question stringlengths 66 3.58k | answer stringlengths 1 230 | options dict | meta_info stringclasses 2
values | answer_idx stringclasses 4
values | metamap_phrases listlengths 1 184 |
|---|---|---|---|---|---|
A 23-year-old man is brought to the emergency department by a coworker for an injury sustained at work. He works in construction and accidentally shot himself in the chest with a nail gun. Physical examination shows a bleeding wound in the left hemithorax at the level of the 4th intercostal space at the midclavicular l... | Left upper lobe of the lung | {
"A": "Right atrium of the heart",
"B": "Superior vena cava",
"C": "Inferior vena cava",
"D": "Left upper lobe of the lung"
} | step1 | D | [
"23 year old man",
"brought",
"emergency department",
"coworker",
"injury sustained",
"work",
"works",
"construction",
"shot",
"chest",
"nail gun",
"Physical examination shows",
"bleeding wound",
"left hemithorax",
"level",
"4th intercostal space",
"midclavicular line",
"following ... |
A 23-year-old woman presents to her primary care physician due to amenorrhea. The patient states that historically she has her period once every three months but recently has not had it at all. Otherwise, she has no other complaints. The patient recently started college and is a varsity athlete for the track team. She ... | Osteoporosis | {
"A": "Endometrial cancer",
"B": "Infertility",
"C": "Osteoarthritis",
"D": "Osteoporosis"
} | step2&3 | D | [
"23 year old woman presents",
"primary care physician",
"amenorrhea",
"patient states",
"period",
"three months",
"recently",
"not",
"complaints",
"patient recently started college",
"athlete",
"track team",
"works part time",
"coffee shop",
"well",
"school",
"patient",
"not sexual... |
A 40-year-old man who was previously antisocial, low energy at work, and not keen to attend office parties was arrested and brought to the emergency department after he showed up to the office Christmas party out of control. He was noted to be very energetic and irritable. He spent the entire evening hijacking conversa... | Irresponsibility | {
"A": "Irresponsibility",
"B": "Patient completing numerous outstanding projects",
"C": "Rapid but interruptible speech pattern",
"D": "Patient is unlikely to have a major depressive episode"
} | step1 | A | [
"40 year old man",
"antisocial",
"low energy",
"work",
"not keen to attend office parties",
"arrested",
"brought",
"emergency department",
"showed",
"office",
"party",
"control",
"noted to",
"very energetic",
"irritable",
"spent",
"entire evening",
"conversations",
"sharing",
"... |
A 70-year-old man is at his dermatologist’s office for the treatment of a severely pruritic erythroderma with scaling on his buttocks that has been slowly progressing over the past two weeks. The patient works as a truck driver and has a history of hypertension treated with enalapril. The patient reports having tried a... | Mycosis fungoides | {
"A": "Psoriasis",
"B": "Linchen planus",
"C": "Atopic dermatitis",
"D": "Mycosis fungoides"
} | step1 | D | [
"70 year old man",
"dermatologists office",
"treatment",
"severely",
"erythroderma",
"scaling",
"buttocks",
"slowly progressing",
"past two weeks",
"patient works",
"truck driver",
"history of hypertension treated with enalapril",
"patient reports",
"over-the-counter cream",
"rash",
"i... |
A 31-year-old G6P6 woman with a history of fibroids gives birth to twins via vaginal delivery. Her pregnancy was uneventful, and she reported having good prenatal care. Both placentas are delivered immediately after the birth. The patient continues to bleed significantly over the next 20 minutes. Her temperature is 97.... | Bimanual massage | {
"A": "Bimanual massage",
"B": "Blood product transfusion",
"C": "Hysterectomy",
"D": "Uterine artery embolization"
} | step2&3 | A | [
"31 year old",
"woman",
"history",
"fibroids gives birth",
"twins",
"vaginal delivery",
"pregnancy",
"reported",
"good prenatal care",
"placentas",
"delivered immediately",
"birth",
"patient continues to bleed",
"next 20 minutes",
"temperature",
"97",
"36",
"blood pressure",
"84 ... |
A 13-year-old boy is brought to the pediatrician by his parents who are concerned about his short stature. He also has had recurrent episodes of diarrhea. Past medical history is significant for iron deficiency anemia diagnosed 6 months ago. Physical examination is unremarkable except that he is in the 9th percentile f... | Blunting of the intestinal villi | {
"A": "Blunting of the intestinal villi",
"B": "Granulomas extending through the layers of the intestinal wall",
"C": "Crypt aplasia",
"D": "Cuboidal appearance of basal epithelial cells"
} | step1 | A | [
"year old boy",
"brought",
"pediatrician",
"parents",
"concerned",
"short stature",
"recurrent episodes of diarrhea",
"Past medical history",
"significant",
"iron deficiency anemia diagnosed",
"months",
"Physical examination",
"unremarkable except",
"percentile",
"height",
"Serum anti ... |
An 11-year-old girl is brought into the clinic by her parents, who are distraught over her behavior. They state that over the past several months she has started to act oddly, combing the hair of her toy dolls for hours without stopping and repetitively counting her steps in the house. She is often brought to tears whe... | Obsessive compulsive disorder (OCD) | {
"A": "Autism spectrum disorder (ASD)",
"B": "Generalized anxiety disorder (GAD)",
"C": "Obsessive compulsive disorder (OCD)",
"D": "Tourette's syndrome"
} | step2&3 | C | [
"year old girl",
"brought",
"clinic",
"parents",
"behavior",
"state",
"past",
"months",
"started to act",
"combing",
"hair",
"toy",
"hours",
"stopping",
"counting",
"steps",
"house",
"often brought",
"tears",
"behaviors",
"patient",
"past medical history",
"questioned",
... |
A 46-year-old man accountant is admitted to the emergency department with complaints of retrosternal crushing pain that radiates to his left arm and jaw. The medical history is significant for hyperlipidemia and arterial hypertension, for which he is prescribed a statin and ACE inhibitor, respectively. An ECG is obtain... | Myocardial stunning | {
"A": "Coronary steal syndrome",
"B": "Reperfusion injury",
"C": "Myocardial stunning",
"D": "Coronary collateral circulation"
} | step1 | C | [
"year old man accountant",
"admitted",
"emergency department",
"complaints",
"retrosternal crushing",
"radiates",
"left arm",
"jaw",
"medical history",
"significant",
"hyperlipidemia",
"arterial hypertension",
"prescribed",
"statin",
"ACE inhibitor",
"ECG",
"obtained",
"shows",
"... |
A 27-year-old woman, primigravida, gave birth to a boy 3 months ago and now presents the newborn to your clinic for evaluation. She did not receive prenatal care. She reports that she was taking a medication for her mood swings, but cannot remember the medication’s name. The baby was born cyanotic, with a congenital ma... | Lithium | {
"A": "Buspirone",
"B": "Clozapine",
"C": "Lithium",
"D": "Enalapril"
} | step1 | C | [
"27 year old woman",
"primigravida",
"gave birth",
"boy",
"months",
"now presents",
"newborn",
"clinic",
"evaluation",
"not receive prenatal care",
"reports",
"taking",
"medication",
"mood swings",
"remember",
"medications name",
"baby",
"born cyanotic",
"congenital malformation"... |
An investigator is studying gene expression in a mouse model. She inactivates the assembly of small nuclear ribonucleoproteins (snRNPs) in motor nerve cells. Which of the following processes is most likely to be affected as a result? | Removal of introns | {
"A": "Aminoacylation of tRNA",
"B": "Activity of 3′ to 5′ proofreading",
"C": "Unwinding of DNA strands",
"D": "Removal of introns"
} | step1 | D | [
"investigator",
"studying gene expression",
"mouse model",
"assembly",
"small nuclear ribonucleoproteins",
"motor nerve cells",
"following processes",
"most likely to",
"affected",
"result"
] |
A 29-year-old woman comes to the physician for evaluation of a mass in the left breast that she first noticed 2 weeks ago. During this period, the mass has not increased in size and the patient has had no pain. Three months ago, she hit her left chest against the closet door, which was painful for a day. Menses occurs ... | Fibroadenoma | {
"A": "Phyllodes tumor",
"B": "Fibrocystic changes of the breast",
"C": "Fibroadenoma",
"D": "Fat necrosis"
} | step2&3 | C | [
"29 year old woman",
"physician",
"evaluation",
"mass",
"left breast",
"first",
"2 weeks",
"period",
"mass",
"not increased in size",
"patient",
"pain",
"Three months",
"hit",
"left chest",
"door",
"painful",
"day",
"Menses occurs",
"regular",
"day intervals",
"last",
"5 ... |
A 70 year-old man comes to the physician for difficulty swallowing for 6 months. During this time, he has occasionally coughed up undigested food. He did not have weight loss or fever. Four weeks ago, he had an episode of sore throat, that resolved spontaneously. He has smoked one pack of cigarettes daily for 5 years. ... | Abnormal esophageal motor function | {
"A": "Deep neck space infection",
"B": "Degeneration of neurons in the esophageal wall",
"C": "Cellular dysplasia",
"D": "Abnormal esophageal motor function"
} | step2&3 | D | [
"70 year old man",
"physician",
"difficulty swallowing",
"months",
"time",
"occasionally coughed",
"undigested food",
"not",
"weight loss",
"fever",
"Four weeks",
"episode of sore throat",
"resolved",
"smoked one pack",
