonazepam",
"C": "Amitriptyline",
"D": "Buspirone"
} | step1 | D | [
"year old man",
"physician",
"month history",
"sleep disturbances",
"restlessness",
"difficulty acquiring erections",
"started",
"new job",
"project coordinator",
"months",
"difficulty falling asleep",
"awake worrying",
"family",
"next day's meetings",
"finances",
"longer concentrate",... |
A new study shows a significant association between patients with a BMI >40 and a diagnosis of diabetes (odds ratio: 7.37; 95% CI 6.39-8.50) compared to non-diabetic patients. Which of the following hypothetical studies most likely yielded these results. | A study consisting of 500 patients with diabetes and 500 patients without diabetes comparing BMI of subjects in both groups | {
"A": "A study consisting of 500 patients with diabetes and 500 patients without diabetes comparing BMI of subjects in both groups",
"B": "A study consisting of 1000 genetically similar mice; 500 randomized to diet to maintain normal weight and 500 randomized to high caloric intake with the outcome of diabetes rat... | step1 | A | [
"new study shows",
"significant association",
"patients",
"BMI",
"40",
"diagnosis",
"diabetes",
"odds ratio",
"95",
"CI",
"50",
"compared",
"non diabetic patients",
"following",
"studies",
"likely",
"results"
] |
A 14-year-old girl is brought to the physician because of a 1-week history of fever, malaise, and chest pain. She describes the pain as 6 out of 10 in intensity and that it is more severe if she takes a deep breath. The pain is centrally located in the chest and does not radiate. Three weeks ago, she had a sore throat ... | Intramuscular benzathine penicillin every 4 weeks for 10 years | {
"A": "Intramuscular benzathine penicillin every 4 weeks for 10 years",
"B": "Intramuscular benzathine penicillin every 4 weeks until the age of 40",
"C": "Intramuscular benzathine penicillin every 4 weeks until the age of 21",
"D": "Intramuscular benzathine penicillin every 4 weeks for 5 years"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"1-week history",
"fever",
"malaise",
"chest pain",
"pain",
"out",
"10",
"intensity",
"more severe",
"takes",
"deep breath",
"pain",
"chest",
"not radiate",
"Three weeks",
"sore throat",
"resolved",
"treatment",
"personal history",
... |
A 58-year-old woman presents to her primary care physician for a wellness checkup. She recently had a DEXA scan that placed her at 2 standard deviations below the mean for bone density. She is following up today to discuss her results. The patient has a past medical history of asthma, breast cancer, COPD, anxiety, irri... | Estrogen receptor antagonist in the uterus | {
"A": "Estrogen receptor agonist in the uterus",
"B": "Estrogen receptor antagonist in the uterus",
"C": "Induces osteoclast apoptosis",
"D": "Parathyroid hormone analogue"
} | step2&3 | B | [
"58 year old woman presents",
"primary care physician",
"wellness checkup",
"recently",
"DEXA scan",
"placed",
"at",
"standard",
"mean",
"bone density",
"following up today to discuss",
"results",
"patient",
"past medical",
"breast cancer",
"COPD",
"anxiety",
"irritable bowel syndr... |
A 62-year-old man with a history notable for alpha-thalassemia now presents to an urgent care clinic with complaints of increased thirst and urinary frequency. The physical exam is unremarkable, although there is a bronze discoloration of his skin. The laboratory analysis reveals a fasting blood glucose of 192 mg/dL, a... | Recurrent phlebotomy | {
"A": "Metformin",
"B": "Basal insulin",
"C": "Recurrent phlebotomy",
"D": "Deferoxamine"
} | step2&3 | C | [
"62 year old man",
"history notable",
"alpha-thalassemia now presents",
"urgent care clinic",
"complaints",
"increased thirst",
"urinary frequency",
"physical exam",
"unremarkable",
"bronze discoloration of",
"skin",
"laboratory analysis reveals",
"fasting blood glucose",
"mg/dL",
"Given... |
A 29-year-old woman presents with convulsions. The patient’s brother says that he found her like that an hour ago and immediately called an ambulance. He also says that she has been extremely distraught and receiving supportive care from a social worker following a sexual assault by a coworker a few days ago. He says t... | Conversion disorder | {
"A": "Somatoform pain disorder",
"B": "Conversion disorder",
"C": "Hypochondriasis",
"D": "Body dysmorphic disorder"
} | step2&3 | B | [
"29 year old woman presents",
"convulsions",
"patients brother",
"found",
"hour",
"immediately called",
"ambulance",
"extremely",
"receiving supportive care",
"social worker following",
"sexual assault",
"coworker",
"few days",
"patient",
"history",
"seizures",
"significant past medi... |
A 67-year-old man comes to the physician because of difficulty walking for 2 months. He has been falling to his left side when he walks more than a few feet. His speech has also changed in the past few months, and he now pauses between each syllable. He has never had similar symptoms before. He has hypertension and cir... | Left-sided cerebellar tumor | {
"A": "Increased number of trinucleotide CAG repeats",
"B": "Decreased serum thiamine levels",
"C": "Left-sided cerebellar tumor",
"D": "Left-sided posterior capsular infarct"
} | step2&3 | C | [
"67 year old man",
"physician",
"of difficulty walking",
"months",
"falling",
"left side",
"walks more",
"feet",
"speech",
"changed",
"past",
"months",
"now pauses",
"syllable",
"never",
"similar symptoms",
"hypertension",
"cirrhosis",
"result of alcoholic liver disease",
"not ... |
A 23-year-old man comes to the physician with a 1-week history of sharp, substernal chest pain that is worse with inspiration and relieved with leaning forward. He has also had nausea and myalgias. His father has coronary artery disease. His temperature is 37.3°C (99.1°F), pulse is 110/min, and blood pressure is 130/84... | Acute viral infection | {
"A": "Dressler syndrome",
"B": "Acute myocardial infarction",
"C": "Systemic lupus erythematosus",
"D": "Acute viral infection"
} | step1 | D | [
"23 year old man",
"physician",
"1-week history of sharp",
"chest pain",
"worse",
"inspiration",
"relieved",
"forward",
"nausea",
"myalgias",
"father",
"coronary artery disease",
"temperature",
"3C",
"99",
"pulse",
"min",
"blood pressure",
"84 mm Hg",
"Cardiac examination shows... |
A 73-year-old man presents to a dermatology clinic after his family physician finds an ulcerated plaque on the dorsal surface of his nose. This lesion has changed in size and form and has bled on multiple occasions even after the patient adopted sun-protection measures. The patient’s medical history is relevant for cig... | Mohs surgery | {
"A": "Mohs surgery",
"B": "Cryotherapy",
"C": "Radiation therapy",
"D": "Imiquimod"
} | step2&3 | A | [
"year old man presents",
"dermatology clinic",
"family physician finds",
"ulcerated plaque",
"dorsal surface",
"nose",
"lesion",
"changed in size",
"form",
"bled",
"multiple occasions",
"patient adopted sun protection measures",
"patients medical history",
"relevant",
"cigarette smoking"... |
A 65-year-old woman presents to your office after three days of fever and productive cough. She is taking Tylenol for her fever and her last dose was yesterday morning. She reports reddish brown sputum. She has a history of hypertension and hypercholesterolemia for which she takes lisinopril and a statin. She has never... | Optochin sensitivity | {
"A": "Beta hemolysis",
"B": "Gamma hemolysis",
"C": "Optochin sensitivity",
"D": "Novobiocin sensitivity"
} | step1 | C | [
"65 year old woman presents",
"office",
"three days",
"fever",
"productive cough",
"taking Tylenol",
"fever",
"last dose",
"morning",
"reports",
"brown sputum",
"history of hypertension",
"hypercholesterolemia",
"takes lisinopril",
"statin",
"never smoked",
"drinks 1-2 glasses",
"w... |
A 53-year-old woman presents for a follow-up. She took some blood tests recently for her yearly physical, and her random blood sugar level was found to be 251 mg/dL. She was asked to repeat her blood sugar and come back with the new reports. At that time, her fasting blood sugar level was 130 mg/dL and the postprandial... | Acts as an agonist at the peroxisome proliferator-activated receptor-Ƴ. | {
"A": "Stimulates the release of insulin from the pancreas.",
"B": "Increases the uptake of glucose and reduces peripheral insulin resistance.",
"C": "Acts as an agonist at the peroxisome proliferator-activated receptor-Ƴ.",
"D": "Inhibit alpha-glucosidase in the intestines."
