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 the physician with severe lower back pain and fatigue for 3 months. The pain increases with activity. He has no history of a serious illness. He takes ibuprofen for pain relief. He does not smoke. The blood pressure is 105/65 mm Hg, the pulse is 86/min, the respirations are 16/min, and the... | Multiple myeloma | {
"A": "Metastatic prostatic cancer",
"B": "Multiple myeloma",
"C": "Secondary hyperparathyroidism",
"D": "Waldenstrom’s macroglobulinemia"
} | step2&3 | B | [
"72 year old man presents",
"physician",
"severe lower back pain",
"fatigue",
"months",
"pain increases",
"activity",
"history",
"serious illness",
"takes ibuprofen",
"pain relief",
"not smoke",
"blood pressure",
"65 mm Hg",
"pulse",
"min",
"respirations",
"min",
"temperature",
... |
A 28-year-old man visits his physician complaining of hematochezia over the last several days. He also has tenesmus and bowel urgency without any abdominal pain. He has had several milder episodes over the past several years that resolved on their own. He has no history of a serious illness and takes no medications. Hi... | Mesalamine | {
"A": "Azathioprine",
"B": "Mesalamine",
"C": "Metronidazole",
"D": "Total parenteral nutrition"
} | step2&3 | B | [
"year old man visits",
"physician",
"hematochezia",
"last",
"days",
"tenesmus",
"bowel urgency",
"abdominal pain",
"several milder episodes",
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"years",
"resolved",
"history",
"serious illness",
"takes",
"medications",
"blood pressure",
"85 mm Hg",
"temperature",
"4C",
... |
A 4-year-old girl is brought to the physician for a well-child examination. She has been healthy apart from an episode of bronchiolitis as an infant. Her 6-year-old sister recently underwent surgery for ventricular septal defect closure. She is at the 60th percentile for height and weight. Her mother is concerned about... | A grade 2/6 continuous murmur heard at the right supraclavicular region | {
"A": "A grade 3/6 systolic ejection murmur heard along the left lower sternal border that increases on valsalva",
"B": "A grade 4/6 midsystolic murmur at the right upper sternal border that increases on rapid squatting",
"C": "A grade 2/6 continuous murmur heard at the right supraclavicular region",
"D": "A g... | step2&3 | C | [
"4 year old girl",
"brought",
"physician",
"well",
"healthy",
"episode of bronchiolitis",
"infant",
"year old sister recently",
"surgery",
"ventricular septal closure",
"percentile",
"height",
"weight",
"mother",
"concerned",
"possibility",
"patient",
"cardiovascular anomaly",
"f... |
A mother with HIV has given birth to a healthy boy 2 days ago. She takes her antiretroviral medication regularly and is compliant with the therapy. Before being discharged, her doctor explains that she cannot breastfeed the child since there is a risk of infection through breastfeeding and stresses that the child can b... | Collagen synthesis | {
"A": "Heme synthesis",
"B": "Collagen synthesis",
"C": "Protein catabolism",
"D": "Fatty acid metabolism"
} | step1 | B | [
"mother",
"HIV",
"given birth",
"healthy boy 2 days",
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"antiretroviral medication",
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"breastfeed",
"child",
"risk",
"infection",
"breastfeeding",
"stresses",
"child",
"benefit",
"formula feeding",
"physician stresses",
"i... |
A healthy 33-year-old gravida 1, para 0, at 15 weeks' gestation comes to the genetic counselor for a follow-up visit. Her uncle had recurrent pulmonary infections, chronic diarrhea, and infertility, and died at the age of 28 years. She does not smoke or drink alcohol. The results of an amniotic karyotype analysis show ... | Meconium ileus | {
"A": "Congenital megacolon",
"B": "Cardiac defects",
"C": "Meconium ileus",
"D": "Neural tube defects"
} | step1 | C | [
"healthy",
"year old gravida 1",
"para 0",
"weeks",
"gestation",
"genetic counselor",
"follow-up visit",
"uncle",
"recurrent pulmonary infections",
"chronic diarrhea",
"infertility",
"died",
"age",
"years",
"not smoke",
"drink alcohol",
"results",
"amniotic karyotype analysis show"... |
Four days after being admitted to the intensive care unit for acute substernal chest pain and dyspnea, an 80-year-old man is evaluated for hypotension. Coronary angiography on admission showed an occlusion in the left anterior descending artery, and a drug-eluting stent was placed successfully. The patient has a histor... | Interventricular septum rupture | {
"A": "Ascending aortic dissection rupture",
"B": "Post-infarction fibrinous pericarditis",
"C": "Left ventricular free wall rupture",
"D": "Interventricular septum rupture"
} | step2&3 | D | [
"Four days",
"admitted to",
"intensive care unit",
"acute",
"chest pain",
"dyspnea",
"80 year old man",
"evaluated",
"hypotension",
"Coronary angiography on admission showed",
"occlusion",
"left anterior descending artery",
"drug-eluting stent",
"placed",
"patient",
"history of hyperte... |
A 68-year-old right hand-dominant man presents to the emergency room complaining of severe right arm pain after falling down a flight of stairs. He landed on his shoulder and developed immediate severe upper arm pain. Physical examination reveals a 2-cm laceration in the patient’s anterior right upper arm. Bone is visi... | Lateral forearm skin sensation | {
"A": "Elbow extension",
"B": "Forearm pronation",
"C": "Lateral forearm skin sensation",
"D": "Wrist extension"
} | step1 | C | [
"68 year old right man presents",
"emergency room",
"severe right arm pain",
"falling down",
"flight",
"stairs",
"landed",
"shoulder",
"immediate severe upper arm pain",
"Physical examination reveals",
"2 cm laceration",
"patients anterior right upper",
"Bone",
"visible",
"laceration",
... |
A first-year medical student is conducting a summer project with his medical school's pediatrics department using adolescent IQ data from a database of 1,252 patients. He observes that the mean IQ of the dataset is 100. The standard deviation was calculated to be 10. Assuming that the values are normally distributed, a... | 85–115 | {
"A": "65–135",
"B": "85–115",
"C": "80–120",
"D": "95–105\n\""
} | step2&3 | B | [
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"conducting",
"summer project",
"medical school's pediatrics department using adolescent",
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"patients",
"observes",
"mean",
"dataset",
"100",
"standard deviation",
"calculated to",
"10",
"values",
"distributed",
"approximately 87",
"... |
The the mean, median, and mode weight of 37 newborns in a hospital nursery is 7 lbs 2 oz. In fact, there are 7 infants in the nursery that weigh exactly 7 lbs 2 oz. The standard deviation of the weights is 2 oz. The weights follow a normal distribution. A newborn delivered at 10 lbs 2 oz is added to the data set. What ... | The mean will increase; the median will stay the same; the mode will stay the same | {
"A": "The mean will increase; the median will increase; the mode will increase",
"B": "The mean will stay the same; the median will increase; the mode will increase",
"C": "The mean will increase; the median will stay the same; the mode will stay the same",
"D": "The mean will increase; the median will increa... | step2&3 | C | [
"mean",
"median",
"mode weight",
"newborns",
"hospital nursery",
"7 lbs 2 oz",
"infants",
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"lbs",
"oz",
"standard deviation",
"weights",
"2 oz",
"weights follow",
"normal distribution",
"newborn delivered",
"10 lbs",
"oz",
"added",
"data set",
"most likely",
"happ... |
A 10-month-old boy is brought to the emergency department by his parents because he has a high fever and severe cough. His fever started 2 days ago and his parents are concerned as he is now listless and fatigued. He had a similar presentation 5 months ago and was diagnosed with pneumonia caused by Staphyloccocus aureu... | NADPH oxidase activity | {
"A": "Autoimmune regulator function",
"B": "Lysosomal trafficking",
"C": "NADPH oxidase activity",
"D": "Thymus development"
} | step1 | C | [
"A 10 month old boy",
"brought",
"emergency department",
"parents",
"high fever",
"severe cough",
"fever started 2 days",
"parents",
"concerned",
"now listless",
"fatigued",
"similar presentation",
"months",
"diagnosed",
"pneumonia caused",
"experiencing intermittent diarrhea",
"skin... |
A 46-year-old woman comes to the physician for a routine health examination. She was last seen by a physician 3 years ago. She has been healthy aside from occasional mild flank pain. Her only medication is a multivitamin. Her blood pressure is 154/90 mm Hg. Physical examination shows no abnormalities. Serum studies sho... | Refer to surgery for parathyroidectomy | {
"A": "Refer to surgery for parathyroidectomy",
"B": "Begin cinacalcet therapy",
"C": "Begin hydrochlorothiazide therapy",
"D": "Perform percutaneous nephrolithotomy"
} | step2&3 | A | [
"year old woman",
"physician",
"routine health examination",
"last seen by",
"physician",
"years",
"healthy",
"occasional mild flank",
"only medication",
"multivitamin",
"blood pressure",
"90 mm Hg",
"Physical examination shows",
"abnormalities",
"Serum studies show",
"Sodium",
"mEq"... |
A 12-year-old boy is brought in by his mother to the emergency department. He has had abdominal pain, fever, nausea, vomiting, and loss of appetite since yesterday. At first, the mother believed it was just a "stomach flu," but she is growing concerned about his progressive decline. Vitals include: T 102.3 F, HR 110 bp... | Right lower quadrant ultrasound | {
"A": "Abdominal CT scan with IV contrast",
"B": "Upright and supine abdominal radiographs",
"C": "Right lower quadrant ultrasound",
"D": "Abdominal MRI with gadolinium contrast"
} | step2&3 | C | [
"year old boy",
"brought",
"mother",
"emergency department",
"abdominal pain",
"fever",
"nausea",
"vomiting",
"loss of appetite",
