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 20-year-old girl presents to a physician following unprotected coitus with her boyfriend about 10 hours ago. She tells the doctor that although they usually use a barrier method of contraception, this time they forgot. She does not want to become pregnant. She also mentions that she has major depression and does not ... | Delayed ovulation through inhibition of follicular development | {
"A": "Reduction in motility of cilia in the fallopian tubes",
"B": "Atrophy of the endometrium",
"C": "Delayed ovulation through inhibition of follicular development",
"D": "Thickening of the cervical mucus"
} | step1 | C | [
"20 year old girl presents",
"physician following unprotected coitus",
"boyfriend",
"10 hours",
"doctor",
"usually use",
"barrier method",
"contraception",
"time",
"forgot",
"not",
"to",
"pregnant",
"major depression",
"not",
"to take",
"estrogen containing pill",
"counseling",
"... |
A 42-year-old man comes to his physician with a history of fever, non-bloody diarrhea, and headache for 10 days. He also complains of anorexia and abdominal pain. He returned from a trip to India 3 weeks ago. His temperature is 40.0°C (104.0°F), pulse is 65/min, respirations are 15/min, and blood pressure is 135/80 mm ... | Enteric fever | {
"A": "Enteric fever",
"B": "Leptospirosis",
"C": "Malaria",
"D": "Nontyphoidal salmonellosis"
} | step2&3 | A | [
"year old man",
"physician",
"history",
"fever",
"non bloody diarrhea",
"headache",
"10 days",
"anorexia",
"abdominal pain",
"returned",
"trip",
"India",
"weeks",
"temperature",
"40",
"pulse",
"65 min",
"respirations",
"min",
"blood pressure",
"80 mm Hg",
"rash",
"chest",... |
An otherwise healthy 25-year-old man comes to the physician because of a 3-month history of intermittent palpitations and worsening shortness of breath on exertion. He has not had chest pain or nocturnal dyspnea. The patient is 195 cm (6 ft 5 in) tall and weighs 70 kg (154 lbs); BMI is 18.4 kg/m2. His pulse is 110/min ... | Aortic regurgitation | {
"A": "Aortic regurgitation",
"B": "Tricuspid stenosis",
"C": "Aortic stenosis",
"D": "Tricuspid regurgitation"
} | step1 | A | [
"healthy",
"year old man",
"physician",
"of",
"3 month history",
"intermittent palpitations",
"worsening shortness of breath",
"exertion",
"not",
"chest pain",
"nocturnal dyspnea",
"patient",
"6 ft 5",
"tall",
"70 kg",
"lbs",
"BMI",
"kg/m2",
"pulse",
"min",
"blood pressure",
... |
A 4-year-old boy is brought to the clinic by his mother with a history of fever for the past 3 days, yellow nasal discharge, and a severe earache in the right ear. He has no prior history of ear infections and is otherwise healthy. The physician suspects that the infectious agent is Streptococcus pneumoniae and prescri... | The pathway involved allows for recognition of extracellular antigens. | {
"A": "The pathway involved allows for recognition of extracellular antigens.",
"B": "The antigen is directly bound to the MHC I.",
"C": "The target cell involved is a CD8+ T cell.",
"D": "The pathway involved allows for recognition of intracellular antigens."
} | step1 | A | [
"4 year old boy",
"brought",
"clinic",
"mother",
"history",
"fever",
"past",
"days",
"yellow nasal discharge",
"severe earache",
"right ear",
"prior history of ear infections",
"healthy",
"physician suspects",
"infectious agent",
"Streptococcus pneumoniae",
"appropriate treatment",
... |
A 39-year-old woman is brought to the emergency room by her husband because of severe dyspnea and dizziness. Her symptoms started suddenly 30 minutes ago. She appears distressed. Arterial blood gas shows a pH of 7.51, pO2 of 100 mm Hg, and a pCO2 of 30 mm Hg. Which of the following is the most likely cause? | Panic attack | {
"A": "Panic attack",
"B": "Opioid toxicity",
"C": "Myasthenia gravis",
"D": "Epiglottitis"
} | step1 | A | [
"year old woman",
"brought",
"emergency room",
"husband",
"severe dyspnea",
"dizziness",
"symptoms started",
"30 minutes",
"appears distressed",
"Arterial blood gas shows",
"pH",
"7",
"pO2",
"100 mm Hg",
"pCO2",
"30 mm Hg",
"following",
"most likely cause"
] |
A 43-year-old man is brought to the emergency department 30 minutes after falling from the roof of a construction site. He reports abdominal and right-sided flank pain. His temperature is 37.1°C (98.8°F), pulse is 114/min, and blood pressure is 100/68 mm Hg. Physical examination shows numerous ecchymoses over the trunk... | Kidney | {
"A": "Liver",
"B": "Spleen",
"C": "Kidney",
"D": "Stomach"
} | step1 | C | [
"year old man",
"brought",
"emergency department 30 minutes",
"falling from",
"roof",
"construction site",
"reports abdominal",
"right-sided flank pain",
"temperature",
"98",
"pulse",
"min",
"blood pressure",
"100 68 mm Hg",
"Physical examination shows numerous ecchymoses",
"trunk",
... |
A 34-year-old female medical professional who works for a non-governmental organization visits her primary care provider for a routine health check-up. She made a recent trip to Sub-Saharan Africa where she participated in a humanitarian medical project. Her medical history and physical examination are unremarkable. A ... | Th1-mediated cytotoxicity | {
"A": "Opsonization",
"B": "Complement activation",
"C": "Th1-mediated cytotoxicity",
"D": "IgE cross-linking"
} | step1 | C | [
"year old female medical professional",
"works",
"non-governmental organization visits",
"primary care provider",
"routine health check-up",
"made",
"recent trip",
"Sub-Saharan Africa",
"medical project",
"medical history",
"physical examination",
"unremarkable",
"chest radiograph",
"tuber... |
A 2-day-old newborn male delivered at 38 weeks' gestation is evaluated for poor feeding and irritability. His temperature is 35°C (95°F), pulse is 168/min, respirations are 80/min, and blood pressure is 60/30 mm Hg. Blood culture on sheep agar grows motile, gram-positive bacteria surrounded by a narrow clear zone. Furt... | Interferon-γ-induced macrophage activation | {
"A": "Secretion of interferon-α from infected cells",
"B": "Formation of the membrane attack complex",
"C": "Interferon-γ-induced macrophage activation",
"D": "Secretion of interleukin 10 by regulatory T cells"
} | step1 | C | [
"2-day old newborn male delivered",
"weeks",
"gestation",
"evaluated",
"poor feeding",
"irritability",
"temperature",
"pulse",
"min",
"respirations",
"80 min",
"blood pressure",
"60 30 mm Hg",
"Blood culture",
"sheep agar",
"motile",
"gram-positive bacteria surrounded",
"narrow cle... |
A 25-year-old woman presents to the emergency department with sudden onset of lower limb weakness for the past 2 days. She says she also hasn’t been able to urinate for that same period. There is no history of trauma, fever, weight loss, recent respiratory tract infection, or diarrhea. She has a past medical history of... | Intravenous methylprednisolone | {
"A": "Interferon beta",
"B": "Intravenous methylprednisolone",
"C": "Plasmapheresis",
"D": "Riluzole"
} | step2&3 | B | [
"year old woman presents",
"emergency department",
"sudden onset of lower limb weakness",
"past 2 days",
"hasnt",
"able to",
"same period",
"history",
"trauma",
"fever",
"weight loss",
"recent respiratory tract infection",
"diarrhea",
"past medical history of left arm weakness",
"months"... |
A 37-year-old man is brought to the emergency department because he was found down on a city sidewalk. Upon presentation he is found to be disheveled with multiple poorly healed wounds on his hands and feet. He has had dozens of previous presentations for alcohol intoxication and is currently known to be homeless. Phys... | RNA polymerase | {
"A": "Hemoglobin",
"B": "Glutathione peroxidase",
"C": "RNA polymerase",
"D": "Thyroid hormone"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"found",
"city sidewalk",
"presentation",
"found to",
"multiple poorly healed",
"hands",
"feet",
"previous presentations",
"alcohol intoxication",
"currently known to",
"homeless",
"Physical examination reveals multiple minor wounds",
... |
A 31-year-old woman presents to the emergency department with a history of fever and vomiting for 2 days and severe headache for a day. Past medical history is significant for migraine diagnosed 10 years ago, but she reports that her current headache is different. She describes the pain as generalized, dull, continuous... | CSF: WBC 8,500 cells/mm3, neutrophil predominant, protein 112 mg/dL, glucose 15 mg/dL | {
"A": "CSF: WBC 4 cells/mm3, protein 35 mg/dL, glucose 66 mg/dL",
"B": "CSF: WBC 8,500 cells/mm3, neutrophil predominant, protein 112 mg/dL, glucose 15 mg/dL",
"C": "CSF: WBC 145 cells/mm3, lymphocytic predominant, protein 42 mg/dL, glucose 60 mg/dL",
"D": "CSF: WBC 2 cells/mm3, protein 142 mg/dL, glucose 70 m... | step2&3 | B | [
"31 year old woman presents",
"emergency department",
"history",
"fever",
"vomiting",
"2 days",
"severe headache",
"day",
"Past medical history",
"significant",
"migraine diagnosed 10 years",
"reports",
"current headache",
"different",
"pain",
"generalized",
"dull",
"continuous",
... |
A 48-year-old man is being evaluated for an acquired defect of the myeloid stem cell line with a mutation in the PIG-A gene. His diagnosis was first suspected due to anemia and recurrent pink-tinged urine. Which of the markers will be negative in the flow cytometry test for his condition? | CD55 | {
"A": "CD19",
