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 mother brings her 2-year-old son to the pediatrician following an episode of abdominal pain and bloody stool. The child has otherwise been healthy and growing normally. On physical exam, the patient is irritable with guarding of the right lower quadrant of the abdomen. Based on clinical suspicion, pertechnetate scint... | Vitelline duct | {
"A": "Metanephric mesenchyme",
"B": "Ductus arteriosus",
"C": "Vitelline duct",
"D": "Paramesonephric duct"
} | step1 | C | [
"mother",
"her 2 year old son",
"pediatrician following",
"episode of abdominal pain",
"bloody stool",
"child",
"healthy",
"physical exam",
"patient",
"irritable",
"guarding of",
"right lower quadrant",
"abdomen",
"Based",
"clinical suspicion",
"pertechnetate scintigraphy demonstrates ... |
A 59-year-old patient comes to the emergency department accompanied by his wife because of severe right leg pain and numbness. His condition suddenly started an hour ago. His wife says that he has a heart rhythm problem for which he takes a blood thinner, but he is not compliant with his medications. He has smoked 10–1... | Urgent assessment for amputation or revascularization | {
"A": "Decompressive laminectomy",
"B": "Urgent assessment for amputation or revascularization",
"C": "Oral acetaminophen and topical capsaicin",
"D": "Arthroscopic synovectomy"
} | step2&3 | B | [
"59 year old patient",
"emergency department",
"wife",
"severe right leg pain",
"numbness",
"condition",
"started",
"hour",
"wife",
"heart problem",
"takes",
"blood thinner",
"not compliant",
"medications",
"smoked",
"cigarettes daily",
"past",
"years",
"temperature",
"36",
"... |
A 12-year-old girl is brought to the pediatrician by her father who is concerned about the child’s ability to sit in a moving vehicle. She frequently develops nausea and dizziness when riding in a car for more than 10 minutes. The child has vomited twice over the past month while riding in the car. Her symptoms are sig... | Muscarinic acetylcholine receptor antagonist | {
"A": "Alpha-2 adrenergic receptor agonist",
"B": "Beta-1 adrenergic receptor agonist",
"C": "Muscarinic acetylcholine receptor antagonist",
"D": "Nicotinic acetylcholine receptor agonist"
} | step1 | C | [
"year old girl",
"brought",
"pediatrician",
"father",
"concerned",
"childs ability to sit",
"moving vehicle",
"frequently",
"nausea",
"dizziness",
"riding",
"car",
"more",
"10 minutes",
"child",
"vomited twice",
"past month",
"riding",
"car",
"symptoms",
"impairing",
"abili... |
A 28-year-old female suffering from a urinary tract infection is given trimethoprim-sulfamethoxazole (TMP-SMX) by her physician. Several days later, she begins to experience itchiness and joint pain. Laboratory and histologic analysis reveals vasculitis and antibody complexes deposited near the basement membrane of the... | Lowered serum levels of complement protein C3 | {
"A": "Decreased levels of IgE",
"B": "Increased levels of IgE",
"C": "Increased serum levels of complement protein C3",
"D": "Lowered serum levels of complement protein C3"
} | step1 | D | [
"year old female suffering",
"urinary tract",
"given trimethoprim-sulfamethoxazole",
"physician",
"days later",
"begins to experience itchiness",
"joint pain",
"Laboratory",
"histologic analysis reveals vasculitis",
"antibody complexes deposited",
"basement membrane",
"glomerulus",
"serologi... |
A 27-year-old woman presents to your office complaining of difficulty swallowing, and she describes that "there is something in the back of her throat". Furthermore, she also feels an "achy" chest pain that has been getting progressively worse over the last few weeks. She denies having any fever, shortness of breath, c... | Benign tumor of the thymus | {
"A": "Benign tumor of the thymus",
"B": "Superior vena cava syndrome",
"C": "Anaplastic thyroid cancer",
"D": "Mediastinitis"
} | step1 | A | [
"27 year old woman presents",
"office",
"difficulty swallowing",
"back of",
"throat",
"feels",
"achy",
"chest pain",
"getting",
"worse",
"weeks",
"denies",
"fever",
"shortness of breath",
"cough",
"abdominal pain",
"heartburn",
"nausea",
"vomiting",
"patient",
"history fractu... |
A 34-year-old woman comes to the physician for a follow-up appointment because of a blood pressure of 148/98 mm Hg at her last health maintenance examination four weeks ago. She feels well. She has a 20-year history of migraine with aura of moderate to severe intensity. For the past year, the headaches have been occurr... | Propranolol | {
"A": "Hydrochlorothiazide",
"B": "Lisinopril",
"C": "Propranolol",
"D": "Prazosin"
} | step2&3 | C | [
"year old woman",
"physician",
"follow-up appointment",
"blood pressure",
"98 mm Hg",
"last health maintenance examination four weeks",
"feels well",
"20 year history of migraine",
"aura",
"moderate",
"severe intensity",
"past year",
"headaches",
"occurring",
"times",
"week",
"only m... |
A mother brings her 25-month-old son to the pediatrician’s office for a well child visit. She reports he had an ear infection 3 months ago for which he took a short course of antibiotics but has otherwise been well. He is now in daycare where he likes to play with the other children. She says he can stack multiple cube... | None | {
"A": "Gross motor",
"B": "Fine motor",
"C": "Social development",
"D": "None"
} | step1 | D | [
"mother",
"month old son",
"pediatricians office",
"well child visit",
"reports",
"ear 3 months",
"took",
"short course",
"antibiotics",
"well",
"now",
"daycare",
"likes to play",
"children",
"stack multiple cubes",
"playing",
"objects",
"goes outside frequently to play",
"ball",... |
A 68-year-old man is brought to the emergency department 25 minutes after he was found shaking violently on the bathroom floor. His wife reports that he has become increasingly confused over the past 2 days and that he has been sleeping more than usual. He was started on chemotherapy 4 months ago for chronic lymphocyti... | Monoclonal antibody against CD20+ | {
"A": "Tyrosine kinase inhibitor",
"B": "Topoisomerase II inhibitor",
"C": "Monoclonal antibody against EGFR",
"D": "Monoclonal antibody against CD20+"
} | step1 | D | [
"68 year old man",
"brought",
"emergency department",
"minutes",
"found shaking",
"bathroom floor",
"wife reports",
"confused",
"past 2 days",
"sleeping more",
"usual",
"started",
"chemotherapy",
"months",
"chronic lymphocytic leukemia",
"confused",
"oriented to person only",
"Neur... |
A 29-year-old woman presents to her primary care provider complaining of lower back pain. She reports a 3 day history of extreme right lower back pain. She also reports mild dysuria. Her past medical history is notable for recurrent urinary tract infections leading to 3 emergency room visits over the past year. Her fam... | Proteus mirabilis | {
"A": "Escherichia coli",
"B": "Citrobacter freundii",
"C": "Proteus mirabilis",
"D": "Staphylococcus epidermidis"
} | step1 | C | [
"29 year old woman presents",
"primary care provider complaining of lower back pain",
"reports",
"3 day history of extreme right lower back pain",
"reports mild dysuria",
"past medical history",
"notable",
"recurrent urinary tract infections leading",
"emergency room visits",
"past year",
"famil... |
An 8-month-old boy is brought to the emergency room by his mother who notes that the child has not been passing stool regularly. Palpation and radiographic imaging of the umbilical region reveal the presence of fecal material in an abnormal out-pocketing of bowel. Which of the following is a common complication seen in... | Ulceration | {
"A": "Enlarged rugal folds",
"B": "Dysplasia",
"C": "Ulceration",
"D": "Paneth cell metaplasia"
} | step1 | C | [
"month old boy",
"brought",
"emergency room",
"mother",
"notes",
"child",
"not",
"passing stool",
"Palpation",
"radiographic imaging",
"umbilical region reveal",
"presence",
"fecal material",
"abnormal out",
"bowel",
"following",
"common complication seen",
"condition"
] |
A 69-year-old woman is brought to the clinic for difficulty breathing over the past 2 months. She denies any clear precipitating factor but reports that her breathing has become progressively labored and she feels like she can’t breathe. Her past medical history is significant for heart failure, diabetes mellitus, and ... | Spironolactone | {
"A": "Amiloride",
"B": "Atorvastatin",
"C": "Furosemide",
"D": "Spironolactone"
} | step1 | D | [
"69 year old woman",
"brought",
"clinic",
"difficulty breathing",
"past",
"months",
"denies",
"clear precipitating factor",
"reports",
"breathing",
"labored",
"feels",
"cant",
"past medical history",
"significant",
"heart failure",
"diabetes mellitus",
"hypertension",
"medication... |
An 80-year-old woman presents with general malaise and low-grade fever. Physical examination reveals several retinal hemorrhages with pale centers, erythematous nodules on palms that are not painful, and splinter hemorrhages under her fingernails. Echocardiogram shows vegetations on the mitral valve. Blood culture indi... | Colon cancer | {
"A": "Subacute sclerosing panencephalitis",
"B": "Dental caries",
"C": "HIV/AIDS",
"D": "Colon cancer"
} | step1 | D | [
"80 year old woman presents",
"general malaise",
"low-grade fever",
"Physical examination reveals several retinal hemorrhages",
"pale centers",
"erythematous nodules",
"palms",
"not painful",
"splinter hemorrhages",
"fingernails",
"Echocardiogram shows vegetations",
"mitral valve",
"Blood cu... |
A 63-year-old man presents to the physician with fever for 5 days. He has had increasing fatigue and dyspnea for the past 2 months. During this time, he has lost 3 kg (6.6 lb). He received outpatient treatment for pneumonia last month. He had urinary tract infection 2 weeks ago. He takes no other medications other than... | Acute myeloblastic leukemia | {
"A": "Acute myeloblastic leukemia",
"B": "Burkitt lymphoma",
"C": "Hairy cell leukemia",
"D": "MALT lymphoma"
} | step2&3 | A | [
"63 year old man presents",
"physician",
"fever",
"5 days",
"increasing fatigue",
"dyspnea",
"past",
"months",
"time",
"lost 3 kg",
"6.6",
"received outpatient treatment",
"pneumonia",
"month",
"urinary tract infection",
"weeks",
"takes",
"medications",
"daily low dose aspirin",
... |
A 9-year-old girl is brought to her pediatrician by her mother for the evaluation of recent-onset seizures. She has had 2 episodes of generalized tonic-clonic seizures in the past 3 days. Each episode lasted for 1–2 minutes and aborted spontaneously. There is no history of fever, headache, altered behavior, diarrhea, v... | Von Recklinghausen disease | {
"A": "Neurofibromatosis type 2",
"B": "Sturge-Weber disease",
"C": "Tuberous sclerosis",
"D": "Von Recklinghausen disease"
} | step2&3 | D | [
"year old girl",
"brought",
"pediatrician",
"mother",
"evaluation",
"recent onset seizures",
"2 episodes of generalized tonic-clonic seizures",
"past",
"days",
"episode lasted",
"minutes",
"aborted",
"history",
"fever",
"headache",
"altered behavior",
"diarrhea",
"vomiting",
"pre... |
A 7-year-old boy is brought to the emergency department by his parents. They state that he has had trouble walking the past day and this morning refuses to walk at all. The child has a past medical history of asthma, which is treated with albuterol. His temperature is 102°F (38.9°C), blood pressure is 77/48 mmHg, pulse... | Staphylococcus aureus | {
"A": "Pseudomonas aeruginosa",
"B": "Salmonella species",
"C": "Staphylococcus aureus",
"D": "Staphylococcus epidermidis"
} | step2&3 | C | [
"year old boy",
"brought",
"emergency department",
"parents",
"state",
"walking",
"past day",
"morning refuses to walk",
"child",
"past medical",
"treated with albuterol",
"temperature",
"blood pressure",
"48 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"9... |
A 24-year-old man presents to his family practitioner for routine follow-up of asthma. He is currently on albuterol, corticosteroids, and salmeterol, all via inhalation. The patient is compliant with his medications, but he still complains of episodic shortness of breath and wheezing. The peak expiratory flow (PEF) has... | Montelukast blocks receptors of some arachidonic acid metabolites. | {
"A": "Montelukast inhibits the release of inflammatory substances from mast cells.",
"B": "Montelukast binds to IgE.",
"C": "Montelukast blocks receptors of some arachidonic acid metabolites.",
"D": "Montelukast inhibits lipoxygenase, thus decreasing the production of inflammatory leukotrienes."
