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 78-year-old woman comes to her family physician for an annual health maintenance examination. Her husband, who worked as an art collector and curator, recently passed away. To express her gratitude for the longstanding medical care of her husband, she offers the physician and his staff a framed painting from her husb... | Politely decline and explain that he cannot accept valuable gifts from his patients. | {
"A": "Accept the gift to maintain a positive patient-physician relationship but decline any further gifts.",
"B": "Politely decline and explain that he cannot accept valuable gifts from his patients.",
"C": "Accept the gift and donate the painting to a local museum.",
"D": "Accept the gift and assure the pati... | step1 | B | [
"year old woman",
"family physician",
"annual health maintenance examination",
"husband",
"worked",
"art collector",
"curator",
"recently passed",
"To",
"medical care",
"husband",
"physician",
"staff",
"framed painting",
"husband's art collection",
"following",
"most appropriate reac... |
A 46-year-old female presents to her primary care physician after noting a lump in her left breast. She reports finding it two months prior to presentation and feels that it has not grown significantly in that time. She denies nipple discharge or tenderness. On exam, she is noted to have a 3-4 cm, rubbery mass in the l... | Decreased risk of endometrial cancer | {
"A": "Decreased risk of endometrial cancer",
"B": "Increased risk of deep vein thrombosis",
"C": "Decreased risk of osteoporosis",
"D": "Increased risk of ocular toxicity"
} | step2&3 | A | [
"year old female presents",
"primary care physician",
"noting",
"lump in",
"left breast",
"reports finding",
"two months prior to presentation",
"feels",
"not",
"time",
"denies nipple discharge",
"tenderness",
"exam",
"noted to",
"3-4",
"rubbery mass in",
"left breast",
"Biopsy sho... |
A 57-year-old man presents to his physician with the complaint of a painful toe joint on his right foot. He states that the onset of pain came on suddenly, waking him up in the middle of the night. On physical exam, the metatarsophalangeal (MTP) joint of the big toe is swollen and erythematous. The physician obtains in... | Hydrochlorothiazide | {
"A": "Colchicine",
"B": "Hydrochlorothiazide",
"C": "Indomethacin",
"D": "Methotrexate"
} | step1 | B | [
"57 year old man presents",
"physician",
"complaint of",
"painful toe joint",
"right foot",
"states",
"onset",
"pain",
"waking",
"middle",
"night",
"physical exam",
"metatarsophalangeal",
"joint of",
"big toe",
"swollen",
"erythematous",
"physician obtains information",
"past med... |
A 75 year-old gentleman presents to his general practitioner. He is currently being treated for hypertension and is on a multi-drug regimen. His current blood pressure is 180/100. The physician would like to begin treatment with minoxidil or hydralazine. Which of the following side effects is associated with administra... | Reflex tachycardia | {
"A": "Persistent cough",
"B": "Systemic volume loss",
"C": "Fetal renal toxicity",
"D": "Reflex tachycardia"
} | step1 | D | [
"75 year old",
"presents",
"general practitioner",
"currently",
"treated",
"hypertension",
"multi drug regimen",
"current blood pressure",
"100",
"physician",
"to begin treatment",
"minoxidil",
"hydralazine",
"following side effects",
"associated with administration",
"drugs"
] |
A 44-year-old woman presents to the emergency department with severe, fluctuating right upper quadrant abdominal pain. The pain was initially a 4/10 but has increased recently to a 6/10 prompting her to come in. The patient has a past medical history of type II diabetes mellitus, depression, anxiety, and irritable bowe... | ERCP with manometry | {
"A": "Elective cholecystectomy",
"B": "Laparoscopy",
"C": "ERCP with manometry",
"D": "MRI of the abdomen"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"severe",
"fluctuating right upper quadrant abdominal pain",
"pain",
"initially",
"4 10",
"increased recently",
"6/10 prompting",
"to",
"patient",
"past medical history of type II diabetes mellitus",
"depression",
"anxiety",
"irritable b... |
A 4-year-old child presents to the pediatrician with mental retardation, ataxia, and inappropriate laughter. The parents of the child decide to have the family undergo genetic testing to determine what the cause may be. The results came back and all three had no mutations that would have caused this constellation of sy... | Uniparental disomy | {
"A": "Codominance",
"B": "Incomplete penetrance",
"C": "Uniparental disomy",
"D": "Variable expressivity"
} | step1 | C | [
"4 year old child presents",
"pediatrician",
"mental retardation",
"ataxia",
"inappropriate laughter",
"parents of",
"child",
"to",
"family",
"genetic testing to",
"cause",
"results",
"back",
"three",
"mutations",
"caused",
"symptoms",
"child",
"Karyotyping",
"performed",
"we... |
A 50-year-old man is brought to his neurologist by his wife for bizarre behavior. On several occasions over the last several days, he had started to complain about ‘bunnies, tigers, and emus’ in the living room. The patient has a history of multiple sclerosis and was last seen by his primary neurologist 2 weeks ago for... | Medication side effect | {
"A": "Medication side effect",
"B": "Primary psychiatric illness",
"C": "Progression of neurologic disease",
"D": "Recreational drug intoxication"
} | step2&3 | A | [
"50 year old man",
"brought",
"neurologist",
"wife",
"bizarre behavior",
"several occasions",
"days",
"started to",
"tigers",
"emus",
"living room",
"patient",
"history",
"multiple sclerosis",
"last seen by",
"primary neurologist 2 weeks",
"complaints",
"new left upper extremity we... |
A 45-year-old man presents to the physician with limb weakness over the last 24 hours. He is an otherwise healthy man with no significant past medical history. On physical examination, his vital signs are stable. On neurological examination, there is decreased strength in the muscles of all 4 extremities, and the deep ... | Acute hypercalcemia | {
"A": "Acute hypercalcemia",
"B": "Acute hypomagnesemia",
"C": "Acute hypernatremia",
"D": "Acute hypochloremia"
} | step1 | A | [
"year old man presents",
"physician",
"limb weakness",
"24 hours",
"healthy man",
"significant past medical history",
"physical examination",
"vital signs",
"stable",
"neurological examination",
"decreased strength",
"muscles",
"extremities",
"deep tendon reflexes",
"depressed",
"detai... |
A 12-year-old boy comes to the physician for the evaluation of intermittent blood-tinged urine for several months. Four months ago, he had an episode of fever and sore throat that resolved without treatment after 5 days. During the past 2 years, he has also had recurrent episodes of swelling of his face and feet. 5 yea... | Defective type IV collagen | {
"A": "IgA deposits",
"B": "WT1 gene mutation",
"C": "Defective type IV collagen",
"D": "Autosomal-recessive kidney disease"
} | step2&3 | C | [
"year old boy",
"physician",
"evaluation",
"intermittent blood urine",
"several months",
"Four months",
"episode of fever",
"sore throat",
"resolved",
"treatment",
"5 days",
"past",
"years",
"recurrent episodes of swelling",
"face",
"feet",
"5 years",
"diagnosed",
"mild bilateral... |
A 7-year-old boy is brought to the emergency department because of high-grade fever and lethargy for 4 days. He has had a severe headache for 3 days and 2 episodes of non-bilious vomiting. He has sickle cell disease. His only medication is hydroxyurea. His mother has refused vaccinations and antibiotics in the past bec... | Hearing loss | {
"A": "Hearing loss",
"B": "Adrenal insufficiency",
"C": "Cerebral palsy",
"D": "Communicating hydrocephalus"
} | step2&3 | A | [
"year old boy",
"brought",
"emergency department",
"high-grade fever",
"lethargy",
"4 days",
"severe headache",
"3 days",
"2 episodes of non bilious vomiting",
"sickle cell disease",
"only medication",
"hydroxyurea",
"mother",
"refused vaccinations",
"antibiotics",
"past",
"possible ... |
A 17-year-old boy is admitted to the emergency department with a history of fatigue, fever of 40.0°C (104.0°F), sore throat, and enlarged cervical lymph nodes. On physical examination, his spleen and liver are not palpable. A complete blood count is remarkable for atypical reactive T cells. An examination of his tonsil... | The infectious organism can become latent in B cells. | {
"A": "The infectious organism is heterophile-negative.",
"B": "The infectious organism causes Cutaneous T-cell lymphoma.",
"C": "The infectious organism can become latent in B cells.",
"D": "The infectious organism can become latent in macrophages."
