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 27-year-old woman presents to her primary care physician for foot pain. The patient states that she has pain in her foot and toes whenever she exerts herself or is at work. The patient is an executive at a medical device company and works 60 hours/week. She is currently training for a marathon. She has a past medical... | Intermetatarsal plantar nerve neuroma | {
"A": "Inflammation and damage to the plantar fascia",
"B": "Compression of the tibial nerve",
"C": "Intermetatarsal plantar nerve neuroma",
"D": "Damage to the trabeculae of the calcaneus"
} | step2&3 | C | [
"27 year old woman presents",
"primary care physician",
"foot pain",
"patient states",
"pain in",
"foot",
"toes",
"exerts",
"work",
"patient",
"executive",
"medical device company",
"works 60 hours/week",
"currently training",
"marathon",
"past medical anxiety",
"constipation",
"ir... |
A 2-year-old boy is brought to the physician by his parents several weeks after the family immigrated from Russia. The parents are worried because the child appears to have trouble seeing and has not started walking. The child was born at home and has never been evaluated by a physician. During the pregnancy, the mothe... | Spasticity of bilateral lower extremities | {
"A": "Continuous machinery murmur",
"B": "Spasticity of bilateral lower extremities",
"C": "Tuft of hair over the lumbosacral area",
"D": "Loss of pain sensation in shawl distribution"
} | step1 | B | [
"2 year old boy",
"brought",
"physician",
"parents",
"weeks",
"family",
"Russia",
"parents",
"worried",
"child appears to",
"seeing",
"not started walking",
"child",
"born at home",
"never",
"evaluated",
"physician",
"pregnancy",
"mother",
"week",
"fever",
"myalgia",
"dif... |
A 10-year-old boy who recently immigrated to the United States from Africa with his family is brought to the emergency department by his mother for a progressively worsening ulcerative lesion on his jaw. His mother reports that her son’s right jaw has rapidly enlarged over the past few months. He says that it is very t... | t(8;14) | {
"A": "t(8;14)",
"B": "t(11;14)",
"C": "t(14;18)",
"D": "t(15;17)"
} | step1 | A | [
"A 10 year old boy",
"recently",
"United States",
"Africa",
"family",
"brought",
"emergency department",
"mother",
"worsening ulcerative lesion",
"jaw",
"mother reports",
"sons right jaw",
"rapidly enlarged",
"past",
"months",
"very tender",
"recall",
"trauma to",
"site",
"In a... |
An investigator is studying the teratogenicity of cigarette smoking during pregnancy. He reviews several databases containing data about birth defects and prenatal drug exposures and finds that infants exposed to cigarette smoke in utero are approximately 2 times as likely to have a particular birth defect than unexpos... | Cleft lip | {
"A": "Cleft palate",
"B": "Cleft lip",
"C": "Macrognathia",
"D": "Torus palatinus\n\""
} | step1 | B | [
"investigator",
"studying",
"teratogenicity",
"cigarette smoking",
"pregnancy",
"reviews several databases containing data",
"birth defects",
"prenatal drug exposures",
"finds",
"infants exposed",
"cigarette smoke in utero",
"approximately 2 times",
"likely to",
"birth defect",
"infants"... |
A 79-year-old woman who lives alone is brought to the emergency department by her neighbor because of worsening confusion over the last 2 days. Due to her level of confusion, she is unable to answer questions appropriately. She has had type 2 diabetes mellitus for 29 years for which she takes metformin. Vital signs inc... | Delirium | {
"A": "Alzheimer's dementia",
"B": "Depression",
"C": "Brief psychotic disorder",
"D": "Delirium"
} | step2&3 | D | [
"year old woman",
"lives alone",
"brought",
"emergency department",
"neighbor",
"worsening confusion",
"last 2 days",
"Due to",
"level",
"confusion",
"unable to answer questions",
"type 2 diabetes mellitus",
"29 years",
"takes metformin",
"Vital signs include",
"blood pressure",
"72 ... |
A 35-year-old woman presents to the clinic with a 2-week history of headaches. She was in her usual state of health until 2 weeks ago, when she started having headaches. The headaches are throughout her whole head and rated as a 7/10. They are worse in the mornings and when she bends over. She has some mild nausea, but... | Vitamin A | {
"A": "Vitamin A",
"B": "Vitamin B12",
"C": "Vitamin C",
"D": "Vitamin K"
} | step2&3 | A | [
"35 year old woman presents",
"clinic",
"2-week history of headaches",
"usual state of health",
"2 weeks",
"started",
"headaches",
"headaches",
"whole head",
"rated",
"10",
"worse",
"mornings",
"bends over",
"mild nausea",
"vomiting",
"headaches",
"not throbbing",
"not associated... |
A 68-year-old man presents for a screening ultrasound scan. He has been feeling well and is in his usual state of good health. His medical history is notable for mild hypertension and a 100-pack-year tobacco history. He has a blood pressure of 128/86 and heart rate of 62/min. Physical examination is clear lung sounds a... | Surveillance | {
"A": "Beta-blockers",
"B": "Surveillance",
"C": "Urgent repair",
"D": "Reassurance"
} | step2&3 | B | [
"68 year old man presents",
"screening ultrasound scan",
"feeling well",
"usual state of good health",
"medical history",
"notable",
"mild hypertension",
"100 pack-year tobacco history",
"blood pressure",
"heart rate of 62 min",
"Physical examination",
"clear lung sounds",
"regular heart sou... |
A 42-year-old woman is brought to the emergency department because of two episodes of hemoptysis over the past 24 hours. The patient has a 6-month history of severe sinusitis and bloody nasal discharge. Her vital parameters are as follows: blood pressure, 155/75 mm Hg; pulse, 75/min; respiratory rate, 14/min; and tempe... | Antiproteinase 3 antineutrophil cytoplasmic antibody | {
"A": "Anticyclic citrullinated peptide antibody",
"B": "Antiglomerular basement membrane antibody",
"C": "Antimyeloperoxidase antibody",
"D": "Antiproteinase 3 antineutrophil cytoplasmic antibody"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"of two episodes",
"hemoptysis",
"past 24 hours",
"patient",
"month history",
"severe sinusitis",
"bloody nasal discharge",
"vital parameters",
"follows",
"blood pressure",
"75 mm Hg",
"pulse",
"75 min",
"respiratory rate",
"min"... |
A 66-year-old man is brought to the emergency department 1 hour after the abrupt onset of painless loss of vision in his left eye. Over the last several years, he has noticed increased blurring of vision; he says the blurring has made it difficult to read, but he can read better if he holds the book below or above eye ... | Ranibizumab
" | {
"A": "Ustekinumab",
"B": "Ruxolitinib",
"C": "Cetuximab",
"D": "Ranibizumab\n\""
} | step1 | D | [
"66 year old man",
"brought",
"emergency department",
"hour",
"abrupt onset of painless loss",
"vision",
"left eye",
"last",
"years",
"increased blurring of vision",
"blurring",
"made",
"difficult to read",
"read better",
"holds",
"book",
"above eye level",
"smoked 1 pack",
"ciga... |
A 40-year-old woman comes to the emergency department due to severe right flank pain, fever, chills, and decreased urine output. The vital signs include a temperature of 39.0°C (102.2°F), heart rate of 120/min, a regular breathing pattern, and blood pressure of 128/70 mm Hg. Cardiopulmonary auscultation is normal. In a... | Struvite | {
"A": "Xanthine",
"B": "Uric acid",
"C": "Cystine",
"D": "Struvite"
} | step1 | D | [
"40 year old woman",
"emergency department",
"severe right flank pain",
"fever",
"chills",
"decreased urine output",
"vital signs include",
"temperature",
"heart rate",
"min",
"regular breathing pattern",
"blood pressure",
"70 mm Hg",
"Cardiopulmonary auscultation",
"normal",
"addition... |
A 7-year-old boy is brought to the pediatrician by his parents for a routine checkup. The parents note that the patient recently joined a baseball team and has had trouble keeping up with his teammates and gets short of breath with exertion. The patient has otherwise been healthy and has no known history of asthma or a... | Holosystolic murmur at the lower left sternal border | {
"A": "Continuous murmur inferior to the left clavicle",
"B": "Crescendo-decrescendo systolic murmur radiating to carotids",
"C": "Holosystolic murmur at the apex radiating to the axilla",
"D": "Holosystolic murmur at the lower left sternal border"
} | step1 | D | [
"year old boy",
"brought",
"pediatrician",
"parents",
"routine checkup",
"parents note",
"patient recently",
"baseball team",
"keeping",
"gets short of breath",
"exertion",
"patient",
"healthy",
"known history of asthma",
"allergic reaction",
"Today",
"patients temperature",
"98",
... |
A 21-year-old woman comes to the physician because she had a positive pregnancy test at home. For the past 3 weeks, she has had nausea and increased urinary frequency. She also had three episodes of non-bloody vomiting. She attends college and is on the varsity soccer team. She runs 45 minutes daily and lifts weights f... | Stop playing soccer, continue strength training, and do not buy a ski pass | {
"A": "Continue playing soccer, continue strength training, and do not buy a ski pass",
"B": "Stop playing soccer, stop strength training, and do not buy a ski pass",
"C": "Continue playing soccer, stop strength training, and do not buy a ski pass",
"D": "Stop playing soccer, continue strength training, and do... | step2&3 | D | [
"21-year-old woman",
"physician",
"positive pregnancy test at home",
"past",
"weeks",
"nausea",
"increased urinary frequency",
"three episodes of non bloody vomiting",
"attends college",
"soccer team",
"runs 45 minutes daily",
"lifts weights",
"strength training",
"1",
"reports",
"to",... |
A 32-year-old man is brought to the emergency department because of a 2-day history of confusion and rapidly progressive dyspnea. He has had a fever and chills for the past five days. Five years ago, he was diagnosed with hepatitis C. He has smoked two packs of cigarettes daily for 15 years and drinks one to two beers ... | Perivalvular thickening with an echolucent cavity | {
"A": "A highly echogenic, thin, linear structure in the right atrium",
"B": "Anechoic space between pericardium and epicardium",
"C": "Perivalvular thickening with an echolucent cavity",
