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 32-year-old woman presents with a 3-month history of intermittent blurred vision and problems walking. The patient states that she often feels “pins and needles” in her legs that cause her problems when she’s walking. The patient is afebrile, and her vital signs are within normal limits. An autoimmune disorder is sus... | Damaged myelin sheath and myelin-producing cells | {
"A": "Decreased cerebrospinal fluid due to destruction of cells",
"B": "Destruction of blood-brain barrier",
"C": "Failure of cells that myelinate individual axons",
"D": "Damaged myelin sheath and myelin-producing cells"
} | step1 | D | [
"year old woman presents",
"month history",
"intermittent blurred vision",
"problems walking",
"patient states",
"often feels pins",
"needles",
"legs",
"cause",
"problems",
"shes walking",
"patient",
"afebrile",
"vital signs",
"normal limits",
"autoimmune disorder",
"suspected",
"f... |
A 2-year-old girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then ... | Builds a tower of 6 cubes | {
"A": "Builds a tower of 6 cubes",
"B": "Hops on one foot",
"C": "Pedals a tricycle",
"D": "Separates easily from parents"
} | step2&3 | A | [
"2 year old girl",
"brought",
"physician",
"mother",
"well",
"percentile",
"height",
"percentile",
"weight",
"Vital signs",
"normal",
"Physical examination shows",
"abnormalities",
"able to follow simple commands",
"close",
"eyes",
"then stick out",
"tongue",
"unable to follow 3 ... |
A 23-year-old primigravida presents to her physician’s office at 12 weeks gestation complaining of increased sweating and palpitations for the last week. She does not have edema or dyspnea, and had no pre-existing illnesses. The patient says that the symptoms started a few days after several episodes of vomiting. She m... | Ensure proper hydration and prescribe a beta-blocker | {
"A": "Ensure proper hydration and prescribe a beta-blocker",
"B": "Manage with propylthiouracil",
"C": "Prescribe methimazole",
"D": "Recommend iodine radioablation"
} | step2&3 | A | [
"23 year old primigravida presents",
"physicians office",
"weeks gestation",
"of increased sweating",
"palpitations",
"week",
"not",
"edema",
"dyspnea",
"pre-existing illnesses",
"patient",
"symptoms started",
"few days",
"episodes of vomiting",
"managed",
"vomiting at home",
"vomiti... |
A 61-year-old man comes to the physician because of a 6-month history of epigastric pain and a 9-kg (20-lb) weight loss. He feels full and bloated even after eating small portions of food. His hemoglobin concentration is 9.5 g/dL with a mean corpuscular volume of 78 μm3. Test of the stool for occult blood is positive. ... | Gland-forming cuboidal cells | {
"A": "Neutrophilic infiltration with pit abscesses",
"B": "Foveolar and smooth muscle hyperplasia",
"C": "Gland-forming cuboidal cells",
"D": "Lymphocytic aggregates with noncaseating granulomas"
} | step1 | C | [
"61 year old man",
"physician",
"month history",
"epigastric pain",
"kg",
"20",
"weight loss",
"feels full",
"bloated",
"eating small portions",
"food",
"hemoglobin concentration",
"9.5 g",
"mean corpuscular volume",
"m3",
"Test",
"stool",
"occult blood",
"positive",
"Esophagog... |
A 62-year-old man comes to the physician because of a growth on his penis that has been gradually increasing in size over the last year. He was diagnosed with HIV 10 years ago. He has been divorced for 25 years and has had “at least 30 sexual partners” since. Physical examination shows a nontender 2.5-cm ulcerated lesi... | Human papillomavirus | {
"A": "Human papillomavirus",
"B": "Epstein-Barr virus",
"C": "Haemophilus ducreyi",
"D": "Chlamydia trachomatis\n\""
} | step1 | A | [
"62 year old man",
"physician",
"of",
"growth",
"penis",
"increasing in size",
"last year",
"diagnosed",
"HIV 10 years",
"divorced",
"years",
"30 sexual partners",
"Physical examination shows",
"nontender",
"ulcerated lesion",
"erythematous base",
"dorsum of",
"glans",
"firm left... |
A 32-year-old G2P0A1 woman presents at 36 weeks of gestation for the first time during her pregnancy. The patient has no complaints, currently. However, her past medical history reveals seizure disorder, which is under control with valproic acid and lithium. She has not seen her neurologist during the past 2 years, in ... | Neural tube defects (NTDs) | {
"A": "Trisomy 21",
"B": "Neural tube defects (NTDs)",
"C": "Intrauterine growth restriction",
"D": "Limb anomalies"
} | step2&3 | B | [
"year old",
"woman presents",
"36 weeks of gestation",
"first time",
"pregnancy",
"patient",
"complaints",
"currently",
"past medical history reveals seizure disorder",
"control",
"valproic acid",
"lithium",
"not seen",
"neurologist",
"past 2 years",
"absence",
"complaints",
"repor... |
A 36-year-old woman comes to the physician for a follow-up visit after she had a PET scan that showed a nodule on the thyroid gland. She has no difficulty or pain while swallowing. She was treated for non-Hodgkin lymphoma at the age of 28 years, which included external beam radiation to the head and neck and 4 cycles o... | Total thyroidectomy
" | {
"A": "Radioiodine therapy",
"B": "Observation and follow-up in 3 months",
"C": "Thyroid scintigraphy",
"D": "Total thyroidectomy\n\""
} | step2&3 | D | [
"36 year old woman",
"physician",
"follow-up visit",
"PET scan",
"showed",
"nodule",
"thyroid gland",
"difficulty",
"pain",
"swallowing",
"treated",
"non-Hodgkin lymphoma",
"age",
"years",
"included external beam radiation",
"head and neck",
"4 cycles",
"chemotherapy",
"appears h... |
A 25-year-old woman with a history of moderate persistent asthma presents to the emergency department with tachypnea, shortness of breath, and cough. She also mentions that she has recently started to notice red flecks in the sputum that she coughs up. The vital signs include: temperature 36.7°C (98.0°F), blood pressur... | Emotional instability | {
"A": "Emotional instability",
"B": "Fat deposits in the face",
"C": "Cushing’s syndrome",
"D": "Amenorrhea"
} | step2&3 | A | [
"year old woman",
"history of moderate persistent asthma presents",
"emergency department",
"tachypnea",
"shortness of breath",
"cough",
"recently started to",
"red flecks",
"sputum",
"coughs",
"vital signs include",
"temperature 36",
"98",
"blood pressure",
"74 mm Hg",
"heart rate 74 ... |
A 55-year-old woman comes to the physician because of fevers for 2 weeks. She works as a nurse and recently returned from a charity work trip to India, where she worked in a medically-underserved rural community. A tuberculin skin test 3 months ago prior to her trip showed an induration of 3 mm. Physical examination is... | Replication of bacteria within alveolar macrophages | {
"A": "Formation of a nodular tubercle in the lung",
"B": "Replication of bacteria within alveolar macrophages",
"C": "Production of interferon-gamma by T-helper cells",
"D": "Migration of T-helper cells to the lungs"
} | step1 | B | [
"55 year old woman",
"physician",
"of fevers",
"2 weeks",
"works",
"nurse",
"recently returned",
"charity work trip",
"India",
"worked",
"rural community",
"tuberculin skin test",
"months",
"prior to",
"trip showed",
"induration",
"mm",
"Physical examination",
"unremarkable",
"... |
A 35-year-old woman is brought to the emergency department 45 minutes after being rescued from a house fire. On arrival, she appears confused and has shortness of breath. The patient is 165 cm (5 ft 5 in) tall and weighs 55 kg (121 lb); BMI is 20 kg/m2. Her pulse is 125/min, respirations are 29/min, and blood pressure ... | Administer 6 liters of intravenous crystalloids over the next 24 hours | {
"A": "Administer 6 liters of intravenous crystalloids over the next 24 hours",
"B": "Administer 4 liters of intravenous colloids over the next 8 hours",
"C": "Administer 8 liters of intravenous colloids over the next 12 hours",
"D": "Administer 5 liters of intravenous colloids over the next 6 hours"
} | step2&3 | A | [
"35 year old woman",
"brought",
"emergency department 45 minutes",
"house fire",
"arrival",
"appears confused",
"shortness of breath",
"patient",
"5 ft 5",
"tall",
"55 kg",
"BMI",
"20 kg/m2",
"pulse",
"min",
"respirations",
"29 min",
"blood pressure",
"65 mm Hg",
"Pulse oximetr... |
Where does the only cranial nerve without a thalamic relay nucleus enter the skull? | Cribriform plate | {
"A": "Foramen rotundum",
"B": "Jugular foramen",
"C": "Internal auditory meatus",
"D": "Cribriform plate"
} | step1 | D | [
"only cranial nerve",
"thalamic relay nucleus enter",
"skull"
] |
A 13-year-old female comes to your office complaining of dry, scaling skin (FIgure A). She is particularly concerned about the appearance of her skin around her peers. She indicates that she did not start having problems until she was 5 years of age, after which her skin has progressively become drier and scalier. She ... | Ichthyosis vulgaris | {
"A": "Ichthyosis vulgaris",
"B": "Psoriasis",
"C": "Miliaria",
"D": "Suborrheic dermatitis"
} | step2&3 | A | [
"year old female",
"office",
"dry",
"scaling skin",
"concerned about",
"appearance",
"skin",
"peers",
"not start",
"problems",
"5",
"age",
"skin",
"scalier",
"types",
"over-the-counter moisturizers",
"resolution",
"most likely diagnosis"
] |
A 35-year-old woman is brought to the emergency department by her coworkers after a sudden onset of vision loss. She is a lawyer and lost 3 cases in the past week. Yesterday, she experienced weakness and paralysis of her left wrist. Past medical history is significant for acid reflux. Physical examination reveals 2/4 i... | Conversion disorder | {
"A": "Factitious disorder",
"B": "Transient ischemic attack",
"C": "Major depressive disorder",
"D": "Conversion disorder"
} | step1 | D | [
"35 year old woman",
"brought",
"emergency department",
"coworkers",
