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 6-year-old girl is brought to the physician for a well-child examination. There is no personal or family history of serious illness. She is at the 90th percentile for height and weight. Vital signs are within normal limits. Examination shows enlarged breast buds that extend beyond the areola. There is coarse pubic ha... | MRI of the brain | {
"A": "Reassurance and follow-up",
"B": "MRI of the brain",
"C": "Ultrasound of the pelvis",
"D": "Anastrozole therapy\n\""
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"well",
"personal",
"family history",
"serious illness",
"90th percentile",
"height",
"weight",
"Vital signs",
"normal limits",
"Examination shows enlarged breast buds",
"extend",
"areola",
"coarse pubic",
"not extend",
"inner thigh",
"exa... |
A 67-year-old female presents to the emergency room with dry cough and malaise. She has no other complaints. She has a past medical history of a meningioma status post resection complicated by hemiplegia and has been managed with dexamethasone for several months. Her vital signs are T 100.4 F (38 C), O2 93% on room air... | Trimethoprim-sulfamethoxazole + steroids | {
"A": "Trimethoprim-sulfamethoxazole",
"B": "Trimethoprim-sulfamethoxazole + steroids",
"C": "Piperacillin-tazobactam",
"D": "Piperacillin-tazobactam + steroids"
} | step2&3 | B | [
"67 year old female presents",
"emergency room",
"dry cough",
"malaise",
"complaints",
"past medical history",
"meningioma",
"resection complicated",
"hemiplegia",
"managed",
"dexamethasone",
"several months",
"vital signs",
"T 100 4 F",
"O2",
"room air",
"RR 20",
"BP",
"75 mmHg"... |
You are called to see a chemotherapy patient who is complaining of severe nausea. This patient is a 52-year-old male with acute lymphoblastic leukemia (ALL) who began his first cycle of chemotherapy 2 days ago. Which of the following structures is involved in the pathway responsible for this patient's nausea? | Medulla oblongata | {
"A": "Medulla oblongata",
"B": "Medial geniculate nucleus",
"C": "Posterior hypothalamus",
"D": "Ventral posterolateral nucleus"
} | step1 | A | [
"called to see",
"chemotherapy patient",
"severe nausea",
"patient",
"year old male",
"acute lymphoblastic leukemia",
"began",
"first cycle",
"chemotherapy 2 days",
"following structures",
"involved",
"pathway responsible",
"patient's nausea"
] |
A 52-year-old tow truck driver presents to the emergency room in the middle of the night complaining of sudden onset right ankle pain. He states that the pain came on suddenly and woke him up from sleep. It was so severe that he had to call an ambulance to bring him to the hospital since he was unable to drive. He has ... | Administer indomethacin | {
"A": "Administer probenecid",
"B": "Administer colchicine",
"C": "Administer indomethacin",
"D": "Administer febuxostat"
} | step2&3 | C | [
"year old",
"truck driver presents",
"emergency room in",
"middle",
"night",
"sudden onset right ankle pain",
"states",
"pain",
"woke",
"sleep",
"so severe",
"to call",
"ambulance to",
"hospital",
"unable to drive",
"history of hypertension",
"types 2 diabetes mellitus",
"takes lis... |
A 63-year-old man with a history of diabetes mellitus presents with complaints of fatigue. He lives alone and has not seen a doctor in 10 years. He does not exercise, eats a poor diet, and drinks 1-2 beers per day. He does not smoke. He has never had a colonoscopy. Labs show a hemoglobin of 8.9 g/dL (normal 13.5 - 17.5... | Chronic inflammation | {
"A": "Vitamin deficiency",
"B": "Mineral deficiency",
"C": "Mineral excess",
"D": "Chronic inflammation"
} | step2&3 | D | [
"63 year old man",
"history of diabetes mellitus presents",
"complaints",
"fatigue",
"lives alone",
"not seen",
"doctor",
"10 years",
"not exercise",
"eats",
"poor diet",
"drinks 1 beers",
"day",
"not smoke",
"never",
"colonoscopy",
"Labs show a hemoglobin",
"g/dL",
"normal",
"... |
A 37-year-old woman, gravida 3, para 3, comes to the physician for a follow-up examination. She gave birth to her third child 8 months ago and now wishes to start a contraception method. Prior to her most recent pregnancy, she used a combined estrogen-progestin pill. Which of the following aspects of her history would ... | She smokes 1 pack of cigarettes daily | {
"A": "She smokes 1 pack of cigarettes daily",
"B": "She has recurrent migraine headaches without aura",
"C": "She has a history of cervical dysplasia",
"D": "Her infant is still breastfeeding"
} | step1 | A | [
"year old woman",
"gravida 3",
"para 3",
"physician",
"follow-up examination",
"gave birth",
"third child",
"months",
"now wishes to start",
"contraception method",
"most recent pregnancy",
"used",
"combined estrogen progestin pill",
"following aspects",
"history",
"contraindication",
... |
A 15-year-old boy is brought to the physician by his mother because of 4 months of strange behavior. She says that during this period, he has had episodic mood swings. She has sometimes found him in his room “seemingly drunk” and with slurred speech. These episodes usually last for approximately 15 minutes, after which... | Inhalants | {
"A": "Inhalants",
"B": "Alcohol",
"C": "Phencyclidine",
"D": "Marijuana"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"mother",
"months",
"behavior",
"period",
"episodic mood swings",
"sometimes found",
"room",
"drunk",
"slurred speech",
"episodes usually last",
"approximately 15 minutes",
"irritable",
"decreased appetite",
"eyes occasionally appear red",
"k... |
A 40-year-old woman comes to the physician because of a small lump on the right side of her neck that she noticed while putting lotion on 1 week ago. She does not have any weight change, palpitations, or altered bowel habits. There is no family history of serious illness. Menses occur at regular 30-day intervals and la... | Thyroid-stimulating hormone level | {
"A": "Open biopsy",
"B": "Thyroid scintigraphy",
"C": "Thyroid-stimulating hormone level",
"D": "CT of the neck"
} | step2&3 | C | [
"40 year old woman",
"physician",
"of",
"small lump",
"right side",
"neck",
"putting lotion",
"1 week",
"not",
"weight change",
"palpitations",
"altered bowel habits",
"family history",
"serious illness",
"Menses occur",
"regular 30 day intervals",
"lasts",
"4 days",
"appears wel... |
A 36-year-old woman, gravida 2, para 1, at 26 weeks' gestation comes to the emergency department because of a gush of clear fluid from her vagina that occurred 1 hour prior. She reports painful pelvic cramping at regular 5-minute intervals. She has missed most of her prenatal care visit because of financial problems fr... | History of spontaneous preterm birth
" | {
"A": "Low socioeconomic status",
"B": "Smoking during pregnancy",
"C": "Substance abuse during pregnancy",
"D": "History of spontaneous preterm birth\n\""
} | step2&3 | D | [
"36 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"emergency department",
"clear fluid",
"vagina",
"occurred 1 hour prior",
"reports painful pelvic cramping",
"regular 5-minute intervals",
"missed most",
"prenatal visit",
"of financial",
"recent divorce",
"first child",... |
A 52-year-old woman comes to the physician because of a 3-week history of pain in her right knee. The pain is worse at the end of the day and when she walks. She says that it has become difficult for her to walk up the flight of stairs to reach her apartment. She has hypertension and psoriasis. Her sister has rheumatoi... | Weight loss program | {
"A": "Intraarticular glucocorticoid injections",
"B": "Weight loss program",
"C": "Total joint replacement",
"D": "Colchicine therapy"
} | step2&3 | B | [
"year old woman",
"physician",
"3 week history",
"pain",
"right knee",
"pain",
"worse",
"end",
"day",
"walks",
"difficult",
"walk",
"flight",
"stairs to reach",
"apartment",
"hypertension",
"psoriasis",
"sister",
"rheumatoid arthritis",
"drinks 23 beers daily",
"Current medic... |
A 12-year-old female with no past medical history is found to have an abnormal cardiovascular exam during routine physical examination at her pediatrician’s office. All other components of her physical exam are normal. During evaluation for potential causes for her abnormal exam, an echocardiogram with doppler is done ... | Splitting of S2 in inspiration and expiration | {
"A": "Decreased splitting of S1 with inspiration",
"B": "Normal splitting of S2",
"C": "Increased splitting of S2 with inspiration",
"D": "Splitting of S2 in inspiration and expiration"
} | step1 | D | [
"year old female",
"past medical history",
"found to",
"abnormal cardiovascular exam",
"routine physical examination",
"pediatricians office",
"components",
"physical exam",
"normal",
"evaluation",
"potential causes",
"abnormal exam",
"echocardiogram",
"doppler",
"shows flow",
"atria",... |
As part of a clinical research study, microscopic analysis of tissues obtained from surgical specimens is performed. Some of these tissues have microscopic findings of an increase in the size of numerous cells within the tissue with an increase in the amount of cytoplasm, but the nuclei are uniform in size. Which of th... | Uterine myometrium in pregnancy | {
"A": "Uterine myometrium in pregnancy",
"B": "Liver following partial resection",
"C": "Ovaries following menopause",
"D": "Cervix with chronic inflammation"
} | step1 | A | [
"part of",
"clinical",
"microscopic analysis",
"tissues obtained",
"surgical specimens",
"performed",
"tissues",
"microscopic findings",
"increase",
"size",
"numerous cells",
"tissue",
"increase",
"amount",
"cytoplasm",
"nuclei",
"uniform",
"size",
"following processes shows",
... |
A 42-year-old man comes to the physician because of a 3-year history of urinating up to 20 times each day. He has not had any dysuria and nocturia. He has been evaluated by several urologists but has not received a specific diagnosis despite extensive diagnostic testing. Various pharmacologic treatments have not improv... | Somatic symptom disorder | {
"A": "Malingering",
"B": "Atypical depression",
"C": "Somatic symptom disorder",
