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 72-year-old man presents to the emergency department with difficulty breathing for the past 3 hours. He also mentions that over the last week he was frequently breathless and fatigued after walking a few blocks. He has had diabetes mellitus and hypertension for the past 10 years, and his regular medications include m... | Acute decompensated heart failure | {
"A": "Diabetic ketoacidosis",
"B": "Acute decompensated heart failure",
"C": "Pulmonary embolism",
"D": "Acute renal failure"
} | step2&3 | B | [
"72 year old man presents",
"emergency department",
"difficulty breathing",
"past",
"hours",
"last week",
"frequently breathless",
"fatigued",
"walking",
"few blocks",
"diabetes mellitus",
"hypertension",
"past 10 years",
"regular medications include metformin",
"glipizide",
"lisinopri... |
A 17-year-old girl comes to the physician because of left lower abdominal pain for 1 day. She describes the pain as 6 out of 10 in intensity. Over the past 5 months, she has had similar episodes of pain that occur once a month and last 1 to 2 days. Menses occur at regular 28-day intervals and last 5 to 6 days. Menarche... | Reassurance | {
"A": "CT scan of the pelvis",
"B": "Reassurance",
"C": "Combined oral contraceptive pill",
"D": "Pelvic ultrasonography\n\""
} | step2&3 | B | [
"year old girl",
"physician",
"left lower abdominal pain",
"1 day",
"pain",
"out",
"10",
"intensity",
"past",
"months",
"similar episodes of pain",
"occur once",
"month",
"last 1",
"2 days",
"Menses occur",
"regular",
"day intervals",
"last 5",
"6 days",
"Menarche",
"age",
... |
A 6-month-old boy is brought to the physician for a well-child examination. The boy was born at term, and the pregnancy was complicated by prolonged labor. There is no family history of any serious illnesses. He can sit upright but needs help to do so and cannot roll over from the prone to the supine position. He can p... | Gross motor | {
"A": "Cognitive",
"B": "Fine motor",
"C": "Gross motor",
"D": "Language"
} | step2&3 | C | [
"month old boy",
"brought",
"physician",
"well",
"boy",
"born",
"term",
"pregnancy",
"complicated",
"prolonged",
"family history",
"serious illnesses",
"sit upright",
"needs help to",
"roll over",
"prone",
"supine position",
"pull",
"to stand",
"grasp",
"transfer",
"one han... |
A 30-year-old woman with HIV comes to the emergency department because of fever and multiple skin lesions for 1 week. She also has nausea, anorexia, and abdominal pain. The skin lesions are non-pruritic and painless. She has smoked one pack of cigarettes daily for 15 years and drinks 2 beers daily. She has been using i... | Erythromycin | {
"A": "Pyrimethamine and sulfadiazine",
"B": "Azithromycin and ethambutol",
"C": "Erythromycin",
"D": "Nitazoxanide"
} | step2&3 | C | [
"30 year old woman",
"HIV",
"emergency department",
"fever",
"multiple skin lesions",
"1 week",
"nausea",
"anorexia",
"abdominal pain",
"skin lesions",
"non-pruritic",
"painless",
"smoked one pack",
"cigarettes daily",
"years",
"drinks 2 beers daily",
"using intravenous crack cocaine... |
A 63-year-old man presents to the emergency department because of progressive difficulty with breathing. He has a history of diabetes, hypertension, and chronic bronchitis. He has been receiving medications to moderate his conditions and reports being compliant with his schedule. He reports a recent difficulty with tac... | O2 supplementation | {
"A": "Albuterol",
"B": "Levofloxacin",
"C": "O2 supplementation",
"D": "Aminophylline"
} | step2&3 | C | [
"63 year old man presents",
"emergency department",
"of progressive difficulty",
"breathing",
"history",
"diabetes",
"hypertension",
"chronic bronchitis",
"receiving medications to moderate",
"conditions",
"reports",
"compliant",
"schedule",
"reports",
"recent difficulty",
"simple chor... |
A 7-year-old girl is brought to the physician for a well-child examination. She is at 95th percentile for height and 70th percentile for weight. Examination shows elevated breast buds that extend beyond the areola. Coarse pubic and axillary hair is present. The external genitalia appear normal. An x-ray of the left wri... | Granulosa cell tumor | {
"A": "Granulosa cell tumor",
"B": "Ovarian fibroma",
"C": "McCune-Albright syndrome",
"D": "Hypothalamic glioma"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"well",
"95th percentile",
"height",
"percentile",
"weight",
"Examination shows elevated breast buds",
"extend",
"areola",
"Coarse pubic",
"axillary hair",
"present",
"external genitalia appear normal",
"x-ray of",
"left wrist shows",
"bone ... |
A researcher is investigating the effects of a new antihypertensive medication on renal physiology. She gives a subject a dose of the new medication, and she then collects plasma and urine samples. She finds the following: Hematocrit: 40%; Serum creatinine: 0.0125 mg/mL; Urine creatinine: 1.25 mg/mL. Urinary output is ... | 17% | {
"A": "10%",
"B": "17%",
"C": "50%",
"D": "33%"
} | step1 | B | [
"researcher",
"investigating",
"effects",
"new antihypertensive medication",
"renal physiology",
"gives",
"subject",
"dose",
"new medication",
"then collects plasma",
"urine samples",
"finds",
"following",
"Hematocrit",
"40",
"Serum creatinine",
"0.0125 mg/mL",
"Urine creatinine",
... |
A 71-year-old man with asthma and dementia presents to the emergency department in acute respiratory distress. He is with his home care nurse who explains that he has been hiding his bronchodilators for the past 3 weeks, and she has had to dutifully look for them and help him administer them. Over the past 2 days, howe... | Sucralfate | {
"A": "Ranitidine",
"B": "Sucralfate",
"C": "Clarithromycin",
"D": "Omeprazole"
} | step2&3 | B | [
"71 year old man",
"asthma",
"dementia presents",
"emergency department",
"acute respiratory distress",
"home nurse",
"hiding",
"bronchodilators",
"past",
"weeks",
"to",
"look",
"help",
"administer",
"past 2 days",
"completely unsuccessful",
"finding",
"medication",
"process",
... |
The serum brain natriuretic peptide and N-terminal pro-BNP are elevated. A diagnosis of heart failure with preserved ejection fraction is made. In addition to supplemental oxygen therapy, which of the following is the most appropriate initial step in management? | Intravenous furosemide therapy
" | {
"A": "Intermittent hemodialysis",
"B": "Intravenous morphine therapy",
"C": "Intravenous dobutamine",
"D": "Intravenous furosemide therapy\n\""
} | step2&3 | D | [
"serum brain natriuretic peptide",
"N-terminal pro-BNP",
"elevated",
"diagnosis",
"heart failure",
"preserved ejection fraction",
"made",
"supplemental oxygen therapy",
"following",
"most appropriate initial step",
"management"
] |
A 53-year-old female presents with worsening shortness of breath with activity. Physical exam reveals a diastolic murmur with an opening snap. The patient’s medical history is significant for a left hip replacement 10 years ago, and she vaguely recalls an extended period of illness as a child described as several sever... | Penicillin | {
"A": "Acyclovir",
"B": "Penicillin",
"C": "Vancomycin",
"D": "Aspirin"
} | step1 | B | [
"year old female presents",
"worsening shortness of breath",
"activity",
"Physical exam reveals",
"diastolic murmur",
"opening snap",
"patients medical history",
"significant",
"left 10 years",
"recalls",
"extended period",
"illness",
"child described",
"severe episodes of sore throat foll... |
A 69-year-old woman with acute myeloid leukemia comes to the physician to discuss future treatment plans. She expresses interest in learning more about an experimental therapy being offered for her condition. After the physician explains the mechanism of the drug and describes the risks and benefits, the patient then s... | Decision-making capacity | {
"A": "Therapeutic privilege",
"B": "Patient autonomy",
"C": "Decision-making capacity",
"D": "Patient competence"
} | step1 | C | [
"69 year old woman",
"acute myeloid leukemia",
"physician to discuss future treatment plans",
"interest",
"learning",
"experimental therapy",
"offered",
"condition",
"physician",
"mechanism",
"drug",
"risks",
"benefits",
"patient then states",
"not ready to die",
"physician",
"unders... |
A 22-year-old man has had dyspnea and hemoptysis for the past week. He has no known sick contacts. There is no personal or family history of serious illness. He takes no medications. His temperature is 37°C (98.6°F), pulse is 82/min, respirations are 22/min, and blood pressure is 152/90 mm Hg. Examination shows inspira... | Increased anti-GBM antibody titers | {
"A": "Increased anti-GBM antibody titers",
"B": "Increased c-ANCA titers",
"C": "Increased p-ANCA titers",
"D": "Increased anti-dsDNA antibody titers"
} | step2&3 | A | [
"year old man",
"dyspnea",
"hemoptysis",
"past week",
"known sick contacts",
"personal",
"family history",
"serious illness",
"takes",
"medications",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"90 mm Hg",
"Examination shows inspiratory crackles"... |
A 62-year-old man comes to the emergency department for severe, acute right leg pain. The patient's symptoms began suddenly 4 hours ago, while he was reading the newspaper. He has poorly-controlled hypertension and osteoarthritis. He has smoked one pack of cigarettes daily for 31 years. Current medications include lisi... | Balloon catheter embolectomy | {
"A": "Balloon catheter embolectomy",
"B": "Amputation of the affected limb",
"C": "Surgical bypass of the affected vessel",
"D": "Percutaneous transluminal angioplasty"
} | step2&3 | A | [
"62 year old man",
"emergency department",
