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 57-year-old man presents with fever and yellow discoloration of the skin for the past 4 days. He denies any recent weight loss or changes in urine or stool color. His past medical history is unremarkable. He admits to drinking about 130 g/day of alcohol and says he has been doing so for the past 25 years. His wife wh... | Mallory-Denk bodies | {
"A": "'Florid' bile duct lesion",
"B": "Steatosis alone",
"C": "Mallory-Denk bodies",
"D": "Hürthle cells"
} | step1 | C | [
"57 year old man presents",
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"130 g day",
"alcohol",
"so",
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Six days after undergoing a thoracic endovascular aortic repair following a high-speed motorcycle accident, a 29-year-old woman develops a fever, cough, and shortness of breath. Serum studies show a sodium concentration of 129 mEq/L. An x-ray of the chest shows a left-sided pleural effusion. Thoracentesis is performed ... | High triglycerides | {
"A": "High triglycerides",
"B": "Antinuclear antibodies",
"C": "High adenosine deaminase",
"D": "High LDH"
} | step1 | A | [
"Six days",
"thoracic endovascular aortic repair following",
"high speed motorcycle accident",
"29 year old woman",
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"shortness of breath",
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"sodium concentration",
"mEq/L",
"x-ray of",
"chest shows",
"left-sided pleural effusion",
"Thoracentesis",
"... |
A 12-year-old boy presents to the emergency department with a swollen and painful knee. He says that he was exploring with his friends when he tripped and hit his knee against the ground. He didn't feel like he hit it very hard but it started swelling and becoming very painful. His mom reports that he has always been p... | Hemophilia A | {
"A": "Bernard-Soulier disease",
"B": "Glanzmann thrombasthenia",
"C": "Hemophilia A",
"D": "Hemophilia B"
} | step1 | C | [
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"very minor trauma",
"others",
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"similar pro... |
A previously healthy 21-year-old man is brought to the emergency department 4 hours after the sudden onset of shortness of breath and pleuritic chest pain. He has smoked 1 pack of cigarettes daily for the past 3 years. He is 188 cm (6.2 ft) tall and weighs 70 kg (154 lb); BMI is 19.8 kg/m2. Physical examination shows d... | Rupture of a subpleural bleb | {
"A": "Embolic occlusion of the pulmonary artery",
"B": "Rupture of a subpleural bleb",
"C": "Infection with gram-positive diplococci",
"D": "Inflammation of the costal cartilage"
} | step1 | B | [
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"6.2 ft",
"tall",
"70 kg",
"BMI",
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"Physical examination shows decreased tactile fremitu... |
A 5-year-old girl brought to the emergency department by her mother with seizures. The blood glucose is 94 mg/dl and the serum calcium is 5.3 mg/dl; however, the PTH levels are low. The medical history includes a delay in achieving developmental milestones. Her mother also says she needs frequent hospital visits due to... | Deletion of the chromosome 22q11 | {
"A": "B cell development failure",
"B": "Lysosomal trafficking regulator gene defect",
"C": "Deletion of the chromosome 22q11",
"D": "Mutation in the WAS gene"
} | step1 | C | [
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A 67-year-old woman comes to the physician because of a 9-month history of progressive fatigue. Examination shows pallor. Her hemoglobin concentration is 8.9 g/dL, mean corpuscular volume is 75 μm3, and serum ferritin is 9 ng/mL. Test of the stool for occult blood is positive. Colonoscopy shows an irregular, bleeding 3... | Villous adenomatous polyp | {
"A": "Submucosal lipomatous polyp",
"B": "Serrated hyperplastic polyp",
"C": "Villous adenomatous polyp",
"D": "Tubular adenomatous polyp"
} | step1 | C | [
"67 year old woman",
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"9 ng mL",
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"positive",
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"irregular",
... |
A 21-year-old woman comes to the physician for the evaluation of dry cough and some chest tightness for the past several weeks. The cough is worse at night and while playing volleyball. She frequently has a runny nose and nasal congestion. Her mother has systemic lupus erythematosus. The patient has smoked one pack of ... | Spirometry | {
"A": "Spirometry",
"B": "Methacholine challenge test",
"C": "CT scan of the chest",
"D": "Laboratory studies"
} | step2&3 | A | [
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"smoked one pack",
"cigarettes da... |
An 8-year-old male presents to his pediatrician with dry, cracking skin on his hands. His mother states that this problem has been getting progressively worse over the past couple of months. During this time period, she has noticed that he also has become increasingly concerned with dirtiness. He tearfully admits to wa... | Tourette's syndrome | {
"A": "Tourette's syndrome",
"B": "Obessive-compulsive personality disorder",
"C": "Delusional disorder",
"D": "Rett's disorder"
} | step1 | A | [
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A 68-year-old man of Mediterranean descent comes to the clinic with complaints of fatigue for the past month. He reports that it is increasingly difficult for him to complete his after-dinner walks as he would get breathless and tired around 10 minutes. He endorses dizziness and an upper respiratory infection last week... | A | {
"A": "A",
"B": "B",
"C": "C",
"D": "E"
} | step2&3 | A | [
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... |
A 50-year-old man with a remote history of intravenous drug use and a past medical history of AIDS presents to his primary care provider with several weeks of productive cough and a mild fever. He was in his normal state of health and slowly started to develop these symptoms. He is hoping to be prescribed an antibiotic... | Community-acquired pneumonia | {
"A": "Aspiration pneumonia",
"B": "Community-acquired pneumonia",
"C": "Disseminated cutaneous infection",
"D": "Pulmonary sequestration"
} | step2&3 | B | [
"50 year old man",
"remote history of intravenous drug use",
"past medical AIDS presents",
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"normal state of health",
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"symptoms",
"hoping to",
"prescribed",
"antibiotic",
"back",
"normal",
"... |
A two-year-old female presents to the pediatrician with her mother for a routine well-child visit. Her mother is concerned that the patient is a picky eater and refuses to eat vegetables. She drinks milk with meals and has juice sparingly. She goes to sleep easily at night and usually sleeps for 11-12 hours. The patien... | Expressive language skills | {
"A": "Fine motor skills",
"B": "Expressive language skills",
"C": "Social and receptive language skills",
"D": "This child is developmentally normal"
} | step2&3 | B | [
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"juice sparingly",
"goes to sleep easily",
"night",
"usually sleeps",
"hours",
"patient",
"tro... |
A 32-year-old woman presents to the office with complaints of frothy urine and swelling in her body that started 6 days ago. She says that she first noticed the swelling in her face that gradually involved other parts of her body. On further questioning, she gives a history of rheumatoid arthritis for 2 years. She is t... | Membranous nephropathy | {
"A": "Lipoid nephrosis",
"B": "Minimal change disease",
"C": "Membranous nephropathy",
"D": "Diabetic glomerulonephropathy"
} | step1 | C | [
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"further questioning",
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"history of rheumatoid arthritis",
"2 years",
"taking Penicillamine",
"Methotrexate",... |
