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 24-year-old woman presents with a 3-month history of bloody diarrhea and intermittent abdominal pain. She says that after she has a bowel movement, she still feels as though she needs to go more. She also reports a 10-pound weight loss, significant fatigue, and frequent cravings to chew ice. Her past medical history ... | Colonoscopy by age 32 and repeated every 1–2 years thereafter | {
"A": "Colonoscopy by age 32 and repeated every 1–2 years thereafter",
"B": "Colonoscopy by age 50 and repeated every 10 years thereafter",
"C": "Colonoscopy by age 32 and repeated every 3 years thereafter",
"D": "Flexible sigmoidoscopy by age 32 and repeated every 1–2 years thereafter"
} | step2&3 | A | [
"year old woman presents",
"month history",
"bloody diarrhea",
"intermittent abdominal pain",
"bowel movement",
"feels",
"needs to go more",
"reports a 10 pound weight loss",
"significant fatigue",
"frequent cravings to chew ice",
"past medical history",
"significant only",
"chronic",
"hig... |
A 24-year-old woman presents to the emergency department with severe abdominal and lower back pain. She describes it as intense cramping and states that she experienced severe pain roughly 1 month ago that was similar. The patient's past medical history is non-contributory, and she states that her menses cause her to s... | Primary dysmenorrhea | {
"A": "Appendicitis",
"B": "Ectopic pregnancy",
"C": "Leiomyoma",
"D": "Primary dysmenorrhea"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"severe abdominal",
"lower back pain",
"intense cramping",
"states",
"experienced severe pain",
"month",
"similar",
"patient's past",
"non contributory",
"states",
"menses cause",
"to soak",
"pad",
"day",
"currently sexually active",... |
Which of the following factors gives the elastin molecule the ability to stretch and recoil? | Cross-links between lysine residues | {
"A": "Hydroxylation of proline and lysine rich regions",
"B": "Cross-links between lysine residues",
"C": "Triple helix formation",
"D": "Cleavage of disulfide rich terminal regions"
} | step1 | B | [
"following factors gives",
"elastin molecule",
"ability to stretch"
] |
A 68-year-old woman, otherwise healthy, is admitted to the coronary care unit due to acute ischemic cardiomyopathy. No other significant past medical history. Her vital signs include: pulse 116/min, respiratory rate 21/min, temperature 37.4°C (99.3°F), and blood pressure 160/100 mm Hg. On physical examination, the pati... | Transfuse packed red blood cells | {
"A": "Transfuse packed red blood cells",
"B": "Transfuse whole blood",
"C": "Treat with erythropoietin",
"D": "Observation and supportive care"
} | step1 | A | [
"68 year old woman",
"healthy",
"admitted",
"coronary care unit",
"acute ischemic cardiomyopathy",
"significant past medical history",
"vital signs include",
"pulse",
"min",
"respiratory rate",
"min",
"temperature",
"4C",
"99",
"blood pressure",
"100 mm Hg",
"physical examination",
... |
A goalkeeper of a famous soccer team gives an interview with a health agency regarding his childhood. He describes how when he was a child, he would constantly clear his throat in class and the teachers would write a note to his mother with advice to go see an ENT doctor. He complained of being restless, fidgety, and s... | Haloperidol | {
"A": "Clonazepam",
"B": "Guanfacine",
"C": "Haloperidol",
"D": "Lithium"
} | step1 | C | [
"famous soccer team gives",
"interview",
"health agency",
"childhood",
"child",
"constantly clear",
"throat",
"class",
"teachers",
"write",
"note",
"mother",
"advice to go see",
"ENT doctor",
"restless",
"fidgety",
"sometimes hyperactive",
"class",
"disrupting",
"environment",
... |
A 36-year-old healthy man presents to his physician to discuss his concerns about developing heart disease. His father, grandfather, and older brother had heart problems, and he has become increasingly worried he might be at risk. He takes no medications and his past medical history is only significant for an appendect... | Vitamin E | {
"A": "Folic acid",
"B": "Vitamin B12",
"C": "Vitamin E",
"D": "Vitamin K"
} | step1 | C | [
"36 year old healthy man presents",
"physician to discuss",
"concerns",
"heart disease",
"father",
"grandfather",
"older brother",
"heart problems",
"worried",
"at risk",
"takes",
"medications",
"past medical history",
"only significant",
"appendectomy",
"20 years",
"married",
"you... |
A 22-year-old man comes to the emergency department for pain and swelling of his left knee one day after injuring it while playing soccer. While sprinting on the field, he slipped as he attempted to kick the ball and landed on the anterior aspect of his knee. He underwent an appendectomy at the age of 16 years. His vit... | Posterior cruciate ligament injury | {
"A": "Lateral meniscus injury",
"B": "Posterior cruciate ligament injury",
"C": "Medial meniscus injury",
"D": "Medial collateral ligament injury"
} | step2&3 | B | [
"year old man",
"emergency department",
"pain",
"swelling of",
"left knee one day",
"playing soccer",
"field",
"slipped",
"attempted to",
"ball",
"landed",
"anterior aspect of",
"knee",
"appendectomy",
"age",
"years",
"signs",
"normal limits",
"Examination shows",
"swollen",
... |
A 49-year-old woman comes to the physician with a 2-month history of mild abdominal pain, nausea, and several episodes of vomiting. She often feels full after eating only a small amount of food. Abdominal examination shows mild right upper quadrant tenderness and a liver span of 16 cm. Ultrasonography shows a 5 x 4 cm ... | Cavernous hemangioma | {
"A": "Hepatocellular adenoma",
"B": "Cavernous hemangioma",
"C": "Focal nodular hyperplasia",
"D": "Angiosarcoma"
} | step1 | B | [
"year old woman",
"physician",
"2 month history",
"mild abdominal",
"nausea",
"several episodes of vomiting",
"often feels full",
"eating only",
"small amount",
"food",
"Abdominal examination shows mild right upper quadrant tenderness",
"liver span of",
"Ultrasonography shows",
"5",
"4",... |
A pharmaceutical company has created an experimental medication, Drug Z, for patients with relapsing-remitting multiple sclerosis. Drug Z has been deemed to be safe in rats and is nearly ready for human trials. Before initiating a Phase I clinical trial, the company would like to study the medication’s pharmacokinetic ... | 53% | {
"A": "53%",
"B": "59%",
"C": "67%",
"D": "71%"
} | step1 | A | [
"pharmaceutical company",
"created",
"experimental medication",
"Drug",
"patients",
"relapsing-remitting multiple sclerosis",
"Drug",
"to",
"safe",
"rats",
"nearly ready",
"human trials",
"Before initiating",
"Phase I clinical trial",
"company",
"to study",
"medications pharmacokinet... |
A 42-year-old homeless male presents with fever and cough. He was found unconscious on the side of the road and was brought to the emergency room. He is noticeably drunk and is unable to answer any questions. On physical exam his temperature is 103°F (40°C), blood pressure is 130/85 mmHg, pulse is 110/min, respirations... | Gram-negative organism that produces mucoid colonies on MacConkey agar | {
"A": "Organism that forms black colonies on cysteine-tellurite agar",
"B": "Disc-shaped yeast seen on methenamine silver stain",
"C": "Negative-sense, single-stranded RNA virus",
"D": "Gram-negative organism that produces mucoid colonies on MacConkey agar"
} | step1 | D | [
"year old homeless male presents",
"fever",
"cough",
"found unconscious",
"side",
"road",
"brought",
"emergency room",
"drunk",
"unable to answer",
"questions",
"physical exam",
"temperature",
"blood pressure",
"85 mmHg",
"pulse",
"min",
"respirations",
"23 min",
"pulse oximetr... |
A 45-year-old Caucasian male presents complaining of inability to open his mouth. Patient history reveals that he recently injured his foot from an exposed floor nail in his house. This patient's symptoms are likely the result of: | Impaired motor neuron release of GABA | {
"A": "Impaired motor neuron release of ACh",
"B": "Impaired motor neuron release of GABA",
"C": "Cross-reactivity of bacterial antigens",
"D": "Bacterial infiltration of the central nervous system"
} | step1 | B | [
"year old Caucasian male presents",
"to open",
"mouth",
"Patient history reveals",
"recently injured",
"foot",
"exposed floor nail",
"house",
"patient's symptoms",
"likely",
"result"
] |
An 18-year-old college student presents to the ED straight from chemistry lab where he ingested an unknown compound. He complains of a headache, and is flushed, tachypneic and tachycardic. Suspecting cyanide poisoning, you administer amyl nitrite which causes which of the following? | Oxidation of ferrous iron in hemoglobin to ferric iron | {
"A": "Oxidation of ferrous iron in hemoglobin to ferric iron",
"B": "A decrease in serum methemoglobin levels",
"C": "Formation of thiocyanate",
"D": "Increase in intracellular NADH/NAD+ ratio"
} | step1 | A | [
"year old college student presents",
"ED straight",
"chemistry lab",
"ingested",
"unknown compound",
"headache",
"flushed",
"tachypneic",
"tachycardic",
"Suspecting cyanide poisoning",
"administer amyl nitrite",
"causes",
"following"
] |
A 76-year-old man presents to his physician with his daughter for evaluation of memory loss and disorientation that has become progressively worse over the last few years. The patient’s daughter states that the memory loss started with her father forgetting things ''here and there'' and the memory loss has progressed t... | Aβ amyloid neuritic plaques | {
"A": "Aβ amyloid neuritic plaques",
"B": "Ubiquitinated TDP-43",
"C": "Beta-pleated sheet proteins resistant to proteases",
"D": "Viral inclusions within oligodendrocytes"
} | step1 | A | [
"76 year old man presents",
"physician",
"daughter",
"evaluation of memory loss",
"disorientation",
