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 young researcher is studying the structure of class I and class II major histocompatibility complex (MHC) molecules. He understands that these molecules are proteins, but the structures of class I MHC molecules are different from those of class II. Although all these molecules consist of α and β chains, some of their... | α3 domain in class I molecules and β2 domain in class II molecules | {
"A": "α1 domain in class I molecules and α1 domain in class II molecules",
"B": "α2 domain in class I molecules and β2 domain in class II molecules",
"C": "α1-α2 domains in class I molecules and α1-β1 domains in class II molecules",
"D": "α3 domain in class I molecules and β2 domain in class II molecules"
} | step1 | D | [
"young researcher",
"studying",
"structure",
"class I",
"class II major histocompatibility complex",
"molecules",
"understands",
"molecules",
"proteins",
"structures",
"class I MHC molecules",
"different",
"class II",
"molecules consist",
"chains",
"domains",
"polymorphic",
"meanin... |
A 17-year-old boy is brought to the physician by his mother because of increasingly withdrawn behavior for the last two years. His mother reports that in the last 2–3 years of high school, her son has spent most of his time in his room playing video games. He does not have any friends and has never had a girlfriend. He... | Schizoid personality disorder | {
"A": "Schizophreniform disorder",
"B": "Schizoid personality disorder",
"C": "Antisocial personality disorder",
"D": "Avoidant personality disorder"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"mother",
"withdrawn behavior",
"last two years",
"mother reports",
"last 23 years",
"high school",
"son",
"spent most of",
"time",
"room playing video games",
"not",
"friends",
"never",
"girlfriend",
"usually refuses to attend family dinner"... |
A 42-year-old man presents with an oral cavity lesion, toothache, and weight loss. He is known to have been HIV-positive for 6 years, but he does not follow a prescribed antiretroviral regimen because of personal beliefs. The vital signs are as follows: blood pressure 110/80 mm Hg, heart rate 89/min, respiratory rate 1... | EBV | {
"A": "EBV",
"B": "HHV-8",
"C": "HHV-1",
"D": "HPV-16"
} | step1 | A | [
"year old man presents",
"oral cavity lesion",
"toothache",
"weight loss",
"known to",
"HIV-positive",
"years",
"not follow",
"prescribed antiretroviral regimen",
"personal beliefs",
"vital signs",
"follows",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"m... |
A 58-year old man comes to his physician because of a 1-month history of increased thirst and nocturia. He is drinking a lot of water to compensate for any dehydration. His brother has type 2 diabetes mellitus. Physical examination shows dry mucous membranes. Laboratory studies show a serum sodium of 151 mEq/L and gluc... | Partial central diabetes inspidus | {
"A": "Partial central diabetes inspidus",
"B": "Complete central diabetes insipidus",
"C": "Primary polydipsia",
"D": "Osmotic diuresis"
} | step1 | A | [
"58 year old man",
"physician",
"month history",
"increased thirst",
"nocturia",
"drinking",
"lot",
"water to compensate",
"dehydration",
"brother",
"type 2 diabetes mellitus",
"Physical examination shows dry mucous membranes",
"Laboratory studies show",
"serum sodium",
"mEq/L",
"gluco... |
A previously healthy 13-year-old girl is brought to the physician by her parents because of a 2-day history of low-grade fever, headache, nausea, and a sore throat. Examination of the oral cavity shows enlarged, erythematous tonsils with exudates and palatal petechiae. There is cervical lymphadenopathy. Her parents agr... | M Protein | {
"A": "Protein A",
"B": "Streptolysin O",
"C": "Hyaluronidase",
"D": "M Protein"
} | step1 | D | [
"healthy",
"year old girl",
"brought",
"physician",
"parents",
"2-day history",
"low-grade fever",
"headache",
"nausea",
"sore throat",
"Examination of",
"oral shows enlarged",
"erythematous tonsils",
"exudates",
"palatal petechiae",
"cervical lymphadenopathy",
"parents agree",
"pa... |
A 40-year-old man comes to the physician for the evaluation of episodic headaches for 5 months. The headaches involve both temples and are 4/10 in intensity. The patient has been taking acetaminophen, but the headaches did not subside. He has also had visual disturbances, including double vision. He has no nausea, temp... | Erectile dysfunction | {
"A": "Galactorrhea",
"B": "Coarse facial features",
"C": "Erectile dysfunction",
"D": "Abdominal striae"
} | step2&3 | C | [
"40 year old man",
"physician",
"evaluation of episodic headaches",
"5 months",
"headaches",
"temples",
"4/10",
"intensity",
"patient",
"taking acetaminophen",
"headaches",
"not",
"visual disturbances",
"including double vision",
"nausea",
"temperature intolerance",
"weight changes",... |
A 4-year-old boy is brought to the physician because of frequent falls, worsening muscle pain, and poor vision in low light conditions. His mother reports that he has been on a low-fat diet since infancy because of persistent diarrhea. He is at the 5th percentile for height and weight. Physical examination shows bilate... | Post-prandial lipid-laden enterocytes | {
"A": "GAA trinucleotide repeats on chromosome 9",
"B": "Post-prandial lipid-laden enterocytes",
"C": "IgA anti-tissue transglutaminase antibodies",
"D": "Fibrofatty replacement of muscle tissue"
} | step1 | B | [
"4 year old boy",
"brought",
"physician",
"frequent falls",
"worsening muscle pain",
"poor",
"low light conditions",
"mother reports",
"low-fat diet",
"infancy",
"persistent diarrhea",
"5th percentile",
"height",
"weight",
"Physical examination shows bilateral proximal",
"wide ataxic g... |
A 52-year-old man presents to his primary care physician complaining of a blistering rash in his inguinal region. Upon further questioning, he also endorses an unintended weight loss, diarrhea, polydipsia, and polyuria. A fingerstick glucose test shows elevated glucose even though this patient has no previous history o... | Increased lipolysis | {
"A": "Inhibition of insulin release",
"B": "Increased glycolysis",
"C": "Increased lipolysis",
"D": "Decreased ketone body producttion"
} | step1 | C | [
"year old man presents",
"primary care physician complaining of a blistering rash",
"inguinal region",
"further questioning",
"unintended weight loss",
"diarrhea",
"polydipsia",
"polyuria",
"fingerstick glucose test shows elevated glucose",
"patient",
"previous history",
"diabetes",
"referra... |
A 38-year-old woman is brought to the emergency department because of 3 1-hour episodes of severe, sharp, penetrating abdominal pain in the right upper quadrant. During these episodes, she had nausea and vomiting. She has no diarrhea, dysuria, or hematuria and is asymptomatic between episodes. She has hypertension and ... | Choledocholithiasis | {
"A": "Acute hepatitis A",
"B": "Cholangitis",
"C": "Choledocholithiasis",
"D": "Pancreatitis"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"of 3 1 hour episodes",
"severe",
"sharp",
"penetrating abdominal pain",
"right upper quadrant",
"episodes",
"nausea",
"vomiting",
"diarrhea",
"dysuria",
"hematuria",
"asymptomatic",
"episodes",
"hypertension",
"hyperlipidemia",
... |
In a recently conducted case-control study that aimed to elucidate the causes of myelomeningocele (a neural tube defect in which there is an incomplete formation of the spinal bones), 200 mothers of infants born with the disease and 200 mothers of infants born without the disease were included in the study. Among the m... | Recall bias | {
"A": "Surveillance bias",
"B": "Recall bias",
"C": "Assessment bias",
"D": "Neyman bias"
} | step1 | B | [
"recently conducted case-control study",
"aimed to",
"causes",
"myelomeningocele",
"neural tube defect",
"incomplete formation",
"spinal bones",
"200 mothers",
"infants born",
"disease",
"200 mothers",
"infants born",
"disease",
"included",
"study",
"mothers",
"infants",
"myelomeni... |
A 66-year-old woman presents to the primary care physician with complaints of involuntary loss of urine. This has been occurring over the past month for no apparent reason while suddenly feeling the need to urinate. History reveals triggers that stimulate the desire to pass urine, such as running water, handwashing, an... | Bladder training | {
"A": "Administer antimuscarinics",
"B": "Bladder training",
"C": "Posterior tibial nerve stimulation",
"D": "Surgery"
} | step2&3 | B | [
"66 year old woman presents",
"primary care physician",
"complaints",
"involuntary loss",
"urine",
"occurring",
"past month",
"apparent reason",
"feeling",
"need to",
"History reveals triggers",
"desire to pass urine",
"running water",
"handwashing",
"cold weather",
"family",
"simila... |
A 40-year-old woman with a recent history of carcinoma of the breast status post mastectomy and adjuvant chemotherapy one week ago presents for follow-up. She reports adequate pain control managed with the analgesic drug she was prescribed. Past medical history is significant for hepatitis C and major depressive disord... | Mixed agonist-antagonist at opioid receptors | {
"A": "Mixed agonist-antagonist at opioid receptors",
"B": "Pure antagonist at opioid receptors",
"C": "Inhibits prostaglandin synthesis",
"D": "Pure agonist at the µ-opioid receptor"
} | step1 | A | [
"40 year old woman",
"recent history of carcinoma",
"the breast",
"mastectomy",
"adjuvant chemotherapy one week",
"presents",
"follow-up",
"reports adequate pain control managed",
"analgesic drug",
"prescribed",
"Past medical history",
"significant",
"hepatitis C",
"major depressive disord... |
A 68-year-old man is brought to the emergency department by ambulance from a homeless shelter. The report from the shelter describes the man as a loner expressing symptoms of depression. He has been living at the shelter for approximately 10 months and has no family or friends and few visitors. He spends most of his ev... | Males are more likely to die from suicide than females. | {
"A": "Males are more likely to die from suicide than females.",
"B": "Males attempt suicide more than females.",
"C": "Females are more likely to self-inflict fatal injuries.",
"D": "Suicide risk is highest among middle-age white women."
