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 |
|---|---|---|---|---|---|
Thirty minutes after vaginal delivery of a 2780-g (6-lb 2-oz) newborn at term, a 25-year-old woman, gravida 1, para 1, has heavy vaginal bleeding. Her pregnancy was complicated by pre-eclampsia. Her pulse is 111/min and blood pressure is 95/65 mm Hg. Physical examination shows a fundal height 2 inches below the xiphoid... | Activation of phospholipase C | {
"A": "Inhibition of norepinephrine reuptake",
"B": "Activation of phospholipase C",
"C": "Increased synthesis of cyclic AMP",
"D": "Binding to prostaglandin I2 receptors"
} | step1 | B | [
"Thirty minutes",
"vaginal delivery",
"g",
"oz",
"newborn",
"term",
"year old woman",
"gravida 1",
"para 1",
"heavy vaginal bleeding",
"pregnancy",
"complicated",
"pre-eclampsia",
"pulse",
"min",
"blood pressure",
"95 65 mm Hg",
"Physical examination shows",
"fundal height",
"i... |
A 30-year-old African American woman develops a facial rash in a "butterfly" pattern over her face and complains of feeling tired and achy in her joints. In the course of a full rheumatologic workup you note that she has anti-snRNP antibodies. Which of the following do snRNPs affect? | Intron removal from the mRNA | {
"A": "Polyadenylation of the 3' end of mRNA",
"B": "Protection of mRNA from degradation",
"C": "Intron removal from the mRNA",
"D": "Transcription of mRNA"
} | step1 | C | [
"30 year old African American woman",
"facial",
"butterfly",
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"feeling tired",
"achy in",
"joints",
"course",
"full rheumatologic workup",
"note",
"anti",
"antibodies",
"following",
"snRNPs affect"
] |
A previously healthy 61-year-old man comes to the physician because of a 6-month history of morning headaches. He also has fatigue and trouble concentrating on his daily tasks at work. He sleeps for 8 hours every night; his wife reports that he sometimes stops breathing for a few seconds while sleeping. His pulse is 71... | Nocturnal upper airway obstruction | {
"A": "Nocturnal upper airway obstruction",
"B": "Hypophyseal neoplasm",
"C": "Hypersecretion of aldosterone",
"D": "Overproduction of cortisol"
} | step1 | A | [
"healthy 61 year old man",
"physician",
"of",
"month history",
"morning headaches",
"fatigue",
"concentrating",
"daily tasks",
"work",
"sleeps",
"hours",
"night",
"wife reports",
"sometimes stops breathing",
"seconds",
"sleeping",
"pulse",
"71 min",
"blood pressure",
"96 mm Hg"... |
A 3-year-old girl is brought to the physician by her parents due to observations of rapid, random, horizontal and vertical eye movements along with occasional jerking movements of her limbs and head. CT scan reveals an abdominal mass that crosses the midline. Further work-up reveals elevated 24-hour urinary homovanilli... | Hirschsprung disease | {
"A": "Craniopharyngioma",
"B": "Hirschsprung disease",
"C": "Parinaud syndrome",
"D": "Pilocytic astrocytoma"
} | step2&3 | B | [
"3 year old girl",
"brought",
"physician",
"parents due to observations",
"rapid",
"random",
"horizontal",
"vertical eye movements",
"occasional jerking",
"limbs",
"head",
"CT scan reveals",
"abdominal mass",
"crosses",
"midline",
"Further work-up reveals elevated",
"hour urinary hom... |
A 41-year-old man comes to the physician because of a 3-week history of fatigue, cough, and a 4.5-kg (10-lb) weight loss. He does not smoke or drink alcohol. He appears emaciated. A chest x-ray shows a calcified nodule in the left lower lobe and left hilar lymphadenopathy. The physician initiates therapy for the condit... | Impaired synthesis of cell wall polysaccharides | {
"A": "Impaired protein synthesis due to binding to 30S ribosomes",
"B": "Impaired synthesis of cell wall polysaccharides",
"C": "Impaired protein synthesis due to binding to 50S ribosomes",
"D": "Impaired production of hemozoin from heme"
} | step1 | B | [
"year old man",
"physician",
"3 week history",
"fatigue",
"cough",
"4.5 kg",
"10",
"weight loss",
"not smoke",
"drink alcohol",
"appears emaciated",
"chest x-ray shows",
"calcified nodule",
"left lower lobe",
"left hilar lymphadenopathy",
"physician initiates therapy",
"condition",
... |
A 12-year-old boy is brought in by his mother with a 2-day history of fever and generalized weakness. She says that her son was involved in a school fight with some other kids 4 days ago and sustained minor injuries to the face. He was otherwise well, until this morning, when he complained of pain in his right eye. Phy... | Absent blink reflex | {
"A": "Anesthesia along the CN V3 distribution",
"B": "Decreased vision with sparing of the optic disc",
"C": "Intact sympathetic innervation to the pupil, but not parasympathetic innervation",
"D": "Absent blink reflex"
} | step1 | D | [
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"sustained minor injuries",
"face",
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"morning",
"pain",
"right eye",
"Physical examination reveals periorbital erythema",
"edema",
"r... |
A 68-year-old man presents with shortness of breath, particularly when walking up stairs and when lying down to go to sleep at night. He also complains of a chronic cough and states that he now uses 2 extra pillows at night. The patient has a history of type 2 diabetes that is well-managed with metformin. He also takes... | Smoking cessation alone | {
"A": "Flu vaccine",
"B": "Smoking cessation alone",
"C": "Inhaled anticholinergics",
"D": "Both smoking cessation and oxygen administration"
} | step2&3 | B | [
"68 year old man presents",
"shortness of breath",
"walking",
"stairs",
"lying",
"to go to sleep",
"night",
"chronic cough",
"states",
"now uses 2 extra pillows",
"night",
"patient",
"history",
"type 2 diabetes",
"well managed",
"metformin",
"takes Prozac",
"long standing history o... |
A 56-year-old woman comes to the physician because of increasing muscle weakness in her shoulders and legs for 1 month. She has difficulties standing up and combing her hair. She also has had a skin rash on her face and hands for the past week. She has hypercholesterolemia treated with simvastatin. She has chronic ecze... | Elevated serum CA-125 | {
"A": "Symptom resolution on statin withdrawal",
"B": "Pathological edrophonium test",
"C": "Intramuscular inclusion bodies",
"D": "Elevated serum CA-125"
} | step2&3 | D | [
"year old woman",
"physician",
"of increasing muscle weakness",
"shoulders",
"legs",
"month",
"difficulties standing up",
"combing",
"hair",
"skin rash",
"face",
"hands",
"past week",
"hypercholesterolemia treated with simvastatin",
"chronic eczema of",
"feet",
"well-controlled",
"... |
A 27-year-old pregnant woman presents to an obstetrician at 35 weeks gestation reporting that she noted the presence of a mucus plug in her vaginal discharge this morning. The obstetrician performs an examination and confirms that she is in labor. She was diagnosed with HIV infection 1 year ago. Her current antiretrovi... | Zidovudine | {
"A": "Enfuvirtide",
"B": "Nevirapine",
"C": "Rilpivirine",
"D": "Zidovudine"
} | step1 | D | [
"27 year old pregnant woman presents",
"obstetrician",
"35 weeks gestation reporting",
"noted",
"presence",
"mucus plug",
"vaginal discharge",
"morning",
"obstetrician performs",
"examination",
"confirms",
"labor",
"diagnosed",
"HIV infection 1 year",
"current antiretroviral includes aba... |
A 67-year-old female is brought to the emergency room by her son for unusual behavior. She moved into her son’s house three years ago after her husband passed away. The son reports that when he returned home from work earlier in the day, he found his mother minimally responsive. She regained consciousness soon after hi... | Normal cerebrum | {
"A": "Normal cerebrum",
"B": "Focal atrophy of the frontal and temporal cortices",
"C": "Mesial temporal lobe atrophy",
"D": "Caudate nucleus atrophy"
} | step1 | A | [
"67 year old female",
"brought",
"emergency room",
"son",
"unusual behavior",
"moved",
"sons house three years",
"husband passed",
"son reports",
"returned home",
"work earlier",
"day",
"found",
"mother",
"responsive",
"regained consciousness",
"arrival",
"not recall",
"event",
... |
A 59-year-old man is brought to the emergency department by a coworker for right arm weakness and numbness. The symptoms started suddenly 2 hours ago. His coworker also noticed his face appears to droop on the right side and his speech is slurred. He has a history of hypertension, hyperlipidemia, type 2 diabetes, and p... | Hypertension | {
"A": "Hypertension",
"B": "Excessive alcohol intake",
"C": "Increased stress",
"D": "Hyperlipidemia"
} | step2&3 | A | [
"59 year old man",
"brought",
"emergency department",
"coworker",
"right",
"numbness",
"symptoms started",
"hours",
"coworker",
"face appears to",
"right side",
"speech",
"slurred",
"history of hypertension",
"hyperlipidemia",
"type 2 diabetes",
"peripheral arterial disease",
"work... |
A 3-year-old boy is brought to the physician because he is easily fatigued and has not gained weight. He eats 3 meals and has 3 to 4 bowel movements daily with bulky stools that float. He had recurrent episodes of sinusitis in infancy. He is at the 15th percentile for height and 5th percentile for weight. Examination s... | Exocrine pancreatic insufficiency | {
"A": "Small intestine bacterial overgrowth",
"B": "Exocrine pancreatic insufficiency",
"C": "Impaired intestinal amino acid transport",
"D": "Intestinal inflammatory reaction to gluten"
} | step1 | B | [
"3 year old boy",
"brought",
"physician",
"easily fatigued",
"not gained weight",
"eats 3 meals",
"3",
"4 bowel movements daily",
"bulky stools",
"float",
"recurrent episodes of sinusitis",
"infancy",
"percentile",
"height",
"5th percentile",
"weight",
"Examination shows pale conjunc... |
