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 32-year-old man comes to the physician because of low-grade fever, dry cough, and shortness of breath. His symptoms began 6 days ago while he was on vacation in Thailand where he went to an urgent care clinic and was started on cefuroxime. His temperature is 38.2°C (100.8°F). Physical examination shows decreased brea... | Lack of peptidoglycan in cell wall | {
"A": "Lack of peptidoglycan in cell wall",
"B": "Enclosure by polysaccharide capsule",
"C": "Formation of biofilms",
"D": "Rapid alteration of drug binding sites"
} | step1 | A | [
"year old man",
"physician",
"low-grade fever",
"dry cough",
"shortness of breath",
"symptoms began 6 days",
"vacation",
"Thailand",
"urgent care clinic",
"started",
"cefuroxime",
"temperature",
"100",
"Physical examination shows decreased breath sounds",
"bilateral lung bases",
"x-ray... |
Four days after undergoing a coronary artery bypass graft for coronary artery disease, a 60-year-old man complains of abdominal fullness and bloating. Since his surgery, he has not had a bowel movement and is unable to pass flatus. He has no nausea or vomiting. Prior to the operation, the patient had daily bowel moveme... | Laparotomy | {
"A": "Nasogastric and rectal tube insertion",
"B": "Colonoscopy",
"C": "Intravenous neostigmine therapy",
"D": "Laparotomy"
} | step2&3 | D | [
"Four days",
"coronary artery bypass graft",
"disease",
"60 year old man",
"abdominal fullness",
"bloating",
"surgery",
"not",
"bowel movement",
"unable to pass flatus",
"nausea",
"vomiting",
"operation",
"patient",
"daily bowel movements",
"abnormalities",
"history of bipolar disord... |
A 42-year-old woman presents with trouble focusing. She says that she has trouble focusing on simple tasks and her thoughts are very scattered. These difficulties have been present since she was a young student in elementary school. She says she had difficulty focusing both at school and at home. The patient is diagnos... | “Appetite suppression is a common side effect of this medication.” | {
"A": "“Appetite suppression is a common side effect of this medication.”",
"B": "“Bupropion is less effective in adults with this disorder than this medication.”",
"C": "“Chronic use of this medication can lead to tardive dyskinesia.”",
"D": "“Hypotension is a common side effect of this medication.”"
} | step1 | A | [
"year old woman presents",
"trouble focusing",
"trouble focusing",
"simple tasks",
"thoughts",
"very scattered",
"difficulties",
"present",
"young student",
"elementary",
"difficulty focusing",
"school",
"at home",
"patient",
"diagnosed",
"psychiatric condition",
"prescribed",
"med... |
A 29-year-old woman presents to the fertility clinic due to an inability to conceive. She and her husband have been attempting to have children for over a year. She underwent menarche at 16 years of age and typically has menses every 29 days regularly. Her menstrual periods would last 6 days and are mildly painful. How... | Cabergoline | {
"A": "Cabergoline",
"B": "Clomiphene",
"C": "Levothyroxine",
"D": "Metformin"
} | step1 | A | [
"29 year old woman presents",
"fertility clinic",
"to",
"husband",
"attempting to",
"children",
"year",
"menarche at",
"years",
"age",
"menses",
"29 days",
"menstrual periods",
"last 6 days",
"mildly painful",
"reports",
"last menstrual period",
"3 months",
"medical history",
"... |
A 47-year-old man with alcoholic cirrhosis comes to the physician for a follow-up examination. Examination of the skin shows erythema over the thenar and hypothenar eminences of both hands. He also has numerous blanching lesions over the trunk and upper extremities that have a central red vessel with thin extensions ra... | Increased circulating estrogen | {
"A": "Increased circulating ammonia",
"B": "Decreased circulating albumin",
"C": "Decreased circulating testosterone",
"D": "Increased circulating estrogen"
} | step1 | D | [
"year old man",
"alcoholic cirrhosis",
"physician",
"follow-up examination",
"skin shows erythema",
"thenar",
"hypothenar eminences",
"hands",
"numerous blanching lesions",
"trunk",
"upper extremities",
"central red vessel",
"thin extensions radiating outwards",
"following",
"most likely... |
An otherwise healthy 15-year-old boy comes to the physician for a routine health maintenance examination. He feels well and is doing well in school. He has no history of serious illness. Vital signs are within normal limits. The lungs are clear to auscultation. Cardiac auscultation shows no murmur, but a wide-split S2 ... | Paradoxical embolism | {
"A": "Cerebral aneurysm",
"B": "Left ventricular hypertrophy",
"C": "Paradoxical embolism",
"D": "Infective endocarditis"
} | step1 | C | [
"healthy",
"year old boy",
"physician",
"routine health maintenance examination",
"feels well",
"well",
"school",
"history of serious illness",
"Vital signs",
"normal limits",
"lungs",
"clear",
"auscultation",
"Cardiac",
"shows",
"murmur",
"wide split S2",
"not change",
"respirat... |
A 33-year-old woman comes to the physician because of a 4-day history of fever and neck pain that radiates to the jaw and ears. She has also noticed swelling in the front part of her throat since the onset of the pain. She reports feeling anxious and sweating profusely over the past 2 days. She has no history of major ... | Subacute thyroiditis | {
"A": "Subacute thyroiditis",
"B": "Thyroid lymphoma",
"C": "Struma ovarii",
"D": "Factitious hyperthyroidism"
} | step2&3 | A | [
"year old woman",
"physician",
"4-day history",
"fever",
"neck pain",
"radiates",
"jaw",
"ears",
"swelling",
"front part of",
"throat",
"onset",
"pain",
"reports feeling anxious",
"sweating",
"past 2 days",
"history",
"major illness",
"takes",
"medication",
"temperature",
"... |
A 20-year-old female arrives at the urgent care clinic at her university’s health plan asking for an HIV test. She is an undergraduate at the university and just started having sexual intercourse with her new boyfriend. They use protection only occasionally so she wants to get tested to make sure everything is okay. Sh... | We need additional bloodwork to see if you have AIDS. | {
"A": "We have to get a confirmatory PCR test to see if you have AIDS.",
"B": "You do not have AIDS because you just started having sex recently.",
"C": "You have AIDS but this disease is now a manageable condition.",
"D": "We need additional bloodwork to see if you have AIDS."
} | step1 | D | [
"20 year old female",
"urgent care clinic",
"health plan",
"HIV test",
"undergraduate",
"university",
"started",
"sexual intercourse",
"new boyfriend",
"use protection only occasionally",
"to",
"tested to make sure",
"never",
"tested",
"STDs",
"reports",
"symptoms",
"not seen",
"... |
A 32-year-old woman visits the office with a complaint of recurrent abdominal pain for the past 2 months. She says the pain has been increasing every day and is located in the right upper quadrant. She has been using oral contraceptive pills for the past 2 years. She is a nonsmoker and does not drink alcohol. Her vital... | Hepatic adenoma | {
"A": "Focal nodular hyperplasia",
"B": "Hepatocellular carcinoma",
"C": "Metastatic disease",
"D": "Hepatic adenoma"
} | step1 | D | [
"year old woman visits",
"office",
"complaint",
"recurrent abdominal pain",
"past",
"months",
"pain",
"increasing",
"day",
"right upper quadrant",
"using oral contraceptive pills",
"past",
"years",
"nonsmoker",
"not drink alcohol",
"vital signs show",
"heart rate",
"85 min",
"res... |
A previously healthy 67-year-old man comes to the physician because of a history of recurrent right lower abdominal pain for the past 2 years. A CT scan shows a 1.2-cm (0.47-in) mass located in the terminal ileum. He undergoes surgical removal of the mass. A photomicrograph of the resected specimen is shown. Cells from... | Chromogranin A | {
"A": "Desmin",
"B": "Chromogranin A",
"C": "Vimentin",
"D": "Cytokeratin"
} | step1 | B | [
"healthy 67 year old man",
"physician",
"history",
"recurrent right lower abdominal pain",
"past",
"years",
"CT scan shows a",
"2",
"0",
"mass",
"terminal ileum",
"surgical",
"mass",
"photomicrograph",
"resected specimen",
"shown",
"Cells",
"tissue",
"most likely to stain positiv... |
A 66-year-old woman presents to the emergency department with abdominal pain. Her symptoms began when she was eating dinner. She has a past medical history of obesity, constipation, intravenous drug use, and diabetes. The patient is instructed to be nil per os and is transferred to the surgical floor. Three days later ... | Blastic and lytic skeletal lesions | {
"A": "Blastic and lytic skeletal lesions",
"B": "Monoclonal plasma cell replication",
"C": "Repeat gastrointestinal tract obstruction",
"D": "Qualitative bone defect"
} | step2&3 | A | [
"66 year old woman presents",
"emergency department",