} | step1 | A | [
"68 year old man",
"brought",
"emergency department",
"ambulance",
"homeless shelter",
"report",
"shelter",
"man",
"symptoms of depression",
"living",
"shelter",
"approximately 10 months",
"family",
"friends",
"few",
"spends most",
"evenings drinking alcohol",
"following statements... |
A 65-year-old man with a history of hypertension visits your office. His blood pressure on physical examination is found to be 150/90. You prescribe him metoprolol. Which of the following do you expect to occur as a result of the drug? | Decreased serum renin levels as a consequence of ß1 receptor antagonism | {
"A": "Decreased serum renin levels as consequence of ß2 antagonism",
"B": "Increased serum renin levels as a consequence of ß2 receptor antagonism",
"C": "Decreased serum renin levels as a consequence of ß1 receptor antagonism",
"D": "Increased serum renin levels as a consequence of ß1 receptor antagonism"
} | step1 | C | [
"65-year-old man",
"history of hypertension visits",
"office",
"blood",
"physical",
"found to",
"90",
"metoprolol",
"following",
"to occur",
"result",
"drug"
] |
A 5-year-old boy is brought to the physician because of a nonpruritic rash on his face that began 5 days ago. It started as a bug bite on his chin that then developed into small pustules with surrounding redness. He has not yet received any routine childhood vaccinations. Physical examination shows small, clustered les... | Glomerulonephritis | {
"A": "Reactive arthritis",
"B": "Shingles",
"C": "Glomerulonephritis",
"D": "Myocarditis"
} | step1 | C | [
"5 year old boy",
"brought",
"physician",
"of",
"nonpruritic rash",
"face",
"began 5 days",
"started",
"bug bite",
"chin",
"then",
"small pustules",
"surrounding redness",
"not",
"received",
"routine",
"Physical examination shows small",
"clustered lesions",
"gold crusts",
"low... |
A 29-year-old G2P1 woman presents at 24 weeks gestation with complaints of blurred vision and headaches. Her symptoms have increased in frequency over the past several weeks. Her medical history is significant only for occasional tension headaches. She takes no medications besides an oral folic acid supplement. The vit... | 24-hour urine collection | {
"A": "Non-contrast enhanced head CT",
"B": "Serum CBC and electrolytes",
"C": "24-hour urine collection",
"D": "Fetal ultrasound"
} | step2&3 | C | [
"29 year old",
"woman presents",
"weeks gestation",
"complaints",
"blurred vision",
"headaches",
"symptoms",
"increased",
"frequency",
"past",
"weeks",
"medical history",
"significant only",
"occasional tension headaches",
"takes",
"medications",
"oral folic acid supplement",
"vita... |
A 45-year-old male presents to the emergency room for toe pain. He reports that his right great toe became acutely painful, red, and swollen approximately five hours prior. He has had one similar prior episode six months ago that resolved with indomethacin. His medical history is notable for obesity, hypertension, and ... | Inhibits microtubule polymerization | {
"A": "Inhibits microtubule polymerization",
"B": "Prevents conversion of xanthine to uric acid",
"C": "Decreases cyclooxygenase-induced production of prostaglandins",
"D": "Metabolizes uric acid to water-soluble allantoin"
} | step1 | A | [
"year old male presents",
"emergency room",
"toe pain",
"reports",
"right great toe",
"painful",
"red",
"swollen approximately five hours prior",
"one similar prior episode six months",
"resolved",
"indomethacin",
"medical history",
"notable",
"obesity",
"hypertension",
"alcohol abuse"... |
A 24-year-old man is referred to an endocrinologist for paroxysms of headaches associated with elevated blood pressure and palpitations. He is otherwise healthy, although he notes a family history of thyroid cancer. His physical examination is significant for the findings shown in Figures A, B, and C. His thyroid is no... | Autosomal dominant | {
"A": "Autosomal dominant",
"B": "Autosomal recessive",
"C": "Mitochondrial",
"D": "X-linked dominant"
} | step2&3 | A | [
"year old man",
"referred",
"endocrinologist",
"paroxysms",
"headaches associated with elevated blood pressure",
"palpitations",
"healthy",
"notes",
"family history of thyroid cancer",
"physical examination",
"significant",
"findings shown",
"thyroid",
"normal",
"size",
"2.5",
"nodul... |
A previously healthy 29-year-old man comes to the emergency department because of a 4-day history of abdominal pain and confusion. Prior to the onset of the abdominal pain, he visited a festival where he consumed large amounts of alcohol. Examination shows a distended abdomen, decreased bowel sounds, and diffuse tender... | Hemin | {
"A": "Intravenous immunoglobulin",
"B": "Hemin",
"C": "Ethylenediaminetetraacetic acid",
"D": "Chlordiazepoxide"
} | step1 | B | [
"healthy 29 year old man",
"emergency department",
"4-day history",
"abdominal pain",
"confusion",
"Prior to",
"onset",
"abdominal",
"visited",
"festival",
"large amounts",
"alcohol",
"Examination shows",
"distended abdomen",
"decreased bowel sounds",
"diffuse tenderness",
"palpation... |
A 4-year-old Caucasian male patient presents with recurrent infections. During examination of his CD4 T-cells, it is noticed that his T-cells lack CD40 ligand. Which type of immunoglobulin is likely to be present in excess? | IgM | {
"A": "IgE",
"B": "IgG",
"C": "IgM",
"D": "IgD"
} | step1 | C | [
"4 year old Caucasian male patient presents",
"recurrent infections",
"examination of",
"CD4",
"cells",
"T-cells lack CD40 ligand",
"type",
"immunoglobulin",
"likely to",
"present",
"excess"
] |
A 22-year-old woman is in her last few months at community college. She has a very important essay due in 2 weeks that will play a big part in determining her final grades. She decides to focus on writing this essay instead and not to worry about her grades until her essay is completed. Which of the following defense m... | Suppression | {
"A": "Suppression",
"B": "Blocking",
"C": "Dissociation",
"D": "Denial"
} | step1 | A | [
"year old woman",
"last",
"months",
"community college",
"very important essay due",
"2 weeks",
"play",
"big part",
"determining",
"final grades",
"focus",
"writing",
"essay",
"not",
"worry",
"grades",
"essay",
"completed",
"following defense mechanisms best",
"behavior"
] |
A 93-year-old woman is brought to the physician because of a purple area on her right arm that has been growing for one month. She has not had any pain or itching of the area. She has hyperlipidemia, a history of basal cell carcinoma treated with Mohs surgery 2 years ago, and a history of invasive ductal carcinoma of t... | Lymphangiosarcoma | {
"A": "Lymphangiosarcoma",
"B": "Cellulitis",
"C": "Lichen planus",
"D": "Kaposi sarcoma"
} | step2&3 | A | [
"year old woman",
"brought",
"physician",
"of",
"purple area",
"right arm",
"one month",
"not",
"pain",
"itching",
"area",
"hyperlipidemia",
"history of basal cell carcinoma treated with Mohs surgery",
"years",
"history of invasive ductal carcinoma",
"the right breast treated with radi... |
A boy born vaginally in the 36th week of gestation to a 19-year-old woman (gravida 3, para 1) is assessed on his 2nd day of life. His vitals include: blood pressure is 85/40 mm Hg, pulse is 161/min, axillary temperature is 36.6°C (98.0°F), and respiratory rate is 44/min. He appears to be lethargic; his skin is jaundice... | Patent ductus arteriosus | {
"A": "Pulmonary valve stenosis",
"B": "Patent ductus arteriosus",
"C": "Ventricular septal defect",
"D": "Atrialization of the right ventricle"
} | step1 | B | [
"boy born",
"week",
"gestation",
"year old woman",
"gravida 3",
"para 1",
"assessed",
"2nd day",
"life",
"include",
"blood pressure",
"85 40 mm Hg",
"pulse",
"min",
"axillary temperature",
"36",
"98",
"respiratory rate",
"min",
"appears to",
"lethargic",
"skin",
"jaundice... |
A 23-year-old woman presents to the emergency department with severe abdominal pain. She states that the pain has been dull and progressive, but became suddenly worse while she was exercising. The patient's past medical history is notable for depression, anxiety, and gonococcal urethritis that was appropriately treated... | Vascular ectasia within the liver | {
"A": "Obstruction of the common bile duct by radio-opaque stones",
"B": "Obstruction of blood flow through the hepatic vein",
"C": "Vascular ectasia within the liver",
"D": "Ectopic implantation of a blastocyst"
} | step2&3 | C | [
"23 year old woman presents",
"emergency department",
"severe abdominal",
"states",
"pain",
"dull",
"progressive",
"worse",
"exercising",
"patient's past",
"notable",
"depression",
"anxiety",
"gonococcal urethritis",
"treated",
"patient states",
"sexually active",
"not use condoms"... |
A 22-year-old immigrant presents to his primary care physician for a general checkup. This is his first time visiting a physician, and he has no known past medical history. The patient’s caretaker states that the patient has experienced episodes of syncope and what seems to be seizures before but has not received treat... | Prolonged QT interval | {
"A": "Peaked T waves",
"B": "Prolonged QRS interval",
"C": "Prolonged QT interval",
"D": "QT shortening"
} | step2&3 | C | [
"year old immigrant presents",
"primary care physician",
"general checkup",
"first time visiting",
"physician",
"known past medical history",
"patients caretaker states",
"patient",
"episodes of syncope",
"to",
"seizures",
"not received treatment",
"temperature",
"98",
"36",
"blood pre... |
A 29-year-old nulliparous woman is found upon transthoracic echocardiography to have a dilated aorta and mitral valve prolapse. The patient has a history of joint pain, and physical examination reveals pectus excavatum and stretch marks on the skin. She does not take any medications and has no history of past drug use.... | Marfan syndrome | {
"A": "Ehlers-Danlos syndrome",
"B": "Turner syndrome",
"C": "DiGeorge syndrome",
"D": "Marfan syndrome"