A 54-year-old man is brought to the emergency department 30 minutes after being hit by a car while crossing the street. He had a left-sided tonic-clonic seizure and one episode of vomiting while being transported to the hospital. On arrival, he is not oriented to person, place, or time. Physical examination shows flacc... | Between the arachnoid mater and the pia mater | {
"A": "Into the ventricular system",
"B": "Between the skull and the dura mater",
"C": "Into the cerebral parenchyma",
"D": "Between the arachnoid mater and the pia mater"
} | step1 | D | [
"54 year old man",
"brought",
"emergency department 30 minutes",
"hit by",
"car",
"crossing",
"street",
"left-sided tonic-clonic seizure",
"one episode of vomiting",
"transported",
"hospital",
"arrival",
"not oriented to person",
"place",
"time",
"Physical examination shows flaccid par... |
A 15-month-old girl is brought to the physician because of the sudden appearance of a rash on her trunk that started 6 hours ago and subsequently spread to her extremities. Four days ago, she was taken to the emergency department because of a high fever and vomiting. She was treated with acetaminophen and discharged th... | Roseola infantum | {
"A": "Nonbullous impetigo",
"B": "Roseola infantum",
"C": "Rubella",
"D": "Erythema infectiosum"
} | step1 | B | [
"month old girl",
"brought",
"physician",
"sudden appearance",
"rash",
"trunk",
"started 6 hours",
"spread",
"extremities",
"Four days",
"taken",
"emergency department",
"high fever",
"vomiting",
"treated with acetaminophen",
"discharged",
"next day",
"fever",
"days",
"abated",... |
A 17-year-old boy presents to his primary care physician for eye pain. The patient states that it has been going on for the past 3 days and has been steadily worsening. He recently suffered a superior orbital fracture secondary to playing football without a helmet that required no treatment other than to refrain from c... | Dacrocystitis | {
"A": "Dacrocystitis",
"B": "Hordeolum",
"C": "Orbital cellulitis",
"D": "Periorbital cellulitis"
} | step2&3 | A | [
"year old boy presents",
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"recently suffered",
"superior orbital fracture secondary to playing football",
"helmet",
"required",
"treatment",
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"contact sports",
"patient's past",
"non contributory",... |
A 68-year-old man is being evaluated in your radiation oncology clinic for treatment of a solid tumor. Your hospital has just purchased a new proton beam purported to deliver targeted radiation with fewer side effects than traditional radiation therapy. The patient expresses strong interest in receiving proton beam the... | Proceed with proton beam therapy as discussed at your patient's appointment | {
"A": "Discuss the issue of cost to the insurer with your patient, pointing out that keeping his insurance company happy may make them more likely to cover additional treatments in the future",
"B": "Proceed with proton beam therapy as discussed at your patient's appointment",
"C": "Tell the patient that proton ... | step1 | B | [
"68 year old man",
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"radiation",
"treatment",
"solid tumor",
"hospital",
"purchased",
"new proton beam",
"to deliver targeted radiation",
"side effects",
"traditional radiation",
"patient",
"strong interest",
"receiving proton beam therapy",
"feel",
"better outcome",
"new... |
A 2-month-old boy is presented to the clinic for a well-child visit by his parents. They are concerned with his weak cry and difficulty with feeding. Birth history reveals that the boy was born at the 37th week of gestation by cesarean section due to poor fetal movement and fetal distress. His Apgar scores were 3 and 5... | Silencing in imprinting region | {
"A": "Heteroplasmy",
"B": "Silencing in imprinting region",
"C": "Anticipation",
"D": "Incomplete penetrance"
} | step1 | B | [
"2 month old boy",
"presented",
"clinic",
"well-child visit",
"parents",
"concerned",
"weak cry",
"difficulty",
"feeding",
"Birth history reveals",
"boy",
"born",
"week",
"gestation",
"cesarean section due to poor fetal movement",
"fetal distress",
"Apgar scores",
"3",
"5",
"1s... |
A 25-year-old male presents to his primary care physician for pain in his knee. The patient was in a wrestling match when his legs were grabbed from behind and he was taken to the floor. The patient states that the moment this impact happened, he felt a snapping and sudden pain in his knee. When the match ended and he ... | Anterior translation of the tibia relative to the femur | {
"A": "Laxity to valgus stress",
"B": "Clicking and locking of the joint with motion",
"C": "Anterior translation of the tibia relative to the femur",
"D": "Posterior translation of the tibia relative to the femur"
} | step2&3 | C | [
"year old male presents",
"primary care physician",
"pain in",
"knee",
"patient",
"wrestling match",
"legs",
"grabbed",
"taken",
"floor",
"patient states",
"impact happened",
"felt",
"snapping",
"sudden pain in",
"knee",
"match ended",
"stood back",
"knee felt unstable",
"Minut... |
A 55-year-old man presents to the physician for the evaluation of excessive daytime sleepiness over the past six months. Despite sleeping 8–9 hours a night and taking a nap during the day, he feels drowsy and is afraid to drive. His wife complains of loud snoring and gasping during the night. His blood pressure is 155/... | Continuous positive airway pressure | {
"A": "Continuous positive airway pressure",
"B": "Oral appliances",
"C": "Supplemental oxygen",
"D": "Upper airway surgery"
} | step2&3 | A | [
"55 year old man presents",
"physician",
"evaluation",
"excessive daytime sleepiness",
"past six months",
"sleeping",
"hours",
"night",
"nap",
"day",
"feels drowsy",
"afraid to drive",
"wife",
"loud snoring",
"gasping",
"night",
"blood pressure",
"95 mm Hg",
"BMI",
"kg/m2",
"... |
A 60-year-old man comes to the emergency department because of a 3-day history of fever and shortness of breath. He has a history of COPD treated with inhaled albuterol. His temperature is 39.0°C (102.2°F), pulse is 95/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows d... | Increased pulmonary capillary permeability | {
"A": "Impaired lymphatic flow",
"B": "Increased pulmonary capillary permeability",
"C": "Decreased intrapleural pressure",
"D": "Decreased plasma oncotic pressure"
} | step1 | B | [
"60 year old man",
"emergency department",
"3-day history",
"fever",
"shortness of breath",
"history",
"COPD treated with inhaled albuterol",
"temperature",
"pulse",
"95 min",
"respirations",
"20 min",
"blood pressure",
"80 mm Hg",
"Cardiopulmonary examination shows decreased breath soun... |
A 30-year-old man comes to the physician for follow-up evaluation for hypertension. He reports a 1-month history of episodic throbbing headaches, palpitations, and paroxysmal sweating. Blood pressure is 160/90 mm Hg. He appears pale but physical examination is otherwise unremarkable. Laboratory studies show elevated ur... | Phenoxybenzamine | {
"A": "Phenoxybenzamine",
"B": "Propranolol",
"C": "Clonidine",
"D": "Hydrochlorothiazide"
} | step1 | A | [
"30 year old man",
"physician",
"follow-up evaluation",
"hypertension",
"reports",
"month history of episodic throbbing headaches",
"palpitations",
"paroxysmal sweating",
"Blood pressure",
"90 mm Hg",
"appears pale",
"physical examination",
"unremarkable",
"Laboratory studies show elevated... |
A 2-year-old boy is brought to the physician for the evaluation of fever, breathing difficulty, and cough during the past week. In the past year, the patient was diagnosed with four sinus infections, 3 upper respiratory tract infections, and an episode of severe bronchiolitis requiring hospitalization. Since birth, he ... | T cells | {
"A": "B cells",
"B": "Immunoglobulin A",
"C": "Interleukin-12 receptor",
"D": "T cells"
} | step2&3 | D | [
"2 year old boy",
"brought",
"physician",
"evaluation",
"fever",
"breathing difficulty",
"cough",
"past week",
"past year",
"patient",
"diagnosed",
"four sinus infections",
"3 upper respiratory tract infections",
"episode of severe bronchiolitis",
"hospitalization",
"birth",
"multipl... |
In recent years, psoriasis has been identified as a risk factor for cardiovascular disease. A researcher conducted a study in which he identified 200 patients with psoriasis and 200 patients without psoriasis. The patients were followed for 10 years. At the end of this period, participants' charts were reviewed for myo... | 0.06 | {
"A": "0.5",
"B": "0.75",
"C": "0.06",
"D": "0.02"
} | step2&3 | C | [
"recent years",
"psoriasis",
"identified",
"a risk factor",
"cardiovascular disease",
"researcher conducted",
"study",
"identified 200 patients",
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"200 patients",
"psoriasis",
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"followed",
"10 years",
"end",
"period",
"participants",
"harts ",
"eviewed ",
... |
A 36-year-old woman, gravida 3, para 2, at 37 weeks' gestation comes to the emergency department because of sparse vaginal bleeding for 3 hours. She also noticed the bleeding 3 days ago. She has had no prenatal care. Both of her previous children were delivered by lower segment transverse cesarean section. Her temperat... | Perform transvaginal sonography | {
"A": "Perform pelvic examination",
"B": "Perform transvaginal sonography",
"C": "Perform Kleihauer-Betke test",
"D": "Conduct contraction stress test"
} | step2&3 | B | [
"36 year old woman",
"gravida 3",
"para 2",
"weeks",
"gestation",
"emergency department",
"of",
"vaginal bleeding",
"hours",
"bleeding",
"days",
"prenatal care",
"previous children",
"delivered",
"lower segment transverse cesarean",
"temperature",
"98",