"first",
"mother",
"stomach flu",
"concerned",
"progressive",
"include",
"T",
"3 F",
"BP",
"mmHg",
"RR",
"O2 Sat 100",
"Abdominal exam",
"nota... |
A 48-year-old man with a long history of mild persistent asthma on daily fluticasone therapy has been using his albuterol inhaler every day for the past month and presents requesting a refill. He denies any recent upper respiratory infections, but he says he has felt much more short of breath throughout this time frame... | Add salmeterol to current regimen | {
"A": "Add salmeterol to current regimen",
"B": "Discontinue fluticasone and instead use salmeterol",
"C": "Add cromolyn to current regimen",
"D": "Discontinue fluticasone and add ipratropium to current regimen"
} | step2&3 | A | [
"48 year old man",
"long history of mild persistent asthma",
"daily fluticasone therapy",
"using",
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"day",
"past month",
"presents requesting",
"refill",
"denies",
"recent upper respiratory infections",
"felt much",
"short of breath",
"time frame",
"works",
"informs... |
A 3500-g (7 lb 11 oz) healthy female newborn is delivered at 38 weeks' gestation. Chorionic villus sampling (CVS) in the first trimester showed a trisomy of chromosome 21 but the pregnancy was otherwise uncomplicated. Physical examination of the newborn is normal. Chromosomal analysis at birth shows a 46, XX karyotype.... | Placental mosaicism | {
"A": "Maternal disomy",
"B": "Phenotypic pleiotropy",
"C": "Variable expressivity",
"D": "Placental mosaicism"
} | step1 | D | [
"3500 g",
"oz",
"healthy female newborn",
"delivered",
"weeks",
"gestation",
"Chorionic villus sampling",
"first trimester showed",
"trisomy",
"chromosome 21",
"pregnancy",
"uncomplicated",
"Physical",
"newborn",
"normal",
"Chromosomal analysis",
"birth shows",
"XX karyotype",
"f... |
An 11-year-old girl presents with a 1-day history of frothy brown urine. She has no significant medical history and takes no medications. She reports that several of her classmates have been sick, and she notes that she had a very sore throat with a fever approx. 2 weeks ago. Her blood pressure is 146/94 mm Hg, heart r... | Poststreptococcal glomerulonephritis | {
"A": "Alport syndrome",
"B": "Membranoproliferative glomerulonephritis",
"C": "Poststreptococcal glomerulonephritis",
"D": "Henoch-Schönlein purpura"
} | step2&3 | C | [
"year old girl presents",
"1-day history",
"frothy brown",
"significant medical history",
"takes",
"medications",
"reports",
"several",
"classmates",
"sick",
"notes",
"very sore throat",
"fever",
"2 weeks",
"blood pressure",
"mm Hg",
"heart rate",
"74 min",
"respiratory rate",
... |
A 16-year-old male adolescent presents to his pediatrician with increasing fatigue and breathlessness with exercise. His parents inform the doctor that they have recently migrated from a developing country, where he was diagnosed as having a large ventricular septal defect (VSD). However, due to their poor economic con... | Right ventricular heave | {
"A": "A mid-diastolic low-pitched rumble at the apex",
"B": "Right ventricular heave",
"C": "Prominence of the left precordium",
"D": "Lateral displacement of the apical impulse"
} | step2&3 | B | [
"year old male adolescent presents",
"pediatrician",
"increasing fatigue",
"breathlessness",
"exercise",
"parents inform",
"doctor",
"recently migrated",
"developing country",
"diagnosed",
"large ventricular septal defect",
"poor economic condition",
"medical facilities",
"surgical repair"... |
A 59-year-old man presents to the emergency department with right-sided weakness and an inability to speak for the past 2 hours. His wife says he was gardening in his backyard when he suddenly lost balance and fell down. The patient has a past medical history of hypertension, diabetes mellitus, and coronary artery dise... | ECG | {
"A": "Duplex ultrasound of his right leg",
"B": "Carotid duplex",
"C": "Head CT without contrast",
"D": "ECG"
} | step1 | D | [
"59 year old man presents",
"emergency department",
"right-sided weakness",
"speak",
"past",
"hours",
"wife",
"gardening",
"backyard",
"lost balance",
"fell",
"patient",
"past medical",
"diabetes mellitus",
"coronary artery disease",
"Two years",
"admitted to",
"coronary intensive ... |
A 3-year-old boy is brought to the emergency department because of worsening pain and swelling in both of his hands for 1 week. He appears distressed. His temperature is 38.5°C (101.4°F). Examination shows erythema, swelling, warmth, and tenderness on the dorsum of his hands. His hemoglobin concentration is 9.1 g/dL. A... | Polycythemia vera | {
"A": "Primary syphilis",
"B": "Megaloblastic anemia",
"C": "Iron intoxication",
"D": "Polycythemia vera"
} | step1 | D | [
"3 year old boy",
"brought",
"emergency department",
"worsening pain",
"swelling",
"of",
"hands",
"1 week",
"appears distressed",
"temperature",
"4F",
"Examination shows erythema",
"swelling",
"warmth",
"tenderness",
"dorsum of",
"hands",
"hemoglobin concentration",
"g/dL",
"pe... |
A 30-year-old primigravid woman at 14 weeks' gestation comes to the physician for her first prenatal visit. She reports some nausea and fatigue. She takes lithium for bipolar disorder and completed a course of clindamycin for bacterial vaginosis 12 weeks ago. She works as a teacher at a local school. She smoked a pack ... | Atrialized right ventricle | {
"A": "Atrialized right ventricle",
"B": "Fetal hydantoin syndrome",
"C": "Bone damage",
"D": "Chorioretinitis\n\""
} | step2&3 | A | [
"30 year old primigravid woman",
"weeks",
"gestation",
"physician",
"first prenatal visit",
"reports",
"nausea",
"fatigue",
"takes lithium",
"bipolar disorder",
"completed",
"course",
"clindamycin",
"bacterial vaginosis",
"weeks",
"works",
"teacher",
"local school",
"smoked",
"... |
A 65-year-old woman with COPD comes to the emergency department with 2-day history of worsening shortness of breath and cough. She often has a mild productive cough, but she noticed that her sputum is more yellow than usual. She has not had any recent fevers, chills, sore throat, or a runny nose. Her only medication is... | Prednisone and albuterol | {
"A": "Albuterol and montelukast",
"B": "Prednisone and salmeterol",
"C": "Albuterol and theophylline",
"D": "Prednisone and albuterol"
} | step2&3 | D | [
"65-year-old woman",
"COPD",
"emergency department",
"2-day history of worsening shortness",
"breath",
"cough",
"often",
"mild productive cough",
"sputum",
"more yellow",
"usual",
"not",
"recent fevers",
"chills",
"sore throat",
"runny nose",
"only medication",
"salmeterol inhaler"... |
A 30-year-old woman comes to the emergency department because of weakness and fatigue for 2 days. She has also noticed that her urine is darker than usual. For the past week, she has had a persistent non-productive cough and low-grade fever. She has seasonal allergies. She drinks one to two glasses of wine on social oc... | Direct Coombs test | {
"A": "Osmotic fragility test",
"B": "Direct Coombs test",
"C": "ADAMTS13 activity and inhibitor profile",
"D": "Flow cytometry"
} | step2&3 | B | [
"30 year old woman",
"emergency department",
"weakness",
"fatigue",
"2 days",
"urine",
"darker",
"usual",
"past week",
"persistent non-productive cough",
"low-grade fever",
"seasonal allergies",
"drinks one",
"two glasses",
"wine",
"social occasions",
"not smoke",
"temperature",
... |
A 46-year-old woman comes to the physician for a follow-up examination. She had a blood pressure recording of 148/94 mm Hg on her previous visit one week ago. Her home blood pressure log shows readings of 151/97 and 146/92 mm Hg in the past week. She has no history of serious illness and takes no medications. She is 16... | Electrocardiogram | {
"A": "Electrocardiogram",
"B": "Polysomnography",
"C": "Echocardiography",
"D": "Renal ultrasonography"
} | step2&3 | A | [
"year old woman",
"physician",
"follow-up examination",
"blood pressure recording",
"mm Hg",
"previous visit one week",
"home blood pressure log shows readings",
"97",
"mm Hg",
"past week",
"history",
"serious illness",
"takes",
"medications",
"5 ft",
"tall",
"kg",
"BMI",
"20 kg/... |
A sample is taken of an ulcer in the inguinal region of a 29-year-old Malaysian male who has had unprotected sex in the past few months. Intracytoplasmic inclusions are seen in the Giemsa staining in Image A. On which of the following can the organism in the staining be grown? | Yolk sac of a chick embryo | {
"A": "Bordet-Gengou agar",
"B": "Löwenstein-Jensen agar",
"C": "Eaton's agar",
"D": "Yolk sac of a chick embryo"
} | step1 | D | [
"sample",
"taken",
"ulcer",
"inguinal region",
"29 year old Malaysian male",
"unprotected sex",
"past",
"months",
"inclusions",
"seen",
"Giemsa staining",
"Image",
"following",
"organism",
"staining"
] |
A 32-year-old man who recently emigrated from Colombia comes to the physician because of a 3-month history of shortness of breath and fatigue. Physical examination shows jugular venous distention and an additional late diastolic heart sound. Crackles are heard at the lung bases bilaterally. Cardiac catheterization is p... | Cardiac sarcoidosis | {
"A": "Chagas heart disease",
"B": "Viral myocarditis",
"C": "Cardiac sarcoidosis",
"D": "Thiamine deficiency"
} | step1 | C | [
"year old man",
"recently",
"Colombia",
"physician",
"of",
"3 month history",
"shortness",
"breath",
"fatigue",
"Physical examination shows jugular venous distention",
"additional late diastolic heart sound",
"Crackles",
"heard",
"lung bases",
"Cardiac catheterization",
"performed",
... |
A 23-year-old female college basketball player presents in Sports Clinic after she felt a "pop" in her knee after coming down with a rebound. To examine the patient, you have her lie down on the table with her knees flexed 90 degrees. With your hand around her knee you are able to draw the tibia toward you from underne... | The anterior intercondylar area of tibia and the posteromedial aspect of the lateral femur | {
