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 45-year-old woman diagnosed with a meningioma localized to the tuberculum sellae undergoes endonasal endoscopic transsphenoidal surgery to resect her tumor. Although the surgery had no complications and the patient is recovering well with no neurological sequelae, she develops intense polydipsia and polyuria. Her pas... | Increase in urine osmolality to greater than 264 mOsm/L | {
"A": "Reduction in urine osmolality to 125 mOsm/L",
"B": "Reduction in urine osmolality to 80 mOsm/L",
"C": "Increase in urine osmolality to greater than 264 mOsm/L",
"D": "No changes in urine osmolality values"
} | step1 | C | [
"year old woman diagnosed",
"meningioma localized",
"tuberculum sellae",
"endonasal endoscopic transsphenoidal to resect",
"tumor",
"surgery",
"complications",
"patient",
"recovering well",
"neurological sequelae",
"intense polydipsia",
"polyuria",
"past medical history",
"negative",
"di... |
A 24-year-old woman comes to the emergency department because of a 4-hour history of headaches, nausea, and vomiting. During this time, she has also had recurrent dizziness and palpitations. The symptoms started while she was at a friend's birthday party, where she had one beer. One week ago, the patient was diagnosed ... | Trichomonas vaginalis | {
"A": "Trichomonas vaginalis",
"B": "Herpes simplex virus",
"C": "Neisseria gonorrhoeae",
"D": "Candida albicans"
} | step1 | A | [
"year old woman",
"emergency department",
"of",
"4-hour history",
"headaches",
"nausea",
"vomiting",
"time",
"recurrent dizziness",
"palpitations",
"symptoms started",
"friend's",
"party",
"one beer",
"week",
"patient",
"diagnosed",
"genitourinary infection",
"started",
"antimi... |
A 47-year-old woman comes to the physician because of progressive pain and stiffness in her hands and wrists for the past several months. Her hands are stiff in the morning; the stiffness improves as she starts her chores. Physical examination shows bilateral swelling and tenderness of the wrists, metacarpophalangeal j... | IgM antibodies against the Fc region of IgG | {
"A": "IgG antibodies with a TNF-α binding domain on the Fc region",
"B": "HLA-DQ2 proteins on white blood cells",
"C": "HLA-A3 proteins on white blood cells",
"D": "IgM antibodies against the Fc region of IgG"
} | step1 | D | [
"year old woman",
"physician",
"progressive pain",
"stiffness",
"hands",
"wrists",
"past",
"months",
"hands",
"stiff",
"morning",
"stiffness improves",
"starts",
"chores",
"Physical examination shows bilateral swelling",
"tenderness",
"wrists",
"metacarpophalangeal joints",
"prox... |
Which of the following is most likely to have prevented this patient's condition? | High-fiber diet | {
"A": "High-fiber diet",
"B": "Long-term use of aspirin",
"C": "Anticoagulation with warfarin",
"D": "Different antibiotic regimen for bronchitis"
} | step2&3 | A | [
"following",
"most likely to",
"prevented",
"patient's condition"
] |
A 44-year-old man comes to the emergency department because of persistent palpitations for the past 2 hours. The day before, he was at a wedding, where he drank several glasses of wine and 9–10 vodka cocktails. He has never had similar symptoms before. He is a manager at a software company and has recently had a lot of... | Observation | {
"A": "Observation",
"B": "Adenosine injection",
"C": "Defibrillation",
"D": "Electrical cardioversion\n\""
} | step2&3 | A | [
"year old man",
"emergency department",
"of persistent palpitations",
"past",
"hours",
"day",
"wedding",
"drank several glasses",
"wine",
"vodka cocktails",
"never",
"similar symptoms",
"manager",
"software company",
"recently",
"lot",
"work-related stress",
"healthy",
"takes",
... |
A previously healthy 29-year-old man comes to the emergency department for a 2-day history of abdominal pain, vomiting, and watery diarrhea. Bowel movements occur every 3 hours and are non-bloody. He recently returned from a backpacking trip in Central America. He does not take any medications. Stool culture shows gram... | Heat-labile toxin | {
"A": "Cereulide",
"B": "Heat-labile toxin",
"C": "Enterotoxin B",
"D": "Shiga toxin"
} | step1 | B | [
"healthy 29 year old man",
"emergency department",
"2-day history",
"abdominal pain",
"vomiting",
"watery diarrhea",
"Bowel movements occur",
"3 hours",
"non bloody",
"recently returned",
"trip",
"Central America",
"not take",
"medications",
"Stool shows gram-negative",
"rod-shaped bac... |
A 40-year-old woman presents with abdominal pain and yellow discoloration of the skin for the past 4 days. She says that her symptoms onset gradually and progressively worsened. Past medical history is unremarkable. She has been taking oral contraceptive pills for 4 years. Her vitals include: pulse 102/min, respiratory... | Budd-Chiari syndrome | {
"A": "Budd-Chiari syndrome",
"B": "Viral hepatitis",
"C": "Nonalcoholic fatty liver disease",
"D": "Drug-induced hepatitis"
} | step1 | A | [
"40 year old woman presents",
"abdominal pain",
"yellow discoloration",
"skin",
"past",
"days",
"symptoms onset",
"worsened",
"Past medical history",
"unremarkable",
"taking oral contraceptive pills",
"years",
"include",
"pulse",
"min",
"respiratory rate",
"min",
"temperature",
"... |
During a study on gastrointestinal hormones, a volunteer is administered the hormone secreted by S cells. Which of the following changes most likely represent the effect of this hormone on gastric and duodenal secretions?
$$$ Gastric H+ %%% Duodenal HCO3- %%% Duodenal Cl- $$$ | ↓ ↑ ↓ | {
"A": "↓ ↓ ↓",
"B": "↓ no change no change",
"C": "↓ ↑ ↓",
"D": "↑ ↓ no change"
} | step1 | C | [
"study",
"gastrointestinal hormones",
"volunteer",
"administered",
"hormone secreted",
"cells",
"following changes",
"likely represent",
"effect",
"hormone",
"gastric",
"duodenal secretions",
"Gastric H",
"Duodenal HCO3",
"Cl"
] |
A 56-year-old man is brought to the emergency department after 4 hours of severe abdominal pain with an increase in its intensity over the last hour. His personal history is relevant for peptic ulcer disease and H. pylori infection that is being treated with clarithromycin triple therapy. Upon admission his vital signs... | Emergency abdominal surgery | {
"A": "Abdominal computed tomography",
"B": "Emergency endoscopy",
"C": "Emergency abdominal surgery",
"D": "Nasogastric tube placement followed by gastric lavage"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"4",
"severe abdominal",
"increase",
"intensity",
"last hour",
"personal history",
"relevant",
"peptic ulcer disease",
"H",
"pylori infection",
"treated with clarithromycin triple therapy",
"admission",
"vital signs",
"follows",
"p... |
A 28-year-old medical student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factu... | Risperidone | {
"A": "Propranolol",
"B": "Sertraline",
"C": "Phenelzine",
"D": "Risperidone"
} | step2&3 | D | [
"year old medical student presents",
"student health center",
"complaint",
"unable to sleep",
"very successful student",
"past",
"months",
"patient states",
"wakes up 10",
"times",
"night to check",
"textbooks",
"recall",
"to suppress",
"thoughts",
"actions",
"extremely anxious",
"... |
A 15-year-old male presents to his pediatrician after school for follow-up after an appendectomy one week ago. The patient denies any abdominal pain, fevers, chills, nausea, vomiting, diarrhea, or constipation. He eats solids and drinks liquids without difficulty. He is back to playing basketball for his school team wi... | Urine dipstick in the morning and in the afternoon | {
"A": "Basic metabolic panel",
"B": "Renal biopsy",
"C": "Urine dipstick in the morning and in the afternoon",
"D": "Urine electrolytes and creatinine"
} | step2&3 | C | [
"year old male presents",
"pediatrician",
"school",
"follow-up",
"appendectomy one week",
"patient denies",
"abdominal pain",
"fevers",
"chills",
"nausea",
"vomiting",
"diarrhea",
"constipation",
"eats solids",
"drinks liquids",
"difficulty",
"back",
"playing basketball",
"school... |
A 29-year-old woman presents to her gynecologist for a routine check-up. She is sexually active with multiple partners and intermittently uses condoms for contraception. She denies vaginal discharge, burning, itching, or rashes in her inguinal region. Pelvic examination is normal. Results from a routine pap smear are s... | Inhibition of p53 | {
"A": "Inhibition of p53",
"B": "Activation p53",
"C": "Activation of Rb",
"D": "Activation of K-Ras"
} | step1 | A | [
"29 year old woman presents",
"gynecologist",
"routine check-up",
"sexually active",
"multiple partners",
"uses condoms",
"contraception",
"denies vaginal discharge",
"burning",
"itching",
"rashes",
"inguinal region",
"Pelvic examination",
"normal",
"Results",
"routine pap smear",
"s... |
An investigator is developing a drug that results in contraction of the pupillary dilator muscle when instilled topically. The drug works by increasing neurotransmitter release from the presynaptic nerve terminal. When administered intravenously, this drug is most likely to have which of the following additional effect... | Increase in pyloric sphincter tone | {
"A": "Contraction of skeletal muscles",
"B": "Relaxation of the bladder neck sphincter",
"C": "Release of epinephrine by the adrenal medulla",
"D": "Increase in pyloric sphincter tone"
} | step1 | D | [
"investigator",
"drug",
"results",
"contraction of",
"pupillary dilator muscle",
"instilled",
"drug works",
"increasing neurotransmitter",
"presynaptic nerve",
"administered",
"drug",
"most likely to",
"following additional effects"
] |
A previously healthy 7-month-old boy presents with fever, chills, cough, runny nose, and watery eyes. He has a blood pressure of 115/76 mm Hg, heart rate of 84/min, and respiratory rate of 14/min. Physical examination reveals clear lung sounds bilaterally. His mother reports that his brother has been having similar sym... | Natural killer cell-induced lysis of infected cells | {