"cigarettes daily",
"5 years",
"gastroesophageal reflux disease"... |
A bacterial isolate obtained from a hospitalized patient is found to be resistant to amikacin. The isolated bacteria most likely has which of the following characteristics? | Enhanced ability to transfer acetyl groups | {
"A": "DNA topoisomerase II mutation",
"B": "Low-affinity penicillin binding protein",
"C": "Increased drug influx capacity",
"D": "Enhanced ability to transfer acetyl groups"
} | step1 | D | [
"bacterial isolate obtained",
"hospitalized patient",
"found to",
"resistant to amikacin",
"isolated bacteria",
"likely",
"following characteristics"
] |
A 10-year-old boy is brought to the pediatrician by his parents with complaints of short stature with small hands and skin hypopigmentation. A detailed development history reveals that he was born by normal vaginal delivery at full term and his neonatal period was uneventful. Until he was 6 months of age, he was breast... | Paternal inheritance | {
"A": "Maternal inheritance",
"B": "Paternal inheritance",
"C": "Both paternal inheritance and maternal inheritance",
"D": "Nutritional and metabolic in origin"
} | step2&3 | B | [
"A 10 year old boy",
"brought",
"pediatrician",
"parents",
"complaints",
"short stature",
"small hands",
"skin hypopigmentation",
"detailed development history reveals",
"born by normal vaginal delivery",
"full term",
"neonatal period",
"months",
"age",
"breast-fed",
"then solid foods"... |
A 37-year-old woman is brought to the physician for worsening depressive mood and irritability. Her mood changes began several months ago. Her husband has also noticed shaky movements of her limbs and trunk for the past year. The patient has no suicidal ideation. She has no history of serious illness and takes no medic... | Caudate nucleus atrophy on MRI | {
"A": "Mitral vegetations on echocardiogram",
"B": "Positive Babinski sign on physical examination",
"C": "Oligoclonal bands on lumbar puncture",
"D": "Caudate nucleus atrophy on MRI"
} | step2&3 | D | [
"year old woman",
"brought",
"physician",
"worsening",
"mood",
"irritability",
"mood changes began several months",
"husband",
"shaky movements",
"limbs",
"trunk",
"past year",
"patient",
"suicidal ideation",
"history",
"serious illness",
"takes",
"medications",
"father died",
... |
A 55-year-old man presents to his primary care physician for a regular check-up. The patient was born in Germany in 1960 in with shortened limbs, underdeveloped digits, absent external ears, and a cleft palate. He is currently in a wheelchair. His past medical history is also notable for hypertension and allergies. He ... | Multiple myeloma | {
"A": "Acne vulgaris",
"B": "Deep venous thrombosis",
"C": "Multiple myeloma",
"D": "Recurrent miscarriage"
} | step1 | C | [
"55 year old man presents",
"primary care physician",
"regular check-up",
"patient",
"born in Germany",
"shortened limbs",
"digits",
"absent external",
"cleft palate",
"currently",
"wheelchair",
"past medical history",
"notable",
"hypertension",
"allergies",
"takes lisinopril daily",
... |
A 29-year-old woman presents to her gynecologist because of chronic pelvic pain that she has been experiencing for the last 6 months. Specifically, she says that she has severe pain during menstruation that is localized primarily to her lower abdomen and pelvis. In addition, she has been having pain while defecating an... | CA-125 | {
"A": "Beta-hCG",
"B": "Bombesin",
"C": "CA-125",
"D": "CA-19-9"
} | step1 | C | [
"29 year old woman presents",
"gynecologist",
"chronic pelvic pain",
"experiencing",
"months",
"severe",
"menstruation",
"localized",
"lower abdomen",
"pelvis",
"addition",
"pain",
"intercourse",
"past surgical history",
"past medical history",
"significant",
"asthma",
"uses protec... |
A 70-year-old man presented to the emergency department complaining of left-sided weakness for the past 5 hours. Past medical history is significant for a previous ischemic stroke involving the right posterior cerebral artery and left-sided homonymous hemianopia. He also has a history of type-II diabetes mellitus and h... | Add dipyridamole | {
"A": "Add dipyridamole",
"B": "Increase aspirin to 325 mg",
"C": "Administer tPA",
"D": "Stop aspirin and start warfarin"
} | step2&3 | A | [
"70 year old man presented",
"emergency department",
"left-sided weakness",
"past",
"hours",
"medical history",
"significant",
"previous ischemic stroke involving",
"right posterior cerebral artery",
"left sided homonymous hemianopia",
"history of type-II diabetes mellitus",
"hypertension",
... |
A 34-year-old primigravid woman comes to the physician for a prenatal visit at 37-weeks' gestation because of worsening back pain for 3 weeks. The pain is worse with extended periods of walking, standing, and sitting. She has not had any changes in bowel movements or urination. Her mother has rheumatoid arthritis. Exam... | Relaxation of the pelvic girdle ligaments | {
"A": "Vertebral bone compression fracture",
"B": "Placental abruption",
"C": "Relaxation of the pelvic girdle ligaments",
"D": "Rheumatoid arthritis"
} | step2&3 | C | [
"year old primigravid woman",
"physician",
"prenatal visit",
"weeks",
"gestation",
"of worsening back pain",
"weeks",
"pain",
"worse",
"extended periods",
"walking",
"standing",
"sitting",
"not",
"changes in bowel movements",
"urination",
"mother",
"rheumatoid arthritis",
"Examin... |
An investigator studying immune response administers a 0.5 mL intradermal injection of an autoclaved microorganism to a study volunteer. Four weeks later, there is a 12-mm, indurated, hypopigmented patch over the site of injection. Which of the following is the most likely explanation for the observed skin finding? | Increased activity of CD4+ Th1 cells | {
"A": "Increased antibody production by B cells",
"B": "Increased activity of neutrophils",
"C": "Increased activity of CD4+ Th1 cells",
"D": "Increased release of transforming growth factor beta"
} | step1 | C | [
"investigator studying immune response administers",
"0.5 mL intradermal injection",
"autoclaved microorganism",
"study volunteer",
"Four weeks later",
"mm",
"indurated",
"hypopigmented patch",
"site of injection",
"following",
"most likely explanation",
"observed skin finding"
] |
A 37-year-old woman comes to the physician because of oligomenorrhea and intermittent vaginal spotting for 5 months. Menses previously occurred at regular 28-day intervals and lasted for 5 days with normal flow. She has also noted increased hair growth on her chin. She is not sexually active. She takes no medications. ... | Sertoli-Leydig cell tumor | {
"A": "Ovarian thecoma",
"B": "Dermoid cyst",
"C": "Ovarian dysgerminoma",
"D": "Sertoli-Leydig cell tumor"
} | step1 | D | [
"year old woman",
"physician",
"oligomenorrhea",
"intermittent vaginal spotting",
"months",
"Menses",
"occurred",
"regular",
"day intervals",
"lasted",
"5 days",
"normal flow",
"noted increased hair growth",
"chin",
"not sexually active",
"takes",
"medications",
"Physical examinati... |
A 9-year-old girl presents to the emergency department with a fever and a change in her behavior. She presented with similar symptoms 6 weeks ago and was treated for an Escherchia coli infection. She also was treated for a urinary tract infection 10 weeks ago. Her mother says that last night her daughter felt ill and h... | Intentional contamination | {
"A": "Intentional contamination",
"B": "Meningitis",
"C": "Sepsis",
"D": "Urinary tract infection"
} | step2&3 | A | [
"year old girl presents",
"emergency department",
"fever",
"change in",
"behavior",
"presented",
"similar symptoms",
"weeks",
"treated",
"infection",
"treated",
"urinary tract infection 10 weeks",
"mother",
"last night",
"daughter felt ill",
"condition",
"worsening",
"daughter expe... |
A 35-year-old woman comes to your office with a variety of complaints. As part of her evaluation, she undergoes laboratory testing which reveals the presence of anti-centromere antibodies. All of the following symptoms and signs would be expected to be present EXCEPT: | Hypercoagulable state | {
"A": "Pallor, cyanosis, and erythema of the hands",
"B": "Blanching vascular abnormalities",
"C": "Hypercoagulable state",
"D": "Heartburn and regurgitation"
} | step1 | C | [
"35 year old woman",
"office",
"variety",
"complaints",
"part of",
"evaluation",
"laboratory testing",
"reveals",
"presence",
"anti-centromere antibodies",
"following symptoms",
"signs",
"expected to",
"present"
] |
A 46-year-old woman comes to the physician for a 6-month history of worsening bronchial asthma control. Before this issue began, she only used her salbutamol inhaler once a day. Now, she has to use it multiple times daily and also reports frequent nighttime awakening. Seven months ago, she moved to an apartment that is... | Interferon-γ | {
"A": "Tryptase",
"B": "Interleukin-10",
"C": "Interferon-γ",
"D": "Superoxide anion\n\""
} | step1 | C | [
"year old woman",
"physician",
"month history of worsening bronchial asthma control",
"issue began",
"only used",
"salbutamol inhaler",
"day",
"Now",
"to use",
"multiple times daily",
"reports frequent nighttime awakening",
"Seven months",
"moved to",
"apartment",
"damp",
"mold",
"wa... |