"B": "CD40L",
"C": "CD55",
"D": "CD3"
} | step1 | C | [
"48 year old man",
"evaluated",
"acquired defect",
"myeloid stem cell line",
"mutation",
"PIG",
"gene",
"diagnosis",
"first suspected due to anemia",
"recurrent pink tinged urine",
"markers",
"negative",
"flow cytometry test",
"condition"
] |
A team of epidemiologists is investigating an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing E. coli O104:H4. In Europe, multiple episodes of illness were reported in May 2017 within a large extended family of 16 family members, who all attended a family reunion in late April where they ate... | 6/15 | {
"A": "6/15",
"B": "6/8",
"C": "7/8",
"D": "7/16"
} | step1 | A | [
"team",
"epidemiologists",
"investigating",
"outbreak",
"hemolytic uremic syndrome",
"caused",
"Shiga toxin",
"E",
"coli",
"Europe",
"multiple episodes of illness",
"reported",
"May",
"large extended family of",
"members",
"attended",
"family reunion",
"late April",
"ate",
"con... |
A 25-year-old man is brought to the emergency department 6 hours after rescuing babies and puppies from a burning daycare center. He says that he has a severe headache, feels nauseous and dizzy. He is tachypneic. An arterial blood gas shows pH 7.3, PaCO2 49 mmHg, PaO2 80 mmHg. Serum lactate level is 6 mmol/L. What bioc... | Low pyruvate dehydrogenase activity | {
"A": "High pyruvate dehydrogenase activity",
"B": "Low pyruvate dehydrogenase activity",
"C": "Low lactate dehydrogenase activity",
"D": "Increased oxidation of NADH"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"hours",
"babies",
"puppies",
"burning daycare center",
"severe headache",
"feels nauseous",
"dizzy",
"tachypneic",
"arterial blood gas shows pH",
"3",
"mmHg",
"PaO2 80 mmHg",
"Serum lactate level",
"mmol/L",
"biochemical process",... |
A 49-year-old woman with a history of hepatitis C cirrhosis complicated by esophageal varices, ascites, and hepatic encephalopathy presents with 1 week of increasing abdominal discomfort. Currently, she takes lactulose, rifaximin, furosemide, and spironolactone. On physical examination, she has mild asterixis, generali... | Cefotaxime | {
"A": "Increased furosemide and spironolactone",
"B": "Transjugular intrahepatic portosystemic shunt placement",
"C": "Cefotaxime",
"D": "Metronidazole"
} | step2&3 | C | [
"year old woman",
"history of hepatitis C cirrhosis complicated",
"esophageal varices",
"ascites",
"hepatic encephalopathy presents",
"1 week",
"increasing abdominal discomfort",
"Currently",
"takes lactulose",
"rifaximin",
"furosemide",
"spironolactone",
"physical examination",
"mild aste... |
A 7-year-old girl is brought to the physician by her parents for the evaluation of pubic hair development. She has a history of a fracture in each leg and one fracture in her right arm. Her performance at school is good. There is no family history of serious illness. She takes no medications. Vital signs are within nor... | McCune-Albright syndrome | {
"A": "Osteogenesis imperfecta",
"B": "McCune-Albright syndrome",
"C": "Neurofibromatosis type I",
"D": "Congenital adrenal hyperplasia"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"parents",
"evaluation of pubic hair development",
"history of",
"fracture",
"leg",
"one fracture",
"right",
"performance",
"school",
"good",
"family history",
"serious illness",
"takes",
"medications",
"Vital signs",
"normal limits",
"G... |
A 63-year-old man with aortic valve disease is admitted to the hospital for a 3-week history of progressively worsening fatigue, fever, and night sweats. He does not smoke, drink alcohol, or use illicit drugs. Temperature is 38.2°C (100.8°F). Physical examination shows a systolic murmur and tender, erythematous nodules... | Viridans streptococci | {
"A": "Streptococcus gallolyticus",
"B": "Streptococcus pneumonia",
"C": "Staphylococcus epidermidis",
"D": "Viridans streptococci"
} | step1 | D | [
"63 year old man",
"aortic valve disease",
"admitted",
"hospital",
"3 week history",
"worsening fatigue",
"fever",
"night sweats",
"not smoke",
"drink alcohol",
"use illicit",
"Temperature",
"100",
"Physical examination shows",
"systolic murmur",
"tender",
"erythematous nodules on",
... |
A 23-year-old woman presents to the emergency department after being found unresponsive by her friends. The patient is an IV drug user and her friends came over and found her passed out in her room. The patient presented to the emergency department 2 days ago after being involved in a bar fight where she broke her nose... | Removal of nasal packing | {
"A": "Nafcillin",
"B": "Norepinephrine",
"C": "Removal of nasal packing",
"D": "Vancomycin"
} | step2&3 | C | [
"23 year old woman presents",
"emergency department",
"found unresponsive",
"friends",
"patient",
"IV drug user",
"friends",
"over",
"found",
"passed out",
"room",
"patient presented",
"emergency department 2 days",
"involved",
"fight",
"broke",
"nose",
"treated",
"packed",
"ga... |
A 25-year-old woman presents to her primary care physician with a chief complaint of diffuse muscle aches and pains. She states that she has trouble doing everyday tasks such as showering, cooking, and cleaning due to the pain. The patient has a past medical history of anxiety and bulimia nervosa and is currently not t... | Dependent | {
"A": "Avoidant",
"B": "Dependent",
"C": "Borderline",
"D": "Histrionic"
} | step2&3 | B | [
"year old woman presents",
"primary care physician",
"chief complaint",
"diffuse muscle aches",
"pains",
"states",
"everyday tasks",
"showering",
"cooking",
"cleaning due to",
"pain",
"patient",
"past medical anxiety",
"bulimia nervosa",
"currently not taking",
"medications",
"furthe... |
A 22-year-old man presents with a history of lightheadedness, weakness, and palpitations when he assumes an upright position from a supine position. He is otherwise a healthy man without a history of alcohol or other substance abuse. His supine and standing blood pressures (measured at 3-minute intervals) were 124/82 m... | During late phase II, there is an increase in both blood pressure and heart rate | {
"A": "During late phase II, there is an increase in both blood pressure and heart rate",
"B": "During early phase II, there is an increase in blood pressure and a decrease in heart rate",
"C": "During phase I, the blood pressure decreases due to increased intrathoracic pressure",
"D": "The Valsalva ratio is d... | step1 | A | [
"year old man presents",
"history",
"lightheadedness",
"weakness",
"palpitations",
"upright position",
"supine",
"healthy man",
"history",
"alcohol",
"substance abuse",
"supine",
"standing blood pressures",
"measured",
"minute intervals",
"mm Hg",
"72 mm Hg",
"to perform",
"Valsa... |
A tall, slender 32-year-old man comes to the emergency room because of sudden chest pain, cough, and shortness of breath. On physical examination, he has decreased breath sounds on the right. Chest radiography shows translucency on the right side of his chest. His pCO2 is elevated and pO2 is decreased. What is the most... | Spontaneous pneumothorax | {
"A": "Chronic obstructive pulmonary disease",
"B": "Asthma",
"C": "Tension pneumothorax",
"D": "Spontaneous pneumothorax"
} | step1 | D | [
"tall",
"year old man",
"emergency room",
"sudden chest",
"cough",
"shortness of breath",
"physical examination",
"decreased breath sounds",
"right",
"Chest radiography shows translucency",
"right side of",
"chest",
"pCO2",
"elevated",
"pO2",
"decreased",
"most likely cause",
"symp... |
A 63-year-old woman presents with dyspnea on exertion. She reports that she used to work in her garden without any symptoms, but recently she started to note dyspnea and fatigue after working for 20–30 minutes. She has type 2 diabetes mellitus diagnosed 2 years ago but she does not take any medications preferring natur... | Enalapril and bisoprolol | {
"A": "Metoprolol and indapamide",
"B": "Enalapril and bisoprolol",
"C": "Indapamide and amlodipine",
"D": "Valsartan and spironolactone"
} | step2&3 | B | [
"63 year old woman presents",
"dyspnea",
"exertion",
"reports",
"used to work",
"garden",
"symptoms",
"recently",
"started to note dyspnea",
"fatigue",
"working",
"minutes",
"type 2 diabetes mellitus diagnosed 2 years",
"not take",
"medications",
"natural remedies",
"arterial hyperte... |
A 77-year-old woman with congestive heart failure is admitted to the hospital for evaluation prior to cardiac transplantation. During her stay at the hospital, the physician prescribes a drug to improve cardiac contractility. The drug works by selectively inhibiting an isoenzyme that is responsible for the degradation ... | Hypotension | {
"A": "Hyperkalemia",
"B": "Hypotension",
"C": "Hyperglycemia",
"D": "Bronchospasm"
} | step1 | B | [
"year old woman",
"congestive heart failure",
"admitted",
"hospital",
"evaluation prior to cardiac transplantation",
"stay",
"hospital",
"physician",
"drug to",
"cardiac contractility",
"drug works",
"inhibiting",
"isoenzyme",
"responsible",
"degradation",
"cyclic adenosine monophospha... |
A 24-year-old woman comes to her physician because of fatigue. She has been coming to the office multiple times a month for various minor problems over the past six months. During the appointments, she insists on a first name basis and flirts with her physician. She always dresses very fashionably. When his assistant e... | Histrionic personality disorder | {