} | step1 | C | [
"year old man presents",
"family practitioner",
"routine follow-up",
"asthma",
"currently",
"albuterol",
"corticosteroids",
"salmeterol",
"inhalation",
"patient",
"compliant",
"medications",
"of episodic shortness",
"breath",
"wheezing",
"peak expiratory flow",
"improved",
"last vi... |
A 25-year-old medical student is doing an international health elective in the Amazon River basin studying tropical disease epidemiology. As part of his pre-trip preparation, he wants to be protected from malaria and is researching options for prophylaxis. Which of the following agents should be avoided for malarial pr... | Chloroquine | {
"A": "Chloroquine",
"B": "Mefloquine",
"C": "Atovaquone-proguanil",
"D": "Quinine"
} | step2&3 | A | [
"year old medical student",
"international health elective",
"Amazon River basin studying tropical disease epidemiology",
"part of",
"pre trip preparation",
"to",
"malaria",
"researching options",
"prophylaxis",
"following agents",
"malarial prophylaxis",
"patient"
] |
A 32-year-old woman presents complaining of nightmares. She reports that these “nightmares” happen when she is asleep and also sometimes when she is awake, but she cannot come up with another description for them. The episodes have been happening for at least 3 weeks now. She states that when it happens she feels “outs... | Depersonalization disorder | {
"A": "Brief psychotic disorder",
"B": "Delusional disorder",
"C": "Depersonalization disorder",
"D": "Dissociative fugue disorder"
} | step2&3 | C | [
"year old woman presents complaining of nightmares",
"reports",
"nightmares happen",
"asleep",
"sometimes",
"awake",
"description",
"episodes",
"happening",
"weeks now",
"states",
"happens",
"feels outside",
"body",
"shes watching",
"reports",
"chronic fatigue",
"patient denies hea... |
A 38-year-old woman comes to the physician for a 6-week history of sleeping difficulties because she thinks that someone is watching her through security cameras. Her anxiety started 6 weeks ago when a security camera was installed outside her house by the police. Ever since, she has felt that she is being monitored by... | Delusions | {
"A": "Agoraphobia",
"B": "Delusions",
"C": "Disorganized thoughts",
"D": "Hallucinations"
} | step1 | B | [
"year old woman",
"physician",
"week history",
"sleeping difficulties",
"thinks",
"watching",
"security cameras",
"anxiety started",
"weeks",
"security camera",
"outside",
"house",
"police",
"Ever",
"felt",
"monitored",
"security cameras",
"city",
"outside",
"possible",
"refu... |
A 49-year-old man with alcohol use disorder is brought to the emergency department immediately after two episodes of coffee-ground emesis. His pulse is 116/min and blood pressure is 92/54 mm Hg. Physical examination shows a distended abdomen with shifting dullness. Skin examination shows jaundice, erythematous palms, a... | D cells | {
"A": "G cells",
"B": "K cells",
"C": "D cells",
"D": "I cells\n\""
} | step1 | C | [
"year old man",
"alcohol use disorder",
"brought",
"emergency department immediately",
"two episodes of coffee-ground emesis",
"pulse",
"min",
"blood pressure",
"54 mm Hg",
"Physical examination shows",
"distended abdomen",
"shifting dullness",
"Skin examination shows jaundice",
"erythemat... |
A 19-year-old college student is brought to the emergency department by his roommates after being found unconscious on their dorm room floor. His temperature is 102.0°F (38.9°C) and blood pressure is 85/64 mmHg. On physical examination, he has multiple rose-colored spots on the skin covering his abdomen and lower limbs... | Waterhouse-Friderichsen syndrome | {
"A": "Dengue hemorrhagic fever",
"B": "Diabetic ketoacidosis",
"C": "Typhoid fever",
"D": "Waterhouse-Friderichsen syndrome"
} | step1 | D | [
"year old college student",
"brought",
"emergency department",
"roommates",
"found unconscious on",
"room floor",
"temperature",
"blood pressure",
"85 64 mmHg",
"physical examination",
"multiple rose colored spots on",
"skin covering",
"abdomen",
"lower limbs",
"Lab tests reveal hyperkal... |
A 39-year-old man with a history of major depression is brought into the emergency department by his concerned daughter. She reports that he was recently let go from work because of his sudden and erratic behavior at work. He was noted to be making inappropriate sexual advances to his female co-workers which is very ou... | Mood stabilizers, antipsychotics, benzodiazepines, ECT | {
"A": "Mood stabilizers, antipsychotics, benzodiazepines, ECT",
"B": "Mood stabilizers, antipsychotics",
"C": "Antipsychotics",
"D": "Benzodiazepines"
} | step1 | A | [
"year old man",
"history of major depression",
"brought",
"emergency department",
"daughter",
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"recently let go",
"work",
"sudden",
"behavior",
"work",
"noted to",
"making inappropriate sexual advances",
"female co workers",
"very out",
"character",
"to",
"full of energy"... |
A 24-year-old woman, gravida 2, para 1, at 33 weeks’ gestation, is admitted to the hospital for treatment of preterm labor. She has no history of serious illness and her only medication is a multivitamin. Her temperature is 37.2°C (99.0°F), pulse is 100/min, respirations are 20/min, and blood pressure is 100/75 mm Hg. ... | Serum electrolytes | {
"A": "Serum electrolytes",
"B": "Complete blood count",
"C": "Amniotic fluid culture",
"D": "Thyroid function tests"
} | step2&3 | A | [
"year old woman",
"gravida 2",
"para 1",
"weeks gestation",
"admitted",
"hospital",
"treatment",
"preterm labor",
"history",
"serious illness",
"only medication",
"multivitamin",
"temperature",
"99",
"pulse",
"100 min",
"respirations",
"20 min",
"blood pressure",
"100 75 mm Hg"... |
A 70-year-old male patient comes into your office because of leg pain. The patient states that his calves have been hurting more and more over the last two months. The pain isn't present at rest, but the pain develops as the patient starts walking and exerting himself. He states that stopping to rest is the only thing ... | Lifestyle modifications | {
"A": "Lifestyle modifications",
"B": "Clopidogrel",
"C": "Angioplasty and stenting",
"D": "Arterial bypass surgery"
} | step2&3 | A | [
"70 year old male patient",
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"leg pain",
"patient states",
"calves",
"more",
"more",
"last two months",
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"present",
"rest",
"pain",
"patient starts walking",
"exerting",
"states",
"stopping to rest",
"only thing",
"relieves",
"pain",
"note",
"patient's medical... |
A 23-year-old man comes to the physician because of a 1-week history of muscle ache, fatigue, and fever that occurs every 2 days. He recently returned from a trip to Myanmar. A peripheral blood smear shows erythrocytes with brick-red granules. The physician recommends a combination of two antimicrobial drugs after conf... | Prevention of infection relapse | {
"A": "Prevention of infection relapse",
"B": "Therapy against polymicrobial infections",
"C": "Prevention of drug resistance",
"D": "Decrease in renal drug secretion"
} | step1 | A | [
"23 year old man",
"physician",
"1-week history",
"muscle ache",
"fatigue",
"fever",
"occurs",
"2 days",
"recently returned",
"trip",
"Myanmar",
"peripheral blood smear shows erythrocytes",
"red granules",
"physician recommends",
"combination",
"two antimicrobial drugs",
"normal gluc... |
A 20-year-old woman is brought to the emergency department by her parents after finding her seizing in her room at home. She has no known medical condition and this is her first witnessed seizure. She is stabilized in the emergency department. A detailed history reveals that the patient has been progressively calorie r... | Hypophosphatemia | {
"A": "Hypophosphatemia",
"B": "Hypermagnesemia",
"C": "Hyponatremia",
"D": "Hypokalemia"
} | step2&3 | A | [
"20 year old woman",
"brought",
"emergency department",
"parents",
"finding",
"room at home",
"known medical condition",
"first witnessed seizure",
"stabilized",
"emergency department",
"detailed history reveals",
"patient",
"calorie restricting",
"past",
"years",
"Based",
"known hei... |
A 27-year-old woman, gravida 3, para 1, at 22 weeks gestation visits her physician for a prenatal visit. She feels well. Her current pregnancy has been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. The... | Cerclage | {
"A": "Cerclage",
"B": "Cervical pessary",
"C": "Intravenous betamethasone",
"D": "Vaginal progesterone"
} | step2&3 | A | [
"27 year old woman",
"gravida 3",
"para 1",
"weeks gestation visits",
"physician",
"prenatal",
"feels well",
"current pregnancy",
"uncomplicated",
"attended",
"prenatal appointments",
"followed",
"physician's advice",
"screening",
"diseases",
"laboratory testing",
"diet",
"exercise... |
A 23-year-old female presents to the emergency department complaining of a worsening headache. The patient reports that the headache started one month ago. It is constant and “all over” but gets worse when she is lying down or in the setting of bright lights. Review of systems is significant for low-grade fever, night ... | Administer amphotericin B and 5-flucytosine | {
"A": "Administer fluconazole",
"B": "Administer amphotericin B and 5-flucytosine",
"C": "Administer acyclovir",
"D": "Administer dexamethasone"
} | step2&3 | B | [
"23 year old female presents",
"emergency department complaining of a worsening headache",
"patient reports",
"headache started one month",
"constant",
"all",
"gets worse",
"lying",
"setting",
"bright lights",