} | step1 | C | [
"year old woman presents",
"follow-up",
"took",
"blood recently",
"yearly physical",
"random blood sugar level",
"found to",
"mg/dL",
"to repeat",
"blood sugar",
"back",
"new reports",
"time",
"fasting blood sugar level",
"mg/dL",
"postprandial glucose level",
"mg/dL",
"occasions",... |
You are conducting a study on hypertension for which you have recruited 60 African-American adults. If the biostatistician for your study informs you that the sample population of your study is approximately normal, the mean systolic blood pressure is 140 mmHg, and the standard deviation is 7 mmHg, how many participant... | 57 participants | {
"A": "10 participants",
"B": "41 participants",
"C": "57 participants",
"D": "68 participants"
} | step1 | C | [
"conducting",
"study",
"hypertension",
"60 African-American adults",
"study informs",
"sample population",
"study",
"approximately normal",
"mean systolic",
"mmHg",
"standard deviation",
"mmHg",
"participants",
"to",
"systolic blood pressure",
"mmHg"
] |
A 35-year-old male is brought to the emergency room after he was found to have a blood pressure of 180/100 mm Hg during a routine health check-up with his family physician. Past medical history is insignificant and both of his parents are healthy. He currently does not take any medication. The patient’s blood pressure ... | Before test: ACTH high, after test: cortisol suppression | {
"A": "Before test: ACTH high, after test: aldosterone suppression",
"B": "Before test: ACTH high, after test: cortisol suppression",
"C": "Before test: ACTH low, after test: aldosterone normalizes",
"D": "Before test: ACTH high, after test: cortisol elevation"
} | step1 | B | [
"35 year old male",
"brought",
"emergency room",
"found to",
"blood pressure",
"100 mm Hg",
"health check-up",
"family physician",
"Past medical history",
"parents",
"healthy",
"currently",
"not take",
"medication",
"patients blood pressure normalizes",
"emergency department physician"... |
A 45-year-old man presents to his primary care physician for a wellness checkup. He states that he feels fatigued at times but feels near his baseline. The patient smokes 1 pack of cigarettes per day, drinks alcohol occasionally, and has a past medical history of poorly controlled diabetes. His temperature is 98.6°F (3... | Eplerenone | {
"A": "Eplerenone",
"B": "Hydrochlorothiazide",
"C": "Spironolactone",
"D": "Surgical excision"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"wellness checkup",
"states",
"feels fatigued",
"times",
"feels",
"baseline",
"patient smokes",
"pack",
"cigarettes",
"day",
"drinks alcohol occasionally",
"past medical poorly controlled diabetes",
"temperature",
"98",
"blood pressu... |
A 39-year-old woman comes to the physician because of an 8-month history of progressive fatigue, shortness of breath, and palpitations. She has a history of recurrent episodes of joint pain and fever during childhood. She emigrated from India with her parents when she was 10 years old. Cardiac examination shows an open... | Esophagus | {
"A": "Trachea",
"B": "Thoracic duct",
"C": "Hemiazygos vein",
"D": "Esophagus"
} | step1 | D | [
"year old woman",
"physician",
"month history",
"progressive fatigue",
"shortness of breath",
"palpitations",
"history of recurrent episodes",
"joint pain",
"fever",
"childhood",
"India",
"parents",
"10 years old",
"Cardiac examination shows",
"opening snap followed by",
"late diastoli... |
A 5-week-old male infant is rushed to the emergency department due to severe vomiting and lethargy for the past 3 days. His mother describes the vomiting as forceful and projectile and contains undigested breast milk, but she did not notice any green fluids. He has not gained much weight in the past 3 weeks and looks v... | Correct electrolyte imbalances | {
"A": "Reassurance and observation",
"B": "Pyloromyotomy",
"C": "Whipple procedure",
"D": "Correct electrolyte imbalances"
} | step1 | D | [
"5 week old male infant",
"rushed",
"emergency department",
"severe vomiting",
"lethargy",
"past 3 days",
"mother",
"vomiting",
"forceful",
"projectile",
"contains",
"breast milk",
"not",
"green fluids",
"not gained",
"weight",
"past",
"weeks",
"looks very thin",
"pulse",
"mi... |
Thirty minutes after delivery, a 3400-g (7.5-lb) female newborn develops cyanosis of her lips and oral mucosa. She was born at 36 weeks of gestation to a 30-year-old woman, gravida 1, para 0. Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. Pregnancy was complicated by polyhydramnios. The patient's temperatur... | Esophageal atresia with tracheoesophageal fistula to the distal esophageal segment | {
"A": "H‑type tracheoesophageal fistula without esophageal atresia",
"B": "Esophageal atresia with tracheoesophageal fistula to the distal esophageal segment",
"C": "Esophageal atresia with tracheoesophageal fistula to the proximal and distal esophageal segments",
"D": "Esophageal atresia without tracheoesopha... | step2&3 | B | [
"Thirty minutes",
"delivery",
"3400",
"female newborn",
"cyanosis",
"lips",
"oral mucosa",
"born",
"36 weeks of gestation",
"30 year old woman",
"gravida 1",
"para 0",
"Apgar scores",
"8",
"1",
"5 minutes",
"Pregnancy",
"complicated",
"polyhydramnios",
"patient's temperature",
... |
Following a gastric surgery, a 45-year-old woman complains of severe nausea and vomiting on the second post-operative day. On physical examination, her vitals are stable and examination of the abdomen reveals no significant abnormality. As she is already receiving an appropriate dosage of ondansetron, the surgeon adds ... | Inhibition of dopamine receptors in the area postrema | {
"A": "Enhancement of small intestinal and colonic motility by dopamine antagonism",
"B": "Inhibition of dopamine receptors in the area postrema",
"C": "Decreased esophageal peristaltic amplitude",
"D": "Stimulation of motilin receptors in gastrointestinal smooth muscle"
} | step1 | B | [
"Following",
"gastric surgery",
"year old woman",
"severe nausea",
"vomiting",
"second post-operative day",
"physical examination",
"stable",
"examination of",
"abdomen reveals",
"significant abnormality",
"receiving",
"appropriate dosage",
"ondansetron",
"surgeon adds metoclopramide",
... |
A 19-year-old boy presents to the emergency department with difficulty breathing, which began 1 hour ago. He has had persistent bronchial asthma since 3 years of age and has been prescribed inhaled fluticasone (400 μg/day) by his pediatrician. He has not taken the preventer inhaler for the last 2 weeks and visited an o... | Inhaled albuterol | {
"A": "Inhaled albuterol",
"B": "Inhaled fluticasone",
"C": "Inhaled cromolyn",
"D": "Oral montelukast"
} | step1 | A | [
"year old boy presents",
"emergency department",
"difficulty breathing",
"began 1 hour",
"persistent bronchial asthma",
"years",
"age",
"prescribed inhaled fluticasone",
"400 g/day",
"pediatrician",
"not taken",
"inhaler",
"2 weeks",
"visited",
"old house today",
"lot",
"dust",
"fl... |
Six days after being admitted to the hospital for a cholecystectomy, a 56-year-old woman has high-grade fevers, chills, malaise, and generalized weakness. She has been hospitalized twice in the last year for acute cholecystitis. She had a molar extraction around 2 weeks ago. Her last colonoscopy was 8 months ago and sh... | Infected peripheral venous catheter | {
"A": "Predamaged heart valve",
"B": "Recent dental procedure",
"C": "Immunosuppression",
"D": "Infected peripheral venous catheter"
} | step2&3 | D | [
"Six days",
"admitted",
"hospital",
"cholecystectomy",
"year old woman",
"high-grade fevers",
"chills",
"malaise",
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"hospitalized twice",
"year",
"acute cholecystitis",
"molar extraction",
"2 weeks",
"last colonoscopy",
"months",
"showed",
"benign polyp",
"... |
A 6-year-old right-handed boy is brought to the emergency department because of difficulty speaking and inability to raise his right arm. The patient’s mother says his symptoms started suddenly 1 hour ago and have not improved. She says he has never had these symptoms before. No other significant past medical history. ... | Regular blood transfusion | {
"A": "Warfarin",
"B": "Carotid endarterectomy",
"C": "Regular blood transfusion",
"D": "Oral penicillin VK"
} | step2&3 | C | [
"year old right-handed boy",
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"emergency department",
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"hour",
"not improved",
"never",
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"significant past medical history",
"patient",
"born full",
"spontaneous transvaginal delivery",... |
A 53-year-old woman comes to the physician because of progressive headache and fatigue for the past 2 months. One year ago, she was diagnosed with Cushing disease, which was ultimately treated with bilateral adrenalectomy. Current medications are hydrocortisone and fludrocortisone. Examination shows generalized hyperpi... | Perform radiotherapy of the pituitary | {
