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 6-month-old boy is brought to a pediatrician by his parents for his first visit after they adopt him from a European country. His parents are concerned about the boy’s short episodes of shaking of his arms and legs; they believe it might be epilepsy. They also note that the child is less responsive than other childre... | Tyrosine | {
"A": "Histidine",
"B": "Isoleucine",
"C": "Leucine",
"D": "Tyrosine"
} | step1 | D | [
"month old boy",
"brought",
"pediatrician",
"parents",
"first visit",
"adopt",
"European country",
"parents",
"concerned",
"boys short episodes of shaking",
"arms",
"legs",
"epilepsy",
"note",
"child",
"less responsive than",
"children",
"age",
"family",
"unable to provide",
... |
A 42-year-old woman comes to her primary care physician because of an irritating sensation in her nose. She noticed recently that there seems to be a lump in her nose. Her past medical history is significant for pain that seems to migrate around her body and is refractory to treatment. She has intermittently been takin... | Increased lipoxygenase pathway activity | {
"A": "Decreased lipoxygenase pathway activity",
"B": "Decreased prostaglandin activity",
"C": "Increased allergic reaction in mucosa",
"D": "Increased lipoxygenase pathway activity"
} | step1 | D | [
"year old woman",
"primary care physician",
"of",
"sensation",
"nose",
"recently",
"to",
"lump",
"nose",
"past medical history",
"significant",
"pain",
"to migrate",
"body",
"refractory",
"treatment",
"taking",
"medication",
"pain",
"recently increased",
"dose",
"drug",
"... |
A 58-year-old man is brought to the emergency department after a witnessed tonic-clonic seizure. His wife says he has had a persistent dry cough for 6 months. During this time period, he has also had fatigue and a 4.5-kg (10-lb) weight loss. The patient has no history of serious illness and does not take any medication... | Small cell lung carcinoma | {
"A": "Squamous cell lung carcinoma",
"B": "Small cell lung carcinoma",
"C": "Large cell lung carcinoma",
"D": "Bronchial carcinoid tumor"
} | step1 | B | [
"58 year old man",
"brought",
"emergency department",
"witnessed tonic-clonic seizure",
"wife",
"persistent dry cough",
"months",
"time period",
"fatigue",
"4.5 kg",
"10",
"weight loss",
"patient",
"history",
"serious illness",
"not take",
"medications",
"smoked 1 pack",
"cigaret... |
A 22-year-old soldier sustains a gunshot wound to the left side of the chest during a deployment in Syria. The soldier and her unit take cover from gunfire in a nearby farmhouse, and a combat medic conducts a primary survey of her injuries. She is breathing spontaneously. Two minutes after sustaining the injury, she de... | Needle thoracostomy
" | {
"A": "Endotracheal intubation",
"B": "Intravenous administration of fentanyl",
"C": "Ultrasonography of the chest",
"D": "Needle thoracostomy\n\""
} | step2&3 | D | [
"year old soldier sustains",
"gunshot wound",
"left side of",
"chest",
"deployment",
"Syria",
"soldier",
"unit take cover",
"nearby",
"conducts",
"primary survey",
"injuries",
"breathing",
"Two minutes",
"sustaining",
"injury",
"severe respiratory distress",
"examination",
"agita... |
A 13-year-old boy is brought to the emergency department by ambulance after suddenly losing consciousness while playing in a soccer tournament. The patient has had 2 episodes of syncope without a discernable trigger over the past year. He has been otherwise healthy. His father died suddenly at the age of 37. He reports... | Mutation of myocardial potassium channels | {
"A": "Myofibrillar disarray of cardiac septum",
"B": "Bicuspid aortic valve",
"C": "Defect in interatrial septum",
"D": "Mutation of myocardial potassium channels"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"ambulance",
"consciousness",
"playing",
"soccer",
"patient",
"2 episodes of syncope",
"discernable trigger",
"past year",
"healthy",
"father died",
"age",
"reports lightheadedness",
"consciousness",
"physical examination",
"attemp... |
A 55-year-old man presents after an episode of severe left ankle pain. The pain has resolved, but he decided to come in for evaluation as he has had pain like this before. He says he has experienced similar episodes of intense pain in the same ankle and his left knee in the past, which he associates with eating copious... | Xanthine oxidase inhibitor | {
"A": "Colchicine",
"B": "Nonsteroidal antiinflammatory drugs (NSAIDs)",
"C": "Intra-articular steroid injection",
"D": "Xanthine oxidase inhibitor"
} | step2&3 | D | [
"55 year old man presents",
"episode of severe left ankle pain",
"pain",
"resolved",
"to",
"evaluation",
"pain",
"before",
"similar episodes of intense pain",
"same ankle",
"left knee",
"past",
"associates",
"eating copious amounts",
"fatty food",
"parties",
"one",
"pain",
"so ex... |
A 6-year-old boy is presented to a pediatric clinic by his mother with complaints of fever, malaise, and cough for the past 2 days. He frequently complains of a sore throat and has difficulty eating solid foods. The mother mentions that, initially, the boy’s fever was low-grade and intermittent but later became high gr... | Prostaglandin E2 | {
"A": "Leukotriene D4",
"B": "Thromboxane A2",
"C": "Prostaglandin E2",
"D": "Prostaglandin F2"
} | step1 | C | [
"year old boy",
"presented",
"pediatric clinic",
"mother",
"complaints",
"fever",
"malaise",
"cough",
"past 2 days",
"frequently",
"sore throat",
"difficulty eating solid foods",
"mother",
"initially",
"boys fever",
"low-grade",
"intermittent",
"later",
"high grade",
"continuou... |
A 1-year-old male with a history of recurrent pseudomonal respiratory infections and steatorrhea presents to the pediatrician for a sweat test. The results demonstrate a chloride concentration of 70 mEq/L (nl < 40 mEq/L). Which of the following defects has a similar mode of inheritance as the disorder experienced by th... | Accumulation of glycogen in the lysosome | {
"A": "Accumulation of glycogen in the lysosome",
"B": "Inability to convert carbamoyl phosphate and ornithine into citrulline",
"C": "Abnormal production of type IV collagen",
"D": "Mutated gene for mitochondrial-tRNA-Lys"
} | step1 | A | [
"1-year-old male",
"history",
"recurrent pseudomonal respiratory infections",
"steatorrhea presents",
"pediatrician",
"sweat test",
"results",
"chloride concentration",
"70 mEq/L",
"nl",
"40 mEq/L",
"following defects",
"similar mode of inheritance",
"disorder experienced",
"patient"
] |
A 54-year-old woman comes to the emergency department because of sharp chest pain and shortness of breath for 1 day. Her temperature is 37.8°C (100°F), pulse is 110/min, respirations are 30/min, and blood pressure is 86/70 mm Hg. CT angiography of the chest shows a large embolus at the right pulmonary artery. Pharmacot... | Aminocaproic acid | {
"A": "Protamine sulfate",
"B": "Vitamin K",
"C": "Plasmin",
"D": "Aminocaproic acid"
} | step1 | D | [
"54 year old woman",
"emergency department",
"sharp chest pain",
"shortness of breath",
"1 day",
"temperature",
"pulse",
"min",
"respirations",
"30/min",
"blood pressure",
"70 mm Hg",
"CT angiography of",
"chest shows",
"large embolus",
"right",
"Pharmacotherapy",
"tissue plasminog... |
You have been entrusted with the task of finding the causes of low birth weight in infants born in the health jurisdiction for which you are responsible. In 2017, there were 1,500 live births and, upon further inspection of the birth certificates, 108 of these children had a low birth weight (i.e. lower than 2,500 g), ... | 50% | {
"A": "10%",
"B": "20%",
"C": "40%",
"D": "50%"
} | step1 | D | [
"task",
"finding",
"causes",
"low birth weight",
"infants born",
"health jurisdiction",
"responsible",
"1 500 live births",
"further inspection",
"birth certificates",
"children",
"low birth weight",
"i.e",
"lower",
"500 g",
"mothers",
"smoked",
"pregnancy",
"Further calculations... |
A 63-year-old woman comes to the physician for a follow-up examination. She has had numbness and burning sensation in her feet for 4 months. The pain is worse at rest and while sleeping. She has hypercholesterolemia and type 2 diabetes mellitus. Current medications include insulin, metformin, and atorvastatin. She has ... | Venlafaxine therapy | {
"A": "Ankle-brachial index",
"B": "MRI with contrast of the spine",
"C": "Vitamin B12 therapy",
"D": "Venlafaxine therapy"
} | step2&3 | D | [
"63 year old woman",
"physician",
"follow-up examination",
"numbness",
"burning sensation",
"feet",
"4 months",
"pain",
"worse",
"rest",
"sleeping",
"hypercholesterolemia",
"type 2 diabetes mellitus",
"Current medications include insulin",
"metformin",
"atorvastatin",
"smoked one pac... |
An 87-year-old man comes to the physician because of progressive involuntary urine dribbling over the past two years. He has to use the restroom more frequently than he used to and feels like he cannot fully empty his bladder. Physical examination shows a palpable suprapubic mass. An ultrasound image of the left kidney... | Compression of renal cortex and medulla | {
"A": "Short intramural ureter segment",
"B": "Compression of renal cortex and medulla",
"C": "Posterior urethral valves",
"D": "Formation of renal parenchymal cysts"
} | step1 | B | [
"87 year old man",
"physician",
"of progressive involuntary urine dribbling",
"past two years",
"to use",
"restroom",
"frequently",
"used",
"feels",
"empty",
"bladder",
"Physical examination shows",
"palpable suprapubic mass",
"ultrasound image of",
"left kidney",
"shown",
"following... |
A 31-year-old woman, gravida 1, para 0, at 10 weeks' gestation comes to the physician because of a rash on her upper arm that appeared 3 days ago. She has also had headaches and muscle aches for 1 day. She went on a camping trip in Maine 10 days ago. Her temperature is 39°C (102.2°F). A photograph of her rash is shown.... | Amoxicillin | {
