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 7-year-old boy with asthma is brought to the emergency department because of a 1-day history of shortness of breath and cough. Current medications are inhaled albuterol and beclomethasone. His temperature is 37°C (98.6°F) and respirations are 24/min. Pulmonary examination shows bilateral expiratory wheezing. Serum st... | Recruitment of eosinophils | {
"A": "Recruitment of eosinophils",
"B": "Differentiation of bone marrow stem cells",
"C": "Secretion of acute phase reactants",
"D": "Suppression of MHC class II expression"
} | step1 | A | [
"year old boy",
"asthma",
"brought",
"emergency department",
"of",
"1-day history",
"shortness",
"breath",
"cough",
"Current medications",
"inhaled albuterol",
"beclomethasone",
"temperature",
"98",
"respirations",
"min",
"Pulmonary examination shows bilateral expiratory wheezing",
... |
Two days after admission for myocardial infarction and subsequent coronary angioplasty, a 65-year-old man becomes distressed and diaphoretic in the cardiac intensive care unit. Suddenly he is no longer responsive. Pulse oximetry does not show a tracing. He has a history of hypertension and depression. Prior to his admi... | Defibrillation | {
"A": "Defibrillation",
"B": "Intravenous magnesium sulfate",
"C": "Cardiac catheterization",
"D": "Intravenous amiodarone"
} | step2&3 | A | [
"Two days",
"admission",
"myocardial infarction",
"subsequent coronary angioplasty",
"65 year old man",
"distressed",
"diaphoretic",
"cardiac intensive care unit",
"longer responsive",
"Pulse oximetry",
"not show",
"history of hypertension",
"depression",
"admission",
"medication include... |
A 17-year-old girl comes to the physician because she had unprotected sexual intercourse the previous day. Menses have occurred at regular 28-day intervals since menarche at the age of 13 years. Her last menstrual period was 12 days ago. Physical examination shows no abnormalities. A urine pregnancy test is negative. S... | Insert copper-containing intra-uterine device
" | {
"A": "Administer ulipristal acetate",
"B": "Insert progestin-containing intra-uterine device",
"C": "Administer combined oral contraceptive",
"D": "Insert copper-containing intra-uterine device\n\""
} | step2&3 | D | [
"year old girl",
"physician",
"unprotected sexual intercourse",
"previous day",
"Menses",
"occurred",
"regular",
"day intervals",
"menarche at",
"age",
"years",
"last menstrual period",
"days",
"Physical examination shows",
"abnormalities",
"urine pregnancy test",
"negative",
"not ... |
A 23-year-old Sicilian male presents to his primary care physician complaining of lethargy, joint pain, and urinary frequency. Vitals signs include T 98.7 F, HR 96 bpm, BP 135/71 mm/Hg, RR 18 breaths/minute, O2 99%. Laboratory findings include: random glucose 326 mg/dL, Hemoglobin 7.1, and elevated reticulocyte count a... | Absence of the hemoglobin beta-chain | {
"A": "Absence of the hemoglobin alpha-chain",
"B": "Absence of the hemoglobin beta-chain",
"C": "Presence of the fetal hemoglobin",
"D": "Mutation resulting in increased iron absorption"
} | step1 | B | [
"23 year old",
"male presents",
"primary care physician",
"lethargy",
"joint pain",
"urinary frequency",
"signs include T 98",
"F",
"96",
"BP",
"71 mm/Hg",
"RR",
"breaths/minute",
"O2 99",
"Laboratory findings include",
"random glucose",
"mg/dL",
"Hemoglobin",
"elevated reticuloc... |
A 55-year-old man who recently immigrated to the United States from Azerbaijan comes to the physician because of a 6-week history of recurrent fever, progressive cough with bloody streaks, fatigue, and a 3.6-kg (8-lb) weight loss. He has poorly-controlled type 2 diabetes mellitus treated with insulin. An x-ray of the c... | Decreased production of catalase-peroxidase | {
"A": "Increased production of arabinosyl transferase",
"B": "Impaired conversion to pyrazinoic acid",
"C": "Mutation in genes encoding RNA polymerase",
"D": "Decreased production of catalase-peroxidase"
} | step1 | D | [
"55 year old man",
"recently",
"United States",
"Azerbaijan",
"physician",
"week history",
"recurrent fever",
"progressive cough",
"bloody streaks",
"fatigue",
"3.6 kg",
"weight loss",
"poorly-controlled type 2 diabetes mellitus treated with insulin",
"x-ray of",
"chest shows",
"lesion... |
A 62-year-old man comes to the physician because of tremors in both hands for the past few months. He has had difficulty buttoning his shirts and holding a cup of coffee without spilling its content. He has noticed that his symptoms improve after a glass of whiskey. His maternal uncle began to develop similar symptoms ... | Primidone | {
"A": "Alprazolam",
"B": "Levodopa",
"C": "Primidone",
"D": "Propranolol"
} | step1 | C | [
"62 year old man",
"physician",
"of tremors",
"hands",
"past",
"months",
"difficulty buttoning",
"shirts",
"cup",
"coffee",
"spilling",
"content",
"symptoms",
"glass",
"whiskey",
"maternal uncle began to",
"similar symptoms",
"same age",
"bronchial asthma controlled",
"albutero... |
A 34-year-old woman, who had her first child 2 weeks ago, visits her family physician with concerns about constant fatigue and difficulty with breastfeeding. She was discharged from the intensive care unit after hospitalization for severe postpartum hemorrhage. Since then, she has tried multiple pumps and self-stimulat... | Pituitary infarction | {
"A": "Pituitary infarction",
"B": "Pituitary stalk epithelial tumor",
"C": "Pituitary hemorrhage",
"D": "Pituitary infiltration by histiocytes"
} | step1 | A | [
"year old woman",
"first child 2 weeks",
"visits",
"family physician",
"concerns",
"constant fatigue",
"difficulty",
"breastfeeding",
"discharged",
"intensive care unit",
"hospitalization",
"severe postpartum",
"then",
"multiple pumps",
"self-stimulation to",
"breast milk production",
... |
A 54-year-old man is brought to the emergency department by his wife because of high fever and confusion for the past 10 hours. His wife reports that 1 week ago during a trip to Guatemala he underwent an emergency appendectomy. His temperature is 40.1°C (104.2°F), pulse is 132/min, and blood pressure is 74/46 mm Hg. He... | Respiratory fatigue | {
"A": "Primary adrenal insufficiency",
"B": "Salicylate toxicity",
"C": "Respiratory fatigue",
"D": "Diabetic ketoacidosis"
} | step1 | C | [
"54 year old man",
"brought",
"emergency department",
"wife",
"high fever",
"confusion",
"past 10 hours",
"wife reports",
"1",
"trip",
"Guatemala",
"emergency appendectomy",
"temperature",
"40",
"pulse",
"min",
"blood pressure",
"74",
"mm Hg",
"oriented only",
"person",
"Ph... |
A 24-year-old college student presents to student health with 2 days of developing a sore throat, runny nose, and a cough that started today. He states that he has been getting mild fevers which began yesterday. On exam, his temperature is 102.0°F (38.9°C), blood pressure is 135/76 mmHg, pulse is 95/min, and respiratio... | Enveloped (+) ssRNA virus | {
"A": "Nonsegmented, enveloped (-) ssRNA virus",
"B": "Enveloped (+) ssRNA virus",
"C": "Nonenveloped dsRNA virus",
"D": "Nonenveloped dsDNA virus"
} | step1 | B | [
"year old college student presents",
"student health",
"2 days",
"sore throat",
"runny nose",
"cough",
"started today",
"states",
"getting mild fevers",
"began",
"exam",
"temperature",
"blood pressure",
"76 mmHg",
"pulse",
"95 min",
"respirations",
"min",
"physician recommends ov... |
During an evaluation of a new diagnostic imaging modality for detecting salivary gland tumors, 90 patients tested positive out of the 100 patients who tested positive with the gold standard test. A total of 80 individuals tested negative with the new test out of the 100 individuals who tested negative with the gold sta... | 90/20 | {
"A": "90/110",
"B": "80/90",
"C": "90/20",
"D": "90/100"
} | step1 | C | [
"evaluation",
"new diagnostic imaging modality",
"detecting salivary gland tumors",
"90 patients tested positive out",
"100 patients",
"tested positive",
"gold standard test",
"total",
"80 individuals tested negative",
"new test",
"100 individuals",
"tested negative",
"gold standard test",
... |
A 49-year-old man is brought to the emergency department after collapsing on the ground at a grocery store 30 minutes ago. His wife states that he complained of dizziness and chest pain prior to falling down. Medical history is significant for hypertension and diabetes mellitus. His wife says that he is not compliant w... | Elevated troponins and elevated CK-MB | {
"A": "Elevated troponins and normal CK-MB",
"B": "Normal CK-MB and normal troponins",
"C": "Elevated troponins and elevated CK-MB",
"D": "Normal troponins and increased CK-MB"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"collapsing",
"grocery store 30 minutes",
"wife states",
"dizziness",
"chest pain prior to falling",
"Medical history",
"significant",
"hypertension",
"diabetes mellitus",
"wife",
"not compliant",
"medications",
"temperature",
"98",
... |
A 33-year-old primigravid visits the clinic at the 22 weeks’ gestation with concerns about several episodes of loose watery stool over the past 4 months, which are sometimes mixed with blood. Use of over-the-counter antidiarrheal medications has not been helpful. She also reports having painful ulcers in her mouth for ... | Intestinal obstruction | {
"A": "Metastasis to the liver",
"B": "Carcinoid syndrome",
"C": "Intestinal obstruction",
"D": "Paralytic ileus"
} | step1 | C | [
"year old primigravid visits",
"clinic",
"weeks gestation",
"concerns",
"episodes of loose watery",
"past",
"months",
"sometimes mixed",
"blood",
"Use of over-the-counter antidiarrheal medications",
"not",
"helpful",
"reports",
"painful ulcers",
"mouth",
"last",
"months",
"Pregnanc... |
A 54-year-old man is brought to the emergency department 1 hour after an episode of loss of consciousness that lasted 3 minutes. Since awakening, he has had weakness of the left arm and leg, and his speech has been slurred. He has had a fever for 10 days. He has not had vomiting or headache. He was treated for bacteria... | Septic emboli | {
