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 previously healthy 23-year-old woman comes to the physician because of a 1-week history of vaginal discharge. She has no pain or pruritus. She is sexually active with one male partner and uses condoms inconsistently. Pelvic examination shows a malodorous gray vaginal discharge. Microscopic examination of the vaginal ... | Bacterial vaginosis | {
"A": "Bacterial vaginosis",
"B": "Gonorrhea",
"C": "Syphilis",
"D": "Vaginal candidiasis"
} | step1 | A | [
"healthy 23 year old woman",
"physician",
"1-week history",
"vaginal discharge",
"pain",
"pruritus",
"sexually active",
"one male partner",
"uses condoms",
"Pelvic examination shows",
"gray vaginal discharge",
"Microscopic examination",
"shown",
"following",
"most likely diagnosis"
] |
A 27-year-old man presents to the emergency department after he was assaulted and shot during a robbery. The patient was beaten with a baseball bat and has a bullet entry wound in his neck. He is currently complaining of diffuse pains but is able to speak. His voice sounds muffled, and he is requesting pain medications... | Orotracheal intubation | {
"A": "Cricothyroidotomy",
"B": "Laryngeal mask",
"C": "Nasotracheal intubation",
"D": "Orotracheal intubation"
} | step2&3 | D | [
"27 year old man presents",
"emergency department",
"assaulted",
"shot",
"robbery",
"patient",
"baseball bat",
"bullet entry wound",
"neck",
"currently",
"diffuse pains",
"able",
"speak",
"voice sounds",
"requesting pain medications",
"initial resuscitation",
"begun",
"trauma bay",... |
A 42-year-old G3P3003 presents to her gynecologist for an annual visit. She complains of urinary incontinence when jogging since the birth of her last child three years ago. Her periods are regular every 30 days. The patient also has cramping that is worse before and during her period but always present at baseline. Sh... | Presence of endometrial tissue within the myometrium | {
"A": "Presence of endometrial tissue outside of the uterus",
"B": "Presence of endometrial tissue within the myometrium",
"C": "Focal hyperplasia of the myometrium",
"D": "Nuclear atypia of endometrial cells"
} | step2&3 | B | [
"year old",
"presents",
"gynecologist",
"annual visit",
"of urinary incontinence",
"jogging",
"birth of",
"child three years",
"periods",
"regular",
"30 days",
"patient",
"cramping",
"worse",
"period",
"always present",
"baseline",
"feeling of heaviness",
"pelvis",
"exacerbated... |
An 8-year-old girl is brought to the physician by her parents for a 10-month history of disturbing dreams and daytime sleepiness. She has difficulty falling asleep and says she sometimes sees ghosts just before falling asleep at night. She has had a 7-kg (15-lb) weight gain during this period despite no changes in appe... | Rapid onset of beta waves | {
"A": "Periodic sharp waves",
"B": "Slow spike-wave pattern",
"C": "Rapid onset of beta waves",
"D": "Decreased delta wave sleep duration"
} | step1 | C | [
"year old girl",
"brought",
"physician",
"parents",
"10 month history",
"dreams",
"daytime sleepiness",
"difficulty falling asleep",
"sometimes sees ghosts",
"falling asleep",
"night",
"kg",
"weight gain",
"period",
"changes in appetite",
"alert",
"oriented",
"neurologic examinatio... |
A 58-year-old woman presents to the office after receiving a bone mineral density screening test result with a T score of -4.1 and a Z score of -3.8. She is diagnosed with osteoporosis. A review of her medical history reveals that she has taken estrogen-containing oral contraceptive pills from the age of 20 to 30. She ... | Lansoprazole | {
"A": "Lansoprazole",
"B": "Hydrochlorothiazide",
"C": "Lithium",
"D": "Estrogen"
} | step2&3 | A | [
"58 year old woman presents",
"office",
"receiving",
"bone mineral density screening",
"T score",
"Z score",
"diagnosed",
"osteoporosis",
"review of",
"medical history reveals",
"taken estrogen containing oral contraceptive pills",
"age",
"20",
"30",
"suffered",
"heartburn",
"age",
... |
A 27-year-old woman, gravida 3, para 2, at 41 weeks' gestation is admitted to the hospital in active labor. Her pregnancy has been uncomplicated. Both of her prior children were delivered by vaginal birth. She has a history of asthma. Current medications include iron and vitamin supplements. After a prolonged labor, sh... | Administer tranexamic acid | {
"A": "Perform hysterectomy",
"B": "Administer carboprost tromethamine",
"C": "Tranfuse blood",
"D": "Administer tranexamic acid"
} | step2&3 | D | [
"27 year old woman",
"gravida 3",
"para 2",
"weeks",
"estation ",
"dmitted ",
"ospital ",
"ctive labor.",
"regnancy ",
"ncomplicated.",
"rior hildren ",
"elivered ",
"aginal birth.",
"istory of asthma.",
"urrent medications nclude ron ",
"itamin supplements.",
"rolonged labor,",
... |
A 2-year-old male is brought to his pediatrician by his mother because of abdominal pain and blood in the stool. Scintigraphy reveals uptake in the right lower quadrant of the abdomen. Persistence of which of the following structures is the most likely cause of this patient's symptoms? | Omphalomesenteric duct | {
"A": "Urachus",
"B": "Omphalomesenteric duct",
"C": "Paramesonephric duct",
"D": "Ureteric bud"
} | step1 | B | [
"2 year old male",
"brought",
"pediatrician",
"mother",
"abdominal pain",
"blood in",
"stool",
"Scintigraphy reveals uptake",
"right lower quadrant of",
"abdomen",
"Persistence of",
"following structures",
"most likely cause",
"patient's symptoms"
] |
An otherwise healthy 25-year-old primigravid woman at 31 weeks' gestation comes to the physician with a 2-day history of epigastric pain and nausea that is worse at night. Three years ago, she was diagnosed with a peptic ulcer and was treated with a proton pump inhibitor and antibiotics. Medications include folic acid ... | Stretching of Glisson capsule | {
"A": "Bacterial invasion of the renal parenchyma",
"B": "Acute inflammation of the pancreas",
"C": "Inflammation of the gallbladder",
"D": "Stretching of Glisson capsule"
} | step1 | D | [
"healthy",
"year old primigravid woman",
"31 weeks",
"estation ",
"hysician ",
"-day istory ",
"pigastric pain ",
"ausea ",
"orse ",
"ight.",
"hree ears ",
"iagnosed ",
"eptic ulcer ",
"reated with ",
"roton pump inhibitor ",
"ntibiotics.",
"edications nclude olic acid ",
"ulti... |
A 6-day-old newborn is brought to the emergency department by his mother due to a high fever that started last night. His mother says that he was born via an uneventful vaginal delivery at home at 38 weeks gestation and was doing fine up until yesterday when he became disinterested in breastfeeding and spit up several ... | During birth | {
"A": "Contaminated food",
"B": "During birth",
"C": "Mother’s roommate",
"D": "Infection from surgery"
} | step2&3 | B | [
"day old newborn",
"brought",
"emergency department",
"mother due to",
"high",
"started",
"night",
"mother",
"born",
"vaginal delivery",
"home",
"weeks gestation",
"fine",
"breastfeeding",
"spit",
"times",
"temperature",
"pulse",
"min",
"respirations",
"min",
"O2 sats",
"... |
A 26-year-old man is brought to the emergency department due to right-sided facial and upper extremity weakness and aphasia. The patient was in his usual state of health until two hours prior to presentation, when he was eating breakfast with a friend and acutely developed the aforementioned symptoms. Medical history i... | Patent foramen ovale | {
"A": "Amyloid deposition within vessels",
"B": "Aortic embolism",
"C": "Cardiac arrhythmia",
"D": "Patent foramen ovale"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"right-sided facial",
"upper extremity weakness",
"aphasia",
"patient",
"usual state of health",
"two hours prior to presentation",
"eating breakfast",
"friend",
"symptoms",
"Medical history",
"unremarkable",
"mild palpitations",
"occu... |
A 24-year-old woman comes to the physician because of a 1-year history of intermittent episodes of shortness of breath, chest tightness, palpitation, dizziness, sweaty hands, and a feeling of impending doom. She says that her symptoms occur when she goes for a walk or waits in line for coffee. She reports that she no l... | Agoraphobia | {
"A": "Agoraphobia",
"B": "Separation anxiety disorder",
"C": "Panic disorder",
"D": "Somatic symptom disorder"
} | step1 | A | [
"year old woman",
"physician",
"of",
"year history",
"intermittent episodes",
"shortness",
"breath",
"chest tightness",
"palpitation",
"dizziness",
"sweaty hands",
"feeling",
"impending doom",
"symptoms occur",
"goes",
"walk",
"waits in line",
"coffee",
"reports",
"longer leave... |
A 20-year-old woman presents with chest pain for the last 20 minutes. She describes a ''squeezing'' sensation in the chest and can feel her heart ''racing''. Worried that she might be having a heart attack, she took aspirin before coming to the hospital. Five days ago, she says she had similar symptoms, but they resolv... | Alprazolam | {
"A": "Alprazolam",
"B": "Nitroglycerin",
"C": "Buspirone",
"D": "Sertraline"
} | step1 | A | [
"20 year old woman presents",
"chest pain",
"last 20 minutes",
"squeezing",
"sensation",
"chest",
"feel",
"heart",
"racing",
"Worried",
"heart attack",
"took aspirin",
"hospital",
"Five days",
"similar symptoms",
"resolved",
"10 minutes",
"medical",
"family history",
"unremarka... |
An 8-year-old boy is brought to the emergency department by his parents because of sudden onset of abdominal pain beginning an hour ago. The parents report that their son has also had an episode of dark urine earlier that morning. Three days ago, he was diagnosed with a urinary tract infection and was treated with trim... | Deficient glucose-6-phosphate dehydrogenase | {
"A": "Production of hemoglobin S",
"B": "Cold agglutinins",
"C": "Lead poisoning",
"D": "Deficient glucose-6-phosphate dehydrogenase"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"parents",
"sudden",
"abdominal beginning",
"hour",
"parents report",
"son",
"episode of dark urine earlier",
"morning",
"Three days",
"diagnosed",
"urinary tract infection",