A 32-year-old man with a history of alcohol binge drinking and polysubstance use is found down in his hotel room with bottles of alcohol, oxycodone, alprazolam, amphetamine-dextroamphetamine, and tadalafil. When EMS arrives, he appears comatose with pinpoint pupils and oxygen saturation of 80% on room air. He is intuba... | Opioids | {
"A": "Alcohol",
"B": "Opioids",
"C": "Benzodiazepines",
"D": "Amphetamines"
} | step1 | B | [
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"tadalafil",
"appears comatose",
"pinpoint pupils",
"oxygen",
"80",
"room air",
"intubated",
"nearest inten... |
An investigator is studying metabolic processes in cells from a mouse model. She identifies certain cells that are unable to generate enough reducing factor for respiratory burst. Increased production of which of the following substances is most likely to be present in these cells? | Ribose-5-phosphate from fructose-6-phosphate | {
"A": "Ribulose-5-phosphate from glucose-6-phosphate",
"B": "Mevalonate from β-hydroxy-β-methylglutaryl-CoA",
"C": "Ribose-5-phosphate from fructose-6-phosphate",
"D": "6-phosphogluconolactone from glucose-6-phosphate"
} | step1 | C | [
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"reducing factor",
"respiratory burst",
"Increased production",
"following substances",
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A 24-year-old woman comes to the clinic because her period is 4 weeks late, and she is experiencing fatigue and morning nausea. She had her last period almost 8 weeks ago. She is gravida 0 para 0 with previously regular menses and an unremarkable medical history. She had her menarche at the age of 13 years. She has a s... | As the patient’s condition progresses, her estriol levels may rise up to 1000-fold | {
"A": "The venous congestion in the patient’s reproductive organs is due to the influence of estrogens",
"B": "Estrone has the largest blood concentration among the estrogens in this patient",
"C": "In the patient’s condition, blood estrogen level falls dramatically",
"D": "As the patient’s condition progresse... | step1 | D | [
"year old woman",
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"4 weeks late",
"experiencing fatigue",
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"regular menses",
"unremarkable medical history",
"menarche at",
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"years",
"single sexual",
"not use contraception",
"presentation",
... |
A 60-year-old gentleman passes away after a car accident. On routine autopsy it is incidentally noted that he has both a ventral and dorsal pancreatic duct. This incidental finding observed by the pathologist is generated due to failure of which of the following embryological processes? | Fusion | {
"A": "Notochord signaling",
"B": "Apoptosis",
"C": "Fusion",
"D": "Stem cell differentiation"
} | step1 | C | [
"60 year old",
"passes",
"car accident",
"routine autopsy",
"noted",
"ventral",
"dorsal pancreatic duct",
"incidental finding observed",
"pathologist",
"generated due to failure",
"following embryological processes"
] |
A 35-year-old man comes to the physician because of a 6-month history of fatigue and increased sweating at night. He says that he feels “constantly tired” and needs more rest than usual although he sleeps well. In the morning, his sheets are often wet and his skin is clammy. He has not had any sore throat, runny nose, ... | Urolithiasis
" | {
"A": "Hypersensitivity reaction",
"B": "Pancreatitis",
"C": "Chronic kidney disease",
"D": "Urolithiasis\n\""
} | step2&3 | D | [
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"night",
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"needs more rest",
"usual",
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"morning",
"sheets",
"often wet",
"skin",
"clammy",
"not",
"sore throat",
"runny nose",
"cough recently",
"not traveled",
"pa... |
A 57-year-old man comes to the physician with a 3-month history of right flank pain. Urinalysis shows 60 RBC/hpf. Renal ultrasound shows a 3 cm, well-defined mass in the upper pole of the right kidney. A photomicrograph of a section of the resected mass is shown. Which of the following is the most likely diagnosis? | Oncocytoma | {
"A": "Clear cell renal carcinoma",
"B": "Oncocytoma",
"C": "Nephroblastoma",
"D": "Angiomyolipoma"
} | step1 | B | [
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"physician",
"3 month history",
"right flank pain",
"Urinalysis shows 60 RBC/hpf",
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"photomicrograph",
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"shown",
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] |
A 40-year-old man comes to the physician because of a 6-week history of increasing shortness of breath, fatigue, and fever. He has had a cough productive of foul-smelling sputum for 4 weeks. He was hospitalized for alcohol intoxication twice over the past 6 months. He has hypertension and depression. He has smoked one ... | Clindamycin therapy | {
"A": "Bronchoscopy and drainage of the lesion",
"B": "Sputum cultures",
"C": "Metronidazole therapy",
"D": "Clindamycin therapy"
} | step2&3 | D | [
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"4 weeks",
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"alcohol intoxication twice",
"past 6 months",
"hypertension",
"depression",
"smoked one pack",
"cigare... |
A 16-year-old girl presents to the emergency department complaining of acute bilateral lower quadrant abdominal pain. She states she is nauseous and reports a 24-hour history of multiple episodes of vomiting. She admits to having unprotected sex with multiple partners. Her temperature is 102.0°F (38.9°C). Physical exam... | Cefoxitin and doxycycline | {
"A": "Cefoxitin and doxycycline",
"B": "Levofloxacin and metronidazole",
"C": "Metronidazole",
"D": "Fluconazole"
} | step2&3 | A | [
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"temperature",
"Physical examination reveals bilateral lower quadrant ... |
A 45-year-old man is brought to the emergency department by ambulance after vomiting blood. The patient reports that he only ate a small snack the morning before and had not eaten anything for over 24 hours. At the hospital, the patient is stabilized. He is admitted to a surgical floor and placed on NPO with a nasogast... | Fructose-1,6-bisphosphatase | {
"A": "Glycogen phosphorylase",
"B": "Glucose-6-phosphate dehydrogenase",
"C": "Fructose-1,6-bisphosphatase",
"D": "Glyceraldehyde-3-phosphate dehydrogenase"
} | step1 | C | [
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"... |
A 41-year-old man is admitted to the emergency room after being struck in the abdomen by a large cement plate while transporting it. On initial assessment by paramedics at the scene, his blood pressure was 110/80 mm Hg, heart rate 85/min, with no signs of respiratory distress. On admission, the patient is alert but in ... | Emergency laparotomy | {
"A": "CT scan",
"B": "Diagnostic peritoneal lavage (DPL)",
"C": "Emergency laparotomy",
"D": "Emergency laparoscopy"
} | step2&3 | C | [
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"heart rate 85 min",
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"On admission",
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"distress",
"severe... |
The incidence of a relatively benign autosomal recessive disease, X, is 1 in 25 in the population. Assuming that the conditions for Hardy Weinberg Equilibrium are met, what is the probability that a male and female, who are carriers, will have a child expressing the disease? | 1/4 | {
"A": "1/4",
"B": "1/5",
"C": "4/5",
"D": "8/25"
} | step1 | A | [
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A 67-year-old male presents to his primary care physician complaining of left hip pain for the past six months. He denies any trauma or recent falls. He is accompanied by his wife who reports that he has experienced progressive hearing loss over the same time period. The patient has also noticed that he is no longer ab... | Elevated serum alkaline phosphatase | {
"A": "Elevated serum parathyroid hormone",
"B": "Decreased serum calcium",
"C": "Elevated serum alkaline phosphatase",
