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 45-year-old man with a history of epilepsy comes to the physician for a follow-up examination. He has had trouble moving the right side of his body for 2 weeks. Three weeks ago he was admitted to the hospital for a generalized convulsive seizure. He was treated with intravenous lorazepam and phenytoin; the seizure ac... | Cortical laminar necrosis | {
"A": "Brain abscess",
"B": "Cortical laminar necrosis",
"C": "Intraventricular hemorrhage",
"D": "Ruptured intracranial aneurysm"
} | step2&3 | B | [
"year old man",
"history of epilepsy",
"physician",
"follow-up examination",
"moving",
"right side of",
"body",
"2 weeks",
"Three",
"admitted",
"hospital",
"generalized convulsive seizure",
"treated with intravenous lorazepam",
"phenytoin",
"seizure activity resolved",
"50 minutes",
... |
A 28-year-old patient presents to the hospital complaining of progressively worsening dyspnea and a dry cough. Radiographic imaging is shown below. Pulmonary function testing (PFT's) reveals a decreased FEV1 and FEV1/FVC, but an increase TLC. The patient states that he does not smoke. Which of the following conditions ... | Alpha1-antitrypsin deficiency | {
"A": "Chronic bronchitis",
"B": "Alpha1-antitrypsin deficiency",
"C": "Pneumothorax",
"D": "Asthma"
} | step1 | B | [
"year old patient presents",
"hospital",
"worsening dyspnea",
"dry cough",
"Radiographic imaging",
"shown",
"Pulmonary function testing",
"PFT's",
"reveals",
"decreased FEV1",
"FEV1/FVC",
"increase",
"patient states",
"not smoke",
"following conditions",
"most consistent with",
"pati... |
A 25-year-old man presents to the clinic with a complaint of lightheadedness when standing up from his bed in the morning and then from his chair at work. He has had similar complaints for many months, and the symptoms have not improved despite drinking lots of fluids, eating regular meals, and taking daily multivitami... | Alpha 1 receptor activation | {
"A": "Alpha 1 receptor activation",
"B": "Carotid massage",
"C": "Increased parasympathetic stimulation",
"D": "Inhibition of the baroreceptor response"
} | step1 | A | [
"year old man presents",
"clinic",
"complaint",
"lightheadedness",
"standing up",
"bed",
"morning",
"then",
"chair",
"work",
"similar complaints",
"months",
"symptoms",
"not improved",
"drinking lots",
"fluids",
"eating regular meals",
"taking daily multivitamin",
"daily routine"... |
A 6-year-old girl is brought to the clinic for evaluation of malaise and low-grade fever over the past 3 days. In the last 24 hours, she developed sores and pain in her mouth. She also had vesicles on her hands and feet. Her past medical history was benign and the immunization history was up-to-date. The oral temperatu... | Supportive care | {
"A": "Supportive care",
"B": "Aspirin",
"C": "Corticosteroids",
"D": "Penicillin"
} | step1 | A | [
"year old girl",
"brought",
"clinic",
"evaluation",
"malaise",
"low-grade fever",
"past 3 days",
"last 24 hours",
"sores",
"pain",
"mouth",
"vesicles",
"hands",
"feet",
"past medical history",
"benign",
"immunization history",
"date",
"oral temperature",
"36",
"97",
"physic... |
A 37-year-old woman presents with a 3-day history of fever. Past medical history is significant for chronic schizophrenia, managed with an antipsychotic medication. The patient has a low-grade fever and is slightly tachycardic. Physical examination is significant for the presence of tonsillar exudates. A CBC shows a ma... | Clozapine | {
"A": "Quetiapine",
"B": "Risperidone",
"C": "Clozapine",
"D": "Haloperidol"
} | step1 | C | [
"year old woman presents",
"3-day history fever",
"Past medical",
"significant",
"chronic schizophrenia",
"managed",
"antipsychotic medication",
"patient",
"low-grade fever",
"slightly tachycardic",
"Physical examination",
"significant",
"presence",
"tonsillar exudates",
"CBC shows",
"... |
A 61-year-old man is brought to the emergency department because of increasing weakness of his right arm and leg that began when he woke up that morning. He did not notice any weakness when he went to bed the night before. He has hypertension and hypercholesterolemia. Current medications include hydrochlorothiazide and... | Posterior limb of the left internal capsule | {
"A": "Posterior limb of the left internal capsule",
"B": "Base of the left pons",
"C": "Left lateral medulla",
"D": "Left cerebellar vermis\n\""
} | step2&3 | A | [
"61 year old man",
"brought",
"emergency department",
"of increasing weakness",
"right arm",
"leg",
"began",
"woke up",
"morning",
"not",
"weakness",
"bed",
"night",
"hypertension",
"hypercholesterolemia",
"Current medications include hydrochlorothiazide",
"atorvastatin",
"alert",
... |
A 65-year-old woman comes to the physician because of a 1-month history of persistent epigastric abdominal pain. She reports dull, aching pain that is worse after meals and wakes her up at night. She is afraid to eat, as it worsens the pain, and has had a 2-kg (4.4-lb) weight loss during this time. She has smoked a pac... | Contrast-enhanced abdominal CT | {
"A": "Colonoscopy",
"B": "Contrast-enhanced abdominal CT",
"C": "Endoscopic ultrasonography",
"D": "Endoscopic retrograde cholangiopancreatography"
} | step2&3 | B | [
"65 year old woman",
"physician",
"month history",
"persistent epigastric abdominal pain",
"reports dull",
"aching pain",
"worse",
"meals",
"wakes",
"night",
"afraid to eat",
"worsens",
"pain",
"2 kg",
"4.4",
"weight loss",
"time",
"smoked",
"pack",
"cigarettes daily",
"past ... |
A 73-year-old male presents to the ED with several days of fevers, cough productive of mucopurulent sputum, and pleuritic chest pain. He has not been to a doctor in 30 years because he “has never been sick”. His vital signs are: T 101F, HR 98, BP 100/55, RR 31. On physical exam he is confused and has decreased breath s... | IV Penicillin G and inpatient admission | {
"A": "Oral Penicillin V and outpatient follow-up",
"B": "IV Penicillin G and inpatient admission",
"C": "Azithromycin and outpatient follow-up",
"D": "Levofloxacin and outpatient follow-up"
} | step2&3 | B | [
"year old male presents",
"ED",
"several days",
"fevers",
"cough productive",
"mucopurulent",
"pleuritic chest pain",
"not",
"doctor",
"30 years",
"never",
"sick",
"vital signs",
"T",
"98",
"BP 100 55",
"RR 31",
"physical exam",
"confused",
"decreased breath sounds",
"crackle... |
A 48-year-old male accountant presents to the family practice clinic for his first health check-up in years. He has no complaints, and as far as he is concerned, he is well. He does not have any known medical conditions. With respect to the family history, the patient reports that his wife's brother died of a heart att... | Return to the clinic for a repeat blood pressure reading and counseling on the importance of aerobic exercise. | {
"A": "Return to the clinic for a repeat blood pressure reading and counseling on the importance of aerobic exercise.",
"B": "Try angiotensin-converting enzyme inhibitor.",
"C": "Treat the patient with beta-blockers.",
"D": "The patient does not require any treatment."