"A": "Eosinophil-mediated lysis of infected cells",
"B": "Complement-mediated lysis of infected cells",
"C": "Presentation of viral peptides on MHC-II of CD4+ T cells",
"D": "Natural killer cell-induced lysis of infected cells"
} | step1 | D | [
"healthy",
"month old boy presents",
"fever",
"chills",
"cough",
"runny nose",
"watery eyes",
"blood pressure",
"76 mm Hg",
"heart rate",
"84 min",
"respiratory rate",
"min",
"Physical examination reveals clear lung sounds",
"mother reports",
"brother",
"similar symptoms",
"nasal s... |
A 57-year-old man presents with an ongoing asymptomatic rash for 2 weeks. A similar rash is seen in both axillae. He has a medical history of diabetes mellitus for 5 years and dyspepsia for 6 months. His medications include metformin and aspirin. His vital signs are within normal limits. His BMI is 29 kg/m2. The physic... | Gastric cancer | {
"A": "Diabetes mellitus",
"B": "Gastric cancer",
"C": "Metformin",
"D": "Sarcoidosis"
} | step2&3 | B | [
"57 year old man presents",
"ongoing asymptomatic rash",
"2 weeks",
"similar rash",
"seen",
"axillae",
"medical history of diabetes mellitus",
"5 years",
"dyspepsia",
"months",
"medications include metformin",
"aspirin",
"vital signs",
"normal limits",
"BMI",
"29 kg/m2",
"physical ex... |
During a humanitarian mission to southeast Asia, a 42-year-old man is brought to the outpatient clinic for a long history (greater than 2 years) of progressive, painless, enlargement of his scrotum. The family history is negative for malignancies and inheritable diseases. The personal history is relevant for cigarette ... | Decreased lymphatic fluid absorption | {
"A": "Autoimmune",
"B": "Invasive neoplasm",
"C": "Decreased lymphatic fluid absorption",
"D": "Patent processus vaginalis"
} | step1 | C | [
"mission",
"southeast Asia",
"year old man",
"brought",
"outpatient clinic",
"long history",
"greater than",
"years",
"progressive",
"painless",
"enlargement",
"scrotum",
"family history",
"negative",
"malignancies",
"diseases",
"personal history",
"relevant",
"cigarette smoking"... |
A 25-year-old African-American woman visits the doctor’s office complaining of fatigue for a couple of months. She says that she feels exhausted by the end of the day. She works as a dental assistant and is on her feet most of the time. However, she eats well and also tries to walk for 30 minutes every morning. She als... | Thalassemia | {
"A": "Thalassemia",
"B": "B12 deficiency",
"C": "Hemolysis",
"D": "Folate deficiency"
} | step2&3 | A | [
"year old African-American woman visits",
"doctors office",
"fatigue",
"couple",
"months",
"feels exhausted",
"end",
"day",
"works",
"dental assistant",
"feet",
"time",
"eats well",
"to walk",
"30 minutes",
"morning",
"sometimes feels breathless",
"gasp",
"air",
"walking",
"j... |
A 32-year-old woman comes to the emergency department with a 2-day history of abdominal pain and diarrhea. She has had about 8 voluminous stools per day, some of which were bloody. She visited an international food festival three days ago. She takes no medications. Her temperature is 39.5°C (103.1°F), pulse is 90/min, ... | Omelette | {
"A": "Reheated rice",
"B": "Yogurt dip",
"C": "Toxic mushrooms",
"D": "Omelette"
} | step2&3 | D | [
"year old woman",
"emergency department",
"2-day history",
"abdominal pain",
"diarrhea",
"about",
"voluminous stools",
"day",
"bloody",
"visited",
"international food festival three days",
"takes",
"medications",
"temperature",
"pulse",
"90 min",
"blood pressure",
"65 mm Hg",
"Ex... |
A 72-year-old man goes to his primary care provider for a checkup after some blood work showed lymphocytosis 3 months ago. He says he has been feeling a bit more tired lately but doesn’t complain of any other symptoms. Past medical history is significant for hypertension and hyperlipidemia. He takes lisinopril, hydroch... | Chronic lymphocytic leukemia | {
"A": "Chronic lymphocytic leukemia",
"B": "Tuberculosis",
"C": "Acute lymphoblastic leukemia",
"D": "Immune thrombocytopenic purpura"
} | step1 | A | [
"72 year old man goes",
"primary care provider",
"checkup",
"blood work showed lymphocytosis",
"months",
"feeling",
"bit more tired",
"symptoms",
"Past medical history",
"significant",
"hypertension",
"hyperlipidemia",
"takes lisinopril",
"hydrochlorothiazide",
"atorvastatin",
"right h... |
If the genetic material were isolated and injected into the cytoplasm of a human cell, which of the following would produce viable, infectious virions? | Rhinovirus | {
"A": "Rhinovirus",
"B": "Rabies virus",
"C": "Influenza virus",
"D": "Lassa fever virus"
} | step1 | A | [
"genetic material",
"isolated",
"injected",
"cytoplasm",
"human cell",
"following",
"viable",
"infectious virions"
] |
A 57-year-old man comes to the physician because of a 2-year history of fatigue, worsening shortness of breath, and a productive cough for 2 years. He has smoked 1 pack of cigarettes daily for the past 40 years. Examination shows pursed-lip breathing and an increased anteroposterior chest diameter. There is diffuse whe... | Lung elastic recoil | {
"A": "Work of breathing",
"B": "Lung elastic recoil",
"C": "Thickness of small airways",
"D": "Pulmonary vascular pressure"
} | step1 | B | [
"57 year old man",
"physician",
"2 year history",
"fatigue",
"worsening shortness of breath",
"productive cough",
"years",
"smoked 1 pack",
"cigarettes daily",
"past 40 years",
"Examination shows pursed-lip breathing",
"increased",
"chest diameter",
"diffuse wheezing",
"breath sounds",
... |
A 3255-g (7-lb) female newborn is delivered at term. Pregnancy and delivery were uncomplicated. On the day of her birth, she is given a routine childhood vaccine that contains a noninfectious glycoprotein. This vaccine will most likely help prevent infection by which of the following pathogens? | Hepatitis D virus
" | {
"A": "Poliovirus",
"B": "Bordetella pertussis",
"C": "Rotavirus",
"D": "Hepatitis D virus\n\""
} | step1 | D | [
"g",
"female newborn",
"delivered",
"term",
"Pregnancy",
"delivery",
"uncomplicated",
"day",
"birth",
"given",
"routine childhood",
"contains",
"noninfectious glycoprotein",
"vaccine",
"most likely help prevent infection",
"following pathogens"
] |
A 47-year-old woman comes to the physician for a mass in her left breast she noticed 2 days ago during breast self-examination. She has hypothyroidism treated with levothyroxine. There is no family history of breast cancer. Examination shows large, moderately ptotic breasts. The mass in her left breast is small (approx... | Lumpectomy with sentinel lymph node biopsy, followed by radiation and hormone therapy
" | {
"A": "Nipple-sparing mastectomy with axillary lymph node dissection followed by hormone therapy",
"B": "Lumpectomy with sentinel lymph node biopsy followed by hormone therapy",
"C": "Radical mastectomy followed by hormone therapy",
"D": "Lumpectomy with sentinel lymph node biopsy, followed by radiation and ho... | step2&3 | D | [
"year old woman",
"physician",
"mass in",
"left breast",
"2 days",
"breast self-examination",
"hypothyroidism treated with levothyroxine",
"family history of breast cancer",
"Examination shows large",
"moderately ptotic breasts",
"mass in",
"left breast",
"small",
"approximately",
"0.5",... |
A 50-year-old male is brought to the dermatologist's office with complaints of a pigmented lesion. The lesion is uniformly dark with clean borders and no asymmetry and has been increasing in size over the past two weeks. He works in construction and spends large portions of his day outside. The dermatologist believes t... | Pressure | {
"A": "Sympathetic stimulation",
"B": "Temperature",
"C": "Touch",
"D": "Pressure"
} | step1 | D | [
"50 year old male",
"brought",
"dermatologist's office",
"complaints",
"pigmented lesion",
"lesion",
"dark",
"clean borders",
"asymmetry",
"increasing in size",
"past two weeks",
"works",
"construction",
"spends large portions",
"day outside",
"dermatologist",
"mole",
"biopsied",
... |
A 36-year-old man is brought to the emergency department 3 hours after the onset of progressively worsening upper abdominal pain and 4 episodes of vomiting. His father had a myocardial infarction at the age of 40 years. Physical examination shows tenderness and guarding in the epigastrium. Bowel sounds are decreased. H... | Eruptive xanthomas | {
"A": "Salt and pepper skull",
"B": "Decreased serum ACTH levels",
"C": "Eruptive xanthomas",
"D": "Elevated serum IgG4 levels"
} | step1 | C | [
"36 year old man",
"brought",
"emergency department",
"hours",
"onset",
"worsening upper abdominal pain",
"4 episodes of vomiting",
"father",
"myocardial infarction",
"age",
"40 years",
"Physical examination shows tenderness",
"guarding",
"epigastrium",
"Bowel sounds",
"decreased",
"... |
A 40-year-old man presents to the emergency department with a chief complaint of chest pain for the last 3 hours. His ECG shows normal sinus rhythm with ST-segment elevation in leads II, III, and aVF and reciprocal segment depression in leads V1–V6. On physical examination, cardiac sounds are normal on auscultation. Hi... | Free radical formation | {
"A": "Increase in cellular pH",
"B": "Calcium efflux",
"C": "Inhibition of lipid peroxidation",
"D": "Free radical formation"
} | step1 | D | [
"40 year old man presents",
"emergency department",
"chief complaint of chest pain",
"last",
"hours",
"ECG shows normal sinus rhythm",
"ST-segment elevation",
"leads",
"III",
"aVF",
"reciprocal segment depression",
"leads",
"physical examination",
"cardiac sounds",
"normal",
"auscultat... |
A 31-year-old woman comes to the physician for evaluation of worsening pain, swelling, and erythema in her left leg for the past 4 hours. She returned from a trip to Taiwan to celebrate her sister's wedding 2 days ago. She has no history of serious illness. She is sexually active with one male partner and uses a combin... | Decreased protein S
