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 16-year-old female presents to your clinic concerned that she has not had her menstrual cycle in 5 months. She has not been sexually active and her urine pregnancy test is negative. She states that she has been extremely stressed as she is in the middle of her gymnastics season and trying to get recruited for a colle... | Low bone density | {
"A": "Elevated TSH",
"B": "Normal menstrual cycles",
"C": "Elevated estrogen levels",
"D": "Low bone density"
} | step1 | D | [
"year old female presents",
"clinic concerned",
"not",
"menstrual cycle",
"months",
"not",
"sexually active",
"urine pregnancy test",
"negative",
"states",
"extremely stressed",
"middle",
"gymnastics season",
"to",
"college scholarship",
"Physical exam",
"BMI",
"dorsal hand calluse... |
A 43-year-old male with a history of thyroid cancer status post total thyroidectomy presents to his primary care physician after repeated bouts of headaches. His headaches are preceded by periods of anxiety, palpitations, and sweating. The patient says he is unable to pinpoint any precipitating factors and instead says... | Plasma fractionated metanephrines | {
"A": "Abdominal CT scan with and without IV contrast",
"B": "24-hour urine free cortisol",
"C": "High dose dexamethasone suppression test",
"D": "Plasma fractionated metanephrines"
} | step2&3 | D | [
"year old male",
"history cancer",
"total thyroidectomy presents",
"primary care physician",
"repeated bouts",
"headaches",
"headaches",
"preceded",
"periods",
"anxiety",
"palpitations",
"sweating",
"patient",
"unable to pinpoint",
"precipitating factors",
"events occur",
"warning",
... |
A 25-year-old woman presents to her college campus clinic with the complaint of being unable to get up for her morning classes. She says that, because of this, her grades are being affected. For the past 6 weeks, she says she has been feeling depressed because her boyfriend dumped her. She finds herself very sleepy, sl... | “While taking this medication, you should avoid drinking red wine.” | {
"A": "“While taking this medication, you should avoid drinking red wine.”",
"B": "“While on this medication, you may have a decreased seizure threshold.”",
"C": "“This medication is known to cause anorgasmia during treatment.”",
"D": "“A common side effect of this medication is sedation.”"
} | step1 | A | [
"year old woman presents",
"college",
"clinic",
"complaint",
"unable to get",
"morning classes",
"grades",
"affected",
"past",
"weeks",
"feeling depressed",
"boyfriend dumped",
"finds",
"very sleepy",
"sleeping",
"mornings",
"eating more snacks",
"fast foods",
"feeling drained",
... |
A 9-year-old boy is brought to the physician for evaluation of 2 months of progressive clumsiness, falls, and increased urinary frequency. Physical examination shows bilateral temporal visual field loss. An MRI of the head shows a small calcified suprasellar mass. The patient undergoes surgery with complete removal of ... | Rathke pouch | {
"A": "Rathke pouch",
"B": "Astroglial cells",
"C": "Lactotroph cells",
"D": "Ventricular ependyma"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"evaluation",
"months",
"progressive clumsiness",
"falls",
"increased urinary frequency",
"Physical examination shows bilateral temporal visual field loss",
"MRI of",
"head shows",
"small calcified suprasellar mass",
"patient",
"surgery",
"complete... |
A 27-year-old male is brought to the emergency department with a 1-week history of worsening headache. Over the past 2 days, he has become increasingly confused and developed nausea as well as vomiting. One week ago, he struck his head while exiting a car, but did not lose consciousness. His maternal uncle had a bleedi... | Subdural hematoma | {
"A": "Subgaleal hemorrhage",
"B": "Cerebral sinus venous thrombosis",
"C": "Epidural hematoma",
"D": "Subdural hematoma"
} | step2&3 | D | [
"27 year old male",
"brought",
"emergency department",
"1-week history of worsening headache",
"past 2 days",
"confused",
"nausea",
"vomiting",
"One week",
"struck",
"head",
"exiting",
"car",
"not",
"consciousness",
"maternal uncle",
"bleeding disorder",
"appears",
"moderate dist... |
A 63-year-old woman is brought to the clinic by her husband with complaints of cognitive decline. The patient’s husband says that she has had intermittent problems with her memory for the past few years. He says she has occasional ‘bad days’ where her memory deteriorates to the point where she cannot perform activities... | Rivastigmine | {
"A": "Haloperidol",
"B": "Penicillamine",
"C": "Rivastigmine",
"D": "Ropinirole"
} | step2&3 | C | [
"63 year old woman",
"brought",
"clinic",
"husband",
"complaints",
"cognitive decline",
"patients husband",
"intermittent problems",
"memory",
"past",
"years",
"occasional bad days",
"memory deteriorates",
"point",
"perform activities of daily living",
"sometimes found",
"empty room"... |
A 37-year-old woman presents for prenatal counseling at 18 weeks gestation. The patient tells you that her sister recently had a child with Down's syndrome, and the patient would like prenatal screening for Down's in her current pregnancy.
Which of the following prenatal screening tests and results would raise concern... | Decreased AFP, increased HCG, decreased unconjugated estriol | {
"A": "Increased AFP, normal HCG, normal unconjugated estriol",
"B": "Decreased AFP, increased HCG, decreased unconjugated estriol",
"C": "Normal AFP, increased HCG, decreased unconjugated estriol",
"D": "Normal AFP, decreased HCG, decreased unconjugated estriol"
} | step1 | B | [
"year old woman presents",
"prenatal counseling",
"weeks gestation",
"patient",
"sister recently",
"child",
"Down's syndrome",
"patient",
"prenatal screening",
"current pregnancy",
"following prenatal",
"results",
"concern",
"Down's syndrome"
] |
A 28-year-old woman gives birth to a 2.2 kg child while on vacation. The mother's medical records are faxed to the hospital and demonstrate the following on hepatitis panel: hepatitis B surface antigen (HbsAg) positive, anti-hepatitis B core antigen (anti-HbcAg) positive, hepatitis C RNA is detected, hepatitis C antibo... | Hepatitis B IVIG and vaccine | {
"A": "Hepatitis B IVIG now, hepatitis B vaccine in one month",
"B": "Hepatitis B IVIG, hepatitis B vaccine and ledipisvir/sofosbuvir",
"C": "Hepatitis B IVIG and vaccine",
"D": "Hepatitis B vaccine"
} | step2&3 | C | [
"year old woman gives birth",
"kg child",
"vacation",
"mother's medical records",
"faxed",
"hospital",
"following",
"hepatitis panel",
"hepatitis B surface antigen",
"positive",
"hepatitis B core antigen",
"HbcAg",
"positive",
"hepatitis C RNA",
"detected",
"hepatitis C antibody",
"r... |
A 19-year-old woman presents to the emergency department with chronic diarrhea, fatigue, and weakness. She also had mild lower extremity edema. On examination, she was noted to be pale. Blood testing revealed peripheral eosinophilia (60%) and a Hb concentration of 8 g/dL. The stool examination revealed Fasciolopsis bus... | Praziquantel | {
"A": "Bethional",
"B": "Praziquantel",
"C": "Niclosamide",
"D": "Oxamniquine"
} | step1 | B | [
"year old woman presents",
"emergency department",
"chronic diarrhea",
"fatigue",
"weakness",
"mild lower extremity edema",
"examination",
"noted to",
"pale",
"Blood revealed peripheral eosinophilia",
"60",
"Hb concentration",
"8 g dL",
"stool examination revealed Fasciolopsis buski eggs",... |
An investigator studying influenza virus variability isolates several distinct influenza virus strains from the respiratory secretions of a study subject. Mass spectrometry analysis of one strain shows that it expresses neuraminidase on its surface. Subsequent sequencing of this strain shows that its genome lacks the n... | Phenotypic mixing | {
"A": "Transduction",
"B": "Reassortment",
"C": "Phenotypic mixing",
"D": "Complementation"
} | step1 | C | [
"investigator studying influenza virus variability isolates several",
"influenza virus strains",
"respiratory secretions",
"study subject",
"Mass spectrometry analysis",
"one",
"shows",
"neuraminidase",
"surface",
"Subsequent sequencing",
"strain shows",
"genome lacks",
"neuraminidase gene",... |
A 67-year-old male presents with left hip pain. Examination reveals mild effusions in both knees, with crepitus in both patellofemoral joints. He states his hearing has worsened recently and that he feels like his hats don't fit anymore. Bone scan reveals diffuse uptake in the calvarium, right proximal femur, and left ... | Increased serum alkaline phosphatase | {
"A": "Decreased serum alkaline phosphatase",
"B": "Increased serum alkaline phosphatase",
"C": "Decreased serum parathyroid hormone",
"D": "Increased serum calcium"
} | step2&3 | B | [
"67 year old male presents",
"left",
"Examination reveals mild effusions",
"knees",
"crepitus",
"joints",
"states",
"hearing",
"worsened recently",
"feels",
"hats",
"fit",
"Bone scan reveals diffuse uptake",
"calvarium",
"right proximal femur",
"left ilium",
"following laboratory abn... |
A 21-year-old G2P1 woman presents to the clinic and is curious about contraception immediately after her baby is born. She is anxious about taking care of one child and does not believe that she can handle the responsibility of caring for another. She has no other questions or complaints today. Her past medical history... | Transdermal contraceptive patch | {
"A": "Norethindrone",
"B": "Copper IUD",
"C": "Levonorgestrel IUD",
"D": "Transdermal contraceptive patch"
} | step2&3 | D | [
"21-year-old",
"woman presents",
"clinic",
"curious",
"contraception immediately",
"baby",
"born",
"anxious",
"care",
"one child",
"not",
"handle",
"responsibility",
"caring",
"questions",
"complaints today",
"past medical history consists",