"sudden onset of vision loss",
"lawyer",
"lost 3 cases",
"past week",
"experienced weakness",
"paralysis of",
"left wrist",
"Past medical",
"significant",
"acid reflux",
"Physical examination reveals 2/4",
"reflexes",... |
A 63-year-old female recovering from a total shoulder arthroplasty completed 6 days ago presents complaining of joint pain in her repaired shoulder. Temperature is 39 degrees Celsius. Physical examination demonstrates erythema and significant tenderness around the incision site. Wound cultures reveal Gram-positive cocc... | Staphylococcus aureus | {
"A": "Streptococcus viridans",
"B": "Escherichia coli",
"C": "Staphylococcus aureus",
"D": "Streptococcus pyogenes"
} | step1 | C | [
"63 year old female recovering from",
"total shoulder arthroplasty completed 6 days",
"presents",
"joint pain",
"repaired shoulder",
"Temperature",
"degrees Celsius",
"Physical examination demonstrates erythema",
"significant tenderness",
"incision site",
"Wound cultures reveal Gram-positive coc... |
A 55-year-old woman presents to the emergency room with severe abdominal pain for the past 24 hours. She has also noticed blood in her urine. She does not have any significant past medical history. Family history is significant for her mother having cholecystitis status post cholecystectomy at age 45. Her vital signs i... | Distal convoluted tubule | {
"A": "Distal convoluted tubule",
"B": "Thick ascending limb of the loop of Henle",
"C": "Collecting ducts",
"D": "Descending limb of the loop of Henle"
} | step2&3 | A | [
"55 year old woman presents",
"emergency room",
"severe abdominal",
"past 24 hours",
"blood in",
"urine",
"not",
"significant past medical history",
"Family history",
"significant",
"mother",
"cholecystitis status post cholecystectomy",
"age",
"vital signs include",
"temperature 36",
"... |
A 70-year-old male is brought to the emergency department from a nursing home due to worsening mental status. His nurse reports that the patient has been very lethargic and sleeping more than usual for the past week. She found him confused and difficult to arouse this morning and decided to bring him to the ER. His pas... | Carcinoma | {
"A": "Carcinoma",
"B": "Bupropion",
"C": "Infection",
"D": "Lithium"
} | step2&3 | A | [
"70 year old male",
"brought",
"emergency department",
"nursing home due to worsening mental status",
"nurse reports",
"patient",
"very lethargic",
"sleeping",
"usual",
"past week",
"found",
"confused",
"difficult to",
"morning",
"to",
"ER",
"past medical history",
"significant",
... |
A 70-year-old male presents for an annual exam. His past medical history is notable for shortness of breath when he sleeps, and upon exertion. Recently he has experienced dyspnea and lower extremity edema that seems to be worsening. Both of these symptoms have resolved since he was started on several medications and in... | Carvedilol | {
"A": "Ibutilide",
"B": "Lidocaine",
"C": "Aspirin",
"D": "Carvedilol"
} | step1 | D | [
"70 year old male presents",
"annual exam",
"past medical history",
"notable",
"shortness of breath",
"sleeps",
"exertion",
"Recently",
"dyspnea",
"lower extremity edema",
"to",
"worsening",
"symptoms",
"resolved",
"started",
"medications",
"daily",
"following",
"most likely",
... |
A 40-year-old man presents to the physician for a pre-employment medical check-up. He has no symptoms and his past medical history is insignificant. He is a non-smoker. His temperature is 36.9°C (98.4°F), the heart rate is 76/min, the blood pressure is 124/82 mm Hg, and the respiratory rate is 16/min. His general and s... | Thin-section computed tomography (CT) through the nodule | {
"A": "Thin-section computed tomography (CT) through the nodule",
"B": "Positron emission tomography (PET) scan",
"C": "CT-guided transthoracic needle aspiration (TTNA)",
"D": "Transbronchial needle aspiration (TBNA)"
} | step2&3 | A | [
"40 year old man presents",
"physician",
"pre employment medical check-up",
"symptoms",
"past medical history",
"non-smoker",
"temperature",
"36",
"98 4F",
"heart rate",
"76 min",
"blood pressure",
"mm Hg",
"respiratory rate",
"min",
"general",
"systemic examination",
"not reveal",... |
A 33-year-old Caucasian female presents to her primary care provider for skin problems and difficulty breathing. She has not sought medical care in over 10 years due to anxiety around physicians. However, she has experienced gradual onset of diffuse pruritus, skin induration, and limited finger mobility over the past 5... | Transforming growth factor beta | {
"A": "Interferon gamma",
"B": "Interleukin 1",
"C": "Tumor necrosis factor alpha",
"D": "Transforming growth factor beta"
} | step1 | D | [
"year old Caucasian female presents",
"primary care provider",
"skin problems",
"difficulty breathing",
"not",
"medical care",
"10 years due to anxiety",
"physicians",
"gradual onset",
"diffuse pruritus",
"skin induration",
"limited finger mobility",
"past 5 years",
"impacted",
"work",
... |
A 2-year-old boy is brought to the emergency department by his mother for evaluation of severe abdominal pain that began one hour ago. On examination, the patient is afebrile and has diffuse rebound tenderness with acute epigastric pain. A stool guaiac test is positive. A small bowel perforation is suspected. What is t... | Vitelline duct | {
"A": "Vermiform appendix",
"B": "Anal membrane",
"C": "Vitelline duct",
"D": "Cloaca"
} | step1 | C | [
"2 year old boy",
"brought",
"emergency department",
"mother",
"evaluation",
"severe abdominal",
"began one hour",
"examination",
"patient",
"afebrile",
"diffuse rebound tenderness",
"acute epigastric pain",
"stool guaiac test",
"positive",
"small bowel perforation",
"suspected",
"em... |
A 32-year-old man comes to the physician because of a 2-week history of diarrhea. During this period, he has had about 10 bowel movements per day. He states that his stools are light brown and watery, with no blood or mucus. He also reports mild abdominal pain and nausea. Over the past year, he has had 6 episodes of di... | Elevated serum VIP concentration | {
"A": "Excessive accumulation of mast cells",
"B": "Elevated serum VIP concentration",
"C": "Increased conversion of 5-hydroxytryptophan to serotonin",
"D": "Transmural inflammation of the intestinal walls"
} | step2&3 | B | [
"year old man",
"physician",
"2-week history",
"diarrhea",
"period",
"about 10 bowel movements",
"day",
"states",
"stools",
"light brown",
"watery",
"blood",
"mucus",
"reports mild abdominal",
"nausea",
"past year",
"6 episodes of diarrhea",
"lasted",
"days",
"resolved",
"tim... |
A 22-year-old man presents to the emergency department with a fever and a sore throat. He has had these symptoms for the past 2 weeks and has felt progressively more fatigued. His temperature is 102°F (38.9°C), blood pressure is 120/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on roo... | Monospot test | {
"A": "Amoxicillin",
"B": "Monospot test",
"C": "No further workup needed",
"D": "Rapid strep test"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"fever",
"sore throat",
"symptoms",
"past 2 weeks",
"felt",
"more fatigued",
"temperature",
"blood pressure",
"68 mmHg",
"pulse",
"100 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Physical exam",
"notable"... |
A 32-year-old woman presents to her gynecologist for an annual visit. She is currently sexually active with 3 men and reports the consistent use of condoms. She denies abnormal vaginal odor, discharge, or dysuria. A routine Pap test is performed, which shows atypical squamous cells of undetermined significance (ASC-US)... | Repeat cytology and HPV testing in 3 years | {
"A": "Routine screening: repeat Pap test every 3 years",
"B": "Colposcopy",
"C": "Repeat cytology and HPV testing in 3 years",
"D": "Excisional treatment"
} | step2&3 | C | [
"year old woman presents",
"gynecologist",
"annual visit",
"currently sexually active with",
"men",
"reports",
"consistent use of condoms",
"denies abnormal vaginal odor",
"discharge",
"dysuria",
"routine Pap test",
"performed",
"shows atypical squamous cells of undetermined significance",
... |
A 13-year-old girl is brought to the physician because she has suddenly withdrawn from her close friends and has been displaying anger and hostility toward her friends at school, as well as toward her parents at home over the past month. She has also begun to skip classes and has been absent from school several times d... | Referring the patient for confirmation of sexual abuse | {
"A": "Obtaining STD screening",
"B": "Performing a thorough genitourinary exam",
"C": "Referring the patient for confirmation of sexual abuse",
"D": "Referring the patient and her parents for family therapy"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"withdrawn",
"close friends",
"displaying anger",
"hostility",
"friends",
"school",
"as well",
"parents at home",
"past month",
"begun",
"skip classes",
"absent",
"school",
"times",
"time period",
"mother",
"making",
"stories",
"new ... |
A 32-year-old man comes to the physician because of a 2-week history of a cough and shortness of breath. He also noted several episodes of blood-tinged sputum over the last 4 days. He has a 3-month history of progressive fatigue. His temperature is 37.5°C (98.6°F), pulse is 86/min, respirations are 17/min, and blood pr... | Perform plasmapheresis | {
"A": "Administer inhalative fluticasone",
"B": "Perform hemodialysis",
"C": "Perform plasmapheresis",
"D": "Administer enalapril"
} | step2&3 | C | [
"year old man",
"physician",
"2-week history",
"cough",
"shortness of breath",
"noted several episodes of blood-tinged sputum",
"last",
"days",
"3 month history",
"progressive fatigue",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Examin... |