" | {
"A": "Decreased fibrinogen",
"B": "ADAMTS13 deficiency",
"C": "Vitamin K supplementation",
"D": "Decreased protein S\n\""
} | step2&3 | D | [
"31 year old woman",
"physician",
"evaluation",
"worsening",
"swelling",
"erythema",
"left leg",
"past",
"hours",
"returned",
"trip",
"Taiwan to",
"sister's wedding 2 days",
"history",
"serious illness",
"sexually active",
"one male partner",
"uses",
"combined oral contraceptive ... |
A 9-year-old male presents to your office with an indurated rash on his face. You diagnose erythema infectiosum. Which of the following is characteristic of the virus causing this patient's disease? | Non-enveloped virus with single-stranded DNA | {
"A": "Enveloped virus with single-stranded DNA",
"B": "Enveloped virus with single-stranded RNA",
"C": "Non-enveloped virus with double-stranded DNA",
"D": "Non-enveloped virus with single-stranded DNA"
} | step1 | D | [
"year old male presents",
"office",
"indurated rash on",
"face",
"diagnose erythema infectiosum",
"following",
"characteristic",
"virus causing",
"patient's disease"
] |
A 5-year-old boy is brought to the physician because of behavioral problems. His mother says that he has frequent angry outbursts and gets into fights with his classmates. He constantly complains of feeling hungry, even after eating a full meal. He has no siblings, and both of his parents are healthy. He is at the 25th... | Methylation of maternal chromosome 15 | {
"A": "Microdeletion of long arm of chromosome 7",
"B": "Mutation of FBN-1 gene on chromosome 15",
"C": "Deletion of Phe508 on maternal chromosome 7",
"D": "Methylation of maternal chromosome 15"
} | step1 | D | [
"5 year old boy",
"brought",
"physician",
"behavioral problems",
"mother",
"frequent angry outbursts",
"gets",
"fights",
"classmates",
"constantly",
"feeling hungry",
"eating",
"full meal",
"siblings",
"parents",
"healthy",
"percentile",
"height",
"95th percentile",
"weight",
... |
A 55-year-old woman with type 1 diabetes mellitus comes to the physician because of a 3-month history of progressively worsening urinary incontinence. She has started to wear incontinence pads because of frequent involuntary dribbling of urine that occurs even when resting. She has the sensation of a full bladder even ... | Intermittent catheterization | {
"A": "Intermittent catheterization",
"B": "Amitriptyline therapy",
"C": "Prazosin therapy",
"D": "Oxybutynin therapy"
} | step1 | A | [
"55 year old woman",
"type 1 diabetes mellitus",
"physician",
"3 month history",
"worsening urinary incontinence",
"started to",
"incontinence",
"of frequent involuntary dribbling",
"urine",
"occurs",
"resting",
"sensation of",
"full bladder",
"voiding",
"only medication",
"insulin",
... |
A 55-year-old man with a past medical history of diabetes and hypertension presents to the emergency department with crushing substernal chest pain. He was given aspirin and nitroglycerin en route and states that his pain is currently a 2/10. The patient’s initial echocardiogram (ECG) is within normal limits, and his f... | Coronary steal | {
"A": "Cardiac sarcoidosis",
"B": "Coronary steal",
"C": "Stress induced cardiomyopathy",
"D": "Vasospastic vessel disease"
} | step2&3 | B | [
"55 year old man",
"past medical history of diabetes",
"hypertension presents",
"emergency department",
"crushing",
"chest pain",
"given aspirin",
"nitroglycerin en route",
"states",
"pain",
"currently",
"2 10",
"patients initial echocardiogram",
"normal limits",
"first set",
"cardiac ... |
A 3-year-old boy is brought in by his parents to the emergency department for lethargy and vomiting. The patient was fine until this afternoon, when his parents found him in the garage with an unlabeled open bottle containing an odorless liquid. On exam, the patient is not alert or oriented, but is responsive to touch ... | Fomepizole | {
"A": "Glucagon",
"B": "Fomepizole",
"C": "Epinephrine",
"D": "Sodium bicarbonate"
} | step1 | B | [
"3 year old boy",
"brought",
"parents",
"emergency department",
"lethargy",
"vomiting",
"patient",
"fine",
"afternoon",
"parents found",
"garage",
"open bottle containing",
"liquid",
"exam",
"patient",
"not alert",
"oriented",
"responsive",
"touch",
"pain",
"patient",
"afeb... |
A 27-year-old woman was found lying unconscious on the side of the street by her friend. He immediately called the ambulance who were close to this neighborhood. On initial examination, she appears barely able to breathe. Her pupils are pinpoint. The needles she likely used were found on site but the drug she injected ... | Mu receptor antagonist | {
"A": "Kappa receptor pure agonist",
"B": "Alpha 2 receptor agonist",
"C": "Mu receptor antagonist",
"D": "Delta receptor antagonist"
} | step1 | C | [
"27 year old woman",
"found lying unconscious",
"side",
"street",
"friend",
"immediately called",
"ambulance",
"close",
"neighborhood",
"initial examination",
"appears",
"able to",
"pupils",
"pinpoint",
"needles",
"likely used",
"found on site",
"drug",
"injected",
"unknown",
... |
A 58-year-old man comes to the emergency department with complaints of abdominal pain, swelling, and fever for the last few days. Pain is situated in the right upper quadrant (RUQ) and is dull and aching. He scores it as 6/10 with no exacerbating or relieving factors. He also complains of anorexia for the same duration... | Ultrasound | {
"A": "Echocardiography",
"B": "Ultrasound",
"C": "MRI",
"D": "Venography"
} | step2&3 | B | [
"58 year old man",
"emergency department",
"complaints",
"abdominal pain",
"swelling",
"fever",
"days",
"Pain",
"right upper quadrant",
"dull",
"aching",
"scores",
"6/10",
"exacerbating",
"relieving factors",
"anorexia",
"same duration",
"patient experiences",
"little discomfort"... |
A 42-year-old female complains of feeling anxious and worrying about nearly every aspect of her daily life. She cannot identify a specific cause for these symptoms and admits that this tension is accompanied by tiredness and difficulty falling asleep. To treat this problem, the patient is prescribed sertraline. She end... | 5HT-1A receptor | {
"A": "GABA receptor",
"B": "Alpha adrenergic receptor",
"C": "Glycine receptor",
"D": "5HT-1A receptor"
} | step1 | D | [
"year old female",
"feeling anxious",
"worrying",
"nearly",
"aspect",
"daily life",
"specific cause",
"symptoms",
"admits",
"tension",
"tiredness",
"difficulty falling asleep",
"To treat",
"problem",
"patient",
"prescribed sertraline",
"mild improvement",
"medication",
"next",
... |
An 81-year-old woman presents to your office accompanied by her husband. She has been doing well except for occasional word finding difficulty. Her husband is concerned that her memory is worsening over the past year. Recently, she got lost twice on her way home from her daughter’s house, was unable to remember her nei... | ApoE4 | {
"A": "ApoE2",
"B": "ApoE4",
"C": "Presenilin-2",
"D": "Frontotemporal lobe degeneration"
} | step1 | B | [
"81 year old woman presents",
"office",
"husband",
"well",
"occasional word finding difficulty",
"husband",
"concerned",
"memory",
"worsening",
"past year",
"Recently",
"got lost twice",
"home",
"daughters house",
"unable to remember",
"neighbors name",
"not pay",
"bills",
"usual... |
A 36-year-old man is brought to the emergency department for right upper quadrant abdominal pain that began 3 days ago. The pain is nonradiating and has no alleviating or exacerbating factors. He denies any nausea or vomiting. He immigrated from Mexico 6 months ago and currently works at a pet shop. He has been healthy... | Amebiasis | {
"A": "Amebiasis",
"B": "Hepatic hydatid cyst",
"C": "Pyogenic liver abscess",
"D": "Hepatocellular carcinoma"
} | step2&3 | A | [
"36 year old man",
"brought",
"emergency department",
"right upper quadrant abdominal pain",
"began 3 days",
"pain",
"exacerbating factors",
"denies",
"nausea",
"vomiting",
"Mexico",
"months",
"currently works",
"pet shop",
"healthy",
"1 week",
"bloody diarrhea",
"months",
"5 ft"... |
A 4-year-old boy with a rash is brought in by his mother. The patient’s mother says that his symptoms started acutely a few hours ago after they had eaten shellfish at a restaurant which has progressively worsened. She says that the rash started with a few bumps on his neck and chest but quickly spread to involve his a... | Cetirizine | {
"A": "Topical corticosteroids",
"B": "Cetirizine",
"C": "Prednisone",
"D": "IM epinephrine"
} | step2&3 | B | [
"4 year old boy",
"rash",
"brought",
"mother",
"patients mother",
"symptoms started",
"few hours",
"eaten shellfish",
"restaurant",
"worsened",
"rash started",
"neck",
"chest",
"spread to",
"arms",
"upper torso",
"patient",
"rash makes",
"itches badly",
"denies",
"fever",
"... |
A 40-year-old woman comes to the physician for a 6-month history of recurrent episodes of chest pain, racing pulse, dizziness, and difficulty breathing. The episodes last up to several minutes. She also reports urinary urgency and two episodes of loss of consciousness followed by spontaneous recovery. There is no perso... | AV node with slow and fast pathway | {
"A": "AV node with slow and fast pathway",
"B": "Pre-excitation of the ventricles",
"C": "Fibrosis of the sinoatrial node and surrounding myocardium",
"D": "Mutations in genes that code for myocyte ion channels"
} | step2&3 | A | [
"40 year old woman",
"physician",
"month history of recurrent episodes",
"chest pain",
"racing pulse",
"dizziness",
"difficulty breathing",
"episodes last",
"minutes",
"reports urinary urgency",
"two episodes of loss",
"consciousness followed by spontaneous recovery",
"personal",
"family h... |