"worse",
"years",
"patients daughter states",
"memory loss started",
"father forgetting things",
"memory loss",
"progressed",
"patient forgetting",
"names",
"loved ones",
"getting lost",... |
A 19-year-old female student presents to her physician for overall fatigue. She is having a hard time concentrating while studying and feeling tired most of the time. She also has had constipation for more than 3 weeks and rectal bleeding on occasions. She notices she is getting colder and often needs to wear warmer cl... | Thyroid ultrasound | {
"A": "Serum T3 levels",
"B": "Thyroid ultrasound",
"C": "Serum calcitonin levels",
"D": "Radionuclide thyroid scan"
} | step2&3 | B | [
"year old female student presents",
"physician",
"overall fatigue",
"hard time concentrating",
"studying",
"feeling tired most of the time",
"constipation",
"3 weeks",
"rectal bleeding",
"occasions",
"getting colder",
"often needs to",
"warmer clothes",
"usual",
"same weather",
"examin... |
A 43-year-old man is brought to the emergency department because of severe back pain for 2 hours. He describes it as a stabbing pain between his scapulae that is 9 out of 10 in intensity. He has vomited once during this period. He has hypertension and type 2 diabetes mellitus. He has not seen a physician in 18 months. ... | Transesophageal echocardiography | {
"A": "Gadolinium-enhanced MRA",
"B": "Contrast-enhanced CT angiography",
"C": "Transesophageal echocardiography",
"D": "Aortography\n\""
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"of severe back pain",
"hours",
"stabbing pain",
"scapulae",
"out",
"10",
"intensity",
"vomited",
"period",
"hypertension",
"type 2 diabetes mellitus",
"not seen",
"physician",
"months",
"Current medications include metformin",
"... |
A 67-year-old man presents to his primary care provider for routine follow-up. He complains of mild fatigue and occasional tingling in both feet. He reports that this numbness and tingling has led to him having 3 falls over the last month. He has had type 2 diabetes mellitus for 23 years and hypertension for 15 years, ... | Methylmalonic acid level | {
"A": "Intrinsic factor antibody",
"B": "Schilling test",
"C": "Folic acid supplementation",
"D": "Methylmalonic acid level"
} | step2&3 | D | [
"67 year old man presents",
"primary care provider",
"routine follow-up",
"mild fatigue",
"occasional tingling",
"feet",
"reports",
"numbness",
"tingling",
"led",
"3 falls",
"month",
"type 2 diabetes mellitus",
"23 years",
"hypertension",
"years",
"takes metformin",
"enalapril",
... |
A previously healthy 31-year-old man comes to the emergency department because of acute onset of left flank pain radiating to his inner groin and scrotum for 3 hours. He also had nausea and one episode of hematuria. His only medication is a multivitamin. He appears uncomfortable. His temperature is 37°C (98.6°F), pulse... | Calcium oxalate | {
"A": "Uric acid",
"B": "Cystine",
"C": "Xanthine",
"D": "Calcium oxalate"
} | step2&3 | D | [
"healthy 31 year old man",
"emergency department",
"acute onset",
"left flank radiating",
"inner groin",
"scrotum",
"hours",
"nausea",
"one episode of hematuria",
"only medication",
"multivitamin",
"appears",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood pres... |
A 50-year-old female teacher presents to the clinic with complaints of discoloration of the skin around the right ankle accompanied by itching. She began noticing it a month ago and the pruritus worsened over time. She also has some pain and swelling of the region every night, especially on days when she teaches late i... | Stasis dermatitis | {
"A": "Basal cell carcinoma",
"B": "Stasis dermatitis",
"C": "Atopic dermatitis",
"D": "Cellulitis"
} | step1 | B | [
"50 year old female teacher presents",
"clinic",
"complaints of discoloration",
"skin",
"right ankle",
"itching",
"began",
"month",
"pruritus worsened",
"time",
"pain",
"swelling",
"region",
"night",
"days",
"teaches late",
"evening",
"past medical history",
"significant",
"dia... |
A 22-year-old man comes to the physician because of a 2-month history of episodes of shortness of breath, lightheadedness, and palpitations. During the examination, he reports the onset of one such episode. His pulse is 170/min and regular, respirations are 22/min, and blood pressure is 100/65 mm Hg. An ECG shows a reg... | Glossopharyngeal | {
"A": "Trigeminal",
"B": "Recurrent laryngeal",
"C": "Facial",
"D": "Glossopharyngeal"
} | step1 | D | [
"year old man",
"physician",
"of",
"2 month history",
"episodes",
"shortness",
"breath",
"lightheadedness",
"palpitations",
"examination",
"reports",
"onset",
"one",
"episode",
"pulse",
"min",
"regular",
"respirations",
"min",
"blood pressure",
"100 65 mm Hg",
"ECG shows",
... |
A 20-year-old man comes to the physician because he believes he has low testosterone. He states that he is embarrassed at his lack of musculature, despite lifting weights twice daily. Every day, he drinks a gallon of milk and several protein shakes in addition to 3 large meals. He is convinced that his female classmate... | Body dysmorphic disorder | {
"A": "Avoidant personality disorder",
"B": "Body dysmorphic disorder",
"C": "Binge eating disorder",
"D": "Generalized anxiety disorder"
} | step1 | B | [
"20 year old man",
"physician",
"low testosterone",
"states",
"embarrassed",
"lack",
"musculature",
"lifting weights twice daily",
"day",
"drinks",
"gallon",
"milk",
"several protein shakes in addition to",
"large meals",
"female classmates",
"community college",
"attends",
"laughi... |
Clinical study looks at the effect of childhood exposure of 2nd-hand smoking on the incidence of bronchogenic adenocarcinoma (BA). Study of 100 subjects (50 exposed to childhood 2nd-hand smoking and 50 healthy controls with no childhood exposure) involves monitoring the lifetime incidence of BA data from the study are ... | The NNH is inversely correlated with the relative risk increase. | {
"A": "If the incidence of BA increases in the control group, the NNH will decrease.",
"B": "If the incidence of BA increases in the experimental group, the NNH will increase.",
"C": "The NNH is inversely correlated with the relative risk increase.",
"D": "If the absolute risk in the exposed group increases, t... | step2&3 | C | [
"Clinical study looks",
"effect",
"childhood exposure",
"2nd hand smoking",
"incidence",
"adenocarcinoma",
"Study",
"100 subjects",
"50 exposed",
"childhood 2nd hand smoking",
"50 healthy controls",
"childhood exposure",
"monitoring",
"lifetime incidence",
"BA data",
"study",
"shown"... |
Two patients are vaccinated for poliomyelitis. Patient A receives the Sabin oral vaccine, and Patient B receives the Salk intramuscular vaccine. Six weeks after their initial vaccinations, which of the following would be the greatest difference regarding these two patients? | Patient A has a higher level of duodenal IgA antibodies | {
"A": "Patient A has a higher level of duodenal IgA antibodies",
"B": "Patient A has a lower level of serum IgA antibodies",
"C": "Patient B has a lower level of serum IgM antibodies",
"D": "Patient A has a higher level of serum IgG antibodies"
} | step1 | A | [
"Two patients",
"vaccinated",
"poliomyelitis",
"Patient",
"receives",
"Sabin oral vaccine",
"Patient",
"receives",
"Salk intramuscular vaccine",
"Six weeks",
"initial vaccinations",
"following",
"greatest difference",
"two patients"
] |
A 71-year-old woman comes to the physician because of dizziness and intermittent episodes of heart palpitations for 5 days. During this time, she has also had one episode of syncope. An ECG shows absence of P waves and irregular RR intervals. Treatment with an antiarrhythmic drug is initiated. The effect of the drug on... | Voltage-gated potassium channels | {
"A": "Voltage-gated nonselective cation channels",
"B": "Voltage-gated sodium channels",
"C": "Voltage-gated potassium channels",
"D": "Voltage-gated chloride channels"
} | step1 | C | [
"71 year old woman",
"physician",
"dizziness",
"intermittent episodes of heart",
"5 days",
"time",
"one episode of syncope",
"ECG shows absence",
"P waves",
"irregular RR intervals",
"Treatment",
"antiarrhythmic drug",
"initiated",
"effect of",
"drug",
"cardiac action potential",
"sh... |
A 53-year-old woman presents to her primary care physician in order to discuss the results of a biopsy. Two weeks ago, her mammogram revealed the presence of suspicious calcifications in her right breast, and she subsequently underwent biopsy of these lesions. Histology of the lesions revealed poorly cohesive cells gro... | High grade and low stage | {
"A": "High grade and high stage",
"B": "High grade and no stage",
"C": "High grade and low stage",
"D": "Low grade and high stage"
} | step1 | C | [
"year old woman presents",
"primary care physician",
"order to discuss",
"results",
"biopsy",
"Two weeks",
"mammogram revealed",
"presence",
"suspicious calcifications",
"right breast",
"biopsy",
"lesions",
"Histology",
"lesions revealed poorly cohesive cells",
"sheets",
"nuclear",
"... |
A graduate student is developing the research design for a current project on the detection of ovarian tumor markers in mice. The main method requires the use of chromogenic substrates, in which a reaction may be interpreted according to an enzyme-mediated color change. The detection of which of the substances below is... | P24 antigen | {
"A": "ABO blood types",
"B": "Anti-D antibodies",
"C": "P24 antigen",
"D": "Epstein-Barr virus infection"
} | step1 | C | [
"graduate student",
"research",
"current project",
"the detection of ovarian tumor markers",
"mice",
"main method",
"use of chromogenic substrates",
"reaction",
"interpreted according",
"enzyme mediated color change",
"detection",
"substances",
"used",
"clinical practice",
"applies",
"... |