"abdominal pain",
"symptoms began",
"eating dinner",
"past medical",
"constipation",
"intravenous drug use",
"diabetes",
"patient",
"to",
"nil per os",
"transferred",
"surgical floor",
"Three days later",
"cholecystectomy",
"recov... |
A 55-year-old obese woman is referred to the cardiology clinic for progressive dyspnea. She has had no recent travel or sick contacts. Besides a multivitamin, she has only tried online weight-loss medications for the past five years, including fenfluramine-phentermine. An echocardiogram reveals a dilated right ventricl... | Carcinoid syndrome | {
"A": "Subacute endocarditis",
"B": "Carcinoid syndrome",
"C": "Left heart failure",
"D": "Chronic obstructive pulmonary disease"
} | step1 | B | [
"55 year old obese woman",
"referred",
"cardiology clinic",
"progressive dyspnea",
"recent travel",
"sick contacts",
"multivitamin",
"only",
"weight-loss medications",
"past five years",
"including fenfluramine phentermine",
"echocardiogram reveals",
"dilated right ventricle",
"systolic pr... |
An 18-year-old man seeks an evaluation from a physician for painful right axillary swelling since 2 days ago. He has malaise. He has no history of serious illnesses and takes no medications. He has a pet kitten which was recently treated for fleas. The temperature is 38.5℃ (101.3℉), the pulse is 88/min, the respiration... | No pharmacotherapy | {
"A": "Azithromycin",
"B": "Doxycycline",
"C": "Streptomycin",
"D": "No pharmacotherapy"
} | step2&3 | D | [
"year old man",
"evaluation",
"physician",
"painful right",
"days",
"malaise",
"history",
"serious illnesses",
"takes",
"medications",
"pet kitten",
"recently treated",
"fleas",
"temperature",
"pulse",
"88 min",
"respiration rate",
"min",
"blood pressure",
"80 mm Hg",
"2 pain... |
A prospective cohort study was conducted to assess the relationship between LDL-C and the incidence of heart disease. The patients were selected at random. Results showed a 10-year relative risk (RR) of 2.30 for people with elevated LDL-C levels compared to individuals with normal LDL levels. The p value was 0.04. This... | 1.01-3.70 | {
"A": "1.01-3.70",
"B": "0.09-3.50",
"C": "0.08-3.40",
"D": "0.07-3.30"
} | step1 | A | [
"prospective cohort study",
"conducted to assess",
"relationship",
"the incidence of heart disease",
"patients",
"selected",
"random",
"Results showed a 10 year relative risk",
"2 30",
"people",
"elevated",
"levels compared",
"individuals",
"normal",
"levels",
"p value",
"0.04",
"s... |
A 60-year-old man is brought to the emergency department by police officers because he was seen acting strangely in public. The patient was found talking nonsensically to the characters on cereal boxes in a grocery store. Past medical history is significant for multiple hospitalizations for alcohol-related injuries and... | Korsakoff amnesia | {
"A": "Delirium",
"B": "Delirium tremens",
"C": "Korsakoff amnesia",
"D": "Dementia"
} | step1 | C | [
"60 year old man",
"brought",
"emergency department",
"police officers",
"seen acting",
"patient",
"found talking",
"characters",
"cereal boxes",
"grocery store",
"Past medical history",
"significant",
"multiple hospitalizations",
"alcohol related injuries",
"alcohol withdrawal seizures"... |
A 76-year-old man presents for a follow-up appointment at his primary care provider’s office. The patient has severe osteoarthritis, which substantially limits his daily physical activity. Several imaging studies have confirmed severe articular degeneration and evidence of bone grinding on bone in his hip joints. The p... | Total hip arthroplasty | {
"A": "Hip osteotomy",
"B": "Total hip arthroplasty",
"C": "Arthroscopic debridement",
"D": "Autologous chondrocyte implantation"
} | step2&3 | B | [
"76 year old man presents",
"follow-up appointment",
"primary care providers office",
"patient",
"severe osteoarthritis",
"limits",
"daily physical activity",
"imaging studies",
"confirmed severe articular degeneration",
"evidence",
"bone grinding",
"bone",
"hip",
"patient suffers",
"chr... |
A 7-year-old boy and the rest of his family visit a physician for a physical after migrating to the United States. His mother reports that her son is always fatigued and has no energy to play like the other kids in their remote village in Nigeria. He was born at 39 weeks via spontaneous vaginal delivery and is meeting ... | Pathological; an intermediate of glycolysis | {
"A": "Pathological; an intermediate of glycolysis",
"B": "Physiological; an intermediate of gluconeogenesis",
"C": "Pathological; an intermediate of the Krebs cycle",
"D": "Physiological; an intermediate of the Krebs cycle"
} | step1 | A | [
"year old boy",
"rest",
"family visit",
"physician",
"physical",
"migrating",
"United States",
"mother reports",
"son",
"always fatigued",
"energy to play",
"kids",
"remote village",
"Nigeria",
"born",
"weeks",
"spontaneous vaginal delivery",
"meeting",
"developmental milestones"... |
A 14-year-old male of eastern European descent presents to the free clinic at a university hospital for a respiratory infection, which his mother explains occurs quite frequently. The male is noted to be of short stature, have a gargoyle-like facies, clouded corneas, poor dentition, and is severely mentally retarded. A... | Hurler's syndrome | {
"A": "Hurler's syndrome",
"B": "Hunter's syndrome",
"C": "Gaucher's disease",
"D": "Fabry's disease"
} | step1 | A | [
"year old male",
"eastern European descent presents",
"free clinic",
"university hospital",
"respiratory infection",
"mother",
"occurs",
"frequently",
"male",
"noted to",
"short stature",
"facies",
"clouded corneas",
"poor dentition",
"severely mentally retarded",
"urinalysis revealed ... |
A 4-year-old girl is brought to the physician by her mother for a follow-up examination. She has a history of recurrent asthma attacks. The mother reports that her daughter has also had mild abdominal pain for the past 2 weeks. The patient's current medications include daily inhaled fluticasone and inhaled albuterol as... | Wilms' tumor | {
"A": "Lymphoma",
"B": "Wilms' tumor",
"C": "Neuroblastoma",
"D": "Renal cell carcinoma"
} | step2&3 | B | [
"4 year old girl",
"brought",
"physician",
"mother",
"follow-up examination",
"history of recurrent asthma attacks",
"mother reports",
"daughter",
"mild abdominal",
"past 2 weeks",
"patient's current medications include daily inhaled fluticasone",
"inhaled albuterol as needed",
"appears well... |
A 58-year-old man with a history of hepatitis C infection presents to his physician because of unintentional weight loss and weakness. He has lost 6.8 kg (15 lb) within the last 6 months. Vital signs are within normal limits. Physical examination shows jaundice, splenomegaly, and caput medusae. A complete metabolic pan... | Alanine aminotransferase | {
"A": "Alanine aminotransferase",
"B": "Alkaline phosphatase",
"C": "Aspartate aminotransferase",
"D": "Blood urea nitrogen"
} | step1 | A | [
"58 year old man",
"history of hepatitis C infection presents",
"physician",
"unintentional weight loss",
"weakness",
"lost",
"kg",
"last",
"months",
"Vital signs",
"normal",
"Physical examination shows jaundice",
"splenomegaly",
"caput medusae",
"complete metabolic panel",
"ordered",
... |
An investigator studying fungal growth isolates organisms from an infant with diaper rash. The isolate is cultured and exposed to increasing concentrations of nystatin. Selected colonies continue to grow and replicate even at high concentrations of the drug. Which of the following is the most likely explanation for thi... | Reduced ergosterol content in cell membrane | {
"A": "Reduced ergosterol content in cell membrane",
"B": "Mutation of the β-glucan gene",
"C": "Altered binding site of squalene epoxidase",
"D": "Expression of dysfunctional cytochrome P-450 enzymes"
} | step1 | A | [
"investigator studying fungal growth isolates organisms",
"infant",
"diaper rash",
"isolate",
"cultured",
"exposed",
"increasing concentrations",
"nystatin",
"Selected colonies continue to",
"replicate",
"high concentrations",
"drug",
"following",
"most likely explanation",
"finding"
] |
A rheumatologist is evaluating the long-term risk of venous thromboembolism in patients with newly diagnosed rheumatoid arthritis by comparing two retrospective cohort studies. In study A, the hazard ratio for venous thromboembolism was found to be 1.7 with a 95% confidence interval of 0.89–2.9. Study B identified a ha... | The p-value of study A is likely larger than the p-value of study B. | {
"A": "The HR of study B is less likely to be statistically significant than the HR of study A.",
"B": "Study A likely had a larger sample size than study B.",
"C": "The p-value of study A is likely larger than the p-value of study B.",
"D": "The power of study B is likely smaller than the power of study A."