"severe",
"acute right leg pain",
"patient's symptoms began",
"hours",
"reading",
"newspaper",
"poorly controlled hypertension",
"osteoarthritis",
"smoked one pack",
"cigarettes daily",
"31 years",
"Current medications include lisinopril",
"meto... |
A 45-year-old man comes to the physician because of intermittent lower back pain for 1 week. His symptoms began shortly after lifting heavy boxes at work. He has not had any fever, chills, or weight loss. He has a history of peptic ulcer disease. He does not smoke or drink alcohol. His vital signs are within normal lim... | Acetaminophen | {
"A": "Acetaminophen",
"B": "Oxycodone",
"C": "Naproxen",
"D": "Ibuprofen"
} | step1 | A | [
"year old man",
"physician",
"of intermittent lower back pain",
"1 week",
"symptoms began",
"lifting heavy boxes",
"work",
"not",
"fever",
"chills",
"weight loss",
"history of peptic ulcer disease",
"not smoke",
"drink alcohol",
"vital signs",
"normal limits",
"Examination shows mild... |
A 30-year-old man presents to his primary care physician complaining of headaches. He states that over the past month he has been trying to study for an accounting exam, but he finds it increasingly more difficult to focus due to his headaches. He also complains of lower extremity muscle cramping. He has no significant... | Low plasma renin | {
"A": "Elevated 17-hydroxyprogesterone",
"B": "High plasma renin",
"C": "Low aldosterone level",
"D": "Low plasma renin"
} | step2&3 | D | [
"30 year old man presents",
"primary care physician",
"headaches",
"states",
"past month",
"to study",
"accounting exam",
"finds",
"difficult",
"focus",
"headaches",
"lower extremity muscle cramping",
"significant past medical history",
"takes ibuprofen",
"acetaminophen as needed",
"pa... |
A 66-year-old woman presents to the emergency department with a throbbing headache. She states that the pain is worse when eating and is localized over the right side of her head. Review of systems is only notable for some blurry vision in the right eye which is slightly worse currently. The patient's past medical hist... | Methylprednisolone | {
"A": "100% oxygen",
"B": "CT head",
"C": "Ibuprofen and acetaminophen",
"D": "Methylprednisolone"
} | step2&3 | D | [
"66 year old woman presents",
"emergency department",
"throbbing headache",
"states",
"pain",
"worse",
"eating",
"localized",
"right side of",
"head",
"Review",
"systems",
"only notable",
"blurry vision",
"right eye",
"slightly worse currently",
"patient's past",
"notable only",
... |
A 72-year-old Caucasian female presents to the emergency department with complaints of a new-onset, right-sided throbbing headache which becomes markedly worse when eating. The daughter also reports that her mother has recently had difficulties with performing daily activities, such as climbing stairs or standing up. P... | Prednisolone | {
"A": "Low-molecular weight heparin ",
"B": "Gabapentin",
"C": "Prednisolone",
"D": "Methotrexate"
} | step2&3 | C | [
"72 year old Caucasian female presents",
"emergency department",
"complaints",
"new-onset",
"right-sided throbbing headache",
"markedly worse",
"eating",
"daughter",
"reports",
"mother",
"recently",
"difficulties",
"performing daily activities",
"climbing stairs",
"standing up",
"Past ... |
A 29-year-old woman presents to the office with the complaint of a tingling sensation over her face and distal parts of her lower limbs. Three weeks ago, she had an episode of bloody diarrhea and was successfully treated with erythromycin. She is a full-time radiology technician. Currently, she takes oral contraceptive... | Antibody-mediated destruction of peripheral myelin by cytotoxic cells | {
"A": "Antibody-mediated destruction of peripheral myelin by cytotoxic cells",
"B": "Granulomatous alteration of the vessels supplying peripheral nerves",
"C": "Radiation-induced oxidative stress in the neurons of dorsal ganglia",
"D": "Failure of Schwann cells to produce myelin"
} | step1 | A | [
"29 year old woman presents",
"office",
"complaint",
"tingling sensation",
"face",
"distal parts of",
"lower limbs",
"Three weeks",
"episode of bloody diarrhea",
"treated with erythromycin",
"full-time radiology technician",
"Currently",
"takes oral contraceptives",
"zopiclone",
"1 mg",
... |
A 12-year-old girl is brought to the physician by her mother 2 hours after cutting her hand while playing in the yard. Examination of the right hand shows a 2-cm laceration on the thenar region of the palm with some surrounding tenderness and erythema. The right palm appears mildly swollen in comparison to the left. In... | Interleukin-1 | {
"A": "Interleukin-10",
"B": "Interleukin-1",
"C": "Interleukin-6",
"D": "Interferon gamma\n\""
} | step1 | B | [
"year old girl",
"brought",
"physician",
"mother",
"hours",
"cutting",
"hand",
"playing",
"yard",
"Examination of",
"right hand shows",
"2",
"laceration",
"thenar region of",
"surrounding tenderness",
"erythema",
"right palm appears mildly swollen",
"comparison",
"left",
"respo... |
A 3-week-old male is brought to the emergency department because of increasing lethargy. He was born at home without prenatal care or neonatal screening and appeared to be normal at birth. Despite this, his parents noticed that he would vomit after breastfeeding. He then progressively became more lethargic and began to... | Galactose-1-phosphate | {
"A": "Galactose",
"B": "Galactose-1-phosphate",
"C": "Fructose",
"D": "Fructose-1-phosphate"
} | step1 | B | [
"3 week old male",
"brought",
"emergency department",
"increasing lethargy",
"born at home",
"prenatal care",
"neonatal screening",
"appeared to",
"normal at birth",
"parents",
"vomit",
"breastfeeding",
"then",
"more lethargic",
"began to",
"few episodes of diarrhea",
"feeding",
"p... |
A 7-year-old boy is brought to the physician by his mother for the evaluation of abdominal pain and trouble sleeping for the past 6 months. His mother says he complains of crampy abdominal pain every morning on school days. He started attending a new school 7 months ago and she is concerned because he has missed school... | Separation anxiety disorder | {
"A": "Separation anxiety disorder",
"B": "Irritable bowel syndrome",
"C": "Conduct disorder",
"D": "Acute stress disorder"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"mother",
"evaluation",
"abdominal",
"trouble sleeping",
"past 6 months",
"mother",
"crampy abdominal pain",
"morning",
"school days",
"started attending",
"new school",
"months",
"concerned",
"missed school frequently due to",
"abdominal pai... |
A 69-year old male presents to the Emergency Department with bilious vomiting that started within the past 24 hours. His medical history is significant for hypertension, hyperlipidemia, and a myocardial infarction six months ago. His past surgical history is significant for a laparotomy 20 years ago for a perforated di... | 20 years ago | {
"A": "At birth",
"B": "One week ago",
"C": "Six months ago",
"D": "20 years ago"
} | step2&3 | D | [
"69 year old male presents",
"Emergency Department",
"bilious vomiting",
"started",
"past 24 hours",
"medical history",
"significant",
"hypertension",
"hyperlipidemia",
"myocardial infarction six months",
"past surgical history",
"significant",
"laparotomy 20 years",
"perforated diverticul... |
A 52-year-old woman comes to the physician because of vaginal itchiness and urinary frequency for the past 1 year. She stopped having vaginal intercourse with her husband because it became painful and occasionally resulted in vaginal spotting. Her last menstrual cycle was 14 months ago. She has vitiligo. Her only medic... | Thinning of the mucosa | {
"A": "Thinning of the mucosa",
"B": "Inflammation of the vestibular glands",
"C": "Decrease of pH",
"D": "Sclerosis of the dermis"
} | step2&3 | A | [
"year old woman",
"physician",
"vaginal itchiness",
"urinary frequency",
"past",
"year",
"stopped",
"vaginal intercourse",
"husband",
"painful",
"occasionally resulted",
"vaginal spotting",
"last menstrual cycle",
"months",
"vitiligo",
"only medication",
"topical tacrolimus ointment"... |
A 26-year-old woman presents to the obstetrics ward to deliver her baby. The obstetrician establishes a pudendal nerve block via intravaginal injection of lidocaine near the tip of the ischial spine. From which of the following nerve roots does the pudendal nerve originate? | S2-S4 | {
"A": "L3-L4",
"B": "L4-L5",
"C": "L5-S1",
"D": "S2-S4"
} | step1 | D | [
"year old woman presents",
"obstetrics ward to deliver",
"baby",
"obstetrician establishes",
"nerve block",
"intravaginal injection of lidocaine",
"tip",
"ischial spine",
"following nerve roots",
"pudendal nerve"
] |
A 25-year-old woman presents to her primary care physician for her yearly physical exam. She has no past medical history and says that she does not currently have any health concerns. On physical exam, she is found to have hyperactive patellar reflexes but says that she has had this finding since she was a child. She a... | They are in parallel with extrafusal skeletal muscle fibers | {
"A": "They activate inhibitory interneurons",
"B": "They are in parallel with extrafusal skeletal muscle fibers",
"C": "They are innervated by group Ib afferent neurons",
"D": "They inhibit the activity of alpha-motoneurons"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"yearly physical exam",
"past medical history",
"not currently",
"health concerns",
"physical exam",
"found to",
"hyperactive patellar reflexes",
"finding",
"child",
"physician",
"case",
"physician",
"certain cells",
"responsible",
... |