A 12-year-old boy is brought to the physician because of a 6-day history of gradually worsening left knee pain. The pain is exacerbated by movement and kneeling. There is no pain at rest and no history of trauma to the knee. He is concerned because his soccer tryouts are in a few days. Vital signs are within normal lim... | Traction apophysitis of the tibial tubercle | {
"A": "Impingement of the infrapatellar fat pad",
"B": "Chondromalacia patella",
"C": "Traction apophysitis of the tibial tubercle",
"D": "Osteochondritis dissecans of the knee"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"6-day history",
"worsening left",
"pain",
"exacerbated",
"movement",
"kneeling",
"pain at rest",
"history",
"trauma",
"knee",
"concerned",
"soccer",
"few days",
"Vital signs",
"normal limits",
"Examination shows mild swelling",
"tenderne... |
A 17-year-old teenager presents to the clinic with her parents complaining of headaches and loss of vision which began insidiously 3 months ago. She describes her headaches as throbbing, mostly on her forehead, and severe enough to affect her daily activities. She has not experienced menarche. Past medical history is n... | Gonadotropins | {
"A": "Thyroid-stimulating hormone",
"B": "Gonadotropins",
"C": "Adrenocorticotropic hormone",
"D": "Prolactin"
} | step1 | B | [
"year old teenager presents",
"clinic",
"parents",
"headaches",
"loss of vision",
"began",
"months",
"headaches",
"throbbing",
"mostly",
"forehead",
"severe",
"to affect",
"daily activities",
"not",
"menarche",
"Past medical history",
"takes",
"medication",
"parents",
"alive"... |
A healthy 31-year-old woman comes to the physician because she is trying to conceive. She is currently timing the frequency of intercourse with at-home ovulation test kits. An increase in the levels of which of the following is the best indicator that ovulation has occurred? | Progesterone | {
"A": "Estrogen",
"B": "Gonadotropin-releasing hormone",
"C": "Progesterone",
"D": "Luteinizing hormone\n\""
} | step1 | C | [
"healthy 31 year old woman",
"physician",
"to",
"currently timing",
"frequency",
"intercourse",
"at-home ovulation test kits",
"increase",
"levels",
"following",
"best indicator",
"ovulation",
"occurred"
] |
A 32-year-old man presents with a 2-month history of increasing lethargy, frequent upper respiratory tract infections, and easy bruising. Past medical history is unremarkable. The patient reports a 14-pack-year smoking history and says he drinks alcohol socially. No significant family history. His vital signs include: ... | Aplastic anemia | {
"A": "Aplastic anemia",
"B": "Infectious mononucleosis",
"C": "Acute lymphocytic leukemia",
"D": "Drug-induced immune pancytopenia"
} | step2&3 | A | [
"year old man presents",
"month history",
"increasing lethargy",
"frequent upper respiratory tract infections",
"easy bruising",
"Past medical history",
"unremarkable",
"patient reports",
"pack-year smoking history",
"drinks alcohol",
"significant family history",
"vital signs include",
"tem... |
A 2-year-old boy is brought to the physician for evaluation of delayed onset of speech. Over the past year, he has also had recurrent dizziness and three episodes of syncope. Examination of the ears shows clear auditory canals and intact tympanic membranes with normal light reflexes. Visual reinforcement audiometry sho... | Prolongation of the QT interval | {
"A": "Pseudo-right bundle branch block",
"B": "Slurred upstroke of the QRS complex",
"C": "Absence of P waves",
"D": "Prolongation of the QT interval"
} | step1 | D | [
"2 year old boy",
"brought",
"physician",
"evaluation",
"delayed onset",
"speech",
"past year",
"recurrent dizziness",
"three episodes of syncope",
"Examination",
"ears shows clear auditory canals",
"intact tympanic membranes",
"normal light reflexes",
"Visual reinforcement audiometry show... |
A 33-year-old man is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oxim... | Observation and follow-up | {
"A": "Suprapubic catheterization",
"B": "Intravenous pyelography",
"C": "Laparotomy",
"D": "Observation and follow-up"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department 20 minutes",
"control",
"bicycle",
"parked car",
"bicycle hit",
"lower abdomen",
"arrival",
"alert",
"oriented",
"pulse",
"90 min",
"respirations",
"min",
"blood pressure",
"70 mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen ... |
Four days after admission to the hospital for acute pancreatitis, a 41-year-old man develops hypotension and fever. His temperature is 39.1°C (102.3°F), pulse is 115/min, and blood pressure is 80/60 mm Hg. Physical examination shows warm extremities, asymmetric calf size, and blood oozing around his IV sites. There are... | ↑ ↑ ↓ ↑ | {
"A": "↑ ↑ ↓ normal",
"B": "Normal normal normal normal",
"C": "↑ ↑ ↓ ↑",
"D": "Normal normal normal ↑"
} | step1 | C | [
"Four days",
"admission",
"hospital",
"acute",
"year old man",
"hypotension",
"fever",
"temperature",
"pulse",
"min",
"blood pressure",
"80 60 mm Hg",
"Physical examination shows warm extremities",
"asymmetric calf size",
"blood",
"IV sites",
"numerous small",
"red",
"non blanchi... |
A 38-year-old man with a history of hypertension presents to his primary care physician for a headache and abdominal pain. His symptoms began approximately 1 week ago and have progressively worsened. He describes his headache as pressure-like and is mildly responsive to ibuprofen. His abdominal pain is located in the b... | Mitral valve prolapse | {
"A": "Epilepsy",
"B": "Lymphangioleiomyomatosis",
"C": "Mitral valve prolapse",
"D": "Neuroendocrine pancreatic tumor"
} | step2&3 | C | [
"year old man",
"history of hypertension presents",
"primary care physician",
"headache",
"abdominal pain",
"symptoms began approximately",
"week",
"worsened",
"headache",
"pressure",
"mildly responsive",
"ibuprofen",
"abdominal pain",
"bilateral flank area",
"hypertension",
"poorly ma... |
A 22-year-old woman comes to the physician because of a 1-week history of nausea and vomiting. She has not had fever, abdominal pain, diarrhea, or vaginal bleeding. She does not remember the date of her last menstrual period. She uses oral contraceptive pills but occasionally forgot to take them. She had pelvic inflamm... | Transvaginal ultrasound in 4 days | {
"A": "Administer misoprostol now",
"B": "Transvaginal ultrasound in 4 days",
"C": "Schedule dilation and evacuation",
"D": "Administer methotrexate now"
} | step2&3 | B | [
"year old woman",
"physician",
"1-week history",
"nausea",
"vomiting",
"not",
"fever",
"abdominal pain",
"diarrhea",
"vaginal bleeding",
"not remember",
"date of",
"last menstrual period",
"uses oral contraceptive pills",
"occasionally forgot to take",
"pelvic inflammatory disease",
... |
A 52-year-old man with chronic kidney disease presents for significant back pain that has gotten worse in the past 2 days. On exam, the patient has a moderate kyphosis with decreased range of motion of the spine secondary to pain. The patient has no neurologic deficits but is in severe pain. Lab work reveals a low norm... | Increased bone turnover | {
"A": "Markedly increased PTH",
"B": "Drastic decrease in estrogen",
"C": "Increased bone turnover",
"D": "Decreased production of calcifediol"
} | step1 | C | [
"year old man",
"chronic kidney disease presents",
"significant back pain",
"gotten worse",
"past 2 days",
"exam",
"patient",
"moderate kyphosis",
"decreased range of motion",
"spine secondary to pain",
"patient",
"neurologic deficits",
"severe pain",
"Lab work reveals",
"low normal",
... |
A 32-year-old woman brought to the emergency department because of a 1-week history of palpitations and shortness of breath. She has congestive heart failure. Current medications include furosemide, lisinopril, and atenolol. Her pulse is 124/min and irregularly irregular, and blood pressure is 110/70 mm Hg. Examination... | Increase in vagal tone | {
"A": "Inhibition of myocardial Na+/K+ ATPase",
"B": "Inhibition of AV node L-type Ca2+ channels",
"C": "Increase in vagal tone",
"D": "Decrease in intracellular cAMP"
} | step1 | C | [
"year old woman brought",
"emergency department",
"of",
"1-week history",
"palpitations",
"shortness of breath",
"congestive heart failure",
"Current medications include furosemide",
"lisinopril",
"atenolol",
"pulse",
"min",
"irregular",
"blood pressure",
"70 mm Hg",
"Examination shows... |
A 65-year-old man presents to the physician with pain in his right calf over the last 3 months. He mentions that the pain typically occurs after he walks approximately 100 meters and subsides after resting for 5 minutes. His medical history is significant for hypercholesterolemia, ischemic heart disease, and bilateral ... | Cilostazol | {
"A": "Acetaminophen",
"B": "Cilostazol",
"C": "Isosorbide dinitrate",
"D": "Ranolazine"
} | step1 | B | [
"65 year old man presents",
"physician",
"pain in",
"right calf",
"last",
"months",
"pain",
"occurs",
"walks approximately 100 meters",
"resting",
"5 minutes",
"medical history",
"significant",
"hypercholesterolemia",
"ischemic heart disease",
"bilateral knee osteoarthritis",
"curren... |
An investigator is studying mechanisms of urea excretion in humans. During the experiment, a healthy male volunteer receives a continuous infusion of para-aminohippurate (PAH) to achieve a PAH plasma concentration of 0.01 mg/mL. A volume of 1.0 L of urine is collected over a period of 10 hours; the urine flow rate is 1... | 25 mg/min | {
"A": "25 mg/min",
"B": "124 mg/min",
"C": "7 mg/min",
"D": "166 mg/min"
} | step1 | A | [
"investigator",
"studying mechanisms",
"urea excretion",
"humans",
"experiment",
"healthy male volunteer receives",
"continuous infusion",
"para-aminohippurate",
"to",
"PAH plasma concentration",
"0.01 mg/mL",
"volume of 1.0",
"urine",
"collected",