"A": "Clotrimazole",
"B": "Ceftriaxone",
"C": "Penicillin G",
"D": "Amoxicillin"
} | step1 | D | [
"31 year old woman",
"gravida 1",
"para 0",
"10 weeks",
"gestation",
"physician",
"of",
"rash",
"upper arm",
"appeared 3 days",
"headaches",
"muscle aches",
"1 day",
"camping trip",
"Maine 10 days",
"temperature",
"photograph",
"rash",
"shown",
"following",
"most appropriate ... |
An investigator studying immune-mediated pulmonary damage performs an autopsy on a bilateral lung transplant recipient who died of hypercapnic respiratory failure. The patient underwent lung transplantation for idiopathic pulmonary fibrosis. Microscopic examination of the lung shows diffuse eosinophilic scarring of the... | Chronic graft rejection | {
"A": "Recurrence of primary disease",
"B": "Chronic graft rejection",
"C": "Acute graft-versus-host disease",
"D": "Acute graft rejection"
} | step1 | B | [
"investigator studying immune-mediated pulmonary damage performs",
"autopsy",
"bilateral lung transplant recipient",
"died",
"hypercapnic respiratory failure",
"patient",
"lung transplantation",
"idiopathic pulmonary fibrosis",
"Microscopic examination of",
"shows diffuse eosinophilic scarring",
... |
A 5-month-old male infant from a consanguineous marriage presents with severe sunburns and freckling in sun exposed areas. The mother explains that the infant experiences these sunburns every time the infant goes outside despite applying copious amounts of sunscreen. Which of the following DNA repair mechanisms is defe... | Nucleotide excision repair | {
"A": "Nucleotide excision repair",
"B": "Base excision repair",
"C": "Mismatch repair",
"D": "Non-homologous end joining"
} | step1 | A | [
"5 month old male infant",
"consanguineous marriage presents",
"severe sunburns",
"freckling",
"sun exposed areas",
"mother",
"infant experiences",
"sunburns",
"time",
"infant goes outside",
"applying copious amounts",
"sunscreen",
"following DNA repair mechanisms",
"defective",
"child"
... |
A 63-year-old woman comes to the physician because of diarrhea and weakness after her meals for 2 weeks. She has the urge to defecate 15–20 minutes after a meal and has 3–6 bowel movements a day. She also has palpitations, sweating, and needs to lie down soon after eating. One month ago, she underwent a distal gastrect... | Dietary modifications | {
"A": "Stool microscopy",
"B": "Octreotide therapy",
"C": "Metronidazole therapy",
"D": "Dietary modifications"
} | step2&3 | D | [
"63 year old woman",
"physician",
"diarrhea",
"weakness",
"meals",
"2 weeks",
"minutes",
"meal",
"36 bowel movements",
"day",
"palpitations",
"sweating",
"needs to",
"eating",
"One month",
"distal gastrectomy",
"gastric cancer",
"post-operative pneumonia",
"treated with cefotaxim... |
A 19-year-old girl comes to her physician with blurred vision upon awakening for 3 months. When she wakes up in the morning, both eyelids are irritated, sore, and covered with a dry crust. Her symptoms improve after she takes a hot shower. She is otherwise healthy and takes no medications. She does not wear contact len... | Lid hygiene and warm compresses | {
"A": "Oral doxycycline",
"B": "Topical cyclosporine",
"C": "Topical mupirocin",
"D": "Lid hygiene and warm compresses"
} | step2&3 | D | [
"year old girl",
"physician",
"blurred vision",
"awakening",
"3 months",
"wakes up",
"morning",
"eyelids",
"sore",
"covered",
"dry crust",
"symptoms",
"takes",
"hot shower",
"healthy",
"takes",
"medications",
"not",
"contact lenses",
"Recently",
"sexually active",
"new male... |
A 50-year-old woman presents with acute onset fever and chills for the past hour. She mentions earlier in the day she felt blue, so she took some St. John’s wort because she was told by a friend that it helps with depression. Past medical history is significant for hypertension, diabetes mellitus, and depression manage... | Serotonin syndrome | {
"A": "Diabetic ketoacidosis",
"B": "Anaphylactic reaction",
"C": "Serotonin syndrome",
"D": "Sepsis"
} | step1 | C | [
"50 year old woman presents",
"acute onset fever",
"chills",
"past hour",
"earlier",
"day",
"felt blue",
"took",
"St",
"Johns wort",
"friend",
"helps",
"depression",
"Past medical history",
"significant",
"hypertension",
"diabetes mellitus",
"depression managed",
"captopril",
"... |
A 61-year-old Caucasian woman comes to the physician for a routine health maintenance examination. She feels well. She had a normal mammography 10 months ago and a normal serum lipid profile 3 years ago. Two years ago, a pap smear and testing for human papillomavirus were performed and were negative. She had a normal c... | Reassurance | {
"A": "Serum HIV testing",
"B": "Colonoscopy",
"C": "Fecal occult blood test",
"D": "Reassurance"
} | step2&3 | D | [
"61 year old Caucasian woman",
"physician",
"routine health maintenance examination",
"feels well",
"normal mammography 10 months",
"normal serum profile",
"years",
"Two",
"pap smear",
"testing",
"human papillomavirus",
"performed",
"negative",
"normal colonoscopy",
"years",
"HIV testi... |
A previously healthy 20-year-old woman comes to her physician because of pain during sexual intercourse. She recently became sexually active with her boyfriend. She has had no other sexual partners. She is frustrated because she has consistently been experiencing a severe, sharp vaginal pain on penetration. She has tri... | Pelvic floor physical therapy | {
"A": "Pelvic floor physical therapy",
"B": "Vaginal Botox injections",
"C": "Sex psychotherapy",
"D": "Vaginal estrogen cream\n\""
} | step2&3 | A | [
"healthy 20 year old woman",
"physician",
"of pain",
"sexual",
"recently",
"sexually active",
"boyfriend",
"sexual partners",
"frustrated",
"experiencing",
"severe",
"sharp vaginal pain on penetration",
"lubricants",
"significant relief",
"not",
"able to use tampons",
"past due to si... |
A 27-year-old man is brought to the emergency department because of weakness, headache, and vomiting for 40 minutes. He is an amateur chef and his symptoms started 10 minutes after he ingested pufferfish that he had prepared. On arrival, he is lethargic. His temperature is 37°C (98.6°F), pulse is 120/min, respirations ... | Decrease in cell membrane permeability to sodium ions | {
"A": "Decrease in cell membrane permeability to sodium ions",
"B": "Decrease in cell membrane permeability to calcium ions",
"C": "Decrease in cell membrane permeability to potassium ions",
"D": "Increase in cell membrane permeability to calcium ions"
} | step1 | A | [
"27 year old man",
"brought",
"emergency department",
"weakness",
"headache",
"vomiting",
"40 minutes",
"amateur chef",
"symptoms started 10 minutes",
"ingested pufferfish",
"prepared",
"arrival",
"lethargic",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood p... |
A group of scientists studies the effects of cytokines on effector cells, including leukocytes. They observe that interleukin (IL)–12 is secreted by antigen-presenting cells in response to bacterial lipopolysaccharide. Which of the following responses will a CD4+ T cell produce when it is exposed to this interleukin? | Cell-mediated immune response | {
"A": "Release of granzymes",
"B": "Activation of B cells",
"C": "Cell-mediated immune response",
"D": "Response to extracellular pathogens"
} | step1 | C | [
"A group",
"scientists studies",
"effects",
"cytokines",
"effector cells",
"including leukocytes",
"observe",
"interleukin",
"12",
"secreted",
"antigen-presenting cells",
"response to bacterial lipopolysaccharide",
"following responses",
"CD4",
"cell",
"exposed",
"interleukin"
] |
A 47-year-old woman presents to the emergency department with pain in her right knee. She states that the pain started last night and rapidly worsened, prompting her presentation for care. The patient has a past medical history of rheumatoid arthritis and osteoarthritis. Her current medications include corticosteroids,... | Aspiration | {
"A": "CT scan",
"B": "Broad spectrum antibiotics",
"C": "Aspiration",
"D": "Conservative therapy"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"pain in",
"right knee",
"states",
"pain started last night",
"rapidly worsened",
"prompting",
"presentation",
"care",
"patient",
"past medical history of rheumatoid arthritis",
"osteoarthritis",
"current medications include corticosteroid... |
An 11-year-old boy presents with a 2-day history of uncontrollable shivering. During admission, the patient’s vital signs are within normal limits, except for a fluctuating body temperature registering as low as 35.0°C (95.0°F) and as high as 40.0°C (104.0°F), requiring alternating use of cooling and warming blankets. ... | Anorexia | {
"A": "Hyperphagia",
"B": "Anorexia",
"C": "Galactorrhea",
"D": "Polyuria"
} | step1 | B | [
"year old boy presents",
"2-day history",
"shivering",
"admission",
"patients vital signs",
"normal limits",
"except for",
"fluctuating body temperature registering",
"low",
"35",
"95",
"high",
"40",
"alternating use of cooling",
"warming blankets",
"complete blood count",
"CBC",
"... |
A 9-month-old girl is brought to the emergency department because of a 3-day history of fever, irritability, and discharge from her right ear. She had an episode of ear pain and fever three weeks ago. Her parents did not seek medical advice and the symptoms improved with symptomatic treatment. There is no family histor... | CT scan of the temporal bone | {
"A": "Phenylephrine nasal drops therapy",
"B": "CT scan of the temporal bone",
"C": "Oral amoxicillin therapy",
"D": "Oral aspirin therapy"
} | step2&3 | B | [
"month old girl",
"brought",
"emergency department",
"3-day history",
"fever",
"irritability",
"discharge from",
"right ear",
"episode of ear pain",
"fever three weeks",
"parents",
"not",
"medical advice",
"symptoms improved",