"A": "The posterior intercondylar area of tibia and the posteromedial aspect of the lateral femur",
"B": "The anterior intercondylar area of tibia and the posteromedial aspect of the lateral femur",
"C": "The lateral epicondyle of the femur and the head of fibula",
"D": "The medial condyle of the femur and th... | step1 | B | [
"23 year old female college basketball",
"presents",
"Sports Clinic",
"felt",
"knee after",
"To",
"patient",
"table",
"knees flexed 90 degrees",
"hand",
"knee",
"able to draw",
"tibia",
"femur",
"torn structure",
"physical exam",
"following attachments"
] |
A 42-year-old man is brought to the emergency department after having a seizure. His wife states that the patient has been struggling with alcohol abuse and has recently decided to "quit once and for all". Physical exam is notable for a malnourished patient responsive to verbal stimuli. He has moderate extremity weakne... | Magnesium | {
"A": "Potassium",
"B": "Folate",
"C": "Magnesium",
"D": "Vitamin D"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"seizure",
"wife states",
"patient",
"alcohol abuse",
"recently",
"quit",
"Physical exam",
"notable",
"malnourished patient responsive",
"verbal stimuli",
"moderate extremity weakness",
"occasional palpitations",
"brisk deep tendon ref... |
A 22-year-old man presents to his physician with a chronic cough which he has had for the last five years. He mentions that his cough is usually productive; however, sometimes it is dry. His past medical records show seven episodes of sinusitis over the last two years and two episodes of community acquired pneumonia. H... | Measurement of sweat chloride levels | {
"A": "Sputum culture for acid-fast bacilli",
"B": "Serum quantitative immunoglobulin levels",
"C": "Measurement of sweat chloride levels",
"D": "Skin testing for Aspergillus reactivity"
} | step2&3 | C | [
"year old man presents",
"physician",
"chronic cough",
"last five years",
"cough",
"usually productive",
"sometimes",
"dry",
"past medical records show seven episodes of sinusitis",
"last two years",
"two episodes of community acquired pneumonia",
"non-smoker",
"history",
"long-term exposu... |
A 64-year-old male with a past medical history of obesity, diabetes, hypertension, and hyperlipidemia presents with an acute onset of nausea, vomiting, diaphoresis, and crushing substernal chest pain. Vital signs are temperature 37° C, HR 110, BP 149/87, and RR of 22 with an oxygen saturation of 99% on room air. Physic... | A fully obstructive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque | {
"A": "A fully obstructive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque",
"B": "A partially occlusive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque",
"C": "Destruction of the vasa vasorum caused by vasculitic phenomena",
"D": "A stable atheromatous lesion without ... | step1 | A | [
"64 year old male",
"past medical",
"diabetes",
"hypertension",
"hyperlipidemia presents",
"acute onset",
"nausea",
"vomiting",
"diaphoresis",
"crushing",
"chest pain",
"Vital signs",
"temperature",
"BP",
"87",
"RR",
"oxygen",
"99",
"room air",
"Physical exam reveals",
"fourt... |
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 and hypertension. His current medications are chlorpromazine and amlodipine. He appears ill. He is not oriented to time, place, or person. His temperature is 40°C (104°F), puls... | Dantrolene | {
"A": "Dantrolene",
"B": "Clozapine",
"C": "Cyproheptadine",
"D": "Physostigmine"
} | step2&3 | A | [
"60 year old man",
"brought",
"emergency room",
"fever",
"increasing confusion",
"past 2 days",
"paranoid schizophrenia",
"hypertension",
"current medications",
"chlorpromazine",
"amlodipine",
"appears ill",
"not oriented to time",
"place",
"person",
"temperature",
"pulse",
"min",
... |
A 67-year-old man comes to the emergency department because of decreased vision and black spots in front of his left eye for the past 24 hours. He states that it feels as if 'a curtain is hanging over his eye.' He sees flashes of light intermittently. He has no pain or diplopia. He underwent cataract surgery on the lef... | Retinal detachment | {
"A": "Degenerative retinoschisis",
"B": "Retinal detachment",
"C": "Endophthalmitis",
"D": "Hemorrhagic choroidal detachment"
} | step2&3 | B | [
"67 year old man",
"emergency department",
"decreased vision",
"black spots in front of",
"left eye",
"past 24 hours",
"states",
"feels",
"curtain",
"hanging",
"eye",
"sees flashes",
"light",
"pain",
"diplopia",
"cataract surgery",
"left eye 2 weeks",
"hypertension",
"type 2 diab... |
A 65-year-old woman presents to her physician with the complaint of ringing in her right ear. She says it started about 3 months ago with associated progressive difficulty in hearing on the same side. Past medical history is significant for a hysterectomy 5 years ago due to dysfunctional uterine bleeding. She is curren... | Cranial nerves IX, X | {
"A": "Cranial nerves VII & VIII",
"B": "Cranial nerves IX, X",
"C": "Cranial nerves III, IV, VI",
"D": "Cranial nerves X, XI, XII"
} | step1 | B | [
"65 year old woman presents",
"physician",
"complaint",
"ringing",
"right ear",
"started",
"months",
"with associated progressive difficulty",
"hearing",
"same side",
"Past medical history",
"significant",
"hysterectomy",
"years",
"dysfunctional uterine bleeding",
"currently not taking... |
A 3-year-old boy presents to a geneticist for generalized developmental delay. Upon presentation he is found to have a distinctive facial structure with prominent epicanthal folds and macroglossia. Further physical examination reveals a simian crease on his palms bilaterally. Based on these findings, the physician stro... | Robertsonian translocation | {
"A": "Nondisjunction",
"B": "Mosaicism",
"C": "Robertsonian translocation",
"D": "Anticipation"
} | step1 | C | [
"3 year old boy presents",
"geneticist",
"generalized developmental delay",
"presentation",
"found to",
"facial structure",
"prominent epicanthal folds",
"macroglossia",
"Further physical examination reveals",
"crease",
"palms",
"Based",
"findings",
"physician",
"suspects Down syndrome",... |
A 6-month-old infant male is brought to the emergency department with a 1-hour history of vomiting and convulsions. He was born at home and had sporadic prenatal care though his parents say that he appeared healthy at birth. He initially fed well; however, his parents have noticed that he has been feeding poorly and is... | Aldolase B | {
"A": "Aldolase B",
"B": "Fructokinase",
"C": "Gal-1-phosphate uridyl transferase",
"D": "Lactase"
} | step1 | A | [
"month old infant male",
"brought",
"emergency department",
"hour history",
"vomiting",
"convulsions",
"born at home",
"sporadic prenatal care",
"parents",
"appeared healthy",
"birth",
"initially fed well",
"parents",
"feeding poorly",
"very irritable",
"moved",
"to baby foods",
"m... |
A 24-year-old woman is brought to the physician for the evaluation of fatigue for the past 6 months. During this period, she has had recurrent episodes of constipation and diarrhea. She also reports frequent nausea and palpitations. She works as a nurse at a local hospital. She has tried cognitive behavioral therapy, b... | Administration of fluoxetine | {
"A": "Administration of fluoxetine",
"B": "Administration of mirtazapine",
"C": "Administration of venlafaxine",
"D": "Administration of topiramate\n\""
} | step2&3 | A | [
"year old woman",
"brought",
"physician",
"evaluation",
"fatigue",
"past 6 months",
"period",
"recurrent episodes of constipation",
"diarrhea",
"reports frequent nausea",
"palpitations",
"works",
"nurse",
"local hospital",
"cognitive behavioral therapy",
"symptoms",
"not improved",
... |
A 50-year-old woman comes to the physician because of intermittent pain and numbness in her right hand for 6 weeks. She has a pins-and-needles sensation that worsens at night and is relieved when she shakes her hand. She also has episodic left knee pain throughout the day. She has a history of hypertension controlled w... | L-thyroxine | {
"A": "L-thyroxine",
"B": "Methotrexate",
"C": "Surgical decompression",
"D": "Oral prednisone"
} | step2&3 | A | [
"50 year old woman",
"physician",
"intermittent pain",
"numbness",
"right",
"weeks",
"pins",
"needles sensation",
"worsens",
"night",
"relieved",
"shakes",
"hand",
"episodic left knee pain",
"day",
"history of hypertension controlled",
"lisinopril",
"takes over-the-counter medicati... |
A 13-year-old female presents to the emergency room complaining of severe abdominal pain. She reports acute onset of diffuse abdominal pain twelve hours prior to presentation. She has vomited twice and has not had a bowel movement in that time. She is in the fetal position because it relieves the pain. Her past medical... | STK11 | {
"A": "C-KIT",
"B": "NF1",
"C": "APC",
"D": "STK11"
} | step1 | D | [
"year old female presents",
"emergency room",
"severe abdominal",
"reports acute onset",
"diffuse abdominal pain twelve hours",
"presentation",
"vomited twice",
"not",
"bowel movement",
"time",
"fetal position",
"relieves",
"pain",
"past medical history",
"notable",
"asthma",
"adopte... |
A 34-year-old woman presents to her OB/GYN with complaints of missing her last 3 periods as well as intermittent spontaneous milky-white nipple discharge bilaterally for the past 3 months. Vital signs are stable and within normal limits. Neurologic examination is without abnormality, including normal visual fields. Ser... | Increased prolactin, decreased FSH, decreased LH | {
"A": "Decreased prolactin, decreased FSH, decreased LH",
"B": "Decreased prolactin, increased FSH, increased LH",
"C": "Increased prolactin, decreased FSH, increased LH",
"D": "Increased prolactin, decreased FSH, decreased LH"
} | step1 | D | [
"year old woman presents",
"OB/GYN",
"complaints",
"missing",
"last",
"periods",
"intermittent spontaneous milky white nipple discharge",
"past 3 months",
"Vital signs",
"stable",
"normal limits",
