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 |
|---|---|---|---|---|---|
Six hours after delivery, a 3050-g (6-lb 12-oz) male newborn is noted to have feeding intolerance and several episodes of bilious vomiting. He was born at term to a healthy 35-year-old woman following a normal vaginal delivery. The pregnancy was uncomplicated, but the patient's mother had missed several of her prenatal... | Duodenal atresia | {
"A": "Necrotizing enterocolitis",
"B": "Duodenal atresia",
"C": "Hirschsprung's disease",
"D": "Meconium ileus"
} | step2&3 | B | [
"Six hours",
"delivery",
"g",
"oz",
"male newborn",
"noted to",
"feeding intolerance",
"several episodes of bilious vomiting",
"born",
"term",
"healthy 35 year old woman following",
"normal vaginal",
"pregnancy",
"uncomplicated",
"patient's mother",
"missed",
"prenatal checkups",
"... |
A researcher is examining the relationship between socioeconomic status and IQ scores. The IQ scores of young American adults have historically been reported to be distributed normally with a mean of 100 and a standard deviation of 15. Initially, the researcher obtains a random sampling of 300 high school students from... | Decrease in standard error of the mean | {
"A": "Decrease in standard deviation",
"B": "Decrease in standard error of the mean",
"C": "Increase in risk of systematic error",
"D": "Increase in probability of type II error"
} | step1 | B | [
"researcher",
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"socioeconomic status",
"scores",
"scores",
"young American adults",
"reported to",
"distributed",
"mean",
"100",
"standard deviation",
"Initially",
"researcher obtains",
"random sampling",
"300 high school students",
"public schools",
"co... |
A 27-year-old male presents to his primary care physician complaining of pain with urination and eye redness. He reports that he developed these symptoms approximately one week ago. He also has noticed left knee and right heel pain that started a few days ago. He denies any recent trauma. He had an episode of abdominal... | HLA-B27 haplotype | {
"A": "HLA-B27 haplotype",
"B": "HLA-DR4 haplotype",
"C": "Anti-cyclic citrullinated peptide (anti-CCP) antibody",
"D": "Anti-centromere antibody"
} | step1 | A | [
"27 year old male presents",
"primary care physician",
"pain",
"urination",
"eye redness",
"reports",
"symptoms approximately one week",
"left knee",
"right",
"started",
"few days",
"denies",
"recent trauma",
"episode of abdominal pain",
"diarrhea ten days",
"resolved",
"felt well",
... |
A 4-year-old boy is brought to the pediatrician by his mother for a routine medical examination. His medical history is relevant for delayed gross motor milestones. The mother is concerned about a growth delay because both of his brothers were twice his size at this age. Physical examination reveals a well-groomed and ... | Fibroblast growth factor receptor 3 | {
"A": "Alpha-1 type I collagen",
"B": "Fibroblast growth factor receptor 3",
"C": "Insulin-like growth factor 1 receptor",
"D": "Runt-related transcription factor 2"
} | step2&3 | B | [
"4 year old boy",
"brought",
"pediatrician",
"mother",
"routine medical examination",
"medical history",
"relevant",
"delayed gross motor milestones",
"mother",
"concerned",
"growth delay",
"brothers",
"twice",
"size",
"age",
"Physical examination reveals",
"well groomed",
"healthy... |
An investigator is studying brachial artery reactivity in women with suspected coronary heart disease. The brachial artery diameter is measured via ultrasound before and after intra-arterial injection of acetylcholine. An increase of 7% in the vascular diameter is noted. The release of which of the following is most li... | Nitric oxide from endothelial cells | {
"A": "Nitric oxide from endothelial cells",
"B": "Endothelin from the peripheral vasculature",
"C": "Serotonin from neuroendocrine cells",
"D": "Norepinephrine from the adrenal medulla"
} | step1 | A | [
"investigator",
"studying brachial artery reactivity",
"women",
"suspected",
"brachial artery diameter",
"measured",
"ultrasound",
"intra-arterial injection",
"acetylcholine",
"increase",
"vascular diameter",
"noted",
"release",
"following",
"most likely responsible",
"observed effect"... |
A 28-year-old female in the 2nd trimester of pregnancy is diagnosed with primary Toxoplasma gondii infection. Her physician fears that the fetus may be infected in utero. Which of the following are associated with T. gondii infection in neonates? | Hydrocephalus, chorioretinitis, intracranial calcifications | {
"A": "Patent ductus arteriosus, cataracts, deafness",
"B": "Hutchinson’s teeth, saddle nose, short maxilla",
"C": "Deafness, seizures, petechial rash",
"D": "Hydrocephalus, chorioretinitis, intracranial calcifications"
} | step1 | D | [
"year old female",
"2nd trimester",
"pregnancy",
"diagnosed",
"primary Toxoplasma gondii infection",
"physician fears",
"fetus",
"infected in utero",
"following",
"associated with",
"infection",
"neonates"
] |
A 62-year-old man comes to the physician because of a swollen and painful right knee for the last 3 days. He has no history of joint disease. His vital signs are within normal limits. Examination shows erythema and swelling of the right knee, with limited range of motion due to pain. Arthrocentesis of the right knee jo... | Calcium pyrophosphate deposition | {
"A": "Calcium pyrophosphate deposition",
"B": "Mechanical stress and trauma",
"C": "Immune complex-mediated cartilage destruction",
"D": "Monosodium urate deposition"
} | step1 | A | [
"62 year old man",
"physician",
"swollen",
"painful right knee",
"3 days",
"history disease",
"vital signs",
"normal limits",
"Examination shows erythema",
"swelling of",
"right knee",
"with limited range of motion due to pain",
"Arthrocentesis",
"right knee joint",
"7 mL",
"cloudy flu... |
A new treatment for hemorrhagic stroke, which is a life-threatening clinical condition that occurs when a diseased blood vessel in the brain ruptures or leaks, was evaluated as soon as it hit the market by an international group of neurology specialists. In those treated with the new drug, a good outcome was achieved i... | 5 | {
"A": "5",
"B": "15",
"C": "20",
"D": "30"
} | step1 | A | [
"new treatment",
"hemorrhagic stroke",
"life-threatening clinical condition",
"occurs",
"blood vessel",
"brain ruptures",
"leaks",
"evaluated",
"hit",
"market",
"international group",
"neurology specialists",
"treated with",
"new drug",
"good outcome",
"30",
"treated with",
"curren... |
A 54-year-old man is brought to the emergency department 1 hour after the sudden onset of shortness of breath, epigastric pain, and sweating. He has no history of similar symptoms. He has hypertension and type 2 diabetes mellitus. Current medications include amlodipine and metformin. He has smoked one pack of cigarette... | Normal saline bolus
" | {
"A": "Intravenous morphine",
"B": "Sublingual nitroglycerin",
"C": "Phenylephrine infusion",
"D": "Normal saline bolus\n\""
} | step2&3 | D | [
"54 year old man",
"brought",
"emergency department",
"hour",
"sudden onset of shortness",
"breath",
"epigastric pain",
"sweating",
"history",
"similar symptoms",
"hypertension",
"type 2 diabetes mellitus",
"Current medications include amlodipine",
"metformin",
"smoked one pack",
"ciga... |
An investigator studying targeted therapy in patients with gastrointestinal stromal tumors requires a reliable test to determine the spatial distribution of CD117-positive cells in biopsy specimens. Which of the following is the most appropriate test? | Immunohistochemistry | {
"A": "Flow cytometry",
"B": "Immunohistochemistry",
"C": "Northern blot",
"D": "Fluorescence in-situ hybridization\n\""
} | step1 | B | [
"investigator studying targeted therapy",
"patients",
"gastrointestinal stromal tumors",
"reliable test to",
"spatial distribution",
"CD117",
"biopsy specimens",
"following",
"most appropriate test"
] |
In an attempt to create other selective dopamine 1 (D1) agonists, a small pharmaceutical company created a cell-based chemical screen that involved three modified receptors - alpha 1 (A1), beta 1 (B1), and D1. In the presence of D1 stimulation, the cell would produce an mRNA that codes for a fluorescent protein; howeve... | Fenoldopam | {
"A": "Bromocriptine",
"B": "Dobutamine",
"C": "Epinephrine",
"D": "Fenoldopam"
} | step1 | D | [
"attempt to create",
"selective dopamine",
"agonists",
"small pharmaceutical created",
"cell based chemical screen",
"involved three modified receptors",
"alpha 1",
"beta",
"D1",
"presence",
"D1 stimulation",
"cell",
"mRNA",
"codes",
"a fluorescent protein",
"A1",
"B1 receptors",
"... |
A 56-year-old woman comes to the physician because of a 2-year-history of intermittent upper abdominal pain that occurs a few hours after meals and occasionally wakes her up in the middle of the night. She reports that the pain is relieved with food intake. Physical examination shows no abnormalities. Endoscopy shows a... | Bicarbonate secretion | {
"A": "Glycoprotein synthesis",
"B": "Antigen presentation",
"C": "Lysozyme secretion",
"D": "Bicarbonate secretion"
} | step1 | D | [
"year old woman",
"physician",
"2 year history",
"intermittent upper",
"occurs",
"few hours after meals",
"occasionally wakes",
"middle",
"night",
"reports",
"pain",
"relieved with food intake",
"Physical examination shows",
"abnormalities",
"Endoscopy shows",
"0",
"ulcer",
"poster... |
The balance between glycolysis and gluconeogenesis is regulated at several steps, and accumulation of one or more products/chemicals can either promote or inhibit one or more enzymes in either pathway. Which of the following molecules if increased in concentration can promote gluconeogenesis? | Acetyl-CoA | {
"A": "AMP",
"B": "Insulin",
"C": "Fructose-2,6-biphosphate",
"D": "Acetyl-CoA"
} | step1 | D | [
"balance",
"glycolysis",
"gluconeogenesis",
"regulated",
"steps",
"accumulation",
"one",
"more products chemicals",