A 19-year-old man is brought to the emergency department 35 minutes after being involved in a high-speed motor vehicle collision. On arrival, he is alert, has mild chest pain, and minimal shortness of breath. He has one episode of vomiting in the hospital. His temperature is 37.3°C (99.1°F), pulse is 108/min, respirati... | Pulmonary contusion | {
"A": "Pneumothorax",
"B": "Pulmonary contusion",
"C": "Pulmonary embolism",
"D": "Aspiration pneumonia"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department 35 minutes",
"involved",
"high speed motor vehicle collision",
"arrival",
"alert",
"mild chest",
"minimal shortness of breath",
"one episode of vomiting",
"hospital",
"temperature",
"3C",
"99",
"pulse",
"min",
"respirations",
"23 min... |
A 17-year-old male with a history of bipolar disorder presents to clinic with a rash (Image A) that he noticed one week after starting a medication to stabilize his mood. The medication blocks voltage-gated sodium channels and can be used to treat partial simple, partial complex, and generalized tonic-clonic seizures. ... | Immediately discontinue the drug | {
"A": "Reassure the patient that it is normal to have a rash in the first week and to continue the drug as directed",
"B": "Begin diphenhydramine and continue the drug as directed",
"C": "Decrease the dose by 50% and continue",
"D": "Immediately discontinue the drug"
} | step1 | D | [
"year old male",
"history of bipolar disorder presents",
"clinic",
"rash",
"Image",
"one week",
"starting",
"medication to stabilize",
"mood",
"medication blocks voltage-gated sodium channels",
"used to treat partial simple",
"complex",
"generalized tonic-clonic seizures",
"patient's rash"... |
A 63-year-old woman comes to the physician for a routine health maintenance examination. She reports feeling tired sometimes and having itchy skin. Over the past 2 years, the amount of urine she passes has been slowly decreasing. She has hypertension and type 2 diabetes mellitus complicated with diabetic nephropathy. H... | Cardiovascular disease | {
"A": "Malignancy",
"B": "Anemia",
"C": "Gastrointestinal bleeding",
"D": "Cardiovascular disease"
} | step2&3 | D | [
"63 year old woman",
"physician",
"routine health maintenance examination",
"reports feeling tired sometimes",
"itchy skin",
"past",
"years",
"amount",
"urine",
"passes",
"slowly decreasing",
"hypertension",
"type 2 diabetes mellitus complicated",
"diabetic nephropathy",
"current medicat... |
A 36-year-old nulligravid woman comes to the physician because of a 1-year history of pelvic discomfort and heavy menstrual bleeding. The pain is dull and pressure-like and occurs intermittently; the patient is asymptomatic between episodes. Menses occur at regular 30-day intervals and last 8 days with heavy flow. Her ... | Pelvic ultrasound | {
"A": "Laparoscopy",
"B": "Pelvic MRI",
"C": "Pelvic ultrasound",
"D": "Repeat β-HCG test"
} | step2&3 | C | [
"36 year old nulligravid woman",
"physician",
"year history",
"pelvic discomfort",
"heavy menstrual bleeding",
"pain",
"dull",
"pressure",
"occurs",
"patient",
"asymptomatic",
"episodes",
"Menses occur",
"regular 30 day intervals",
"last",
"days",
"heavy flow",
"last menstrual peri... |
A 63-year-old man presents to the emergency department complaining of sudden-onset severe dyspnea and right-sided chest pain. The patient has a history of chronic obstructive pulmonary disease, hypertension, peptic ulcer disease, and hyperthyroidism. He has smoked a pack of cigarettes daily for 20 years, drinks sociall... | Rupture of an apical alveolar bleb | {
"A": "Compression of a main bronchus due to neoplasia",
"B": "Formation of an intimal flap in the aorta",
"C": "Increased myocardial oxygen demand",
"D": "Rupture of an apical alveolar bleb"
} | step2&3 | D | [
"63 year old man presents",
"emergency department",
"sudden-onset severe dyspnea",
"right-sided chest pain",
"patient",
"history",
"chronic obstructive pulmonary disease",
"hypertension",
"peptic ulcer disease",
"hyperthyroidism",
"smoked",
"pack",
"cigarettes daily",
"20 years",
"drinks... |
An investigator is studying genetic mutations of coagulation factors from patient samples. Genetic sequencing of one patient's coagulation factors shows a DNA point mutation that substitutes guanine for adenine. The corresponding mRNA codon forms a glutamine in place of arginine on position 506 at the polypeptide cleav... | Cerebral vein thrombosis | {
"A": "Petechiae",
"B": "Cerebral vein thrombosis",
"C": "Hemarthrosis",
"D": "Ischemic stroke"
} | step1 | B | [
"investigator",
"studying genetic mutations",
"coagulation factors",
"patient samples",
"Genetic sequencing",
"one",
"coagulation factors shows a DNA point mutation",
"guanine",
"adenine",
"mRNA codon forms",
"glutamine",
"place",
"arginine",
"position",
"polypeptide cleavage site",
"p... |
A 29-year-old woman presents to the primary care office for a recent history of falls. She has fallen 5 times over the last year. These falls are not associated with any preceding symptoms; she specifically denies dizziness, lightheadedness, or visual changes. However, she has started noticing that both of her legs fee... | Electromyography (including nerve conduction studies) | {
"A": "Ankle-brachial index",
"B": "Electromyography (including nerve conduction studies)",
"C": "Lumbar puncture",
"D": "MRI brain"
} | step2&3 | B | [
"29 year old woman presents",
"primary care office",
"recent history of falls",
"fallen",
"times",
"year",
"falls",
"not associated with",
"preceding symptoms",
"denies dizziness",
"lightheadedness",
"visual changes",
"started",
"legs feel weak",
"carpet feels",
"feet",
"mother",
"... |
An 8-year-old African-American boy is brought into the emergency department by his mother due to intense abdominal pain and pain in his thighs. The mother states that she also suffers from the same disease and that the boy has been previously admitted for episodes such as this. On exam, the boy is in 10/10 pain. His vi... | Hydroxyurea | {
"A": "Oxygen",
"B": "Hydroxyurea",
"C": "Normal saline",
"D": "Exchange transfusion"
} | step2&3 | B | [
"year old African-American boy",
"brought",
"emergency department",
"mother due to intense abdominal pain",
"pain in",
"thighs",
"mother states",
"suffers",
"same disease",
"boy",
"admitted",
"episodes",
"exam",
"boy",
"10",
"pain",
"BP 100 55",
"T 100",
"RR 20",
"CBC",
"sign... |
A 23-year-old woman comes to the emergency department because of a diffuse, itchy rash and swollen face for 6 hours. That morning, she was diagnosed with an abscess of the lower leg. She underwent treatment with incision and drainage as well as oral antibiotics. She has no history of serious illness. She is not in acut... | Intravenous methylprednisolone, ranitidine, and diphenhydramine administration | {
"A": "Watchful waiting and regular reassessments",
"B": "Intravenous methylprednisolone, ranitidine, and diphenhydramine administration",
"C": "Intramuscular epinephrine and intravenous hydrocortisone administration",
"D": "Endotracheal intubation and mechanical ventilation"
} | step2&3 | B | [
"23 year old woman",
"emergency department",
"diffuse",
"itchy",
"swollen face",
"hours",
"morning",
"diagnosed",
"abscess of",
"lower leg",
"treatment",
"incision",
"drainage",
"oral antibiotics",
"history",
"serious illness",
"not",
"acute distress",
"temperature",
"pulse",
... |
An 86-year-old male is admitted to the hospital under your care for management of pneumonia. His hospital course has been relatively uneventful, and he is progressing well. While making morning rounds on your patients, the patient's cousin approaches you in the hallway and asks about the patient's prognosis and potenti... | Explain that you cannot discuss the patient's care without explicit permission from the patient themselves. | {
"A": "Explain that the patient is progressing well and should be discharged within the next few days.",
"B": "Direct the cousin to the patient's room, telling him that you will be by within the hour to discuss the plan.",
"C": "Refer the cousin to ask the patient's wife about these topics.",
"D": "Explain tha... | step1 | D | [
"year old male",
"admitted",
"hospital",
"care",
"management",
"pneumonia",
"hospital course",
"progressing well",
"making morning rounds",
"patients",
"patient's cousin approaches",
"hallway",
"patient's prognosis",
"potential future discharge date",
"patient",
"not",
"advanced dire... |
A first time mother of a healthy, full term, newborn girl is anxious about sudden infant death syndrome. Which of the following pieces of advice can reduce the risk of SIDS? | Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and avoidance smoking | {
"A": "Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and avoidance smoking",
"B": "Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and use a home apnea monitor",
"C": "Sleep supine in a crib with bumpers, head propped up on a pillow, and wrapped in a wa... | step2&3 | A | [
"first time mother",
"healthy",
"full term",
"newborn girl",
"anxious",
"sudden infant death syndrome",
"following pieces",
"advice",
"risk",
"SIDS"
] |
A 70-year-old man presents to his primary care physician for a general checkup. He states that he has been doing well and taking his medications as prescribed. He recently started a new diet and supplement to improve his health and has started exercising. The patient has a past medical history of diabetes, a myocardial... | Medication | {
"A": "Dietary changes",
"B": "Hemolysis",
"C": "Medication",
"D": "Rhabdomyolysis"
} | step2&3 | C | [
"70 year old man presents",
"primary care physician",
"general checkup",
"states",
"well",
"medications",
"prescribed",
"recently started",
"new diet",
"supplement to",
"health",
"started exercising",
"patient",
"past medical diabetes",
"myocardial infarction",
"hypertension",
"denie... |
