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 30-year-old man is brought to the emergency department by the police after starting a fight at a local bar. He has several minor bruises and he appears agitated. He talks incessantly about his future plans. He reports that he has no history of disease and that he is "super healthy" and "never felt better". His temper... | Increased appetite | {
"A": "Increased appetite",
"B": "Increased sympathetic stimulation",
"C": "Lacrimation",
"D": "Seizures"
} | step1 | A | [
"30 year old man",
"brought",
"emergency department",
"police",
"starting",
"fight",
"local",
"several minor bruises",
"appears agitated",
"talks",
"future plans",
"reports",
"history of disease",
"healthy",
"never felt better",
"temperature",
"100 4F",
"pulse",
"min",
"respira... |
A young couple expecting their first child present to the obstetrician for routine follow up at 16 weeks gestation. The father suffers from Leber hereditary optic neuropathy and wants to know if is possible that he has passed down the disease to his unborn daughter. The correct response is: | No, the father cannot pass the disease to any offpring. | {
"A": "Yes, the father can pass the disease to daughters only.",
"B": "No, the father cannot pass the disease to any offpring.",
"C": "Yes, the father will pass the disease to all of his offspring, but the severity of disease can very.",
"D": "No, the father can pass the disease to sons only."
} | step1 | B | [
"young couple",
"first child present",
"obstetrician",
"routine follow up",
"weeks gestation",
"father suffers",
"Leber hereditary optic neuropathy",
"to",
"possible",
"passed",
"disease",
"unborn daughter",
"correct response"
] |
A 65-year-old homeless man with a history of hospitalization for alcohol intoxication is brought in confused. His serum glucose is 39mg/dl. Which of the following is likely true? | His hepatic NADH/NAD+ ratio is high | {
"A": "He has also been using cocaine",
"B": "He has decreased activity of alcohol dehydrogenase",
"C": "Hepatic gluconeogenesis is elevated",
"D": "His hepatic NADH/NAD+ ratio is high"
} | step1 | D | [
"65-year-old homeless man",
"history of hospitalization",
"alcohol intoxication",
"brought",
"confused",
"serum glucose",
"dl",
"following",
"likely true"
] |
A 72-year-old man is brought to the physician for the evaluation of severe nosebleeds and two episodes of bloody vomit over the past 40 minutes. He reports that he has had recurrent nosebleeds almost daily for the last 3 weeks. The nosebleeds last between 30 and 40 minutes. He appears pale. His temperature is 36.5°C (9... | Endoscopic ligation of the sphenopalatine artery | {
"A": "Endoscopic ligation of the sphenopalatine artery",
"B": "Endoscopic ligation of the anterior ethmoidal artery",
"C": "Endoscopic ligation of the lesser palatine artery",
"D": "Endoscopic ligation of the greater palatine artery"
} | step2&3 | A | [
"72 year old man",
"brought",
"physician",
"evaluation",
"severe nosebleeds",
"two episodes of bloody vomit",
"past 40 minutes",
"reports",
"recurrent nosebleeds almost daily",
"weeks",
"nosebleeds last",
"30",
"40 minutes",
"appears pale",
"temperature",
"36",
"97",
"pulse",
"95... |
A 50-year-old man comes to the physician for his annual health maintenance examination. The patient feels well. He has a history of hypertension, for which he currently takes lisinopril. He has smoked a pack of cigarettes daily for 20 years. He drinks 5–6 beers on weekends. He is 181 cm tall (5 ft 11 in), weighs 80 kg ... | HMG-CoA reductase inhibitor | {
"A": "Cholesterol absorption inhibitor",
"B": "Proprotein convertase subtilisin kexin 9 inhibitor",
"C": "HMG-CoA reductase inhibitor",
"D": "Bile acid resins"
} | step2&3 | C | [
"50 year old man",
"physician",
"annual health maintenance examination",
"patient feels well",
"history of hypertension",
"currently takes lisinopril",
"smoked",
"pack",
"cigarettes daily",
"20 years",
"drinks",
"beers",
"weekends",
"tall",
"5 ft",
"80 kg",
"lbs",
"BMI",
"kg/m2",... |
A 68-year-old man presents to the emergency department because of difficulty breathing and chest tightness for the last 3 days. He also has a productive cough with excessive amounts of green sputum. He has had chronic obstructive pulmonary disease for the past 10 years, but says that the cough and sputum are different ... | Reversing bronchoconstriction and correction of electrolyte abnormalities | {
"A": "Reversing bronchoconstriction and correction of electrolyte abnormalities",
"B": "Synchronized cardioversion",
"C": "Catheter ablation of the cavotricuspid isthmus (CTI)",
"D": "Metoprolol"
} | step2&3 | A | [
"68 year old man presents",
"emergency department",
"difficulty breathing",
"chest tightness",
"3 days",
"productive cough",
"excessive amounts",
"green sputum",
"chronic obstructive pulmonary disease",
"past 10 years",
"cough",
"sputum",
"different compared",
"baseline",
"took 2 doses",... |
A 65-year-old man presents with low-grade fever and malaise for the last 4 months. He also says he has lost 9 kg (20 lb) during this period and suffers from extreme fatigue. Past medical history is significant for a mitral valve replacement 5 years ago. His temperature is 38.1°C (100.6°F), respirations are 22/min, puls... | Coagulase-negative Staphylococcus spp. | {
"A": "Candida albicans",
"B": "Coagulase-negative Staphylococcus spp.",
"C": "Pseudomonas aeruginosa",
"D": "Escherichia coli"
} | step1 | B | [
"65 year old man presents",
"low-grade fever",
"malaise",
"months",
"lost",
"kg",
"20",
"period",
"suffers",
"extreme fatigue",
"Past medical history",
"significant",
"mitral valve replacement",
"years",
"temperature",
"100",
"respirations",
"min",
"pulse",
"min",
"blood pres... |
A 55-year-old man comes to the physician with a 3-month history of headache, periodic loss of vision, and easy bruising. Physical examination shows splenomegaly. His hemoglobin concentration is 13.8 g/dL, leukocyte count is 8000/mm3, and platelet count is 995,000/mm3. Bone marrow biopsy shows markedly increased megakar... | Prolactin | {
"A": "Cortisol",
"B": "Oxytocin",
"C": "Prolactin",
"D": "Adrenocorticotropic hormone"
} | step1 | C | [
"55 year old man",
"physician",
"3 month history of headache",
"periodic loss of vision",
"easy bruising",
"Physical examination shows splenomegaly",
"hemoglobin concentration",
"g/dL",
"leukocyte count",
"8000 mm3",
"platelet count",
"mm3",
"Bone marrow biopsy shows markedly increased megak... |
A 71-year-old man presents to the emergency department with severe substernal chest pain. An initial EKG demonstrates ST elevation in leads V2, V3, V4, and V5 with reciprocal changes. The patient is started on aspirin and heparin and is transferred to the cardiac catheterization lab. The patient recovers over the next ... | Increased pulmonary capillary wedge pressure | {
"A": "Decreased systemic vascular resistance",
"B": "Decreased tissue oxygen extraction",
"C": "Increased ejection fraction",
"D": "Increased pulmonary capillary wedge pressure"
} | step2&3 | D | [
"71 year old man presents",
"emergency department",
"severe substernal chest pain",
"initial EKG demonstrates ST elevation",
"leads V2",
"V3",
"V4",
"V5",
"reciprocal changes",
"patient",
"started",
"aspirin",
"heparin",
"transferred",
"cardiac catheterization lab",
"patient recovers",... |
A 55-year-old African American man presents to the emergency department with central chest pressure. His symptoms started the day before. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder. He also complains of some difficulty breathing. The patient was diagn... | Esmolol and intravenous nitroglycerin | {
"A": "Esmolol and intravenous nitroglycerin",
"B": "Fenoldopam",
"C": "Diazepam",
"D": "Hydralazine"
} | step2&3 | A | [
"55 year old African American man presents",
"emergency department",
"central chest pressure",
"symptoms started",
"day",
"pain",
"initially intermittent",
"nature",
"constant",
"radiates",
"jaw",
"left shoulder",
"difficulty breathing",
"patient",
"diagnosed",
"essential hypertension"... |
A 27-year-old African American man presents to a primary care physician for a routine checkup as a new patient. The patient states that he has been doing well lately and recently was promoted at his job. He states that 2 weeks ago he went to the ED for severe pain and was treated with morphine and oral fluids and disch... | Extravascular hemolysis | {
"A": "Chronic inflammation",
"B": "Extravascular hemolysis",
"C": "Folate deficiency",
"D": "Ineffective erythropoiesis"
} | step2&3 | B | [
"27 year old African American man presents",
"primary care physician",
"routine checkup",
"new patient",
"patient states",
"well",
"recently",
"promoted",
"job",
"states",
"2 weeks",
"ED",
"severe pain",
"treated with morphine",
"oral fluids",
"discharged home",
"night",
"happened"... |
A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He underwent appendectomy at the age of 25 years. He has a history of hypercholesterolemia that is well controlled with atorvastatin. He is an avid marathon runner and runs 8 miles per day four times a week. His father... | Mobitz type I AV block | {
"A": "Third-degree AV block",
"B": "Mobitz type I AV block",
"C": "Atrial fibrillation",
"D": "First-degree AV block"
} | step2&3 | B | [
"year old man",
"physician",
"routine health maintenance examination",
"feels well",
"appendectomy",
"age",
"years",
"history of hypercholesterolemia",
"well controlled",
"atorvastatin",
"avid marathon",