} | step2&3 | A | [
"48 year old male accountant presents",
"family practice clinic",
"first health check-up",
"years",
"complaints",
"as far",
"concerned",
"well",
"not",
"known medical conditions",
"family history",
"patient reports",
"wife's brother died",
"heart attack",
"35 years",
"age",
"blood pr... |
A 24-year-old man, an information technology professional, gets himself tested for serum immunoglobulin M (IgM) levels because he wants to know more about his immunity. He knows that IgM levels reflect the status of his immunity, based on the internet. Although the laboratory report is normal, he consults a physician. ... | B-1 B cells | {
"A": "B-1 B cells",
"B": "Follicular B cells",
"C": "Memory B cells",
"D": "Naïve B cells"
} | step1 | A | [
"year old man",
"information technology professional",
"gets",
"tested",
"serum immunoglobulin M",
"levels",
"to",
"more",
"immunity",
"IgM levels reflect",
"status",
"immunity",
"based",
"internet",
"laboratory report",
"normal",
"consults",
"physician",
"physician discusses hum... |
A 37-year-old man presents to his gastroenterologist due to a transaminitis found by his primary care physician (PCP). He reports currently feeling well and has no acute concerns. Medical history is significant for ulcerative colitis treated with 5-aminosalicylate. He recently went on a trip to Mexico and experienced a... | Primary sclerosing cholangitis | {
"A": "Acute cholecystitis",
"B": "Choledocholithiasis",
"C": "Primary biliary cirrhosis",
"D": "Primary sclerosing cholangitis"
} | step1 | D | [
"year old man presents",
"gastroenterologist",
"transaminitis found",
"primary care physician",
"PCP",
"reports currently feeling well",
"acute concerns",
"Medical history",
"significant",
"ulcerative colitis treated with",
"aminosalicylate",
"recently",
"trip",
"Mexico",
"experienced",
... |
A 33-year-old man comes to the emergency department because of a pounding headache for the past 3 hours. The pain is 8 out of 10 in intensity, does not radiate, and is not relieved by ibuprofen. He also has associated dizziness, blurring of vision, and palpitations. He has had similar episodes over the last 6 months bu... | Adrenal medullary mass | {
"A": "Paravertebral mass",
"B": "Meningeal mass",
"C": "Adrenal medullary mass",
"D": "Intracranial hemorrhage"
} | step2&3 | C | [
"year old man",
"emergency department",
"of",
"pounding headache",
"past",
"hours",
"pain",
"8 out",
"10",
"intensity",
"not radiate",
"not relieved by ibuprofen",
"associated dizziness",
"blurring of vision",
"palpitations",
"similar episodes",
"months",
"severe",
"not",
"feve... |
A 65-year-old male with multiple comorbidities presents to your office complaining of difficulty falling asleep. Specifically, he says he has been having trouble breathing while lying flat very shortly after going to bed. He notes it only gets better when he adds several pillows, but that sitting up straight is an unco... | Left-sided heart failure | {
"A": "Obstructive sleep apnea",
"B": "Myasthenia gravis",
"C": "Right-sided heart failure",
"D": "Left-sided heart failure"
} | step1 | D | [
"65-year-old male",
"multiple comorbidities presents",
"office",
"difficulty falling asleep",
"trouble breathing",
"lying flat very",
"bed",
"notes",
"only gets better",
"adds several pillows",
"sitting",
"straight",
"position",
"to fall asleep",
"most likely etiology",
"man's sleeping... |
A previously healthy 2-month-old girl is brought to the emergency department because her lips turned blue while passing stools 30 minutes ago. She is at the 40th percentile for length and below the 35th percentile for weight. Pulse oximetry on room air shows an oxygen saturation of 65%, which increases to 76% on admini... | Knee to chest positioning | {
"A": "Elevation of the lower extremities",
"B": "Administration of indomethacin",
"C": "Hyperextension of the neck",
"D": "Knee to chest positioning"
} | step1 | D | [
"healthy",
"month old girl",
"brought",
"emergency department",
"lips turned blue",
"stools 30 minutes",
"percentile",
"length",
"percentile",
"weight",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"65",
"increases",
"76",
"administration",
"100",
"oxygen",
"Physica... |
A newborn male is evaluated in the hospital nursery two hours after birth. The patient was born at 39 weeks of gestation to a 30-year-old primigravid via vaginal delivery. The patient’s mother received routine prenatal care, and the pregnancy was uncomplicated. The patient’s anatomy ultrasound at 20 weeks of gestation ... | 5p | {
"A": "4p",
"B": "5p",
"C": "5q",
"D": "15q"
} | step2&3 | B | [
"newborn male",
"evaluated",
"hospital nursery two hours after birth",
"patient",
"born",
"weeks of gestation",
"30 year old primigravid",
"vaginal delivery",
"patients mother received routine prenatal care",
"pregnancy",
"uncomplicated",
"patients anatomy ultrasound",
"20 weeks of gestation... |
A 44-year-old male presents to his primary care physician with complaints of fatigue, muscle weakness, cramps, and increased urination over the past several weeks. His past medical history is significant only for hypertension, for which he was started on hydrochlorothiazide (HCTZ) 4 weeks ago. Vital signs at today's vi... | Hyperaldosteronism | {
"A": "Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)",
"B": "Pituitary adenoma",
"C": "Hyperaldosteronism",
"D": "Cushing's disease"
} | step2&3 | C | [
"year old male presents",
"primary care physician",
"complaints",
"fatigue",
"muscle weakness",
"cramps",
"increased urination",
"past",
"weeks",
"past medical history",
"significant only",
"hypertension",
"started",
"hydrochlorothiazide",
"weeks",
"Vital signs",
"today's visit",
"... |
A 50-year-old man presents the emergency department for intense chest pain, profuse sweating, and shortness of breath. The onset of these symptoms was 3 hours ago. The chest pain began after a heated discussion with a colleague at the community college where he is employed. Upon arrival, he is found conscious and respo... | Subendocardial necrosis | {
"A": "Ventricular pseudoaneurysm",
"B": "Subendocardial necrosis",
"C": "Incomplete occlusion of a coronary artery",
"D": "Coronary artery spasm"
} | step1 | B | [
"50 year old man presents",
"emergency department",
"intense chest pain",
"profuse sweating",
"shortness of breath",
"onset",
"symptoms",
"3 hours",
"chest pain began",
"heated discussion",
"community college",
"employed",
"arrival",
"found conscious",
"responsive",
"vital signs includ... |
The patient is admitted to the hospital. A stereotactic brain biopsy of the suspicious lesion is performed that shows many large lymphocytes with irregular nuclei. Which of the following is the most appropriate treatment? | Methotrexate | {
"A": "Intrathecal glucocorticoids",
"B": "Temozolomide",
"C": "Methotrexate",
"D": "Surgical resection"
} | step2&3 | C | [
"patient",
"admitted",
"hospital",
"stereotactic brain biopsy of",
"suspicious lesion",
"performed",
"shows",
"large lymphocytes",
"irregular nuclei",
"following",
"most appropriate treatment"
] |
You are counseling a mother whose newborn has just screened positive for a deficit of phenylalanine hydroxylase enzyme. You inform her that her child will require dietary supplementation of which of the following? | Tyrosine | {
"A": "Leucine",
"B": "Aspartame",
"C": "Tyrosine",
"D": "Niacin"
} | step1 | C | [
"counseling",
"mother",
"newborn",
"screened positive",
"deficit",
"phenylalanine hydroxylase enzyme",
"inform",
"child",
"dietary supplementation"
] |
A 35-year-old male is brought to the physician by his wife who is concerned because he has begun to demonstrate odd behavior which has worsened over the past several months. She states that he has become very aggressive and at times will have sudden, jerky movements which he is unable to control. The patient states tha... | It demonstrates anticipation | {
"A": "A mutation in ATP7B on chromosome 13 is responsible",
"B": "Erythema marginatum is a complication associated with this disease",
"C": "Overactivity of dopamine in the mesolimbic pathway is the underlying pathology",
"D": "It demonstrates anticipation"
} | step1 | D | [
"35 year old male",
"brought",
"physician",
"wife",
"concerned",
"begun to",
"odd behavior",
"worsened",
"past",
"months",
"states",
"very aggressive",
"times",
"sudden",
"jerky movements",
"unable to control",
"patient states",
"father",
"same problem",
"died",
"age 69",
"... |
A 20-year-old male with no significant medical history comes to you with a urine positive for fructose. He does not have diabetes mellitus. Which enzyme is most likely to be deficient in this patient? | Fructokinase | {
"A": "Aldolase B",
"B": "Fructokinase",
"C": "Pyruvate kinase",
"D": "Lactase"
} | step1 | B | [
"20 year old male",
"significant medical history",
"urine positive",
"fructose",
"not",
"diabetes mellitus",
"enzyme",
"most likely to",
"deficient",
"patient"
] |
A 21-year-old male presents after several days of flatulence and greasy, foul-smelling diarrhea. The patient reports symptoms of nausea and abdominal cramps followed by sudden diarrhea. He says that his symptoms started after he came back from a camping trip. When asked about his camping activities, he reports that his... | Metronidazole | {
"A": "Ciprofloxacin",
"B": "Metronidazole",
"C": "Vancomycin",
"D": "Cephalexin"
} | step2&3 | B | [
"21-year-old male presents",
"days",
"flatulence",
"greasy",
"smelling diarrhea",
"patient reports symptoms",
"nausea",
"abdominal cramps followed by sudden diarrhea",
"symptoms started",
"back",
"camping trip",
