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 19-year-old G1P0 presents to the emergency department with severe abdominal pain. She states that the pain has been recurring every 3 to 5 minutes for the past 5 hours. She denies having regular prenatal care but recalls that her last menstrual period was about 9 months ago. She denies taking or using any substances.... | Morphine | {
"A": "Acetaminophen",
"B": "Naloxone",
"C": "Phenobarbital",
"D": "Morphine"
} | step2&3 | D | [
"year old",
"presents",
"emergency department",
"severe abdominal",
"states",
"pain",
"recurring",
"3",
"5",
"past",
"hours",
"denies",
"regular prenatal care",
"recalls",
"last menstrual period",
"about",
"months",
"denies",
"using",
"substances",
"temperature",
"blood pre... |
A 55-year-old man with a history of myocardial infarction 3 months ago presents with feelings of depression. He says that he has become detached from his friends and family and has daily feelings of hopelessness. He says he has started to avoid strenuous activities and is no longer going to his favorite bar where he us... | Post-traumatic stress disorder | {
"A": "Post-traumatic stress disorder",
"B": "Major depression disorder",
"C": "Alcohol withdrawal",
"D": "Midlife crisis"
} | step1 | A | [
"55 year old man",
"history of myocardial infarction 3 months",
"presents",
"feelings",
"depression",
"detached",
"friends",
"family",
"daily feelings of hopelessness",
"started to",
"strenuous activities",
"longer",
"used to spend",
"lot",
"time drinking",
"patient",
"symptoms",
"... |
A 20-year-old man presents to the emergency department with complaints of severe malaise, fevers, and sore throat for the past 7 days. He also has had episodes of nausea and vomiting during this period. He does not smoke or drink alcohol. There is no family history of liver disease. His blood pressure is 130/80 mm Hg, ... | False negative | {
"A": "Low specificity",
"B": "False negative",
"C": "Concurrent viral hepatitis A infection",
"D": "CMV infection"
} | step1 | B | [
"20 year old man presents",
"emergency department",
"complaints",
"severe malaise",
"fevers",
"sore throat",
"past 7 days",
"episodes of nausea",
"vomiting during this period",
"not smoke",
"drink alcohol",
"family disease",
"blood pressure",
"80 mm Hg",
"temperature",
"100",
"pulse"... |
A 57-year-old otherwise healthy male presents to his primary care physician for a check-up. He has no complaints. His blood pressure at the previous visit was 160/95. The patient did not wish to be on any medications and at the time attempted to manage his blood pressure with diet and exercise. On repeat measurement of... | Bilateral renal artery stenosis | {
"A": "Chronic obstructive pulmonary disease",
"B": "Gout",
"C": "Bilateral renal artery stenosis",
"D": "Congestive heart failure"
} | step2&3 | C | [
"57 year old",
"healthy male presents",
"primary care physician",
"check-up",
"complaints",
"blood pressure",
"previous visit",
"95",
"patient",
"not wish to",
"medications",
"time attempted to",
"blood pressure",
"diet",
"exercise",
"repeat measurement",
"blood pressure today",
"r... |
A 61-year-old man comes to the physician because of progressively worsening swelling of his ankles. He says he has felt exhausted lately. Over the past 3 months, he has gained 5 kg. He has smoked one pack of cigarettes daily for 30 years. His pulse is 75/min and his blood pressure is 140/90 mmHg. Examination shows 2+ p... | Nodular glomerulosclerosis | {
"A": "Interstitial inflammation",
"B": "Wire looping of capillaries",
"C": "Nodular glomerulosclerosis",
"D": "Split glomerular basement membrane"
} | step2&3 | C | [
"61 year old man",
"physician",
"worsening swelling",
"ankles",
"felt exhausted",
"past 3 months",
"gained 5 kg",
"smoked one pack",
"cigarettes daily",
"30 years",
"pulse",
"75 min",
"blood pressure",
"90 mmHg",
"Examination shows 2",
"pitting edema",
"lower extremities",
"Neurolo... |
A 21-year-old man presents to the office for a follow-up visit. He was recently diagnosed with type 1 diabetes mellitus after being hospitalized for diabetic ketoacidosis following a respiratory infection. He is here today to discuss treatment options available for his condition. The doctor mentions a recent study in w... | Phase 3 | {
"A": "Phase 4",
"B": "Phase 3",
"C": "Phase 0",
"D": "Phase 2"
} | step1 | B | [
"21-year-old man presents",
"office",
"follow-up visit",
"recently diagnosed",
"type 1 diabetes mellitus",
"hospitalized",
"diabetic ketoacidosis following",
"respiratory infection",
"today to discuss treatment options available",
"condition",
"doctor",
"recent study",
"researchers",
"new ... |
A 64-year-old man presents to his physician for a scheduled follow-up visit. He has chronic left-sided heart failure with systolic dysfunction. His current regular medications include captopril and digoxin, which were started after his last episode of symptomatic heart failure approximately 3 months ago. His last episo... | Captopril is likely to improve the long-term survival of the patient with heart failure, unlike digoxin. | {
"A": "Digoxin is useful to treat atrial fibrillation, but does not benefit patients with systolic dysfunction who are in sinus rhythm.",
"B": "Digoxin does not benefit patients with left-sided heart failure in the absence of atrial fibrillation.",
"C": "Captopril is likely to improve the long-term survival of t... | step1 | C | [
"64 year old man presents",
"physician",
"scheduled follow-up visit",
"chronic left-sided heart failure",
"systolic dysfunction",
"current regular medications include captopril",
"digoxin",
"started",
"episode of symptomatic heart failure approximately",
"months",
"last episode of heart failure"... |
A 26-year-old male professional soccer player is brought to the emergency department due to an episode of syncope during a game. He has felt increasing shortness of breath during the past 3 months. During the past week, he has been feeling chest pain upon exertion. He also tells the doctor that his brother had a sudden... | Hypertrophic cardiomyopathy | {
"A": "Aortic stenosis",
"B": "First-degree heart block",
"C": "Hypertrophic cardiomyopathy",
"D": "Third-degree heart block"
} | step1 | C | [
"year old male professional soccer",
"brought",
"emergency department due to",
"episode of syncope",
"game",
"felt increasing shortness of breath",
"past 3 months",
"past week",
"feeling chest pain",
"exertion",
"doctor",
"brother",
"sudden death",
"couple",
"years",
"heart rate",
"9... |
A 61-year-old man presents to the emergency department because he has developed blisters at multiple locations on his body. He says that the blisters appeared several days ago after a day of hiking in the mountains with his colleagues. When asked about potential triggering events, he says that he recently had an infect... | Antibodies to proteins connecting intermediate filaments to type IV collagen | {
"A": "Antibodies to proteins connecting intermediate filaments to type IV collagen",
"B": "Antibodies to proteins connecting two sets of intermediate filaments",
"C": "Depletion of protein C and protein S levels",
"D": "Necrosis of skin in reaction to a drug"
} | step1 | A | [
"61 year old man presents",
"emergency department",
"blisters",
"multiple locations",
"body",
"blisters appeared several days",
"hiking",
"mountains",
"potential triggering events",
"recently",
"infection",
"treated with antibiotics",
"recall",
"name",
"drug",
"took",
"addition",
"... |
A 31-year-old woman presents to her gynecologist for a routine well-visit. She is sexually active with multiple male partners and uses an intrauterine device for contraception. Her last menstrual period was two weeks ago. She denies abnormal vaginal discharge or sensations of burning or itching. Pelvic exam is normal. ... | Human papillomavirus | {
"A": "Chlamydia trachomatis",
"B": "Herpes simplex virus 1",
"C": "Human papillomavirus",
"D": "Trichomonas vaginalis"
} | step1 | C | [
"31 year old woman presents",
"gynecologist",
"routine well visit",
"sexually active",
"multiple male partners",
"uses",
"intrauterine device",
"contraception",
"last menstrual period",
"two weeks",
"denies abnormal vaginal discharge",
"sensations",
"burning",
"itching",
"Pelvic exam",
... |
A 27-year-old woman presents to the emergency room with a rash over her shins for the last 3 months. She also has a swell in her knee and wrist joints on both sides for a few days. The rash is painful and erythematous. She had an episode of uveitis 6 months ago that was treated with topical therapy. She is not on any m... | Activation of T lymphocytes | {
"A": "Loss of protection against proteases",
"B": "Release of toxins by spirochete",
"C": "Activation of T lymphocytes",
"D": "Activation of Langerhans cells"
} | step1 | C | [
"27 year old woman presents",
"emergency room",
"rash",
"shins",
"last",
"months",
"swell",
"knee",
"wrist joints",
"sides",
"few days",
"rash",
"painful",
"erythematous",
"episode of uveitis",
"months",
"treated with topical therapy",
"not",
"medication currently",
"addition",... |
A 24-year-old woman comes to the physician because of a 2-month history of increased urination. She has also had dry mouth and excessive thirst despite drinking several gallons of water daily. She has a history of obsessive-compulsive disorder treated with citalopram. She drinks 1–2 cans of beer daily. Physical examina... | Primary polydipsia | {
"A": "Primary hyperparathyroidism",
"B": "Nephrogenic diabetes insipidus",
"C": "Primary polydipsia",
"D": "Beer potomania"
} | step1 | C | [