"A": "Administer metyrapone",
"B": "Perform radiotherapy of the pituitary",
"C": "Reduce dosage of glucocorticoids",
"D": "Resect small cell lung carcinoma"
} | step1 | B | [
"year old woman",
"physician",
"progressive headache",
"fatigue",
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"months",
"One year ago",
"diagnosed",
"Cushing disease",
"treated with bilateral adrenalectomy",
"Current medications",
"hydrocortisone",
"fludrocortisone",
"Examination shows generalized hyperpigmentation of the sk... |
A 35-year-old woman presents to her family doctor worried that she might have a heart condition. For the past 7 months, she has been having short panic attacks where she feels short of breath, sweaty, and feels like her heart wants to jump out her chest. During these attacks, she feels like she ‘is going crazy’. She ha... | Panic disorder and agoraphobia | {
"A": "Panic disorder and agoraphobia",
"B": "Panic disorder",
"C": "Agoraphobia",
"D": "Generalized anxiety disorder"
} | step2&3 | A | [
"35 year old woman presents",
"family doctor worried",
"heart condition",
"past",
"months",
"short panic attacks",
"feels short of breath",
"sweaty",
"feels",
"heart",
"jump out",
"chest",
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"feels",
"now mapped out",
"places",
"attack",
"subway",
"crowded pharmacy",
"... |
A 25-year-old woman comes to the emergency department because of a mild headache, dizziness, fatigue, and nausea over the past several hours. She has no history of serious illness and takes no medications. She lives in a basement apartment and uses a wood stove for heating. Her temperature is 36°C (96.8°F) and pulse is... | Inhibition of mitochondrial cytochrome c oxidase | {
"A": "Inhibition of mitochondrial succinate dehydrogenase",
"B": "Inhibition of mitochondrial ATP synthase",
"C": "Inhibition of mitochondrial cytochrome c oxidase",
"D": "Increased mitochondrial membrane permeability"
} | step1 | C | [
"year old woman",
"emergency department",
"mild headache",
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"hours",
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"lives in",
"basement apartment",
"uses",
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"heating",
"temperature",
"96",
"pulse",
"min",
"Arter... |
A 31-year-old woman with a history of anorexia nervosa diagnosed 2 years ago presents for follow up. She says that, although she feels some improvement with cognitive-behavioral therapy (CBT), she is still struggling with her body image and fears gaining weight. She says that for the past 3 weeks she has noticed her an... | Lower extremity edema | {
"A": "BMI of 17.1 kg/m2",
"B": "Bigeminy",
"C": "Pulse 55/min",
"D": "Lower extremity edema"
} | step2&3 | D | [
"31 year old woman",
"history of anorexia nervosa diagnosed 2 years",
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"follow up",
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"improvement",
"cognitive-behavioral therapy",
"body image",
"fears gaining weight",
"past",
"weeks",
"ankles",
"swollen",
"mornings",
"intermittent menstruation",
"last menstrual cy... |
A 54-year-old man with a long-standing history of chronic obstructive pulmonary disease (COPD) presents to the clinic for progressive shortness of breath. The patient reports generalized fatigue, distress, and difficulty breathing that is exacerbated with exertion. Physical examination demonstrates clubbing of the fing... | Competitive inhibition of endothelin-1 receptors | {
"A": "Competitive inhibition of endothelin-1 receptors",
"B": "Competitive inhibition of muscarinic receptors",
"C": "Inhibition of phosphodiesterase-5",
"D": "Prostacylin with direct vasodilatory effects"
} | step1 | A | [
"year",
"man",
"long standing history of chronic obstructive pulmonary disease",
"presents",
"clinic",
"progressive shortness of breath",
"patient reports generalized fatigue",
"distress",
"difficulty breathing",
"exacerbated",
"exertion",
"Physical examination demonstrates clubbing of the fin... |
A 34-year-old woman, gravida 4, para 0, at 8 weeks' gestation comes to the physician for a prenatal visit. The previous pregnancies ended in spontaneous abortion between the 8th and 10th week of gestation. She feels well but is worried about having another miscarriage. She has no history of serious illness. Previous gy... | Aspirin and enoxaparin | {
"A": "Heparin bridged to warfarin",
"B": "Aspirin and enoxaparin",
"C": "Enoxaparin",
"D": "Warfarin"
} | step2&3 | B | [
"year old woman",
"gravida 4",
"para 0",
"weeks",
"estation ",
"hysician ",
"renatal visit.",
"revious pregnancies nded ",
"pontaneous abortion ",
"eek ",
"estation.",
"eels ell ",
"orried ",
"iscarriage.",
"istory ",
"erious llness.",
"revious ynecologic valuations howed ",
... |
A 32-year-old Caucasian woman presents to her primary care physician’s office with a chief complaint of excessive facial and arm hair. On further questioning, she reveals that in the past year, she has often gone more than 3 months without menstruating. On exam she is well-appearing; her temperature is 98.6°F (37°C), b... | Rx: Weight loss, CC: Insulin resistance and lipid dysfunction | {
"A": "Rx: Combined oral contraceptives, CC: Infertility and insulin resistance",
"B": "Rx: Weight loss, CC: Infertility and insulin resistance",
"C": "Rx: Weight loss, CC: Infertility and lipid dysfunction",
"D": "Rx: Weight loss, CC: Insulin resistance and lipid dysfunction"
} | step2&3 | D | [
"year old Caucasian woman presents",
"primary care physicians office",
"chief complaint",
"excessive facial",
"arm hair",
"further questioning",
"reveals",
"past year",
"often",
"more",
"months",
"exam",
"well appearing",
"temperature",
"98",
"blood pressure",
"80 mmHg",
"pulse",
... |
A 29-year-old man is brought to the emergency department 20 minutes after sustaining a gunshot wound to the abdomen. On arrival, he is awake and oriented to person, place, and time. He appears agitated. His pulse is 102/min, respirations are 20/min, and blood pressure is 115/70 mm Hg. The pupils are equal and reactive ... | CT scan of the abdomen | {
"A": "CT scan of the abdomen",
"B": "Close observation",
"C": "Diagnostic laparoscopy",
"D": "Immediate laparotomy"
} | step2&3 | A | [
"29 year old man",
"brought",
"emergency department 20 minutes",
"sustaining",
"gunshot",
"abdomen",
"arrival",
"awake",
"oriented to person",
"place",
"time",
"appears agitated",
"pulse",
"min",
"respirations",
"20 min",
"blood pressure",
"70 mm Hg",
"pupils",
"equal",
"reac... |
A 42-year-old woman presents with fatigue. She says that her symptoms have gradually onset after she recently had a total thyroidectomy due to Graves’ disease. Past medical history is otherwise unremarkable. The patient is afebrile, and her vital signs are within normal limits. Physical examination is unremarkable. Lab... | Parathyroid hormone (PTH) | {
"A": "1-alpha-hydroxylase",
"B": "25-hydroxycholecalciferol",
"C": "Calcitonin",
"D": "Parathyroid hormone (PTH)"
} | step1 | D | [
"year old woman presents",
"fatigue",
"symptoms",
"onset",
"recently",
"total thyroidectomy due to Graves disease",
"Past medical history",
"unremarkable",
"patient",
"afebrile",
"vital signs",
"normal limits",
"Physical examination",
"unremarkable",
"Laboratory findings",
"significant... |
A 36-year-old female presents to her gynecologist for a check-up. She has had normal Pap smears as recommended every 3 years since she turned 30 years old. The physician conducts a pelvic examination that is without abnormality and obtains a cervical Pap smear. The results of the patient's Pap smear from the visit retu... | Perform colposcopy | {
"A": "Repeat Pap smear in 12 months",
"B": "Repeat Pap smear in 3 years",
"C": "Obtain HPV DNA test",
"D": "Perform colposcopy"
} | step2&3 | D | [
"36 year old female presents",
"gynecologist",
"check-up",
"normal Pap smears",
"recommended",
"3 years",
"turned 30 years old",
"physician conducts",
"pelvic examination",
"abnormality",
"obtains",
"cervical Pap smear",
"results",
"patient's Pap smear",
"visit return",
"high grade squ... |
An 88-year-old man is brought to his primary care physician by his son. The patient has been in excellent health his entire life, but in the last few years appears to have grown steadily confused. He frequently calls his son about things that they have already discussed, forgets where he has placed his keys, and recent... | Cortical atrophy | {
"A": "Cortical atrophy",
"B": "Increased CSF production",
"C": "Congenital malformation",
"D": "Infection"
} | step1 | A | [
"88 year old man",
"brought",
"primary care physician",
"son",
"patient",
"excellent health",
"entire life",
"last",
"years appears to",
"confused",
"frequently calls",
"son",