"runs 8 miles per day four times",
"week",
"father died",
"myocardial infarction",
... |
A 54-year-old man comes to the emergency department because of severe pain in his right leg that began suddenly 3 hours ago. He has had repeated cramping in his right calf while walking for the past 4 months, but it has never been this severe. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. Cur... | Administer normal saline | {
"A": "Administer mannitol",
"B": "Administer ionic contrast",
"C": "Administer normal saline",
"D": "Administer sodium bicarbonate"
} | step2&3 | C | [
"54 year old man",
"emergency department",
"of severe pain in",
"right leg",
"began",
"hours",
"repeated cramping",
"right calf",
"walking",
"past",
"months",
"never",
"severe",
"type 2 diabetes mellitus",
"hypercholesterolemia",
"hypertension",
"Current medications include insulin",... |
A 27-year-old G2P1 woman is diagnosed with an HIV infection after undergoing routine prenatal blood work testing. Her estimated gestational age by first-trimester ultrasound is 12 weeks. Her CD4 count is 150 cells/mm^3 and her viral load is 126,000 copies/mL. She denies experiencing any symptoms of HIV infection. Which... | HAART | {
"A": "Avoidance of antibiotic prophylaxis",
"B": "Breastfeeding",
"C": "HAART",
"D": "Vaginal delivery"
} | step2&3 | C | [
"27 year old",
"woman",
"diagnosed",
"HIV infection",
"routine prenatal blood work testing",
"estimated gestational age",
"first-trimester ultrasound",
"weeks",
"CD4 count",
"cells mm",
"viral load",
"copies/mL",
"denies experiencing",
"symptoms",
"HIV infection",
"following",
"appro... |
A 16-year-old boy presents to the emergency department after a skateboarding accident. He fell on a broken bottle and received a 4 cm wound on the dorsal aspect of his left hand. His vitals are stable and he was evaluated by the surgeon on call who determined to suture was not required. After several weeks the wound ha... | Incised wound | {
"A": "Incised wound",
"B": "Abrasion",
"C": "Avulsion",
"D": "Puncture"
} | step1 | A | [
"year old boy presents",
"emergency department",
"skateboarding accident",
"fell",
"bottle",
"received",
"4",
"wound",
"dorsal aspect",
"left hand",
"stable",
"evaluated",
"surgeon",
"call",
"determined",
"suture",
"not required",
"several weeks",
"wound",
"almost completely he... |
A 44-year-old female with a 3-year history of biliary colic presents with acute cholecystitis. After further evaluation, she undergoes a laparoscopic cholecystectomy without complication. Which of the following is true following this procedure? | Lipid absorption is unaffected | {
"A": "Lipid absorption is decreased",
"B": "Lipid absorption is increased",
"C": "Lipid absorption is unaffected",
"D": "The overall amount of bile acids is reduced"
} | step1 | C | [
"year old female",
"history",
"biliary colic presents",
"acute cholecystitis",
"further evaluation",
"laparoscopic cholecystectomy",
"complication",
"following",
"true following",
"procedure"
] |
A 56-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. Three months ago, the patient was started on metformin therapy after counseling on diet, exercise, and weight reduction failed to reduce his hyperglycemia. Physical examination shows no abnormalities. His hemoglobin A1c ... | Increased transcription of adipokines | {
"A": "Decreased breakdown of glucagon-like peptide 1",
"B": "Depolarization of pancreatic β-cells",
"C": "Autophosphorylation of receptor tyrosine kinase",
"D": "Increased transcription of adipokines"
} | step1 | D | [
"year old man",
"type 2 diabetes mellitus",
"physician",
"follow-up examination",
"Three months",
"patient",
"started",
"metformin therapy",
"counseling",
"diet",
"exercise",
"weight reduction failed to",
"hyperglycemia",
"Physical examination shows",
"abnormalities",
"hemoglobin A1c",... |
A 60-year-old man presents to the emergency department with pleuritic chest pain. He recently returned from a vacation in Germany and noticed he felt short of breath and had chest pain the following morning. The patient is generally healthy but did have surgery on his ankle 3 weeks ago and has been less ambulatory. His... | Hemoptysis | {
"A": "Bilateral wheezing",
"B": "Decreased breath sounds over area of the lung",
"C": "Hemoptysis",
"D": "Increased breath sounds over area of the lung"
} | step2&3 | C | [
"60 year old man presents",
"emergency department",
"pleuritic chest pain",
"recently returned",
"vacation",
"Germany",
"felt short of breath",
"chest pain",
"following morning",
"patient",
"healthy",
"surgery",
"ankle 3 weeks",
"less ambulatory",
"temperature",
"99",
"blood pressure... |
A 39-year-old man presents to the emergency room for epistaxis. He reports having frequent nosebleeds over the past 48 hours. He also reports a constant pounding headache over the same timeframe. He is accompanied by his wife who reports that he has seemed “off” lately, frequently forgetting recent events and names of ... | Metalloproteinase-mediated protein degradation | {
"A": "Metalloproteinase-mediated protein degradation",
"B": "Nucleotide excision repair",
"C": "Platelet binding to fibrinogen",
"D": "Porphobilinogen metabolism"
} | step1 | A | [
"year old man presents",
"emergency room",
"epistaxis",
"reports",
"frequent nosebleeds",
"past 48 hours",
"reports",
"constant pounding headache",
"same timeframe",
"wife",
"reports",
"frequently forgetting recent events",
"names",
"friends",
"past medical history",
"notable",
"hype... |
A 65-year-old man comes to his primary care physician for a routine health maintenance examination. He takes no medications. Physical examination and laboratory studies show no abnormalities. Compared to a healthy adolescent, this patient is most likely to have which of the following changes in immune function? | Decreased responsiveness to vaccines | {
"A": "Decreased autoimmunity",
"B": "Decreased number of neutrophil precursors",
"C": "Decreased responsiveness to vaccines",
"D": "Increased number of circulating B cells"
} | step1 | C | [
"65 year old man",
"primary care physician",
"routine health maintenance examination",
"takes",
"medications",
"Physical examination",
"laboratory studies show",
"abnormalities",
"Compared",
"healthy adolescent",
"patient",
"most likely to",
"following changes",
"immune function"
] |
Two hours after undergoing elective cholecystectomy with general anesthesia, a 41-year-old woman is evaluated for decreased mental status. BMI is 36.6 kg/m2. Respirations are 18/min and blood pressure is 126/73 mm Hg. Physical examination shows the endotracheal tube in normal position. She does not respond to sternal r... | High lipid solubility | {
"A": "Low cytochrome P450 activity",
"B": "High minimal alveolar concentration",
"C": "High lipid solubility",
"D": "Low blood solubility"
} | step1 | C | [
"Two hours",
"elective cholecystectomy",
"general anesthesia",
"year old woman",
"evaluated",
"decreased mental status",
"BMI",
"36",
"kg/m2",
"Respirations",
"min",
"blood pressure",
"mm Hg",
"Physical examination shows",
"endotracheal tube",
"normal position",
"not",
"sternal rub... |
A 58-year-old woman presents with a 2-week history of fever, fatigue, generalized weakness, and bleeding gums. Past medical history is significant for type 2 diabetes mellitus, managed with metformin. The patient is afebrile, and her vitals are within normal limits. On physical examination, she has bilateral cervical l... | t(15;17) | {
"A": "t(9;22)",
"B": "t(15;17)",
"C": "t(11;14)",
"D": "t(8;14)"
} | step1 | B | [
"58 year old woman presents",
"2-week history",
"fever",
"fatigue",
"generalized weakness",
"bleeding gums",
"Past medical history",
"significant",
"type 2 diabetes mellitus",
"managed",
"metformin",
"patient",
"afebrile",
"normal limits",
"physical examination",
"bilateral cervical ly... |
A 45-year-old man comes to the physician because of severe left knee pain and swelling. He has hypercholesterolemia and hypertension. Current medications include pravastatin and captopril. He eats a low-fat diet that includes fish and leafy green vegetables. He drinks 4–6 cups of coffee daily. He has smoked one pack of... | Reduce fish intake | {
"A": "Start aspirin",
"B": "Reduce fish intake",
"C": "Discontinue pravastatin",
"D": "Start colchicine\n\""
} | step2&3 | B | [
"year old man",
"physician",
"severe left knee pain",
"swelling",
"hypercholesterolemia",
"hypertension",
"Current medications include pravastatin",
"captopril",
"eats",
"low-fat diet",
"includes fish",
"leafy green vegetables",
"drinks",
"cups",
"coffee daily",
"smoked one pack",
"c... |
A 69-year-old man is brought to the emergency department by his wife because of fever, cough, diarrhea, and confusion for 2 days. He recently returned from a cruise to the Caribbean. He has a history of chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His temperature is 39... | Charcoal yeast extract agar | {
"A": "Charcoal yeast extract agar",
"B": "Chocolate agar",
"C": "Mannitol salt agar",
"D": "Eaton agar"
} | step1 | A | [
"69 year old man",
"brought",
"emergency department",
"wife",
"fever",
"cough",
"diarrhea",
"confusion",
"2 days",
"recently returned",
"Caribbean",
"history",
"chronic obstructive pulmonary disease",
"smoked one pack",
"cigarettes daily",
"40 years",
"temperature",
"4F",
"pulse"... |
A 70-year-old male visits his primary care physician because of progressive weight loss. He has a 20-year history of smoking 2 packs of cigarettes a day and was diagnosed with diabetes mellitus 6 years ago. After physical examination, the physician tells the patient he suspects adenocarcinoma at the head of the pancrea... | Palpable gallbladder | {