A 3-month-old boy is brought to the physician for a routine follow-up examination. He was delivered at 32 weeks' gestation to a 35-year-old woman. Cardiac examination is shown. Which of the following is the most likely cause for this patient's findings? | Patent ductus arteriosus | {
"A": "Patent ductus arteriosus",
"B": "Ventricular septal defect",
"C": "Atrial septal defect",
"D": "Mitral valve prolapse"
} | step2&3 | A | [
"3 month old boy",
"brought",
"physician",
"routine follow-up examination",
"delivered",
"weeks",
"gestation",
"35 year old woman",
"Cardiac examination",
"shown",
"following",
"most likely cause",
"patient's findings"
] |
A 61-year-old woman is brought to an urgent care clinic by her husband with an altered mental status. The patient’s husband says that her symptoms onset acutely 24 hours ago. He says she suddenly started to feel excessively drowsy and quickly became altered. Past medical history is significant for renal transplant 18 m... | Decreased phagocytic cell count | {
"A": "Failure of immunosuppressive therapy",
"B": "Decreased interleukin-2 levels",
"C": "DiGeorge Syndrome",
"D": "Decreased phagocytic cell count"
} | step1 | D | [
"61 year old woman",
"brought",
"urgent care clinic",
"husband",
"altered mental status",
"patients husband",
"symptoms onset",
"24 hours",
"started to feel excessively drowsy",
"altered",
"Past medical history",
"significant",
"renal transplant",
"months",
"well managed",
"immunosuppr... |
A 44-year-old male is brought to the emergency department by fire and rescue after he was the unrestrained driver in a motor vehicle accident. His wife notes that the patient’s only past medical history is recent development of severe episodes of headache accompanied by sweating and palpitations. She says that these ep... | Phenoxybenzamine | {
"A": "Dantrolene",
"B": "Lorazepam",
"C": "Phenoxybenzamine",
"D": "Phentolamine"
} | step2&3 | C | [
"year old male",
"brought",
"emergency department",
"fire",
"driver",
"motor vehicle accident",
"wife notes",
"patients only past medical history",
"recent development of severe episodes",
"headache",
"sweating",
"palpitations",
"episodes",
"diagnosed",
"atypical panic attacks",
"patie... |
A 44-year-old man comes to the emergency department because of a severe headache and blurry vision for the past 3 hours. He has hypertension treated with hydrochlorothiazide. He has missed taking his medication for the past week as he was traveling. He is only oriented to time and person. His temperature is 37.1°C (98.... | Intravenous nitroprusside | {
"A": "Intravenous nitroprusside",
"B": "Oral captopril",
"C": "Intravenous mannitol",
"D": "Oral clonidine"
} | step2&3 | A | [
"year old man",
"emergency department",
"severe headache",
"blurry vision",
"past",
"hours",
"hypertension treated with hydrochlorothiazide",
"missed taking",
"medication",
"past",
"traveling",
"only oriented to time",
"person",
"temperature",
"98",
"pulse",
"min",
"regular",
"bl... |
A 65-year-old man is brought to the emergency department by ambulance after falling during a hiking trip. He was hiking with friends when he fell off a 3 story ledge and was not able to be rescued until 6 hours after the accident. On arrival, he is found to have multiple lacerations as well as a pelvic fracture. His pa... | Blood loss | {
"A": "Autoimmune disease",
"B": "Blood loss",
"C": "Compression of urethra by prostate",
"D": "Rhabdomyolysis"
} | step1 | B | [
"65 year old man",
"brought",
"emergency department",
"ambulance",
"falling",
"hiking trip",
"hiking",
"friends",
"fell",
"story",
"not able to",
"hours",
"accident",
"arrival",
"found to",
"multiple lacerations",
"pelvic fracture",
"past medical history",
"significant",
"diabe... |
A 2-year-old boy is brought to the emergency department because of fever, fatigue, and productive cough for 2 days. He had similar symptoms 6 months ago, when he was diagnosed with pneumonia. Three weeks ago, he was diagnosed with otitis media for the sixth time since his birth and was treated with amoxicillin. His tem... | Intravenous immunoglobulins | {
"A": "Thymus transplantation",
"B": "Intravenous immunoglobulins",
"C": "Recombinant human granulocyte-colony stimulating factor administration",
"D": "Interferon-γ therapy"
} | step2&3 | B | [
"2 year old boy",
"brought",
"emergency department",
"fever",
"fatigue",
"productive cough",
"2 days",
"similar symptoms",
"months",
"diagnosed",
"pneumonia",
"Three weeks",
"diagnosed",
"otitis media",
"sixth time",
"birth",
"treated with amoxicillin",
"temperature",
"pulse",
... |
A 17-year-old woman presents to the emergency department with dysuria. She denies any hematuria or dyspareunia. Her last menstrual period was 3 weeks ago, and she denies any recent sexual activity. Her temperature is 99.7°F (37.6°F), blood pressure is 127/67 mmHg, pulse is 90/min, and respirations are 17/min. An unusua... | Urinalysis, urine culture, KOH prep, and urine pregnancy test | {
"A": "Complete blood count (CBC)",
"B": "Urinalysis and Pap smear",
"C": "Urinalysis, urine culture, and potassium hydoxide prep (KOH)",
"D": "Urinalysis, urine culture, KOH prep, and urine pregnancy test"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"dysuria",
"denies",
"hematuria",
"dyspareunia",
"last menstrual period",
"3 weeks",
"denies",
"recent sexual activity",
"temperature",
"99",
"blood pressure",
"67 mmHg",
"pulse",
"90 min",
"respirations",
"min",
"unusual odor",
... |
A 24-year-old man is brought to the emergency department because of violent jerky movements of his arms and legs that began 30 minutes ago. His father reports that the patient has a history of epilepsy. He is not responsive. Physical examination shows alternating tonic jerks and clonic episodes. There is blood in the m... | Fosphenytoin | {
"A": "Topiramate",
"B": "Fosphenytoin",
"C": "Phenobarbital",
"D": "Carbamazepine"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"violent jerky movements",
"arms",
"legs",
"began 30 minutes",
"father reports",
"patient",
"history of epilepsy",
"not responsive",
"Physical examination shows alternating tonic jerks",
"episodes",
"blood",
"mouth",
"Administration",
... |
A 16-year-old girl is brought to the physician because of generalized fatigue and an inability to concentrate in school for the past 4 months. During this period, she has had excessive daytime sleepiness. While going to sleep, she sees cartoon characters playing in her room. She wakes up once or twice every night. Whil... | Modafinil | {
"A": "Modafinil",
"B": "Citalopram",
"C": "Risperidone",
"D": "Venlafaxine"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"generalized fatigue",
"to concentrate in school",
"the past",
"months",
"period",
"excessive daytime sleepiness",
"to sleep",
"sees cartoon characters playing",
"room",
"wakes up",
"twice",
"night",
"awakening",
"feels stiff",
"move",
"co... |
A 24-year-old woman presents to the emergency department for chest pain and shortness of breath. She was at home making breakfast when her symptoms began. She describes the pain as sharp and located in her chest. She thought she was having a heart attack and began to feel short of breath shortly after. The patient is a... | Musculoskeletal inflammation | {
"A": "Clot in the pulmonary arteries",
"B": "Ischemia of the myocardium",
"C": "Musculoskeletal inflammation",
"D": "Psychogenic etiology"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"chest pain",
"shortness of breath",
"at home making breakfast",
"symptoms began",
"pain",
"sharp",
"chest",
"thought",
"heart attack",
"began to feel short of breath",
"patient",
"college student",
"recently",
"soccer team",
"signif... |
A 26-year-old nursing home staff presents to the emergency room with complaints of palpitations and chest pain for the past 2 days. She was working at the nursing home for the last year but has been trying to get into modeling for the last 6 months and trying hard to lose weight. She is a non-smoker and occasionally dr... | Factitious thyrotoxicosis | {
"A": "Factitious thyrotoxicosis",
"B": "Anorexia nervosa",
"C": "Hashimoto thyroiditis",
"D": "Toxic nodular goiter"
} | step1 | A | [
"year old nursing staff presents",
"emergency room",
"complaints",
"palpitations",
"chest pain",
"past 2 days",
"working",
"nursing",
"last year",
"to get",
"modeling",
"last",
"months",
"hard to",
"weight",
"non-smoker",
"occasionally drinks alcohol",
"weekends",
"friends",
"e... |
You are taking care of a patient with renal failure secondary to anti-fungal therapy. The patient is a 66-year-old male being treated for cryptococcal meningitis. This drug has a variety of known side effects including acute febrile reactions to infusions, anemia, hypokalemia and hypomagnesemia. What is the mechanism o... | Pore formation secondary to ergosterol binding | {
"A": "Inhibition of 1,3-beta-glucan synthase",
"B": "Pore formation secondary to ergosterol binding",
"C": "Disruption of microtubule formation",
"D": "Inhibition of squalene epoxidase"
} | step1 | B | [
"taking care",
"patient",
"renal failure secondary to anti-fungal therapy",
"patient",
"66 year old male",
"treated",
"cryptococcal meningitis",
"drug",
"variety",
"known side effects including acute febrile reactions",
"infusions",
"anemia",
"hypokalemia",
"hypomagnesemia",
"mechanism o... |
A 65-year-old man presents to the physician for the evaluation of increasing dyspnea and swelling of the lower extremities over the past year. He has no cough. He also complains of frequent awakenings at night and excessive daytime sleepiness. He has no history of a serious illness. He takes no medications other than z... | Obstructive sleep apnea | {