"treated with trimethoprim-sulfamethoxazole",
"Liberia",
"... |
A 23-year-old man comes to the emergency department because of a rash on his neck and back for the past 6 hours. He says that he first noticed some reddening of the skin on his back the previous evening, which turned into a blistering, red rash overnight. He went surfing the previous day and spent 5 hours at the beach.... | Reapply sunscreen after water exposure | {
"A": "Reapply sunscreen after water exposure",
"B": "Use SPF 50 sunscreen",
"C": "Apply at least 3 oz of sunscreen",
"D": "Use waterproof sunscreen"
} | step2&3 | A | [
"23 year old man",
"emergency department",
"of",
"rash",
"neck",
"back",
"past",
"hours",
"first",
"reddening",
"skin",
"back",
"previous evening",
"turned",
"blistering",
"red rash overnight",
"surfing",
"previous day",
"spent 5 hours",
"beach",
"reports",
"applied",
"oz... |
A 34-year-old woman comes to the physician because she has not had her period for 4 months. Menses had previously occurred at regular 28-day intervals with moderate flow. A home pregnancy test was negative. She also reports recurrent headaches and has noticed that when she goes to the movies she cannot see the outer ed... | Adenohypophysis | {
"A": "Astrocytes",
"B": "Adenohypophysis",
"C": "Schwann cells",
"D": "Pineal gland"
} | step1 | B | [
"year old woman",
"physician",
"not",
"period",
"months",
"Menses",
"occurred",
"regular",
"day intervals",
"moderate flow",
"home pregnancy test",
"negative",
"reports recurrent headaches",
"goes",
"movies",
"see",
"outer edges",
"screen",
"turning",
"head",
"side",
"patie... |
A 26-year-old man comes to the physician because of discoloration of the toenails. He has a history of peptic ulcer disease treated with pantoprazole. The physician prescribes oral itraconazole for a fungal infection and temporarily discontinues pantoprazole. Which of the following best describes the reason for discont... | Decreased therapeutic effect of itraconazole due to decreased absorption | {
"A": "Increased toxicity of itraconazole due to cytochrome p450 induction",
"B": "Decreased therapeutic effect of itraconazole due to cytochrome p450 inhibition",
"C": "Decreased therapeutic effect of itraconazole due to decreased absorption",
"D": "Increased toxicity of itraconazole due to decreased protein ... | step1 | C | [
"year old man",
"physician",
"discoloration",
"toenails",
"history of peptic ulcer disease treated with pantoprazole",
"physician",
"oral itraconazole",
"fungal infection",
"discontinues pantoprazole",
"following best",
"reason",
"discontinuing pantoprazole therapy"
] |
A 15-year-old girl comes to the physician for a routine health maintenance examination. She recently became sexually active with her boyfriend and requests a prescription for an oral contraception. She lives with her parents. She has smoked half a pack of cigarettes daily for the past 2 years. Physical examination show... | """I would like to discuss the various contraceptive options that are available.""" | {
"A": "\"\"\"I would like to discuss the various contraceptive options that are available.\"\"\"",
"B": "\"\"\"I would need your parent's permission before I can provide information about contraceptive therapy.\"\"\"",
"C": "\"\"\"I cannot prescribe oral contraceptives if you are currently a smoker.\"\"\"",
"D... | step1 | A | [
"year old girl",
"physician",
"routine health maintenance examination",
"recently",
"sexually active",
"boyfriend",
"requests",
"prescription for",
"oral contraception",
"lives with",
"parents",
"smoked half",
"pack",
"cigarettes daily",
"past",
"years",
"Physical examination shows",... |
A 53-year-old woman comes to the physician for evaluation of a 5-month history of painful sexual intercourse. She also reports vaginal dryness and occasional spotting. She has no pain with urination. She has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. Her last menstrual period was 8 months ago. Sh... | Topical estrogen cream | {
"A": "Oral fluconazole",
"B": "Topical nystatin",
"C": "Topical estrogen cream",
"D": "Oral metronidazole"
} | step2&3 | C | [
"year old woman",
"physician",
"evaluation",
"month history",
"painful sexual intercourse",
"reports vaginal dryness",
"occasional spotting",
"pain",
"urination",
"hypertension",
"type 2 diabetes mellitus",
"hypercholesterolemia",
"last menstrual period",
"months",
"sexually active",
"... |
A 36-year-old man is brought to the emergency department by his wife 20 minutes after having a seizure. Over the past 3 days, he has had a fever and worsening headaches. This morning, his wife noticed that he was irritable and demonstrated strange behavior; he put the back of his fork, the salt shaker, and the lid of t... | Breakdown of endothelial tight junctions | {
"A": "Release of vascular endothelial growth factor",
"B": "Cellular retention of sodium",
"C": "Breakdown of endothelial tight junctions",
"D": "Increased hydrostatic pressure"
} | step1 | C | [
"36 year old man",
"brought",
"emergency department",
"wife 20 minutes",
"seizure",
"past",
"days",
"fever",
"worsening headaches",
"morning",
"wife",
"irritable",
"strange behavior",
"put",
"back of",
"fork",
"salt shaker",
"coffee",
"mouth",
"history",
"serious illness",
... |
A 30-year-old woman presents to her primary care provider with blood in her urine and pain in her left flank. She has a 5-year history of polycystic ovarian syndrome managed with oral contraceptives and metformin. She is single and is not sexually active and denies a history of kidney stones or abdominal trauma. She ha... | Administer heparin | {
"A": "Surgery",
"B": "Administer heparin",
"C": "Thrombectomy",
"D": "Administer warfarin"
} | step2&3 | B | [
"30 year old woman presents",
"primary care provider",
"blood in",
"urine",
"pain",
"left flank",
"5 year history",
"polycystic ovarian syndrome managed",
"oral contraceptives",
"metformin",
"single",
"not sexually active",
"denies",
"history of kidney stones",
"abdominal trauma",
"pac... |
A 57-year-old man is brought to the emergency department for crushing substernal chest pain at rest for the past 2 hours. The pain began gradually while he was having an argument with his wife and is now severe. He does not take any medications. He has smoked 1 pack of cigarettes daily for 35 years. He is diaphoretic. ... | Occlusion of the left anterior descending artery | {
"A": "Occlusion of the left anterior descending artery",
"B": "Thromboembolism to the right interlobar pulmonary artery",
"C": "Occlusion of the left circumflex artery",
"D": "Tear in the intimal lining of the aorta"
} | step2&3 | A | [
"57 year old man",
"brought",
"emergency department",
"crushing",
"chest pain at rest",
"past",
"hours",
"pain began",
"argument",
"wife",
"now severe",
"not take",
"medications",
"smoked 1 pack",
"cigarettes daily",
"35 years",
"diaphoretic",
"temperature",
"98",
"pulse",
"m... |
A 60-year-old man presents to the office for a scheduled follow-up visit. He has had hypertension for the past 30 years and his current anti-hypertensive medications include lisinopril (40 mg/day) and hydrochlorothiazide (50 mg/day). He follows most of the lifestyle modifications recommended by his physician, but is co... | Cyclic adenosine monophosphate | {
"A": "Cyclic adenosine monophosphate",
"B": "Cyclic guanosine monophosphate",
"C": "Diacylglycerol",
"D": "Calcium ions"
} | step1 | A | [
"60 year old man presents",
"office",
"scheduled follow-up visit",
"hypertension",
"past 30 years",
"current anti-hypertensive medications include lisinopril",
"40 mg/day",
"hydrochlorothiazide",
"50 mg/day",
"follows most",
"lifestyle modifications recommended",
"physician",
"concerned",
... |
A 61-year-old woman comes to her physician for a burning sensation and numbness in her right hand for 4 weeks. The burning sensation is worse at night and is sometimes relieved by shaking the wrist. In the past week, she has noticed an exacerbation of her symptoms. She has rheumatoid arthritis and type 2 diabetes melli... | Volar splinting | {
"A": "Physiotherapy",
"B": "Initiate azathioprine therapy",
"C": "Volar splinting",
"D": "Vitamin B6 supplementation\n\""
} | step2&3 | C | [
"61 year old woman",
"physician",
"burning sensation",
"numbness",
"right",
"4 weeks",
"burning sensation",
"worse",
"night",
"sometimes relieved by shaking",
"wrist",
"past week",
"exacerbation",
"symptoms",
"rheumatoid arthritis",
"type 2 diabetes mellitus",
"medications include in... |
A 32-year-old man with a history of chronic alcoholism presents to the emergency department with vomiting and diarrhea for 1 week. He states he feels weak and has had poor oral intake during this time. The patient is a current smoker and has presented many times to the emergency department for alcohol intoxication. His... | Hypophosphatemia | {
"A": "Hypocalcemia",
"B": "Hypoglycemia",
"C": "Hyponatremia",
"D": "Hypophosphatemia"
} | step2&3 | D | [
"year old man",
"history of chronic alcoholism presents",
"emergency department",
"vomiting",
"diarrhea",
"1 week",
"states",
"feels weak",
"poor oral intake",
"time",
"patient",
"current smoker",
"presented",
"times",
"emergency department",
"alcohol intoxication",
"temperature",
... |
A 2-year-old boy from a rural community is brought to the pediatrician after his parents noticed a white reflection in both of his eyes in recent pictures. Physical examination reveals bilateral leukocoria, nystagmus, and inflammation. When asked about family history of malignancy, the father of the child reports losin... | Regulation of the G1-S transition | {
"A": "DNA mismatch repair",
"B": "Nucleotide excision repair",
"C": "Regulation of the G1-S transition",
"D": "Stem cell self-renewal"
} | step1 | C | [
"2 year old boy",
"rural community",
"brought",
"pediatrician",
"parents",
"white reflection",
"of",
"eyes",
"recent pictures",
"Physical examination reveals bilateral leukocoria",
"nystagmus",
"inflammation",
"family history",
"malignancy",
"father",
"child reports",