} | step1 | C | [
"rheumatologist",
"evaluating",
"long-term risk of venous thromboembolism",
"patients",
"newly diagnosed rheumatoid arthritis",
"comparing two retrospective cohort studies",
"hazard ratio",
"venous thromboembolism",
"found to",
"1",
"95",
"confidence interval",
"0",
"9",
"Study",
"iden... |
A 17-year-old girl is brought into the clinic by her mother who is concerned that she may be depressed. The mother states that her daughter feels unattractive and does not fit into any of the social groups at school. When talking to the patient, it is discovered that she mostly avoids the kids in school because of fear... | Avoidant personality disorder | {
"A": "Avoidant personality disorder",
"B": "Schizoid personality disorder",
"C": "Social phobia",
"D": "Body dysmorphic disorder"
} | step2&3 | A | [
"year old girl",
"brought",
"clinic",
"mother",
"concerned",
"depressed",
"mother states",
"daughter feels unattractive",
"not fit",
"social groups",
"school",
"talking to",
"patient",
"discovered",
"mostly",
"kids in school",
"of fear",
"rejection",
"usually keeps",
"hasnt inv... |
A 16-year-old female presents to her pediatrician complaining of 2 weeks of fever and 1 week of swollen lumps in her left armpit. Upon examination of the left upper extremity, her physician notes the presence of a single papule which the patient claimed appeared one week ago. The patient started her first job at a pet ... | Cats | {
"A": "Animal urine",
"B": "Cats",
"C": "Parrots",
"D": "Rabbits"
} | step1 | B | [
"year old female presents",
"pediatrician",
"2 weeks",
"fever",
"1 week",
"swollen lumps",
"left armpit",
"examination of the left upper extremity",
"physician notes",
"presence",
"single papule",
"patient",
"appeared one week",
"patient started",
"first job",
"pet store 2",
"weeks",... |
A 63-year-old woman presents to her primary care provider with her spouse for routine follow-up. She has a history of schizophrenia and is currently living at a nursing facility. Her symptoms first started 2 years ago, when she developed auditory hallucinations and her family noticed that her thoughts and speech became... | Haloperidol | {
"A": "Clozapine",
"B": "Haloperidol",
"C": "Olanzapine",
"D": "Risperidone"
} | step1 | B | [
"63 year old woman presents",
"primary care provider",
"spouse",
"routine follow-up",
"history of schizophrenia",
"currently living",
"nursing facility",
"symptoms first started 2 years",
"auditory hallucinations",
"family",
"thoughts",
"speech",
"more tangential",
"referred",
"psychiatr... |
A 65-year-old G4P4 woman presents to her primary care physician complaining of a breast lump. She reports that she felt the lump while conducting a breast self-examination. Her past medical history is notable for endometrial cancer status post radical hysterectomy. She takes aspirin and fish oil. The patient drinks 3-4... | Photosensitivity | {
"A": "Peripheral neuropathy",
"B": "Pulmonary fibrosis",
"C": "Dilated cardiomyopathy",
"D": "Photosensitivity"
} | step1 | D | [
"65 year old",
"woman presents",
"primary care physician",
"breast lump",
"reports",
"felt",
"lump",
"conducting",
"breast self-examination",
"past medical history",
"notable",
"endometrial cancer",
"radical hysterectomy",
"takes aspirin",
"fish oil",
"patient drinks 3 alcoholic bevera... |
A 59-year-old man is evaluated for progressive joint pain. There is swelling and tenderness over the first, second, and third metacarpophalangeal joints of both hands. His hand radiograph shows beak-like osteophytes on his 2nd and 3rd metacarpophalangeal joints, subchondral cysts, and osteopenia. He has had diabetes me... | Hypogonadism | {
"A": "Hypogonadism",
"B": "Hepatic adenoma",
"C": "Hypertrophic cardiomyopathy",
"D": "Hepatic steatosis"
} | step2&3 | A | [
"59 year old man",
"evaluated",
"progressive joint pain",
"swelling",
"tenderness",
"first",
"second",
"third",
"joints of",
"hands",
"hand radiograph shows beak",
"osteophytes",
"2nd",
"3rd metacarpophalangeal joints",
"subchondral cysts",
"osteopenia",
"diabetes mellitus",
"years... |
A 60-year-old woman is brought to the emergency department because of altered mental status for 2 hours. She and her husband were at the grocery store when she suddenly could not remember why she was there or how she got there. She has not had any head trauma. She has a history of depression and migraines. She does not... | Transient global amnesia | {
"A": "Transient global amnesia",
"B": "Depersonalization/derealization disorder",
"C": "Seizure",
"D": "Migraine"
} | step2&3 | A | [
"60 year old woman",
"brought",
"emergency department",
"of altered mental status",
"hours",
"husband",
"grocery store",
"not remember",
"got",
"not",
"head trauma",
"history of depression",
"migraines",
"not smoke",
"drinks",
"glass",
"wine",
"night",
"dinner",
"takes fluoxeti... |
A team of biology graduate students are performing research on epigenetics and chromosome inactivation. The goal is to silence all the genes on a chromosome at once. The team chooses to develop a model based on a known human gene that can accomplish this task in vivo. Which of the genes listed below would be a suitable... | XIST | {
"A": "SRY",
"B": "XIST",
"C": "Hedgehog",
"D": "NF1"
} | step1 | B | [
"team",
"biology graduate students",
"research",
"epigenetics",
"chromosome inactivation",
"goal",
"to silence",
"genes",
"chromosome",
"team chooses to",
"model based",
"known human gene",
"task in vivo",
"genes listed",
"suitable model",
"research"
] |
A 36-year-old man presents to a physician with the complaint of a dry cough for the last 2 months. He denies any nasal discharge, sneezing, nose congestion, blood in sputum, breathlessness, fever, or weight loss. He started smoking 2 years back. His temperature is 37.3°C (99.2°F), the heart rate is 88/min, the blood pr... | Lack of calcification | {
"A": "Lack of calcification",
"B": "Dense central nidus of calcification",
"C": "Multiple punctate foci of calcification throughout the nodule",
"D": "Popcorn ball calcification"
} | step2&3 | A | [
"36 year old man presents",
"physician",
"complaint",
"dry cough",
"last",
"months",
"denies",
"nasal discharge",
"sneezing",
"nose congestion",
"blood",
"sputum",
"breathlessness",
"fever",
"weight loss",
"started smoking 2 years back",
"temperature",
"3C",
"99",
"heart rate",... |
A 23-year-old man comes to the physician because of progressive pain, redness, and swelling of his left forearm. The symptoms began after he scratched his arm on a metal table 4 days ago. Examination of the left forearm shows a 2-cm, tender, erythematous, fluctuant lesion at the site of trauma. Incision and drainage of... | IL-8 | {
"A": "IL-11",
"B": "IL-8",
"C": "IL-5",
"D": "IL-14"
} | step1 | B | [
"23 year old man",
"physician",
"progressive pain",
"redness",
"swelling",
"left forearm",
"symptoms began",
"scratched",
"arm",
"metal table 4 days",
"Examination of",
"left forearm shows",
"2",
"tender",
"erythematous",
"fluctuant lesion",
"site of trauma",
"Incision",
"drainag... |
Your test subject is a stout 52-year-old gentleman participating in a study on digestion. After eating a platter of meat riblets and beef strips a test subjects digestive tract undergoes vast hormonal changes. Which of the following changes likely occurred in this patient as a result of the meal? | Increased release of secretin from S cells of the duodenum | {
"A": "Increased gastrin release leading to a decrease in proton secretion",
"B": "Decreased cholecystokinin release from the I cells of the duodenum",
"C": "Increased release of secretin from S cells of the duodenum",
"D": "Decreased Ach release from the vagus nerve"
} | step1 | C | [
"test subject",
"stout",
"year old",
"participating",
"study",
"digestion",
"eating",
"meat",
"beef strips",
"test subjects digestive tract",
"vast hormonal changes",
"following changes likely occurred",
"patient",
"result",
"meal"
] |
A 27-year-old G1P0 woman at 25 weeks estimated gestational age presents with a blood pressure of 188/99 mm Hg during a routine prenatal visit. She has no symptoms, except for a mild headache. The patient's heart rate is 78/min. An injectable antihypertensive along with a beta-blocker is administered, and her blood pres... | Interference with action of inositol trisphosphate (IP3) on intracellular calcium release | {
"A": "Calcium channel antagonism",
"B": "Potassium channel activation",
"C": "Release endogenous nitrous oxide",
"D": "Interference with action of inositol trisphosphate (IP3) on intracellular calcium release"
} | step1 | D | [
"27 year old",
"woman",
"weeks estimated gestational age presents",
"blood pressure",
"99 mm Hg",
"routine prenatal visit",
"symptoms",
"mild headache",
"patient's heart rate",
"min",
"injectable antihypertensive",
"beta-blocker",
"administered",
"blood pressure returns",
"normal",
"co... |
A 65-year-old man presents with acute abdominal pain accompanied by chills, nausea, and vomiting. His past medical history is significant for benign prostatic hyperplasia and diabetes mellitus type 2. His medications are tamsulosin and metformin. His last HbA1c, 5 months ago, was 6.7. He had a screening colonoscopy 5 y... | Surgical removal and antibiotics | {
"A": "Observation with hydration, bed rest, and analgesics",
"B": "Amlodipine",
"C": "Surgical removal and antibiotics",
"D": "Urine alkalinization"
} | step2&3 | C | [
"65 year old man presents",
"acute abdominal pain",
"chills",
"nausea",
"vomiting",
"past medical history",
"significant",
"benign prostatic hyperplasia",
"diabetes mellitus type 2",
"medications",
"tamsulosin",
"metformin",
"last",
"5 months",
"screening colonoscopy",
"years",
"norm... |
A 74-year-old man returns to his physician to follow-up on laboratory studies obtained for anemia 2 weeks ago. He has no complaints. He has a 20-year history of hypertension and several years of knee osteoarthritis. He walks 2 miles a day. He does not smoke. He drinks alcohol moderately. He takes hydrochlorothiazide, l... | Monoclonal gammopathy of undetermined significance | {
"A": "Monoclonal gammopathy of undetermined significance",
"B": "Smoldering (asymptomatic) multiple myeloma",
"C": "Symptomatic multiple myeloma",
"D": "Waldenstrom’s macroglobulinemia"
} | step2&3 | A | [
"74 year old man returns",
"physician to follow-up",
"laboratory studies obtained",
"anemia 2 weeks",
"complaints",
"20 year history of hypertension",
"several years of knee osteoarthritis",
"walks 2 miles",
"day",
"not smoke",
"drinks alcohol moderately",
"takes hydrochlorothiazide",
"losar... |
A 2-year-old boy is brought to the physician because of fever, productive cough, and shortness of breath. Since birth, he has had multiple respiratory infections requiring treatment with antibiotics. His immunizations are up-to-date. He is in the 10th percentile for height and weight. His temperature is 38°C (100.3°F).... | Serratia marcescens | {
"A": "Enterococcus faecium",
"B": "Serratia marcescens",
"C": "Clostridioides difficile",
"D": "Streptococcus pyogenes"
} | step1 | B | [
"2 year old boy",
"brought",
"physician",
"fever",
"productive cough",
"shortness of breath",
"birth",
"multiple respiratory infections",
"treatment",
"antibiotics",
"immunizations",
"date",
"percentile",
"height",
"weight",
"temperature",
