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 72-year-old man presents to his primary care provider to discuss the frequency with which he wakes up at night to urinate. He avoids drinking liquids at night, but the symptoms have progressively worsened. The medical history is significant for hypertension and hyperlipidemia. He takes lisinopril, atorvastatin, and a... | Finasteride | {
"A": "Tamsulosin",
"B": "Finasteride",
"C": "Tadalafil",
"D": "Leuprolide"
} | step1 | B | [
"72 year old man presents",
"primary care provider to discuss",
"frequency",
"wakes up",
"night to",
"drinking liquids",
"night",
"symptoms",
"worsened",
"medical history",
"significant",
"hypertension",
"hyperlipidemia",
"takes lisinopril",
"atorvastatin",
"multivitamin",
"day",
"... |
A 63-year-old man comes to the physician for the evaluation of a skin lesion on his chest. He first noticed the lesion 2 months ago and thinks that it has increased in size since then. The lesion is not painful or pruritic. He has type 2 diabetes mellitus, hypercholesterolemia, and glaucoma. The patient has smoked 1 pa... | Malignant melanoma | {
"A": "Malignant melanoma",
"B": "Keratoacanthoma",
"C": "Lentigo maligna",
"D": "Basal cell carcinoma"
} | step2&3 | A | [
"63 year old man",
"physician",
"evaluation",
"skin",
"chest",
"first",
"lesion",
"months",
"thinks",
"increased in size",
"then",
"lesion",
"not painful",
"type 2 diabetes mellitus",
"hypercholesterolemia",
"glaucoma",
"patient",
"smoked 1 pack",
"cigarettes daily",
"last 40 y... |
A case-control study looking to study the relationship between infection with the bacterium Chlamydia trachomatis and having multiple sexual partners was conducted in the United States. A total of 100 women with newly diagnosed chlamydial infection visiting an outpatient clinic for sexually transmitted diseases (STDs) ... | Reporting bias | {
"A": "Ascertainment bias",
"B": "Response bias",
"C": "Detection bias",
"D": "Reporting bias"
} | step1 | D | [
"case-control study looking to study",
"relationship",
"infection",
"bacterium Chlamydia trachomatis",
"multiple sexual partners",
"conducted",
"United States",
"total",
"100 women",
"newly diagnosed chlamydial infection visiting",
"outpatient clinic",
"sexually transmitted diseases",
"compa... |
A 34-year-old man is brought to the emergency department 3 hours after being bitten by a rattlesnake. He was hiking in the Arizona desert when he accidentally stepped on the snake and it bit his right leg. His pulse is 135/min and blood pressure is 104/81 mm Hg. Examination shows right lower leg swelling, ecchymosis, a... | Superficial peroneal nerve | {
"A": "Sural nerve",
"B": "Deep peroneal nerve",
"C": "Superficial peroneal nerve",
"D": "Saphenous nerve"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"hours",
"bitten",
"rattlesnake",
"hiking",
"Arizona desert",
"stepped",
"snake",
"bit",
"right leg",
"pulse",
"min",
"blood pressure",
"81 mm Hg",
"Examination shows right",
"ecchymosis",
"blistering",
"Right ankle dorsiflexio... |
A 31-year-old woman visits the clinic with chronic diarrhea on most days for the past four months. She also complains of lower abdominal discomfort and cramping, which is relieved by episodes of diarrhea. She denies any recent change in her weight. Bowel movements are preceded by a sensation of urgency, associated with... | Irritable bowel syndrome | {
"A": "Irritable bowel syndrome",
"B": "Crohn’s disease",
"C": "Giardiasis",
"D": "Laxative abuse"
} | step2&3 | A | [
"31 year old woman visits",
"clinic",
"chronic diarrhea",
"days",
"past four months",
"lower abdominal discomfort",
"cramping",
"relieved by episodes of diarrhea",
"denies",
"recent change in",
"weight",
"Bowel movements",
"preceded",
"sensation",
"urgency",
"associated with mucus disc... |
A 24-year-old man presents to his primary care physician for a persistent and low grade headache as well as trouble focusing. The patient was seen in the emergency department 3 days ago after hitting his head on a branch while biking under the influence of alcohol. His head CT at the time was normal, and the patient wa... | Rest and primary care follow up | {
"A": "CT scan of the head without contrast",
"B": "Fluoxetine",
"C": "Rest and primary care follow up",
"D": "Thiamine"
} | step2&3 | C | [
"year old man presents",
"primary care physician",
"persistent",
"low grade headache",
"trouble focusing",
"patient",
"seen in",
"emergency department 3 days",
"hitting",
"head",
"branch",
"biking",
"influence",
"alcohol",
"head CT",
"time",
"normal",
"patient",
"sent home",
"f... |
While playing the catcher position in baseball, a 27-year-old male sustained a blow to his left testes which required surgical removal. Upon awakening from anesthesia, he jokes to his wife that he is now half the man that she once knew. Which of the following scenarios is a similar ego defense as the one above? | A recently divorced man states he will finally be able to watch a football game without nagging | {
"A": "A religious woman with homosexual desires speaks out against gay marriage",
"B": "A husband angry at his wife takes out his anger on his employees",
"C": "A short-tempered male lifts weights to deal with his anger",
"D": "A recently divorced man states he will finally be able to watch a football game wi... | step1 | D | [
"playing",
"position",
"baseball",
"27 year old male sustained",
"blow",
"left testes",
"required surgical removal",
"awakening",
"anesthesia",
"jokes",
"wife",
"now half",
"man",
"following scenarios",
"similar ego defense",
"one above"
] |
A 31-year-old man comes to the physician because of severe muscle pain and fever for 4 days. He likes to go hunting and consumed bear meat 1 month ago. Examination shows periorbital edema and generalized muscle tenderness. His leukocyte count is 12,000/mm3 with 19% eosinophils. The release of major basic protein in res... | Antibody-dependent cell-mediated cytotoxicity | {
"A": "Interaction between Th1 cells and macrophages",
"B": "Increased expression of MHC class I molecules",
"C": "Increased expression of MHC class II molecules",
"D": "Antibody-dependent cell-mediated cytotoxicity"
} | step1 | D | [
"31 year old man",
"physician",
"severe muscle",
"fever",
"4 days",
"likes to go hunting",
"bear meat",
"month",
"Examination shows periorbital edema",
"generalized muscle tenderness",
"leukocyte count",
"mm3",
"eosinophils",
"release",
"major basic protein",
"response",
"patients in... |
A 65-year-old patient with a history of COPD and open-angle glaucoma in the left eye has had uncontrolled intraocular pressure (IOP) for the last few months. She is currently using latanoprost eye drops. Her ophthalmologist adds another eye drop to her regimen to further decrease her IOP. A week later, the patient retu... | Opening the canal of Schlemm by contracting the ciliary muscle | {
"A": "Inhibiting the production of aqueous humor by the ciliary epithelium",
"B": "Closing the trabecular mesh by relaxing the ciliary muscles",
"C": "Opening the canal of Schlemm by contracting the ciliary muscle",
"D": "Increasing the permeability of sclera to aqueous humor"
} | step1 | C | [
"65-year-old patient",
"history",
"COPD",
"open-angle glaucoma",
"left eye",
"uncontrolled intraocular pressure",
"months",
"currently using latanoprost eye drops",
"ophthalmologist adds",
"eye drop",
"regimen",
"further decrease",
"IOP",
"week later",
"patient returns",
"persistent di... |
A 47-year-old man presents to the clinic with a 10-day history of a sore throat and fever. He has a past medical history significant for ulcerative colitis and chronic lower back pain. He smokes at least 1 pack of cigarettes daily for 10 years. The father of the patient died of colon cancer at the age of 50. He takes s... | Colonoscopy | {
"A": "Fecal occult blood testing",
"B": "Flexible sigmoidoscopy",
"C": "Low-dose CT",
"D": "Colonoscopy"
} | step2&3 | D | [
"year old man presents",
"clinic",
"10 day history",
"sore throat",
"fever",
"past medical history significant",
"ulcerative colitis",
"chronic lower back pain",
"smokes at least",
"pack",
"cigarettes daily",
"10 years",
"father",
"patient died of colon cancer",
"age",
"50",
"takes s... |
A patient with HCC and a long history of alcohol dependence and chronic hepatitis C has been using the mTOR inhibitor Metalimus 100 mg for cancer treatment. Her cancer has shown a partial response. She also has a history of hypertension and poorly controlled type 2 diabetes mellitus complicated by diabetic retinopathy.... | The patient is not a good candidate for Noxbinle due to her history of diabetes | {
"A": "The patient is not a good candidate for Noxbinle due to her history of diabetes",
