question stringlengths 66 3.58k | answer stringlengths 1 230 | options dict | meta_info stringclasses 2
values | answer_idx stringclasses 4
values | metamap_phrases listlengths 1 184 |
|---|---|---|---|---|---|
An otherwise healthy 1-month-old girl is brought to the physician because of a 1-day history of multiple episodes of bilious vomiting. She is diagnosed with intestinal malrotation and volvulus and undergoes emergency laparotomy. During surgery, a 3 x 3 cm cystic mass is excised from behind the umbilicus. Microscopic ex... | Vitelline duct | {
"A": "Umbilical ring",
"B": "Vitelline duct",
"C": "Ovarian follicle",
"D": "Common bile duct"
} | step1 | B | [
"healthy",
"month old girl",
"brought",
"physician",
"of",
"1-day history",
"multiple episodes",
"bilious vomiting",
"diagnosed",
"intestinal malrotation",
"volvulus",
"emergency laparotomy",
"surgery",
"3",
"cystic mass",
"umbilicus",
"Microscopic examination",
"mass shows mature"... |
A 34-year-old woman comes to the emergency department because of right flank pain and vomiting for 5 hours. She has had fever and chills for the past 2 days. She attended a barbecue 3 days ago, where she ate egg salad. She underwent surgery for left ovarian torsion a year ago. Menses occur at regular 28-day intervals a... | Pyelonephritis | {
"A": "Ovarian torsion",
"B": "Gastroenteritis",
"C": "Pelvic inflammatory disease",
"D": "Pyelonephritis"
} | step2&3 | D | [
"year old woman",
"emergency department",
"right flank pain",
"vomiting",
"hours",
"fever",
"chills",
"past 2 days",
"attended",
"days",
"ate egg salad",
"surgery",
"left ovarian",
"year",
"Menses occur",
"regular",
"day intervals",
"last 5 days",
"sexually active",
"male partn... |
A 5-year-old boy is brought to the pediatrician by his mother for a recurring cough and difficult breathing. He was tentatively diagnosed with asthma last year, and the mother was advised to administer albuterol nebulizers at home when symptoms occur. The boy has only required nebulizers once every 10 days. The mother ... | Chart C | {
"A": "Chart A",
"B": "Chart C",
"C": "Chart D",
"D": "Chart E"
} | step1 | B | [
"5 year old boy",
"brought",
"pediatrician",
"mother",
"recurring cough",
"difficult breathing",
"diagnosed",
"asthma",
"year",
"mother",
"administer albuterol nebulizers at home",
"symptoms occur",
"boy",
"only required nebulizers",
"10 days",
"mother",
"cough",
"usually",
"prom... |
A 74-year-old African-American woman is brought to the emergency department by her home health aid. The patient was eating breakfast this morning when she suddenly was unable to lift her spoon with her right hand. She attempted to get up from the table, but her right leg felt weak. One hour later in the emergency depar... | The most important risk factors are hypertension and diabetes | {
"A": "The most important risk factors are hypertension and diabetes",
"B": "The most common cause is embolism originating from the left atrium",
"C": "It is caused by ischemia to watershed areas",
"D": "IV thrombolysis cannot be used"
} | step1 | A | [
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"brought",
"emergency department",
"home health aid",
"patient",
"eating breakfast",
"morning",
"unable to lift",
"spoon",
"right hand",
"attempted to get",
"table",
"right leg felt weak",
"One hour later",
"emergency department",
"strength",
"0/... |
A 60-year-old male presents to your office for follow-up after an upper gastrointestinal (GI) endoscopy revealed the presence of esophageal varices. His medical history is significant for cirrhosis caused by heavy alcohol abuse for the past 20 years. He was instructed to follow-up with his primary care physician for ma... | Nadolol | {
"A": "Careful observation",
"B": "Nadolol",
"C": "Isosorbide mononitrate",
"D": "Transjugular intrahepatic portosystemic shunt"
} | step1 | B | [
"60 year old male presents",
"office",
"follow-up",
"upper gastrointestinal",
"endoscopy revealed",
"presence",
"esophageal varices",
"medical history",
"significant",
"cirrhosis caused",
"heavy alcohol abuse",
"past 20 years",
"to follow-up",
"primary physician",
"management",
"condit... |
A 3-year-old boy is taken to the ER by his parents due to his elevated temperature. He has had a fever (>101.1 deg F) for a little over a week, and over that time, his parents noticed his eyes had gotten a little pink, and his palms and soles were red and swollen. His lips and tongue are also peeling. His parents note ... | Coronary artery aneurysms | {
"A": "Digital gangrene",
"B": "Coronary artery aneurysms",
"C": "Endocardial valve damage",
"D": "Toxic endodermal necrolysis"
} | step1 | B | [
"3 year old boy",
"taken",
"ER",
"parents due to",
"elevated temperature",
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"little",
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"parents",
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"little pink",
"palms",
"soles",
"red",
"swollen",
"lips",
"tongue",
"peeling",
"parents note",
"not taken",
"ne... |
A 22-year-old woman seeks evaluation at a local walk-in clinic for severe lower abdominal pain, vaginal discharge, and painful intercourse for the last couple of weeks. Her last day of menstruation was 1 week ago, and since then the pain has worsened. She is an out-of-town college student engaged in an open relationshi... | Neisseria gonorrhoeae | {
"A": "Neisseria gonorrhoeae",
"B": "Mycobacterium tuberculosis",
"C": "Mycoplasma genitalium",
"D": "Streptococcus agalactiae"
} | step1 | A | [
"year old woman",
"evaluation",
"local walk-in clinic",
"severe lower abdominal pain",
"vaginal discharge",
"painful intercourse",
"couple",
"weeks",
"last day",
"menstruation",
"1 week",
"since then",
"pain",
"worsened",
"out",
"town college student engaged",
"open relationship",
... |
A 35-year-old man comes to the physician because of a rash on the thigh for 10 days. He reports that the rash has been enlarging and is intensely itchy. Two weeks ago, he adopted a stray dog from an animal shelter. Vital signs are within normal limits. A photograph of the examination findings is shown. Which of the fol... | Dermatophyte infection | {
"A": "Psoriasis",
"B": "Erythrasma",
"C": "Pityriasis rosea",
"D": "Dermatophyte infection"
} | step1 | D | [
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"physician",
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"thigh",
"10 days",
"reports",
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"enlarging",
"itchy",
"Two weeks",
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"stray dog",
"animal shelter",
"Vital signs",
"normal limits",
"photograph",
"examination findings",
"shown",
"following",
"most likely cause",
... |
A 50-year-old man with hypertension comes to the physician for a routine follow-up evaluation. His blood pressure is 146/98 mm Hg. The physician wishes to prescribe lisinopril. The patient says that his blood pressure is high when he is “anxious” and requests alprazolam instead of lisinopril. Which of the following is ... | “What have you heard about the use of alprazolam to treat high blood pressure?” | {
"A": "“I would recommend fluoxetine because alprazolam can cause dependence.”",
"B": "“I would recommend consultation with a psychiatrist.”",
"C": "“What have you heard about the use of alprazolam to treat high blood pressure?”",
"D": "“Lisinopril is more effective to treat hypertension. If you do not control... | step1 | C | [
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"physician",
"routine follow-up evaluation",
"blood pressure",
"98 mm Hg",
"physician wishes to",
"lisinopril",
"patient",
"blood pressure",
"high",
"anxious",
"requests alprazolam",
"lisinopril",
"following",
"most appropriate initial response",
"p... |
A 78-year-old right-handed male is brought in by ambulance after being found down in his home. After being aroused, the patient has difficulty answering questions and appears to be frustrated by his inability to communicate. He is able to speak his name and a few other words but his speech is not fluent. Subsequent neu... | Inferior frontal gyrus | {
"A": "Inferior frontal gyrus",
"B": "Arcuate fasciculus",
"C": "Watershed zone",
"D": "Precentral gyrus"
} | step1 | A | [
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"home",
"aroused",
"patient",
"difficulty answering questions",
"appears to",
"frustrated",
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"able to speak",
"name",
"few",
"words",
"speech",
"not fluent",
"Subsequent neurologic exam finds",
"patient"... |
A 66-year-old man presents to the emergency department for a 1-hour history of right arm weakness. He was having breakfast this morning when his right arm suddenly became weak, causing him to drop his coffee mug. He also noticed that he was slurring his speech and had some additional weakness in his right leg. He had n... | Carotid endarterectomy | {
"A": "Carotid endarterectomy",
"B": "Brain MRI",
"C": "Initiation of aspirin and atorvastatinInitiation of aspirin and atorvastatin",
"D": "Initiation of lisinopril"
} | step2&3 | A | [
"66 year old man presents",
"emergency department",
"hour history of right arm weakness",
"breakfast",
"morning",
"right arm",
"weak",
"causing",
"to drop",
"coffee mug",
"slurring",
"speech",
"additional weakness",
"right",
"symptoms prior to",
"onset",
"weakness",
"noted",
"unu... |
A 62-year-old woman is seen in the hospital for neutropenic fever. She was admitted 1 week ago for newly diagnosed acute myeloid leukemia. Due to her chemotherapy, she became pancytopenic. Last night, during a packed red blood cell transfusion, she became febrile to 102.6°F (39.3°C), her blood pressure was 92/55, pulse... | ABO incompatibility | {
"A": "ABO incompatibility",
"B": "Disseminated intravascular coagulation",
"C": "Transfusion associated circulatory overload",
"D": "Transfusion related acute lung injury"
} | step2&3 | A | [
"62 year old woman",
"seen",
"hospital",
"neutropenic fever",
"admitted 1 week",
"newly diagnosed acute myeloid leukemia",
"chemotherapy",
"pancytopenic",
"night",
"packed red blood cell transfusion",
"febrile",
"3C",
"blood pressure",
"55",
"pulse",
"min",
"respirations",
"min",
... |
A 3-year-old African-American boy presents with a rapid onset of severe abdominal pain. He has a palpably enlarged mass in the left upper quadrant of his abdomen. Complete blood count is notable for a hemoglobin of 7.2 g/dL. Serum haptoglobin level returns normal. Serum unconjugated bilirubin is elevated. The corrected... | Extravascular hemolysis | {
"A": "Aplastic crisis",
"B": "Renal infarction",
"C": "Intravascular hemolysis",
"D": "Extravascular hemolysis"
} | step2&3 | D | [
"3 year old African-American boy presents",
"rapid onset",
"severe abdominal",
"enlarged mass",
"left upper quadrant of",
"abdomen",
"Complete blood count",
"notable",
"a hemoglobin",
"7.2 g/dL",
"Serum haptoglobin level returns normal",
"unconjugated",
"elevated",
"corrected reticulocyte ... |
