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 |
|---|---|---|---|---|---|
An 82-year-old woman visits her primary care provider complaining of a vague cramping pain on the right side of her abdomen for the past 6 hours. She is also and had an episode of vomiting earlier today and two episodes yesterday. Past medical history includes third-degree heart block, gastroesophageal reflux disease, ... | Gallstone ileus | {
"A": "Cholecystitis",
"B": "Choledocolithiasis",
"C": "Gallstone ileus",
"D": "Primary biliary cholangitis"
} | step1 | C | [
"year old woman visits",
"primary care provider complaining of a vague cramping pain",
"right side of",
"abdomen",
"past",
"hours",
"episode of vomiting earlier today",
"two episodes",
"Past medical history includes third-degree heart block",
"gastroesophageal reflux disease",
"hypertension",
... |
A 60-year-old man with a long-standing history of type 2 diabetes and hypertension managed with lisinopril and metformin presents with itchy skin. He also describes moderate nausea, vomiting, muscle weakness, and fatigue. The vital signs include: temperature 36.8°C (98.2°F), heart rate 98/min, respiratory rate 15/min, ... | Hypertriglyceridemia | {
"A": "Hypoglycemia",
"B": "Hypotension",
"C": "Hypertriglyceridemia",
"D": "Excessive bleeding"
} | step2&3 | C | [
"60 year old man",
"long standing history",
"type 2 diabetes",
"hypertension managed",
"lisinopril",
"metformin presents",
"itchy skin",
"moderate nausea",
"vomiting",
"muscle weakness",
"fatigue",
"vital signs include",
"temperature 36",
"98",
"heart rate 98 min",
"respiratory rate",
... |
A 35-year-old man is brought to the emergency department because of a 2-week history of abdominal cramps, vomiting, and constipation. He also reports having to urinate frequently and occasional leg pain. He has had similar episodes in the past. He has hypertension and peptic ulcer disease. Current medications include c... | Normal saline and intravenous calcitonin therapy | {
"A": "Reduction of dietary intake of calcium",
"B": "Normal saline and intravenous furosemide therapy",
"C": "Normal saline and intravenous fentanyl therapy",
"D": "Normal saline and intravenous calcitonin therapy"
} | step2&3 | D | [
"35 year old man",
"brought",
"emergency department",
"2-week history",
"abdominal cramps",
"vomiting",
"constipation",
"reports",
"to",
"frequently",
"occasional leg pain",
"similar episodes",
"past",
"hypertension",
"peptic ulcer disease",
"Current medications include captopril",
"... |
An obese 37-year-old woman is brought to the emergency department 2 hours after the onset of weakness in her left arm and leg. She fell from the stairs the day prior but did not have any loss of consciousness or nausea after the fall. She travels to Asia regularly on business; her last trip was 4 days ago. She has no h... | Patent foramen ovale | {
"A": "Ventricular septal defect",
"B": "Carotid artery dissection",
"C": "Atrial fibrillation",
"D": "Patent foramen ovale"
} | step2&3 | D | [
"obese",
"year old woman",
"brought",
"emergency department",
"hours",
"onset",
"weakness",
"left arm",
"leg",
"fell from",
"stairs",
"day prior",
"not",
"loss of consciousness",
"nausea",
"fall",
"travels",
"Asia",
"business",
"last trip",
"4 days",
"history",
"serious i... |
A 21-year-old female was brought to the emergency room after losing large amounts of blood from slicing her wrists longitudinally. A few days later, she was interviewed by the psychiatrist and discussed with him why she had tried to kill herself. "My evil boyfriend of 2 months left me because I never let him leave my s... | Borderline | {
"A": "Histrionic",
"B": "Dependent",
"C": "Avoidant",
"D": "Borderline"
} | step1 | D | [
"21-year-old female",
"brought",
"emergency room",
"large amounts",
"blood",
"slicing",
"wrists",
"few days later",
"interviewed",
"psychiatrist",
"discussed",
"to kill",
"boyfriend",
"months left",
"I never let",
"leave",
"side",
"fear",
"cheat",
"leave me",
"now I feel so e... |
A 40-year-old man comes to the physician because of weight gain over the past 3 months. During this period, he has gained 10 kg (22 lb) unintentionally. He also reports decreased sexual desire, oily skin, and sleeping difficulties. There is no personal or family history of serious illness. He has smoked one pack of cig... | Pituitary microadenoma | {
"A": "Pituitary microadenoma",
"B": "Decreased thyroid size",
"C": "Multiple kidney cysts",
"D": "Adrenal carcinoma"
} | step2&3 | A | [
"40 year old man",
"physician",
"of weight gain",
"past 3 months",
"period",
"gained 10 kg",
"reports decreased sexual desire",
"oily skin",
"sleeping difficulties",
"personal",
"family history",
"serious illness",
"smoked one pack",
"cigarettes daily",
"past 10 years",
"patient appear... |
A 23-year-old man is brought to the emergency department by the police after attempting to assault a waiter with a broom. The patient states that the FBI has been following him his entire life and that this man was an agent spying on him. The patient has a past medical history of irritable bowel syndrome. His temperatu... | Urine toxicology | {
"A": "Assess for suicidal ideation",
"B": "Complete blood count",
"C": "Thyroid stimulating hormone level",
"D": "Urine toxicology"
} | step2&3 | D | [
"23 year old man",
"brought",
"emergency department",
"police",
"attempting to assault",
"waiter",
"broom",
"patient states",
"following",
"entire life",
"man",
"agent",
"patient",
"past medical history of irritable bowel syndrome",
"temperature",
"98",
"36",
"blood pressure",
"6... |
A 58-year-old woman presents to a physician with a painless swelling behind her right ear, which she noticed 1 month ago. She has no other complaint nor does she have any specific medical condition. On physical examination, her vital signs are stable. An examination of the right post-auricular area shows enlarged lymph... | t(14;18)(q32;q21) | {
"A": "t(3;3)(q27;27)",
"B": "t(9;14)(p13;q32)",
"C": "t(11;18)(q21;q21)",
"D": "t(14;18)(q32;q21)"
} | step1 | D | [
"58 year old woman presents",
"physician",
"painless swelling",
"right",
"1 month",
"complaint",
"specific medical condition",
"physical examination",
"vital signs",
"stable",
"examination",
"right post-auricular area shows enlarged lymph nodes",
"non-tender",
"rubbery",
"consistency",
... |
A 72-year-old woman is brought in to the emergency department after her husband noticed that she appeared to be choking on her dinner. He performed a Heimlich maneuver but was concerned that she may have aspirated something. The patient reports a lack of pain and temperature on the right half of her face, as well as th... | Medulla | {
"A": "Internal capsule",
"B": "Midbrain",
"C": "Pons",
"D": "Medulla"
} | step2&3 | D | [
"72 year old woman",
"brought",
"emergency department",
"husband",
"appeared to",
"choking on",
"dinner",
"performed",
"Heimlich maneuver",
"concerned",
"aspirated",
"patient reports",
"lack",
"pain",
"temperature",
"right half",
"face",
"same lack of sensation",
"left side of",
... |
A 2300-g (5-lb 1-oz) male newborn is delivered to a 29-year-old primigravid woman. The mother has HIV and received triple antiretroviral therapy during pregnancy. Her HIV viral load was 678 copies/mL 1 week prior to delivery. Labor was uncomplicated. Apgar scores are 7 and 8 at 1 and 5 minutes respectively. Physical ex... | Administer zidovudine | {
"A": "Administer zidovudine, lamivudine and nevirapine",
"B": "Administer lamivudine and nevirapine",
"C": "Administer nevirapine",
"D": "Administer zidovudine"
} | step2&3 | D | [
"g",
"1 oz",
"male newborn",
"delivered",
"29 year old primigravid woman",
"mother",
"HIV",
"received triple antiretroviral therapy",
"pregnancy",
"HIV viral load",
"copies/mL 1 week prior to delivery",
"Labor",
"uncomplicated",
"Apgar scores",
"8",
"1",
"5 minutes",
"Physical",
... |
A 33-year-old woman comes to the physician 1 week after noticing a lump in her right breast. Fifteen years ago, she was diagnosed with osteosarcoma of her left distal femur. Her father died of an adrenocortical carcinoma at the age of 41 years. Examination shows a 2-cm, firm, immobile mass in the lower outer quadrant o... | TP53 | {
"A": "KRAS",
"B": "TP53",
"C": "PTEN",
"D": "Rb"
} | step1 | B | [
"year old woman",
"physician 1 week",
"lump in",
"right breast",
"Fifteen years",
"diagnosed",
"osteosarcoma",
"left distal femur",
"father died",
"adrenocortical carcinoma",
"age",
"years",
"Examination shows",
"2",
"firm",
"immobile mass",
"lower outer quadrant of",
"right breast... |
A 46-year-old African American man presents to the physician with dyspnea on exertion for the past 2 months. He also has occasional episodes of coughing at night. He says that he has been healthy most of his life. He is a non-smoker and a non-alcoholic. He does not have hypercholesterolemia or ischemic heart disease. H... | Isosorbide dinitrate-Hydralazine | {
"A": "Amlodipine-Atenolol",
"B": "Amlodipine-Valsartan",
"C": "Isosorbide dinitrate-Hydralazine",
"D": "Metoprolol-Atorvastatin"
} | step1 | C | [
"year old African American man presents",
"physician",
"dyspnea on exertion",
"past",
"months",
"occasional episodes of coughing",
"night",
"healthy",
"life",
"non-smoker",
"non alcoholic",
"not",
"hypercholesterolemia",
"ischemic heart disease",
"father died due to congestive heart fail... |
A 26-year-old woman comes to the physician for a pre-employment examination. She has no complaints. She has a history of polycystic ovarian syndrome. She exercises daily and plays soccer recreationally on the weekends. Her mother was diagnosed with hypertension at a young age. She does not smoke and drinks 2 glasses of... | Transthoracic echocardiogram | {
"A": "Exercise stress test",
"B": "No further testing",
"C": "Transthoracic echocardiogram",
"D": "CT scan of the chest with contrast"
} | step2&3 | C | [
"year old woman",
"physician",
"pre employment examination",
"complaints",
"history",
"polycystic ovarian syndrome",
"exercises daily",
"plays soccer",
"weekends",
"mother",
"diagnosed",
"hypertension",
"young age",
"not smoke",
"drinks 2 glasses",
"wine",
"weekends",
"current medi... |
A 54-year-old man comes to the emergency department because of burning oral mucosal pain, chest pain, and shortness of breath that started one hour ago. He reports that the pain is worse when swallowing. Two years ago, he was diagnosed with major depressive disorder but does not adhere to his medication regimen. He liv... | Potassium hydroxide | {
"A": "Potassium hydroxide",
"B": "Parathion",
"C": "Morphine",
"D": "Amitriptyline"
} | step2&3 | A | [
"54 year old man",
"emergency department",
"burning oral mucosal pain",
"chest pain",
"shortness of breath",
"started one hour",
"reports",
"pain",
"worse",
"swallowing",
"Two years",
"diagnosed",
"major depressive disorder",
"not adhere",
