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 57-year-old immigrant from Nigeria presents to the emergency department for sudden, severe pain and swelling in her lower extremity. She was at a rehabilitation hospital when her symptoms became apparent. The patient has a past medical history of obesity, diabetes, bipolar disorder, and tonic-clonic seizures. Her cur... | Nephrotic syndrome | {
"A": "Factor V Leiden",
"B": "Prothrombin gene mutation",
"C": "Liver failure",
"D": "Nephrotic syndrome"
} | step2&3 | D | [
"57 year old immigrant",
"Nigeria presents",
"emergency department",
"sudden",
"severe",
"swelling",
"lower extremity",
"rehabilitation hospital",
"symptoms",
"apparent",
"patient",
"past medical",
"diabetes",
"bipolar disorder",
"tonic-clonic seizures",
"current medications include me... |
A 41-year-old woman presents to the emergency room with chest pain. She has had progressive substernal chest pain accompanied by weakness and mild shortness of breath for the past 2 hours. Her past medical history is notable for poorly controlled systemic lupus erythematosus (SLE), Sjogren syndrome, and interstitial lu... | QRS complex height variation | {
"A": "ST elevations in leads II, III, and aVF",
"B": "Polymorphic P waves",
"C": "Wide QRS complexes with no P waves",
"D": "QRS complex height variation"
} | step1 | D | [
"year old woman presents",
"emergency room",
"chest pain",
"progressive substernal chest pain",
"weakness",
"mild shortness of breath",
"past",
"hours",
"past medical history",
"notable",
"poorly controlled systemic lupus erythematosus",
"Sjogren syndrome",
"interstitial lung disease",
"ho... |
A 14-year-old girl is brought to the emergency department because of a 3-day history of worsening confusion, high-grade fever, and a productive cough. She has had recurrent respiratory infections and bulky, foul-smelling, oily stools since infancy. She is at the 14th percentile for height and 8th percentile for weight.... | Deletion of phenylalanine codon on chromosome 7 | {
"A": "Deletion of phenylalanine codon on chromosome 7",
"B": "Mutation of DNAI1 gene on chromosome 9",
"C": "Deficiency in apolipoprotein B-48",
"D": "Deficiency in alpha-1 antitrypsin"
} | step1 | A | [
"year old girl",
"brought",
"emergency department",
"of",
"3-day history",
"worsening confusion",
"high-grade fever",
"productive cough",
"recurrent respiratory infections",
"bulky",
"foul-smelling",
"oily stools",
"infancy",
"percentile",
"height",
"percentile",
"weight",
"appropr... |
A 25-year-old woman presents to a physician for a new patient physical exam. Aside from occasional shin splints, she has a relatively unremarkable medical history. She takes oral contraceptive pills as scheduled and a multivitamin daily. She reports no known drug allergies. All of her age appropriate immunizations are ... | Colonoscopy in 5 years | {
"A": "Colonoscopy in 5 years",
"B": "Colonoscopy in 10 years",
"C": "Pap smear with human papillomavirus (HPV) DNA testing now",
"D": "Pap smear in 5 years"
} | step2&3 | A | [
"year old woman presents",
"physician",
"new patient",
"occasional shin splints",
"unremarkable medical history",
"takes oral contraceptive pills",
"scheduled",
"multivitamin daily",
"reports",
"known drug allergies",
"age appropriate immunizations",
"date",
"periods",
"regular",
"occurr... |
A 35-year-old computer programmer presents to the psychiatrist at the request of his mother for his oddities. He explains that he wears an aluminum foil cap while he works because he does not want extraterrestial life to steal his thoughts. He spends his free time building a radio transmitter to contact distant planets... | Schizotypal | {
"A": "Schizoid",
"B": "Schizotypal",
"C": "Paranoid",
"D": "Borderline"
} | step1 | B | [
"35 year old computer programmer presents",
"psychiatrist",
"request",
"mother",
"oddities",
"aluminum foil cap",
"works",
"not",
"life to steal",
"thoughts",
"spends",
"free time building",
"radio transmitter to contact distant planets",
"denies",
"delusions",
"hallucinations",
"wro... |
A 45-year-old homeless man is brought to the emergency department after he was found unconscious at the park. The patient's past medical history is unknown; however, he was admitted to the emergency department 2 times over the past year for severe pain treated with hydromorphone and IV fluids. His temperature is 100°F ... | Parvovirus B19 infection | {
"A": "Benign genetic carrier condition",
"B": "Iron deficiency",
"C": "Parvovirus B19 infection",
"D": "Vitamin B12 deficiency"
} | step2&3 | C | [
"year old homeless man",
"brought",
"emergency department",
"found unconscious",
"park",
"patient's past",
"unknown",
"admitted",
"emergency department 2 times",
"past year",
"severe pain treated with hydromorphone",
"IV fluids",
"temperature",
"blood pressure",
"97 48 mmHg",
"pulse",
... |
A 48-year-old patient with congestive heart failure is brought into the emergency room after an attempted suicide. He was found by his daughter whom he lives with while trying to suffocate himself. He had recently moved in with his daughter after his house went into foreclosure. The daughter lives in a small two-bedroo... | Having a support system | {
"A": "Having a support system",
"B": "Lack of access to sharp objects",
"C": "Lack of illicit drug use",
"D": "Lack of immediate family history of suicide"
} | step1 | A | [
"48 year old patient",
"congestive heart failure",
"brought",
"emergency room",
"attempted suicide",
"found",
"daughter",
"lives",
"suffocate",
"recently moved",
"daughter",
"house",
"daughter lives in",
"small two bedroom apartment",
"recently baby proofed",
"daughter",
"cares",
"... |
A 52-year-old woman complains of severe vomiting for the past 2 hours. She recently had a chemotherapy session for breast cancer. She denies a history of any relevant gastrointestinal diseases, including GERD. The physical exam does not demonstrate any epigastric or abdominal tenderness. The last bowel movement was yes... | 5-HT3 blocker | {
"A": "D1 blocker",
"B": "5-HT4 blocker",
"C": "5-HT1 blocker",
"D": "5-HT3 blocker"
} | step1 | D | [
"year old woman",
"severe vomiting",
"past",
"hours",
"recently",
"chemotherapy session",
"breast",
"denies",
"history of",
"relevant gastrointestinal diseases",
"including GERD",
"physical exam",
"not",
"epigastric",
"abdominal tenderness",
"last bowel movement",
"normal",
"primar... |
A 25-year-old male visits his primary care physician with complaints of hemoptysis and dysuria. Serum blood urea nitrogen and creatinine are elevated, blood pressure is 160/100 mm Hg, and urinalysis shows hematuria and RBC casts. A 24-hour urine excretion yields 1 gm/day protein. A kidney biopsy is obtained, and immuno... | Anti-glomerular basement membrane antibody (Anti-GBM) | {
"A": "Anti-DNA antibody",
"B": "Anti-neutrophil cytoplasmic antibody (C-ANCA)",
"C": "Anti-neutrophil perinuclear antibody (P-ANCA)",
"D": "Anti-glomerular basement membrane antibody (Anti-GBM)"
} | step1 | D | [
"year old male visits",
"primary care physician",
"complaints",
"hemoptysis",
"dysuria",
"Serum blood urea nitrogen",
"creatinine",
"elevated",
"blood pressure",
"100 mm Hg",
"urinalysis shows hematuria",
"RBC casts",
"hour urine excretion",
"1 gm day protein",
"kidney biopsy",
"obtain... |
A 31-year-old woman with multiple sclerosis comes to the physician because of a 4-day history of cramps in her left leg. Physical examination shows flexion of the left hip and increased tone in the thigh muscles. A local anesthetic block of which of the following nerves would most likely improve this patient's conditio... | Femoral nerve | {
"A": "Obturator nerve",
"B": "Inferior gluteal nerve",
"C": "Femoral nerve",
"D": "Superior gluteal nerve"
} | step1 | C | [
"31 year old woman",
"multiple sclerosis",
"physician",
"4-day history",
"cramps",
"left leg",
"Physical examination shows flexion",
"left hip",
"increased tone",
"thigh muscles",
"local anesthetic block",
"following nerves",
"most likely",
"patient's condition",
"most"
] |
A 64-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and type II diabetes presents to his primary care physician with increasing shortness of breath and ankle swelling over the past month. Which of the following findings is more likely to be seen in left-sided heart failure and le... | Basilar crackles on pulmonary auscultation | {
"A": "Increased ejection fraction on echocardiogram",
"B": "Basilar crackles on pulmonary auscultation",
"C": "Hepatojugular reflex",
"D": "Abdominal fullness"
} | step2&3 | B | [
"year",
"male",
"history of coronary artery disease",
"hypertension",
"hyperlipidemia",
"type II diabetes presents",
"primary care physician",
"increasing shortness of breath",
"ankle swelling",
"past month",
"following findings",
"more likely to",
"seen",
"left-sided heart failure",
"le... |
A 27-year-old woman, gravida 1, para 1, presents to the obstetrics and gynecology clinic because of galactorrhea, fatigue, cold intolerance, hair loss, and unintentional weight gain for the past year. She had placenta accreta during her first pregnancy with an estimated blood loss of 2,000 mL. Her past medical history ... | Sheehan’s syndrome | {
"A": "Addison’s disease",
"B": "Cushing syndrome",
"C": "Hashimoto thyroiditis",
"D": "Sheehan’s syndrome"
} | step2&3 | D | [
"27 year old woman",
"gravida 1",
"para 1",
"presents",
"obstetrics",
"gynecology clinic",
"galactorrhea",
"fatigue",
"cold intolerance",
"hair loss",
"unintentional weight gain",