"year old woman",
"physician",
"2 month history",
"increased urination",
"dry mouth",
"excessive thirst",
"drinking",
"gallons",
"water daily",
"history of",
"disorder treated with citalopram",
"drinks",
"cans",
"beer daily",
"Physical examination shows",
"abnormalities",
"Serum stud... |
A 64-year-old man presents with unilateral severe chest pain which started a day ago. He describes the chest pain as sharp in nature and localized mainly to his right side. He also complains of mild shortness of breath but says that it is tolerable. He denies any recent history of fever, sweating, dizziness, or similar... | Famciclovir | {
"A": "Cardiac catheterization",
"B": "Ganciclovir",
"C": "Rest and NSAIDs",
"D": "Famciclovir"
} | step1 | D | [
"64 year old man presents",
"unilateral severe chest",
"started",
"day",
"chest pain",
"sharp",
"nature",
"localized",
"right side",
"of mild shortness",
"breath",
"tolerable",
"denies",
"recent history",
"fever",
"sweating",
"dizziness",
"similar episodes",
"past",
"Past medic... |
A 21-year-old Caucasian woman presents to her gynecologist's office with a chief complaint of irregular periods. In the past 2 years, she has often gone > 3 months without menstruating. Menarche was at 13 years old, and prior to the past 2 years, she had regular periods every 28 days lasting 5 days with normal flow and... | Ethinyl estradiol - norgestimate | {
"A": "Ethinyl estradiol - norgestimate",
"B": "Metformin",
"C": "Spironolactone",
"D": "Simvastatin"
} | step2&3 | A | [
"21-year-old Caucasian woman presents",
"gynecologist's office",
"chief complaint",
"irregular periods",
"past",
"years",
"often",
"3 months",
"Menarche",
"years old",
"prior to",
"past",
"years",
"regular periods",
"days lasting 5 days",
"normal flow",
"pain",
"denies",
"symptom... |
A 41-year-old man presents at an office for a regular health check-up. He has no complaints. He has no history of significant illnesses. He currently takes omeprazole for gastroesophageal reflux disease. He occasionally smokes cigarettes and drinks alcohol. The family history is unremarkable. The vital signs include: b... | Non-specific; can be a normal finding | {
"A": "Post-streptococcal glomerulonephritis",
"B": "Non-specific; can be a normal finding",
"C": "Nephrotic syndrome",
"D": "End-stage renal disease/chronic kidney disease (CKD)"
} | step1 | B | [
"year old man presents",
"office",
"regular health check-up",
"complaints",
"history",
"significant illnesses",
"currently takes omeprazole",
"gastroesophageal reflux disease",
"occasionally smokes cigarettes",
"drinks alcohol",
"family history",
"unremarkable",
"vital signs include",
"blo... |
A 47-year-old woman presents with blurry vision for the past 2 weeks. She says that symptoms onset gradually and have progressively worsened. She works as a secretary in a law firm, and now her vision is hampering her work. Past medical history is significant for psoriasis, diagnosed 7 years ago, managed with topical c... | Myocardial infarction | {
"A": "Renal failure",
"B": "Rhinocerebral mucormycosis",
"C": "Peripheral neuropathy",
"D": "Myocardial infarction"
} | step1 | D | [
"year old woman presents",
"blurry vision",
"past 2 weeks",
"symptoms onset",
"worsened",
"works",
"secretary",
"law firm",
"now",
"vision",
"hampering",
"work",
"Past medical history",
"significant",
"psoriasis",
"diagnosed",
"years",
"managed",
"topical corticosteroids",
"blo... |
A 46-year-old man who recently immigrated from Mexico comes to the physician for a pre-employment wellness examination. A tuberculin skin test is administered and he develops a raised, erythematous 12 mm lesion on his forearm within 48 hours. An x-ray of the chest shows no abnormalities. He is started on the recommende... | Inhibition of mycolic acid synthesis | {
"A": "Inhibition of dihydropteroate synthase",
"B": "Binding to 50S ribosomal subunit",
"C": "Inhibition of mycolic acid synthesis",
"D": "Inhibition of arabinosyltransferase"
} | step1 | C | [
"year old man",
"recently",
"Mexico",
"physician",
"pre employment wellness examination",
"tuberculin skin test",
"administered",
"raised",
"erythematous",
"mm lesion",
"forearm",
"48 hours",
"x-ray of",
"chest shows",
"abnormalities",
"started",
"recommended antibiotic treatment",
... |
In your peripheral tissues and lungs, carbonic anhydrase works to control the equilibrium between carbon dioxide and carbonic acid in order to maintain proper blood pH. Through which mechanism does carbonic anhydrase exert its influence on reaction kinetics? | Lowers the activation energy | {
"A": "Lowers the activation energy",
"B": "Changes the delta G of the reaction",
"C": "Raises the activation energy",
"D": "Lowers the free energy of products"
} | step1 | A | [
"peripheral tissues",
"lungs",
"carbonic anhydrase works to control",
"equilibrium",
"carbon dioxide",
"carbonic acid",
"order to maintain",
"blood pH",
"mechanism",
"carbonic anhydrase exert",
"influence",
"reaction kinetics"
] |
A previously healthy 10-year-old boy is brought to the emergency department for the evaluation of one episode of vomiting and severe headache since this morning. His mother says he also had difficulty getting dressed on his own. He has not had any trauma. The patient appears nervous. His temperature is 37°C (98.6°F), p... | CT angiography | {
"A": "Echocardiography",
"B": "Oral sodium loading test",
"C": "CT angiography",
"D": "High-dose dexamethasone suppression test"
} | step2&3 | C | [
"healthy 10 year old boy",
"brought",
"emergency department",
"evaluation of one episode",
"vomiting",
"severe headache",
"morning",
"mother",
"difficulty getting dressed",
"not",
"trauma",
"patient appears nervous",
"temperature",
"98",
"pulse",
"100 min",
"blood pressure",
"mm Hg... |
A 26-year-old man is brought to the emergency room by his roommate after he was found attempting to commit suicide. His roommate says that he stopped him before he was about to jump off the balcony. He has been receiving treatment for depression for about a year. 6 months ago, he had come to the hospital reporting decr... | Electroconvulsive therapy | {
"A": "Cognitive behavioral theory",
"B": "Electroconvulsive therapy",
"C": "Amitriptyline",
"D": "Olanzapine"
} | step2&3 | B | [
"year old man",
"brought",
"emergency room",
"roommate",
"found attempting to commit suicide",
"roommate",
"stopped",
"before",
"about",
"jump",
"receiving treatment",
"depression",
"about",
"year",
"months",
"hospital reporting decreased interest",
"daily activities",
"to concentr... |
A 12-year-old male presents to the emergency department following several days of facial edema. A urinalysis confirms proteinuria and hematuria. Once admitted, a kidney biopsy is viewed under an electron microscope to confirm the diagnosis of minimal change disease. In the following electron micrograph, what process oc... | rRNA is produced | {
"A": "Proteins are synthesized for extracellular secretion",
"B": "Translation occurs",
"C": "rRNA is produced",
"D": "Initiation factors bind RNA"
} | step1 | C | [
"year old male presents",
"emergency department following several days",
"facial edema",
"urinalysis confirms proteinuria",
"hematuria",
"admitted",
"kidney biopsy",
"viewed",
"electron microscope to confirm",
"diagnosis",
"minimal change disease",
"following electron micrograph",
"process o... |
A 28-year-old man who works as a resident in general surgery presents feeling "burned out" for the last 2 months. He says he has been working extremely long hours under stressful conditions, which makes him irritable, edgy, unfocused, and forgetful. He says he also has severe anxiety about how these symptoms are affect... | Adjustment disorder | {
"A": "Adjustment disorder",
"B": "Generalized anxiety disorder",
"C": "Anxiety disorder",
"D": "Panic disorder"
} | step1 | A | [
"year old man",
"works",
"resident",
"general surgery presents feeling",
"burned out",
"last",
"months",
"working extremely long hours",
"stressful conditions",
"makes",
"irritable",
"edgy",
"forgetful",
"severe anxiety",
"symptoms",
"affecting",
"performance at work",
"making",
... |
A 60-year-old woman presents with changes in her left breast that started 1 month ago. The patient states that she noticed that an area of her left breast felt thicker than before, and has not improved. She came to get it checked out because her best friend was just diagnosed with invasive ductal carcinoma. The past me... | Can present bilaterally | {
"A": "Worse prognosis",
"B": "Can present bilaterally",
"C": "Higher prevalence",
"D": "Mammogram is more likely to demonstrate a discrete spiculated mass"
} | step2&3 | B | [
"60 year old woman presents",
"changes",
"left breast",
"started 1 month",
"patient states",
"area",
"left breast felt thicker",
"not improved",
"to",
"checked out",
"best friend",
"diagnosed",
"invasive ductal carcinoma",
"past medical history",
"significant",
"Hashimotos thyroiditis"... |
A 6-year-old boy is brought to the emergency department due to a severe infection. Laboratory work shows leukocytosis of 60 × 109/L with marked left shift, but no blast cells. The patient is febrile and dehydrated. The physician believes that this is a severe reaction to the infection and orders a leukocyte alkaline ph... | A blood count will contain band forms, metamyelocytes, and myelocytes. | {
"A": "Myeloblasts and promyelocytes are expected to be found.",
"B": "A blood count will contain band forms, metamyelocytes, and myelocytes.",
"C": "Chemotherapy is the treatment of choice.",
"D": "The patient may develop anemia secondary to infection."