} | step1 | C | [
"year old boy",
"admitted",
"emergency department",
"history",
"fatigue",
"fever",
"40",
"sore throat",
"enlarged cervical lymph nodes",
"physical examination",
"spleen",
"liver",
"not palpable",
"complete blood count",
"atypical reactive T cells",
"examination of",
"tonsils",
"sho... |
A 54-year-old man was brought to the emergency room due to acute onset of slurred speech while at work, after which he lost consciousness. The patient’s wife says this occurred approximately 30 minutes ago. Past medical history is significant for poorly controlled hypertension and type 2 diabetes mellitus. His blood pr... | Hippocampus | {
"A": "Hippocampus",
"B": "Caudate nucleus",
"C": "Cortex or cerebral hemisphere",
"D": "Substantia nigra"
} | step1 | A | [
"54 year old man",
"brought",
"emergency room due to acute onset",
"slurred speech",
"work",
"lost consciousness",
"patients wife",
"occurred approximately 30 minutes",
"Past medical history",
"significant",
"poorly controlled hypertension",
"type 2 diabetes mellitus",
"blood pressure",
"9... |
A 43-year-old man is brought to the emergency department 40 minutes after falling off a 10-foot ladder. He has severe pain and swelling of his right ankle and is unable to walk. He did not lose consciousness after the fall. He has no nausea. He appears uncomfortable. His temperature is 37°C (98.6°F), pulse is 98/min, r... | X-ray of the spine | {
"A": "MRI of the right ankle",
"B": "Long leg cast",
"C": "Open reduction and internal fixation",
"D": "X-ray of the spine"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department 40 minutes",
"falling",
"10 foot ladder",
"severe pain",
"swelling",
"right",
"unable to walk",
"not",
"consciousness",
"fall",
"nausea",
"appears",
"temperature",
"98",
"pulse",
"98 min",
"respirations",
"min",
"blood pressure... |
A G1P0 mother gives birth to a male infant at 37 weeks gestation. She received adequate prenatal care and took all her prenatal vitamins. She is otherwise healthy and takes no medications. On the 1 month checkup, examination revealed a machine-like murmur heard at the left sternal border. Which of the following medicat... | Indomethacin | {
"A": "Digoxin",
"B": "Indomethacin",
"C": "Prostaglandin E1",
"D": "Prostaglandin E2"
} | step1 | B | [
"mother gives birth",
"male infant",
"weeks gestation",
"received adequate prenatal care",
"took",
"prenatal vitamins",
"healthy",
"takes",
"medications",
"1 month checkup",
"examination revealed",
"machine",
"murmur heard",
"left sternal border",
"following medications",
"most appropr... |
A 23-year-old woman is brought to the physician by her father because of strange behavior for the past 6 months. The father reports that his daughter has increasingly isolated herself in college and received poor grades. She has told her father that aliens are trying to infiltrate her mind and that she has to continuou... | Loose associations | {
"A": "Circumstantial speech",
"B": "Loose associations",
"C": "Flight of ideas",
"D": "Clang associations"
} | step2&3 | B | [
"23 year old woman",
"brought",
"physician",
"father",
"strange behavior",
"past 6 months",
"father reports",
"daughter",
"isolated",
"college",
"received poor grades",
"father",
"aliens",
"to infiltrate",
"mind",
"to",
"listen",
"radio to monitor",
"activities",
"appears anxio... |
A 55-year-old man presents to urgent care for weakness and weight loss. He states for the past several months he has felt progressively weaker and has lost 25 pounds. The patient also endorses intermittent abdominal pain. The patient has not seen a physician in 30 years and recalls being current on most of his vaccinat... | CT scan of the abdomen | {
"A": "CT scan of the abdomen",
"B": "CT scan of the liver",
"C": "HIDA scan",
"D": "Smoking cessation advice and primary care follow up"
} | step2&3 | A | [
"55 year old man presents",
"urgent care",
"weakness",
"weight loss",
"states",
"past",
"months",
"felt",
"weaker",
"lost 25 pounds",
"patient",
"intermittent abdominal pain",
"patient",
"not seen",
"physician",
"30 years",
"recalls",
"current",
"vaccinations",
"few years",
"... |
A 69-year-old woman is brought to the emergency department by her husband because of a 1-day history of fever, shortness of breath, dizziness, and cough productive of purulent sputum. Six days ago, she developed malaise, headache, sore throat, and myalgias that improved initially. Her temperature is 39.3°C (102.7°F) an... | Binding of Fc domain of immunoglobulin G | {
"A": "Degradation of membranous phospholipids",
"B": "Binding of Fc domain of immunoglobulin G",
"C": "Overstimulation of guanylate cyclase",
"D": "Inactivation of elongation factor 2"
} | step1 | B | [
"69 year old woman",
"brought",
"emergency department",
"husband",
"1-day history",
"fever",
"shortness of breath",
"dizziness",
"cough productive",
"purulent",
"Six days",
"malaise",
"headache",
"sore throat",
"myalgias",
"improved initially",
"temperature",
"3C",
"blood pressur... |
A man is brought into the emergency department by police. The patient was found somnolent in the park and did not respond to questioning. The patient's past medical history is unknown, and he is poorly kempt. The patient's personal belongings include prescription medications and illicit substances such as alprazolam, d... | Naloxone | {
"A": "Flumazenil",
"B": "N-acetylcysteine",
"C": "Naloxone",
"D": "Supportive therapy, thiamine, and dextrose"
} | step2&3 | C | [
"man",
"brought",
"emergency department",
"police",
"patient",
"found somnolent",
"park",
"not",
"questioning",
"patient's past",
"unknown",
"poorly",
"patient's personal",
"include prescription medications",
"illicit substances",
"alprazolam",
"diazepam",
"marijuana",
"cocaine",... |
An investigator inoculates three different broths with one colony-forming unit of Escherichia coli. Broth A contains 100 μmol of lactose, broth B contains 100 μmol of glucose, and broth C contains both 100 μmol of lactose and 100 μmol of glucose. After 24 hours, the amounts of lactose, galactose, and glucose in the thr... | Increased activity of adenylate cyclase | {
"A": "Increased activity of glycosylases",
"B": "Decreased activity of catabolite activator protein",
"C": "Decreased production of α-galactosidase A",
"D": "Increased activity of adenylate cyclase"
} | step1 | D | [
"investigator inoculates three different",
"one colony-forming unit",
"Escherichia coli",
"contains 100 mol",
"lactose",
"contains 100 mol",
"glucose",
"contains",
"100 mol",
"lactose",
"100 mol",
"glucose",
"24 hours",
"amounts",
"lactose",
"galactose",
"glucose",
"three",
"meas... |
A 45-year-old woman presents with a complaint of pain in the metacarpophalangeal joints and proximal interphalangeal joints bilaterally. Serology showed positive anti-CCP antibodies. She has been prescribed infliximab for control of her condition. Which of the following needs to be tested before starting treatment in t... | PPD skin test | {
"A": "PPD skin test",
"B": "Complete blood counts",
"C": "G6PD levels",
"D": "Ophthalmic examination"
} | step1 | A | [
"year old woman presents",
"complaint",
"pain",
"metacarpophalangeal joints",
"proximal interphalangeal joints",
"Serology showed positive anti-CCP antibodies",
"prescribed infliximab",
"control",
"condition",
"following needs to",
"tested",
"starting treatment",
"patient"
] |
A 30-year-old African American G1P0 mother gives birth to a male infant at 33 weeks' gestation. The mother had no prenatal care and took no prenatal vitamins. The child’s postnatal period was complicated by neonatal sepsis due to group B Streptococcus. He required a two week stay in the neonatal intensive care unit to ... | DOPA | {
"A": "DOPA",
"B": "Phenylalanine",
"C": "Leucine",
"D": "Homogentisic acid"
} | step1 | A | [
"30 year old African American",
"mother gives birth",
"male infant",
"weeks",
"gestation",
"mother",
"prenatal care",
"took",
"prenatal vitamins",
"childs postnatal period",
"complicated",
"neonatal sepsis",
"group B Streptococcus",
"required",
"two week",
"neonatal intensive care unit... |
A pathologist performed an autopsy on an 18-month-old infant boy who died of pneumonia. Clinical notes revealed the infant had repeated respiratory infections that started after he was weaned off of breast-milk. Laboratory investigation revealed hypogammaglobulinemia and an absence of B-cells. T-cell levels were normal... | X-linked recessive | {
"A": "Autosomal recessive",
"B": "Autosomal dominant",
"C": "X-linked recessive",
"D": "X-linked dominant"
} | step1 | C | [
"pathologist performed",
"autopsy",
"month old infant boy",
"died",
"pneumonia",
"Clinical notes revealed",
"infant",
"repeated respiratory infections",
"started",
"weaned",
"breast-milk",
"Laboratory investigation revealed hypogammaglobulinemia",
"absence of B-cells",
"T-cell levels",
"... |
A 62-year-old man is brought to the emergency department for the evaluation of intermittent bloody vomiting for the past 2 hours. He has had similar episodes during the last 6 months that usually stop spontaneously within an hour. The patient is not aware of any medical problems. He has smoked one pack of cigarettes da... | Intravenous ceftriaxone | {
"A": "Transfusion of packed red blood cells",
"B": "Endoscopic band ligation",
"C": "Intravenous ceftriaxone",
"D": "Transjugular intrahepatic portal shunt"
} | step2&3 | C | [
"62 year old man",
"brought",
"emergency department",
"evaluation of intermittent bloody vomiting",
"past",
"hours",
"similar episodes",
"months",
"usually stop",
"hour",
"patient",
"not aware",
"medical problems",
"smoked one pack",
"cigarettes daily",
"30 years",
"quit 10 years",
... |
A 33-year-old woman presents with lethargy and neck pain. She says that, for the past 6 months, she has been feeling tired all the time and has noticed a lot of muscle tension around the base of her neck. She also says she finds herself constantly worrying about everything, such as if her registered mail would reach fa... | Buspirone | {
"A": "Buspirone",
"B": "Diazepam",
"C": "Family therapy",
"D": "Support groups"
} | step1 | A | [
"year old woman presents",
"lethargy",
"neck pain",
"past 6 months",
"feeling tired",
"time",
"lot",
"muscle tension",
