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 53-year-old woman with hypertension is brought to the emergency department 30 minutes after having a generalized, tonic-clonic seizure. She has had recurrent headaches and dizziness in the last 3 months. One year ago, she had diarrhea after a trip to Ecuador that resolved without treatment. She has not received any m... | Avoidance of contaminated food | {
"A": "Avoidance of contaminated food",
"B": "Vaccination against meningococcus",
"C": "Smoking cessation",
"D": "Improved blood pressure control"
} | step1 | A | [
"year old woman",
"hypertension",
"brought",
"emergency department 30 minutes",
"generalized",
"tonic-clonic seizure",
"recurrent headaches",
"dizziness",
"months",
"One year ago",
"diarrhea",
"trip",
"Ecuador",
"resolved",
"treatment",
"not received",
"medical care",
"five years",... |
A 6-year-old boy is brought to the physician because of increasing swelling around his eyes for the past 3 days. During this period, he has had frothy light yellow urine. He had a sore throat 12 days ago. He appears tired. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 105/65 mm Hg. Examinatio... | Fatty casts | {
"A": "WBC casts",
"B": "Hyaline casts",
"C": "RBC casts",
"D": "Fatty casts"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"of increasing swelling around",
"eyes",
"past",
"days",
"period",
"frothy light yellow",
"sore throat",
"days",
"appears tired",
"temperature",
"98",
"pulse",
"90 min",
"blood pressure",
"65 mm Hg",
"Examination shows periorbital edema",
... |
A 55-year-old female presents to the emergency room complaining of severe abdominal pain. She reports a six-month history of worsening dull mid-epigastric pain that she had attributed to stress at work. She has lost fifteen pounds over that time. She also reports that her stools have become bulky, foul-smelling, and gr... | Ampulla of Vater | {
"A": "Common hepatic duct",
"B": "Common bile duct",
"C": "Pancreatic duct",
"D": "Ampulla of Vater"
} | step1 | D | [
"55 year old female presents",
"emergency room",
"severe abdominal",
"reports",
"six-month history",
"worsening dull",
"epigastric",
"attributed",
"stress",
"work",
"lost fifteen pounds over",
"time",
"reports",
"stools",
"bulky",
"smelling",
"greasy",
"past",
"days",
"abdomina... |
A 67-year-old woman comes to the physician because of intermittent chest pain and dizziness on exertion for 6 months. Her pulse is 76/min and blood pressure is 125/82 mm Hg. Cardiac examination shows a grade 3/6, late-peaking, crescendo-decrescendo murmur heard best at the right upper sternal border. An echocardiogram ... | Decreased left ventricular preload | {
"A": "Impaired pulmonary artery outflow",
"B": "Decreased left ventricular preload",
"C": "Decreased impulse conduction across the AV node",
"D": "Increased systemic vascular resistance"
} | step1 | B | [
"67 year old woman",
"physician",
"intermittent chest",
"dizziness",
"exertion",
"months",
"pulse",
"76 min",
"blood pressure",
"mm Hg",
"Cardiac examination shows",
"grade",
"6",
"late peaking",
"crescendo-decrescendo murmur heard best",
"right upper sternal border",
"echocardiogram... |
A 45-year-old woman presents with fever, pain, and swelling of the right leg. She says that her right leg swelling has gradually worsened over the last 2 weeks. She has also noted worsening fatigue and anorexia. Two days ago, she developed a low-grade fever. Her past medical history is significant for type 2 diabetes m... | Catalase-negative cocci in chain | {
"A": "Catalase-negative cocci in grape-like clusters",
"B": "Catalase-negative cocci in chain",
"C": "Shows no hemolysis on blood agar",
"D": "Catalase-positive Gram-positive diplococci"
} | step1 | B | [
"year old woman presents",
"fever",
"pain",
"swelling of",
"right leg",
"right",
"worsened",
"2 weeks",
"noted worsening fatigue",
"anorexia",
"Two days",
"low-grade fever",
"past medical history",
"significant",
"type 2 diabetes mellitus diagnosed 5 years",
"managed",
"metformin",
... |
A 7-year-old boy is brought to a pediatric clinic by his mother because he had difficulty swallowing for 4 days. He was diagnosed with asthma 3 months ago and has been using an inhaler as directed by the pediatrician. The child does not have a fever or a cough and is not short of breath. He denies pain during swallowin... | Oral thrush | {
"A": "Leukoplakia",
"B": "Primary gingivostomatitis",
"C": "Oral thrush",
"D": "Oral hairy leukoplakia"
} | step1 | C | [
"year old boy",
"brought",
"pediatric clinic",
"mother",
"difficulty swallowing",
"4 days",
"diagnosed",
"asthma",
"months",
"using",
"inhaler",
"directed",
"pediatrician",
"child",
"not",
"fever",
"cough",
"not short of breath",
"denies pain",
"swallowing",
"vital signs incl... |
A 13-year-old boy is brought to the emergency room by his mother for a generalized tonic-clonic seizure that occurred while attending a laser light show. His mother says that he has been otherwise healthy but “he often daydreams”. Over the past several months, he has reported recurrent episodes of jerky movements of hi... | Valproate | {
"A": "Carbamazepine",
"B": "Tiagabine",
"C": "Valproate",
"D": "Vigabatrin"
} | step1 | C | [
"year old boy",
"brought",
"emergency room",
"mother",
"generalized tonic-clonic seizure",
"occurred",
"attending",
"laser light show",
"mother",
"healthy",
"often daydreams",
"past",
"months",
"reported recurrent episodes of jerky movements",
"fingers",
"arms",
"episodes usually occ... |
A 4-day-old male newborn is brought to the physician because of increasing yellowish discoloration of his skin for 2 days. He was born at 38 weeks' gestation and weighed 2466 g (5 lb 7 oz); he currently weighs 2198 g (4 lb 14 oz). Pregnancy was complicated by pregnancy-induced hypertension. The mother says he breastfee... | Inadequate breastfeeding | {
"A": "Increased breakdown of fetal RBCs",
"B": "Elevated β-glucuronidase in breast milk",
"C": "Inadequate breastfeeding",
"D": "Defective alpha-globin chains of hemoglobin"
} | step2&3 | C | [
"4 day old male newborn",
"brought",
"physician",
"of increasing",
"discoloration",
"skin",
"2 days",
"born",
"weeks",
"estation ",
" ",
"z)",
"urrently ",
" ",
"z)",
"regnancy ",
"omplicated by pregnancy- nduced ypertension.",
"other ",
"reastfeeds ",
" hours ",
" et iape... |
A 19-year-old man and recent immigrant from Brazil present to the clinic. He has no known past medical, past surgical, or family history. The patient admits to having several regular sexual partners. Today, he complains of a skin rash on his back. He is unclear when it started but became aware when one of his partners ... | Tinea versicolor | {
"A": "Tinea versicolor",
"B": "Mycosis fungoides",
"C": "Pityriasis rosea",
"D": "Secondary syphilis"
} | step2&3 | A | [
"year old man",
"recent immigrant",
"Brazil present",
"clinic",
"known past medical",
"surgical",
"family history",
"patient admits",
"several regular sexual partners",
"Today",
"skin rash",
"back",
"started",
"aware",
"one",
"partners pointed",
"out",
"review of systems",
"negat... |
A 56-year-old woman visits her family physician accompanied by her son. She has recently immigrated to Canada and does not speak English. Her son tells the physician that he is worried that his mother gets a lot of sugar in her diet and does not often monitor her glucose levels. Her previous lab work shows a HbA1c valu... | Skeletal muscle | {
"A": "Pancreas",
"B": "Liver",
"C": "Skeletal muscle",
"D": "Red blood cells"
} | step1 | C | [
"year old woman visits",
"family physician",
"son",
"recently",
"Canada",
"not speak English",
"son",
"physician",
"worried",
"mother gets",
"lot",
"sugar",
"diet",
"not often monitor",
"glucose levels",
"previous lab work shows",
"value",
"examination",
"blood pressure",
"87 m... |
A 33-year-old woman comes to the emergency department because of severe right flank pain for 2 hours. The pain is colicky in nature and she describes it as 9 out of 10 in intensity. She has had 2 episodes of vomiting. She has no history of similar episodes in the past. She is 160 cm (5 ft 3 in) tall and weighs 104 kg (... | Ureterorenoscopy | {
"A": "Ureterorenoscopy",
"B": "Observation",
"C": "Ureteral stenting",
"D": "Thiazide diuretic therapy\n\""
} | step2&3 | A | [
"year old woman",
"emergency department",
"of severe right flank pain",
"hours",
"pain",
"colicky",
"nature",
"out",
"10",
"intensity",
"2 episodes of vomiting",
"history of similar episodes",
"past",
"5 ft",
"tall",
"kg",
"BMI",
"kg/m2",
"temperature",
"3C",
"99",
"pulse",... |
A 55-year-old man presents to the emergency department with shortness of breath and weakness. Past medical history includes coronary artery disease, arterial hypertension, and chronic heart failure. He reports that the symptoms started around 2 weeks ago and have been gradually worsening. His temperature is 36.5°C (97.... | Restricted aldosterone release | {
"A": "Increased water reabsorption by the renal collecting ducts",
"B": "Restricted aldosterone release",
"C": "Increased potassium release from cardiomyocytes",
"D": "Inhibition of funny sodium channels"
} | step1 | B | [
"55 year old man presents",
"emergency department",
"shortness of breath",
"weakness",
"Past medical history includes coronary artery disease",
"arterial hypertension",
"chronic heart failure",
"reports",
"symptoms started",
"2 weeks",
"worsening",
"temperature",
"36",
"97",
"blood press... |
An 11-month-old boy presents with a scaly erythematous rash on his back for the past 2 days. No significant past medical history. Family history is significant for the fact that the patient’s parents are first-degree cousins. In addition, his older sibling had similar symptoms and was diagnosed with a rare unknown skin... | CD1a | {
"A": "CD21",
"B": "CD1a",
"C": "CD15",
"D": "CD30"
} | step1 | B | [
"month old boy presents",
"scaly erythematous rash",
"back",
"past 2 days",
"significant past medical history",
"Family history",
"significant",
"fact",
"patients parents",
"first-degree cousins",
"addition",
"older sibling",
"similar symptoms",
"diagnosed",
"rare unknown skin",
"physi... |
A 22-year-old man is brought to the emergency department 10 minutes after falling down a flight of stairs. An x-ray of the right wrist shows a distal radius fracture. A rapidly acting intravenous anesthetic agent is administered, and closed reduction of the fracture is performed. Following the procedure, the patient re... | Glutamate | {
"A": "Glutamate",
"B": "Norepinephrine",
"C": "Endorphin",
"D": "Gamma-aminobutyric acid"
} | step1 | A | [
"year old man",
"brought",
"emergency department 10 minutes",
"falling down",
"flight",
"stairs",
"x-ray of",
"right wrist shows",
"distal radius fracture",
"rapidly acting intravenous anesthetic agent",
"administered",
"closed reduction of",
"fracture",
"performed",
"Following",
"proc... |
An otherwise healthy 45-year-old woman comes to the physician because of a 2-week history of an itchy rash on her left nipple. The rash began as small vesicles on the nipple and spread to the areola. It has become a painful ulcer with yellow, watery discharge that is occasionally blood-tinged. She has asthma treated wi... | Paget disease of the breast
" | {
"A": "Inflammatory breast cancer",
"B": "Mastitis",
"C": "Breast abscess",
"D": "Paget disease of the breast\n\""
} | step2&3 | D | [
"healthy",
"year old woman",
"physician",
"2-week history",
"itchy rash",
"left nipple",
"rash began",
"small vesicles",
"nipple",
"spread",
"areola",
"painful ulcer",
"yellow",
"watery discharge",
"occasionally blood-tinged",
"asthma treated with theophylline",
"inhaled salbutamol",... |
A 40-year-old woman in her 18th week of pregnancy based on the last menstrual period (LMP) presents to her obstetrician for an antenatal check-up.
