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 3-year-old boy presents to an urgent care clinic with his mother. She states that his behavior has been lethargic for the past 3 days. She also notes that he has had a runny nose, mild cough, and sore throat during this time. She does not believe that he has been febrile. His temperature is 99.1°F (37.2°C), blood pre... | Single-stranded, positive-sense RNA | {
"A": "Single-stranded, positive-sense RNA",
"B": "Single-stranded, negative-sense RNA",
"C": "Double-stranded RNA",
"D": "Double-stranded DNA"
} | step1 | A | [
"3 year old boy presents",
"urgent care clinic",
"mother",
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"behavior",
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"past 3 days",
"notes",
"runny nose",
"mild cough",
"sore throat",
"time",
"not",
"febrile",
"temperature",
"99",
"blood pressure",
"67 mmHg",
"pulse",
"100 min",
"respirations",
"... |
A 26-year-old male with no significant past medical history goes camping with several friends in Virginia. Several days after returning, he begins to experience fevers, headaches, myalgias, and malaise. He also notices a rash on his wrists and ankles (FIgure A). Which of following should be initiated for treatment of h... | Doxycycline | {
"A": "Pyrazinamide",
"B": "Vancomycin",
"C": "Azithromycin",
"D": "Doxycycline"
} | step2&3 | D | [
"year old male",
"significant past medical history goes camping",
"several friends",
"Virginia",
"days",
"returning",
"begins to experience fevers",
"headaches",
"myalgias",
"malaise",
"rash",
"wrists",
"ankles",
"following",
"initiated",
"treatment",
"condition"
] |
An obese 63-year-old man comes to the physician because of 3 episodes of red urine over the past week. He has also had recurrent headaches and intermittent blurry vision during the past month. He has benign prostatic hyperplasia. He works as an attendant at a gas station. The patient has smoked one pack of cigarettes d... | Renal cell carcinoma | {
"A": "Nephrolithiasis",
"B": "Transitional cell bladder carcinoma",
"C": "Renal oncocytoma",
"D": "Renal cell carcinoma"
} | step2&3 | D | [
"obese 63 year old man",
"physician",
"of 3 episodes",
"red urine",
"past week",
"recurrent headaches",
"intermittent blurry vision",
"past month",
"benign prostatic hyperplasia",
"works",
"attendant",
"gas station",
"patient",
"smoked one pack",
"cigarettes daily",
"last 40 years",
... |
A 24-year-old man presents to the emergency department after a suicide attempt. He is admitted to the hospital and diagnosed with schizoaffective disorder. A review of medical records reveals a history of illicit drug use, particularly cocaine and amphetamines. He is started on aripiprazole, paroxetine, and trazodone. ... | Add propranolol | {
"A": "Add lithium",
"B": "Add propranolol",
"C": "Increase the aripiprazole dose",
"D": "Stop paroxetine"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"suicide attempt",
"admitted",
"hospital",
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"schizoaffective disorder",
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"medical records reveals",
"history",
"illicit drug use",
"cocaine",
"amphetamines",
"started",
"aripiprazole",
"paroxetine",
"trazodone",
... |
A 55-year-old man visits the clinic with his wife. He has had difficulty swallowing solid foods for the past 2 months. His wife adds that his voice is getting hoarse but they thought it was due to his recent flu. His medical history is significant for type 2 diabetes mellitus for which he is on metformin. He suffered f... | Left atrium | {
"A": "Left ventricle",
"B": "Left atrium",
"C": "Right ventricle",
"D": "Patent ductus arteriosus"
} | step1 | B | [
"55 year old man visits",
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"due to",
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"medical history",
"significant",
"type 2 diabetes mellitus",
"metformin",
"suffered",
"childhood diseases d... |
A 2-year-old boy is brought to the physician for generalized fatigue and multiple episodes of abdominal pain and vomiting for the past week. His last bowel movement was 4 days ago. He has been having behavioral problems at home for the past few weeks as well. He can walk up stairs with support and build a tower of 3 bl... | Succimer and calcium disodium edetate | {
"A": "Succimer and calcium disodium edetate",
"B": "Thiosulfate and hydroxocobalamin",
"C": "Penicillamine",
"D": "Iron"
} | step2&3 | A | [
"2 year old boy",
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"physician",
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"multiple episodes of abdominal pain",
"vomiting",
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"4 days",
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"support",
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"us... |
A 74-year-old man presents to the emergency department by paramedics for slurred speech and weakness in the left arm and leg for 1 hour. The patient was playing with his grandson when the symptoms started and his wife immediately called an ambulance. There is no history of head trauma or recent surgery. The patient tak... | Systolic blood pressure of 200 mm Hg | {
"A": "Creatinine level of 1.3 mg/dL",
"B": "Cholesterol level of 240 mg/dL",
"C": "Systolic blood pressure of 200 mm Hg",
"D": "Age of 74 years"
} | step1 | C | [
"74 year old man presents",
"emergency department",
"paramedics",
"slurred speech",
"weakness",
"left",
"leg",
"hour",
"patient",
"playing",
"grandson",
"symptoms started",
"wife immediately called",
"ambulance",
"history",
"head trauma",
"recent surgery",
"patient takes captopril"... |
A 33-year-old African American woman presents to the office complaining of blurry vision and headache for the past 2 weeks. She states that she has not been feeling herself lately and also fell down once after a dizzy episode. Her medical history is remarkable for hypertension and pulmonary sarcoidosis treated with hyd... | Methylprednisolone and methotrexate | {
"A": "Methotrexate",
"B": "Methylprednisolone and methotrexate",
"C": "Heparin",
"D": "Plasmapheresis"
} | step2&3 | B | [
"year old African American woman presents",
"office",
"blurry vision",
"headache",
"past 2 weeks",
"states",
"not",
"feeling",
"fell",
"dizzy episode",
"medical history",
"hypertension",
"pulmonary sarcoidosis treated with hydralazine",
"prednisone",
"recent bout",
"acute optic neuriti... |
A 54-year-old man comes to the emergency department because of episodic palpitations for the past 12 hours. He has no chest pain. He has coronary artery disease and type 2 diabetes mellitus. His current medications include aspirin, insulin, and atorvastatin. His pulse is 155/min and blood pressure is 116/77 mm Hg. Phys... | Chronic interstitial pneumonitis | {
"A": "Hepatic adenoma",
"B": "Shortened QT interval on ECG",
"C": "Chronic interstitial pneumonitis",
"D": "Angle-closure glaucoma"
} | step2&3 | C | [
"54 year old man",
"emergency department",
"of palpitations",
"past 12 hours",
"chest pain",
"coronary artery disease",
"type 2 diabetes mellitus",
"current medications include aspirin",
"insulin",
"atorvastatin",
"pulse",
"min",
"blood pressure",
"mm Hg",
"Physical examination shows",
... |
A 24-year-old woman is brought to the hospital by her mother because she has "not been herself" for the past 3 months. The patient says she hears voices in her head. The mother said that when she is talking to her daughter she can’t seem to make out what she is saying; it is as if her thoughts are disorganized. When ta... | Schizophreniform disorder | {
"A": "Major depressive disorder",
"B": "Brief psychotic disorder",
"C": "Schizotypal disorder",
"D": "Schizophreniform disorder"
} | step1 | D | [
"year old woman",
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"hospital",
"mother",
"not",
"past 3 months",
"patient",
"hears voices",
"head",
"mother",
"talking",
"daughter",
"cant",
"to make out",
"thoughts",
"talking",
"patient",
"lack of energy",
"apathetic affect",
"following",
"most likely diagnosis",
... |
A 4-year-old girl is brought to the emergency department by her parents because of a painful rash of her hands and lower arms. According to the mother, she developed blisters and redness on her arms 2 days ago. Both parents claim there is no recent history of fever, itching, or trauma. Physical examination shows erythe... | Notify Child Protective Services | {
"A": "Notify Child Protective Services",
"B": "Ask both parents to leave the examination room to perform a forensic interview of the child",
"C": "Talk to both parents individually",
"D": "Obtain a biopsy specimen of the skin lesions for histopathological examination\n\""
} | step1 | A | [
"4 year old girl",
"brought",
"emergency department",
"parents",
"painful rash",
"hands",
"lower arms",
"mother",
"blisters",
"redness",
"arms 2 days",
"parents",
"recent history",
"fever",
"itching",
"trauma",
"Physical examination shows erythema",
"multiple fluid filled bullae",
... |
A 53-year-old man is brought to the emergency department for confusion. He was in his usual state of health until about 3 hours ago when he tried to use his sandwich to turn off the TV. He also complained to his wife that he had a severe headache. Past medical history is notable for hypertension, which has been difficu... | MRI of the brain | {
"A": "CT angiography of the brain",
"B": "CT angiography of the neck",
"C": "Lumbar puncture",