"symptomatic treatment",
"family history",
"frequent infe... |
A 17-year-old boy is brought to the physician with complaints of an ataxic gait and hearing deficits for the past few days. His parents also reported a history of tonic gaze deviation on the right side and the spontaneous remission of a similar episode 6 months ago. His temperature is 37°C (98.6°F), pulse is 88/min, an... | Type IV hypersensitivity | {
"A": "Type II hypersensitivity",
"B": "Type III hypersensitivity",
"C": "Type IV hypersensitivity",
"D": "Type V hypersensitivity"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"complaints",
"ataxic gait",
"hearing deficits",
"past",
"days",
"parents",
"reported",
"history",
"tonic gaze deviation",
"right side",
"spontaneous remission of",
"similar episode",
"months",
"temperature",
"98",
"pulse",
"88 min",
"r... |
A 75-year-old male is diagnosed with advanced metastatic prostate cancer. After further evaluation and staging, the patient is started on flutamide therapy. Addition of which of the following medications to this patient’s medication regimen would be of greatest benefit in the treatment of this patient’s condition? | Leuprolide | {
"A": "Leuprolide",
"B": "Anastrozole",
"C": "Clomiphene",
"D": "Cyproterone"
} | step1 | A | [
"75 year old male",
"diagnosed",
"advanced metastatic prostate cancer",
"further evaluation",
"staging",
"patient",
"started",
"flutamide therapy",
"Addition",
"following medications",
"patients medication regimen",
"greatest benefit",
"treatment",
"patients"
] |
A 28-year-old man comes to the physician because of a persistent tingling sensation in the right side of his face. The sensation began after he underwent an extraction of an impacted molar 2 weeks ago. Examination shows decreased sensation of the skin over the right side of the mandible, chin, and the anterior portion ... | Foramen ovale | {
"A": "Foramen magnum",
"B": "Foramen ovale",
"C": "Foramen rotundum",
"D": "Stylomastoid foramen"
} | step1 | B | [
"year old man",
"physician",
"of",
"persistent tingling sensation",
"right side",
"face",
"sensation began",
"extraction",
"impacted molar 2 weeks",
"Examination shows decreased sensation",
"skin",
"right",
"mandible",
"chin",
"anterior portion",
"tongue",
"Taste sensation",
"prese... |
A 3-year-old male presents with his parents to a pediatrician for a new patient visit. The child was recently adopted and little is known about his prior medical or family history. The parents report that the child seems to be doing well, but they are concerned because the patient is much larger than any of the other 3... | Thromboembolic stroke | {
"A": "Aortic dissection",
"B": "Medullary thyroid cancer",
"C": "Osteoarthritis",
"D": "Thromboembolic stroke"
} | step2&3 | D | [
"3 year old male presents",
"parents",
"pediatrician",
"new patient visit",
"child",
"recently adopted",
"little",
"known",
"prior medical",
"family history",
"parents report",
"child",
"to",
"well",
"concerned",
"patient",
"much larger",
"3 year olds",
"preschool class",
"repo... |
A 21-year-old woman is evaluated for dry cough, shortness of breath, and chest tightness which occur episodically 1–2 times per week. She notes that she develops significant shortness of breath when running, especially during cool weather. She also says she has 1 episode of coughing attacks during the night per month. ... | Methacholine challenge test | {
"A": "Methacholine challenge test",
"B": "Skin-prick testing",
"C": "Ciliary studies",
"D": "Clinical observation without further evaluation"
} | step2&3 | A | [
"21-year-old woman",
"evaluated",
"dry cough",
"shortness of breath",
"chest tightness",
"occur",
"times",
"week",
"notes",
"significant shortness of breath",
"running",
"cool weather",
"has",
"episode of coughing attacks",
"night",
"month",
"denies",
"history",
"Medical",
"sig... |
A 17-year-old boy is brought to the physician because of swelling of his face and legs for 5 days. He immigrated to the United States from Korea with his family 10 years ago. He has been healthy except for an episode of sore throat 2 weeks ago. His younger sister has type 1 diabetes mellitus. His temperature is 37°C (9... | Subepithelial deposits on renal biopsy | {
"A": "Subepithelial deposits on renal biopsy",
"B": "Eosinophilic nodules on renal biopsy",
"C": "Normal-appearing glomeruli on renal biopsy",
"D": "Increased IgA levels in serum"
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"of swelling",
"face",
"legs",
"5 days",
"United States",
"Korea",
"family 10 years",
"healthy",
"episode of sore throat 2 weeks",
"younger sister",
"type 1 diabetes mellitus",
"temperature",
"98",
"pulse",
"90 min",
"blood pressure",
"87... |
A 45-year-old man comes to the physician because of fatigue and joint pain for 8 months. He has pain in both knees, both elbows, and diffuse muscle pain. He does not have dyspnea. He also had several episodes of a nonpruritic rash on his lower extremities. Eight years ago, the patient was diagnosed with hepatitis C. Hi... | Hypocomplementemia | {
"A": "Elevated perinuclear anti-neutrophil cytoplasmic antibodies",
"B": "Elevated IgA in serum",
"C": "Positive pathergy test",
"D": "Hypocomplementemia"
} | step2&3 | D | [
"year old man",
"physician",
"fatigue",
"joint pain",
"months",
"pain in both knees",
"elbows",
"diffuse muscle",
"not",
"dyspnea",
"several episodes of",
"nonpruritic rash",
"lower extremities",
"Eight years",
"patient",
"diagnosed",
"hepatitis C",
"temperature",
"100",
"pulse... |
A 46-year-old homeless man was found wandering aimlessly in the supermarket. On examination, he is confused and said that the President appointed men to kill him because he is disclosing state secrets to extraterrestrial organisms. The man also has horizontal nystagmus and an ataxic gait. What is the most likely cause ... | Necrosis of mammillary bodies | {
"A": "Hypothyroidism",
"B": "Trinucleotide repeat disorder",
"C": "Neurofibrillary tangles",
"D": "Necrosis of mammillary bodies"
} | step1 | D | [
"year old homeless man",
"found wandering",
"supermarket",
"examination",
"confused",
"President",
"men to kill",
"state secrets",
"organisms",
"man",
"horizontal nystagmus",
"ataxic gait",
"most likely cause",
"clinical presentation"
] |
A 30-year-old man comes to the physician because of an episode of bloody vomiting this morning and a 1-week history of burning upper abdominal pain. Two weeks ago, he sustained a head injury and was in a coma for 3 days. An endoscopy shows multiple, shallow hemorrhagic lesions predominantly in the gastric fundus and gr... | Erosive gastritis | {
"A": "Type B gastritis",
"B": "Cushing ulcer",
"C": "Penetrating ulcer",
"D": "Erosive gastritis"
} | step1 | D | [
"30 year old man",
"physician",
"of",
"episode",
"bloody vomiting",
"morning",
"1-week history",
"burning upper abdominal pain",
"Two weeks",
"sustained",
"head injury",
"coma",
"3 days",
"endoscopy shows multiple",
"shallow hemorrhagic lesions",
"gastric fundus",
"greater curvature"... |
A 26-year-old medical student comes to the physician for a chest x-ray to rule out active pulmonary tuberculosis. He needs a medical and radiological report before starting a medical internship in South Africa. He has no history of serious illness and does not complain of any symptoms. He has smoked 1 pack of cigarette... | Observation and follow-up x-ray | {
"A": "Emergent needle thoracostomy",
"B": "Observation and follow-up x-ray",
"C": "Immediate intubation and assisted ventilation",
"D": "Urgent chest tube placement"
} | step2&3 | B | [
"year old medical student",
"physician",
"chest x-ray to rule out active pulmonary",
"needs",
"medical",
"radiological report",
"starting",
"medical internship",
"South Africa",
"history",
"serious illness",
"not",
"symptoms",
"smoked 1 pack",
"cigarettes daily",
"past",
"years",
"... |
A 47-year-old woman presents to her physician for a routine checkup. She is in good health and has no complaints. Past medical history is significant for type 2 diabetes mellitus and obesity. She recently started metformin and is tolerating the mild side effects, but her fasting blood glucose levels range from 160–190 ... | Serum creatinine | {
"A": "γ-glutamyltransferase",
"B": "β-hCG levels",
"C": "Alanine aminotransferase",
"D": "Serum creatinine"
} | step1 | D | [
"year old woman presents",
"physician",
"routine checkup",
"good health",
"complaints",
"Past medical history",
"significant",
"type 2 diabetes mellitus",
"obesity",
"recently started metformin",
"mild side effects",
"fasting blood glucose levels range",
"mg/dL",
"Today",
"blood pressure... |
A 28-year-old primigravid woman comes to the emergency department because of a 12-hour history of lower abdominal pain and vaginal bleeding. She also had nausea and fatigue for the past 3 weeks. Her last menstrual period was 8 weeks ago. Prior to that, her menses occurred regularly at 30-day intervals and lasted for 4 ... | Trophoblastic proliferation with chorionic villi distention | {
"A": "Placenta implantation into myometrium",
"B": "Malignant transformation of trophoblastic tissue",
"C": "Trophoblastic proliferation with chorionic villi distention",
"D": "Malpositioned placenta overlying the cervix"
} | step2&3 | C | [
"year old primigravid woman",
"emergency department",
"12-hour history",
"lower abdominal pain",
"vaginal bleeding",
"nausea",
"fatigue",
"past",
"weeks",
"last menstrual period",
"weeks",
"menses occurred",
"30 day intervals",
"lasted",
"4 days",
"history of medical illness",
"takes... |
A 28-year-old man presents with a 3-day history of cough and fever. He says that he recently became a factory worker in a huge plant that is involved in the polyvinyl chloride (PVC) polymerization process. Because he has heard about occupational diseases specifically related to this particular industry, he asks the phy... | Hepatic angiosarcoma | {