"100",
"Examination detects diffuse bilate... |
A 23-year-old woman presented to the clinic for her first prenatal appointment with fatigue and pain in the perineum for the past 8 days. The past medical history is benign and she claimed to have only had unprotected intercourse with her husband. She had a documented allergic reaction to amoxicillin 2 years ago. The v... | Penicillin desensitization, then intramuscular benzathine penicillin, G 2.4 million units | {
"A": "Penicillin desensitization, then intramuscular benzathine penicillin, G 2.4 million units",
"B": "Oral tetracycline, 500 mg 4 times daily x 1 week",
"C": "Doxycycline, 100 mg twice daily x 14 days",
"D": "Delay treatment until delivery"
} | step1 | A | [
"23 year old woman presented",
"clinic",
"first prenatal appointment",
"fatigue",
"pain",
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"past",
"days",
"past medical history",
"benign",
"to",
"only",
"unprotected intercourse",
"husband",
"documented allergic reaction",
"amoxicillin",
"years",
"vaginal exam revealed... |
A 63-year-old woman is brought to the emergency department by one of her neighbors because of fever and confusion. She has a 10-year history of diabetes mellitus and hemorrhoids. Her medications include insulin and metformin. Her blood pressure is 90/70 mm Hg, the pulse is 115/min, the respirations are 21/min, and the ... | Surgical debridement | {
"A": "High-dose IV steroids",
"B": "Image-guided needle aspiration",
"C": "Surgical debridement",
"D": "No further management is indicated at this time"
} | step2&3 | C | [
"63 year old woman",
"brought",
"emergency department",
"one",
"neighbors",
"fever",
"confusion",
"a 10 year history of diabetes mellitus",
"hemorrhoids",
"medications include insulin",
"metformin",
"blood pressure",
"90 70 mm Hg",
"pulse",
"min",
"respirations",
"min",
"temperatur... |
A previously healthy 14-year-old boy is brought to the physician for evaluation because of loss of appetite, sleeplessness, and extreme irritability for 3 weeks. He recently quit the school's football team after missing many practices. He has also been avoiding his family and friends because he is not in the mood to se... | Involuntary hospitalization after informing the parents | {
"A": "Involuntary hospitalization after informing the parents",
"B": "Reassure the patient that he will feel better",
"C": "Begin paroxetine therapy",
"D": "Start outpatient psychotherapy"
} | step2&3 | A | [
"healthy",
"year old boy",
"brought",
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"of loss",
"appetite",
"sleeplessness",
"extreme irritability",
"weeks",
"recently quit",
"school's football team",
"missing",
"practices",
"family",
"friends",
"not",
"mood to see",
"admits",
"lonely",
"not lef... |
A 58-year-old man comes to the clinic complaining of increased urinary frequency for the past 3 days. The patient reports that he has had to get up every few hours in the night to go to the bathroom, and says "whenever I feel the urge I have to go right away.” Past medical history is significant for a chlamydial infect... | Infection with Escherichia coli | {
"A": "Chemical irritation of the prostate",
"B": "Infection with Escherichia coli",
"C": "Prostatic adenocarcinoma",
"D": "Reinfection with Chlamydia trachomatis"
} | step1 | B | [
"58 year old man",
"clinic",
"increased urinary frequency",
"past",
"days",
"patient reports",
"to get",
"hours",
"night to go",
"bathroom",
"I feel",
"I",
"to go right",
"Past medical history",
"significant",
"chlamydial infection",
"twenties",
"treated",
"lower back pain",
"s... |
A 21-year-old woman presents with right eye irritation, redness, and watery discharge. These symptoms started abruptly 4 days ago. She is on summer vacation and does not report any contacts with evidently ill patients. However, during the vacation, she frequently visited crowded places. The patient denies any other sym... | No medical treatment required | {
"A": "Acyclovir ointment",
"B": "No medical treatment required",
"C": "Levofloxacin drops",
"D": "Tetracycline ointment"
} | step2&3 | B | [
"21-year-old woman presents",
"right",
"redness",
"watery discharge",
"symptoms started",
"days",
"summer vacation",
"not report",
"contacts with",
"ill patients",
"vacation",
"frequently visited crowded places",
"patient denies",
"symptoms",
"presentation",
"patients vital signs inclu... |
A 30-year-old man presents with a 1-month history of frequent intermittent headaches. He says the headaches typically occur between 3–4 times/day, mostly at night, each lasting minutes to 1–2 hours. He describes the pain as severe, stabbing, unilateral, and localized to the left periorbital region. He says he frequentl... | High-flow 100% oxygen | {
"A": "Sumatriptan",
"B": "High-flow 100% oxygen",
"C": "Hydrocodone",
"D": "Intranasal lidocaine"
} | step2&3 | B | [
"30 year old man presents",
"month history of frequent intermittent headaches",
"headaches",
"occur",
"times/day",
"mostly",
"night",
"minutes",
"12 hours",
"pain",
"severe",
"stabbing",
"unilateral",
"localized",
"left periorbital region",
"frequently notes increased tear production",... |
A 28-year-old man comes to the physician because of skin lesions on and around his anus. He noticed them 3 days ago. The lesions are not painful and he does not have any urinary complaints. He has smoked one pack of cigarettes daily for 10 years and he drinks 6–7 beers on weekends. He is sexually active with two male p... | Curettage | {
"A": "Oral acyclovir",
"B": "Topical mometasone",
"C": "Parenteral benzathine penicillin",
"D": "Curettage"
} | step2&3 | D | [
"year old man",
"physician",
"of skin lesions",
"anus",
"3 days",
"lesions",
"not painful",
"not",
"urinary complaints",
"smoked one pack",
"cigarettes daily",
"10 years",
"drinks 67 beers",
"weekends",
"sexually active",
"two male partners",
"uses condoms",
"appears healthy",
"p... |
A 28-year-old woman presents with severe diarrhea and abdominal pain. She says she has had 10 watery stools since the previous morning and is experiencing severe cramping in her abdomen. She reports similar past episodes of diarrhea with excruciating abdominal pain and mentions that she has taken diphenoxylate and atro... | µ receptor | {
"A": "H2 receptor",
"B": "5-HT3 receptor",
"C": "D2 receptor",
"D": "µ receptor"
} | step1 | D | [
"year old woman presents",
"severe diarrhea",
"abdominal pain",
"10 watery stools",
"previous morning",
"experiencing severe cramping",
"abdomen",
"reports similar past episodes of diarrhea",
"excruciating abdominal",
"taken diphenoxylate",
"atropine",
"helped",
"diarrhea",
"pain",
"resu... |
A 29-year-old woman comes to the physician because of poor balance and recurrent falls for the past month. She has also had blurry vision in her right eye for the past 2 weeks. She reports worsening of her symptoms after taking warm baths. Physical examination shows generalized hyperreflexia and an intention tremor. Ro... | Neuroectoderm | {
"A": "Mesoderm",
"B": "Neuroectoderm",
"C": "Neural crest",
"D": "Notochord"
} | step1 | B | [
"29 year old woman",
"physician",
"poor balance",
"recurrent falls",
"past month",
"blurry vision",
"right eye",
"past 2 weeks",
"reports worsening",
"symptoms",
"warm baths",
"Physical examination shows generalized hyperreflexia",
"intention tremor",
"Romberg sign",
"positive",
"Visua... |
A 4-year-old boy is brought to the emergency department for a right ankle injury sustained during a fall earlier that morning. His parents report that he is 'clumsy' when he runs and has fallen multiple times in the last year. He has reached most of his developmental milestones but did not walk until the age of 17 mont... | Absence of dystrophin protein | {
"A": "Loss of the ATM protein",
"B": "Myotonin protein kinase defect",
"C": "Absence of dystrophin protein",
"D": "Arylsulfatase A deficiency"
} | step2&3 | C | [
"4 year old boy",
"brought",
"emergency department",
"right ankle injury sustained",
"fall earlier",
"morning",
"parents report",
"is",
"clumsy",
"runs",
"fallen multiple times",
"year",
"reached most",
"developmental milestones",
"not walk",
"age",
"months",
"only child",
"adopt... |
A group of 6 college students with multiple sclerosis (MS) was evaluated for flares in a neurology clinic. The results are shown in the figure. Each row represents a patient. The gray bars represent the duration of the flare. The arrowheads indicate that disease was already present before and/or persisted beyond the ti... | Incidence during the month of May was 2 | {
"A": "Incidence from April 1st to June 1st was 3",
"B": "Incidence during the month of May was 2",
"C": "The year-long prevalence was 4/6",
"D": "Prevalence of the disease on May 15 was 4/6"
} | step2&3 | B | [
"A group",
"college students",
"multiple sclerosis",
"evaluated",
"flares",
"neurology clinic",
"results",
"shown",
"row represents",
"patient",
"gray bars represent",
"duration",
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"arrowheads",
"disease",
"present before",
"timeframe",
"study",
"Based",
"following",
... |
A 33-year-old man presents to the emergency department with sudden onset right hand and right leg weakness. The patient was at home cleaning when his symptoms began. He also complains of diffuse and severe pain throughout his entire body which he states he has experienced before. The patient is an immigrant from South ... | Exchange transfusion | {
"A": "Aspirin",
"B": "Exchange transfusion",
"C": "Heparin",
"D": "Morphine and IV fluids"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"sudden onset right hand",
"right",
"patient",
"at home cleaning",
"symptoms began",
"diffuse",
"severe pain",
"entire body",
"states",
"experienced before",
"patient",
"immigrant",
"South America",
"medical history",
"not known",
"t... |
A 28-year-old man presents to his primary care physician because he has been experiencing constipation for the last 6 days. He says that the constipation started 1 day after he started taking an over the counter medication for sinus congestion and a chronic cough. He has no other findings associated with the constipati... | Dextromethorphan | {
"A": "Dextromethorphan",
"B": "Diphenhydramine",
"C": "Guaifenesin",
"D": "Loratadine"
} | step1 | A | [
"year old man presents",
"primary care physician",
"experiencing constipation",
"6 days",
"constipation started 1 day",
"started taking",
"over the counter medication",
"sinus congestion",
"chronic cough",
"findings associated with",
"constipation",
"past medical history",
"significant",
"... |
A 28-year-old woman follows up at an outpatient surgery clinic with an abnormal scarring of her incisional wound from an abdominal surgical procedure 6 months ago. She gives a history of a wound infection with a purulent discharge 1 week after surgery. On examination of the scar, a dense, raised, healed lesion is note... | There is excessive scar tissue projecting beyond the level of the surrounding skin, but not extending into the underlying subcutaneous tissue. | {
"A": "The scar has hair follicles and other adnexal glands within.",
"B": "There is excessive scar tissue projecting beyond the level of the surrounding skin, but not extending into the underlying subcutaneous tissue.",