"A": "Chronic obstructive pulmonary disease",
"B": "Idiopathic pulmonary artery hypertension",
"C": "Obstructive sleep apnea",
"D": "Pulmonary thromboembolism"
} | step2&3 | C | [
"65 year old man presents",
"physician",
"evaluation",
"increasing dyspnea",
"swelling",
"lower extremities",
"past year",
"cough",
"frequent awakenings",
"night",
"excessive daytime sleepiness",
"history",
"serious illness",
"takes",
"medications",
"zolpidem",
"sleep",
"35 pack-ye... |
A 43-year-old man comes to the physician for a follow-up examination. Four months ago, he was treated conservatively for ureteric colic. He has noticed during micturition that his urine is reddish-brown initially and then clears by the end of the stream. He has no dysuria. He has hypertension. His only medication is hy... | Urethra | {
"A": "Renal glomeruli",
"B": "Renal pelvis",
"C": "Urethra",
"D": "Urinary bladder\n\""
} | step2&3 | C | [
"year old man",
"physician",
"follow-up examination",
"Four months",
"treated",
"ureteric colic",
"micturition",
"urine",
"brown initially",
"then clears",
"end",
"stream",
"dysuria",
"hypertension",
"only medication",
"hydrochlorothiazide",
"appears healthy",
"well-nourished",
"... |
A 15-year-old African-American boy is brought to the physician because of left-sided groin pain and difficulty walking for 3 weeks. He reports having pain at rest and increased pain with activity. He recently started playing flag football but does not recall any trauma. He has had many episodes of joint and bone pain t... | Avascular necrosis | {
"A": "Developmental dysplasia of the hip",
"B": "Slipped capital femoral epiphysis",
"C": "Stress fracture",
"D": "Avascular necrosis"
} | step2&3 | D | [
"year old African-American boy",
"brought",
"physician",
"left-sided groin pain",
"difficulty walking",
"weeks",
"reports",
"pain at rest",
"increased pain",
"activity",
"recently started playing flag football",
"not recall",
"trauma",
"episodes of joint",
"bone pain",
"required hospit... |
A 36-year-old primigravid woman comes to the physician for a prenatal visit at 14 weeks' gestation. She has had episodic headaches over the past month. At home, blood pressure measurements have ranged from 134/82 mm Hg to 148/94 mm Hg. Today, her blood pressure is 146/91 mm Hg. Pelvic examination shows a uterus consist... | Chronic hypertension | {
"A": "Chronic hypertension",
"B": "Gestational hypertension",
"C": "Eclampsia",
"D": "Isolated systolic hypertension"
} | step1 | A | [
"36 year old primigravid woman",
"physician",
"prenatal visit",
"weeks",
"gestation",
"episodic headaches",
"past month",
"At home",
"blood pressure measurements",
"ranged",
"mm Hg",
"mm Hg",
"Today",
"blood pressure",
"mm Hg",
"Pelvic examination shows",
"uterus consistent",
"size... |
A 35-year-old woman visits the office with complaints of yellowish vaginal discharge and increased urinary frequency for a week. She also complains of pain during urination. Past medical history is irrelevant. She admits to having multiple sexual partners in the past few months. Physical examination is within normal li... | Doxycycline | {
"A": "Acyclovir",
"B": "Doxycycline",
"C": "Boric acid",
"D": "Metronidazole"
} | step1 | B | [
"35 year old woman visits",
"office",
"complaints",
"vaginal discharge",
"increased urinary frequency",
"week",
"pain",
"urination",
"Past medical history",
"admits to",
"multiple sexual partners",
"past",
"months",
"Physical examination",
"normal limits",
"lower abdominal tenderness",... |
A 24-year-old man who is postoperative day 1 after an emergency appendectomy is evaluated by the team managing his care. He complains that he still has not been able to urinate after removal of the urinary catheter that was inserted during surgery. Given this issue, he is started on a medication that acts on a post-syn... | Neurogenic ileus | {
"A": "Diagnosis of myasthenia gravis",
"B": "Glaucoma management",
"C": "Neurogenic ileus",
"D": "Pupillary contraction"
} | step1 | C | [
"year old man",
"postoperative day 1",
"emergency appendectomy",
"evaluated",
"team managing",
"care",
"not",
"able to",
"removal of",
"urinary catheter",
"inserted",
"surgery",
"Given",
"issue",
"started",
"medication",
"acts",
"post synaptic receptor",
"resistant to a",
"este... |
A 7-year-old boy is brought to his pediatrician by his mother who is worried about his clumsiness. She states that over the past 3 months she has noticed progressive weakness. He used to climb trees and run outside with his cousins, but now he says he gets “too tired.” She’s recently noticed him starting to “walk funny... | Becker muscular dystrophy | {
"A": "Becker muscular dystrophy",
"B": "Duchenne muscular dystrophy",
"C": "Pompe disease",
"D": "Spinal muscular atrophy"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatrician",
"mother",
"worried",
"clumsiness",
"states",
"past 3 months",
"progressive weakness",
"used",
"climb trees",
"run outside",
"cousins",
"now",
"gets",
"tired",
"Shes recently",
"starting to walk",
"muscular legs",
"physical examination"... |
A 3-month-old male is brought to the emergency room by his mother who reports that the child has a fever. The child was born at 39 weeks of gestation and is at the 15th and 10th percentiles for height and weight, respectively. The child has a history of eczema. Physical examination reveals an erythematous fluctuant mas... | Aspergillus fumigatus | {
"A": "Aspergillus fumigatus",
"B": "Enterococcus faecalis",
"C": "Giardia lamblia",
"D": "Streptococcus viridans"
} | step1 | A | [
"3 month old male",
"brought",
"emergency room",
"mother",
"reports",
"child",
"fever",
"child",
"born",
"weeks of gestation",
"percentiles",
"height",
"weight",
"child",
"history of eczema",
"Physical examination reveals",
"erythematous fluctuant",
"patients inner thigh",
"tempe... |
A 21-year-old male presents to the emergency department after losing his footing and falling 20 feet off a construction scaffold. He hit his left side on a railing on the way down before landing on his left arm. He denies loss of consciousness during the event or feelings of lightheadedness. He has no significant past ... | Pneumococcal vaccine | {
"A": "Pneumococcal vaccine",
"B": "Prophylactic ceftriaxone",
"C": "Open reduction internal fixation",
"D": "Total parenteral nutrition (TPN)"
} | step1 | A | [
"21-year-old male presents",
"emergency department",
"falling 20 feet",
"construction scaffold",
"hit",
"left side",
"railing",
"before landing",
"left arm",
"denies loss of consciousness",
"event",
"feelings",
"lightheadedness",
"significant past medical",
"surgical history",
"not tak... |
A 53-year-old woman is brought to the physician by her husband for the evaluation of progressive memory loss, which he reports began approximately 2 weeks ago. During this time, she has had problems getting dressed and finding her way back home after running errands. She has also had several episodes of jerky, repetiti... | Mutant prion accumulation | {
"A": "Copper accumulation",
"B": "Mutant prion accumulation",
"C": "Severe cerebral ischemia",
"D": "Increased number of CAG repeats"
} | step1 | B | [
"year old woman",
"brought",
"physician",
"husband",
"evaluation of progressive memory loss",
"reports began approximately",
"weeks",
"time",
"problems getting dressed",
"finding",
"back home",
"running errands",
"several episodes of jerky",
"twitching movements",
"resolved",
"oriented... |
A 5-day-old male newborn is brought to the emergency department 1 hour after having a seizure. It lasted approximately 1 minute, and involved blinking and lip-smacking movements as well as left-sided jerking of the hand and foot. His mother says she measured a temperature of 38.2°C (100.7°F) at that time. He has had in... | IV acyclovir | {
"A": "IV ganciclovir",
"B": "Pyrimethamine",
"C": "IV acyclovir",
"D": "IV vancomycin"
} | step2&3 | C | [
"5 day old male newborn",
"brought",
"emergency department",
"hour",
"seizure",
"lasted approximately",
"minute",
"involved blinking",
"lip-smacking movements",
"left-sided jerking",
"hand",
"foot",
"mother",
"measured",
"temperature",
"100",
"time",
"increasing difficulty feeding"... |
A 3-day-old boy is brought to the pediatrician for nonpigmented vomiting for the last day. A detailed developmental history reveals that his parents have a nonconsanguineous marriage. He was born by cesarean section at 36 weeks of gestation. His birth weight was 2.6 kg (5.7 lb) and he has been breastfed exclusively. Hi... | Annular pancreas | {
"A": "Meckel diverticulum",
"B": "Annular pancreas",
"C": "Leukocyte adhesion deficiency",
"D": "Crigler-Najjar type 1"
} | step2&3 | B | [
"3 day old boy",
"brought",
"pediatrician",
"nonpigmented vomiting",
"day",
"detailed developmental history reveals",
"parents",
"marriage",
"born by cesarean section",
"36 weeks of gestation",
"birth weight",
"2.6 kg",
"5",
"breastfed",
"temperature",
"98",
"pulse",
"min",
"resp... |
A 59-year-old female presents to your office with complaints of progressive numbness and tingling in her fingers and toes over the last several months. She also reports "feeling weak" in her arms and legs. The patient's past medical history is significant for hypertension and Crohn's disease, which has been well-contro... | Vitamin B12 | {
"A": "Vitamin B2",
"B": "Vitamin B3",
"C": "Vitamin B6",
"D": "Vitamin B12"
} | step1 | D | [
"59 year old female presents",
"office",
"complaints",
"progressive numbness",
"tingling in",
"fingers",
"toes",
"months",
"reports",
"feeling weak",
"arms",
"legs",
"patient",
"ast ",
"ignificant ",