"A": "Adenocarcinoma of the small intestine",
"B": "Bronchogenic carcinoma",
"C": "Hepatic angiosarcoma",
"D": "Urothelial carcinoma"
} | step1 | C | [
"year old man presents",
"3-day history",
"cough",
"fever",
"recently",
"factory worker",
"plant",
"involved",
"polyvinyl chloride",
"polymerization process",
"heard",
"occupational diseases",
"related",
"industry",
"physician",
"new job",
"associated",
"serious conditions",
"phy... |
A previously healthy 29-year-old African-American male comes to the physician with a 2-week history of progressive fatigue and shortness of breath on exertion. Last week he noticed that his eyes were gradually turning yellow and his urine was dark. He has a family history of type II diabetes. He denies changes in urina... | Autoimmune hemolytic anemia
" | {
"A": "Hereditary spherocytosis",
"B": "Alpha thalassemia",
"C": "Spur cell hemolytic anemia",
"D": "Autoimmune hemolytic anemia\n\""
} | step2&3 | D | [
"healthy 29 year old African-American male",
"physician",
"2-week history",
"progressive fatigue",
"shortness of breath",
"exertion",
"Last week",
"eyes",
"turning yellow",
"urine",
"dark",
"family history of type II diabetes",
"denies changes",
"urinary frequency",
"dysuria",
"nocturi... |
A 25-year-old woman is admitted to the intensive care unit (ICU) with hematemesis and shock. Five days ago she had a severe fever 40.0℃ (104.0℉), retro-orbital pain, nausea, and myalgias. The high temperatures decreased over a few days, but she developed severe abdominal pain and bleeding gums. A single episode of hema... | Dengue fever | {
"A": "Chikungunya virus infection",
"B": "Dengue fever",
"C": "Chagas disease",
"D": "Yellow fever"
} | step2&3 | B | [
"year old woman",
"admitted to",
"intensive care unit",
"hematemesis",
"shock",
"Five days",
"severe fever 40 0",
"0",
"retro orbital pain",
"nausea",
"myalgias",
"high temperatures decreased",
"days",
"severe abdominal",
"bleeding gums",
"single episode of hematemesis occurred prior t... |
A 12-year-old boy is brought to the emergency department after he vomited and said he was having double vision in school. He also says that he has been experiencing morning headaches, nausea, and dizziness over the last month. He has no past medical history and is not taking any medications. Physical exam reveals a bro... | Rosettes with small blue cells | {
"A": "Eosinophilic corkscrew fibers",
"B": "Foamy cells and high vascularity",
"C": "Rosettes with small blue cells",
"D": "Tooth enamel-like calcification"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"vomited",
"double vision in school",
"experiencing morning headaches",
"nausea",
"dizziness",
"month",
"past medical history",
"not taking",
"medications",
"Physical exam reveals",
"broad-based gait",
"dysmetria",
"finger",
"nose te... |
A 16-year-old boy is brought to the emergency department following a car accident in which he suffered multiple injuries. He is accompanied by his mother. She reports that his medical history is notable only for recurrent sinusitis and otitis as a child. He lost a significant amount of blood from the accident, and he i... | Administering washed blood products | {
"A": "Pre-transfusion acetaminophen",
"B": "Pre-transfusion diphenhydramine",
"C": "Administering type-specific blood",
"D": "Administering washed blood products"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department following",
"car accident",
"suffered multiple injuries",
"mother",
"reports",
"medical history",
"notable only",
"recurrent sinusitis",
"otitis",
"child",
"lost",
"significant amount",
"blood",
"accident",
"transfused two units of",
... |
Three hours after undergoing a total right hip replacement, a 71-year-old woman has tingling around the lips and numbness in her fingertips. Her surgery was complicated by unintentional laceration of the right femoral artery that resulted in profuse bleeding. She appears uncomfortable. Examination shows an adducted thu... | Calcium chelation | {
"A": "Acute kidney injury",
"B": "Calcium chelation",
"C": "Intravascular hemolysis",
"D": "Parathyroid ischemia"
} | step1 | B | [
"Three hours",
"total right hip replacement",
"71 year old woman",
"tingling",
"lips",
"numbness",
"fingertips",
"surgery",
"complicated",
"unintentional laceration of",
"right femoral artery",
"resulted",
"bleeding",
"appears",
"Examination shows",
"adducted thumb",
"extended finger... |
A 34-year-old man presents to the office for evaluation of a lesion on his upper arm that appeared a few months ago and has not healed. A patient appears healthful but has a history of cardiovascular disease. He states that his friend at the industrial ammunition factory where he works told him he should “get it looked... | Squamous cell carcinoma (SCC) | {
"A": "Squamous cell carcinoma (SCC)",
"B": "Actinic keratosis",
"C": "Erysipelas",
"D": "Contact dermatitis"
} | step1 | A | [
"year old man presents",
"office",
"evaluation",
"lesion",
"upper arm",
"appeared",
"few months",
"not healed",
"patient appears healthful",
"history of cardiovascular disease",
"states",
"friend",
"industrial ammunition factory",
"works",
"looked",
"patient admits",
"nausea",
"vom... |
A 30-year-old man is brought to the emergency department with complaints of fevers to 39.0℃ (102.2℉) and diarrhea for the past 12 hours. There is no history of headaches, vomiting, or loss of consciousness. The past medical history is unobtainable because the patient recently immigrated from abroad and has a language b... | Streptococcus pneumoniae | {
"A": "Staphylococcus aureus",
"B": "Streptococcus pneumoniae",
"C": "Neisseria meningitidis",
"D": "Non-typeable H. influenzae"
} | step1 | B | [
"30 year old man",
"brought",
"emergency department",
"complaints",
"fevers",
"0",
"diarrhea",
"past 12 hours",
"history of headaches",
"vomiting",
"loss of consciousness",
"past medical history",
"patient recently",
"language barrier",
"wife",
"husband",
"motor vehicle accident",
... |
A 79-year-old woman is brought to the emergency department by her husband 20 minutes after losing consciousness. She was walking briskly with her husband when she collapsed suddenly. Her husband says that she regained consciousness after 1 minute. She has had episodes of mild chest pain for the past 2 months, especiall... | Dystrophic calcification on the aortic valve | {
"A": "Cystic medial degeneration of the aortic root",
"B": "Infected fibrin aggregates on the tricuspid valve",
"C": "Dystrophic calcification on the aortic valve",
"D": "Granulomatous nodules on the mitral valve"
} | step1 | C | [
"year old woman",
"brought",
"emergency department",
"husband 20 minutes",
"consciousness",
"walking",
"husband",
"collapsed",
"husband",
"regained consciousness",
"minute",
"episodes of mild chest pain",
"past",
"months",
"working",
"garden",
"Physical examination shows",
"grade",... |
A researcher is studying receptors that respond to epinephrine in the body and discovers a particular subset that is expressed in presynaptic adrenergic nerve terminals. She discovers that upon activation, these receptors will lead to decreased sympathetic nervous system activity. She then studies the intracellular sec... | Dopamine receptors in the brain | {
"A": "Aldosterone receptors in the kidney",
"B": "Dopamine receptors in the brain",
"C": "Growth hormone receptors in the musculoskeletal system",
"D": "Vasopressin receptors in the kidney"
} | step1 | B | [
"researcher",
"studying receptors",
"epinephrine",
"body",
"discovers",
"subset",
"presynaptic adrenergic nerve terminals",
"discovers",
"activation",
"receptors",
"lead",
"decreased activity",
"then studies",
"intracellular second messenger changes",
"occur",
"receptor",
"activated"... |
A 33-year-old man comes to the emergency department because of a dry mouth and blurred vision for the past 30 minutes. Prior to this, he was on a road trip and started to feel nauseous, dizzy, and fatigued, so his friend gave him a drug that had helped in the past. Physical examination shows dry mucous membranes and di... | Oxybutynin | {
"A": "Oxycodone",
"B": "Oxybutynin",
"C": "Phenylephrine",
"D": "Loratadine"
} | step1 | B | [
"year old man",
"emergency department",
"dry mouth",
"blurred vision",
"past 30 minutes",
"road trip",
"started to feel nauseous",
"dizzy",
"fatigued",
"friend gave",
"drug",
"helped",
"past",
"Physical examination shows dry mucous membranes",
"dilated pupils",
"examination shows",
"... |
An inconsolable mother brings her 2-year-old son to the emergency room after finding a large amount of bright red blood in his diaper, an hour ago. She states that for the past week her son has been having crying fits while curling his legs towards his chest in a fetal position. His crying resolves either after vomitin... | Failure of the vitelline duct to close | {
"A": "Failure of the vitelline duct to open",
"B": "Failure of the vitelline duct to close",
"C": "Problem with bilirubin conjugation",
"D": "Elevated anti-mitochondrial uptake"
} | step1 | B | [
"mother",
"her 2 year old son",
"emergency room",
"finding",
"large amount",
"bright red blood",
"diaper",
"hour",
"states",
"past week",
"son",
"crying fits",
"legs",
"chest",
"fetal position",
"crying resolves either",
"vomiting",
"fecal material",
"Currently",
"child",
"ap... |
A 25-year-old man is brought to the emergency department by police for abnormal behavior in a mini-market. The patient was found passed out in the aisle, and police were unable to arouse him. The patient has a past medical history of alcohol abuse and is not currently taking any medications according to his medical rec... | Miosis | {
"A": "Conjunctival hyperemia",
"B": "Hyperactive bowel sounds",
"C": "Miosis",
"D": "Mydriasis"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"police",