} | step1 | B | [
"year old boy",
"brought",
"emergency department",
"severe infection",
"Laboratory work shows leukocytosis",
"60",
"marked left shift",
"blast cells",
"patient",
"febrile",
"dehydrated",
"physician",
"severe reaction",
"infection",
"orders",
"leukocyte",
"stain",
"peripheral smear"... |
A 25-year-old male visits his physician because of fertility issues with his wife. Physical exam reveals bilateral gynecomastia, elongated limbs, and shrunken testicles. Levels of plasma gonadotropins are elevated. Which of the following is also likely to be increased in this patient: | Aromatase | {
"A": "Testosterone",
"B": "Inhibin",
"C": "Aromatase",
"D": "Sertoli cells"
} | step1 | C | [
"year old male visits",
"physician",
"fertility issues",
"wife",
"Physical exam reveals bilateral gynecomastia",
"elongated limbs",
"shrunken testicles",
"Levels",
"plasma gonadotropins",
"elevated",
"following",
"likely to",
"increased",
"patient"
] |
A 7-year-old boy is brought to the physician by his parents because of a 4.5-kg (10-lb) weight loss during the last 3 months. During this period, he has complained of abdominal pain and fullness, and his parents feel that he has been eating less. His parents also report that his urine has appeared pink for several week... | Tuberous sclerosis | {
"A": "Neurofibromatosis type 1",
"B": "Sturge-Weber syndrome",
"C": "Tuberous sclerosis",
"D": "Neurofibromatosis type 2"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"parents",
"kg",
"10",
"weight loss during the last 3 months",
"period",
"abdominal pain",
"fullness",
"parents feel",
"eating less",
"parents",
"report",
"urine",
"appeared pink",
"weeks",
"performing poorly",
"school",
"reports",
"tea... |
A 9-month-old boy is brought to the pediatrician because he can not sit on his own without support and has involuntary movements. He was born vaginally with no complications at full term. There is no history of consanguinity among parents. On physical examination, it was noticed that he is a stunted infant with general... | Purine nucleoside phosphorylase | {
"A": "Purine nucleoside phosphorylase",
"B": "Orotate phosphoribosyltransferase",
"C": "Ribonucleotide reductase",
"D": "Dihydrofolate reductase"
} | step1 | A | [
"month old boy",
"brought",
"pediatrician",
"not sit",
"support",
"involuntary movements",
"born",
"complications",
"full term",
"history of consanguinity",
"parents",
"physical examination",
"infant",
"generalized hypotonia",
"severe generalized dystonic movements",
"mother",
"prese... |
A 49-year-old man presents to the emergency department with acute onset of pain and redness of the skin of his lower leg for the past 3 days. He has had type 2 diabetes mellitus for the past 12 years, but he is not compliant with his medications. He has smoked 10–15 cigarettes per day for the past 20 years. His tempera... | Oral vancomycin | {
"A": "Intravenous vancomycin",
"B": "Oral vancomycin",
"C": "Oral metronidazole",
"D": "Oral ciprofloxacin"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"acute onset",
"pain",
"redness of",
"skin",
"lower leg",
"past",
"days",
"type 2 diabetes mellitus",
"past",
"years",
"not compliant",
"medications",
"smoked",
"cigarettes",
"day",
"past 20 years",
"temperature",
"100 4F",
"pu... |
At postpartum physical examination, a newborn is found to have male external genitalia. Scrotal examination shows a single palpable testicle in the right hemiscrotum. Ultrasound of the abdomen and pelvis shows an undescended left testis, seminal vesicles, uterus, and fallopian tubes. Chromosomal analysis shows a 46, XY... | Normal ↓ normal normal | {
"A": "↓ ↓ ↓ ↓",
"B": "Normal normal ↑ ↑",
"C": "Normal ↓ normal normal",
"D": "Normal normal normal ↓"
} | step1 | C | [
"postpartum physical examination",
"newborn",
"found to",
"male external genitalia",
"Scrotal examination shows",
"single palpable testicle",
"right hemiscrotum",
"Ultrasound of",
"abdomen",
"pelvis shows",
"undescended left",
"seminal vesicles",
"uterus",
"fallopian tubes",
"Chromosomal... |
A 3080-g (6-lb 13-oz) male newborn is delivered at term to a 27-year-old woman, gravida 2, para 1. Pregnancy was uncomplicated. He appears pale. His temperature is 36.8°C (98.2°F), pulse is 167/min, and respirations are 56/min. Examination shows jaundice of the skin and conjunctivae. The liver is palpated 2–3 cm below ... | Increased hemoglobin Barts concentration | {
"A": "Elevated HbF",
"B": "Low serum ferritin",
"C": "Increased hemoglobin Barts concentration",
"D": "Elevated HbA2\n\""
} | step2&3 | C | [
"g",
"oz",
"male newborn",
"delivered",
"term",
"27 year old woman",
"gravida 2",
"para 1",
"Pregnancy",
"uncomplicated",
"appears pale",
"temperature",
"36",
"98",
"pulse",
"min",
"respirations",
"min",
"Examination shows jaundice",
"skin",
"conjunctivae",
"liver",
"palp... |
A 31-year-old woman presents with dysuria and pain in the lower abdomen. It is the first time she has experienced such symptoms. She denies a history of any genitourinary or gynecologic diseases. The blood pressure is 120/80 mm Hg, heart rate is 78/min, respiratory rate is 13/min, and temperature is 37.0°C (98.6°F). Th... | P-fimbriae | {
"A": "P-fimbriae",
"B": "K-capsule",
"C": "Heat-stable toxin",
"D": "Hemolysin"
} | step1 | A | [
"31 year old woman presents",
"dysuria",
"pain",
"lower abdomen",
"first time",
"experienced",
"symptoms",
"denies",
"history",
"genitourinary",
"gynecologic diseases",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"98",
"physical ... |
A 44-year-old woman presents to the outpatient clinic for the evaluation of amenorrhea which she noted roughly 4 months ago. Her monthly cycles up to that point were normal. Initially, she thought that it was related to early menopause; however, she has also noticed that she has a small amount of milk coming from her b... | MRI brain | {
"A": "MRI brain",
"B": "Serum estrogen and progesterone levels",
"C": "Mammogram",
"D": "Serum TSH and free T4"
} | step2&3 | A | [
"year old woman presents",
"outpatient clinic",
"evaluation",
"amenorrhea",
"noted",
"months",
"monthly cycles",
"point",
"normal",
"Initially",
"thought",
"related",
"early menopause",
"small amount",
"milk",
"breasts",
"well",
"denies",
"nausea",
"vomiting",
"weight gain",
... |
A 45-year-old man is rushed to the emergency department by his wife after complaining of sudden onset, an excruciating headache that started about an hour ago. On further questioning, the patient’s wife gives a prior history of flank pain, hematuria, and hypertension in the patient, and she recalls that similar symptom... | Increased wall tension within an aneurysm | {
"A": "Increased wall tension within an aneurysm",
"B": "Intracerebral hemorrhage due to vascular malformations",
"C": "Meningeal irritation from a space occupying lesion",
"D": "Uremic encephalopathy from chronic renal disease"
} | step1 | A | [
"year old man",
"rushed",
"emergency department",
"wife",
"sudden onset",
"excruciating headache",
"started",
"hour",
"further questioning",
"patients wife gives",
"prior history",
"flank pain",
"hematuria",
"hypertension",
"patient",
"recalls",
"similar symptoms",
"present",
"un... |
A 33-year-old woman comes to the physician because of a 6-month history of worsening shortness of breath and fatigue. Her paternal uncle had similar symptoms and died of respiratory failure at 45 years of age. The lungs are clear to auscultation. Pulmonary function testing shows an FVC of 84%, an FEV1/FVC ratio of 92%,... | Elevated pulmonary arterial pressure | {
"A": "Chronic intravascular hemolysis",
"B": "Fibrosis of the pulmonary parenchyma",
"C": "Thickening of the interventricular septum",
"D": "Elevated pulmonary arterial pressure"
} | step1 | D | [
"year old woman",
"physician",
"of",
"month history",
"worsening shortness",
"breath",
"fatigue",
"paternal uncle",
"similar symptoms",
"died",
"respiratory failure",
"years",
"age",
"lungs",
"clear",
"auscultation",
"Pulmonary function testing shows",
"FVC",
"84",
"FEV1/FVC ra... |
A 6-year-old girl is referred to the pediatrician after a primary care practitioner found her to be anemic, in addition to presenting with decreased bowel movements, intermittent abdominal pain, and hearing loss. The child has also shown poor performance at school and has lost interest in continuing her classes of glaz... | Porphobilinogen | {
"A": "Aminolevulinic acid",
"B": "Hydroxymethylbilane",
"C": "Porphobilinogen",
"D": "Protoporphyrin"
} | step1 | C | [
"year old girl",
"referred",
"pediatrician",
"primary practitioner found",
"to",
"anemic",
"in addition to presenting",
"decreased bowel movements",
"intermittent abdominal pain",
"hearing loss",
"child",
"shown poor performance",
"school",
"lost interest",
"continuing",
"classes",
"... |
A 10-year-old boy presents to the emergency department with sudden shortness of breath. He was playing in the school garden and suddenly started to complain of abdominal pain. He then vomited a few times. An hour later in the hospital, he slowly developed a rash on his chest, arms, and legs. His breathing became faster... | Tryptase | {
"A": "Prostaglandin D2",
"B": "Serotonin",
"C": "Tryptase",
"D": "Leukotrienes"
} | step1 | C | [
"A 10 year old boy presents",
"emergency department",
"sudden shortness of breath",
"playing",
"school garden",
"started to",
"abdominal pain",
"then vomited",
"few times",
"hour later",
"hospital",
"slowly",
"rash",
"chest",
"arms",
"legs",
"breathing",
"faster",
"wheezing",
"... |
A 30-year-old African American woman comes to the physician because of fatigue and muscle weakness for the past 5 weeks. During this period, she has had recurrent headaches and palpitations. She has hypertension and major depressive disorder. She works as a nurse at a local hospital. She has smoked about 6–8 cigarettes... | Aldosteronoma | {
"A": "Laxative abuse",
"B": "Aldosteronoma",
"C": "Pheochromocytoma",
"D": "Cushing syndrome"
} | step2&3 | B | [
"30 year old African American woman",
"physician",
"fatigue",
"muscle weakness",
"past",
"weeks",
"period",
"recurrent headaches",
"palpitations",
"hypertension",
"major depressive disorder",
"works",
"nurse",
"local hospital",
"smoked",
"68 cigarettes daily",
"past 10 years",
"dri... |
A 31 year-old-man presents to an urgent care clinic with symptoms of lower abdominal pain, bloating, bloody diarrhea, and fullness, all of which have become more frequent over the last 3 months. His vital signs are as follows: blood pressure is 121/81 mm Hg, heart rate is 87/min, and respiratory rate is 15/min. Rectal ... | Total proctocolectomy | {