A 31-year-old, G1P0 woman at 35 weeks of gestation comes to the emergency room for a severe headache. She reports that she was washing the dishes 2 hours ago when a dull headache came on and progressively worsened. She also reports 2 episodes of intermittent blurred vision over the past hour that has since cleared. Not... | Abnormal placental spiral arteries | {
"A": "Abnormal placental spiral arteries",
"B": "Premature separation of the placenta from the uterine wall",
"C": "Production of pathogenic autoantibodies and tissue injury",
"D": "Rupture of an aneurysm"
} | step1 | A | [
"31 year old",
"woman",
"35 weeks of gestation",
"emergency room",
"severe headache",
"reports",
"washing",
"dishes",
"hours",
"dull headache",
"worsened",
"reports 2 episodes of intermittent blurred vision",
"past hour",
"since cleared",
"similar",
"happened before",
"denies",
"pr... |
A 43-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was a restrained passenger. On arrival, he has shortness of breath and is in severe pain. His pulse is 130/min, respirations are 35/min, and blood pressure is 90/40 mm Hg. Examina... | Flail chest | {
"A": "Phrenic nerve paralysis",
"B": "Cardiac tamponade",
"C": "Sternal fracture",
"D": "Flail chest"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"minutes",
"involved",
"high speed motor vehicle collision",
"restrained passenger",
"arrival",
"shortness of breath",
"severe pain",
"pulse",
"min",
"respirations",
"35 min",
"blood pressure",
"90 40 mm Hg",
"Examination shows super... |
A 66-year-old man presents to the emergency room with blurred vision, lightheadedness, and chest pain that started 30 minutes ago. The patient is awake and alert. His history is significant for uncontrolled hypertension, coronary artery disease, and he previously underwent percutaneous coronary intervention. He is afeb... | Cyanide poisoning | {
"A": "Cyanide poisoning",
"B": "Status asthmaticus",
"C": "Intractable headache",
"D": "Increased intraocular pressure"
} | step1 | A | [
"66 year old man presents",
"emergency room",
"blurred vision",
"lightheadedness",
"chest pain",
"started 30 minutes",
"patient",
"awake",
"alert",
"history",
"significant",
"uncontrolled hypertension",
"coronary artery disease",
"percutaneous coronary intervention",
"afebrile",
"heart... |
A 75-year-old man is brought to the emergency department because of a 5-hour history of worsening chest pain and dyspnea. Six days ago, he fell in the shower and since then has had mild pain in his left chest. He appears pale and anxious. His temperature is 36.5°C (97.7°F), pulse is 108/min, respirations are 30/min, an... | Chest tube insertion in the fifth intercostal space at the midaxillary line
" | {
"A": "Admission to the ICU and observation",
"B": "Needle thoracentesis in the eighth intercostal space at the posterior axillary line",
"C": "Pericardiocentesis",
"D": "Chest tube insertion in the fifth intercostal space at the midaxillary line\n\""
} | step2&3 | D | [
"75 year old man",
"brought",
"emergency department",
"of",
"5 hour history",
"worsening chest pain",
"dyspnea",
"Six days",
"fell in",
"shower",
"since then",
"mild pain in",
"left chest",
"appears pale",
"anxious",
"temperature",
"36",
"97",
"pulse",
"min",
"respirations",
... |
A 36-year-old woman comes to the physician because of growths around her anus that developed over the past 4 weeks. They are not painful and she does not have blood in her stool. She is sexually active with two male partners and uses condoms inconsistently. She appears healthy. Vital signs are within normal limits. Exa... | Human papilloma virus | {
"A": "Poxvirus",
"B": "Treponema pallidum",
"C": "Benign fibroepithelial growth",
"D": "Human papilloma virus"
} | step2&3 | D | [
"36 year old woman",
"physician",
"of growths",
"anus",
"past 4 weeks",
"not painful",
"not",
"blood in",
"stool",
"sexually active",
"two male partners",
"uses condoms",
"appears healthy",
"Vital signs",
"normal limits",
"Examination shows nontender",
"irregular",
"hyperkeratotic ... |
A 26-year-old woman comes to the physician because of intermittent episodes of cramping lower abdominal pain and bloating over the past 3 months. These episodes are often associated with non-bloody, watery, frothy stools, and excessive flatulence. The cramping does not subside after defecation. She reports that her sym... | Hydrogen breath test | {
"A": "Fecal fat test",
"B": "Jejunal biopsy",
"C": "Hydrogen breath test",
"D": "Serum IgE levels"
} | step2&3 | C | [
"year old woman",
"physician",
"of intermittent episodes",
"cramping lower abdominal pain",
"bloating",
"past 3 months",
"episodes",
"often associated with non bloody",
"watery",
"frothy",
"excessive flatulence",
"cramping",
"not",
"defecation",
"reports",
"symptoms",
"begin",
"hou... |
A 56-year-old woman presents with 5-day history of progressively worsening shortness of breath and bilateral pleuritic chest pain. She also has been having associated fatigue, low grade fever, and night sweats. Her temperature is 38.1°C (100.6°F), pulse is 106/min, respiratory rate is 26/min, and blood pressure is 136/... | Infective endocarditis | {
"A": "Infective endocarditis",
"B": "Myocardial infarction",
"C": "Rheumatic fever",
"D": "Small cell lung cancer"
} | step1 | A | [
"year old woman presents",
"5-day history",
"worsening shortness of breath",
"bilateral pleuritic chest pain",
"associated fatigue",
"low grade fever",
"night sweats",
"temperature",
"100",
"pulse",
"min",
"respiratory rate",
"min",
"blood pressure",
"88 mm Hg",
"physical examination",... |
A 78-year-old female presents to her primary care provider complaining of shaking of her hands. She reports that her hands shake when she is pouring her coffee in the morning and when she is buttoning her shirt. She has noticed that her tremor improves with the several beers she has every night with dinner. She has a p... | Asthma | {
"A": "Acute intermittent porphyria",
"B": "Asthma",
"C": "Urinary retention",
"D": "Warfarin use"
} | step2&3 | B | [
"year old female presents",
"primary care provider",
"of shaking",
"hands",
"reports",
"hands shake",
"coffee",
"morning",
"buttoning",
"shirt",
"tremor improves",
"beers",
"night",
"dinner",
"past medical",
"atrial fibrillation",
"moderate persistent",
"acute intermittent porphyri... |
A 34-year-old woman, gravida 1, para 0, at 16 weeks' gestation comes to the physician for a routine prenatal visit. She feels well. She has no history of serious illness. She has smoked one pack of cigarettes daily for 10 years but quit when she learned she was pregnant. She does not drink alcohol or use illicit drugs.... | Amniocentesis | {
"A": "Cell-free fetal DNA testing",
"B": "Amniocentesis",
"C": "Chorionic villus sampling",
"D": "Pelvic ultrasound"
} | step2&3 | B | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"estation ",
"hysician ",
"outine renatal visit.",
"eels ell.",
"istory ",
"erious llness.",
"moked ne ack ",
"igarettes aily ",
"0 years ",
"uit ",
"earned ",
"regnant.",
"ot rink lcohol ",
"se llicit ",
"other ",
"ype... |
A 55-year-old black male otherwise healthy presents for a yearly physical. No significant past medical history. Current medications are a multivitamin and rosuvastatin 20 mg orally daily. Vitals are temperature 37°C (98.6°F), blood pressure 155/75 mm Hg, pulse 95/min, respirations 16/min, and oxygen saturation 99% on r... | Admit to hospital for aortic valve replacement | {
"A": "Reassurance and recommend long-term follow-up with outpatient cardiology for clinical surveillance with regular echocardiography",
"B": "Outpatient management on nifedipine 45 mg orally daily",
"C": "Outpatient management on enalapril 10 mg orally twice daily",
"D": "Admit to hospital for aortic valve r... | step2&3 | D | [
"55 year old black male",
"healthy presents",
"yearly physical",
"significant past medical history",
"Current medications",
"multivitamin",
"rosuvastatin 20 mg orally daily",
"temperature",
"98",
"blood pressure",
"75 mm Hg",
"pulse 95 min",
"respirations",
"min",
"oxygen 99",
"room ai... |
A 44-year-old woman presents to the outpatient infectious disease clinic. She has a known history of HIV, well-controlled on HAART for the past 8 years. She currently has no additional significant medical conditions. She feels well and a physical examination is within normal limits. She denies any current tobacco use, ... | Kaposi’s sarcoma | {
"A": "Colonic adenocarcinoma",
"B": "Kaposi’s sarcoma",
"C": "Thymomas",
"D": "Malignant melanoma"
} | step2&3 | B | [
"year old woman presents",
"outpatient infectious disease clinic",
"known history",
"HIV",
"well-controlled",
"HAART",
"past",
"years",
"currently",
"additional significant medical conditions",
"feels well",
"physical examination",
"normal limits",
"denies",
"current tobacco use",
"alc... |
A 13-year-old boy presents to the emergency department with severe right-lower-quadrant abdominal pain. Workup reveals acute appendicitis, and he subsequently undergoes laparoscopic appendectomy. The appendix is sent for histological examination. A pathologist reviews the slide shown in the image below. Which statement... | In children, appendicitis can frequently arise from certain changes in these structures. | {
"A": "In children, appendicitis can frequently arise from certain changes in these structures.",
"B": "Neutrophils are the major components of these structures.",
"C": "These structures are not normally present within the appendix.",
"D": "These structures belong to the primary lymphatic system."