"camping activities",
"reports",
"friend collected water",
"stream",
"not ... |
A 72-year-old man comes to the physician for a 5-month history of hoarseness, exertional dyspnea, and fatigue. He does not smoke or drink alcohol. His pulse is 98/min and irregular. His voice is coarse in quality. Physical examination shows a liver span of 16 cm and a soft diastolic murmur heard best at the apex. Which... | Extrinsic impingement of the recurrent laryngeal nerve | {
"A": "Extrinsic impingement of the recurrent laryngeal nerve",
"B": "Bacterial infection of the vocal folds",
"C": "Laryngeal inflammation due to chemical irritant",
"D": "Circulating acetylcholine receptor antibodies\n\""
} | step1 | A | [
"72 year old man",
"physician",
"5 month history",
"hoarseness",
"exertional dyspnea",
"fatigue",
"not smoke",
"drink alcohol",
"pulse",
"98 min",
"irregular",
"voice",
"coarse",
"quality",
"Physical examination shows",
"liver span",
"soft diastolic murmur heard best",
"apex",
"f... |
A 2-year-old girl is brought to the physician by her mother for a well-child examination. Cardiac auscultation is shown. When she clenches her fist forcefully for a sustained time, the intensity of the murmur increases. Which of the following is the most likely cause of this patient's auscultation findings? | Defect in the ventricular septum | {
"A": "Fusion of the right and left coronary leaflets",
"B": "Defect in the atrial septum",
"C": "Defect in the ventricular septum",
"D": "Failure of the ductus arteriosus to close"
} | step2&3 | C | [
"2 year old girl",
"brought",
"physician",
"mother",
"well",
"Cardiac",
"shown",
"fist",
"sustained time",
"intensity",
"murmur increases",
"following",
"most likely cause",
"patient's auscultation findings"
] |
A 36-year-old woman comes to the physician because she has not had her menstrual period for the past 4 months. During this period, she has had frequent headaches, difficulty sleeping, and increased sweating. She has not had any weight changes. Over the past year, menses occurred at irregular 30- to 45-day intervals wit... | Premature ovarian failure | {
"A": "Primary hypothyroidism",
"B": "Pregnancy",
"C": "Premature ovarian failure",
"D": "Polycystic ovary syndrome"
} | step2&3 | C | [
"36 year old woman",
"physician",
"not",
"menstrual period",
"past",
"months",
"period",
"frequent headaches",
"difficulty sleeping",
"increased sweating",
"not",
"weight changes",
"past year",
"menses occurred",
"irregular 30",
"day intervals",
"light flow",
"patient",
"two succ... |
A 63-year-old man comes to the physician for blurry vision and increased difficulty walking over the past month. He feels very fatigued after watering his garden but feels better after taking a nap. He has not had any recent illness. He has smoked one pack of cigarettes daily for 35 years. Examination shows drooping of... | Inhibition of acetylcholinesterase | {
"A": "Inhibition of muscarinic ACh receptor",
"B": "Regeneration of acetylcholinesterase",
"C": "Stimulation of D2 receptors",
"D": "Inhibition of acetylcholinesterase"
} | step1 | D | [
"63 year old man",
"physician",
"blurry vision",
"increased difficulty walking",
"past month",
"feels very fatigued",
"watering",
"garden",
"feels better",
"nap",
"not",
"recent illness",
"smoked one pack",
"cigarettes daily",
"35 years",
"Examination shows drooping",
"upper eyelids"... |
An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation.... | ICAM-1 | {
"A": "P antigen",
"B": "CD21",
"C": "ICAM-1",
"D": "Sialic acid residues"
} | step1 | C | [
"year old woman",
"brought",
"physician",
"daughter",
"3-day history",
"runny nose",
"headache",
"cough",
"patient's grandson recently",
"similar symptoms",
"vital signs",
"normal limits",
"Pulse oximetry",
"room air shows",
"oxygen",
"99",
"Lungs",
"clear",
"auscultation",
"Te... |
A 31-year-old man presents to the Emergency Department with severe left leg pain and paresthesias 4 hours after his leg got trapped by the closing door of a bus. Initially, he had a mild pain which gradually increased to unbearable levels. Past medical history is noncontributory. In the Emergency Department, his blood ... | Fasciotomy | {
"A": "Lower limb X-ray in two projections",
"B": "Lower limb ultrasound",
"C": "Splinting and limb rest",
"D": "Fasciotomy"
} | step2&3 | D | [
"31 year old man presents",
"Emergency Department",
"severe left leg pain",
"paresthesias",
"hours",
"leg",
"trapped",
"closing door",
"bus",
"Initially",
"mild pain",
"increased",
"levels",
"Past medical history",
"Emergency Department",
"blood pressure",
"80 mm Hg",
"heart rate",... |
A 27-year-old G2P0A2 woman comes to the office complaining of light vaginal spotting. She received a suction curettage 2 weeks ago for an empty gestational sac. Pathology reports showed hyperplastic and hydropic trophoblastic villi, but no fetal tissue. The patient denies fever, abdominal pain, dysuria, dyspareunia, or... | Theca lutein cysts | {
"A": "Corpus luteal cysts",
"B": "Ectopic pregnancy",
"C": "Endometrioma",
"D": "Theca lutein cysts"
} | step2&3 | D | [
"27 year old",
"woman",
"office",
"light vaginal",
"received",
"suction curettage 2 weeks",
"empty gestational sac",
"Pathology reports showed hyperplastic",
"hydropic trophoblastic villi",
"fetal tissue",
"patient denies fever",
"abdominal pain",
"dysuria",
"dyspareunia",
"abnormal vagi... |
A 78-year-old man is brought to the emergency department because of difficulty speaking. The symptoms began abruptly one hour ago while he was having breakfast with his wife. He has hypertension, type 2 diabetes mellitus, and coronary artery disease. Current medications include pravastatin, lisinopril, metformin, and a... | Occlusion of the left middle cerebral artery | {
"A": "Occlusion of the right penetrating arteries",
"B": "Occlusion of the left middle cerebral artery",
"C": "Occlusion of the right posterior inferior cerebellar artery",
"D": "Rupture of left posterior cerebral artery malformation"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"difficulty speaking",
"symptoms began",
"one hour",
"breakfast",
"wife",
"hypertension",
"type 2 diabetes mellitus",
"coronary artery disease",
"Current medications include pravastatin",
"lisinopril",
"metformin",
"aspirin",
"temperat... |
A 24-year-old man presents for an annual check-up. He is a bodybuilder and tells you he is on a protein-rich diet that only allows for minimal carbohydrate intake. His friend suggests he try exogenous glucagon to help him lose some excess weight before an upcoming competition. Which of the following effects of glucagon... | Increased lipolysis in adipose tissues | {
"A": "Increased hepatic gluconeogenesis",
"B": "Increased glucose utilization by tissues",
"C": "Decreased blood cholesterol level",
"D": "Increased lipolysis in adipose tissues"
} | step1 | D | [
"year old man presents",
"annual check-up",
"a protein rich diet",
"only allows",
"minimal carbohydrate intake",
"friend suggests",
"exogenous glucagon to help",
"excess weight",
"competition",
"following effects",
"glucagon",
"attempting"
] |
An 18-month-old boy presents to the emergency department for malaise. The boy’s parents report worsening fatigue for 3 days with associated irritability and anorexia. The patient’s newborn screening revealed a point mutation in the beta-globin gene but the patient has otherwise been healthy since birth. On physical exa... | Streptococcus pneumoniae | {
"A": "Haemophilus influenzae",
"B": "Neisseria meningitidis",
"C": "Salmonella",
"D": "Streptococcus pneumoniae"
} | step2&3 | D | [
"month old boy presents",
"emergency department",
"malaise",
"boys parents report worsening fatigue",
"3 days",
"associated irritability",
"anorexia",
"patients newborn screening revealed a point mutation",
"beta-globin gene",
"patient",
"healthy",
"birth",
"physical exam",
"temperature",
... |
A 2-day-old newborn boy has failed to pass meconium after 48 hours. There is an absence of stool in the rectal vault. Family history is significant for MEN2A syndrome. Which of the following confirms the diagnosis? | Absence of ganglion cells demonstrated by rectal suction biopsy | {
"A": "Absence of ganglion cells demonstrated by rectal suction biopsy",
"B": "Atrophic nerve fibers and decreased acetylcholinesterase activity",
"C": "Barium enema demonstrating absence of a transition zone",
"D": "Rectal manometry demonstrating relaxation of the internal anal sphincter with distension of th... | step2&3 | A | [
"2-day old newborn boy",
"failed to pass meconium",
"48 hours",
"absence",
"stool",
"rectal vault",
"Family history",
"significant",
"MEN2A syndrome",
"following confirms",
"diagnosis"
] |
A 50-year-old man presents to the emergency department with pain and swelling of his right leg for the past 2 days. Three days ago he collapsed on his leg after tripping on a rug. It was a hard fall and left him with bruising of his leg. Since then the pain and swelling of his leg have been gradually increasing. Past m... | Perform a venous ultrasound | {
"A": "Make a diagnosis of deep vein thrombosis based on history and physical",
"B": "Perform a venous ultrasound",
"C": "Start intravenous heparin therapy immediately",
"D": "Perform intravenous venography within 24 hours"
} | step1 | B | [
"50 year old man presents",
"emergency department",
"pain",
"swelling of",
"right leg",
"past 2 days",
"Three",
"collapsed",
"leg",
"tripping",
"rug",
"hard fall",
"left",
"bruising",
"leg",
"then",
"pain",
"swelling of",
"leg",
"increasing",
"Past medical history",
"lives"... |