"B": "The patient should start Noxbinle 50 mg because of the survival benefit relative to Metalimus 100 mg",
"C": "The patient should start Noxbinle 100 mg because of the survival benefit relative to Metalimus 100 mg",
"D"... | step2&3 | A | [
"patient",
"HCC",
"long history",
"alcohol dependence",
"chronic hepatitis C",
"using",
"mTOR inhibitor",
"100 mg",
"cancer treatment",
"cancer",
"shown",
"partial response",
"history of hypertension",
"poorly controlled type 2 diabetes mellitus complicated",
"diabetic retinopathy",
"C... |
A 22-year-old G4P2 at 35 weeks gestation presents to the hospital after she noticed that "her water broke." Her prenatal course is unremarkable, but her obstetric history includes postpartum hemorrhage after her third pregnancy, attributed to a retained placenta. The patient undergoes augmentation of labor with oxytoci... | Hemorrhagic shock | {
"A": "Heart failure",
"B": "Hemorrhagic shock",
"C": "Hypertension",
"D": "Hyperthermia"
} | step2&3 | B | [
"year old",
"35 weeks gestation presents",
"hospital",
"water",
"prenatal course",
"unremarkable",
"obstetric history includes postpartum hemorrhage",
"third pregnancy",
"attributed",
"retained placenta",
"patient",
"augmentation of labor",
"oxytocin",
"four hours delivers",
"male infant... |
A 40-year-old nulliparous woman with no significant medical history presents to your office with shortness of breath and increased abdominal girth over the past month. The initial assessment demonstrates that the patient has a right-sided hydrothorax, ascites, and a large ovarian mass. Surgery is performed to remove th... | Meigs syndrome | {
"A": "Metastatic colon cancer",
"B": "Metastatic ovarian cancer",
"C": "Meigs syndrome",
"D": "Nephrotic syndrome"
} | step1 | C | [
"40 year old nulliparous woman",
"significant medical history presents",
"office",
"shortness of breath",
"increased abdominal",
"past month",
"initial assessment demonstrates",
"patient",
"right-sided hydrothorax",
"ascites",
"large ovarian",
"Surgery",
"performed to remove",
"ovarian mas... |
A 32-year-old man comes to the physician for a follow-up examination. He has a 2-month history of increasing generalized fatigue and severe pruritus. He has hypertension and ulcerative colitis which was diagnosed via colonoscopy 5 years ago. Current medications include lisinopril and rectal mesalamine. He is sexually a... | Primary sclerosing cholangitis | {
"A": "Autoimmune hepatitis",
"B": "Primary sclerosing cholangitis",
"C": "Hepatitis B infection",
"D": "IgG4-associated cholangitis"
} | step2&3 | B | [
"year old man",
"physician",
"follow-up examination",
"2 month history",
"increasing generalized fatigue",
"severe pruritus",
"hypertension",
"ulcerative colitis",
"diagnosed",
"colonoscopy",
"years",
"Current medications include lisinopril",
"rectal mesalamine",
"sexually active",
"fema... |
An 82-year-old woman is brought to the emergency department after losing consciousness at her nursing home. She had been watching TV for several hours and while getting up to use the bathroom, she fell and was unconscious for several seconds. She felt dizzy shortly before the fall. She does not have a headache or any o... | Elevated blood urea nitrogen concentration | {
"A": "Absent P waves on ECG",
"B": "Elevated blood urea nitrogen concentration",
"C": "Hypodense lesions on CT scan of the head",
"D": "Elevated serum creatine kinase concentration"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"consciousness",
"nursing home",
"watching TV",
"hours",
"getting",
"use",
"bathroom",
"fell",
"unconscious",
"seconds",
"felt dizzy",
"fall",
"not",
"headache",
"pain",
"history of hypertension",
"intermittent atrial fibrill... |
A 38-year-old woman comes to the physician because of a 10-month history of nonbloody diarrhea and recurrent episodes of flushing and wheezing. She does not take any medications. Physical examination shows a hyperpigmented rash around the base of her neck. Cardiac examination shows a grade 4/6, holosystolic murmur in t... | Tumor in the lung without metastasis | {
"A": "Tumor in the pancreas without metastasis",
"B": "Tumor in the lung without metastasis",
"C": "Tumor in the appendix without metastasis",
"D": "Tumor in the descending colon with hepatic metastasis"
} | step1 | B | [
"year old woman",
"physician",
"a 10 month history",
"diarrhea",
"recurrent episodes of flushing",
"wheezing",
"not take",
"medications",
"Physical examination shows",
"hyperpigmented rash",
"base of",
"neck",
"Cardiac examination shows",
"grade",
"6",
"holosystolic murmur",
"5th int... |
A 4-year-old boy is brought to the clinic by his mother with fever and a rash. The patient’s mother says his symptoms started 1 week ago with the acute onset of fever and a runny nose, which resolved over the next 3 days. Then, 4 days later, she noted a rash on his face, which, after a day, spread to his neck, torso, a... | ELISA for parvovirus B-19 IgM and IgG antibodies | {
"A": "Assay for IgM and IgG against measles virus",
"B": "Serology for human herpesvirus-6 IgM antibodies",
"C": "ELISA for IgG antibodies against Rubella virus",
"D": "ELISA for parvovirus B-19 IgM and IgG antibodies"
} | step2&3 | D | [
"4 year old boy",
"brought",
"clinic",
"mother",
"fever",
"rash",
"patients mother",
"symptoms started 1 week",
"acute onset",
"fever",
"runny nose",
"resolved",
"next 3 days",
"Then",
"4 days later",
"noted",
"rash on",
"face",
"day",
"spread",
"neck",
"torso",
"extremit... |
A 24-year-old woman presents to her physician’s office complaining of a worsening cough with large volumes of mucoid sputum in her phlegm every morning and thickened foul smell sputum almost every time she coughs. She says that this cough started about one month ago and has been increasing in intensity. Over the counte... | Intravenous ciprofloxacin | {
"A": "Amoxicillin and clavulanic acid",
"B": "Surgical therapy",
"C": "Trimethoprim and sulfamethoxazole",
"D": "Intravenous ciprofloxacin"
} | step2&3 | D | [
"year old woman presents",
"physicians office complaining of",
"worsening cough",
"large volumes of mucoid sputum",
"phlegm",
"morning",
"thickened",
"smell sputum almost",
"time",
"coughs",
"cough started",
"one month",
"increasing",
"intensity",
"Over the counter medications",
"ineff... |
A 7-month-old boy is brought to the pediatrician for a change in his behavior. The patient has been breastfeeding up until this point and has been meeting his developmental milestones. He is in the 90th percentile for weight and 89th percentile for height. This past week, the patient has been lethargic, vomiting, and h... | Aldolase B | {
"A": "Aldolase B",
"B": "Galactose-1-phosphate uridyltransferase",
"C": "Glucose",
"D": "Ornithine transcarbamolase"
} | step2&3 | A | [
"month old boy",
"brought",
"pediatrician",
"change in",
"behavior",
"patient",
"breastfeeding",
"point",
"meeting",
"developmental milestones",
"90th percentile",
"weight",
"percentile",
"height",
"past week",
"patient",
"lethargic",
"vomiting",
"refusing to eat",
"patient's p... |
A 21-year-old woman is admitted to the hospital for severe malnutrition with a BMI of 15 kg/m2. Past medical history is significant for chronic anorexia nervosa. During the course of her stay, she is treated with parenteral fluids and nutrition management. On the 4th day, her status changes. Her blood pressure is 110/7... | Measure electrolytes | {
"A": "MRI of the brain",
"B": "Arrange for outpatient counseling",
"C": "Measure electrolytes",
"D": "Administer insulin"
} | step1 | C | [
"21-year-old woman",
"admitted",
"hospital",
"severe malnutrition",
"BMI of",
"kg/m2",
"Past medical",
"significant",
"chronic anorexia nervosa",
"course",
"treated with parenteral fluids",
"nutrition management",
"4th day",
"status changes",
"blood pressure",
"75 mm Hg",
"heart rate... |
A 62-year-old man comes to the physician because of a 5-day history of fatigue, fever, and chills. For the past 9 months, he has had hand pain and stiffness that has progressively worsened. He started a new medication for these symptoms 3 months ago. Medications used prior to that included ibuprofen, prednisone, and hy... | Leucovorin | {
"A": "Amifostine",
"B": "Pyridoxine",
"C": "Leucovorin",
"D": "Mesna\n\""
} | step2&3 | C | [
"62 year old man",
"physician",
"5-day history",
"fatigue",
"fever",
"chills",
"past",
"months",
"hand pain",
"stiffness",
"worsened",
"started",
"new medication",
"symptoms 3 months",
"Medications used prior to",
"included ibuprofen",
"prednisone",
"hydroxychloroquine",
"not smo... |
Please refer to the summary above to answer this question
An ECG is most likely to show which of the following findings in this patient?"