} | step1 | A | [
"year old boy presents",
"emergency department",
"severe right-lower-quadrant abdominal pain",
"Workup reveals acute appendicitis",
"laparoscopic appendectomy",
"appendix",
"sent",
"histological examination",
"pathologist reviews",
"slide shown",
"image",
"statement",
"structures marked",
... |
A 21-year-old female college student is brought to the university clinic by her roommates. They became worried because they noted long strands of hair all over the dormitory room floor. This has progressively worsened, with the midterms approaching. During discussions with the physician, the roommates also mention that... | Cognitive-behavior therapy or behavior modification | {
"A": "Cognitive-behavior therapy or behavior modification",
"B": "Clomipramine",
"C": "Venlafaxine",
"D": "Electroconvulsive therapy"
} | step1 | A | [
"21-year-old female college student",
"brought",
"university clinic",
"roommates",
"worried",
"noted long strands",
"hair",
"dormitory room floor",
"worsened",
"approaching",
"discussions",
"physician",
"roommates",
"manipulates",
"scalp",
"upset",
"stressed",
"Physical examination... |
A 47-year-old Hispanic man presents with complaints of recent heat intolerance and rapid heart rate. The patient has also experienced recent unintentional weight loss of 15 pounds. Physical exam reveals tachycardia and skin that is warm to the touch. A radioactive iodine uptake scan of the thyroid reveals several focal... | Low TSH and high T4 | {
"A": "High TSH and low T4",
"B": "Low TSH and high T4",
"C": "High TSH and normal T4",
"D": "Low TSH and low T4"
} | step1 | B | [
"year old Hispanic man presents",
"complaints of recent heat intolerance",
"rapid heart rate",
"patient",
"experienced recent unintentional weight loss of",
"pounds",
"Physical exam reveals tachycardia",
"skin",
"warm",
"touch",
"radioactive iodine uptake scan",
"thyroid reveals several focal ... |
A 74-year-old man is brought to the emergency department because of increasing abdominal pain and distention for 3 days. The pain is diffuse and colicky, and he describes it as 4 out of 10 in intensity. His last bowel movement was 5 days ago. He has not undergone any previous abdominal surgeries. He has hypertension, c... | Neostigmine therapy | {
"A": "Percutaneous cecostomy",
"B": "Neostigmine therapy",
"C": "Laparotomy",
"D": "Colonoscopy"
} | step2&3 | B | [
"74 year old man",
"brought",
"emergency department",
"increasing abdominal pain",
"distention",
"3 days",
"pain",
"diffuse",
"colicky",
"4 out",
"10",
"intensity",
"last bowel movement",
"5 days",
"not",
"previous abdominal surgeries",
"hypertension",
"chronic lower back pain",
... |
A 68-year-old man comes to the physician because of a 2-day history of a rash across his trunk and extremities. For the past 3 months, he has had persistent pruritus in these areas. He started hiking in the woods with his grandson last week to try to lose weight. His grandson, who often spends the weekends with him, re... | Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies | {
"A": "Growth of Gram-positive bacteria on blood culture",
"B": "Antibodies to tissue transglutaminase on serologic testing",
"C": "Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies",
"D": "Spongiotic dermatitis on skin biopsy"
} | step2&3 | C | [
"68 year old man",
"physician",
"2-day history",
"rash",
"trunk",
"extremities",
"past 3 months",
"persistent pruritus",
"areas",
"started hiking",
"woods",
"grandson",
"week to",
"to",
"weight",
"grandson",
"often spends",
"weekends",
"recently",
"impetigo",
"hypertension",
... |
A 51-year-old man is undergoing chemotherapy treatment for a rapidly progressive newly-diagnosed acute myelogenous leukemia. On day 4 of his hospitalization, the patient is noted to be obtunded. Other than the chemotherapy, he is receiving lansoprazole, acetaminophen, and an infusion of D5–0.9% normal saline at 50 mL/h... | Calcium chloride | {
"A": "Glucagon",
"B": "Subcutaneous regular insulin",
"C": "Polystyrene sulfonate",
"D": "Calcium chloride"
} | step2&3 | D | [
"year old man",
"chemotherapy treatment",
"rapidly progressive newly diagnosed acute myelogenous leukemia",
"day 4",
"hospitalization",
"patient",
"noted to",
"obtunded",
"chemotherapy",
"receiving lansoprazole",
"acetaminophen",
"infusion",
"normal saline",
"50 mL/h",
"examination",
"... |
A 4-year-old boy is brought to the pediatrician’s office for a flu-like episode. His father tells the physician that his child has fallen ill several times over the past few months. He also has occasional bouts of night sweats and loss of appetite. He has lost 5 lbs (2.3 kg) in the last 6 months. At the pediatrician’s ... | Alzheimer’s disease | {
"A": "Lewy body dementia",
"B": "Alzheimer’s disease",
"C": "Amyotrophic lateral sclerosis",
"D": "Parkinson’s dementia"
} | step2&3 | B | [
"4 year old boy",
"brought",
"pediatricians office",
"flu",
"episode",
"father",
"physician",
"child",
"fallen ill",
"times",
"past",
"months",
"occasional bouts",
"night sweats",
"loss of appetite",
"lost 5 lbs",
"2.3 kg",
"last",
"months",
"pediatricians office",
"temperatu... |
A 21-year-old man comes to the military base physician for evaluation of progressive discomfort in his right shoulder for the past 4 months. He joined the military 6 months ago and is part of a drill team. In anticipation of an upcoming competition, he has been practicing rifle drills and firing exercises 8 hours a day... | Myositis ossificans | {
"A": "Osteoid osteoma",
"B": "Lipoma",
"C": "Acromioclavicular joint separation",
"D": "Myositis ossificans"
} | step1 | D | [
"21-year-old man",
"military base physician",
"evaluation",
"progressive discomfort",
"right shoulder",
"past",
"months",
"military",
"months",
"part of",
"drill team",
"anticipation",
"competition",
"practicing rifle drills",
"firing exercises 8 hours",
"day",
"Physical examination ... |
A 5-year-old girl is brought to the physician by her mother because of a 3-week history of a foul-smelling discharge from the left nostril. There was one episode of blood-tinged fluid draining from the nostril during this period. She has been mouth-breathing in her sleep for the past 4 days. She was born at term. Her 1... | Foreign body extraction | {
"A": "Transnasal puncture and stenting",
"B": "Foreign body extraction",
"C": "Adenoidectomy",
"D": "Intranasal glucocorticoid therapy\n\""
} | step2&3 | B | [
"5 year old girl",
"brought",
"physician",
"mother",
"week history",
"smelling discharge",
"left nostril",
"one episode of blood-tinged fluid draining",
"nostril",
"period",
"mouth-breathing",
"sleep",
"past",
"days",
"born",
"term",
"1-year-old brother",
"treated",
"viral gastro... |
A previously healthy 57-year-old man is brought to the emergency department because of a 3-day history of fever and headache. He also has nausea and vomited twice in the past 24 hours. His temperature is 39.1°C (102.4°F). He is lethargic but oriented to person, place, and time. Examination shows severe neck rigidity wi... | Encapsulated, gram-positive cocci in pairs | {
"A": "Non-encapsulated, gram-negative cocci in pairs",
"B": "Gram-positive cocci in clusters",
"C": "Encapsulated, gram-positive cocci in pairs",
"D": "Gram-positive bacilli"
} | step1 | C | [
"healthy 57 year old man",
"brought",
"emergency department",
"3-day history",
"fever",
"headache",
"nausea",
"vomited twice",
"past 24 hours",
"temperature",
"4F",
"lethargic",
"oriented to person",
"place",
"time",
"Examination shows severe neck rigidity",
"limited active",
"pass... |
A 35-year-old G2P0 presents to her physician to discuss the results of her 16-week obstetric screening tests. She has no complaints. Her previous pregnancy at 28 years of age was a spontaneous abortion in the first trimester. She has no history of gynecologic diseases. Her quadruple test shows the following findings:
A... | Maternal age is a significant risk factor for the condition of the patient, the increased risk of which is indicated by the results of the study. | {
"A": "Such results are associated with a 100% lethal fetal condition.",
"B": "Maternal age is a significant risk factor for the condition of the patient, the increased risk of which is indicated by the results of the study.",
"C": "The obtained results can be normal for women aged 35 and older.",
"D": "The re... | step2&3 | B | [
"35 year old",
"presents",
"physician to discuss",
"results",
"week obstetric screening tests",
"complaints",
"previous pregnancy at",
"years",
"age",
"spontaneous abortion in",
"first trimester",
"history of gynecologic diseases",
"quadruple test shows",
"following findings",
"Alpha-fet... |
A 35-year-old man comes to the clinic complaining of yellow discoloration of his skin and eyes for the past week. He also complains about loss of appetite, nausea, malaise, and severe tiredness. He has no known past medical history and takes over-the-counter acetaminophen for headache. He has smoked a half pack of ciga... | HbsAg and Anti-IgM Hbc | {
"A": "USG of the abdomen",
"B": "CT scan of the abdomen",
"C": "Reassurance and counselling",
"D": "HbsAg and Anti-IgM Hbc"
} | step2&3 | D | [
"35 year old man",
"clinic",
"yellow discoloration",
"skin",
"eyes",
"past week",
"loss of appetite",
"nausea",
"malaise",
"severe tiredness",
"known past medical history",
"takes over-the-counter acetaminophen",
"headache",
"smoked",
"half pack",
"cigarettes",
"day",
"years",
"d... |
A 42-year-old woman presents with loss of sensation in her left arm and hand. A rapid evaluation is performed to rule out stroke. No other focal neurologic deficits are found except for a loss of fine touch sensation in a C6 dermatome pattern. Further evaluation reveals that the patient was recently sick with an upper ... | Dorsal root ganglion | {
"A": "Meissner's corpuscles",
"B": "Dorsal root ganglion",
"C": "Ventral root ganglion",
"D": "Dorsal column"
} | step1 | B | [
"year old woman presents",
"loss of sensation",
"left arm",
"hand",
"rapid evaluation",
"performed to rule out stroke",
"focal neurologic deficits",
"found",
"loss of fine touch sensation",
"C6 dermatome pattern",
"Further evaluation reveals",
"patient",
"recently sick",
"upper respiratory... |
Lipidator is a nonionic surfactant that is used to disrupt the lipid membranes of cells. This disruption of the lipid membrane results in the release of all of its cytoplasmic contents. Which of the following viruses would not be disrupted if treated with this detergent? | Picornavirus | {