"medication regimen",
"lives alone",
"works"... |
A 23-year-old man comes to the emergency department with an open wound on his right hand. He states that he got into a bar fight about an hour ago. He appears heavily intoxicated and does not remember the whole situation, but he does recall lying on the ground in front of the bar after the fight. He does not recall any... | Application of moist sterile dressing + tetanus vaccine | {
"A": "Apposition of wound edges under tension + rifampin",
"B": "Surgical treatment with skin graft + tetanus vaccine",
"C": "Application of moist sterile dressing + tetanus vaccine",
"D": "Surgical treatment with skin flap + ciprofloxacin"
} | step2&3 | C | [
"23 year old man",
"emergency department",
"open wound",
"right hand",
"states",
"got",
"fight",
"hour",
"appears",
"not remember",
"whole",
"recall lying",
"in front",
"fight",
"not recall",
"history of injuries",
"remember",
"tetanus shot",
"received",
"years",
"temperature... |
A 55-year-old man comes to the physician because of a 3-week history of intermittent burning epigastric pain. His pain improves with antacid use and eating but returns approximately 2 hours following meals. He has a history of chronic osteoarthritis and takes ibuprofen daily. Upper endoscopy shows a deep ulcer located ... | Gastroduodenal artery | {
"A": "Pancreatic duct",
"B": "Descending aorta",
"C": "Gastroduodenal artery",
"D": "Transverse colon"
} | step1 | C | [
"55 year old man",
"physician",
"3 week history",
"intermittent burning epigastric pain",
"pain improves",
"antacid use",
"eating",
"returns approximately",
"hours following meals",
"history of chronic osteoarthritis",
"takes ibuprofen daily",
"Upper endoscopy shows",
"deep ulcer",
"poster... |
A 29-year-old woman with Wolff-Parkinson-White syndrome presents to her cardiologist’s office for a follow-up visit. She collapsed at her job and made a trip to the emergency department 1 week ago. At that time, she received a diagnosis of atrial fibrillation with rapid ventricular response and hemodynamic instability.... | Refer her for electrophysiology (EP) study and ablation | {
"A": "Begin anticoagulation with warfarin",
"B": "Begin anticoagulation with dabigatran",
"C": "Refer her for electrophysiology (EP) study and ablation",
"D": "Refer her for right heart catheterization"
} | step2&3 | C | [
"29 year old woman",
"Wolff-Parkinson-White syndrome presents",
"cardiologists office",
"follow-up visit",
"collapsed",
"job",
"made",
"trip",
"emergency department 1",
"time",
"received",
"diagnosis",
"atrial fibrillation",
"rapid ventricular response",
"hemodynamic instability",
"eme... |
A 43-year-old woman is brought to the emergency department for evaluation of worsening abdominal pain that suddenly started 2 hours ago. The patient also has nausea and has vomited twice. She has hypothyroidism, systemic lupus erythematosus, major depressive disorder, and chronic right knee pain. Current medications in... | Exploratory laparotomy | {
"A": "Peritoneal lavage",
"B": "Esophagogastroduodenoscopy",
"C": "Endoscopic retrograde cholangiopancreatography",
"D": "Exploratory laparotomy"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"evaluation",
"worsening abdominal",
"started 2 hours",
"patient",
"nausea",
"vomited twice",
"hypothyroidism",
"systemic lupus erythematosus",
"major depressive disorder",
"chronic right knee pain",
"Current medications include levothyr... |
A 67-year-old man is brought to the emergency department because of severe dyspnea and orthopnea for 6 hours. He has a history of congestive heart disease and an ejection fraction of 40%. The medical history is otherwise unremarkable. He appears confused. At the hospital, his blood pressure is 165/110 mm Hg, the pulse ... | Condom catheter placement | {
"A": "Condom catheter placement",
"B": "Daily urinary catheter irrigation with antimicrobial agent",
"C": "Daily oropharynx decontamination with antiseptic agent",
"D": "Suprapubic catheter insertion"
} | step2&3 | A | [
"67 year old man",
"brought",
"emergency department",
"severe dyspnea",
"orthopnea",
"hours",
"history of congestive heart disease",
"ejection fraction of 40",
"medical history",
"unremarkable",
"appears confused",
"hospital",
"blood pressure",
"mm Hg",
"pulse",
"min",
"respirations"... |
A 24-year-old woman with no past medical history is post operative day 2 from a cesarean section that resulted in the birth of her first child. She begins to cry when she's told that today's lunch will be gluten-free. Although the patient feels "exhausted" and has had trouble sleeping, she deeply desires to return home... | Postpartum "blues"; her symptoms are likely self-limited | {
"A": "Postpartum \"blues\"; her symptoms are likely self-limited",
"B": "Postpartum depression; the patient will likely remain depressed for at least six more months",
"C": "Major depressive episode; this patient is at high risk of recurrence",
"D": "Postpartum psychosis; symptoms will resolve in time, but sh... | step1 | A | [
"year old woman",
"past medical history",
"post operative day 2",
"cesarean section",
"resulted",
"birth of",
"first child",
"begins to cry",
"she",
"oday'",
"nch w",
"uten-free. ",
"tient f els \"",
"hausted\" ",
"ouble sleeping, ",
"eply d sires t r turn h me a",
"ke c re o",
"w... |
A 48-year-old man comes to the physician because of a hypopigmented skin lesion on his finger. He first noticed it 4 weeks ago after cutting his finger with a knife while preparing food. He did not feel the cut. For the past week, he has also had fever, fatigue, and malaise. He has not traveled outside the country sinc... | Mycobacterium leprae | {
"A": "Epidermophyton floccosum",
"B": "Mycobacterium leprae",
"C": "Leishmania donovani",
"D": "Malassezia furfur"
} | step1 | B | [
"48 year old man",
"physician",
"of",
"hypopigmented skin lesion",
"finger",
"first",
"4 weeks",
"cutting",
"finger",
"knife",
"preparing food",
"not feel",
"cut",
"past week",
"fever",
"fatigue",
"malaise",
"not traveled outside",
"country",
"India to",
"family",
"United S... |
A 57-year-old man presents to his primary care provider with progressive right foot swelling, redness, and malaise. He reports seeing a blister on his forefoot several months ago after he started using new work boots. He has dressed the affected area daily with bandages; however, healing has not occurred. He has a hist... | Antibiotics and supportive care | {
"A": "Superficial swabs",
"B": "Antibiotics and supportive care",
"C": "Endovascular intervention",
"D": "Minor amputation"
} | step2&3 | B | [
"57 year old man presents",
"primary care provider",
"progressive right",
"redness",
"malaise",
"reports seeing",
"blister",
"forefoot",
"months",
"started using new work boots",
"dressed",
"affected area daily",
"bandages",
"healing",
"not occurred",
"history of type 2 diabetes mellit... |
A 22-year-old woman presents to the doctor's office seeking evaluation for her recurrent urinary tract infections. She admits to urinary frequency and a burning sensation when urinating. This is her 3rd UTI in the past year. She has a history of generalized anxiety disorder for which she takes paroxetine. She is sexual... | Trimethoprim-sulfamethoxazole, and urinating before and after intercourse | {
"A": "Trimethoprim-sulfamethoxazole, and urinating before and after intercourse",
"B": "Urinating before and after intercourse",
"C": "Cephalexin",
"D": "Trimethoprim-sulfamethoxazole"
} | step2&3 | A | [
"year old woman presents",
"doctor's office",
"evaluation",
"recurrent urinary tract infections",
"admits",
"urinary frequency",
"burning sensation",
"3rd UTI",
"past year",
"history of generalized anxiety disorder",
"takes paroxetine",
"sexually active",
"multiple partners",
"past year",
... |
A primary care physician who focuses on treating elderly patients is researching recommendations for primary, secondary, and tertiary prevention. She is particularly interested in recommendations regarding aspirin, as she has several patients who ask her if they should take it. Of the following, which patient should be... | A 63-year-old male with a history of a transient ischemic attack | {
"A": "A 75-year-old male who had a drug-eluting coronary stent placed 3 days ago",
"B": "A 67-year-old female who has diabetes mellitus and atrial fibrillation",
"C": "An 83-year-old female with a history of a hemorrhagic stroke 1 year ago without residual deficits",
"D": "A 63-year-old male with a history of... | step2&3 | D | [
"primary care physician",
"focuses",
"treating elderly patients",
"researching recommendations",
"primary",
"secondary",
"tertiary prevention",
"interested",
"recommendations",
"aspirin",
"several patients",
"take",
"following",
"patient",
"started",
"lifelong aspirin",
"atherosclero... |
A 60-year-old man presents with breathlessness for the past 3 months. His symptoms have been getting progressively worse during this time. He denies any history of cough, fever, or chest pain. He works at a local shipyard and is responsible for installing the plumbing aboard the vessels. His past medical history is sig... | Decreased diffusion lung capacity of CO | {
"A": "Decreased diffusion lung capacity of CO",
"B": "Decreased pulmonary arterial pressure",
"C": "Increased pulmonary capillary wedge pressure",
"D": "Reduced FEV1/FVC ratio"
} | step1 | A | [
"60 year old man presents",
"breathlessness",
"past 3 months",
"symptoms",
"getting",
"worse",
"time",
"denies",
"history",
"cough",
"fever",
"chest pain",
"works",
"local",
"responsible",
"plumbing",
"vessels",
"past medical history",
"significant",
"hypertension",
"takes me... |
A 2-year-old boy is presented to the pediatrician due to poor weight gain and easy fatigability. His mother states that the patient barely engages in any physical activity as he becomes short of breath easily. The prenatal and birth histories are insignificant. Past medical history includes a few episodes of upper resp... | Ventricular septal defect (VSD) | {
"A": "Atrial septal defect (ASD)",
"B": "Ventricular septal defect (VSD)",
"C": "Coarctation of aorta",
"D": "Tetralogy of Fallot (TOF)"
} | step2&3 | B | [
"2 year old boy",
"presented",
"pediatrician",
"poor weight gain",
"easy fatigability",
"mother states",
"patient",
"physical activity",
"short of breath easily",
"prenatal",
"birth histories",
"Past medical history includes",
"few episodes of upper respiratory tract infection",
"treated",... |
On cardiology service rounds, your team sees a patient admitted with an acute congestive heart failure exacerbation. In congestive heart failure, decreased cardiac function leads to decreased renal perfusion, which eventually leads to excess volume retention. To test your knowledge of physiology, your attending asks yo... | Proximal convoluted tubule via passive diffusion following ion reabsorption | {