"Review of systems",
"significant",
"low-grade fever",
"night sweats",
"cough"... |
A 67-year-old man is brought to the emergency department by his wife due to dizziness, trouble with walking, and progressively worsening headache. These symptoms began approximately two hours prior to arriving to the hospital and were associated with nausea and one episode of vomiting. Medical history is significant fo... | Dentate and interposed nuclei | {
"A": "Dentate and vestibular nuclei",
"B": "Eboliform and fastigial nuclei",
"C": "Dentate and interposed nuclei",
"D": "Vestibular and eboliform nuclei"
} | step1 | C | [
"67 year old man",
"brought",
"emergency department",
"wife due to dizziness",
"walking",
"worsening headache",
"symptoms began approximately two hours prior to",
"hospital",
"associated with nausea",
"one episode of vomiting",
"Medical history",
"significant",
"hypertension",
"hypercholes... |
A 52-year-old woman presents with fatigue and pain of the proximal interphalangeal and metacarpophalangeal joints for the past 6 months. She also has knee and wrist pain that has been present for the past 2 months, with morning stiffness that improves over the course of the day. Physical examination is significant for ... | HLA-DR4 | {
"A": "HLA-DR4",
"B": "HLA-DR2",
"C": "HLA-DQ2",
"D": "HLA-B27"
} | step1 | A | [
"year old woman presents",
"fatigue",
"pain",
"proximal",
"metacarpophalangeal joints",
"past 6 months",
"knee",
"wrist pain",
"present",
"past",
"months",
"morning stiffness",
"improves",
"course",
"day",
"Physical examination",
"significant",
"subcutaneous nodules",
"Laboratory... |
A 27-year-old woman presents to the emergency department for sudden, bilateral, painful loss of vision. She states that her symptoms started last night and have persisted until this morning. The patient has a past medical history of peripheral neuropathy which is currently treated with duloxetine and severe anxiety. He... | A lumbar puncture demonstrating oligoclonal bands | {
"A": "A repeat MRI 3 days later demonstrating periventricular lesions",
"B": "A high resolution CT demonstrating hyperdense lesions",
"C": "A lumbar puncture demonstrating oligoclonal bands",
"D": "Urine toxicology panel demonstrating cocaine use"
} | step2&3 | C | [
"27 year old woman presents",
"emergency department",
"sudden",
"bilateral",
"painful loss of vision",
"states",
"symptoms started last night",
"morning",
"patient",
"past medical peripheral neuropathy",
"currently treated with duloxetine",
"severe anxiety",
"temperature",
"99",
"blood p... |
A 36-year-old woman is fasting prior to a religious ceremony. Her only oral intake in the last 36 hours has been small amounts of water. The metabolic enzyme that is primarily responsible for maintaining normal blood glucose in this patient is located exclusively within the mitochondria. An increase in which of the fol... | Acetyl coenzyme A | {
"A": "Adenosine monophosphate",
"B": "Glucagon",
"C": "Oxidized nicotinamide adenine dinucleotide",
"D": "Acetyl coenzyme A"
} | step1 | D | [
"36 year old woman",
"fasting prior to",
"religious ceremony",
"only oral intake",
"36 hours",
"small amounts",
"water",
"metabolic enzyme",
"responsible",
"maintaining normal blood glucose",
"patient",
"mitochondria",
"increase",
"following substances",
"most likely to increase",
"act... |
An 8-year-old boy is brought to the emergency department 3 hours after being bitten by his neighbor's dog. He was chasing the dog with a stick when it attacked him. He has fed the dog on multiple occasions and it has never bitten him before. His father saw the dog 2 hours after the incident and its behavior seemed norm... | Observe the dog for 10 days | {
"A": "Observe the dog for 10 days",
"B": "Euthanize the dog and test for rabies",
"C": "Administer rabies immune globulin",
"D": "Administer rabies vaccine\n\""
} | step2&3 | A | [
"year old boy",
"brought",
"emergency department",
"hours",
"bitten by",
"neighbor's dog",
"dog",
"stick",
"attacked",
"fed",
"dog",
"multiple occasions",
"never bitten",
"before",
"father saw",
"dog",
"hours",
"incident",
"behavior",
"normal",
"personal",
"family history",... |
A 15-year-old Caucasian male is brought to his pediatrician by his parents, who note the development of a tremor in their child. Urine and serum analysis reveal elevated levels of copper. Which of the following clinical manifestations would the physician most expect to see in this patient? | Kaiser-Fleischer rings | {
"A": "Diabetes mellitus",
"B": "Kaiser-Fleischer rings",
"C": "Panacinar emphysema",
"D": "Increased serum ceruloplasmin"
} | step1 | B | [
"year old Caucasian male",
"brought",
"pediatrician",
"parents",
"note",
"development",
"tremor",
"child",
"Urine",
"serum analysis reveal elevated levels",
"copper",
"of",
"following clinical manifestations",
"physician most",
"to see",
"patient"
] |
A 61-year-old man is brought to the emergency department by his son after collapsing to the ground while at home. His son immediately performed cardiopulmonary resuscitation and later the patient underwent successful defibrillation after being evaluated by the emergency medical technician. The patient has a medical his... | Caudal medulla | {
"A": "Thalamus",
"B": "Pons",
"C": "Caudal medulla",
"D": "Spinal cord"
} | step1 | C | [
"61 year old man",
"brought",
"emergency department",
"son",
"collapsing",
"at home",
"son immediately performed cardiopulmonary resuscitation",
"later",
"patient",
"successful defibrillation",
"evaluated",
"emergency medical technician",
"patient",
"medical",
"hyperlipidemia",
"type I... |
A 67-year-old woman comes to the emergency department 1 hour after her husband saw her faint shortly after getting out of bed from a nap. She regained consciousness within 30 seconds and was fully alert and oriented. She has had 2 similar episodes in the last 5 years, once while standing in line at the grocery store an... | Autonomic dysfunction | {
"A": "Adrenal insufficiency",
"B": "Autonomic dysfunction",
"C": "Structural cardiac abnormality",
"D": "Cardiac arrhythmia"
} | step2&3 | B | [
"67 year old woman",
"emergency department",
"hour",
"husband saw",
"faint",
"getting out",
"bed",
"nap",
"regained consciousness",
"30 seconds",
"alert",
"oriented",
"2 similar episodes",
"5 years",
"standing in line",
"grocery store",
"getting out of bed",
"morning",
"hour Holt... |
A 45-year-old executive travels frequently around the world. He often has difficulty falling asleep at night when he returns home. You suspect a circadian rhythm disorder is responsible for his pathology. Which of the following regulates the circadian rhythm? | Suprachiasmatic nucleus of hypothalamus | {
"A": "Anterior hypothalamus",
"B": "Posterior hypothalamus",
"C": "Supraoptic area of hypothalamus",
"D": "Suprachiasmatic nucleus of hypothalamus"
} | step1 | D | [
"year old executive travels frequently",
"world",
"often",
"difficulty falling asleep",
"night",
"returns home",
"suspect",
"circadian rhythm disorder",
"responsible",
"pathology",
"following",
"circadian rhythm"
] |
A 16-year-old male presents to his pediatrician concerned that he is not maturing like his friends. He has a history of cleft palate status-post multiple surgeries and asthma treated with budesonide and albuterol. He is a good student and is very active on his school’s gymnastics team. His mother is also concerned that... | Decreased testosterone, decreased FSH, decreased LH, decreased GnRH | {
"A": "Decreased testosterone, decreased FSH, decreased LH, decreased GnRH",
"B": "Increased testosterone, decreased FSH, decreased LH, decreased GnRH",
"C": "Decreased testosterone, decreased FSH, decreased LH, increased GnRH",
"D": "Normal testosterone, normal FSH, normal LH, normal GnRH"
} | step1 | A | [
"year old male presents",
"pediatrician concerned",
"not maturing",
"friends",
"history of cleft palate",
"multiple surgeries",
"asthma treated with budesonide",
"albuterol",
"good student",
"very active",
"schools gymnastics team",
"mother",
"concerned",
"son",
"not understand good pers... |
A 26-year-old primigravid woman at 10 weeks' gestation comes to the physician for a prenatal visit. Pregnancy was confirmed by an ultrasound 3 weeks earlier after the patient presented with severe nausea and vomiting. The nausea and vomiting have subsided without medication. She has no vaginal bleeding or discharge. Vi... | Misoprostol therapy | {
"A": "Misoprostol therapy",
"B": "Cervical cerclage",
"C": "Thrombophilia work-up",
"D": "Methotrexate therapy"
} | step2&3 | A | [
"year old primigravid woman",
"10 weeks",
"gestation",
"physician",
"prenatal visit",
"Pregnancy",
"confirmed by",
"ultrasound",
"weeks earlier",
"patient presented",
"severe nausea",
"vomiting",
"nausea",
"vomiting",
"medication",
"vaginal bleeding",
"discharge",
"Vital signs",
... |
A 67-year-old man is brought to the emergency department when he was found obtunded at the homeless shelter. The patient is currently not responsive and smells of alcohol. The patient has a past medical history of alcohol use, IV drug use, and hepatitis C. His temperature is 99°F (37.2°C), blood pressure is 95/65 mmHg,... | Liver failure | {
"A": "Congestive heart failure",
"B": "Dehydration",
"C": "Liver failure",
"D": "Nephrotoxic agent"
} | step2&3 | C | [
"67 year old man",
"brought",
"emergency department",
"found obtunded",
"homeless shelter",
"patient",
"currently not responsive",
"smells",
"alcohol",
"patient",
"past medical history of alcohol use",
"IV drug use",
"hepatitis C",