"D": "Adjustment disorder"
} | step1 | C | [
"year old man",
"physician",
"3 year history",
"20 times",
"day",
"not",
"dysuria",
"nocturia",
"evaluated",
"urologists",
"not received",
"specific diagnosis",
"extensive",
"testing",
"Various pharmacologic treatments",
"not improved",
"symptoms",
"quit",
"job 1 year",
"stoppe... |
A 62-year-old woman is brought to the emergency department of a busy suburban hospital because of a 1-week history of nausea and vomiting. She also has had intermittent fevers and headaches during the past 5 weeks. She does not have a stiff neck or sensitivity to light. She appears tired. Her temperature is 37°C (98.6°... | """I was unable to obtain results from the earlier tests because I misplaced the specimens. I sincerely apologize for the mistake.""" | {
"A": "\"\"\"I sincerely apologize; I misplaced the specimens. Thankfully, this is not a big issue because I can easily obtain more fluid.\"\"\"",
"B": "\"\"\"I was unable to obtain results from the earlier tests because I misplaced the specimens. I sincerely apologize for the mistake.\"\"\"",
"C": "\"\"\"I was ... | step2&3 | B | [
"62 year old woman",
"brought",
"emergency department",
"suburban hospital",
"1-week history",
"nausea",
"vomiting",
"intermittent fevers",
"headaches",
"past",
"weeks",
"not",
"stiff neck",
"sensitivity to light",
"appears tired",
"temperature",
"98",
"pulse",
"70 min",
"respi... |
A 74-year-old woman with a past medical history of hypertension, peripheral artery disease, and migraine headaches presents to the emergency department with a two hour history of severe abdominal pain. The patient cannot recall any similar episodes, although she notes occasional abdominal discomfort after eating. She d... | CT angiography | {
"A": "Plain abdominal radiograph",
"B": "Exploratory laparotomy",
"C": "CT angiography",
"D": "Abdominal duplex ultrasound"
} | step2&3 | C | [
"74 year old woman",
"past medical",
"peripheral artery disease",
"migraine headaches presents",
"emergency department",
"two hour history",
"severe abdominal",
"patient",
"recall",
"similar episodes",
"notes occasional abdominal discomfort",
"eating",
"pain",
"sharp",
"denies recent ill... |
A 39-year-old man presents to his primary care physician with a 10-hour history of severe diarrhea. He says that he was recently at a company picnic and after returning home he began to experience severe watery diarrhea. He says that the diarrhea was accompanied by nausea and abdominal pain. His physician informs him t... | Increased cyclic guanosine monophosphate | {
"A": "Decreased cyclic adenosine monophosphate",
"B": "Increased calcium",
"C": "Increased cyclic adenosine monophosphate",
"D": "Increased cyclic guanosine monophosphate"
} | step1 | D | [
"year old man presents",
"primary care physician",
"a 10 hour history",
"severe diarrhea",
"recently",
"company",
"returning home",
"began to experience severe watery",
"diarrhea",
"nausea",
"abdominal pain",
"physician informs",
"likely infected",
"lactose",
"gram negative organism",
... |
An investigator is studying the structure of the amino-terminal of the Huntingtin protein using x-ray crystallography. The terminal region is determined to have an α-helix conformation. Which of the following forces is most likely responsible for maintaining this conformation? | Hydrogen bonds | {
"A": "Hydrophobic interactions",
"B": "Disulfide bonds",
"C": "Peptide bonds",
"D": "Hydrogen bonds"
} | step1 | D | [
"investigator",
"studying",
"structure",
"terminal",
"Huntingtin using x-ray crystallography",
"terminal region",
"to",
"helix conformation",
"following forces",
"most likely responsible",
"maintaining",
"conformation"
] |
A 65-year-old man with a past medical history of anterior myocardial infarction, peripheral arterial disease, and known patent foramen ovale presents to the emergency department after being found down from a fall on the sidewalk in the middle of winter. He states that his right leg feels numb and painful at the same ti... | Catheter-based thrombectomy / thrombolysis | {
"A": "Percutaneous transluminal stent implantation",
"B": "Rivaroxaban",
"C": "Catheter-based thrombectomy / thrombolysis",
"D": "Heparin"
} | step2&3 | C | [
"65-year-old man",
"past",
"history of",
"myocardial infarction",
"peripheral arterial disease",
"known patent foramen ovale presents",
"emergency department",
"found",
"fall",
"sidewalk",
"middle",
"winter",
"states",
"right leg feels numb",
"painful",
"same time",
"not slip",
"ic... |
A 3-year-old boy is brought to the physician by his parents for the evaluation of easy bruising for several months. Minor trauma also causes scratches that bleed. Two months ago, a fall from his bed caused a large forehead hematoma and a left elbow laceration. He sometimes does not eat because of pain while chewing. Vi... | Defective type V collagen | {
"A": "Impaired copper absorption",
"B": "Defective type III collagen",
"C": "Defective type V collagen",
"D": "Defective type I collagen\n\""
} | step2&3 | C | [
"3 year old boy",
"brought",
"physician",
"parents",
"evaluation",
"easy bruising",
"several months",
"Minor trauma",
"causes scratches",
"bleed",
"Two months",
"fall from",
"bed caused",
"large forehead hematoma",
"left elbow laceration",
"sometimes",
"not eat",
"pain",
"chewing... |
A 64-year-old male presents to the emergency room with difficulty breathing. He recently returned to the USA following a trip to Singapore. He reports that he developed pleuritic chest pain, shortness of breath, and a cough. His temperature is 99°F (37.2°C), blood pressure is 140/85 mmHg, pulse is 110/min, and respirat... | Autoantibodies directed against platelet factor 4 | {
"A": "Loss of vitamin K-dependent clotting factors",
"B": "Autoantibodies directed against platelet factor 4",
"C": "Medication-mediated platelet aggregation",
"D": "ADAMTS13 deficiency"
} | step1 | B | [
"64 year old male presents",
"emergency room",
"difficulty breathing",
"recently returned",
"USA following",
"trip",
"Singapore",
"reports",
"pleuritic chest pain",
"shortness of breath",
"cough",
"temperature",
"blood pressure",
"85 mmHg",
"pulse",
"min",
"respirations",
"min",
... |
An autopsy is performed on a 39-year-old man 5 days after he was found pulseless at his apartment by his neighbor. Examination of the brain shows liquefactive necrosis in the distribution of the right middle cerebral artery with surrounding edema. Immunophenotyping of a sample of the affected brain tissue shows numerou... | Microglia | {
"A": "Radial glial cells",
"B": "Microglia",
"C": "Astrocytes",
"D": "Oligodendrocytes"
} | step1 | B | [
"autopsy",
"performed",
"year old man 5 days",
"found pulseless",
"apartment",
"neighbor",
"Examination",
"brain shows liquefactive necrosis",
"distribution",
"right middle cerebral artery",
"surrounding edema",
"Immunophenotyping",
"sample",
"affected brain shows numerous cells",
"surfa... |
A recent study shows that almost 40% of the antibiotics prescribed by primary care physicians in the ambulatory setting are for patients with a clinical presentation consistent with a viral acute respiratory tract infection. Recent evidence suggests that the implementation of a set of interventions may reduce such inap... | Local peer comparison | {
"A": "C-reactive protein (CRP) testing",
"B": "Local peer comparison",
"C": "Procalcitonin testing",
"D": "Testing for non-antibiotic-appropriate diagnoses"
} | step2&3 | B | [
"recent study shows",
"almost 40",
"antibiotics prescribed",
"primary care physicians",
"ambulatory setting",
"patients",
"clinical presentation consistent with",
"viral acute",
"Recent evidence suggests",
"implementation",
"set",
"interventions",
"inappropriate prescribing",
"following st... |
A 14-year-old boy is brought to the physician for generalized fatigue and mild shortness of breath on exertion for 3 months. He has a history of recurrent patellar dislocations. He is at the 99th percentile for height and at the 30th percentile for weight. His temperature is 37°C (98.6°F), pulse is 99/min, and blood pr... | Water hammer pulse | {
"A": "Paradoxical splitting of S2",
"B": "Pulsus paradoxus",
"C": "Fixed splitting of S2",
"D": "Water hammer pulse"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"generalized fatigue",
"mild shortness of breath",
"exertion",
"months",
"history of recurrent patellar dislocations",
"99th percentile",
"height",
"percentile",
"weight",
"temperature",
"98",
"pulse",
"99 min",
"blood pressure",
"50 mm Hg",
... |
A 17-year old girl is brought to the physician by her mother because menarche has not yet occurred. She is at the 3rd percentile for height. Examination of a buccal mucosal scraping shows several cells with a single dark body attached to the nuclear membrane. Karyotyping of a neutrophil shows 45 chromosomes. Which of t... | Postzygotic mitotic error | {
"A": "Uniparental isodisomy",
"B": "Postzygotic mitotic error",
"C": "Robertsonian translocation",
"D": "Reciprocal translocation\n\""
} | step1 | B | [
"year old girl",
"brought",
"physician",
"mother",
"menarche",
"not",
"occurred",
"3rd percentile",
"height",
"Examination of",
"buccal mucosal scraping shows several cells",
"single dark body attached",
"nuclear",
"Karyotyping",
"neutrophil shows",
"chromosomes",
"following",
"mos... |
A 3-month-old boy is brought to the emergency department by his mother after a seizure at home. The mother is not sure how long the seizure lasted, but says that the boy was unresponsive and had episodes of stiffness and jerking of his extremities throughout the episode. The mother states that the boy has not seemed hi... | No change in plasma glucose; glucose-6-phosphatase | {
"A": "Rise in plasma glucose; glycogen debranching enzyme",
"B": "Rise in plasma glucose; glucose-6-phosphatase",
"C": "Rise in plasma glucose; alpha-1,4-glucosidase",
"D": "No change in plasma glucose; glucose-6-phosphatase"
} | step1 | D | [
"3 month old boy",
"brought",
"emergency department",
"mother",
"seizure at home",
"mother",
"not sure",
"long",