"D": "Decreased serum alkaline phosphatase"
} | step1 | C | [
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"denies",
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"patient",
"longer able to fit",
"hat",
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"radiograph",
"patients pelvis",
"shown",
"... |
A 19-year-old male is brought to the emergency department by his roommate for 'strange' behavior over the last 48 hours. The patient states that he is hearing voices speak to him, giving him secret messages and instructions to carry out. He believes that the FBI is following him and spying on his conversations. The pat... | Risperidone | {
"A": "Sertraline",
"B": "Risperidone",
"C": "Chlorpromazine",
"D": "Psychotherapy"
} | step2&3 | B | [
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A 68-year-old man presents to the emergency department with left lower quadrant abdominal pain and fever for 1 day. He states during this time frame he has had weight loss and a decreased appetite. The patient had surgery for a ruptured Achilles tendon 1 month ago and is still recovering but is otherwise generally heal... | CT abdomen | {
"A": "Ceftriaxone and metronidazole",
"B": "Ciprofloxacin and metronidazole",
"C": "CT abdomen",
"D": "MRI abdomen"
} | step2&3 | C | [
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"1 day",
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"decreased appetite",
"patient",
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"ruptured Achilles tendon 1 month",
"recovering",
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"blood pressure",
... |
Six days after falling in the shower, a 75-year-old man with COPD is brought to the emergency department because of progressively worsening left-sided chest pain and shortness of breath. He has smoked one pack of cigarettes daily for 50 years. His temperature is 36.5°C (97.7°F), pulse is 110/min, respirations are 30/mi... | Blood in the pleural space | {
"A": "Air between the pleura and chest wall",
"B": "Bacteria in the pulmonary parenchyma",
"C": "Fluid in alveoli",
"D": "Blood in the pleural space"
} | step1 | D | [
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"50 years",
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"97",
"pulse",
"min",
"respirations",
"30/min",
"bloo... |
A 12-month-old boy is brought to the emergency department by his mother for several hours of crying and severe abdominal pain, followed by dark and bloody stools in the last hour. The mother reports that she did not note any vomiting or fevers leading up to this incident. She does report that the boy and his 7-year-old... | Hyperplasia of Peyer patches | {
"A": "Failure of neural crest migration",
"B": "Hyperplasia of Peyer patches",
"C": "Intestinal mass",
"D": "Vascular malformation"
} | step1 | B | [
"month old boy",
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"stomach bugs"... |
A 24-year-old man comes to the physician because of severe lower back pain for the past 2 days. The pain is constant and non-radiating, and he describes it as 7 out of 10 in intensity. The pain began after he helped a friend move into a new apartment. Three weeks ago, he was diagnosed with urethritis and was treated wi... | Analgesia and regular activity | {
"A": "Analgesia and regular activity",
"B": "MRI of the spine",
"C": "Measurement of serum HLA-B27",
"D": "Spinal traction"
} | step2&3 | A | [
"year old man",
"physician",
"of severe lower back pain",
"past 2 days",
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"constant",
"non radiating",
"out",
"10",
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"pain began",
"helped",
"friend move",
"new apartment",
"Three weeks",
"diagnosed",
"urethritis",
"treated with azithromycin",
"ceftriaxone",
... |
A 55-year-old man with known coronary artery disease presents to the ED with epigastric pain, worsening fatigue, and melena. He takes aspirin and rosuvastatin, but took ibuprofen over the past two weeks for lower back pain. He denies nausea, vomiting, hematemesis, chest pain, fever, and weight loss. Sitting blood press... | threshold does not matter | {
"A": "threshold does not matter",
"B": "< 10",
"C": "< 8",
"D": "< 7"
} | step2&3 | A | [
"55 year old man",
"known coronary artery disease presents",
"ED",
"epigastric pain",
"worsening fatigue",
"melena",
"takes aspirin",
"rosuvastatin",
"took ibuprofen",
"past two weeks",
"lower back pain",
"denies nausea",
"vomiting",
"hematemesis",
"chest pain",
"fever",
"weight loss... |
A 61-year-old farmer comes to the physician because of a 3-month history of progressively worsening cough and shortness of breath. He has had a 7.5-kg (16.5-lb) weight loss during this period. He smokes occasionally and does not drink alcohol. Physical examination shows clubbing of the fingers. End-inspiratory crackles... | IgG-mediated immune complex deposition | {
"A": "Aspergillus-induced eosinophil release",
"B": "Silica-induced macrophage activation",
"C": "IgG-mediated immune complex deposition",
"D": "IgE-mediated histamine release"
} | step1 | C | [
"61 year old farmer",
"physician",
"3 month history",
"worsening cough",
"shortness of breath",
"7.5 kg",
"weight loss",
"period",
"smokes occasionally",
"not drink alcohol",
"Physical examination shows clubbing of the fingers",
"End inspiratory crackles",
"heard",
"lower lung fields",
"... |
A 57-year-old man comes to the emergency department because he has been having problems seeing over the last week. He says that he has been seeing specks in his vision and his vision also becomes blurry when he tries to focus on objects. He says that he cannot recall anything that may have precipitated this; however, h... | Cidofovir | {
"A": "Cidofovir",
"B": "Foscarnet",
"C": "Ganciclovir",
"D": "Oseltamivir"
} | step1 | A | [
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... |
One day after a 4700-g (10-lb 6-oz) male newborn is delivered to a 28-year-old primigravid woman, the newborn has bluish discoloration of the lips and fingernails. His temperature is 37.3°C (99.1°F), pulse is 166/min, respirations are 63/min, and blood pressure is 68/44 mm Hg. Pulse oximetry on room air shows an oxygen... | Elevated hemoglobin A1c | {
"A": "Increased serum TSH",
"B": "Prenatal lithium intake",
"C": "Positive rapid plasma reagin test",
"D": "Elevated hemoglobin A1c"
} | step2&3 | D | [
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A 36-year-old woman gravida 5, para 4 was admitted at 31 weeks of gestation with worsening fatigue and shortness of breath on exertion for the past month. She also has nausea and loss of appetite. No significant past medical history. The patient denies any smoking history, alcohol or illicit drug use. Her vital signs i... | Folate deficiency | {
"A": "Vitamin B12 deficiency",
"B": "Iron deficiency anemia",
"C": "Folate deficiency",
"D": "Aplastic anemia"
} | step2&3 | C | [
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A 78-year-old Caucasian male actor presents to your office complaining of a dry, non-productive cough. He has a history of hypertension, diabetes, and coronary artery disease and he follows a complicated regimen of medications to treat his multiple co-morbidities. Which of the following medications is most likely to be... | Lisinopril | {
"A": "Aspirin",
"B": "Lisinopril",
"C": "Hydrochlorothiazide",
"D": "Nifedipine"
} | step1 | B | [
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An investigator studying viral mutation isolates a virus strain from the gastric contents of an infant with gastroenteritis. This virus has a nonenveloped RNA genome with 11 segments and a helical symmetrical capsid. The investigator finds that if 2 strains of this virus coinfect a single host cell, some of the resulti... | Orthomyxoviruses | {
"A": "Flaviviruses",
"B": "Orthomyxoviruses",
"C": "Picornaviruses",
"D": "Retroviruses"
} | step1 | B | [
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Please refer to the summary above to answer this question
Administration of which of the following is most likely to improve this patient's current symptoms?"