"D": "MRI of the brain"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"confusion",
"usual state of health",
"about",
"hours",
"to use",
"sandwich",
"turn",
"TV",
"wife",
"severe headache",
"Past medical history",
"notable",
"hypertension",
"difficult",
"control",
"multiple medications",
"temperat... |
A 66-year-old man is brought into the emergency department by his daughter for a change in behavior. Yesterday the patient seemed more confused than usual and was asking the same questions repetitively. His symptoms have not improved over the past 24 hours, thus the decision to bring him in today. Last year, the patien... | Vascular dementia | {
"A": "Normal aging",
"B": "Alzheimer's dementia",
"C": "Lewy body dementia",
"D": "Vascular dementia"
} | step2&3 | D | [
"66 year old man",
"brought",
"emergency department",
"daughter",
"change",
"behavior",
"patient",
"more confused",
"usual",
"same questions",
"symptoms",
"not improved",
"past 24 hours",
"decision to",
"today",
"Last year",
"patient",
"almost completely independent",
"then suffe... |
A 33-year-old woman presents to her primary care physician for a wellness check-up. She states that recently she has been feeling well other than headaches that occur occasionally, which improve with ibuprofen and rest. She has a past medical history of hypertension and headaches and is currently taking hydrochlorothia... | Primary hyperaldosteronism | {
"A": "Cushing syndrome",
"B": "Narrowing of the renal arteries",
"C": "Pheochromocytoma",
"D": "Primary hyperaldosteronism"
} | step2&3 | D | [
"year old woman presents",
"primary care physician",
"wellness check-up",
"states",
"recently",
"feeling well",
"headaches",
"occur occasionally",
"ibuprofen",
"rest",
"past medical",
"headaches",
"currently taking hydrochlorothiazide",
"temperature",
"99",
"3C",
"blood pressure",
... |
A 42-year-old man is brought to the physician 25 minutes after an episode of violent jerky movements of his hands and legs that lasted for 5 minutes. After the episode, he had difficulty conversing. For the past 10 days, he has had a left-sided headache and nausea. Apart from a history of recurrent ear infections treat... | Aspiration and surgical drainage | {
"A": "Ciprofloxacin and metronidazole therapy",
"B": "Aspiration and surgical drainage",
"C": "Albendazole therapy",
"D": "Pyrimethamine and sulfadiazine therapy\n\""
} | step2&3 | B | [
"year old man",
"brought",
"physician",
"minutes",
"episode of violent jerky movements",
"hands",
"legs",
"lasted",
"5 minutes",
"episode",
"difficulty",
"past 10 days",
"left-sided headache",
"nausea",
"history",
"recurrent ear infections treated with antibiotics",
"reports",
"per... |
A 12-year-old girl is brought to the physician by her mother because of high fever and left ankle and knee joint swelling. She had a sore throat 3 weeks ago. There is no family history of serious illness. Her immunizations are up-to-date. She had an episode of breathlessness and generalized rash when she received diclo... | Clarithromycin | {
"A": "Clarithromycin",
"B": "High-dose glucocorticoids",
"C": "Amoxicillin",
"D": "Methotrexate"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"mother",
"high",
"left ankle",
"knee",
"sore throat",
"weeks",
"family history",
"serious illness",
"immunizations",
"date",
"episode of breathlessness",
"generalized rash",
"received dicloxacillin",
"skin infection",
"years",
"appears il... |
A 58-year-old woman with HIV infection is brought to the emergency department because of a 2-week history of headaches, blurred vision, and confusion. Her current medications include antiretroviral therapy and trimethoprim-sulfamethoxazole. Neurological examination shows ataxia and memory impairment. Her CD4+ T-lymphoc... | Primary cerebral lymphoma | {
"A": "AIDS dementia",
"B": "Cerebral toxoplasmosis",
"C": "Primary cerebral lymphoma",
"D": "Progressive multifocal leukoencephalopathy"
} | step1 | C | [
"58 year old woman",
"HIV infection",
"brought",
"emergency department",
"of",
"2-week history",
"headaches",
"blurred vision",
"confusion",
"current medications include antiretroviral therapy",
"trimethoprim-sulfamethoxazole",
"Neurological examination shows ataxia",
"memory impairment",
... |
A 19-year-old man presents to a psychiatrist for the management of substance abuse. He reports that he started using the substance 2 years ago and that he smokes it after sprinkling it on his cigarette. He describes that after smoking the substance, he feels excited and as if he does not belong to himself. He also repo... | Nystagmus | {
"A": "Nystagmus",
"B": "Generalized hypotonia",
"C": "Increased sensitivity to pain",
"D": "Excessive perspiration"
} | step2&3 | A | [
"year old man presents",
"psychiatrist",
"management of substance abuse",
"reports",
"started using",
"substance",
"years",
"smokes",
"sprinkling",
"cigarette",
"smoking",
"substance",
"feels excited",
"not",
"reports",
"room",
"sees vivid colors",
"walls",
"using",
"substance"... |
An experimental infusable drug, X729, is currently being studied to determine its pharmacokinetics. The drug was found to have a half life of 1.5 hours and is eliminated by first order kinetics. What is the minimum number of hours required to reach a steady state concentration of >90%? | 6 | {
"A": "1.5",
"B": "4.5",
"C": "6",
"D": "7.5"
} | step1 | C | [
"experimental",
"drug",
"currently",
"studied to",
"pharmacokinetics",
"drug",
"found to",
"half life",
"hours",
"eliminated",
"first order kinetics",
"minimum number",
"hours required to reach",
"steady state concentration",
"90"
] |
A 67-year-old man comes to the physician for a follow-up examination. He feels well. His last visit to a physician was 3 years ago. He has chronic obstructive pulmonary disease, coronary artery disease, and hypertension. Current medications include albuterol, atenolol, lisinopril, and aspirin. He has smoked one pack of... | Abdominal ultrasonography | {
"A": "Pulmonary function testing",
"B": "Abdominal ultrasonography",
"C": "CT scan of the chest",
"D": "Bone densitometry scan"
} | step2&3 | B | [
"67 year old man",
"physician",
"follow-up examination",
"feels well",
"last visit",
"physician",
"3 years",
"chronic obstructive pulmonary disease",
"coronary artery disease",
"hypertension",
"Current medications include albuterol",
"atenolol",
"lisinopril",
"aspirin",
"smoked one pack"... |
A 72-year-old retired shipyard worker received a chest x-ray as part of a routine medical work-up. The radiologist reported incidental findings suggestive of an occupational lung disease. Which of the following descriptions is most consistent with this patient's film? | Fibrocalcific parietal pleural plaques on the diaphragm | {
"A": "Enlarged hilar lymph nodes",
"B": "Fibrocalcific parietal pleural plaques on the diaphragm",
"C": "Hyperinflated lungs with a loss of lung markings",
"D": "Nodular calcium lesions in the apex of the lung"
} | step1 | B | [
"72 year old retired",
"worker received",
"chest x-ray",
"part of",
"routine medical work-up",
"radiologist reported incidental findings suggestive of",
"occupational lung disease",
"following descriptions",
"most consistent with",
"patient's film"
] |
A 32-year-old man presents to the clinic with a dull low back pain radiating to the buttocks. He first noted it about 2 years ago and it has; progressed since then. He notes that it is worse in the morning and improves later in the day after physical activity. The patient also reports morning stiffness lasting up to 30... | HLA-B27 | {
"A": "HLA-DQ2",
"B": "HLA-B47",
"C": "HLA-B27",
"D": "HLA-DR3"
} | step1 | C | [
"year old man presents",
"clinic",
"dull low back pain radiating to",
"buttocks",
"first noted",
"about",
"years",
"progressed since then",
"notes",
"worse",
"morning",
"improves later",
"day",
"physical activity",
"patient",
"reports morning stiffness",
"30 minutes",
"blurred visi... |
A 60-year-old man who was admitted for a fractured hip and is awaiting surgery presents with acute onset altered mental status. The patient is noted by the nurses to be shouting and screaming profanities and has already pulled out his IV and urine catheter. He says he believes he is being kept against his will and does... | Administer an Antipsychotic | {
"A": "Administer an Antipsychotic",
"B": "Repair the fractured hip",
"C": "Change his medication",
"D": "Order 24-hour restraints"
} | step2&3 | A | [
"60 year old man",
"admitted",
"fractured hip",
"surgery presents",
"acute onset altered mental status",
"patient",
"noted",
"nurses to",
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"screaming profanities",
"pulled out",
"IV",
"urine catheter",
"kept",
"not recall falling",
"fracturing",
"hip",
"patient",
"rest... |
A 34-year-old woman comes to the physician for evaluation of a breast lump she noticed 2 days ago while showering. She has no history of major illness. Her mother died of ovarian cancer at age 38, and her sister was diagnosed with breast cancer at age 33. Examination shows a 1.5-cm, nontender, mobile mass in the upper ... | Repair of double-stranded DNA breaks | {
"A": "Activity of cytoplasmic tyrosine kinase",
"B": "Arrest of cell cycle in G1 phase",
"C": "Repair of double-stranded DNA breaks",
"D": "Inhibition of programmed cell death"
} | step1 | C | [
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"physician",
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"2 days",
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"major illness",
