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 36-year-old G3P2002 presents to her obstetrician’s office for her first prenatal visit at ten weeks and two days gestation. She notes that she has felt nauseous the last several mornings and has been especially tired for a few weeks. Otherwise, she feels well. The patient has had two uncomplicated spontaneous vaginal... | Chorionic villus sampling | {
"A": "Chorionic villus sampling",
"B": "Anatomy ultrasound",
"C": "Genetic testing of patient’s sister",
"D": "Nuchal translucency test"
} | step2&3 | A | [
"36 year old",
"presents",
"obstetricians office",
"first prenatal visit",
"ten weeks",
"two days gestation",
"notes",
"felt nauseous",
"last",
"mornings",
"tired",
"weeks",
"feels well",
"patient",
"two uncomplicated spontaneous vaginal deliveries",
"full term",
"last child born six... |
A 48-year-old woman is transferred from her primary care physician's office to the emergency department for further evaluation of hypokalemia to 2.5 mEq/L. She was recently diagnosed with hypertension 2 weeks ago and started on medical therapy. The patient said that she enjoys all kinds of food and exercises regularly,... | Administer isotonic saline 1 liter via peripheral IV | {
"A": "Obtain an electrocardiogram",
"B": "Administer potassium bicarbonate 50mEq per oral",
"C": "Administer isotonic saline 1 liter via peripheral IV",
"D": "Obtain urine sodium and creatinine"
} | step2&3 | C | [
"48 year old woman",
"transferred",
"primary care physician's office",
"emergency department",
"further evaluation",
"hypokalemia",
"2.5 mEq/L",
"recently diagnosed",
"hypertension 2 weeks",
"started",
"medical therapy",
"patient",
"kinds",
"food",
"exercises",
"not",
"able to comple... |
Nine days after being treated for a perforated gastric ulcer and sepsis, a 78-year-old woman develops decreased urinary output and malaise. She required emergency laparotomy and was subsequently treated in the intensive care unit for sepsis. Blood cultures grew Pseudomonas aeruginosa. The patient was treated with cefta... | Muddy brown casts | {
"A": "Pigmented casts",
"B": "Muddy brown casts",
"C": "RBC casts",
"D": "Waxy casts"
} | step2&3 | B | [
"Nine days",
"treated",
"perforated gastric ulcer",
"sepsis",
"year old woman",
"decreased urinary output",
"malaise",
"required emergency laparotomy",
"treated",
"intensive care unit",
"sepsis",
"Blood cultures",
"Pseudomonas aeruginosa",
"patient",
"treated with ceftazidime",
"gentam... |
A 50-year-old woman comes to the physician because of palpitations and irritability. Over the past 4 months, she has had several episodes of heart racing and skipping beats that lasted between 30 seconds and several hours. She has also been arguing with her husband more, often about the temperature being too warm. The ... | L-thyroxine therapy | {
"A": "Near-total thyroidectomy",
"B": "Methimazole therapy",
"C": "Propranolol therapy",
"D": "L-thyroxine therapy"
} | step2&3 | D | [
"50 year old woman",
"physician",
"palpitations",
"irritability",
"past",
"months",
"several episodes of heart racing",
"skipping beats",
"lasted",
"30 seconds",
"several hours",
"husband",
"often",
"temperature",
"warm",
"patient",
"lost 8.8 kg",
"19.4",
"past",
"months",
"l... |
A 30-year-old woman presents to the office with complaints of pain in her right breast for 5 days. The pain is moderate-to-intense and is localized to the upper quadrant of the right breast, and mainly to the areola for the past 48 hours. She adds that there is some nipple discharge on the same side and that the right ... | Smoking | {
"A": "Trauma",
"B": "Smoking",
"C": "Diabetes",
"D": "Parity"
} | step1 | B | [
"30 year old woman presents",
"office",
"complaints",
"pain",
"right breast",
"5 days",
"pain",
"moderate",
"intense",
"localized",
"upper quadrant of",
"right breast",
"areola",
"past 48 hours",
"adds",
"nipple discharge",
"same side",
"right breast",
"red",
"diagnosed",
"ty... |
A previously healthy 33-year-old woman comes to the physician because of pain and sometimes numbness in her right thigh for the past 2 months. She reports that her symptoms are worse when walking or standing and are better while sitting. Three months ago, she started going to a fitness class a couple times a week. She ... | Advise patient to wear looser pants | {
"A": "MRI of the lumbar spine",
"B": "Blood work for inflammatory markers",
"C": "Advise patient to wear looser pants",
"D": "Reduction of physical activity"
} | step2&3 | C | [
"healthy",
"year old woman",
"physician",
"pain",
"sometimes numbness",
"right",
"past",
"months",
"reports",
"symptoms",
"worse",
"walking",
"standing",
"better",
"sitting",
"Three months",
"started",
"fitness class",
"couple times",
"week",
"5 ft 4",
"tall",
"88 kg",
... |
A 68-year-old man presents to the office with progressive shortness of breath and cough. A chest X-ray shows prominent hilar lymph nodes and scattered nodular infiltrates. Biopsy of the latter reveals noncaseating granulomas. This patient most likely as a history of exposure to which of the following? | Beryllium | {
"A": "Organic dust",
"B": "Coal dust",
"C": "Beryllium",
"D": "Silica"
} | step2&3 | C | [
"68 year old man presents",
"office",
"progressive shortness of breath",
"cough",
"chest X-ray shows prominent hilar lymph nodes",
"scattered nodular infiltrates",
"Biopsy",
"reveals noncaseating granulomas",
"patient",
"likely",
"history",
"exposure",
"following"
] |
A 67-year-old man presents to the emergency department acutely confused. The patient's wife found him mumbling incoherently in the kitchen this morning as they were preparing for a hike. The patient was previously healthy and only had a history of mild forgetfulness, depression, asthma, and seasonal allergies. His temp... | Urinary retention | {
"A": "Coronary artery vasospasm",
"B": "Increased bronchial secretions",
"C": "QRS widening",
"D": "Urinary retention"
} | step2&3 | D | [
"67 year old man presents",
"emergency department",
"confused",
"patient's wife found",
"kitchen",
"morning",
"preparing",
"patient",
"healthy",
"only",
"history",
"mild forgetfulness",
"depression",
"asthma",
"seasonal allergies",
"temperature",
"98",
"36",
"blood pressure",
"... |
A 61-year-old male presents to your office with fever and dyspnea on exertion. He has been suffering from chronic, non-productive cough for 1 year. You note late inspiratory crackles on auscultation. Pulmonary function tests reveal an FEV1/FVC ratio of 90% and an FVC that is 50% of the predicted value. Which of the fol... | Subpleural cystic enlargement | {
"A": "Subpleural cystic enlargement",
"B": "Hyaline membranes",
"C": "Arteriovenous malformations",
"D": "Anti-GBM antibodies"
} | step1 | A | [
"61 year old male presents",
"office",
"fever",
"dyspnea on exertion",
"suffering",
"chronic",
"non-productive cough",
"1 year",
"note late inspiratory crackles",
"auscultation",
"Pulmonary function tests reveal",
"FEV1/FVC ratio",
"90",
"FVC",
"50",
"predicted value",
"following",
... |
A team of intensivists working in a private intensive care unit (ICU) observe that the clinical efficacy of vancomycin is low, and proven nosocomial infections have increased progressively over the past year. A clinical microbiologist is invited to conduct a bacteriological audit of the ICU. He analyzes the microbiolog... | Replacement of the terminal D-ala in the cell wall peptidoglycan by D-lactate | {
"A": "Protection of the antibiotic-binding site by Qnr protein",
"B": "Replacement of the terminal D-ala in the cell wall peptidoglycan by D-lactate",
"C": "Increased expression of efflux pumps which extrude the antibiotic from the bacterial cell",
"D": "Decreased number of porins in the bacterial cell wall l... | step1 | B | [
"team",
"working",
"private intensive care unit",
"observe",
"clinical efficacy",
"vancomycin",
"low",
"proven nosocomial infections",
"increased",
"past year",
"clinical microbiologist",
"to conduct",
"bacteriological audit",
"ICU",
"microbiological reports",
"patients treated with va... |
A 46-year-old male with a history of recurrent deep venous thromboses on warfarin presents to his hematologist for a follow-up visit. He reports that he feels well and has no complaints. His INR at his last visit was 2.5 while his current INR is 4.0. His past medical history is also notable for recent diagnoses of hype... | Omeprazole | {
"A": "Omeprazole",
"B": "Lisinopril",
"C": "Atorvastatin",
"D": "Cetirizine"
} | step1 | A | [
"year old male",
"history of recurrent deep venous thromboses",
"warfarin presents",
"hematologist",
"follow-up visit",
"reports",
"feels well",
"complaints",
"INR",
"visit",
"2.5",
"current INR",
"4 0",
"past medical history",
"notable",
"recent diagnoses",
"hypertension",
"hyperl... |
A 67-year-old man presents to his physician with increased thirst and polyuria for the past 4 months. Patient also notes a decrease in his vision for the past 6 months and tingling in his feet. The medical history is significant for a chronic pyelonephritis and stage 2 chronic kidney disease. The current medications in... | Lactic acidosis | {
"A": "Hypoglycemia",
"B": "Lactic acidosis",
"C": "Infections",
"D": "Hyperkalemia"
} | step2&3 | B | [
"67 year old man presents",
"physician",
"increased thirst",
"polyuria",
"past",
"months",
"Patient",
"notes",
"decrease",
"vision",
"past 6 months",
"tingling",
"feet",
"medical history",
"significant",
"chronic pyelonephritis",
"stage 2 chronic kidney disease",
"current medicatio... |
A 59-year-old man comes to the physician for evaluation of a progressively enlarging, 8-mm skin lesion on the right shoulder that developed 1 month ago. The patient has a light-skinned complexion and has had several dysplastic nevi removed in the past. A photograph of the lesion is shown. The lesion is most likely deri... | Neuroblastoma | {
"A": "Neuroblastoma",