"Patient information
Age: 82 years
Gender: M, self-identified
Ethnicity: Caucasian
Site of care: office
History
Reason for Visit/Chief Concern: “I have been gett... | Vitamin C | {
"A": "Vitamin C",
"B": "Vitamin A",
"C": "Vitamin B6",
"D": "Vitamin K\n\""
} | step2&3 | A | [
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A 53-year-old woman comes to the emergency department because of weakness and abdominal pain for 24 hours. She has had three bowel movements with dark stool during this period. She has not had vomiting and has never had such episodes in the past. She underwent a tubal ligation 15 years ago. She has chronic lower extrem... | Esophagogastroduodenoscopy | {
"A": "CT scan of the abdomen with contrast",
"B": "Colonoscopy",
"C": "Flexible sigmoidoscopy",
"D": "Esophagogastroduodenoscopy"
} | step2&3 | D | [
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A 66-year-old woman with no significant past medical, past surgical, or family history presents with new symptoms of chest pain, an oral rash, and pain with swallowing. She lost her husband several months earlier and has moved into an elderly assisted living community. She states that her symptoms began several weeks e... | CD4 count | {
"A": "Single contrast esophagram with barium sulfate contrast",
"B": "Denture fitting assessment",
"C": "CD4 count",
"D": "Single contrast esophagram with water soluble iodine contrast"
} | step2&3 | C | [
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"Physical examina... |
A 33-year-old man presents to the emergency department with a fever and fatigue. He states that he has not felt well since he returned from a hiking trip in Alabama. He is generally healthy and has no other medical conditions. His temperature is 101°F (38.3°C), blood pressure is 127/85 mmHg, pulse is 108/min, respirati... | Ehrlichiosis | {
"A": "Ehrlichiosis",
"B": "Influenza",
"C": "Lyme disease",
"D": "Rocky mountain spotted fever"
} | step2&3 | A | [
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A 42-year-old woman comes to the physician for evaluation of a 6-month history of irregular menstrual periods. Her last period was 3 months ago. Previously, her periods occurred at regular 28-day intervals and lasted 4–5 days with moderate flow. She has also noticed breast tenderness and scant nipple discharge. She has... | Blockade of pituitary dopamine receptors | {
"A": "Dysregulation of theca and granulosa cell steroidogenesis",
"B": "Reduced renal elimination of prolactin",
"C": "Impaired production and release of thyroxine",
"D": "Blockade of pituitary dopamine receptors"
} | step1 | D | [
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"moderate flow",
"breast tenderness",
"scant nipple discharge",
"type 2 diabetes mellitus",
"refra... |
A 15-year-old boy is brought to the physician by his mother for a well-child examination. He recently stopped attending his swim classes. The patient is at the 97th percentile for height and the 50th percentile for weight. Examination shows decreased facial hair, bilateral breast enlargement, and long extremities. Geni... | 47,XXY | {
"A": "47,XYY",
"B": "45,XO",
"C": "47,XXY",
"D": "45,XO/46,XX"
} | step1 | C | [
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"long extremities",
"Genital examination sh... |
A 14-year-old girl comes to the physician for exertional leg pain. The pain began last week when she started jogging to lose weight. She is at the 5th percentile for height and 80th percentile for weight. Physical examination shows a broad neck with bilateral excess skin folds that extend to the shoulders, as well as a... | Ovarian dysgenesis | {
"A": "Ovarian dysgenesis",
"B": "Absent uterus",
"C": "Mitral valve prolapse",
"D": "Horseshoe adrenal gland"
} | step1 | A | [
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... |
A 5-year-old boy is brought to the physician because of recurrent respiratory infections and difficulty walking for 2 months. Physical examination shows numerous telangiectasias on the nose, ears, and neck. There is overshoot on the finger-to-nose test. He has a narrow-based gait. Genetic analysis shows a nonsense muta... | 3'ACC5' | {
"A": "3'AUU5'",
"B": "3'UAC5'",
"C": "3'ACC5'",
"D": "3'AUC5'"
} | step1 | C | [
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"ataxia-telangiectas... |
An 8-year-old child with “elfin” facial features is very friendly with strangers. He has a history of mild mental retardation, and a hemizygous deletion on chromosome 7q11.23, that includes a portion of the elastin gene. Which of the following is most likely true in this patient? | Symptoms may develop secondary to left ventricular outflow tract obstruction | {
"A": "Carpopedal spasm induced by sphygmomanometer inflation",
"B": "Vitamin D supplementation is recommended",
"C": "Symptoms may develop secondary to left ventricular outflow tract obstruction",
"D": "This patient is less likely to experience angina"
} | step1 | C | [
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A study aimed to evaluate the relationship between inflammatory markers and lipid metabolism in individuals with rheumatoid arthritis (RA) recruited 252 patients with RA in a tertiary care hospital. Fasting blood samples were taken for lipid profiling and for the assessment of inflammatory markers such as C-reactive pr... | r value lies between 0 and -1 | {
"A": "r value is exactly +1",
"B": "r value lies between 0 and +1",
"C": "r value is exactly 0",
"D": "r value lies between 0 and -1"
} | step1 | D | [
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A 29-year-old woman, gravida 1, para 0, at 33 weeks' gestation comes to her doctor for a routine visit. Her pregnancy has been uncomplicated. She has systemic lupus erythematosus and has had no flares during her pregnancy. She does not smoke cigarettes, drink alcohol, or use illicit drugs. Current medications include i... | Induction of labor | {
"A": "Perform cesarean delivery",
"B": "Discontinue hydroxychloroquine and continue close monitoring",
"C": "Induction of labor",
"D": "Reassurance with expectant management"
} | step2&3 | C | [
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"Current medications include iron",
"vitamin suppl... |
A 15-year-old girl is brought to the physician by her parents because she has not had menstrual bleeding for the past 2 months. Menses had previously occurred at irregular 15–45 day intervals with moderate to heavy flow. Menarche was at the age of 14 years. Eight months ago, she was diagnosed with bipolar disorder and ... | Anovulatory cycles | {
"A": "Primary ovarian insufficiency",
"B": "Anovulatory cycles",
"C": "Uterine leiomyomas",
"D": "Adverse effect of medication"
} | step1 | B | [
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A 52-year-old man is brought to the emergency department because of headaches, vertigo, and changes to his personality for the past few weeks. He was diagnosed with HIV 14 years ago and was started on antiretroviral therapy at that time. Medical records from one month ago indicate that he followed his medication schedu... | CNS lymphoma | {
"A": "AIDS dementia",
"B": "CNS lymphoma",
"C": "Progressive multifocal leukoencephalopathy",
"D": "Glioblastoma\n\""
} | step2&3 | B | [
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A 52-year-old man comes to the physician because of right shoulder pain that began after he repainted his house 1 week ago. Physical examination shows right subacromial tenderness. The pain is reproduced when the patient is asked to abduct the shoulder against resistance with the arm flexed forward by 30° and the thumb... | Supraspinatus | {
"A": "Supraspinatus",
"B": "Infraspinatus",
"C": "Teres minor",
"D": "Deltoid"
} | step1 | A | [
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A 19-year-old woman presents to the primary care clinic to establish care. She has no acute complaints or concerns. Upon further questioning, she shares that she gets frequent nosebleeds and often bleeds from her gums a little after brushing her teeth. She also typically has relatively heavy menstrual periods, soaking ... | Perform platelet aggregation tests | {
"A": "Perform bone marrow biopsy",
"B": "Start corticosteroids",
"C": "Start intravenous immunoglobulin",
"D": "Perform platelet aggregation tests"
} | step2&3 | D | [
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A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. Sh... | Bipolar disorder type I | {
"A": "Delusional disorder",
"B": "Bipolar disorder type II",
"C": "Bipolar disorder type I",
"D": "Attention-deficit hyperactivity disorder"
} | step1 | C | [
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A previously healthy 6-year-old girl is brought to the physician by her parents because of slowed growth and fatigue. Over the past year, she went from average height for her age group to the shortest in her class. She has also been having more problems concentrating in class and is less interested in playing. She has ... | Lymphocytic infiltration on fine needle aspiration | {
"A": "Lymphocytic infiltration on fine needle aspiration",
"B": "Positive serum thyroid stimulating hormone receptor antibody",
