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 23-year-old primigravida pregnant patient is in her 3rd trimester with twins. She complains of itching and skin lesions. The examination shows vesicular skin lesions on the abdomen but not on the face, palms, or soles. A picture of her abdomen is shown in the image. Her past medical history is insignificant. Her vita... | Reassure her and provide symptomatic relief with topical steroids | {
"A": "Begin treatment with systemic oral corticosteroids",
"B": "Begin weekly antepartum testing to ensure fetal well-being",
"C": "Biopsy the lesions to ensure proper diagnosis",
"D": "Reassure her and provide symptomatic relief with topical steroids"
} | step2&3 | D | [
"23 year old primigravida pregnant patient",
"3rd trimester",
"twins",
"itching",
"skin lesions",
"examination shows vesicular skin lesions",
"abdomen",
"not",
"face",
"palms",
"soles",
"picture",
"abdomen",
"shown",
"image",
"past medical history",
"vital signs",
"normal limits",
... |
A 67-year-old man is brought to the physician by his daughter because he frequently misplaces his personal belongings and becomes easily confused. His daughter mentions that his symptoms have progressively worsened for the past one year. On mental status examination, he is oriented to person, place, and time. He vividl... | Hippocampus | {
"A": "Substantia nigra",
"B": "Ventral posterolateral nucleus",
"C": "Hippocampus",
"D": "Superior temporal gyrus"
} | step1 | C | [
"67 year old man",
"brought",
"physician",
"daughter",
"frequently",
"personal",
"easily confused",
"daughter",
"symptoms",
"worsened",
"past one",
"mental",
"oriented to person",
"place",
"time",
"recalls memories",
"childhood",
"only recall one",
"three objects presented",
"5... |
A 59-year-old woman comes to the physician because of a 1-year history of pain and stiffness in her fingers and knees. The stiffness lasts for about 10 minutes after she wakes up in the morning. She also reports that her knee pain is worse in the evening. She drinks one glass of wine daily. Her only medication is aceta... | Osteoarthritis | {
"A": "Pseudogout",
"B": "Gout",
"C": "Septic arthritis",
"D": "Osteoarthritis"
} | step1 | D | [
"59 year old woman",
"physician",
"year history",
"pain",
"stiffness",
"fingers",
"knees",
"stiffness",
"10 minutes",
"wakes up",
"morning",
"reports",
"knee pain",
"worse",
"evening",
"drinks one glass",
"wine daily",
"only medication",
"acetaminophen",
"5 ft 9",
"tall",
"... |
A 23-year-old man is brought to the emergency department from a college party because of a 1-hour history of a crawling sensation under his skin. He appears anxious and is markedly pale. His temperature is 38°C (100.4°F), pulse is 104/min, respirations are 18/min, and blood pressure is 145/90 mm Hg. Physical examinatio... | Cocaine | {
"A": "Lysergic acid diethylamide",
"B": "Phencyclidine",
"C": "Cocaine",
"D": "Scopolamine"
} | step1 | C | [
"23 year old man",
"brought",
"emergency department",
"college party",
"hour history",
"crawling sensation",
"skin",
"appears anxious",
"markedly pale",
"temperature",
"100 4F",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"90 mm Hg",
"Physical examination shows diaphor... |
A 68-year old woman presents with recurring headaches and pain while combing her hair. Her past medical history is significant for hypertension, glaucoma and chronic deep vein thrombosis in her right leg. Current medication includes rivaroxaban, latanoprost, and benazepril. Her vitals include: blood pressure 130/82 mm ... | Erythrocyte sedimentation rate | {
"A": "Lumbar puncture",
"B": "Erythrocyte sedimentation rate",
"C": "Temporal artery biopsy",
"D": "Fundoscopic examination"
} | step2&3 | B | [
"68 year old woman presents",
"recurring headaches",
"pain",
"combing",
"hair",
"past medical history",
"significant",
"hypertension",
"glaucoma",
"chronic deep vein thrombosis",
"right leg",
"Current medication includes rivaroxaban",
"latanoprost",
"benazepril",
"include",
"blood pres... |
A 13-year-old boy with recently diagnosed schizophrenia presents with feelings of anxiety. The patient says that he has been having feelings of dread, especially since a friend of his has been getting bullied at school. He feels troubled by these feeling almost every day and makes it difficult for him to get ready to g... | Ziprasidone | {
"A": "Chlorpromazine",
"B": "Fluoxetine",
"C": "Ziprasidone",
"D": "Alprazolam"
} | step1 | C | [
"13 year old boy",
"recently diagnosed schizophrenia presents",
"feelings",
"anxiety",
"patient",
"feelings",
"friend",
"getting bullied at school",
"feels",
"feeling almost every day",
"makes",
"difficult",
"to",
"ready",
"go",
"school",
"hallucinating worse",
"Past medical histor... |
A 39-year-old woman, gravida 3, para 2, at 32 weeks' gestation comes to the emergency department 1 hour after the sudden onset of severe abdominal pain and nausea. She has had one episode of nonbloody vomiting. Pregnancy has been uncomplicated, except for a blood pressure measurement of 150/90 mm Hg on her last prenata... | Abruptio placentae | {
"A": "Ruptured uterus",
"B": "Ruptured vasa previa",
"C": "Abruptio placentae",
"D": "Placenta accreta"
} | step2&3 | C | [
"year old woman",
"gravida 3",
"para 2",
"weeks",
"gestation",
"emergency department",
"hour",
"sudden",
"severe abdominal",
"nausea",
"one episode of",
"vomiting",
"Pregnancy",
"uncomplicated",
"except for",
"blood pressure measurement",
"90 mm Hg",
"last prenatal visit",
"first... |
A 24-year-old professional soccer player presents to the clinic with discomfort and pain while walking. He says that he has an unstable knee joint that started after an injury during a match last week. He adds that he heard a popping sound at the time of the injury. Physical examination of the knee reveals swelling of ... | Anterior cruciate ligament | {
"A": "Lateral collateral ligament",
"B": "Anterior cruciate ligament",
"C": "Posterior cruciate ligament",
"D": "Ligamentum patellae"
} | step1 | B | [
"year old professional soccer",
"presents",
"clinic",
"discomfort",
"pain",
"walking",
"unstable",
"started",
"injury",
"match",
"week",
"adds",
"heard",
"popping sound",
"time of",
"injury",
"Physical examination",
"knee reveals swelling of",
"knee joint",
"positive anterior d... |
A 42-year-old woman comes to the physician with acute, severe pain in the middle of her lower back. She also complains of constipation and trouble sleeping recently. Menses occur regularly at 28-day intervals. Examination shows localized tenderness to palpation over the lumbar spine. Serum calcium is 14 mg/dL and serum... | Increase in interleukin-1 secretion | {
"A": "Decrease in ovarian estrogen production",
"B": "Increase in calcitonin secretion",
"C": "Increase in interleukin-1 secretion",
"D": "Decrease in RANKL receptor expression"
} | step1 | C | [
"year old woman",
"physician",
"severe pain",
"back",
"constipation",
"trouble sleeping recently",
"Menses occur",
"day intervals",
"Examination shows localized tenderness",
"palpation",
"lumbar spine",
"Serum calcium",
"mg/dL",
"serum phosphorus",
"1.5 mg/dL",
"x-ray of",
"lumbar sp... |
A 55-year-old man with a history of hypertension and benign prostate hyperplasia presents for follow-up 4 days into the treatment of a urinary tract infection with trimethoprim-sulfamethoxazole. His symptoms have resolved, and he reports no problems with urination, with the exception of a weak urine stream and hesitanc... | Reassure the patient, stop trimethoprim-sulfamethoxazole and repeat the measurement in 1–2 weeks | {
"A": "Reassure the patient, stop trimethoprim-sulfamethoxazole and repeat the measurement in 1–2 weeks",
"B": "Schedule an intravenous pyelography for urinary obstruction",
"C": "Schedule a cystoscopy for urethral obstruction",
"D": "Admit the patient for further management of acute interstitial nephritis"
} | step2&3 | A | [
"55 year old man",
"history of hypertension",
"benign prostate hyperplasia presents",
"follow-up 4 days",
"treatment of",
"urinary tract infection",
"trimethoprim-sulfamethoxazole",
"symptoms",
"resolved",
"reports",
"problems with urination",
"exception of",
"weak urine stream",
"hesitanc... |
An 18-year-old female presents to the clinic complaining of acute abdominal pain for the past couple of hours. The pain is concentrated at the right lower quadrant (RLQ) with no clear precipitating factor and is worse with movement. Acetaminophen seems to help a little but she is concerned as the pain has occurred mont... | Increases the activity of cholesterol desmolase to synthesize progesterone | {
"A": "Increases the activity of cholesterol desmolase to synthesize progesterone",
"B": "Increases the activity of aromatase to synthesize 17-beta-estradiol",
"C": "Inhibition of the anterior pituitary to decrease secretion of FSH and LH",
"D": "Inhibition of the hypothalamus to decrease secretion of gonadotr... | step1 | A | [
"year old female presents",
"clinic",
"acute pain",
"past couple",
"hours",
"pain",
"concentrated",
"right lower quadrant",
"clear precipitating factor",
"worse",
"movement",
"Acetaminophen",
"to help",
"little",
"concerned",
"pain",
"occurred monthly",
"past 3 months",
"denies",... |
A 5-year-old boy is brought to the emergency department by his stepmother because of multiple injuries. She says that he sustained these injuries while playing. Radiographic findings show multiple fractures in various stages of healing. Physical examination shows the findings in the image below. What is the most likely... | Osteogenesis imperfecta | {
"A": "Marfan syndrome",
"B": "Wilson disease",
"C": "Osteogenesis imperfecta",
"D": "Child abuse"
} | step1 | C | [
"5 year old boy",
"brought",
"emergency department",
"stepmother",
"multiple injuries",
"sustained",
"injuries",
"playing",
"Radiographic findings show multiple",