"either promote",
"inhibit one",
"more enzymes",
"pathway",
"following molecules",
"increased",
"concentration",
"promote gluconeogenesis"
] |
A 37-year-old man who had undergone liver transplantation 7 years ago, presents to the physician because of yellowish discoloration of the skin, sclera, and urine. He is on regular immunosuppressive therapy and is well-adherent to the treatment. He has no comorbidities and is not taking any other medication. He provide... | Interstitial cellular infiltration with parenchymal fibrosis, obliterative arteritis | {
"A": "Normal architecture of bile ducts and hepatocytes",
"B": "Broad fibrous septations with formation of micronodules",
"C": "Ballooning degeneration of hepatocytes",
"D": "Interstitial cellular infiltration with parenchymal fibrosis, obliterative arteritis"
} | step2&3 | D | [
"year old man",
"liver transplantation",
"years",
"presents",
"physician",
"of",
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"sclera",
"urine",
"regular immunosuppressive therapy",
"well adherent",
"treatment",
"comorbidities",
"not taking",
"medication",
"provides",
"history of similar episodes",
... |
A 14-year-old girl is brought to the physician after she accidentally cut her right forearm earlier that morning while working with her mother's embroidery scissors. She has no history of serious illness. The mother says she went to elementary and middle school abroad and is not sure if she received all of her childhoo... | Administer Tdap only | {
"A": "Administer DTaP only",
"B": "Intravenous metronidazole",
"C": "Administer Tdap only",
"D": "No further steps are necessary"
} | step2&3 | C | [
"year old girl",
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"physician",
"cut",
"right forearm earlier",
"morning",
"working",
"mother's",
"scissors",
"history",
"serious illness",
"mother",
"elementary",
"middle school",
"not sure",
"received",
"childhood vaccinations",
"appears healthy",
"temperature",
"98"... |
A 27-year-old woman comes to the physician because of a 3-day history of a sore throat and fever. Her temperature is 38.5°C (101.3°F). Examination shows edematous oropharyngeal mucosa and enlarged tonsils with purulent exudate. There is tender cervical lymphadenopathy. If left untreated, which of the following conditio... | Dilated cardiomyopathy | {
"A": "Toxic shock syndrome",
"B": "Polymyalgia rheumatica",
"C": "Dilated cardiomyopathy",
"D": "Erythema multiforme"
} | step1 | C | [
"27 year old woman",
"physician",
"3-day history",
"sore throat",
"fever",
"temperature",
"Examination shows edematous oropharyngeal mucosa",
"enlarged",
"purulent exudate",
"tender cervical lymphadenopathy",
"left untreated",
"following conditions",
"most likely to occur",
"patient"
] |
A 72-year-old man comes to his primary care provider because of double vision and headache. He says these symptoms developed suddenly last night and have not improved. He has had type 2 diabetes mellitus for 32 years and essential hypertension for 19 years for which he takes metformin and lisinopril. His last recorded ... | Oculomotor nerve | {
"A": "Trochlear nerve",
"B": "Oculomotor nerve",
"C": "Abducens nerve",
"D": "Facial nerve"
} | step2&3 | B | [
"72 year old man",
"primary care provider",
"double vision",
"headache",
"symptoms",
"last night",
"not improved",
"type 2 diabetes mellitus",
"years",
"essential hypertension",
"years",
"takes metformin",
"lisinopril",
"last recorded A1c",
"smoked 10",
"cigarettes",
"day",
"past 3... |
A 3-year-old boy is brought to the emergency department with abdominal pain. His father tells the attending physician that his son has been experiencing severe stomach aches over the past week. They are intermittent in nature, but whenever they occur he cries and draws up his knees to his chest. This usually provides s... | Idiopathic | {
"A": "Meckel's diverticulum",
"B": "Gastrointestinal infection",
"C": "Henoch-Schonlein purpura",
"D": "Idiopathic"
} | step2&3 | D | [
"3 year old boy",
"brought",
"emergency department",
"abdominal pain",
"father",
"attending physician",
"son",
"experiencing severe stomach aches",
"past week",
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"nature",
"occur",
"cries",
"draws",
"knees",
"chest",
"usually provides",
"relief",
"parents",
"obse... |
A 51-year-old man presents complaining of decreased vibratory sense in his lower limbs. Physical exam reveals a widened pulse pressure and a decrescendo murmur occurring after the S2 heart sound. After further questioning, he also reports he experienced a maculopapular rash over his trunk, palms and soles many years ag... | Agglutination of antibodies with beef cardiolipin | {
"A": "Agglutination of antibodies with beef cardiolipin",
"B": "Indirect immunofluoresence of the patient’s serum and killed T. palladium",
"C": "Cytoplasmic inclusions on Giemsa stain",
"D": "Agglutination of patients serum with Proteus O antigens"
} | step1 | A | [
"year old man presents",
"decreased vibratory sense",
"lower limbs",
"Physical exam reveals",
"widened pulse pressure",
"decrescendo murmur occurring",
"S2 heart sound",
"further questioning",
"reports",
"experienced",
"maculopapular rash",
"trunk",
"palms",
"soles",
"years",
"resolved... |
A 28-year-old woman comes to the physician for genetic counseling prior to conception. For the past year, she has had intermittent episodes of headache, nausea, abdominal pain, and tingling of her fingers. She also complains of dark urine during the episodes. Her mother and maternal uncle have similar symptoms and her ... | 50% | {
"A": "67%",
"B": "50%",
"C": "25%",
"D": "100%"
} | step1 | B | [
"year old woman",
"physician",
"genetic counseling prior to conception",
"past year",
"intermittent episodes of headache",
"nausea",
"abdominal pain",
"tingling",
"fingers",
"dark urine",
"episodes",
"mother",
"maternal uncle",
"similar symptoms",
"father",
"healthy",
"husband",
"h... |
Three days after undergoing cardiac catheterization and coronary angioplasty for acute myocardial infarction, a 70-year-old man develops shortness of breath at rest. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. His current medications include aspirin, clopidogrel, atorvastatin, sublingual nitrogly... | Papillary muscle rupture | {
"A": "Ventricular septal rupture",
"B": "Postmyocardial infarction syndrome",
"C": "Coronary artery dissection",
"D": "Papillary muscle rupture"
} | step2&3 | D | [
"Three days",
"cardiac catheterization",
"coronary angioplasty",
"acute myocardial infarction",
"70 year old man",
"shortness of breath",
"rest",
"hypertension",
"hyperlipidemia",
"type 2 diabetes mellitus",
"current medications include aspirin",
"clopidogrel",
"atorvastatin",
"sublingual ... |
An investigator is studying the mechanism of HIV infection in cells obtained from a human donor. The effect of a drug that impairs viral fusion and entry is being evaluated. This drug acts on a protein that is cleaved off of a larger glycosylated protein in the endoplasmic reticulum of the host cell. The protein that i... | env | {
"A": "rev",
"B": "gag",
"C": "env",
"D": "tat"
} | step1 | C | [
"investigator",
"studying",
"mechanism",
"HIV infection",
"cells obtained",
"human donor",
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"drug",
"viral fusion",
"entry",
"evaluated",
"drug acts",
"a protein",
"cleaved",
"a larger glycosylated protein",
"endoplasmic reticulum",
"host cell",
"protein",
"affected",... |
A 54-year-old man comes to the physician for a follow-up examination. One week ago, he was treated in the emergency department for chest pain, palpitations, and dyspnea. As part of his regimen, he was started on a medication that irreversibly inhibits the synthesis of thromboxane A2 and prostaglandins. Which of the fol... | Gastrointestinal hemorrhage | {
"A": "Chronic rhinosinusitis",
"B": "Acute interstitial nephritis",
"C": "Tinnitus",
"D": "Gastrointestinal hemorrhage"
} | step1 | D | [
"54 year old man",
"physician",
"follow-up examination",
"One week",
"treated",
"emergency department",
"chest pain",
"palpitations",
"dyspnea",
"part of",
"regimen",
"started",
"medication",
"inhibits",
"synthesis",
"thromboxane A2",
"prostaglandins",
"following",
"most likely a... |
A 66-year-old man undergoes a coronary artery bypass grafting. Upon regaining consciousness, he reports that he cannot see from either eye and cannot move his arms. Physical examination shows bilaterally equal, reactive pupils. A fundoscopy shows no abnormalities. An MRI of the brain shows wedge-shaped cortical infarct... | Systemic hypotension
" | {
"A": "Lipohyalinosis",
"B": "Cardiac embolism",
"C": "Atherothrombosis",
"D": "Systemic hypotension\n\""
} | step1 | D | [
"66 year old man",
"coronary artery bypass grafting",
"regaining consciousness",
"reports",
"see",
"eye",
"move",
"arms",
"Physical examination shows",
"equal",
"reactive pupils",
"fundoscopy shows",
"abnormalities",
"MRI of",
"brain shows wedge-shaped cortical infarcts",
"occipital lo... |
A 74-year-old man presents to the emergency room with abdominal pain. He reports acute onset of left lower quadrant abdominal pain and nausea three hours prior to presentation. The pain is severe, constant, and non-radiating. He has had two maroon-colored bowel movements since the pain started. His past medical history... | Cardiac thromboembolism | {
"A": "Cardiac thromboembolism",
"B": "Duodenal compression",
"C": "Perforated intestinal mucosal herniation",
"D": "Paradoxical thromboembolism"
} | step1 | A | [
"74 year old man presents",
"emergency room",
"abdominal pain",
"reports acute onset",
"left lower quadrant abdominal pain",
"nausea three hours prior to presentation",
"pain",
"severe",
"constant",
"non radiating",
"two maroon colored bowel movements",
"pain started",
"past medical history"... |