"A": "Lymphadenopathy of the umbilicus",
"B": "Acanthosis nigricans",
"C": "Palpable gallbladder",
"D": "Splenomegaly"
} | step1 | C | [
"70 year old male visits",
"primary care physician",
"of progressive weight loss",
"20 year history of smoking 2 packs",
"cigarettes",
"day",
"diagnosed",
"diabetes mellitus",
"years",
"physical examination",
"physician",
"patient",
"suspects adenocarcinoma",
"the of",
"pancreas",
"fol... |
A 48-year-old woman is brought to the emergency department by police because of confusion and agitation. Her medical record indicates that she has peptic ulcer disease that is treated with omeprazole. The patient's brother arrives shortly after. He reports that she drinks around 17 oz. of vodka daily. Neurological exam... | Folate deficiency | {
"A": "Folate deficiency",
"B": "Vitamin E deficiency",
"C": "Alcohol toxicity",
"D": "Vitamin B12 deficiency"
} | step1 | A | [
"48 year old woman",
"brought",
"emergency department",
"police",
"confusion",
"agitation",
"medical record",
"peptic ulcer disease",
"treated with omeprazole",
"patient's brother",
"reports",
"drinks",
"oz",
"vodka daily",
"Neurological examination shows horizontal nystagmus",
"gait",... |
A 17-year-old girl presents to her pediatrician for a wellness visit. She currently feels well but is concerned that she has not experienced menarche. She reports to recently developing headaches and describes them as pulsating, occurring on the left side of her head, associated with nausea, and relieved by ibuprofen. ... | Pelvic ultrasound | {
"A": "MRI of the head",
"B": "Pelvic ultrasound",
"C": "Serum estradiol",
"D": "Serum testosterone"
} | step2&3 | B | [
"year old girl presents",
"pediatrician",
"wellness visit",
"currently feels well",
"concerned",
"not",
"menarche",
"reports to recently",
"headaches",
"pulsating",
"occurring",
"left side of",
"head",
"associated with nausea",
"relieved by ibuprofen",
"part of",
"schools rugby team"... |
A 52-year-old man presents to his physician after his routine screening revealed that he has elevated liver enzymes. He complains of occasional headaches during the past year, but otherwise feels well. The patient reports that he was involved in a serious car accident in the 1980s. He does not smoke or drink alcohol. H... | Sofosbuvir and ledipasvir therapy | {
"A": "Interferon and ribavirin therapy",
"B": "Sofosbuvir and ledipasvir therapy",
"C": "Tenofovir and entecavir therapy",
"D": "Tenofovir and velpatasvir therapy"
} | step2&3 | B | [
"year old man presents",
"physician",
"routine screening revealed",
"elevated liver enzymes",
"occasional headaches",
"past year",
"feels well",
"patient reports",
"involved",
"serious car accident",
"1980s",
"not smoke",
"drink alcohol",
"history",
"illicit intravenous",
"not currentl... |
Four days after being admitted to the hospital for widespread second-degree burns over his arms and thorax, a 29-year-old man develops a fever and wound discharge. His temperature is 38.8°C (101.8°F). Examination shows a discolored burn eschar with edema and redness of the surrounding skin. The wounds have a sickly, sw... | Phospholipase C | {
"A": "Tetanospasmin",
"B": "Phospholipase C",
"C": "Alpha toxin",
"D": "Protein A"
} | step1 | B | [
"Four days",
"admitted",
"hospital",
"widespread second-degree burns",
"arms",
"thorax",
"29 year old man",
"fever",
"wound discharge",
"temperature",
"Examination shows",
"discolored burn eschar",
"edema",
"redness of",
"surrounding skin",
"wounds",
"sweet odor",
"culture",
"aff... |
A 73-year-old woman recently diagnosed with colonic adenocarcinoma comes to the physician because of a 1-week history of nausea and multiple episodes of vomiting. These symptoms started shortly after her first infusion of oxaliplatin and fluorouracil. The patient is started on an appropriate medication. Three weeks lat... | 5-HT3 receptor antagonist | {
"A": "H1 receptor antagonist",
"B": "NK1 receptor antagonist",
"C": "5-HT3 receptor antagonist",
"D": "Cannabinoid receptor agonist"
} | step1 | C | [
"year old woman recently diagnosed",
"colonic adenocarcinoma",
"physician",
"1-week history",
"nausea",
"multiple episodes of vomiting",
"symptoms started",
"first infusion",
"oxaliplatin",
"fluorouracil",
"patient",
"started",
"appropriate medication",
"Three weeks later",
"follow-up ap... |
A 11-year-old girl comes to the physician for evaluation of recurrent nosebleeds since childhood. She has multiple, small dilated capillaries on the lips, nose, and fingers on exam. Her father has a similar history of recurrent nosebleeds. Which of the following conditions is this patient at increased risk for? | High-output heart failure | {
"A": "High-output heart failure",
"B": "Pheochromocytoma",
"C": "Glaucoma",
"D": "Renal cell carcinoma"
} | step1 | A | [
"year old girl",
"physician",
"evaluation",
"recurrent nosebleeds",
"childhood",
"multiple",
"small dilated capillaries",
"lips",
"nose",
"fingers",
"exam",
"father",
"similar history",
"recurrent nosebleeds",
"following conditions",
"patient",
"increased risk"
] |
A 16-year-old boy is brought to the emergency department after being tackled at a football game. Per his mom, he is the quarterback of his team and was head-butted in the left shoulder region by the opposing team. Shortly after, the mother noticed that his left arm was hanging by his torso and his hand was “bent backwa... | C5-C6 nerve roots | {
"A": "C5-C6 nerve roots",
"B": "C8-T1 nerve roots",
"C": "Radial nerve",
"D": "Long thoracic nerve"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"football game",
"mom",
"team",
"head",
"left shoulder region",
"team",
"mother",
"left arm",
"hanging",
"torso",
"hand",
"bent backwards",
"sky",
"patient denies head trauma",
"loss of consciousness",
"sensory changes",
"gross... |
A 58-year-old man comes to the physician because of a 4-day history of abdominal pain and vomiting. Initially, the vomitus was food that he had recently eaten, but it is now bilious. He has had similar complaints several times in the past 6 years. He has smoked 1 pack of cigarettes daily for the past 25 years and drink... | Pancreatic pseudocyst | {
"A": "Chronic cholecystitis",
"B": "Retroperitoneal fibrosis",
"C": "Hypertrophic pyloric stenosis",
"D": "Pancreatic pseudocyst"
} | step1 | D | [
"58 year old man",
"physician",
"4-day history",
"abdominal pain",
"vomiting",
"Initially",
"vomitus",
"food",
"recently eaten",
"now",
"similar complaints",
"times",
"past",
"years",
"smoked 1 pack",
"cigarettes daily",
"past",
"years",
"drinks",
"oz",
"alcohol daily",
"5 ... |
A 63-year-old woman is brought to the emergency department because of severe abdominal pain and vomiting for 3 hours. She had previous episodes of abdominal pain that lasted for 10–15 minutes and resolved with antacids. She lives with her daughter and grandchildren. She divorced her husband last year. She is alert and ... | Cancel the surgery | {
"A": "Consult hospital ethics committee",
"B": "Cancel the surgery",
"C": "Continue with emergency life-saving surgery",
"D": "Obtain consent from the patient's ex-husband"
} | step2&3 | B | [
"63 year old woman",
"brought",
"emergency department",
"severe abdominal",
"vomiting",
"hours",
"previous episodes of abdominal pain",
"lasted",
"minutes",
"resolved",
"antacids",
"lives with",
"daughter",
"grandchildren",
"divorced",
"husband",
"year",
"alert",
"oriented",
"t... |
A 1-year-old boy is brought to the physician by his mother because he has become increasingly pale over the past several months. He has otherwise been healthy. Apart from his maternal grandfather, who had a blood disorder and required frequent blood transfusions since birth, the rest of his family, including his parent... | Glycine + succinyl-CoA → aminolevulinic acid | {
"A": "Aminolevulinic acid → porphobilinogen",
"B": "Glycine + succinyl-CoA → aminolevulinic acid",
"C": "Protoporphyrin → heme",
"D": "Uroporphyrinogen III → coproporphyrinogen III"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"mother",
"pale",
"past",
"months",
"healthy",
"maternal grandfather",
"blood disorder",
"required frequent blood transfusions",
"birth",
"rest",
"family",
"including",
"parents",
"older sister",
"healthy",
"Examination shows conjunctival p... |
A 21-year-old man presents to an outpatient psychiatrist with chief complaints of fatigue and “hearing voices.” He describes multiple voices which sometimes call his name or say nonsensical things to him before he falls asleep at night. He occasionally awakes to see “strange people” in his room, which frighten him but ... | Modafinil | {
"A": "Haloperidol",
"B": "Levetiracetam",
"C": "Modafinil",
"D": "Valproic acid"
} | step2&3 | C | [
"21-year-old man presents",
"outpatient psychiatrist",
"chief complaints",
"fatigue",
"hearing voices",
"multiple voices",
"sometimes call",
"name",
"nonsensical things",
"falls asleep",
"night",
"occasionally awakes to see",
"people",
"room",
"then",
"patient",
"worried",
"uncle",... |
A 57-year-old man was brought into the emergency department unconscious 2 days ago. His friends who were with him at that time say he collapsed on the street. Upon arrival to the ED, he had a generalized tonic seizure. At that time, he was intubated and is being treated with diazepam and phenytoin. A noncontrast head C... | Repeat examination in several hours | {