"A": "Collecting duct via aquaporin channels",
"B": "Thick ascending loop of Henle via passive diffusion following ion reabsorption",
"C": "Proximal convoluted tubule via passive diffusion following ion reabsorption",
"D": "Distal convoluted tubule via passive diffusion following ion reabsorption"
} | step1 | C | [
"cardiology service rounds",
"team sees",
"patient admitted",
"acute congestive heart failure exacerbation",
"congestive heart failure",
"decreased cardiac function leads",
"decreased renal perfusion",
"leads",
"excess volume retention",
"To test",
"knowledge",
"physiology",
"attending",
"... |
A 58-year-old male presents to his primary care physician for a check-up. He reports that he visited an urgent care clinic last week for seasonal allergies; he was instructed at that encounter to follow-up with his primary care doctor because his blood pressure measured at that time was 162/88. He denies any bothersome... | Start propranolol | {
"A": "Referral to a neurologist",
"B": "Initiate levodopa",
"C": "Prescribe losartan",
"D": "Start propranolol"
} | step2&3 | D | [
"58 year old male presents",
"primary care physician",
"check-up",
"reports",
"visited",
"urgent care clinic",
"week",
"seasonal allergies",
"encounter to follow-up",
"primary doctor",
"blood pressure measured",
"time",
"88",
"denies",
"symptoms",
"reports",
"feels well overall",
"... |
A 68-year-old man presents with a 3-month history of difficulty starting urination, weak stream, and terminal dribbling. The patient has no history of serious illnesses and is not under any medications currently. The patient’s father had prostate cancer at the age of 58 years. Vital signs are within normal range. Upon ... | Radiation therapy + androgen deprivation therapy | {
"A": "Chemotherapy + androgen deprivation therapy",
"B": "Finasteride + tamsulosin",
"C": "Radiation therapy + androgen deprivation therapy",
"D": "Radical prostatectomy + chemotherapy"
} | step2&3 | C | [
"68 year old man presents",
"month history",
"difficulty starting urination",
"weak stream",
"terminal dribbling",
"patient",
"history",
"serious illnesses",
"not",
"medications currently",
"patients father",
"prostate cancer",
"the age of 58 years",
"Vital signs",
"normal range",
"exa... |
A 55-year-old woman recently underwent kidney transplantation for end-stage renal disease. Her early postoperative period was uneventful, and her serum creatinine is lowered from 4.3 mg/dL (preoperative) to 2.5 mg/dL. She is immediately started on immunosuppressive therapy. On postoperative day 7, she presents to the e... | Continue with an ultrasound-guided biopsy of the transplanted kidney | {
"A": "Continue with an ultrasound-guided biopsy of the transplanted kidney",
"B": "Consider hemodialysis",
"C": "Re-operate and remove the failed kidney transplant",
"D": "Supportive treatment with IV fluids, antibiotics, and antipyretics"
} | step2&3 | A | [
"55 year old woman recently",
"kidney transplantation",
"end-stage renal disease",
"early postoperative period",
"serum creatinine",
"lowered",
"mg/dL",
"preoperative",
"2.5 mg/dL",
"immediately started",
"immunosuppressive therapy",
"postoperative day 7",
"presents",
"emergency department... |
A 40-year-old African American female with a past obstetrical history of para 5, gravida 4 with vaginal birth 4 weeks ago presents with the chief complaint of shortness of breath. On examination, the patient has an elevated jugular venous pressure, an S3, respiratory crackles, and bilateral pedal edema. Chest X-ray sho... | Ventricular dilatation | {
"A": "Hypertrophy",
"B": "Infarction",
"C": "Pericarditis",
"D": "Ventricular dilatation"
} | step2&3 | D | [
"40 year old African American female",
"past obstetrical history of para 5",
"gravida 4",
"vaginal birth",
"weeks",
"presents",
"chief complaint of shortness",
"breath",
"examination",
"patient",
"elevated jugular venous pressure",
"S3",
"respiratory crackles",
"bilateral pedal edema",
"... |
A 59-year-old man presents to a clinic with exertional chest pain for the past several months. He says the pain is central in his chest and relieved with rest. The physical examination is unremarkable. An electrocardiogram is normal, but an exercise tolerance test revealed ST-segment depression in chest leads V1-V4. He... | To avoid nitrate tolerance | {
"A": "To prevent collapse",
"B": "To avoid nitrate headache",
"C": "To prevent methemoglobinemia",
"D": "To avoid nitrate tolerance"
} | step1 | D | [
"59 year old man presents",
"clinic",
"exertional chest pain",
"past",
"months",
"pain",
"central",
"chest",
"relieved with rest",
"physical examination",
"unremarkable",
"electrocardiogram",
"normal",
"exercise tolerance test revealed ST-segment depression",
"chest leads V1",
"prescri... |
A 39-year-old woman comes to the physician for difficulty sleeping and poor concentration at work. She sleeps with the lights turned on and wakes up frequently during the night with palpitations and profuse sweating. Three weeks ago she was sexually assaulted in her car. Since the assault she has avoided using her car ... | Acute stress disorder | {
"A": "Acute stress disorder",
"B": "Adjustment disorder",
"C": "Post-traumatic stress disorder",
"D": "Persistent complex bereavement disorder"
} | step2&3 | A | [
"year old woman",
"physician",
"difficulty sleeping",
"poor concentration",
"work",
"sleeps",
"lights turned",
"wakes up frequently",
"night",
"palpitations",
"profuse sweating",
"Three weeks",
"sexually assaulted",
"car",
"assault",
"using",
"car",
"only uses public transportation... |
A 1-day-old infant presents to the office because the mother noticed “blood” in the diaper of her child. She has brought the diaper with her which shows a small reddish marking. The pregnancy was without complications, as was the delivery. The patient presents with no abnormal findings on physical examination. The labo... | No therapy is required | {
"A": "Allopurinol",
"B": "Febuxostat",
"C": "No therapy is required",
"D": "Sodium bicarbonate"
} | step2&3 | C | [
"day old infant presents",
"office",
"mother",
"blood",
"diaper",
"child",
"brought",
"diaper",
"shows",
"small",
"marking",
"pregnancy",
"complications",
"delivery",
"patient presents",
"abnormal findings",
"physical examination",
"laboratory analysis shows uric acid levels",
"b... |
A 65-year-old man presents to the emergency department because of a sudden loss of vision in his left eye for 2 hours. He has no pain. He had a similar episode 1 month ago which lasted only seconds. He has no history of a headache or musculoskeletal pain. He has had ischemic heart disease for 8 years and hypertension a... | Central retinal artery occlusion | {
"A": "Central retinal artery occlusion",
"B": "Demyelinating optic neuritis",
"C": "Temporal arteritis",
"D": "Wet macular degeneration"
} | step2&3 | A | [
"65 year old man presents",
"emergency department",
"of",
"sudden loss",
"vision",
"left eye",
"hours",
"pain",
"similar episode",
"month",
"lasted only seconds",
"history of",
"headache",
"musculoskeletal pain",
"ischemic heart disease",
"years",
"hypertension",
"diabetes mellitus... |
A 29-year-old woman presents with low mood and tearfulness on most days for the past 4 weeks. She says that she has been struggling to cope with her life and feels that everything that is going wrong is her fault. She also says that there are nights when she cries herself to sleep as the burden of the whole day is too ... | Inhibits the uptake of serotonin and norepinephrine at the presynaptic terminal | {
"A": "Blocks the reuptake of serotonin, increasing its concentration in the synaptic cleft",
"B": "Stimulates the release of norepinephrine and dopamine in the presynaptic terminal",
"C": "Inhibits the uptake of serotonin and norepinephrine at the presynaptic terminal",
"D": "Acts as an antagonist at the dopa... | step2&3 | C | [
"29 year old woman presents",
"low mood",
"tearfulness",
"days",
"past 4 weeks",
"to cope",
"life",
"feels",
"wrong",
"fault",
"nights",
"cries",
"to sleep",
"burden",
"whole day",
"last",
"weeks",
"recall",
"day",
"felt interested in",
"out",
"participating",
"daily acti... |
A 46-year-old man comes to the clinic complaining of abdominal pain for the past month. The pain comes and goes and is the most prominent after meals. He reports 1-2 episodes of black stools in the past month, a 10-lbs weight loss, fevers, and a skin rash on his left arm. A review of systems is negative for any recent ... | Segmental ischemic necrosis of various ages at the mesenteric arteries | {
"A": "Diffuse bridging fibrosis and regenerative nodules at the liver",
"B": "Presence of anti-proteinase 3",
"C": "Segmental ischemic necrosis of various ages at the mesenteric arteries",
"D": "Ulcers at the gastric mucosa"
} | step1 | C | [
"year old man",
"clinic",
"abdominal",
"past month",
"pain",
"goes",
"most prominent",
"meals",
"reports 1-2 episodes of black stools",
"past month",
"a 10 lbs weight loss",
"fevers",
"skin rash",
"left arm",
"review of systems",
"negative",
"recent travel",
"abnormal ingestion",
... |
An investigator is studying the effects of zinc deprivation on cancer cell proliferation. It is hypothesized that because zinc is known to be a component of transcription factor motifs, zinc deprivation will result in slower tumor growth. To test this hypothesis, tumor cells are cultured on media containing low and hig... | Southwestern blot | {
"A": "Western blot",
"B": "Northern blot",
"C": "PCR",
"D": "Southwestern blot"
} | step1 | D | [
"investigator",
"studying",
"effects",
"zinc deprivation",
"cancer",
"zinc",
"known to",
"a component",
"transcription factor motifs",
"zinc deprivation",
"result",
"slower tumor growth",
"To test",
"hypothesis",
"tumor cells",
"cultured",
"media containing low",
"high concentratio... |
A 64-year-old female presents with acute right wrist pain after she lost her balance while reaching overhead and fell from standing height. Her right wrist radiographs shows a fracture of her right distal radius. A follow-up DEXA bone density scan is performed and demonstrates a T-score of -3.5 at the femoral neck and ... | Hydrochlorothiazide | {
"A": "Hydrochlorothiazide",
"B": "Furosemide",
"C": "Lisinopril",
"D": "Amlodipine"
} | step1 | A | [
"64 year old female presents",
"acute right wrist pain",
"lost",
"balance",
"reaching",
"fell from standing height",
"right shows",
"fracture of",
"right distal radius",
"follow-up DEXA bone density scan",
"performed",
"demonstrates a T score",
"3",
"femoral neck",
"spine",
"medical hi... |
An 18-month-old boy is brought to the physician because of walking difficulties. His mother says that he cannot walk unless he is supported. She has also noted orange, sandy residues in his diapers. Over the past year, she has frequently caught him pulling his toenails and chewing the tips of his fingers. Examination s... | Xanthine to urate