"generalized anxiety disorder",
"antit... |
A 1-year-old girl born to a 40-year-old woman is undergoing an examination by a pediatric resident in the hospital. The pregnancy was uneventful and there were no complications during the delivery. The physical examination reveals midface hypoplasia with a flat nasal bridge and upslanting palpebral fissures. She has a ... | Meiotic non-disjunction | {
"A": "Meiotic non-disjunction",
"B": "Uniparental disomy",
"C": "Genomic imprinting",
"D": "Partial deletion"
} | step1 | A | [
"year old girl born",
"40 year old woman",
"examination",
"pediatric resident",
"hospital",
"pregnancy",
"complications",
"delivery",
"physical examination reveals midface hypoplasia",
"flat nasal bridge",
"upslanting palpebral fissures",
"small mouth",
"chest auscultation reveals",
"blowi... |
A 25-year-old man presents to the clinic with a midline swelling in his neck. He is unsure about when it appeared. He denies any difficulty with swallowing or hoarseness. His past medical history is insignificant. On physical examination, there is a 1 cm x 2 cm firm mildly tender nodule on the anterior midline aspect o... | Midline endoderm of the pharynx | {
"A": "1st and 2nd pharyngeal arch",
"B": "4th pharyngeal arch",
"C": "4th pharyngeal pouch",
"D": "Midline endoderm of the pharynx"
} | step1 | D | [
"year old man presents",
"clinic",
"midline swelling",
"neck",
"unsure",
"appeared",
"denies",
"difficulty",
"swallowing",
"hoarseness",
"past medical history",
"physical examination",
"a",
"2",
"firm mildly tender nodule",
"anterior midline aspect",
"neck",
"moves",
"deglutition... |
A 13-year-old girl presents after losing consciousness during class 30 minutes ago. According to her friends, she was doing okay since morning, and nobody noticed anything abnormal. The patient’s mother says that her daughter does not have any medical conditions. She also says that the patient has always been healthy b... | DR3 | {
"A": "A3",
"B": "B8",
"C": "DR3",
"D": "B27"
} | step1 | C | [
"year old girl presents",
"consciousness",
"class 30 minutes",
"friends",
"morning",
"abnormal",
"patients mother",
"daughter",
"not",
"medical conditions",
"patient",
"always",
"healthy",
"recently lost weight",
"eating",
"usual",
"vital signs",
"blood pressure",
"100",
"mm Hg... |
A 58-year-old woman comes to the physician because of a 3-month history of recurring chest discomfort. The symptoms occur when walking up the stairs to her apartment or when walking quickly for 5 minutes on level terrain. She has not had shortness of breath, palpitations, or dizziness. She has hypertension and hyperlip... | Metoprolol and amlodipine | {
"A": "Metoprolol and amlodipine",
"B": "Metoprolol and rosuvastatin",
"C": "Estrogen and hydrochlorothiazide",
"D": "Estrogen and amlodipine"
} | step2&3 | A | [
"58 year old woman",
"physician",
"3 month history",
"recurring chest discomfort",
"symptoms occur",
"walking",
"stairs",
"apartment",
"walking",
"5 minutes",
"level",
"not",
"shortness of breath",
"palpitations",
"dizziness",
"hypertension",
"hyperlipidemia",
"Current medications ... |
A 13-year-old boy presents with several light brown macules measuring 4–5 cm located on his trunk. He has no other medical conditions, but his mother has similar skin findings. He takes no medications, and his vital signs are within normal limits. Ophthalmic examination findings are shown in the image below. What is th... | Neurofibroma | {
"A": "Acoustic neuroma",
"B": "Dermatofibroma",
"C": "Neurofibroma",
"D": "Retinoblastoma"
} | step1 | C | [
"year old boy presents",
"light brown macules measuring",
"trunk",
"medical conditions",
"mother",
"similar skin findings",
"takes",
"medications",
"vital signs",
"normal limits",
"Ophthalmic examination findings",
"shown",
"image",
"most likely neoplasm",
"child"
] |
A 23-year-old woman is brought to the emergency room by her mother after she is found to have cut both of her wrists with razor blades. The patient admits to a history of self-mutilation and attributed this incident to a recent breakup with a man she had been seeing for the previous 2 weeks. On morning rounds, the pati... | Dialectical behavior therapy | {
"A": "Amitriptyline",
"B": "Cognitive behavioral therapy",
"C": "Dialectical behavior therapy",
"D": "Fluoxetine"
} | step2&3 | C | [
"23 year old woman",
"brought",
"emergency room",
"mother",
"found to",
"cut",
"wrists",
"razor blades",
"patient admits",
"history of self-mutilation",
"attributed",
"incident",
"recent",
"man",
"seeing",
"previous 2 weeks",
"morning rounds",
"patient reports",
"nurses",
"inco... |
A 16-year-old boy is brought to the emergency department by ambulance with a visible deformity of the upper thigh after being involved in a motor vehicle collision. He is informed that he will require surgery and is asked about his medical history. He mentions that he had surgery to remove his tonsils several years ago... | Atropine | {
"A": "Atropine",
"B": "Echothiophate",
"C": "Epinephrine",
"D": "Methacholine"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"ambulance",
"visible deformity of",
"upper thigh",
"involved",
"motor vehicle collision",
"informed",
"surgery",
"medical history",
"surgery to remove",
"tonsils",
"years",
"time suffered",
"complication",
"surgery",
"surgery bega... |
A 47-year-old male presents to his primary care physician complaining of upper abdominal pain. He reports a four-month history of gnawing epigastric discomfort that improves with meals. He has lost 10 pounds over that same period. His past medical history is significant for a prolactinoma for which he underwent transph... | Elevated fasting serum gastrin that increases with secretin administration | {
"A": "Normal fasting serum gastrin",
"B": "Elevated fasting serum gastrin that decreases with secretin administration",
"C": "Elevated fasting serum gastrin that decreases with cholecystokinin administration",
"D": "Elevated fasting serum gastrin that increases with secretin administration"
} | step1 | D | [
"year old male presents",
"primary care physician",
"upper abdominal pain",
"reports",
"four month history",
"gnawing epigastric discomfort",
"improves",
"meals",
"lost 10 pounds",
"same period",
"past medical history",
"significant",
"prolactinoma",
"transphenoidal resection",
"not smok... |
A 65-year-old man presents to the emergency department with a fever and weakness. He states his symptoms started yesterday and have been gradually worsening. The patient has a past medical history of obesity, diabetes, alcohol abuse, as well as a 30 pack-year smoking history. He lives in a nursing home and has presente... | Colonoscopy | {
"A": "Addiction medicine referral",
"B": "Colonoscopy",
"C": "Replace the patient’s central line and repeat echocardiography",
"D": "Social work consult for elder abuse"
} | step2&3 | B | [
"65 year old man presents",
"emergency department",
"fever",
"weakness",
"states",
"symptoms started",
"worsening",
"patient",
"past medical",
"diabetes",
"alcohol abuse",
"30 pack-year smoking history",
"lives in a nursing home",
"presented multiple times",
"past",
"ulcers",
"deliri... |
A 32-year-old man is brought to the emergency department by the police for examination. The police have reason to believe he may have swallowed a large number of cocaine-containing capsules during an attempt to smuggle the drug across the border. They request an examination of the patient to determine if this is actual... | Explain the risk of internal rupture to the patient | {
"A": "Examine the patient without his consent",
"B": "Explain the risk of internal rupture to the patient",
"C": "Obtain an abdominal X-ray",
"D": "Request a court order from the police"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"police",
"examination",
"police",
"reason to",
"swallowed",
"large number",
"cocaine containing capsules",
"attempt to",
"drug",
"border",
"request",
"examination of",
"patient to",
"case",
"patient",
"history",
"serious illne... |
A 10-year-old boy presents to the emergency department with his parents. The boy complains of fever, neck stiffness, and drowsiness for the last several days. His past medical history is noncontributory. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is mee... | Inhibition of DNA polymerase | {
"A": "Binding with ergosterol in the cell membrane",
"B": "Inhibition of DNA polymerase",
"C": "Nucleoside reverse transcriptase inhibition",
"D": "Cell wall synthesis inhibition"
} | step1 | B | [
"A 10 year old boy presents",
"emergency department",
"parents",
"boy",
"fever",
"neck stiffness",
"drowsiness",
"days",
"past medical history",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"sick contac... |
A 52-year-old man is seen by his endocrinologist for routine followup of his type 2 diabetes. Although he has previously been on a number of medication regimens, his A1C has remained significantly elevated. In order to try to better control his glucose level, the endocrinologist prescribes a new medication. He explains... | Canagliflozin | {
"A": "Canagliflozin",
"B": "Exenatide",
"C": "Glyburide",
"D": "Metformin"
} | step1 | A | [
"year old man",
"seen by",
"endocrinologist",
"routine followup of",
"type",
"diabetes",
"number",
"medication regimens",
"A1C",
"elevated",
"order to",
"to better control",
"glucose level",
"endocrinologist",
"new medication",
"new medication works",
"blocking",
"ability",
"kidn... |
A 56-year-old African-American man comes to the physician for intermittent episodes of dark urine and mild flank pain. The patient has had 3 episodes of frank reddish discoloration of his urine within 1 month. He has chronic headaches and back pain for which he has been taking aspirin and ibuprofen daily for 1 year. Th... | Renal papillary ischemia | {