"things",
"discussed",
"forgets",
"placed",
"recently",
"patient",
"on ",
"everal ",
"ills ",
"ati... |
A 39-year-old woman presents to the family medicine clinic to be evaluated by her physician for weight gain. She reports feeling fatigued most of the day despite eating a healthy diet and exercising regularly. The patient smokes a half-pack of cigarettes daily and has done so for the last 23 years. She is employed as a... | Hepatitis B vaccination | {
"A": "Hepatitis B vaccination",
"B": "Low-dose chest CT",
"C": "Hepatitis C vaccination",
"D": "Shingles vaccination"
} | step2&3 | A | [
"year old woman presents",
"family medicine clinic to",
"evaluated",
"physician",
"weight gain",
"reports feeling fatigued most of the day",
"eating",
"healthy diet",
"exercising",
"patient smokes",
"half pack",
"cigarettes daily",
"so",
"23 years",
"employed",
"phlebotomist",
"Red C... |
A 75-year-old man comes to the physician because of a 4-month history of progressive shortness of breath and chest pressure with exertion. Cardiac examination shows a crescendo-decrescendo systolic murmur that is heard best in the second right intercostal space. Radial pulses are decreased and delayed bilaterally. Tran... | 10.2 mm2 | {
"A": "10.2 mm2",
"B": "23 mm2",
"C": "6.2 mm2",
"D": "2.0 mm2"
} | step1 | A | [
"75 year old man",
"physician",
"of",
"4 month history",
"progressive shortness",
"breath",
"chest pressure",
"exertion",
"Cardiac examination shows",
"crescendo-decrescendo systolic murmur",
"heard best",
"second right intercostal space",
"Radial pulses",
"decreased",
"delayed",
"Tran... |
A newborn male born prematurely at 33 weeks is noted to have mild dyspnea and difficulty with feeding. Examination reveals bounding peripheral radial pulses and a continuous 'machine-like' murmur. The patient is subsequently started on indomethacin. Which of the following is the embryologic origin of the structure most... | 6th aortic arch | {
"A": "1st branchial cleft",
"B": "4th branchial pouch",
"C": "6th aortic arch",
"D": "6th branchial pouch"
} | step1 | C | [
"newborn male born",
"weeks",
"noted to",
"mild dyspnea",
"difficulty",
"feeding",
"Examination reveals bounding peripheral radial",
"continuous",
"machine",
"murmur",
"patient",
"started",
"indomethacin",
"following",
"embryologic origin",
"structure",
"likely responsible",
"patie... |
An 18-year-old female visits your obstetrics clinic for her first prenatal check up. It's her first month of pregnancy and other than morning sickness, she is feeling well. Upon inquiring about her past medical history, the patient admits that she used to be very fearful of weight gain and often used laxatives to lose ... | Postpartum depression for mother | {
"A": "Down syndrome in newborn",
"B": "Postpartum depression for mother",
"C": "Bradycardia in newborn",
"D": "Anemia in newborn"
} | step2&3 | B | [
"year old female visits",
"obstetrics",
"first prenatal check up",
"first month",
"pregnancy",
"other",
"morning sickness",
"feeling well",
"past medical history",
"patient admits",
"used to",
"very fearful",
"weight gain",
"often used laxatives to",
"weight",
"getting therapy",
"con... |
A 4-year-old boy presents to the pediatrician's office for a well child checkup. He does not speak during the visit and will not make eye contact. The father explains that the child has always been shy with strangers. However, the child speaks a lot at home and with friends. He can speak in 4 word sentences, tells stor... | Selective mutism | {
"A": "Child abuse at school",
"B": "Expressive speech delay",
"C": "Normal development",
"D": "Selective mutism"
} | step2&3 | D | [
"4 year old boy presents",
"pediatrician's office",
"well child checkup",
"not speak",
"visit",
"not make eye contact",
"father",
"child",
"always",
"shy",
"strangers",
"child speaks",
"lot at home",
"friends",
"speak",
"word sentences",
"stories",
"parents understand 100",
"name... |
A 61-year-old man with Alzheimer disease is brought to the emergency department 20 minutes after ingesting an unknown amount of his medications in a suicide attempt. He reports abdominal cramps, diarrhea, diaphoresis, and muscular weakness and spasms in his extremities. His temperature is 38.4°C (101.1°F), pulse is 51/... | Pralidoxime | {
"A": "Carbachol",
"B": "Physostigmine",
"C": "Pancuronium",
"D": "Pralidoxime"
} | step1 | D | [
"61 year old man",
"Alzheimer disease",
"brought",
"emergency department 20 minutes",
"ingesting",
"unknown amount",
"medications",
"suicide attempt",
"reports abdominal cramps",
"diarrhea",
"diaphoresis",
"muscular weakness",
"spasms",
"extremities",
"temperature",
"4C",
"pulse",
... |
A 46-year-old woman comes to the physician because of a 3-day history of diarrhea and abdominal pain. She returned from a trip to Egypt 4 weeks ago. Her vital signs are within normal limits. There is mild tenderness in the right lower quadrant. Stool studies show occult blood and unicellular organisms with engulfed ery... | Metronidazole | {
"A": "Doxycycline",
"B": "Metronidazole",
"C": "Paromomycin",
"D": "Ciprofloxacin"
} | step1 | B | [
"year old woman",
"physician",
"3-day history",
"diarrhea",
"abdominal pain",
"returned",
"trip",
"Egypt",
"weeks",
"vital signs",
"normal limits",
"mild tenderness",
"right lower quadrant",
"Stool studies show occult blood",
"unicellular organisms",
"erythrocytes",
"following",
"m... |
A 36-year-old woman is brought to the emergency department after being involved in a motor vehicle collision. She is alert, awake, and oriented. There is no family history of serious illness and her only medication is an oral contraceptive. Her temperature is 37.3°C (99°F), pulse is 100/min, respirations are 20/min, an... | Reassurance and observation | {
"A": "Reassurance and observation",
"B": "Biopsy of the mass",
"C": "Discontinue the oral contraceptive",
"D": "Percutaneous aspiration of the mass"
} | step2&3 | A | [
"36 year old woman",
"brought",
"emergency department",
"involved",
"motor vehicle collision",
"alert",
"awake",
"oriented",
"family history",
"serious illness",
"only medication",
"oral contraceptive",
"temperature",
"3C",
"pulse",
"100 min",
"respirations",
"20 min",
"blood pre... |
Two hours after a 2280-g male newborn is born at 38 weeks' gestation to a 22-year-old primigravid woman, he has 2 episodes of vomiting and jitteriness. The mother has noticed that the baby is not feeding adequately. She received adequate prenatal care and admits to smoking one pack of cigarettes daily while pregnant. H... | Intrauterine hypoxia
" | {
"A": "Intraventricular hemorrhage",
"B": "Hyperinsulinism",
"C": "Congenital heart disease",
"D": "Intrauterine hypoxia\n\""
} | step2&3 | D | [
"Two hours",
"g male newborn",
"born",
"weeks",
"estation ",
"ear- ld rimigravid oman,",
"as ",
"pisodes of omiting ",
"itteriness.",
"other ",
"aby ",
"ot eeding ",
"eceived dequate renatal care ",
"dmits ",
"moking ne ack ",
"igarettes aily ",
"regnant.",
"emperature ",
... |
A 20-year-old man comes to the physician because of dark urine and decreased urine output for 2 days. He had a skin infection that required antibiotic treatment 3 weeks ago but stopped the antibiotics early because the infection had resolved. His blood pressure is 140/90 mm Hg. Physical examination shows periorbital ed... | Elevated Anti-DNase B titer | {
"A": "Impaired glutathione regeneration",
"B": "Mesangial IgA deposition",
"C": "Decreased platelet count",
"D": "Elevated Anti-DNase B titer"
} | step1 | D | [
"20 year old man",
"physician",
"dark urine",
"decreased urine output",
"2 days",
"skin infection",
"required antibiotic",
"weeks",
"stopped",
"antibiotics early",
"infection",
"resolved",
"blood pressure",
"90 mm Hg",
"Physical examination shows periorbital edema",
"photomicrograph",
... |
A 7-year-old boy with a history of fetal alcohol syndrome is brought by his mother to the emergency room for malaise and lethargy. His mother reports that the family was on vacation in a cabin in the mountains for the past 10 days. Five days ago, the child developed a fever with a max temperature of 102.6°F (39.2°F). S... | Microvesicular steatosis | {
"A": "Microvesicular steatosis",
"B": "Macrovesicular steatosis",
"C": "Hepatocyte necrosis with ballooning degeneration",
"D": "Macronodular cirrhosis"
} | step1 | A | [
"year old boy",
"history",
"fetal alcohol syndrome",
"brought",
"mother",
"emergency room",
"malaise",
"lethargy",
"mother reports",
"family",
"vacation",
"mountains",
"past 10 days",
"Five",
"child",
"fever",
"temperature",
"reports",
"given multiple medications to",
"to",
"... |
A 25-year-old woman presents to the ED with a diffuse, erythematous rash in the setting of nausea, vomiting, and fever for 2 days. Physical exam reveals a soaked tampon in her vagina. Blood cultures are negative. The likely cause of this patient's disease binds to which molecule on T cells? | Variable beta portion of the T-cell receptor | {