"A": "Dependent personality disorder",
"B": "Histrionic personality disorder",
"C": "Borderline personality disorder",
"D": "Schizotypal personality disorder"
} | step2&3 | B | [
"year old woman",
"physician",
"fatigue",
"office multiple times",
"month",
"various minor problems",
"past six months",
"appointments",
"first name basis",
"physician",
"always dresses very",
"assistant enters",
"room",
"to start fidgeting",
"interrupt",
"conversation",
"physician",... |
A 59-year-old man comes to the physician for evaluation of progressively worsening back pain that began about 2 months ago. It started as a dull pain that has now developed into a constant throbbing pain that makes falling asleep difficult. Ibuprofen and acetaminophen do not provide relief. The patient has not had any ... | Local radiation | {
"A": "Flutamide",
"B": "Spinal surgery",
"C": "Prostatectomy",
"D": "Local radiation"
} | step2&3 | D | [
"59 year old man",
"physician",
"evaluation",
"worsening back pain",
"began",
"months",
"started",
"dull pain",
"now",
"constant throbbing",
"makes falling asleep difficult",
"Ibuprofen",
"acetaminophen",
"not provide relief",
"patient",
"not",
"bowel incontinence",
"limb weakness"... |
A 62-year-old man comes to the physician because of fatigue and swelling of the lower legs for 3 weeks. One year ago, he had an 85% stenosis in the left anterior descending artery, for which he received 2 stents. He was diagnosed with hepatitis C 5 years ago. He has type 2 diabetes mellitus and arterial hypertension. C... | Arterial hypertension | {
"A": "Diabetes mellitus",
"B": "Amyloidosis",
"C": "Arterial hypertension",
"D": "Membranoproliferative glomerulonephritis"
} | step2&3 | C | [
"62 year old man",
"physician",
"fatigue",
"swelling of",
"lower legs",
"3 weeks",
"One year ago",
"85",
"stenosis",
"left anterior descending artery",
"received 2 stents",
"diagnosed",
"hepatitis C",
"years",
"type 2 diabetes mellitus",
"arterial hypertension",
"Current medications ... |
A 17-year-old girl comes to the physician because of a 1-week history of severe itching in the area of her genitals. She reports that the itching is most severe at night. She has been sexually active with three partners over the past year; she uses condoms for contraception. Her current sexual partner is experiencing s... | Phthirus pubis | {
"A": "Phthirus pubis",
"B": "Pediculus humanus",
"C": "Enterobius vermicularis",
"D": "Epidermophyton floccosum"
} | step1 | A | [
"year old girl",
"physician",
"1-week history",
"severe itching",
"area",
"genitals",
"reports",
"itching",
"most severe",
"night",
"sexually active",
"three partners",
"past year",
"uses condoms",
"contraception",
"current sexual partner",
"experiencing similar symptoms",
"Pelvic ... |
An 15-year-old boy is brought to the emergency department after he passed out in the hallway. On presentation, he is alert but confused about why he is in the hospital. He says that he remembers seeing flashes of light to his right while walking out of class but cannot recall what happened next. His next memory is bein... | Starts in the left occipital lobe and then generalizes | {
"A": "Begins with 10-15 seconds of muscle contraction",
"B": "Episodes with 3-4 hertz spike and wave discharges",
"C": "Isolated to the left occipital lobe",
"D": "Starts in the left occipital lobe and then generalizes"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"passed out",
"hallway",
"presentation",
"alert",
"confused about",
"hospital",
"remembers seeing flashes",
"light",
"right",
"walking out",
"class",
"recall",
"happened next",
"next memory",
"woken up",
"emergency responders",
... |
A clinical study is performed to examine the effect of smoking on the development of pulmonary hypertension (PAH) in a sample of 40-year-old women. A group of 1,000 matched healthy subjects (500 controls; 500 smokers) were monitored for the development of (PAH) from enrollment to death. The data from the study are show... | The lifetime absolute risk increase of developing PAH in female smokers is 3%. | {
"A": "The lifetime absolute risk of developing PAH in healthy nonsmoking women is 5.5%.",
"B": "The increase in the absolute risk of developing PAH by quitting smoking is 75%.",
"C": "The lifetime absolute risk increase of developing PAH in female smokers is 3%.",
"D": "The lifetime absolute risk of developin... | step2&3 | C | [
"clinical study",
"performed to",
"effect",
"smoking",
"development",
"pulmonary hypertension",
"sample",
"40 year old women",
"group",
"matched healthy subjects",
"500 controls",
"500 smokers",
"monitored",
"development",
"PAH",
"enrollment",
"death",
"data",
"study",
"shown",... |
A 41-year-old man with a history of hypertension and hyperlipidemia is brought to the emergency department by his wife for difficulty breathing after choking on food at dinner. He is unconscious and pulseless on arrival. Despite appropriate life-saving measures, he dies. Examination of the heart shows a necrotic, pale ... | Abdominal aorta | {
"A": "Abdominal aorta",
"B": "Thoracic aorta",
"C": "Internal carotid artery",
"D": "Pulmonary artery"
} | step1 | A | [
"year old man",
"history of hypertension",
"hyperlipidemia",
"brought",
"emergency department",
"wife",
"difficulty breathing",
"choking on food",
"dinner",
"unconscious",
"pulseless",
"arrival",
"appropriate life saving measures",
"Examination of",
"heart shows",
"necrotic",
"pale",... |
A 6-month-old girl is brought to the emergency department by her father after he observed jerking movements of her arms and legs earlier in the day. She appears lethargic. Physical examination shows generalized hypotonia. The liver edge is palpable 3 cm below the right costophrenic angle. Her fingerstick glucose shows ... | Medium-chain triglycerides | {
"A": "Coenzyme A",
"B": "Medium-chain triglycerides",
"C": "Thiamine",
"D": "Methionine"
} | step1 | B | [
"month old girl",
"brought",
"emergency department",
"father",
"observed jerking movements",
"arms",
"legs earlier",
"day",
"appears lethargic",
"Physical examination shows generalized hypotonia",
"liver edge",
"palpable",
"cm",
"right costophrenic angle",
"fingerstick glucose shows hypo... |
A 45-year-old male reports several years of asbestos exposure while working in the construction industry. He reports smoking 2 packs of cigarettes per day for over 20 years. Smoking and asbestos exposure increase the incidence of which of the following diseases? | Bronchogenic carcinoma | {
"A": "Chronic bronchitis",
"B": "Emphysema",
"C": "Multiple myeloma",
"D": "Bronchogenic carcinoma"
} | step1 | D | [
"year old male reports several years",
"asbestos exposure",
"working",
"construction industry",
"reports smoking 2 packs",
"cigarettes",
"day",
"20 years",
"Smoking",
"asbestos exposure increase",
"incidence",
"following diseases"
] |
A 19-year-old woman presents for a sports physical. She says he feels healthy and has no concerns. Past medical history is significant for depression and seasonal allergies. Current medications are fluoxetine and oral estrogen/progesterone contraceptive pills. Family history is significant for a sister with polycystic ... | No cervical cancer screening is indicated at this time | {
"A": "Cytology (pap smear) every 3 years",
"B": "Cytology (pap smear) and HPV DNA co-testing every 5 years",
"C": "No cervical cancer screening is indicated at this time",
"D": "Cytology (pap smear) and HPV DNA co-testing every 3 years"
} | step2&3 | C | [
"year old woman presents",
"sports physical",
"feels healthy",
"concerns",
"Past medical history",
"significant",
"depression",
"seasonal allergies",
"Current medications",
"fluoxetine",
"oral estrogen progesterone contraceptive pills",
"Family history",
"significant",
"sister",
"polycys... |
A 47-year-old man comes to the physician for a routine health maintenance examination. He has no complaints and has no history of serious illness. He works as a forklift operator in a factory. His brother died of malignant melanoma. He smokes occasionally and drinks a glass of wine once a week. His pulse is 79/min and ... | Coronary artery disease | {
"A": "Coronary artery disease",
"B": "Malignant melanoma",
"C": "Industrial accident",
"D": "Prostate cancer"
} | step1 | A | [
"year old man",
"physician",
"routine health maintenance examination",
"complaints",
"history",
"serious illness",
"works",
"operator",
"factory",
"brother died",
"malignant melanoma",
"smokes occasionally",
"drinks",
"glass",
"wine",
"week",
"pulse",
"min",
"blood pressure",
"... |
A 3-year-old boy is brought to the emergency department after losing consciousness. His parents report that he collapsed and then had repetitive, twitching movements of the right side of his body that lasted approximately one minute. He recently started to walk with support. He speaks in bisyllables and has a vocabular... | Leptomeningeal vascular malformation | {
"A": "Intraparenchymal cyst",
"B": "Brainstem glioma",
"C": "Leptomeningeal vascular malformation",
"D": "Subependymal giant cell astrocytoma"
} | step1 | C | [
"3 year old boy",
"brought",
"emergency department",
"consciousness",
"parents report",
"collapsed",
"then",
"twitching movements of",
"right side",
"body",
"lasted approximately one minute",
"recently started to walk",
"support",
"speaks",
"vocabulary",
"almost 50 words",
"Examinati... |
