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 14-year-old Caucasian girl presents to the pediatrician for poor balance. She reports a 7-month history of frequent falls that has progressively worsened. She has fallen 3 times in the past week and feels like she cannot walk normally. She was born full-term and spent 2 days in the neonatal intensive care unit for re... | GAA | {
"A": "CAG",
"B": "CTG",
"C": "GAA",
"D": "GAC"
} | step1 | C | [
"year old Caucasian girl presents",
"pediatrician",
"poor balance",
"reports",
"month history of frequent falls",
"worsened",
"fallen",
"times",
"past",
"feels",
"walk",
"born full-term",
"spent 2 days",
"neonatal intensive care unit",
"respiratory distress",
"normal childhood",
"fam... |
A 47-year-old farmer presents to his primary care physician for the first time appointment. The patient has never seen a doctor and states that he is in good health. He has worked as a farmer for the past 30 years and has no complaints. His temperature is 98.9°F (37.2°C), blood pressure is 197/118 mmHg, pulse is 90/min... | Lisinopril | {
"A": "Carvedilol",
"B": "Lisinopril",
"C": "Metoprolol",
"D": "Nicardipine"
} | step2&3 | B | [
"year old farmer presents",
"primary care physician",
"first time appointment",
"patient",
"never seen",
"doctor",
"states",
"good health",
"worked",
"farmer",
"past 30 years",
"complaints",
"temperature",
"98 9F",
"blood pressure",
"mmHg",
"pulse",
"90 min",
"respirations",
"m... |
A 26-year-old woman presents to the office complaining of bloating and consistent fatigue. Past medical notes on her record show that she has seen several doctors at the clinic in the past year for the same concerns. During the discussion, she admits that coming to the doctor intensifies her anxiety and she does not en... | Illness anxiety disorder | {
"A": "Malingering",
"B": "Somatic symptoms disorder",
"C": "Illness anxiety disorder",
"D": "Generalized anxiety disorder"
} | step1 | C | [
"year old woman presents",
"office",
"bloating",
"consistent fatigue",
"Past medical notes",
"record show",
"seen several doctors",
"clinic",
"past year",
"same concerns",
"discussion",
"admits",
"doctor",
"anxiety",
"not",
"fears",
"colon cancer",
"wrong",
"I",
"feel",
"Past... |
A 45-year-old man presents to his primary care physician for lower extremity pain and unsteadiness. He describes the pain as severe and stabbing and affecting his lower extremities. These episodes of pain last for minutes at a time. He also reports knocking into furniture regularly. Medical history is significant for s... | Intravenous penicillin | {
"A": "Intramuscular ceftriaxone",
"B": "Intravenous doxycycline",
"C": "Intravenous penicillin",
"D": "Oral doxycycline"
} | step2&3 | C | [
"year old man presents",
"primary care physician",
"lower extremity pain",
"unsteadiness",
"pain",
"severe",
"stabbing",
"affecting",
"lower extremities",
"episodes of pain last",
"minutes",
"time",
"reports",
"furniture",
"Medical history",
"significant",
"streptococcal pharyngitis"... |
A 25-year-old male wrestler presents to his primary care physician for knee pain. He was in a wrestling match yesterday when he was abruptly taken down. Since then, he has had pain in his left knee. The patient states that at times it feels as if his knee locks as he moves it. The patient has a past medical history of ... | Medial meniscus | {
"A": "Medial meniscus",
"B": "Lateral meniscus",
"C": "Medial collateral ligament",
"D": "Anterior cruciate ligament"
} | step2&3 | A | [
"year old male",
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"primary care physician",
"knee pain",
"wrestling match",
"taken",
"then",
"pain in",
"left knee",
"patient states",
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"feels",
"knee locks",
"moves",
"patient",
"past medical anabolic",
"longer",
"using",
"current medications include NSAIDs as... |
A 71-year-old woman comes to the physician because of progressive shortness of breath and swollen legs for 4 weeks. She has tried sleeping in a raised position using 2 pillows but still wakes up occasionally from a choking sensation. She returned from a safari tour in Tanzania 3 months ago. She has type 2 diabetes mell... | Multiple myeloma | {
"A": "Endocardial fibroelastosis",
"B": "Systemic sclerosis",
"C": "Multiple myeloma",
"D": "Rheumatoid arthritis"
} | step2&3 | C | [
"71 year old woman",
"physician",
"of progressive shortness",
"breath",
"swollen legs",
"weeks",
"sleeping",
"raised position using 2 pillows",
"wakes up occasionally",
"choking sensation",
"returned",
"tour",
"Tanzania",
"months",
"type 2 diabetes mellitus",
"arterial hypertension",
... |
A 6-year-old boy is brought to the pediatrician by his mother for diarrhea and a skin rash. His mother reports that he had a cough, sore throat, and runny nose 1 week ago. Although his upper respiratory symptoms improved after two days, he started having multiple watery bowel movements 3 days ago. He also developed a r... | Nicotinic acid | {
"A": "Nicotinic acid",
"B": "Phenylbutyrate",
"C": "Pyridoxine",
"D": "Tryptophan"
} | step1 | A | [
"year old boy",
"brought",
"pediatrician",
"mother",
"diarrhea",
"skin rash",
"mother reports",
"cough",
"sore throat",
"runny nose",
"week",
"upper respiratory symptoms improved",
"two days",
"started",
"multiple watery bowel movements",
"days",
"red pruritic rash",
"arms",
"leg... |
A 49-year-old man comes to the physician because of a 5-month history of progressive fatigue and exertional dyspnea. Cardiac examination shows a loud S2 in the 2nd left intercostal space. Right heart catheterization shows a pulmonary artery pressure of 32 mm Hg. Treatment with bosentan is initiated. The beneficial effe... | Endothelin receptors | {
"A": "L-type voltage-gated calcium channels",
"B": "Phosphodiesterase-5",
"C": "Adenosine receptors",
"D": "Endothelin receptors"
} | step1 | D | [
"year old man",
"physician",
"5 month history",
"progressive fatigue",
"exertional dyspnea",
"Cardiac examination shows",
"loud S2",
"2nd left intercostal space",
"Right heart catheterization shows",
"pulmonary artery pressure",
"mm Hg",
"Treatment",
"bosentan",
"initiated",
"beneficial ... |
A 2-week-old newborn girl is brought to the physician for a follow-up examination after the initial newborn examination showed asymmetry of the legs. She was born at term to a 26-year-old woman, gravida 3, para 2. Pregnancy was complicated by a breech presentation and treated with an emergency lower-segment transverse ... | Treat using a harness | {
"A": "Obtain an MRI of the right hip",
"B": "Obtain an X-ray of the right hip",
"C": "Reassure the mother and schedule follow-up appointment in 4 weeks",
"D": "Treat using a harness"
} | step2&3 | D | [
"2 week old newborn girl",
"brought",
"physician",
"follow-up examination",
"initial newborn",
"showed asymmetry",
"legs",
"born",
"term",
"year old woman",
"gravida 3",
"para 2",
"Pregnancy",
"complicated",
"breech presentation",
"treated with",
"emergency lower segment transverse c... |
A 26-year-old woman comes to the physician because of a progressive swelling in her mouth that she first noticed 5 years ago. Initially, the swelling was asymptomatic but has now caused some difficulty while chewing food for the past month. She has no pain. She has not undergone any dental procedures in the past 5 year... | Torus palatinus
" | {
"A": "Palatal pleomorphic adenoma",
"B": "Necrotizing sialometaplasia",
"C": "Nasopalatine duct cyst",
"D": "Torus palatinus\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"of",
"progressive swelling",
"mouth",
"first",
"5 years",
"Initially",
"swelling",
"asymptomatic",
"now caused",
"difficulty",
"chewing food",
"past month",
"pain",
"not",
"dental procedures",
"past",
"years",
"bronchial asthma",
"only medicati... |
A 54-year-old man presents to the emergency department after vomiting blood an hour ago. He says this happens to him occasionally but denies feeling pain in these episodes. The man is disheveled and has slurred speech as he describes his symptoms. He is reluctant to give further history and wants immediate treatment of... | Increased pressure in the distal esophageal vein due to increased pressure in the left gastric vein | {
"A": "Increased pressure in the distal esophageal vein due to increased pressure in the left gastric vein",
"B": "Lacerations of the mucosa at the gastroesophageal junction",
"C": "Decreased GABA activity due to downregulation of receptors",
"D": "Inflammation of the portal tract due to a chronic viral illnes... | step1 | A | [
"54 year old man presents",
"emergency department",
"vomiting blood",
"hour",
"happens",
"occasionally",
"denies feeling pain",
"episodes",
"man",
"slurred speech",
"symptoms",
"reluctant to give further history",
"immediate treatment",
"condition",
"examination",
"patient",
"evidenc... |
A 60-year-old man is brought to the emergency room because of fever and increasing confusion for the past 2 days. He has paranoid schizophrenia treated with chlorpromazine. He appears diaphoretic. His temperature is 40°C (104°F), pulse is 130/min, respirations are 29/min, and blood pressure is 155/100 mm Hg. Neurologic... | Ryanodine receptor on the sarcoplasmic reticulum | {
"A": "Cholinesterase",
"B": "Postsynaptic dopamine D2 receptors and serotonin 2A receptors",
"C": "Ryanodine receptor on the sarcoplasmic reticulum",
"D": "Beta adrenergic receptors"
} | step1 | C | [
"60 year old man",
"brought",
"emergency room",
"fever",
"increasing confusion",
"past 2 days",
"paranoid schizophrenia treated with chlorpromazine",
"appears diaphoretic",
"temperature",
"pulse",
"min",
"respirations",
"29 min",
"blood pressure",
"100 mm Hg",
"Neurologic examination s... |
A 10-month-old infant is brought to the emergency by his parents after a seizure. The parents report no history of trauma, fever, or a family history of seizures. However, they both say that the patient fell while he was running. Neurologic examination was normal. A head CT scan was ordered and is shown in figure A. Wh... | Retinal hemorrhages | {