"Neurologic examination",
"abnormality",
"including normal visual fields",
"Serology",
"M... |
A 29-year-old primigravid woman at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. She has no personal history of serious illness. Medications include iron supplements and a multivitamin. Her temperature is 37.2°C (99°F) and blood pressure is 108/60 mm Hg. Pelvic examination shows a ute... | Hypocalcemia | {
"A": "Hypocalcemia",
"B": "Omphalocele",
"C": "Intrauterine growth restriction",
"D": "Hypermagnesemia"
} | step2&3 | A | [
"29 year old primigravid woman",
"weeks",
"gestation",
"physician",
"prenatal visit",
"feels well",
"personal history",
"serious illness",
"Medications include iron supplements",
"multivitamin",
"temperature",
"blood pressure",
"60 mm Hg",
"Pelvic examination shows",
"uterus consistent",... |
A 45-year-old man walks into an urgent care clinic complaining of a headache and dizziness. Earlier today he was in his normal state of health when symptoms started and lasted about 20 minutes. He did not lose consciousness or actually vomit. He also mentions that he was sweating a lot at that time. He has had similar ... | Pale skin | {
"A": "Bronchospasm",
"B": "Decreased cardiac contractility",
"C": "Pale skin",
"D": "Bradycardia"
} | step1 | C | [
"A",
"year old man walks",
"urgent care clinic complaining of",
"headache",
"dizziness",
"Earlier today",
"normal state of health",
"symptoms started",
"lasted",
"20 minutes",
"not",
"consciousness",
"vomit",
"sweating",
"lot",
"time",
"similar dizzy spells",
"three separate occasi... |
A 68-year-old male with past history of hypertension, hyperlipidemia, and a 30 pack/year smoking history presents to his primary care physician for his annual physical. Because of his age and past smoking history, he is sent for screening abdominal ultrasound. He is found to have a 4 cm infrarenal abdominal aortic aneu... | Abdominal, back, or groin pain | {
"A": "Abdominal, back, or groin pain",
"B": "Smoking history",
"C": "Growth of < 0.5 cm in one year",
"D": "Marfan's syndrome"
} | step2&3 | A | [
"68 year old male",
"past history of hypertension",
"hyperlipidemia",
"30 pack/year smoking history presents",
"primary care physician",
"annual physical",
"age",
"past smoking",
"sent",
"screening abdominal ultrasound",
"found to",
"4",
"abdominal aortic aneurysm",
"Surgical repair",
"i... |
Twelve hours after undergoing a femoral artery embolectomy, an 84-year-old man is found unconscious on the floor by his hospital bed. He had received a patient-controlled analgesia pump after surgery. He underwent 2 coronary bypass surgeries, 2 and 6 years ago. He has coronary artery disease, hypertension, hypercholest... | A new left bundle branch block on an ECG | {
"A": "A new left bundle branch block on an ECG",
"B": "Pulsatile abdominal mass at the level of the umbilicus",
"C": "Positive procalcitonin and interleukin-6 levels",
"D": "Improved mental status after naloxone administration\n\""
} | step2&3 | A | [
"Twelve hours",
"femoral artery embolectomy",
"84 year old man",
"found unconscious",
"floor",
"hospital bed",
"received",
"patient-controlled analgesia pump",
"surgery",
"2 coronary bypass surgeries",
"2",
"years",
"coronary artery disease",
"hypertension",
"hypercholesterolemia",
"ga... |
An 8-year-old boy is brought to the physician because of a 2-month history of headaches. He is at the 25th percentile for weight and 80th percentile for height. His vital signs are within normal limits. Physical examination shows no abnormalities. CT scan of the head shows a small suprasellar cystic mass compressing th... | Prolactin | {
"A": "Luteinizing hormone",
"B": "Somatotropin",
"C": "Prolactin",
"D": "Vasopressin"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"of",
"2 month history",
"headaches",
"percentile",
"weight",
"80th percentile",
"height",
"vital signs",
"normal",
"Physical examination shows",
"abnormalities",
"CT scan of the head shows",
"small suprasellar cystic mass compressing",
"infund... |
A 39-year-old woman comes to the physician because of recurrent episodes of severe pain over her neck, back, and shoulders for the past year. The pain worsens with exercise and lack of sleep. Use of over-the-counter analgesics have not resolved her symptoms. She also has stiffness of the shoulders and knees and tinglin... | Fibromyalgia | {
"A": "Polymyalgia rheumatica",
"B": "Fibromyalgia",
"C": "Polymyositis",
"D": "Major depressive disorder"
} | step2&3 | B | [
"year old woman",
"physician",
"of recurrent episodes",
"severe pain",
"neck",
"back",
"shoulders",
"past year",
"pain worsens",
"exercise",
"lack of sleep",
"Use",
"over-the-counter analgesics",
"not resolved",
"symptoms",
"stiffness",
"shoulders",
"knees",
"tingling",
"upper ... |
A cross-sectional study of 650 patients with confirmed bronchogenic carcinoma was conducted in patients of all age groups in order to establish a baseline picture for further mortality comparisons. All patients were investigated using thoracic ultrasound and computed tomography of the chest. Also, data about the size o... | Uncover more indolent cases of the disease preferentially | {
"A": "Observe only the late stages of a disease with more severe manifestations",
"B": "Detect only asymptomatic cases of the disease",
"C": "Uncover more indolent cases of the disease preferentially",
"D": "Identify more instances of fatal disease"
} | step1 | C | [
"cross-sectional study",
"650 patients",
"confirmed bronchogenic carcinoma",
"conducted",
"patients",
"age groups",
"order to establish",
"baseline picture",
"further mortality comparisons",
"patients",
"investigated using",
"ultrasound",
"computed tomography of",
"chest",
"data",
"siz... |
A randomized, controlled trial was undertaken by a team of clinical researchers to evaluate a new drug for the treatment of cluster headaches. This type of headache (that mostly affects men) is characterized by excruciating pain on 1 side of the head. After careful randomization and controlling for all of the known con... | Response bias | {
"A": "Observer bias",
"B": "Response bias",
"C": "Convenience sampling bias",
"D": "Intention to treat bias"
} | step1 | B | [
"randomized",
"controlled trial",
"team",
"clinical researchers to evaluate",
"new drug",
"treatment",
"cluster headaches",
"type",
"headache",
"mostly affects men",
"characterized",
"excruciating pain",
"1 side of",
"head",
"careful randomization",
"controlling",
"known",
"total",... |
A previously healthy 15-year-old girl is brought to the physician by her parents for lethargy, increased thirst, and urinary frequency for 10 days. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Physical examination shows no abnormalities. Her serum glucose concentration is 224 mg/dL. A urin... | T-cell infiltration of pancreatic islets | {
"A": "Expression of human leukocyte antigen subtype A3",
"B": "Complement-mediated destruction of insulin receptors",
"C": "T-cell infiltration of pancreatic islets",
"D": "Pancreatic islet amyloid polypeptide deposition"
} | step1 | C | [
"healthy",
"year old girl",
"brought",
"physician",
"parents",
"lethargy",
"increased thirst",
"urinary frequency",
"10 days",
"5 ft 8",
"tall",
"54 kg",
"BMI",
"kg/m2",
"Physical examination shows",
"abnormalities",
"serum",
"mg/dL",
"urine dipstick",
"positive",
"ketone bod... |
Last night you admitted a 72-year-old woman with severe COPD in respiratory distress. She is currently intubated and sedated and her family is at bedside. At the completion of morning rounds, the patient's adult son asks that you and the team take a minute to pray with him for his mother. What is the most appropriate r... | "I understand what you are experiencing and am happy to take a minute." | {
"A": "\"I understand what you are experiencing and am happy to take a minute.\"",
"B": "\"I also believe in the power of prayer, so I will pray with you and insist that the rest of team joins us.\"",
"C": "\"While I cannot offer you my prayers, I will work very hard to take care of your mother.\"",
"D": "\"I ... | step1 | A | [
"Last night",
"admitted",
"72 year old woman",
"severe COPD",
"respiratory distress",
"currently intubated",
"sedated",
"family",
"completion",
"morning rounds",
"patient's adult son",
"team take",
"minute",
"pray",
"mother",
"most appropriate response"
] |
A previously healthy 32-year-old man comes to the physician because of a 2-month history of fatigue and daytime sleepiness. He works as an accountant and cannot concentrate at work anymore. He also has depressed mood and no longer takes pleasure in activities he used to enjoy, such as playing tennis with his friends. H... | Decreased libido | {
"A": "Urinary retention",
"B": "Increased suicidality",
"C": "Decreased libido",
"D": "Priapism"
} | step1 | C | [
"healthy",
"year old man",
"physician",
"2 month history",
"fatigue",
"daytime sleepiness",
"works",
"accountant",
"concentrate",
"work",
"depressed mood",
"longer takes pleasure",
"activities",
"used",
"as playing tennis",
"friends",
"decreased appetite",
"4 kg",
"8.8",
"weigh... |
A 20-year-old woman is brought to the emergency department with a puncture wound on the right side of her chest. She was walking to her apartment when she was assaulted. As she resisted to give up her purse, the assailant stabbed her in the chest with a knife and ran away. She is in severe respiratory distress. Her hea... | Equal intrapleural and atmospheric pressures | {
"A": "Decreased intrapleural pressure",
"B": "Equal intrapleural and atmospheric pressures",
"C": "Paralysis of the diaphragm",
"D": "Increased elastic force of the chest wall pulling it inwards"
} | step1 | B | [
"20 year old woman",
"brought",
"emergency department",
"puncture wound",
"right side",
"chest",
"walking",
"apartment",
"assaulted",
"to give",
"stabbed",
"chest",
"knife",
"ran away",
"severe respiratory distress",
"heart rate",
"min",
"respiratory rate",
"min",
"blood pressu... |