"various stages",
"healing",
"Physical examination shows",
"findings",
"image",
"most likely diagnosis",
"patient"
] |
A 5-year-old boy is brought to the physician by his mother because he does not “listen to her” anymore. The mother also reports that her son cannot concentrate on any tasks lasting longer than just a few minutes. Teachers at his preschool report that the patient is more active compared to other preschoolers, frequently... | Behavior therapy | {
"A": "Behavior therapy",
"B": "Methimazole",
"C": "Fluoxetine",
"D": "Hearing aids"
} | step2&3 | A | [
"5 year old boy",
"brought",
"physician",
"mother",
"not listen",
"mother",
"reports",
"son",
"concentrate",
"tasks lasting longer",
"few minutes",
"Teachers",
"preschool report",
"patient",
"more active compared",
"preschoolers",
"frequently interrupts",
"children",
"very forget... |
At a routine exam, a 68-year-old woman is discovered to have a serum calcium level of 11.5 mg/dL. Follow-up laboratory tests show a high parathyroid hormone with low phosphorus and mildly elevated alkaline phosphatase. 24-hour urine calcium level is elevated. Review of symptoms includes complaints of fatigue, constipat... | Subperiosteal bone resorption on hand X-ray | {
"A": "Subperiosteal bone resorption on hand X-ray",
"B": "Osteopenia, osteolytic lesions and pathological fractures",
"C": "Lytic changes in early stage and sclerotic picture in later stage",
"D": "Fibronodular opacities in upper lobes of the lung with or without cavitation"
} | step2&3 | A | [
"routine exam",
"68 year old woman",
"discovered to",
"serum calcium level",
"5 mg/dL",
"Follow-up laboratory tests show",
"high parathyroid hormone",
"low phosphorus",
"mildly elevated alkaline phosphatase",
"24-hour urine calcium level",
"elevated",
"Review",
"symptoms includes complaints"... |
A 29-year-old woman, gravida 1, para 0, at 36 weeks' gestation is brought to the emergency department after an episode of dizziness and vomiting followed by loss of consciousness lasting 1 minute. She reports that her symptoms started after lying down on her back to rest, as she felt tired during yoga class. Her pregna... | Lying in the left lateral decubitus position | {
"A": "Performing the Muller maneuver",
"B": "Lying in the supine position and elevating legs",
"C": "Gentle compression with an abdominal binder",
"D": "Lying in the left lateral decubitus position"
} | step1 | D | [
"29 year old woman",
"gravida 1",
"para 0",
"36 weeks",
"gestation",
"brought",
"emergency department",
"episode of dizziness",
"vomiting followed by loss of consciousness lasting 1 minute",
"reports",
"symptoms started",
"lying",
"back to rest",
"felt tired",
"yoga class",
"pregnancy"... |
A 32-year-old man presents to an outpatient clinic for tuberculosis prophylaxis before leaving for a trip to Asia, where tuberculosis is endemic. The Mantoux test is positive, but the chest X-ray and AFB sputum culture are negative. He was started on isoniazid. What is the most likely mechanism of resistance to isoniaz... | Mutations in katG | {
"A": "Mutations in katG",
"B": "Reduction of drug binding to RNA polymerase",
"C": "Plasmid-mediated resistance",
"D": "Increased efflux from the cell"
} | step1 | A | [
"year old man presents",
"outpatient clinic",
"tuberculosis prophylaxis",
"leaving",
"trip",
"Asia",
"tuberculosis",
"Mantoux test",
"positive",
"chest X-ray",
"AFB sputum culture",
"negative",
"started",
"isoniazid",
"most likely mechanism",
"resistance",
"isoniazid"
] |
A 33-year-old man with recently diagnosed testicular cancer visits his oncologist to discuss the treatment plan. His left testicle was removed after a thorough workup of a lump. A pelvic CT showed no enlarged lymph nodes and a simple orchiectomy and pelvic lymph node dissection was completed. The final diagnosis was st... | DNA polymerase β | {
"A": "DNA polymerase β",
"B": "DNA polymerase III",
"C": "Thymidylate synthase",
"D": "Ribonucleotide reductase"
} | step1 | A | [
"year old man",
"recently diagnosed testicular cancer visits",
"oncologist to discuss",
"treatment plan",
"left testicle",
"removed",
"workup",
"lump",
"pelvic CT showed",
"enlarged lymph nodes",
"simple orchiectomy",
"pelvic lymph node dissection",
"completed",
"final diagnosis",
"stage... |
A 67-year-old woman presents to the clinic with a 9-month history of seeing bright red blood in the toilet after defecating. Additional complaints include fatigue, shortness of breath, and mild lethargy. She denies the loss of weight, abdominal pain, or changes in dietary behavior. She consumes a balanced diet and take... | Hemoglobin: ↓, hematocrit: ↓, red blood cell count: ↓, mean corpuscular volume: ↓ | {
"A": "Hemoglobin: ↑, hematocrit: ↓, red blood cell count: ↓, mean corpuscular volume: ↑",
"B": "Hemoglobin: ↓, hematocrit: ↑, red blood cell count: ↓, mean corpuscular volume: ↓",
"C": "Hemoglobin: ↓, hematocrit: ↓, red blood cell count: ↑, mean corpuscular volume: ↑",
"D": "Hemoglobin: ↓, hematocrit: ↓, red ... | step1 | D | [
"67 year old woman presents",
"clinic",
"month history",
"seeing bright red blood",
"toilet",
"Additional complaints include fatigue",
"shortness of breath",
"mild lethargy",
"denies",
"loss of weight",
"abdominal pain",
"changes in dietary behavior",
"balanced diet",
"takes multiple vitam... |
A 20-year-old woman presents to student health for a 7-day history of sinus congestion. She has also had fever, sore throat, and infectious gastroenteritis. Upon further questioning, she has had similar problems 2 or 3 times a year for as long as she can remember. These have included sinus infections, ear infections, a... | IgM Level: Normal, IgG Level: Normal, IgA Level: Low | {
"A": "IgM Level: Normal, IgG Level: Low, IgA Level: Low",
"B": "IgM Level: Elevated, IgG Level: Low, IgA Level: Low",
"C": "IgM Level: Normal, IgG Level: Normal, IgA Level: Low",
"D": "IgM Level: Normal, IgG Level: Normal, IgA Level: Normal"
} | step2&3 | C | [
"20 year old woman presents",
"student health",
"7-day history",
"sinus congestion",
"fever",
"sore throat",
"infectious gastroenteritis",
"further questioning",
"similar problems",
"3 times",
"year",
"long",
"remember",
"included sinus infections",
"ear infections",
"lung infections",... |
A 16-year-old girl is brought to the physician because menarche has not yet occurred. She has no history of serious illness and takes no medications. She is 162 cm (5 ft 3 in) tall and weighs 80 kg (176 lb); BMI is 31.2 kg/m2. Breast and pubic hair development is Tanner stage 4. She also has oily skin, acne, and hyperp... | Elevated LH:FSH ratio | {
"A": "XO chromosomal abnormality",
"B": "Müllerian agenesis",
"C": "Elevated LH:FSH ratio",
"D": "Elevated β-hCG levels"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"menarche",
"not",
"occurred",
"history",
"serious illness",
"takes",
"medications",
"5 ft",
"tall",
"80 kg",
"BMI",
"31",
"kg/m2",
"Breast",
"pubic hair development",
"Tanner",
"oily skin",
"acne",
"hyperpigmentation",
"intertrigi... |
A 21-year-old man presents to the emergency department with acute back pain. The pain began a few hours prior to presentation and is located on the left lower back. The pain is described to be “shock-like,” 9/10 in pain severity, and radiates to the left groin. His temperature is 98.6°F (37°C), blood pressure is 120/75... | Lysine | {
"A": "Aspartic acid",
"B": "Histidine",
"C": "Lysine",
"D": "Phenylalanine"
} | step1 | C | [
"21-year-old man presents",
"emergency department",
"acute back pain",
"pain began",
"few hours prior to presentation",
"left lower back",
"pain",
"described to",
"shock",
"10",
"pain severity",
"radiates",
"left groin",
"temperature",
"98",
"blood pressure",
"75 mmHg",
"pulse",
... |
A 29-year-old woman, gravida 2, para 1, at 10 weeks' gestation comes to the physician for a prenatal visit. Over the past two weeks, she has felt nauseous in the morning and has had vulvar pruritus and dysuria that started 5 days ago. Her first child was delivered by lower segment transverse cesarean section because of... | Intravaginal clotrimazole | {
"A": "Oral metronidazole",
"B": "Intravaginal treatment with lactobacillus",
"C": "Oral fluconazole",
"D": "Intravaginal clotrimazole"
} | step2&3 | D | [
"29 year old woman",
"gravida 2",
"para 1",
"10 weeks",
"gestation",
"physician",
"prenatal visit",
"past two weeks",
"felt",
"morning",
"vulvar pruritus",
"dysuria",
"started 5 days",
"first child",
"delivered",
"lower segment transverse cesarean",
"macrosomia",
"gestational diabe... |
A 31-year-old man is brought in to the clinic by his sister because she is concerned about his behavior since the death of their mother 2 months ago. The patient’s sister states that he has always been a ‘loner’ and preferred being by himself than socializing with others. His social isolation resulted in him being ‘soc... | Schizoid personality disorder | {
"A": "Schizoid personality disorder",
"B": "Schizophrenia",
"C": "Social anxiety disorder",
"D": "Asperger’s syndrome"
} | step2&3 | A | [
"31 year old man",
"brought",
"clinic",
"sister",
"concerned",
"behavior",
"death of",
"mother",
"months",
"patients sister states",
"always",
"preferred",
"socializing",
"others",
"social isolation resulted",
"awkward",
"described",
"family",
"2 months",
"found out",
"death ... |
A male newborn is born at 37 weeks' gestation after spontaneous vaginal delivery. The mother had no prenatal care. Physical examination shows a urethral opening on the dorsal aspect of the penis, 4 mm proximal to the glans. There is a 3-cm defect in the midline abdominal wall superior to the pubic symphysis with exposu... | Malpositioning of the genital tubercle | {
"A": "Persistence of the urogenital membrane",
"B": "Malpositioning of the genital tubercle",
"C": "Abnormal development of the gubernaculum",
"D": "Failed fusion of the urethral folds"