"A": "Slipped capital femoral epiphysis",
"B": "Retinal hemorrhages",
"C": "Microcephaly",
"D": "Rupture of middle meningeal artery"
} | step2&3 | B | [
"A 10 month old infant",
"brought",
"emergency",
"parents",
"seizure",
"parents report",
"history",
"trauma",
"fever",
"family history",
"seizures",
"patient fell",
"running",
"Neurologic examination",
"normal",
"head CT scan",
"ordered",
"shown",
"following",
"most likely foun... |
An 80-year-old woman presents to her cardiologist for a scheduled appointment. She was shown to have moderate atrial dilation on echocardiography 3 years ago and was started on oral medications. The patient insists that she does not want aggressive treatment because she wants her remaining years to be peaceful. She has... | Liver | {
"A": "Eyes",
"B": "Kidneys",
"C": "Liver",
"D": "Spleen"
} | step1 | C | [
"80 year old woman presents",
"cardiologist",
"scheduled appointment",
"shown to",
"moderate atrial dilation",
"echocardiography",
"years",
"started",
"oral medications",
"patient",
"not",
"aggressive treatment",
"remaining years to",
"peaceful",
"not",
"compliant",
"medications",
... |
A 3-year-old girl is brought in by her parents to her pediatrician for concerns about their child’s behavior. Since the parents started taking their child to daycare, they have become concerned that their daughter has not been behaving like other children her age. Most notably, she seldom responds when her name is call... | Autism spectrum disorder | {
"A": "Attention-deficit hyperactivity disorder",
"B": "Autism spectrum disorder",
"C": "Normal development",
"D": "Rett syndrome"
} | step1 | B | [
"3 year old girl",
"brought",
"parents",
"pediatrician",
"concerns",
"childs behavior",
"parents started taking",
"child",
"daycare",
"concerned",
"daughter",
"not",
"children",
"age",
"seldom",
"name",
"called at home",
"daycare",
"getting",
"day care staff",
"not following ... |
A 27-year-old man comes to the physician because of multiple, dry, scaly lesions on his elbows. The lesions appeared 4 months ago and have progressively increased in size. They are itchy and bleed when he scratches them. There is no associated pain or discharge. He was diagnosed with HIV infection 6 years ago. He has s... | Increased keratinocyte proliferation | {
"A": "HPV-2 infection",
"B": "Malassezia furfur infection",
"C": "Neoplastic T-cell Infiltration",
"D": "Increased keratinocyte proliferation"
} | step2&3 | D | [
"27 year old man",
"physician",
"multiple",
"dry",
"scaly lesions",
"elbows",
"lesions appeared 4 months",
"increased in size",
"itchy",
"bleed",
"scratches",
"associated pain",
"discharge",
"diagnosed",
"HIV infection",
"years",
"smoked",
"pack",
"cigarettes daily",
"past 10 y... |
A 45-year-old African-American woman presents with dyspnea, cough, and non-radiating chest pain. Her chest pain is relieved by leaning forward and worsens upon leaning backwards. A scratchy rub is heard best with the patient leaning forward. Physical examination did not elucidate evidence of a positive Kussmaul's sign,... | Acute pericarditis | {
"A": "Constrictive pericarditis",
"B": "Acute pericarditis",
"C": "Libman-Sacks endocarditis",
"D": "Acute myocardial infarction"
} | step1 | B | [
"year old African-American woman presents",
"dyspnea",
"cough",
"non radiating chest pain",
"chest pain",
"relieved by",
"forward",
"worsens",
"backwards",
"scratchy rub",
"heard best",
"patient",
"forward",
"Physical examination",
"not",
"evidence",
"positive Kussmaul's sign",
"pu... |
Shortly after the removal of a subclavian venous catheter by a surgical resident in an academic medical center, a 50-year-old man develops tachycardia, respiratory distress, and hypotension. Despite appropriate lifesaving treatment, the patient dies. Examination of the lungs during autopsy shows air in the main pulmona... | Conduct interviews with all staff members involved in the patient's care | {
"A": "Schedule a required lecture on central venous catheter removal for all residents",
"B": "Examine the central line placement curriculum used for all surgical residents",
"C": "Conduct interviews with all staff members involved in the patient's care",
"D": "Review all possible causes of venous air embolis... | step1 | C | [
"removal of",
"subclavian venous catheter",
"surgical resident",
"academic medical center",
"50 year old man",
"tachycardia",
"respiratory distress",
"hypotension",
"appropriate lifesaving treatment",
"patient",
"Examination of",
"lungs",
"autopsy shows air",
"main pulmonary artery",
"ro... |
A 63-year-old woman comes to the physician because of a skin lesion on her neck for 7 months. It is neither pruritic nor painful. She has tried using over-the-counter topical medications, but none have helped. She has hypertension, hypothyroidism, and gastroesophageal reflux disease. Current medications include amlodip... | Perform an excisional biopsy of the entire lesion | {
"A": "Perform a punch biopsy of the center of the lesion",
"B": "Perform an excisional biopsy of the entire lesion",
"C": "Schedule external beam radiotherapy sessions",
"D": "Perform a wedge biopsy of the lesion and surrounding tissue"
} | step2&3 | B | [
"63 year old woman",
"physician",
"of",
"skin lesion on",
"neck",
"months",
"painful",
"using over-the-counter topical medications",
"helped",
"hypertension",
"hypothyroidism",
"gastroesophageal reflux disease",
"Current medications include amlodipine",
"hydrochlorothiazide",
"levothyrox... |
A 45-year-old man comes to the physician for a follow-up examination after being diagnosed with hypertension 6 months ago. He has cut salt out of his diet and started exercising regularly, but home blood pressure measurements continue to be elevated. His blood pressure is 160/85 mm Hg. An antihypertensive medication is... | Skeletal muscle contraction occurs independently of extracellular calcium influx | {
"A": "Skeletal muscle contraction occurs independently of extracellular calcium influx",
"B": "Skeletal muscle ryanodine receptor activation occurs independently of membrane depolarization",
"C": "Skeletal muscle preferentially expresses N-type and P-type calcium channels",
"D": "Skeletal muscle calcium chann... | step1 | A | [
"year old man",
"physician",
"follow-up examination",
"diagnosed",
"hypertension",
"months",
"cut salt out",
"diet",
"started exercising",
"home blood pressure measurements continue to",
"elevated",
"blood pressure",
"85 mm Hg",
"antihypertensive medication",
"prescribed",
"decreases b... |
A 10-year-old boy presents with sudden shortness of breath. The patient’s mother says he was playing in the school garden 2 hours ago and suddenly started to complain of abdominal pain and vomited a few times. An hour later, he slowly developed a rash that involved his chest, arms, and legs, and his breathing became fa... | Neutrophils | {
"A": "Basophils",
"B": "Fibroblasts",
"C": "Plasma cells",
"D": "Neutrophils"
} | step1 | D | [
"A 10 year old boy presents",
"sudden shortness of breath",
"patients mother",
"playing",
"school garden",
"hours",
"started to",
"abdominal pain",
"vomited",
"few times",
"hour later",
"slowly",
"rash",
"involved",
"chest",
"arms",
"legs",
"breathing",
"faster",
"wheezing",
... |
A 60-year-old man comes to the emergency department because of a 2-day history of sharp chest pain and a nonproductive cough. The pain worsens with deep inspiration and improves when he leans forward. Three weeks ago, the patient was diagnosed with an ST-elevation myocardial infarction and underwent stent implantation ... | Immune response to cardiac antigens | {
"A": "Occlusion of coronary artery stent",
"B": "Embolism to left pulmonary artery",
"C": "Immune response to cardiac antigens",
"D": "Rupture of interventricular septum"
} | step1 | C | [
"60 year old man",
"emergency department",
"of",
"2-day history",
"sharp chest pain",
"nonproductive cough",
"pain worsens",
"deep inspiration",
"improves",
"forward",
"Three weeks",
"patient",
"diagnosed",
"ST-elevation myocardial infarction",
"stent implantation",
"right coronary art... |
Which of the following correctly pairs a neurotransmitter with its location of synthesis? | Serotonin -- Raphe nucleus | {
"A": "Norepinephrine -- Caudate nucleus",
"B": "GABA -- Ventral tegmentum",
"C": "Serotonin -- Raphe nucleus",
"D": "Acetylcholine -- Nucleus accumbens"
} | step1 | C | [
"following",
"pairs",
"neurotransmitter",
"location",
"synthesis"
] |
A 22-year-old man presents to the emergency department with abdominal pain. The patient states that he has had right lower quadrant abdominal pain for "a while now". The pain comes and goes, and today it is particularly painful. The patient is a college student studying philosophy. He drinks alcohol occasionally and is... | Inflammatory bowel syndrome | {
"A": "Appendicitis",
"B": "Colon cancer",
"C": "Infectious colitis",
"D": "Inflammatory bowel syndrome"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"abdominal pain",
"patient states",
"right lower quadrant abdominal pain",
"now",
"pain",
"goes",
"today",
"painful",
"patient",
"college student studying philosophy",
"drinks alcohol occasionally",
"currently sexually active",
"states",
... |
A 12-year-old girl is brought to the physician because of fatigue, dyspnea, and mild chest pain on exertion for 1 week. She does not have a fever or a rash. She had an upper respiratory infection 3 weeks ago. She returned from summer camp in Colorado 3 days ago. She says they went hiking and camping as part of their ac... | Coxsackie virus infection | {
"A": "Acute rheumatic fever",
"B": "Borrelia burgdorferi infection",
"C": "Coxsackie virus infection",
"D": "Rhinovirus infection"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"fatigue",
"dyspnea",
"mild chest pain on exertion",
"1 week",