A 51-year-old woman presents to the emergency department with a 2-day history of bilateral lower extremity swelling. She says that her legs do not hurt, but she noticed she was gaining weight and her legs were becoming larger. Her past medical history is significant for morbid obesity, hypertension, and hypercholestero... | Inhibition of calcium channels | {
"A": "Inhibition of calcium channels",
"B": "Inhibition of hormone receptor",
"C": "Potassium-sparing diuretic",
"D": "Potassium-wasting diuretic"
} | step1 | A | [
"year old woman presents",
"emergency department",
"2-day history",
"bilateral",
"legs",
"not",
"gaining weight",
"legs",
"larger",
"past medical history",
"significant",
"morbid obesity",
"hypertension",
"hypercholesterolemia",
"swelling started",
"recently started",
"new medication... |
A 5-year-old boy is brought to the emergency room by his parents after slipping on a rug at home and experiencing exquisite pain and swelling of his arms. Radiographs reveal a new supracondylar fracture of the humerus, as well as indications of multiple, old fractures that have healed. His parents note that an inherite... | Deficiency of type 1 collagen | {
"A": "Defect in the glycoprotein that forms a sheath around elastin",
"B": "Defect in the hydroxylation step of collagen synthesis",
"C": "Deficiency of type 1 collagen",
"D": "Deficiency of type 5 collagen"
} | step1 | C | [
"5 year old boy",
"brought",
"emergency room",
"parents",
"slipping",
"rug at home",
"experiencing exquisite pain",
"swelling of",
"arms",
"Radiographs reveal",
"new supracondylar fracture of",
"humerus",
"indications",
"multiple",
"old fractures",
"healed",
"parents note",
"inheri... |
A 27-year-old male presents to urgent care complaining of pain with urination. He reports that the pain started 3 days ago. He has never experienced these symptoms before. He denies gross hematuria or pelvic pain. He is sexually active with his girlfriend, and they consistently use condoms. When asked about recent trav... | Chlamydia trachomatis | {
"A": "Chlamydia trachomatis",
"B": "Herpes simplex virus",
"C": "Systemic lupus erythematosus",
"D": "Treponema pallidum"
} | step1 | A | [
"27 year old male presents",
"urgent care",
"pain",
"urination",
"reports",
"pain started 3 days",
"never experienced",
"symptoms",
"denies gross hematuria",
"pelvic pain",
"sexually active",
"girlfriend",
"use condoms",
"recent travel",
"admits to recently returning",
"boys",
"rip\"... |
A 26-year-old woman, gravida 2, para 1, at 9 weeks' gestation comes to the physician with her 16-month-old son for her first prenatal visit. Her son has had low-grade fever, headache, and arthralgia for 5 days. He has also had a generalized rash that started on the cheeks 2 days ago and has since spread to his body. Th... | Maternal serologic assays for virus-specific IgG and IgM | {
"A": "Report the disease to health authorities",
"B": "Maternal serologic assays for virus-specific IgG and IgM",
"C": "Serial fetal ultrasounds",
"D": "Isolation precautions for the child"
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"month old son",
"first prenatal visit",
"son",
"low-grade fever",
"headache",
"arthralgia",
"5 days",
"generalized rash",
"started",
"cheeks 2 days",
"since spread",
"body",
"woman",
"mild nausea",
"... |
A 5-year-old is presented to the emergency department after being involved in an accident on the way to school. According to the paramedics, the patient was hit by a motor vehicle and his right leg was crushed. The parents were immediately contacted, and the physician explains that a limb-saving operation is the best t... | Inform the hospital Ethics Committee, state authority, and child protective services, and try to get a court order if it takes too long to proceed with the physician’s treatment plan. | {
"A": "Take the parents' wishes into account",
"B": "Ask for a court order",
"C": "Take into account the child’s wishes",
"D": "Inform the hospital Ethics Committee, state authority, and child protective services, and try to get a court order if it takes too long to proceed with the physician’s treatment plan.... | step1 | D | [
"5 year old",
"presented",
"emergency department",
"involved",
"accident",
"school",
"paramedics",
"patient",
"hit",
"motor vehicle",
"right leg",
"crushed",
"parents",
"immediately contacted",
"physician",
"limb saving operation",
"best treatment",
"parents",
"medical treatment"... |
An investigator is studying the relationship between suicide and unemployment using data from a national health registry that encompasses 10,000 people who died by suicide, as well as 100,000 matched controls. The investigator finds that unemployment was associated with an increased risk of death by suicide (odds ratio... | Confounding | {
"A": "Matching",
"B": "Selection bias",
"C": "Effect modification",
"D": "Confounding"
} | step1 | D | [
"investigator",
"studying",
"relationship",
"suicide",
"unemployment using data",
"national health registry",
"10",
"people",
"died",
"suicide",
"100",
"matched controls",
"investigator finds",
"unemployment",
"associated with",
"increased risk",
"death",
"suicide",
"odds ratio",... |
A 7-month-old girl is brought to the hospital by her mother, who complains of a lesion on the infant’s labia for the past 5 days. The lesion is 2 x 2 cm in size and red in color with serosanguinous fluid oozing out of the right labia. The parents note that the girl has had a history of recurrent bacterial skin infectio... | Integrin subunit | {
"A": "Cellular adhesion molecule",
"B": "vWF",
"C": "Integrin subunit",
"D": "TNF-alpha"
} | step1 | C | [
"month old girl",
"brought",
"hospital",
"mother",
"lesion",
"infants labia",
"past 5 days",
"lesion",
"2",
"2",
"size",
"red",
"color",
"serosanguinous fluid",
"out",
"right labia",
"parents note",
"girl",
"history bacterial",
"pus",
"delayed healing",
"birth",
"delayed ... |
A 45-year-old man visits the office with complaints of severe pain with urination for 5 days. In addition, he reports having burning discomfort and itchiness at the tip of his penis. He is also concerned regarding a yellow-colored urethral discharge that started a week ago. Before his symptoms began, he states that he ... | Nucleic acid amplification tests (NAATs) | {
"A": "Urethral biopsy",
"B": "Leukocyte esterase dipstick test",
"C": "Nucleic acid amplification tests (NAATs)",
"D": "Tzanck smear"
} | step1 | C | [
"year old man visits",
"office",
"complaints",
"severe pain",
"urination",
"5 days",
"addition",
"reports",
"burning discomfort",
"itchiness",
"tip",
"penis",
"concerned",
"yellow-colored urethral discharge",
"started",
"week",
"symptoms began",
"states",
"sexual intercourse",
... |
A 31-year-old female receives a kidney transplant for autosomal dominant polycystic kidney disease (ADPKD). Three weeks later, the patient experiences acute, T-cell mediated rejection of the allograft and is given sirolimus. Which of the following are side effects of this medication? | Hyperlipidemia, thrombocytopenia | {
"A": "Pancreatitis",
"B": "Hyperlipidemia, thrombocytopenia",
"C": "Cytokine release syndrome, hypersensitivity reaction",
"D": "Nephrotoxicity, gingival hyperplasia"
} | step1 | B | [
"31 year old female receives",
"kidney",
"autosomal dominant polycystic",
"disease",
"Three weeks later",
"patient experiences acute",
"T-cell mediated rejection",
"allograft",
"given sirolimus",
"following",
"side effects",
"medication"
] |
A 39-year-old woman, gravida 5, para 4, at 41 weeks' gestation is brought to the hospital because of regular uterine contractions that started 2 hours ago. Pregnancy has been complicated by iron deficiency anemia treated with iron supplements. Pelvic examination shows the cervix is 90% effaced and 7-cm dilated; the ver... | Emergent cesarean delivery | {
"A": "Begin active pushing",
"B": "Administer tocolytics",
"C": "Monitor without intervention",
"D": "Emergent cesarean delivery"
} | step2&3 | D | [
"year old woman",
"gravida 5",
"para 4",
"weeks",
"gestation",
"brought",
"hospital",
"regular uterine contractions",
"started 2 hours",
"Pregnancy",
"complicated",
"iron deficiency anemia treated with iron supplements",
"Pelvic examination shows",
"cervix",
"90",
"dilated",
"vertex"... |
A 6-year-old girl is brought to the physician for pain and increasing swelling over her scalp for 1 month. She has not had any trauma to the area. There is no family or personal history of serious illness. Vital signs are within normal limits. Examination shows a 3-cm solitary, tender mass over the right parietal bone.... | Langerhans cell histiocytosis | {
"A": "Multiple myeloma",
"B": "Langerhans cell histiocytosis",
"C": "Ewing sarcoma",
"D": "Giant-cell tumor of bone"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"pain",
"increasing swelling",
"scalp",
"1 month",
"not",
"trauma",
"area",
"family",
"personal history",
"serious illness",
"Vital signs",
"normal limits",
"Examination shows",
"3 cm solitary",
"tender mass",
"right parietal bone",
"X-r... |
A 45-year-old man with a history of biliary colic presents with one-day of intractable nausea, vomiting, and abdominal pain radiating to the back. Temperature is 99.7 deg F (37.6 deg C), blood pressure is 102/78 mmHg, pulse is 112/min, and respirations are 22/min. On abdominal exam, he has involuntary guarding and tend... | White blood cell count | {
"A": "White blood cell count",
"B": "Total bilirubin",
"C": "Amylase",
"D": "Lipase"
} | step2&3 | A | [
"year old man",
"history",
"biliary colic presents",
"one-day",
"intractable nausea",
"vomiting",
"abdominal pain radiating to",
"back",
"Temperature",
"99",
"deg F",
"blood pressure",
"mmHg",
"pulse",
"min",
"respirations",
"min",
"abdominal exam",
"involuntary guarding",
"ten... |
A 4-year-old girl is brought to the emergency department by her parents with a sudden onset of breathlessness. She has been having similar episodes over the past few months with a progressive increase in frequency over the past week. They have noticed that the difficulty in breathing is more prominent during the day wh... | Airway hyperreactivity to external allergens causing intermittent airway obstruction | {