} | step1 | B | [
"male newborn",
"born",
"weeks",
"gestation",
"spontaneous vaginal delivery",
"mother",
"prenatal care",
"Physical examination shows",
"urethral opening",
"dorsal aspect of",
"penis",
"4 mm proximal",
"glans",
"3",
"defect",
"midline abdominal wall superior",
"pubic symphysis",
"ex... |
A 37-year-old obese woman presents to the neurology clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. The pain started as an occasional throb and she could ignore it or takes analgesics but now the pain is muc... | Inability to oppose thumb to other digits | {
"A": "Inability to oppose thumb to other digits",
"B": "Flattened hypothenar eminence",
"C": "Atrophied adductor pollicis muscle",
"D": "Paresthesia over the thenar eminence"
} | step1 | A | [
"year old obese woman presents",
"neurology clinic",
"severe pain",
"left wrist",
"tingling sensation",
"left thumb",
"index finger",
"middle finger",
"part of",
"ring finger",
"pain started",
"occasional",
"ignore",
"takes analgesics",
"now",
"pain",
"worse",
"wakes",
"night",
... |
An otherwise healthy 45-year-old man comes to the physician because of a painful ulcer on his tongue for 3 days. Examination shows a shallow, tender 5-mm wide ulcer on the lateral aspect of the tongue, adjacent to his left first molar. There is no induration surrounding the ulcer or cervical lymphadenopathy. A lesion o... | Difficulty chewing | {
"A": "Difficulty chewing",
"B": "Loss of taste from the supraglottic region",
"C": "Inability to wrinkle the forehead",
"D": "Lateral deviation of the tongue"
} | step1 | A | [
"healthy",
"year old man",
"physician",
"of",
"painful ulcer",
"tongue",
"3 days",
"Examination shows",
"shallow",
"tender",
"mm wide ulcer on",
"lateral aspect",
"tongue",
"adjacent to",
"left first molar",
"induration surrounding",
"ulcer",
"cervical lymphadenopathy",
"lesion",... |
A 60-year-old man has had intermittent pain in his right great toe for the past 2 years. Joint aspiration and crystal analysis shows thin, tapered, needle shaped intracellular crystals that are strongly negatively birefringent. Radiograph demonstrates joint space narrowing of the 1st metatarsophalangeal (MTP) joint wit... | Monosodium urate crystal deposition | {
"A": "Monosodium urate crystal deposition",
"B": "Calcium pyrophosphate deposition",
"C": "Tuberculosis",
"D": "Rheumatoid arthritis"
} | step1 | A | [
"60 year old man",
"intermittent pain",
"right great toe",
"past",
"years",
"Joint aspiration",
"crystal analysis shows thin",
"tapered",
"needle shaped intracellular crystals",
"birefringent",
"Radiograph demonstrates joint",
"1st metatarsophalangeal",
"medial soft tissue swelling",
"most... |
A 53-year-old man comes to the physician because of a 3-month history of a nonpruritic rash, fatigue, and decreased urination. Physical examination shows multiple erythematous, purpuric papules on his trunk and extremities that do not blanch when pressed. Serum creatinine is elevated and urinalysis shows red blood cell... | Anti-hepatitis C antibodies | {
"A": "Anti-desmoglein antibodies",
"B": "Anti-hepatitis C antibodies",
"C": "Anti-DNA topoisomerase antibodies",
"D": "Anticardiolipin antibodies"
} | step1 | B | [
"year old man",
"physician",
"3 month history",
"nonpruritic rash",
"fatigue",
"decreased urination",
"Physical examination shows multiple erythematous",
"purpuric papules",
"trunk",
"extremities",
"not blanch",
"Serum creatinine",
"elevated",
"urinalysis shows red blood cell casts",
"pr... |
A 75-year-old woman presents to the physician with a complaint of a frequent need to void at nighttime, which has been disrupting her sleep. She notes embarrassingly that she is often unable to reach the bathroom in time, and experiences urinary leakage throughout the night as well as during the day. The patient underg... | Urge incontinence | {
"A": "Overflow incontinence",
"B": "Stress incontinence",
"C": "Total incontinence",
"D": "Urge incontinence"
} | step2&3 | D | [
"75 year old woman presents",
"physician",
"complaint",
"frequent need",
"void",
"nighttime",
"disrupting",
"sleep",
"notes",
"often unable to reach",
"bathroom",
"time",
"experiences urinary leakage",
"night as well",
"day",
"patient",
"urodynamic testing",
"urinalysis",
"obtain... |
A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these indiv... | 6 | {
"A": "0.17",
"B": "1.5",
"C": "2.25",
"D": "6"
} | step1 | D | [
"researcher",
"investigating",
"association",
"use of social",
"teenagers",
"bipolar disorder",
"order to study",
"potential relationship",
"collects data",
"people",
"bipolar disorder",
"matched controls",
"disorder",
"then",
"average",
"individuals used social media",
"years",
"d... |
A 35-year-old female presents to her primary care physician because of chronic fatigue that has stopped her from gardening and walking with her friends. Upon further questioning, she elaborates that she feels fine after waking up but gradually becomes more tired and weak as the day progresses. This appears to be partic... | Hemicholinium | {
"A": "Botulinum",
"B": "Hemicholinium",
"C": "Reserpine",
"D": "Vesamicol"
} | step1 | B | [
"35 year old female presents",
"primary care physician",
"chronic fatigue",
"stopped",
"gardening",
"walking",
"friends",
"further questioning",
"feels fine",
"waking",
"more tired",
"weak",
"day progresses",
"appears to",
"engaged in physical activity",
"eating",
"Review of systems ... |
A 3-day-old newborn is brought to the physician because of abdominal distention, inconsolable crying, and 3 episodes of bilious vomiting since the previous evening. He was delivered at home at 40 weeks' gestation by a trained midwife. He has not passed meconium. Physical examination shows abdominal distention, a tight ... | Submucosa and muscularis externa | {
"A": "Muscularis mucosae and serosa",
"B": "Submucosa and muscularis externa",
"C": "Epithelium and submucosa",
"D": "Muscularis mucosae and lamina propria"
} | step1 | B | [
"3 day old newborn",
"brought",
"physician",
"abdominal distention",
"inconsolable crying",
"3 episodes of bilious vomiting",
"previous evening",
"delivered",
"home",
"40 weeks",
"gestation",
"trained midwife",
"not passed meconium",
"Physical examination shows abdominal distention",
"ti... |
Two days after undergoing porcine aortic valve replacement surgery for aortic valve stenosis, a 62-year-old patient develops yellow discoloration of the sclera. His vital signs are within normal limits. Physical examination shows scleral icterus. Abdominal examination shows no abnormalities. Laboratory studies show:
He... | Impaired bilirubin conjugation | {
"A": "Impaired bilirubin conjugation",
"B": "Drug-induced toxicity",
"C": "Absent hepatic glucuronosyltransferase",
"D": "Impaired bilirubin excretion"
} | step1 | A | [
"Two days",
"porcine aortic valve replacement surgery",
"aortic valve stenosis",
"62 year old patient",
"yellow",
"sclera",
"vital signs",
"normal limits",
"Physical examination shows scleral icterus",
"Abdominal examination shows",
"abnormalities",
"Laboratory studies show",
"Hematocrit",
... |
A 59-year-old woman comes to the emergency department because of a 2-day history of worsening fever, chills, malaise, productive cough, and difficulty breathing. Three days ago, she returned from a trip to South Africa. She has type 2 diabetes mellitus, hypertension, and varicose veins. Her current medications include ... | Intravenous vancomycin and ceftriaxone | {
"A": "Intravenous ceftriaxone and azithromycin",
"B": "Erythromycin",
"C": "External cooling and intravenous acetaminophen",
"D": "Intravenous vancomycin and ceftriaxone"
} | step2&3 | D | [
"59 year old woman",
"emergency department",
"2-day history",
"worsening fever",
"chills",
"malaise",
"productive cough",
"difficulty breathing",
"Three days",
"returned",
"trip",
"South Africa",
"type 2 diabetes mellitus",
"hypertension",
"varicose veins",
"current medications include... |
A 30-year-old woman, gravida 1, para 0, at 30 weeks' gestation is brought to the emergency department because of progressive upper abdominal pain for the past hour. The patient vomited once on her way to the hospital. She said she initially had dull, generalized stomach pain about 6 hours prior, but now the pain is loc... | Appendectomy | {
"A": "Appendectomy",
"B": "Cefoxitin and azithromycin",
"C": "Biliary drainage",
"D": "Intramuscular ceftriaxone followed by cephalexin"
} | step2&3 | A | [
"30 year old woman",
"gravida 1",
"para 0",
"30 weeks",
"gestation",
"brought",
"emergency department",
"of progressive upper abdominal pain",
"past hour",
"patient vomited",
"hospital",
"initially",
"dull",
"generalized stomach pain",
"hours prior",
"now",
"pain",
"upper abdomen",... |
A 59-year-old male with a 1-year history of bilateral knee arthritis presents with epigastric pain that intensifies with meals. He has been self-medicating with aspirin, taking up to 2,000 mg per day for the past six months. Which of the following medications, if taken instead of aspirin, could have minimized his risk ... | Celecoxib | {
"A": "Ketorolac",
"B": "Indomethacin",
"C": "Naproxen",
"D": "Celecoxib"
} | step1 | D | [
"59 year old male",
"history of bilateral knee arthritis presents",
"epigastric pain",
"meals",
"self",
"aspirin",
"taking",
"2",
"mg",
"day",
"past six months",
"following medications",
"taken",
"aspirin",
"risk",
"experiencing",
"epigastric pain"
] |
A 29-year-old woman comes to the physician because of a 2-day history of intermittent dark urine and mild flank pain. She has also had a cough, sore throat, and runny nose for the past 5 days. She has not had dysuria. She takes no medications. She has no known allergies. Her temperature is 37°C (98.6°F). Examination of... | Renal glomerular damage | {
"A": "Interstitial renal inflammation",
"B": "Renal papillary necrosis",