"mother died of ovarian cancer",
"age",
"sister",
"diagnosed",
"breast cancer",
"age",
"Examination shows",
"nontender",
"mobile mass",
"the upper outer quadrant of",
"b... |
A 9-month-old boy is brought to the physician because of abnormal crawling and inability to sit without support. A 2nd-trimester urinary tract infection that required antibiotic use and a spontaneous preterm birth via vaginal delivery at 36 weeks’ gestation both complicated the mother’s pregnancy. Physical examination ... | Antenatal injury | {
"A": "Antenatal injury",
"B": "Genetic defect",
"C": "Intrapartum asphyxia",
"D": "Preterm birth"
} | step2&3 | A | [
"month old boy",
"brought",
"physician",
"abnormal crawling",
"to sit",
"support",
"2nd-trimester urinary tract infection",
"required antibiotic use",
"spontaneous",
"vaginal delivery",
"36 weeks gestation",
"complicated",
"mothers pregnancy",
"Physical shows",
"scissoring posture",
"l... |
A 69-year-old man is brought to the emergency room by his wife 30 minutes after losing consciousness while they were working in their garden together. The patient says that time seemed to slow down, his vision went dark, and he had a sensation of falling. After 3–5 seconds, he awoke slightly disoriented but quickly reg... | A slow-rising and delayed upstroke of the carotid pulse | {
"A": "A slow-rising and delayed upstroke of the carotid pulse",
"B": "Distant heart sounds",
"C": "Increased capillary pulsations of the fingertips",
"D": "A carotid biphasic pulse"
} | step1 | A | [
"69 year old man",
"brought",
"emergency room",
"wife 30 minutes",
"consciousness",
"working",
"garden together",
"patient",
"time",
"slow down",
"vision",
"dark",
"sensation of falling",
"35 seconds",
"awoke slightly disoriented",
"regained",
"baseline mental status",
"patient",
... |
A 69-year-old man comes to the physician because of a 1-week history of blood in the urine and fatigue. He also has had a 5.0-kg (11-lb) weight loss during the past month. Physical examination shows pallor and cachexia. A nontender right flank mass is palpated. A CT scan of the chest, abdomen, and pelvis shows a 5-cm r... | VHL gene deletion | {
"A": "NF1 gene inactivation",
"B": "VHL gene deletion",
"C": "TSC1 gene insertion",
"D": "WT1 gene deletion"
} | step1 | B | [
"69 year old man",
"physician",
"1-week history",
"blood",
"urine",
"fatigue",
"5 0 kg",
"weight loss",
"past month",
"Physical examination shows pallor",
"cachexia",
"nontender right",
"palpated",
"CT scan of",
"chest",
"abdomen",
"pelvis shows",
"5",
"right renal",
"several p... |
A 72-year-old man is brought to the emergency department by his daughter because he was found to have decreased alertness that has gotten progressively worse. Three weeks ago he was diagnosed with an infection and given an antibiotic, though his daughter does not remember what drug was prescribed. His medical history i... | Overdiuresis by thiazides | {
"A": "Allergic reaction to antibiotic",
"B": "Forgetting to take tamsulosin",
"C": "Overdiuresis by thiazides",
"D": "Toxic reaction to antibiotic"
} | step1 | C | [
"72 year old man",
"brought",
"emergency department",
"daughter",
"found to",
"decreased alertness",
"gotten",
"worse",
"Three weeks",
"diagnosed",
"infection",
"given",
"antibiotic",
"daughter",
"not remember",
"drug",
"prescribed",
"medical history",
"significant",
"benign pr... |
Steroid hormone synthesis, lipid synthesis, and chemical detoxification are activities of which of the following? | Smooth Endoplasmic Reticulum | {
"A": "Golgi bodies",
"B": "Peroxisomes",
"C": "Smooth Endoplasmic Reticulum",
"D": "Nucleolus"
} | step1 | C | [
"Steroid hormone synthesis",
"lipid synthesis",
"chemical detoxification",
"activities"
] |
A 60-year-old woman presents to the emergency department due to progressive shortness of breath and a dry cough for the past week. She notes that her symptoms are exacerbated by physical activity and relieved by rest. The woman was diagnosed with chronic kidney disease 2 years ago and was recently started on regular di... | Pleural effusion | {
"A": "Primary spontaneous pneumothorax (PSP)",
"B": "Pleural effusion",
"C": "Pulmonary tuberculosis (TB)",
"D": "Acute bronchitis"
} | step1 | B | [
"60 year old woman presents",
"emergency department due to progressive shortness of breath",
"dry cough",
"past week",
"notes",
"symptoms",
"exacerbated",
"physical activity",
"relieved by rest",
"woman",
"diagnosed",
"chronic kidney disease",
"years",
"recently started",
"regular dialys... |
A 22-year-old female is brought to the emergency department by her roommate with a one day history of fever and malaise. She did not feel well after class the previous night and has been in her room since then. She has not been eating or drinking due to severe nausea. Her roommate checked on her one hour ago and was al... | Ceftriaxone | {
"A": "Ceftriaxone",
"B": "Rifampin",
"C": "Acyclovir",
"D": "Dexamethasone"
} | step1 | A | [
"year old female",
"brought",
"emergency department",
"roommate",
"one day history",
"fever",
"malaise",
"not feel well",
"class",
"previous night",
"room",
"then",
"not",
"eating",
"drinking due to severe nausea",
"roommate checked",
"one hour",
"alarmed to find",
"fever",
"ph... |
A 65-year-old man is brought to the emergency department because of a fall that occurred while he was taking a shower earlier that morning. His wife heard him fall and entered the bathroom to find all four of his extremities twitching. The episode lasted approximately 30 seconds. He was unsure of what had happened and ... | Meningioma | {
"A": "Glioblastoma multiforme",
"B": "Schwannoma",
"C": "Hemangioblastoma",
"D": "Meningioma"
} | step2&3 | D | [
"65 year old man",
"brought",
"emergency department",
"fall",
"occurred",
"taking",
"shower earlier",
"morning",
"wife heard",
"fall",
"entered",
"bathroom to find",
"four",
"extremities twitching",
"episode lasted approximately 30 seconds",
"unsure",
"happened",
"unable to answer ... |
A 48-year-old woman comes to the physician because of a 6-month history of excessive fatigue and a 1-month history of progressively increasing generalized pruritus. She has hypothyroidism, for which she receives thyroid replacement therapy. Physical examination shows jaundice. The liver is palpated 4 cm below the right... | Destruction of intrahepatic bile ducts | {
"A": "Idiopathic hepatocellular accumulation of fat",
"B": "Neoplasia of the ampulla of Vater",
"C": "Destruction of intrahepatic bile ducts",
"D": "Inflammation and fibrosis of the biliary tree"
} | step1 | C | [
"48 year old woman",
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"Physical examination shows jaundice",
"liver",
"palpated 4 cm",
"right costal margin",
"Serum studies show",
"direc... |
A 53-year-old woman presents to her primary care physician with joint pain. She reports a 6-month history of progressive pain in her hands that is worse around her knuckles. The pain is symmetric bilaterally and seems to improve after she starts working in the morning at her job in a local grocery store. She has also l... | HLA-DR4 | {
"A": "HLA-B27",
"B": "HLA-DR2",
"C": "HLA-DR3",
"D": "HLA-DR4"
} | step1 | D | [
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... |
A 3100-g (6.9-lb) male newborn is brought to the emergency department by his mother because of fever and irritability. The newborn was delivered at home 15 hours ago. He was born at 39 weeks' gestation. The mother's last prenatal visit was at the beginning of the first trimester. She received all standard immunizations... | Streptococcus agalactiae | {
"A": "Clostridium botulinum",
"B": "Staphylococcus epidermidis",
"C": "Neisseria meningitidis",
"D": "Streptococcus agalactiae"
} | step2&3 | D | [
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A 10-year-old boy is brought in by his parents with increasing breathlessness. He was diagnosed with asthma about 2 years ago and has been on treatment since then. He was initially observed to have breathlessness, cough and chest tightness 2 or 3 times a week. He would wake up once or twice a month in the nighttime wit... | 65% | {
"A": "40%",
"B": "55%",
"C": "65%",
"D": "90%"
} | step2&3 | C | [
"A 10 year old boy",
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A 17-year-old girl is brought to the physician by her mother because she has not had her menstrual period yet. At birth, she had ambiguous genitalia. The mother reports that during the pregnancy she had noticed abnormal hair growth on her chin. A year ago, the girl broke her distal radius after a minor trauma. She is a... | Aromatase deficiency | {
"A": "Aromatase deficiency",
"B": "Kallmann syndrome",
"C": "Congenital adrenal hyperplasia",
"D": "Mullerian agenesis"
} | step1 | A | [
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"minor trauma",
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A 56-year-old woman is referred to a plastic surgeon for breast reconstruction approximately 18 months after undergoing right modified radical mastectomy for breast cancer. Physical exam demonstrates atrophy of the lower lateral pectoralis major muscle. Damage to which of the following nerves during mastectomy is the m... | Medial pectoral | {
"A": "Long thoracic",
"B": "Intercostobrachial",
"C": "Medial pectoral",
"D": "Lateral pectoral"
} | step1 | C | [
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] |