"A": "Ruptured saccular aneurysm",
"B": "Temporal encephalitis",
"C": "Septic emboli",
"D": "Contiguous spread of infection"
} | step2&3 | C | [
"54 year old man",
"brought",
"emergency department",
"hour",
"episode of loss",
"consciousness",
"lasted 3 minutes",
"awakening",
"weakness of",
"left arm",
"leg",
"speech",
"slurred",
"fever",
"10 days",
"not",
"vomiting",
"headache",
"treated",
"bacterial sinusitis",
"week... |
A 63-year-old male is accompanied by his wife to his primary care doctor complaining of shortness of breath. He reports a seven-month history of progressively worsening dyspnea and a dry non-productive cough. He has also lost 15 pounds over the same time despite no change in diet. Additionally, over the past week, his ... | Undifferentiated small round blue cells | {
"A": "Pleomorphic cells arising from the alveolar lining with disruption of the alveolar architecture",
"B": "Sheets of large pleomorphic cells containing keratin and intercellular bridges",
"C": "Undifferentiated small round blue cells",
"D": "Anaplastic pleomorphic giant cells"
} | step1 | C | [
"63 year old male",
"wife",
"primary care doctor",
"of shortness",
"breath",
"reports",
"seven month history",
"worsening dyspnea",
"dry non-productive cough",
"lost",
"pounds",
"same time",
"change in diet",
"past week",
"wife",
"patient appears confused",
"disoriented",
"past med... |
A 7-month-old boy presents to the family physician with extensive scaliness and pigmentation of sun-exposed skin areas. His mother says that these symptoms were absent until mid-spring and then became significantly worse after their trip to California in the summer. The child was born in December to a consanguineous co... | Nucleotide-excision DNA repair | {
"A": "Conversion of uroporphyrinogen III to coproporphyrinogen III",
"B": "Hydroxylation of proline and lysine in the procollagen molecule",
"C": "Base-excision DNA repair",
"D": "Nucleotide-excision DNA repair"
} | step1 | D | [
"month old boy presents",
"family physician",
"extensive scaliness",
"pigmentation of sun-exposed skin areas",
"mother",
"symptoms",
"absent",
"spring",
"then",
"worse",
"trip",
"California",
"summer",
"child",
"born",
"December",
"consanguineous couple",
"uncomplicated pregnancy",... |
A 34-year-old woman with no significant prior medical history presents to the clinic with several days of bloody stool. She also complains of constipation and straining, but she has no other symptoms. She has no family history of colorectal cancer or inflammatory bowel disease. She does not smoke or drink alcohol. Her ... | Internal hemorrhoids | {
"A": "Colorectal cancer",
"B": "Ulcerative colitis",
"C": "Anal fissure",
"D": "Internal hemorrhoids"
} | step2&3 | D | [
"year old woman",
"significant prior medical history presents",
"clinic",
"several days",
"bloody stool",
"constipation",
"straining",
"symptoms",
"family history of colorectal cancer",
"inflammatory bowel disease",
"not smoke",
"drink alcohol",
"vital signs",
"follows",
"blood pressure"... |
A 53-year-old man comes to the physician because of fatigue, recurrent diarrhea, and an 8-kg (17.6-lb) weight loss over the past 6 months. He has a 4-month history of recurrent blistering rashes on different parts of his body that grow and develop into pruritic, crusty lesions before resolving spontaneously. Physical e... | Pancreatic α-cells | {
"A": "Pancreatic α-cells",
"B": "Pancreatic β-cells",
"C": "Pancreatic δ-cells",
"D": "Gastric G-cells"
} | step1 | A | [
"year old man",
"physician",
"fatigue",
"recurrent diarrhea",
"kg",
"weight loss",
"past 6 months",
"4 month history",
"recurrent blistering rashes",
"different parts",
"body",
"crusty lesions before resolving",
"Physical examination shows scaly lesions",
"different phases",
"healing",
... |
A 42-year-old man presents to his primary care provider complaining of foamy urine for the last 2 weeks. He has also begun to notice swelling in his hands and feet, and he says that his shoes have not been fitting normally. On exam, the patient has a temperature of 98.8°F (37.1°C), blood pressure is 132/84 mmHg, pulse ... | Antibodies to phospholipase A2 receptor | {
"A": "Antibodies to phospholipase A2 receptor",
"B": "IgA immune complex deposition",
"C": "Loss of podocyte foot processes",
"D": "X-linked condition"
} | step1 | A | [
"year old man presents",
"primary care provider",
"foamy urine",
"last",
"weeks",
"begun",
"swelling",
"hands",
"feet",
"shoes",
"not",
"fitting",
"exam",
"patient",
"temperature",
"98",
"blood pressure",
"84 mmHg",
"pulse",
"64 min",
"respirations",
"min",
"patient",
"... |
A 72-year-old woman is brought to the emergency department because of severe pain in her left hip after a fall this morning. She has smoked one pack of cigarettes daily for 45 years. Her only medication is a vitamin D supplement. Physical examination shows that her left leg is externally rotated and appears shorter tha... | Loss of cortical bone mass and thinning of trabeculae | {
"A": "Overgrowth of cortical bone and reduced marrow space",
"B": "Loss of cortical bone mass and thinning of trabeculae",
"C": "Formation of multiple sclerotic lesions in bony cortex",
"D": "Deposition of lamellar bone interspersed with woven bone"
} | step1 | B | [
"72 year old woman",
"brought",
"emergency department",
"of severe pain in",
"left hip",
"fall",
"morning",
"smoked one pack",
"cigarettes daily",
"years",
"only medication",
"vitamin D supplement",
"Physical examination shows",
"left leg",
"externally rotated",
"appears shorter",
"r... |
A 69-year-old woman comes to the physician because of lower back pain and right-sided chest pain for the past month. The pain is aggravated by movement. Over the past 2 months, she has had increasing fatigue. Her mother died of breast cancer. She has hypertension and reflux disease. Current medications include metoprol... | Urinary tract infection | {
"A": "Urinary tract infection",
"B": "Leukemic hiatus",
"C": "Splenomegaly",
"D": "Richter's transformation"
} | step2&3 | A | [
"69 year old woman",
"physician",
"lower back pain",
"right-sided chest pain",
"past month",
"pain",
"aggravated",
"movement",
"past",
"months",
"increasing fatigue",
"mother died of breast cancer",
"hypertension",
"reflux disease",
"Current medications include metoprolol",
"omeprazole... |
A 68-year-old man comes to the physician because of a 6-month history of difficulty swallowing pieces of meat and choking frequently during meal times. He also sometimes regurgitates foul-smelling, undigested food particles. Examination shows a 3 x 3 cm soft cystic, immobile mass in the upper third of the left side of ... | Increased intrapharyngeal pressure | {
"A": "Remnant of the embryological omphalomesenteric duct",
"B": "Increased intrapharyngeal pressure",
"C": "Remnant of the thyroglossal duct",
"D": "Remnant of the second branchial cleft"
} | step1 | B | [
"68 year old man",
"physician",
"month history",
"difficulty swallowing pieces",
"meat",
"choking frequently",
"meal times",
"sometimes regurgitates",
"smelling",
"undigested food particles",
"Examination shows",
"3",
"3",
"soft cystic",
"immobile mass",
"upper third of",
"left side"... |
A 67-year-old male with a history of poorly controlled hypertension, COPD, and diabetes presents to his cardiologist for a routine appointment. He reports that he has no current complaints and has not noticed any significant changes in his health. On exam, the cardiologist hears an extra heart sound in late diastole th... | Left ventricular hypertrophy | {
"A": "Ventricular dilation",
"B": "Left ventricular hypertrophy",
"C": "Increased filling pressures",
"D": "Mitral regurgitation"
} | step1 | B | [
"67 year old male",
"history of poorly controlled hypertension",
"COPD",
"diabetes presents",
"cardiologist",
"routine appointment",
"reports",
"current complaints",
"not",
"significant changes",
"health",
"exam",
"cardiologist hears",
"extra heart sound",
"late",
"immediately",
"S1"... |
A 42-year-old woman comes to the physician because of increasing fatigue and difficulty concentrating at work for the last 2 months. She has hypertension and a 22-year history of Crohn disease. She has been hospitalized and treated for acute exacerbations, sometimes involving strictures, multiple times in the past. She... | Decreased vibratory sensation | {
"A": "Tarry stools",
"B": "Unexplained weight gain",
"C": "Dark-colored urine",
"D": "Decreased vibratory sensation"
} | step2&3 | D | [
"year old woman",
"physician",
"increasing fatigue",
"difficulty concentrating",
"work",
"last",
"months",
"hypertension",
"year history of Crohn disease",
"hospitalized",
"treated",
"acute exacerbations",
"sometimes involving strictures",
"multiple times",
"past",
"not",
"significan... |
A resident in the department of obstetrics and gynecology is reading about a randomized clinical trial from the late 1990s that was conducted to compare breast cancer mortality risk, disease localization, and tumor size in women who were randomized to groups receiving either annual mammograms starting at age 40 or annu... | Randomization | {
"A": "Statistical power",
"B": "Observer bias",
"C": "Confounding",
"D": "Randomization"
} | step2&3 | D | [
"resident",
"department",
"obstetrics",
"gynecology",
"reading",
"randomized clinical trial",
"late 1990s",
"conducted to compare breast risk",
"disease localization",
"tumor size",
"women",
"randomized",
"groups receiving either annual mammograms starting",
"age 40",
"annual mammograms ... |
A 56-year-old man is seen in the hospital for a chief complaint of intense thirst and polyuria. His history is significant for recent transsphenoidal resection of a pituitary adenoma. With regard to the man's fluid balance, which of the following would be expected? | Increased extracellular fluid osmolarity | {
"A": "Hyponatremia",
"B": "Serum osmolarity <290 mOsm/L",
"C": "Increased extracellular fluid osmolarity",
"D": "Elevated blood glucose"