"D": "Oscillating mobile mass on the tricuspid valve"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"of",
"2-day history",
"confusion",
"rapidly",
"fever",
"chills",
"past five days",
"years",
"diagnosed",
"hepatitis C",
"smoked two packs",
"cigarettes daily",
"years",
"drinks one",
"two beers daily",
"history of past intraveno... |
A 10-year-old girl is admitted to the medical floor for a respiratory infection. The patient lives in a foster home and has been admitted many times. Since birth, the patient has had repeated episodes of pain/pressure over her frontal sinuses and a chronic cough that produces mucus. She was recently treated with amoxic... | Diastolic murmur best heard along the right lower sternal border | {
"A": "Diastolic murmur best heard along the right lower sternal border",
"B": "Hypocalcemia",
"C": "Repeat sinus infections secondary to seasonal allergies",
"D": "Social withdrawal and avoidance of eye contact"
} | step2&3 | A | [
"A 10 year old girl",
"admitted",
"medical floor",
"respiratory infection",
"patient lives",
"foster home",
"admitted",
"times",
"birth",
"patient",
"repeated episodes of pain pressure",
"frontal sinuses",
"chronic cough",
"mucus",
"recently treated with amoxicillin",
"infection",
"p... |
A 34-year-old man comes to the physician for a follow-up examination. He has a 3-month history of a nonproductive cough. He has been treated with diphenhydramine since his last visit 2 weeks ago, but his symptoms have persisted. He does not smoke. He drinks 3 beers on the weekends. He is 177 cm (5 ft 10 in) tall and we... | Pulmonary function testing | {
"A": "Azithromycin therapy",
"B": "Pulmonary function testing",
"C": "Omeprazole therapy",
"D": "CT scan of the chest"
} | step2&3 | B | [
"year old man",
"physician",
"follow-up examination",
"3 month history",
"nonproductive cough",
"treated with diphenhydramine",
"last visit",
"weeks",
"symptoms",
"not smoke",
"drinks 3 beers",
"weekends",
"5 ft 10",
"tall",
"100 kg",
"lbs",
"BMI",
"35",
"kg/m2",
"temperature",... |
A 70-year-old man with a recent above-the-knee amputation of the left lower extremity, due to wet gangrene secondary to refractory peripheral artery disease, presents with weakness and dizziness. He says that the symptoms began acutely 24 hours after surgery and have not improved. The amputation was complicated by subs... | Administer IV fluids and withhold lisinopril | {
"A": "Administer IV fluids and withhold lisinopril",
"B": "Administer oral fludrocortisone",
"C": "Administer IV norepinephrine",
"D": "Administer IV fluids"
} | step2&3 | A | [
"70 year old man",
"recent",
"knee amputation",
"left lower extremity",
"wet gangrene secondary to refractory peripheral artery disease",
"presents",
"weakness",
"dizziness",
"symptoms began",
"24 hours",
"surgery",
"not improved",
"amputation",
"complicated",
"blood loss",
"placed",
... |
A 31-year-old African American woman presents to her primary care provider complaining of stiff, painful fingers. She reports that her symptoms started 2 years ago and have gradually worsened. Her pain is not relieved by ibuprofen or acetaminophen. She is most concerned about having occasional episodes in which her fin... | Nifedipine | {
"A": "Ambrisentan",
"B": "Enalapril",
"C": "Methotrexate",
"D": "Nifedipine"
} | step1 | D | [
"31 year old African American woman presents",
"primary care provider",
"stiff",
"painful fingers",
"reports",
"symptoms started 2 years",
"worsened",
"pain",
"not relieved by ibuprofen",
"acetaminophen",
"most concerned",
"occasional episodes",
"fingers",
"extremely painful",
"turn whit... |
A 47-year-old woman comes to the physician because of easy bruising and fatigue. She appears pale. Her temperature is 38°C (100.4°F). Examination shows a palm-sized hematoma on her left leg. Abdominal examination shows an enlarged liver and spleen. Her hemoglobin concentration is 9.5 g/dL, leukocyte count is 12,300/mm3... | All-trans retinoic acid | {
"A": "Platelet transfusion",
"B": "Rituximab",
"C": "All-trans retinoic acid",
"D": "Cyclophosphamide"
} | step1 | C | [
"year old woman",
"physician",
"easy bruising",
"fatigue",
"appears pale",
"temperature",
"100 4F",
"Examination shows",
"palm sized hematoma",
"left leg",
"Abdominal examination shows",
"enlarged liver",
"spleen",
"hemoglobin concentration",
"9.5 g/dL",
"leukocyte count",
"300 mm3",... |
A 38-year-old woman presents to her primary care physician for evaluation of 3 months of increasing fatigue. She states that she feels normal in the morning, but that her fatigue gets worse throughout the day. Specifically, she says that her head drops when trying to perform overhead tasks. She also says that she exper... | Thymectomy | {
"A": "Antitoxin",
"B": "Chemotherapy",
"C": "Thymectomy",
"D": "Vaccination"
} | step1 | C | [
"year old woman presents",
"primary care physician",
"evaluation",
"months",
"increasing fatigue",
"states",
"feels normal",
"morning",
"fatigue gets worse",
"day",
"head drops",
"to perform",
"tasks",
"experiences double vision",
"watching television",
"reading",
"book",
"physical... |
A 20-year-old male is brought to a psychiatrist by his parents for bizarre behavior. His parents report that over the past two semesters in school, his personality and behavior have changed noticeably. He refuses to leave his room because he believes people are spying on him. He hears voices that are persecutory and is... | Mesolimbic pathway | {
"A": "Mesolimbic pathway",
"B": "Nigrostriatal pathway",
"C": "Tuberoinfundibular pathway",
"D": "Papez circuit"
} | step1 | A | [
"20 year old male",
"brought",
"psychiatrist",
"parents",
"behavior",
"parents report",
"past two semesters in school",
"personality",
"behavior",
"changed",
"refuses to leave",
"room",
"people",
"hears voices",
"people",
"school",
"chips implanted",
"brains",
"Screenings",
"de... |
A 51-year-old man comes to the physician because of a 3-month history of diffuse perineal and scrotal pain. On a 10-point scale, he rates the pain as a 5 to 6. He reports that during this time he also has pain during ejaculation and dysuria. He did not have fever. The pain is persistent despite taking over-the-counter ... | Chronic pelvic pain syndrome | {
"A": "Prostatic abscess",
"B": "Benign prostatic hyperplasia",
"C": "Chronic pelvic pain syndrome",
"D": "Bladder neck cancer"
} | step2&3 | C | [
"year old man",
"physician",
"3 month history",
"diffuse perineal",
"scrotal pain",
"a point scale",
"rates",
"pain",
"reports",
"time",
"pain",
"ejaculation",
"dysuria",
"not",
"fever",
"pain",
"persistent",
"over-the-counter analgesics",
"smoked one pack",
"cigarettes daily",... |
A 57-year-old man presents to the emergency department for evaluation of slurred speech and left arm and leg weakness over the last 3 hours. History reveals hypertension that is being treated with hydrochlorothiazide. Vital signs include: blood pressure of 110/70 mm Hg, heart rate 104/min, respiratory rate 18/min, and ... | Warfarin | {
"A": "Acetylsalicylic acid",
"B": "Clopidogrel",
"C": "Heparin",
"D": "Warfarin"
} | step2&3 | D | [
"57 year old man presents",
"emergency department",
"evaluation",
"slurred",
"left arm",
"leg weakness",
"hours",
"History reveals hypertension",
"treated with hydrochlorothiazide",
"Vital signs include",
"blood pressure",
"70 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"... |
A 36-year-old man was sent to the Emergency Department after a stray baseball hit him in the left eye during a game. Paramedics on sight could not perform the necessary testing and encouraged the patient to visit an ED for further testing and imaging. At the Emergency Department, the patient complains of slight pain in... | The patient can be initially managed conservatively with corticosteroids and observation. | {
"A": "MRI is the best method to evaluate the patient’s condition.",
"B": "There is a low chance of spontaneous improvement of the ocular motility.",
"C": "The patient can be initially managed conservatively with corticosteroids and observation.",
"D": "Surgical intervention within 3 days would allow to preven... | step2&3 | C | [
"36 year old man",
"sent",
"Emergency Department",
"baseball hit",
"left eye",
"game",
"Paramedics",
"sight",
"not perform",
"testing",
"patient to visit",
"ED",
"further testing",
"imaging",
"Emergency Department",
"patient",
"slight pain",
"orbital region",
"minimal diplopia",
... |
A 37-year-old primigravid woman at 36 weeks' gestation is admitted to the hospital 30 minutes after the onset of labor. On arrival, contractions occur every 8–10 minutes. During the last 2 days she has noted decreased fetal movements. The pregnancy had been complicated by gestational hypertension. Current medications i... | Placental insufficiency | {
"A": "Umbilical cord prolapse",
"B": "Umbilical cord compression",
"C": "Physiologic fetal heart rate pattern",
"D": "Placental insufficiency"
} | step2&3 | D | [
"year old primigravid woman",
"36 weeks",
"gestation",
"admitted",
"hospital 30 minutes",
"onset of labor",
"arrival",
"contractions occur",
"minutes",
"last 2 days",
"noted decreased fetal movements",
"pregnancy",
"complicated",
"gestational",
"Current medications include labetalol",
... |
A 2-year-old male presents to the pediatrician for abdominal pain. The patient’s parents report that he has been experiencing intermittent abdominal pain for two days. Each episode lasts several minutes, and the patient seems to be entirely well between the episodes. The pain seems to improve when the patient squats on... | Positive technetium-99m scan | {
"A": "Henoch-Schonlein purpura",
"B": "Positive stool culture",
"C": "Positive technetium-99m scan",
"D": "Resolution with dietary modification"
} | step2&3 | C | [
"2 year old male presents",
"pediatrician",
"abdominal pain",
"patients parents report",
"experiencing intermittent abdominal pain",
"two days",
"episode",
"minutes",
"patient",
"to",
"well",
"episodes",
"pain",
"to",
"patient squats",
"knees",
"chest",
"patients parents",
"decre... |
A 41-year-old female complains of frequent diarrhea and abdominal pain between meals. Endoscopy reveals a duodenal ulcer distal to the duodenal bulb. CT scan of the abdomen demonstrates a pancreatic mass, and subsequent tissue biopsy of the pancreas reveals a malignant islet cell tumor. Which of the following hormones ... | Gastrin | {