"past year",
"placenta accreta",
"first pregnancy",
"estimated blood loss",
"mL",
"past medical history"... |
A 54-year-old man is referred to a tertiary care hospital with a history of 5 months of progressive difficulty in walking and left leg numbness. He first noticed mild gait unsteadiness and later developed gradual right leg weakness. His left leg developed progressive numbness and tingling. His blood pressure is 138/88 ... | Right hemi-spinal cord | {
"A": "Left hemi-spinal cord",
"B": "Right frontal lobe",
"C": "Right hemi-spinal cord",
"D": "Right pons"
} | step2&3 | C | [
"54 year old man",
"referred to",
"tertiary care hospital",
"history",
"months",
"progressive difficulty",
"walking",
"left",
"first",
"mild gait unsteadiness",
"later",
"gradual right",
"left leg",
"progressive numbness",
"tingling",
"blood pressure",
"88 mm Hg",
"heart rate",
"... |
An 18-year-old woman presents to the emergency department with severe right lower quadrant discomfort and stomach pain for the past day. She has no significant past medical history. She states that she is sexually active and uses oral contraceptive pills for birth control. Her vital signs include: blood pressure 127/81... | Ultrasound of the appendix | {
"A": "Pelvic exam",
"B": "Ultrasound of the pelvis",
"C": "Ultrasound of the appendix",
"D": "Upper gastrointestinal series"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"severe right lower quadrant discomfort",
"stomach pain",
"past day",
"significant past medical history",
"states",
"sexually active",
"uses oral contraceptive pills for birth control",
"vital signs include",
"blood pressure",
"81 mm Hg",
"p... |
A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How wou... | Reliable | {
"A": "Valid",
"B": "Reliable",
"C": "Biased",
"D": "Valid and reliable"
} | step1 | B | [
"A group",
"neurologists",
"new blood test",
"optimistic",
"test",
"found",
"given patient",
"test repeatedly",
"very similar results",
"find",
"new test results",
"not",
"consistent with",
"gold",
"diagnosis",
"new test",
"described"
] |
A 6-year-old boy presents with fever, sore throat, hoarseness, and neck enlargement. The symptoms started 3 days ago and progressed gradually with an elevated temperature and swollen lymph nodes. His family immigrated recently from Honduras. He was born via spontaneous vaginal delivery at 39 weeks after an uneventful g... | Eukaryotic elongation factor-2 (eEF-2) | {
"A": "ADP-ribosylation factor 6",
"B": "Eukaryotic elongation factor-2 (eEF-2)",
"C": "Desmoglein",
"D": "RNA polymerase II"
} | step1 | B | [
"year old boy presents",
"fever",
"sore throat",
"hoarseness",
"neck enlargement",
"symptoms started 3 days",
"progressed",
"elevated temperature",
"swollen lymph nodes",
"family",
"recently",
"Honduras",
"born",
"spontaneous vaginal delivery",
"39 weeks",
"gestational period",
"now"... |
A 45-year-old unconscious man is brought to the emergency department by a friend who witnessed him collapse. They were working in a greenhouse spraying the vegetables when the man started to complain of blurred vision and nausea. On the way to the hospital, the man lost consciousness and lost bladder continence. The pa... | Activation of M2-cholinergic receptors | {
"A": "Activation of M2-cholinergic receptors",
"B": "Inhibition of β1-adrenergic receptors",
"C": "Activation of M1-cholinergic receptors",
"D": "Inhibition of M2-cholinergic receptors"
} | step1 | A | [
"year old unconscious man",
"brought",
"emergency department",
"friend",
"witnessed",
"collapse",
"working",
"spraying",
"vegetables",
"man started to",
"blurred vision",
"nausea",
"hospital",
"man lost consciousness",
"lost bladder continence",
"patients vital signs",
"follows",
"... |
A 10-year-old boy is brought to the physician by his mother because of a 2-day history of fever and productive cough. He has had similar episodes sporadically in the past with frequent episodes of thick, discolored nasal discharge. Physical examination shows diffuse crackles and rhonchi. An x-ray of the chest is shown.... | Ciliated columnar cells | {
"A": "Alveolar macrophages",
"B": "Ciliated columnar cells",
"C": "Type I pneumocytes",
"D": "Type II pneumocytes"
} | step1 | B | [
"A 10 year old boy",
"brought",
"physician",
"mother",
"2-day history",
"fever",
"productive cough",
"similar episodes sporadically",
"past",
"frequent episodes of thick",
"discolored nasal discharge",
"Physical examination shows diffuse crackles",
"rhonchi",
"x-ray of",
"chest",
"show... |
A study is conducted in a hospital to estimate the prevalence of handwashing among healthcare workers. All of the hospital staff members are informed that the study is being conducted for 1 month, and the study method will be a passive observation of their daily routine at the hospital. A total of 89 medical staff memb... | Hawthorne effect | {
"A": "Observer-expectancy bias",
"B": "Berksonian bias",
"C": "Attrition bias",
"D": "Hawthorne effect"
} | step1 | D | [
"study",
"conducted",
"hospital to estimate",
"prevalence",
"handwashing",
"healthcare workers",
"hospital staff members",
"informed",
"study",
"conducted",
"month",
"study method",
"passive observation",
"daily routine",
"hospital",
"total",
"medical staff members give",
"consent"... |
A 59-year-old man with angina pectoris comes to the physician because of a 6-month history of shortness of breath on exertion that improves with rest. He has hypertension and hyperlipidemia. Current medications include aspirin, metoprolol, and nitroglycerine. Echocardiography shows left ventricular septal and apical hy... | Hibernating myocardium | {
"A": "Unstable angina pectoris",
"B": "Stress cardiomyopathy",
"C": "Hibernating myocardium",
"D": "Cardiac remodeling"
} | step1 | C | [
"59 year old man",
"angina pectoris",
"physician",
"of",
"month history",
"shortness",
"breath",
"exertion",
"improves",
"rest",
"hypertension",
"hyperlipidemia",
"Current medications include aspirin",
"metoprolol",
"nitroglycerine",
"Echocardiography shows left ventricular septal",
... |
A 25-year-old woman is brought to the emergency department 12 hours after ingesting 30 tablets of an unknown drug in a suicide attempt. The tablets belonged to her father, who has a chronic heart condition. She has had nausea and vomiting. She also reports blurring and yellowing of her vision. Her temperature is 36.7°C... | Increased serum K+ | {
"A": "Increased serum Na+",
"B": "Decreased serum K+",
"C": "Decreased serum Na+",
"D": "Increased serum K+"
} | step1 | D | [
"year old woman",
"brought",
"emergency department 12 hours",
"ingesting 30 tablets",
"unknown drug",
"suicide attempt",
"tablets",
"father",
"chronic heart",
"nausea",
"vomiting",
"reports blurring",
"yellowing",
"vision",
"temperature",
"36",
"pulse",
"min",
"blood pressure",
... |
A 78-year-old man presents with fatigue and exertional dyspnea. The patient says that symptoms onset gradually 4 weeks ago and have not improved. He denies any history of anemia or nutritional deficiency. Past medical history is significant for ST-elevation myocardial infarction 6 months ago, status post coronary arter... | Anemia of chronic disease | {
"A": "Iron deficiency anemia",
"B": "Hemolytic anemia",
"C": "Anemia of chronic disease",
"D": "Thalassemia"
} | step1 | C | [
"year old man presents",
"fatigue",
"exertional dyspnea",
"patient",
"symptoms onset",
"weeks",
"not improved",
"denies",
"history of anemia",
"nutritional deficiency",
"Past medical history",
"significant",
"ST-elevation myocardial infarction",
"months",
"coronary artery bypass graft",
... |
A 72-year-old man presents to the emergency department after a fall. The patient was found lying down on the floor in his room in his retirement community. The patient has a past medical history of Alzheimer dementia and a prosthetic valve. His current medications include donepezil and warfarin. His temperature is 97.7... | CT scan | {
"A": "CT scan",
"B": "Exploratory laparoscopy",
"C": "Exploratory laparotomy",
"D": "Fresh frozen plasma"
} | step2&3 | A | [
"72 year old man presents",
"emergency department",
"fall",
"patient",
"found lying",
"floor",
"room",
"retirement community",
"patient",
"past medical Alzheimer dementia",
"prosthetic valve",
"current medications include donepezil",
"warfarin",
"temperature",
"97",
"36",
"blood pres... |
A 46-year-old woman presents to her primary care physician for her annual examination. At her prior exam one year earlier, she had a Pap smear which was within normal limits. Which of the following health screenings is recommended for this patient? | Blood glucose and/or HbA1c screening | {
"A": "Blood glucose and/or HbA1c screening",
"B": "Yearly Pap smear",
"C": "Bone mineral density screening",
"D": "Colorectal screening"
} | step2&3 | A | [
"year old woman presents",
"primary care physician",
"annual examination",
"prior exam one year earlier",
"Pap smear",
"normal limits",
"following health screenings",
"recommended",
"patient"
] |
A 75-year-old woman comes to the physician because of a 3-month history of involuntary weight loss and a painless lump on her neck. Physical examination shows a firm, irregular swelling on the right side of the neck. Ultrasonography of the thyroid gland shows a 2-cm nodule with irregular margins and microcalcifications... | Negative staining of tumor cells for thyroglobulin | {
"A": "Negative staining of tumor cells for thyroglobulin",
"B": "Reduced number of functional thyroid cells",
"C": "Disorganized proliferation of mature thyroid cells",