"A": "Herpesvirus",
"B": "Hepadnavirus",
"C": "Flavivirus",
"D": "Picornavirus"
} | step1 | D | [
"nonionic surfactant",
"used to disrupt",
"lipid membranes",
"cells",
"disruption",
"lipid membrane results",
"release",
"cytoplasmic contents",
"following viruses",
"not",
"disrupted",
"treated with",
"detergent"
] |
A 52-year-old woman presents to her primary care physician with a 1-week history of facial drooping. Specifically, she has noticed that the left side of her face does not move when she tries to smile. Furthermore, she has been having difficulty closing her left eye. Her past medical history is significant for hypertens... | Internal auditory meatus | {
"A": "Foramen ovale",
"B": "Internal auditory meatus",
"C": "Jugular foramen",
"D": "Superior orbital fissure"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"1-week history",
"facial drooping",
"left side of",
"face",
"not move",
"smile",
"difficulty closing",
"left eye",
"past medical history",
"significant",
"hypertension",
"not",
"known prior neurological deficits",
"Imaging reveals",... |
A 47-year-old woman comes to the physician because of a 5-month history of insomnia. She frequently experiences leg discomfort when trying to fall asleep that is relieved temporarily by movement. Her husband tells her that she frequently flexes her ankles upward when she sleeps. She appears fatigued and anxious. Physic... | Ropinirole | {
"A": "Ropinirole",
"B": "Zolpidem",
"C": "Atenolol",
"D": "Sertraline"
} | step1 | A | [
"year old woman",
"physician",
"5 month history",
"insomnia",
"frequently experiences leg discomfort",
"to fall asleep",
"relieved",
"movement",
"husband",
"frequently",
"ankles upward",
"sleeps",
"appears fatigued",
"anxious",
"Physical examination shows",
"abnormalities",
"Laborato... |
A 72-year-old man comes to the emergency department for progressively worsening abdominal pain. The pain began 2 weeks ago and is localized to the right upper quadrant. He feels sick and fatigued. He also reports breathlessness when climbing the stairs to his first-floor apartment. He is a retired painter. He has hyper... | Hepatic vein obstruction | {
"A": "Hepatotropic viral infection",
"B": "Increased iron absorption",
"C": "Hepatic vein obstruction",
"D": "Thickened pericaridium"
} | step2&3 | C | [
"72 year old man",
"emergency department",
"worsening abdominal pain",
"pain began 2 weeks",
"localized",
"right upper quadrant",
"feels sick",
"fatigued",
"reports breathlessness",
"climbing",
"stairs",
"first-floor apartment",
"retired painter",
"hypertension",
"type 2 diabetes mellitu... |
A 59-year-old man is brought to the emergency department because of a 2-hour history of abdominal pain and severe vomiting after ingesting an unknown medication in a suicide attempt. On the way to the hospital, he had a generalized tonic-clonic seizure. He has chronic obstructive pulmonary disease, coronary artery dise... | Theophylline | {
"A": "Albuterol",
"B": "Theophylline",
"C": "Metoprolol",
"D": "Amitriptyline"
} | step1 | B | [
"59 year old man",
"brought",
"emergency department",
"2-hour history",
"abdominal pain",
"severe vomiting",
"ingesting",
"unknown medication",
"suicide attempt",
"hospital",
"generalized tonic-clonic seizure",
"chronic obstructive pulmonary disease",
"coronary artery disease",
"chronic ba... |
A 26-year-old woman presents to the clinic today complaining of weakness and fatigue. She is a vegetarian and often struggles to maintain an adequate intake of non-animal based protein. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use. Her ... | Iron replacement for 4–6 months | {
"A": "Iron replacement for 4–6 months",
"B": "Lifelong Vitamin B6 supplementation",
"C": "Lifelong Vitamin B1 supplementation",
"D": "Obtain a bone-marrow biopsy"
} | step2&3 | A | [
"year old woman presents",
"clinic today",
"weakness",
"fatigue",
"vegetarian",
"often",
"to maintain",
"adequate intake",
"non animal based protein",
"currently smokes 1 pack",
"cigarettes",
"day",
"drinks",
"glass",
"wine",
"day",
"currently denies",
"illicit drug use",
"past m... |
An autopsy was performed on a 2-year-old male child. The clinical report stated that the child's parents were first cousins, and that he had deteriorated physically and mentally over the past year, becoming deaf, unable to eat, and paralyzed. A brain biopsy demonstrated the accumulation of GM2-gangliosides in the neuro... | Hexosaminidase A | {
"A": "Sphingomyelinase",
"B": "ß-galactocerebrosidase",
"C": "Hexosaminidase A",
"D": "a-L-iduronidase"
} | step1 | C | [
"autopsy",
"performed",
"2 year old male child",
"clinical report stated",
"child's parents",
"first cousins",
"deteriorated",
"past year",
"deaf",
"unable to eat",
"brain biopsy",
"accumulation",
"GM2-gangliosides",
"neurons",
"following enzymes",
"missing",
"child"
] |
A 70-year-old woman comes to the physician for a follow-up examination 2 months after undergoing a total hip replacement surgery. She reports that she has persistent difficulty in walking since the surgery despite regular physiotherapy. Examination of her gait shows sagging of the left pelvis when her right leg is weig... | Right superior gluteal nerve | {
"A": "Left superior gluteal nerve",
"B": "Right femoral nerve",
"C": "Left femoral nerve",
"D": "Right superior gluteal nerve"
} | step1 | D | [
"70 year old woman",
"physician",
"follow-up examination",
"months",
"total hip replacement surgery",
"reports",
"persistent difficulty in walking",
"surgery",
"regular physiotherapy",
"Examination of",
"gait shows sagging",
"left pelvis",
"right leg",
"weight-bearing",
"following nerves... |
A 35-year-old man seeks evaluation at a clinic with a 2-week history of pain during urination and a yellow-white discharge from the urethra. He has a history of multiple sexual partners and inconsistent use of condoms. He admits to having similar symptoms in the past and being treated with antibiotics. On genital exami... | Protein pili | {
"A": "Lipooligosaccharide",
"B": "Protein pili",
"C": "Exotoxin",
"D": "Lack of vaccine"
} | step1 | B | [
"35 year old man",
"evaluation",
"clinic",
"2-week history",
"pain",
"urination",
"yellow white discharge",
"urethra",
"history",
"multiple sexual partners",
"inconsistent use of condoms",
"admits to",
"similar symptoms",
"past",
"treated with antibiotics",
"genital examination",
"so... |
A 35-year-old woman is diagnosed with schizophrenia after nine months of experiencing auditory hallucinations and persecutory delusions. Over the next year, she fails to experience symptom relief from separate and appropriately dosed trials of olanzapine, quetiapine, and risperidone. At this point, which of the followi... | Clozapine | {
"A": "Aripiprazole",
"B": "Haloperidol",
"C": "Clozapine",
"D": "Cognitive behavioral therapy"
} | step2&3 | C | [
"35 year old woman",
"diagnosed",
"schizophrenia",
"nine months",
"experiencing auditory hallucinations",
"persecutory delusions",
"next year",
"fails to experience symptom relief",
"separate",
"dosed trials",
"olanzapine",
"quetiapine",
"risperidone",
"point",
"following treatment optio... |
A 54-year-old woman comes to the physician because of an ulcer on her left ankle for 6 years. She has had multiple ulcers over her left lower extremity during this period that have subsided with wound care and dressing. She has type 2 diabetes mellitus and gastroesophageal reflux disease. Current medications include me... | Punch biopsy
" | {
"A": "CT scan of the left leg",
"B": "Perthes test",
"C": "Trendelenburg test",
"D": "Punch biopsy\n\""
} | step2&3 | D | [
"54 year old woman",
"physician",
"of",
"ulcer",
"left ankle",
"years",
"multiple ulcers",
"left lower extremity",
"period",
"wound care",
"dressing",
"type 2 diabetes mellitus",
"gastroesophageal reflux disease",
"Current medications include metformin",
"sitagliptin",
"omeprazole",
... |
A 60-year-old woman presents to you with vision problems. Objects appear clear, but she just can't see as well as before. She says she first noticed this when she went to the movies with her grandkids, and she could not see the whole screen. She denies any complaints of redness, itchiness, or excessive tearing of her e... | Brimonidine causes release of prostaglandins that relax the ciliary muscle and increases uveoscleral outflow. | {
"A": "Brimonidine causes an increase in cAMP, leading to increased aqueous humor formation by the ciliary body.",
"B": "Brimonidine blocks the beta-receptors on the ciliary body to reduce aqueous humor production.",
"C": "Peripheral vasoconstriction by brimonidine leads to better control of her hypertension.",
... | step1 | D | [
"60 year old woman presents",
"vision problems",
"Objects appear clear",
"see",
"before",
"first",
"movies",
"not see",
"whole screen",
"denies",
"complaints",
"redness",
"itchiness",
"excessive",
"eyes",
"Current medications",
"captopril",
"hypertension",
"acetaminophen",
"occ... |
A 62-year-old woman presents to the office because she has noticed yellowish bumps and patches on her elbows and knees that seem to come and go. Recently she noticed the same yellow bumps on her eyelids. She is a new patient and reports that she is otherwise healthy but did not have insurance until recently so she has ... | Lipid panel | {
"A": "Biopsy",
"B": "Celiac panel",
"C": "Lipid panel",
"D": "Erythrocyte sedimentation rate (ESR)"
} | step2&3 | C | [
"62 year old woman presents",
"office",
"patches",
"elbows",
"knees",
"to",
"go",
"Recently",
"same yellow bumps",
"eyelids",
"new patient",
"reports",
"healthy",
"not",
"insurance",
"recently",
"not",
"doctor",
"over",
"years",
"Past medical history",
"significant",
"occ... |
A previously healthy 47-year-old woman comes to the emergency department because of a 2-week history of fatigue, abdominal distention, and vomiting. She drinks 6 beers daily. Physical examination shows pallor and scleral icterus. A fluid wave and shifting dullness are present on abdominal examination. The intravascular... | Short gastric vein | {
"A": "Short gastric vein",
"B": "Splenic artery",
"C": "Inferior epigastric vein",
"D": "Azygos vein"
} | step1 | A | [
"healthy",
"year old woman",
"emergency department",
"2-week history",
"fatigue",
"abdominal distention",
"vomiting",
"drinks",
"beers daily",
"Physical examination shows pallor",
"scleral icterus",
"fluid wave",