A 62-year-old man comes to the physician because of a persistent cough for the past 2 weeks. During this time, he has also had occasional discomfort in his chest. Three weeks ago, he had a sore throat, headache, and a low-grade fever, which were treated with acetaminophen and rest. He has a history of hypertension and ... | CT scan of the chest | {
"A": "Esophageal manometry",
"B": "CT scan of the chest",
"C": "Arteriography",
"D": "Endovascular repair"
} | step2&3 | B | [
"62 year old man",
"physician",
"of",
"persistent cough",
"past 2 weeks",
"time",
"occasional discomfort in",
"chest",
"Three weeks",
"sore throat",
"headache",
"low-grade fever",
"treated with acetaminophen",
"rest",
"history of hypertension",
"hyperlipidemia",
"father died",
"myo... |
A 31-year-old male with cirrhosis, dementia, and Parkinson-like symptoms is diagnosed with a hereditary metabolic disease resulting from the accumulation of a certain metal in various tissues. Impairment of which of the following elimination pathways is most likely responsible? | Secretion into bile | {
"A": "Secretion into bile",
"B": "Loop of Henle secretion into lumen of kidney",
"C": "Glomerular filtration",
"D": "Bleeding"
} | step1 | A | [
"31 year old male",
"cirrhosis",
"dementia",
"Parkinson",
"symptoms",
"diagnosed",
"hereditary metabolic resulting",
"accumulation",
"certain metal",
"various tissues",
"Impairment",
"following elimination pathways",
"most likely responsible"
] |
An x-ray of the chest shows an extensive consolidation within the right lower lobe consistent with lobar pneumonia. Sputum and blood cultures are sent to the laboratory for analysis, and empiric antibiotic treatment with intravenous cefotaxime is begun. Which of the following is most likely to have prevented this patie... | Incentive spirometry | {
"A": "Incentive spirometry",
"B": "Rapid sequence induction",
"C": "Prolonged bed rest",
"D": "Smoking cessation"
} | step2&3 | A | [
"x-ray of",
"chest shows",
"extensive consolidation",
"right lower lobe consistent with lobar pneumonia",
"Sputum",
"blood cultures",
"sent",
"laboratory",
"analysis",
"empiric antibiotic",
"intravenous cefotaxime",
"begun",
"following",
"most likely to",
"prevented",
"patient's pneumo... |
A 58-year-old man with history of diabetes and hypertension suffers a cardiac arrest at home. The family calls 911, yet no one performs CPR. Five minutes after the arrest, EMS arrives to begin resuscitation. At this point, which region of the CNS is most likely to suffer ischemic damage? | Hippocampus | {
"A": "Spinal cord",
"B": "Pons",
"C": "Medulla",
"D": "Hippocampus"
} | step1 | D | [
"58 year old man",
"history",
"diabetes",
"hypertension suffers",
"cardiac arrest at home",
"family calls",
"performs CPR",
"Five minutes",
"arrest",
"to begin resuscitation",
"point",
"region",
"CNS",
"most likely to suffer ischemic damage"
] |
A 77-year-old man with type 2 diabetes mellitus is admitted to the hospital because of chest pain and dyspnea. Serum troponin levels are elevated and an ECG shows ST-segment depressions in the lateral leads. Percutaneous coronary angiography is performed and occlusion of the distal left anterior descending coronary art... | Glanzmann thrombasthenia | {
"A": "Von Willebrand disease",
"B": "Protein C deficiency",
"C": "Thrombotic thrombocytopenic purpura",
"D": "Glanzmann thrombasthenia"
} | step1 | D | [
"year old man",
"type 2 diabetes mellitus",
"admitted",
"hospital",
"chest pain",
"dyspnea",
"Serum troponin levels",
"elevated",
"ECG shows ST-segment depressions",
"lateral leads",
"Percutaneous coronary angiography",
"performed",
"occlusion",
"distal left anterior descending coronary ar... |
A 66-year-old man comes to the physician for a follow-up examination after a below-knee amputation of the right lower leg. Three weeks ago, he had an acute arterial embolism that could not be revascularized in time to save the leg. He now reports episodic hot, shooting, and tingling pain in the right lower leg that beg... | Phantom limb pain | {
"A": "Phantom limb pain",
"B": "Foreign body reaction",
"C": "Reinfarction",
"D": "Diabetic neuropathy"
} | step1 | A | [
"66 year old man",
"physician",
"follow-up examination",
"below-knee amputation",
"right lower leg",
"Three weeks",
"acute arterial embolism",
"not",
"time",
"save",
"leg",
"now reports episodic hot",
"shooting",
"tingling pain in",
"right lower leg",
"began",
"amputation",
"type 2... |
Four days after undergoing liver transplantation, a 47-year-old man develops fever, chills, malaise, and confusion while in the intensive care unit. His temperature is 39.1°C (102.4°F). Blood cultures grow an organism. Microscopic examination of this organism after incubation at 25°C (77°F) for 3 hours is shown. Which ... | Candida albicans | {
"A": "Aspergillus fumigatus",
"B": "Candida albicans",
"C": "Cryptococcus neoformans",
"D": "Malassezia furfur"
} | step1 | B | [
"Four days",
"liver transplantation",
"year old man",
"fever",
"chills",
"malaise",
"confusion",
"intensive care unit",
"temperature",
"4F",
"Blood cultures",
"organism",
"Microscopic examination",
"3 hours",
"shown",
"following",
"most likely causal organism",
"patient's symptoms"... |
An 18-year-old man presents to his primary care provider for a routine checkup. He feels well and has no complaints. He is the captain of his high school football team and will be attending college on a football scholarship the following year. His past medical history is unremarkable. He underwent a laparoscopic append... | Hepatic adenoma | {
"A": "Hepatic adenoma",
"B": "Hepatocellular carcinoma",
"C": "Renal cyst",
"D": "Type 1 diabetes mellitus"
} | step1 | A | [
"year old man presents",
"primary care provider",
"routine checkup",
"feels well",
"complaints",
"captain",
"high school football team",
"attending college",
"football scholarship",
"following year",
"past medical history",
"unremarkable",
"laparoscopic appendectomy",
"age",
"takes",
"... |
A 72-year-old man with a 4-year history of Parkinson disease comes to the physician for evaluation of his medication. Since his last visit one year ago, he has had increased tremor and bradykinesia up to an hour before his next scheduled dose and sometimes feels like he does not respond to some doses at all. One week a... | Entacapone | {
"A": "Entacapone",
"B": "Ropinirole",
"C": "Amantadine",
"D": "Rasagiline"
} | step1 | A | [
"72 year old man",
"history of Parkinson disease",
"physician",
"evaluation",
"medication",
"last visit one year ago",
"increased tremor",
"bradykinesia",
"hour",
"next scheduled dose",
"sometimes feels",
"not",
"doses",
"One week",
"unable to move",
"minute",
"wanted to exit",
"el... |
A 31-year-old woman has a follow-up visit with her psychiatrist. She was recently diagnosed with major depressive disorder and was started on citalopram 3 months ago. Her dosage was increased one time 6 weeks ago. She has come in to discuss her progress and notes that she feels “normal again” and “happier” and has not ... | Maintain the current dose of citalopram for several months | {
"A": "Lower the dose of citalopram",
"B": "Maintain the current dose of citalopram for several months",
"C": "Increase the dose of citalopram",
"D": "Discontinue the citalopram and switch to amitriptyline"
} | step2&3 | B | [
"31 year old woman",
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"psychiatrist",
"recently diagnosed",
"major depressive disorder",
"started",
"citalopram",
"months",
"dosage",
"increased one time",
"weeks",
"discuss",
"progress",
"notes",
"feels normal",
"happier",
"not experienced",
"usual feelings",
"... |
A 43-year-old construction worker presents to the emergency department two hours after sustaining a deep laceration to his left forearm by a piece of soiled and rusted sheet metal. His vital signs are stable, there is no active bleeding, his pain is well controlled, and a hand surgeon has been notified about damage to ... | Tetanus vaccine + immunoglobulin | {
"A": "IV metronidazole only",
"B": "Anthrax vaccine",
"C": "Tetanus immunglobulin only",
"D": "Tetanus vaccine + immunoglobulin"
} | step2&3 | D | [
"year old construction worker presents",
"emergency department two hours",
"sustaining",
"deep laceration",
"left forearm",
"piece",
"soiled",
"rusted",
"metal",
"vital signs",
"stable",
"active bleeding",
"pain",
"well controlled",
"hand surgeon",
"notified",
"damage",
"forearm te... |
A 53-year-old woman presents with a feeling of pelvic pressure which worsens with prolonged standing, pain on sexual intercourse, and lower back pain. She reports no urinary or fecal incontinence. She is G3P3 with no history of any gynecological disease and is premenopausal. All pregnancies were without complication an... | Rectovaginal fascia | {
"A": "Rectovaginal fascia",
"B": "Cardinal ligaments",
"C": "Round ligaments",
"D": "Uterosacral ligaments"
} | step2&3 | A | [
"year old woman presents",
"feeling",
"pelvic pressure",
"worsens",
"prolonged standing",
"pain on sexual intercourse",
"lower back pain",
"reports",
"urinary",
"fecal incontinence",
"history of",
"gynecological disease",
"premenopausal",
"pregnancies",
"complication",
"resolved",
"f... |
A 64-year-old woman presents to the emergency department with a 1-hour history of shortness of breath and chest pain. She said that the symptoms came on suddenly and that the chest pain is worse when she tries to take a deep breath. Her past medical history is significant for a previous deep venous thrombosis for which... | Carbamazepine | {
"A": "Atorvastatin",
"B": "Carbamazepine",
"C": "Lisinopril",
"D": "Valproic acid"
} | step1 | B | [
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"emergency department",
"hour history of shortness",
"breath",
"chest pain",
"symptoms",
"chest pain",
"worse",
"to take",
"deep breath",
"past medical history",
"significant",
"previous deep venous thrombosis",
"taking",
"blood thinner",
"diabetes",
"hy... |
5 days after receiving chemotherapy for ovarian cancer, a 74-year-old woman comes to the physician for a follow-up examination. She feels well and has no complaints. Her leukocyte count is 3,500/mm3 (11% neutrophils and 89% lymphocytes). This patient's profound granulocytopenia is most likely to predispose her to infec... | Enterococcus faecalis | {
"A": "Enterococcus faecalis",
"B": "Gardnerella vaginalis",
"C": "Giardia lamblia",
"D": "Pneumocystis jirovecii"
} | step1 | A | [
"5 days",
"receiving chemotherapy",
"ovarian cancer",
"74 year old woman",
"physician",
"follow-up examination",
"feels well",
"complaints",
"leukocyte count",
"3 500 mm3",
"neutrophils",
"lymphocytes",
"patient's profound granulocytopenia",
"most likely to",
"infection",
"following or... |
A 60-year-old man presents to your office because he noticed a "weird patch" on the floor of his mouth. He states that he noticed it a few months ago, but did not report it because it did not hurt. However, he is concerned because it has not regressed and seems to have changed in shape. On examination, you notice the p... | This lesion necessitates biopsy. | {
"A": "This lesion is due to an infection.",
"B": "This lesion necessitates biopsy.",
"C": "This lesion carries no increased risk of cancer.",
"D": "Tobacco use is not a risk factor."