"period",
"10 hours",
"urine flow r... |
A 22-year-old student presents to the college health clinic with a 1-week history of fever, sore throat, nausea, and fatigue. He could hardly get out of bed this morning. There are no pets at home. He admits to having recent unprotected sex. The vital signs include: temperature 38.3°C (101.0°F), pulse 72/min, blood pre... | Infectious mononucleosis | {
"A": "Acute HIV infection",
"B": "Toxoplasma infection",
"C": "Infectious mononucleosis",
"D": "Streptococcal pharyngitis"
} | step1 | C | [
"year old student presents",
"college health clinic",
"1-week history",
"fever",
"sore throat",
"nausea",
"fatigue",
"get out",
"bed",
"morning",
"pets at home",
"admits to",
"recent unprotected sex",
"vital signs include",
"temperature",
"3C",
"pulse 72 min",
"blood pressure",
"... |
An 18-year-old man presents to the emergency department after an automobile accident. His vitals have significantly dropped since admission. Upon examination, his abdomen is slightly distended, the ribs on the right side are tender and appear broken, and breath sounds are diminished at the base of the right lung. An ab... | Hepatoduodenal ligament | {
"A": "Aorta above coeliac axis",
"B": "Hepatic vein only",
"C": "Hepatoduodenal ligament",
"D": "Splenic artery only"
} | step2&3 | C | [
"year old man presents",
"emergency department",
"automobile accident",
"dropped",
"admission",
"examination",
"abdomen",
"slightly distended",
"ribs on",
"right side",
"tender",
"appear",
"breath sounds",
"diminished",
"base of",
"right lung",
"abdominal ultrasound",
"chest X-ray"... |
A 52-year-old woman comes to the physician because of a 3-month history of worsening chest pain and breathlessness during exercise. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Auscultation of the chest shows a murmur in the 2nd right intercostal space. A phonoca... | Congenital leaflet fusion | {
"A": "Metastatic valvular calcification",
"B": "Congenital leaflet fusion",
"C": "Sterile platelet thrombi formation",
"D": "Viridans group streptococci infection"
} | step1 | B | [
"year old woman",
"physician",
"of",
"3 month history",
"worsening chest pain",
"breathlessness",
"exercise",
"history",
"serious illness",
"takes",
"medications",
"Vital signs",
"normal limits",
"Auscultation",
"chest shows",
"murmur",
"2nd right intercostal space",
"phonocardiogr... |
A 45-year-old woman with type 2 diabetes mellitus is brought to the physician because of a 3-week history of nausea, abdominal pain, and confusion. She has a history of gastroesophageal reflux disease treated with over-the-counter antacids. She does not smoke or drink alcohol. Her only medication is metformin. Her puls... | 24,25-dihydroxycholecalciferol | {
"A": "Thyroid stimulating hormone",
"B": "β-hydroxybutyrate",
"C": "Phosphate",
"D": "24,25-dihydroxycholecalciferol"
} | step1 | D | [
"year old woman",
"type 2 diabetes mellitus",
"brought",
"physician",
"3 week history",
"nausea",
"abdominal pain",
"confusion",
"history of gastroesophageal reflux disease treated with over-the-counter antacids",
"not smoke",
"drink alcohol",
"only medication",
"metformin",
"pulse",
"mi... |
A 3-week-old male newborn is brought to the physician by his 33-year-old mother for a well-child examination. He was born at term and delivered at home because his parents wanted a natural childbirth. The mother did not receive prenatal care. She has no history of serious illness and takes no medications. According to ... | Hemorrhage | {
"A": "Hemorrhage",
"B": "Iron deficiency anemia",
"C": "Diabetes mellitus",
"D": "Intussusception"
} | step2&3 | A | [
"3 week old male newborn",
"brought",
"physician",
"year old mother",
"well",
"born",
"term",
"delivered at home",
"parents wanted",
"natural childbirth",
"mother",
"not receive prenatal care",
"history",
"serious illness",
"takes",
"medications",
"mother",
"delivery",
"fast",
... |
A 38-year-old woman comes to the physician because of a 4-month history of crampy abdominal pain, recurrent watery diarrhea, and a 2.5-kg (5.5-lb) weight loss. Her husband has noticed that after meals, her face and neck sometimes become red, and she develops shortness of breath and starts wheezing. Examination shows a ... | Pigmented dermatitis | {
"A": "Laryngeal edema",
"B": "Pigmented dermatitis",
"C": "Megaloblastic anemia",
"D": "T-cell lymphoma"
} | step1 | B | [
"year old woman",
"physician",
"4 month history",
"crampy abdominal pain",
"recurrent watery",
"2.5 kg",
"5.5",
"weight loss",
"husband",
"meals",
"face",
"neck sometimes",
"red",
"shortness of breath",
"starts wheezing",
"Examination shows",
"grade",
"6 systolic murmur heard best"... |
A 23-year-old man presents to his primary care physician with 2 weeks of headache, palpitations, and excessive sweating. He has no past medical history and his family history is significant for clear cell renal cell carcinoma in his father as well as retinal hemangioblastomas in his older sister. On presentation his te... | 3 | {
"A": "2",
"B": "3",
"C": "10",
"D": "11"
} | step1 | B | [
"23 year old man presents",
"primary care physician",
"2 weeks",
"headache",
"palpitations",
"excessive sweating",
"past medical history",
"family history",
"significant",
"clear cell renal cell carcinoma",
"father",
"retinal hemangioblastomas",
"older sister",
"presentation",
"temperatu... |
A 17-year-old male presents to the emergency department after a knife fight. He initially refused to come to the hospital, but one of his wounds overlying the right antecubital fossa would not stop bleeding. Vitals include: BP 90/65, HR 115, and RR 24. He reports that he is light-headed and having visual changes. You h... | Measure forearm compartment pressures | {
"A": "Watchful waiting",
"B": "Compressive bandage",
"C": "Measure forearm compartment pressures",
"D": "Nerve block"
} | step1 | C | [
"year old male presents",
"emergency department",
"knife fight",
"initially refused to",
"hospital",
"one",
"wounds",
"right antecubital fossa",
"not stop bleeding",
"include",
"BP 90 65",
"RR",
"reports",
"light-headed",
"visual changes",
"hold direct pressure",
"wound",
"right ar... |
A 59-year-old woman is admitted to the intensive care unit after surgery following a motor vehicle collision. She has received a total of four units of packed red blood cells. Physical examination shows dry mucous membranes and flat neck veins. Serum studies show a creatinine of 2.1 mg/dL and urine microscopy shows gra... | Swelling of the mitochondria | {
"A": "Vacuolization of the endoplasmatic reticulum",
"B": "Rupture of lysosomes",
"C": "Swelling of the mitochondria",
"D": "Release of cytochrome C"
} | step1 | C | [
"59 year old woman",
"admitted to",
"intensive care unit",
"surgery following",
"motor vehicle collision",
"received",
"total",
"units",
"packed red blood cells",
"Physical examination shows dry mucous membranes",
"flat neck veins",
"Serum studies show",
"creatinine",
"mg/dL",
"urine mic... |
A 35-year-old man is brought to the emergency department 30 minutes after being involved in a motor vehicle collision. The patient was on his way to work before he lost control of his car and crashed into a tree. On arrival, the patient appears weak and lethargic. He has pain in his abdomen. His temperature is 37°C (98... | Diagnostic peritoneal lavage | {
"A": "CT scan of the abdomen",
"B": "Exploratory laparotomy",
"C": "X-ray of the abdomen",
"D": "Diagnostic peritoneal lavage"
} | step2&3 | D | [
"35 year old man",
"brought",
"emergency department 30 minutes",
"involved",
"motor vehicle collision",
"patient",
"to work",
"lost control",
"car",
"tree",
"arrival",
"patient appears weak",
"lethargic",
"pain",
"abdomen",
"temperature",
"98",
"pulse",
"min",
"respirations",
... |
A 41-year-old woman presents with occasional dyspareunia and vaginal bleeding after a sexual encounter. She is in a monogamous relationship and uses oral contraception. She does not have a family history of gynecologic malignancies. She has smoked 1 pack of cigarettes per day for 15 years and drinks several glasses of ... | p53 | {
"A": "p53",
"B": "Myc",
"C": "Btk",
"D": "c-Src"
} | step1 | A | [
"year old woman presents",
"occasional dyspareunia",
"vaginal bleeding",
"sexual encounter",
"monogamous relationship",
"uses oral contraception",
"not",
"family history",
"gynecologic malignancies",
"smoked 1 pack",
"cigarettes",
"day",
"years",
"drinks several glasses",
"wine daily",
... |
A 23-year-old man is brought to the emergency department because of severe right shoulder pain and inability to move the shoulder for the past 30 minutes. The pain began after being tackled while playing football. He has nausea but has not vomited. He is in no apparent distress. Examination shows the right upper extrem... | Test sensation of the lateral shoulder | {
"A": "Neer impingement test",
"B": "Closed reduction",
"C": "Test sensation of the lateral shoulder",
"D": "Drop arm test"
} | step2&3 | C | [
"23 year old man",
"brought",
"emergency department",
"severe right shoulder pain",
"to move",
"shoulder",
"past 30 minutes",
"pain began",
"playing football",
"nausea",
"not vomited",
"apparent distress",
"Examination shows",
"right upper extremity externally rotated",
"slightly",
"Pa... |
A 20-year-old man is found lying unconscious on the floor of his room by his roommate. The paramedics arrive at the site and find him unresponsive with cold, clammy extremities and constricted, non-reactive pupils. He smells of alcohol and his vital signs show the following: blood pressure 110/80 mm Hg, pulse 100/min, ... | Naloxone | {
"A": "Ethanol",
"B": "Methadone",
"C": "Naloxone",
"D": "Atropine"
} | step1 | C | [
"20 year old man",
"found lying unconscious",
"floor",
"room",
"roommate",
"paramedics",
"site",
"find",
"unresponsive",