"ypertension ",
"rohn'",
"sease, ",
"ll-controlled s nce u",
"eocolectomy 7",
... |
A 32-year-old man presents to his physician with a complaint of pain with urination that has developed and persisted over the past 8 days. Upon awakening today, he also noted a clear discharge from his urethra. The patient states he is otherwise healthy. Social history is notable for the patient working at a local farm... | HLA-B27 | {
"A": "Anti-dsDNA",
"B": "HLA-B27",
"C": "HLA-DR4",
"D": "p-ANCA"
} | step2&3 | B | [
"year old man presents",
"physician",
"complaint",
"pain",
"urination",
"past",
"days",
"awakening today",
"noted",
"clear discharge",
"urethra",
"patient states",
"healthy",
"Social history",
"notable",
"patient working",
"local farm",
"livestock",
"Review of systems",
"notabl... |
A 50-year-old woman with a history of schizophrenia is being admitted to a locked inpatient psychiatry unit after discontinuing her medication. She was found wandering the streets, screaming in the air. According to her medical records, she was diagnosed with schizophrenia in her early 20s. She was initially living wit... | Haloperidol | {
"A": "Clozapine",
"B": "Quetiapine",
"C": "Haloperidol",
"D": "Risperidone"
} | step2&3 | C | [
"50 year old woman",
"history of schizophrenia",
"admitted",
"locked inpatient",
"discontinuing",
"medication",
"found wandering",
"streets",
"screaming",
"air",
"medical records",
"diagnosed",
"schizophrenia",
"early 20s",
"initially living with",
"family",
"of issues",
"medicatio... |
A 22-year-old sexually active, otherwise healthy female presents to her primary care physician complaining of several days of dysuria, frequency, urgency, and suprapubic pain. She denies fever, flank pain, vaginal itching, or vaginal bleeding/discharge. Which organism is most likely responsible for this patient's sympt... | Escherichia coli | {
"A": "Staphylococcus saprophyticus",
"B": "Chlamydia trachomatis",
"C": "Klebsiella pneumoniae",
"D": "Escherichia coli"
} | step1 | D | [
"year old sexually active",
"healthy female presents",
"primary care physician",
"days",
"dysuria",
"frequency",
"urgency",
"suprapubic pain",
"denies fever",
"flank pain",
"vaginal itching",
"vaginal discharge",
"organism",
"most likely responsible",
"patient's symptoms"
] |
A 55-year-old IV drug user comes into the emergency department after four days of pain in his right ankle. The patient is lethargic and unable to answer any questions about his medical history. His vitals are HR 110, T 101.5, RR 20, BP 100/60. His physical exam is notable for track marks in his toes and his right ankle... | Staphylococcus infectious arthritis | {
"A": "Salmonella infectious arthritis",
"B": "Staphylococcus infectious arthritis",
"C": "Borrelia infectious arthritis",
"D": "Osteoarthritis"
} | step2&3 | B | [
"55 year old IV drug user",
"emergency department",
"four days",
"pain",
"right ankle",
"patient",
"lethargic",
"unable to answer",
"questions",
"medical history",
"T",
"RR 20",
"BP 100 60",
"physical exam",
"notable",
"track marks",
"toes",
"right ankle",
"erythematous",
"swol... |
A 32-year-old woman presents with abdominal pain. She says that she has been experiencing a mild ‘tummy ache’ for about a week. On further questioning, the physician finds that she has been struggling to cope with her daily activities for the past month. She says that she is sad on most days of the week and doesn’t hav... | Inability to participate in social events she is invited to | {
"A": "Inability to participate in social events she is invited to",
"B": "A belief that people are secretly out to sabotage her",
"C": "An increased frequency of symptoms during winter",
"D": "Guilt related to the way she treats others"
} | step2&3 | A | [
"year old woman presents",
"abdominal pain",
"experiencing",
"mild tummy ache",
"week",
"further questioning",
"physician finds",
"to cope",
"daily activities",
"past month",
"sad",
"days of the week",
"motivation to get",
"difficulty concentrating",
"focusing",
"job",
"occasions",
... |
A 2-month-old boy is brought to the emergency department 25 minutes after having a seizure. He has had multiple seizures during the past week. His mother has noticed that he has become lethargic and has had a weak cry for the past month. He was born at 37 weeks' gestation. He is at the 20th percentile for height and 15... | Glucose 6-phosphatase | {
"A": "Galactose 1-phosphate uridyltransferase",
"B": "Fructokinase",
"C": "Glucose 6-phosphatase",
"D": "Acid maltase\n\""
} | step2&3 | C | [
"2 month old boy",
"brought",
"emergency department",
"minutes",
"seizure",
"multiple seizures",
"past week",
"mother",
"lethargic",
"weak cry",
"past month",
"born",
"weeks",
"estation.",
"ercentile ",
"eight ",
"ercentile ",
"eight.",
"emperature ",
"6.",
"espirations ",
... |
A 67-year-old gentleman with severe COPD is found to have a respiratory quotient of 0.8. His physician would like to decrease the amount of CO2 produced by the patient's metabolism, thereby reducing the energy breathing expenditure required to eliminate the patient's CO2 respiratory burden. Which of the following dieta... | Decreasing carbohydrate intake, increasing fat intake | {
"A": "Increasing carbohydrate intake, decreasing protein intake",
"B": "Decreasing carbohydrate intake, increasing fat intake",
"C": "Decreasing carbohydrate intake, increasing protein intake",
"D": "Decreasing fat intake, increasing protein intake"
} | step2&3 | B | [
"67 year old",
"severe COPD",
"found to",
"respiratory quotient",
"0.8",
"physician",
"to decrease",
"amount",
"CO2",
"patient's metabolism",
"reducing",
"energy breathing expenditure required to",
"patient's CO2 respiratory burden",
"following dietary modifications",
"decrease",
"pati... |
A 61-year-old man presents to the family medicine clinic with a worsening cough for the last week. He denies hemoptysis, sputum production, shortness of breath, or upper respiratory tract symptoms. He does endorse nausea and heartburn after he eats large meals, as well as an occasional metallic taste in his mouth throu... | Zoster vaccine | {
"A": "Low-dose chest CT",
"B": "Intra-articular steroid injection",
"C": "Zoster vaccine",
"D": "Meningococcal vaccine"
} | step2&3 | C | [
"61 year old man presents",
"family medicine clinic",
"worsening cough",
"week",
"denies hemoptysis",
"sputum production",
"shortness of breath",
"upper respiratory tract symptoms",
"nausea",
"heartburn",
"eats large meals",
"occasional metallic taste",
"mouth",
"day",
"diagnosed",
"hy... |
A 62-year-old man, a retired oil pipeline engineer, presents to his primary care physician with complaints of headaches, fatigue, and constant ringing in his ears. Recurrently he has developed pruritus, usually after a hot shower. He also noted a constant burning sensation in his fingers and toes, independent of physic... | Mutation of the JAK2 gene is commonly seen in this condition. | {
"A": "Arterial oxygen saturation is usually higher than normal values in this condition.",
"B": "Mutation of the JAK2 gene is commonly seen in this condition.",
"C": "Serum erythropoietin is expected to be high.",
"D": "Warfarin and phlebotomy are the preferred course of treatment."
} | step1 | B | [
"62 year old man",
"retired oil",
"engineer",
"presents",
"primary care physician",
"complaints",
"headaches",
"fatigue",
"constant ringing in",
"ears",
"pruritus",
"usually",
"hot shower",
"noted",
"constant burning",
"fingers",
"toes",
"physical activity",
"examination",
"red... |
A 33-year-old man presents with yellowing of the eyes. He says symptoms onset acutely 3 days ago and have not improved. He says he has had similar episodes for the past 10 years. Each episode is self-limited, lasting no more than 3–5 days. The patient denies any recent history of nausea, weight loss, abdominal pain, li... | Gilbert’s syndrome | {
"A": "Medication-induced hemolysis",
"B": "Dubin-Johnson syndrome",
"C": "Cholelithiasis",
"D": "Gilbert’s syndrome"
} | step1 | D | [
"year old man presents",
"yellowing",
"eyes",
"symptoms onset",
"days",
"not improved",
"similar episodes",
"past 10 years",
"episode",
"self limited",
"lasting",
"more",
"35 days",
"patient denies",
"recent history",
"nausea",
"weight loss",
"abdominal pain",
"light-colored stoo... |
A 75-year-old woman with hypertension presents to your office for a routine health exam. Her medications include hydrochlorothiazide and a multivitamin. She has been feeling well; however, she mentions that her family has been complaining about the volume of the television. She also reports difficulty hearing when othe... | Destruction of cochlear hair cells | {
"A": "Increased endolymph production",
"B": "Destruction of cochlear hair cells",
"C": "Abnormal skin growth in the middle ear",
"D": "Fixation of the stapes to the cochlea"
} | step1 | B | [
"75 year old woman",
"hypertension presents",
"office",
"routine health exam",
"medications include hydrochlorothiazide",
"multivitamin",
"feeling well",
"family",
"volume",
"television",
"reports difficulty hearing",
"others",
"called",
"name",
"physical examination",
"temperature",
... |
A 51-year-old woman presents to the dermatologist with concern for a new skin lesion (Image A). You note two similar lesions on her back. Which of the following is a true statement about these lesions? | They will likely increase in number over time. | {
"A": "They will likely grow rapidly.",
"B": "They may be associated with von Hippel-Lindau disease.",
"C": "They will likely increase in number over time.",
"D": "They must be followed closely for concern of malignancy."