"temperature",
"blood pressure",
"95 65 mmHg",
"puls... |
Two days after spontaneous delivery, a 23-year-old woman has progressively worsening, throbbing pain in the back of her head. The pain radiates to the neck and shoulder area. The patient is nauseous and had one episode of clear emesis. She wants to be in a dark and quiet room. The patient's symptoms are exacerbated whe... | Epidural blood injection | {
"A": "Send coagulation panel",
"B": "Cerebrospinal fluid analysis",
"C": "Continued bed rest",
"D": "Epidural blood injection"
} | step2&3 | D | [
"Two days",
"spontaneous delivery",
"23 year old woman",
"worsening",
"throbbing pain in",
"back of",
"head",
"pain radiates",
"neck",
"shoulder area",
"patient",
"nauseous",
"one episode of clear emesis",
"to",
"dark",
"quiet room",
"patient's symptoms",
"exacerbated",
"gets",
... |
A 42-year-old man presents to the emergency department with persistent cough. The patient states that for the past week he has been coughing. He also states that he has seen blood in his sputum and experienced shortness of breath. On review of systems, the patient endorses fever and chills as well as joint pain. His te... | Type IV collagen antibody levels | {
"A": "Azithromycin",
"B": "Type IV collagen antibody levels",
"C": "p-ANCA levels",
"D": "Renal biopsy"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"persistent cough",
"patient states",
"past week",
"coughing",
"states",
"seen blood",
"sputum",
"shortness of breath",
"review of systems",
"patient",
"fever",
"chills",
"joint pain",
"temperature",
"blood pressure",
"98 mmHg",
"p... |
A previously healthy 5-year-old boy is brought to the emergency department because of fever, irritability, malaise, and left knee pain for 4 days. Four days ago, he fell off his bike and scraped his elbow. His temperature is 39.1°C (102.4°F). The patient walks with a limp. Examination shows swelling and point tendernes... | Staphylococcus aureus | {
"A": "Staphylococcus epidermidis",
"B": "Staphylococcus aureus",
"C": "Pseudomonas aeruginosa",
"D": "Pasteurella multocida"
} | step1 | B | [
"healthy",
"year old boy",
"brought",
"emergency department",
"fever",
"irritability",
"malaise",
"left knee pain",
"4 days",
"Four",
"fell",
"bike",
"scraped",
"elbow",
"temperature",
"4F",
"patient walks",
"limp",
"Examination shows swelling",
"point tenderness",
"medial as... |
A 64-year-old woman presents to her primary care physician complaining of difficulty maintaining her balance while walking. Her husband comes along to the appointment with her, because he feels that she has not been acting herself at home lately. After further questioning him, it is noted that she has recently been voi... | Dilated ventricles; ventricular shunt | {
"A": "Constricted ventricles; surgical resection",
"B": "Dilated ventricles; ventricular shunt",
"C": "Dilated ventricles; surgical resection",
"D": "Constricted ventricles; watch and wait"
} | step1 | B | [
"64 year old woman presents",
"primary care physician",
"difficulty maintaining",
"balance",
"walking",
"husband",
"appointment",
"feels",
"not",
"acting",
"at home",
"further questioning",
"noted",
"recently",
"voiding urine",
"inappropriate times",
"suspicion",
"intracranial proc... |
A 55-year-old man with type 2 diabetes mellitus comes to the physician for a routine health maintenance. He feels well. His blood pressure is 155/60 mm Hg. Physical exam shows no abnormalities. Laboratory studies show a glucose concentration of 150 mg/dL and a hemoglobin A1c concentration of 9%. Treatment with lisinopr... | ↓ ↑ ↓ | {
"A": "↓ no change ↓",
"B": "↓ ↓ no change",
"C": "↓ ↑ ↓",
"D": "↓ ↓ ↑"
} | step1 | C | [
"55 year old man",
"type 2 diabetes mellitus",
"physician",
"routine health maintenance",
"feels well",
"blood pressure",
"60 mm Hg",
"Physical exam shows",
"abnormalities",
"Laboratory studies show",
"glucose concentration",
"mg/dL",
"a hemoglobin A1c concentration",
"Treatment",
"lisin... |
A 3629-g (8-lb) newborn is examined shortly after spontaneous vaginal delivery. She was delivered at 40 weeks' gestation and pregnancy was uncomplicated. Her mother is concerned because she is not moving her left arm as much as her right arm. Physical examination shows her left arm to be adducted and internally rotated... | Upper trunk | {
"A": "Upper trunk",
"B": "Long thoracic nerve",
"C": "Axillary nerve",
"D": "Posterior cord"
} | step1 | A | [
"g",
"8",
"newborn",
"examined",
"spontaneous vaginal delivery",
"delivered",
"40 weeks",
"gestation",
"pregnancy",
"uncomplicated",
"mother",
"concerned",
"not moving",
"left arm",
"much",
"right arm",
"Physical examination shows",
"left arm to",
"adducted",
"internally rotate... |
A 45-year-old woman presents to the office complaining of bilateral joint pain and stiffness in her hand joints for the past 3 months. She reports increasing difficulty holding a coffee cup or pen due to stiffness, especially in the morning. Over-the-counter ibuprofen partially relieves her symptoms. Past medical histo... | Osteoporosis | {
"A": "Osteoporosis",
"B": "Sacroiliac joint inflammation",
"C": "Obstructive pulmonary disease",
"D": "Osteitis deformans"
} | step2&3 | A | [
"year old woman presents",
"office",
"bilateral joint",
"stiffness in",
"hand joints",
"past 3 months",
"reports increasing difficulty holding",
"coffee cup",
"pen due to stiffness",
"the morning",
"Over",
"counter ibuprofen",
"relieves",
"symptoms",
"Past medical history",
"significan... |
A 40-year-old woman comes to the physician for a preoperative examination before undergoing a planned elective cholecystectomy. She has a history of myasthenia gravis, for which she takes oral pyridostigmine. She has had occasional episodes of muscle weakness, blurred vision, and slurred speech recently. Physical exami... | Increase the dose of pyridostigmine | {
"A": "Administer timed doses of edrophonium",
"B": "Increase the dose of pyridostigmine",
"C": "Discontinue treatment with pyridostigmine",
"D": "Initiate treatment with intravenous atropine"
} | step1 | B | [
"40 year old woman",
"physician",
"preoperative examination",
"planned elective cholecystectomy",
"history",
"myasthenia gravis",
"takes oral pyridostigmine",
"occasional episodes of muscle weakness",
"blurred vision",
"slurred speech recently",
"Physical examination shows mild ptosis",
"pupil... |
A 42-year-old woman presents to the emergency department with abdominal pain. She states that she was eating dinner when she suddenly felt abdominal pain and nausea. The pain did not improve after 30 minutes, so her husband brought her in. The patient has a past medical history of diabetes that is well-treated with exe... | NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 72 hours | {
"A": "NPO, IV fluids, analgesics, antibiotics",
"B": "NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 24 hours",
"C": "NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 48 hours",
"D": "NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 72 hours"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"abdominal pain",
"states",
"eating dinner",
"felt abdominal pain",
"nausea",
"pain",
"not",
"30 minutes",
"husband brought",
"patient",
"past medical diabetes",
"well treated with exercise",
"metformin",
"temperature",
"3C",
"bloo... |
An otherwise healthy 56-year-old man comes to the physician for a 2-year history of recurrent upper abdominal pain and fullness that worsens after meals. Urea breath test is positive. An endoscopy shows diffuse mucosal atrophy and patchy erythema, but no ulcer. A biopsy from which of the following areas is most likely ... | Gastric antrum | {
"A": "Gastric fundus",
"B": "Gastric antrum",
"C": "Duodenal bulb",
"D": "Gastric pylorus"
} | step1 | B | [
"healthy",
"year old man",
"physician",
"2 year history",
"recurrent upper",
"fullness",
"worsens",
"meals",
"Urea breath",
"positive",
"endoscopy shows diffuse mucosal atrophy",
"patchy erythema",
"ulcer",
"biopsy",
"following areas",
"most likely to",
"accurate diagnosis"
] |
To study the flow of blood in the systemic circulation, partially occlusive stents are placed in the pulmonary trunk of a physiological system while the pressure in the right atrium is monitored. A graph where the right atrial pressure is a function of venous return is plotted. Assuming all circulatory nerve reflexes a... | Point III | {
"A": "Point II",
"B": "Point III",
"C": "Point IV",
"D": "Point V"
} | step1 | B | [
"To study",
"flow",
"blood",
"systemic circulation",
"occlusive stents",
"placed",
"pulmonary",
"physiological system",
"pressure",
"right atrium",
"monitored",
"graph",
"right atrial pressure",
"function",
"venous return",
"circulatory nerve reflexes",
"absent",
"system",
"point... |
A 63-year-old man presents to the emergency room with severe upper abdominal pain. His symptoms started 2 days prior to presentation and have progressed rapidly. He has been seen in the emergency room 3 times in the past year for acute alcohol intoxication. His past medical history is notable for multiple deep venous t... | Hepatic vein | {
"A": "Common hepatic artery",
"B": "Hepatic vein",
"C": "Inferior vena cava",
"D": "Splenic vein"
} | step1 | B | [
"63 year old man presents",
"emergency room",
"severe upper abdominal pain",
"symptoms started 2 days prior to presentation",
"progressed rapidly",
"seen",
"emergency room",
"times",
"past year",
"acute alcohol intoxication",
"past medical history",
"notable",
"multiple deep venous thrombose... |