} | step1 | C | [
"year old man",
"seen",
"hospital",
"chief complaint",
"intense thirst",
"polyuria",
"history",
"significant",
"recent transsphenoidal resection of",
"pituitary adenoma",
"man's fluid balance",
"following",
"expected"
] |
An 82-year-old man presents with painless swelling of the neck for the past week. He reports no recent fever, night sweats, or weight loss. He has no significant medical history, and his only medication is daily aspirin. His temperature is 36.8℃ (98.2℉). On physical examination, there are several non-tender lymph nodes... | Stage of the disease | {
"A": "Stage of the disease",
"B": "Erythrocyte sedimentation rate (ESR)",
"C": "Hemoglobin level",
"D": "Leukocyte count and differential"
} | step2&3 | A | [
"year old man presents",
"painless swelling of the neck",
"past week",
"reports",
"recent fever",
"night sweats",
"weight loss",
"significant medical history",
"only medication",
"daily aspirin",
"temperature",
"36",
"98",
"physical examination",
"several non tender lymph nodes",
"aver... |
A 66-year-old gentleman presents to a new primary care physician to establish care after a recent relocation. His past medical history is significant for gout, erectile dysfunction, osteoarthritis of bilateral knees, mitral stenosis, and diabetic peripheral neuropathy. He denies any past surgeries along with the use of... | Erectile dysfunction | {
"A": "Erectile dysfunction",
"B": "Arthritis",
"C": "Mitral stenosis",
"D": "Diabetic peripheral neuropathy"
} | step1 | A | [
"66 year old",
"presents",
"new primary care physician to establish care",
"recent relocation",
"past medical history",
"significant",
"gout",
"erectile dysfunction",
"osteoarthritis of bilateral knees",
"mitral stenosis",
"diabetic peripheral neuropathy",
"denies",
"past surgeries",
"use"... |
A 30-year-old gravida 1 woman comes to the office for a prenatal visit. She is at 20 weeks gestation with no complaints. She is taking her prenatal vitamins but stopped the prescribed ferrous sulfate because it was making her constipated. Urinalysis shows trace protein. Uterine fundus is the expected size for a 20-week... | Iron deficiency anemia | {
"A": "Brief psychotic disorder",
"B": "Iron deficiency anemia",
"C": "Pre-eclampsia",
"D": "Plummer-Vinson syndrome"
} | step1 | B | [
"30 year old gravida 1 woman",
"office",
"prenatal visit",
"20 weeks gestation",
"complaints",
"taking",
"prenatal vitamins",
"stopped",
"prescribed ferrous sulfate",
"making",
"constipated",
"Urinalysis shows trace protein",
"Uterine fundus",
"expected size",
"20 week gestation",
"bef... |
A 32-year-old woman presents to the emergency department with unilateral vision loss. She states it started suddenly this evening and this has never happened to her before. The patient is not followed by a primary care physician and is not currently taking any medications. She has had a few episodes of weakness or numb... | Electrical pain with neck flexion | {
"A": "Electrical pain with neck flexion",
"B": "Ipsilateral loss of proprioception and vibration sensation",
"C": "Symmetric lower extremity reflex loss",
"D": "Weakness with repeat exertion"
} | step2&3 | A | [
"year old woman presents",
"emergency department",
"unilateral vision loss",
"states",
"started",
"evening",
"never happened",
"patient",
"not followed by",
"primary care physician",
"not currently taking",
"medications",
"few episodes of weakness",
"numbness",
"past",
"states",
"sym... |
A 36-year-old woman comes to the physician because of progressively worsening painful swelling of both breasts for the past 24 hours. Three days ago, she vaginally delivered a healthy 2690-g (5-lb 15-oz) girl. The patient says that breastfeeding her newborn daughter is very painful. She reports exhaustion and moodiness... | Cold compresses and analgesia | {
"A": "Cold compresses and analgesia",
"B": "Oral contraceptives",
"C": "Mammography",
"D": "Incision and drainage"
} | step2&3 | A | [
"36 year old woman",
"physician",
"worsening painful swelling of both breasts",
"past 24 hours",
"Three days",
"delivered",
"healthy",
"g",
"oz",
"girl",
"patient",
"breastfeeding",
"newborn daughter",
"very painful",
"reports exhaustion",
"moodiness",
"history",
"serious illness",... |
A 48-year-old man comes to the emergency department because of sudden right flank pain that began 3 hours ago. He also noticed blood in his urine. Over the past two weeks, he has developed progressive lower extremity swelling and a 4-kg (9-lb) weight gain. Examination shows bilateral 2+ pitting edema of the lower extre... | Loss of antithrombin III | {
"A": "Factor V Leiden",
"B": "Increased lipoprotein synthesis",
"C": "Loss of antithrombin III",
"D": "Malignant erythropoietin production"
} | step1 | C | [
"48 year old man",
"emergency department",
"sudden right",
"began 3 hours",
"blood in",
"urine",
"past two weeks",
"progressive lower extremity swelling",
"4 kg",
"weight gain",
"Examination shows bilateral 2",
"pitting edema of",
"lower extremities",
"Urinalysis",
"dipstick shows 4",
... |
A 13-year-old girl presents to an orthopedic surgeon for evaluation of a spinal curvature that was discovered during a school screening. She has otherwise been healthy and does not take any medications. On presentation, she is found to have significant asymmetry of her back and is sent for a spine radiograph. The radio... | Homeobox | {
"A": "Homeobox",
"B": "PAX",
"C": "Sonic hedgehog",
"D": "WNT7"
} | step1 | A | [
"year old girl presents",
"orthopedic surgeon",
"evaluation",
"spinal curvature",
"discovered",
"school screening",
"healthy",
"not take",
"medications",
"presentation",
"found to",
"significant asymmetry of",
"back",
"sent",
"spine radiograph",
"radiograph reveals",
"unilateral rib ... |
A 4-year-old boy is brought to a pediatrician by his parents for a consultation after his teacher complained about his inability to focus or make friends at school. They mention that the boy does not interact well with others at home, school, or daycare. On physical examination, his vital signs are stable with normal w... | No further testing is needed | {
"A": "Magnetic resonance imaging (MRI) of brain",
"B": "Electroencephalography",
"C": "Genetic testing for methyl-CpG-binding protein 2 (MECP-2) gene mutations",
"D": "No further testing is needed"
} | step2&3 | D | [
"4 year old boy",
"brought",
"pediatrician",
"parents",
"consultation",
"teacher",
"focus",
"make friends",
"school",
"boy",
"not",
"well",
"others",
"home",
"school",
"daycare",
"physical examination",
"vital signs",
"stable",
"normal",
"height",
"head circumference",
"a... |
A 73-year-old male presents to the the clinic with lumbar pain and symmetrical bone pain in his legs and arms. He has trouble going up to his bedroom on the second floor and getting up from a chair. Past medical history reveals that he has had acid reflux for the past 5 years that is refractory to medications (PPIs & H... | Bone mineralization | {
"A": "Bone mineralization",
"B": "Iron absorption",
"C": "Collagen synthesis",
"D": "Degradation of branched chain amino acids"
} | step1 | A | [
"year old male presents",
"clinic",
"lumbar",
"symmetrical bone pain in",
"legs",
"arms",
"bedroom",
"second floor",
"getting",
"chair",
"Past medical history reveals",
"acid reflux",
"past",
"years",
"refractory",
"medications",
"PPIs",
"H2 antagonists",
"to",
"foods",
"give... |
A 13-month-old boy is referred to an immunologist with recurrent otitis media, bacterial sinus infections, and pneumonia, which began several months earlier. He is healthy now, but the recurrent nature of these infections are troubling to his parents and they are hoping to find a definitive cause. The boy was born at 3... | Flow cytometry | {
"A": "Genetic analysis",
"B": "Flow cytometry",
"C": "Urine protein screening",
"D": "Stool cultures"
} | step2&3 | B | [
"month old boy",
"referred",
"immunologist",
"recurrent otitis media",
"bacterial sinus infections",
"pneumonia",
"began several months earlier",
"healthy now",
"recurrent nature",
"infections",
"parents",
"hoping to find",
"definitive cause",
"boy",
"born",
"weeks gestation",
"spont... |
A 58-year-old man presents with a lump on his neck. He says the mass gradually onset 2 months ago and has been progressively enlarging. He denies any pain, weight loss, fevers, chills, or night sweats. Past medical history is significant for HIV, diagnosed 5 years ago, managed on a new HAART regimen he just started. Th... | Mixed cellularity classical Hodgkin lymphoma | {
"A": "Lymphocyte-rich classical Hodgkin lymphoma",
"B": "Mixed cellularity classical Hodgkin lymphoma",
"C": "Nodular sclerosis classical Hodgkin lymphoma",
"D": "Lymphocyte depleted Hodgkin lymphoma"
} | step1 | B | [
"58 year old man presents",
"lump",
"neck",
"mass",
"onset",
"months",
"enlarging",
"denies",
"pain",
"weight loss",
"fevers",
"chills",
"night sweats",
"Past medical history",
"significant",
"HIV",
"diagnosed 5 years",
"managed",
"new HAART regimen",
"started",
"patient",
... |
A 42-year-old man presents to his primary care physician for preventative care. He does not have any current complaint. His father died of diabetic nephropathy. Vital signs include a temperature of 36.7°C (98.06°F), blood pressure of 150/95 mm Hg, and pulse of 90/min. His fasting blood glucose is 159 mg/dL (on 2 occasi... | Basal-bolus insulin | {
"A": "Basal-bolus insulin",
"B": "Basal insulin added to metformin",
"C": "A sodium-glucose cotransporter 2 inhibitor added to metformin",
"D": "A thiazolidinedione added to metformin"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"preventative care",
"not",
"current complaint",
"father died",
"diabetic nephropathy",
"Vital signs include",
"temperature",
"36",
"98",
"blood pressure",
"95 mm Hg",
"pulse",
"90 min",
"fasting blood glucose",
"mg/dL",
"2 occasio... |