"Patient Information
Age: 64 years
Gender: F, self-identified
Ethnicity: unspecified
Site of Care: emergency department
History
Reason for Visit/Chief Concern: “My chest hurts, espec... | Diffuse, concave ST-segment elevations | {
"A": "S waves in lead I, Q waves in lead III, and inverted T waves in lead III",
"B": "Diffuse, concave ST-segment elevations",
"C": "Sawtooth-appearance of P waves",
"D": "Peaked T waves and ST-segment elevations in leads V1-V6"
} | step2&3 | B | [
"refer",
"summary above to answer",
"question",
"ECG",
"most likely to show",
"following findings",
"patient",
"Patient Age",
"64 years Gender",
"F",
"self identified Ethnicity",
"unspecified Site of Care",
"emergency department History Reason for Visit",
"Concern",
"chest",
"I take",
... |
A 16-year-old boy is brought to the physician for a follow-up appointment. He has a seizure disorder treated with valproic acid. He has always had difficulties with his schoolwork. He was able to walk independently at the age of 2 years and was able to use a fork and spoon at the age of 3 years. Ophthalmic examination ... | Pheochromocytoma | {
"A": "Vestibular schwannoma",
"B": "Pheochromocytoma",
"C": "Leptomeningeal angioma",
"D": "Cardiac rhabdomyoma"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"follow-up appointment",
"seizure disorder treated with valproic acid",
"always",
"difficulties",
"able to walk",
"age",
"years",
"able to use",
"fork",
"spoon",
"age of",
"years",
"Ophthalmic examination shows hyperpigmented iris",
"photograph... |
A 52-year-old woman presents to her primary care physician with a chief complaint of diarrhea. She states that it has been going on for the past month and started after she ate a burger cooked over a campfire. She endorses having lost 10 pounds during this time. The patient has no other complaints other than hoarseness... | Episodic hypertension and headaches | {
"A": "Acute renal failure",
"B": "Acute liver failure",
"C": "Episodic hypertension and headaches",
"D": "Bitemporal hemianopsia"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"chief complaint",
"diarrhea",
"states",
"past month",
"started",
"ate",
"burger cooked",
"lost 10 pounds",
"time",
"patient",
"complaints",
"hoarseness",
"time",
"patient",
"past medical",
"hypothyroidism",
"diabetes",
"anxi... |
A 27-year-old female presents to her OB/GYN for a check-up. During her visit, a pelvic exam and Pap smear are performed. The patient does not have any past medical issues and has had routine gynecologic care with normal pap smears every 3 years since age 21. The results of the Pap smear demonstrate atypical squamous ce... | Perform an HPV DNA test | {
"A": "Repeat Pap smear in 1 year",
"B": "Repeat Pap smear in 3 years",
"C": "Perform an HPV DNA test",
"D": "Perform a Loop Electrosurgical Excision Procedure (LEEP)"
} | step2&3 | C | [
"27 year old female presents",
"OB/GYN",
"check-up",
"visit",
"pelvic exam",
"Pap smear",
"performed",
"patient",
"not",
"past medical issues",
"routine gynecologic care",
"normal pap smears",
"3 years",
"age",
"results",
"Pap smear",
"atypical squamous cells of undetermined signific... |
A 19-year-old man comes to the physician for the evaluation of progressive difficulty climbing stairs over the last 2 years. During this period, he has also had problems with running, occasional falls, and standing from a chair. He has not had any vision problems or muscle cramping. There is no personal or family histo... | Genetic analysis | {
"A": "Tensilon test",
"B": "Anti-Jo-1 antibodies measurement",
"C": "Electromyography",
"D": "Genetic analysis"
} | step2&3 | D | [
"year old man",
"physician",
"evaluation",
"progressive difficulty climbing stairs",
"last",
"years",
"period",
"problems",
"running",
"occasional falls",
"standing",
"chair",
"not",
"vision problems",
"muscle cramping",
"personal",
"family history",
"serious illness",
"Neurologi... |
An 11-year-old man presents with fever and joint pain for the last 3 days. His mother says that he had a sore throat 3 weeks ago but did not seek medical care at that time. The family immigrated from the Middle East 3 years ago. The patient has no past medical history. The current illness started with a fever and a swo... | Positive anti-streptococcal serology | {
"A": "Elevated erythrocyte sedimentation rate (ESR)",
"B": "Elevated leukocyte count",
"C": "Prolonged PR interval",
"D": "Positive anti-streptococcal serology"
} | step2&3 | D | [
"year old man presents",
"fever",
"joint pain",
"3 days",
"mother",
"sore throat",
"weeks",
"not",
"medical care",
"time",
"family",
"Middle East",
"years",
"patient",
"past medical history",
"current illness started",
"fever",
"swollen right",
"very painful",
"following day",
... |
A 41-year-old woman is referred by her radiation oncologist to the medical genetics clinic. She was recently diagnosed with an infiltrating ductal carcinoma of the breast. She has a previous history of colonic polyps for which she undergoes bi-annual colonoscopy. The maternal and paternal family history is unremarkable... | Hamartomatous polyp | {
"A": "Hyperplastic polyps",
"B": "Adenomatous polyps",
"C": "Inflammatory polyps",
"D": "Hamartomatous polyp"
} | step2&3 | D | [
"year old woman",
"referred",
"radiation oncologist",
"medical genetics clinic",
"recently diagnosed",
"infiltrating ductal carcinoma of the breast",
"previous history of colonic polyps",
"annual colonoscopy",
"maternal",
"paternal family",
"unremarkable",
"polyps",
"malignant",
"benign tu... |
A 40-year-old woman presents to her primary care physician with a 5-month history of worsening bladder discomfort. Her discomfort is relieved by voiding. She voids 10–15 times per day and wakes up 2–3 times per night to void. She has not had any involuntary loss of urine. She has tried cutting down on fluids and taking... | Interstitial cystitis | {
"A": "Overactive bladder",
"B": "Interstitial cystitis",
"C": "Urinary retention",
"D": "Diabetes insipidus"
} | step2&3 | B | [
"40 year old woman presents",
"primary care physician",
"5 month history",
"worsening bladder discomfort",
"discomfort",
"relieved by voiding",
"voids",
"times per day",
"wakes up 23 times",
"night",
"void",
"not",
"involuntary loss",
"urine",
"cutting",
"fluids",
"taking NSAIDs to",... |
A 55-year-old woman presents to her primary care provider with a 2-month history of insidious onset of left shoulder pain. It only occurs at the extremes of her range of motion and has made it difficult to sleep on the affected side. She has noticed increasing difficulty with activities of daily living, including brush... | Adhesive capsulitis | {
"A": "Degenerative cervical spine disease",
"B": "Adhesive capsulitis",
"C": "Rotator cuff injury",
"D": "Glenohumeral arthritis"
} | step2&3 | B | [
"55 year old woman presents",
"primary care provider",
"2 month history",
"insidious onset",
"left shoulder pain",
"only occurs",
"extremes of",
"range",
"motion",
"made",
"difficult to sleep",
"affected side",
"increasing difficulty",
"activities of daily living",
"including brushing",
... |
A 70-year-old man comes to the physician because of right-sided back pain, red urine, and weight loss for the last 4 months. He has smoked one pack of cigarettes daily for 40 years. A CT scan of the abdomen shows a large right-sided renal mass. Biopsy of the mass shows polygonal clear cells filled with lipids. Which of... | Degree of mitotic activity | {
"A": "Size of malignant proliferation",
"B": "Degree of mitotic activity",
"C": "Response to chemotherapy",
"D": "Involvement of regional lymph nodes\n\""
} | step1 | B | [
"70 year old man",
"physician",
"right-sided back pain",
"red urine",
"weight loss",
"months",
"smoked one pack",
"cigarettes daily",
"40 years",
"CT scan",
"abdomen shows",
"large right-sided renal mass",
"Biopsy",
"shows polygonal clear cells filled",
"lipids",
"following features",
... |
A previously healthy 46-year-old woman comes to her physician because of an itchy rash on her legs. She denies any recent trauma, insect bites, or travel. Her vital signs are within normal limits. Examination of the oral cavity shows white lace-like lines on the buccal mucosa. A photograph of the rash is shown. A biops... | Lymphocytes at the dermoepidermal junction | {
"A": "Decreased thickness of the stratum granulosum",
"B": "Lymphocytes at the dermoepidermal junction",
"C": "Proliferation of vascular endothelium",
"D": "Deposition of antibodies around epidermal cells"
} | step1 | B | [
"healthy",
"year old woman",
"physician",
"of",
"itchy",
"legs",
"denies",
"recent trauma",
"insect bites",
"travel",
"vital signs",
"normal limits",
"Examination of",
"oral cavity shows white lace",
"lines",
"buccal mucosa",
"photograph",
"rash",
"shown",
"biopsy specimen",
... |
A 48-year-old female presents to the emergency room with mental status changes.
Laboratory analysis of the patient's serum shows:
Na 122 mEq/L
K 3.9 mEq/L
HCO3 24 mEq/L
BUN 21 mg/dL
Cr 0.9 mg/dL
Ca 8.5 mg/dL
Glu 105 mg/dL
Urinalysis shows:
Osmolality 334 mOsm/kg
Na 45 mEq/L
Glu 0 mg/dL
Which of the following is the m... | Lung cancer | {
"A": "Diarrhea",
"B": "Diabetes insipidus",
"C": "Primary polydipsia",
"D": "Lung cancer"
} | step1 | D | [
"48 year old female presents",
"emergency room",
"mental status changes",
"Laboratory analysis",
"patient's serum shows",
"Na",
"mEq K",
"HCO3",
"mg dL Cr 0",
"mg dL",
"8 5",
"Glu",
"Urinalysis shows",
"Osmolality",
"mOsm/kg Na",
"mEq/L Glu 0 mg/dL",
"following",
"most likely diagn... |
On the 4th day of hospital admission due to pneumonia, a 69-year-old woman develops non-bloody diarrhea and abdominal pain. She is currently treated with ceftriaxone. Despite the resolution of fever after the first 2 days of admission, her temperature is now 38.5°C (101.3°F). On physical examination, she has mild gener... | Stool culture for bacterial isolation and toxin presence | {
"A": "Endoscopy ",
"B": "Gram stain of stool sample ",
"C": "Nucleic acid amplification test",
"D": "Stool culture for bacterial isolation and toxin presence"
} | step1 | D | [
"4th day",
"hospital",
"pneumonia",
"69 year old woman",
"non bloody diarrhea",
"abdominal pain",
"currently treated with ceftriaxone",
"resolution",
"fever",
"first 2 days",
"admission",
"temperature",
"now",
"physical examination",
"mild generalized abdominal tenderness",
"guarding",... |
A 2-year-old boy is brought to the physician for a well-child examination. Since infancy, he has frequently had large-volume stools that are loose and greasy. He was treated for otitis media twice in the past year. He has a history of recurrent respiratory tract infections since birth. He is at the 5th percentile for h... | CFTR gene mutation | {