"A": "Gastrin",
"B": "Secretin",
"C": "Vasoactive intestinal peptide",
"D": "Motilin"
} | step1 | A | [
"year old female",
"of frequent diarrhea",
"abdominal pain",
"meals",
"Endoscopy reveals",
"duodenal ulcer distal",
"duodenal bulb",
"CT scan",
"abdomen demonstrates",
"pancreatic mass",
"subsequent tissue biopsy of",
"pancreas reveals",
"malignant islet cell tumor",
"following hormones",
... |
A 9-year-old boy is brought to the physician by his father, who is concerned because his son has been less interested in playing soccer with him recently. The father and son used to play every weekend, but the son now tires easily and complains of pain in his lower legs while running around on the soccer field. The pat... | Intracranial hemorrhage | {
"A": "Central cyanosis",
"B": "Intracranial hemorrhage",
"C": "Paradoxical embolism",
"D": "Right heart failure"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"father",
"concerned",
"son",
"less interested",
"playing soccer",
"recently",
"father",
"son used to play",
"weekend",
"son now tires easily",
"pain",
"lower legs",
"running",
"soccer field",
"patient",
"personal",
"family history",
"s... |
A 58-year-old woman presents to the physician with a cough that began 6 years ago, as well as intermittent difficulty in breathing for the last year. There is no significant sputum production. There is no history of rhinorrhea, sneezing or nose congestion. She has been a chronic smoker from early adulthood. Her tempera... | Structural cell death mediated by Rtp801 | {
"A": "Infiltration of the lower airway mucosa by activated eosinophils and T lymphocytes",
"B": "Increased release of matrix metalloproteinase 12 (MMP-12) by neutrophils",
"C": "Structural cell death mediated by Rtp801",
"D": "Activation of histone deacetylase-2"
} | step2&3 | C | [
"58 year old woman presents",
"physician",
"cough",
"began",
"years",
"intermittent difficulty",
"breathing",
"last year",
"significant sputum production",
"history",
"rhinorrhea",
"sneezing",
"nose congestion",
"chronic smoker",
"early adulthood",
"temperature",
"36",
"98 4F",
"... |
An 82-year-old man presents to the emergency department complaining of vision loss in his left eye. He states that it suddenly appeared as if a curtain was coming down over his left eye. It resolved after five minutes, and his vision has returned to normal. He has a history of coronary artery disease and type 2 diabete... | Cholesterol plaque embolization | {
"A": "Sclerosis and narrowing of retinal vessels",
"B": "Deposition of retinal metabolism byproducts",
"C": "Increased intraocular pressure due to a defect in the drainage of aqueous humor",
"D": "Cholesterol plaque embolization"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"of vision loss",
"left eye",
"states",
"appeared",
"curtain",
"left eye",
"resolved",
"five minutes",
"vision",
"returned",
"normal",
"history of coronary artery disease",
"type 2 diabetes",
"most likely cause",
"patient's presentatio... |
A 55-year-old woman presents with symptoms of rectal bleeding and pruritus in the perianal region. She works as a real estate agent and has a history of gastroesophageal reflux disease (GERD). On physical examination, her spleen and liver are enlarged. A blood smear reveals teardrop red blood cells (RBCs), and a leucoe... | Fibrous tissue with sclerotic spicules observed in early stages | {
"A": "Hypercellular bone marrow with fibrosis in later stages",
"B": "Ringed sideroblasts and < 20% of myeloblasts",
"C": "Fibrous tissue with sclerotic spicules observed in early stages",
"D": "Hypocellular bone marrow"
} | step1 | C | [
"55 year old woman presents",
"symptoms",
"rectal",
"pruritus",
"perianal",
"works",
"real estate agent",
"history of gastroesophageal reflux disease",
"physical examination",
"spleen",
"liver",
"enlarged",
"blood smear reveals teardrop red blood cells",
"picture",
"presence",
"nucleat... |
A 25-year-old woman is being evaluated due to complaint of fatigue and voiding pink urine. The laboratory results are as follows:
Hb 6.7
Red blood cell count 3.0 x 1012/L
Leukocyte count 5,000/mm3
Platelets 170 x 109/L
Reticulocyte count 6%
Hematocrit 32%
The physician thinks that the patient is suffering from an acqui... | 4.6% | {
"A": "0.4%",
"B": "0.6%",
"C": "3.1%",
"D": "4.6%"
} | step1 | D | [
"year old woman",
"evaluated due to complaint",
"fatigue",
"voiding pink",
"laboratory results",
"follows",
"Hb",
"Red blood cell count",
"x",
"L",
"5",
"mm3 Platelets",
"Hematocrit",
"physician thinks",
"patient",
"suffering",
"acquired mutation",
"hematopoietic stem cells",
"co... |
A 30-year-old woman presents to the clinic for a 3-month history of painful hair loss. She was in her usual state of health until about 3 months ago when she started to develop some painfully itchy spots across her scalp. Since that time these spots have lost hair and scarred, with new spots continuing to form. On furt... | Discoid lupus erythematosus (DLE) | {
"A": "Alopecia areata",
"B": "Discoid lupus erythematosus (DLE)",
"C": "Tinea capitis",
"D": "Trichotillomania"
} | step2&3 | B | [
"30 year old woman presents",
"clinic",
"3 month history of painful hair loss",
"usual state of health",
"about",
"months",
"started to",
"itchy spots",
"scalp",
"time",
"spots",
"lost hair",
"scarred",
"new spots continuing to form",
"further questioning",
"shares",
"last couple",
... |
A 60-year-old woman presents to the physician because of shortness of breath and easy fatigability over the past 3 months. Her symptoms become worse with physical activity. She notes no chest pain, cough, or wheezing. Her last menstrual period was 10 years ago. She currently takes calcium and vitamin D supplements as w... | Serum methylmalonic acid level | {
"A": "Erythrocyte glutathione reductase activity",
"B": "Erythrocyte pyruvate kinase activity",
"C": "Serum methylmalonic acid level",
"D": "Serum protoporphyrin level"
} | step1 | C | [
"60 year old woman presents",
"physician",
"of shortness",
"breath",
"easy fatigability",
"past 3 months",
"symptoms",
"worse",
"physical activity",
"notes",
"chest pain",
"cough",
"wheezing",
"last menstrual period",
"10 years",
"currently takes calcium",
"vitamin D supplements",
... |
Two weeks after returning from vacation in Mexico, a 21-year-old man comes to the emergency department because of malaise, nausea, vomiting, fever, and abdominal pain. He has no history of serious illness and takes no medications. Physical examination shows scleral icterus and right upper quadrant tenderness. The liver... | Ballooning degeneration and bridging necrosis | {
"A": "Dysplastic hepatocytes with intracellular bile",
"B": "Ballooning degeneration and bridging necrosis",
"C": "Lymphocytic infiltration and progressive ductopenia",
"D": "Piecemeal necrosis and fatty changes"
} | step1 | B | [
"Two weeks",
"returning",
"vacation",
"Mexico",
"21-year-old man",
"emergency department",
"malaise",
"nausea",
"vomiting",
"fever",
"abdominal pain",
"history",
"serious illness",
"takes",
"medications",
"Physical examination shows scleral icterus",
"right upper quadrant tenderness"... |
A 40-year-old woman comes to the physician because of a 2 week history of anorexia and a feeling of dryness in the mouth; she has had a 5.8-kg (12.8-lb) weight loss during this period. She also complains of fatigue and inability to carry out daily chores. One year ago, she was diagnosed with advanced cervical carcinoma... | Megestrol acetate | {
"A": "Mirtazapine",
"B": "Megestrol acetate",
"C": "Cyproheptadine",
"D": "Cognitive behavioral therapy"
} | step2&3 | B | [
"40 year old woman",
"physician",
"2 week history",
"anorexia",
"feeling",
"dryness",
"mouth",
"5.8 kg",
"12.8",
"weight loss",
"period",
"fatigue",
"to carry out daily chores",
"One year ago",
"diagnosed",
"advanced cervical carcinoma",
"metastatic to",
"pancreas",
"treated with... |
A 23-year-old woman is brought to the psychiatric emergency room after she was found naked in the street proclaiming that she was a prophet sent down from heaven to save the world. A review of the electronic medical record reveals that she has a history of an unspecified coagulation disorder. On exam, she speaks rapidl... | Atrialized right ventricle | {
"A": "Atrialized right ventricle",
"B": "Failure of vertebral arch fusion",
"C": "Phocomelia",
"D": "Sirenomelia"
} | step1 | A | [
"23 year old woman",
"brought",
"psychiatric emergency room",
"found naked",
"street",
"sent",
"save",
"world",
"review",
"electronic reveals",
"history of",
"unspecified coagulation disorder",
"exam",
"speaks rapidly",
"makes inappropriate sexual comments",
"physician",
"alert",
"... |
A 10-year-old boy is brought to the emergency department by his parents because of a dull persistent headache beginning that morning. He has nausea and has vomited twice. During the past four days, the patient has had left-sided ear pain and fever, but his parents did not seek medical attention. He is from Thailand and... | MRI of the brain | {
"A": "Intravenous ceftriaxone and clindamycin therapy",
"B": "Intravenous cefazolin and metronidazole therapy",
"C": "MRI of the brain",
"D": "Cranial burr hole evacuation"
} | step2&3 | C | [
"A 10 year old boy",
"brought",
"emergency department",
"parents",
"dull persistent beginning",
"morning",
"nausea",
"vomited twice",
"past four days",
"patient",
"left-sided ear pain",
"fever",
"parents",
"not",
"medical attention",
"Thailand",
"visiting",
"relatives",
"United S... |
A 7-year-old boy is brought to his pediatrician's office by his mother with a new onset rash. His mother says that the rash appeared suddenly yesterday. He is otherwise well. His medical history is unremarkable except for a recent upper respiratory infection that resolved without intervention two weeks ago. His tempera... | Observation | {
"A": "Intravenous immunoglobulin (IVIg)",
"B": "Observation",
"C": "Rituximab",
"D": "Splenectomy"
} | step2&3 | B | [
"year old boy",
"brought",
"pediatrician's office",
"mother",
"new onset rash",
"mother",
"rash appeared",
"well",
"medical history",
"unremarkable",
"recent upper respiratory infection",
"resolved",
"intervention two weeks",
"temperature",
"98",
"36",
"blood pressure",
"74 mmHg",
... |