} | step1 | B | [
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"patch",
"the floor of",
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"states",
"few months",
"not report",
"not",
"concerned",
"not regressed",
"to",
"changed in shape",
"examination",
"patient",
"poor dentition",
"admits to using chewing tobacco daily",
"The patch",
"floor of... |
A 58-year-old woman comes to the physician for evaluation of worsening fatigue for 1 week. She also has a 1-year history of hand pain and stiffness. Four months ago, she started a new medication for these symptoms. Medications used prior to that included ibuprofen, prednisone, and hydroxychloroquine. Examination shows ... | Leucovorin | {
"A": "Vitamin B6",
"B": "Vitamin B12",
"C": "Amifostine",
"D": "Leucovorin"
} | step1 | D | [
"58 year old woman",
"physician",
"evaluation",
"worsening fatigue",
"1 week",
"year history",
"hand pain",
"stiffness",
"Four months",
"started",
"new medication",
"symptoms",
"Medications used prior to",
"included ibuprofen",
"prednisone",
"hydroxychloroquine",
"Examination shows",... |
A 32-year-old previously healthy female presents to her primary care physician with double vision. She first noted the double vision yesterday and saw no improvement this morning. She does not think it is worsening. She has not had any changes in her normal routine though she recalls one episode of right arm weakness 2... | Horizontal nystagmus in the left eye on leftward gaze | {
"A": "Horizontal nystagmus in the left eye on leftward gaze",
"B": "Ptosis on the right",
"C": "Left abduction palsy on leftward gaze",
"D": "Afferent pupillary defect in the left eye"
} | step1 | A | [
"year old",
"healthy female presents",
"primary care physician",
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"first noted",
"double vision",
"saw",
"improvement",
"morning",
"not think",
"worsening",
"not",
"changes",
"normal routine",
"recalls one episode of right arm weakness",
"months",
"not",
"treatment"... |
A team of researchers is investigating different mechanisms of transmitting sensory information in the body. They are particularly interested in the different types of sensory receptors. From a sample of tissue, they isolate a receptor that is encased in deep skin layers and joints. The receptor adapts quickly and they... | Large, myelinated fibers | {
"A": "Small, myelinated fibers",
"B": "Large, unmyelinated fibers",
"C": "Large, myelinated fibers",
"D": "Dendritic endings"
} | step1 | C | [
"team",
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"tissue",
"isolate",
"receptor",
"encased",
"deep skin layers",
"joints",
"receptor adapts",
"discover",
"role",
... |
A 28-year-old African American woman comes to the emergency department with intermittent and progressively worsening dizziness with near-fainting incidents for the last 3 weeks. She denies fever, weight loss, nausea, vomiting, or chest pain. Her medical history is significant for a chronic cough and intermittent skin r... | Sarcoidosis | {
"A": "Carotid artery stenosis",
"B": "Non-Hodgkin’s lymphoma",
"C": "Small cell lung cancer",
"D": "Sarcoidosis"
} | step2&3 | D | [
"year old African American woman",
"emergency department",
"intermittent",
"worsening dizziness",
"fainting incidents",
"last",
"weeks",
"denies fever",
"weight loss",
"nausea",
"vomiting",
"chest pain",
"medical history",
"significant",
"chronic cough",
"intermittent skin rashes",
"... |
A 36-year-old woman comes to the physician for evaluation of unintentional weight gain of 5.5 kg (12.2 lb) and irregular menstrual cycles over the past 2 months. She does not take any medications. Her blood pressure is 155/85 mm Hg. Physical examination shows central obesity, hyperpigmentation of the palmar creases, an... | Bilateral hyperplasia of the zona fasciculata | {
"A": "Benign adenoma of the adrenal medulla",
"B": "Nodular hypertrophy of the zona reticularis",
"C": "Bilateral hyperplasia of the zona fasciculata",
"D": "Unilateral carcinoma of the adrenal cortex"
} | step1 | C | [
"36 year old woman",
"physician",
"evaluation",
"unintentional weight gain",
"kg",
"irregular menstrual cycles",
"past",
"months",
"not take",
"medications",
"blood pressure",
"85 mm Hg",
"Physical examination shows central obesity",
"hyperpigmentation",
"palmar creases",
"violaceous s... |
A 45-year-old gentleman with a history of poorly controlled diabetes mellitus is referred to a nephrologist for evaluation of the possibility of early stage kidney failure. Upon evaluation, the nephrologist decides to assess the patient's renal plasma flow by performing a laboratory test. Which of the following substan... | Para-aminohippurate (PAH) | {
"A": "Creatinine",
"B": "Inulin",
"C": "Glucose",
"D": "Para-aminohippurate (PAH)"
} | step1 | D | [
"year old",
"history of poorly controlled diabetes mellitus",
"referred",
"nephrologist",
"evaluation",
"possibility",
"early stage kidney failure",
"evaluation",
"nephrologist",
"to assess",
"patient's renal plasma flow",
"performing",
"laboratory test",
"following substances",
"best",
... |
A 43-year-old woman comes to the physician because of a 2-week history of malaise, nausea, and a 3-kg (6.6-lb) weight loss. She has been drinking 8–9 alcoholic beverages daily for the past 20 years. Her temperature is 37.8°C (100°F) and pulse is 105/min. Examination shows jaundice and hepatosplenomegaly. A photomicrogr... | Increased glycerol 3-phosphate formation | {
"A": "Excessive interstitial TGF-β activity",
"B": "Decreased clearance of N-acetyl-p-benzoquinone imine",
"C": "Intracellular accumulation of lactate",
"D": "Increased glycerol 3-phosphate formation"
} | step1 | D | [
"year old woman",
"physician",
"2-week history",
"malaise",
"nausea",
"3 kg",
"6.6",
"weight loss",
"drinking",
"alcoholic beverages daily",
"past 20 years",
"temperature",
"pulse",
"min",
"Examination shows jaundice",
"hepatosplenomegaly",
"photomicrograph",
"section",
"biopsy s... |
A 48-year-old female with a history of hypertension, type II diabetes mellitus, hypothyroidism, and asthma undergoes a scheduled total abdominal hysterectomy for symptomatic fibroids. She is given a dose of preoperative prophylactic antibiotics. Her urinary catheter is removed on post-operative day one. She is on low-m... | Vancomycin/piperacillin-tazobactam/clindamycin and debridement of the surgical wound | {
"A": "Discontinue low-molecular-weight heparin",
"B": "Oral levofloxacin for 3 days",
"C": "Vancomycin/piperacillin-tazobactam/clindamycin and observation",
"D": "Vancomycin/piperacillin-tazobactam/clindamycin and debridement of the surgical wound"
} | step2&3 | D | [
"48 year old female",
"history of hypertension",
"type II diabetes mellitus",
"hypothyroidism",
"asthma",
"scheduled total abdominal hysterectomy",
"symptomatic fibroids",
"given",
"dose",
"preoperative prophylactic antibiotics",
"urinary catheter",
"removed",
"post-operative day one",
"lo... |
A 1-month-old boy is brought to the emergency department 25 minutes after having a seizure. His mother reports that he has become lethargic and does not cry as vigorously anymore. Examination shows muscular hypotonia and hepatomegaly. Arterial blood gas on room air shows metabolic acidosis. Serum studies show elevated ... | Mutase | {
"A": "Phosphorylase",
"B": "Phosphatase",
"C": "Hydroxylase",
"D": "Mutase"
} | step1 | D | [
"month old boy",
"brought",
"emergency department",
"minutes",
"seizure",
"mother reports",
"lethargic",
"not cry",
"vigorously",
"Examination shows muscular hypotonia",
"hepatomegaly",
"Arterial blood gas",
"room air shows metabolic",
"Serum studies show elevated levels",
"methylmalonic... |
A 22-year-old patient presents to the rural medicine clinic for a physical examination. She has a past medical history of major depressive disorder. The patient has a history of smoking 1 pack of cigarettes daily for 5 years. She states that she is not currently sexually active, but had sexual intercourse in the past. ... | Pap smear | {
"A": "Pap smear",
"B": "Pap smear and HPV testing",
"C": "Colposcopy and biopsy",
"D": "Screening for hyperlipidemia"
} | step2&3 | A | [
"year old patient presents",
"rural medicine clinic",
"physical examination",
"past medical major",
"patient",
"history of smoking",
"pack",
"cigarettes daily",
"5 years",
"states",
"not currently sexually active",
"sexual intercourse",
"past",
"paternal grandfather died",
"heart attack"... |
A 66-year-old homeless HIV-positive male presents with numbness in his hands and feet. The patient says that his symptoms started gradually a couple weeks ago and have slowly worsened. He describes numbness initially in just his fingertips and toes but it has now spread to involve his entire hands and feet. Past medica... | Elevated levels of methylmalonic acid (MMA) | {
"A": "Elevated levels of methylmalonic acid (MMA)",
"B": "Poorly controlled, undiagnosed diabetes",
"C": "Autoimmune reaction",
"D": "Deposition of an insoluble protein"
} | step2&3 | A | [
"66 year old homeless HIV-positive male presents",
"numbness",
"hands",
"feet",
"patient",
"symptoms started",
"couple weeks",
"slowly worsened",
"numbness initially",
"fingertips",
"toes",
"now spread to",
"entire hands",
"feet",
"Past medical history",
"significant",
"HIV diagnosed... |
A 47-year-old woman presents to the emergency department in a frantic state and demands immediate treatment for an allergic reaction, which started soon after she had lunch (approximately 1 hour ago). She had her usual meal consisting of homemade salad and lemonade. She was recently started on niacin because she could ... | Prostaglandin release | {
"A": "Anxiety",
"B": "Drug overdose",
"C": "Prostaglandin release",
"D": "Serotonin"
} | step1 | C | [
"year old woman presents",
"emergency department",