"A": "Destruction of the elastic layers of bronchial walls leading to abnormal dilation",
"B": "Defective chloride channel function leading to mucus plugging",
"C": "Inflammation leading to permanent dilation and destruction of alveoli",
"D": "Airway hyperreactivity to external allergens causing intermittent ... | step2&3 | D | [
"4 year old girl",
"brought",
"emergency department",
"parents",
"sudden onset",
"breathlessness",
"similar episodes",
"past",
"months",
"progressive increase",
"frequency",
"past week",
"difficulty",
"breathing",
"more prominent",
"day",
"plays",
"garden",
"siblings",
"gets be... |
During an experiment, the immunophenotypes of different cells in a sample are determined. The cells are labeled with fluorescent antibodies specific to surface proteins, and a laser is then focused on the samples. The intensity of fluorescence created by the laser beam is then plotted on a scatter plot. The result show... | Mature cytotoxic T lymphocytes | {
"A": "Activated regulatory T lymphocytes",
"B": "Mature cytotoxic T lymphocytes",
"C": "Inactive B lymphocytes",
"D": "Mature helper T lymphocytes"
} | step1 | B | [
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A 59-year-old truck driver presents to the emergency department after returning from his usual week-long trucking trip with excruciating pain around his anus. The patient admits to drinking beer when not working and notes that his meals usually consist of fast food. He has no allergies, takes no medications, and his vi... | Internal pudendal | {
"A": "Internal hemorrhoids",
"B": "Internal pudendal",
"C": "Inferior mesenteric",
"D": "Middle rectal"
} | step1 | B | [
"59 year old truck driver presents",
"emergency department",
"returning",
"usual week long trucking trip",
"excruciating",
"anus",
"patient admits",
"drinking beer",
"not working",
"notes",
"meals usually consist",
"fast food",
"allergies",
"takes",
"medications",
"vital signs",
"nor... |
A 42-year-old man comes to the emergency department complaining of chest pain. He states that he was at the grocery store when he developed severe, burning chest pain along with palpitations and nausea. He screamed for someone to call an ambulance. He says this has happened before, including at least 4 episodes in the ... | Cognitive behavioral therapy | {
"A": "Alprazolam",
"B": "Buspirone",
"C": "Cognitive behavioral therapy",
"D": "Fluoxetine"
} | step2&3 | C | [
"year old man",
"emergency department",
"of chest pain",
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"grocery store",
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"to call",
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"including",
"episodes",
"past month",
"in different locations including",
"at home",... |
A 29-year-old woman presents to the emergency department with a broken arm after she tripped and fell at work. She says that she has no history of broken bones but that she has been having bone pain in her back and hips for several months. In addition, she says that she has been waking up several times in the middle of... | Hypocalcemia | {
"A": "Decreased serum creatinine",
"B": "Hypernatremia",
"C": "Hypocalcemia",
"D": "Metabolic alkalosis"
} | step1 | C | [
"29 year old woman presents",
"emergency department",
"arm",
"tripped",
"fell",
"work",
"history",
"broken bones",
"bone pain in",
"back",
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"months",
"addition",
"waking up",
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"middle",
"night to use",
"restroom",
"drinking",
"lot",
"water",
"symptoms started... |
A 33-year-old pilot is transported to the emergency department after she was involved in a cargo plane crash during a military training exercise in South Korea. She is conscious but confused. She has no history of serious illness and takes no medications. Physical examination shows numerous lacerations and ecchymoses o... | Increased heart rate | {
"A": "Increased heart rate",
"B": "Increased capillary refill time",
"C": "Decreased systolic blood pressure",
"D": "Increased respiratory rate"
} | step2&3 | A | [
"year old pilot",
"transported",
"emergency department",
"involved",
"plane",
"military training exercise",
"South Korea",
"conscious",
"confused",
"history",
"serious illness",
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"medications",
"Physical examination shows numerous lacerations",
"ecchymoses",
"face",
"trunk",
... |
A 61-year-old man comes to the physician for shortness of breath and chest discomfort that is becoming progressively worse. He has had increasing problems exerting himself for the past 5 years. He is now unable to walk more than 50 m on level terrain without stopping and mostly rests at home. He has smoked 1–2 packs of... | Elevated pulmonary artery pressure | {
"A": "Elevated pulmonary artery pressure",
"B": "Chronic respiratory acidosis",
"C": "Coronary plaque deposits",
"D": "Decreased intrathoracic gas volume"
} | step2&3 | A | [
"61 year old man",
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"shortness of breath",
"chest discomfort",
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"now unable to walk more than 50 m",
"level",
"stopping",
"mostly rests at home",
"smoked",
"packs",
"cigarettes daily",
"40 years",
"appears distresse... |
A previously healthy 36-year-old man is brought to the physician by a friend because of fatigue and a depressed mood for the past few weeks. During this time, he has not been going to work and did not show up to meet his friends for two bowling nights. The friend is concerned that he may lose his job. He spends most of... | Initiate cognitive behavioral therapy | {
"A": "Prescribe a short course of alprazolam",
"B": "Initiate cognitive behavioral therapy",
"C": "Initiate disulfiram therapy",
"D": "Hospitalize the patient\n\""
} | step2&3 | B | [
"healthy 36 year old man",
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"not show",
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"friend",
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"job",
"spends most of",
"time alone",
"home watching television",
... |
A 64-year-old homeless man comes to the emergency department with right ear pain and difficulty hearing for 2 weeks. Over the last 5 days, he has also noticed discharge from his right ear. He does not recall the last time he saw a physician. His temperature is 39.0°C (102.2°F), blood pressure is 153/92 mm Hg, pulse is ... | Elevated HBA1c | {
"A": "Malignant epithelial growth of the external auditory canal",
"B": "Opacified mastoid air cells",
"C": "Streptococcus pneumoniae",
"D": "Elevated HBA1c"
} | step2&3 | D | [
"64 year old homeless man",
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"2 weeks",
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"days",
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"temperature",
"blood pressure",
"mm Hg",
"pulse",
"minute",
"respirations",
"minute",
"... |
A 1-year-old girl is brought to the pediatrician because of a 6-month history of diarrhea. She has not received recommended well-child examinations. Her stools are foul-smelling and nonbloody. There is no family history of serious illness. She is at the 15th percentile for height and 5th percentile for weight. Physical... | Restriction of long-chain fatty acids | {
"A": "Nicotinic acid supplementation",
"B": "Restriction of long-chain fatty acids",
"C": "Long-term antibiotic therapy",
"D": "Pancreatic enzyme replacement"
} | step1 | B | [
"year old girl",
"brought",
"pediatrician",
"6 month history",
"diarrhea",
"not received recommended well-child examinations",
"stools",
"smelling",
"family history",
"serious illness",
"percentile",
"height",
"5th percentile",
"weight",
"Physical examination shows abdominal distension",... |
A 33-year-old man presents to the emergency department with back pain. He is currently intoxicated but states that he is having severe back pain and is requesting morphine and lorazepam. The patient has a past medical history of alcohol abuse, drug seeking behavior, and IV drug abuse and does not routinely see a physic... | Spinal epidural abscess | {
"A": "Herniated nucleus pulposus",
"B": "Malingering",
"C": "Musculoskeletal strain",
"D": "Spinal epidural abscess"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"back pain",
"currently",
"states",
"severe back pain",
"requesting morphine",
"lorazepam",
"patient",
"past medical history of alcohol abuse",
"drug seeking behavior",
"IV drug abuse",
"not",
"see",
"physician",
"temperature",
"blood ... |
A 62-year-old man is brought to the emergency department because of headache, blurring of vision, and numbness of the right leg for the past 2 hours. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He is oriented only to person. His temperature is 37.3°C (99.1°F), ... | Infarct of the left posterior cerebral artery | {
"A": "Infarct of the right posterior cerebral artery",
"B": "Infarct of the right anterior cerebral artery",
"C": "Herpes simplex encephalitis",
"D": "Infarct of the left posterior cerebral artery"
} | step2&3 | D | [
"62 year old man",
"brought",
"emergency department",
"headache",
"blurring of vision",
"numbness",
"right",
"past",
"hours",
"hypertension",
"type 2 diabetes mellitus",
"Current medications include enalapril",
"metformin",
"oriented only",
"person",
"temperature",
"3C",
"99",
"p... |
A 12-year-old girl presents to her primary care physician for a well-child visit. She has a history of asthma and uses her inhaler 1-2 times per week when she exercises. She does not smoke and is not currently sexually active; however, she does have a boyfriend. She lives with her mother in an apartment and is doing we... | HPV vaccine | {