A 7-year-old boy is brought to the physician by his father because of a 1-day history of a pruritic rash on his trunk and face. Five days ago, he developed low-grade fever, nausea, and diarrhea. Physical examination shows a lace-like erythematous rash on the trunk and face with circumoral pallor. The agent most likely ... | Erythroid progenitor cells | {
"A": "T lymphocytes",
"B": "Erythroid progenitor cells",
"C": "Sensory neuronal cells",
"D": "Monocytes\n\""
} | step1 | B | [
"year old boy",
"brought",
"physician",
"father",
"1-day history",
"pruritic rash",
"trunk",
"face",
"Five days",
"low-grade fever",
"nausea",
"diarrhea",
"Physical examination shows",
"lace",
"erythematous",
"trunk",
"face",
"circumoral pallor",
"agent",
"likely causing sympto... |
A 43-year-old woman presents to your clinic for the evaluation of an abnormal skin lesion on her forearm. The patient is worried because her mother passed away from melanoma. You believe that the lesion warrants biopsy for further evaluation for possible melanoma. Your patient is concerned about her risk for malignant ... | Depth of invasion of atypical cells | {
"A": "Evolution of lesion over time",
"B": "Age at presentation",
"C": "Depth of invasion of atypical cells",
"D": "Level of irregularity of the borders"
} | step1 | C | [
"year old woman presents",
"clinic",
"evaluation",
"abnormal",
"forearm",
"patient",
"worried",
"mother passed",
"melanoma",
"lesion",
"biopsy",
"further evaluation",
"possible melanoma",
"patient",
"concerned",
"risk",
"malignant disease",
"most important prognostic factor",
"me... |
A 30-year-old woman presents to her physician for her annual checkup. She has diabetes mellitus, type 1 and takes insulin regularly. She reports no incidents of elevated or low blood sugar and that she is feeling energetic and ready to face the morning every day. Her vital signs and physical are normal. On the way home... | Activation of tyrosine kinase | {
"A": "Increased permeability of the cell membrane to positively charged molecules",
"B": "Activation of tyrosine kinase",
"C": "Increased concentration intracellular cAMP",
"D": "Rapid and direct upregulation of enzyme transcription"
} | step1 | B | [
"30 year old woman presents",
"physician",
"annual checkup",
"diabetes mellitus",
"type 1",
"takes insulin",
"reports",
"incidents",
"elevated",
"low blood sugar",
"feeling energetic",
"ready to face",
"morning",
"day",
"vital signs",
"physical",
"normal",
"home",
"checkup",
"s... |
A 14-year-old girl comes to the physician because of excessive flow and duration of her menses. Since menarche a year ago, menses have occurred at irregular intervals and lasted 8–9 days. Her last menstrual period was 5 weeks ago with passage of clots. She has no family or personal history of serious illness and takes ... | Inadequate gonadotropin production | {
"A": "Endometrial polyp",
"B": "Inadequate gonadotropin production",
"C": "Defective von Willebrand factor",
"D": "Excessive androgen production"
} | step2&3 | B | [
"year old girl",
"physician",
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"duration",
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"menarche",
"year",
"menses",
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"irregular intervals",
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"days",
"last menstrual period",
"5 weeks",
"passage",
"clots",
"family",
"personal history",
"serious illness",
"takes",
"medicati... |
A 3-week-old boy is brought to the pediatrician by his parents for a circumcision. The circumcision was uncomplicated; however, after a few hours, the diaper contained blood, and the bleeding has not subsided. A complete blood count was ordered, which was significant for a platelet count of 70,000/mm3. On peripheral bl... | Decreased GpIb | {
"A": "Decreased GpIIb/IIIa",
"B": "Adding epinephrine would not lead to platelet aggregation",
"C": "Responsive to desmopressin",
"D": "Decreased GpIb"
} | step1 | D | [
"3 week old boy",
"brought",
"pediatrician",
"parents",
"circumcision",
"circumcision",
"uncomplicated",
"few hours",
"diaper contained blood",
"bleeding",
"not",
"complete blood count",
"ordered",
"significant",
"platelet count",
"70",
"mm3",
"peripheral blood smear",
"following... |
A 57-year-old man presents to the emergency department with shortness of breath. He was eating dinner with his family during the holidays and felt very short of breath, thus prompting him to come in. The patient has a past medical history of diabetes, hypertension, 2 myocardial infarctions, and obesity. Physical exam i... | Chronic use leads to long-term nephrogenic adaptations | {
"A": "Can lead to respiratory depression",
"B": "Causes venodilation and a decrease in preload",
"C": "Increases cardiac contractility and afterload",
"D": "Chronic use leads to long-term nephrogenic adaptations"
} | step2&3 | D | [
"57 year old man presents",
"emergency department",
"shortness of breath",
"eating dinner",
"family",
"holidays",
"felt very short of breath",
"prompting",
"to",
"patient",
"past medical diabetes",
"hypertension",
"2 myocardial infarctions",
"obesity",
"Physical exam",
"notable",
"bi... |
A 47-year-old woman presents to her physician for difficulty swallowing. She states that she intentionally delayed seeing a physician for this issue. She says her primary issue with swallowing is that her mouth always feels dry so she has difficulty chewing food to the point that it can be swallowed. On physical examin... | Follicular hyperplasia | {
"A": "Follicular hyperplasia",
"B": "Paracortical hyperplasia",
"C": "Diffuse hyperplasia",
"D": "Mixed B and T cell hyperplasia"
} | step1 | A | [
"year old woman presents",
"physician",
"difficulty swallowing",
"states",
"delayed seeing",
"physician",
"issue",
"primary issue",
"swallowing",
"mouth always feels dry so",
"difficulty",
"point",
"swallowed",
"physical examination",
"oral mucosa appears dry",
"eyes",
"appear dry",
... |
A 45-year-old female is admitted to the hospital after worsening headaches for the past month. She has noticed that the headaches are usually generalized, and frequently occur during sleep. She does not have a history of migraines or other types of headaches. Her past medical history is significant for breast cancer, w... | Surgical resection of the mass | {
"A": "Chemotherapy",
"B": "Seizure prophylaxis and palliative pain therapy",
"C": "Irradiation to the brain mass",
"D": "Surgical resection of the mass"
} | step2&3 | D | [
"year old female",
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"past medical history",
"significant",
"breast cancer",
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A 42-year-old woman comes to the physician because of progressive weakness. She has noticed increasing difficulty performing household chores and walking her dog over the past month. Sometimes she feels too fatigued to cook dinner. She has noticed that she feels better after sleeping. She does not have chest pain, shor... | Inhibition of acetylcholinesterase | {
"A": "Inhibition of acetylcholinesterase",
"B": "Stimulation of B2 adrenergic receptors",
"C": "Removing autoantibodies, immune complexes, and cytotoxic constituents from serum",
"D": "Reactivation of acetylcholinesterase"
} | step2&3 | A | [
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An investigator is studying cardiomyocytes in both normal and genetically modified mice. Both the normal and genetically modified mice are observed after aerobic exercise and their heart rates are recorded and compared. After a 10-minute session on a treadmill, the average pulse measured in the normal mice is 680/min, ... | Greater T-tubule density | {
"A": "Greater cardiomyocyte size",
"B": "Greater ratio of heart to body weight",
"C": "Lower number of gap junctions",
"D": "Greater T-tubule density"
} | step1 | D | [
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A 54-year-old man presents to his primary care physician with a 2-month-history of diarrhea. He says that he feels the urge to defecate 3-4 times per day and that his stools have changed in character since the diarrhea began. Specifically, they now float, stick to the side of the toilet bowl, and smell extremely foul. ... | Colipase | {
"A": "Amylase",
"B": "Chymotrypsin",
"C": "Colipase",
"D": "Lipase"
} | step1 | C | [
"54 year old man presents",
"primary care physician",
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"now float",
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"smell extremely",
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"significant",
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A 50-year-old woman comes to the physician because of worsening pain and swelling of her left knee. For the past year, she has had pain in her knees and hands bilaterally, but never this severe. During this period, she has also had difficulties moving around for about an hour in the mornings and has been sweating more ... | Joint space narrowing and bone erosions | {
"A": "Calcifications and osteolysis with moth-eaten appearance",
"B": "Irregularity or fragmentation of the tubercle",
"C": "Calcification of the meniscal and hyaline cartilage",
"D": "Joint space narrowing and bone erosions"
} | step2&3 | D | [
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"usual",
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A 35-year-old woman, gravida 2, para 1, at 16 weeks' gestation comes to the office for a prenatal visit. She reports increased urinary frequency but otherwise feels well. Pregnancy and delivery of her first child were uncomplicated. Her vital signs are within normal limits. Pelvic examination shows a uterus consistent ... | Increased glomerular filtration rate | {
"A": "Decreased insulin production",
"B": "Increased glomerular filtration barrier permeability",
"C": "Decreased insulin sensitivity",
"D": "Increased glomerular filtration rate"
} | step1 | D | [
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"first child",
"uncomplicated",
"vital signs",