"A": "Purulent renal inflammation",
"B": "Renal reperfusion injury",
"C": "Renal papillary ischemia",
"D": "Direct nephrotoxic injury"
} | step2&3 | C | [
"year old African-American man",
"physician",
"intermittent episodes of dark urine",
"mild flank",
"patient",
"3 episodes of",
"discoloration",
"urine",
"1 month",
"chronic headaches",
"back pain",
"taking aspirin",
"ibuprofen daily",
"year",
"patient",
"sickle cell trait",
"smoked",... |
A 36-year-old woman comes to the physician because of painless lesions on the vulva that she first noticed 2 days ago. She does not have any urinary symptoms. She has gastroesophageal reflux disease for which she takes omeprazole. She has smoked one pack of cigarettes daily for 10 years. She is sexually active with mul... | Cryotherapy | {
"A": "Parenteral benzathine penicillin",
"B": "Cryotherapy",
"C": "Radiotherapy",
"D": "Oral acyclovir"
} | step2&3 | B | [
"36 year old woman",
"physician",
"painless lesions",
"vulva",
"first",
"2 days",
"not",
"urinary symptoms",
"gastroesophageal reflux disease",
"takes omeprazole",
"smoked one pack",
"cigarettes daily",
"10 years",
"sexually active",
"multiple partners",
"uses condoms",
"Examination ... |
A 24-year-old male is brought into the emergency department complaining of chills, headaches, and malaise for several days. He also states that he experiences shortness of breath when climbing two flights of stairs in his home. He admits to occasionally using intravenous drugs during the previous year. On exam, his vit... | Staphylococcus aureus | {
"A": "Streptococcus bovis",
"B": "Staphylococcus epidermidis",
"C": "Streptococcus mutans",
"D": "Staphylococcus aureus"
} | step1 | D | [
"year old male",
"brought",
"emergency department",
"chills",
"headaches",
"malaise",
"days",
"states",
"experiences shortness of breath",
"climbing two flights",
"stairs",
"home",
"admits to occasionally using intravenous drugs",
"previous year",
"exam",
"vital signs",
"temperature"... |
A 55-year-old patient who immigrated from the Middle East to the United States 10 years ago presents to the emergency department because of excessive weakness, abdominal discomfort, and weight loss for the past 10 months. He has had type 2 diabetes mellitus for 10 years for which he takes metformin. He had an appendect... | Ascites | {
"A": "Hepatic encephalopathy",
"B": "Hepatorenal syndrome",
"C": "Hepatopulmonary syndrome",
"D": "Ascites"
} | step2&3 | D | [
"55 year old patient",
"Middle East",
"United States 10 years",
"presents",
"emergency department",
"excessive weakness",
"abdominal discomfort",
"weight loss",
"past 10 months",
"type 2 diabetes mellitus",
"10 years",
"takes metformin",
"appendectomy",
"years",
"home country",
"postop... |
A 9-year-old girl is brought to the physician by her father because of abnormal movements of her limbs for 4 days. She has had involuntary nonrhythmic movements of her arms and legs, and has been dropping drinking cups and toys. The symptoms are worse when she is agitated, and she rarely experiences them while sleeping... | Antibody cross-reactivity | {
"A": "Cerebral viral infection",
"B": "Tumor in the posterior fossa",
"C": "Antibody cross-reactivity",
"D": "Trinucleotide repeat mutation"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"father",
"abnormal",
"limbs",
"4 days",
"involuntary",
"movements",
"arms",
"legs",
"dropping drinking cups",
"toys",
"symptoms",
"worse",
"agitated",
"rarely experiences",
"sleeping",
"period",
"irritable",
"tearful",
"sore throat"... |
A 70-year-old man comes to the physician because of progressive fatigue and lower back pain for the past 4 months. The back pain worsened significantly after he had a minor fall while doing yard work the previous day. For the past year, he has had a feeling of incomplete emptying of his bladder after voiding. His vital... | Serum protein electrophoresis | {
"A": "Bone marrow biopsy",
"B": "Serum protein electrophoresis",
"C": "Serum vitamin D levels",
"D": "Prostate biopsy"
} | step2&3 | B | [
"70 year old man",
"physician",
"progressive fatigue",
"lower back pain",
"past",
"months",
"back pain worsened",
"minor fall",
"yard work",
"previous day",
"past year",
"feeling of incomplete emptying",
"bladder",
"voiding",
"vital signs",
"normal limits",
"Examination shows bilater... |
A 24-year-old man presents to his primary care provider with complaints of 2 days of profuse diarrhea. He states that his stool started to turn watery and lighter in color beginning yesterday, and he has not noticed any fevers. His diarrhea episodes have become more frequent and white-colored over the past day. He has ... | Increased cyclic AMP | {
"A": "Decreased cyclic AMP",
"B": "Increased cyclic AMP",
"C": "Increased cyclic GMP",
"D": "Shortening of intestinal villi"
} | step1 | B | [
"year old man presents",
"primary care provider",
"complaints",
"2 days",
"diarrhea",
"states",
"stool started to turn watery",
"lighter",
"color beginning",
"not",
"fevers",
"diarrhea episodes",
"more frequent",
"white colored",
"past day",
"dry",
"darker urine today",
"healthy",
... |
A 6-year-old boy is brought to the physician for a well-child examination. His mother has noticed he frequently falls while running. He was born at term and pregnancy was uncomplicated. He has a seizure disorder treated with phenytoin. He is at the 20th percentile for height and at 30th percentile for weight. Vital sig... | Metabolic abnormality | {
"A": "Normal development",
"B": "Proximal tibial growth plate disruption",
"C": "Metabolic abnormality",
"D": "Neoplastic growth"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"well",
"mother",
"frequently falls",
"running",
"born",
"term",
"pregnancy",
"uncomplicated",
"seizure disorder treated with phenytoin",
"percentile",
"height",
"percentile",
"weight",
"Vital signs",
"normal limits",
"Examination shows dec... |
A 26-year-old woman presents with an 8-month history of insomnia and anxiety. She says that she has difficulty sleeping and has feelings of impending doom linked to her difficult financial situation. No significant family history and no current medications. The patient has prescribed an 8 week supply of medication. She... | Triazolam | {
"A": "Hydroxyzine",
"B": "Buspirone",
"C": "Propranolol",
"D": "Triazolam"
} | step1 | D | [
"year old woman presents",
"month history",
"insomnia",
"anxiety",
"difficulty sleeping",
"feelings",
"impending doom linked",
"difficult financial",
"significant family history",
"current medications",
"patient",
"prescribed",
"week supply",
"medication",
"follows up",
"weeks later",
... |
A 15-year-old girl comes to the physician because of a sore throat and subjective fevers for the past 2 weeks. She has been feeling lethargic and is unable to attend school. She has a history of multiple episodes of streptococcal pharyngitis treated with amoxicillin. She immigrated with her family to the United States ... | Nasopharyngeal carcinoma | {
"A": "Kaposi sarcoma",
"B": "Nasopharyngeal carcinoma",
"C": "Necrotizing retinitis",
"D": "Glomerulonephritis"
} | step2&3 | B | [
"year old girl",
"physician",
"sore throat",
"subjective fevers",
"past 2 weeks",
"feeling lethargic",
"unable to attend school",
"history of multiple episodes",
"streptococcal pharyngitis treated with amoxicillin",
"family",
"United States",
"China 10 years",
"appears thin",
"temperature"... |
A 49 year-old-male presents with a primary complaint of several recent episodes of severe headache, sudden anxiety, and a "racing heart". The patient originally attributed these symptoms to stress at work; however, these episodes are becoming more frequent and severe. Laboratory evaluation during such an episode reveal... | Episodic hypertension | {
"A": "Decreased 24 hour urine vanillylmandelic acid (VMA) levels",
"B": "Episodic hypertension",
"C": "Anhidrosis",
"D": "Hypoglycemia"
} | step1 | B | [
"year old male presents",
"primary complaint of",
"recent episodes",
"severe headache",
"sudden anxiety",
"racing heart",
"patient",
"attributed",
"symptoms",
"stress",
"work",
"episodes",
"more frequent",
"severe",
"Laboratory evaluation",
"episode reveals elevated plasma free metanep... |
A 34-year-old woman is brought to the emergency department following a motor vehicle accident. She was walking on the sidewalk when a car traveling at high speed knocked her off her feet. She did not sustain any obvious injury but has painful breathing. An X-ray of the chest is taken to exclude a rib fracture and contu... | Repeat chest CT scan in 6 months | {
"A": "Positron emission scan",
"B": "Sputum cytology",
"C": "CT scan of abdomen",
"D": "Repeat chest CT scan in 6 months"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department following",
"motor vehicle accident",
"walking",
"sidewalk",
"car traveling",
"high speed",
"feet",
"not sustain",
"injury",
"painful breathing",
"X-ray of",
"chest",
"taken to exclude",
"rib fracture",
"contusion of",
"lungs",
"... |
A 32-year-old man with a past medical history significant for HIV and a social history of multiple sexual partners presents with new skin findings. His past surgical and family histories are noncontributory. The patient's blood pressure is 129/75 mm Hg, the pulse is 66/min, the respiratory rate is 16/min, and the tempe... | HPV (types 6 & 11) | {
"A": "HPV (types 6 & 11)",
"B": "Neisseria gonorrhoeae",
"C": "HPV (types 16 & 18)",
"D": "HSV (type 2)"
} | step2&3 | A | [
"year old man",
"past medical history significant",
"HIV",
"social history",
"multiple sexual partners presents",
"new skin findings",
"past surgical",
"family histories",
"patient's blood pressure",
"75 mm Hg",
"pulse",
"66 min",
"respiratory rate",
"min",
"temperature",