"seizure lasted",
"boy",
"unresponsive",
"episodes of stiffness",
"jerking",
"extremities",
"episode",
"mother states",
"boy",
"not",
"past",
"weeks",
"fussy",
"... |
A 4-year-old boy is brought to the emergency department for evaluation of a fever for 1 day. The mother reports that he has had severe pain in his lower extremities and difficulty eating since yesterday. He has not had a cough, nausea, or vomiting. He was born at term and has been healthy. His immunizations are up-to-d... | Coxsackie A virus | {
"A": "Human herpesvirus 6",
"B": "Rubella virus",
"C": "Herpes simplex virus 1",
"D": "Coxsackie A virus"
} | step2&3 | D | [
"4 year old boy",
"brought",
"emergency department",
"evaluation",
"fever",
"1 day",
"mother reports",
"severe pain in",
"lower extremities",
"difficulty eating",
"not",
"cough",
"nausea",
"vomiting",
"born",
"term",
"healthy",
"immunizations",
"date",
"appears irritable",
"t... |
After the administration of an erroneous dose of intravenous phenytoin for recurrent seizures, a 9-year-old girl is resuscitated because of bradycardia and asystole. Later, the patient is taken to the critical care unit and placed on mechanical ventilation. Neurologic consultation shows hypoxic brain injury. To reduce ... | Root cause analysis | {
"A": "Closed-loop communication",
"B": "Computerized physician order entry",
"C": "Root cause analysis",
"D": "Structured handovers"
} | step2&3 | C | [
"administration",
"erroneous dose",
"intravenous phenytoin",
"recurrent seizures",
"year old girl",
"resuscitated",
"bradycardia",
"asystole",
"Later",
"patient",
"taken",
"critical care unit",
"placed",
"mechanical ventilation",
"Neurologic consultation shows hypoxic brain injury",
"T... |
A 70-year-old chronic smoker presents to the emergency department with a sudden onset of left-sided weakness. The past medical history is insignificant except for hypertension, for which he has been taking medications regularly. The vital signs include: blood pressure 165/110 mm Hg, pulse rate 78/min, respiratory rate ... | Oxidized low-density lipoprotein (ox-LDL) | {
"A": "Very low-density lipoprotein (VLDL)",
"B": "Oxidized low-density lipoprotein (ox-LDL)",
"C": "Lipoprotein lipase (LPL)",
"D": "High-density lipoprotein (HDL)-cholesterol"
} | step1 | B | [
"70 year old chronic smoker presents",
"emergency department",
"sudden onset",
"left-sided weakness",
"past medical history",
"hypertension",
"taking medications",
"vital signs include",
"blood pressure",
"mm Hg",
"pulse rate",
"min",
"respiratory rate",
"min",
"temperature 36",
"neuro... |
An 80-year-old man comes to the office for evaluation of anemia. His medical history is relevant for end-stage renal disease and aortic stenosis. When questioned about his bowel movements, the patient mentions that he has occasional episodes of loose, black, tarry stools. His heart rate is 78/min, respiratory rate is 1... | Angiodysplasia | {
"A": "Angiodysplasia",
"B": "Ischemic colitis",
"C": "Portal hypertension",
"D": "Colonic polyps"
} | step1 | A | [
"80 year old man",
"office",
"evaluation",
"anemia",
"medical history",
"relevant",
"end-stage renal disease",
"aortic stenosis",
"questioned",
"bowel movements",
"patient",
"occasional episodes of loose",
"black",
"tarry stools",
"heart rate",
"min",
"respiratory rate",
"min",
"... |
A 69-year-old man with history of coronary artery disease necessitating angioplasty and stent placement presents to the ED due to fever, chills, and productive cough for one day. He is started on levofloxacin and admitted because of his comorbidity and observed tachypnea of 35 breaths per minute. He is continued on his... | Low molecular weight heparin | {
"A": "Clopidogrel is sufficient; hold aspirin",
"B": "Aspirin and clopidogrel are sufficient",
"C": "Warfarin",
"D": "Low molecular weight heparin"
} | step1 | D | [
"69 year",
"man",
"history of coronary artery disease",
"stent placement presents",
"ED",
"fever",
"chills",
"productive cough",
"one day",
"started",
"levofloxacin",
"admitted",
"comorbidity",
"observed tachypnea",
"35 breaths",
"minute",
"continued",
"home medications including a... |
A 68-year-old woman presents to the physician with complaints of unexplained weight loss of approximately 5 kg (11.02 lb) over the last 6 months. Her other complaints include repeated stomatitis and diarrhea for 1 year. She was diagnosed with diabetes mellitus 1 year ago. Her temperature is 36.9°C (98.4°F), heart rate ... | Serum glucagon | {
"A": "Serum gastrin",
"B": "Serum glucagon",
"C": "Serum insulin",
"D": "Serum vasoactive intestinal polypeptide"
} | step2&3 | B | [
"68 year old woman presents",
"physician",
"complaints of unexplained weight loss",
"approximately",
"kg",
"last",
"months",
"complaints include repeated stomatitis",
"diarrhea",
"year",
"diagnosed",
"diabetes mellitus",
"year",
"temperature",
"36",
"98 4F",
"heart rate",
"84 min",... |
A 55-year-old man comes to the physician because of increasing swelling of the legs and face over the past 2 months. During this time, he has experienced fatigue and weight loss. He has no history of any serious illness and takes no medications. Vital signs are within normal range. On physical examination, both lower l... | Death within 1–2 years | {
"A": "Death within 1–2 years",
"B": "Long-term survival without serious complications",
"C": "Richter’s transformation",
"D": "Transformation into multiple myeloma"
} | step2&3 | A | [
"55 year old man",
"physician",
"of increasing swelling",
"legs",
"face",
"past 2 months",
"time",
"fatigue",
"weight loss",
"history",
"serious illness",
"takes",
"medications",
"Vital signs",
"normal range",
"physical examination",
"lower limbs show significant pitting extending",
... |
A six-month-old infant presents with chronic, persistent diarrhea, oral thrush, and a severe diaper rash. The infant was treated four weeks ago for an upper respiratory and ear infection. A family history is significant for a consanguineous relationship between the mother and father. Physical examination demonstrates t... | Deoxyadenosine | {
"A": "Deoxyadenosine",
"B": "Phenylalanine",
"C": "Ceramide trihexoside",
"D": "Sphingomyelin"
} | step1 | A | [
"six-month old infant presents",
"chronic",
"persistent",
"oral thrush",
"severe diaper rash",
"infant",
"treated four weeks",
"upper respiratory",
"ear infection",
"family history",
"significant",
"consanguineous relationship",
"mother",
"father",
"Physical examination demonstrates",
... |
A 19-year-old Caucasian college student is home for the summer. Her parents note that she has lost quite a bit of weight. The daughter explains that the weight loss was unintentional. She also notes an increase in thirst, hunger, and urine output. Her parents decide to take her to their family physician, who suspects f... | Elevated ketone levels | {
"A": "Evidence of amyloid deposition in pancreatic islets",
"B": "Elevated ketone levels",
"C": "Hypoglycemia",
"D": "Hyperinsulinemia"
} | step1 | B | [
"year old Caucasian college student",
"home",
"summer",
"parents note",
"lost",
"bit",
"weight",
"daughter",
"weight loss",
"unintentional",
"notes",
"increase",
"thirst",
"hunger",
"urine output",
"parents",
"to take",
"family physician",
"suspects finding",
"following"
] |
An 84-year-old woman with Alzheimer's disease is brought to the physician by her son for a follow-up examination. The patient lives with her son, who is her primary caregiver. He reports that it is becoming gradually more difficult to care for her. She occasionally has tantrums and there are times when she does not rec... | Adhere to a regular sleep schedule | {
"A": "Start quetiapine daily",
"B": "Start lorazepam as needed",
"C": "Adhere to a regular sleep schedule",
"D": "Frequently play classical music"
} | step2&3 | C | [
"84 year old woman",
"Alzheimer's disease",
"brought",
"physician",
"son",
"follow-up examination",
"patient lives with",
"son",
"primary caregiver",
"reports",
"difficult to care",
"occasionally",
"tantrums",
"times",
"not",
"sleeps 68 hours",
"day",
"agitated",
"confused",
"n... |
A 24-year-old man is hospitalized for an elective gastrointestinal surgery 24 hours before the scheduled day of surgery. The surgeon has ordered food and fluids to be withheld from the patient from 12 hours before the surgery and the administration of intravenous isotonic saline. Based on his body weight, his fluid req... | No change in ICF volume, no change in body osmolality | {
"A": "Increased ICF volume, decreased body osmolality",
"B": "Decreased ICF volume, no change in body osmolality",
"C": "Decreased ICF volume, increased body osmolality",
"D": "No change in ICF volume, no change in body osmolality"
} | step1 | D | [
"year old man",
"hospitalized",
"elective gastrointestinal 24 hours",
"scheduled day",
"surgery",
"surgeon",
"ordered food",
"fluids to",
"patient",
"12 hours",
"surgery",
"administration",
"intravenous isotonic saline",
"Based",
"body weight",
"fluid requirement",
"12 hours",
"900... |
A 50-year-old man presents to the emergency department with a complaint of crushing chest pain. The pain started suddenly 30 minutes ago while he was walking his dog. The patient also complains of difficulty breathing and palpitations. The pain is described as starting behind the sternum and moving towards the left jaw... | Urgent percutaneous coronary intervention | {
"A": "Start heparin infusion and ICU admission",
"B": "Perform an urgent bedside echocardiography",
"C": "Urgent percutaneous coronary intervention",
"D": "Monitor closely and wait for cardiac troponin levels"
} | step2&3 | C | [
"50 year old man presents",
"emergency department",
"complaint of crushing chest pain",
"pain started",
"30 minutes",
"walking",
"dog",
"patient",
"difficulty breathing",
"palpitations",
"pain",
"described",
"starting",
"sternum",
"moving",
"left jaw",
"Medical history includes recen... |