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"Pelvic examination shows",
"uterus consistent",... |
A 10-month-old boy is referred to the hospital because of suspected severe pneumonia. During the first month of his life, he had developed upper airway infections, bronchitis, and diarrhea. He has received all the immunizations according to his age. He failed to thrive since the age of 3 months. A month ago, he had a s... | Absent respiratory burst | {
"A": "Absent respiratory burst",
"B": "Leukocyte adhesion molecule deficiency",
"C": "Phagocytosis defect",
"D": "Lysosomal trafficking defect"
} | step1 | A | [
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"failed to thrive",
"age",
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"month",
"severe lung infection",
"cough",
... |
A 74-year-old man presents to the physician with a painful lesion over his right lower limb which began 2 days ago. He says that the lesion began with pain and severe tenderness in the area. The next day, the size of the lesion increased and it became erythematous. He also mentions that a similar lesion had appeared ov... | Adenocarcinoma of pancreas | {
"A": "Multiple myeloma",
"B": "Malignant melanoma",
"C": "Squamous cell carcinoma of head and neck",
"D": "Adenocarcinoma of pancreas"
} | step1 | D | [
"74 year old man presents",
"physician",
"painful lesion",
"right lower limb",
"began 2 days",
"lesion began",
"pain",
"severe tenderness",
"area",
"next day",
"size of",
"lesion increased",
"erythematous",
"similar lesion",
"appeared",
"left lower limb",
"weeks earlier",
"days",
... |
A 53-year-old man is being evaluated for a 3-week history of fatigue, difficulty to concentrate, dyspnea with exertion, dizziness, and digital pain that improves with cold. He has smoked half a pack of cigarettes a day since he was 20. His current medical history involves hypertension. He takes enalapril daily. The vit... | Essential thrombocythemia | {
"A": "Myelofibrosis with myeloid metaplasia",
"B": "Essential thrombocythemia",
"C": "Polycythemia vera",
"D": "Aplastic anemia"
} | step1 | B | [
"year old man",
"evaluated",
"week history",
"fatigue",
"difficulty to concentrate",
"dyspnea",
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"smoked half",
"pack",
"cigarettes",
"day",
"20",
"current medical history",
"hypertension",
"takes enalapril daily",
"vi... |
A 50-year-old Caucasian man presents for a routine checkup. He does not have any current complaint. He is healthy and takes no medications. He has smoked 10–15 cigarettes per day for the past 10 years. His family history is negative for gastrointestinal disorders. Which of the following screening tests is recommended f... | Colonoscopy for colorectal cancer | {
"A": "Prostate-specific antigen for prostate cancer",
"B": "Carcinoembryonic antigen for colorectal cancer ",
"C": "Abdominal ultrasonography for abdominal aortic aneurysm",
"D": "Colonoscopy for colorectal cancer"
} | step2&3 | D | [
"50 year old Caucasian man presents",
"routine checkup",
"not",
"current complaint",
"healthy",
"takes",
"medications",
"smoked",
"cigarettes",
"day",
"past 10 years",
"family history",
"negative",
"gastrointestinal disorders",
"following screening tests",
"recommended",
"patient",
... |
A 76-year-old man comes to the physician for a follow-up examination. One week ago, he was prescribed azithromycin for acute bacterial sinusitis. He has a history of atrial fibrillation treated with warfarin and metoprolol. Physical examination shows no abnormalities. Compared to one month ago, laboratory studies show ... | Depletion of intestinal flora | {
"A": "Depletion of intestinal flora",
"B": "Inhibition of cytochrome p450",
"C": "Increased non-protein bound warfarin fraction",
"D": "Drug-induced hepatotoxicity"
} | step1 | A | [
"76 year old man",
"physician",
"follow-up examination",
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"prescribed azithromycin",
"acute bacterial sinusitis",
"history of atrial fibrillation treated with warfarin",
"metoprolol",
"Physical examination shows",
"abnormalities",
"Compared",
"one month",
"laboratory studies show"... |
A 2-week-old male newborn is brought to the physician because his mother has noticed her son has occasional bouts of ""turning blue in the face"" while crying. He also tires easily and sweats while feeding. He weighed 2150 g (4 lb 11 oz) at birth and has gained 200 g (7 oz). The baby appears mildly cyanotic. Examinatio... | Right ventricular outflow obstruction | {
"A": "Right ventricular outflow obstruction",
"B": "Left ventricular outflow obstruction",
"C": "Right ventricular hypertrophy",
"D": "Atrial septal defect"
} | step1 | A | [
"2 week old male newborn",
"brought",
"physician",
"mother",
"son",
"occasional bouts",
"turning blue",
"face",
"crying",
"tires easily",
"sweats",
"feeding",
"g",
"oz",
"birth",
"gained 200 g",
"oz",
"baby appears mildly cyanotic",
"Examination shows",
"3/6 systolic ejection m... |
A 19-year-old man presents to an orthopedic surgeon to discuss repair of his torn anterior cruciate ligament. He suffered the injury during a college basketball game 1 week ago and has been using a knee immobilizer since the accident. His past medical history is significant for an emergency appendectomy when he was 12 ... | He has the right to revoke his consent at any time | {
"A": "He cannot provide consent because he lacks capacity",
"B": "He has the right to revoke his consent at any time",
"C": "His consent is invalid because his decision is not stable over time",
"D": "His parents also need to give consent to this operation"
} | step1 | B | [
"year old man presents",
"orthopedic surgeon to discuss repair of",
"torn anterior cruciate ligament",
"suffered",
"injury",
"college basketball game 1",
"using",
"knee immobilizer",
"accident",
"past medical history",
"significant",
"emergency appendectomy",
"years",
"age",
"time",
"n... |
A 55-year-old male presents with complaints of intermittent facial flushing. He also reports feeling itchy after showering. On review of systems, the patient says he has been having new onset headaches recently. On physical exam, his vital signs, including O2 saturation, are normal. He has an abnormal abdominal mass pa... | Tyrosine kinase mutation | {
"A": "Fibrosis of bone marrow",
"B": "Tyrosine kinase mutation",
"C": "BCR-ABL fusion",
"D": "Chronic hypoxemia"
} | step1 | B | [
"55 year old male presents",
"complaints",
"intermittent facial flushing",
"reports feeling itchy",
"showering",
"review of systems",
"patient",
"new onset headaches recently",
"physical exam",
"vital signs",
"including O2 saturation",
"normal",
"abnormal abdominal mass palpable",
"left up... |
A 42-year-old Caucasian male presents to your office with hematuria and right flank pain. He has no history of renal dialysis but has a history of recurrent urinary tract infections. You order an intravenous pyelogram, which reveals multiple cysts of the collecting ducts in the medulla. What is the most likely diagnosi... | Medullary sponge kidney | {
"A": "Simple retention cysts",
"B": "Acquired polycystic kidney disease",
"C": "Autosomal dominant polycystic kidney disease",
"D": "Medullary sponge kidney"
} | step1 | D | [
"year old Caucasian male presents",
"office",
"hematuria",
"right flank pain",
"history of renal dialysis",
"history of recurrent urinary tract infections",
"order",
"intravenous pyelogram",
"reveals multiple cysts",
"collecting ducts",
"medulla",
"most likely diagnosis"
] |
A 28-year-old woman presents with severe vertigo. She also reports multiple episodes of vomiting and difficulty walking. The vertigo is continuous, not related to the position, and not associated with tinnitus or hearing disturbances. She has a past history of acute vision loss in her right eye that resolved spontaneou... | High-doses of corticosteroids | {
"A": "Acyclovir",
"B": "High doses of glucose",
"C": "High-doses of corticosteroids",
"D": "Plasma exchange"
} | step2&3 | C | [
"year old woman presents",
"severe",
"reports multiple episodes of vomiting",
"difficulty walking",
"vertigo",
"continuous",
"not related",
"position",
"not associated with tinnitus",
"hearing disturbances",
"past history of acute vision loss",
"right eye",
"resolved",
"years",
"left-sid... |
A 19-year-old man is brought to the emergency department by the resident assistant of his dormitory for strange behavior. He was found locked out of his room, where the patient admitted to attending a fraternity party before becoming paranoid that the resident assistant would report him to the police. The patient appea... | Impaired reaction time | {
"A": "Tactile hallucinations",
"B": "Pupillary constriction",
"C": "Synesthesia",
"D": "Impaired reaction time"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"resident assistant",
"dormitory",
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"patient admitted",
"attending",
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"resident assistant",
"report",
"police",
"patient appears anxious",
"pulse",
"min",
"blood pressure",
"... |
A 23-year-old primigravid woman comes to the physician at 36 weeks' gestation for her first prenatal visit. She confirmed the pregnancy with a home urine pregnancy kit a few months ago but has not yet followed up with a physician. She takes no medications. Vital signs are within normal limits. Pelvic examination shows ... | Start cART and schedule cesarean delivery at 38 weeks' gestation | {
"A": "Intrapartum zidovudine and vaginal delivery when labor occurs",
"B": "Start cART and schedule cesarean delivery at 38 weeks' gestation",
"C": "Start cART and prepare for vaginal delivery at 38 weeks' gestation",
"D": "Conduct cesarean delivery immediately"
} | step2&3 | B | [
"23 year old primigravid woman",
"physician",
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"estation ",
"irst prenatal visit.",
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"ital signs ",