"pulse",
"90 min",
"resp... |
A 51-year-old woman schedules an appointment with her physician with complaints of upper abdominal pain, nausea, and early satiety for the last 6 months. She has type 1 diabetes for the past 10 years and is on subcutaneous insulin with metformin. She complains of occasional heartburn and lost 4.5 kg (10 lb) in the past... | Cisapride | {
"A": "Bethanechol",
"B": "Cisapride",
"C": "Erythromycin",
"D": "Domperidone"
} | step1 | B | [
"year old woman schedules",
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"physician",
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"upper abdominal pain",
"nausea",
"early satiety",
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"past 10 years",
"subcutaneous insulin",
"metformin",
"occasional heartburn",
"lost 4.5 kg",
"10",
"past 6 months",
"changes in",
"d... |
A 3-year-old girl is brought to the physician by her parents for complaints of breast development and pubic hair growth for the past 6 months. She has no significant birth or medical history. The temperature is 37.0°C (98.6°F), the pulse is 88/min, and the respirations are 20/min. Physical examination shows enlarged br... | Use a leuprolide test to see the estradiol levels | {
"A": "Repeat the GnRH stimulation test to see the LH response",
"B": "Use a GnRH test to see the LH:FSH ratio",
"C": "Use a leuprolide test to see the estradiol levels",
"D": "Use a GnRH test to see the FSH levels"
} | step2&3 | C | [
"3 year old girl",
"brought",
"physician",
"parents",
"complaints",
"breast development",
"pubic",
"past 6 months",
"significant birth",
"medical history",
"temperature",
"98",
"pulse",
"88 min",
"respirations",
"20 min",
"Physical examination shows enlarged breasts",
"Tanner stage... |
A 19-year-old woman presents to the physician for a routine health maintenance examination. She has a past medical history of gastroesophageal reflux disease. She recently moved to a new city to begin her undergraduate studies. Her father was diagnosed with colon cancer at age 46. Her father's brother died because of s... | Annual colonoscopy beginning at 20–25 years of age | {
"A": "Annual colonoscopy beginning at 20–25 years of age",
"B": "Celecoxib or sulindac therapy",
"C": "Measurement of carcinoembryonic antigen and CA 19-9 yearly",
"D": "Surgical removal of a desmoid tumor"
} | step2&3 | A | [
"year old woman presents",
"physician",
"routine health maintenance examination",
"past medical history of gastroesophageal reflux disease",
"recently moved to",
"new city to begin",
"undergraduate studies",
"father",
"diagnosed",
"colon cancer",
"age",
"father's brother died",
"of small bow... |
A 61-year-old man presents to the emergency department for the evaluation of polyuria, polydipsia, and confusion. He has a history of the psychiatric disease but is unable to provide additional details. He is admitted to the hospital and his home medications are continued. Routine testing is unrevealing for the etiolog... | Lithium | {
"A": "Omeprazole",
"B": "Nitrofurantoin",
"C": "Nafcillin",
"D": "Lithium"
} | step2&3 | D | [
"61 year old man presents",
"emergency department",
"evaluation",
"polyuria",
"polydipsia",
"confusion",
"history of",
"psychiatric disease",
"unable to provide additional details",
"admitted",
"hospital",
"home medications",
"continued",
"Routine testing",
"etiology",
"symptoms",
"D... |
A 32-year-old woman presents to your office with abdominal pain and bloating over the last month. She also complains of intermittent, copious, non-bloody diarrhea over the same time. Last month, she had a cough that has since improved but has not completely resolved. She has no sick contacts and has not left the countr... | Penetration of skin | {
"A": "Inhalation",
"B": "Penetration of skin",
"C": "Animal bite",
"D": "Insect bite"
} | step1 | B | [
"year old woman presents",
"office",
"abdominal pain",
"bloating",
"month",
"intermittent",
"copious",
"non bloody",
"same time",
"month",
"cough",
"since improved",
"not completely resolved",
"sick contacts",
"not left",
"country recently",
"denies",
"myalgias",
"itching",
"ra... |
A 78-year-old man presented to his primary physician with a 3-month history of weight loss, fever, fatigue, night sweats, and cough. He is a former smoker. A recent HIV test was negative. A CT scan of the chest reveals a 3 cm lesion in the lower lobe of the left lung and calcification around the left lung hilus. A sput... | Primary tuberculosis | {
"A": "Primary tuberculosis",
"B": "Adenocarcinoma",
"C": "Miliary tuberculosis",
"D": "Secondary tuberculosis"
} | step1 | A | [
"year old man presented",
"primary physician",
"3 month history of weight loss",
"fever",
"fatigue",
"night sweats",
"cough",
"former smoker",
"recent HIV test",
"negative",
"CT scan of",
"chest reveals",
"3",
"lesion",
"the lower lobe of",
"left lung",
"calcification",
"left lung ... |
A 45-year-old woman comes to see you for a second opinion regarding an upcoming surgery for pancreatic insulinoma. While taking a surgical history, she tells you she previously had a pituitary tumor resected. For which additional neoplasms might you consider testing her? | Parathyroid adenoma | {
"A": "Medullary thyroid carcinoma",
"B": "Pheochromocytoma",
"C": "Parathyroid adenoma",
"D": "Multiple myeloma"
} | step1 | C | [
"year old woman",
"to see",
"second opinion",
"surgery",
"pancreatic insulinoma",
"taking",
"surgical history",
"pituitary tumor resected",
"additional neoplasms",
"consider testing"
] |
A 12-year-old girl comes to the clinic with a grossly enlarged abdomen. She has a history of frequent episodes of weakness, sweating, and pallor that are eliminated by eating. Her development has been slow. She started to walk unassisted at 2 years and was not performing well at school. Physical examination reveals a b... | Von-Gierke's disease | {
"A": "Cori's disease",
"B": "Pompe's disease",
"C": "Von-Gierke's disease",
"D": "McArdle disease"
} | step1 | C | [
"year old girl",
"clinic",
"enlarged abdomen",
"history of frequent episodes",
"weakness",
"sweating",
"pallor",
"eliminated",
"eating",
"development",
"slow",
"started to walk",
"years",
"not performing well",
"school",
"Physical examination reveals",
"blood pressure",
"100 60 mm ... |
A 25-year-old man is brought to the emergency department after his girlfriend discovered him at home in a minimally responsive state. He has a history of drinking alcohol excessively and using illicit drugs. On arrival, he does not respond to commands but withdraws all extremities to pain. His pulse is 90/min, respirat... | Naloxone | {
"A": "Naloxone",
"B": "Phentolamine",
"C": "Methadone",
"D": "Naltrexone"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department",
"girlfriend discovered",
"at home",
"responsive state",
"history",
"drinking alcohol excessively",
"using illicit drugs",
"arrival",
"not",
"commands",
"withdraws",
"extremities",
"pain",
"pulse",
"90 min",
"respirations",
"min",... |
A 63-year-old man undergoes uncomplicated laparascopic cholecystectomy for acute cholecystitis and is admitted to the surgical ward for postoperative management. On postoperative day 1, routine laboratory studies reveal an increase in serum creatinine to 1.46 mg/dL from 0.98 mg/dL before the operation; BUN is 37 mg/dL,... | Evaluate urinary catheter for obstruction | {
"A": "Obtain urinalysis",
"B": "Evaluate urinary catheter for obstruction",
"C": "Administer IV fluid bolus",
"D": "Initiate emergent hemodialysis"
} | step2&3 | B | [
"63 year old man",
"uncomplicated",
"cholecystectomy",
"acute cholecystitis",
"admitted",
"surgical ward",
"postoperative management",
"postoperative day 1",
"routine laboratory studies reveal",
"increase",
"serum creatinine",
"1 46 mg dL",
"0 98",
"dL",
"operation",
"mg/dL",
"increa... |
A 23-year-old male presents to the emergency room following a gunshot wound to the leg. On arrival his temperature is 99°F (37.2°C), blood pressure is 90/60 mmHg, pulse is 112/min, respirations are 21/min, and pulse oximetry is 99% on room air. Two large bore IVs are placed and he receives crystalloid fluid replacement... | Preformed antibodies | {
"A": "Preformed antibodies",
"B": "Deposition of immune complexes",
"C": "T lymphocyte reaction",
"D": "Production of leukotrienes"
} | step1 | A | [
"23 year old male presents",
"emergency room following",
"gunshot",
"leg",
"arrival",
"temperature",
"blood pressure",
"90 60 mmHg",
"pulse",
"min",
"respirations",
"min",
"pulse oximetry",
"99",
"room air",
"Two large bore",
"placed",
"receives crystalloid fluid replacement follow... |
A 3-year-old boy is brought to the emergency department for evaluation of fever and cough for one week. The mother reports that her son has muscle rigidity and difficulty breathing. He has also had a generalized skin rash for the past 4 days. His symptoms began shortly after returning from a trip to India. His immuniza... | Decreased IFN-γ levels | {
"A": "Decreased IFN-γ levels",
"B": "Mutation in WAS gene",
"C": "Absent B cells with normal T cell count",
"D": "Decreased T-cell receptor excision circles on PCR"
} | step2&3 | A | [
"3 year old boy",
"brought",
"emergency department",
"evaluation",
"fever",
"cough",
"one week",
"mother reports",
"son",
"muscle rigidity",
"difficulty breathing",
"generalized skin rash",
"past 4 days",
"symptoms began",
"returning",
"trip",
"India",
"immunizations",
"date",
... |
A 60-year-old woman with a history of emphysema has been referred by her pulmonologist for follow-up pulmonary function testing. During the test, the patient reaches a point where her airway pressure is equal to the atmospheric pressure. Which of the following is most likely to be found during this respiratory state? | Pulmonary vascular resistance is at a minimum | {