"A": "Deficient α1 antitrypsin",
"B": "CFTR gene mutation",
"C": "Absent T cells",
"D": "Impaired ciliary function"
} | step2&3 | B | [
"2 year old boy",
"brought",
"physician",
"well",
"infancy",
"frequently",
"large volume stools",
"loose",
"greasy",
"treated",
"otitis media twice",
"past year",
"history",
"recurrent respiratory tract infections",
"birth",
"5th percentile",
"height",
"3rd percentile",
"weight",... |
A 77-year-old woman is brought to her primary care provider by her daughter with behavioral changes and an abnormally bad memory for the past few months. The patient’s daughter says she sometimes gets angry and aggressive while at other times she seems lost and stares at her surroundings. Her daughter also reports that... | Lewy body dementia | {
"A": "Alzheimer's disease",
"B": "Frontotemporal dementia",
"C": "Lewy body dementia",
"D": "Serotonin syndrome"
} | step2&3 | C | [
"year old woman",
"brought",
"primary care provider",
"daughter",
"behavioral changes",
"bad memory",
"past",
"months",
"patients daughter",
"sometimes gets angry",
"aggressive",
"times",
"lost",
"stares",
"surroundings",
"daughter",
"reports",
"seen",
"mother talking",
"empty ... |
A 49-year-old man comes to the physician because of severe, shooting pain in his lower back for the past 2 weeks. The pain radiates down the back of both legs and started after he lifted a concrete manhole cover from the ground. Physical examination shows decreased sensation to light touch bilaterally over the lateral ... | Herniation of nucleus pulposus into vertebral canal | {
"A": "Inflammatory degeneration of the spine",
"B": "Compromised integrity of the vertebral body",
"C": "Herniation of nucleus pulposus into vertebral canal",
"D": "Inflammatory reaction in the epidural space"
} | step1 | C | [
"year old man",
"physician",
"of severe",
"shooting pain in",
"lower back",
"past 2 weeks",
"pain radiates",
"back of",
"legs",
"started",
"lifted",
"concrete",
"cover",
"Physical examination shows decreased",
"light",
"lateral thigh area",
"lateral calf",
"Patellar reflex",
"dec... |
A 23-year-old patient with a past medical history of anxiety and appropriately treated schizophrenia presents to the emergency department for a first time seizure. The patient was at home eating dinner when he began moving abnormally and did not respond to his mother, prompting her to bring him in. His symptoms persist... | P450 induction | {
"A": "Elevated blood levels of a medication",
"B": "Increased water consumption",
"C": "P450 induction",
"D": "Sub-therapeutic dose"
} | step2&3 | C | [
"23 year old patient",
"past medical history of anxiety",
"treated schizophrenia presents",
"emergency department",
"first time seizure",
"patient",
"at home eating dinner",
"began moving",
"not",
"mother",
"prompting",
"to",
"symptoms",
"emergency department",
"treated with diazepam",
... |
A 16-year-old boy comes to the physician because of a 1-week history of difficulty swallowing, a foreign body sensation at the back of his throat, and trouble breathing at night. He has just recovered from an upper respiratory tract infection that began 5 days ago. On questioning, he reports that he has had similar sym... | Arrested endodermal migration from pharyngeal floor | {
"A": "Ductal obstruction of the sublingual salivary glands",
"B": "Chronic infection of the palatine and lingual tonsils",
"C": "Arrested endodermal migration from pharyngeal floor",
"D": "Persistent epithelial tract between the foramen cecum and thyroid isthmus"
} | step1 | C | [
"year old boy",
"physician",
"1-week history",
"difficulty swallowing",
"foreign body sensation",
"back of",
"throat",
"trouble breathing",
"night",
"recovered",
"upper respiratory tract infection",
"began 5 days",
"questioning",
"reports",
"similar symptoms",
"past",
"time",
"uppe... |
A previously healthy 44-year-old man is brought by his coworkers to the emergency department 45 minutes after he became light-headed and collapsed while working in the boiler room of a factory. He did not lose consciousness. His coworkers report that 30 minutes prior to collapsing, he told them he was nauseous and had ... | Ice water immersion | {
"A": "Acetaminophen therapy",
"B": "Dantrolene",
"C": "Ice water immersion",
"D": "Hemodialysis"
} | step2&3 | C | [
"healthy",
"year old man",
"brought",
"coworkers",
"emergency department 45 minutes",
"light-headed",
"collapsed",
"working",
"boiler room",
"factory",
"not",
"consciousness",
"coworkers report",
"30 minutes prior to collapsing",
"nauseous",
"headache",
"patient appears sweaty",
"l... |
A 35-year-old male anesthesiologist presents to the occupational health clinic after a needlestick exposure while obtaining an arterial line in a patient with cirrhosis. In addition to a standard bloodborne pathogen laboratory panel sent for all needlestick exposures at his hospital, additional hepatitis panels are ord... | Immune due to infection | {
"A": "Chronic infection",
"B": "Immune due to infection",
"C": "Immune due to vaccination",
"D": "Window period"
} | step2&3 | B | [
"35 year old male anesthesiologist presents",
"occupational health clinic",
"needlestick exposure",
"obtaining",
"arterial line",
"patient",
"cirrhosis",
"standard bloodborne pathogen laboratory panel sent",
"needlestick exposures",
"hospital",
"additional hepatitis panels",
"ordered",
"pati... |
A 75-year-old woman presents to her physician with a cough and shortness of breath. She says that cough gets worse at night and her shortness of breath occurs with moderate exertion or when lying flat. She says these symptoms have been getting worse over the last 6 months. She mentions that she has to use 3 pillows whi... | Ventricular hypertrophy with sarcomeres duplicated in parallel | {
"A": "Ventricular hypertrophy with sarcomeres duplicated in series",
"B": "Ventricular hypertrophy with sarcomeres duplicated in parallel",
"C": "Asymmetric hypertrophy of the interventricular septum",
"D": "Granuloma consisting of lymphocytes, plasma cells and macrophages surrounding necrotic"
} | step1 | B | [
"75 year old woman presents",
"physician",
"cough",
"shortness of breath",
"cough gets worse",
"night",
"shortness of breath occurs",
"moderate exertion",
"lying flat",
"symptoms",
"getting worse",
"months",
"to use 3 pillows",
"sleeping",
"order to relieve",
"symptoms",
"denies",
... |
A 62-year-old woman presents to the emergency department with a 2-hour history of sharp chest pain. She says that the pain is worse when she inhales and is relieved by sitting up and leaning forward. Her past medical history is significant for rheumatoid arthritis, myocardial infarction status post coronary artery bypa... | Malignancy | {
"A": "Malignancy",
"B": "Myocardial infarction",
"C": "Rheumatoid arthritis",
"D": "Uremia"
} | step1 | A | [
"62 year old woman presents",
"emergency department",
"2-hour history of sharp chest pain",
"pain",
"worse",
"inhales",
"relieved by sitting",
"forward",
"past medical history",
"significant",
"rheumatoid arthritis",
"myocardial infarction status post coronary artery bypass graft",
"radiatio... |
Four days after admission to the hospital for anorexia nervosa, a 20-year-old woman has new-onset palpitations and paresthesias in all four limbs. Prior to admission, she was found unconscious by her parents on the floor of a residential treatment center. The patient was started on a trial of nutritional rehabilitation... | Increased insulin release | {
"A": "Thiamine deficiency",
"B": "Rapid gastric emptying",
"C": "Increased insulin release",
"D": "Euthyroid sick syndrome"
} | step2&3 | C | [
"Four days",
"admission",
"hospital",
"anorexia nervosa",
"20 year old woman",
"new-onset palpitations",
"paresthesias",
"four limbs",
"admission",
"found unconscious",
"parents",
"floor",
"residential treatment center",
"patient",
"started",
"trial",
"nutritional rehabilitation",
... |
A 17-year-old boy comes to the emergency department because of a 3-day history of pain in his left wrist. That morning the pain increased and he started to have chills and malaise. Last week he had self-resolving left knee pain. He is otherwise healthy and has not had any trauma to the wrist. He recently returned from ... | Disseminated gonococcal infection | {
"A": "Lyme arthritis",
"B": "Acute rheumatic fever",
"C": "Disseminated gonococcal infection",
"D": "Reactive arthritis\n\""
} | step2&3 | C | [
"year old boy",
"emergency department",
"3-day history",
"pain",
"left wrist",
"morning",
"pain increased",
"started to",
"chills",
"malaise",
"week",
"self resolving left",
"healthy",
"not",
"trauma",
"wrist",
"recently returned",
"camping trip",
"Minnesota",
"sexually active"... |
A 53-year-old man with obesity and heart disease presents to your outpatient clinic with complaints of orthopnea, significant dyspnea on minimal exertion, nausea, vomiting, and diarrhea. He says that his old doctor gave him "some pills" that he takes in varying amounts every morning. Physical exam is significant for a ... | Digoxin | {
"A": "Digoxin",
"B": "Verapamil",
"C": "Amiodarone",
"D": "Lidocaine"
} | step1 | A | [
"year old man",
"obesity",
"heart disease presents",
"outpatient clinic",
"complaints",
"orthopnea",
"significant dyspnea on minimal exertion",
"nausea",
"vomiting",
"diarrhea",
"old doctor gave",
"pills",
"takes",
"amounts",
"morning",
"Physical exam",
"significant",
"a severely d... |
A 7-year-old African-American boy presents to his physician with fatigue, bone and abdominal pain, and mild jaundice. The pain is dull and remitting, and the patient complains it sometimes migrates from one extremity to another. His mother reports that his jaundice and pain have occurred periodically for the past 5 yea... | The patient should receive serogroup B meningococcal vaccination at the age of 10 years. | {
"A": "The patient should not receive meningococcal, pneumococcal, or Haemophilus influenzae vaccines, because they are likely to cause complications or elicit disease in his case.",
"B": "The patient should receive serogroup B meningococcal vaccination at the age of 10 years.",
"C": "The patient should receive ... | step1 | B | [
"year old African-American boy presents",
"physician",
"fatigue",
"bone",
"abdominal pain",
"mild jaundice",
"pain",
"dull",
"remitting",
"patient",
"sometimes migrates",
"one extremity",
"mother reports",
"jaundice",
"pain",
"occurred periodically",
"past",
"years",
"time",
"p... |