"not",
"fever",
"rash",
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"weeks",
"returned",
"summer camp",
"Colorado",
"days",
"hiking",
"camping",
"part of",
"activities",
"temperature",
... |
A 2-year-old boy is brought to a pediatrician for recurrent respiratory infections. The parents explain that their child has gotten sick every month since 2 months of age. The boy had multiple upper respiratory infections and has been treated for pneumonia twice. He coughs frequently, and a trial of salbutamol has not ... | Frameshift | {
"A": "Frameshift",
"B": "Insertion",
"C": "Missense",
"D": "Silent"
} | step1 | A | [
"2 year old boy",
"brought",
"pediatrician",
"recurrent respiratory infections",
"parents",
"child",
"gotten sick",
"month",
"months",
"age",
"boy",
"multiple upper",
"treated",
"pneumonia twice",
"coughs frequently",
"trial",
"salbutamol",
"not helped much",
"parents",
"child"... |
A 43-year-old man comes to the physician for evaluation of a headache he has had for the last 6 months. The patient reports that nothing helps to relieve the headache and that it is more severe in the morning. Throughout the last 2 months, he has been unable to maintain an erection and states that his sexual desire is ... | Serum IGF-1 measurement | {
"A": "Serum IGF-1 measurement",
"B": "Oral glucose tolerance test",
"C": "Basal prolactin measurement",
"D": "24-hour urine cortisol measurement\n\""
} | step2&3 | A | [
"year old man",
"physician",
"evaluation",
"headache",
"last",
"months",
"patient reports",
"helps to relieve",
"headache",
"more severe",
"morning",
"last",
"months",
"unable to maintain",
"erection",
"states",
"sexual desire",
"low",
"personal",
"family history",
"serious i... |
A 68-year-old male presents with several years of progressively worsening pain in his buttocks. Pain is characterized as dull, worse with exertion especially when ascending the stairs. He has a history of diabetes mellitus type II, obesity, coronary artery disease with prior myocardial infarction, and a 44 pack-year sm... | Ankle-brachial index | {
"A": "Cilostazol",
"B": "Guided exercise therapy",
"C": "Ankle-brachial index",
"D": "Angiography"
} | step2&3 | C | [
"68 year old male presents",
"years",
"worsening pain in",
"buttocks",
"characterized",
"dull",
"worse",
"exertion",
"ascending",
"stairs",
"history of diabetes mellitus type II",
"obesity",
"coronary artery disease with prior myocardial infarction",
"pack-year smoking history",
"Current... |
A 27-year-old man presents to the emergency department following a motor vehicle accident. Having been found as a restrained driver, he did not suffer from any chest injuries; nevertheless, his legs were pinned in position by the front of the highly damaged vehicle. After a prolonged extrication, the man sustained mult... | Fat embolism | {
"A": "Pulmonary edema",
"B": "Cardiac tamponade",
"C": "Bacterial pneumonia",
"D": "Fat embolism"
} | step1 | D | [
"27 year old man presents",
"emergency department following",
"motor vehicle accident",
"found",
"restrained driver",
"not suffer",
"chest injuries",
"legs",
"pinned",
"position",
"front",
"highly damaged vehicle",
"prolonged extrication",
"man sustained multiple fractures",
"left femur"... |
A 3-year-old is brought to the pediatrician by by his mother. She is concerned that he appears fatigued all the time. She also mentions that he struggles to get out of his seat after eating his meals and when he waddles when he walks now. The child was born at 39 weeks via spontaneous vaginal delivery. He is up to date... | Nonsense mutation in DMD gene | {
"A": "Missense mutation in β-thalassemia gene",
"B": "Missense mutation in DMD gene",
"C": "Nonsense mutation in DMD gene",
"D": "Mutation in WT gene"
} | step1 | C | [
"3 year old",
"brought",
"pediatrician",
"mother",
"concerned",
"appears fatigued",
"time",
"to get out",
"eating",
"meals",
"walks now",
"child",
"born",
"weeks",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental goals",
"maternal uncle",
"similar... |
A 5-month-old boy is brought to the physician by his parents because of difficulty breathing for the past hour. The parents report noisy breathing and bluish discoloration of their son's lips. During the past two months, the patient has had several upper respiratory tract infections and poor weight gain. Pregnancy and ... | Defective CD40 ligand | {
"A": "Defective WAS gene",
"B": "Defective CD40 ligand",
"C": "Tyrosine kinase gene mutation",
"D": "Impaired NADPH oxidase"
} | step2&3 | B | [
"5 month old boy",
"brought",
"physician",
"parents",
"difficulty breathing",
"past hour",
"parents report noisy breathing",
"discoloration",
"son's lips",
"past two months",
"patient",
"several upper respiratory tract infections",
"poor weight gain",
"Pregnancy",
"delivery",
"uncompli... |
A 68-year-old man presents to his primary care physician for fatigue. He is accompanied by his granddaughter who is worried that the patient is depressed. She states that over the past 2 months he has lost 15 lbs. He has not come to some family events because he complains of being “too tired.” The patient states that h... | Colonoscopy | {
"A": "Citalopram",
"B": "Colonoscopy",
"C": "Fluorouracil, leucovorin, and oxaliplatin",
"D": "Surgical resection"
} | step2&3 | B | [
"68 year old man presents",
"primary care physician",
"fatigue",
"granddaughter",
"worried",
"patient",
"depressed",
"states",
"past",
"months",
"lost",
"lbs",
"not",
"family events",
"tired",
"patient states",
"to keep",
"things",
"likes to",
"biking",
"bowling",
"friends"... |
Eighteen hours after undergoing surgery for a splenic rupture and liver laceration following a high-speed motor vehicle collision, a 23-year-old man's pulse is 140/min, blood pressure is 80/50 mm Hg, and central venous pressure is 19 cm H2O. He was transfused with 6 units of packed red blood cells during surgery. Exami... | Reopen abdomen and cover with plastic | {
"A": "Reopen abdomen and cover with plastic",
"B": "Administration of intravenous antibiotics",
"C": "Angiographic embolization",
"D": "Hemicolonic resection"
} | step2&3 | A | [
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"urgery.",
"xa... |
A 30-year-old man presents to his family physician admitting to using heroin. He says he started using about 6-months ago when his back pain medication ran out. At first, he says he would borrow his wife’s Percocet but, eventually, that ran out and he had to find a different source. Since then, he has been having more ... | Improved interpersonal relationships | {
"A": "Improved interpersonal relationships",
"B": "Euphoria without the side effects",
"C": "Decreased incidence of hepatitis A",
"D": "Decreases methadone dependence"
} | step2&3 | A | [
"30 year old man presents",
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"months",
"back pain medication ran out",
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"then",
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"more issues related",
"heroin use",
"started to affect",
"work",
"home life",
"concerne... |
A 53-year-old man presents to an urgent care center with severe fever that began during the day along with muscle and joint pains. He states that he felt fine the day before but then developed a fever to 103°F (39.4°C) and had to leave work after which he developed a headache and body pains. The patient states that he ... | Dengue virus | {
"A": "Dengue virus",
"B": "Marburg virus",
"C": "Norovirus",
"D": "Saint Louis encephalitis virus"
} | step1 | A | [
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"4C",
"to leave work",
"headache",
"body pains",
"patient states",
"recently",
"South Asia",
"business trip",
"feeling well s... |
A 64-hour-old baby girl is being evaluated for discharge. She was born by forceps-assisted vaginal delivery at 39 weeks gestation. The mother has no chronic medical conditions and attended all her prenatal visits. The mother’s blood type is A+. On day 1, the patient was noted to have a scalp laceration. Breastfeeding w... | Observation | {
"A": "Coombs test",
"B": "Exchange transfusion",
"C": "Observation",
"D": "Phototherapy"
} | step2&3 | C | [
"64 hour old baby girl",
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"discharge",
"born by forceps assisted vaginal delivery",
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"mothers blood type",
"day 1",
"patient",
"noted to",
"scalp laceration",
"Breastfeeding",
"difficul... |
An autopsy of a 75-year-old man reveals obliterating endarteritis of the vasa vasorum of the aorta. Which of the following investigations will most likely be positive in this patient? | Rapid plasma reagin (RPR) | {
"A": "Increased double-stranded (ds) DNA titer",
"B": "Increased ketonuria",
"C": "Increased serum creatinine",
"D": "Rapid plasma reagin (RPR)"
} | step1 | D | [
"autopsy",
"75 year old man reveals obliterating endarteritis",
"vasa vasorum",
"aorta",
"following investigations",
"most likely",
"positive",
"patient"
] |
A 43-year-old woman comes to the physician for a routine examination prior to starting a new job as a nurse. Over the past year, the patient has had mild shortness of breath and a cough productive of white sputum, particularly in the morning. She immigrated to the United States from South Africa with her parents 40 yea... | Interferon-gamma release assay | {
"A": "Tuberculin skin test",
"B": "Sputum culture",
"C": "PCR of the sputum",
"D": "Interferon-gamma release assay"
} | step2&3 | D | [
"year old woman",
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"United States",
"South Africa",
"parents 40 years",
"received",
"appropriate immunizations",
"child... |
A 24-year-old G1P0000 presents for her first obstetric visit and is found to be at approximately 8 weeks gestation. She has no complaints aside from increased fatigue and occasional nausea. The patient is a recent immigrant from Africa and is currently working as a babysitter for several neighborhood children. One of t... | Intramuscular flu vaccine | {