A 54-year-old man electively underwent an open cholecystectomy for his cholelithiasis. The procedure was performed under general anesthesia with inhaled anesthetic agents after induction with an intravenous agent. The surgeon operated quickly, and the procedure was uncomplicated. As the surgery ended, the anesthesia re... | Diffusion hypoxia | {
"A": "Pneumothorax",
"B": "Second gas effect",
"C": "Laryngospasm",
"D": "Diffusion hypoxia"
} | step1 | D | [
"54 year old man",
"open cholecystectomy",
"cholelithiasis",
"procedure",
"performed",
"general anesthesia",
"inhaled anesthetic agents",
"induction",
"intravenous agent",
"surgeon operated",
"procedure",
"uncomplicated",
"surgery ended",
"anesthesia resident stopped",
"anesthesia",
"o... |
A 37-year-old woman presents to clinic for routine checkup. She has no complaints with the exception of occasional "shortness of breath." Her physical examination is unremarkable with the exception of a "snap"-like sound after S2, followed by a rumbling murmur. You notice that this murmur is heard best at the cardiac a... | Repeated episodes of streptococcal pharyngitis as a child | {
"A": "Hyperflexibility, vision problems, and pneumothorax",
"B": "Systolic click auscultated on physical exam 10 years prior",
"C": "Repeated episodes of streptococcal pharyngitis as a child",
"D": "Cutaneous flushing, diarrhea, and bronchospasm"
} | step1 | C | [
"year old woman presents",
"clinic",
"routine checkup",
"complaints",
"exception of occasional",
"shortness",
"breath",
"physical examination",
"unremarkable",
"exception",
"snap",
"sound",
"S2",
"followed by",
"rumbling murmur",
"murmur",
"heard best",
"cardiac apex",
"history",... |
A 57-year-old man comes to the emergency department because of shortness of breath and palpitations for 3 hours. He has had similar episodes intermittently for 4 months. His pulse is 140/min and blood pressure is 90/60 mm Hg. An ECG shows irregular narrow-complex tachycardia with no discernable P waves. Emergent electr... | Decreased AV nodal conduction | {
"A": "Decreased AV nodal conduction",
"B": "Increased ventricular repolarization rate",
"C": "Decreased Purkinje fiber conduction",
"D": "Increased K+ efflux from myocytes"
} | step1 | A | [
"57 year old man",
"emergency department",
"of shortness",
"breath",
"palpitations",
"hours",
"similar episodes",
"months",
"pulse",
"min",
"blood pressure",
"90 60 mm Hg",
"ECG shows irregular narrow complex tachycardia",
"discernable P waves",
"Emergent electrical cardioversion",
"pe... |
A 53-year-old man presents to your Louisiana gulf coast community hospital with 48 hours of profuse watery diarrhea and 24 hours of vomiting and chills. The patient has a past medical history significant for hypertension and hypercholesterolemia. The patient denies sick contacts or any interaction with animals for the ... | Vibrio vulnificus | {
"A": "Campylobacter jejuni",
"B": "Listeria monocytogenes",
"C": "Vibrio vulnificus",
"D": "Shigella dysenteriae"
} | step1 | C | [
"year old man presents",
"Louisiana",
"community hospital",
"48 hours",
"watery diarrhea",
"24 hours",
"vomiting",
"chills",
"patient",
"past medical history significant",
"hypertension",
"hypercholesterolemia",
"patient denies sick contacts",
"interaction",
"animals",
"last month",
... |
A 59-year-old presents with right-sided hemiparesis, right-sided sensory loss, leftward eye deviation, and slurred speech. A head CT is performed which is significant for a hyperdense lesion affecting the putamen. The patient has a history of hypertension treated with hydrochlorothiazide, but is non-adherent. Which of ... | Vessel lipohyalinosis and microaneurysm formation | {
"A": "Thrombotic development over ruptured atherosclerotic plaque",
"B": "Vessel lipohyalinosis and microaneurysm formation",
"C": "Amyloid deposition in small cortical vessels",
"D": "Predisposed vessel rupture secondary to cortical atrophy"
} | step1 | B | [
"59 year old presents",
"right-sided hemiparesis",
"right-sided sensory loss",
"eye deviation",
"slurred speech",
"head CT",
"performed",
"significant",
"lesion affecting",
"putamen",
"patient",
"history of hypertension treated with hydrochlorothiazide",
"non-adherent",
"following",
"mos... |
A 58-year-old man is brought to the Emergency Department after 2 days of shortness breath, orthopnea, and lower limb edema. His past medical history is significant for hypertension and a myocardial infarction 3 years ago that required a coronary arterial bypass graft. He has not been able to take prescribed medicine in... | Diuretic therapy | {
"A": "Diuretic therapy",
"B": "Cholesterol emboli",
"C": "Glomerular basement membrane damage",
"D": "Urinary tract obstruction"
} | step2&3 | A | [
"58 year old man",
"brought",
"Emergency Department",
"2 days of shortness breath",
"orthopnea",
"lower limb edema",
"past medical history",
"significant",
"hypertension",
"myocardial infarction",
"years",
"required",
"coronary arterial",
"not",
"able to take prescribed medicine",
"mon... |
A 28-year-old woman presents to discuss the results of her Pap smear. Her previous Pap smear 1 year ago showed atypical squamous cells of undetermined significance. This year the Pap smear was negative. She had a single pregnancy with a cesarean delivery. Currently, she and her partner do not use contraception because ... | HPV vaccination is not recommended for women older than 26 years of age. | {
"A": "The patient can receive the vaccine after the pregnancy test is negative.",
"B": "This vaccination does not produce proper immunity in people who had at least 1 abnormal cytology report, so is unreasonable in this patient.",
"C": "The patient should undergo HPV DNA testing; vaccination is indicated if the... | step2&3 | D | [
"year old woman presents to discuss",
"results",
"Pap smear",
"previous Pap smear 1 year",
"showed atypical squamous cells of undetermined significance",
"year",
"Pap smear",
"negative",
"single pregnancy",
"cesarean delivery",
"Currently",
"partner",
"not use contraception",
"planning",
... |
A 9-year-old girl is brought to the emergency room by her parents with severe shortness of breath, cough, and wheezing after playing with her friends in the garden. She has a history of bronchial asthma. Her vital signs are as follows: respiratory rate 39/min, pulse 121/min, blood pressure 129/67 mm Hg, and temperature... | Inhaled albuterol | {
"A": "Inhaled cromolyn",
"B": "Inhaled beclomethasone",
"C": "Inhaled albuterol",
"D": "Oral montelukast"
} | step1 | C | [
"year old girl",
"brought",
"emergency room",
"parents",
"severe shortness of breath",
"cough",
"wheezing",
"playing",
"friends",
"garden",
"history of bronchial asthma",
"vital signs",
"follows",
"respiratory rate",
"min",
"pulse",
"min",
"blood pressure",
"67 mm Hg",
"tempera... |
A 45-year-old woman presents to the emergency department due to new-onset symptoms of asthma. She reports that the asthmatic attacks started a week ago. The past medical history includes gastroesophageal reflux disease and hepatitis B. On physical examination, the patient has bilateral foot drop as well as numbness and... | p-ANCA | {
"A": "ESR",
"B": "p-ANCA",
"C": "HLA B-27",
"D": "Anti-histone antibodies"
} | step2&3 | B | [
"year old woman presents",
"emergency department due to new-onset symptoms",
"asthma",
"reports",
"asthmatic attacks started",
"week",
"past medical history includes gastroesophageal reflux disease",
"hepatitis B",
"physical examination",
"patient",
"bilateral foot drop",
"numbness",
"tingli... |
A 45-year-old man is brought to the physician for a follow-up examination. Three weeks ago, he was hospitalized and treated for spontaneous bacterial peritonitis. He has alcoholic liver cirrhosis and hypothyroidism. His current medications include spironolactone, lactulose, levothyroxine, trimethoprim-sulfamethoxazole,... | Recurrent variceal hemorrhage | {
"A": "Hepatic veno-occlusive disease",
"B": "Recurrent variceal hemorrhage",
"C": "Portal hypertensive gastropathy",
"D": "Hepatic hydrothorax"
} | step2&3 | B | [
"year old man",
"brought",
"physician",
"follow-up examination",
"Three weeks",
"hospitalized",
"treated",
"spontaneous bacterial peritonitis",
"alcoholic liver cirrhosis",
"hypothyroidism",
"current medications include spironolactone",
"lactulose",
"levothyroxine",
"trimethoprim-sulfameth... |
Three days after delivery of a male newborn, a 36-year-old gravida 1, para 1 woman has fever and pain in her left leg. Pregnancy was complicated by premature rupture of membranes; the child was delivered at 35 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The... | Low molecular weight heparin | {
"A": "Low molecular weight heparin",
"B": "Embolectomy",
"C": "Urokinase",
"D": "Warfarin"
} | step2&3 | A | [
"Three days",
"delivery",
"male newborn",
"36 year old gravida 1",
"para 1 woman",
"fever",
"pain in",
"left leg",
"Pregnancy",
"complicated",
"premature rupture of membranes",
"child",
"delivered",
"35 weeks",
"gestation",
"lower segment transverse cesarean",
"fetal heart rate",
"... |
Three hours later, the patient is reassessed. Her right arm is put in an elevated position and physical examination of the extremity is performed. The examination reveals reduced capillary return and peripheral pallor. Pulse oximetry of her right index finger on room air shows an oxygen saturation of 84%. Which of the ... | Perform escharotomy | {
"A": "Perform fasciotomy",
"B": "Perform right upper extremity amputation",
"C": "Decrease rate of IV fluids",
"D": "Perform escharotomy"
} | step2&3 | D | [
"Three hours later",
"patient",
"right arm",
"put",
"elevated position",
"physical examination of the extremity",
"performed",
"examination reveals reduced capillary return",
"peripheral pallor",
"Pulse",
"right index finger",
"room air shows",
"oxygen saturation",
"84",
"following",
"... |