"C": "Renal glomerular damage",
"D": "Urothelial neoplasia"
} | step2&3 | C | [
"29 year old woman",
"physician",
"2-day history",
"intermittent dark urine",
"mild flank",
"cough",
"sore throat",
"runny nose",
"past 5 days",
"not",
"dysuria",
"takes",
"medications",
"known allergies",
"temperature",
"98",
"Examination of",
"back shows",
"costovertebral angle... |
A study is being conducted on depression using the Patient Health questionnaire (PHQ-9) survey data embedded within a popular social media network with a response size of 500,000 participants. The sample population of this study is approximately normal. The mean PHQ-9 score is 14, and the standard deviation is 4. How m... | 12,500 | {
"A": "12,500",
"B": "17,500",
"C": "160,000",
"D": "175,000"
} | step1 | A | [
"study",
"conducted",
"depression using",
"Patient Health questionnaire",
"survey data embedded",
"popular social network",
"response size",
"500",
"participants",
"sample population",
"study",
"approximately normal",
"mean PHQ-9 score",
"standard deviation",
"4",
"participants",
"sc... |
A 77-year-old woman is brought to the physician for gradually increasing confusion and difficulty walking for the past 4 months. Her daughter is concerned because she has been forgetful and seems to be walking more slowly. She has been distracted during her weekly bridge games and her usual television shows. She has al... | Normal pressure hydrocephalus | {
"A": "Pseudodementia",
"B": "Frontotemporal dementia",
"C": "Normal pressure hydrocephalus",
"D": "Creutzfeldt-Jakob disease"
} | step2&3 | C | [
"year old woman",
"brought",
"physician",
"increasing confusion",
"difficulty walking",
"past",
"months",
"daughter",
"concerned",
"forgetful",
"to",
"walking more slowly",
"weekly bridge games",
"usual television shows",
"frequent episodes of incontinence",
"now",
"adult diaper dail... |
A 1-year-old boy is brought to the physician for the evaluation of swelling around the eyelids. He was born at term after an uncomplicated pregnancy. He is at the 95th percentile for weight and 60th percentile for length. His blood pressure is 130/86 mm Hg. Physical examination shows an empty scrotal sac and a left-sid... | Loss of function of zinc finger transcription factor | {
"A": "Inhibition of hypoxia-inducible factor 1a",
"B": "Deficiency of 17α-hydroxylase",
"C": "Increased expression of insulin-like growth factor 2",
"D": "Loss of function of zinc finger transcription factor"
} | step1 | D | [
"year old boy",
"brought",
"physician",
"evaluation",
"swelling",
"eyelids",
"born",
"term",
"uncomplicated pregnancy",
"95th percentile",
"weight",
"percentile",
"length",
"blood pressure",
"mm Hg",
"Physical examination shows",
"empty scrotal sac",
"left-sided abdominal mass",
... |
A 35-year-old female presents to her primary care physician complaining of right upper quadrant pain over the last 6 months. Pain is worst after eating and feels like intermittent squeezing. She also admits to lighter colored stools and a feeling of itchiness on her skin. Physical exam demonstrates a positive Murphy's ... | Scurvy | {
"A": "Night blindness",
"B": "Scurvy",
"C": "Hemolytic anemia",
"D": "Increased prothrombin time and easy bleeding"
} | step1 | B | [
"35 year old female presents",
"primary care physician",
"right upper quadrant pain",
"last",
"months",
"Pain",
"worst",
"eating",
"feels",
"intermittent squeezing",
"admits to lighter colored stools",
"feeling",
"itchiness",
"skin",
"Physical exam demonstrates",
"positive Murphy's sig... |
On morning labs, a patient's potassium comes back at 5.9 mEq/L. The attending thinks that this result is spurious, and asks the team to repeat the electrolytes. Inadvertently, the medical student, intern, and resident all repeat the electrolytes that same morning. The following values are reported: 4.3 mEq/L, 4.2 mEq/L... | 4.25 mEq/L | {
"A": "4.2 mEq/L",
"B": "4.25 mEq/L",
"C": "4.65 mEq/L",
"D": "1.7 mEq/L"
} | step1 | B | [
"morning labs",
"patient's potassium",
"back",
"5.9 mEq/L",
"attending thinks",
"result",
"spurious",
"team to repeat",
"electrolytes",
"medical student",
"intern",
"resident",
"repeat",
"electrolytes",
"same morning",
"following values",
"reported",
"4",
"mEq/L",
"4.2 mEq/L",
... |
A 24-year-old woman presents to a medical office for a follow-up evaluation. The medical history is significant for type 1 diabetes, for which she takes insulin. She was recently hospitalized for diabetic ketoacidosis following a respiratory infection. Today she brings in a list of her most recent early morning fasting... | Mean | {
"A": "Mean",
"B": "Mode",
"C": "Mean and median",
"D": "Median and mode"
} | step1 | A | [
"year old woman presents",
"medical office",
"follow-up evaluation",
"medical history",
"significant",
"type 1 diabetes",
"takes insulin",
"recently hospitalized",
"diabetic ketoacidosis following",
"respiratory infection",
"Today",
"list",
"recent early morning fasting blood glucose reading... |
A 32-year-old woman comes to the physician because of a 6-week history of fatigue and weakness. Examination shows marked pallor of the conjunctivae. The spleen tip is palpated 2 cm below the left costal margin. Her hemoglobin concentration is 9.5 g/dL, serum lactate dehydrogenase concentration is 750 IU/L, and her seru... | Systemic lupus erythematosus | {
"A": "Hereditary spectrin defect",
"B": "Bicuspid aortic valve",
"C": "Mycoplasma pneumoniae infection",
"D": "Systemic lupus erythematosus"
} | step1 | D | [
"year old woman",
"physician",
"week history",
"fatigue",
"weakness",
"Examination shows marked pallor",
"conjunctivae",
"spleen tip",
"palpated 2 cm",
"left costal margin",
"hemoglobin concentration",
"9.5 g/dL",
"serum lactate dehydrogenase concentration",
"750 IU/L",
"serum haptoglobi... |
A 4-month-old girl is seen for ongoing lethargy and vomiting. She was born to a 31-year-old G2P2 mother with a history of hypertension. She has had 7 episodes of non-bloody, non-bilious vomiting and 3 wet diapers over the last 24 hours. Laboratory results are shown below.
Serum:
Na+: 132 mEq/L
Cl-: 100 mEq/L
K+: 3.2 m... | Medium chain acyl-CoA dehydrogenase deficiency | {
"A": "Glucocerebrosidase deficiency",
"B": "Sphingomyelinase deficiency",
"C": "Medium chain acyl-CoA dehydrogenase deficiency",
"D": "Galactose-1-phosphate uridyltransferase deficiency"
} | step1 | C | [
"4 month old girl",
"seen",
"ongoing lethargy",
"vomiting",
"born",
"31 year old",
"mother",
"history of hypertension",
"episodes of non bloody",
"vomiting",
"3 wet diapers",
"24",
"Laboratory results",
"shown",
"Serum",
"Na",
"mEq/L Cl",
"100 mEq/L K",
"3.2 mEq/L HCO3",
"27 mE... |
A previously healthy 6-month-old boy is brought to the emergency department because of irritability and poor feeding for 6 days. He has also not had a bowel movement in 9 days and has been crying less than usual. He is bottle fed with formula and his mother has been weaning him with mashed bananas mixed with honey for ... | Human-derived immune globulin | {
"A": "Human-derived immune globulin",
"B": "Equine-derived antitoxin",
"C": "Plasmapheresis",
"D": "Pyridostigmine"
} | step2&3 | A | [
"healthy",
"month old boy",
"brought",
"emergency department",
"irritability",
"poor feeding",
"6 days",
"not",
"bowel movement",
"days",
"crying less than usual",
"bottle fed",
"formula",
"mother",
"weaning",
"bananas mixed",
"honey",
"past",
"weeks",
"immunizations",
"date"... |
A 68-year-old man comes to the emergency department 12 hours after the appearance of tender, purple discolorations on his thighs and lower abdomen. He began taking a medication 4 days ago after failed cardioversion for atrial fibrillation, but he cannot remember the name. Physical examination shows a tender bluish-blac... | Reduced levels of protein C | {
"A": "Deficiency of vitamin K",
"B": "Decreased synthesis of antithrombin III",
"C": "Antibodies against platelet factor 4",
"D": "Reduced levels of protein C"
} | step1 | D | [
"68 year old man",
"emergency department 12 hours",
"appearance",
"tender",
"purple discolorations",
"thighs",
"lower abdomen",
"began taking",
"medication",
"days",
"failed cardioversion",
"atrial",
"remember",
"name",
"Physical examination shows",
"tender",
"black discoloration",
... |
An 8-year-old girl is brought to the physician for a well-child examination. Since the age of 2 years, she has had multiple fractures after minor trauma. During the past year, she has fractured the left humerus and right clavicle after falls. Her father also has a history of recurrent fractures. She is at the 5th perce... | Hearing impairment | {
"A": "Dislocated lens",
"B": "Hearing impairment",
"C": "Widely spaced permanent teeth",
"D": "Cerebral berry aneurysm"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"well",
"age",
"years",
"multiple fractures after minor trauma",
"past year",
"fractured",
"left humerus",
"right clavicle",
"falls",
"father",
"history of recurrent fractures",
"5th percentile",
"height",
"percentile",
"weight",
"Vital si... |
A 59-year-old healthy woman presents to her primary care physician’s office six weeks after undergoing an elective breast augmentation procedure in the Dominican Republic. She was told by her surgeon to establish post-operative care once back in the United States. Today she is bothered by nausea and early satiety. Her ... | Naloxegol | {
"A": "Pantoprazole",
"B": "Senna",
"C": "Naloxegol",
"D": "Naproxen"
} | step2&3 | C | [
"59 year old healthy woman presents",
"primary care physicians office six weeks",
"elective breast augmentation procedure",
"Dominican Republic",
"surgeon to establish post-operative care",
"back",
"United States",
"Today",
"bothered by nausea",
"early satiety",
"past medical history",
"signif... |