A 3-year-old boy is brought to the pediatrician by his parents because of excessive growth and a large tongue. His past medical-social history reveals that he is a product of non-consanguineous marriage to a 20-year-old primigravida. He was born at full term with a birth weight of 3.8 kg (8.4 lb) and length of 52 cm (2... | Mutation in tumor suppressor gene on the short arm of chromosome 11 | {
"A": "Mutation in tumor suppressor gene on the short arm of chromosome 11",
"B": "Mutation in tumor suppressor gene on the long arm of chromosome 22",
"C": "Nondisjunction of chromosome 21",
"D": "Mutation in tumor suppressor gene on the long arm of chromosome 17"
} | step2&3 | A | [
"3 year old boy",
"brought",
"pediatrician",
"parents",
"excessive growth",
"large tongue",
"past medical social history reveals",
"product",
"non consanguineous marriage",
"20 year old primigravida",
"born",
"full term",
"birth weight",
"kg",
"8.4",
"length",
"20",
"temperature",
... |
A female neonate born to a 21-year-old G2P1 had jaundice at 8 hours of life. The neonate’s red blood cell type was A+, while the mother’s RBC type was O+. The mother’s anti-A antibody titer was elevated. A screen for a fetomaternal bleed was negative. The direct Coombs test was weakly positive. The infant’s hemoglobin... | ABO incompatibility | {
"A": "Rh Incompatibility",
"B": "ABO incompatibility",
"C": "G6PD deficiency",
"D": "Sickle cell disease"
} | step1 | B | [
"female neonate born",
"21-year-old",
"jaundice",
"8 hours",
"life",
"neonates red blood cell type",
"mothers RBC type",
"O",
"mothers anti-A antibody titer",
"elevated",
"screen",
"fetomaternal bleed",
"negative",
"direct Coombs test",
"weakly positive",
"infants hemoglobin",
"total... |
A 26-year-old G1P0 woman comes to her maternal and fetal medicine doctor at 15 weeks of gestation in order to be evaluated for fetal developmental abnormalities. Her family has a history of congenital disorders leading to difficulty walking so she was concerned about her child. Amniocentesis shows normal levels of all ... | Tuft of hair or skin dimple on lower back | {
"A": "Absence of the brain and calvarium",
"B": "Protrusion of the meninges through a bony defect",
"C": "Protrusion of the meninges and spinal cord through a bony defect",
"D": "Tuft of hair or skin dimple on lower back"
} | step1 | D | [
"year old",
"woman",
"maternal",
"fetal medicine",
"weeks gestation",
"order to",
"evaluated",
"fetal developmental abnormalities",
"family",
"history of congenital disorders leading",
"difficulty walking",
"concerned",
"child",
"Amniocentesis shows normal levels",
"serum proteins",
"c... |
A 75-year-old man comes to the physician because of a 2-week history of sharp, stabbing pain in the lower back that radiates to the back of his left leg. He also has had a loss of sensitivity around his buttocks and inner thighs as well as increased trouble urinating the last week. Two years ago, he was diagnosed with ... | Cauda equina syndrome | {
"A": "Brown-sequard syndrome",
"B": "Central cord syndrome",
"C": "Conus medullaris syndrome",
"D": "Cauda equina syndrome"
} | step1 | D | [
"75 year old man",
"physician",
"2-week history",
"sharp",
"stabbing pain",
"lower back",
"radiates",
"back of",
"left leg",
"loss",
"sensitivity",
"buttocks",
"inner thighs",
"increased",
"last week",
"Two years",
"diagnosed",
"prostate cancer",
"treated with radiation therapy",... |
A 4-year-old girl is brought to the physician by her mother because of fatigue and generalized weakness for 4 months. Examination shows decreased muscle tone. Her fasting serum glucose concentration is 41 mg/dL. The physician suspects a defect in one of the enzymes involved in the carnitine shuttle. Increased serum con... | β-hydroxybutyrate | {
"A": "β-hydroxybutyrate",
"B": "Alanine aminotransferase",
"C": "Uric acid",
"D": "Creatine kinase"
} | step1 | A | [
"4 year old girl",
"brought",
"physician",
"mother",
"fatigue",
"generalized weakness",
"months",
"Examination shows decreased muscle tone",
"fasting serum",
"mg/dL",
"physician suspects",
"defect",
"one",
"enzymes involved",
"carnitine shuttle",
"Increased serum concentration",
"fol... |
A 58-year-old man is admitted to the hospital for severe abdominal pain and confusion. He has a history of alcohol use disorder, with several previous admissions for intoxication. Twelve hours after admission, he has worsening shortness of breath. His temperature is 38.3°C (100.9°F), pulse is 120/min, respirations are ... | Acute respiratory distress syndrome | {
"A": "Hospital-acquired pneumonia",
"B": "Acute respiratory distress syndrome",
"C": "Congestive heart failure",
"D": "Hepatic hydrothorax"
} | step2&3 | B | [
"58 year old man",
"admitted",
"hospital",
"severe abdominal",
"confusion",
"history of alcohol use disorder",
"several previous admissions",
"intoxication",
"Twelve hours",
"admission",
"worsening shortness of breath",
"temperature",
"3C",
"100 9F",
"pulse",
"min",
"respirations",
... |
A 70-year-old man with a history of poorly controlled congestive heart failure comes to the physician for a follow-up examination. At his previous visit 4 months ago, a new drug was added to his treatment regimen. He reports that his dyspnea and peripheral edema have improved. His pulse is 70/min and blood pressure is ... | Cortical collecting duct | {
"A": "Juxtaglomerular apparatus",
"B": "Efferent arteriole",
"C": "Early distal convoluted tubule",
"D": "Cortical collecting duct"
} | step1 | D | [
"70 year old man",
"history",
"poorly controlled congestive heart failure",
"physician",
"follow-up examination",
"previous visit",
"months",
"new drug",
"added",
"treatment regimen",
"reports",
"dyspnea",
"peripheral edema",
"improved",
"pulse",
"70 min",
"blood pressure",
"80 mm ... |
A 17-year-old white female with a history of depression is brought to your office by her parents because they are concerned that she is acting differently. She is quiet and denies any changes in her personality or drug use. After the parents step out so that you can speak alone, she begins crying. She states that schoo... | Explain to her that she will have to be hospitalized as she is an acute threat to herself | {
"A": "Prescribe an anti-depressant medication and allow her to return home",
"B": "Explain to her that she will have to be hospitalized as she is an acute threat to herself",
"C": "Tell her parents about the situation and allow them to handle it as a family",
"D": "Prescribe an anti-psychotic medication"
} | step2&3 | B | [
"year old white female",
"history of depression",
"brought",
"office",
"parents",
"concerned",
"acting",
"quiet",
"denies",
"changes in",
"personality",
"drug use",
"parents step out",
"speak alone",
"begins crying",
"states",
"school",
"very difficult",
"very depressed",
"past... |
A 62-year-old man presents to his primary care physician. He was brought in by his daughter as he has refused to see a physician for the past 10 years. The patient has been having worsening abdominal pain. He claims that it was mild initially but has gotten worse over the past week. The patient has been eating lots of ... | Colon cancer | {
"A": "Acute cholecystitis",
"B": "Hepatocellular carcinoma",
"C": "Pancreatic cancer",
"D": "Colon cancer"
} | step2&3 | D | [
"62 year old man presents",
"primary care physician",
"brought",
"daughter",
"refused to see",
"physician",
"past 10 years",
"patient",
"worsening abdominal pain",
"mild initially",
"gotten worse",
"past week",
"patient",
"eating lots",
"vegetables recently to help",
"pain",
"patient... |
A 66-year-old man comes to the physician for a 3-month history of fatigue. He has hypertension and hyperlipidemia. He had a transient ischemic attack 3 years ago. He drinks 3 beers a day, and sometimes a couple more on social occasions. He currently takes aspirin, simvastatin, hydrochlorothiazide, and metoprolol. His t... | Acute myelogenous leukemia | {
"A": "Acute lymphoblastic leukemia",
"B": "Myelodysplastic syndrome",
"C": "Chronic lymphocytic leukemia",
"D": "Acute myelogenous leukemia"
} | step2&3 | D | [
"66 year old man",
"physician",
"3 month history",
"fatigue",
"hypertension",
"hyperlipidemia",
"transient ischemic attack",
"years",
"drinks 3 beers",
"day",
"sometimes",
"couple",
"social occasions",
"currently takes aspirin",
"simvastatin",
"hydrochlorothiazide",
"metoprolol",
"... |
A 45-year-old man is brought to the emergency department after a car accident with pain in the middle of his chest and some shortness of breath. He has sustained injuries to his right arm and leg. He did not lose consciousness. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 18/min, and blood press... | Transthoracic echocardiography | {
"A": "Contrast esophagram with gastrografin",
"B": "X-ray of the chest",
"C": "CT scan of the brain",
"D": "Transthoracic echocardiography"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"car accident",
"pain",
"middle",
"chest",
"shortness of breath",
"sustained injuries",
"right",
"leg",
"not",
"consciousness",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"90 60 mm Hg",
"a... |
An 8-year-old boy is brought to the emergency department 3 hours after having a 2-minute episode of violent, jerky movements of his right arm at school. He was sweating profusely during the episode and did not lose consciousness. He remembers having felt a chill down his spine before the episode. Following the episode,... | Focal seizure | {
"A": "Sydenham chorea",
"B": "Sporadic transient tic disorder",
"C": "Hemiplegic migraine",
"D": "Focal seizure"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"hours",
"2 minute episode of violent",
"jerky movements",
"right arm",
"school",
"sweating",
"episode",
"not",
"consciousness",
"remembers",
"felt",
"chill",
"spine",
"episode",
"Following",
"episode",
"experienced weakness",
... |
An investigator is conducting a study to identify potential risk factors for post-transplant hypertension. The investigator selects post-transplant patients with hypertension and gathers detailed information regarding their age, gender, preoperative blood pressure readings, and current medications. The results of the s... | Case series | {