"A": "HPV vaccine",
"B": "Hypertension screening",
"C": "Pelvic examination",
"D": "Serum lipids and cholesterol"
} | step2&3 | A | [
"year old girl presents",
"primary care physician",
"well-child visit",
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"97",
"3... |
A 3500-g (7.7-lbs) girl is delivered at 39 weeks' gestation to a 27-year-old woman, gravida 2, para 1. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. The mother had regular prenatal visits throughout the pregnancy. She did not smoke or drink alcohol. She took multivitamins as prescribed by her physician. Th... | Hydrocortisone and fludrocortisone therapy | {
"A": "Hydrocortisone and fludrocortisone therapy",
"B": "Estrogen replacement therapy",
"C": "Dexamethasone therapy",
"D": "Spironolactone therapy"
} | step2&3 | A | [
"3500",
"lbs",
"girl",
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"weeks",
"estation ",
"7- ear- ld oman,",
"ravida 2,",
"ara 1.",
"pgar scores ",
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"egular renatal visits ",
"regnancy.",
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"rink alcohol.",
"ook ultivitamins ",
"rescribed ",
"hysician.",
"ewborn ppears c... |
A 35-year-old male with a history of hypertension presents with hematuria and abdominal discomfort. Ultrasound and CT scan reveal large, bilateral cysts in all regions of the kidney. The patient’s disease is most commonly associated with: | Berry aneurysm | {
"A": "Aortic stenosis",
"B": "Berger’s disease",
"C": "Diabetes mellitus",
"D": "Berry aneurysm"
} | step1 | D | [
"35 year old male",
"history of hypertension presents",
"hematuria",
"abdominal discomfort",
"Ultrasound",
"CT scan reveal large",
"bilateral cysts",
"regions of the kidney",
"patients disease",
"most",
"associated with"
] |
A 62-year-old man presents to the emergency department for evaluation of a 2-year history of increasing shortness of breath. He also has an occasional nonproductive cough. The symptoms get worse with exertion. The medical history is significant for hypertension and he takes chlorthalidone. He is a smoker with a 40-pack... | FEV1/FVC of 65% | {
"A": "FEV1/FVC of 65%",
"B": "Decreased total lung capacity",
"C": "Increased DLCO",
"D": "FEV1/FVC of 80% with an FEV1 of 82%"
} | step1 | A | [
"62 year old man presents",
"emergency department",
"evaluation of",
"year history",
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"breath",
"occasional nonproductive cough",
"symptoms",
"worse",
"exertion",
"medical history",
"significant",
"hypertension",
"takes chlorthalidone",
"smoker",
"40 pack-year sm... |
A 61-year-old woman comes to the physician because of a 6-month history of left knee pain and stiffness. Examination of the left knee shows tenderness to palpation along the joint line; there is crepitus with full flexion and extension. An x-ray of the knee shows osteophytes with joint-space narrowing. Arthrocentesis o... | Conversion of arachidonic acid to prostaglandin G2 | {
"A": "Conversion of dihydroorotate to orotate",
"B": "Conversion of hypoxanthine to urate",
"C": "Conversion of arachidonic acid to prostaglandin G2",
"D": "Conversion of phospholipids to arachidonic acid"
} | step1 | C | [
"61 year old woman",
"physician",
"month history",
"left",
"stiffness",
"Examination of",
"left knee shows tenderness",
"palpation",
"joint line",
"crepitus",
"full flexion",
"extension",
"x-ray",
"knee shows osteophytes",
"joint",
"Arthrocentesis of",
"knee",
"clear fluid",
"leu... |
A 55-year-old woman presents to a physician’s clinic for a diabetes follow-up. She recently lost weight and believes the diabetes is ‘winding down’ because the urinary frequency has slowed down compared to when her diabetes was "at its worst". She had been poorly compliant with medications, but she is now asking if she... | Inulin | {
"A": "Creatinine",
"B": "Inulin",
"C": "Urea",
"D": "Para-aminohippurate (PAH)"
} | step1 | B | [
"55 year old woman presents",
"physicians clinic",
"diabetes follow-up",
"recently lost weight",
"diabetes",
"winding",
"urinary frequency",
"slowed",
"compared to",
"diabetes",
"worst",
"poorly compliant",
"medications",
"now",
"decrease",
"medications",
"feels",
"diabetes",
"im... |
A 67-year-old man presents to the emergency department for altered mental status. The patient is a member of a retirement community and was found to have a depressed mental status when compared to his baseline. The patient has a past medical history of Alzheimer dementia and diabetes mellitus that is currently well-con... | Ceftriaxone, vancomycin, ampicillin, and steroids | {
"A": "Ceftriaxone and vancomycin",
"B": "Ceftriaxone, vancomycin, and ampicillin",
"C": "Ceftriaxone, vancomycin, ampicillin, and steroids",
"D": "CT scan of the head"
} | step2&3 | C | [
"67 year old man presents",
"emergency department",
"altered mental status",
"patient",
"member",
"retirement community",
"found to",
"depressed mental status",
"compared",
"baseline",
"patient",
"past medical Alzheimer dementia",
"diabetes mellitus",
"currently well-controlled",
"temper... |
A 58-year-old man with type 2 diabetes mellitus comes to the emergency department because of a 2-day history of dysphagia and swelling in the neck and lower jaw. He has had tooth pain on the left side over the past week, which has made it difficult for him to sleep. Four weeks ago, he had a 3-day episode of flu-like sy... | Ludwig angina
" | {
"A": "Lymphadenitis",
"B": "Peritonsillar abscess",
"C": "Sublingual hematoma",
"D": "Ludwig angina\n\""
} | step2&3 | D | [
"58 year old man",
"type 2 diabetes mellitus",
"emergency department",
"2-day history",
"dysphagia",
"swelling",
"neck",
"lower jaw",
"tooth pain",
"left side",
"past week",
"made",
"difficult",
"to sleep",
"Four weeks",
"3-day episode of flu-like symptoms",
"including sore throat",
... |
A previously healthy 19-year-old man is brought to the emergency department by his girlfriend after briefly losing consciousness. He passed out while moving furniture into her apartment. She said that he was unresponsive for a minute but regained consciousness and was not confused. The patient did not have any chest pa... | Hypertrophic cardiomyopathy | {
"A": "Prolonged QT interval",
"B": "Hypertrophic cardiomyopathy",
"C": "Bicuspid aortic valve",
"D": "Mitral valve prolapse"
} | step2&3 | B | [
"healthy",
"year old man",
"brought",
"emergency department",
"girlfriend",
"consciousness",
"passed out",
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"unresponsive",
"minute",
"regained consciousness",
"not confused",
"patient",
"not",
"chest pain",
"palpitations",
"difficulty breathing",
... |
A 33-year-old woman comes to the emergency department because of a 1-hour history of severe pelvic pain and nausea. She was diagnosed with a follicular cyst in the left ovary 3 months ago. The cyst was found incidentally during a fertility evaluation. A pelvic ultrasound with Doppler flow shows an enlarged, edematous l... | Ureter | {
"A": "Ureter",
"B": "Bladder trigone",
"C": "Cervical os",
"D": "Uterine artery"
} | step1 | A | [
"year old woman",
"emergency department",
"hour history",
"severe pelvic pain",
"nausea",
"diagnosed",
"follicular cyst",
"left ovary",
"months",
"cyst",
"found",
"fertility evaluation",
"pelvic ultrasound",
"Doppler flow shows",
"enlarged",
"edematous left",
"blood",
"Laparoscopic... |
A 31-year-old unresponsive man is admitted to the emergency department after a single-vehicle roll-over accident. On primary assessment by paramedics, he was unresponsive. On admission, he opened his eyes to painful stimuli, was not responsive to verbal commands, his arms were flexed and the legs were straight with no ... | Placement of an intraventricular catheter | {
"A": "Lumbar puncture",
"B": "Placement of an intraventricular catheter",
"C": "Diagnostic peritoneal lavage",
"D": "Brain MRI"
} | step2&3 | B | [
"31 year old unresponsive man",
"admitted",
"emergency department",
"single-vehicle roll-over accident",
"primary assessment",
"paramedics",
"unresponsive",
"admission",
"opened",
"eyes",
"painful stimuli",
"not responsive",
"verbal commands",
"arms",
"flexed",
"legs",
"straight",
... |
A 38-year-old male is brought to the emergency department by ambulance after a motor vehicle collision. He is found to have a broken femur and multiple soft tissue injuries and is admitted to the hospital. During the hospital course, he is found to have lower extremity swelling, redness, and pain, so he is given an inf... | Factors V and VIII | {
"A": "Factor II only",
"B": "Factors II and X",
"C": "Factors II, VII, IX, and X",
"D": "Factors V and VIII"
} | step1 | D | [
"year old male",
"brought",
"emergency department",
"ambulance",
"motor vehicle collision",
"found to",
"femur",
"multiple soft tissue injuries",
"admitted",
"hospital",
"hospital course",
"found to",
"lower extremity swelling",
"redness",
"pain",
"given",
"infusion of",
"medicatio... |
A 19-year-old male college student is brought to the emergency department by his girlfriend complaining of intense pain. They had been playing outside in the snow when the patient started to have severe hand and feet pain. He says the pain is 9 out of 10 and causing him to have trouble moving his fingers and toes. He a... | Increase in hemoglobin with higher oxygen affinity | {
"A": "Decrease in hemoglobin A",
"B": "Decrease in hemoglobin with higher oxygen affinity",
"C": "Increase in hemoglobin A",
"D": "Increase in hemoglobin with higher oxygen affinity"
} | step2&3 | D | [
"year old male college student",
"brought",
"emergency department",
"girlfriend",
"intense pain",
"playing outside",
"snow",
"patient started to",
"severe hand",
"feet pain",
"pain",
"out",
"10",
"causing",
"to",
"moving",
"fingers",
"toes",
"reports",
"difficulty catching",
... |