"C": "Increased prevalence of this type of scar has no genetic basis or linkage.",
"D": "T... | step1 | B | [
"year old woman follows up",
"outpatient surgery clinic",
"abnormal scarring",
"incisional wound",
"abdominal surgical procedure",
"months",
"gives",
"history",
"wound infection",
"purulent discharge 1",
"surgery",
"examination",
"scar",
"dense",
"raised",
"healed lesion",
"noted",
... |
You are attempting to quantify the degree of infectivity of a novel respiratory virus. You assess 1,000 patients who have been exposed to the virus and find that 500 ultimately are found positive for the virus within a 1-year follow up period. Conversely, from a 1,000 patient control group who has not been exposed to c... | [500/ (500 + 500)] / [5 / (5 + 995)] | {
"A": "[5 / (500 + 500)] / [5 / (995 + 995)]",
"B": "[995 / (995 + 5)] / [500 / (500 + 500)]",
"C": "[500/ (500 + 500)] / [5 / (5 + 995)]",
"D": "(500 * 995) / (500 * 5)"
} | step2&3 | C | [
"attempting to quantify",
"degree",
"infectivity",
"novel respiratory virus",
"assess 1",
"patients",
"exposed",
"virus",
"find",
"500",
"found positive",
"virus",
"year follow up period",
"a",
"patient control group",
"not",
"exposed",
"carriers",
"virus",
"only",
"positive"... |
A 19-year-old man comes to the physician because of recurrent yellowing of his eyes over the past 2 years. He reports that each episode lasts 1–2 weeks and resolves spontaneously. He has no family history of serious illness. He recently spent a week in Mexico for a vacation. He is sexually active with two partners and ... | Impaired hepatic storage of bilirubin | {
"A": "Destruction of the intralobular bile ducts",
"B": "Inflammation of intra- and extrahepatic bile ducts",
"C": "Impaired hepatic storage of bilirubin",
"D": "Excess cellular bilirubin release"
} | step2&3 | C | [
"year old man",
"physician",
"recurrent yellowing",
"eyes",
"past",
"years",
"reports",
"episode",
"weeks",
"resolves",
"family history",
"serious illness",
"recently spent",
"week",
"Mexico",
"vacation",
"sexually active",
"two partners",
"uses condoms",
"not drink alcohol",
... |
A 49-year-old man presents to his primary care provider complaining of weakness and fatigue. He reports that he has started moving slower than normal and has noticed difficulty buttoning up his pants or tying his tie. He is accompanied by his wife who reports that he has started to move more slowly over the past 2 year... | Activate dopamine receptors | {
"A": "Activate dopamine receptors",
"B": "Increase dopamine release",
"C": "Inhibit dopamine receptors",
"D": "Prevent dopamine degradation into 3-O-methyldopa"
} | step1 | A | [
"year old man presents",
"primary care provider",
"weakness",
"fatigue",
"reports",
"started moving slower",
"normal",
"difficulty buttoning",
"pants",
"tying",
"tie",
"wife",
"reports",
"started to move more slowly",
"past",
"years",
"irritable",
"trouble sleeping",
"past medica... |
A 1-year-old boy is brought to his pediatrician for a follow-up appointment. He was recently diagnosed with failure to thrive and developmental delay. His weight is 7 kg (15.4 lb), height is 61 cm (24 in), and head circumference is 42 cm (16.5 in). The patient’s father had a younger sister who suffered from mental and ... | The lysosomal enzymes are secreted from the cells instead of being targeted to lysosomes because of lack of mannose phosphorylation on N-linked glycoproteins. | {
"A": "The patient’s symptoms are due to dysfunctional metabolism of sphingomyelin, which accumulates within the lysosomes.",
"B": "There is impaired hydrolysis of GM2-ganglioside, which accumulates in the cytoplasm.",
"C": "The lysosomal enzymes are secreted from the cells instead of being targeted to lysosomes... | step1 | C | [
"year old boy",
"brought",
"pediatrician",
"follow-up appointment",
"recently diagnosed",
"failure to thrive",
"developmental delay",
"weight",
"kg",
"15.4",
"height",
"61",
"head circumference",
"patients father",
"younger sister",
"suffered",
"mental",
"physical delay",
"died",... |
A 13-year-old girl presents with a right infected ingrown toenail. On examination, the skin on the lateral side of the toe is red, warm, swollen, and severely tender to touch. When gentle pressure is applied, pus oozes out. Culture and sensitivity analysis of the pus shows methicillin-resistant Staphylococcus aureus (M... | Clindamycin | {
"A": "Oral vancomycin",
"B": "Clindamycin",
"C": "Cefuroxime",
"D": "Aztreonam"
} | step1 | B | [
"year old girl presents",
"right infected ingrown toenail",
"examination",
"skin",
"lateral side of",
"toe",
"red",
"warm",
"swollen",
"severely tender",
"touch",
"gentle pressure",
"applied",
"pus",
"out",
"Culture",
"sensitivity analysis",
"pus shows methicillin-resistant Staphyl... |
A 39-year-old man comes to the physician for a follow-up examination. He was diagnosed with latent tuberculosis infection 3 months ago. He has had generalized fatigue and dyspnea on exertion for the past 6 weeks. He does not smoke and drinks 2–3 beers on weekends. Vital signs are within normal limits. Examination shows... | Adverse effect of medication | {
"A": "Iron deficiency",
"B": "Chronic inflammation",
"C": "Beta thalessemia minor",
"D": "Adverse effect of medication"
} | step2&3 | D | [
"year old man",
"physician",
"follow-up examination",
"diagnosed",
"latent tuberculosis infection",
"months",
"generalized fatigue",
"dyspnea on exertion",
"past",
"weeks",
"not smoke",
"drinks 23 beers",
"weekends",
"Vital signs",
"normal limits",
"Examination shows conjunctival pallo... |
A 33-year-old woman comes to the physician for a follow-up examination. She was treated for a urinary stone 1 year ago with medical expulsive therapy. There is no personal or family history of serious illness. Her only medication is an oral contraceptive pill that she has been taking for 12 years. She appears healthy. ... | Reimage in 6 months | {
"A": "Embolization of the mass",
"B": "Percutaneous liver biopsy",
"C": "Reimage in 6 months",
"D": "Radiofrequency ablation of the mass"
} | step2&3 | C | [
"year old woman",
"physician",
"follow-up examination",
"treated",
"urinary stone",
"year",
"medical expulsive therapy",
"personal",
"family history",
"serious illness",
"only medication",
"oral contraceptive pill",
"taking",
"years",
"appears healthy",
"Physical examination shows",
... |
A 73-year-old man is brought to the emergency department because of fever, malaise, dyspnea, and a productive cough with purulent sputum for the past day. His temperature is 39.2°C (102.6°F). Pulmonary examination shows crackles over the right upper lung field. Sputum Gram stain shows gram-positive cocci. Despite the a... | Fibrinopurulent leukocytic exudate with lysed erythrocytes | {
"A": "Fibrinopurulent leukocytic exudate with lysed erythrocytes",
"B": "Fibrinous exudate with erythrocytes, leukocytes, and bacteria",
"C": "Resorbed exudate with aerated alveoli",
"D": "Dilation of alveolar capillaries and serous exudate with abundant bacteria"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"fever",
"malaise",
"dyspnea",
"productive cough",
"purulent sputum",
"past day",
"temperature",
"Pulmonary examination shows crackles",
"right upper lung field",
"Sputum Gram stain shows gram-positive cocci",
"appropriate treatment",
"p... |
A 27-year-old woman presents to the clinic with a runny nose and productive cough for the past two weeks. She also complains of headaches and lethargy. She was started on sertraline after she was diagnosed with major depressive disorder 2 months ago and had the dosage periodically increased to achieve symptom control. ... | Migraine medication can trigger a life-threatening complication. | {
"A": "Migraine medication can trigger a life-threatening complication.",
"B": "Monoamine-oxidase-inhibitors are safe for concurrent use.",
"C": "Over-the-counter (OTC) medications are safe for her to use.",
"D": "Treat life-threatening complication with gradual drug withdrawal."
} | step1 | A | [
"27 year old woman presents",
"clinic",
"runny nose",
"productive cough",
"past two weeks",
"headaches",
"lethargy",
"started",
"sertraline",
"diagnosed",
"major depressive disorder 2 months",
"dosage periodically increased to",
"symptom control",
"afraid",
"starting",
"medication",
... |
A 24-year-old man presents to the office, complaining of a rash and “not feeling well.” The patient reports fatigue, a headache, and a possible fever. He says he has felt this way since a camping trip with his family in North Carolina, but he denies any contact with sick individuals. On examination, his vital signs inc... | A gram-negative bacteria transmitted via the Dermacentor tick | {
"A": "A sexually transmitted spirochete",
"B": "A gram-negative bacteria transmitted via the Dermacentor tick",
"C": "A gram-negative bacterium transmitted via the Ixodes tick",
"D": "A positive-sense, single-stranded RNA virus that is non-enveloped"
} | step1 | B | [
"year old man presents",
"office",
"complaining of a rash",
"not feeling well",
"patient reports fatigue",
"headache",
"possible fever",
"felt",
"camping trip",
"family",
"North Carolina",
"denies",
"contact with sick individuals",
"examination",
"vital signs include",
"temperature",
... |
A 67-year-old man presents to the emergency department with anxiety and trouble swallowing. He states that his symptoms have slowly been getting worse over the past year, and he now struggles to swallow liquids. He recently recovered from the flu. Review of systems is notable only for recent weight loss. The patient ha... | Squamous cell carcinoma | {
"A": "Achalasia",
"B": "Globus hystericus",
"C": "Squamous cell carcinoma",
"D": "Zenker diverticulum"
} | step2&3 | C | [
"67 year old man presents",
"emergency department",
"anxiety",
"swallowing",
"states",
"symptoms",
"slowly",
"getting worse",
"past year",
"now",
"to swallow liquids",
"recently recovered",
"flu",
"Review of systems",
"notable only",
"recent weight loss",
"patient",
"pack-year smok... |
A group of scientists studied the effects of cytokines on effector cells, including leukocytes. They observed that interleukin-12 (IL-12) is secreted by antigen-presenting cells (APCs) in response to bacterial lipopolysaccharide. When a CD4+ T cell is exposed to this interleukin, which of the following responses will i... | Cell-mediated immune responses | {
"A": "Cell-mediated immune responses",
"B": "Activate B cells",
"C": "Releases granzymes",
"D": "Responds to extracellular pathogens"
} | step1 | A | [
"A group",
"scientists studied",
"effects",
"cytokines",
"effector cells",
"including leukocytes",
"observed",
"interleukin-12",
"secreted",
"antigen-presenting cells",
"response to bacterial lipopolysaccharide",
"CD4",
"cell",
"exposed",
"interleukin",
"following responses"
] |
A 36-year-old woman presents with a whitish vaginal discharge over the last week. She also complains of itching and discomfort around her genitals. She says her symptoms are getting progressively worse. She has been changing her undergarments frequently and changed the brand of detergent she uses to wash her clothes, b... | Start fluconazole. | {
"A": "Stop empagliflozin.",
"B": "Advise her to drink lots of cranberry juice.",
"C": "Switch her from oral antidiabetic medication to insulin.",
"D": "Start fluconazole."