"B": "Medullary thyroid cancer",
"C": "Adrenal adenoma",
"D": "Basal cell carcinoma"
} | step1 | A | [
"59 year old man",
"physician",
"evaluation",
"enlarging",
"mm skin lesion",
"right shoulder",
"1 month",
"patient",
"light skinned complexion",
"several dysplastic nevi removed",
"past",
"photograph",
"lesion",
"shown",
"lesion",
"most likely derived",
"cells",
"embryological orig... |
A 33-year-old woman comes to the physician because of a 14-hour history of left flank pain associated with dark urine. Her temperature is 37.2°C (99°F). The abdomen is soft with normal bowel sounds. There is guarding on the left lateral side and tenderness to palpation over the left costophrenic angle. An x-ray of the ... | Low-protein diet | {
"A": "High-oxalate diet",
"B": "Vitamin C supplementation",
"C": "Low-protein diet",
"D": "Low-calcium diet"
} | step1 | C | [
"year old woman",
"physician",
"hour history",
"left flank pain associated with dark urine",
"temperature",
"abdomen",
"soft",
"normal bowel sounds",
"guarding",
"left side",
"tenderness",
"palpation",
"left costophrenic angle",
"x-ray of",
"abdomen shows",
"mm kidney stone",
"adequa... |
A 35-year-old woman presents to her primary care physician for recurrent deep venous thrombosis (DVT) of her left lower extremity. She is a vegetarian and often struggles to maintain an adequate intake of non-animal based protein. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and cu... | Begin heparin and warfarin | {
"A": "Begin heparin and warfarin",
"B": "Begin warfarin, target INR 2.0–3.0",
"C": "Begin warfarin, target INR 2.5–3.5",
"D": "Consult IR for IVC filter placement"
} | step2&3 | A | [
"35 year old woman presents",
"primary care physician",
"recurrent deep venous thrombosis",
"of",
"left lower extremity",
"vegetarian",
"often",
"to maintain",
"adequate intake",
"non animal based protein",
"currently smokes 1 pack",
"cigarettes",
"day",
"drinks",
"glass",
"wine",
"d... |
A 10-year-old woman presents to the clinic, with her mother, complaining of a circular, itchy rash on her scalp for the past 3 weeks. Her mother is also worried about her hair loss. The girl has a past medical history significant for asthma. She needs to use her albuterol inhaler once per week on average. Her blood pre... | Oral terbinafine | {
"A": "Subcutaneous triamcinolone",
"B": "Ketoconazole shampoo",
"C": "Oral doxycycline",
"D": "Oral terbinafine"
} | step2&3 | D | [
"A 10 year old woman presents",
"clinic",
"mother",
"complaining of a circular",
"itchy rash",
"scalp",
"past",
"weeks",
"mother",
"worried",
"hair loss",
"girl",
"past medical history significant",
"asthma",
"needs to use",
"albuterol inhaler",
"week",
"average",
"blood pressure... |
A 66-year-old man is brought to the emergency department by his daughter because of 3 days of fever, chills, cough, and shortness of breath. The cough is productive of yellow sputum. His symptoms have not improved with rest and guaifenesin. His past medical history is significant for hypertension, for which he takes hy... | Respiratory alkalosis | {
"A": "Normal acid-base status",
"B": "Metabolic acidosis",
"C": "Respiratory acidosis",
"D": "Respiratory alkalosis"
} | step1 | D | [
"66 year old man",
"brought",
"emergency department",
"daughter",
"3 days",
"fever",
"chills",
"cough",
"shortness of breath",
"cough",
"productive",
"yellow",
"symptoms",
"not improved",
"rest",
"guaifenesin",
"past medical history",
"significant",
"hypertension",
"takes hydro... |
A 59-year-old patient presented to his family physician 8 years ago with initial complaints of increasing generalized stiffness with trouble initiating movement and worsening micrographia. He was started on levodopa after further evaluation led to a suspected diagnosis of Parkinson's disease; however, this therapy ulti... | Glial cytoplasmic inclusions | {
"A": "Astrocytosis and caudate atrophy",
"B": "Glial cytoplasmic inclusions",
"C": "Round intracellular tau protein aggregates",
"D": "Periventricular white matter plaques"
} | step2&3 | B | [
"59 year old patient presented",
"family physician",
"years",
"initial complaints",
"increasing generalized stiffness",
"initiating movement",
"worsening micrographia",
"started",
"levodopa",
"further evaluation led",
"suspected diagnosis",
"Parkinson's disease",
"therapy",
"failed to",
... |
A newborn girl is delivered vaginally at term to a healthy 25-year-old G1P1. The pregnancy was uncomplicated. On examination, she was found to have a slight anal invagination, but no opening. Further examination shows a vestibular fistula and normally developed external genitalia. Which of the following statements abou... | There is a failure of the invagination and rupture of the dorsal portion of the cloacal membrane. | {
"A": "Such abnormal anatomy is formed after week 12 of intrauterine development.",
"B": "The presence of an associated perineal or vestibular fistula is more likely in females with trisomy 21.",
"C": "There is a failure of the division of the embryonic cloaca into the urogenital sinus and rectoanal canal.",
"... | step1 | D | [
"newborn girl",
"delivered",
"term",
"healthy",
"year old G1P1",
"pregnancy",
"uncomplicated",
"examination",
"found to",
"slight anal invagination",
"opening",
"Further examination shows",
"vestibular fistula",
"external genitalia",
"following statements",
"condition",
"correct"
] |
A 71-year-old man comes to the physician because of decreased sexual performance for the past 2 years. He reports that it takes longer for his penis to become erect, and he cannot maintain an erection for as long as before. His ejaculations have become less forceful. Once he has achieved an orgasm, he requires several ... | Physiologic | {
"A": "Vascular",
"B": "Psychogenic",
"C": "Neurogenic",
"D": "Physiologic"
} | step1 | D | [
"71 year old man",
"physician",
"of decreased sexual performance",
"past",
"years",
"reports",
"takes longer",
"penis to",
"erect",
"maintain",
"erection",
"long",
"ejaculations",
"less forceful",
"orgasm",
"several hours",
"orgasm",
"married",
"40 years",
"marital conflicts",
... |
A 33-year-old man comes to the otolaryngologist for the evaluation of a 6-month history of difficulty breathing through his nose and clear nasal discharge. He has a history of seasonal atopic rhinosinusitis. Anterior rhinoscopy shows a nasal polyp obstructing the superior nasal meatus. A CT scan of the head is most lik... | Sphenoidal sinus and posterior ethmoidal sinuses | {
"A": "Pterygopalatine fossa and middle ethmoidal sinus",
"B": "Sphenoidal sinus and posterior ethmoidal sinuses",
"C": "Nasolacrimal duct and eustachian tube",
"D": "Frontal sinus and anterior ethmoidal sinus"
} | step1 | B | [
"year old man",
"otolaryngologist",
"evaluation",
"month history",
"difficulty breathing",
"nose",
"clear nasal discharge",
"history",
"seasonal atopic rhinosinusitis",
"Anterior rhinoscopy shows",
"nasal polyp obstructing",
"superior nasal meatus",
"CT scan of",
"head",
"most likely to ... |
A 21-year-old man presents to a physician with repeated episodes of syncope and dizziness over the last month. On physical examination, his pulse is 64/min while all other vital signs are normal. His 24-hour ECG monitoring suggests a diagnosis of sinus node dysfunction. His detailed genetic evaluation shows that he car... | HCN-channels | {
"A": "HCN-channels",
"B": "L-type voltage-dependent calcium channels",
"C": "Fast delayed rectifier (IKr) voltage-dependent K+ channels",
"D": "Stretch-activated cationic channels"
} | step1 | A | [
"21-year-old man presents",
"physician",
"repeated episodes of syncope",
"dizziness",
"month",
"physical examination",
"pulse",
"64 min",
"vital signs",
"normal",
"24-hour ECG monitoring suggests",
"diagnosis",
"sinus node dysfunction",
"detailed genetic evaluation shows",
"carries",
"... |
A 25-year-old man presents the office for a 3-day history of fever and fatigue. Upon further questioning, he says that he also had constant muscular pain, headaches, and fever during these days. He adds additional information by giving a history of regular unprotected sexual relationship with multiple partners. He is a... | Viral hepatitis B | {
"A": "Viral hepatitis D",
"B": "Viral hepatitis A",
"C": "Viral hepatitis C",
"D": "Viral hepatitis B"
} | step1 | D | [
"year old man presents",
"office",
"3-day history",
"fever",
"fatigue",
"further questioning",
"constant muscular",
"headaches",
"fever",
"days",
"adds additional information",
"giving",
"history",
"regular",
"sexual relationship",
"multiple partners",
"non-smoker",
"drinks alcohol... |
After a year of trying to conceive, a young couple in their early twenties decided to try in vitro fertilization. During preliminary testing of fertility, it was found that the male partner had dysfunctional sperm. Past medical history revealed that he had frequent sinus and lung infections throughout his life. The phy... | Kartagener syndrome | {
"A": "Chédiak-Higashi syndrome",
"B": "Williams syndrome",
"C": "Adenosine deaminase deficiency",
"D": "Kartagener syndrome"
} | step1 | D | [
"year",
"to",
"young couple",
"early twenties",
"to",
"in vitro fertilization",
"preliminary testing",
"fertility",
"found",
"male partner",
"dysfunctional sperm",
"Past medical history revealed",
"frequent sinus",
"lung infections",
"life",
"physician noted",
"abnormal exam finding"... |
A 62-year-old man presents to the office because of painless rectal bleeding for the past 3 months. He describes intermittent streaks of bright red blood on the toilet paper after wiping and blood on but not mixed within the stool. Occasionally, he has noted a small volume of blood within the toilet bowl, and he associ... | Grade 2 internal hemorrhoids | {
"A": "Grade 1 external hemorrhoids",
"B": "Grade 2 external hemorrhoids",
"C": "Grade 2 internal hemorrhoids",
"D": "Grade 3 external hemorrhoids"
} | step2&3 | C | [