A 27-year-old African American male presents to his family physician for “spots” on his foot. Yesterday, he noticed brown spots on his foot that have a whitish rim around them. The skin lesions are not painful, but he got particularly concerned when he found similar lesions on his penis that appear wet. He recalls havi... | HLA B27 allele | {
"A": "Race",
"B": "HLA B27 allele",
"C": "Co-infection with HIV",
"D": "Diagnosis with psoriasis"
} | step2&3 | B | [
"27 year old African American male presents",
"family physician",
"spots",
"foot",
"brown spots",
"foot",
"rim",
"skin lesions",
"not painful",
"got",
"concerned",
"found similar lesions",
"penis",
"appear wet",
"recalls",
"pain",
"urination",
"last",
"weeks",
"not",
"medical... |
A 28-year-old pregnant female presents for a prenatal check-up at 20 weeks gestation, which includes routine screening ultrasound. Fetal ultrasound demonstrates bilateral multicystic dysplastic kidneys. Her pregnancy has been complicated by persistent oligohydramnios. The child requires significant pulmonary support up... | Clubbed feet | {
"A": "Urachal fistula",
"B": "Esophageal atresia",
"C": "Spina bifida occulta",
"D": "Clubbed feet"
} | step1 | D | [
"year old pregnant female presents",
"prenatal check-up",
"20 weeks gestation",
"includes routine screening ultrasound",
"Fetal",
"demonstrates bilateral multicystic dysplastic kidneys",
"pregnancy",
"complicated",
"persistent oligohydramnios",
"child",
"significant pulmonary support",
"delive... |
A 7-year-old boy is brought to the hospital for evaluation, he is accompanied by agents from child protective services after he was rescued from a home where he was being neglected. He was found locked in a closet and says that he was fed only once every 2 days for the past month. On presentation, he is found to be ext... | Has high affinity for glucose | {
"A": "Has high affinity for glucose",
"B": "Responsive to insulin",
"C": "Has high affinity for fructose",
"D": "Transports glucose against its concentration gradient"
} | step1 | A | [
"year old boy",
"brought",
"hospital",
"evaluation",
"agents",
"child protective services",
"home",
"neglected",
"found locked",
"fed only",
"2 days",
"past month",
"presentation",
"found to",
"extremely emaciated",
"protruding ribs",
"prominent joints",
"provided",
"appropriate ... |
A 23-year-old woman comes to the physician because of vaginal discharge for 4 days. Her last menstrual period was 3 weeks ago. Twelve months ago, she was diagnosed with trichomoniasis, for which she and her partner were treated with a course of an antimicrobial. She is sexually active with one male partner, and they us... | Neisseria gonorrhoeae | {
"A": "Neisseria gonorrhoeae",
"B": "Gardnerella vaginalis",
"C": "Klebsiella granulomatis",
"D": "Treponema pallidum"
} | step1 | A | [
"23 year old woman",
"physician",
"of vaginal discharge",
"4 days",
"last menstrual period",
"3",
"Twelve months",
"diagnosed",
"trichomoniasis",
"partner",
"treated with",
"course",
"antimicrobial",
"sexually active",
"one male partner",
"use condoms",
"only medication",
"combined... |
A 52-year-old woman presents to the physician for a routine physical examination. She has type 2 diabetes that she treats with metformin. Her pulse is 85/min, respiratory rate is 15/min, blood pressure is 162/96 mm Hg, and temperature is 37.0°C (98.6°F). Treatment with a first-line drug is initiated. Which of the follo... | A | {
"A": "A",
"B": "B",
"C": "C",
"D": "E"
} | step2&3 | A | [
"year old woman presents",
"physician",
"routine physical examination",
"type 2 diabetes",
"treats",
"metformin",
"pulse",
"85 min",
"respiratory rate",
"min",
"blood pressure",
"96 mm Hg",
"temperature",
"98",
"Treatment",
"first-line drug",
"initiated",
"following",
"most likel... |
A 59-year-old man comes to the physician because of a 6-month history of numbness and burning sensation in his feet that is worse at rest. He has not been seen by a physician in several years. He is 178 cm (5 ft 10 in) tall and weighs 118 kg (260 lb); BMI is 37.3 kg/m2. Physical examination shows decreased sensation to... | Accumulation of islet amyloid polypeptide | {
"A": "Accumulation of islet amyloid polypeptide",
"B": "Complement-mediated destruction of insulin receptors",
"C": "Increased production of adiponectin by adipocytes",
"D": "Lymphocytic infiltration of islet cells"
} | step1 | A | [
"59 year old man",
"physician",
"month history",
"numbness",
"burning sensation",
"feet",
"worse",
"rest",
"not",
"seen by",
"physician",
"several years",
"5 ft 10",
"tall",
"kg",
"BMI",
"kg/m2",
"Physical examination shows decreased sensation",
"light touch",
"vibration",
"s... |
A 55-year-old woman who works as a chef is brought to the hospital for evaluation of burns sustained in a kitchen accident. Physical examination reveals 3rd-degree burns over the anterior surface of the right thigh and the lower limbs, which involve approx. 11% of the total body surface area (TBSA). The skin in the bur... | Early excision and split-thickness skin grafting | {
"A": "Early excision and split-thickness skin grafting",
"B": "Delayed excision and skin grafting",
"C": "Topical antibiotic application of mafenide acetate",
"D": "Fluid resuscitation with Ringer’s lactate solution per the Parkland formula"
} | step2&3 | A | [
"55 year old woman",
"works",
"chef",
"brought",
"hospital",
"evaluation",
"burns sustained",
"kitchen accident",
"Physical examination reveals 3rd degree burns",
"anterior surface of",
"right thigh",
"lower limbs",
"total",
"skin",
"burned areas",
"thick",
"painless",
"touch",
"... |
A 7-year-old boy with a past medical history significant only for prior head lice infection presents to the clinic after being sent by the school nurse for a repeat lice infection. The boy endorses an itchy scalp, but a review of systems is otherwise negative. After confirming the child’s diagnosis and sending him home... | Treatment of household members with topical ivermectin | {
"A": "Observation with close monitoring",
"B": "Encourage family to move out of their home",
"C": "Treatment of household members with topical ivermectin",
"D": "Treatment with oral albendazole"
} | step2&3 | C | [
"year old boy",
"past medical history significant only",
"prior head lice infection presents",
"clinic",
"sent",
"school nurse",
"repeat lice infection",
"boy",
"itchy scalp",
"review of systems",
"negative",
"confirming",
"childs diagnosis",
"sending",
"home",
"appropriate treatment",... |
A 24-year-old woman at 6 weeks gestation seeks evaluation at a local walk-in clinic because she has noticed a clear, sticky discharge from her right nipple for the past 1 week. The discharge leaves a pink stain on her bra. She does not have pain in her breasts and denies changes in skin color or nipple shape. The past ... | Papilloma | {
"A": "Mastitis",
"B": "Drug-induced",
"C": "Papilloma",
"D": "Breast cancer"
} | step1 | C | [
"year old woman",
"6 weeks gestation",
"evaluation",
"local walk-in clinic",
"clear",
"discharge from",
"right nipple",
"past",
"week",
"discharge leaves",
"pink stain",
"bra",
"not",
"pain in",
"breasts",
"denies changes in skin color",
"nipple shape",
"past medical history",
"s... |
A 56-year-old woman, gravida 3, para 3, comes to the physician because her left breast has become larger, hot, and itchy over the past 2 months. The patient felt a small lump in her left breast 1 year ago but did not seek medical attention at that time. She has hypertension and hyperlipidemia. Menarche was at the age o... | Inflammatory breast cancer | {
"A": "Paget's disease of the breast",
"B": "Mastitis",
"C": "Breast abscess",
"D": "Inflammatory breast cancer"
} | step2&3 | D | [
"year old woman",
"gravida 3",
"para 3",
"physician",
"left breast",
"larger",
"hot",
"itchy",
"past",
"months",
"patient felt",
"small lump in",
"left breast",
"year",
"not",
"medical attention",
"time",
"hypertension",
"hyperlipidemia",
"Menarche",
"age",
"years",
"meno... |
A 22-year-old man is brought to the emergency department 25 minutes after an episode of violent jerky movements of his arms and legs. He has no recollection of the episode. The episode lasted for 3–4 minutes. His girlfriend reports that he has not been sleeping well over the past month. He is only oriented to place and... | Electroencephalography | {
"A": "Lorazepam",
"B": "Tilt table test",
"C": "Electroencephalography",
"D": "Lamotrigine"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"minutes",
"episode of violent jerky movements",
"arms",
"legs",
"recollection of",
"episode",
"episode lasted",
"minutes",
"girlfriend reports",
"not",
"sleeping well",
"past month",
"only oriented to place",
"person",
"temperatur... |
A 60-year-old man is admitted to the ER for a severe persistent abdominal pain of 6 hours duration with nausea, vomiting, and steatorrhea. His medical history is relevant for multiple similar episodes of abdominal pain, hypertension, a recent fasting plasma glucose test of 150 mg/dL, and an HbA1c of 7.8%. His temperatu... | Low serum trypsin, low stool elastase | {
"A": "Elevated amylase, elevated lipase",
"B": "Low serum trypsin, low stool elastase",
"C": "High serum trypsin, high stool elastase",
"D": "Elevated alkaline phosphatase, elevated total bilirubin"
} | step2&3 | B | [
"60 year old man",
"admitted",
"ER",
"severe persistent abdominal",
"hours duration",
"nausea",
"vomiting",
"steatorrhea",
"medical history",
"relevant",
"multiple similar episodes of abdominal pain",
"hypertension",
"recent fasting plasma glucose test",
"mg/dL",
"temperature",