A 32-year-old man presents to his primary care provider reporting weakness. He recently noticed that he has difficulty letting go of a doorknob or releasing his hand after shaking hands with others. His past medical history is notable for diabetes, for which he takes metformin. He drinks 2-3 beers per day, uses marijua... | DMPK | {
"A": "DMPK",
"B": "DPC",
"C": "Dystrophin",
"D": "SMN1"
} | step1 | A | [
"year old man presents",
"primary care provider reporting weakness",
"recently",
"difficulty letting go",
"releasing",
"hand",
"shaking",
"others",
"past medical history",
"notable",
"diabetes",
"takes metformin",
"drinks 2 beers",
"day",
"uses marijuana occasionally",
"works",
"secu... |
A 71-year-old man presents to the emergency department for shortness of breath. The patient was returning from a business trip to China, when he suddenly felt short of breath during the taxi ride home from the airport. The patient has a past medical history of poorly controlled diabetes mellitus and a 50 pack-year smok... | Ventilation perfusion scan | {
"A": "Arterial blood gas",
"B": "CT angiogram",
"C": "D-dimer",
"D": "Ventilation perfusion scan"
} | step2&3 | D | [
"71 year old man presents",
"emergency department",
"shortness of breath",
"patient",
"returning",
"business trip",
"China",
"felt short of breath",
"taxi",
"home",
"airport",
"patient",
"past medical poorly controlled diabetes mellitus",
"50 pack-year smoking history",
"patient",
"non... |
A 2-week-old boy presents to the emergency department because of unusual irritability and lethargy. The patient is admitted to the pediatric intensive care unit and minutes later develops metabolic encephalopathy. This progressed to a coma, followed by death before any laboratory tests are completed. The infant was bor... | Ornithine transcarbamylase | {
"A": "Branched-chain alpha-ketoacid dehydrogenase",
"B": "Cystathionine synthase deficiency",
"C": "Homogentisic acid dioxygenase",
"D": "Ornithine transcarbamylase"
} | step1 | D | [
"2 week old boy presents",
"emergency department",
"unusual irritability",
"lethargy",
"patient",
"admitted to",
"pediatric intensive care unit",
"minutes later",
"metabolic encephalopathy",
"progressed",
"coma",
"followed by death",
"laboratory tests",
"completed",
"infant",
"born at ... |
A 29-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the emergency department because of severe right-sided back pain for the last hour. The pain is colicky and radiates to the right groin. The patient also reports nausea and pain with urination. Pregnancy has been uncomplicated and the patient repor... | Nephrolithiasis | {
"A": "Cholecystitis",
"B": "Nephrolithiasis",
"C": "Pelvic inflammatory disease",
"D": "Pyelonephritis"
} | step2&3 | B | [
"29 year old woman",
"gravida 2",
"para 1",
"30 weeks",
"estation ",
"mergency department ",
"f evere ight-sided ack pain ",
"ain ",
"olicky ",
"adiates ",
"ight groin.",
"atient ",
"eports ausea ",
"ain ",
"rination.",
"regnancy ",
"ncomplicated ",
"atient eports ",
"ollowi... |
An 18-year-old man is brought to the emergency department after his mother found him locked in his room stammering about a government conspiracy to brainwash him in subterranean tunnels. His mother says that he has never done this before, but 6 months ago he stopped going to classes and was subsequently suspended from ... | Acute onset of symptoms | {
"A": "Predominance of negative symptoms",
"B": "Acute onset of symptoms",
"C": "Lack of social support",
"D": "Cannabis use"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"mother found",
"locked",
"room stammering",
"government",
"brainwash",
"tunnels",
"mother",
"never",
"before",
"months",
"stopped",
"classes",
"suspended",
"college",
"reports",
"course",
"past month",
"drinks one",
"two b... |
An investigator studying patients with symptoms of arthritis detects a nonenveloped virus with a single-stranded DNA genome in the serum of a pregnant patient. Fetal infection with this pathogen is most likely to cause which of the following manifestations? | Hydrops fetalis | {
"A": "Hydrops fetalis",
"B": "Chorioretinitis",
"C": "Microcephaly",
"D": "Vesicular rash"
} | step1 | A | [
"investigator studying patients",
"symptoms",
"arthritis detects",
"virus",
"single-stranded DNA genome",
"serum",
"pregnant patient",
"Fetal infection",
"pathogen",
"most likely to cause",
"of",
"following manifestations"
] |
A 32-year-old man comes to the Veterans Affairs hospital because of difficulty sleeping for the past 9 weeks. He is a soldier who returned from a deployment in Afghanistan 12 weeks ago. Fifteen weeks ago, his unit was ambushed in a deserted street, and a fellow soldier was killed. He wakes up frequently during the nigh... | Prazosin therapy | {
"A": "Diazepam therapy",
"B": "Triazolam therapy",
"C": "Phenelzine therapy",
"D": "Prazosin therapy"
} | step2&3 | D | [
"year old man",
"Veterans",
"hospital",
"of difficulty sleeping",
"past",
"weeks",
"soldier",
"returned",
"deployment",
"Afghanistan",
"weeks",
"Fifteen",
"unit",
"ambushed",
"deserted street",
"soldier",
"killed",
"wakes up frequently",
"night",
"vivid dreams",
"incident",
... |
A 32-year-old woman is brought into the emergency department at 5 AM because of chest pain that woke her up at 3 AM. The pain is constant and has not decreased in intensity during this time. She has no history of any similar episodes. She has systemic lupus erythematosus without major organ involvement. She takes predn... | Pill esophagitis | {
"A": "Diffuse esophageal spasm",
"B": "Esophageal perforation",
"C": "Esophageal stricture",
"D": "Pill esophagitis"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"5",
"of chest pain",
"woke",
"3",
"pain",
"constant",
"not decreased",
"intensity",
"time",
"history of",
"similar episodes",
"systemic lupus erythematosus without major organ involvement",
"takes prednisone",
"calcium",
"alendr... |
Six hours after near-total thyroidectomy for Graves disease, a 58-year-old man has not had any urine output. The surgery was successful and the patient feels well except for slight neck pain. He has type 2 diabetes mellitus and hypertension. His father had autosomal dominant polycystic kidney disease. Prior to the surg... | Perform bedside bladder scan | {
"A": "Obtain urinalysis",
"B": "Perform bedside bladder scan",
"C": "Obtain renal biopsy",
"D": "Administer furosemide\n\""
} | step2&3 | B | [
"Six hours",
"total thyroidectomy",
"Graves disease",
"58 year old man",
"not",
"urine output",
"surgery",
"successful",
"patient feels well",
"slight neck pain",
"type 2 diabetes mellitus",
"hypertension",
"father",
"autosomal dominant polycystic kidney disease",
"surgery",
"patient",... |
A 45-year-old man presents to his primary care physician because of abdominal pain. He has had this pain intermittently for several years but feels that it has gotten worse after he started a low carbohydrate diet. He says that the pain is most prominent in the epigastric region and is also associated with constipation... | Osteomalacia | {
"A": "Encephalopathy, ophthalmoplegia, and gait ataxia",
"B": "Microcytic anemia",
"C": "Megaloblastic anemia without neurologic changes",
"D": "Osteomalacia"
} | step1 | D | [
"year old man presents",
"primary care physician",
"abdominal pain",
"pain",
"years",
"feels",
"gotten worse",
"started",
"low carbohydrate diet",
"pain",
"most prominent",
"epigastric region",
"associated with constipation",
"foul smelling stools",
"float",
"toilet bowl",
"year hist... |
A 67-year-old man comes to the physician because of a 6-month history of increasing shortness of breath on exertion, dry cough, and fatigue. He has not had any fevers or night sweats. He worked in a glass manufacturing factory for 15 years and retired 2 years ago. Pulmonary examination shows diffuse crackles bilaterall... | Pulmonary tuberculosis | {
"A": "Malignant mesothelioma",
"B": "Invasive aspergillosis",
"C": "Pneumocystis pneumonia",
"D": "Pulmonary tuberculosis"
} | step1 | D | [
"67 year old man",
"physician",
"of",
"month history",
"increasing shortness",
"breath",
"exertion",
"dry cough",
"fatigue",
"not",
"fevers",
"night sweats",
"worked",
"glass manufacturing factory",
"years",
"retired 2 years",
"Pulmonary examination shows diffuse crackles",
"x-ray ... |
A 47-year-old woman comes to the physician because of fatigue, difficulty falling asleep, and night sweats for the past 6 months. Over the past year, her menstrual cycle has become irregular and her last menstrual period was 2 months ago. She quit smoking 2 years ago. Pelvic exam shows vulvovaginal atrophy. A pregnancy... | Increased follicle-stimulating hormone | {
"A": "Increased estrogen",
"B": "Increased inhibin B",
"C": "Decreased gonadotropin-releasing hormone",
"D": "Increased follicle-stimulating hormone"
} | step1 | D | [
"year old woman",
"physician",
"fatigue",
"difficulty falling asleep",
"night sweats",
"past 6 months",
"past year",
"menstrual cycle",
"irregular",
"last menstrual period",
"2 months",
"quit smoking 2 years",
"Pelvic exam shows vulvovaginal atrophy",
"pregnancy test",
"negative",
"fol... |
A 41-year-old woman presents with back pain for the past 2 days. She says that the pain radiates down along the posterior right thigh and leg. She says the pain started suddenly after lifting a heavy box 2 days ago. Past medical history is irrelevant. Physical examination reveals a straight leg raise (SLR) test restric... | First sacral nerve root (S1) | {
"A": "Fifth lumbar nerve root (L5)",
"B": "First sacral nerve root (S1)",
"C": "Fourth lumbar nerve root (L4)",
"D": "Second sacral nerve root (S2)"
} | step1 | B | [
"year old woman presents",
"back pain",
"past 2 days",
"pain radiates",
"posterior",
"leg",
"pain started",
"lifting",
"heavy box",
"days",
"Past medical history",
"Physical examination reveals",
"straight leg raise",
"test restricted",
"30",
"to walk",
"toes",
"decreased sensation... |