"A": "Sulfasalazine",
"B": "Systemic corticosteroids",
"C": "Azathioprine",
"D": "Total proctocolectomy"
} | step2&3 | D | [
"31 year old man presents",
"urgent care clinic",
"symptoms",
"lower",
"bloating",
"bloody diarrhea",
"fullness",
"more frequent",
"months",
"vital signs",
"follows",
"blood pressure",
"81 mm Hg",
"heart rate",
"87 min",
"respiratory rate",
"min",
"Rectal examination reveals",
"s... |
A woman presents to the emergency department due to abdominal pain that began 1 hour ago. She is in the 35th week of her pregnancy when the pain came on during dinner. She also noted a clear rush of fluid that came from her vagina. The patient has a past medical history of depression which is treated with cognitive beh... | Betamethasone | {
"A": "Betamethasone",
"B": "Terbutaline",
"C": "RhoGAM",
"D": "Expectant management"
} | step2&3 | A | [
"woman presents",
"emergency department",
"abdominal pain",
"began 1 hour",
"week",
"pregnancy",
"pain",
"dinner",
"noted",
"clear rush",
"fluid",
"vagina",
"patient",
"past medical history of depression",
"treated with cognitive behavioral therapy",
"temperature",
"99",
"blood pre... |
Five days after undergoing a pancreaticoduodenectomy for pancreatic cancer, a 46-year-old woman has 2 episodes of non-bilious vomiting and mild epigastric pain. She has a patient-controlled analgesia pump. She has a history of hypertension. She has smoked one pack of cigarettes daily for 25 years. She drinks 3–4 beers ... | Fistula | {
"A": "Adrenal insufficiency",
"B": "Excessive alcohol intake",
"C": "Adverse effect of medication",
"D": "Fistula"
} | step2&3 | D | [
"Five days",
"pancreaticoduodenectomy",
"pancreatic cancer",
"year old woman",
"episodes of non bilious vomiting",
"mild epigastric",
"patient-controlled analgesia pump",
"history of hypertension",
"smoked one pack",
"cigarettes daily",
"years",
"drinks",
"beers daily",
"Prior to admission... |
A 44-year-old woman presents to the emergency department with jaundice and diffuse abdominal pain. She denies any previous medical problems and says she does not take any medications, drugs, or supplements. Her temperature is 97.6°F (36.4°C), blood pressure is 133/87 mmHg, pulse is 86/min, respirations are 22/min, and ... | Chronic hepatitis B infection | {
"A": "Acute hepatitis B infection",
"B": "Chronic hepatitis B infection",
"C": "No hepatitis B vaccination or infection",
"D": "Resolved hepatitis B infection"
} | step2&3 | B | [
"year old woman presents",
"emergency department",
"jaundice",
"diffuse abdominal",
"denies",
"previous medical problems",
"not take",
"medications",
"drugs",
"supplements",
"temperature",
"97",
"36 4C",
"blood pressure",
"87 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxyge... |
A 27-year-old woman presents to the emergency department complaining of a left-sided headache and right-sided blurry vision. She states that 2 weeks ago she developed dark urine and abdominal pain. She thought it was a urinary tract infection so she took trimethoprim-sulfamethoxazole that she had left over. She planned... | Flow cytometry | {
"A": "Anti-histone antibodies",
"B": "Flow cytometry",
"C": "Glucose-6-phosphate-dehydrogenase levels",
"D": "Hemoglobin electrophoresis"
} | step2&3 | B | [
"27 year old woman presents",
"emergency department complaining of a left-sided headache",
"right-sided blurry vision",
"states",
"2 weeks",
"dark urine",
"abdominal pain",
"thought",
"urinary tract infection",
"took trimethoprim-sulfamethoxazole",
"left",
"planned on",
"primary care physici... |
A 25-year-old woman presents to her primary care physician with 3 weeks of palpitations and shortness of breath while exercising. She says that these symptoms have been limiting her ability to play recreational sports with her friends. Her past medical history is significant for pharyngitis treated with antibiotics and... | Increased valvular dermatan sulfate | {
"A": "Bicuspid aortic valve",
"B": "Increased valvular dermatan sulfate",
"C": "Intravenous drug abuse",
"D": "Mutation in cardiac contractile proteins"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"3 weeks",
"palpitations",
"shortness of breath",
"exercising",
"symptoms",
"limiting",
"ability to play recreational sports",
"friends",
"past medical history",
"significant",
"pharyngitis treated with antibiotics",
"family history reve... |
A 33-year-old woman comes to the physician because of a 3-day history of dry cough and low-grade fever. Four months ago, she was diagnosed with major depressive disorder and started treatment with fluoxetine. Physical examination shows no abnormalities. A diagnosis of upper respiratory infection is made and a medicatio... | Inhibition of NMDA glutamate receptors | {
"A": "Disruption of mucoid disulfide bonds",
"B": "Inhibition of H1 receptors",
"C": "Reduction in secretion viscosity",
"D": "Inhibition of NMDA glutamate receptors"
} | step1 | D | [
"year old woman",
"physician",
"3-day history",
"dry cough",
"low-grade fever",
"Four months",
"diagnosed",
"major depressive disorder",
"started treatment",
"fluoxetine",
"Physical examination shows",
"abnormalities",
"diagnosis",
"upper respiratory infection",
"made",
"medication",
... |
A 55-year-old man is brought to the emergency department by his wife after falling down. About 90 minutes ago, they were standing in their kitchen making lunch and chatting when he suddenly complained that he could not see as well, felt weak, and was getting dizzy. He began to lean to 1 side, and he eventually fell to ... | Lateral medulla | {
"A": "Anterior spinal cord",
"B": "Lateral medulla",
"C": "Primary somatosensory cortex",
"D": "Thalamus"
} | step2&3 | B | [
"55 year old man",
"brought",
"emergency department",
"wife",
"falling",
"90 minutes",
"standing",
"kitchen making lunch",
"chatting",
"not see",
"well",
"felt weak",
"getting dizzy",
"began",
"1 side",
"fell",
"not hit",
"head",
"emergency department",
"seated",
"right",
"... |
A 77-year-old Caucasian woman presents to her primary care provider for a general checkup. The patient is with her daughter who brought her to this appointment. The patient states that she is doing well and has some minor joint pain in both hips. She states that sometimes she is sad because her husband recently died. S... | Donepezil | {
"A": "Donepezil",
"B": "Fluoxetine and cognitive behavioral therapy",
"C": "Vitamin B12 and discontinue pantoprazole",
"D": "No intervention needed"
} | step2&3 | A | [
"year old Caucasian woman presents",
"primary care provider",
"general checkup",
"patient",
"daughter",
"brought",
"appointment",
"patient states",
"well",
"minor joint pain in both hips",
"states",
"sometimes",
"sad",
"husband recently died",
"lives alone",
"follows",
"vegan diet",
... |
A 33-year-old woman presents to her primary care physician for non-bloody nipple discharge. She states that it has been going on for the past month and that it sometimes soils her shirt. The patient drinks 2 to 3 alcoholic beverages per day and smokes 1 pack of cigarettes per day. She is currently seeking mental health... | TSH level | {
"A": "Discontinuation of current psychiatric medications",
"B": "Mammography",
"C": "TSH level",
"D": "Ultrasound and biopsy"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"non bloody nipple discharge",
"states",
"past month",
"sometimes soils",
"shirt",
"patient drinks 2",
"3 alcoholic beverages",
"day",
"smokes",
"pack",
"cigarettes",
"day",
"currently",
"mental health treatment",
"outpatient psych... |
A 45-year-old man is brought to the physician by his wife for the evaluation of abnormal sleep patterns that began 10 days ago. She reports that he has only been sleeping 2–3 hours nightly during this time and has been jogging for long periods of the night on the treadmill. The patient has also been excessively talkati... | Valproate | {
"A": "Buproprion",
"B": "Valproate",
"C": "Mirtazapine",
"D": "Fluoxetine"
} | step1 | B | [
"year old man",
"brought",
"physician",
"wife",
"evaluation",
"abnormal sleep patterns",
"began 10 days",
"reports",
"only",
"sleeping 23 hours",
"time",
"jogging",
"long periods",
"night",
"treadmill",
"patient",
"excessively talkative",
"missed work",
"occasions",
"write emai... |
A 17-year-old high school student is brought to the emergency department because of irritability and rapid breathing. He appears agitated and is diaphoretic. His temperature is 38.3°C (101°F), pulse is 129/min, respirations are 28/min, and blood pressure is 158/95 mmHg. His pupils are dilated. An ECG shows sinus tachyc... | Pseudoephedrine | {
"A": "Ergotamine",
"B": "Pseudoephedrine",
"C": "Homatropine",
"D": "Sodium oxybate"
} | step1 | B | [
"year old high school student",
"brought",
"emergency department",
"irritability",
"rapid breathing",
"appears agitated",
"diaphoretic",
"temperature",
"3C",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"95 mmHg",
"pupils",
"dilated",
"ECG shows sinus tachycardia",
"f... |
A 60-year-old man is brought to the emergency department because of a 30-minute history of dizziness and shortness of breath. After establishing the diagnosis, treatment with a drug is administered. Shortly after administration, the patient develops severe left eye pain and decreased vision of the left eye, along with ... | Atrioventricular block | {
"A": "Atrioventricular block",
"B": "Hypertensive crisis",
"C": "Mitral regurgitation",
"D": "Viral pleuritis"
} | step1 | A | [
"60 year old man",
"brought",
"emergency department",
"30-minute history",
"dizziness",
"shortness of breath",
"establishing",
"diagnosis",
"treatment",
"drug",
"administered",
"administration",
"patient",
"severe left eye pain",
"decreased vision",
"left eye",
"nausea",
"vomiting"... |
A 4-year-old girl is brought to the pediatrician by her parents after her mother recently noticed that other girls of similar age talk much more than her daughter. Her mother reports that her language development has been abnormal and she was able to use only 5–6 words at the age of 2 years. Detailed history reveals th... | This condition is 4 times more common in boys than girls. | {
"A": "This condition is 4 times more common in boys than girls.",
"B": "There is an increased incidence if the mother gives birth before 25 years of age.",
"C": "There is an increased risk if the mother smoked during pregnancy.",
"D": "There is an increased risk with low prenatal maternal serum vitamin D leve... | step2&3 | A | [