A 38-year-old man presents to his physician with recurrent episodes of facial swelling and abdominal pain. He reports that these episodes started when he was approximately 16 years of age. His mother also has similar episodes of swelling accompanied by swelling of her extremities. The vital signs include: blood pressur... | Fosinopril | {
"A": "Amlodipine",
"B": "Valsartan",
"C": "Fosinopril",
"D": "Atenolol"
} | step1 | C | [
"year old man presents",
"physician",
"recurrent episodes of facial swelling",
"abdominal pain",
"reports",
"episodes started",
"approximately 16 years",
"age",
"mother",
"similar episodes of swelling",
"swelling",
"extremities",
"vital signs include",
"blood pressure",
"80 mm Hg",
"he... |
A 5-year-old boy undergoes MRI neuroimaging for the evaluation of worsening headaches and intermittent nausea upon awakening. He receives a bolus of intravenous thiopental for sedation during the procedure. Ten minutes after the MRI, the patient is awake and responsive. Which of the following pharmacological properties... | Redistribution | {
"A": "First-pass metabolism",
"B": "Redistribution",
"C": "Zero-order elimination",
"D": "Ion trapping"
} | step1 | B | [
"5 year old boy",
"MRI neuroimaging",
"evaluation",
"worsening headaches",
"intermittent nausea",
"awakening",
"receives",
"bolus",
"intravenous thiopental",
"sedation",
"procedure",
"Ten minutes",
"MRI",
"patient",
"awake",
"responsive",
"following pharmacological properties",
"mo... |
A 65-year-old woman with osteoarthritis comes to the physician because of severe lower back and left leg pain. She has chronic lower back pain that is usually well-controlled with ibuprofen, but 3 hours ago her back pain acutely worsened after she picked up her 3-year-old granddaughter. The pain radiates from her lower... | Intervertebral foramen | {
"A": "Inferior facet joint",
"B": "Subdural space",
"C": "Subarachnoid space",
"D": "Intervertebral foramen"
} | step1 | D | [
"65-year-old woman",
"osteoarthritis",
"physician",
"severe lower back",
"left leg pain",
"chronic lower back pain",
"usually well-controlled",
"ibuprofen",
"3 hours",
"back pain",
"worsened",
"picked",
"year old granddaughter",
"pain radiates",
"lower back",
"left outer thigh",
"kne... |
A 68-year-old man presents to the emergency department complaining of difficulty in breathing for the past 2 days. He has had recurrent episodes of bacterial pneumonia in the right lower lobe during the last 6 months. His last episode of pneumonia started 7 days ago for which he is being treated with antibiotics. He ha... | Small cell lung cancer | {
"A": "Pulmonary hamartoma",
"B": "Mesothelioma",
"C": "Small cell lung cancer",
"D": "Metastatic lung disease"
} | step1 | C | [
"68 year old man presents",
"emergency department",
"difficulty",
"breathing",
"past 2 days",
"recurrent episodes of bacterial pneumonia",
"right lower lobe",
"months",
"last episode of pneumonia started 7 days",
"treated with antibiotics",
"35 pack-year smoking history",
"Past medical history... |
A 37-year-old man comes to the physician because of a 3-day history of fatigue and yellowish discoloration of his eyes and skin. Physical examination shows mild right upper quadrant abdominal tenderness. The course of different serum parameters over the following 4 months is shown. Which of the following is the most li... | Resolved acute hepatitis B infection | {
"A": "Chronic hepatitis B infection with low infectivity",
"B": "Chronic hepatitis B infection with high infectivity",
"C": "Adverse reaction to hepatitis B vaccination",
"D": "Resolved acute hepatitis B infection"
} | step1 | D | [
"year old man",
"physician",
"3-day history",
"fatigue",
"discoloration",
"eyes",
"skin",
"Physical shows mild right upper quadrant abdominal tenderness",
"course",
"different serum parameters",
"following",
"months",
"shown",
"following",
"most likely explanation",
"course",
"patien... |
A 68-year-old man comes to the physician because of fatigue and muscle cramps for the past 4 weeks. He has also noticed several episodes of tingling in both hands. He has not had fever or nausea. He has had a chronic cough for 10 years. He has chronic bronchitis, hypertension, and osteoarthritis of both knees. His fath... | Destruction of parathyroid glands | {
"A": "Multiple endocrine neoplasia",
"B": "Ectopic hormone production",
"C": "Destruction of parathyroid glands",
"D": "Vitamin D deficiency"
} | step2&3 | C | [
"68 year old man",
"physician",
"fatigue",
"muscle cramps",
"past 4 weeks",
"several episodes of tingling",
"hands",
"not",
"fever",
"nausea",
"chronic cough",
"10 years",
"chronic bronchitis",
"hypertension",
"osteoarthritis of",
"knees",
"father died",
"lung cancer",
"Current m... |
An investigator is studying the rate of multiplication of hepatitis C virus in hepatocytes. The viral genomic material is isolated, enzymatically cleaved into smaller fragments and then separated on a formaldehyde agarose gel membrane. Targeted probes are then applied to the gel and visualized under x-ray. Which of the... | Ribonucleic acids | {
"A": "Ribonucleic acids",
"B": "Deoxyribonucleic acids",
"C": "Transcription factors",
"D": "Lipid-linked oligosaccharides"
} | step1 | A | [
"investigator",
"studying",
"rate",
"multiplication",
"hepatitis C virus",
"hepatocytes",
"viral genomic material",
"isolated",
"cleaved",
"smaller fragments",
"then separated",
"formaldehyde agarose gel membrane",
"Targeted probes",
"then applied",
"gel",
"visualized",
"x-ray",
"f... |
A 72-year-old male is brought from his nursing home to the emergency department for fever, chills, dyspnea, productive cough, and oliguria over the past 72 hours. He was in his normal state of health and slowly developed breathing problems and fever. His past medical history is significant for hepatitis C, hypertension... | Blood urea nitrogen (BUN):Serum creatinine ratio (SCr) <15:1 | {
"A": "Urinary osmolality > 500 mOsmol/kg",
"B": "Urinary osmolality < 350 mOsmol/kg",
"C": "Blood urea nitrogen (BUN):Serum creatinine ratio (SCr) <15:1",
"D": "Urine sodium > 40 mEq/L"
} | step2&3 | C | [
"72 year old male",
"brought",
"nursing home",
"emergency department",
"fever",
"chills",
"dyspnea",
"productive cough",
"oliguria",
"past 72 hours",
"normal state of health",
"slowly",
"breathing problems",
"fever",
"past medical history",
"significant",
"hepatitis C",
"hypertensi... |
A 70-year-old Caucasian male presents to the emergency room following a fall. The patient's past medical history is significant for myocardial infarction and atrial fibrillation. His home medications are unknown. The patient's head CT is shown in Image A. Laboratory results reveal an International Normalized Ratio (INR... | Vitamin K | {
"A": "Vitamin K",
"B": "Protamine",
"C": "Platelet transfusion",
"D": "Fresh frozen plasma"
} | step1 | A | [
"70 year old Caucasian male presents",
"emergency room following",
"fall",
"patient's past",
"significant",
"myocardial infarction",
"atrial fibrillation",
"home medications",
"unknown",
"patient's head CT",
"shown",
"Image",
"Laboratory results reveal",
"International Normalized Ratio",
... |
A 26-year-old woman presents to her gynecologist with complaints of pain with her menses and during intercourse. She also complains of chest pain that occurs whenever she has her menstrual period. The patient has a past medical history of bipolar disorder and borderline personality disorder. Her current medications inc... | Laparoscopy | {
"A": "Clinical diagnosis",
"B": "Endometrial biopsy",
"C": "Laparoscopy",
"D": "Transvaginal ultrasound"
} | step2&3 | C | [
"year old woman presents",
"gynecologist",
"complaints",
"pain",
"menses",
"intercourse",
"of chest pain",
"occurs",
"menstrual period",
"patient",
"past medical bipolar disorder",
"borderline personality disorder",
"current medications include lithium",
"haloperidol",
"Review of systems... |
A 47-year-old man is brought to the emergency department by police. He was forcibly removed from a bar for lewd behavior. The patient smells of alcohol, and his speech is slurred and unintelligible. The patient has a past medical history of alcohol abuse, obesity, diabetes, and Wernicke encephalopathy. The patient's cu... | AST: 255, ALT: 130, GGT: 114 | {
"A": "AST: 225, ALT: 245, GGT: 127",
"B": "AST: 255, ALT: 130, GGT: 114",
"C": "AST: 425, ALT: 475, GGT: 95",
"D": "AST: 455, ALT: 410, GGT: 115"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"police",
"removed",
"behavior",
"patient smells",
"alcohol",
"speech",
"slurred",
"unintelligible",
"patient",
"past medical history of alcohol abuse",
"obesity",
"diabetes",
"Wernicke encephalopathy",
"patient's currently prescribe... |
A 72-year-old man is seen in the hospital for a sacral rash. The patient has been hospitalized for the past 3 weeks for a heart failure exacerbation. When the nurse went to bathe him this morning, she noticed a red rash over his sacrum. The patient reports mild discomfort and denies pruritus. The patient has chronic ki... | Repositioning | {
"A": "Metformin",
"B": "Prophylactic oral ciprofloxacin",
"C": "Repositioning",
"D": "Topical silver sulfadiazine"
} | step2&3 | C | [
"72 year old man",
"seen",
"hospital",
"sacral rash",
"patient",
"hospitalized",
"past",
"weeks",
"heart failure exacerbation",
"nurse",
"to bathe",
"morning",
"red rash",
"sacrum",
"patient reports mild discomfort",
"denies pruritus",
"patient",
"chronic kidney disease",
"urinar... |
A 70-year-old man with a long-standing history of diabetes mellitus type 2 and hypertension presents with complaints of constant wrist and shoulder pain. Currently, the patient undergoes hemodialysis 2 to 3 times a week and is on the transplant list for a kidney. The patient denies any recent traumas. Which of the foll... | β2-microglobulin | {
"A": "Ig light chains",
"B": "Amyloid A (AA)",
"C": "Amyloid precursor protein",
"D": "β2-microglobulin"
} | step1 | D | [
"year old man",
"long standing history of diabetes mellitus type 2",
"hypertension presents",
"complaints",
"constant wrist",
"shoulder pain",
"Currently",
"patient",
"hemodialysis 2",
"times",
"week",
"transplant list",
"kidney",
"patient denies",
"recent traumas",
"following proteins... |
A 25-year-old woman presents to the clinic with complaints of dysuria and increased urinary frequency. Her urinalysis results are negative for nitrites. Urine microscopy shows the findings in figure A.