"brother",
"e... |
A scientist is studying the excretion of a novel toxin X by the kidney in order to understand the dynamics of this new substance. He discovers that this new toxin X has a clearance that is half that of inulin in a particular patient. This patient's filtration fraction is 20% and his para-aminohippuric acid (PAH) dynami... | 60 ml/min | {
"A": "60 ml/min",
"B": "120 ml/min",
"C": "300 ml/min",
"D": "600 ml/min"
} | step1 | A | [
"scientist",
"studying",
"excretion",
"novel toxin",
"kidney",
"order to understand",
"dynamics",
"new substance",
"discovers",
"new toxin",
"clearance",
"half",
"inulin",
"patient",
"patient's filtration fraction",
"20",
"para-aminohippuric acid",
"dynamics",
"follows",
"Urine... |
A 31-year-old male with bipolar disorder comes to the physician because of erectile dysfunction for the past month. He cannot maintain an erection during intercourse and rarely wakes up with an erection. He says he is happy in his current relationship, but admits to decreased desire for sex and feeling embarrassed abou... | Decreased testosterone levels | {
"A": "Decreased testosterone levels",
"B": "Peyronie disease",
"C": "Microvascular disease",
"D": "Psychologic stressors"
} | step1 | A | [
"31 year old male",
"bipolar disorder",
"physician",
"of erectile dysfunction",
"past month",
"maintain",
"erection",
"intercourse",
"rarely wakes up",
"erection",
"happy",
"current relationship",
"admits",
"decreased desire",
"sex",
"feeling embarrassed",
"sexual performance",
"su... |
A scientist is designing experiments to better appreciate how the lung expands. He acquires two sets of cat lungs and fills one set with saline. He plots changes in the lungs' volume with respect to pressure as shown in Image A. The pressure-volume loop of the liquid-ventilated lung is different from the gas-ventilated... | Increased compliance | {
"A": "Reduced airway resistance",
"B": "Increased residual volume",
"C": "More pronounced hysteresis",
"D": "Increased compliance"
} | step1 | D | [
"scientist",
"experiments",
"better",
"lung expands",
"acquires two sets of cat lungs",
"fills one set",
"saline",
"changes",
"lungs",
"volume",
"pressure",
"shown",
"Image",
"pressure-volume loop",
"liquid ventilated lung",
"different",
"gas ventilated lung",
"property"
] |
A 58-year-old man with a history of alcoholism is hospitalized with acute onset nausea and hematemesis. On admission, his vitals are as follows: blood pressure 110/70 mm Hg, heart rate 88/min, respiratory rate 16/min, and temperature 37.8℃ (100.0℉). Physical examination shows jaundice, palmar erythema, widespread spide... | Perisinusoidal space | {
"A": "Portal field",
"B": "Perisinusoidal space",
"C": "Interlobular connective tissue",
"D": "Lumen of bile ducts"
} | step1 | B | [
"58 year old man",
"history of alcoholism",
"hospitalized",
"acute onset nausea",
"hematemesis",
"On admission",
"follows",
"blood pressure",
"70 mm Hg",
"heart rate 88 min",
"respiratory rate",
"min",
"temperature",
"100 0",
"Physical examination shows jaundice",
"palmar erythema",
... |
A 54-year-old gardener with diabetes mellitus from the Northeast Jillin Province in China acquired a small scratch from a thorn while working in his flower garden. After 3 weeks, he noticed a small pink, painless bump at the site of a scratch. He was not concerned by the bump; however, additional linearly-distributed b... | Sporotrichosis | {
"A": "Paracoccidioidomycosis",
"B": "Blastomycosis",
"C": "Leishmaniasis",
"D": "Sporotrichosis"
} | step1 | D | [
"54 year old gardener",
"diabetes mellitus",
"Northeast",
"Province",
"China acquired",
"small scratch",
"thorn",
"working",
"flower garden",
"3 weeks",
"small pink",
"painless",
"site of",
"scratch",
"not concerned",
"additional",
"distributed",
"boils began to appear 1 week later... |
A 5-year-old girl is brought to her pediatrician by her mother. The mother is concerned about a fine, red rash on her daughter’s limbs and easy bruising. The rash started about 1 week ago and has progressed. Past medical history is significant for a minor cold two weeks ago. The girl was born at 39 weeks gestation via ... | Immune thrombocytopenic purpura (ITP) | {
"A": "Hemophilia B",
"B": "Hemophilia A",
"C": "Immune thrombocytopenic purpura (ITP)",
"D": "Von Willebrand disease"
} | step1 | C | [
"5 year old girl",
"brought",
"pediatrician",
"mother",
"mother",
"concerned",
"fine",
"red rash",
"daughters limbs",
"easy bruising",
"rash started",
"1 week",
"progressed",
"Past medical history",
"significant",
"minor cold two weeks",
"girl",
"born",
"weeks gestation",
"spon... |
An otherwise healthy 45-year-old woman comes to the physician because of a 1-year history of episodic abdominal cramps, bloating, and flatulence. The symptoms worsen when she has pizza or ice cream and have become more frequent over the past 4 months. Lactose intolerance is suspected. Which of the following findings wo... | Tall villi with focal collections of goblet cells | {
"A": "Partial villous atrophy with eosinophilic infiltrates",
"B": "Periodic acid-Schiff-positive foamy macrophages",
"C": "Tall villi with focal collections of goblet cells",
"D": "Noncaseating granulomas with lymphoid aggregates"
} | step1 | C | [
"healthy",
"year old woman",
"physician",
"of",
"year history",
"episodic abdominal cramps",
"bloating",
"flatulence",
"symptoms worsen",
"pizza",
"ice cream",
"more frequent",
"past",
"months",
"Lactose intolerance",
"suspected",
"following findings",
"most",
"support",
"diagn... |
A 55-year-old man presents with an unremitting cough and swelling of the lower limbs for the past 2 weeks. He says he has had a chronic cough for years, however, he feels it is getting worse. He reports a 30-pack-year smoking history. Physical examination reveals mild central cyanosis and expiratory wheezes throughout ... | Central chemoreceptors | {
"A": "Airway stretch receptors",
"B": "Central chemoreceptors",
"C": "Peripheral chemoreceptors",
"D": "Pulmonary stretch receptors"
} | step1 | B | [
"55 year old man presents",
"cough",
"swelling of",
"lower limbs",
"past 2 weeks",
"chronic cough",
"years",
"feels",
"getting worse",
"reports",
"30 pack-year smoking history",
"Physical examination reveals mild central cyanosis",
"expiratory wheezes",
"chest",
"Oxygen therapy",
"orde... |
A 39-year-old woman comes to the physician because of a 5-month history of episodic retrosternal chest pain. She currently feels well. The pain is unrelated to exercise and does not radiate. The episodes typically last less than 15 minutes and lead to feelings of anxiety; resting relieves the pain. She has not had dysp... | No further testing needed | {
"A": "Coronary CT angiogram",
"B": "Nuclear exercise stress test",
"C": "No further testing needed",
"D": "Dobutamine stress echocardiography"
} | step2&3 | C | [
"year old woman",
"physician",
"of",
"5 month history",
"episodic retrosternal chest pain",
"currently feels well",
"pain",
"unrelated to exercise",
"not radiate",
"episodes",
"last less than 15 minutes",
"lead",
"feelings",
"anxiety",
"resting relieves",
"pain",
"not",
"dyspnea",
... |
A 52-year-old woman comes to the physician because of swelling of her legs for 2 months. She has noticed that her legs gradually swell up throughout the day. Two years ago, she underwent a coronary angioplasty. She has hypertension and coronary artery disease. She works as a waitress at a local diner. Her father died o... | Compression stockings | {
"A": "CT scan of abdomen and pelvis",
"B": "Sclerotherapy",
"C": "Compression stockings",
"D": "Adjust antihypertensive medication"
} | step2&3 | C | [
"year old woman",
"physician",
"of swelling",
"legs",
"2 months",
"legs",
"swell",
"day",
"Two years",
"coronary angioplasty",
"hypertension",
"coronary artery disease",
"works",
"waitress",
"local",
"father died of liver cancer",
"age",
"61 years",
"smoked one pack",
"cigarett... |
A 51-year-old woman with a history of paroxysmal atrial fibrillation comes to the physician for a follow-up visit. She feels well and wants to discuss pausing her only current medication, flecainide. Her pulse is 75/min and regular, blood pressure is 125/75 mm Hg. Physical examination shows no abnormalities. An ECG sho... | Prolonged QRS complex | {
"A": "Prolonged QTc interval",
"B": "False-positive ST-segment depression",
"C": "Prolonged QRS complex",
"D": "Decreased maximal heart rate"
} | step1 | C | [
"year old woman",
"history of paroxysmal atrial fibrillation",
"physician",
"follow-up visit",
"feels well",
"to discuss pausing",
"only current medication",
"flecainide",
"pulse",
"75 min",
"regular",
"blood pressure",
"75 mm Hg",
"Physical examination shows",
"abnormalities",
"ECG sh... |
A 4-year-old male is brought to the pediatrician for a low-grade fever. His mother states that he has had a waxing and waning fever for the past 6 days with temperatures ranging from 99.8°F (37.7°C) to 101.0°F (38.3°C). She reports that he had a similar episode three months ago. She also reports symmetric joint swellin... | Iridocyclitis | {
"A": "Iridocyclitis",
"B": "Sacroiliitis",
"C": "Scoliosis",
"D": "Aortitis"
} | step1 | A | [
"4 year old male",
"brought",
"pediatrician",
"low-grade fever",
"mother states",
"waxing",
"fever",
"past 6 days",
"temperatures ranging",
"99",
"3C",
"reports",
"similar episode three months",
"reports symmetric joint swelling in the childs knees",
"wrists",
"past",
"weeks",
"not... |
A 51-year-old woman comes to the physician because of worsening chest pain on exertion. She was diagnosed with coronary artery disease and hyperlipidemia 3 months ago. At the time of diagnosis, she was able to walk for 15 minutes on the treadmill until the onset of chest pain. Her endurance had improved temporarily aft... | Avoid isosorbide dinitrate at night | {
"A": "Avoid isosorbide dinitrate at night",
"B": "Discontinue atorvastatin therapy",
"C": "Add tadalafil to medication regimen",
"D": "Decrease amount of aerobic exercise"
} | step1 | A | [
"year old woman",