"4 year old girl",
"brought",
"pediatrician",
"parents",
"mother recently",
"girls",
"similar age talk",
"more",
"daughter",
"mother reports",
"language development",
"abnormal",
"able to use only",
"words",
"age",
"years",
"Detailed history reveals",
"never used",
"index finger ... |
An 85-year-old man with hypertension and type 2 diabetes mellitus is brought to the emergency department because of a 2-day history of shortness of breath. He has smoked one pack of cigarettes daily for 30 years. His temperature is 36.9°C (98.4°F), pulse is 100/min, respirations are 30/min, and blood pressure is 138/75... | Rib fracture | {
"A": "Emphysema exacerbation",
"B": "Tension pneumothorax",
"C": "Rib fracture",
"D": "Pulmonary edema"
} | step1 | C | [
"85 year old man",
"hypertension",
"type 2 diabetes mellitus",
"brought",
"emergency department",
"of",
"2-day history",
"shortness",
"breath",
"smoked one pack",
"cigarettes daily",
"30 years",
"temperature",
"36",
"98 4F",
"pulse",
"100 min",
"respirations",
"30/min",
"blood ... |
A 2-year-old boy is brought to the emergency department because of fever, fatigue, and productive cough for the past 2 days. He had similar symptoms 6 months ago when he was diagnosed with pneumonia. Three weeks ago, he was diagnosed with otitis media for the 6th time since birth and was treated with amoxicillin. His t... | Intravenous immunoglobulins | {
"A": "Intravenous immunoglobulins",
"B": "Recombinant human granulocyte-colony stimulating factor administration",
"C": "Stem cell transplantation",
"D": "Thymus transplantation"
} | step2&3 | A | [
"2 year old boy",
"brought",
"emergency department",
"fever",
"fatigue",
"productive cough",
"past 2 days",
"similar symptoms",
"months",
"diagnosed",
"pneumonia",
"Three weeks",
"diagnosed",
"otitis media",
"time",
"birth",
"treated with amoxicillin",
"temperature",
"pulse",
"... |
A 58-year-old man comes to the physician for recurrent heartburn for 12 years. He has also developed a cough for a year, which is worse at night. He has smoked a pack of cigarettes daily for 30 years. His only medication is an over-the-counter antacid. He has not seen a physician for 8 years. He is 175 cm (5 ft 9 in) t... | Endoscopic therapy | {
"A": "Repeat endoscopy in 18 months",
"B": "Endoscopic therapy",
"C": "Omeprazole, clarithromycin, and metronidazole therapy",
"D": "External beam radiotherapy"
} | step2&3 | B | [
"58 year old man",
"physician",
"recurrent heartburn",
"years",
"cough",
"year",
"worse",
"night",
"smoked",
"pack",
"cigarettes daily",
"30 years",
"only medication",
"over-the-counter antacid",
"not seen",
"physician",
"years",
"5 ft 9",
"tall",
"95 kg",
"BMI",
"31 kg/m2"... |
A 25-year-old man of Mediterranean descent makes an appointment with his physician because his skin and sclera have become yellow. He complains of fatigue and fever that started at the same time icterus appeared. On examination, he is tachycardic and tachypneic. The oxygen (O2) saturation is < 90%. He has increased unc... | Hemolytic anemia caused by glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) | {
"A": "Hemolytic anemia caused by glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)",
"B": "Anemia caused by renal failure",
"C": "Autoimmune hemolytic anemia (AIHA)",
"D": "Aplastic anemia"
} | step1 | A | [
"year old man",
"Mediterranean descent makes",
"appointment",
"physician",
"skin",
"sclera",
"yellow",
"fatigue",
"fever",
"started",
"same time icterus appeared",
"examination",
"tachycardic",
"tachypneic",
"oxygen",
"O2",
"saturation",
"90",
"increased unconjugated bilirubin",
... |
A 65-year-old man comes to a follow-up appointment with his surgeon 2 months after undergoing hip replacement surgery. His major concern at this visit is that he is still limping since the surgery even after the post-operative pain has subsided. Specifically, when he stands on his right leg, he feels that he has to lea... | Superior gluteal nerve | {
"A": "Femoral nerve",
"B": "Inferior gluteal nerve",
"C": "Superior gluteal nerve",
"D": "Tibial nerve"
} | step1 | C | [
"65 year old man",
"follow-up appointment",
"surgeon 2 months",
"hip replacement surgery",
"major concern",
"visit",
"limping",
"surgery",
"post pain",
"stands",
"right leg",
"feels",
"further",
"right",
"order to maintain balance",
"standing",
"left leg",
"feels",
"able to step"... |
A 55-year-old man presents to his primary care physician for diarrhea. He states that he has experienced roughly 10 episodes of non-bloody and watery diarrhea every day for the past 3 days. The patient has a past medical history of IV drug abuse and recently completed treatment for an abscess with cellulitis. His vital... | Vancomycin | {
"A": "Clindamycin",
"B": "Metronidazole",
"C": "Oral rehydration and discharge",
"D": "Vancomycin"
} | step2&3 | D | [
"55 year old man presents",
"primary care physician",
"diarrhea",
"states",
"experienced",
"10 episodes of non bloody",
"watery diarrhea",
"day",
"past 3 days",
"patient",
"past medical history of IV drug abuse",
"recently completed treatment",
"abscess",
"cellulitis",
"notable",
"puls... |
A 22-year-old Caucasian female presents with severe right lower quadrant pain, malaise, and diarrhea. The physician performs an endoscopy and finds disease involvement in the terminal ileum, noting that that the disease process is patchy with normal intervening mucosa. The entire wall of the region is thickened and inf... | Fistulas | {
"A": "Fistulas",
"B": "Toxic megacolon",
"C": "Widening of the intestinal lumen",
"D": "Plummer-Vinson syndrome"
} | step1 | A | [
"year old Caucasian female presents",
"severe right lower quadrant pain",
"malaise",
"diarrhea",
"physician performs",
"endoscopy",
"finds disease involvement",
"terminal",
"noting",
"disease process",
"patchy",
"normal",
"mucosa",
"entire wall",
"region",
"thickened",
"inflamed",
... |
A 45-year-old man is brought to the emergency department by his friends because of a 1-hour history of shortness of breath and squeezing chest pain. They were at a party where cocaine was consumed. A diagnosis of acute myocardial infarction is made. The physician stabilizes the patient and transfers him to the inpatien... | Obtain authorization from the patient to release information | {
"A": "Obtain authorization from the patient to release information",
"B": "Inform the wife about her husband's condition",
"C": "Consult the hospital ethics committee",
"D": "Request the patient's durable power of attorney document"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"friends",
"of",
"hour history",
"shortness",
"breath",
"squeezing chest pain",
"party",
"cocaine",
"diagnosis",
"acute myocardial infarction",
"made",
"physician stabilizes",
"patient",
"transfers",
"inpatient unit",
"Six hours ... |
A 71-year-old, hospitalized man develops abnormal laboratory studies 4 days after starting treatment for exacerbation of congestive heart failure. He also has a history of osteoarthritis and benign prostatic hyperplasia. He recently completed a course of amikacin for bacterial prostatitis. Before hospitalization, his m... | Volume depletion | {
"A": "Volume depletion",
"B": "Urinary tract infection",
"C": "Bladder outlet obstruction",
"D": "Antibiotic use"
} | step1 | A | [
"71 year old",
"hospitalized man",
"abnormal laboratory studies 4 days",
"starting treatment",
"exacerbation of congestive heart failure",
"history of osteoarthritis",
"benign prostatic hyperplasia",
"recently completed",
"course",
"amikacin",
"bacterial prostatitis",
"hospitalization",
"med... |
A 21-year-old woman comes to the physician because of a 1-day history of right leg pain. The pain is worse while walking and improves when resting. Eight months ago, she was diagnosed with a pulmonary embolism and was started on warfarin. Anticoagulant therapy was discontinued two months ago. Her mother had systemic lu... | Mutation of coagulation factor V | {
"A": "Protein S deficiency",
"B": "Elevated coagulation factor VIII levels",
"C": "Mutation of coagulation factor V",
"D": "Deficiency of protein C\n\""
} | step1 | C | [
"21-year-old woman",
"physician",
"1-day history",
"right leg pain",
"pain",
"worse",
"walking",
"improves",
"resting",
"Eight months",
"diagnosed",
"pulmonary embolism",
"started",
"warfarin",
"Anticoagulant",
"discontinued two months",
"mother",
"systemic lupus erythematosus",
... |
A 68-year-old man is brought to the emergency department because of right-sided weakness for 2 hours. He has hypertension, dyslipidemia, and type 2 diabetes. Current medications include hydrochlorothiazide, metoprolol, amlodipine, pravastatin, and metformin. His pulse is 87/min and blood pressure is 164/98 mm Hg. Neuro... | Lipohyalinosis of penetrating vessels | {
"A": "Rupture of an intracranial aneurysm",
"B": "Lipohyalinosis of penetrating vessels",
"C": "Stenosis of the internal carotid artery",
"D": "Embolism from the left atrium"
} | step1 | B | [
"68 year old man",
"brought",
"emergency department",
"of right-sided weakness",
"hours",
"hypertension",
"dyslipidemia",
"type 2 diabetes",
"Current medications include hydrochlorothiazide",
"metoprolol",
"amlodipine",
"pravastatin",
"metformin",
"pulse",
"87 min",
"blood pressure",
... |
A 59-year-old woman comes to the physician for a 3-month history of progressively worsening shortness of breath on exertion and swelling of her legs. She has a history of breast cancer, which was treated with surgery followed by therapy with doxorubicin and trastuzumab 4 years ago. Cardiac examination shows an S3 gallo... | ↓ ↑ normal normal | {
"A": "Normal normal ↓ normal",
"B": "↑ ↑ normal normal",
"C": "↑ ↓ ↓ ↑",
"D": "↓ ↑ normal normal"
} | step1 | D | [
"59 year old woman",
"physician",
"3 month history",
"worsening shortness of breath",
"exertion",
"swelling of",
"legs",
"history of breast cancer",
"treated with surgery followed by therapy",
"doxorubicin",
"trastuzumab",
"years",
"Cardiac examination shows",
"S3 gallop",
"murmurs",
"... |
A 40-year-old female volunteers for an invasive study to measure her cardiac function. She has no previous cardiovascular history and takes no medications. With the test subject at rest, the following data is collected using blood tests, intravascular probes, and a closed rebreathing circuit:
Blood hemoglobin concentra... | 5.0 L/min | {
"A": "5.0 L/min",
"B": "50 L/min",
"C": "Stroke volume is required to calculate cardiac output.",
"D": "Body surface area is required to calculate cardiac output."