A 60-year-old man comes to the clinic complaining of a persistent cough for the last few months. His cough started gradually about a year ago, and it became more severe and persistent despite all his attempts to alleviate it. During the past year, he also noticed some weight loss and a decrease in his appetite. He also... | Phrenic nerve | {
"A": "Intercostal nerves",
"B": "Phrenic nerve",
"C": "Pulmonary plexus",
"D": "Thoracic spinal nerves"
} | step1 | B | [
"60 year old man",
"clinic complaining of",
"persistent cough",
"last",
"months",
"cough started",
"year",
"more severe",
"persistent",
"attempts to",
"past year",
"weight loss",
"decrease in",
"appetite",
"of progressive shortness",
"breath",
"40 pack-year smoking history",
"Physi... |
A 25-year-old woman comes to the emergency department one hour after the sudden onset of diffuse abdominal pain and nausea. She has no history of serious illness. Menses occur at regular 27-day intervals and last 4 to 6 days with moderate flow. Her last menstrual period was 6 weeks ago. She is sexually active with two ... | Administer intravenous normal saline fluids | {
"A": "Administer intravenous normal saline fluids",
"B": "Perform CT scan of the abdomen and pelvis with contrast",
"C": "Transfuse O negative packed red blood cells",
"D": "Perform pelvic ultrasound"
} | step2&3 | A | [
"year old woman",
"emergency department one hour",
"sudden",
"diffuse abdominal",
"nausea",
"history",
"serious illness",
"Menses occur",
"regular 27 day intervals",
"last 4",
"days",
"moderate flow",
"last menstrual period",
"weeks",
"sexually active",
"two sexual partners",
"uses o... |
An otherwise healthy 15-year-old girl is brought to the physician for evaluation of severe acne that involves her face, chest, and back. It has not improved with her current combination therapy of oral cephalexin and topical benzoyl peroxide. She is sexually active with one male partner, and they use condoms consistent... | Perform quantitative beta-hCG assay | {
"A": "Perform quantitative beta-hCG assay",
"B": "Switch cephalexin to doxycycline",
"C": "Evaluate color vision",
"D": "Measure serum DHEA-S and testosterone levels"
} | step1 | A | [
"healthy",
"year old girl",
"brought",
"physician",
"evaluation",
"severe acne",
"face",
"chest",
"back",
"not improved",
"current combination",
"oral cephalexin",
"topical benzoyl peroxide",
"sexually active",
"one male partner",
"use condoms",
"Facial scarring",
"numerous comedon... |
A 76-year-old female is brought to the emergency department after being found unresponsive in her room at her nursing facility. Past medical history is significant for Alzheimer's disease, hypertension, and diabetes. Surgical history is notable for an open cholecystectomy at age 38 and multiple cesarean sections. On ar... | Immediate laparotomy and surgical management | {
"A": "Therapy with levofloxacin and metronidazole",
"B": "Immediate laparotomy and surgical management",
"C": "Pneumatic enema",
"D": "Sigmoidoscopy, attempted derotation and rectal tube placement"
} | step2&3 | B | [
"76 year old female",
"brought",
"emergency department",
"found unresponsive",
"room",
"nursing facility",
"Past medical history",
"significant",
"Alzheimer's disease",
"hypertension",
"diabetes",
"Surgical history",
"notable",
"open cholecystectomy",
"age",
"multiple cesarean sections... |
A 34-year-old woman, gravida 4, para 3, comes to the physician because of left ankle swelling for 2 months. She notes that the swelling is present throughout the day and decreases when she goes to sleep. One year ago, she has had an episode of deep venous thrombosis after the delivery of her third child. Her prepregnan... | Popliteal vein to small saphenous vein | {
"A": "Anterior tibial vein to popliteal vein",
"B": "Popliteal vein to small saphenous vein",
"C": "Great saphenous vein to femoral vein",
"D": "Dorsal venous arch to great saphenous vein"
} | step1 | B | [
"year old woman",
"gravida 4",
"para 3",
"physician",
"of left",
"months",
"notes",
"swelling",
"present",
"day",
"decreases",
"goes to sleep",
"One year ago",
"episode of deep venous thrombosis",
"delivery",
"third child",
"prepregnancy BMI",
"kg/m2",
"Examination shows distende... |
A 55-year-old woman is brought to the physician by her daughter because of progressive memory loss and weakness over the past 6 months. She is now unable to perform activities of daily living and has had several falls in her apartment. She has diarrhea but has not had nausea or vomiting. She was treated for tuberculosi... | Vitamin B3 (niacin) | {
"A": "Vitamin B5 (panthothenic acid)",
"B": "Vitamin B7 (biotin)",
"C": "Vitamin B2 (riboflavin)",
"D": "Vitamin B3 (niacin)"
} | step2&3 | D | [
"55 year old woman",
"brought",
"physician",
"daughter",
"progressive memory loss",
"weakness",
"past 6 months",
"now unable to perform activities of daily living",
"several falls",
"apartment",
"diarrhea",
"not",
"nausea",
"vomiting",
"treated",
"tuberculosis 10 years",
"smoked half... |
A 6-month old child is brought to the ER by parents for one day of fever, decreased feeding, and lethargy. They report that neither she nor her siblings are immunized due to their concerns about vaccinations. On exam, the infant is toxic-appearing. Antibiotics are started and lumbar puncture reveals bacterial meningiti... | Haemophilus influenza | {
"A": "Moraxella catarrhalis",
"B": "Streptococcus pneumoniae",
"C": "Haemophilus influenza",
"D": "Listeria monocytogenes"
} | step1 | C | [
"month old child",
"brought",
"ER",
"parents",
"one day",
"fever",
"decreased feeding",
"lethargy",
"report",
"siblings",
"due to",
"concerns",
"vaccinations",
"exam",
"infant",
"toxic appearing",
"Antibiotics",
"started",
"lumbar puncture reveals bacterial meningitis caused",
... |
Two days after hospital admission, a 32-year-old woman with breast cancer is visited by the attending physician in the presence of medical students. She has limited English proficiency. The attending physician describes the situation to the patient in English, and the patient nods understandably. Subsequently, the atte... | Hiring a qualified medical interpreter in patients’ native languages | {
"A": "Asking a family member who knows English to interpret physician requests",
"B": "Employing medical staff with above-average familiarity with a language other than English",
"C": "Hiring a qualified medical interpreter in patients’ native languages",
"D": "Limiting encounters with such patients to nonedu... | step2&3 | C | [
"Two days",
"hospital admission",
"year old woman",
"breast cancer",
"visited",
"attending physician",
"presence",
"medical students",
"limited English proficiency",
"attending physician",
"patient",
"English",
"patient nods",
"attending physician pulls",
"patients hospital gown",
"bre... |
A 35-year-old G3P2 woman currently 39 weeks pregnant presents to the emergency department with painful vaginal bleeding shortly after a motor vehicle accident in which she was a passenger. She had her seat belt on and reports that the airbag deployed immediately upon her car's impact against a tree. She admits that she... | Placental abruption | {
"A": "Preterm labor",
"B": "Vasa previa",
"C": "Placental abruption",
"D": "Eclampsia"
} | step2&3 | C | [
"35 year old",
"woman currently 39 weeks pregnant presents",
"emergency department",
"painful vaginal bleeding",
"motor vehicle accident",
"passenger",
"seat belt",
"reports",
"airbag deployed immediately",
"car's impact",
"tree",
"admits",
"smokes cigarettes",
"prenatal workup",
"unrema... |
A potassium hydroxide preparation is conducted on a skin scraping of the hypopigmented area. Microscopy of the preparation shows long hyphae among clusters of yeast cells. Based on these findings, which of the following is the most appropriate pharmacotherapy? | Topical selenium sulfide | {
"A": "Oral fluconazole",
"B": "Topical corticosteroid",
"C": "Oral ketoconazole",
"D": "Topical selenium sulfide"
} | step2&3 | D | [
"potassium hydroxide preparation",
"conducted",
"skin scraping of the hypopigmented area",
"Microscopy",
"preparation shows long hyphae",
"clusters",
"yeast cells",
"Based",
"findings",
"following",
"most appropriate pharmacotherapy"
] |
A 26-year-old woman presents to her physician at the 3rd week postpartum with a fever and a swollen breast with redness and tenderness. She has been breastfeeding her infant since birth. The symptoms of the patient started 4 days ago. She has not taken any antibiotics for the past 12 months. She does not have any concu... | Prescribe dicloxacillin and encourage continuing breastfeeding | {
"A": "Prescribe dicloxacillin and encourage continuing breastfeeding",
"B": "Manage with trimethoprim-sulfamethoxazole and encourage continuing breastfeeding",
"C": "Prescribe trimethoprim-sulfamethoxazole and recommend emptying affected breast without feeding",
"D": "Manage with clindamycin and recommend to ... | step2&3 | A | [
"year old woman presents",
"physician",
"3rd week postpartum",
"fever",
"swollen",
"redness",
"tenderness",
"breastfeeding",
"infant",
"birth",
"symptoms",
"patient started 4 days",
"not taken",
"antibiotics",
"past 12 months",
"not",
"concurrent diseases",
"vital signs include",
... |
A 6-month-old boy is brought to the emergency department by his mother, who informs the doctor that her alcoholic husband hit the boy hard on his back. The blow was followed by excessive crying for several minutes and the development of redness in the area. On physical examination, the boy is dehydrated, dirty, and irr... | Skeletal survey in 2 weeks | {
"A": "Babygram",