"physician",
"of worsening chest pain on exertion",
"diagnosed",
"coronary artery disease",
"hyperlipidemia",
"months",
"time",
"diagnosis",
"able to walk",
"15 minutes",
"treadmill",
"onset of chest pain",
"endurance",
"improved",
"began medical treatment",
"able t... |
A 63-year-old man presents to his primary care provider with colicky pain radiating to his left groin. The pain has been intermittent for several days. He has also been experiencing occasional burning pain in his hands and feet and frequent headaches. His past medical history is significant for an NSTEMI last year. He ... | Allopurinol | {
"A": "Allopurinol",
"B": "Thiazide",
"C": "Hydroxyurea",
"D": "Antihistamines"
} | step2&3 | A | [
"63 year old man presents",
"primary care provider",
"colicky pain radiating to",
"left groin",
"pain",
"intermittent",
"days",
"experiencing occasional burning",
"hands",
"feet",
"frequent headaches",
"past medical history",
"significant",
"NSTEMI",
"year",
"currently taking atorvasta... |
A 59-year-old woman comes to the physician because of a 1-year history of nausea and chronic abdominal pain that is worse after eating. She has Hashimoto thyroiditis. She does not smoke or drink alcohol. A biopsy specimen of the corpus of the stomach shows destruction of the upper glandular layer of the gastric mucosa ... | Gastric adenocarcinoma | {
"A": "Gastric adenocarcinoma",
"B": "Curling ulcer",
"C": "Aplastic anemia",
"D": "Gastric MALT lymphoma"
} | step1 | A | [
"59 year old woman",
"physician",
"year history",
"nausea",
"chronic abdominal pain",
"worse after eating",
"Hashimoto thyroiditis",
"not smoke",
"drink alcohol",
"biopsy specimen",
"corpus",
"stomach shows destruction",
"upper glandular layer",
"gastric mucosa",
"G-cell hyperplasia",
... |
A 20-year-old female presents to the emergency department with squeezing right upper quadrant pain worse after eating. She has a history of a microcytic, hypochromic anemia with target cells. Physical exam shows severe tenderness to palpation in the right upper quadrant and a positive Murphy's sign. By genetic analysis... | Exon | {
"A": "Exon",
"B": "Intron",
"C": "Kozak consensus sequence",
"D": "Transcriptional promoter"
} | step1 | A | [
"20 year old female presents",
"emergency department",
"squeezing right upper quadrant pain worse after eating",
"history",
"microcytic",
"hypochromic anemia",
"target cells",
"Physical exam shows severe tenderness",
"palpation",
"right upper quadrant",
"positive Murphy's sign",
"genetic analy... |
A 59-year-old woman is referred to a neurologist for a hand tremor. Her symptoms began a few months prior to presentation and has progressively worsened. She noticed she was having difficulty drinking her coffee and writing in her notebook. The patient reports that her father also had a tremor but is unsure what type o... | Primidone | {
"A": "Alprazolam",
"B": "Botulism-toxin injection",
"C": "Deep brain stimulation",
"D": "Primidone"
} | step2&3 | D | [
"59 year old woman",
"referred",
"neurologist",
"hand tremor",
"symptoms began",
"few months prior to presentation",
"worsened",
"difficulty drinking",
"coffee",
"writing",
"patient reports",
"father",
"tremor",
"unsure",
"type",
"tremor",
"drinks 2-3 glasses of wine",
"week",
"o... |
A 38-year-old man complains of a persistent high fever with chills, malaise, and diffuse abdominal pain for over a week. He recently returned from a trip to India. The fever began slowly and climbed its way up to 40.0°C (104.0°F) over the last 4 days. A physical exam reveals a white-coated tongue, enlarged spleen, and ... | It survives intracellularly within phagocytes of Peyer's patches. | {
"A": "It forms blue-green colonies with fruity odor.",
"B": "It survives intracellularly within phagocytes of Peyer's patches.",
"C": "Splenectomy may be necessary for carriers.",
"D": "It releases a toxin which inactivates 60S ribosomes."
} | step1 | B | [
"year old man",
"persistent high",
"chills",
"malaise",
"diffuse abdominal",
"week",
"recently returned",
"trip",
"India",
"fever began slowly",
"climbed",
"40",
"last",
"days",
"physical exam reveals",
"white coated",
"enlarged spleen",
"rose spots",
"abdomen",
"bone marrow as... |
A 2-year-old girl is brought to the emergency department for evaluation of fever, poor feeding, and cough that began after she returned with her family from a trip to Mexico 1 week ago. Her temperature is 39°C (102.2°F), pulse is 120/min, respirations are 28/min, and blood pressure is 78/56 mm Hg. An x-ray of the chest... | Decreased IFN-γ levels | {
"A": "Mutation in WAS gene",
"B": "Mutations in common gamma chain gene",
"C": "Decreased PTH levels",
"D": "Decreased IFN-γ levels"
} | step1 | D | [
"2 year old girl",
"brought",
"emergency department",
"evaluation",
"fever",
"poor feeding",
"cough",
"began",
"returned",
"family",
"trip",
"Mexico 1",
"temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"x-ray of",
"chest shows",
"infiltrate",... |
A 23-year-old college student was playing basketball when he fell directly onto his left elbow. He had sudden, intense pain and was unable to move his elbow. He was taken immediately to the emergency room by his teammates. He has no prior history of trauma or any chronic medical conditions. His blood pressure is 128/84... | Ulnar neuropathy | {
"A": "Axillary neuropathy",
"B": "Radial neuropathy",
"C": "Median neuropathy",
"D": "Ulnar neuropathy"
} | step2&3 | D | [
"23 year old college student",
"playing basketball",
"fell directly",
"left elbow",
"sudden",
"intense pain",
"unable to move",
"elbow",
"taken immediately",
"emergency room",
"prior history",
"trauma",
"chronic medical conditions",
"blood pressure",
"84 mm Hg",
"heart rate",
"min",
... |
A 20-week-old infant is brought to an urgent care clinic by her mother because she has not been eating well for the past 2 days. The mother said her daughter has also been "floppy" since yesterday morning and has been unable to move or open her eyes since the afternoon of the same day. The child has recently started so... | Contaminated food | {
"A": "Direct contact",
"B": "Airborne transmission",
"C": "Contaminated food",
"D": "Vertical transmission"
} | step1 | C | [
"20 week old infant",
"brought",
"urgent care clinic",
"mother",
"not",
"eating well",
"past 2 days",
"mother",
"daughter",
"floppy",
"morning",
"unable to move",
"open",
"eyes",
"afternoon",
"same day",
"child",
"recently started solid foods",
"cereals",
"honey",
"history",
... |
A 45-year-old woman presents with headaches. She says the headaches started about a month ago, and although initially, they were intermittent, over the past 2 weeks, they have progressively worsened. She describes the pain as severe, worse on the left than the right, and relieved somewhat by non-steroidal anti-inflamma... | Right-sided weakness | {
"A": "Right-sided weakness",
"B": "Obesity",
"C": "Age of onset",
"D": "Photophobia"
} | step2&3 | A | [
"year old woman presents",
"headaches",
"headaches started",
"month",
"initially",
"intermittent",
"past 2 weeks",
"worsened",
"pain",
"severe",
"worse",
"left",
"right",
"relieved somewhat",
"non-steroidal anti-inflammatory drugs",
"headaches",
"usually associated with nausea",
"v... |
A 30-year-old woman presents to her physician for difficulty breathing. She states that this typically happens to her when she goes outside and improves with rest and staying indoors. Her symptoms are currently worse than usual. The patient has never seen a physician before and has no diagnosed past medical history. He... | Epinephrine | {
"A": "Albuterol",
"B": "Epinephrine",
"C": "Intubation",
"D": "Prednisone"
} | step2&3 | B | [
"30 year old woman presents",
"physician",
"difficulty breathing",
"states",
"happens",
"goes outside",
"improves",
"rest",
"symptoms",
"currently worse than usual",
"patient",
"never seen",
"physician",
"diagnosed past medical history",
"temperature",
"99",
"blood pressure",
"97 5... |
A 44-year-old man presents to his psychiatrist for a follow-up appointment. He is currently being treated for schizophrenia. He states that he is doing well but has experienced some odd movement of his face recently. The patient's sister is with him and states that he has been more reclusive lately and holding what see... | Infection | {
"A": "Anxiolysis",
"B": "Dry mouth and dry eyes",
"C": "Infection",
"D": "QT prolongation on EKG"
} | step2&3 | C | [
"year old man presents",
"psychiatrist",
"follow-up appointment",
"currently",
"treated",
"schizophrenia",
"states",
"well",
"experienced",
"odd movement",
"face recently",
"patient's sister",
"states",
"more reclusive",
"to",
"conversations",
"room",
"not",
"improvement",
"sym... |
A 46-year-old man comes to the physician because of a 6-week history of fatigue and cramping abdominal pain. He works at a gun range. Examination shows pale conjunctivae and gingival hyperpigmentation. There is weakness when extending the left wrist against resistance. Further evaluation of this patient is most likely ... | Basophilic stippling of erythrocytes | {
"A": "Beta‑2 microglobulin in urine",
"B": "White bands across the nails",
"C": "Increased total iron binding capacity",
"D": "Basophilic stippling of erythrocytes"
} | step1 | D | [
"year old man",
"physician",
"week history",
"fatigue",
"cramping abdominal",
"works",
"gun range",
"Examination shows pale conjunctivae",
"gingival hyperpigmentation",
"weakness",
"extending",
"left wrist",
"resistance",
"Further evaluation",
"patient",
"most likely to show",
"follo... |
A 67-year-old man comes to the clinic for establishment of care. He recently retired and moved to Florida with his wife. His past medical history includes hypertension, diabetes, chronic back pain, and hyperlipidemia. According to the patient, he takes lisinopril, metformin, atorvastatin, acetaminophen, and methadone. ... | Assess the patient's pain medication history | {
"A": "Assess the patient's pain medication history",
"B": "Encourage the patient to switch to duloxetine",