"C": "Increased uptake on I-131 scan in a discrete 1-cm nodule",
"D": "Low urine iodine levels\n\""
} | step2&3 | A | [
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A 5-year-old non-verbal child with a history of autism is brought into the emergency department by his grandmother. The patient’s grandmother is concerned her grandchild is being abused at home. The patient lives in an apartment with his mother, step-father, and two older brothers in low-income housing. The department ... | Mother | {
"A": "Mother",
"B": "Step-father",
"C": "Brother",
"D": "Neighbor"
} | step2&3 | A | [
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BACKGROUND:
Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by... | 0.15 | {
"A": "0.15",
"B": "0.17",
"C": "0.13",
"D": "0.21"
} | step2&3 | A | [
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A 20-year-old woman comes to the physician for the evaluation of fatigue and low energy levels for 2 months. She has not had fever or weight changes. She has no history of serious illness except for an episode of infectious mononucleosis 4 weeks ago. Menses occur at regular 28-day intervals and last 5 days with moderat... | Iron studies | {
"A": "Iron studies",
"B": "Vitamin B12 levels",
"C": "Hemoglobin electrophoresis",
"D": "Peripheral blood smear"
} | step2&3 | A | [
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A 15-year-old boy is brought to the clinic by his father for complaints of “constant irritation.” His father explains that ever since his divorce with the son’s mother last year he has noticed increased irritability in his son. "He has been skipping out on his baseball practices which he has always enjoyed,” his dad co... | Escitalopram | {
"A": "Buspirone",
"B": "Escitalopram",
"C": "Quetiapine",
"D": "Venlafaxine"
} | step1 | B | [
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A 12-year-old boy is brought to the emergency room by his mother with complaints of abdominal pain and fever that started 24 hours ago. On further questioning, the mother says that her son vomited twice and has constipation that started approximately 1 and one-half days ago. The medical history is benign. The vital sig... | Luminal obstruction due to a fecalith | {
"A": "Luminal obstruction due to a fecalith",
"B": "Twisting of testes on its axis, hampering the blood supply",
"C": "Ascending infection of the urinary tract",
"D": "Immune-mediated vasculitis associated with IgA deposition"
} | step1 | A | [
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A 32-year-old man comes to the emergency department because of a wound in his foot. Four days ago, he stepped on a nail while barefoot at the beach. Examination of the plantar surface of his right foot shows a purulent puncture wound at the base of his second toe with erythema and tenderness of the surrounding skin. Th... | Superficial inguinal | {
"A": "Deep inguinal",
"B": "Superficial inguinal",
"C": "External iliac",
"D": "Anterior tibial"
} | step1 | B | [
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A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a ... | CT head without intravenous contrast | {
"A": "CT head with intravenous contrast",
"B": "CT head without intravenous contrast",
"C": "MRI head with intravenous constrast",
"D": "MRI head without intravenous constrast"
} | step2&3 | B | [
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A 23-year-old nulligravida presents for evaluation 5 weeks after her last menstrual period. Her previous menstruation cycle was regular, and her medical history is benign. She is sexually active with one partner and does not use contraception. A urine dipstick pregnancy test is negative. The vital signs are as follows:... | Blood human chorionic gonadotropin | {
"A": "Blood estriol",
"B": "Blood progesterone",
"C": "Urinary estrogen metabolites",
"D": "Blood human chorionic gonadotropin"
} | step1 | D | [
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A scientist wants to extract mRNA from a cell line of interest, amplify a specific mRNA, and insert it into a plasmid so that he can transfect it into a cell in order to over-express that protein. Which of the following proteins is required for the first step of amplification of this mRNA? | Reverse transcriptase | {
"A": "Taq DNA polymerase",
"B": "Ligase",
"C": "Reverse transcriptase",
"D": "RNA polymerase"
} | step1 | C | [
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A 33-year-old pregnant woman undergoes a routine quad-screen during her second trimester. The quad-screen results demonstrate the following: decreased alpha-fetoprotein, increased Beta-hCG, decreased estriol, and increased inhibin A. A presumptive diagnosis is made based upon these findings and is later confirmed with ... | Acute lymphoblastic leukemia | {
"A": "Chronic lymphocytic leukemia",
"B": "Acute promyelocytic leukemia",
"C": "Acute lymphoblastic leukemia",
"D": "Chronic myelogenous leukemia"
} | step1 | C | [
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"genetic testing"... |
A 2-year-old girl is brought to her pediatrician’s office with intermittent and severe stomach ache and vomiting for the last 2 days. Last week the whole family had a stomach bug involving a few days of mild fever, lack of appetite, and diarrhea but they have all made a full recovery since. This current pain is differe... | Air enema | {
"A": "Air enema",
"B": "Abdominal CT scan",
"C": "Abdominal radiograph",
"D": "Observe for 24 hours"
} | step2&3 | A | [
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"vomiting",
"days",
"week",
"whole family",
"stomach bug involving",
"few days",
"mild fever",
"lack of appetite",
"diarrhea",
"made",
"full recovery",
"current pain",
"different",
"type"... |
A 23-year-old woman presents to the emergency department with a 3-day history of fever and headache. She says that the symptoms started suddenly after she woke up 3 days ago, though she has been feeling increasingly fatigued over the last 5 months. On presentation, her temperature is 102°F (38.9°C), blood pressure is 1... | Increased serum von Willebrand factor multimers | {
"A": "Decreased platelet aggregation on peripheral blood smear",
"B": "Immune production of anti-platelet antibodies",
"C": "Increased serum von Willebrand factor multimers",
"D": "Large platelets on peripheral blood smear"
} | step1 | C | [
"23 year old woman presents",
"emergency department",
"3-day history",
"fever",
"headache",
"symptoms started",
"woke up 3 days",
"feeling",
"fatigued",
"months",
"presentation",
"temperature",
"blood pressure",
"74 mmHg",
"pulse",
"min",
"respirations",
"min",
"Physical exam rev... |
A 27-year-old healthy college student presents to the clinic with her boyfriend complaining of a productive cough with rust-colored sputum associated with breathlessness for the past week. She also reports symptoms of the common cold which began about 1 week ago. She reports that her weekly routine has not changed desp... | Anthracyclines | {
"A": "Quinidine",
"B": "Anthracyclines",
"C": "Metoprolol",
"D": "Vincristine"
} | step1 | B | [
"27 year old healthy college student presents",
"clinic",
"boyfriend complaining of",
"productive cough",
"rust colored sputum associated with breathlessness",
"past week",
"reports symptoms",
"common",
"began",
"1 week",
"reports",
"weekly routine",
"not changed",
"feelings",
"sick",
... |
A 40-year-old Caucasian woman presents to the physician with urinary frequency, urgency, and pelvic pain for 1 week. She has poor sleep quality because her symptoms persist throughout the night, as well as the day. Her pain partially subsides with urination. She does not have dysuria or urinary incontinence. Her menstr... | Behavior modification | {
"A": "Amitriptyline",
"B": "Behavior modification",
"C": "Bladder hydrodistention",
"D": "Intravesical dimethyl sulfoxide"
} | step2&3 | B | [
"40 year old Caucasian woman presents",
"physician",
"urinary frequency",
"urgency",
"pelvic pain",
"1 week",
"poor",
"symptoms",
"night",
"day",
"pain",
"urination",
"not",
"dysuria",
"urinary incontinence",
"menstrual cycles",
"regular",
"past 6 months",
"several similar episod... |
A mother brings her 6-month-old boy to the emergency department. She reports that her son has been breathing faster than usual for the past 2 days, and she has noted occasional wheezing. She states that prior to the difficulty breathing, she noticed some clear nasal discharge for several days. The infant was born full-... | Monitoring | {
"A": "Azithromycin and ceftriaxone",
"B": "Chest radiograph",
"C": "Intubation",
"D": "Monitoring"
} | step2&3 | D | [
"mother",
"month old boy",
"emergency department",
"reports",
"son",
"breathing faster",
"usual",
"past 2 days",
"noted occasional wheezing",
"states",
"prior to",
"difficulty breathing",
"clear nasal discharge",
"days",
"infant",
"born full-term",
"complications",
"significant med... |
A patient presents to the emergency room in an obtunded state. The patient is a known nurse within the hospital system and has no history of any medical problems. A finger stick blood glucose is drawn showing a blood glucose of 25 mg/dL.