"abnormal behavior",
"mini market",
"patient",
"found passed out",
"police",
"unable",
"patient",
"past medical history of alcohol abuse",
"not currently taking",
"medications according",
"medical records",
"temperature",
"... |
An 8-year-old boy with asthma is brought to the physician because of a 2-week history of facial pain and congestion. His mother states that the nasal discharge was initially clear, but it has become thicker and more purulent over the last week. He has tried multiple over-the-counter oral decongestants and antihistamine... | Viral upper respiratory tract infection | {
"A": "Nasal polyps",
"B": "Viral upper respiratory tract infection",
"C": "Asthma",
"D": "Recent use of antihistamines\n\""
} | step2&3 | B | [
"year old boy",
"asthma",
"brought",
"physician",
"2-week history",
"facial pain",
"congestion",
"mother states",
"nasal discharge",
"initially clear",
"thicker",
"more purulent",
"week",
"multiple over-the-counter oral decongestants",
"antihistamines",
"minimal relief",
"Current med... |
A 76-year-old woman is brought to the physician because of lesions on her left arm. She first noticed them 3 months ago and they have grown larger since that time. She has not had any pain or pruritus in the area. She has a history of invasive ductal carcinoma of the left breast, which was treated with mastectomy and r... | Angiosarcoma | {
"A": "Thrombophlebitis",
"B": "Angiosarcoma",
"C": "Melanoma",
"D": "Kaposi sarcoma"
} | step1 | B | [
"76 year old woman",
"brought",
"physician",
"of lesions",
"left arm",
"first",
"3 months",
"larger",
"time",
"not",
"pain",
"pruritus",
"area",
"history of invasive ductal carcinoma",
"the left breast",
"treated with mastectomy",
"radiation therapy 27 years",
"time",
"lymphedema... |
A 39-year-old female presents to the clinic with the complaints of dry skin for a few months. She adds that she also has constipation for which she started eating vegetables and fruits but with no improvement. She lives with her husband and children who often complain when she turns the air conditioning to high as she ... | Amiodarone | {
"A": "Digoxin",
"B": "Amiodarone",
"C": "Theophylline",
"D": "Warfarin"
} | step2&3 | B | [
"year old female presents",
"clinic",
"complaints",
"dry skin",
"few months",
"adds",
"constipation",
"started eating vegetables",
"fruits",
"improvement",
"lives with",
"husband",
"children",
"often",
"turns",
"air conditioning",
"high",
"low temperatures",
"gained 5",
"last v... |
A 62-year-old man with a past medical history of previous myocardial infarction, angina, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, and below knee amputation has developed new chest pain. His medication includes insulin, hydrochlorothiazide, lisinopril, metoprolol, daily aspirin, ator... | Coronary artery bypass grafting (CABG) | {
"A": "Coronary artery bypass grafting (CABG)",
"B": "Heparin",
"C": "Extended release nitrate therapy",
"D": "Angioplasty with stent placement"
} | step2&3 | A | [
"man",
"past medical history of",
"myocardial infarction",
"angina",
"hypertension",
"hyperlipidemia",
"diabetes mellitus",
"peripheral vascular disease",
"below knee amputation",
"new chest pain",
"medication includes insulin",
"hydrochlorothiazide",
"lisinopril",
"metoprolol",
"daily a... |
A newborn infant is born at 41 weeks gestation to a healthy G1P0 mother. The delivery was complicated by shoulder dystocia. The infant is in the 89th and 92th percentiles for height and weight, respectively. The mother's past medical history is notable for diabetes mellitus and obesity. Immediately after birth, the chi... | C5 and C6 nerve roots | {
"A": "C5 and C6 nerve roots",
"B": "C5, C6, and C7 nerve roots",
"C": "Musculocutaneous nerve only",
"D": "Suprascapular nerve only"
} | step1 | A | [
"newborn infant",
"born",
"weeks gestation",
"healthy",
"mother",
"delivery",
"complicated",
"shoulder dystocia",
"infant",
"percentiles",
"height",
"weight",
"mother's past medical history",
"notable",
"diabetes mellitus",
"obesity",
"Immediately",
"birth",
"child's temperature"... |
Activation of the renin-angiotensin-aldosterone system yields a significant physiological effect on renal blood flow and filtration. Which of the following is most likely to occur in response to increased levels of Angiotensin-II? | Decreased renal plasma flow, increased filtration fraction | {
"A": "Increased renal plasma flow, decreased filtration fraction",
"B": "Increased renal plasma flow, increased filtration fraction",
"C": "Decreased renal plasma flow, decreased filtration fraction",
"D": "Decreased renal plasma flow, increased filtration fraction"
} | step1 | D | [
"Activation",
"renin-angiotensin-aldosterone system",
"significant physiological effect",
"renal blood flow",
"filtration",
"following",
"most likely to occur",
"response",
"increased levels",
"Angiotensin-II"
] |
A 57-year-old woman presents to her family physician because of sinusitis and nasal drainage for 3 months. The nasal drainage is purulent and occasionally hemorrhagic. She has only temporary improvement after trying multiple over the counter medications. Over the last 2 weeks, she also has fatigue and joint pain, mainl... | Granulomatosis with polyangiitis | {
"A": "Churg-Strauss syndrome",
"B": "Granulomatosis with polyangiitis",
"C": "Immunoglobulin A nephropathy",
"D": "Sarcoidosis"
} | step2&3 | B | [
"57 year old woman presents",
"family physician",
"sinusitis",
"nasal drainage",
"months",
"nasal drainage",
"purulent",
"occasionally hemorrhagic",
"only temporary improvement",
"multiple over the counter medications",
"last",
"weeks",
"fatigue",
"joint pain",
"affecting",
"ankles",
... |
A 64-year-old male presents to the emergency room complaining of chest pain. He reports a pressure-like sensation over his sternum that radiates into his jaw. The pain came on suddenly 2 hours ago and has been constant since then. His past medical history is notable for a stable abdominal aortic aneurysm, hypertension,... | Friction rub | {
"A": "Friction rub",
"B": "Intra-cardiac shunt",
"C": "Mitral insufficiency",
"D": "Ventricular fibrillation"
} | step1 | A | [
"64 year old male presents",
"emergency room",
"of chest pain",
"reports",
"pressure",
"sensation",
"sternum",
"radiates",
"jaw",
"pain",
"hours",
"constant",
"then",
"past medical history",
"notable",
"stable abdominal aortic aneurysm",
"hypertension",
"diabetes",
"hyperlipidemi... |
A 69-year-old woman is rushed to the emergency room by her daughter after she found her unconscious. Bruises are visible on the patient’s torso and limbs, and it is evident that she has epistaxis. Her daughter says that the patient was diagnosed with immune thrombocytopenic purpura at 61 years of age and has not had a ... | Administration of intravenous immunoglobulins | {
"A": "Platelet transfusion",
"B": "Administration of intravenous immunoglobulins",
"C": "Continuation of corticosteroids",
"D": "Stem cell transplantation"
} | step1 | B | [
"69 year old woman",
"rushed",
"emergency room",
"daughter",
"found",
"unconscious",
"Bruises",
"visible",
"patients torso",
"limbs",
"evident",
"epistaxis",
"daughter",
"patient",
"diagnosed",
"immune thrombocytopenic purpura",
"61 years",
"age",
"not",
"normal thrombocyte cou... |
A 9-year-old girl is admitted to the hospital with a one-day history of acute abdominal pain and vomiting. She also has a two-day history of fever, headache, and neck pain. Her immunizations are up-to-date. She is confused and oriented only to place and person. Her temperature is 39.7°C (103.5°F), pulse is 148/min, blo... | Adrenal hemorrhage | {
"A": "Pancreatitis",
"B": "Adrenal hemorrhage",
"C": "Vesicular skin eruptions",
"D": "Temporal lobe inflammation"
} | step2&3 | B | [
"year old girl",
"admitted",
"hospital",
"one-day history",
"acute abdominal pain",
"vomiting",
"two day history",
"fever",
"headache",
"neck pain",
"immunizations",
"date",
"confused",
"oriented only to place",
"person",
"temperature",
"pulse",
"min",
"blood pressure",
"90 50 ... |
A 48-year-old woman comes to the physician because of a 6-month history of muscle stiffness, myalgia, and a 7-kg (15-lb) weight gain. Her last menstrual period was 4 months ago. Physical examination shows cold, dry skin, and proximal muscle weakness. Deep tendon reflexes are 2+ bilaterally, with delayed relaxation. The... | Thyroid function tests | {
"A": "Thyroid function tests",
"B": "Muscle biopsy",
"C": "Serum electrolytes",
"D": "Repetitive nerve stimulation"
} | step1 | A | [
"48 year old woman",
"physician",
"month history",
"muscle stiffness",
"myalgia",
"kg",
"weight gain",
"last menstrual period",
"4 months",
"Physical examination shows cold",
"dry skin",
"proximal muscle weakness",
"Deep tendon reflexes",
"2",
"delayed relaxation",
"creatine kinase lev... |
A 73-year-old man presents to the emergency department with acute substernal chest pain that began a few hours ago. The pain is described as a “pressure” that radiates to his left arm. His past medical history is significant for hypertension and hyperlipidemia. He is on chlorthalidone for his hypertension and simvastat... | Papillary muscle rupture | {
"A": "Ventricular wall aneurysm",
"B": "Restrictive pericarditis",
"C": "Papillary muscle rupture",
"D": "Arrhythmia"
} | step1 | C | [
"year old man presents",
"emergency department",
"acute",
"chest pain",
"began",
"few hours",
"pain",
"described",
"pressure",
"radiates",
"left arm",
"past medical history",
"significant",
"hypertension",
"hyperlipidemia",
"chlorthalidone",
"hypertension",
"simvastatin",
"hyperl... |
A 31-year-old woman is brought to the emergency department for a severe throbbing headache, nausea, and photophobia for 3 hours. She has severe occipital pain and chest tightness. Prior to onset of symptoms, she had attended a networking event where she had red wine and, shortly after, a snack consisting of salami and ... | Phenelzine | {