} | step1 | D | [
"29 year old nulliparous woman",
"found",
"transthoracic echocardiography to",
"dilated aorta",
"mitral valve prolapse",
"patient",
"history",
"joint pain",
"physical examination reveals pectus excavatum",
"stretch",
"skin",
"not take",
"medications",
"history of past drug use",
"patient... |
A 34-year-old woman comes to the physician with fever and malaise. For the past 2 days, she has felt fatigued and weak and has had chills. Last night, she had a temperature of 40.8°C (104.2°F). She has also had difficulty swallowing since this morning. The patient was recently diagnosed with Graves disease and started ... | Discontinue methimazole | {
"A": "Bone marrow biopsy",
"B": "Discontinue methimazole",
"C": "Test for EBV, HIV, and CMV",
"D": "Decrease methimazole dose"
} | step2&3 | B | [
"year old woman",
"physician",
"fever",
"malaise",
"past 2 days",
"felt fatigued",
"weak",
"chills",
"Last night",
"temperature",
"40",
"difficulty swallowing",
"morning",
"patient",
"recently diagnosed",
"Graves disease",
"started",
"methimazole",
"appears",
"temperature",
"... |
A 6-year-old refugee with delayed growth and weakness is brought to the physician. Her family has been displaced several times over the last few years, and nutrition and housing were frequently inadequate. Examination of the lower limbs shows bowing of the legs with reduced proximal muscle strength. The abdomen is prot... | Vitamin D deficiency | {
"A": "Defective collagen synthesis",
"B": "Insufficient protein consumption",
"C": "Osteoclast hyperactivity",
"D": "Vitamin D deficiency"
} | step2&3 | D | [
"year old refugee",
"delayed growth",
"weakness",
"brought",
"physician",
"family",
"displaced",
"times",
"years",
"nutrition",
"housing",
"frequently inadequate",
"Examination of",
"lower limbs shows bowing of the legs",
"reduced proximal muscle strength",
"abdomen",
"protruded",
... |
A 16-year-old boy presents with a long-standing history of anemia. Past medical history is significant for prolonged neonatal jaundice and multiple episodes of jaundice without fever. On physical examination, the patient shows generalized pallor, scleral icterus, and splenomegaly. His hemoglobin is 10 g/dL, and examina... | Pyrimidine 5’-nucleotidase deficiency | {
"A": "Pyruvate kinase deficiency",
"B": "Cytochrome b5 reductase deficiency",
"C": "Lead poisoning",
"D": "Pyrimidine 5’-nucleotidase deficiency"
} | step1 | D | [
"year old boy presents",
"long standing history",
"Past medical",
"significant",
"prolonged neonatal jaundice",
"multiple episodes of jaundice",
"fever",
"physical examination",
"patient shows generalized pallor",
"scleral icterus",
"splenomegaly",
"hemoglobin",
"10 g/dL",
"examination",
... |
A 19-year-old woman with a history of poorly controlled asthma presents to her pulmonologist for a follow-up visit. She was recently hospitalized for an asthma exacerbation. It is her third hospitalization in the past five years. She currently takes inhaled salmeterol and medium-dose inhaled budesonide. Her past medica... | Decreased production of leukotrienes | {
"A": "Decreased production of leukotrienes",
"B": "Decreased IgE-mediated pro-inflammatory activity",
"C": "Decreased mast cell degranulation",
"D": "Decreased signaling via the muscarinic receptor"
} | step1 | A | [
"year old woman",
"history of poorly controlled asthma presents",
"pulmonologist",
"follow-up visit",
"recently hospitalized",
"asthma exacerbation",
"third hospitalization",
"past five years",
"currently takes inhaled salmeterol",
"medium dose inhaled budesonide",
"past medical history",
"not... |
A 6-year-old boy is brought to the emergency department with acute intermittent umbilical abdominal pain that began that morning. The pain radiates to his right lower abdomen and occurs every 15–30 minutes. During these episodes of pain, the boy draws up his knees to the chest. The patient has had several episodes of n... | Meckel diverticulum | {
"A": "Intestinal adhesions",
"B": "Meckel diverticulum",
"C": "Acute appendicitis",
"D": "Malrotation with volvulus"
} | step2&3 | B | [
"year old boy",
"brought",
"emergency department",
"acute intermittent umbilical abdominal pain",
"began",
"morning",
"pain radiates",
"right lower abdomen",
"occurs",
"minutes",
"episodes",
"pain",
"boy draws",
"knees",
"chest",
"patient",
"several episodes of",
"vomiting",
"sim... |
A lung mass of a 50 pack-year smoker is biopsied. If ADH levels were grossly increased, what would most likely be the histologic appearance of this mass? | Sheets of small round cells with hyperchromatic nuclei | {
"A": "Tall columnar cells bordering the alveolar septum",
"B": "Sheets of small round cells with hyperchromatic nuclei",
"C": "Layered squamous cells with keratin pearls",
"D": "Pleomorphic giant cells with leukocyte fragments in cytoplasm"
} | step1 | B | [
"lung",
"50 pack-year smoker",
"biopsied",
"ADH levels",
"increased",
"most likely",
"histologic appearance",
"mass"
] |
A 26-year-old man presents to his primary care physician for a routine physical exam. He is concerned about a burning sensation that he feels in his throat whenever he eats large meals and is concerned he may have esophageal cancer like his uncle. The patient has a past medical history of irritable bowel syndrome and c... | Generalized anxiety disorder | {
"A": "Depression",
"B": "Generalized anxiety disorder",
"C": "Obsessive compulsive disorder",
"D": "Post traumatic stress disorder"
} | step2&3 | B | [
"year old man presents",
"primary care physician",
"routine physical exam",
"concerned",
"burning sensation",
"feels",
"throat",
"eats large meals",
"concerned",
"esophageal cancer",
"uncle",
"patient",
"past medical history of irritable bowel syndrome",
"constipation",
"current medicati... |
A 32-year-old man presents to the physician for a check-up as part of his immigration application. On auscultation, there is a mild rumble heard at the cardiac apex preceded by an opening snap. His blood pressure is 132/76 and heart rate is 78/min. The patient suffers from occasional asthma attacks but has noticed that... | Penicillin | {
"A": "Penicillin",
"B": "Sulfasalazine",
"C": "Indomethacin",
"D": "PGE1 infusion"
} | step2&3 | A | [
"year old man presents",
"physician",
"check-up",
"part of",
"immigration application",
"auscultation",
"mild",
"heard",
"cardiac apex preceded",
"opening snap",
"blood pressure",
"76",
"heart rate",
"min",
"patient suffers",
"occasional asthma attacks",
"hold",
"breath",
"exerti... |
A 82-year-old woman is brought to the physician by her son because he is concerned about her forgetfulness for the past 2 years. She occasionally walks into a room and forgets why she went there and often forgets where she left her keys. She is sometimes unable to recall a familiar individual's name. She reports that s... | Aging | {
"A": "Aging",
"B": "Alzheimer's disease",
"C": "Lewy-body dementia",
"D": "Vascular Dementia"
} | step2&3 | A | [
"year old woman",
"brought",
"physician",
"son",
"concerned",
"forgetfulness",
"past",
"years",
"occasionally walks",
"room",
"forgets",
"often forgets",
"left",
"sometimes unable to recall",
"familiar individual's name",
"reports",
"slower",
"completing",
"living",
"death",
... |
A 40-year-old man comes to the physician because of fatigue, increased sweating, and itching in his legs for the past 2 years. He has chronic bronchitis. He has smoked two packs of cigarettes daily for 24 years and drinks one to two beers every night. His only medication is a tiotropium bromide inhaler. His vital signs... | Phlebotomy | {
"A": "Weight loss",
"B": "Hydroxyurea",
"C": "Inhaled budesonide",
"D": "Phlebotomy"
} | step2&3 | D | [
"40 year old man",
"physician",
"fatigue",
"increased sweating",
"itching",
"legs",
"past",
"years",
"chronic bronchitis",
"smoked two packs",
"cigarettes daily",
"years",
"drinks one",
"two beers",
"night",
"only medication",
"tiotropium bromide inhaler",
"vital signs",
"normal ... |
A 24-year-old woman comes to the clinic complaining of headache and sinus drainage for the past 13 days. She reports cold-like symptoms 2 weeks ago that progressively got worse. The patient endorses subjective fever, congestion, sinus headache, cough, and chills. She claims that this is her 5th episode within the past ... | Common variable immunodeficiency | {
"A": "Ataxia-telangiectasia",
"B": "Common variable immunodeficiency",
"C": "Wiskott-Aldrich syndrome",
"D": "X-linked agammaglobinemia"
} | step1 | B | [
"year old woman",
"clinic",
"headache",
"sinus drainage",
"past",
"days",
"reports cold",
"symptoms",
"weeks",
"got worse",
"patient",
"subjective fever",
"congestion",
"sinus headache",
"cough",
"chills",
"5th episode",
"past year",
"concerned",
"else",
"medical history",
... |
A 30-year-old man presents to his primary care physician for a routine check-up. During the appointment, he remarks that he has started noticing some thinning and hair loss without other symptoms. The physician reassures him that he is likely experiencing male-pattern baldness and explains that the condition is largely... | Polygenic inheritance | {
"A": "Pleiotropy",
"B": "Anticipation",
"C": "Polygenic inheritance",
"D": "Uniparental disomy"
} | step1 | C | [
"30 year old man presents",
"primary care physician",
"routine check-up",
"appointment",
"remarks",
"started",
"thinning",
"hair loss",
"symptoms",
"physician",
"likely experiencing male-pattern baldness",
"condition",
"inherited",
"notes",
"multiple genes",
"responsible",
"condition... |
A 67-year-old man comes to the physician because of a 3-month history of difficulty initiating urination. He wakes up at least 3–4 times at night to urinate. Digital rectal examination shows a symmetrically enlarged, nontender prostate with a rubbery consistency. Laboratory studies show a prostate-specific antigen leve... | Hyperplasia of lateral prostatic lobe tissue | {