"A": "Withdraw ventilation support and mark time of death",
"B": "Electroencephalogram",
"C": "Repeat examination in several hours",
"D": "Second opinion from a neurologist"
} | step2&3 | C | [
"57 year old man",
"brought",
"emergency department unconscious 2 days",
"friends",
"time",
"collapsed",
"street",
"arrival",
"ED",
"generalized tonic",
"time",
"intubated",
"treated with diazepam",
"phenytoin",
"head CT revealed hemorrhages",
"pons",
"cerebellum",
"mass effect",
... |
A 63-year-old woman comes to the office because of a 2-year history of upper and lower extremity weakness and neck pain that is worse with sneezing. She has had difficulty swallowing and speaking for the past 8 months. Musculoskeletal examination shows spasticity and decreased muscle strength in all extremities. There ... | Foramen magnum meningioma | {
"A": "Foramen magnum meningioma",
"B": "Cerebral glioblastoma multiforme",
"C": "Amytrophic lateral sclerosis",
"D": "Syringomyelia\n\""
} | step1 | A | [
"63 year old woman",
"office",
"2 year history",
"upper",
"lower extremity weakness",
"neck pain",
"worse",
"sneezing",
"difficulty swallowing",
"speaking",
"past",
"months",
"Musculoskeletal examination shows spasticity",
"decreased muscle strength",
"extremities",
"bilateral atrophy"... |
A 20-year-old man is brought to the emergency room for evaluation of a back injury sustained while at work. A CT scan of the lumbar spine shows an incidental 2-cm mass adjacent to the inferior vena cava. Histologic examination of a biopsy specimen of the mass shows clusters of chromaffin cells. This mass is most likely... | Norepinephrine | {
"A": "Norepinephrine",
"B": "Cortisol",
"C": "Estrogen",
"D": "Dehydroepiandrosterone"
} | step1 | A | [
"20 year old man",
"brought",
"emergency room",
"evaluation of",
"back injury sustained",
"work",
"CT scan of",
"lumbar spine shows",
"incidental",
"mass adjacent to",
"inferior vena cava",
"Histologic examination",
"biopsy",
"mass shows clusters",
"cells",
"mass",
"most likely to se... |
A 1-week-old infant that was birthed at home is rushed to the emergency room by his parents. His parents are recent immigrants who do not speak English. Through a translator, the child's parents say that during play with the infant, the infant's body became rigid and his mouth 'locked up'. The child likely suffered fro... | Infection of the umbilical stump | {
"A": "Infection of a foot ulcer",
"B": "Intrauterine infection",
"C": "Infection of the umbilical stump",
"D": "Dental infection"
} | step1 | C | [
"week old infant",
"at home",
"rushed",
"emergency room",
"parents",
"parents",
"recent immigrants",
"not speak English",
"translator",
"child's parents",
"play",
"infant",
"infant's body",
"rigid",
"mouth",
"locked",
"child likely suffered",
"n"
] |
A 42-year-old male presents to his primary care physician with complaints of fatigue and occasionally darkened urine over the past 3 months. Upon further questioning, the patient reveals that he has regularly had dark, 'cola-colored' urine when he has urinated at night or early in the morning. However, when he urinates... | Deficiency of CD-55 and CD-59 cell membrane proteins | {
"A": "Deficiency of C1 esterase-inhibitor",
"B": "Presence of a temperature-dependent IgG autoantibody",
"C": "Deficiency of CD-55 and CD-59 cell membrane proteins",
"D": "Autosomal recessive deficiency of platelet Glycoprotein IIb/IIIa receptor"
} | step1 | C | [
"year old male presents",
"primary care physician",
"complaints",
"fatigue",
"occasionally",
"urine",
"past 3 months",
"further questioning",
"patient reveals",
"dark",
"cola colored",
"urine",
"night",
"early",
"morning",
"day",
"appears",
"much lighter yellow color",
"Laborator... |
A 48-year-old man presents to the emergency department with complaints of substernal chest pain for the past 1 hour. The pain is crushing in nature and radiates to his neck and left arm. He rates the pain as 7/10. He gives a history of similar episodes in the past that resolved with rest. He is a non-smoker and drinks ... | Atenolol | {
"A": "Celiprolol",
"B": "Atenolol",
"C": "Penbutolol",
"D": "Pindolol"
} | step1 | B | [
"48 year old man presents",
"emergency department",
"complaints",
"substernal chest pain",
"past",
"hour",
"pain",
"crushing",
"nature",
"radiates",
"neck",
"left arm",
"rates",
"pain",
"10",
"gives",
"history of similar episodes",
"past",
"resolved",
"rest",
"non-smoker",
... |
A 19-year-old woman presents with abdominal pain and diarrhea for the last week. She has missed 3 days of school and is extremely stressed about the effect of this absence on her academic performance. She has had a couple of similar though less intense episodes in the past. She says that the diarrhea alternates with co... | Loperamide | {
"A": "Norfloxacin + metronidazole",
"B": "Metronidazole",
"C": "Dicyclomine",
"D": "Loperamide"
} | step1 | D | [
"year old woman presents",
"abdominal pain",
"diarrhea",
"week",
"missed 3 days",
"school",
"extremely stressed",
"effect of",
"absence",
"academic performance",
"couple",
"similar",
"less intense episodes",
"past",
"diarrhea alternates",
"constipation",
"associated with bloating",
... |
A 57-year-old woman undergoes an operation for a long-term toxic multinodular goiter. 13 hours after the procedure, she complains of tingling around her lips and difficulty breathing. While measuring her blood pressure, her hand turned as seen in the picture. On physical examination, she looks anxious and her chest is ... | Intravenous calcium gluconate | {
"A": "Oral calcium and calcitriol",
"B": "Human recombinant parathyroid hormone (PTH)",
"C": "Oral magnesium",
"D": "Intravenous calcium gluconate"
} | step2&3 | D | [
"57 year old woman",
"operation",
"long-term toxic multinodular goiter",
"hours",
"procedure",
"tingling",
"lips",
"difficulty breathing",
"measuring",
"blood pressure",
"hand turned",
"seen",
"picture",
"physical examination",
"looks anxious",
"chest",
"wheezy",
"sides",
"follow... |
A 62-year-old man with history of heart failure with preserved ejection fraction (HFpEF) and COPD presents to his cardiologist for a right heart catheterization procedure after a recent echocardiogram revealed pulmonary artery pressure (PAP) of 55 mmHg. Intraoperative administration of intravenous adenosine causes the ... | Amlodipine | {
"A": "Epoprostenol",
"B": "Adenosine",
"C": "Bosentan",
"D": "Amlodipine"
} | step2&3 | D | [
"year old man with history",
"heart failure",
"preserved ejection fraction",
"COPD presents",
"cardiologist",
"right",
"recent echocardiogram revealed pulmonary artery pressure",
"PAP",
"55 mmHg",
"Intraoperative administration",
"intravenous adenosine causes",
"PAP to decrease",
"35 mmHg",
... |
A 15-year-old male presents to the emergency department with fever, malaise, and shortness of breath for 1 week. Further history reveals that the patient experiences swelling in his face in the morning that disappears as the day progresses. Physical exam reveals hepatosplenomegaly. A complete blood count shows WBC 84,0... | CD2 | {
"A": "CD2",
"B": "CD10",
"C": "CD19",
"D": "CD20"
} | step1 | A | [
"year old male presents",
"emergency department",
"fever",
"malaise",
"shortness of breath",
"1 week",
"Further history reveals",
"patient experiences swelling",
"face",
"morning",
"day progresses",
"Physical exam reveals hepatosplenomegaly",
"complete blood count shows WBC 84",
"cells/mL"... |
A 42-year-old man presents to his physician with dark urine and intermittent flank pain. He has no significant past medical history and generally is healthy. His temperature is 97.5°F (36.4°C), blood pressure is 182/112 mmHg, pulse is 85/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical e... | Renal ultrasound | {
"A": "Abdominal CT",
"B": "Renal biopsy",
"C": "Renal ultrasound",
"D": "Voiding cystourethrogram"
} | step2&3 | C | [
"year old man presents",
"physician",
"dark urine",
"intermittent flank",
"significant past medical history",
"healthy",
"temperature",
"97",
"36 4C",
"blood pressure",
"mmHg",
"pulse",
"85 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Physical examination"... |
A 2-year-old boy is brought to the physician because of the rash shown in the picture for 2 days. Her mother says that the rash initially appeared on his face and neck. He has had fever, cough, and poor appetite for 5 days. The boy’s family recently immigrated from Asia and is unable to provide his vaccination records.... | Rubella | {
"A": "Measles",
"B": "Roseola",
"C": "Rubella",
"D": "Parvovirus B19 infection"
} | step1 | C | [
"2 year old boy",
"brought",
"physician",
"rash shown",
"picture",
"2 days",
"mother",
"rash initially appeared",
"face",
"neck",
"fever",
"cough",
"poor appetite",
"5 days",
"boys family recently",
"Asia",
"unable to provide",
"vaccination records",
"temperature",
"pulse",
"... |
A 15-year-old boy is sent from gym class with a chief complaint of severe muscle aches. In class today he was competing with his friends and therefore engaged in weightlifting for the first time. A few hours later he was extremely sore and found that his urine was red when he went to urinate. This concerned him and he ... | Normal glycogen structure | {
"A": "Glycogen without normal branching pattern",
"B": "Normal glycogen structure",
"C": "Short outer glycogen chains",
"D": "Absence of glycogen in muscles"
} | step1 | B | [
"year old boy",
"sent",
"class",
"chief complaint",
"severe muscle aches",
"class today",
"friends",
"engaged",
"weightlifting",
"first time",
"few hours later",