"A": "Retrospective cohort study",
"B": "Cross-sectional study",
"C": "Case-control study",
"D": "Case series"
} | step1 | D | [
"investigator",
"conducting",
"study to",
"potential risk factors",
"post transplant hypertension",
"investigator selects post transplant patients",
"hypertension",
"detailed information",
"age",
"gender",
"preoperative blood pressure readings",
"current medications",
"results",
"study rev... |
A 56-year-old man presents to the emergency room with severe substernal chest pain associated with a 2-hour history of breathlessness and sweating. An electrocardiogram shows an ST-segment elevation myocardial infarction. Cardiac enzyme levels confirm a diagnosis of acute myocardial infarction. The patient is rushed to... | Creatine kinase (CK)-MB | {
"A": "Lactate dehydrogenase (LDH)",
"B": "Creatine kinase (CK)-MB",
"C": "Troponin I",
"D": "Creatine kinase – MM"
} | step1 | B | [
"year old man presents",
"emergency room",
"severe substernal chest pain associated with",
"hour history",
"breathlessness",
"sweating",
"electrocardiogram shows",
"ST-segment elevation myocardial infarction",
"Cardiac enzyme levels confirm",
"diagnosis",
"acute myocardial infarction",
"patien... |
A 3-week-old male newborn is brought to the physician because his mother has noticed that he tires easily and sweats while feeding. During the past week, she has noticed that his lips and nails turn blue while crying. He was born at 35 weeks' gestation and weighed 2100 g (4 lb 10 oz); he currently weighs 2300 g (5 lb 1... | Degree of right ventricular outflow obstruction | {
"A": "Degree of right ventricular hypertrophy",
"B": "Degree of right ventricular outflow obstruction",
"C": "Size of ventricular septal defect",
"D": "Degree of aortic override"
} | step2&3 | B | [
"3 week old male newborn",
"brought",
"physician",
"mother",
"tires easily",
"sweats",
"feeding",
"past week",
"lips",
"nails turn blue",
"crying",
"born",
"35 weeks",
"gestation",
"g",
"10 oz",
"currently",
"g",
"1 oz",
"temperature",
"3C",
"99",
"pulse",
"min",
"res... |
A 13-year-old boy presents to his pediatrician with a 1-day history of frothy brown urine. He says that he believes he had strep throat some weeks ago, but he was not treated with antibiotics as his parents were worried about him experiencing harmful side effects. His blood pressure is 148/96 mm Hg, heart rate is 84/mi... | Once a patient is infected with a nephritogenic strain of group A streptococcus, the development of PSGN cannot be prevented. | {
"A": "Antibiotic therapy can prevent the development of PSGN.",
"B": "Once a patient is infected with a nephritogenic strain of group A streptococcus, the development of PSGN cannot be prevented.",
"C": "Antibiotic therapy only prevents PSGN in immunosuppressed patients.",
"D": "Antibiotic therapy decreases t... | step2&3 | B | [
"year old boy presents",
"pediatrician",
"1-day history",
"frothy brown",
"strep throat",
"weeks",
"not treated with antibiotics",
"parents",
"worried",
"experiencing",
"side effects",
"blood pressure",
"96 mm Hg",
"heart rate",
"84 min",
"respiratory rate",
"min",
"Laboratory anal... |
A 4-year-old boy is brought to the physician because of yellowish discoloration of his eyes and skin for 5 days. He has had generalized fatigue and mild shortness of breath over the past 2 months. Two weeks ago, he was treated for a urinary tract infection with antibiotics. His father has a history of undergoing a sple... | Defective spectrin in the RBC membrane | {
"A": "Decreased synthesis of alpha chains of hemoglobin",
"B": "Defective spectrin in the RBC membrane",
"C": "Thrombotic microangiopathy",
"D": "Decreased CD55 and CD59 in RBC"
} | step2&3 | B | [
"4 year old boy",
"brought",
"physician",
"discoloration",
"eyes",
"skin",
"5 days",
"generalized fatigue",
"mild shortness of breath",
"past",
"months",
"Two weeks",
"treated",
"urinary tract infection",
"antibiotics",
"father",
"history",
"splenectomy",
"childhood",
"Examinat... |
A 35-year-old man is transferred to the intensive care unit after a motorcycle accident. He does not open his eyes with painful stimuli. He makes no sounds. He assumes decerebrate posture with sternal rub. His right eye is abnormally positioned downward and outward and has a dilated pupil which is not responsive to lig... | Downward and outward gaze with ptosis and a responsive pupil | {
"A": "Downward and outward gaze, ptosis, and a fixed, dilated pupil",
"B": "Downward and outward gaze with ptosis and a responsive pupil",
"C": "Fixed dilated pupil with normal extraocular movements",
"D": "Inability to abduct the eye"
} | step1 | B | [
"35 year old man",
"transferred",
"intensive care unit",
"motorcycle accident",
"not open",
"eyes",
"painful stimuli",
"makes",
"sounds",
"decerebrate posture",
"sternal rub",
"right eye",
"positioned downward",
"outward",
"dilated pupil",
"not responsive",
"light",
"patient's find... |
A 3-year-old girl is brought to the physician for the evaluation of a 1-month history of episodes of irritability and occasional vomiting. The parents report that she has been drowsy during much of the day and has not engaged in her usual activities during this period. She was born at term and has been healthy. She is ... | Cerebrospinal fluid outflow obstruction | {
"A": "Edema of brain parenchyma",
"B": "Closed foramen of Magendie",
"C": "Impaired reabsorption of cerebrospinal fluid",
"D": "Cerebrospinal fluid outflow obstruction"
} | step2&3 | D | [
"3 year old girl",
"brought",
"physician",
"evaluation of",
"month history",
"episodes",
"irritability",
"occasional vomiting",
"parents report",
"drowsy",
"day",
"not engaged",
"usual activities",
"period",
"born",
"term",
"healthy",
"percentile",
"height",
"percentile",
"we... |
A 38-year-old man comes to the physician because of persistent sadness and difficulty concentrating for the past 6 weeks. During this period, he has also had difficulty sleeping. He adds that he has been “feeling down” most of the time since his girlfriend broke up with him 4 years ago. Since then, he has only had a fe... | Persistent depressive disorder | {
"A": "Major depressive disorder",
"B": "Cyclothymic disorder",
"C": "Persistent depressive disorder",
"D": "Adjustment disorder with depressed mood"
} | step1 | C | [
"year old man",
"physician",
"persistent sadness",
"difficulty concentrating",
"past",
"weeks",
"period",
"difficulty sleeping",
"adds",
"feeling",
"time",
"girlfriend",
"4 years",
"then",
"only",
"few periods",
"time",
"not feel",
"lasted",
"month",
"reports",
"problems",
... |
A 28-year-old man comes to his general practitioner for a regular checkup. He has had trouble breathing lately with coughing, shortness of breath, and wheezing. Problems first started when he went running (outside), but he is also observing the problems when taking a light walk or resting. As a child, he suffered from ... | Type I hypersensitivity | {
"A": "Exercise",
"B": "Chronic obstructive pulmonary disease",
"C": "Type I hypersensitivity",
"D": "Smoking"
} | step1 | C | [
"year old man",
"general practitioner",
"regular checkup",
"trouble breathing",
"coughing",
"shortness of breath",
"wheezing",
"Problems first started",
"running",
"outside",
"observing",
"problems",
"taking",
"light walk",
"resting",
"child",
"suffered",
"atopic dermatitis",
"fa... |
A previously healthy 35-year-old woman is brought into the emergency department after being found unresponsive by her husband. Her husband finds an empty bottle of diazepam tablets in her pocket. She is stuporous. At the hospital, her blood pressure is 90/40 mm Hg, the pulse is 58/min, and the respirations are 6/min. T... | Daily evaluation for ventilator weaning | {
"A": "Daily evaluation for ventilator weaning",
"B": "Nasogastric tube insertion",
"C": "Oropharynx and gut antibacterial decontamination",
"D": "Prone positioning during mechanical ventilation"
} | step2&3 | A | [
"healthy 35 year old woman",
"brought",
"emergency department",
"found unresponsive",
"husband",
"husband finds",
"empty bottle",
"diazepam tablets",
"stuporous",
"hospital",
"blood pressure",
"90 40 mm Hg",
"pulse",
"58 min",
"respirations",
"min",
"examination of",
"pupils shows ... |
A 65-year-old woman comes to the physician because of increased difficulty hearing. She has also had dull and progressive pain in her hip and lower back for the past 2 months that is worse with exertion. Examination of the ears shows impaired hearing on the left with whispered voice test and lateralization to the right... | Increased rate of bone remodeling | {
"A": "Proliferation of plasma cells in the bone marrow",
"B": "Defective bone matrix mineralization",
"C": "Increased rate of bone remodeling",
"D": "Metastatic destruction of the bone"
} | step1 | C | [
"65 year old woman",
"physician",
"increased difficulty hearing",
"dull",
"progressive pain in",
"hip",
"lower back",
"past",
"months",
"worse",
"exertion",
"Examination of",
"ears shows impaired hearing",
"left",
"whispered voice test",
"right",
"Weber testing",
"localized tendern... |
A 24-year-old woman calls her gynecologist complaining of vaginal odor and vaginal discharge. She had an intrauterine device placed last year and does not use condoms with her boyfriend. She has a past medical history of constipation and depression. She recently was successfully treated for a urinary tract infection wi... | Anaerobic bacteria overgrowth within the vagina | {
"A": "Anaerobic bacteria overgrowth within the vagina",
"B": "Inflammatory bacterial infection",
"C": "Physiologic discharge secondary to normal hormonal fluctuations",
"D": "Pregnancy within the uterine tubes"
} | step2&3 | A | [
"year old woman calls",
"gynecologist",
"vaginal odor",
"vaginal discharge",
"intrauterine device placed last year",
"not use condoms",
"boyfriend",
"past medical constipation",
"depression",
"recently",
"treated",
"urinary tract infection",
"2-day course",
"antibiotics",
"Physical exam ... |