} | step1 | D | [
"36 year old woman presents",
"vaginal discharge",
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"itching",
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"clothes",
"not resolve",
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"painf... |
A 44-year-old female patient comes to the physician’s office with her husband with complaints of abdominal pain. For the past 4 months, she has experienced cramping right upper quadrant pain that starts after meals. The physician performs a right upper quadrant ultrasound that shows round echogenic masses in the gallbl... | The patient has the right to revoke her consent at any time before the procedure | {
"A": "A family member must also provide consent for this procedure",
"B": "The patient must give consent again before the procedure",
"C": "The patient has the right to revoke her consent at any time before the procedure",
"D": "The results of the procedure must be disclosed to her husband"
} | step1 | C | [
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"right upper quadrant ultrasound",
"shows round echogenic masses",
"gallbladder",
"physi... |
A patient presents to the clinic with symptoms of dizziness on standing up. He says it started soon after he was diagnosed with hypertension and started taking treatment for it. He has no other medical history. The physician decides to switch to another antihypertensive that does not cause orthostatic hypotension. Whic... | Propanolol | {
"A": "Methyldopa",
"B": "Clonidine",
"C": "Amlodipine",
"D": "Propanolol"
} | step1 | D | [
"patient presents",
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"not cause orthostatic hypotension",
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] |
A 42-year-old woman comes to the physician with a 6-month history of breast tenderness and menstrual irregularities. Physical examination shows no abnormalities. An ultrasound of the pelvis shows a right adnexal mass. A laparoscopic right salpingo-oophorectomy is performed. Histologic examination of the adnexal mass sh... | Estradiol | {
"A": "Estradiol",
"B": "Lactate dehydrogenase",
"C": "α-fetoprotein",
"D": "β-human chorionic gonadotropin"
} | step1 | A | [
"year old woman",
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"pelvis shows",
"right adnexal mass",
"laparoscopic right salpingo-oophorectomy",
"performed",
"Histologic examination",
"adnexal mass... |
A 50-year-old man presents to the emergency department complaining of chest pain and drooling that started immediately after eating a steak. His past medical history is significant for lye ingestion 5 years ago during a suicidal attempt. He also suffers from hypertension and diabetes mellitus, type 2. He takes fluoxeti... | The superior mediastinum | {
"A": "The superior mediastinum",
"B": "The diaphragm",
"C": "The posterior mediastinum",
"D": "The epigastrium"
} | step1 | A | [
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"years",
"suicidal attempt",
"suffers",
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"diabetes mellitus",
"type 2",
"takes fluoxetine",
"lisino... |
A 45-year-old man presents with a chief complaint of pain in the great toe. He has a history of gout, which is under control. He was diagnosed with diabetes 5 years ago and is currently taking metformin. He was recently diagnosed with hypertension and was placed on a hypertensive drug. He is a non-smoker and does not a... | Thiazide diuretics | {
"A": "Angiotensin II receptor blockers (ARBs)",
"B": "Thiazide diuretics",
"C": "Calcium channel blockers (CCBs)",
"D": "Angiotensin-converting enzyme (ACE) inhibitors"
} | step1 | B | [
"year old man presents",
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"years",
"currently taking metformin",
"recently diagnosed",
"hypertension",
"placed",
"hypertensive drug",
"non-smoker",
"not abuse alcohol",
"family history",
"... |
A 15-year-old girl is brought to the physician for a school physical examination. She feels well. She is performing well in school and getting good grades. She is 147 cm (4 ft 10 in) tall and weighs 60 kg (132 lbs); BMI is 27.6 kg/m2. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 16/min, and blood... | Streak ovaries on pelvic ultrasound
" | {
"A": "Horseshoe adrenal gland on abdominal CT",
"B": "Prolonged activated partial thromboplastin time",
"C": "Mutation of FBN1 on genetic testing",
"D": "Streak ovaries on pelvic ultrasound\n\""
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
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"feels well",
"performing well",
"school",
"getting good grades",
"4 ft 10",
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"BMI",
"27",
"kg/m2",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
... |
A 27-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the physician for a prenatal visit. She feels that her baby's movements have decreased recently. She says that she used to feel 10–12 movements/hour earlier, but that it has recently decreased to about 7–8/hour. Pregnancy and delivery of her first ... | Provide reassurance to the mother | {
"A": "Provide reassurance to the mother",
"B": "Administer intravenous oxytocin",
"C": "Perform vibroacoustic stimulation",
"D": "Extend the nonstress test by 20 minutes"
} | step2&3 | A | [
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"recently decreased to",
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"first child",
"uncomplicated",
... |
А 41-уеаr-old woman рrеѕеnts to thе offісе wіth a сomрlаіnt of а hеаdасhе for 1 month and a еріѕodе of аbnormаl bodу movеmеnt. The headaches are more severe іn thе mornіng, moѕtlу after waking up. Ѕhе doеѕn’t give a history of any mајor іllnеѕѕ or trauma in the past. Неr vіtаlѕ ѕіgnѕ include: blood рrеѕѕurе 160/80 mm Н... | Spindle cells concentrically arranged in whorled pattern with laminated calcification | {
"A": "Oligodendrocytes with round nuclei and clear surrounding cytoplasm giving a fried-egg appearance",
"B": "Closely arranged thin walled capillaries with minimal intervening parenchyma",
"C": "Pseudopalisading pleomorphic tumor cells",
"D": "Spindle cells concentrically arranged in whorled pattern with lam... | step1 | D | [
"r old woman",
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"1 month",
"od",
"bod",
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"th",
"waking",
"h",
"give",
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"80 mm g",
"ul 58 mn",
"36",
"97",
"rt",
"mn",
"fundoscopic",
"mld",
"present",
"ul r",
"r... |
A 40-year-old woman has complaints of dyspnea, cough, and arthritis in her ankle joints. A CT scan reveals multiples granulomas in both lungs, as well as bilateral hilar lymphadenopathy. On examination, cutaneous nodules over the trunk are found. Erythrocyte sedimentation rate, angiotensin-converting enzyme, and serum ... | Sarcoidosis | {
"A": "Hodgkin's lymphoma",
"B": "Tuberculosis",
"C": "Silicosis",
"D": "Sarcoidosis"
} | step1 | D | [
"40 year old woman",
"complaints",
"dyspnea",
"cough",
"arthritis",
"ankle joints",
"CT scan reveals multiples granulomas",
"lungs",
"bilateral hilar lymphadenopathy",
"examination",
"cutaneous nodules",
"trunk",
"found",
"Erythrocyte sedimentation rate",
"angiotensin-converting enzyme",... |
A cell biologist is studying the activity of a novel chemotherapeutic agent against a cancer cell line. After incubation with the agent and cell detachment from the tissue culture plate, the DNA is harvested from the cells and run on a gel. Of note, there are large bands at every multiple of 180 base pairs on the gel. ... | Caspase activation | {
"A": "ATP depletion",
"B": "Caspase activation",
"C": "Protein denaturation",
"D": "Release of lysosomal enzymes"
} | step1 | B | [
"cell biologist",
"studying",
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"novel chemotherapeutic agent",
"cancer",
"agent",
"cell detachment",
"tissue culture plate",
"DNA",
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"multiple",
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"finding"... |
A 2-week-old newborn is brought to the physician because of worsening feeding difficulty since birth. Examination shows a grade 2/6 harsh holosystolic murmur, heard most clearly at the left lower sternal border, and a soft mid-diastolic rumble over the cardiac apex. Echocardiography shows shunting of blood through the ... | ↓ ↑ ↓ | {
"A": "↓ ↑ no change",
"B": "↓ ↑ ↓",
"C": "↑ ↑ ↑",
"D": "↑ ↑ ↓"
} | step1 | B | [
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"6 harsh holosystolic murmur",
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"left lower sternal border",
"soft",
"diastolic rumble",
"cardiac apex",
"Echocardiography shows shunting",
"blood",
"ventricular... |
A 77-year-old man with a history of advanced dementia, hypertension, Parkinson’s disease, and diabetes mellitus type 2 is brought to the hospital from a nursing home after several days of non-bloody diarrhea and vomiting. The patient is evaluated and admitted to the hospital. Physical examination shows a grade 2/6 holo... | Fractional excretion of sodium of 0.5% | {
"A": "Urine osmolarity of 280 mOsm/kg",
"B": "Urine Na of 80 mEq/L",
"C": "Urine/plasma creatinine ratio of 10",
"D": "Fractional excretion of sodium of 0.5%"
} | step2&3 | D | [
"year old man",
"history of advanced dementia",
"hypertension",
"Parkinsons disease",
"diabetes mellitus type 2",
"brought",
"hospital",
"nursing home",
"days",
"non bloody diarrhea",
"vomiting",
"patient",
"evaluated",
"admitted",
"hospital",
"Physical examination shows",
"grade",
... |
A 7-year-old boy is brought to the physician by his mother because of a 2-week history of intermittent shortness of breath and a dry cough that is worse at night. He had an upper respiratory tract infection 3 weeks ago. Lungs are clear to auscultation. Spirometry shows normal forced vital capacity and peak expiratory f... | Methacholine | {
"A": "Atenolol",
"B": "Methacholine",
"C": "Ipratropium bromide",
"D": "Methoxyflurane"
} | step1 | B | [
"year old boy",
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"physician",
"mother",