"A": "Tetanus/Diphtheria/Pertussis vaccine",
"B": "Hepatitis B vaccine",
"C": "Varicella vaccine",
"D": "Intramuscular flu vaccine"
} | step2&3 | D | [
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"patient",
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"Africa",
"currently working",
"babysitter",
"several neighborhood children",
"One",
"recently",
"... |
A 54-year-old man is brought to the emergency department by his wife because of progressive nausea, vomiting, and right-sided flank pain for 2 days. The pain is colicky and radiates to the groin. He has a history of gout and type 2 diabetes mellitus. Current medications are metformin and allopurinol. He recently began ... | Vitamin C | {
"A": "Vitamin B3",
"B": "Vitamin E",
"C": "Vitamin C",
"D": "Uric acid"
} | step1 | C | [
"54 year old man",
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"radiates",
"groin",
"history of gout",
"type 2 diabetes mellitus",
"Current medications",
"metformin",
"allopurinol",
"recently bega... |
A 33-year-old man comes to the physician because of decreased hearing in his right ear for the past 4 months. During this period, he has also had multiple episodes of dizziness and a constant ringing noise in his right ear. Over the past 5 weeks, he has also noticed scant amounts of right-sided ear discharge. He has a ... | Surgical excision | {
"A": "Topical ciprofloxacin",
"B": "Systemic corticosteroids",
"C": "Fitting for hearing aids",
"D": "Surgical excision"
} | step2&3 | D | [
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"physician",
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"multiple episodes of dizziness",
"constant ringing noise in",
"right ear",
"past",
"weeks",
"scant amounts of right-sided ear discharge",
"history of multiple ear infections",
"childhood",
"t... |
A 73-year-old woman presents to the emergency department with diffuse abdominal pain, nausea, and vomiting. Her daughter who accompanies her says she was in her usual state of health until two days ago when she started to complain of abdominal pain and was unable to tolerate oral intake. She has hypertension, congestiv... | Administer fresh frozen plasma and Vitamin K | {
"A": "Administer protamine sulfate",
"B": "Administer fresh frozen plasma and Vitamin K",
"C": "Administer platelet concentrate",
"D": "Administer recombinant activated factor VII"
} | step2&3 | B | [
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"emergency department",
"diffuse abdominal",
"nausea",
"vomiting",
"daughter",
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"two days",
"started to",
"abdominal pain",
"unable to",
"oral intake",
"hypertension",
"congestive heart failure",
"atrial fibrillation",
"osteoarthritis"... |
You are asked to examine a 1-year-old child brought to the emergency department by his sister. The sister reports that the child has been acting strangely since that morning after "getting in trouble" for crying. The child appears lethargic and confused and is noted to have a cigarette burn on his forearm. Emergency he... | Bilateral retinal hemorrhages | {
"A": "Posterior rib fracture",
"B": "Bilateral retinal hemorrhages",
"C": "Burns to buttocks",
"D": "Epidural hematoma"
} | step1 | B | [
"to",
"year old child brought",
"emergency department",
"sister",
"sister reports",
"child",
"acting",
"morning",
"getting",
"crying",
"child appears lethargic",
"confused",
"noted to",
"cigarette burn",
"forearm",
"Emergency head CT reveals",
"subdural hematoma",
"following additi... |
Paramedics respond to a call regarding an 18-year-old male with severe sudden-onset heart palpitations. The patient reports symptoms of chest pain, fatigue, and dizziness. Upon examination, his heart rate is 175/min and regular. His blood pressure is 110/75 mm Hg. Gentle massage below the level of the left mandible eli... | Slowing conduction in the AV node | {
"A": "Increasing the refractory period in ventricular myocytes",
"B": "Decreasing the length of phase 4 of the SA node myocytes",
"C": "Slowing conduction in the AV node",
"D": "Decreasing the firing rate of carotid baroreceptors"
} | step1 | C | [
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"fatigue",
"dizziness",
"examination",
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"min",
"regular",
"blood pressure",
"75 mm Hg",
"Gentle massage",
"level",
"left mandible elicits",
"immedia... |
A 57-year-old female visits her primary care physician with 2+ pitting edema in her legs. She takes no medications and does not use alcohol, tobacco, or illicit drugs. 4.5 grams of protein are collected during 24-hour urine excretion. A kidney biopsy is obtained. Examination with light microscopy shows diffuse thickeni... | Membranous nephropathy | {
"A": "Postinfectious glomerulonephritis",
"B": "Focal segmental glomerulosclerosis",
"C": "Rapidly progressive glomerulonephritis",
"D": "Membranous nephropathy"
} | step1 | D | [
"57 year old female visits",
"primary care physician",
"2",
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"legs",
"takes",
"medications",
"not use alcohol",
"tobacco",
"illicit drugs",
"4.5 grams of protein",
"collected",
"hour urine excretion",
"kidney biopsy",
"obtained",
"Examination",
"light microscopy shows... |
A 28-year-old woman, gravida 1, para 0, at 10 weeks' gestation comes to the physician for her initial prenatal visit. She has no history of serious illness, but reports that she is allergic to penicillin. Vital signs are within normal limits. The lungs are clear to auscultation, and cardiac examination shows no abnorma... | Administer penicillin desensitization dose | {
"A": "Administer therapeutic dose of intramuscular penicillin G",
"B": "Administer intravenous ceftriaxone",
"C": "Administer penicillin desensitization dose",
"D": "Perform oral penicillin challenge test"
} | step2&3 | C | [
"year old woman",
"gravida 1",
"para 0",
"10 weeks",
"gestation",
"physician",
"initial prenatal visit",
"history",
"serious illness",
"reports",
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"penicillin",
"Vital signs",
"normal limits",
"lungs",
"clear",
"auscultation",
"cardiac examination shows",
"abnormalitie... |
A 46-year-old man is brought to the emergency room by police after being found passed out on the sidewalk. He is intermittently alert and smells strongly of alcohol. He is unable to provide a history, but an electronic medical record search reveals that the patient has a history of alcohol abuse and was seen in the eme... | Bacteroides melaninogenicus | {
"A": "Bacteroides melaninogenicus",
"B": "Coxiella burnetii",
"C": "Francisella tularensis",
"D": "Mycoplasma pneumoniae"
} | step1 | A | [
"year old man",
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"unable to provide",
"history",
"electronic medical record search reveals",
"patient",
"history of alcohol abuse",
"seen",
"emergency room twice",
"past year",
"alco... |
A 27-year-old woman who resides in an area endemic for chloroquine-resistant P. falciparum malaria presents to the physician with fatigue, malaise, and episodes of fever with chills over the last 5 days. She mentions that she has episodes of shivering and chills on alternate days that last for approximately 2 hours, fo... | Quinine sulfate plus clindamycin | {
"A": "Mefloquine only",
"B": "Quinine sulfate plus clindamycin",
"C": "Quinine sulfate plus doxycycline",
"D": "Quinine sulfate plus sulfadoxine-pyrimethamine"
} | step1 | B | [
"27 year old woman",
"resides",
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"chloroquine resistant",
"falciparum malaria presents",
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"chills",
"5 days",
"episodes of shivering",
"chills",
"alternate days",
"last",
"approximately",
"hours",
"followed by high-grade... |
An 8-year-old boy presents to your office for a routine well-child visit. Upon physical examination, he is found to have a harsh-sounding, holosystolic murmur that is best appreciated at the left sternal border. The murmur becomes louder when you ask him to make fists with his hands. Which of the following is the most ... | Ventricular septal defect | {
"A": "Aortic stenosis",
"B": "Tricuspid atresia",
"C": "Ventricular septal defect",
"D": "Left ventricular hypertrophy"
} | step1 | C | [
"year old boy presents",
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"routine well-child visit",
"physical examination",
"found to",
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"holosystolic murmur",
"best",
"left sternal border",
"murmur",
"louder",
"to make fists",
"hands",
"following",
"most likely explanation",
"findings"
] |
A 50-year-old woman, gravida 5, para 5, comes to the physician for the evaluation of decreased sexual desire for approximately 6 months. She has been sexually active with her husband but reports that she has no desire in having sexual intercourse anymore. She states that she feels guilty and is worried about losing her... | Decreased testosterone | {
"A": "Chronic alcohol intake",
"B": "Major depressive disorder",
"C": "Decreased testosterone",
"D": "Elevated prolactin"
} | step2&3 | C | [
"50 year old woman",
"gravida 5",
"para 5",
"physician",
"evaluation",
"decreased sexual desire",
"approximately",
"months",
"sexually active",
"husband",
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"desire",
"sexual intercourse",
"states",
"feels guilty",
"worried",
"husband",
"problem goes",
"longer period",
... |
A 37-year-old previously healthy woman presents to the emergency room with right leg pain and difficulty breathing. She recently returned from a trip to Alaska and noticed her leg started to swell when she got home. Her medications include a multivitamin and oral contraceptives. She is diagnosed with a deep venous thro... | VII | {
"A": "II",
"B": "VII",
"C": "IX",
"D": "X"