"98",
... |
An investigator is studying the effect of chromatin structure on gene regulation. The investigator isolates a class of proteins that compact DNA by serving as spools upon which DNA winds around. These proteins are most likely rich in which of the following compounds? | Lysine and arginine | {
"A": "Phosphate",
"B": "Heparan sulfate",
"C": "Lysine and arginine",
"D": "Disulfide-bonded cysteine"
} | step1 | C | [
"investigator",
"studying",
"effect",
"chromatin structure",
"gene regulation",
"investigator isolates a class",
"proteins",
"compact DNA",
"serving",
"spools",
"DNA winds",
"proteins",
"most likely rich",
"following compounds"
] |
A 73-year-old man comes to the physician because of a 2-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 2-cm mass located above the dentate line. Further evaluation of the mass confirms adenocarcinoma. Which of the following describes the most likely ro... | Superior rectal vein → inferior mesenteric vein → hepatic portal vein | {
"A": "Superior rectal vein → inferior mesenteric vein → hepatic portal vein",
"B": "Inferior rectal vein → inferior mesenteric vein → splenic vein",
"C": "Superior rectal vein → superior mesenteric vein → hepatic portal vein",
"D": "Inferior rectal vein → internal pudendal vein → external iliac vein"
} | step1 | A | [
"year old man",
"physician",
"2 month history",
"intermittent blood",
"stool",
"pain",
"defecation",
"Physical examination shows",
"2",
"mass",
"above",
"line",
"Further evaluation",
"mass confirms adenocarcinoma",
"following",
"most likely route",
"hematogenous spread",
"malignanc... |
A 12-year-old boy and his mother are brought to the emergency department after a motor vehicle accident. The boy was an unrestrained passenger in a head-on collision and was ejected from the front seat. The patient's mother was the driver and she is currently being resuscitated. Neither the child nor the mother are con... | Do not transfuse the mother and transfuse the boy | {
"A": "Consult the hospital ethics committee",
"B": "Do not transfuse the boy or the mother",
"C": "Do not transfuse the mother and transfuse the boy",
"D": "Transfuse the boy and mother"
} | step2&3 | C | [
"year old boy",
"mother",
"brought",
"emergency department",
"motor vehicle accident",
"boy",
"passenger",
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"collision",
"front",
"patient's mother",
"driver",
"currently",
"resuscitated",
"child",
"mother",
"conscious",
"documented",
"family",
"Jehovah's witnesses",
"... |
A 68-year-old woman comes to the physician because of increasing heartburn for the last few months. During this period, she has taken ranitidine several times a day without relief and has lost 10 kg (22 lbs). She has retrosternal pressure and burning with every meal. She has had heartburn for several years and took ran... | Esophagogastroduodenoscopy | {
"A": "24-hour esophageal pH monitoring",
"B": "Trial of proton-pump inhibitor",
"C": "Esophageal manometry",
"D": "Esophagogastroduodenoscopy"
} | step2&3 | D | [
"68 year old woman",
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"of increasing heartburn",
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"burning",
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"heartburn",
"years",
"took ranitidine as needed",
"hypertension",
"smoked one pack",
... |
A 66-year-old man is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision in which he was the unrestrained passenger. His wife confirms that he has hypertension, atrial fibrillation, and chronic lower back pain. Current medications include metoprolol, warfarin, hyd... | Hyperventilation | {
"A": "Hyperventilation",
"B": "Decompressive craniectomy",
"C": "Lumbar puncture",
"D": "Intravenous mannitol"
} | step2&3 | A | [
"66 year old man",
"brought",
"emergency department 20 minutes",
"involved",
"high speed motor vehicle collision",
"passenger",
"wife confirms",
"hypertension",
"atrial fibrillation",
"chronic lower back pain",
"Current medications include metoprolol",
"warfarin",
"hydrochlorothiazide",
"o... |
A 29-year-old woman comes to her primary care physician hoping she is pregnant. She reports that she had been taking oral contraceptive pills, but she stopped when she began trying to get pregnant about 7 months ago. Since then she has not had her period. She took a few home pregnancy tests that were negative, but she ... | Serum thyroid-stimulating hormone level | {
"A": "Mammogram",
"B": "Magnetic resonance imaging of the head",
"C": "Serum follicle-stimulating hormone/luteinizing hormone ratio",
"D": "Serum thyroid-stimulating hormone level"
} | step2&3 | D | [
"29 year old woman",
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"reports",
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"began",
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"7 months",
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"not",
"period",
"took",
"few home pregnancy tests",
"negative",
"feels",
"wrong",
"gained 4 lbs",
"past mon... |
A 72-year-old man comes to the physician for a routine physical examination. He does not take any medications. Physical examination shows no abnormalities. Laboratory studies show a calcium concentration of 8.5 mg/dL, a phosphorus concentration of 3.1 mg/dL, an elevated bone-specific alkaline phosphatase concentration,... | Increased osteoblast activity | {
"A": "Decreased osteoclast activity",
"B": "Increased osteoblast activity",
"C": "Decreased parathyroid chief cell activity",
"D": "Increased chondroblast activity"
} | step1 | B | [
"72 year old man",
"physician",
"routine physical examination",
"not take",
"medications",
"Physical examination shows",
"abnormalities",
"Laboratory studies show",
"calcium concentration",
"8.5 mg/dL",
"phosphorus concentration",
"mg/dL",
"elevated bone-specific alkaline phosphatase concent... |
A 28-year-old woman who has never been pregnant presents to the physician for a follow-up examination. She has had 5 months of deep pain during sexual intercourse and pelvic pain that intensified prior to her menses. The pain has not subsided despite taking oral contraceptives. She denies any vaginal discharge or foul ... | Laparoscopy | {
"A": "Abdominopelvic computed tomography (CT) scan",
"B": "Cancer antigen 125 (CA-125)",
"C": "Laparoscopy",
"D": "Dilation and curettage"
} | step2&3 | C | [
"year old woman",
"never",
"pregnant presents",
"physician",
"follow-up examination",
"5 months",
"deep pain",
"sexual intercourse",
"pelvic pain",
"prior to",
"menses",
"pain",
"not",
"oral contraceptives",
"denies",
"vaginal discharge",
"smell",
"monogamous relationship",
"husb... |
A 62-year-old woman with metastatic breast cancer comes to the physician because of a 2-day history of fever, chills, and new gluteal lesions. The lesions began as painless red macules and evolved into painful ulcers overnight. She received her fourth course of palliative chemotherapy 2 weeks ago. Her temperature is 38... | Exotoxin A | {
"A": "Edema toxin",
"B": "Heat-stable toxin",
"C": "Toxic shock syndrome toxin-1",
"D": "Exotoxin A"
} | step1 | D | [
"62 year old woman",
"metastatic",
"physician",
"2-day history",
"fever",
"chills",
"new gluteal lesions",
"lesions began",
"painless red macules",
"evolved",
"painful ulcers overnight",
"received",
"fourth course",
"palliative chemotherapy 2 weeks",
"temperature",
"100",
"Laboratory... |
A 61-year-old female presents to her primary care physician complaining of fatigue and feeling sad. She reports that ever since her husband passed away 3 months ago, she has noticed a decrease in her energy level and reports frequently awaking at 2 in the morning and cannot fall back asleep. She sometimes wakes up and ... | Major depressive disorder | {
"A": "Bipolar II disorder",
"B": "Major depressive disorder",
"C": "Acute grief",
"D": "Persistent depressive disorder"
} | step1 | B | [
"61 year old female presents",
"primary care physician",
"fatigue",
"feeling sad",
"reports",
"ever",
"husband passed",
"months",
"decrease",
"energy level",
"reports frequently awaking at",
"morning",
"fall back asleep",
"sometimes wakes up",
"hears",
"husband's voice",
"constantly ... |
A physician is describing a case to his residents where a kidney transplant was rapidly rejected by the recipient minutes after graft perfusion. The physician most likely describes all of the following manifestations EXCEPT? | Histological evidence of arteriosclerosis | {
"A": "Graft cyanosis",
"B": "Low urine output with evidence of blood",
"C": "Histological evidence of arteriosclerosis",
"D": "Histological evidence of vascular damage"
} | step1 | C | [
"physician",
"case",
"residents",
"kidney transplant",
"rapidly rejected",
"recipient minutes",
"graft perfusion",
"physician",
"likely",
"of",
"following manifestations"
] |
A 32-year-old man comes to the physician because of a 3-month history of intermittent flank pain and reddish discoloration of urine. His blood pressure is 150/92 mm Hg. His serum creatinine concentration is 1.4 mg/dL. An abdominal CT scan is shown. This patient's condition is most likely caused by a genetic defect in w... | Short arm of chromosome 16 | {
"A": "Short arm of chromosome 16",
"B": "Short arm of chromosome 3",
"C": "Long arm of chromosome 10",
"D": "Short arm of chromosome 6"
} | step1 | A | [
"year old man",
"physician",
"3 month history",
"intermittent flank",
"discoloration",
"urine",
"blood pressure",
"mm Hg",
"serum concentration",
"1.4 mg/dL",
"abdominal CT",
"shown",
"patient's condition",