A 25-year-old man is brought to the emergency department by his wife for evaluation of abnormal behavior that began 2 weeks ago. The patient has not slept in over a week and has been partying each night. He has never done this before. The patient has also been skipping work and purchased a car last week with money they... | Valproate | {
"A": "Dialectical behavioral therapy",
"B": "Valproate",
"C": "Lithium",
"D": "Escitalopram\n\""
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"wife",
"evaluation",
"abnormal",
"began 2 weeks",
"patient",
"not slept",
"week",
"partying",
"night",
"never",
"before",
"patient",
"skipping work",
"purchased",
"car",
"week",
"money",
"saved",
"vacation",
"Italy",
"... |
A 30-year-old caucasian female comes to the physician because of chronic diarrhea and abdominal bloating that started 6 months ago. She also reports increasing fatigue and intermittent tingling in her hands and feet. She lost 5 kg (11 lb) of weight over the past 6 months without changing her diet or trying to lose weig... | IgG deamidated gliadin peptide test | {
"A": "Fecal fat test",
"B": "IgG deamidated gliadin peptide test",
"C": "IgA endomysial antibody",
"D": "Skin prick test"
} | step2&3 | B | [
"30 year old caucasian female",
"physician",
"chronic diarrhea",
"abdominal bloating",
"started",
"months",
"reports increasing fatigue",
"intermittent tingling",
"hands",
"feet",
"lost 5 kg",
"weight",
"past 6 months",
"changing",
"diet",
"to",
"weight",
"husband",
"to",
"year... |
A 7-year-old boy presents with difficulty swallowing, diarrhea, itching, and weakness. He also complains of episodes of headaches, sweating, and palpitations, which are accompanied by fear and tend to end with micturition. His mother is concerned about the strange nodules on his lips and eyelids. The boy's younger brot... | Neural crest cells | {
"A": "First pharyngeal groove",
"B": "First pharyngeal pouch",
"C": "Neurogenic placodes",
"D": "Neural crest cells"
} | step1 | D | [
"year old boy presents",
"difficulty swallowing",
"diarrhea",
"itching",
"weakness",
"episodes",
"headaches",
"sweating",
"palpitations",
"fear",
"to end",
"micturition",
"mother",
"concerned",
"nodules",
"lips",
"eyelids",
"boy's younger brother",
"similar nodules",
"died",
... |
A 42-year-old woman with well-controlled HIV on antiretroviral therapy comes to the physician because of a 2-week history of a painless lesion on her right calf. Many years ago, she had a maculopapular rash over her trunk, palms, and soles that resolved spontaneously. Physical examination shows a 4-cm firm, non-tender,... | Coagulative necrosis surrounded by fibroblast and macrophage infiltrate | {
"A": "Epidermal hyperplasia with dermal lymphocytic infiltrate",
"B": "Lichenoid hyperplasia with superficial neutrophilic infiltrate",
"C": "Ulcerated epidermis with plasma cell infiltrate",
"D": "Coagulative necrosis surrounded by fibroblast and macrophage infiltrate"
} | step1 | D | [
"year old woman",
"well-controlled HIV",
"antiretroviral therapy",
"physician",
"2-week history",
"painless lesion",
"right calf",
"years",
"maculopapular rash",
"trunk",
"palms",
"soles",
"resolved",
"Physical examination shows",
"4",
"firm",
"non-tender",
"indurated ulcer",
"mo... |
A 58-year-old man presents to his primary care physician with a 3-week history of increasing pain in his legs and feet. Specifically, he says that he has been getting electric shock sensations that started in his feet, but have progressed up his leg. In addition, the pain is accompanied by numbness and tingling in his ... | Serotonin norepinephrine reuptake inhibitor | {
"A": "Increased duration of GABA channel opening",
"B": "Increased frequency of GABA channel opening",
"C": "Selective serotonin reuptake inhibitor",
"D": "Serotonin norepinephrine reuptake inhibitor"
} | step1 | D | [
"58 year old man presents",
"primary care physician",
"3 week history",
"increasing pain",
"legs",
"feet",
"getting electric shock sensations",
"started",
"feet",
"progressed up",
"leg",
"addition",
"pain",
"numbness",
"tingling",
"hands",
"feet",
"past medical history",
"signifi... |
A 22-year-old soldier sustains a stab wound to his chest during a military attack in Mali. He is brought to the combat medic by his unit for a primary survey. The soldier reports shortness of breath. He is alert and oriented to time, place, and person. His pulse is 99/min, respirations are 32/min, and blood pressure is... | Partially occlusive dressing | {
"A": "Partially occlusive dressing",
"B": "Emergency pericardiocentesis",
"C": "Emergency echocardiography",
"D": "Supplemental oxygen\n\""
} | step2&3 | A | [
"year old soldier sustains",
"stab wound",
"chest",
"military attack",
"Mali",
"brought",
"unit",
"primary survey",
"soldier reports shortness of breath",
"alert",
"oriented to time",
"place",
"person",
"pulse",
"99 min",
"respirations",
"min",
"blood pressure",
"72 mm Hg",
"Ex... |
A 22-year-old G1P1 woman comes to the clinic asking about “the morning after pill.” She reports that she had sexual intercourse with her boyfriend last night and she thinks the condom broke. She is not using any other form of contraception. She reports her last menstrual period was 10 days ago, and they are normally re... | Copper intrauterine device | {
"A": "Copper intrauterine device",
"B": "High-dose oral contraceptive therapy",
"C": "Levonorgesterel pill",
"D": "Ulipristal pill"
} | step2&3 | A | [
"year old G1P1 woman",
"clinic",
"morning after pill",
"reports",
"sexual intercourse",
"boyfriend",
"night",
"thinks",
"condom",
"not using",
"form",
"contraception",
"reports",
"last menstrual period",
"10 days",
"regular",
"patients medical history",
"significant",
"obesity",
... |
A 15-year-old adolescent boy presents to his pediatrician for his scheduled follow-up after he was prescribed low-dose methylphenidate for treatment of attention-deficit/hyperactivity disorder 4 weeks ago. On follow-up, his mother reports mild improvement in his symptoms, but she also notes that his appetite has decrea... | Atomoxetine | {
"A": "Atomoxetine",
"B": "Dexmethylphenidate",
"C": "Dextroamphetamine",
"D": "Imipramine"
} | step2&3 | A | [
"year old adolescent boy presents",
"pediatrician",
"scheduled follow-up",
"prescribed low-dose methylphenidate",
"treatment",
"attention-deficit/hyperactivity disorder",
"follow-up",
"mother reports mild improvement",
"symptoms",
"notes",
"appetite",
"decreased",
"starting",
"medication",... |
An investigator is studying the metabolism of an experimental drug that is known to have first order kinetics. Immediately after administering an intravenous dose of the drug to a patient, the serum concentration is 60 U/L. 3 hours later, the serum concentration of the drug is 30 U/L. 9 hours after administration, the ... | 7.5 U/L | {
"A": "5 U/L",
"B": "7.5 U/L",
"C": "15 U/L",
"D": "0 U/L"
} | step1 | B | [
"investigator",
"studying",
"metabolism",
"experimental",
"known to",
"first order kinetics",
"Immediately",
"administering",
"intravenous dose",
"drug",
"patient",
"serum concentration",
"60 U/L",
"hours later",
"serum concentration",
"drug",
"30 U/L",
"hours",
"administration",... |
A 26-year-old gravida-1-para-0 (G-1-P-0) presents for a routine prenatal check-up at 16 weeks gestation. The patient has no concerns but is excited to learn the gender of the baby. Genetic testing was performed that showed an XY genotype; however, an ultrasound does not reveal the development of external male genitalia... | SRY gene product | {
"A": "Formation of the genital ridge",
"B": "Formation of the paramesonephric duct",
"C": "Conversion of testosterone to DHT",
"D": "SRY gene product"
} | step1 | D | [
"year old gravida-1 para 0",
"presents",
"routine prenatal check-up",
"weeks gestation",
"patient",
"concerns",
"excited to learn",
"gender",
"baby",
"Genetic testing",
"performed",
"showed",
"XY genotype",
"ultrasound",
"not reveal",
"development",
"external",
"following",
"resp... |
An 82-year-old woman presents to the emergency department after a fall. Imaging reveals diffuse trauma to the left humerus from the midshaft to the olecranon process with shearing of the periosteum. The orthopedic surgeon suggests a follow-up in 2 weeks. In that time, the patient develops worsening pain. At follow-up, ... | Volkmann’s canal | {
"A": "Brachial artery",
"B": "Volkmann’s canal",
"C": "Ulnar nerve",
"D": "Epiphyseal plate"
} | step1 | B | [
"year old woman presents",
"emergency department",
"fall",
"Imaging reveals diffuse trauma",
"left humerus",
"olecranon process",
"shearing",
"periosteum",
"orthopedic surgeon suggests",
"follow-up",
"2 weeks",
"time",
"patient",
"worsening pain",
"follow-up",
"found to",
"diffuse bo... |
A 7-year-old boy with a sore throat, fever, and generalized malaise is admitted to the pediatric floor. On physical examination, he has diffuse white exudate on both tonsils, and also a palpable spleen with mild hepatomegaly. His blood smear shows large and abundant lymphocytes with blue-gray cytoplasm, irregular nucle... | Infectious mononucleosis | {
"A": "Infectious mononucleosis",
"B": "Cytomegalovirus infection",
"C": "Graves' disease",
"D": "Viral hepatitis"
} | step1 | A | [
"year old boy",
"sore throat",
"fever",
"generalized malaise",
"admitted",
"pediatric floor",
"physical examination",
"diffuse white exudate on",
"tonsils",
"palpable spleen",
"mild hepatomegaly",
"blood smear shows large",
"abundant lymphocytes",
"blue gray cytoplasm",
"irregular nuclei... |
A 71-year-old man is brought to the emergency department because of severe, progressive left leg pain and tingling for 8 hours. The symptoms began while he was watching television. For several months, the patient has noticed calf cramping when going for long walks, as well as occasional foot tingling and numbness, but ... | Digital subtraction angiography | {
"A": "Creatine kinase concentration",
"B": "Digital subtraction angiography",
"C": "Ankle-brachial index",
"D": "Compartment pressures\n\""
} | step2&3 | B | [
"71 year old man",
"brought",
"emergency department",
"severe",
"progressive left leg pain",
"tingling",
"8 hours",
"symptoms began",
"watching television",