"62 year old man presents",
"office",
"of painless rectal bleeding",
"past 3 months",
"intermittent streaks",
"bright red blood",
"toilet paper",
"wiping",
"blood",
"not mixed",
"stool",
"Occasionally",
"noted",
"small volume of blood",
"toilet bowl",
"associates",
"straining",
"pa... |
A 2755-g (6-lb 1-oz) baby boy is delivered at 37 weeks' gestation to a 29-year-old woman who is gravida 3, para 3. His mother received no prenatal care during her pregnancy. 12 hours after birth, he is evaluated for jaundice and lethargy. Laboratory studies show a hemoglobin concentration of 9.6 g/dL and a serum total ... | Hepatosplenomegaly | {
"A": "Hyposthenuria",
"B": "Positive eosin-5-maleimide binding test",
"C": "Hepatosplenomegaly",
"D": "Elevated urinary coproporphyrins"
} | step1 | C | [
"g",
"1 oz",
"baby boy",
"delivered",
"weeks",
"gestation",
"29 year old woman",
"gravida 3",
"para 3",
"mother received",
"prenatal",
"pregnancy",
"12 hours after birth",
"evaluated",
"jaundice",
"lethargy",
"Laboratory studies show",
"hemoglobin concentration",
"g/dL",
"serum... |
A 45-year-old woman presents to her primary care provider complaining of daytime drowsiness and fatigue. She reports that she can manage at most a couple of hours of work before needing a nap. She has also noted impaired memory and a 6.8 kg (15 lb) weight gain. She denies shortness of breath, chest pain, lightheadednes... | Hypercholesterolemia | {
"A": "Anxiety",
"B": "Hypercholesterolemia",
"C": "Palpitations",
"D": "Tremor"
} | step2&3 | B | [
"year old woman presents",
"primary care provider",
"daytime drowsiness",
"fatigue",
"reports",
"couple",
"hours",
"work",
"needing",
"nap",
"noted impaired memory",
"kg",
"weight gain",
"denies shortness of breath",
"chest pain",
"lightheadedness",
"blood in",
"stool",
"doctors ... |
A 5-month-old male infant is brought to the physician by his mother because of a generalized pruritic rash for 2-weeks. The itchiness often causes the infant to wake up at night. He was strictly breastfed until 4 months of age, when he was transitioned to formula feeding. His father has a history of asthma. His immuniz... | Topical emollient
" | {
"A": "Topical coal tar",
"B": "Oral acyclovir",
"C": "Oral vitamin A",
"D": "Topical emollient\n\""
} | step2&3 | D | [
"5 month old male infant",
"brought",
"physician",
"mother",
"generalized",
"rash",
"2-weeks",
"itchiness often causes",
"infant",
"wake",
"night",
"breastfed",
"months",
"age",
"transitioned",
"formula feeding",
"father",
"history of asthma",
"immunizations",
"date",
"percen... |
A 74-year-old man is rushed to the emergency department with left-sided weakness, facial deviation, and slurred speech. His wife first noticed these changes about an hour ago. The patient is having difficulty communicating. He can answer questions by nodding his head, and his wife is providing detailed information. He ... | History of myocardial infarction 6 weeks ago | {
"A": "Atrial fibrillation on electrocardiogram",
"B": "Chronic kidney disease",
"C": "History of myocardial infarction 6 weeks ago",
"D": "Raised blood pressures"
} | step2&3 | C | [
"74 year old man",
"rushed",
"emergency department",
"left-sided weakness",
"facial deviation",
"slurred speech",
"wife first",
"changes",
"hour",
"patient",
"difficulty communicating",
"answer questions",
"nodding",
"head",
"wife",
"providing detailed information",
"denies fever",
... |
A 59-year-old woman is brought to the emergency room after collapsing at home. She had been sitting on her couch reading, when she started feeling lightheaded and lost consciousness. According to her husband, she was unconscious for approximately 30 seconds. Since regaining consciousness, she has continued to be lighth... | Administration of atropine | {
"A": "Administration of dopamine",
"B": "Administration of atropine",
"C": "Administration of norepinephrine",
"D": "Transcutaneous pacemaker placement"
} | step2&3 | B | [
"59 year old woman",
"brought",
"emergency room",
"collapsing at home",
"sitting",
"reading",
"started feeling lightheaded",
"lost consciousness",
"husband",
"unconscious",
"approximately 30 seconds",
"regaining consciousness",
"continued to",
"lightheaded",
"dizzy",
"not",
"palpitat... |
A 78-year-old man presents to the hospital because of shortness of breath and chest pain that started a few hours ago. 3 weeks ago he had surgery for a total hip replacement with a prosthesis. The patient was treated with prophylactic doses of low-weight heparin until he was discharged. He did not have a fever, expecto... | Pulmonary thromboembolism | {
"A": "Pneumonia",
"B": "Myocardial infarction",
"C": "Pulmonary thromboembolism",
"D": "Exacerbation of chronic lung disease"
} | step1 | C | [
"year old man presents",
"hospital",
"of shortness",
"breath",
"chest pain",
"started",
"few hours",
"3 weeks",
"surgery",
"total hip replacement",
"prosthesis",
"patient",
"treated with prophylactic doses",
"low-weight heparin",
"discharged",
"not",
"fever",
"expectoration",
"sy... |
A 41-year-old woman with a past medical history significant for asthma and seasonal allergies presents with a new rash. She has no significant past surgical, social, or family history. The patient's blood pressure is 131/90 mm Hg, the pulse is 77/min, the respiratory rate is 17/min, and the temperature is 36.9°C (98.5°... | Contact dermatitis | {
"A": "Scabies",
"B": "Atopic dermatitis",
"C": "Psoriasis",
"D": "Contact dermatitis"
} | step2&3 | D | [
"year old woman",
"past medical history significant",
"asthma",
"seasonal allergies presents",
"new rash",
"significant past surgical",
"social",
"family history",
"patient's blood pressure",
"90 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"98",
"Physica... |
A 3-year-old male is brought to the pediatrician for a check-up. The patient has a history of recurrent ear infections and several episodes of pneumonia. His mother reports the presence of scaly skin lesions on the face and in the antecubital and popliteal fossa since the patient was 2 months old. Physical examination ... | Decreased CD43 expression on flow cytometry | {
"A": "Decreased CD43 expression on flow cytometry",
"B": "Decreased CD8/CD4 ratio on flow cytometry",
"C": "Increased IgM on quantitative immunoglobulin serology",
"D": "Decreased IgE on quantitative immunoglobulin serology"
} | step2&3 | A | [
"3 year old male",
"brought",
"pediatrician",
"check-up",
"patient",
"history of recurrent ear infections",
"several episodes of pneumonia",
"mother reports",
"presence of scaly skin lesions",
"face",
"antecubital",
"popliteal fossa",
"patient",
"2 months old",
"Physical examination",
... |
A 62-year-old woman makes an appointment with her primary care physician because she recently started experiencing post-menopausal bleeding. She states that she suffered from anorexia as a young adult and has been thin throughout her life. She says that this nutritional deficit is likely what caused her to not experien... | Never becoming pregnant | {
"A": "Being underweight",
"B": "Menarche at age 15",
"C": "Menopause at age 50",
"D": "Never becoming pregnant"
} | step1 | D | [
"62 year old woman makes",
"appointment",
"primary care physician",
"recently started experiencing post-menopausal bleeding",
"states",
"suffered",
"anorexia",
"young adult",
"thin",
"life",
"nutritional deficit",
"likely",
"caused",
"to not experience menarche",
"age",
"used oral cont... |
A 48-year-old woman is brought to the emergency department because of a 1-hour history of sudden-onset headache associated with nausea and vomiting. The patient reports she was sitting at her desk when the headache began. The headache is global and radiates to her neck. She has hypertension. She has smoked one pack of ... | Perform surgical clipping | {
"A": "Administer intravenous vancomycin and ceftriaxone",
"B": "Administer intravenous alteplase",
"C": "Perform burr hole surgery",
"D": "Perform surgical clipping"
} | step2&3 | D | [
"48 year old woman",
"brought",
"emergency department",
"of",
"hour history",
"sudden-onset headache associated with nausea",
"vomiting",
"patient reports",
"sitting",
"headache began",
"headache",
"global",
"radiates",
"neck",
"hypertension",
"smoked one pack",
"cigarettes daily",
... |
A 29-year-old nulligravid woman comes to the physician because of a 10-day history of small quantities of intermittent, blood-tinged discharge from her left nipple. There is no personal or family history of serious illness. She has smoked 1 pack of cigarettes daily for 5 years. Her last menstrual period was 12 days ago... | Subareolar ultrasound | {
"A": "Subareolar ultrasound",
"B": "Image-guided core biopsy of the affected duct",
"C": "Nipple discharge cytology",
"D": "Reassurance"
} | step2&3 | A | [
"29 year old nulligravid woman",
"physician",
"a day history",
"small quantities",
"intermittent",
"blood-tinged discharge",
"left nipple",
"personal",
"family history",
"serious illness",
"smoked 1 pack",
"cigarettes daily",
"5 years",
"last menstrual period",
"days",
"sexually active... |
An investigator is studying the immune response and the spleen in a mouse model infected with Escherichia coli. Which of the following anatomical sites in the spleen is important for the initial maturation of B cells that will ultimately target Escherichia coli? | Germinal center | {
"A": "Red pulp",
"B": "Marginal zone",
"C": "Germinal center",
"D": "Sinusoids"
} | step1 | C | [
"investigator",
"studying",
"immune response",
"spleen",
"mouse infected",
"Escherichia coli",
"following anatomical sites",
"spleen",
"important",
"initial maturation",
"B cells",
"target Escherichia coli"
] |
A 28-year-old woman at 30 weeks gestation is rushed to the emergency room with the sudden onset of vaginal bleeding accompanied by intense abdominopelvic pain and uterine contractions. The intensity and frequency of pain have increased in the past 2 hours. This is her 1st pregnancy and she was diagnosed with gestationa... | Placenta abruption | {