"state",
"demands immediate treatment",
"allergic reaction",
"started",
"lunch",
"approximately",
"hour",
"usual meal consisting",
"salad",
"lemonade",
"recently started",
"niacin",
"not",
"statins",
"only",
"medication",
"takes"... |
A 51-year-old man comes to the physician for 2 months of intermittent low-grade fever, malaise, and joint pain. He has a history of recurrent dental abscesses requiring drainage but has otherwise been healthy. His temperature is 38.3°C (100.9°F) and pulse is 112/min. Physical examination shows a new holosystolic murmur... | Fibrin clot formation | {
"A": "Antibody cross-reaction",
"B": "Sterile platelet thrombi deposition",
"C": "Leaflet calcification and fibrosis",
"D": "Fibrin clot formation"
} | step1 | D | [
"year old man",
"physician",
"2 months",
"intermittent low-grade fever",
"malaise",
"joint pain",
"history",
"recurrent dental abscesses",
"drainage",
"healthy",
"temperature",
"3C",
"100 9F",
"pulse",
"min",
"Physical examination shows",
"new holosystolic murmur",
"left midclavicu... |
A 4-year-old boy is brought to the physician by his mother because of painless lesions on his face that he has had since shortly after birth. They recently moved to the USA from Indonesia where they had limited access to healthcare. A photograph of the lesions is shown. Which of the following is the most likely diagnos... | Infantile hemangioma | {
"A": "Infantile hemangioma",
"B": "Verruca vulgaris",
"C": "Spider angioma",
"D": "Molluscum contagiosum"
} | step1 | A | [
"4 year old boy",
"brought",
"physician",
"mother",
"painless lesions",
"face",
"since",
"birth",
"recently moved to",
"USA",
"Indonesia",
"limited access to healthcare",
"photograph",
"lesions",
"shown",
"following",
"most likely diagnosis"
] |
A 30-year-old man is diagnosed with multi-drug resistant tuberculosis after a recent trip to Eastern Europe. After drug susceptibility testing is completed, he is given a regimen of antibiotics as treatment. He returns two weeks later complaining of decreased visual acuity and color-blindness. Which drug of the followi... | Inhibition of arabinogalactan synthesis | {
"A": "Inhibition of mycolic acid synthesis",
"B": "Inhibition of arabinogalactan synthesis",
"C": "Inhibition of RNA synthesis",
"D": "Inhibition of RNA translation"
} | step1 | B | [
"30 year old man",
"diagnosed",
"multi-drug resistant tuberculosis",
"recent trip",
"Eastern Europe",
"drug susceptibility",
"completed",
"given",
"regimen",
"antibiotics",
"treatment",
"returns two weeks later",
"decreased visual acuity",
"color-blindness",
"drug",
"following",
"mec... |
A 5-year-old boy is brought to the physician because of intermittent abdominal cramps and recurrent episodes of foul-smelling greasy diarrhea for 3 months. He has a history of recurrent upper respiratory infection. The abdomen is diffusely tender to palpation and resonant to percussion. A photomicrograph of a stool sam... | Hypersensitivity reaction to transfusion | {
"A": "Hypersensitivity reaction to transfusion",
"B": "Gastric adenocarcinoma",
"C": "Progressive peripheral neuropathy",
"D": "Disseminated tuberculosis"
} | step1 | A | [
"5 year old boy",
"brought",
"physician",
"intermittent abdominal cramps",
"recurrent episodes of",
"smelling greasy diarrhea",
"3 months",
"history",
"recurrent upper respiratory infection",
"abdomen",
"tender",
"palpation",
"resonant",
"percussion",
"photomicrograph",
"stool sample",... |
A 23-year-old man comes to the emergency department for 2 days of severe headaches. The pain is most intense on his left forehead and eye. He had similar symptoms last summer. He has been taking indomethacin every 6 hours for the last 24 hours but has not had any relief. He has smoked 1 pack of cigarettes daily for the... | Cluster headache | {
"A": "Giant cell arteritis",
"B": "Medication overuse headache",
"C": "Cluster headache",
"D": "Trigeminal neuralgia"
} | step1 | C | [
"23 year old man",
"emergency department",
"2 days",
"severe headaches",
"pain",
"most intense",
"left forehead",
"eye",
"similar symptoms last summer",
"taking indomethacin",
"6 hours",
"not",
"relief",
"smoked 1 pack",
"cigarettes daily",
"past",
"years",
"works",
"accountant",... |
A research group wants to assess the relationship between childhood diet and cardiovascular disease in adulthood. A prospective cohort study of 500 children between 10 to 15 years of age is conducted in which the participants' diets are recorded for 1 year and then the patients are assessed 20 years later for the prese... | Stratification | {
"A": "Blinding",
"B": "Crossover",
"C": "Matching",
"D": "Stratification"
} | step1 | D | [
"research group",
"to assess",
"relationship",
"childhood diet",
"cardiovascular disease",
"adulthood",
"prospective cohort study",
"500 children",
"10",
"years",
"age",
"conducted",
"participants",
"diets",
"recorded",
"year",
"then",
"patients",
"assessed 20 years later",
"pr... |
A 40-year-old male with Down syndrome is brought to your clinic by his mother. She reports that over the past few months he has started having difficulty managing his daily routine at his assisted-living facility and no longer seems like himself. She says that last week he wandered away from the facility and was brough... | Abnormal protein metabolism | {
"A": "Abnormal protein metabolism",
"B": "Hormone deficiency",
"C": "Premature degradation of a protein",
"D": "Nutritional deficiency"
} | step1 | A | [
"40 year old male",
"Down syndrome",
"brought",
"clinic",
"mother",
"reports",
"past",
"months",
"started",
"difficulty managing",
"daily routine",
"assisted-living facility",
"longer",
"last week",
"wandered",
"facility",
"brought back",
"police",
"stopped taking",
"regular an... |
A 14-year-old Caucasian male patient found to have low serum copper, high urine copper, and low serum ceruloplasmin is placed on penicillamine for management of his genetic disorder. Which of the following is LEAST consistent with this patient's clinical picture? | Kinky, easily breakable hair | {
"A": "Kinky, easily breakable hair",
"B": "Cirrhosis",
"C": "Hemiballismus",
"D": "Corneal deposits"
} | step1 | A | [
"year old Caucasian male patient found to",
"low serum copper",
"high urine copper",
"low serum ceruloplasmin",
"placed",
"penicillamine",
"management",
"genetic",
"following",
"LEAST consistent with",
"patient's clinical picture"
] |
A 59-year-old man is brought to the emergency department 30 minutes after having a seizure. His wife reports that the patient has been having recurrent headaches and has become increasingly irritable over the past 3 months. Physical examination shows a spastic paresis of the right lower extremity. The Babinski sign is ... | Meningioma | {
"A": "Pituitary adenoma",
"B": "Ependymoma",
"C": "Oligodendroglioma",
"D": "Meningioma"
} | step1 | D | [
"59 year old man",
"brought",
"emergency department 30 minutes",
"seizure",
"wife reports",
"patient",
"recurrent headaches",
"irritable",
"past 3 months",
"Physical examination shows",
"spastic paresis of",
"right lower extremity",
"Babinski sign",
"present",
"right side",
"MRI of",
... |
A high-throughput screen to identify new sympathomimetic compounds was developed such that a transgenic line of cells was created that contained the alpha-1 (red), alpha-2 (yellow), beta-1 (green) and beta-2 (blue) receptors. When each of the receptors was activated a different fluorescent protein was expressed and new... | Albuterol | {
"A": "Albuterol",
"B": "Midrodrine",
"C": "Epinephrine",
"D": "Isoproterenol"
} | step1 | A | [
"high",
"screen to",
"new sympathomimetic compounds",
"transgenic line",
"cells",
"created",
"contained",
"alpha-1",
"red",
"alpha-2",
"yellow",
"beta",
"green",
"beta",
"blue",
"receptors",
"receptors",
"activated",
"different fluorescent protein",
"new compounds",
"differen... |
A 53-year-old man is brought by his daughter to the clinic. She lives a town away but visits often. She reports that on recent visits, his mood has been volatile, ranging from aggressive at some moments to depressed at others. She has noticed some new jerky movements which she has never seen before and has been quite f... | Decreased GABA at the caudate | {
"A": "Increased norepinephrine at the locus ceruleus",
"B": "Increased acetylcholine at the caudate",
"C": "Decreased GABA at the caudate",
"D": "Decreased dopamine at the ventral tegmentum and substantia nigra pars compacta"
} | step1 | C | [
"year old man",
"brought",
"daughter",
"clinic",
"lives",
"town",
"visits often",
"reports",
"recent visits",
"mood",
"volatile",
"ranging",
"aggressive",
"depressed",
"others",
"new jerky movements",
"never seen",
"forgetful",
"concerned",
"abusing alcohol",
"drugs",
"chan... |
A male newborn is delivered at term to a 30-year-old woman. Pregnancy and delivery were uncomplicated. At birth, the umbilical cord is noted to be large. When the newborn cries, straw-colored fluid leaks from the umbilicus. The external genitalia appear normal. Which of the following is the most likely cause of this ne... | Failed obliteration of an allantoic remnant | {
"A": "Abnormal fusion of the urethral folds",
"B": "Failed closure of the vitelline duct",
"C": "Failed obliteration of an allantoic remnant",
"D": "Infection of the umbilical cord stump"
} | step1 | C | [
"male newborn",
"delivered",
"term",
"30 year old woman",
"Pregnancy",
"delivery",
"uncomplicated",
"birth",
"umbilical cord",
"noted to",
"large",
"newborn cries",
"straw colored fluid leaks",
"umbilicus",
"external genitalia appear normal",
"following",
"most likely cause",
"newb... |
A medical student is performing research on the properties of viruses in order to determine the transmission patterns of various organisms. He accidentally drops a rack of tubes and spills various virus samples on the benchtop. Upon seeing this, the laboratory technician wipes down the workbench with alcohol in order t... | Adenovirus and rhinovirus | {