" | {
"A": "Ornithine to citrulline",
"B": "Orotate to uridine monophosphate",
"C": "Adenosine to inosine",
"D": "Xanthine to urate\n\""
} | step1 | D | [
"month old boy",
"brought",
"physician",
"walking difficulties",
"mother",
"walk",
"supported",
"noted orange",
"sandy residues",
"diapers",
"past year",
"frequently caught",
"pulling",
"toenails",
"chewing",
"tips of",
"fingers",
"Examination shows scarring",
"fingertips",
"Mu... |
A 37-year-old man, otherwise healthy, has a routine CBC done prior to donating blood for the first time. The results are as follows:
Hemoglobin 10.8 g/dL
Mean corpuscular volume (MCV) 82 μm3
Mean corpuscular hemoglobin concentration (MCHC) 42%
Reticulocyte count 3.2%
White blood cell count 8,700/mm3
Platelet count 325,... | Inherited membrane abnormality of red cells | {
"A": "Bone marrow hypocellularity",
"B": "Inherited membrane abnormality of red cells",
"C": "Immune-mediated hemolysis",
"D": "Oxidant hemolysis"
} | step2&3 | B | [
"year old man",
"healthy",
"routine CBC done prior to donating blood",
"first time",
"results",
"follows",
"Hemoglobin 10.8 g dL Mean corpuscular volume",
"Reticulocyte count",
"2",
"White blood cell count",
"700",
"325",
"patient",
"afebrile",
"vital signs",
"normal limits",
"physic... |
A 43-year-old man is brought to the emergency department because of severe retrosternal pain radiating to the back and left shoulder for 4 hours. The pain began after attending a farewell party for his coworker at a local bar. He had 3–4 episodes of nonbilious vomiting before the onset of the pain. He has hypertension.... | CT scan of the chest | {
"A": "Esophagogastroduodenoscopy",
"B": "Aortography",
"C": "CT scan of the chest",
"D": "Transthoracic echocardiography\n\""
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"of severe retrosternal pain radiating to",
"back",
"left shoulder",
"hours",
"pain began",
"attending",
"party",
"coworker",
"local",
"episodes",
"vomiting",
"onset",
"pain",
"hypertension",
"father died",
"cardiac arrest",
"a... |
A 4430-g (9-lb 10-oz) male newborn is delivered at term to a 27-year-old woman, gravida 2, para 1. The second stage of labor was prolonged and required vacuum-assisted vaginal delivery. Apgar scores are 9 and 10 at 1 and 5 minutes, respectively. Examination of the neonate 2 hours later shows a soft, nonpulsatile swelli... | Cephalohematoma | {
"A": "Lipoma",
"B": "Cephalohematoma",
"C": "Subgaleal hemorrhage",
"D": "Epidermoid cyst"
} | step2&3 | B | [
"g",
"10 oz",
"male newborn",
"delivered",
"term",
"27 year old woman",
"gravida 2",
"para 1",
"second stage of labor",
"prolonged",
"required vacuum assisted vaginal delivery",
"Apgar scores",
"10",
"5 minutes",
"Examination",
"neonate",
"hours later shows",
"soft",
"swelling",
... |
A 19-year-old university student presents to the student clinic with painful joints. He states that over the past week his right wrist has become increasingly stiff. This morning he noticed pain and stiffness in his left ankle and left knee. The patient has celiac disease and takes a daily multivitamin. He says he is s... | Disseminated gonococcal infection | {
"A": "Dermatitis herpetiformis",
"B": "Disseminated gonococcal infection",
"C": "Lyme disease",
"D": "Reactive arthritis"
} | step2&3 | B | [
"year old university student presents",
"student clinic",
"painful joints",
"states",
"past week",
"right wrist",
"stiff",
"morning",
"pain",
"stiffness",
"left",
"left knee",
"patient",
"celiac disease",
"takes",
"daily multivitamin",
"sexually active",
"multiple male",
"female ... |
A 56-year-old man comes to the physician because of lower back pain for the past 2 weeks. The pain is stabbing and shooting in quality and radiates down the backs of his legs. It began when he was lifting a bag of cement at work. The pain has been getting worse, and he has started to notice occasional numbness and clum... | MRI of the lumbar spine | {
"A": "Erythrocyte sedimentation rate",
"B": "MRI of the lumbar spine",
"C": "Therapeutic exercise regimen",
"D": "PSA measurement"
} | step2&3 | B | [
"year old man",
"physician",
"of lower back pain",
"past 2 weeks",
"pain",
"stabbing",
"shooting",
"quality",
"radiates",
"backs of",
"legs",
"began",
"lifting",
"bag",
"cement",
"work",
"pain",
"getting worse",
"started to",
"occasional numbness",
"clumsiness",
"walking",
... |
A 12-year-old boy is brought to the emergency department after a motor vehicle collision. He was being carpooled to school by an intoxicated driver and was involved in a high velocity head-on collision. The patient is otherwise healthy and has no past medical history. His temperature is 99.2°F (37.3°C), blood pressure ... | Blood products and emergency surgery | {
"A": "Blood products and emergency surgery",
"B": "IV fluids alone as surgery is too dangerous without blood product stabilization",
"C": "IV fluids and vasopressors followed by emergency surgery",
"D": "Observation and monitoring and obtain a translator"
} | step2&3 | A | [
"year old boy",
"brought",
"emergency department",
"motor vehicle collision",
"school",
"driver",
"involved",
"high velocity head",
"collision",
"patient",
"healthy",
"past medical history",
"temperature",
"99",
"3C",
"blood pressure",
"80",
"mmHg",
"pulse",
"min",
"respirati... |
A 57-year-old male presents to his primary care physician with upper abdominal pain. He reports a 3-month history of mild epigastric pain that improves with meals. He has lost 15 pounds since his symptoms started. His past medical history is notable for gynecomastia in the setting of a prolactinoma for which he underwe... | Promote gastric mucosal growth | {
"A": "Decrease gastric acid secretion",
"B": "Increase pancreatic bicarbonate secretion",
"C": "Increase pancreatic exocrine secretion",
"D": "Promote gastric mucosal growth"
} | step1 | D | [
"57 year old male presents",
"primary care physician",
"upper abdominal pain",
"reports",
"3 month history",
"mild epigastric",
"improves",
"meals",
"lost",
"pounds",
"symptoms started",
"past medical history",
"notable",
"gynecomastia",
"setting",
"prolactinoma",
"surgical resection... |
A 65-year-old male with a history of hypertension presents to his primary care physician complaining of multiple episodes of chest pain, palpitations, and syncope. Episodes have occurred twice daily for the last week, and he is asymptomatic between episodes. Electrocardiogram reveals a narrow-complex supraventricular t... | L-type Ca channels in smooth muscle | {
"A": "L-type Ca channels in skeletal muscle",
"B": "L-type Ca channels in smooth muscle",
"C": "P-type Ca channels in Purkinje fibers",
"D": "N-type Ca channels in the peripheral nervous system"
} | step1 | B | [
"65-year-old male",
"history of hypertension presents",
"primary care physician",
"of multiple episodes",
"chest pain",
"palpitations",
"syncope",
"Episodes",
"occurred twice daily",
"week",
"asymptomatic",
"episodes",
"Electrocardiogram reveals",
"narrow complex supraventricular tachycard... |
A 32-year-old G2P1 female at 30 weeks gestation presents to the emergency department with complaints of vaginal bleeding and severe abdominal pain. She states that she began feeling poorly yesterday with a stomach-ache, nausea, and vomiting. She first noted a small amount of spotting this morning that progressed to muc... | Hypertension | {
"A": "Hypertension",
"B": "Patient age",
"C": "Prior Cesarean section",
"D": "Singleton pregnancy"
} | step2&3 | A | [
"year old",
"female",
"30 weeks presents",
"emergency department",
"complaints",
"vaginal bleeding",
"severe abdominal",
"states",
"began feeling poorly",
"stomach-ache",
"nausea",
"vomiting",
"first noted",
"small amount",
"spotting",
"morning",
"progressed to",
"larger amounts",
... |
A 48-year-old woman presents to her family practitioner complaining of tremulousness of both hands for the past few years that have deteriorated over the past 7 months. She sometimes spills coffee while holding a full cup. She is a receptionist and her symptoms have led to difficulties with typing at work. She denies w... | Primidone | {
"A": "Clonazepam",
"B": "Primidone",
"C": "Propranolol",
"D": "Reassurance"
} | step2&3 | B | [
"48 year old woman presents",
"family practitioner",
"tremulousness",
"hands",
"past",
"years",
"deteriorated",
"past",
"months",
"sometimes",
"coffee",
"holding",
"full cup",
"receptionist",
"symptoms",
"led",
"difficulties",
"typing",
"work",
"denies weight loss",
"diarrhea... |
A 29-year-old man presents to his primary care provider after complaining of a rash on his penis. He describes it as small painless growths that have developed over the past several months. They have slowly increased in size over time. His medical history is unremarkable. He has had several sexual partners and uses con... | Cryotherapy | {
"A": "Cryotherapy",
"B": "Interferon ɑ",
"C": "Laser therapy",
"D": "Topical imiquimod"
} | step2&3 | A | [
"29 year old man presents",
"primary care provider",
"complaining of a rash",
"penis",
"small painless growths",
"past",
"months",
"slowly increased in size",
"time",
"medical history",
"unremarkable",
"several sexual partners",
"uses condoms",
"good health",
"takes",
"medication",
"... |
A 19-year-old man presents with painful oral ulcers and rash. He says that his symptoms started 1 week ago with a low-grade fever, malaise, and cough. Then, 3 days ago, he noted small painful red bumps on his hands and feet, which quickly worsened and spread to involve his extremities and upper torso. At the same time,... | Rich dermal inflammatory infiltrate, predominantly composed of CD4+ T cells | {
"A": "Scant dermal inflammatory infiltrate, predominantly composed of macrophages and dendritic cells",
"B": "Rich dermal inflammatory infiltrate, predominantly composed of CD4+ T cells",
"C": "Presence of a subepidermal blister and a polymorphous inflammatory infiltrate with an eosinophilic predominance",
"D... | step2&3 | B | [
"year old man presents",
"painful oral ulcers",
"rash",
"symptoms started 1 week",
"low-grade fever",
"malaise",
"cough",
"Then",
"3 days",
"noted small painful red",
"hands",
"feet",
"worsened",
"spread to",
"extremities",
"upper torso",
"same time",
"multiple painful oral ulcers ... |
A 52-year-old woman presents to her gynecologist's office with complaints of frequent hot flashes and significant sweating episodes, which affect her sleep at night. She complains that she has to change her clothes in the middle of the night because of the sweating events. She also complains of irritability, which is a... | Low-dose vaginal estrogen | {
"A": "Conjugated estrogen orally",
"B": "Low-dose vaginal estrogen",
"C": "Transdermal estradiol-17B patch",
"D": "This patient is not a candidate for hormone replacement therapy."