"ormal limits.",
"elvic examination hows ",
"teru... |
A 54-year-old woman comes to the emergency department because of drooping on the left side of her face since that morning. She also reports difficulty closing her eyes and chewing. During the neurologic examination, the physician asks the patient to open her jaw against resistance. Which of the following muscles is mos... | Lateral pterygoid | {
"A": "Lateral pterygoid",
"B": "Masseter",
"C": "Hyoglossus",
"D": "Buccinator"
} | step1 | A | [
"54 year old woman",
"emergency department",
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"face",
"morning",
"reports difficulty closing",
"eyes",
"chewing",
"neurologic examination",
"physician",
"patient to open",
"jaw",
"resistance",
"following muscles",
"most likely activated",
"movement"
] |
A 45-year-old female with a history of gastroesophageal reflux disease presents to her family physician with symptoms of epigastric pain right after a meal. The physician performs a urea breath test which is positive and the patient is started on appropriate medical therapy. Three days later at a restaurant, she experi... | Forms toxic metabolites that damage bacterial DNA | {
"A": "Blocks protein synthesis by binding to the 50S ribosomal subunit inhibiting protein translocation",
"B": "Binds to the 30S ribosomal subunit preventing attachment of the aminoacyl-tRNA",
"C": "Forms toxic metabolites that damage bacterial DNA",
"D": "Inhibits the H+/K+ ATPase"
} | step1 | C | [
"year old female",
"history of gastroesophageal reflux disease presents",
"family physician",
"symptoms",
"epigastric right",
"meal",
"physician performs",
"urea breath",
"positive",
"patient",
"started",
"appropriate medical",
"Three days later",
"restaurant",
"experienced severe flushi... |
A 53-year-old woman presents to your office with several months of fatigue and abdominal pain. The pain is dull in character and unrelated to meals. She has a history of type 2 diabetes mellitus and rheumatic arthritis for which she is taking ibuprofen, methotrexate, and metformin. She has 2-3 drinks on the weekends an... | Fatty infiltration of hepatocytes | {
"A": "Copper accumulation in hepatocytes",
"B": "Fatty infiltration of hepatocytes",
"C": "Alcohol-induced destruction of hepatocytes",
"D": "Drug-induced liver damage"
} | step1 | B | [
"year old woman presents",
"office",
"several months",
"fatigue",
"abdominal pain",
"pain",
"dull",
"character",
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"history of type 2 diabetes mellitus",
"rheumatic arthritis",
"taking ibuprofen",
"methotrexate",
"metformin",
"has",
"drinks",
"weekends",
"not ... |
A 24-year-old man presents with low-grade fever and shortness of breath for the last 3 weeks. Past medical history is significant for severe mitral regurgitation status post mitral valve replacement five years ago. His temperature is 38.3°C (101.0°F) and respiratory rate is 18/min. Physical examination reveals vertical... | Novobiocin sensitive | {
"A": "Hemolysis",
"B": "Coagulase positive",
"C": "DNAse positive",
"D": "Novobiocin sensitive"
} | step1 | D | [
"year old man presents",
"low-grade fever",
"shortness of breath",
"last",
"weeks",
"Past medical history",
"significant",
"severe mitral regurgitation",
"mitral valve replacement five years",
"temperature",
"3C",
"respiratory rate",
"min",
"Physical examination reveals vertical hemorrhage... |
A 23-year-old woman with asthma is brought to the emergency department because of shortness of breath and wheezing for 20 minutes. She is unable to speak more than a few words at a time. Her pulse is 116/min and respirations are 28/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination of the lu... | Hypokalemia | {
"A": "Miosis",
"B": "Hypoglycemia",
"C": "Hypokalemia",
"D": "Urinary frequency"
} | step1 | C | [
"23 year old woman",
"asthma",
"brought",
"emergency department",
"of shortness",
"breath",
"wheezing",
"20 minutes",
"unable",
"speak more",
"words",
"time",
"pulse",
"min",
"respirations",
"min",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"Examination",
"lungs... |
A 59-year-old man comes to the physician because of a 4-month history of a pruritic rash. His symptoms have not improved despite treatment with over-the-counter creams. During this period, he has also had a 6-kg (13.5-lb) weight loss. Examination shows a scaly rash over his chest, back, and thighs. A photograph of the ... | T cells | {
"A": "T cells",
"B": "Keratinocytes",
"C": "Mast cells",
"D": "B cells"
} | step1 | A | [
"59 year old man",
"physician",
"4 month history",
"pruritic rash",
"symptoms",
"not improved",
"treatment",
"over-the-counter creams",
"period",
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"weight loss",
"Examination shows",
"scaly rash",
"chest",
"back",
"thighs",
"photograph",
"rash",
"thighs",
"shown",
"biops... |
A 6-year-old boy is brought in by his mother to his pediatrician for headache and nausea. His headaches began approximately 3 weeks ago and occur in the morning. Throughout the 3 weeks, his nausea has progressively worsened, and he had 2 episodes of emesis 1 day ago. On physical exam, cranial nerves are grossly intact,... | Medulloblastoma | {
"A": "Ependymoma",
"B": "Medulloblastoma",
"C": "Pilocytic astrocytoma",
"D": "Pinealoma"
} | step2&3 | B | [
"year old boy",
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"mother",
"pediatrician",
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"headaches began approximately",
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"occur",
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"3 weeks",
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"worsened",
"2 episodes of emesis 1",
"physical exam",
"cranial nerves",
"intact",
"visual field",
"intact",
"patient",
... |
A simple experiment is performed to measure the breakdown of sucrose into glucose and fructose by a gut enzyme that catalyzes this reaction. A glucose meter is used to follow the breakdown of sucrose into glucose. When no enzyme is added to the sucrose solution, the glucose meter will have a reading of 0 mg/dL; but whe... | Acarbose | {
"A": "Glyburide",
"B": "Metformin",
"C": "Acarbose",
"D": "Exenatide"
} | step1 | C | [
"simple experiment",
"performed to measure",
"breakdown",
"sucrose",
"glucose",
"fructose",
"gut enzyme",
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"glucose meter",
"used to follow",
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"glucose",
"enzyme",
"added",
"sucrose solution",
"glucose meter",
"reading",
"0 mg/dL",
"enzyme",
... |
Three days into hospitalization for a fractured distal femur, a 33-year-old man develops dyspnea and confusion. He has no history of a serious illness. He is unable to answer any questions or follow any commands. His blood pressure is 145/90 mm Hg, the pulse is 120/min, the respiratory rate is 36/min, and the temperatu... | Fat embolism | {
"A": "Acute respiratory distress syndrome",
"B": "Fat embolism",
"C": "Hospital-acquired pneumonia",
"D": "Pulmonary thromboembolism"
} | step2&3 | B | [
"Three days",
"hospitalization",
"fractured distal femur",
"year old man",
"dyspnea",
"confusion",
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"questions",
"follow",
"commands",
"blood pressure",
"90 mm Hg",
"pulse",
"min",
"respiratory rate",
"36 min",
"temperature",
"36... |
A 32-year-old woman comes to the emergency department for a 2-week history of right upper quadrant abdominal pain. She has also been feeling tired and nauseous for the past 5 weeks. She has a history of depression and suicidal ideation. She is a social worker for an international charity foundation. She used intravenou... | Supportive therapy | {
"A": "Supportive therapy",
"B": "Tenofovir",
"C": "Ribavirin and interferon",
"D": "Vaccination against Hepatitis B"
} | step2&3 | A | [
"year old woman",
"emergency department",
"2-week history",
"right upper quadrant abdominal pain",
"feeling tired",
"nauseous",
"past",
"weeks",
"history of depression",
"suicidal ideation",
"social worker",
"international charity foundation",
"used intravenous illicit drugs",
"past",
"q... |
A 57-year-old man comes to the physician because of sudden-onset fever, malaise, and pain and swelling of his wrists and ankles that began a week ago. One month ago, he was started on hydralazine for adjunctive treatment of hypertension. His temperature is 37.8°C (100°F). Examination shows swelling, tenderness, warmth,... | Anti-histone | {
"A": "Anti-dsDNA",
"B": "Anti-Smith",
"C": "Anti-β2-glycoprotein",
"D": "Anti-histone"
} | step1 | D | [
"57 year old man",
"physician",
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"week",
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"adjunctive",
"hypertension",
"temperature",
"Examination shows swelling",
"tenderness",
"warmth",
"erythema of",
"wrists... |
A 64-year-old man who recently immigrated to the United States from Haiti comes to the physician because of a 3-week history of progressively worsening exertional dyspnea and fatigue. For the past few days, he has also had difficulty lying flat due to trouble breathing. Over the past year, he has had intermittent fever... | Jugular venous distention on inspiration | {
"A": "Elimination of S2 heart sound splitting with inspiration",
"B": "Head bobbing in synchrony with heart beat",
"C": "Jugular venous distention on inspiration",
"D": "Crescendo-decrescendo systolic ejection murmur"
} | step1 | C | [
"64 year old man",
"recently",
"United States",
"Haiti",
"physician",
"3 week history",
"worsening exertional dyspnea",
"fatigue",
"past",
"days",
"difficulty lying flat due to trouble breathing",
"past year",
"intermittent fever",
"night sweats",
"cough",
"not",
"seen by",
"physic... |