A 7-year-old girl is brought to the pediatrician by her parents for red papules over her left thigh and swelling in the right axilla for the past few days. Her parents say that she had a cat bite on her left thigh 2 weeks ago. Her temperature is 38.6°C (101.4°F), pulse is 90/min, and respirations are 22/min. On her phy... | Rifampin + azithromycin | {
"A": "Doxycycline + rifampin",
"B": "Rifampin + azithromycin",
"C": "No treatment is required",
"D": "Surgical excision of the lymph node"
} | step2&3 | B | [
"year old girl",
"brought",
"pediatrician",
"parents",
"red papules",
"left thigh",
"swelling",
"right axilla",
"past",
"days",
"parents",
"cat bite",
"left thigh 2 weeks",
"temperature",
"4F",
"pulse",
"90 min",
"respirations",
"min",
"physical examination",
"hepatosplenomeg... |
A 5-month-old girl is brought to the physician because of a red lesion on her scalp that was first noticed 2 months ago. The lesion has been slowly increasing in size. It is not associated with pain or pruritus. She was born at 37 weeks' gestation after an uncomplicated pregnancy and delivery. Her older sister is curre... | Reassurance and follow-up
" | {
"A": "Intralesional bevacizumab",
"B": "Topical ketoconazole",
"C": "Systemic griseofulvin",
"D": "Reassurance and follow-up\n\""
} | step2&3 | D | [
"5 month old girl",
"brought",
"physician",
"of",
"red lesion",
"scalp",
"first",
"2 months",
"lesion",
"slowly increasing in size",
"not associated with pain",
"pruritus",
"born",
"weeks",
"gestation",
"uncomplicated pregnancy",
"delivery",
"older sister",
"currently",
"treatm... |
A 19-year-old female complains of abnormal facial hair growth. This has been very stressful for her, especially in the setting of not being happy with her weight. Upon further questioning you learn she has a history of type 2 diabetes mellitus. Her height is 61 inches, and weight is 185 pounds (84 kg). Physical examina... | Thickens cervical mucus | {
"A": "Decreases thyroid binding globulin",
"B": "Thickens cervical mucus",
"C": "Decreases LDL",
"D": "Increases bone fractures"
} | step1 | B | [
"year old female",
"abnormal facial hair growth",
"very stressful",
"setting",
"not",
"happy",
"weight",
"further questioning",
"learn",
"history of type 2 diabetes mellitus",
"height",
"61 inches",
"weight",
"pounds",
"84 kg",
"Physical examination",
"notable",
"facial hair",
"s... |
A 63-year-old woman presents to her physician with intractable bone pain, poor appetite, and hiccups. She says symptoms began 3 months ago and have progressively worsened. She also complains of chest pain, generalized pruritus, and dryness of her skin. Past medical history is significant for frequent fractures, poorly ... | Hormone-mediated fibrous replacement of bone | {
"A": "Germline mutation of a tumor suppressor gene",
"B": "Defective mineralization of osteoid secondary to hormone deficiency",
"C": "IgM antibody binding to Fc receptor of IgG",
"D": "Hormone-mediated fibrous replacement of bone"
} | step1 | D | [
"63 year old woman presents",
"physician",
"intractable bone",
"poor appetite",
"hiccups",
"symptoms began 3 months",
"worsened",
"of chest pain",
"generalized pruritus",
"dryness",
"skin",
"Past medical history",
"significant",
"frequent fractures",
"poorly controlled hypertension",
"... |
A 38-year-old woman comes to the physician because of frequent headaches and blurring of vision. She also complains of weight gain, menstrual irregularities, and excessive growth of body hair. She says that, for the first time since she turned 18, her shoe and ring sizes have increased, and also complains that her voic... | Reduced cardiac output | {
"A": "Deposition of mucopolysaccharides in the myocardium",
"B": "Thickening of the coronary artery walls",
"C": "Prolongation of the QT interval on ECG",
"D": "Reduced cardiac output"
} | step2&3 | D | [
"year old woman",
"physician",
"frequent headaches",
"blurring of vision",
"weight gain",
"menstrual irregularities",
"excessive growth of body hair",
"first time",
"turned",
"shoe",
"ring sizes",
"increased",
"voice",
"hoarser",
"not smoke",
"drink alcohol",
"takes",
"medications"... |
An investigator is studying a local anesthetic that activates both alpha and beta adrenergic receptors. When given intravenously, it causes euphoria and pupillary dilation. Which of the following is the most likely effect of this drug at the synaptic cleft? | Decreased reuptake of norepinephrine | {
"A": "Increased release of norepinephrine",
"B": "Decreased reuptake of norepinephrine",
"C": "Increased release of serotonin",
"D": "Decreased release of acetylcholine"
} | step1 | B | [
"investigator",
"studying",
"local anesthetic",
"activates",
"alpha",
"beta adrenergic receptors",
"given",
"causes euphoria",
"pupillary dilation",
"following",
"most likely effect of",
"drug",
"synaptic cleft"
] |
A 35-year-old male is brought into the emergency department for a trauma emergency. The emergency medical services states that the patient was wounded with a knife on his upper left thigh near the inguinal ligament. Upon examination in the trauma bay, the patient is awake and alert. His physical exam and FAST exam is n... | Coagulation studies and blood typing/crossmatch | {
"A": "CT lower extremities",
"B": "Radiograph lower extremities",
"C": "Coagulation studies and blood typing/crossmatch",
"D": "Tourniquet of proximal lower extremity"
} | step2&3 | C | [
"35 year old male",
"brought",
"emergency department",
"trauma emergency",
"emergency medical services states",
"patient",
"wounded",
"knife",
"upper left thigh",
"inguinal ligament",
"examination",
"trauma bay",
"patient",
"awake",
"alert",
"physical exam",
"FAST exam",
"normal",
... |
Five days after undergoing surgical repair of a hip fracture, a 71-year-old man is agitated and confused. Last night, he had to be restrained multiple times after attempting to leave his room. His overnight nurse reported that at times he would be resting, but shortly afterward he would become agitated again for no cle... | Administer haloperidol | {
"A": "Obtain x-ray of the chest",
"B": "Obtain CT scan of the head",
"C": "Administer lorazepam",
"D": "Administer haloperidol"
} | step2&3 | D | [
"Five days",
"surgical",
"hip",
"71 year old man",
"agitated",
"confused",
"Last night",
"to",
"restrained multiple times",
"attempting to leave",
"room",
"overnight nurse reported",
"times",
"resting",
"agitated",
"clear reason",
"hypertension",
"COPD",
"smoked one pack",
"cig... |
An 18-year-old man presents to a rural emergency department after being stabbed multiple times. The patient's past medical history is notable for obesity, diabetes, chronic upper respiratory infections, a 10 pack-year smoking history, and heart failure. He is protecting his airway and he is oxygenating and ventilating ... | IgA deficiency | {
"A": "COPD",
"B": "Heart failure",
"C": "IgA deficiency",
"D": "Persistent intraabdominal bleeding"
} | step2&3 | C | [
"year old man presents",
"rural emergency department",
"stabbed multiple times",
"patient's past",
"notable",
"obesity",
"diabetes",
"chronic upper respiratory infections",
"a 10 pack-year smoking history",
"heart failure",
"airway",
"ventilating well",
"temperature",
"97",
"36 4C",
"b... |
A 10-year-old boy is brought in by his mother with increasing abdominal pain for the past week. The patient’s mother says he has been almost constantly nauseous over that time. She denies any change in his bowel habits, fever, chills, sick contacts or recent travel. The patient has no significant past medical history a... | Burkitt lymphoma | {
"A": "Burkitt lymphoma",
"B": "Hepatoblastoma",
"C": "Neuroblastoma",
"D": "Wilms tumor"
} | step2&3 | A | [
"A 10 year old boy",
"brought",
"mother",
"increasing abdominal pain",
"past week",
"patients mother",
"almost constantly nauseous",
"time",
"denies",
"change in",
"bowel habits",
"fever",
"chills",
"sick contacts",
"recent travel",
"patient",
"significant past medical history",
"t... |
A 26-year-old woman seeks evaluation at an urgent care clinic with complaints of fever and generalized muscle and joint pain for the past 3 days. She also complains of nausea, but denies vomiting. She does not mention any past similar episodes. Her past medical history is unremarkable, but she returned to the United St... | Dengue fever | {
"A": "Dengue fever",
"B": "Ebola virus",
"C": "Leptospirosis",
"D": "Yellow fever"
} | step1 | A | [
"year old woman",
"evaluation",
"urgent care clinic",
"complaints",
"fever",
"generalized muscle",
"joint pain",
"past 3 days",
"nausea",
"denies vomiting",
"not",
"past similar episodes",
"past medical history",
"unremarkable",
"returned",
"United States 1 week",
"spending 2 weeks",... |
A 24-year-old man presents with a complaint of breathlessness while jogging. He says that he recently started marathon training. He does not have any family history of asthma nor has any allergies. He currently takes no medication. The blood pressure is 120/80 mm Hg, and the heart rate is 67/min. With each heartbeat, h... | Marfan's Syndrome | {
"A": "Kawasaki syndrome",
"B": "Marfan's Syndrome",
"C": "Gonorrhea",
"D": "Klinefelter syndrome"
} | step1 | B | [
"year old man presents",
"complaint",
"breathlessness",
"jogging",
"recently started marathon training",
"not",
"family history of asthma",
"allergies",
"currently takes",