"A": "CD3",
"B": "CD40 ligand",
"C": "Variable beta portion of the T-cell receptor",
"D": "Fas ligand"
} | step1 | C | [
"year old woman presents",
"ED",
"diffuse",
"erythematous",
"setting",
"nausea",
"vomiting",
"fever",
"2 days",
"Physical exam reveals",
"soaked tampon in",
"vagina",
"Blood cultures",
"negative",
"likely cause",
"patient's binds",
"molecule",
"T cells"
] |
A 22-year-old woman comes to the physician because of pain and swelling of her left foot. Three days ago, she cut her foot on an exposed rock at the beach. Her temperature is 37.7°C (100°F). Examination of the left foot shows edema around a fluctuant erythematous lesion on the lateral foot. Which of the following is mo... | Separation of endothelial junctions | {
"A": "Fluid production by bacteria",
"B": "Decreased plasma oncotic pressure",
"C": "Systemic cytokine release",
"D": "Separation of endothelial junctions"
} | step1 | D | [
"year old woman",
"physician",
"pain",
"swelling of",
"left foot",
"Three days",
"cut",
"foot",
"exposed rock",
"beach",
"temperature",
"Examination of",
"left foot shows edema",
"fluctuant erythematous lesion",
"lateral foot",
"following",
"most likely",
"primary mechanism",
"de... |
A 60-year-old woman with a history of atrial arrhythmia arrives in the emergency department with complaints of tinnitus, headache, visual disturbances, and severe diarrhea. The patient is given oxygen by nasal cannula. ECG leads, pulse oximeter and an automated blood pressure cuff are applied. The patient suddenly fain... | Quinidine | {
"A": "Digoxin",
"B": "Quinidine",
"C": "Amiodarone",
"D": "Verapamil"
} | step1 | B | [
"60 year old woman",
"history",
"atrial arrhythmia",
"emergency department",
"complaints",
"tinnitus",
"headache",
"visual disturbances",
"severe diarrhea",
"patient",
"given oxygen",
"nasal cannula",
"ECG leads",
"pulse oximeter",
"automated blood pressure cuff",
"applied",
"patient... |
A 35-year-old soldier is rescued from a helicopter crash in the Arctic Circle and brought back to a treatment facility at a nearby military base. On arrival, the patient's wet clothes are removed. He appears pale and is not shivering. He is unresponsive to verbal and painful stimuli. His temperature is 27.4°C (81.3°F),... | Intravenous administration of warmed normal saline | {
"A": "Intravenous administration of diltiazem",
"B": "Application of heating pads to the extremities",
"C": "Intravenous administration of warmed normal saline",
"D": "Emergent electrical cardioversion"
} | step2&3 | C | [
"35 year old soldier",
"rescued",
"helicopter",
"Arctic Circle",
"brought back",
"treatment facility",
"nearby military base",
"arrival",
"patient's wet clothes",
"removed",
"appears pale",
"not shivering",
"unresponsive",
"verbal",
"painful stimuli",
"temperature",
"27 4C",
"81",
... |
A 44-year-old woman comes to the physician for the evaluation of right knee pain for 1 week. The pain began after the patient twisted her knee during basketball practice. At the time of the injury, she felt a popping sensation and her knee became swollen over the next few hours. The pain is exacerbated by walking up or... | Hyperintense line in the meniscus on MRI | {
"A": "Hyperintense line in the meniscus on MRI",
"B": "Trabecular loss in the proximal femur on x-ray",
"C": "Erosions and synovial hyperplasia on MRI",
"D": "Posterior tibial translation on examination"
} | step2&3 | A | [
"year old woman",
"physician",
"evaluation",
"right knee pain",
"1 week",
"pain began",
"patient twisted",
"knee",
"basketball practice",
"time",
"injury",
"felt",
"popping sensation",
"knee",
"swollen",
"next",
"hours",
"pain",
"exacerbated",
"walking",
"stairs",
"worsens"... |
A 31-year-old man living in a remote tropical village presents with a swollen left leg and scrotum (see image). He says that his symptoms started more than 2 years ago with several small swollen areas near his groin and have gradually and progressively worsened. He has also noticed that over time, there has been a prog... | Mosquito | {
"A": "Mosquito",
"B": "Tick",
"C": "Tsetse fly",
"D": "Sandfly"
} | step1 | A | [
"31 year old man living",
"remote",
"village presents",
"swollen left",
"scrotum",
"see image",
"symptoms started more",
"years",
"several small swollen areas",
"groin",
"worsened",
"time",
"progressive",
"fissuring of",
"skin",
"swollen areas",
"Blood samples drawn",
"night show w... |
A 17-year-old female is found to have an inherited deficiency of alpha-galactosidase A. Skin biopsy shows accumulation of ceramide trihexose in the tissue. Which of the following abnormalities would be expected in this patient? | Angiokeratomas | {
"A": "Cherry red spots on macula",
"B": "Histiocytes with a wrinkled tissue paper appearance",
"C": "Corneal clouding",
"D": "Angiokeratomas"
} | step1 | D | [
"year old female",
"found to",
"inherited deficiency",
"Skin biopsy shows accumulation",
"ceramide",
"tissue",
"following abnormalities",
"expected",
"patient"
] |
A 39-year-old woman presents to your office with 4 days of fever, sore throat, generalized aching, arthralgias, and tender nodules on both of her shins that arose in the last 48 hours. Her medical history is negative for disease and she does not take oral contraceptives or any other medication regularly. The physical e... | Erythema nodosum | {
"A": "Erythema induratum",
"B": "Cutaneous polyarteritis nodosa",
"C": "Henoch-Schönlein purpura",
"D": "Erythema nodosum"
} | step1 | D | [
"year old woman presents",
"office",
"4 days",
"fever",
"sore throat",
"generalized aching",
"arthralgias",
"tender nodules",
"shins",
"48 hours",
"medical history",
"negative",
"disease",
"not take oral contraceptives",
"medication",
"physical examination reveals",
"vital signs",
... |
A 66-year-old man is brought to the emergency department because of weakness of his left leg for the past 30 minutes. His pants are soaked with urine. He has hypertension and atrial fibrillation. His temperature is 37°C (98.6°F), pulse is 98/min, and blood pressure is 160/90 mm Hg. Examination shows equal pupils that a... | Intracellular depletion of ATP | {
"A": "Rupture of lysosomes",
"B": "Intracellular depletion of ATP",
"C": "Release of pro-apoptotic proteins",
"D": "Breakdown of the cell membrane"
} | step1 | B | [
"66 year old man",
"brought",
"emergency department",
"of weakness",
"left leg",
"past 30 minutes",
"pants",
"soaked",
"urine",
"hypertension",
"atrial fibrillation",
"temperature",
"98",
"pulse",
"98 min",
"blood pressure",
"90 mm Hg",
"Examination shows equal pupils",
"reactive... |
A 23-year-old male presents to his primary care physician after an injury during a rugby game. The patient states that he was tackled and ever since then has had pain in his knee. The patient has tried NSAIDs and ice to no avail. The patient has no past medical history and is currently taking a multivitamin, fish oil, ... | Lateral collateral ligament tear | {
"A": "Medial collateral ligament tear",
"B": "Lateral collateral ligament tear",
"C": "Anterior cruciate ligament tear",
"D": "Posterior cruciate ligament tear"
} | step2&3 | B | [
"23 year old male presents",
"primary care physician",
"injury",
"rugby game",
"patient states",
"ever",
"then",
"pain in",
"knee",
"patient",
"NSAIDs",
"ice",
"patient",
"past medical history",
"currently taking",
"multivitamin",
"fish oil",
"whey",
"physical exam",
"note",
... |
An 80-year-old woman is brought to the emergency department due to the gradual worsening of confusion and lethargy for the past 5 days. Her son reports that she had recovered from a severe stomach bug with vomiting and diarrhea 3 days ago without seeing a physician or going to the hospital. The patient’s past medical h... | Increased BUN/creatinine ratio | {
"A": "Characteristic breath odor",
"B": "Flapping hand tremor",
"C": "Increased BUN/creatinine ratio",
"D": "Diffuse abdominal pain"
} | step2&3 | C | [
"80 year old woman",
"brought",
"emergency department due to",
"gradual worsening",
"confusion",
"lethargy",
"past 5 days",
"son reports",
"recovered",
"severe stomach bug",
"vomiting",
"diarrhea 3 days",
"seeing",
"physician",
"hospital",
"patients past medical history",
"notable",
... |
A 73-year-old man presents to the emergency department complaining of abdominal pain with nausea and vomiting, stating that he “can’t keep anything down”. He states that the pain has been gradually getting worse over the past 2 months, saying that, at first, it was present only an hour after he ate but now is constant.... | Mass effect from a tumor | {
"A": "Incarcerated hernia",
"B": "Mass effect from a tumor",
"C": "Crohn's disease",
"D": "Adhesions"
} | step1 | B | [
"year old man presents",
"emergency department",
"abdominal pain",
"nausea",
"vomiting",
"stating",
"cant keep",
"states",