"extremely sore",
"found",
"urine",
"red",
"to",
"sent",
"emergency department",
"evaluation",
"further questioning"... |
A previously healthy 30-year-old man comes to the physician because of a 2-week history of lesions on his elbows. He has no history of serious illness and takes no medications. Physical examination shows skin lesions on bilateral elbows. A photograph of his right elbow is shown. Which of the following is the most appro... | Calcipotriene | {
"A": "Dapsone",
"B": "Terbinafine",
"C": "Ketoconazole",
"D": "Calcipotriene"
} | step1 | D | [
"healthy 30 year old man",
"physician",
"2-week history",
"lesions",
"elbows",
"history",
"serious illness",
"takes",
"medications",
"Physical examination shows skin lesions",
"bilateral elbows",
"photograph",
"right elbow",
"shown",
"following",
"most appropriate",
"patient's skin"
... |
A 23-year-old woman is brought to the emergency department 30 minutes after stepping on a piece of broken glass. Physical examination shows a 3-cm, ragged laceration on the plantar aspect of the left foot. The physician uses hydrogen peroxide to clean the wound. Which of the following is the most likely mechanism of ac... | Formation of free radicals | {
"A": "Halogenation of nucleic acids",
"B": "Crosslinking of proteins",
"C": "Formation of free radicals",
"D": "Congealing of cytoplasm"
} | step1 | C | [
"23 year old woman",
"brought",
"emergency department 30 minutes",
"stepping",
"piece",
"glass",
"Physical examination shows",
"3",
"laceration",
"plantar of",
"left",
"physician uses hydrogen peroxide to clean",
"wound",
"following",
"most likely mechanism of action",
"disinfectant"
] |
A 49-year-old man is brought to the emergency department after being discovered unconscious in a field near the county fair. Several empty bottles of vodka were found near him. On arrival, he is mumbling incoherently. He appears malodorous and disheveled. Serum studies show:
Na+ 150 mEq/L
K+ 3.3 mEq/L
Cl- 115 mEq/L
HCO... | Decreased activity of pyruvate dehydrogenase | {
"A": "Decreased activity of glucose-6-phosphate dehydrogenase",
"B": "Increased activity of α-ketoglutarate dehydrogenase",
"C": "Increased activity of phenylalanine hydroxylase",
"D": "Decreased activity of pyruvate dehydrogenase"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"discovered unconscious",
"field",
"county fair",
"Several empty bottles",
"vodka",
"found near",
"arrival",
"appears",
"Serum studies show",
"mEq",
"K",
"HCO3",
"nitrogen 30 mg",
"mg",
"Creatinine",
"4",
"mmol",
"N",
"foll... |
A 63-year-old woman presents to the outpatient clinic complaining of severe vulvar itching. The pruritus started 1 year ago and became worse over the last several months. She has tried over-the-counter topical steroids without relief. She is not currently sexually active. Her medical history is notable for long-standin... | Squamous cell carcinoma | {
"A": "Bartholin gland cyst",
"B": "Bartholin gland carcinoma",
"C": "Squamous cell carcinoma",
"D": "Vulvar Paget's disease"
} | step2&3 | C | [
"63 year old woman presents",
"outpatient clinic complaining of severe vulvar itching",
"pruritus started 1 year",
"worse",
"months",
"over-the-counter topical steroids",
"relief",
"not currently sexually active",
"medical history",
"notable",
"long standing lichen sclerosus",
"physical examin... |
A 34-year-old man is admitted to the hospital because of a 3-week history of abdominal distention and yellowing of the skin. He also has a 2-year history of progressively worsening breathlessness and cough. Three days after admission, he suddenly develops peritonitis and sepsis. Despite appropriate care, he dies. At au... | Oxidative deamination of lysine residues | {
"A": "Oxidative deamination of lysine residues",
"B": "Arrangement in a triple helical structure",
"C": "Formation of disulfide bridges",
"D": "N-glycosylation of serine residues"
} | step1 | A | [
"year old man",
"admitted",
"hospital",
"3 week history",
"abdominal distention",
"yellowing of the skin",
"2 year history",
"worsening breathlessness",
"cough",
"Three days",
"admission",
"peritonitis",
"sepsis",
"appropriate care",
"autopsy",
"histopathological examination",
"liver... |
A stock trader was reprimanded by his boss for making a series of miscalculated trades that almost cost him his job and the firm a significant amount of money. After leaving work, the trader went to donate his time by tutoring math at the local public school. When his tutee arrived for the session, the trader realized ... | Displacement | {
"A": "Projection",
"B": "Reaction formation",
"C": "Displacement",
"D": "Passive aggression"
} | step1 | C | [
"stock",
"boss",
"making",
"series",
"almost cost",
"job",
"firm",
"significant amount",
"money",
"leaving work",
"to",
"time",
"tutoring math",
"local public school",
"arrived",
"session",
"not complete",
"assignment",
"previous session",
"then",
"to",
"resulting in",
"l... |
A 32-year-old woman comes to the clinic for a routine evaluation. This is her first time visiting this office. Her medical history is significant for cystic medial necrosis of the aorta. Her vital signs include: heart rate 85/min, respiratory rate 15/min, temperature 36.0°C (96.8°F), and blood pressure 110/80 mm Hg. Ph... | Marfan syndrome | {
"A": "Fabry disease",
"B": "Marfan syndrome",
"C": "Tay-Sachs disease",
"D": "Von Hippel-Lindau disease"
} | step1 | B | [
"year old woman",
"clinic",
"routine evaluation",
"first time visiting",
"office",
"medical history",
"significant",
"cystic medial necrosis of the aorta",
"vital signs include",
"heart rate 85 min",
"respiratory rate",
"min",
"temperature 36",
"96",
"blood pressure",
"80 mm Hg",
"Ph... |
A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 ... | Language delay | {
"A": "Inadequate growth",
"B": "Language delay",
"C": "Gross motor skill delay",
"D": "There are no developmental concerns"
} | step2&3 | B | [
"year old male presents",
"pediatrician",
"well-child visit",
"history",
"mother",
"physical examination",
"pediatrician learns",
"baby babbles non",
"takes several steps",
"picks",
"cereal using two fingers",
"weight",
"currently",
"lbs",
"birth-weight",
"lbs",
"oz",
"height",
"... |
An investigator is studying DNA repair processes in an experimental animal. The investigator inactivates a gene encoding a protein that physiologically excises nucleotides from damaged, bulky, helix-distorting DNA strands. A patient with a similar defect in this gene is most likely to present with which of the followin... | Dry skin and increased photosensitivity | {
"A": "Dry skin and increased photosensitivity",
"B": "Colorectal and endometrial cancers",
"C": "Leukocoria and a painful bone mass",
"D": "Ataxic gait and facial telangiectasias"
} | step1 | A | [
"investigator",
"studying DNA repair processes",
"experimental animal",
"investigator",
"gene encoding a protein",
"nucleotides",
"damaged",
"bulky",
"helix distorting DNA strands",
"patient",
"similar defect",
"gene",
"most likely to present",
"following findings"
] |
A 27-year-old man comes to the physician because of a 4-month history of recurrent episodes of headaches, palpitations, and sweating. He was adopted shortly after birth and does not know his biological parents. His pulse is 103/min and blood pressure is 160/105 mm Hg. Physical examination shows multiple soft, yellow pa... | RET | {
"A": "RET",
"B": "FBN1",
"C": "TSC2",
"D": "COL5A1"
} | step1 | A | [
"27 year old man",
"physician",
"of",
"4 month history",
"recurrent episodes",
"headaches",
"palpitations",
"sweating",
"adopted",
"birth",
"not",
"biological parents",
"pulse",
"min",
"blood pressure",
"mm Hg",
"Physical examination shows multiple soft",
"yellow",
"the tip of",
... |
A 50-year-old man presents to the emergency department complaining of blood in his stool. He reports that this morning he saw bright red blood in the toilet bowl. He denies fatigue, headache, weight loss, palpitations, constipation, or diarrhea. He has well-controlled hypertension and takes hydrochlorothiazide. His fat... | Colonoscopy | {
"A": "Anoscopy",
"B": "Barium enema",
"C": "Colonoscopy",
"D": "Upper endoscopy"
} | step2&3 | C | [
"50 year old man presents",
"emergency department",
"blood",
"stool",
"reports",
"morning",
"saw bright red blood",
"toilet bowl",
"denies fatigue",
"headache",
"weight loss",
"palpitations",
"constipation",
"diarrhea",
"well-controlled hypertension",
"takes hydrochlorothiazide",
"fa... |
A 52-year-old man is brought to the emergency department with a 2-hour history of severe, sudden-onset generalized headache. He has since developed nausea and has had one episode of vomiting. The symptoms began while he was at home watching television. Six days ago, he experienced a severe headache that resolved withou... | Obtain a lumbar puncture | {
"A": "Obtain a lumbar puncture",
"B": "Administer 100% oxygen and intranasal sumatriptan",
"C": "Place ventriculoperitoneal shunt",
"D": "Obtain an MRI scan of the head"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department",
"2-hour history",
"severe",
"sudden-onset generalized headache",
"since",
"nausea",
"one episode of vomiting",
"symptoms began",
"at home watching television",
"Six days",
"experienced",
"severe headache",
"resolved",
"treatment",
"h... |
A 44-year-old woman presents for her annual physical checkup. She says she first noticed a mass in her right breast while taking a shower 3 months ago, which has progressively increased in size. She denies any weight loss, fever, night sweats, discharge from or change in her nipples. Her family history is negative for ... | Phyllodes tumor | {