} | step1 | A | [
"40 year old female volunteers",
"invasive study to measure",
"cardiac function",
"previous cardiovascular history",
"takes",
"medications",
"test subject",
"rest",
"following data",
"collected using blood tests",
"intravascular probes",
"closed rebreathing",
"Blood",
"concentration",
"o... |
A 48-year-old man, with a history of gluten intolerance, presents to the emergency department with persistent vomiting and diarrhea, and no fever. He recently returned from a vacation in Central America. He describes his diarrhea as profuse and almost clear. On physical examination, his skin turgor is decreased and his... | Decreased extracellular volume with no change in osmolarity | {
"A": "Increased extracellular volume, increased osmolarity, and decreased intracellular volume",
"B": "Decreased extracellular volume with no change in osmolarity",
"C": "Increased extracellular volume with no change in osmolarity or intracellular volume",
"D": "Decreased extracellular volume and intracellula... | step1 | B | [
"48 year old man",
"history",
"gluten intolerance",
"presents",
"emergency department",
"persistent vomiting",
"diarrhea",
"fever",
"recently returned",
"vacation",
"Central America",
"diarrhea",
"almost clear",
"physical examination",
"skin turgor",
"decreased",
"blood pressure",
... |
A 42-year-old woman comes to the physician because of 2 episodes of loss of consciousness over the past week. She recovered immediately and was not confused following the episodes. During the past 5 months, she has also had increased shortness of breath and palpitations. She has been unable to carry out her daily activ... | Increased left atrial pressure | {
"A": "Increased left ventricular end diastolic pressure",
"B": "Increased left to right shunting",
"C": "Decreased left ventricular contractility",
"D": "Increased left atrial pressure"
} | step2&3 | D | [
"year old woman",
"physician",
"of 2 episodes",
"loss",
"consciousness",
"past week",
"recovered immediately",
"not confused following",
"episodes",
"past",
"months",
"increased shortness of breath",
"palpitations",
"unable to carry out",
"daily activities",
"reports",
"chest tightne... |
A 62-year-old man with small cell lung cancer undergoes radiation therapy. His oncologist explains that radiation causes DNA damage and double strand breaks and this damage stops the cancer cells from growing because they can no longer replicate their DNA. One key mediator of this process is a cell cycle regulator call... | Histone acetyltransferase | {
"A": "DNA methyltransferase",
"B": "Histone acetyltransferase",
"C": "Histone deacetylase",
"D": "Xist"
} | step1 | B | [
"62 year old man",
"small cell lung cancer",
"radiation therapy",
"oncologist",
"radiation causes DNA damage",
"double strand breaks",
"damage stops",
"cancer cells",
"longer replicate",
"DNA",
"One",
"mediator",
"process",
"cell cycle regulator called P53",
"DNA damage",
"helps to tri... |
A 5-year-old girl is brought to the physician because her mother has found her to be inattentive at home and has received multiple complaints from her teachers at school. She does not complete her assignments and does not listen to her teachers' instructions. She refuses to talk to her parents or peers. Her mother says... | Autism spectrum disorder | {
"A": "Oppositional defiant disorder",
"B": "Autism spectrum disorder",
"C": "Conduct disorder",
"D": "Rett syndrome"
} | step2&3 | B | [
"5 year old girl",
"brought",
"physician",
"mother",
"found",
"to",
"inattentive",
"home",
"received multiple complaints",
"teachers",
"school",
"not complete",
"assignments",
"not listen",
"teachers",
"instructions",
"refuses to talk",
"parents",
"peers",
"mother",
"ignores"... |
A 38-year-old man comes to the physician because of a 2-year-history of cough and progressively worsening breathlessness. He has smoked 1 pack of cigarettes daily for the past 10 years. Physical examination shows contraction of the anterior scalene and sternocleidomastoid muscles during inspiration. An x-ray of the che... | Leukotriene B4 | {
"A": "Lactoferrin",
"B": "Interferon gamma",
"C": "Leukotriene B4",
"D": "Thromboxane A2"
} | step1 | C | [
"year old man",
"physician",
"2 year history",
"cough",
"worsening breathlessness",
"smoked 1 pack",
"cigarettes daily",
"past 10 years",
"Physical examination shows contraction",
"anterior scalene",
"sternocleidomastoid muscles",
"inspiration",
"x-ray of",
"chest shows flattening",
"dia... |
A 40-year-old woman is brought to the emergency department by a paramedic team from the scene of a motor vehicle accident where she was the driver. The patient was restrained by a seat belt and was unconscious at the scene. On physical examination, the patient appears to have multiple injuries involving the trunk and e... | T8 | {
"A": "T4",
"B": "T1",
"C": "T5",
"D": "T8"
} | step1 | D | [
"40 year old woman",
"brought",
"emergency department",
"paramedic team",
"motor vehicle accident",
"driver",
"patient",
"restrained",
"seat belt",
"unconscious",
"physical examination",
"patient appears to",
"multiple injuries involving",
"trunk",
"extremities",
"penetrating injuries"... |
A 28-year-old woman presents with continuous feelings of sadness and rejection. She says that over the past couple of weeks, she has been unable to concentrate on her job and has missed several days of work. She also has no interest in any activity and typically rejects invitations to go out with friends. She has no in... | Bipolar disorder, type II | {
"A": "Major depressive disorder",
"B": "Schizoaffective disorder",
"C": "Bipolar disorder, type II",
"D": "Bipolar disorder, type I"
} | step2&3 | C | [
"year old woman presents",
"continuous feelings of sadness",
"rejection",
"past couple",
"weeks",
"unable to concentrate",
"job",
"missed",
"days",
"work",
"interest",
"activity",
"rejects invitations to go out",
"friends",
"interest",
"food",
"playing",
"dog",
"husband",
"conc... |
A 7-year-old boy with asthma is brought to the physician because of a 1-month history of worsening shortness of breath and cough. The mother reports that the shortness of breath usually occurs when he is exercising with his older brother. His only medication is an albuterol inhaler that is taken as needed. The physicia... | Antagonism at leukotriene receptors | {
"A": "Antagonism at leukotriene receptors",
"B": "Inhibition of phosphodiesterase",
"C": "Inhibition of mast cell degranulation",
"D": "Blockade of 5-lipoxygenase pathway"
} | step1 | A | [
"year old boy",
"asthma",
"brought",
"physician",
"of",
"month history",
"worsening shortness",
"breath",
"cough",
"mother reports",
"shortness of breath usually occurs",
"exercising",
"older brother",
"only medication",
"albuterol inhaler",
"taken as needed",
"physician considers ad... |
A 24-year-old woman comes to the physician because she feels sad and has had frequent, brief episodes of crying for the last month. During this period, she sleeps in every morning and spends most of her time in bed playing video games or reading. She has not been spending time with friends but still attends a weekly bo... | Adjustment disorder | {
"A": "Adjustment disorder",
"B": "Dysthymic disorder",
"C": "Substance use disorder",
"D": "Bipolar disorder"
} | step2&3 | A | [
"year old woman",
"physician",
"feels sad",
"frequent",
"brief episodes of crying",
"last month",
"period",
"sleeps",
"morning",
"spends most of",
"time",
"bed playing video games",
"reading",
"not",
"spending time",
"friends",
"attends",
"weekly book club",
"continues to plan",
... |
A 63-old man is brought in by ambulance after a bar fight. Witnesses report that he is a bar regular and often drinks several shots of hard liquor throughout the night. The emergency department recognize him as a local homeless man with a long history of alcohol abuse. During the initial workup in the ED, he has a prol... | Erythrocyte transketolase activity | {
"A": "Rapid fluorescent spot test",
"B": "Serum methylmalonic acid",
"C": "Erythrocyte transketolase activity",
"D": "Aldolase B activity"
} | step1 | C | [
"63 old man",
"brought",
"ambulance",
"fight",
"Witnesses report",
"bar regular",
"often drinks several shots",
"hard liquor",
"night",
"emergency department",
"local homeless man",
"long history of alcohol abuse",
"initial workup",
"ED",
"prolonged seizure",
"autopsy",
"performed",
... |
A 56-year-old woman presents to her primary care physician complaining of heartburn, belching, and epigastic pain that is aggravated by coffee and fatty foods. She states that she has recently been having difficulty swallowing in addition to her usual symptoms. What is the most appropriate next step in management of th... | Upper endoscopy | {
"A": "Nissen fundoplication",
"B": "Lifestyle changes - don't lie down after eating; avoid spicy foods; eat small servings",
"C": "Trial of an H2 receptor antagonist",
"D": "Upper endoscopy"
} | step2&3 | D | [
"year old woman presents",
"primary care physician",
"heartburn",
"belching",
"pain",
"aggravated",
"coffee",
"fatty foods",
"states",
"recently",
"difficulty in addition to",
"usual symptoms",
"most appropriate next step",
"management",
"patient"
] |
A 17-year-old boy is brought to the emergency department by his parents 6 hours after he suddenly began to experience dyspnea and pleuritic chest pain at home. He has a remote history of asthma in childhood but has not required any treatment since the age of four. His temperature is 98.4°F (36.9°C), blood pressure is 1... | Needle decompression | {
"A": "Chest tube placement",
"B": "CT scan for apical blebs",
"C": "Needle decompression",
"D": "Observe for another six hours for resolution"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"parents",
"hours",
"began to experience dyspnea",