"B": "Bedside ultrasonography",
"C": "Magnetic resonance imaging",
"D": "Skeletal survey in 2 weeks"
} | step2&3 | D | [
"month old boy",
"brought",
"emergency department",
"mother",
"informs",
"doctor",
"alcoholic husband hit",
"boy hard",
"back",
"blow",
"followed by excessive crying",
"several minutes",
"development",
"redness",
"area",
"physical examination",
"boy",
"dehydrated",
"dirty",
"ir... |
A 21-year-old man presents to the emergency department with a 1-week history of increasing knee pain. Specifically, he says that the pain is severe enough that he is no longer able to bend his knee. His past medical history is not significant, but he says that he is sexually active with multiple partners. On physical e... | Gram-negative diplococci | {
"A": "Gram-negative diplococci",
"B": "Gram-positive cocci in chains",
"C": "Gram-positive cocci in clusters",
"D": "Tick born gram-variable"
} | step1 | A | [
"21-year-old man presents",
"emergency department",
"1-week history",
"increasing knee pain",
"pain",
"severe",
"longer able to bend",
"knee",
"past medical history",
"not significant",
"sexually active",
"multiple partners",
"physical exam",
"right knee",
"found to",
"swollen",
"ery... |
A 30-year-old man presents with fever, malaise, and severe pain in his right wrist and left knee for the last 2 days. He describes the pain as 8/10 in intensity, sharp in character, and extending from his right wrist to his fingers. He denies any recent inciting trauma or similar symptoms in the past. His past medical ... | Arthrocentesis aspirate showing minimal, purulent joint effusion with negative culture | {
"A": "Arthrocentesis aspirate showing gram-positive cocci in clusters",
"B": "Arthrocentesis aspirate showing minimal, purulent joint effusion with negative culture",
"C": "Positive serum ASO titer",
"D": "Radiographs of right wrist and left knee showing osteopenia and joint space narrowing"
} | step1 | B | [
"30 year old man presents",
"fever",
"malaise",
"severe pain in",
"right wrist",
"left knee",
"2 days",
"pain",
"8/10",
"intensity",
"sharp",
"character",
"extending",
"right wrist",
"fingers",
"denies",
"recent",
"trauma",
"similar symptoms",
"past",
"past medical history",
... |
A 52-year-old man presents with 2 months of diarrhea, abdominal pain, and fatigue. He reports a weight loss of 4 kg (8 lb). He also says his joints have been hurting recently, as well. Past medical history is unremarkable. Review of systems is significant for problems with concentration and memory. Physical examination... | PAS positive macrophages | {
"A": "PAS positive macrophages",
"B": "Blunting of the villi",
"C": "Absence of nerves in the myenteric plexus",
"D": "Presence of C. trachomatis in urine specimen"
} | step1 | A | [
"year old man presents",
"months",
"diarrhea",
"abdominal pain",
"fatigue",
"reports",
"weight loss of",
"kg",
"joints",
"recently",
"well",
"Past medical history",
"unremarkable",
"Review of systems",
"significant",
"problems",
"concentration",
"memory",
"Physical examination",
... |
A 27-year-old man who recently immigrated to the United States with his family is diagnosed with an autosomal dominant disorder that causes anemia by extravascular hemolysis. The doctor explains that his red blood cells (RBCs) are spherical, which decreases their lifespan and explains that a splenectomy may be required... | Spectrin | {
"A": "Iron absorption",
"B": "Glucose-6-phosphatase dehydrogenase",
"C": "Spectrin",
"D": "Glycosylphosphatidylinositol"
} | step1 | C | [
"27 year old man",
"recently",
"United States",
"family",
"diagnosed",
"autosomal dominant disorder",
"causes anemia",
"extravascular hemolysis",
"doctor",
"red blood cells",
"spherical",
"decreases",
"lifespan",
"splenectomy",
"required",
"future",
"following",
"most likely to",
... |
A 47-year-old African-American woman presents to her primary care physician for a general checkup appointment. She works as a middle school teacher and has a 25 pack-year smoking history. She has a body mass index (BMI) of 22 kg/m^2 and is a vegetarian. Her last menstrual period was 1 week ago. Her current medications ... | Smoking history | {
"A": "Body mass index",
"B": "Estrogen therapy",
"C": "Race",
"D": "Smoking history"
} | step2&3 | D | [
"year old African-American woman presents",
"primary care physician",
"general checkup appointment",
"works",
"middle school teacher",
"pack-year smoking history",
"body mass index",
"kg/m",
"vegetarian",
"last menstrual period",
"1 week",
"current medications include oral contraceptive pills"... |
A 45-year-old man comes to the physician for the evaluation of painful swallowing and retrosternal pain over the past 2 days. He was recently diagnosed with HIV infection, for which he now takes tenofovir, emtricitabine, and raltegravir. There is no family history of serious illness. He has smoked one pack of cigarette... | Infection with herpes simplex virus | {
"A": "Infection with herpes simplex virus",
"B": "Transient lower esophageal sphincter relaxation",
"C": "Degeneration of inhibitory neurons within the myenteric plexuses",
"D": "Infection with cytomegalovirus"
} | step2&3 | A | [
"year old man",
"physician",
"evaluation",
"painful swallowing",
"retrosternal pain",
"past 2 days",
"recently diagnosed",
"HIV infection",
"now takes tenofovir",
"emtricitabine",
"raltegravir",
"family history",
"serious illness",
"smoked one pack",
"cigarettes daily",
"past 20 years"... |
A 16-year-old male presents to the cardiologist after passing out during a basketball practice. An echocardiogram confirmed the diagnosis of hypertrophic cardiomyopathy. The cardiologist advises that a pacemaker must be implanted to prevent any further complications and states the player cannot play basketball anymore.... | Recommend to the legal guardian that the player stop playing and have the procedure performed | {
"A": "Allow the patient to play and schedule a follow up after the game",
"B": "Postpone the procedure so the patient can play",
"C": "Recommend to the legal guardian that the player stop playing and have the procedure performed",
"D": "Allow the patient to make the decision regarding his health"
} | step1 | C | [
"year old male presents",
"cardiologist",
"out",
"basketball practice",
"echocardiogram confirmed",
"diagnosis",
"hypertrophic cardiomyopathy",
"cardiologist",
"pacemaker",
"implanted to prevent",
"further complications",
"states",
"play basketball",
"coach objects",
"big game",
"next ... |
A 17-year-old girl comes to the physician because of a sore throat, fevers, and fatigue for the past 3 weeks. Her temperature is 37.8°C (100°F), pulse is 97/min, and blood pressure is 90/60 mm Hg. Examination of the head and neck shows cervical lymphadenopathy, pharyngeal erythema, enlarged tonsils with exudates, and p... | Hodgkin lymphoma | {
"A": "Rheumatic fever",
"B": "Kaposi sarcoma",
"C": "Hodgkin lymphoma",
"D": "Mycotic aneurysm"
} | step1 | C | [
"year old girl",
"physician",
"sore throat",
"fevers",
"fatigue",
"past",
"weeks",
"temperature",
"pulse",
"97 min",
"blood pressure",
"90 60 mm Hg",
"Examination of",
"head",
"neck shows cervical lymphadenopathy",
"pharyngeal erythema",
"enlarged tonsils",
"exudates",
"palatal p... |
A 27-year-old soldier stationed in Libya sustains a shrapnel injury during an attack, causing a traumatic above-elbow amputation. The resulting arterial bleed is managed with a tourniquet prior to transport to the military treatment facility. On arrival, he is alert and oriented to person, place, and time. His armor an... | Establish intraosseous access | {
"A": "Irrigate the shrapnel wounds",
"B": "Establish central venous access",
"C": "Replace the tourniquet with a pressure dressing",
"D": "Establish intraosseous access"
} | step2&3 | D | [
"27 year old soldier stationed",
"Libya sustains",
"shrapnel injury",
"attack",
"causing",
"traumatic above-elbow amputation",
"resulting arterial bleed",
"managed",
"tourniquet prior to transport",
"military treatment facility",
"arrival",
"alert",
"oriented to person",
"place",
"time",... |
A 50-year-old female presents to her physician with vesicles and tense blisters across her chest, arms, and the back of her shoulders. Physical examination reveals that blistering is not present in her oral mucosa, and the epidermis does not separate upon light stroking of the skin. The patient most likely suffers from... | Linearly along the epidermal basement membrane | {
"A": "Linearly along the epidermal basement membrane",
"B": "In granular deposits at the tips of dermal papillae",
"C": "In fat cells beneath the skin",
"D": "In nuclei within epidermal cells"
} | step1 | A | [
"50 year old female presents",
"physician",
"vesicles",
"tense blisters",
"chest",
"arms",
"back of",
"shoulders",
"Physical examination reveals",
"blistering",
"not present",
"oral mucosa",
"epidermis",
"not separate",
"light stroking",
"skin",
"patient most likely suffers",
"hype... |
In 2006, three researchers from North Carolina wanted to examine the benefits of treating the risk of suicidality in children and adolescents by looking at randomized, multicenter, controlled trials of sertraline usage compared to placebo. Their analysis found clinically significant benefits of the drug and a positive ... | Input values must be probabilities of the events of interest. | {
"A": "Input values must be probabilities of the events of interest.",
"B": "The final metric represents proportions in percentage terms.",
"C": "The measure can include multiple events at one time.",
"D": "Higher measures indicate greater risk."