An investigator is conducting a phase 1 trial for a novel epoxide reductase inhibitor with favorable pharmacokinetic properties for cerebrovascular accident prophylaxis. Two days after the trial starts, a subject begins to notice pain and erythema over the right thigh. It rapidly progresses to a purpuric rash with the ... | Increased factor VIII activity | {
"A": "Decreased platelet count",
"B": "Increased factor VII activity",
"C": "Increased factor VIII activity",
"D": "Decreased plasmin activity"
} | step1 | C | [
"investigator",
"conducting",
"phase 1 trial",
"novel epoxide reductase inhibitor",
"favorable pharmacokinetic properties",
"cerebrovascular accident prophylaxis",
"Two days",
"trial starts",
"subject begins to",
"pain",
"erythema",
"right",
"rapidly progresses",
"purpuric rash",
"develo... |
A 47-year-old man presents to the physician’s office with an inability to maintain an erection. He can achieve an erection, but it is brief and decreases soon after the penetration. His erectile dysfunction developed gradually over the past 2 years. He denies decreased libido, depressed mood, or anhedonia. He does not ... | Fasting serum glucose | {
"A": "Plasma calcium",
"B": "Fasting serum glucose",
"C": "Total serum bilirubin",
"D": "Follicle-stimulating hormone"
} | step2&3 | B | [
"year old man presents",
"physicians office",
"to maintain",
"erection",
"erection",
"brief",
"decreases",
"penetration",
"erectile dysfunction",
"past",
"years",
"denies decreased libido",
"depressed mood",
"anhedonia",
"not report",
"chronic conditions",
"20 history of smoking",
... |
Part of the success of the Streptococcus pyogenes bacterium lies in its ability to evade phagocytosis. Which of the following helps in this evasion? | M protein | {
"A": "M protein",
"B": "Streptolysin S",
"C": "Pyrogenic toxin",
"D": "Streptokinase"
} | step1 | A | [
"Part of",
"success",
"Streptococcus pyogenes bacterium",
"ability to",
"phagocytosis",
"following helps"
] |
A 39-year-old woman with type 1 diabetes mellitus comes to the physician because of a 2-month history of fatigue and hair loss. She has smoked one pack of cigarettes daily for the past 15 years. Her only medication is insulin. Her pulse is 59/min and blood pressure is 102/76 mm Hg. Physical examination shows dry skin, ... | Antimicrosomal antibodies in serum | {
"A": "Diffusely increased uptake on a radioactive iodine scan",
"B": "Antimicrosomal antibodies in serum",
"C": "DR5 subtype on HLA haplotype analysis",
"D": "B8 subtype on HLA haplotype analysis"
} | step1 | B | [
"year old woman",
"type 1 diabetes mellitus",
"physician",
"2 month history",
"fatigue",
"hair loss",
"smoked one pack",
"cigarettes daily",
"past",
"years",
"only medication",
"insulin",
"pulse",
"59 min",
"blood pressure",
"76 mm Hg",
"Physical examination shows dry skin",
"coars... |
A 23-year-old man presents to the emergency room with right flank pain. On physical examination, there is no rebound tenderness, guarding, and rigidity. The pain is radiating to the groin region and is associated with nausea. Plain X-ray of the kidney, ureter, and bladder is normal. Urinalysis showed the presence of mi... | Uric acid | {
"A": "Calcium carbonate",
"B": "Uric acid",
"C": "Cysteine stones",
"D": "Calcium oxalate"
} | step1 | B | [
"23 year old man presents",
"emergency room",
"right flank pain",
"physical examination",
"rebound tenderness",
"guarding",
"rigidity",
"pain",
"radiating to",
"groin region",
"associated with nausea",
"X-ray of",
"kidney",
"ureter",
"bladder",
"normal",
"Urinalysis showed",
"prese... |
A research team is working on a new assay meant to increase the sensitivity of testing in cervical cancer. Current sensitivity is listed at 77%. If this research team’s latest work culminates in the following results (listed in the table), has the sensitivity improved, and, if so, then by what percentage?
Research team... | Yes, the research team has seen an improvement in sensitivity of almost 7% according to the new results listed. | {
"A": "No, the research team has not seen any improvement in sensitivity according to the new results listed.",
"B": "Yes, the research team has seen an improvement in sensitivity of more than 10% according to the new results listed.",
"C": "Yes, the research team has seen an improvement in sensitivity of almost... | step1 | C | [
"research team",
"working",
"new assay meant to increase",
"sensitivity",
"testing",
"cervical cancer",
"Current sensitivity",
"listed",
"research teams latest work",
"following results",
"listed",
"table",
"sensitivity improved",
"so",
"then",
"percentage",
"Research teams latest re... |
A 10-year-old boy presents to the emergency department accompanied by his parents with a swollen and painful right knee after he fell from his bicycle a few hours ago. The patient’s mother says he fell off the bike and struck the ground with his whole weight on his right knee. Immediately, his right knee swelled signif... | Hemophilia A | {
"A": "Hemophilia A",
"B": "Factor V Leiden",
"C": "Homocystinuria",
"D": "Protein C deficiency"
} | step2&3 | A | [
"A 10 year old boy presents",
"emergency department",
"parents",
"swollen",
"painful right",
"fell",
"bicycle",
"few hours",
"patients mother",
"fell",
"bike",
"struck",
"whole weight",
"right knee",
"Immediately",
"right knee swelled",
"experienced severe pain",
"patients past med... |
A 29-year-old woman presents to the clinic regularly with her young daughter and complains that ever since her last delivery 5 years ago, she has been having intermittent light vaginal bleeding. She has seen several doctors so far and even some ‘specialist doctors.’ Her menstrual history also appears to be variable. Ph... | Factitious disorder with a primary gain | {
"A": "Malingering disorder with a secondary gain",
"B": "Factitious disorder with a primary gain",
"C": "Factitious disorder with a secondary gain",
"D": "Factitious disorder by proxy"
} | step2&3 | B | [
"29 year old woman presents",
"clinic",
"young daughter",
"ever",
"last delivery",
"years",
"intermittent light vaginal bleeding",
"seen several doctors",
"far",
"specialist doctors",
"menstrual history",
"appears to",
"variable",
"Physical examination",
"normal limits",
"urine analysi... |
A 61-year-old man comes to the physician because of a 2-month history of a cough productive of clear mucoid sputum. He has smoked one pack of cigarettes daily for 33 years. Physical examination shows no abnormalities. Chest x-ray shows a 2-cm solid nodule in the periphery of the lower left lobe. A bronchial biopsy of t... | Adenocarcinoma in situ | {
"A": "Small cell carcinoma",
"B": "Pulmonary hamartoma",
"C": "Adenocarcinoma in situ",
"D": "Carcinoid tumor"
} | step1 | C | [
"61 year old man",
"physician",
"2 month history",
"cough productive",
"clear mucoid",
"smoked one pack",
"cigarettes daily",
"years",
"Physical examination shows",
"abnormalities",
"Chest x-ray shows",
"2",
"solid nodule",
"periphery",
"lower left lobe",
"bronchial biopsy of",
"mass... |
A 67-year-old man with a history of diabetes mellitus type II and a previous myocardial infarction presents to your office for a routine examination. His blood pressure is found to be 180/100 mmHg. Which drug is the first-line choice of treatment for this patient's hypertension? | Lisinopril | {
"A": "Hydrochlorothiazide",
"B": "Lisinopril",
"C": "Prazosin",
"D": "Isoproterenol"
} | step1 | B | [
"67 year old man",
"history of diabetes mellitus type II",
"previous myocardial infarction presents",
"office",
"routine examination",
"blood pressure",
"found to",
"100 mmHg",
"drug",
"first-line choice",
"treatment",
"patient's hypertension"
] |
A 40-year-old overweight man presents to the office complaining of heartburn for 6 months. He describes burning in his chest brought on by meals. He has a 20 pack-year smoking history and drinks 2 glasses of red wine with dinner nightly. He denies dysphagia, odynophagia, weight loss, melena, and hematemesis. Over the p... | Omeprazole | {
"A": "Esophagogastroduodenoscopy",
"B": "Omeprazole",
"C": "Pantoprazole, sucralfate, and amoxicillin",
"D": "Ranitidine"
} | step2&3 | B | [
"40 year old overweight man presents",
"office",
"heartburn",
"months",
"burning",
"chest brought",
"meals",
"20 smoking history",
"drinks 2 glasses",
"red wine",
"dinner",
"denies dysphagia",
"odynophagia",
"weight loss",
"melena",
"hematemesis",
"past month",
"reduced",
"intake... |
A 34-year-old woman comes to the physician because of a 6-week history of depressed mood, loss of interest, and difficulty sleeping. She also has had a 4.5-kg (10-lb) weight loss during this period. She has not been as productive as before at work due to difficulty concentrating. There is no evidence of suicidal ideati... | Raphe nucleus | {
"A": "Locus coeruleus",
"B": "Basal nucleus of Meynert",
"C": "Nucleus accumbens",
"D": "Raphe nucleus"
} | step1 | D | [
"year old woman",
"physician",
"week history",
"depressed mood",
"loss of interest",
"difficulty sleeping",
"4.5 kg",
"10",
"weight loss",
"period",
"not",
"productive",
"before",
"work",
"difficulty concentrating",
"evidence",
"suicidal ideation",
"Laboratory studies including thy... |
Parkinson’s disease is a progressive neurodegenerative disease. It is characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta and the formation of cellular inclusions called Lewy bodies. These are composed of α-synuclein that has been bound to ubiquitin. In healthy individuals, α-synuclein... | Proteasome | {
"A": "Vesicle",
"B": "Peroxisome",
"C": "Proteasome",
"D": "Lysosome"
} | step1 | C | [
"Parkinsons disease",
"progressive",
"disease",
"characterized",
"loss of dopaminergic neurons",
"substantia nigra pars compacta",
"formation",
"cellular called Lewy bodies",
"synuclein",
"bound",
"ubiquitin",
"healthy individuals",
"synuclein bound",
"ubiquitin",
"degraded"
] |