"shifting dullness",
"present",
"abdominal examination",
"intravascular p... |
One month after undergoing surgical spinal fusion because of a traumatic spinal cord injury, a 68-year-old man comes to the physician because of lower abdominal pain. He last voided yesterday. Physical examination shows a suprapubic mass and decreased sensation below the umbilicus. Urodynamic studies show simultaneous ... | Prazosin | {
"A": "Neostigmine",
"B": "Phenylephrine",
"C": "Bethanechol",
"D": "Prazosin"
} | step1 | D | [
"One month",
"surgical spinal fusion",
"traumatic spinal cord injury",
"68 year old man",
"physician",
"lower abdominal pain",
"last voided",
"Physical examination shows",
"suprapubic mass",
"decreased sensation",
"umbilicus",
"Urodynamic studies show simultaneous contractions",
"detrusor mu... |
A 24-year-old African American male with sickle cell disease has been followed by a hematologist since infancy. Two years ago, he was started on hydroxyurea for frequent pain crises but has not achieved good control. The addition of a Gardos channel blocking agent is being considered. What is the mechanism of action of... | Prevents RBC dehydration by inhibiting K+ efflux | {
"A": "Prevents RBC dehydration by inhibiting K+ efflux",
"B": "Increases production of hemoglobin F",
"C": "Prevents dehydration of RBCs by inhibiting Ca2+ efflux",
"D": "Encourages alkalinization of the blood by facilitating H+/K+ antiporter activity"
} | step1 | A | [
"year old African American male",
"sickle cell disease",
"followed by",
"hematologist",
"infancy",
"Two years",
"started",
"hydroxyurea",
"frequent pain crises",
"not",
"good control",
"addition",
"channel blocking agent",
"considered",
"mechanism of action",
"class",
"medications"
] |
A previously healthy 5-year-old boy is brought to the physician by his parents because of a 2-day history of poor balance and difficulty walking. He has fallen multiple times and is unable to walk up the stairs unassisted. He has also had difficulty tying his shoes and dressing himself. His family adheres to a vegetari... | Varicella zoster infection | {
"A": "Vitamin B1 deficiency",
"B": "Varicella zoster infection",
"C": "Posterior fossa malignancy",
"D": "Peripheral nerve demyelination"
} | step2&3 | B | [
"healthy",
"year old boy",
"brought",
"physician",
"parents",
"2-day history",
"poor balance",
"difficulty walking",
"fallen multiple times",
"unable to walk",
"stairs",
"difficulty tying",
"shoes",
"dressing",
"family adheres",
"vegetarian diet",
"not",
"received",
"routine chil... |
A 58-year-old female presents to her primary care physician with a 1-month history of facial and chest flushing, as well as intermittent diarrhea and occasional difficulty breathing. On physical exam, a new-onset systolic ejection murmur is auscultated and is loudest at the left second intercostal space. Subsequent ech... | Elevated urinary 5-hydroxyindoleacetic acid | {
"A": "Elevated serum bicarbonate",
"B": "Elevated urinary vanillylmandelic acid",
"C": "Elevated serum potassium",
"D": "Elevated urinary 5-hydroxyindoleacetic acid"
} | step1 | D | [
"58 year old female presents",
"primary care physician",
"month history",
"facial",
"chest flushing",
"intermittent diarrhea",
"occasional difficulty breathing",
"physical exam",
"new-onset systolic ejection murmur",
"loudest",
"left second intercostal space",
"Subsequent echocardiography reve... |
A 53-year-old man is brought to the clinic by his son for the evaluation of unusual behavior. He is a shopkeeper by profession and sometimes behaves very rudely to the customers. Recently, he accused one of the customers of using black magic over his shop. He has been increasingly irritable, forgetting things, and havi... | Pick’s disease | {
"A": "Creutzfeldt–Jakob disease",
"B": "Huntington’s disease",
"C": "Lewy body dementia",
"D": "Pick’s disease"
} | step2&3 | D | [
"year old man",
"brought",
"clinic",
"son",
"evaluation",
"unusual behavior",
"shopkeeper",
"profession",
"sometimes",
"very",
"customers",
"Recently",
"one",
"customers",
"using black magic",
"shop",
"irritable",
"forgetting things",
"problems managing",
"finances",
"past",
... |
A 32-year-old G0P0 African American woman presents to the physician with complaints of heavy menstrual bleeding as well as menstrual bleeding in between her periods. She also reports feeling fatigued and having bizarre cravings for ice and chalk. Despite heavy bleeding, she does not report any pain with menstruation. P... | Whorled pattern of smooth muscle bundles with well-defined borders | {
"A": "Clustered pleomorphic, hyperchromatic smooth muscle cells with extensive mitosis",
"B": "Laminated, concentric spherules with dystrophic calcification",
"C": "Presence of endometrial glands and stroma in the myometrium",
"D": "Whorled pattern of smooth muscle bundles with well-defined borders"
} | step1 | D | [
"year old",
"African American woman presents",
"physician",
"complaints",
"heavy menstrual bleeding",
"menstrual bleeding",
"periods",
"reports feeling fatigued",
"cravings",
"ice",
"chalk",
"heavy bleeding",
"not report",
"pain",
"menstruation",
"Physical examination",
"notable",
... |
A young immigrant girl presents with low-grade fever, sore throat, painful swallowing, and difficulty in breathing. Her voice is unusually nasal and her swollen neck gives the impression of “bull's neck”. On examination, a large gray membrane is noticed on the oropharynx as shown in the picture. Removal of the membrane... | ADP ribosylates EF-2 and prevents protein synthesis (ADP = adenosine diphosphate; EF-2 = elongation factor-2) | {
"A": "Travels retrogradely on axons of peripheral motor neurons and blocks the release of inhibitory neurotransmitters",
"B": "Spreads to peripheral cholinergic nerve terminals and blocks the release of acetylcholine ",
"C": "ADP ribosylates EF-2 and prevents protein synthesis (ADP = adenosine diphosphate; EF-2... | step1 | C | [
"young immigrant girl presents",
"low-grade fever",
"sore throat",
"painful swallowing",
"difficulty",
"breathing",
"voice",
"nasal",
"swollen neck gives",
"impression",
"bull's neck",
"examination",
"large gray membrane",
"oropharynx",
"shown",
"picture",
"Removal",
"membrane reve... |
A 68-year-old man is brought to the emergency department by ambulance after he was found to be altered at home. Specifically, his wife says that he fell and was unable to get back up while walking to bed. When she approached him, she found that he was unable to move his left leg. His past medical history is significant... | Cingulate gyrus | {
"A": "Cingulate gyrus",
"B": "Globus pallidus",
"C": "Lateral medulla",
"D": "Lingual gyrus"
} | step1 | A | [
"68 year old man",
"brought",
"emergency department",
"ambulance",
"found to",
"altered at home",
"wife",
"fell",
"unable to",
"back",
"walking",
"bed",
"approached",
"found",
"unable to move",
"left leg",
"past medical history",
"significant",
"hypertension",
"atrial fibrillat... |
A 9-year-old boy is brought to the emergency room by his mother for weakness, diaphoresis, and syncope. His mother says that he has never been diagnosed with any medical conditions but has been having “fainting spells” over the past month. Routine lab work reveals a glucose level of 25 mg/dL. The patient is promptly gi... | Munchausen syndrome by proxy | {
"A": "Munchausen syndrome",
"B": "Munchausen syndrome by proxy",
"C": "Somatic symptom disorder",
"D": "Conversion disorder"
} | step1 | B | [
"year old boy",
"brought",
"emergency room",
"mother",
"weakness",
"diaphoresis",
"syncope",
"mother",
"never",
"diagnosed",
"medical conditions",
"fainting spells",
"past month",
"Routine lab work reveals",
"glucose level",
"mg/dL",
"patient",
"glucagon",
"intravenous dextrose",... |
A 35-year-old woman comes to the physician because of progressive left flank pain and increased urinary frequency for the past two weeks. Her appetite is normal and she has not had any nausea or vomiting. She has a history of type 1 diabetes mellitus that is poorly controlled with insulin. She is sexually active with h... | Psoas muscle abscess | {
"A": "Ectopic pregnancy",
"B": "Nephrolithiasis",
"C": "Psoas muscle abscess",
"D": "Uterine leiomyoma"
} | step2&3 | C | [
"35 year old woman",
"physician",
"progressive left flank pain",
"increased urinary frequency",
"past two weeks",
"appetite",
"normal",
"not",
"nausea",
"vomiting",
"history of type 1 diabetes mellitus",
"poorly controlled",
"insulin",
"sexually active",
"boyfriend",
"use condoms",
"... |
A 27-year-old woman, gravida 3, para 2, delivers twins via an uncomplicated vaginal delivery. Both placentas are delivered shortly afterward. The patient received regular prenatal care and experienced no issues during her pregnancy. Over the next hour, she continues to experience vaginal bleeding, with an estimated blo... | Bimanual uterine massage | {
"A": "Methylergometrine",
"B": "Curettage with suctioning",
"C": "Tranexamic acid",
"D": "Bimanual uterine massage"
} | step2&3 | D | [
"27 year old woman",
"gravida 3",
"para 2",
"delivers twins",
"uncomplicated vaginal",
"placentas",
"delivered",
"patient received regular prenatal care",
"experienced",
"issues",
"pregnancy",
"next hour",
"continues to experience vaginal bleeding",
"estimated blood loss of",
"mL",
"Vi... |
An otherwise healthy 78-year-old man is brought to the emergency department by his daughter because of a 1-day history of a diffuse headache and an inability to understand speech. There is no history of head trauma. He drinks one to two beers daily and occasionally more on weekends. His vital signs are within normal li... | Amyloid angiopathy | {
"A": "Ruptured vascular malformation",
"B": "Hypertensive encephalopathy",
"C": "Cardiac embolism",
"D": "Amyloid angiopathy"
} | step1 | D | [
"healthy",
"year old man",
"brought",
"emergency department",
"daughter",
"of",
"1-day history",
"diffuse headache",
"to understand speech",
"history",
"head trauma",
"drinks one",
"two beers daily",
"occasionally",
"weekends",
"vital signs",
"normal",
"Mental shows fluent",
"mea... |
A 40-year-old woman presents to her primary care physician complaining of a several-month history of episodic sweating and heart racing. Her husband noticed that she becomes pale during these episodes. She also has progressive episodic pounding headaches which are not relieved by paracetamol. Her family history is nega... | Adrenal chromaffin cells | {