"99",
"Phys... |
A 37-year-old female presents to her primary care physician with constipation and abdominal pain. She notes that the pain has been present for several days and is not related to food. She also reports increased urinary frequency without incontinence, as well as increased thirst. She takes no medications, but notes taki... | Vitamin overdose | {
"A": "Vitamin overdose",
"B": "Primary endocrine dysfunction",
"C": "Plasma cell neoplasm",
"D": "Inherited disorder"
} | step1 | A | [
"year old female presents",
"primary care physician",
"constipation",
"abdominal pain",
"notes",
"pain",
"present",
"days",
"not related",
"food",
"reports increased urinary frequency",
"incontinence",
"increased thirst",
"takes",
"medications",
"notes taking vitamin supplements daily"... |
A previously healthy 39-year-old woman comes to the physician because of a slowly enlarging, painless neck mass that she first noticed 3 months ago. During this period, she has also experienced intermittent palpitations, hair loss, and a weight loss of 4.5 kg (10 lb). There is no personal or family history of serious i... | Gain-of-function mutations of the TSH receptor | {
"A": "Thyroid peroxidase autoantibody-mediated destruction of thyroid tissue",
"B": "Gain-of-function mutations of the TSH receptor",
"C": "Thyroglobulin antibody production",
"D": "Activation of oncogenes promoting cell division"
} | step2&3 | B | [
"healthy",
"year old woman",
"physician",
"slowly enlarging",
"painless neck",
"first",
"3 months",
"period",
"experienced intermittent palpitations",
"hair loss",
"weight loss of",
"kg",
"10",
"personal",
"family history",
"serious illness",
"appears anxious",
"fidgety",
"temper... |
A 57-year-old woman presents to the emergency room with complaints of severe headache, vomiting, neck stiffness, and chest pain that have developed over the last several hours. Her past medical history is notable for diabetes, hypertension, and dyslipidemia. Her temperature is 99.0°F (37.2°C), blood pressure is 197/124... | Esmolol | {
"A": "Esmolol",
"B": "Lisinopril",
"C": "Nitroprusside",
"D": "Propranolol"
} | step2&3 | A | [
"57 year old woman presents",
"emergency room",
"complaints",
"severe headache",
"vomiting",
"neck stiffness",
"chest pain",
"hours",
"past medical history",
"notable",
"diabetes",
"hypertension",
"dyslipidemia",
"temperature",
"99",
"blood pressure",
"mm Hg",
"pulse",
"min",
"... |
A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for adva... | Level 2 | {
"A": "Level 1",
"B": "Level 2",
"C": "Level 4",
"D": "Level 5"
} | step1 | B | [
"research team",
"new monoclonal checkpoint inhibitor",
"advanced melanoma",
"shown promise",
"animal studies",
"high efficacy",
"low toxicity",
"early phase human clinical trials",
"research team",
"now",
"to compare",
"drug",
"standard of care immunotherapy",
"advanced melanoma",
"nove... |
A 23-year-old male with a homozygous CCR5 mutation is found to be immune to HIV infection. The patient’s CCR5 mutation interferes with the function of which viral protein? | gp120 | {
"A": "Reverse transcriptase",
"B": "gp120",
"C": "gp41",
"D": "pp17"
} | step1 | B | [
"23 year old male",
"homozygous CCR5 mutation",
"found to",
"immune",
"HIV infection",
"patients CCR5 mutation interferes with",
"function",
"viral"
] |
A cross-sectional study is investigating the association between smoking and the presence of Raynaud phenomenon in adults presenting to a primary care clinic in a major city. A standardized 3-question survey that assesses symptoms of Raynaud phenomenon was used to clinically diagnosis patients if they answered positive... | Dose-response | {
"A": "Confounding",
"B": "Consistency",
"C": "Dose-response",
"D": "Temporality"
} | step2&3 | C | [
"cross-sectional study",
"investigating",
"association",
"smoking",
"presence",
"Raynaud phenomenon",
"adults presenting",
"primary care clinic",
"major city",
"question survey",
"assesses symptoms",
"Raynaud phenomenon",
"used to",
"diagnosis patients",
"answered",
"questions",
"hea... |
A 10-year-old boy is brought to a family physician by his mother with a history of recurrent headaches. The headaches are moderate-to-severe in intensity, unilateral, mostly affecting the left side, and pulsatile in nature. Past medical history is significant for mild intellectual disability and complex partial seizure... | Glaucoma | {
"A": "Ash leaf spots",
"B": "Café-au-lait spots",
"C": "Charcot-Bouchard aneurysm",
"D": "Glaucoma"
} | step2&3 | D | [
"A 10 year old boy",
"brought",
"family physician",
"mother",
"history of recurrent headaches",
"headaches",
"moderate-to-severe",
"intensity",
"unilateral",
"mostly affecting",
"left side",
"pulsatile",
"nature",
"Past medical history",
"significant",
"mild intellectual disability",
... |
A 58-year-old man comes to the physician for a 2-month history of increased urinary frequency. Urodynamic testing shows a urinary flow rate of 11 mL/s (N>15) and a postvoid residual volume of 65 mL (N<50). Prostate-specific antigen level is 3.2 ng/mL (N<4). Treatment with a drug that also increases scalp hair regrowth ... | Decreased conversion of testosterone to dihydrotestosterone | {
"A": "Decreased conversion of testosterone to dihydrotestosterone",
"B": "Decreased conversion of hydroxyprogesterone to androstenedione",
"C": "Selective alpha-1A/D receptor antagonism",
"D": "Decreased conversion of testosterone to estradiol"
} | step1 | A | [
"58 year old man",
"physician",
"2 month history",
"increased urinary frequency",
"Urodynamic testing shows",
"urinary flow rate",
"mL",
"postvoid residual volume",
"65 mL",
"N 50",
"Prostate-specific antigen level",
"3.2 ng/mL",
"N 4",
"Treatment",
"drug",
"increases scalp hair",
"i... |
A 35-year-old man who suffered a motor vehicle accident 3 months ago presents to the office for a neurological evaluation. He has no significant past medical history and takes no current medications. He has a family history of coronary artery disease in his father and Alzheimer’s disease in his mother. On physical exam... | Preserved pressure sensation | {
"A": "Negative plantar extensor response in his lower limbs",
"B": "Preserved pressure sensation",
"C": "Flaccid paralysis on the right side",
"D": "Loss of vibratory sense below the level of the lesion"
} | step1 | B | [
"35 year old man",
"suffered",
"motor vehicle accident",
"months",
"presents",
"office",
"neurological evaluation",
"significant past medical history",
"takes",
"current medications",
"family history of coronary artery disease",
"father",
"Alzheimers disease",
"mother",
"physical examina... |
A 23-year-old male presents with complaints of polydipsia and frequent, large-volume urination. Laboratory testing does not demonstrate any evidence of diabetes; however, a reduced urine osmolality of 120 mOsm/L is measured. Which of the following findings on a desmopressin test would be most consistent with a diagnosi... | Increase in urine osmolality to 400 mOsm/L following vasopressin administration | {
"A": "Reduction in urine osmolality to 110 mOsm/L following vasopressin administration",
"B": "Increase in urine osmolality to 130 mOsm/L following vasopressin administration",
"C": "Increase in urine osmolality to 400 mOsm/L following vasopressin administration",
"D": "No detectable change in urine osmolalit... | step1 | C | [
"23 year old male presents",
"complaints",
"polydipsia",
"frequent",
"large volume urination",
"Laboratory testing",
"not",
"evidence",
"diabetes",
"reduced urine osmolality of",
"mOsm/L",
"measured",
"following findings",
"desmopressin test",
"most consistent with",
"diagnosis",
"ce... |
A 35-year-old woman comes into the primary care office as a new patient with gradually worsening arthritis and reduced grip strength, primarily involving the base of her fingers, wrists, and ankles. She reports feeling slow after getting out of bed in the morning. After further questioning, she notes fatigue, low-grade... | Type III–immune complex-mediated hypersensitivity reaction | {
"A": "Type II–cytotoxic hypersensitivity reaction",
"B": "Type III–immune complex-mediated hypersensitivity reaction",
"C": "Type IV–cell-mediated (delayed) hypersensitivity reaction",
"D": "Type III and IV–mixed immune complex and cell-mediated hypersensitivity reactions"
} | step2&3 | B | [
"35 year old woman",
"primary care office",
"new patient",
"worsening arthritis",
"reduced grip strength",
"involving",
"base",
"fingers",
"wrists",
"ankles",
"reports feeling slow",
"getting out",
"bed",
"morning",
"further questioning",
"notes fatigue",
"low-grade fever",
"feelin... |
A 32-year-old G1P0 woman undergoes her 2nd-trimester ultrasound in a community hospital. During her prenatal care, she was found to have mild anemia, low levels of folate, and serum alpha-fetoprotein levels greater than 2 multiples of the median (MoM) on 2 separate occasions. Her 1st-trimester ultrasound was significan... | Failure of the caudal neuropore to close | {
"A": "Persistence of the anterior accessory neurenteric canal (ANC)",
"B": "Failure of the rostral neuropore to close",
"C": "Failure of the caudal neuropore to close",
"D": "Failure of mesenchymal cells to form a neural rod"
} | step1 | C | [
"year old",
"woman",
"2nd-trimester ultrasound",
"community hospital",
"prenatal care",
"found to",
"mild anemia",
"low levels",
"folate",
"serum alpha-fetoprotein levels greater than",
"multiples of the median",
"2 separate occasions",
"1st-trimester ultrasound",
"significant",
"absence... |
A 72-year-old male visits his gastroenterologist for a check-up one year following resection of a 2-cm malignant lesion in his sigmoid colon. Serum levels of which of the following can be used in this patient to test for cancer recurrence? | Carcinoembryonic antigen | {