The antenatal testing is normal, except the quadruple screen results which are given below:
Maternal serum alpha-fetoprotein (MS-AFP) low
Unconjugated estriol low
Human chor... | Trisomy 21 | {
"A": "Trisomy 21",
"B": "Spina bifida",
"C": "Gastroschisis",
"D": "Fetal alcohol syndrome"
} | step1 | A | [
"40 year old woman",
"week",
"pregnancy based",
"last menstrual period",
"LMP",
"presents",
"obstetrician",
"antenatal check-up",
"antenatal testing",
"normal",
"quadruple screen results",
"given",
"Maternal serum alpha-fetoprotein",
"low Unconjugated estriol",
"gonadotropin",
"high In... |
A 46-year-old man presents with increasing fatigue and weakness for the past 3 months. He works as a lawyer and is handling a complicated criminal case which is very stressful, and he attributes his fatigue to his work. He lost 2.3 kg (5.0 lb) during this time despite no change in diet or activity level. His past histo... | A genetic test followed by colonoscopy for the son should be ordered. | {
"A": "The son should undergo a prophylactic colonic resection.",
"B": "The son doesn't need to be tested now.",
"C": "A genetic test followed by colonoscopy for the son should be ordered.",
"D": "Screening can be started by 50 years of age as the son’s risk is similar to the general population."
} | step1 | C | [
"year old man presents",
"increasing fatigue",
"weakness",
"past 3 months",
"works",
"lawyer",
"handling",
"complicated criminal case",
"very stressful",
"attributes",
"fatigue",
"work",
"lost 2.3 kg",
"5 0",
"time",
"change",
"diet",
"activity level",
"past history",
"signific... |
Background:
Beta-blockers reduce mortality in patients who have heart failure reduced ejection fraction and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors. We aimed to compare the effects of carvedilol and metoprolol on clinical outcome.
Methods:
In a multicenter, double-blind, ... | A 68-year-old male with NYHA class II systolic heart failure and EF 30% | {
"A": "A 62-year-old male with primarily preserved ejection fraction heart failure",
"B": "A 75-year-old female with systolic dysfunction and an EF of 45%",
"C": "A 56-year-old male with NYHA class I systolic heart failure",
"D": "A 68-year-old male with NYHA class II systolic heart failure and EF 30%"
} | step2&3 | D | [
"Background",
"Beta-blockers",
"mortality",
"patients",
"heart failure reduced ejection fraction",
"background treatment",
"diuretics",
"angiotensin-converting enzyme inhibitors",
"aimed to compare",
"effects",
"carvedilol",
"metoprolol",
"clinical outcome",
"Methods",
"multicenter",
"... |
A 48-year-old female comes into the ER with chest pain. An electrocardiogram (EKG) shows a heart beat of this individual in Image A. The QR segment best correlates with what part of the action potential of the ventricular myocyte shown in Image B? | Phase 0, which is primarily characterized by sodium influx | {
"A": "Phase 0, which is primarily characterized by sodium influx",
"B": "Phase 0, which is primarily characterized by potassium efflux",
"C": "Phase 1, which is primarily characterized by potassium and chloride efflux",
"D": "Phase 1, which is primarily characterized by calcium efflux"
} | step1 | A | [
"48 year old female",
"ER",
"chest pain",
"electrocardiogram",
"EKG",
"shows",
"heart beat",
"individual",
"Image",
"QR segment best",
"part of",
"action potential",
"ventricular myocyte shown",
"Image"
] |
Ten days after being discharged from the hospital, a 42-year-old man comes to the emergency department because of reduced urine output for 3 days. Physical examination is normal. Serum creatinine concentration is 2.9 mg/dL. Urinalysis shows brownish granular casts and 2+ proteinuria. Renal biopsy shows patchy necrosis ... | Gentamicin | {
"A": "Captopril",
"B": "Aspirin",
"C": "Acyclovir",
"D": "Gentamicin"
} | step1 | D | [
"Ten days",
"discharged from",
"hospital",
"year old man",
"emergency department",
"of reduced urine output",
"3 days",
"Physical examination",
"normal",
"Serum creatinine concentration",
"2.9 mg/dL",
"Urinalysis shows",
"granular casts",
"2",
"proteinuria",
"Renal biopsy shows patchy ... |
A 3-year-old boy is brought to the physician because of a 4-week history of generalized fatigue and malaise. He was born at term and has been healthy since. His mother has a history of recurrent anemia. He appears pale. His temperature is 37°C (98.6°F) and pulse is 97/min. Examination shows pale conjunctivae and jaundi... | Eosin-5-maleimide binding test | {
"A": "Fluorescent spot test",
"B": "Eosin-5-maleimide binding test",
"C": "Indirect antiglobulin test",
"D": "Peripheral smear"
} | step2&3 | B | [
"3 year old boy",
"brought",
"physician",
"4 week history",
"generalized fatigue",
"malaise",
"born",
"term",
"healthy",
"mother",
"history of recurrent anemia",
"appears pale",
"temperature",
"98",
"pulse",
"97 min",
"Examination shows pale conjunctivae",
"jaundice",
"abdomen",
... |
A 71-year-old woman presents with high-grade fever and chills, difficulty breathing, and a productive cough with rust-colored sputum. She complains of a sharp left-sided chest pain. Physical examination reveals increased fremitus, dullness to percussion, and bronchial breath sounds on the lower left side. A chest X-ray... | Gram-positive diplococci | {
"A": "Cannot be seen with gram staining since the organism lacks a cell wall",
"B": "Gram-negative rod",
"C": "Gram-positive diplococci",
"D": "Gram-negative diplococci"
} | step1 | C | [
"71 year old woman presents",
"high-grade fever",
"chills",
"difficulty breathing",
"productive cough",
"rust colored sputum",
"sharp left-sided chest pain",
"Physical examination reveals increased fremitus",
"dullness",
"percussion",
"bronchial breath sounds",
"lower left side",
"chest X-ra... |
You are conducting a lab experiment on skeletal muscle tissue to examine force in different settings. The skeletal muscle tissue is hanging down from a hook. The experiment has 3 different phases. In the first phase, you compress the muscle tissue upwards, making it shorter. In the second phase, you attach a weight of ... | Lengthening of the muscle in phase 2 increases passive tension. | {
"A": "Shortening of the muscle in phase 1 uses up ATP stores.",
"B": "Lengthening of the muscle in phase 2 increases passive tension.",
"C": "The tension in phase 1 is only active, while in phase 2 it is both active and passive.",
"D": "Shortening the muscle in phase 1 pulls the actin and myosin filaments apa... | step1 | B | [
"conducting",
"lab experiment",
"skeletal muscle tissue to",
"force",
"different settings",
"skeletal muscle tissue",
"hanging",
"hook",
"experiment",
"3 different phases",
"first phase",
"compress",
"muscle tissue",
"making",
"shorter",
"second phase",
"attach",
"weight",
"kg",
... |
A 20-year-old woman reports to student health complaining of 5 days of viral symptoms including sneezing and a runny nose. She started coughing 2 days ago and is seeking cough medication. She additionally mentions that she developed a fever 2 days ago, but this has resolved. On exam, her temperature is 99.0°F (37.2°C),... | Anterior hypothalamus | {
"A": "Anterior hypothalamus",
"B": "Lateral area",
"C": "Paraventricular nucleus",
"D": "Suprachiasmatic nucleus"
} | step1 | A | [
"20 year old woman reports",
"student health",
"5 days",
"viral symptoms including sneezing",
"runny nose",
"started coughing 2 days",
"cough medication",
"fever",
"days",
"resolved",
"exam",
"temperature",
"99",
"blood pressure",
"76 mmHg",
"pulse",
"min",
"respirations",
"min",... |
A 28-year-old woman is brought to a counselor by her father after he found out that she is being physically abused by her husband. The father reports that she refuses to end the relationship with her husband despite the physical abuse. She says that she feels uneasy when her husband is not around. She adds, “I'm worrie... | Dependent personality disorder | {
"A": "Borderline personality disorder",
"B": "Separation anxiety disorder",
"C": "Dependent personality disorder",
"D": "Avoidant personality disorder"
} | step1 | C | [
"year old woman",
"brought",
"counselor",
"father",
"found out",
"abused",
"husband",
"father reports",
"refuses to end",
"relationship",
"husband",
"physical abuse",
"feels uneasy",
"husband",
"not",
"adds",
"I m worried",
"I leave",
"life",
"only",
"worse",
"never",
"em... |
A 23-year-old patient presents to the emergency department after a motor vehicle accident. The patient was an unrestrained driver involved in a head-on collision. The patient is heavily intoxicated on what he claims is only alcohol. An initial trauma assessment is performed, and is notable for significant bruising of t... | Fasciotomy | {
"A": "IV fluids",
"B": "Analgesics",
"C": "Fasciotomy",
"D": "Pressure measurement"
} | step2&3 | C | [
"23 year old patient presents",
"emergency department",
"motor vehicle accident",
"patient",
"driver involved",
"head",
"collision",
"patient",
"only alcohol",
"initial trauma",
"performed",
"notable",
"significant bruising",
"right forearm",
"patient",
"trauma bay",
"severe pain",
... |
A 57-year-old man presents with 2 days of severe, generalized, abdominal pain that is worse after meals. He is also nauseated and reports occasional diarrhea mixed with blood. Apart from essential hypertension, his medical history is unremarkable. His vital signs include a temperature of 36.9°C (98.4°F), blood pressure... | Acute mesenteric ischemia | {