"pleuritic chest pain at home",
"remote history of asthma",
"childhood",
"not required",
"treatment",
"age",
"four",
"temperature",
"98 4F",
"36",
"blood pressure",
"100 76 mmHg",
... |
A 4-month-old male infant is brought in because he rejects food and is losing weight. He had several upper respiratory tract infections during the last 2 months. Upon examination, hepatosplenomegaly is noted, as well as mild hypotonia. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, a... | Niemann-Pick disease type A | {
"A": "Crigler-Najjar syndrome type I",
"B": "Niemann-Pick disease type A",
"C": "Gaucher disease",
"D": "Gilbert syndrome"
} | step1 | B | [
"4 month old male infant",
"brought",
"rejects food",
"weight",
"several upper respiratory tract infections",
"months",
"examination",
"hepatosplenomegaly",
"noted",
"mild hypotonia",
"next",
"weeks",
"hepatosplenomegaly progresses",
"boy fails to thrive",
"continues to reject food",
"... |
A 51-year-old man with a history of severe persistent asthma is seen today with the complaint of white patches on his tongue and inside his mouth. He says this all started a couple of weeks ago when he recently started a new medication for his asthma. The vital signs include: temperature 36.7°C (98.0°F), blood pressure... | Beclomethasone inhaler | {
"A": "Over-use of the albuterol inhaler",
"B": "Salmeterol inhaler",
"C": "Beclomethasone inhaler",
"D": "Omalizumab"
} | step2&3 | C | [
"year old man",
"history of severe persistent asthma",
"seen today",
"complaint",
"white patches",
"tongue",
"mouth",
"started",
"couple",
"weeks",
"recently started",
"new medication",
"asthma",
"vital signs include",
"temperature 36",
"98",
"blood pressure",
"74 mm Hg",
"heart ... |
A 29-year-old male is brought to the emergency department 20 minutes after sustaining a stab wound to the right chest. First-responders found the patient sitting on the curb smoking a cigarette, complaining of pain where he had been stabbed. On arrival, he is alert. His temperature is 36.8°C (98.2°F), pulse is 110/min,... | Endotracheal intubation | {
"A": "Right needle thoracostomy",
"B": "Endotracheal intubation",
"C": "Cricothyroiditomy",
"D": "CT scan of the chest"
} | step2&3 | B | [
"29 year old male",
"brought",
"emergency department 20 minutes",
"sustaining",
"stab wound to",
"right chest",
"First-responders found",
"patient sitting",
"curb smoking",
"cigarette",
"pain",
"stabbed",
"arrival",
"alert",
"temperature",
"36",
"98",
"pulse",
"min",
"respirati... |
A 26-year-old woman presents to the clinic complaining of a headache, runny nose, and malaise. A few minutes into the interview, she mentions that she recently started her job and is glad to work long hours despite the toll on her health. However, she admits that she is finding it difficult to keep up with the workload... | Ego-syntonic obsessive-compulsive personality disorder | {
"A": "Ego-syntonic obsessive-compulsive personality disorder",
"B": "Ego-syntonic obsessive-compulsive disorder",
"C": "Ego-dystonic obsessive-compulsive disorder",
"D": "Personality disorder not otherwise specified"
} | step2&3 | A | [
"year old woman presents",
"clinic complaining of a headache",
"runny nose",
"malaise",
"few minutes",
"interview",
"recently started",
"job",
"to work long hours",
"toll",
"health",
"admits",
"finding",
"difficult to keep",
"workload",
"numerous",
"papers",
"correct",
"to",
"h... |
A 28-year-old woman comes to the emergency department for a 1-week history of jaundice and nausea. She recalls eating some seafood last weekend at a cookout. She lives at home with her 2-year-old son who attends a daycare center. The child's immunizations are up-to-date. The woman's temperature is 37.5°C (99.5°F), puls... | No additional steps are needed | {
"A": "Administer hepatitis B immunoglobulin and hepatitis B vaccine",
"B": "No additional steps are needed",
"C": "Administer hepatitis B immunoglobulin only",
"D": "Administer hepatitis A vaccine and hepatitis A immunoglobulin"
} | step2&3 | B | [
"year old woman",
"emergency department",
"1-week history of jaundice",
"nausea",
"recalls eating",
"seafood",
"weekend",
"lives at home",
"her 2 year old son",
"attends",
"daycare center",
"child",
"mmunizations ",
"ate.",
"oman'",
"mperature i",
".5",
"lse i",
"n, ",
"ood pre... |
A 45-year-old male immigrant with rheumatoid arthritis comes to the physician because of severe pain and swelling in both his knees. He also reports an unintentional weight loss of around 10 kg over 3 months and episodic abdominal pain, varying in intensity and location. He has been having loose stools with no blood, 2... | PAS-positive macrophages | {
"A": "Poorly differentiated cells",
"B": "Granuloma with caseating necrosis",
"C": "Villous atrophy and crypt hyperplasia",
"D": "PAS-positive macrophages"
} | step2&3 | D | [
"year old male immigrant",
"rheumatoid arthritis",
"physician",
"severe pain",
"swelling",
"knees",
"reports",
"unintentional weight loss",
"10 kg",
"3 months",
"episodic abdominal pain",
"intensity",
"location",
"loose stools",
"blood",
"23 times",
"day",
"1 month",
"denies feve... |
A 65-year-old man presents to the emergency department for shortness of breath. He was at home working on his car when he suddenly felt very short of breath, which failed to improve with rest. He states he was working with various chemicals and inhalants while trying to replace a broken piece in the engine. The patient... | Rupture of an emphysematous bleb | {
"A": "Fe3+ hemoglobin in circulating red blood cells",
"B": "Pulmonary edema secondary to decreased cardiac output",
"C": "Rupture of an emphysematous bleb",
"D": "Severe bronchoconstriction"
} | step2&3 | C | [
"65 year old man presents",
"emergency department",
"shortness of breath",
"at",
"car",
"felt very short of breath",
"failed to",
"rest",
"states",
"working",
"various chemicals",
"inhalants",
"to replace",
"piece",
"patient",
"brought",
"paramedics",
"currently",
"100",
"O2",
... |
A 38-year-old man presents to the emergency department due to severe alcohol intoxication. The patient is agitated and refuses to answer any questions in regards to his medical history. The vital signs are within normal limits. The complete blood count results demonstrate hemoglobin of 11.5 g/dL, hematocrit of 39%, and... | Ferritin: ↑, total iron-binding capacity: ↓, serum iron: ↑ | {
"A": "Ferritin: ↓, total iron-binding capacity: ↓, serum iron: ↓",
"B": "Ferritin: normal, total iron binding capacity: normal, serum iron: normal",
"C": "Ferritin: ↑, total iron-binding capacity: ↓, serum iron: ↑",
"D": "Ferritin: ↑, total iron-binding capacity: ↓, serum iron: ↓"
} | step1 | C | [
"year old man presents",
"emergency department",
"severe alcohol intoxication",
"patient",
"agitated",
"refuses to answer",
"questions",
"medical history",
"vital signs",
"normal limits",
"complete blood count results",
"hemoglobin",
"g",
"hematocrit",
"mean corpuscular volume",
"m3",
... |
A 5-year-old boy is brought to see his pediatrician because of painless swelling in both legs and around his eyes. His mother reports that it is worse in the morning and these symptoms have started 4 days ago. The child has just recovered from a severe upper respiratory tract infection 8 days ago. The boy was born at 3... | Prednisolone | {
"A": "Albumin infusion",
"B": "Enalapril",
"C": "Prednisolone and cyclophosphamide",
"D": "Prednisolone"
} | step2&3 | D | [
"5 year old boy",
"brought to see",
"pediatrician",
"painless swelling",
"legs",
"eyes",
"mother reports",
"worse",
"morning",
"symptoms",
"started 4 days",
"child",
"recovered",
"severe upper respiratory tract infection",
"days",
"boy",
"born",
"weeks gestation",
"spontaneous va... |
A 56-year-old man is brought to the Emergency Department with intense chest pain that radiates to his left arm and jaw. He also complains of feeling lightheaded. Upon arrival, his blood pressure is 104/60 mm Hg, pulse is 102/min, respiratory rate is 25/min, body temperature is 36.5°C (97.7°F), and oxygen saturation is ... | Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) < 15:1 | {
"A": "Urinary osmolality 900 mOsmol/kg (normal: 500–800 mOsmol/kg)",
"B": "Urinary osmolality 550 mOsmol/kg (normal: 500–800 mOsmol/kg)",
"C": "Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) > 20:1",
"D": "Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) < 15:1"
} | step2&3 | D | [
"year old man",
"brought",
"Emergency Department",
"intense chest pain",
"radiates",
"left arm",
"jaw",
"feeling lightheaded",
"arrival",
"blood pressure",
"60 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"body temperature",
"36",
"97",
"oxygen saturation",
"room air",
... |
A previously-healthy 24-year-old male is admitted to the intensive care unit following a motorcycle crash. He sustained head trauma requiring an emergency craniotomy, has burns over 30% of his body, and a fractured humerus. His pain is managed with a continuous fentanyl infusion. Two days after admission to the ICU he ... | Answers 1 and 2 | {
"A": "Gastric mucosal disruption",
"B": "Increased gastric acid production",
"C": "Answers 1 and 2",
"D": "Fentanyl overuse"
} | step1 | C | [
"healthy",
"year old male",
"admitted to",
"intensive care unit following",
"motorcycle",
"sustained head trauma",
"emergency craniotomy",
"burns",
"30",
"body",
"fractured humerus",
"pain",
"managed",
"continuous fentanyl infusion",
"Two days",
"admission",
"ICU",
"severe hemateme... |
An 18-year-old man presents with a sudden loss of consciousness while playing college football. There was no history of a concussion. Echocardiography shows left ventricular hypertrophy and increased thickness of the interventricular septum. Which is the most likely pathology underlying the present condition? | Mutation in the myosin heavy chain | {