A 65-year-old man comes to the emergency department because of sudden, worsening pain in his right calf and foot that started 30 minutes ago. He also has a tingling sensation and weakness in his right leg. He has had no similar episodes, recent trauma, or claudication. He has type 2 diabetes mellitus and was diagnosed ... | Arterial embolism | {
"A": "Arterial vasospasm",
"B": "Popliteal artery aneurysm",
"C": "Atherosclerotic narrowing of the artery",
"D": "Arterial embolism"
} | step2&3 | D | [
"65 year old man",
"emergency department",
"sudden",
"worsening pain in",
"right calf",
"foot",
"started 30 minutes",
"tingling sensation",
"weakness",
"right",
"similar episodes",
"recent trauma",
"claudication",
"type 2 diabetes mellitus",
"diagnosed",
"hypertension 20 years",
"sis... |
A 24-year-old woman comes to the physician because of a 3-day history of lower abdominal pain and dysuria. She has a history of recurring urinary tract infections that have resolved with antibiotic treatment. She is sexually active with one male partner and they do not use condoms. She had mild pain during her last sex... | Intramuscular ceftriaxone and oral doxycycline | {
"A": "Oral metronidazole",
"B": "Oral levofloxacin and azithromycin",
"C": "Oral trimethoprim-sulfamethoxazole",
"D": "Intramuscular ceftriaxone and oral doxycycline"
} | step2&3 | D | [
"year old woman",
"physician",
"3-day history",
"lower abdominal pain",
"dysuria",
"history of recurring urinary tract infections",
"resolved",
"antibiotic treatment",
"sexually active",
"one male partner",
"not use condoms",
"mild pain",
"sexual intercourse one week",
"temperature",
"10... |
A 33-year-old woman presents to a walk-in clinic for evaluation of some bumps around her eyes. The bumps are not itchy or painful. They have been getting larger since appearing last year. She has no other complaints. She has not sought out medical attention for the last 20 years due to lack of insurance coverage. Her m... | Fasting lipid profile alone | {
"A": "Fasting blood glucose and lipid profile",
"B": "Fasting lipid profile alone",
"C": "Thyroid stimulating hormone alone",
"D": "Fasting blood glucose, lipid profile, and thyroid stimulating hormone"
} | step1 | B | [
"year old woman presents",
"walk-in clinic",
"evaluation",
"eyes",
"not itchy",
"painful",
"getting larger",
"appearing last year",
"complaints",
"not",
"out medical attention",
"20 years due to lack of insurance coverage",
"medical history reveals",
"problems",
"takes",
"medications",... |
A 55-year-old man comes to the physician because of a 2-day history of severe perianal pain and bright red blood in his stool. Examination shows a bulging, red nodule at the rim of the anal opening. Which of the following arteries is the most likely source of blood to the mass found during examination? | Internal pudendal | {
"A": "Deep circumflex iliac",
"B": "Internal pudendal",
"C": "Median sacral",
"D": "Inferior gluteal"
} | step1 | B | [
"55 year old man",
"physician",
"2-day history",
"severe perianal",
"bright red blood in",
"stool",
"Examination shows",
"bulging",
"red nodule",
"rim",
"anal opening",
"following arteries",
"most likely source",
"blood",
"mass found",
"examination"
] |
A 35-year-old man attends an appointment with a fertility specialist together with his wife. The couple has been attempting to conceive for over 2 years but without success. She has recently undergone a comprehensive gynecological exam and all the results were normal. He states that he has no prior medical history to r... | Presence of Barr body | {
"A": "Absence of chloride channel",
"B": "Primary ciliary dyskinesia",
"C": "Androgen insensitivity",
"D": "Presence of Barr body"
} | step2&3 | D | [
"35 year old man attends",
"appointment",
"fertility specialist",
"wife",
"couple",
"attempting to",
"years",
"success",
"recently",
"comprehensive gynecological exam",
"results",
"normal",
"states",
"prior medical history to report",
"low libido compared",
"men",
"age",
"physical ... |
A 62-year-old woman is hospitalized after a recent viral illness complicated by congestive heart failure. She has a past medical history of obesity and hypertension controlled on lisinopril but was otherwise healthy until she developed fatigue and edema after a recent viral illness. In the hospital, she is started on f... | Leukocyte esterase positive | {
"A": "Bacteria > 100 CFU/mL",
"B": "Crystals",
"C": "Leukocyte esterase positive",
"D": "Red blood cell casts"
} | step1 | C | [
"62 year old woman",
"hospitalized",
"recent viral illness complicated",
"congestive heart failure",
"past medical",
"hypertension controlled",
"lisinopril",
"healthy",
"fatigue",
"edema",
"recent viral illness",
"hospital",
"started",
"furosemide to",
"fluid status",
"day 5",
"admis... |
A 36-year-old right-handed man presents with complaints of difficulty writing for the past 6 months. He denies right-hand weakness, numbness, pain, and trauma. He can do most normal activities with his right hand, but whenever he holds a pen and starts to write, he experiences painful muscle spasms in his hand and arm.... | Botulinum injection | {
"A": "Botulinum injection",
"B": "Refer to the psychiatry clinic",
"C": "Selective serotonin reuptake inhibitor",
"D": "Wrist splint"
} | step2&3 | A | [
"36 year old right-handed man presents",
"complaints",
"difficulty writing",
"past 6 months",
"denies right-hand weakness",
"numbness",
"pain",
"trauma",
"most normal activities",
"right hand",
"holds",
"pen",
"starts",
"write",
"experiences painful muscle spasms",
"hand",
"arm",
"... |
A 37-year-old G1P0 at 15 weeks gestation presents for an amniocentesis after a routine triple screen demonstrated a mildly elevated serum AFP. A chromosomal analysis revealed the absence of a second sex chromosome. Which of the following features will the infant most likely have? | Streak ovaries | {
"A": "Mental retardation",
"B": "Micrognathia",
"C": "Cystic kidneys",
"D": "Streak ovaries"
} | step1 | D | [
"year old",
"weeks presents",
"amniocentesis",
"routine triple screen",
"mildly elevated serum AFP",
"chromosomal analysis revealed",
"absence of",
"second sex chromosome",
"following features",
"infant",
"likely"
] |
A 16-year-old boy is brought to his primary care physician for evaluation of visual loss and is found to have lens subluxation. In addition, he is found to have mild scoliosis that is currently being monitored. Physical exam reveals a tall and thin boy with long extremities. Notably, his fingers and toes are extended a... | Locus heterogeneity | {
"A": "Incomplete penetrance",
"B": "Locus heterogeneity",
"C": "Pleiotropy",
"D": "Variable expression"
} | step1 | B | [
"year old boy",
"brought",
"primary care physician",
"evaluation",
"visual",
"found to",
"lens subluxation",
"addition",
"found to",
"mild scoliosis",
"currently",
"monitored",
"Physical exam reveals",
"tall",
"thin boy",
"long",
"fingers",
"toes",
"extended",
"thumb",
"littl... |
A 19-year-old woman comes to the physician because of increased sweating for the past 6 months. She experiences severe sweating that is triggered by stressful situations and speaking in public. She is failing one of her university classes because of her avoidance of public speaking. She has not had any fevers, chills, ... | Glycopyrrolate | {
"A": "Pilocarpine",
"B": "Oxytocin",
"C": "Phenylephrine",
"D": "Glycopyrrolate"
} | step1 | D | [
"year old woman",
"physician",
"of increased sweating",
"past 6 months",
"experiences severe sweating",
"triggered by stressful",
"speaking",
"public",
"failing one",
"university classes",
"avoidance",
"public speaking",
"not",
"fevers",
"chills",
"weight loss",
"night sweats",
"te... |
A 73-year-old man is admitted to the hospital for jaundice and weight loss. He is an immigrant from the Dominican Republic and speaks little English. A CT scan is performed showing a large mass at the head of the pancreas. When you enter the room to discuss these results with the patient, his daughter and son ask to sp... | Explore the reasoning behind the children's reluctance to have their father know his prognosis | {
"A": "Explore the reasoning behind the children's reluctance to have their father know his prognosis",
"B": "Tell the children that you are obligated to tell the father his prognosis",
"C": "Respect the children's wishes to hold prognosis information from their father",
"D": "Bring the situation to the hospit... | step1 | A | [
"year old man",
"admitted",
"hospital",
"jaundice",
"weight loss",
"immigrant",
"Dominican Republic",
"speaks little English",
"CT scan",
"performed showing",
"large mass",
"the head of",
"pancreas",
"enter",
"room to discuss",
"results",
"patient",
"daughter",
"son",
"speak",
... |
A 55-year-old man is seen in the hospital for new onset shortness of breath. The patient was hospitalized 5 days ago after initially presenting with chest pain. He was found to have an ST-elevation myocardial infarction. He underwent percutaneous coronary intervention with stent placement with resolution of his chest p... | Papillary muscle rupture | {
"A": "Dressler syndrome",
"B": "Free wall rupture",
"C": "Interventricular septum rupture",
"D": "Papillary muscle rupture"
} | step2&3 | D | [
"55 year old man",
"seen",
"hospital",
"new onset shortness of breath",
"patient",
"hospitalized 5 days",
"initially presenting",
"chest pain",
"found to",
"ST-elevation myocardial infarction",
"percutaneous coronary intervention",
"stent placement",
"resolution of",
"chest pain",
"state... |
A mother brings her 2-year-old son to your office after she noticed a “sore on the back of his throat.” She states that her son had a fever and was complaining of throat pain 2 days ago. The child has also been fussy and eating poorly. On examination, the child has met all appropriate developmental milestones and appea... | Coxsackievirus A | {
"A": "Type 2 sensitivity reaction",
"B": "Herpes simplex virus type 1",
"C": "Coxsackievirus A",
"D": "Varicella-zoster"
} | step1 | C | [
"mother",