A 52-year-old man presents to his primary care physician for generalized pain. The patient states that he feels like his muscles and bones are in constant pain. This has persisted for the past several weeks, and his symptoms have not improved with use of ibuprofen or acetaminophen. The patient has a past medical histor... | Hearing loss | {
"A": "Hearing loss",
"B": "Bence Jones proteins",
"C": "Hypercalcemia",
"D": "Obstructive jaundice"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"generalized pain",
"patient states",
"feels",
"muscles",
"bones",
"constant pain",
"past",
"weeks",
"symptoms",
"not improved",
"use of ibuprofen",
"acetaminophen",
"patient",
"past medical history of alcohol abuse",
"repeat episode... |
A 26-year-old woman comes to the physician because of a 3-day history of redness, foreign body sensation, and discharge of both eyes. She reports that her eyes feel “stuck together” with yellow crusts every morning. She has a 3-year history of nasal allergies; her sister has allergic rhinitis. She is sexually active wi... | Topical erythromycin | {
"A": "Topical natamycin",
"B": "Topical prednisolone acetate",
"C": "Topical erythromycin",
"D": "Oral erythromycin"
} | step2&3 | C | [
"year old woman",
"physician",
"3-day history",
"redness",
"foreign body sensation",
"discharge of",
"eyes",
"reports",
"eyes feel",
"together",
"yellow crusts",
"morning",
"3 year history of nasal allergies",
"sister",
"allergic rhinitis",
"sexually active",
"male partners",
"uses... |
A 59-year-old man is brought to the emergency department by paramedics following a high-speed motor vehicle collision. The patient complains of excruciating chest pain, which he describes as tearing. Further history reveals that the patient is healthy, taking no medications, and is not under the influence of drugs or a... | Traumatic aortic dissection | {
"A": "Rib fracture",
"B": "Traumatic aortic dissection",
"C": "Myocardial rupture",
"D": "Diaphragmatic rupture"
} | step2&3 | B | [
"59 year old man",
"brought",
"emergency department",
"paramedics following",
"high speed motor vehicle collision",
"patient",
"of excruciating chest pain",
"tearing",
"Further history reveals",
"patient",
"healthy",
"taking",
"medications",
"not",
"influence",
"drugs",
"alcohol",
... |
A 23-year-old man presents to the emergency department with shortness of breath. The patient was at a lunch hosted by his employer. He started to feel his symptoms begin when he started playing football outside with a few of the other employees. The patient has a past medical history of atopic dermatitis and asthma. Hi... | IM epinephrine | {
"A": "Albuterol and prednisone",
"B": "IM epinephrine",
"C": "IV epinephrine",
"D": "IV fluids and 100% oxygen"
} | step2&3 | B | [
"23 year old man presents",
"emergency department",
"shortness of breath",
"patient",
"lunch hosted",
"employer",
"started to feel",
"symptoms begin",
"started playing football outside",
"employees",
"patient",
"past medical atopic dermatitis",
"asthma",
"temperature",
"98",
"36",
"b... |
A 32-year-old G1P0 woman presents to her obstetrician for a prenatal visit. She is 30 weeks pregnant. She reports some fatigue and complains of urinary urgency. Prior to this pregnancy, she had no significant medical history. She takes a prenatal vitamin and folate supplements daily. Her mother has diabetes, and her br... | Rubella infection | {
"A": "Antiphospholipid syndrome",
"B": "Gestational diabetes",
"C": "Pre-eclampsia",
"D": "Rubella infection"
} | step2&3 | D | [
"year old",
"woman presents",
"obstetrician",
"prenatal visit",
"30 weeks pregnant",
"reports",
"fatigue",
"urinary urgency",
"pregnancy",
"significant medical history",
"takes",
"prenatal vitamin",
"folate supplements daily",
"mother",
"diabetes",
"brother",
"coronary artery disease... |
A 71-year-old male presents to the emergency department after having a generalized tonic-clonic seizure. His son reports that he does not have a history of seizures but has had increasing confusion and weakness over the last several weeks. An electrolyte panel reveals a sodium level of 120 mEq/L and a serum osmolality ... | Syndrome of Inappropriate Antidiuretic Hormone (SIADH) | {
"A": "Syndrome of Inappropriate Antidiuretic Hormone (SIADH)",
"B": "Sheehan’s syndrome",
"C": "Lithium use",
"D": "Diabetic ketoacidosis"
} | step2&3 | A | [
"71 year old male presents",
"emergency department",
"generalized tonic-clonic seizure",
"son reports",
"not",
"history",
"seizures",
"increasing confusion",
"weakness",
"weeks",
"electrolyte panel reveals",
"sodium level",
"mEq/L",
"serum osmolality",
"mOsm/kg",
"urine",
"found to",... |
A 69-year-old woman presents with pain in her hip and groin. She states that the pain is present in the morning, and by the end of the day it is nearly unbearable. Her past medical history is notable for a treated episode of acute renal failure, diabetes mellitus, obesity, and hypertension. Her current medications incl... | Loss of joint space and osteophytes | {
"A": "Loss of joint space and osteophytes",
"B": "Hyperdense foci in the ureters",
"C": "Femoral neck fracture",
"D": "Normal radiography"
} | step2&3 | A | [
"69 year old woman presents",
"pain",
"hip",
"groin",
"states",
"pain",
"present",
"morning",
"end",
"day",
"nearly",
"past medical history",
"notable",
"treated episode of acute renal failure",
"diabetes mellitus",
"obesity",
"hypertension",
"current medications include losartan",... |
A 35-year-old woman presents to a physician’s office for a follow-up visit. She recently underwent a complete physical examination with routine laboratory tests. She also had a Pap smear and testing for sexually transmitted diseases. Since her divorce 2 years ago, she had sexual encounters with random men at bars or so... | Replace didanosine with lamivudine | {
"A": "Add ritonavir to the HIV treatment regimen",
"B": "Replace efavirenz with nevirapine",
"C": "Check hemoglobin levels",
"D": "Replace didanosine with lamivudine"
} | step1 | D | [
"35 year old woman presents",
"physicians office",
"follow-up visit",
"recently",
"complete",
"routine laboratory tests",
"Pap smear",
"testing",
"sexually transmitted diseases",
"divorce",
"years",
"sexual encounters",
"random men",
"bars",
"social events",
"frequently",
"not use",
... |
A primigravida at 10+5 weeks gestation registers in an obstetric clinic for prenatal care. She has noted a rash that is rough with red-brown spots on her palms. The rapid plasma reagin (RPR) test is positive. The diagnosis is confirmed by darkfield microscopy. What is the fetus at risk for secondary to the mother’s con... | Saddle nose | {
"A": "Vision loss",
"B": "Saddle nose",
"C": "Chorioretinitis",
"D": "Muscle atrophy"
} | step1 | B | [
"primigravida",
"10+5 weeks gestation registers",
"obstetric clinic",
"prenatal",
"noted",
"rash",
"red brown",
"palms",
"rapid plasma reagin",
"RPR",
"test",
"positive",
"diagnosis",
"confirmed by darkfield microscopy",
"fetus at risk",
"secondary",
"mothers condition"
] |
A 35-year-old woman that has recently immigrated from Southeast Asia is brought to the emergency department due to a 3-week history of fatigue, night sweats, and enlarged lymph nodes and persistent fever. These symptoms have been getting worse during the past week. She has no history of any cardiac or pulmonary disease... | Isoniazid | {
"A": "Rifampicin",
"B": "Isoniazid",
"C": "Ethambutol",
"D": "Streptomycin"
} | step1 | B | [
"35 year old woman",
"recently",
"Southeast Asia",
"brought",
"emergency department due to",
"week history",
"fatigue",
"night sweats",
"enlarged lymph nodes",
"persistent fever",
"symptoms",
"getting worse",
"past week",
"history",
"cardiac",
"pulmonary disease",
"chest X-ray reveal... |
A 71-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1°C (98.8... | Proliferation of tumor cells | {
"A": "Acidosis-induced bone lysis",
"B": "Increased mechanical pressure",
"C": "Increased osteoblastic activity",
"D": "Proliferation of tumor cells"
} | step2&3 | D | [
"71 year old African American man",
"brought",
"emergency department",
"sudden onset lower",
"back pain",
"generalized bone",
"months",
"history",
"severe illnesses",
"takes ibuprofen",
"pain",
"examination",
"pale",
"vital signs include",
"temperature",
"98",
"pulse 68 min",
"resp... |
A 24-year-old male was in a motor vehicle accident that caused him to fracture his femur and pelvis. After 2 days in the hospital, the patient became delirious, tachypneic, and a petechial rash was found in his upper extremities. Which of the following is most likely responsible for this patient’s symptoms? | Fat microglobules in the microvasculature | {
"A": "Thrombotic clot in the pulmonary artery",
"B": "Fat microglobules in the microvasculature",
"C": "Type I and type II pneumocyte damage due to neutrophils",
"D": "Alveolar foamy exudates with disc shaped cysts seen with methenamine silver stain"
} | step1 | B | [
"year old male",
"motor vehicle accident",
"caused",
"to fracture",
"femur",
"pelvis",
"2 days in",
"hospital",
"patient",
"delirious",
"tachypneic",
"petechial rash",
"found",
"upper extremities",
"following",
"most likely responsible",
"patients symptoms"
] |
A 48-year-old man with a 30-pack-year history comes to the physician for a follow-up examination 6 months after a chest CT showed a solitary 5-mm solid nodule in the upper lobe of the right lung. The follow-up CT shows that the size of the nodule has increased to 2 cm. Ipsilateral mediastinal lymph node involvement is ... | Cisplatin-etoposide therapy and radiotherapy | {
"A": "Wedge resection",
"B": "Cisplatin-etoposide therapy and radiotherapy",
"C": "Right lobectomy",
"D": "Gefitinib therapy"
} | step2&3 | B | [
"48 year old man",
"30 pack",
"history",
"physician",
"follow-up examination 6 months",
"chest CT showed",
"solitary",
"solid nodule",
"the upper lobe of",
"right lung",
"follow-up CT shows",
"size of",
"nodule",
"increased",
"Ipsilateral mediastinal",
"noted",
"biopsy",
"pulmonary... |
A newborn born at 33 weeks of gestation has a respiratory rate of 70/min and a heart rate of 148/min 2 hours after birth. He is grunting and has intercostal and subcostal retractions. He has peripheral cyanosis as well. An immediate chest radiograph is taken which shows a fine reticular granulation with ground glass ap... | Respiratory distress syndrome | {
"A": "Pneumothorax",
"B": "Transient tachypnea of the newborn",
"C": "Respiratory distress syndrome",
"D": "Cyanotic congenital heart disease"
} | step1 | C | [
"newborn born",
"weeks of gestation",
"respiratory rate",
"70 min",
"heart rate",
"min",
"hours after birth",
"grunting",
"subcostal retractions",
"peripheral cyanosis",
"well",