"A": "Zona glomerulosa",
"B": "Zonta reticularis",
"C": "Adrenal chromaffin cells",
"D": "Extra-adrenal chromaffin cells"
} | step2&3 | C | [
"40 year old woman presents",
"primary care physician",
"month history",
"episodic sweating",
"heart racing",
"husband",
"pale",
"episodes",
"progressive episodic pounding headaches",
"not relieved by paracetamol",
"family history",
"negative",
"hypertension",
"endocrinopathies",
"tumors... |
A 13-year-old boy is brought to the physician because of swelling around his eyes for the past 2 days. His mother also notes that his urine became gradually darker during this time. Three weeks ago, he was treated for bacterial tonsillitis. His temperature is 37.6°C (99.7°F), pulse is 79/min, and blood pressure is 158/... | Granular deposits of IgG, IgM, and C3 on immunofluorescence | {
"A": "\"\"\"Spike-and-dome\"\" appearance of subepithelial deposits on electron microscopy\"",
"B": "Splitting and alternating thickening and thinning of the glomerular basement membrane on light microscopy",
"C": "Mesangial IgA deposits on immunofluorescence",
"D": "Granular deposits of IgG, IgM, and C3 on i... | step1 | D | [
"year old boy",
"brought",
"physician",
"of swelling",
"eyes",
"past 2 days",
"mother",
"notes",
"urine",
"darker",
"time",
"Three weeks",
"treated",
"bacterial tonsillitis",
"temperature",
"99",
"pulse",
"min",
"blood pressure",
"87 mm Hg",
"Examination shows periorbital swe... |
A 71 year-old female is brought to the emergency room by her husband. The husband reports that they were taking a walk together one hour ago, when his wife experienced sudden, right arm and leg weakness. He noticed that she had slurred speech, and that she was not able to tell him where she was. The patient underwent a... | Atrial fibrillation | {
"A": "Supraventricular tachycardia",
"B": "Atrial bigeminy",
"C": "Prolonged QT",
"D": "Atrial fibrillation"
} | step1 | D | [
"71 year old female",
"brought",
"emergency room",
"husband",
"husband reports",
"taking",
"walk together one hour",
"wife experienced sudden",
"right arm",
"leg weakness",
"slurred speech",
"not able to",
"patient",
"emergent CT scan",
"unremarkable",
"treated with tissue plasminogen ... |
A 23-year-old man presents with increasing neck pain for several months that does not improve with nonsteroidal anti-inflammatory drugs. The patient says he has had neck pain ever since he was involved in a motor vehicle accident 10 months ago. For the last 2 weeks, he says he has also noticed weakness and numbness in ... | A cavitation in the cervical spinal cord | {
"A": "Fusion of cervical vertebrae",
"B": "Hypoplasia of the cerebellar vermis",
"C": "A cavitation in the cervical spinal cord",
"D": "Cervical spinal epidural abscess"
} | step1 | C | [
"23 year old man presents",
"increasing neck pain",
"several months",
"not",
"nonsteroidal anti-inflammatory drugs",
"patient",
"neck pain ever",
"involved",
"motor vehicle accident 10 months",
"last",
"weeks",
"weakness",
"numbness",
"hands",
"difficulty gripping objects",
"Physical e... |
A 45-year-old man presents to the emergency department because of fever and scrotal pain for 2 days. Medical history includes diabetes mellitus and morbid obesity. His temperature is 40.0°C (104.0°F), the pulse is 130/min, the respirations are 35/min, and the blood pressure is 90/68 mm Hg. Physical examination shows a ... | Obtain an immediate portable chest radiograph to evaluate line placement | {
"A": "Begin infusion of norepinephrine to maintain systolic blood pressure over 90 mm Hg",
"B": "Begin to use the line after documenting the return of dark, non-pulsatile blood from all ports",
"C": "Confirm line placement by ultrasound",
"D": "Obtain an immediate portable chest radiograph to evaluate line pl... | step2&3 | D | [
"year old man presents",
"emergency department",
"fever",
"scrotal pain",
"2 days",
"Medical history includes diabetes mellitus",
"morbid obesity",
"temperature",
"40",
"pulse",
"min",
"respirations",
"35 min",
"blood pressure",
"90 68 mm Hg",
"Physical examination shows",
"large are... |
A 32-year-old man of Asian descent presents with a skin rash after being started on prophylactic doses of trimethoprim/sulfamethoxazole 3 weeks earlier. He was diagnosed with acquired immunodeficiency syndrome (AIDS) 2 months ago which prompted the initiation of prophylactic antibiotics. The vital signs include: blood ... | Stevens-Johnson syndrome | {
"A": "Erythema multiforme",
"B": "Stevens-Johnson syndrome",
"C": "Drug rash with eosinophilia and systemic symptoms",
"D": "Toxic shock syndrome"
} | step2&3 | B | [
"year old man",
"Asian descent presents",
"skin rash",
"started",
"prophylactic doses",
"trimethoprim/sulfamethoxazole",
"weeks earlier",
"diagnosed",
"acquired immunodeficiency syndrome",
"months",
"prompted",
"initiation",
"prophylactic antibiotics",
"vital signs include",
"blood press... |
A 43-year-old woman comes to the physician because of a 2-month history of chest pain. She describes the pain as intermittent and burning-like. She states that she has tried using proton pump inhibitors but has had no relief of her symptoms. She has had a 5-kg (11-lb) weight loss over the past 2 months. Her temperature... | Anti-topoisomerase antibodies | {
"A": "c-ANCA",
"B": "Anti-topoisomerase antibodies",
"C": "Anti-histone antibodies",
"D": "Anti-Ro/SSA and anti-La/SSB antibodies"
} | step2&3 | B | [
"year old woman",
"physician",
"of",
"2 month history",
"chest pain",
"pain",
"intermittent",
"burning",
"states",
"using proton pump inhibitors",
"relief",
"symptoms",
"5 kg",
"weight loss",
"past",
"months",
"temperature",
"36",
"98",
"pulse",
"75 min",
"blood pressure",
... |
A 27-year-old man presents to the emergency department with general weakness and fatigue. He states that he has not felt well for several days and can't take care of himself anymore due to fatigue. The patient has a past medical history of IV drug abuse, alcohol abuse, and multiple minor traumas associated with intoxic... | Pseudomembranes of fibrin | {
"A": "Ascitic fluid infection",
"B": "Pseudomembranes of fibrin",
"C": "Increased osmotic load",
"D": "Schistocytes on peripheral smear"
} | step1 | B | [
"27 year old man presents",
"emergency department",
"general weakness",
"fatigue",
"states",
"not felt well",
"days",
"take care",
"fatigue",
"patient",
"past medical history of IV drug abuse",
"alcohol abuse",
"multiple minor traumas associated with intoxication",
"temperature",
"blood ... |
A 9-year-old boy is brought to the physician for evaluation of a 3-day history of fever, sore throat, and itchy, red eyes. His symptoms began while he was away at summer camp. His immunizations are not up-to-date. He appears ill. His temperature is 39.1°C (102.3°F). Physical examination shows erythema and edema of the ... | Adenovirus | {
"A": "Adenovirus",
"B": "Parvovirus",
"C": "Picornavirus",
"D": "Paramyxovirus"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"evaluation",
"3-day history",
"fever",
"sore throat",
"itchy",
"red",
"symptoms began",
"summer camp",
"immunizations",
"not",
"date",
"appears ill",
"temperature",
"Physical examination shows erythema",
"edema of",
"conjunctivae",
"post... |
A 70-year-old man presents to the emergency department with severe substernal chest pain of one hour’s duration. The patient was taking a morning walk when the onset of pain led him to seek care. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, lo... | Lateral wall of left ventricle, left circumflex coronary artery | {
"A": "Interventricular septum, left anterior descending coronary artery",
"B": "Lateral wall of left ventricle, left circumflex coronary artery",
"C": "Left atrium, left main coronary artery",
"D": "Right ventricle, left main coronary artery"
} | step2&3 | B | [
"70 year old man presents",
"emergency department",
"severe",
"chest pain of one hours duration",
"patient",
"taking",
"morning walk",
"onset",
"pain led",
"to",
"care",
"past medical history includes coronary artery disease",
"hyperlipidemia",
"hypertension",
"Medications include aspiri... |
A 68-year-old male visits his primary care physician after an episode of syncope during a tennis match. He reports exertional dyspnea with mild substernal chest pain. On physical exam a systolic crescendo-decrescendo murmur is heard best at the right 2nd intercostal space. This murmur was not heard at the patient's las... | Murmur radiates to carotid arteries bilaterally | {
"A": "Presence of S3",
"B": "Murmur radiates to carotid arteries bilaterally",
"C": "Murmur radiates to axilla",
"D": "Asymmetric ventricular hypertrophy"
} | step1 | B | [
"68 year old male visits",
"primary care physician",
"episode of syncope",
"tennis match",
"reports exertional dyspnea",
"mild substernal chest pain",
"physical exam",
"systolic crescendo-decrescendo murmur",
"heard best",
"right 2nd intercostal space",
"murmur",
"not heard",
"patient's",
... |
A 37-year-old man presents to the physician. He has been overweight since childhood. He has not succeeded in losing weight despite following different diet and exercise programs over the past several years. He has had diabetes mellitus for 2 years and severe gastroesophageal reflux disease for 9 years. His medications ... | Laparoscopic Roux-en-Y gastric bypass | {
"A": "Biliopancreatic diversion and duodenal switch (BPD-DS)",
"B": "Laparoscopic adjustable gastric banding",
"C": "Laparoscopic Roux-en-Y gastric bypass",
"D": "No surgical management at this time"
} | step2&3 | C | [
"year old man presents",
"physician",
"overweight",
"childhood",
"not",
"weight",
"following different diet",
"exercise programs",
"past",
"years",
"diabetes mellitus",
"years",
"severe gastroesophageal reflux disease",
"years",
"medications include metformin",
"aspirin",
"pantoprazo... |
An 8-year-old girl is brought to the emergency department because of a 2-day history of an intermittent, diffuse abdominal pain. She has also had a nonpruritic rash on her legs and swelling of her ankles for 1 week. Two weeks ago, she had a sore throat, which was treated with oral amoxicillin. Examination of the lower ... | Leukocytoclastic vasculitis | {
"A": "Immune thrombocytopenic purpura",
"B": "Acute rheumatic fever",
"C": "Familial Mediterranean fever",
"D": "Leukocytoclastic vasculitis"
} | step1 | D | [
"year old girl",
"brought",
"emergency department",
"2-day history",
"intermittent",