"her 2 year old son",
"office",
"sore",
"back of",
"throat",
"states",
"son",
"fever",
"throat pain 2 days",
"child",
"fussy",
"eating poorly",
"examination",
"child",
"met",
"appropriate developmental milestones",
"appears well-nourished",
"submandibular",
"anterior ... |
You are called to the bedside of a 75-year-old woman, who is post-op day 4 from a right total hip replacement. The patient appears agitated; she is trying to pull out her IV, and for the past 4 hours she has been accusing the nursing staff of trying to poison her. Her family notes that this behavior is completely diffe... | Amyloid accumulation | {
"A": "Infection",
"B": "Polypharmacy",
"C": "Amyloid accumulation",
"D": "Electrolyte abnormalities"
} | step2&3 | C | [
"called",
"75 year old woman",
"post",
"day 4",
"right total hip replacement",
"patient appears agitated",
"to pull out",
"IV",
"past",
"hours",
"nursing staff",
"poison",
"family notes",
"behavior",
"completely different",
"baseline",
"not shown",
"signs of memory loss",
"behavi... |
A 53-year-old man presents to the emergency department with a complaint of chest pain for 5 hours. The chest pain is continuous and squeezing in nature, not relieved by aspirin, and not related to the position of respiration. The blood pressure was 102/64 mm Hg, and the heart rate was 73/min. On physical examination, h... | Coagulative necrosis | {
"A": "Caseous necrosis",
"B": "Coagulative necrosis",
"C": "Liquefactive necrosis",
"D": "Fibrinoid necrosis"
} | step1 | B | [
"year old man presents",
"emergency department",
"complaint of chest pain",
"5 hours",
"chest pain",
"continuous",
"squeezing",
"nature",
"not relieved by aspirin",
"not related",
"position",
"respiration",
"blood pressure",
"64 mm Hg",
"heart rate",
"min",
"physical examination",
... |
A 44-year-old man presents to the clinic with recurrent epigastric pain following meals for a month. He adds that the pain radiates up his neck and throat. Over the counter antacids have not helped. On further questioning, he endorses foul breath upon waking in the morning and worsening of pain when lying down. He deni... | Lansoprazole | {
"A": "Barium swallow",
"B": "Lansoprazole",
"C": "Liquid antacid",
"D": "Ranitidine"
} | step2&3 | B | [
"year old man presents",
"clinic",
"recurrent epigastric pain following meals",
"month",
"adds",
"pain radiates",
"neck",
"throat",
"Over the counter antacids",
"not helped",
"further questioning",
"foul breath",
"waking",
"morning",
"worsening",
"pain",
"lying",
"denies",
"recen... |
A 37-year-old woman, gravida 3, para 2, at 35 weeks' gestation is brought to the emergency department for the evaluation of lower abdominal and back pain and vaginal bleeding that started one hour ago. She has had no prenatal care. Her first two pregnancies were uncomplicated and her children were delivered vaginally. ... | Vaginal delivery | {
"A": "Vaginal delivery",
"B": "Elective cesarean delivery",
"C": "Administration of betamethasone",
"D": "Administration of terbutaline"
} | step2&3 | A | [
"year old woman",
"gravida 3",
"para 2",
"35 weeks",
"gestation",
"brought",
"emergency department",
"evaluation",
"lower abdominal",
"back pain",
"vaginal bleeding",
"started one hour",
"prenatal care",
"first two pregnancies",
"uncomplicated",
"children",
"delivered",
"patient sm... |
A 28-year-old woman presents with right lower quadrant abdominal pain, fatigue, and low-volume diarrhea of intermittent frequency for the past 4 months. She also reports weight loss and believes it to be due to a decreased appetite. She has noticed herself being more "forgetful" and she denies seeing any blood in her s... | Ileum | {
"A": "Colon",
"B": "Gastric fundus",
"C": "Ileum",
"D": "Jejunum"
} | step1 | C | [
"year old woman presents",
"right lower quadrant abdominal pain",
"fatigue",
"low volume diarrhea of intermittent frequency",
"past",
"months",
"reports weight loss",
"to",
"due to",
"decreased appetite",
"more",
"forgetful",
"denies seeing",
"blood in",
"stool",
"changes in diet",
"... |
A 43-year-old man with a history of untreated HIV presents with fever, shortness of breath, and a nonproductive cough for the past week. Past medical history is significant for HIV diagnosed 10 years ago and never treated. His most recent CD4+ T cell count was 105/µL. Physical examination reveals bilateral crepitus ove... | Trimethoprim-sulfamethoxazole | {
"A": "Highly active antiretroviral therapy (HAART)",
"B": "Trimethoprim-sulfamethoxazole",
"C": "Ganciclovir",
"D": "Azithromycin"
} | step1 | B | [
"year old man",
"history",
"untreated HIV presents",
"fever",
"shortness of breath",
"nonproductive cough",
"past week",
"medical history",
"significant",
"HIV diagnosed 10 years",
"never treated",
"most recent CD4",
"T cell count",
"Physical examination reveals bilateral crepitus",
"lob... |
A 1-week-old male newborn is brought to the physician for a follow-up examination after the results of newborn screening showed an increased serum concentration of phenylalanine. Genetic analysis confirms a diagnosis of phenylketonuria. The physician counsels the patient's family on the recommended dietary restrictions... | Dipeptidase | {
"A": "Pepsin",
"B": "Dipeptidase",
"C": "Trypsin",
"D": "Carboxypeptidase A"
} | step1 | B | [
"week old male newborn",
"brought",
"physician",
"follow-up examination",
"results",
"newborn screening showed",
"increased serum concentration",
"phenylalanine",
"Genetic analysis confirms",
"diagnosis",
"phenylketonuria",
"physician counsels",
"patient's family",
"recommended dietary res... |
An American doctor is on an outreach trip to visit local communities in Ethiopia. In one clinic, he found many cases of children ages 2–5 years who have significantly low weight and height for their age. These children also had pale sclerae, distended abdomens, dermatoses, and marked edema in the lower extremities. Mal... | Methionine | {
"A": "Alanine",
"B": "Tyrosine",
"C": "Arginine",
"D": "Methionine"
} | step1 | D | [
"American doctor",
"outreach trip to visit local communities",
"Ethiopia",
"one clinic",
"found",
"cases",
"children ages",
"years",
"significantly low",
"height",
"age",
"children",
"pale sclerae",
"distended abdomens",
"dermatoses",
"marked edema",
"lower extremities",
"Malnutrit... |
Under what physiologic state is the endogenous human analog of nesiritide produced? | Increased ventricular stretch | {
"A": "Increased external stress",
"B": "Increased ventricular stretch",
"C": "Increased intracranial pressure",
"D": "Increased circulatory volume presenting to the kidneys"
} | step1 | B | [
"physiologic state",
"endogenous human analog",
"nesiritide"
] |
A 9-year-old boy is brought to the physician for a well-child examination. His mother says his teachers report him being easily distracted, lagging behind his classmates in most of the subjects, and frequently falling asleep during class. She says that her son has complained of leg pain on multiple occasions. He is at ... | Myotonic dystrophy | {
"A": "Spinal muscular atrophy",
"B": "McArdle disease",
"C": "Myotonic dystrophy",
"D": "Juvenile dermatomyositis"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"well",
"mother",
"teachers report",
"easily",
"lagging",
"classmates",
"most",
"subjects",
"frequently falling asleep",
"class",
"son",
"leg pain",
"multiple occasions",
"percentile",
"height",
"percentile",
"weight",
"Vital signs",
... |
A 56-year old man is brought in by ambulance to the emergency department and presents with altered consciousness, confabulation, and widespread rash. He is recognized as a homeless man that lives in the area with a past medical history is significant for traumatic brain injury 4 years ago and chronic gastritis. He also... | Hydroxylation of proline residues | {
"A": "Hydroxylation of proline residues",
"B": "Carboxylation of clotting factors",
"C": "Decarboxylation of histidine",
"D": "Ethanol oxidation to acetaldehyde"
} | step1 | A | [
"year old man",
"brought",
"ambulance",
"emergency department",
"presents",
"altered consciousness",
"confabulation",
"widespread rash",
"homeless man",
"lives",
"area",
"past medical history",
"significant",
"traumatic brain injury",
"years",
"chronic gastritis",
"long history of al... |
An 8-year-old girl is brought to the emergency department by her parents because she complained of very fast heartbeats. The patient has previously been healthy without any childhood illnesses and has not needed to visit a physician in the past 2 years. On examination, the heart rate is 198/min. Further examination by ... | Ebstein anomaly | {
"A": "Pulmonic stenosis",
"B": "Tricuspid atresia",
"C": "Ebstein anomaly",
"D": "Tetralogy of Fallot"
} | step2&3 | C | [
"year old girl",
"brought",
"emergency department",
"parents",
"very fast heartbeats",
"patient",
"healthy",
"childhood illnesses",
"not needed to visit",
"physician",
"past",
"years",
"examination",
"heart rate",
"min",
"Further examination",
"physician reveals",
"grade III holosy... |
A 78-year-old man with advanced lung cancer with metastases to the brain is brought to the physician by his daughter, with whom he lives. The daughter reports that her father's condition has been slowly deteriorating over the past 2 months. His seizures have been poorly controlled despite maximal medical therapy. He ha... | """Your father is only eligible if his life expectancy is less than 6 months.""" | {
"A": "\"\"\"Your father would have to be moved from home to a center that specializes in hospice care.\"\"\"",
"B": "\"\"\"Your father cannot enter hospice care if there is a definitive cure for his disease.\"\"\"",
"C": "\"\"\"Your father is only eligible if his life expectancy is less than 6 months.\"\"\"",
... | step1 | C | [
"year old man",
"advanced lung",
"metastases to",
"brain",
"brought",
"physician",
"daughter",
"lives",
"daughter reports",
"father's condition",
"slowly deteriorating",
"past",
"months",
"seizures",