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"first",
"present only",
"hour",
"ate",
"now",
"constant",
"constipated",
"2 weeks",
"getting",
"worse",
"... |
A 20-year-old college student has elevated stress levels due to her rigorous academic schedule, social commitments, and family pressures. She complains of never having enough time for all her responsibilities. Which of the following hormones acts by intracellular receptors to exert the physiologic effects of her stress... | Cortisol | {
"A": "Cortisol",
"B": "Glucagon",
"C": "Growth hormone",
"D": "Norepinephrine"
} | step1 | A | [
"20 year old college student",
"elevated stress levels due to",
"rigorous academic schedule",
"social commitments",
"family pressures",
"never",
"time",
"responsibilities",
"following hormones acts",
"intracellular receptors to exert",
"physiologic",
"stress"
] |
A 61-year-old female is referred to an oncologist for evaluation of a breast lump that she noticed two weeks ago while doing a breast self-examination. Her past medical history is notable for essential hypertension and major depressive disorder for which she takes lisinopril and escitalopram, respectively. Her temperat... | Dexrazoxane | {
"A": "Dexrazoxane",
"B": "Aspirin",
"C": "Rosuvastatin",
"D": "Cyclophosphamide"
} | step1 | A | [
"61 year old female",
"referred",
"oncologist",
"evaluation",
"breast lump",
"two weeks",
"breast self-examination",
"past medical history",
"notable",
"essential hypertension",
"major depressive disorder",
"takes lisinopril",
"escitalopram",
"temperature",
"98",
"blood pressure",
"6... |
A 58-year-old woman presents with frequent headaches for the past few months. She says the pain starts randomly and is unrelated to any stimulus. She also says that has difficulty falling asleep and has had problems concentrating at work for several months. While she occasionally thinks about committing suicide, she de... | Blockage of α1 adrenergic receptors | {
"A": "Blockage of muscarinic receptors",
"B": "Decreased reuptake of norepinephrine",
"C": "Blockage of α1 adrenergic receptors",
"D": "Decreased reuptake of serotonin"
} | step1 | C | [
"58 year old woman presents",
"frequent headaches",
"past",
"months",
"pain starts",
"unrelated",
"stimulus",
"difficulty falling asleep",
"problems concentrating",
"work",
"several months",
"occasionally thinks",
"committing suicide",
"denies",
"suicidal plans",
"appetite",
"diminis... |
A new real time-PCR test for the hepatitis C virus is approved for medical use. The manufacturer sets the threshold number of DNA copies required to achieve a positive result such that the sensitivity is 98% and the specificity is 80%. The tested population has a hepatitis C prevalence of 0.7%. Which of the following c... | An increase in prevalence | {
"A": "An increase in incidence",
"B": "An increase in prevalence",
"C": "A decrease in incidence",
"D": "Lowering the threshold concentration required for a positive test."
} | step1 | B | [
"A",
"real time-PCR test",
"hepatitis",
"virus",
"approved",
"medical use",
"manufacturer sets",
"threshold number",
"DNA required to",
"positive result",
"sensitivity",
"specificity",
"80",
"tested population",
"a hepatitis C prevalence",
"0.7",
"following changes",
"prevalence",
... |
A 4080-g (9-lb) male newborn is delivered at term to a 32-year-old woman, gravida 2, para 1. Apgar scores are 8 and 9 at 1- and 5-minutes, respectively. Examination in the delivery room shows both feet pointing downwards and inwards. Both the forefeet are twisted medially in adduction, with the hindfeet elevated and th... | Repositioning and serial casting | {
"A": "Foot abduction brace",
"B": "Surgery",
"C": "Repositioning and serial casting",
"D": "Physiotherapy"
} | step2&3 | C | [
"g",
"male newborn",
"delivered",
"term",
"year old woman",
"gravida 2",
"para 1",
"Apgar scores",
"5-minutes",
"Examination",
"delivery shows",
"feet pointing downwards",
"inwards",
"forefeet",
"twisted",
"adduction",
"hindfeet elevated",
"midfeet appearing concave",
"Achilles t... |
A 4390-g (9-lb 11-oz) male newborn is delivered at term to a 28-year-old primigravid woman. Pregnancy was complicated by gestational diabetes mellitus. Labor was prolonged by the impaction of the fetal shoulder and required hyperabduction of the left upper extremity. Apgar scores were 7 and 8 at 1 and 5 minutes, respec... | Absent unilateral grasp reflex | {
"A": "Generalized hypotonia",
"B": "Absent unilateral grasp reflex",
"C": "Lower back mass",
"D": "Decreased movement of unilateral rib cage\n\""
} | step2&3 | B | [
"g",
"oz",
"male newborn",
"delivered",
"term",
"year old primigravid woman",
"Pregnancy",
"complicated",
"gestational diabetes mellitus",
"Labor",
"prolonged",
"impaction",
"fetal shoulder",
"required",
"left upper extremity",
"Apgar scores",
"8",
"1",
"5 minutes",
"Vital sign... |
A 4-year-old girl presents to the emergency department after persistent vomiting and complaints that her abdomen hurts. Her parents came home to their daughter like this while she was at home being watched by the babysitter. The child is otherwise healthy. Family history is notable for depression, suicide, neuropathic ... | Iron | {
"A": "Acetaminophen",
"B": "Aspirin",
"C": "Iron",
"D": "Nortriptyline"
} | step2&3 | C | [
"4 year old girl presents",
"emergency department",
"persistent vomiting",
"complaints",
"abdomen",
"parents",
"home",
"daughter",
"at home",
"babysitter",
"child",
"healthy",
"Family history",
"notable",
"depression",
"suicide",
"neuropathic pain",
"diabetes",
"hypertension",
... |
A 70-year-old woman comes to the physician because of a 4-month history of fatigue, worsening swelling of her ankles, and a 5-kg (11-lb) weight gain. Neurologic examination shows diminished two-point discrimination in her fingers. Laboratory studies show a hemoglobin A1c concentration of 9.2% and a creatinine concentra... | Nodular glomerulosclerosis | {
"A": "Immune complex deposition",
"B": "Interstitial inflammation",
"C": "Wire looping of capillaries",
"D": "Nodular glomerulosclerosis"
} | step1 | D | [
"70 year old woman",
"physician",
"4 month history",
"fatigue",
"worsening swelling",
"ankles",
"5 kg",
"weight gain",
"Neurologic examination shows diminished two point discrimination",
"fingers",
"Laboratory studies show",
"hemoglobin concentration",
"creatinine concentration",
"mg/dL",
... |
An 11-year-old male with light purple eyes presents with gradual loss of bilateral visual acuity. Over the past several years, vision has worsened from 20/20 to 20/100 in both eyes. He also has mild nystagmus when focusing on objects such as when he is trying to do his homework. He is diagnosed with a disease affecting... | Male: 50% Female: 0% | {
"A": "Same as general population",
"B": "Male: 50% Female: 50%",
"C": "Male: 50% Female: 0%",
"D": "Male: 100% Female: 0%"
} | step1 | C | [
"year old male",
"light purple eyes presents",
"gradual loss of bilateral visual acuity",
"past",
"years",
"vision",
"worsened",
"20/20",
"20/100",
"eyes",
"mild nystagmus",
"focusing",
"objects",
"to",
"homework",
"diagnosed",
"disease affecting melanin production",
"iris",
"par... |
A 75-year-old man comes to his primary care physician because he has been having diarrhea and difficulty breathing. The diarrhea has been intermittent with frequent watery stools that occur along with abdominal cramps. Furthermore, the skin on his face and upper chest feels hot and changes color in episodes lasting fro... | It also arises in the GI tract | {
"A": "Contains psammoma bodies",
"B": "It also arises in the GI tract",
"C": "Most common lung cancer in non-smokers and females",
"D": "Stains positive for vimentin"
} | step1 | B | [
"75 year old man",
"primary care physician",
"diarrhea",
"difficulty breathing",
"diarrhea",
"intermittent",
"frequent watery stools",
"occur",
"abdominal cramps",
"skin",
"face",
"upper chest feels hot",
"changes color",
"episodes lasting",
"minutes",
"hours",
"patient",
"of loss"... |
An 8-year-old boy is brought to the physician by his foster mother because of complaints from his teachers regarding poor performance at school for the past 8 months. He does not listen to their instructions, often talks during class, and rarely completes his school assignments. He does not sit in his seat in the class... | Attention-deficit/hyperactivity disorder | {
"A": "Age-appropriate behavior",
"B": "Oppositional defiant disorder",
"C": "Attention-deficit/hyperactivity disorder",
"D": "Hearing impairment"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"foster mother",
"complaints",
"teachers",
"poor performance",
"school",
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"months",
"not listen",
"instructions",
"often talks",
"class",
"rarely completes",
"school assignments",
"not sit",
"classroom",
"often cuts in line",
"cafe... |