"most likely caused",
"genetic defect",
"following locations"
] |
A 6-year-old boy is brought to the physician because of inability to concentrate and difficulties completing assignments at school. His mother says that he frequently interrupts others during conversations at home and that his teachers often reprimand him for talking excessively in school. He refuses to play with the o... | Prenatal alcohol exposure | {
"A": "Nondisjunction of chromosome 21",
"B": "Deletion of long arm of chromosome 7",
"C": "Prenatal alcohol exposure",
"D": "FMR1 gene mutation"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"to concentrate",
"difficulties completing assignments",
"school",
"mother",
"frequently interrupts others",
"conversations at home",
"teachers often",
"talking excessively",
"school",
"refuses to play",
"children",
"often",
"physical altercation... |
A 27-year-old female is brought in by ambulance with altered mental status. She is in a comatose state, but is breathing spontaneously with deep and rapid respirations. Her vital signs are as follows: T 100.2F, BP 92/54 mmHg, HR 103 bpm, RR 28, and SpO2 97% on room air. Complete blood count reveals: WBC 12.7, hemoglobi... | Medication overdose | {
"A": "Undiagnosed type 1 diabetes mellitus",
"B": "Severe sepsis",
"C": "Medication overdose",
"D": "Acute renal failure"
} | step1 | C | [
"27 year old female",
"brought",
"ambulance",
"altered mental status",
"comatose state",
"breathing",
"deep",
"rapid respirations",
"vital signs",
"follows",
"T 100",
"BP",
"54 mmHg",
"RR",
"97",
"room air",
"Complete blood count reveals",
"WBC",
"hemoglobin",
"platelets",
"B... |
Researchers are studying the relationship between heart disease and alcohol consumption. They review the electronic medical records of 500 patients at a local hospital during the study period and identify the presence or absence of acute coronary syndrome (ACS) and the number of alcoholic drinks consumed on the day of ... | Cross-sectional study | {
"A": "Randomized controlled trial",
"B": "Case-control study",
"C": "Cross-sectional study",
"D": "Retrospective study"
} | step2&3 | C | [
"Researchers",
"studying",
"relationship",
"heart",
"alcohol consumption",
"review",
"electronic medical records",
"500 patients",
"local hospital",
"study period",
"presence",
"absence",
"acute coronary syndrome",
"number",
"alcoholic drinks",
"day",
"presentation",
"researchers",... |
A 69-year-old man is brought to the emergency department because of a 1-week history of recurring black stools. On questioning, he reports fatigue and loss of appetite over the last 3 months. Twenty years ago, he underwent a partial gastrectomy for peptic ulcer disease. The patient's father died of metastatic colon can... | Abdominopelvic CT scan | {
"A": "Stool antigen test for H. pylori",
"B": "Laparoscopy",
"C": "Abdominopelvic CT scan",
"D": "Vitamin B12 assessment"
} | step2&3 | C | [
"69 year old man",
"brought",
"emergency department",
"1-week history",
"recurring black stools",
"questioning",
"reports fatigue",
"loss of appetite",
"last",
"months",
"Twenty years",
"partial gastrectomy",
"peptic ulcer disease",
"patient's father died of metastatic colon cancer",
"ag... |
A 21-year-old woman comes to the physician because of a 4-month history of fatigue. She admits to binge eating several times per month, after which she usually induces vomiting for compensation. She exercises daily in an effort to lose weight. She is 168 cm (5 ft 6 in) tall and weighs 60 kg (132 lb); BMI is 21.3 kg/m2.... | Fluoxetine | {
"A": "Orlistat",
"B": "Mirtazapine",
"C": "Venlafaxine",
"D": "Fluoxetine"
} | step1 | D | [
"21-year-old woman",
"physician",
"4 month history",
"fatigue",
"admits to binge eating",
"times",
"month",
"usually induces vomiting",
"compensation",
"exercises daily",
"effort to",
"weight",
"5 ft 6",
"tall",
"60 kg",
"BMI",
"kg/m2",
"Physical examination shows calluses",
"knu... |
A 33-year-old man comes to the physician with his wife for evaluation of infertility. They have been unable to conceive for 2 years. The man reports normal libido and erectile function. He has smoked one pack of cigarettes daily for 13 years. He does not take any medications. He has a history of right-sided cryptorchid... | Decreased inhibin B concentration | {
"A": "Increased placental ALP concentration",
"B": "Increased prolactin concentration",
"C": "Decreased inhibin B concentration",
"D": "Decreased FSH concentration"
} | step1 | C | [
"year old man",
"physician",
"wife",
"evaluation",
"infertility",
"unable to",
"years",
"man reports normal libido",
"erectile function",
"smoked one pack",
"cigarettes daily",
"years",
"not take",
"medications",
"history",
"right-sided cryptorchidism",
"surgically corrected",
"yea... |
A 17-year-old boy was brought to the emergency department because of palpitations and lightheadedness that began 16 hours ago. He admitted to binge drinking the night before. He was sedated and electrically cardioverted. An ECG that was recorded following cardioversion is shown. After regaining consciousness, he was ad... | Administer procainamide | {
"A": "Administer magnesium sulfate",
"B": "Administer verapamil",
"C": "Administer atenolol",
"D": "Administer procainamide"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"palpitations",
"lightheadedness",
"began",
"hours",
"admitted to binge drinking",
"night",
"sedated",
"electrically",
"ECG",
"recorded following cardioversion",
"shown",
"regaining consciousness",
"admitted for observation",
"Serum"... |
A 4-year-old girl is brought to the emergency department after falling about from a chair and injuring her right leg. During the past 2 years, she has had two long bone fractures. She is at the 5th percentile for height and 20th percentile for weight. Her right lower leg is diffusely erythematous. The patient withdraws... | Type 1 collagen defect | {
"A": "Type 3 collagen defect",
"B": "Type 1 collagen defect",
"C": "Type 4 collagen defect",
"D": "Type 2 collagen defect"
} | step1 | B | [
"4 year old girl",
"brought",
"emergency department",
"falling",
"from",
"chair",
"right leg",
"past",
"years",
"two long bone fractures",
"5th percentile",
"height",
"percentile",
"weight",
"right lower leg",
"erythematous",
"patient withdraws",
"lower leg",
"touched",
"photog... |
A 21-year-old woman with type 1 diabetes mellitus suddenly develops tremors, cold sweats, and confusion while on a backpacking trip with friends. She is only oriented to person and is unable to follow commands. Her fingerstick blood glucose concentration is 28 mg/dL. Her friend administers an intramuscular injection wi... | Activation of adenylyl cyclase | {
"A": "Activation of glucokinase",
"B": "Inhibition of glucose-6-phosphatase",
"C": "Inhibition of α-glucosidase",
"D": "Activation of adenylyl cyclase"
} | step1 | D | [
"21-year-old woman",
"type 1 diabetes mellitus",
"tremors",
"cold sweats",
"confusion",
"trip",
"friends",
"only oriented to person",
"unable to follow commands",
"fingerstick blood glucose concentration",
"28 mg",
"friend administers",
"intramuscular injection",
"substance",
"reverses",... |
A 52-year-old diabetic man presents with fever, headache, and excruciating pain in his right eye for the past 2 days. He says that he has been taking sitagliptin and metformin regularly. He endorses recently having a sore throat. On examination, vesicles are present in groups with an erythematous base on the upper eyel... | Ophthalmic nerve | {
"A": "Nasociliary nerve",
"B": "Ophthalmic nerve",
"C": "Supraorbital nerve",
"D": "Lacrimal nerve"
} | step1 | B | [
"year old diabetic man presents",
"fever",
"headache",
"excruciating pain in",
"right eye",
"past 2 days",
"taking sitagliptin",
"metformin",
"recently",
"sore throat",
"examination",
"vesicles",
"present",
"groups",
"erythematous base",
"upper eyelid",
"forehead",
"nose",
"right... |
A 42-year-old man presents to his primary care provider with recent swelling in his legs that has now spread to the lower part of his thighs. He sometimes has difficulty putting on his shoes and pants. He also noticed puffiness under his eyes over the last 3 weeks. A 24-hour urine collection confirms proteinuria of 5 g... | Hepatitis B infection | {
"A": "HIV infection",
"B": "High HbA1C",
"C": "Hepatitis B infection",
"D": "Monoclonal protein spike"
} | step2&3 | C | [
"year old man presents",
"primary care provider",
"recent swelling",
"legs",
"now spread",
"lower part of",
"thighs",
"sometimes",
"difficulty putting on",
"shoes",
"pants",
"puffiness",
"eyes",
"last",
"weeks",
"24-hour urine collection confirms proteinuria",
"5 g day",
"Electron ... |
A 24-year-old woman comes to the physician for an annual routine examination. Menses occur at regular 28-day intervals and last for 4 days with normal flow. Her last menstrual period was 3 weeks ago. She is sexually active with one male partner and they use condoms consistently. The patient is 160 cm (5 ft 3 in) tall a... | Follow-up examination | {
"A": "Diagnostic laparoscopy",
"B": "CA-125 level",
"C": "Oral contraceptive",
"D": "Follow-up examination"
} | step2&3 | D | [
"year old woman",
"physician",
"annual routine examination",
"Menses occur",
"regular",
"day intervals",
"last",
"4 days",
"normal flow",
"last menstrual period",
"3 weeks",
"sexually active",
"one male partner",
"use condoms",
"patient",
"5 ft",
"tall",
"72 kg",
"BMI",
"kg/m2"... |