"poorly controlled",
"maximal medical therapy",
"progressive loss",
"mobility",
... |
A 26-year-old G1P0 mother is in the delivery room in labor. Her unborn fetus is known to have a patent urachus. Which of the following abnormalities would you expect to observe in the infant? | Urine discharge from umbilicus | {
"A": "Gastroschisis",
"B": "Omphalocele",
"C": "Meconium discharge from umbilicus",
"D": "Urine discharge from umbilicus"
} | step1 | D | [
"year old",
"mother",
"delivery room",
"labor",
"unborn fetus",
"known to",
"patent urachus",
"following abnormalities",
"to observe",
"infant"
] |
A 44-year-old woman is being treated by her oncologist for metastatic breast cancer. The patient had noticed severe weight loss and a fixed breast mass over the past 8 months but refused to see a physician until her husband brought her in. Surgery is scheduled, and the patient is given an initial dose of radiation ther... | Induction therapy | {
"A": "Adjuvant therapy",
"B": "Induction therapy",
"C": "Maintenance therapy",
"D": "Salvage therapy"
} | step2&3 | B | [
"year old woman",
"treated",
"oncologist",
"metastatic breast cancer",
"patient",
"severe weight loss",
"fixed breast mass",
"past",
"months",
"refused to see",
"physician",
"husband brought",
"Surgery",
"scheduled",
"patient",
"given",
"initial dose",
"radiation therapy",
"destr... |
A 50-year-old man presents to the emergency department with chief complaints of abdominal pain, distension, and bloody diarrhea for a day. Abdominal pain was episodic in nature and limited to the left lower quadrant. It was also associated with nausea and vomiting. He also has a history of postprandial abdominal pain f... | Atherosclerosis | {
"A": "Hypokalemia",
"B": "Aneurysm",
"C": "Embolism",
"D": "Atherosclerosis"
} | step1 | D | [
"50 year old man presents",
"emergency department",
"chief complaints",
"abdominal pain",
"distension",
"bloody diarrhea",
"day",
"Abdominal pain",
"episodic",
"nature",
"limited",
"left lower quadrant",
"associated with nausea",
"vomiting",
"history",
"postprandial abdominal pain",
... |
A 46-year-old man comes to the physician for routine physical examination. His blood pressure is 158/96 mm Hg. Physical examination shows no abnormalities. Serum studies show a potassium concentration of 3.1 mEq/L. His plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is 47 (N < 10). A saline ... | Eplerenone therapy | {
"A": "Bilateral adrenalectomy",
"B": "Eplerenone therapy",
"C": "Amiloride therapy",
"D": "Propranolol therapy"
} | step1 | B | [
"year old man",
"physician",
"routine physical examination",
"blood pressure",
"96 mm Hg",
"Physical examination shows",
"abnormalities",
"Serum studies show",
"potassium concentration",
"mEq/L",
"plasma aldosterone concentration",
"renin activity",
"ratio",
"N",
"10",
"saline infusion... |
In a routine medical examination, an otherwise healthy 12-year-old by is noted to have tall stature with a wide arm span and slight scoliosis. Chest auscultation reveals a heart murmur. Transthoracic echocardiography shows an enlarged aortic root and aortic valve insufficiency. Mutations in mutations in fibrillin-1 gen... | Aortic aneurysm | {
"A": "Aortic aneurysm",
"B": "Thrombotic events",
"C": "Infertility",
"D": "Pheochromocytoma"
} | step2&3 | A | [
"routine medical examination",
"healthy",
"year old",
"noted to",
"tall stature",
"wide arm span",
"slight scoliosis",
"Chest auscultation reveals",
"heart murmur",
"Transthoracic echocardiography shows",
"enlarged aortic root",
"aortic valve insufficiency",
"Mutations",
"fibrillin-1 gene"... |
A 5-day-old boy is brought to the emergency department by his mother because of a 2-day history of difficulty feeding and multiple episodes of his lips turning blue. He was born at home via spontaneous vaginal delivery and Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Physical examination shows grunting a... | Failure of neural crest cell migration | {
"A": "Failure of neural crest cell migration",
"B": "Abnormal placement of the infundibular septum",
"C": "Absent fusion of septum primum and septum secundum",
"D": "Abnormal cardiac looping"
} | step1 | A | [
"5 day old boy",
"brought",
"emergency department",
"mother",
"2-day history",
"difficulty feeding",
"multiple episodes of",
"lips turning blue",
"born at home",
"spontaneous vaginal delivery",
"Apgar scores",
"8",
"1",
"5 minutes",
"Physical examination shows grunting",
"moderate",
... |
A 58-year-old woman presents to her primary care doctor with her husband. The patient's husband reports that his wife has been acting "funny" ever since she was in a motor vehicle accident 2 months ago. She's been very rude to him, their children, and her friends, often saying inappropriate things. She is not intereste... | Frontal lobe | {
"A": "Broca's area",
"B": "Occipital lobe",
"C": "Temporal lobe",
"D": "Frontal lobe"
} | step1 | D | [
"58 year old woman presents",
"primary care doctor",
"husband",
"patient",
"usband eports ",
"ife ",
"cting ",
"ver ",
"otor vehicle accident ",
"onths ",
"he'",
"ry r de t",
"ildren, ",
"iends, ",
"ten s",
"appropriate t ings. ",
"t i terested i",
"evious h bbies a",
"t w",
"... |
A 32-year-old woman presents to a psychiatrist to discuss a recent event in her life. At a social function 2 days back, she met a man who introduced himself as having worked with her at another private company 3 years ago. However, she did not recognize him. She also says that she does not remember working at any such ... | Dissociative amnesia | {
"A": "Pseudodementia",
"B": "Dissociative amnesia",
"C": "Dissociative identity disorder",
"D": "Transient global amnesia"
} | step2&3 | B | [
"year old woman presents",
"psychiatrist to discuss",
"recent event",
"life",
"social function",
"days back",
"met",
"man",
"introduced",
"worked",
"private company",
"years",
"not",
"not remember working",
"company",
"time",
"life",
"patients husband",
"worked",
"company",
"... |
A 12-year-old boy is brought by his parents to the physician for a fever for the past 2 days. His temperature is 101.3°F (38.5°C). His medical history is significant for sickle cell disease and recurrent infections. A year ago, he underwent spleen scintigraphy with technetium-99m that revealed functional hyposplenism. ... | Howell-Jolly bodies | {
"A": "Acanthocytes",
"B": "Basophilic stippling",
"C": "Howell-Jolly bodies",
"D": "Schistocytes"
} | step2&3 | C | [
"year old boy",
"brought",
"parents",
"physician",
"fever",
"past 2 days",
"temperature",
"medical history",
"significant",
"sickle cell disease",
"recurrent infections",
"year",
"spleen scintigraphy",
"technetium-99m",
"revealed functional hyposplenism",
"following findings",
"found... |
A 35-year-old woman presents to the emergency department multiple times over the past 3 months feeling like her chest is about to explode. She has been screened on several occasions for acute coronary syndrome, but each time, her cardiac enzymes have all been within normal limits. She comes into the emergency room diap... | The patient must have symptoms of elevated autonomic activity. | {
"A": "The patient must have symptoms of elevated autonomic activity.",
"B": "Attacks occur at regular intervals.",
"C": "There is a fixed number of attacks needed for diagnosis.",
"D": "The patients must have symptoms for at least 3 months."
} | step1 | A | [
"35 year old woman presents",
"emergency department multiple times",
"past 3 months feeling",
"chest",
"to",
"screened",
"occasions",
"acute coronary syndrome",
"time",
"cardiac enzymes",
"normal limits",
"emergency room diaphoretic",
"breath",
"of chest pain",
"symptoms usually resolve"... |
An 18-month-old toddler is brought to a pediatric hematologist by his father. The boy was referred to this office for prolonged neutropenia. He has had several blood tests with an isolated low neutrophil count while hemoglobin, hematocrit, and platelet count is normal. The boy was born at 39 weeks gestation via spontan... | Chronic benign neutropenia | {
"A": "Chronic benign neutropenia",
"B": "Sepsis",
"C": "Aplastic anemia",
"D": "Acute lymphoblastic leukemia"
} | step1 | A | [
"month old toddler",
"brought",
"pediatric hematologist",
"father",
"boy",
"referred",
"office",
"prolonged neutropenia",
"several blood tests",
"isolated low neutrophil count",
"hemoglobin",
"hematocrit",
"platelet count",
"normal",
"boy",
"born",
"weeks gestation",
"spontaneous v... |
A 4-year-old girl is brought to the physician for a routine checkup. She was recently adopted and has never seen a doctor before. The patient's parents state she was very emaciated when they adopted her and noticed she has trouble seeing in the evening. They also noted that she was experiencing profuse foul-smelling di... | Xerophthalmia | {
"A": "Ataxia",
"B": "Cheilosis",
"C": "Perifollicular hemorrhages",
"D": "Xerophthalmia"
} | step2&3 | D | [
"4 year old girl",
"brought",
"physician",
"routine checkup",
"recently adopted",
"never seen",
"doctor",
"patient's parents state",
"very emaciated",
"adopted",
"seeing",
"evening",
"noted",
"experiencing",
"smelling diarrhea",
"well",
"currently",
"worked up",
"gastroenterologi... |
A 32-year-old man presents to the emergency department with vomiting, diarrhea, and abdominal pain 2 hours after eating seafood in a restaurant. He also mentions that immediately after ingestion of the food, he experienced tingling and numbness over the lips and face. On physical examination, his vital signs are stable... | Tetrodotoxin | {
"A": "Latrotoxin",
"B": "Okadaic acid",
"C": "Scombrotoxin",
"D": "Tetrodotoxin"
} | step1 | D | [
"year old man presents",
"emergency department",
"vomiting",
"diarrhea",
"abdominal pain 2 hours",
"eating seafood",
"restaurant",
"immediately",
"ingestion",
"food",
"experienced tingling",
"numbness",
"lips",
"face",
"physical examination",
"vital signs",
"stable",
"neurological ... |
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