} | step1 | B | [
"year old",
"healthy woman presents",
"emergency room",
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"difficulty breathing",
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"Alaska",
"leg started to swell",
"got home",
"medications include",
"multivitamin",
"oral contraceptives",
"diagnosed",
"deep venous thrombosis complicated",
... |
A 25-year-old man presents to the emergency department after fainting at his investment banking office. He states that he has experienced intermittent headaches since high school, but has never fainted. He reports eating multiple small meals regularly throughout the day. He further notes that multiple family members ha... | smooth endoplasmic reticulum | {
"A": "lysosome",
"B": "peroxisome",
"C": "smooth endoplasmic reticulum",
"D": "beta-adrenergic receptor"
} | step1 | C | [
"year old man presents",
"emergency department",
"fainting",
"investment banking office",
"states",
"intermittent headaches",
"high school",
"never fainted",
"reports eating multiple small meals",
"day",
"further notes",
"multiple family members",
"frequently",
"headaches",
"Physical exa... |
A 43-year-old man presents to the emergency department with nausea and vomiting. He says symptoms onset 4 hours ago and is progressively worsening. He denies any hematemesis. Past medical history is significant for a recent negative screening colonoscopy that was performed due to a family history of colon cancer. His v... | Fibrinogen | {
"A": "GpIIb/IIIa",
"B": "Vitamin K",
"C": "Fibrinogen",
"D": "Giant platelets"
} | step1 | C | [
"year old man presents",
"emergency department",
"nausea",
"vomiting",
"symptoms onset",
"hours",
"worsening",
"denies",
"hematemesis",
"Past medical history",
"significant",
"recent negative screening colonoscopy",
"performed due to",
"family history of colon cancer",
"vital signs",
"... |
A group of investigators is evaluating the diagnostic properties of a new blood test that uses two serum biomarkers, dityrosine and Nε-carboxymethyl-lysine, for the clinical diagnosis of autism spectrum disorder (ASD) in children. The test is considered positive only if both markers are found in the serum. 50 children ... | 70% | {
"A": "30%",
"B": "88%",
"C": "70%",
"D": "90%"
} | step1 | C | [
"A group",
"investigators",
"evaluating",
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"new blood test",
"uses two serum biomarkers",
"dityrosine",
"N carboxymethyl-lysine",
"clinical diagnosis",
"autism spectrum disorder",
"children",
"test",
"considered positive only",
"markers",
"found",
"serum",
"50... |
A 51-year-old man is brought to the local emergency room in severe respiratory distress. The patient is an industrial chemist and was working in his lab with a new partner when a massive chemical spill occurred releasing fumes into their workspace. The patient and his lab partner attempted to clean up the spill before ... | Continue to administer albuterol | {
"A": "Administer IV prednisone in addition to IV methylprednisolone",
"B": "Continue to administer albuterol",
"C": "Switch from nebulized albuterol to nebulized ipratropium",
"D": "Intubate the patient and begin mechanical ventilation"
} | step2&3 | B | [
"year old man",
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"massive chemical",
"occurred releasing fumes",
"patient",
"lab partner attempted to clean up",
"large",
"to handle",
"not",
"protective... |
Blood cultures are sent to the laboratory. Antibiotic treatment is started. Blood cultures confirm an infection with methicillin-susceptible Staphylococcus epidermidis. Which of the following is the most appropriate next step in management? | Intravenous nafcillin + rifampin for 6 weeks + gentamicin for 2 weeks | {
"A": "Oral penicillin V + gentamicin for 4 weeks",
"B": "Oral gentamicin + ceftriaxone for 4 weeks",
"C": "Oral amoxicillin for 6 weeks",
"D": "Intravenous nafcillin + rifampin for 6 weeks + gentamicin for 2 weeks"
} | step2&3 | D | [
"Blood cultures",
"sent",
"laboratory",
"Antibiotic treatment",
"started",
"Blood cultures confirm",
"infection",
"methicillin susceptible Staphylococcus epidermidis",
"following",
"most appropriate next step",
"management"
] |
A 6-week-old child is brought to his pediatrician for a physical exam and hepatitis B booster. The boy was born at 39 weeks gestation via spontaneous vaginal delivery to a 19-year-old G-1-P-1. He was previously up to date on all vaccines and is mildly delayed in some developmental milestones. His mother is especially c... | Contact child protective services | {
"A": "Confront the mother directly",
"B": "Contact child protective services",
"C": "Recommend treating the colic with a few drops of whiskey",
"D": "Encourage the mother to take a class on parenting"
} | step2&3 | B | [
"week old child",
"brought",
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"born",
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"spontaneous vaginal delivery",
"year old G-1",
"date",
"vaccines",
"mildly delayed",
"developmental milestones",
"mother",
"concerned",
"colic",
"boy cries",
"n... |
A 16-year-old girl presents to the emergency room with her 8-month-old daughter for evaluation of “turning blue when she cries.” The baby is found to have an atrial septal defect that is causing a left to right shunt, resulting in cyanosis and pulmonary hypertension. Surgical intervention is indicated; however, the mot... | Allow the mother to take the patient for a second opinion. | {
"A": "Contact child protective services.",
"B": "Perform the surgery.",
"C": "Allow the mother to take the patient for a second opinion.",
"D": "Obtain a court order to perform the surgery."
} | step1 | C | [
"year old girl presents",
"emergency room",
"month old daughter",
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"cries",
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"atrial septal defect",
"causing",
"left to right shunt",
"resulting in cyanosis",
"pulmonary hypertension",
"Surgical intervention",
"indicated",
"mother",
"t... |
A 27-year-old man presents to the outpatient clinic with a swollen and painful toe. The pain intensity increased further after he went to a party last night. Which of the following is the drug of choice for the treatment of this patient's condition? | Indomethacin | {
"A": "Aspirin",
"B": "Rasburicase",
"C": "Indomethacin",
"D": "Allopurinol"
} | step1 | C | [
"27 year old man presents",
"outpatient clinic",
"swollen",
"painful toe",
"pain intensity increased further",
"party",
"night",
"following",
"drug",
"choice",
"treatment",
"patient's"
] |
A 30-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been complicated by iron deficiency anemia, which was treated with iron supplements. Her first pregnancy and vaginal delivery were uncomplicated. There is no personal or family history of serious il... | Cesarean section | {
"A": "Administration of oxytocin and normal vaginal birth",
"B": "Lateral positioning of the mother",
"C": "Cesarean section",
"D": "External cephalic version"
} | step2&3 | C | [
"30 year old woman",
"gravida 2",
"para 1",
"40 weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"Pregnancy",
"complicated",
"iron deficiency anemia",
"treated with iron supplements",
"first pregnancy",
"vaginal delivery",
"uncomplicated",
"personal",
"family history",
... |
A scientist is studying the process by which innate immune cells are able to respond to damage and pathogen infiltration. Specifically, she examines patients with an immunodeficiency where they are unable to respond to local infections. She notices that these patients do not produce pustulant fluid and do not have recr... | C5a | {
"A": "C5a",
"B": "Integrins",
"C": "ICAM proteins",
"D": "Selectins"
} | step1 | A | [
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"fluid",
"not",
"recruitment",
"immune cells",
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"inflammation",
"Examining neutr... |
A 1-month-old boy is brought to the physician because of a 5-day history of generalized fatigue and multiple episodes of vomiting which is most pronounced after formula feeding. His vomiting progressed from 2–3 episodes on the first day to 6–8 episodes at present. The vomitus is whitish in color. The mother reports tha... | Administer IV 0.9% NaCl and replace electrolytes | {
"A": "Administer IV 0.9% NaCl and replace electrolytes",
"B": "Perform emergency pyloromyotomy",
"C": "Obtain CT scan of the abdomen with contrast",
"D": "Measure serum cortisol levels"
} | step2&3 | A | [
"month old boy",
"brought",
"physician",
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"generalized fatigue",
"multiple episodes of vomiting",
"most",
"formula feeding",
"vomiting progressed",
"23 episodes",
"first day",
"68 episodes",
"present",
"vomitus",
"color",
"mother reports",
"very hungry",
"episode of... |
In order to study the association between coffee drinking and the subsequent development of lung cancer, a group of researchers decides to carry out a multicentric case-control study with a large number of participants–800 with a diagnosis of lung cancer, and 800 as age-adjusted controls. According to the results outli... | Confounding bias | {
"A": "Selection bias",
"B": "Confounding bias",
"C": "Attrition bias",
"D": "Information bias"
} | step1 | B | [
"order to study",
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"800",
"age-adjusted controls",
"results outlined",
"table",
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"... |
A 48-hour-old newborn presents in respiratory distress. He is gasping for breath in the neonatal intensive care unit (NICU) and has had a fever for the past 2 days with a temperature ranging between 37.2°C (99.0°F) and 38.6°C (101.5°F). He also has not been feeding well and seems to be lethargic. The patient was delive... | Ampicillin and gentamicin | {
"A": "Ampicillin and gentamicin",
"B": "Ampicillin and cefotaxime",