"D": "Increased expression of thyroid transcription factor-1"
} | step1 | A | [
"75 year old woman",
"physician",
"of",
"3 month history",
"involuntary weight loss",
"painless lump on",
"neck",
"Physical examination shows",
"firm",
"irregular swelling",
"right side of",
"neck",
"Ultrasonography",
"thyroid gland shows",
"2",
"nodule",
"irregular margins",
"micr... |
A 13-year-old boy with a history of asthma and seasonal allergies is currently using albuterol to manage his asthma symptoms. Recently, his use of albuterol increased from 1–2 days/week to 4 times/week over the past several weeks, though he does not experience his symptoms daily. The vital signs include: temperature 36... | Add fluticasone daily | {
"A": "Add salmeterol twice daily",
"B": "Add fluticasone daily",
"C": "Add formoterol + budesonide twice daily",
"D": "Add tiotropium"
} | step2&3 | B | [
"year old boy",
"history of asthma",
"seasonal allergies",
"currently using albuterol to",
"asthma symptoms",
"Recently",
"use of albuterol increased",
"days/week",
"4 times/week",
"past",
"weeks",
"not experience",
"symptoms daily",
"vital signs include",
"temperature 36",
"98",
"bl... |
A 32-year-old woman comes to her physician because of increasing back pain for the past 10 months. The pain is worse in the morning when she wakes up and improves with activity. She used to practice yoga, but stopped 5 months ago as bending forward became increasingly difficult. She has also had bilateral hip pain for ... | HLA-B27 positive genotype | {
"A": "HLA-B27 positive genotype",
"B": "Presence of anti-dsDNA antibodies",
"C": "High levels of creatine phosphokinase",
"D": "Presence of anti-Ro and anti-La antibodies"
} | step2&3 | A | [
"year old woman",
"physician",
"of increasing back pain",
"past 10 months",
"pain",
"worse",
"morning",
"wakes up",
"improves",
"activity",
"used to practice yoga",
"stopped 5 months",
"bending forward",
"difficult",
"bilateral hip pain",
"past",
"months",
"not",
"change",
"uri... |
A 65-year-old G2P2 presents to her physician for a routine gynecologic check-up. She has been menopausal since 54 years of age, but has not been on hormone replacement therapy. Both pregnancies and deliveries were uneventful. Her husband has been her only sexual partner for the past 30 years. At 45 years of age she und... | Discontinuing screening in this patient should be considered | {
"A": "Pap smear and HPV co-testing should be performed every 5 years",
"B": "The Pap smear should be repeated every 3 years",
"C": "Discontinuing screening in this patient should be considered",
"D": "Pap smears should be repeated every 5 years"
} | step2&3 | C | [
"65 year old",
"presents",
"physician",
"routine gynecologic check-up",
"menopausal",
"54 years",
"age",
"not",
"hormone replacement therapy",
"pregnancies",
"deliveries",
"husband",
"only sexual partner",
"past 30 years",
"years",
"age",
"myomectomy",
"submucosal uterine",
"neve... |
A 38-year-old woman undergoes a diagnostic hysteroscopy for a 6-month history of small volume intermenstrual bleeding with no other complaints. There is no history of pelvic pain, painful intercourse, or vaginal discharge other than blood. During the procedure, a red beefy pedunculated mass is seen arising from the end... | Endometrial polyp | {
"A": "Endometrial polyp",
"B": "Endometrial carcinoma",
"C": "Uterine adenomyosis",
"D": "Endometrial hyperplasia"
} | step1 | A | [
"year old woman",
"diagnostic hysteroscopy",
"month history of small volume intermenstrual bleeding",
"complaints",
"history",
"pelvic pain",
"painful intercourse",
"vaginal discharge",
"blood",
"procedure",
"red beefy pedunculated mass",
"seen arising",
"endometrium of",
"anterior wall",
... |
A 63-year-old man with a history of hypertension and atrial fibrillation is brought into the emergency room and found to have a ventricular tachyarrhythmia. Ibutilide is discontinued and the patient is switched to another drug that also prolongs the QT interval but is associated with a decreased risk of torsades de poi... | Amiodarone | {
"A": "Digoxin",
"B": "Esmolol",
"C": "Amiodarone",
"D": "Quinidine"
} | step1 | C | [
"63 year old man",
"history of hypertension",
"atrial fibrillation",
"brought",
"emergency room",
"found to",
"ventricular tachyarrhythmia",
"Ibutilide",
"discontinued",
"patient",
"switched",
"drug",
"QT interval",
"associated with",
"decreased risk",
"torsades de pointes",
"drug",
... |
A 45-year-old-man presents to the physician with complaints of intermittent episodes of severe headaches and palpitations. During these episodes, he notices that he sweats profusely and becomes pale in complexion. He describes the episodes as coming and going within the past 2 months. His temperature is 99.3°F (37.4°C)... | Phenoxybenzamine | {
"A": "Phenoxybenzamine",
"B": "Pilocarpine",
"C": "Prazosin",
"D": "Propanolol"
} | step1 | A | [
"year old man presents",
"physician",
"complaints of intermittent episodes",
"severe headaches",
"palpitations",
"episodes",
"sweats",
"pale",
"complexion",
"episodes",
"past",
"months",
"temperature",
"99",
"4C",
"blood pressure",
"mmHg",
"pulse",
"min",
"respirations",
"min... |
A 57-year-old woman presents to her physician’s office because she is coughing up blood. She says that she first observed a somewhat reddish sputum a few months ago. However, over the past couple of weeks, the amount of blood she coughs has significantly increased. She has been smoking for the past 30 years. She says t... | Chest radiograph | {
"A": "Chest radiograph",
"B": "CT scan",
"C": "Endoscopy",
"D": "Bronchoscopy"
} | step2&3 | A | [
"57 year old woman presents",
"physicians office",
"coughing up blood",
"first observed",
"somewhat",
"sputum",
"few months",
"past couple",
"weeks",
"amount",
"blood",
"coughs",
"increased",
"smoking",
"past 30 years",
"smokes",
"packs",
"cigarettes daily",
"not",
"fever",
"... |
A 72-year-old man presents to a physician with multiple skin lesions on his trunk, face, neck, and extremities. The lesions are painless, but they itch mildly. He mentions that 3 weeks ago, his skin was completely normal. The lesions developed all over his body just over the past few days. Although he says that he has ... | Adenocarcinoma of stomach | {
"A": "Glioblastoma multiforme",
"B": "Anaplastic astrocytoma",
"C": "Medullary carcinoma of thyroid",
"D": "Adenocarcinoma of stomach"
} | step1 | D | [
"72 year old man presents",
"physician",
"multiple skin lesions",
"trunk",
"face",
"neck",
"extremities",
"lesions",
"painless",
"itch mildly",
"3 weeks",
"skin",
"completely normal",
"lesions",
"body",
"past",
"days",
"lost",
"weight",
"weeks",
"history",
"symptoms",
"kn... |
A 37-year-old man comes to the physician because of increasing swelling and pain of his right knee for the past month. He has not had any trauma to the knee or previous problems with his joints. He has hypertension. His only medication is hydrochlorothiazide. He works as a carpet installer. He drinks two to three beers... | Prepatellar bursitis | {
"A": "Septic arthritis",
"B": "Prepatellar bursitis",
"C": "Osteoarthritis",
"D": "Osgood-Schlatter disease\n\""
} | step2&3 | B | [
"year old man",
"physician",
"increasing swelling",
"pain",
"right",
"past month",
"not",
"trauma",
"knee",
"previous problems",
"joints",
"hypertension",
"only medication",
"hydrochlorothiazide",
"works",
"carpet",
"drinks two",
"three beers daily",
"5 ft",
"tall",
"97 kg",
... |
A 25-year-old woman is brought to the physician by her husband because she has appeared increasingly agitated over the last week. She feels restless, has not been able to sleep well, and has been pacing around her house continuously in an attempt to relieve her symptoms. Two weeks ago, she was diagnosed with schizophre... | Akathisia | {
"A": "Restless legs syndrome",
"B": "Akathisia",
"C": "Inadequately treated schizophrenia",
"D": "Drug-induced mania"
} | step1 | B | [
"year old woman",
"brought",
"physician",
"husband",
"appeared",
"agitated",
"week",
"feels restless",
"not",
"able to sleep well",
"pacing",
"house",
"attempt to relieve",
"symptoms",
"Two weeks",
"diagnosed",
"schizophrenia",
"treatment",
"fluphenazine",
"initiated",
"Today... |
A 33-year-old female with bipolar disorder, well controlled with lithium, presents to your clinic. She would like to discuss pregnancy and her medication. She is in a committed monogamous relationship and because her symptoms are well-controlled, would like to become pregnant. She is worried that her folate levels migh... | Discontinue the lithium | {
"A": "Discontinue the lithium",
"B": "Switch to lamotrigine for the 1st trimester",
"C": "The fetus will be at risk for neural tube defects",
"D": "She can be maintained on valproate instead"
} | step1 | A | [
"year old female",
"bipolar disorder",
"well controlled",
"lithium",
"presents",
"clinic",
"to discuss pregnancy",
"medication",
"committed monogamous relationship",
"symptoms",
"well-controlled",
"to",
"pregnant",
"worried",
"folate levels",
"low",
"taking multivitamins",
"day",
... |
A 60-year-old patient presents to the urgent care clinic with complaints of pain and abdominal distention for the past several weeks. The pain began with a change in bowel habits 3 months ago, and he gradually defecated less until he became completely constipated, which led to increasing pain and distention. He also me... | Sigmoid colon | {
"A": "Small bowel",
"B": "Ascending colon",
"C": "Cecum",
"D": "Sigmoid colon"
} | step1 | D | [