"base of",
"neck",
"finds",
"constantly worrying",
"registered mail",
"reach family",
"friends",
"time",
"holidays",
"children got",
"bath",
"weekend",
"worr... |
A 27-year-old woman, gravida 2, para 1, at 26 weeks' gestation comes to the emergency department because of vaginal bleeding and epistaxis for the past 2 days. She missed her last prenatal visit 2 weeks ago. Physical examination shows blood in the posterior pharynx and a uterus consistent in size with 23 weeks' gestati... | Decreased fibrinogen concentration | {
"A": "Increased antithrombin concentration",
"B": "Decreased prothrombin time",
"C": "Increased factor V concentration",
"D": "Decreased fibrinogen concentration"
} | step1 | D | [
"27 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"emergency department",
"vaginal bleeding",
"epistaxis",
"past 2 days",
"missed",
"last prenatal visit",
"weeks",
"Physical examination shows blood",
"posterior pharynx",
"uterus consistent",
"size",
"23 weeks",
"ges... |
A 62-year-old woman presents to her primary care physician because of fever, fatigue, and shortness of breath. She has noticed that she has a number of bruises, but she attributes this to a hike she went on 1 week ago. She has diabetes and hypertension well controlled on medication and previously had an abdominal surge... | Recruiting histone acetylase proteins | {
"A": "Binding to anti-apoptotic factors",
"B": "Inhibiting pro-apoptotic factors",
"C": "Interacting with IL-3 receptor",
"D": "Recruiting histone acetylase proteins"
} | step1 | D | [
"62 year old woman presents",
"primary care physician",
"fever",
"fatigue",
"shortness of breath",
"number",
"bruises",
"attributes",
"1 week",
"diabetes",
"hypertension well controlled",
"medication",
"abdominal surgery",
"remember",
"physical exam",
"lumps",
"neck",
"palpable",
... |
A 17-year-old girl is brought to the physician because of amenorrhea for 4 months. Menses previously occurred at regular 28-day intervals and last for 3 to 4 days. There is no family history of serious illness. She receives good grades in school and is on the high school track team. She is sexually active with one male... | Nutritional deficiency | {
"A": "Exogenous steroid use",
"B": "Defective androgen receptors",
"C": "Gonadal dysgenesis",
"D": "Nutritional deficiency"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"of amenorrhea",
"months",
"Menses",
"occurred",
"regular",
"day intervals",
"last",
"4 days",
"family history",
"serious illness",
"receives good grades in school",
"high school track team",
"sexually active",
"one male partner",
"uses cond... |
A 52-year-old man with chronic alcoholism presents to an ambulatory medical clinic, where the hepatologist elects to perform comprehensive hepatitis B screening, in addition to several other screening and preventative measures. Given the following choices, which serologic marker, if positive, would indicate the patient... | HBsAb | {
"A": "HBsAgrn",
"B": "HBsAb",
"C": "HBcAbrn",
"D": "HBeAg"
} | step2&3 | B | [
"year old man",
"chronic alcoholism presents",
"ambulatory medical clinic",
"hepatologist",
"to perform comprehensive hepatitis B screening",
"several",
"screening",
"preventative measures",
"Given",
"following choices",
"serologic marker",
"positive",
"patient",
"immunity",
"hepatitis B... |
A 65-year-old woman presents with memory problems for the past few weeks. Patient vividly describes how she forgot where she put her car keys this morning and did not remember to wish her grandson a happy birthday last week. Patient denies any cognitive problems, bowel/bladder incontinence, tremors, gait problems, or f... | "No, taking ginkgo will increase your risk for bleeding." | {
"A": "\"Yes, ginkgo is widely used for improving brain function and memory.\"",
"B": "\"No, taking ginkgo will increase your risk for bleeding.\"",
"C": "\"Yes, gingko may not help with your memory, but there is no risk of adverse events so it is safe to take.\"",
"D": "“No, herbal preparations are unsafe bec... | step1 | B | [
"65 year old woman presents",
"memory problems",
"past",
"weeks",
"Patient",
"forgot",
"put",
"car",
"morning",
"not remember to wish",
"grandson",
"happy",
"week",
"Patient denies",
"cognitive problems",
"bowel bladder",
"tremors",
"gait problems",
"focal neurologic signs",
"P... |
A 54-year-old man comes to the physician because of excessive daytime sleepiness for 5 months. He wakes up frequently at night, and his wife says his snoring has become louder. He is 180 cm (5 ft 10 in) tall and weighs 104 kg (230 lb); his BMI is 33 kg/m2. His pulse is 80/min and his respiratory rate is 11/min. His jug... | Intermittent collapse of the oropharynx | {
"A": "Increased medullary ventilatory responsiveness",
"B": "Decreased levels of hypocretin-1",
"C": "Intermittent collapse of the oropharynx",
"D": "Daytime alveolar hypoventilation"
} | step1 | C | [
"54 year old man",
"physician",
"of excessive daytime sleepiness",
"months",
"wakes up frequently",
"night",
"wife",
"snoring",
"louder",
"5 ft 10",
"tall",
"kg",
"BMI",
"kg/m2",
"pulse",
"80 min",
"respiratory rate",
"min",
"jugular venous pressure",
"cm H2O",
"has 2",
"pi... |
A 27-year-old woman with a history of a "heart murmur since childhood" presents following a series of syncopal episodes over the past several months. She also complains of worsening fatigue over this time period, and notes that her lips have begun to take on a bluish tinge, for which she has been using a brighter shade... | Positive bubble study | {
"A": "Aortic stenosis",
"B": "Mitral insufficiency",
"C": "Positive bubble study",
"D": "Ventricular aneurysm"
} | step1 | C | [
"27 year old woman",
"history",
"heart murmur",
"childhood",
"presents following",
"series of syncopal episodes",
"past",
"months",
"worsening fatigue",
"time period",
"notes",
"lips",
"begun to take",
"using",
"brighter shade",
"lipstick",
"careful examination",
"detect",
"right... |
A 42-year-old woman comes to the emergency department with gradually worsening pain in the abdomen and right flank. The abdominal pain started one week ago and is accompanied by foul-smelling, lightly-colored diarrhea. The flank pain started two days ago and is now an 8 out of 10 in intensity. It worsens on rapid movem... | Hypercalcemia | {
"A": "Hypertensive crisis",
"B": "Cutaneous flushing",
"C": "Hypercalcemia",
"D": "QT prolongation on ECG"
} | step2&3 | C | [
"year old woman",
"emergency department",
"worsening pain",
"abdomen",
"right flank",
"abdominal pain started one week",
"smelling",
"lightly colored diarrhea",
"flank pain started two days",
"now",
"8 out",
"10",
"intensity",
"worsens",
"rapid movement",
"history of intermittent knee ... |
A 53-year-old woman presents to a physician with a cough which she has had for the last 5 years. She mentions that her cough is worse in the morning and is associated with significant expectoration. There is no history of weight loss or constitutional symptoms like fever and malaise. Her past medical records show that ... | Chronic bronchitis | {
"A": "Asthma",
"B": "Chronic bronchitis",
"C": "Emphysema",
"D": "Idiopathic pulmonary fibrosis"
} | step2&3 | B | [
"year old woman presents",
"physician",
"cough",
"last",
"years",
"cough",
"worse",
"morning",
"associated with significant expectoration",
"history of weight loss",
"constitutional",
"fever",
"malaise",
"past medical records show",
"required hospitalization",
"breathing difficulty",
... |
A 55-year-old man comes to the physician because of increasing shortness of breath for 1 month. Initially, he was able to climb the 3 flights of stairs to his apartment, but he now needs several breaks to catch his breath. He has no chest pain. He has rheumatic heart disease and type 2 diabetes mellitus. He emigrated f... | Percutaneous mitral balloon commissurotomy | {
"A": "Tricuspid valve repair",
"B": "Mitral valve replacement",
"C": "Percutaneous mitral balloon commissurotomy",
"D": "Transcatheter aortic valve replacement"
} | step2&3 | C | [
"55 year old man",
"physician",
"of increasing shortness",
"breath",
"1 month",
"Initially",
"able to climb",
"3 flights",
"stairs",
"apartment",
"now needs several breaks to catch",
"breath",
"chest pain",
"rheumatic heart disease",
"type 2 diabetes mellitus",
"India",
"years",
"p... |
A 70-year-old male presents to his primary care physician for complaints of fatigue. The patient reports feeling tired during the day over the past 6 months. Past medical history is significant for moderately controlled type II diabetes. Family history is unremarkable. Thyroid stimulating hormone and testosterone level... | Colonoscopy | {
"A": "MRI abdomen",
"B": "Blood transfusion",
"C": "CT abdomen",
"D": "Colonoscopy"
} | step1 | D | [
"70 year old male presents",
"primary care physician",
"complaints",
"fatigue",
"patient reports feeling tired",
"day",
"past 6 months",
"Past medical history",
"significant",
"moderately controlled type II diabetes",
"Family history",
"unremarkable",
"Thyroid stimulating hormone",
"testos... |
A 52-year-old woman presents with involuntary passage of urine and occasional watery vaginal discharge. She associates the onset of these symptoms with her discharge from the hospital for an abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma and a left ovary cyst 2 months ago. The inco... | Voiding cystourethrography | {
"A": "Cystometry",
"B": "Voiding cystourethrography",
"C": "Antegrade pyelography",
"D": "Urine flow test"
} | step2&3 | B | [
"year old woman presents",
"involuntary passage",
"urine",
"occasional watery vaginal discharge",
"associates",
"onset",
"symptoms",
"discharge from",
"hospital",
"abdominal hysterectomy",
"bilateral salpingo-oophorectomy",
"endometrial carcinoma",
"left ovary cyst",
"months",
"incontine... |
A 73-year-old man noted a rapid onset of severe dizziness and difficulty swallowing while watching TV at home. His wife reports that he had difficulty forming sentences and his gait was unsteady at this time. Symptoms were severe within 1 minute and began to improve spontaneously after 10 minutes. He has had type 2 dia... | Vertebral artery occlusion | {
"A": "Vertebral artery occlusion",
"B": "Middle cerebral artery occlusion",