"C": "Ampicillin and ticarcillin",
"D": "Ampicillin and sulbactam"
} | step1 | A | [
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"99",
"not",
"feeding well",
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"lethargic",
"patient",
"delivered",
"36 weeks of gestation",
"mother",
"premature rupture o... |
A 8-year-old boy is brought to the clinic by his father for an annual well-check. His dad reports that he has been “difficult to handle” as he would not listen and follow instructions at home. “Telling him to sit still and do something is just so hard,” the father says. His teacher also reports difficulties in the clas... | Methylphenidate | {
"A": "Haloperidol",
"B": "Methylphenidate",
"C": "Psychodynamic therapy",
"D": "Reassurance"
} | step1 | B | [
"year old boy",
"brought",
"clinic",
"father",
"annual well check",
"dad reports",
"difficult",
"handle",
"not listen",
"follow instructions",
"home",
"to sit",
"hard",
"father",
"teacher",
"reports difficulties",
"classroom",
"child",
"talk out",
"turn",
"interrupt",
"clas... |
A previously healthy 30-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and nonproductive cough. She also complains of constipation and fatigue during the same time period. She has not traveled recently or been exposed to any sick contacts. Physical examination show... | Low serum CD4+ T-cell count | {
"A": "Positive interferon-gamma release assay",
"B": "Low serum angiotensin-converting enzyme levels",
"C": "Low serum CD4+ T-cell count",
"D": "Positive anti-dsDNA antibody testing"
} | step1 | C | [
"healthy 30 year old woman",
"physician",
"of",
"3 month history",
"progressive shortness",
"breath",
"nonproductive cough",
"constipation",
"fatigue",
"same time period",
"not traveled recently",
"exposed",
"sick contacts",
"Physical examination shows injected conjunctivae",
"tender",
... |
A 29-year-old female reports having a positive home pregnancy test result 9 weeks ago. She presents today with vaginal bleeding and complains of recent onset abdominal pain. Ultrasound of the patient’s uterus is included as Image A. Subsequent histologic analysis (Image B) reveals regions of both normal as well as enla... | 69 XXY | {
"A": "46 XX, both of maternal origin",
"B": "46 XY, both of paternal origin",
"C": "69 XXY",
"D": "47 XXY"
} | step1 | C | [
"29 year old female reports",
"positive home",
"weeks",
"presents today",
"vaginal bleeding",
"of recent onset abdominal pain",
"Ultrasound",
"patients uterus",
"included",
"Image",
"Subsequent histologic analysis",
"Image",
"reveals regions",
"normal",
"enlarged trophoblastic villi",
... |
A mother brings her infant for a regular well-child check-up with the pediatrician. During the routine developmental examination, the physician notes that the child is looking at him with his head lifted upwards when he is about to pick up the child from the table. At what age is it common to begin to observe this find... | 2 months | {
"A": "2 months",
"B": "6 months",
"C": "9 months",
"D": "12 months"
} | step2&3 | A | [
"mother",
"infant",
"regular well check-up",
"pediatrician",
"routine developmental examination",
"physician notes",
"child",
"looking",
"head lifted",
"about",
"pick",
"child",
"table",
"age",
"common to begin to observe",
"finding",
"child",
"child",
"normal"
] |
A 55-year-old man comes to the physician because of a 2-month history of headaches, facial numbness, recurrent epistaxis, and a 5-kg (11-lb) weight loss. He recently immigrated from Hong Kong. Examination shows right-sided cervical lymphadenopathy. Endoscopy shows an exophytic nasopharyngeal mass. Histologic examinatio... | Transfer of saliva | {
"A": "Sexual contact",
"B": "Tick bite",
"C": "Transfer of saliva",
"D": "Fecal-oral"
} | step1 | C | [
"55 year old man",
"physician",
"of",
"2 month history",
"headaches",
"facial numbness",
"recurrent epistaxis",
"5 kg",
"weight loss",
"recently",
"Hong Kong",
"Examination shows right-sided cervical lymphadenopathy",
"Endoscopy shows",
"exophytic nasopharyngeal mass",
"Histologic examin... |
An 8-year-old boy is brought to the physician by his parents for blurry vision for the past 2 months. He is at the 97th percentile for height and 25th percentile for weight. Physical examination shows joint hypermobility, a high-arched palate, and abnormally long, slender fingers and toes. Slit lamp examination shows s... | Fibrillin | {
"A": "Laminin",
"B": "Fibrillin",
"C": "Type I collagen",
"D": "Keratin"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"parents",
"blurry vision",
"past",
"months",
"percentile",
"height",
"percentile",
"weight",
"Physical examination shows joint hypermobility",
"high-arched palate",
"long",
"slender fingers",
"toes",
"Slit lamp examination shows",
"lens subl... |
A 70-year-old man presents to a medical office with painful micturition for 2 weeks. He denies any other symptoms. The past medical history is unremarkable. He has been a smoker most of his life, smoking approx. 1 pack of cigarettes every day. The physical examination is benign. A urinalysis shows an abundance of red b... | Urothelial carcinoma-in-situ | {
"A": "Reactive atypia",
"B": "Microinvasion",
"C": "Urothelial metaplasia",
"D": "Urothelial carcinoma-in-situ"
} | step1 | D | [
"70 year old man presents",
"medical office",
"painful micturition",
"2 weeks",
"denies",
"symptoms",
"past medical history",
"unremarkable",
"smoker",
"life",
"smoking",
"1 pack",
"cigarettes",
"day",
"physical examination",
"benign",
"urinalysis shows",
"abundance",
"red blood ... |
A 13-year-old girl is brought to the physician by her father because of a 1-month history of pain in her right knee. She is a competitive volleyball player and has missed several games recently due to pain. Examination shows swelling distal to the right knee joint on the anterior surface of the proximal tibia; there is... | Patellar ligament | {
"A": "Anterior cruciate ligament",
"B": "Patellar ligament",
"C": "Iliotibial band",
"D": "Pes anserinus tendon"
} | step1 | B | [
"year old girl",
"brought",
"physician",
"father",
"month history",
"pain",
"right knee",
"competitive volleyball",
"missed",
"games recently due to pain",
"Examination shows swelling distal",
"right knee joint",
"anterior surface of",
"proximal tibia",
"warmth",
"deformity",
"Extens... |
A 51-year-old woman presents the following significant and unintentional weight loss. She denies any personal history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. She also mentions that she had been struggling with her weight, so she was ... | Chronic myelogenous leukemia | {
"A": "Acute lymphocytic leukemia",
"B": "Acute myelogenous leukemia",
"C": "Chronic myelogenous leukemia",
"D": "Hairy cell leukemia"
} | step2&3 | C | [
"year old woman presents",
"following significant",
"unintentional weight loss",
"denies",
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"to",
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"pulmonary embolism",
"recent past",
"weight",
"initially content",
"weight",
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"office to",
"checked o... |
A 75-year-old man presents to the physician with a complaint of persistent back pain. The patient states that the pain has been constant and occurs throughout the day. He says that he has also been experiencing greater fatigue when carrying out his daily activities. On review of systems, the patient notes that he lost ... | Rouleaux formation | {
"A": "Atypical lymphocytes",
"B": "Rouleaux formation",
"C": "Schistocytes",
"D": "Target cells"
} | step2&3 | B | [
"75 year old man presents",
"physician",
"complaint of persistent back pain",
"patient states",
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"constant",
"occurs",
"day",
"experiencing greater fatigue",
"carrying out",
"daily activities",
"review of systems",
"patient notes",
"lost more",
"10 pounds",
"past month",
"main... |
An 8-year-old girl is brought into your clinic with a 5 day history of decreased oral intake, body aches and lymphadenopathy. She has no significant medical history. Upon further questioning you find that the patient frequently plays outside, where she enjoys chasing the neighborhood cats and dogs. She has had no recen... | Bartonella henselae infection | {
"A": "Extrapulmonary tuberculosis",
"B": "Toxoplasmosis gandii infection",
"C": "Bartonella henselae infection",
"D": "Staphlococcal aureus adenitis"
} | step2&3 | C | [
"year old girl",
"brought",
"clinic",
"5 day history",
"decreased oral intake",
"body aches",
"lymphadenopathy",
"significant medical history",
"further questioning",
"find",
"patient frequently plays outside",
"neighborhood cats",
"dogs",
"recent sick contacts",
"travel",
"foreign cou... |
A 28-year-old G2P1 female with a history of hypertension presents to the emergency room at 33 weeks with headache and blurry vision. On exam, her vitals include BP 186/102 mmHg, HR 102 beats per minute, RR 15 breaths per minute, and T 98.9 degrees Fahrenheit. She undergoes an immediate Caesarian section, and although s... | Brain MRI | {
"A": "Observation of maternal-child interactions",
"B": "Brain MRI",
"C": "Head CT",
"D": "Breast ultrasound"
} | step2&3 | B | [
"year old",
"female",
"history of hypertension presents",
"emergency room",
"weeks",
"headache",
"blurry vision",
"exam",
"include BP",
"mmHg",
"beats per minute",
"RR",
"breaths per minute",
"T 98",
"degrees Fahrenheit",
"immediate Caesarian section",
"noted to",
"large volume blo... |
A female child presents to her pediatrician for a well child visit. Her mother reports that she is eating well at home and sleeping well throughout the night. She can jump and walk up and down stairs with both feet on each step. In the doctor’s office, the patient builds a six-cube tower and imitates a circle. She seem... | Follows two-step commands | {
"A": "Balances on one foot",
"B": "Cuts with scissors",
"C": "Follows two-step commands",