"A": "Ibuprofen",
"B": "Verapamil",
"C": "Phenelzine",
"D": "Topiramate"
} | step2&3 | C | [
"31 year old woman",
"brought",
"emergency department",
"severe throbbing",
"nausea",
"photophobia",
"hours",
"severe occipital pain",
"chest tightness",
"Prior to onset",
"symptoms",
"attended",
"networking event",
"red wine",
"snack consisting",
"salami",
"dried fruits",
"patient... |
A group of scientists is verifying previous research on DNA replication. The diagram below illustrates the theoretical DNA replication process in bacteria such as E. coli. Which of the following enzymes would need to be decreased to prevent the removal of RNA primers formed in the lagging strand? | DNA polymerase I 5’ to 3’ exonuclease activity | {
"A": "Helicase",
"B": "DNA polymerase I 3’ to 5’ exonuclease activity",
"C": "DNA polymerase I 5’ to 3’ exonuclease activity",
"D": "DNA ligase"
} | step1 | C | [
"A group",
"scientists",
"verifying previous research",
"DNA replication",
"diagram",
"theoretical DNA replication process",
"bacteria",
"E",
"coli",
"following enzymes",
"need to",
"decreased to prevent",
"removal",
"RNA primers formed",
"lagging strand"
] |
A 58-year-old man is brought to the emergency department by his family because of severe upper back pain, which he describes as ripping. The pain started suddenly 1 hour ago while he was watching television. He has hypertension for 13 years, but he is not compliant with his medications. He denies the use of nicotine, a... | Intravenous esmolol | {
"A": "Emergency surgical intervention",
"B": "Oral metoprolol and/or enalapril",
"C": "Sublingual nitroglycerin",
"D": "Intravenous esmolol"
} | step2&3 | D | [
"58 year old man",
"brought",
"emergency department",
"family",
"severe upper",
"ripping",
"pain started",
"hour",
"watching television",
"hypertension",
"years",
"not compliant",
"medications",
"denies",
"use of nicotine",
"alcohol",
"illicit drugs",
"temperature",
"36",
"97",... |
A 22-year-old man comes to the physician because of several episodes of painless bloody urine over the past 6 months. The episodes are not related to physical activity. He has had frequent nosebleeds since early childhood and an episode of heavy bleeding after a tooth extraction one year ago. He smokes one pack of ciga... | Intraarticular iron deposition | {
"A": "Evasive behavior when asked about the hematomas",
"B": "Palpable spleen below the left costal margin",
"C": "Intraarticular iron deposition",
"D": "Hemosiderin-laden alveolar macrophages\n\""
} | step2&3 | C | [
"year old man",
"physician",
"of several episodes",
"painless bloody urine",
"past 6 months",
"episodes",
"not related",
"physical activity",
"frequent nosebleeds",
"early childhood",
"episode of heavy bleeding",
"tooth extraction one year ago",
"smokes one pack",
"cigarettes daily",
"dr... |
A 45-year-old man comes to the physician because of a 3-week history of progressive diarrhea and a 2.2-kg (5-lb) weight loss. During the past week, he has had six small bloody stools daily. He is employed as a sales manager and regularly flies to South America. He has HIV, gastroesophageal reflux disease, and hypertens... | Cytomegalovirus | {
"A": "Cytomegalovirus",
"B": "Hepatitis A virus",
"C": "Adverse effect of medications",
"D": "Cryptosporidium parvum"
} | step2&3 | A | [
"year old man",
"physician",
"3 week history",
"progressive diarrhea",
"2.2 kg",
"5",
"weight loss",
"past week",
"six small bloody daily",
"employed",
"sales manager",
"flies",
"South America",
"HIV",
"gastroesophageal reflux disease",
"hypertension",
"Current medications include ch... |
A 43-year-old female presents to her primary care physician complaining of a gradually enlarging neck mass. She reports that she first developed a firm nodular midline mass on the anterior aspect of her neck two months ago. She is otherwise healthy and takes no medications. A fine-needle aspiration is performed and a h... | Papillary thyroid carcinoma | {
"A": "Medullary thyroid carcinoma",
"B": "Follicular thyroid carcinoma",
"C": "Papillary thyroid carcinoma",
"D": "B-cell lymphoma"
} | step1 | C | [
"year old female presents",
"primary care physician",
"enlarging neck mass",
"reports",
"first",
"firm nodular midline mass",
"anterior aspect",
"neck two months",
"healthy",
"takes",
"medications",
"fine-needle aspiration",
"performed",
"histological sample",
"specimen",
"shown",
"f... |
A 25-year-old G1P0 female of Middle Eastern descent gives birth to a male infant at 38 weeks’ gestation. The child is in the 15th percentile for both height and weight. Over the course of the first six months of the child’s life, he develops multiple severe skin and mucosal infections characterized by dramatically elev... | Rolling | {
"A": "Chemoattraction",
"B": "Rolling",
"C": "Tight adhesion",
"D": "Diapedesis"
} | step1 | B | [
"year old",
"female",
"Middle Eastern descent gives birth",
"male infant",
"weeks gestation",
"child",
"percentile",
"height",
"weight",
"course",
"first six months",
"childs life",
"multiple severe skin",
"mucosal infections characterized",
"elevated white blood cell counts",
"patient... |
A 15-year-old girl is brought to the physician by her mother for a 2-day history of abdominal pain, nausea, vomiting, diarrhea, and decreased appetite. Her last menstrual period was 3 weeks ago. Her temperature is 37.6°C (99.7°F). Abdominal examination shows tenderness to palpation with guarding in the right lower quad... | Lymphatic tissue hyperplasia | {
"A": "Bacterial mesenteric lymphadenitis",
"B": "Pseudomembranous plaque formation in the colon",
"C": "Congenital anomaly of the omphalomesenteric duct",
"D": "Lymphatic tissue hyperplasia"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"mother",
"2-day history",
"abdominal pain",
"nausea",
"vomiting",
"diarrhea",
"decreased appetite",
"last menstrual period",
"3 weeks",
"temperature",
"99",
"Abdominal examination shows tenderness",
"palpation",
"guarding",
"right lower qua... |
A 55-year-old man presents to the emergency department with a headache, blurry vision, and abdominal pain. He states that his symptoms started several hours ago and have been gradually worsening. His temperature is 99.3°F (37.4°C), blood pressure is 222/128 mmHg, pulse is 87/min, respirations are 16/min, and oxygen sat... | Hydroxocobalamin | {
"A": "Amyl nitrite",
"B": "Hydroxocobalamin",
"C": "Insulin",
"D": "Labetalol"
} | step2&3 | B | [
"55 year old man presents",
"emergency department",
"headache",
"blurry vision",
"abdominal pain",
"states",
"symptoms started several hours",
"worsening",
"temperature",
"99",
"4C",
"blood pressure",
"mmHg",
"pulse",
"87 min",
"respirations",
"min",
"oxygen saturation",
"99",
... |
An 18-year-old man presents to his primary care physician with a complaint of excessive daytime sleepiness. He denies any substance abuse or major changes in his sleep schedule. He reports frequently dozing off during his regular daily activities. On further review of systems, he endorses falling asleep frequently with... | Hypothalamus | {
"A": "Thalamus",
"B": "Hippocampus",
"C": "Hypothalamus",
"D": "Midbrain"
} | step1 | C | [
"year old man presents",
"primary care physician",
"complaint",
"excessive daytime sleepiness",
"denies",
"substance abuse",
"major changes",
"sleep schedule",
"reports frequently",
"regular daily activities",
"further review of systems",
"falling asleep frequently",
"sensation",
"room",
... |
A 35-year-old man presents to the primary care office with a recent history of frequent falls. He had been able to walk normally until about a year ago when he started noticing that both of his legs felt weak. He's also had some trouble with feeling in his feet. These 2 problems have caused multiple falls over the last... | Genetic | {
"A": "Autoimmune",
"B": "Genetic",
"C": "Infectious",
"D": "Metabolic"
} | step2&3 | B | [
"35 year old man presents",
"primary care office",
"recent history of frequent falls",
"able to walk",
"year",
"started",
"legs felt weak",
"feeling",
"feet",
"2 problems",
"caused multiple falls",
"year",
"physical exam",
"notable leg",
"foot muscular atrophy",
"4/5 strength",
"bila... |
A 60-year-old man is brought to the emergency department because of a 1-hour history of disorientation and slurred speech. He has a 10-year history of hypertension and hypercholesterolemia. His blood pressure is 210/110 mm Hg, and pulse is 90/min. Once the patient is stabilized, an MRI of the brain is performed, which ... | Flattening of the right nasolabial fold | {
"A": "Flattening of the right nasolabial fold",
"B": "Decreased lacrimation of the left eye",
"C": "Drooping of the left eyelid",
"D": "Inability to raise the right eyebrow\n\""
} | step1 | A | [
"60 year old man",
"brought",
"emergency department",
"hour history",
"disorientation",
"slurred speech",
"a 10 year history of hypertension",
"hypercholesterolemia",
"blood pressure",
"mm Hg",
"pulse",
"90 min",
"patient",
"stabilized",
"MRI of",
"brain",
"performed",
"shows",
"... |
A 5-year-old boy presents to the pediatrician for a well child visit. He is meeting his developmental milestones and is in the 15th percentile for height and 70th percentile for weight. His parents report that he complains of fatiguing easily and having trouble participating in sports. They are concerned he is not gett... | Increased RDW and TIBC | {
"A": "Decreased IGF levels",
"B": "Decreased oxygen saturation when the patient sleeps",
"C": "Decreased vitamin D level",
"D": "Increased RDW and TIBC"
} | step2&3 | D | [
"5 year old boy presents",
"pediatrician",
"well child visit",
"meeting",
"developmental milestones",
"percentile",
"height",
"percentile",
"weight",
"parents report",