"immediate chest radiograph",
"taken",
"shows",
"fine reticular granulation",
"ground glass appearance",
"... |
A hospitalized 70-year-old woman, who recently underwent orthopedic surgery, develops severe thrombocytopenia of 40,000/mm3 during her 7th day of hospitalization. She has no other symptoms and has no relevant medical history. All of the appropriate post-surgery prophylactic measures had been taken. Her labs from the 7t... | Heparin-induced thrombocytopenia | {
"A": "DIC",
"B": "Thrombotic microangiopathy",
"C": "Myelodysplasia",
"D": "Heparin-induced thrombocytopenia"
} | step1 | D | [
"hospitalized 70 year old woman",
"recently",
"orthopedic surgery",
"severe thrombocytopenia",
"40",
"mm3",
"day",
"hospitalization",
"symptoms",
"relevant medical history",
"appropriate post-surgery prophylactic measures",
"taken",
"labs",
"day",
"hospitalization",
"shown",
"complet... |
A 57-year-old man presents to his physician with dyspnea on exertion and rapid heartbeat. He denies any pain during these episodes. He works as a machine operator at a solar panels manufacturer. He has a 21-pack-year history of smoking. The medical history is significant for a perforated ulcer, in which he had to under... | Smoking | {
"A": "The patient’s body mass",
"B": "History of gastric bypass surgery",
"C": "Exposure to heavy metals",
"D": "Smoking"
} | step2&3 | D | [
"57 year old man presents",
"physician",
"dyspnea on exertion",
"rapid heartbeat",
"denies",
"pain",
"episodes",
"works",
"machine operator",
"solar panels manufacturer",
"pack-year history of smoking",
"medical history",
"significant",
"perforated ulcer",
"to",
"gastric resection",
... |
A 25-year-old man presents to the emergency department with bilateral eye pain. The patient states it has slowly been worsening over the past 48 hours. He admits to going out this past weekend and drinking large amounts of alcohol and having unprotected sex but cannot recall a predisposing event. The patient's vitals a... | Gatifloxacin eye drops | {
"A": "Acyclovir",
"B": "Gatifloxacin eye drops",
"C": "Intravitreal vancomycin and ceftazidime",
"D": "Topical dexamethasone and refrain from wearing contacts"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"bilateral eye pain",
"patient states",
"slowly",
"worsening",
"past 48 hours",
"admits to",
"out",
"past weekend",
"drinking large amounts",
"alcohol",
"unprotected sex",
"recall",
"predisposing event",
"patient's",
"normal limits",
... |
A 73-year-old man is brought in by his wife with a history of progressive personality changes. The patient’s wife says that, over the past 3 years, he has become increasingly aggressive and easily agitated, which is extremely out of character for him. His wife also says that he has had several episodes of urinary incon... | Lumbar puncture | {
"A": "Contrast MRI of the head",
"B": "Lumbar puncture",
"C": "Brain biopsy",
"D": "Serum ceruloplasmin level"
} | step2&3 | B | [
"year old man",
"brought",
"wife",
"history",
"progressive personality changes",
"patients wife",
"past",
"years",
"aggressive",
"easily agitated",
"extremely out",
"character",
"wife",
"several episodes of urinary incontinence",
"past month",
"significant past medical history",
"pat... |
A 25-year-old woman presents to the emergency department with palpitations, sweating, and blurry vision after playing volleyball on the beach. She denies chest pain and shortness of breath. She states that these episodes occur often, but resolve after eating a meal or drinking a sugary soda. Past medical history is unr... | Beta cell tumor of the pancreas | {
"A": "Heat stroke",
"B": "Exogenous insulin",
"C": "Beta cell tumor of the pancreas",
"D": "Alpha cell tumor of the pancreas"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"palpitations",
"sweating",
"blurry vision",
"playing volleyball",
"beach",
"denies chest pain",
"shortness of breath",
"states",
"episodes occur often",
"resolve",
"eating",
"meal",
"drinking",
"sugary soda",
"Past medical history",... |
A 12-month-old boy is brought in by his mother who is worried about pallor. She says that the patient has always been fair-skinned, but over the past month relatives have commented that he appears more pale. The mother says that the patient seems to tire easy, but plays well with his older brother and has even started ... | Limit milk intake | {
"A": "Administer deferoxamine",
"B": "Echocardiogram",
"C": "Limit milk intake",
"D": "Measure folate level"
} | step2&3 | C | [
"month old boy",
"brought",
"mother",
"worried",
"pallor",
"patient",
"always",
"fair-skinned",
"past month relatives",
"commented",
"appears more pale",
"mother",
"patient",
"to tire easy",
"plays well",
"older brother",
"started to walk",
"denies bloody",
"black stools",
"eas... |
A 58-year-old man presents to the emergency department with a chief complaint of ringing in his ears that started several hours previously that has progressed to confusion. The patient denies any history of medical problems except for bilateral knee arthritis. He was recently seen by an orthopedic surgeon to evaluate h... | pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L | {
"A": "pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L",
"B": "pH: 7.31, PaCO2: 31 mmHg, HCO3-: 15 mEq/L",
"C": "pH: 7.41, PaCO2: 65 mmHg, HCO3-: 34 mEq/L",
"D": "pH: 7.47, PaCO2: 11 mmHg, HCO3-: 24 mEq/L"
} | step2&3 | A | [
"58 year old man presents",
"emergency department",
"chief complaint",
"ringing",
"ears",
"started several hours",
"progressed",
"confusion",
"patient denies",
"history of medical problems",
"bilateral knee arthritis",
"recently seen by",
"orthopedic surgeon to evaluate",
"bilateral knee a... |
A 56-year-old woman is referred to your office with mammography results showing a dense, spiculated mass with clustered microcalcifications. The family history is negative for breast, endometrial, and ovarian cancers. She was formerly a flight attendant and since retirement, she has started a strict Mediterranean diet ... | Occupation | {
"A": "Sedentarism",
"B": "Mediterranean diet",
"C": "Breast implants",
"D": "Occupation"
} | step1 | D | [
"year old woman",
"referred",
"office",
"mammography results showing",
"dense",
"spiculated mass",
"clustered microcalcifications",
"family history",
"negative",
"breast",
"endometrial",
"ovarian cancers",
"formerly",
"flight attendant",
"since retirement",
"started",
"Mediterranean ... |
A 29-year-old woman is brought to the emergency department after an episode of syncope. For the past 10 days, she has had dyspnea and palpitations occurring with mild exertion. The patient returned from a hiking trip in Upstate New York 5 weeks ago. Except for an episode of flu with fever and chills a month ago, she ha... | Intravenous ceftriaxone | {
"A": "Intravenous ceftriaxone",
"B": "Oral doxycycline",
"C": "Atropine",
"D": "Permanent pacemaker implantation"
} | step1 | A | [
"29 year old woman",
"brought",
"emergency department",
"episode of syncope",
"past 10 days",
"dyspnea",
"palpitations occurring",
"mild exertion",
"patient returned",
"hiking trip",
"New York",
"weeks",
"Except for",
"episode of flu",
"fever",
"chills",
"month",
"history",
"seri... |
A 64-year-old male presents to his primary care physician. Laboratory work-up and physical examination are suggestive of a diagnosis of prostatic adenocarcinoma. A tissue biopsy is obtained, which confirms the diagnosis. Which of the following is indicative of metastatic disease? | New-onset lower back pain | {
"A": "Elevated prostatic acid phosphatase (PAP)",
"B": "Involvement of the periurethral zone",
"C": "New-onset lower back pain",
"D": "Palpation of a hard nodule on digital rectal examination"
} | step1 | C | [
"64 year old male presents",
"primary care physician",
"Laboratory work-up",
"physical examination",
"suggestive of",
"diagnosis",
"prostatic adenocarcinoma",
"tissue biopsy",
"obtained",
"confirms",
"diagnosis",
"following",
"metastatic disease"
] |
A patient with a known spinal cord ependymoma presents to his neurologist for a check up. He complains that he has had difficulty walking, which he attributes to left leg weakness. On exam, he is noted to have 1/5 strength in his left lower extremity, as well as decreased vibration and position sensation in the left lo... | Left-sided Brown-Sequard (hemisection) | {
"A": "Left-sided Brown-Sequard (hemisection)",
"B": "Right-sided Brown-Sequard (hemisection)",
"C": "Anterior cord syndrome",
"D": "Posterior cord syndrome"
} | step1 | A | [
"patient",
"known spinal cord ependymoma presents",
"neurologist",
"check up",
"difficulty walking",
"attributes",
"left",
"exam",
"noted to",
"1/5 strength",
"left lower extremity",
"decreased vibration",
"position sensation",
"left lower extremity",
"decreased pain",
"temperature sen... |
A 2500-g (5-lb 8-oz) female newborn delivered at 37 weeks' gestation develops rapid breathing, grunting, and subcostal retractions shortly after birth. Despite appropriate lifesaving measures, the newborn dies 2 hours later. Autopsy shows bilateral renal agenesis. Which of the following is the most likely underlying ca... | Decreased amniotic fluid ingestion | {
"A": "Decreased amniotic fluid ingestion",
"B": "Injury to the diaphragmatic innervation",
"C": "Collapse of the supraglottic airway",
"D": "Surfactant inactivation and epithelial inflammation"
} | step1 | A | [
"2500 g",
"8 oz",
"female newborn delivered",
"weeks",
"gestation",
"rapid breathing",
"grunting",
"subcostal retractions",
"birth",
"appropriate lifesaving measures",
"newborn",
"hours later",
"Autopsy shows bilateral renal agenesis",
"following",
"most likely underlying cause of",
"n... |
A 53-year-old man comes to the physician for recurring fever and night sweats for the past 6 months. The fevers persist for 7 to 10 days and then subside completely for about a week before returning again. During this period, he has also noticed two painless lumps on his neck that have gradually increased in size. Over... | CD15/30 positive cells | {
"A": "Anti-viral capsid antigen IgG and IgM positive",
"B": "CD15/30 positive cells",
"C": "Leukocyte count > 500,000/μL",
"D": "Acid fast bacilli in the sputum"
} | step2&3 | B | [
"year old man",
"physician",
"recurring fever",
"night sweats",
"past 6 months",
"fevers",
"10 days",
"then",
"completely",
"week",
"returning",
"period",
"two painless lumps on",
"neck",
"increased in size",
"past year",
"kg",
"lbs",
"weight loss",
"Two years",
"severe sore ... |