"A": "Hyperplasia of lateral prostatic lobe tissue",
"B": "Infiltrating neoplasia of bladder urothelium",
"C": "Hypertrophy of middle prostatic lobe tissue",
"D": "Lymphocytic infiltration of anterior prostatic lobe stroma"
} | step1 | A | [
"67 year old man",
"physician",
"3 month history",
"difficulty initiating urination",
"wakes up",
"times",
"night to",
"Digital rectal examination shows",
"enlarged",
"nontender prostate with",
"rubbery consistency",
"Laboratory studies show",
"prostate-specific antigen level",
"2 1 mL",
... |
A 2860-g (6-lb 3-oz) male newborn is born at term to a primigravid woman via spontaneous vaginal delivery. The mother has had no routine prenatal care. She reports that there is no family history of serious illness. The initial examination of the newborn shows bowing of the legs and respiratory distress upon palpation ... | Hearing loss | {
"A": "Costochondral junction enlargement",
"B": "Intestinal rupture",
"C": "Spinal canal stenosis",
"D": "Hearing loss"
} | step1 | D | [
"g",
"oz",
"male newborn",
"born",
"term",
"primigravid woman",
"spontaneous vaginal delivery",
"mother",
"routine prenatal care",
"reports",
"family history",
"serious illness",
"initial examination",
"newborn shows bowing of the legs",
"respiratory distress",
"palpation",
"chest",
... |
A 56-year-old man presents to his primary care provider because of a lack of flexibility in his right hand. He has noticed that his hand has become less flexible and more fixed over the past year and he now has trouble shaking other people’s hands comfortably. He has a history of chronic alcohol abuse, hepatitis C, and... | Collagenase injections | {
"A": "Surgery",
"B": "Colchicine",
"C": "Steroid injections",
"D": "Collagenase injections"
} | step2&3 | D | [
"year old man presents",
"primary care provider",
"lack",
"flexibility",
"right hand",
"hand",
"less flexible",
"more fixed",
"past year",
"now",
"shaking",
"peoples hands",
"history of chronic alcohol abuse",
"hepatitis C",
"cirrhosis",
"family history",
"40 pack-year smoking histor... |
A 35-year-old man presents to the physician with concerns that a “bad flu” he has had for the past 10 days is getting worse and causing sleeplessness. On presentation today, his sore throat has improved; however, fever and chest and body aches persist despite the use of ibuprofen. He reports sharp, intermittent chest p... | Decreased cardiac contractility due to cardiac myocyte injury | {
"A": "Progressive cardiac ischemia caused by a plaque event",
"B": "Impaired gaseous exchange caused by pulmonary edema",
"C": "Lobar consolidation due to Staphylococcus aureus",
"D": "Decreased cardiac contractility due to cardiac myocyte injury"
} | step1 | D | [
"35 year old man presents",
"physician",
"concerns",
"bad flu",
"past 10 days",
"getting worse",
"causing sleeplessness",
"presentation today",
"sore throat",
"improved",
"fever",
"chest",
"body aches",
"use of ibuprofen",
"reports sharp",
"intermittent chest pain",
"worsens",
"exe... |
A 60-year-old man presents to the emergency department with shortness of breath, cough, and fever. He states that his symptoms started a few days ago and have been progressively worsening. The patient recently returned from international travel. He works from home and manages a chicken coop as a hobby. He has a past me... | Rifampin, isoniazid, pyrazinamide, and ethambutol | {
"A": "Azithromycin and ceftriaxone",
"B": "Azithromycin and vancomycin",
"C": "Furosemide",
"D": "Rifampin, isoniazid, pyrazinamide, and ethambutol"
} | step2&3 | D | [
"60 year old man presents",
"emergency department",
"shortness of breath",
"cough",
"fever",
"states",
"symptoms started",
"few days",
"worsening",
"patient recently returned",
"international travel",
"works",
"home",
"chicken coop",
"hobby",
"past medical history of",
"ST-elevation ... |
A 25-year-old sexually active male presents to an internal medicine physician for a routine health check up after having several unprotected sexual encounters. After appropriate testing the physician discusses with the patient that he is HIV+ and must be started on anti-retroviral treatment. Which of the following medi... | Enfuvirtide | {
"A": "Amantadine",
"B": "Zidovudine",
"C": "Saquinavir",
"D": "Enfuvirtide"
} | step1 | D | [
"year old sexually active male presents",
"internal medicine physician",
"routine health check up",
"several",
"sexual encounters",
"appropriate testing",
"physician discusses",
"patient",
"HIV",
"started",
"retroviral treatment",
"following medications prescribed acts",
"gp41 subunit",
"H... |
A 36-year-old primigravid woman who recently immigrated to the United States presents to her gynecologist for the first time during the 28th week of her pregnancy. She hasn’t received any prenatal care or folic acid supplementation. The patient’s history reveals that she has received blood transfusions in the past due ... | Mother is A negative, father is B positive | {
"A": "Mother is O positive, father is B negative",
"B": "Mother is A negative, father is B positive",
"C": "Mother is AB negative, father is O negative",
"D": "Mother is O positive, father is AB negative"
} | step1 | B | [
"36 year old primigravid woman",
"recently",
"United States presents",
"gynecologist",
"first time",
"week",
"pregnancy",
"hasnt received",
"prenatal care",
"folic acid supplementation",
"patients history reveals",
"received blood transfusions",
"past",
"severe anemia",
"following blood ... |
A 60-year-old male engineer who complains of shortness of breath when walking a few blocks undergoes a cardiac stress test because of concern for coronary artery disease. During the test he asks his cardiologist about what variables are usually used to quantify the functioning of the heart. He learns that one of these ... | Heart failure | {
"A": "Anxiety",
"B": "Exercise",
"C": "Pregnancy",
"D": "Heart failure"
} | step1 | D | [
"60 year old male engineer",
"of shortness",
"breath",
"walking",
"few blocks",
"cardiac stress test",
"concern",
"coronary artery disease",
"test",
"cardiologist",
"variables",
"usually used to quantify",
"functioning",
"heart",
"learns",
"one",
"variables",
"stroke volume",
"fo... |
A 58-year-old woman presents to the clinic with an abnormal sensation on the left side of her body that has been present for the past several months. At first, the area seemed numb and she recalls touching a hot stove and accidentally burning herself but not feeling the heat. Now she is suffering from a constant, uncom... | Dejerine-Roussy syndrome | {
"A": "Complex regional pain syndrome",
"B": "Conversion disorder",
"C": "Dejerine-Roussy syndrome",
"D": "Medial medullary syndrome"
} | step2&3 | C | [
"58 year old woman presents",
"clinic",
"abnormal sensation",
"left side of",
"body",
"present",
"past",
"months",
"first",
"area",
"numb",
"recalls touching",
"hot stove",
"burning",
"not feeling",
"heat",
"Now",
"suffering",
"constant",
"burning pain",
"left side",
"past ... |
A young researcher is responsible for graphing laboratory data involving pulmonary blood flow and ventilation pattern obtained from a healthy volunteer who was standing in an upright position. After plotting the following graph, the researcher realizes he forgot to label the curves and the x-axis (which represents the ... | A: Ventilation B: Blood flow C: Base of the lung D: Apex of the lung | {
"A": "A: Ventilation B: Blood flow C: Base of the lung D: Apex of the lung",
"B": "A: Blood flow B: Ventilation C: Apex of the lung D: Base of the lung",
"C": "A: Ventilation B: Blood flow C: Apex of the lung D: Base of the lung",
"D": "A: Ventilation B: Blood flow C: Mid-portion of the lung D: Apex of the lu... | step1 | A | [
"young researcher",
"responsible",
"graphing laboratory data involving pulmonary blood flow",
"ventilation pattern obtained",
"healthy volunteer",
"standing",
"upright position",
"following graph",
"researcher",
"forgot",
"label",
"curves",
"axis",
"represents",
"position",
"lung",
"... |
A 70-year-old man is brought to the emergency department by his wife because of lethargy, confusion, and nausea for the past 2 days. He has previously been healthy and has no past medical history. His only medications are a daily multivitamin and acetaminophen, which he takes daily for hip pain. Vital signs are within ... | Overproliferation of plasma cells
" | {
"A": "Ectopic PTHrP release",
"B": "Increased serum levels of 1,25-hydroxyvitamin D",
"C": "Excess PTH secretion from parathyroid glands",
"D": "Overproliferation of plasma cells\n\""
} | step2&3 | D | [
"70 year old man",
"brought",
"emergency department",
"wife",
"lethargy",
"confusion",
"nausea",
"past 2 days",
"healthy",
"past medical history",
"only medications",
"daily multivitamin",
"acetaminophen",
"takes daily",
"hip",
"Vital signs",
"normal limits",
"disoriented to place"... |
A 3-day-old female infant presents with poor feeding, lethargy, vomiting after feeding, and seizures. Labs revealed ketoacidosis and elevated hydroxypropionic acid levels. Upon administration of parenteral glucose and protein devoid of valine, leucine, methionine, and threonine, and carnitine, the infant began to recov... | Propionyl-CoA carboxylase | {
"A": "Branched-chain ketoacid dehydrogenase",
"B": "Phenylalanine hydroxylase",
"C": "Propionyl-CoA carboxylase",
"D": "Cystathionine synthase"
} | step1 | C | [
"3 day old female infant presents",
"poor feeding",
"lethargy",
"vomiting",
"feeding",
"seizures",
"Labs revealed ketoacidosis",
"elevated",
"acid levels",
"administration",
"parenteral glucose",
"protein",
"valine",
"leucine",
"methionine",
"threonine",
"carnitine",
"infant began ... |
A 34-year-old woman presents with recurrent panic attacks that have been worsening over the past 5 weeks. She also says she has been seeing things that are not present in reality and is significantly bothered by a short attention span which has badly affected her job in the past 6 months. No significant past medical hi... | Ziprasidone | {