A 57-year-old man presents to his primary care provider because of chest pain for the past 3 weeks. The chest pain occurs after climbing more than 2 flight of stairs or walking for more than 10 minutes and resolves with rest. He is obese, has a history of type 2 diabetes mellitus, and has smoked 15-20 cigarettes a day ... | Fixed, atherosclerotic coronary stenosis (> 70%) | {
"A": "Multivessel atherosclerotic disease with or without a nonocclusive thrombus",
"B": "Intermittent coronary vasospasm with or without coronary atherosclerosis",
"C": "Sudden disruption of an atheromatous plaque, with a resulting occlusive thrombus",
"D": "Fixed, atherosclerotic coronary stenosis (> 70%)"
... | step2&3 | D | [
"57 year old man presents",
"primary care provider",
"of chest pain",
"past",
"weeks",
"chest pain occurs",
"climbing",
"2 flight",
"stairs",
"walking",
"10 minutes",
"resolves",
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"obese",
"history of type 2 diabetes mellitus",
"smoked",
"20 cigarettes",
"day",
"past",
"... |
A 40-year-old man is brought to the emergency department after sustaining multiple lacerations during a bar fight. The patient’s wife says that he has been showing worsening aggression and has been involved in a lot of arguments and fights for the past 2 years. The patient has no significant past medical or psychiatric... | Caudate nucleus | {
"A": "Caudate nucleus",
"B": "Cerebral cortex",
"C": "Medulla oblongata",
"D": "Substantia nigra"
} | step1 | A | [
"40 year old man",
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A 9-year-old girl is brought to the physician by her mother because of a 3-day history of face and foot swelling, dark urine, and a rash on her hands and feet. The mother reports that her daughter has had a low-grade fever, shortness of breath, and a dry cough for the past 8 days. She has had generalized weakness and p... | Infective endocarditis | {
"A": "Infective endocarditis",
"B": "Acute lymphoblastic leukemia",
"C": "Myocarditis",
"D": "Kawasaki disease"
} | step2&3 | A | [
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A 36 year-old woman presents to the doctor’s office for evaluation of substernal chest pain and a metallic taste in her mouth. The patient has a history of metabolic syndrome and hypothyroidism. She takes levothyroxine daily. The patient’s vital signs are currently stable. On examination, she appears to be in mild disc... | Omeprazole | {
"A": "Omeprazole",
"B": "Ranitidine",
"C": "Bismuth subsalicylate",
"D": "Magnesium hydroxide"
} | step2&3 | A | [
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"hypothyroidism",
"takes levothyroxine daily",
"patients vital signs",
"currently stable",
"examination",
"appears to",
"mild di... |
A 27-year-old woman presents with painful urination and malodorous urethral discharge. She states she has a single sexual partner and uses condoms for contraception. The patient's blood pressure is 115/80 mm Hg, the heart rate is 73/min, the respiratory rate is 14/min, and the temperature is 36.6℃ (97.9℉). Physical exa... | Explain to the patient that gonorrhea is a mandatory reported disease. | {
"A": "Let the patient do as she suggests, because it is her right not to disclose her diagnosis to anyone.",
"B": "Explain to the patient that gonorrhea is a mandatory reported disease.",
"C": "Refer to the medical ethics committee for consultation.",
"D": "Tell the patient that she is required to tell her pa... | step1 | B | [
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"80 mm Hg",
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"min",
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"36",
"97",
"Physical examination shows swelling... |
A scientist is studying a protein that is present on the plasma membrane of cells. He therefore purifies the protein in a lipid bilayer and subjects it to a number of conditions. His investigations show that the protein has the following properties:
1) It is able to change ion concentrations across the membrane withou... | Mediating neuronal to muscle end plate communication | {
"A": "Causing depolarization during action potentials",
"B": "Maintenance of resting sodium and potassium concentrations",
"C": "Mediating neuronal to muscle end plate communication",
"D": "Transporting water in the collecting duct of the kidney"
} | step1 | C | [
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A 45-year-old Caucasian man is given nitroglycerin for the management of his stable angina. Nitroglycerin given for the rapid relief of acute angina would most likely be given through what route of administration? | Sublingual | {
"A": "Oral",
"B": "Sublingual",
"C": "Intramuscular injection",
"D": "Intravenous injection"
} | step1 | B | [
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"management",
"stable angina",
"given",
"rapid relief",
"acute angina",
"most likely",
"given",
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] |
A 54-year-old patient is brought to the emergency department by ambulance with palpitations, lightheadedness, and generalized weakness. He was enjoying the long weekend with his friends at a prolonged destination bachelor’s party over the last several days. They all drank a great deal of alcohol. He can’t quite recall ... | Left atrial appendage | {
"A": "Left main coronary artery",
"B": "Right coronary artery",
"C": "Posterior descending artery",
"D": "Left atrial appendage"
} | step1 | D | [
"54 year old patient",
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"days",
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"great",
"alcohol",
"cant",
"recall",
"to drink",
"not blackout",
... |
A 31-year-old G3P0 is admitted to the hospital with profuse vaginal bleeding and abdominal pain at 34 weeks gestation. She reports passing bright blood with clots and no water in the discharge. She denies recent trauma or medical illnesses. She had no prenatal care. Her previous pregnancies culminated in spontaneous ab... | Abrupt constriction of maternal and placental vessels | {
"A": "Thrombosis of the placental vessels",
"B": "Abrupt constriction of maternal and placental vessels",
"C": "Rupture of the placental vessels",
"D": "Premature rupture of the membranes"
} | step2&3 | B | [
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"abdominal pain",
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"reports passing bright blood",
"clots",
"water",
"discharge",
"denies recent trauma",
"medical illnesses",
"prenatal care",
"previous pregnancies",
"spontaneous abortions",
"second ... |
A 61-year-old woman presents to a surgical oncologist for consideration of surgical removal of biopsy-confirmed breast cancer. The mass is located in the tail of Spence along the superolateral aspect of the left breast extending into the axilla. The surgical oncologist determines that the optimal treatment for this pat... | Scapular protrusion while pressing against a wall | {
"A": "Scapular protrusion while pressing against a wall",
"B": "Weakness in shoulder abduction and numbness over the lateral shoulder",
"C": "Weakness in wrist extension and numbness over the dorsal hand",
"D": "Weakness in arm flexion at the elbow and numbness over the lateral forearm"
} | step1 | A | [
"61 year old woman presents",
"surgical oncologist",
"consideration of surgical removal",
"biopsy confirmed breast cancer",
"mass",
"tail of Spence",
"superolateral aspect",
"left extending",
"axilla",
"surgical oncologist",
"optimal treatment",
"patient",
"radical mastectomy including remov... |
A 25-year-old woman presents with slightly yellow discoloration of her skin and eyes. She says she has had multiple episodes with similar symptoms before. She denies any recent history of nausea, fatigue, fever, or change in bowel/bladder habits. No significant past medical history. The patient is afebrile and vital si... | Gilbert syndrome | {
"A": "Crigler-Najjar syndrome type II",
"B": "Crigler -Najjar syndrome type I",
"C": "Hemolytic anemia",
"D": "Gilbert syndrome"
} | step1 | D | [
"year old woman presents",
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"eyes",
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"similar symptoms",
"denies",
"recent history",
"nausea",
"fatigue",
"fever",
"change in bowel bladder habits",
"significant past medical history",
"patient",
"afebrile",
"vital signs",
... |
A 55-year-old African American female presents to her breast surgeon for a six-month follow-up visit after undergoing a modified radical mastectomy for invasive ductal carcinoma of the left breast. She reports that she feels well and her pain has been well controlled with ibuprofen. However, she is frustrated that her ... | Type III collagen | {
"A": "Type I collagen",
"B": "Type II collagen",
"C": "Type III collagen",
"D": "Elastin"
} | step1 | C | [
"55 year old African American female presents",
"breast",
"six-month follow-up visit",
"modified radical mastectomy",
"invasive ductal carcinoma of the",
"breast",
"reports",
"feels well",
"pain",
"well controlled",
"ibuprofen",
"frustrated",
"incisional scar",
"much larger",
"expected",... |
A 24-year-old woman comes to the emergency department because of lower abdominal pain for 4 hours. She has had vaginal spotting for 2 days. Menses occur at irregular 20- to 45-day intervals and last for 3 to 7 days. Her last menstrual period was 8 weeks ago. She was treated for pelvic inflammatory disease at the age of... | Interstitial pregnancy | {
"A": "Interstitial pregnancy",
"B": "Spontaneous abortion",
"C": "Incomplete hydatidiform mole",
"D": "Placenta previa"
} | step2&3 | A | [
"year old woman",
"emergency department",
"of lower abdominal pain",
"hours",
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"2 days",
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"last menstrual period",
"weeks",
"treated",
"pelvic inflammatory disease",
"age",
"20",
"ceftriaxone",
"... |