"several months",
"patient",
"calf cramping",
"long walks",
"occasional foot tingling",
"numbness",
"not",
"medical attention",... |
A 28-year-old gravida 2 para 1 is receiving care from her obstetrician at 28 weeks. She states that she has been having suprapubic pain and urinary frequency for the past week. Her past medical history is significant for dermatomyositis for which she takes prednisone every day. She does not smoke cigarettes or drinks a... | Nitrofurantoin | {
"A": "Trimethoprim-sulfamethoxazole",
"B": "Nitrofurantoin",
"C": "Tetracycline",
"D": "Cephalexin"
} | step2&3 | B | [
"year old gravida 2 para 1",
"receiving care",
"obstetrician",
"weeks",
"states",
"suprapubic pain",
"urinary frequency",
"past week",
"past medical history",
"significant",
"dermatomyositis",
"takes prednisone",
"day",
"not smoke cigarettes",
"drinks alcohol",
"vital signs",
"normal... |
A 43-year-old woman visits her primary care physician complaining of abdominal pain for the past 6 months. She reports that the pain is localized to her lower abdomen and often resolves with bowel movements. She states that some days she has diarrhea while other times she will go 4-5 days without having a bowel movemen... | Colonoscopy | {
"A": "Anti-endomysial antibody titer",
"B": "Colonoscopy",
"C": "High fiber diet",
"D": "Thyroid ultrasound"
} | step2&3 | B | [
"year old woman visits",
"primary care physician",
"abdominal pain",
"past 6 months",
"reports",
"pain",
"localized",
"lower abdomen",
"often resolves",
"bowel movements",
"states",
"days",
"diarrhea",
"times",
"go 4-5 days",
"bowel movement",
"started",
"gluten-free diet",
"hope... |
A 26-year-old woman comes to the physician because of severe pain in her right wrist one day after falling onto her hands and knees while rollerskating. Physical examination shows abrasions over the knees and bruising over the volar aspect of the right wrist. There is swelling and tenderness on palpation of the volar w... | Paresthesia over the volar aspect of the first 3 fingers on wrist flexion | {
"A": "Paresthesia over the volar aspect of the first 3 fingers on wrist flexion",
"B": "Anesthesia over the dorsal aspect of the first 3 fingers",
"C": "Tenderness to palpation of the anatomic snuffbox",
"D": "Pale skin color on the volar surface when pressure is applied to the radial artery"
} | step1 | A | [
"year old woman",
"physician",
"of severe pain in",
"right wrist one day",
"falling",
"hands",
"knees",
"Physical examination shows abrasions",
"knees",
"bruising",
"volar aspect",
"right wrist",
"swelling",
"tenderness",
"palpation of",
"volar wrist joint",
"restricted range of moti... |
A 56-year-old man with hypertension comes to the physician for a follow-up examination. His blood pressure is 165/92 mm Hg on the left arm and 162/90 mm Hg on the right arm. He reports that he is compliant with his medication and exercise regimen. The physician adds a drug to his antihypertensive medication regimen. Th... | Candesartan | {
"A": "Candesartan",
"B": "Aliskiren",
"C": "Lisinopril",
"D": "Triamterene"
} | step1 | A | [
"year old man",
"hypertension",
"physician",
"follow-up examination",
"blood pressure",
"mm Hg",
"left arm",
"90 mm Hg",
"right arm",
"reports",
"compliant",
"medication",
"exercise regimen",
"physician adds",
"drug",
"antihypertensive medication regimen",
"drug increases serum renin... |
A 65-year-old man comes to the physician because of a 6-month history of muscle weakness. During this period, the patient has had low energy, intermittent nosebleeds, and a 5-kg (11-lb) weight loss. He also reports progressive hearing and vision problems. He has a history of pins-and-needles sensation, numbness, and pa... | Waldenstrom macroglobulinemia | {
"A": "Hairy cell leukemia",
"B": "Waldenstrom macroglobulinemia",
"C": "Monoclonal gammopathy of undetermined significance",
"D": "Mantle cell lymphoma\n\""
} | step2&3 | B | [
"65 year old man",
"physician",
"month history",
"muscle weakness",
"period",
"patient",
"low energy",
"intermittent nosebleeds",
"5 kg",
"weight loss",
"reports progressive hearing",
"vision problems",
"history",
"pins",
"needles sensation",
"numbness",
"pain in",
"feet",
"Vital... |
A previously healthy 6-week-old infant is brought to the emergency department because of fever, fatigue, and dry cough for one day. She has been feeding poorly and had difficulty latching on to breastfeed since yesterday. She has had nasal congestion. The mother reports that her daughter has not been going through as m... | Respiratory syncytial virus | {
"A": "Listeria monocytogenes",
"B": "Respiratory syncytial virus",
"C": "Coronavirus",
"D": "Streptococcus pneumoniae"
} | step2&3 | B | [
"healthy",
"week old infant",
"brought",
"emergency department",
"fever",
"fatigue",
"dry cough",
"one day",
"feeding poorly",
"difficulty latching",
"breastfeed",
"nasal congestion",
"mother reports",
"daughter",
"not",
"diapers",
"usual",
"born",
"uncomplicated vaginal",
"wee... |
A 38-year-old woman presents to the physician’s clinic with a 6-month history of generalized weakness that usually worsens as the day progresses. She also complains of the drooping of her eyelids and double vision that is worse in the evening. Physical examination reveals bilateral ptosis after a sustained upward gaze ... | High ATPase activity | {
"A": "High myoglobin content",
"B": "Increased amount of ATP generated per molecule of glucose",
"C": "A small mass per motor unit",
"D": "High ATPase activity"
} | step1 | D | [
"year old woman presents",
"physicians clinic",
"month history",
"generalized weakness",
"usually worsens",
"day progresses",
"drooping",
"eyelids",
"double vision",
"worse",
"evening",
"Physical examination reveals bilateral ptosis",
"sustained upward gaze",
"loss",
"eye",
"improves",... |
A 24-year-old professional wrestler recently participated in a charitable tournament event in Bora Bora, a tropical island that is part of the French Polynesia Leeward Islands. During his stay, he wore tight-fitting clothes and tight bathing trunks for extended periods. After 6 days, he observed symmetric, erythematous... | Terbinafine | {
"A": "Nystatin",
"B": "Terbinafine",
"C": "Betamethasone/clotrimazole combination",
"D": "Miconazole"
} | step1 | B | [
"year old professional",
"recently",
"event",
"Bora Bora",
"island",
"part of",
"French Polynesia Leeward Islands",
"tight fitting clothes",
"tight bathing trunks",
"extended periods",
"6 days",
"observed symmetric",
"erythematous itchy rash",
"groin",
"significant amount",
"moisture",... |
A 59-year-old woman comes to the clinic complaining of an intermittent, gnawing epigastric pain for the past 2 months. The pain is exacerbated with food and has been getting progressively worse. The patient denies any weight changes, nausea, vomiting, cough, or dyspepsia. Medical history is significant for chronic back... | Acetaminophen | {
"A": "Acetaminophen",
"B": "Aspirin",
"C": "Omeprazole",
"D": "Ranitidine"
} | step1 | A | [
"59 year old woman",
"clinic",
"intermittent",
"gnawing epigastric pain",
"past",
"months",
"pain",
"exacerbated",
"food",
"getting",
"worse",
"patient denies",
"weight changes",
"nausea",
"vomiting",
"cough",
"dyspepsia",
"Medical history",
"significant",
"chronic back pain",
... |
A 57-year-old woman presents to the emergency department for laboratory abnormalities detected by her primary care physician. The patient went to her appointment complaining of difficulty using her hands and swelling of her arms and lower extremities. The patient has notably smooth skin that seems to have not aged cons... | Start valproic acid and discontinue lithium | {
"A": "Continue medications and start metformin",
"B": "Continue medications and add nifedipine",
"C": "Start lisinopril and discontinue captopril",
"D": "Start valproic acid and discontinue lithium"
} | step2&3 | D | [
"57 year old woman presents",
"emergency department",
"laboratory abnormalities detected",
"primary care physician",
"patient",
"appointment",
"difficulty using",
"hands",
"swelling of",
"arms",
"lower extremities",
"patient",
"smooth skin",
"to",
"not aged",
"seeing",
"lab values",
... |
A 7-year-old patient is brought in by his mother for a routine check-up for school. The child is cooperative throughout the visit and excitedly talks about school. The mother congratulates her son on his behavior, and mentions that when he was being treated for leukemia three years ago, he would start crying in the par... | Extinction | {
"A": "Classical conditioning",
"B": "Positive reinforcement",
"C": "Extinction",
"D": "Acting out"
} | step1 | C | [
"year old patient",
"brought",
"mother",
"routine check-up",
"school",
"child",
"cooperative",
"visit",
"talks",
"school",
"mother",
"son",
"behavior",
"treated",
"leukemia three years",
"start crying",
"parking lot",
"arrived",
"clinic",
"blood checks",
"mother notes",
"re... |
A previously healthy 3-week-old infant is brought to the emergency department 6 hours after the onset of fever and persistent irritability. He had been well until 2 days ago, when he started feeding poorly and sleeping more than usual. He appears lethargic and irritable when roused for examination. His temperature is 3... | Ampicillin, gentamicin, and cefotaxime | {
"A": "Ampicillin and ceftriaxone",
"B": "Gentamicin and cefotaxime",
"C": "Ampicillin, gentamicin, and cefotaxime",
"D": "Vancomycin, ampicillin, and cefotaxime"
} | step2&3 | C | [
"healthy",
"week old infant",
"brought",
"emergency department",
"hours",
"onset",
"fever",
"persistent irritability",
"well",
"2 days",
"started feeding poorly",
"sleeping",
"usual",
"appears lethargic",
"irritable",
"examination",
"temperature",
"cries",
"picked",
"neck",
"... |
A 27-year-old primigravida presents at 16 weeks gestation for a check-up. She has no co-existing diseases. Currently, she has no subjective complaints, but she worries about the results of her triple screen. She takes 400 mg of folic acid and 30 mg of iron daily. The results of the triple screen are shown below.