A 21-year-old man presents with fever, headache, and clouded sensorium for the past 3 days. His fever is low-grade. He says his headache is mild-to-moderate in intensity and associated with nausea, vomiting, and photophobia. There is no history of a sore throat, pain on urination, abdominal pain, or loose motions. He s... | Clouded sensorium | {
"A": "Clouded sensorium",
"B": "Headache",
"C": "Nausea and vomiting",
"D": "Photophobia"
} | step2&3 | A | [
"21-year-old man presents",
"fever",
"headache",
"clouded sensorium",
"past 3 days",
"fever",
"low-grade",
"headache",
"mild-to-moderate",
"intensity",
"associated with nausea",
"vomiting",
"photophobia",
"history",
"sore throat",
"pain",
"urination",
"abdominal pain",
"loose mot... |
A 68-year-old man comes to the physician because of a 3-month history of anorexia, weight loss, and cough productive of blood-tinged sputum with yellow granules. Four months ago he was treated for gingivitis. He has smoked 1 pack of cigarettes daily for 40 years. Examination shows crackles over the right upper lung fie... | Penicillin G | {
"A": "Penicillin G",
"B": "Trimethoprim-sulfamethoxazole",
"C": "Rifampin, isoniazid, pyrazinamide, and ethambutol",
"D": "Itraconazole"
} | step1 | A | [
"68 year old man",
"physician",
"3 month history",
"anorexia",
"weight loss",
"cough productive of blood tinged sputum",
"yellow granules",
"Four months",
"treated",
"gingivitis",
"smoked 1 pack",
"cigarettes daily",
"40 years",
"Examination shows crackles",
"right upper lung field",
"... |
A 70-year-old man comes to the physician because of intermittent shortness of breath while going up stairs and walking his dog. It began about 1 month ago and seems to be getting worse. He has also developed a dry cough. He has not had any wheezing, fevers, chills, recent weight loss, or shortness of breath at rest. He... | Occupational exposure | {
"A": "Occupational exposure",
"B": "Advanced age",
"C": "Family history",
"D": "Radiation therapy"
} | step2&3 | A | [
"70 year old man",
"physician",
"of intermittent shortness",
"breath",
"stairs",
"walking",
"dog",
"began",
"month",
"to",
"getting worse",
"dry cough",
"not",
"wheezing",
"fevers",
"chills",
"recent weight loss",
"shortness of breath",
"rest",
"history of Hodgkin lymphoma",
... |
A 65-year-old obese woman presents with changes in her left breast. The patient states that, about a month ago, she noticed that she was able to feel a hard mass in the upper outer quadrant of her left breast, which has not gone away. In addition, her nipple and skin overlying the breast have started to look different.... | Trastuzumab | {
"A": "Goserelin",
"B": "Trastuzumab",
"C": "Anastrozole",
"D": "Raloxifene"
} | step2&3 | B | [
"65 year old obese woman presents",
"changes",
"left breast",
"patient states",
"month",
"able to feel",
"hard mass",
"upper outer quadrant of",
"left breast",
"not",
"addition",
"nipple",
"skin",
"breast",
"started to look different",
"Past medical history",
"significant",
"polycy... |
An 11-year-old boy is brought to the doctor by his father because his father is worried about the boy's performance in school and his lack of a social life. His father is also worried about the ongoing bullying his son is experiencing due to swearing outbursts the boy has exhibited for several years. During these outbu... | Risperidone | {
"A": "Valproic acid",
"B": "Risperidone",
"C": "Clonazepam",
"D": "Lithium"
} | step2&3 | B | [
"year old boy",
"brought",
"doctor",
"father",
"father",
"worried",
"boy's performance in school",
"lack",
"social life",
"father",
"worried",
"ongoing bullying",
"son",
"experiencing due to swearing outbursts",
"boy",
"exhibited",
"years",
"outbursts",
"boy",
"face",
"blinks... |
A 54-year-old woman presents to the emergency room after falling on her right side at a bar and breaking her clavicle and 2 ribs. Her husband reports that she has had a 6-month history of diarrhea and has lost 6.8 kg (15 lb) over the last year without dieting or exercising. She has a family history of type I diabetes. ... | Insulin aspart and glargine with pancreatic enzyme replacement therapy | {
"A": "Thiamine and 50% dextrose",
"B": "Pancreatic resection followed by 5-fluorouracil with leucovorin",
"C": "Insulin aspart and glargine",
"D": "Insulin aspart and glargine with pancreatic enzyme replacement therapy"
} | step1 | D | [
"54 year old woman presents",
"emergency room",
"falling",
"right side",
"bar",
"breaking",
"clavicle",
"2 ribs",
"husband reports",
"6 month history",
"diarrhea",
"lost",
"kg",
"last year",
"dieting",
"exercising",
"family history",
"type I",
"physical exam",
"ecchymosis",
"... |
A 34-year-old G2P1 female at 37 weeks of gestation presents to the clinic for complaints of right-hand numbness and pain for the past month. She reports that the pain is usually worse at night and that she would sometimes wake up in the middle of the night from the “pins and needles.” She denies fever, weakness, or wei... | Tingling when the right wrist is percussed | {
"A": "Hairline fracture of the scaphoid bone on magnetic resonance imaging (MRI)",
"B": "Small cross-sectional area of the median nerve on ultrasonography",
"C": "Tingling when the right wrist is percussed",
"D": "Tingling when the wrists are extended 90 degrees"
} | step1 | C | [
"year old",
"female",
"weeks of gestation presents",
"clinic",
"complaints of right hand numbness",
"pain",
"past month",
"reports",
"pain",
"usually worse",
"night",
"sometimes wake up",
"middle",
"night",
"pins",
"needles",
"denies fever",
"weakness",
"weight changes",
"pares... |
A 6-year-old boy presents to his pediatrician’s office for muscle weakness. The patient is accompanied by his mother who states that he has difficulty running and walking up the stairs. The mother has noticed mild weakness when the patient attempts to sit up from a supine position since he was 4-years-old. Medical hist... | Genetic testing | {
"A": "Electromyogram",
"B": "Genetic testing",
"C": "Muscle biopsy",
"D": "Serum creatine kinase level"
} | step2&3 | B | [
"year old boy presents",
"pediatricians office",
"muscle weakness",
"patient",
"mother",
"states",
"difficulty running",
"walking",
"stairs",
"mother",
"mild weakness",
"patient attempts to sit up",
"supine position",
"4 years old",
"Medical history",
"significant",
"fractures involv... |
A 26-year-old male currently undergoing standard therapy for a recently diagnosed active tuberculosis infection develops sudden onset of fever and oliguria. Laboratory evaluations demonstrate high levels of eosinophils in both the blood and urine. Which of the following is most likely responsible for the patient’s symp... | Rifampin | {
"A": "Rifampin",
"B": "Isoniazid",
"C": "Ethambutol",
"D": "Return of active tuberculosis symptoms secondary to patient non-compliance with anti-TB regimen"
} | step1 | A | [
"year old male currently",
"standard therapy",
"recently diagnosed active tuberculosis infection",
"sudden",
"fever",
"oliguria",
"Laboratory evaluations",
"high levels",
"eosinophils",
"blood",
"urine",
"following",
"most likely responsible",
"patients symptoms"
] |
A 3-year-old boy is brought to the physician for evaluation of a generalized, pruritic rash. The rash began during infancy and did not resolve despite initiating treatment with topical corticosteroids. Three months ago, he was treated for several asymptomatic soft tissue abscesses on his legs. He has been admitted to t... | Impaired chemotaxis of neutrophils | {
"A": "Impaired chemotaxis of neutrophils",
"B": "Impaired actin assembly in lymphocytes",
"C": "Impaired Ig class-switching in lymphocytes",
"D": "Impaired interferon-γ secretion by Th1 cells"
} | step1 | A | [
"3 year old boy",
"brought",
"physician",
"evaluation",
"generalized",
"pruritic rash",
"rash began",
"infancy",
"not resolve",
"initiating treatment",
"topical corticosteroids",
"Three months",
"treated",
"asymptomatic soft tissue abscesses",
"legs",
"admitted",
"hospital three time... |
A 2-month-old boy is brought to the pediatrician for a routine check-up. His mother says he is feeding well and has no concerns. He is at the 85th percentile for height and 82nd percentile for weight. Immunizations are up-to-date. Results of serum hepatitis B surface IgG antibody testing are positive. Which of the foll... | Passive immunity | {
"A": "Window period",
"B": "Spontaneous recovery",
"C": "Vaccination reaction",
"D": "Passive immunity"
} | step1 | D | [
"2 month old boy",
"brought",
"pediatrician",
"routine check-up",
"mother",
"feeding well",
"concerns",
"percentile",
"height",
"percentile",
"weight",
"Immunizations",
"to date",
"Results",
"serum hepatitis B surface IgG antibody testing",
"positive",
"following best",
"patient's ... |
A 60-year-old man comes to the physician because of progressive pain in his right hip and lower back over the past 4 weeks. He describes the pain as dull and constant. It is worse with exertion and at night. Over the past 2 months, he has helped his son with renovating his home, which required heavy lifting and kneelin... | Increased rate of bone remodeling | {
"A": "Increased rate of bone remodeling",
"B": "Decreased bone mass with microarchitectural disruption",
"C": "Infarction of the bone and marrow",
"D": "Osteoblastic destruction of the bone"
} | step2&3 | A | [
"60 year old man",
"physician",
"of progressive pain in",
"right hip",
"lower back",
"past 4 weeks",
"pain",
"dull",
"constant",
"worse",
"exertion",
"night",
"past",
"months",
"helped",
"son",
"home",
"required heavy lifting",
"kneeling",
"father died of prostate cancer",
"d... |
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