A 17-year-old male presents with altered mental status. He was recently admitted to the hospital due to a tibial fracture suffered while playing soccer. His nurse states that he is difficult to arouse. His temperature is 98.6 deg F (37 deg C), blood pressure is 130/80 mm Hg, pulse is 60/min, and respirations are 6/min.... | Neuronal hyperpolarization due to potassium efflux | {
"A": "Neuronal hyperpolarization due to potassium efflux",
"B": "Neuronal hyperpolarization due to sodium influx",
"C": "Neuronal depolarization due to sodium efflux",
"D": "Neuronal hyperpolarization due to chloride influx"
} | step1 | A | [
"year old male presents",
"altered mental status",
"recently admitted",
"hospital",
"tibial fracture suffered",
"playing soccer",
"nurse states",
"difficult",
"temperature",
"98",
"deg F",
"blood pressure",
"80 mm Hg",
"pulse",
"60 min",
"respirations",
"min",
"Exam",
"notable",
... |
A 7-year-old boy is brought to the emergency department because of sudden-onset abdominal pain that began 1 hour ago. Three days ago, he was diagnosed with a urinary tract infection and was treated with nitrofurantoin. There is no personal history of serious illness. His parents emigrated from Kenya before he was born.... | Enzyme deficiency in red blood cells | {
"A": "Enzyme deficiency in red blood cells",
"B": "Defective red blood cell membrane proteins",
"C": "Defect in orotic acid metabolism",
"D": "Absent hemoglobin beta chain"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"sudden abdominal",
"began 1 hour",
"Three days",
"diagnosed",
"urinary tract infection",
"treated with nitrofurantoin",
"personal history",
"serious illness",
"parents",
"Kenya",
"born",
"Examination shows diffuse abdominal tenderness",... |
A 72-year-old man comes to the physician with chills, nausea, and diffuse muscle aches for 3 days. His niece had similar symptoms 2 weeks ago and H1N1 influenza strain was isolated from her respiratory secretions. He received his influenza vaccination 2 months ago. His temperature is 38°C (100.4°F). A rapid influenza t... | Random point mutations within viral genome | {
"A": "Random point mutations within viral genome",
"B": "Exchange of viral genes between chromosomes",
"C": "Reassortment of viral genome segments",
"D": "Acquisition of viral surface proteins"
} | step1 | A | [
"72 year old man",
"physician",
"chills",
"nausea",
"diffuse muscle aches",
"3 days",
"niece",
"similar symptoms",
"weeks",
"H1N1 influenza strain",
"isolated",
"respiratory secretions",
"received",
"influenza vaccination",
"months",
"temperature",
"100 4F",
"rapid influenza test",... |
A 34-year-old G1P0 woman gives birth to a male infant at 35 weeks gestation. The child demonstrates a strong cry and moves all his arms and legs upon birth. Respirations are slow and irregular. His temperature is 99.1°F (37.3°C), blood pressure is 100/55 mmHg, pulse is 115/min, and respirations are 18/min. At a follow ... | Continuous systolic and diastolic murmur at left upper sternal border | {
"A": "Early diastolic decrescendo murmur at the left sternal border",
"B": "Holosystolic murmur radiating to the right sternal border",
"C": "Holosystolic murmur radiating to the axilla",
"D": "Continuous systolic and diastolic murmur at left upper sternal border"
} | step1 | D | [
"year old",
"woman gives birth",
"male infant",
"35 weeks gestation",
"child demonstrates",
"strong cry",
"moves",
"arms",
"legs",
"birth",
"Respirations",
"slow",
"irregular",
"temperature",
"99",
"3C",
"blood pressure",
"100 55 mmHg",
"pulse",
"min",
"respirations",
"min"... |
Blood cultures are sent to the laboratory. Intravenous antibiotic therapy is started. Transesophageal echocardiography shows a large, oscillating vegetation attached to the tricuspid valve. There are multiple small vegetations attached to tips of the tricuspid valve leaflets. There is moderate tricuspid regurgitation. ... | Staphylococcus aureus | {
"A": "Streptococcus sanguinis",
"B": "Enterococcus faecalis",
"C": "Neisseria gonorrhoeae",
"D": "Staphylococcus aureus"
} | step2&3 | D | [
"Blood cultures",
"sent",
"laboratory",
"Intravenous antibiotic therapy",
"started",
"Transesophageal echocardiography shows",
"large",
"vegetation attached",
"tricuspid valve",
"multiple small vegetations attached",
"tips of",
"tricuspid valve leaflets",
"moderate tricuspid regurgitation",
... |
A 59-year-old male presents to the emergency room complaining of substernal chest pain. He reports a three-hour history of dull substernal chest pain that radiates into his left arm and jaw. He has experienced similar chest pain before that was brought on with exertion, but this pain is more severe and occurred with re... | Decrease preload | {
"A": "Decrease preload",
"B": "Increase preload",
"C": "Decrease afterload",
"D": "Increase contractility"
} | step1 | A | [
"59 year old male presents",
"emergency room",
"substernal chest pain",
"reports",
"three hour history of dull",
"chest pain",
"radiates",
"left arm",
"jaw",
"similar chest pain",
"brought",
"exertion",
"pain",
"more severe",
"occurred",
"rest",
"past medical history includes gout",
... |
A 6-day-old male newborn is brought to the physician by his mother for the evaluation of yellowing of his skin and eyes for one day. The mother reports that she is breastfeeding her son about 7 times per day. She also states that her son had two wet diapers and two bowel movements yesterday. He was born at 38 weeks' ge... | Increasing frequency of breastfeeding | {
"A": "Intravenous immunoglobulin",
"B": "Phenobarbital",
"C": "Increasing frequency of breastfeeding",
"D": "Abdominal sonography"
} | step2&3 | C | [
"day old male newborn",
"brought",
"physician",
"mother",
"the evaluation of yellowing",
"skin",
"eyes",
"one day",
"mother reports",
"breastfeeding",
"son",
"times",
"day",
"states",
"son",
"two wet diapers",
"two bowel movements",
"born",
"weeks",
"estation ",
"500 ",
"... |
A 25-year-old woman is rushed to the emergency department after she was found unconscious in a house fire. She has no previous medical history available. At the hospital, the vital signs include: blood pressure 110/70 mm Hg, temperature 36.0°C (97.0°F), and heart rate 76/min with oxygen saturation 99% on room air. On p... | Administer 100% oxygen | {
"A": "Penicillamine",
"B": "Sodium nitrite",
"C": "Administer 100% oxygen",
"D": "Pyridoxine (vitamin B6)"
} | step2&3 | C | [
"year old woman",
"rushed",
"emergency department",
"found unconscious",
"house fire",
"previous medical history available",
"hospital",
"vital signs include",
"blood pressure",
"70 mm Hg",
"temperature 36",
"97",
"heart rate 76 min",
"oxygen 99",
"room air",
"physical exam",
"uncons... |
A 39-year-old woman is brought to the emergency department in a semi-unconscious state by her neighbor who saw her lose consciousness. There was no apparent injury on the primary survey. She is not currently taking any medications. She has had loose stools for the past 3 days and a decreased frequency of urination. No ... | Serum blood urea nitrogen/creatinine (BUN/Cr) > 20 | {
"A": "Urine osmolality < 350 mOsm/kg",
"B": "Urine Na+ > 40 mEq/L",
"C": "Serum blood urea nitrogen/creatinine (BUN/Cr) > 20",
"D": "Serum creatinine < 1 mg/dL"
} | step1 | C | [
"year old woman",
"brought",
"emergency department",
"unconscious state",
"neighbor",
"saw",
"consciousness",
"apparent injury",
"primary survey",
"not currently taking",
"medications",
"loose stools",
"past 3 days",
"decreased frequency of urination",
"further history",
"obtained",
... |
A 45-year-old man is brought to the emergency department following a house fire. Following initial stabilization, the patient is transferred to the ICU for management of his third-degree burn injuries. On the second day of hospitalization, a routine laboratory panel is obtained, and the results are demonstrated below. ... | Continued management of his burn wounds | {
"A": "Continued management of his burn wounds",
"B": "Immediate administration of propanolol",
"C": "Regular levothyroxine sodium injections",
"D": "Start patient on intravenous ceftriaxone and vancomycin"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department following",
"house fire",
"Following initial stabilization",
"patient",
"transferred to",
"ICU",
"management",
"third-degree burn injuries",
"second day",
"hospitalization",
"routine laboratory panel",
"obtained",
"results",
"nurse",
"... |
A 17-year-old boy comes to the physician because of fever, fatigue, and a sore throat for 12 days. He was prescribed amoxicillin at another clinic and now has a diffuse rash all over his body. He was treated for gonorrhea one year ago. He has multiple sexual partners and uses condoms inconsistently. He appears lethargi... | Heterophile agglutination test | {
"A": "Anti-CMV IgM",
"B": "ELISA for HIV",
"C": "Heterophile agglutination test",
"D": "Flow cytometry"
} | step2&3 | C | [
"year old boy",
"physician",
"fever",
"fatigue",
"sore throat",
"days",
"prescribed amoxicillin",
"clinic",
"now",
"diffuse rash",
"body",
"treated",
"gonorrhea one year ago",
"multiple sexual partners",
"uses condoms",
"appears lethargic",
"thin",
"BMI",
"0 kg/m2",
"temperatur... |
A 71-year-old man presents to the primary care clinic with non-specific complaints of fatigue and malaise. His past medical history is significant for diabetes mellitus type II, hypertension, non-seminomatous testicular cancer, and hypercholesterolemia. He currently smokes 1 pack of cigarettes per day, drinks a glass o... | Chronic lymphocytic leukemia | {
"A": "Acute lymphocytic leukemia",
"B": "Acute myelogenous leukemia",
"C": "Chronic lymphocytic leukemia",
"D": "Hairy cell leukemia"
} | step2&3 | C | [
"71 year old man presents",
"primary care clinic",
"non-specific complaints",
"fatigue",
"malaise",
"past medical history",
"significant",
"diabetes mellitus type II",
"hypertension",
"non seminomatous testicular cancer",
"hypercholesterolemia",
"currently smokes 1 pack",
"cigarettes",
"da... |
A 69-year-old man comes to his cardiologist for a follow-up visit. He is being considered for a new drug therapy that works by modulating certain proteins released from the heart in patients with heart failure. A drug called candoxatril is being investigated for its ability to inhibit the action of an endopeptidase tha... | Natriuretic peptides | {
"A": "Nitric oxide",
"B": "Leukotrienes",
"C": "Acetylcholine",
"D": "Natriuretic peptides"
} | step1 | D | [
"69 year old man",
"cardiologist",
"follow-up visit",
"considered",
"new drug",
"works",
"modulating certain proteins released",
"heart",
"patients",
"heart",
"drug called candoxatril",
"investigated",
"ability to inhibit",
"action",
"endopeptidase",
"breaks down",
"mediator released... |