A 30-year-old Caucasian male is brought to the emergency room for recurrent diarrhea. He has had multiple upper respiratory infections since birth and does not take any medications at home. It is determined that Giardia lamblia is responsible for the recurrent diarrhea. The physician performs a serum analysis and finds... | Deficiency in IgA | {
"A": "Deficiency in neutrophils",
"B": "Deficiency in IgA",
"C": "Deficiency in NK cells",
"D": "Deficiency in IgG"
} | step1 | B | [
"30 year old Caucasian male",
"brought",
"emergency room",
"recurrent diarrhea",
"multiple upper",
"birth",
"not take",
"medications at home",
"Giardia lamblia",
"responsible",
"recurrent diarrhea",
"physician performs",
"serum analysis",
"finds normal levels",
"mature B lymphocytes",
... |
Paramedics are called to a 35-year-old man who had accidentally amputated his left index finger tip with a knife. He has no significant past medical history. His temperature is 37.2°C (99°F), pulse is 96/min, and blood pressure is 112/72 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. His left inde... | Wrap finger tip in gauze damp with saline in a sealed plastic bag placed on ice water | {
"A": "Wrap finger in gauze wet with iodine in a sealed plastic bag placed on ice",
"B": "Preserve finger tip in cooled saline water",
"C": "Preserve finger tip in warm saline water",
"D": "Wrap finger tip in gauze damp with saline in a sealed plastic bag placed on ice water"
} | step2&3 | D | [
"Paramedics",
"called",
"35 year old man",
"amputated",
"left index finger tip",
"knife",
"significant past medical history",
"temperature",
"pulse",
"96 min",
"blood pressure",
"72 mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen",
"99",
"left index finger",
"amputated distal",... |
A 22-year-old medical student presents to a community health center due to an episode of loss of consciousness 3 days ago. She also has a history of multiple episodes of dizziness in the last year. These episodes almost always occur when she is observing surgery in the operating room. She describes her dizziness as a f... | Electrocardiogram (ECG) | {
"A": "Echocardiogram",
"B": "Electrocardiogram (ECG)",
"C": "Electroencephalogram (EEG)",
"D": "Psychiatric evaluation for anxiety"
} | step2&3 | B | [
"year old medical student presents",
"community health center due to",
"episode of loss",
"consciousness 3 days",
"history of multiple episodes",
"dizziness",
"last year",
"episodes almost always occur",
"observing surgery",
"operating room",
"dizziness",
"feeling",
"lightheadedness",
"war... |
A 51-year-old Caucasian female presents to her primary care provider complaining of intermittent chest pain. She reports that over the past 6 months, she has developed burning chest pain that occurs whenever she exerts herself. The pain decreases when she rests. Her past medical history is notable for type II diabetes ... | Mevalonic acid | {
"A": "Farnesyl pyrophosphate",
"B": "HMG-CoA",
"C": "Mevalonic acid",
"D": "Squalene"
} | step1 | C | [
"year old Caucasian female presents",
"primary care provider",
"of intermittent chest pain",
"reports",
"past 6 months",
"burning chest pain",
"occurs",
"exerts",
"pain decreases",
"rests",
"past medical history",
"notable",
"type II diabetes mellitus",
"family history",
"notable",
"mu... |
A 26-year-old man presents to his primary care physician complaining of impotence. He reports that he has a healthy, long-term relationship with a woman whom he hopes to marry, but he is embarrassed that he is unable to have an erection. Which of the following is the next best step? | Evaluate nocturnal tumescence | {
"A": "Evaluate nocturnal tumescence",
"B": "Duplex penile ultrasound",
"C": "Prescribe sildenafil",
"D": "Prescribe vardenafil"
} | step2&3 | A | [
"year old man presents",
"primary care physician complaining of impotence",
"reports",
"healthy",
"long-term relationship",
"woman",
"hopes",
"marry",
"embarrassed",
"unable to",
"erection",
"following",
"next best step"
] |
A cohort study was done to assess the differential incidence of diabetes in patients consuming a typical western diet, versus those consuming a Mediterranean diet. A total of 600 subjects were included with 300 in each arm. Results are as follows:
Diabetes development No-diabetes development
Western diet 36 264
Medit... | 4.4 | {
"A": "1.0",
"B": "3.2",
"C": "4.4",
"D": "5.6"
} | step2&3 | C | [
"cohort study",
"to assess",
"differential incidence",
"diabetes",
"patients",
"typical western diet",
"Mediterranean diet",
"total",
"600 subjects",
"included",
"300",
"arm",
"Results",
"follows",
"Diabetes development",
"diabetes development Western diet 36",
"Mediterranean diet",
... |
Researchers are investigating the effects of an Amazonian plant extract as a novel therapy for certain types of tumors. When applied to tumor cells in culture, the extract causes widespread endoplasmic reticulum stress and subsequent cell death. Further experiments show that the extract acts on an important member of a... | Covalent bonds between carboxyl and amino groups | {
"A": "Hydrogen bonds",
"B": "Ionic bonds",
"C": "Covalent bond between two sulfide groups",
"D": "Covalent bonds between carboxyl and amino groups"
} | step1 | D | [
"Researchers",
"investigating",
"effects",
"plant extract",
"a novel therapy",
"certain types",
"tumors",
"applied",
"tumor cells",
"culture",
"extract causes widespread endoplasmic reticulum stress",
"subsequent cell death",
"Further experiments show",
"extract acts",
"important member"... |
A 37-year-old woman accompanied by her husband presents to the emergency department after loss of consciousness 30 minutes ago. The husband reports that she was sitting in a chair at home and began having sustained rhythmic contractions of all 4 extremities for approximately 1 minute. During transport via ambulance she... | Surreptitious insulin use | {
"A": "Beta cell tumor",
"B": "Diabetic ketoacidosis",
"C": "Surreptitious insulin use",
"D": "Surreptitious sulfonylurea use"
} | step1 | C | [
"year old woman",
"husband presents",
"emergency department",
"loss of consciousness 30 minutes",
"husband reports",
"sitting",
"chair at home",
"began",
"sustained rhythmic contractions",
"extremities",
"approximately",
"minute",
"transport",
"ambulance",
"appeared confused",
"husband... |
A healthy 36-year-old Caucasian man takes part in an experimental drug trial. The drug is designed to lower glomerular filtration rate (GFR) while simultaneously raising the filtration fraction. Which of the following effects on the glomerulus would you expect the drug to have? | Afferent arteriole constriction and efferent arteriole constriction | {
"A": "Afferent arteriole constriction and efferent arteriole vasodilation",
"B": "Afferent arteriole constriction and efferent arteriole constriction",
"C": "Afferent arteriole dilation and efferent arteriole constriction",
"D": "Increased oncotic pressure in Bowman's space"
} | step1 | B | [
"healthy 36 year old Caucasian man takes part",
"experimental",
"drug",
"designed to lower glomerular filtration rate",
"simultaneously",
"filtration fraction",
"following effects",
"glomerulus",
"drug to"
] |
A pathologist is investigating the cytology of cells that have been infected with a particularly virulent strain of the influenza virus. The physician suspects that the virus results in cell death after viral replication in order to expedite the spread of the virus. She recalls that there are three known biochemical me... | Caspase-3 | {
"A": "Caspase-3",
"B": "Bax",
"C": "Bcl-2",
"D": "CD-95 protein"
} | step1 | A | [
"pathologist",
"investigating",
"cytology",
"cells",
"infected",
"a",
"virulent strain",
"influenza virus",
"physician suspects",
"virus results in cell death",
"viral replication",
"order to expedite",
"spread",
"virus",
"recalls",
"three known biochemical mechanisms of initiating",
... |
A 15-year-old girl is hospitalized because of increased fatigue and weight loss over the past 2 months. The patient has no personal or family history of a serious illness. She takes no medications, currently. Her blood pressure is 175/74 mm Hg on the left arm and 90/45 on the right. The radial pulse is 84/min but weake... | Carvedilol + hydrochlorothiazide | {
"A": "Carvedilol + hydrochlorothiazide",
"B": "Plasmapheresis",
"C": "Rituximab",
"D": "Surgery"
} | step2&3 | A | [
"year old girl",
"hospitalized",
"increased fatigue",
"weight loss",
"past",
"months",
"patient",
"personal",
"family history",
"serious illness",
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"medications",
"currently",
"blood pressure",
"74 mm Hg",
"left arm",
"90",
"right",
"radial pulse",
"84 min",
"weaker",... |
A neonate appears irritable and refuses to feed. The patient is febrile and physical examination reveals a bulge at the anterior fontanelle. A CSF culture yields Gram-negative bacilli that form a metallic green sheen on eosin methylene blue (EMB) agar. The virulence factor most important to the development of infection... | K capsule | {