What is the most likely cause underlying her symptoms? | S. saprophyticus infection | {
"A": "E. coli infection",
"B": "S. saprophyticus infection",
"C": "Acute tubular necrosis",
"D": "Renal calculi"
} | step1 | B | [
"year old woman presents",
"clinic",
"complaints",
"dysuria",
"increased urinary frequency",
"urinalysis results",
"negative",
"nitrites",
"Urine microscopy shows",
"findings",
"most likely cause",
"symptoms"
] |
A newborn infant is born at 42 weeks gestation to a healthy 36-year-old G1P0. The delivery was complicated by prolonged labor and shoulder dystocia. The child is in the 87th and 91st percentiles for height and weight at birth, respectively. The mother’s past medical history is notable for diabetes mellitus and obesity.... | Triceps | {
"A": "Brachialis",
"B": "Brachioradialis",
"C": "Biceps",
"D": "Triceps"
} | step1 | D | [
"newborn infant",
"born",
"weeks gestation",
"healthy 36 year old",
"delivery",
"complicated",
"prolonged",
"shoulder dystocia",
"child",
"percentiles",
"height",
"weight",
"birth",
"mothers past medical history",
"notable",
"diabetes mellitus",
"obesity",
"Immediately",
"birth",... |
A 28-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the physician because of headache for the past 5 days. Her pregnancy has been uncomplicated to date. Pregnancy and vaginal delivery of her first child were uncomplicated. The patient does not smoke or drink alcohol. She does not use illicit drugs. ... | Abruptio placentae | {
"A": "Abruptio placentae",
"B": "Spontaneous abortion",
"C": "Uterine rupture",
"D": "Polyhydramnios"
} | step1 | A | [
"year old woman",
"gravida 2",
"para 1",
"30 weeks",
"estation ",
"hysician ",
"f eadache ",
"ast days.",
"regnancy ",
"ncomplicated ",
"ate.",
"regnancy ",
"aginal delivery ",
"irst hild ",
"ncomplicated.",
"atient ",
"ot moke ",
"rink alcohol.",
"ot se llicit drugs.",
... |
A 16-year-old boy with history of seizure disorder is rushed to the Emergency Department with multiple generalized tonic-clonic seizures that have spanned more than 30 minutes in duration. He has not regained consciousness between these episodes. In addition to taking measures to ensure that he maintains adequate respi... | Lorazepam | {
"A": "Phenytoin",
"B": "Carbamazepine",
"C": "Gabapentin",
"D": "Lorazepam"
} | step1 | D | [
"year old boy",
"history of seizure disorder",
"rushed",
"Emergency Department",
"multiple generalized tonic-clonic seizures",
"spanned more",
"30 minutes",
"duration",
"not regained consciousness",
"episodes",
"measures to ensure",
"maintains adequate respiration",
"following",
"appropria... |
A 35-year-old woman presents to an outpatient clinic during winter for persistant rhinorrhea. She states it is persistent and seems to be worse when she goes outside. Otherwise, she states she is generally healthy and only has a history of constipation. Her temperature is 98.7°F (37.1°C), blood pressure is 144/91 mmHg,... | Environmental allergen | {
"A": "Cold weather",
"B": "Coronavirus",
"C": "Environmental allergen",
"D": "Streptococcus pneumonia"
} | step2&3 | C | [
"35 year old woman presents",
"outpatient clinic",
"winter",
"rhinorrhea",
"states",
"persistent",
"to",
"worse",
"goes outside",
"states",
"healthy",
"only",
"history",
"constipation",
"temperature",
"98",
"blood pressure",
"mmHg",
"pulse",
"min",
"respirations",
"min",
... |
A 21-year-old male presents to your office with hematuria 3 days after the onset of a productive cough and fever. Following renal biopsy, immunofluorescence shows granular IgA deposits in the glomerular mesangium. Which of the following do you suspect in this patient? | Berger’s disease | {
"A": "Lipoid nephrosis",
"B": "Berger’s disease",
"C": "Poststreptococcal glomerulonephritis",
"D": "HIV infection"
} | step1 | B | [
"21-year-old male presents",
"office",
"hematuria 3 days",
"onset",
"productive cough",
"fever",
"Following renal biopsy",
"immunofluorescence shows granular IgA deposits",
"glomerular",
"following",
"suspect",
"patient"
] |
A 73-year-old man presents to the office, complaining of “weird blisters” on his right hand, which appeared 2 weeks ago. The patient says that he initially had a rash, which progressed to blisters. He denies any trauma or known contact with sick people. He is worried because he hasn’t been able to garden since the rash... | Itraconazole | {
"A": "Potassium iodide solution",
"B": "Azithromycin",
"C": "Doxycycline",
"D": "Itraconazole"
} | step1 | D | [
"year old man presents",
"office",
"blisters",
"right hand",
"appeared 2 weeks",
"patient",
"initially",
"rash",
"progressed",
"blisters",
"denies",
"trauma",
"known contact with sick people",
"worried",
"hasnt",
"able",
"garden",
"rash appeared",
"planning",
"entering",
"ros... |
A 60-year-old male presents to the emergency room complaining of substernal chest pain. He reports a three-hour history of dull substernal chest pain that radiates into his left arm and jaw. He had a similar incident two months ago after walking one mile, but this pain is more severe. His past medical history is notabl... | Guanylyl cyclase activation | {
"A": "Guanylyl cyclase activation",
"B": "cAMP production",
"C": "ß1-adrenergic antagonism",
"D": "L-type calcium channel inhibition"
} | step1 | A | [
"60 year old male presents",
"emergency room",
"substernal chest pain",
"reports",
"three hour history of dull",
"chest pain",
"radiates",
"left arm",
"jaw",
"similar incident two months",
"walking one mile",
"pain",
"more severe",
"past medical history",
"notable",
"hypertension",
"... |
A 3-year-old male is brought by his mother to the pediatrician because she is concerned about a lump in his neck. She reports that the child was recently ill with a cough, nasal congestion, and rhinorrhea. She also noticed that a small red lump developed on the patient’s neck while he was sick. Although his cough and c... | Follicular cells surrounding colloid and admixed with a neutrophilic infiltrate | {
"A": "Follicular cells surrounding colloid and admixed with a neutrophilic infiltrate",
"B": "Randomly oriented papillae with fibrovascular cores and empty-appearing nuclei",
"C": "Diffuse hyperplasia and hypertrophy of follicular cells",
"D": "Stratified squamous epithelium associated with hair follicles and... | step1 | A | [
"3 year old male",
"brought",
"mother",
"pediatrician",
"concerned",
"lump",
"neck",
"reports",
"child",
"recently ill",
"cough",
"nasal congestion",
"rhinorrhea",
"small red lump",
"patients neck",
"sick",
"cough",
"congestion",
"days",
"neck lump",
"child",
"notable past ... |
A 50-year-old woman presents to the outpatient clinic because of a swollen and enlarged right breast. Clinical examination shows no evidence of mass or axillary lymphadenopathy. There is no history of trauma or inflammation. Her past medical and surgical history is positive for breast augmentation with a textured impla... | Cytological analysis for CD30 and ALK | {
"A": "Surgical replacement of textured implant with a smooth implant",
"B": "Mammogram",
"C": "Cytological analysis for CD30 and ALK",
"D": "Chemotherapy"
} | step2&3 | C | [
"50 year old woman presents",
"outpatient clinic",
"swollen",
"enlarged right breast",
"Clinical examination shows",
"evidence",
"mass",
"axillary lymphadenopathy",
"history",
"trauma",
"inflammation",
"past medical",
"surgical history",
"positive",
"breast augmentation",
"textured imp... |
A 48-year-old man presents to his primary care physician with diarrhea and weight loss. He states he has had diarrhea for the past several months that has been worsening steadily. The patient recently went on a camping trip and drank unfiltered stream water. Otherwise, the patient endorses a warm and flushed feeling in... | Urinary 5-hydroxyindoleacetic acid level | {
"A": "Echocardiography",
"B": "Plasma free metanephrine levels",
"C": "Pulmonary function tests",
"D": "Urinary 5-hydroxyindoleacetic acid level"
} | step2&3 | D | [
"48 year old man presents",
"primary care physician",
"diarrhea",
"weight loss",
"states",
"diarrhea",
"past",
"months",
"worsening",
"patient recently",
"camping trip",
"drank unfiltered stream water",
"patient",
"warm",
"flushed feeling",
"face",
"occurs sporadically",
"temperatu... |
A 25-year-old man presents to the emergency department after a motor vehicle accident. He was the unrestrained front seat driver in a head on collision. The patient is unresponsive and his medical history is unknown. His temperature is 99.5°F (37.5°C), blood pressure is 67/38 mmHg, pulse is 190/min, respirations are 33... | Febrile non-hemolytic transfusion reaction | {
"A": "Acute hemolytic transfusion reaction",
"B": "Febrile non-hemolytic transfusion reaction",
"C": "Leukoagglutination reaction",
"D": "Minor blood group incompatibility"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"motor vehicle accident",
"front",
"driver",
"head",
"collision",
"patient",