"A": "Acute pancreatitis",
"B": "Crohn's disease",
"C": "Acute mesenteric ischemia",
"D": "Diverticular disease"
} | step2&3 | C | [
"57 year old man presents",
"2 days",
"severe",
"generalized",
"abdominal pain",
"worse",
"meals",
"nauseated",
"reports occasional diarrhea mixed",
"blood",
"essential hypertension",
"medical history",
"unremarkable",
"vital signs include",
"temperature",
"36",
"98 4F",
"blood pre... |
A 66-year-old farmer is being evaluated for abnormal lung findings on a low dose chest CT scan obtained as part of his lung cancer screening. He has a 50-pack-year smoking history and has been hesitant to quit. He has a non-productive cough but brushes it away saying he is not bothered by it. He denies ever coughing up... | Dendritic cells | {
"A": "T lymphocytes",
"B": "Natural killer cells",
"C": "Dendritic cells",
"D": "Ciliary epithelium"
} | step1 | C | [
"66 year old farmer",
"evaluated",
"abnormal lung",
"low dose chest CT scan obtained",
"part of",
"lung cancer screening",
"50 pack-year smoking history",
"hesitant to quit",
"non-productive cough",
"brushes",
"not",
"denies",
"coughing up blood",
"breathlessness",
"chest pain",
"fatig... |
A 51-year-old man seeks evaluation from his family physician with a complaint of heartburn, which has been gradually increasing over the last 10 years. The heartburn gets worse after eating spicy foods and improves with antacids. The past medical history is benign. He is a security guard and works long hours at night. ... | Urease | {
"A": "β-lactamase",
"B": "Hyaluronidase",
"C": "Urease",
"D": "Prostaglandins"
} | step1 | C | [
"year old man",
"evaluation",
"family",
"complaint",
"heartburn",
"increasing",
"10 years",
"heartburn gets worse after eating spicy foods",
"improves",
"antacids",
"past medical history",
"benign",
"security guard",
"works long hours",
"night",
"admits",
"smoking 1 5 packs",
"ciga... |
A previously healthy 32-year-old woman comes to the physician because of a 1-week history of progressively worsening cough with blood-tinged sputum, shortness of breath at rest, and intermittent left-sided chest pain. She has some mild vaginal bleeding since she had a cesarean delivery 6 weeks ago due to premature rupt... | Increased serum β-HCG levels | {
"A": "Increased angiotensin converting enzyme levels",
"B": "Increased serum β-HCG levels",
"C": "Increased carcinoembryonic antigen levels",
"D": "Increased brain natriuretic peptide levels"
} | step2&3 | B | [
"healthy",
"year old woman",
"physician",
"1-week history",
"worsening cough",
"blood-tinged sputum",
"shortness of breath",
"rest",
"intermittent left-sided chest pain",
"mild vaginal",
"cesarean delivery",
"weeks",
"due to premature rupture of membranes",
"fetal distress",
"weeks",
"... |
A 32-year-old woman presents to her physician concerned about wet spots on the inside part of her dress shirts, which she thinks it may be coming from one of her breasts. She states that it is painless and that the discharge is usually blood-tinged. She denies any history of malignancy in her family and states that she... | Intraductal papilloma | {
"A": "Paget's disease",
"B": "Breast abscess",
"C": "Ductal carcinoma",
"D": "Intraductal papilloma"
} | step2&3 | D | [
"year old woman presents",
"physician concerned",
"wet spots",
"part of",
"dress shirts",
"thinks",
"one",
"breasts",
"states",
"painless",
"discharge",
"usually blood-tinged",
"denies",
"history",
"malignancy",
"family",
"states",
"regular periods",
"first started",
"age",
"... |
A 54-year-old African American male presents to the emergency department with 1 day history of severe headaches. He has a history of poorly controlled hypertension and notes he hasn't been taking his antihypertensive medications. His temperature is 100.1 deg F (37.8 deg C), blood pressure is 190/90 mmHg, pulse is 60/mi... | Sodium nitrite | {
"A": "Methylene blue",
"B": "Sodium nitrite",
"C": "Glucagon",
"D": "Ethanol"
} | step1 | B | [
"54 year old African American male presents",
"emergency department",
"1 day history of severe headaches",
"history of poorly controlled hypertension",
"notes",
"taking",
"antihypertensive medications",
"temperature",
"100",
"deg F",
"blood pressure",
"90 mmHg",
"pulse",
"60 min",
"respi... |
A 33-year-old man is brought to the emergency department because of trauma from a motor vehicle accident. His pulse is 122/min and rapid and thready, the blood pressure is 78/37 mm Hg, the respirations are 26/min, and the oxygen saturation is 90% on room air. On physical examination, the patient is drowsy, with cold an... | Take the patient to the OR for an exploratory laparotomy | {
"A": "CT of the abdomen and pelvis with contrast",
"B": "Take the patient to the OR for an exploratory laparotomy",
"C": "Obtain a retrograde urethrogram",
"D": "Perform a diagnostic peritoneal lavage"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"of trauma",
"motor vehicle",
"pulse",
"min",
"rapid",
"thready",
"blood pressure",
"mm Hg",
"respirations",
"min",
"oxygen saturation",
"90",
"room air",
"physical examination",
"patient",
"drowsy",
"cold",
"clammy",
"Abdo... |
A 45-year-old homeless man is brought to the emergency department. He was found unconscious at the park. The patient has a past medical history of IV drug abuse, hepatitis C, alcohol abuse, schizophrenia, and depression. He does not receive normal medical follow up or care. His temperature is 102°F (38.9°C), blood pres... | Paracentesis | {
"A": "Cefotaxime",
"B": "Ceftriaxone",
"C": "Paracentesis",
"D": "Ultrasound"
} | step2&3 | C | [
"year old homeless man",
"brought",
"emergency department",
"found unconscious",
"park",
"patient",
"past medical history of IV drug abuse",
"hepatitis C",
"alcohol abuse",
"schizophrenia",
"depression",
"not receive normal medical follow up",
"care",
"temperature",
"blood pressure",
"... |
A 32-year-old woman comes to the physician because of a 4-day history of low-grade fever, joint pain, and muscle aches. The day before the onset of her symptoms, she was severely sunburned on her face and arms during a hike with friends. She also reports being unusually fatigued over the past 3 months. Her only medicat... | Nuclear Sm proteins | {
"A": "Cell nucleus",
"B": "Single-stranded DNA",
"C": "Fc region of IgG",
"D": "Nuclear Sm proteins"
} | step1 | D | [
"year old woman",
"physician",
"4-day history",
"low-grade fever",
"joint pain",
"muscle aches",
"day",
"onset",
"symptoms",
"severely sunburned",
"face",
"arms",
"friends",
"reports",
"fatigued",
"past 3 months",
"only medication",
"combined oral contraceptive pill",
"temperatur... |
A 24-year-old primigravida presents at 36 weeks gestation with vaginal bleeding, mild abdominal pain, and uterine contractions that appeared after bumping into a handrail. The vital signs are as follows: blood pressure 130/80 mm Hg, heart rate 79/min, respiratory rate 12/min, and temperature 36.5℃ (97.7℉). The fetal he... | Admit for maternal and fetal monitoring and observation | {
"A": "Urgent cesarean delivery",
"B": "Admit for maternal and fetal monitoring and observation",
"C": "Corticosteroid administration and schedule a cesarean section after",
"D": "Manage as an outpatient with modified rest"
} | step2&3 | B | [
"year old primigravida presents",
"36 weeks gestation",
"vaginal bleeding",
"mild abdominal",
"uterine contractions",
"appeared",
"handrail",
"vital signs",
"follows",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature 36",
"97",
"fetal heart... |
A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close co... | Cognitive-behavioral therapy | {
"A": "Motivational interviewing",
"B": "Cognitive-behavioral therapy",
"C": "Psychodynamic psychotherapy",
"D": "Group therapy\n\""
} | step2&3 | B | [
"20 year old man",
"physician",
"of decreasing academic performance",
"college",
"past 6 months",
"reports",
"persistent fear",
"catching germs",
"students",
"contracting",
"disease",
"finds",
"difficult to attend classes",
"close contact with",
"people",
"states",
"to think",
"els... |
A 6-month-old girl presents with recurring skin infections. Past medical history is significant for 3 episodes of acute otitis media since birth. The patient was born at 39 weeks via an uncomplicated, spontaneous transvaginal delivery, but there was delayed umbilical cord separation. She has met all developmental miles... | Absence of CD18 molecule on the surface of leukocytes | {
"A": "Defect in tyrosine kinase",
"B": "IL-12 receptor deficiency",
"C": "Absence of CD18 molecule on the surface of leukocytes",
"D": "Deficiency in NADPH oxidase"
} | step1 | C | [
"month old girl presents",
"recurring skin infections",
"Past medical history",
"significant",
"episodes of acute otitis media",
"birth",
"patient",
"born",
"weeks",
"uncomplicated",
"spontaneous transvaginal delivery",
"delayed umbilical cord separation",
"met",
"developmental milestones"... |
An investigator is studying gastric secretions in human volunteers. Measurements of gastric activity are recorded after electrical stimulation of the vagus nerve. Which of the following sets of changes is most likely to occur after vagus nerve stimulation?