"A": "Vasa previa",
"B": "Uterine rupture",
"C": "Placenta previa",
"D": "Placenta abruption"
} | step1 | D | [
"year old woman",
"30 weeks",
"rushed",
"emergency room",
"sudden onset",
"vaginal bleeding",
"intense",
"pain",
"uterine contractions",
"intensity",
"frequency of pain",
"increased",
"past",
"hours",
"1st pregnancy",
"diagnosed",
"gestational",
"weeks",
"vital signs include",
... |
An 18-month-old girl is brought to the emergency room by her mother because of wheezing for 1 day. The baby has never had similar symptoms. She also has a runny nose and a cough. She is not feeding well. Her immunizations are up-to-date. Her rectal temperature is 38.8°C (101.8°F), the heart rate is 120/min, and the res... | Bronchiolitis | {
"A": "Bronchial asthma",
"B": "Bronchiolitis",
"C": "Bacterial pneumonia",
"D": "Bronchial foreign body"
} | step1 | B | [
"month old girl",
"brought",
"emergency room",
"mother",
"wheezing",
"1 day",
"baby",
"never",
"similar symptoms",
"runny nose",
"cough",
"not feeding well",
"immunizations",
"date",
"rectal temperature",
"heart rate",
"min",
"respiratory rate",
"23 min",
"examination",
"clea... |
A 61-year-old man presents to the urgent care clinic complaining of cough and unintentional weight loss over the past 3 months. He works as a computer engineer, and he informs you that he has been having to meet several deadlines recently and has been under significant stress. His medical history is significant for gou... | Small cell lung cancer | {
"A": "Small cell lung cancer",
"B": "Non-small cell lung cancer",
"C": "Large cell lung cancer",
"D": "Adenocarcinoma"
} | step2&3 | A | [
"61 year old man presents",
"urgent care clinic complaining of cough",
"unintentional weight loss over",
"past 3 months",
"works",
"computer engineer",
"informs",
"to meet several",
"recently",
"significant stress",
"medical history",
"significant",
"gout",
"hypertension",
"hypercholeste... |
A 22-year-old female presents to an urgent care clinic for evaluation of a loose bowel movement that she developed after returning from her honeymoon in Mexico last week. She states that she has been having watery stools for the past 3 days at least 3 times per day. She now has abdominal cramps as well. She has no sign... | Ciprofloxacin | {
"A": "Ciprofloxacin",
"B": "Metronidazole",
"C": "Doxycycline",
"D": "Albendazole"
} | step2&3 | A | [
"year old female presents",
"urgent care clinic",
"evaluation",
"loose bowel movement",
"returning",
"Mexico",
"week",
"states",
"watery stools",
"past 3 days",
"times",
"day",
"now",
"abdominal cramps",
"well",
"significant past medical history",
"only medication",
"takes",
"dep... |
A 12-year-old girl is brought to a pediatrician by her parents to establish care after moving to a new state. She does not have any complaints. Her past medical history is insignificant, and immunization history is up to date. The physical examination reveals a slightly raised strawberry-colored nodule on the skin of h... | Hemangioma | {
"A": "Hemangioma",
"B": "Sarcoma",
"C": "Lymphoma",
"D": "Malignant melanoma"
} | step1 | A | [
"year old girl",
"brought",
"pediatrician",
"parents to establish care",
"moving",
"new state",
"not",
"complaints",
"past medical history",
"immunization history",
"date",
"physical examination reveals",
"slightly raised strawberry colored nodule",
"the skin of",
"abdomen",
"umbilicus... |
A 65-year-old man comes to the physician because of progressive abdominal distension and swelling of his legs for 4 months. He has a history of ulcerative colitis. Physical examination shows jaundice. Abdominal examination shows shifting dullness and dilated veins in the periumbilical region. This patient's abdominal f... | Superior epigastric vein | {
"A": "Hepatic vein",
"B": "Superior epigastric vein",
"C": "Superior mesenteric vein",
"D": "Superior rectal vein"
} | step1 | B | [
"65 year old man",
"physician",
"progressive abdominal distension",
"swelling of",
"legs",
"4 months",
"history of ulcerative colitis",
"Physical examination shows jaundice",
"Abdominal examination shows shifting dullness",
"dilated veins",
"periumbilical region",
"patient's abdominal findings... |
A 24-year-old man comes to the physician for the evaluation of a severely pruritic skin rash. Physical examination shows a symmetrical rash over the knees and elbows with tense, grouped vesicles, and several excoriation marks. Microabscesses in the papillary dermis are seen on light microscopy. Immunofluorescence shows... | Gliadin-dependent hypersensitivity | {
"A": "Mite eggs and fecal pellets",
"B": "Gliadin-dependent hypersensitivity",
"C": "Nail pitting",
"D": "Positive Nikolsky sign"
} | step1 | B | [
"year old man",
"physician",
"evaluation",
"severely pruritic skin rash",
"Physical shows",
"symmetrical rash",
"knees",
"elbows",
"tense",
"grouped vesicles",
"several excoriation marks",
"Microabscesses",
"papillary dermis",
"seen",
"light",
"Immunofluorescence shows deposits",
"im... |
A 33-year-old man presents to the emergency department with agitation and combativeness. The paramedics who brought him in say that he was demonstrating violent, reckless behavior and was running into oncoming traffic. Chemical sedation is required to evaluate the patient. Physical examination reveals horizontal and ve... | Phencyclidine (PCP) | {
"A": "Cocaine",
"B": "Gamma-hydroxybutyric acid (GHB)",
"C": "Lysergic acid diethylamide (LSD)",
"D": "Phencyclidine (PCP)"
} | step1 | D | [
"year old man presents",
"emergency department",
"agitation",
"combativeness",
"paramedics",
"brought",
"violent",
"behavior",
"running",
"traffic",
"Chemical sedation",
"required to evaluate",
"patient",
"Physical examination reveals horizontal",
"vertical nystagmus",
"tachycardia",
... |
One day after undergoing a left carotid endarterectomy, a 63-year-old man has a severe headache. He describes it as 9 out of 10 in intensity. He has nausea. He had 80% stenosis in the left carotid artery and received heparin prior to the surgery. He has a history of 2 transient ischemic attacks, 2 and 4 months ago. He ... | Hypertension | {
"A": "Degree of carotid stenosis",
"B": "Aspirin therapy",
"C": "Hypertension",
"D": "Smoking"
} | step2&3 | C | [
"One day",
"left carotid endarterectomy",
"63 year old man",
"severe headache",
"out",
"10",
"intensity",
"nausea",
"80",
"stenosis",
"left carotid artery",
"received heparin prior to",
"surgery",
"history of",
"transient ischemic attacks",
"2",
"4 months",
"hypertension",
"type ... |
A 25-year-old mother presents to her primary care physician for wrist pain. The patient recently gave birth to a healthy newborn at 40 weeks gestation. Beginning one week ago, she started having pain over her wrist that has steadily worsened. The patient notes that she also recently fell while walking and broke the fal... | Rest and ibuprofen | {
"A": "Radiography of the wrist",
"B": "Thumb spica cast",
"C": "Wrist guard to be worn during work and at night",
"D": "Rest and ibuprofen"
} | step2&3 | D | [
"year old mother presents",
"primary care physician",
"wrist pain",
"patient recently gave birth",
"healthy newborn",
"40 weeks gestation",
"Beginning one",
"started",
"pain",
"wrist",
"worsened",
"patient notes",
"recently fell",
"walking",
"broke",
"fall",
"arm",
"patient",
"ac... |
A 55-year-old woman comes to the physician because of a 2-week history of painful swelling on the right side of her face. The pain worsens when she eats. Examination of the face shows a right-sided, firm swelling that is tender to palpation. Oral examination shows no abnormalities. Ultrasonography shows a stone located... | Lateral to the second upper molar tooth | {
"A": "Lateral to the lingual frenulum",
"B": "Lateral to the second upper molar tooth",
"C": "Into the floor of the mouth",
"D": "Into the mandibular foramen"
} | step1 | B | [
"55 year old woman",
"physician",
"2-week history",
"painful swelling",
"right side of",
"face",
"pain worsens",
"eats",
"Examination",
"face shows",
"right-sided",
"firm swelling",
"tender",
"palpation",
"Oral examination shows",
"abnormalities",
"Ultrasonography shows",
"stone",
... |
Ten days after the vaginal delivery of a healthy infant girl, a 27-year-old woman is brought to the physician by her husband because of frequent mood changes. She has been tearful and anxious since she went home from the hospital 2 days after delivery. She says that she feels overwhelmed with her new responsibilities a... | Reassurance | {
"A": "Sertraline therapy",
"B": "Risperidone therapy",
"C": "Reassurance",
"D": "Bupropion therapy"
} | step2&3 | C | [
"Ten days",
"vaginal delivery",
"healthy infant girl",
"27 year old woman",
"brought",
"physician",
"husband",
"frequent mood changes",
"tearful",
"anxious",
"home",
"hospital 2 days",
"delivery",
"feels",
"new responsibilities",
"difficulties taking care",
"newborn",
"feels consta... |
A previously healthy 82-year-old man dies in a motor vehicle collision. At autopsy, the heart shows slight ventricular thickening. There are abnormal, insoluble aggregations of protein filaments in beta-pleated linear sheets in the ventricular walls and, to a lesser degree, in the atria and lungs. No other organs show ... | Normal transthyretin | {
"A": "Natriuretic peptide",
"B": "Normal transthyretin",
"C": "Immunoglobulin light chain",
"D": "Serum amyloid A"
} | step1 | B | [
"healthy",
"year old man",
"motor vehicle collision",
"autopsy",
"heart shows slight ventricular thickening",
"abnormal",
"aggregations",
"protein filaments",
"beta-pleated linear sheets",
"ventricular walls",
"lesser degree",
"atria",
"lungs",
"organs show",
"abnormality",
"Bone marro... |