A 23-year-old man presents to an outpatient psychiatrist complaining of anxiety and a persistent feeling that “something terrible will happen to my family.” He describes 1 year of vague, disturbing thoughts about his family members contracting a “horrible disease” or dying in an accident. He believes that he can preven... | Cognitive behavioral therapy and fluoxetine | {
"A": "Cognitive behavioral therapy and clonazepam",
"B": "Cognitive behavioral therapy and fluoxetine",
"C": "Psychodynamic psychotherapy and citalopram",
"D": "Psychodynamic psychotherapy and aripiprazole"
} | step1 | B | [
"23 year old man presents",
"outpatient psychiatrist",
"anxiety",
"persistent feeling",
"terrible",
"happen",
"family",
"1 year",
"vague",
"thoughts",
"family members contracting",
"disease",
"dying",
"accident",
"prevent",
"outcomes",
"washing",
"hands",
"contaminants",
"time"... |
A 23-year-old man presents with a blunt force injury to the head from a baseball bat. He is currently unconscious, although his friends say he was awake and speaking with them en route to the hospital. He has no significant past medical history and takes no current medications. The vital signs include: temperature 37.0... | Mannitol | {
"A": "Mannitol",
"B": "Maintain a PaCO2 of 24 mm Hg",
"C": "Placement of a ventriculoperitoneal (VP) shunt",
"D": "Acetazolamide"
} | step2&3 | A | [
"23 year old man presents",
"blunt force injury",
"head",
"baseball bat",
"currently unconscious",
"friends",
"awake",
"speaking",
"en route",
"hospital",
"significant past medical history",
"takes",
"current medications",
"vital signs include",
"temperature",
"98",
"blood pressure",... |
A 5-month-old boy presents with increasing weakness for the past 3 months. The patient’s mother says that the weakness is accompanied by dizziness, sweating, and vertigo early in the morning. Physical examination shows hepatomegaly. Laboratory findings show an increased amount of lactate, uric acid, and elevated trigly... | Glucose-6-phosphatase | {
"A": "Debranching enzyme",
"B": "Lysosomal α-1,4-glucosidase",
"C": "Muscle glycogen phosphorylase",
"D": "Glucose-6-phosphatase"
} | step1 | D | [
"5 month old boy presents",
"increasing weakness",
"past 3 months",
"patients mother",
"weakness",
"dizziness",
"sweating",
"vertigo early",
"morning",
"Physical examination shows hepatomegaly",
"Laboratory findings show",
"increased amount",
"lactate",
"uric acid",
"elevated triglycerid... |
A 35-year-old alcoholic patient presents with high-output cardiac failure, tachycardia, a bounding pulse, and warm extremities. Blood work reveals vitamin deficiency. Which of the following vitamin deficiencies is most likely associated with such a clinical presentation? | Thiamine | {
"A": "Vitamin B12",
"B": "Thiamine",
"C": "Niacin",
"D": "Riboflavin"
} | step1 | B | [
"35 year old alcoholic patient presents",
"high-output cardiac failure",
"tachycardia",
"bounding pulse",
"warm extremities",
"Blood work reveals vitamin deficiency",
"following vitamin deficiencies",
"most likely associated with",
"clinical presentation"
] |
A 56-year-old male with a history of hepatitis C cirrhosis status post TIPS procedure is brought in by his wife to the emergency department because he has been acting disoriented, slurring his speech, and sleeping throughout the day. On arrival the patient is afebrile and his vital signs are pulse is 87/min, blood pres... | Administer lactulose | {
"A": "Liver transplantation",
"B": "Adminsiter rifaximin and glucose",
"C": "Administer lactulose",
"D": "Administer neomycin and glucose"
} | step2&3 | C | [
"year old male",
"history of hepatitis C cirrhosis",
"TIPS procedure",
"brought",
"wife",
"emergency department",
"acting disoriented",
"slurring",
"speech",
"sleeping",
"day",
"arrival",
"patient",
"afebrile",
"vital signs",
"pulse",
"87 min",
"blood pressure",
"mmHg",
"respir... |
A 78-year-old woman with a history of cerebrovascular accident (CVA) presents to the emergency department with slurred speech, diplopia and dizziness that has persisted for eight hours. Upon further questioning you find that since her CVA one year ago, she has struggled with depression and poor nutrition. Her dose of p... | Lower the dose of her anti-seizure medication | {
"A": "Administer tissue plasminogen activator (tPA)",
"B": "Start trimethoprim-sulfamethoxazole (TMP-SMX)",
"C": "Lower the dose of her anti-seizure medication",
"D": "Start total parenteral nutrition (TPN)"
} | step2&3 | C | [
"year old woman",
"history of cerebrovascular accident",
"presents",
"emergency department",
"slurred speech",
"diplopia",
"dizziness",
"eight hours",
"further questioning",
"find",
"CVA one year ago",
"depression",
"poor nutrition",
"dose",
"paroxetine",
"recently increased",
"seizu... |
A 1-year-old previously healthy male presents to the emergency department with 3 hours of intermittent abdominal pain, vomiting, and one episode of dark red stools. On exam, his abdomen is tender to palpation and there are decreased bowel sounds. A CT scan reveals air fluid levels and a cystic mass in the ileum. Gross ... | Abnormal closure of the vitilline duct | {
"A": "Obstruction of the lumen of the appendix by a fecalith",
"B": "Abnormal closure of the vitilline duct",
"C": "Twisting of the midgut secondary to malrotation",
"D": "Ingestion of contaminated water"
} | step1 | B | [
"year old",
"healthy male presents",
"emergency department",
"3 hours",
"intermittent abdominal pain",
"vomiting",
"one episode of dark red stools",
"exam",
"abdomen",
"tender",
"palpation",
"decreased bowel sounds",
"CT scan reveals air fluid levels",
"cystic",
"ileum",
"Gross specime... |
A 55-year-old woman presents to her primary care physician for a worsening cough. She states that she has had a cough for 5 months. Over the past 2 weeks, the cough has become more frequent and produces yellow sputum. She has dyspnea on exertion at baseline, which she feels is also worsening. She denies fever, hemoptys... | Vaccination to induce a B-cell response with moderate level affinity antibodies | {
"A": "Vaccination composed of a protein-based surface antigen",
"B": "Vaccination directed against a toxin",
"C": "Vaccination to induce a B-cell response with moderate level affinity antibodies",
"D": "Vaccination to induce a T-cell dependent B-cell response with high affinity antibodies"
} | step2&3 | C | [
"55 year old woman presents",
"primary care physician",
"worsening cough",
"states",
"cough",
"months",
"past 2 weeks",
"cough",
"more frequent",
"yellow sputum",
"dyspnea on exertion",
"baseline",
"feels",
"worsening",
"denies fever",
"hemoptysis",
"chest pain",
"chronic obstructi... |
A 55-year-old man visits his primary care physician for a follow-up visit. He was diagnosed with asthma during childhood, but it has always been well controlled with an albuterol inhaler. He is hypertensive and admits that he is not compliant with his antihypertensive medication. He expresses his concerns about frequen... | Papilledema | {
"A": "Papilledema",
"B": "Retinal hemorrhage",
"C": "Optic nerve inflammation",
"D": "Neovascularization"
} | step1 | A | [
"55 year old man visits",
"primary care physician",
"follow-up visit",
"diagnosed",
"asthma",
"childhood",
"always",
"well controlled",
"albuterol inhaler",
"hypertensive",
"admits",
"not compliant",
"antihypertensive medication",
"concerns",
"frequent headaches",
"blurry vision",
"p... |
A 29-year-old woman presents to the physician with a blurred vision of her right eye over the past day. She has pain around her right eye during eye movement. She has a history of tingling in her left leg 5 months ago, which spontaneously resolved after 2 weeks. She takes no medications. Her blood pressure is 110/70 mm... | Methylprednisolone | {
"A": "Carbamazepine",
"B": "Intravenous immunoglobulin (IVIG)",
"C": "Methylprednisolone",
"D": "Plasma exchange"
} | step2&3 | C | [
"29 year old woman presents",
"physician",
"blurred vision",
"right eye",
"past day",
"pain around",
"right eye",
"eye movement",
"history",
"tingling",
"left leg",
"months",
"resolved",
"2 weeks",
"takes",
"medications",
"blood pressure",
"70 mm Hg",
"pulse",
"72 min",
"resp... |
A 27-year-old man presents with a 2-week history of fever, malaise, and occasional diarrhea. On physical examination, the physician notes enlarged inguinal lymph nodes. An HIV screening test is positive. Laboratory studies show a CD4+ count of 650/mm3. This patient is most likely currently in which of the following sta... | Acute HIV infection | {
"A": "Latent HIV infection",
"B": "AIDS",
"C": "Acute HIV infection",
"D": "Asymptomatic HIV infection"
} | step1 | C | [
"27 year old man presents",
"2-week history",
"fever",
"malaise",
"occasional diarrhea",
"physical examination",
"physician notes enlarged inguinal",
"HIV screening test",
"positive",
"Laboratory studies show",
"CD4",
"count",
"650 mm3",
"patient",
"most likely currently",
"following s... |
A 66-year old man with a 45-pack-year smoking history presents with abdominal pain and constipation. He reports that he has had a worsening cough for several months and has lost 20 pounds over this time period. You order a complete metabolic profile, which demonstrates hypercalcemia. A chest radiograph shows a centrall... | Squamous cell carcinoma producing a peptide with hormonal activity | {
"A": "Squamous cell carcinoma producing parathyroid hormone",
"B": "Squamous cell carcinoma producing a peptide with hormonal activity",
"C": "Metastatic abdominal cancer",
"D": "Small cell carcinoma producing a peptide with hormonal activity"
} | step1 | B | [
"66 year old man",
"pack",
"smoking history presents",
"abdominal pain",
"constipation",
"reports",
"worsening cough",
"months",
"lost 20 pounds",
"time period",
"order",
"complete metabolic profile",