"A": "Adenovirus and herpesvirus",
"B": "Adenovirus and rhinovirus",
"C": "Coronavirus and herpesvirus",
"D": "Coronavirus and rhinovirus"
} | step1 | B | [
"medical student",
"performing research",
"properties",
"viruses",
"order to",
"transmission patterns",
"various organisms",
"drops",
"rack",
"tubes",
"various virus samples",
"seeing",
"laboratory technician wipes",
"alcohol",
"order",
"clean up",
"following organisms",
"most like... |
An 3-year-old boy is brought in to his pediatrician by his mother after she noticed that the child was starting to turn yellow. She has not noticed any behavioral changes. On exam, the boy is icteric but is behaving normally. His temperature is 98.8°F (37.1°C), blood pressure is 108/78 mmHg, pulse is 78/min, and respir... | Reduced UDP-glucuronosyltransferase activity | {
"A": "Absent UDP-glucuronosyltransferase activity",
"B": "Defective liver excretion of bilirubin due to SLCO1B1 and SLCO1B3 mutations",
"C": "Impaired bilirubin uptake",
"D": "Reduced UDP-glucuronosyltransferase activity"
} | step1 | D | [
"3 year old boy",
"brought",
"pediatrician",
"mother",
"child",
"starting to turn yellow",
"not",
"behavioral changes",
"exam",
"boy",
"icteric",
"temperature",
"98",
"blood pressure",
"mmHg",
"pulse",
"min",
"respirations",
"min",
"labs",
"drawn",
"found to",
"unconjugat... |
A 20-year-old woman presents to the emergency department after developing a widespread rash when she was playing in the park. She states she feels somewhat light-headed. She is otherwise healthy and has no significant past medical history. Her temperature is 97.0°F (36.1°C), blood pressure is 84/54 mmHg, pulse is 130/m... | Epinephrine | {
"A": "Albuterol",
"B": "Continuous monitoring",
"C": "Diphenhydramine",
"D": "Epinephrine"
} | step2&3 | D | [
"20 year old woman presents",
"emergency department",
"widespread rash",
"playing",
"park",
"states",
"feels somewhat light-headed",
"healthy",
"significant past medical history",
"temperature",
"97",
"36",
"blood pressure",
"84 54 mmHg",
"pulse",
"min",
"respirations",
"min",
"o... |
A 55-year-old woman with rheumatoid arthritis comes to the physician because of a 3-month history of worsening fatigue and dyspnea. She has felt short-of-breath when walking up the stairs to her apartment. Menopause occurred 5 years ago. Her medications are methotrexate and folic acid supplementation. Physical examinat... | Increased release of hepcidin by hepatocytes | {
"A": "Increased activity of ferroportin-1 in enterocytes",
"B": "Increased release of iron from macrophages",
"C": "Increased release of hepcidin by hepatocytes",
"D": "Increased production of reticulocytes in bone marrow"
} | step1 | C | [
"55 year old woman",
"rheumatoid arthritis",
"physician",
"3 month history",
"worsening fatigue",
"dyspnea",
"felt short-of-breath",
"walking",
"stairs",
"apartment",
"Menopause occurred 5 years",
"medications",
"methotrexate",
"folic acid supplementation",
"Physical examination shows co... |
A 65-year-old man presents with complaints of weakness and swollen gums for the past 3 weeks. He also says he cut his finger while cooking, and the bleeding took more than 10 minutes to stop. He has a family history of diabetes mellitus type 2 and prostate cancer. Current medications are multivitamin. His blood pressur... | t(15;17) | {
"A": "JAK2 mutation",
"B": "t(9;22)",
"C": "t(15;17)",
"D": "t(11;14)"
} | step1 | C | [
"65 year old man presents",
"complaints",
"weakness",
"swollen gums",
"past",
"weeks",
"cut",
"finger",
"cooking",
"bleeding took more",
"10 minutes to stop",
"family history of diabetes mellitus type 2",
"prostate cancer",
"Current medications",
"multivitamin",
"blood pressure",
"67... |
An otherwise healthy 16-year-old girl comes to the physician because she has not had a menstrual period. Examination shows normal breast development. There is coarse pubic and axillary hair. Pelvic examination shows a blind vaginal pouch. Ultrasonography shows normal ovaries and an atretic uterus. Which of the followin... | Agenesis of the paramesonephric duct | {
"A": "Deficiency of 5-alpha reductase",
"B": "Monosomy of sex chromosomes",
"C": "Agenesis of the paramesonephric duct",
"D": "Deficiency of 17-alpha-hydroxylase"
} | step1 | C | [
"healthy",
"year old girl",
"physician",
"not",
"menstrual period",
"Examination shows normal breast development",
"coarse pubic",
"axillary hair",
"Pelvic examination shows",
"blind vaginal pouch",
"Ultrasonography shows normal ovaries",
"atretic uterus",
"following",
"most likely underly... |
A 75-year-old woman is being treated for atrial fibrillation. She presents to the clinic with complaints of nausea, vomiting, photophobia, and yellow-green vision with yellow halos around the lights. She has a heart rate of 64/min, blood pressure is 118/76 mm Hg, and respiratory rate is 15/min. Physical examination rev... | Digoxin | {
"A": "Digoxin",
"B": "Amiodarone",
"C": "Propafenone",
"D": "Atenolol"
} | step1 | A | [
"75 year old woman",
"treated",
"atrial fibrillation",
"presents",
"clinic",
"complaints",
"nausea",
"vomiting",
"photophobia",
"yellow-green vision",
"halos",
"lights",
"heart rate",
"64 min",
"blood pressure",
"76 mm Hg",
"respiratory rate",
"min",
"Physical examination reveals... |
A 40-year-old man is rushed to the emergency department after being involved in a motor vehicle accident. He has lacerations on his right arm and some minor abrasions on his face and lower limbs. The resident on call quickly manages the patient with proper care of his open wounds in the emergency department. The patien... | Healing by secondary intention will occur along with the deposition of large amount of granulation tissue. | {
"A": "Abundant lymphocytes accumulate during the healing process, forming a granuloma.",
"B": "Healing by secondary intention will occur along with the deposition of large amount of granulation tissue.",
"C": "Healing involves abscess formation, which should be drained.",
"D": "Healing by primary intention wi... | step1 | B | [
"40 year old man",
"rushed",
"emergency department",
"involved",
"motor vehicle accident",
"lacerations",
"right",
"minor abrasions",
"face",
"lower limbs",
"resident",
"call",
"patient",
"care",
"open wounds",
"emergency department",
"patient",
"admitted",
"surgery unit",
"dai... |
Hormone balance is essential for maintaining a normal pregnancy. Early on, elevated progesterone levels are needed to maintain pregnancy and progesterone is produced in excess by the corpus luteum. In the normal menstrual cycle the corpus luteum involutes, but this process is impeded during pregnancy because of the pre... | Human chorionic gonadotropin | {
"A": "Cortisol",
"B": "Human chorionic gonadotropin",
"C": "Estrogen",
"D": "Progesterone"
} | step1 | B | [
"Hormone balance",
"essential",
"maintaining",
"normal",
"Early",
"elevated",
"needed to maintain pregnancy",
"progesterone",
"excess",
"corpus luteum",
"normal menstrual cycle",
"corpus luteum involutes",
"process",
"pregnancy",
"presence",
"hormone"
] |
A 32-year-old man comes to the emergency department because of worsening shortness of breath and a productive cough for 3 days. He sustained trauma to the right hemithorax during a fight 3 weeks ago. He had significant pain and mild shortness of breath following the incident but did not seek medical care. He does not s... | Pleural empyema | {
"A": "Viral pleurisy",
"B": "Lung abscess",
"C": "Pleural empyema",
"D": "Mesothelioma"
} | step2&3 | C | [
"year old man",
"emergency department",
"of worsening shortness",
"breath",
"productive cough",
"3 days",
"sustained trauma",
"right hemithorax",
"fight",
"weeks",
"significant pain",
"mild shortness of breath following",
"incident",
"not",
"medical care",
"not smoke",
"drink alcohol... |
A cross-sectional oral health survey was designed to assess both functional and psychosocial effects of dental disease on the elderly population of Buda, Texas (US). Printed surveys that consisted of 50 open-ended questions on dental disease history and dental hygiene were mailed to the selected members of a target pop... | ...the difference between the observed and nonrespondent answers is increased. | {
"A": "....the proportion of nonrespondents from the targeted sample is decreased.",
"B": "...the specific weighting-class adjustments are used on the final data.",
"C": "...the difference between the observed and nonrespondent answers is increased.",
"D": "...the imputation techniques for data correction are ... | step1 | C | [
"cross-sectional oral health",
"designed to assess",
"functional",
"psychosocial effects",
"dental disease",
"elderly population",
"Texas",
"Printed surveys",
"consisted",
"50 open-ended questions",
"dental",
"dental hygiene",
"mailed",
"selected members",
"target population",
"respons... |
A 16-year-old boy is brought to the physician for a follow-up examination. He has a 6-year history of type 1 diabetes mellitus and his only medication is insulin. Seven months ago, he was treated for an episode of diabetic ketoacidosis. He has previously been compliant with his diet and insulin regimen. He wants to joi... | Lower insulin dosage on days of exercise | {
"A": "Advise against physical activity",
"B": "Lower insulin dosage on days of exercise",
"C": "Switch from insulin to metformin",
"D": "Increase insulin dosage on days of exercise"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"follow-up examination",
"year history of type 1 diabetes mellitus",
"only medication",
"insulin",
"Seven months",
"treated",
"episode of diabetic ketoacidosis",
"compliant with",
"diet",
"insulin regimen",
"to",