} | step1 | C | [
"year old woman presents",
"dermatologist",
"concern",
"new skin lesion",
"Image",
"note two similar lesions",
"back",
"following",
"true statement",
"lesions"
] |
A 52-year-old man comes to the physician because of a 3-month history of upper abdominal pain and nausea that occurs about 3 hours after eating and at night. These symptoms improve with eating. After eating, he often has a feeling of fullness and bloating. He has had several episodes of dark stools over the past month.... | Amoxicillin, clarithromycin, and omeprazole | {
"A": "Amoxicillin, clarithromycin, and omeprazole",
"B": "Fundoplication, hiatoplasty, and gastropexy",
"C": "Distal gastrectomy with gastroduodenostomy",
"D": "Intravenous vitamin B12 supplementation"
} | step2&3 | A | [
"year old man",
"physician",
"3 month history",
"upper abdominal pain",
"nausea",
"occurs",
"hours",
"eating",
"night",
"symptoms",
"eating",
"eating",
"often",
"feeling",
"fullness",
"bloating",
"several episodes of dark stools",
"past month",
"smoked one pack",
"cigarettes da... |
A 22-year-old woman comes to the physician because of a 12-week history of persistent cough. The cough is nonproductive and worse at night. She otherwise feels well. She has not had any changes in appetite or exercise tolerance. For the past year, she has smoked an occasional cigarette at social occasions. Use of herba... | Oral diphenhydramine | {
"A": "Prednisone therapy",
"B": "Oral amoxicillin-clavulanate",
"C": "Oral acetylcysteine",
"D": "Oral diphenhydramine"
} | step2&3 | D | [
"year old woman",
"physician",
"week history",
"persistent cough",
"cough",
"worse",
"night",
"feels well",
"not",
"changes in appetite",
"exercise tolerance",
"past year",
"smoked",
"occasional cigarette",
"social",
"Use of herbal cough medications",
"not provided",
"symptom relie... |
A 51-year-old man comes to the physician because of progressively worsening dyspnea on exertion and fatigue for the past 2 months. Cardiac examination shows no murmurs or bruits. Coarse crackles are heard at the lung bases bilaterally. An ECG shows an irregularly irregular rhythm with absent p waves. An x-ray of the ch... | Chronic supraventricular tachycardia | {
"A": "Uncontrolled essential hypertension",
"B": "Chronic supraventricular tachycardia",
"C": "Inherited β-myosin heavy chain mutation",
"D": "Acute psychological stress"
} | step1 | B | [
"year old man",
"physician",
"worsening dyspnea on exertion",
"fatigue",
"past",
"months",
"Cardiac examination shows",
"murmurs",
"bruits",
"Coarse crackles",
"heard",
"lung bases",
"ECG shows",
"irregular rhythm",
"absent p waves",
"x-ray of",
"chest shows globular enlargement",
... |
A 60-year-old female presents to her gynecologist with bloating, abdominal discomfort, and fatigue. She has a history of hypertension and takes hydrochlorothiazide. Physical exam reveals ascites and right adnexal tenderness. Initial imaging reveals a mass in the right ovary and eventual biopsy of the mass reveals ovari... | DNA alkylating agent | {
"A": "DNA alkylating agent",
"B": "Platinum-based DNA intercalator",
"C": "Folate analog",
"D": "BRAF inhibitor"
} | step1 | A | [
"60 year old female presents",
"gynecologist",
"bloating",
"abdominal discomfort",
"fatigue",
"history of hypertension",
"takes hydrochlorothiazide",
"Physical exam reveals ascites",
"right adnexal tenderness",
"Initial imaging reveals",
"mass",
"right",
"biopsy",
"mass reveals ovarian ser... |
A 24-year-old man is running a marathon. Upon reaching the finish line, his serum lactate levels were measured and were significantly increased as compared to his baseline. Which of the following pathways converts the lactate produced by muscles into glucose and transports it back to the muscles? | Cori cycle | {
"A": "Citric acid cycle",
"B": "Glycolysis",
"C": "Cori cycle",
"D": "Pentose phosphate pathway"
} | step1 | C | [
"year old man",
"running",
"marathon",
"reaching",
"finish line",
"serum lactate levels",
"measured",
"increased",
"compared",
"baseline",
"following pathways",
"lactate",
"muscles",
"glucose",
"transports",
"back",
"muscles"
] |
A 42-year-old man is admitted to the hospital for pain and swelling in his right foot. His temperature is 39.7°C (103.5°F), pulse is 116/min, respirations are 23/min, and blood pressure is 69/39 mmHg. A drug is administered via a peripheral intravenous line that works primarily by increasing inositol trisphosphate conc... | Phentolamine | {
"A": "Procaine",
"B": "Phentolamine",
"C": "Conivaptan",
"D": "Heparin"
} | step1 | B | [
"year old man",
"admitted",
"hospital",
"pain",
"swelling",
"right",
"temperature",
"pulse",
"min",
"respirations",
"23 min",
"blood pressure",
"69",
"mmHg",
"drug",
"administered",
"peripheral intravenous line",
"works",
"increasing inositol",
"concentrations",
"arteriolar s... |
A 42-year-old man comes to the physician for the evaluation of episodic headaches involving both temples for 5 months. The patient has been taking acetaminophen, but it has not provided relief. He has also had double vision. Ophthalmic examination shows impaired peripheral vision bilaterally. Contrast MRI of the head s... | Impotence | {
"A": "Macroglossia",
"B": "Impotence",
"C": "Galactorrhea",
"D": "Polyuria"
} | step1 | B | [
"year old man",
"physician",
"evaluation of episodic headaches involving",
"temples",
"months",
"patient",
"taking acetaminophen",
"not provided relief",
"double vision",
"Ophthalmic examination shows impaired peripheral",
"Contrast MRI of",
"head shows",
"10",
"8 mm",
"mass",
"Further... |
A 44-year-old G2P2 African American woman presents to her gynecologist for dysmenorrhea. She reports that for the past few months, she has been having severe pain during her menses. She also endorses menstrual bleeding that has been heavier than usual. The patient reports that her cycles are regular and occur every 30 ... | Presence of endometrial glands and stroma in uterine myometrium | {
"A": "Hyperplastic overgrowths of endometrial glands and stroma",
"B": "Malignant invasion of endometrial cells into uterine myometrium",
"C": "Presence of endometrial glands and stroma in uterine myometrium",
"D": "Presence of endometrial glands and stroma outside the uterus"
} | step2&3 | C | [
"year old",
"African American woman presents",
"gynecologist",
"dysmenorrhea",
"reports",
"past",
"months",
"severe pain",
"menses",
"menstrual bleeding",
"heavier",
"usual",
"patient reports",
"cycles",
"regular",
"occur",
"30 days",
"denies",
"dyspareunia",
"spotting between"... |
A 23-year-old woman is brought to the emergency department by her friend because of strange behavior. Two hours ago, she was at a night club where she got involved in a fight with the bartender. Her friend says that she was smoking a cigarette before she became irritable and combative. She repeatedly asked “Why are you... | Inhibition of NMDA receptors | {
"A": "Stimulation of cannabinoid receptors",
"B": "Stimulation of 5HT2A and dopamine D2 receptors",
"C": "Inhibition of norepinephrine, serotonin, and dopamine reuptake",
"D": "Inhibition of NMDA receptors"
} | step1 | D | [
"23 year old woman",
"brought",
"emergency department",
"friend",
"strange behavior",
"Two hours",
"night club",
"got involved",
"fight",
"bartender",
"friend",
"smoking",
"cigarette",
"irritable",
"combative",
"repeatedly",
"blood",
"drink",
"before hitting",
"bartender",
"h... |
A 50-year-old overweight woman presents to her physician with complaints of recurrent episodes of right upper abdominal discomfort and cramping. She says that the pain is mild and occasionally brought on by the ingestion of fatty foods. The pain radiates to the right shoulder and around to the back, and it is accompani... | Choledocholithiasis | {
"A": "Choledocholithiasis",
"B": "Pancreatitis",
"C": "Duodenal peptic ulcer",
"D": "Gallbladder cancer"
} | step2&3 | A | [
"50 year old overweight woman presents",
"physician",
"complaints of recurrent episodes",
"right upper abdominal discomfort",
"cramping",
"pain",
"mild",
"occasionally brought",
"ingestion",
"fatty foods",
"pain radiates",
"right shoulder",
"back",
"nausea",
"occasional vomiting",
"adm... |
A 2400-g (5.29-lb) male newborn is delivered at term to a 38-year-old woman. The initial examination shows that the child is at the 5th percentile for head circumference and 10th percentile for weight and length. He has a sloping forehead, a flat nasal bridge, increased interocular distance, low-set ears, and a protrud... | Atrioventricular septal defect | {
"A": "Atrioventricular septal defect",
"B": "Ventricular septal defect",
"C": "Pulmonary valve stenosis",
"D": "Transposition of the great arteries\n\""
} | step2&3 | A | [
"2400 g",
"29",
"male newborn",
"delivered",
"term",
"year old woman",
"initial examination shows",
"child",
"5th percentile",
"head circumference",
"percentile",
"weight",
"length",
"sloping forehead",
"flat nasal bridge",
"increased",
"distance",
"low-set ears",
"protruding ton... |
A 15-month-old boy is brought the pediatrician for immunizations and assessment. His parents report that he is eating well and produces several wet diapers every day. He is occasionally fussy, but overall a happy and curious child. The boy was born at 39 weeks gestation via spontaneous vaginal delivery On physical exam... | Reassurance of the parents and regular follow-up | {
"A": "Reassurance of the parents and regular follow-up",
"B": "Antibiotic prophylaxis against infective endocarditis",
"C": "Oral digoxin and regular follow-up",
"D": "Transcatheter occlusion closure of the defect"
} | step2&3 | A | [
"month old boy",
"brought",
"pediatrician",
"immunizations",
"assessment",
"parents report",
"eating well",
"several wet diapers",
"day",
"occasionally fussy",
"overall",
"happy",
"curious child",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"physical examinati... |
A 49-year-old male presents to the emergency room with dyspnea and pulmonary edema. He reports that he has been smoking 2 packs a day for the past 25 years and has difficulty breathing during any sustained physical activity. His blood pressure is normal, and he reports a history of COPD. An echocardiogram was ordered a... | Coronary sinus dilation | {
"A": "Aortic stenosis",
"B": "Mitral valve insufficiency",