"demonstrates hypercalcemia",
"chest radiograph shows",
"mass suspicious for malignancy... |
A scientist is researching the long term effects of the hepatitis viruses on hepatic tissue. She finds that certain strains are oncogenic and increase the risk of hepatocellular carcinoma. However, they appear to do so via different mechanisms. Which of the following answer choices correctly pairs the hepatitis virus w... | Hepatitis B virus - integration of viral DNA into host hepatocyte genome | {
"A": "Hepatitis A virus - chronic inflammation",
"B": "Hepatitis A virus - integration of viral DNA into host hepatocyte genome",
"C": "Hepatitis B virus - integration of viral DNA into host hepatocyte genome",
"D": "Hepatitis E virus - integration of viral DNA into host hepatocyte genome"
} | step1 | C | [
"scientist",
"researching",
"long term effects",
"hepatitis viruses",
"hepatic tissue",
"finds",
"certain strains",
"oncogenic",
"increase",
"risk",
"hepatocellular carcinoma",
"appear to",
"different mechanisms",
"following answer choices",
"pairs",
"hepatitis virus",
"correct oncog... |
A 62-year-old man is brought to the emergency department by his wife because she thinks he has had a stroke. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He has smoked 1 pack of cigarettes per day for the past 35 years. His blood pressure is 162/95 mm Hg. A CT s... | Hemiballismus | {
"A": "Cogwheel rigidity",
"B": "Dystonia",
"C": "Hemiballismus",
"D": "Vertical gaze palsy"
} | step1 | C | [
"62 year old man",
"brought",
"emergency department",
"wife",
"thinks",
"stroke",
"hypertension",
"type 2 diabetes mellitus",
"Current medications include enalapril",
"metformin",
"smoked 1 pack",
"cigarettes",
"day",
"past 35 years",
"blood pressure",
"95 mm Hg",
"CT scan",
"brain... |
A 64-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of type 2 diabetes mellitus for which she takes metformin. Her surgical history is a total knee arthroplasty 7 years ago. Her family history is insignificant. Physi... | Lumpectomy | {
"A": "Vasectomy",
"B": "Mastectomy",
"C": "Lumpectomy",
"D": "Laminectomy"
} | step2&3 | C | [
"64 year old woman presents",
"surgical",
"new patient",
"evaluation of recently diagnosed breast cancer",
"medical history of type 2 diabetes mellitus",
"takes metformin",
"surgical history",
"total knee arthroplasty",
"years",
"family history",
"Physical examination",
"notable",
"irregular... |
A 26-year-old male presents to the emergency room with weight loss, abdominal pain, and bloody diarrhea. He reports having intermittent bloody stools and crampy left lower quadrant abdominal pain over the past several days. He is otherwise healthy, does not smoke, and takes no medications. His family history is notable... | Primary sclerosing cholangitis | {
"A": "Primary biliary cirrhosis",
"B": "Primary sclerosing cholangitis",
"C": "Intestinal strictures",
"D": "Aphthous ulcers"
} | step1 | B | [
"year old male presents",
"emergency room",
"weight loss",
"abdominal pain",
"bloody diarrhea",
"reports",
"intermittent bloody stools",
"crampy left lower quadrant abdominal pain",
"past",
"days",
"healthy",
"not smoke",
"takes",
"medications",
"family history",
"notable",
"colon ca... |
A 6-year-old boy is brought to the office by his mother. She reports that her son is well but has some concerns about his overall health: he is shorter and, physically, seems less developed compared to his siblings when they were the same age. He recently started school and the mother reports that the boy’s teachers ar... | Deficiency of uridine monophosphate synthase | {
"A": "Deficiency of uridine monophosphate synthase",
"B": "Overactivity of uridine monophosphate synthase",
"C": "Inhibition of carbamoyl phosphate synthetase II",
"D": "Deficiency of cobalamin"
} | step1 | A | [
"year old boy",
"brought",
"office",
"mother",
"reports",
"son",
"well",
"concerns",
"overall health",
"shorter",
"less",
"compared",
"siblings",
"same age",
"recently started school",
"mother reports",
"boys teachers",
"concerned",
"learning capability",
"height",
"weight",
... |
An 8-year-old boy is shifted to a post-surgical floor following neck surgery. The surgeon has restricted his oral intake for the next 24 hours. He does not have diarrhea, vomiting, or dehydration. His calculated fluid requirement is 1500 mL/day. However, he receives 2000 mL of intravenous isotonic fluids over 24 hours.... | Capillary hydrostatic pressure | {
"A": "Capillary wall permeability",
"B": "Capillary hydrostatic pressure",
"C": "Interstitial hydrostatic pressure",
"D": "Interstitial oncotic pressure"
} | step1 | B | [
"year old boy",
"shifted",
"post surgical floor following neck surgery",
"surgeon",
"restricted",
"oral intake",
"next 24 hours",
"not",
"diarrhea",
"vomiting",
"dehydration",
"calculated fluid requirement",
"1500 mL/day",
"receives 2000 mL",
"intravenous",
"fluids",
"24 hours",
"f... |
A 42-year-old woman presents to the urgent care clinic with recurrent chest pain and pressure radiating to her jaw. ECG is obtained and shows ST-segment elevation, but her cardiac enzymes are repeatedly found to be within normal ranges. She has a heart rate of 82/min and a blood pressure of 128/76 mm Hg. Physical exami... | Calcium channel blockers and nitrates | {
"A": "Nitrates only",
"B": "Aspirin and clopidogrel",
"C": "Calcium channel blockers and nitrates",
"D": "Aspirin, clopidogrel, beta-blockers, and nitrates"
} | step2&3 | C | [
"year old woman presents",
"urgent care clinic",
"recurrent chest pain",
"pressure radiating to",
"jaw",
"ECG",
"obtained",
"shows ST-segment elevation",
"cardiac enzymes",
"repeatedly found to",
"normal ranges",
"heart rate",
"min",
"blood pressure of",
"76 mm Hg",
"Physical examinati... |
A 35-year-old man presents to the physician’s clinic due to episodic chest pain over the last couple of months. He is currently pain-free. His chest pain occurs soon after he starts to exercise, and it is rapidly relieved by rest. He recently started training for a marathon after a decade of a fairly sedentary lifestyl... | Duration of diastole | {
"A": "Coronary vasoconstriction",
"B": "Diastolic aortic pressure",
"C": "Duration of diastole",
"D": "Force of myocardial contraction"
} | step1 | C | [
"35 year old man presents",
"physicians clinic due to episodic chest pain",
"couple of months",
"currently pain-free",
"chest pain occurs",
"starts to exercise",
"rapidly relieved by rest",
"recently started training",
"marathon",
"decade",
"sedentary lifestyle",
"competitive",
"college year... |
A 56-year-old man with substernal chest pain calls 911. When paramedics arrive, they administer drug X sublingually for the immediate relief of angina. What is the most likely site of action of drug X? | Large veins | {
"A": "Large arteries",
"B": "Large veins",
"C": "Cardiac muscle",
"D": "Pulmonary arteries"
} | step1 | B | [
"year old man",
"substernal chest pain calls",
"paramedics",
"administer drug",
"immediate relief",
"angina",
"most likely site of action",
"drug"
] |
A 74-year-old woman comes to the physician for a follow-up examination. Eight months ago, she underwent an emergency cardiac catheterization with stenting for myocardial infarction. At the time of discharge, her heart configuration was normal, end-diastolic volume was 300 mL and ejection fraction was 51%. For the past ... | Enalapril | {
"A": "Digoxin",
"B": "Diltiazem",
"C": "Enalapril",
"D": "Atorvastatin"
} | step2&3 | C | [
"74 year old woman",
"physician",
"follow-up examination",
"Eight months",
"emergency cardiac",
"stenting",
"myocardial infarction",
"time",
"discharge",
"heart configuration",
"normal",
"end-diastolic volume",
"300 mL",
"ejection fraction",
"past",
"weeks",
"increasing shortness of ... |
A 46-year-old woman presents to her family physician for a general wellness checkup with a chief complaint of high levels of anxiety over the past year. Her anxiety has started to affect her performance at work, making her even more anxious and concerned that she will lose her job. She started psychotherapy several mon... | Dietary supplement | {
"A": "Acetaminophen",
"B": "Alcoholic hepatitis",
"C": "Chronic hepatitis C infection",
"D": "Dietary supplement"
} | step2&3 | D | [
"year old woman presents",
"family physician",
"general wellness checkup",
"chief complaint of high levels",
"anxiety",
"past year",
"anxiety",
"started to affect",
"performance at work",
"making",
"anxious",
"concerned",
"job",
"started psychotherapy",
"months",
"minimal improvement",... |
A 60-year-old woman is brought to the emergency department by ambulance after suffering a generalized tonic-clonic seizure. The seizure lasted 2 minutes, followed by a short period of unresponsiveness and loud breathing. Her blood pressure is 130/80 mm Hg, the heart rate is 76/min, and the respiratory rate is 15/min an... | Loss of endothelial tight junctions | {
"A": "Increased interstitial fluid low in protein",
"B": "Replacement of interstitial fluid with cerebrospinal fluid (CSF)",
"C": "Loss of endothelial tight junctions",
"D": "Upregulation of aquaporin-4"
} | step1 | C | [
"60 year old woman",
"brought",
"emergency department",
"ambulance",
"suffering",
"generalized tonic-clonic seizure",
"seizure lasted 2 minutes",
"followed by",
"short period",
"unresponsiveness",
"loud breathing",
"blood pressure",
"80 mm Hg",
"heart rate",
"76 min",
"respiratory rate... |
A 22-year-old nulligravid woman comes to the physician for evaluation of irregular periods. Menarche was at the age of 12 years. Her menses have always occurred at variable intervals, and she has spotting between her periods. Her last menstrual period was 6 months ago. She has diabetes mellitus type 2 and depression. S... | Progesterone withdrawal test | {
"A": "Measurement of follicle-stimulating hormone",