A 55-year-old man with a past medical history of obesity and hyperlipidemia suddenly develops left-sided chest pain and shortness of breath while at work. He relays to coworkers that the pain is intense and has spread to his upper left arm over the past 10 minutes. He reports it feels a lot like the “heart attack” he h... | Ventricular tachycardia | {
"A": "Atrial fibrillation",
"B": "Free wall rupture",
"C": "Pericarditis",
"D": "Ventricular tachycardia"
} | step1 | D | [
"55 year old man",
"past medical",
"hyperlipidemia",
"left-sided chest pain",
"shortness of breath",
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"relays to coworkers",
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"spread",
"upper left arm",
"past 10 minutes",
"reports",
"feels",
"lot",
"heart attack",
"year",
"collapses",
"unresponsive",
... |
A previously healthy 13-year-old girl is brought to the physician for evaluation of a 2-month history of fatigue. She reports recurrent episodes of pain in her right wrist and left knee. During this period, she has had a 4-kg (8.8-lb) weight loss. Her mother has rheumatoid arthritis. Her temperature is 38°C (100.4°F). ... | Anti-dsDNA antibodies | {
"A": "Leukocytoclastic vasculitis with IgA and C3 immune complex deposition",
"B": "Anti-dsDNA antibodies",
"C": "Excessive lymphoblasts",
"D": "Positive HLA-B27 test"
} | step1 | B | [
"healthy",
"year old girl",
"brought",
"physician",
"evaluation",
"month history",
"fatigue",
"reports recurrent episodes of pain",
"right wrist",
"left knee",
"period",
"4 kg",
"8.8",
"weight loss",
"mother",
"rheumatoid arthritis",
"temperature",
"100 4F",
"Examination shows di... |
A 23-year-old man comes to the emergency department because of palpitations, dizziness, and substernal chest pain for three hours. The day prior, he was at a friend’s wedding, where he consumed seven glasses of wine. The patient appears diaphoretic. His pulse is 220/min and blood pressure is 120/84 mm Hg. Based on the ... | Slurred upstroke of the QRS complex | {
"A": "Slurred upstroke of the QRS complex",
"B": "Epsilon wave following the QRS complex",
"C": "Prolongation of the QT interval",
"D": "Positive Sokolow-Lyon index"
} | step1 | A | [
"23 year old man",
"emergency department",
"palpitations",
"dizziness",
"substernal chest pain",
"three hours",
"day prior",
"friends wedding",
"seven glasses",
"wine",
"patient appears diaphoretic",
"pulse",
"min",
"blood pressure",
"84 mm Hg",
"Based",
"patient's findings",
"elec... |
A typically healthy 27-year-old woman presents to the physician because of a 3-week history of fatigue, headache, and dry cough. She does not smoke or use illicit drugs. Her temperature is 37.8°C (100.0°F). Chest examination shows mild inspiratory crackles in both lung fields. An X-ray of the chest shows diffuse inters... | Oral azithromycin | {
"A": "Intravenous ceftriaxone",
"B": "Intravenous ceftriaxone and oral azithromycin",
"C": "Oral amoxicillin",
"D": "Oral azithromycin"
} | step2&3 | D | [
"healthy 27 year old woman presents",
"physician",
"3 week history",
"fatigue",
"headache",
"dry cough",
"not smoke",
"use illicit",
"temperature",
"100",
"Chest examination shows mild inspiratory crackles",
"lung fields",
"X-ray of",
"chest shows diffuse interstitial infiltrates",
"Gram... |
A 59-year-old Caucasian man with a history of hypertension and emphysema is brought to the hospital because of progressive lethargy and confusion. The patient has been experiencing poor appetite for the past 3 months and has unintentionally lost 9 kg (19.8 lb). He was a smoker for 35 years and smoked 1 pack daily, but ... | 3% saline at 35 mL/h | {
"A": "Dextrose with 20 mEq/L KCl at 250 mL/h",
"B": "0.45% saline at 100 mL/h",
"C": "3% saline at 35 mL/h",
"D": "0.45% saline with 30 mEq/L KCl at 100 mL/h"
} | step2&3 | C | [
"59 year old Caucasian man",
"history of hypertension",
"emphysema",
"brought",
"hospital",
"progressive lethargy",
"confusion",
"patient",
"experiencing poor appetite",
"past 3 months",
"lost",
"kg",
"smoker",
"35 years",
"smoked 1 pack daily",
"quit 5 years",
"takes lisinopril",
... |
A 30-year-old male presents with a testicular mass of unknown duration. The patient states he first noticed something unusual with his right testicle two weeks ago, but states he did not think it was urgent because it was not painful and believed it would resolve on its own. It has not changed since he first noticed th... | Testicular ultrasound | {
"A": "Needle biopsy",
"B": "Testicular ultrasound",
"C": "CT abdomen and pelvis",
"D": "Send labs"
} | step2&3 | B | [
"30 year old male presents",
"testicular mass of unknown duration",
"patient states",
"first",
"unusual",
"right testicle two weeks",
"states",
"not think",
"urgent",
"not painful",
"resolve",
"not changed",
"first",
"mass",
"patient",
"denies pain",
"exam",
"patients right testicl... |
A 1-year-old boy is brought to the emergency department after his mother witnessed him swallow a nickel-sized battery a few hours ago. She denies any episodes of vomiting or hematemesis. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/45 mm Hg, pulse 140/min, respiratory rate 15/min, and oxygen ... | Immediate endoscopic removal | {
"A": "Induce emesis to expel the battery",
"B": "Induce gastrointestinal motility with metoclopramide to expel the battery",
"C": "Computed tomography (CT) scan to confirm the diagnosis ",
"D": "Immediate endoscopic removal"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"mother witnessed",
"swallow",
"nickel sized battery",
"few hours",
"denies",
"episodes of vomiting",
"hematemesis",
"vital signs include",
"temperature",
"98",
"blood pressure 95",
"mm Hg",
"pulse",
"min",
"respiratory rate",
"m... |
A 28-year-old soldier is brought back to a military treatment facility 45 minutes after sustaining injuries in a building fire from a mortar attack. He was trapped inside the building for around 20 minutes. On arrival, he is confused and appears uncomfortable. He has a Glasgow Coma Score of 13. His pulse is 113/min, re... | Intubation and mechanical ventilation | {
"A": "Insertion of nasogastric tube and enteral nutrition",
"B": "Intravenous antibiotic therapy",
"C": "Intubation and mechanical ventilation",
"D": "Intravenous corticosteroid therapy"
} | step2&3 | C | [
"year old soldier",
"brought back",
"military treatment facility 45 minutes",
"sustaining injuries",
"building fire",
"attack",
"trapped",
"building",
"20 minutes",
"arrival",
"confused",
"appears",
"Glasgow Coma Score",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"7... |
A 49-year-old woman presents to her primary care physician for a routine health maintenance examination. She says that she is currently feeling well and has not noticed any acute changes in her health. She exercises 3 times a week and has tried to increase the amount of fruits and vegetables in her diet. She has smoked... | Statin therapy | {
"A": "Chest radiography",
"B": "Colonoscopy",
"C": "Mammogram",
"D": "Statin therapy"
} | step2&3 | D | [
"year old woman presents",
"primary care physician",
"routine health maintenance examination",
"currently feeling well",
"not",
"acute changes",
"health",
"exercises 3 times",
"week",
"to increase",
"amount",
"fruits",
"vegetables",
"diet",
"smoked approximately",
"pack",
"cigarettes... |
A 24-year-old woman with a past medical history of anorexia nervosa presents to the clinic due to heavy menses, bleeding gums, and easy bruisability. She says she is trying to lose weight by restricting her food intake. She has taken multiple courses of antibiotics for recurrent sinusitis over the past month. No other ... | Vitamin K deficiency | {
"A": "Vitamin K deficiency",
"B": "Acute myelogenous leukemia",
"C": "Missed miscarriage",
"D": "Physical abuse"
} | step2&3 | A | [
"year old woman",
"past medical history of anorexia nervosa presents",
"clinic",
"heavy menses",
"bleeding gums",
"easy bruisability",
"to",
"weight",
"restricting",
"food intake",
"taken multiple courses",
"antibiotics",
"recurrent sinusitis",
"past month",
"past medical history",
"cu... |
A 65-year-old obese female presents to the emergency room complaining of severe abdominal pain. She reports pain localized to the epigastrium that radiates to the right scapula. The pain occurred suddenly after a fast food meal with her grandchildren. Her temperature is 100.9°F (38.2°C), blood pressure is 140/85 mmHg, ... | Cystic duct | {
"A": "Common hepatic duct",
"B": "Ampulla of Vater",
"C": "Cystic duct",
"D": "Pancreatic duct of Wirsung"
} | step1 | C | [
"65 year old obese female presents",
"emergency room",
"severe abdominal",
"reports pain localized",
"epigastrium",
"radiates",
"right scapula",
"pain occurred",
"fast food meal",
"grandchildren",
"temperature",
"100 9F",
"blood pressure",
"85 mmHg",
"pulse",
"min",
"respirations",
... |
A 27-year-old Asian woman presents to her primary care physician with joint pain and a headache. She has had intermittent joint and muscle pain for the past several months in the setting of a chronic headache. She states that the pain seems to migrate from joint to joint, and her muscles typically ache making it hard f... | Prednisone | {
"A": "Anti-dsDNA level",
"B": "Methotrexate",
"C": "Prednisone",
"D": "Temporal artery biopsy"
} | step2&3 | C | [
"27 year old Asian woman presents",
"primary care physician",
"joint pain",
"headache",
"intermittent joint",
"muscle pain",
"past",
"months",
"setting",
"chronic headache",
"states",
"pain",
"to migrate",
"joint",
"joint",
"muscles",
"ache making",
"hard",
"to sleep",
"patient... |
Your colleague has been reading the literature on beta-carotene supplementation and the risk of heart disease. She thinks they may share a clinically relevant association and would like to submit an editorial to a top journal. Upon final literature review, she discovers a newly published study that refutes any associat... | Meta-analysis | {
"A": "Randomized control trial",
"B": "Case-cohort study",
"C": "Meta-analysis",
"D": "Cross-sectional study"
} | step1 | C | [
"reading",
"literature",