A 4-year-old boy is brought to the physician in December for episodic shortness of breath and a nonproductive cough for 3 months. These episodes frequently occur before sleeping, and he occasionally wakes up because of difficulty breathing. His mother also reports that he became short of breath while playing with his f... | Asthma | {
"A": "Asthma",
"B": "Cardiac failure",
"C": "Primary ciliary dyskinesia",
"D": "Tracheomalacia"
} | step2&3 | A | [
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An investigator is studying membranous transport proteins in striated muscle fibers of an experimental animal. An electrode is inserted into the gluteus maximus muscle and a low voltage current is applied. In response to this, calcium is released from the sarcoplasmic reticulum of the muscle fibers and binds to troponi... | Uptake of fructose by small intestinal enterocytes | {
"A": "Reabsorption of glucose by renal tubular cells",
"B": "Secretion of doxorubicin from dysplastic colonic cells",
"C": "Uptake of fructose by small intestinal enterocytes",
"D": "Absorption of LDL-cholesterol by hepatocytes"
} | step1 | C | [
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"troponin C",
"results",... |
A 5-year-old boy is brought to the emergency room lapsing in and out of consciousness. The mother reports that 30 minutes ago, the young boy was found exiting the garage severely confused. A container of freshly spilled antifreeze was found on the garage floor. The next appropriate step would be to administer: | Fomepizole | {
"A": "Dimercaprol",
"B": "N-acetylcysteine",
"C": "Flumazenil",
"D": "Fomepizole"
} | step1 | D | [
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"garage severely confused",
"container",
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"found on",
"garage floor",
"next appropriate step",
"administer"
] |
A 39-year-old man comes to the emergency department because of a 2-day history of fever, chills, dyspnea, and a non-bloody productive cough. He was diagnosed with HIV infection 4 years ago and has been on highly active antiretroviral therapy since then. His temperature is 38.8°C (101.8°F). Examination shows crackles ov... | Polysaccharide capsule | {
"A": "M protein",
"B": "Type III secretion system",
"C": "Polysaccharide capsule",
"D": "Protein A"
} | step1 | C | [
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"highly active antiretroviral therapy",
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"Examination shows crackles",
"left lower lung base",
"CD4",
"ly... |
A 38-year-old woman, gravida 3, para 2, at 12 weeks' gestation comes to her obstetrician for a prenatal visit. Screening tests in the first trimester showed a decreased level of pregnancy-associated plasma protein and an increased level of β-hCG. A genetic disorder is suspected. Which of the following results from an a... | Additional chromosome in placental tissue | {
"A": "Additional chromosome in placental tissue",
"B": "Decreased estriol in maternal serum",
"C": "Triploidy in amniotic fluid",
"D": "Decreased inhibin A in maternal serum"
} | step1 | A | [
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"increased level",
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"suspected",
"following results",
"additi... |
A 82-year-old woman is brought to the emergency department from a retirement community after she was found down during the evening. On presentation, she complains that she experienced several hours of nausea, vomiting, crampy abdominal pain, and diarrhea prior to blacking out. She said that she cannot recall any factor... | Synthesis of small nucleolar RNA | {
"A": "Synthesis of 5S ribosomal RNA",
"B": "Synthesis of small nucleolar RNA",
"C": "Synthesis of small ribosomal RNA",
"D": "Synthesis of transfer RNA"
} | step1 | B | [
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"recalls",
"f... |
A 6-month-old boy presents with decreased growth, pigmented retinopathy, hemolytic anemia, and peripheral neuropathy. You suspect that these signs are the result of a vitamin deficiency leading to increased fatty acid oxidation. Which of the following is most likely responsible for this patient's symptoms? | Abetalipoproteinemia | {
"A": "Pernicious anemia",
"B": "Abetalipoproteinemia",
"C": "Hartnup disease",
"D": "Excessive boiling of formula"
} | step1 | B | [
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"result of a vitamin deficiency leading",
"increased fatty acid oxidation",
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A 2-year-old boy is brought to the emergency department after his mother noticed maroon-colored stools in his diaper. He has not had any diarrhea or vomiting. The prenatal and birth histories are unremarkable, and he has had no recent trauma. He tolerates solid foods well. The vital signs include: temperature 37.0℃ (98... | Technetium-99m pertechnetate scan | {
"A": "Stool culture and leukocytes",
"B": "Elimination of cow’s milk from the diet",
"C": "Technetium-99m pertechnetate scan",
"D": "Abdominal ultrasound"
} | step2&3 | C | [
"2 year old boy",
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"emergency department",
"mother",
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"solid foods well",
"vital signs include",
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"98",
"blood pressure 90... |
A 14-year-old boy presents to his pediatrician with weakness and frequent episodes of dizziness. He had chronic mucocutaneous candidiasis when he was 4 years old and was diagnosed with autoimmune hypoparathyroidism at age 8. On physical examination, his blood pressure is 118/70 mm Hg in the supine position and 96/64 mm... | Negative selection | {
"A": "Positive selection",
"B": "Negative selection",
"C": "Inhibition of the inactivation of harmful lymphocytes by regulatory T cells",
"D": "Deletion of mature lymphocytes"
} | step1 | B | [
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"physical examination",
"blood pressure",
"70 mm Hg",
"supine position",
"96 64 mm Hg",
"upright... |
A 71-year old man is brought to the emergency department because of progressively worsening shortness of breath and fatigue for 3 days. During the last month, he has also noticed dark colored urine. He had an upper respiratory infection 6 weeks ago. He underwent a cholecystectomy at the age of 30 years. He has hyperten... | Aortic valve replacement | {
"A": "Administration of hydroxyurea",
"B": "Supplementation with iron",
"C": "Aortic valve replacement",
"D": "Discontinuation of medication\n\""
} | step2&3 | C | [
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"30 years",
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"hyperlipidemia",
"type 2 diabetes mellitus",
... |
A 62-year-old man with gastroesophageal reflux disease and osteoarthritis is brought to the emergency department because of a 1-hour history of severe, stabbing epigastric pain. For the last 6 months, he has had progressively worsening right knee pain, for which he takes ibuprofen several times a day. He has smoked hal... | Left shoulder | {
"A": "Left shoulder",
"B": "Umbilicus",
"C": "Left jaw",
"D": "Right groin"
} | step1 | A | [
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A 57-year-old woman comes to the physician because of a 2-week history of swelling of both her feet. It improves a little bit with elevation but is still bothersome to her because her shoes no longer fit. She has type 2 diabetes mellitus treated with metformin and linagliptin. She was diagnosed with hypertension 6 mont... | Addition of enalapril | {
"A": "Addition of enalapril",
"B": "Addition of furosemide",
"C": "Use of compression stockings",
"D": "Use of nifedipine instead"
} | step2&3 | A | [
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"amlodipine",
"Subsequ... |
A 50-year-old woman comes to the physician for the evaluation of excessive hair growth on her chin over the past 2 weeks. She also reports progressive enlargement of her gums. Three months ago, she underwent a liver transplantation due to Wilson disease. Following the procedure, the patient was started on transplant re... | Cyclosporine | {
"A": "Daclizumab",
"B": "Cyclosporine",
"C": "Tacrolimus",
"D": "Methotrexate"
} | step2&3 | B | [
"50 year old woman",
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"... |
A 24-year-old man presents to the clinic with the complaint of a new rash. The lesions are not bothersome, but he is worried as he has never seen anything like this on his body. Upon further questioning the patient states has been generally healthy except for a one time "horrible" flu-like episode two months ago in Jun... | Molluscum contagiosum virus | {
"A": "Staphylococcus aureus cellulitis",
"B": "Molluscum contagiosum virus",
"C": "Human papilloma virus (HPV)",
"D": "Varicella zoster virus (VZV)"
} | step2&3 | B | [
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An HIV-positive 48-year-old man comes to the emergency department because of a 3-month history of recurrent, painful mouth ulcers. This time, the pain is so severe that the patient cannot eat. He has a history of a seizure disorder but currently does not take any medications. He appears very ill. His temperature is 39.... | Cidofovir | {
"A": "Acyclovir",
"B": "Cidofovir",
"C": "Ganciclovir",
"D": "Famciclovir"
} | step1 | B | [