"A": "Ziprasidone",
"B": "Clozapine",
"C": "Clonazepam",
"D": "Chlorpromazine"
} | step1 | A | [
"year old woman presents",
"recurrent panic attacks",
"worsening",
"past",
"weeks",
"seeing things",
"not present",
"reality",
"short attention span",
"badly affected",
"job",
"past 6 months",
"significant past medical history",
"current medications",
"patient",
"afebrile",
"vital si... |
An investigator is studying the relationship between fetal blood oxygen saturation and intrauterine growth restriction using MRI studies. The magnetic resonance transverse relaxation time (T2) is inversely related to the concentration of deoxyhemoglobin so that high concentrations of deoxyhemoglobin produce a low signa... | Ductus venosus | {
"A": "Pulmonary veins",
"B": "Ductus venosus",
"C": "Superior vena cava",
"D": "Right atrium\n\""
} | step1 | B | [
"investigator",
"studying",
"relationship",
"fetal blood oxygen saturation",
"intrauterine growth restriction using MRI studies",
"magnetic resonance transverse relaxation time",
"T2",
"related",
"concentration",
"deoxyhemoglobin so",
"high concentrations",
"deoxyhemoglobin",
"low signal int... |
A 29-year-old woman presents to her primary care physician because she has been experiencing episodes of intense fear. Specifically, she says that roughly once per week she will feel an intense fear of dying accompanied by chest pain, lightheadedness, sweating, and palpitations. In addition, she will feel as if she is ... | Submissive, clingy, and low self-confidence | {
"A": "Criminality and disregard for rights of others",
"B": "Eccentric appearance and magical thinking",
"C": "Social withdrawal and limited emotional expression",
"D": "Submissive, clingy, and low self-confidence"
} | step1 | D | [
"29 year old woman presents",
"primary care physician",
"experiencing episodes of intense fear",
"week",
"feel",
"intense fear of dying",
"chest pain",
"lightheadedness",
"sweating",
"palpitations",
"addition",
"feel",
"choking",
"leads",
"to hyperventilate",
"recall",
"trigger",
"... |
A 72-year-old man who was involved in a traffic collision is brought to the emergency room by the ambulance service. He was in shock and comatose at the time of presentation. On examination, the heart rate is 60/min, and the blood pressure is 70/40 mm Hg. The patient dies, despite resuscitative efforts. Autopsy reveals... | Senile calcific aortic stenosis | {
"A": "Mitral valve stenosis",
"B": "Senile calcific aortic stenosis",
"C": "Accumulation of amyloid in the myocardium",
"D": "Genetic mutation"
} | step1 | B | [
"72 year old man",
"involved",
"traffic collision",
"brought",
"emergency room",
"ambulance service",
"shock",
"comatose",
"time",
"presentation",
"examination",
"heart rate",
"60 min",
"blood pressure",
"70 40 mm Hg",
"patient",
"resuscitative efforts",
"Autopsy reveals multiple i... |
A 75-year-old woman with metastatic colon cancer comes to the physician requesting assistance in ending her life. She states: “I just can't take it anymore; the pain is unbearable. Please help me die.” Current medications include 10 mg oral hydrocodone every 12 hours. Her cancer has progressed despite chemotherapy and ... | Increase her pain medication dose | {
"A": "Submit a referral to hospice care",
"B": "Consult with the local ethics committee",
"C": "Increase her pain medication dose",
"D": "Initiate authorization of physician-assisted suicide"
} | step1 | C | [
"75 year old woman",
"metastatic colon cancer",
"physician requesting assistance",
"ending",
"life",
"states",
"I",
"take",
"pain",
"help",
"die",
"Current medications include 10 mg oral hydrocodone",
"12 hours",
"cancer",
"progressed",
"chemotherapy",
"very frail",
"lives alone",
... |
A 40-year-old man presents with a swollen left big toe that started this morning. The patient states that he attended a party last night and drank 4 glasses of whiskey. He denies any trauma to the foot. The patient has a history of similar episodes in the past that were related to alcohol use. His symptoms were previou... | Upregulation of cellular adhesion molecules to promote neutrophil migration | {
"A": "Vasoconstriction",
"B": "Downregulation of integrins in the neutrophils",
"C": "Upregulation of cellular adhesion molecules to promote neutrophil migration",
"D": "Decreased expression of selectin in the endothelium"
} | step1 | C | [
"40 year old man presents",
"swollen left big toe",
"started",
"morning",
"patient states",
"attended",
"party",
"night",
"drank 4 glasses",
"whiskey",
"denies",
"trauma",
"foot",
"patient",
"history of similar episodes",
"past",
"related",
"alcohol use",
"symptoms",
"relieved"... |
A 35-year-old woman presents to a pre-operative evaluation clinic prior to an elective cholecystectomy. She has a 5 pack-year smoking history. The anesthesiologist highly recommends to discontinue smoking for at least 8 weeks prior to the procedure for which she is compliant. What is the most likely histology of her up... | Pseudostratified columnar | {
"A": "Simple squamous",
"B": "Stratified columnar",
"C": "Pseudostratified columnar",
"D": "Simple columnar"
} | step1 | C | [
"35 year old woman presents",
"pre-operative evaluation clinic",
"elective cholecystectomy",
"5 smoking history",
"anesthesiologist highly recommends",
"discontinue smoking",
"weeks prior",
"procedure",
"compliant",
"most likely histology",
"upper respiratory tract's epithelial lining",
"time"... |
A 59-year-old man is brought to the emergency department by his wife for a 1-hour history of sudden behavior changes. They were having lunch together when, at 1:07 PM, he suddenly dropped his sandwich on the floor. Since then, he has been unable to use his right arm. She also reports that he is slurring his speech and ... | Middle cerebral artery | {
"A": "Anterior cerebral artery",
"B": "Middle cerebral artery",
"C": "Posterior cerebral artery",
"D": "Basilar artery"
} | step2&3 | B | [
"59 year old man",
"brought",
"emergency department",
"wife",
"hour history",
"sudden behavior changes",
"lunch together",
"at 1",
"PM",
"dropped",
"sandwich",
"floor",
"Since then",
"unable to use",
"right arm",
"reports",
"slurring",
"speech",
"dragging",
"right foot",
"wal... |
A 45-year-old woman comes to the physician because of a 6-month history of worsening involuntary movement of the left hand. Her symptoms are worse when she feels stressed at work. She has no history of serious illness and takes no medications. Neurological examination shows difficulty initiating movement and a tremor i... | Pramipexole | {
"A": "Methimazole",
"B": "Trihexyphenidyl",
"C": "Donepezil",
"D": "Pramipexole"
} | step1 | D | [
"year old woman",
"physician",
"month history",
"worsening involuntary movement",
"left hand",
"symptoms",
"worse",
"feels stressed at work",
"history",
"serious illness",
"takes",
"medications",
"Neurological examination shows difficulty initiating movement",
"tremor",
"left",
"rest",... |
A 46-year-old man presents to the clinic complaining of fatigue and difficulty breathing for the past month. He reports that it is particularly worse when he exercises as he becomes out of breath at 1 mile when he used to routinely run 3 miles. He is frustrated as he was recently diagnosed with diabetes despite a good ... | Increased intestinal absorption of iron | {
"A": "Decreased copper excretion into bile",
"B": "Increased intestinal absorption of iron",
"C": "Persistently elevated blood pressure",
"D": "Systemic inflammatory state caused by type 2 diabetes"
} | step1 | B | [
"year old man presents",
"clinic",
"fatigue",
"difficulty breathing",
"past month",
"reports",
"worse",
"exercises",
"out of breath",
"mile",
"used to",
"run 3 miles",
"frustrated",
"recently diagnosed",
"diabetes",
"good diet",
"regular exercise",
"denies",
"weight changes",
"... |
A 35-year-old soldier is rescued from a helicopter crash in the Arctic Circle and brought back to a treatment facility at a nearby military base. On arrival, the soldier’s wet clothes are removed. He appears pale and is not shivering. The patient is unresponsive to verbal or painful stimuli. His temperature is 27.4°C (... | Intravenous administration of warmed normal saline | {
"A": "Application of heating pads to the extremities",
"B": "Emergent electrical cardioversion",
"C": "Intravenous administration of tissue plasminogen activator",
"D": "Intravenous administration of warmed normal saline"
} | step2&3 | D | [
"35 year old soldier",
"rescued",
"helicopter",
"Arctic Circle",
"brought back",
"treatment facility",
"nearby military base",
"arrival",
"soldiers wet clothes",
"removed",
"appears pale",
"not shivering",
"patient",
"unresponsive",
"verbal",
"painful stimuli",
"temperature",
"27 4... |
A 24-year-old woman presents to the emergency department with abdominal pain that started while she was at the gym. The patient competes as a power lifter and states that her pain started after one of her heavier lifts. The patient has no significant past medical history and is currently taking a multivitamin and oral ... | Increased LDL and decreased HDL | {
"A": "Elevated alpha fetoprotein",
"B": "Elevated viral core antigen",
"C": "Increased pigmentation in flexural areas",
"D": "Increased LDL and decreased HDL"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"abdominal pain",
"started",
"patient",
"power",
"states",
"pain started",
"one",
"heavier lifts",
"patient",
"significant past medical history",
"currently taking",
"multivitamin",
"oral contraceptive pills",
"smokes cigarettes",
"d... |
A male newborn is delivered at term to a 26-year-old woman, gravida 2, para 3. The mother has no medical insurance and did not receive prenatal care. Physical examination shows microcephaly and ocular hypotelorism. There is a single nostril, cleft lip, and a solitary central maxillary incisor. An MRI of the head shows ... | Hedgehog | {