"high school soccer team",
"Vital... |
A 58-year-old woman comes to the physician because of headaches for 1 month. She describes them as 7 out of 10 in intensity. She has no nausea. Two years ago, she was treated for invasive lobular carcinoma of the left breast. She underwent a left mastectomy and multiple cycles of chemotherapy. She has been in good heal... | Surgical resection | {
"A": "Whole brain radiation therapy",
"B": "Surgical resection",
"C": "Chemotherapy",
"D": "Antibiotic therapy"
} | step2&3 | B | [
"58 year old woman",
"physician",
"of headaches",
"month",
"out",
"10",
"intensity",
"nausea",
"Two years",
"treated",
"invasive lobular carcinoma of the left breast",
"left mastectomy",
"multiple cycles",
"chemotherapy",
"good health",
"treatment",
"temperature",
"98",
"pulse",
... |
A 44-year-old man presents to his primary care physician due to a shock-like pain in his left leg. He describes the pain as sharp and lasting a few minutes at a time. He has noticed being "clumsy" when walking in a dark room. Approximately 2 weeks ago, he was helping his daughter move and this required him to lift heav... | Sexually transmitted infection | {
"A": "Diabetic peripheral neuropathy",
"B": "Lumbar disc herniation",
"C": "Lumbar spinal stenosis",
"D": "Sexually transmitted infection"
} | step1 | D | [
"year old man presents",
"primary care physician due to",
"shock",
"pain in",
"left leg",
"pain",
"sharp",
"few minutes",
"time",
"clumsy",
"walking in",
"dark room",
"Approximately",
"weeks",
"helping",
"daughter move",
"required",
"to lift heavy boxes",
"denies",
"trauma",
... |
The VALIANT trial compared the effect of captopril and valsartan on mortality in patients with myocardial infarction complicated by heart failure. Subjects were randomly assigned to treatment with either captopril or valsartan and subsequently followed for 2 years. The primary endpoint was death from any cause. The stu... | Randomized controlled trial | {
"A": "Randomized controlled trial",
"B": "Cohort study",
"C": "Case-control study",
"D": "Crossover study"
} | step2&3 | A | [
"trial compared",
"effect",
"captopril",
"valsartan",
"mortality",
"patients",
"myocardial infarction complicated",
"heart failure",
"Subjects",
"assigned",
"treatment",
"either captopril",
"valsartan",
"followed",
"years",
"primary endpoint",
"death",
"cause",
"study concluded",... |
A 45-year-old woman comes to the physician because of a 3-month history of mild right upper abdominal pain. She has not had any fevers, chills, or weight loss. There is no personal or family history of serious illness. Medications include transdermal estrogen, which she recently started taking for symptoms related to m... | Intraperitoneal hemorrhage | {
"A": "Intraperitoneal hemorrhage",
"B": "Biliary peritonitis",
"C": "Bacteremia",
"D": "Metastatic spread"
} | step1 | A | [
"year old woman",
"physician",
"3 month history",
"mild right upper",
"not",
"fevers",
"chills",
"weight loss",
"personal",
"family history",
"serious illness",
"Medications include transdermal estrogen",
"recently started taking",
"symptoms related",
"menopause",
"Abdominal examinatio... |
A 33-year-old Honduran woman presents to your clinic with shortness of breath. She reports that her symptoms have progressed over the past several months and are now impacting her quality of life because she cannot complete her usual exercise routine. She recalls "normal" childhood illnesses, including sore throats and... | Increase with squatting or handgrip | {
"A": "Radiate to the neck",
"B": "Increase with squatting or handgrip",
"C": "Also have a mid-systolic click loudest at S2",
"D": "Have a characteristic machine-like sound"
} | step1 | B | [
"year old Honduran woman presents",
"clinic",
"shortness of breath",
"reports",
"symptoms",
"progressed",
"past",
"months",
"now impacting",
"quality of life",
"complete",
"usual exercise routine",
"recalls",
"normal",
"childhood illnesses",
"including sore throats",
"fevers",
"nev... |
A 73-year-old man dies 4 months after being diagnosed with advanced adenocarcinoma of the colon. Examination of the heart at autopsy shows vegetations lining the mitral valve margins. The vegetations are loosely attached and can be easily scraped off. Microscopic examination shows the vegetations to be composed of inte... | Procoagulant release | {
"A": "Procoagulant release",
"B": "Dystrophic calcifications",
"C": "Bacterial colonization",
"D": "Metastatic infiltration"
} | step1 | A | [
"year old man",
"months",
"diagnosed",
"advanced adenocarcinoma of the colon",
"Examination",
"heart",
"autopsy shows vegetations lining",
"mitral valve margins",
"vegetations",
"attached",
"easily scraped",
"Microscopic examination shows",
"vegetations to",
"fibrin strands",
"mononuclea... |
A 22-year-old primigravid woman comes to the physician for her first prenatal visit at 10 weeks' gestation. She has no history of serious illness. She has been using cocaine for the past two years. Without cessation of cocaine use, which of the following complications is most likely to occur? | Premature delivery | {
"A": "Premature delivery",
"B": "Congenital heart defect",
"C": "Neural tube defects",
"D": "Polyhydramnios"
} | step1 | A | [
"year old primigravid woman",
"physician",
"first prenatal visit",
"10 weeks",
"gestation",
"history",
"serious illness",
"using cocaine",
"past two years",
"cessation of cocaine use",
"following complications",
"most likely to occur"
] |
An 18-year-old man comes to the physician because of severe left shoulder pain after a basketball match. During the game, the patient sustained an injury to the posterior part of his outstretched arm after being blocked by a defender. Examination shows no gross deformity of the left shoulder. Palpation of the shoulder ... | Subscapularis | {
"A": "Supraspinatus",
"B": "Deltoid",
"C": "Subscapularis",
"D": "Infraspinatus"
} | step1 | C | [
"year old man",
"physician",
"of severe left shoulder pain",
"basketball match",
"game",
"patient sustained",
"injury",
"posterior part of",
"arm",
"blocked",
"Examination shows",
"gross deformity",
"left",
"Palpation",
"elicits mild tenderness",
"Internal rotation",
"arm",
"resist... |
A six-month-old male presents to the pediatrician for a well-child visit. His mother reports that the patient has just started eating solids and sleeps well throughout the night. She notes that she often puts the patient to sleep on his stomach because he seems to breathe more easily in that position. The patient’s mot... | Laryngomalacia | {
"A": "Epiglottitis",
"B": "Foreign body aspiration",
"C": "Laryngomalacia",
"D": "Laryngotracheitis"
} | step2&3 | C | [
"six-month old male presents",
"pediatrician",
"well-child visit",
"mother reports",
"patient",
"started eating solids",
"sleeps well",
"night",
"notes",
"often puts",
"patient to sleep",
"stomach",
"to",
"more easily",
"position",
"patients mother",
"patients breathing",
"more str... |
A 36-year-old woman comes to the physician because of blurred vision and difficulty keeping her eyes open. She also has occasional difficulty chewing, especially when eating meat or other foods that require prolonged chewing. The symptoms are worse at the end of the day. Physical examination shows bilateral drooping of... | Decreased generation of end plate potential | {
"A": "Inhibition of calcium release from the sarcoplasmic reticulum",
"B": "Sustained blockade of actin myosin-binding sites",
"C": "Decreased generation of end plate potential",
"D": "Impaired flow of calcium ions between gap junctions"
} | step1 | C | [
"36 year old woman",
"physician",
"blurred vision",
"difficulty keeping",
"eyes open",
"occasional difficulty chewing",
"eating meat",
"foods",
"prolonged chewing",
"symptoms",
"worse",
"end",
"day",
"Physical examination shows bilateral drooping",
"eyelids",
"more",
"to look",
"30... |
A 32-year-old man presents to the emergency room for a generalized tonic-clonic seizure. After stabilizing the patient, a full radiologic evaluation reveals multiple contrast-enhancing lesions in the brain, lungs, and liver. According to his wife, he lost several pounds in the last few months. The medical history is re... | Intimate association of syncytiotrophoblast and cytotrophoblast cells | {
"A": "Glomerulus-like structure with a mesoderm core, a central capillary, and lined with germ cells",
"B": "Germ cells with well-defined borders, central nuclei, prominent nucleoli, and clear cytoplasm",
"C": "Cells with hyaline-like globules",
"D": "Intimate association of syncytiotrophoblast and cytotropho... | step1 | D | [
"year old man presents",
"emergency room",
"generalized tonic-clonic seizure",
"stabilizing",
"patient",
"full radiologic evaluation reveals multiple contrast-enhancing lesions",
"brain",
"lungs",
"liver",
"wife",
"lost several pounds",
"months",
"medical history",
"relevant",
"cryptorch... |
A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 1-year history of progressively worsening paresthesias in her upper limbs. She has accidentally burned her fingers on hot dishes several times. She was involved in a motor vehicle collision 3 years ago. Neurologic examination shows ab... | Drooping of the eyelid | {
"A": "Exaggerated biceps reflex",
"B": "Decreased Mini-Mental State Examination score",
"C": "Drooping of the eyelid",
"D": "Absent knee-jerk reflex"
} | step1 | C | [
"62 year old woman",
"type 2 diabetes mellitus",
"physician",
"year history",
"worsening paresthesias",
"upper limbs",
"burned",
"fingers",
"hot dishes",
"times",
"involved",
"motor vehicle collision",
"years",
"Neurologic examination shows absent temperature sensation",
"normal fine tou... |