"A": "Fibroadenoma",
"B": "Breast abscess",
"C": "Phyllodes tumor",
"D": "Fat necrosis"
} | step1 | C | [
"year old woman presents",
"annual physical checkup",
"first",
"mass in",
"right breast",
"taking",
"shower",
"months",
"increased in size",
"denies",
"weight loss",
"fever",
"night sweats",
"discharge",
"change in",
"nipples",
"family history",
"negative",
"breast",
"ovarian",... |
A 35-year-old female presents to your office with complaints of painful bleeding between regular menstrual cycles, pain during sexual intercourse, and postcoital bleeding for the past 6 months. She also gives a long history of mild, crampy, vague, lower abdominal pain, but has never sought medical attention. She underw... | Endometritis | {
"A": "Endometritis",
"B": "Ovulatory dysfunction",
"C": "Ectropion",
"D": "Endometriosis"
} | step1 | A | [
"35 year old female presents",
"office",
"complaints",
"painful bleeding",
"regular menstrual cycles",
"pain",
"sexual intercourse",
"postcoital bleeding",
"past 6 months",
"gives",
"long history",
"mild",
"crampy",
"vague",
"lower abdominal pain",
"never",
"medical attention",
"su... |
A longstanding patient of yours has been hospitalized for a week with pneumonia. You have taken care of her while she was in the hospital. At the end of her hospitalization, she tells you how grateful she is for your care and gives you a small gift basket with homemade food, which you accept. However, when you get home... | Keep the food, but return the gift certificate | {
"A": "Return both the food and gift certificate because it is never acceptable to take gifts from patients",
"B": "Keep both the food and gift certificate",
"C": "Keep the food, but return the gift certificate",
"D": "Return the gift certificate for cash, and donate the cash to the hospital's free clinic"
} | step1 | C | [
"patient",
"hospitalized",
"week",
"pneumonia",
"taken care",
"hospital",
"end",
"hospitalization",
"care",
"gives",
"small gift",
"food",
"accept",
"home",
"contains",
"gift certificate",
"expensive restaurant",
"following",
"appropriate response"
] |
A 29-year-old man presents to his primary care provider complaining of testicular pain. He reports a four-day history of dull chronic pain in his left testicle that is worse with standing. His past medical history is notable for asthma and major depressive disorder. He takes inhaled albuterol as needed and sertraline. ... | Left testicular vein – Left renal vein | {
"A": "Left testicular vein – Left renal vein",
"B": "Left testicular vein – Inferior vena cava",
"C": "Descending aorta – Left testicular artery",
"D": "Left testicular vein – Left internal iliac vein"
} | step1 | A | [
"29 year old man presents",
"primary care provider",
"of testicular pain",
"reports",
"four day history",
"dull chronic",
"left testicle",
"worse",
"standing",
"past medical history",
"notable",
"asthma",
"major depressive disorder",
"takes inhaled albuterol as needed",
"sertraline",
"... |
A 26-year-old African American woman presents to the clinic with burning upon urination. The patient describes increased frequency, urgency, and a painful sensation at the urethra when urinating for the past 3 days. She also reports increased vaginal discharge and abnormal odor during the same time. The patient denies ... | Surgery | {
"A": "IM ceftriaxone and oral azithromycin",
"B": "Increase in sulfasalazine dose",
"C": "IV ceftriaxone",
"D": "Surgery"
} | step2&3 | D | [
"year old African American woman presents",
"clinic",
"burning",
"urination",
"patient",
"increased frequency",
"urgency",
"painful",
"urethra",
"past 3 days",
"reports increased vaginal discharge",
"abnormal odor",
"same time",
"patient denies fever",
"flank pain",
"hematuria",
"pat... |
A 62-year-old woman is brought to the emergency department because of the sudden onset of severe left eye pain, blurred vision, nausea, and vomiting. She has had an upper respiratory tract infection for the past 2 days and has been taking phenylephrine to control symptoms. Examination shows a rock-hard, injected left g... | Metabolic acidosis | {
"A": "Xerostomia",
"B": "Bradycardia",
"C": "Metabolic acidosis",
"D": "Diaphoresis"
} | step1 | C | [
"62 year old woman",
"brought",
"emergency department",
"of",
"sudden onset",
"severe left eye pain",
"blurred vision",
"nausea",
"vomiting",
"upper respiratory tract infection",
"past 2 days",
"taking phenylephrine to control symptoms",
"Examination shows",
"rock hard",
"injected left g... |
A 46-year-old woman presents to her primary care physician with complaints of increasing left upper quadrant discomfort. She has a known history of type 1 Gaucher disease. On physical examination, her spleen is palpable 8 cm below the costal margin. Routine laboratory work reveals severe pancytopenia. After consultatio... | Pneumococcal septicemia | {
"A": "Anemia",
"B": "Pneumococcal septicemia",
"C": "Thrombocytopenia",
"D": "Staphylococcal septicemia"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"complaints",
"increasing left upper quadrant discomfort",
"known history",
"type 1 Gaucher disease",
"physical examination",
"spleen",
"palpable 8",
"costal margin",
"Routine laboratory work reveals severe pancytopenia",
"consultation",
"... |
An investigator is studying growth patterns of various fungal pathogens. Incubation of an isolated fungus at 25°C shows branching hyphae with rosettes of conidia under light microscopy. After incubation at 37°C, microscopic examination of the same organism instead shows smooth, white colonies with rounded, elongated ce... | Sporotrichosis | {
"A": "Pityriasis versicolor",
"B": "Candidiasis",
"C": "Coccidioidomycosis",
"D": "Sporotrichosis"
} | step1 | D | [
"investigator",
"studying growth patterns of various fungal pathogens",
"isolated",
"shows branching hyphae",
"rosettes of conidia",
"light microscopy",
"microscopic examination",
"same organism",
"shows smooth",
"white colonies",
"rounded",
"elongated cells",
"Infection",
"investigated pa... |
A group of scientists discovered a neurotoxin that prevents neurons from releasing neurotransmitters. They performed a series of experiments to determine the protein that the neurotoxin affected. They used a fluorescent molecule that localizes to synaptic vesicles. In the control experiment, they observed the movement ... | Kinesin | {
"A": "Kinesin",
"B": "Dynein",
"C": "Synaptobrevin",
"D": "Alpha/Beta tubulin"
} | step1 | A | [
"A group",
"scientists discovered",
"neurotoxin",
"prevents neurons",
"releasing neurotransmitters",
"performed",
"series",
"experiments to",
"protein",
"neurotoxin affected",
"used",
"fluorescent molecule",
"localizes",
"synaptic vesicles",
"control experiment",
"observed",
"movemen... |
An investigator is studying nosocomial infections in hospitals. The weekly incidence of hospital-acquired pulmonary infections within the pediatric wards of eight different hospitals is recorded. The results are shown. Which of the following values best represents the median value of these incidence rates? | 6.0 | {
"A": "7.0",
"B": "5.5",
"C": "6.0",
"D": "8.0"
} | step1 | C | [
"investigator",
"studying nosocomial infections",
"weekly incidence",
"hospital-acquired pulmonary infections",
"pediatric wards",
"eight different hospitals",
"recorded",
"results",
"shown",
"following values best represents",
"median value",
"incidence rates"
] |
A 58-year old man comes to the emergency department because of progressively worsening shortness of breath and fatigue for 3 days. During the last month, he has also noticed dark colored urine. One month ago, he underwent mechanical aortic valve replacement for high-grade aortic stenosis. A photomicrograph of a periphe... | Elevated lactate dehydrogenase | {
"A": "Low unconjugated bilirubin",
"B": "Elevated lactate dehydrogenase",
"C": "Low platelets",
"D": "Elevated haptoglobin"
} | step1 | B | [
"58 year old man",
"emergency department",
"worsening shortness of breath",
"fatigue",
"3 days",
"last month",
"dark colored urine",
"One month",
"mechanical",
"high-grade",
"stenosis",
"photomicrograph",
"peripheral blood smear",
"patient",
"shown",
"following findings",
"most likel... |
A 30-year-old woman comes to the physician for a pelvic examination and Pap smear. Menses have occurred at regular 28-day intervals since menarche at the age of 11 years and last for 5 days. The first day of her last menstrual period was 3 weeks ago. She is sexually active with her husband and takes oral contraceptive ... | Pap smear and human papillomavirus testing now and every 5 years, mammography at age 40 | {
"A": "Pap smear and human papillomavirus testing now and every year, mammography at age 40",
"B": "Pap smear every 5 years, mammography at age 40",
"C": "Pap smear only every year, mammography at age 50",
"D": "Pap smear and human papillomavirus testing now and every 5 years, mammography at age 40"
} | step2&3 | D | [
"30 year old woman",
"physician",
"pelvic examination",
"Pap smear",
"Menses",
"occurred",
"regular",
"day intervals",
"menarche at",
"age",
"years",
"last",
"5 days",
"first day",
"last menstrual period",
"3 weeks",
"sexually active",
"husband",
"takes oral contraceptive pills",... |
A 29-year-old man is outside his home doing yard work when a bee stings him in the right arm. Within 10 minutes, he reports breathlessness and multiple, circular, pruritic rashes over his right arm. He drives to his family physician’s office for evaluation. His past medical history is significant for hypertension and h... | Epinephrine and go to the emergency department | {