"fatiguing easily",
"participating",
"sports",
"concerned",
"not getting",
"sleep",
"state",
"sometimes",
"hear"... |
A 27-year-old man is brought to the emergency department because of a knife wound to his back. His pulse is 110/min, respirations are 14/min, and blood pressure is 125/78 mm Hg. Examination shows a 5-cm deep stab wound at the level of T9. He withdraws the right foot to pain but is unable to sense vibration or whether h... | Posterior spinal artery | {
"A": "Dorsal root",
"B": "Posterior spinal artery",
"C": "Lateral corticospinal tract",
"D": "Artery of Adamkiewicz"
} | step1 | B | [
"27 year old man",
"brought",
"emergency department",
"of",
"knife wound",
"back",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Examination shows",
"5",
"deep stab wound",
"level",
"T9",
"withdraws",
"right",
"pain",
"unable to sense vibration",
"right... |
A 12-year-old girl is brought to the physician because of a 2-hour history of severe epigastric pain, nausea, and vomiting. Her father has a history of similar episodes of abdominal pain and developed diabetes mellitus at the age of 30 years. Abdominal examination shows guarding and rigidity. Ultrasonography of the abd... | Premature activation of trypsinogen | {
"A": "Elevated serum amylase levels",
"B": "Increased β-glucuronidase activity",
"C": "Premature activation of trypsinogen",
"D": "Impaired cellular copper transport"
} | step1 | C | [
"year old girl",
"brought",
"physician",
"2-hour history",
"severe epigastric",
"nausea",
"vomiting",
"father",
"history of similar episodes",
"abdominal pain",
"diabetes mellitus",
"age",
"30 years",
"Abdominal examination shows guarding",
"rigidity",
"Ultrasonography of",
"abdomen ... |
A 24-year-old man is brought to your emergency department under arrest by the local police. The patient was found naked at a busy intersection jumping up and down on top of a car. Interviewing the patient, you discover that he has not slept in 2 days because he does not feel tired. He reports hearing voices. The patien... | Schizoaffective disorder | {
"A": "Schizophrenia",
"B": "Schizotypal disorder",
"C": "Schizoaffective disorder",
"D": "Unipolar mania"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"arrest by",
"local police",
"patient",
"found naked",
"intersection jumping",
"down",
"car",
"Interviewing",
"patient",
"discover",
"not slept",
"2 days",
"not feel tired",
"reports hearing voices",
"patient",
"hospitalized 1 ye... |
A 2-year-old boy is brought to the emergency department with an enlarged left knee. The patient’s parents state that his knee began to swell up a few hours ago while the family was indoors, watching TV. This has never happened before. The boy says his knee hurts when he puts weight on it. Past medical history is unrema... | Desmopressin | {
"A": "Fresh frozen plasma (FFP)",
"B": "Cryoprecipitate",
"C": "Desmopressin",
"D": "vWF product"
} | step2&3 | C | [
"2 year old boy",
"brought",
"emergency department",
"enlarged left knee",
"patients parents state",
"knee began to swell",
"hours",
"family",
"watching TV",
"never happened before",
"boy",
"knee",
"puts weight",
"Past medical history",
"unremarkable",
"born",
"weeks gestation",
"s... |
A 69-year-old man is brought in by his wife with acute onset aphasia for the past 5 hours. The patient’s wife says that they were sitting having dinner when suddenly he was not able to speak. They delayed coming to the hospital because he had a similar episode 2 months ago which resolved within an hour. His past medica... | Mechanical thrombectomy | {
"A": "IV tPA",
"B": "Aspirin",
"C": "Mechanical thrombectomy",
"D": "Mannitol"
} | step2&3 | C | [
"69 year old man",
"brought",
"wife",
"acute onset aphasia",
"past",
"hours",
"patients wife",
"sitting",
"dinner",
"not able",
"speak",
"delayed",
"hospital",
"similar episode",
"months",
"resolved",
"hour",
"past medical history",
"significant",
"hypercholesterolemia",
"man... |
A 23-year-old woman presents with a painful lesion in her mouth. She denies tooth pain, bleeding from the gums, nausea, vomiting, diarrhea, or previous episodes similar to this in the past. She states that her last normal menstrual period was 12 days ago, and she has not been sexually active since starting medical scho... | This lesion is non-contagious but will most likely recur. | {
"A": "This lesion is highly contagious and is due to reactivation of a dormant virus.",
"B": "This lesion is associated with an autoimmune disease characterized by a sensitivity to gluten.",
"C": "This lesion is non-contagious but will most likely recur.",
"D": "This lesion may progress to squamous cell carci... | step1 | C | [
"23 year old woman presents",
"painful lesion",
"mouth",
"denies tooth pain",
"bleeding",
"gums",
"nausea",
"vomiting",
"diarrhea",
"previous episodes similar",
"past",
"states",
"last normal",
"days",
"not",
"sexually active",
"starting medical school",
"years",
"physical examin... |
A 29-year-old woman, gravida 1, para 1, comes to the physician for the evaluation of a painful mass in her left breast for several days. She has no fevers or chills. She has not noticed any changes in the right breast. She has no history of serious illness. Her last menstrual period was 3 weeks ago. She appears anxious... | Fine needle aspiration | {
"A": "Fine needle aspiration",
"B": "Mammogram",
"C": "MRI scan of the left breast",
"D": "Core needle biopsy"
} | step2&3 | A | [
"29 year old woman",
"gravida 1",
"para 1",
"physician",
"evaluation",
"painful mass",
"left breast",
"days",
"fevers",
"chills",
"not",
"changes",
"right",
"history",
"serious illness",
"last menstrual period",
"3 weeks",
"appears anxious",
"temperature",
"98",
"pulse",
"8... |
A 15-month-old girl is brought to the pediatrician by her mother with a history of 3 episodes of breath-holding spells. The patient’s mother says that this is a new behavior and she is concerned. The patient was born at full term by spontaneous vaginal delivery with an uneventful perinatal period. She is also up to dat... | Loss of purposeful use of her hands | {
"A": "Absence seizures",
"B": "Hemiparesis",
"C": "Intention tremor",
"D": "Loss of purposeful use of her hands"
} | step2&3 | D | [
"month old girl",
"brought",
"pediatrician",
"mother",
"history of",
"episodes",
"breath-holding spells",
"patients mother",
"new behavior",
"concerned",
"patient",
"born",
"full term",
"spontaneous vaginal delivery",
"perinatal period",
"date",
"vaccines",
"age",
"months",
"pa... |
A 43-year-old woman presents to the physician with the complaint of worsening fatigue over the past several months. She has found that she requires nearly double the amount of coffee consumption each day to stay awake at work and that despite maintaining a balanced, healthy diet, she has experienced significant weight ... | Galactorrhea | {
"A": "Brisk deep tendon reflexes",
"B": "Diarrhea",
"C": "Galactorrhea",
"D": "Proptosis of the globe"
} | step2&3 | C | [
"year old woman presents",
"physician",
"complaint",
"worsening fatigue",
"past",
"months",
"found",
"nearly double",
"amount",
"coffee consumption",
"day to",
"awake",
"work",
"maintaining",
"balanced",
"healthy",
"significant weight gain",
"blood test confirms",
"presence",
"... |
A 65-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and a dry cough. She has also noticed gradual development of facial discoloration. She has coronary artery disease, hypertension, and atrial fibrillation. She does not remember which medications she takes. Her tem... | Amiodarone | {
"A": "Lisinopril",
"B": "Metoprolol",
"C": "Amiodarone",
"D": "Warfarin"
} | step1 | C | [
"65 year old woman",
"physician",
"of",
"3 month history",
"progressive shortness",
"breath",
"dry cough",
"gradual development",
"facial discoloration",
"coronary artery disease",
"hypertension",
"atrial fibrillation",
"not remember",
"medications",
"takes",
"temperature",
"98",
"... |
A 12-month-old boy is brought to the physician by his mother for a well-child examination. He was delivered at term after an uncomplicated pregnancy. His mother says he is breastfeeding well. He is at the 50th percentile for height and 65th percentile for weight. Physical examination shows no abnormalities. Urinalysis ... | Hexokinase | {
"A": "Aldolase B",
"B": "Galactokinase",
"C": "α-1,6-glucosidase",
"D": "Hexokinase"
} | step1 | D | [
"month old boy",
"brought",
"physician",
"mother",
"well",
"delivered",
"term",
"uncomplicated pregnancy",
"mother",
"breastfeeding well",
"50th percentile",
"height",
"percentile",
"weight",
"Physical examination shows",
"abnormalities",
"Urinalysis shows 3",
"reducing substances"... |
A 15-year-old girl presents with menorrhagia for the last 4 months. The patient’s mother says that she just started getting her period 4 months ago, which have been heavy and prolonged. The patient does recall getting a tooth extracted 3 years ago that was complicated by persistent bleeding afterward. She has no other ... | Partial thromboplastin time (PTT) | {
"A": "Factor IX assay",
"B": "Partial thromboplastin time (PTT)",
"C": "Anti-cardiolipin antibodies",
"D": "Prothrombin time (PT)"
} | step2&3 | B | [
"year old girl presents",
"menorrhagia",
"last",
"months",
"patients mother",
"started getting",
"period",
"months",
"heavy",
"prolonged",
"patient",
"recall getting",
"tooth extracted 3 years",
"complicated",
"persistent bleeding",
"significant past medical history",
"takes",
"cur... |
A 57-year-old man comes to the physician because of a 2-month history of worsening shortness of breath with walking. He has not had any cough, fevers, or recent weight loss. He has hypercholesterolemia, for which he takes simvastatin, but otherwise is healthy. For 35 years he has worked for a demolition company. He has... | Bronchogenic carcinoma
" | {
"A": "Tuberculosis",