"B": "Progesterone withdrawal test",
"C": "Measurement of thyroid-stimulating hormone",
"D": "Measurement of prolactin levels"
} | step2&3 | B | [
"year old nulligravid woman",
"physician",
"evaluation",
"irregular periods",
"Menarche",
"age",
"years",
"menses",
"always occurred",
"variable intervals",
"spotting between",
"periods",
"last menstrual period",
"months",
"diabetes mellitus type 2",
"depression",
"not sexually activ... |
A 52-year-old man comes to the physician because of increasing weakness of his arms and legs over the past year. He has also had difficulty speaking for the past 5 months. He underwent a partial gastrectomy for gastric cancer 10 years ago. His temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 118/7... | Riluzole | {
"A": "Vitamin B12",
"B": "Glatiramer acetate",
"C": "Riluzole",
"D": "Corticosteroids\n\""
} | step2&3 | C | [
"year old man",
"physician",
"of increasing weakness",
"arms",
"legs",
"past year",
"difficulty speaking",
"past",
"months",
"partial gastrectomy",
"gastric cancer 10 years",
"temperature",
"98",
"pulse",
"88 min",
"blood pressure",
"70 mm Hg",
"Examination shows dysarthria",
"mi... |
A 38-year-old woman, gravida 2, para 1, at 24 weeks' gestation comes to the physician for a routine prenatal evaluation. She has no history of major medical illness and takes no medications. Fetal ultrasonography shows a cardiac defect resulting from abnormal development of the endocardial cushions. This defect is most... | Atrioventricular septal defect | {
"A": "Atrioventricular septal defect",
"B": "Sinus venosus defect",
"C": "Transposition of the great vessels",
"D": "Dextrocardia"
} | step1 | A | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"routine prenatal evaluation",
"history of major medical illness",
"takes",
"medications",
"Fetal ultrasonography shows",
"cardiac defect resulting",
"abnormal development",
"endocardial cushions",
"defect",
"m... |
Many large clinics have noticed that the prevalence of primary biliary cholangitis (PBC) has increased significantly over the past 20 years. An epidemiologist is working to identify possible reasons for this. After analyzing a series of nationwide health surveillance databases, the epidemiologist finds that the inciden... | Improved quality of care for PBC | {
"A": "Increased exposure to environmental risk factors for PBC",
"B": "Improved quality of care for PBC",
"C": "Increased availability of diagnostic testing for PBC",
"D": "Increased awareness of PBC among clinicians"
} | step2&3 | B | [
"large clinics",
"prevalence",
"primary biliary cholangitis",
"increased",
"past 20 years",
"epidemiologist",
"working to",
"possible reasons",
"series",
"health surveillance databases",
"epidemiologist finds",
"incidence",
"PBC",
"stable",
"past 20 years",
"following",
"most",
"ex... |
A 35-year-old man presents to his primary care provider in Philadelphia with a skin rash on his right thigh. He reports that the rash appeared 3 days ago. He recently returned from a weeklong trip to his vacation home in central Pennsylvania. He denies pain, numbness, paresthesias, itchiness, or burning around the rash... | A | {
"A": "A",
"B": "B",
"C": "D",
"D": "E"
} | step2&3 | A | [
"35 year old man presents",
"primary care provider",
"Philadelphia",
"skin rash",
"right thigh",
"reports",
"rash appeared 3 days",
"recently returned",
"trip",
"vacation home",
"central Pennsylvania",
"denies pain",
"numbness",
"paresthesias",
"itchiness",
"burning",
"rash",
"not ... |
A 14-year-old female with no past medical history presents to the emergency department with nausea and abdominal pain. On physical examination, her blood pressure is 78/65, her respiratory rate is 30, her breath has a fruity odor, and capillary refill is > 3 seconds. Serum glucose is 820 mg/dL. After starting IV fluids... | Intravenous regular insulin | {
"A": "Intravenous regular insulin",
"B": "Subcutaneous insulin glargine",
"C": "Subcutaneous insulin lispro",
"D": "Intravenous glucagon"
} | step1 | A | [
"year old female",
"past medical history presents",
"emergency department",
"nausea",
"abdominal pain",
"physical examination",
"blood pressure",
"65",
"respiratory rate",
"30",
"breath",
"fruity odor",
"capillary refill",
"3 seconds",
"Serum glucose",
"mg/dL",
"starting IV fluids",
... |
A group of investigators are studying the effects of transcranial direct current stimulation (tDCS) on cognitive performance in patients with Alzheimer disease. A cohort of 50 patients with mild Alzheimer disease were randomized 1:1 to either tDCS or sham tDCS over the temporoparietal cortex. Both procedures were condu... | Crossover | {
"A": "Crossover",
"B": "Meta-analysis",
"C": "Parallel group",
"D": "Factorial\n\""
} | step1 | A | [
"A group",
"investigators",
"studying",
"effects",
"transcranial direct current stimulation",
"cognitive performance",
"patients",
"Alzheimer disease",
"cohort",
"50 patients",
"mild",
"disease",
"randomized 1 1",
"tDCS",
"sham tDCS",
"cortex",
"procedures",
"conducted so",
"pati... |
A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 5/10 in severity at its worst and is described as a "burning" pain. He has noticed that the pain is acutely wors... | Magnetic resonance imaging | {
"A": "Ankle-brachial index",
"B": "Computerized tomography myelography",
"C": "Electromyography",
"D": "Magnetic resonance imaging"
} | step2&3 | D | [
"65 year old man",
"referred",
"primary care provider",
"neurologist",
"leg pain",
"reports",
"month history",
"progressive bilateral",
"worse",
"left leg",
"pain",
"5/10",
"severity",
"worst",
"described",
"burning",
"pain",
"pain",
"worse",
"walks",
"started",
"stationary... |
A 27-year-old woman, gravida 2, para 1, at 36 weeks' gestation comes to the physician for a prenatal visit. She feels well. Fetal movements are adequate. This is her 7th prenatal visit. She had an ultrasound scan performed 1 month ago that showed a live intrauterine pregnancy consistent with a 32-week gestation with no... | Swab for GBS culture | {
"A": "Complete blood count",
"B": "Transabdominal doppler ultrasonography",
"C": "Serum PAPP-A and HCG levels",
"D": "Swab for GBS culture"
} | step2&3 | D | [
"27 year old woman",
"gravida 2",
"para 1",
"36 weeks",
"gestation",
"physician",
"prenatal visit",
"feels well",
"Fetal movements",
"adequate",
"prenatal visit",
"ultrasound scan performed 1 month",
"showed",
"live intrauterine pregnancy consistent with",
"week gestation",
"anomalies"... |
A 25-year-old man presents with jaw discomfort and the inability to open his mouth fully for about 3 days. About a week ago, he says he cut himself while preparing a chicken dinner but did not seek medical assistance. Five days after the original injury, he started noticing jaw discomfort and an inability to open his m... | Tetanus immunoglobulin (TIG) | {
"A": "Tdap ",
"B": "Td",
"C": "Tetanus immunoglobulin (TIG) ",
"D": "DTaP"
} | step1 | C | [
"year old man presents",
"jaw discomfort",
"to open",
"mouth",
"3 days",
"week",
"cut",
"preparing",
"chicken dinner",
"not",
"medical assistance",
"Five days",
"original injury",
"started",
"jaw discomfort",
"to open",
"mouth completely",
"history",
"serious illness",
"allergi... |
A 69-year-old woman is brought to the physician by her husband because of multiple falls and difficulty maintaining balance while standing or walking over the past year. During this period, she has had blurred vision and diplopia. Her husband has had difficulty understanding her speech for the past 3 months. She has be... | Midbrain atrophy with intact pons | {
"A": "Asymmetric focal cortical atrophy",
"B": "Midbrain atrophy with intact pons",
"C": "Frontal atrophy with intact hippocampi",
"D": "Enlarged ventricles with mild cortical atrophy"
} | step2&3 | B | [
"69 year old woman",
"brought",
"physician",
"husband",
"multiple falls",
"difficulty maintaining balance",
"standing",
"walking",
"past year",
"period",
"blurred vision",
"diplopia",
"husband",
"difficulty understanding",
"speech",
"past 3 months",
"withdrawn",
"now refuses to go"... |
A 22-year-old G2P1 female presents to the clinic at the beginning of her third trimester for a fetal ultrasound. The sonographer is unable to visualize any of the structures arising from the mesonephric duct. This infant is at risk for malformation of which of the following? | No malformation would be expected | {
"A": "Fallopian tubes",
"B": "Uterus",
"C": "Upper 1/3 of vagina",
"D": "No malformation would be expected"
} | step1 | D | [
"year old",
"female presents",
"clinic",
"beginning",
"third trimester",
"fetal ultrasound",
"sonographer",
"unable to",
"structures arising",
"mesonephric duct",
"infant",
"at risk",
"malformation"
] |
A 29-year-old female is hospitalized 1 day after an endoscopic retrograde cholangiopancreatography (ERCP) because of vomiting, weakness, and severe abdominal pain. Physical examination findings include abdominal tenderness and diminished bowel sounds. A CT scan demonstrates fluid around the pancreas. Serum levels of wh... | Calcium | {
"A": "Calcium",
"B": "Amylase",
"C": "Lipase",
"D": "Triglycerides"
} | step1 | A | [
"29 year old female",
"hospitalized 1 day",
"endoscopic retrograde cholangiopancreatography",
"vomiting",
"weakness",
"severe abdominal",
"Physical examination findings include abdominal tenderness",
"diminished bowel sounds",
"CT scan demonstrates fluid",
"pancreas",
"Serum levels",
"followin... |
A 22-year-old woman comes to the urgent care clinic with sudden onset of severe vomiting. She had been at a picnic with her boyfriend a few hours earlier, enjoying barbecue, potato salad, and cake. Shortly thereafter, she began vomiting and has vomited 5 times in the last 3 hours. She has no prior history of symptoms. ... | Toxin ingestion from non-spore-forming organism | {