A 72-year-old woman comes to the physician because of a 3-day history of redness and swelling of her right leg and fever. She says the leg is very painful and the redness over it has become larger. She appears ill. Her temperature is 39.3°C (102.7°F), pulse is 103/min, and blood pressure is 138/90 mm Hg. Cardiopulmonar... | Tinea pedis
" | {
"A": "Rheumatoid arthritis",
"B": "Graves disease",
"C": "Cigarette smoking",
"D": "Tinea pedis\n\""
} | step2&3 | D | [
"72 year old woman",
"physician",
"3-day history",
"redness",
"swelling of",
"right leg",
"fever",
"leg",
"very painful",
"redness",
"larger",
"appears ill",
"temperature",
"3C",
"pulse",
"min",
"blood pressure",
"90 mm Hg",
"Cardiopulmonary examination shows",
"abnormalities",... |
A 35-year-old female presents to the emergency room complaining of diarrhea and dehydration. She has been experiencing severe watery diarrhea for the past 3 days. She reports that she has been unable to leave the bathroom for more than a few minutes at a time. She noticed earlier today that there was some blood on her ... | Transduction | {
"A": "Transformation",
"B": "Conjugation",
"C": "Transduction",
"D": "Transposition"
} | step1 | C | [
"35 year old female presents",
"emergency room",
"diarrhea",
"dehydration",
"experiencing severe watery diarrhea",
"past 3 days",
"reports",
"unable to leave",
"bathroom",
"few minutes",
"time",
"earlier today",
"blood on",
"toilet paper",
"wiping",
"recently returned",
"volunteer tr... |
A 3-year-old toddler was rushed to the emergency department after consuming peanut butter crackers at daycare. The daycare staff report that the patient has a severe allergy to peanut butter and he was offered the crackers by mistake. The patient is in acute distress. The vital signs include: blood pressure 60/40 mm Hg... | Release of IL-4 | {
"A": "Release of IL-4",
"B": "Deposition of antigen-antibody complexes",
"C": "IL-2 secretion",
"D": "C3b interaction"
} | step1 | A | [
"3 year old toddler",
"rushed",
"emergency department",
"peanut butter crackers",
"daycare",
"daycare staff report",
"patient",
"severe allergy",
"peanut butter",
"offered",
"crackers",
"mistake",
"patient",
"acute distress",
"vital signs include",
"blood pressure 60 40 mm Hg",
"hear... |
A 32-year-old G2P0 presents at 37 weeks gestation with a watery vaginal discharge. The antepartum course was remarkable for an abnormal ultrasound finding at 20 weeks gestation. The vital signs are as follows: blood pressure, 110/80 mm Hg; heart rate, 91/min; respiratory rate, 13/min; and temperature, 36.4℃ (97.5℉). Th... | Velamentous cord insertion | {
"A": "Loss of the normal retroplacental hyperechogenic region",
"B": "Velamentous cord insertion",
"C": "Retroplacental hematoma",
"D": "Subchorionic cyst"
} | step2&3 | B | [
"year old",
"presents",
"weeks gestation",
"watery vaginal discharge",
"antepartum course",
"abnormal",
"20 weeks gestation",
"vital signs",
"follows",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"97",
"fetal heart rate",
"... |
An experimental drug, ES 62, is being studied. It prohibits the growth of vancomycin-resistant Staphylococcus aureus. It is highly lipid-soluble. The experimental design is dependent on a certain plasma concentration of the drug. The target plasma concentration is 100 mmol/dL. Which of the following factors is most imp... | Volume of distribution | {
"A": "Clearance of the drug",
"B": "Half-life of the drug",
"C": "Therapeutic index",
"D": "Volume of distribution"
} | step1 | D | [
"experimental drug",
"ES 62",
"studied",
"prohibits",
"growth",
"vancomycin-resistant Staphylococcus aureus",
"highly lipid soluble",
"experimental design",
"dependent",
"certain plasma concentration",
"drug",
"target plasma concentration",
"100 mmol/dL",
"following factors",
"most impor... |
A 24-year-old male graduate student comes to the physician for a two-month history of repeated thoughts and anxiety that he is going to be harmed by someone on the street. The anxiety worsened after witnessing a pedestrian getting hit by a car two weeks ago. He says, “That was a warning sign.” On his way to school, he ... | Delusional disorder | {
"A": "Schizotypal personality disorder",
"B": "Delusional disorder",
"C": "Generalized anxiety disorder",
"D": "Schizoid personality disorder"
} | step2&3 | B | [
"year old male graduate student",
"physician",
"two month history",
"repeated thoughts",
"anxiety",
"to",
"street",
"anxiety worsened",
"witnessing",
"pedestrian getting hit by",
"car two weeks",
"warning sign",
"school",
"now often leaves",
"hour earlier to take",
"hide",
"people",
... |
A 58-year-old male presents to the clinic for a follow-up visit. He takes metformin every day and says that he is compliant with his medication but can not control his diet. Three months prior, his HbA1c was 8.2% when he was started on metformin. He does not have any complaints on this visit. His temperature is 37°C (9... | Sitagliptin | {
"A": "Rosiglitazone",
"B": "Pioglitazone",
"C": "Sitagliptin",
"D": "Glyburide"
} | step2&3 | C | [
"58 year old male presents",
"clinic",
"follow-up visit",
"takes metformin",
"day",
"compliant",
"medication",
"not control",
"diet",
"Three months prior",
"started",
"metformin",
"not",
"complaints",
"visit",
"temperature",
"98",
"respirations",
"min",
"pulse",
"67 min",
"... |
A 24-year-old man presents to the college campus clinic worried that he is having a nervous breakdown. The patient was diagnosed with attention-deficit/hyperactivity disorder (ADHD) during his freshman year and has been struggling to keep his grades up. He has recently become increasingly worried that he might not be a... | Tourette syndrome | {
"A": "Tourette syndrome",
"B": "Obsessive-compulsive personality disorder",
"C": "Schizophrenia",
"D": "Not related to other disorders"
} | step2&3 | A | [
"year old man presents",
"college",
"clinic worried",
"nervous breakdown",
"patient",
"diagnosed with attention-deficit/hyperactivity disorder",
"year",
"to keep",
"grades",
"recently",
"worried",
"not",
"able to graduate on time",
"past",
"months",
"thoughts",
"room burning",
"fin... |
A 49-year-old male complains of abdominal discomfort that worsens following meals. A gastric biopsy reveals a 2 cm gastric ulcer, and immunohistochemical staining demonstrates the presence of a rod-shaped bacterium in the gastric mucosa. Which of the following is used by the infiltrating pathogen to neutralize gastric ... | Urease | {
"A": "Mucinase",
"B": "Bismuth",
"C": "Urease",
"D": "LT toxin"
} | step1 | C | [
"year old male",
"abdominal discomfort",
"worsens following meals",
"gastric biopsy reveals",
"2",
"gastric ulcer",
"staining demonstrates",
"presence",
"rod-shaped bacterium",
"gastric mucosa",
"following",
"used by",
"infiltrating pathogen to",
"gastric acidity"
] |
A 7-year-old boy is brought to the emergency department by his mother 1 hour after falling off his bike and landing head-first on the pavement. His mother says that he did not lose consciousness but has been agitated and complaining about a headache since the event. He has no history of serious illness and takes no med... | Inpatient observation | {
"A": "Inpatient observation",
"B": "Discharge home",
"C": "MRI of the brain",
"D": "CT angiography\n\""
} | step2&3 | A | [
"year old boy",
"brought",
"emergency department",
"mother",
"hour",
"falling",
"bike",
"landing head-first",
"pavement",
"mother",
"not",
"consciousness",
"agitated",
"headache",
"event",
"history",
"serious illness",
"takes",
"medications",
"temperature",
"98",
"pulse",
... |
A 67-year-old man presents to the emergency department with altered mental status. The patient is non-verbal at baseline, but his caretakers at the nursing home noticed he was particularly somnolent recently. The patient has a past medical history of diabetes and Alzheimer dementia. His temperature is 99.7°F (37.6°C), ... | Bone marrow biopsy | {
"A": "Bone marrow biopsy",
"B": "Radiograph of the lumbar spine",
"C": "Urine, blood, and cerebrospinal fluid cultures",
"D": "Urine protein levels"
} | step2&3 | A | [
"67 year old man presents",
"emergency department",
"altered mental status",
"patient",
"non-verbal",
"baseline",
"caretakers",
"nursing home",
"somnolent recently",
"patient",
"past medical diabetes",
"Alzheimer dementia",
"temperature",
"99",
"blood pressure",
"98 mmHg",
"pulse",
... |
A 31-year-old G1P0 woman is brought into the emergency room by the police after a failed suicide attempt. She jumped off a nearby bridge but was quickly rescued by some nearby locals. The height of the bridge was not significant, so the patient did not sustain any injuries. For the 3 weeks before this incident, the pat... | Electroconvulsive therapy | {
"A": "Electroconvulsive therapy",
"B": "Paroxetine",
"C": "Phenelzine",
"D": "Bupropion"
} | step1 | A | [
"31 year old",
"woman",
"brought",
"emergency room",
"police",
"failed suicide attempt",
"jumped",
"bridge",
"locals",
"height",
"bridge",
"not significant",
"patient",
"not sustain",
"injuries",
"3 weeks",
"incident",
"patient",
"lacking energy",
"unable to focus at home",
"... |
A 35-year-old woman is brought into the emergency room by her boyfriend with a superficial cut to the wrist. Her vital signs are normal. On physical examination, the laceration is superficial and bleeding has stopped. She says that the injury was self-inflicted because her boyfriend canceled a dinner date due to his m... | Splitting | {
"A": "Splitting",
"B": "Repression",
"C": "Suppression",
"D": "Regression"
} | step2&3 | A | [
"35 year old woman",
"brought",
"emergency room",
"boyfriend",
"superficial cut",
"wrist",
"vital signs",
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"physical examination",
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"superficial",
"bleeding",
"stopped",
"injury",
"self-inflicted",
"boyfriend canceled",