"cold",
"clammy extremities",
"constricted",
"non-reactive pupils",
"smells",
"alcohol",
"vital signs show",
"following",
"blood pressure",
"80 mm Hg",
"puls... |
A 22-year-old woman presents with a complaint of low energy levels for the past 6 months. She feels as if she has no energy to do anything and has lost interest in photography, which she was previously passionate about. Feelings of hopelessness occupy her mind and she can no longer focus at work. She says she forces he... | History of bulimia nervosa | {
"A": "History of bulimia nervosa",
"B": "Age of 22 years",
"C": "BMI of 24 kg/m2",
"D": "Esomeprazole usage"
} | step1 | A | [
"year old woman presents",
"complaint",
"low energy levels",
"past 6 months",
"feels",
"energy",
"lost interest",
"photography",
"passionate",
"Feelings of hopelessness",
"mind",
"longer focus",
"work",
"forces",
"to hang out",
"friends",
"weekends",
"home",
"denies",
"suicidal... |
An 11-year-old girl presents to her pediatrician for evaluation of asymmetry that was detected during routine school screening. Specifically, she was asked to bend forwards while the school nurse examined her back. While leaning forward, her right scapula was found to be higher than her left scapula. She was also found... | Restrictive lung disease | {
"A": "Congestive heart failure",
"B": "Dislocation of the shoulders",
"C": "Obstructive lung disease",
"D": "Restrictive lung disease"
} | step1 | D | [
"year old girl presents",
"pediatrician",
"evaluation",
"asymmetry",
"detected",
"routine school screening",
"to bend forwards",
"school nurse examined",
"back",
"forward",
"right scapula",
"found to",
"higher",
"left scapula",
"found to",
"prominent line",
"spinal processes",
"mid... |
A group of investigators is studying the effects of aberrant protein isoforms on the pathogenesis of lung cancer. They observe that three protein isoforms are transcribed from the same 30,160 base-pair-long DNA segment on chromosome 13q. The canonical protein has a primary peptide sequence of 1186 amino acids. The seco... | Alternative pre-mRNA splicing | {
"A": "Site-specific recombination",
"B": "Alternative pre-mRNA splicing",
"C": "RNA interference",
"D": "Post-translational protein trimming"
} | step1 | B | [
"A group",
"investigators",
"studying",
"effects",
"aberrant protein isoforms",
"the pathogenesis of lung cancer",
"observe",
"three protein isoforms",
"same 30",
"base-pair long DNA segment",
"chromosome 13q",
"protein",
"primary peptide sequence",
"amino acids",
"second isoform",
"am... |
A 54-year-old woman comes to the physician because of paresthesias and weakness in her left leg for one year. Her symptoms have become progressively worse during this period and have led to some difficulty walking for the past month. She has had frequent headaches for the past 4 months. She has a history of hypertensio... | Surgical resection | {
"A": "Surgical resection",
"B": "Stereotactic brain biopsy",
"C": "Stereotactic radiosurgery",
"D": "Intrathecal methotrexate therapy"
} | step2&3 | A | [
"54 year old woman",
"physician",
"paresthesias",
"weakness",
"left",
"one year",
"symptoms",
"worse",
"period",
"led",
"difficulty walking",
"past month",
"frequent headaches",
"past",
"months",
"history of hypertension",
"hypothyroidism",
"Current medications include amlodipine",... |
The rapid response team is called for a 74-year-old woman on an inpatient surgical floor for supraventricular tachycardia. The patient had surgery earlier in the day for operative management of a femur fracture. The patient has a history of hypertension, atherosclerosis, type 2 diabetes, and uterine cancer status post ... | Atherosclerosis | {
"A": "Atherosclerosis",
"B": "Diabetes",
"C": "Hypertension",
"D": "Malignancy"
} | step1 | A | [
"rapid response team",
"called",
"74 year old woman",
"inpatient surgical floor",
"supraventricular tachycardia",
"patient",
"surgery earlier",
"day",
"operative management of",
"femur fracture",
"patient",
"history of hypertension",
"atherosclerosis",
"type 2 diabetes",
"uterine cancer ... |
A 42-year-old woman presents with exertional dyspnea and fatigue for the past 3 months. Her past medical history is significant for multiple episodes of mild diarrhea for many years, which was earlier diagnosed as irritable bowel syndrome (IBS). She denies any current significant gastrointestinal symptoms. The patient ... | Non-tropical sprue | {
"A": "Small intestinal bacterial overgrowth",
"B": "Non-tropical sprue",
"C": "Whipple's disease",
"D": "Irritable bowel disease"
} | step1 | B | [
"year old woman presents",
"exertional dyspnea",
"fatigue",
"past 3 months",
"past medical history",
"significant",
"multiple episodes of mild diarrhea",
"years",
"earlier diagnosed",
"irritable bowel syndrome",
"denies",
"current significant gastrointestinal symptoms",
"patient",
"afebril... |
A 24-year-old woman in graduate school comes to the physician for recurrent headaches. The headaches are unilateral, throbbing, and usually preceded by blurring of vision. The symptoms last between 12 and 48 hours and are only relieved by lying down in a dark room. She has approximately two headaches per month and has ... | Activation of 5-HT1 receptors | {
"A": "Inhibition of β1- and β2-adrenergic receptors",
"B": "Activation of 5-HT1 receptors",
"C": "Inhibition of 5-HT and NE reuptake",
"D": "Inhibition of voltage-dependent Na+ channels"
} | step1 | B | [
"year old woman",
"graduate school",
"physician",
"recurrent headaches",
"headaches",
"unilateral",
"throbbing",
"usually preceded",
"blurring of vision",
"symptoms last",
"48 hours",
"only relieved by lying",
"dark room",
"approximately two headaches",
"month",
"missed",
"days",
"... |
A 24-year-old woman comes to the physician because of pain and swelling of her left leg over the past 24 hours. The pain is worse while walking and improves when resting. Seven months ago, she was diagnosed with a pulmonary embolism and was started on warfarin. Anticoagulant therapy was discontinued 1 month ago. Her si... | Mutation of coagulation factor V | {
"A": "Antiphospholipid antibodies",
"B": "Mutation of coagulation factor V",
"C": "Elevated levels of homocysteine",
"D": "Deficiency of protein C"
} | step2&3 | B | [
"year old woman",
"physician",
"pain",
"swelling of",
"left leg",
"past 24 hours",
"pain",
"worse",
"walking",
"improves",
"resting",
"Seven months",
"diagnosed",
"pulmonary embolism",
"started",
"warfarin",
"Anticoagulant",
"discontinued 1 month",
"sister",
"systemic lupus ery... |
A 23-year-old woman visits her general practitioner with left ear pain and fever. She complains of multiple episodes of respiratory infection including bronchitis, laryngitis, and sinusitis. She was diagnosed with systemic lupus erythematosus with nephritis 8 months ago and was placed on oral prednisone. Currently, she... | NF-kß pathways | {
"A": "Wnt pathway",
"B": "NF-kß pathways",
"C": "PI3K/AKT/mTOR pathway",
"D": "Notch pathway"
} | step1 | B | [
"23 year old woman visits",
"general",
"left",
"fever",
"of multiple episodes",
"respiratory infection including bronchitis",
"laryngitis",
"sinusitis",
"diagnosed",
"systemic lupus erythematosus",
"nephritis",
"months",
"placed",
"oral prednisone",
"Currently",
"takes prednisone daily... |
A 16-year-old girl with celiac disease is brought to the physician because of a 1-week history of generalized weakness and tingling around her mouth and in her fingertips. She also complains of abdominal cramps and nausea. In addition to following a gluten-free diet, she has been following a vegan diet for the past 2 y... | Decreased intestinal absorption of ergocalciferol | {
"A": "Decreased levels of renal 1α-hydroxylase",
"B": "Decreased dietary intake of ergocalciferol",
"C": "Decreased intestinal absorption of ergocalciferol",
"D": "Autoimmune-mediated destruction of parathyroid tissue"
} | step1 | C | [
"year old girl",
"celiac disease",
"brought",
"physician",
"1-week history",
"generalized weakness",
"tingling",
"mouth",
"fingertips",
"abdominal cramps",
"nausea",
"following",
"gluten-free diet",
"following",
"vegan diet",
"past",
"years",
"Physical examination shows involuntary... |
A 7-year-old girl is brought to the physician because of vaginal bleeding for 2 days. There is no personal or family history of serious illness. She is at the 95th percentile for height and at the 90th percentile for weight. Examination shows enlarged breasts, and the areola and papilla have formed a secondary mound. T... | GnRH stimulation test | {
"A": "MRI of the brain",
"B": "Ultrasound of the pelvis",
"C": "GnRH stimulation test",
"D": "Serum dehydroepiandrosterone level"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"of vaginal bleeding",
"2 days",
"personal",
"family history",
"serious illness",
"95th percentile",
"height",
"90th percentile",
"weight",
"Examination shows enlarged breasts",
"areola",
"papilla",
"formed",
"secondary",
"coarse pubic",
"... |
An investigator studying disorders of hemostasis performs gene expression profiling in a family with a specific type of bleeding disorder. These patients were found to have abnormally large von Willebrand factor (vWF) multimers in their blood. Genetic analysis shows that the underlying cause is a mutation in the ADAMTS... | Fragmented erythrocytes | {
"A": "Elevated haptoglobin",
"B": "Urinary red blood cell casts",
"C": "Elevated platelet count",
"D": "Fragmented erythrocytes"
} | step1 | D | [
"investigator studying disorders of hemostasis performs gene expression profiling",
"family",
"a specific type",
"bleeding disorder",
"patients",
"found to",
"large von Willebrand factor",
"multimers",
"blood",
"Genetic shows",
"underlying cause",
"mutation",
"ADAMTS13 gene",
"mutation res... |