"A": "Diphenhydramine and go to the emergency department",
"B": "Methylprednisolone and go to the emergency department",
"C": "Go to the emergency department",
"D": "Epinephrine and go to the emergency department"
} | step2&3 | D | [
"29 year old man",
"outside",
"home",
"yard work",
"bee stings",
"right arm",
"10 minutes",
"reports breathlessness",
"multiple",
"circular",
"pruritic rashes",
"right arm",
"drives",
"family",
"evaluation",
"past medical history",
"significant",
"hypertension",
"takes lisinopril... |
A 45-year-old woman is brought to the Emergency Department by her husband due to increasing confusion. He reports that she has been urinating a lot for the past month or so, especially at night, and has also been constantly drinking water and tea. Lately, she has been more tired than usual as well. Her past medical his... | Nephrogenic diabetes insipidus | {
"A": "SIADH",
"B": "Psychogenic polydipsia",
"C": "Nephrogenic diabetes insipidus",
"D": "Central diabetes insipidus"
} | step2&3 | C | [
"year old woman",
"brought",
"Emergency Department",
"husband due to increasing confusion",
"reports",
"lot",
"past month",
"so",
"night",
"constantly drinking water",
"tea",
"more tired",
"usual",
"well",
"past medical history",
"significant",
"bipolar disorder",
"takes lithium",
... |
A 27-year-old man presents to the emergency department with severe dyspnea and sharp chest pain that suddenly started an hour ago after he finished exercising. He has a history of asthma as a child, and he achieves good control of his acute attacks with Ventolin. On examination, his right lung field is hyperresonant al... | Tube insertion | {
"A": "Chest X-rays",
"B": "ABG",
"C": "Tube insertion",
"D": "CT scan"
} | step2&3 | C | [
"27 year old man presents",
"emergency department",
"severe dyspnea",
"sharp chest pain",
"started",
"hour",
"finished exercising",
"history of asthma",
"child",
"good control",
"acute attacks",
"Ventolin",
"examination",
"right lung field",
"hyperresonant",
"diminished lung sounds",
... |
A 40-year-old woman presents with an acute loss of vision in her right eye. Past medical history is significant for depression diagnosed 2 years ago and well-managed medically. Further history reveals that the patient recently came to know that her trusted neighbor was sexually abusing her younger daughter. Physical ex... | La belle indifference | {
"A": "La belle indifference",
"B": "Pseudologia fantastica",
"C": "Desire for the sick-role",
"D": "Hyperactive insula"
} | step2&3 | A | [
"40 year old woman presents",
"acute loss of vision",
"right eye",
"Past medical history",
"significant",
"depression diagnosed 2 years",
"well managed",
"Further history reveals",
"patient recently",
"to",
"trusted neighbor",
"sexually abusing",
"younger daughter",
"Physical examination",... |
A 33-year-old man presents to his primary care physician for numbness and tingling in his hands. He does not typically see a physician, but states that he has had some worsening numbness and weakness in his hands that has been progressing over the past month. His temperature is 99°F (37.2°C), blood pressure is 120/66 m... | Congestive heart failure | {
"A": "Adrenal failure",
"B": "Congestive heart failure",
"C": "Kidney failure",
"D": "Stroke"
} | step2&3 | B | [
"year old man presents",
"primary care physician",
"numbness",
"tingling",
"hands",
"not",
"see",
"physician",
"states",
"worsening numbness",
"weakness",
"hands",
"progressing",
"past month",
"temperature",
"blood pressure",
"66 mmHg",
"pulse",
"80 min",
"respirations",
"min... |
A 1-year-old boy is brought to the physician by his parents for the evaluation of recurrent seizures. He is at the 5th percentile for height and 10th percentile for weight. Examination shows coarse pale hair, inelastic hypopigmented skin, and generalized hypotonia. Laboratory studies show low serum ceruloplasmin levels... | Lysyl oxidase | {
"A": "Prolyl hydroxylase",
"B": "Lysyl oxidase",
"C": "Glucocerebrosidase",
"D": "Homogentisate oxidase"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"parents",
"evaluation",
"recurrent seizures",
"5th percentile",
"height",
"percentile",
"weight",
"Examination shows coarse pale",
"inelastic hypopigmented",
"generalized hypotonia",
"Laboratory studies show low serum ceruloplasmin levels",
"Decre... |
A 55-year-old woman presents to her primary care physician with diarrhea. She states that it has persisted for the past several weeks and has not been improving. She also endorses episodes of feeling particularly flushed in the face. Her temperature is 99°F (37.2°C), blood pressure is 125/63 mmHg, pulse is 100/min, res... | Niacin deficiency | {
"A": "Increased catecholamine levels",
"B": "Increased serotonin levels",
"C": "Increased vasoactive intestinal peptide levels",
"D": "Niacin deficiency"
} | step2&3 | D | [
"55 year old woman presents",
"primary care physician",
"diarrhea",
"states",
"past",
"weeks",
"not",
"improving",
"episodes of feeling",
"flushed",
"face",
"temperature",
"blood pressure",
"63 mmHg",
"pulse",
"100 min",
"respirations",
"min",
"oxygen saturation",
"97",
"room... |
A previously healthy 36-year-old woman comes to the emergency department because of a progressively worsening headache for 5 days. She vomited twice after waking up this morning. She does not smoke or drink alcohol. She is sexually active with one male partner and uses an oral contraceptive. Her temperature is 37.5°C (... | Administer dalteparin | {
"A": "Administer dalteparin",
"B": "Administer intravenous antibiotics",
"C": "Measure D-dimer levels",
"D": "Perform endovascular thrombolysis"
} | step2&3 | A | [
"healthy 36 year old woman",
"emergency department",
"worsening headache",
"5 days",
"vomited twice",
"waking",
"morning",
"not smoke",
"drink alcohol",
"sexually active",
"one male partner",
"uses",
"oral contraceptive",
"temperature",
"99",
"pulse",
"min",
"blood pressure",
"80... |
A 38-year-old woman comes to the physician because of a 1-month history of fatigue and pruritus. Examination of the abdomen shows an enlarged, nontender liver. Serum studies show an alkaline phosphatase level of 140 U/L, aspartate aminotransferase activity of 18 U/L, and alanine aminotransferase activity of 19 U/L. Ser... | Lymphocytic infiltration of portal areas and periductal granulomas
" | {
"A": "Fibrous, concentric obliteration of small and large bile ducts",
"B": "Macrovesicular fatty infiltration and necrosis of hepatocytes",
"C": "Ballooning degeneration and apoptosis of hepatocytes",
"D": "Lymphocytic infiltration of portal areas and periductal granulomas\n\""
} | step1 | D | [
"year old woman",
"physician",
"month history",
"fatigue",
"pruritus",
"Examination of",
"abdomen shows",
"enlarged",
"nontender liver",
"Serum studies show",
"alkaline phosphatase level",
"U/L",
"aspartate aminotransferase activity",
"18 U",
"alanine aminotransferase",
"U/L",
"Serum... |
A 68-year-old man presents to the physician for a follow-up examination, accompanied by his spouse. Two years ago, he was diagnosed with localized prostate cancer, for which he underwent radiation therapy. He was recently diagnosed with osteoblastic metastases to the spine and is scheduled to initiate physical therapy ... | "I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your husband." | {
"A": "\"I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your husband.\"",
"B": "\"It concerns me that he's not speaking openly with you. I recommend that you seek medical power of attorney for your husband. Then, we can legally discuss ... | step2&3 | A | [
"68 year old man presents",
"physician",
"follow-up examination",
"spouse",
"Two years",
"diagnosed",
"localized prostate",
"radiation therapy",
"recently diagnosed",
"metastases",
"spine",
"scheduled to initiate physical therapy next week",
"private",
"patients spouse",
"weight",
"wet... |
A mother brings her 3-day-old son to the pediatrician with a concern over drops of a clear yellow discharge from the clamped umbilical cord. These drops have formed every few hours every day. The vital signs are within normal limits and a cursory physical shows no abnormalities. On closer examination, the discharge is ... | Median umbilical ligament | {
"A": "Lateral umbilical ligament",
"B": "Medial umbilical ligament",
"C": "Median umbilical ligament",
"D": "Falciform ligament"
} | step1 | C | [
"mother",
"3-day old son",
"pediatrician",
"concern",
"drops",
"clear yellow discharge",
"clamped umbilical cord",
"drops",
"formed",
"few hours",
"day",
"vital signs",
"normal limits",
"physical shows",
"abnormalities",
"examination",
"discharge",
"shown to",
"urine",
"skin",
... |
A 5-year-old boy is taken to his pediatrician by his mother for evaluation of painless testicular swelling. His mother says that it became apparent at 1 year of age and has been progressively increasing in size. There is no history of infectious diseases other than the seasonal flu. The boy has no history of trauma or ... | A similar condition in girls could involve the canal of Nuck. | {
"A": "Puncture of this structure will yield blood.",
"B": "It is most likely a result of viral replication within testicular tissue.",
"C": "Impaired lymphatic drainage from the scrotum is the cause of the patient’s condition.",
"D": "A similar condition in girls could involve the canal of Nuck."