Meas... | Perform ultrasound examination | {
"A": "Perform amniocentesis",
"B": "Recommend additional inhibit A test",
"C": "Perform ultrasound examination",
"D": "Arrange a chorionic villus sampling procedure"
} | step2&3 | C | [
"27 year old primigravida presents",
"weeks gestation",
"check-up",
"co existing diseases",
"Currently",
"subjective complaints",
"worries",
"results",
"triple screen",
"takes 400 mg",
"folic acid",
"30 mg",
"iron daily",
"results",
"triple screen",
"shown",
"Measured values Referenc... |
A 71-year-old woman comes to the physician because of a 4-month history of worsening cough and a 4.5-kg (10-lb) weight loss. She has smoked one pack of cigarettes daily for 35 years. Physical examination shows wheezing over the right lung fields. Laboratory studies show a serum calcium concentration of 12.5 mg/dL. X-ra... | Squamous cell lung carcinoma | {
"A": "Lobar pneumonia",
"B": "Tuberculosis",
"C": "Sarcoidosis",
"D": "Squamous cell lung carcinoma"
} | step1 | D | [
"71 year old woman",
"physician",
"4 month history",
"worsening cough",
"4.5 kg",
"10",
"weight loss",
"smoked one pack",
"cigarettes daily",
"35 years",
"Physical examination shows wheezing",
"right lung fields",
"Laboratory studies show",
"serum calcium concentration of 12.5 mg/dL",
"X... |
A 12-year-old boy presents with recurrent joint pain that migrates from joint to joint and intermittent fever for the last several weeks. He also says that he has no appetite and has been losing weight. The patient is afebrile, and vital signs are within normal limits. On physical examination, he is pale with diffuse p... | Acute leukemia | {
"A": "Acute leukemia",
"B": "Tuberculosis of the bone marrow",
"C": "Aplastic anemia",
"D": "Chronic leukemia"
} | step1 | A | [
"year old boy presents",
"recurrent joint",
"migrates",
"joint",
"joint",
"intermittent fever",
"weeks",
"appetite",
"weight",
"patient",
"afebrile",
"vital signs",
"normal limits",
"physical examination",
"pale",
"diffuse petechial",
"bruises",
"legs",
"abdominal examination",
... |
A 56 year old female comes to the ED complaining of moderate right eye pain, headache, and acute onset of blurry vision, which she describes as colored halos around lights. She was watching a movie at home with her husband about an hour ago when the pain began. On physical exam of her right eye, her pupil is mid-dilate... | Timolol ophthalmic solution | {
"A": "Timolol ophthalmic solution",
"B": "Epinephrine ophthalmic solution",
"C": "Laser peripheral iridotomy",
"D": "NSAID ophthalmic solution"
} | step2&3 | A | [
"year old female",
"ED",
"of moderate right eye pain",
"headache",
"acute onset",
"blurry vision",
"colored halos",
"lights",
"watching",
"movie at home",
"husband",
"hour",
"pain began",
"physical exam",
"right eye",
"pupil",
"dilated",
"unresponsive",
"light",
"right eyeball"... |
A 6-year-old boy is brought to the emergency department because of worsening confusion for the last hour. He has had high-grade fever, productive cough, fatigue, and malaise for the past 2 days. He has not seen a physician in several years. His temperature is 38.9°C (102°F), pulse is 133/min, respirations are 33/min, a... | Streptococcus pneumoniae | {
"A": "Salmonella paratyphi",
"B": "Streptococcus pneumoniae",
"C": "Staphylococcus aureus",
"D": "Nontypeable Haemophilus influenzae"
} | step1 | B | [
"year old boy",
"brought",
"emergency department",
"of worsening confusion",
"hour",
"high-grade fever",
"productive cough",
"fatigue",
"malaise",
"past 2 days",
"not seen",
"physician",
"years",
"temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"48 mm Hg"... |
A 2-year-old female with abdominal pain undergoes laparoscopic surgery. An outpouching of tissue is excised from the ileum and sent to the laboratory for evaluation. The pathologist notes inflammation and the presence of mucosa, submucosa, and muscle in the walls of the specimen. Which of the following is the most like... | Meckel's diverticulum | {
"A": "Crohn's disease",
"B": "Meckel's diverticulum",
"C": "Appendicitis",
"D": "Henoch-Schonlein purpura"
} | step1 | B | [
"2 year old female",
"abdominal pain",
"laparoscopic surgery",
"tissue",
"ileum",
"sent",
"laboratory",
"evaluation",
"pathologist notes inflammation",
"presence",
"mucosa",
"submucosa",
"muscle",
"walls",
"specimen",
"following",
"most likely diagnosis"
] |
A 33-year-old woman schedules an appointment at an outpatient clinic for the first time after moving to the US from Peru a few months ago. She complains of easy fatigability and shortness of breath with minimal exertion for the past 6 months. She further adds that her breathlessness is worse when she goes to bed at nig... | Decrease total peripheral resistance | {
"A": "Decrease total peripheral resistance",
"B": "Increase inotropy of cardiac muscle",
"C": "Increase the rate of SA node discharge",
"D": "Increase coronary blood flow"
} | step1 | A | [
"year old woman schedules",
"appointment",
"outpatient clinic",
"first time",
"moving",
"Peru",
"few months",
"easy fatigability",
"shortness of breath",
"minimal exertion",
"past 6 months",
"further adds",
"breathlessness",
"worse",
"goes",
"bed",
"night",
"concerned",
"swelling... |
A 56-year-old man with chronic kidney failure is brought to to the emergency department by ambulance after he passed out during dinner. On presentation, he is alert and complains of shortness of breath as well as chest palpitations. An EKG is obtained demonstrating an irregular rhythm consisting of QT amplitudes that v... | Bradycardia | {
"A": "Bradycardia",
"B": "Diffuse calcifications",
"C": "Kidney stones",
"D": "Seizures"
} | step1 | A | [
"year old man",
"chronic kidney failure",
"brought to",
"emergency department",
"ambulance",
"passed out",
"dinner",
"presentation",
"alert",
"of shortness",
"breath",
"chest palpitations",
"EKG",
"obtained",
"irregular rhythm consisting",
"QT amplitudes",
"height",
"time",
"find... |
A 55-year-old man with recurrent pneumonia comes to the physician for a follow-up examination one week after hospitalization for pneumonia. He feels well but still has a productive cough. He has smoked 1 pack of cigarettes daily for 5 years. His temperature is 36.9°C (98.4°F) and respirations are 20/min. Cardiopulmonar... | Lecithin production | {
"A": "Lecithin production",
"B": "Cytokine release",
"C": "Toxin degradation",
"D": "Gas diffusion"
} | step1 | A | [
"55 year old man",
"recurrent pneumonia",
"physician",
"follow-up examination one week",
"hospitalization",
"pneumonia",
"feels well",
"productive cough",
"smoked 1 pack",
"cigarettes daily",
"5 years",
"temperature",
"36",
"98 4F",
"respirations",
"20 min",
"Cardiopulmonary examinat... |
A pediatrician is called to examine a recently born dysmorphic boy. The birth weight was 1.6 kg (3.5 lb). On physical examination of the face and skull, the head was shown to be microcephalic with a prominent occiput and a narrow bifrontal diameter. The jaw was comparatively small with short palpebral fissures. The nos... | 95% of these patients die in the 1st year of life. | {
"A": "This condition is associated with teenage mothers.",
"B": "95% of these patients die in the 1st year of life.",
"C": "The condition is more common in males.",
"D": "Thrombocytopenia is the least common hematologic abnormality in these patients."