"C": "Prescribe a limited dose of methadone for breakthrough back pain",
"D": "Refer the patient to a pain management clinic"
} | step1 | A | [
"67 year old man",
"clinic",
"care",
"recently retired",
"moved to Florida",
"wife",
"past medical history includes hypertension",
"diabetes",
"chronic back pain",
"hyperlipidemia",
"patient",
"takes lisinopril",
"metformin",
"atorvastatin",
"acetaminophen",
"methadone",
"previous do... |
A 75-year-old man presents to the physician because of bloody urine, which has occurred several times over the past month. He has no dysuria or flank pain. He has no history of serious illness, and he currently takes no medications. He is a 40-pack-year smoker. The vital signs are within normal limits. Physical exam sh... | Intravesical Bacille Calmette-Guérin (BCG) | {
"A": "Bladder radiation",
"B": "Bladder-sparing partial cystectomy",
"C": "Intravesical Bacille Calmette-Guérin (BCG)",
"D": "Systemic combination chemotherapy"
} | step2&3 | C | [
"75 year old man presents",
"physician",
"bloody urine",
"occurred several times",
"past",
"dysuria",
"flank pain",
"history",
"serious illness",
"currently takes",
"medications",
"40 pack-year smoker",
"vital signs",
"normal limits",
"Physical exam shows",
"abnormalities",
"generali... |
A 35-year-old man comes to the emergency room for severe left leg pain several hours after injuring himself on a gardening tool. His temperature is 39°C (102.2°F) and his pulse is 105/min. Physical examination of the left leg shows a small laceration on the ankle surrounded by dusky skin and overlying bullae extending ... | Degradation of cell membranes by phospholipase | {
"A": "Lipopolysaccharide-induced complement and macrophage activation",
"B": "Degradation of cell membranes by phospholipase",
"C": "Inactivation of elongation factor by ribosyltransferase",
"D": "Inhibition of neurotransmitter release by protease"
} | step1 | B | [
"35 year old man",
"emergency room",
"severe left leg pain",
"hours",
"gardening tool",
"temperature",
"pulse",
"min",
"Physical examination of",
"left leg shows",
"small laceration",
"ankle surrounded",
"dusky skin",
"bullae extending",
"posterior thigh",
"crackling sound",
"skin",
... |
A 34-year-old male presents to clinic today complaining that his medication has stopped working. He states despite being able to manage the side effects, a voice has returned again telling him to hurt his Mother. You prescribe him a drug which has shown improved efficacy in treating his disorder but requires frequent f... | Clozapine | {
"A": "Halperidol",
"B": "Chlorpromazine",
"C": "Clozapine",
"D": "Lurasidone"
} | step2&3 | C | [
"year old male presents",
"clinic today",
"medication",
"stopped working",
"states",
"able to",
"side effects",
"voice",
"returned",
"to",
"Mother",
"drug",
"shown improved efficacy",
"treating",
"disorder",
"frequent followup visits",
"One week later",
"returns",
"following lab ... |
A 25-year-old male presents to his primary care physician for fatigue, abdominal pain, diarrhea, and weight loss. He states that this issue has occurred throughout his life but seems to “flare up” on occasion. He states that his GI pain is relieved with defecation, and his stools are frequent, large, and particularly f... | Bowel wall biopsy | {
"A": "Stool ELISA",
"B": "Vitamin E level",
"C": "Vitamin B12 and folate level",
"D": "Bowel wall biopsy"
} | step2&3 | D | [
"year old male presents",
"primary care physician",
"fatigue",
"abdominal pain",
"diarrhea",
"weight loss",
"states",
"issue",
"occurred",
"life",
"to flare up",
"occasion",
"states",
"GI pain",
"relieved",
"defecation",
"stools",
"frequent",
"large",
"smelling",
"patient",
... |
A 3-month-old boy has a malodorous umbilical discharge that developed shortly after umbilical cord separation. He was treated for omphalitis with 3 doses of antibiotics. The vital signs are as follows: blood pressure 70/40 mm Hg, heart rate 125/min, respiratory rate 34/min, and temperature 36.8℃ (98.2℉). On physical ex... | Omphalomesenteric duct | {
"A": "Urachus",
"B": "Right umbilical artery",
"C": "Left umbilical artery",
"D": "Omphalomesenteric duct"
} | step1 | D | [
"3 month old boy",
"umbilical discharge",
"umbilical cord separation",
"treated",
"omphalitis",
"3 doses",
"antibiotics",
"vital signs",
"follows",
"blood pressure 70 40 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature 36",
"98",
"physical examination",
"appears... |
A 42-year-old woman with a history of multiple sclerosis and recurrent urinary tract infections comes to the emergency department because of flank pain and fever. Her temperature is 38.8°C (101.8°F). Examination shows left-sided costovertebral angle tenderness. She is admitted to the hospital and started on intravenous... | Alteration of peptidoglycan synthesis | {
"A": "Production of beta-lactamase",
"B": "Alteration of penicillin-binding proteins",
"C": "Alteration of peptidoglycan synthesis",
"D": "Alteration of ribosomal targets"
} | step1 | C | [
"year old woman",
"history",
"multiple sclerosis",
"recurrent urinary tract infections",
"emergency department",
"flank pain",
"fever",
"temperature",
"Examination shows left-sided costovertebral angle tenderness",
"admitted",
"hospital",
"started",
"intravenous vancomycin",
"Three days la... |
A 23-year-old gravida 1-para-1 (G1P1) presents to the emergency department with severe lower abdominal pain that started several hours ago. She has had fevers, malaise, and nausea for the last 2 days. Her last menstrual period was 3 weeks ago. Her past medical history is insignificant. She has had 3 sexual partners in ... | Pelvic inflammatory disease | {
"A": "Vaginitis",
"B": "Cervicitis",
"C": "Pelvic inflammatory disease",
"D": "Ruptured ectopic pregnancy"
} | step1 | C | [
"23 year old gravida 1 para",
"presents",
"emergency department",
"severe lower abdominal pain",
"started",
"hours",
"fevers",
"malaise",
"nausea",
"2 days",
"last menstrual period",
"3 weeks",
"past medical history",
"3 sexual partners",
"past 1 month",
"uses oral contraception",
"v... |
A 54-year-old man presents to the emergency department with a severe diffuse abdominal pain, nausea, and vomiting. The patient states that the pain acute onset approximately 3 hours ago and has not improved. He denies any fever or chills. His last bowel movement was yesterday morning which was normal. The patient has a... | Lack of enhancement of the branches of the superior mesenteric artery | {
"A": "Numerous round and tubular structures communicating with the small intestine wall",
"B": "Inner and outer layer enhancement of the bowel wall with non-enhancing middle layer",
"C": "Lack of enhancement of the branches of the superior mesenteric artery",
"D": "Loss of normal haustral markings of the larg... | step2&3 | C | [
"54 year old man presents",
"emergency department",
"severe diffuse abdominal",
"nausea",
"vomiting",
"patient states",
"pain acute onset approximately",
"hours ago",
"not improved",
"denies",
"fever",
"chills",
"last bowel movement",
"morning",
"normal",
"patient",
"history of hyper... |
A 59-year-old woman presents to the family medicine clinic with a lump in her breast for the past 6 months. She states that she has been doing breast self-examinations once a month. She has a medical history significant for generalized anxiety disorder and systemic lupus erythematosus. She takes sertraline and hydroxyc... | Mammography | {
"A": "Referral to general surgery",
"B": "Mammography",
"C": "Biopsy of the mass",
"D": "Continue breast self-examinations"
} | step2&3 | B | [
"59 year old woman presents",
"family medicine clinic",
"lump in",
"breast",
"past 6 months",
"states",
"breast self-examinations",
"month",
"medical history significant",
"generalized anxiety disorder",
"systemic lupus erythematosus",
"takes sertraline",
"hydroxychloroquine",
"medical con... |
A 28-year-old woman, gravida 2, para 1, at 31 weeks gestation is admitted to the hospital because of regular contractions and pelvic pressure for 3 hours. Her pregnancy has been uncomplicated so far. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory... | Magnesium sulfate + Betamethasone | {
"A": "Magnesium sulfate + Betamethasone",
"B": "Oxytocin + Magnesium sulfate",
"C": "Progesterone + Terbutaline",
"D": "Terbutaline + Oxytocin"
} | step2&3 | A | [
"year old woman",
"gravida 2",
"para 1",
"31 weeks gestation",
"admitted",
"hospital",
"regular contractions",
"pelvic pressure",
"hours",
"pregnancy",
"uncomplicated",
"far",
"attended",
"prenatal appointments",
"followed",
"physician's advice",
"screening",
"diseases",
"laborat... |
A 58-year-old man comes to the physician because of a sore throat and painful lesions in his mouth for the past few days. Six weeks ago, he underwent cardiac catheterization and stent implantation of the left anterior descending artery for treatment of acute myocardial infarction. Pharmacotherapy with dual antiplatelet... | Ticlopidine | {
"A": "Ticlopidine",
"B": "Apixaban",
"C": "Enoxaparin",
"D": "Aspirin"
} | step1 | A | [
"58 year old man",
"physician",
"sore throat",
"painful lesions",
"mouth",
"past",
"days",
"Six weeks",
"cardiac catheterization",
"stent implantation",
"left anterior descending artery",
"treatment",
"acute myocardial infarction",
"Pharmacotherapy",
"dual antiplatelet medication",
"st... |
A 31-year-old G3P2 who is at 24 weeks gestation presents for a regular check-up. She has no complaints, no concurrent diseases, and her previous pregnancies were vaginal deliveries with birth weights of 3100 g and 4180 g. The patient weighs 78 kg (172 lb) and is 164 cm (5 ft 5 in) in height. She has gained 10 kg (22 lb... | Insulin antagonism of human placental lactogen | {
"A": "Insulin antagonism of human placental lactogen",
"B": "Production of autoantibodies against pancreatic beta cells",
"C": "Point mutations in the gene coding for insulin",
"D": "Decrease in insulin gene expression"
} | step2&3 | A | [
"31 year old",
"weeks gestation presents",