"A": "Pulmonary vascular resistance is at a maximum",
"B": "Pulmonary vascular resistance is at a minimum",
"C": "Transmural pressure of the lung-chest wall system is at a maximum",
"D": "Transmural pressure of the lung-chest wall system is at a minimum"
} | step1 | B | [
"60 year old woman",
"history of emphysema",
"referred",
"pulmonologist",
"follow-up pulmonary function testing",
"test",
"patient reaches",
"point",
"airway pressure",
"equal to",
"atmospheric pressure",
"following",
"most likely to",
"found",
"respiratory state"
] |
A 51-year-old woman is brought to the emergency department after not being able to urinate for the past 12 hours. She also complains of a headache that is sharp in nature, 9/10, without radiation, and associated with nausea and vomiting. She neither smokes cigarettes nor drinks alcohol. She complains that her fingers h... | Ramipril | {
"A": "Nitroprusside",
"B": "Labetalol",
"C": "Dialysis",
"D": "Ramipril"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"not",
"able to",
"past 12 hours",
"headache",
"sharp",
"nature",
"10",
"radiation",
"associated with nausea",
"vomiting",
"smokes cigarettes",
"drinks alcohol",
"fingers",
"numb",
"very painful",
"exposure",
"cold weather",
... |
A 70-year-old man comes to the physician because of a 6-month-history of worsening shortness of breath on exertion and bouts of coughing while sleeping. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. Current medications include lisinopril, simvastatin, and insulin. The patient appears tired but in n... | Metoprolol | {
"A": "Gemfibrozil",
"B": "Metoprolol",
"C": "Amlodipine",
"D": "Dobutamine"
} | step1 | B | [
"70 year old man",
"physician",
"of",
"month history",
"worsening shortness",
"breath",
"exertion",
"bouts of coughing",
"sleeping",
"hypertension",
"hyperlipidemia",
"type 2 diabetes mellitus",
"Current medications include lisinopril",
"simvastatin",
"insulin",
"patient appears tired"... |
A 52-year-old woman comes to the physician because of a 1-month history of mild fever, fatigue, and shortness of breath. She has no history of serious medical illness and takes no medications. Cardiopulmonary examination shows a mid-diastolic plopping sound heard best at the apex and bilateral rales at the base of the ... | Increased IL-6 serum concentration | {
"A": "Increased IL-6 serum concentration",
"B": "Axillary lymphadenopathy",
"C": "Malignant pleural effusion",
"D": "Ash-leaf skin lesions"
} | step1 | A | [
"year old woman",
"physician",
"month history",
"mild fever",
"fatigue",
"shortness of breath",
"history of serious medical illness",
"takes",
"medications",
"Cardiopulmonary examination shows",
"mid-diastolic",
"sound heard best",
"apex",
"bilateral rales",
"the base of",
"lungs",
"... |
A 57-year-old man with a history of coronary artery disease has been brought to the emergency department due to the sudden onset of chest pain. He was diagnosed with hypertension 12 years ago and takes enalapril regularly. The patient is hypotensive to 70/42 mm Hg, and on further examination his skin is cold and clammy... | I, II, IV | {
"A": "I, II, III",
"B": "I, IV, VI",
"C": "I, II, IV, V",
"D": "I, II, IV"
} | step1 | D | [
"year old man",
"history of coronary artery disease",
"brought",
"emergency department due to",
"sudden onset of chest pain",
"diagnosed",
"hypertension",
"years",
"takes enalapril",
"patient",
"hypotensive",
"70",
"mm Hg",
"further examination",
"skin",
"cold",
"clammy",
"diagnose... |
A 50-year-old man comes to the emergency department because of a severely painful right eye. The pain started an hour ago and is accompanied by frontal headache and nausea. The patient has vomited twice since the onset of the pain. He has type 2 diabetes mellitus. He immigrated to the US from China 10 years ago. He wor... | Topical epinephrine | {
"A": "Topical timolol",
"B": "Topical epinephrine",
"C": "Topical apraclonidine",
"D": "Oral acetazolamide"
} | step2&3 | B | [
"50 year old man",
"emergency department",
"severely painful right eye",
"pain started",
"hour",
"frontal headache",
"nausea",
"patient",
"vomited twice",
"onset",
"pain",
"type 2 diabetes mellitus",
"China 10 years",
"works",
"engineer",
"local company",
"great",
"stress",
"only... |
A 19-year-old male arrives to student health for an annual check up. He is up to date on his infant and childhood vaccinations up to age 10. At age 12, he received a single dose of the tetanus, diphtheria, and acellular pertussis vaccine, and a quadrivalent meningococcal conjugate vaccine. A month ago, he received the ... | Human papilloma virus | {
"A": "Hepatitis A vaccine",
"B": "Herpes zoster vaccine",
"C": "Human papilloma virus",
"D": "Tetanus and reduced diphtheria toxoid booster"
} | step2&3 | C | [
"year old male",
"student health",
"annual check up",
"date",
"infant",
"childhood",
"age 10",
"age",
"received",
"single dose",
"tetanus",
"diphtheria",
"acellular pertussis vaccine",
"meningococcal conjugate vaccine",
"month",
"received",
"influenza vaccine",
"patient",
"signif... |
A 12-year-old girl is brought to the emergency department by her parents due to severe shortness of breath that started 20 minutes ago. She has a history of asthma and her current treatment regime includes a beta-agonist inhaler as well as a medium-dose corticosteroid inhaler. Her mother tells the physician that her da... | Inhaled albuterol | {
"A": "Inhaled albuterol",
"B": "Intravenous corticosteroid",
"C": "Inhaled ipratropium bromide",
"D": "Inhaled theophylline"
} | step2&3 | A | [
"year old girl",
"brought",
"emergency department",
"parents due to severe shortness of breath",
"started 20 minutes",
"history of asthma",
"current treatment",
"includes a beta agonist inhaler",
"medium dose corticosteroid inhaler",
"mother",
"physician",
"daughter",
"playing outside",
"f... |
Over the course of a year, 5 children with identical congenital heart defects were referred to a pediatric cardiac surgeon for evaluation. All 5 children had stable vital signs and were on appropriate medication. Upon review of medical records, all of them had a loud holosystolic murmur over the third intercostal space... | A 2-year-old boy with a 2-mm supracristal defect, without heart failure, pulmonary hypertension, or growth failure | {
"A": "A 4-month-old male infant with a 12-mm muscular defect, without heart failure, pulmonary hypertension or growth failure",
"B": "A 2-year-old boy with a 2-mm supracristal defect, without heart failure, pulmonary hypertension, or growth failure",
"C": "A 5-year-old girl with a 2-mm membranous defect, no hea... | step2&3 | B | [
"course",
"year",
"5 children",
"identical congenital heart defects",
"referred",
"pediatric cardiac",
"evaluation",
"5 children",
"stable vital signs",
"appropriate medication",
"review",
"medical records",
"loud holosystolic murmur",
"third intercostal space",
"left sternal border",
... |
A 35-year-old woman is presenting for a general wellness checkup. She is generally healthy and has no complaints. The patient does not smoke, drinks 1 alcoholic drink per day, and exercises 1 day per week. She recently had silicone breast implants placed 1 month ago. Her family history is notable for a heart attack in ... | Mammography at age 50 | {
"A": "Colonoscopy at age 60",
"B": "Colonoscopy now",
"C": "Mammography at age 50",
"D": "Mammography now"
} | step2&3 | C | [
"35 year old woman",
"presenting",
"general wellness checkup",
"healthy",
"complaints",
"patient",
"not smoke",
"drinks 1 alcoholic drink",
"day",
"exercises 1 day per week",
"recently",
"silicone breast implants placed 1 month",
"family history",
"notable",
"heart attack",
"mother",
... |
A 13-year-old boy is brought to the emergency department because of a 2-day history of fever, headache, and irritability. He shares a room with his 7-year-old brother, who does not have any symptoms. The patient appears weak and lethargic. His temperature is 39.1°C (102.4°F) and blood pressure is 99/60 mm Hg. Physical ... | Rifampin | {
"A": "Penicillin G",
"B": "Cephalexin",
"C": "Rifampin",
"D": "Doxycycline"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"2-day history",
"fever",
"headache",
"irritability",
"shares",
"room",
"year old brother",
"not",
"symptoms",
"patient appears weak",
"lethargic",
"temperature",
"4F",
"blood pressure",
"99 60 mm Hg",
"Physical examination shows... |
A 75-year-old male presents to his primary care physician complaining of epigastric pain. He has developed progressively worsening epigastric pain, heartburn, and nausea over the past five months. The pain does not change with meals and is not positional. He also reports that he is rarely hungry and has lost ten pounds... | Nitrosamine | {
"A": "Nitrosamine",
"B": "Aflatoxin",
"C": "Naphthalene",
"D": "Asbestos"
} | step1 | A | [
"75 year old male presents",
"primary care physician",
"epigastric pain",
"worsening epigastric pain",
"heartburn",
"nausea",
"past five months",
"pain",
"not change",
"meals",
"not positional",
"reports",
"rarely hungry",
"lost ten pounds",
"patient",
"Japan two years",
"to live",
... |
A mother brings her 1-year-old daughter who has had several seizures in the past 2 weeks to the pediatrician. The mother explains that the child is unable to crawl, sit, or even hold up her own head. She thinks the weakness is getting worse. The parents of the child are first cousins, and the mother's sister had one ch... | Cherry red spot | {
"A": "Papilledema",
"B": "Cotton wool spots",
"C": "Hollenhorst plaque",
"D": "Cherry red spot"
} | step1 | D | [
"mother",
"1-year-old daughter",
"several seizures",
"past 2 weeks",
"pediatrician",
"mother",
"child",
"unable to crawl",
"sit",
"hold",
"head",
"thinks",