"C": "Coronary sinus dilation",
"D": "Tricuspid valve stenosis"
} | step1 | C | [
"year old male presents",
"emergency room",
"dyspnea",
"pulmonary edema",
"reports",
"smoking 2 packs",
"day",
"past",
"years",
"difficulty breathing",
"sustained physical activity",
"blood pressure",
"normal",
"reports",
"history",
"COPD",
"echocardiogram",
"ordered",
"part of",... |
A 23-year-old woman comes to the physician because of an 8-month history of weakness and intermittent burning pain in her neck, shoulders, and arms. She was involved in a motor vehicle collision 1 year ago. Examination of the upper extremities shows absent reflexes, muscle weakness, and fasciculations bilaterally. Sens... | Syringomyelia | {
"A": "Tabes dorsalis",
"B": "Syringomyelia",
"C": "Amytrophic lateral sclerosis",
"D": "Cervical disk prolapse"
} | step1 | B | [
"23 year old woman",
"physician",
"month history",
"weakness",
"intermittent burning pain in",
"neck",
"shoulders",
"arms",
"involved",
"motor vehicle collision",
"year",
"Examination of the upper extremities shows absent reflexes",
"muscle weakness",
"fasciculations",
"Sensation",
"te... |
A 43-year-old man presents to his primary care provider with concerns about general weakness and decreased concentration over the past several months. He reports constipation and unintentional weight loss of about 9.1 kg (20 lb). The past medical symptoms are noncontributory. He works as a bank manager and occasionally... | Malignancy | {
"A": "Chronic kidney disease",
"B": "Hyperparathyroidism",
"C": "Hypervitaminosis D",
"D": "Malignancy"
} | step1 | D | [
"year old man presents",
"primary care provider",
"concerns",
"general weakness",
"decreased concentration",
"past",
"months",
"reports constipation",
"unintentional weight loss",
"kg",
"20",
"past medical symptoms",
"works",
"bank manager",
"occasionally drinks alcohol",
"not smoke to... |
A 61-year-old woman who recently emigrated from India comes to the physician because of a 2-month history of fever, fatigue, night sweats, and a productive cough. She has had a 5-kg (11-lb) weight loss during this period. She has a history of type 2 diabetes mellitus and poorly controlled asthma. She has had multiple a... | Alteration in 30S ribosomal subunit | {
"A": "Alteration in the sequence of gyrA genes",
"B": "Inhibition of bacterial synthesis of RNA",
"C": "Alteration in 30S ribosomal subunit",
"D": "Upregulation of mycolic acid synthesis"
} | step1 | C | [
"61 year old woman",
"recently",
"India",
"physician",
"2 month history",
"fever",
"fatigue",
"night sweats",
"productive cough",
"5 kg",
"weight loss",
"period",
"history of type 2 diabetes mellitus",
"poorly controlled asthma",
"multiple asthma exacerbations",
"past year",
"treated... |
A 53-year-old woman comes to the physician because of a 3-month history of intermittent severe left neck, shoulder, and arm pain and paresthesias of the left hand. The pain radiates to the radial aspect of her left forearm, thumb, and index finger. She first noticed her symptoms after helping a friend set up a canopy t... | C5-C6 disc herniation
" | {
"A": "Carpal tunnel syndrome",
"B": "Syringomyelia",
"C": "Thoracic outlet syndrome",
"D": "C5-C6 disc herniation\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"3 month history",
"intermittent severe left neck",
"shoulder",
"arm pain",
"paresthesias of",
"left hand",
"pain radiates",
"radial aspect",
"left",
"thumb",
"index finger",
"first",
"symptoms",
"friend set up",
"tent",
"family history",
"serious i... |
A 38-year-old male is admitted to the hospital after a motor vehicle accident in which he sustained a right diaphyseal femur fracture. His medical history is significant for untreated hypertension. He reports smoking 1 pack of cigarettes per day and drinking 1 liter of bourbon daily. On hospital day 1, he undergoes ope... | 48-72 hours | {
"A": "Less than 24 hours",
"B": "24-48 hours",
"C": "48-72 hours",
"D": "5-6 days"
} | step1 | C | [
"year old male",
"admitted",
"hospital",
"motor vehicle accident",
"sustained",
"right diaphyseal",
"medical history",
"significant",
"untreated hypertension",
"reports smoking 1 pack",
"cigarettes",
"day",
"drinking",
"liter",
"bourbon daily",
"hospital",
"open reduction internal fi... |
A 54-year-old male comes to the clinic to initiate care with a new physician. He has no complaints at this time. When taking his history, the patient says his medical history is notable for diabetes and hypertension both of which are well managed on his medications. His medications are metformin and lisinopril. A revie... | Contemplation | {
"A": "Contemplation",
"B": "Preparation",
"C": "Action",
"D": "Maintenance"
} | step1 | A | [
"54 year old male",
"clinic to initiate care",
"new physician",
"complaints",
"time",
"taking",
"history",
"patient",
"medical history",
"notable",
"diabetes",
"hypertension",
"well managed",
"medications",
"medications",
"metformin",
"lisinopril",
"review of systems",
"negative"... |
A 61-year-old man comes to the physician because of a 2-month history of severe chest discomfort. The chest discomfort usually occurs after heavy meals or eating in the late evening and lasts several hours. He has nausea sometimes but no vomiting. He has also had an occasional nighttime cough during this period. He has... | Laparoscopic Nissen fundoplication with hiatoplasty | {
"A": "Clarithromycin, amoxicillin, and omeprazole therapy for 2 weeks",
"B": "Laparoscopic herniotomy",
"C": "Laparoscopic Nissen fundoplication with hiatoplasty",
"D": "Calcium carbonate therapy for 2 months"
} | step2&3 | C | [
"61 year old man",
"physician",
"2 month history",
"severe chest discomfort",
"chest discomfort usually occurs",
"heavy meals",
"eating",
"late evening",
"lasts",
"hours",
"nausea sometimes",
"vomiting",
"occasional nighttime cough",
"period",
"hypertension",
"type 2 diabetes mellitus"... |
A 37-year-old man presents to his primary care physician because he has been experiencing episodes where he wakes up at night gasping for breath. His past medical history is significant for morbid obesity as well as hypertension for which he takes lisinopril. He is diagnosed with sleep apnea and prescribed a continuous... | Provide follow-up appointments to assess progress in attaining goals | {
"A": "Ask the patient to bring a family member to next appointment",
"B": "Inform the patient of the health consequences of not intervening",
"C": "Provide follow-up appointments to assess progress in attaining goals",
"D": "Refer the patient to a peer support group addressing lifestyle changes"
} | step1 | C | [
"year old man presents",
"primary care physician",
"experiencing episodes",
"wakes up",
"night gasping for breath",
"past medical history",
"significant",
"morbid obesity",
"hypertension",
"takes lisinopril",
"diagnosed",
"sleep apnea",
"prescribed",
"continuous positive airway pressure ap... |
A 12-year-old boy presents to the emergency room with difficulty breathing after several days of severe sore throat. Further history reveals that his family immigrated recently from Eastern Europe and he has never previously seen a doctor. Physical exam shows cervical lymphadenopathy with extensive neck edema as well a... | Tellurite Agar | {
"A": "Bordet-Genou Agar",
"B": "Eaton's Agar",
"C": "Tellurite Agar",
"D": "Thayer-Martin Agar"
} | step1 | C | [
"year old boy presents",
"emergency room",
"difficulty breathing",
"days",
"severe sore throat",
"Further history reveals",
"family",
"recently",
"Eastern Europe",
"never",
"seen",
"doctor",
"Physical exam shows cervical lymphadenopathy",
"extensive neck edema",
"finding shown",
"image... |
A 45-year-old woman with β-thalassemia major comes to the physician with a 1-week history of fatigue. She receives approximately 8 blood transfusions per year; her last transfusion was 1 month ago. Examination shows conjunctival pallor. Her hemoglobin level is 6.5 mg/dL. Microscopic evaluation of a liver biopsy specime... | Macrophages with cytoplasmic granules that stain golden-yellow with hematoxylin | {
"A": "Macrophages with yellow-brown, lipid-containing granules",
"B": "Macrophages with cytoplasmic granules that stain golden-yellow with hematoxylin",
"C": "Extracellular deposition of pink-staining proteins",
"D": "Cytoplasmic brown-pigmented granules that stain positive for S-100"
} | step1 | B | [
"year old woman",
"thalassemia major",
"physician",
"1-week history",
"fatigue",
"receives approximately",
"blood transfusions",
"year",
"last transfusion",
"1 month",
"Examination shows conjunctival pallor",
"hemoglobin level",
"6.5 mg/dL",
"Microscopic evaluation of",
"liver biopsy spe... |
Myeloperoxidase (MPO) is a heme-containing molecule that is found in the azurophilic granules of neutrophils. Upon release, the enzyme catalyzes hypochlorous acid production during the phagocytic response. In the setting of pneumonia, which of the following is the end result and clinical significance of this reaction? | Green color of sputum | {
"A": "Green color of sputum",
"B": "Cough",
"C": "Rust-tinged sputum",
"D": "Shortness of breath"
} | step1 | A | [
"Myeloperoxidase",
"heme containing molecule",
"found",
"azurophilic granules",
"neutrophils",
"release",
"enzyme",
"hypochlorous acid production",
"phagocytic response",
"setting",
"pneumonia",
"following",
"end result",
"clinical significance",
"reaction"
] |
An 11-year-old male is brought in by ambulance to the emergency department after being a restrained passenger in a motor vehicle accident. His father was driving him to soccer practice when they were hit by a wrong way driver. On presentation, his temperature is 101°F (38.3°C), blood pressure is 100/62 mmHg, pulse is 1... | Lipases | {
"A": "Immunoglobulin",
"B": "Lipases",
"C": "Plasmin",
"D": "Proteases"
} | step1 | B | [
"year old male",
"brought",
"ambulance",
"emergency department",
"restrained passenger",
"motor vehicle accident",
"father",
"driving",
"to soccer practice",
"hit",
"wrong",
"driver",
"presentation",
"temperature",
"3C",
"blood pressure",
"100 62 mmHg",
"pulse",
"min",
"respira... |
A 60-year-old homeless man presents to the emergency department with an altered mental status. He is not answering questions. His past medical history is unknown. A venous blood gas is drawn demonstrating the following.