A 2-year-old boy is brought to the physician with complaints of gingival growth in the lower jaw with associated pain for the past few weeks. He has no history of trauma or any other significant medical conditions. His temperature is 37.0°C (98.6°F), pulse is 92/min, and respiratory rate is 24/min. On extraoral examina... | Birbeck granules | {
"A": "Ragged red fibers",
"B": "Prominent perifascicular and paraseptal atrophy",
"C": "Birbeck granules",
"D": "Endomysial inflammatory infiltrates and myofiber necrosis"
} | step2&3 | C | [
"2 year old boy",
"brought",
"physician",
"complaints",
"gingival growth",
"lower jaw with associated pain",
"past",
"weeks",
"history",
"trauma",
"significant medical conditions",
"temperature",
"98",
"pulse",
"min",
"respiratory rate",
"min",
"extraoral examination",
"swelling"... |
A 62-year-old man presents to the emergency department with chest pain. He was at home watching television when he suddenly felt chest pain that traveled to his back. The patient has a past medical history of alcoholism, obesity, hypertension, diabetes, and depression. His temperature is 98.4°F (36.9°C), blood pressure... | Labetalol | {
"A": "CT scan",
"B": "Labetalol",
"C": "Nitroprusside",
"D": "NPO, IV fluids, serum lipase"
} | step2&3 | B | [
"62 year old man presents",
"emergency department",
"chest pain",
"at home watching television",
"felt chest pain",
"traveled",
"back",
"patient",
"past medical",
"obesity",
"hypertension",
"diabetes",
"depression",
"temperature",
"98 4F",
"36",
"blood pressure",
"mmHg",
"pulse",... |
A 28-year-old G1P0 woman comes to the emergency department complaining that her water just broke. She reports irregular prenatal care due to her erratic schedule. She is also unsure of her gestational age but claims that her belly began to show shortly after she received her thyroidectomy for her Graves disease about 9... | High levels of free T4 and total T3 | {
"A": "Group B streptococcus in blood",
"B": "High levels of free T4 and total T3",
"C": "Low hemoglobin",
"D": "Pericardial effusion"
} | step1 | B | [
"year old",
"woman",
"emergency department",
"water",
"reports irregular prenatal care due to",
"schedule",
"unsure",
"gestational age",
"belly began to show",
"received",
"thyroidectomy",
"Graves disease",
"months",
"denies",
"known fevers",
"chills",
"abnormal vaginal bleeding",
... |
A 40-year-old male visits a urologist and reports that for the past 2 weeks, his penis has been gradually curving to the right with associated pain during intercourse. He is able to have a normal erection and he does not recollect of any trauma to his penis. Although he is married, he admits to having unprotected sexua... | Fibrosis of tunica albuginea | {
"A": "Fibrosis of corpus cavernosa",
"B": "Congenital hypospadias",
"C": "Fibrosis of tunica albuginea",
"D": "Hypertrophy of corpus cavernosa"
} | step1 | C | [
"40 year old male visits",
"urologist",
"reports",
"past 2 weeks",
"penis",
"curving",
"right with associated pain",
"intercourse",
"able to",
"normal erection",
"not recollect",
"trauma",
"penis",
"married",
"admits to",
"sexual relationship",
"females",
"past year",
"normal",
... |
An 18-day-old newborn has difficulty feeding and diarrhea for 2 days. During this period he has vomited after each of his feeds. He was born at 28 weeks' gestation and weighed 1100-g (2-lb 7-oz). His feeds consist of breast milk and cow milk based-formula. He appears lethargic. His temperature is 36.4°C (97.5°F), pulse... | Necrotizing enterocolitis
" | {
"A": "Meckel diverticululum",
"B": "Hypertrophic pyloric stenosis",
"C": "Duodenal atresia",
"D": "Necrotizing enterocolitis\n\""
} | step2&3 | D | [
"day old newborn",
"difficulty feeding",
"diarrhea",
"2 days",
"period",
"vomited",
"feeds",
"born",
"weeks",
"gestation",
"g",
"oz",
"feeds consist",
"breast milk",
"cow milk based formula",
"appears lethargic",
"temperature",
"36 4C",
"97",
"pulse",
"min",
"respirations",... |
A 6-month-old male infant is brought to a pediatrician by his guardian for scheduled immunizations. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The infant is generally healthy; however, the guardian is concerned a... | Reassurance | {
"A": "Reassurance",
"B": "Topical hydrocortisone cream",
"C": "Inform child protective services",
"D": "Radiographic skeletal survey"
} | step2&3 | A | [
"month old male infant",
"brought",
"pediatrician",
"guardian",
"scheduled immunizations",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"infant",
"healthy",
"guardian",
"concerned",
"multiple patches",
... |
A previously healthy 46-year-old woman comes to the physician with a one-week history of productive cough and fatigue. Two weeks ago, she had fever, nasal congestion, rhinorrhea, and myalgias that resolved with supportive care. She has not traveled out of the United States. Pulmonary examination shows dullness to percu... | Gram-positive, catalase-positive cocci | {
"A": "Gram-positive, catalase-positive cocci",
"B": "Silver-staining, gram-negative bacilli",
"C": "Gram-positive, beta-hemolytic cocci in chains",
"D": "Septate, acute-branching hyphae"
} | step1 | A | [
"healthy",
"year old woman",
"physician",
"one-week history",
"productive cough",
"fatigue",
"Two weeks",
"fever",
"nasal congestion",
"rhinorrhea",
"myalgias",
"resolved",
"supportive care",
"not traveled out of",
"United States",
"Pulmonary examination shows dullness",
"percussion"... |
A 34-year-old man comes to the physician because of progressive swelling of the left lower leg for 4 months. One year ago, he had an episode of intermittent fever and tender lymphadenopathy that occurred shortly after he returned from a trip to India and resolved spontaneously. Physical examination shows 4+ nonpitting ... | Deposition of thread-like larvae into the skin by a female mosquito | {
"A": "Deposition of larvae into the skin by a female black fly",
"B": "Penetration of the skin by cercariae from contaminated fresh water",
"C": "Deposition of thread-like larvae into the skin by a female mosquito",
"D": "Penetration of the skin by hookworms in feces"
} | step1 | C | [
"year old man",
"physician",
"of progressive swelling",
"left lower leg",
"4 months",
"One year ago",
"episode of intermittent fever",
"tender lymphadenopathy",
"occurred",
"returned",
"trip",
"India",
"resolved",
"Physical examination shows 4",
"nonpitting edema of",
"left lower leg",... |
A 23-year-old woman presents with progressively worsening headache, photophobia, and intermittent fever that have lasted for 6 days. She says her headache is mostly frontal and radiates down her neck. She denies any recent history of blood transfusions, recent travel, or contact with animals. Her past medical history i... | Enterovirus meningitis | {
"A": "Brucellosis",
"B": "Mumps meningitis",
"C": "Ehrlichiosis",
"D": "Enterovirus meningitis"
} | step1 | D | [
"23 year old woman presents",
"worsening headache",
"photophobia",
"intermittent fever",
"lasted",
"6 days",
"headache",
"mostly frontal",
"radiates",
"neck",
"denies",
"recent history of blood transfusions",
"recent travel",
"contact with animals",
"past medical history",
"unremarkabl... |
A 26-year-old man comes to the emergency room complaining of severe, episodic back pain. He states that it started suddenly this morning. The pain is 9/10 and radiates to his left groin. He endorses seeing blood in his urine earlier but denies dysuria or abnormal urethral discharge. His medical history is significant f... | Crohn disease | {
"A": "Crohn disease",
"B": "Diabetes mellitus",
"C": "Gout",
"D": "Medication effect"
} | step2&3 | A | [
"year old man",
"emergency room",
"severe",
"episodic back pain",
"states",
"started",
"morning",
"pain",
"10",
"radiates",
"left groin",
"seeing blood in",
"urine earlier",
"denies dysuria",
"abnormal urethral",
"medical history",
"significant",
"Crohn disease",
"gout",
"insul... |
A 19-year-old man with a history of type 1 diabetes presents to the emergency department for the evaluation of a blood glucose level of 492 mg/dL. Laboratory examination revealed a serum bicarbonate level of 13 mEq/L, serum sodium level of 122 mEq/L, and ketonuria. Arterial blood gas demonstrated a pH of 6.9. He is adm... | Papilledema | {
"A": "Pupillary constriction",
"B": "Pancreatitis",
"C": "Papilledema",
"D": "Peripheral edema"
} | step2&3 | C | [
"year old man",
"history",
"type 1 diabetes presents",
"emergency department",
"evaluation",
"blood glucose level",
"mg/dL",
"Laboratory examination revealed",
"serum bicarbonate level",
"mEq/L",
"serum sodium level",
"mEq/L",
"ketonuria",
"Arterial blood gas",
"pH",
"admitted",
"hos... |
A 24-year-old African American college student comes to the office for a scheduled visit. He has been healthy, although he reports occasional flank discomfort which comes and goes. He denies any fever, chills, dysuria, or polyuria in the past year. His vaccinations are up to date. His family history is unknown, as he w... | Intravenous (IV) pyelogram | {
"A": "Plain abdominal X-ray",
"B": "Intravenous (IV) pyelogram",
"C": "24-hour urine collection test",
"D": "Repeat urinalysis in 6 months"
} | step2&3 | B | [
"year old African American college student",
"office",
"scheduled visit",
"healthy",
"reports occasional flank discomfort",
"goes",
"denies",
"fever",
"chills",
"dysuria",
"polyuria",
"past year",
"vaccinations",
"date",
"family history",
"unknown",
"adopted",
"smokes 1 pack",
"c... |
An 11-year-old girl is brought to the emergency department after she fell during a dance class. She was unable to stand after the accident and has a painful and swollen knee. On presentation she says that she has had 2 previous swollen joints as well as profuse bleeding after minor cuts. Based on her presentation, a pa... | Desmopressin | {
"A": "Desmopressin",
"B": "Factor VIII repletion",
"C": "Platelet infusion",
"D": "Vitamin K"
} | step1 | A | [
"year old girl",
"brought",
"emergency department",
"fell",
"dance class",
"unable to stand",