"beta-carotene supplementation",
"the risk of heart disease",
"thinks",
"share",
"relevant association",
"to submit",
"editorial",
"top journal",
"final literature review",
"discovers",
"newly published study",
"association",
"beta-carotene",
"heart disease",
... |
A 15-year-old girl comes to the physician with her father for evaluation of short stature. She feels well overall but is concerned because all of her friends are taller than her. Her birth weight was normal. Menarche has not yet occurred. Her father says he also had short stature and late puberty. The girl is at the 5t... | Normal normal normal normal | {
"A": "↓ ↓ ↓ ↓",
"B": "↓ ↓ ↑ ↓",
"C": "Normal normal normal normal",
"D": "↑ ↑ ↓ ↑"
} | step1 | C | [
"year old girl",
"physician",
"father",
"evaluation",
"short stature",
"feels well overall",
"concerned",
"friends",
"birth weight",
"normal",
"Menarche",
"not",
"occurred",
"father",
"short stature",
"late puberty",
"girl",
"5th percentile",
"height",
"percentile",
"weight",... |
In which of the following pathological states would the oxygen content of the trachea resemble the oxygen content in the affected alveoli? | Pulmonary embolism | {
"A": "Emphysema",
"B": "Pulmonary fibrosis",
"C": "Pulmonary embolism",
"D": "Foreign body obstruction distal to the trachea"
} | step1 | C | [
"following pathological states",
"oxygen content",
"trachea",
"oxygen content",
"affected alveoli"
] |
A previously healthy 32-year-old man comes to the physician because of a 1-week history of upper back pain, dyspnea, and a sensation of pressure in his chest. He has had no shortness of breath, palpitations, fevers, or chills. He emigrated from Ecuador when he was 5 years old. He does not smoke or drink alcohol. He tak... | Cystic medial necrosis | {
"A": "Infection with Trypanosoma cruzi",
"B": "Cystic medial necrosis",
"C": "Atherosclerotic plaque formation",
"D": "Congenital narrowing of the aortic arch"
} | step2&3 | B | [
"healthy",
"year old man",
"physician",
"of",
"1-week history",
"upper back pain",
"dyspnea",
"sensation of pressure",
"chest",
"shortness of breath",
"palpitations",
"fevers",
"chills",
"Ecuador",
"5 years old",
"not smoke",
"drink alcohol",
"takes",
"medications",
"6 ft 4",
... |
A 26-year-old woman presents to the emergency department with fever, chills, lower quadrant abdominal pain, and urinary frequency for the past week. Her vital signs include temperature 38.9°C (102.0°F), pulse 110/min, respirations 16/min, and blood pressure 122/78 mm Hg. Physical examination is unremarkable. Urinalysis... | Gram-negative rod-shaped bacilli | {
"A": "Nonmotile, pleomorphic rod-shaped, gram-negative bacilli ",
"B": "Pear-shaped motile protozoa",
"C": "Gram-negative rod-shaped bacilli",
"D": "Gram-positive cocci that grow in chains"
} | step1 | C | [
"year old woman presents",
"emergency department",
"fever",
"chills",
"lower quadrant abdominal pain",
"urinary frequency",
"past week",
"vital signs include temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Physical examination",
"unremarkable",
"Urina... |
A 30-year-old man comes to the emergency department because of the sudden onset of back pain beginning 2 hours ago. Beginning yesterday, he noticed that his eyes started appearing yellowish and his urine was darker than normal. Two months ago, he returned from a trip to Greece, where he lived before immigrating to the ... | Absence of reduced glutathione | {
"A": "Crescent-shaped erythrocytes",
"B": "Absence of reduced glutathione",
"C": "Inhibition of aminolevulinate dehydratase",
"D": "Defective ankyrin in the RBC membrane"
} | step2&3 | B | [
"30 year old man",
"emergency department",
"sudden onset",
"back pain beginning 2 hours",
"Beginning",
"eyes started appearing",
"urine",
"darker",
"normal",
"Two months",
"returned",
"trip",
"Greece",
"lived",
"10 years",
"Three days",
"diagnosed",
"latent tuberculosis",
"starte... |
A 69-year-old Caucasian man presents for a routine health maintenance examination. He feels well. He has no significant past medical history. He takes aspirin for the occasional headaches that he has had for over several years. He exercises every day and does not smoke. His father was diagnosed with a hematologic malig... | Chronic lymphocytic leukemia | {
"A": "Acute lymphoid leukemia",
"B": "Acute myeloid leukemia",
"C": "Adult T cell leukemia",
"D": "Chronic lymphocytic leukemia"
} | step2&3 | D | [
"69 year old Caucasian man presents",
"routine health maintenance examination",
"feels well",
"significant past medical history",
"takes aspirin",
"occasional headaches",
"over several years",
"exercises",
"day",
"not smoke",
"father",
"diagnosed",
"hematologic malignancy",
"years old",
... |
A 62-year-old woman is referred to a tertiary care hospital with a history of diplopia and fatigue for the past 3 months. She has also noticed difficulty in climbing the stairs and combing her hair. She confirms a history of 2.3 kg (5.0 lb) weight loss in the past 6 weeks and constipation. Past medical history is signi... | Incremental pattern on repetitive nerve conduction studies | {
"A": "Antibodies against muscle-specific kinase",
"B": "Incremental pattern on repetitive nerve conduction studies",
"C": "Periventricular plaques on MRI of the brain",
"D": "Thymoma on CT scan of the chest"
} | step2&3 | B | [
"62 year old woman",
"referred to",
"tertiary care hospital",
"history",
"diplopia",
"fatigue",
"past 3 months",
"difficulty",
"climbing",
"stairs",
"combing",
"hair",
"confirms",
"history",
"kg",
"5 0",
"weight loss",
"past",
"weeks",
"constipation",
"Past medical history",
... |
A 60-year-old man is brought to the emergency department by police officers because he was acting strangely in public. The patient was found talking nonsensically to characters on cereal boxes in the store. Past medical history is significant for multiple hospitalizations for alcohol-related injuries and seizures. The ... | Korsakoff's syndrome | {
"A": "Delirium tremens",
"B": "Korsakoff's syndrome",
"C": "Schizophrenia",
"D": "Wernicke encephalopathy"
} | step1 | B | [
"60 year old man",
"brought",
"emergency department",
"police officers",
"acting",
"patient",
"found talking",
"characters",
"cereal boxes",
"store",
"Past medical history",
"significant",
"multiple hospitalizations",
"alcohol related injuries",
"seizures",
"patients vital signs",
"n... |
A 43-year-old woman presents to her primary care physician for a general wellness appointment. The patient states that sometimes she has headaches and is ashamed of her body habitus. Otherwise, the patient has no complaints. The patient's 90-year-old mother recently died of breast cancer. The patient smokes 1 pack of c... | Exercise and reduce alcohol intake | {
"A": "Begin breastfeeding",
"B": "Test for BRCA1 and 2",
"C": "Recommend monthly self breast exams",
"D": "Exercise and reduce alcohol intake"
} | step2&3 | D | [
"year old woman presents",
"primary care physician",
"general wellness appointment",
"patient states",
"sometimes",
"headaches",
"ashamed",
"body",
"patient",
"complaints",
"patient's 90 year old mother recently died of breast cancer",
"patient smokes",
"pack",
"cigarettes",
"day",
"dr... |
A 12-year-old boy is brought to his pediatrician with a high fever. He was feeling fatigued yesterday and then developed a high fever overnight that was accompanied by chills and malaise. This morning he also started complaining of headaches and myalgias. He has otherwise been healthy and does not take any medications.... | Segmented genomic material | {
"A": "Concurrent infection with 2 viruses",
"B": "Crossing over of homologous regions",
"C": "One virus that produces a non-functional protein",
"D": "Segmented genomic material"
} | step1 | D | [
"year old boy",
"brought",
"pediatrician",
"high fever",
"feeling fatigued",
"then",
"high fever overnight",
"chills",
"malaise",
"morning",
"started",
"headaches",
"myalgias",
"healthy",
"not take",
"medications",
"friends",
"same symptoms last week",
"given oseltamivir",
"giv... |
A 52-year-old woman presents to the clinic with complaints of intermittent chest pain for 3 days. The pain is retrosternal, 3/10, and positional (laying down seems to make it worse). She describes it as “squeezing and burning” in quality, is worse after food intake and emotional stress, and improves with antacids. The ... | Incompetence of the lower esophageal sphincter | {
"A": "Blood clot within the lungs",
"B": "Decreased gastric mucosal protection",
"C": "Incompetence of the lower esophageal sphincter",
"D": "Insufficient blood supply to the myocardium"
} | step1 | C | [
"year old woman presents",
"clinic",
"complaints of intermittent chest pain",
"3 days",
"pain",
"retrosternal",
"10",
"positional",
"laying",
"to make",
"worse",
"squeezing",
"burning",
"quality",
"worse",
"food intake",
"emotional stress",
"improves",
"antacids",
"patient rece... |
A 24-year-old man presents to the emergency department for severe abdominal pain for the past day. The patient states he has had profuse, watery diarrhea and abdominal pain that is keeping him up at night. The patient also claims that he sees blood on the toilet paper when he wipes and endorses having lost 5 pounds rec... | Vancomycin | {
"A": "Metronidazole",
"B": "Vancomycin",
"C": "Clindamycin",
"D": "Supportive therapy and ciprofloxacin if symptoms persist"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"severe abdominal",
"past day",
"patient states",
"watery diarrhea",
"abdominal pain",
"keeping",
"night",
"patient",
"sees blood on",
"toilet paper",
"wipes",
"lost 5 pounds recently",
"patient's past",
"notable",
"IV drug abuse",
"... |
A 57-year-old man is brought to the emergency department for worsening pain and swelling of his left ankle for the past 2 hours. The pain is severe and awakened him from sleep. He has hypertension and hyperlipidemia. Current medications include hydrochlorothiazide and pravastatin. His temperature is 37.8°C (100.1°F), p... | Colchicine | {