"60 year old patient presents",
"urgent care clinic",
"complaints",
"pain",
"abdominal distention",
"past",
"weeks",
"pain began",
"change",
"bowel habits",
"months",
"less",
"completely constipated",
"led",
"increasing pain",
"distention",
"lost weight",
"period",
"not changed",... |
A 45-year-old man comes to the clinic concerned about his recent exposure to radon. He heard from his co-worker that radon exposure can cause lung cancer. He brings in a study concerning the risks of radon exposure. In the study, there were 300 patients exposed to radon, and 18 developed lung cancer over a 10-year peri... | 63.3% | {
"A": "0.31%",
"B": "2.2%",
"C": "3.8%",
"D": "63.3%"
} | step2&3 | D | [
"year old man",
"clinic concerned",
"recent exposure",
"radon",
"heard",
"co worker",
"radon exposure",
"cause lung cancer",
"study concerning",
"risks",
"radon exposure",
"study",
"300 patients exposed",
"radon",
"lung cancer",
"10 year period",
"To compare",
"500 patients",
"ra... |
A 79-year-old woman with type 2 diabetes mellitus and hypertension undergoes 99mTc cardiac scintigraphy for the evaluation of a 3-month history of retrosternal chest tightness on exertion. The patient's symptoms are reproduced following the administration of dipyridamole. A repeat ECG shows new ST depression and T wave... | Dilation of coronary vasculature | {
"A": "Transient atrioventricular nodal blockade",
"B": "Reduced left ventricular preload",
"C": "Dilation of coronary vasculature",
"D": "Ruptured cholesterol plaque within a coronary vessel"
} | step1 | C | [
"year old woman",
"type 2 diabetes mellitus",
"hypertension",
"cardiac scintigraphy",
"evaluation of",
"month history",
"retrosternal chest tightness",
"exertion",
"patient's symptoms",
"following",
"administration of dipyridamole",
"repeat ECG shows new ST depression",
"T wave inversion",
... |
A 9-year-old healthy female presents to her pediatrician for a healthy child visit. She is doing well in school and has good relationships with her teachers, friends, and family. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 85/min, and respirations are 16/min. On examination, a minimal amou... | Tanner stage 2 | {
"A": "Tanner stage 1",
"B": "Tanner stage 2",
"C": "Tanner stage 3",
"D": "Tanner stage 4"
} | step1 | B | [
"year old healthy female presents",
"pediatrician",
"healthy child visit",
"well",
"school",
"good relationships",
"teachers",
"friends",
"family",
"temperature",
"98",
"blood pressure",
"70 mmHg",
"pulse",
"85 min",
"respirations",
"min",
"examination",
"minimal amount of pubic ... |
A 10-year-old boy is brought to his pediatrician over concern for a 2-month history of headaches. Recently, the patient has been experiencing nausea and vomiting, along with some difficulty with coordination during soccer practice last week. On exam, the patient's temperature is 98.2°F (36.8°C), blood pressure is 110/8... | Ependymal cells | {
"A": "Ependymal cells",
"B": "Melanocytes",
"C": "Microglia",
"D": "Schwann cells"
} | step1 | A | [
"A 10 year old boy",
"brought",
"pediatrician",
"concern",
"2 month history of headaches",
"Recently",
"patient",
"experiencing nausea",
"vomiting",
"difficulty",
"coordination",
"soccer practice last week",
"exam",
"patient's temperature",
"98",
"36",
"blood pressure",
"80 mmHg",
... |
A 42-year-old woman with hypertension comes to the physician because of a 2-month history of persistent reddening of her face, daytime fatigue, and difficulty concentrating. She has fallen asleep multiple times during important meetings. Her only medication is lisinopril. She is 170 cm (5 ft 7 in) tall and weighs 88 kg... | Increased erythropoietin production | {
"A": "Antibody-mediated vasculopathy",
"B": "Increased cortisol levels",
"C": "Increased bradykinin production",
"D": "Increased erythropoietin production"
} | step1 | D | [
"year old woman",
"hypertension",
"physician",
"2 month history",
"persistent",
"face",
"daytime fatigue",
"difficulty concentrating",
"fallen asleep multiple times",
"important meetings",
"only medication",
"lisinopril",
"5 ft",
"tall",
"88 kg",
"BMI",
"30 kg/m2",
"blood pressure"... |
Two-hours into recovery from general anesthesia for an orthopedic fracture, a 34-year-old woman develops fever and masseter muscle rigidity with lockjaw. She has no history of a similar episode. She has no history of serious illness and takes no medications. She appears confused. In the recovery room, her blood pressur... | Dantrolene | {
"A": "Cyproheptadine",
"B": "Dantrolene",
"C": "Labetalol",
"D": "Lorazepam"
} | step2&3 | B | [
"Two hours",
"recovery",
"general anesthesia",
"orthopedic fracture",
"year old woman",
"fever",
"masseter",
"lockjaw",
"history of",
"similar episode",
"history",
"serious illness",
"takes",
"medications",
"appears confused",
"recovery room",
"blood pressure",
"50 mm Hg",
"pulse... |
A 62-year-old female with a history of uncontrolled hypertension undergoes kidney transplantation. One month following surgery she has elevated serum blood urea nitrogen and creatinine and the patient complains of fever and arthralgia. Her medications include tacrolimus and prednisone. If the patient were experiencing ... | Lymphocytic infiltrate of the tubules and interstitium | {
"A": "Sloughing of proximal tubular epithelial cells",
"B": "Lymphocytic infiltrate of the tubules and interstitium",
"C": "Drug precipitation in the renal tubules",
"D": "Granular immunofluorescence around the glomerular basement membrane"
} | step1 | B | [
"62 year old female",
"history of uncontrolled hypertension",
"kidney transplantation",
"One month following surgery",
"elevated serum blood urea nitrogen",
"creatinine",
"patient",
"fever",
"arthralgia",
"medications include tacrolimus",
"prednisone",
"patient",
"experiencing acute",
"cel... |
A 28-year-old graduate student visits the university health clinic for 3-weeks of epigastric pain that worsens with meals, associated with retrosternal pain, early satiety, and bloating. She denies vomiting blood or blood in her stool. She has been consuming large volumes of caffeinated-drinks and fast-food for a month... | Fecal antigen testing for Helicobacter pylori | {
"A": "Upper endoscopy",
"B": "Barium swallow radiograph",
"C": "Fecal antigen testing for Helicobacter pylori",
"D": "Treatment with metoclopramide"
} | step2&3 | C | [
"year old graduate student visits",
"university health clinic",
"weeks",
"epigastric",
"worsens",
"meals",
"associated with retrosternal pain",
"early satiety",
"bloating",
"denies vomiting blood",
"blood in",
"stool",
"large volumes",
"drinks",
"fast-food",
"month",
"studying",
"t... |
A 54-year-old man comes to the physician because of dysphagia and hoarseness of voice for the past 3 months. Initially, he had difficulty swallowing solid food but now has difficulty swallowing porridge and liquids as well. He has recently been choking on his oral secretions. During this period, he has had an 8.2-kg (1... | Destruction of upper and lower motor neurons | {
"A": "Destruction of upper and lower motor neurons",
"B": "Dilation of the central spinal canal",
"C": "Demyelination of peripheral nerves",
"D": "Autoimmune destruction of acetylcholine receptors"
} | step2&3 | A | [
"54 year old man",
"physician",
"dysphagia",
"hoarseness of voice",
"past 3 months",
"Initially",
"difficulty swallowing solid food",
"now",
"difficulty swallowing porridge",
"liquids",
"well",
"recently",
"choking on",
"oral secretions",
"period",
"kg",
"weight loss",
"increasing ... |
A 63-year-old man with non-Hodgkin lymphoma is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He also has a 3-day history of loose stools. He returned from France 2 weeks ago where he stayed in the countryside and ate typical French cuisine, inc... | Vancomycin, ampicillin, and cefepime | {
"A": "Ampicillin and cefotaxime",
"B": "Acyclovir and dexamethasone",
"C": "Acyclovir",
"D": "Vancomycin, ampicillin, and cefepime"
} | step2&3 | D | [
"63 year old man",
"non-Hodgkin lymphoma",
"brought",
"emergency department",
"fever",
"confusion",
"worsened",
"past 3 days",
"3-day history",
"loose stools",
"returned",
"France 2 weeks",
"countryside",
"ate typical French",
"including frog",
"snail",
"various",
"cheeses",
"las... |
A 28-year-old woman presents with a 12-month history of headache, tinnitus, retrobulbar pain, and photopsias. She says the headaches are mild to moderate, intermittent, diffusely localized, and refractory to nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, this past week, she began to have associated dizzine... | Elevated intracranial venous pressure | {
"A": "Arachnoid granulation adhesions",
"B": "Elevated intracranial venous pressure",
"C": "Increased cerebrospinal production",
"D": "Systemic hypertension"
} | step1 | B | [
"year old woman presents",
"month history of headache",
"tinnitus",
"retrobulbar pain",
"photopsias",
"headaches",
"mild to moderate",
"intermittent",
"localized",
"refractory to nonsteroidal anti-inflammatory drugs",
"In addition",
"past week",
"began to",
"associated dizziness",
"photo... |
A 1-month-old girl is brought to the physician for a follow-up examination. The mother has noticed that the girl's neck is always tilted to the right. She was delivered at term, and childbirth was complicated by a breech position. There is no family history of serious illness. She appears healthy. She is at 60th percen... | Stretching program | {
"A": "CT scan of the neck",
"B": "Botulinum toxin injection",
"C": "Stretching program",