} | step1 | A | [
"three researchers",
"North Carolina wanted to",
"benefits",
"treating",
"risk",
"suicidality",
"children",
"adolescents",
"looking",
"randomized",
"multicenter",
"controlled trials",
"sertraline usage compared",
"placebo",
"analysis found",
"significant benefits",
"drug",
"positiv... |
A 52-year-old Caucasian man presents to the clinic for evaluation of a mole on his back that he finds concerning. He states that his wife noticed the lesion and believes that it has been getting larger. On inspection, the lesion is 10 mm in diameter with irregular borders. A biopsy is performed. Pathology reveals abnor... | Superficial spreading melanoma | {
"A": "Nodular melanoma",
"B": "Superficial spreading melanoma",
"C": "Lentigo melanoma",
"D": "Desmoplastic melanoma"
} | step1 | B | [
"year old Caucasian man presents",
"clinic",
"evaluation",
"mole",
"back",
"finds concerning",
"states",
"wife",
"lesion",
"getting larger",
"inspection",
"lesion",
"10 mm",
"diameter",
"irregular borders",
"biopsy",
"performed",
"Pathology reveals abnormal melanocytes forming nest... |
A 47-year-old woman presents with complaints of fever, chills, and rigor. On physical exam, she also has left sided costovertebral tenderness. Vitals include a temperature of 39.4°C (103.0°F), blood pressure of 125/84 mm Hg, and pulse of 84/min. She has type 2 diabetes and is currently taking metformin daily. Urine dip... | Acute papillary necrosis | {
"A": "Acute cystitis",
"B": "Acute glomerulonephritis",
"C": "Acute interstitial nephritis",
"D": "Acute papillary necrosis"
} | step1 | D | [
"year old woman presents",
"complaints",
"fever",
"chills",
"rigor",
"physical exam",
"left sided",
"tenderness",
"include",
"temperature",
"4C",
"blood pressure",
"84 mm Hg",
"pulse",
"84 min",
"type 2 diabetes",
"currently taking metformin daily",
"Urine dipstick analysis",
"po... |
A 70-year-old man comes to the emergency department because of severe lower back pain for 3 weeks. The pain was initially exacerbated by activity but now presents also at rest. The patient has not had a headache or a cough. He reports no changes in bowel movements or urination. He has type 2 diabetes mellitus and hyper... | CT-guided biopsy | {
"A": "CT-guided biopsy",
"B": "Surgical debridement",
"C": "Prostate-specific antigen assay",
"D": "Isoniazid, rifampin, pyrazinamide, ethambutol\n\""
} | step2&3 | A | [
"70 year old man",
"emergency department",
"of severe lower back pain",
"pain",
"initially exacerbated",
"activity",
"now presents",
"rest",
"patient",
"not",
"headache",
"cough",
"reports",
"changes in bowel movements",
"urination",
"type 2 diabetes mellitus",
"hypertension",
"not... |
A 32-year-old woman comes to the physician because of a 1-week history of left flank pain and dysuria. She has had 2 episodes of urinary tract infection over the past 2 years. Her temperature is 37°C (98.6°F) and pulse is 82/min. An ultrasound of the kidneys shows left-sided hydronephrosis and echogenic foci with acous... | Magnesium ammonium phosphate
" | {
"A": "Cystine",
"B": "Calcium oxalate",
"C": "Calcium phosphate",
"D": "Magnesium ammonium phosphate\n\""
} | step1 | D | [
"year old woman",
"physician",
"1-week history",
"left flank pain",
"dysuria",
"2 episodes of urinary tract infection",
"past",
"years",
"temperature",
"98",
"pulse",
"min",
"ultrasound of",
"kidneys shows left-sided hydronephrosis",
"echogenic foci",
"acoustic shadowing",
"photomicr... |
A 58-year-old woman comes to the physician because of a 2-year history of progressively worsening pain in her knees and fingers. The knee pain is worse when she walks for longer than 30 minutes. When she wakes up in the morning, her fingers and knees are stiff for about 15 minutes. She cannot recall any trauma to the j... | Osteoarthritis | {
"A": "Gout",
"B": "Lyme arthritis",
"C": "Osteoarthritis",
"D": "Septic arthritis"
} | step2&3 | C | [
"58 year old woman",
"physician",
"2 year history",
"worsening pain in",
"knees",
"fingers",
"knee pain",
"worse",
"walks",
"longer",
"30 minutes",
"wakes up",
"morning",
"fingers",
"knees",
"stiff",
"15 minutes",
"recall",
"trauma",
"joints",
"treated with amoxicillin follow... |
A 23-year-old woman on prednisone for lupus presents to her primary care physician because she experiences a burning sensation with urination. She has also been urinating more frequently than normal. The patient denies fever, chills, nausea/vomiting, abdominal or back pain, or other changes with urination. Her vital si... | Tendon rupture | {
"A": "Rhabdomyolysis",
"B": "Facial redness/flushing",
"C": "Hemolytic anemia",
"D": "Tendon rupture"
} | step1 | D | [
"23 year old woman",
"prednisone",
"lupus presents",
"primary care physician",
"experiences",
"burning sensation",
"urination",
"more frequently",
"normal",
"patient denies fever",
"chills",
"nausea/vomiting",
"abdominal",
"back pain",
"changes",
"urination",
"vital signs",
"physic... |
A 16-year-old boy is brought to the physician because of a cough and clear nasal secretions over the past 2 days. He is not coughing up any sputum. He says that he is the quarterback of his high school's football team and wants to get back to training as soon as possible. The patient's father had a myocardial infarctio... | Reassurance | {
"A": "Echocardiography",
"B": "Cardiac stress testing",
"C": "24-hour ambulatory ECG monitoring",
"D": "Reassurance"
} | step2&3 | D | [
"year old boy",
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"patient's father",
"myocardial infarction",
"age",
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"cardiac catheterization",
"stenti... |
You are called to evaluate a newborn. The patient was born yesterday to a 39-year-old mother. You observe the findings illustrated in Figures A-C. What is the most likely mechanism responsible for these findings? | Trisomy 21 | {
"A": "Microdeletion on chromosome 22",
"B": "Maternal alcohol consumption during pregnancy",
"C": "Trisomy 18",
"D": "Trisomy 21"
} | step1 | D | [
"called to evaluate",
"newborn",
"patient",
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"year old mother",
"observe",
"findings",
"most likely mechanism responsible",
"findings"
] |
A 29-year-old man presents to the emergency department with a sharp pain in the center of his chest. The pain is knife-like and constant. Sitting alleviates the pain and lying supine aggravates it. He denies the use of nicotine, alcohol or illicit drugs. Vital signs include: temperature 37.0°C (98.6°F), blood pressure ... | Colchicine | {
"A": "Ibuprofen",
"B": "Colchicine",
"C": "Aspirin",
"D": "Systemic antibiotics"
} | step2&3 | B | [
"29 year old man presents",
"emergency department",
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"denies",
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"alcohol",
"illicit drugs",
"Vital signs include",
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"98",
"blood pressure",... |
A 42-year-old man is brought in to the emergency department by his daughter. She reports that her father drank heavily for the last 16 years, but he stopped 4 days ago after he decided to quit drinking on his birthday. She also reports that he has been talking about seeing cats running in his room since this morning, a... | Increased activity of NMDA receptors | {
"A": "Functional increase in GABA",
"B": "Increased activity of NMDA receptors",
"C": "Increased inhibition of norepinephrine",
"D": "Increased inhibition of glutamate"
} | step2&3 | B | [
"year old man",
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"seeing cats running in",
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"morning",
"cats",
"history of",
"known medical problems",
"substance use",
"physical e... |
A 13-year-old boy is brought by his mother to the emergency department because he has had fever, chills, and severe coughing for the last two days. While they originally tried to manage his condition at home, he has become increasingly fatigued and hard to arouse. He has a history of recurrent lung infections and occas... | Green gram-negative rod | {
"A": "Green gram-negative rod",
"B": "Lancet-shaped diplococci",
"C": "Mixed anaerobic rods",
"D": "Mucoid lactose-fermenting rod"
} | step1 | A | [
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"fatigued",
"hard",
"history of recurrent lung infections",
"occasionally",
"multiple foul smelling stools",
"presentation",
"temperature",
"F",... |
An investigator is developing a drug that selectively inhibits the retrograde axonal transport of rabies virus towards the central nervous system. To achieve this effect, this drug must target which of the following? | Dynein | {
"A": "Tubulin",
"B": "Kinesin",
"C": "Dynein",
"D": "Acetylcholine"
} | step1 | C | [
"investigator",
"drug",
"inhibits",
"retrograde axonal transport of rabies virus",
"central nervous system",
"To",
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"drug",
"target",
"following"
] |
A previously healthy 21-year-old man comes to the physician for the evaluation of lethargy, headache, and nausea for 2 months. His headache is holocephalic and most severe upon waking up. He is concerned about losing his spot on next season's college track team, given a recent decline in his performance during winter t... | Chronic cerebral hypoxia | {
"A": "Chronic cerebral hypoxia",
"B": "Exogenous erythropoietin",
"C": "Inherited JAK2 kinase mutation",
"D": "Overuse of NSAIDs"
} | step2&3 | A | [
"healthy 21-year-old man",
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"ew ouse ",
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A 15-year-old boy is brought to the physician for a well-child visit. His parents are concerned that he has not had his growth spurt yet. As a child, he was consistently in the 60th percentile for height; now he is in the 25th percentile. His classmates make fun of his height and high-pitched voice. His parents are als... | Kallmann syndrome | {
"A": "Hyperprolactinemia",
"B": "Hypothyroidism",
"C": "Primary hypogonadism",
"D": "Kallmann syndrome"
} | step2&3 | D | [
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"percentile",
"classmates make",
"height",
"high-pitched voice",
"parents",
"concerned",
"not maintain good hygiene",
"frequently f... |
An investigator is studying the genetic profile of an isolated pathogen that proliferates within macrophages. The pathogen contains sulfatide on the surface of its cell wall to prevent fusion of the phagosome and lysosome. She finds that some of the organisms under investigation have mutations in a gene that encodes th... | Rifampin | {
"A": "Streptomycin",
"B": "Rifampin",
"C": "Pyrazinamide",
"D": "Levofloxacin"
} | step1 | B | [
"investigator",
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"genetic profile",
"isolated pathogen",
"macrophages",
"pathogen contains sulfatide",
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"phagosome",
"lysosome",
"finds",
"organisms",
"investigation",
"mutations",
"gene",
"encodes",
"enzyme required",
"synthes... |