"D": "Turns pages in book"
} | step2&3 | C | [
"female child presents",
"pediatrician",
"well child visit",
"mother reports",
"eating well",
"home",
"sleeping well",
"night",
"jump",
"walk",
"stairs",
"feet",
"step",
"doctors office",
"patient builds",
"six cube tower",
"circle",
"to",
"vocabulary",
"50 words",
"uses",
... |
A 51-year-old woman comes to the emergency department because of a 1-day history of severe pain in her left knee. To lose weight, she recently started jogging for 30 minutes a few times per week. She has type 2 diabetes mellitus and hypertension treated with metformin and chlorothiazide. Her sister has rheumatoid arthr... | Perform arthrocentesis | {
"A": "Perform MRI of the knee",
"B": "Perform arthrocentesis",
"C": "Measure rheumatoid factor",
"D": "Perform ultrasonography of the knee"
} | step1 | B | [
"year old woman",
"emergency department",
"1-day history",
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"recently started jogging",
"30 minutes",
"few times",
"week",
"type 2 diabetes mellitus",
"hypertension treated with metformin",
"chlorothiazide",
"sister",
"rheumatoid arthritis",
... |
A 25-year-old man comes to the physician with intermittent bloody diarrhea over the past 2 months. He has occasional abdominal pain. His symptoms have not improved over this time. He has no history of a serious illness and takes no medications. His blood pressure is 110/70 mm Hg, pulse is 75/min, respirations are 14/mi... | Primary sclerosing cholangitis | {
"A": "Cholangiocarcinoma",
"B": "Hepatocellular carcinoma",
"C": "Primary biliary cirrhosis",
"D": "Primary sclerosing cholangitis"
} | step2&3 | D | [
"year old man",
"physician",
"intermittent bloody",
"past",
"months",
"occasional abdominal pain",
"symptoms",
"not improved",
"time",
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"medications",
"blood pressure",
"70 mm Hg",
"pulse",
"75 min",
"respirations",
"min",
"temperature",
... |
A 48-year-old woman presents to her primary care physician with the complaints of persistent fatigue, dizziness, and weight loss for the past 3 months. She has hypothyroidism for 15 years and takes thyroxine replacement. Her blood pressure is 90/60 mm Hg in a supine position and 65/40 mm Hg while sitting, temperature i... | Adrenocorticotropic hormone (ACTH) stimulation test | {
"A": "Plasma aldosterone",
"B": "Adrenocorticotropic hormone (ACTH) stimulation test",
"C": "Adrenal imaging",
"D": "21-hydroxylase antibodies"
} | step2&3 | B | [
"48 year old woman presents",
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"persistent fatigue",
"dizziness",
"weight loss",
"past 3 months",
"hypothyroidism",
"years",
"takes thyroxine replacement",
"blood pressure",
"90 60 mm Hg",
"supine position",
"65 40 mm Hg",
"sitting",
"temperature"... |
A 17-year-old girl comes to your outpatient clinic. She is sexually active with multiple partners and requests a prescription for oral contraceptive pills. A urine pregnancy test in your office is negative. Which of the following is the most appropriate next step? | Recommend sexually-transmitted infection screening and provide the requested prescription | {
"A": "Contact the patient's parents to obtain consent",
"B": "Recommend sexually-transmitted infection screening and provide the requested prescription",
"C": "Perform urine drug screen",
"D": "Advise against oral contraceptive medications and recommend condom use instead"
} | step1 | B | [
"year old girl",
"outpatient clinic",
"sexually active",
"multiple partners",
"requests",
"prescription for oral contraceptive pills",
"urine pregnancy test",
"office",
"negative",
"following",
"most appropriate next step"
] |
A newborn infant presents with severe weakness. He was born to a G1P1 mother at 40 weeks gestation with the pregnancy attended by a midwife. The mother's past medical history is unremarkable. She took a prenatal vitamin and folic acid throughout the pregnancy. Since birth, the child has had trouble breastfeeding despit... | Acid maltase deficiency | {
"A": "Acid maltase deficiency",
"B": "Clostridium tetani infection",
"C": "Familial hypertrophic cardiomyopathy",
"D": "Spinal muscular atrophy type I disease"
} | step2&3 | A | [
"newborn infant presents",
"severe weakness",
"born",
"G1P1 mother",
"40 weeks",
"pregnancy attended",
"midwife",
"mother's past medical history",
"unremarkable",
"took",
"prenatal vitamin",
"folic acid",
"pregnancy",
"birth",
"child",
"breastfeeding",
"counseling",
"poor muscle to... |
A 2-week-old infant is brought to the emergency room because of 4 episodes of bilious vomiting and inconsolable crying for the past 3 hours. Abdominal examination shows no abnormalities. An upper GI contrast series shows the duodenojejunal junction to the right of the vertebral midline; an air-filled cecum is noted in ... | Incomplete intestinal rotation | {
"A": "Failure of duodenal recanalization",
"B": "Incomplete intestinal rotation",
"C": "Arrested rotation of ventral pancreatic bud",
"D": "Hypertrophy and hyperplasia of the pyloric sphincter"
} | step1 | B | [
"2 week old infant",
"brought",
"emergency room",
"of 4 episodes",
"bilious vomiting",
"inconsolable crying",
"past",
"hours",
"Abdominal examination shows",
"abnormalities",
"upper GI contrast series shows",
"duodenojejunal junction",
"right",
"vertebral midline",
"air filled cecum",
... |
A 43-year-old male is admitted to the hospital for a left leg cellulitis. He is being treated with clindamycin and is recovering nicely. On the second day of his admission, a nurse incorrectly administers 100 mg of metoprolol which was intended for another patient with the same last name. The error is not discovered un... | Immediately disclose the error to the patient | {
"A": "Immediately disclose the error to the patient",
"B": "Notify hospital administration but do not notify the patient as no ill effects occurred",
"C": "Tell the nurse who administered the drug to notify the patient an error has occurred",
"D": "Make a note in the patient's chart an error has occurred but ... | step1 | A | [
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"hospital",
"left",
"treated with clindamycin",
"recovering",
"second day",
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"intended",
"patient",
"same",
"name",
"error",
"not discovered",
"next day",
"time",
"clear",
"patient",
"suff... |
A 42-year-old woman presents to her primary care physician with 2 weeks of abdominal pain. She says that the pain is squeezing in character and gets worse after she eats food. The pain is particularly bad after she eats dairy products so she has begun to avoid ice cream and cheese. Furthermore, she has noticed that she... | I cells | {
"A": "D cells",
"B": "I cells",
"C": "P/D1 cells",
"D": "S cells"
} | step1 | B | [
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"primary care physician",
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"pain",
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"eats food",
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"bad",
"eats dairy products",
"begun to",
"ice cream",
"cheese",
"experiencing episodes of nausea associated with abdominal pain",
"l... |
A 65-year-old woman comes to clinic complaining of pain with chewing solid foods. She reports that she has been feeling unwell lately, with pains in her shoulders and hips, and she has lost five pounds in the past few months. Her vital signs are T 39C, RR 18 breaths/min, HR 95 bpm, BP 120/65 mmHg. When you ask her to s... | Blindness | {
"A": "Blindness",
"B": "Easily sunburned on face and hands",
"C": "Hemoptysis",
"D": "Thickened, tight skin on the fingers"
} | step1 | A | [
"65 year old woman",
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"chewing solid",
"reports",
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"pains in",
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"hips",
"lost five pounds",
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"RR",
"breaths/min",
"95",
"BP",
"65 mmHg",
"to stand",
"chair to get",
"exam table",
"moves",
... |
An 1800-g (4.0-lb) male newborn is delivered to a 26-year-old woman, gravida 2, para 1, at 33 weeks' gestation. The Apgar scores are 7 at 1 minute and 8 at 5 minutes. The pregnancy was complicated by iron deficiency anemia. The mother has no other history of serious illness. She has smoked one-half pack of cigarettes d... | Give first dose of diphtheria and tetanus toxoids, acellular pertussis (DTaP) vaccine at 2 months of chronological age | {
"A": "Give first dose of influenza vaccine at 2 months of chronological age",
"B": "Give first dose of varicella vaccine at 2 months of chronological age",
"C": "Give first dose of Haemophilus influenza type b vaccine at 3 months of chronological age",
"D": "Give first dose of diphtheria and tetanus toxoids, ... | step2&3 | D | [
"g",
"0",
"male newborn",
"delivered",
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"Apgar scores",
"minute",
"5 minutes",
"pregnancy",
"complicated",
"iron deficiency anemia",
"mother",
"history",
"serious illness",
"smoked one half pack",
"cigarettes daily",... |
One day after undergoing a right hemicolectomy for colon cancer, a 55-year-old woman has back pain and numbness and difficulty moving her legs. Her initial postoperative course was uncomplicated. Current medications include prophylactic subcutaneous heparin. Her temperature is 37.2°C (98.9°F), pulse is 100/min, respira... | Perform surgical decompression | {
"A": "Perform surgical decompression",
"B": "Perform CT-guided aspiration",
"C": "Obtain lumbar puncture",
"D": "Obtain blood cultures\n\""
} | step2&3 | A | [
"One day",
"right hemicolectomy",
"colon cancer",
"55 year old woman",
"back pain",
"numbness",
"difficulty moving",
"legs",
"initial postoperative course",
"uncomplicated",
"Current medications include prophylactic subcutaneous heparin",
"temperature",
"98 9F",
"pulse",
"100 min",
"re... |