"A": "Alpha-fetoprotein",
"B": "Carcinoembryonic antigen",
"C": "Cancer antigen 125 (CA-125)",
"D": "Gamma glutamyl transferase"
} | step1 | B | [
"72 year old male visits",
"gastroenterologist",
"check-up one year following resection",
"malignant lesion",
"sigmoid colon",
"Serum levels",
"following",
"used",
"patient to test",
"cancer recurrence"
] |
A 19-year-old man is seen by his primary care physician. The patient has a history of excessive daytime sleepiness going back several years. He has begun experiencing episodes in which his knees become weak and he drops to the floor when he laughs. He has a history of marijuana use. His family history is notable for hy... | Modafinil | {
"A": "Lisdexamfetamine",
"B": "Methylphenidate",
"C": "Zolpidem",
"D": "Modafinil"
} | step1 | D | [
"year old man",
"seen by",
"primary care physician",
"patient",
"history",
"excessive daytime sleepiness",
"back",
"years",
"begun experiencing episodes",
"knees",
"weak",
"drops",
"floor",
"laughs",
"history of marijuana use",
"family history",
"notable",
"hypertension",
"cardia... |
A 58-year-old woman presents to her physician complaining of a headache in the occipital region for 1 week. Past medical history is significant for essential hypertension, managed with lifestyle modifications and 2 antihypertensives for the previous 6 months. Her blood pressure is 150/90 mm Hg. Neurological examination... | Decreased peripheral sympathetic outflow | {
"A": "Negative inotropic effect on the heart",
"B": "Vasodilation of peripheral veins",
"C": "Vasodilation of peripheral arteries",
"D": "Decreased peripheral sympathetic outflow"
} | step1 | D | [
"58 year old woman presents",
"physician complaining of a headache",
"occipital region",
"1 week",
"Past medical history",
"significant",
"essential hypertension",
"managed",
"lifestyle modifications",
"2 antihypertensives",
"previous 6 months",
"blood pressure",
"90 mm Hg",
"Neurological ... |
A 23-year-old woman comes to the emergency department for the evaluation of mild retrosternal pain for the last 7 hours after several episodes of self-induced vomiting. The patient was diagnosed with bulimia nervosa 9 months ago. Her only medication is citalopram. She is 170 cm (5 ft 7 in) tall and weighs 62 kg (136.6 ... | Intravenous ampicillin and sulbactam therapy | {
"A": "Intravenous octreotide therapy",
"B": "Intravenous labetalol therapy",
"C": "Intravenous ampicillin and sulbactam therapy",
"D": "CT scan with contrast\n\""
} | step2&3 | C | [
"23 year old woman",
"emergency department",
"evaluation",
"mild retrosternal",
"last",
"hours",
"episodes of self-induced vomiting",
"patient",
"diagnosed",
"bulimia nervosa",
"months",
"only medication",
"citalopram",
"5 ft",
"tall",
"62 kg",
"BMI",
"kg/m2",
"appears pale",
"... |
A 25-year-old woman with an extensive psychiatric history is suspected of having metabolic acidosis after ingesting a large amount of aspirin in a suicide attempt. Labs are drawn and the values from the ABG are found to be: PCO2: 25, and HCO3: 15, but the pH value is smeared on the print-out and illegible. The medical ... | 6.1 + log[15/(0.03*25)] | {
"A": "6.1 + log[15/(0.03*25)]",
"B": "10^6.1 + 15/0.03*25",
"C": "6.1 + log[0.03/15*25)",
"D": "6.1 + log [25/(15*0.03)]"
} | step1 | A | [
"year old woman",
"extensive psychiatric history",
"suspected",
"metabolic acidosis",
"ingesting",
"large amount",
"aspirin",
"suicide attempt",
"Labs",
"drawn",
"values",
"ABG",
"found to",
"PCO2",
"HCO3",
"pH value",
"smeared",
"print out",
"medical student",
"given",
"task... |
A 41-year-old woman presents to the emergency room with a fever. She has had intermittent fevers accompanied by malaise, weakness, and mild shortness of breath for the past 2 weeks. Her past medical history is notable for recurrent bloody diarrhea for over 3 years. She underwent a flexible sigmoidosopy several months a... | Streptococcus gallolyticus | {
"A": "Candida albicans",
"B": "Pseudomonas aeruginosa",
"C": "Staphylococcus epidermidis",
"D": "Streptococcus gallolyticus"
} | step1 | D | [
"year old woman presents",
"emergency room",
"fever",
"intermittent fevers",
"malaise",
"weakness",
"mild shortness of breath",
"past 2 weeks",
"past medical history",
"notable",
"recurrent bloody",
"over",
"years",
"flexible",
"months",
"granular",
"hyperemic rectal mucosa",
"dist... |
A 42-year-old man presents to his family physician for evaluation of oral pain. He states that he has increasing pain in a molar on the top left of his mouth. The pain started 1 week ago and has been progressively worsening since then. His medical history is significant for hypertension and type 2 diabetes mellitus, bo... | Minimal Sedation | {
"A": "Minimal Sedation",
"B": "Epidural anesthesia",
"C": "Deep sedation",
"D": "Regional anesthesia"
} | step2&3 | A | [
"year old man presents",
"family physician",
"evaluation",
"oral",
"states",
"increasing pain",
"molar",
"top left",
"mouth",
"pain started 1 week",
"worsening since then",
"medical history",
"significant",
"hypertension",
"type 2 diabetes mellitus",
"currently controlled",
"lifestyl... |
A 3-month-old infant is brought to her pediatrician for a well-child visit. The infant was born to a 22-year-old mother via a spontaneous vaginal delivery at 38 weeks of gestation in her home. She moved to the United States approximately 3 weeks ago from a small village. She reports that her infant had 2 episodes of no... | Dietary restriction | {
"A": "Abdominal radiography",
"B": "Dermatology consult",
"C": "Dietary restriction",
"D": "MRI of the brain"
} | step2&3 | C | [
"3 month old infant",
"brought",
"pediatrician",
"well-child visit",
"infant",
"born",
"year old mother",
"spontaneous vaginal delivery",
"weeks of gestation",
"home",
"moved to",
"United States approximately",
"weeks",
"small village",
"reports",
"infant",
"2 episodes of non bloody"... |
A 33-year-old woman is brought to the physician by her husband because of persistent sadness for the past 2 months. During this period, she also has had difficulty sleeping and an increased appetite. She had similar episodes that occurred 2 years ago and 9 months ago that each lasted for 4 months. Between these episode... | Cyclothymic disorder | {
"A": "Major depressive disorder with seasonal pattern",
"B": "Persistent depressive disorder",
"C": "Cyclothymic disorder",
"D": "Major depressive disorder with atypical features\n\""
} | step1 | C | [
"year old woman",
"brought",
"physician",
"husband",
"persistent sadness",
"past",
"months",
"period",
"difficulty sleeping",
"increased appetite",
"similar episodes",
"occurred 2 years",
"months",
"lasted",
"months",
"episodes",
"reported feeling very energetic",
"rested",
"hour... |
A child presents to his pediatrician’s clinic for a routine well visit. He can bend down and stand back up without assistance and walk backward but is not able to run or walk upstairs. He can stack 2 blocks and put the blocks in a cup. He can bring over a book when asked, and he will say “mama” and “dada” to call for h... | 15 months | {
"A": "12 months",
"B": "15 months",
"C": "18 months",
"D": "24 months"
} | step2&3 | B | [
"child presents",
"pediatricians clinic",
"routine well visit",
"bend",
"stand back up",
"assistance",
"walk backward",
"not able to run",
"walk upstairs",
"stack 2 blocks",
"put",
"blocks",
"cup",
"book",
"mama",
"to call",
"parents",
"book",
"milk",
"truck",
"old",
"child... |
A 4-year-old girl is brought to the physician by her parents because she is severely underweight. She is easily fatigued and has difficulty keeping up with other children at her daycare. She has a good appetite and eats 3 full meals a day. She has 4 to 5 bowel movements daily with bulky, foul-smelling stools that float... | Exocrine pancreatic insufficiency | {
"A": "Exocrine pancreatic insufficiency",
"B": "Impaired intestinal amino acid transport",
"C": "Intestinal inflammatory reaction to gluten",
"D": "T. whippelii infiltration of intestinal villi"
} | step2&3 | A | [
"4 year old girl",
"brought",
"physician",
"parents",
"severely underweight",
"easily fatigued",
"difficulty keeping",
"children",
"daycare",
"good appetite",
"eats",
"full meals",
"day",
"4",
"5 bowel movements daily",
"bulky",
"foul-smelling stools",
"float",
"recurrent episode... |
A 72-year-old woman with a history of atrial fibrillation on warfarin, diabetes, seizure disorder and recent MRSA infection is admitted to the hospital. She subsequently begins therapy with another drug and is found to have a supratherapeutic International Normalized Ratio (INR). Which of the following drugs is likely ... | Valproic acid | {
"A": "Phenobarbital",
"B": "Glipizide",
"C": "Rifampin",
"D": "Valproic acid"
} | step1 | D | [
"72 year old woman",
"history of atrial fibrillation",
"warfarin",
"diabetes",
"seizure disorder",
"recent MRSA",
"admitted",
"hospital",
"begins therapy",
"drug",
"found to",
"supratherapeutic International Normalized Ratio",
"following drugs",
"likely contributing",
"patient's elevated... |
A 16-year-old boy presents to the emergency department with abdominal pain and tenderness. The pain began approximately 2 days ago in the area just above his umbilicus and was crampy in nature. Earlier this morning, the pain moved laterally to his right lower abdomen. At that time, the pain in the right lower quadrant ... | His pain is mainly transmitted by the right splanchnic nerve. | {
"A": "His pain is mainly transmitted by the right splanchnic nerve.",
"B": "His pain is transmitted bilaterally by somatic afferent nerve fibers of the abdomen.",
"C": "His pain is transmitted by somatic afferent nerve fibers located in the right flank.",
"D": "His pain is transmitted by the pelvic nerves."