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A 28-year-old woman presents to an outpatient clinic for a routine gynecologic examination. She is concerned about some swelling on the right side of her vagina. She senses that the right side is larger than the left and complains that sometimes that area itches and there is a dull ache. She denies any recent travel or... | Bartholin duct cyst | {
"A": "Condylomata acuminata",
"B": "Bartholin duct cyst",
"C": "Vulvar hematoma",
"D": "Squamous cell carcinoma"
} | step2&3 | B | [
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"dull ache",
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"trauma",
"sexually acti... |
A 64-year-old woman presents to the physician’s office to find out the results of her recent abdominal CT. She had been complaining of fatigue, weight loss, and jaundice for 6 months prior to seeing the physician. The patient has a significant medical history of hypothyroidism, generalized anxiety disorder, and hyperli... | Set aside an appropriate amount of time in your schedule, and ensure you will not have any interruptions as you explain the bad news to the patient | {
"A": "Set aside an appropriate amount of time in your schedule, and ensure you will not have any interruptions as you explain the bad news to the patient",
"B": "Ask that a spouse or close relative come to the appointment, explain to them the bad news, and see if they will tell the patient since they have a close... | step2&3 | A | [
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"significant medical",
"generalized anxiety disorder",
"hyperlipidemia",
"takes levothyroxine",
"sertraline... |
An investigator studying DNA replication in Campylobacter jejuni inoculates a strain of this organism into a growth medium that contains radiolabeled thymine. After 2 hours, the rate of incorporation of radiolabeled thymine is measured as a proxy for the rate of DNA replication. The cells are then collected by centrifu... | Primase | {
"A": "Telomerase",
"B": "DNA polymerase I",
"C": "Ligase",
"D": "Primase"
} | step1 | D | [
"investigator studying DNA replication",
"Campylobacter jejuni inoculates",
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"cells",
"then collected",
"... |
A 22-year-old woman presents to the emergency department feeling lightheaded and states that her heart is racing. She does not have a history of any chronic medical conditions. She is a college sophomore and plays club volleyball. Although she feels stressed about her upcoming final exams next week, she limits her caff... | Verapamil | {
"A": "Procainamide",
"B": "Verapamil",
"C": "Ablation",
"D": "Amlodipine"
} | step2&3 | B | [
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"g... |
A 13-year-old boy is brought to the physician because of a 4-month history of worsening dizziness, nausea, and feeling clumsy. An MRI of the brain shows a well-demarcated, 4-cm cystic mass in the posterior fossa. The patient undergoes complete surgical resection of the mass. Pathologic examination of the surgical speci... | Pilocytic astrocytoma | {
"A": "Medulloblastoma",
"B": "Pilocytic astrocytoma",
"C": "Craniopharyngioma",
"D": "Pinealoma"
} | step1 | B | [
"year old boy",
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"patient",
"complete surgical",
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"specimen shows parallel",
"cells",
"... |
A 45-year-old man comes to the physician for a 2-day history of headache and breathlessness on exertion. During the same period, he has vomited twice and not passed urine. He also reports pain and stiffness in his fingers that has worsened progressively over the past 2 years. He has no history of serious illness and ta... | Decreased serum haptoglobin levels | {
"A": "Increased anticentromere antibody titers",
"B": "Decreased serum haptoglobin levels",
"C": "Increased total iron binding capacity",
"D": "Increased anti-CCP antibody titers\n\""
} | step2&3 | B | [
"year old man",
"physician",
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"breathlessness on exertion",
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"vomited twice",
"not passed urine",
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"years",
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"serious illness",
"takes",
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"not smoke",
"dri... |
A 62-year-old woman presents to the emergency department complaining of fever, worsening fatigue, and muscle weakness for the previous 48 hours. The patient describes her muscle weakness as symmetric and worse in the upper limbs. Her past medical history is significant for long-standing diabetes type 2 complicated by s... | Administer IV calcium gluconate | {
"A": "Administer IV calcium gluconate",
"B": "Order a stat serum potassium level",
"C": "Administer regular insulin and 50% dextrose in water",
"D": "Administer IV sodium bicarbonate"
} | step2&3 | A | [
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"previous 48 hours",
"patient",
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"symmetric",
"worse",
"upper limbs",
"past medical history",
"significant",
"long standing diabetes type 2 complicated",
"stage 5 chro... |
A 71-year-old man with recently diagnosed small-cell lung cancer sees his physician because of increasing weakness over the past 3 months. He is unable to climb stairs or comb his hair. His weakness is worse after inactivity and improves with exercise. He is a former smoker with a 30-pack-year history. He is currently ... | Autoantibody-impaired acetylcholine release from nerve terminals | {
"A": "Acute autoimmune demyelination of axons",
"B": "Autoantibody-impaired acetylcholine release from nerve terminals",
"C": "Endomysial CD8+ T cell infiltration with vacuoles and inclusion bodies",
"D": "Necrotizing vasculitis with granuloma formation"
} | step2&3 | B | [
"71 year old man",
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"unable to climb stairs",
"comb",
"hair",
"weakness",
"worse",
"inactivity",
"improves",
"exercise",
"former smoker",
"30 pack-year history",
"currently preparing",... |
A 68-year-old man is brought to the emergency department for increasing colicky lower abdominal pain and distention for 4 days. He has nausea. He has not passed flatus for the past 2 days. His last bowel movement was 4 days ago. He has hypertension, type 2 diabetes mellitus, and left hemiplegia due to a cerebral infarc... | Endoscopic detorsion | {
"A": "Endoscopic detorsion",
"B": "Intravenous antibiotic therapy",
"C": "Colonoscopy",
"D": "Rectal tube insertion"
} | step2&3 | A | [
"68 year old man",
"brought",
"emergency department",
"increasing colicky lower abdominal pain",
"distention",
"4 days",
"nausea",
"not passed flatus",
"past 2 days",
"last bowel movement",
"4 days",
"hypertension",
"type 2 diabetes mellitus",
"left hemiplegia due to",
"cerebral infarcti... |
A 27-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the emergency department in active labor. She received all of her prenatal care for this pregnancy. Pregnancy and delivery of her first child were uncomplicated. The patient's blood type is Rh-negative. Four hours after arrival, a healthy 3650-g (8... | Perform rosette test | {
"A": "Perform flow cytometry",
"B": "Perform rosette test",
"C": "Perform Kleihauer-Betke test",
"D": "Perform Coombs test"
} | step2&3 | B | [
"27 year old woman",
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"para 1",
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"active labor",
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"prenatal care",
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"Pregnancy",
"delivery",
"first child",
"uncomplicated",
"patient's blood",
"Rh-negative",
"Four hours",
"arrival",
"healthy",
"g"... |
A 5-year-old boy is brought to the emergency department because of a generalized pruritic rash for 14 hours. Five days ago, he had pink eyes that resolved spontaneously. He has acute lymphoblastic leukemia. He has received 3 cycles of chemotherapy with vincristine, asparaginase, dexamethasone, and doxorubicin. His last... | Acyclovir administration | {
"A": "Immunoglobulin administration",
"B": "Symptomatic therapy",
"C": "Acyclovir administration",
"D": "Penicillin V administration"
} | step2&3 | C | [
"5 year old boy",
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"of",
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"Five",
"pink eyes",
"resolved",
"acute lymphoblastic leukemia",
"received 3 cycles",
"chemotherapy",
"vincristine",
"asparaginase",
"dexamethasone",
"doxorubicin",
"last treatment cycle"... |
A 17-year-old adolescent male is brought to the emergency department by fire and rescue after being struck by a moving vehicle. The patient reports that he was running through his neighborhood when a car struck him while turning right on a red light. He denies any loss of consciousness. His temperature is 99.0°F (37.2°... | Focused Abdominal Sonography for Trauma (FAST) exam | {
"A": "Focused Abdominal Sonography for Trauma (FAST) exam",
"B": "Diagnostic peritoneal lavage",
"C": "Diagnostic laparoscopy",
"D": "Emergency laparotomy"
} | step2&3 | A | [
"year old adolescent male",
"brought",
"emergency department",
"fire",
"struck by",
"moving vehicle",
"patient reports",
"running",
"neighborhood",
"car struck",
"turning right",
"red light",
"denies",
"loss of consciousness",
"temperature",
"99",
"blood pressure",
"88",
"mmHg",
... |