"medication",
"blood pressure",
"80 mm Hg",
"heart rate",
"67 min",
"heartbeat",
"experiences pounding",
"chest"... |
A 62-year-old man comes to the physician for evaluation of an increasing right-sided cheek swelling for 2 years. He has had recurrent right-sided oral ulcers for the past 2 months. He has smoked a pack of cigarettes daily for 30 years. He drinks a beer every night. His temperature is 37.1°C (98.8°F), pulse is 71/min, r... | Paralysis of the right lower lip | {
"A": "Hyperesthesia of the right ear lobe",
"B": "Hyperacusis of the right ear",
"C": "Paralysis of the right lower lip",
"D": "Impaired taste and sensation of the posterior 1/3 of the tongue"
} | step2&3 | C | [
"62 year old man",
"physician",
"evaluation",
"increasing right-sided cheek swelling",
"2 years",
"recurrent right-sided oral ulcers",
"past",
"months",
"smoked",
"pack",
"cigarettes daily",
"30 years",
"drinks",
"beer",
"night",
"temperature",
"98",
"pulse",
"71 min",
"respira... |
A 52-year-old man comes to the physician because of a 6-month history of shortness of breath and nonproductive cough. He has smoked 1 pack of cigarettes daily for 15 years. Cardiopulmonary examination shows fine inspiratory crackles bilaterally. There is clubbing present in the fingers bilaterally. Pulmonary function t... | Pulmonary fibrosis | {
"A": "Pulmonary fibrosis",
"B": "Bronchopulmonary aspergillosis",
"C": "Chronic bronchiectasis",
"D": "Chronic obstructive pulmonary disease"
} | step1 | A | [
"year old man",
"physician",
"of",
"month history",
"shortness",
"breath",
"nonproductive cough",
"smoked 1 pack",
"cigarettes daily",
"15 years",
"Cardiopulmonary examination shows fine inspiratory crackles",
"clubbing present",
"fingers",
"Pulmonary function tests",
"show",
"FVC",
... |
A 45-year-old man comes to the physician because of a 5-day history of fever, malaise, and right upper abdominal pain. Examination of the abdomen shows tenderness in the right upper quadrant. His leukocyte count is 18,000/mm3 (90% neutrophils) and serum alkaline phosphatase is 130 U/L. Ultrasonography of the abdomen sh... | Cholangitis | {
"A": "Infectious endocarditis",
"B": "Echinococcosis",
"C": "Diverticulitis",
"D": "Cholangitis"
} | step1 | D | [
"year old man",
"physician",
"5-day history",
"fever",
"malaise",
"right upper",
"Examination of",
"abdomen shows tenderness",
"right upper quadrant",
"leukocyte count",
"mm3",
"90",
"neutrophils",
"serum alkaline phosphatase",
"U/L",
"Ultrasonography of",
"abdomen shows",
"3",
"... |
A 40-year-old male presents to the physician's office complaining of an inability to push doors open. He has had this problem since he was playing football with his children and was tackled underneath his right arm on his lateral chest. On examination, he has a winged scapula on the right side. Which of the following n... | Long thoracic nerve | {
"A": "Musculocutaneous nerve",
"B": "Long thoracic nerve",
"C": "Spinal accessory nerve",
"D": "Phrenic nerve"
} | step1 | B | [
"40 year old male presents",
"physician's office",
"push doors open",
"problem",
"playing football",
"children",
"right arm",
"lateral chest",
"examination",
"winged scapula",
"right side",
"following nerves",
"most likely",
"cause",
"presentation"
] |
A previously healthy 52-year-old man comes to the physician because of a 4-month history of recurrent abdominal pain, foul-smelling, greasy stools, and a 5-kg (11-lb) weight loss despite no change in appetite. Physical examination shows pain on palpation of the right upper quadrant. His fasting serum glucose concentrat... | Somatostatin | {
"A": "Somatostatin",
"B": "Glucagon",
"C": "Serotonin",
"D": "Insulin"
} | step1 | A | [
"healthy",
"year old man",
"physician",
"4 month history",
"recurrent abdominal pain",
"smelling",
"greasy stools",
"5 kg",
"weight loss",
"change",
"appetite",
"Physical examination shows pain",
"palpation",
"right upper quadrant",
"fasting serum",
"mg/dL",
"Abdominal ultrasound sho... |
A 59-year-old man comes to the physician for a follow-up examination after being diagnosed with localized prostate cancer 3 weeks ago. The physician is delayed because of an emergency with another patient; miscommunication between the physician and his staff created further delays. When he enters the patient's room, th... | """I apologize for the inconvenience, and if I were you I would be frustrated and angry as well. Let's talk about your concerns.""" | {
"A": "\"\"\"I can tell that you are angry and there is no excuse for my delay. But you are not going to die of prostate cancer any time soon.\"\"\"",
"B": "\"\"\"You have a right to be frustrated, but shouting at me is not appropriate. I am afraid I will have to ask you to leave.\"\"\"",
"C": "\"\"\"Let me apol... | step1 | D | [
"59 year old man",
"physician",
"follow-up examination",
"diagnosed",
"localized prostate",
"weeks",
"physician",
"delayed",
"emergency",
"patient",
"physician",
"staff created further delays",
"enters",
"patient's room",
"patient",
"I waited 45 minutes",
"waiting room",
"on time",... |
A 43-year-old woman presents to her primary care provider for follow-up of her glucose levels. At her last visit 3 months ago, her fasting serum glucose was 128 mg/dl. At that time, she was instructed to follow a weight loss regimen consisting of diet and exercise. Her family history is notable for a myocardial infarct... | Inhibition of hepatic gluconeogenesis | {
"A": "Activation of peroxisome proliferator-activating receptors",
"B": "Closure of potassium channels in pancreatic beta cells",
"C": "Inhibition of alpha-glucosidase in the intestinal brush border",
"D": "Inhibition of hepatic gluconeogenesis"
} | step1 | D | [
"year old woman presents",
"primary care provider",
"follow-up",
"glucose levels",
"last visit",
"months",
"fasting serum glucose",
"mg/dl",
"time",
"to follow",
"weight loss regimen consisting",
"diet",
"exercise",
"family history",
"notable",
"myocardial infarction",
"father",
"t... |
A 26-year-old woman, G1P0, at 22 weeks of gestation presents to the clinic for a prenatal visit. Her recent pregnancy scan shows a single live intrauterine fetus with adequate fetal movements. Facial appearance shows the presence of a cleft lip. The rest of the fetal development is within normal limits. The fetal heart... | Respiratory difficulty | {
"A": "Respiratory difficulty",
"B": "Neural tube abnormalities",
"C": "Trisomy 13",
"D": "Ocular abnormalities"
} | step2&3 | A | [
"year old woman",
"weeks of gestation presents",
"clinic",
"prenatal visit",
"recent pregnancy scan shows",
"single live intrauterine fetus",
"adequate fetal movements",
"Facial appearance shows the presence of",
"cleft lip",
"rest",
"fetal development",
"normal limits",
"fetal heart rate",
... |
A 10-year-old boy is brought to the pediatrician by his mother for evaluation. Last night, he was playing with his younger brother and a hot cup of coffee fell on his left shoulder. Though his skin became red and swollen, he acted as if nothing happened and did not complain of pain or discomfort. He has met all expecte... | Arnold-Chiari malformation | {
"A": "Arnold-Chiari malformation",
"B": "Leprosy",
"C": "Spina bifida occulta",
"D": "Transverse myelitis"
} | step2&3 | A | [
"A 10 year old boy",
"brought",
"pediatrician",
"mother",
"evaluation",
"night",
"playing",
"younger brother",
"hot cup",
"coffee fell",
"left shoulder",
"skin",
"red",
"swollen",
"acted",
"happened",
"not",
"pain",
"discomfort",
"met",
"expected developmental milestones",
... |
A 61-year-old woman comes to the physician because of a constant, dull headache and generalized body pains for the past 8 months. She has also had difficulty hearing from her left side, which started a month after the onset of the headaches. Five months ago, she had surgery to correct a fracture of the right femur that... | Mixed lytic and sclerotic lesions | {
"A": "Lytic lesions with no sclerotic margin",
"B": "Mixed lytic and sclerotic lesions",
"C": "Periosteal trabeculations with radiolucent marrow hyperplasia",
"D": "Generalized dense, sclerotic bone"
} | step2&3 | B | [
"61 year old woman",
"physician",
"constant",
"dull headache",
"generalized body pains",
"past",
"months",
"difficulty hearing",
"left side",
"started",
"month",
"onset",
"headaches",
"Five months",
"surgery",
"correct",
"fracture of",
"right femur",
"occurred",
"fall",
"sign... |
A 65-year-old man comes to the physician because of a 1-month history of progressive back pain. He has also had a 5-kg (11-lb) weight loss over the past 3 months. His only medications are a daily multivitamin and ibuprofen, which he takes daily for the back pain. Physical examination shows tenderness to palpation over ... | Lomustine | {
"A": "Vemurafenib",
"B": "Etoposide",
"C": "Lomustine",
"D": "Cytarabine"
} | step1 | C | [
"65 year old man",
"physician",
"of",
"month history",
"progressive back pain",
"5 kg",
"weight loss over",
"past 3 months",
"only medications",
"daily multivitamin",
"ibuprofen",
"takes daily",
"back pain",
"Physical examination shows tenderness",
"palpation",
"lower spine",
"left i... |
Background: Beta-blockers reduce mortality in patients who have chronic heart failure, systolic dysfunction, and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors. We aimed to compare the effects of carvedilol and metoprolol on clinical outcome.