} | step2&3 | B | [
"year old woman presents",
"gynecologist's office",
"complaints",
"frequent hot flashes",
"significant sweating episodes",
"affect",
"sleep",
"night",
"to change",
"clothes",
"middle",
"night",
"sweating events",
"irritability",
"affecting",
"relationships",
"husband",
"daughter",
... |
An investigator is studying a hereditary defect in the mitochondrial enzyme succinyl-CoA synthetase. In addition to succinate, the reaction catalyzed by this enzyme produces a molecule that is utilized as an energy source for protein translation. This molecule is also required for which of the following conversion reac... | Oxaloacetate to phosphoenolpyruvate | {
"A": "Acetaldehyde to acetate",
"B": "Fructose-6-phosphate to fructose-1,6-bisphosphate",
"C": "Glucose-6-phosphate to 6-phosphogluconolactone",
"D": "Oxaloacetate to phosphoenolpyruvate"
} | step1 | D | [
"investigator",
"studying",
"hereditary defect",
"mitochondrial enzyme succinyl-CoA synthetase",
"succinate",
"reaction",
"enzyme",
"molecule",
"energy source",
"protein translation",
"molecule",
"required",
"following conversion reactions"
] |
A 68-year-old man comes to the physician because of a 1-month history of fatigue, low-grade fevers, and cough productive of blood-tinged sputum. He has type 2 diabetes mellitus and chronic kidney disease and underwent kidney transplantation 8 months ago. His temperature is 38.9°C (102.1°F) and pulse is 98/min. Examinat... | Exposure to contaminated soil | {
"A": "Poor oral hygiene",
"B": "Exposure to contaminated soil",
"C": "Exposure to contaminated air-conditioning unit",
"D": "Crowded living situation"
} | step1 | B | [
"68 year old man",
"physician",
"month history",
"fatigue",
"low-grade fevers",
"cough productive of blood tinged sputum",
"type 2 diabetes mellitus",
"chronic kidney disease",
"kidney transplantation",
"months",
"temperature",
"pulse",
"98 min",
"Examination shows rhonchi",
"right lower... |
A 2-day-old male newborn born at 39 weeks' gestation is brought to the physician because of yellowing of his skin. His mother received no prenatal care and the delivery was uncomplicated. She has no history of serious medical illness and has one other son who is healthy. Physical examination shows jaundice, hepatomegal... | IgG antibody formation against Rh antigen | {
"A": "Glucose-6-phosphate dehydrogenase deficiency",
"B": "Biliary duct malformation",
"C": "UDP-glucuronosyltransferase deficiency",
"D": "IgG antibody formation against Rh antigen"
} | step1 | D | [
"2-day old male newborn born",
"weeks",
"estation ",
"rought ",
"hysician ",
"ellowing ",
"kin.",
"other eceived ",
"renatal care ",
"elivery ",
"ncomplicated.",
"istory of erious edical llness ",
"ne ",
"on ",
"ealthy.",
"hysical examination hows aundice,",
"epatomegaly,",
"... |
A 36-year-old man is brought to the emergency department by a neighbor with signs of altered mental status. He was found 6 hours ago stumbling through his neighbor's bushes and yelling obscenities. The neighbor helped him home, but found him again 1 hour later slumped over on his driveway in a puddle of vomit. He is or... | Fomepizole | {
"A": "Ethanol",
"B": "Fomepizole",
"C": "Hydroxocobalamin",
"D": "Methylene blue"
} | step2&3 | B | [
"36 year old man",
"brought",
"emergency department",
"neighbor",
"signs",
"altered mental status",
"found 6 hours",
"stumbling",
"neighbor's bushes",
"obscenities",
"neighbor helped",
"home",
"found",
"hour later",
"over",
"vomit",
"oriented",
"self",
"not to place",
"time",
... |
A 23-year-old woman from Texas is transferred to the intensive care unit after delivering a child at 40 weeks gestation. The pregnancy was not complicated, and there was some blood loss during the delivery. The patient was transferred for severe hypotension refractory to IV fluids and vasopressors. She is currently on ... | Primary adrenal insufficiency | {
"A": "Acute kidney injury",
"B": "Mycobacteria tuberculosis",
"C": "Primary adrenal insufficiency",
"D": "Withdrawal from prednisone use"
} | step2&3 | C | [
"23 year old woman",
"Texas",
"transferred",
"intensive care unit",
"delivering",
"child",
"40 weeks gestation",
"pregnancy",
"not complicated",
"blood loss",
"delivery",
"patient",
"transferred",
"severe hypotension refractory",
"IV fluids",
"vasopressors",
"currently",
"norepinep... |
A 22-year-old man is evaluated for abdominal discomfort he has had for the past 6 days and fever for the past 2 weeks. He also notes that his right upper abdomen is bothering him. He states that he does not drink alcohol or use illicit drugs. His medical history is insignificant and family history is negative for any l... | B lymphocyte induced maturation protein 1 (BLIMP1) | {
"A": "B cell lymphoma 6 (BCL6)",
"B": "Microphthalmia-associated transcription factor (MITF)",
"C": "Metastasis-associated 1 family, member 3 (MTA-3)",
"D": "B lymphocyte induced maturation protein 1 (BLIMP1)"
} | step1 | D | [
"year old man",
"evaluated",
"abdominal discomfort",
"past 6 days",
"fever",
"past 2 weeks",
"notes",
"right",
"states",
"not drink alcohol",
"use illicit",
"medical history",
"family history",
"negative",
"liver disease",
"physical examination",
"temperature",
"100 4F",
"blood p... |
A 53-year-old woman presents to her primary care provider complaining of fatigue for the last several months. She reports feeling tired all day, regardless of her quality or quantity of sleep. On further questioning, she has also noted constipation and a 4.5 kg (10 lb) weight gain. She denies shortness of breath, chest... | Autoimmune attack on endocrine tissue | {
"A": "Autoimmune attack on endocrine tissue",
"B": "Chronic blood loss",
"C": "Iatrogenesis",
"D": "Nutritional deficiency"
} | step2&3 | A | [
"year old woman presents",
"primary care provider",
"fatigue",
"last",
"months",
"reports feeling tired all day",
"quality",
"quantity",
"sleep",
"further questioning",
"noted constipation",
"4.5 kg",
"10",
"weight gain",
"denies shortness of breath",
"chest pain",
"lightheadedness",... |
A 67-year-old woman is brought to the emergency department for evaluation of fever, chest pain, and a cough that has produced a moderate amount of greenish-yellow sputum for the past 2 days. During this period, she has had severe malaise, chills, and difficulty breathing. Her past medical history is significant for hyp... | Inpatient treatment with azithromycin and ceftriaxone | {
"A": "ICU admission and administration of ampicillin-sulbactam and levofloxacin",
"B": "Inpatient treatment with azithromycin and ceftriaxone",
"C": "Inpatient treatment with cefepime, azithromycin, and gentamicin",
"D": "Inpatient treatment with cefepime, azithromycin, and gentamicin"
} | step2&3 | B | [
"67 year old woman",
"brought",
"emergency department",
"evaluation",
"fever",
"chest pain",
"cough",
"moderate amount",
"yellow sputum",
"past 2 days",
"period",
"severe malaise",
"chills",
"difficulty breathing",
"past medical history",
"significant",
"hypertension",
"hypercholes... |
A previously healthy 68-year-old woman is brought to the emergency department because of a 3-day history of nausea, anorexia, polyuria, and confusion. Her only medication is acetaminophen, which she takes daily for back pain that started 6 weeks ago. Physical examination shows conjunctival pallor. She is oriented to pe... | Overproliferation of plasma cells | {
"A": "Overproliferation of plasma cells",
"B": "Ectopic release of PTHrP",
"C": "Decreased renal excretion of calcium",
"D": "Excess PTH secretion from parathyroid glands"
} | step1 | A | [
"healthy 68 year old woman",
"brought",
"emergency department",
"3-day history",
"nausea",
"anorexia",
"polyuria",
"confusion",
"only medication",
"acetaminophen",
"takes daily",
"back pain",
"started",
"weeks",
"Physical examination shows conjunctival pallor",
"oriented to person",
... |
A 40-year-old man with alcohol use disorder is brought to the emergency department because of sudden-onset blurry vision, severe upper abdominal pain, and vomiting that started one day after he drank a bottle of paint thinner. Physical examination shows epigastric tenderness without rebound or guarding. Ophthalmologic ... | Inhibition of alcohol dehydrogenase | {
"A": "Activation of acetyl-CoA synthetase",
"B": "Inhibition of acetaldehyde dehydrogenase",
"C": "Inhibition of acetyl-CoA synthetase",
"D": "Inhibition of alcohol dehydrogenase"
} | step1 | D | [
"40 year old man",
"alcohol use disorder",
"brought",
"emergency department",
"sudden-onset blurry vision",
"severe upper abdominal pain",
"vomiting",
"started one day",
"drank",
"bottle",
"paint thinner",
"Physical examination shows epigastric tenderness",
"guarding",
"Ophthalmologic exam... |
One week after delivery, a 3550-g (7-lb 13-oz) newborn has multiple episodes of bilious vomiting and abdominal distention. He passed urine 14 hours after delivery and had his first bowel movement 3 days after delivery. He was born at term to a 31-year-old woman. Pregnancy was uncomplicated and the mother received adequ... | Defective migration of neural crest cells | {
"A": "Defective migration of neural crest cells",
"B": "Disruption of blood flow to the fetal jejunum",
"C": "Mutation in the CFTR gene",
"D": "Abnormal rotation of the intestine"
} | step2&3 | A | [
"One week",
"delivery",
"g",
"oz",
"newborn",
"multiple episodes of bilious vomiting",
"abdominal distention",
"passed urine",
"hours",
"delivery",
"first bowel movement 3 days",
"delivery",
"born",
"term",