"unresponsive",
"medical history",
"unknown",
"temperature",
"99",
"blood pressure",
"67",
"mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen satu... |
A newborn is rushed to the neonatal ICU after becoming cyanotic shortly after birth. An ultrasound is performed which shows the aorta coming off the right ventricle and lying anterior to the pulmonary artery. The newborn is given prostaglandin E1 and surgery is planned to correct the anatomic defect. Which of the follo... | Failure of the aorticopulmonary septum to spiral | {
"A": "Failure of the septum primum to fuse with the septum secundum",
"B": "Failure of the membranous ventricular septum to fuse with the muscular interventricular septum",
"C": "Failure of the ductus arteriosus to close",
"D": "Failure of the aorticopulmonary septum to spiral"
} | step1 | D | [
"newborn",
"rushed",
"neonatal ICU",
"cyanotic",
"birth",
"ultrasound",
"performed",
"shows",
"aorta",
"right",
"lying anterior",
"pulmonary artery",
"newborn",
"given prostaglandin E1",
"surgery",
"planned",
"correct",
"anatomic defect",
"following developmental processes failed... |
A 48-year-old woman underwent a thyroidectomy with central neck dissection due to papillary thyroid carcinoma. On day 2 postoperatively, she developed irritability, dysphagia, difficulty breathing, and spasms in different muscle groups in her upper and lower extremities. The vital signs include blood pressure 102/65 mm... | Vitamin D and ionic calcium prior to and 2 weeks after the operation | {
"A": "Anticonvulsants prior to and for 1 week after the operation",
"B": "Magnesium sulfate intraoperatively",
"C": "Vitamin D and ionic calcium prior to and 2 weeks after the operation",
"D": "Potassium supplementation prior to and 2 weeks after the operation"
} | step1 | C | [
"48 year old woman",
"thyroidectomy",
"central neck dissection",
"papillary thyroid carcinoma",
"day 2",
"irritability",
"dysphagia",
"difficulty breathing",
"spasms",
"different muscle groups",
"upper",
"lower extremities",
"vital signs include blood pressure",
"65 mm Hg",
"heart rate",... |
A 56-year-old man presents with sudden-onset severe eye pain and blurred vision. He says the symptoms onset an hour ago and his vision has progressively worsened. Physical examination reveals a cloudy cornea and decreased visual acuity. Timolol is administered into the eyes to treat this patient’s symptoms. Which of th... | It suppresses the ciliary epithelium from producing aqueous humor | {
"A": "Increased outflow via dilatation of the uveoscleral veins",
"B": "It suppresses the ciliary epithelium from producing aqueous humor",
"C": "It increases the transit of aqueous humor into the vitreous humor for absorption into the choroid",
"D": "It leads to opening of the trabecular meshwork"
} | step1 | B | [
"year old man presents",
"sudden-onset severe eye pain",
"blurred vision",
"symptoms onset",
"hour",
"vision",
"worsened",
"Physical examination reveals",
"cloudy cornea",
"decreased visual acuity",
"Timolol",
"administered",
"eyes to treat",
"patients symptoms",
"following best",
"mec... |
Four days after undergoing a craniotomy and evacuation of a subdural hematoma, a 56-year-old man has severe pain and swelling of his right leg. He has chills and nausea. He has type 2 diabetes mellitus and chronic kidney disease, and was started on hemodialysis 2 years ago. Prior to admission, his medications were insu... | Inferior vena cava filter | {
"A": "Unfractionated heparin therapy",
"B": "Inferior vena cava filter",
"C": "Urokinase therapy",
"D": "Warfarin therapy\n\""
} | step2&3 | B | [
"Four days",
"craniotomy",
"evacuation of",
"subdural hematoma",
"year old man",
"severe pain",
"swelling of",
"right leg",
"chills",
"nausea",
"type 2 diabetes mellitus",
"chronic kidney disease",
"started",
"hemodialysis",
"years",
"admission",
"medications",
"insulin",
"enalap... |
A 10-year-old boy is presented to the hospital for a kidney transplant. In the operating room, the surgeon connects an allograft kidney renal artery to the aorta, and after a few moments, the kidney becomes cyanotic, edematous, and dusky with mottling. Which of the following in the recipient’s serum is responsible for ... | IgG | {
"A": "IgA",
"B": "IgG",
"C": "CD8+ T cells",
"D": "CD4+ T cells"
} | step1 | B | [
"A 10 year old boy",
"presented",
"hospital",
"kidney transplant",
"operating room",
"surgeon connects",
"allograft kidney",
"artery",
"aorta",
"few",
"kidney",
"cyanotic",
"edematous",
"dusky",
"mottling",
"following",
"recipients serum",
"responsible",
"rejection"
] |
Background: Beta-blockers reduce mortality in patients who have chronic heart failure, systolic dysfunction, and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors. We aimed to compare the effects of carvedilol and metoprolol on clinical outcome.
Methods: In a multicenter, double-bl... | 1/(0.40 - 0.34) | {
"A": "1/(0.40 - 0.34)",
"B": "1/(40 - 34)",
"C": "1/(34 - 40)",
"D": "1/0.83"
} | step2&3 | A | [
"Background",
"Beta-blockers",
"mortality",
"patients",
"chronic heart failure",
"systolic dysfunction",
"background treatment",
"diuretics",
"angiotensin-converting enzyme inhibitors",
"aimed to compare",
"effects",
"carvedilol",
"metoprolol",
"clinical outcome",
"Methods",
"multicent... |
A 52-year-old man who was recently hospitalized with a pulmonary embolism is put on an unfractionated heparin drip as a bridge to chronic warfarin therapy. During morning rounds, he is found to have diffuse bruising despite minimal trauma, and his heparin infusion rate is found to be faster than prescribed. A coagulati... | Protamine sulfate | {
"A": "Aminocaproic acid",
"B": "Fresh frozen plasma",
"C": "Platelets",
"D": "Protamine sulfate"
} | step1 | D | [
"year old man",
"recently hospitalized",
"pulmonary embolism",
"put",
"unfractionated heparin drip",
"bridge",
"chronic warfarin therapy",
"morning rounds",
"found to",
"diffuse bruising",
"minimal trauma",
"heparin infusion rate",
"found to",
"faster",
"prescribed",
"coagulation panel... |
A new formula for an anti-wrinkle cream is being tested for efficacy in a group of 362 healthy 40- to 60-year-old female volunteers. The marketing team randomizes the volunteers. Half receive the new formula and the other half of the volunteers receive the original formula. The mean age in the test group is 48 (95% CI ... | Observer bias | {
"A": "Selection bias",
"B": "Observer bias",
"C": "Procedure bias",
"D": "Recall bias"
} | step1 | B | [
"A new formula",
"anti wrinkle cream",
"tested",
"efficacy",
"a group",
"healthy 40",
"60 year old female volunteers",
"marketing team",
"volunteers",
"Half receive",
"new formula",
"half",
"volunteers receive",
"original formula",
"mean age",
"test group",
"95",
"CI",
"average a... |
A 49-year-old woman comes to the physician because of a 1-year history of bloating and constipation alternating with diarrhea. She eats a balanced diet, and there are no associations between her symptoms and specific foods. She had been a competitive swimmer since high school but stopped going to training 4 months ago ... | Calcium deposits in the skin | {
"A": "Bilateral pupillary constriction",
"B": "Outpouchings of the sigmoid colon",
"C": "Villous atrophy in the duodenum",
"D": "Calcium deposits in the skin"
} | step2&3 | D | [
"year old woman",
"physician",
"year history",
"bloating",
"constipation alternating",
"diarrhea",
"eats",
"balanced diet",
"associations",
"symptoms",
"specific foods",
"competitive swimmer",
"high school",
"stopped",
"training",
"months",
"fingers",
"turned blue",
"got",
"col... |
A 20-year-old woman is brought to the emergency department because of severe muscle soreness, nausea, and darkened urine for 2 days. The patient is on the college track team and has been training intensively for an upcoming event. One month ago, she had a urinary tract infection and was treated with nitrofurantoin. She... | Acute kidney injury | {
"A": "Acute kidney injury",
"B": "Compartment syndrome",
"C": "Metabolic alkalosis",
"D": "Myocarditis"
} | step2&3 | A | [
"20 year old woman",
"brought",
"emergency department",
"severe muscle soreness",
"nausea",
"urine",
"2 days",
"patient",
"college track team",
"training",
"event",
"One month",
"urinary tract infection",
"treated with nitrofurantoin",
"appears healthy",
"temperature",
"98",
"pulse... |
A 56-year-old man presents for a follow-up regarding his management for type 2 diabetes mellitus (DM). He was diagnosed with type 2 DM about 7 years ago and was recently started on insulin therapy because oral agents were insufficient to control his glucose levels. He is currently following a regimen combining insulin ... | Add another dose of NPH in the evening. | {
"A": "Add another dose of NPH in the evening.",
"B": "Add insulin glargine to the current regime.",
"C": "Replace lispro with insulin aspart.",
"D": "Reduce a dose of insulin lispro."