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"night",
"upper respiratory tract infection",
"weeks",
"Lungs",
"clear",
"auscultation",
"Spirometry shows normal forced vital capacity",
"peak expira... |
А 42-уеаr-old woman рrеѕеntѕ wіth fасіаl аѕуmmеtrу. The patient says yesterday she noticed that her face appeared to be dеvіаted to the rіght. Ѕhе dеnіеѕ аnу trаumа or rесеnt trаvеl. Неr раѕt mеdісаl hіѕtorу іѕ nonсontrіbutorу. Her vitals are blood pressure 110/78 mm Hg, temperature 36.5°C (97.8°F), pulse 78/min, and r... | Idiopathic | {
"A": "Lyme disease",
"B": "Idiopathic",
"C": "Cerebrovascular accident",
"D": "Malignancy"
} | step1 | B | [
"r old woman",
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"r t",
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"temperature 36",
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"h left",
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"h",
"lo",
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"wrinkle th left d",
"Whn"... |
You are the intern on the labor and delivery floor. Your resident asks you to check on the patient in Bed 1. She is a 27-year-old prima gravida with no significant past medical history. She has had an uncomplicated pregnancy and has received regular prenatal care. You go to her bedside and glance at the fetal heart rat... | Fetal head compression | {
"A": "Fetal head compression",
"B": "Utero-placental insufficiency",
"C": "Cord compression",
"D": "Congenital heart block"
} | step2&3 | A | [
"intern",
"labor",
"delivery floor",
"resident",
"to check",
"patient",
"Bed",
"27 year old prima gravida",
"significant past medical history",
"uncomplicated pregnancy",
"received regular prenatal care",
"go",
"fetal heart rate",
"Image",
"most likely cause",
"finding"
] |
A 22-year-old woman presents to her primary care provider with an unrelenting headache accompanied by fever, chills, and malaise for the past 4 days. She also complains of an earache and dry hacking cough. Past medical history is noncontributory. She takes oral contraceptives and a multivitamin with calcium daily. She ... | Mycoplasma pneumonia | {
"A": "Streptococcus pneumonia",
"B": "Legionella pneumophila",
"C": "Mycoplasma pneumonia",
"D": "Haemophilus influenza"
} | step1 | C | [
"year old woman presents",
"primary care provider",
"headache",
"fever",
"chills",
"malaise",
"past 4 days",
"earache",
"dry hacking cough",
"Past medical history",
"takes oral contraceptives",
"multivitamin",
"calcium daily",
"drinks alcohol",
"smokes occasionally",
"Today",
"temper... |
One day after doctors helped a 28-year-old primigravid woman deliver a 4,700 g (10 lb 6 oz) boy, the newborn has bluish discoloration of the lips and fingernails. His temperature is 37.3°C (99.1°F), the pulse is 166/min, the respirations are 63/min, and the blood pressure is 68/44 mm Hg. Pulse oximetry on room air show... | Ventricular septal defect | {
"A": "Alignment of infundibular septum",
"B": "Division of aorta and pulmonary artery",
"C": "Fusion of endocardial cushion",
"D": "Ventricular septal defect"
} | step2&3 | D | [
"One day",
"doctors helped",
"year old primigravid woman deliver",
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"99",
"pulse",
"min",
"respirations",
"63 min",
"blood pressure",
"68",
"mm Hg",
"Pulse oximetry",
"r... |
A 44-year-old woman is admitted after an episode of dizziness and palpitations with a subsequent loss of consciousness. At the time of admission, the patient is alert, but then quickly becomes lethargic and reports reoccurrence of palpitations. Past medical history is significant for an episode of ventricular tachycard... | Sotalol | {
"A": "Lidocaine",
"B": "Sotalol",
"C": "Propranolol",
"D": "Diltiazem"
} | step1 | B | [
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"admitted",
"episode of dizziness",
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"subsequent loss of consciousness",
"time",
"admission",
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"alert",
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"lethargic",
"reports",
"of",
"Past medical",
"significant",
"episode of ventricular tachycardia",
"months",
"now managed",
"... |
A 62-year-old woman presents to the clinic with a lacerated wound on her left forearm. She got the wound accidentally when she slipped in her garden and scraped her hand against some nails sticking out of the fence. The patient has rheumatoid arthritis and takes methylprednisolone 16 mg/day. She cannot recall her vacci... | The immunoglobulin administration will provide sufficient levels of anti-tetanus toxin antibodies until the production of the patient’s own antibodies starts. | {
"A": "It does not make sense to administer tetanus toxoid as it will fail to induce sufficient immunity in a patient who takes oral glucocorticoids.",
"B": "The immunoglobulin administration will provide sufficient levels of anti-tetanus toxin antibodies until the production of the patient’s own antibodies starts... | step1 | B | [
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"slipped",
"garden",
"scraped",
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"nails sticking out",
"patient",
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"takes methylprednisolone 16 mg day",
"recall",
"vaccination history",
"physical examination",
... |
A 50-year-old man is brought to the emergency department because of a 3-day history of left flank pain. The patient has had two episodes of urolithiasis during the last year. He initially had pain with urination that improved with oxycodone. Over the past day, the pain has worsened and he has additionally developed fev... | Percutaneous nephrostomy | {
"A": "Percutaneous nephrostomy",
"B": "Ureteroscopy and stent placement",
"C": "Shock wave lithotripsy",
"D": "Intravenous pyelography"
} | step2&3 | A | [
"50 year old man",
"brought",
"emergency department",
"3-day history",
"left flank pain",
"patient",
"two episodes of urolithiasis",
"last year",
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"pain",
"urination",
"improved",
"oxycodone",
"past day",
"pain",
"worsened",
"fever",
"chills",
"hypertension",
"type ... |
A 48-year-old homeless man is brought to the emergency department 2 hours after his right arm was burned by a fire. He is diagnosed with extensive third-degree burns of the right forearm and upper arm and is admitted to the hospital for debridement and grafting. During his stay in the hospital, he suddenly develops con... | Glucose | {
"A": "Cobalamin",
"B": "Glucose",
"C": "Hypertonic saline",
"D": "Haloperidol"
} | step1 | B | [
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"upper arm",
"admitted",
"hospital",
"debridement",
"grafting",
"stay",
"hospital",
"confusion",
"agitation",... |
An 11-year-old girl comes to the physician with her mother because of a 2-day history of passing “cola-colored“ urine. During the past week, her mother noticed episodes of facial swelling. The patient had a rash on her face about 4 weeks ago. A renal biopsy after immunofluorescence is shown. Which of the following is t... | Poststreptococcal glomerulonephritis | {
"A": "Poststreptococcal glomerulonephritis",
"B": "IgA nephropathy",
"C": "Diffuse proliferative glomerulonephritis",
"D": "Rapidly progressive glomerulonephritis"
} | step1 | A | [
"year old girl",
"physician",
"mother",
"2-day history",
"passing cola colored urine",
"past week",
"mother",
"episodes of facial swelling",
"patient",
"rash on",
"face",
"4 weeks",
"renal biopsy",
"immunofluorescence",
"shown",
"following",
"most likely diagnosis"
] |
A 69-year-old woman with type 2 diabetes mellitus has an HbA1c of 3.9% and has been using basal-bolus insulin to manage her diabetes for the past 5 years. She has been maintaining a healthy diet, taking her insulin as scheduled but her records show morning hyperglycemia before eating breakfast. To determine the cause o... | She is experiencing Somogyi effect so her nighttime insulin should be decreased | {
"A": "She is experiencing dawn phenomenon so her nighttime insulin should be increased",
"B": "She is experiencing Somogyi effect so her nighttime insulin should be increased",
"C": "She is experiencing Somogyi effect so her nighttime insulin should be decreased",
"D": "Hyperosmolar hyperglycemic state; incre... | step2&3 | C | [
"69 year old woman",
"type 2 diabetes mellitus",
"using basal bolus insulin to",
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"years",
"maintaining",
"healthy diet",
"taking",
"insulin",
"scheduled",
"records show morning hyperglycemia",
"eating breakfast",
"To",
"cause",
"hyperglycemia",
"to set",
"alarm"... |
A 37-year-old man is brought to the emergency department after being attacked with a knife. Physical examination shows a 4-cm laceration in the midline of the right forearm. An MRI of the right arm shows damage to a nerve that runs between the superficial and deep flexor digitorum muscles. Loss of sensation over which ... | Fingertip of the index finger | {
"A": "Lateral aspect of the forearm",
"B": "Fingertip of the index finger",
"C": "Medial aspect of the forearm",
"D": "Dorsum of the thumb"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"attacked",
"knife",
"Physical examination shows",
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"midline of",
"right forearm",
"MRI",
"right arm shows damage",
"nerve",
"runs",
"superficial",
"deep flexor digitorum muscles",
"Loss of sensation",
"following ... |
A 25-year-old nulliparous woman at 8 weeks' gestation comes to her physician accompanied by her husband for her first prenatal visit. She has no personal or family history of serious illness. Her vaccinations are up-to-date and she takes no medications. She has no history of recreational drug use and does not drink alc... | ELISA for HIV, rapid plasma reagin test, and serum HBsAg | {
"A": "Culture for group B streptococci, hepatitis C serology, and PPD skin test",
"B": "Serum TSH, CMV serology, and PCR for HSV-2",
"C": "VDRL, Western blot for HIV, and serum HBsAg",
"D": "ELISA for HIV, rapid plasma reagin test, and serum HBsAg"
} | step2&3 | D | [