"B": "Sarcoidosis",
"C": "Mesothelioma",
"D": "Bronchogenic carcinoma\n\""
} | step2&3 | D | [
"57 year old man",
"physician",
"of",
"2 month history",
"worsening shortness",
"breath",
"walking",
"not",
"cough",
"fevers",
"recent weight loss",
"hypercholesterolemia",
"takes simvastatin",
"healthy",
"35 years",
"worked",
"company",
"smoked 1 pack",
"cigarettes daily",
"pa... |
A 26-year-old woman comes to the physician because of painful paresthesias in her foot. Examination shows decreased sensation in the first interdigital space and a hallux valgus deformity. This patient's paresthesias are most likely caused by compression of which of the following nerves? | Deep peroneal nerve | {
"A": "Superficial peroneal nerve",
"B": "Deep peroneal nerve",
"C": "Sural nerve",
"D": "Medial plantar nerve\n\""
} | step1 | B | [
"year old woman",
"physician",
"of painful paresthesias",
"foot",
"Examination shows decreased sensation",
"first interdigital space",
"hallux",
"patient's paresthesias",
"most likely caused",
"compression of",
"following nerves"
] |
A 34-year-old male is brought to the emergency department by paramedics after being found down on the sidewalk. The paramedics are unable to provide any further history and the patient in unresponsive. On exam, the patient's vitals are: T: 36 deg C, HR: 65 bpm, BP: 100/66, RR: 4, SaO2: 96%. The emergency physician also... | Heroin | {
"A": "Cocaine",
"B": "Marijuana",
"C": "Alcohol",
"D": "Heroin"
} | step2&3 | D | [
"year old male",
"brought",
"emergency department",
"paramedics",
"found",
"sidewalk",
"paramedics",
"unable to provide",
"further history",
"patient",
"unresponsive",
"exam",
"patient's",
"T",
"36 deg",
"65",
"BP",
"100 66",
"96",
"emergency physician",
"observes",
"findin... |
A retrospective study was conducted in a US county in order to determine the frequency of hypodontia (tooth agenesis), the most common craniofacial malformation in humans, as well as to assess the need for an interdisciplinary approach to managing subsequent functional and esthetic sequelae in a target population. Usin... | Period prevalence | {
"A": "Period prevalence",
"B": "Cumulative incidence",
"C": "Incidence rate",
"D": "Attack rate"
} | step1 | A | [
"retrospective study",
"conducted",
"county",
"order to",
"frequency",
"hypodontia",
"tooth agenesis",
"most common craniofacial malformation",
"humans",
"to assess",
"need",
"interdisciplinary approach",
"managing subsequent functional",
"esthetic sequelae",
"target population",
"Usin... |
A child is brought into the emergency room by her mother. Her mother states that the 7-year-old child was playing with their dog, who is up to date on his vaccinations. When the dog started playing more aggressively, the child suffered a bite on the hand with two puncture wounds from the dog's canines. The child is up-... | Pasteurella multocida | {
"A": "Pseudomonas aeruginosa",
"B": "Pasteurella multocida",
"C": "Clostridium tetani",
"D": "Fusobacterium"
} | step2&3 | B | [
"child",
"brought",
"emergency room",
"mother",
"mother states",
"year old child",
"playing",
"dog",
"date",
"vaccinations",
"dog started playing more",
"child suffered",
"bite",
"hand",
"two puncture wounds",
"dog's canines",
"child",
"date",
"vaccinations",
"medical history",... |
A previously healthy 4-year-old boy is brought to the physician because of a 2-day history of fever and swelling of the neck. His mother says that he has been increasingly weak over the past month. He takes no medications. His vaccination history is complete. His temperature is 39.5°C (103.1°F), blood pressure is 115/7... | Acute lymphoid leukemia | {
"A": "Acute lymphoid leukemia",
"B": "Bacterial sepsis",
"C": "Burkitt’s lymphoma",
"D": "Infectious mononucleosis"
} | step2&3 | A | [
"healthy",
"year old boy",
"brought",
"physician",
"2-day history",
"fever",
"swelling of the neck",
"mother",
"weak",
"past month",
"takes",
"medications",
"vaccination history",
"complete",
"temperature",
"blood pressure",
"70 mm Hg",
"pulse",
"min",
"respiratory rate",
"mi... |
A 4-month-old male infant is brought to the physician by his father because of swelling of his left hemiscrotum. He has otherwise been healthy and is gaining weight appropriately. Physical examination shows a nontender left scrotal mass that transilluminates. The mass increases in size when the boy cries but is easily ... | Patent processus vaginalis | {
"A": "Lack of testicular fixation",
"B": "Germ cell neoplasia",
"C": "Sperm collection in epididymal duct",
"D": "Patent processus vaginalis"
} | step1 | D | [
"4 month old male infant",
"brought",
"physician",
"father",
"swelling",
"left hemiscrotum",
"healthy",
"gaining weight",
"Physical examination shows",
"nontender left scrotal mass",
"mass increases in size",
"boy cries",
"easily reducible",
"following",
"most likely underlying cause",
... |
A 19-year-old woman presents to the family medical center with a 2-week history of a sore throat. She says that she has felt increasingly tired during the day and has a difficult time staying awake during her classes at the university. She appears well-nourished with a low energy level. Her vital signs include the foll... | Positive monospot test | {
"A": "Positive monospot test",
"B": "Positive rapid strep test",
"C": "Increased transaminase levels",
"D": "Growth in Loffler’s medium"
} | step2&3 | A | [
"year old woman presents",
"family medical center",
"2-week history",
"sore throat",
"felt",
"tired",
"day",
"difficult time",
"awake",
"classes",
"university",
"appears well-nourished",
"low energy level",
"vital signs include",
"following",
"heart rate",
"min",
"respiratory rate"... |
A 64-year-old man is brought to the emergency department because of a 2-hour history of nausea, vomiting, and retrosternal pain that radiates to the back. Abdominal examination shows tenderness to palpation in the epigastric area. A CT scan of the patient's chest is shown. Which of the following is the most likely diag... | Esophageal rupture | {
"A": "Esophageal rupture",
"B": "Pulmonary embolism",
"C": "Pneumothorax",
"D": "Aspiration pneumonia"
} | step1 | A | [
"64 year old man",
"brought",
"emergency department",
"2-hour history",
"nausea",
"vomiting",
"retrosternal pain",
"radiates",
"back",
"Abdominal examination shows tenderness",
"palpation",
"epigastric area",
"CT scan of",
"patient's chest",
"shown",
"following",
"most likely diagnos... |
A 45-year-old woman comes to the emergency department because of abdominal cramping, vomiting, and watery diarrhea for the past 4 hours. One day ago, she went to a seafood restaurant with her family to celebrate her birthday. Three of the attendees have developed similar symptoms. The patient appears lethargic. Her tem... | Vibrio parahaemolyticus | {
"A": "Campylobacter jejuni",
"B": "Vibrio parahaemolyticus",
"C": "Listeria monocytogenes",
"D": "Salmonella enterica"
} | step1 | B | [
"year old woman",
"emergency department",
"abdominal cramping",
"vomiting",
"watery diarrhea",
"past 4 hours",
"One day",
"seafood restaurant",
"family to",
"Three",
"similar symptoms",
"patient appears lethargic",
"temperature",
"following organisms",
"most likely responsible",
"patie... |
A 25-year-old woman comes to the physician because of recurrent episodes of reddish discoloration of her urine. She also has a 3-month history of intermittent abdominal pain, yellowish discoloration of the skin and eyes, and fatigue. Physical examination shows pallor and scleral icterus. The spleen is not palpable. Her... | Absence of protective factors against destruction by complement | {
"A": "Activation and consumption of platelets and coagulation factors",
"B": "Absence of protective factors against destruction by complement",
"C": "Formation of IgG antibodies against glycoprotein IIb/IIIa",
"D": "Replacement of a single amino acid in a β-globin chain\n\""
} | step1 | B | [
"year old woman",
"physician",
"recurrent episodes",
"discoloration",
"urine",
"3 month history",
"intermittent abdominal pain",
"discoloration of",
"skin",
"eyes",
"fatigue",
"Physical examination shows pallor",
"scleral icterus",
"spleen",
"not palpable",
"hemoglobin concentration",
... |
A 47-year-old male presents to the emergency department with facial swelling and trouble breathing. These symptoms began this morning and progressively worsened over the past several hours. Vital signs are as follows: T 37.7, HR 108, BP 120/76, RR 20, and SpO2 96%. Physical examination reveals nonpitting swelling of th... | Deficiency of C1 esterase inhibitor | {
"A": "Defective lysosomal storage proteins",
"B": "Lack of NADPH oxidase",
"C": "Defect in cytoskeletal glycoprotein",
"D": "Deficiency of C1 esterase inhibitor"
} | step1 | D | [
"year old male presents",
"emergency department",
"facial swelling",
"trouble breathing",
"symptoms began",
"morning",
"worsened",
"past",
"hours",
"Vital signs",
"follows",
"T",
"BP",
"76",
"RR 20",
"96",
"Physical examination reveals nonpitting swelling of",
"face",
"hands",
... |
A 23-year-old man comes to the emergency department with palpitations, sweating, and shortness of breath that began 10 minutes ago. He says, “Please help me, I don't want to die.” He has experienced several similar episodes over the past 2 months, which occurred without warning in situations including open spaces or cr... | Oral alprazolam | {
"A": "Oral propranolol",
"B": "Oral buspirone",
"C": "Oral alprazolam",
"D": "Long-term ECG monitoring"
} | step1 | C | [
"23 year old man",
"emergency department",
"palpitations",
"sweating",
"shortness of breath",
"began 10 minutes",
"help",
"I",
"to die",
"similar episodes",
"past",
"months",
"occurred",
"warning",
"including open spaces",
"crowds",
"resolved",
"10 minutes",
"at home",
"much",
... |
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