"D": "Myotomy"
} | step2&3 | C | [
"month old girl",
"brought",
"physician",
"follow-up examination",
"mother",
"girl's neck",
"always tilted",
"right",
"delivered",
"term",
"childbirth",
"complicated",
"breech position",
"family history",
"serious illness",
"appears healthy",
"percentile",
"length",
"weight",
"... |
A 45-year-old Caucasian male with a history of chronic myeloid leukemia for which he is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. His serum creatinine is 3.0 mg/dL and is urine pH is 5.0. You diagnose nephrolithiasis. His kidney stones, however, are not visible on ... | Uric acid | {
"A": "Calcium oxalate",
"B": "Magnesium ammonium phosphate",
"C": "Uric acid",
"D": "Cystine"
} | step1 | C | [
"year old Caucasian male",
"history of chronic myeloid leukemia",
"receiving chemotherapy presents",
"emergency room",
"oliguria",
"colicky left flank pain",
"serum creatinine",
"3 0 mg/dL",
"urine pH",
"5 0",
"diagnose nephrolithiasis",
"kidney stones",
"not visible",
"abdominal x-ray",
... |
A 48-year-old man comes to the physician because of a skin lesion on his nose and in his mouth. The lesions have been gradually increasing in size and are not painful or pruritic. Two months ago, he was treated for esophageal candidiasis. Physical examination shows one pinkish-brown papule on the right wing of the nose... | Human herpes virus 8 | {
"A": "Polyomavirus",
"B": "Poxvirus",
"C": "Epstein-Barr virus",
"D": "Human herpes virus 8"
} | step1 | D | [
"48 year old man",
"physician",
"of",
"skin",
"nose",
"mouth",
"lesions",
"increasing in size",
"not painful",
"Two months",
"treated",
"esophageal candidiasis",
"Physical examination shows one",
"brown papule",
"right wing of",
"nose",
"two similar nodular lesions",
"hard palate",... |
A 3580-g (7-lb 14-oz) male newborn is delivered at 36 weeks' gestation to a 26-year-old woman, gravida 2, para 1 after an uncomplicated pregnancy. His temperature is 36.7°C (98.1°F), heart rate is 96/min, and respirations are 55/min and irregular. Pulse oximetry on room air shows an oxygen saturation of 65% measured in... | Administer positive pressure ventilation | {
"A": "Administer erythromycin ophthalmic ointment",
"B": "Administer positive pressure ventilation",
"C": "Perform endotracheal intubation",
"D": "Administer intravenous epinephrine"
} | step2&3 | B | [
"g",
"oz",
"male newborn",
"delivered",
"36 weeks",
"gestation",
"year old woman",
"gravida 2",
"para 1",
"uncomplicated pregnancy",
"temperature",
"36",
"98",
"heart rate",
"96 min",
"respirations",
"55 min",
"irregular",
"Pulse oximetry",
"room air shows",
"oxygen saturatio... |
A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previousl... | Genetic predisposition | {
"A": "Maternal obstetric complications",
"B": "Advanced paternal age",
"C": "Genetic predisposition",
"D": "Being married"
} | step2&3 | C | [
"29 year old man",
"physician",
"wife",
"change in",
"behavior",
"past 2 weeks",
"wife reports",
"very",
"irritable",
"voiced concerns",
"not",
"turning",
"work",
"husband",
"reliable",
"person",
"patient",
"feels",
"only needs 4 hours",
"sleep",
"night",
"wakes up cheerful... |
A 65-year-old man with decompensated cirrhosis secondary to hepatitis C is brought to the emergency department with 2 episodes of massive hematemesis that started 2 hours ago. He is a liver transplant candidate. The blood pressure is 110/85 mm Hg in the supine position and 90/70 mm Hg after sitting for 3 minutes. The p... | Octreotide | {
"A": "Fresh frozen plasma",
"B": "Octreotide",
"C": "Packed red blood cells (RBCs)",
"D": "Pantoprazole"
} | step2&3 | B | [
"65-year-old man",
"decompensated cirrhosis secondary to hepatitis C",
"brought",
"emergency department",
"2 episodes of massive hematemesis",
"started 2 hours",
"liver transplant candidate",
"blood pressure",
"85 mm Hg",
"supine position",
"90 70 mm Hg",
"sitting",
"3 minutes",
"pulse",
... |
A 55-year-old man presents to the emergency department with fatigue and a change in his memory. The patient and his wife state that over the past several weeks the patient has been more confused and irritable and has had trouble focusing. He has had generalized and non-specific pain in his muscles and joints and is con... | Heavy metal exposure | {
"A": "Guillain-Barre syndrome",
"B": "Heavy metal exposure",
"C": "Iron deficiency",
"D": "Systemic lupus erythematosus"
} | step2&3 | B | [
"55 year old man presents",
"emergency department",
"fatigue",
"change",
"memory",
"patient",
"wife state",
"past",
"weeks",
"patient",
"more confused",
"irritable",
"trouble focusing",
"generalized",
"non-specific pain",
"muscles",
"joints",
"constipated",
"temperature",
"99",... |
A previously healthy 25-year-old male comes to his primary care physician with a painless solitary lesion on his penis that developed 4 days ago. He has not experienced anything like this before. He is currently sexually active with multiple partners and uses condoms inconsistently. His temperature is 37.0°C (98.7°F), ... | Dark-field microscopy
" | {
"A": "Swab culture",
"B": "Rapid plasma reagin",
"C": "Fluorescent treponemal antibody absorption test",
"D": "Dark-field microscopy\n\""
} | step2&3 | D | [
"healthy",
"year old male",
"primary care physician",
"painless solitary",
"penis",
"4 days",
"not experienced",
"before",
"currently sexually active",
"multiple partners",
"uses condoms",
"temperature",
"98",
"pulse",
"67 min",
"respirations",
"min",
"blood pressure",
"70 mm Hg"... |
A 4-month-old is noted to have a grade 3/6, harsh, systolic ejection murmur heard at the left upper sternal border. The mother reports that the child's lips occasionally turn blue during feeding. A cardiologist recommends surgery. Later, the physician remarks that the infant's congenital abnormality was related to a fa... | Pulmonic stenosis | {
"A": "Atrial septal defect",
"B": "Pulmonic stenosis",
"C": "Coarctation of the aorta",
"D": "Transposition of the great vessels"
} | step1 | B | [
"4 month old",
"noted to",
"grade",
"6",
"harsh",
"systolic ejection murmur heard",
"left upper sternal border",
"mother reports",
"child's lips occasionally turn blue",
"feeding",
"cardiologist recommends surgery",
"Later",
"physician remarks",
"infant's congenital",
"related",
"failu... |
A 45-year-old man presents to the physician with complaints of burning pain in both feet and lower legs for 3 months. He reports that the pain is especially severe at night. He has a history of diabetes mellitus for the past 5 years, and he frequently skips his oral antidiabetic medications. His temperature is 36.9°C (... | Aδ & C fibers | {
"A": "Aα & Aβ fibers",
"B": "Aγ & B fibers",
"C": "Aδ & C fibers",
"D": "Aγ & C fibers"
} | step2&3 | C | [
"year old man presents",
"physician",
"complaints",
"burning pain",
"feet",
"lower legs",
"months",
"reports",
"pain",
"severe",
"night",
"history of diabetes mellitus",
"past",
"years",
"frequently skips",
"oral antidiabetic",
"temperature",
"36",
"98 4F",
"heart rate",
"80 ... |
A 31-year-old man presents with jaundice, scleral icterus, dark urine, and pruritus. He also says that he has been experiencing abdominal pain shortly after eating. He says that symptoms started a week ago and have not improved. The patient denies any associated fever or recent weight-loss. He is afebrile and vital sig... | Endoscopic retrograde cholangiopancreatography (ERCP) | {
"A": "Antibiotics and admit to observation",
"B": "HIDA scan",
"C": "Endoscopic retrograde cholangiopancreatography (ERCP)",
"D": "Serologies for antimitochondrial antibodies"
} | step1 | C | [
"31 year old man presents",
"jaundice",
"scleral icterus",
"dark urine",
"pruritus",
"experiencing abdominal",
"eating",
"symptoms started",
"week",
"not improved",
"patient denies",
"associated fever",
"recent weight-loss",
"afebrile",
"vital signs",
"normal limits",
"physical exami... |
A 5-year-old African-American boy is brought to the physician because of fatigue and night sweats for the past month. During this time, he has also lost 3 kg (6.6 lbs). Before the onset of symptoms, he had been healthy except for a febrile seizure as an infant. His brother had chickenpox 2 months ago. He is at the 75th... | Imatinib | {
"A": "Hydroxyurea",
"B": "Transfuse platelets",
"C": "Cladribine",
"D": "Imatinib"
} | step2&3 | D | [
"5 year old African-American boy",
"brought",
"physician",
"fatigue",
"night sweats",
"past month",
"time",
"lost 3 kg",
"6.6 lbs",
"onset",
"symptoms",
"healthy",
"febrile seizure",
"infant",
"brother",
"chickenpox",
"months",
"percentile",
"height",
"50th percentile",
"weig... |
A newborn infant with karyotype 46, XY has male internal and external reproductive structures. The lack of a uterus in this infant can be attributed to the actions of which of the following cell types? | Sertoli | {
"A": "Sertoli",
"B": "Theca",
"C": "Granulosa",
"D": "Reticularis"
} | step1 | A | [
"newborn infant",
"karyotype",
"XY",
"male internal",
"external reproductive structures",
"lack",
"uterus",
"infant",
"attributed",
"actions of",
"following cell types"
] |
A 32-year-old woman comes to the physician because of increasing muscle weakness in her shoulders and legs for 6 weeks. She is unable to climb stairs or comb her hair. She has also had difficulty swallowing food for the past week. Her symptoms do not improve with rest. Physical examination shows normal muscle tone. The... | Electromyography | {
"A": "Lumbar puncture",
"B": "Electromyography",
"C": "Tensilon test",
"D": "Temporal artery biopsy"