"weakness",
"getting worse",
"parents of",
"child",
"first cousins",
"mother's sister",
"one child",
"died",
"age",
"s... |
A 61-year-old man presents to the emergency department with severe left flank pain radiating to the left groin and severe nausea. His condition started suddenly 3 hours earlier. His past medical history is significant for chronic migraine headaches and type 2 diabetes mellitus. He takes metformin and glyburide for his ... | Renal papillary necrosis | {
"A": "Nephrolithiasis",
"B": "Renal cell carcinoma",
"C": "Renal papillary necrosis",
"D": "Polycystic kidney disease"
} | step2&3 | C | [
"61 year old man presents",
"emergency department",
"severe left flank pain radiating to",
"groin",
"severe nausea",
"condition started",
"hours earlier",
"past medical history",
"significant",
"chronic migraine headaches",
"type 2 diabetes mellitus",
"takes metformin",
"glyburide",
"diabe... |
A 33-year-old man is evaluated by paramedics after being found unconscious outside of his home. He has no palpable pulses. Physical examination shows erythematous marks in a fern-leaf pattern on his lower extremities. An ECG shows ventricular fibrillation. Which of the following is the most likely cause of this patient... | Lightning strike | {
"A": "Lightning strike",
"B": "Hypothermia",
"C": "Opioid overdose",
"D": "Infective endocarditis"
} | step1 | A | [
"year old man",
"evaluated",
"paramedics",
"found unconscious outside",
"home",
"palpable pulses",
"Physical examination shows erythematous marks",
"fern leaf pattern",
"lower extremities",
"ECG shows ventricular fibrillation",
"following",
"most likely cause",
"patient's findings"
] |
A 34-year-old female presents to a counselor at the urging of her parents because they are concerned that she might be depressed. After recently breaking up with her long-term boyfriend, she moved back in with her parents because she could not handle making decisions alone. Soon after their breakup, she started going o... | Dependent personality disorder | {
"A": "Separation anxiety disorder",
"B": "Dependent personality disorder",
"C": "Histrionic personality disorder",
"D": "Borderline personality disorder"
} | step2&3 | B | [
"year old female presents",
"counselor",
"parents",
"concerned",
"depressed",
"recently breaking",
"long-term boyfriend",
"moved back",
"parents",
"not handle making decisions alone",
"started",
"57 dates",
"week",
"unemployed",
"years",
"boyfriend took care",
"bills",
"past year",... |
A 31-year-old woman delivers a healthy boy at 38 weeks gestation. The delivery is vaginal and uncomplicated. The pregnancy was unremarkable. On examination of the newborn, it is noted that his head is tilted to the left and his chin is rotated to the right. Palpation reveals no masses or infiltration in the neck. The b... | Intrauterine malposition | {
"A": "Congenital infection",
"B": "Basal ganglia abnormalities",
"C": "Antenatal trauma",
"D": "Intrauterine malposition"
} | step1 | D | [
"31 year old woman delivers",
"healthy boy",
"weeks gestation",
"delivery",
"vaginal",
"uncomplicated",
"pregnancy",
"unremarkable",
"examination",
"newborn",
"noted",
"head",
"tilted",
"left",
"chin",
"rotated",
"right",
"Palpation reveals",
"masses",
"infiltration",
"neck",... |
A healthy 30-year-old woman comes to the physician with her husband for preconception counseling. Her husband is healthy but she is concerned because her brother was recently diagnosed with a genetic liver condition for which he takes penicillamine. Her father-in-law has liver cirrhosis and a tremor. The results of gen... | 25% | {
"A": "0%",
"B": "100%",
"C": "25%",
"D": "50%"
} | step1 | C | [
"healthy 30 year old woman",
"physician",
"husband",
"preconception counseling",
"husband",
"healthy",
"concerned",
"brother",
"recently diagnosed",
"genetic liver",
"takes penicillamine",
"father-in-law",
"liver cirrhosis",
"tremor",
"results",
"genetic testing show",
"patient",
"... |
A 20-year-old man who is a biology major presents to his physician for a simple check-up. He is informed that he hasn’t received a hepatitis B vaccine. When the first injection is applied, the medical professional informs him that he will need to come back 2 more times on assigned days, since the vaccine is given in 3 ... | IgM | {
"A": "IgA",
"B": "IgM",
"C": "IgD",
"D": "IgE"
} | step1 | B | [
"20 year old man",
"biology major presents",
"physician",
"simple check-up",
"informed",
"hasnt received",
"hepatitis B vaccine",
"first injection",
"applied",
"medical professional informs",
"need to",
"back 2",
"times",
"assigned days",
"vaccine",
"given",
"doses",
"following ant... |
A 28-year-old woman presents with an abnormal vaginal discharge for the past week. She maintains a monogamous relationship but denies the use of barrier protection with her partner. She is 5 weeks late for her menstrual cycle. Subsequent testing demonstrates a positive pregnancy test. A wet mount demonstrates motile, p... | Metronidazole | {
"A": "Azithromycin",
"B": "Fluconazole",
"C": "Metronidazole",
"D": "Ceftriaxone"
} | step1 | C | [
"year old woman presents",
"abnormal",
"past week",
"maintains",
"monogamous relationship",
"denies",
"use of barrier protection",
"partner",
"5 weeks late",
"menstrual cycle",
"Subsequent testing demonstrates",
"positive pregnancy test",
"wet mount demonstrates motile",
"pear-shaped organ... |
A 53-year-old woman presents to her primary care physician with complaints of pain and swelling in her hands and fingers. She states that she has had these symptoms since she was in her 20s, but they have recently become more severe. She states that her wedding ring no longer fits, due to increased swelling of her fing... | Administer indomethacin and methotrexate | {
"A": "Administer indomethacin and sulfasalazine",
"B": "Administer indomethacin and methotrexate",
"C": "Administer indomethacin",
"D": "Administer methotrexate"
} | step2&3 | B | [
"year old woman presents",
"primary care physician",
"complaints",
"pain",
"swelling",
"hands",
"fingers",
"states",
"symptoms",
"20s",
"recently",
"more severe",
"states",
"wedding ring",
"longer fits",
"due to increased swelling of",
"fingers",
"pack-year smoker",
"body mass in... |
A 15-year-old boy comes to the physician for the evaluation of progressive difficulty climbing stairs for the last 2 years. During this period, he has also had problems running and standing up from a seated position. He is at the 50th percentile for height and weight. Examination shows enlarged calf muscles bilaterally... | Missense mutation | {
"A": "Missense mutation",
"B": "Trinucleotide repeat expansions",
"C": "Splice site mutation",
"D": "Frameshift mutation"
} | step1 | A | [
"year old boy",
"physician",
"evaluation",
"progressive difficulty climbing stairs",
"last",
"years",
"period",
"problems running",
"standing up",
"seated position",
"50th percentile",
"height",
"weight",
"Examination shows enlarged calf muscles",
"waddling gait",
"following",
"most ... |
A 71-year-old man is admitted to the hospital one hour after he was found unconscious. His pulse is 80/min and systolic blood pressure is 98 mm Hg; diastolic blood pressure cannot be measured. He is intubated and mechanically ventilated with supplemental oxygen at a tidal volume of 450 mL and a respiratory rate of 10/m... | Pulmonary artery oxygen content | {
"A": "End-tidal carbon dioxide pressure",
"B": "Total peripheral resistance",
"C": "Left ventricular end-diastolic volume",
"D": "Pulmonary artery oxygen content"
} | step1 | D | [
"71 year old man",
"admitted",
"hospital one hour",
"found unconscious",
"pulse",
"80 min",
"systolic blood pressure",
"98 mm Hg",
"diastolic blood pressure",
"measured",
"intubated",
"ventilated",
"supplemental oxygen",
"tidal volume",
"450 mL",
"respiratory rate",
"10/min",
"Arte... |
A 57-year-old man presents to the office with complaints of perianal pain during defecation and perineal heaviness for 1 month. He also complains of discharge around his anus, and bright red bleeding during defecation. The patient provides a history of having a sexual relationship with other men without using any metho... | Anal cancer | {
"A": "Anal fissure",
"B": "Anal cancer",
"C": "Proctitis",
"D": "Polyps"
} | step1 | B | [
"57 year old man presents",
"office",
"complaints",
"perianal pain",
"defecation",
"perineal heaviness",
"month",
"discharge",
"anus",
"bright red bleeding",
"defecation",
"patient provides",
"history",
"sexual relationship",
"men",
"using",
"methods",
"protection",
"physical exa... |
A 64-year-old male retired farmer presents to the orthopaedic surgery clinic with chronic left knee pain. Radiographic imaging demonstrates severe tricompartmental osteoarthritis. The patient has a history of diabetes mellitus, chronic kidney disease, hypertension, hyperlipidemia, and congestive heart failure. He under... | 0.002 | {
"A": "0.02",
"B": "0.002",
"C": "0.0002",
"D": "0.00002"
} | step1 | B | [
"64 year old male retired farmer presents",
"orthopaedic surgery clinic",
"chronic left knee pain",
"Radiographic imaging demonstrates severe",
"osteoarthritis",
"patient",
"history of diabetes mellitus",
"chronic kidney disease",
"hypertension",
"hyperlipidemia",
"congestive heart failure",
"... |
A 52-year-man is brought to the physician because of a 2-week history of memory loss. Three weeks ago, he had a cardiac arrest that required cardiopulmonary resuscitation and intravenous epinephrine. On mental status examination, he cannot recall objects shown to him 20 minutes earlier but vividly recalls memories from... | Pyramidal cells of the hippocampus | {
"A": "Purkinje cells of the cerebellum",
"B": "Microglial cells of dorsal midbrain",
"C": "Pyramidal cells of the hippocampus",