} | step1 | A | [
"year old boy presents",
"emergency department",
"abdominal pain",
"tenderness",
"pain began approximately 2 days",
"area",
"umbilicus",
"crampy",
"nature",
"Earlier",
"morning",
"pain moved",
"right lower abdomen",
"time",
"pain",
"right lower quadrant",
"severe",
"constant",
"w... |
A 57-year-old man presents to the emergency department after an episode of syncope. He states that he was at home when he suddenly felt weak and experienced back pain that has been persistent. He states that he vomited forcefully several times after the episode. The patient has a past medical history of diabetes, hyper... | Abdominal aortic aneurysm | {
"A": "Abdominal aortic aneurysm",
"B": "Boerhaave syndrome",
"C": "Nephrolithiasis",
"D": "Pancreatitis"
} | step2&3 | A | [
"57 year old man presents",
"emergency department",
"episode of syncope",
"states",
"at home",
"felt weak",
"experienced back pain",
"persistent",
"states",
"vomited",
"times",
"episode",
"patient",
"past medical diabetes",
"hypertension",
"dyslipidemia",
"depression",
"smokes 1.5 ... |
An 84-year-old woman is brought by her caretaker to the physician because of a 2-day history of fever, severe headache, neck pain, and aversion to bright light. She appears uncomfortable. Her temperature is 38.5°C (101.3°F), pulse is 110/min, and blood pressure is 145/75 mm Hg. Physical examination shows involuntary fl... | Ceftriaxone, vancomycin, and ampicillin | {
"A": "Vancomycin, gentamicin, and cephalexin",
"B": "Vancomycin, metronidazole, and cefotaxime",
"C": "Ampicillin and gentamicin",
"D": "Ceftriaxone, vancomycin, and ampicillin"
} | step1 | D | [
"84 year old woman",
"brought",
"caretaker",
"physician",
"2-day history",
"fever",
"severe headache",
"neck pain",
"aversion",
"bright light",
"appears",
"temperature",
"pulse",
"min",
"blood pressure",
"75 mm Hg",
"Physical examination shows involuntary flexion",
"bilateral hips"... |
A 72-year-old woman with type 2 diabetes mellitus comes to the physician because she is concerned about the appearance of her toenails. Examination shows yellowish discoloration of all toenails on both feet. The edges of the toenails are lifted, and there is subungual debris. Potassium hydroxide preparation of scraping... | Inhibition of squalene epoxidase | {
"A": "Interference with mitosis during metaphase",
"B": "Prevention of lanosterol to ergosterol conversion",
"C": "Inhibition of squalene epoxidase",
"D": "Formation of pores in cell membrane"
} | step1 | C | [
"72 year old woman",
"type 2 diabetes mellitus",
"physician",
"concerned about",
"appearance of",
"toenails",
"Examination shows yellowish discoloration",
"toenails",
"feet",
"edges",
"toenails",
"lifted",
"subungual debris",
"Potassium hydroxide preparation",
"scrapings",
"nails shows... |
A 31-year-old G3P2 woman presents to labor and delivery triage because she has had bleeding over the last day. She is currently 5 months into her pregnancy and has had no concerns prior to this visit. She previously had a delivery through cesarean section and has otherwise had uncomplicated pregnancies. She denies feve... | Multiparity | {
"A": "Early menarche",
"B": "Multiparity",
"C": "Presence of uterine fibroids",
"D": "Smoking"
} | step1 | B | [
"31 year old",
"woman presents to labor",
"delivery triage",
"bleeding",
"day",
"currently 5 months",
"pregnancy",
"concerns prior to",
"visit",
"delivery",
"cesarean",
"uncomplicated pregnancies",
"denies fever",
"pain",
"discomfort",
"presentation",
"temperature",
"99",
"3C",
... |
A 32-year-old man visits his family physician for 10 months of persistent left flank pain, weight loss, and fatigue. Also, he has had hematuria a couple of times in the last month. His mother was diagnosed and treated for a pheochromocytoma when she was 36 years old, and his father died at 45 years due to myocardial in... | Clear-cell carcinoma | {
"A": "Collecting duct carcinoma",
"B": "Papillary carcinoma",
"C": "Clear-cell carcinoma",
"D": "Oncocytic carcinoma"
} | step1 | C | [
"year old man visits",
"family physician",
"10 months",
"persistent left flank pain",
"weight loss",
"fatigue",
"hematuria",
"couple",
"times",
"last month",
"mother",
"diagnosed",
"treated",
"pheochromocytoma",
"36 years old",
"father died",
"years",
"myocardial infarction",
"pe... |
A 55-year-old man comes to the physician because of a 4-month history of fatigue, increased sweating, and a 5.4-kg (12-lb) weight loss. Over the past 3 weeks, he has had gingival bleeding when brushing his teeth. Twenty years ago, he was diagnosed with a testicular tumor and treated with radiation therapy. His temperat... | Imatinib therapy | {
"A": "Rituximab therapy",
"B": "Low-dose aspirin therapy",
"C": "Phlebotomy",
"D": "Imatinib therapy"
} | step2&3 | D | [
"55 year old man",
"physician",
"4 month history",
"fatigue",
"increased sweating",
"5.4 kg",
"weight loss",
"past",
"weeks",
"gingival bleeding",
"brushing",
"teeth",
"Twenty years",
"diagnosed",
"testicular tumor",
"treated with radiation therapy",
"temperature",
"pulse",
"70 m... |
A 15-year-old boy presents with shortness of breath on exertion for the past 2 weeks. Although he does not have any other complaints, he is concerned about not gaining much weight despite a good appetite. His height is 188 cm (6 ft 2 in) and weight is 58 kg (124 lb). His blood pressure is 134/56 mm Hg and his pulse rat... | Fibrillin | {
"A": "Fibrillin",
"B": "Laminin",
"C": "Fibronectin",
"D": "Reticular fibers"
} | step1 | A | [
"year old boy presents",
"shortness of breath",
"exertion",
"past 2 weeks",
"not",
"complaints",
"concerned",
"not gaining",
"weight",
"good appetite",
"height",
"6 ft 2",
"weight",
"58 kg",
"blood pressure",
"mm Hg",
"pulse rate",
"min",
"cardiac auscultation",
"apex beat",
... |
Three days after admission to the intensive care unit for septic shock and bacteremia from a urinary tract infection, a 34-year-old woman has persistent hypotension. Her blood cultures were positive for Escherichia coli, for which she has been receiving appropriate antibiotics since admission. She has no history of ser... | Sick euthyroid syndrome | {
"A": "Medication toxicity",
"B": "Sick euthyroid syndrome",
"C": "Fibrous thyroiditis",
"D": "Pituitary apoplexy"
} | step2&3 | B | [
"Three days",
"admission",
"intensive care unit",
"septic shock",
"bacteremia",
"urinary tract infection",
"year old woman",
"persistent hypotension",
"blood cultures",
"positive",
"Escherichia coli",
"receiving appropriate antibiotics",
"admission",
"history",
"serious illness",
"not ... |
A 68-year-old woman presents to her primary care physician with a complaint of fatigue, difficulty breathing upon exertion, and crampy lower abdominal pain. She also noticed that her stools are dark. She has had essential hypertension for 20 years, for which she takes bisoprolol. Her family history is positive for type... | Colonoscopy | {
"A": "Intra-anal glyceryl trinitrate",
"B": "Red cell transfusion",
"C": "Colonoscopy",
"D": "Rectal hydrocortisone"
} | step2&3 | C | [
"68 year old woman presents",
"primary care physician",
"complaint",
"fatigue",
"difficulty breathing",
"exertion",
"crampy lower abdominal pain",
"stools",
"dark",
"essential hypertension",
"20 years",
"takes bisoprolol",
"family history",
"positive",
"type 2 diabetes mellitus",
"phys... |
A 25-year-old woman presents to the emergency department with intermittent uterine contractions. She is 39 weeks pregnant and experienced a deluge of fluid between her legs while she was grocery shopping. She now complains of painful contractions. She is transferred to the labor and delivery floor and a healthy male ba... | Maternal hyperglycemia during the pregnancy | {
"A": "Dehydration",
"B": "Healthy infant",
"C": "Maternal hyperglycemia during the pregnancy",
"D": "Renal abnormality"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"intermittent uterine contractions",
"weeks pregnant",
"experienced",
"fluid",
"legs",
"shopping",
"now",
"painful contractions",
"transferred",
"labor",
"delivery floor",
"healthy male baby",
"delivered",
"complexion",
"crying",
"... |
A 46-year-old obese man comes to the emergency room because of paresthesias in his feet and a hypopigmented skin lesion on his knee that he first noticed 6 weeks ago. He has also had fever, fatigue, and malaise for the last week. He has a history of chronic autoimmune thyroiditis for which he takes levothyroxine. He im... | Oral rifampicin and dapsone | {
"A": "Topical fluconazole",
"B": "Topical betamethasone",
"C": "Intravenous amphotericin",
"D": "Oral rifampicin and dapsone"
} | step2&3 | D | [
"year old obese man",
"emergency room",
"of paresthesias",
"feet",
"hypopigmented skin lesion",
"knee",
"first",
"weeks",
"fever",
"fatigue",
"malaise",
"week",
"history",
"chronic autoimmune thyroiditis",
"takes levothyroxine",
"Indonesia",
"years",
"to",
"family",
"United Sta... |
A 21-year-old woman comes to the physician because of hair loss on her frontal scalp over the past year. Menses have occurred at irregular 40- to 60-day intervals since menarche at the age of 17 years. She has no history of serious illness and takes no medications. She is 162 cm (5 ft 3 in) tall and weighs 73 kg (158.7... | Theca interna cells | {
"A": "Zona fasciculata cells",
"B": "Theca interna cells",
"C": "Granulosa cells",
"D": "Follicular thyroid cells"
} | step1 | B | [
"21-year-old woman",
"physician",
"of hair loss",
"frontal scalp",
"past year",
"Menses",
"occurred",
"irregular 40",
"60 day intervals",
"menarche at",
"age",
"years",
"history",
"serious illness",
"takes",
"medications",
"5 ft",
"tall",
"kg",
"BMI",
"kg/m2",
"pulse",
"7... |
A 5-year-old boy is brought to his physician by his mother for the evaluation of increased bruising for 3 weeks. The mother reports that the patient has also had two episodes of nose bleeding in the last week that subsided spontaneously within a few minutes. The boy was born at term and has been healthy except for an e... | Observation | {