} | step2&3 | B | [
"year old woman",
"physician",
"of increasing muscle weakness",
"shoulders",
"legs",
"weeks",
"unable to climb stairs",
"comb",
"hair",
"difficulty swallowing food",
"past week",
"symptoms",
"not",
"rest",
"Physical examination shows normal muscle tone",
"bilateral weakness",
"iliops... |
A 5-year-old boy is brought by his mother to the emergency department with fever, sore throat, runny nose, and rash. The patient’s mother says that symptoms started 3 days ago and that the rash first appeared on his face before spreading. His past medical history is unremarkable. The patient’s family recently moved fro... | Single-stranded positive-sense RNA virus | {
"A": "Single-stranded positive-sense RNA virus",
"B": "Cocci in chains",
"C": "Double-stranded RNA virus",
"D": "Single-stranded RNA retrovirus"
} | step1 | A | [
"5 year old boy",
"brought",
"mother",
"emergency department",
"fever",
"sore throat",
"runny nose",
"rash",
"patients mother",
"symptoms started 3 days",
"rash first appeared",
"face",
"spreading",
"past medical history",
"unremarkable",
"patients family recently moved from Japan",
... |
A 4-year-old girl is brought to the doctor by her mother with the complaint of hearing loss, which her mother noticed a few days ago when the girl stopped responding to her name. The mother is anxious and says, “I want my child to get better even if it requires admission to the hospital.” Her family moved to a 70-year-... | Remove and prevent the child from exposure to the source of lead | {
"A": "Blood transfusion",
"B": "Chelation therapy if the blood lead level is more than 25 µg/dL",
"C": "Remove and prevent the child from exposure to the source of lead",
"D": "Treatment for hookworm"
} | step1 | C | [
"4 year old girl",
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"70 year old family home",
"Flint",
"Michigan",
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... |
A 58-year-old woman presents to her primary care physician with complaints of an aching pain and stiffness in her neck, shoulders, and hips for the past several months. She reports difficulty in rising from a seated position as well as in raising her arms above her head. The patient also states that she has had fatigue... | Elevated erythrocyte sedimentation rate and normal serum creatinine kinase | {
"A": "Normal erythrocyte sedimentation rate and normal serum creatinine kinase",
"B": "Elevated erythrocyte sedimentation rate and normal serum creatinine kinase",
"C": "Elevated erythrocyte sedimentation rate and elevated serum creatinine kinase",
"D": "Elevated serum C-reactive protein and normal erythrocyt... | step2&3 | B | [
"58 year old woman presents",
"primary care physician",
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"aching pain",
"stiffness",
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"shoulders",
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"months",
"reports difficulty",
"rising",
"seated position as well",
"arms",
"head",
"patient",
"states",
"fatigue",
"chronic fevers",
"past mo... |
A 70-year-old man with loose stools over the last 24 hours, accompanied by abdominal pain, cramps, nausea, and anorexia, was hospitalized. Previously, the man was diagnosed with a lung abscess and was treated with clindamycin for 5 days. Past medical history was significant for non-erosive antral gastritis and hyperten... | Glucosylation of Rho family GTPases | {
"A": "Glucosylation of Rho family GTPases",
"B": "Inactivation of elongation factor EF-2",
"C": "ADP-ribosylation of Gs-alpha subunit of G-protein coupled receptors",
"D": "Cell membrane degradation by lecithinase"
} | step1 | A | [
"70 year old man",
"loose stools",
"last 24 hours",
"abdominal pain",
"cramps",
"nausea",
"anorexia",
"hospitalized",
"man",
"diagnosed",
"lung abscess",
"treated with clindamycin",
"5 days",
"Past medical history",
"significant",
"non antral gastritis",
"hypertension",
"takes esom... |
A 23-year-old man is admitted to the intensive care unit with acute respiratory distress syndrome (ARDS) due to influenza A. He has no history of serious illness and does not smoke. An x-ray of the chest shows diffuse bilateral infiltrates. Two weeks later, his symptoms have improved. Pulmonary examination on discharge... | Interstitial lung disease | {
"A": "Interstitial lung disease",
"B": "Spontaneous pneumothorax",
"C": "Panacinar emphysema",
"D": "Asthma"
} | step1 | A | [
"23 year old man",
"admitted to",
"intensive care unit",
"acute respiratory distress syndrome",
"due to influenza A",
"history",
"serious illness",
"not smoke",
"x-ray of",
"chest shows diffuse bilateral infiltrates",
"Two weeks later",
"symptoms",
"improved",
"Pulmonary examination",
"d... |
A 49-year-old African American female with a history of chronic myeloid leukemia for which she is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. Her serum creatinine is 3.3 mg/dL. What is the preferred preventative therapy that could have been administered to this patie... | Diuresis | {
"A": "Diuresis",
"B": "Acidification of the urine",
"C": "Colchicine",
"D": "Steroids"
} | step1 | A | [
"year old African American female",
"history of chronic myeloid leukemia",
"receiving chemotherapy presents",
"emergency room",
"oliguria",
"colicky left flank pain",
"serum creatinine",
"3.3 mg/dL",
"preferred preventative therapy",
"administered",
"patient to prevent",
"complication of chemo... |
A research consortium is studying a new vaccine for respiratory syncytial virus (RSV) in premature infants compared to the current standard of care. 1000 infants were randomized to either the new vaccine group or the standard of care group. In total, 520 receive the new vaccine and 480 receive the standard of care. Of ... | 3.75% | {
"A": "1.7%",
"B": "2.5%",
"C": "3.75%",
"D": "4.3%"
} | step1 | C | [
"research consortium",
"studying",
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"respiratory syncytial virus",
"premature infants compared",
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"infants",
"randomized",
"new vaccine group",
"standard of care group",
"total",
"520 receive",
"new vaccine",
"480 receive",
"standard of care",
"... |
A 71-year-old woman comes to her doctor because she is having trouble staying awake in the evening. Over the past year, she has noticed that she gets tired unusually early in the evenings and has trouble staying awake through dinner. She also experiences increased daytime sleepiness, fatigue, and difficulty concentrati... | Advanced sleep phase disorder | {
"A": "Advanced sleep phase disorder",
"B": "Depressive disorder",
"C": "Delayed sleep phase disorder",
"D": "Non-REM sleep arousal disorder"
} | step2&3 | A | [
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"PM",
"gets out",
"bed",
"2",
"3",
"not",
"trouble fall... |
A 63-year-old woman presents to the emergency department after being found unresponsive by her family. Upon presentation she is confused and does not answer questions that are addressed to her. An EKG is obtained and the result is provided here. Which of the following processes would be consistent with the findings see... | Acute kidney failure | {
"A": "Acute kidney failure",
"B": "Bundle branch conduction changes",
"C": "Failure of atrioventricular node conduction",
"D": "Interruption of pulmonary perfusion"
} | step1 | A | [
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"found unresponsive",
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"not answer questions",
"addressed",
"EKG",
"obtained",
"result",
"provided",
"following processes",
"consistent with",
"findings seen",
"patient's EKG"
] |
A 24-year-old woman, gravida 1, at 35 weeks gestation is admitted to the hospital with regular contractions and pelvic pressure for the last 5 hours. Her pregnancy has been uncomplicated and she has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing,... | No pharmacotherapy at this time | {
"A": "Magnesium sulfate",
"B": "Oxytocin",
"C": "Terbutaline",
"D": "No pharmacotherapy at this time"
} | step2&3 | D | [
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"35 weeks gestation",
"admitted",
"hospital",
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"hours",
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"prenatal appointments",
"followed",
"physician's advice",
"screening",
"diseases",
"laboratory testing",
"diet... |
Researchers are studying a farming community with a high incidence of acute myelogenous leukemia (AML). A retrospective cohort study is performed looking at the relationship between exposure to a certain pesticide chemical and the risk of developing AML. In 84 patients who developed AML, 17 had exposure to the pesticid... | Probability of AML among exposed (17/19) divided by probability of AML among unexposed (67/181) | {
"A": "Prevalence of cases (84/200) divided by prevalence of controls (116/200)",
"B": "Odds of exposure in the cases (17/67) divided by odds of exposure in the controls (2/114)",
"C": "Probability of AML among exposed (17/19) divided by probability of AML among unexposed (67/181)",
"D": "Total number of cases... | step1 | C | [
"Researchers",
"studying",
"farming community",
"high incidence",
"acute myelogenous leukemia",
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"performed looking",
"relationship",
"exposure to",
"certain pesticide chemical",
"risk",
"AML",
"84 patients",
"AML",
"exposure to",
"pesticide chemical",
"c... |