"C": "Posterior cerebral artery occlusion",
"D": "Lenticulostriate artery occlusion"
} | step2&3 | A | [
"year old man noted",
"rapid onset",
"severe dizziness",
"difficulty swallowing",
"watching TV at home",
"wife reports",
"difficulty forming sentences",
"gait",
"unsteady",
"time",
"Symptoms",
"severe",
"minute",
"began to",
"10 minutes",
"type 2 diabetes mellitus",
"years",
"50 pa... |
A 72-year-old man is brought to the emergency department with increasing fever and abdominal pain over the past week. The pain is constant and limited to the lower right part of his abdomen. He has nausea but no vomiting or diarrhea. His past medical history is unremarkable for any serious illnesses. He takes acetamino... | Antibiotics + CT-guided drainage | {
"A": "Antibiotics + CT-guided drainage",
"B": "Antibiotics + interval appendectomy",
"C": "Appendectomy within 12 hours",
"D": "Early surgical drainage + interval appendectomy"
} | step2&3 | A | [
"72 year old man",
"brought",
"emergency department",
"increasing fever",
"abdominal pain",
"past week",
"pain",
"constant",
"limited",
"lower right part of",
"abdomen",
"nausea",
"vomiting",
"diarrhea",
"past medical history",
"unremarkable",
"serious illnesses",
"takes acetaminop... |
A 40-day-old child presents to a physician for the first time for a well-child visit. The mother is a 22-year-old college student who opted for a home birth. Upon examination, the child weighs 4.0 kg (8.8 lbs) and has intact reflexes. The umbilical cord is still attached and looks erythematous and indurated. A complete... | CD18 | {
"A": "CD21",
"B": "CD1a",
"C": "CD3",
"D": "CD18"
} | step1 | D | [
"40 day old child presents",
"physician",
"first time",
"well-child visit",
"mother",
"year old college student",
"opted",
"home birth",
"examination",
"child",
"4 0 kg",
"8.8 lbs",
"intact reflexes",
"umbilical cord",
"attached",
"looks erythematous",
"indurated",
"complete blood ... |
A 27-year-old woman presents for her routine annual examination. She has no complaints. She has a 3-year-old child who was born via normal vaginal delivery with no complications. She had a Pap smear during her last pregnancy and the findings were normal. Her remaining past medical history is not significant, and her fa... | “We should do a Pap smear now. Blood tests are not recommended for screening purposes.” | {
"A": "“We should do a Pap smear now. Blood tests are not recommended for screening purposes.”",
"B": "“You need HPV (human papillomavirus) co-testing only.”",
"C": "“Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”",
"D": "“Your last Pap smear 3 years ago was normal. We ... | step1 | A | [
"27 year old woman presents",
"routine annual examination",
"complaints",
"3 year old child",
"born",
"normal vaginal",
"complications",
"Pap smear",
"pregnancy",
"findings",
"normal",
"remaining past medical history",
"not significant",
"family history",
"not significant",
"Recently",... |
A 59-year-old woman presents to the physician for a 3-month history of progressively worsening shortness of breath on exertion and swelling of her legs. She has a history of breast cancer that was treated with surgery, followed by doxorubicin and cyclophosphamide therapy 4 years ago. Cardiac examination shows an S3 gal... | E | {
"A": "A",
"B": "C",
"C": "D",
"D": "E"
} | step2&3 | D | [
"59 year old woman presents",
"physician",
"3 month history",
"worsening shortness of breath",
"exertion",
"swelling of",
"legs",
"history of breast cancer",
"treated with surgery",
"followed by doxorubicin",
"cyclophosphamide therapy",
"years",
"Cardiac examination shows",
"S3 gallop",
... |
A 19-year-old girl with a history of immune thrombocytopenic purpura (ITP), managed with systemic corticosteroids, presents with bruising, acne, and weight gain. Patient says that 3 months ago she gradually began to notice significant weight gain and facial and truncal acne. She says these symptoms progressively worsen... | Splenectomy | {
"A": "Administration of intravenous immunoglobulin",
"B": "Continuation of systemic corticosteroid therapy",
"C": "Splenectomy",
"D": "Transfusion of thrombocytes"
} | step1 | C | [
"year old girl",
"history immune",
"managed",
"systemic corticosteroids",
"presents",
"bruising",
"acne",
"weight gain",
"Patient",
"3 months",
"began to",
"significant weight gain",
"facial",
"truncal acne",
"symptoms",
"worsened",
"discontinued",
"corticosteroid therapy",
"week... |
A 30-year-old boxer seeks evaluation by his physician after he noticed swelling at the angle of his jaw a few days ago. He recalls a recent boxing match when he was punched in his face. He says that his jaw is very painful. On examination, a firm mass is palpated, measuring 4 x 4 cm. An ultrasound was performed, which ... | Parotid gland | {
"A": "Minor salivary gland",
"B": "Thyroid",
"C": "Parotid gland",
"D": "Seventh cranial nerve"
} | step1 | C | [
"30 year old boxer",
"evaluation",
"physician",
"swelling",
"angle of his jaw",
"few days",
"recalls",
"recent boxing match",
"punched",
"face",
"jaw",
"very painful",
"examination",
"firm mass",
"palpated",
"measuring 4",
"4",
"ultrasound",
"performed",
"shows",
"thin",
"e... |
A 32-year-old woman comes to the physician because of a 2-week history of involuntary loss of urine. She loses small amounts of urine in the absence of an urge to urinate and for no apparent reason. She also reports that she has an intermittent urinary stream. Two years ago, she was diagnosed with multiple sclerosis. C... | Detrusor sphincter dyssynergia | {
"A": "Cognitive impairment",
"B": "Vesicovaginal fistula",
"C": "Detrusor sphincter dyssynergia",
"D": "Impaired detrusor contractility"
} | step2&3 | C | [
"year old woman",
"physician",
"2-week history",
"involuntary loss",
"urine",
"small amounts",
"urine",
"absence",
"to",
"apparent reason",
"reports",
"intermittent urinary stream",
"Two years",
"diagnosed",
"multiple sclerosis",
"Current medications include glatiramer acetate",
"mul... |
A 55-year-old female comes to see her doctor for a rapidly enlarging abdomen and swelling of both legs. She was hospitalized 2 weeks ago for an upper gastrointestinal bleeding episode. On that occasion, her esophagogastroduodenoscopy showed grade 1 esophageal varices and a 1 cm clean-based antral ulcer. The patient was... | The zone closest to the centrolobular vein | {
"A": "The zone where gluconeogenesis is predominant",
"B": "The zone with little or no cytochrome P450 enzymes",
"C": "The zone closest to the centrolobular vein",
"D": "The zone involved in cholesterol synthesis"
} | step1 | C | [
"55 year old female",
"to see",
"doctor",
"rapidly enlarging abdomen",
"swelling of",
"legs",
"hospitalized 2 weeks",
"upper gastrointestinal bleeding episode",
"occasion",
"esophagogastroduodenoscopy showed grade 1 esophageal varices",
"clean based antral ulcer",
"patient",
"discharged",
... |
A 34-year-old woman comes to the physician because of a 6-week history of fever and productive cough with blood-tinged sputum. She has also had a 4-kg (8.8-lb) weight loss during the same time period. Examination shows enlarged cervical lymph nodes. An x-ray of the chest shows a 2.5-cm pulmonary nodule in the right upp... | Delayed T cell-mediated reaction | {
"A": "Delayed T cell-mediated reaction",
"B": "Antibody-mediated cytotoxic reaction",
"C": "Combined type III/IV hypersensitivity reaction",
"D": "Immune complex deposition\n\""
} | step1 | A | [
"year old woman",
"physician",
"week history",
"fever",
"productive cough",
"blood-tinged sputum",
"4 kg",
"8.8",
"weight loss",
"same time period",
"Examination shows enlarged cervical lymph nodes",
"x-ray of",
"chest shows",
"2.5",
"pulmonary nodule",
"right upper lobe",
"biopsy sp... |
A 26-year-old man comes to the emergency department because of a 1-week history of fever, throat pain, and difficulty swallowing. Head and neck examination shows an erythematous pharynx with purulent exudates overlying the palatine tonsils. Microscopic examination of a throat culture shows pink, spherical bacteria arra... | Inform the colleague that she cannot divulge any information about the patient | {
"A": "Inform the colleague that she cannot divulge any information about the patient",
"B": "Inform the colleague that he should ask the patient's attending physician",
"C": "Tell her colleague the patient's case file number so he can look it up himself",
"D": "Ask the colleague to meet in her office so they ... | step1 | A | [
"year old man",
"emergency department",
"1-week history",
"fever",
"throat pain",
"difficulty swallowing",
"Head and neck examination shows",
"erythematous pharynx",
"purulent exudates",
"palatine tonsils",
"Microscopic examination of",
"throat culture shows pink",
"spherical bacteria arrang... |
A 32-year-old African American woman comes to the physician because of fatigue and difficulty swallowing for 6 weeks. She also complains of painful discoloration in her fingers when exposed to cold weather. She has smoked one pack of cigarettes daily for 4 years. She appears younger than her stated age. Physical examin... | Pulmonary hypertension | {
"A": "Liver cirrhosis",
"B": "Chronic obstructive pulmonary disease",
"C": "Pulmonary hypertension",
"D": "Chondrocalcinosis"
} | step1 | C | [
"year old African American woman",
"physician",
"fatigue",
"difficulty swallowing",
"weeks",
"painful discoloration",
"fingers",
"exposed",
"cold weather",
"smoked one pack",
"cigarettes daily",
"4 years",
"appears younger",
"stated age",
"Physical examination shows smooth",
"swollen f... |
A 61-year-old man presents to the emergency room with a painful, swollen left leg. He states that his symptoms began that morning after a long flight from Australia. He denies shortness of breath, chest pain, or cough. On review of systems, he notes that he has been constipated recently and had several episodes of brig... | Resistance of factor V to inactivation by protein C | {
"A": "Protein C deficiency",
"B": "Loss of antithrombin III in urine",
"C": "Resistance of factor V to inactivation by protein C",
"D": "Malignancy"
} | step2&3 | C | [
"61 year old man presents",
"emergency room",
"painful",
"swollen left leg",
"states",
"symptoms began",
"morning",
"long flight",