} | step1 | A | [
"year old man presents",
"follow-up",
"management",
"type 2 diabetes mellitus",
"diagnosed",
"type 2 DM",
"years",
"recently started",
"insulin therapy",
"oral agents",
"insufficient to control",
"glucose levels",
"currently following",
"regimen combining insulin lispro",
"neutral protam... |
A 17-year-old high school student presents to the physician’s office for a health maintenance examination. He is a recent immigrant from Venezuela and has no complaints at this time. Past medical history is significant for appendicitis at age 10, treated with an appendectomy. He denies the use of alcohol and cigarettes... | HPV vaccine | {
"A": "Ceftriaxone and azithromycin as prophylaxis",
"B": "HPV vaccine",
"C": "HPV vaccine as a legal adult at age 18",
"D": "Urine toxicology"
} | step2&3 | B | [
"year old high school student presents",
"physicians office",
"health maintenance examination",
"recent immigrant",
"Venezuela",
"complaints",
"time",
"Past medical history",
"significant",
"appendicitis",
"age 10",
"treated with",
"appendectomy",
"denies",
"use",
"alcohol",
"cigaret... |
A group of researchers aimed to study the association between phosphate levels in plasma and renal function decline in pre-dialysis patients. The study started in 2018 by including incident pre-dialysis patients (with chronic kidney disease in stage IV or V) who were already included in pre-dialysis care procedures bet... | Inability to control for specific factors | {
"A": "Hypotheses generation",
"B": "Selection based on the exposure status",
"C": "Inability to control for specific factors",
"D": "Lack of inter-rater reliability"
} | step1 | C | [
"A group",
"researchers aimed to study",
"association",
"phosphate levels",
"plasma",
"renal function",
"pre-dialysis patients",
"study started",
"including incident pre-dialysis patients",
"chronic kidney disease",
"stage IV",
"included",
"pre dialysis care procedures",
"patients",
"fou... |
A 56-year-old man comes to the office complaining of a dry cough for 2 months. His medical history includes a recent myocardial infarction (MI), after which he was placed on several medications. He is currently on ramipril, clopidogrel, digoxin, lovastatin, and nitroglycerin. He does not smoke cigarettes and does not d... | Ramipril | {
"A": "Ramipril",
"B": "Clopidogrel",
"C": "Nitroglycerin",
"D": "Lovastatin"
} | step1 | A | [
"year old man",
"office complaining of",
"dry cough",
"2 months",
"medical history includes",
"recent myocardial infarction",
"placed",
"medications",
"currently",
"ramipril",
"clopidogrel",
"digoxin",
"lovastatin",
"nitroglycerin",
"not smoke cigarettes",
"not drink alcohol",
"denie... |
An investigator is studying the effect of extracellular pH changes on the substrates for the citric acid cycle. Which of the following substances is required for the reaction catalyzed by the enzyme marked by the arrow in the overview of the citric acid cycle? | Pantothenic acid | {
"A": "Thiamine",
"B": "Pantothenic acid",
"C": "Lipoic acid",
"D": "Niacin"
} | step1 | B | [
"investigator",
"studying",
"effect",
"extracellular pH changes",
"substrates",
"citric acid cycle",
"following substances",
"required",
"reaction",
"enzyme marked",
"arrow",
"overview",
"citric acid cycle"
] |
A 60-year-old woman and her son are visited at her home by a health aid. He is her caregiver but has difficulty getting her out of the house. Her son is concerned about continuous and repetitive mouth and tongue movements that started about 2 weeks ago and have become more evident ever since. She is non-verbal at basel... | Stop the medication | {
"A": "Start clozapine",
"B": "Switch to chlorpromazine",
"C": "Expectant management",
"D": "Stop the medication"
} | step1 | D | [
"60 year old woman",
"son",
"visited",
"home",
"health aid",
"caregiver",
"difficulty getting",
"out",
"house",
"son",
"concerned",
"continuous",
"mouth",
"tongue movements",
"started",
"2 weeks",
"more evident ever",
"non-verbal",
"baseline",
"complete",
"activities of daily... |
A 52-year-old woman presents to her primary care physician complaining of 3 weeks of persistent thirst despite consumption of increased quantities of water. She also admits that she has had increased frequency of urination during the same time period. A basic metabolic panel is performed which reveals mild hypernatremi... | Central diabetes insipidus | {
"A": "Primary polydipsia",
"B": "Diabetes mellitus",
"C": "Central diabetes insipidus",
"D": "Surreptitious diuretic use"
} | step1 | C | [
"year old woman presents",
"primary care physician",
"weeks",
"persistent thirst",
"consumption",
"increased quantities",
"water",
"admits",
"increased frequency of urination",
"same time period",
"basic metabolic panel",
"performed",
"reveals mild hypernatremia",
"normal glucose level",
... |
A 19-year-old woman with no known past medical history presents to the emergency department with increasing lower pelvic pain and vaginal discharge over the last several days. She endorses some experimentation with marijuana and cocaine, drinks liquor almost daily, and smokes 2 packs of cigarettes per day. The patient'... | Exploratory laparotomy | {
"A": "Levofloxacin and metronidazole × 14 days",
"B": "Single-dose ceftriaxone IM",
"C": "Exploratory laparotomy",
"D": "Clindamycin + gentamicin × 14 days"
} | step2&3 | C | [
"year old woman",
"known past medical history presents",
"emergency department",
"increasing lower pelvic pain",
"vaginal discharge",
"days",
"experimentation",
"marijuana",
"cocaine",
"drinks liquor almost daily",
"smokes",
"packs",
"cigarettes",
"day",
"patient's blood pressure",
"84... |
A 5-year-old boy presents to your office with his mother. The boy has been complaining of a sore throat and headache for the past 2 days. His mother states that he had a fever of 39.3°C (102.7°F) and had difficulty eating. On examination, the patient has cervical lymphadenopathy and erythematous tonsils with exudates. ... | A naked, double-stranded DNA virus | {
"A": "A gram-negative, pleomorphic, obligate intracellular bacteria",
"B": "A naked, double-stranded DNA virus",
"C": "A gram-positive, beta-hemolytic cocci in chains",
"D": "An enveloped, double-stranded DNA virus"
} | step1 | B | [
"5 year old boy presents",
"office",
"mother",
"boy",
"sore throat",
"headache",
"past 2 days",
"mother states",
"fever",
"3C",
"difficulty eating",
"examination",
"patient",
"cervical lymphadenopathy",
"erythematous tonsils",
"exudates",
"streptococcal rapid antigen detection test",... |
A 57-year-old man presents to his family physician for a checkup. He has had type 2 diabetes mellitus for 13 years, for which he has been taking metformin and vildagliptin. He has smoked 10–15 cigarettes daily for 29 years. Family history is irrelevant. Vital signs include: temperature 36.6°C (97.8°F), blood pressure 1... | Inhibition of cholesterol synthesis | {
"A": "Inhibition of cholesterol absorption",
"B": "Bile acid sequestration",
"C": "Inhibition of cholesterol synthesis",
"D": "Activation of PPAR-alpha"
} | step2&3 | C | [
"57 year old man presents",
"family physician",
"checkup",
"type 2 diabetes mellitus",
"years",
"taking metformin",
"vildagliptin",
"smoked",
"cigarettes daily",
"29 years",
"Family history",
"Vital signs include",
"temperature 36",
"97",
"blood pressure",
"87 mm Hg",
"pulse 88 min",... |
A 69-year-old man comes to the physician with a 2-year history of progressive hearing loss. His hearing is worse in crowded rooms, and he has noticed that he has more difficulty understanding women than men. He has no history of serious illness and does not take any medications. A Rinne test shows air conduction is gre... | Basal turn of the cochlea | {
"A": "External acoustic meatus",
"B": "Tympanic membrane",
"C": "Basal turn of the cochlea",
"D": "Base of the stapes"
} | step1 | C | [
"69 year old man",
"physician",
"2 year history of progressive hearing loss",
"hearing",
"worse",
"crowded rooms",
"more difficulty understanding women",
"men",
"history",
"serious illness",
"not take",
"medications",
"Rinne test shows air conduction",
"greater than bone conduction",
"co... |
An investigator is studying the growth of an organism in different media. The organism is inoculated on a petri dish that contains heated sheep blood, vancomycin, nystatin, trimethoprim, and colistin. The resulting growth medium is incubated at 37°C. Numerous small, white colonies are seen after incubation for 48 hours... | Gonorrhea | {
"A": "Pontiac fever",
"B": "Hemolytic uremic syndrome",
"C": "Oral thrush",
"D": "Gonorrhea"
} | step1 | D | [
"investigator",
"studying",
"growth",
"organism",
"different media",
"organism",
"inoculated",
"petri dish",
"contains heated sheep blood",
"vancomycin",
"nystatin",
"trimethoprim",
"colistin",
"resulting growth medium",
"incubated",
"Numerous small",
"white colonies",
"seen",
"4... |
The parents of a 4-year-old present to the pediatrician because they are concerned about the poor growth and odd behavior of their son. Their son has been at the 10th percentile for growth since birth and they have noticed that his skin seems to have a bluish hue to it whenever he cries or is agitated. Recently, they h... | Anterosuperior displacement of aorticopulmonary septum | {
"A": "Failure of the aorticopulmonary septum to spiral",
"B": "Failure of the ductus arteriosus to obliterate",
"C": "Partial aorticopulmonary septum development",
"D": "Anterosuperior displacement of aorticopulmonary septum"
} | step1 | D | [
"parents",
"year old present",
"pediatrician",
"concerned",
"poor growth",
"odd behavior",
"son",
"son",
"percentile",
"growth",
"birth",
"skin",
"to",
"hue",
"cries",
"agitated",
"Recently",
"squats",
"to relieve",
"symptoms",
"embryologic cause",
"patient's current sympto... |
A 5-year-old boy is brought to the physician because of early morning headaches for the past 6 months. During this period, he has had severe nausea and occasional episodes of vomiting. For the past month, he has had difficulty walking and intermittent double vision. He was born at term and has been healthy apart from a... | Medulloblastoma
" | {
"A": "Schwannoma",
"B": "Hemangioblastoma",
"C": "Meningioma",
"D": "Medulloblastoma\n\""
} | step2&3 | D | [
"5 year old boy",
"brought",
"physician",
"of early morning headaches",
"past 6 months",
"period",
"severe nausea",
"occasional episodes of vomiting",
"past month",
"difficulty walking",
"intermittent double vision",