"A": "Antiplatelet antibody testing",
"B": "Romiplostim therapy",
"C": "Splenectomy",
"D": "Observation"
} | step2&3 | D | [
"5 year old boy",
"brought",
"physician",
"mother",
"evaluation",
"increased bruising",
"3 weeks",
"mother reports",
"patient",
"two episodes of nose bleeding",
"last week",
"minutes",
"boy",
"born",
"term",
"healthy",
"episode of gastroenteritis",
"weeks",
"resolved",
"treatme... |
A 23-year-old woman comes to the emergency department complaining of abdominal pain and bloody vaginal discharge with clots. Her last menstrual period was 7 weeks ago. She does not smoke cigarettes or drink alcohol. She was admitted to the hospital for a deep vein thrombosis about 1 year ago and was treated with hepari... | Antiphospholipid antibody syndrome | {
"A": "Antiphospholipid antibody syndrome",
"B": "Disseminated intravascular coagulation",
"C": "Von Willebrand disease",
"D": "Factor V leiden"
} | step2&3 | A | [
"23 year old woman",
"emergency department",
"abdominal pain",
"bloody vaginal discharge",
"clots",
"last menstrual period",
"weeks",
"not smoke cigarettes",
"drink alcohol",
"admitted",
"hospital",
"deep vein thrombosis",
"year",
"treated with heparin followed by warfarin",
"Therapy end... |
An 8-year-old boy is referred to your office by his school for kyphoscoliosis. His mother recently noticed a change in the way he walks but thought it was a normal part of his growth. She notes that he has always been clumsy and has frequent falls. He has a history of type 1 diabetes mellitus for which he receives insu... | Frataxin | {
"A": "Frataxin",
"B": "Fructokinase",
"C": "Myophosphorylase",
"D": "Fibrillin"
} | step1 | A | [
"year old boy",
"referred",
"office",
"school",
"kyphoscoliosis",
"mother recently",
"change",
"walks",
"thought",
"normal part of",
"growth",
"notes",
"always",
"clumsy",
"frequent falls",
"history of type 1 diabetes mellitus",
"receives insulin",
"health problems",
"well",
"s... |
A 27-year-old man presents to the emergency department with painless yellowing of his skin. The patient states he is generally healthy and has no past medical history. He smokes 2 packs of cigarettes per day and was recently treated for a urinary tract infection with a single dose of ceftriaxone followed by a 7 day cou... | Gilbert syndrome | {
"A": "Ceftriaxone administration",
"B": "Crigler-Najjar syndrome",
"C": "Gilbert syndrome",
"D": "Pancreatic cancer"
} | step2&3 | C | [
"27 year old man presents",
"emergency department",
"painless yellowing",
"skin",
"patient states",
"healthy",
"past medical history",
"smokes 2 packs",
"cigarettes",
"day",
"recently treated",
"urinary tract infection",
"single dose",
"ceftriaxone followed by",
"7 day course",
"ciprof... |
A 15-year-old boy is undergoing the bodily changes associated with puberty. He is concerned that he easily develops a foul skin odor, even with mild exercise. Which of the following glandular structures is the causative agent for this foul skin odor? | Apocrine gland | {
"A": "Mucous gland",
"B": "Apocrine gland",
"C": "Sebaceous gland",
"D": "Serous gland"
} | step1 | B | [
"year old boy",
"changes associated with puberty",
"concerned",
"easily",
"foul skin",
"mild exercise",
"following glandular structures",
"causative agent",
"skin odor"
] |
A 50-year-old man presents to the office with the complaint of pain in his left great toe. The pain started 2 days ago and has been progressively getting worse to the point that it is difficult to walk even a few steps. He adds that his left big toe is swollen and hot to the touch. He has never had similar symptoms in ... | Inhibits xanthine oxidase | {
"A": "Inhibits renal clearance of uric acid",
"B": "Inhibits xanthine oxidase",
"C": "Activates adenosine monophosphate (AMP) deaminase",
"D": "Increases renal clearance of uric acid"
} | step1 | B | [
"50 year old man presents",
"office",
"complaint",
"pain",
"left great toe",
"pain started 2 days",
"getting worse",
"point",
"difficult to walk",
"few steps",
"adds",
"left big toe",
"swollen",
"hot",
"touch",
"never",
"similar symptoms",
"past",
"drinks 23 cans",
"beer",
"n... |
A 25-year-old woman presented to an urgent care center with a complaint of a cough for more than 3 weeks that was accompanied by night sweats, weight loss, and malaise. On physical examination, the patient had slightly pale palpebral conjunctivae bilateral posterior cervical lymphadenopathy, but with no adventitious br... | Pyrazinamide | {
"A": "Pyrazinamide",
"B": "Isoniazid",
"C": "Streptomycin",
"D": "Ethambutol"
} | step1 | A | [
"year old woman presented",
"urgent care center",
"complaint",
"cough",
"more",
"weeks",
"night sweats",
"weight loss",
"malaise",
"physical examination",
"patient",
"slightly pale palpebral bilateral posterior cervical lymphadenopathy",
"adventitious breath sounds",
"lung fields",
"phys... |
A 9-year-old boy is referred to an orthopedic surgeon after his primary care physician noticed that he was developing scoliosis. He has been otherwise healthy. His family history includes blindness and a cancer causing extremely high blood pressure. On physical exam there are scattered nodules in his skin as well as th... | Autosomal dominant | {
"A": "Autosomal dominant",
"B": "Autosomal recessive",
"C": "X-linked dominant",
"D": "X-linked recessive"
} | step1 | A | [
"year old boy",
"referred",
"orthopedic surgeon",
"primary care physician",
"scoliosis",
"healthy",
"family history includes blindness",
"cancer causing extremely high blood pressure",
"physical exam",
"scattered nodules",
"skin",
"findings shown",
"photographs",
"patient's disorder",
"l... |
A 67-year-old man presents to his primary care physician complaining of frequent urination overnight. He states that for several years he has had trouble maintaining his urine stream along with the need for frequent urination, but the nighttime urination has only recently started. The patient also states that he has ha... | Increased serum creatinine | {
"A": "Increased serum ALP",
"B": "Increased serum creatinine",
"C": "Increased serum hCG",
"D": "Malignant transformation"
} | step1 | B | [
"67 year old man presents",
"primary care physician",
"of frequent urination overnight",
"states",
"several years",
"maintaining",
"urine stream",
"need",
"frequent urination",
"nighttime urination",
"only recently started",
"patient",
"states",
"2 urinary tract infections",
"year",
"n... |
A 71-year-old man comes to the emergency department because of pain and swelling in his left leg that started after he cut his foot while swimming in the ocean. He has a history of alcoholic cirrhosis. His temperature is 38.3°C (101.0°F). Examination of the left foot shows a small, purulent wound with surrounding swell... | Vibrio vulnificus | {
"A": "Shigella flexneri",
"B": "Clostridium perfringens",
"C": "Streptococcus pyogenes",
"D": "Vibrio vulnificus"
} | step1 | D | [
"71 year old man",
"emergency department",
"pain",
"swelling",
"left",
"started",
"cut",
"foot",
"swimming",
"history",
"alcoholic cirrhosis",
"temperature",
"3C",
"Examination of",
"left foot shows",
"small",
"purulent wound",
"surrounding swelling",
"dusky redness extending",
... |
A 3-year-old boy is brought to a respiratory specialist. The family physician referred the child because of recurrent respiratory infections over the past 2 years. Chest X-rays showed a lesion of < 2 cm that includes glands and cysts in the upper lobe of the right lung. Diseases affecting the immune system were investi... | Lobectomy | {
"A": "Antibiotics",
"B": "Bronchoscopy",
"C": "Lobectomy",
"D": "Pneumonectomy"
} | step2&3 | C | [
"3 year old boy",
"brought",
"respiratory specialist",
"family physician referred",
"child",
"recurrent respiratory infections",
"past",
"years",
"Chest X-rays showed",
"lesion",
"2",
"includes glands",
"cysts",
"the upper lobe of",
"right lung",
"Diseases affecting",
"immune system"... |
A 22-year-old man is brought to the emergency department by his friends 30 minutes after falling down a flight of stairs. His friends report that they were at a college party, where he drank large amounts of alcohol. He is aggressive and restless. Examination shows tenderness to palpation and swelling of his right lowe... | """I understand that you want to go home, but I'll have to keep you here as long as you are intoxicated.""" | {
"A": "\"\"\"If you don't consent to treatment, I'll be forced to obtain consent from your parents.\"\"\"",
"B": "\"\"\"You can leave the hospital after signing a self-discharge against medical advice form.\"\"\"",
"C": "\"\"\"I understand that you want to go home, but I'll have to keep you here as long as you a... | step1 | C | [
"year old man",
"brought",
"emergency department",
"friends 30 minutes",
"falling",
"flight",
"stairs",
"friends report",
"college party",
"drank large amounts",
"alcohol",
"aggressive",
"restless",
"Examination shows tenderness",
"palpation",
"swelling of",
"right lower leg",
"x-r... |
A 25-year-old man comes to the physician because of a 2-week history of numbness in his left lower extremity. One month ago, he sustained a fracture of the neck of the left fibula during soccer practice that was treated with immobilization in a plaster cast. Physical examination of the left lower extremity is most like... | Impaired dorsiflexion of the foot | {
"A": "Impaired dorsiflexion of the foot",
"B": "Loss of sensation over the medial calf",
"C": "Inability to stand on tiptoes",
"D": "Decreased ankle reflex"
} | step1 | A | [
"year old man",
"physician",
"2-week history",
"numbness",
"left lower extremity",
"One month",
"sustained",
"fracture of",
"neck of",
"left fibula",
"soccer practice",
"treated with immobilization",
"plaster cast",
"Physical examination of the left lower extremity",
"most likely to show... |