A 10-month-old boy is brought to the physician by his mother because of a 2-day history of rhinorrhea, nasal congestion, and cough. He has been feeding normally and has not had vomiting or diarrhea. The infant was born at term via uncomplicated spontaneous vaginal delivery. Immunizations are up-to-date. Eight months ag... | Provide reassurance | {
"A": "Provide reassurance",
"B": "Perform PPD skin testing",
"C": "Obtain a thoracic CT scan",
"D": "Measure T cell count"
} | step2&3 | A | [
"A 10 month old boy",
"brought",
"physician",
"mother",
"2-day history",
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"nasal congestion",
"cough",
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"not",
"vomiting",
"diarrhea",
"infant",
"born",
"term",
"uncomplicated spontaneous vaginal delivery",
"Immunizations",
"date",
"Eight months",
"treate... |
A 73-year-old man presents to his primary care physician with chest pain. He noticed the pain after walking several blocks, and the pain is relieved by sitting. On exam, he has a BP 155/89 mmHg, HR 79 bpm, and T 98.9 F. The physician refers the patient to a cardiologist and offers prescriptions for carvedilol and nitro... | Decreased cAMP; Increased cGMP | {
"A": "Increased cAMP; Increased cAMP",
"B": "Increased contractility; Decreased endothelial nitrous oxide",
"C": "Decreased cAMP; Increased cGMP",
"D": "Increased heart rate; Decreased arterial resistance"
} | step1 | C | [
"year old man presents",
"primary care physician",
"chest pain",
"pain",
"walking",
"blocks",
"pain",
"relieved by sitting",
"exam",
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"mmHg",
"T 98",
"F",
"physician refers",
"patient",
"cardiologist",
"prescriptions",
"carvedilol",
"nitroglycerin",
"following",
"mechani... |
An 84-year-old man comes to the emergency department because of lower back pain and lower extremity weakness for 3 weeks. Over the past week, he has also found it increasingly difficult to urinate. He has a history of prostate cancer, for which he underwent radical prostatectomy 8 years ago. His prostate-specific antig... | Generation of hydroxyl radicals | {
"A": "Formation of pyrimidine dimers",
"B": "Intercalation of neighbouring DNA base pairs",
"C": "Generation of hydroxyl radicals",
"D": "Formation of DNA crosslinks"
} | step1 | C | [
"84 year old man",
"emergency department",
"lower back pain",
"lower extremity weakness",
"weeks",
"past week",
"found",
"difficult to",
"history cancer",
"radical prostatectomy",
"years",
"prostate-specific antigen",
"level",
"undetectable",
"routine follow-up visit",
"year",
"began... |
A 33-year-old man presents to the emergency department with severe anxiety. He has had multiple episodes in the past treated with low dose lorazepam. The patient states that he feels as if he is going to die and that he cannot breathe. His past medical history is notable for depression and anxiety. His temperature is 9... | Electrophysiological studies | {
"A": "Cardiac catheterization",
"B": "Electrophysiological studies",
"C": "No further management needed",
"D": "Sodium bicarbonate"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"severe anxiety",
"multiple episodes",
"past treated with low",
"patient states",
"feels",
"to die",
"past medical history",
"notable",
"depression",
"anxiety",
"temperature",
"98",
"36",
"blood pressure",
"83 mmHg",
"pulse",
"min"... |
A 74-year-old male presents to his primary care physician complaining of left lower back pain. He reports a four-month history of worsening left flank pain. More recently, he has started to notice that his urine appears brown. His past medical history is notable for gout, hypertension, hyperlipidemia, and myocardial in... | Proximal tubule cells | {
"A": "Proximal tubule cells",
"B": "Distal convoluted tubule cells",
"C": "Mesangial cells",
"D": "Perirenal adipocytes"
} | step1 | A | [
"74 year old male presents",
"primary care physician complaining of left lower back pain",
"reports",
"four month history",
"worsening left flank pain",
"recently",
"started to",
"urine appears brown",
"past medical history",
"notable",
"gout",
"hypertension",
"hyperlipidemia",
"myocardial... |
A 62-year-old man is brought to the emergency department by his wife for high blood pressure readings at home. He is asymptomatic. He has a history of hypertension and hyperlipidemia for which he takes atenolol and atorvastatin, however, his wife reports that he recently ran out of atenolol and has not been able to ref... | Start or restart low-dose medication to reduce blood pressure gradually over the next 24–48 hours | {
"A": "Start or restart low-dose medication to reduce blood pressure gradually over the next 24–48 hours",
"B": "Start or restart low-dose medication to reduce blood pressure aggressively over the next 24–48 hours",
"C": "Admit him to the ICU and start intravenous medication to reduce blood pressure by 10% in th... | step2&3 | A | [
"62 year old man",
"brought",
"emergency department",
"wife",
"high blood pressure readings at home",
"asymptomatic",
"history of hypertension",
"hyperlipidemia",
"takes atenolol",
"atorvastatin",
"wife reports",
"recently ran out",
"atenolol",
"not",
"able",
"refill",
"due to lack o... |
A 45-year-old woman is in a high-speed motor vehicle accident and suffers multiple injuries to her extremities and abdomen. In the field, she was bleeding profusely bleeding and, upon arrival to the emergency department, she is lethargic and unable to speak. Her blood pressure on presentation is 70/40 mmHg. The trauma ... | Provide transfusions as needed | {
"A": "Provide transfusions as needed",
"B": "Withhold transfusion based on husband's request",
"C": "Obtain an ethics consult",
"D": "Obtain a court order for transfusion"
} | step2&3 | A | [
"year old woman",
"high speed motor vehicle accident",
"suffers multiple injuries",
"extremities",
"abdomen",
"field",
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"bleeding",
"arrival",
"emergency department",
"lethargic",
"unable",
"speak",
"blood pressure",
"presentation",
"70 40 mmHg",
"trauma surgery team recom... |
A 21-year-old woman presents to her primary care physician for evaluation of malaise, joint pains, and rash. She has developed joint pain in her hands over the last month, and has noted a rash over her face that gets worse with sun exposure. She is taking no medication at the present time. On further physical examinati... | I, II, IV, V | {
"A": "I, III, V",
"B": "III, IV",
"C": "I, II, IV, V",
"D": "III, V"
} | step1 | C | [
"21-year-old woman presents",
"primary care physician",
"evaluation",
"malaise",
"joint pains",
"rash",
"joint pain",
"hands",
"last month",
"noted",
"rash",
"face",
"gets worse",
"sun exposure",
"taking",
"medication",
"present time",
"further physical examination",
"erythematou... |
A 33-year-old woman comes to the physician for a follow-up examination. She has a history of Crohn disease, for which she takes methotrexate. She and her husband would like to start trying to have a child. Because of the teratogenicity of methotrexate, the physician switches the patient from methotrexate to a purine an... | Febuxostat | {
"A": "Febuxostat",
"B": "Pemetrexed",
"C": "Rasburicase",
"D": "Hydroxyurea"
} | step1 | A | [
"year old woman",
"physician",
"follow-up examination",
"history of Crohn disease",
"takes methotrexate",
"husband",
"to start",
"to",
"child",
"teratogenicity",
"methotrexate",
"physician switches",
"patient",
"methotrexate",
"purine",
"inhibits lymphocyte proliferation",
"blocking ... |
Antituberculosis treatment is started. Two months later, the patient comes to the physician for a follow-up examination. The patient feels well. She reports that she has had tingling and bilateral numbness of her feet for the past 6 days. Her vital signs are within normal limits. Her lips are dry, scaly, and slightly s... | Pyridoxine | {
"A": "Vitamin B12",
"B": "Vitamin E",
"C": "Pyridoxine",
"D": "Iron"
} | step2&3 | C | [
"Antituberculosis treatment",
"started",
"Two months later",
"patient",
"physician",
"follow-up examination",
"patient feels well",
"reports",
"tingling",
"bilateral numbness of",
"feet",
"past",
"days",
"vital signs",
"normal limits",
"lips",
"dry",
"scaly",
"slightly swollen",
... |
Before starting a new job at a law firm, a 33-year-old woman speaks to a representative about the health insurance plan offered by the firm. The representative explains that treatment is provided by primary health care physicians who focus on preventive care. Patients require a referral by the primary care physician fo... | Capitation | {
"A": "Per diem payment",
"B": "Bundled payment",
"C": "Discounted fee-for-service",
"D": "Capitation"
} | step1 | D | [
"starting",
"new job",
"law firm",
"year old woman speaks",
"representative",
"health insurance plan offered",
"firm",
"representative",
"treatment",
"provided",
"primary health care physicians",
"focus",
"preventive care",
"Patients",
"referral by",
"primary care physician",
"specia... |
A 73-year-old man with a 50-year history of type 2 diabetes and stage 3 chronic kidney disease presents to his primary care doctor for a scheduled follow-up and routine labs. He states that he has had no real change in his health except that he feels like he has had bouts of lightheadedness and almost passing out, whic... | Normocytic anemia with decreased reticulocyte count | {
"A": "Macrocytic anemia with megaloblasts",
"B": "Macrocytic anemia without megaloblasts",
"C": "Microcytic anemia",
"D": "Normocytic anemia with decreased reticulocyte count"
} | step1 | D | [
"year old man",
"50",
"history",
"type 2 diabetes",
"stage 3 chronic kidney disease presents",
"primary care doctor",
"scheduled follow-up",
"routine labs",
"states",
"real change",
"health except",
"feels",
"bouts",
"lightheadedness",
"almost passing out",
"resolve",
"sitting",
"p... |
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