A 66-year-old man presents to his family physician complaining of a sandpaper-like sensation when he touches the lesion on his forehead. His medical history is relevant for hypertension and hypercholesterolemia, for which he is taking losartan and atorvastatin. He used to work as a gardener, but he retired 3 years ago.... | Squamous cell carcinoma | {
"A": "Basal cell carcinoma",
"B": "Squamous cell carcinoma",
"C": "Mycosis fungoides",
"D": "Seborrheic keratosis"
} | step2&3 | B | [
"66 year old man presents",
"family physician",
"sensation",
"touches",
"lesion",
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"hypertension",
"hypercholesterolemia",
"taking losartan",
"atorvastatin",
"used to work",
"gardener",
"retired 3 years",
"vital signs",
"normal limits",
"Ph... |
A 19-year-old woman comes to the physician because of episodic, bilateral finger pain and discoloration that occurs with cold weather. Her fingers first turn white, then blue, before eventually returning to a normal skin color. The symptoms have been occurring daily and limit her ability to work. She has no history of ... | Nifedipine | {
"A": "Phenylephrine",
"B": "Isosorbide dinitrate",
"C": "Nifedipine",
"D": "Ergotamine"
} | step1 | C | [
"year old woman",
"physician",
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"bilateral finger",
"discoloration",
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"fingers first turn white",
"then blue",
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"normal skin color",
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"occurring daily",
"limit",
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"history",
"serious illness",
"takes",
"... |
A 65-year-old man presents to the emergency department with a complaint of intense pain in his right foot for the past month, along with fever and chills. He denies any traumatic injury to his foot in recent memory. He has a medical history of poorly-controlled type II diabetes and is a former smoker with extensive per... | Staphylococcus aureus | {
"A": "Mycobacterium tuberculosis",
"B": "Neisseria gonorrhoeae",
"C": "Pasteurella multocida",
"D": "Staphylococcus aureus"
} | step1 | D | [
"65 year old man presents",
"emergency department",
"complaint",
"intense pain",
"right foot",
"past month",
"fever",
"chills",
"denies",
"traumatic",
"foot",
"recent memory",
"a medical history of poorly controlled type II diabetes",
"former smoker",
"extensive peripheral vascular disea... |
A 14-year-old girl with a history of severe persistent asthma presents to her pediatrician after a recent hospital discharge for asthma exacerbation. Her mother is concerned that her daughter continues to wheeze and cough multiple nights per week. She is also concerned that her daughter frequently uses the bathroom to ... | Omalizumab | {
"A": "Natalizumab",
"B": "Omalizumab",
"C": "Imatinib",
"D": "Nivolumab"
} | step1 | B | [
"year old girl",
"history of severe persistent asthma presents",
"pediatrician",
"recent hospital discharge",
"asthma exacerbation",
"mother",
"concerned",
"daughter continues to wheeze",
"cough multiple nights",
"week",
"concerned",
"daughter frequently uses",
"bathroom to",
"recent chang... |
A medical student is studying human physiology. She learns that there is a membrane potential across cell membranes in excitable cells. The differential distribution of anions and cations both inside and outside the cells significantly contributes to the genesis of the membrane potential. Which of the following distrib... | High concentration of Na+ outside the cell and high concentration of K+ inside the cell | {
"A": "High concentration of Na+ outside the cell and high concentration of K+ inside the cell",
"B": "High concentration of K+ outside the cell and low concentration of K+ inside the cell",
"C": "High concentration of Ca2+ outside the cell and high concentration of Cl- inside the cell",
"D": "Low concentratio... | step1 | A | [
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"studying human physiology",
"learns",
"membrane potential",
"cell membranes",
"excitable cells",
"differential distribution",
"anions",
"cations",
"outside",
"cells",
"contributes",
"genesis",
"membrane potential",
"following distributions",
"anions",
"cations bes... |
A 3-year-old African-American female presents to the emergency department with fatigue. Her parents endorse malaise and weakness on behalf of the patient for two weeks. Her temperature is 98.9°F (37.2°C), blood pressure is 94/70 mmHg, pulse is 102/min, and respirations are 22/min. On physical exam, she is tired-appeari... | Vitamin B9 | {
"A": "Vitamin B6",
"B": "Vitamin B9",
"C": "Vitamin D",
"D": "Iron"
} | step2&3 | B | [
"3 year old African-American female presents",
"emergency department",
"fatigue",
"parents",
"malaise",
"weakness",
"patient",
"two weeks",
"temperature",
"98 9F",
"blood pressure",
"70 mmHg",
"pulse",
"min",
"respirations",
"min",
"physical exam",
"tired appearing",
"conjunctiva... |
A 1-month-old male infant is brought to the physician because of inconsolable crying for the past 3 hours. For the past 3 weeks, he has had multiple episodes of high-pitched unprovoked crying every day that last up to 4 hours and resolve spontaneously. He was born at term and weighed 2966 g (6 lb 9 oz); he now weighs 3... | Reassurance | {
"A": "Administer simethicone",
"B": "Administer pantoprazole",
"C": "Reassurance",
"D": "Recommend the use of Gripe water"
} | step2&3 | C | [
"month old male infant",
"brought",
"physician",
"of inconsolable crying",
"past",
"hours",
"past",
"weeks",
"multiple episodes of high-pitched",
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"last",
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"term",
"g",
"oz",
"now",
"g",
"8",
"oz",
"breast fed",
"temperature",
... |
A 40-year-old man comes to the physician because of a 1-month history of a painless lump on his neck. Two years ago, he underwent surgery for treatment-resistant hypertension, episodic headaches, and palpitations. Physical examination shows a firm, irregular swelling on the right side of the neck. Ultrasonography of th... | Calcitonin | {
"A": "Calcitonin",
"B": "Gastrin",
"C": "Metanephrines",
"D": "Thyroid-stimulating hormone"
} | step1 | A | [
"40 year old man",
"physician",
"1-month history",
"painless lump",
"neck",
"Two years",
"surgery",
"treatment resistant hypertension",
"episodic headaches",
"palpitations",
"Physical examination shows",
"firm",
"irregular swelling",
"right side of",
"neck",
"Ultrasonography",
"thyro... |
A 16-year-old girl is brought to the physician because she has not yet had her 1st period. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and meeting all developmental milestones. She has no history of a serious illness and takes no medications. Physical examinati... | 46,XY | {
"A": "45,X",
"B": "46,XX",
"C": "46,XY",
"D": "47,XXY"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"not",
"1st period",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"history",
"serious illness",
"takes",
"medications",
"Physical examination shows underdeveloped breasts... |
A 64-year-old woman with osteoarthritis is brought to the emergency room because of a 2-day history of nausea and vomiting. Over the past few weeks, she has been taking acetaminophen frequently for worsening knee pain. Examination shows scleral icterus and tender hepatomegaly. She appears confused. Serum alanine aminot... | N-acetyl-p-benzoquinoneimine formation | {
"A": "Glucuronide-conjugate formation",
"B": "Salicylic acid formation",
"C": "N-acetyl-p-benzoquinoneimine formation",
"D": "N-acetylcysteine formation"
} | step1 | C | [
"64 year old woman",
"osteoarthritis",
"brought",
"emergency room",
"2-day history",
"nausea",
"vomiting",
"past",
"weeks",
"taking acetaminophen frequently",
"worsening knee pain",
"Examination shows scleral icterus",
"tender hepatomegaly",
"appears confused",
"Serum alanine aminotransf... |
A 7-year-old girl presents with a lump in her neck which she noticed a few days ago. The patient’s mother states that her daughter’s left eyelid seems to be drooping, making her left eye look small. There is no significant past medical history. On neurological examination, the patient has normal bilateral pupillary ref... | Deletion of short arm of chromosome 1 | {
"A": "Detectable levels of homovanillic acid (HVA) and/or vanillylmandelic acid (VMA) in urine",
"B": "Age younger than 18 months",
"C": "Absence of nodular pattern",
"D": "Deletion of short arm of chromosome 1"
} | step1 | D | [
"year old girl presents",
"lump",
"neck",
"few days",
"patients mother states",
"daughters left eyelid",
"to",
"making",
"left eye look small",
"significant past medical history",
"neurological examination",
"patient",
"normal bilateral pupillary reflexes",
"miotic left",
"lateral radiog... |
A 45-year-old man presents for a follow-up visit as part of his immigration requirements into the United States. Earlier this week, he was administered the Mantoux tuberculin skin test (TST). Today’s reading, 3 days after being administered the test, he shows an induration of 10 mm. Given his recent immigration from a ... | If the spinous process is not in-between the two clavicular heads, the image is repeated. | {
"A": "If the spinous process is not in-between the two clavicular heads, the image is repeated.",
"B": "The film is taken in a supine position.",
"C": "Posterior ribs 9 and 10 are visible only in an expiratory film.",
"D": "The view is anteroposterior (AP)."