"dinner date due to",
"mother",
"hospi... |
A 29-year-old female presents to the family physician concerned over the blue-black discoloration of her sclera and skin. She notes that at the end of her day, there are black stains in her underwear. The incomplete breakdown of which of the following amino acids is responsible for this presentation? | Tyrosine | {
"A": "Tyrosine",
"B": "Valine",
"C": "Leucine",
"D": "Methionine"
} | step1 | A | [
"29 year old female presents",
"family physician concerned",
"blue black discoloration",
"sclera",
"skin",
"notes",
"end",
"day",
"black stains",
"underwear",
"incomplete breakdown",
"following amino acids",
"responsible",
"presentation"
] |
A 35-year-old woman presents as a new patient to a primary care physician. She hasn't seen a doctor in many years and came in for a routine check-up. She has no specific complaints, although she has occasional shortness of breath with mild activity. On physical exam, her vital signs are as follows: HR 80, BP 110/70, RR... | Bleeding from acquired von Willebrand disease | {
"A": "Infective endocarditis",
"B": "Bleeding from acquired von Willebrand disease",
"C": "Cerebral embolism",
"D": "Sudden death"
} | step1 | B | [
"35 year old woman presents",
"new patient",
"primary care physician",
"seen",
"doctor",
"years",
"routine check-up",
"specific complaints",
"occasional shortness of breath",
"mild activity",
"physical exam",
"vital signs",
"follows",
"80",
"BP",
"70",
"RR",
"auscultation",
"lung... |
A 30-year-old woman seeks evaluation at a clinic complaining of shaking, chills, fevers, and headaches for the last 3 days. She recently returned from a trip to India, where she was visiting her family. There is no history of loss of consciousness or respiratory distress. The vital signs include temperature 38.9℃ (102.... | Cerebral edema | {
"A": "Heart block",
"B": "Cerebral edema",
"C": "Aplastic crisis",
"D": "Rheumatoid arthritis"
} | step1 | B | [
"30 year old woman",
"evaluation",
"clinic",
"shaking",
"chills",
"fevers",
"headaches",
"3 days",
"recently returned",
"trip",
"India",
"visiting",
"family",
"history of loss",
"consciousness",
"respiratory distress",
"vital signs include temperature",
"0",
"respiratory rate",
... |
A 13-year-old girl is brought to the physician by her mother because of a 1-year history of worsening clumsiness. Initially, she swayed while walking; over the past 3 months, she has fallen 4 times. Ophthalmic examination shows a horizontal nystagmus. Proprioception and vibratory sensation are decreased in the distal e... | Hammer toes | {
"A": "Telangiectasias",
"B": "Hammer toes",
"C": "Myoclonic jerks",
"D": "Adenoma sebaceum"
} | step1 | B | [
"year old girl",
"brought",
"physician",
"mother",
"year history",
"worsening clumsiness",
"Initially",
"walking",
"past 3 months",
"fallen",
"times",
"Ophthalmic examination shows",
"horizontal nystagmus",
"Proprioception",
"vibratory sensation",
"decreased",
"distal extremities",
... |
A 36-year-old man comes to the physician because of a 2-day history of malaise and a painful, pruritic rash on his lower back and thighs. His temperature is 37.8°C (100°F). Physical examination shows the findings in the photograph. Skin scrapings from the thigh grow neutral colonies on MacConkey agar. The colony-produc... | Swimming in pool | {
"A": "Swimming in pool",
"B": "Unprotected sexual intercourse",
"C": "Rose pruning",
"D": "Outdoor camping"
} | step1 | A | [
"36 year old man",
"physician",
"2-day history",
"malaise",
"painful",
"pruritic rash",
"lower back",
"thighs",
"temperature",
"Physical examination shows",
"findings",
"photograph",
"Skin scrapings",
"thigh",
"neutral colonies",
"MacConkey agar",
"colony",
"bacteria",
"oxidase p... |
A 2-month-old baby boy and his mother present to his pediatrician for vaccination as per the immunization schedule. His mother denies any active complaints but mentions that he has not smiled yet. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. His mother received minimal prenatal care. On phys... | Acute megakaryoblastic leukemia | {
"A": "Acute megakaryoblastic leukemia",
"B": "Celiac disease",
"C": "Congenital cataracts",
"D": "Endocardial cushion defect"
} | step1 | A | [
"2 month old baby boy",
"mother present",
"pediatrician",
"vaccination",
"immunization schedule",
"mother denies",
"active complaints",
"not smiled",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"mother received minimal prenatal care",
"physical examination",
"stable... |
A 28-year-old woman presents to the emergency department with fever, cough, and difficulty in breathing for the last 6 hours. She also mentions that she noticed some blood in her sputum an hour ago. She denies nasal congestion or discharge, sneezing, wheezing, chest pain, or palpitation. Her past history does not sugge... | History of surgery within the last 30 days | {
"A": "Use of oral contraceptives within last 90 days",
"B": "History of travel of 2 hours in 30 days",
"C": "History of surgery within the last 30 days",
"D": "History of smoking for more than 1 year"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"fever",
"cough",
"difficulty",
"breathing",
"last",
"hours",
"blood",
"sputum",
"hour",
"denies nasal congestion",
"discharge",
"sneezing",
"wheezing",
"chest pain",
"palpitation",
"past history",
"not suggest",
"chronic medic... |
A 62-year-old man comes to the physician because of a 5-day history of swelling in his left arm. Two months ago, he was diagnosed with a deep venous thrombosis in the left calf. He has had a 7-kg (15-lb) weight loss in the last 3 months. He has smoked 1 pack of cigarettes daily for the past 25 years. His only medicatio... | CT scan of the abdomen | {
"A": "X-ray of the chest",
"B": "CT scan of the abdomen",
"C": "Serum antiphospholipid antibody level",
"D": "Serum D-dimer level"
} | step1 | B | [
"62 year old man",
"physician",
"5-day history",
"swelling",
"left arm",
"Two months",
"diagnosed",
"deep venous thrombosis",
"left calf",
"kg",
"weight loss",
"months",
"smoked 1 pack",
"cigarettes daily",
"past",
"years",
"only medication",
"warfarin",
"Physical examination sho... |
A 24-day-old infant girl is brought to the emergency department because of a 2-hour history of fever, vomiting, and diarrhea. She has fed less and has had decreased urine output for 1 day. She was born at 33 weeks' gestation and weighed 1400-g (3-lb 1-oz). Her diet consists of breast milk and cow milk protein-based for... | Necrotizing enterocolitis | {
"A": "Meckel diverticululum",
"B": "Cow milk protein allergy",
"C": "Hirschsprung disease",
"D": "Necrotizing enterocolitis"
} | step1 | D | [
"day old infant girl",
"brought",
"emergency department",
"2-hour history",
"fever",
"vomiting",
"diarrhea",
"fed less",
"decreased urine output",
"1 day",
"born",
"weeks",
"gestation",
"g",
"1 oz",
"diet consists",
"breast milk",
"cow milk protein based formula",
"Examination sh... |
A previously healthy 42-year-old woman comes to the physician because of a 7-month history of diffuse weakness. There is no cervical or axillary lymphadenopathy. Cardiopulmonary and abdominal examination shows no abnormalities. A lateral x-ray of the chest shows an anterior mediastinal mass. Further evaluation of this ... | Acetylcholine receptor antibodies | {
"A": "Acetylcholine receptor antibodies",
"B": "Elevated serum alpha-fetoprotein level",
"C": "History of fever, night sweats, and weight loss",
"D": "Increased urinary catecholamines"
} | step1 | A | [
"healthy",
"year old woman",
"physician",
"month history",
"diffuse weakness",
"cervical",
"axillary lymphadenopathy",
"Cardiopulmonary",
"abdominal examination shows",
"abnormalities",
"lateral x-ray of",
"chest shows",
"anterior mediastinal mass",
"Further evaluation of",
"patient",
... |
A 17-year-old patient presents to the emergency department with left wrist pain after falling off of his bike and landing on his left hand. On physical exam the thenar eminence is red, swollen, and tender to palpation, so a radiograph is ordered. The patient is worried because he learned in biology class that radiograp... | Strand breakage | {
"A": "Thymidine dimer formation",
"B": "Microsatellite instability",
"C": "Strand breakage",
"D": "Cyclobutane pyrimidine dimer formation"
} | step1 | C | [
"year old patient presents",
"emergency department",
"left",
"falling",
"bike",
"landing",
"left hand",
"physical exam",
"thenar eminence",
"red",
"swollen",
"tender",
"palpation",
"radiograph",
"ordered",
"patient",
"worried",
"learned",
"biology class",
"radiography",
"caus... |
A 34-year-old G3P2 presents at 33 weeks gestation with vaginal bleeding that started last night while she was asleep. She denies uterine contractions or abdominal pain. She had a cesarean delivery in her previous pregnancy. She also reports a 10 pack-year smoking history. The vital signs are as follows: blood pressure,... | Partial covering of the internal cervical os by the placental edge | {
"A": "Partial covering of the internal cervical os by the placental edge",
"B": "Retroplacental blood accumulation",
"C": "Placental calcification",
"D": "Cysts on the placental surface"
} | step2&3 | A | [
"year old",
"presents",
"weeks gestation",
"vaginal bleeding",
"started",
"night",
"asleep",
"denies uterine contractions",
"abdominal pain",
"cesarean delivery",
"previous pregnancy",
"reports a 10 pack-year smoking history",
"vital signs",
"follows",
"blood pressure",
"80 mm Hg",
"... |
A group of scientists is conducting an experiment on the human cells involved in the immune response. They genetically modify B cells so they do not express the cluster of differentiation 21 (CD21) on their cell surfaces. The pathogenesis of which of the following organisms would most likely be affected by this genetic... | Epstein-Barr virus (EBV) | {
"A": "Epstein-Barr virus (EBV)",