"A": "Probenecid",
"B": "Colchicine and allopurinol",
"C": "Triamcinolone and probenecid",
"D": "Colchicine"
} | step2&3 | D | [
"57 year old man",
"brought",
"emergency department",
"worsening pain",
"swelling",
"left",
"past",
"hours",
"pain",
"severe",
"sleep",
"hypertension",
"hyperlipidemia",
"Current medications include hydrochlorothiazide",
"pravastatin",
"temperature",
"100",
"pulse",
"min",
"blo... |
A 37-year-old man presents to the physician because of dysphagia and regurgitation for the past 5 years. In recent weeks, it has become very difficult for him to ingest solid or liquid food. He has lost 3 kg (6 lb) during this time. He was admitted to the hospital last year because of pneumonia. Three years ago, he had... | Absent peristalsis and impaired lower esophageal sphincter relaxation | {
"A": "Abnormal esophageal contraction with deglutition lower esophageal sphincter relaxation",
"B": "Absent peristalsis and impaired lower esophageal sphincter relaxation",
"C": "Poor pharyngeal propulsion and upper esophageal sphincter obstruction",
"D": "Severely weak peristalsis and patulous lower esophage... | step2&3 | B | [
"year old man presents",
"physician",
"dysphagia",
"regurgitation",
"past",
"years",
"recent weeks",
"very difficult",
"to ingest solid",
"liquid food",
"lost 3 kg",
"time",
"admitted",
"hospital",
"year",
"pneumonia",
"Three years",
"endoscopic procedure",
"improved",
"dysphag... |
A 23-year-old woman is seen by her primary care physician. The patient has a several year history of excessive daytime sleepiness. She also reports episodes where she suddenly falls to the floor after her knees become weak, often during a laughing spell. She has no other significant past medical history. Her primary ca... | Undetectable CSF hypocretin-1 | {
"A": "Increased serum methoxyhemoglobin",
"B": "Reduced serum hemoglobin",
"C": "Undetectable CSF hypocretin-1",
"D": "Increased serum ESR"
} | step1 | C | [
"23 year old woman",
"seen by",
"primary care physician",
"patient",
"several year history",
"excessive daytime sleepiness",
"reports episodes",
"falls",
"floor",
"knees",
"weak",
"often",
"laughing spell",
"significant past medical history",
"primary care physician refers",
"sleep stu... |
A 30-year-old woman comes to the physician with her husband because they have been trying to conceive for 15 months with no success. They have been sexually active at least twice a week. The husband sometimes has difficulties maintaining erection during sexual activity. During attempted vaginal penetration, the patient... | Genitopelvic pain disorder | {
"A": "Vulvodynia",
"B": "Vulvovaginitis",
"C": "Painful bladder syndrome",
"D": "Genitopelvic pain disorder"
} | step2&3 | D | [
"30 year old woman",
"physician",
"husband",
"to",
"months",
"success",
"sexually active",
"twice",
"week",
"husband sometimes",
"difficulties maintaining erection",
"sexual activity",
"attempted vaginal penetration",
"patient",
"discomfort",
"pelvic floor muscles",
"Three years",
... |
An otherwise healthy 76-year-old man is brought to the physician because of poor sleep for the past several years. Every night he has been sleeping less and taking longer to fall asleep. During the day, he feels tired and has low energy and difficulty concentrating. Sleep hygiene and relaxation techniques have failed t... | Zaleplon | {
"A": "Temazepam",
"B": "Diphenhydramine",
"C": "Suvorexant",
"D": "Zaleplon"
} | step1 | D | [
"healthy 76 year old man",
"brought",
"physician",
"of poor sleep",
"past",
"years",
"night",
"sleeping less",
"longer to fall asleep",
"day",
"feels tired",
"low energy",
"difficulty concentrating",
"Sleep hygiene",
"relaxation techniques",
"failed to",
"sleep",
"to start",
"sho... |
A 23-year-old man is brought to the emergency department by ambulance following a motor vehicle accident. He was pinned between 2 cars for several hours. The patient has a history of asthma. He uses an albuterol inhaler intermittently. The patient was not the driver, and admits to having a few beers at a party prior to... | Succinylcholine | {
"A": "Etomidate",
"B": "Halothane",
"C": "Neostigmine",
"D": "Succinylcholine"
} | step2&3 | D | [
"23 year old man",
"brought",
"emergency department",
"ambulance following",
"motor vehicle accident",
"pinned",
"cars",
"several hours",
"patient",
"history of asthma",
"uses",
"albuterol inhaler",
"patient",
"not",
"driver",
"admits",
"few beers",
"party",
"accident",
"ambula... |
A 3-year-old girl is brought to the physician for a well-child visit. Her father is concerned about the color and strength of her teeth. He says that most of her teeth have had stains since the time that they erupted. She also has a limp when she walks. Examination shows brownish-gray discoloration of the teeth. She ha... | Tetracycline | {
"A": "Trimethoprim",
"B": "Gentamicin",
"C": "Chloramphenicol",
"D": "Tetracycline"
} | step1 | D | [
"3 year old girl",
"brought",
"physician",
"well-child visit",
"father",
"concerned",
"color",
"strength",
"teeth",
"most",
"teeth",
"stains",
"time",
"limp",
"walks",
"Examination shows",
"gray discoloration of",
"teeth",
"lower limb length discrepancy",
"left",
"ankle lengt... |
A 2300-g (5.07-lb) male newborn is delivered at term to a 39-year-old woman. Examination shows a sloping forehead, a flat nasal bridge, increased interocular distance, low-set ears, a protruding tongue, a single palmar crease and an increased gap between the first and second toe. There are small white and brown spots i... | Atrioventricular septal defect | {
"A": "Atrial septal defects",
"B": "Atrioventricular septal defect",
"C": "Tetralogy of Fallot",
"D": "Ventricular septal defect"
} | step1 | B | [
"g",
"male newborn",
"delivered",
"term",
"year old woman",
"Examination shows",
"sloping forehead",
"flat nasal bridge",
"increased",
"distance",
"low-set ears",
"protruding tongue",
"single palmar crease",
"increased gap",
"first",
"second toe",
"small white",
"brown spots",
"p... |
A 47-year-old woman comes to the physician because of a 3-week history of generalized fatigue, mild fever, abdominal pain, and nausea. She attended the state fair over a month ago, where she tried a number of regional foods, and wonders if it might have been caused by something she ate. She has also noticed darkening o... | Active chronic hepatitis B infection | {
"A": "Inactive chronic hepatitis B infection",
"B": "Acute hepatitis B infection",
"C": "Active chronic hepatitis B infection",
"D": "Alcoholic hepatitis"
} | step2&3 | C | [
"year old woman",
"physician",
"3 week history",
"generalized fatigue",
"mild fever",
"abdominal pain",
"nausea",
"attended",
"state fair",
"month",
"number",
"regional foods",
"caused",
"ate",
"urine",
"attributes to not drinking",
"water recently",
"type 2 diabetes mellitus",
"... |
A 5-year-old boy is brought to the emergency department for evaluation of a progressive rash that started 2 days ago. The rash began on the face and progressed to the trunk and extremities. Over the past week, he has had a runny nose, a cough, and red, crusty eyes. He immigrated with his family from Turkey 3 months ago... | Vitamin A supplementation | {
"A": "Oral acyclovir",
"B": "Vitamin A supplementation",
"C": "Reassurance and follow-up in 3 days",
"D": "Oral penicillin V"
} | step2&3 | B | [
"5 year old boy",
"brought",
"emergency department",
"evaluation",
"progressive rash",
"started 2 days",
"rash began",
"face",
"progressed",
"trunk",
"extremities",
"past week",
"runny nose",
"cough",
"red",
"crusty eyes",
"family",
"Turkey",
"months",
"father",
"older brothe... |
A 7-year-old boy presents to the ER with progressive dysphagia over the course of 3 months and a new onset fever for the past 24 hours. The temperature in the ER was 39.5°C (103.1°F). There are white exudates present on enlarged tonsils (Grade 2). Routine blood work reveals a WBC count of 89,000/mm3, with the automatic... | CD 19 | {
"A": "CD 8",
"B": "CD 7",
"C": "CD 19",
"D": "CD 5"
} | step1 | C | [
"year old boy presents",
"ER",
"progressive dysphagia",
"course",
"months",
"new onset fever",
"past 24 hours",
"temperature",
"ER",
"white exudates present",
"enlarged tonsils",
"Grade 2",
"Routine blood work reveals",
"WBC count",
"mm3",
"automatic differential",
"high",
"90",
... |
A 74-year-old man presents to the emergency department with sudden onset of abdominal pain that is most felt around the umbilicus. The pain began 16 hours ago and has no association with meals. He has not been vomiting, but he has had several episodes of bloody loose bowel movements. He was hospitalized 1 week ago for ... | Acute mesenteric ischemia | {
"A": "Colonic ischemia",
"B": "Acute mesenteric ischemia",
"C": "Peptic ulcer disease",
"D": "Irritable bowel syndrome"
} | step2&3 | B | [
"74 year old man presents",
"emergency department",
"sudden",
"abdominal",
"most felt",
"umbilicus",
"pain began",
"hours",
"association",
"meals",
"not",
"vomiting",
"several episodes of bloody loose bowel movements",
"hospitalized 1 week",
"acute myocardial infarction",
"diabetes mel... |
A 33-year-old woman, gravida 2, para 1, at 26 weeks' gestation comes to the emergency department because of frequent contractions. The contractions are 40 seconds each, occurring every 2 minutes, and increasing in intensity. Her first child was delivered by lower segment transverse cesarean section because of a nonreas... | Allow vaginal delivery | {
"A": "Perform cesarean delivery",
"B": "Allow vaginal delivery",
"C": "Perform dilation and evacuation",
"D": "Initiate nifedipine therapy"
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"emergency department",
"frequent contractions",
"contractions",
"40 seconds",
"occurring",
"2 minutes",
"increasing",
"intensity",
"first child",
"delivered",
"lower segment transverse cesarean",
"fetal heart rate",
"c... |
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