A 40-year-old woman comes to the physician because of a 2-week history of anal pain that occurs during defecation and lasts for several hours. She reports that she often strains during defecation and sees bright red blood on toilet paper after wiping. She typically has 3 bowel movements per week. Physical examination s... | Posterior midline of the anal canal, distal to the pectinate line | {
"A": "Posterior midline of the anal canal, distal to the pectinate line",
"B": "Anterior midline of the anal canal, distal to the pectinate line",
"C": "Posterior midline of the anal canal, proximal to the pectinate line",
"D": "Lateral aspect of the anal canal, distal to the pectinate line"
} | step1 | A | [
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"sees bright red blood on toilet paper",
"wiping",
"3 bowel movements",
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"Physical examination shows",
"longitudinal",
"perian... |
A 72-year-old man comes to the physician because of a 2-month history of intermittent retrosternal chest pain and tightness on exertion. He has type 2 diabetes mellitus, osteoarthritis of the right hip, and hypertension. Current medications include insulin, ibuprofen, enalapril, and hydrochlorothiazide. Vital signs are... | Diversion of blood flow from stenotic coronary arteries | {
"A": "Diversion of blood flow from stenotic coronary arteries",
"B": "Transient atrioventricular nodal blockade",
"C": "Reduced left ventricular preload",
"D": "Increased myocardial oxygen demand"
} | step2&3 | A | [
"72 year old man",
"physician",
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"intermittent retrosternal chest pain",
"tightness",
"exertion",
"type 2 diabetes mellitus",
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"Current medications include insulin",
"ibuprofen",
"enalapril",
"hydrochlorothiazide",
... |
A 14-year-old boy is brought to the physician by his parents for a follow-up examination. Since early childhood, he has had recurrent respiratory infections that cause him to miss several weeks of school each year. Last month, he had received treatment for his seventh episode of sinusitis this year. He has always had b... | Absent vas deferens | {
"A": "Hypersensitivity to aspirin",
"B": "Absent vas deferens",
"C": "Selective IgA deficiency",
"D": "Positive methacholine challenge test"
} | step2&3 | B | [
"year old boy",
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"to miss several weeks",
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"month",
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"seventh episode of sinusitis",
"year",
"always",
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"foul-sme... |
A 25-year-old woman presents to her primary care provider for fatigue. She states that she has felt fatigued for the past 6 months and has tried multiple diets and sleep schedules to improve her condition, but none have succeeded. She has no significant past medical history. She is currently taking a multivitamin, fola... | Anti-intrinsic factor antibodies | {
"A": "Anti-intrinsic factor antibodies",
"B": "Bone marrow biopsy",
"C": "Iron level",
"D": "Transferrin level"
} | step2&3 | A | [
"year old woman presents",
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"states",
"felt fatigued",
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"multiple diets",
"sleep schedules to",
"condition",
"significant past medical history",
"currently taking",
"multivitamin",
"folate",
"B12",
"iron",
"fish oil",
"whey protein",... |
A 4-month-old boy is brought to the emergency department by his mother because of lethargy and vomiting since he woke up 1 hour ago. The mother says that he last breastfed the previous evening and slept through the night for the first time. His family recently immigrated from Bolivia. His temperature is 38.7°C (101.2°F... | Medium-chain acyl-CoA dehydrogenase | {
"A": "Medium-chain acyl-CoA dehydrogenase",
"B": "Alpha-L-iduronidase",
"C": "Galactose-1-phosphate uridyltransferase",
"D": "Lysosomal acid α-1,4- glucosidase"
} | step1 | A | [
"4 month old boy",
"brought",
"emergency department",
"mother",
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"hour",
"mother",
"last breastfed",
"previous evening",
"slept",
"night",
"first time",
"family recently",
"Bolivia",
"temperature",
"Physical examination shows dry mucous membranes",... |
A 9-year-old boy is brought to a pediatric psychologist by his mother because of poor academic performance. The patient’s mother mentions that his academic performance was excellent in kindergarten and first grade, but his second and third-grade teachers complain that he is extremely talkative, does not complete school... | Attention-deficit/hyperactivity disorder | {
"A": "Attention-deficit/hyperactivity disorder",
"B": "Dyslexia",
"C": "Persistent depressive disorder",
"D": "Intellectual disability"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatric psychologist",
"mother",
"poor academic performance",
"patients mother",
"academic performance",
"excellent",
"kindergarten",
"first grade",
"second",
"third grade teachers",
"extremely talkative",
"not complete",
"frequently makes",
"mistakes",
... |
A 39-year-old man presents to a primary care clinic for a routine physical exam. He denies any complaints. He has a long beard and hair, wears several copper bracelets, and a crystal amulet. When asked about his diet, he discloses eating mostly canned foods, which he has stockpiled in his cabin in case there is a natur... | Schizotypal personality disorder | {
"A": "Schizoid personality disorder",
"B": "Schizophrenia",
"C": "Schizophreniform disorder",
"D": "Schizotypal personality disorder"
} | step1 | D | [
"year old man presents",
"primary care clinic",
"routine physical exam",
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"complaints",
"long beard",
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"several copper bracelets",
"crystal",
"diet",
"eating mostly canned foods",
"case",
"natural disaster",
"admits",
"highly unlikely",
"few close friends",
"feels awk... |
A 24-year-old woman visits her physician to seek preconception advice. She is recently married and plans to have a child soon. Menses occur at regular 28-day intervals and last 5 days. She has sexual intercourse only with her husband and, at this time, they consistently use condoms for birth control. The patient consum... | As soon as possible | {
"A": "As soon as possible",
"B": "In the second half of pregnancy",
"C": "When off contraception",
"D": "No folic acid supplement is required as nutritional sources are adequate"
} | step2&3 | A | [
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"sexual intercourse only",
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"patient",
"well balanced diet",
"moder... |
A 28-year-old woman is brought to the emergency department 30 minutes after being involved in a high-speed motor vehicle collision in which she was the unrestrained driver. On arrival, she is semiconscious and incoherent. She has shortness of breath and is cyanotic. Her pulse is 112/min, respirations are 59/min, and bl... | Bronchial rupture | {
"A": "Bronchial rupture",
"B": "Flail chest",
"C": "Myocardial rupture",
"D": "Pulmonary embolism"
} | step2&3 | A | [
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"emergency department 30 minutes",
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"min",
"respirations",
"59 min",
"blood pressure",
"mm Hg",
"Examination... |
You are a resident on a pediatric service entering orders late at night. Upon arrival the next morning, you note that you had mistakenly ordered that low molecular weight heparin be administered to a 17-year-old patient who does not need anti-coagulation. When you talk to her, she complains about the "shot" she had to ... | Tell the patient and her parents about the error | {
"A": "You cannot disclose the error as a resident due to hospital policy",
"B": "Tell the patient, but ask her not to tell her parents",
"C": "Tell the patient and her parents about the error",
"D": "Since there was no lasting harm to the patient, it is not necessary to disclose the error"
} | step1 | C | [
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"well",
"handle"
] |
A 4-year-old boy presents with a history of recurrent bacterial infections, including several episodes of pneumococcal sepsis. His family history is significant for 2 maternal uncles who died from similar symptoms. Laboratory tests reveal undetectable serum levels of all isotypes of immunoglobulins and reduced levels o... | Bruton agammaglobulinemia | {
"A": "Bruton agammaglobulinemia",
"B": "Common variable immunodeficiency",
"C": "DiGeorge syndrome",
"D": "Hereditary angioedema"
} | step1 | A | [
"4 year old boy presents",
"history of recurrent bacterial infections",
"including several episodes of pneumococcal sepsis",
"family history",
"significant",
"maternal uncles",
"died",
"similar symptoms",
"Laboratory tests reveal undetectable serum levels",
"isotypes",
"immunoglobulins",
"redu... |
A 32-year-old man comes to the emergency room because of severe breathlessness for the past few hours. Over the course of a few years, he has been treated for asthma by several physicians, but his symptoms have continued to progress. He doesn’t smoke and never did. Both his father who died at the age of 40 years and hi... | α1-antitrypsin-deficiency | {
"A": "Pulmonary edema",
"B": "Lung cancer",
"C": "α1-antitrypsin-deficiency",
"D": "Asthma"
} | step1 | C | [
"year old man",
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"uncle",
"fathers brother",
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"chronic ob... |
A 51-year-old woman presents to her primary care doctor with diarrhea. She has had 3-10 malodorous and loose bowel movements daily for the last 6 months, though she recalls that her bowel movements started increasing in frequency nearly 2 years ago. She was otherwise healthy until 2 years ago, when she had multiple ele... | Streptozotocin | {
"A": "Streptozotocin",
"B": "Paclitaxel",
"C": "Glucagon",
"D": "Methotrexate"
} | step1 | A | [
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"loose bowel movements daily",
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"recalls",
"bowel movements started increasing",
"frequency nearly",
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"healthy",
"years",
"multiple elevated fasting",
"diagnosed",
"type 2 diabetes mellitus",
"hospit... |
A 31-year-old woman presents with difficulty walking and climbing stairs for the last 3 weeks. She has no history of trauma. The physical examination reveals a waddling gait with the trunk swaying from side-to-side towards the weight-bearing limb. When she stands on her right leg, the pelvis on the left side falls, but... | Right superior gluteal nerve | {
"A": "Right superior gluteal nerve",
"B": "Right femoral nerve",
"C": "Right inferior gluteal nerve",
"D": "Right obturator nerve"
} | step1 | A | [
"31 year old woman presents",
"difficulty",
"climbing stairs",
"weeks",
"history",
"trauma",
"physical examination reveals",
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"trunk swaying",
"side-to-side",
"weight-bearing limb",
"stands",
"right leg",
"pelvis",
"left side falls",
"stands",
"left leg",