The patient's daughter immediately arrives at the hospital stating that her mothe... | C-peptide level | {
"A": "Genetic testing",
"B": "C-peptide level",
"C": "24 hr cortisol",
"D": "Fasting blood glucose"
} | step1 | B | [
"patient presents",
"emergency room",
"obtunded state",
"patient",
"known nurse",
"hospital system",
"history of",
"medical problems",
"finger stick blood glucose",
"drawn showing",
"blood glucose",
"mg/dL",
"patient's daughter immediately",
"hospital stating",
"mother",
"depressed rec... |
A 38-year-old project manager is told by her boss that her team will need to work on an additional project in the coming week for a very important client. This frustrates the woman, who already feels that she works too many hours. Instead of discussing her feelings directly with her boss, the woman leaves a voice messa... | Passive aggression | {
"A": "Acting out",
"B": "Passive aggression",
"C": "Malingering",
"D": "Blocking"
} | step1 | B | [
"year old project manager",
"boss",
"team",
"need to work",
"additional project",
"week",
"very important client",
"woman",
"feels",
"works",
"hours",
"discussing",
"feelings directly",
"boss",
"woman leaves",
"voice message",
"boss",
"next day",
"to work",
"next week",
"fami... |
An 83-year-old woman with fever, malaise, and cough for the past 24 hours is brought to the emergency department. She lives in an assisted living facility, and several of her neighbors have had similar symptoms. She has a past medical history of hypertension treated with lisinopril. Her temperature is 38.9°C (102.2°F),... | Inhibition of neuraminidase | {
"A": "Inhibition of DNA polymerase",
"B": "Inhibition of neuraminidase",
"C": "Inhibition of nucleoside reverse transcriptase",
"D": "Inhibition of protease"
} | step2&3 | B | [
"83 year old woman",
"fever",
"malaise",
"cough",
"past 24 hours",
"brought",
"emergency department",
"lives in",
"assisted living facility",
"several",
"neighbors",
"similar symptoms",
"past medical treated with lisinopril",
"temperature",
"pulse",
"min",
"respirations",
"min",
... |
A 36-year-old woman presents for a pre-employment health assessment. She has no complaints. Her last annual physical examination 8 months ago was normal. She has no significant past medical history. She is a nonsmoker and says she quit all alcohol consumption last year. A complete hepatic biochemistry panel is performe... | Primary biliary cholangitis | {
"A": "Hepatic amyloidosis",
"B": "Fascioliasis",
"C": "Primary biliary cholangitis",
"D": "Pancreatic cancer"
} | step1 | C | [
"36 year old woman presents",
"pre employment health assessment",
"complaints",
"last annual physical examination",
"months",
"normal",
"significant past medical history",
"nonsmoker",
"quit",
"alcohol consumption",
"year",
"complete hepatic biochemistry panel",
"performed",
"significant",... |
A 60-year-old Caucasian man is brought to the emergency department by his roommate after he reportedly ingested a bottle of Tylenol. He reports being suddenly sad and very lonely and impulsively overdosed on some pills that he had laying around. He then immediately induced vomiting and regurgitated most of the pills ba... | He has a previous attempt | {
"A": "He has a previous attempt",
"B": "He has a plan",
"C": "His race",
"D": "His lack of social support"
} | step2&3 | A | [
"60 year old Caucasian man",
"brought",
"emergency department",
"roommate",
"ingested",
"bottle",
"Tylenol",
"reports",
"sad",
"very lonely",
"overdosed",
"pills",
"laying",
"then immediately induced vomiting",
"regurgitated most of",
"pills back",
"rushed",
"roommate",
"help",
... |
A 59-year-old man is brought to the physician by his wife for a psychiatric evaluation. Over the past 12 months, his behavior has become increasingly disruptive. His wife no longer brings him along shopping because he has attempted to grope a female cashier on 2 occasions. He has begun to address the mail carrier using... | Ubiquitin | {
"A": "Kinesin",
"B": "Cyclin",
"C": "Ubiquitin",
"D": "Clathrin\n\""
} | step1 | C | [
"59 year old man",
"brought",
"physician",
"wife",
"psychiatric evaluation",
"past 12 months",
"behavior",
"disruptive",
"wife",
"longer",
"shopping",
"attempted to",
"female",
"occasions",
"begun to address",
"mail carrier using",
"racial",
"Three years later",
"patient dies",
... |
A 73-year-old man presents to your office accompanied by his wife. He has been experiencing a tremor in his right hand for the last several months that seems to be worsening. He does not have any other complaints and says he’s “fine.” His wife thinks that he has also had more difficulty walking. His history is signific... | Substantia nigra pars compacta | {
"A": "Substantia nigra pars compacta",
"B": "Subthalamic nucleus",
"C": "Caudate and putamen",
"D": "Vermis"
} | step1 | A | [
"year old man presents",
"office",
"wife",
"experiencing",
"tremor",
"right",
"last",
"months",
"to",
"worsening",
"not",
"complaints",
"fine",
"wife thinks",
"more difficulty walking",
"history",
"significant",
"hypertension",
"ischemic stroke",
"right middle cerebral artery",... |
A 42-year-old woman, gravida 3, para 3 comes to the physician because of a 14-month history of prolonged and heavy menstrual bleeding. Menses occur at regular 28-day intervals and last 7 days with heavy flow. She also feels fatigued. She is sexually active with her husband and does not use contraception. Vital signs ar... | Leuprolide | {
"A": "Progestin-only contraceptive pills",
"B": "Leuprolide",
"C": "Levonorgestrel-releasing intrauterine device",
"D": "Tranexamic acid"
} | step2&3 | B | [
"year old woman",
"gravida 3",
"para 3",
"physician",
"month history",
"prolonged",
"heavy menstrual bleeding",
"Menses occur",
"regular",
"day intervals",
"last 7 days",
"heavy flow",
"feels fatigued",
"sexually active",
"husband",
"not use contraception",
"Vital signs",
"normal l... |
A 53-year-old man presents with swelling of the right knee. He says that the pain began the previous night and was reduced by ibuprofen and an ice-pack. The pain persists but is tolerable. He denies any recent fever, chills, or joint pains in the past. Past medical history includes a coronary artery bypass graft (CABG)... | Aspirin | {
"A": "Aspirin",
"B": "Vitamin C",
"C": "Carvedilol",
"D": "Atorvastatin"
} | step1 | A | [
"year old man presents",
"swelling of",
"right knee",
"pain began",
"previous night",
"reduced",
"ibuprofen",
"ice-pack",
"pain",
"tolerable",
"denies",
"recent fever",
"chills",
"joint pains in",
"past",
"medical history includes",
"coronary artery bypass graft",
"year",
"takes ... |
A 26-year-old woman presents with blood in her urine for the past 2 days. She says she has had increasing urinary frequency at night for the past several days and recently noticed a reddish tinge in her urine. She is also concerned that her feet are beginning to swell, and she has been feeling increasingly fatigued for... | Corticosteroids | {
"A": "Corticosteroids",
"B": "Azathioprine",
"C": "Cyclosporine",
"D": "Cyclophosphamide"
} | step1 | A | [
"year old woman presents",
"blood",
"urine",
"past 2 days",
"increasing urinary frequency",
"night",
"past",
"days",
"recently",
"urine",
"concerned",
"feet",
"beginning",
"swell",
"feeling",
"fatigued",
"past week",
"gives",
"history",
"joint pains",
"rashes",
"skin change... |
A physician scientist is looking for a more efficient way to treat HIV. Patients infected with HIV mount a humoral immune response by producing antibodies against the HIV envelope proteins. These antibodies are the same antibodies detected by the ELISA and western blot assays used to diagnose the disease. The physician... | gp120 | {
"A": "gp120",
"B": "CXCR4",
"C": "p24",
"D": "p17"
} | step1 | A | [
"physician scientist",
"looking",
"efficient",
"to treat HIV",
"Patients infected",
"HIV mount",
"humoral immune response",
"antibodies",
"HIV envelope proteins",
"antibodies",
"same antibodies detected",
"ELISA",
"western blot assays used to diagnose",
"disease",
"physician scientist",
... |
A previously healthy 21-year-old man is brought to the emergency department for the evaluation of an episode of unconsciousness that suddenly happened while playing football 30 minutes ago. He was not shaking and regained consciousness after about 30 seconds. Over the past three months, the patient has had several epis... | Abnormal movement of the mitral valve | {