An investigator is examining tissue samples from various muscle tissue throughout the body. She notices that biopsies collected from a specific site have a high concentration of sarcoplasmic reticulum, mitochondria, and myoglobin; they also stain poorly for ATPase. Additionally, the cell surface membranes of the myocyt... | Semispinalis muscle | {
"A": "Ventricular myocardium",
"B": "Semispinalis muscle",
"C": "Glandular myoepithelium",
"D": "Lateral rectus muscle"
} | step1 | B | [
"investigator",
"examining tissue",
"various muscle",
"body",
"biopsies collected",
"specific site",
"high concentration",
"sarcoplasmic reticulum",
"mitochondria",
"myoglobin",
"stain poorly",
"ATPase",
"cell surface membranes of",
"myocytes",
"specimen lack voltage-gated calcium channe... |
A 36-year-old woman comes to the physician for a 2-month history of urinary incontinence and a vaginal mass. She has a history of five full-term normal vaginal deliveries. She gave birth to a healthy newborn 2-months ago. Since then she has felt a sensation of vaginal fullness and a firm mass in the lower vagina. She h... | Uterosacral ligament | {
"A": "Infundibulopelvic ligament",
"B": "Uterosacral ligament",
"C": "Cardinal ligament of the uterus",
"D": "Round ligament of uterus"
} | step1 | B | [
"36 year old woman",
"physician",
"2 month history of urinary incontinence",
"vaginal mass",
"history of five full-term normal vaginal deliveries",
"gave birth",
"healthy newborn",
"months",
"then",
"felt",
"sensation",
"vaginal fullness",
"firm mass",
"lower vagina",
"loss",
"urine",
... |
A 23-year-old woman presents to the emergency department with an acute exacerbation of her 3-month history of low back and right leg pain. She says she has had similar symptoms in the past, but this time the pain was so excruciating, it took her breath away. She describes the pain as severe, shock-like, and localized t... | Gastrocnemius/soleus-tibial nerve | {
"A": "Tibialis posterior-tibial nerve",
"B": "Sartorius-femoral nerve",
"C": "Adductors-obturator nerve",
"D": "Gastrocnemius/soleus-tibial nerve"
} | step1 | D | [
"23 year old woman presents",
"emergency department",
"acute exacerbation of",
"month history",
"low back",
"right leg pain",
"similar symptoms",
"past",
"time",
"pain",
"so excruciating",
"took",
"breath away",
"pain",
"severe",
"shock",
"localized",
"lower back",
"radiating str... |
A 36-year-old man comes to the physician because of a 2-week history of productive cough, weight loss, and intermittent fever. He recently returned from a 6-month medical deployment to Indonesia. He appears tired. Physical examination shows nontender, enlarged, palpable cervical lymph nodes. An x-ray of the chest shows... | Inform the local public health department of the diagnosis | {
"A": "Inform the local public health department of the diagnosis",
"B": "Request the patient's permission to discuss the diagnosis with an infectious disease specialist",
"C": "Assure the patient that his diagnosis will remain confidential",
"D": "Confirm the diagnosis with a sputum culture"
} | step2&3 | A | [
"36 year old man",
"physician",
"2-week history",
"productive cough",
"weight loss",
"intermittent fever",
"recently returned",
"month medical deployment",
"Indonesia",
"appears tired",
"Physical examination shows nontender",
"enlarged",
"palpable cervical lymph nodes",
"x-ray of",
"ches... |
A 32-year-old African American woman presents to her family physician complaining of fevers, fatigue, weight loss, joint pains, night sweats and a rash on her face that extends over the bridge of her nose. She has also had multiple sores in her mouth over the past few weeks. She recently had a root canal procedure done... | Immune complex deposition and subsequent inflammation | {
"A": "Bacteremia secondary to a recent dental procedure",
"B": "Bacteremia secondary to a urinary tract infection",
"C": "Immune complex deposition and subsequent inflammation",
"D": "Left atrial mass causing a ball valve-type outflow obstruction"
} | step1 | C | [
"year old African American woman presents",
"family physician",
"fevers",
"fatigue",
"weight loss",
"joint pains",
"night sweats",
"rash",
"face",
"extends",
"bridge of",
"nose",
"multiple sores",
"mouth",
"past",
"weeks",
"recently",
"root canal procedure done",
"complications",... |
A 38-year-old woman comes to the physician for a follow-up examination. Two years ago, she was diagnosed with multiple sclerosis. Three weeks ago, she was admitted and treated for right lower leg weakness with high-dose methylprednisone for 5 days. She has had 4 exacerbations over the past 6 months. Current medications... | Progressive multifocal leukoencephalopathy | {
"A": "Progressive multifocal leukoencephalopathy",
"B": "Parkinsonism",
"C": "Tuberculosis",
"D": "Aplastic anemia"
} | step2&3 | A | [
"year old woman",
"physician",
"follow-up examination",
"Two years",
"diagnosed",
"multiple sclerosis",
"Three weeks",
"admitted",
"treated",
"right lower leg weakness",
"high-dose methylprednisone",
"5 days",
"4 exacerbations",
"past 6 months",
"Current medications include interferon be... |
A 2-day-old male newborn is brought to the emergency department by his mother because of irritability and vomiting for two hours. During this period, he has vomited bilious fluid three times. He has not yet passed stool. The mother has breastfed the newborn every two hours. He has wet two diapers during the last two da... | Gastrografin enema | {
"A": "Reassurance and follow-up in 2 weeks",
"B": "Gastrografin enema",
"C": "Exploratory laparotomy",
"D": "Colonoscopy"
} | step2&3 | B | [
"2-day old male newborn",
"brought",
"emergency department",
"mother",
"irritability",
"vomiting",
"two hours",
"period",
"vomited",
"fluid three times",
"not",
"passed stool",
"mother",
"breastfed",
"newborn",
"two hours",
"wet two diapers",
"days",
"born",
"term",
"delivere... |
A 40-year-old woman comes to the physician for the evaluation of fatigue, poor appetite, and an unintentional 10-kg (22-lb) weight loss over the past 6 months. The patient also reports several episodes of nausea and two episodes of non-bloody vomiting. There is no personal or family history of serious illness. Menses o... | Cosyntropin administration
" | {
"A": "TSH measurement",
"B": "Urine aldosterone level measurement",
"C": "Adrenal imaging",
"D": "Cosyntropin administration\n\""
} | step2&3 | D | [
"40 year old woman",
"physician",
"evaluation",
"fatigue",
"poor appetite",
"unintentional 10 kg",
"weight loss",
"past 6 months",
"patient",
"reports several episodes of nausea",
"two episodes of non bloody vomiting",
"personal",
"family history",
"serious illness",
"Menses occur",
"r... |
A 22-year-old Caucasian male is stabbed in his left flank, injuring his left kidney. As the surgeon undertakes operative repair, she reviews relevant renal anatomy. All of the following are correct regarding the left kidney EXCEPT? | The left kidney has a longer renal artery than the right kidney | {
"A": "The left kidney has a longer renal vein than the right kidney",
"B": "The left kidney has a longer renal artery than the right kidney",
"C": "The left kidney lies between T12 and L3",
"D": "The left kidney underlies the left 12th rib"
} | step1 | B | [
"year old Caucasian male",
"stabbed",
"left flank",
"left kidney",
"surgeon",
"operative repair",
"reviews relevant renal anatomy",
"following",
"correct",
"left kidney"
] |
An 82-year-old male with a history of congestive heart failure presented with new-onset atrial fibrillation. He was initially started on carvedilol, but he now requires an additional agent for rate control. He is started on a medicine and is warned by his physician of the following potential side effects associated wit... | Hypokalemia | {
"A": "Hyponatremia",
"B": "Hypokalemia",
"C": "Increased GFR with normal creatinine",
"D": "Hyperkalemia"
} | step1 | B | [
"year old male",
"history of congestive heart failure presented",
"new-onset atrial fibrillation",
"initially started",
"carvedilol",
"now",
"additional agent",
"rate control",
"started",
"medicine",
"warned",
"physician",
"following potential side effects associated with",
"therapy",
"n... |
A 25-year-old woman with a psychiatric history of bipolar disorder is brought into the emergency department by emergency medical services. The patient is unconscious, but the mother states that she walked into the patient's room with the patient lying on the floor and an empty bottle of unknown pills next to her. The p... | Acetaminophen ingestion | {
"A": "Beta-blocker ingestion",
"B": "Acetaminophen ingestion",
"C": "Tricyclic antidepressant ingestion",
"D": "Salicylate ingestion"
} | step2&3 | B | [
"year old woman",
"psychiatric history of bipolar disorder",
"brought",
"emergency department",
"emergency medical services",
"patient",
"unconscious",
"mother states",
"walked",
"patient's room",
"patient lying",
"floor",
"empty bottle",
"unknown pills next to",
"patient",
"to commit ... |
A 25-year-old woman presents into the clinic complaining of worsening malaise, hair loss, and a rash on her face. The patient states that she has been avoiding daylight because the rash becomes painful, and she has not been able to go to classes because of debilitating arthralgia in her fingers and ankles. No significa... | Antinuclear antibody | {
"A": "Anti-smith antibody",
"B": "Anti-histone antibody",
"C": "Anti-Ro antibody",
"D": "Antinuclear antibody"
} | step1 | D | [
"year old woman presents",
"clinic",
"worsening malaise",
"hair loss",
"rash on",
"face",
"patient states",
"rash",
"painful",
"not",
"able to go",
"classes",
"of",
"arthralgia",