"31 year old woman",
"Pregnancy",
"uncomplicated",
"mother received adequat... |
A 35-year-old man presents with erectile dysfunction. Past medical history is significant for diabetes mellitus type 1 diagnosed 25 years ago, managed with insulin, and for donating blood 6 months ago. The patient denies any history of smoking or alcohol use. He is afebrile, and his vital signs are within normal limits... | Hemochromatosis | {
"A": "Hemochromatosis",
"B": "Psychogenic erectile dysfunction",
"C": "Wilson's disease",
"D": "Porphyria cutanea tarda"
} | step1 | A | [
"35 year old man presents",
"erectile",
"Past medical history",
"significant",
"diabetes mellitus type 1 diagnosed",
"years",
"managed",
"insulin",
"donating blood",
"months",
"patient denies",
"history of smoking",
"alcohol use",
"afebrile",
"vital signs",
"normal",
"Physical examin... |
A 55-year-old woman sees her family doctor for a follow-up appointment to discuss her imaging studies. She previously presented with chest pain and shortness of breath for the past 2 months. Her CT scan shows a 3.5 cm mass in the lower lobe of her right lung. The mass has irregular borders. Saddle/hilar lymph nodes are... | Tissue biopsy | {
"A": "Tissue biopsy",
"B": "Sputum cytology",
"C": "CT scan in 3 months",
"D": "Paclitaxel"
} | step2&3 | A | [
"55 year old woman sees",
"family doctor",
"follow-up appointment to discuss",
"imaging studies",
"presented",
"chest pain",
"shortness of breath",
"past",
"months",
"CT scan shows",
"3",
"mass",
"the lower lobe of",
"right lung",
"mass",
"irregular borders",
"hilar lymph nodes",
"... |
A researcher discovers a new inhibitor for 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase that she believes will be more effective than current drugs. The compound she discovers uses the same mechanism of inhibiting the target enzyme as current drugs of this class; however, it has fewer off target effects and side ef... | Higher Km and same Vmax | {
"A": "Higher Km and same Vmax",
"B": "Same Km and higher Vmax",
"C": "Same Km and lower Vmax",
"D": "Same Km and same Vmax"
} | step1 | A | [
"researcher discovers a new inhibitor",
"hydroxy",
"glutaryl-coenzyme",
"reductase",
"more effective",
"current drugs",
"compound",
"discovers uses",
"same mechanism",
"inhibiting",
"target enzyme",
"current drugs",
"class",
"fewer",
"target effects",
"side effects",
"thinks",
"dru... |
A 37-year-old G1P1 woman gives birth to a male infant at 36 weeks gestation. The patient had an uncomplicated Caesarean delivery and gave birth to a 6-pound infant. The patient has a past medical history of cocaine and heroine use but states she quit 8 years ago. She also suffers from obesity and type II diabetes melli... | Maternal hypertension | {
"A": "Caesarean section delivery",
"B": "Gestational age",
"C": "Maternal diabetes",
"D": "Maternal hypertension"
} | step2&3 | D | [
"year old G1P1 woman gives birth",
"male infant",
"36 weeks gestation",
"patient",
"uncomplicated Caesarean",
"gave birth",
"pound infant",
"patient",
"past medical cocaine",
"use",
"states",
"quit",
"years",
"suffers",
"obesity",
"type II diabetes mellitus",
"blood sugar",
"well",... |
A 26-year-old patient presents to your office with rhinorrhea that you believe to be viral in origin. He respectfully requests treatment with antibiotics, and he demonstrates an understanding of the risks, benefits, and alternatives to treatment. His mental status is intact, and you believe him to have full decision-ma... | Deny the patient's request | {
"A": "Prescribe amoxicillin",
"B": "Prescribe zidovudine",
"C": "Refer the patient to an infectious disease specialist",
"D": "Deny the patient's request"
} | step1 | D | [
"year old patient presents",
"office",
"rhinorrhea",
"to",
"viral",
"origin",
"requests treatment",
"antibiotics",
"demonstrates",
"understanding",
"risks",
"benefits",
"alternatives",
"treatment",
"mental status",
"intact",
"to",
"full decision-making capacity",
"following",
"... |
A 42-year-old man is discovered unconscious by local police while patrolling in a park. He is unresponsive to stimulation. Syringes were found scattered around him. His heart rate is 70/min and respiratory rate is 6/min. Physical examination reveals a disheveled man with track marks on both arms. His glasgow coma scale... | Results in acute withdrawal | {
"A": "Results in acute withdrawal",
"B": "Works on dopamine receptors",
"C": "Is a non-competitive inhibitor",
"D": "Can be given per oral"
} | step2&3 | A | [
"year old man",
"discovered unconscious",
"local police",
"patrolling",
"park",
"unresponsive",
"stimulation",
"Syringes",
"found scattered",
"heart rate",
"70 min",
"respiratory rate",
"min",
"Physical examination reveals",
"man",
"track marks",
"arms",
"glasgow coma scale",
"Pu... |
A 35-year-old pregnant woman gives birth to a baby at term. The antepartum course was uneventful. She was compliant with all prenatal examinations and was given a prophylactic tetanus vaccine. While performing the neonatal examination, the pediatrician reports Apgar scores of 9 and 10 at 1 and 5 min, respectively. The ... | Increased amount of 11-deoxycorticosterone | {
"A": "Increased concentration of sex hormones",
"B": "Decreased amount of aldosterone",
"C": "Increased amount of 11-deoxycorticosterone",
"D": "Decreased amount of cortisol"
} | step1 | C | [
"35 year old pregnant woman gives birth",
"baby",
"term",
"antepartum course",
"compliant",
"prenatal examinations",
"given",
"prophylactic tetanus vaccine",
"performing",
"neonatal examination",
"pediatrician reports Apgar scores",
"9",
"10",
"5 min",
"pediatrician",
"baby",
"ambigu... |
A 64-year-old woman comes to the physician because of a 7-month history of abdominal discomfort, fatigue, and a 6.8-kg (15-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Laboratory studies show anemia with pronounced leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR-ABL... | Tyrosine kinase inhibitor | {
"A": "Tyrosine kinase inhibitor",
"B": "Monoclonal anti-CD20 antibody",
"C": "Monoclonal anti-HER-2 antibody",
"D": "Ribonucleotide reductase inhibitor"
} | step1 | A | [
"64 year old woman",
"physician",
"month history",
"abdominal discomfort",
"fatigue",
"kg",
"weight loss",
"Physical examination shows generalized pallor",
"splenomegaly",
"Laboratory studies show anemia",
"leukocytosis",
"thrombocytosis",
"Cytogenetic analysis shows",
"BCR-ABL fusion gene... |
A 72-year-old man is brought to the emergency room by his daughter with complaints of a productive cough, rust-colored sputum, and fever for 1 week. He denies any breathlessness or chest pain. The past medical history is unremarkable. The vital signs include a pulse rate of 103/min, respiratory rate of 34/min, and bloo... | Norepinephrine | {
"A": "Captopril",
"B": "Low-dose dopamine",
"C": "Isoproterenol",
"D": "Norepinephrine"
} | step1 | D | [
"72 year old man",
"brought",
"emergency room",
"daughter",
"complaints",
"productive cough",
"rust colored sputum",
"fever",
"1 week",
"denies",
"breathlessness",
"chest pain",
"past medical history",
"unremarkable",
"vital signs include",
"pulse rate",
"min",
"respiratory rate",
... |
A 64-year-old man presents with a complaint of prominent stiffness in his legs which is causing a difficulty in ambulation. He is not able to relax his trunk area and has frequent, painful muscle spasms. He denies diplopia, swallowing difficulties, and urinary or bowel problems. He has a medical history of stage IV lun... | Amphiphysin | {
"A": "Amphiphysin",
"B": "Anti-Hu",
"C": "Anti-Ri",
"D": "Voltage-gated calcium channel"
} | step2&3 | A | [
"64 year old man presents",
"complaint",
"prominent stiffness",
"legs",
"causing",
"difficulty",
"ambulation",
"not able to relax",
"trunk area",
"frequent",
"painful muscle spasms",
"denies diplopia",
"swallowing difficulties",
"urinary",
"bowel problems",
"medical history of stage IV... |
A 45-year-old man comes to the physician for the evaluation of difficulty swallowing that has worsened over the past year. He also reports some hoarseness and generalized bone, muscle, and joint pain. During the past six months, he has had progressive constipation and two episodes of kidney stones. He also reports recu... | Altered RET proto-oncogene expression | {
"A": "Mutated NF1 gene",
"B": "Exposure to ionizing radiation",
"C": "Deleted VHL gene",
"D": "Altered RET proto-oncogene expression"
} | step2&3 | D | [
"year old man",
"physician",
"evaluation",
"difficulty swallowing",
"worsened",
"past year",
"reports",
"hoarseness",
"generalized bone",
"muscle",
"joint pain",
"past six months",
"progressive constipation",
"two episodes of kidney stones",
"reports recurrent episodes of throbbing",
"... |
A 5-year-old boy presents with bilateral conjunctivitis and pharyngitis. The patient’s mother says that symptoms acutely onset 3 days ago and include itchy red eyes, a low-grade fever, and a sore throat. She says that the patient recently attended a camp where other kids were also ill and were completely healthy before... | Adenovirus | {
"A": "Metapneumovirus",
"B": "Influenza virus",
"C": "Rhinovirus",
"D": "Adenovirus"
} | step1 | D | [
"5 year old boy presents",
"bilateral conjunctivitis",
"pharyngitis",
"patients mother",
"symptoms",
"onset",
"days",
"include itchy red",
"low-grade fever",
"sore throat",
"patient recently attended",
"camp",
"kids",
"ill",
"completely healthy",
"significant past medical history",
"... |