$$$ Somatostatin secretion %%% Gastrin secretion %%% Gastric p... | ↓ ↑ ↓ | {
"A": "↓ ↑ ↓",
"B": "↑ ↑ ↑",
"C": "↓ ↓ ↓",
"D": "↑ ↓ ↑"
} | step1 | A | [
"investigator",
"studying gastric secretions",
"human",
"Measurements",
"activity",
"recorded",
"electrical stimulation",
"vagus nerve",
"following sets",
"changes",
"most likely to occur",
"vagus nerve stimulation",
"Somatostatin secretion",
"Gastrin",
"Gastric pH"
] |
A 44-year-old man comes to the physician because of progressive memory loss for the past 6 months. He reports that he often misplaces his possessions and has begun writing notes to remind himself of names and important appointments. He generally feels fatigued and unmotivated, and has poor concentration at work. He has... | HIV-related encephalopathy | {
"A": "Cerebral toxoplasmosis",
"B": "Pseudodementia",
"C": "HIV-related encephalopathy",
"D": "Frontotemporal dementia"
} | step2&3 | C | [
"year old man",
"physician",
"of progressive",
"past 6 months",
"reports",
"often",
"possessions",
"begun writing notes to remind",
"names",
"important appointments",
"feels fatigued",
"poor concentration",
"work",
"given",
"playing soccer",
"feels slow",
"unsteady on",
"feet",
"... |
A 12-year-old male presents to the pediatrician after two days of tea-colored urine which appeared to coincide with the first day of junior high football. He explains that he refused to go back to practice because he was humiliated by the other players due to his quick and excessive fatigue after a set of drills accomp... | Breaking down glycogen to glucose-1-phosphate | {
"A": "Converting glucose-6-phosphate to glucose",
"B": "Breaking down glycogen to glucose-1-phosphate",
"C": "Cleaving alpha-1,6 glycosidic bonds from glycogen",
"D": "Converting galactose to galactose-1-phosphate"
} | step1 | B | [
"year old male presents",
"pediatrician",
"two days of tea colored urine",
"appeared to",
"first day",
"junior high football",
"refused to go back to practice",
"due to",
"quick",
"excessive fatigue",
"set",
"drills",
"pain",
"muscles",
"blood test revealed elevated creatine kinase",
"... |
A 38-year-old woman presents with progressive muscle weakness. The patient says that symptoms onset a couple of weeks ago and have progressively worsened. She says she hasn’t been able to lift her arms to comb her hair the past few days. No significant past medical history and no current medications. Family history is ... | High-dose corticosteroids | {
"A": "Hydroxychloroquine",
"B": "Methotrexate",
"C": "High-dose corticosteroids",
"D": "Intravenous immunoglobulin"
} | step2&3 | C | [
"year old woman presents",
"progressive muscle weakness",
"patient",
"symptoms onset",
"couple",
"weeks",
"worsened",
"hasnt",
"able to lift",
"arms to comb",
"hair",
"past",
"days",
"significant past medical history",
"current medications",
"Family history",
"significant",
"mother... |
A 20-year-old college student comes to the physician because she has been extremely sad for the past 3 weeks and has to cry constantly. Three weeks ago, her boyfriend left her after they were together for 4 years. She has no appetite and has had a 2.3-kg (5.1-lb) weight loss. She has missed several classes because she ... | Adjustment disorder with depressed mood | {
"A": "Bereavement",
"B": "Adjustment disorder with depressed mood",
"C": "Acute stress disorder",
"D": "Anorexia nervosa"
} | step2&3 | B | [
"20 year old college student",
"physician",
"extremely sad",
"past",
"weeks",
"cry constantly",
"Three weeks",
"boyfriend left",
"together",
"years",
"appetite",
"2.3 kg",
"5",
"weight loss",
"missed",
"classes",
"not stop crying",
"get out",
"bed",
"thinks",
"boyfriend",
"... |
A 10-year-old child presents to your office with a chronic cough. His mother states that he has had a cough for the past two weeks that is non-productive along with low fevers of 100.5 F as measured by an oral thermometer. The mother denies any other medical history and states that he has been around one other friend w... | Mycoplasma pneumoniae | {
"A": "Mycoplasma pneumoniae",
"B": "Staphylococcus aureus",
"C": "Streptococcus pneumoniae",
"D": "Streptococcus agalactiae"
} | step2&3 | A | [
"A 10 year old child presents",
"office",
"chronic cough",
"mother states",
"cough",
"past two weeks",
"non productive",
"low fevers",
"100",
"F",
"measured",
"oral thermometer",
"mother denies",
"medical history",
"states",
"one",
"friend",
"cough",
"weeks",
"patient's",
"no... |
A 4-hour-old male newborn has perioral discoloration for the past several minutes. Oxygen by nasal cannula does not improve the cyanosis. He was delivered by cesarean delivery at 37 weeks' gestation to a 38-year-old woman, gravida 3, para 2. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The mother has typ... | Prostaglandin E1 administration | {
"A": "Reassurance",
"B": "Prostaglandin E1 administration",
"C": "Surgical repair",
"D": "Obtain a CT Angiography\n\""
} | step2&3 | B | [
"4-hour old male newborn",
"perioral discoloration",
"past",
"minutes",
"Oxygen",
"nasal cannula",
"not",
"cyanosis",
"delivered",
"cesarean delivery",
"weeks",
"gestation",
"year old woman",
"gravida 3",
"para 2",
"Apgar scores",
"5 minutes",
"mother",
"type 2 diabetes mellitus"... |
A 34-year-old woman, gravida 3, para 2, at 16 weeks' gestation comes to the physician because of nausea and recurrent burning epigastric discomfort for 1 month. Her symptoms are worse after heavy meals. She does not smoke or drink alcohol. Examination shows a uterus consistent in size with a 16-week gestation. Palpatio... | Misoprostol | {
"A": "Misoprostol",
"B": "Magnesium hydroxide",
"C": "Cimetidine",
"D": "Sucralfate"
} | step1 | A | [
"year old woman",
"gravida 3",
"para 2",
"weeks",
"gestation",
"physician",
"nausea",
"recurrent burning",
"month",
"symptoms",
"worse",
"heavy meals",
"not smoke",
"drink alcohol",
"Examination shows",
"uterus consistent",
"size",
"week gestation",
"Palpation of",
"abdomen eli... |
A 71-year-old man develops worsening chest pressure while shoveling snow in the morning. He tells his wife that he has a squeezing pain that is radiating to his jaw and left arm. His wife calls for an ambulance. On the way, he received chewable aspirin and 3 doses of sublingual nitroglycerin with little relief of pain.... | Clopidogrel, atenolol, anticoagulation and monitoring | {
"A": "Oral nifedipine",
"B": "Clopidogrel, atenolol, anticoagulation and monitoring",
"C": "Echocardiography",
"D": "CT scan of the chest with contrast"
} | step2&3 | B | [
"71 year old man",
"worsening chest pressure",
"shoveling snow",
"morning",
"wife",
"squeezing pain",
"radiating to",
"jaw",
"left arm",
"wife calls",
"ambulance",
"received",
"aspirin",
"3 doses",
"sublingual nitroglycerin",
"little relief",
"pain",
"borderline diabetes",
"essen... |
An obese 52-year-old man is brought to the emergency department because of increasing shortness of breath for the past 8 hours. Two months ago, he noticed a mass on the right side of his neck and was diagnosed with laryngeal cancer. He has smoked two packs of cigarettes daily for 27 years. He drinks two pints of rum da... | Tracheostomy | {
"A": "Tracheal stenting",
"B": "Tracheostomy",
"C": "Intramuscular epinephrine",
"D": "Cricothyroidotomy"
} | step2&3 | B | [
"obese",
"year old man",
"brought",
"emergency department",
"of increasing shortness",
"breath",
"past 8 hours",
"Two months",
"mass",
"right side of",
"neck",
"diagnosed",
"laryngeal cancer",
"smoked two packs",
"cigarettes daily",
"27 years",
"drinks two pints",
"rum daily",
"a... |
An 87-year-old woman is admitted to the intensive care unit after a neighbor found her lying on the floor at her home. Her respirations are 13/min and shallow. Despite appropriate therapy, the patient dies. Gross examination of the brain at autopsy shows neovascularization and liquefactive necrosis without cavitation i... | 10 days | {
"A": "10 days",
"B": "12 hours",
"C": "25 days",
"D": "2 hours"
} | step1 | A | [
"87 year old woman",
"admitted to",
"intensive care unit",
"neighbor found",
"lying",
"floor",
"home",
"respirations",
"min",
"shallow",
"appropriate therapy",
"patient",
"Gross examination of",
"brain",
"autopsy shows neovascularization",
"liquefactive necrosis",
"cavitation",
"di... |
A 34-year-old female with a past medical history of a gastric sleeve operation for morbid obesity presents for pre-surgical clearance prior to a knee arthroplasty. Work-up reveals a hemoglobin of 8.7 g/dL, hematocrit of 26.1%, and MCV of 106 fL. With concern for folate deficiency, she is started on high dose folate sup... | Peripheral neuropathy | {
"A": "Neural tube defects",
"B": "Peripheral neuropathy",
"C": "Hypothyroidism",
"D": "Microcytic anemia"
} | step2&3 | B | [
"year old female",
"past medical history of",
"gastric sleeve operation",
"morbid obesity presents",
"pre surgical clearance",
"knee arthroplasty",
"Work-up reveals a hemoglobin",
"g/dL",
"hematocrit",
"MCV",
"fL",
"concern",
"folate deficiency",
"started",
"high dose folate supplementat... |
A 50-year-old morbidly obese woman presents to a primary care clinic for the first time. She states that her father recently died due to kidney failure and wants to make sure she is healthy. She works as an accountant, is not married or sexually active, and drinks alcohol occasionally. She currently does not take any m... | Urinalysis | {
"A": "Cortisol levels",
"B": "Renal artery doppler ultrasonography",
"C": "Thyroid-stimulating hormone",
"D": "Urinalysis"
} | step2&3 | D | [
"50 year old",
"obese woman presents",
"primary care clinic",