Venous blood gas
pH: 7.2
PaO2: 80 mmHg
PaCO2: 80 mmHg
HCO3-: 24 mEq/L
Which of the following is th... | Heroin overdose | {
"A": "Aspirin overdose",
"B": "Diabetic ketoacidosis",
"C": "Ethylene glycol intoxication",
"D": "Heroin overdose"
} | step2&3 | D | [
"60 year old homeless man presents",
"emergency department",
"altered mental status",
"not answering questions",
"past medical history",
"unknown",
"venous",
"drawn",
"following",
"Venous pH",
"7.2 PaO2",
"80 mmHg",
"80 mmHg HCO3",
"mEq/L",
"following",
"most likely etiology",
"patie... |
A 5-year-old girl is brought to the physician by her mother because of a 1-month history of a painful ulcer on her face. She has developed painful sunburns in the past with minimal UV exposure. Examination of the skin shows a 2-cm ulcerated nodule on the left cheek. There are scaly, hyperpigmented papules and plaques o... | Excision endonuclease | {
"A": "Excision endonuclease",
"B": "Rb nuclear protein",
"C": "Base-specific glycosylase",
"D": "DNA helicase"
} | step1 | A | [
"5 year old girl",
"brought",
"physician",
"mother",
"month history",
"painful ulcer",
"face",
"painful sunburns",
"past",
"minimal UV exposure",
"Examination of",
"skin shows",
"2 cm ulcerated nodule",
"left cheek",
"scaly",
"hyperpigmented papules",
"plaques",
"skin of",
"entir... |
A 72-year-old woman is brought to the physician by her son for an evaluation of cognitive decline. Her son reports that she has had increased difficulty finding her way back home for the last several months, despite having lived in the same city for 40 years. He also reports that his mother has been unable to recall th... | Generalized cerebral atrophy | {
"A": "Hallucinations",
"B": "Resting tremor",
"C": "Generalized cerebral atrophy",
"D": "Urinary incontinence"
} | step2&3 | C | [
"72 year old woman",
"brought",
"physician",
"son",
"evaluation",
"cognitive",
"son reports",
"increased difficulty finding",
"back home",
"months",
"lived",
"same city",
"40 years",
"reports",
"mother",
"unable to recall",
"names",
"relatives",
"forgetting important family",
"... |
A 20-year-old man is brought to the behavioral health clinic by his roommate. The patient’s roommate says that the patient has been looking for cameras that aliens planted in their apartment for the past 2 weeks. Approximately 3 months prior to the onset of this episode, the roommate says the patient stopped playing ba... | Schizoaffective disorder | {
"A": "Schizophrenia with depression",
"B": "Schizoaffective disorder",
"C": "Depression with psychotic features",
"D": "Cannabis intoxication"
} | step2&3 | B | [
"20 year old man",
"brought",
"behavioral health clinic",
"roommate",
"patients roommate",
"patient",
"looking",
"cameras",
"aliens planted",
"apartment",
"past 2 weeks",
"Approximately",
"months prior to",
"onset of",
"episode",
"roommate",
"patient stopped playing basketball daily"... |
A 32-year-old woman presents with diplopia. She says that she has been experiencing drooping of her eyelids and severe muscle weakness. She reports that her symptoms are worse at the end of the day. Which of the following additional findings would most likely be seen in this patient? | Increased acetylcholine receptor antibody | {
"A": "Increased antinuclear antibodies",
"B": "Increased acetylcholine receptor antibody",
"C": "Increased calcium channel receptor antibodies",
"D": "Albuminocytological dissociation in the cerebrospinal fluid"
} | step1 | B | [
"year old woman presents",
"diplopia",
"experiencing drooping",
"eyelids",
"severe muscle weakness",
"reports",
"symptoms",
"worse",
"end",
"day",
"following additional findings",
"most likely",
"seen",
"patient"
] |
A 61-year-old man presents to the primary care clinic to establish care. He has not seen a physician for many years. He has no complaints or concerns but, on further questioning, does have some vague abdominal discomfort. He has no known past medical history and takes no medications. His social history is notable for i... | Hepatitis C antibody | {
"A": "Anti-nuclear antibody test",
"B": "Hepatitis C antibody",
"C": "HIV ELISA",
"D": "Platelet aggregation assay"
} | step2&3 | B | [
"61 year old man presents",
"primary care clinic to establish care",
"not seen",
"physician",
"years",
"complaints",
"concerns",
"further questioning",
"vague abdominal discomfort",
"known past medical history",
"takes",
"medications",
"social history",
"notable",
"injecting heroin",
"... |
An 8-year-old boy presents with a limp favoring his right leg. The patient’s mother noticed he had been limping without complaint for the past 6 months. Past medical history is significant for the flu last year. No current medications. All immunizations are up to date. The vital signs include: temperature 37.0°C (98.6°... | Legg-Calve-Perthes disease | {
"A": "Slipped capital femoral epiphysis",
"B": "Developmental dysplasia of the hip",
"C": "Viral-induced synovitis",
"D": "Legg-Calve-Perthes disease"
} | step2&3 | D | [
"year old boy presents",
"limp favoring",
"right leg",
"patients mother",
"limping",
"complaint",
"past 6 months",
"Past medical history",
"significant",
"flu",
"year",
"current medications",
"immunizations",
"date",
"vital signs include",
"temperature",
"98",
"blood pressure 100 6... |
A 59-year-old female is brought to the emergency department with an acute onset of weakness in her left hand that started 3 hours ago. She has not had numbness or tingling of the hand. Other than recent episodes of blurry vision and headaches, her medical history is unremarkable. She has one daughter who was diagnosed ... | Repeated phlebotomies | {
"A": "Glucocorticoid therapy",
"B": "Busulfan",
"C": "Imatinib therapy",
"D": "Repeated phlebotomies"
} | step2&3 | D | [
"59 year old female",
"brought",
"emergency department",
"acute onset",
"weakness",
"left hand",
"started 3 hours",
"not",
"numbness",
"tingling",
"hand",
"Other",
"recent episodes of blurry vision",
"headaches",
"medical history",
"unremarkable",
"one daughter",
"diagnosed",
"mu... |
A 26-year-old man is undergoing a bone marrow transplantation for treatment of a non-Hodgkin lymphoma that has been refractory to several rounds of chemotherapy and radiation over the past 2 years. He has been undergoing a regimen of cyclophosphamide and total body irradiation for the past several weeks in anticipation... | Aspergillus fumigatus | {
"A": "Aspergillus fumigatus",
"B": "Mycoplasma pneumonia",
"C": "Staphylococcus aureus",
"D": "Streptococcus pneumonia"
} | step2&3 | A | [
"year old man",
"bone marrow transplantation",
"treatment of",
"non-Hodgkin lymphoma",
"refractory",
"rounds",
"chemotherapy",
"radiation",
"past",
"years",
"regimen",
"cyclophosphamide",
"total body irradiation",
"past",
"weeks",
"anticipation",
"future transplant",
"morning",
"... |
A 47-year-old woman comes to the physician because of a 2-month history of a lump on her neck and a 1-week history of hoarseness. Examination shows a 3-cm, firm, non-tender nodule on the anterior neck. Further evaluation confirms a thyroid malignancy, and she undergoes thyroidectomy. Histopathologic examination of the ... | Calcified spherules and large oval cells with empty-appearing nuclei | {
"A": "Sheets of polygonal cells surrounding amyloid deposition",
"B": "Calcified spherules and large oval cells with empty-appearing nuclei",
"C": "Cuboidal cells arranged spherically around colloid lakes",
"D": "Hyperplastic epithelium with colloid scalloping"
} | step1 | B | [
"year old woman",
"physician",
"2 month history",
"lump",
"neck",
"1-week history",
"hoarseness",
"Examination shows",
"3",
"firm",
"non-tender nodule",
"anterior neck",
"Further evaluation confirms",
"thyroid malignancy",
"thyroidectomy",
"Histopathologic examination",
"surgical sho... |
A 71-year-old woman is brought to the emergency department following a syncopal episode. Earlier in the day, the patient had multiple bowel movements that filled the toilet bowl with copious amounts of bright red blood. Minutes later, she felt dizzy and lightheaded and collapsed into her daughter's arms. The patient ha... | Type and screen | {
"A": "Colonoscopy",
"B": "CT abdomen",
"C": "Packed red blood cells",
"D": "Type and screen"
} | step2&3 | D | [
"71 year old woman",
"brought",
"emergency department following",
"syncopal episode",
"Earlier",
"day",
"patient",
"multiple bowel movements",
"filled",
"toilet bowl",
"copious amounts",
"bright red blood",
"Minutes later",
"felt dizzy",
"lightheaded",
"collapsed",
"daughter's arms",... |
A 35-year-old man who works in a shipyard presents with a sharp pain in his left big toe for the past 5 hours. He says he has had this kind of pain before a few days ago after an evening of heavy drinking with his friends. He says he took acetaminophen and ibuprofen for the pain as before but, unlike the last time, it ... | Naproxen | {
"A": "Probenecid",
"B": "Morphine",
"C": "Allopurinol",
"D": "Naproxen"
} | step1 | D | [
"35 year old man",
"works",
"presents",
"sharp pain",
"left big toe",
"past",
"hours",
"kind",
"pain",
"few days",
"evening",
"heavy drinking",
"friends",
"took acetaminophen",
"ibuprofen",
"pain",
"before",
"last time",
"helped",
"patient denies",
"recent history",
"trauma... |
An investigator studying epigenetic mechanisms isolates histone proteins, the structural motifs involved in DNA binding and regulation of transcription. The peptide bonds of histone proteins are hydrolyzed and one type of amino acid is isolated. At normal body pH, this amino acid has a net charge of +1 . The investigat... | Lysine | {
"A": "Lysine",
"B": "Aspartate",
"C": "Histidine",
"D": "Proline"
} | step1 | A | [
"investigator studying epigenetic mechanisms isolates histone proteins",
"structural motifs involved",
"DNA binding",
"regulation",
"transcription",
"peptide bonds",
"histone proteins",
"one type",
"amino acid",
"isolated",
"normal body pH",
"amino acid",
"net charge",
"1",
"investigator... |
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