} | step1 | B | [
"pediatrician",
"called to",
"recently born dysmorphic boy",
"birth weight",
"1.6 kg",
"3.5",
"physical examination",
"face",
"skull",
"head",
"shown to",
"microcephalic",
"prominent occiput",
"narrow bifrontal diameter",
"jaw",
"small",
"short",
"nose",
"narrow",
"nasal ala",
... |
A 60-year-old man comes to the emergency department because of nausea, headache, and generalized fatigue for 2 days. He has not vomited. He was diagnosed with small cell lung cancer and liver metastases around 3 months ago and is currently receiving chemotherapy with cisplatin and etoposide. His last chemotherapy cycle... | (B) | {
"A": "(B)",
"B": "(C)",
"C": "(D)",
"D": "(E)\n\""
} | step2&3 | A | [
"60 year old man",
"emergency department",
"nausea",
"headache",
"generalized fatigue",
"2 days",
"not vomited",
"diagnosed",
"small cell lung cancer",
"liver metastases",
"months",
"currently receiving chemotherapy",
"cisplatin",
"etoposide",
"last chemotherapy cycle ended one week",
... |
A 45-year-old woman repetitively visits the general surgery clinic worried that her inguinal hernia is incarcerated. 2 months ago, she was seen in the emergency department where she presented with a left lower abdominal swelling. The mass was easily reduced and the patient was referred to the general surgery clinic for... | Somatic symptom disorder | {
"A": "Conversion disorder",
"B": "Malingering disorder",
"C": "Illness anxiety disorder",
"D": "Somatic symptom disorder"
} | step2&3 | D | [
"year old woman",
"visits",
"general surgery clinic worried",
"inguinal hernia",
"incarcerated",
"months",
"seen in",
"emergency department",
"presented",
"left lower abdominal swelling",
"mass",
"easily reduced",
"patient",
"referred",
"general surgery clinic",
"elective",
"conditio... |
A 3-year-old boy is brought to the physician by his parents for a well-child examination. The boy was born at term via vaginal delivery and has been healthy except for impaired vision due to severe short-sightedness. He is at the 97th percentile for height and 25th percentile for weight. Oral examination shows a high-a... | Mutation in fibrillin-1 gene | {
"A": "Mutation in fibrillin-1 gene",
"B": "Defective collagen cross-linking",
"C": "Nondisjunction of sex chromosomes",
"D": "Mutation in RET gene"
} | step2&3 | A | [
"3 year old boy",
"brought",
"physician",
"parents",
"well",
"boy",
"born",
"term",
"vaginal delivery",
"healthy",
"impaired vision",
"severe short-sightedness",
"percentile",
"height",
"percentile",
"weight",
"Oral examination shows",
"high-arched palate",
"long",
"slender fin... |
A patient presents to the emergency department with abdominal pain. While having dinner, the patient experienced pain that prompted the patient to come to the emergency department. The patient states that the pain is episodic and radiates to the shoulder. The patient's temperature is 98°F (36.7°C), blood pressure is 12... | A middle-aged overweight mother | {
"A": "A middle-aged male with a positive urea breath test",
"B": "A middle-aged overweight mother",
"C": "A middle-aged patient with a history of bowel surgery",
"D": "An elderly smoker with painless jaundice"
} | step2&3 | B | [
"patient presents",
"emergency department",
"abdominal pain",
"dinner",
"patient experienced pain",
"prompted",
"patient to",
"emergency department",
"patient states",
"pain",
"episodic",
"radiates",
"shoulder",
"patient's temperature",
"36",
"blood pressure",
"80 mmHg",
"pulse",
... |
A 62-year-old man comes to the physician for evaluation of multiple red spots on his trunk. He first noticed these several months ago, and some appear to have increased in size. One day ago, he scratched one of these spots, and it bled for several minutes. Physical examination shows the findings in the photograph. Whic... | Cherry angioma | {
"A": "Cherry angioma",
"B": "Amelanotic melanoma",
"C": "Spider angioma",
"D": "Seborrheic keratosis"
} | step1 | A | [
"62 year old man",
"physician",
"evaluation",
"multiple red",
"trunk",
"first",
"several months",
"appear to",
"increased in size",
"One day",
"scratched one",
"spots",
"bled",
"minutes",
"Physical examination shows",
"findings",
"photograph",
"following",
"most likely diagnosis"... |
A 25-year-old man is brought by his wife to the emergency department due to sudden onset confusion that started 40 minutes ago. The patient’s wife says that he came home from work complaining of pain in his arms and legs. While resting on the couch, he mentioned feeling nauseous and then became quite confused. He has n... | Diving instructor | {
"A": "Diving instructor",
"B": "Farmer",
"C": "Fireman",
"D": "Shipyard worker"
} | step1 | A | [
"year old man",
"brought",
"wife to",
"emergency department due",
"sudden",
"started 40 minutes",
"patients wife",
"home",
"work",
"pain",
"arms",
"legs",
"resting",
"feeling nauseous",
"then",
"confused",
"previous medical history",
"takes",
"medications",
"not smoke",
"only... |
A 3-year-old boy goes camping with his parents in the Appalachian mountains of Western North Carolina. While on the hiking trip, he is exposed to an antigen. After the exposure, this antigen is phagocytosed by a CD4+ T helper cell and is presented on an MHC class II molecule. This CD4+ T helper cell encounters a B cell... | 3 | {
"A": "1",
"B": "3",
"C": "4",
"D": "5"
} | step1 | B | [
"3 year old boy goes camping",
"parents",
"Appalachian mountains",
"Western North Carolina",
"hiking trip",
"exposed",
"antigen",
"exposure",
"antigen",
"phagocytosed",
"CD4",
"T helper cell",
"presented",
"MHC class II molecule",
"CD4",
"T helper cell encounters a B cell",
"lymph sh... |
A 73-year-old woman is brought to the physician by her son because of increasing forgetfulness over the past 2 years. Initially, she used to misplace keys and forget her dog's name or her phone number. Now, she often forgets about what she has seen on television or read about the day before. She used to go for a walk e... | Alzheimer disease | {
"A": "Normal pressure hydrocephalus",
"B": "Frontotemporal dementia",
"C": "Creutzfeld-Jakob disease",
"D": "Alzheimer disease"
} | step2&3 | D | [
"year old woman",
"brought",
"physician",
"son",
"increasing forgetfulness",
"past",
"years",
"Initially",
"used",
"forget",
"dog's name",
"phone number",
"Now",
"often forgets",
"seen",
"television",
"read",
"day",
"used to go",
"walk",
"morning",
"stopped one month",
"l... |
A 32-year-old woman is brought to the emergency department by her husband because of an episode of hematemesis 2 hours ago. She has had dyspepsia for 2 years. Her medications include occasional ibuprofen for headaches. After initial stabilization, the risks and benefits of upper endoscopy and alternative treatments, in... | Documentation of her decision prior to treatment is required | {
"A": "Documentation of her decision prior to treatment is required",
"B": "Endoscopic treatment may be performed without further action",
"C": "Her decision to have an endoscopy is not voluntary",
"D": "Her sister must sign the consent form"
} | step2&3 | A | [
"year old woman",
"brought",
"emergency department",
"husband",
"of",
"episode",
"hematemesis",
"hours",
"dyspepsia",
"years",
"medications include occasional ibuprofen",
"headaches",
"initial stabilization",
"risks",
"benefits",
"upper endoscopy",
"alternative treatments",
"includ... |
A 25-year-old man is admitted to the hospital after a severe motor vehicle accident as an unrestrained front-seat passenger. Appropriate life-saving measures are given, and the patient is now hemodynamically stable. Physical examination shows a complete loss of consciousness. There are no motor or ocular movements with... | Warm water causing ipsilateral saccadic movement. | {
"A": "Cold water causing ipsilateral saccadic movement.",
"B": "Warm water causing ipsilateral saccadic movement.",
"C": "Warm water mimicking the head turning left.",
"D": "Cold water causing contralateral slow pursuit."
} | step1 | B | [
"year old man",
"admitted",
"hospital",
"severe motor vehicle accident",
"front-seat passenger",
"Appropriate life saving measures",
"given",
"patient",
"now hemodynamically stable",
"Physical examination shows",
"complete loss of consciousness",
"motor",
"ocular movements",
"painful stimu... |
A 68-year-old man presents to the emergency department with palpitations. He also feels that his exercise tolerance has reduced over the previous week. His past history is positive for ischemic heart disease and he has been on multiple medications for a long time. On physical examination, his temperature is 36.9°C (98.... | Atrioventricular block | {
"A": "Atrial rate above 400 beats per minute",
"B": "Slurred upstroke of R wave",
"C": "Atrioventricular block",
"D": "No discernible P waves"
} | step1 | C | [
"68 year old man presents",
"emergency department",
"palpitations",
"feels",
"exercise tolerance",
"reduced",
"previous week",
"past history",
"positive",
"ischemic heart disease",
"multiple medications",
"long time",
"physical examination",
"temperature",
"36",
"98 4F",
"pulse rate"... |
A 55-year-old man presents to the physician with a cough which he has had for the last 5 years. He also mentions that he has been feeling breathless when playing any active sport for the last 1 year. He is a manager in a corporate company and has been a regular smoker for 10 years. He has visited multiple physicians an... | Decreased diffusion capacity of the lung for carbon monoxide (DLCO) | {
"A": "History of long-term exposure to cigarette smoke",
"B": "Increased hematocrit in hematologic evaluation",
"C": "Presence of chronic respiratory acidosis in arterial blood gas analysis",
"D": "Decreased diffusion capacity of the lung for carbon monoxide (DLCO)"
} | step2&3 | D | [
"55 year old man presents",
"physician",
"cough",
"last",
"years",
"feeling breathless",
"playing",
"active sport",
"year",
"manager",
"corporate company",
"regular smoker",
"10 years",
"visited multiple physicians",
"multiple diagnostic evaluations",
"permanent benefit",
"physical e... |
A 24-year-old male is rushed to the emergency department after sustaining several gunshot wounds to the chest. He was found nonresponsive in the field and was intubated en route to the hospital. His vital signs are as follows: temperature is 98.8 deg F (37.1 deg C), blood pressure is 87/52 mmHg, pulse is 120/min, and r... | Open thoracotomy | {
"A": "Clamp the chest tube",
"B": "Place the chest tube to water seal",
"C": "Remove the chest tube",
"D": "Open thoracotomy"
} | step2&3 | D | [
"year old male",
"rushed",
"emergency department",
"sustaining",
"gunshot wounds to",
"chest",
"found",
"field",
"intubated en route",
"hospital",
"vital signs",
"follows",
"temperature",
"98 8 deg F",
"1",
"blood pressure",
"87",
"mmHg",
"pulse",
"min",
"respirations",
"mi... |
A 5-year-old is brought into your office by his mother. His mother states that he is having 10-20 episodes per day where he stops responding to his mother and is found staring out of the window. During these periods, he blinks more frequently than normal, but returns to his normal self afterwards. These episodes last 3... | Absence seizure | {