"regular check-up",
"complaints",
"concurrent diseases",
"previous pregnancies",
"vaginal deliveries",
"birth weights",
"3100 g",
"g",
"patient",
"kg",
"5 ft 5",
"height",
"gained 10 kg",
"current pregnancy",
"vital signs",
"physical exami... |
A 62-year-old man comes to the physician for a follow-up examination. For the past year, he has had increasing calf cramping in both legs when walking, especially on an incline. He has hypertension. Since the last visit 6 months ago, he has been exercising on a treadmill four times a week; he has been walking until the... | Clopidogrel and simvastatin | {
"A": "Clopidogrel and simvastatin",
"B": "Operative vascular reconstruction",
"C": "Percutaneous transluminal angioplasty and stenting",
"D": "Vancomycin and piperacillin"
} | step2&3 | A | [
"62 year old man",
"physician",
"follow-up examination",
"past year",
"increasing calf cramping",
"legs",
"walking",
"hypertension",
"last visit",
"months",
"exercising",
"treadmill four times",
"week",
"walking",
"pain",
"then continues",
"short break",
"history of hypertension co... |
A 7-year-old boy is brought to the physician because his parents are concerned about his early sexual development. He has no history of serious illness and takes no medications. His brother was diagnosed with testicular cancer 5 years ago and underwent a radical orchiectomy. The patient is at the 85th percentile for he... | Leuprolide therapy | {
"A": "Radiation therapy",
"B": "Leuprolide therapy",
"C": "Testicular ultrasound",
"D": "Observation"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"parents",
"concerned",
"early sexual development",
"history",
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"medications",
"brother",
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"testicular cancer",
"years",
"radical orchiectomy",
"patient",
"percentile",
"height",
"percentile",
"weigh... |
A 41-year-old male presents to his primary care provider after seeing bright red blood in the toilet bowl after his last two bowel movements. He reports that the second time he also noticed some blood mixed with his stool. The patient denies abdominal pain and any changes in his stool habits. He notes a weight loss of ... | Colonoscopy | {
"A": "Complete blood count",
"B": "Colonoscopy",
"C": "Barium enema",
"D": "Anoscopy"
} | step2&3 | B | [
"year old male presents",
"primary care provider",
"seeing bright red blood",
"toilet bowl",
"last two bowel movements",
"reports",
"second time",
"blood mixed",
"stool",
"patient denies abdominal pain",
"changes in",
"stool habits",
"notes",
"weight loss of eight pounds",
"two months",
... |
You are interested in studying the etiology of heart failure reduced ejection fraction (HFrEF) and attempt to construct an appropriate design study. Specifically, you wish to look for potential causality between dietary glucose consumption and HFrEF. Which of the following study designs would allow you to assess for an... | Cohort study | {
"A": "Randomized controlled trial",
"B": "Cohort study",
"C": "Cross-sectional study",
"D": "Case series"
} | step2&3 | B | [
"interested",
"studying",
"etiology of heart failure reduced ejection fraction",
"attempt to construct",
"appropriate design study",
"wish to look",
"potential causality",
"dietary glucose consumption",
"HFrEF",
"following study designs",
"allow",
"to assess",
"causality"
] |
A 66-year-old man comes to the physician because of yellowish discoloration of his eyes and skin, abdominal discomfort, and generalized fatigue for the past 2 weeks. He has had dark urine and pale stools during this period. He has had a 10-kg (22-lb) weight loss since his last visit 6 months ago. He has hypertension. H... | Pancreaticoduodenectomy | {
"A": "Stereotactic radiation therapy",
"B": "Pancreaticoduodenectomy",
"C": "Gemcitabine and 5-fluorouracil therapy",
"D": "Central pancreatectomy"
} | step2&3 | B | [
"66 year old man",
"physician",
"discoloration",
"eyes",
"skin",
"abdominal discomfort",
"generalized fatigue",
"past 2 weeks",
"dark urine",
"pale stools",
"period",
"a 10 kg",
"weight loss",
"last visit",
"months",
"hypertension",
"smoked one pack",
"cigarettes daily",
"years",... |
A 38-year-old man presents to the outpatient clinic for an annual employee health checkup. He does not have any complaints at the moment except for skin changes, as seen in the following image. He denies any history of trauma. His medical history is insignificant. His family history is negative for any skin disorders o... | Autoreactive T cells against melanocytes | {
"A": "Autoreactive T cells against melanocytes",
"B": "Post-inflammatory hypopigmentation",
"C": "Melanocytes unable to synthesize melanin",
"D": "Invasion of the stratum corneum by Malassezia"
} | step1 | A | [
"year old man presents",
"outpatient clinic",
"annual employee health checkup",
"not",
"complaints",
"skin changes",
"seen",
"following image",
"denies",
"history",
"trauma",
"medical history",
"family history",
"negative",
"skin disorders",
"autoimmune disease",
"non-smoker",
"not... |
A 16-year-old boy is brought to a psychotherapist for counseling because he was physically abused by his father. During the first therapy session, the patient recounts the numerous encounters that he had with his abuser. At the end of the session, the therapist, who lost her own son in a car accident when he was 15 yea... | Countertransference | {
"A": "Isolation",
"B": "Sublimation",
"C": "Countertransference",
"D": "Identification"
} | step1 | C | [
"year old boy",
"brought",
"psychotherapist",
"counseling",
"abused",
"father",
"first therapy session",
"patient",
"numerous encounters",
"end",
"session",
"therapist",
"lost",
"son",
"car accident",
"years old",
"refuses to let",
"patient take",
"bus back alone",
"guardian's ... |
An 8-year-old boy is brought to the physician by his parents because of repeated episodes of “daydreaming.” The mother reports that during these episodes the boy interrupts his current activity and just “stares into space.” She says that he sometimes also smacks his lips. The episodes typically last 1–2 minutes. Over t... | Temporal lobe spikes on EEG | {
"A": "Defiant behavior towards figures of authority",
"B": "Impairment in communication and social interaction",
"C": "Temporal lobe spikes on EEG",
"D": "Conductive hearing loss on audiometry"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"parents",
"of repeated episodes",
"daydreaming",
"mother reports",
"episodes",
"boy interrupts",
"current activity",
"stares",
"space",
"sometimes",
"smacks",
"lips",
"episodes",
"last",
"minutes",
"past",
"months",
"occurred 23 times"... |
A 9-year-old boy is brought to the emergency room by his mother. She is concerned because her son’s face has been swollen over the past 2 days. Upon further questioning, the boy reports having darker urine without dysuria. The boy was seen by his pediatrician 10 days prior to presentation with a crusty yellow sore on h... | Antigen-antibody complex deposition | {
"A": "Antigen-antibody complex deposition",
"B": "IgE-mediated complement activation",
"C": "IgM-mediated complement activation targeting antigens on the cellular surface",
"D": "IgG-mediated complement activation targeting antigens on the cellular surface"
} | step1 | A | [
"year old boy",
"brought",
"emergency room",
"mother",
"concerned",
"sons face",
"swollen",
"past 2 days",
"further questioning",
"boy reports",
"darker urine",
"dysuria",
"boy",
"seen by",
"pediatrician 10 days prior to presentation",
"crusty yellow sore",
"right",
"since resolved... |
A 34-year-old pregnant woman with unknown medical history is admitted to the hospital at her 36th week of gestation with painful contractions. She received no proper prenatal care during the current pregnancy. On presentation, her vital signs are as follows: blood pressure is 110/60 mm Hg, heart rate is 102/min, respir... | Fundal cesarean delivery | {
"A": "Postabortion metroendometritis",
"B": "Adenomyosis",
"C": "Fundal cesarean delivery",
"D": "Multiple vaginal births"
} | step2&3 | C | [
"year old pregnant woman",
"unknown medical history",
"admitted",
"hospital",
"week",
"gestation",
"painful contractions",
"received",
"prenatal",
"current pregnancy",
"presentation",
"vital signs",
"follows",
"blood pressure",
"60 mm Hg",
"heart rate",
"min",
"respiratory rate",
... |
A 27-year-old woman presents to her family physician with pain on the front of her right knee. The pain started 2 months ago after she began training for a marathon, and it was gradual in onset and has slowly worsened. The pain increases with prolonged sitting and climbing stairs. She denies significant knee trauma. He... | Patellofemoral pain syndrome | {
"A": "Iliotibial band syndrome",
"B": "Prepatellar bursitis",
"C": "Patellofemoral pain syndrome",
"D": "Osgood-Schlatter's disease"
} | step2&3 | C | [
"27 year old woman presents",
"family physician",
"pain",
"front",
"right knee",
"pain started 2 months",
"began training",
"marathon",
"gradual",
"onset",
"slowly worsened",
"pain increases",
"prolonged sitting",
"climbing stairs",
"denies significant knee trauma",
"only medication",
... |
A 52-year-old Caucasian male presents to your office complaining of black, tarry stool. Which of the following possible causes of this patient's presentation is LEAST associated with the development of carcinoma? | Duodenal ulcer | {
"A": "Barrett's esophagus",
"B": "Adenomatous polyp",
"C": "Gastric ulcer",
"D": "Duodenal ulcer"
} | step1 | D | [
"year old Caucasian male presents",
"office",
"black",
"tarry stool",
"following possible causes",
"patient's presentation",
"LEAST associated with",
"development",
"carcinoma"
] |
A 30-year-old man with a BMI of 33.7 kg/m2 presents with severe pain in his right toe that began this morning. He had a few beers last night at a friend’s party but otherwise has had no recent dietary changes. On examination, the right toe appears swollen, warm, red, and tender to touch. Joint aspiration is performed. ... | Needle-shaped, negatively birefringent crystals on polarized light | {