"A": "Abnormal movement of the mitral valve",
"B": "Ventricular septum defect",
"C": "Mitral valve leaflet thickening ≥ 5 mm",
"D": "Reduced left ventricular ejection fraction"
} | step2&3 | A | [
"healthy 21-year-old man",
"brought",
"emergency department",
"evaluation of",
"episode",
"unconsciousness",
"happened",
"playing football 30 minutes",
"not shaking",
"regained consciousness",
"about 30 seconds",
"past three months",
"patient",
"several episodes of shortness",
"breath",
... |
A 1-week-old baby is brought to the pediatrician’s office for a routine checkup. On examination, she is observed to have microcephaly with a prominent occiput. She also has clenched fists and rocker-bottom feet with prominent calcanei. A cardiac murmur is evident on auscultation. Based on the clinical findings, a diagn... | Death within the first year life | {
"A": "Alzheimer’s disease",
"B": "Death within the first year life",
"C": "Cutis aplasia",
"D": "Macroglossia"
} | step2&3 | B | [
"week old baby",
"brought",
"pediatricians office",
"routine checkup",
"examination",
"observed to",
"microcephaly",
"prominent occiput",
"clenched fists",
"rocker-bottom feet",
"prominent calcanei",
"cardiac murmur",
"evident",
"auscultation",
"Based",
"clinical findings",
"diagnosi... |
A 42-year-old biochemist receives negative feedback from a senior associate on a recent project. He is placed on probation within the company and told that he must improve his performance on the next project to remain with the company. He is distraught and leaves his office early. When he gives an account of the episod... | Projection | {
"A": "Projection",
"B": "Transference",
"C": "Displacement",
"D": "Passive aggression"
} | step1 | A | [
"year old biochemist receives negative feedback",
"senior associate",
"recent project",
"placed",
"probation",
"company",
"performance",
"next project to",
"company",
"leaves",
"office early",
"gives",
"account of",
"episode",
"wife",
"I",
"always",
"proud",
"I",
"always",
"b... |
A 43-year-old woman presents to the neurology clinic in significant pain. She reports a sharp, stabbing electric-like pain on the right side of her face. The pain started suddenly 2 weeks ago. The pain is so excruciating that she can no longer laugh, speak, or eat her meals as these activities cause episodes of pain. S... | Trigeminal neuralgia | {
"A": "Bell’s palsy",
"B": "Cluster headache",
"C": "Trigeminal neuralgia",
"D": "Basilar migraine"
} | step2&3 | C | [
"year old woman presents",
"neurology clinic",
"significant pain",
"reports",
"sharp",
"stabbing electric",
"pain",
"right side of",
"face",
"pain started",
"weeks",
"pain",
"so excruciating",
"longer laugh",
"speak",
"eat",
"meals",
"activities cause episodes of pain",
"miss wor... |
During a clinical study on an island with a population of 2540 individuals, 510 are found to have fasting hyperglycemia. Analysis of medical records of deceased individuals shows that the average age of onset of fasting hyperglycemia is 45 years, and the average life expectancy is 70 years. Assuming a steady state of p... | 20 | {
"A": "50",
"B": "10",
"C": "40",
"D": "20"
} | step1 | D | [
"clinical study",
"island",
"population",
"individuals",
"510",
"found to",
"fasting hyperglycemia",
"Analysis",
"medical records",
"deceased individuals shows",
"average age of onset",
"fasting hyperglycemia",
"years",
"average life expectancy",
"70 years",
"steady state",
"populati... |
A 57-year-old woman is brought to the emergency department because of crampy abdominal pain and foul-smelling, watery diarrhea. One week ago, she underwent treatment of cellulitis with clindamycin. She has developed shortness of breath and urticaria after treatment with vancomycin in the past. Her temperature is 38.4°C... | Inhibition of RNA polymerase sigma subunit | {
"A": "Inhibition of cell wall peptidoglycan formation",
"B": "Blocking of protein synthesis at 50S ribosomal subunit",
"C": "Generation of toxic free radical metabolites",
"D": "Inhibition of RNA polymerase sigma subunit"
} | step1 | D | [
"57 year old woman",
"brought",
"emergency department",
"crampy abdominal pain",
"smelling",
"watery diarrhea",
"One week",
"treatment",
"cellulitis",
"clindamycin",
"shortness of breath",
"urticaria after treatment",
"vancomycin",
"past",
"temperature",
"4C",
"Abdominal examination ... |
A 52-year-old woman comes to the physician because of abdominal discomfort, anorexia, and mild fatigue. She has systemic lupus erythematosus and takes hydroxychloroquine. She does not drink alcohol or use illicit drugs. Physical examination shows no abnormalities. Laboratory studies show:
Alanine aminotransferase 455 U... | Tenofovir | {
"A": "Pegylated interferon-gamma",
"B": "Acyclovir",
"C": "Tenofovir",
"D": "Sofosbuvir\n\""
} | step1 | C | [
"year old woman",
"physician",
"abdominal discomfort",
"anorexia",
"mild fatigue",
"systemic lupus erythematosus",
"takes hydroxychloroquine",
"not drink alcohol",
"use illicit",
"Physical examination shows",
"abnormalities",
"Laboratory studies show",
"U",
"Hepatitis B surface antigen pos... |
A 34-year-old man was brought into the emergency room after he was found running in the streets. Upon arrival to the emergency room, he keeps screaming, “they are eating me alive," and swatting his hands. He reports that there are spiders crawling all over him. His girlfriend, who arrives shortly after, claims that he ... | Cocaine use | {
"A": "Cocaine use",
"B": "Narcolepsy",
"C": "Pick disease",
"D": "Schizophrenia"
} | step1 | A | [
"year old man",
"brought",
"emergency room",
"found running in",
"streets",
"arrival",
"emergency room",
"keeps screaming",
"eating",
"alive",
"hands",
"reports",
"spiders crawling",
"girlfriend",
"forgetful",
"forget",
"time",
"time",
"denies weight loss",
"fever",
"shortnes... |
A 4-year-old boy is brought to the pediatrician with fever, diarrhea and bilateral red eye for 7 days. His parents noted that he has never had an episode of diarrhea this prolonged, but several other children at daycare had been ill. His immunization history is up to date. His vitals are normal except for a temperature... | Adenovirus infection | {
"A": "Rotavirus infection",
"B": "C. difficile colitis",
"C": "Adenovirus infection",
"D": "Vibrio parahaemolyticus infection"
} | step2&3 | C | [
"4 year old boy",
"brought",
"pediatrician",
"fever",
"diarrhea",
"bilateral red eye",
"7 days",
"parents noted",
"never",
"episode of diarrhea",
"prolonged",
"several",
"children",
"daycare",
"ill",
"immunization history",
"date",
"normal",
"temperature",
"physical exam",
"s... |
Three hours after the onset of labor, a 39-year-old woman, gravida 2, para 1, at 40 weeks' gestation has sudden worsening of abdominal pain and vaginal bleeding. 18 months ago her first child was delivered by a lower segment transverse cesarean section because of cephalopelvic disproportion. Her temperature is 37.5°C (... | Loss of fetal station | {
"A": "Loss of fetal station",
"B": "Hemodynamic instability",
"C": "Fetal distress",
"D": "Abdominal tenderness"
} | step2&3 | A | [
"Three hours",
"onset of labor",
"year old woman",
"gravida 2",
"para 1",
"40 weeks",
"gestation",
"sudden worsening",
"abdominal pain",
"vaginal bleeding",
"months",
"first child",
"delivered",
"lower segment transverse cesarean",
"cephalopelvic disproportion",
"temperature",
"99",
... |
A 64-year-old man with longstanding ischemic heart disease presents to the clinic with complaints of increasing exercise intolerance and easy fatigability for the past 2 weeks. He further states that he has been experiencing excessive daytime somnolence and shortness of breath with exertion. His wife adds that his shor... | Increased pulmonary artery pressure | {
"A": "Increased pulmonary artery pressure",
"B": "Decreased sympathetic activity",
"C": "Increased partial pressure of oxygen",
"D": "Shortened lung-to-brain circulation time"
} | step1 | A | [
"64 year old man",
"ischemic heart disease presents",
"clinic",
"complaints",
"increasing exercise intolerance",
"easy fatigability",
"past 2 weeks",
"further states",
"experiencing excessive daytime somnolence",