A 71-year-old Caucasian male presents to your office with bloody diarrhea and epigastric pain that occurs 30 minutes after eating. He has lost 15 pounds in 1 month, which he attributes to fear that the pain will return following a meal. He has a history of hyperlipidemia and myocardial infarction. Physical exam and eso... | Atherosclerosis | {
"A": "Atherosclerosis",
"B": "Peptic ulcer disease",
"C": "Crohn's disease",
"D": "Amyloid deposition"
} | step1 | A | [
"71 year old Caucasian male presents",
"office",
"bloody diarrhea",
"epigastric pain",
"occurs 30 minutes",
"eating",
"lost",
"pounds",
"month",
"attributes to fear",
"pain",
"return following",
"meal",
"history of hyperlipidemia",
"myocardial infarction",
"Physical exam",
"esophagog... |
A 10-year-old boy is brought to the physician with painful and enlarged lymph nodes in his right axilla that was noticed 5 days ago and has slowly grown bigger. He has had weakness, sweating, and poor appetite during this time. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on... | Contact with pets | {
"A": "Contact with pets",
"B": "Frequent infections",
"C": "Swimming",
"D": "Tick bites"
} | step2&3 | A | [
"A 10 year old boy",
"brought",
"physician",
"painful",
"enlarged lymph nodes",
"right axilla",
"5 days",
"slowly",
"bigger",
"weakness",
"sweating",
"poor appetite",
"time",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"dev... |
A 4-year-old boy presents with bloody diarrhea. The patient’s mother states that he was fine this morning, but around midday, she received a call from his daycare center stating that the patient had a single bloody bowel movement. His mother states that there have been no recent changes in his diet, although they did a... | Stool culture in sorbitol-MacConkey medium | {
"A": "Gram stain for gull-winged, curved rods",
"B": "Sigmoidoscopy",
"C": "Stool culture in sorbitol-MacConkey medium",
"D": "Test stool for C. difficile toxins"
} | step1 | C | [
"4 year old boy presents",
"bloody diarrhea",
"patients mother states",
"fine",
"morning",
"midday",
"received",
"call",
"daycare center stating",
"patient",
"single bloody bowel movement",
"mother states",
"recent changes",
"diet",
"attend",
"weekend",
"patient",
"recent history",... |
A 52-year-old male presents with several months of fatigue, malaise, dry cough, and occasional episodes of painless hematuria. He recalls having had a sore throat several days prior to the onset of these symptoms that resolved without antibiotics. Physical exam is remarkable for diffusely coarse breath sounds bilateral... | Microscopic polyangiitis | {
"A": "Diffuse membranous glomerulopathy",
"B": "Microscopic polyangiitis",
"C": "Focal segmental glomerulosclerosis",
"D": "Transitional cell bladder carcinoma"
} | step1 | B | [
"year old male presents",
"months",
"fatigue",
"malaise",
"dry cough",
"occasional episodes of painless hematuria",
"recalls",
"sore throat",
"days prior to",
"onset",
"symptoms",
"resolved",
"antibiotics",
"Physical exam",
"coarse breath sounds",
"Urinalysis reveals 2",
"protein",
... |
A 68-year-old man comes to the physician for a wellness visit. Physical examination shows an enlarged and nodular prostate. Laboratory studies show elevated levels of prostate-specific antigen. A prostate biopsy confirms the diagnosis of prostate cancer and a radical prostatectomy is planned. This patient should be cou... | Cavernous nerve | {
"A": "Cavernous nerve",
"B": "Superior vesical artery",
"C": "External anal sphincter",
"D": "Hypogastric nerve"
} | step1 | A | [
"68 year old man",
"physician",
"wellness visit",
"Physical examination shows",
"enlarged",
"nodular prostate",
"Laboratory studies show elevated levels",
"prostate-specific antigen",
"prostate biopsy confirms the diagnosis of prostate cancer",
"radical prostatectomy",
"planned",
"patient",
... |
An otherwise healthy 15-month-old boy is brought to the emergency department by his mother 1 hour after having a single episode of generalized tonic-clonic seizure, which stopped spontaneously after 1 minute. He was sleepy initially but is now awake and alert. His mother reports that he has had a fever and runny nose f... | Decreasing production of prostaglandin E2 | {
"A": "Increasing duration of Cl− channel opening",
"B": "Decreasing production of prostaglandin E2",
"C": "Inhibiting transpeptidase cross-linking",
"D": "Blocking T-type Ca2+ channels"
} | step1 | B | [
"healthy",
"month old boy",
"brought",
"emergency department",
"mother",
"hour",
"single episode of generalized tonic-clonic seizure",
"stopped",
"minute",
"sleepy initially",
"now awake",
"alert",
"mother reports",
"fever",
"runny nose",
"past 3 days",
"temperature",
"40",
"Phys... |
A previously healthy 53-year-old man is brought to the emergency department 45 minutes after the onset of a severe headache. He returned from a vacation in the mountains 4 days ago, during which he went swimming in a freshwater lake. On arrival, he is confused. His temperature is 39°C (102.2°F) and blood pressure is 10... | Herpes simplex virus | {
"A": "Herpes simplex virus",
"B": "La Crosse virus",
"C": "Enterovirus",
"D": "Rabies virus"
} | step1 | A | [
"healthy",
"year old man",
"brought",
"emergency department 45 minutes",
"onset",
"severe headache",
"returned",
"vacation",
"mountains",
"days",
"swimming",
"freshwater lake",
"arrival",
"confused",
"temperature",
"blood pressure",
"68 mm Hg",
"Neurologic examination shows diffuse... |
A 10-year-old girl is brought to the physician because of itching of the vulva and anal region for the past 2 weeks. She has difficulty sleeping because of the itching. Physical examination shows excoriation marks around the vulva and perianal region. There is minor perianal erythema, but no edema or fissures. Microsco... | Mebendazole | {
"A": "Mebendazole",
"B": "Melarsoprol",
"C": "Diethylcarbamazine",
"D": "Praziquantel"
} | step1 | A | [
"A 10 year old girl",
"brought",
"physician",
"of itching",
"vulva",
"anal region",
"past 2 weeks",
"difficulty sleeping",
"itching",
"Physical examination shows excoriation marks",
"vulva",
"perianal region",
"minor perianal erythema",
"edema",
"fissures",
"Microscopy",
"adhesive ta... |
A 45-year-old female who recently immigrated to the United States presents to the community health clinic for episodes of disrupted vision. She is concerned because she knows several people from her hometown who went blind after having these episodes. Over the past several months, she also has developed itchy bumps on ... | Ivermectin | {
"A": "Diethylcarbamazine",
"B": "Ivermectin",
"C": "Mebendazole",
"D": "Nifurtimox"
} | step1 | B | [
"year old female",
"recently",
"United States presents",
"community clinic",
"episodes of disrupted vision",
"concerned",
"several people",
"blind",
"episodes",
"past",
"months",
"itchy",
"back",
"lower extremities",
"Physical exam reveals black hyperpigmented nodules",
"edema",
"pal... |
A 10-day-old male newborn is brought to the physician by his mother because of difficulty feeding and frequent nonbilious vomiting. His stool is soft and yellow-colored. The pregnancy was complicated by polyhydramnios and results from chorionic villus sampling showed a 47, XY, +21 karyotype. Physical examination shows ... | Rotation of the ventral pancreatic bud | {
"A": "Rotation of the ventral pancreatic bud",
"B": "Foregut septation",
"C": "Ganglion cell migration",
"D": "Umbilical ring closure"
} | step1 | A | [
"A 10 day old male newborn",
"brought",
"physician",
"mother",
"difficulty feeding",
"frequent",
"vomiting",
"stool",
"soft",
"yellow-colored",
"pregnancy",
"complicated",
"polyhydramnios",
"results",
"chorionic villus sampling showed",
"XY",
"karyotype",
"Physical examination show... |
A 24-year-old sexually active man complains of painless growths on his penis. He is worried that he might have transmitted them to his girlfriend. Biopsy shows squamous cells with perinuclear cytoplasmic vacuolization, nuclear enlargement, and koilocytes. The doctor treats the patient by chemically ablating the warts w... | Cervical carcinoma | {
"A": "Kaposi sarcoma",
"B": "Burkitt lymphoma",
"C": "Hepatocellular carcinoma",
"D": "Cervical carcinoma"
} | step1 | D | [
"year old sexually active man",
"painless growths",
"penis",
"worried",
"transmitted",
"girlfriend",
"Biopsy shows squamous cells",
"perinuclear cytoplasmic vacuolization",
"nuclear enlargement",
"koilocytes",
"doctor treats",
"patient",
"chemically ablating",
"warts",
"cryoablation",
... |
A 56-year-old woman is brought to the emergency department by her husband because of slurred speech and left facial droop for the past 30 minutes. During this period, she has also had numbness on the left side of her face. She has never had such an episode before. She has hypertension, hypercholesterolemia, and type 2 ... | Transient ischemic attack | {
"A": "Conversion disorder",
"B": "Partial seizure",
"C": "Transient ischemic attack",
"D": "Multiple sclerosis"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"husband",
"slurred speech",
"left facial droop",
"past 30 minutes",
"period",
"numbness",
"left side of",
"face",
"never",
"episode",
"hypertension",
"hypercholesterolemia",
"type 2 diabetes mellitus",
"father died of lung cancer ... |
A 22-year-old white woman comes to the physician because of a 6-month history of lower abdominal pain. She has also had multiple episodes of loose stools with blood during this period. She has had painful bowel movements for 1 month. Over the past year, she has had a 10-kg (22-lb) weight loss. She was treated for strep... | Confluent inflammation of the colonic mucosa with edema, fibrin-covered ulcers, and loss of vascular pattern | {
"A": "Pseudomembranes overlying regions of colonic inflammation",