"first time",
"states",
"father recently died due to kidney failure",
"to make sure",
"healthy",
"works",
"accountant",
"not married",
"sexually active",
"drinks alcohol occasionally",
"currently",
"not take",
"medications",... |
A 55-year-old male was picked up by police in the public library for harassing the patrons and for public nudity. He displayed disorganized speech and believed that the books were the only way to his salvation. Identification was found on the man and his sister was called to provide more information. She described that... | Brief psychotic disorder | {
"A": "Brief psychotic disorder",
"B": "Schizophreniform disoder",
"C": "Schizophrenia",
"D": "Schizotypal personality disoder"
} | step1 | A | [
"55 year old male",
"picked",
"police",
"library",
"nudity",
"displayed disorganized speech",
"books",
"only",
"salvation",
"Identification",
"found",
"man",
"sister",
"called to provide more information",
"described",
"recently lost",
"house",
"got divorced",
"same week",
"fin... |
A 56-year-old man comes to the clinic complaining of sexual dysfunction. He reports normal sexual function until 4 months ago when his relationship with his wife became stressful due to a death in the family. When asked about the details of his dysfunction, he claims that he is “able to get it up, but just can’t finish... | Damage to the pudendal nerve | {
"A": "Autonomic neuropathy secondary to systemic disease",
"B": "Damage to the pudendal nerve",
"C": "Medication side effect",
"D": "Psychological stress"
} | step1 | B | [
"year old man",
"clinic",
"sexual dysfunction",
"reports normal sexual function",
"months",
"relationship",
"wife",
"stressful due to",
"death",
"family",
"details",
"dysfunction",
"able to",
"cant finish",
"job",
"denies",
"decrease",
"libido",
"erections",
"morning erections"... |
A 3-year-old girl presents with delayed growth, anemia, and jaundice. Her mother denies any history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism and multiple episodes of unexplained pain in the past. Her prenatal history is significant for preeclampsia, pret... | Hydroxyurea | {
"A": "Hydroxyurea",
"B": "Darbepoetin",
"C": "Epoetin",
"D": "Intravenous immunoglobulin"
} | step2&3 | A | [
"3 year old girl presents",
"delayed growth",
"anemia",
"jaundice",
"mother denies",
"history",
"blood clots",
"past",
"mother",
"to",
"treated",
"pulmonary embolism",
"multiple episodes of unexplained pain",
"past",
"prenatal history",
"significant",
"preeclampsia",
"preterm birth... |
A 35-year-old woman presents for evaluation of symmetric proximal muscle weakness. The patient also presents with a blue-purple discoloration of the upper eyelids accompanied by rashes on the knuckles, as shown in the picture below. What is the most likely cause? | Dermatomyositis | {
"A": "Duchenne muscular dystrophy",
"B": "Hypothyroidism",
"C": "Inclusion body myositis",
"D": "Dermatomyositis"
} | step1 | D | [
"35 year old woman presents",
"evaluation",
"symmetric proximal muscle weakness",
"patient",
"presents",
"blue purple discoloration",
"upper eyelids",
"rashes",
"knuckles",
"shown",
"picture",
"most likely cause"
] |
A 26-year-old man comes to the physician because of a 1-week history of left-sided chest pain. The pain is worse when he takes deep breaths. Over the past 6 weeks, he had been training daily for an upcoming hockey tournament. He does not smoke cigarettes or drink alcohol but has used cocaine once. His temperature is 37... | Naproxen | {
"A": "Alprazolam",
"B": "Alteplase",
"C": "Heparin",
"D": "Naproxen"
} | step1 | D | [
"year old man",
"physician",
"of",
"1-week history",
"left-sided chest pain",
"pain",
"worse",
"takes deep breaths",
"past",
"weeks",
"training daily",
"hockey",
"not smoke cigarettes",
"drink alcohol",
"used cocaine",
"temperature",
"98",
"pulse",
"75 min",
"blood pressure",
... |
A prospective cohort study is conducted to evaluate the risk of pleural mesothelioma in construction workers exposed to asbestos in Los Angeles. Three hundred construction workers reporting current occupational asbestos exposure were followed alongside 300 construction workers without a history of asbestos exposure. Af... | Latency period | {
"A": "Length-time bias",
"B": "Lead-time bias",
"C": "Latency period",
"D": "Berkson bias"
} | step1 | C | [
"prospective cohort study",
"conducted to evaluate the risk of pleural mesothelioma",
"construction workers exposed",
"asbestos",
"Los Angeles",
"Three hundred construction workers reporting current occupational asbestos",
"followed",
"300 construction workers",
"history of asbestos exposure",
"ye... |
A 70-year-old woman with history of coronary artery disease status-post coronary artery bypass graft presents with a stroke due to an infarction in the right middle cerebral artery territory. She is admitted to the intensive care unit for neurological monitoring following a successful thrombectomy. Overnight, the patie... | Argatroban | {
"A": "Argatroban",
"B": "Dalteparin",
"C": "Protamine",
"D": "Tinzaparin"
} | step2&3 | A | [
"70 year old woman",
"history of coronary artery disease",
"coronary artery bypass graft presents",
"stroke due",
"infarction",
"right middle cerebral artery territory",
"admitted to",
"intensive care unit",
"neurological monitoring following",
"successful thrombectomy",
"Overnight",
"patient"... |
A 45-day-old male infant is brought to a pediatrician by his parents with concerns of poor feeding and excessive perspiration for one week. On physical examination, his temperature is 37.7°C (99.8°F), pulse rate is 190/min, and respiratory rate is 70/min. Mild cyanosis is present over the lips, and over the nail beds. ... | Double-inlet ventricle with unobstructed pulmonary flow | {
"A": "Double-inlet ventricle with unobstructed pulmonary flow",
"B": "Infracardiac total anomalous pulmonary venous return",
"C": "Severe Ebstein anomaly",
"D": "Pulmonary atresia with intact ventricular septum"
} | step2&3 | A | [
"day old male infant",
"brought",
"pediatrician",
"parents",
"concerns",
"poor feeding",
"excessive perspiration",
"one week",
"physical examination",
"temperature",
"99",
"pulse rate",
"min",
"respiratory rate",
"70 min",
"Mild cyanosis",
"present",
"lips",
"nail beds",
"Oxyge... |
A 17-year-old white male is brought to the emergency department after being struck by a car. He complains of pain in his right leg and left wrist, and slowly recounts how he was hit by a car while being chased by a lion. In between sentences of the story, he repeatedly complains of dry mouth and severe hunger and reque... | Marijuana | {
"A": "Cocaine",
"B": "Phencylidine (PCP)",
"C": "Benzodiazepines",
"D": "Marijuana"
} | step2&3 | D | [
"year old white male",
"brought",
"emergency department",
"struck by",
"car",
"pain",
"right leg",
"left wrist",
"slowly",
"hit by",
"car",
"lion",
"sentences",
"story",
"repeatedly",
"dry mouth",
"severe hunger",
"requests",
"to eat",
"drink",
"mother",
"very concerned",
... |
A 72-year-old woman with hypertension comes to the physician because of swelling and pain in both legs for the past year. The symptoms are worse at night and improve in the morning. Current medications include losartan and metoprolol. Her temperature is 36°C (96.8°F), pulse is 67/min, and blood pressure is 142/88 mm Hg... | Increased venous valve reflux | {
"A": "Decreased lymphatic flow",
"B": "Decreased intravascular oncotic pressure",
"C": "Decreased arteriolar resistance",
"D": "Increased venous valve reflux"
} | step1 | D | [
"72 year old woman",
"hypertension",
"physician",
"swelling",
"pain in both legs",
"past year",
"symptoms",
"worse",
"night",
"morning",
"Current medications include losartan",
"metoprolol",
"temperature",
"96",
"pulse",
"67 min",
"blood pressure",
"88 mm Hg",
"Examination shows ... |
A 60-year-old post-menopausal female presents to her gynecologist with vaginal bleeding. Her last period was over 10 years ago. Dilation and curettage reveals endometrial carcinoma so she is scheduled to undergo a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During surgery, the gynecologist visuali... | Uterine artery | {
"A": "Superior vesical artery",
"B": "Artery of Sampson",
"C": "Uterine artery",
"D": "Ovarian artery"
} | step1 | C | [
"60 year old post-menopausal female presents",
"gynecologist",
"vaginal bleeding",
"last period",
"over 10 years",
"Dilation",
"curettage reveals endometrial carcinoma",
"scheduled to",
"total abdominal hysterectomy",
"bilateral salpingo-oophorectomy",
"surgery",
"gynecologist",
"paired fibr... |
A 56-year-old woman presents with sudden-onset severe headache, nausea, vomiting, and neck pain for the past 90 minutes. She describes her headache as a ‘thunderclap’, followed quickly by severe neck pain and stiffness, nausea and vomiting. She denies any loss of consciousness, seizure, or similar symptoms in the past.... | Lumbar puncture | {
"A": "IV tPA",
"B": "Lumbar puncture",
"C": "Diffusion-weighted magnetic resonance imaging of the brain",
"D": "Placement of a ventriculoperitoneal (VP) shunt"
} | step2&3 | B | [
"year old woman presents",
"sudden-onset severe headache",
"nausea",
"vomiting",
"neck pain",
"past 90 minutes",
"headache",
"thunderclap",
"followed",
"severe neck",
"stiffness",
"nausea",
"vomiting",
"denies",
"loss of consciousness",
"seizure",
"similar symptoms",
"past",
"pas... |
A 1-minute-old newborn is being examined by the pediatric nurse. The nurse auscultates the heart and determines that the heart rate is 89/min. The respirations are spontaneous and regular. The chest and abdomen are both pink while the tips of the fingers and toes are blue. When the newborn’s foot is slapped the face gr... | 8 | {