"A": "Hedgehog",
"B": "Transforming growth factor",
"C": "Homeobox",
"D": "Fibroblast growth factor"
} | step1 | A | [
"male newborn",
"delivered",
"term",
"year old woman",
"gravida 2",
"para 3",
"mother",
"medical insurance",
"not receive prenatal care",
"Physical examination shows microcephaly",
"ocular hypotelorism",
"single nostril",
"cleft lip",
"solitary central maxillary incisor",
"MRI of",
"he... |
A 62-year-old woman presents to the emergency department for evaluation of a spreading skin infection that began from an ulcer on her foot. The patient has type 2 diabetes mellitus that is poorly controlled. On examination, there is redness and erythema to the lower limb with skin breakdown along an extensive portion o... | Streptococcal pyogenic exotoxin B | {
"A": "Diphtheria toxin",
"B": "Streptococcal pyogenic exotoxin A",
"C": "Streptococcal pyogenic exotoxin B",
"D": "TSST-1"
} | step1 | C | [
"62 year old woman presents",
"emergency department",
"evaluation",
"spreading skin infection",
"began",
"ulcer",
"foot",
"patient",
"type 2 diabetes mellitus",
"poorly controlled",
"examination",
"redness",
"erythema",
"lower limb",
"skin breakdown",
"extensive portion of",
"leg",
... |
A 45-year-old man presents an urgent care clinic because he coughed up blood this morning. Although he had a persistent cough for the past 3 weeks, he had never coughed up blood until now. His voice is hoarse and admits that it has been like that for the past few months. Both his past medical history and family history... | Laryngeal carcinoma | {
"A": "Leukoplakia",
"B": "Polypoid corditis",
"C": "Vocal cord nodule",
"D": "Laryngeal carcinoma"
} | step1 | D | [
"year old man presents",
"urgent care clinic",
"coughed up blood",
"morning",
"persistent cough",
"past",
"weeks",
"never coughed up blood",
"now",
"voice",
"hoarse",
"admits",
"past",
"months",
"past medical history",
"family history",
"smoked",
"pack",
"cigarettes",
"day",
... |
A 23-year-old male is brought into the emergency department by his girlfriend following an argument. The patient’s girlfriend claims that she threatened to break up with him. He then called her saying he was going to kill himself. When she arrived at the patient’s home, she found him lying on the couch with empty alcoh... | IV sodium bicarbonate | {
"A": "Acetazolamide",
"B": "Activated charcoal",
"C": "IV haloperidol",
"D": "IV sodium bicarbonate"
} | step2&3 | D | [
"23 year old male",
"brought",
"emergency department",
"girlfriend following",
"argument",
"patients girlfriend",
"to break",
"then called",
"to kill",
"arrived",
"patients home",
"found",
"lying",
"empty alcohol bottles",
"multiple pill containers",
"patient reports",
"not remember"... |
An 82-year-old woman is brought to the physician by her nephew, who lives with her because she has a pessimistic attitude and has displayed overall distrust of her nephew for 1 year. She frequently argues with her nephew and embarrasses him in front of his friends. She had a Colles’ fracture 2 months ago and has had hy... | Reporting possible elder abuse by phone | {
"A": "Discussing advance directives",
"B": "Emphasizing compliance with medication and follow-up in 1 month",
"C": "Referral for hospice care",
"D": "Reporting possible elder abuse by phone"
} | step2&3 | D | [
"year old woman",
"brought",
"physician",
"nephew",
"lives",
"pessimistic attitude",
"displayed overall distrust",
"nephew",
"1 year",
"frequently",
"nephew",
"embarrasses",
"in front",
"friends",
"Colles fracture",
"months",
"hypertension",
"years",
"medications include hydrochl... |
A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having dull pain in the left portion of the midback for 2 weeks that has persisted despite taking ibuprofen. His father died of prostate cancer at 70 years of age. The patient has smoked one pack of cigarettes ... | CT scan of the abdomen | {
"A": "CT scan of the abdomen",
"B": "Urine cytology",
"C": "Chest x-ray",
"D": "Prostate biopsy"
} | step2&3 | A | [
"63 year old man",
"physician",
"3 month history",
"fatigue",
"constipation",
"reports",
"dull pain",
"left portion",
"midback",
"2 weeks",
"taking ibuprofen",
"father died of prostate cancer",
"70 years",
"age",
"patient",
"smoked one pack",
"cigarettes daily",
"years",
"Vital s... |
A 23-year-old woman with Ehlers-Danlos syndrome is brought to the emergency department with right knee pain and swelling after she twisted it while dancing. She had two similar episodes last year that were treated conservatively. She was treated for a fracture of her humerus 2 years ago. She has gastroesophageal reflux... | Arthroscopy | {
"A": "Arthroscopy",
"B": "Above knee cast",
"C": "Total knee replacement",
"D": "Physiotherapy only"
} | step2&3 | A | [
"23 year old woman",
"Ehlers-Danlos syndrome",
"brought",
"emergency department",
"right",
"swelling",
"twisted",
"dancing",
"two similar episodes last year",
"treated",
"treated",
"fracture of",
"humerus",
"years",
"gastroesophageal reflux disease",
"sister",
"allergic rhinitis",
... |
A 64-year-old woman presents for the scheduled annual physical examination for management of her hypertension. The patient is asymptomatic and her blood pressure is within normal limits throughout the year. She has a past medical history of polyarthrosis, and she is a carrier of hepatitis B antibodies. She does not smo... | Osteoporosis | {
"A": "Acanthosis nigricans",
"B": "Myeloblasts with azurophilic granules",
"C": "Osteoporosis",
"D": "Teardrop cells in blood smear"
} | step2&3 | C | [
"64 year old woman presents",
"scheduled annual physical examination",
"management",
"hypertension",
"patient",
"asymptomatic",
"blood pressure",
"normal limits",
"year",
"past medical polyarthrosis",
"carrier of hepatitis B antibodies",
"not smoke",
"drink alcohol",
"currently taking",
... |
A 17-year-old girl is brought to the physician for a physical examination prior to participating in sports. She has no history of serious illness. She is on the school's cheerleading team and is preparing for an upcoming competition. Menarche was at 13 years of age, and her last menstrual period was 4 months ago. She i... | Fractures | {
"A": "Hyperkalemia",
"B": "Hyperphosphatemia",
"C": "Fractures",
"D": "Hyperthyroidism"
} | step1 | C | [
"year old girl",
"brought",
"physician",
"physical examination prior to participating",
"sports",
"history",
"serious illness",
"school's cheerleading team",
"preparing",
"competition",
"Menarche",
"years",
"age",
"last menstrual period",
"4 months",
"5 ft 6",
"tall",
"kg",
"99",... |
A 63-year-old male is admitted to the Emergency Department after 3 days difficulty breathing, orthopnea, and shortness of breath with effort. His personal medical history is positive for a myocardial infarction 6 years ago and a cholecystectomy 10 years ago. Medications include metoprolol, lisinopril, atorvastatin, and... | Furosemide | {
"A": "Furosemide",
"B": "Normal saline",
"C": "Terlipressin",
"D": "Norepinephrine"
} | step2&3 | A | [
"63 year old male",
"admitted",
"Emergency Department",
"3 days difficulty breathing",
"orthopnea",
"shortness of breath",
"effort",
"personal medical history",
"positive",
"myocardial infarction",
"years",
"cholecystectomy 10 years",
"Medications include metoprolol",
"lisinopril",
"ator... |
A 42-year-old man presents to his primary care physician for a wellness checkup. The patient has a past medical history of obesity, constipation, and depression. His current medications include metformin, lactulose, and fluoxetine. His temperature is 99.5°F (37.5°C), blood pressure is 157/102 mmHg, pulse is 90/min, res... | Administer bicarbonate and repeat lab studies | {
"A": "Administer bicarbonate and repeat lab studies",
"B": "Administer high dose bicarbonate",
"C": "Administer hydrochlorothiazide",
"D": "Obtain urine sodium level"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"wellness checkup",
"patient",
"past medical",
"constipation",
"depression",
"current medications include metformin",
"lactulose",
"fluoxetine",
"temperature",
"99",
"blood pressure",
"mmHg",
"pulse",
"90 min",
"respirations",
"min... |
A 35-year-old male presents to his physician with the complaint of fatigue and weakness for six months. His physician orders a CBC which demonstrates anemia and thrombocytopenia. During the subsequent work up, a bone marrow biopsy is performed which ultimately leads to the diagnosis of acute promyelocytic leukemia. Whi... | t(15;17) - PML/RARalpha | {
"A": "t(8;14) - BCR/Abl1",
"B": "t(15;17) - PML/RARalpha",
"C": "t(14;18) - PML/RARalpha",
"D": "t(9;22) - PML/RARalpha"
} | step1 | B | [
"35 year old male presents",
"physician",
"complaint",
"fatigue",
"weakness",
"six months",
"physician orders",
"CBC",
"demonstrates anemia",
"thrombocytopenia",
"subsequent work up",
"bone marrow biopsy",
"performed",
"leads",
"diagnosis",
"acute promyelocytic leukemia",
"following ... |
A 25-year-old man comes to the physician because of diarrhea, bloating, nausea, and vomiting for the past 3 days. He describes his stool as soft, frothy, and greasy. He denies seeing blood in stool. The patient went on a hiking trip last week and drank fresh water from the stream. Three months ago, he was on vacation w... | Metronidazole therapy | {
"A": "Octreotide therapy",
"B": "Metronidazole therapy",
"C": "Trimethoprim-sulfamethoxazole therapy",
"D": "Supportive treatment only"
} | step2&3 | B | [
"year old man",
"physician",
"diarrhea",
"bloating",
"nausea",
"vomiting",
"past 3 days",
"stool",
"soft",
"frothy",
"greasy",
"denies seeing blood in stool",
"patient",
"hiking trip",
"week",
"drank fresh water",
"stream",
"Three months",
"vacation",
"family",
"2 weeks",
"... |
A 17-year-old man presents to his primary care physician with bilateral tremor of the hands. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing. He says his memory is now poor, and he has trouble focusing on tasks. His behavior has changed in the past 6 months i... | Oral zinc | {