"fingers",
"ankles",
"significant past medical history",
"takes",
"medication",
"time",
"consult"... |
A 45-year-old woman presents to your office with a serum glucose of 250 mg/dL and you diagnose diabetes mellitus type II. You intend to prescribe the patient metformin, but you decide to order laboratory tests before proceeding. Which of the following basic metabolic panel values would serve as a contraindication to th... | Creatinine > 2.0 | {
"A": "K+ > 4.0",
"B": "Na+ > 140",
"C": "Glucose > 300",
"D": "Creatinine > 2.0"
} | step1 | D | [
"year old woman presents",
"office",
"serum glucose",
"mg dL",
"diagnose diabetes mellitus type II",
"to",
"patient metformin",
"to order laboratory tests",
"following basic metabolic panel values",
"contraindication",
"use of metformin"
] |
You are reading through a recent article that reports significant decreases in all-cause mortality for patients with malignant melanoma following treatment with a novel biological infusion. Which of the following choices refers to the probability that a study will find a statistically significant difference when one tr... | Power | {
"A": "Type I error",
"B": "Type II error",
"C": "Power",
"D": "p-value"
} | step2&3 | C | [
"reading",
"recent article",
"reports significant decreases",
"cause mortality",
"patients",
"malignant melanoma following treatment",
"novel biological infusion",
"following choices refers",
"probability",
"study",
"find",
"statistically significant difference",
"one",
"exist"
] |
A 17-year-old girl comes to the physician because of a 2-day history of pain in her right knee. Last week she had right wrist pain. She has no history of recent trauma. She returned from summer camp in Connecticut 2 weeks ago. She is sexually active with one male partner and uses an oral contraceptive. Her temperature ... | Disseminated gonococcal infection | {
"A": "Reactive arthritis",
"B": "Staphylococcus aureus arthritis",
"C": "Disseminated gonococcal infection",
"D": "Acute rheumatic fever"
} | step1 | C | [
"year old girl",
"physician",
"2-day history",
"pain",
"right knee",
"week",
"right wrist pain",
"history",
"recent trauma",
"returned",
"summer camp",
"Connecticut",
"weeks",
"sexually active",
"one male partner",
"uses",
"oral contraceptive",
"temperature",
"100 4F",
"Examina... |
A 25-year-old man comes to the physician because of an 8-hour history of painful leg cramping, runny nose, chills, diarrhea, and abdominal pain. Examination shows cool, damp skin with piloerection. The pupils are 7 mm in diameter and equal in size. Deep tendon reflexes are 3+ bilaterally. The diagnosis of opioid withdr... | Long elimination half-life | {
"A": "Low dependence risk",
"B": "Limited potency",
"C": "Long elimination half-life",
"D": "Low tolerance potential"
} | step1 | C | [
"year old man",
"physician",
"8-hour history",
"painful leg",
"runny nose",
"chills",
"diarrhea",
"abdominal pain",
"Examination shows cool",
"damp skin",
"piloerection",
"pupils",
"7 mm",
"diameter",
"equal",
"size",
"Deep tendon reflexes",
"3",
"diagnosis",
"opioid withdrawal... |
A 55-year-old man presents with intense pain in his left knee that started after returning from a camping trip 2 days ago, during which he consumed copious amounts of alcohol and red meat. He says he has had similar episodes in the past that resolved spontaneously usually over a period of about 10 days. His past medica... | Nonsteroidal antiinflammatory drugs | {
"A": "Nonsteroidal antiinflammatory drugs",
"B": "Uricosuric drug",
"C": "Intra-articular steroid injection",
"D": "Xanthine oxidase inhibitor"
} | step2&3 | A | [
"55 year old man presents",
"intense pain",
"left knee",
"started",
"returning",
"camping trip 2 days",
"copious amounts",
"alcohol",
"red meat",
"similar episodes",
"past",
"resolved",
"usually",
"period",
"10 days",
"past medical history",
"significant",
"essential hypertension m... |
A 9-month-old male infant is brought to his pediatrician by his mother with lethargy and decreased oral intake for one day. His mother also mentions that he did not sleep well the previous night. A review of the medical record reveals several missed appointments and that the boy was born at 36 weeks gestation via spont... | Noncontrast computed tomography of head | {
"A": "Hemoglobin electrophoresis",
"B": "Peripheral blood smear",
"C": "Noncontrast computed tomography of head",
"D": "Bone marrow aspiration"
} | step2&3 | C | [
"month old male infant",
"brought",
"pediatrician",
"mother",
"lethargy",
"decreased oral intake",
"one day",
"mother",
"not sleep well",
"previous night",
"review",
"medical record reveals several missed appointments",
"boy",
"born",
"36 weeks gestation",
"spontaneous vaginal delivery... |
A 21-year-old girl with a history of bipolar disorder, now in a depressive episode, presents to the emergency in distress. She reports that she wanted to "end it all" and swallowed a full bottle of acetaminophen. However, regretting what it would do to her parents, and she decided that she wants to live. She appears in... | Give activated charcoal and draw a serum acetaminophen level in three hours | {
"A": "Give activated charcoal and draw a serum acetaminophen level now",
"B": "Give activated charcoal and draw a serum acetaminophen level in three hours",
"C": "Give activated charcoal and test the urine for an acetaminophen level",
"D": "Draw a serum acetaminophen level now"
} | step1 | B | [
"21-year-old girl",
"history of bipolar disorder",
"now",
"depressive episode",
"presents",
"emergency",
"distress",
"reports",
"wanted",
"end",
"swallowed",
"full bottle",
"acetaminophen",
"regretting",
"parents",
"to live",
"appears",
"acute distress",
"states",
"swallowed",
... |
A 7-year-old boy presents to an urgent care clinic from his friend’s birthday party after experiencing trouble breathing. His father explains that the patient had eaten peanut butter at the party, and soon after, he developed facial flushing and began scratching his face and neck. This has never happened before but his... | Type I hypersensitivity reaction | {
"A": "Type I hypersensitivity reaction",
"B": "Type II hypersensitivity reaction",
"C": "Type III hypersensitivity reaction",
"D": "Type IV hypersensitivity reaction"
} | step2&3 | A | [
"year old boy presents",
"urgent care clinic",
"friends",
"party",
"experiencing trouble breathing",
"father",
"patient",
"eaten peanut butter",
"party",
"facial flushing",
"began scratching",
"face",
"neck",
"never happened",
"father",
"peanuts",
"peanut butter",
"past",
"worrie... |
You conduct a medical research study to determine the screening efficacy of a novel serum marker for colon cancer. The study is divided into 2 subsets. In the first, there are 500 patients with colon cancer, of which 450 are found positive for the novel serum marker. In the second arm, there are 500 patients who do not... | 450 / (450 + 50) | {
"A": "450 / (450 + 50)",
"B": "490 / (50 + 490)",
"C": "450 / (450 + 10)",
"D": "490 / (450 + 490)"
} | step2&3 | A | [
"conduct",
"medical to",
"screening efficacy",
"novel serum marker",
"colon cancer",
"study",
"divided",
"subsets",
"first",
"500 patients",
"colon cancer",
"of",
"450",
"found positive",
"novel serum marker",
"second arm",
"500 patients",
"not",
"colon cancer",
"only 10",
"f... |
A 43-year-old man comes to the physician because of weight loss and swelling on the left side of his neck. Physical examination shows a firm, enlarged left upper cervical lymph node that is immobile. Immunohistochemical testing performed on a biopsy specimen from the lymph node stains positive for cytokeratin. Which of... | Skin | {
"A": "Skin",
"B": "Brain",
"C": "Bone",
"D": "Muscle"
} | step1 | A | [
"year old man",
"physician",
"weight loss",
"swelling",
"the left side of",
"neck",
"Physical examination shows",
"firm",
"enlarged left upper cervical lymph node",
"immobile",
"testing performed",
"biopsy specimen",
"lymph node stains positive",
"cytokeratin",
"following",
"most likel... |
A 32-year-old woman presents to the clinic with the complaint of excessive fatigue for the past few weeks. After returning home from the office, she feels too tired to climb up the stairs, comb her hair, or chew her food. She has occasionally experienced double vision. She denies any history of fever, cough, weight los... | Single-fiber electromyography | {
"A": "CT scan chest",
"B": "Plasmapheresis",
"C": "Single-fiber electromyography",
"D": "Tensilon test"
} | step2&3 | C | [
"year old woman presents",
"clinic",
"complaint",
"excessive fatigue",
"past",
"weeks",
"returning home",
"office",
"feels",
"tired",
"climb",
"stairs",
"comb",
"hair",
"chew",
"food",
"occasionally experienced double vision",
"denies",
"history",
"fever",
"cough",
"weight ... |
A 30-month-old toddler presents with his mother to the pediatrician for a scheduled follow-up. She is concerned that his appetite has been poor since the death of his father, approximately one year ago. She denies any history of vomiting, refusal of food, diarrhea, constipation, recurrent cough and colds, recurrent whe... | Present gender-specific weight for age between 75 and 50 percentile markers | {
"A": "Present gender-specific weight for age between 90 and 75 percentile markers",
"B": "Present gender-specific weight for age between 75 and 50 percentile markers",
"C": "Present gender-specific height for age between 90 and 75 percentile markers",
"D": "Present gender-specific weight for height between 90... | step2&3 | B | [