A 72-year-old man presents to his primary care physician due to worsening headache and double vision. His headache began several months ago, and he describes them as sharp and localized to the left side of the head. His double vision began one week prior to presentation. Medical history is significant for hypertension ... | Abducens | {
"A": "Oculomotor",
"B": "Ophthalmic",
"C": "Abducens",
"D": "Optic"
} | step1 | C | [
"72 year old man presents",
"primary care physician",
"worsening headache",
"double vision",
"headache began several months",
"sharp",
"localized",
"left side of",
"head",
"double vision began one week prior to presentation",
"Medical history",
"significant",
"hypertension",
"type II diabe... |
A 56-year-old woman undergoes open reduction and internal fixation of the distal tibia 1 day after a fall. She has had rheumatoid arthritis for 12 years and diabetes mellitus for 2 years. Her medications over the past year have included metformin, prednisone, calcium supplements, and methotrexate. Prior to surgery, ins... | Vitamin A | {
"A": "Arginine",
"B": "Vitamin A",
"C": "Vitamin C",
"D": "Zinc"
} | step2&3 | B | [
"year old woman",
"open reduction",
"internal fixation of",
"distal tibia 1 day",
"fall",
"rheumatoid arthritis",
"years",
"diabetes mellitus",
"years",
"medications",
"past year",
"included metformin",
"prednisone",
"calcium supplements",
"methotrexate",
"surgery",
"insulin",
"add... |
A 32-year-old woman makes an appointment with her family physician for a new-employment physical examination. She has no complaints and the physical examination is unremarkable. The family history is negative for malignancies and inherited disorders. During the visit, she provides the results of a Pap smear taken last ... | 3 years | {
"A": "Immediately",
"B": "6 months",
"C": "3 years",
"D": "1 year"
} | step1 | C | [
"year old woman makes",
"appointment",
"family physician",
"new employment physical examination",
"complaints",
"physical examination",
"unremarkable",
"family history",
"negative",
"malignancies",
"inherited disorders",
"visit",
"provides",
"results",
"Pap smear taken last week",
"rep... |
A 35-year-old woman gravida 2, para 1, comes to the physician for her first prenatal visit. Pregnancy and delivery of her first child were uncomplicated. She is not sure about the date of her last menstrual period. Pelvic examination shows a uterus consistent in size with a 10-week gestation. An ultrasound examination ... | Cell-free fetal DNA testing | {
"A": "Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A",
"B": "Amniocentesis",
"C": "Cell-free fetal DNA testing",
"D": "Chorionic villus sampling"
} | step2&3 | C | [
"35 year old woman gravida 2",
"para 1",
"physician",
"first prenatal visit",
"Pregnancy",
"delivery",
"first child",
"uncomplicated",
"not sure",
"date of",
"last menstrual period",
"Pelvic examination shows",
"uterus consistent",
"size",
"a 10 week gestation",
"ultrasound examination... |
A 72-year-old African American man presents with progressive fatigue, difficulty breathing on exertion, and lower extremity swelling for 3 months. The patient was seen at the emergency department 2 times before. The first time was because of back pain, and the second was because of fever and cough. He took medications ... | Deposition of an extracellular fibrillar protein that stains positive for Congo red in the myocardium | {
"A": "Deposition of an extracellular fibrillar protein that stains positive for Congo red in the myocardium",
"B": "Concentric hypertrophy of the myocytes with thickening of the interventricular septum",
"C": "Calcification of the aortic valve orifice with obstruction of the left ventricular outflow tract",
"... | step2&3 | A | [
"72 year old African American man presents",
"progressive fatigue",
"difficulty breathing",
"exertion",
"lower extremity swelling",
"months",
"patient",
"seen",
"emergency department 2 times",
"first time",
"of back pain",
"second",
"of fever",
"cough",
"took medications",
"emergency r... |
A 73-year-old woman is brought in by her daughter stating that her mom has become increasingly forgetful and has trouble remembering recent events. Her memory for remote events is remarkably intact. The patient is no longer able to cook for herself as she frequently leaves the stove on unattended. She has recently been... | Nucleus basalis | {
"A": "Nucleus basalis",
"B": "Raphe nucleus",
"C": "Ventral tegmentum",
"D": "Nucleus accumbens"
} | step1 | A | [
"year old woman",
"brought",
"daughter stating",
"mom",
"forgetful",
"remembering recent events",
"memory",
"remote events",
"intact",
"patient",
"longer able to cook",
"frequently leaves",
"stove",
"recently",
"getting lost",
"neighborhood",
"lived",
"30 years",
"mood",
"not d... |
A 27-year-old female in her 20th week of pregnancy presents for a routine fetal ultrasound screening. An abnormality of the right fetal kidney is detected. It is determined that the right ureteropelvic junction has failed to recanalize. Which of the following findings is most likely to be seen on fetal ultrasound: | Unilateral hydronephrosis | {
"A": "Unilateral hydronephrosis",
"B": "Renal cysts",
"C": "Pelvic kidney",
"D": "Duplicated ureter"
} | step1 | A | [
"27 year old female",
"week",
"pregnancy presents",
"routine fetal ultrasound screening",
"abnormality of the right fetal kidney",
"detected",
"right ureteropelvic junction",
"failed to recanalize",
"following findings",
"most likely to",
"seen",
"fetal ultrasound"
] |
A 16-year-old boy is brought to the pediatrician by his mother because she is concerned about the “spots” on his abdomen and back. The patient’s mother reports that there are several “light spots” on the patient’s trunk that have been slowly increasing in number. The lesions are not painful nor pruritic. The patient’s ... | Bilateral vestibular schwannomas | {
"A": "Bilateral vestibular schwannomas",
"B": "Optic nerve glioma",
"C": "Subependymal hamartomas",
"D": "Thyroid nodule"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatrician",
"mother",
"concerned",
"spots",
"abdomen",
"back",
"patients mother reports",
"several light spots",
"patients trunk",
"slowly increasing",
"number",
"lesions",
"not painful",
"patients mother",
"worried",
"nephew",
"vitiligo",
"patien... |
A 4-year-old girl is brought to the pediatrician's office by her parents with a complaint of foul-smelling discharge from one side of her nose for the past 2 weeks. There is no history of trauma to the nose and she was completely fine during her well-child visit last month. She was born at 39 weeks gestation via sponta... | Nasal foreign body | {
"A": "Nasal foreign body",
"B": "Bilateral maxillary sinusitis",
"C": "Septal hematoma",
"D": "Nasal tumor"
} | step1 | A | [
"4 year old girl",
"brought",
"pediatrician's office",
"parents",
"complaint",
"smelling discharge",
"one side",
"nose",
"past 2 weeks",
"history",
"trauma",
"nose",
"completely fine",
"well-child visit",
"month",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",... |
A 27-year-old male presents to clinic complaining of coughing up small amounts of blood daily for the past week. He denies smoking, sick contacts, or recent travel. Chest radiographs demonstrates interstitial pneumonia with patchy alveolar infiltrates suggestive of multiple bleeding sites. Urinalysis is positive for bl... | Goodpasture disease | {
"A": "Systemic lupus erythematous (SLE)",
"B": "Granulomatosis with polyangiitis (Wegner's)",
"C": "Churg-Strauss syndrome",
"D": "Goodpasture disease"
} | step2&3 | D | [
"27 year old male presents",
"clinic complaining of coughing",
"small amounts",
"blood daily",
"past week",
"denies smoking",
"sick contacts",
"recent travel",
"Chest radiographs demonstrates interstitial pneumonia",
"patchy alveolar infiltrates suggestive of multiple bleeding sites",
"Urinalysi... |
A 66-year-old man presents with severe respiratory distress. He was diagnosed with pulmonary hypertension secondary to occupational pneumoconiosis. Biopsy findings of the lung showed ferruginous bodies. What is the most likely etiology? | Asbestos | {
"A": "Iron",
"B": "Asbestos",
"C": "Beryllium",
"D": "Silica"
} | step1 | B | [
"66 year old man presents",
"severe respiratory distress",
"diagnosed",
"pulmonary hypertension secondary to occupational pneumoconiosis",
"Biopsy findings of",
"lung showed ferruginous bodies",
"most likely etiology"
] |
A 25-year-old G1P1 with a history of diabetes and epilepsy gives birth to a female infant at 32 weeks gestation. The mother had no prenatal care and took no prenatal vitamins. The child’s temperature is 98.6°F (37°C), blood pressure is 100/70 mmHg, pulse is 130/min, and respirations are 25/min. On physical examination ... | Valproic acid | {
"A": "Lithium",
"B": "Ethosuximide",
"C": "Gentamicin",
"D": "Valproic acid"
} | step1 | D | [
"year old G1P1",
"history",
"diabetes",
"epilepsy gives birth",
"female infant",
"weeks gestation",
"mother",
"prenatal care",
"took",
"prenatal vitamins",
"childs temperature",
"98",
"blood pressure",
"100 70 mmHg",
"pulse",
"min",
"respirations",
"min",
"physical examination",
... |
Following a motor vehicle accident, a 63-year-old man is scheduled for surgery. The emergency physician notes a posture abnormality in the distal left lower limb and a fracture-dislocation of the right hip and acetabulum based on the radiology report. The senior orthopedic resident mistakenly notes a fraction dislocati... | Swiss-cheese model | {
"A": "Closed-loop communication",
"B": "Root cause analysis",
"C": "Swiss-cheese model",
"D": "Sentinel event"
} | step2&3 | C | [
"Following",
"motor vehicle accident",
"63 year old man",
"scheduled",
"surgery",
"emergency physician notes",
"posture abnormality",
"distal left lower limb",
"fracture dislocation of the right hip",
"acetabulum based",
"radiology report",
"senior orthopedic resident",
"notes",
"fraction ... |
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