A healthy, 16-year-old girl is brought in by her mother for a wellness visit. During the appointment, the patient’s mother brings up concerns about her daughter’s acne. The patient has had acne for 2 years. She washes her face twice a day with benzoyl peroxide and has been on doxycycline for 2 months with only mild imp... | Ask the mother to leave the room before talking to the patient about her sexual activity | {
"A": "Ask the mother to leave the room before talking to the patient about her sexual activity",
"B": "Have the patient take a pregnancy test to prove abstinence",
"C": "Prescribe the isotretinoin after giving the patient a handout about birth control methods",
"D": "Talk to patient and mother about patient’s... | step1 | A | [
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"doxycycline",
"2 months",
"only mild improvement",
"patient",
"not f... |
A 20-year-old medical student presents to the clinic with a very painful lesion on her lower lip, as shown in the photograph below. She admits that she applied polymyxin ointment to the lesion without improvement. A few months ago, she used the same antibiotic ointment to treat an infected cut on her arm. At that time,... | Organism has no cell membrane | {
"A": "Organism has no cell membrane",
"B": "Cold sore is non-infective in nature",
"C": "Organism has become resistant",
"D": "Topical antiviral creams are not effective for cold sores"
} | step1 | A | [
"20 year old medical student presents",
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"improvement",
"few months",
"used",
"same antibiotic ointment to treat",
"infected cut",
"arm",
"time",
"read",
"microbiology ... |
A 47-year-old male presents to a psychiatrist for the first time, explaining that he is tired of living his 'double life.' At church, he preaches vehemently against the sin of drinking alcohol, but at home he gets drunk every night. Which of the following ego defenses best explains his behavior? | Reaction formation | {
"A": "Acting out",
"B": "Displacement",
"C": "Reaction formation",
"D": "Rationalization"
} | step1 | C | [
"year old male presents",
"psychiatrist",
"first time",
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"living his",
"double life",
"church",
"sin",
"drinking alcohol",
"at home",
"gets drunk",
"night",
"following ego defenses best",
"behavior"
] |
A 23-year-old man is admitted to the hospital for observation because of a headache, dizziness, and nausea that started earlier in the day while he was working. He moves supplies for a refrigeration company and was handling a barrel of carbon tetrachloride before the symptoms began. He was not wearing a mask. One day a... | Lipid peroxidation | {
"A": "Glutathione depletion",
"B": "Metabolite haptenization",
"C": "Microtubule stabilization",
"D": "Lipid peroxidation"
} | step1 | D | [
"23 year old man",
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"refrigeration company",
"handling",
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"carbon tetrachloride",
"symptoms began",
"not",
"mask",
"One day",
"admission",
... |
A 20-year-old college student presents to the emergency room complaining of insomnia for the past 48 hours. He explains that although his body feels tired, he is "full of energy and focus" after taking a certain drug an hour ago. He now wants to sleep because he is having hallucinations. His vital signs are T 100.0 F, ... | Increases presynaptic dopamine and norepinephrine releases from vesicles | {
"A": "Increases presynaptic dopamine and norepinephrine releases from vesicles",
"B": "Displaces norepinephrine from secretory vesicles leading to norepinephrine depletion",
"C": "Binds to cannabinoid receptors",
"D": "Activates mu opioid receptors"
} | step1 | A | [
"20 year old college student presents",
"emergency room complaining of insomnia",
"past 48 hours",
"body feels tired",
"full of energy",
"focus",
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"hour",
"now",
"to sleep",
"hallucinations",
"vital signs",
"T 100 0 F",
"BP",
"mmHg",
"patient states",
"rece... |
You submit a paper to a prestigious journal about the effects of coffee consumption on mesothelioma risk. The first reviewer lauds your clinical and scientific acumen, but expresses concern that your study does not have adequate statistical power. Statistical power refers to which of the following? | The probability of detecting an association when an association does exist. | {
"A": "The probability of detecting an association when no association exists.",
"B": "The probability of detecting an association when an association does exist.",
"C": "The probability of not detecting an association when an association does exist.",
"D": "The probability of not detecting an association when... | step1 | B | [
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"refers"
] |
A 35-year-old African American man presents with fever, abdominal pain, and severe weakness since yesterday. On physical examination, the patient is jaundiced and shows a generalized pallor. Past medical history is significant for recently receiving anti-malaria prophylaxis before visiting Nigeria. Laboratory tests sho... | Glucose-6-phosphate-dehydrogenase (G6PD) deficiency | {
"A": "Autoimmune hemolytic anemia",
"B": "Microangiopathic hemolytic anemia",
"C": "Paroxysmal nocturnal hemoglobinuria (PNH)",
"D": "Glucose-6-phosphate-dehydrogenase (G6PD) deficiency"
} | step1 | D | [
"35 year old African American man presents",
"fever",
"abdominal pain",
"severe weakness",
"physical examination",
"patient",
"jaundiced",
"shows",
"generalized pallor",
"Past medical history",
"significant",
"recently receiving anti-malaria prophylaxis",
"visiting Nigeria",
"Laboratory te... |
A 42-year-old man with hypertension and type 2 diabetes mellitus is admitted to the hospital because of swelling and redness of the left leg for 3 days. He has chills and malaise. He is treated with intravenous clindamycin for 7 days. On the 8th day at the hospital, he has profuse, foul-smelling, and watery diarrhea. H... | Oral fidaxomicin | {
"A": "Oral metronidazole",
"B": "Oral fidaxomicin",
"C": "Oral rifaximin",
"D": "Intravenous metronidazole"
} | step2&3 | B | [
"year old man",
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"type 2 diabetes mellitus",
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"redness of",
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"3 days",
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"malaise",
"treated with intravenous clindamycin",
"7 days",
"day",
"hospital",
"smelling",
"watery diarrhea",
"nausea",
"intermittent abd... |
A 14-year-old girl is brought to the physician because of a 10-day history of vaginal bleeding. The flow is heavy with the passage of clots. Since menarche 1 year ago, menses have occurred at irregular 26- to 32-day intervals and last 3 to 6 days. Her last menstrual period was 4 weeks ago. She has no history of serious... | Conjugated estrogen therapy | {
"A": "Tranexamic acid",
"B": "Uterine artery embolization",
"C": "Uterine curretage",
"D": "Conjugated estrogen therapy"
} | step2&3 | D | [
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"irregular",
"day intervals",
"last 3",
"days",
"last menstrual period",
"4 weeks",
"history",
"serious illness",
... |
An investigator is studying the structural integrity of collagen. Human fibroblasts are cultured on a medium and different enzymes are applied. One of the cultures is supplemented with an enzyme that inhibits the formation of hydrogen and disulfide bonds between collagen α-chains. Which of the following processes is mo... | Bone matrix synthesis | {
"A": "Bone matrix synthesis",
"B": "Osteoclast activation",
"C": "Internal elastic lamina formation",
"D": "Cartilaginous growth plate mineralization"
} | step1 | A | [
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"inhibits",
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"following proce... |
A 12-year-old African American is exposed to pollen while playing outside. The allergen stimulates TH2 cells of his immune system to secrete a factor that leads to B-cell class switching to IgE. What factor is secreted by the TH2 cell? | IL-4 | {
"A": "IFN-gamma",
"B": "IL-4",
"C": "IL-17",
"D": "TGF-beta"
} | step1 | B | [
"year old African American",
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"immune system to secrete",
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"TH2 cell"
] |
A 3-year-old boy is brought to the physician because of a 5-day history of yellowing of his eyes and skin. He has had generalized fatigue and mild shortness of breath over the past 2 months. Examination shows pale conjunctivae and scleral jaundice. The spleen is palpated 4 cm below the left costal margin. Laboratory st... | Work hypertrophy | {
"A": "Reticuloendothelial hyperplasia",
"B": "Metabolite accumulation",
"C": "Work hypertrophy",
"D": "Extramedullary hematopoiesis"
} | step1 | C | [
"3 year old boy",
"brought",
"physician",
"5-day history",
"yellowing",
"eyes",
"skin",
"generalized fatigue",
"mild shortness of breath",
"past",
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"Examination shows pale conjunctivae",
"scleral jaundice",
"spleen",
"palpated 4 cm",
"left costal margin",
"Laboratory studies... |
A 55-year-old woman comes to the physician because of a 4-day history of chest pain and cough with rust-colored sputum. The chest pain is sharp, stabbing, and exacerbated by coughing. Ten days ago, she had a sore throat and a runny nose. She was diagnosed with multiple sclerosis at the age of 40 years and uses a wheelc... | Pulmonary embolism | {
"A": "Pericarditis",
"B": "Bacterial pneumonia",
"C": "Pulmonary embolism",
"D": "Pulmonary edema"
} | step2&3 | C | [
"55 year old woman",
"physician",
"of",
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"chest pain",
"cough",
"rust colored",
"chest pain",
"sharp",
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"Ten days",
"sore throat",
"runny nose",
"diagnosed",
"multiple sclerosis",
"age",
"40",
"uses",
"wheelchair",
"mobi... |