"pelvis",
... |
A 25-year-old man presents to the emergency department with pain in his leg. He states that the pain was sudden and that his leg feels very tender. This has happened before, but symptoms resolved a few days later with acetaminophen. His temperature is 98.5°F (36.9°C), blood pressure is 129/88 mmHg, pulse is 90/min, res... | Heparin | {
"A": "Aspirin",
"B": "Heparin",
"C": "Ibuprofen and rest",
"D": "Warfarin"
} | step2&3 | B | [
"year old man presents",
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"acetaminophen",
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"98",
"36",
"blood pressure",
"88 mmHg",
"pulse",
"90 min",
"respira... |
A 51-year-old man presents to his physician with decreased libido and inability to achieve an erection. He also reports poor sleep, loss of pleasure to do his job, and depressed mood. His symptoms started a year ago, soon after his wife got into the car accident. She survived and recovered with the minimal deficit, but... | Penile tumescence testing | {
"A": "Penile tumescence testing",
"B": "Biothesiometry",
"C": "Injection of prostaglandin E1",
"D": "Angiography"
} | step2&3 | A | [
"year old man presents",
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"loss of pleasure",
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"wife",
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"survived",
"recovered",
"minimal deficit",
"patient",
"feels guilty due to",
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A 24-year-old woman, otherwise healthy, presents with a non-productive cough, sore throat, and myalgia. The patient reports that her symptoms started gradually 2 weeks ago and have not improved. She has no significant past medical history and no current medications. She is a college student and denies any recent overse... | Low serum levels of complement | {
"A": "Low serum levels of complement",
"B": "Low serum ferritin and serum iron",
"C": "Schistocytes on peripheral smear",
"D": "Heinz bodies on peripheral smear"
} | step2&3 | A | [
"year old woman",
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"weeks",
"not improved",
"significant past medical history",
"current medications",
"college student",
"denies",
"recent",
"travel",
"patient received",
... |
A 37-year-old woman, gravida 3, para 3, comes to the physician for very painful menses that have caused her to miss at least 3 days of work during each menstrual cycle for the past 6 months. Menses occur with heavy bleeding at regular 28-day intervals. She also has constant dull pain in the pelvic region between cycles... | Endometrial tissue within the uterine wall | {
"A": "Endometrial tissue within the uterine wall",
"B": "Endometrial tissue in the fallopian tubes",
"C": "Cystic enlargement of the ovaries",
"D": "Benign smooth muscle tumors of the uterus"
} | step2&3 | A | [
"year old woman",
"gravida 3",
"para 3",
"physician",
"very painful menses",
"caused",
"miss",
"3 days",
"work",
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"past 6 months",
"Menses occur",
"heavy bleeding",
"regular",
"day intervals",
"constant dull",
"pelvic region",
"cycles",
"healthy",
"kg",
"tal... |
A 52-year-old man is brought to the emergency department with severe epigastric discomfort and left-sided chest pain radiating to the back that began after waking up. He has also vomited several times since the pain began. He underwent an esophagogastroduodenoscopy the previous day for evaluation of epigastric pain. He... | Esophageal perforation | {
"A": "Pneumothorax",
"B": "Esophageal perforation",
"C": "Aortic dissection",
"D": "Acute myocardial infarction"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"severe epigastric discomfort",
"left-sided chest pain radiating to",
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"began",
"waking",
"vomited several times",
"pain began",
"esophagogastroduodenoscopy",
"previous day",
"evaluation",
"epigastric",
"ischemic heart disease",
... |
A 22-year-old male with a history of difficult-to-treat bipolar disorder with psychotic features is under going a medication adjustment under the guidance of his psychiatrist. The patient was previously treated with lithium and is transitioning to clozapine. Which of the following tests will the patient need routinely? | Complete blood count, weekly | {
"A": "Basic metabolic panel, weekly",
"B": "Complete blood count, weekly",
"C": "Hemoglobin A1c, weekly",
"D": "Dexamethasone suppression test, monthly"
} | step1 | B | [
"year old male",
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"difficult",
"treat bipolar disorder",
"psychotic features",
"medication adjustment",
"guidance",
"psychiatrist",
"patient",
"treated with lithium",
"transitioning",
"clozapine",
"following tests",
"patient need"
] |
A 47-year-old man comes to the emergency department because of urinary and fecal incontinence for 6 hours. Earlier in the day, he suffered a fall at a construction site and sustained injuries to his back and thighs but did not seek medical attention. He took ibuprofen for lower back pain. His temperature is 36.9°C (98.... | Conus medullaris syndrome | {
"A": "Spinal epidural abscess",
"B": "Cerebellar stroke",
"C": "Conus medullaris syndrome",
"D": "Anterior spinal cord syndrome"
} | step2&3 | C | [
"year old man",
"emergency department",
"urinary",
"fecal incontinence",
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"Earlier",
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"thighs",
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"lower back pain",
"temperature",
"36",
"98 4F",... |
A 20-year-old female presents to the college health clinic concerned about a rash that has recently developed along her back and flank. Aside from a history of chronic diarrhea and flatulence, she reports being otherwise healthy. She is concerned that this rash could be either from bed bugs or possible be sexually tran... | Immunologic response to gluten | {
"A": "Disseminiated chlamydial infection",
"B": "Streptococcal meningitis infection",
"C": "Immunologic response to gluten",
"D": "Bed bug infestation"
} | step1 | C | [
"20 year old female presents",
"college health clinic concerned",
"rash",
"recently",
"back",
"flank",
"history",
"chronic diarrhea",
"flatulence",
"reports",
"healthy",
"concerned",
"rash",
"bed bugs",
"possible",
"sexually transmitted",
"engaged",
"unprotected sex multiple times"... |
A 55-year-old man presents to the physician with tiredness, lethargy, bone pain, and colicky right abdominal pain for 1 month. He has no comorbidities. He does not have any significant past medical history. His height is 176 cm (5 ft 7 in), weight is 88 kg (194 lb), and his BMI is 28.47 kg/m2. The physical examination ... | 99mTc sestamibi scan with ultrasound of the neck | {
"A": "99mTc sestamibi scan with ultrasound of the neck",
"B": "CT scan of the neck",
"C": "Bone scan (DEXA)",
"D": "Sestamibi scan only"
} | step2&3 | A | [
"55 year old man presents",
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"bone pain",
"colicky right",
"month",
"comorbidities",
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"BMI",
"kg/m2",
"physical examination",
"normal",
"mild right lumbar region te... |
A 22-year-old woman with type 1 diabetes mellitus and mild asthma comes to the physician for a follow-up examination. She has had several episodes of sweating, dizziness, and nausea in the past 2 months that occur during the day and always resolve after she drinks orange juice. She is compliant with her diet and insuli... | Before exercise | {
"A": "During a viral infection",
"B": "After large meals",
"C": "Before exercise",
"D": "After a stressful exam"
} | step1 | C | [
"year old woman",
"type 1 diabetes mellitus",
"mild asthma",
"physician",
"follow-up examination",
"several episodes of sweating",
"dizziness",
"nausea",
"past",
"months",
"occur",
"day",
"always resolve",
"drinks orange juice",
"compliant with",
"diet",
"insulin regimen",
"physici... |
A 38-year-old woman seeks evaluation at the emergency room for sudden onset of pain and swelling of her left leg since last night. Her family history is significant for maternal breast cancer (diagnosed at 52 years of age) and a grandfather with bronchioloalveolar carcinoma of the lungs at 45 years of age. When the pat... | TP53 | {
"A": "TP53",
"B": "BRCA2",
"C": "MLH1",
"D": "STK11"
} | step1 | A | [
"year old woman",
"evaluation",
"emergency room",
"sudden onset",
"pain",
"swelling of",
"left leg",
"night",
"family history",
"significant",
"maternal breast cancer",
"diagnosed",
"years",
"age",
"grandfather",
"bronchioloalveolar carcinoma of the lungs",
"years",
"age",
"patie... |
A 60-year-old man presents with fever and cough productive of rust-colored sputum and is diagnosed with community acquired pneumonia. The causative organism is isolated, and a Gram stain is shown in Figure 1. Which of the following most correctly describes additional features of the most likely causative organism? | Catalase negative, alpha hemolytic, optochin sensitive | {
"A": "Catalase positive, alpha hemolytic, optochin sensitive",
"B": "Catalase positive, beta hemolytic, optochin sensitive",
"C": "Catalase negative, alpha hemolytic, optochin sensitive",
"D": "Catalase negative, beta hemolytic, optochin sensitive"
} | step1 | C | [
"60 year old man presents",
"fever",
"cough productive",
"rust colored",
"diagnosed",
"community acquired pneumonia",
"organism",
"isolated",
"Gram stain",
"shown",
"following most",
"additional features",
"likely",
"organism"
] |
A 30-year-old man is brought to the emergency room by ambulance after being found unconscious in his car parked in his garage with the engine running. His wife arrives and reveals that his past medical history is significant for severe depression treated with fluoxetine. He is now disoriented to person, place, and time... | Decreased oxygen delivery to tissues | {
"A": "Decreased minute ventilation",
"B": "Decreased oxygen delivery to tissues",
"C": "Increased metabolic rate",
"D": "Decreased ability for the tissues to use oxygen"
} | step2&3 | B | [
"30 year old man",
"brought",
"emergency room",
"ambulance",
"found unconscious",
"car parked",
"garage",
"running",
"wife",
"reveals",
"past medical history",
"significant",
"severe depression treated with fluoxetine",
"now disoriented",
"person",
"place",
"time",
"temperature",
... |
A 4-day-old boy is brought to the physician by his mother because of vomiting, irritability, and poor feeding. Pregnancy and delivery were uncomplicated. Physical examination shows increased muscle tone in all extremities. He appears lethargic. His diapers emit a caramel-like odor. Urine studies are positive for ketone... | Thiamine | {
"A": "Thiamine",
"B": "Leucine",
"C": "Tyrosine",
"D": "Tetrahydrobiopterin"
} | step1 | A | [
"4 day old boy",
"brought",
"physician",
"mother",
"vomiting",
"irritability",
"poor feeding",
"Pregnancy",
"delivery",
"uncomplicated",
"Physical examination shows increased muscle tone",
"extremities",
"appears lethargic",
"diapers emit",
"caramel",
"odor",
"Urine studies",
"posi... |
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