A 32-year-old woman, gravida 2, para 1, at 38 weeks' gestation is admitted to the hospital 30 minutes after spontaneous rupture of membranes. Her pregnancy has been complicated by gestational diabetes treated with insulin. Her first child was delivered vaginally. Her immunizations are up-to-date. She delivers the child... | Observation
" | {
"A": "Pelvic ultrasound",
"B": "Hysterectomy",
"C": "Administration of intravenous clindamycin and gentamycin",
"D": "Observation\n\""
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"admitted",
"hospital 30 minutes",
"spontaneous rupture of membranes",
"pregnancy",
"complicated",
"gestational diabetes treated with insulin",
"first child",
"delivered",
"immunizations",
"date",
"delivers",
"child",
"... |
A 45-year-old chronic smoker presents to the physician with a complaint of worsening left shoulder pain for several months which has become acutely worse the past 2 weeks and now radiates down his left arm. Physical examination reveals a palpable 2 x 1.5 cm supraclavicular lymph node along with decreased grip strength ... | Pancoast tumor | {
"A": "Pulmonary hamartoma",
"B": "Pancoast tumor",
"C": "Subclavian aneurysm",
"D": "Osteophyte"
} | step1 | B | [
"year old chronic smoker presents",
"physician",
"complaint",
"worsening left shoulder pain",
"several months",
"worse",
"past 2 weeks",
"now radiates",
"left arm",
"Physical examination reveals",
"palpable",
"supraclavicular",
"decreased grip strength",
"left hand",
"Examination",
"fa... |
A 24-year-old 70 kilogram African-American man with epilepsy refractory to valproic acid, phenytoin, and levetiracetam undergoes magnetic resonance imaging of his brain under monitored anesthetic care. He wakes up screaming in pain due to an electrocardiogram lead having caused a significant thermal burn circumferentia... | Escharotomy | {
"A": "Amputation",
"B": "Escharotomy",
"C": "Fasciotomy",
"D": "Transfer to burn center"
} | step2&3 | B | [
"year old 70 kilogram African-American man",
"epilepsy refractory",
"valproic acid",
"phenytoin",
"levetiracetam",
"magnetic resonance imaging",
"brain",
"monitored anesthetic care",
"wakes up screaming",
"pain due to",
"electrocardiogram lead",
"caused",
"significant thermal burn",
"left ... |
A 60-year-old African American woman presents to her ophthalmologist with blurry vision. She reports a 2-month history of decreased vision primarily affecting her right eye. Her past medical history is notable for type 1 diabetes and hypertension. She takes insulin and enalapril. She has a 40-pack-year smoking history ... | Optic nerve | {
"A": "Ciliary ganglion",
"B": "Lateral geniculate nucleus",
"C": "Oculomotor nerve",
"D": "Optic nerve"
} | step1 | D | [
"60 year old African American woman presents",
"ophthalmologist",
"blurry vision",
"reports",
"2 month history",
"decreased vision",
"affecting",
"right eye",
"past medical history",
"notable",
"type 1 diabetes",
"hypertension",
"takes insulin",
"enalapril",
"40 pack-year smoking history... |
A 47-year-old man with a history of diabetes mellitus presents for a primary care visit. His diabetes is well controlled on metformin, with fasting glucose concentrations between 110–150 mg/dl. His blood pressure on multiple office visits are between 115-130/75-85 mmHg. Today his temperature is 98°F (36.7 °C), blood pr... | Enalapril | {
"A": "No effective treatments",
"B": "Enalapril",
"C": "Simvastatin",
"D": "Aspirin"
} | step1 | B | [
"year old man",
"history of diabetes mellitus presents",
"primary care visit",
"diabetes",
"well controlled",
"metformin",
"fasting glucose concentrations",
"mg/dl",
"blood pressure",
"multiple office visits",
"75 85 mmHg",
"Today",
"temperature",
"36",
"blood pressure",
"80 mmHg",
"... |
A 24-year-old woman with a missed menstrual cycle has a positive pregnancy test. The estimated gestational age is 4 weeks. The patient questions the pregnancy test results and mentions that a urinary pregnancy test she took 3 weeks ago was negative. What is the explanation for the patient’s first negative pregnancy tes... | The syncytiotrophoblast had not yet developed to produce human chorionic gonadotropin at that term. | {
"A": "The embryonic liver has not yet developed to produce human chorionic gonadotropin at that term.",
"B": "The syncytiotrophoblast had not yet developed to produce human chorionic gonadotropin at that term.",
"C": "Human chorionic gonadotropin starts to be produced by the uterus only after the embryonic impl... | step2&3 | B | [
"year old woman",
"missed menstrual cycle",
"positive pregnancy test",
"estimated gestational age",
"4 weeks",
"patient questions",
"pregnancy test results",
"urinary pregnancy test",
"took 3 weeks",
"negative",
"explanation",
"patients first negative pregnancy test result"
] |
A 68-year-old man is brought to the emergency department by ambulance after he fainted in the supermarket. He recently had 2 days of gastroenteritis, but did not come to the hospital for treatment. He also recently arrived in Denver for a vacation, but normally lives in Florida. His past medical history is significant ... | Diarrhea | {
"A": "Altitude sickness",
"B": "Diarrhea",
"C": "Ethanol consumption",
"D": "Vomiting"
} | step1 | B | [
"68 year old man",
"brought",
"emergency department",
"ambulance",
"fainted",
"supermarket",
"recently",
"2 days",
"gastroenteritis",
"not",
"hospital",
"treatment",
"recently arrived",
"vacation",
"lives",
"Florida",
"past medical history",
"significant",
"morbid obesity",
"he... |
A 15-year-old boy is brought to the emergency department by his mother because of a 5-hour history of right lower quadrant pain, vomiting, and abdominal distention. Examination shows a palpable mass in the right lower quadrant of the abdomen. An x-ray of the abdomen shows a dilated ascending colon with an air-fluid lev... | Pulmonary infection | {
"A": "Pulmonary embolism",
"B": "Diabetes mellitus",
"C": "Pulmonary infection",
"D": "Nephrolithiasis"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"mother",
"hour history",
"right lower quadrant pain",
"vomiting",
"abdominal distention",
"Examination shows",
"palpable mass",
"right lower quadrant of",
"abdomen",
"x-ray of",
"abdomen shows",
"dilated ascending colon",
"air-fluid l... |
An 8-year-old boy is brought by his mother to his pediatrician because his urine is tea-colored and his face has appeared puffy for the past 2 days. He suffered a fever and sore throat several weeks ago that was treated with ibuprofen. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to... | Immune complex deposition | {
"A": "Diffuse mesangial IgA deposition",
"B": "Immune complex deposition",
"C": "Complement-dependent antibody reaction",
"D": "Complement-independent reaction"
} | step2&3 | B | [
"year old boy",
"brought",
"mother",
"pediatrician",
"urine",
"tea colored",
"face",
"appeared puffy",
"past 2 days",
"suffered",
"fever",
"sore throat",
"weeks",
"treated with ibuprofen",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"... |
A 39-year-old man presents to his primary care physician with new onset lower extremity edema, fatigue, and hematuria. His symptoms began approximately 2 weeks prior to presentation and have progressively worsened. Medical history is significant for opioid-use disorder with heroin treated with methadone. He is in a mon... | Diffuse mesangial cell proliferation with capillary wall thickening | {
"A": "Apple-green birefringence on Congo red stain",
"B": "Diffuse mesangial cell proliferation with capillary wall thickening",
"C": "Glomerular basement membrane thinning and splitting",
"D": "Normal appearing glomerulus"
} | step2&3 | B | [
"year old man presents",
"primary care physician",
"new onset lower extremity edema",
"fatigue",
"hematuria",
"symptoms began approximately 2 weeks prior to presentation",
"worsened",
"Medical history",
"significant",
"opioid-use disorder",
"heroin treated with methadone",
"monogamous relation... |
A 16-year-old boy presents after suffering a tonic-clonic seizure. He says it had a duration of 2 minutes and a postictal period of 10 minutes. Patient denies any similar episodes in the past. Past medical history is unremarkable. Family history is significant for his mother and older brother who died of colorectal can... | Turcot syndrome | {
"A": "Lynch syndrome",
"B": "Gardner syndrome",
"C": "Turcot syndrome",
"D": "Cowden syndrome"
} | step1 | C | [
"year old boy presents",
"suffering",
"tonic-clonic seizure",
"duration",
"minutes",
"period",
"10 minutes",
"Patient denies",
"similar episodes",
"past",
"medical history",
"unremarkable",
"Family history",
"significant",
"mother",
"older brother",
"died",
"colorectal cancer",
"... |
A 2-day-old boy fails to pass meconium for the first 48 hours of life. He was born at term to a healthy 19-year-old woman after an uncomplicated pregnancy. At birth, his weight was 3.9 kg (8.6 lb); at the time of presentation, he weighs 3.8 kg (8.4 lb). His vital signs are as follows: blood pressure 70/50 mm Hg, heart ... | Failure of neural crest cells to migrate caudally to intestinal wall during embryogenesis | {
"A": "Failure of neural crest cells to migrate caudally to intestinal wall during embryogenesis",
"B": "Disruption of apoptosis of intestinal cells",
"C": "Propelling of a polyp distally by peristalsis",
"D": "Decreased blood supply to developing intestine in the embryonic period"
} | step1 | A | [
"2-day old boy fails to pass meconium",
"first 48 hours",
"life",
"born",
"term",
"healthy",
"year old woman",
"uncomplicated",
"birth",
"weight",
"3.9 kg",
"8.6",
"time",
"presentation",
"3",
"kg",
"8.4",
"vital signs",
"follows",
"blood pressure 70 50 mm Hg",
"heart rate",
... |
A 34-year-old woman with a past medical history of obesity and longstanding GERD presents to the emergency room with chest pain. She describes the pain as central with a sensation of something being stuck in her chest, and this is the third episode in the last month. The prior two incidents occurred at the gym while sh... | Esophageal manometry | {