"accident",
"painful",
"swollen knee",
"presentation",
"2 previous swollen joints",
"bleeding",
"minor cuts",
"Based",
"presentation",
"panel",
"bleeding tests",
"obtained",
"following r... |
Researchers are studying the effects of a new medication for the treatment of type 2 diabetes. A randomized group of 100 subjects is given the new medication 1st for 2 months, followed by a washout period of 2 weeks, and then administration of the gold standard medication for 2 months. Another randomized group of 100 s... | Carryover effect | {
"A": "Increasing confounding bias",
"B": "Decreasing power",
"C": "Hawthorne effect",
"D": "Carryover effect"
} | step1 | D | [
"Researchers",
"studying",
"effects",
"new medication",
"treatment",
"type 2 diabetes",
"A randomized group",
"100 subjects",
"given",
"new medication 1st",
"2 months",
"followed by",
"washout period",
"2 weeks",
"then administration of",
"gold standard medication",
"2 months",
"ra... |
A 33-year-old woman, gravida 1, para 0, at 26 weeks' gestation comes to the physician for a routine prenatal examination. Her pregnancy has been uneventful. Physical examination shows a uterus consistent in size with a 26-week gestation. She is given an oral 50-g glucose load; 1 hour later, her serum glucose concentrat... | Generation of adenosine triphosphate | {
"A": "Closure of membranous potassium channels",
"B": "Generation of adenosine triphosphate",
"C": "Depolarization of beta-cell membrane",
"D": "Exocytosis of insulin granules"
} | step1 | B | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"physician",
"routine prenatal examination",
"pregnancy",
"Physical examination shows",
"uterus consistent",
"size",
"week gestation",
"given",
"oral 50 g glucose load",
"1 hour later",
"serum",
"mg/dL",
"following most... |
You are treating a neonate with meningitis using ampicillin and a second antibiotic, X, that is known to cause ototoxicity. What is the mechanism of antibiotic X? | It binds the 30s ribosomal subunit and inhibits formation of the initiation complex | {
"A": "It binds the 50S ribosomal subunit and inhibits peptidyltransferase",
"B": "It binds the 50S ribosomal subunit and inhibits formation of the initiation complex",
"C": "It binds the 30s ribosomal subunit and inhibits formation of the initiation complex",
"D": "It binds the 30s ribosomal subunit and rever... | step1 | C | [
"treating",
"neonate",
"meningitis using ampicillin",
"second antibiotic",
"known to cause ototoxicity",
"mechanism",
"antibiotic"
] |
A 52-year-old man is brought to the emergency department after being found down on the sidewalk. On presentation, he is found to have overdosed on opioids so he is given naloxone and quickly recovers. Physical exam also reveals lumps on his neck and face that are covered by small yellow granules. These lumps are slowly... | Gram-positive rod | {
"A": "Acid-fast rods",
"B": "Gram-negative cocci",
"C": "Gram-positive cocci",
"D": "Gram-positive rod"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"found",
"sidewalk",
"presentation",
"found to",
"overdosed",
"opioids",
"given naloxone",
"recovers",
"Physical exam",
"reveals lumps on",
"neck",
"face",
"covered",
"small yellow granules",
"lumps",
"slowly draining yellow pus"... |
A 34-year-old woman presents to the physician because of fever and sore throat for 2 days. She also reports generalized body pain and fatigue over this period. She was diagnosed with Graves’ disease 6 months ago. Because of arthralgias and rash due to methimazole 3 months ago, her physician switched methimazole to PTU.... | Complete blood count with differential | {
"A": "Complete blood count with differential",
"B": "Erythrocyte sedimentation rate",
"C": "Thyroid-stimulating hormone",
"D": "No further testing is indicated"
} | step2&3 | A | [
"year old woman presents",
"physician",
"fever",
"sore throat",
"2 days",
"reports generalized body pain",
"fatigue",
"period",
"diagnosed",
"Graves disease",
"months",
"arthralgias",
"rash due to methimazole",
"months",
"physician switched methimazole",
"appears ill",
"vital signs i... |
A 45-year-old man with a history of poorly controlled human immunodeficiency virus (HIV) infection presents to the emergency room complaining of clumsiness and weakness. He reports a 3-month history of worsening balance, asymmetric muscle weakness, and speech difficulties. He recently returned from a trip to Guatemala ... | Polyomavirus | {
"A": "Arenavirus",
"B": "Bunyavirus",
"C": "Picornavirus",
"D": "Polyomavirus"
} | step1 | D | [
"year old man",
"history",
"poorly controlled human immunodeficiency virus",
"infection presents",
"emergency room",
"clumsiness",
"weakness",
"reports",
"3 month history",
"worsening balance",
"asymmetric muscle weakness",
"speech difficulties",
"recently returned",
"trip",
"Guatemala t... |
A 6-year-old girl is brought to the pediatrician by her father for an annual physical examination. The father reports that the patient is a happy and healthy child, but he sometimes worries about her weight. He says that she is a “picky” eater and only wants chicken nuggets and French fries. He also notes some mild acn... | Head computed tomography (CT) | {
"A": "Dehydroepiandrosterone sulfate levels",
"B": "Estrogen levels",
"C": "Head computed tomography (CT)",
"D": "Pelvic ultrasound"
} | step2&3 | C | [
"year old girl",
"brought",
"pediatrician",
"father",
"annual physical examination",
"father reports",
"patient",
"happy",
"healthy child",
"sometimes worries",
"weight",
"picky eater",
"only",
"chicken",
"French fries",
"notes",
"mild acne",
"cheeks",
"forehead",
"thinks",
"... |
A 42-year-old woman presents complaining of pain in her hands. She reports that the pain is in both hands, and that it is usually worse in the morning. She reports that her hands are also stiff in the morning, but that this gradually improves throughout the morning. She notes, however, that her symptoms seem to be gett... | Production of antibodies against antibodies | {
"A": "Repetitive microtrauma",
"B": "Production of antibodies against smooth muscle",
"C": "Production of antibodies against antibodies",
"D": "Anti-neutrophil cytoplasmic antibody production"
} | step1 | C | [
"year old woman presents",
"pain",
"hands",
"reports",
"pain",
"hands",
"usually worse",
"morning",
"reports",
"hands",
"stiff",
"morning",
"improves",
"morning",
"notes",
"symptoms",
"to",
"getting worse",
"three months",
"most likely pathogenesis",
"disease process"
] |
A 67-year-old male presents to the emergency department with sudden onset shortness of breath and epigastric pain. The patient has a past medical history of GERD, obesity, diabetes mellitus type II, anxiety, glaucoma, and irritable bowel syndrome. His current medications include omeprazole, insulin, metformin, lisinopr... | Increased cGMP | {
"A": "Beta-adrenergic blockade",
"B": "Increased cGMP",
"C": "Fluid overload",
"D": "Left ventricular failure"
} | step2&3 | B | [
"67 year old male presents",
"emergency department",
"sudden onset shortness of breath",
"epigastric pain",
"patient",
"past medical GERD",
"obesity",
"diabetes mellitus type II",
"anxiety",
"glaucoma",
"irritable bowel syndrome",
"current medications include omeprazole",
"insulin",
"metfo... |
A 70-year-old man comes to the physician because of a painless skin lesion on his neck for the past 5 months. The lesion has gradually become darker in color and is often pruritic. He has a similar lesion on the back. He is a retired landscaper. He has smoked half a pack of cigarettes daily for 45 years. Physical exami... | Immature keratinocytes with small keratin-filled cysts | {
"A": "S100-positive epithelioid cells with fine granules in the cytoplasm",
"B": "Koilocytes in the granular cell layer of the epidermis",
"C": "Immature keratinocytes with small keratin-filled cysts",
"D": "Fibroblast proliferation with small, benign dermal growth"
} | step1 | C | [
"70 year old man",
"physician",
"of",
"painless skin lesion on",
"neck",
"past",
"months",
"lesion",
"darker",
"color",
"often",
"similar lesion",
"back",
"retired",
"smoked half",
"pack",
"cigarettes daily",
"years",
"Physical examination shows",
"0.9",
"hyperpigmented papul... |
A 23-year-old man presents to the emergency department brought in by police. He was found shouting at strangers in the middle of the street. The patient has no significant past medical history, and his only medications include a short course of prednisone recently prescribed for poison ivy exposure. His temperature is ... | Warmed IV normal saline and warm blankets | {
"A": "Haloperidol IM",
"B": "Lorazepam and discontinue steroids",
"C": "Warm air recirculator",
"D": "Warmed IV normal saline and warm blankets"
} | step2&3 | D | [
"23 year old man presents",
"emergency department brought",
"police",
"found shouting",
"strangers",
"middle",
"street",
"patient",
"significant past medical history",
"only medications include",
"short course",
"prednisone recently prescribed",
"poison exposure",
"temperature",
"blood p... |
A 66-year-old man with coronary artery disease and hypertension comes to the emergency department because of intermittent retrosternal chest pain, lightheadedness, and palpitations. He has smoked one pack of cigarettes daily for 39 years. His pulse is 140/min and irregularly irregular, respirations are 20/min, and bloo... | Interference with carboxylation of glutamate residues | {
"A": "Binding and activation of antithrombin III",
"B": "Irreversible inhibition of cyclooxygenase",
"C": "Interference with carboxylation of glutamate residues",
"D": "Irreversible blockade of adenosine diphosphate receptors"
} | step1 | C | [
"66 year old man",
"coronary artery disease",
"hypertension",
"emergency department",
"intermittent retrosternal chest pain",
"lightheadedness",
"palpitations",
"smoked one pack",
"cigarettes daily",
"years",
"pulse",
"min",
"irregular",