"diffuse abdominal pain",
"nonpruritic rash",
"legs",
"swelling",
"ankles",
"1 week",
"Two weeks",
"sore throat",
"treated with oral amoxicillin",
"Examination of the lower extremities shows non blanchin... |
A 31-year-old physician notices that her senior colleague has been arriving late for work for the past 2 weeks. The colleague recently lost his wife to cancer and has been taking care of his four young children. Following the death of his wife, the department chair offered him extended time off but he declined. There h... | Inform the local Physician Health Program | {
"A": "Confront the colleague in private",
"B": "Inform the local Physician Health Program",
"C": "Inform the colleague's patients about the potential hazard",
"D": "Alert the State Licensing Board"
} | step1 | B | [
"31 year old physician",
"senior",
"late",
"work",
"past 2 weeks",
"recently lost",
"wife",
"cancer",
"taking care",
"four young",
"Following",
"death",
"wife",
"department chair offered",
"extended time",
"recent changes noted",
"discussed",
"resident physicians",
"missed clinic... |
A 58-year-old man presents for a follow-up appointment. He recently was found to have a history of stage 2 chronic kidney disease secondary to benign prostatic hyperplasia leading to urinary tract obstruction. He has no other medical conditions. His father died at age 86 from a stroke, and his mother lives in an assist... | Enalapril | {
"A": "Ezetimibe",
"B": "Enalapril",
"C": "Carvedilol",
"D": "Aspirin"
} | step2&3 | B | [
"58 year old man presents",
"follow-up appointment",
"recently",
"found to",
"history of stage 2 chronic kidney disease secondary to benign prostatic hyperplasia leading",
"urinary tract obstruction",
"medical conditions",
"father died",
"age",
"stroke",
"mother lives in",
"assisted living fac... |
A 25-year-old man comes to the physician because he and his wife have been unable to conceive despite regular unprotected sex for the past 15 months without using contraception. His wife has been tested and is fertile. The patient began puberty at the age of 14 years. He was treated for Chlamydia trachomatis 6 years ag... | Anabolic steroid use | {
"A": "Psychogenic erectile dysfunction",
"B": "Kallmann syndrome",
"C": "Anabolic steroid use",
"D": "Klinefelter syndrome"
} | step1 | C | [
"year old man",
"physician",
"wife",
"unable to",
"regular unprotected sex",
"past",
"months",
"using contraception",
"wife",
"tested",
"fertile",
"patient began puberty",
"age",
"years",
"treated",
"Chlamydia",
"years",
"professional",
"trains",
"day",
"hours",
"feels stre... |
A 48-year-old male with a history of rhinitis presents to the emergency department with complaints of shortness of breath and wheezing over the past 2 days. He reports bilateral knee pain over the past month for which he recently began taking naproxen 1 week ago. Physical examination is significant for a nasal polyp an... | Asthma | {
"A": "Pulmonary hypertension",
"B": "Asthma",
"C": "Pulmonary embolism",
"D": "Cardiac tamponade"
} | step2&3 | B | [
"48 year old male",
"history",
"rhinitis presents",
"emergency department",
"complaints of shortness",
"breath",
"wheezing",
"past 2 days",
"reports bilateral knee pain",
"past month",
"recently began taking naproxen",
"week",
"Physical examination",
"significant",
"nasal polyp",
"bila... |
A 58-year-old lifeguard develops squamous cell carcinoma of the skin on his forehead. Which of the following most likely preceded the development of this carcinoma? | Dry, scaly, hyperkeratotic papule | {
"A": "Dry, scaly, hyperkeratotic papule",
"B": "A single, large pink patch",
"C": "Dermatophyte infection",
"D": "UVC exposure"
} | step1 | A | [
"58 year old lifeguard",
"squamous cell carcinoma of the skin",
"forehead",
"following most likely preceded",
"development",
"carcinoma"
] |
A 29-year-old man is brought to the emergency department by his wife due to unusual behavior for the past week. She has noted several incidents when he spoke to her so fast that she could not understand what he was saying. She also says that one evening, he drove home naked after a night where he said he was ‘painting ... | Bipolar disorder, type I | {
"A": "Major depressive disorder",
"B": "Brief psychotic disorder",
"C": "Bipolar disorder, type I",
"D": "Bipolar disorder, type II"
} | step2&3 | C | [
"29 year old man",
"brought",
"emergency department",
"wife due to unusual behavior",
"past week",
"noted",
"incidents",
"spoke",
"fast",
"not understand",
"one evening",
"drove home naked",
"night",
"painting",
"town red",
"sleeping",
"hours",
"night",
"sleep",
"past 2 weeks",... |
A 65-year-old man presents with a small painless ulcer with a raised border on his right forearm which has persisted for the last 3 weeks. His past history is significant for 3 occurrences of basal cell carcinoma on different areas of the body during the last 4 years, which have all been surgically excised. The morphol... | Inhibition of thymidylate synthase | {
"A": "Inhibition of ribonucleotide reductase",
"B": "Inhibition of DNA repair",
"C": "Inhibition of thymidylate synthase",
"D": "Inhibition of de novo purine nucleotide synthesis"
} | step1 | C | [
"65 year old man presents",
"small painless ulcer",
"raised border",
"right forearm",
"weeks",
"past history",
"significant",
"occurrences",
"basal cell carcinoma",
"different areas",
"body",
"last",
"years",
"surgically",
"morphology",
"present lesion",
"highly suggestive of basal c... |
A 29-year-old woman presents for a follow-up visit after an emergency appendectomy. The laparoscopic procedure went well with no complications. Physical examination reveals the surgical site is slightly tender but is healing appropriately. She is delighted that the operation went well and offers you a cake and VIP tick... | "Thank you, but I cannot accept the tickets you offered. Accepting such a generous gift is against our policy. However, I will gladly accept your cake and distribute it among the staff." | {
"A": "\"Thank you, I will enjoy these gifts immensely.\"",
"B": "\"No, I cannot accept these gifts, please take them with you as you leave.\"",
"C": "\"Thank you, but I cannot accept the tickets you offered. Accepting such a generous gift is against our policy. However, I will gladly accept your cake and distri... | step1 | C | [
"29 year old woman presents",
"follow-up visit",
"emergency appendectomy",
"laparoscopic procedure",
"well",
"complications",
"Physical examination reveals",
"surgical site",
"slightly tender",
"healing",
"delighted",
"operation",
"well",
"cake",
"VIP",
"musical",
"following",
"mos... |
A 62-year-old man presents to the emergency department with increased fatigue and changes in his vision. The patient states that for the past month he has felt abnormally tired, and today he noticed his vision was blurry. The patient also endorses increased sweating at night and new onset headaches. He states that he c... | IgM | {
"A": "Calcium",
"B": "IgM",
"C": "Natural killer cells",
"D": "T-cells"
} | step2&3 | B | [
"62 year old man presents",
"emergency department",
"increased fatigue",
"changes",
"vision",
"patient states",
"past month",
"felt",
"tired",
"today",
"vision",
"blurry",
"patient",
"increased",
"night",
"new onset headaches",
"states",
"currently feels dizzy",
"patient",
"pas... |
A 42-year-old man presents to his primary care provider for a follow-up appointment after a new diagnosis of hypertension follow-up. The doctor mentions that a recent study where the effect of a healthy lifestyle education program on blood pressure was studied in 2 matched rural communities. One community received heal... | Community trial | {
"A": "Case-control trial",
"B": "Explanatory study",
"C": "Community trial",
"D": "Cross-sectional study"
} | step1 | C | [
"year old man presents",
"primary care provider",
"follow-up appointment",
"new diagnosis",
"hypertension follow-up",
"doctor",
"recent study",
"effect",
"healthy lifestyle education program",
"blood pressure",
"studied",
"matched rural communities",
"One",
"received health",
"not",
"t... |
A 50-year-old female radiologist who is interviewing for a night shift position states that she was fired from her past 3 previous positions because she had difficulty working with others. She states that she is perfect for this job however, as she likes to work on her own and be left alone. She emphasizes that she doe... | Schizoid | {
"A": "Schizoid",
"B": "Antisocial",
"C": "Borderline",
"D": "Obsessive-compulsive disorder"
} | step1 | A | [
"50 year old female radiologist",
"interviewing",
"night shift position states",
"fired",
"past",
"previous positions",
"difficulty working",
"others",
"states",
"job",
"likes to work",
"left alone",
"not",
"distractions",
"meaningful relationships",
"always",
"never calls",
"sick"... |
A 67-year-old female presents to her primary care physician complaining of headaches in her left temple and scalp area, neck stiffness, occasional blurred vision, and pain in her jaw when chewing. The appropriate medical therapy is initiated, and a subsequent biopsy of the temporal artery reveals arteritis. Five months... | Drug-induced myopathy | {
"A": "Mononeuritis multiplex",
"B": "Polymyalgia rheumatica",
"C": "Drug-induced myopathy",
"D": "Polymyositis"
} | step2&3 | C | [
"67 year old female presents",
"primary care physician",
"headaches",
"left temple",
"scalp area",
"neck stiffness",
"occasional blurred vision",
"pain in",
"jaw",
"chewing",
"appropriate medical therapy",
"initiated",
"subsequent biopsy of the temporal artery reveals arteritis",
"Five mon... |
A 67-year-old man presents to the office complaining of abdominal pain. He was started on a trial of proton pump inhibitors 5 weeks ago but the pain has not improved. He describes the pain as dull, cramping, and worse during meals. Medical history is unremarkable. Physical examination is normal except for tenderness in... | Left gastro-omental artery | {
"A": "Left gastric artery",
"B": "Right gastro-omental artery",
"C": "Left gastro-omental artery",
"D": "Cystic artery"
} | step1 | C | [
"67 year old man presents",
"office",
"abdominal pain",
"started",
"trial",
"proton pump inhibitors",
"weeks",
"pain",
"not improved",
"pain",
"dull",
"cramping",
"worse",
"meals",
"Medical history",
"unremarkable",
"Physical",
"normal",
"tenderness",
"epigastric region",
"En... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.