An 8-year-old boy is brought to the pediatrician by his parents due to recurrent episodes of wheezing for the last 2 years. He uses a salbutamol inhaler for relief from wheezing, but his symptoms have recently worsened. He often coughs during the night, which awakens him from sleep almost every other day. He is not abl... | Hoarseness of voice | {
"A": "Suppression of hypothalamus-pituitary-adrenal (HPA) axis",
"B": "Steroid psychosis",
"C": "Hoarseness of voice",
"D": "Short stature"
} | step1 | C | [
"year old boy",
"brought",
"pediatrician",
"parents due to recurrent episodes of wheezing",
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"symptoms",
"recently worsened",
"often coughs",
"night",
"sleep almost",
"day",
"not able to play football",
"starts cou... |
A 40-year-old male accountant is brought to the physician by his wife. She complains of her husband talking strangely for the past 6 months. She has taken him to multiple physicians during this time, but her husband did not comply with their treatment. She says he keeps things to himself, stays alone, and rarely spends... | Patient has disorganized thinking | {
"A": "It is associated with a better prognosis",
"B": "Patient has no insight",
"C": "Patient has disorganized thinking",
"D": "Confrontational psychoeducation would be beneficial"
} | step1 | C | [
"40 year old male accountant",
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"wife",
"husband talking",
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"husband",
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"treatment",
"keeps things",
"alone",
"rarely spends time",
"kids",
"clear",
"I",
"fine",
"pine",
"dine doc",
... |
A 62-year-old man comes to the physician because of painless swelling in his left foot for 4 months. The swelling was initially accompanied by redness, which has since resolved. He has not had fever or chills. He has a history of coronary artery disease, hyperlipidemia, and type 2 diabetes mellitus. He has had 3 sexual... | Diabetic arthropathy | {
"A": "Calcium pyrophosphate arthropathy",
"B": "Tertiary syphilis",
"C": "Reactive arthritis",
"D": "Diabetic arthropathy"
} | step2&3 | D | [
"62 year old man",
"physician",
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"left foot",
"4 months",
"swelling",
"initially",
"redness",
"since resolved",
"not",
"fever",
"chills",
"history of coronary artery disease",
"hyperlipidemia",
"type 2 diabetes mellitus",
"3 sexual partners",
"past year",
"us... |
A critical care fellow is interested in whether the auscultatory finding of pulmonary rales can accurately predict hypervolemic state. He conducts a study in 100 patients with volume overloaded state confirmed by a Swan Ganz catheter in his hospital's cardiac critical care unit. He also recruits 100 patients with euvol... | 80/130 | {
"A": "50/100",
"B": "80/130",
"C": "50/70",
"D": "100/200"
} | step2&3 | B | [
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"state confirmed by",
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"hospital's cardiac critical care unit",
"100 patients",
"euvolemic state confirmed by Swan Ganz catheter",
"patients",
... |
An investigator is studying the efficacy of preventative measures to reduce pesticide poisonings among Central American farmers. The investigator evaluates the effect of a ban on aldicarb, an especially neurotoxic pesticide of the carbamate class. The ban aims to reduce pesticide poisonings attributable to carbamates. ... | 0.04 | {
"A": "0.04",
"B": "0.2",
"C": "90",
"D": "0.8"
} | step1 | A | [
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"carbamate class",
"ban aims to",
"pesticide poisonings attributable",
"carbamates",
"i... |
A 65-year-old man comes to the physician because of double vision that began this morning. He has hypertension and type 2 diabetes mellitus. He has smoked two packs of cigarettes daily for 40 years. His current medications include lisinopril, metformin, and insulin. Physical examination shows the right eye is abducted ... | Upper eyelid droop on the right eye | {
"A": "Absent consensual light reaction on the right eye",
"B": "Loss of the right nasolabial fold",
"C": "Upper eyelid droop on the right eye",
"D": "Loss of smell"
} | step1 | C | [
"65 year old man",
"physician",
"double vision",
"began",
"morning",
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"type 2 diabetes mellitus",
"smoked two packs",
"cigarettes daily",
"40 years",
"current medications include lisinopril",
"metformin",
"insulin",
"Physical examination shows",
"right eye",
"depressed",... |
A 55-year-old woman returns to her physician for a follow-up on the anemia that was detected last month. She received treatment for a nasopharyngeal infection 2 weeks ago. She was diagnosed with small cell lung cancer 2 years ago and was treated with combination chemotherapy. She was a 30-pack-year smoker and quit when... | Chemotherapy | {
"A": "Chemotherapy",
"B": "Small cell lung cancer",
"C": "Tobacco smoking",
"D": "Vegan diet"
} | step2&3 | A | [
"55 year old woman returns",
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"detected last month",
"received treatment",
"nasopharyngeal infection 2 weeks",
"diagnosed",
"small cell lung cancer",
"years",
"treated with combination chemotherapy",
"30 pack-year smoker",
"quit",
"lung cancer",
"vegan"... |
A 41-year-old woman comes to the physician because of a 3-month history of anxiety, difficulty falling asleep, heat intolerance, and a 6-kg (13.2-lb) weight loss. The patient's nephew, who is studying medicine, mentioned that her symptoms might be caused by a condition that is due to somatic activating mutations of the... | Nonpitting edema | {
"A": "Nonpitting edema",
"B": "Atrial fibrillation",
"C": "Lid lag",
"D": "Fine tremor"
} | step1 | A | [
"year old woman",
"physician",
"3 month history",
"anxiety",
"difficulty falling asleep",
"heat intolerance",
"kg",
"weight loss",
"patient's nephew",
"studying medicine",
"symptoms",
"caused",
"condition",
"due to somatic activating mutations",
"genes",
"TSH receptor",
"Examination ... |
A 67-year-old man presents to his primary care physician primarily complaining of a tremor. He said that his symptoms began approximately 1 month ago, when his wife noticed his right hand making "abnormal movements" while watching television. His tremor worsens when he is distracted and improves with purposeful action,... | Carbidopa-levodopa | {
"A": "Amantadine",
"B": "Carbidopa-levodopa",
"C": "Selegiline",
"D": "Trihexyphenidyl"
} | step2&3 | B | [
"67 year old man presents",
"primary care physician",
"tremor",
"symptoms began approximately",
"month",
"wife",
"right hand making",
"abnormal movements",
"watching television",
"tremor worsens",
"improves",
"purposeful action",
"brushing",
"teeth",
"combing",
"hair",
"reports to",
... |
Immediately after undergoing a right total knee replacement, a 69-year-old woman has severe abdominal pain, non-bloody emesis, and confusion. She has a history of Hashimoto thyroiditis that is well-controlled with levothyroxine and hyperlipidemia that is controlled by diet. She underwent bunion removal surgery from her... | High-dose hydrocortisone | {
"A": "High-dose hydrocortisone",
"B": "Noncontrast CT of the head",
"C": "Intravenous hypotonic saline infusion",
"D": "CT angiogram of the abdomen"
} | step2&3 | A | [
"Immediately",
"right total knee replacement",
"69 year old woman",
"severe abdominal",
"non bloody emesis",
"confusion",
"history",
"Hashimoto thyroiditis",
"well-controlled",
"levothyroxine",
"hyperlipidemia",
"controlled by diet",
"bunion removal",
"right foot 10 years",
"temperature"... |
A 16-year-old presents to the primary care physician because he has noticed an increase in the size of his breast tissue over the past 3 years. He states that he is significantly taller than his entire class at school although he feels increasingly weak and uncoordinated. He performs at the bottom of his grade level ac... | 47, XXY | {
"A": "47, XXY",
"B": "46, XY",
"C": "47, XY",
"D": "45, XO"
} | step1 | A | [
"year old presents",
"primary care physician",
"increase in",
"size",
"breast tissue",
"past",
"years",
"states",
"entire class",
"school",
"feels",
"weak",
"uncoordinated",
"performs",
"bottom",
"grade level",
"physical exam",
"patient",
"marked gynecomastia",
"small firm test... |
A 30-year-old woman comes to the physician because of increased urinary frequency over the past month. She also reports having dry mouth and feeling thirsty all the time despite drinking several liters of water per day. She has not had any weight changes and her appetite is normal. She has a history of obsessive compul... | Primary polydipsia | {
"A": "Cerebral salt wasting",
"B": "Diabetes mellitus",
"C": "Primary polydipsia",
"D": "Nephrogenic diabetes insipidus"
} | step2&3 | C | [
"30 year old woman",
"physician",
"of increased urinary frequency",
"past month",
"reports",
"dry mouth",
"feeling thirsty",
"time",
"drinking",
"liters",
"water",
"day",
"not",
"weight changes",
"appetite",
"normal",
"history of",
"disorder treated with citalopram",
"drinks",
... |
A 43-year-old woman comes to the physician because of tingling and weakness in her left arm for the past 2 days. An image of the brachial plexus is shown. Nerve conduction study shows decreased transmission of electrical impulses in the labeled structure. Physical examination is most likely to show impairment of which ... | Extension of the wrist and fingers | {
"A": "Extension of the wrist and fingers",
"B": "Opposition of the thumb",
"C": "Flexion of the metacarpophalangeal joints",
"D": "Abduction of the shoulder above 100 degrees"
} | step1 | A | [
"year old woman",
"physician",
"tingling",
"weakness",
"left",
"past 2 days",
"image",
"brachial plexus",
"shown",
"Nerve conduction study shows decreased transmission",
"electrical impulses",
"labeled structure",
"Physical examination",
"most likely to show impairment",
"following movem... |
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