"30 month old toddler presents",
"mother",
"pediatrician",
"scheduled follow-up",
"concerned",
"appetite",
"poor",
"death",
"father",
"approximately one year ago",
"denies",
"history",
"vomiting",
"refusal",
"food",
"diarrhea",
"constipation",
"recurrent cough",
"colds",
"recur... |
A 28-year-old woman presents to her primary care physician complaining of intense thirst and frequent urination for the past 2 weeks. She says that she constantly feels the urge to drink water and is also going to the bathroom to urinate frequently throughout the day and multiple times at night. She was most recently h... | Posterior pituitary | {
"A": "Anterior pituitary",
"B": "Posterior pituitary",
"C": "Preoptic nucleus of the hypothalamus",
"D": "Suprachiasmatic nucleus of the hypothalamus"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"intense thirst",
"frequent urination",
"past 2 weeks",
"constantly feels",
"to drink water",
"bathroom to",
"frequently",
"day",
"multiple times",
"night",
"most recently hospitalized 1 month prior to presentation following",
"motor veh... |
A 28-year-old man presents with one week of redness and discharge in his eyes, pain and swelling in his left second and third toes, and rash on the soles of his feet. He is sexually active with multiple partners and uses condoms occasionally. He denies any recent travel or illness and does not take any medications. Rev... | Nucleic acid amplification testing for Chlamydia trachomatis | {
"A": "Rheumatoid factor",
"B": "Antinuclear antibody assay",
"C": "HLA-B27",
"D": "Nucleic acid amplification testing for Chlamydia trachomatis"
} | step2&3 | D | [
"year old man presents",
"one week",
"redness",
"discharge",
"eyes",
"pain",
"swelling",
"left second",
"third toes",
"rash",
"soles of",
"feet",
"sexually active",
"multiple partners",
"uses condoms occasionally",
"denies",
"recent travel",
"illness",
"not take",
"medications"... |
An 18-year old college freshman presents to his university clinic because he has not been feeling well for the past two weeks. He has had a persistent headache, occasional cough, and chills without rigors. The patient’s vital signs are normal and physical exam is unremarkable. His radiograph shows patchy interstitial l... | Methylation of ribosomal binding site | {
"A": "Presence of a beta-lactamase",
"B": "Insertion of drug efflux pumps",
"C": "Mutation in topoisomerase II",
"D": "Methylation of ribosomal binding site"
} | step1 | D | [
"year old college",
"presents",
"university clinic",
"not",
"feeling well",
"past two weeks",
"persistent headache",
"occasional cough",
"chills",
"rigors",
"patients vital signs",
"normal",
"physical exam",
"unremarkable",
"radiograph shows patchy interstitial lung infiltrates",
"diag... |
A group of researchers is studying various inhaled substances to determine their anesthetic properties. In particular, they are trying to identify an anesthetic with fast onset and quick recovery for use in emergencies. They determine the following data:
Inhalational anesthetic Blood-gas partition coefficient
A 0.15
B... | Agent A has the fastest onset of action | {
"A": "Agent A is the most potent",
"B": "Agent A has the fastest onset of action",
"C": "Agent B is the most potent",
"D": "Agent C has the fastest onset of action"
} | step1 | B | [
"A group",
"researchers",
"studying various inhaled substances to",
"anesthetic properties",
"to",
"anesthetic",
"fast onset",
"quick recovery",
"use",
"emergencies",
"following data",
"Inhalational anesthetic",
"Blood-gas partition coefficient",
"0",
"42",
"following statements",
"a... |
A 14-year-old boy presents to the office for a checkup. He is well-nourished and meets all developmental milestones. He denies any complaints, and you offer him counseling on adolescent issues. On examination, he appears to be a normal, healthy teenager. The only significant finding is the bilateral swelling of the tib... | Osgood-Schlatter disease | {
"A": "Osteopetrosis",
"B": "Paget disease",
"C": "Ewing sarcoma",
"D": "Osgood-Schlatter disease"
} | step1 | D | [
"year old boy presents",
"office",
"checkup",
"well-nourished",
"meets",
"developmental milestones",
"denies",
"complaints",
"counseling",
"adolescent issues",
"examination",
"appears to",
"normal",
"healthy teenager",
"only significant finding",
"bilateral swelling",
"tibial tuberos... |
A 23-year-old female presents to the emergency department with monocular blindness. She states that early this morning she lost her vision seemingly "out of nowhere." She denies trauma or any precipitating factors. She does state though that over the past year she has had occasional episodes of weakness and even an epi... | Oligoclonal bands | {
"A": "Increased opening pressure",
"B": "Oligoclonal bands",
"C": "Albuminocytologic dissociation",
"D": "Increased lymphocyte count"
} | step2&3 | B | [
"23 year old female presents",
"emergency department",
"monocular blindness",
"states",
"early",
"morning",
"lost",
"vision",
"denies trauma",
"precipitating factors",
"state",
"past year",
"occasional episodes of weakness",
"episode of urinary incontinence",
"always resolve",
"exam",
... |
ََA 22-month-old girl is brought to the emergency department with a 24-hour history of fever, irritability, and poor feeding. The patient never experienced such an episode in the past. She met the normal developmental milestones, and her vaccination history is up-to-date. She takes no medications, currently. Her temper... | Renal and bladder ultrasonography | {
"A": "Dimercaptosuccinic acid renal scan",
"B": "Intravenous pyelography",
"C": "Renal and bladder ultrasonography",
"D": "Voiding cystourethrography"
} | step2&3 | C | [
"month old girl",
"brought",
"emergency department",
"hour history",
"fever",
"irritability",
"poor feeding",
"patient never experienced",
"episode",
"past",
"met",
"normal developmental milestones",
"vaccination history",
"date",
"takes",
"medications",
"currently",
"temperature",... |
A 34-year-old woman presents to her primary care physician for a routine check-up. She complains that she is not feeling her normal self, but has no specific complaints. After a routine examination, the physician orders a full thyroid workup, including TSH, T3, and free T4. He also refers her directly to an oncologist ... | Localized painless lymphadenopathy | {
"A": "Generalized painful lymphadenopathy",
"B": "Generalized painless lymphadenopathy",
"C": "Localized painful lymphadenopathy",
"D": "Localized painless lymphadenopathy"
} | step1 | D | [
"year old woman presents",
"primary care physician",
"routine check-up",
"not feeling",
"normal self",
"specific complaints",
"routine examination",
"physician orders",
"full thyroid workup",
"including",
"free T4",
"refers",
"directly",
"oncologist",
"initial consultation",
"type",
... |
A 52-year-old man presents to his primary care physician to discuss laboratory results that were obtained during his annual checkup. He has no symptoms or concerns and denies changes in eating or urination patterns. Specifically, the physician ordered a panel of metabolic laboratory tests to look for signs of diabetes,... | This patient has type 2 diabetes as diagnosed by his oral tolerance blood glucose | {
"A": "This patient does not have type 2 diabetes",
"B": "This patient has type 2 diabetes as diagnosed by his fasting blood glucose",
"C": "This patient has type 2 diabetes as diagnosed by his oral tolerance blood glucose",
"D": "This patient has type 2 diabetes as diagnosed by his random blood glucose"
} | step1 | C | [
"year old man presents",
"primary care physician to discuss laboratory results",
"obtained",
"annual checkup",
"symptoms",
"concerns",
"denies changes",
"eating",
"urination patterns",
"physician ordered",
"panel",
"metabolic laboratory tests to look",
"signs",
"diabetes",
"hyperlipidemi... |
A 35-year-old man is brought to the emergency department from a kitchen fire. The patient was cooking when boiling oil splashed on his exposed skin. His temperature is 99.7°F (37.6°C), blood pressure is 127/82 mmHg, pulse is 120/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has dry, nontend... | Additional fluids and escharotomy | {
"A": "Additional fluids and escharotomy",
"B": "Continuous observation",
"C": "Escharotomy",
"D": "Moist dressings and discharge"
} | step2&3 | A | [
"35 year old man",
"brought",
"emergency department",
"kitchen fire",
"patient",
"cooking",
"boiling oil splashed",
"exposed skin",
"temperature",
"99",
"blood pressure",
"mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"dry",
"nontender",... |
An 8-year-old girl is brought to the physician by her parents for the evaluation of an episode of unconsciousness while at the playground that morning. She was unconscious for about 15 seconds and did not shake, bite her tongue, or lose bowel or bladder control. Her grandfather died suddenly at the age of 29 of an unkn... | Sensorineural hearing loss | {
"A": "Oblique palpebral fissures",
"B": "Sensorineural hearing loss",
"C": "Brachial-femoral pulse delay",
"D": "Subvalvular ventricular outflow obstruction murmur"
} | step1 | B | [
"year old girl",
"brought",
"physician",
"parents",
"evaluation of",
"episode",
"unconsciousness",
"playground",
"morning",
"unconscious",
"seconds",
"not shake",
"bite",
"tongue",
"bowel",
"bladder control",
"grandfather died",
"age",
"29",
"unknown heart condition",
"parent... |
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