"A": "Penicillamine",
"B": "Oral zinc",
"C": "Oral deferasirox",
"D": "Watchful waiting"
} | step2&3 | B | [
"year old man presents",
"primary care physician",
"bilateral tremor of",
"hands",
"senior",
"high school",
"year",
"grades",
"point",
"failing",
"memory",
"now poor",
"trouble focusing",
"tasks",
"behavior",
"changed",
"past 6 months",
"frequent episodes of depression",
"separat... |
A 28-year-old man comes to the physician because of a 2-week history of testicular swelling and dull lower abdominal discomfort. Physical examination shows a firm, nontender left testicular nodule. Ultrasonography of the scrotum shows a well-defined hypoechoic lesion of the left testicle. Serum studies show an elevated... | Para-aortic | {
"A": "External iliac",
"B": "Internal iliac",
"C": "Mediastinal",
"D": "Para-aortic"
} | step1 | D | [
"year old man",
"physician",
"of",
"2-week history",
"testicular swelling",
"dull lower abdominal discomfort",
"Physical examination shows",
"firm",
"nontender left testicular nodule",
"Ultrasonography of",
"scrotum shows",
"well-defined",
"lesion of",
"left testicle",
"Serum studies sho... |
A 4-year-old child is brought to a pediatric clinic with complaints of a foul-smelling, recurrent, persistent vaginal discharge that started a few days ago. The child shows increased irritability with a slightly elevated temperature. The mother says that the child plays in the house and has no contact with other childr... | Foreign body in the vagina | {
"A": "Sarcoma botyroides",
"B": "Foreign body in the vagina",
"C": "Clear cell carcinoma of the cervix",
"D": "Sexual abuse"
} | step1 | B | [
"4 year old child",
"brought",
"pediatric clinic",
"complaints",
"smelling",
"recurrent",
"persistent vaginal discharge",
"started",
"few days",
"child shows increased irritability",
"slightly elevated",
"mother",
"child plays",
"house",
"contact with",
"children",
"most common cause... |
A 32-year-old man presents to his primary care physician complaining of pain accompanied by a feeling of heaviness in his scrotum. He is otherwise healthy except for a broken arm he obtained while skiing several years ago. Physical exam reveals an enlarged “bag of worms” upon palpation of the painful scrotal region. Sh... | More common on left due to drainage into renal vein | {
"A": "Equally common on both sides",
"B": "More common on left due to drainage into renal vein",
"C": "More common on right due to drainage into inferior vena cava",
"D": "More common on right due to drainage into renal vein"
} | step1 | B | [
"year old man presents",
"primary care physician",
"pain",
"feeling of heaviness",
"scrotum",
"healthy",
"arm",
"obtained",
"skiing several years",
"Physical exam reveals",
"enlarged bag",
"worms",
"palpation of",
"painful scrotal region",
"light",
"area shows",
"scrotum",
"not",
... |
A 25-year-old primigravid woman at 34-weeks' gestation comes to the physician because of an 8-day history of generalized pruritus. She has no history of rash. She has had standard prenatal care. Three weeks ago she was diagnosed with iron deficiency anemia. She traveled to Mexico for a vacation 3 months ago. She takes ... | Cholestasis of pregnancy | {
"A": "Cholestasis of pregnancy",
"B": "Viral hepatitis A",
"C": "Gilbert syndrome",
"D": "HELLP syndrome"
} | step2&3 | A | [
"year old primigravid woman",
"weeks",
"estation ",
"hysician ",
"ay istory ",
"eneralized pruritus.",
"istory ",
"ash.",
"tandard renatal care.",
"hree weeks ",
"iagnosed ",
"ron deficiency anemia.",
"raveled ",
"exico ",
"acation ",
"onths ",
"akes ",
"ultivitamin upplements "... |
A 21-year-old woman comes to the physician because of a 1-week history of white discoloration of the tongue. She has had similar, recurrent episodes over the past 5 years. Examination shows white plaques on the tongue that easily scrape off and thick, cracked fingernails with white discoloration. KOH preparation of a t... | T cells | {
"A": "B cells",
"B": "T cells",
"C": "Complement C1–4",
"D": "Neutrophils"
} | step1 | B | [
"21-year-old woman",
"physician",
"1-week history",
"white discoloration",
"tongue",
"similar",
"recurrent episodes",
"past",
"years",
"Examination shows white plaques on",
"tongue",
"easily scrape",
"thick",
"cracked fingernails",
"white discoloration",
"KOH preparation",
"tongue sc... |
A 62-year-old man returns to his physician for a follow-up examination. During his last visit 1 month ago splenomegaly was detected. He has had night sweats for the past several months and has lost 5 kg (11 lb) unintentionally during this period. He has no history of a serious illness and takes no medications. The vita... | Allogeneic bone marrow transplantation | {
"A": "Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD)",
"B": "Allogeneic bone marrow transplantation",
"C": "Imatinib mesylate",
"D": "Splenectomy"
} | step2&3 | B | [
"62 year old man returns",
"physician",
"follow-up examination",
"last visit",
"month",
"splenomegaly",
"detected",
"night sweats",
"past",
"months",
"lost 5 kg",
"period",
"history",
"serious illness",
"takes",
"medications",
"vital signs",
"normal limits",
"physical examination... |
A 24-year-old previously healthy man comes to his physician because of dyspnea and hemoptysis for the past week. Examination shows inspiratory crackles at both lung bases. The remainder of the examination shows no abnormalities. His hemoglobin concentration is 14.2 g/dL, leukocyte count is 10,300/mm3, and platelet coun... | Anti-GBM antibody | {
"A": "Anti-GBM antibody",
"B": "Anti-dsDNA antibody",
"C": "Anti-PLA2R antibody",
"D": "P-ANCA"
} | step1 | A | [
"year old",
"healthy man",
"physician",
"dyspnea",
"hemoptysis",
"past week",
"Examination shows inspiratory crackles",
"lung bases",
"examination shows",
"abnormalities",
"hemoglobin concentration",
"g/dL",
"leukocyte count",
"10 300 mm3",
"platelet count",
"mm3",
"Urine dipstick sh... |
A 42-year-old man presents to the clinic for a second evaluation of worsening blackened ulcers on the tips of his toes. His past medical history includes diabetes mellitus for which he takes metformin and his most recent HgA1c was 6.0, done 3 months ago. He also has hypertension for which he’s prescribed amlodipine and... | Tobacco smoking | {
"A": "Diabetes mellitus",
"B": "Tobacco smoking",
"C": "Autoimmune disorder",
"D": "Hypertension"
} | step1 | B | [
"year old man presents",
"clinic",
"second evaluation",
"worsening",
"ulcers",
"tips of",
"toes",
"past medical history includes diabetes mellitus",
"takes metformin",
"most recent",
"0",
"3 months",
"hypertension",
"prescribed amlodipine",
"chronic obstructive pulmonary disease",
"use... |
A 32-year-old man is brought to the emergency department 10 minutes after he sustained a stab wound to the left chest just below the clavicle. On arrival, he is hypotensive with rapid and shallow breathing and appears anxious and agitated. He is intubated and mechanically ventilated. Infusion of 0.9% saline is begun. F... | A 15 mm Hg decrease in systolic blood pressure during inspiration | {
"A": "A 15 mm Hg decrease in systolic blood pressure during inspiration",
"B": "Lateral shift of the trachea toward the right side",
"C": "Subcutaneous crepitus on palpation of the chest wall",
"D": "Inward collapse of part of the chest with inspiration"
} | step1 | A | [
"year old man",
"brought",
"emergency department 10 minutes",
"sustained",
"stab wound",
"left chest",
"clavicle",
"arrival",
"hypotensive",
"rapid",
"shallow breathing",
"appears anxious",
"agitated",
"intubated",
"ventilated",
"Infusion",
"0.9",
"saline",
"begun",
"Five minut... |
A 48-year-old woman comes to the physician for a follow-up examination. At her visit 1 month ago, her glomerular filtration rate (GFR) was 100 mL/min/1.73 m2 and her renal plasma flow (RPF) was 588 mL/min. Today, her RPF is 540 mL/min and her filtration fraction (FF) is 0.2. After her previous appointment, this patient... | Constriction of the efferent arteriole | {
"A": "Inhibition of the renal Na-K-Cl cotransporter",
"B": "Inhibition of vasopressin",
"C": "Constriction of the afferent arteriole",
"D": "Constriction of the efferent arteriole"
} | step1 | D | [
"48 year old woman",
"physician",
"follow-up examination",
"visit",
"month",
"glomerular filtration rate",
"100 mL/min",
"m2",
"renal plasma flow",
"mL/min",
"Today",
"RPF",
"mL/min",
"filtration fraction",
"0.2",
"previous appointment",
"patient",
"most likely started",
"drug",
... |
A 72-year-old man with coronary artery disease comes to the emergency department because of chest pain and shortness of breath for the past 3 hours. Troponin levels are elevated and an ECG shows ST-elevations in the precordial leads. Revascularization with percutaneous coronary intervention is performed, and a stent is... | Normal perfusion with bilateral ventilation defects | {
"A": "Increased apical ventilation with normal perfusion bilaterally",
"B": "Matched ventilation and perfusion bilaterally",
"C": "Normal perfusion with bilateral ventilation defects",
"D": "Normal perfusion with decreased ventilation at the right base"
} | step1 | C | [
"72 year old man",
"coronary artery disease",
"emergency department",
"chest pain",
"shortness of breath",
"past",
"hours",
"Troponin levels",
"elevated",
"ECG shows ST-elevations",
"precordial leads",
"Revascularization",
"percutaneous coronary intervention",
"performed",
"stent",
"pl... |
A 48-year-old woman presented to the hospital with a headache, intermittent fevers and chills, generalized arthralgias, excessive thirst, increased fluid intake, and a progressive rash that developed on her back. Three days before seeking evaluation at the hospital, she noticed a small, slightly raised lesion appearing... | Amoxicillin | {
"A": "Cephalexin",
"B": "Amoxicillin",
"C": "Azithromycin",
"D": "Erythromycin"