"Australia",
"denies shortness of breath",
"chest pain",
"cough",
"review of systems",
"notes",
"constipated recently",
"several episodes of bright red blo... |
A 58-year-old woman with breast cancer presents to her primary care physician for referral to a medical oncologist. She denies any personal history of blood clots in her past. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smo... | Aprepitant + dexamethasone + 5-HT3 receptor antagonist | {
"A": "Dronabinol + dexamethasone",
"B": "Aprepitant + dexamethasone + 5-HT3 receptor antagonist",
"C": "Dexamethasone + 5-HT3 receptor antagonist",
"D": "Aprepitant + dronabinol"
} | step2&3 | B | [
"58 year old woman",
"breast cancer presents",
"primary care physician",
"referral to",
"medical oncologist",
"denies",
"personal history",
"blood clots",
"past",
"past medical history",
"significant",
"preeclampsia",
"hypertension",
"polycystic ovarian syndrome",
"hypercholesterolemia",... |
A parent presents to her pediatrician requesting information about immunizations for her newborn. The pediatrician explains about basic principles of immunization, types of vaccines, possible adverse effects, and the immunization schedule. Regarding how immunizations work, the pediatrician explains that there are mainl... | Yellow fever vaccine | {
"A": "Yellow fever vaccine",
"B": "Rabies vaccine",
"C": "Hepatitis A vaccine",
"D": "Polio vaccine (Salk)"
} | step1 | A | [
"parent presents",
"pediatrician requesting information",
"immunizations",
"newborn",
"pediatrician",
"basic",
"immunization",
"types",
"vaccines",
"possible adverse effects",
"immunization schedule",
"immunizations work",
"pediatrician",
"types",
"vaccines",
"first type",
"vaccine p... |
A 22-year-old man, accompanied by his brother, presents to the emergency department with palpitations for the past 30 minutes and nausea for the past hour. When the patient meets the physician, he says, “Doctor, I am the happiest person in the world because I have the best brain possible. It’s just that my heart is say... | Dilated pupils | {
"A": "Dilated pupils",
"B": "Rotatory nystagmus",
"C": "Bilateral foveal yellow spots",
"D": "Bilateral optic disc edema"
} | step2&3 | A | [
"year old man",
"brother",
"presents",
"emergency department",
"palpitations",
"past 30 minutes",
"nausea",
"past hour",
"patient meets",
"physician",
"Doctor",
"I",
"happiest person",
"world",
"I",
"best brain possible",
"heart",
"I",
"to check",
"to see",
"brother",
"pati... |
A 68-year-old man comes to the emergency department because of a 1-week history of worsening bouts of shortness of breath at night. He has had a cough for 1 month. Occasionally, he has coughed up frothy sputum during this time. He has type 2 diabetes mellitus and long-standing hypertension. Two years ago, he was diagno... | Impaired myocardial relaxation | {
"A": "Destruction of alveolar walls",
"B": "Decreased myocardial contractility",
"C": "Diuretic overdose",
"D": "Impaired myocardial relaxation"
} | step2&3 | D | [
"68 year old man",
"emergency department",
"of",
"1-week history",
"worsening bouts",
"shortness",
"breath",
"night",
"cough",
"month",
"Occasionally",
"coughed",
"frothy sputum",
"time",
"type 2 diabetes mellitus",
"long standing hypertension",
"Two years",
"diagnosed",
"Paget d... |
A 62-year-old man comes to the physician for hematemesis and progressive heartburn over the past 5 days. Ten days ago, he was started on a medication to treat a condition that causes hearing difficulties and pain of the lower legs. He has no other history of serious illness. He has smoked 1 pack of cigarettes daily for... | Risedronate | {
"A": "Calcium citrate",
"B": "Denosumab",
"C": "Risedronate",
"D": "Acetaminophen"
} | step1 | C | [
"62 year old man",
"physician",
"hematemesis",
"progressive heartburn",
"past 5 days",
"Ten",
"started",
"medication to treat",
"condition",
"causes hearing difficulties",
"pain",
"lower legs",
"history",
"serious illness",
"smoked 1 pack",
"cigarettes daily",
"past 20 years",
"Phy... |
A 56-year-old male died in a motor vehicle accident. Autopsy reveals extensive atherosclerosis of his left anterior descending artery marked by intimal smooth muscle and collagen proliferation. Which of the following is implicated in recruiting smooth muscle cells from the media to intima in atherosclerotic lesions? | Platelet-derived growth factor | {
"A": "IgE",
"B": "Prostacyclin",
"C": "Factor V Leiden",
"D": "Platelet-derived growth factor"
} | step1 | D | [
"year old male died",
"motor vehicle accident",
"Autopsy reveals extensive atherosclerosis",
"left anterior descending artery marked",
"intimal smooth muscle",
"collagen proliferation",
"following",
"smooth muscle cells",
"media",
"intima",
"atherosclerotic lesions"
] |
A 29-year-old man presents to the emergency room with severe abdominal pain. He states that for the entire day, he has had pain in his lower right abdomen in addition to a loss of appetite accompanied by nausea and vomiting. His temperature is 101.3°F (38.5°C), blood pressure is 125/98 mmHg, pulse is 78/min, and respir... | Laparoscopic surgery | {
"A": "Abdominal radiograph",
"B": "Abdominal ultrasound",
"C": "Colonoscopy",
"D": "Laparoscopic surgery"
} | step2&3 | D | [
"29 year old man presents",
"emergency room",
"severe abdominal",
"states",
"entire day",
"pain",
"lower right abdomen in addition to",
"loss of appetite",
"nausea",
"vomiting",
"temperature",
"blood pressure",
"98 mmHg",
"pulse",
"min",
"respirations",
"min",
"physical examination... |
A 2400-g (5.29-lb) male newborn is delivered at term to a 26-year-old woman. Physical examination shows a sloping forehead, a flat nasal bridge, increased interocular distance, low-set ears, and a protruding tongue. There is a single palmar crease and an increased gap between the first and second toe. The abdomen is di... | Unbalanced translocation | {
"A": "Meiotic nondisjunction",
"B": "Mitotic nondisjunction",
"C": "Unbalanced translocation",
"D": "Uniparental disomy"
} | step1 | C | [
"2400 g",
"29",
"male newborn",
"delivered",
"term",
"year old woman",
"Physical examination shows",
"sloping forehead",
"flat nasal bridge",
"increased",
"distance",
"low-set ears",
"protruding tongue",
"single palmar crease",
"increased gap",
"first",
"second toe",
"abdomen",
"... |
A 3-year-old boy is brought to his pediatrician for a regular checkup by his mother. The patient’s mother is concerned about a slight deviation of his left eye and she also notes that her child’s left eye looks strange on the photos, especially if there is a flash. The patient is the first child in the family born to a... | Eye enucleation | {
"A": "Brachytherapy",
"B": "Eye enucleation",
"C": "Cryotherapy",
"D": "Laser coagulation"
} | step2&3 | B | [
"3 year old boy",
"brought",
"pediatrician",
"regular checkup",
"mother",
"patients mother",
"concerned",
"slight deviation",
"left eye",
"notes",
"childs left eye looks",
"flash",
"patient",
"first child",
"family born",
"31 year old woman",
"boy",
"born",
"weeks gestation",
"... |
A 21-year-old man comes to the physician because of a 3-day history of yellowing of his eyes. He has also noticed a decrease in his exercise capacity and gets quickly exhausted after minor physical activity. Examination shows scleral icterus and pale mucous membranes. He has splenomegaly. His hemoglobin concentration i... | Decreased haptoglobin levels | {
"A": "Decreased reticulocyte count",
"B": "Decreased haptoglobin levels",
"C": "Decreased mean corpuscular volume",
"D": "Increased direct to total bilirubin ratio"
} | step1 | B | [
"21-year-old man",
"physician",
"3-day history",
"yellowing",
"eyes",
"decrease",
"exercise capacity",
"gets",
"exhausted",
"minor physical activity",
"Examination shows scleral icterus",
"pale mucous membranes",
"splenomegaly",
"hemoglobin concentration",
"mg/dL",
"leukocyte",
"coun... |
A previously healthy 24-year-old woman comes to the physician because of a 1-day history of painful rash after spending several hours in the sun. Skin examination shows well-demarcated areas of erythema with some scaling on the face, chest, upper back, and arms. The affected areas are hot and sensitive to touch. The or... | Apoptosis of keratinocytes in the epidermis | {
"A": "Immune complex deposits at the dermoepidermal junction",
"B": "Mast cell activation in the superficial dermis",
"C": "Apoptosis of keratinocytes in the epidermis",
"D": "T-cell-mediated inflammatory reaction in the dermis"
} | step1 | C | [
"healthy",
"year old woman",
"physician",
"1-day history",
"painful rash",
"spending",
"hours",
"sun",
"Skin examination shows well",
"areas",
"erythema",
"scaling",
"face",
"chest",
"upper back",
"arms",
"affected areas",
"hot",
"sensitive to touch",
"oral mucosa appears norma... |
Sixteen hours after delivery, a newborn develops respiratory distress. She was born at 38 weeks' gestation with a birth weight of 3200 g (7 lb 1 oz). Pregnancy was complicated by polyhydramnios. Physical examination shows tachypnea and bluish discoloration of the extremities. Auscultation of the chest shows diffuse cra... | Defect in mesodermal differentiation | {
"A": "Defect in the pleuroperitoneal membrane",
"B": "Defect in mesodermal differentiation",
"C": "Absence of dynein",
"D": "Deletion in the long arm of chromosome 22"
} | step1 | B | [
"Sixteen hours",
"delivery",
"newborn",
"respiratory distress",
"born",
"weeks",
"gestation",
"birth weight",
"g",
"1 oz",
"Pregnancy",
"complicated",
"polyhydramnios",
"Physical examination shows tachypnea",
"discoloration",
"extremities",
"Auscultation",
"chest shows diffuse crac... |
A 46-year-old male presents to his dermatologist for routine follow-up of his psoriasis. He was last seen in the office six months prior, at which time he started undergoing ultraviolet light therapy. He reports that he initially noticed an improvement in his symptoms but the effects were transient. He has also started... | Reactivation of latent tuberculosis | {
"A": "Reactivation of latent tuberculosis",
"B": "Nephrotoxicity",
"C": "Myelosuppression",
"D": "Cushing’s syndrome"
} | step1 | A | [
"year old male presents",
"dermatologist",
"routine follow-up",
"psoriasis",
"last seen",