"D": "Astroglial cells of the putamen"
} | step1 | C | [
"year man",
"brought",
"physician",
"of",
"2-week history",
"memory loss",
"Three weeks",
"cardiac arrest",
"required cardiopulmonary resuscitation",
"intravenous epinephrine",
"mental",
"recall objects shown",
"20 minutes earlier",
"recalls memories",
"incident",
"examination shows",
... |
A 28-year-old woman comes to the physician because she had a positive pregnancy test at home. She reports feeling nauseated and has vomited several times over the past week. During this period, she has also had increased urinary frequency. She is sexually active with her boyfriend and they use condoms inconsistently. H... | Reevaluation with cytology and colposcopy 6 weeks after birth | {
"A": "Reevaluation with cytology and colposcopy 6 weeks after birth",
"B": "Endocervical curettage",
"C": "Perform loop electrosurgical excision",
"D": "Diagnostic excisional procedure\n\""
} | step2&3 | A | [
"year old woman",
"physician",
"positive pregnancy test at home",
"reports feeling nauseated",
"vomited",
"times",
"past",
"period",
"increased urinary frequency",
"sexually active",
"boyfriend",
"use condoms",
"last menstrual period",
"5 weeks",
"Physical examination shows",
"abnormal... |
A 55-year-old woman presents to the emergency department with retrosternal pain that started this evening. The patient states that her symptoms started as she was going to bed after taking her medications. She describes the pain as sudden in onset, worse with swallowing, and not associated with exertion. The patient ha... | Esophagitis | {
"A": "Esophageal rupture",
"B": "Esophagitis",
"C": "Myocardial infarction",
"D": "Pulmonary embolism"
} | step2&3 | B | [
"55 year old woman presents",
"emergency department",
"retrosternal pain",
"started",
"evening",
"patient states",
"symptoms started",
"bed",
"medications",
"pain",
"sudden",
"onset",
"worse",
"swallowing",
"not associated with exertion",
"patient",
"past medical diabetes",
"anemia... |
A 28-year-old man comes to the physician for a follow-up examination after a previous visit showed an elevated serum calcium level. He has a history of bipolar disorder. His mother had a parathyroidectomy in her 30s. The patient does not drink alcohol or smoke. Current medications include lithium and a daily multivitam... | Abnormal calcium sensing receptors | {
"A": "Excess calcium intake",
"B": "Abnormal calcium sensing receptors",
"C": "Lithium toxicity",
"D": "Parathyroid adenoma"
} | step2&3 | B | [
"year old man",
"physician",
"follow-up",
"previous visit showed",
"elevated serum calcium level",
"history of bipolar disorder",
"mother",
"parathyroidectomy",
"30s",
"patient",
"not drink alcohol",
"smoke",
"Current medications include lithium",
"daily multivitamin",
"vital signs",
"... |
A 55-year-old woman with type 2 diabetes mellitus presents to her physician with intermittent nausea for the past 2 months. Her symptoms are exacerbated within one hour after eating. She has no other history of a serious illness. She takes metformin and injects insulin. Her vitals are normal. Abdominal examination is n... | Metoclopramide | {
"A": "Dimenhydrinate",
"B": "Metoclopramide",
"C": "Octreotide",
"D": "Ondansetron"
} | step2&3 | B | [
"55 year old woman",
"type 2 diabetes mellitus presents",
"physician",
"intermittent nausea",
"past",
"months",
"symptoms",
"exacerbated",
"one hour",
"eating",
"history",
"serious illness",
"takes metformin",
"injects insulin",
"normal",
"Abdominal examination",
"normal",
"ECG sho... |
A 7-year-old boy is brought by his parents to his pediatrician with a one-day history of fever, chills, and pain in the right upper extremity. The patient’s mother says that he has injured his right index finger while playing in the garden 3 days earlier. His temperature is 38.8°C (101.8°F), pulse is 120/min, respirato... | Group A β-hemolytic Streptococcus | {
"A": "Aeromonas hydrophila",
"B": "Group A β-hemolytic Streptococcus",
"C": "Pseudomonas aeruginosa",
"D": "Staphylococcus aureus"
} | step1 | B | [
"year old boy",
"brought",
"parents",
"pediatrician",
"one-day history",
"fever",
"chills",
"pain",
"right upper extremity",
"patients mother",
"injured",
"right index finger",
"playing",
"garden 3 days earlier",
"temperature",
"pulse",
"min",
"respiratory rate",
"min",
"blood ... |
A 7-year-old boy is brought to the emergency department by his parents. He is complaining of left-sided knee pain which has progressively increased in severity over the past 2 days. It started when he was playing football with his brothers but he does not recall falling or getting any injury. Past medical history is si... | Duchenne muscular dystrophy | {
"A": "Alkaptonuria",
"B": "Sickle cell disease",
"C": "Duchenne muscular dystrophy",
"D": "Huntington's disease"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"parents",
"left-sided knee pain",
"increased",
"severity",
"past 2 days",
"started",
"playing football",
"brothers",
"not recall falling",
"getting",
"injury",
"Past medical history",
"significant",
"prolonged bleeding",
"easy bru... |
A 34-year-old woman presents to her primary care provider after intermittently passing bright pink urine over several days. She is concerned this discoloration is due to blood. Her medical history is unremarkable, she denies being sick in the past weeks and has only taken a couple of diclofenac capsules for pelvic pain... | Renal biopsy | {
"A": "Discontinuation of NSAID",
"B": "Fomepizole",
"C": "Intravenous fluid therapy and electrolyte correction",
"D": "Renal biopsy"
} | step2&3 | D | [
"year old woman presents",
"primary care provider",
"passing bright pink urine",
"days",
"concerned",
"discoloration",
"due to blood",
"medical history",
"unremarkable",
"denies",
"sick",
"past weeks",
"only taken",
"couple",
"diclofenac capsules",
"pelvic pain associated",
"menstrua... |
A 32-year-old man comes to the physician because of a 3-month history of progressively worsening shortness of breath on exertion. He is concerned that he has asthma and would like to be started on albuterol. Which of the following findings is most likely to indicate a different diagnosis in this patient? | Decrease in FEV1 by 6% after administration of high-dose methacholine | {
"A": "129% of the predicted diffusion capacity of the lung for carbon monoxide",
"B": "Decrease in systolic blood pressure by 16 mm Hg during inspiration",
"C": "Decrease in FEV1 by 6% after administration of high-dose methacholine",
"D": "Visibility of 11 posterior ribs in the midclavicular line above the di... | step1 | C | [
"year old man",
"physician",
"3 month history",
"worsening shortness of breath",
"exertion",
"concerned",
"asthma",
"to",
"started",
"albuterol",
"following findings",
"most likely to",
"different diagnosis",
"patient"
] |
A 25-year-old man is brought to the emergency department by the police after a motor vehicle accident. He was reportedly speeding in a residential area and collided with a tree. He was later found by police naked in the street, screaming "shoot me so the devil will leave". A review of his medical record is unremarkable... | Phencyclidine (PCP) intoxication | {
"A": "Cocaine intoxication",
"B": "Central nervous system infection",
"C": "Phencyclidine (PCP) intoxication",
"D": "Serotonin syndrome"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"police",
"motor vehicle accident",
"speeding",
"residential area",
"tree",
"later found",
"police naked",
"street",
"screaming",
"shoot",
"so",
"devil",
"leave",
"review",
"medical record",
"unremarkable",
"hospital",
"conti... |
A 28-year-old man comes to the physician because of a 6-month history of progressive fatigue and intermittent diarrhea. During this time, he has had a 6-kg (13-lb) weight loss. Physical examination shows pale conjunctivae. Abdominal examination shows tenderness to palpation in the lower quadrants. An image from a colon... | Perinuclear antineutrophil cytoplasmic antibodies | {
"A": "Positive lactose hydrogen breath test",
"B": "Anti-Saccharomyces cerevisiae antibodies",
"C": "Perinuclear antineutrophil cytoplasmic antibodies",
"D": "Anti-tissue transglutaminase antibodies"
} | step1 | C | [
"year old man",
"physician",
"month history",
"progressive fatigue",
"intermittent diarrhea",
"time",
"kg",
"weight loss",
"Physical examination shows pale conjunctivae",
"Abdominal examination shows tenderness",
"palpation",
"lower quadrants",
"image",
"colonoscopy",
"descending colon",... |
A 51-year-old woman comes to the physician because of a 6-month history of fatigue and increased thirst. She has no history of serious medical illness and takes no medications. She is 163 cm (5 ft 4 in) tall and weighs 72 kg (160 lb); BMI is 28 kg/m2. Her fasting serum glucose concentration is 249 mg/dL. Treatment with... | Decreased hepatic gluconeogenesis | {
"A": "Decreased glucagon release",
"B": "Increased insulin release",
"C": "Decreased carbohydrate hydrolysis",
"D": "Decreased hepatic gluconeogenesis"
} | step1 | D | [
"year old woman",
"physician",
"month history",
"fatigue",
"increased thirst",
"history of serious medical illness",
"takes",
"medications",
"5 ft 4",
"tall",
"72 kg",
"BMI",
"kg/m2",
"fasting serum",
"mg/dL",
"Treatment",
"oral hypoglycemic agent",
"begun",
"following best",
"... |
An investigator is conducting an experiment to study different pathways of glucose metabolism. He obtains cells cultured from various tissues to study the effect of increased extracellular glucose concentration. Following the incubation of these cells in 5% dextrose, he measures the intracellular fructose concentration... | Ovary | {
"A": "Ovary",
"B": "Kidney",
"C": "Lens",
"D": "Retina"
} | step1 | A | [
"investigator",
"conducting",
"experiment to study different pathways",