Seventy-two hours after admission for an acute myocardial infarction, a 48-year-old man develops dyspnea and a productive cough with frothy sputum. Physical examination shows coarse crackles in both lungs and a blowing, holosystolic murmur heard best at the apex. ECG shows Q waves in the anteroseptal leads. Pulmonary c... | Rupture of the chordae tendinae | {
"A": "Postmyocardial infarction syndrome",
"B": "Aortic root dilation",
"C": "Rupture of the chordae tendinae",
"D": "Rupture of the ventricular free wall"
} | step1 | C | [
"Seventy-two hours",
"admission",
"acute myocardial infarction",
"48 year old man",
"dyspnea",
"productive cough",
"frothy sputum",
"Physical examination shows coarse crackles",
"lungs",
"blowing",
"holosystolic murmur heard best",
"apex",
"ECG shows Q waves",
"leads",
"Pulmonary capilla... |
A 45-year-old man comes to the physician because of a productive cough and dyspnea. He has smoked one pack of cigarettes daily for 15 years. His temperature is 38.8°C (102°F). Physical examination shows decreased breath sounds and dullness on percussion above the right lower lobe. An x-ray of the chest shows a right lo... | Fibrin-rich infiltrate | {
"A": "Fibrin-rich infiltrate",
"B": "Dense bacterial infiltrate",
"C": "Epithelioid infiltrate with central necrosis",
"D": "Red blood cell infiltrate"
} | step1 | A | [
"year old man",
"physician",
"productive cough",
"dyspnea",
"smoked one pack",
"cigarettes daily",
"years",
"temperature",
"Physical examination shows decreased breath sounds",
"dullness",
"percussion",
"right lower lobe",
"x-ray of",
"chest shows",
"right lower lobe density",
"small a... |
A 50-year-old obese woman presents for a follow-up appointment regarding microcalcifications found in her left breast on a recent screening mammogram. The patient denies any recent associated symptoms. The past medical history is significant for polycystic ovarian syndrome (PCOS), for which she takes metformin. Her men... | Lumpectomy | {
"A": "Observation with bilateral mammograms every 6 months",
"B": "Radiotherapy",
"C": "Lumpectomy",
"D": "Bilateral mastectomy"
} | step2&3 | C | [
"50 year old obese woman presents",
"follow-up appointment",
"microcalcifications found",
"left breast",
"recent screening mammogram",
"patient denies",
"recent associated symptoms",
"past medical history",
"significant",
"polycystic ovarian syndrome",
"takes metformin",
"menarche occurred",
... |
An 18-month-old boy presents to the clinic with his mother for evaluation of a rash around the eyes and mouth. His mother states that the rash appeared 2 weeks ago and seems to be very itchy because the boy scratches his eyes often. The patient is up to date on all of his vaccinations and is meeting all developmental m... | Atopic dermatitis | {
"A": "Viral conjunctivitis",
"B": "Impetigo",
"C": "Atopic dermatitis",
"D": "Scalded skin syndrome"
} | step1 | C | [
"month old boy presents",
"clinic",
"mother",
"evaluation",
"rash",
"eyes",
"mouth",
"mother states",
"rash appeared 2 weeks",
"to",
"very itchy",
"boy scratches",
"eyes often",
"patient",
"date",
"of",
"vaccinations",
"meeting",
"developmental milestones",
"history of asthma",... |
A 63-year-old man presents to the emergency department with periorbital swelling. He states that he was gardening, came inside, looked in the mirror, and then noticed his eyelids were swollen. He denies pain, pruritus, or visual disturbances. He states that he was drinking “a lot of water" to prevent dehydration, becau... | Apple green birefringence with Congo red staining | {
"A": "Apple green birefringence with Congo red staining",
"B": "Glomerular basement membrane splitting",
"C": "Subepithelial dense deposits",
"D": "Tubulointerstitial fibrosis"
} | step2&3 | A | [
"63 year old man presents",
"emergency department",
"periorbital swelling",
"states",
"gardening",
"looked",
"mirror",
"then",
"eyelids",
"swollen",
"denies pain",
"pruritus",
"visual disturbances",
"states",
"drinking",
"lot",
"water",
"to prevent dehydration",
"hot outside",
... |
A 68-year-old woman presents to her primary care physician for a regular check-up. She complains of swelling of her legs and face, which is worse in the morning and decreases during the day. She was diagnosed with type 2 diabetes mellitus a year ago and prescribed metformin, but she has not been compliant with it prefe... | If measured in this patient, there would be an increased PTH level. | {
"A": "If measured in this patient, there would be an increased PTH level.",
"B": "Hypoparathyroidism is most likely the cause of the patient’s altered laboratory results.",
"C": "Increase in 1α, 25(OH)2D3 production is likely to contribute to alteration of the patient’s laboratory values.",
"D": "There is an ... | step1 | A | [
"68 year old woman presents",
"primary care physician",
"regular check-up",
"of swelling",
"legs",
"face",
"worse",
"morning",
"decreases",
"day",
"diagnosed",
"type 2 diabetes mellitus",
"year",
"prescribed metformin",
"not",
"compliant",
"natural remedies",
"medications",
"not"... |
An otherwise healthy 27-year-old man presents to the Emergency Department with dark urine and left flank pain. He has had a fever, sore throat, and malaise for the last 2 days. Vital signs reveal a temperature of 38.1°C (100.5°F), blood pressure of 120/82 mm Hg, and a pulse of 95/min. His family history is noncontribut... | Diffuse mesangial IgA deposition | {
"A": "Inherited abnormalities in type IV collagen",
"B": "C3 nephritic factor",
"C": "Immune complex deposition",
"D": "Diffuse mesangial IgA deposition"
} | step2&3 | D | [
"healthy 27 year old man presents",
"Emergency Department",
"dark urine",
"left flank pain",
"fever",
"sore throat",
"malaise",
"2 days",
"Vital signs reveal",
"temperature",
"100",
"blood pressure",
"mm Hg",
"pulse",
"95 min",
"family history",
"Physical examination reveals enlarged... |
A 70-year-old man is brought to the emergency department with complaints of chest pain for the last 2 hours. He had been discharged from the hospital 10 days ago when he was admitted for acute myocardial infarction. It was successfully treated with percutaneous coronary intervention. During the physical exam, the patie... | Ibuprofen | {
"A": "Ibuprofen",
"B": "Levofloxacin",
"C": "Propranolol",
"D": "Warfarin"
} | step2&3 | A | [
"70 year old man",
"brought",
"emergency department",
"complaints of chest pain",
"last",
"hours",
"discharged from",
"hospital 10 days",
"admitted",
"acute myocardial infarction",
"treated with percutaneous coronary intervention",
"physical exam",
"patient",
"forwards",
"decreases",
"... |
A 55-year-old female presents to her primary care physician complaining of a mass in her mid-thigh. The mass has grown slowly over the past six months and is not painful. The patient’s past medical history is notable for hypertension and hyperlipidemia. She takes lisinopril and rosuvastatin. On examination, there is a ... | Desmin | {
"A": "Chromogranin",
"B": "Desmin",
"C": "Cytokeratin",
"D": "Glial fibrillary acidic protein"
} | step1 | B | [
"55 year old female presents",
"primary care physician",
"mass",
"mid thigh",
"mass",
"slowly",
"past six months",
"not painful",
"patients past medical history",
"notable",
"hypertension",
"hyperlipidemia",
"takes lisinopril",
"rosuvastatin",
"examination",
"firm",
"immobile mass",
... |
A 27-year-old woman presents to the emergency department for fever and generalized malaise. Her symptoms began approximately 3 days ago, when she noticed pain with urination and mild blood in her urine. Earlier this morning she experienced chills, flank pain, and mild nausea. Approximately 1 month ago she had the "flu"... | Suppurative inflammation with interstitial neutrophilic infiltration | {
"A": "Focal and segmental sclerosis of the glomeruli and mesangium",
"B": "Mesangial proliferation",
"C": "Normal appearing glomeruli",
"D": "Suppurative inflammation with interstitial neutrophilic infiltration"
} | step1 | D | [
"27 year old woman presents",
"emergency department",
"fever",
"generalized malaise",
"symptoms began approximately",
"days",
"pain",
"urination",
"mild blood in",
"urine",
"Earlier",
"morning",
"experienced chills",
"flank pain",
"mild nausea",
"Approximately",
"month",
"flu",
"... |
A 20-year-old man, who was previously healthy, is taken to the emergency department due to agitation during the past 24 hours. During the past week, his family members noticed a yellowish coloring of his skin and eyes. He occasionally uses cocaine and ecstasy, and he drinks alcohol (about 20 g) on weekends. The patient... | Fulminant hepatic failure | {
"A": "Hemolytic uremic syndrome",
"B": "Fulminant hepatic failure",
"C": "Ecstasy intoxication",
"D": "Cocaine-abstinence syndrome"
} | step1 | B | [
"20 year old man",
"healthy",
"taken",
"emergency department due to agitation",
"past 24 hours",
"past week",
"family members",
"coloring of",
"skin",
"eyes",
"occasionally uses cocaine",
"ecstasy",
"drinks alcohol",
"about 20 g",
"weekends",
"patient",
"admits",
"high-risk sexual ... |
A 31-year-old woman is brought to the physician because of increasing restlessness over the past 2 weeks. She reports that she continuously paces around the house and is unable to sit still for more than 10 minutes at a time. During this period, she has had multiple episodes of anxiety with chest tightness and shortnes... | 5-HT2Areceptor antagonism | {
"A": "NMDA receptor antagonism",
"B": "GABA receptor antagonism",
"C": "5-HT2Areceptor antagonism",
"D": "α2 receptor antagonism"
} | step2&3 | C | [
"31 year old woman",
"brought",
"physician",
"of increasing restlessness",
"past 2 weeks",
"reports",
"paces",
"house",
"unable to sit",
"10 minutes",
"time",
"period",
"multiple episodes of anxiety",
"chest tightness",
"shortness of breath",
"diagnosed",
"psychotic illness",
"mont... |
A 62-year-old man presents to the emergency department with shortness of breath on exertion and fatigue. He says that his symptoms onset gradually 5 days ago and have progressively worsened. Past medical history is significant for chronic alcoholism. His vital signs are blood pressure 100/60 mm Hg, temperature 36.9°C (... | Thiamine | {
"A": "Thiamine",
"B": "Riboflavin",
"C": "Vitamin C",
"D": "Niacin"
} | step1 | A | [
"62 year old man presents",
"emergency department",
"shortness of breath",
"exertion",
"fatigue",
"symptoms onset",
"days",
"worsened",
"Past medical history",
"significant",
"chronic alcoholism",
"vital signs",
"blood pressure 100 60 mm Hg",
"temperature 36",
"98 4F",
"respiratory rat... |
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