"A": "6",
"B": "8",
"C": "9",
"D": "10"
} | step2&3 | B | [
"minute old newborn",
"examined",
"pediatric nurse",
"nurse",
"heart",
"heart rate",
"min",
"respirations",
"spontaneous",
"regular",
"chest",
"abdomen",
"pink",
"tips of",
"fingers",
"toes",
"blue",
"newborns foot",
"slapped",
"face grimaces",
"cries loud",
"strong",
"ar... |
A 37-year-old man presents with back pain which began 3 days ago when he was lifting heavy boxes. The pain radiates from the right hip to the back of the thigh. The pain is exacerbated when he bends at the waist. He rates the severity of the pain as 6 out of 10. The patient has asthma and mitral insufficiency due to un... | Over-the-counter NSAIDs | {
"A": "Stenting",
"B": "Observation",
"C": "Referral for surgery",
"D": "Over-the-counter NSAIDs"
} | step2&3 | D | [
"year old man presents",
"back pain",
"began 3 days",
"lifting heavy boxes",
"pain radiates",
"right hip",
"back of",
"thigh",
"pain",
"exacerbated",
"bends",
"waist",
"rates",
"severity of",
"pain",
"6 out",
"10",
"patient",
"asthma",
"mitral insufficiency due to untreated rhe... |
A 27-year-old man is brought to the emergency department with minor injuries sustained in a motor vehicle accident. He says that he is fine. He also witnessed the death of a teenage girl in the accident who was his sister’s friend. He is able to return to work within a few days. A month later, he presents being withdra... | Post-traumatic stress disorder | {
"A": "Adjustment disorder",
"B": "Generalized anxiety disorder",
"C": "Panic disorder",
"D": "Post-traumatic stress disorder"
} | step2&3 | D | [
"27 year old man",
"brought",
"emergency department",
"minor injuries sustained",
"motor vehicle accident",
"fine",
"witnessed",
"death",
"teenage girl",
"accident",
"sisters friend",
"able to return to work",
"days",
"month later",
"presents",
"withdrawn",
"irritable",
"recently",... |
A 25-year-old woman, gravida 2, para 1, at 36 weeks' gestation comes to the physician because of irritability, palpitations, heat intolerance, and frequent bowel movements for the last 5 months. She has received no prenatal care. Her pulse is 118/min and blood pressure is 133/80 mm Hg. She appears anxious. There is a f... | Microcephaly and stridor | {
"A": "Bradycardia and annular rash",
"B": "Umbilical hernia and erosive scalp lesion",
"C": "Mechanical holosystolic murmur and tetany",
"D": "Microcephaly and stridor"
} | step1 | D | [
"year old woman",
"gravida 2",
"para 1",
"36 weeks",
"gestation",
"physician",
"irritability",
"palpitations",
"heat intolerance",
"frequent bowel movements",
"months",
"received",
"prenatal care",
"pulse",
"min",
"blood pressure",
"80 mm Hg",
"appears anxious",
"fine",
"hands"... |
A 53-year-old multiparous woman is scheduled to undergo elective sling surgery for treatment of stress incontinence. She has frequent loss of small amounts of urine when she coughs or laughs, despite attempts at conservative treatment. The physician inserts trocars in the obturator foramen bilaterally to make the incis... | Adductor longus | {
"A": "Adductor longus",
"B": "Tensor fascia latae",
"C": "Transversus abdominis",
"D": "Semitendinosus"
} | step1 | A | [
"year old multiparous woman",
"scheduled to",
"elective sling surgery",
"treatment",
"stress incontinence",
"frequent loss",
"small amounts",
"urine",
"coughs",
"laughs",
"attempts",
"conservative treatment",
"physician inserts trocars",
"obturator foramen",
"to make",
"incision",
"p... |
A 70-year-old woman is on hospital day 2 in the medical intensive care unit. She was admitted from the emergency department for a 2-day history of shortness of breath and fever. In the emergency department, her temperature is 39.4°C (103.0°F), the pulse is 120/min, the blood pressure is 94/54 mm Hg, the respiratory rat... | D-dimer: elevated, fibrinogen level: low, platelet count: low | {
"A": "D-dimer: negative, fibrinogen level: normal, platelet count: normal",
"B": "D-dimer: elevated, fibrinogen level: low, platelet count: low",
"C": "D-dimer: negative, fibrinogen level: elevated, platelet count: elevated",
"D": "D-dimer: elevated, fibrinogen level: normal, platelet count: normal"
} | step2&3 | B | [
"70 year old woman",
"hospital day",
"medical intensive care unit",
"admitted",
"emergency department",
"2-day history of shortness",
"breath",
"fever",
"emergency department",
"temperature",
"4C",
"pulse",
"min",
"blood pressure",
"54 mm Hg",
"respiratory rate",
"36 min",
"oxygen ... |
A newborn undergoing the standard screening tests is found to have a positive test for reducing sugars. Further testing is performed and reveals that the patient does not have galactosemia, but rather is given a diagnosis of fructosuria. What levels of enzymatic activity are altered in this patient? | Hexokinase increased; fructokinase decreased | {
"A": "Hexokinase increased; fructokinase decreased",
"B": "Hexokinase decreased; fructokinase increased",
"C": "Hexokinase decreased; fructokinase decreased",
"D": "Hexokinase unchanged; fructokinase unchanged"
} | step1 | A | [
"newborn",
"standard screening tests",
"found to",
"positive test",
"reducing sugars",
"Further testing",
"performed",
"reveals",
"patient",
"not",
"galactosemia",
"given",
"diagnosis",
"fructosuria",
"levels",
"enzymatic activity",
"altered",
"patient"
] |
A 53-year-old man is brought to the emergency department because of wheezing and shortness of breath that began 1 hour after he took a new medication. Earlier in the day he was diagnosed with stable angina pectoris and prescribed a drug that irreversibly inhibits cyclooxygenase-1 and 2. He has chronic rhinosinusitis an... | Blockage of P2Y12 component of ADP receptors | {
"A": "Blockage of P2Y12 component of ADP receptors",
"B": "Direct inhibition of Factor Xa",
"C": "Sequestration of Ca2+ ions",
"D": "Potentiation of antithrombin III"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"wheezing",
"shortness of breath",
"began 1 hour",
"took",
"new medication",
"Earlier",
"day",
"diagnosed",
"stable angina pectoris",
"prescribed",
"drug",
"inhibits cyclooxygenase-1",
"2",
"chronic rhinosinusitis",
"asthma treated... |
A 6-year-old boy is brought to the physician by his parents because of right lower extremity weakness, worsening headaches, abdominal pain, dark urine, and a 5-kg (11-lb) weight loss for the past 2 months. His teachers report that he has not been paying attention in class and his grades have been worsening. He has a hi... | Subependymal giant cell astrocytoma | {
"A": "Port wine stain",
"B": "Lisch nodules",
"C": "Subependymal giant cell astrocytoma",
"D": "Vestibular schwannoma"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"parents",
"right",
"worsening headaches",
"abdominal pain",
"dark urine",
"5 kg",
"weight loss",
"past",
"months",
"teachers report",
"not",
"paying attention",
"class",
"grades",
"worsening",
"history",
"infantile seizures",
"Physical... |
A 60-year-old diabetic male presents to your clinic for right ear pain. The patient reports noting worsening right ear pain for three weeks, purulent otorrhea initially which has resolved, and facial asymmetry for the past several days. He reports being poorly compliant with his diabetes medication regimen. His tempera... | Intravenous ciprofloxacin for 6 weeks | {
"A": "Intravenous ciprofloxacin for 6 weeks",
"B": "Topical polymyxin and neosporin for 14 days",
"C": "Hyperbaric oxygen treatment for 4 weeks",
"D": "Surgical intervention"
} | step2&3 | A | [
"60 year old diabetic male presents",
"clinic",
"right",
"patient reports noting worsening right ear pain",
"three weeks",
"purulent otorrhea initially",
"resolved",
"facial asymmetry",
"past",
"days",
"reports",
"poorly compliant",
"diabetes medication regimen",
"temperature",
"100",
... |
A 66-year-old man weighing 50 kg (110 lb) is admitted to the hospital because of sepsis complicated by acute respiratory distress syndrome. The physician decides to initiate total parenteral nutrition and prescribes short-term hypocaloric intake of 20 kcal/kg/day with 20% of the total energy requirement provided by pro... | 500 mL of 25% dextrose solution | {
"A": "500 mL of 10% dextrose solution",
"B": "250 mL of 50% dextrose solution",
"C": "750 mL of 10% dextrose solution",
"D": "500 mL of 25% dextrose solution"
} | step1 | D | [
"66 year old man weighing 50 kg",
"admitted",
"hospital",
"sepsis complicated",
"acute respiratory distress syndrome",
"physician",
"to initiate total parenteral nutrition",
"short-term",
"intake",
"20 kcal/kg/day",
"20",
"total energy requirement provided",
"proteins",
"30",
"provided",... |
A 35-year-old woman who was recently ill with an upper respiratory infection presents to the emergency department with weakness in her lower limbs and difficulty breathing. Her symptoms began with a burning sensation in her toes along with numbness. She claims that the weakness has been getting worse over the last few... | Guillain-Barré syndrome | {
"A": "Acute disseminated encephalomyelitis",
"B": "Adrenoleukodystrophy",
"C": "Guillain-Barré syndrome",
"D": "Multiple sclerosis"
} | step1 | C | [
"35 year old woman",
"recently ill",
"upper respiratory infection presents",
"emergency department",
"weakness",
"lower limbs",
"difficulty breathing",
"symptoms began",
"burning sensation in",
"toes",
"numbness",
"weakness",
"getting worse",
"days",
"now involving",
"arms",
"face",
... |