"glucose metabolism",
"obtains cells cultured",
"various tissues to study",
"effect",
"increased extracellular glucose concentration",
"Following",
"cells",
"5",
"dextrose",
"measures",
"intracellular fructose concentr... |
A 21-year-old primigravid woman comes to the physician at 10 weeks' gestation because of progressive fatigue for the past 3 weeks. She reports that she has had a 3.2-kg (7-lb) weight loss after conceiving despite an increase in appetite. She has become increasingly anxious and has trouble falling asleep. There is no pe... | Propylthiouracil | {
"A": "Lugol's iodine",
"B": "Thyroidectomy",
"C": "Propylthiouracil",
"D": "Atenolol"
} | step2&3 | C | [
"21-year-old primigravid woman",
"physician",
"10 weeks",
"gestation",
"of progressive fatigue",
"past",
"weeks",
"reports",
"3.2 kg",
"weight loss",
"conceiving",
"increase",
"appetite",
"anxious",
"trouble falling asleep",
"personal",
"family history",
"serious illness",
"Medic... |
A 52-year-old unconscious man is brought to the emergency department. He was found unresponsive on the sidewalk in the snow. He is recognized by the staff as a local homeless man and IV drug user. Rapid warming procedures are initiated. At physical examination, he is dirty and disheveled and unrousable with a blood pre... | Check liver enzymes regularly | {
"A": "Acyclovir should be started empirically as well",
"B": "Check liver enzymes regularly",
"C": "Verify response to antibiotic therapy",
"D": "Treatment should only be started after CSF culture results"
} | step2&3 | B | [
"year old unconscious man",
"brought",
"emergency department",
"found unresponsive",
"sidewalk",
"snow",
"staff",
"local homeless man",
"IV drug user",
"Rapid warming procedures",
"initiated",
"physical examination",
"dirty",
"blood pressure",
"100 76 mm Hg",
"temperature",
"thin",
... |
A 23-year-old male presents to the emergency department. He was brought in by police for shouting on a subway. The patient claims that little people were trying to kill him, and he was acting within his rights to defend himself. The patient has a past medical history of marijuana and IV drug use as well as multiple sui... | Clozapine | {
"A": "Fluphenazine",
"B": "Thioridazine",
"C": "Olanzapine",
"D": "Clozapine"
} | step2&3 | D | [
"23 year old male presents",
"emergency department",
"brought",
"police",
"shouting",
"subway",
"patient",
"little people",
"to kill",
"acting",
"rights to defend",
"patient",
"past medical marijuana",
"IV drug use",
"multiple suicide attempts",
"currently homeless",
"ED",
"patient... |
An 18-year-old man presents to his primary care provider before leaving for college. He has no complaints. His past medical history is significant for asthma, acne vulgaris, and infectious mononucleosis at age 16. His home medications include doxycycline and albuterol as needed. His family history is significant for co... | Colonoscopy every 1-2 years beginning at age 25 | {
"A": "Colonoscopy every 1-2 years beginning at age 25",
"B": "Colonoscopy every 5 years beginning at age 40",
"C": "Colonoscopy every 10 years beginning at age 50",
"D": "Prophylactic colectomy"
} | step2&3 | A | [
"year old man presents",
"primary care provider",
"leaving",
"college",
"complaints",
"past medical history",
"significant",
"asthma",
"acne vulgaris",
"infectious mononucleosis",
"age 16",
"home medications include doxycycline",
"albuterol as needed",
"family history",
"significant",
... |
A 57-year-old woman with a long-standing history of liver cirrhosis presents to her primary care provider with a complaint of unintended weight loss of 8.2 kg (18.0 lb) within the last month. She has a history of intermittent right upper quadrant pain in her abdomen with decreased appetite for a few years and occasiona... | History of blood transfusion | {
"A": "Shortness of breath",
"B": "History of alcoholism",
"C": "History of blood transfusion",
"D": "Hemochromatosis"
} | step1 | C | [
"57 year old woman",
"long standing history of liver cirrhosis presents",
"primary care provider",
"complaint of unintended weight loss",
"kg",
"0",
"last month",
"history",
"intermittent right upper quadrant pain in",
"abdomen",
"decreased appetite",
"few years",
"occasional shortness of br... |
A 79-year-old man presents to a physician’s office for a routine appointment. He had a myocardial infarction 3 years ago and was started on aspirin, carvedilol, captopril, and high-dose atorvastatin. He denies shortness of breath or cough. He exercises regularly and is on a healthy diet that is good for his heart. The ... | Ezetimibe | {
"A": "Furosemide",
"B": "Orlistat",
"C": "Ezetimibe",
"D": "Losartan"
} | step1 | C | [
"year old man presents",
"physicians office",
"routine appointment",
"myocardial infarction",
"years",
"started",
"aspirin",
"carvedilol",
"captopril",
"high-dose atorvastatin",
"denies shortness of breath",
"cough",
"exercises",
"healthy diet",
"good",
"heart",
"vital signs include"... |
A 69-year-old man comes to the physician because of a 4-month history of progressive fatigue, cough, shortness of breath, and a 6.6-kg (14.5-lb) weight loss. For the past week, he has had blood-tinged sputum. He is a retired demolition foreman. There is dullness to percussion and decreased breath sounds over the left l... | Calretinin-positive polygonal cells with numerous long surface microvilli | {
"A": "Synaptophysin-positive dark blue cells with hyperchromatic nuclei and scarce cytoplasm",
"B": "Calretinin-positive polygonal cells with numerous long surface microvilli",
"C": "Napsin-positive cells in an acinar growth pattern with intracytoplasmatic mucin",
"D": "Keratin-producing large polygonal cells... | step1 | B | [
"69 year old man",
"physician",
"4 month history",
"progressive fatigue",
"cough",
"shortness of breath",
"6.6 kg",
"weight loss",
"past week",
"blood-tinged sputum",
"retired",
"foreman",
"dullness",
"percussion",
"decreased breath sounds",
"left lung base",
"CT scan of",
"chest s... |
A 57-year-old man presents with acute-onset nausea and left flank pain. He says his symptoms suddenly started 10 hours ago and have not improved. He describes the pain as severe, colicky, intermittent, and localized to the left flank. The patient denies any fever, chills, or dysuria. His past medical history is signifi... | Ureteroscopy | {
"A": "Ureteroscopy",
"B": "Percutaneous nephrostolithotomy (PCNL)",
"C": "Extracorporeal shockwave lithotripsy (ESWL)",
"D": "24-hour urine chemistry"
} | step2&3 | A | [
"57 year old man presents",
"acute-onset nausea",
"left flank pain",
"symptoms",
"started 10 hours",
"not improved",
"pain",
"severe",
"colicky",
"intermittent",
"localized",
"left flank",
"patient denies",
"fever",
"chills",
"dysuria",
"past medical history",
"significant",
"nep... |
A 27-year-old woman is brought to the physician by her parents because they are concerned about her mood. They say that she has “not been herself” since the death of her friend, who was killed 3 weeks ago when the fighter jet he piloted was shot down overseas. She says that since the incident, she feels sad and alone. ... | """I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts?""" | {
"A": "\"\"\"I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts?\"\"\"",
"B": "\"\"\"Your grief over the loss of your friend appears to have a negative effect on your social and... | step2&3 | A | [
"27 year old woman",
"brought",
"physician",
"parents",
"concerned",
"mood",
"not",
"since",
"death",
"friend",
"killed 3 weeks",
"jet",
"piloted",
"shot",
"incident",
"feels sad",
"alone",
"reports",
"repeated nightmares",
"friend's death",
"appetite",
"decreased",
"eati... |
A 25-year-old man is rushed to the emergency department following a motor vehicle accident. After an initial evaluation, he is found to have bilateral femoral fractures. After surgical fixation of his fractures, he suddenly starts to feel nauseated and becomes agitated. Past medical history is significant for a thyroid... | Decrease the peripheral conversion of T4 to T3 | {
"A": "Inhibition of thyroid peroxidase enzyme",
"B": "Inhibition of an underlying autoimmune process",
"C": "Decrease the peripheral conversion of T4 to T3",
"D": "Interference with enterohepatic circulation and recycling of thyroid hormones"
} | step1 | C | [
"year old man",
"rushed",
"emergency department following",
"motor vehicle accident",
"initial evaluation",
"found to",
"bilateral femoral fractures",
"surgical fixation of",
"fractures",
"starts to feel nauseated",
"agitated",
"Past medical history",
"significant",
"thyroid disorder",
"... |
A 25-year-old medical student returns from a volunteer mission trip in Nicaragua with persistent cough and occasional hemoptysis for 3 weeks. A purified protein derivative test revealing a 20 mm wheal and a chest radiograph with hilar lymphadenopathy support a diagnosis of active tuberculosis. The patient is started on... | Vision changes | {
"A": "Joint pain",
"B": "Leg numbness",
"C": "Orange colored urine",
"D": "Vision changes"
} | step2&3 | D | [
"year old medical student returns",
"volunteer mission trip",
"Nicaragua",
"persistent cough",
"occasional hemoptysis",
"weeks",
"purified protein derivative test revealing",
"20 mm wheal",
"chest radiograph",
"hilar lymphadenopathy support",
"diagnosis",
"active tuberculosis",
"patient",
... |
A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patien... | It sounds like you have been going through some tough experiences lately. | {
"A": "I don’t think any agents are pursuing you.",
"B": "I think you are safe from the agents here.",
"C": "It sounds like you have been going through some tough experiences lately.",
"D": "You have a mental disorder but don’t worry we will help you."