"B": "Patchy inflammation of mucosa with cobblestone appearance and intervening areas of normal mucosa",
"C": "Confluent inflammation of the colonic mucosa with edema, fibrin-covered ulcers, and loss of vascular pattern",
"D": "Numerous polyps ... | step2&3 | C | [
"year old white woman",
"physician",
"month history",
"lower abdominal pain",
"multiple episodes of loose stools",
"blood",
"period",
"painful bowel movements",
"month",
"past year",
"a 10 kg",
"weight loss",
"treated",
"streptococcal pharyngitis",
"week",
"maternal grandfather died of... |
A 44-year-old woman comes to the physician with increasingly yellow sclera and pruritus over the past 3 months. She has intermittent right-upper-quadrant pain and discomfort. She has no history of any serious illnesses and takes no medications. Her vital signs are within normal limits. Her sclera are icteric. Skin exam... | Rectosigmoidoscopy | {
"A": "Endoscopic retrograde cholangiopancreatography (ERCP)",
"B": "Liver biopsy",
"C": "Rectosigmoidoscopy",
"D": "Upper endoscopy"
} | step2&3 | C | [
"year old woman",
"physician",
"yellow sclera",
"pruritus",
"past 3 months",
"intermittent right-upper-quadrant pain",
"discomfort",
"history",
"serious illnesses",
"takes",
"medications",
"vital signs",
"normal limits",
"sclera",
"icteric",
"Skin examination shows linear scratch marks... |
A 62-year-old woman presents with sudden onset of vertigo, difficulty walking, sensory changes on the left side of her face and the right side of the body, and left facial drooping. Her past medical history is significant for hypertension and hypercholesterolemia. On physical examination, there is left-sided Horner’s s... | Anterior inferior cerebellar artery (AICA) | {
"A": "Anterior spinal artery (ASA)",
"B": "Anterior inferior cerebellar artery (AICA)",
"C": "Posterior cerebral artery (PCA)",
"D": "Basilar artery"
} | step1 | B | [
"62 year old woman presents",
"sudden onset",
"vertigo",
"difficulty walking",
"sensory changes",
"left side of",
"face",
"right side of",
"body",
"left facial drooping",
"past medical history",
"significant",
"hypertension",
"hypercholesterolemia",
"physical examination",
"left-sided ... |
A previously healthy 15-year-old girl is brought to the emergency department 24 hours after the onset of a severe headache. She returned from a 1-week camping trip 3 days ago; she went spelunking and swimming in a freshwater lake during the trip. She is agitated, uncooperative, and oriented only to person. Her temperat... | Herpes simplex virus | {
"A": "West Nile virus",
"B": "La Crosse virus",
"C": "Enterovirus",
"D": "Herpes simplex virus"
} | step2&3 | D | [
"healthy",
"year old girl",
"brought",
"emergency department 24 hours",
"onset",
"severe headache",
"returned",
"1-week camping trip 3 days",
"spelunking",
"swimming",
"freshwater lake",
"trip",
"agitated",
"uncooperative",
"oriented only",
"person",
"temperature",
"pulse",
"min"... |
A 60-year-old man is brought to the emergency department 25 minutes after falling and hitting his left flank on a concrete block. He has severe left-sided chest pain and mild shortness of breath. He underwent a right knee replacement surgery 2 years ago. He has type 2 diabetes mellitus. He has smoked one pack of cigare... | Adequate analgesia and conservative management | {
"A": "Continuous positive airway pressure",
"B": "Admission and surveillance in the intensive care unit",
"C": "Adequate analgesia and conservative management",
"D": "Internal fixation"
} | step2&3 | C | [
"60 year old man",
"brought",
"emergency department",
"minutes",
"falling",
"hitting",
"left flank",
"concrete block",
"severe left-sided chest pain",
"mild shortness of breath",
"right surgery 2 years",
"type 2 diabetes mellitus",
"smoked one pack",
"cigarettes daily",
"years",
"Curre... |
A 26-year-old woman presents to her primary care physician because she has been experiencing occasional fevers and chills for the last 3 weeks. She says that the fevers have been accompanied by abdominal pain and increased vaginal discharge. On presentation her temperature is 101.0°F (38.3°C), blood pressure is 113/75 ... | Cell wall synthesis inhibitor | {
"A": "Cell wall synthesis inhibitor",
"B": "DNA synthesis inhibitor",
"C": "Folic acid synthesis inhibitor",
"D": "RNA synthesis inhibitor"
} | step1 | A | [
"year old woman presents",
"primary care physician",
"experiencing occasional fevers",
"chills",
"weeks",
"fevers",
"abdominal pain",
"increased vaginal discharge",
"presentation",
"temperature",
"3C",
"blood pressure",
"75 mmHg",
"pulse",
"min",
"respirations",
"min",
"physical ex... |
A 38-year-old man comes to the physician because of a 3-week history of right-sided knee pain. He works as a bricklayer and reports that the pain worsens when he kneels. He has no history of trauma. Examination of the right knee shows erythema, fluctuant swelling, and tenderness on palpation of the kneecap. Passive fle... | Prepatellar bursa | {
"A": "Anserine bursa",
"B": "Medial meniscus",
"C": "Synovial membrane",
"D": "Prepatellar bursa"
} | step1 | D | [
"year old man",
"physician",
"3 week history",
"right-sided knee pain",
"works",
"bricklayer",
"reports",
"pain worsens",
"kneels",
"history",
"trauma",
"Examination",
"right shows erythema",
"fluctuant swelling",
"tenderness",
"palpation of",
"kneecap",
"Passive flexion",
"right... |
A 38-year-old woman presents with anxiety. She says that, for as long as she can remember, she has been anxious, especially when at work or in social situations, which she has difficulty controlling. She also reports difficulty sleeping, irritability, and muscle tension. She says her symptoms have significantly limited... | Paroxetine | {
"A": "Propranolol",
"B": "Paroxetine",
"C": "Alprazolam",
"D": "Lurasidone"
} | step2&3 | B | [
"year old woman presents",
"anxiety",
"long",
"remember",
"anxious",
"work",
"social situations",
"difficulty controlling",
"reports difficulty sleeping",
"irritability",
"muscle tension",
"symptoms",
"limited",
"work",
"personal relationships",
"significant past medical history",
"p... |
A 28-year-old man presents to his physician with a complaint of a 4-week history of headaches that is affecting his academic performance. Over-the-counter medications do not seem to help. He also mentions that he has to raise his head each time to look at the board when taking notes. His blood pressure is 125/75 mm Hg,... | Pseudo-Argyll Robertson pupils | {
"A": "Sensorineural hearing loss",
"B": "Pseudo-Argyll Robertson pupils",
"C": "Eyes down and out",
"D": "Conducting hearing loss"
} | step1 | B | [
"year old man presents",
"physician",
"complaint of",
"week history",
"headaches",
"affecting",
"academic performance",
"Over-the-counter medications",
"not",
"to help",
"to",
"head",
"time to look",
"board",
"taking notes",
"blood pressure",
"75 mm Hg",
"pulse",
"min",
"respir... |
A 41-year-old woman presents with acute onset severe epigastric pain radiating to the back that began a few hours ago. She also complains of nausea and has vomited twice in the past hour. She denies any history of similar symptoms or trauma in the past. Past medical history is significant for diabetes type 2 and HIV in... | HIV medication-related | {
"A": "HIV medication-related",
"B": "Alcohol use",
"C": "Metformin",
"D": "Congenital anomaly of the pancreas"
} | step1 | A | [
"year old woman presents",
"acute onset severe epigastric pain radiating",
"back",
"began",
"few hours",
"nausea",
"vomited twice",
"past hour",
"denies",
"history",
"similar symptoms",
"trauma",
"past",
"Past medical history",
"significant",
"diabetes type 2",
"HIV infection diagnos... |
A 34-year-old woman presents to the emergency department with sudden onset of painful vision loss in her left eye. The patient is otherwise healthy with a history only notable for a few emergency department presentations for numbness and tingling in her extremities with no clear etiology of her symptoms. Her temperatur... | Methylprednisolone | {
"A": "Estriol",
"B": "Glatiramer acetate",
"C": "Interferon-beta",
"D": "Methylprednisolone"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"sudden onset of painful vision loss",
"left eye",
"patient",
"healthy",
"history only notable",
"emergency presentations",
"numbness",
"tingling",
"extremities",
"clear etiology",
"symptoms",
"temperature",
"blood pressure",
"83 mmHg"... |
A 24-year-old man is taken to the emergency department by local law enforcement after they witnessed him physically assaulting a complete stranger. The officers report that they saw his eyes “moving back and forth quickly” and noted that he was very red-faced. The patient has no significant past medical or psychiatric ... | Phencyclidine hydrochloride (PCP) | {
"A": "Marijuana",
"B": "Methamphetamine",
"C": "Cocaine",
"D": "Phencyclidine hydrochloride (PCP)"
} | step2&3 | D | [
"year old man",
"taken",
"emergency department",
"local law enforcement",
"witnessed",
"assaulting",
"complete",
"officers report",
"saw",
"eyes moving back",
"noted",
"very red faced",
"patient",
"significant past medical",
"psychiatric history",
"vital signs include",
"temperature"... |
A 73-year-old man presents to his primary care physician endorsing 4-5 days of decreased urinary output and mild shortness of breath. He has a complex medical history, including uncontrolled diabetes mellitus type 2, hypertension, chronic kidney disease, and end-stage emphysema. It is determined that his kidney disease... | "I respect that this is ultimately your decision, and will focus on making sure you are comfortable" | {
"A": "\"I will involve a psychiatrist to help determine your capacity to refuse this treatment\"",
"B": "\"I cannot be your physician going forward if you refuse to undergo dialysis\"",
"C": "\"I strongly encourage you to reconsider your decision\"",