"shortness of breath",
"exertion",
"wife adds",
"shortness of breath",
"more"... |
A 35-year-old woman with a medical history significant for asthma, hypertension, and occasional IV drug use comes to the emergency department with fever. On physical exam, there are findings depicted in figure A, for which the patient cannot account. What test will be most helpful to establish the diagnosis? | Echocardiography | {
"A": "Echocardiography",
"B": "Chest X-ray",
"C": "Electrocardiogram (EKG)",
"D": "CT pulmonary angiography"
} | step1 | A | [
"35 year old woman",
"medical history significant",
"asthma",
"hypertension",
"occasional IV drug use",
"emergency department",
"fever",
"physical exam",
"findings",
"patient",
"account",
"test",
"most helpful to establish",
"diagnosis"
] |
A 72-year-old man is brought to the emergency department because of progressive weakness of his lower extremities and urinary incontinence for the past 3 weeks. Over the past 2 months, he has also had increasing back pain. Physical examination shows an unsteady gait. Muscle strength is decreased in both lower extremiti... | Elevated prostate-specific antigen in the serum | {
"A": "Elevated prostate-specific antigen in the serum",
"B": "Palpable thyroid nodule on neck examination",
"C": "Elevated carcinoembryonic antigen in the serum",
"D": "Irregular, asymmetric mole on skin examination\n\""
} | step1 | A | [
"72 year old man",
"brought",
"emergency department",
"progressive weakness",
"lower extremities",
"urinary incontinence",
"past",
"weeks",
"past",
"months",
"increasing back pain",
"Physical examination shows",
"unsteady gait",
"Muscle strength",
"decreased in",
"lower extremities",
... |
A previously healthy 75-year-old woman comes to the physician because of fatigue and decreasing exercise tolerance over the past 6 weeks. She also has intermittent episodes of dizziness. She has never smoked and does not drink alcohol. She takes a daily multivitamin. She appears pale. Physical examination shows a smoot... | Acute myelocytic leukemia | {
"A": "Sézary syndrome",
"B": "Chronic lymphocytic leukemia",
"C": "Burkitt lymphoma",
"D": "Acute myelocytic leukemia"
} | step2&3 | D | [
"healthy 75 year old woman",
"physician",
"fatigue",
"decreasing exercise tolerance",
"past",
"weeks",
"intermittent episodes of dizziness",
"never smoked",
"not drink alcohol",
"takes",
"daily multivitamin",
"appears pale",
"Physical examination shows",
"smooth liver",
"palpable",
"co... |
A 28-year-old woman has a follow-up visit with her physician. She was diagnosed with allergic rhinitis and bronchial asthma at 11 years of age. Her regular controller medications include daily high-dose inhaled corticosteroids and montelukast, but she still needs to use a rescue inhaler 3–4 times a week following exerc... | Prevention of binding of IgE antibodies to mast cell receptors | {
"A": "Inhibition of synthesis of interleukin-4 (IL-4)",
"B": "Prevention of binding of IgE antibodies to mast cell receptors",
"C": "Selective binding to interleukin-3 (IL-3) and inhibition of its actions",
"D": "Inhibition of synthesis of IgE antibodies"
} | step1 | B | [
"year old woman",
"follow-up visit",
"physician",
"diagnosed",
"allergic rhinitis",
"bronchial asthma",
"years",
"age",
"regular controller medications include daily high inhaled corticosteroids",
"montelukast",
"needs to use",
"inhaler",
"times",
"week following exercise",
"breathless",... |
A 26-year-old woman comes to the physician because of several days of fever, abdominal cramps, and diarrhea. She drank water from a stream 1 week ago while she was hiking in the woods. Abdominal examination shows increased bowel sounds. Stool analysis for ova and parasites shows flagellated multinucleated trophozoites.... | CD40 to CD40 ligand | {
"A": "CD8 to MHC I",
"B": "CD40 to CD40 ligand",
"C": "gp120 to CD4",
"D": "CD80/86 to CTLA-4"
} | step1 | B | [
"year old woman",
"physician",
"several days",
"fever",
"abdominal cramps",
"diarrhea",
"drank water",
"stream 1 week",
"hiking",
"woods",
"Abdominal examination shows increased bowel sounds",
"Stool analysis",
"ova",
"parasites shows flagellated multinucleated trophozoites",
"Further ev... |
A 2-year-old boy is brought in to his pediatrician for a routine checkup. The parents mention that the child has been developing appropriately, although they have been noticing that the child appears to have chronic constipation. The parents report that their child does not routinely have daily bowel movements, and the... | Submucosa | {
"A": "Lamina propria",
"B": "Neural crest layer",
"C": "Outer longitudinal layer of muscularis",
"D": "Submucosa"
} | step1 | D | [
"2 year old boy",
"brought",
"pediatrician",
"routine checkup",
"parents",
"child",
"child appears to",
"chronic constipation",
"parents report",
"child",
"not",
"daily bowel movements",
"abdomen",
"more distended recently",
"past",
"report",
"patient",
"delayed",
"meconium",
"... |
A 60-year-old rock musician presents to the office because he has been feeling increasingly tired for the past 6 months. He has a history of intravenous drug use and alcohol abuse. He states that he feels quite tired, but he otherwise has no complaints. Physical examination is noncontributory. His laboratory values are... | Hepatitis C virus RNA | {
"A": "Hepatitis A virus-specific IgM antibodies",
"B": "Hepatitis C virus RNA",
"C": "Hepatitis D virus-specific IgG antibody",
"D": "Hepatitis E virus-specific IgM antibodies"
} | step2&3 | B | [
"60 year old rock musician presents",
"office",
"feeling",
"tired",
"past 6 months",
"history",
"intravenous drug use",
"alcohol abuse",
"states",
"feels",
"tired",
"complaints",
"Physical examination",
"laboratory values",
"normal",
"moderately elevated",
"following additional tests... |
A 54-year-old male has a history of gout complicated by several prior episodes of acute gouty arthritis and 3 prior instances of nephrolithiasis secondary to uric acid stones. He has a serum uric acid level of 11 mg/dL (normal range 3-8 mg/dL), a 24 hr urine collection of 1300 mg uric acid (normal range 250-750 mg), an... | Probenecid | {
"A": "Colchicine",
"B": "Allopurinol",
"C": "Indomethacin",
"D": "Probenecid"
} | step1 | D | [
"54 year old male",
"history of gout complicated",
"prior episodes of acute gouty arthritis",
"3 prior instances",
"nephrolithiasis secondary to uric acid stones",
"serum uric acid level",
"mg/dL",
"normal range",
"mg/dL",
"hr urine collection of",
"mg uric acid",
"normal range",
"750 mg",
... |
A 16-year-old woman is brought to the emergency department by her family for not being responsive. The patient had locked herself in her room for several hours after breaking up with her boyfriend. When her family found her, they were unable to arouse her and immediately took her to the hospital. The patient has a past... | QRS prolongation | {
"A": "Liver enzyme elevation",
"B": "QRS prolongation",
"C": "QT prolongation",
"D": "Serum drug level"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"family",
"not",
"responsive",
"patient",
"locked",
"room",
"several hours",
"breaking",
"boyfriend",
"family found",
"unable to",
"immediately took",
"hospital",
"patient",
"past medical history of anorexia nervosa",
"treated"... |
After hospitalization for urgent chemotherapy to treat Burkitt’s lymphoma, a 7-year-old boy developed paresthesias of the fingers, toes, and face. Vital signs are taken. When inflating the blood pressure cuff, the patient reports numbness and tingling of the fingers. His blood pressure is 100/65 mm Hg. Respirations are... | Precipitation of uric acid in renal tubules/tumor lysis syndrome | {
"A": "Deposition of calcium phosphate in the kidney",
"B": "Intense renal vasoconstriction and volume depletion",
"C": "Pigment-induced nephropathy",
"D": "Precipitation of uric acid in renal tubules/tumor lysis syndrome"
} | step2&3 | D | [
"hospitalization",
"urgent chemotherapy to treat Burkitts lymphoma",
"year old boy",
"paresthesias of",
"fingers",
"toes",
"face",
"Vital signs",
"taken",
"blood pressure cuff",
"patient reports numbness",
"tingling",
"fingers",
"blood pressure",
"100 65 mm Hg",
"Respirations",
"min"... |
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