} | step2&3 | C | [
"23 year old man presents",
"emergency department",
"chief complaint",
"assaulted",
"street",
"patient",
"followed by",
"government",
"time",
"assaulted",
"government agent",
"able to escape",
"often hears voices",
"to hide",
"patient",
"unknown past medical history",
"admits",
"sm... |
A 35-year-old Caucasian female with a history of rheumatoid arthritis presents to your clinic with pleuritic chest pain that improves while leaning forward. Which of the following additional findings would you expect to observe in this patient? | Increase in jugular venous pressure on inspiration | {
"A": "Increase in jugular venous pressure on inspiration",
"B": "Exaggerated amplitude of pulse on inspiration",
"C": "Pulsatile abdominal mass",
"D": "Continuous machine-like murmur"
} | step1 | A | [
"35 year old Caucasian female",
"history of rheumatoid arthritis presents",
"clinic",
"pleuritic chest pain",
"improves",
"forward",
"following additional findings",
"to observe",
"patient"
] |
A 27-year-old man presents to his primary care physician after a recent illness. For the past 48 hours the patient has experienced constant vomiting and diarrhea with a high fever. He is feeling better today and wants to be seen to ensure he is healthy. The patient has a past medical history of schizophrenia well contr... | Volume depletion | {
"A": "Aldosterone-secreting mass",
"B": "Intrarenal injury",
"C": "Psychogenic polydipsia",
"D": "Volume depletion"
} | step2&3 | D | [
"27 year old man presents",
"primary care physician",
"recent illness",
"past 48 hours",
"patient",
"constant vomiting",
"diarrhea",
"high fever",
"feeling better today",
"to",
"seen to ensure",
"healthy",
"patient",
"past medical well controlled",
"risperidone",
"lithium",
"takes ib... |
A 46-year-old woman comes to the emergency department because of intermittent abdominal pain and vomiting for 2 days. The abdominal pain is colicky and diffuse. The patient's last bowel movement was 3 days ago. She has had multiple episodes of upper abdominal pain that radiates to her scapulae and vomiting over the pas... | Cholecystoenteric fistula | {
"A": "Cholecystoenteric fistula",
"B": "Cecal torsion",
"C": "Bowel infarction",
"D": "Viscus perforation"
} | step2&3 | A | [
"year old woman",
"emergency department",
"intermittent abdominal pain",
"vomiting",
"2 days",
"abdominal pain",
"colicky",
"diffuse",
"patient's",
"bowel movement",
"3 days",
"multiple episodes of upper abdominal pain",
"radiates",
"scapulae",
"vomiting",
"past 3 months",
"symptoms"... |
A 41-year-old woman comes to the physician because of a 1-year history of fatigue, irregular menstrual cycles, and recurrent sinus infections. Examination shows hirsutism and hypopigmented linear striations on the abdomen. Serum studies show hypernatremia, hypokalemia, and metabolic alkalosis. A 24-hour urinary cortiso... | Small cell lung cancer | {
"A": "Adrenal adenoma",
"B": "Pituitary adenoma",
"C": "Pheochromocytoma",
"D": "Small cell lung cancer"
} | step1 | D | [
"year old woman",
"physician",
"year history",
"fatigue",
"irregular menstrual cycles",
"recurrent sinus",
"Examination shows hirsutism",
"hypopigmented linear striations",
"abdomen",
"Serum studies show hypernatremia",
"hypokalemia",
"metabolic alkalosis",
"hour urinary cortisol level",
"... |
A group of investigators is studying thermoregulatory adaptations of the human body. A subject is seated in a thermally insulated isolation chamber with an internal temperature of 48°C (118°F), a pressure of 1 atmosphere, and a relative humidity of 10%. Which of the following is the primary mechanism of heat loss in th... | Evaporation | {
"A": "Evaporation",
"B": "Conduction",
"C": "Convection",
"D": "Radiation"
} | step1 | A | [
"A group",
"investigators",
"studying",
"adaptations",
"human body",
"subject",
"seated",
"isolation chamber",
"internal temperature",
"pressure",
"atmosphere",
"relative humidity",
"10",
"following",
"primary mechanism",
"heat loss",
"subject"
] |
A 52-year-old woman sees you in her office with a complaint of new-onset headaches over the past few weeks. On exam, you find a 2 x 2 cm dark, irregularly shaped, pigmented lesion on her back. She is concerned because her father recently passed away from skin cancer. What tissue type most directly gives rise to the les... | Neural crest cells | {
"A": "Ectoderm",
"B": "Mesoderm",
"C": "Neural crest cells",
"D": "Endoderm"
} | step1 | C | [
"year old woman sees",
"office",
"complaint",
"new-onset headaches",
"past",
"weeks",
"exam",
"find",
"2",
"2",
"dark",
"shaped",
"pigmented lesion",
"back",
"concerned",
"father recently passed",
"skin cancer",
"tissue type",
"directly gives rise",
"lesion",
"patient",
"ex... |
A 19-year-old man is brought to the emergency department following a high-speed motor vehicle collision in which he was a restrained passenger. He complains of pelvic pain and involuntary loss of urine, with constant dribbling. Examination shows perineal bruising and there is pain with manual compression of the pelvis.... | Pelvic splanchnic nerves | {
"A": "Pelvic splanchnic nerves",
"B": "Genitofemoral nerve",
"C": "Superior gluteal nerve",
"D": "Obturator nerve"
} | step1 | A | [
"year old man",
"brought",
"emergency department following",
"high speed motor vehicle collision",
"restrained passenger",
"pelvic pain",
"involuntary loss",
"urine",
"constant dribbling",
"Examination shows perineal bruising",
"pain",
"manual compression",
"pelvis",
"ultrasound shows",
... |
A 29-year-old woman comes to the physician because of a 4-day history of fever with chills, nausea, myalgias, and malaise. One week ago, she returned from a trip to Rhode Island, where she participated in a month-long program to become an assistant park ranger. Laboratory studies show a leukocyte count of 1,400/mm3. A ... | Binding of bacterial tRNA to the acceptor site of ribosomes | {
"A": "Transcription of bacterial DNA by RNA-polymerase",
"B": "Bacterial topoisomerase II and topoisomerase IV activity",
"C": "Peptidoglycan crosslinking and bacterial cell wall synthesis",
"D": "Binding of bacterial tRNA to the acceptor site of ribosomes"
} | step1 | D | [
"29 year old woman",
"physician",
"4-day history",
"fever",
"chills",
"nausea",
"myalgias",
"malaise",
"One week",
"returned",
"trip",
"Rhode Island",
"month long program to",
"assistant park",
"Laboratory studies show",
"leukocyte count",
"1 400 mm3",
"peripheral blood smear shows... |
A 32-year-old Caucasian woman presents with a three-month history of weight loss, anxiety, and tremors. She recalls frequent heart palpitations and new discomfort while being outside in the heat. Her labs include a TSH level of 0.1 mIU/L. Additionally, the patient’s serum is positive for antibodies that stimulate the T... | Stimulation of retroorbital fibroblasts | {
"A": "Hyperplasia of thyroid follicular cells",
"B": "Lymphocyte-mediated destruction of the thyroid gland",
"C": "Elevated levels of cholesterol and low density lipoprotein (LDL)",
"D": "Stimulation of retroorbital fibroblasts"
} | step1 | D | [
"year old Caucasian woman presents",
"three month history of weight loss",
"anxiety",
"tremors",
"recalls frequent heart palpitations",
"new discomfort",
"outside",
"heat",
"labs include",
"TSH level",
"0.1 mIU/L",
"patients serum",
"positive",
"antibodies",
"TSH receptor",
"process",
... |
A 59-year-old Caucasian man presents with a one-month history of left flank fullness and pain. The patient has stable angina, which is controlled with medications including atorvastatin, metoprolol, and aspirin. His vital signs are within normal limits. BMI is 32 kg/m2. Clinical examination reveals a 10 x 10-cm palpabl... | Obesity | {
"A": "Atorvastatin",
"B": "Caucasian race",
"C": "Lynch syndrome",
"D": "Obesity"
} | step2&3 | D | [
"59 year old Caucasian man presents",
"one-month history",
"left flank fullness",
"pain",
"patient",
"stable angina",
"controlled with medications including atorvastatin",
"metoprolol",
"aspirin",
"vital signs",
"normal limits",
"BMI",
"kg/m2",
"Clinical examination reveals a 10",
"cm pa... |
Two hours after undergoing laparoscopic roux-en-Y gastric bypass surgery, a 44-year-old man complains of pain in the site of surgery and nausea. He has vomited twice in the past hour. He has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. Current medications include insulin, atorvastatin, hydrochlorot... | Hypoxia | {
"A": "Uremia",
"B": "Early dumping syndrome",
"C": "Hypoxia",
"D": "Late dumping syndrome"
} | step2&3 | C | [
"Two hours",
"laparoscopic roux-en-Y gastric bypass surgery",
"year old man",
"pain",
"site of surgery",
"nausea",
"vomited twice",
"past hour",
"hypertension",
"type 2 diabetes mellitus",
"hypercholesterolemia",
"Current medications include insulin",
"atorvastatin",
"hydrochlorothiazide",... |
A 31-year-old man presents with a headache, myalgias, nausea, irritability, and forgetfulness. He developed these symptoms gradually over the past 3 months. He is a motor mechanic, and he changed his place of work 4 months ago. He smokes a half a pack of cigarettes per day. His vaccinations are up to date. On presentat... | This patient’s symptoms are due to CO-induced inactivation of cytochrome oxidase and carboxyhemoglobin formation. | {
"A": "The patient’s symptoms are a consequence of his essential hypertension.",
"B": "Chronic cyanide exposure is the main cause of patient’s condition.",
"C": "This patient’s symptoms are due to CO-induced inactivation of cytochrome oxidase and carboxyhemoglobin formation.",
"D": "Viral infection should be s... | step1 | C | [
"31 year old man presents",
"headache",
"myalgias",
"nausea",
"irritability",
"forgetfulness",
"symptoms",
"past 3 months",
"motor mechanic",
"changed",
"place of work",
"months",
"smokes",
"half",
"pack",
"cigarettes",
"day",
"vaccinations",
"date",
"presentation",
"vital si... |
A 38-year-old woman was brought to the emergency department after she experienced dizziness and shortness of breath while walking with her friend. She recently immigrated to the United States and is unable to report her previous medical history. Physical exam reveals pallor underneath her eyelids. Labs are obtained wit... | Administration of a 50S ribosomal inhibitor | {
"A": "Administration of a 50S ribosomal inhibitor",
"B": "Chronic alcohol abuse",
"C": "Living in an old house",
"D": "Vegan diet"
} | step1 | A | [
"year old woman",
"brought",
"emergency department",
"experienced dizziness",
"shortness of breath",
"walking",
"friend",
"recently",
"United States",
"unable to report",
"previous medical history",
"Physical exam reveals pallor",
"eyelids",
"Labs",
"obtained",
"following results",
"... |
A 68-year-old man presents to the office for his annual physical examination. He has no current complaints. Past medical history is unremarkable. He reports a 30-pack-year smoking history but no alcohol or drug use. Review of systems is only remarkable for thicker mucous production that is worse in the morning when he ... | Latent period | {
"A": "Surveillance bias",
"B": "Confounding bias",
"C": "Latent period",
"D": "Lead time bias"
} | step1 | C | [
"68 year old man presents",
"office",
"annual physical examination",
"current complaints",
"Past medical history",
"unremarkable",
"reports",
"30 pack-year smoking history",
"alcohol",
"drug use",
"Review of systems",
"only",
"thicker mucous production",
"worse",
"morning",
"coughs",
... |
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