A 43-year-old woman comes to the physician because of a 3-month history of a painless ulcer on the sole of her right foot. There is no history of trauma. She has been dressing the ulcer once daily at home with gauze. She has a 15-year history of poorly-controlled type 1 diabetes mellitus and hypertension. Current medic... | Sharp surgical debridement of the ulcer | {
"A": "Total contact casting of right foot",
"B": "Intravenous antibiotic therapy",
"C": "Sharp surgical debridement of the ulcer",
"D": "Surgical revascularization of the right foot"
} | step2&3 | C | [
"year old woman",
"physician",
"3 month history",
"painless ulcer",
"sole of",
"right foot",
"history",
"trauma",
"dressing",
"ulcer",
"daily",
"home",
"gauze",
"year history of poorly controlled type 1 diabetes mellitus",
"hypertension",
"Current medications include insulin",
"lisin... |
A 9-year-old boy is brought to the office due to exertional dyspnea and fatigability. He tires easily when walking or playing. His parents say that he was diagnosed with a congenital heart disease during his infancy, but they refused any treatment. They do not remember much about his diagnosis. The patient also had occ... | Patent ductus arteriosus | {
"A": "Atrial septal defect",
"B": "Coarctation of the aorta",
"C": "Patent ductus arteriosus",
"D": "Tetralogy of Fallot"
} | step1 | C | [
"year old boy",
"brought",
"office",
"exertional dyspnea",
"fatigability",
"tires easily",
"walking",
"playing",
"parents",
"diagnosed",
"congenital heart disease",
"infancy",
"refused",
"treatment",
"not remember much",
"diagnosis",
"patient",
"occasional respiratory infections",
... |
A 16-year-old teenager presents to the pediatrician with his mother. After she leaves the room he tells the physician that he is worried about puberty. All of his friends have had growth spurts, started building muscle mass, and their voices have changed while he still feels underdeveloped. The physician takes a comple... | The absence of testicular enlargement by age of 14 years | {
"A": "The absence of linear growth acceleration by age of 13 years",
"B": "The absence of testicular enlargement by age of 14 years",
"C": "Presence of gynecomastia at age of 15 years",
"D": "The absence of an adult type of pubic hair distribution by age of 16 years"
} | step2&3 | B | [
"year old teenager presents",
"pediatrician",
"mother",
"leaves",
"room",
"physician",
"worried",
"puberty",
"friends",
"growth spurts",
"started building muscle mass",
"voices",
"changed",
"feels",
"physician takes",
"complete history",
"performs",
"physical examination",
"goes"... |
A 62-year-old man is brought to the physician by his wife for increased forgetfulness and unsteady gait over the past 3 months. He is a journalist and has had difficulty concentrating on his writing. He also complains of urinary urgency recently. His temperature is 36.8°C (98.2°F) and blood pressure is 139/83 mm Hg. He... | Normal pressure hydrocephalus | {
"A": "Normal pressure hydrocephalus",
"B": "Vascular dementia",
"C": "Frontotemporal dementia",
"D": "Lewy body dementia"
} | step1 | A | [
"62 year old man",
"brought",
"physician",
"wife",
"increased forgetfulness",
"unsteady gait",
"past 3 months",
"journalist",
"difficulty",
"writing",
"urinary urgency recently",
"temperature",
"36",
"98",
"blood pressure",
"83 mm Hg",
"oriented only",
"person",
"place",
"able ... |
A 19-year-old woman presents with worsening pain in her neck for the past 5 days. She says she is not able to wear her tie for her evening job because is it too painful. She also reports associated anxiety, palpitations, and lethargy for the past 10 days. Past medical history is significant for a recent 3-day episode o... | Aspirin | {
"A": "Levothyroxine administration",
"B": "Aspirin",
"C": "Increase dietary intake of iodine",
"D": "Reassurance"
} | step1 | B | [
"year old woman presents",
"worsening pain",
"neck",
"past 5 days",
"not able to",
"tie",
"evening job",
"painful",
"reports associated anxiety",
"palpitations",
"lethargy",
"past 10 days",
"Past medical history",
"significant",
"recent 3-day episode of flu-like symptoms",
"20 days",
... |
A 68-year-old man with atrial fibrillation comes to the emergency department with acute-onset severe upper abdominal pain. He takes no medications. He is severely hypotensive. Despite maximal resuscitation efforts, he dies. Autopsy shows necrosis of the proximal portion of the greater curvature of the stomach caused by... | Splenic artery | {
"A": "Inferior mesenteric artery",
"B": "Right gastroepiploic artery",
"C": "Splenic artery",
"D": "Left gastric artery"
} | step1 | C | [
"68 year old man",
"atrial fibrillation",
"emergency department",
"acute-onset severe upper abdominal pain",
"takes",
"medications",
"severely hypotensive",
"maximal resuscitation efforts",
"Autopsy shows necrosis of the proximal portion",
"greater curvature",
"stomach caused",
"embolic occlus... |
A 65-year-old woman was referred to a specialist for dysphagia and weight loss. She has a history of difficulty swallowing solid foods, which has become worse over the past year. She has unintentionally lost 2.3 kg (5 lb). A previous gastroscopy showed mild gastritis with a positive culture for Helicobacter pylori. A c... | Left atrium enlargement | {
"A": "Thoracic aortic aneurysm",
"B": "Achalasia",
"C": "Left atrium enlargement",
"D": "Diffuse esophageal spasm"
} | step1 | C | [
"65 year old woman",
"referred",
"specialist",
"dysphagia",
"weight loss",
"history",
"difficulty swallowing solid foods",
"worse",
"past year",
"lost 2.3 kg",
"5",
"previous gastroscopy showed mild gastritis",
"positive culture",
"Helicobacter pylori",
"course",
"triple",
"omeprazol... |
A 46-year-old man presents to his primary care provider for an ulcerating skin lesion on his leg for the past week. He says that the week prior he slipped while hiking and scraped his left leg. Over the course of the next week, he noticed redness and swelling of the scraped area and the development of a nodule that eve... | Trimethoprim-sulfamethoxazole | {
"A": "Doxycycline",
"B": "Penicillin",
"C": "Streptomycin",
"D": "Trimethoprim-sulfamethoxazole"
} | step1 | D | [
"year old man presents",
"primary care provider",
"ulcerating skin",
"leg",
"past week",
"week prior",
"slipped",
"hiking",
"scraped",
"left leg",
"course",
"next week",
"redness",
"swelling",
"scraped area",
"development",
"nodule",
"ulcerated",
"exam",
"temperature",
"99",
... |
A 33-year-old man presents with a darkening of the skin on his neck over the past month. Past medical history is significant for primary hypothyroidism treated with levothyroxine. His vital signs include: blood pressure 130/80 mm Hg, pulse 84/min, respiratory rate 18/min, temperature 36.8°C (98.2°F). His body mass inde... | Exercise and diet | {
"A": "Adjust the dose of levothyroxine",
"B": "Cyproheptadine",
"C": "Exercise and diet",
"D": "Surgical excision"
} | step2&3 | C | [
"year old man presents",
"darkening",
"skin",
"neck",
"past month",
"Past medical history",
"significant",
"primary hypothyroidism treated with levothyroxine",
"vital signs include",
"blood pressure",
"80 mm Hg",
"pulse 84 min",
"respiratory rate",
"min",
"temperature 36",
"98",
"bod... |
A 33-year-old woman is brought to the emergency department after she was involved in a high-speed motor vehicle collision. She reports severe pelvic pain. Her pulse is 124/min and blood pressure is 80/56 mm Hg. Physical examination shows instability of the pelvic ring. As part of the initial emergency treatment, she re... | Crescent-shaped, fragmented erythrocytes | {
"A": "Erythrocytes with irregular, thorny projections",
"B": "Crescent-shaped, fragmented erythrocytes",
"C": "Grouped erythrocytes with a stacked-coin appearance",
"D": "Erythrocytes with cytoplasmic hemoglobin inclusions"
} | step1 | B | [
"year old woman",
"brought",
"emergency department",
"involved",
"high speed motor vehicle collision",
"reports severe pelvic pain",
"pulse",
"min",
"blood pressure",
"80",
"mm Hg",
"Physical examination shows instability",
"pelvic ring",
"part of",
"initial emergency treatment",
"rece... |
A 45-year-old man with a 15-pack-year smoking history is referred for pulmonary function testing. On physical exam, he appears barrel-chested and mildly overweight, but breathes normally. Which of the following tests will most accurately measure his total lung capacity? | Body plethysmography | {
"A": "Open-circuit nitrogen washout",
"B": "Body plethysmography",
"C": "Closed-circuit helium dilution",
"D": "Exhaled nitric oxide"
} | step1 | B | [
"year old man",
"pack",
"smoking history",
"referred",
"pulmonary function testing",
"physical exam",
"appears barrel-chested",
"mildly overweight",
"following tests",
"most",
"measure",
"total lung capacity"
] |
A 24-year-old man is brought to the emergency department after being involved in a motor vehicle accident as an unrestrained driver. He was initially found unconscious at the scene but, after a few minutes, he regained consciousness. He says he is having difficulty breathing and has right-sided pleuritic chest pain. A ... | Needle thoracostomy at the 2nd intercostal space, midclavicular line | {
"A": "Needle thoracostomy at the 5th intercostal space, midclavicular line",
"B": "Needle thoracostomy at the 2nd intercostal space, midclavicular line",
"C": "Tube thoracostomy at the 2nd intercostal space, midclavicular line",
"D": "Tube thoracostomy at the 5th intercostal space, anterior axillary line"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"involved",
"motor vehicle accident",
"driver",
"initially found unconscious",
"few minutes",
"regained consciousness",
"difficulty breathing",
"right-sided pleuritic chest pain",
"primary trauma survey reveals multiple bruises",
"laceration... |
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