"born",
"term",
"healthy",
"episode of sinusitis",
"months",
"resol... |
An 82-year-old male visits his primary care physician for a check-up. He reports that he is in his usual state of health. His only new complaint is that he feels as if the room is spinning, which has affected his ability to live independently. He is currently on lisinopril, metformin, aspirin, warfarin, metoprolol, and... | Multiple sclerosis | {
"A": "Aminoglycoside toxicity",
"B": "Benign paroxysmal positional vertigo",
"C": "Meniere disease",
"D": "Multiple sclerosis"
} | step1 | D | [
"year old male visits",
"primary care physician",
"check-up",
"reports",
"usual state of health",
"only new complaint",
"feels",
"room",
"spinning",
"affected",
"ability to live",
"currently",
"lisinopril",
"metformin",
"aspirin",
"warfarin",
"metoprolol",
"simvastatin",
"prescri... |
A 56-year-old man comes to the physician because of a painless blistering rash on his hands, forearms, and face for 2 weeks. The rash is not itchy and seems to get worse in the sunlight. He has also noticed that his urine is darker than usual. His aunt and sister have a history of similar skin lesions. Examination of t... | Hydroxychloroquine | {
"A": "Hemin",
"B": "Prednisone",
"C": "Fexofenadine",
"D": "Hydroxychloroquine"
} | step1 | D | [
"year old man",
"physician",
"of",
"painless blistering",
"hands",
"forearms",
"face",
"2 weeks",
"rash",
"not itchy",
"to",
"worse",
"sunlight",
"urine",
"darker",
"usual",
"aunt",
"sister",
"history of similar skin lesions",
"Examination",
"shows multiple fluid filled blist... |
A 34-year-old man presents with a 2-day history of loose stools, anorexia, malaise, and abdominal pain. He describes the pain as moderate, cramping in character, and diffusely localized to the periumbilical region. His past medical history is unremarkable. He works as a wildlife photographer and, 1 week ago, he was in ... | Overactivation of guanylate cyclase | {
"A": "Production of lecithinase",
"B": "Presynaptic vesicle dysregulation",
"C": "Overactivation of guanylate cyclase",
"D": "Disabling Gi alpha subunit"
} | step1 | C | [
"year old man presents",
"2-day history",
"loose stools",
"anorexia",
"malaise",
"abdominal pain",
"pain",
"moderate",
"cramping",
"character",
"localized",
"periumbilical region",
"past medical history",
"unremarkable",
"works",
"wildlife photographer",
"1 week",
"Yucatan",
"mag... |
A young Caucasian couple in their late twenties present for an infertility evaluation after trying to conceive over 2 years. On physical exam, the female appears healthy and states that she has regular menstrual cycles. The male partner is noted to have long extremities with wide hips, low muscle mass, gynecomastia, sp... | Presence of a barr body | {
"A": "Presence of a barr body",
"B": "Absence of a barr body",
"C": "Absence of a second sex chromosome",
"D": "Trisomy of chromosome 13"
} | step1 | A | [
"young Caucasian couple",
"late twenties present",
"infertility evaluation",
"to",
"years",
"physical exam",
"female appears healthy",
"states",
"regular menstrual cycles",
"male partner",
"noted to",
"long extremities",
"wide hips",
"low muscle mass",
"gynecomastia",
"facial",
"ches... |
A 21-year-old female presents to the family physician with 3 weeks of headaches, sweating, and palpitations. Her BP was 160/125 mmHg, and a 24-hour urine test revealed elevated vanillylmandelic acid (VMA) and normetanephrine. Past medical history is notable for bilateral retinal hemangioblastomas, and family history is... | Clear cell renal cell carcinoma | {
"A": "Clear cell renal cell carcinoma",
"B": "Retinoblastoma",
"C": "Osteosarcoma",
"D": "Breast cancer"
} | step1 | A | [
"21-year-old female presents",
"family physician",
"3 weeks",
"headaches",
"sweating",
"palpitations",
"BP",
"mmHg",
"24-hour urine test revealed elevated vanillylmandelic acid",
"normetanephrine",
"Past medical history",
"notable",
"bilateral retinal hemangioblastomas",
"family history",
... |
A 25-year-old female presents to a physician's office with complaints of having no energy for the last 2 weeks and sometimes feeling like staying home all day. She works for a technology start-up company and is attending graduate school part-time in the evening. She is very concerned about her health and tries to eat a... | She is likely over-exerted and taking the herbal supplements has no proven medical benefit. | {
"A": "She should not take St. John's wort because of potential drug interactions with antidepressants.",
"B": "She should start with the herbal product and return if her energy level does not improve in 2 weeks.",
"C": "She is likely over-exerted and taking the herbal supplements has no proven medical benefit."... | step1 | C | [
"year old female presents",
"physician's office",
"complaints",
"energy",
"2 weeks",
"sometimes feeling",
"home all day",
"works",
"technology start company",
"attending graduate school part-time",
"evening",
"very concerned",
"health",
"to eat",
"balanced diet",
"runs daily",
"takes... |
A 40-year-old man is brought to the emergency department by police officers due to inappropriate public behavior. He was at a pharmacy demanding to speak with the manager so he could discuss a business deal. Two weeks ago, he left his wife of 10 years and moved from another city in order to pursue his dreams of being a... | Valproic acid and quetiapine | {
"A": "Carbamazepine only",
"B": "Clozapine only",
"C": "Lithium and valproic acid",
"D": "Valproic acid and quetiapine"
} | step2&3 | D | [
"40 year old man",
"brought",
"emergency department",
"police officers due to inappropriate",
"behavior",
"pharmacy demanding",
"speak",
"manager",
"discuss",
"business",
"Two weeks",
"left",
"wife",
"10 years",
"moved from",
"city",
"order to",
"dreams",
"entrepreneur",
"not s... |
A 37-year-old woman undergoes diagnostic laparoscopy under general anesthesia for evaluation of chronic pelvic pain. Postoperatively, the patient requires prolonged intubation. Neostigmine is administered. Results of acceleromyography during train-of-four ulnar nerve stimulation are shown. Which of the following drugs ... | Succinylcholine | {
"A": "Ropivacaine",
"B": "Rocuronium",
"C": "Tizanidine",
"D": "Succinylcholine"
} | step1 | D | [
"year old woman",
"diagnostic laparoscopy",
"general anesthesia",
"evaluation",
"chronic pain",
"patient",
"prolonged intubation",
"Neostigmine",
"administered",
"Results",
"train",
"four ulnar nerve stimulation",
"shown",
"following drugs",
"most likely to",
"used",
"patient"
] |
A 45-year-old woman is found to have multiple masses in her liver while performing abdominal ultrasonography for recurrent right upper quadrant abdominal pain. Biopsy of one of the masses discloses large plates of adenoma cells, which are larger than normal hepatocytes and contain glycogen and lipid. Regular septa, por... | Oral contraceptive pills | {
"A": "Carbon tetrachloride",
"B": "Aflatoxin",
"C": "Oral contraceptive pills",
"D": "Smoking"
} | step2&3 | C | [
"year old woman",
"found to",
"multiple",
"liver",
"performing abdominal ultrasonography",
"recurrent right upper quadrant",
"pain",
"Biopsy of one",
"masses",
"large plates",
"adenoma cells",
"larger",
"normal hepatocytes",
"contain glycogen",
"lipid",
"Regular septa",
"portal tract... |
An investigator is following a 4-year-old boy with Duchenne muscular dystrophy. Western blot of skeletal muscle cells from this boy shows that the dystrophin protein is significantly smaller compared to the dystrophin protein of a healthy subject. Further evaluation shows that the boy's genetic mutation involves a sequ... | UAG | {
"A": "GUG",
"B": "AUG",
"C": "UAG",
"D": "UCG"
} | step1 | C | [
"investigator",
"following",
"4 year old boy",
"Duchenne muscular dystrophy",
"Western blot",
"skeletal muscle cells",
"boy shows",
"dystrophin protein",
"smaller compared",
"dystrophin protein",
"a healthy subject",
"Further evaluation shows",
"boy's genetic mutation",
"sequence",
"enco... |
A 31-year-old woman gives birth to a boy in the labor and delivery ward of the local hospital. The child is immediately assessed and found to be crying vigorously. He is pink in appearance with blue extremities that appear to be flexed. Inducing some discomfort shows that both his arms and legs move slightly but remain... | 7 | {
"A": "5",
"B": "7",
"C": "8",
"D": "9"
} | step1 | B | [
"31 year old woman gives birth",
"boy",
"labor",
"delivery ward",
"local hospital",
"child",
"immediately assessed",
"found to",
"crying vigorously",
"pink",
"appearance",
"blue extremities",
"appear to",
"flexed",
"Inducing",
"discomfort shows",
"arms",
"legs move slightly",
"fl... |
A 68-year-old man comes to his physician because of fatigue, night sweats, chills, and a 5-kg (11-lb) weight loss during the past 3 weeks. Eight years ago, he was treated for a hematological malignancy after biopsy of a neck swelling showed CD15+ and CD30+ cells. Physical examination shows conjunctival pallor and scatt... | Radiation-induced myeloid leukemia | {
"A": "Leukemic transformation of T-cell lymphoma",
"B": "Richter transformation of small lymphocytic lymphoma",
"C": "Leukemic transformation of myelodysplastic syndrome",
"D": "Radiation-induced myeloid leukemia"
} | step1 | D | [
"68 year old man",
"physician",
"fatigue",
"night sweats",
"chills",
"5 kg",
"weight loss",
"past",
"weeks",
"Eight years",
"treated",
"hematological malignancy",
"biopsy of",
"neck swelling showed CD15",
"CD30",
"cells",
"Physical examination shows conjunctival pallor",
"scattered... |
A 45-year-old male presents to his primary care doctor complaining of abdominal pain. He reports a three-month history of intermittent burning pain localized to the epigastrium that worsens 2-3 hours after a meal. He attributes this pain to increased stress at his job. He is otherwise healthy and takes no medications. ... | Amoxicillin, clarithromycin, and omeprazole | {
"A": "Sulfasalazine",
"B": "Pantoprazole",
"C": "Amoxicillin, clarithromycin, and omeprazole",
"D": "Tetracycline, omeprazole, bismuth, and metronidazole"
} | step1 | C | [
"year old male presents",
"primary care doctor",
"abdominal pain",
"reports",
"three month history of intermittent burning pain localized",
"epigastrium",
"worsens 2-3 hours after",
"meal",
"attributes",
"pain",
"increased stress",
"job",
"healthy",
"takes",
"medications",
"not smoke",... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.