"respirations",
"20 min",
"blood pressure",
"6... |
A 65-year-old woman comes to the physician because of a 3-month history of intermittent palpitations and shortness of breath. Cardiopulmonary examination shows no other abnormalities. An ECG shows an absence of P waves, an oscillating baseline, and irregular RR intervals at a rate of approximately 95 beats per minute. ... | Temporary inactivation of Na+ channels in the AV node | {
"A": "Temporary inactivation of Na+ channels in the AV node",
"B": "Inhibition of the Na+/K+-ATPase pump in ventricular cells",
"C": "Limited speed of conduction through the left bundle branch",
"D": "Prolonged influx through voltage-gated Ca2+ channels in the bundle of His"
} | step1 | A | [
"65 year old woman",
"physician",
"of",
"3 month history",
"intermittent palpitations",
"shortness of breath",
"Cardiopulmonary examination shows",
"abnormalities",
"ECG shows",
"absence",
"P waves",
"baseline",
"irregular RR intervals",
"rate",
"approximately 95",
"minute",
"differe... |
A 17-year-old woman presents to the emergency department with abdominal and pelvic pain. She states it started 3 days ago and it has been getting gradually worse. She states it is diffuse and is located over her abdomen, pelvis, and inside her vagina. She also endorses vaginal pruritus and a discharge from her vagina. ... | Urine hCG | {
"A": "Cervical swab and culture",
"B": "CT abdomen/pelvis",
"C": "Urine hCG",
"D": "Wet mount"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"abdominal",
"pelvic pain",
"states",
"started 3 days",
"getting",
"worse",
"states",
"diffuse",
"abdomen",
"pelvis",
"vagina",
"vaginal pruritus",
"discharge",
"vagina",
"patient works",
"ice cream",
"sexually active",
"multip... |
A 52-year-old man presents to his primary care physician because he has been experiencing shortness of breath and cough. He began feeling short of breath when playing recreational soccer with his friends. Over time these episodes have become more severe. They now impair his ability to work as a construction worker. In ... | Dihydrofolate reductase inhibitor | {
"A": "Dihydrofolate reductase inhibitor",
"B": "Microtubule inhibitor",
"C": "Purine analogue",
"D": "Pyrimidine analogue"
} | step1 | A | [
"year old man presents",
"primary care physician",
"experiencing shortness of breath",
"cough",
"began feeling short of breath",
"playing recreational soccer",
"friends",
"time",
"episodes",
"more severe",
"now",
"ability to work",
"construction worker",
"addition",
"chronic dry",
"inc... |
While walking through a park with his wife, a 51-year-old man with type 2 diabetes mellitus develops nausea, sweating, pallor, and palpitations. For the past 3 weeks, he has been trying to lose weight and has adjusted his diet and activity level. He eats a low-carb diet and swims 3 times a week. The man returned home f... | Intramuscular glucagon | {
"A": "Sublingual nitroglycerine",
"B": "Oral glucose",
"C": "Intramuscular glucagon",
"D": "Intra-arterial dextrose"
} | step1 | C | [
"walking",
"park",
"wife",
"year old man",
"type 2 diabetes mellitus",
"nausea",
"sweating",
"pallor",
"palpitations",
"past",
"weeks",
"to",
"weight",
"adjusted",
"diet",
"activity level",
"eats",
"low carb diet",
"swims",
"times",
"week",
"man returned home",
"training ... |
An x-ray of the chest is conducted and shown below. Which of the following is the most appropriate next step in management? | Administer isoniazid for 9 months | {
"A": "Perform interferon-γ release assay",
"B": "Administer isoniazid for 9 months",
"C": "Administer isoniazid + rifampin + pyrazinamide + ethambutol",
"D": "Obtain a chest CT scan"
} | step2&3 | B | [
"x-ray of",
"chest",
"conducted",
"shown",
"following",
"most appropriate next step",
"management"
] |
A 45-year-old woman presents to her physician with a four-month history of headache. Her headache is nonfocal but persistent throughout the day without any obvious trigger. She was told that it was a migraine but has never responded to sumatriptan, oxygen, or antiemetics. She takes amlodipine for hypertension. She does... | Inferior petrosal sinus sampling | {
"A": "Repeat high dose dexamethasone suppression test",
"B": "Inferior petrosal sinus sampling",
"C": "Pituitary resection",
"D": "Pulmonary nodule resection"
} | step2&3 | B | [
"year old woman presents",
"physician",
"four month history of headache",
"headache",
"nonfocal",
"persistent",
"day",
"trigger",
"migraine",
"never",
"sumatriptan",
"oxygen",
"antiemetics",
"takes amlodipine",
"hypertension",
"not smoke",
"denies",
"recent weight loss",
"constit... |
During the exam of a 2-day-old female neonate you determine that she appears lethargic, cyanotic, and has a coarse tremor of her right arm. The patient's mother explains that she observed what she believed to be seizure-like activity just before you arrived in the room. The mother has a history of type two diabetes mel... | Partial exchange transfusion with hydration | {
"A": "Partial exchange transfusion with hydration",
"B": "Fluid resuscitation",
"C": "Hydroxyurea",
"D": "Interferon alpha"
} | step2&3 | A | [
"exam",
"2-day old female neonate",
"appears lethargic",
"cyanotic",
"coarse tremor",
"right arm",
"patient's mother",
"observed",
"to",
"seizure",
"activity",
"arrived",
"room",
"mother",
"history of type two diabetes mellitus",
"childbirth",
"delay",
"cord clamping",
"to",
"e... |
A 75-year-old woman comes to the physician because of generalized weakness for 6 months. During this period, she has also had a 4-kg (8.8-lb) weight loss and frequent headaches. She has been avoiding eating solids because of severe jaw pain. She has hypertension and osteoporosis. She underwent a total left-sided knee a... | Oral prednisone and temporal artery biopsy | {
"A": "Intravenous methylprednisolone only",
"B": "Intravenous methylprednisolone and temporal artery biopsy",
"C": "Oral prednisone and temporal artery biopsy",
"D": "Temporal artery biopsy only\n\""
} | step2&3 | C | [
"75 year old woman",
"physician",
"of generalized weakness",
"months",
"period",
"4 kg",
"8.8",
"weight loss",
"frequent headaches",
"eating solids",
"of severe jaw pain",
"hypertension",
"osteoporosis",
"total left-sided knee",
"years",
"of",
"patient",
"not smoke",
"drink alcoh... |
A 24-year-old primigravida at 28 weeks gestation presents to the office stating that she “can’t feel her baby kicking anymore.” She also noticed mild-to-moderate vaginal bleeding. A prenatal visit a few days ago confirmed the fetal cardiac activity by Doppler. The medical history is significant for GERD, hypertension, ... | Confirmation of cardiac activity by Doppler | {
"A": "Confirmation of cardiac activity by Doppler",
"B": "Speculum examination",
"C": "Misoprostol",
"D": "Order platelet count, fibrinogen, PT and PTT levels"
} | step2&3 | A | [
"year old primigravida",
"weeks presents",
"office stating",
"cant feel",
"baby kicking",
"mild-to-moderate vaginal bleeding",
"prenatal visit",
"few days",
"confirmed",
"fetal",
"Doppler",
"medical history",
"significant",
"GERD",
"hypertension",
"SLE",
"temperature",
"36",
"98"... |
A 47-year-old woman comes to her primary care doctor because of a new, pruritic rash. She was gardening in her yard two days ago and now has an eczematous papulovesicular rash on both ankles. You also note a single, 5 mm brown lesion with a slightly raised border on her left thigh. You prescribe a topical corticosteroi... | Further questioning | {
"A": "Further questioning",
"B": "Reassurance",
"C": "Simple shave biopsy",
"D": "Full thickness biopsy"
} | step2&3 | A | [
"year old woman",
"primary care doctor",
"new",
"pruritic rash",
"gardening",
"yard two days",
"now",
"eczematous",
"rash",
"ankles",
"note",
"single",
"mm brown lesion",
"slightly raised border",
"left thigh",
"topical corticosteroid",
"contact dermatitis",
"following",
"appropr... |
A 28-year-old man presents to the emergency department with vomiting. He states that he has experienced severe vomiting starting last night that has not been improving. He states that his symptoms improve with hot showers. The patient has presented to the emergency department with a similar complaints several times in ... | Marijuana use | {
"A": "Alcohol use",
"B": "Marijuana use",
"C": "Substance withdrawal",
"D": "Viral gastroenteritis"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"vomiting",
"states",
"severe vomiting starting last night",
"not",
"improving",
"states",
"symptoms",
"hot showers",
"patient",
"presented",
"emergency department",
"similar complaints",
"times",
"past as well",
"intravenous drug abus... |
A 12-year-old female presents to your office complaining of several brief episodes of shortness of breath of varying severity. Which of the following substances would lead to a decrease in FEV1 of 20% if the patient has asthma? | Methacholine | {
"A": "Methacholine",
"B": "Epinephrine",
"C": "Ipratroprium",
"D": "Albuterol"
} | step1 | A | [
"year old female presents",
"office",
"of",
"brief episodes",
"shortness",
"breath",
"severity",
"following substances",
"lead",
"decrease",
"FEV1",
"20",
"patient",
"asthma"
] |
A 59-year-old man presents to his primary care physician with a 5-month history of breathing difficulties. He says that he has been experiencing exertional dyspnea that is accompanied by a nonproductive cough. His past medical history is significant for a solitary lung nodule that was removed surgically 10 years ago an... | Subpleural cystic enlargement | {
"A": "Anticancer agents",
"B": "Interstitial lymphoid infiltrates in lung tissue",
"C": "Subpleural cystic enlargement",
"D": "Type III hypersensitivity reaction"
} | step1 | C | [
"59 year old man presents",
"primary care physician",
"5 month history",
"breathing difficulties",
"experiencing exertional dyspnea",
"nonproductive cough",
"past medical history",
"significant",