Methods: In a multicenter, double-bl... | Carvedilol demonstrated a significant improvement in all-cause mortality in patients with heart failure as compared to metoprolol. | {
"A": "There is no appreciable, statistically significant difference in overall mortality between the 2 treatment arms.",
"B": "Carvedilol demonstrated a significant improvement in all-cause mortality in patients with heart failure as compared to metoprolol.",
"C": "Metoprolol demonstrated a significant improvem... | step2&3 | B | [
"Background",
"Beta-blockers",
"mortality",
"patients",
"chronic heart failure",
"systolic dysfunction",
"background treatment",
"diuretics",
"angiotensin-converting enzyme inhibitors",
"aimed to compare",
"effects",
"carvedilol",
"metoprolol",
"clinical outcome",
"Methods",
"multicent... |
A 27-year-old man is brought into the emergency department by ambulance. The patient was at an appointment to receive welfare when he began acting abnormally. The patient was denied welfare. Shortly afterwards, he no longer responded to questions and stared blankly off into space, not responding to verbal stimuli. Othe... | Complex partial seizure | {
"A": "Complex partial seizure",
"B": "Generalized seizure",
"C": "Malingering",
"D": "Transient ischemic attack"
} | step2&3 | A | [
"27 year old man",
"brought",
"emergency department",
"ambulance",
"patient",
"appointment to receive welfare",
"began acting",
"patient",
"denied welfare",
"longer",
"questions",
"stared",
"space",
"not",
"verbal stimuli",
"odd lip-smacking behavior",
"minutes later",
"responsive"... |
An 89-year-old woman presents to clinic complaining of a cough. She reports that she has never had a cough like this before. She takes a deep breath and then coughs multiple times, sometimes so much that she vomits. When she tries to catch her breath after a coughing spell, she has difficulty. She reports the cough has... | that may prolong the QT interval | {
"A": "that may prolong the QT interval",
"B": "that may cause tooth discoloration and inhibit bone growth in children",
"C": "that is known to cause nephrotoxicity and ototoxicity",
"D": "that may cause a disulfiram like reaction when taken with alcohol"
} | step2&3 | A | [
"year old woman presents",
"clinic complaining of",
"cough",
"reports",
"never",
"cough",
"takes",
"deep breath",
"then coughs multiple times",
"sometimes",
"much",
"vomits",
"to catch",
"breath",
"coughing spell",
"difficulty",
"reports",
"cough",
"weeks",
"usually",
"fits",... |
A 27-year-old Caucasian female presents to her physician for episodes of urinary incontinence that began shortly after a breakup with her boyfriend. She claimed to be psychologically devastated when she found him sleeping with her brother and has had trouble caring for herself ever since. The patient states that the ep... | Magnetic resonance imaging (MRI) of the head | {
"A": "Magnetic resonance imaging (MRI) of the head",
"B": "Cognitive behavioral therapy (CBT) for symptoms of regression",
"C": "Urine dipstick and culture",
"D": "Psychological assessment for conversion disorder"
} | step2&3 | A | [
"27 year old Caucasian female presents",
"physician",
"episodes of urinary incontinence",
"began",
"boyfriend",
"to",
"found",
"sleeping",
"brother",
"caring",
"ever",
"patient states",
"episodes",
"occur",
"patient denies",
"burning",
"pain",
"urination",
"obtaining further hist... |
A 25-year-old man presents with an ulcer on his penis. He says that he noticed the ulcer a week ago while taking a shower and it has not improved. He denies any pain, penile discharge, rash, dysuria, fever, or pain on urination. His past medical history is nonsignificant. Sexual history reveals that the patient has had... | Treponema pallidum | {
"A": "Haemophilus ducreyi",
"B": "Klebsiella inguinale",
"C": "Treponema pallidum",
"D": "Chlamydia trachomatis "
} | step1 | C | [
"year old man presents",
"ulcer",
"penis",
"ulcer",
"week",
"taking",
"shower",
"not improved",
"denies",
"pain",
"penile discharge",
"rash",
"dysuria",
"fever",
"pain",
"urination",
"past medical history",
"Sexual history reveals",
"patient",
"male partners",
"past year",
... |
A 56-year-old man presents to his physician’s office with a sudden increase in urinary frequency. During the past month, he has observed that he needs more frequent bathroom breaks. This is quite unusual as he hasn’t been consuming extra fluids. He reports feeling generally unwell over the past 2 months. He has lost ov... | Kulchitsky cells with hyperchromatic nuclei | {
"A": "Glandular cells, positive for mucin",
"B": "Squamous cells with keratin pearls",
"C": "Pleomorphic giant cells",
"D": "Kulchitsky cells with hyperchromatic nuclei"
} | step2&3 | D | [
"year old man presents",
"physicians office",
"sudden increase",
"urinary frequency",
"past month",
"observed",
"needs more frequent bathroom breaks",
"unusual",
"hasnt",
"extra fluids",
"reports feeling generally unwell",
"past",
"months",
"lost",
"kg",
"15.4",
"weight",
"feeling"... |
A 31-year-old man presents to his primary care physician endorsing three months of decreased sleep. He reports an inability to fall asleep; although once asleep, he generally sleeps through the night and wakes up at a desired time. He has instituted sleep hygiene measures, but this has not helped. He has not felt anxio... | Raphe nucleus | {
"A": "Substantia nigra",
"B": "Raphe nucleus",
"C": "Locus ceruleus",
"D": "Posterior pituitary"
} | step1 | B | [
"31 year old man presents",
"primary care physician",
"three months",
"decreased sleep",
"reports",
"to fall asleep",
"asleep",
"sleeps",
"night",
"wakes up",
"desired time",
"instituted sleep hygiene measures",
"not helped",
"not felt anxious",
"depressed",
"healthy",
"medication",
... |
A mother brings her 3-year-old son to his pediatrician because he is having tantrums. The boy has no history of serious illness and is on track with developmental milestones. His mother recently returned to work 2 weeks ago. She explains that, since then, her son has had a tantrum roughly every other morning, usually w... | Normal development | {
"A": "Autism spectrum disorder",
"B": "Conduct disorder",
"C": "Normal development",
"D": "Disruptive mood dysregulation disorder"
} | step2&3 | C | [
"mother",
"year old son",
"pediatrician",
"tantrums",
"boy",
"history",
"serious illness",
"track",
"developmental milestones",
"mother recently returned to work 2 weeks",
"then",
"son",
"tantrum",
"morning",
"usually",
"getting",
"dressed",
"dropping",
"daycare",
"cries",
"5... |
A 35-year-old woman comes to the physician because of a 3-month history of progressive fatigue, shortness of breath, and pain in her knees and ankles. Her temperature is 37.6°C (99.7°F). Physical examination shows mild hepatomegaly and tender, red nodules on her shins. There are purple, indurated lesions on her nose, n... | Sarcoidosis | {
"A": "Sarcoidosis",
"B": "Systemic lupus erythematosus",
"C": "Hemochromatosis",
"D": "Serum sickness"
} | step1 | A | [
"35 year old woman",
"physician",
"3 month history",
"progressive fatigue",
"shortness of breath",
"pain in",
"knees",
"ankles",
"temperature",
"99",
"Physical examination shows mild hepatomegaly",
"tender",
"red nodules",
"shins",
"purple",
"indurated lesions",
"nose",
"nasolabial... |
A 63-year-old man presents to the ambulatory medical clinic with symptoms of dysphagia and ‘heartburn’, which he states have become more troublesome over the past year. Past medical history is significant for primary hypertension. On physical exam, he is somewhat tender to palpation over his upper abdomen. The vital si... | Surgical gastropexy | {
"A": "Lifestyle modification",
"B": "Antacid therapy",
"C": "Cimetidine",
"D": "Surgical gastropexy"
} | step2&3 | D | [
"63 year old man presents",
"ambulatory medical clinic",
"symptoms",
"dysphagia",
"heartburn",
"states",
"more",
"past year",
"Past medical history",
"significant",
"primary hypertension",
"physical exam",
"somewhat tender",
"palpation",
"upper abdomen",
"vital signs include",
"tempe... |
A 71-year-old man presents to his cardiologist with a 1-month history of increasing shortness of breath. He says that he is finding it very difficult to walk up the flight of stairs to his bedroom and he is no longer able to sleep flat on his bed because he wakes up choking for breath. His past medical history is signi... | Inhibits release of renin | {
"A": "Binds to intracellular receptors in the collecting duct",
"B": "Increases water reabsorption in the kidney",
"C": "Inhibits release of renin",
"D": "Stimulates parasympathetic nerves"
} | step1 | C | [
"71 year old man presents",
"cardiologist",
"month history of increasing shortness",
"breath",
"finding",
"very difficult",
"walk",
"flight",
"stairs",
"bedroom",
"longer able to sleep flat",
"bed",
"wakes up choking",
"breath",
"past medical history",
"significant",
"myocardial infa... |
A 50-year-old farmer presents to a physician with painless, black, severely swollen pustules on the left hand. Examination reveals extensive swelling around the wound. Microscopy reveals gram-positive bacilli with a bamboo stick appearance. Culture shows large, gray, non-hemolytic colonies with irregular borders. Which... | Anthrax | {
"A": "Brucellosis",
"B": "Listeriosis",
"C": "Tularemia",
"D": "Anthrax"
} | step1 | D | [
"50 year old farmer presents",
"physician",
"painless",
"black",
"severely swollen pustules",
"left",
"Examination reveals extensive swelling",
"wound",
"Microscopy reveals gram-positive bacilli",
"bamboo stick appearance",
"Culture shows large",
"gray",
"non-hemolytic colonies",
"irregula... |
A 64-year-old woman comes to the physician because of a 4-month history of vulvar itching and dryness. During this period, she has also had pain during sexual intercourse but no postcoital bleeding. Her last menstrual period was at the age of 51 years. She has type 2 diabetes mellitus and her only medication is metform... | Topical clobetasol | {
"A": "Topical clobetasol",
"B": "Topical progesterone",
"C": "Topical estrogen",
"D": "Phototherapy"
} | step2&3 | A | [
"64 year old woman",
"physician",
"of",
"4 month history",
"vulvar itching",
"dryness",
"period",
"pain",
"sexual intercourse",
"postcoital bleeding",
"last menstrual period",
"age",
"years",
"type 2 diabetes mellitus",
"only medication",
"metformin",
"Pelvic examination shows atroph... |
A male newborn delivered at 32 weeks' gestation to a 41-year-old woman dies shortly after birth. The mother did not receive prenatal care and consistently consumed alcohol during her pregnancy. At autopsy, examination shows microcephaly, an eye in the midline, a cleft lip, and a single basal ganglion. Failure of which ... | Cleavage of the forebrain | {
"A": "Closure of the rostral neuropore",
"B": "Formation of the 1st branchial arch",
"C": "Development of the metencephalon",
"D": "Cleavage of the forebrain"
} | step1 | D | [
"male newborn delivered",
"weeks",
"gestation",