"D": "\"I respect that this is ultimately your decision, an... | step1 | D | [
"year old man presents",
"primary care physician",
"4-5 days of decreased urinary output",
"mild shortness of breath",
"complex medical history",
"including uncontrolled diabetes mellitus type 2",
"hypertension",
"chronic kidney disease",
"end-stage emphysema",
"kidney disease",
"progressed",
... |
A 26-year-old man with HIV and a recent CD4+ count of 800 presents to his PCP with fever, cough, and dyspnea. He notes that he recently lost his job as a construction worker and has not been able to afford his HAART medication. His temperature is 102.6°F (39.2°C), pulse is 75/min, respirations are 24/min, and blood pre... | Silver stain | {
"A": "Ziehl-Neelsen stain",
"B": "Silver stain",
"C": "India ink stain",
"D": "Periodic acid schiff stain"
} | step1 | B | [
"year old man",
"HIV",
"recent CD4",
"count",
"800 presents",
"PCP",
"fever",
"cough",
"dyspnea",
"notes",
"recently lost",
"job",
"construction worker",
"not",
"able to",
"HAART medication",
"temperature",
"pulse",
"75 min",
"respirations",
"min",
"blood pressure",
"mmHg... |
A 49-year-old woman is brought to the emergency department by her daughter because of increasing arthralgia, headache, and somnolence for the past week. She has a history of systemic lupus erythematosus without vital organ involvement. She last received low-dose glucocorticoids 2 months ago. Her temperature is 38.6 °C ... | Thrombotic thrombocytopenic purpura | {
"A": "Immune thrombocytopenic purpura",
"B": "Disseminated intravascular coagulation",
"C": "Thrombotic thrombocytopenic purpura",
"D": "Glanzmann thrombasthenia"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"daughter",
"increasing arthralgia",
"headache",
"somnolence",
"past week",
"history of systemic lupus erythematosus",
"vital organ involvement",
"last received low-dose glucocorticoids",
"months",
"temperature",
"F",
"pulse",
"80 mi... |
A 28-year-old woman comes to the physician because of a 1-year history of intermittent buzzing in both her ears. She says she sometimes has episodes of mild dizziness which resolve spontaneously. She has a 15-year history of type 1 diabetes mellitus and episodes of low back pain. She does not smoke or drink alcohol. Cu... | Otosclerosis | {
"A": "Drug-induced ototoxicity",
"B": "Presbycusis",
"C": "Otosclerosis",
"D": "Diabetic otopathy"
} | step2&3 | C | [
"year old woman",
"physician",
"year history",
"intermittent",
"ears",
"sometimes",
"episodes of mild dizziness",
"resolve",
"year history of type 1 diabetes mellitus",
"episodes of low back pain",
"not smoke",
"drink alcohol",
"Current medications include insulin",
"aspirin",
"works",
... |
A 25-year-old man comes to the physician for a 2-month history of abdominal discomfort, fatigue, and increased urinary frequency, especially at night. He has also noticed that despite eating more often he has lost 14-lbs (6-kg). He has a congenital solitary kidney and a history of Hashimoto thyroiditis, for which he ta... | Serum glucose | {
"A": "Ultrasonography of the thyroid gland",
"B": "Serum glucose",
"C": "Water deprivation test",
"D": "Serum creatinine"
} | step1 | B | [
"year old man",
"physician",
"2 month history",
"abdominal discomfort",
"fatigue",
"increased urinary frequency",
"night",
"eating more often",
"lost",
"lbs",
"kg",
"congenital solitary kidney",
"history",
"Hashimoto thyroiditis",
"takes levothyroxine",
"smoked two packs",
"cigarette... |
A 77-year-old man is brought to his primary care physician by his daughter. She states that lately, his speech has been incoherent. It seemed to have started a few weeks ago and has been steadily worsening. He is otherwise well; however, she notes that she has had to start him on adult diapers. The patient has a past m... | Dilated ventricles on MRI | {
"A": "Decreased dopamine synthesis in the substantia nigra on dopamine uptake scan",
"B": "Dilated ventricles on MRI",
"C": "Minor atrophy of the cerebral cortex on CT",
"D": "Severe atrophy of the cerebral cortex on MRI"
} | step2&3 | B | [
"year old man",
"brought",
"primary care physician",
"daughter",
"states",
"speech",
"incoherent",
"to",
"started",
"few weeks",
"worsening",
"well",
"notes",
"to start",
"adult diapers",
"patient",
"past medical",
"hyperlipidemia",
"type 2 diabetes mellitus",
"smoking 1 pack",... |
A 23-year-old man comes to the physician because of a painless swelling on the left side of his jaw for 2 months. It has been progressively increasing in size and is draining thick, foul-smelling fluid. He had a molar extracted 3 months ago. Examination shows a 4-cm, tender, erythematous mass in the left submandibular ... | Actinomyces israelii | {
"A": "Acinetobacter baumannii",
"B": "Actinomyces israelii",
"C": "Streptococcus pneumoniae",
"D": "Nocardia asteroides\n\""
} | step1 | B | [
"23 year old man",
"physician",
"of",
"painless swelling",
"left side",
"jaw",
"2 months",
"increasing in size",
"draining thick",
"smelling fluid",
"molar extracted 3 months",
"Examination shows",
"4",
"tender",
"erythematous mass",
"left submandibular region",
"purulent drainage",
... |
A 20-month-old boy is brought to the emergency department by his parents with fever and diarrhea that have persisted for the past 2 days. He has a history of repeated bouts of diarrhea, upper respiratory tract infections, and failure to thrive. His vital signs are as follows: blood pressure 80/40 mm Hg, pulse 130/min, ... | X-linked severe combined immunodeficiency | {
"A": "X-linked severe combined immunodeficiency",
"B": "Adenosine deaminase deficiency",
"C": "Janus-associated kinase 3 (JAK3) deficiency",
"D": "Bare lymphocyte syndrome"
} | step1 | A | [
"20 month old boy",
"brought",
"emergency department",
"parents",
"fever",
"diarrhea",
"past 2 days",
"history",
"repeated bouts",
"diarrhea",
"upper respiratory tract infections",
"failure to thrive",
"vital signs",
"follows",
"blood pressure 80 40 mm Hg",
"pulse",
"min",
"tempera... |
A 68-year-old man seeks evaluation by a physician with complaints of worsening forgetfulness and confusion for 1 year. According to his wife, he has always been in good health and is generally very happy; however, he has started to forget important things. He recently had his driving license revoked because of multiple... | Alzheimer’s dementia | {
"A": "Alzheimer’s dementia",
"B": "Creutzfeldt-Jakob disease",
"C": "Parkinson’s disease",
"D": "Vascular dementia"
} | step1 | A | [
"68 year old man",
"evaluation",
"physician",
"complaints",
"worsening forgetfulness",
"confusion",
"year",
"wife",
"always",
"good health",
"very happy",
"started to forget important things",
"recently",
"driving license revoked",
"multiple",
"recall",
"wrong",
"morning",
"negle... |
A 26-year-old woman is brought to the emergency department after a suicide attempt. Her mother found her next to an empty bottle of acetaminophen in the bathroom. The patient reports that she ingested about twenty-five 500 mg pills. She took the pills 1 hour prior to arrival to the emergency department. She has a histo... | Administer activated charcoal | {
"A": "Administer activated charcoal",
"B": "Admit for observation",
"C": "List for liver transplant",
"D": "Perform liver biopsy"
} | step2&3 | A | [
"year old woman",
"brought",
"emergency department",
"suicide attempt",
"mother found",
"next to",
"empty bottle",
"acetaminophen",
"bathroom",
"patient reports",
"ingested",
"twenty-five 500 mg pills",
"took",
"pills",
"hour prior to arrival",
"emergency department",
"history of maj... |
A 42-year-old woman is brought to the physician by her husband because she cries frequently and refuses to get out of bed. Over the past 3 weeks, she has been feeling sad and tired most of the time. She has difficulty staying asleep at night and often wakes up early in the morning. After losing her job as a waitress 1 ... | Mirtazapine | {
"A": "Lithium",
"B": "Mirtazapine",
"C": "Olanzapine",
"D": "Phenelzine\n\""
} | step2&3 | B | [
"year old woman",
"brought",
"physician",
"husband",
"cries frequently",
"refuses to get out",
"bed",
"past",
"weeks",
"feeling sad",
"tired most of the time",
"difficulty staying asleep",
"night",
"often wakes up early",
"morning",
"job",
"waitress 1 month",
"feeling guilty",
"n... |
A 2-month-old girl with a previous diagnosis of DiGeorge syndrome is brought to the emergency department with her parents following a seizure. Her mother states that the baby had been inconsolable all day and refused to feed. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all ... | Hypocalcemia | {
"A": "Hypernatremia",
"B": "Hypocalcemia",
"C": "Meningitis",
"D": "High fever"
} | step1 | B | [
"2 month old girl",
"previous diagnosis",
"DiGeorge syndrome",
"brought",
"emergency department",
"parents following",
"seizure",
"mother states",
"baby",
"day",
"refused to feed",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"arrival",
"hospital",... |
A 2900-g (6.4-lb) male newborn is delivered at term to a 29-year-old primigravid woman. His mother had no routine prenatal care. She reports that the pregnancy was uncomplicated apart from a 2-week episode of a low-grade fever and swollen lymph nodes during her early pregnancy. She has avoided all routine vaccinations ... | Undercooked pork | {
"A": "Exposure to unvaccinated children",
"B": "Undercooked pork",
"C": "Unprotected sexual intercourse",
"D": "Mosquito bites"
} | step1 | B | [
"male newborn",
"delivered",
"term",
"29 year old primigravid woman",
"mother",
"routine prenatal care",
"reports",
"pregnancy",
"uncomplicated",
"2-week episode of",
"low-grade fever",
"swollen lymph nodes",
"early pregnancy",
"routine vaccinations",
"natural immunity",
"better",
"n... |
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