"A": "Hepatitis",
"B": "Gallstones",
"C": "Toxin ingestion from spore-forming organism",
"D": "Toxin ingestion from non-spore-forming organism"
} | step1 | D | [
"year old woman",
"urgent care clinic",
"sudden onset",
"severe vomiting",
"boyfriend",
"few hours earlier",
"potato salad",
"cake",
"began vomiting",
"vomited 5 times",
"hours",
"prior history",
"symptoms",
"few hours",
"observation",
"symptoms abate",
"discharged home",
"followin... |
A 3-day-old boy is brought to the physician by his mother because of irritability and feeding intolerance for 1 day. His temperature is 39.2°C (102.6°F). Physical examination shows a bulging anterior fontanelle. A photomicrograph of a Gram stain of the cerebrospinal fluid is shown. Further evaluation shows that the org... | Escherichia coli | {
"A": "Escherichia coli",
"B": "Pseudomonas aeruginosa",
"C": "Salmonella typhi",
"D": "Streptococcus agalactiae"
} | step1 | A | [
"3 day old boy",
"brought",
"physician",
"mother",
"irritability",
"feeding intolerance",
"1 day",
"temperature",
"Physical examination shows",
"bulging anterior",
"photomicrograph",
"Gram stain",
"cerebrospinal fluid",
"shown",
"Further evaluation shows",
"organism",
"K1 capsular po... |
A 56-year-old man comes to the physician for a follow-up examination one week after a chest x-ray showed a solitary pulmonary nodule. He has no history of major medical illness. He has smoked 1 pack of cigarettes daily for the past 30 years. Physical examination shows no abnormalities. A tuberculin skin test is negativ... | Pulmonary hamartoma | {
"A": "Pulmonary hamartoma",
"B": "Mature teratoma",
"C": "Small cell lung carcinoma",
"D": "Bronchogenic cyst"
} | step1 | A | [
"year old man",
"physician",
"follow-up examination one week",
"chest x-ray showed",
"solitary pulmonary nodule",
"history of major medical illness",
"smoked 1 pack",
"cigarettes daily",
"past 30 years",
"Physical examination shows",
"abnormalities",
"tuberculin skin test",
"negative",
"CT... |
A 74-year-old man with a history of encephalomyelitis, ataxia, and nystagmus a new diagnosis of small cell carcinoma of the lung (T2, N1, Mn/a) is admitted to the hospital due to painless loss of vision in his right eye. A full workup reveals optic neuritis and uveitis in the affected eye. Which of the following antibo... | Anti-CV2 (CRMP5) | {
"A": "Anti-amphiphysin",
"B": "Anti-Hu",
"C": "Anti-Ri",
"D": "Anti-CV2 (CRMP5)"
} | step1 | D | [
"74 year old man",
"history",
"encephalomyelitis",
"ataxia",
"nystagmus",
"new diagnosis of small cell carcinoma",
"the lung",
"T2",
"N1",
"Mn",
"admitted",
"hospital due to painless loss of vision",
"right eye",
"full workup reveals optic neuritis",
"uveitis",
"affected eye",
"follo... |
A previously healthy 24-year-old man is brought to the emergency department 30 minutes after an episode of loss of consciousness. He was standing in line at a bus stop when he suddenly became tense, fell down, and lost consciousness; this was followed by 4 minutes of violent jerky movements of his arms and legs. He was... | Reduced serum bicarbonate | {
"A": "Increased serum calcium",
"B": "Increased serum sodium",
"C": "Reduced serum bicarbonate",
"D": "Increased serum magnesium"
} | step2&3 | C | [
"healthy",
"year old man",
"brought",
"emergency department 30 minutes",
"episode of loss",
"consciousness",
"standing in line",
"bus stop",
"tense",
"fell",
"lost consciousness",
"followed by",
"minutes",
"violent jerky movements",
"arms",
"legs",
"confused",
"episode",
"recolle... |
A 21-year-old woman comes to the physician for a routine physical examination. She feels well. She is 163 cm (5 ft 4 in) tall and weighs 54 kg (120 lb); BMI is 20.3 kg/m2. Physical examination shows no abnormalities. Her fasting serum glucose concentration is 132 mg/dL. Serum insulin concentration 30 minutes after oral... | Defect in expression of glucokinase gene | {
"A": "Defect in expression of glucokinase gene",
"B": "Resistance to insulin-mediated glucose uptake",
"C": "Autoantibodies to pancreatic beta cells",
"D": "Mutation in hepatocyte nuclear factor 1\n\""
} | step1 | A | [
"21-year-old woman",
"physician",
"routine physical examination",
"feels well",
"5 ft 4",
"tall",
"54 kg",
"BMI",
"20",
"kg/m2",
"Physical examination shows",
"abnormalities",
"fasting serum",
"mg/dL",
"Serum concentration 30 minutes",
"oral administration",
"20 mIU/L",
"N",
"hem... |
A 67-year-old man comes to the physician because of urinary frequency, dysuria, and blood in his urine. He has also had a 4.5-kg (10-lb) weight loss over the past 3 months and has been feeling more fatigued than usual. He smoked one pack of cigarettes daily for 40 years but quit 2 years ago. A urinalysis shows 3+ blood... | Dysplastic cells extending into the lamina propria | {
"A": "Dysplastic cells extending into the lamina propria",
"B": "Nests of atypical cells in the urothelium",
"C": "Friable urothelium with ulcerations",
"D": "Disordered urothelium lined with papillary fronds"
} | step1 | A | [
"67 year old man",
"physician",
"urinary frequency",
"dysuria",
"blood in",
"urine",
"4.5 kg",
"10",
"weight loss over",
"past 3 months",
"feeling more fatigued",
"usual",
"smoked one pack",
"cigarettes daily",
"40 years",
"quit",
"years",
"urinalysis shows 3",
"blood",
"Cystos... |
A 24-year-old woman comes to the physician for a routine health maintenance examination. She feels well. On questioning, she has had occasional morning dizziness and palpitations during the past year. She is a graduate student. She does not smoke and drinks 1–2 glasses of wine on the weekends. Her vital signs are withi... | Reassurance | {
"A": "Reassurance",
"B": "Event recorder implantation",
"C": "Stress echocardiography",
"D": "Administration of flecainide"
} | step2&3 | A | [
"year old woman",
"physician",
"routine health maintenance examination",
"feels well",
"questioning",
"occasional morning dizziness",
"palpitations",
"past year",
"graduate student",
"not smoke",
"drinks",
"glasses",
"wine",
"weekends",
"vital signs",
"normal",
"Physical examination ... |
A 25-year-old patient is brought into the emergency department after he was found down by the police in 5 degree celsius weather. The police state the patient is a heroin-user and is homeless. The patient's vitals are T 95.3 HR 80 and regular BP 150/90 RR 10. After warming the patient, you notice his left lower leg is ... | Reperfusion associated edema | {
"A": "Cellulitis",
"B": "Necrotizing fasciitis",
"C": "Reperfusion associated edema",
"D": "Diabetes"
} | step2&3 | C | [
"year old patient",
"brought",
"emergency department",
"found",
"police",
"degree celsius weather",
"police state",
"patient",
"heroin user",
"homeless",
"patient's",
"T 95 3",
"80",
"regular BP",
"90 RR 10",
"warming",
"patient",
"left lower leg",
"now",
"larger",
"right leg... |
A 24-year-old woman comes to the physician because of excessive hair growth. She has noticed increasing numbers of dark hairs on her upper lip and on her abdomen over the past 8 years. Menarche was at the age of 13 years. Menses occur at regular 28-day intervals and last 5–6 days with moderate flow. She is sexually act... | Increased activity of 5-alpha reductase | {
"A": "Increased activity of 5-alpha reductase",
"B": "Deficiency of 21-hydroxylase",
"C": "Peripheral insulin resistance",
"D": "Tumor of granulosa-theca cells of the ovary\n\""
} | step2&3 | A | [
"year old woman",
"physician",
"excessive hair growth",
"increasing numbers",
"dark hairs",
"upper lip",
"abdomen",
"past",
"years",
"Menarche",
"age",
"years",
"Menses occur",
"regular",
"day intervals",
"last",
"days",
"moderate flow",
"sexually active",
"one male partner",
... |
A 65-year-old woman comes to the physician for a 18-month history of gradual enlargement of her fingertips and a 2-month history of a hoarse voice. She has had decreased appetite after a respiratory tract infection 3 months ago and a 8-kg (17.6-lb) weight loss during this period. The patient has never smoked. She was d... | Miosis | {
"A": "Miosis",
"B": "Increased serum ACE",
"C": "Reticular opacities on chest x-ray",
"D": "Peripheral cyanosis"
} | step2&3 | A | [
"65 year old woman",
"physician",
"month history",
"gradual enlargement",
"fingertips",
"2 month history of",
"hoarse voice",
"decreased appetite",
"respiratory tract infection",
"months",
"kg",
"weight loss",
"period",
"patient",
"never smoked",
"diagnosed",
"obstructive sleep apnea... |
A 72-year-old male with history of hypertension, diabetes mellitus, cluster headaches, and basal cell carcinoma presents with complaints of progressive dyspnea. He has had increasing shortness of breath, especially when going on walks or mowing the lawn. In addition, he had two episodes of extreme lightheadedness while... | Colonic angiodysplasia | {
"A": "Carotid atherosclerosis",
"B": "Deep vein thrombosis",
"C": "Colonic angiodysplasia",
"D": "Erectile dysfunction"
} | step2&3 | C | [
"72 year old male",
"history of hypertension",
"diabetes mellitus",
"cluster headaches",
"basal cell carcinoma presents",
"complaints",
"progressive dyspnea",
"increasing shortness of breath",
"walks",
"addition",
"two episodes of extreme lightheadedness",
"moving",
"furniture",
"temperatu... |
A 43-year-old woman comes to the physician because of a 6-week history of hoarseness and difficulty swallowing. She also has a history of lower back pain treated with ibuprofen. She is 162 cm (5 ft 4 in) tall and weighs 77 kg (169 lb); BMI is 29 kg/m2. Her pulse is 64/min and blood pressure is 130/86 mm Hg. Physical ex... | Collagen deposition and decreased number of follicles | {
"A": "Spindle cells and areas of focal necrosis",
"B": "Collagen deposition and decreased number of follicles",
"C": "Giant cells and noncaseating granulomas",
"D": "Lymphocytic infiltrate and germinal center formation"