"year old woman",
"birth",
"mother",
"not receive prenatal care",
"alcohol",
"pregnancy",
"autopsy",
"examination shows microcephaly",
"eye",
"midline",
"cleft lip",
"single basal ganglion",
"Failure",
"following processes",
"most lik... |
In 2013 the national mean score on the USMLE Step 1 exam was 227 with a standard deviation of 22. Assuming that the scores for 15,000 people follow a normal distribution, approximately how many students scored above the mean but below 250? | 5,100 | {
"A": "3,750",
"B": "4,500",
"C": "5,100",
"D": "6,750"
} | step1 | C | [
"national mean score",
"Step 1 exam",
"standard deviation",
"scores",
"15",
"people follow",
"normal distribution",
"approximately",
"students scored",
"mean"
] |
A 53-year-old man with a past medical history significant for hyperlipidemia, hypertension, and hyperhomocysteinemia presents to the emergency department complaining of 10/10 crushing, left-sided chest pain radiating down his left arm and up his neck into the left side of his jaw. His ECG shows ST-segment elevation in ... | Myocardial stunning | {
"A": "Ventricular remodeling",
"B": "Myocardial hibernation",
"C": "Myocardial stunning",
"D": "Coronary collateral circulation"
} | step1 | C | [
"year old man",
"past medical history significant",
"hyperlipidemia",
"hypertension",
"hyperhomocysteinemia presents",
"emergency department",
"10",
"crushing",
"left-sided chest pain radiating",
"arm",
"neck",
"left side of",
"jaw",
"ECG shows ST-segment elevation",
"leads V2 V4",
"ta... |
A 64-year-old man is brought to the emergency department because of fever, chills, shortness of breath, chest pain, and a productive cough with bloody sputum for the past several days. He has metastatic pancreatic cancer and is currently undergoing polychemotherapy. His temperature is 38.3°C (101°F). Pulmonary examinat... | Aspergillus fumigatus | {
"A": "Mycobacterium tuberculosis",
"B": "Aspergillus fumigatus",
"C": "Pneumocystis jirovecii",
"D": "Rhizopus oryzae"
} | step1 | B | [
"64 year old man",
"brought",
"emergency department",
"fever",
"chills",
"shortness of breath",
"chest pain",
"productive cough",
"bloody sputum",
"past",
"days",
"metastatic pancreatic cancer",
"currently",
"polychemotherapy",
"temperature",
"3C",
"Pulmonary examination shows scatte... |
A 10-month-old girl is brought to the physician by her mother because of fever and irritability for the past 2 days. The mother says that the girl's diapers have smelled bad since the symptoms started. The patient has had some clear nasal secretions over the past week. Two months ago, she was brought to the emergency d... | Perform renal and bladder ultrasound | {
"A": "Obtain CT scan of the abdomen",
"B": "Perform renal and bladder ultrasound",
"C": "Perform an intravenous pyelogram (IVP)",
"D": "Start prophylaxis with trimethoprim-sulfamethoxazole"
} | step2&3 | B | [
"A 10 month old girl",
"brought",
"physician",
"mother",
"fever",
"irritability",
"past 2 days",
"mother",
"girl",
"iapers ",
"melled ad ",
"ymptoms tarted.",
"atient ",
"lear asal secretions ",
"ast week.",
"wo onths ",
"rought ",
"mergency department ",
"imple febrile seizu... |
A 33-year-old woman presents to the physician because of abdominal discomfort, weakness, and fever. She has had a significant weight loss of 15 kg (33.1 lb) over the past 2 months. She has no history of medical illness and is not on any medications. Her pulse is 96/min, the blood pressure is 167/92 mm Hg, the respirato... | Impaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and low plasma ACTH | {
"A": "Normal glucose tolerance, elevated serum cortisol, normal 24-h urinary free cortisol, and normal plasma adrenocorticotropic hormone (ACTH)",
"B": "Impaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and high plasma ACTH",
"C": "Impaired glucose tolerance, elevated ser... | step2&3 | C | [
"year old woman presents",
"physician",
"abdominal discomfort",
"weakness",
"fever",
"significant weight loss of",
"kg",
"past",
"months",
"history of medical illness",
"not",
"medications",
"pulse",
"96 min",
"blood pressure",
"mm Hg",
"respiratory rate",
"20 min",
"temperature"... |
A 52-year-old man presents to the office for a regular health checkup. He was diagnosed with type 2 diabetes mellitus 6 years ago and has been taking metformin alone. Over the past year, his daily blood glucose measurements have gradually been increasing. During his previous visit, his HbA1c level was 7.9% and the doct... | Increasing sample size | {
"A": "Decreasing post-market surveillance time",
"B": "Increasing sample size",
"C": "Non-randomization",
"D": "Increasing selection bias"
} | step1 | B | [
"year old man presents",
"office",
"regular health checkup",
"diagnosed",
"type 2 diabetes mellitus",
"years",
"taking metformin alone",
"past year",
"daily blood glucose measurements",
"increasing",
"previous visit",
"level",
"doctor",
"possibility",
"additional medication to keep",
"... |
A 5-year-old girl is brought in for a routine checkup. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. Upon examination, she is pale with a few petechiae on her chest neck and back. Examination of the abdomen reveals pain... | Gaucher disease type I | {
"A": "Viral hepatitis",
"B": "Biliary obstruction",
"C": "Autoimmune disorder",
"D": "Gaucher disease type I"
} | step1 | D | [
"5 year old girl",
"brought",
"routine checkup",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"examination",
"pale",
"petechiae",
"chest neck",
"back",
"Examination",
"abdomen reveals painless hepatosplenomegaly... |
A 15-year-old boy presents to the emergency department after a rusty nail pierced through his right foot. He was able to pull out the nail, but not able to walk on his foot. He believes he had all his shots as a child, with the last one just before starting middle school at the age of 12. The vital signs are within nor... | Administer Td and TIG | {
"A": "Clean and dress the wound only",
"B": "Administer Tdap, Td, and TIG (tetanus immune globulin)",
"C": "Administer Td only",
"D": "Administer Td and TIG"
} | step2&3 | D | [
"year old boy presents",
"emergency department",
"rusty nail pierced",
"right foot",
"able to pull out",
"nail",
"not able to walk",
"foot",
"shots",
"child",
"last one",
"before starting middle",
"age",
"vital signs",
"normal",
"Physical examination reveals",
"0.5 inch puncture woun... |
An 11-year-old boy presents to the emergency department with sudden pain. The patient's parents state the child suddenly felt pain in his hands an hour ago. He has not eaten anything new lately. He did play football earlier this morning and admits to being tackled forcefully multiple times. The child is doing well in s... | Altered red blood cell morphology | {
"A": "Altered red blood cell morphology",
"B": "Benign edema secondary to trauma",
"C": "Sexually transmitted infection",
"D": "Viral infection"
} | step2&3 | A | [
"year old boy presents",
"emergency department",
"sudden pain",
"patient's parents state",
"child",
"felt",
"hands",
"hour",
"not eaten",
"new",
"play football earlier",
"morning",
"admits",
"multiple times",
"child",
"well",
"school",
"proud",
"new girlfriend",
"child",
"pas... |
An 8-year-old boy is brought to the physician because of worsening confusion and lethargy for the last hour. He has had high-grade fever, productive cough, fatigue, and malaise for 2 days. He was diagnosed with sickle cell anemia at the age of 2 years but has not seen a physician in over a year. His temperature is 38.9... | Polysaccharide vaccination | {
"A": "Chronic transfusion therapy",
"B": "Polysaccharide vaccination",
"C": "Folic acid",
"D": "Low molecular weight heparin"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"worsening confusion",
"lethargy",
"hour",
"high-grade fever",
"productive cough",
"fatigue",
"malaise",
"2 days",
"diagnosed",
"sickle cell anemia",
"age",
"years",
"not seen",
"physician",
"year",
"temperature",
"pulse",
"min",
"res... |
A 4-month-old boy is brought by his mother to the pediatrician for a routine check-up. He was born at 39 weeks’ gestation. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The child has been breastfeeding well and sleeping through the night. He smiles spontaneously and has started to babble. He is up to date... | 6 | {
"A": "5",
"B": "6",
"C": "7",
"D": "16"
} | step1 | B | [
"4 month old boy",
"brought",
"mother",
"pediatrician",
"routine check-up",
"born",
"weeks gestation",
"Apgar scores",
"5 minutes",
"child",
"breastfeeding well",
"sleeping",
"night",
"smiles",
"started",
"babble",
"date",
"vaccinations",
"temperature",
"98",
"blood pressure"... |
A 50-year-old man visits his primary care practitioner for a general health check-up. He was recently hired as a fitness instructor at a local fitness center. His father died of advanced colorectal cancer, however, his personal medical history is significant for the use of performance-enhancing drugs during his 20’s wh... | Endoscopy and colonoscopy | {
"A": "Endoscopy only",
"B": "Colonoscopy only",
"C": "Endoscopy and colonoscopy",
"D": "Transfusion"
} | step2&3 | C | [
"50 year old man visits",
"primary care practitioner",
"general health check-up",
"recently hired",
"fitness instructor",
"local fitness",
"father died",
"advanced colorectal",
"personal medical history",
"significant",
"use of performance-enhancing drugs",
"20s",
"bodybuilding",
"competit... |
A 14-year-old girl is brought to the pediatrician by her mother. The girl's mother states that she began having her period 6 months ago. The patient states that after her first period she has had a period every 10 to 40 days. Her menses have ranged from very light flow to intense and severe symptoms. Otherwise, the pat... | Normal development | {
"A": "Normal development",
"B": "Polycystic ovarian syndrome",
"C": "Pregnancy",
"D": "Premenstrual dysphoric disorder"
} | step2&3 | A | [
"year old girl",
"brought",
"pediatrician",
"mother",
"girl's mother states",
"began",
"period",
"months",
"patient states",
"first period",
"period",
"10",
"40 days",
"menses",
"ranged",
"very light flow",
"intense",
"severe symptoms",
"patient",
"well",
"school",
"track t... |
A 79-year-old man is admitted to the intensive care unit for hospital acquired pneumonia, a COPD flare, and acute heart failure requiring intubation and mechanical ventilation. On his first night in the intensive care unit, his temperature is 99.7°F (37.6°C), blood pressure is 107/58 mm Hg, and pulse is 150/min which i... | Needle thoracostomy | {
"A": "FAST exam",
"B": "Needle thoracostomy",
"C": "Thoracotomy",
"D": "Tube thoracostomy"
} | step2&3 | B | [
"year old man",
"admitted to",
"intensive care unit",
"hospital acquired pneumonia",
"COPD flare",
"acute heart failure",
"intubation",
"mechanical ventilation",
"first night",
"intensive care unit",
"temperature",
"99",
"blood pressure",
"58 mm Hg",
"pulse",
"min",
"sudden change",
... |