A 3-year-old boy is brought to the emergency department after the sudden onset of a rash that started on the head and progressed to the trunk and extremities. Over the past week, he has had a runny nose, a cough, and red, crusty eyes. He recently immigrated with his family from Yemen and immunization records are unavai... | Retinol | {
"A": "Valacyclovir",
"B": "Penicillin V",
"C": "Retinol",
"D": "Live-attenuated vaccine"
} | step1 | C | [
"3 year old boy",
"brought",
"emergency department",
"sudden onset",
"rash",
"started",
"head",
"progressed",
"trunk",
"extremities",
"past week",
"runny nose",
"cough",
"red",
"crusty eyes",
"recently",
"family",
"Yemen",
"immunization records",
"unavailable",
"patient appea... |
A 38-year-old man presents with a 1-year history of resting tremor and clumsiness in his right hand. He says his symptoms are progressively worsening and are starting to interfere with his work. He has no significant past medical history and is not currently taking any medications. The patient denies any smoking histor... | Selegiline | {
"A": "Benztropine",
"B": "Selegiline",
"C": "Bromocriptine",
"D": "Levodopa/carbidopa"
} | step1 | B | [
"year old man presents",
"year history",
"resting tremor",
"clumsiness",
"right hand",
"symptoms",
"worsening",
"starting to interfere",
"work",
"significant past medical history",
"not currently taking",
"medications",
"patient denies",
"smoking history",
"alcohol",
"recreational drug... |
A 53-year-old woman presented to her PCP with one week of difficulty falling asleep, despite having good sleep hygiene. She denies changes in her mood, weight loss, and anhedonia. She has had difficulty concentrating and feels tired throughout the day. Recently, she was fired from her previous job. What medication woul... | Zolpidem | {
"A": "Quetiapine",
"B": "Zolpidem",
"C": "Diphenhydramine",
"D": "Citalopram"
} | step1 | B | [
"year old woman presented",
"PCP",
"one week",
"difficulty falling asleep",
"good sleep hygiene",
"denies changes in",
"mood",
"weight loss",
"anhedonia",
"difficulty concentrating",
"feels tired",
"day",
"Recently",
"fired",
"previous job",
"medication",
"most helpful",
"patient"
... |
A 35-year-old male patient is brought into the emergency department by emergency medical services. The patient has a history of schizophrenia and is on medication per his mother. His mother also states that the dose of his medication was recently increased, though she is not sure of the specific medication he takes. Hi... | Dantrolene | {
"A": "Morphine",
"B": "Dantrolene",
"C": "Valproate",
"D": "Lamotrigine"
} | step2&3 | B | [
"35 year old male patient",
"brought",
"emergency department",
"emergency medical services",
"patient",
"history of schizophrenia",
"on medication",
"mother",
"mother",
"states",
"dose",
"medication",
"recently increased",
"not",
"specific medication",
"takes",
"BP",
"100",
"T",
... |
A 35-year-old woman presents to the clinic for a several-month history of heat intolerance. She lives in a small apartment with her husband and reports that she always feels hot and sweaty, even when their air conditioning is on high. On further questioning, she's also had a 4.5 kg (10 lb) unintentional weight loss. Th... | Thyroid-stimulating hormone | {
"A": "Calcitonin",
"B": "Triiodothyronine (T3)",
"C": "Thyroxine (T4)",
"D": "Thyroid-stimulating hormone"
} | step2&3 | D | [
"35 year old woman presents",
"clinic",
"several month history of heat intolerance",
"lives in",
"small apartment",
"husband",
"reports",
"always feels hot",
"sweaty",
"air conditioning",
"high",
"further questioning",
"she",
"4.5 kg",
"10",
"unintentional weight loss",
"vital signs ... |
A 26-year-old man presents to the emergency room with a complaint of lower abdominal pain that started about 5 hours ago. The pain was initially located around the umbilicus but later shifted to the right lower abdomen. It is a continuous dull, aching pain that does not radiate. He rates the severity of his pain as 7/1... | Pylephlebitis | {
"A": "Pylephlebitis",
"B": "Intestinal obstruction",
"C": "Perforation",
"D": "Appendiceal abscess"
} | step1 | A | [
"year old man presents",
"emergency room",
"complaint",
"lower abdominal pain",
"started",
"hours",
"pain",
"initially",
"umbilicus",
"later shifted to the right lower abdomen",
"continuous dull",
"aching pain",
"not radiate",
"rates",
"severity of",
"pain",
"10",
"denies",
"prev... |
A 37-year-old man comes to the physician for a follow-up examination. He is being evaluated for high blood pressure readings that were incidentally recorded at a routine health maintenance examination 1 month ago. He has no history of serious illness and takes no medications. His pulse is 88/min and blood pressure is 1... | Eplerenone therapy | {
"A": "Amiloride therapy",
"B": "Propranolol therapy",
"C": "Unilateral adrenalectomy",
"D": "Eplerenone therapy"
} | step2&3 | D | [
"year old man",
"physician",
"follow-up examination",
"evaluated",
"high blood pressure readings",
"recorded",
"routine health examination",
"month",
"history",
"serious illness",
"takes",
"medications",
"pulse",
"88 min",
"blood pressure",
"98 mm Hg",
"Physical examination shows",
... |
A 73-year-old woman is brought to the emergency department because of a 1-day history of skin lesions. Initially, she experienced pain in the affected areas, followed by discoloration of the skin and formation of blisters. Four days ago, the patient was started on a new medication by her physician after failed cardiove... | Deficiency of a natural anticoagulant | {
"A": "Mutation in clotting factor V",
"B": "Deficiency of a natural anticoagulant",
"C": "Damaged aortic valve",
"D": "Formation of antibodies against a platelet antigen"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"1-day history",
"skin lesions",
"Initially",
"experienced pain",
"affected areas",
"followed by discoloration of",
"skin",
"formation",
"blisters",
"Four days",
"patient",
"started",
"new medication",
"physician",
"failed cardio... |
A 34-year-old man presents with multiple painful ulcers on his penis. He says that the ulcers all appeared suddenly at the same time 3 days ago. He reports that he is sexually active with multiple partners and uses condoms inconsistently. He is afebrile and his vital signs are within normal limits. Physical examination... | Herpes simplex virus | {
"A": "Human papillomavirus",
"B": "Treponema pallidum",
"C": "Haemophilus ducreyi",
"D": "Herpes simplex virus"
} | step1 | D | [
"year old man presents",
"multiple painful ulcers",
"penis",
"ulcers",
"appeared",
"same time 3 days",
"reports",
"sexually active",
"multiple partners",
"uses condoms",
"afebrile",
"vital signs",
"normal",
"Physical examination reveals multiple small shallow ulcers",
"erythematous base"... |
A 71-year-old male is admitted to the hospital with a Staphylococcal aureus infection of his decubitus ulcers. He is diabetic and has a body mass index of 45. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min and blood pressure is 122/98 mm Hg. The nurse is monitoring his blood glucose and reco... | Yes, glargine insulin is a long-acting insulin and should still be given to control his blood glucose over the next 24 hours. | {
"A": "Yes, glargine insulin is a long-acting insulin and should still be given to control his blood glucose over the next 24 hours.",
"B": "No, glargine insulin should not be given during an episode of hypoglycemia as it will further lower blood glucose.",
"C": "No, glargine insulin was probably ordered in erro... | step2&3 | A | [
"71 year old male",
"admitted",
"hospital",
"Staphylococcal aureus infection",
"decubitus ulcers",
"diabetic",
"body mass index",
"temperature",
"98",
"respirations",
"min",
"pulse",
"67 min",
"blood pressure",
"98 mm Hg",
"nurse",
"monitoring",
"blood glucose",
"records",
"63 ... |
A 10-year-old boy presents to your office with puffy eyes. The patient's mother states that his eyes seem abnormally puffy and thinks he may have an eye infection. Additionally, he had a sore throat a week ago which resolved with over the counter medications. The mother also thought that his urine was darker than usual... | Sub-epithelial electron dense deposits on electron microscopy | {
"A": "Linear Ig deposits along the basement membrane",
"B": "No abnormalities",
"C": "Podocyte fusion on electron microscopy",
"D": "Sub-epithelial electron dense deposits on electron microscopy"
} | step1 | D | [
"A 10 year old boy presents",
"office",
"puffy eyes",
"patient's mother states",
"eyes",
"puffy",
"thinks",
"eye infection",
"sore throat",
"week",
"resolved",
"over the counter medications",
"mother",
"thought",
"urine",
"darker",
"usual",
"concerned",
"blood",
"present",
"t... |
A 65-year-old man presents to his primary care provider after noticing increasing fatigue over the past several weeks. He now becomes short of breath after going up 1 flight of stairs. He was previously healthy and has not seen a doctor for several years. He denies any fever or changes to his bowel movements. On exam, ... | Superior mesenteric vein | {
"A": "Inferior mesenteric vein",
"B": "Inferior rectal vein",
"C": "Right gonadal vein",
"D": "Superior mesenteric vein"
} | step1 | D | [
"65 year old man presents",
"primary care provider",
"increasing fatigue",
"past",
"weeks",
"now",
"short of breath",
"flight",
"stairs",
"healthy",
"not seen",
"doctor",
"years",
"denies",
"fever",
"changes",
"bowel movements",
"exam",
"temperature",
"98",
"blood pressure",
... |