A 75-year-old man is brought to the emergency department after 2 days of severe diffuse abdominal pain, nausea, vomiting, and lack of bowel movements, which has led him to stop eating. He has a history of type-2 diabetes mellitus, hypertension, and chronic pulmonary obstructive disease. Upon admission, his vital signs ... | Nasogastric decompression | {
"A": "Initiate pain management with morphine",
"B": "Nasogastric decompression",
"C": "Exploratory surgery",
"D": "Gastrografin enema"
} | step2&3 | B | [
"75 year old man",
"brought",
"emergency department",
"2 days",
"severe diffuse abdominal",
"nausea",
"vomiting",
"lack",
"bowel movements",
"led",
"to stop eating",
"history of type-2 diabetes mellitus",
"hypertension",
"chronic disease",
"admission",
"vital signs",
"normal limits",... |
A 13-year-old girl is brought to the outpatient clinic by her parents with a complaint of episodic spasm in her fingers for the past few months. Upon further questioning, her mother notes that the girl has not been doing well at school. She also believes that the girl is shorter than the other children in her class. On... | Autosomal dominant | {
"A": "X-linked recessive",
"B": "Autosomal dominant",
"C": "Mitochondrial inheritance",
"D": "Autosomal recessive"
} | step1 | B | [
"year old girl",
"brought",
"outpatient clinic",
"parents",
"complaint of episodic spasm",
"fingers",
"past",
"months",
"further questioning",
"mother notes",
"girl",
"not",
"well",
"school",
"girl",
"shorter",
"children",
"class",
"examination",
"pulse",
"72 min",
"tempera... |
A 27-year-old man presents to the emergency department for bizarre behavior. The patient had boarded up his house and had been refusing to leave for several weeks. The police were called when a foul odor emanated from his property prompting his neighbors to contact the authorities. Upon questioning, the patient states ... | HbA1c levels | {
"A": "CBC",
"B": "ECG",
"C": "HbA1c levels",
"D": "Renal function studies"
} | step2&3 | C | [
"27 year old man presents",
"emergency department",
"bizarre behavior",
"patient",
"boarded",
"house",
"refusing to leave",
"weeks",
"police",
"called",
"foul odor",
"property prompting",
"neighbors to contact",
"authorities",
"questioning",
"patient states",
"elves",
"entire life"... |
A 9-year-old boy with cystic fibrosis (CF) presents to the clinic with fever, increased sputum production, and cough. The vital signs include: temperature 38.0°C (100.4°F), blood pressure 126/74 mm Hg, heart rate 103/min, and respiratory rate 22/min. His physical examination is significant for short stature, thin body ... | Inhaled tobramycin for 28 days | {
"A": "Inhaled tobramycin for 28 days",
"B": "Dornase alfa 2.5 mg as a single-use",
"C": "Oral cephalexin for 14 days",
"D": "Minocycline for 28 days"
} | step2&3 | A | [
"year old boy",
"cystic fibrosis",
"presents",
"clinic",
"fever",
"increased sputum production",
"cough",
"vital signs include",
"temperature",
"100 4F",
"blood pressure",
"74 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"physical examination",
"significant",
"short st... |
A 66-year-old man is brought to the emergency department after a motor vehicle accident. The patient was a restrained passenger in a car that was struck on the passenger side while crossing an intersection. In the emergency department, he is alert and complaining of abdominal pain. He has a history of hyperlipidemia, g... | Shoulder pain | {
"A": "Pain radiating to the back",
"B": "Gross hematuria",
"C": "Shoulder pain",
"D": "Muffled heart sounds"
} | step2&3 | C | [
"66 year old man",
"brought",
"emergency department",
"motor vehicle accident",
"patient",
"restrained passenger",
"car",
"struck",
"passenger side",
"crossing",
"intersection",
"emergency department",
"alert",
"abdominal pain",
"history of hyperlipidemia",
"gastroesophageal reflux dis... |
A 4-year-old girl is brought to the physician because her mother is concerned that she has been talking to an imaginary friend for 2 months. The child calls her friend 'Lucy' and says “Lucy is my best friend”. The child has multiple conversation and plays with the 'Lucy' throughout the day. The girl attends preschool r... | Reassure the mother | {
"A": "Perform MRI of the brain",
"B": "Inform Child Protective Services",
"C": "Schedule psychiatry consult",
"D": "Reassure the mother"
} | step2&3 | D | [
"4 year old girl",
"brought",
"physician",
"mother",
"concerned",
"talking",
"imaginary friend",
"2 months",
"child calls",
"friend",
"best friend",
"child",
"multiple conversation",
"plays",
"day",
"girl attends preschool",
"copy",
"circle",
"stories",
"hop",
"one foot",
"... |
A 33-year-old man presents to the emergency department after an episode of syncope. He states that for the past month ever since starting a new job he has experienced an episode of syncope or near-syncope every morning while he is getting dressed. The patient states that he now gets dressed, shaves, and puts on his tie... | Carotid hypersensitivity syndrome | {
"A": "Anxiety",
"B": "Aortic stenosis",
"C": "Carotid hypersensitivity syndrome",
"D": "Hypertrophic obstructive cardiomyopathy"
} | step2&3 | C | [
"year old man presents",
"emergency department",
"episode of syncope",
"states",
"past month ever since starting",
"new job",
"experienced",
"episode of syncope",
"near-syncope",
"morning",
"getting dressed",
"patient states",
"now gets dressed",
"shaves",
"puts",
"tie sitting",
"to"... |
A 42-year-old male presents to your office with cellulitis on his leg secondary to a dog bite. You suspect that the causative agent is a small, facultatively anaerobic, Gram-negative rod sensitive to penicillin with clavulanate. When you ask the patient how the bite occurred, the patient explains that he had a fight wi... | Displacement | {
"A": "Projection",
"B": "Reaction formation",
"C": "Regression",
"D": "Displacement"
} | step1 | D | [
"year old male presents",
"office",
"cellulitis",
"leg secondary to",
"dog bite",
"suspect",
"causative agent",
"small",
"facultatively anaerobic",
"Gram-negative rod sensitive to penicillin",
"clavulanate",
"patient",
"bite occurred",
"patient",
"fight",
"wife earlier",
"day",
"Fr... |
A 12-year-old boy and his siblings are referred to a geneticist for evaluation of a mild but chronic hemolytic anemia that has presented with fatigue, splenomegaly, and scleral icterus. Coombs test is negative and blood smear does not show any abnormal findings. An enzymatic panel is assayed, and pyruvate kinase is fou... | Fructose-1,6-bisphosphate | {
"A": "Glucose-6-phosphate",
"B": "Fructose-1,6-bisphosphate",
"C": "Glyceraldehyde-3-phosphate",
"D": "Alanine"
} | step1 | B | [
"year old boy",
"siblings",
"referred",
"geneticist",
"evaluation",
"mild",
"chronic hemolytic anemia",
"presented",
"fatigue",
"splenomegaly",
"scleral icterus",
"Coombs test",
"negative",
"blood smear",
"not show",
"abnormal findings",
"enzymatic panel",
"assayed",
"pyruvate ki... |
A 63-year-old woman, gravida 0, para 0 comes to the physician because of a 3-month history of abdominal distension, constipation, and weight loss. She has a history of endometriosis. Pelvic examination shows a nontender, irregular, left adnexal mass. Her serum level of CA-125 is elevated. Serum concentrations of human ... | Atypical epithelial cells along with psammoma bodies | {
"A": "Large undifferentiated germ cells with clear cytoplasm",
"B": "Small, round cells that form Call-Exner bodies",
"C": "Atypical epithelial cells along with psammoma bodies",
"D": "Spindle-shaped stromal cells along with signet ring cells"
} | step1 | C | [
"63 year old woman",
"gravida 0",
"para 0",
"physician",
"3 month history",
"abdominal distension",
"constipation",
"weight loss",
"history of endometriosis",
"Pelvic examination shows",
"nontender",
"irregular",
"left adnexal mass",
"serum level",
"CA-125",
"elevated",
"Serum concen... |
Three days after undergoing open surgery to repair a bilateral inguinal hernia, a 66-year-old man has new, intermittent upper abdominal discomfort that worsens when he walks around. He also has new shortness of breath that resolves with rest. There were no complications during surgery or during the immediate postsurgic... | Cardiac pharmacological stress test | {
"A": "Magnetic resonance imaging of the abdomen",
"B": "Culture swab from the surgical site",
"C": "Coronary angiography",
"D": "Cardiac pharmacological stress test"
} | step2&3 | D | [
"Three days",
"open surgery to repair",
"bilateral inguinal hernia",
"66 year old man",
"new",
"intermittent upper abdominal discomfort",
"worsens",
"walks",
"new shortness of breath",
"resolves",
"rest",
"complications",
"surgery",
"immediate",
"period",
"Ambulation",
"restarted",
... |
A 69-year-old male presents to his primary care physician for a checkup. He has not seen a doctor in 15 years and thought he may need an exam. The patient’s past medical history is unknown and he is not currently taking any medications. The patient lives on a rural farm alone and has since he was 27 years of age. The p... | Schizoid | {
"A": "Schizoid",
"B": "Schizotypal",
"C": "Avoidant",
"D": "Antisocial"
} | step2&3 | A | [
"69 year old male presents",
"primary care physician",
"checkup",
"not seen",
"doctor",
"years",
"thought",
"need",
"exam",
"patients past medical history",
"unknown",
"not currently taking",
"medications",
"patient lives",
"rural farm alone",
"since",
"27 years",
"age",
"patient... |
You are developing a new diagnostic test to identify patients with disease X. Of 100 patients tested with the gold standard test, 10% tested positive. Of those that tested positive, the experimental test was positive for 90% of those patients. The specificity of the experimental test is 20%. What is the positive predic... | 11% | {