"A": "Endoscopy",
"B": "Esophageal manometry",
"C": "EKG",
"D": "Troponin I"
} | step2&3 | B | [
"year old woman",
"past medical",
"GERD presents",
"emergency room",
"chest pain",
"pain",
"central",
"sensation",
"stuck",
"chest",
"third episode",
"month",
"prior two incidents occurred",
"drinking",
"sport drink",
"resolved",
"resting",
"minutes",
"episode started",
"receiv... |
A 35-year-old man comes to the physician because of several episodes of crushing substernal chest pain on exertion over the past 6 weeks. The pain occurs when he goes for his morning run and disappears if he slows down to a walk. The patient is concerned because two of his uncles died of myocardial infarction in their ... | Defective apolipoprotein E
" | {
"A": "Hepatic overproduction of VLDL",
"B": "Defective apolipoprotein B-100",
"C": "Decreased apolipoprotein C-II",
"D": "Defective apolipoprotein E\n\""
} | step1 | D | [
"35 year old man",
"physician",
"of several episodes",
"crushing substernal chest pain",
"exertion",
"past",
"weeks",
"pain occurs",
"goes",
"morning run",
"slows",
"walk",
"patient",
"concerned",
"two",
"uncles died",
"myocardial infarction",
"early",
"Physical examination shows... |
A 35-year-old woman comes to the physician because of a 2-month history of vaginal bleeding after intercourse. Menarche occurred at the age of 13 years and menses occur at regular 28-day intervals. Gynecologic examination shows an irregular lesion at the cervical os. Histological evaluation of a cervical biopsy specime... | Non-keratinized stratified squamous epithelium | {
"A": "Ciliated simple columnar epithelium",
"B": "Non-keratinized stratified squamous epithelium",
"C": "Simple cuboidal epithelium",
"D": "Keratinized stratified squamous epithelium"
} | step1 | B | [
"35 year old woman",
"physician",
"2 month history",
"vaginal bleeding",
"intercourse",
"Menarche occurred",
"age",
"years",
"menses occur",
"regular",
"day intervals",
"Gynecologic examination shows",
"irregular lesion",
"cervical",
"Histological evaluation of",
"biopsy specimen obtai... |
A 55-year-old college professor with a long-standing history of neuropathic pain presents to a medical clinic with weight loss and early morning awakening for the past several months. She feels as if she has no energy to go about her work. She complains that she is not as focused at work or home as she used to be and f... | The medication can cause serotonin syndrome. | {
"A": "The medication can cause serotonin syndrome.",
"B": "The medication can cause agranulocytosis.",
"C": "The medication can lower the seizure threshold.",
"D": "This medication is rarely lethal at high doses."
} | step1 | A | [
"55 year old college professor",
"long standing history",
"neuropathic pain presents",
"medical clinic",
"weight loss",
"early morning awakening",
"past",
"months",
"feels",
"energy to go",
"work",
"not",
"focused",
"work",
"home",
"used to",
"finds",
"life",
"work",
"symptoms"... |
A 8-month-old girl is brought to the emergency department because of fever, vomiting, and diarrhea for 3 days. Her parents report at least 10 watery stools daily. She has had three upper respiratory tract infections since she started daycare 2 months ago, but has otherwise been developing normally. Her mother has a his... | Enzyme immunoassay of stool | {
"A": "Sonography of the abdomen",
"B": "Administration of antidiarrheal medication",
"C": "Blood cultures",
"D": "Enzyme immunoassay of stool"
} | step2&3 | D | [
"month old girl",
"brought",
"emergency department",
"fever",
"vomiting",
"diarrhea",
"3 days",
"parents report at least 10 watery stools daily",
"three upper respiratory tract infections",
"started daycare 2 months",
"mother",
"history of",
"disease",
"patient",
"percentile",
"height"... |
A 5-year-old girl is brought to her pediatrician for vaccinations and a physical. She is a generally healthy child with no thumb on her right hand and a shortened and deformed left thumb. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and meeting all developmental ... | Holt-Oram syndrome | {
"A": "Alagille syndrome",
"B": "Holt-Oram syndrome",
"C": "Marfan syndrome",
"D": "Williams-Beuren syndrome"
} | step2&3 | B | [
"5 year old girl",
"brought",
"pediatrician",
"vaccinations",
"physical",
"healthy child",
"thumb",
"right hand",
"shortened",
"deformed left thumb",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"physical exam... |
A 23-year-old woman presents to the emergency department with pain and frequent urination. She states she has felt uncomfortable with frequent small-volume urinary voids for the past 3 days, which have progressively worsened. The patient has no past medical history. She currently smokes 1 pack of cigarettes per day and... | Levofloxacin and outpatient followup | {
"A": "Abscess drainage and IV antibiotics",
"B": "Ceftriaxone and hospital admission",
"C": "Levofloxacin and outpatient followup",
"D": "Nitrofurantoin"
} | step2&3 | C | [
"23 year old woman presents",
"emergency department",
"pain",
"frequent urination",
"states",
"felt",
"frequent small volume urinary voids",
"past",
"days",
"worsened",
"patient",
"past medical history",
"currently smokes 1 pack",
"cigarettes",
"day",
"unprotected sex",
"2 male partn... |
A 37-year-old woman presents to the occupational health clinic for a new employee health screening. She has limited medical records prior to her immigration to the United States several years ago. She denies any current illness or significant medical history. Purified protein derivative (PPD) is injected on the inside ... | Type IV–cell-mediated (delayed) hypersensitivity reaction | {
"A": "Type I–anaphylactic hypersensitivity reaction",
"B": "Type II–cytotoxic hypersensitivity reaction",
"C": "Type IV–cell-mediated (delayed) hypersensitivity reaction",
"D": "Type III and IV–mixed immune complex and cell-mediated hypersensitivity reactions"
} | step2&3 | C | [
"year old woman presents",
"occupational health clinic",
"new employee",
"limited medical records prior to",
"immigration",
"United States",
"years",
"denies",
"current illness",
"significant medical history",
"Purified protein derivative",
"injected",
"left forearm",
"tuberculosis",
"sc... |
A 32-year-old HIV positive female known to be non-adherent to her treatment regimen, presents to the hospital with the complaint of new-onset headaches. Her vital signs are only significant for a low-grade fever. Neurological examination reveals right-sided upper motor neuron signs, as well as a inattention and difficu... | Begin treatment with pyrimethamine-sulfadiazine | {
"A": "Perform a biopsy of the lesion",
"B": "Perform an analysis for 14-3-3 protein levels",
"C": "Begin treatment with pyrimethamine-sulfadiazine",
"D": "Begin treatment with acyclovir"
} | step2&3 | C | [
"year old HIV positive female known to",
"non",
"treatment regimen",
"presents",
"hospital",
"complaint",
"new-onset headaches",
"vital signs",
"only significant",
"low-grade fever",
"Neurological examination reveals right-sided upper motor neuron signs",
"inattention",
"difficulty",
"conc... |
A 29-year-old woman, gravida 1, para 1, comes to the physician because of difficulty conceiving for one year. She is sexually active with her husband 4–5 times a week. Pregnancy and delivery of her first child 3 years ago were uncomplicated. She returned to work as an event coordinator 12 months ago and has found the t... | Offer pulsatile gonadotropin-releasing hormone therapy | {
"A": "Offer clomiphene citrate therapy",
"B": "Offer in vitro fertilization",
"C": "Offer pulsatile gonadotropin-releasing hormone therapy",
"D": "Offer human chorionic gonadotropin therapy"
} | step2&3 | C | [
"29 year old woman",
"gravida 1",
"para 1",
"physician",
"difficulty conceiving",
"one year",
"sexually active",
"husband",
"times",
"week",
"Pregnancy",
"delivery",
"first child 3 years",
"uncomplicated",
"returned to work",
"event coordinator 12 months",
"found",
"transition stre... |
A neonate is noted to have very light skin, light blue eyes, and sparse blonde-white hair. The family states that the baby is much lighter in appearance than anyone else in the family. Both parents are Fitzpatrick skin type III with dark brown hair. On further exam, the baby's temperature is 98.4°F (36.9°C), blood pres... | Dihydroxyphenylalanine | {
"A": "Dihydroxyphenylalanine",
"B": "Dopamine",
"C": "Homogentisic Acid",
"D": "Tetrahydrobiopterin"
} | step1 | A | [
"neonate",
"noted to",
"very light skin",
"light",
"white hair",
"family states",
"baby",
"much lighter",
"appearance",
"else",
"family",
"parents",
"Fitzpatrick skin type III",
"dark brown hair",
"further exam",
"baby's temperature",
"98 4F",
"36",
"blood pressure",
"70 mmHg",... |
A 2-year-old girl is brought to the emergency room by her parents for seizure-like activity earlier today. Her mother describes that she was napping when both of her arms began to twitch and she started foaming at the mouth. She was unresponsive during this time and the episode lasted a total of 30 seconds. The mother ... | Medium-chain acyl-CoA dehydrogenase deficiency | {
"A": "Accumulation of sphingomyelin",
"B": "Defieincy of myophosphorylase",
"C": "Medium-chain acyl-CoA dehydrogenase deficiency",
"D": "Primary carnitine deficiency"
} | step1 | C | [
"2 year old girl",
"brought",
"emergency room",
"parents",
"seizure",
"activity earlier today",
"mother",
"napping",
"arms began to twitch",
"started foaming at",
"mouth",
"unresponsive",
"time",
"episode lasted",
"total",
"30 seconds",
"mother denies",
"fever",
"pain",
"recent... |
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