"office six months prior",
"time",
"started",
"ultraviolet light therapy",
"reports",
"initially",
"improvement",
"symptoms",
"effects",
"transient",
"started",
"pain",
"stiffness",
"fingers... |
A 72-year-old man comes to the physician because of a lesion on his eyelid for 6 months. The lesion is not painful or pruritic. He initially dismissed it as a 'skin tag' but the lesion has increased in size over the past 3 months. He has type 2 diabetes mellitus, coronary artery disease, and left hemiplegia from a stro... | Mohs micrographic surgery | {
"A": "Cryotherapy",
"B": "Topical chemotherapy",
"C": "Mohs micrographic surgery",
"D": "Laser ablation\n\""
} | step2&3 | C | [
"72 year old man",
"physician",
"of",
"lesion",
"eyelid",
"months",
"lesion",
"not painful",
"initially dismissed",
"skin tag",
"lesion",
"increased in size",
"past 3 months",
"type 2 diabetes mellitus",
"coronary artery disease",
"left hemiplegia",
"stroke",
"years",
"Current me... |
A 65-year-old man comes to the physician because of a 2-week history of dizziness, fatigue, and shortness of breath. He has noticed increased straining with bowel movements and decreased caliber of his stools over the past 3 months. He has no history of medical illness and takes no medications. He appears pale. Physica... | Filling defect of the rectosigmoid colon | {
"A": "Thumbprint sign of the transverse colon",
"B": "Lead pipe sign of the descending colon",
"C": "Filling defect of the rectosigmoid colon",
"D": "String sign in the terminal ileum"
} | step1 | C | [
"65 year old man",
"physician",
"2-week history",
"dizziness",
"fatigue",
"shortness of breath",
"increased straining",
"bowel movements",
"decreased caliber",
"stools",
"past 3 months",
"history of medical illness",
"takes",
"medications",
"appears pale",
"Physical examination shows m... |
A 55-year-old man is brought to the emergency department 30 minutes after the sudden onset of severe, migrating anterior chest pain, shortness of breath, and sweating at rest. He has hypertension, hypercholesterolemia, and type 2 diabetes mellitus. Medications include atorvastatin, hydrochlorothiazide, lisinopril, and ... | Aortic dissection | {
"A": "Pulmonary embolism",
"B": "Aortic dissection",
"C": "Spontaneous pneumothorax",
"D": "Papillary muscle rupture"
} | step2&3 | B | [
"55 year old man",
"brought",
"emergency department 30 minutes",
"sudden onset",
"severe",
"migrating anterior chest pain",
"shortness of breath",
"sweating",
"rest",
"hypertension",
"hypercholesterolemia",
"type 2 diabetes mellitus",
"Medications include atorvastatin",
"hydrochlorothiazid... |
A 19-year-old woman undergoes an laparoscopic appendectomy for acute appendicitis. During the procedure, a black, discolored liver is noted. Other than the recent appendicitis, the patient has no history of serious illness and takes no medications. She has no medication allergies. She does not drink alcohol or use illi... | Dubin-Johnson syndrome | {
"A": "Type II Crigler-Najjar syndrome",
"B": "Dubin-Johnson syndrome",
"C": "Rotor syndrome",
"D": "Wilson disease"
} | step2&3 | B | [
"year old woman",
"laparoscopic appendectomy",
"acute appendicitis",
"procedure",
"black",
"discolored liver",
"noted",
"recent appendicitis",
"patient",
"history",
"serious illness",
"takes",
"medications",
"medication allergies",
"not drink alcohol",
"use illicit",
"uncomplicated p... |
A 55-year-old man with atrial fibrillation is brought to the emergency department by his wife 6 hours after the acute onset of right arm weakness and slurred speech. An MRI of the brain shows a thrombus in the left middle cerebral artery. Twelve hours later, the patient develops ventricular tachycardia. Despite appropr... | Eosinophilic neuronal cytoplasm with pyknotic nuclei | {
"A": "Neutrophilic infiltration with central necrosis",
"B": "Reactive gliosis with vascular proliferation",
"C": "Glial scarring with fibrous tissue hypertrophy",
"D": "Eosinophilic neuronal cytoplasm with pyknotic nuclei"
} | step1 | D | [
"55 year old man",
"atrial fibrillation",
"brought",
"emergency department",
"wife",
"hours",
"acute onset of right arm weakness",
"slurred speech",
"MRI of",
"brain shows",
"thrombus",
"left middle cerebral artery",
"Twelve hours later",
"patient",
"ventricular tachycardia",
"appropri... |
A 54-year-old woman is diagnosed with locally-advanced invasive ductal adenocarcinoma of the breast. She undergoes surgical resection, radiation therapy, and is now being started on adjunctive chemotherapy with cyclophosphamide and doxorubicin. The patient is scheduled for follow up by her primary care provider. Which ... | Echocardiography | {
"A": "Cardiac MRI",
"B": "ECG",
"C": "Echocardiography",
"D": "No regular monitoring indicated"
} | step2&3 | C | [
"54 year old woman",
"diagnosed",
"locally advanced invasive ductal adenocarcinoma of the breast",
"surgical resection",
"radiation therapy",
"now",
"started",
"adjunctive chemotherapy",
"cyclophosphamide",
"doxorubicin",
"patient",
"scheduled",
"follow up",
"primary care provider",
"fol... |
A 55-year-old man presents to his primary care physician for a new patient appointment. The patient states that he feels well and has no concerns at this time. The patient has a past medical history of hypertension, an elevated fasting blood glucose, and is not currently taking any medications. His blood pressure is 17... | Dexamethasone suppression test | {
"A": "Dexamethasone suppression test",
"B": "Hydrochlorothiazide",
"C": "Metformin",
"D": "MRI of the head"
} | step2&3 | A | [
"55 year old man presents",
"primary care physician",
"new patient appointment",
"patient states",
"feels well",
"concerns",
"time",
"patient",
"past medical",
"elevated fasting",
"not currently taking",
"medications",
"blood pressure",
"mmHg",
"pulse",
"90 min",
"respirations",
"m... |
A 25-year-old man presents with abdominal pain and bloody diarrhea. His symptoms have been recurrent for the past few months, and, currently, he says he is having on average four bowel movements daily, often bloody. He describes the pain as cramping and localized to the left side of his abdomen. He also says that he ha... | Inhibition of leukotriene synthesis and lipoxygenase | {
"A": "Inhibition of leukotriene synthesis and lipoxygenase",
"B": "Suppression of cellular and humoral immunity",
"C": "Inhibition of enzyme phospholipase A2",
"D": "Cross-linking of DNA of the bacteria causing UC"
} | step1 | A | [
"year old man presents",
"abdominal pain",
"bloody diarrhea",
"symptoms",
"recurrent",
"past",
"months",
"currently",
"average four bowel movements daily",
"often bloody",
"pain",
"cramping",
"localized",
"left side of",
"abdomen",
"lost",
"kg",
"10",
"past 3 months",
"signific... |
A 5-year-old boy is brought to the emergency department by his mother because of a 2-hour history of word-finding difficulty, speech slurring, and weakness and sensory loss of his right arm and leg. He has not had fever, nausea, headache, or diarrhea. His mother reports an episode of severe pain and soft tissue swellin... | Exchange transfusion therapy | {
"A": "Exchange transfusion therapy",
"B": "Intravenous tissue plasminogen activator therapy",
"C": "Hydroxyurea therapy",
"D": "Aspirin therapy\n\""
} | step2&3 | A | [
"5 year old boy",
"brought",
"emergency department",
"mother",
"hour history",
"word finding difficulty",
"speech slurring",
"weakness",
"sensory loss of",
"right arm",
"leg",
"not",
"fever",
"nausea",
"headache",
"diarrhea",
"mother reports",
"episode of severe pain",
"soft tiss... |
A 9-year-old girl presents with dyspnea, palpitations, joint pain, and fever for the past week. She says that her symptoms started 2 weeks ago with bilateral knee pain which has shifted to both ankles over the past week. She says she noticed bilateral leg swelling since yesterday. Past medical history is significant fo... | Acute rheumatic fever | {
"A": "Acute rheumatic fever",
"B": "Aortic regurgitation",
"C": "Tricuspid regurgitation",
"D": "Aortic stenosis"
} | step1 | A | [
"year old girl presents",
"dyspnea",
"palpitations",
"joint pain",
"fever",
"past week",
"symptoms started 2 weeks",
"bilateral knee pain",
"shifted",
"ankles",
"past week",
"bilateral leg swelling",
"Past medical history",
"significant",
"severe sore throat",
"fever",
"chills",
"m... |
A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 3-month history of fatigue and weakness. Her hemoglobin A1c concentration was 13.5% 12 weeks ago. Her blood pressure is 152/92 mm Hg. Examination shows lower extremity edema. Serum studies show:
K+ 5.1 mEq/L
Phosphorus 5.0 mg/dL
Ca2+ ... | Urinary albumin | {
"A": "Urinary red blood cell casts",
"B": "Serum total protein",
"C": "Urinary albumin",
"D": "Serum creatinine"
} | step1 | C | [
"62 year old woman",
"type 2 diabetes mellitus",
"physician",
"3 month history",
"fatigue",
"weakness",
"hemoglobin concentration",
"weeks",
"blood pressure",
"mm Hg",
"Examination shows lower extremity edema",
"Serum studies show",
"K",
"5",
"mEq",
"Phosphorus",
"mg dL",
"Urea nit... |
A 10-year-old boy is brought to the pediatrician by his father because of recent changes in his behavior. His father states that he has noticed that the boy has begun to appear less coordinated than normal and has had frequent falls. On exam, the pediatrician observes pes cavus and hammer toes. The pediatrician makes a... | Hypertrophic cardiomyopathy | {
"A": "Tetrology of fallot",
"B": "Endocardial cushion defect",
"C": "Hypertrophic cardiomyopathy",
"D": "Aortic cystic medial necrosis"
} | step1 | C | [
"A 10 year old boy",
"brought",
"pediatrician",
"father",
"recent changes",
"behavior",
"father states",
"boy",
"begun to appear less coordinated",
"normal",
"frequent falls",
"exam",
"pediatrician observes pes cavus",
"hammer toes",
"pediatrician makes",
"presumptive diagnosis based",... |
A 3-year-old girl presents to the emergency department with skin desquamation over her hips and buttocks and right arm; she also has conjunctivitis and fever. The patient was previously seen by her pediatrician for symptoms of impetigo around the nasal folds, and she was treated with topical fusidic acid. She was born ... | Staphylococcus aureus infection | {