"solitary lung nodule",
"removed surgically 10 years",
"found to",
"benign",
"works",
"secreta... |
A 22-year-old woman comes to the physician because of a 1-month history of persistent abdominal cramping, diarrhea, and rectal pain. During the past 2 weeks, she has had up to 4 small volumed, blood-tinged stools with mucus daily. She has also had intermittent fevers and a 4.5-kg (10-lb) weight loss during this time. S... | Colorectal cancer | {
"A": "Hemolytic uremic syndrome",
"B": "Oral ulcers",
"C": "Gastric cancer",
"D": "Colorectal cancer"
} | step2&3 | D | [
"year old woman",
"physician",
"month history",
"persistent abdominal cramping",
"diarrhea",
"rectal pain",
"past 2 weeks",
"up to",
"small volumed",
"blood-tinged stools",
"mucus daily",
"intermittent fevers",
"4.5 kg",
"10",
"weight loss",
"time",
"traveled",
"Southeast Asia",
... |
A 32-year-old man comes to the emergency department because of recurrent episodes of vomiting for 1 day. He has had over 15 episodes of bilious vomiting. During this period he has had cramping abdominal pain but has not had a bowel movement or passed flatus. He does not have fever or diarrhea. He was diagnosed with Cro... | Strictureplasty of individual strictures | {
"A": "Ileocolectomy",
"B": "Strictureplasty of individual strictures",
"C": "Abdominal closure and start palliative care",
"D": "Small bowel resection with ileostomy\n\""
} | step2&3 | B | [
"year old man",
"emergency department",
"of recurrent episodes",
"vomiting",
"1 day",
"over",
"episodes of bilious vomiting",
"period",
"cramping abdominal",
"not",
"bowel movement",
"passed flatus",
"not",
"fever",
"diarrhea",
"diagnosed",
"Crohn disease",
"age",
"years",
"wel... |
A 26-year-old gravida 4 para 1 presents to the emergency department with sudden severe abdominal pain and mild vaginal bleeding. Her last menstrual period was 12 weeks ago. She describes her pain as similar to uterine contractions. She has a history of 2 spontaneous abortions in the first trimester. She is not complain... | Increase myometrial sensitivity to contractions and induced decidual breakdown | {
"A": "Induce teratogenesis in the fetus",
"B": "Induce cervical dilation",
"C": "Increase myometrial sensitivity to contractions and induced decidual breakdown",
"D": "Interferes with placental blood supply to the fetus"
} | step1 | C | [
"year old gravida 4 para 1 presents",
"emergency department",
"sudden severe abdominal pain",
"mild vaginal",
"last menstrual period",
"weeks",
"pain",
"similar",
"uterine contractions",
"history of",
"spontaneous abortions",
"first trimester",
"not",
"dizziness",
"dyspnea",
"physical ... |
A 57-year-old man presents to his family physician for a routine exam. He feels well and reports no new complaints since his visit last year. Last year, he had a colonoscopy which showed no polyps, a low dose chest computerized tomography (CT) scan that showed no masses, and routine labs which showed a fasting glucose ... | Chest computerized tomography (CT) scan | {
"A": "Abdominal ultrasound",
"B": "Chest computerized tomography (CT) scan",
"C": "Colonoscopy",
"D": "Chest radiograph"
} | step2&3 | B | [
"57 year old man presents",
"family physician",
"routine exam",
"feels well",
"reports",
"new complaints",
"visit",
"year",
"colonoscopy",
"showed",
"polyps",
"low dose chest computerized tomography",
"scan",
"showed",
"masses",
"routine labs",
"showed",
"fasting glucose",
"mg/dL... |
A 72-year-old man presents to his primary care physician for a wellness visit. He says that he has been experiencing episodes of chest pain and lightheadedness. Approximately 1 week ago he fell to the ground after abruptly getting up from the bed. Prior to the fall, he felt lightheaded and his vision began to get blurr... | Increased blood flow velocity through the aortic valve | {
"A": "Bicuspid aortic valve",
"B": "Decreased murmur intensity with squatting",
"C": "Increased blood flow velocity through the aortic valve",
"D": "Pulsus paradoxus"
} | step2&3 | C | [
"72 year old man presents",
"primary care physician",
"wellness visit",
"experiencing episodes of chest pain",
"lightheadedness",
"Approximately",
"week",
"fell",
"getting",
"bed",
"fall",
"felt lightheaded",
"vision began to",
"blurry",
"wife",
"unconscious",
"seconds",
"then",
... |
A 37-year-old G1P1001 presents for her 6-week postpartum visit after delivering a male infant by spontaneous vaginal delivery at 41 weeks and 5 days gestation. She notes that five days ago, her right breast began to hurt, and the skin near her nipple turned red. She also states that she has felt feverish and generally ... | Needle aspiration and oral dicloxacillin | {
"A": "Mammogram",
"B": "Incision and drainage",
"C": "Needle aspiration and oral dicloxacillin",
"D": "Cessation of smoking"
} | step2&3 | C | [
"year old",
"presents",
"week postpartum visit",
"delivering",
"male infant",
"spontaneous vaginal delivery",
"weeks",
"5 days gestation",
"notes",
"five days",
"right breast began to",
"skin",
"nipple turned red",
"states",
"felt feverish",
"achy",
"2 days",
"thought",
"sleep",
... |
A 66-year-old woman with hypertension comes to the physician because of crampy, dull abdominal pain and weight loss for 1 month. The pain is located in the epigastric region and typically occurs within the first hour after eating. She has had a 7-kg (15.4-lb) weight loss in the past month. She has smoked 1 pack of ciga... | Narrowing of the celiac artery | {
"A": "Narrowing of the celiac artery",
"B": "Malignant mass at the head of the pancreas",
"C": "Embolus in the superior mesenteric artery",
"D": "Decreased motility of gastric smooth muscle"
} | step1 | A | [
"66 year old woman",
"hypertension",
"physician",
"crampy",
"dull abdominal pain",
"weight loss",
"month",
"pain",
"epigastric region",
"occurs",
"first hour",
"eating",
"kg",
"15.4",
"weight loss",
"past month",
"smoked 1 pack",
"cigarettes daily",
"20 years",
"Physical examin... |
A 56-year-old woman makes an appointment with her physician to discuss the results of her cervical cancer screening. She has been menopausal for 2 years and does not take hormone replacement therapy. Her previous Pap smear showed low-grade squamous intraepithelial lesion (LSIL); no HPV testing was performed. Her gynec... | Colposcopy | {
"A": "Test for HPV 16 and 18",
"B": "Colposcopy",
"C": "Immediate loop excision",
"D": "Repeat HPV testing in 6 months"
} | step2&3 | B | [
"year old woman makes",
"appointment",
"physician to discuss",
"results",
"cervical cancer screening",
"menopausal",
"years",
"not take hormone replacement therapy",
"previous Pap smear showed low-grade squamous intraepithelial lesion",
"HPV testing",
"performed",
"gynecologic examination",
... |
A 19-year-old woman is brought to the physician by her parents because of irritable mood that started 5 days ago. Since then, she has been staying up late at night working on a secret project. She is energetic despite sleeping less than 4 hours per day. Her parents report that she seems easily distracted. She is usuall... | Bipolar II disorder | {
"A": "Bipolar II disorder",
"B": "Bipolar I disorder",
"C": "Major depressive disorder",
"D": "Substance abuse"
} | step2&3 | A | [
"year old woman",
"brought",
"physician",
"parents",
"irritable mood",
"started 5 days",
"then",
"late",
"night working",
"secret project",
"energetic",
"sleeping",
"4 hours per day",
"parents report",
"easily",
"usually very responsible",
"week",
"spent",
"supplies",
"project"... |
A 36-year-old man presents with massive hematemesis. Past medical history is significant for a gastric ulcer. He has a pulse of 115/min, respiratory rate of 20/min, temperature of 36°C (96.8°F), and blood pressure of 90/59 mm Hg. The patient receives a transfusion of 2 units of packed red blood cells. Around 5–10 minut... | Acute hemolytic transfusion reaction | {
"A": "Acute hemolytic transfusion reaction",
"B": "Anaphylactic transfusion reaction",
"C": "Febrile non-hemolytic transfusion reaction",
"D": "Transfusion-related acute lung injury"
} | step1 | A | [
"36 year old man presents",
"massive hematemesis",
"Past medical history",
"significant",
"gastric ulcer",
"pulse",
"min",
"respiratory rate",
"20 min",
"temperature",
"96",
"blood pressure",
"90 59 mm Hg",
"patient receives",
"transfusion of",
"packed red blood cells",
"510 minutes"... |
A 5-day-old neonate is brought to the pediatrician by his parents for yellow skin for the past few days. His parents also reported that he remains quiet all day and does not even respond to sound. Further perinatal history reveals that he was born by cesarean section at 36 weeks of gestation, and his birth weight was 2... | Liver transplantation | {
"A": "Phenobarbital",
"B": "Phototherapy",
"C": "Liver transplantation",
"D": "Discontinue the breast feeding"
} | step2&3 | C | [
"5 day old neonate",
"brought",
"pediatrician",
"parents",
"yellow skin",
"past",
"days",
"parents",
"reported",
"quiet",
"day",
"not",
"sound",
"Further perinatal history reveals",
"born by cesarean section",
"36 weeks of gestation",
"birth weight",
"2",
"kg",
"baby",
"secon... |
A 5-year-old boy presents to the pediatrician after his parents noted that he could not sustain physical exertion and would experience muscle cramping. It was noted that after physical exertion the boy experienced severe muscle pain. After a series of biochemical and genetic tests, it was discovered the that the boy ha... | UAU -> UAA | {
"A": "UGU -> CGC",
"B": "AUG -> UCA",
"C": "CUG -> AUG",
"D": "UAU -> UAA"
} | step1 | D | [
"5 year old boy presents",
"pediatrician",
"parents noted",
"not sustain physical exertion",
"experience muscle cramping",
"noted",
"physical exertion",
"boy experienced severe muscle",
"series",
"biochemical",
"genetic tests",
"discovered",
"boy",
"nonsense",
"gene encoding",
"muscle ... |
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