} | step1 | D | [
"5 year old boy",
"taken",
"pediatrician",
"mother",
"evaluation of painless testicular swelling",
"mother",
"apparent",
"year",
"age",
"increasing in size",
"history of infectious diseases",
"seasonal flu",
"boy",
"history",
"trauma",
"surgery",
"not visited",
"countries",
"vacc... |
A 35-year-old man from Thailand presents with low-grade fever, chronic cough, and night sweats for 3 months. He describes the cough as productive and producing white sputum that is sometimes streaked with blood. He also says he has lost 10 lb in the last 3 months. Past medical history is unremarkable. The patient denie... | Ziehl-Neelsen stain | {
"A": "Gram stain",
"B": "Ziehl-Neelsen stain",
"C": "PPD test",
"D": "Interferon-gamma assay"
} | step1 | B | [
"35 year old man",
"Thailand presents",
"low-grade fever",
"chronic cough",
"night sweats",
"months",
"cough",
"productive",
"producing white",
"sometimes streaked",
"blood",
"lost 10",
"3",
"Past",
"unremarkable",
"patient denies",
"smoking history",
"alcohol",
"recreational dru... |
A 70-year-old male comes to the emergency department complaining of severe back pain. The pain started 20 minutes ago when he was sitting and watching TV. He describes the pain as intense, epigastric, and radiating to his back. His vitals on presentation to the emergency department are blood pressure is 150/75 mmHg, pu... | Smoking | {
"A": "Obesity",
"B": "Smoking",
"C": "Diabetes",
"D": "Alcohol consumption"
} | step1 | B | [
"70 year old male",
"emergency department",
"severe back pain",
"pain started 20 minutes",
"sitting",
"watching TV",
"pain",
"intense",
"epigastric",
"radiating to",
"back",
"presentation",
"emergency department",
"blood pressure",
"75 mmHg",
"pulse",
"min",
"respirations",
"24 m... |
A 32-year-old woman presents with new left-arm pain. She was previously well but for 2 months has had episodes of low-grade fever, night sweats, and dizziness. She works as a stock assistant and has noticed left arm pain when she stocks shelves. She is taking a multivitamin but no other medications. On physical examina... | Subclavian steal syndrome | {
"A": "Subclavian steal syndrome",
"B": "Raynaud’s phenomenon",
"C": "Kawasaki disease",
"D": "Aortic coarctation"
} | step2&3 | A | [
"year old woman presents",
"new left-arm pain",
"well",
"months",
"episodes of low-grade fever",
"night sweats",
"dizziness",
"works",
"stock assistant",
"left arm pain",
"stocks shelves",
"taking",
"multivitamin",
"medications",
"physical examination",
"blood pressure",
"72",
"rig... |
An 18-year-old female is brought to the emergency department by her boyfriend. She is screaming uncontrollably. Eventually, she states that she is afraid that "death is near" but cannot give a rational reason for this thought. She reports both seeing colors "coming out of other people's mouths" and "hearing" these colo... | 5-hydroxytryptamine | {
"A": "Cannabinoid",
"B": "5-hydroxytryptamine",
"C": "NMDA",
"D": "GABA"
} | step1 | B | [
"year old female",
"brought",
"emergency department",
"boyfriend",
"screaming",
"states",
"afraid",
"death",
"near",
"give",
"reason",
"thought",
"reports",
"seeing colors",
"out of",
"people",
"ouths\"",
"earing\"",
"olors.",
"atient'",
"yfriend e perienced s milar s nsory s... |
A 12-year-old boy is brought to the emergency department because of acute onset abdominal pain. On arrival, he also complains of nausea and shortness of breath in addition to epigastric pain. He has previously been admitted to the hospital several times for respiratory infections with Pseudomonas species and uses a neb... | Activates phospholipase A2 | {
"A": "Activates phospholipase A2",
"B": "Breaks down elastin molecules",
"C": "Digests triglycerides",
"D": "Exclusively performs digestive proteolysis"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"acute onset abdominal pain",
"arrival",
"nausea",
"shortness of breath",
"epigastric pain",
"admitted",
"hospital",
"times",
"respiratory infections",
"Pseudomonas species",
"uses",
"nebulizer",
"chest wall oscillation vest at home",
... |
A 2-year-old boy has a history of recurrent bacterial infections, especially of his skin. When he has an infection, pus does not form. His mother reports that, when he was born, his umbilical cord took 5 weeks to detach. He is ultimately diagnosed with a defect in a molecule in the pathway that results in neutrophil ex... | LFA-1 (integrin); tight adhesion | {
"A": "ICAM-1; margination",
"B": "LFA-1 (integrin); margination",
"C": "LFA-1 (integrin); tight adhesion",
"D": "E-selectin; tight adhesion"
} | step1 | C | [
"2 year old boy",
"history of recurrent bacterial infections",
"skin",
"infection",
"pus",
"not form",
"mother reports",
"born",
"umbilical cord took 5 weeks",
"detach",
"diagnosed",
"defect",
"molecule",
"pathway",
"results",
"neutrophil extravasation",
"following",
"pairs",
"de... |
A patient presents to his primary care physician with complaints of regular headaches and upper abdominal pain. On physical examination, his spleen and liver seem enlarged, and his face is plethoric. Gastroendoscopy reveals several gastric ulcers ranging from 5–3 mm in greatest dimension. A bone marrow aspirate shows h... | Essential thrombocythemia | {
"A": "Mantle cell lymphoma",
"B": "Chronic myelogenous leukemia",
"C": "Burkitt's lymphoma",
"D": "Essential thrombocythemia"
} | step1 | D | [
"patient presents",
"primary care physician",
"complaints",
"regular headaches",
"upper abdominal pain",
"physical examination",
"spleen",
"liver",
"enlarged",
"face",
"reveals several gastric ranging",
"mm",
"greatest dimension",
"bone marrow aspirate shows hypercellularity",
"fibrosis"... |
A 68-year-old male with a history of congestive heart failure presents to his cardiologist complaining of mild dyspnea on exertion and swollen ankles. His past medical history is also significant for hypertension and alcohol abuse. He has a 50 pack-year smoking history. He currently takes lisinopril, aspirin, and metop... | Digoxin | {
"A": "Hydralazine",
"B": "Dobutamine",
"C": "Digoxin",
"D": "Nitroprusside"
} | step1 | C | [
"68 year old male",
"history of congestive heart failure presents",
"cardiologist",
"mild dyspnea",
"exertion",
"swollen ankles",
"past medical history",
"significant",
"hypertension",
"alcohol abuse",
"50 pack-year smoking history",
"currently takes lisinopril",
"aspirin",
"metoprolol",
... |
A 20-year-old female presents to your clinic for evaluation. She complain of months of daily rhinorrhea, which she describes as watery and clear, as well as nasal congestion bilaterally. In addition, she reports frequent watery and itchy eyes, as well as daily sneezing. Her temperature is 100.1 deg F (37.8 deg C), bloo... | Intranasal fluticasone | {
"A": "Intravenous penicillin",
"B": "Oral amoxicillin",
"C": "Oral acetaminophen",
"D": "Intranasal fluticasone"
} | step2&3 | D | [
"20 year old female presents",
"clinic",
"evaluation",
"months",
"daily rhinorrhea",
"watery",
"clear",
"nasal congestion",
"addition",
"reports frequent watery",
"itchy eyes",
"daily sneezing",
"temperature",
"100",
"deg F",
"blood pressure",
"70 mmHg",
"pulse",
"70 min",
"res... |
A 39-year-old man comes to the physician with a 4-week history of lesions on his penis and scrotum. He has no pain or discharge from the lesions. Two years ago, he was diagnosed with chronic myeloid leukemia and was treated with imatinib. He takes no medications. He has smoked one pack of cigarettes daily for 20 years ... | Klebsiella granulomatis | {
"A": "Klebsiella granulomatis",
"B": "Herpes simplex virus",
"C": "Haemophilus ducreyi",
"D": "Chlamydia trachomatis"
} | step2&3 | A | [
"year old man",
"physician",
"4 week history",
"lesions",
"penis",
"scrotum",
"pain",
"discharge",
"lesions",
"Two years",
"diagnosed",
"chronic myeloid leukemia",
"treated with imatinib",
"takes",
"medications",
"smoked one pack",
"cigarettes daily",
"20 years",
"drinks one",
... |
A 69-year-old man is brought to clinic by his daughter for poor memory. She states that over the past two years his memory has been slowly declining though he has been able to take care of himself, pay his own rent, and manage his finances. However, two months ago she noticed a sharp decline in his cognitive functionin... | Multiple lacunar infarcts | {
"A": "Neurofibrillary tangles and hyperphosphorylated tau",
"B": "Fronto-temporal degeneration",
"C": "Multiple lacunar infarcts",
"D": "Lewy bodies found on biopsy"
} | step2&3 | C | [
"69 year old man",
"brought",
"clinic",
"daughter",
"poor memory",
"states",
"past two years",
"memory",
"slowly declining",
"able to take care",
"pay",
"rent",
"finances",
"two months",
"sharp decline",
"cognitive functioning",
"gait",
"Then one month",
"similar",
"functioning... |
A 57-year-old man calls his primary care physician to discuss the results of his annual laboratory exams. The results show that he has dramatically decreased levels of high-density lipoprotein (HDL) and mildly increased levels of low-density lipoprotein (LDL). The physician says that the HDL levels are of primary conce... | Flushing | {
"A": "Flushing",
"B": "Gallstones",
"C": "Hepatotoxicity",
"D": "Myalgia"
} | step1 | A | [
"57 year old man calls",
"primary care physician to discuss",
"results",
"annual laboratory exams",
"results show",
"decreased levels",
"high-density lipoprotein",
"mildly increased levels",
"low-density lipoprotein",
"physician",
"HDL levels",
"primary concern",
"started",
"lipid level mo... |
A 23-year-old woman and her husband come to a genetic counselor because she is concerned about the chance of having an inherited defect if they had a child. Family history reveals no significant family history in her husband; however, her sister had a son who has seizures, failure to thrive, and neurodegeneration. She ... | 25% | {
"A": "Close to 0%",
"B": "25%",
"C": "50%",
"D": "100%"
} | step1 | B | [
"23 year old woman",
"husband",
"genetic counselor",
"concerned",
"chance",
"inherited defect",
"child",
"Family history reveals",
"significant family history",
"husband",
"sister",
"son",
"seizures",
"failure to thrive",
"neurodegeneration",
"not remember",
"name",
"disease",
"r... |
An 8-year-old boy is brought to the physician by his father because of abnormal movements of his limbs. For the past four days, he has had uncontrolled jerking movements of his arms and legs and has been dropping cups and toys. His symptoms are worse when he is excited and improve while he is asleep. During the same ti... | Mitral regurgitation | {
"A": "Extraneural metastasis",
"B": "Attention deficit hyperactivity disorder",
"C": "Diabetes mellitus",
"D": "Mitral regurgitation"
} | step1 | D | [
"year old boy",
"brought",
"physician",
"father",
"abnormal",
"limbs",
"past four days",
"uncontrolled jerking movements",
"arms",
"legs",
"dropping cups",
"toys",
"symptoms",
"worse",
"excited",
"asleep",
"same time period",
"irritable",
"tearful",
"sore throat",
"weeks",
... |
A prospective cohort study was conducted to evaluate the effectiveness of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for treatment of aortic stenosis in adults 65 years of age and older. Three hundred patients who received TAVR and another 300 patients who received SAVR w... | Ejection fraction influences both probability of receiving TAVR and risk of death | {
"A": "The increase in risk of death conferred by TAVR is higher in patients with low ejection fraction",
"B": "TAVR correlates with increased risk of death, but the magnitude of effect differs based on ejection fraction",
"C": "Ejection fraction influences both probability of receiving TAVR and risk of death",
... | step2&3 | C | [
"prospective cohort study",
"conducted to evaluate",
"effectiveness of transcatheter aortic valve replacement",
"surgical aortic valve",
"treatment of",
"stenosis in adults 65 years",
"age",
"older",
"Three hundred patients",
"received TAVR",
"300 patients",
"received SAVR",
"followed",
"y... |
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