"A": "Herpes simplex virus infection",
"B": "Staphylococcus aureus infection",
"C": "Bullous pemphigoid",
"D": "Psoriasis"
} | step1 | B | [
"3 year old girl presents",
"emergency department",
"skin desquamation",
"hips",
"buttocks",
"right arm",
"conjunctivitis",
"fever",
"patient",
"seen by",
"pediatrician",
"symptoms",
"impetigo",
"nasal folds",
"treated with topical fusidic acid",
"born",
"weeks gestation",
"spontan... |
A 22-year-old woman comes to the emergency department because of chest and epigastric pain that started just after vomiting 30 minutes ago. She does not take any medications and does not drink alcohol or smoke cigarettes. While in the emergency department, the patient experiences two episodes of forceful, bloody emesis... | Mucosal lacerations at the gastroesophageal junction | {
"A": "Dilated veins in the esophageal submucosa",
"B": "Rupture of the distal esophagus",
"C": "Mucosal lacerations at the gastroesophageal junction",
"D": "Friable mass in the distal esophagus"
} | step1 | C | [
"year old woman",
"emergency department",
"chest",
"epigastric pain",
"started",
"vomiting 30 minutes",
"not take",
"medications",
"not drink alcohol",
"smoke cigarettes",
"emergency department",
"patient experiences two episodes of forceful",
"bloody emesis",
"temperature",
"99",
"3C"... |
An 86-year-old man is admitted to the hospital for management of pneumonia. His hospital course has been relatively uneventful, and he is progressing well. On morning rounds nearing the end of the patient's hospital stay, the patient's cousin finally arrives to the hospital for the first time after not being present fo... | Explain that you cannot discuss the patient's care at this time | {
"A": "Bring the cousin to the room and ask the patient if it is acceptable to disclose his course",
"B": "Bring the cousin to the room and explain the plan to both the patient and cousin",
"C": "Explain that you cannot discuss the patient's care at this time",
"D": "Tell the cousin that you do not know the pa... | step2&3 | C | [
"year old man",
"admitted",
"hospital",
"management",
"pneumonia",
"hospital course",
"progressing well",
"morning rounds nearing",
"end",
"patient's hospital",
"patient's cousin",
"hospital",
"first time",
"not",
"present",
"patient's hospitalization",
"patient's prognosis",
"pote... |
A 58-year-old man presents with an occasional tremor in his left hand. While the tremor disappears when he moves his hand, he finds it increasingly difficult to type and feels his handwriting has gotten much smaller. He finds the tremor is more pronounced when he is stressed out at work. He also complains of a decrease... | Bromocriptine | {
"A": "Selegiline",
"B": "Bromocriptine",
"C": "Carbidopa",
"D": "Benztropine"
} | step1 | B | [
"58 year old man presents",
"occasional tremor",
"left hand",
"tremor",
"moves",
"hand",
"finds",
"difficult",
"type",
"feels",
"handwriting",
"gotten",
"smaller",
"finds",
"tremor",
"more",
"stressed out",
"work",
"decrease",
"sense of smell",
"mild constipation",
"difficu... |
A 10-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. They used to play every weekend, but his son has started to tire easily and has complained of pain in his lower legs while running around on the soccer field. The b... | Intracranial hemorrhage | {
"A": "Intracranial hemorrhage",
"B": "Central cyanosis",
"C": "Paradoxical embolism",
"D": "Right heart failure"
} | step1 | A | [
"A 10 year old boy",
"brought",
"physician",
"father",
"concerned",
"son",
"less interested",
"playing soccer",
"recently",
"used to play",
"weekend",
"son",
"started to tire easily",
"pain",
"lower legs",
"running",
"soccer field",
"boy",
"personal",
"family history",
"serio... |
A 45-year-old woman comes to the physician because of progressive difficulty swallowing solids and liquids over the past 4 months. She has lost 4 kg (9 lb) during this period. There is no history of serious illness. She emigrated to the US from Panama 7 years ago. She does not smoke cigarettes or drink alcohol. Cardiop... | Absence of myenteric plexus neurons | {
"A": "Atrophy of esophageal smooth muscle cells",
"B": "Infiltration of eosinophils in the epithelium",
"C": "Absence of myenteric plexus neurons",
"D": "Presence of metaplastic columnar epithelium"
} | step1 | C | [
"year old woman",
"physician",
"progressive difficulty swallowing solids",
"liquids",
"past",
"months",
"lost 4 kg",
"period",
"history",
"serious illness",
"Panama",
"years",
"not smoke cigarettes",
"drink alcohol",
"Cardiopulmonary examination shows",
"systolic murmur",
"S3 gallop"... |
A 51-year-old man is admitted to the hospital because of a 2-day history of fever, nausea, and abdominal pain. His temperature is 39.4°C (102.9°F) and pulse is 106/min. Physical examination shows tenderness in the right upper quadrant. Blood cultures grow nonhemolytic, gram-positive cocci that grow in hypertonic saline... | Increase in the intracellular uptake of gentamicin | {
"A": "Additive bacteriostatic effect of ampicillin",
"B": "Increase in the intracellular uptake of gentamicin",
"C": "Stabilization of gentamicin binding at the target site",
"D": "Sequential block of essential micronutrient synthesis"
} | step1 | B | [
"year old man",
"admitted",
"hospital",
"2-day history",
"fever",
"nausea",
"abdominal pain",
"temperature",
"4C",
"9F",
"pulse",
"min",
"Physical examination shows tenderness",
"right upper quadrant",
"Blood cultures",
"nonhemolytic",
"gram-positive cocci",
"hypertonic saline",
... |
A 5-year-old boy is brought to the physician because of a painful, burning rash on his left arm for 3 days. Three years ago, he was diagnosed with heart failure due to congenital heart disease and received an allogeneic heart transplantation. He takes cyclosporine to prevent chronic transplant rejection. He has not rec... | Multinucleated epidermal giant cells and intranuclear inclusions | {
"A": "Eosinophilic spongiosis and subepidermal blister formation",
"B": "Multinucleated epidermal giant cells and intranuclear inclusions",
"C": "Papillary microabscesses and granular deposits of IgA",
"D": "Fungal hyphae and hyperkeratosis"
} | step1 | B | [
"5 year old boy",
"brought",
"physician",
"painful",
"burning rash",
"left arm",
"3 days",
"Three years",
"diagnosed",
"heart failure",
"congenital heart disease",
"received",
"allogeneic heart",
"takes cyclosporine to prevent chronic transplant rejection",
"not received",
"routine chi... |
A 58-year-old woman with refractory gastrointestinal complaints undergoes a bowel biopsy. On histology, the pathologist observes that submucosal glands of Brunner are present in the specimen. Which portion of the bowel was most likely biopsied? | Duodenum | {
"A": "Duodenum",
"B": "Jejunum",
"C": "Ileum",
"D": "Descending colon"
} | step1 | A | [
"58 year old woman",
"refractory gastrointestinal complaints",
"bowel biopsy",
"histology",
"pathologist observes",
"submucosal glands of Brunner",
"present",
"specimen",
"portion",
"bowel",
"most likely biopsied"
] |
A 65-year-old man is brought to the emergency department because of a 3-day history of increasing shortness of breath and chest pain. He has had a productive cough with foul-smelling sputum for 1 week. He has gastritis as well as advanced Parkinson disease and currently lives in an assisted-living community. He smoked ... | Parkinson disease
" | {
"A": "Living in an assisted-living community",
"B": "Tobacco use history",
"C": "Gastritis",
"D": "Parkinson disease\n\""
} | step1 | D | [
"65 year old man",
"brought",
"emergency department",
"of",
"3-day history",
"increasing shortness",
"breath",
"chest pain",
"productive cough",
"foul-smelling sputum",
"1 week",
"gastritis",
"advanced Parkinson disease",
"currently lives in",
"assisted-living community",
"smoked one p... |
A 34-year-old man comes to the physician because of palpitations, shortness of breath, diarrhea, and abdominal cramps for 2 months. Physical examination shows cutaneous flushing of the face. Auscultation of the chest shows bilateral wheezing. A 24-hour urine collection shows increased 5-hydroxyindoleacetic acid (5-HIAA... | Tryptophan hydroxylase | {
"A": "Dopamine β-hydroxylase",
"B": "Plasma kallikrein",
"C": "Histidine decarboxylase",
"D": "Tryptophan hydroxylase"
} | step1 | D | [
"year old man",
"physician",
"palpitations",
"shortness of breath",
"diarrhea",
"abdominal cramps",
"months",
"Physical examination shows cutaneous flushing of the face",
"Auscultation",
"chest shows bilateral wheezing",
"24-hour urine collection shows increased 5-hydroxyindoleacetic acid",
"5... |
A 16-year-old girl is brought to the physician because she has not attained menarche. There is no personal or family history of serious illness. She is 165 cm (5 ft 5 in) tall and weighs 60 kg (132 lb); BMI is 22 kg/m2. Breast development is Tanner stage 4, and pubic hair development is Tanner stage 1. Pelvic examinati... | 46,XY | {
"A": "45,XO",
"B": "46,XX",
"C": "46,XY",
"D": "47,XXY"
} | step1 | C | [
"year old girl",
"brought",
"physician",
"not",
"menarche",
"personal",
"family history",
"serious illness",
"5 ft 5",
"tall",
"60 kg",
"BMI",
"kg/m2",
"Breast development",
"Tanner",
"pubic hair development",
"Tanner stage 1",
"Pelvic examination shows",
"blind vaginal pouch",
... |
A 22-year-old woman is brought to the emergency department after being struck by a car while crossing the street. She has major depressive disorder with psychosis. Current medications include sertraline and haloperidol. Vital signs are within normal limits. X-ray of the lower extremity shows a mid-shaft femur fracture.... | Dantrolene therapy | {
"A": "Dantrolene therapy",
"B": "Fat embolectomy",
"C": "Cyproheptadine therapy",
"D": "Propranolol therapy"
} | step1 | A | [
"year old woman",
"brought",
"emergency department",
"struck by",
"car",
"crossing",
"street",
"major depressive disorder",
"psychosis",
"Current medications include sertraline",
"haloperidol",
"Vital signs",
"normal limits",
"X-ray of",
"lower extremity shows",
"mid shaft femur fractu... |