} | step1 | B | [
"year old woman",
"physician",
"week history",
"hoarseness",
"difficulty swallowing",
"history of lower back pain treated with ibuprofen",
"5 ft 4",
"tall",
"kg",
"BMI",
"29 kg/m2",
"pulse",
"64 min",
"blood pressure",
"mm Hg",
"Physical examination shows dry skin",
"swelling",
"lo... |
A 29-year-old man is being monitored at the hospital after cutting open his left wrist. He has a long-standing history of unipolar depressive disorder and multiple trials of antidepressants. The patient expresses thoughts of self-harm and does not deny suicidal intent. A course of electroconvulsive therapy is suggested... | Retrograde amnesia
" | {
"A": "Intracranial hemorrhage",
"B": "Amnesic aphasia",
"C": "Acute coronary syndrome",
"D": "Retrograde amnesia\n\""
} | step2&3 | D | [
"29 year old man",
"monitored",
"hospital",
"cutting open",
"left wrist",
"long standing history of unipolar depressive disorder",
"multiple trials",
"antidepressants",
"patient",
"thoughts",
"self-harm",
"not deny suicidal intent",
"course",
"electroconvulsive therapy",
"suggested",
"... |
A 770-g (1-lb 11-oz) female newborn delivered at 28 weeks' gestation develops rapid breathing, grunting, cyanosis, and subcostal retractions shortly after birth. Her mother did not receive any prenatal care. Breath sounds are decreased over both lung fields. An x-ray of the chest shows diffuse fine, reticular densities... | Betamethasone | {
"A": "Epinephrine",
"B": "Betamethasone",
"C": "Thyrotropin-releasing hormone",
"D": "Oxytocin"
} | step1 | B | [
"770 g",
"1",
"oz",
"female newborn delivered",
"weeks",
"gestation",
"rapid breathing",
"grunting",
"cyanosis",
"subcostal retractions",
"birth",
"mother",
"not receive",
"prenatal care",
"Breath sounds",
"decreased",
"lung fields",
"x-ray of",
"chest shows diffuse fine",
"ret... |
A 52-year-old postmenopausal woman seeks evaluation at a medical clinic with complaints of back pain and increased fatigue for 6 months. For the past week, the back pain has radiated to her legs and is stabbing in nature (7/10 in intensity). There are no associated paresthesias. She unintentionally lost 4.5 kg (10.0 lb... | Multiple myeloma | {
"A": "Metastatic bone disease",
"B": "Multiple myeloma",
"C": "Waldenstrom macroglobulinemia",
"D": "Monoclonal gammopathy of unknown significance"
} | step1 | B | [
"year old postmenopausal woman",
"evaluation",
"medical",
"complaints of back pain",
"increased fatigue",
"months",
"past week",
"back pain",
"radiated",
"legs",
"stabbing",
"nature",
"10",
"intensity",
"associated paresthesias",
"lost 4.5 kg",
"10 0",
"past 6 months",
"history",... |
A 74-year-old man is brought to the emergency department after he had copious amounts of blood-stained stools. Minutes later, he turned sweaty, felt light-headed, and collapsed into his wife’s arms. Upon admission, he is found to have a blood pressure of 78/40 mm Hg, a pulse of 140/min, and oxygen saturation of 98%. Hi... | Nasogastric lavage | {
"A": "Colonoscopy",
"B": "Nasogastric lavage",
"C": "Upper endoscopy",
"D": "Mesenteric angiography"
} | step2&3 | B | [
"74 year old man",
"brought",
"emergency department",
"copious amounts of blood-stained stools",
"Minutes later",
"turned sweaty",
"felt light-headed",
"collapsed",
"arms",
"admission",
"found to",
"blood pressure",
"40 mm Hg",
"pulse",
"min",
"oxygen saturation",
"98",
"family his... |
A 40-year-old man with persistent moderate asthma presents for a pulmonary function test. His ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is 0.69, and his FEV1 is 65% of his predicted values. What other findings can be expected in the remainder of his pulmonary function test? | Increase in fractional exhalation of nitric oxide | {
"A": "Decreased diffusion limitation of carbon monoxide (DLCO)",
"B": "Increase in FEV1 with methacholine",
"C": "Decrease in FEV1 with albuterol",
"D": "Increase in fractional exhalation of nitric oxide"
} | step1 | D | [
"40 year old man",
"persistent moderate presents",
"pulmonary function test",
"ratio",
"forced expiratory volume",
"one second",
"FEV1",
"forced vital capacity",
"0 69",
"FEV1",
"65",
"predicted values",
"findings",
"expected",
"pulmonary function test"
] |
A 56-year-old man presents to his general practitioner with frequent episodes of facial flushing for the past 2 weeks. He says the episodes are associated with mild headaches and a sensation of fullness in his head and neck. Additionally, he has developed recurrent, often severe, itching after taking a hot shower. The ... | ↑ Blood viscosity, ↓ blood flow, ↓ erythropoietin | {
"A": "↑ Blood viscosity, ↓ blood flow with blast cells",
"B": "↓ Blood viscosity, ↑ blood flow, ↓erythropoietin, ↑ferritin",
"C": "↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin M",
"D": "↑ Blood viscosity, ↓ blood flow, ↓ erythropoietin"
} | step1 | D | [
"year old man presents",
"general practitioner",
"frequent episodes of facial flushing",
"past 2 weeks",
"episodes",
"associated with mild headaches",
"sensation",
"fullness",
"head and neck",
"recurrent",
"often severe",
"itching",
"hot shower",
"patient denies",
"smoking history",
"d... |
An 8-day-old boy is brought to the physician by his mother because of vomiting and poor feeding. The pregnancy was uncomplicated, and he was born at full term. He appears pale and lethargic. Physical examination shows diffusely increased muscle tone. His urine is noted to have a sweet odor. This patient's symptoms are ... | Isoleucine | {
"A": "Isoleucine",
"B": "Phytanic acid",
"C": "Homogentisic acid",
"D": "Homocysteine"
} | step1 | A | [
"day old boy",
"brought",
"physician",
"mother",
"vomiting",
"poor feeding",
"pregnancy",
"uncomplicated",
"born",
"full term",
"appears pale",
"lethargic",
"Physical examination shows",
"increased muscle tone",
"urine",
"noted to",
"sweet odor",
"patient's symptoms",
"most likel... |
A 55-year-old male smoker presents to your office with hemoptysis, central obesity, and a round face with a "moon-like" appearance. He is found to have a neoplasm near the hilum of his left lung. A biopsy of the tumor reveals small basophilic cells with finely granular nuclear chromatin (a "salt and pepper" pattern). W... | Cisplatin and radiotherapy | {
"A": "Tamoxifen",
"B": "Prednisone",
"C": "Surgical resection",
"D": "Cisplatin and radiotherapy"
} | step1 | D | [
"55 year old male smoker presents",
"office",
"hemoptysis",
"central obesity",
"round",
"moon",
"appearance",
"found to",
"neoplasm",
"hilum of",
"left lung",
"biopsy",
"tumor reveals small basophilic cells",
"granular nuclear chromatin",
"salt",
"pepper",
"pattern",
"following",
... |
A 3-year-old girl swallowed a handful of pills after her grandmother dropped the bottle on the ground this afternoon. She presents to the ER in a very drowsy but agitated state. She is clutching her abdomen, as if in pain, her skin is dry and flushed, and she does not know her name or where she is. Her pupils are dilat... | Physostigmine | {
"A": "Atropine",
"B": "Naloxone",
"C": "Physostigmine",
"D": "Deferoxamine"
} | step1 | C | [
"3 year old girl swallowed",
"pills",
"grandmother dropped",
"bottle",
"ground",
"afternoon",
"presents",
"ER",
"very drowsy",
"agitated state",
"abdomen",
"as",
"pain",
"skin",
"dry",
"flushed",
"not",
"name",
"pupils",
"dilated",
"grandmother reports",
"not",
"hours",
... |
A 49-year-old man was brought to the emergency department by ambulance with complaints of sudden-onset chest pain that radiates into his neck and down his left arm. This substernal pain started 2 hours ago while he was having dinner. His past medical history is remarkable for hypercholesterolemia that is responsive to ... | Right main coronary artery occlusion | {
"A": "Left main coronary artery occlusion",
"B": "Left circumflex artery occlusion",
"C": "Left anterior descending artery occlusion",
"D": "Right main coronary artery occlusion"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"ambulance",
"complaints of sudden-onset chest pain",
"radiates",
"neck",
"left arm",
"substernal pain started 2 hours",
"dinner",
"past medical history",
"hypercholesterolemia",
"responsive",
"therapy",
"statins",
"coronary artery dis... |
A 43-year-old man comes to the physician for a 1-week history of swelling around his eyes and decreased urination. His pulse is 87/min, and blood pressure is 152/95 mm Hg. Physical examination shows 1+ periorbital and pretibial edema. Serum studies show a urea nitrogen concentration of 21 mg/dL and a creatinine concent... | Red blood cell casts | {
"A": "Urinary rhomboid crystals",
"B": "Hypoalbuminemia",
"C": "Red blood cell casts",
"D": "Detached renal tubular epithelial cells"
} | step1 | C | [
"year old man",
"physician",
"1-week history",
"swelling",
"eyes",
"decreased urination",
"pulse",
"87 min",
"blood pressure",
"95 mm Hg",
"Physical examination shows 1",
"periorbital",
"edema",
"Serum studies show",
"urea nitrogen concentration",
"21 mg/dL",
"creatinine concentratio... |
A 62-year-old woman with hypertension and type 2 diabetes mellitus comes to the physician because of increasing shortness of breath and a dry cough over the past 6 months. She has smoked 1 pack of cigarettes daily for the past 40 years. Chest auscultation shows scattered expiratory wheezes in both lung fields. Spiromet... | Emphysema | {
"A": "Pulmonary fibrosis",
"B": "Emphysema",
"C": "Bronchial asthma",
"D": "Bronchiectasis"
} | step1 | B | [
"62 year old woman",
"hypertension",
"type 2 diabetes mellitus",
"physician",
"of increasing shortness",
"breath",
"dry cough",
"past 6 months",
"smoked 1 pack",
"cigarettes daily",
"past 40 years",
"Chest auscultation shows scattered expiratory wheezes",
"lung fields",
"Spirometry shows",... |
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