"A": "Increased glucose",
"B": "Needle-shaped, negatively birefringent crystals on polarized light",
"C": "Rhomboid-shaped, positively birefringent crystals on polarized light",
"D": "Anti-CCP antibodies"
} | step1 | B | [
"30 year old man",
"BMI",
"kg/m2 presents",
"severe pain",
"right toe",
"began",
"morning",
"few beers last night",
"friends party",
"recent dietary changes",
"examination",
"right toe appears swollen",
"warm",
"red",
"tender",
"touch",
"Joint",
"performed",
"examination",
"flu... |
A 38-year-old male presents to his primary care physician complaining of increasing shortness of breath over the past 2 months. He reports experiencing an extended illness of several weeks as a child that required him to miss school. He is unsure but believes it involved a sore throat followed by a fever and joint pain... | Epitope homology | {
"A": "Annular calcification",
"B": "Epitope homology",
"C": "Myocardial ischemia",
"D": "Atherosclerosis"
} | step1 | B | [
"year old male presents",
"primary care physician",
"of increasing shortness",
"breath",
"past",
"months",
"reports experiencing",
"extended illness",
"weeks",
"child",
"required",
"to miss school",
"unsure",
"involved",
"sore throat followed by",
"fever",
"joint pains",
"not recal... |
A 56-year-old woman presents to the emergency department with an episode of nausea and severe unrelenting right upper abdominal pain. She had a cholecystectomy for gallstones a year earlier and has since experienced frequent recurrences of abdominal pain, most often after a meal. Her past medical history is otherwise u... | A hormone released by the I cells of the duodenum in the presence of fatty acids is the most effective cause of relaxation. | {
"A": "A hormone released by the I cells of the duodenum in the presence of fatty acids is the most effective cause of relaxation.",
"B": "The sphincter is contracted between meals.",
"C": "Sphincter relaxation is enhanced via stimulation of opioid receptors.",
"D": "A hormone released by the M cells of the du... | step1 | A | [
"year old woman presents",
"emergency department",
"episode of nausea",
"severe",
"right upper",
"cholecystectomy",
"gallstones",
"year earlier",
"since experienced frequent recurrences of abdominal pain",
"most often",
"meal",
"past medical history",
"unremarkable",
"only takes medication... |
A 45-year-old man comes to the emergency department because of a 1-day history of black, tarry stools. He has also had upper abdominal pain that occurs immediately after eating and a 4.4-kg (9.7-lb) weight loss in the past 6 months. He has no history of major medical illness but drinks 3 beers daily. His only medicatio... | Helicobacter pylori infection | {
"A": "Age above 40 years",
"B": "Alcohol consumption",
"C": "Work-related stress",
"D": "Helicobacter pylori infection"
} | step1 | D | [
"year old man",
"emergency department",
"1-day history",
"black",
"tarry stools",
"upper abdominal pain",
"occurs immediately",
"eating",
"4.4 kg",
"weight loss",
"past 6 months",
"history of major medical illness",
"drinks 3 beers daily",
"only medication",
"acetaminophen",
"financial... |
A 62-year-old Nigerian woman arrived 2 days ago to the US to visit her adult children from Nigeria. She is now brought to an urgent care center by her daughter for leg pain. Her right leg has been painful for 24 hours and is now causing her to limp. She denies any fevers, chills, or sweats and does not remember injurin... | Initiation of heparin followed by bridge to warfarin | {
"A": "Initiation of warfarin",
"B": "Initiation of heparin",
"C": "Treatment with tissue plasminogen activator",
"D": "Initiation of heparin followed by bridge to warfarin"
} | step2&3 | D | [
"62 year old Nigerian woman arrived 2 days",
"to visit",
"adult children",
"Nigeria",
"now brought",
"urgent care center",
"daughter",
"leg pain",
"right leg",
"painful",
"24 hours",
"now causing",
"limp",
"denies",
"fevers",
"chills",
"sweats",
"not remember",
"leg",
"takes me... |
A 42-year-old G1P0 woman presents to an obstetrician for her first prenatal visit. She has been pregnant for about 10 weeks and is concerned about how pregnancy will affect her health. Specifically, she is afraid that her complicated medical history will be adversely affected by her pregnancy. Her past medical history ... | Heart murmur | {
"A": "Easy bleeding",
"B": "Heart murmur",
"C": "Multiple sclerosis",
"D": "Polycythemia"
} | step1 | B | [
"year old",
"woman presents",
"obstetrician",
"first prenatal visit",
"pregnant",
"10 weeks",
"concerned about",
"pregnancy",
"affect",
"health",
"afraid",
"complicated medical history",
"affected",
"pregnancy",
"past medical history",
"significant",
"mild polycythemia",
"obesity h... |
A 53-year-old man presents to a physician with repeated episodes of joint pain and fever for the last 3 months. The pain is present in the knee joints and small joints of the hands bilaterally. He recorded his temperature at home which never increased above 37.8°C (100.0°F). The medical history is significant for an ac... | Presence of anti-histone antibodies | {
"A": "Presence of anti-dsDNA antibodies",
"B": "Decreased serum C4 level",
"C": "Decreased serum C3 level",
"D": "Presence of anti-histone antibodies"
} | step1 | D | [
"year old man presents",
"physician",
"repeated episodes of joint pain",
"fever",
"months",
"pain",
"present",
"knee joints",
"small joints of",
"hands",
"recorded",
"temperature at home",
"never increased",
"100",
"medical history",
"significant",
"acute myocardial infarction",
"y... |
A 47-year-old man is brought to the emergency department by his wife 30 minutes after the onset of nausea, sweating, and palpitations. On the way to the hospital, he had an episode of non-bloody vomiting and intravenous fluid resuscitation has been started. He has no history of similar symptoms. For the past 2 weeks, h... | Administer intravenous dextrose | {
"A": "Administer intravenous dextrose",
"B": "Administer intravenous phenoxybenzamine",
"C": "Administer intravenous lorazepam",
"D": "Obtain an EEG"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department",
"wife 30 minutes",
"onset",
"nausea",
"sweating",
"palpitations",
"hospital",
"episode of non bloody vomiting",
"intravenous",
"started",
"history",
"similar symptoms",
"past 2 weeks",
"to",
"weight",
"adjusted",
"diet",
"activ... |
A 6-year-old girl is brought to the physician by her parents because of concern that she is the shortest in her class. She has always been short for her age, but she is upset now that her classmates have begun teasing her for her height. She has no history of serious illness and takes no medications. She is 109 cm (3 f... | Aortic insufficiency | {
"A": "Renal cell carcinoma",
"B": "Precocious puberty",
"C": "Aortic insufficiency",
"D": "Acute lymphoblastic leukemia"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"parents",
"concern",
"shortest",
"class",
"always",
"short for",
"age",
"upset now",
"classmates",
"begun teasing",
"height",
"history",
"serious illness",
"takes",
"medications",
"3 ft",
"tall",
"percentile",
"20 kg",
"50th perce... |
A 62-year-old man presents to the ED complaining of severe eye pain that started a few hours ago. The patient reports that he fell asleep while watching TV on the couch and woke up with right-sided eye pain and blurry vision. His wife drove him to the emergency room. His wife reports that since they arrived the patient... | Intravenous acetazolamide | {
"A": "Intravenous acetazolamide",
"B": "Retinal photocoagulation",
"C": "Topical epinephrine",
"D": "Topical prednisolone"
} | step2&3 | A | [
"62 year old man presents",
"ED",
"severe eye pain",
"started",
"few hours",
"patient reports",
"fell asleep",
"watching TV",
"woke up",
"right-sided eye pain",
"blurry vision",
"wife drove",
"emergency room",
"wife reports",
"arrived",
"patient",
"intense nausea",
"patient denies ... |
A 3-year-old boy presents to the office with his mother. She states that her son seems weak and unwilling to walk. He only learned how to walk recently after a very notable delay. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all verbal and soci... | Duchenne muscular dystrophy | {
"A": "Duchenne muscular dystrophy",
"B": "Becker muscular dystrophy",
"C": "Limb-girdle muscular dystrophy",
"D": "Emery-Dreifuss muscular dystrophy"
} | step1 | A | [
"3 year old boy presents",
"office",
"mother",
"states",
"son",
"weak",
"unwilling to walk",
"only learned",
"to walk recently",
"very notable delay",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"verbal",
"social milestones",
... |
A 31-year-old woman is brought to the emergency room after an apparent suicide attempt. She is unable to provide a history, but her husband reports that he found her at home severely confused and agitated. She reportedly mentioned swallowing several of her pills but was unable to provide additional details. Her husband... | Cyproheptadine | {
"A": "Ammonium chloride",
"B": "Cyproheptadine",
"C": "Flumazenil",
"D": "Naloxone"
} | step1 | B | [
"31 year old woman",
"brought",
"emergency room",
"apparent suicide attempt",
"unable to provide",
"history",
"husband reports",
"found",
"at home severely confused",
"agitated",
"swallowing several",
"pills",
"unable to provide additional details",
"husband reports",
"history of Crohn d... |
A 21-year-old man was involved in a motor vehicle accident and died. At autopsy, the patient demonstrated abnormally increased mobility at the neck. A section of cervical spinal cord at C6 was removed and processed into slides. Which of the following gross anatomic features is most likely true of this spinal cord level... | Cuneate and gracilis fasciculi are present | {
"A": "Prominent lateral horns",
"B": "Least amount of white matter",
"C": "Absence of gray matter enlargement",
"D": "Cuneate and gracilis fasciculi are present"
} | step1 | D | [
"21-year-old man",
"involved",