A 24-year-old woman is brought to the emergency department by her roommate because of bizarre behavior and incoherent talkativeness for the past week. Her roommate reports that the patient has been rearranging the furniture in her room at night and has ordered a variety of expensive clothes online. The patient says she... | Obtain TSH, β-hCG, and serum creatinine concentration | {
"A": "Obtain CBC, liver function studies, and beta-HCG",
"B": "Assess for suicidal ideation and obtain echocardiography",
"C": "Obtain TSH, β-hCG, and serum creatinine concentration",
"D": "Obtain BMI, HbA1c, lipid levels, and prolactin levels"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"roommate",
"bizarre behavior",
"incoherent talkativeness",
"past week",
"roommate reports",
"patient",
"furniture",
"room",
"night",
"ordered",
"variety",
"expensive clothes",
"patient",
"feels better",
"ever",
"lot",
"energ... |
A 36-year-old woman comes to the physician because of a 12-month history of upper abdominal pain. The pain is worse after eating, which she reports as 7 out of 10 in intensity. Over the last year, she has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. Eight months ago, she underwe... | Fasting serum gastrin level | {
"A": "Secretin stimulation test",
"B": "Urea breath test",
"C": "24-hour esophageal pH monitoring",
"D": "Fasting serum gastrin level"
} | step2&3 | D | [
"36 year old woman",
"physician",
"month history",
"upper abdominal pain",
"pain",
"worse after eating",
"reports",
"out",
"10",
"intensity",
"last year",
"nausea",
"heartburn",
"multiple episodes of diarrhea",
"blood",
"mucus",
"Eight months",
"upper endoscopy",
"showed several ... |
A 65-year-old Caucasian woman comes to the clinic with complaints of fatigability and persistent headaches for the last month. Her headache is dull, encompassing her whole head, and has been getting worse lately. She has associated diplopia and progressively diminishing peripheral vision. She also complains of difficul... | Craniopharyngioma | {
"A": "Craniopharyngioma",
"B": "Primary hypothyroidism",
"C": "Optic nerve atrophy",
"D": "Pituitary adenoma"
} | step2&3 | A | [
"65 year old Caucasian woman",
"clinic",
"complaints",
"fatigability",
"persistent headaches",
"month",
"headache",
"dull",
"whole head",
"getting worse",
"associated diplopia",
"diminishing peripheral vision",
"difficulty",
"weight",
"to control",
"diet",
"exercising",
"kg",
"20... |
A 22-year-old man is brought to the emergency department by his roommate 20 minutes after being discovered unconscious at home. On arrival, he is unresponsive to painful stimuli. His pulse is 65/min, respirations are 8/min, and blood pressure is 110/70 mm Hg. Pulse oximetry shows an oxygen saturation of 75%. Despite ap... | Opioid analgesics | {
"A": "Opioid analgesics",
"B": "Heroin",
"C": "Antidepressants",
"D": "Acetaminophen"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"roommate 20 minutes",
"discovered unconscious",
"home",
"arrival",
"unresponsive to painful stimuli",
"pulse",
"65 min",
"respirations",
"min",
"blood pressure",
"70 mm Hg",
"Pulse oximetry shows",
"oxygen saturation",
"75",
"appr... |
A 45-year-old woman presents with fever, chills, nausea, and dysuria. She says her symptoms started 4 days ago and have progressively worsened. Her past medical history is significant for recurrent UTIs for the past 6 months and for diabetes mellitus type 2, diagnosed 5 years ago and treated with metformin. Her vital s... | Admit for IV antibiotic therapy | {
"A": "Contrast MRI of the abdomen and pelvis",
"B": "Admit for prompt percutaneous nephrostomy",
"C": "Renal ultrasound",
"D": "Admit for IV antibiotic therapy"
} | step2&3 | D | [
"year old woman presents",
"fever",
"chills",
"nausea",
"dysuria",
"symptoms started 4 days",
"worsened",
"past medical history",
"significant",
"recurrent UTIs",
"past 6 months",
"diabetes mellitus type 2",
"diagnosed 5 years",
"treated with metformin",
"vital signs include",
"tempera... |
A 29-year-old woman presents with progressive vision loss in her right eye and periorbital pain for 5 days. She says that she has also noticed weakness, numbness, and tingling in her left leg. Her vital signs are within normal limits. Neurological examination shows gait imbalance, positive Babinski reflexes, bilateral ... | Multiple sclerosis | {
"A": "Acute disseminated encephalomyelitis",
"B": "Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephaly (CADASIL)",
"C": "Lead intoxication",
"D": "Multiple sclerosis"
} | step1 | D | [
"29 year old woman presents",
"progressive vision loss",
"right eye",
"periorbital pain",
"5 days",
"weakness",
"numbness",
"tingling",
"left leg",
"vital signs",
"normal limits",
"Neurological examination shows gait imbalance",
"positive Babinski reflexes",
"bilateral spasticity",
"exag... |
A 3-month-old girl is brought to the emergency department by her parents after she appeared to have a seizure at home. On presentation, she no longer has convulsions though she is still noted to be lethargic. She was born through uncomplicated vaginal delivery and was not noted to have any abnormalities at the time of ... | Debranching enzyme | {
"A": "Branching enzyme",
"B": "Debranching enzyme",
"C": "Glucose-6-phosphatase",
"D": "Muscle phosphorylase"
} | step1 | B | [
"3 month old girl",
"brought",
"emergency department",
"parents",
"appeared to",
"seizure at home",
"presentation",
"longer",
"convulsions",
"noted to",
"lethargic",
"born",
"uncomplicated vaginal",
"not noted to",
"abnormalities",
"time",
"birth",
"then",
"noted",
"pediatricia... |
A scientist is studying the mechanisms by which bacteria become resistant to antibiotics. She begins by obtaining a culture of vancomycin-resistant Enterococcus faecalis and conducts replicate plating experiments. In these experiments, colonies are inoculated onto a membrane and smeared on 2 separate plates, 1 containi... | Plasmid loss | {
"A": "Plasmid loss",
"B": "Point mutation",
"C": "Loss of function mutation",
"D": "Viral infection"
} | step1 | A | [
"scientist",
"studying",
"mechanisms",
"bacteria",
"resistant to antibiotics",
"begins",
"obtaining",
"culture",
"vancomycin-resistant Enterococcus",
"conducts replicate plating experiments",
"experiments",
"colonies",
"inoculated",
"membrane",
"smeared",
"separate plates",
"1 contai... |
A 35-year-old woman presents to clinic in emotional distress. She states she has been unhappy for the past couple of months and is having problems with her sleep and appetite. Additionally, she reports significant anxiety regarding thoughts of dirtiness around the house. She states that she cleans all of the doorknobs ... | Obsessive compulsive disorder (OCD) | {
"A": "Obsessive compulsive disorder (OCD)",
"B": "Tic disorder",
"C": "Panic Disorder (PD)",
"D": "Generalized anxiety disorder (GAD)"
} | step2&3 | A | [
"35 year old woman presents",
"clinic",
"emotional distress",
"states",
"unhappy",
"past couple",
"months",
"problems with",
"sleep",
"appetite",
"reports significant anxiety",
"thoughts",
"dirtiness",
"house",
"states",
"cleans",
"5-10 times",
"day",
"actions",
"stress related... |
A 22-year-old woman presents to the emergency department with a chief concern of shortness of breath. She was hiking when she suddenly felt unable to breathe and had to take slow deep breaths to improve her symptoms. The patient is a Swedish foreign exchange student and does not speak any English. Her past medical hist... | Normal DLCO | {
"A": "Decreased airway tone",
"B": "Increased FEV1/FVC",
"C": "Increased FVC",
"D": "Normal DLCO"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"concern of shortness",
"breath",
"hiking",
"felt unable to",
"to take slow deep to",
"symptoms",
"patient",
"Swedish foreign exchange student",
"not speak",
"English",
"past medical history",
"current medications",
"unknown",
"tempera... |
A mother brings her 1-week-old son to the pediatrician because she is concerned about the child’s umbilicus. She notes that there appears to be fluid draining from the child’s umbilicus several times a day. The child has been breastfeeding normally. On exam, a small amount of clear light yellow fluid drains from the ch... | Urachus | {
"A": "Omphalomesenteric duct",
"B": "Umbilical vein",
"C": "Urachus",
"D": "Ductus venosus"
} | step1 | C | [
"mother",
"1-week old son",
"pediatrician",
"concerned",
"childs umbilicus",
"notes",
"appears to",
"fluid draining",
"childs umbilicus",
"times",
"day",
"child",
"breastfeeding",
"exam",
"small amount",
"clear light yellow fluid drains",
"childs umbilical stump",
"pressure",
"ap... |
A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation is admitted to the hospital for the management of elevated blood pressures. On admission, her pulse is 81/min, and blood pressure is 165/89 mm Hg. Treatment with an intravenous drug is initiated. Two days after admission, she has a headache and palpitations... | Direct dilation of the arterioles | {
"A": "Inhibition of β1, β2, and α1 receptors",
"B": "Activation of α2 adrenergic receptors",
"C": "Inhibition of sodium reabsorption",
"D": "Direct dilation of the arterioles"
} | step1 | D | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"admitted",
"hospital",
"management",
"elevated blood pressures",
"On admission",
"pulse",
"81 min",
"blood pressure",
"mm Hg",
"Treatment",
"intravenous",
"initiated",
"Two days",
"admission",
"headache",
"palpit... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.