"A": "Mutation in the myosin heavy chain",
"B": "Drug abuse",
"C": "Viral infection",
"D": "Autoimmunity of myocardial fibers"
} | step1 | A | [
"year old man presents",
"sudden loss of consciousness",
"playing college football",
"history",
"concussion",
"Echocardiography shows left ventricular hypertrophy",
"increased thickness",
"interventricular septum",
"most likely pathology",
"present condition"
] |
A 69-year-old man is brought to the emergency department because of severe abdominal pain radiating to his left flank for 30 minutes. He is weak and has been unable to stand since the onset of the pain. He vomited twice on the way to the hospital. He has not passed stools for 3 days. He has hypertension, coronary heart... | Open emergency surgery | {
"A": "Supine and erect x-rays of the abdomen",
"B": "Open emergency surgery",
"C": "Transfusion of packed red blood cells",
"D": "Colonoscopy"
} | step2&3 | B | [
"69 year old man",
"brought",
"emergency department",
"severe abdominal pain radiating to",
"left flank",
"30 minutes",
"weak",
"unable to stand",
"onset",
"pain",
"vomited twice",
"hospital",
"not passed stools",
"3 days",
"hypertension",
"coronary heart disease",
"peptic ulcer dise... |
A 35-year-old man comes to the emergency department with fever, chills, dyspnea, and a productive cough. His symptoms began suddenly 2 days ago. He was diagnosed with HIV 4 years ago and has been on triple antiretroviral therapy since then. He smokes one pack of cigarettes daily. He is 181 cm (5 ft 11 in) tall and weig... | Streptococcus pneumoniae | {
"A": "Staphylococcus aureus",
"B": "Cryptococcus neoformans",
"C": "Streptococcus pneumoniae",
"D": "Pneumocystis jirovecii"
} | step2&3 | C | [
"35 year old man",
"emergency department",
"fever",
"chills",
"dyspnea",
"productive cough",
"symptoms began",
"days",
"diagnosed",
"HIV",
"years",
"triple antiretroviral therapy",
"then",
"smokes one pack",
"cigarettes daily",
"5 ft",
"tall",
"70 kg",
"BMI",
"kg/m2",
"lives"... |
A 5-month-old boy is brought to his pediatrician because his parents have noticed that he has very restricted joint movement. He was born at home without prenatal care, but they say that he appeared healthy at birth. Since then, they say that he doesn't seem to move very much and is hard to arouse. Physical exam reveal... | Mannose-6-phosphate | {
"A": "Glucocerebroside",
"B": "GM3",
"C": "Heparin sulfate",
"D": "Mannose-6-phosphate"
} | step1 | D | [
"5 month old boy",
"brought",
"pediatrician",
"parents",
"very restricted joint movement",
"born at home",
"prenatal care",
"appeared healthy",
"birth",
"Since then",
"to move very much",
"hard",
"Physical exam reveals coarse facial structures",
"hepatosplenomegaly",
"Radiography reveals... |
A 32-year-old man comes to the physician for a 1-month history of fever, chest pain with deep breathing, and a 4-kg (9 lb) weight loss. His temperature is 38°C (100.4°F). An x-ray of the chest shows a subpleural nodule in the right lower lobe with right hilar lymphadenopathy. Histological examination of a right hilar l... | Primary tuberculosis | {
"A": "Hodgkin lymphoma",
"B": "Primary tuberculosis",
"C": "Miliary tuberculosis",
"D": "Pulmonary sarcoidosis"
} | step1 | B | [
"year old man",
"physician",
"month history",
"fever",
"chest pain",
"deep breathing",
"4 kg",
"weight loss",
"temperature",
"100 4F",
"x-ray of",
"chest shows",
"nodule",
"right lower lobe",
"right hilar lymphadenopathy",
"Histological examination of",
"lymph node biopsy specimen sh... |
A 56-year-old man presents with breathlessness and altered mental status. The patient’s daughter says that he has been having high fever and cough for the last 3 days. Past medical history is significant for a recent hospitalization 5 days ago, following a successful coronary artery bypass grafting (CABG). In the post-... | Synergism of aztreonam with tobramycin | {
"A": "Broad-spectrum coverage against gram-positive cocci by adding tobramycin to aztreonam",
"B": "Effective combination of a bactericidal and a bacteriostatic antimicrobial against Pseudomonas aeruginosa",
"C": "Synergism of aztreonam with tobramycin",
"D": "Broad-spectrum coverage against anaerobes by addi... | step1 | C | [
"year old man presents",
"breathlessness",
"altered mental status",
"patients daughter",
"high fever",
"cough",
"3 days",
"Past medical history",
"significant",
"recent hospitalization 5 days",
"following",
"successful coronary artery bypass grafting",
"post-operative period",
"intensive c... |
A 9-year-old girl is brought to the emergency department with a headache and double vision 1 hour after being hit on the head while playing with a friend. Her friend's elbow struck her head, just above her left ear. She did not lose consciousness, but her mother reports that she was confused for 20 minutes after the in... | Trochlear nerve damage | {
"A": "Oculomotor nerve damage",
"B": "Retrobulbar hemorrhage",
"C": "Trochlear nerve damage",
"D": "Dorsal midbrain damage"
} | step2&3 | C | [
"year old girl",
"brought",
"emergency department",
"headache",
"double vision",
"hour",
"hit",
"head",
"playing",
"friend",
"friend's elbow struck",
"head",
"left ear",
"not",
"consciousness",
"mother reports",
"confused",
"20 minutes",
"incident",
"not recall",
"hit",
"ap... |
An 8-year-old girl is brought to the emergency department by her parents with severe difficulty in breathing for an hour. She is struggling to breathe. She was playing outside with her friends, when she suddenly fell to the ground, out of breath. She was diagnosed with asthma one year before and has since been on treat... | Mechanical ventilation | {
"A": "Methacholine challenge test",
"B": "Inhaled corticosteroid",
"C": "Intravenous corticosteroid",
"D": "Mechanical ventilation"
} | step2&3 | D | [
"year old girl",
"brought",
"emergency department",
"parents with severe difficulty",
"breathing",
"hour",
"to",
"playing outside",
"friends",
"fell",
"breath",
"diagnosed",
"asthma one year",
"since",
"on treatment",
"present",
"sitting",
"forward",
"severe retractions",
"inte... |
A 12-hour-old newborn is found to have difficulty breathing and bluish skin appearance by the shift nurse. The birth was unremarkable and the mother is known to be diabetic. The child is examined by the on-call physician, who detects a single loud S2. The chest X-ray shows an 'egg-shaped' heart. Which medication below ... | Prostaglandins E2 | {
"A": "Indomethacin",
"B": "Low-dose aspirin",
"C": "Prostaglandins E2",
"D": "Vitamin K"
} | step1 | C | [
"12-hour old newborn",
"found to",
"difficulty breathing",
"skin appearance",
"shift nurse",
"birth",
"unremarkable",
"mother",
"known to",
"diabetic",
"child",
"examined",
"call physician",
"detects",
"single loud S2",
"chest X-ray shows an",
"egg shaped",
"heart",
"medication",... |
A 68-year-old woman was recently diagnosed with pancreatic cancer. At what point should her physician initiate a discussion with her regarding advance directive planning? | At this visit | {
"A": "Now that she is ill, speaking about advanced directives is no longer an option",
"B": "At this visit",
"C": "Once she enters hospice",
"D": "Only if she initiates the conversation"
} | step1 | B | [
"68 year old woman",
"recently diagnosed",
"pancreatic cancer",
"point",
"physician initiate",
"discussion",
"advance directive planning"
] |
A 38-year-old woman comes to the physician for a follow-up visit. She has a 2-year history of depressed mood and fatigue accompanied by early morning awakening. One week ago, she started feeling a decrease in her need for sleep and now feels rested after about 5 hours of sleep per night. She had two similar episodes th... | Cyclothymic disorder
" | {
"A": "Medication-induced bipolar disorder",
"B": "Bipolar disorder with rapid cycling",
"C": "Schizoaffective disorder",
"D": "Cyclothymic disorder\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"follow-up visit",
"2 year history",
"depressed mood",
"fatigue",
"early morning awakening",
"One week",
"started feeling",
"decrease",
"need",
"sleep",
"now feels rested",
"about",
"hours of sleep",
"night",
"two similar episodes",
"occurred",
"mon... |
A 33-year-old man presents to his primary care physician with shoulder pain. He states that he can't remember a specific instance when the injury occurred. He is a weight lifter and competes in martial arts. The patient has no past medical history and is currently taking a multivitamin. Physical exam demonstrates pain ... | MRI | {
"A": "MRI",
"B": "Physical exam and history",
"C": "Radiography",
"D": "Ultrasound"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"shoulder pain",
"states",
"remember",
"specific instance",
"injury occurred",
"weight lifter",
"martial arts",
"patient",
"past medical history",
"currently taking",
"multivitamin",
"Physical exam demonstrates pain",
"abduction",
"pat... |
A 10-year-old boy comes to the physician because of a 4-month history of intermittent red urine. During the past 2 years, he has had recurrent episodes of swelling of his face and feet. Five years ago, he was diagnosed with mild bilateral sensorineural hearing loss. His uncle died of kidney disease in his twenties. His... | Defective type IV collagen | {
"A": "Defective type IV collagen",
"B": "Phospholipase A2 receptor antibody",
"C": "Prior streptococcal infection",
"D": "Vascular IgA deposits"
} | step1 | A | [
"A 10 year old boy",
"physician",
"4 month history",
"intermittent red urine",
"past",
"years",
"recurrent episodes of swelling",
"face",
"feet",
"Five years",
"diagnosed",
"mild bilateral",
"uncle died of kidney disease",
"twenties",
"blood pressure",
"85 mm Hg",
"Laboratory studies... |
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