"A": "Febrile seizure",
"B": "Benign focal epilepsy",
"C": "Juvenile myoclonic epilepsy",
"D": "Absence seizure"
} | step2&3 | D | [
"5 year old",
"brought",
"office",
"mother",
"mother states",
"10-20 episodes",
"day",
"stops",
"mother",
"found staring out",
"window",
"periods",
"blinks more frequently",
"normal",
"returns",
"normal self",
"episodes last 30 to 60 seconds",
"mother states",
"milestones",
"no... |
A 19-year-old woman presents to the ED after multiple episodes of vomiting in the last 6 hours. The vomitus is non-bloody and non-bilious. The vomiting started shortly after she began having a throbbing, unilateral headache and associated photophobia. She has had several similar headaches in the past. Her vital signs a... | Chlorpromazine | {
"A": "Propranolol",
"B": "Ergonovine",
"C": "Chlorpromazine",
"D": "Calcium channel blockers"
} | step2&3 | C | [
"year old woman presents",
"ED",
"multiple episodes of vomiting",
"last",
"hours",
"vomitus",
"non bloody",
"non",
"vomiting started",
"began",
"throbbing",
"unilateral headache",
"associated photophobia",
"several similar headaches",
"past",
"vital signs",
"unremarkable",
"followi... |
A 22-year-old woman is brought to the emergency department by her roommate for unusual behavior. They were at a party where alcohol and recreational drugs were consumed, but her roommate is unsure of what she may have taken or had to drink. She is otherwise healthy and does not take any medications. The patient appears... | Impaired reaction time | {
"A": "Respiratory depression",
"B": "Decreased appetite",
"C": "Pupillary constriction",
"D": "Impaired reaction time"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"roommate",
"unusual behavior",
"party",
"alcohol",
"recreational drugs",
"roommate",
"unsure",
"taken",
"to drink",
"healthy",
"not take",
"medications",
"patient appears anxious",
"temperature",
"99",
"pulse",
"min",
"res... |
A 62-year-old woman presents to her primary care physician for her annual check-up. She has no current complaints and says that she has been healthy over the last year. Her past medical history is significant for obesity and diabetes that is well controlled on metformin. She does not smoke and drinks socially. Selected... | Hepatotoxicity | {
"A": "Gastrointestinal upset",
"B": "Hepatotoxicity",
"C": "Malabsorption",
"D": "Pruritus"
} | step1 | B | [
"62 year old woman presents",
"primary care physician",
"annual check-up",
"current complaints",
"healthy",
"year",
"past medical history",
"significant",
"obesity",
"diabetes",
"well controlled",
"metformin",
"not smoke",
"drinks",
"Selected lab results",
"shown",
"High-density lipo... |
A 67-year-old man presents to his primary care physician for fatigue. This has persisted for the past several months and has been steadily worsening. The patient has a past medical history of hypertension and diabetes; however, he is not currently taking any medications and does not frequently visit his physician. The ... | Malignancy | {
"A": "Bone marrow aplasia",
"B": "Intravascular hemolysis",
"C": "Malignancy",
"D": "Vitamin B12 and folate deficiency"
} | step2&3 | C | [
"67 year old man presents",
"primary care physician",
"fatigue",
"past",
"months",
"worsening",
"patient",
"past medical",
"diabetes",
"not currently taking",
"medications",
"not frequently visit",
"physician",
"patient",
"lost 20 pounds",
"last visit",
"laboratory values",
"shown"... |
A 19-year-old male soccer player undergoes an exercise tolerance test to measure his maximal oxygen uptake during exercise. Which of the following changes are most likely to occur during exercise? | Decreased physiologic dead space | {
"A": "Increased pulmonary vascular resistance",
"B": "Decreased physiologic dead space",
"C": "Decreased alveolar-arterial oxygen gradient",
"D": "Increased arterial partial pressure of oxygen"
} | step1 | B | [
"year old male soccer",
"exercise tolerance test to measure",
"maximal oxygen uptake",
"exercise",
"following changes",
"most likely to occur",
"exercise"
] |
A 15-year-old Caucasian female presents with Parkinson-like symptoms. Serum analysis shows increased levels of free copper and elevated liver enzymes. What test would prove most helpful in diagnosing the patient's underlying disease? | Slit lamp examination | {
"A": "Serum detection of anti-myelin antibodies",
"B": "Slit lamp examination",
"C": "Vitamin B12 test",
"D": "Reflex test"
} | step1 | B | [
"year old Caucasian female presents",
"Parkinson",
"symptoms",
"Serum analysis shows increased levels",
"free copper",
"elevated liver enzymes",
"test",
"helpful",
"diagnosing",
"patient's",
"disease"
] |
A 60-year-old male comes to the emergency department because of a 3-day history of intermittent shortness of breath and palpitations. The episodes are unprovoked and occur randomly. The day before, he felt lightheaded while walking and had to sit down abruptly to keep from passing out. He has hypertension and coronary ... | Degeneration of sinoatrial node automaticity | {
"A": "Premature ventricular contractions",
"B": "Abnormal automaticity within the ventricle",
"C": "Degeneration of sinoatrial node automaticity",
"D": "Wandering atrial pacemaker"
} | step2&3 | C | [
"60 year old male",
"emergency department",
"of",
"3-day history",
"intermittent shortness",
"breath",
"palpitations",
"episodes",
"occur",
"day",
"felt lightheaded",
"walking",
"to sit down",
"to keep",
"out",
"hypertension",
"coronary artery disease",
"Cardiac catheterization 5 y... |
A 32-year-old woman presents to her primary care doctor complaining of increased fatigue and cold intolerance after her recent delivery. The patient delivered a healthy 39-week-old boy 3 weeks ago via spontaneous vaginal delivery. Delivery was complicated by postpartum hemorrhage requiring admission to the intensive ca... | Decreased prolactin | {
"A": "Decreased prolactin",
"B": "Decreased thyroid releasing hormone",
"C": "Increased follicle stimulating hormone",
"D": "Increased luteinizing hormone"
} | step1 | A | [
"year old woman presents",
"primary care doctor",
"increased fatigue",
"cold intolerance",
"recent delivery",
"patient delivered",
"healthy",
"week old boy",
"weeks",
"spontaneous vaginal delivery",
"complicated",
"postpartum hemorrhage",
"admission",
"intensive care unit",
"blood transf... |
A 24-year-old woman comes to the physician because of progressively worsening joint pain. She has had diffuse, aching pain in her knees, shoulders, and hands bilaterally for the past few months, but the pain has become much more severe in the past few weeks. She also reports night sweats and generalized malaise. On phy... | Takayasu arteritis | {
"A": "Temporal arteritis",
"B": "Polyarteritis nodosa",
"C": "Thromboangiitis obliterans",
"D": "Takayasu arteritis"
} | step2&3 | D | [
"year old woman",
"physician",
"worsening joint pain",
"diffuse",
"aching pain in",
"knees",
"shoulders",
"hands",
"past",
"months",
"pain",
"much",
"severe",
"past",
"weeks",
"reports night sweats",
"generalized malaise",
"physical examination",
"radial",
"pedal pulses",
"we... |
A 19-year-old college student is brought to the emergency department with persistent vomiting overnight. He spent all day drinking beer yesterday at a college party according to his friends. He appears to be in shock and when asked about vomiting, he says that he vomited up blood about an hour ago. At the hospital, his... | Mallory-Weiss tear | {
"A": "Boerhaave syndrome",
"B": "Mallory-Weiss tear",
"C": "Pill esophagitis",
"D": "Dieulafoy's lesion"
} | step2&3 | B | [
"year old college student",
"brought",
"emergency department",
"persistent vomiting overnight",
"spent all day beer",
"college party",
"friends",
"appears to",
"shock",
"vomiting",
"vomited",
"blood",
"hour",
"hospital",
"vomit contains streaks",
"blood",
"temperature",
"98",
"re... |
A 40-year-old woman presents to her primary care physician with a 2-month history of joint pain and morning stiffness that improves through the course of the day. Her left knee also sometimes bothers her. She has taken ibuprofen and tylenol without relief, and the pain is starting to upset her daily routine. On physica... | Methotrexate | {
"A": "Ibuprofen",
"B": "Hydroxychloroquine",
"C": "Infliximab",
"D": "Methotrexate"
} | step2&3 | D | [
"40 year old woman presents",
"primary care physician",
"2 month history",
"joint pain",
"morning stiffness",
"improves",
"course",
"day",
"left knee",
"sometimes",
"taken ibuprofen",
"tylenol",
"relief",
"pain",
"starting to upset",
"daily routine",
"physical examination",
"joints... |
A 6-year-old boy is brought to the pediatrician by his foster father because he is concerned about the boy's health. He states that at seemingly random times he will have episodes of severe difficulty breathing and wheezing. Upon questioning, the pediatrician learns that these episodes do not appear to be associated wi... | Major basic protein | {
"A": "IL-5",
"B": "Major basic protein",
"C": "IgM",
"D": "Interferon-gamma"
} | step1 | B | [
"year old boy",
"brought",
"pediatrician",
"foster father",
"concerned",
"boy's health",
"states",
"random times",
"episodes of severe difficulty breathing",
"wheezing",
"questioning",
"pediatrician learns",
"episodes",
"not appear to",
"associated with exercise",
"irritants",
"infec... |
A 55-year-old man presents with fever, chills, fatigue, cough, sore throat, and breathlessness for the past 7 days. He describes the cough as productive and says he is fatigued all the time. He says he is a farmer with daily contact with rabbits, horses, sheep, pigeons, and chickens and reports cleaning the barn 3 days... | Francisella tularensis | {
"A": "Francisella tularensis",
"B": "Bacillus anthracis",
"C": "Staphylococcus aureus ",
"D": "Yersinia pestis"
} | step1 | A | [
"55 year old man presents",
"fever",
"chills",
"fatigue",
"cough",
"sore throat",
"breathlessness",
"past 7 days",
"cough",
"productive",
"fatigued",
"time",
"farmer with daily contact",
"rabbits",
"horses",
"sheep",
"pigeons",
"chickens",
"reports cleaning",
"barn 3 days",
"... |
Two days after undergoing an uncomplicated total thyroidectomy, a 63-year-old woman has acute, progressive chest pain. The pain is sharp and burning. She feels nauseated and short of breath. The patient has a history of hypertension, type 1 diabetes mellitus, medullary thyroid cancer, multiple endocrine neoplasia type ... | Obtain an ECG and troponin T levels | {
"A": "Obtain an ECG and troponin T levels",
"B": "Administer IV pantoprazole and schedule endoscopy",
"C": "Discontinue levothyroxine and obtain fT4 levels",
"D": "Administer IV levofloxacin and obtain chest radiograph"
} | step2&3 | A | [
"Two days",
"uncomplicated total thyroidectomy",
"63 year old woman",
"acute",
"progressive chest pain",
"pain",
"sharp",
"burning",
"feels nauseated",
"short of breath",
"patient",
"history of hypertension",
"type 1 diabetes mellitus",
"medullary thyroid cancer",
"multiple endocrine neo... |
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