"motor vehicle accident",
"died",
"autopsy",
"patient",
"increased mobility",
"neck",
"section",
"cervical spinal cord",
"removed",
"processed",
"slides",
"following gross anatomic features",
"most likely true",
"spinal level"
] |
A rapid diagnostic test has been developed amid a major avian influenza outbreak in Asia. The outbreak has reached epidemic levels with a very high attack rate. Epidemiologists are hoping to use the rapid diagnostic test to identify all exposed individuals and curb the rapid spread of disease by isolating patients with... | Sensitivity of 95/100 | {
"A": "Sensitivity of 98/100",
"B": "Specificity of 95/100",
"C": "Specificity of 98/100",
"D": "Sensitivity of 95/100"
} | step2&3 | D | [
"rapid diagnostic",
"a major avian influenza outbreak",
"Asia",
"outbreak",
"reached epidemic levels",
"very high attack rate",
"Epidemiologists",
"hoping to use",
"rapid diagnostic to",
"exposed individuals",
"curb",
"rapid spread",
"disease",
"isolating patients",
"evidence",
"exposu... |
A 69-year-old woman comes to the emergency department because of a 2-day history of cough and dyspnea. The cough is productive of small amounts of green phlegm. She has stage IV colon cancer and chronic obstructive pulmonary disease. Her medications include 5-fluorouracil, leucovorin, a fluticasone-salmeterol inhaler, ... | Cefepime and levofloxacin | {
"A": "Clarithromycin and amoxicillin-clavulanate",
"B": "Cefepime and levofloxacin",
"C": "Vancomycin",
"D": "Colistin"
} | step1 | B | [
"69 year old woman",
"emergency department",
"2-day history",
"cough",
"dyspnea",
"cough",
"productive",
"small amounts",
"green phlegm",
"stage IV colon cancer",
"chronic obstructive pulmonary disease",
"medications include 5-fluorouracil",
"leucovorin",
"fluticasone-salmeterol inhaler",
... |
A 31-year-old man presents to the office with complaints of multiple episodes of blood in his urine as well as coughing of blood for the past 3 days. He also reports a decrease in urinary frequency, and denies pain with urination. No previous similar symptoms or significant past medical history is noted. There is no hi... | Linear immunofluorescence deposits of IgG and C3 along GBM | {
"A": "Mesangial deposition of IgA often with C3",
"B": "Granular sub-endothelial deposits",
"C": "Linear immunofluorescence deposits of IgG and C3 along GBM",
"D": "Negative immunofluorescence"
} | step1 | C | [
"31 year old man presents",
"office",
"complaints of multiple episodes",
"blood",
"urine",
"coughing",
"blood",
"past",
"days",
"reports",
"decrease",
"urinary frequency",
"denies pain",
"urination",
"previous similar symptoms",
"significant past medical history",
"noted",
"history... |
A 13-year-old girl is evaluated by an orthopedic surgeon for knee pain. She thinks that the pain started after she fell while playing basketball during gym class 4 months ago. At the time she was evaluated and diagnosed with a muscle strain and told to rest and ice the joint. Since then the pain has gotten progressivel... | Osteochondritis dissecans | {
"A": "Anterior cruciate ligament injury",
"B": "Osgood-Schlatter disease",
"C": "Osteochondritis dissecans",
"D": "Osteogenesis imperfecta"
} | step1 | C | [
"year old girl",
"evaluated",
"orthopedic surgeon",
"knee pain",
"thinks",
"pain started",
"fell",
"playing basketball",
"class 4 months",
"time",
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"diagnosed",
"muscle strain",
"to rest",
"ice",
"joint",
"then",
"pain",
"gotten",
"worse",
"interferes with",
"ab... |
E. coli has the ability to regulate its enzymes to break down various sources of energy when available. It prevents waste by the use of the lac operon, which encodes a polycistronic transcript. At a low concentration of glucose and absence of lactose, which of the following occurs? | Increased cAMP levels result in binding to the catabolite activator protein | {
"A": "Increased cAMP levels result in binding to the catabolite activator protein",
"B": "Decreased cAMP levels result in poor binding to the catabolite activator protein",
"C": "Trascription of the lac Z, Y, and A genes increase",
"D": "Repressor releases from lac operator"
} | step1 | A | [
"E",
"coli",
"ability to",
"enzymes",
"break down various sources of energy",
"available",
"prevents",
"use of",
"lac operon",
"encodes",
"transcript",
"low concentration",
"glucose",
"absence",
"lactose",
"following occurs"
] |
A 1-month-old female presents with her parents to the pediatrician for a well visit. Her mother reports that the patient has been exclusively breastfed since birth. The patient feeds for 30 minutes 6-7 times per day, urinates 8-10 times per day, and passes 4-5 loose, “seedy” yellow stools per day. The patient sleeps fo... | Normal infant crying | {
"A": "Gastroesophageal reflux disease",
"B": "Infantile colic",
"C": "Milk protein allergy",
"D": "Normal infant crying"
} | step2&3 | D | [
"month old female presents",
"parents",
"pediatrician",
"well visit",
"mother reports",
"patient",
"breastfed",
"birth",
"patient feeds",
"30 minutes",
"times",
"day",
"8 10 times per day",
"passes 4 loose",
"seedy yellow stools",
"day",
"patient sleeps",
"ten hours",
"night",
... |
A newborn girl develops poor feeding and respiratory distress 4 days after delivery. She was born at a gestational age of 29 weeks. The child was born via cesarean section due to reduced movement and a non-reassuring fetal heart tracing. APGAR scores were 6 and 8 at 1 and 5 minutes, respectively. Her vitals are as foll... | Indomethacin | {
"A": "Indomethacin",
"B": "Methadone",
"C": "Caffeine",
"D": "Alprostadil"
} | step2&3 | A | [
"newborn girl",
"poor feeding",
"respiratory distress 4 days",
"delivery",
"born",
"gestational age of 29 weeks",
"child",
"born",
"cesarean section",
"reduced movement",
"non reassuring fetal heart",
"APGAR scores",
"8",
"1",
"5 minutes",
"follows",
"Patient values Normal newborn",
... |
A 34-year-old, previously healthy woman is admitted to the hospital with abdominal pain and bloody diarrhea. She reports consuming undercooked beef a day before the onset of her symptoms. Her medical history is unremarkable. Vital signs include: blood pressure 100/70 mm Hg, pulse rate 70/min, respiratory rate 16/min, a... | Verotoxin | {
"A": "Shiga toxin",
"B": "Verotoxin",
"C": "Enterotoxin type B",
"D": "Erythrogenic toxin"
} | step1 | B | [
"year old",
"healthy woman",
"admitted",
"hospital",
"abdominal pain",
"bloody diarrhea",
"reports",
"beef",
"day",
"onset",
"symptoms",
"medical history",
"unremarkable",
"Vital signs include",
"blood pressure 100 70 mm Hg",
"pulse rate 70 min",
"respiratory rate",
"min",
"tempe... |
A 38-year-old woman, gravida 2, para 1, at 35 weeks' gestation comes to the emergency department because of an episode of vaginal bleeding that morning. The bleeding has subsided. She has had no prenatal care. Her previous child was delivered with a caesarean section because of a breech presentation. Her temperature is... | Schedule elective cesarean delivery | {
"A": "Perform emergency cesarean delivery",
"B": "Administer oxytocin to induce labor",
"C": "Perform bimanual pelvic examination",
"D": "Schedule elective cesarean delivery"
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
"35 weeks",
"gestation",
"emergency department",
"of",
"episode",
"vaginal bleeding",
"morning",
"bleeding",
"prenatal care",
"previous child",
"delivered",
"caesarean section",
"breech presentation",
"temperature",
"98",
"pulse",
"88 mi... |
A 27-year-old man presents to the emergency department with his family because of abdominal pain, excessive urination, and drowsiness since the day before. He has had type 1 diabetes mellitus for 2 years. He ran out of insulin 2 days ago. The vital signs at admission include: temperature 36.8°C (98.2°F), blood pressure... | ↓ pH, ↓ bicarbonate and ↑ anion gap | {
"A": "↑ pH, ↑ bicarbonate, and normal pCO2",
"B": "↓ pH, normal bicarbonate and ↑ pCO2",
"C": "↓ pH, ↓ bicarbonate and ↑ anion gap",
"D": "↓ pH, ↓ bicarbonate and normal anion gap"
} | step2&3 | C | [
"27 year old man presents",
"emergency department",
"family",
"abdominal pain",
"excessive urination",
"drowsiness",
"day",
"type 1 diabetes mellitus",
"years",
"ran out",
"insulin 2 days",
"vital signs",
"admission include",
"temperature 36",
"98",
"blood pressure",
"69 mm Hg",
"p... |
A 42-year-old woman comes to the physician because of right flank pain that started 3 days following a procedure. Her vital signs are within normal limits. Physical examination shows right costovertebral angle tenderness. An intravenous pyelogram shows a dilated renal pelvis and ureter on the right with a lack of contr... | Hysterectomy | {
"A": "Cesarean delivery",
"B": "Hysterectomy",
"C": "Foley catheter insertion",
"D": "Inguinal hernia repair"
} | step1 | B | [
"year old woman",
"physician",
"right flank pain",
"started 3 days following",
"procedure",
"vital signs",
"normal",
"Physical examination shows right costovertebral angle tenderness",
"intravenous pyelogram shows",
"dilated renal pelvis",
"ureter",
"right",
"lack",
"contrast proximal",
... |
A 3-month-old is referred to a pediatric immunologist by his pediatrician for further workup of recurrent sinopulmonary infections which have not abated despite adequate treatment. During the workup flow cytometry demonstrates a decrease in normal CD40L cells. Based on these findings, the immunologist decides to pursue... | Increased IgM; Decreased IgG, IgA, IgE | {
"A": "Increased IgE; Decreased IgG, IgM",
"B": "Decreased IgE, IgM, IgA, IgG",
"C": "Increased IgE, IgA; Decreased IgM",
"D": "Increased IgM; Decreased IgG, IgA, IgE"
} | step1 | D | [
"3 month old",
"referred",
"pediatric immunologist",
"pediatrician",
"further workup",
"recurrent sinopulmonary infections",
"not abated",
"adequate treatment",
"workup flow cytometry demonstrates",
"decrease",
"normal CD40L cells",
"Based",
"findings",
"immunologist",
"to",
"further w... |
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