"A": "LPS endotoxin",
"B": "Fimbrial antigen",
"C": "IgA protease",
"D": "K capsule"
} | step1 | D | [
"neonate appears irritable",
"refuses to feed",
"patient",
"febrile",
"physical examination reveals",
"bulge",
"anterior fontanelle",
"CSF culture",
"Gram-negative bacilli",
"form",
"metallic green",
"eosin methylene blue",
"agar",
"virulence factor most important",
"development",
"inf... |
A 16-year-old female is brought to the primary care clinic by her mother. The mother is concerned about her daughter’s grades, which have been recently slipping. Per the mother, the patient usually earns a mix of As and Bs in her classes, but this past semester she has been getting Cs and a few Ds. Her mother is also f... | Reassure the patient that there is confidentiality in this situation but encourage her to tell her mother | {
"A": "Apologize and say that you must inform legal authorities because the use of these drugs is illegal",
"B": "Apologize and say that you must inform her mother because these drugs pose a danger to her health",
"C": "Agree to the patient’s request and do not inform the patient’s mother",
"D": "Reassure the ... | step1 | D | [
"year old female",
"brought",
"primary care clinic",
"mother",
"mother",
"concerned",
"daughters grades",
"recently slipping",
"mother",
"patient usually earns",
"mix",
"Bs",
"classes",
"past semester",
"getting Cs",
"few Ds",
"mother",
"frustrated",
"feels",
"daughter",
"act... |
A 60-year-old woman comes to the physician because of a 2-week history of severe, retrosternal chest pain. She also has pain when swallowing solid food and medications. She has hypertension, type 2 diabetes mellitus, poorly-controlled asthma, and osteoporosis. She was recently admitted to the hospital for an acute asth... | Discontinue alendronate | {
"A": "Start ganciclovir",
"B": "Discontinue alendronate",
"C": "Start pantoprazole",
"D": "Discontinue amlodipine"
} | step2&3 | B | [
"60 year old woman",
"physician",
"of",
"2-week history",
"severe",
"retrosternal chest pain",
"pain",
"swallowing solid food",
"medications",
"hypertension",
"type 2 diabetes mellitus",
"poorly controlled asthma",
"osteoporosis",
"recently admitted",
"hospital",
"acute asthma exacerba... |
A 36-year-old woman is admitted to the hospital because of irritability, nausea, and diarrhea. She has a history of recreational oxycodone use and last took a dose 48 hours ago. Physical examination shows mydriasis, rhinorrhea, and piloerection. A drug is administered that provides an effect similar to oxycodone but do... | Lower efficacy | {
"A": "Lower bioavailability",
"B": "Lower efficacy",
"C": "Lower affinity",
"D": "Lower tolerance"
} | step1 | B | [
"36 year old woman",
"admitted",
"hospital",
"irritability",
"nausea",
"diarrhea",
"history of recreational oxycodone use",
"last took",
"dose 48 hours",
"Physical examination shows mydriasis",
"rhinorrhea",
"piloerection",
"drug",
"administered",
"provides",
"effect similar",
"oxyco... |
A 6-year-old girl is brought to a clinic with complaints of fever and sore throat for 2 days. This morning, she developed a rash on her face and neck which is progressing towards the trunk. The teachers in her school report that none of her classmates has similar symptoms. She has a normal birth history. On physical ex... | Scarlet fever | {
"A": "Scarlet fever",
"B": "Erythema Infectiosum",
"C": "Kawasaki disease",
"D": "Measles"
} | step1 | A | [
"year old girl",
"brought",
"clinic",
"complaints",
"fever",
"sore throat",
"2 days",
"morning",
"rash on",
"face",
"neck",
"progressing",
"trunk",
"teachers",
"school report",
"classmates",
"similar symptoms",
"normal",
"physical examination",
"child looks healthy",
"heart r... |
A 4-day-old healthy male infant is born with normal internal and external male reproductive organs. Karyotype analysis reveals a 46XY genotype. Production of what substance by which cell type is responsible for the development of the normal male seminal vesicles, epididymides, ejaculatory ducts, and ductus deferens? | Testosterone; Leydig cells | {
"A": "Testis-determining factor; Sertoli cells",
"B": "Testis-determining factor; Leydig cells",
"C": "Testosterone; Leydig cells",
"D": "Mullerian inhibitory factor; Sertoli cells"
} | step1 | C | [
"4 day old healthy male infant",
"born",
"normal internal",
"external male reproductive organs",
"Karyotype analysis reveals",
"46XY genotype",
"Production",
"substance",
"cell type",
"responsible",
"development",
"normal male seminal vesicles",
"epididymides",
"ejaculatory ducts",
"duct... |
A 51-year-old man presents to his primary care physician with 3 months of increasing fatigue. He says that he has been feeling short of breath while walking to his office from the parking lot and is no longer able to participate in recreational activities that he enjoys such as hiking. His wife also comments that he ha... | Increased production of platelet derived growth factor | {
"A": "Increased production of platelet derived growth factor",
"B": "Inhibition of metalloproteinase activity",
"C": "Mutation in cytoskeletal proteins",
"D": "Mutation in glycolysis pathway protein"
} | step1 | A | [
"year old man presents",
"primary care physician",
"3 months",
"increasing fatigue",
"feeling short of breath",
"walking",
"office",
"parking lot",
"longer able to",
"recreational activities",
"hiking",
"wife",
"comments",
"looking very pale",
"spend",
"lot",
"time outdoors",
"past... |
A 47-year-old man is referred to the outpatient psychiatry clinic for depressed mood. He was diagnosed with pancreatic cancer recently. Since then, he has not been able to go to work. Over the past several weeks, he has had significant unintentional weight loss and several bouts of epigastric pain. He lost his father t... | This patient must have anhedonia or depressed mood. | {
"A": "This patient must have anhedonia or depressed mood.",
"B": "This patient may have a history of elated mood.",
"C": "This patient has preserved social and occupational functioning.",
"D": "This patient’s symptoms must have been present for at least 1 month."
} | step1 | A | [
"year old man",
"referred",
"outpatient psychiatry clinic",
"depressed mood",
"diagnosed",
"pancreatic cancer recently",
"then",
"not",
"able to go to work",
"past",
"weeks",
"significant unintentional weight loss",
"several bouts",
"epigastric pain",
"lost",
"father",
"cancer",
"1... |
A 68-year-old man is admitted to the intensive care unit after open abdominal aortic aneurysm repair. The patient has received 4 units of packed red blood cells during the surgery. During the first 24 hours following the procedure, he has only passed 200 mL of urine. He has congestive heart failure and hypertension. Cu... | Low urine sodium | {
"A": "Decreased urine osmolarity",
"B": "Leukocyte casts",
"C": "Low urine sodium",
"D": "Proteinuria"
} | step2&3 | C | [
"68 year old man",
"admitted to",
"intensive care unit",
"open abdominal aortic aneurysm repair",
"patient",
"received 4 units",
"packed red blood cells",
"surgery",
"first 24 hours following",
"procedure",
"only passed 200 mL",
"urine",
"congestive heart failure",
"hypertension",
"Curre... |
A 5-year-old boy is brought to the physician by his parents because of 2 episodes of screaming in the night over the past week. The parents report that their son woke up suddenly screaming, crying, and aggressively kicking his legs around both times. The episodes lasted several minutes and were accompanied by sweating ... | Sleep terror disorder | {
"A": "Insomnia disorder",
"B": "Sleep terror disorder",
"C": "Nightmare disorder",
"D": "Sleepwalking disorder"
} | step2&3 | B | [
"5 year old boy",
"brought",
"physician",
"parents",
"of",
"episodes",
"screaming",
"night",
"past week",
"parents report",
"son woke up",
"screaming",
"crying",
"kicking",
"legs",
"times",
"episodes lasted several minutes",
"sweating",
"fast breathing",
"parents state",
"una... |
A 17-year-old boy is brought to the pediatrician by his mother for fatigue. The patient reports that he was supposed to try out for winter track this year, but he had to quit because his “legs just give up.” He also reports increased difficulty breathing with exercise but denies chest pain or palpitations. He has no ch... | Abnormal dystrophin | {
"A": "Abnormal dystrophin",
"B": "Absent dystrophin",
"C": "Peripheral nerve demyelination",
"D": "Trinucleotide repeats"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatrician",
"mother",
"fatigue",
"patient reports",
"to",
"out",
"winter track",
"year",
"to quit",
"legs",
"give",
"reports increased difficulty",
"exercise",
"denies chest pain",
"palpitations",
"chronic medical conditions",
"takes",
"medication... |
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