} | step1 | A | [
"year old man presents",
"follow-up visit",
"part of",
"immigration requirements",
"United States",
"Earlier",
"week",
"administered",
"Mantoux tuberculin skin test",
"Todays reading",
"3 days",
"administered",
"test",
"shows",
"induration",
"10 mm",
"Given",
"recent immigration",
... |
A 21-year-old man undergoes orthopedic surgery for a leg fracture that he has sustained in a motorbike accident. After induction of anesthesia with desflurane, the patient's respiratory minute ventilation decreases notably. Which of the following additional effects is most likely to occur in response to this drug? | Increased intracranial pressure | {
"A": "Increased glomerular filtration rate",
"B": "Increased cerebral metabolic rate",
"C": "Decreased seizure threshold",
"D": "Increased intracranial pressure"
} | step1 | D | [
"21-year-old man",
"orthopedic",
"leg fracture",
"sustained",
"motorbike accident",
"induction of anesthesia",
"desflurane",
"patient's respiratory minute ventilation decreases",
"following additional effects",
"most likely to occur",
"response",
"drug"
] |
A 64-year-old woman otherwise healthy presents with acute onset severe rectal bleeding. The patient says that 2 hours ago bleeding began suddenly after a difficult bowel movement. She says the blood is bright red, and, initially, bleeding was brisk but now has stopped. The patient denies having any similar symptoms in ... | von Willebrand factor | {
"A": "Antithrombin III",
"B": "von Willebrand factor",
"C": "Factor VIII",
"D": "ADAMST13 gene mutation"
} | step2&3 | B | [
"64 year old woman",
"healthy presents",
"acute onset severe rectal bleeding",
"patient",
"2 hours",
"bleeding began",
"difficult bowel movement",
"blood",
"bright red",
"initially",
"bleeding",
"brisk",
"now",
"stopped",
"patient denies",
"similar symptoms",
"past",
"bled more eas... |
A 6-month-old girl is brought to the physician because of drooling and excessive crying for 3 days. She calms down when cuddled or with a pacifier in her mouth. She feeds well and has no vomiting or diarrhea. She was breastfed exclusively for 5 months. She is given no medications and was born at 39 weeks gestation via ... | Eruption of mandibular incisors | {
"A": "Crying on frontal sinus palpation",
"B": "Eruption of mandibular incisors",
"C": "Erythema and fluctuance of the submandibular area",
"D": "The rooting reflex"
} | step2&3 | B | [
"month old girl",
"brought",
"physician",
"drooling",
"excessive crying",
"3 days",
"calms",
"pacifier",
"mouth",
"feeds well",
"vomiting",
"diarrhea",
"breastfed",
"months",
"given",
"medications",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines"... |
A 23-year-old woman gravida 2, para 1 at 12 weeks' gestation comes to the physician for her initial prenatal visit. She feels well. She was treated for genital herpes one year ago and gonorrhea 3 months ago. Medications include folic acid and a multivitamin. Vital signs are within normal limits. Pelvic examination show... | Administer amoxicillin/clavulanate | {
"A": "Administer gentamicin",
"B": "Perform renal ultrasound",
"C": "Perform cystoscopy",
"D": "Administer amoxicillin/clavulanate"
} | step2&3 | D | [
"23 year old woman gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"initial prenatal visit",
"feels well",
"treated",
"genital herpes one year ago",
"gonorrhea",
"months",
"Medications include folic acid",
"multivitamin",
"Vital signs",
"normal limits",
"Pelvic examination sho... |
A 60-year-old man comes to the physician because of progressive fatigue and shortness of breath for 2 months. The dyspnea occurs on moderate exertion and during the night; he sometimes wakes up coughing and “gasping for air.” He has also had several episodes of heart pounding and palpitations. Two weeks ago, he had a r... | Mitral valve regurgitation | {
"A": "Mitral valve regurgitation",
"B": "Tricuspid valve regurgitation",
"C": "Aortic valve regurgitation",
"D": "Aortic valve stenosis"
} | step2&3 | A | [
"60 year old man",
"physician",
"progressive fatigue",
"shortness of breath",
"2 months",
"dyspnea occurs",
"moderate exertion",
"night",
"sometimes wakes up coughing",
"gasping for air",
"several episodes of heart pounding",
"palpitations",
"Two weeks",
"runny nose",
"productive cough",... |
A 20-year-old woman college volleyball player presents with left shoulder pain and difficulty elevating her left arm. The patient began to experience dull pain in her left shoulder 5 days ago after a volleyball game. The pain is worse when she sleeps with her arm under the pillow or elevates or abducts her left arm. He... | Tear of the supraspinatus muscle | {
"A": "IV disk protrusion at the C4-5 level",
"B": "Tear of the supraspinatus muscle",
"C": "Intra-articular humeral fracture",
"D": "Shoulder joint dislocation"
} | step2&3 | B | [
"20 year old woman college volleyball",
"presents",
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"difficulty elevating",
"left arm",
"patient began to experience dull pain in",
"left shoulder 5 days",
"volleyball game",
"pain",
"worse",
"sleeps",
"arm",
"pillow",
"elevates",
"left arm",
"temperature",
"0",... |
An investigator is studying the mechanism regulating pigment production in the skin. She has isolated a hormone produced by the anterior and intermediate lobe of the pituitary gland that stimulates neural crest-derived cells to produce pigments through the oxidation and polymerization of the amino acid tyrosine. This h... | Mu receptor | {
"A": "Vasopressin receptor",
"B": "TSH receptor",
"C": "Mu receptor",
"D": "Dopamine receptor\n\""
} | step1 | C | [
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"neural crest derived cells to",
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"oxidation",
"polymerization",
"amino acid tyrosine",
"hormone",
"most likely",
"substan... |
A 44-year-old woman with type 2 diabetes mellitus comes to the physician with a 3-day history of fever, right calf pain, and swelling. Her temperature is 38.7°C (101.7°F). Physical examination shows a 5 x 6-cm erythematous, warm, raised skin lesion with well-defined margins over the right upper posterior calf. The orga... | Susceptibility to bacitracin | {
"A": "Solubility in bile",
"B": "Susceptibility to bacitracin",
"C": "Positive coagulase test",
"D": "Resistance to optochin\n\""
} | step1 | B | [
"year old woman",
"type 2 diabetes mellitus",
"physician",
"3-day history",
"fever",
"right",
"swelling",
"temperature",
"Physical examination shows",
"5",
"6",
"erythematous",
"warm",
"raised skin lesion",
"well-defined margins",
"right posterior calf",
"organism isolated",
"lesio... |
A 67-year-old man is seen on the surgical floor after a transplant procedure. The previous day, the patient had a renal transplant from a matched donor. He is currently recovering and doing well. The patient has a past medical history of IV drug use, diabetes mellitus, oral cold sores, hypertension, renal failure, and ... | TMP-SMX | {
"A": "Azithromycin",
"B": "Low dose acyclovir",
"C": "Penicillin",
"D": "TMP-SMX"
} | step2&3 | D | [
"67 year old man",
"seen",
"surgical floor",
"transplant procedure",
"previous day",
"patient",
"renal",
"matched donor",
"currently recovering",
"well",
"patient",
"past medical IV drug use",
"diabetes mellitus",
"oral cold",
"hypertension",
"renal failure",
"dyslipidemia",
"patie... |
A 50-year-old woman presents with an acute worsening of a chronic rash on her arms and hands for the past week. She says she first noticed the rash 1 year ago which started as little red spots and gradually increased in size. 7 days ago, she noticed the rash suddenly got much worse and spread to her inguinal area, scal... | Methotrexate | {
"A": "Skin biopsy",
"B": "Phototherapy",
"C": "Methotrexate",
"D": "Infliximab"
} | step2&3 | C | [
"50 year old woman presents",
"acute worsening",
"chronic rash",
"arms",
"hands",
"past week",
"first",
"rash",
"year",
"started",
"little red spots",
"increased in size",
"7 days",
"rash",
"got",
"worse",
"spread",
"inguinal area",
"scalp",
"knees",
"worsened",
"rash",
"... |
A 1-day-old infant born at full term by uncomplicated spontaneous vaginal delivery is noted to have cyanosis of the oral mucosa. The baby otherwise appears comfortable. On examination, his respiratory rate is 40/min and pulse oximetry is 80%. His left thumb is displaced and hypoplastic. A right ventricular lift is palp... | Tetralogy of Fallot | {
"A": "Transposition of great vessels",
"B": "Tetralogy of Fallot",
"C": "Ventricular septal defect",
"D": "Transient tachypnoea of the newborn"
} | step2&3 | B | [
"day old infant born",
"full term",
"uncomplicated spontaneous vaginal delivery",
"noted to",
"cyanosis of",
"oral mucosa",
"baby",
"appears",
"examination",
"respiratory rate",
"40 min",
"pulse oximetry",
"80",
"left thumb",
"displaced",
"hypoplastic",
"right ventricular lift",
"p... |
A 35-year-old man is pulled out of a burning building. He is unconscious and severely injured. He is transported to the nearest emergency department. Upon arrival, he is stabilized and evaluated for burns and trauma. Approximately 40% of his body is covered in burns. The burned areas appear blackened and charred but th... | Deep-partial thickness (3rd degree) | {
"A": "Superficial (1st degree)",
"B": "Deep-partial thickness (3rd degree)",
"C": "Superficial-partial thickness (2nd degree)",
"D": "Electric burn"
} | step1 | B | [
"35 year old man",
"pulled out",
"burning building",
"unconscious",
"severely injured",
"transported",
"nearest emergency department",
"arrival",
"stabilized",
"evaluated",
"burns",
"trauma",
"Approximately 40",
"body",
"covered",
"burns",
"burned areas appear",
"charred",
"skin"... |
An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's he... | Dystonia | {
"A": "Akathisia",
"B": "Dystonia",
"C": "Chorea",
"D": "Athetosis"
} | step1 | B | [
"healthy",
"year old woman",
"physician",
"of several episodes",
"involuntary",
"head",
"past",
"months",
"sometimes associated with neck pain",
"last minutes",
"hours",
"Neurologic examination shows",
"abnormalities",
"examination of",
"neck",
"patient's head turns",
"left",
"stat... |
A 35-year-old woman presents to her family physician with a complaint of painful joints for the past 2 weeks. She reports symmetric bilateral joint pain in her hands, knees, and ankles. She has never had this before, and her past medical history is notable only for asthma. She states the pain is worse in the morning an... | Parvovirus | {
"A": "Parvovirus",
"B": "Reactive arthritis",
"C": "Rheumatoid arthritis",
"D": "Transient synovitis"
} | step2&3 | A | [
"35 year old woman presents",
"family physician",
"complaint",
"painful joints",
"past 2 weeks",
"reports symmetric bilateral joint pain in",
"hands",
"knees",
"ankles",
"never",
"before",
"past medical history",
"notable only",
"asthma",
"states",
"pain",
"worse",
"morning",
"im... |
A 65-year-old man presents to the emergency department with abdominal pain and a pulsatile abdominal mass. Further examination of the mass shows that it is an abdominal aortic aneurysm. A computed tomography scan with contrast reveals an incidental finding of a horseshoe kidney, and the surgeon is informed of this find... | Anomalous origins of multiple renal arteries | {
"A": "Anomalous origins of multiple renal arteries",
"B": "Low glomerular filtration rate due to unilateral renal agenesis",
"C": "Proximity of the fused kidney to the celiac artery",
"D": "There are no additional complications"
} | step1 | A | [
"65 year old man presents",
"emergency department",
"abdominal pain",
"pulsatile abdominal mass",
"Further examination",
"shows",
"abdominal aortic aneurysm",
"computed tomography scan with contrast reveals",
"incidental finding",
"horseshoe kidney",
"surgeon",
"informed",
"finding",
"oper... |
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