"A": "10%",
"B": "11%",
"C": "95%",
"D": "20%"
} | step1 | B | [
"new diagnostic test to",
"patients",
"disease",
"100",
"tested",
"gold standard test",
"10",
"tested positive",
"tested positive",
"experimental test",
"positive",
"90",
"patients",
"specificity",
"experimental test",
"20",
"positive predictive value of",
"new test"
] |
A 70-year-old woman presents with substernal chest pain. She says that the symptoms began 2 hours ago and have not improved. She describes the pain as severe, episodic, and worse with exertion. She reports that she has had multiple similar episodes that have worsened and increased in frequency over the previous 4 month... | Left ventricle | {
"A": "Left atrium",
"B": "Aorta",
"C": "Right atrium",
"D": "Left ventricle"
} | step1 | D | [
"70 year old woman presents",
"substernal chest pain",
"symptoms began 2 hours",
"not improved",
"pain",
"severe",
"episodic",
"worse",
"exertion",
"reports",
"multiple similar episodes",
"worsened",
"increased",
"frequency",
"previous",
"months",
"Past medical history",
"significa... |
A 5-month-old boy is brought to the physician because of fever and a cough for 3 days. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times during the past 3 months. He was born at 37 weeks' gestation and the ... | Severe combined immunodeficiency | {
"A": "Wiskott-Aldrich syndrome",
"B": "Severe combined immunodeficiency",
"C": "Chronic granulomatous disease",
"D": "X-linked agammaglobulinemia"
} | step2&3 | B | [
"5 month old boy",
"brought",
"physician",
"fever",
"cough",
"3 days",
"mother reports",
"multiple episodes of loose stools",
"past 3 months",
"treated",
"otitis media",
"times",
"bronchiolitis 3 times",
"past",
"months",
"born",
"weeks",
"gestation",
"neonatal period",
"uncomp... |
A 57-year-old man presents the urgent care clinic with a one-week history of diffuse bone pain and generalized weakness. He was diagnosed with end-stage renal disease 6 months ago and is currently on dialysis. His wife, who is accompanying him today, adds that he is not compliant with his medicines. He has been diabeti... | 1-α-hydroxylase | {
"A": "7-α-hydroxylase",
"B": "1-α-hydroxylase",
"C": "α-Glucosidase",
"D": "24,25 hydroxylase"
} | step1 | B | [
"57 year old man presents",
"urgent care clinic",
"one-week history",
"diffuse bone",
"generalized weakness",
"diagnosed",
"end-stage renal disease",
"months",
"currently",
"dialysis",
"wife",
"today",
"adds",
"not compliant",
"medicines",
"diabetic",
"10 years",
"hypertensive",
... |
A 94-year-old woman is brought to the emergency department after she was found unresponsive and febrile at her home. Her son reports that she had an acute episode of coughing while having breakfast the day before. Six days after admission, the patient develops progressive tachypnea and a gradual decrease in oxygen satu... | Increased pulmonary shunt fraction | {
"A": "Increased pulmonary shunt fraction",
"B": "Increased pulmonary wedge pressure",
"C": "Increased mixed venous oxygen saturation",
"D": "Decreased pulmonary artery pressure\n\""
} | step1 | A | [
"year old woman",
"brought",
"emergency department",
"found unresponsive",
"febrile",
"home",
"son reports",
"acute episode of coughing",
"breakfast",
"day",
"Six days",
"admission",
"patient",
"progressive tachypnea",
"gradual decrease",
"oxygen",
"ventilation",
"supplemental oxyg... |
A 31-year-old man comes to the emergency department because of chest pain for the last 3 hours. He describes the pain as a sharp, substernal chest pain that radiates to the right shoulder; he says “Please help me. I'm having a heart attack.” He has been admitted to the hospital twice over the past week for evaluation o... | Malingering | {
"A": "Conversion disorder",
"B": "Factitious disorder",
"C": "Malingering",
"D": "Illness anxiety disorder"
} | step1 | C | [
"31 year old man",
"emergency department",
"of chest pain",
"hours",
"pain",
"sharp",
"substernal chest",
"radiates",
"right shoulder",
"help",
"I m",
"heart attack",
"admitted",
"hospital twice",
"past week",
"evaluation of shortness",
"breath",
"abdominal pain",
"left",
"hosp... |
A 56-year-old man presents to the emergency department with increasing shortness of breath and mild chest discomfort. One week ago he developed cold-like symptoms, including a mild fever, headache, and occasional night sweats. He noticed that he required 2 additional pillows in order to sleep comfortably. Approximately... | Bumetanide | {
"A": "Bumetanide",
"B": "Carvedilol",
"C": "Dopamine",
"D": "Milrinone"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"increasing shortness of breath",
"mild chest discomfort",
"One week",
"cold",
"symptoms",
"including",
"mild fever",
"headache",
"occasional night sweats",
"required 2 additional pillows",
"order to sleep",
"Approximately",
"nights",
"s... |
A 62-year-old man presents to his primary care provider complaining of leg pain with exertion for the past 6 months. He notices that he has bilateral calf cramping with walking. He states that it is worse in his right calf than in his left, and it goes away when he stops walking. He has also noticed that his symptoms a... | Cilostazol | {
"A": "Endovascular revascularization",
"B": "Duloxetine",
"C": "Heparin",
"D": "Cilostazol"
} | step2&3 | D | [
"62 year old man presents",
"primary care provider",
"leg pain",
"exertion",
"past 6 months",
"bilateral calf cramping",
"walking",
"states",
"worse",
"right calf",
"left",
"goes",
"stops walking",
"symptoms",
"progressing",
"pain",
"occurring",
"medical history",
"type 2 diabete... |
A 59-year-old man presents to the health clinic for evaluation of severe itching for the past week. The itching is worse at night while lying in bed. The patient has a past medical history of hyperlipidemia, atrial fibrillation, and colon cancer. The patient takes rivaroxaban, simvastatin, and aspirin. The patient has ... | Permethrin | {
"A": "Permethrin",
"B": "Ivermectin",
"C": "Acyclovir",
"D": "Dicloxacillin"
} | step2&3 | A | [
"59 year old man presents",
"health clinic",
"evaluation",
"severe itching",
"past week",
"itching",
"worse",
"night",
"lying in bed",
"patient",
"past medical",
"atrial fibrillation",
"colon cancer",
"patient takes rivaroxaban",
"simvastatin",
"aspirin",
"patient",
"surgical",
"... |
A 26-year-old G1P0 woman is brought to the emergency room by her spouse for persistently erratic behavior. Her spouse reports that she has been sleeping > 1 hour a night, and it sometimes seems like she’s talking to herself. She has maxed out their credit cards on baby clothes. The patient’s spouse reports this has bee... | Right ventricular atrialization | {
"A": "Caudal regression syndrome",
"B": "Ototoxicity",
"C": "Renal defects",
"D": "Right ventricular atrialization"
} | step2&3 | D | [
"year old",
"woman",
"brought",
"emergency room",
"spouse",
"persistently",
"behavior",
"spouse reports",
"sleeping",
"1 hour",
"night",
"sometimes",
"shes talking",
"out",
"credit cards",
"baby clothes",
"patients spouse reports",
"over",
"month",
"first seeing",
"physician"... |
A 45-year-old woman presents to her primary care physician for knee pain. She states that she has been experiencing a discomfort and pain in her left knee that lasts for several hours but tends to improve with use. She takes ibuprofen occasionally which has been minimally helpful. She states that this pain is making it... | Type IV hypersensitivity | {
"A": "Herniated nucleus pulposus",
"B": "Inflammation of the pes anserine bursa",
"C": "Type IV hypersensitivity",
"D": "Venous valve failure"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"knee pain",
"states",
"experiencing",
"discomfort",
"pain in",
"left knee",
"lasts",
"hours",
"to",
"use",
"takes ibuprofen occasionally",
"helpful",
"states",
"pain",
"making",
"difficult",
"to work",
"temperature",
"98",... |
One day after undergoing total knee replacement for advanced degenerative osteoarthritis, a 66-year-old man has progressive lower abdominal pain. The surgery was performed under general anesthesia and the patient was temporarily catheterized for perioperative fluid balance. Several hours after the surgery, the patient ... | Benign prostatic enlargement | {
"A": "Benign prostatic enlargement",
"B": "Adverse effect of pilocarpine",
"C": "Urethral stricture",
"D": "Prostate cancer\n\""
} | step2&3 | A | [
"One day",
"total knee replacement",
"advanced degenerative osteoarthritis",
"66 year old man",
"progressive lower abdominal pain",
"surgery",
"performed",
"general anesthesia",
"patient",
"catheterized",
"perioperative fluid balance",
"hours",
"surgery",
"patient began to",
"decreasing ... |
A 25-day-old male infant presents to the emergency department because his mother states that he has been acting irritable for the past 2 days and has now developed a fever. On exam, the infant appears uncomfortable and has a temperature of 39.1 C. IV access is immediately obtained and a complete blood count and blood c... | K capsule | {
"A": "LPS endotoxin",
"B": "K capsule",
"C": "IgA protease",
"D": "M protein"
} | step1 | B | [
"day old male infant presents",
"emergency department",
"mother states",
"acting irritable",
"past 2 days",
"now",
"fever",
"exam",
"infant appears",
"temperature",
"C",
"IV access",
"immediately obtained",
"complete blood count",
"blood cultures",
"drawn",
"Lumbar puncture demonstra... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.