A 67-year-old woman is admitted to the hospital because of a 2-day history of fever, headache, jaw pain, and decreased vision in the right eye. Her erythrocyte sedimentation rate is 84 mm per hour. Treatment with methylprednisolone is initiated but her symptoms do not improve. The physician recommends the administratio... | Interleukin-6 | {
"A": "Thromboxane A2",
"B": "Leukotriene D4",
"C": "Interleukin-6",
"D": "Interleukin-4"
} | step1 | C | [
"67 year old woman",
"admitted",
"hospital",
"2-day history",
"fever",
"headache",
"jaw pain",
"decreased vision",
"right eye",
"erythrocyte sedimentation rate",
"84 mm",
"hour",
"Treatment",
"methylprednisolone",
"initiated",
"symptoms",
"not",
"physician recommends",
"administr... |
A 65-year-old man comes to the physician for a routine health maintenance examination. He has a strong family history of colon cancer. A screening colonoscopy shows a 4 mm polyp in the upper sigmoid colon. Which of the following findings on biopsy is associated with the lowest potential for malignant transformation int... | Hyperplastic epithelium at the base of crypts | {
"A": "Tree-like branching of muscularis mucosa",
"B": "Regenerating epithelium with inflammatory infiltrate",
"C": "Finger-like projections with a fibrovascular core",
"D": "Hyperplastic epithelium at the base of crypts"
} | step1 | D | [
"65 year old man",
"physician",
"routine health maintenance examination",
"strong family history of colon cancer",
"screening colonoscopy shows",
"4 mm polyp in",
"upper sigmoid colon",
"following findings",
"biopsy",
"associated with",
"lowest potential",
"malignant transformation",
"colore... |
A 45-year-old man comes to the physician because of a 3-month history of recurrent headaches. The headaches are of a dull, nonpulsating quality. The patient denies nausea, vomiting, photophobia, or phonophobia. Neurologic examination shows no abnormalities. The physician prescribes a drug that irreversibly inhibits cyc... | Aspirin | {
"A": "Indomethacin",
"B": "Aspirin",
"C": "Celecoxib",
"D": "Carbamazepine"
} | step1 | B | [
"year old man",
"physician",
"of",
"3 month history",
"recurrent headaches",
"headaches",
"dull",
"quality",
"patient denies nausea",
"vomiting",
"photophobia",
"phonophobia",
"Neurologic examination shows",
"abnormalities",
"physician",
"drug",
"inhibits cyclooxygenase-1",
"cycloo... |
A 48-year-old Caucasian male suffering from ischemic heart disease is placed on a heart transplant list. Months later, he receives a heart from a matched donor. During an endomyocardial biopsy performed 3 weeks later, there is damage consistent with acute graft rejection. What is most likely evident on the endomyocardi... | Lymphocytic infiltrate | {
"A": "Granuloma",
"B": "Tissue necrosis",
"C": "Fibrosis",
"D": "Lymphocytic infiltrate"
} | step1 | D | [
"48 year old Caucasian male suffering",
"ischemic heart disease",
"placed",
"heart transplant list",
"Months later",
"receives",
"heart",
"matched donor",
"endomyocardial biopsy performed 3 weeks later",
"damage consistent with acute graft",
"most likely evident",
"endomyocardial biopsy"
] |
A 58-year-old woman is brought to the emergency department because of a 2-day history of increasing chest pain and shortness of breath. She has had a productive cough with foul-smelling sputum for 1 week. Seven months ago, the patient had an ischemic stroke. She has gastritis and untreated hypertension. She currently l... | A history of ischemic stroke | {
"A": "Living in an assisted-living community",
"B": "Past history of alcohol abuse",
"C": "A history of ischemic stroke",
"D": "Gastritis"
} | step2&3 | C | [
"58 year old woman",
"brought",
"emergency department",
"of",
"2-day history",
"increasing chest pain",
"shortness of breath",
"productive cough",
"foul-smelling sputum",
"1 week",
"Seven months",
"patient",
"ischemic stroke",
"gastritis",
"untreated hypertension",
"currently lives in"... |
A 36-year-old primigravid woman at 34 weeks' gestation comes to the physician because of a 1-week history of upper abdominal discomfort, nausea, and malaise. She had a mild upper respiratory tract infection a week ago. She has a 10-year history of polycystic ovarian syndrome and a 3-year history of hypertension. Her me... | Serum transaminase levels and platelet count | {
"A": "Serum bile acid levels",
"B": "Stool antigen assay for H. pylori",
"C": "Reassurance and follow-up",
"D": "Serum transaminase levels and platelet count"
} | step2&3 | D | [
"36 year old primigravid woman",
"weeks",
"gestation",
"physician",
"1-week history",
"upper abdominal discomfort",
"nausea",
"malaise",
"mild upper respiratory tract infection",
"week",
"a 10 year history",
"polycystic ovarian syndrome",
"3 year history of hypertension",
"medications incl... |
A 72-year-old woman presents to the emergency department for vision loss. She was reading a magazine this afternoon when she started having trouble seeing out of her left eye. Her vision in that eye got progressively darker, eventually becoming completely black over the course of a few minutes. It then returned to norm... | Carotid artery | {
"A": "Carotid artery",
"B": "Left atrium",
"C": "Temporal artery",
"D": "Vertebral artery"
} | step2&3 | A | [
"72 year old woman presents",
"emergency department",
"vision loss",
"reading",
"magazine",
"afternoon",
"started",
"seeing out",
"left",
"vision",
"eye",
"darker",
"completely black",
"course",
"minutes",
"then returned",
"normal",
"about 10 minutes",
"reports",
"see",
"now"... |
A 67-year-old man presents with pain in both legs. He says the pain is intermittent in nature and has been present for approx. 6 months. The pain increases with walking, especially downhill, and prolonged standing. It is relieved by lying down and leaning forward. Past medical history is significant for type 2 diabetes... | MRI of the spine | {
"A": "Ankle-brachial index",
"B": "Cilostazol",
"C": "CT angiography of the lower extremities",
"D": "MRI of the spine"
} | step2&3 | D | [
"67 year old man presents",
"pain",
"legs",
"pain",
"intermittent",
"nature",
"present",
"months",
"pain increases",
"walking",
"prolonged standing",
"relieved by lying",
"forward",
"Past medical history",
"significant",
"type 2 diabetes mellitus",
"hypercholesterolemia",
"osteoart... |
A 28-year-old woman presents to a psychiatrist with a 10-year history of unexplained anxiety symptoms. To date, she has not visited any psychiatrist, because she believes that she should not take medicines to change her emotions or thoughts. However, after explaining the nature of her disorder, the psychiatrist prescri... | Daily consumption of grapefruit juice | {
"A": "Daily consumption of tomatoes",
"B": "Daily consumption of charcoal-broiled foods",
"C": "Daily consumption of St. John's wort",
"D": "Daily consumption of grapefruit juice"
} | step1 | D | [
"year old woman presents",
"psychiatrist",
"a 10 year history",
"unexplained anxiety",
"date",
"not visited",
"psychiatrist",
"not take medicines to change",
"emotions",
"thoughts",
"nature of",
"disorder",
"psychiatrist",
"daily alprazolam",
"first follow-up",
"reports excellent relie... |
A 13-year-old boy is brought to the emergency department by his parents for evaluation of severe groin pain for the past 4 hours. His symptoms began while he was participating in a basketball game. On arrival to the ED, the resident on call notes a swollen, tender, and elevated left testicle with absence of the cremast... | Tunica vaginalis | {
"A": "Tunica albuginea",
"B": "Cremasteric muscle",
"C": "Tunica dartos",
"D": "Tunica vaginalis"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"parents",
"evaluation",
"severe groin",
"past",
"hours",
"symptoms began",
"participating",
"basketball game",
"arrival",
"ED",
"resident",
"call notes",
"swollen",
"tender",
"elevated left testicle",
"absence of",
"cremasteri... |
A 39-year-old male presents to the emergency department with fever, jaundice, and abdominal pain. The patient is a known intravenous drug-user. Serologic testing reveals an ALT of 1040 units/L, AST of 810 units/L, and titer evidence of infection with an enveloped, negative sense, single-stranded, closed circular RNA vi... | Hepatitis B virus | {
"A": "Hepatitis A virus",
"B": "Hepatitis B virus",
"C": "Hepatitis C virus",
"D": "Hepatitis D virus"
} | step1 | B | [
"year old male presents",
"emergency department",
"fever",
"jaundice",
"abdominal pain",
"patient",
"known intravenous drug-user",
"Serologic testing reveals",
"ALT",
"units/L",
"AST",
"units/L",
"titer evidence",
"infection",
"negative sense",
"single-stranded",
"closed circular",
... |
A 5-day-old boy is brought to see his pediatrician after his newborn blood screening showed elevated levels of immunoreactive trypsinogen, a marker for cystic fibrosis. The boy was born at 39 weeks gestation after regular prenatal care. He has 2 siblings that tested negative on screening. On physical exam, his vitals a... | Sweat test | {
"A": "Sweat test",
"B": "Mutation analysis",
"C": "Measurement of fecal elastase levels",
"D": "Nasal potential difference"
} | step2&3 | A | [
"5 day old boy",
"brought to see",
"pediatrician",
"newborn blood showed elevated levels",
"trypsinogen",
"marker",
"cystic fibrosis",
"boy",
"born",
"weeks gestation",
"regular prenatal care",
"has",
"siblings",
"tested negative",
"screening",
"physical exam",
"normal",
"appears h... |
A 5-year-old girl is brought to the emergency department by her father due to a 6-day history of fevers and irritability. His father reports that the fevers have ranged from 101-104°F (38.3-40°C). He tried to give her ibuprofen, but the fevers have been unresponsive. Additionally, she developed a rash 3 days ago and ha... | High dose aspirin | {
"A": "High dose aspirin",
"B": "Nafcillin",
"C": "Penicillin V",
"D": "Vitamin A"
} | step2&3 | A | [
"5 year old girl",
"brought",
"emergency department",
"father due to",
"6-day history",
"fevers",
"irritability",
"father reports",
"fevers",
"ranged",
"to give",
"ibuprofen",
"fevers",
"unresponsive",
"rash",
"days",
"refused to",
"shoes",
"feel tight",
"father reports",
"ot... |
A 15-year-old man presents with his father to the urgent care department with a 5-day history of frequent diarrhea, occasionally mixed with streaks of blood. Stool cultures are pending, but preliminary stool samples demonstrate fecal leukocytes and erythrocytes. The patient's vital signs are within normal limits, and h... | Oral trimethoprim-sulfamethoxazole (TMP-SMX) | {
"A": "Oral erythromycin",
"B": "Oral metronidazole",
"C": "An oral quinolone",
"D": "Oral trimethoprim-sulfamethoxazole (TMP-SMX)"
} | step2&3 | D | [
"year old man presents",
"father",
"urgent care department",
"5-day history of frequent diarrhea",
"occasionally mixed",
"streaks of blood",
"Stool cultures",
"preliminary stool samples",
"fecal leukocytes",
"erythrocytes",
"patient's vital signs",
"normal limits",
"started",
"outpatient t... |
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