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"personal",
"family history",
"serious illness",
"vaccinations",
"date",
"takes",
"medications",
"history of recreational drug use",
"not drink alcohol",
"vital signs",
"normal limits"... |
A 24-year-old woman presents with generalized edema, hematuria, and severe right-sided flank pain. Her vital signs are normal. A 24-hour urine collection shows >10 grams of protein in her urine. Serum LDH is markedly elevated. Contrast-enhanced spiral CT scan shows thrombosis of the right renal vein. Which of the follo... | Urinary loss of antithrombin III | {
"A": "Urinary loss of antithrombin III",
"B": "Hepatic synthetic failure",
"C": "Oral contraceptive pills",
"D": "Hereditary factor VIII deficiency"
} | step1 | A | [
"year old woman presents",
"generalized",
"hematuria",
"severe right-sided flank pain",
"vital signs",
"normal",
"24-hour urine collection shows",
"10 grams",
"protein",
"urine",
"Serum LDH",
"markedly elevated",
"Contrast CT scan shows thrombosis of",
"right renal vein",
"following",
... |
Ten days after undergoing left hip replacement, a 73-year-old hospitalized man develops a fever, dyspnea, cough productive of yellow sputum, confusion, nausea, and diarrhea. Several patients in the hospital report similar symptoms. Physical examination shows decreased breath sounds on the left side and inspiratory crac... | Colonization of the air conditioning system | {
"A": "Contamination of reheated hospital food",
"B": "Colonization of the air conditioning system",
"C": "Entry through colonized intravenous catheters",
"D": "Insufficient adherence to hand hygiene measures"
} | step1 | B | [
"Ten days",
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"yellow",
"confusion",
"nausea",
"diarrhea",
"patients in",
"hospital report similar symptoms",
"Physical examination shows decreased breath sounds",
"left side",
"inspiratory crackle... |
A group of scientists is studying various methods of bacterial reproduction. They find out that bacteria also exchange genetic material via these reproductive processes. They are about to study one such method known as bacterial conjugation. Which of the following occurs through bacterial conjugation? | Two Pseudomonas aeruginosa bacteria with identical copies of a plasmid after sharing DNA through sex pili. | {
"A": "Two Pseudomonas aeruginosa bacteria with identical copies of a plasmid after sharing DNA through sex pili.",
"B": "A strain of MRSA acquiring the gene of capsulation from another encapsulated strain via DNA extraction.",
"C": "A multidrug-resistant Shigella species passing resistance factor R to a Strepto... | step1 | A | [
"A group",
"scientists",
"studying various methods",
"bacterial reproduction",
"find out",
"bacteria",
"exchange genetic material",
"processes",
"to study one",
"method known",
"bacterial conjugation",
"following occurs",
"bacterial conjugation"
] |
An 81-year-old man is brought in by his neighbor with altered mental status. The patient’s neighbor is unsure exactly how long he was alone, but estimates that it was at least 3 days. The neighbor says that the patient usually has his daughter at home to look after him but she had to go into the hospital recently. The ... | Dehydration | {
"A": "Dehydration",
"B": "Sepsis",
"C": "NSAID use",
"D": "UTI due to obstructive nephrolithiasis"
} | step2&3 | A | [
"81 year old man",
"brought",
"neighbor",
"altered mental status",
"patients neighbor",
"unsure",
"long",
"alone",
"estimates",
"days",
"neighbor",
"patient usually",
"daughter at home to look",
"to go",
"hospital recently",
"patient",
"unable to provide",
"useful history",
"Past... |
A 52-year-old man is brought to the emergency department by a friend because of a 5-day history of fever and cough productive of purulent sputum. One week ago, he was woken up by an episode of heavy coughing while lying on his back. He drinks large amounts of alcohol daily and has spent most of his time in bed since hi... | Superior segment of the right lower lobe | {
"A": "Posterior basal segment of the right lower lobe",
"B": "Apicoposterior segment of the left upper lobe",
"C": "Superior segment of the right lower lobe",
"D": "Posterior basal segment of the left lower lobe"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"friend",
"5-day history",
"fever",
"cough productive",
"purulent",
"One week",
"woken up",
"episode of heavy coughing",
"lying on",
"back",
"drinks large amounts",
"alcohol daily",
"spent most of",
"time",
"bed",
"wife passed",
... |
A 42-year-old man is brought to the emergency department because his neck was fixed in lateral flexion. For the past week, the patient has been complaining of low-grade fever, head pain, and neck pain. His partner has also noticed him behaving erratically. His family and personal medical history are not relevant. Upon ... | Viral infection | {
"A": "Genetic mutation",
"B": "Exposure to D2-antagonists",
"C": "Viral infection",
"D": "Acid-fast resistant bacilli infection"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"neck",
"fixed",
"lateral flexion",
"past week",
"patient",
"low-grade fever",
"head pain",
"neck pain",
"partner",
"family",
"personal medical history",
"not relevant",
"admission",
"found",
"body temperature",
"physical examina... |
A 36-year-old software professional consults a physician to discuss his concerns about small-vessel vasculitis as his mother and sister both have autoimmune small-vessel vasculitides. He has read about vasculitides and recently he came across an article which stated that an analgesic that he often uses for relief from ... | Palpable purpura | {
"A": "Absence of pulses in the upper extremity",
"B": "Infarction of an internal organ",
"C": "Aneurysm of an artery",
"D": "Palpable purpura"
} | step1 | D | [
"36 year old software professional consults",
"physician to discuss",
"concerns",
"small-vessel vasculitis",
"mother",
"sister",
"autoimmune small-vessel vasculitides",
"read",
"vasculitides",
"recently",
"article",
"stated",
"analgesic",
"often uses",
"relief",
"headache",
"cause sm... |
A 22-year-old man with no significant medical history presents with a two day history of bilateral eye redness, irritation, and watery mucous discharge as seen in the photograph provided. He has crusting of his eyes in the mornings without adhesion of his eyelids. He does not wear contact lenses and has had a sore thro... | Warm compresses | {
"A": "Topical erythromycin ointment",
"B": "Oral azithromycin",
"C": "Warm compresses",
"D": "Topical glucocorticoids"
} | step1 | C | [
"year old man",
"significant medical history presents",
"two day history of bilateral eye redness",
"irritation",
"watery mucous discharge",
"seen",
"photograph provided",
"crusting",
"eyes",
"mornings",
"adhesion of",
"eyelids",
"not",
"contact lenses",
"sore throat",
"last three days... |
A 58-year-old man with an unknown previous medical history is found on the floor at home by his daughter. During the initial assessment, the patient has right-sided arm weakness and incomprehensible speech. The patient is admitted to the hospital where he is diagnosed with an ischemic stroke where his magnetic resonanc... | Forced diuresis with intravenous (IV) fluids | {
"A": "Forced diuresis with intravenous (IV) fluids",
"B": "Stress echocardiography",
"C": "Transfusion of fresh frozen plasma (FFP)",
"D": "Rhythm control with metoprolol"
} | step2&3 | A | [
"58 year old man",
"unknown previous medical history",
"found on",
"floor at home",
"daughter",
"initial assessment",
"patient",
"right-sided weakness",
"incomprehensible speech",
"patient",
"admitted",
"hospital",
"diagnosed",
"ischemic stroke",
"magnetic resonance image",
"scan showe... |
A 16-year-old girl is brought to the emergency department by her parents because of fever, vomiting, rash, and worsening confusion since this morning. On questioning, her mother reports that her last menstrual period was 1 week ago and that she recently started using tampons. She appears lethargic and is only oriented ... | Polyclonal T cell activation | {
"A": "Erythrogenic toxin production",
"B": "Lipooligosaccharide expression",
"C": "Unregulated B cell proliferation",
"D": "Polyclonal T cell activation"
} | step1 | D | [
"year old girl",
"brought",
"emergency department",
"parents",
"fever",
"vomiting",
"rash",
"worsening confusion",
"morning",
"questioning",
"mother reports",
"last menstrual period",
"1 week",
"recently started using tampons",
"appears lethargic",
"only oriented to person",
"tempera... |
A 27-year-old man is brought to the emergency department after a motor vehicle accident. He complains of tingling of his legs, and he is unable to move them. His temperature is 36.5°C (97.7°F), the blood pressure is 110/75 mm Hg, and the pulse is 88/min. On physical examination, pinprick sensation is absent below the u... | Intravenous methylprednisolone | {
"A": "Positron emission tomography (PET) scan of the spine",
"B": "Intravenous methylprednisolone",
"C": "Radiation therapy",
"D": "Intravenous antibiotics"
} | step2&3 | B | [
"27 year old man",
"brought",
"emergency department",
"motor vehicle accident",
"tingling",
"legs",
"unable to move",
"temperature",
"36",
"97",
"blood pressure",
"75 mm Hg",
"pulse",
"88 min",
"physical examination",
"pinprick sensation",
"absent",
"umbilicus",
"rectal tone",
... |
A 40-year-old Indian female is hospitalized with exertional dyspnea and lower extremity edema. The patient immigrated to the United States at age 15 and does not use tobacco, alcohol, or drugs. A mid-diastolic murmur is present and heard best at the apex. Which of the following symptoms would be most consistent with th... | Hoarseness | {
"A": "Hoarseness",
"B": "Pulsus parodoxus",
"C": "Increased intracranial pressure",
"D": "Hirsutism"
} | step1 | A | [
"40 year old Indian female",
"hospitalized",
"exertional dyspnea",
"lower extremity edema",
"patient",
"United States",
"age",
"not use tobacco",
"alcohol",
"drugs",
"mid-diastolic murmur",
"present",
"heard best",
"apex",
"following symptoms",
"most consistent with",
"rest",
"pati... |
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