A previously healthy 10-year-old girl is brought to the physician because of severe malaise, pink eyes, cough, and a runny nose for 3 days. She recently immigrated from Sudan and immunization records are unavailable. Her temperature is 40.1°C (104.1°F). Examination shows bilateral conjunctival injections. There are mul... | Subacute sclerosing panencephalitis | {
"A": "Immune thrombocytopenic purpura",
"B": "Subacute sclerosing panencephalitis",
"C": "Transient arrest of erythropoiesis",
"D": "Glomerular immune complex deposition\n\""
} | step1 | B | [
"healthy 10 year old girl",
"brought",
"physician",
"severe malaise",
"pink eyes",
"cough",
"runny nose",
"3 days",
"recently",
"Sudan",
"immunization records",
"unavailable",
"temperature",
"40",
"Examination shows bilateral conjunctival injections",
"multiple",
"gray lesions",
"e... |
A 54-year-old man with known end-stage liver disease from alcoholic cirrhosis presents to the emergency department with decreased urinary output and swelling in his lower extremities. His disease has been complicated by ascites and hepatic encephalopathy in the past. Initial laboratory studies show a creatinine of 1.73... | Liver transplantation | {
"A": "Peritoneovenous shunt",
"B": "Transjugular intrahepatic portosystemic shunt (TIPS)",
"C": "Liver transplantation",
"D": "Hemodialysis"
} | step2&3 | C | [
"54 year old man",
"known end-stage liver disease",
"alcoholic cirrhosis presents",
"emergency department",
"decreased urinary output",
"swelling",
"lower extremities",
"disease",
"complicated",
"ascites",
"hepatic encephalopathy",
"past",
"Initial laboratory studies show",
"creatinine",
... |
A 37-year-old machinist presents to his primary care physician with eye problems. The patient states that he has had a mass in his eye that has persisted for the past month. The patient has a past medical history of blepharitis treated with eye cleansing and squamous cell carcinoma of the skin treated with Mohs surgery... | Chalazion | {
"A": "Chalazion",
"B": "Foreign body",
"C": "Ingrown eyelash follicle",
"D": "Meibomian cell carcinoma"
} | step2&3 | A | [
"year old",
"presents",
"primary care physician",
"eye problems",
"patient states",
"mass",
"eye",
"past month",
"patient",
"past medical treated with eye cleansing",
"squamous cell carcinoma of the skin treated with Mohs surgery",
"temperature",
"99",
"blood pressure",
"mmHg",
"pulse"... |
An 8-year-old boy is brought to the physician for evaluation of developmental delay and recurrent tonic-clonic seizures. There is no family history of seizures or other serious illness. Current medications include risperidone for hyperactivity. He is at the 17th percentile for head circumference. Examination shows prot... | Uniparental disomy of chromosome 15 | {
"A": "Chromosome 22q11 microdeletion",
"B": "De novo mutation of MECP2 on the X chromosome",
"C": "Uniparental disomy of chromosome 15",
"D": "Trinucleotide repeat in FMR1 gene"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"evaluation",
"developmental delay",
"recurrent tonic-clonic seizures",
"family history",
"seizures",
"serious illness",
"Current medications include risperidone",
"hyperactivity",
"percentile",
"head",
"Examination shows protrusion",
"mandible",
... |
Twelve days after undergoing a cadaveric renal transplant for adult polycystic kidney disease, a 23-year-old man has pain in the right lower abdomen and generalized fatigue. During the past 4 days, he has had decreasing urinary output. Creatinine concentration was 2.3 mg/dL on the second postoperative day. Current medi... | Allorecognition with T cell activation | {
"A": "Drug-induced nephrotoxicity",
"B": "Donor T cells from the graft",
"C": "Allorecognition with T cell activation",
"D": "Irreversible fibrosis of the glomerular vessels"
} | step1 | C | [
"Twelve days",
"cadaveric renal transplant",
"adult polycystic kidney disease",
"23 year old man",
"pain",
"right lower abdomen",
"generalized fatigue",
"past",
"days",
"decreasing urinary output",
"Creatinine concentration",
"2 mg",
"second postoperative day",
"Current medications include... |
A 60-year-old man is rushed to the emergency room after he was found unconscious in bed that afternoon. The patient’s wife says he has been confused and irritable for the past several days. She says he has a history of chronic daily alcohol abuse and has been hospitalized multiple times with similar symptoms His temper... | Decreases pH in the gastrointestinal lumen | {
"A": "Decreases the colonic concentration of bacteria",
"B": "Increases ammonia production and absorption",
"C": "Increases pH in the gastrointestinal lumen",
"D": "Decreases pH in the gastrointestinal lumen"
} | step1 | D | [
"60 year old man",
"rushed",
"emergency room",
"found unconscious",
"bed",
"afternoon",
"patients wife",
"confused",
"irritable",
"past",
"days",
"history of chronic daily alcohol abuse",
"hospitalized multiple times",
"similar symptoms",
"temperature",
"98",
"blood pressure",
"80 ... |
A 41-year-old homeless man is brought to the emergency department complaining of severe fever, dizziness, and a persistent cough. The patient has a history of long-standing alcohol abuse and has frequently presented to the emergency department with acute alcohol intoxication. The patient states that his cough produces ... | Ciprofloxacin | {
"A": "Vancomycin",
"B": "Piperacillin-tazobactam",
"C": "Clindamycin",
"D": "Ciprofloxacin"
} | step2&3 | D | [
"year old homeless man",
"brought",
"emergency department",
"severe fever",
"dizziness",
"persistent cough",
"patient",
"history of long standing alcohol abuse",
"frequently presented",
"emergency department",
"acute alcohol intoxication",
"patient states",
"cough",
"dark brown",
"provid... |
A 28-year-old man is brought to the emergency department by ambulance after developing an altered mental state following blunt trauma to the head. The patient was competing at a local mixed martial arts competition when he was struck in the head and lost consciousness. A few minutes later, upon regaining consciousness,... | Middle Meningeal artery | {
"A": "Bridging veins",
"B": "Middle Meningeal artery",
"C": "Subarachnoid space",
"D": "Suprasellar cistern"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"ambulance",
"altered mental state following blunt trauma",
"head",
"patient",
"local mixed martial arts competition",
"struck",
"head",
"lost consciousness",
"few minutes later",
"regaining consciousness",
"progressive",
"mental status"... |
An investigator is studying the efficacy of a new bisphosphonate analog in preventing hip fractures in patients above 60 years of age with risk factors for osteoporosis but no confirmed diagnosis. Participating patients were randomized to either pharmacologic therapy with the new bisphosphonate analog or a placebo. The... | 40% | {
"A": "5%",
"B": "40%",
"C": "2%",
"D": "60%"
} | step1 | B | [
"investigator",
"studying",
"efficacy",
"new bisphosphonate analog",
"preventing hip fractures",
"patients",
"60 years",
"age",
"risk factors",
"osteoporosis",
"confirmed diagnosis",
"Participating patients",
"randomized",
"pharmacologic therapy",
"new bisphosphonate analog",
"placebo"... |
A 44-year-old man presents to the emergency department with weakness. He states that he has felt progressively more weak over the past month. He endorses decreased libido, weight gain, and headaches. His temperature is 97.0°F (36.1°C), blood pressure is 177/108 mmHg, pulse is 80/min, respirations are 17/min, and oxygen... | Eplerenone | {
"A": "Eplerenone",
"B": "Hydrochlorothiazide",
"C": "Insulin",
"D": "Torsemide"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"weakness",
"states",
"felt",
"weak",
"past month",
"decreased libido",
"weight gain",
"headaches",
"temperature",
"97",
"36",
"blood pressure",
"mmHg",
"pulse",
"80 min",
"respirations",
"min",
"oxygen saturation",
"98",
"ro... |
A 1-year-old boy is brought to the physician for a well-child examination. He has no history of serious illness. His older sister had an eye disease that required removal of one eye at the age of 3 years. Examination shows inward deviation of the right eye. Indirect ophthalmoscopy shows a white reflex in the right eye ... | Osteosarcoma | {
"A": "Neuroblastoma",
"B": "Basal cell carcinoma",
"C": "Osteosarcoma",
"D": "Gastric cancer"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"well",
"history",
"serious illness",
"older sister",
"eye disease",
"required removal of one eye",
"age",
"years",
"Examination shows inward deviation",
"right",
"Indirect ophthalmoscopy shows",
"white reflex",
"right",
"red reflex",
"left e... |
A 67-year-old Caucasian female presents to her primary care physician after a screening DEXA scan reveals a T-score of -3.0. Laboratory work-up reveals normal serum calcium, phosphate, vitamin D, and PTH levels. She smokes 1-2 cigarettes per day. Which of the following measures would have reduced this patient's risk of... | Calcium and vitamin D supplementation | {
"A": "Reduced physical activity to decrease the chance of a fall",
"B": "Initiating a swimming exercise program three days per week",
"C": "Calcium and vitamin D supplementation",
"D": "Weight loss"
} | step2&3 | C | [
"67 year old Caucasian female presents",
"primary care physician",
"screening DEXA scan reveals a T score",
"3",
"Laboratory work-up reveals normal serum calcium",
"phosphate",
"vitamin D",
"levels",
"smokes 1",
"cigarettes per day",
"following measures",
"reduced",
"patient's risk",
"oste... |
A 43-year-old man is brought to the emergency department 45 minutes after his wife found him on the floor sweating profusely. On arrival, he is lethargic and unable to provide a history. He vomited multiple times on the way to the hospital. His temperature is 37.3°C (99.1°F), pulse is 55/min, respirations are 22/min, a... | Competitive antagonism of mACh receptors | {
"A": "Enteral binding",
"B": "Competitive antagonism of mACh receptors",
"C": "Non-selective α-adrenergic antagonism",
"D": "Alkaloid emesis-induction"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department 45 minutes",
"wife found",
"floor sweating",
"arrival",
"lethargic",
"unable to provide",
"history",
"vomited multiple times",
"hospital",
"temperature",
"3C",
"99",
"pulse",
"55 min",
"respirations",
"min",
"blood pressure",
"98... |
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