} | step1 | B | [
"48 year old woman presented",
"hospital",
"headache",
"intermittent fevers",
"chills",
"generalized arthralgias",
"excessive thirst",
"increased fluid intake",
"progressive rash",
"back",
"Three days",
"evaluation",
"hospital",
"small",
"slightly raised lesion appearing",
"spider",
... |
A 3-year-old boy is brought to the emergency department by his mother because of a cough and mild shortness of breath for the past 12 hours. He has not had fever. He has been to the emergency department 4 times during the past 6 months for treatment of asthma exacerbations. His 9-month-old sister was treated for bronch... | Bronchoscopy | {
"A": "Bronchoscopy",
"B": "Albuterol nebulization",
"C": "CT of the lung",
"D": "Azithromycin therapy"
} | step2&3 | A | [
"3 year old boy",
"brought",
"emergency department",
"mother",
"cough",
"mild shortness of breath",
"past 12 hours",
"not",
"fever",
"emergency department",
"times",
"past 6 months",
"treatment of asthma exacerbations",
"month old sister",
"treated",
"bronchiolitis",
"week",
"fathe... |
A 37-year-old man presents to the emergency department after he cut his hand while working on his car. The patient has a past medical history of antisocial personality disorder and has been incarcerated multiple times. His vitals are within normal limits. Physical exam is notable for a man covered in tattoos with many ... | Surgical irrigation, debridement, and amoxicillin-clavulanic acid | {
"A": "Ciprofloxacin and topical erythromycin",
"B": "Closure of the wound with sutures",
"C": "No further management necessary",
"D": "Surgical irrigation, debridement, and amoxicillin-clavulanic acid"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"cut",
"hand",
"working",
"car",
"patient",
"past medical antisocial personality disorder",
"incarcerated multiple times",
"normal limits",
"Physical exam",
"notable",
"man covered",
"tattoos",
"bruises",
"face",
"torso",
"Inspection... |
A 39-year-old woman comes to the physician because of progressive pain and swelling of her wrists and hands for the past 2 months. Her hands are stiff in the morning; the stiffness decreases as she starts her chores. She also reports early-morning neck pain at rest for the past 3 weeks. She has no history of serious il... | X-ray of the cervical spine | {
"A": "X-ray of the cervical spine",
"B": "Measurement of anti-Smith antibodies",
"C": "CT scan of the chest",
"D": "Tuberculin skin test"
} | step2&3 | A | [
"year old woman",
"physician",
"progressive pain",
"swelling",
"wrists",
"hands",
"past",
"months",
"hands",
"stiff",
"morning",
"stiffness decreases",
"starts",
"chores",
"reports early morning neck pain at rest",
"past",
"weeks",
"history",
"serious illness",
"takes",
"medi... |
A 54-year-old man comes to the physician because of a cough with blood-tinged sputum for 1 week. He also reports fever and a 5-kg (11 lb) weight loss during the past 2 months. Over the past year, he has had 4 episodes of sinusitis. Physical examination shows palpable nonblanching skin lesions over the hands and feet. E... | Neutrophil-mediated damage | {
"A": "Metalloprotease enzyme deficiency",
"B": "Neutrophil-mediated damage",
"C": "Arteriovenous malformation",
"D": "Malignant myeloid cell proliferation"
} | step1 | B | [
"54 year old man",
"physician",
"of",
"cough",
"blood-tinged sputum",
"1 week",
"reports fever",
"5 kg",
"weight loss",
"past",
"months",
"past year",
"4 episodes of sinusitis",
"Physical examination shows palpable",
"skin lesions",
"hands",
"feet",
"Examination of",
"nasal cavit... |
A 33-year-old pregnant woman in the 28th week of gestation presents to the emergency department for evaluation of bilateral edema of her legs. It seems to worsen at the end of the day and has lasted for the past 3 weeks. History reveals that this is her 3rd pregnancy. Vital signs include: blood pressure 120/80 mm Hg, h... | Compression stockings | {
"A": "Compression stockings",
"B": "Endovenous laser treatment",
"C": "Foam sclerotherapy",
"D": "Warfarin"
} | step2&3 | A | [
"year old pregnant woman",
"the",
"week of gestation presents",
"emergency department",
"evaluation of bilateral edema",
"legs",
"to worsen",
"end",
"day",
"lasted",
"past",
"weeks",
"History reveals",
"3rd pregnancy",
"Vital signs include",
"blood pressure",
"80 mm Hg",
"heart rat... |
A 9-year-old boy presents with abdominal pain that started nearly 6 hours ago. The pain is located in the periumbilical area and radiates to the right lower quadrant. There was no vomiting or passage of stool since the onset of pain. The patient reports that he passed stools with blood several times during the past mon... | It is a remnant of the embryonic omphalomesenteric duct. | {
"A": "It resulted from traction by embryonic peritoneal adhesions.",
"B": "The most probable cause of this diverticulum is increased intraluminal pressure.",
"C": "It is an unobliterated embryonic bile duct.",
"D": "It is a remnant of the embryonic omphalomesenteric duct."
} | step1 | D | [
"year old boy presents",
"abdominal pain",
"started nearly",
"hours",
"pain",
"periumbilical area",
"radiates",
"right lower quadrant",
"vomiting",
"passage",
"stool",
"onset",
"pain",
"patient reports",
"passed stools",
"blood",
"times",
"past month",
"vital signs include",
"b... |
A 55-year-old man comes to the physician for a routine health visit. He feels well except for occasional left-sided abdominal discomfort and left shoulder pain. He has smoked 1 pack of cigarettes daily for 20 years. He does not drink alcohol. His pulse is 85/min and his blood pressure is 130/70 mmHg. Examination shows ... | Low leukocyte alkaline phosphatase score | {
"A": "Low leukocyte alkaline phosphatase score",
"B": "Decreased basophil count",
"C": "Autoimmune hemolytic anemia",
"D": "Elevated serum β2 microglobulin"
} | step2&3 | A | [
"55 year old man",
"physician",
"routine health visit",
"feels well",
"occasional left-sided abdominal discomfort",
"left shoulder pain",
"smoked 1 pack",
"cigarettes daily",
"20 years",
"not drink alcohol",
"pulse",
"85 min",
"blood pressure",
"70 mmHg",
"Examination shows",
"soft",
... |
A 17-year-old boy comes to the physician for a follow-up examination. Two months ago, he suffered a spinal fracture after a fall from the roof. He feels well. His father has multiple endocrine neoplasia type 1. Vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies show:
Hemoglobin... | Immobilization | {
"A": "Sarcoidosis",
"B": "Immobilization",
"C": "Pseudohypercalcemia",
"D": "Paraneoplastic syndrome"
} | step2&3 | B | [
"year old boy",
"physician",
"follow-up examination",
"Two months",
"suffered",
"spinal fracture",
"fall",
"roof",
"feels well",
"father",
"multiple endocrine neoplasia type 1",
"Vital signs",
"normal limits",
"Examination shows",
"abnormalities",
"Laboratory studies show",
"0",
"T... |
A 25-year-old woman presents to the ED with nausea, vomiting, diarrhea, abdominal pain, and hematemesis after ingesting large quantities of a drug. Which of the following pairs a drug overdose with the correct antidote for this scenario? | Iron; deferoxamine | {
"A": "Iron; deferoxamine",
"B": "Atropine; fomepizole",
"C": "Organophosphate; physostigmine",
"D": "Acetaminophen; naloxone"
} | step1 | A | [
"year old woman presents",
"ED",
"nausea",
"vomiting",
"diarrhea",
"abdominal pain",
"hematemesis",
"ingesting large quantities",
"drug",
"following pairs",
"drug",
"correct antidote",
"scenario"
] |
A 27-year-old soldier is brought to the emergency department of a military hospital 20 minutes after being involved in a motor vehicle accident during a training exercise. He was an unrestrained passenger. On arrival, he has shortness of breath and chest pain. He appears pale and anxious. His temperature is 37°C (98.6°... | CT scan of the chest with contrast | {
"A": "Pericardiocentesis",
"B": "CT scan of the chest with contrast",
"C": "Abdominal ultrasonography",
"D": "Placement of a chest tube"
} | step2&3 | B | [
"27 year old soldier",
"brought",
"emergency department",
"military hospital 20 minutes",
"involved",
"motor vehicle accident",
"training exercise",
"passenger",
"arrival",
"shortness of breath",
"chest pain",
"appears pale",
"anxious",
"temperature",
"98",
"pulse",
"min",
"respira... |
An investigator is studying the effects of influenza virus on human lung tissue. Biopsy specimens of lung parenchyma are obtained from patients recovering from influenza pneumonia and healthy control subjects. Compared to the lung tissue from the healthy control subjects, the lung tissue from the affected patients is m... | Increased type II pneumocytes | {
"A": "Decreased alveolar macrophages",
"B": "Decreased interstitial fibroblasts",
"C": "Increased type II pneumocytes",
"D": "Increased goblet cells"
} | step1 | C | [
"investigator",
"studying",
"effects",
"influenza virus",
"human lung tissue",
"Biopsy of",
"parenchyma",
"obtained",
"patients recovering from influenza pneumonia",
"healthy control subjects",
"Compared",
"lung tissue",
"healthy control subjects",
"lung tissue",
"affected patients",
"... |
A 24-year-old male with cystic fibrosis is brought to the emergency room by his mother after he had difficulty breathing. He previously received a lung transplant 6 months ago and was able to recover quickly from the operation. He is compliant with all of his medications and had been doing well with no major complaints... | Simple cuboidal cells | {
"A": "Cartilage",
"B": "Goblet cells",
"C": "Pseudostratified columnar cells",
"D": "Simple cuboidal cells"
} | step1 | D | [
"year old male",
"cystic fibrosis",
"brought",
"emergency room",
"mother",
"difficulty breathing",
"received",
"lung transplant",
"months",
"able to recover",
"operation",
"compliant",
"medications",
"well",
"major complaints",
"2 weeks",
"began to experience shortness of breath",
... |
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