"B": "Measles virus",
"C": "Human immunodeficiency virus (HIV)",
"D": "Human papillomavirus"
} | step1 | A | [
"A group",
"scientists",
"conducting",
"experiment",
"human cells involved",
"immune response",
"modify B cells",
"not",
"cluster",
"differentiation",
"cell surfaces",
"pathogenesis",
"following organisms",
"most likely",
"affected",
"genetic modification"
] |
A 13-year-old boy is brought to the physician by his parents, who are concerned about recurrent muscle cramps he experiences while playing soccer. The boy has always loved sports and has been playing in a soccer league for the past 3 years. He now complains of severe cramping pain in his legs after intense practice ses... | Carnitine palmitoyltransferase II | {
"A": "Carnitine palmitoyltransferase I",
"B": "Carnitine palmitoyltransferase II",
"C": "Medium-chain acyl-coenzyme A dehydrogenase",
"D": "Reye syndrome"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"parents",
"concerned",
"recurrent muscle cramps",
"experiences",
"playing soccer",
"boy",
"always loved sports",
"playing",
"soccer",
"past",
"years",
"now",
"severe cramping",
"legs",
"intense practice sessions",
"significant medical hist... |
A 40-year-old male presents to his primary care physician for a regularly scheduled check-up. Physical examination reveals nontender cervical lymphadenopathy. A biopsy of the lymph node reveals aggregates of follicular architecture, and cytogenic analysis shows a t(14;18) translocation. The protein most likely responsi... | Inhibits apoptosis | {
"A": "Regulates passage through the cell cycle",
"B": "Activates DNA repair proteins",
"C": "Inhibits apoptosis",
"D": "Regulates cell growth through signal transduction"
} | step1 | C | [
"40 year old male presents",
"primary care physician",
"scheduled check-up",
"Physical examination reveals nontender cervical lymphadenopathy",
"biopsy of",
"lymph node reveals aggregates",
"follicular architecture",
"cytogenic analysis shows a t",
"translocation",
"protein",
"likely responsible... |
A 25-year-old woman comes to the physician for the evaluation of blindness in her right eye that suddenly started 1 hour ago. She has no feeling of pain, pressure, or sensation of a foreign body in the right eye. She has a history of major depressive disorder treated with fluoxetine. The patient attends college and sta... | Conversion disorder | {
"A": "Malingering",
"B": "Retinal detachment",
"C": "Somatic symptom disorder",
"D": "Conversion disorder"
} | step2&3 | D | [
"year old woman",
"physician",
"evaluation",
"blindness",
"right eye",
"started 1 hour",
"feeling",
"pain",
"pressure",
"sensation of",
"foreign body",
"right eye",
"history of major depressive disorder treated with fluoxetine",
"patient attends college",
"states",
"lot",
"stress",
... |
A 52-year-old woman presents to the clinic with several days of vomiting and diarrhea. She also complains of headaches, muscle aches, and fever, but denies tenesmus, urgency, and bloody diarrhea. Past medical history is insignificant. When asked about any recent travel she says that she just came back from a cruise shi... | Norovirus infection | {
"A": "Giardiasis",
"B": "C. difficile colitis",
"C": "Irritable bowel syndrome",
"D": "Norovirus infection"
} | step2&3 | D | [
"year old woman presents",
"clinic",
"several days",
"vomiting",
"diarrhea",
"headaches",
"muscle aches",
"fever",
"denies tenesmus",
"urgency",
"bloody diarrhea",
"Past medical history",
"recent travel",
"back",
"ship vacation",
"temperature",
"98",
"F",
"respiratory rate",
"m... |
A 34-year-old female presents to the emergency room with headache and palpitations. She is sweating profusely and appears tremulous on exam. Vital signs are as follows: HR 120, BP 190/110, RR 18, O2 99% on room air, and Temp 37C. Urinary metanephrines and catechols are positive. Which of the following medical regimens ... | Propranolol | {
"A": "Phenoxybenzamine",
"B": "Nitroprusside",
"C": "Propranolol",
"D": "Labetalol"
} | step1 | C | [
"year old female presents",
"emergency room",
"headache",
"palpitations",
"sweating",
"appears tremulous",
"exam",
"Vital signs",
"follows",
"BP",
"RR",
"O2 99",
"room air",
"Temp",
"Urinary metanephrines",
"catechols",
"positive",
"following medical regimens",
"contraindicated",... |
A 9-year-old boy is brought to the physician for evaluation of short stature. He is at the 5th percentile for height, 65th percentile for weight, and 95th percentile for head circumference. Examination shows midface retrusion, a bulging forehead, and flattening of the nose. The extremities are disproportionately short.... | Complete penetrance | {
"A": "Anticipation",
"B": "Imprinting",
"C": "Complete penetrance",
"D": "Codominance"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"evaluation",
"short stature",
"5th percentile",
"height",
"percentile",
"weight",
"95th percentile",
"head",
"Examination shows midface retrusion",
"bulging forehead",
"flattening",
"nose",
"extremities",
"short",
"adopted",
"not",
"biol... |
A 33-year-old woman comes to the physician for week-long episodes of headaches that have occurred every four weeks for the last year. During these episodes she also has bouts of lower abdominal pain and breast tenderness. She is often irritable at these times. Her menses occur at regular 28-day intervals with moderate ... | Maintaining a menstrual diary | {
"A": "Therapeutic trial with nicotine gum",
"B": "Assessment of thyroid hormones",
"C": "Serial measurements of gonadotropin levels",
"D": "Maintaining a menstrual diary"
} | step2&3 | D | [
"year old woman",
"physician",
"week long episodes of headaches",
"occurred",
"four weeks",
"year",
"episodes",
"bouts",
"lower abdominal pain",
"breast tenderness",
"often irritable",
"times",
"menses occur",
"regular",
"day intervals",
"moderate flow",
"last menstrual period",
"3... |
A 51-year-old woman presents for her annual wellness visit. She says she feels healthy and has no specific concerns. Past medical history is significant for bipolar disorder, hypertension, and diabetes mellitus type 2, managed with lithium, lisinopril, and metformin, respectively. Her family history is significant for ... | Follow-up mammogram in 6 months | {
"A": "Follow-up mammogram in 1 year",
"B": "Follow-up mammogram in 6 months",
"C": "Biopsy",
"D": "Treatment"
} | step2&3 | B | [
"year old woman presents",
"annual wellness visit",
"feels healthy",
"specific concerns",
"Past medical history",
"significant",
"bipolar disorder",
"hypertension",
"diabetes mellitus type 2",
"managed",
"lithium",
"lisinopril",
"metformin",
"family history",
"significant",
"hypertensi... |
A 37-year-old woman comes to the physician because of right-sided inguinal pain for the past 8 weeks. During this period, the patient has had increased pain during activities such as walking and standing. She has no nausea, vomiting, or fever. Her temperature is 36.8°C (98.2°F), pulse is 73/min, and blood pressure is 1... | Indirect inguinal hernia | {
"A": "Lipoma",
"B": "Indirect inguinal hernia",
"C": "Inguinal lymphadenopathy",
"D": "Strangulated hernia"
} | step2&3 | B | [
"year old woman",
"physician",
"of right-sided inguinal pain",
"past",
"weeks",
"period",
"patient",
"increased pain",
"activities",
"walking",
"standing",
"nausea",
"vomiting",
"fever",
"temperature",
"36",
"98",
"pulse",
"min",
"blood pressure",
"80 mm Hg",
"abdomen",
"... |
A 45-year-old man presents to the emergency department with decreased exercise tolerance and shortness of breath which has progressed slowly over the past month. The patient recalls that shortly before the onset of these symptoms, he had a low-grade fever, malaise, and sore throat which resolved after a few days with o... | Observation and anti-inflammatory medicines | {
"A": "Pericardiocentesis",
"B": "Surgical drainage",
"C": "Pericardiectomy",
"D": "Observation and anti-inflammatory medicines"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"decreased exercise tolerance",
"shortness of breath",
"progressed slowly",
"past month",
"patient recalls",
"onset",
"symptoms",
"low-grade fever",
"malaise",
"sore throat",
"resolved",
"days",
"over the counter medications",
"not",
"... |
A 5-year-old boy is brought to the physician for excessive weight gain. The mother reports that her son has been “chubby” since he was a toddler and that he has gained 10 kg (22 lbs) over the last year. During this period, he fractured his left arm twice from falling on the playground. He had cryptorchidism requiring o... | Growth hormone and testosterone | {
"A": "Fluoxetine",
"B": "Laparoscopic gastric banding",
"C": "Growth hormone and testosterone",
"D": "Levothyroxine"
} | step2&3 | C | [
"5 year old boy",
"brought",
"physician",
"excessive weight gain",
"mother reports",
"son",
"chubby",
"toddler",
"gained 10 kg",
"lbs",
"last year",
"period",
"fractured",
"left arm twice",
"falling",
"playground",
"cryptorchidism",
"orchiopexy",
"age",
"able to follow 1 step i... |
A 40-year-old man comes to the physician because of a 2-year history of gradually worsening shortness of breath. He smoked half a pack of cigarettes daily for 10 years but stopped 8 years ago. His pulse is 72/min, blood pressure is 135/75 mm Hg, and respirations are 20/min. Examination shows an increased anteroposterio... | Hepatocellular carcinoma | {
"A": "Antineutrophil cytoplasmic antibody-positive vasculitis",
"B": "Hepatocellular carcinoma",
"C": "Bronchiolitis obliterans",
"D": "IgA nephropathy"
} | step2&3 | B | [
"40 year old man",
"physician",
"2 year history",
"worsening shortness of breath",
"smoked half",
"pack",
"cigarettes daily",
"10 years",
"stopped",
"years",
"pulse",
"72 min",
"blood pressure",
"75 mm Hg",
"respirations",
"20 min",
"Examination shows",
"increased anteroposterior d... |
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